Mortality and causes of death in the WHO multinational study of vascular disease in diabetes

Aims/hypothesis. We aimed to examine the mortality rates, excess mortality and causes of death in diabetic patients from ten centres throughout the wo rld. Methods. A mortality follow-up of 4713 WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD) participants from ten centres was carried o ut, causes of death were ascertained and age-adjusted mortality rates were calculated by centre, sex and type of diabetes. Excess mortality, compared with the background population, was assessed in terms of standardised morta lity ratios (SMRs) for each of the 10 cohorts. Results. Cardiovascular disease was the most common underlying cause of dea th, accounting for 44% of deaths in Type I (insulin-dependent) diabetes mel litus and 52% of deaths in Type II (non-insulin-dependent) diabetes mellitu s. Renal disease accounted for 21% of deaths in Type I diabetes and 11% in Type II diabetes. For Type I diabetes, all-cause mortality rates were highe st in Berlin men and Warsaw women, and lowest in London men and Zagreb wome n. For Type II diabetes, rates were highest in Warsaw men and Oklahoma wome n and lowest in Tokyo men and women. Age adjusted mortality rates and SMRs were generally higher in patients with Type I diabetes compared with those with Type II diabetes. Men and women in the Tokyo cohort had a very low exc ess mortality when compared with the background population. Conclusion/interpretation. This study confirms the importance of cardiovasc ular disease as the major cause of death in people with both types of diabe tes. The low excess mortality in the Japanese cohort could have implication s for the possible reduction of the burden of mortality associated with dia betes in other parts of the world.