The value of death certification statistics in measuring mortality in persons with diabetes

Abstract

Objective — To study how often deceased diabetic patients have a diagnosis of diabetes on the death certificate and to study factors related to this circumstance.

Design — A community-based clinical diabetes register was checked against death certificate data.

Setting and Subjects — Diabetic subjects in the community of Laxå, Sweden, during 1972-1986.

Main Outcome measures — Recording of diabetes on the death certificate.

Results — Diabetes was recorded on the death certificate in 57 % of all known diabetic subjects (men 48 % and women 67 %, p<0.05). It was registered significantly more often in females, when there had been insulin treatment, and when an autopsy was not the basis for the certification of cause of death.

Conclusion — The population with diabetes recorded on the death certificate is not representative of the actual population who die with the disease. In this study the presence of diabetes was underestimated by half for men and by a third for women.

Key Words:

• death certificate
• mortality
• underlying cause of death
• contributory cause of death
• diabetes
• insulin treatment
• basis of cause of death certification
• autopsy