Diabetes Mortality Data Trends for 2000-2008 DS 10-10001
Diabetes was California’s seventh leading cause of death for the years 2000 through 2008 and the seventh leading cause of death nationally in 20071, the most recent year for which national data is available.
Diabetes disproportionately affects minority populations and the elderly, and its incidence is likely to increase as minority populations grow and the U.S. population becomes older.2 The burden of disease and economic cost of diabetes to society is significant. Diabetes can have a harmful effect on most of the body’s organ systems. Most non-traumatic lower-extremity amputations occur in persons with diabetes. Diabetes is the leading cause of kidney failure and onset of blindness in adults aged 20-74 years. Persons with diabetes are at increased risk for heart disease and stroke, and their overall risk of death is approximately twice that of similarly aged people without diabetes. In economic terms, the direct medical expenditures attributable to diabetes in 2007 have been estimated at $116 billion, or about 2.3 times higher on average than the estimated costs for people without diabetes.3
This report examines mortality trends for the California resident population over the period 2000 through 2008, and presents data in five major sections. The first section discusses diabetes mortality for the total California resident population. The second section analyzes male and female populations separately. The third section describes differences in diabetes mortality by race/ethnic groups. Sex differences within race/ethnic groups are discussed in the fourth section. Each of these sections includes information about the numbers and age distributions for diabetes deaths and mortality trends over time. The final section reviews trends in diabetes mortality by county of residence and includes trend charts for each county.
Detailed tables are also provided. Table 1a (PDF), Table 1b (PDF), and Table 1c (PDF) show 2000 to 2008 California resident diabetes deaths by age and race/ethnicity for both sexes combined, males, and females, respectively. Table 2a (PDF), Table 2b (PDF), and Table 2c (PDF) display diabetes death rates for the same period. Table 3 (PDF) provides age-adjusted death rates and 95% confidence intervals. Table 4 (PDF), Table 5 (PDF), and Table 6 (PDF) provide diabetes deaths, age-adjusted death rates, and 95% confidence intervals by county of residence.
Information about rate calculation and trend analysis is located in the Technical Notes.
Use of Underlying Cause of Death and Limitations
The definition of diabetes used in this report is based on the International Classification of Diseases, Tenth Revision (ICD-10) codes E10-E14. For the purposes of this report, deaths are coded to E10-E14 only when diabetes is identified as the underlying cause of death. More information about cause of death is located in the technical notes. The U.S. Department of Health and Human Services has established a number of health objectives pertaining to diabetes. However, these objectives are based on both underlying and contributing causes of diabetes deaths rather than underlying cause only.4 Therefore, California’s progress in meeting the HP 2010 national objectives for diabetes is not addressed in this report.
There are some limitations to using underlying cause to tabulate diabetes deaths. When analysis is based on deaths with any mention of diabetes on the death certificate, the number of diabetes-related deaths increases greatly. Diabetes has been found to be about three times more likely to be reported as a contributing rather than underlying cause of death in California.
On the other hand, heart disease and cerebrovascular disease were slightly more likely to be listed as the underlying cause than as contributing causes, and cancer was about six times more likely to be listed as the underlying cause than as a contributing cause of death.5 In 2008, there were 7,349 deaths in California with diabetes listed as the underlying cause on the death certificate, but there were 21,362 deaths with diabetes listed elsewhere on the certificate.