Fall in population-based mortality from coronary heart disease negated in people with diabetes mellitus: Data from England
Ecclestone TC., Yeates DGR., Goldacre MJ.
© 2015 Diabetes UK. Aims: Mortality rates for coronary heart disease (CHD) have declined substantially in developed countries. Diabetes mellitus is an important risk factor for CHD; its prevalence is increasing. We aimed to compare trends in population-based mortality for CHD without diabetes on the death certificate with trends for CHD with diabetes on the same certificate. Methods: Analysis of an all-England dataset with multiple-cause coded mortality records from 1995 to 2010. Analysis of a similar dataset for Oxford, because it has the longest run of multiple-cause coded mortality in England, from 1979. Age-specific and age-standardized mortality rates were calculated. Results: In the all-England dataset, there were 1 772 760 deaths with CHD and no mention of diabetes; and 173 184 deaths with CHD and diabetes on the same death certificate. Of deaths with CHD without a mention of diabetes, rates per million men fell by more than half from 2843 (95% confidence interval: 2822-2862) in 1995 to 1379 (1366-1391) in 2010; and those in women halved from 1324 (1314-1336) to 628 (621-635). Of deaths with CHD and diabetes, rates per million men increased from 194 (188-200) to 215 (210-220); and those for women fell, but only very slightly, from 114 (111-118) to 101 (98-104). The longer run in Oxford, from 1979, showed that rates in men and women without diabetes had fallen by two-thirds; but that rates for CHD with diabetes had not fallen. Conclusions: The fall in mortality from CHD without diabetes has been spectacular. There has been no comparable fall in mortality from CHD with diabetes. What's new?: Trends in population-based mortality for coronary heart disease (CHD) without diabetes on the same death certificate were compared with trends for CHD with diabetes on the same certificate, from 1979 to 2010. The fall in mortality from CHD without diabetes was very substantial; but there was no fall in mortality from CHD with diabetes. Investigation is needed into whether this simply reflects an increase in diabetes; whether people with diabetes have not benefited, as others have, from changes in other risk factors for CHD or from treatments for CHD; or whether the findings result from a combination of these.