Cited by 889Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and ResearchDiabetes Management and Education

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Mortality in Adults With and Without Diabetes in a National Cohort of the U.S. Population, 1971–1993

Gu, Ken, Cowie, Catherine C, Harris, Maureen I·1998·Diabetes Care

DOI 10.2337/diacare.21.7.1138

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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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Influential
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“C oronary heart disease (CHD) is a major complication and the leading cause of death for people with diabetes.(1,2) People with diabetes are 2 to 4 times more likely to have heart disease than people without diabetes.”
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Cardiovascular Complications and Mortality After Diabetes Diagnosis for South Asian and Chinese Patients
Shah, B. R., Victor, J. C., Chiu, M., Tu, J. V., Anand, S. S., Austin, P. C., Manuel, D. G., & Hux, J. E. (2013) · Diabetes Care · doi:10.2337/dc12-2105 · Cited by 43
“Mortality rates are decreased for Hispanic populations with diabetes and increased for AfricanAmericans (7,8).”
Background
Coadjuvants in the Diabetic Complications: Nutraceuticals and Drugs with Pleiotropic Effects
Pereira, T. D. M. C., Pimenta, F. S., Porto, M. L., Baldo, M. P., Campagnaro, B. P., Gava, A. L., Meyrelles, S. S., & Vasquez, E. C. (2016) · International Journal of Molecular Sciences · doi:10.3390/ijms17081273 · Cited by 43
“Abbreviations ACE angiotensin-converting enzyme AGEs glycation end products cGMP cyclic guanosine monophosphate COX cyclooxygenase CRP C-reactive protein CVD cardiovascular diseases CYP450 cytochrome P450 DM diabetes mellitus ECM extracellular matrix eGFR estimated glomerular filtration rate eNOS endothelial nitric ox…”
BackgroundInfluential
Tailoring a Diabetes Self-Care Intervention for Use With Older, Rural African American Women
Leeman, J., Skelly, A. H., Burns, D., Carlson, J., & Soward, A. C. M. (2008) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721708316623 · Cited by 43
“African Americans also have a higher incidence of and greater mortality from diabetes complications such as kidney failure, visual impairment, and amputations.(5) Diabetes is a particular problem for older African American women; more than 20% of African American women older than age 60 are diagnosed with diabetes.”
Background
Recording of diabetes on death certificates
Will, J. C., Vinicor, F., & Stevenson, J. F. (2001) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(00)00303-6 · Cited by 43
Renal damage in patients with type 2 diabetes: a strong predictor of mortality
Bo, S., Ciccone, G., Rosato, R., Gancia, R., Grassi, G., Merletti, F., & Pagano, G. F. (2005) · Diabetic Medicine · doi:10.1111/j.1464-5491.2004.01394.x · Cited by 42
Genitourinary infections in diabetic patients in the new era of diabetes therapy with sodium-glucose cotransporter-2 inhibitors
Rizzi, M., & Trevisan, R. (2016) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2016.07.006 · Cited by 42
Editorial: Diabetes Mellitus: A Major Disease Of Older Persons
Morley, J. E. (2000) · The Journals of Gerontology Series A · doi:10.1093/gerona/55.5.m255 · Cited by 42
Relationship between preoperative hemoglobin A1c levels and long-term mortality after coronary artery bypass grafting in patients with type 2 diabetes mellitus
Kuhl, J., Sartipy, U., Eliasson, B., Nyström, T., & Holzmann, M. J. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.09.008 · Cited by 40
Life expectancy and survival analysis of patients with diabetes compared to the non diabetic population in Bulgaria
Tachkov, K., Mitov, K., Koleva, Y. N., Mitkova, Z. E., Kamusheva, M., Dimitrova, M. J., Petkova, V. B., Savova, A., Doneva, M., Tcarukciev, D., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0232815 · Cited by 43
Excess mortality related to diabetes mellitus in elderly medicare beneficiaries
Bertoni, A. G., Kirk, J. K., Goff, D. C., & Wagenknecht, L. E. (2003) · Annals of Epidemiology · doi:10.1016/j.annepidem.2003.09.004 · Cited by 41
Effectiveness of diabetes mellitus screening recommendations
Dallo, F. J., & Weller, S. C. (2003) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1733839100 · Cited by 41
Peripheral Arterial Disease among Adult Diabetic Patients Attending a Large Outpatient Diabetic Clinic at a National Referral Hospital in Uganda: A Descriptive Cross Sectional Study
Mwebaze, R. M., & Kibirige, D. (2014) · PLoS ONE · doi:10.1371/journal.pone.0105211 · Cited by 40
“Macro vascular complications like stroke, myocardial infarction and PAD tend to occur earlier in diabetics compared to non diabetics [1].”
Background
Urban-Rural Differences in Excess Mortality among High-Poverty Populations: Evidence from the Harlem Household Survey and the Pitt County, North Carolina Study of African American Health
Geronimus, A. T., Colen, C. G., Shochet, T., et al. (2006) · Journal of Health Care for the Poor and Underserved · doi:10.1353/hpu.2006.0105 · Cited by 40
“Gu et al.(31) utilize data from NHANES I Epidemiologic Follow-up Studies conducted in 1982, 1984, 1986, 1987, and 1992.”
Method
Mortality, causes of death and associated risk factors in a cohort of diabetic patients after lower-extremity amputation: A 6.5-year follow-up study in Taiwan
Tseng, C., Chong, C., Tseng, C., Cheng, J., Wong, M., & Tai, T. (2007) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2007.02.011 · Cited by 40
Reporting of diabetes on death certificates using data from the UK Prospective Diabetes Study
Thomason, M. J., Biddulph, J. P., Cull, C. A., & Holman, R. R. (2005) · Diabetic Medicine · doi:10.1111/j.1464-5491.2005.01584.x · Cited by 38
Conversational Agent for Healthy Lifestyle Behavior Change: Web-Based Feasibility Study
Dhinagaran, D. A., Sathish, T., Soong, A., Theng, Y. L., Best, J. D., & Car, L. T. (2021) · JMIR Formative Research · doi:10.2196/27956 · Cited by 39
“People with diabetes live shorter lives—by at least 10 years—and have a lower quality of life (QoL) than those without diabetes [4,5].”
Background
Combination therapy using metformin or thiazolidinediones and insulin in the treatment of diabetes mellitus
Strowig, S. M., & Raskin, P. (2004) · Diabetes Obesity and Metabolism · doi:10.1111/j.1463-1326.2004.00440.x · Cited by 38
Race Differences in Long-Term Diabetes Management in an HMO
Adams, A. S., Zhang, F., Mah, C., Grant, R. W., Kleinman, K., Meigs, J. B., & Ross‐Degnan, D. (2005) · Diabetes Care · doi:10.2337/diacare.28.12.2844 · Cited by 39
Erectile dysfunction as a cardiovascular risk factor in patients with diabetes
Gandaglia, G., Salonia, A., Passoni, N. M., Montorsi, P., Briganti, A., & Montorsi, F. (2012) · Endocrine · doi:10.1007/s12020-012-9780-2 · Cited by 37
“In this context, CVD is the leading cause of death and is considered to be responsible for about 70 % of all causes of death in patients with type 2 DM [17, 18, 34, 35].”
Background
The role of urotensin-II and its receptors in sepsis-induced lung injury under diabetic conditions
Uğan, R. A., Çadırcı, E., Halıcı, Z., et al. (2017) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2017.11.011 · Cited by 38
Silent myocardial ischemia screening in patients with diabetes mellitus.
Barthélémy, O., Feuvre, C. L., & Timsit, J. (2007) · Arquivos brasileiros de endocrinologia e metabologia · doi:10.1590/s0004-27302007000200018 · Cited by 39
“They participate in the shortening of life expectancy, by 8 years for 55- to 64-year-old diabetics and 4 years for the elderly (4).”
Background
Treating diabetic ulcers
Tecilazich, F., Dinh, T., & Veves, A. (2011) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2011.530658 · Cited by 37
“Because of its secondary complications, the life expectancy of diabetic patients is on average 10 years shorter than nondiabetics [2].”
Background
Diabetes, Myocardial Infarction and Stroke Are Distinct and Duration-Dependent Predictors of Subsequent Cardiovascular Events and All-Cause Mortality in Older Men
Yeap, B. B., McCaul, K. A., Flicker, L. A., Hankey, G. J., Almeida, O. P., Golledge, J., & Norman, P. E. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-3339 · Cited by 37
“In a study of 14 374 adults aged 25–74 years, age-adjusted mortality was higher for those with diabetes duration 15 years compared to 5–14 or 5 years, but the relative mortality risk attributable to diabetes was lower in 65–74 year-old men and highest in 25–44 year olds (4).”
Decreased production of inflammatory cytokines by circulating monocytes and dendritic cells in type 2 diabetic men with atherosclerotic complications
Hernández, J. J. C., Almeida, M. D. G., Burgo, R. M., Hernández, P., Miralles, J. M., & Órfão, A. (2006) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2005.09.006 · Cited by 37
Personality and diabetes mellitus incidence in a national sample
Čukić, I., & Weiß, A. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.07.004 · Cited by 37
Prevalence of macrovascular complications and cardiovascular risk factors in people treated for diabetes and living in France: The ENTRED study 2001
Romon, I., Fosse‐Edorh, S., Eschwège, É., Simon, D., Weill, A., Varroud-Vial, M., Detournay, B., & Fagot‐Campagna, A. (2008) · Diabetes & Metabolism · doi:10.1016/j.diabet.2007.11.002 · Cited by 37
“While one diabetic out f two dies because of cardiovascular disease [6], it is essential o better target secondary and tertiary prevention by reducing he level of cardiovascular risk factors, especially in people with iabetes and multiple cardiovascular risk factors.”
Background
All-cause and cause-specific mortality associated with diabetes in prevalent hemodialysis patients
Sattar, A., Argyropoulos, C., Weissfeld, L. A., et al. (2012) · BMC Nephrology · doi:10.1186/1471-2369-13-130 · Cited by 37
Impact of Diabetes on Coronary Artery Disease in Women and Men
Lee, W. L., & Cheung, A. M. (2000) · Cited by 37
Effects of simvastatin on the lipid profile and attainment of low-density lipoprotein cholesterol goals when added to thiazolidinedione therapy in patients with type 2 diabetes mellitus: A multicenter, randomized, double-blind, placebo-controlled trial
Lewin, A. J., Kipnes, M. S., Meneghini, L., Plotkin, D. J., Perevozskaya, I. T., Shah, S., Maccubbin, D., Mitchel, Y., & Tobert, J. A. (2004) · Clinical Therapeutics · doi:10.1016/s0149-2918(04)90033-1 · Cited by 37

Authors: Gu, K., Cowie, C. C., & Harris, M. I.
Affiliations: National Institutes of Health (US)
ORCID: Gu, Ken
Cowie, Catherine C
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
DOI: 10.2337/diacare.21.7.1138
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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Mortality in Adults With and Without Diabetes in a National Cohort of the U.S. Population, 1971–1993

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