Deaths attributable to diabetes in the United States: comparison of data sources and estimation approaches

OBJECTIVE: The goal of this research was to identify the fraction of deaths attributable to diabetes in the United States. RESEARCH DESIGN AND METHODS: We estimated population attributable fractions (PAF) for cohorts aged 30±84 who were surveyed in the National Health Interview Survey (NHIS) between 1997 and 2009 (N = 282,322) and in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2010 (N = 21,814). Cohort members were followed prospectively for mortality through 2011. We identified diabetes status using self-reported diagnoses in both NHIS and NHANES and using HbA1c in NHANES. Hazard ratios associated with diabetes were estimated using Cox model adjusted for age, sex, race/ethnicity, educational attainment, and smoking status. RESULTS: We found a high degree of consistency between data sets and definitions of diabetes in the hazard ratios, estimates of diabetes prevalence, and estimates of the proportion of deaths attributable to diabetes. The proportion of deaths attributable to diabetes was estimated to be 11.5% using self-reports in NHIS, 11.7% using self-reports in NHANES, and 11.8% using HbA1c in NHANES. Among the sub-groups that we examined, the PAF was highest among obese persons at 19.4%. The proportion of deaths in which diabetes was assigned as the underlying cause of death (3.3±3.7%) severely understated the contribution of diabetes to mortality in the United States. CONCLUSIONS: Diabetes may represent a more prominent factor in American mortality than is commonly appreciated, reinforcing the need for robust population-level interventions aimed at diabetes prevention and care

American Longevity: Past, Present, and Future

How long we live, and how long members of our families and social groups live, is extraordinarily important to us. It's not a subject of daily discussion, but it would be if we were threatened with a return to earlier conditions. Unfortunately, the subject of longevity falls between the cracks of academe and has received far less attention than it warrants. We are all aware, at least dimly, that peole are living longer than they used to. The numbers are impressive: at the turn of the century, life expectancy at birth in the United States was 48 years; it's now 76 years. Since life expectancy during the Stone Age was in the range of 20 to 30 years, it is clear that a majority of the cumulative advances have taken place in the short span of the 20th century. Without the improvements during this century, half of us would not e here: a quarter of the present U.S. population would have been born and died, and another quarter would never have been born because of the pre-reproductive death of a mother, grandmother, or great grandmother. In developing countries, nearly all of the improvements in longevity have occurred in this century. How these gains were achieved has important implications for public policy; how large future gains will be is the single most important area of uncertainty affecting the fiscal viability of our "old age welfare state." These are the two related issues that I focus on in this policy brief.

Cohort fertility patterns and breast cancer mortality among U.S. women, 1948-2003

Epidemiological research has shown that women who have early and numerous births have reduced risks of being diagnosed with breast cancer. We use U.S. Vital Statistics and Census data and age-period-cohort models to examine whether cohort fertility patterns are associated with breast cancer mortality rates among women aged 40 and older in 1948-2003. Cohorts marked by higher proportions childless at ages 15-24 and lower cumulative second birth rates at ages 15-29 have higher rates of breast cancer mortality. This is the first demonstration that cohort fertility patterns have left a clear imprint on trends in U.S. breast cancer mortality rates.age-period-cohort, breast cancer mortality, cohort fertility