Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
German Center for Diabetes Research, München-Neuherberg, Germany.
Diabetes Care. 2017 Dec;40(12):1703-1709. doi: 10.2337/dc17-0954. Epub 2017 Oct 9.
In Germany, as in many other countries, nationwide data on mortality attributable to diagnosed diabetes are not available. This study estimated the absolute number of excess deaths associated with diabetes (all types) and type 2 diabetes in Germany.
A prevalence approach that included nationwide routine data from 64.9 million people insured in the German statutory health insurance system in 2010 was used for the calculation. Because nationwide data on diabetes mortality are lacking in Germany, the mortality rate ratio from the Danish National Diabetes Register was used. The absolute number of excess deaths associated with diabetes was calculated as the number of deaths due to diabetes minus the number of deaths due to diabetes with a mortality that was as high as in the population without diabetes. Furthermore, the mortality population-attributable fraction was calculated.
A total of 174,627 excess deaths were due to diabetes in 2010, including 137,950 due to type 2 diabetes. Overall, 21% of all deaths in Germany were attributable to diabetes and 16% were attributable to type 2 diabetes. Most of the excess deaths (34% each) occurred in the 70- to 89-year-old age-group.
In this first nationwide calculation of excess deaths related to diabetes in Germany, the results suggest that the official German estimates that rely on information from death certificates are grossly underestimated. Countries without national cohorts or diabetes registries could easily use this method to estimate the number of excess deaths due to diabetes.
在德国，与诊断糖尿病相关的全国死亡率数据与许多其他国家一样并不完备。本研究旨在评估德国糖尿病（包括所有类型）和 2 型糖尿病患者的超额死亡绝对人数。
本研究采用流行率法，纳入了德国法定健康保险体系中 2010 年 6490 万人的全国常规数据。由于德国缺乏全国性的糖尿病死亡率数据，本研究使用了丹麦国家糖尿病登记处的死亡率比值。糖尿病相关超额死亡人数的计算方法为：糖尿病死亡人数减去死亡率与非糖尿病人群相当的糖尿病死亡人数。此外，还计算了归因于糖尿病的死亡率人群归因分数。
2010 年，德国共有 174627 例糖尿病死亡，其中 137950 例归因于 2 型糖尿病。总的来说，德国 21%的死亡归因于糖尿病，16%归因于 2 型糖尿病。大多数超额死亡（各占 34%）发生在 70 至 89 岁年龄组。
在德国首次对与糖尿病相关的超额死亡进行全国性计算，结果表明，依赖死亡证明信息的官方德国估计值严重低估了实际情况。没有全国性队列或糖尿病登记处的国家可以轻松使用该方法来估计糖尿病导致的超额死亡人数。
