Background: Little is known about the magnitude of excess mortality due to diabetes in low and middle income countries. Brazilian data to that end have been limited by reliance on death certificates and their subjective assignment of diabetes as a cause of death. We provide estimates of excess mortality due to diabetes by combining mortality risks from the ELSA-Brasil cohort with nationally representative surveys and databases.
Methods: We calculated the standardized mortality rate ratio for those with (vs. without) self-reported diabetes in ELSA-Brasil by Poisson regression adjusting for age, sex, race and education. We obtained similarly adjusted, self-reported diabetes prevalence from the 2013 National Health Survey. Mortality and population projections were from national statistics. We combined these data to model the excess deaths due to diabetes.
Results: In 2013, among adults with diabetes aged 35 to 74 (table), 73,092 deaths (13% of total) could have been avoided if the mortality rate in people with diabetes were the same as in those without diabetes. The percent ranged from 5.9% in persons aged 35-49 to more than 16% in those 60 or older. In the national mortality system, only 31,117 deaths had diabetes as a main cause.
Age GroupStandardized Mortality Rate Ratio Population NTotal Deaths NDeaths among People with Diabetes NExcess Deaths Associated with Self-Reported Diabetes With diabetesWithout diabetes Assuming diabetes mortality rateAssuming non-diabetes mortality rateExcess deaths among people with diabetes N% of total deaths35-492.40 (1.13 - 5.08)746,790 (3.7 %)19,538,124 (96.3%)120,20011,7224,6777,0455.950-591.94 (1.24 - 3.04)992,878 (10.2%)8,781,526 (79.8%)140,57730,86012,91417,94612.860-691.93 (1.35 - 2.74)941,815 (16.3%)4,853,378 (83.7%)182,45055,78725,15930,62816.870-741.58 (0.94 - 2.66)338,769 (20.3%)1,333,776 (79.7%)106,63735,53518,06217,47316.4Total1.91 (1.51 - 2.41)3,020,252 (8.1%)34,506,804 (92.9%)549,864133,90460,81273,09213.3
Conclusion: This calculation of excess deaths related to known diabetes in Brazil suggests a major diabetes mortality burden, which is considerably underestimated by calculations based only on death certificates.
P. Bracco: None. E.W. Gregg: None. D.B. Rolka: None. M.I. Schmidt: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company. S. Barreto: None. P.A. Lotufo: Consultant; Self; AbbVie Inc.. E.C. Melo: None. B.B. Duncan: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company.