HIGH MORTALITY FROM RENAL-DISEASE AND INFECTION IN ABORIGINAL CENTRALAUSTRALIANS WITH DIABETES

Few studies have examined the consequences of the high prevalence of d iabetes in Aboriginal communities. We aimed to determine the rates and causes of mortality in all Aboriginal central Australians with diagno sed diabetes, identified by a previous study (n = 374). Cohort members were followed from 1 January 1984, or the date of diagnosis (to 31 De cember 1986), to 31 December 1991 of death. Death certificates, medica l notes and autopsy reports were examined for cause of death. There we re 130 deaths in 2280.7 person-years of follow-up. Standardised mortal ity ratios for Aboriginal people with diabetes, compared to the Northe rn Territory Aboriginal population, were 209 (95 per cent confidence i nterval (CI) 158 to 273) for men and 169 (CI 129 to 218) for women. Th e difference in ratios for men and women was not statistically signifi cant when adjusted for age (P = 0.2). The eight-year survival rates fo r men and women diagnosed between 1984 and 1986 were 55.8 per cent (CI 32.6 to 73.7) for men and 80.3 per cent (CI 64.8 to 89.5) for women. Renal disease was the direct cause of death in 22.3 per cent. Infectio n accounted for 20.8 per cent of deaths and ischaemic heart disease fo r 13.8 per cent Forty-four per cent of death certificates made no ment ion of diabetes. Diabetes confers an additional risk of death on a pop ulation whose mortality is already markedly worse than that of other A ustralians. Unlike Western diabetic populations, infections and renal disease were more common causes of death than macrovascular disease. D iabetes amplifies the effect of the community prevalence of infection and renal disease.