Trends in heart disease death rates in diabetic and nondiabetic Pima Indians

Secular trends over 34 years (1965–1998) in overall and cause-specific mortality were examined in 4623 Pima Indians ≥35 years old. The underlying and contributing causes of the 1363 deaths were determined from a review of all available clinical records; 540 of the deaths occurred in the 2528 nondiabetic participants and 823 in the 2095 participants who had diabetes during all or part of the study period. Age/sex-adjusted death rates were calculated across four 8.5-year time intervals. In the nondiabetic participants, the rate of death from natural causes declined gradually over time (20.4, 17.3, 17.3, and 16.0 deaths per 1000 persons/year; P=.11); deaths from ischemic heart disease (IHD) were uncommon ( n=22), and the rate did not change appreciably, remaining as the fifth leading natural cause of death. In the diabetic participants, the rate of death from natural causes was unchanged over time, but the rate of death from IHD ( n=141) increased nearly twofold (3.3, 4.2, 6.4, and 6.4 deaths per 1000 persons/year; P