title: Causes of death in childhood-onset Type 1 diabetes: long-term follow-up.
abstract: To assess the causes of death and cause-specific standardized mortality ratios in two nationwide, population-based cohorts diagnosed with Type 1 diabetes during the periods 1973-1982 and 1989-2012, and to evaluate changes in causes of death during the follow-up period.
  
  
  
  People with Type 1 diabetes who were aged < 15 years at diagnosis were identified in the Norwegian Childhood Diabetes Registry and followed from diagnosis until death, emigration or September 2013 (n = 7871). We assessed causes of death by linking data to the nationwide Cause of Death Registry and through a review committee that evaluated medical records, autopsy reports and death certificates.
  
  
  
  During a mean (range) follow-up of 16.8 (0-40.7) years, 241 individuals (3.1%) died, representing 132 143 person-years. The leading cause of death before the age of 30 years was acute complications (41/119, 34.5%). After the age of 30 years cardiovascular disease was predominant (41/122, 33.6%), although death attributable to acute complications was still important in this age group (22/122, 18.0%). A total of 5% of deaths were caused by 'dead-in-bed' syndrome. The standardized mortality ratio was elevated for cardiovascular disease [11.9 (95% CI 8.6-16.4)] and violent death [1.7 (95% CI 1.3-2.1)] in both sexes combined, but was elevated for suicide only in women [2.5 (95% CI 1.2-5.3)]. The risk of death from acute complications was approximately half in women compared with men [hazard ratio 0.43 (95% CI 0.25-0.76)], and did not change with more recent year of diagnosis [hazard ratio 1.02 (0.98-1.05)].
  
  
  
  There was no change in mortality attributable to acute complications during the study period. To reduce premature mortality in people with childhood-onset diabetes focus should be on prevention of acute complications. Male gender implied increased risk.
authors.affiliation: Department of Paediatrics, Oslo University Hospital, Oslo, Norway.|Oslo Diabetes Research Centre, Oslo, Norway.
authors.forename: V
authors.initials: V
authors.lastname: Gagnum
authors.affiliation: Oslo Diabetes Research Centre, Oslo, Norway.|Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: L C
authors.initials: LC
authors.lastname: Stene
authors.affiliation: Oslo Diabetes Research Centre, Oslo, Norway.|Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Oslo, Norway.|Metabolic and Renal Research Group, Arctic University of Norway, Tromsø, Norway.
authors.forename: T G
authors.initials: TG
authors.lastname: Jenssen
authors.affiliation: Department of Forensic Pathology and Clinical Forensic Medicine, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: L M
authors.initials: LM
authors.lastname: Berteussen
authors.affiliation: Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: Department of Paediatrics, Oslo University Hospital, Oslo, Norway.|Oslo Diabetes Research Centre, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: G
authors.initials: G
authors.lastname: Joner
authors.affiliation: KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway.|Department of Paediatrics, Haukeland University Hospital, Bergen, Norway.
authors.forename: P R
authors.initials: PR
authors.lastname: Njølstad
authors.affiliation: Department of Paediatrics, Oslo University Hospital, Oslo, Norway.|Oslo Diabetes Research Centre, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Norwegian Childhood Diabetes Registry, Department of Paediatrics, Oslo University Hospital, Oslo, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Skrivarhaug
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D048909:Diabetes Complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology* / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D058065:Diabetic Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D061213:Mortality, Premature / Q000208:ethnology; D009664:Norway / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors