title: The decline in mortality due to acute complications of diabetes mellitus in Brazil, 1991-2010.
abstract: BACKGROUND
  Mortality from acute complications of diabetes, a predominantly preventable condition, although controlled in high income countries, remains a major challenge for low/middle income countries. The aim of this study is to describe trends in mortality from acute complications of diabetes between 1991 and 2010 in Brazil, a period during which a national health system was implemented offering broad access to diabetes treatment.
  
  
  METHODS
  We obtained the number of deaths listed in the Brazilian Mortality Information System between 1991 and 2010 as due to acute complications of diabetes (ICD-9 250.1, .2, or .3 and ICD-10 E10-14.0 or 1), corrected this number for ill-defined causes of death and incompleteness in mortality reporting, and calculated mortality rates standardized to the world's population. We describe mortality trends with Joinpoint regressions.
  
  
  RESULTS
  Over this 20 year period, mortality due to the acute complications of diabetes fell 70.9 % (95 % CI 67.2 to 74.5 %), from 8.42 (95 % CI 8.27 to 8.57) deaths per 100000 inhabitants in 1991 to 2.45 (95 % CI 2.38 to 2.52) per 100000 in 2010. The reduction occurred in men and women, in all age groups, and in all regions of Brazil.
  
  
  CONCLUSIONS
  Mortality from acute complications of diabetes in Brazil has declined markedly in parallel with the implementation of a national health system providing access to insulin and organization of health care. Further decline is possible and necessary.
authors.affiliation: Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil. andreklafke@hotmail.com.|Community Health Service, Grupo Hospitalar Conceição, Av. Francisco Trein, 596, Porto Alegre, RS, CEP 91.350-200, Brazil. andreklafke@hotmail.com.
authors.forename: André
authors.initials: A
authors.lastname: Klafke
authors.affiliation: Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil. bbduncan@ufrgs.br.
authors.forename: Bruce Bartholow
authors.initials: BB
authors.lastname: Duncan
authors.affiliation: Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil. antony.stevens@gmail.com.
authors.forename: Antony
authors.initials: A
authors.lastname: Stevens
authors.affiliation: Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil. roger.rosa@bcb.gov.br.
authors.forename: Roger dos Santos
authors.initials: Rdos S
authors.lastname: Rosa
authors.affiliation: Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil. lenildo.moura@gmail.com.|Pan American Health Organization, Setor de Embaixadas Norte, Lote 19, 70800-400, Brasilia, DF, CEP 70.312-970, Brazil. lenildo.moura@gmail.com.
authors.forename: Lenildo
authors.initials: L
authors.lastname: de Moura
authors.affiliation: Department of Chronic Disease Surveillance and Health Promotion, Secretariate of Health Surveillance, Brazilian Ministry of Health, SAF Sul, Trecho 2, Lote 5/6, Bloco F, Torre 1, Edifício Premium, Térreo, Sala 16, Brasilia, DF, CEP 70.070-600, Brazil. deborah.malta@saude.gov.br.
authors.forename: Deborah
authors.initials: D
authors.lastname: Malta
authors.affiliation: Post-Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600, sala 419, Porto Alegre, RS, CEP 90.035-003, Brazil. maria.schmidt@ufrgs.br.
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D048909:Diabetes Complications / Q000401:mortality*; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D055815:Young Adult