Trend of diabetes mellitus related mortality in Tianjin, China, 1999-2014

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Objective To explore the trends of mortality from causes of death related to diabetes mellitus (DM) in Tianjin, and provide basis for prevention and control of DM. Methods All the death certificates data mentioning DM in 1999-2014 were from Tianjin population based mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention, the mortality rates from causes of death related to DM and the proportion from DM specified complications were analyzed, permanent residents' population data was from Tianjin Municipal Public Security Bureau. Standardized mortality rates were calculated for DM related death, adjusted for age and gender using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend were used to determine the statistical significance of differences in mortality trends. Results The proportions of specified complications including ketoacidosis, coma, renal complications, retinopathy, peripheral circulatory and multiple complications increased dramatically which collectively accounted for over 46.82% in the underlying death cause of DM. Mortality rates from causes of death related to DM in Tianjin was observed from year 1999 to 2014 with the crude mortality rate of 13.53/100 000 to 26.21/100 000[Z=29.21, P<0.001, annual percent change (APC)=3.72%], and with the standardized mortality rate of 12.48/100 000 to 15.08/100 000 (Z=3.74, P<0.001, APC=0.56%). The crude mortality rate of male was lower than that of female. The standardized mortality rate increased in male but flatted in female. With the increase of age, the mortality increased gradually. The distributions of DM mortality in urban and rural were different. The mortality rate was higher for people of living in the urban with the standardized mortality rate of 16.38/100 000 to 16.98/100 000 (Z=-1.53, P=0.125, APC=-0.25%) than that in the rural with the standardized mortality rate of 7.19/100 000 to 12.05/100 000 (Z=9.35, P<0.001, APC=2.17%) during this study period. Conclusions The general mortality of DM related death and the proportions of DM complications had increased since the period 1999-2014. The people of elder, female and in urban areas had higher mortality rates. The people of male and in rural areas had mortality in a rising state. Therefore further efforts is needed to prevention and control of DM and to reduce DM related death in Tianjin. Key words: Diabetes mellitus; Mortality rate; Surveillance; Epidemiology