Population-based estimates of mortality associated with diabetes: use of a death certificate check box in North Dakota

Overall and cause-specific mortality among persons with diabetes in North Dakota was estimated and compared with estimates from previous population-based studies. Data were derived from North Dakota death certificate data, which included unique information on decedents' diabetes status and Behavioral Risk Factor Surveillance System estimates of the diabetic and nondiabetic adult populations of North Dakota. The risk of death among adults with diabetes was 2.6 (2.2, 2.9) times that of adults without diabetes. Relative risks of death among adults with diabetes were at least twice as high for heart disease, cerebrovascular disease, accidents and adverse events, and kidney disease and 70% to 80% higher for pneumonia and influenza, malignant neoplasms, arterial disease, and other causes. Risks remained substantial in the oldest age group. These findings are comparable to results of other population-based studies. Diabetes status information enhanced the usefulness of death certificate data in examining mortality associated with diabetes and confirms that the effect of diabetes on death is substantial.