Background Although a growing body of evidence demonstrates an increase in cardiovascular disease (CVD) mortality among those with diabetes mellitus, the results related to other causes of death are less homogenous. The strength of the association between diabetes and mortality appears to differ by geographic location. The role that Body Mass Index (BMI) plays also requires further exploration. In the UK, one in 20 individuals is estimated to have diabetes. Therefore, even a small increase in mortality risk among those with diabetes, could result in a large number of deaths among those with the disease. This large general-population cohort study used data from England and Scotland to explore the associations between diabetes and risk of all-cause and cause-specific mortality, and examine the extent to which any increase was attributable to raised BMI.
Methods Nationally-representative, cross-sectional data from 15 years of the Health Survey for England (HSE) (1994–2005) and Scottish Health Survey (SHeS) (1995, 1998 and 2003) were linked with mortality records up to the first quarter of 2011. Odds ratios (OR) and 95% confidence intervals (CI) adjusted for age-group and sex (model 1), plus smoking status (model 2) and additionally for BMI category (model 3) were estimated using logistic and multinomial logistic regression. Participants mentioning cancer at baseline were excluded from the study.
Results Within this sample of 166,600 participants (5,131 with diabetes) there were 19,483 deaths (1,060 among those with diabetes, 18,423 without diabetes). All-cause mortality was greater among those with diabetes when adjusted for age, sex and smoking status (OR 1.52, 95% CI 1.41–1.65), with no reduction when adjusting for BMI category (OR 1.49, 1.37–1.64). Cause-specific mortality among those with diabetes was raised for CVD (model 2 OR 1.73, 1.55–1.93), cancer (1.24, 1.08–1.43) and ‘Other’ (1.77, 1.54–2.04) with a non-significant increase for respiratory diseases (1.21, CI 0.99–1.47). Additional adjustment for BMI had a minimal impact upon the excess mortality found among those with diabetes: CVD (OR 1.69, 1.49–1.93), cancer (1.24, 1.05–1.45), ‘Other’ causes (1.75, 1.49–2.07), and respiratory diseases (1.16, 0.92–1.47). Survival was also lower among those with diabetes compared with those without the disease at baseline.
Conclusion Diabetes is associated with an excess of all-cause and cause-specific mortality from CVD, cancer, and ‘Other’ causes but probably not respiratory diseases. Increased BMI does not appear to be a mediating factor within the association between diabetes and cause-specific mortality.
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