Trends in the Mortality Burden Associated With Diabetes Mellitus

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Abstract
MARKED DECLINES in mortality, primarily from cardiovascular disease (CVD), have been noted in the United States and throughout the world during the past 4 decades.1,2 This reflects reductions in CVD risk factors (cigarette smoking, high blood pressure, and hypercholesterolemia) and event rates (myocardial infarction and stroke) and improved survival following CVD-related events.2-6 By contrast, the number of new cases of diabetes mellitus (DM), an important risk factor for CVD-related events and for mortality following CVD-related events, has increased markedly in recent decades.7-9 In addition, 2 studies7,10 have shown that persons with DM did not exhibit the same improvements in survival in recent decades as persons without DM. In light of these disparate trends, it is likely that DM is accounting for an increasing proportion of CVD-related morbidity and mortality within the population. The extent to which this has occurred is unclear, however, because most studies11-13 of trends in DM-associated morbidity and mortality have relied on death certificate data. The serious limitations of death certificate data for identifying DM are well recognized.14-16 In particular, only a few patients with DM have the condition listed on the death certificate,15 and this proportion has changed over time.7 Thus, reports of trends in the mortality burden associated with DM are lacking.