title: Diabetes and ischemic heart disease death in people age 25-54: a multiple-cause-of-death analysis based on over 400 000 deaths from 1990 to 2008 in New York City.
abstract: BACKGROUND
  Over the past decade, ischemic heart disease (IHD) mortality trends have been less favorable among adults age 25-54 than age ≥55 years.
  
  
  OBJECTIVE
  Disorders associated with IHD such as diabetes, chronic inflammatory and infectious diseases, and cocaine use are important contributors to premature IHD mortality.
  
  
  METHODS
  Multiple-cause-of-death analysis was performed using the New York City (NYC) Vital Statistics database. Frequencies of selected contributing causes on death records with IHD as the underlying cause for decedents age ≥25 were assessed (n = 418,151; 1990-2008). Concurrent Telephone risk-factor surveys (NYC Community Health Survey, Centers for Disease Control Behavioral Risk Factor Survey in New York State) were analyzed.
  
  
  RESULTS
  In sum, a prespecified contributing cause was identified on 13.6% of death certificates for IHD decedents age 25-54. Diabetes was reported more frequently for younger IHD decedents (15% of females and 10% of males age 25-54 vs 6% of both sexes age ≥ 55). In contrast, concurrent diabetes prevalence in New York State was 3.4% for those age 25-54 and 13.6% for those age >55 (P < 0.0001). Systemic lupus erythematosus, human immunodeficiency virus, and cocaine were also more likely to contribute to IHD death among younger than older people.
  
  
  CONCLUSIONS
  Diabetes may be a potent risk factor for IHD death in young people, particularly young women, in whom it was reported on IHD death records at a rate 5× higher than local prevalence. The high frequency of reporting of studied contributing causes in younger IHD decedents may provide a focus for further IHD mortality-reduction efforts in younger adults.
authors.affiliation: Cardiovascular Clinical Research Center, Department of Medicine, New York, New York.
authors.forename: Adriana
authors.initials: A
authors.lastname: Quinones
authors.forename: Iryna
authors.initials: I
authors.lastname: Lobach
authors.forename: Gil A
authors.initials: GA
authors.lastname: Maduro
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Smilowitz
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D002423:Cause of Death; D015897:Comorbidity; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000401:mortality*; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors