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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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“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]
In the citing paper
“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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“Moreover, African Americans are more likely to experience complications associated with diabetes.(2,3) For example, the incidence of end-stage renal disease among African Americans is twice the rate as for whites.”
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“Accordingly, patients with diabetes have a reduced life expectancy than subjects without diabetes [2] with a higher incidence of cardiac, cerebrovascular, and peripheral vascular diseases [3].”
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Pan, A., Lucas, M., Sun, Q., van Dam, R. M., Franco, O. H., Willett, W. C., Manson, J. E., Rexrode, K. M., Ascherio, A., & Hu, F. B. (2011) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.176 · Cited by 188
Colagiuri, S., Cull, C. A., Holman, R. R., & For the UKPDS Group (2002) · Diabetes Care · doi:10.2337/diacare.25.8.1410 · Cited by 183
Natarajan, S., Liao, Y., Cao, G., Lipsitz, S. R., & McGee, D. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.14.1735 · Cited by 181
“CHD categories, No. (%)† MI 19 (61.3) 96 (50.3) 5 ( 25 ) 27 (24.8)”
InfluentialCause-Specific Mortality in a Population With Diabetes
Roper, N. A., Bilous, R., Kelly, W. F., Unwin, N. C., & Connolly, V. M. (2002) · Diabetes Care · doi:10.2337/diacare.25.1.43 · Cited by 179
“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.”
BackgroundRisk Prediction of Cardiovascular Disease in Type 2 Diabetes
Cederholm, J., Eeg-Olofsson, K., Eliasson, B., Zethelius, B., Nilsson, P. M., Gudbjörnsdottir, S., & Register, O. B. O. T. S. N. D. (2008) · Diabetes Care · doi:10.2337/dc08-0662 · Cited by 173
Age and the Burden of Death Attributable to Diabetes in the United States
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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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“Alarmingly, literature statistics indicate that atherosclerosis accounts for about 8 to 10% of all diabetic deaths.(3) Hyperglycemia has been accepted as an essential factor in”
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Longitudinal Incidence and Prevalence of Adverse Outcomes of Diabetes Mellitus in Elderly Patients
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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
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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
“. 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
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
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 162
Manuel, D. G., & Schultz, S. E. (2004) · Diabetes Care · doi:10.2337/diacare.27.2.407 · Cited by 153
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
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 144
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 146
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
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
Vaccaro, O. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.13.1438 · Cited by 140
“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
Nwaneri, C., Cooper, H., & Bowen-Jones, D. (2013) · The British Journal of Diabetes · doi:10.1177/1474651413495703 · Cited by 141
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 142
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
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 135
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
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
“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
“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
Metadata
- 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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