title: Certification of deaths from diabetes mellitus and obesity in England: trends into the twenty-first century.
abstract: BACKGROUND
  Most cases of Type 2 diabetes are attributable to excess weight and physical inactivity. We investigated trends in mortality based on doctors' certification of diabetes and obesity.
  
  
  METHODS
  Analysis of a national data set of all certified causes of death, i.e. underlying cause and contributing causes ('mentions'), in England 1995-2010.
  
  
  RESULTS
  Diabetes exhibited divergent trends for mortality based on underlying cause and mentions. Underlying cause rates were 107.2 per million population [95% confidence interval (CI): 105.7-108.6] in 1995, but only 68.9/10(6) (CI: 67.9-69.9) in 2010. Mortality rates for mentions of diabetes were 403.1/10(6) (CI: 400.4-405.8) in 1995, increasing to 478.4/10(6) (CI: 475.7-481.0) in 2010. Underlying cause mortality for obesity was 3.7/10(6) (CI: 3.2-4.1) in 1995 and 7.5 (CI: 7.0-8.0) in 2010. The corresponding rates for mentions of obesity were 13.2/10(6) (CI: 12.6-13.9) and 34.5/10(6) (CI: 33.6-35.4), respectively. 24.0% of death certificates with a mention of obesity also had diabetes recorded on the same certificate.
  
  
  CONCLUSIONS
  Multiple-cause mortality statistics provide a more accurate picture than underlying cause of the total mortality burden attributed on death certificates to diabetes and obesity. Rates for both increased substantially: analysis by underlying cause alone would have missed this for diabetes.
authors.affiliation: Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK.
authors.forename: Marie E
authors.initials: ME
authors.lastname: Duncan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldacre
mesh_terms: D002423:Cause of Death / Q000639:trends; D003644:Death Certificates; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D004739:England / Q000453:epidemiology; D006801:Humans; D009765:Obesity / Q000401:mortality*