Declining Mortality Rate Among People With Diabetes in North Dakota, 1997–2002
- Edward F. Tierney, MPH1,
- Betsy L. Cadwell, MSPH1,
- Michael M. Engelgau, MD, MS1,
- Larry Shireley, MS, MPH2,
- Sherri L. Parsons, MT (ASCP), BB2,
- Kathy Moum, MA2 and
- Linda S. Geiss, MA1
- 1Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
- 2North Dakota Department of Health, Bismark, North Dakota
- Address correspondence and reprint requests to Edward F. Tierney, M.P.H., Epidemiologist, Division of Diabetes Translation, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS K-10, Atlanta, Georgia 30341. E-mail: ext5{at}cdc.gov
Both the increasing prevalence (1,2) and the high lifetime risk for diabetes (3) have enormous implications for the future; this disease is a major cause of premature mortality, and people with diabetes die at about twice the rate of people without diabetes (4). Efforts to track mortality trends have been difficult because death certificates, as currently structured, are inadequate to assess diabetes mortality, as less than half of diabetic decedents have diabetes listed (4). To improve the tracking of mortality among people with diabetes, North Dakota added a check box to its death certificate in 1992 that asked whether the decedent had diabetes. The period of 1992–1996 has been reported previously (5). In this study, we use the check box to aid in calculating the number of decedents with diabetes and in examining mortality rates among those with diabetes from 1997 through 2002.
RESEARCH DESIGN AND METHODS
We used 1997–2002 North Dakota death certificate data to calculate the number of deaths among individuals with diabetes. A decedent was considered to have diabetes if the underlying cause of death or the contributing causes of death had an ICD-9 or -10 code for diabetes (ICD-9 code 250 in 1997 or 1998; ICD-10 codes E10–E14 in 1999–2002) or if the diabetes check box (responses: yes or no) indicated that the decedent had diabetes. Multiple imputation (6) was used to adjust for missing …
