Diabetes and the Risk of Infection-Related Mortality in the U.S.

  1. Alain G. Bertoni, MD, MPH1,
  2. Sharon Saydah, MHS2 and
  3. Frederick L. Brancati, MD, MHS12
  1. 1Department of Medicine, School of Medicine
  2. 2Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland


    OBJECTIVE—To determine whether diabetes predicts infection-related mortality and to clarify the extent to which this relationship is mediated by comorbid conditions that may themselves increase risk of infection.

    RESEARCH DESIGN AND METHODS—We performed a retrospective cohort study using the Second National Health and Nutrition Examination Survey Mortality Study of 9,208 adults aged 30–74 years in 1976–1980. We defined demographic variables, diabetes, cardiovascular disease (CVD), and smoking by self-report; BMI, blood pressure, and serum cholesterol from baseline examination; and cause-specific mortality from death certificates.

    RESULTS—Over 12–16 years of follow-up, 36 infection-related deaths occurred among 533 adults with diabetes vs. 265 deaths in 8,675 adults without diabetes (4.7 vs. 1.5 per 1,000 person-years, P < 0.001). Diabetes (RR 2.0, 95% CI 1.2–3.2) and congestive heart failure (2.8, 1.6–5.1) were independent predictors of infection-related mortality after simultaneous adjustment for age, sex, race, poverty status, smoking, BMI, and hypertension. After subdividing infection-related deaths into those with (n = 145) and without (n = 156) concurrent cardiovascular diagnoses at the time of death, diabetic adults were at risk for infection-related death with CVD (3.0, 1.8–5.0) but not without CVD (1.0, 0.5–2.2).

    CONCLUSIONS—These nationally representative data suggest that diabetic adults are at greater risk for infection-related mortality, and the excess risk may be mediated by CVD.


    • Address correspondence and reprint requests to Frederick Brancati, MD, MHS, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21205. E-mail: fbrancat{at}jhmi.edu.

      Received for publication 31 October 2000 and accepted in revised form 15 February 2001.

      The original data source for this study was the National Center for Health Statistics. However, all analyses, interpretations, and conclusions of this study should be credited only to the authors and not to the National Center for Health Statistics.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    | Table of Contents