Diabetes-related mortality among African-American, Hispanic, and non-Hispanic white young people age 1-24

The course of insulin-dependent diabetes mellitus (IDDM) in young patients is a good indication of the quality of health care, since well-developed treatment guidelines are widely available, and deficiencies in IDDM management can lead to severe acute and chronic complications. Deaths in IDDM patients in this age group are rare, resulting primarily from acute metabolic disruptions. Incidence studies indicate that African Americans and US Hispanics are at somewhat lower risk of developing IDDM than non-Hispanic whites. This reduced risk of disease should translate into a lower risk of IDDM-related mortality among minority children if access to adequate health care is readily available. A study among Chicago residents ages 1-24 investigated this question. Death certificates with any mention of diabetes during 1987-1994 were examined for Chicago residents born after 12/31/66. IDDM prevalence was estimated from various sources. When available, autopsy reports or medical records were examined. There were 30 deaths in the 8-year interval: 23 among African Americans, five among Hispanics and two among non-Hispanic whites. Average annual case-fatality rates (95% CI) were 193.3 (122.6-290.0)x10(-5) for African Americans, 81.9 (26.5-190.8)x10(-5) for Hispanics, and 21.8 (2.6-78.7)x10(-5) for non-Hispanic whites. These data indicate that the short-term risk of death is elevated among minority youth with IDDM. While non-white young people in Chicago experience a 2- to 3-fold greater risk of death from all causes compared to non-Hispanic whites, the 9-fold excess risk of dying for African American youth with IDDM indicates gaps in access to comprehensive diabetes care.