Diabetes Atlas
Mortality attributable to diabetes: Estimates for the year 2010

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Abstract

Country and global health statistics underestimate the number of excess deaths due to diabetes. The aim of the study was to provide a more accurate estimate of the number of deaths attributable to diabetes for the year 2010. A computerized disease model was used to obtain the estimates. The baseline input data included the population structure, estimates of diabetes prevalence, estimates of underlying mortality and estimates of the relative risk of death for people with diabetes compared to people without diabetes.

The total number of excess deaths attributable to diabetes worldwide was estimated to be 3.96 million in the age group 20–79 years, 6.8% of global (all ages) mortality. Diabetes accounted for 6% of deaths in adults in the African Region, to 15.7% in the North American Region. Beyond 49 years of age diabetes constituted a higher proportion of deaths in females than in males in all regions, reaching over 25% in some regions and age groups. Thus, diabetes is a considerable cause of premature mortality, a situation that is likely to worsen, particularly in low and middle income countries as diabetes prevalence increases. Investments in primary and secondary prevention are urgently required to reduce this burden.

Introduction

Mortality is an important measure of population health and is often used to assign priorities in health interventions. Estimating mortality due to diabetes has been challenging because more than a third of countries of the world have no reliable data available on mortality and also because existing routine health statistics have been shown to underestimate mortality from diabetes [1]. The latter is largely because persons with diabetes most frequently die of cardiovascular disease or renal failure, rather than a complication specific to diabetes [2]. Cause specific mortality statistics are based on the underlying cause of death recorded on the death certificate. In cases of cardiovascular disease death in particular diabetes is frequently not mentioned at all, or if it is, it is not specified as the underlying cause of death [3]. The problem of assessing the true mortality contribution of a disease is not unique to diabetes. Complex and resource-demanding methods that combine vital registration, results of population-monitoring laboratories and epidemiologic studies, have been developed for estimating mortality attributable to some conditions deemed to be of public health importance (AIDS, tuberculosis), but equivalent methods have not been developed for diabetes [4].

To provide a more realistic estimate of the burden of mortality attributable to diabetes than is available from routine sources of health statistics, a modelling approach has been used recently for the years 2000 and 2007 [5], [6]. This study uses similar methodology to estimate the number of deaths attributable to diabetes in the year 2010.

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Methods

The number of deaths attributable to diabetes was calculated using the following input data:

  • (1)

    Expected number of all deaths in the year 2010, applying the age- and sex-specific death rate for the year 2007, as 2007 is the latest year for which WHO life tables are available.

  • (2)

    Country-specific diabetes prevalence by age and sex for the year 2010 (see the paper by Shaw et al., also available on this site/CD rom).

  • (3)

    Age- and sex-specific relative risks of death for persons with diabetes, compared to their

Results

The numbers of excess deaths due to diabetes are presented by IDF Regions in Table 2. It is predicted that almost 4 million deaths in 2010 could be attributed to diabetes, which is 6.8% of global (all ages) all-cause mortality. In all regions, bar one, roughly 10% or more of deaths in the age group 20–79 were attributable to diabetes, with the highest proportion (15.7%) being in North America, reflecting both a high prevalence of diabetes and a relatively elderly population. Africa is the

Discussion

While there has been a documented decline in the morbidity and mortality of some chronic noncommunicable diseases in some countries [13], no such decline has been reported for diabetes. Wherever measured, the prevalence seems to be increasing. Although some developed countries have documented an improved survival of persons with diabetes, the increased prevalence is most likely due to increased incidence rather than improved survival [14].

Comparing these estimates of mortality attributable to

Conflict of interest

The authors state that they have no conflict of interest. The views expressed within this paper are those of the authors and not necessarily those of WHO.

Acknowledgements

We would like to thank the investigators of the DECODE and DECODA Study for providing the relative risk of deaths estimates necessary for the calculation of the number of deaths attributable to diabetes.

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