School of Population Health, University of Queensland, Public Health Building, Herston Road, Herston, QLD 4006, Australia.
J Clin Epidemiol. 2010 Feb;63(2):199-204. doi: 10.1016/j.jclinepi.2009.04.002. Epub 2009 Aug 6.
This paper seeks to better understand diabetes-related mortality in Australia and the United States through analysis of the impact of certification practices of diabetes as a multiple cause of death, specifically with cardiovascular diseases (CVDs).
Vital registration multiple cause of death data in Australia and the United States since 1999 are used to examine trends in the ratio of diabetes reported in Part I (underlying cause) and Part II (associated cause) of the death certificate, when CVDs are also reported.
Underlying cause of death (UCOD) statistics mask the magnitude of diabetes-related mortality. In both countries, since 1999 there has been an increase in the ratio of diabetes deaths in Part I vs. Part II where CVD deaths, including ischemic heart disease and cerebrovascular diseases, are also reported. In Australia, diabetes reported as an UCOD would be 12% lower in 2006 if the ratio from 1999 was applied.
The increasing likelihood of physicians to report diabetes in Part I reflects the subjectivity of diabetes death certification. There is a need for specific guidelines on death certification of diabetes with cardiovascular conditions, relating to its reporting as an underlying or associated cause.
通过分析将糖尿病列为多种死因的认证实践对澳大利亚和美国的糖尿病相关死亡率的影响，特别是与心血管疾病（CVDs）的关系，来更好地了解这一问题。
自 1999 年以来，澳大利亚和美国的生命登记多重死因数据被用于检查在死亡证明的第一部分（根本原因）和第二部分（相关原因）报告心血管疾病时，报告的糖尿病比例的趋势。
根本死因（UCOD）统计数据掩盖了与糖尿病相关的死亡率的严重程度。自 1999 年以来，在报告包括缺血性心脏病和脑血管疾病在内的心血管疾病死亡的情况下，第一部分的糖尿病死亡比例与第二部分相比有所增加。在澳大利亚，如果应用 1999 年的比例，2006 年报告为 UCOD 的糖尿病将减少 12%。
医生更有可能将糖尿病报告为第一部分的原因，这反映了糖尿病死亡认证的主观性。需要制定关于心血管疾病合并糖尿病的死亡认证的具体指南，涉及将其作为根本原因或相关原因的报告。
