Mortality rates and the causes of death related to diabetes mellitus in Shanghai Songjiang District: an 11-year retrospective analysis of death certificates.
BACKGROUND
China is one of the countries with the highest prevalence of diabetes in the world. We analysed all the death certificates mentioning diabetes from 2002 to 2012 in Songjiang District of Shanghai to estimate morality rates and examine cause of death patterns.


METHODS
Mortality data of 2654 diabetics were collected from the database of local CDC. The data set comprises all causes of death, contributing causes and the underlying cause, thereby the mortality rates of diabetes and its specified complications were analysed.


RESULTS
The leading underlying causes of death were various cardiovascular diseases (CVD), which collectively accounted for about 30% of the collected death certificates. Diabetes was determined as the underlying cause of death on 28.7%. The trends in mortality showed that the diabetes related death rate increased about 1.78 fold in the total population during the 11-year period, and the death rate of diabetes and CVD comorbidity increased 2.66 fold. In all the diabetes related deaths, the proportion of people dying of ischaemic heart disease or cerebrovascular disease increased from 18.0% in 2002 to 30.5% in 2012. But the proportions attributed directly to diabetes showed a downtrend, from 46.7-22.0%.


CONCLUSIONS
The increasing diabetes related mortality could be chiefly due to the expanding prevalence of CVD, but has nothing to do with diabetes as the underlying cause. Policy makers should pay more attention to primary prevention of diabetes and on the prevention of cardiovascular complications to reduce the burden of diabetes on survival.
Shanghai Songjiang Center for Disease Control and Prevention (CDC), North Xilin Road 1050, Songjiang District, Shanghai, 201620, China.
Meiying
M
Zhu
Department of Preventive Medicine, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Yixueyuan Road 138, PO Box 248, Shanghai, 200032, China. Lijiang_fd@fudan.edu.cn.
Jiang
J
Li
Shanghai Songjiang Center for Disease Control and Prevention (CDC), North Xilin Road 1050, Songjiang District, Shanghai, 201620, China.
Zhiyuan
Z
Li
Shanghai Songjiang Center for Disease Control and Prevention (CDC), North Xilin Road 1050, Songjiang District, Shanghai, 201620, China.
Wei
W
Luo
Department of Geosciences, Georgia State University, 24 Peachtree Center Avenue SE, Atlanta, GA, 30302, USA.
Dajun
D
Dai
School of Public Health, Georgia State University, 140 Decatur Street, Atlanta, GA, 30302, USA.
Scott R
SR
Weaver
School of Public Health, Georgia State University, 140 Decatur Street, Atlanta, GA, 30302, USA.
Christine
C
Stauber
School of Public Health, Georgia State University, 140 Decatur Street, Atlanta, GA, 30302, USA.
Ruiyan
R
Luo
Shanghai Songjiang Center for Disease Control and Prevention (CDC), North Xilin Road 1050, Songjiang District, Shanghai, 201620, China.
Hua
H
Fu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000401:mortality*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003644:Death Certificates; D003920:Diabetes Mellitus / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D017202:Myocardial Ischemia / Q000401:mortality*; D009369:Neoplasms / Q000401:mortality*; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult