Mortality experience of diabetic patients: A twenty-six year follow-up study

Abstract

Mortality over a twenty-six year period was ascertained in a group of 21,447 diabetic patients in the Joslin Clinic in Boston. Analysis was by a comparison of the observed number of deaths with the number expected if the sex- and age-specific rates of the general Massachusetts population over the same period of time applied. Observed deaths from all causes were significantly in excess of the expected number in both sexes and in nearly all age groups throughout the period of study. However, the excess mortality risk was greatest in patients between the ages of thirty and thirty-nine years. Cohort and cross sectional analyses by time period suggest that the survivorship of diabetic patients in relation to that of the general population has not improved during the past three decades. A significant excess risk of death from coronary heart disease was observed in the group. When this disease and diabetes mellitus were eliminated as causes of death, the mortality fell to general population levels. Mortality from respiratory diseases and lung cancer was reduced in the male patients in whom the risk of accidental death was also diminished. By contrast, in the female patients the rate of death due to respiratory tuberculosis and accidents (primarily falls) was excessive. The results of this study are also consistent with previous reports of associations between diabetes and cerebrovascular disease.