BMJ 2001;322:1389-1393 ( 9 June )

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Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study

Editorial by Williams

Nick A Roper, NHS research training fellow, a Rudy W Bilous, professor of clinical medicine, b William F Kelly, consultant physician, a Nigel C Unwin, senior lecturer in epidemiology, c Vincent M Connolly, consultant physician. a

a Diabetes Care Centre, Middlesbrough General Hospital, Middlesbrough TS5 5AZ, b School of Clinical Medical Sciences, University of Newcastle, Newcastle upon Tyne NE2 4HH, c Departments of Diabetes and Epidemiology and Public Health, University of Newcastle, Newcastle upon Tyne NE2 4HH

Correspondence to: N A Roper n.a.roper{at}ncl.ac.uk

Objectives: To establish the age and sex specific mortality for people with diabetes in comparison with local and national background populations; to investigate the relationship between mortality and material deprivation in an unselected population with diabetes.
Design: Longitudinal study, using a population based district diabetes register.
Setting: South Tees, United Kingdom.
Participants: All people known to have diabetes living in Middlesbrough and Redcar and Cleveland local authorities on 1 January 1994.
Main outcome measure: Death, from any cause, between 1 January 1994 and 31 December 1999.
Results: Over the six years of the study 1205 (24.9%) of 4842 participants died. All cause standardised mortality ratios for type 1 diabetes were 641 (95% confidence interval 406 to 962) in women and 294 (200 to 418) in men, and those for type 2 diabetes were 160 (147 to 174) in women and 141 (130 to 152) in men. Cause specific standardised mortality ratios were increased for ischaemic heart disease, cerebrovascular disease, and renal disease; no reductions in mortality from other causes were seen. The risk of premature death increased significantly with increasing material deprivation (P<0.001).
Conclusions: Diabetes is associated with excess mortality, even in an area with high background death rates from cardiovascular disease. This excess mortality is evident in all age groups, most pronounced in young people with type 1 diabetes, and exacerbated by material deprivation. Aggressive approaches to the management of cardiovascular risk factors could reduce the excess mortality in people with diabetes.


What is already known on this topic
Mortality, mainly from cardiovascular disease, is increased in people with diabetes, but this excess varies considerably by country and ethnic group

Previous British studies have reported no excess mortality in old age, a reduction in deaths from non-cardiovascular causes, and that mortality may be adversely affected by deprivation

What this study adds
Mortality is increased, across all ages, in an unselected population with diabetes compared with the local population without diabetes, which itself has high mortality

Most of the excess is from cardiovascular causes, but there are no reductions in other causes of death

Mortality among people with diabetes is increased even in the most affluent group, and this excess increases with worsening material deprivation



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Bed-side primary prevention is the major step in the war against diabetes mellitus.
Sergio Stagnaro
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