title: Temporal trends in recording of diabetes on death certificates: results from Translating Research Into Action for Diabetes (TRIAD).
abstract: OBJECTIVE
  To determine the frequency that diabetes is reported on death certificates of decedents with known diabetes and describe trends in reporting over 8 years.
  
  
  METHODS
  Data were obtained from 11,927 participants with diabetes who were enrolled in Translating Research into Action for Diabetes, a multicenter prospective observational study of diabetes care in managed care. Data on decedents (N=2,261) were obtained from the National Death Index from 1 January 2000 through 31 December 2007. The primary dependent variables were the presence of the ICD-10 codes for diabetes listed anywhere on the death certificate or as the underlying cause of death.
  
  
  RESULTS
  Diabetes was recorded on 41% of death certificates and as the underlying cause of death for 13% of decedents with diabetes. Diabetes was significantly more likely to be reported on the death certificate of decedents dying of cardiovascular disease than all other causes. There was a statistically significant trend of increased reporting of diabetes as the underlying cause of death over time (P<0.001), which persisted after controlling for duration of diabetes at death. The increase in reporting of diabetes as the underlying cause of death was associated with a decrease in the reporting of cardiovascular disease as the underlying cause of death (P<0.001).
  
  
  CONCLUSIONS
  Death certificates continue to underestimate the prevalence of diabetes among decedents. The increase in reporting of diabetes as the underlying cause of death over the past 8 years will likely impact estimates of the burden of diabetes in the U.S.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. lmattei@med.umich.edu
authors.forename: Laura N
authors.initials: LN
authors.lastname: McEwen
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: J David
authors.initials: JD
authors.lastname: Curb
authors.forename: David G
authors.initials: DG
authors.lastname: Marrero
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Crosson
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D003644:Death Certificates; D003920:Diabetes Mellitus / Q000401:mortality*; D006302:Health Services Research; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008329:Managed Care Programs; D015995:Prevalence; D014481:United States / Q000453:epidemiology