School of Public Health and Community Medicine (SPHCM), Faculty of Medicine University of New South Wales (UNSW), Sydney, Australia.
Fiji Ministry of Health, Suva, Fiji.
BMC Public Health. 2019 May 2;19(1):481. doi: 10.1186/s12889-019-6748-7.
Many developing countries are experiencing the epidemiological transition, with the majority of deaths attributed to cardiovascular disease, cancer, Type 2 diabetes (T2DM) and others. In some countries, large proportional mortality attributed to diabetes is evident in official mortality statistics, with Mauritius and Fiji rated as the highest in the world.
This study investigates trends in recorded diabetes and cardiovascular disease mortality in Mauritius and Fiji under coding from the International Classification of Diseases (ICD) versions 9 and 10, using mortality data reported from these countries to the World Health Organization (WHO).
In Mauritius over 1981-2004, T2DM proportional mortality varied between 4% and 7% in males (M) and 5% and 9% in females (F). In 2005 there was a sudden increase to M 20% and F 25%, which continued to M 25% and F 30% by 2012. Over 1981-2004 the proportion of circulatory disease mortality rose from 44% to 49% in males, and from 46% to 57% in females. In 2005, circulatory disease mortality proportions fell precipitously to 34% in males and 37% in females, and declined to 31% and 34% by 2013. ICD-10 coding was introduced in 2005. In Fiji, sharp rises in proportional T2DM mortality from 3% in both sexes in 2001 to M 15% and F 20% in 2002 were followed by more gradual trend increases to M 20% and F 26% by 2012-13. Circulatory disease proportions fell steeply from M 57% and F 53% in 2001 to M 44% and M 38% by 2004, with subsequent less steep declines to M 39% and F 30% by 2012. ICD-10 coding was introduced in 2001.
Large, abrupt changes in diabetes and circulatory disease proportional mortality in Fiji and Mauritius coincided with the local introduction of ICD-10 coding in different years. There is also evidence for diabetes-related misclassification of underlying cause of death in Australia and the USA. These artefacts can undermine accurate monitoring of cause of death for evaluation of effectiveness of prevention and control, especially of circulatory disease mortality which is demonstrably reversible in populations.
许多发展中国家正在经历流行病学转变，其中大多数死亡归因于心血管疾病、癌症、2 型糖尿病（T2DM）等。在一些国家，官方死亡率统计数据中明显存在归因于糖尿病的较大比例死亡，毛里求斯和斐济的糖尿病死亡率全球最高。
本研究通过使用这些国家向世界卫生组织（WHO）报告的死亡率数据，根据国际疾病分类（ICD）第 9 版和第 10 版的编码，调查了毛里求斯和斐济在记录的糖尿病和心血管疾病死亡率方面的趋势。
在毛里求斯，1981 年至 2004 年间，男性（M）T2DM 比例死亡率在 4%至 7%之间，女性（F）比例死亡率在 5%至 9%之间。2005 年，M 比例突然增加到 20%，F 比例增加到 25%，到 2012 年 M 比例增加到 25%，F 比例增加到 30%。1981 年至 2004 年间，男性的循环系统疾病死亡率从 44%上升到 49%，女性的循环系统疾病死亡率从 46%上升到 57%。2005 年，男性循环系统疾病死亡率急剧下降至 34%，女性循环系统疾病死亡率下降至 37%，到 2013 年，男性循环系统疾病死亡率下降至 31%，女性循环系统疾病死亡率下降至 34%。ICD-10 编码于 2005 年推出。在斐济，2001 年男女两性的 T2DM 死亡率比例分别从 3%急剧上升到 2002 年的男性 15%和女性 20%，随后逐渐上升到 2012-13 年的男性 20%和女性 26%。2001 年，循环系统疾病的比例从男性 57%和女性 53%急剧下降到 2004 年的男性 44%和女性 38%，随后到 2012 年，男性和女性的下降速度分别放缓至 39%和 30%。ICD-10 编码于 2001 年推出。
在斐济和毛里求斯，糖尿病和循环系统疾病比例死亡率的大幅、突然变化与当地在不同年份引入 ICD-10 编码同时发生。在澳大利亚和美国也有证据表明与糖尿病相关的死因分类错误。这些人为因素会破坏对死亡原因进行准确监测的能力，从而无法对疾病的预防和控制效果进行评估，特别是对人群中可明显逆转的循环系统疾病死亡率。
