Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study

Objectives To establish the age and sex specific mortality for people with diabetes in comparison with local and national background populations; to i nvestigate the relationship between mortality and material deprivation in a n unselected population with diabetes. Design Longitudinal study, using a population based district diabetes regis ter. Setting South Tees, United Kingdom. Participants All people known to have diabetes living in Middlesbrough and Redcar and Cleveland local authorities on 1 January 1994. Main outcome measure Death, from any cause, between 1 January 1994 and 31 D ecember 1999. Results Over the six years of the study 1205 (24.9%) of 4842 participants d ied. All cause standardised mortality ratios for type 1 diabetes were 641 ( 95% confidence interval 406 to 962) in women and 294 (200 to 418) in men, a nd those for type 2 diabetes were 160 (147 to 174) in women and 141 (130 to 152) in men. Cause specific standardised mortality ratios were increased f or ischaemic heart disease, cerebrovascular disease, and renal disease; no reductions in mortality from other causes were seen. The risk of premature death increased significantly with increasing material deprivation (P < 0.0 01). Conclusions Diabetes is associated with excess mortality, even in an area w ith high background death rates from cardiovascular disease. This excess mo rtality is evident in all age groups, most pronounced in young people with type 1 diabetes, and exacerbated by material deprivation. Aggressive approa ches to the management of cardiovascular risk factors could reduce the exce ss mortality in people with diabetes.