Mortality experience of Navajos with type 2 diabetes mellitus

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Abstract
Objectives. We sought to determine the contribution of type 2 diabetes mellitus to mortality in a Navajo population, and to assess the impact of pre‐existing coronary heart disease on this relationship. Methods. A cohort of 77 Navajos with type 2 diabetes mellitus and 77 non‐diabetic controls matched on age, gender and community of residence were followed for an 18‐year period, from 1974 to 1992. Results. The vital status of 152 of the 154 study subjects was ascertained at 18‐year follow‐up. There were 30 deaths (39%) in the type 2 diabetes group and 13 (17%) in the control group during the 18‐year period which was significantly different in bivariate matched pairs analysis (risk ratio = 3.12, McNemar's χ2 = 7.76, p < 0.07). Multivariate conditional logistic response models (risk ratio = 3.02, 95% CI 1.21, 7.53) and stratification analysis (McNemar's Summary χ2 = 8.05, 2 df, p < 0.05), confirmed that survival was significantly different for the two groups, even when controlling for baseline cardiovascular comorbidity and hypertension. Conclusion. These data describe the mortality impact of the epidemic of type 2 diabetes and cardiovascular disease now accelerating among the Navajo. The significant mortality differences between the diabetes and non‐diabetes groups and the continuing rise in prevalence of type 2 diabetes underscore the need for an effective community‐based approach to diabetes prevention among the Navajo.