Question

• Think about how diabetes and all of the above are diseases in and of themselves but also linked with cardiovascular disease.
• Are we likely to be overestimating or underestimating the number of deaths relating to diabetes? Could you loosely tell me why that might be?

Answer 1

Ans) Approximately 71.2% of the diabetes-related deaths would not be ascribed to diabetes on death certificates.

- The diabetic men have higher risk of dying than women, and diabetic patients have excess mortality when compared with the general population.

- For underlying causes of death not listed as diabetes, total cardiovascular death, including cardiopulmonary disease, stroke, and disease of arteries, arterioles, and capillaries, is the most common cause of death, followed by cancer.

- NHI, National Health InsuranceSMR, standardized mortality ratio
Although diabetic patients have an excess risk of mortality in other races and ethnic groups (1–7), data on diabetes-related mortality are limited.

Example:

- A study using data of vital statistics demonstrated that mortality ascribed to diabetes has increased 6.3-fold from 1960 to 1988 in Taiwan. Because diabetes is rarely mentioned as a cause of death on the death certificates of diabetic patients, vital statistics unavoidably underestimate the impact of diabetes-related death. Longitudinal follow-up of a cohort of diabetic patients will surely provide more information than using the data of vital statistics followed a cohort of 766 diabetic patients attending a general hospital in Taipei City for a median of 3.5 years and analyzed the mortality rate and causes of death of the cohort. However, patients from a single general hospital were highly selective, and the small number of deaths (131 cases) in the study made the estimate unreliable.

- Therefore, the purpose of this study was 1) to determine the mortality rate and causes of death in a national sample of known diabetic patients covered by the National Health Insurance (NHI) in Taiwan and 2) to assess standardized mortality ratios (SMRs) compared with the general population.