Sensitivity and Specificity of Death Certificates for Diabetes

Cheng, W. Susan; Wingard, Deborah L.; Kritz‐Silverstein, Donna; Barrett‐Connor, Elizabeth

doi:10.2337/dc07-1327

Cited by 55 publications

(50 citation statements)

References 31 publications

(54 reference statements)

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“…Many previous studies have looked at death certificates to determine diabetes status, but these have been found to underestimate the number of individuals with diabetes because of an under-recording of diabetes on death certificates [22][23][24][25][26]. Other studies have relied on selfreported diabetes status, but this is also not very reliable either since the under-reporting of diabetes status has been found to be in the range 17-44% in some previous studies [27][28][29].…”

Section: Discussionmentioning

confidence: 89%

Causes of death among diabetic patients in Denmark

2011

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Aims/hypothesis To study the distribution of causes of death in the Danish population, and its variation by diabetes status, sex, age and calendar year as well as the years of life lost from the specific causes of death. Methods Persons aged 30-98 years were followed from 1995 to 2008 by linkage of Danish registers. Poisson regression was used to model cause-specific mortality rates by age and calendar time for each specific cause of death, according to sex and diabetes status. The mortality rates were also modelled as a function of age and birth cohort. We computed the distribution of causes of death and years of life lost from specific causes of death due to diabetes. Results During the 14-year study period, patients with diabetes contributed 2.3 million person-years of follow-up and 124,210 deaths, whereas persons without diabetes contributed 45.1 million person-years and 648,020 deaths. The mortality was higher among individuals with diabetes, and the mortality ratio (diabetes vs no diabetes) decreased with age and for all causes and cardiovascular diseases also by calendar time. The effect of sex on the association between diabetes and mortality varied with age and cause of death. About 9 years of life were lost to diabetes at age 30 years, and 3 years at age 70 years. Conclusions/interpretation Age-specific mortality is higher among people with diabetes, and rate ratios vary with age, sex, calendar period and cause of death. The distribution of causes of death was similar for persons with and without diabetes.

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Section: Discussionmentioning

confidence: 89%

Causes of death among diabetic patients in Denmark

2011

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“…Most of the attention in this area has focused on whether or not death certificates in people with diabetes refer to diabetes at all (17)(18)(19). It is also possible that due to an increasing recognition of the role of diabetes, the underlying COD may be given as diabetes when the death was primarily caused by CVD.…”

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confidence: 99%

Mortality Trends Among People With Type 1 and Type 2 Diabetes in Australia: 1997–2010

et al. 2014

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OBJECTIVEWith improvements in cardiovascular disease (CVD) rates among people with diabetes, mortality rates may also be changing. However, these trends may be influenced by coding practices of CVD-related deaths on death certificates. We analyzed trends of mortality over 13 years in people with diabetes and quantified the potential misclassification of CVD mortality according to current coding methods. RESEARCH DESIGN AND METHODSA total of 1,136,617 Australians with diabetes registered on the National Diabetes Services Scheme between 1997 and 2010 were linked to the National Death Index. Excess mortality relative to the Australian population was reported as standardized mortality ratios (SMRs). Potential misclassification of CVD mortality was determined by coding CVD according to underlying cause of death (COD) and then after consideration of both the underlying and other causes listed in part I of the death certificate. RESULTSFor type 1 diabetes, the SMR decreased in males from 4.20 in 1997 to 3.08 in 2010 (P trend < 0.001) and from 3.92 to 3.46 in females (P trend < 0.01). For type 2 diabetes, the SMR decreased in males from 1.40 to 1.21 (P trend < 0.001) and from 1.56 to 1.22 in females (P trend < 0.001). CVD deaths decreased from 35.6 to 31.2% and from 31.5 to 27.2% in males and females with type 1 diabetes, respectively (P trend < 0.001 for both sexes). For type 2 diabetes, CVD decreased from 44.5 to 29.2% in males and from 45.5 to 31.6% in females (P trend < 0.001 for both sexes). Using traditional coding methods, ∼38 and 26% of CVD deaths are underestimated in type 1 diabetes and type 2 diabetes, respectively. CONCLUSIONSAll-cause and CVD mortality has decreased in diabetes. However, the total CVD mortality burden is underestimated when only underlying COD is considered. This has important ramifications for understanding mortality patterns in diabetes.

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“…In addition, the AusDiab study that used an oral glucose tolerance test to define diabetes provided more definitive data on the true prevalence of diabetes. Since we linked the diabetes registry to the death index, we identified all deaths in people with diabetes, not just those identified on death certificates, which would be an underestimate [34].…”

Section: Discussionmentioning

confidence: 99%

Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes

et al. 2016

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Aims/hypothesis The aim of this work was to estimate the life expectancy (LE) and disability-free life expectancy (DFLE) for adults with and without diabetes. Methods The Chiang method and the adapted Sullivan method were used to estimate LE and DFLE by age and sex. Mortality data in 2011 were available from the National Diabetes Services Scheme for diabetes and from standard national mortality datasets for the general population. Data on prevalence of disability and severe or profound core activity limitation were derived from the 2012 Australian Survey of Disability, Ageing and Carers (SDAC). The definitions of disability used in the SDAC followed the International Classification of Functioning, Disability and Health. Data on diabetes prevalence were derived from the Australian Diabetes, Obesity and Lifestyle study. ResultsThe estimated LE and DFLE (with 95% uncertainty interval [UI]) at age 50 years were 30.2 (30.0, 30.4) and 12.7 (11.5, 13.7) years, respectively, for men with diabetes, and the estimates were 33.9 (33.6, 34.1) and 13.1 (12.3, 13.9) years, respectively, for women with diabetes. The estimated loss of LE associated with diabetes at age 50 years was 3.2 (3.0, 3.4) years for men and 3.1 (2.9, 3.4) years for women, as compared with their counterparts without diabetes. The corresponding estimated loss of DFLE was 8.2 (6.7, 9.7) years for men and 9.1 (7.9, 10.4) years for women. Women with diabetes spent a greater number of absolute years and a greater proportion of their life with disability as compared with men with diabetes and women without diabetes. The gains in LE and DFLE across the whole population at age 50 years after hypothetically eliminating diagnosed diabetes were 0.6 (0.5, 0.6) years and 1.8 (1.0, 2.8) years. Conclusions/interpretation In adults, diabetes results in a modest reduction in LE and a substantial reduction in DFLE. Efforts to identify the specific causes of disability and effective interventions are needed.

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Sensitivity and Specificity of Death Certificates for Diabetes

Cited by 55 publications

References 31 publications

Causes of death among diabetic patients in Denmark

Causes of death among diabetic patients in Denmark

Mortality Trends Among People With Type 1 and Type 2 Diabetes in Australia: 1997–2010

Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes

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