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. 2017 Jan 25;12(1):e0170219.
doi: 10.1371/journal.pone.0170219. eCollection 2017.

Deaths Attributable to Diabetes in the United States: Comparison of Data Sources and Estimation Approaches

Andrew Stokes  1 , Samuel H Preston  2
Affiliations

Deaths Attributable to Diabetes in the United States: Comparison of Data Sources and Estimation Approaches

Andrew Stokes et al. PLoS One. .

Abstract

Objective: The goal of this research was to identify the fraction of deaths attributable to diabetes in the United States.

Research design and methods: We estimated population attributable fractions (PAF) for cohorts aged 30-84 who were surveyed in the National Health Interview Survey (NHIS) between 1997 and 2009 (N = 282,322) and in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2010 (N = 21,814). Cohort members were followed prospectively for mortality through 2011. We identified diabetes status using self-reported diagnoses in both NHIS and NHANES and using HbA1c in NHANES. Hazard ratios associated with diabetes were estimated using Cox model adjusted for age, sex, race/ethnicity, educational attainment, and smoking status.

Results: We found a high degree of consistency between data sets and definitions of diabetes in the hazard ratios, estimates of diabetes prevalence, and estimates of the proportion of deaths attributable to diabetes. The proportion of deaths attributable to diabetes was estimated to be 11.5% using self-reports in NHIS, 11.7% using self-reports in NHANES, and 11.8% using HbA1c in NHANES. Among the sub-groups that we examined, the PAF was highest among obese persons at 19.4%. The proportion of deaths in which diabetes was assigned as the underlying cause of death (3.3-3.7%) severely understated the contribution of diabetes to mortality in the United States.

Conclusion: Diabetes may represent a more prominent factor in American mortality than is commonly appreciated, reinforcing the need for robust population-level interventions aimed at diabetes prevention and care.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Prevalence of diabetes in the sample and among individuals who died in the total NHIS sample and in various population subgroups.
BMI: body mass index. Cohort 1 includes years 1997–2001 and cohort 2 includes years 2002–2006. Source: NHIS.
Fig 2
Fig 2. Hazard ratios expressing the association between diabetes status and mortality for all participants and by population subgroup.
Source: NHIS years 1997–2009 with prospective mortality follow-up through Dec. 2011.
See this image and copyright information in PMC

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