Long-Term Trends in Childhood Diabetes Mortality: 1968–1998

Long-Term Trends in Childhood Diabetes Mortality: 1968–1998 John H. DiLiberti , MD, PHD and Rodney A. Lorenz , MD Department of Pediatrics, University of Illinois College of Medicine, Peoria, Illinois Abstract OBJECTIVE —In the context of recent improvements in type 1 diabetes therapy, to describe longitudinal trends in mortality attributable to childhood diabetes and to investigate socioeconomic and health services correlates of mortality. RESEARCH DESIGN AND METHODS —We extracted mortality data for 1968–1998 from National Center for Health Statistics files and covariates from the Bureau of Health Professions Area Resource File. Analytical techniques included linear and Poisson regression and standard descriptive statistics. RESULTS —Childhood (defined as 0–19 years of age) age-adjusted mortality from diabetes declined from 9.5 (1968) to 3.0 (1984) deaths per 10 million but remained relatively constant subsequently. All-cause childhood mortality, however, continued to decline. Older children experienced higher mortality rates, as did those living in counties with higher levels of unemployment. CONCLUSIONS —Despite recent improvements in therapy, diabetes-related mortality among children has not declined for 14 years. This finding may be partially attributable to sociodemographic factors influencing access to care, but the remaining mortality may defy available treatment methods. Reducing childhood diabetes mortality rates below the current apparent plateau may require new prevention and/or treatment strategies. CDC, Centers for Disease Control and Prevention CMF, Compressed Mortality File DKA, diabetic ketoacidosis DRG, diagnosis-related group MCOD, multiple-cause-of-death PICU, pediatric intensive care unit Footnotes Address correspondence and reprint requests to Dr. John H. DiLiberti, University of Illinois College of Medicine, 530 N.E. Glen Oak, Peoria, IL 61637. E-mail: jdiliberti{at}nc.rr.com . Received for publication 7 September 2000 and accepted in revised form 3 May 2001. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.