Mortality Trends Among People With Type 1 and Type 2 Diabetes in Australia: 1997–2010
Open accessAbstract
OBJECTIVE: With improvements in cardiovascular disease (CVD) rates among people with diabetes, mortality rates may also be changing. However, these trends may be influenced by coding practices of CVD-related deaths on death certificates. We analyzed trends of mortality over 13 years in people with diabetes and quantified the potential misclassification of CVD mortality according to current coding methods. RESEARCH DESIGN AND METHODS: A total of 1,136,617 Australians with diabetes registered on the National Diabetes Services Scheme between 1997 and 2010 were linked to the National Death Index. Excess mortality relative to the Australian population was reported as standardized mortality ratios (SMRs). Potential misclassification of CVD mortality was determined by coding CVD according to underlying cause of death (COD) and then after consideration of both the underlying and other causes listed in part I of the death certificate. RESULTS: For type 1 diabetes, the SMR decreased in males from 4.20 in 1997 to 3.08 in 2010 (Ptrend < 0.001) and from 3.92 to 3.46 in females (Ptrend < 0.01). For type 2 diabetes, the SMR decreased in males from 1.40 to 1.21 (Ptrend < 0.001) and from 1.56 to 1.22 in females (Ptrend < 0.001). CVD deaths decreased from 35.6 to 31.2% and from 31.5 to 27.2% in males and females with type 1 diabetes, respectively (Ptrend < 0.001 for both sexes). For type 2 diabetes, CVD decreased from 44.5 to 29.2% in males and from 45.5 to 31.6% in females (Ptrend < 0.001 for both sexes). Using traditional coding methods, ∼38 and 26% of CVD deaths are underestimated in type 1 diabetes and type 2 diabetes, respectively. CONCLUSIONS: All-cause and CVD mortality has decreased in diabetes. However, the total CVD mortality burden is underestimated when only underlying COD is considered. This has important ramifications for understanding mortality patterns in diabetes.
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Older Australian adults with type 1 diabetes mellitus had death rates two to three times higher than those in the general population.
“Another study found that older Australian adults with T1DM had death rates that were two to three times higher than those in the general population.”
From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [29]
In Australia from 1997 to 2010, the standardized mortality ratio was 2.60 (95% CI 2.36-2.87) for men and 3.40 (95% CI 3.00-3.87) for women aged 60-69 years with type 1 diabetes mellitus.
“Specifically, from 1997 to 2010, the standardized mortality ratio (SMR) was 2.60 (95% CI 2.36–2.87) for men and 3.40 (95% CI 3.00–3.87) for women aged 60–69 years29.”
From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [29]
Misclassification of type 2 diabetes mellitus as type 1 diabetes mellitus would have flow-on effects for reported prevalence, which would also be inflated, and reported mortality would probably be reduced due to the lower death rates of those with type 2 diabetes mellitus than of those with type 1 diabetes mellitus.
“This misclassification would have flow-on effects for reported prevalence, which would also be inflated, and reported mortality would probably be reduced due to the lower death rates of those with T2DM than of those with T1DM29.”
From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [29]
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“Specifically, from 1997 to 2010, the standardized mortality ratio (SMR) was 2.60 (95% CI 2.36–2.87) for men and 3.40 (95% CI 3.00–3.87) for women aged 60–69 years 29 .”
InfluentialSelf-citation
- Authors
- Harding, J. L., Shaw, J. E., Peeters, A., Guiver, T., Davidson, S., & Magliano, D. J.
- Affiliations
- Baker Heart and Diabetes Institute (AU)
- Australian Institute of Health and Welfare (AU)
- Diabetes Australia (AU)
- Corresponding author
- Harding, Jessica L.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-08-07
- Volume
- 37
- Issue
- 9
- Pages
- 2579-2586
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2167613047
- Cited by
- 158
- References
- 3
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 16 · 2023: 10 · 2022: 13 · 2021: 13 · 2020: 18 · 2019: 20 · 2018: 17 · 2017: 12 · 2016: 18 · 2015: 8 · 2014: 4
- FWCI
- 11.25
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- cc-by
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Deakin Research Online (Deakin University) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- type 1 diabetes, type 2 diabetes, diabetes mortality, cardiovascular mortality, death certificate coding, standardized mortality ratio, mortality trends, sex differences in mortality, National Death Index
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Australia, Cause of Death, Child, Child, Preschool, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Mortality, Prognosis, Time Factors, Survival Rate, Young Adult
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