Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993
Abstract
OBJECTIVE: To examine 22-year mortality (1971-1993), causes of death, life expectancy, and survival in a national sample of diabetic and nondiabetic adults according to age, sex, and race. RESEARCH DESIGN AND METHODS: A representative national cohort of 14,374 adults aged 25-74 years was identified in 1971-1975 in the First National Health and Nutrition Examination Survey (NHANES I). Diabetes was ascertained by medical history interview. The cohort was followed for mortality through 1992-1993, with verification of vital status for 96.2% (n = 13,830). Causes of death were determined from death certificates. RESULTS: Diabetic subjects comprised 5.1% of the cohort and accounted for 10.6% of the deaths. Mortality for diabetic subjects increased from 12.4 per 1,000 person-years for those aged 25-44 years at baseline to 89.7 per 1,000 person-years for those aged 65-74 years. The age-adjusted mortality rate was 57% higher for diabetic men than for diabetic women; the rate was 27% higher for diabetic non-Hispanic blacks than for diabetic non-Hispanic whites. Mortality rates were highest for insulin-treated subjects and for those with > or = 15 years' duration of diabetes. Diabetes was listed on the death certificate as the underlying cause of death for only 7.7% of diabetic men and 13.4% of diabetic women. Considering multiple causes of death, heart disease was listed the most frequently and was present on 69.5% of death certificates of people with diabetes. Death rates were higher for diabetic than for nondiabetic subjects in all age, sex, and race groups. The relative risk of death (diabetic versus nondiabetic subjects) declined with age from a value of 3.6 for those aged 25-44 years at baseline to 1.5 for those aged 65-74 years. The relative risk was elevated in diabetic subjects for all major causes of death except malignant neoplasms. Survival of diabetic subjects was lower than that of nondiabetic subjects in all age, sex, and race groups. Median life expectancy was 8 years lower for diabetic adults aged 55-64 years and 4 years lower for those aged 65-74 years. CONCLUSIONS: In this representative national sample of adults, mortality rates were higher for diabetic men than for diabetic women and for diabetic blacks than for diabetic whites. The study confirms the substantially higher risk of death, lower survival, and lower life expectancy of diabetic adults compared with nondiabetic adults.
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T2DM is associated with a two-to four-fold higher CAD- and stroke-related mortality.
“and a two-to four-fold higher CAD-and stroke-related mortality.139 -141”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [139]
T2DM is associated with a two-fold higher risk of CAD and ischaemic stroke.
“T2DM is associated with a two-fold higher risk of CAD and ischaemic stroke”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [139]
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“CHD categories, No. (%)† MI 19 (61.3) 96 (50.3) 5 ( 25 ) 27 (24.8)”
InfluentialCause-Specific Mortality in a Population With Diabetes
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“Moreover, it is well recognized that the inclusion of diabetes on death certificates is low (6,8,20,21); in our study, diabetes was mentioned on the death certificates of only 45.”
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“Unfortunately, to our knowledge, there are no previously published studies with data on the PAR of diabetes-related death in the United States (10, 11), nor have”
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Longitudinal Incidence and Prevalence of Adverse Outcomes of Diabetes Mellitus in Elderly Patients
Bethel, M. A. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.9.921 · Cited by 162 · see citing works
Johnson, J. A., Simpson, S. H., Toth, E. L., & Majumdar, S. R. (2005) · Diabetic Medicine · doi:10.1111/j.1464-5491.2005.01448.x · Cited by 161 · see citing works
Wee, H. L., Cheung, Y., Li, S., Fong, K., & Thumboo, J. (2005) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-3-2 · Cited by 161 · see citing works
Clarke, P. M., Glasziou, P., Patel, A., Chalmers, J., Woodward, M., Harrap, S. B., Salomon, J. A., & on behalf of the ADVANCE Collaborative Group (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000236 · Cited by 159 · see citing works
“. Diabetes imposes a considerable burden in terms of premature mortality, morbidity, and health care costs. Life expectancy for people with diabetes has been estimated to be up to 10 y shorter than for people without diabetes”
BackgroundPersonality and risk of diabetes in adults: Pooled analysis of 5 cohort studies.
Jokela, M. M., Elovainio, M. J., Nyberg, S. T., Tabák, Á. G., Hintsa, T., Batty, G. D., & Mika Kivimaki, B. (2013) · Health Psychology · doi:10.1037/hea0000003 · Cited by 154 · see citing works
Saydah, S., Geiss, L. S., Tierney, E. F., Benjamin, S. M., Engelgau, M. M., & Brancati, F. L. (2004) · Annals of Epidemiology · doi:10.1016/j.annepidem.2003.09.016 · Cited by 151 · see citing works
Aging, Diabetes, and the Public Health System in the United States
Caspersen, C. J., Thomas, G. D., Boseman, L. A., Beckles, G. L., & Albright, A. L. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300616 · Cited by 150 · see citing works
Manuel, D. G., & Schultz, S. E. (2004) · Diabetes Care · doi:10.2337/diacare.27.2.407 · Cited by 148 · see citing works
A longitudinal analysis of salivary flow in control subjects and older adults with type 2 diabetes
Chávez, E. M., Borrell, L. N., Taylor, G. W., & Ship, J. A. (2001) · Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology · doi:10.1067/moe.2001.112054 · Cited by 148 · see citing works
Alcohol Consumption and Risk of Coronary Heart Disease by Diabetes Status
Ajani, U. A., Gaziano, J. M., Lotufo, P. A., Liu, S., Hennekens, C. H., Buring, J. E., & Manson, J. E. (2000) · Circulation · doi:10.1161/01.cir.102.5.500 · Cited by 145 · see citing works
Runx2 Expression in Smooth Muscle Cells Is Required for Arterial Medial Calcification in Mice
Lin, M.-E., Chen, T., Leaf, E. M., Speer, M. Y., & Giachelli, C. M. (2015) · American Journal Of Pathology · doi:10.1016/j.ajpath.2015.03.020 · Cited by 141 · see citing works
The influence of diabetes mellitus and hyperglycaemia on stroke incidence and outcome
Baird, T. A., Parsons, M. W., Barber, P. A., Butcher, K., Desmond, P. M., Tress, B. M., Colman, P. G., Jerums, G., Chambers, B. R., & Davis, S. M. (2002) · Journal of Clinical Neuroscience · doi:10.1054/jocn.2002.1081 · Cited by 142 · see citing works
Rapid A1c Availability Improves Clinical Decision-Making in an Urban Primary Care Clinic
Miller, C. D., Barnes, C. S., Phillips, L. S., Ziemer, D. C., Gallina, D. L., Cook, C. B., Maryman, S. D., & El‐Kebbi, I. M. (2003) · Diabetes Care · doi:10.2337/diacare.26.4.1158 · Cited by 144 · see citing works
Vaccaro, O. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.13.1438 · Cited by 140 · see citing works
“This is particularly relevant since the contribution of noncardiovascular mortality to excess all-cause mortality associated with diabetes has not received as much attention as CVD risk.(15-17,26-28) In the present study, although total mortality was quantitatively similar for men with diabetes or previous MI, the rel…”
ResultValdez, R. A., Narayan, K. M. V., Geiss, L. S., & Engelgau, M. M. (1999) · American Journal of Public Health · doi:10.2105/ajph.89.11.1715 · Cited by 141 · see citing works
Nwaneri, C., Cooper, H., & Bowen-Jones, D. (2013) · The British Journal of Diabetes · doi:10.1177/1474651413495703 · Cited by 141 · see citing works
Selecting indicators for the quality of diabetes care at the health systems level in OECD countries
Nicolucci, A., Greenfield, S., & Mattke, S. (2006) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzl023 · Cited by 140 · see citing works
Shah, S. S., Todkar, J. S., Shah, P. S., & Cummings, D. E. (2009) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2009.08.009 · Cited by 138 · see citing works
Diabetes duration and cause-specific mortality in the Verona Diabetes Study.
Brun, E., Nelson, R. G., Bennett, P. H., Imperatore, G., Zoppini, G., Verlato, G., Muggeo, M., & Study, V. D. (2000) · Diabetes Care · doi:10.2337/diacare.23.8.1119 · Cited by 136 · see citing works
The long-term effects of laser photocoagulation treatment in patients with diabetic retinopathy
Chew, E. Y., Ferris, F. L., Csaky, K. G., Murphy, R., Agrón, E., Thompson, D. J. S., Reed, G. F., & SCHACHAT, A. P. (2003) · Ophthalmology · doi:10.1016/s0161-6420(03)00579-7 · Cited by 136 · see citing works
Bernard, S., Sérusclat, A., Targe, F., Charrière, S., Roth, O., Beaune, J., Berthézène, F., & Moulin, P. (2005) · Diabetes Care · doi:10.2337/diacare.28.5.1158 · Cited by 131 · see citing works
“C ardiovascular diseases are the main causes of death for diabetic patients (1).”
BackgroundMeta‐analysis: mortality in Crohn’s disease
Canavan, C., Abrams, K. R., & Mayberry, J. F. (2007) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2007.03276.x · Cited by 135 · see citing works
“10.([52]) The concept of SMR is probably difficult for patients to grasp and information needs to be presented in terms of life expectancy, which requires further research, as does prognosis after 20 years of disease and study into the cause of the increased mortality that is seen in these patients.”
BackgroundEstimating the burden of disease attributable to diabetes in South Africa in 2000
Bradshaw, D., Pieterse, D., Norman, R. E., & Levitt, N. S. (2007) · Journal of Endocrinology Metabolism and Diabetes of South Africa · doi:10.1080/22201009.2007.10872159 · Cited by 139 · see citing works
- Authors
- Gu, K., Cowie, C. C., & Harris, M. I.
- Affiliations
- National Institutes of Health (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 1998-07-01
- Volume
- 21
- Issue
- 7
- Pages
- 1138-1145
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2050695519
- Cited by
- 881
- References
- 0
- Citations by year
- 2026: 1 · 2025: 12 · 2024: 15 · 2023: 11 · 2022: 21 · 2021: 25 · 2020: 25 · 2019: 27 · 2018: 33 · 2017: 39 · 2016: 36 · 2015: 26 · 2014: 32 · 2013: 44 · 2012: 48
- FWCI
- 10.98
- 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 › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- diabetes mortality, causes of death, life expectancy, survival, sex differences, racial differences, non-Hispanic blacks, insulin-treated diabetes, diabetes duration, heart disease, death certificates, adults with diabetes, age differences in mortality risk, cancer
- MeSH terms
- Adult, Aged, Cause of Death, Diabetes Mellitus, Female, Humans, Life Expectancy, Male, Middle Aged, Mortality, Population, United States, Cohort Studies, Survival Rate, Survival Analysis
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