RECENT TRENDS IN DIABETES MORTALITY IN ENGLAND AND WALES

Trends in diabetes-related mortality in England and Wales between 1975-6 and 1985-6, and regional and ethnic differences in diabetes-related mortality in 1985-6, have been examined. Data from death certificates mentioning diabetes in 1975-6 were compared with those for 1985-6 for different age groups. Data for 1985-6 were also analysed for different regions of England and Wales, and for country of birth. Between 1975-6 and 1985-6, the age-standardized rate of mentioning diabetes rose by 2.7% (95% confidence interval 1.4%, 4.1%) in men of all ages, and fell by 11.7% (10.6, 12.8) in women of all ages. By contrast, the rate of mentioning diabetes in those below 45 years fell by 30.7% (23.0, 37.7) in men and by 26.7% (16.5, 35.6) in women. Deaths in which the underlying cause was ischaemic heart disease (IHD), and where diabetes was also mentioned on the death certificate, rose by 14.4% (11.5, 16.8) in men and did not change significantly in women of all ages, but fell by 18.4 % (-35.1, +2.6) in men, and 23.5% (-49.1, +15.2) in women below age 45. This was less favourable than the trend in the general population, where IHD mortality fell by 9.7% in men and 8.3% in women of all ages, and by 31.1% (28.6, 33.5) in men and 40.5% (35.0, 45.5) in women under 45 years. The age-standardized rate of mentioning diabetes in 1985-6 was 2.6 (2.4, 2.9) times higher in men and 2.5 (2.3, 2.8) times higher in women of all ages born in Africa or the Caribbean, compared with those born in the UK. The corresponding ratios for men and women born in the Indian subcontinent were 3.0 (2.8, 3.2) and 2.7 (2.5, 2.9). The ratios were also raised in persons below 45 years born in Africa or the Caribbean (1.6 for men plus women) or in the Indian subcontinent (1.6), but the increase was not significant. In conclusion, the reduction between 1975-6 and 1985-6 in the rate of mentioning diabetes in men and women dying before the age of 45 is substantial and encouraging, since other evidence suggests that the incidence of insulin-dependent diabetes in England and Wales has increased over the past few decades. Trends in ischaemic heart disease mortality in association with diabetes are less optimistic.