Changing patterns of diabetic deaths in youth and young adults by gender in the major developed countries 1974-97.

UNLABELLED

The objective was to examine any changes in "Diabetic Deaths" in major developed countries 1974-97 and to determine whether youth (aged 15-24 years) and young adult (aged 25-44 years) males are at greater risk of Diabetic Death (DD) than women by comparing DD with "All Cause Deaths" (ACD) by gender.

DESIGN

Based upon WHO standardized mortality data, three year average death rates for 1974-76 were contrasted against three year average for 1995-97 for ACD and DD rate per million, by gender. Ratios of change for each country were calculated, which were then used for comparison between countries, thus ensuring comparison of like with like, resolving the inherent problem of differential recording between countries. Ratios of ratios were calculated between the ACD and DD ratios by gender indicating any changes between mortalities by gender over the period. Chi square tests examined differences between the gender.

RESULTS

ALL CAUSE DEATHS: Wide range of male ACD, lowest Japan 939 (per million p.m) to USA 2039 p.m. but there were substantial falls (< 0.2) in five countries. Female ACD ranged from Japan 485 p.m. to USA 889 but fell substantially in every country except the Netherlands. DIABETIC DEATHS: Male DD highest in USA at 24 p.m., lowest Italy 6 p.m. with substantial falls in 8 countries. Female DD were 17 p.m. in USA and 3 p.m. in France and Spain. Fell substantially in every country except the USA. DD:ACD male rates saw substantial improvements in Ratio of Ratios (RoR) in France, Italy and Spain but rose 1.22 in USA. Female RoR showed better improvements in DD in France, Netherlands and Spain but substantial rises in Canada and USA. DD AND GENDER: In every country there were more male than female DD and over time male DD worsened significantly compared to female DD in Japan, Netherlands, Spain and USA.

CONCLUSIONS

Whilst diabetes continues to be associated with greater mortality, over the period there have been major improvements in DD relative to ACD deaths, especially amongst females. Nonetheless, there are still gains to be made if compliance can be further improved amongst male patients.