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Risk of death greater in diabetics regardless of sex, age or affluence

Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study

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Editorial: Diabetes black spots and death by postcode

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A study in this week's BMJ finds that people with diabetes are at a higher risk of death - irrespective of age, sex or affluence - compared to those without diabetes. This excess mortality exists even in the poorest areas of the United Kingdom, where death rates are already above the national average, and presents a depressing snapshot of the prospects for diabetic people in the UK today.

Roper and colleagues identified people with known diabetes living in the South Tees region of the UK on 1 January 1994. Over a six year period, deaths in this group were compared with the mortality of the population of England and Wales and the local population without diabetes. A measure of material deprivation was also calculated for each participant.

The team found excess mortality in people with diabetes in both sexes and across all ages - extending even to those aged 80 and over, but most pronounced in young people. In both men and women diagnosed with diabetes by the age of 40, life expectancy was reduced by eight years compared to people without diabetes. Women diagnosed after the age of 50 lost more years than men. Even the most affluent people with diabetes still had a higher mortality than the local population without diabetes, say the authors, and this excess increased with worsening material deprivation.

Given that the main cause of death in our group with diabetes was ischaemic heart disease, say the authors, aggressive approaches to the management of cardiovascular risk factors could reduce the risk of premature death in people with diabetes.

Obesity is now recognised as a cardiovascular risk factor in its own right, and this may well explain a large part of the excess cardiovascular mortality associated with social deprivation, writes Professor Gareth Williams in an accompanying editorial.

He describes the rising prevalence of diabetes, particularly amongst young people, and the "dire consequences" of this increasing burden both in the UK and the developing world. "We can only hope that the national service framework and its counterparts in other countries can rise to these difficult challenges and that, against expectation, public health measures will be able to turn the rising tide of obesity," he concludes.

Contacts:

[Paper]: Nick Roper, NHS Research Training Fellow, Diabetes Care Centre, Middlesbrough General Hospital, Middlesbrough, UK

Tel: 44-0-1642-854-235
Email: n.a.roper@ncl.ac.uk

[Editorial]: Gareth Williams, Professor of Medicine, Department of Medicine, University Hospital Aintree, Liverpool, UK

Tel: 44-0-151-529-5885
Email: garethw@liv.ac.uk

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