Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes The Allegheny County Type 1 Diabetes Registry

  1. Trevor J. Orchard, MBBCh, MMedSci (orchardt{at}edc.pitt.edu)1
  1. 1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  2. 2Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Abstract

Objective: Little is known concerning the primary cause(s) of mortality in type 1 diabetes responsible for the excess mortality seen in this population.

Research Design and Methods: The Allegheny County (Pennsylvania) childhood-onset (age<18 yrs) type 1 diabetes registry (n=1,075) with diagnosis from 1965-79 was used to explore patterns in cause-specific mortality. Cause of death was determined by a mortality classification committee of at least 3 physician epidemiologists, based on the death certificate and additional records surrounding the death.

Results: Vital status for 1,043 (97%) participants was ascertained as of 1 January 2008, revealing 279 (26.0%) deaths overall (141 females and 138 males). Within the first 10 years after diagnosis, the leading cause of death was acute diabetes complications (73.6%), while during the next 10 years, deaths were nearly evenly attributed to acute (15%), cardiovascular (22%), renal (20%), or infectious (18%) causes. After 20 years duration, chronic diabetes complications (cardiovascular, renal, or infectious) accounted for >70% of all deaths, with cardiovascular disease as the leading cause of death (40%). Women (p<0.05) and African-Americans (p<0.001) have significantly higher diabetes-related mortality rates than men and Caucasians, respectively. SMRs for non-diabetes-related causes do not significantly differ from the general population (violent deaths: SMR=1.2, 0.6-1.8; cancer: SMR=1.2, 0.5-2.0).

Conclusions: The excess mortality seen in type 1 diabetes is almost entirely related to diabetes and its comorbidities, but varies by duration of diabetes and particularly affects women and African-Americans.

Footnotes

    • Received June 21, 2010.
    • Accepted August 11, 2010.

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