Endocrine Abstracts

Introduction: Between-country comparability and validity of mortality statistics is a global public health challenge, especially for cause-of-death assignment of diabetes mellitus (here after diabetes) in relation to cardiovascular disease. The multiple contributing causes of death (MCD) representing comorbidity are not used to classify mortality cause, as the underlying cause of death (UCD) becomes the cause-of-death. Diabetes increases risk of ischemic heart disease (IHD). To aid in policy making for preventing IHD deaths as comorbidity of diabetes, this study determines demographic and clinical factors on having IHD as a MCD among deaths with diabetes as the UCD.

Methods: Death records including causes of death were obtained through the World Health Organization, which are originally from the Centers for Disease Control and Prevention (CDC) in the US for years 2012–2015, and from Sistema de Informação sobre Mortalidade in Brazil for years 2006-2009 and 2011-2013. A logistic regression analysis was conducted to identify factors associated with having IHD as a MCD among diabetes deaths.

Results: IHD appeared as the MCD in 38% and 16% of 305,885 deaths in the U.S and 367,717 deaths in Brazil that were deaths with diabetes as the UCD, respectively. Marital status, smoking, age, place of death, high cholesterol, and existence of autopsy were significantly associated to having IHD as a MCD in the two countries. In the U.S., in addition, race was significantly associated to having IHD as a MCD. In Brazil, significant factors also included assistance of medical staff, education, having hypertension, and obesity (P-values <0.05).

Conclusion: MCD could play a large role in better characterizing diabetes mortality estimates. Differences in existence of IHD as comorbidity of diabetes deaths were observed between the U.S. and Brazil. Factors identified in this study could help detect population subgroups with masked IHD among diabetes deaths. Representation of IHD comorbidity among diabetes deaths is needed for adequate public health measures to be taken, leading to lower mortality through a more target-specific intervention for non-communicable disease.