Cause-Specific Mortality Trends in a Large Population-Based Cohort With Long-Standing Childhood-Onset Type 1 Diabetes

被引:233
作者
Secrest, Aaron M. [1 ]
Becker, Dorothy J. [2 ]
Kelsey, Sheryl F. [1 ]
LaPorte, Ronald E. [1 ]
Orchard, Trevor J. [1 ]
机构
[1] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA 15260 USA
[2] Univ Pittsburgh, Dept Pediat, Childrens Hosp Pittsburgh, Sch Med, Pittsburgh, PA 15260 USA
关键词
ALLEGHENY-COUNTY; EXCESS MORTALITY; NATURAL-HISTORY; MELLITUS; IDDM; COMPLICATIONS; PENNSYLVANIA; AGE; PROGNOSIS; SURVIVAL;
D O I
10.2337/db10-0862
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. Diabetes 59:3216-3222, 2010
引用
收藏
页码:3216 / 3222
页数:7
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