Improving the comparability of diabetes mortality statistics in the U.S. and Mexico.
Abstract
OBJECTIVE—The aim of this study was to increase the cross-state comparability of diabetes mortality statistics related in the U.S. and Mexico. RESEARCH DESIGN AND METHODS—We used multinomial logistic regression to estimate the effects of individual and community factors on a death for which diabetes was recorded as one of the multiple contributing causes of death (MCD) being assigned to diabetes as the underlying cause of death (UCD) versus assignment to cardiovascular, other noncommunicable, or communicable diseases. We used the model to estimate state-level diabetes death rates that are standardized in the individual and community factors. RESULTS—Deaths with diabetes as one of the MCD were more likely to be assigned to cardiovascular causes as the UCD if they occurred in hospitals or if an autopsy was performed and if the decedents were from states with higher BMI and systolic blood pressure, were more educated, or had insurance. Adjusting for individual- and community-level factors substantially increased the cross-state correlation of diabetes as the UCD and diabetes as one of the MCD mortality rates. The adjustment also reduced the number of direct diabetes deaths by 10% in the U.S. and by 24% in Mexico. In the U.S., deaths with diabetes as the UCD declined most in Utah, New Mexico, New Jersey, and Louisiana and increased in California and Hawaii. In Mexico, the numbers of adjusted diabetes deaths were smaller than those observed in all states by 3–34%. An additional 126,300 deaths due to ischemic heart disease and stroke in the U.S. and 19,497 in Mexico were attributable to high blood glucose. CONCLUSIONS—There is a need to improve the comparability of diabetes cause-of-death assignment, especially in relation to cardiovascular diseases.
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The analysis adjusted for incomparability in cause-of-death assignment using previously described methods.
“We adjusted for incomparability in cause of death assignment using previously described methods [22],[23].”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [23]
The validity and comparability of US cause-of-death statistics may be affected at the time of medical certification, especially for cardiovascular causes and diabetes.
“Although the US has automated (computerized) assignment of an International Classification of Diseases (ICD) code for the underlying cause of death, the validity and comparability of cause of death statistics may be affected at the time of medical certification, especially for cardiovascular causes and diabetes [22]–[24].”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [23]
After adjustment for comparability of cause-of-death assignment, the four most common causes of death were ischemic heart disease (434,000 deaths), lung cancer (163,000 deaths), stroke (150,000 deaths), and chronic obstructive pulmonary diseases (124,000 deaths).
“After adjustment for comparability of cause-of-death assignment [22],[23], the four most common causes of death were IHD (434,000 deaths), lung cancer (163,000 deaths), stroke (150,000 deaths), and chronic obstructive pulmonary diseases (124,000 deaths).”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [23]
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Self-citation
- Authors
- Murray, C. J. L., Dias, R. H., Kulkarni, S. C., Lozano, R., Stevens, G. A., & Ezzati, M.
- Affiliations
- Harvard University (US)
- Secretaria de Salud (MX)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2008-03-01
- Volume
- 31
- Issue
- 3
- Pages
- 451-458
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W1975772564
- Cited by
- 44
- References
- 16
- Citations by year
- 2026: 1 · 2025: 2 · 2022: 1 · 2021: 5 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 5 · 2015: 1 · 2013: 2 · 2012: 3
- FWCI
- 4.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- diabetes mortality, cause of death assignment, underlying cause of death, international comparability, United States, Mexico, ischemic heart disease, stroke, hyperglycemia, hospitalization, autopsy, body mass index, systolic blood pressure, educational attainment, health insurance
- MeSH terms
- Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Humans, Mexico, Mortality, Regression Analysis, United States, Logistic Models
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