Mortality and its predictors in people with diabetes in managed care.
Mattei, Laura Nicole
2005
Abstract
<italic>Objective</italic>. The goals of this dissertation were to describe the frequency of reporting diabetes on death certificates of decedents with known diabetes, to determine the factors associated with more complete reporting of diabetes, and describe demographic, socioeconomic, biological, and health-related quality of life predictors of all-cause, cardiovascular, and noncardiovascular mortality in diabetic patients in managed care. <italic>Methods</italic>. Survey, medical record, and administrative data were obtained from 11,927 diabetic participants in Translating Research Into Action for Diabetes, a multicenter prospective observational study of diabetes care in managed care. Data on deaths (n=540) and cause of death (categorized as due to cardiovascular and noncardiovascular causes) were obtained from the National Death Index. Predictors examined included age, gender, race, education, income, age at diagnosis, duration, type and treatment of diabetes, body mass index, glycosolated hemoglobin, blood pressure, low density lipoprotein cholesterol, smoking, microvascular and macrovascular complications, number of comorbidities, the individual components of EQ-5D, the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Medical Outcomes Study Short Form, and self-rated health. <italic>Results</italic>. Diabetes was recorded on 39% of death certificates and as the underlying cause of death for 10% of decedents with diabetes. Predictors of recording diabetes anywhere on the death certificate included longer duration of diabetes and insulin treatment. When examining mortality in persons with diabetes, all-cause mortality was associated with older age, male gender, lower income, smoking, history of macrovascular disease, nephropathy, greater number of comorbidities, problems with mobility, and problems with usual activities. History of macrovascular disease and problems with mobility were significant predictors of cardiovascular but not noncardiovascular mortality. <italic>Conclusions</italic>. Death certificates underestimate mortality among persons with diabetes and present a biased picture of the causes of death among people with diabetes. Mortality is associated with smoking, microvascular and macrovascular complications, and comorbidities. It is likely that chronic complications of diabetes also contribute to a low health-related quality of life and mortality. In managed care enrollees with diabetes, treatment reduces the association between cardiovascular risk factors and mortality, but it does not eliminate the association between mortality and biological and non-biological risk factors such as income.Subjects
Death Certificates Diabetes Managed Care Mortality People Predictors
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