Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes

Aaron M Secrest, Dorothy J Becker, Sheryl F Kelsey, Ronald E Laporte, Trevor J Orchard, Aaron M Secrest, Dorothy J Becker, Sheryl F Kelsey, Ronald E Laporte, Trevor J Orchard

Abstract

Objective: Little is known concerning the primary cause(s) of mortality in type 1 diabetes responsible for the excess mortality seen in this population.

Research design and methods: The Allegheny County (Pennsylvania) childhood-onset (age < 18 years) type 1 diabetes registry (n = 1,075) with diagnosis from 1965 to 1979 was used to explore patterns in cause-specific mortality. Cause of death was determined by a mortality classification committee of at least three physician epidemiologists, based on the death certificate and additional records surrounding the death.

Results: Vital status for 1,043 (97%) participants was ascertained as of 1 January 2008, revealing 279 (26.0%) deaths overall (141 females and 138 males). Within the first 10 years after diagnosis, the leading cause of death was acute diabetes complications (73.6%), while during the next 10 years, deaths were nearly evenly attributed to acute (15%), cardiovascular (22%), renal (20%), or infectious (18%) causes. After 20 years' duration, chronic diabetes complications (cardiovascular, renal, or infectious) accounted for >70% of all deaths, with cardiovascular disease as the leading cause of death (40%). Women (P < 0.05) and African Americans (P < 0.001) have significantly higher diabetes-related mortality rates than men and Caucasians, respectively. Standardized mortality ratios (SMRs) for non-diabetes-related causes do not significantly differ from the general population (violent deaths: SMR 1.2, 95% CI 0.6-1.8; cancer: SMR 1.2, 0.5-2.0).

Conclusions: The excess mortality seen in type 1 diabetes is almost entirely related to diabetes and its comorbidities but varies by duration of diabetes and particularly affects women and African Americans.

Figures

FIG. 1.
FIG. 1.
Distribution of underlying causes of death within 10-year intervals of type 1 diabetes duration. Ten deaths where the cause of death was unknown were excluded.
FIG. 2.
FIG. 2.
Total contribution (underlying and/or secondary cause of death) of major diabetes complications to deaths in type 1 diabetes. Proportions of death in each diabetes duration interval where the following complications either caused or contributed to death are shown: acute complications (A), end-stage renal disease (ESRD) (B), and CVD (C).

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