Scientific Data Documentation
Diabetes Supplement, 1991
ABSTRACT
General Information
Diabetes Surveillance, 1991
The Division of Diabetes Translation
National Center for Chronic Disease Prevention and Health Promotion
Acknowledgments
Editor:
Linda S. Geiss
Contributors:
Frank DeStefano, Barbara L. Dougherty, Mark S. Eberhardt, Earl S. Ford,
Robert R. German, William H. Herman, Merilyn G. Goldschmid,, Jeffrey M.
Newman, David R. Olson, Todd W. Pierce, Stephen J. Sepe, John M. Stevenson,
Frank Vinicor, Scott F. Wetterhall, Julie C. Will
Secretarial support:
Myra A. Montalbano
Description
Public health surveillance is the ongoing and systematic collection,
analysis, and dissemination of health data for public health action.
Surveillance data are important for formulating policy, identifying high-risk
groups, targeting interventions, and evaluating progress in disease prevention
and control. Diabetes mellitus is a major cause of morbidity and premature
mortality in the United States, and surveillance is essential for developing
and evaluating public health strategies to reduce the burden associated with
diabetes and for monitoring progress toward the national health objectives for
the year 2000.
In 1990, the Division of Diabetes Translation (DDT), National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control,
established a framework for an ongoing surveillance system to compile national
data on diabetes and its complications. In establishing this framework, DDT
identified and evaluated data sources providing periodic and representative
data on the disease burden associated with diabetes and its complications in
the United States. These data sources, which included vital statistics, the
National Health Interview Survey, the National Hospital Discharge Survey, and
Medicare claims data for end-stage renal disease, were analyzed to estimate
diabetes prevalence and incidence, mortality, hospitalization, cardiovascular
disease, lower extremity amputation, diabetic ketoacidosis, and end-stage
renal disease. The results of these analyses were reported in Chapters 2
through 8 of DDT's first surveillance report, Diabetes Surveillance,
1980-1987.
The current report reprints Chapters 2 through 8 from the first report.
These chapters describe methods and operational definitions and discuss the
implications of the findings. The update sections of each chapter briefly
highlights and, in some cases, slightly modifies these findings in light of
one additional year of hospitalization data, two additional years of
mortality, prevalence, and incidence data, and three additional years of
Medicare data on end-stage renal disease. In addition, Medicare data on end-
stage renal disease for years 1980-1986 have been updated. The 1991 report
also contains a new chapter,"Disability," which addresses that important
aspect of the disease burden of diabetes.
We evaluated temporal trends by age, sex, and race. For most topics, we
could only evaluate race-specific results for whites and blacks because racial
designation for other groups was not adequate or because the number of persons
in the sample was not sufficient to calculate stable estimates. Where
possible, we provide data by region of the country or state. Regional
estimates are classified according to the four major Bureau of the Census
regions (Figure 1.1). State-specific data could only be obtained for
mortality and end-stage renal disease. Since we generally limit the
presentation of detailed results to specific subgroups for which we are able
to obtain relatively stable estimates, the extent of subgroup information
varies by data source.
This report contains a section of detailed data tables upon which we
base discussions of the disease burden of diabetes. In these detailed tables,
totals may not equal the sum of the individual cell counts because of
unknowns, rounding, or the presentation of race-specific results for whites
and blacks only.
In most instances, we calculated rates based on two different
denominators. First, rates were calculated using the resident population of
the United States as the denominator. These general population rates indicate
the disease burden of diabetes in the U.S. population and are useful for
comparison with the disease burden of other diseases and conditions. The
general population rates are also useful for assessing the prevalence of
diabetes and its complications and for estimating health care needs. Second,
we calculated rates using estimates of the number of persons known to have
diabetes in the United States as the denominator. These diabetic population
rates are affected by differences in diabetes prevalence among different age,
sex, or race groups and indicate the risk of various complications among
persons with diabetes. They are useful for comparing complication rates among
subgroups of people with diabetes.
In several analyses, we standardized the results. For rates based on
the general population denominators, we standardized the rates to the 1980
resident population of the United States (Tables 1.1-1.7). For rates based on
diabetic population denominators, we standardized rates to estimates of the
1980 population of persons with diabetes in the United States (Table 2.1).
We were not able to distinguish persons with insulin-dependent diabetes
mellitus (IDDM, or Type I diabetes) from those with non-insulin-dependent
diabetes mellitus (NIDDM, or Type II diabetes) in any of the analyses.
Because NIDDM is much more common after 45 years of age and because it
accounts for 90% or more of patients with diabetes in the United States, the
results presented for persons aged 45 and older pertain mostly to NIDDM.
We are aware that each of the data sources used has limitations. These
limitations are discussed within each chapter. The analysis of surveillance
data can indicate general trends and differences between groups, but usually
the information available is not sufficient to provide reasons for observed
differences and trends. Identifying differences and trends, however, can be
useful in pointing out areas and raising questions for more specific and
rigorous research. We believe the data we have used are adequate for public
health surveillance. They should be useful for formulating public health
strategies to decrease disease burden related to diabetes and for monitoring
progress toward this goal.
PREVALENCE AND INCIDENCE
Introduction
We present data on the prevalence and incidence of diabetes in
the United States during 1980-1987. The data are limited to those
persons who were diagnosed and were aware they had diabetes. Prevalence
is the total number of persons known to have diabetes at a particular
point in time, whereas incidence is the number of persons who discovered
they had diabetes for the first time during the preceding year. Incidence,
in general, is a more sensitive indicator of trends related to the
etiology of diabetes. Prevalence, on the other hand, is a measure
of the disease burden of diabetes, which is useful for public health
planning purposes.
We present results by calendar year, age, sex, race, and geographic
region. The estimated number of persons with diabetes presented here
will be used in subsequent chapters to calculate mortality and morbidity
rates among persons with the disease.
Methods
Incidence and prevalence of self-reported diabetes were determined
from the 1980-1987 National Health Interview Surveys (NHIS).
The NHIS is a national health survey which has been continuously conducted
since 1957. Approximately 800 households are surveyed each week,
totaling about 130,000 persons interviewed each year. Each person
interviewed represents approximately 1,800 persons within the United
States.
The NHIS is designed as a multistage cluster sample survey. Households
are selected to represent a small geographic unit, such as a county,
a small group of contiguous counties, or a standard metropolitan statistical
area. When information gathered from these households is combined,
the health status of the civilian, non-institutionalized population
in four U.S. Bureau of the Census regions can be analyzed: Northeast,
North Central, South, and West. State-level data are not available
from the NHIS.
The NHIS questionnaire consists of two basic parts: core and supplements.
The core interview is administered each year, and the supplements
can change each year. Chronic disease questions, including questions
about diabetes, are included on condition lists which are administered
as part of the core questionnaire. A one-third sample of respondents
in 1980 and 1981 were asked questions about diabetes as were a one-sixth
sample of the respondents during 1982-1987. The condition list for
diabetes asks the following questions: 1) "During the past 12
months, did anyone in the family have diabetes?" 2) "Who was
this?" and 3) "During the past 12 months, did anyone else
have diabetes?" If a person in the household has diabetes, when
the person was diagnosed is ascertained.
In 1987, more than 20,000 persons were asked to respond to the question
regarding diabetes in their family. For each year of data analyzed,
diabetes prevalence was determined by counting the number of persons
in a household with diabetes and projecting the number to reflect
either a regional or national estimate. Diabetes incidence was calculated
by counting only those persons who reportedly discovered their diabetes
during the past 12 months.
We calculated incidence and prevalence rates and their relative standard
errors using the SESUDAAN computer software package (Shah, 1981). In
calculating annual incidence and regional prevalence rates, we found
it necessary to pool three years of data to develop precise estimates.
These estimates were obtained by using three-year moving averages.
To interpret yearly trends, we age-adjusted the prevalence and incidence
rates to remove any influence of a changing age structure of the population.
The age-adjusted diabetes prevalence and incidence rates were calculated
by direct standardization (Fleiss, 1981) using the 1980 U.S. resident
population as the standard.
Results
Prevalence
In 1987, 6.8 million persons in the United States were known
to have diabetes (Table 2.1). From 1980 to 1987, the number
of persons with diabetes increased by more than one million (Figure
2.1). Population subgroups with the greatest relative increases between
1980 and 1987 in the number of persons diagnosed with diabetes were
the following: 1) those persons younger than age 45 years (35% increase);
2) those aged 75 years and older (39% increase); 3) white males (33%
increase); and 4) black females (24% increase) (Tables 2.1-2.5). The
large increase among white males was attributable to almost a doubling
of diagnosed diabetes among the youngest age group (less
than 45 years). Meanwhile, the large increase among black females
was from a doubling of diagnosed diabetes in the 75 years and older
age group. Although the numbers fluctuated from year to year, the
overall trend in the various groups was toward an increased number
of persons diagnosed with diabetes.
From 1980 to 1987, the prevalence rate of diabetes in the United States
increased (Figure 2.2, Table 2.1). The increase cannot be attributed
to differences in age structure of the population from year to year.
The age-adjusted prevalence rate was stable from 1980-1982, dipped
slightly in 1983, and then increased steadily up to 1986. Trends in
prevalence rates were similar to the trends noted among numbers of
persons with diabetes. Black females and white males had the largest
increases in diabetes prevalence rates (Figure 2.3, Tables 2.2-2.5).
These increases resulted from the large increases in diagnosed diabetes
among young white males and older black females. In general, the prevalence
rate of diabetes increased with increasing age (Tables 2.1-2.5). In
1987, black females had the highest age-specific rates, and about
one in four black women 75 years or older had diabetes (Figure 2.4).
In 1987, the North Central region had the lowest age-adjusted prevalence
rate of the four regions (Table 2.6). From 1980 to 1987, the prevalence
rate increased in all regions except the North Central (Figure 2.5).
The greatest overall increases in the prevalence rate occurred in
the Northeast and West (17%-18%).
We present average prevalence rates during 1980-1987 by race, sex,
and age for the different regions (Tables 2.7-2.10). The highest age-adjusted
prevalence rates among white males occurred in the Northeast region
(Table 2.7). This resulted from high rates among men aged 65 years
and older. Among white females, the highest age-adjusted rate occurred
in the South (Table 2.8). This increase occurred because of higher
rates among women less than age 65 years. For black males, the highest
diabetes rates occurred in the West--the rates were especially
high among black men 45 through 74 years old (Table 2.9). The second
highest age-adjusted rate for black males occurred in the Northeast
region as a result of high rates in persons aged 65 years and older. Among
black females, the highest rates occurred in the North Central and
South regions (Table 2.10). The South had prevalence rates of approximately
200 per 1,000 black women aged 65 years and older.
Incidence
We present the incidence rates of diabetes for various population subgroups
(Tables 2.11-2.15). The rate of new diabetes cases in the total population
increased from 1980 to 1983 and then leveled off (Figure 2.6). Among white
females the incidence rate increased during 1980-1987, whereas among white
males the rate decreased (Figure 2.7). We did not conduct separate analyses
of black males and females because sample sizes were too small.
The lowest age-specific incidence rates in all years occurred among
persons aged 0-44 years (Table 2.11). In 1986 and 1987, the incidence
rate was highest among those 65 years or older, whereas in previous
years the incidence rate among 45- to 64-year-old persons was similar
to or higher than the rate among persons aged 65 years and older. There
was no definite temporal trend apparent for persons less than 65 years
old. Among those persons 65 years old and older, however, the incidence
rate tended to increase, from slightly more than 5.6 per 1,000 in
the early 1980s to more than 8 per 1,000 in 1986 and 1987. The increasing
incidence rate in the oldest age group was most evident in females,
among whom the rate increased from 6.3 per 1,000 in 1980 to 10.6 per
1,000 in 1987 (Table 2.13).
Discussion
During 1980-1987, the number of persons known to have diabetes
increased by more than 1 million, such that by 1987 nearly
7 million persons in the United States knew that they had diabetes.
This increase was related to both growth in the United States population
and an increase in the prevalence rate of diabetes. The prevalence
rate of diabetes has been increasing since 1959, but the rate of increase
appears to be leveling off. Prevalence rates estimated from NHIS data
from 1959 to 1987 have shown the following increases: 1) 67% from
1959 to 1966; 2) 41% from 1966 to 1973; 3) 21% from 1973 to 1980;
and 4) 9% from 1980 to 1987.
During 1980-1987, diabetes prevalence rates were higher among blacks than
whites. Black males had a rate 1.4 times higher than white males--black
females had a rate approximately two times higher than white females.
Black women aged 75 years and older had the highest rate, with almost
one in four having diabetes. We could not estimate incidence rates
for blacks and other minorities because the sample sizes were too
small to provide precise estimates.
Overall, the South had the highest diabetes prevalence rate and the
highest rate among women. Black males had the highest rate in the
West and in the Northeast.
Because prevalence is influenced by both disease incidence and duration
(i.e., mortality rates), we have noted only small changes in the prevalence
rate. Our results suggest an increase in diabetes incidence in the
early 1980s with a leveling off after 1983. Mortality rates among
persons with diabetes decreased slightly during 1980-1987 (Chapter 3).
Relying on self-report for estimating incidence and prevalence of
diabetes has two potential drawbacks: 1) inaccurate reporting of disease
status; and 2) incomplete disease ascertainment. Recent research
indicates excellent agreement between self-report and medical records
concerning a person's diabetes status (Bush et al., 1989). Thus, self-report
adequately estimates the incidence and prevalence of diagnosed diabetes. A
substantial number of persons with diabetes, however, are not diagnosed.
According to the second National Health and Nutrition Examination
Survey (NHANES II), about half of the persons with diabetes have not
been diagnosed (Harris et al., 1987). Thus, the NHIS undoubtedly
underestimates the true prevalence of diabetes.
For surveillance of temporal trends, diabetes cases not diagnosed
would not be an impediment if the degree of underascertainment were
constant over time and similar among different population groups.
From NHANES II, the proportion of persons with undiagnosed diabetes
was similar among males and females and among blacks and whites (Harris
et al., 1987). Thus, differences among race and sex groups we have
noted probably do not result from differences in disease ascertainment.
We do not suspect that diabetes ascertainment changed from 1980 to 1987,
but we cannot be certain until NHANES III, currently being conducted,
is completed.
Unstandardized diagnostic techniques and criteria also can cause the
rate of diabetes to fluctuate (West, 1978). Because diagnostic criteria
for diabetes have been standardized since 1979 (National Diabetes
Data Group, 1979), we believe that changing diagnostic criteria have
had very little impact on diabetes trends during 1980-1987.
Random variation may have influenced our results, but we have tried
to minimize the impact by presenting results that have less than 30%
relative standard errors. Thus, we restricted race-specific incidence
results to whites and used wide age groupings for all age-specific
results.
Data from NHIS indicate that the number of persons with diabetes
is increasing, that blacks have higher prevalence rates than whites,
and that the incidence rate is highest among women older than 64 years
and is increasing in this group. As the population ages, we can expect
that the number of persons with diabetes will continue to grow unless
effective strategies are identified to prevent its occurrence.
Update
This section updates data presented in previous sections in light of two
additional years of prevalence and incidence data. For a complete description
of the methods and operational definitions and for a discussion of the
implications of the findings, see previous sections.
Prevalence
In 1989, about 6.7 million persons in the United States (2.7% of the
population) reported that they had diabetes (Table 2.1). Although the
prevalence of diabetes has increased since 1959, the overall rate of increase
has slowed and leveled off. Diabetes prevalence as estimated from National
Health Interview Survey (NHIS) data has increased as follows: 1) 67% increase
from 1959 to 1966; 2) 41% increase from 1966 to 1973; 3) 21% increase from
1973 to 1980; and 4) 4% increase from 1980 to 1989.
During the 1980s, diabetes prevalence was higher among blacks than
whites (Figure 1.2, Tables 2.2-2.5). Black females aged 65 years and older
had the highest rates. Black males were the only race-sex group to show a
marked increase in prevalence during the 1980s, increasing 28% between 1980
and 1989.
Incidence
In 1989, there were 677,000 new cases of diabetes (Table 2.11). The
rate of new diabetes cases (i.e., diabetes incidence) increased in the early
1980s and then leveled off (Figure 1.3). The lowest age-specific incidence
rates occurred among persons younger than age 45. Throughout the 1980s, white
females had higher incidence rates than white males (Tables 2.14-2.15).
Incidence rates for black males and black females could not be examined
because of small sample sizes.
Detailed Tables
1.1-1.7 Resident Population by Age and Year, U.S., 80-89
1.1 Age and Year
Table 1.1 Resident Population (a), by Age and Year, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-4 16457 16931 17297 17651 17830 18004
5-9 16608 16094 16022 16149 16467 16826
10-14 18236 18314 18172 17913 17511 17101
15-19 21104 20503 19889 19277 18789 18555
20-24 21379 21614 21587 21487 21325 20993
25-29 19697 20202 20756 21205 21540 21764
30-34 17753 18787 18809 19213 19698 20271
35-39 14080 14379 15597 16161 16929 17706
40-44 11725 12019 12449 13134 13614 14057
45-49 11048 10991 11026 11228 11461 11646
50-54 11698 11614 11452 11207 11026 10936
55-59 11615 11577 11508 11524 11439 11336
60-64 10145 10372 10596 10695 10859 10980
65-69 8812 8917 9038 9181 9285 9432
70-74 6840 6996 7157 7310 7449 7573
75-79 4827 4951 5085 5223 5360 5499
80-84 2953 3017 3091 3166 3244 3330
85+ 2269 2353 2449 2538 2623 2694
Total 227247 229630 231981 234260 236448 238703
(a) In thousands.
Table 1.1 Resident Population (a), by Age and Year, United States, 1986-1989
Year
1986 1987 1988 1989
Age
0-4 18157 18279 18459 18754
5-9 17300 17667 18034 18212
10-14 16567 16487 16630 16951
15-19 18616 18465 18222 17813
20-24 20407 19785 19178 18702
25-29 22013 21986 21886 21699
30-34 20778 21337 21804 22136
35-39 18723 18737 19142 19622
40-44 14351 15572 16129 16883
45-49 11927 12351 13030 13522
50-54 10882 10920 11131 11374
55-59 11267 11120 10892 10725
60-64 10947 10881 10918 10865
65-69 9661 9885 9992 10170
70-74 7670 7776 7901 8011
75-79 5635 5772 5898 6031
80-84 3418 3517 3615 3727
85+ 2776 2863 2947 3041
Total 241096 243400 245807 248239
(a) In thousands.
1.2 Age and Year, White Males
Table 1.2 Resident Population (a) of White Males, by Age and Year,
United States, 1980-85
Year
1980 1981 1982 1983 1984 1985
Age
0-4 6923 7104 7238 7370 7434 7496
5-9 6987 6742 6699 6747 6863 6990
10-14 7725 7740 7649 7504 7305 7099
15-19 8971 8663 8364 8081 7849 7746
20-24 9127 9204 9157 9084 8991 8807
25-29 8441 8646 8863 9046 9175 9253
30-34 7650 8077 8044 8199 8399 8639
35-39 6065 6191 6744 6970 7285 7607
40-44 5016 5137 5318 5628 5836 6025
45-49 4736 4702 4708 4788 4882 4948
50-54 5011 4972 4895 4775 4686 4634
55-59 4923 4886 4840 4848 4811 4771
60-64 4247 4349 4446 4474 4536 4576
65-69 3531 3578 3634 3704 3753 3823
70-74 2595 2658 2723 2789 2849 2904
75-79 1680 1724 1771 1822 1874 1927
80-84 937 956 978 1000 1023 1049
85+ 626 638 654 668 682 692
Total 95191 95966 96725 97498 98231 98986
(a) In thousands.
Table 1.2 Resident Population (a) of White Males, by Age and Year,
United States, 1986-89
Year
1986 1987 1988 1989
Age
0-4 7541 7573 7634 7716
5-9 7173 7308 7443 7504
10-14 6849 6804 6857 6973
15-19 7757 7664 7527 7327
20-24 8523 8228 7944 7731
25-29 9349 9314 9239 9142
30-34 8850 9074 9261 9385
35-39 8029 7993 8146 8342
40-44 6147 6699 6920 7229
45-49 5062 5241 5546 5758
50-54 4600 4610 4695 4791
55-59 4740 4673 4561 4480
60-64 4540 4499 4517 4498
65-69 3928 4026 4058 4130
70-74 2949 3001 3064 3120
75-79 1980 2036 2088 2147
80-84 1077 1112 1147 1189
85+ 706 722 739 761
Total 99802 100579 101387 102224
(a) In thousands.
1.3 Age and Year, White Females
Table 1.3 Resident Population (a) of White Females, by Age and Year,
United States, 1980-85
Year
1980 1981 1982 1983 1984 1985
Age
0-4 6571 6744 6876 7000 7061 7119
5-9 6635 6403 6355 6397 6508 6633
10-14 7360 7366 7271 7130 6932 6727
15-19 8634 8345 8063 7779 7558 7445
20-24 8985 9056 9026 8956 8860 8694
25-29 8357 8536 8734 8892 9003 9074
30-34 7663 8063 8008 8140 8313 8526
35-39 6153 6275 6814 7032 7332 7634
40-44 5140 5258 5441 5748 5958 6145
45-49 4913 4866 4864 4942 5033 5098
50-54 5332 5269 5168 5031 4926 4871
55-59 5464 5433 5383 5369 5301 5218
60-64 4882 4974 5065 5096 5162 5209
65-69 4387 4425 4473 4529 4564 4616
70-74 3595 3667 3738 3805 3865 3916
75-79 2700 2766 2837 2908 2977 3044
80-84 1784 1822 1864 1908 1954 2003
85+ 1461 1524 1594 1657 1717 1768
Total 100017 100792 101572 102317 103023 103741
(a) In thousands.
Table 1.3 Resident Population (a) of White Females, by Age and Year,
United States, 1986-89
Year
1986 1987 1988 1989
Age
0-4 7164 7194 7252 7335
5-9 6807 6938 7067 7124
10-14 6491 6442 6489 6601
15-19 7448 7349 7214 7015
20-24 8410 8125 7849 7628
25-29 9155 9127 9064 8960
30-34 8706 8907 9074 9182
35-39 8031 7975 8111 8283
40-44 6267 6811 7026 7321
45-49 5211 5391 5697 5915
50-54 4824 4823 4903 4998
55-59 5159 5062 4930 4830
60-64 5180 5129 5122 5071
65-69 4706 4796 4830 4899
70-74 3949 3990 4036 4074
75-79 3109 3171 3225 3282
80-84 2054 2109 2161 2220
85+ 1825 1884 1940 2000
Total 104497 105224 105990 106737
(a) In thousands.
1.4 Age and Year, Black Males
Table 1.4 Resident Population (a) of Black Males, by Age and Year,
United States, 1980-85
Year
1980 1981 1982 1983 1984 1985
Age
0-4 1248 1287 1313 1342 1351 1362
5-9 1263 1234 1235 1245 1277 1314
10-14 1350 1362 1367 1367 1356 1347
15-19 1503 1491 1467 1439 1412 1392
20-24 1317 1340 1350 1363 1370 1371
25-29 1106 1149 1201 1242 1277 1302
30-34 891 963 999 1036 1076 1119
35-39 671 682 721 757 809 861
40-44 572 585 604 623 638 653
45-49 519 522 527 538 550 563
50-54 508 510 511 512 513 514
55-59 470 478 486 491 496 500
60-64 389 398 408 420 430 439
65-69 334 338 342 347 353 361
70-74 236 241 246 251 255 259
75-79 154 158 162 165 169 172
80-84 76 77 79 80 82 83
85+ 54 56 58 61 63 65
Total 12659 12870 13074 13279 13475 13678
(a) In thousands.
Table 1.4 Resident Population (a) of Black Males, by Age and Year,
United States, 1986-89
Year
1986 1987 1988 1989
Age
0-4 1380 1400 1423 1469
5-9 1354 1383 1412 1423
10-14 1314 1315 1327 1362
15-19 1403 1408 1408 1394
20-24 1360 1335 1306 1279
25-29 1326 1334 1342 1342
30-34 1162 1213 1254 1289
35-39 930 961 999 1035
40-44 662 699 735 782
45-49 575 594 612 626
50-54 517 523 533 544
55-59 503 505 506 508
60-64 448 455 463 467
65-69 369 380 391 402
70-74 263 266 269 274
75-79 176 180 183 187
80-84 86 88 89 91
85+ 66 68 70 72
Total 13894 14106 14320 14545
(a) In thousands.
1.5 Age and Year, Black Females
Table 1.5 Resident Population (a) of Black Females, by Age and Year,
United States, 1980-85
Year
1980 1981 1982 1983 1984 1985
Age
0-4 1228 1263 1289 1312 1319 1326
5-9 1242 1213 1210 1218 1247 1284
10-14 1334 1341 1343 1338 1322 1310
15-19 1506 1489 1462 1434 1406 1381
20-24 1440 1463 1470 1480 1479 1476
25-29 1259 1301 1351 1392 1426 1449
30-34 1038 1120 1160 1201 1242 1287
35-39 806 819 866 910 970 1028
40-44 692 708 730 752 769 790
45-49 631 636 643 658 675 692
50-54 629 631 633 633 632 634
55-59 575 583 590 595 598 601
60-64 490 499 510 522 533 543
65-69 448 453 457 461 465 472
70-74 332 342 351 360 367 372
75-79 237 243 250 256 263 270
80-84 126 131 136 141 145 149
85+ 108 113 120 126 133 138
Total 14123 14347 14570 14787 14991 15202
(a) In thousands.
Table 1.5 Resident Population (a) of Black Females, by Age and Year,
United States, 1986-89
Year
1986 1987 1988 1989
Age
0-4 1340 1357 1380 1421
5-9 1320 1346 1371 1378
10-14 1278 1275 1286 1318
15-19 1386 1387 1384 1365
20-24 1458 1431 1402 1372
25-29 1471 1478 1487 1485
30-34 1329 1378 1420 1455
35-39 1107 1145 1186 1225
40-44 802 847 889 945
45-49 707 729 751 769
50-54 640 646 661 679
55-59 605 607 608 608
60-64 551 557 562 567
65-69 480 491 503 515
70-74 378 381 383 386
75-79 278 285 293 299
80-84 153 157 161 165
85+ 145 152 158 165
Total 15427 15648 15882 16115
(a) In thousands.
1.6 Age and Year, Other Males
Table 1.6 Resident Population (a) of Other Males, by Age and Year,
United States, 1980-85
Year
1980 1981 1982 1983 1984 1985
Age
0-4 247 270 294 316 336 353
5-9 245 256 266 274 288 305
10-14 238 259 279 294 305 316
15-19 253 268 278 285 295 308
20-24 256 279 297 310 321 332
25-29 254 274 294 307 321 336
30-34 239 265 284 303 321 339
35-39 184 197 215 232 251 270
40-44 149 162 174 185 198 212
45-49 116 125 136 146 157 169
50-54 99 105 111 116 123 130
55-59 86 91 95 99 103 108
60-64 64 70 77 83 91 96
65-69 54 57 61 64 68 72
70-74 41 44 48 50 53 56
75-79 27 29 31 34 36 40
80-84 12 14 15 16 17 19
85+ 8 8 9 10 11 12
Total 2573 2771 2962 3124 3296 3473
(a) In thousands.
Table 1.6 Resident Population (a) of Other Males, by Age and Year,
United States, 1986-89
Year
1986 1987 1988 1989
Age
0-4 370 381 391 414
5-9 326 349 374 394
10-14 325 332 342 355
15-19 325 343 360 371
20-24 339 344 349 357
25-29 350 362 372 381
30-34 355 373 389 404
35-39 295 315 333 354
40-44 225 244 262 283
45-49 181 192 204 217
50-54 140 150 161 174
55-59 113 119 125 133
60-64 102 106 110 113
65-69 79 86 94 100
70-74 59 62 66 69
75-79 42 45 49 51
80-84 20 21 24 26
85+ 14 15 16 17
Total 3661 3836 4022 4212
(a) In thousands.
1.7 Age and Year, Other Females
Table 1.7 Resident Population (a) of Other Females, by Age and Year,
United States, 1980-85
Year
1980 1981 1982 1983 1984 1985
Age
0-4 241 265 288 311 330 348
5-9 237 247 258 268 282 299
10-14 228 246 263 280 291 302
15-19 237 247 255 260 269 282
20-24 254 272 287 295 304 312
25-29 280 296 314 326 338 350
30-34 272 299 316 333 347 361
35-39 199 215 238 259 282 305
40-44 156 169 183 198 215 233
45-49 133 140 148 156 165 177
50-54 119 127 134 140 146 153
55-59 97 106 114 122 130 138
60-64 74 82 90 99 108 116
65-69 59 66 72 77 83 89
70-74 40 45 51 56 60 66
75-79 29 32 34 38 42 46
80-84 17 18 20 21 23 26
85+ 13 14 15 17 17 19
Total 2685 2884 3077 3255 3431 3623
(a) In thousands.
Table 1.7 Resident Population (a) of Other Females, by Age and Year,
United States, 1986-89
Year
1986 1987 1988 1989
Age
0-4 362 373 380 399
5-9 321 344 368 389
10-14 310 318 329 342
15-19 297 314 329 341
20-24 317 322 328 335
25-29 362 372 383 389
30-34 376 393 406 420
35-39 332 348 366 382
40-44 249 273 296 322
45-49 191 204 220 237
50-54 160 168 178 189
55-59 146 154 161 167
60-64 125 135 144 150
65-69 98 106 116 125
70-74 72 77 83 89
75-79 50 55 60 66
80-84 28 30 33 37
85+ 20 22 25 27
Total 3816 4007 4205 4406
(a) In thousands.
2.1-2.5 Prevalence of Diabetes, Age & Year, U.S., 80-89
2.1 Age and Year
Table 2.1 Prevalence of Diabetes, by Age and Year, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 Number (a) 1010 952 984 1002 994 1038
Rate (b) 6.4 6.0 6.1 6.2 6.1 6.3
45-64 Number 2389 2544 2567 2599 2359 2330
Rate 53.7 57.1 57.6 58.2 52.7 51.9
65-74 Number 1522 1365 1525 1305 1757 1851
Rate 97.3 85.8 94.2 79.1 105.0 108.9
75+ Number 861 948 810 874 1090 1101
Rate 85.7 91.8 76.3 80.0 97.1 95.5
Total Number 5782 5809 5886 5781 6200 6320
Rate 25.4 25.1 25.2 24.5 25.9 26.2
Age-adjusted Rate 25.4 25.3 25.4 24.7 26.0 26.2
(a) In thousands.
(b) Per 1,000 people.
Table 2.1 Prevalence of Diabetes, by Age and Year, United States, 1986-1989
Year
1986 1987 1988 1989
Age
0-44 Number (a) 1047 1364 1092 1224
Rate (b) 6.3 8.1 6.4 7.2
45-64 Number 2847 2552 2460 2707
Rate 63.2 56.4 53.5 58.2
65-74 Number 1593 1703 1704 1632
Rate 91.9 96.4 95.2 89.8
75+ Number 1284 1193 1094 1096
Rate 108.6 98.2 87.8 85.7
Total Number 6772 6812 6350 6659
Rate 27.8 27.7 25.6 26.6
Age-adjusted Rate 27.9 27.6 25.4 26.3
(a) In thousands.
(b) Per 1,000 people.
2.2 Age and Year, White Males
Table 2.2 Prevalence of Diabetes, by Age and Year, White Males,
United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 Number (a) 311 369 384 408 354 392
Rate (b) 4.7 5.5 5.6 5.9 5.1 5.6
45-64 Number 917 1017 977 920 813 873
Rate 48.5 53.8 51.7 48.7 43.0 46.1
65-74 Number 595 553 430 417 592 679
Rate 97.1 88.7 67.6 64.2 89.6 101.0
75+ Number 256 228 301 328 324 350
Rate 78.8 68.8 88.4 94.0 90.5 95.5
Total Number 2079 2168 2092 2073 2083 2295
Rate 22.0 22.7 21.6 21.2 21.2 23.2
Age-adjusted Rate 22.9 23.5 22.6 22.2 22.1 24.1
(a) In thousands.
(b) Per 1,000 people.
Table 2.2 Prevalence of Diabetes, by Age and Year, White Males,
United States, 1986-1989
Year
1986 1987 1988 1989
Age
0-44 Number (a) 301 578 484 415
Rate (b) 4.3 8.2 6.8 5.8
45-64 Number 1237 1052 936 1080
Rate 65.3 55.3 48.5 55.3
65-74 Number 625 705 558 535
Rate 90.9 100.3 78.3 73.8
75+ Number 405 420 386 257
Rate 107.6 108.5 97.1 62.8
Total Number 2568 2756 2363 2288
Rate 25.7 27.4 23.3 22.4
Age-adjusted Rate 26.8 28.2 23.9 22.7
(a) In thousands.
(b) Per 1,000 people.
2.3 Age and Year, White Females
Table 2.3 Prevalence of Diabetes, by Age and Year, White Females, United
States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 Number (a) 476 420 475 404 439 500
Rate (b) 7.3 6.4 7.1 6.0 6.5 7.4
45-64 Number 980 998 986 1081 1045 913
Rate 47.6 48.6 48.1 52.9 51.2 44.8
65-74 Number 749 617 785 630 802 885
Rate 93.9 76.2 95.6 75.5 95.2 103.8
75+ Number 519 595 425 458 593 594
Rate 87.2 97.4 67.5 70.8 89.2 87.1
Total Number 2723 2630 2670 2572 2879 2893
Rate 26.7 25.6 25.9 24.7 27.4 27.4
Age-adjusted Rate 24.7 23.5 23.9 22.8 25.0 24.9
(a) In thousands.
(b) Per 1,000 people.
Table 2.3 Prevalence of Diabetes, by Age and Year, White Females, United
States, 1986-1989
Year
1986 1987 1988 1989
Age
0-44 Number (a) 591 511 356 547
Rate (b) 8.6 7.4 5.1 7.9
45-64 Number 1071 955 923 1045
Rate 52.6 46.8 44.7 50.2
65-74 Number 677 745 827 801
Rate 78.2 84.7 93.3 89.3
75+ Number 681 535 512 644
Rate 97.4 74.7 69.9 85.9
Total Number 3019 2746 2618 3037
Rate 28.2 25.6 24.2 27.9
Age-adjusted Rate 25.9 23.4 21.8 25.2
(a) In thousands.
(b) Per 1,000 people.
2.4 Age and Year, Black Males
Table 2.4 Prevalence of Diabetes, By Age and Year, Black Males,
United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 Number (a) 73 64 62 37 55 63
Rate (b) 7.4 6.4 6.0 3.5 5.2 5.9
45-64 Number 186 185 180 204 215 222
Rate 98.7 97.2 93.2 104.2 108.3 110.1
65-74 Number 62 68 71 85 88 99
Rate 108.1 116.8 120.1 142.7 145.0 159.2
75+ Number 29 23 25 24 35 34
Rate 103.6 79.3 83.7 79.8 111.6 107.3
Total Number 350 340 337 351 394 418
Rate 28.2 26.9 25.8 26.2 29.1 30.7
Age-adjusted Rate 35.6 37.2 32.4 33.7 42.5 43.1
(a) In thousands.
(b) Per 1,000 people.
Table 2.4 Prevalence of Diabetes, by Age and Year, Black Males,
United States, 1986-1989
Year
1986 1987 1988 1989
Age
0-44 Number (a) 83 91 81 82
Rate (b) 7.6 8.2 7.2 7.3
45-64 Number 204 210 247 276
Rate 99.8 100.9 116.8 128.7
65-74 Number 91 104 85 87
Rate 143.3 160.5 128.6 128.2
75+ Number 39 35 51 54
Rate 119.5 104.4 150.9 155.2
Total Number 417 439 464 499
Rate 30.4 31.6 32.9 34.8
Age-adjusted Rate 38.7 38.2 46.3 45.5
(a) In thousands.
(b) Per 1,000 people.
2.5 Age and Year, Black Females
Table 2.5 Prevalence of Diabetes, By Age and Year, Black Females, United
States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 Number (a) 112 97 86 116 109 91
Rate (b) 10.6 9.0 7.9 10.5 9.7 8.1
45-64 Number 251 284 322 301 281 259
Rate 108.2 120.8 135.6 124.9 115.4 104.8
65-74 Number 103 137 160 200 186 183
Rate 132.5 172.3 197.9 243.6 224.0 216.6
75+ Number 71 70 68 84 92 118
Rate 151.2 144.9 134.1 160.1 170.6 211.6
Total Number 538 588 636 700 669 651
Rate 37.7 40.6 43.2 46.8 44.1 42.3
Age-adjusted Rate 43.7 45.0 55.8 53.9 56.9 46.2
(a) In thousands.
(b) Per 1,000 people.
Table 2.5 Prevalence of Diabetes, by Age and Year, Black Females, United
States, 1986-1989
Year
1986 1987 1988 1989
Age
0-44 Number (a) 87 109 135 131
Rate (b) 7.6 9.4 11.4 11.0
45-64 Number 280 280 243 226
Rate 112.0 110.2 94.2 86.2
65-74 Number 144 142 155 176
Rate 167.8 163.5 174.6 195.6
75+ Number 126 147 141 135
Rate 219.7 247.1 230.1 214.7
Total Number 638 678 674 669
Rate 40.9 42.7 41.8 40.9
Age-adjusted Rate 48.2 50.9 51.6 43.4
(a) In thousands.
(b) Per 1,000 people.
2.6-2.10 Prevalence Rate of Diabetes per 1,000 Pop., U.S., 80-89
2.6 Region and Year
Table 2.6 Prevalence (a) of Diabetes, by Region and Year, United States,
1980-1985
Year
1980 1981 1982 1983 1984 1985
Region Rate
Northeast Crude 26.0 25.1 25.3 25.2 26.8 29.5
Age-Adjusted 24.8 23.9 23.9 23.8 25.4 28.1
North Central Crude 24.6 24.8 24.5 25.0 25.6 26.4
Age-Adjusted 24.8 25.1 25.4 25.8 25.9 25.7
South Crude 27.8 27.9 27.8 27.9 27.4 27.5
Age-Adjusted 28.1 28.2 28.1 28.3 27.7 28.1
West Crude 20.8 21.3 20.1 21.0 21.1 22.3
Age-Adjusted 21.9 22.4 21.1 21.4 22.1 23.7
(a) Per 1,000 People
Table 2.6 Prevalence (a) of Diabetes, by Region and Year, United States,
1986-1989
Year
1986 1987 1988 1989
Region Rate
Northeast Crude 30.4 29.8 26.9 25.9
Age-Adjusted 28.4 27.7 24.9 23.9
North Central Crude 25.7 25.5 26.0 26.8
Age-Adjusted 25.0 25.1 25.8 26.4
South Crude 28.6 28.7 29.2 28.0
Age-Adjusted 29.1 29.1 29.2 28.0
West Crude 23.4 23.1 22.9 22.3
Age-Adjusted 25.5 24.5 24.1 23.4
(a) Per 1,000 People
2.7 Age and Region, White Males
Table 2.7 Prevalence Rate of Diabetes per 1,000 Population,
by Age and Region, White Males, United States, 1980-1989
Age
0-44 45-64 65-74 75+ Total Age-adjusted
Region
Northeast 5.6 53.4 97.5 99.2 25.7 25.4
North Central 5.7 53.7 78.8 83.0 22.5 23.6
South 6.2 52.7 92.9 82.5 23.9 24.6
West 4.9 44.6 72.2 85.6 19.2 20.9
2.8 Age and Region, White Females
Table 2.8 Prevalence Rate of Diabetes per 1,000 Population,
by Age and Region, White Females, United States, 1980-1989
Age
0-44 45-64 65-74 75+ Total Age-adjusted
Region
Northeast 5.4 47.9 93.4 89.7 27.7 23.5
North Central 7.1 48.7 94.3 79.9 26.5 24.5
South 8.4 52.0 83.0 85.3 27.6 25.5
West 6.1 44.1 80.5 80.0 22.5 21.9
2.9 Age and Region, Black Males
Table 2.9 Prevalence Rate of Diabetes per 1,000 Population,
by Age and Region, Black Males, United States, 1980-1989
Age
0-44 45-64 65-74 75+ Total Age-adjusted
Region
Northeast 4.8 111.2 150.9 176.0 30.1 43.3
North Central 3.8 112.8 93.9 106.8 26.8 35.9
South 7.6 87.3 126.8 106.8 27.9 35.8
West 8.2 180.0 214.1 78.2 43.7 59.2
2.10 Age and Region, Black Females
Table 2.10 Prevalence Rate of Diabetes per 1,000 Population,
by Age and Region, Black Females, United States, 1980-1989
Age
0-44 45-64 65-74 75+ Total Age-adjusted
Region
Northeast 4.3 93.9 152.4 113.4 30.2 36.9
North Central 11.0 132.6 102.3 150.8 40.2 47.3
South 10.8 115.4 221.2 203.1 47.0 54.3
West 13.8 59.4 93.5 273.2 33.1 39.7
2.11-15 Incidence Rate of Diabetes per 1,000 Pop., U.S., 80-89
2.11 Age and Year
Table 2.11 Incidence Rate (a) of Diabetes per 1,000 Population, by Age
and Year, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 Number (b) 179 149 218 159 169 151
Rate 1.07 1.18 1.11 1.14 0.99 1.10
45-64 Number 191 243 367 363 319 294
Rate 4.94 6.07 7.34 7.91 7.34 6.54
65+ Number 172 103 128 168 145 235
Rate 5.65 5.44 5.25 5.68 6.91 6.73
Total Number 541 495 713 690 633 679
Rate 2.34 2.61 2.79 2.96 2.88 2.79
Age-adjusted Rate 2.35 2.62 2.80 2.98 2.90 2.80
(a) Three-year moving average
(b) In thousands
Table 2.11 Incidence Rate (a) of Diabetes per 1,000 Population, by Age
and Year, United States, 1986-1989
Year
1986 1987 1988 1989
Age
0-44 Number (b) 218 226 265 256
Rate 1.21 1.43 1.50 1.56
45-64 Number 260 215 256 335
Rate 5.73 5.41 5.90 6.45
65+ Number 165 290 156 86
Rate 8.34 7.25 6.18 4.18
Total Number 644 731 678 677
Rate 2.90 2.87 2.89 2.80
Age-adjusted Rate 2.90 2.87 2.89 2.81
(a) Three-year moving average
(b) In thousands
2.12 Age and Year, Males
Table 2.12 Incidence Rate (a) of Diabetes per 1,000 Population, by Age
and Year, Males, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 Number (b) 45 84 110 14 26 56
Rate 0.85 1.04 0.89 0.63 0.40 0.69
45-64 Number 108 134 208 164 112 115
Rate 5.81 7.19 8.05 7.70 6.18 5.26
65+ Number 61 33 10 77 50 93
Rate 4.67 3.40 3.84 4.31 6.78 4.83
Total Number 215 251 328 255 189 263
Rate 2.18 2.45 2.53 2.32 2.11 1.95
Age-adjusted Rate 2.26 2.51 2.62 2.43 2.25 2.05
(a) Three-year moving average
(b) In thousands
Table 2.12 Incidence Rate (a) of Diabetes per 1,000 Population, by Age
and Year, Males, United States, 1986-1989
Year
1986 1987 1988 1989
Age
0-44 Number (b) 85 83 131 51
Rate 0.92 1.21 1.06 1.09
45-64 Number 107 112 133 188
Rate 5.22 5.46 6.63 7.31
65+ Number 17 91 54 43
Rate 5.91 4.66 5.28 4.06
Total Number 210 286 318 282
Rate 2.22 2.35 2.53 2.56
Age-adjusted Rate 2.32 2.43 2.63 2.64
(a) Three-year moving average
(b) In thousands
2.13 Age and Year, Females
Table 2.13 Incidence Rate (a) of Diabetes per 1,000 Population, by Age
and Year, Females, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 Number (b) 134 65 108 145 143 95
Rate 1.29 1.31 1.34 1.65 1.58 1.51
45-64 Number 82 108 159 199 207 179
Rate 4.15 5.05 6.69 8.10 8.38 7.70
65+ Number 111 71 119 91 95 142
Rate 6.33 6.86 6.24 6.63 6.99 8.05
Total Number 327 245 385 435 444 416
Rate 2.49 2.76 3.02 3.55 3.61 3.57
Age-adjusted Rate 2.42 2.67 2.94 3.47 3.52 3.46
(a) Three-year moving average
(b) In thousands
Table 2.13 Incidence Rate (a) of Diabetes per 1,000 Population, by Age
and Year, Females, United States, 1986-1989
Year
1986 1987 1988 1989
Age
0-44 Number (b) 133 143 135 206
Rate 1.50 1.65 1.92 2.02
45-64 Number 153 102 124 147
Rate 6.19 5.36 5.23 5.67
65+ Number 148 199 102 42
Rate 10.05 9.07 6.81 4.26
Total Number 434 445 360 395
Rate 3.54 3.35 3.22 3.02
Age-adjusted Rate 3.39 3.22 3.13 2.99
(a) Three-year moving average
(b) In thousands
2.14 Age and Year, White Males
Table 2.14 Incidence Rate (a) of Diabetes per 1,000 Population, by Age
and Year, White Males, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 Number (b) 45 74 79 14 26 56
Rate 0.93 1.02 0.85 0.60 0.47 0.76
45-64 Number 96 109 177 94 53 103
Rate 5.52 6.85 6.80 5.78 4.44 4.65
65+ Number 61 22 10 65 50 93
Rate 4.59 3.38 3.45 4.35 7.10 5.33
Total Number 203 206 266 174 129 251
Rate 2.22 2.42 2.28 1.99 1.92 1.99
Age-adjusted Rate 2.25 2.43 2.31 2.04 2.00 2.04
(a) Three-year moving average
(b) In thousands
Table 2.14 Incidence Rate (a) of Diabetes per 1,000 Population, by Age
and Year, White Males, United States, 1986-1989
Year
1986 1987 1988 1989
Age
0-44 Number (b) 73 71 93 51
Rate 0.97 1.14 1.03 1.04
45-64 Number 107 47 112 149
Rate 4.53 4.66 5.35 6.78
65+ Number 17 74 50 43
Rate 5.98 4.47 5.20 4.31
Total Number 198 192 254 243
Rate 2.18 2.17 2.32 2.50
Age-adjusted Rate 2.23 2.21 2.35 2.53
(a) Three-year moving average
(b) In thousands
2.15 Age and Year, White Females
Table 2.15 Incidence Rate (a) of Diabetes per 1,000 Population, by Age
and Year, White Females, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 Number (b) 96 60 108 102 125 86
Rate 1.21 1.35 1.37 1.68 1.56 1.69
45-64 Number 82 94 121 159 170 126
Rate 4.36 4.90 6.14 7.37 7.44 7.14
65+ Number 101 61 97 80 73 125
Rate 6.23 6.52 5.83 5.99 6.57 8.03
Total Number 279 216 325 342 368 338
Rate 2.53 2.77 2.94 3.42 3.43 3.66
Age-adjusted Rate 2.39 2.63 2.80 3.28 3.28 3.48
(a) Three-year moving average
(b) In thousands
Table 2.15 Incidence Rate (a) of Diabetes per 1,000 Population, by Age
and Year, White Females, United States, 1986-1989
Year
1986 1987 1988 1989
Age
0-44 Number (b) 133 105 99 173
Rate 1.58 1.64 1.83 1.97
45-64 Number 141 67 98 113
Rate 5.47 4.99 4.52 5.11
65+ Number 148 92 102 36
Rate 8.32 7.65 5.06 4.53
Total Number 422 264 299 323
Rate 3.30 3.15 2.82 2.96
Age-adjusted Rate 3.11 2.97 2.72 2.88
(a) Three-year moving average
(b) In thousands
MORTALITY
Introduction
In 1986, diabetes mellitus was the seventh leading cause of death in the
United States (National Center for Health Statistics, 1988) and the 13th
leading cause of years of potential life lost before age 65 (Centers for
Disease Control, 1988). Because these statistics are based on underlying
cause of death, however, they understate diabetes' overall impact on
mortality. Previous studies have shown that diabetes is selected as the
underlying cause on approximately one quarter of the death certificates on
which it appears in any field, and diabetes is recorded on only half of the
certificates for persons who have the disease at the time of death (Harris
and Entmacher, 1985). Thus, diabetes contributes to a much larger number of
deaths than it directly causes.
We describe the number of deaths resulting from diabetes, and the associated
mortality rates, for 1980 through 1986. We examine diabetes both as an
underlying cause and as any listed (either underlying or contributory) cause
of death. We evaluate the number and rates of deaths from diabetes by age,
race, sex, calendar year, and state. We determine mortality rates for the
general US population, as well as rates among persons with diabetes. Other
mortality rates of interest are presented somewhere else. These include
mortality rates for cardiovascular disease among persons with diabetes
(Chapter 5) and mortality rates associated with diabetic ketoacidosis
(Chapter 7).
Methods
To enumerate deaths from diabetes during 1980 through 1986,
we used mortality data provided by the National Center for Health
Statistics (NCHS). The NCHS creates national mortality data tapes
by abstracting and coding medical information, including underlying
and contributing causes of death, recorded on vital records from each
state. The underlying cause of death is selected according to standard
criteria (including order) that determine which cause or contributing
factor listed on the death certificate presides over others that may
be listed. For each record on the mortality tape, a single underlying
cause and a maximum of 20 contributory causes of death may be coded. We
identified deaths attributable to diabetes (as either the underlying
or contributing cause) by using rubric 250 of the 9th Version of the
International Classification of Diseases.
We used 1980 census estimates, and intercensal estimates for subsequent
years, for calculating diabetes mortality rates in the general population.
To determine diabetic persons' risks of dying from their disease, we
calculated mortality rates for the U.S. population known to have diabetes.
We estimated the number of persons with diabetes using information from
annual Health Interview Surveys (Chapter 2) and used this estimate
as the denominator in calculating mortality rates for persons known
to have diabetes. Because the Health Interview Survey provides national
or regional estimates, rather than state-specific estimates, of the
diabetic population in the United States, we restricted our analysis
of state diabetes mortality to general population rates.
Mortality rates were standardized according to the direct method (Fleiss,
1981). We used the 1980 resident population of the United States
to standardize rates in the general population and the estimated 1980
diabetic population to standardize diabetes-specific mortality rates.
Results
Diabetes Mortality in the General Population
The annual number of deaths attributed to diabetes as an underlying
cause steadily increased from 1980 to 1986, reaching 37,184
in 1986 (Figure 3.1). Between 1980 and 1986, the age-standardized
mortality rates for diabetes as the underlying cause of death among
U.S. residents declined 4.6%--from 15.3 to 14.6 per 100,000 population
(Figure 3.2, Table 3.1). Most of the secular decline in mortality
rates occurred among persons 65 years and older; rates in other age
groups stayed about the same (Table 3.1). In each year, mortality
rates increased with age, particularly after age 55. During these
7 years, age-adjusted mortality rates decreased for white males and
females, while the corresponding rates for black males and females
were unchanged (Tables 3.2-3.5).
Diabetes-related mortality includes those deaths for which diabetes
was listed as either an underlying or contributing cause on the vital
record. In each year, the number of diabetes-related deaths was about
four times the number of deaths in which diabetes was the underlying
cause. The number of diabetes-related deaths increased each year
and reached 150,000 in 1986 (Table 3.6). Age-adjusted mortality rates,
however, for diabetes-related deaths declined 1.8% between 1980 and
1986 (Figure 3.2). As with mortality rates for diabetes as an underlying
cause, most of the decline in rates during these years was seen among
persons 65 years and older.
Temporal trends in mortality rates for diabetes as any listed cause
varied by race and sex (Figure 3.3). The age-standardized rates for
white males and white females generally reflect the temporal trends
seen in the total population. Between 1980 and 1986, the rates for
white males and females declined 1.6% and 4.5%, respectively (Tables
3.7-3.8). The corresponding mortality rates for black males and females,
however, increased 11% and 5.5%, respectively (Tables 3.9-3.10). Black
females, the group with the highest mortality rates, had annual mortality
rates that were two-fold higher than those for white females. Mortality
rates for black males were 20%-40% higher than those for white males.
We present annual unadjusted state-specific mortality rates for
diabetes-related deaths (Table 3.11). The large variability in
state-specific mortality rates reflects, in part, demographic differences
among state populations. After adjustment for age and race, this
variability diminishes, with average annual mortality rates (per 100,000)
ranging from 37.3 in Arkansas to 76.7 in Rhode Island (Table 3.12). These
state-specific rates are grouped by quartile (Figure 3.4). States with
rates in the highest quartile appear to be located primarily in the
Northeast and in the region surrounding the Great Lakes.
Mortality Rates of Persons with Diabetes
Among the diabetic population, the age-adjusted mortality rate
for diabetes as the underlying cause of death declined 14.5%
between 1980 and 1986 (Figure 3.5). This temporal trend, however,
was somewhat erratic, with small rate increases noted during the periods
1981-1983 and 1984-1985. During these seven years, trends in age-specific
mortality rates varied (Table 3.13). Rates clearly fell for persons
aged 75 years and older. Mortality declines were also seen for persons
aged 45 to 74, but these trends are less striking because of year-to-year
variability. In contrast, for persons less than 45 years, mortality
rates increased between 1980 and 1986.
Mortality rates for diabetes as the underlying cause of death declined
in each race and sex category. Between 1980 and 1986, the age-adjusted
rate fell 18.6% for white males and black females, 12.0% for black
males, and 7.9% for white females (Tables 3.14-3.17). Of the four
groups, black males each year consistently had the highest rates.
The age-adjusted rate for diabetes-related deaths decreased from 2,350
per 100,000 persons with diabetes in 1980 to 2,066 per 100,000 in
1986, a 12.1% decline (Figure 3.5, Table 3.18). As with age-specific
mortality rates for diabetes as the underlying cause of death,
diabetes-related mortality rates declined during this period in those
75 years and older; meanwhile, mortality rates in those persons less
than 45 years old appeared to increase.
Age-standardized mortality rates for diabetes-related deaths decreased
in each race-sex category (Figure 3.6, Tables 3.19-3.22). Compared
with rates in 1980, diabetes-related mortality rates in 1986 declined
16.6% for white males, 14.0% for black females, 4.9% for white females,
and 3.6% for black males. In contrast to the results for mortality
rates among the general population (Figure 3.3), the highest rates
of diabetes-related mortality in the diabetic population were among
white males (Figure 3.6). Moreover, whereas black females have the
highest diabetes-related mortality rates in the general population,
they have the lowest rates in the diabetic population.
Discussion
National death certificate data for 1980 to 1986 indicate that, although
the number of deaths attributable to diabetes has increased, age-adjusted
mortality rates for diabetes have declined. Compared with the rate
in 1980, the mortality rate in the general population for diabetes
as an underlying cause of death declined 4.6% to 14.6 per 100,000
by 1986. For diabetes-related mortality (diabetes as any listed cause),
the age-adjusted mortality rate declined 1.8% to 58.7 per 100,000
by 1986. When we calculated mortality rates using the population
of people with diabetes as the denominator, the declines were more
substantial--12% for diabetes-related mortality.
We found that diabetes-related mortality rates in the general population
varied by race and sex. Rates for black females were highest and
were double those for white females. Black males had the second highest
mortality rates. Temporal trends also varied by race. Whereas
diabetes-related mortality rates declined among whites during 1980-1986,
the corresponding mortality rates increased among blacks. These rate
increases probably reflect the higher prevalence of diabetes among blacks.
In support of this explanation, mortality rates for the diabetic population,
which are not influenced by the prevalence of diabetes, declined for
both races. Moreover, in contrast to general population rates, rates
of diabetes-related mortality among persons with diabetes were highest
among white males.
Death certificate data are useful for examining secular trends and
relative differences within subgroups categorized by age, race, and
sex. There are, however, several well known limitations associated
with using death certificate data for monitoring cause-specific mortality.
Foremost are the misclassification and underreporting of diabetes as a
cause of death on vital records. Several studies have shown that diabetes
is recorded on the death certificate of only about 40% of the people
who are known to have diabetes (Brousseau, 1987; Ochi et al., 1985;
Palumbo et al., 1976). This proportion has been fairly constant from
studies conducted from the mid-1970s to the mid-1980s. The proportion
has also been similar for different race and sex groups. Therefore,
the mortality rates reported herein probably represent conservative
estimates of the actual U.S. rates. Nonetheless, the temporal trends
and relative differences between race and sex groups are probably valid.
In each year, the number of deaths from diabetes as any listed cause
were about four times greater than the number of deaths from diabetes
as an underlying cause. Similarly, rates based on underlying cause
of death, the usual measure of diabetes mortality, reflect only about
one-quarter of the deaths to which diabetes may have contributed. Total
diabetes-related deaths, and the corresponding mortality rates, more
accurately reflect the considerable disease burden that diabetes imposes
upon society. These results suggest that gradual declines in mortality
from diabetes are occurring, but that diabetes continues to be a leading
cause of mortality in the United States.
During 1980 through 1986, there was a substantial decrease in the
age-adjusted mortality rate of people with diabetes. Despite this
improvement, the annual number of deaths related to diabetes increased.
These findings indicate that, even with improved care for patients
with diabetes, decreasing the disease burden from diabetes will be
difficult because of the increasingly older population age structure
and the concomitant increasing prevalence of diabetes.
Update
This section updates data presented in previous sections in light of two
additional years of mortality data. For a complete description of the methods
and operational definitions and for a discussion of the implications of the
findings, see previous sections.
Diabetes Mortality in the General Population
The annual number of deaths with diabetes as the underlying cause of
death increased from 1980 (34,851) to 1988 (40,368) (Table 3.1). Between 1982
and 1988, the age-standardized mortality rates for both black males and
females increased (23% and 11%, respectively) (Tables 3.4-3.5). The rates for
white males and white females remained relatively constant (Tables 3.2-3.3).
The annual number of deaths with diabetes listed as any cause of death
(diabetes-related deaths) increased from 135,931 in 1980 to 157,265 in 1988
(Table 3.6). Between 1982 and 1988, age-standardized diabetes-related
mortality rates increased 21% for black males and 15% for black females
(Figure 1.4, Tables 3.9-3.10). The rates remained relatively constant for
white males and white females (Figure 1.4, Tables 3.7-3.8).
Between 1980 and 1988, both mortality rates for diabetes as an
underlying cause of death and diabetes-related mortality rates increased with
age, with the highest rates occurring among those aged 85 and older (Tables
3.1-3.6).
Diabetes Mortality in the Diabetic Population
When age-standardized mortality rates were calculated using as the
denominator people known to have diabetes, race-sex trends in age-standardized
mortality rates were less clear. Age-standardized rates for diabetes as
underlying cause of death were lower in 1988 than in 1980 for white males,
black males, and black females (Figure 1.5, Tables 3.14, 3.16, and 3.17).
White females were the only group whose rates were higher in 1988 than in 1980
(Figure 1.5, Table 3.15). Of the four race-sex groups examined, black males
had the highest age-standardized rates.
Race-sex trends for diabetes-related mortality rates were similar to
those seen for diabetes as underlying cause of death, except that white males
had the highest age-standardized rates.
Detailed Tables
3.1-3.5 Deaths with Diabetes as Underlying Cause & Mort. Rate
3.1 100,000 Pop., by Age and Year, U.S., 80-88
Table 3.1 Number of Deaths with Diabetes as Underlying Cause and
Mortality Rate per 100,000 Population, by Age and Year,
United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-14 Number 53 46 63 51 36 44
Rate 0.1 0.1 0.1 0.1 0.1 0.1
15-24 Number 128 149 134 129 119 121
Rate 0.3 0.4 0.3 0.3 0.3 0.3
25-34 Number 572 554 533 584 578 537
Rate 1.5 1.4 1.3 1.4 1.4 1.3
35-44 Number 900 916 922 1064 1072 1165
Rate 3.5 3.5 3.3 3.6 3.5 3.7
45-54 Number 2188 2167 2060 2078 2005 1991
Rate 9.6 9.6 9.2 9.3 8.9 8.8
55-64 Number 5789 5620 5643 5900 5495 5819
Rate 26.6 25.6 25.5 26.6 24.6 26.1
65-74 Number 10111 9841 9711 10185 9934 10159
Rate 64.6 61.8 60.0 61.8 59.4 59.7
75-84 Number 10134 10221 10339 10923 10857 11308
Rate 130.3 128.3 126.5 130.2 126.2 128.1
85+ Number 4971 5120 5170 5328 5690 5817
Rate 219.0 217.6 211.1 209.9 217.0 216.0
Total Number 34851 34642 34583 36246 35787 36969
Rate 15.3 15.1 14.9 15.5 15.1 15.5
Age-Adjusted Rate 15.3 15.0 14.6 15.0 14.5 14.7
Table 3.1 Number of Deaths with Diabetes as Underlying Cause and
Mortality Rate per 100,000 Population, by Age and Year,
United States, 1986-1988
Year
1986 1987 1988
Age
0-14 Number 36 41 40
Rate 0.1 0.1 0.1
15-24 Number 140 119 119
Rate 0.4 0.3 0.3
25-34 Number 634 618 656
Rate 1.5 1.4 1.5
35-44 Number 1174 1203 1395
Rate 3.5 3.5 4.0
45-54 Number 2158 2258 2502
Rate 9.5 9.7 10.4
55-64 Number 5780 5914 6109
Rate 26.0 26.9 28.0
65-74 Number 10269 10789 11092
Rate 59.3 61.1 62.0
75-84 Number 11048 11470 11907
Rate 122.0 123.5 125.2
85+ Number 5939 6118 6548
Rate 213.9 213.7 222.2
Total Number 37184 38532 40368
Rate 15.4 15.8 16.4
Age-Adjusted Rate 14.6 14.8 15.3
3.2 100,000 Pop., by Age and Year, U.S., 80-88, White Males
Table 3.2 Number of Deaths with Diabetes as Underlying Cause and
Mortality Rate per 100,000 Population, by Age and Year,
White Males, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-14 Number 19 20 19 15 9 11
Rate 0.1 0.1 0.1 0.1 0.0 0.1
15-24 Number 46 47 59 44 50 34
Rate 0.3 0.3 0.3 0.3 0.3 0.2
25-34 Number 260 247 221 239 243 253
Rate 1.6 1.5 1.3 1.4 1.4 1.4
35-44 Number 373 391 422 474 486 544
Rate 3.4 3.5 3.5 3.8 3.7 4.0
45-54 Number 853 898 841 812 837 793
Rate 8.8 9.3 8.8 8.5 8.7 8.3
55-64 Number 2217 2238 2203 2202 2067 2216
Rate 24.2 24.2 23.7 23.6 22.1 23.7
65-74 Number 3682 3572 3686 3749 3638 3802
Rate 60.1 57.3 58.0 57.7 55.1 56.5
75-84 Number 3314 3289 3380 3449 3650 3673
Rate 126.6 122.7 123.0 122.2 126.0 123.4
85+ Number 1361 1362 1261 1353 1470 1432
Rate 217.4 213.5 192.8 202.6 215.7 207.1
Total Number 12125 12066 12092 12337 12450 12758
Rate 12.7 12.6 12.5 12.7 12.7 12.9
Age-Adjusted Rate 14.6 14.2 14.0 14.0 14.0 14.0
Table 3.2 Number of Deaths with Diabetes as Underlying Cause and
Mortality Rate per 100,000 Population, by Age and Year,
White Males, United States, 1986-1988
Year
1986 1987 1988
Age
0-14 Number 13 13 14
Rate 0.1 0.1 0.1
15-24 Number 55 50 50
Rate 0.3 0.3 0.3
25-34 Number 290 288 303
Rate 1.6 1.6 1.6
35-44 Number 504 583 622
Rate 3.6 4.0 4.1
45-54 Number 843 890 1002
Rate 8.7 9.0 9.8
55-64 Number 2201 2307 2293
Rate 23.7 25.2 25.3
65-74 Number 3835 4130 4091
Rate 55.8 58.8 57.4
75-84 Number 3580 3789 3941
Rate 117.1 120.3 121.8
85+ Number 1466 1503 1692
Rate 207.6 208.1 229.1
Total Number 12788 13553 14008
Rate 12.8 13.5 13.8
Age-Adjusted Rate 13.8 14.3 14.6
3.3 100,000 Pop., by Age and Year, U.S., 80-88, White Females
Table 3.3 Number of Deaths with Diabetes as Underlying Cause and
Mortality Rate per 100,000 Population, by Age and Year,
White Females, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-14 Number 18 15 26 22 19 22
Rate 0.1 0.1 0.1 0.1 0.1 0.1
15-24 Number 50 59 43 54 43 44
Rate 0.3 0.3 0.3 0.3 0.3 0.3
25-34 Number 192 189 194 216 198 171
Rate 1.2 1.1 1.2 1.3 1.1 1.0
35-44 Number 283 289 297 331 307 350
Rate 2.5 2.5 2.4 2.6 2.3 2.5
45-54 Number 741 687 664 685 604 596
Rate 7.2 6.8 6.6 6.9 6.1 6.0
55-64 Number 2231 2109 2151 2267 2093 2213
Rate 21.6 20.3 20.6 21.7 20.0 21.2
65-74 Number 4583 4454 4375 4637 4361 4415
Rate 57.4 55.0 53.3 55.6 51.7 51.7
75-84 Number 5507 5607 5632 5963 5716 5941
Rate 122.8 122.2 119.8 123.8 115.9 117.7
85+ Number 3137 3273 3431 3474 3675 3791
Rate 214.7 214.8 215.3 209.7 214.0 214.4
Total Number 16743 16684 16818 17650 17016 17547
Rate 16.7 16.6 16.6 17.3 16.5 16.9
Age-Adjusted Rate 13.6 13.3 13.1 13.5 12.7 12.9
Table 3.3 Number of Deaths with Diabetes as Underlying Cause and
Mortality Rate per 100,000 Population, by Age and Year,
White Females, United States, 1986-1988
Year
1986 1987 1988
Age
0-14 Number 18 15 19
Rate 0.1 0.1 0.1
15-24 Number 56 45 37
Rate 0.4 0.3 0.2
25-34 Number 226 186 196
Rate 1.3 1.0 1.1
35-44 Number 354 352 395
Rate 2.5 2.4 2.6
45-54 Number 671 712 777
Rate 6.7 7.0 7.3
55-64 Number 2124 2130 2279
Rate 20.5 20.9 22.7
65-74 Number 4471 4561 4782
Rate 51.7 51.9 53.9
75-84 Number 5822 5905 6117
Rate 112.8 111.8 113.6
85+ Number 3752 3936 4082
Rate 205.6 208.9 210.4
Total Number 17496 17842 18684
Rate 16.7 17.0 17.6
Age-Adjusted Rate 12.7 12.7 13.1
3.4 100,000 Pop., by Age and Year, U.S., 80-88, Black Males
Table 3.4 Number of Deaths with Diabetes as Underlying Cause and
Mortality Rate per 100,000 Population, by Age and Year,
Black Males, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-14 Number 10 4 6 3 6 7
Rate 0.3 0.1 0.2 0.1 0.2 0.2
15-24 Number 16 22 13 14 9 21
Rate 0.6 0.8 0.5 0.5 0.3 0.8
25-34 Number 55 63 65 69 73 59
Rate 2.8 3.0 3.0 3.0 3.1 2.4
35-44 Number 120 117 108 130 142 146
Rate 9.6 9.2 8.2 9.4 9.8 9.6
45-54 Number 216 244 223 257 264 259
Rate 21.0 23.6 21.5 24.5 24.8 24.1
55-64 Number 489 424 435 540 485 485
Rate 56.9 48.4 48.7 59.3 52.3 51.6
65-74 Number 577 560 525 569 621 615
Rate 101.3 96.7 89.3 95.2 102.1 99.1
75-84 Number 415 380 390 432 443 504
Rate 180.9 162.0 162.1 176.2 176.3 197.5
85+ Number 111 110 113 107 117 132
Rate 206.9 197.1 195.0 176.2 186.3 203.8
Total Number 2010 1925 1878 2123 2160 2230
Rate 15.9 15.0 14.4 16.0 16.0 16.3
Age-Adjusted Rate 24.5 22.9 22.0 24.2 24.2 24.7
Table 3.4 Number of Deaths with Diabetes as Underlying Cause and
Mortality Rate per 100,000 Population, by Age and Year,
Black Males, United States, 1986-1988
Year
1986 1987 1988
Age
0-14 Number 2 5 1
Rate 0.0 0.1 0.0
15-24 Number 17 9 16
Rate 0.6 0.3 0.6
25-34 Number 63 71 83
Rate 2.5 2.8 3.2
35-44 Number 166 139 210
Rate 10.4 8.4 12.1
45-54 Number 264 310 315
Rate 24.2 27.8 27.5
55-64 Number 526 550 585
Rate 55.3 57.3 60.4
65-74 Number 638 693 727
Rate 100.8 107.3 110.1
75-84 Number 467 469 540
Rate 178.6 175.5 199.1
85+ Number 150 141 163
Rate 228.4 208.4 234.1
Total Number 2295 2388 2640
Rate 16.5 16.9 18.4
Age-Adjusted Rate 24.8 25.2 27.3
3.5 100,000 Pop., by Age and Year, U.S., 80-88, Black Females
Table 3.5 Number of Deaths with Diabetes as Underlying Cause and
Mortality Rate per 100,000 Population, by Age and Year,
Black Females, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-14 Number 5 6 11 10 1 3
Rate 0.1 0.2 0.3 0.3 0.0 0.1
15-24 Number 15 21 15 17 15 21
Rate 0.5 0.7 0.5 0.6 0.5 0.7
25-34 Number 58 48 48 56 58 49
Rate 2.5 2.0 1.9 2.2 2.2 1.8
35-44 Number 107 105 84 110 127 108
Rate 7.1 6.9 5.3 6.6 7.3 5.9
45-54 Number 328 292 285 293 256 294
Rate 26.0 23.0 22.3 22.7 19.6 22.2
55-64 Number 739 753 761 785 735 768
Rate 69.4 69.6 69.1 70.3 65.0 67.1
65-74 Number 1143 1125 1005 1088 1159 1163
Rate 146.5 141.5 124.4 132.6 139.3 137.8
75-84 Number 806 845 815 957 934 1065
Rate 221.9 226.2 211.2 241.4 229.2 254.4
85+ Number 330 338 322 351 364 401
Rate 306.1 299.8 269.2 279.3 274.4 291.0
Total Number 3534 3536 3349 3667 3650 3874
Rate 25.0 24.6 23.0 24.8 24.3 25.5
Age-Adjusted Rate 31.3 30.7 28.4 30.5 29.7 30.9
Table 3.5 Number of Deaths with Diabetes as Underlying Cause and
Mortality Rate per 100,000 Population, by Age and Year,
Black Females, United States, 1986-1988
Year
1986 1987 1988
Age
0-14 Number 3 7 6
Rate 0.1 0.2 0.1
15-24 Number 12 14 12
Rate 0.4 0.5 0.4
25-34 Number 48 63 68
Rate 1.7 2.2 2.3
35-44 Number 129 111 149
Rate 6.8 5.6 7.2
45-54 Number 330 298 336
Rate 24.5 21.7 23.8
55-64 Number 800 787 813
Rate 69.2 67.6 69.5
65-74 Number 1158 1210 1285
Rate 135.0 138.9 145.1
75-84 Number 1014 1151 1133
Rate 235.4 260.7 249.9
85+ Number 509 467 530
Rate 351.7 308.0 336.1
Total Number 4004 4109 4332
Rate 26.0 26.3 27.3
Age-Adjusted Rate 31.1 31.3 32.3
3.6-3.10 No. Deaths w/Diabetes as Any Listed Cause & Mort. Rate
3.6 100,000 Pop., by Age and Year, U.S., 80-88
Table 3.6 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by Age and Year,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
AGE
0-14 Number 69 75 93 92 61
Rate 0.1 0.1 0.2 0.2 0.1
15-24 Number 209 231 180 208 201
Rate 0.5 0.5 0.4 0.5 0.5
25-34 Number 918 910 968 953 991
Rate 2.5 2.3 2.4 2.4 2.4
35-44 Number 2038 2046 2042 2282 2426
Rate 7.9 7.8 7.3 7.8 7.9
45-54 Number 6956 6979 6729 6809 6648
Rate 30.6 30.9 29.9 30.4 29.6
55-64 Number 21873 21926 21759 22513 22383
Rate 100.5 99.9 98.4 101.3 100.4
65-74 Number 41000 40875 40898 42370 43036
Rate 262.0 256.9 252.5 256.9 257.2
75-84 Number 42938 42661 43340 45539 46462
Rate 551.9 535.4 530.1 542.9 540.0
85+ Number 19919 20223 20724 21787 22332
Rate 877.7 859.6 846.1 858.5 851.6
Total Number 135931 135939 136764 142570 144548
Rate 59.8 59.2 59.0 60.9 61.1
Age-adjusted Rate 59.8 58.7 57.8 59.0 58.7
Table 3.6 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by Age and Year,
United States, 1985-1988
Year
1985 1986 1987 1988
AGE
0-14 Number 59 57 53 60
Rate 0.1 0.1 0.1 0.1
15-24 Number 206 217 209 195
Rate 0.5 0.6 0.5 0.5
25-34 Number 960 1094 1117 1135
Rate 2.3 2.6 2.6 2.6
35-44 Number 2525 2652 2738 2903
Rate 7.9 8.0 8.0 8.2
45-54 Number 6736 6890 7231 7516
Rate 29.8 30.2 31.1 31.1
55-64 Number 22803 22809 22647 22646
Rate 102.2 102.7 102.9 103.8
65-74 Number 44058 44218 45735 46195
Rate 259.1 255.1 259.0 258.2
75-84 Number 47607 48220 48830 50549
Rate 539.2 532.6 525.7 531.4
85+ Number 23309 23945 24700 26057
Rate 865.4 862.6 862.8 884.1
Total Number 148284 150120 153271 157265
Rate 62.1 62.3 63.0 64.0
Age-adjusted Rate 59.1 58.7 58.9 59.3
3.7 100,000 Pop., by Age and Year, U.S., 80-88, White Males
Table 3.7 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by Age and Year,
White Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-14 Number 21 32 26 31 19
Rate 0.1 0.1 0.1 0.1 0.1
15-24 Number 70 78 77 69 80
Rate 0.4 0.4 0.4 0.4 0.5
25-34 Number 407 402 409 406 428
Rate 2.5 2.4 2.4 2.4 2.4
35-44 Number 854 872 852 1024 1078
Rate 7.7 7.7 7.1 8.1 8.2
45-54 Number 2997 3013 2943 2862 2883
Rate 30.7 31.1 30.6 29.9 30.1
55-64 Number 9702 9819 9705 9776 9655
Rate 105.8 106.3 104.5 104.9 103.3
65-74 Number 17064 17083 17498 17763 18081
Rate 278.6 273.9 275.3 273.6 273.9
75-84 Number 15244 15397 15604 16366 17048
Rate 582.3 574.5 567.7 579.9 588.5
85+ Number 5806 5610 5619 5946 6122
Rate 927.5 879.2 859.3 890.2 898.1
Total Number 52166 52310 52738 54247 55396
Rate 54.8 54.5 54.5 55.6 56.4
Age-adjusted Rate 63.0 62.0 61.4 62.0 62.3
Table 3.7 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by Age and Year,
White Males, United States, 1985-1988
Year
1985 1986 1987 1988
AGE
0-14 Number 16 17 19 20
Rate 0.1 0.1 0.1 0.1
15-24 Number 73 90 86 75
Rate 0.4 0.6 0.5 0.5
25-34 Number 412 487 512 495
Rate 2.3 2.7 2.8 2.7
35-44 Number 1111 1129 1261 1302
Rate 8.2 8.0 8.6 8.6
45-54 Number 2887 2857 3017 3115
Rate 30.1 29.6 30.6 30.4
55-64 Number 9906 9812 9810 9583
Rate 106.0 105.7 107.0 105.6
65-74 Number 18688 18746 19364 19688
Rate 277.8 272.6 275.6 276.4
75-84 Number 17271 17607 17952 18942
Rate 580.4 575.8 570.2 585.4
85+ Number 6284 6325 6591 7095
Rate 908.7 895.5 912.4 960.7
Total Number 56652 57075 58614 60317
Rate 57.2 57.2 58.3 59.5
Age-adjusted Rate 62.6 62.0 62.5 63.4
3.8 100,000 Pop., by Age and Year, U.S., 80-88, White Females
Table 3.8 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by Age and Year,
White Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-14 Number 30 30 37 37 32
Rate 0.1 0.1 0.2 0.2 0.2
15-24 Number 87 92 60 94 77
Rate 0.5 0.5 0.4 0.6 0.5
25-34 Number 304 310 326 335 328
Rate 1.9 1.9 1.9 2.0 1.9
35-44 Number 614 577 646 639 694
Rate 5.4 5.0 5.3 5.0 5.2
45-54 Number 2195 2154 2043 2154 2001
Rate 21.4 21.3 20.4 21.6 20.1
55-64 Number 8012 7997 7812 8157 8221
Rate 77.4 76.8 74.8 77.9 78.6
65-74 Number 18034 18039 17759 18468 18450
Rate 225.9 222.9 216.3 221.6 218.9
75-84 Number 23437 23065 23461 24247 24411
Rate 522.6 502.8 499.1 503.4 495.1
85+ Number 12686 13149 13596 14171 14470
Rate 868.1 862.8 853.0 855.4 842.5
Total Number 65401 65417 65755 68308 68685
Rate 65.4 64.9 64.7 66.8 66.7
Age-adjusted Rate 52.7 51.7 50.7 51.7 51.0
Table 3.8 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by Age and Year,
White Females, United States, 1985-1988
Year
1985 1986 1987 1988
AGE
0-14 Number 30 27 19 29
Rate 0.1 0.1 0.1 0.1
15-24 Number 77 88 83 65
Rate 0.5 0.6 0.5 0.4
25-34 Number 318 367 331 360
Rate 1.8 2.1 1.8 2.0
35-44 Number 749 778 764 778
Rate 5.4 5.4 5.2 5.1
45-54 Number 2006 2102 2171 2242
Rate 20.1 20.9 21.3 21.2
55-64 Number 8238 8164 7989 8050
Rate 79.0 79.0 78.4 80.1
65-74 Number 18621 18425 19198 18975
Rate 218.2 212.9 218.5 214.0
75-84 Number 24907 24949 25078 25295
Rate 493.4 483.2 475.0 469.6
85+ Number 15099 15443 15934 16547
Rate 853.8 846.0 845.6 852.8
Total Number 70055 70349 71572 72344
Rate 67.5 67.3 68.0 68.3
Age-adjusted Rate 51.1 50.4 50.4 50.1
3.9 100,000 Pop., by Age and Year, U.S., 80-88, Black Males
Table 3.9 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by Age and Year,
Black Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-14 Number 11 8 11 5 8
Rate 0.3 0.2 0.3 0.1 0.2
15-24 Number 28 26 14 19 15
Rate 1.0 0.9 0.5 0.7 0.5
25-34 Number 100 103 106 112 123
Rate 5.0 4.9 4.8 4.9 5.2
35-44 Number 290 286 268 307 330
Rate 23.3 22.6 20.2 22.2 22.8
45-54 Number 704 781 712 808 796
Rate 68.6 75.7 68.6 77.0 74.9
55-64 Number 1590 1555 1561 1787 1768
Rate 185.1 177.6 174.6 196.1 190.8
65-74 Number 1946 1996 1889 2125 2208
Rate 341.6 344.7 321.2 355.4 363.1
75-84 Number 1309 1227 1304 1452 1483
Rate 570.4 523.0 542.1 592.3 590.2
85+ Number 346 357 373 403 406
Rate 645.0 639.8 643.8 663.5 646.4
Total Number 6326 6341 6239 7021 7138
Rate 50.0 49.3 47.7 52.9 53.0
Age-adjusted Rate 77.8 76.2 73.9 81.4 81.0
Table 3.9 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by Age and Year,
Black Males, United States, 1985-1988
Year
1985 1986 1987 1988
AGE
0-14 Number 8 5 6 2
Rate 0.2 0.1 0.1 0.0
15-24 Number 26 22 14 28
Rate 0.9 0.8 0.5 1.0
25-34 Number 122 119 145 140
Rate 5.0 4.8 5.7 5.4
35-44 Number 326 381 354 446
Rate 21.5 23.9 21.3 25.7
45-54 Number 791 784 930 953
Rate 73.5 71.8 83.3 83.3
55-64 Number 1819 1879 1889 1894
Rate 193.6 197.6 196.7 195.5
65-74 Number 2340 2439 2550 2618
Rate 377.1 385.5 394.7 396.5
75-84 Number 1585 1725 1720 1869
Rate 621.0 659.6 643.7 689.2
85+ Number 446 494 501 518
Rate 688.6 752.3 740.5 743.9
Total Number 7466 7851 8110 8469
Rate 54.6 56.5 57.5 59.1
Age-adjusted Rate 83.5 86.4 87.3 89.4
3.10 100,000 Pop., by Age and Year, U.S., 80-88, Black Females
Table 3.10 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by Age and Year,
Black Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-14 Number 6 4 18 16 1
Rate 0.2 0.1 0.5 0.4 0.0
15-24 Number 22 35 24 25 25
Rate 0.7 1.2 0.8 0.9 0.9
25-34 Number 96 83 115 93 100
Rate 4.2 3.4 4.6 3.6 3.7
35-44 Number 246 277 246 264 289
Rate 16.4 18.1 15.4 15.9 16.6
45-54 Number 935 905 901 866 821
Rate 74.2 71.4 70.6 67.1 62.8
55-64 Number 2289 2298 2380 2446 2392
Rate 215.0 212.3 216.2 218.9 211.4
65-74 Number 3543 3385 3281 3524 3746
Rate 454.0 425.9 406.1 429.5 450.2
75-84 Number 2544 2602 2524 2993 3020
Rate 700.4 696.4 654.2 755.1 741.2
85+ Number 930 958 978 1083 1103
Rate 862.7 849.6 817.6 861.7 831.6
Total Number 10617 10550 10477 11313 11501
Rate 75.2 73.5 71.9 76.5 76.7
Age-adjusted Rate 94.6 92.0 89.1 94.4 93.9
Table 3.10 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by Age and Year,
Black Females, United States, 1985-1988
Year
1985 1986 1987 1988
AGE
0-14 Number 4 5 7 9
Rate 0.1 0.1 0.2 0.2
15-24 Number 28 17 22 21
Rate 1.0 0.6 0.8 0.8
25-34 Number 97 103 111 128
Rate 3.5 3.7 3.9 4.4
35-44 Number 286 307 304 334
Rate 15.7 16.1 15.3 16.1
45-54 Number 901 972 925 993
Rate 67.9 72.1 67.3 70.3
55-64 Number 2435 2556 2522 2640
Rate 212.8 221.0 216.6 225.6
65-74 Number 3789 4018 3953 4160
Rate 448.8 468.4 453.6 469.8
75-84 Number 3303 3314 3458 3721
Rate 789.0 769.2 783.2 820.8
85+ Number 1248 1450 1409 1607
Rate 905.5 1001.8 929.2 1019.0
Total Number 12095 12746 12714 13616
Rate 79.6 82.6 81.3 85.7
Age-adjusted Rate 96.7 99.6 97.4 102.0
3.11 No. Deaths with Diabetes as Any Listed Cause, State & Year
Table 3.11 Number of Deaths with Diabetes as Any Listed Cause and Mortality
Rate per 100,000 Population, by State and Year, United States,
1980-1982
Year
1980 1981 1982
Number Rate Number Rate Number Rate
State
Alabama 1829 46.9 1856 47.3 1937 49.1
Alaska 38 9.4 54 13.0 52 11.7
Arizona 1004 36.7 1079 38.4 1033 35.9
Arkansas 1050 45.9 1059 46.0 998 43.2
California 11922 50.1 12183 50.2 12812 51.7
Colorado 1003 34.5 993 33.3 1053 34.3
Connecticut 2189 70.4 2244 71.9 2381 76.1
Delaware 386 64.9 357 59.8 403 67.2
Dist of Columbia 469 73.4 418 66.0 428 68.3
Florida 6548 66.1 6740 66.1 6624 63.3
Georgia 2563 46.7 2558 45.9 2530 44.7
Hawaii 406 41.5 419 42.7 492 49.3
Idaho 341 36.0 356 36.9 345 35.3
Illinois 7612 66.6 7453 65.0 7750 67.5
Indiana 3393 61.8 3469 63.2 3357 61.2
Iowa 1759 60.4 1761 60.3 1786 61.4
Kansas 1296 54.7 1314 55.0 1388 57.6
Kentucky 2057 56.2 2115 57.5 2011 54.4
Louisiana 2151 50.9 2308 53.7 2326 53.1
Maine 781 69.4 724 63.8 809 71.0
Maryland 2315 54.8 2325 54.6 2315 54.2
Massachusetts 4074 71.0 3888 67.6 3913 68.1
Michigan 6089 65.8 6050 65.7 6104 66.9
Minnesota 2337 57.2 2297 55.9 2442 59.1
Mississippi 1499 59.3 1441 56.6 1401 54.6
Missouri 2971 60.4 2999 60.7 3025 61.2
Montana 322 40.8 369 46.4 360 44.7
Nebraska 875 55.7 923 58.3 918 57.7
Nevada 252 31.1 263 31.1 285 32.5
New Hampshire 560 60.6 595 63.5 617 65.1
New Jersey 5958 80.8 5752 77.7 5662 76.2
New Mexico 434 33.1 374 28.0 476 34.8
New York 13403 76.3 12923 73.6 12452 70.9
North Carolina 3601 61.1 3619 60.7 3672 61.0
North Dakota 400 61.1 374 56.6 420 62.5
Ohio 8262 76.5 8241 76.3 7999 74.2
Oklahoma 1565 51.4 1670 53.7 1623 50.2
Oregon 1218 46.1 1273 47.7 1232 46.2
Pennsylvania 10464 88.2 10307 86.8 10280 86.5
Rhode Island 858 90.5 822 86.3 840 88.1
South Carolina 1589 50.7 1614 50.7 1629 50.6
South Dakota 389 56.3 396 57.2 472 68.0
Tennessee 2075 45.1 2188 47.2 2148 46.0
Texas 5677 39.6 5853 39.6 5830 37.9
Utah 530 36.0 502 33.1 556 35.7
Vermont 326 63.7 319 61.8 340 65.4
Virginia 2649 49.4 2617 48.1 2649 48.3
Washington 1863 44.8 1820 43.0 1955 45.7
West Virginia 1361 69.8 1410 71.9 1318 67.2
Wisconsin 3093 65.7 3110 65.7 3164 66.7
Wyoming 125 26.4 145 29.4 152 29.8
Table 3.11 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by State and Year,
United States, 1983-1985
Year
1983 1984 1985
Number Rate Number Rate Number Rate
State
Alabama 1901 48.0 2019 50.6 2002 49.8
Alaska 65 13.5 58 11.5 68 13.0
Arizona 1255 42.5 1252 41.1 1263 40.0
Arkansas 1065 45.8 1075 45.8 1118 47.4
California 12943 51.1 13718 53.2 14379 54.6
Colorado 1094 34.7 1162 36.4 1190 36.8
Connecticut 2414 76.9 2566 81.4 2492 78.6
Delaware 365 60.2 336 54.7 416 66.9
Dist of Columbia 447 71.6 397 63.6 452 72.5
Florida 7037 65.4 7002 63.4 7486 65.9
Georgia 2765 48.2 2842 48.6 2920 48.9
Hawaii 517 50.8 560 54.1 562 53.4
Idaho 380 38.5 440 44.0 423 42.1
Illinois 7942 69.1 7699 66.8 7960 69.0
Indiana 3712 67.8 3707 67.5 3789 68.9
Iowa 1845 63.5 1873 64.5 1921 66.7
Kansas 1354 55.8 1402 57.4 1372 56.0
Kentucky 2175 58.5 2047 55.0 2171 58.2
Louisiana 2455 55.3 2464 55.2 2532 56.4
Maine 851 74.2 855 73.9 917 78.7
Maryland 2438 56.7 2437 56.0 2526 57.5
Massachusetts 4021 69.8 4303 74.3 4262 73.2
Michigan 6101 67.4 6379 70.4 6361 70.0
Minnesota 2543 61.3 2599 62.4 2676 63.8
Mississippi 1549 60.0 1515 58.3 1623 62.1
Missouri 3083 62.1 3098 61.9 3100 61.6
Montana 336 41.2 333 40.4 352 42.6
Nebraska 947 59.3 944 58.8 912 56.8
Nevada 310 34.6 348 38.0 363 38.8
New Hampshire 675 70.4 641 65.5 670 67.1
New Jersey 6000 80.4 6031 80.3 6278 83.0
New Mexico 488 34.8 521 36.5 540 37.2
New York 12607 71.4 12345 69.7 12507 70.5
North Carolina 3766 61.9 3968 64.3 4130 66.0
North Dakota 380 55.8 380 55.3 435 63.5
Ohio 8514 79.3 8444 78.6 8762 81.5
Oklahoma 1747 52.7 1739 52.5 1755 53.1
Oregon 1378 51.8 1443 53.9 1438 53.5
Pennsylvania 10560 88.8 10750 90.4 10845 91.4
Rhode Island 893 93.5 888 92.5 857 88.6
South Carolina 1703 52.3 1807 54.8 1814 54.4
South Dakota 422 60.4 431 61.1 443 62.5
Tennessee 2423 51.7 2518 53.2 2515 52.8
Texas 6411 40.5 6393 39.8 6619 40.4
Utah 560 35.1 613 37.8 618 37.6
Vermont 334 63.6 344 64.9 388 72.5
Virginia 2825 50.8 2872 51.0 2875 50.4
Washington 2079 48.3 2132 49.0 2278 51.7
West Virginia 1541 78.5 1421 72.8 1387 71.6
Wisconsin 3194 67.3 3264 68.5 3360 70.4
Wyoming 160 31.0 173 33.7 162 31.8
Table 3.11 Number of Deaths with Diabetes as Any Listed Cause and
Mortality Rate per 100,000 Population, by State and Year,
United States, 1986-1988
Year
1986 1987 1988
Number Rate Number Rate Number Rate
State
Alabama 2111 52.1 2045 50.1 2199 53.4
Alaska 85 16.0 91 17.3 109 20.1
Arizona 1393 42.5 1404 41.5 1536 43.6
Arkansas 1088 45.9 1126 47.1 1224 50.9
California 14929 55.3 15876 57.4 16624 58.9
Colorado 1228 37.6 1230 37.3 1293 38.7
Connecticut 2553 80.0 2475 77.1 2448 75.7
Delaware 447 70.6 421 65.4 425 65.2
Dist of Columbia 505 80.8 510 82.0 480 77.5
Florida 7458 63.8 8063 67.1 7866 64.0
Georgia 2875 47.1 3151 50.6 3158 49.6
Hawaii 588 55.2 644 59.5 598 54.3
Idaho 423 42.2 441 44.2 464 46.2
Illinois 8089 70.0 8218 71.0 8297 71.5
Indiana 3714 67.5 3664 66.2 3831 69.1
Iowa 1775 62.3 1861 65.7 1779 63.3
Kansas 1369 55.7 1382 55.8 1464 58.9
Kentucky 2097 56.3 2111 56.6 2435 65.2
Louisiana 2586 57.5 2497 56.0 2771 61.8
Maine 879 75.0 890 75.0 930 77.7
Maryland 2563 57.4 2716 59.9 2725 59.2
Massachusetts 4446 76.2 4301 73.5 4361 74.2
Michigan 6443 70.5 6392 69.5 6731 72.8
Minnesota 2755 65.4 2769 65.2 2806 65.6
Mississippi 1639 62.5 1604 61.1 1753 66.2
Missouri 3176 62.7 3141 61.6 3137 61.0
Montana 357 43.7 365 45.1 435 53.8
Nebraska 950 59.5 996 62.5 975 61.2
Nevada 371 38.4 469 46.6 424 41.1
New Hampshire 744 72.4 691 65.4 735 67.7
New Jersey 6108 80.1 6268 81.7 6258 80.8
New Mexico 561 37.9 546 36.4 608 39.4
New York 12374 69.5 12056 67.6 12495 70.1
North Carolina 4300 67.9 4744 74.0 4895 75.3
North Dakota 347 51.1 398 59.2 406 60.7
Ohio 8811 82.0 8723 80.9 8747 81.0
Oklahoma 1843 55.7 1844 56.4 1974 60.2
Oregon 1401 51.8 1618 59.4 1712 62.5
Pennsylvania 10802 90.8 10953 91.8 10957 91.9
Rhode Island 784 80.4 828 84.0 892 90.4
South Carolina 1955 57.8 2000 58.4 2084 60.1
South Dakota 432 61.1 433 61.1 439 61.8
Tennessee 2669 55.6 2688 55.4 2822 57.6
Texas 6619 39.7 7049 42.0 7212 42.2
Utah 634 38.1 600 35.7 683 39.9
Vermont 374 69.1 395 72.1 383 69.2
Virginia 3073 53.0 3108 52.6 3158 52.7
Washington 2311 51.8 2233 49.2 2328 50.7
West Virginia 1526 79.6 1620 85.4 1521 80.7
Wisconsin 3413 71.4 3461 72.0 3481 72.3
Wyoming 147 29.0 162 33.0 197 39.8
3.12 Avg. Mort. Rate for Diabetes as Listed Cause, State & Rank
Table 3.12 Average Mortality Rate for Diabetes as Any Listed Cause
per 100,000 Population, By State and Rank, United States,
1980-1988
Adjusted Rate
Rate Rank (a) Rank
State
Alabama 49.7 38 43.9 47
Alaska 14.2 51 51.9 33
Arizona 40.4 44 41.2 50
Arkansas 46.5 41 37.5 51
California 53.8 33 59.6 19
Colorado 36.0 48 46.3 44
Connecticut 76.5 5 69.9 6
Delaware 63.9 19 63.7 13
Dist of Columbia 72.9 8 42.1 49
Florida 65.0 18 45.9 45
Georgia 47.9 40 50.6 36
Hawaii 51.4 36 51.6 34
Idaho 40.7 43 57.4 21
Illinois 68.5 13 65.8 10
Indiana 65.9 17 65.4 12
Iowa 63.1 20 55.2 26
Kansas 56.3 29 50.6 37
Kentucky 57.6 27 56.7 23
Louisiana 55.6 30 57.2 22
Maine 73.2 7 61.9 17
Maryland 56.8 28 59.0 20
Massachusetts 72.0 9 63.1 15
Michigan 68.8 12 70.4 5
Minnesota 61.8 21 60.7 18
Mississippi 60.1 24 53.5 29
Missouri 61.5 22 52.0 32
Montana 44.3 42 43.0 48
Nebraska 58.9 25 52.7 31
Nevada 37.2 46 46.9 42
New Hampshire 66.5 15 66.2 9
New Jersey 80.1 3 73.2 4
New Mexico 35.5 49 44.7 46
New York 71.1 10 63.0 16
North Carolina 66.0 16 63.4 14
North Dakota 58.4 26 47.9 41
Ohio 78.9 4 75.7 2
Oklahoma 54.0 32 51.0 35
Oregon 52.6 34 54.6 27
Pennsylvania 89.6 1 74.5 3
Rhode Island 88.3 2 75.7 1
South Carolina 54.5 31 55.3 25
South Dakota 61.1 23 50.5 38
Tennessee 51.7 35 48.1 40
Texas 40.2 45 46.3 43
Utah 36.6 47 55.4 24
Vermont 67.0 14 69.5 8
Virginia 50.8 37 53.0 30
Washington 48.3 39 54.1 28
West Virginia 75.2 6 69.8 7
Wisconsin 68.9 11 65.5 11
Wyoming 31.6 50 48.1 39
(a) Ajusted for age and race.
3.13-3.17 Mort. Rate for Diabetes as Underlying Cause,U.S.,80-88
3.13 100,000 Diabetic Pop., Age and Year
Table 3.13 Mortality Rate for Diabetes as Underlying Cause per 100,000
Diabetic Population, by Age and Year, United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 163.7 174.9 167.9 182.4 181.5 179.8
45-64 333.8 306.1 300.1 306.9 318.0 335.2
65-74 664.2 721.1 636.6 780.4 565.5 548.8
75+ 1753.9 1619.0 1913.6 1859.0 1517.7 1555.8
Total 602.7 596.4 587.5 627.0 577.2 585.0
Age-Adjusted 602.6 588.0 605.9 641.0 538.0 546.1
Table 3.13 Mortality Rate for Diabetes as Underlying Cause per 100,000
Diabetic Population, by Age and Year, United States, 1986-1988
Year
1986 1987 1988
Age
0-44 189.5 145.2 202.4
45-64 278.8 320.3 350.0
65-74 644.6 633.6 650.9
75+ 1322.8 1473.7 1686.9
Total 549.1 565.7 635.7
Age-Adjusted 515.0 544.0 602.6
3.14 100,000 Diabetic Pop., Age and Year, White Males
Table 3.14 Mortality Rate for Diabetes as Underlying Cause per 100,000
Diabetic Population, by Age and Year, White Males, United States,
1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 224.3 191.0 187.6 189.2 222.8 214.8
45-64 334.6 308.3 311.5 327.5 357.0 344.5
65-74 619.0 645.8 857.8 900.0 614.9 559.8
75+ 1828.4 2038.2 1542.7 1463.1 1580.4 1457.0
Total 583.2 556.7 578.0 595.1 597.8 556.0
Age-Adjusted 612.7 634.3 617.1 623.2 583.7 544.3
Table 3.14 Mortality Rate for Diabetes as Underlying Cause per 100,000
Diabetic Population, by Age and Year, White Males, United States,
1986-1988
Year
1986 1987 1988
Age
0-44 286.3 161.5 204.4
45-64 246.1 303.8 351.9
65-74 613.6 585.8 733.8
75+ 1245.8 1260.1 1460.1
Total 498.0 491.8 592.7
Age-Adjusted 498.8 495.6 591.7
3.15 100,000 Diabetic Pop., Age and Year, White Females
Table 3.15 Mortality Rate for Diabetes as Underlying Cause per 100,000
Diabetic Population, by Age and Year, White Females,
United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 114.1 131.4 117.9 154.4 129.3 117.3
45-64 303.3 280.3 285.6 273.1 258.1 307.6
65-74 611.7 722.0 557.6 736.5 543.5 498.7
75+ 1667.0 1491.7 2131.9 2060.3 1584.6 1639.3
Total 614.8 634.5 629.8 686.2 591.1 606.6
Age-Adjusted 554.6 551.0 602.9 640.5 508.3 523.0
Table 3.15 Mortality Rate for Diabetes as Underlying Cause per 100,000
Diabetic Population, by Age and Year, White Females,
United States, 1986-1988
Year
1986 1987 1988
Age
0-44 110.7 117.0 181.9
45-64 261.0 297.5 331.1
65-74 660.8 612.6 578.1
75+ 1406.1 1838.1 1992.2
Total 579.5 649.7 713.8
Age-Adjusted 510.6 578.4 617.5
3.16 100,000 Diabetic Pop., Age and Year, Black Males
Table 3.16 Mortality Rate for Diabetes as Underlying Cause per 100,000
Diabetic Population, by Age and Year, Black Males, United States,
1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 275.4 320.0 311.2 588.5 416.6 370.9
45-64 378.8 360.2 365.5 390.2 347.8 335.0
65-74 937.3 828.1 743.3 667.0 704.1 622.5
75+ 1793.6 2127.3 2013.9 2207.2 1597.2 1851.8
Total 574.3 565.4 556.7 605.4 548.4 533.5
Age-Adjusted 718.5 739.5 701.0 768.3 639.7 642.9
Table 3.16 Mortality Rate for Diabetes as Underlying Cause per 100,000
Diabetic Population, by Age and Year, Black Males, United States,
1986-1988
Year
1986 1987 1988
Age
0-44 298.9 246.6 385.1
45-64 387.6 410.3 364.6
65-74 703.8 668.1 856.0
75+ 1577.9 1744.4 1367.2
Total 551.0 543.8 569.4
Age-Adjusted 632.6 648.3 646.9
3.17 100,000 Diabetic Pop., Age and Year, Black Females
Table 3.17 Mortality Rate for Diabetes as Underlying Cause per 100,000
Diabetic Population, by Age and Year, Black Females,
United States, 1980-1985
Year
1980 1981 1982 1983 1984 1985
Age
0-44 165.0 186.1 184.2 166.3 184.5 198.2
45-64 424.3 368.3 324.5 358.2 352.1 410.4
65-74 1105.1 821.5 628.5 544.3 622.0 636.0
75+ 1595.3 1678.9 1677.1 1564.8 1408.5 1245.3
Total 656.6 601.5 526.7 523.5 545.7 595.3
Age-Adjusted 732.7 651.0 581.5 553.4 551.2 557.1
Table 3.17 Mortality Rate for Diabetes as Underlying Cause per 100,000
Diabetic Population, by Age and Year, Black Females,
United States, 1986-1988
Year
1986 1987 1988
Age
0-44 220.3 179.0 174.0
45-64 403.0 387.9 472.3
65-74 804.8 849.2 831.3
75+ 1204.5 1103.7 1182.8
Total 627.7 606.3 643.2
Age-Adjusted 596.2 579.5 620.5
3.18-3.22 Mort. Rate for Diabetes as Any Listed Cause,U.S.,80-88
3.18 100,000 Diabetic Pop., Age & Year
Tables 3.18 Mortality Rate for Diabetes as Any Listed Cause per 100,000
Diabetic Population, by Age and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 320.4 342.6 333.7 352.7 370.0
45-64 1206.5 1136.1 1110.0 1128.1 1230.8
65-74 2693.4 2995.1 2681.1 3246.6 2449.8
75+ 7298.6 6636.2 7904.7 7701.7 6309.9
Total 2350.7 2340.3 2323.4 2466.3 2331.4
Age-adjusted 2350.5 2306.1 2400.0 2529.5 2157.9
Table 3.18 Mortality Rate for Diabetes as Any Listed Cause per 100,000
Diabetic Population, by Age and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 361.2 384.0 301.9 393.1
45-64 1267.8 1043.0 1171.0 1226.0
65-74 2380.1 2775.5 2686.0 2710.9
75+ 6442.8 5619.7 6161.0 7002.4
Total 2346.3 2216.9 2250.1 2476.5
Age-adjusted 2173.1 2065.7 2161.3 2331.8
3.19 100,000 Diabetic Pop., Age & Year, White Males
Table 3.19 Mortality Rate for Diabetes as Any Listed Cause per 100,000
Diabetic Population, by Age and Year, White Males, United States,
1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 434.5 375.0 354.9 375.0 453.8
45-64 1384.2 1261.5 1294.5 1373.4 1541.3
65-74 2868.6 3088.3 4071.9 4264.1 3056.0
75+ 8232.5 9205.7 7054.7 6798.3 7152.0
Total 2509.0 2413.3 2520.9 2616.9 2659.7
Age-adjusted 2629.1 2770.8 2719.5 2768.1 2585.8
Table 3.19 Mortality Rate for Diabetes as Any Listed Cause per 100,000
Diabetic Population, by Age and Year, White Males, United States,
1985-1988
Year
1985 1986 1987 1988
Age
0-44 411.3 572.2 324.7 391.0
45-64 1464.9 1024.4 1218.7 1356.2
65-74 2751.7 2999.4 2746.6 3531.4
75+ 6722.7 5908.6 5844.1 6749.0
Total 2468.7 2222.7 2126.8 2552.1
Age-adjusted 2402.8 2192.8 2153.7 2563.5
3.20 100,000 Diabetic Pop., Age & Year, White Females
Table 3.20 Mortality Rate for Diabetes as Any Listed Cause per 100,000
Diabetic Population, by Age and Year, White Females,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 217.5 240.3 225.0 273.8 257.8
45-64 1041.7 1017.6 999.8 953.9 978.3
65-74 2407.0 2924.2 2263.4 2933.4 2299.2
75+ 6966.3 6083.4 8717.1 8387.4 6560.5
Total 2401.4 2487.7 2462.3 2655.7 2386.0
Age-adjusted 2139.6 2138.3 2346.6 2463.4 2031.6
Table 3.20 Mortality Rate for Diabetes as Any Listed Cause per 100,000
Diabetic Population, by Age and Year, White Females,
United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 234.6 213.3 234.2 346.4
45-64 1121.7 958.6 1063.7 1115.2
65-74 2103.3 2723.1 2578.5 2294.0
75+ 6738.7 5932.3 7660.4 8173.0
Total 2421.7 2330.1 2606.3 2763.7
Age-adjusted 2061.8 2033.8 2300.2 2342.5
3.21 100,000 Diabetic Pop., Age & Year, Black Males
Table 3.21 Mortality Rate for Diabetes as Any Listed Cause per 100,000
Diabetic Population, by Age and Year, Black Males, United States,
1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 587.7 657.2 646.7 1206.9 862.3
45-64 1232.7 1259.5 1262.7 1270.4 1190.5
65-74 3161.2 2951.5 2674.4 2491.2 2503.4
75+ 5643.4 6876.8 6714.3 7596.2 5387.6
Total 1807.6 1862.3 1849.6 2002.1 1812.4
Age-adjusted 2284.7 2436.4 2338.7 2522.8 2103.9
Table 3.21 Mortality Rate for Diabetes as Any Listed Cause per 100,000
Diabetic Population, by Age and Year, Black Males, United States,
1985-1988
Year
1985 1986 1987 1988
Age
0-44 767.3 635.1 571.4 765.1
45-64 1175.3 1306.6 1344.9 1153.5
65-74 2368.5 2690.5 2458.5 3082.7
75+ 5913.5 5674.9 6351.2 4642.3
Total 1786.0 1884.8 1846.8 1826.5
Age-adjusted 2123.9 2204.3 2248.6 2113.1
3.22 100,000 Diabetic Pop., Age & Year, Black Females
Table 3.22 Mortality Rate for Diabetes as Any Listed Cause per 100,000
Diabetic Population, by Age and Year, Black Females,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 330.1 412.5 469.7 343.0 381.0
45-64 1282.1 1128.9 1017.9 1100.6 1141.6
65-74 3425.5 2471.8 2051.9 1763.1 2010.4
75+ 4878.6 5052.4 5165.6 4876.3 4474.0
Total 1972.7 1794.6 1647.8 1615.2 1719.5
Age-adjusted 2215.8 1941.7 1812.2 1705.1 1733.8
Table 3.22 Mortality Rate for Diabetes as Any Listed Cause per 100,000
Diabetic Population, by Age and Year, Black Females,
United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 454.3 495.7 407.6 364.3
45-64 1289.0 1258.1 1232.4 1493.3
65-74 2072.1 2792.3 2774.4 2691.1
75+ 3865.9 3767.6 3320.0 3789.4
Total 1858.7 1998.1 1876.1 2021.6
Age-adjusted 1733.2 1902.7 1805.3 1953.5
HOSPITALIZATIONS
Introduction
Hospitalization related to diabetes mellitus is one indicator of the
morbidity and health care burden associated with this disease. In
this chapter, we examine trends in hospitalizations related to diabetes
in the United States during 1980-1987. We evaluate the numbers and
rates of hospitalizations by calendar year, age, sex, race, and geographic
region of the country. We present rates based on denominators for
both the general population and the population with diabetes. We
examine hospitalizations related to diabetes both as a primary diagnosis
and as any listed hospital discharge diagnosis. We will emphasize
results based on any listed diagnosis because they more accurately
represent the disease burden associated with diabetes.
We present overall hospitalization data in this chapter. In subsequent
chapters, we evaluate hospital discharges related specifically to
cardiovascular disease (Chapter 5), lower extremity amputations (Chapter
6), and diabetic ketoacidosis (Chapter 7).
Methods
We used data from the National Hospital Discharge Survey (NHDS) to
estimate the number of diabetes-related hospitalizations in U.S.
noninstitutional, nonfederal hospitals (National Center for Health Statistics,
1988b). Conducted by the National Center for Health Statistics, NHDS
provides a continuous sample of hospital discharge records. The survey
collects information on the characteristics of patients, on their
diagnoses and surgical procedures, and on the characteristics
of the hospitals from which they are discharged. Sampling of hospital
discharges is based on a two-stage, stratified design. At the first
stage, sample hospitals are chosen from strata based on geographic
region and number of beds. At the second stage, sample discharges
are selected from each hospital in the survey. The overall sampling
fraction for all discharges is 1 in 100. We used SAS (SAS Institute
Inc., 1985) to compute the weighted number of discharges and hospital
discharge rates. To account for the multistage survey design, we
used SESUDAAN (Shah, 1981) to compute associated standard errors.
To determine numbers and rates of diabetes-related discharges, we
selected all discharges for which any of the up to seven listed discharge
diagnoses were coded to the International Classification of Diseases,
Ninth Revision rubric 250. We used estimates of the total population
of the United States (Irwin, 1989) as the denominators in calculating
general population rates. We used estimates of the prevalence of
diabetes from the National Health Interview Survey (Chapter 2) to
estimate numbers of people with diabetes and used these numbers in
calculating rates of hospital discharges among people with diabetes.
We standardized rates according to the direct method (Fleiss, 1981). We
used the 1980 U.S resident population to standardize rates based on
the total resident population. We used the 1980 U.S. population of
persons with diabetes to standardize rates based on the diabetic population.
Results
General Information
In 1987, the last year for which data are available, an
estimated 2.8 million hospital discharges listed diabetes as one of
the discharge diagnoses. Among these discharges, the most common
primary discharge diagnosis was for diseases of the circulatory system
(33.7%), followed by diabetes-specific conditions (17.2%) (Table 4.1).
General Population Rates
In 1987, diabetes was the primary diagnosis for 474,000
hospital discharges (Table 4.2). From 1980 through 1983, the number
and rate of hospital discharges with diabetes as the primary discharge
diagnosis were relatively stable, but both figures declined from 1984
through 1987. Trends similar to those noted in the total population
were also seen among white males and white females (Tables 4.3-4.4). Among
black males, however, temporal trends were not as clear as among whites
(Table 4.5). Among black females, the rates decreased steadily from
1981 through 1987 (Table 4.6).
Many more hospital discharges had diabetes as any listed diagnosis
than as the primary diagnosis. Both the numbers and rates of hospitalizations
with diabetes as any listed diagnosis increased from 1980 through
1984, decreased in 1985, and then increased again in subsequent years
(Figures 4.1-4.2).
In all years, the rate of hospitalization increased with increasing
age (Table 4.7). In 1987, the rate of hospitalization for which diabetes
was any listed diagnosis increased from 8.7 per 10,000 among those
19 years old or younger to 580.7 per 10,000 among those 75 years old
or older.
In all years, black women had the highest age-adjusted rate of
hospitalizations related to diabetes (Figure 4.3, Tables 4.8-4.11). In 1987,
the age-adjusted rate of 183 hospitalizations per 10,000 black women was 36%
higher than for black men (135 per 10,000), 95% higher than for white women
(94/10,000), and 108% higher than for white men (88 per 10,000).
Diabetes Population Rates
When rates of hospitalization were calculated by using people
known to have diabetes as the denominator, the rates of hospital
discharges with diabetes as a primary diagnosis showed a small increase
from 1980 to 1983, but then steadily decreased after 1983 (Table 4.12). The
temporal trends varied among the four race-sex groups (Tables 4.13-4.16).
Among people known to have diabetes, the rates of hospital discharges
with diabetes as any listed diagnosis showed a similar temporal trend
to that seen for diabetes as a primary diagnosis. The rates increased
from 1980 to 1983 and decreased after 1983 (Figure 4.4). The 1987
rate of 402 hospital discharges per 1,000 persons with diabetes was
14% lower than the peak rate in 1983 of 469 per 1,000 persons.
In all years, the age-specific rates were highest in the oldest age
group, decreased with decreasing age, and leveled off or increased
slightly in the youngest age group (Table 4.17). In 1987, the rates
ranged from 287 hospital discharges per 1,000 people with diabetes
among those younger than age 45 to 591 per 1,000 people with diabetes
among those 75 years old or older.
Among people known to have diabetes, differences in hospitalization
rates for diabetes as any listed diagnosis were not consistent between the
four race-sex groups (Figure 4.5, Tables 4.8-4.21). In all except
two years, white women had the highest hospital discharge rates. The
relative rankings of the other three race-sex groups varied from year
to year. In 1987, the rates of hospital discharges with diabetes
as any listed diagnosis per 1,000 people with diabetes were 409 for
white women, 311 for white men, 365 for black men, and 382 for black
women.
Rates by Region
The rates of hospital discharges with diabetes as a primary
diagnosis were highest in the South and lowest in the West (Table
4.22). The West also had the lowest rates of hospital discharges
with diabetes as any listed diagnosis (Table 4.23). When the rates
were age- and race-adjusted, the rankings between Northeast, Midwest,
and South tended to vary from year to year. In all years, the
hospitalization rates in the West were at least 25% lower than for
the other three regions.
Discussion
In 1987, diabetes was listed as one of the discharge diagnoses
for 2.8 million hospital discharges. In general, during 1980-1987,
hospital discharges with diabetes as any listed diagnosis tended to
increase; they reached a peak in 1984 and have slightly decreased
and leveled off subsequently.
Rates of diabetes-related hospitalizations based on general population
denominators are influenced by the prevalence of diabetes in the population,
the severity of the disease, and the availability and use of health
care. Except for a dip in 1985, the rates of diabetes-related hospital
discharges in the general population increased during 1980-1987, similar
to the trends in numbers of diabetes-related hospital discharges. The
rates per 10,000 general population increased with increasing age,
reflecting both the increasing prevalence of diabetes and the more
frequent occurrence of complications as people age.
Rates of diabetes hospitalizations calculated by using the population
of people known to have diabetes as the denominator are not affected
by prevalence of diabetes, but rather are dependent on disease severity
and health care utilization. In 1987, there were 400 hospital discharges
related to diabetes for every 1,000 people known to have diabetes. During
the years covered in this report, the rates of hospitalization per
1,000 people with diabetes increased during 1980-1983 and decreased
thereafter.
Among people with diabetes, the age-specific rates of hospitalization
were highest in the oldest age group (75 years or older) and decreased
with decreasing age until leveling off, or increasing slightly, for
the age group younger than age 45. The general tendency of hospitalization
rates to increase with increasing age reflects the higher prevalence
of complications among older people with diabetes. The tendency for
the age group below age 45 to have rates similar to or higher than
the 45 to 64 group may reflect the higher proportion, in the younger
age group, of people with insulin-dependent diabetes relative to
noninsulin-dependent diabetes.
We noted some differences in race- and sex-specific rates for diabetes-related
hospitalizations. When calculated by using general population denominators,
the hospital discharge rate for diabetes as any listed diagnosis was
higher among blacks than among whites, with black women having the
highest rates and white men having the lowest. Black men tended to
have rates about 50% higher than white men, and black women tended
to have rates nearly twice as high as white women. When hospital
discharge rates were calculated for the population of persons known
to have diabetes, however, white women tended to have the highest
rates; no consistent differences emerged between the other three race-sex
groups. These results suggest that the higher rates of diabetes-related
hospitalizations seen among blacks in the general population are at
least partly due to the higher prevalence of diabetes among blacks.
The most striking regional variation in the hospital discharge rates
occurred in the West, where rates of diabetes-related hospital discharges
were lowest among the four regions. The age- and race-adjusted rates
of hospital discharges for diabetes as any listed diagnosis were 25%
to 32% lower in the West than in the other regions.
We have emphasized the results based on discharges with diabetes as
any listed diagnosis rather than those based on primary diagnosis because
the former better indicate the diabetes-related disease burden. Also,
listing of primary diagnosis may be more subject to changes in coding
practices. For example, in 1983 Medicare instituted the prospective
payment system and diagnosis-related groups. After 1983, there was
a 30% decrease in hospital discharges with diabetes listed as the
primary diagnosis (from 675,000 in 1983 to 474,000 in 1987). The
number of discharges with diabetes as any listed diagnosis, on the
other hand, slightly decreased (7% decrease) in 1985, but increased
thereafter. As a consequence of these different trends, the proportion
of diabetes-related hospital discharges for which diabetes was listed
as the primary diagnosis decreased from 25% in 1983 to 17% in 1987.
The NHDS data also suggest that hospitalization practices for patients
with diabetes changed after 1983. As noted, the rate of hospital
discharges per 1,000 people with diabetes decreased after 1983. The
age-adjusted rate decreased 14% from 1983 to 1987 (from 469 to 402
per 1,000 people with diabetes). The increasing number of diabetes-related
hospitalizations, despite decreasing rates of hospitalization among
people with diabetes, is due to the disease's increasing prevalence.
The methods we used have some limitations when interpreting the results
in this chapter. First, the NHDS is limited to the civilian population
of the United States and thus probably underestimates diabetes-related
hospital discharge rates. This limitation, however, should not affect
the temporal patterns nor the relative differences between different
population groups. Second, the rates calculated for the population
of people with diabetes were computed from estimates derived from
the NHIS and thus represent people with diagnosed diabetes. About
half of the people with diabetes, however, do not know they have the
disease (Harris et al., 1987). Third, the NHDS sample represents
hospital discharges and not individual persons. Thus, some people
who were hospitalized on more than one occasion for the same condition
may have been counted more than once. This is not a serious problem
for public health purposes, however, since we are primarily concerned
with the impact of diabetes on overall health care utilization-and
multiple hospitalizations certainly are a part of health care use.
Although not a perfect surveillance mechanism, the NHDS provides
useful indicators of the morbidity and public health burden related
to diabetes in the United States.
Update
This section updates data presented in previous sections in light of one
additional year of hospitalization data. For a complete description of the
methods and operational definitions and for a discussion of the implications
of the findings, see previous sections.
In 1988, diabetes was the primary diagnosis for 454,000 hospital
discharges and occurred as any one of seven listed diagnoses for 2.8 million
hospital discharges (Tables 4.2 and 4.7). Hospital discharge rates with
diabetes as primary diagnosis among people known to have diabetes showed a
small increase from 1980 to 1983, but then decreased and leveled off (Table
4.12). This temporal trend varied somewhat among the four race-sex groups
(Tables 4.13-4.16). Regardless of race and sex, hospital discharge rates for
diabetes as primary diagnosis among people known to have diabetes were highest
among persons younger than 45 years of age. The next highest rates were found
among persons aged 75 or older, and only small differences were seen among
those aged 45-64 and those aged 65-74.
In general, rates of hospital discharges with diabetes as any listed
diagnosis among people known to have diabetes (Figure 1.6) showed a similar
temporal trend as those with diabetes as a primary diagnosis (Tables 4.17-
4.21). However, among black females, these rates have tended to increase
since 1983. The 1988 rate of 411 hospital discharges per 1,000 black females
with diabetes was 27% higher than the corresponding 1983 rate of 324 per 1,000
(Table 4.21). Among white males and white females with diabetes, hospital
discharge rates for diabetes as any listed diagnosis tended to increase with
age. For black males and black females with diabetes, the rates were higher
among the youngest (under 45 years of age) and oldest age groups (75 years and
older) than among the middle two age groups (45-64 and 65-74 years of age).
Detailed Tables
4.1 Dist. among Hospital Discharges with Diabetes as Diagnosis
Table 4.1 Distribution of Primary Diagnosis among all Hospital Discharges
with Diabetes as Any Listed Diagnosis, United States, 1988
Primary Diagnosis (ICD-9-CM Codes) Percent
Circulatory System (390-459) 33.9
Diabetes (250) 16.3
Digestive System (520-579) 8.4
Respiratory System (460-519) 8.3
Genitourinary System (580-629) 5.2
Injury and Poisoning (800-999) 5.1
Neoplasms (140-239) 4.7
Musculoskeletal System and Connective Tissue 3.3
(710-739)
Endocrine, Nutritional, and Metabolic Diseases
and Immunity Disorders (240-279, not 250) 2.8
Skin and Subcutaneous Tissue (680-709) 2.7
Nervous System and Sense Organs (320-389) 2.5
Mental Disorders (290-319) 1.9
Infectious and Parasitic Disease (001-139) 1.9
Other 3.0
4.2-4.6 Hosp. Discharges & Rates w/Diabetes as Primary Diagnosis
4.2 10,000 Pop., by Age and Year, U.S., 80-88
Table 4.2 Number of Discharges with Diabetes as Primary Diagnosis and
Hospital Discharge Rate per 10,000 Population, by Age and Year,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 44 44 41 48 45
Rate 6.1 6.1 5.7 6.8 6.4
20-44 Number 114 123 139 135 121
Rate 13.5 14.1 15.6 14.8 13.0
45-64 Number 245 239 241 237 199
Rate 55.0 53.6 54.1 53.0 44.4
65-74 Number 138 144 145 146 130
Rate 87.9 90.4 89.3 88.6 77.5
75+ Number 105 106 95 109 98
Rate 104.0 102.4 89.8 99.8 87.0
Total Number 645 655 661 675 593
Rate 28.4 28.5 28.5 28.8 25.1
Age-adjusted Rate 28.4 28.5 28.3 28.6 24.8
(a) In thousands
Table 4.2 Number of Discharges with Diabetes as Primary Diagnosis and
Hospital Discharge Rate per 10,000 Population, by Age and Year,
United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 39 40 49 41
Rate 5.6 5.7 6.9 5.8
20-44 Number 110 113 109 112
Rate 11.6 11.7 11.2 11.4
45-64 Number 160 159 150 134
Rate 35.5 35.4 33.2 29.2
65-74 Number 96 107 92 91
Rate 56.3 61.9 52.1 50.7
75+ Number 75 72 74 76
Rate 65.1 61.0 60.8 60.7
Total Number 480 491 474 454
Rate 20.1 20.4 19.5 18.5
Age-adjusted Rate 19.8 20.0 19.1 18.0
(a) In thousands
4.3 10,000 Pop., by Age and Year, U.S., 80-88, White Males
Table 4.3 Number of Discharges with Diabetes as Primary Diagnosis and
Hospital Discharge Rate per 10,000 Population, by Age and Year,
White Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 13 16 12 16 13
Rate 4.2 5.2 3.9 5.3 4.3
20-44 Number 36 42 53 42 41
Rate 10.0 11.2 13.8 10.7 10.4
45-64 Number 63 78 71 67 54
Rate 33.1 41.0 37.4 35.6 28.7
65-74 Number 32 45 38 39 32
Rate 52.5 72.8 59.7 59.9 48.7
75+ Number 24 28 25 25 25
Rate 72.8 84.7 74.2 72.4 70.2
Total Number 167 209 198 189 166
Rate 17.6 21.8 20.5 19.4 16.9
Age-adjusted Rate 18.4 22.6 21.1 20.0 17.3
(a) In thousands
Table 4.3 Number of Discharges with Diabetes as Primary Diagnosis and
Hospital Discharge Rate per 10,000 Population, by Age and Year,
White Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 11 15 16 12
Rate 3.6 5.1 5.5 4.0
20-44 Number 34 29 33 36
Rate 8.4 7.1 7.9 8.6
45-64 Number 47 42 40 43
Rate 24.8 22.1 20.9 22.4
65-74 Number 23 28 26 28
Rate 34.1 40.1 36.5 39.7
75+ Number 19 20 16 22
Rate 51.6 53.9 40.9 54.7
Total Number 133 133 130 141
Rate 13.4 13.4 12.9 13.9
Age-adjusted Rate 13.7 13.7 13.1 14.0
(a) In thousands
4.4 10,000 Pop., by Age and Year, U.S., 80-88, White Females
Table 4.4 Number of Discharges with Diabetes as Primary Diagnosis and
Hospital Discharge Rate per 10,000 Population, by Age and Year,
White Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 18 18 19 20 22
Rate 6.0 6.2 6.6 7.2 7.8
20-44 Number 40 53 48 53 36
Rate 10.9 14.3 12.7 13.5 9.2
45-64 Number 97 96 102 100 72
Rate 47.0 46.9 49.9 48.9 35.2
65-74 Number 66 74 66 74 59
Rate 82.9 91.9 80.8 88.5 70.3
75+ Number 55 64 53 61 53
Rate 92.0 104.4 84.9 93.8 79.1
Total Number 275 305 289 307 242
Rate 27.5 30.3 28.5 30.0 23.5
Age-adjusted Rate 25.0 27.4 25.9 27.2 21.1
(a) In thousands
Table 4.4 Number of Discharges with Diabetes as Primary Diagnosis and
Hospital Discharge Rate per 10,000 Population, by Age and Year,
White Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 19 16 18 16
Rate 6.9 5.6 6.4 5.8
20-44 Number 41 38 38 36
Rate 10.3 9.4 9.2 8.8
45-64 Number 57 60 52 42
Rate 28.1 29.4 25.5 20.5
65-74 Number 41 46 41 38
Rate 48.0 53.0 47.2 42.6
75+ Number 35 33 37 35
Rate 51.8 47.0 51.8 47.9
Total Number 194 192 186 167
Rate 18.7 18.4 17.7 15.8
Age-adjusted Rate 17.1 16.8 16.0 14.2
(a) In thousands
4.5 10,000 Pop., by Age and Year, U.S., 80-88, Black Males
Table 4.5 Number of Discharges with Diabetes as Primary Diagnosis and
Hospital Discharge Rate per 10,000 Population, by Age and Year,
Black Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 2 2 2 3 2
Rate 3.5 3.7 4.4 5.1 3.8
20-44 Number 12 13 10 13 13
Rate 25.4 26.6 20.8 25.5 25.6
45-64 Number 21 20 17 16 15
Rate 113.2 103.5 86.4 81.5 73.7
65-74 Number 5 6 7 5 6
Rate 82.8 107.0 113.3 89.9 93.6
75+ Number 3 4 2 3 3
Rate 113.5 151.2 65.9 103.1 88.0
Total Number 43 45 38 40 38
Rate 33.8 34.9 28.9 30.2 28.5
Age-adjusted Rate 43.5 45.4 36.8 37.8 35.5
(a) In thousands
Table 4.5 Number of Discharges with Diabetes as Primary Diagnosis and
Hospital Discharge Rate per 10,000 Population, by Age and Year,
Black Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 3 3 4 4
Rate 4.7 5.5 7.3 6.9
20-44 Number 10 14 12 16
Rate 19.5 26.0 21.5 28.1
45-64 Number 14 16 12 14
Rate 70.8 77.3 56.9 63.9
65-74 Number 4 6 6 4
Rate 58.8 100.9 88.3 53.4
75+ Number 3 3 3 4
Rate 106.5 82.3 102.9 108.5
Total Number 34 42 37 40
Rate 25.0 30.2 26.2 28.2
Age-adjusted Rate 31.4 37.2 32.1 33.7
(a) In thousands
4.6 10,000 Pop., by Age and Year, U.S., 80-88, Black Females
Table 4.6 Number of Discharges with Diabetes as Primary Diagnosis and
Hospital Discharge Rate per 10,000 Population, by Age and Year,
Black Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 5 6 2 3 3
Rate 9.4 11.9 3.8 5.9 5.8
20-44 Number 13 13 16 10 11
Rate 24.5 24.5 28.1 18.1 18.3
45-64 Number 36 38 29 27 29
Rate 154.4 159.8 122.9 111.1 117.5
65-74 Number 14 15 18 16 17
Rate 180.2 194.3 226.1 201.0 200.8
75+ Number 9 8 5 10 9
Rate 193.9 156.2 92.1 186.3 158.6
Total Number 77 80 70 66 68
Rate 54.5 55.9 47.9 45.0 45.2
Age-adjusted Rate 63.4 64.5 55.4 52.5 52.5
(a) In thousands
Table 4.6 Number of Discharges with Diabetes as Primary Diagnosis and
Hospital Discharge Rate per 10,000 Population, by Age and Year,
Black Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 4 4 2 5
Rate 7.7 7.0 4.1 8.6
20-44 Number 11 14 8 12
Rate 18.9 22.1 13.5 18.4
45-64 Number 19 21 24 16
Rate 76.8 83.7 94.7 61.7
65-74 Number 15 13 8 13
Rate 181.7 147.1 91.4 145.0
75+ Number 8 7 6 8
Rate 149.4 121.5 106.2 125.3
Total Number 58 58 49 53
Rate 38.3 37.5 31.3 33.3
Age-adjusted Rate 43.7 42.4 35.9 37.2
(a) In thousands
4.7-4.11 Hosp. Discharge/Rate w/Diabetes as Any Listed Diagnosis
4.7 10,000 Pop., by Age and Year, U.S., 80-88
Table 4.7 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population, by Age and Year,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 61 58 52 69 63
Rate 8.5 8.1 7.3 9.7 9.0
20-44 Number 255 278 311 320 326
Rate 30.1 32.0 34.9 35.1 35.0
45-64 Number 798 791 850 873 897
Rate 179.3 177.5 190.7 195.5 200.3
65-74 Number 605 647 687 738 800
Rate 386.8 406.6 424.3 447.5 477.9
75+ Number 507 549 583 669 720
Rate 504.9 532.0 549.1 611.9 641.4
Total Number 2227 2324 2484 2669 2806
Rate 98.0 101.2 107.1 113.9 118.7
Age-adjusted Rate 98.0 100.8 106.2 112.3 116.4
(a) In thousands
Table 4.7 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population, by Age and Year,
United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 54 55 62 56
Rate 7.7 7.7 8.7 7.8
20-44 Number 315 316 330 314
Rate 33.2 32.8 33.9 32.0
45-64 Number 834 845 863 858
Rate 185.9 187.6 190.6 186.6
65-74 Number 738 799 800 807
Rate 434.1 461.1 453.2 451.1
75+ Number 663 701 707 743
Rate 575.7 593.0 581.4 596.6
Total Number 2605 2716 2762 2778
Rate 109.1 112.7 113.5 113.0
Age-adjusted Rate 106.6 109.4 109.6 108.4
(a) In thousands
4.8 10,000 Pop., by Age and Year, U.S., 80-88, White Males
Table 4.8 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population, by Age and Year,
White Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 18 22 16 23 19
Rate 5.9 7.2 5.4 7.9 6.3
20-44 Number 70 82 96 85 92
Rate 19.4 22.0 25.2 21.8 23.2
45-64 Number 248 274 282 289 293
Rate 131.1 145.0 149.2 152.9 155.1
65-74 Number 186 232 224 234 245
Rate 303.8 372.7 351.6 360.5 371.5
75+ Number 129 161 171 203 202
Rate 398.4 484.6 501.7 580.5 564.5
Total Number 652 771 788 834 851
Rate 68.5 80.3 81.5 85.5 86.7
Age-adjusted Rate 73.3 86.0 86.7 91.1 91.6
(a) In thousands
Table 4.8 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population, by Age and Year,
White Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 16 19 21 17
Rate 5.4 6.4 7.0 5.7
20-44 Number 83 76 81 87
Rate 20.6 18.7 19.7 21.0
45-64 Number 286 270 276 306
Rate 151.3 142.7 145.1 158.5
65-74 Number 245 274 269 289
Rate 364.9 397.9 382.3 405.6
75+ Number 185 205 203 223
Rate 503.8 545.5 524.3 560.5
Total Number 815 845 850 922
Rate 82.4 84.6 84.5 90.9
Age-adjusted Rate 86.4 88.5 87.5 93.4
(a) In thousands
4.9 10,000 Pop., by Age and Year, U.S., 80-88, White Females
Table 4.9 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population, by Age and Year,
White Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 28 24 24 29 30
Rate 9.4 8.2 8.4 10.3 10.8
20-44 Number 101 123 120 135 126
Rate 27.7 33.2 31.5 34.9 31.9
45-64 Number 319 327 337 357 346
Rate 154.9 159.4 164.8 174.5 169.5
65-74 Number 274 320 323 353 370
Rate 343.1 395.7 393.1 423.1 438.7
75+ Number 272 335 307 356 397
Rate 456.7 548.0 488.1 550.2 597.6
Total Number 993 1130 1111 1230 1269
Rate 99.2 112.1 109.4 120.2 123.2
Age-adjusted Rate 87.5 97.7 95.3 103.9 105.1
(a) In thousands
Table 4.9 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population, by Age and Year,
White Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 27 22 23 22
Rate 9.5 7.9 8.1 7.9
20-44 Number 124 120 133 118
Rate 30.9 29.6 32.5 28.6
45-64 Number 316 309 316 297
Rate 154.9 151.9 155.1 143.8
65-74 Number 319 335 342 323
Rate 374.3 386.8 389.3 364.0
75+ Number 338 350 353 383
Rate 495.4 500.1 493.2 522.7
Total Number 1123 1136 1168 1143
Rate 108.3 108.7 111.0 107.8
Age-adjusted Rate 92.6 92.1 93.7 89.5
(a) In thousands
4.10 10,000 Pop., by Age and Year, U.S., 80-88, Black Males
Table 4.10 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population,
by Age and Year, Black Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 2 2 3 3 2
Rate 3.5 4.2 5.0 5.1 3.8
20-44 Number 21 23 19 26 23
Rate 45.4 48.4 39.4 50.8 45.3
45-64 Number 51 53 45 53 60
Rate 272.5 276.3 230.7 271.8 300.8
65-74 Number 20 22 23 26 29
Rate 356.9 385.0 399.4 431.3 483.9
75+ Number 12 14 13 12 16
Rate 428.5 494.8 436.3 382.6 520.2
Total Number 106 114 103 119 131
Rate 84.1 88.9 78.7 89.7 97.3
Age-adjusted Rate 114.9 121.9 108.2 120.4 133.3
(a) In thousands
Table 4.10 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population,
by Age and Year, Black Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 3 4 5 5
Rate 5.4 6.5 9.3 9.4
20-44 Number 24 28 26 31
Rate 44.6 52.3 47.7 54.3
45-64 Number 62 59 52 61
Rate 307.2 290.4 249.7 289.6
65-74 Number 29 31 32 37
Rate 461.8 490.0 500.9 559.4
75+ Number 22 24 24 25
Rate 684.7 745.2 705.8 732.8
Total Number 139 147 139 159
Rate 101.7 105.6 98.8 111.0
Age-adjusted Rate 140.6 145.1 135.3 150.9
(a) In thousands
4.11 10,000 Pop., by Age and Year, U.S., 80-88, Black Females
Table 4.11 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population, by Age and Year,
Black Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 6 9 3 7 5
Rate 11.6 16.5 5.5 12.3 9.1
20-44 Number 32 40 41 36 36
Rate 61.8 73.6 73.7 62.5 60.4
45-64 Number 88 106 99 88 100
Rate 377.6 450.9 418.5 364.7 410.6
65-74 Number 42 57 46 58 73
Rate 536.9 712.0 570.6 710.7 879.3
75+ Number 27 29 31 35 41
Rate 563.0 602.9 623.0 675.7 765.5
Total Number 195 240 221 224 255
Rate 137.9 167.6 151.8 151.3 170.1
Age-adjusted Rate 162.6 196.7 178.0 177.4 200.2
(a) In thousands
Table 4.11 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population, by Age and Year,
Black Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 5 6 4 6
Rate 9.6 11.2 6.6 10.7
20-44 Number 42 46 39 38
Rate 69.0 75.0 62.2 60.1
45-64 Number 78 96 103 98
Rate 315.4 382.9 403.8 380.1
65-74 Number 65 71 62 82
Rate 765.5 827.7 712.8 931.2
75+ Number 42 45 40 45
Rate 745.8 787.5 672.6 729.3
Total Number 231 264 247 269
Rate 151.8 171.4 157.9 169.6
Age-adjusted Rate 176.2 198.3 183.2 196.6
(a) In thousands
4.12-4.16 Hosp. Discharge Rate for Diabetes as Primary Diagnosis
4.12 1,000 Diabetic Pop., by Age and Year, U.S., 80-88
Table 4.12 Hospital Discharge Rate for Diabetes as Primary Diagnosis
per 1,000 Diabetic Population, by Age and Year,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 156.7 175.1 183.0 182.4 167.3
45-64 102.5 93.9 93.9 91.1 84.3
65-74 90.3 105.5 94.8 111.9 73.8
75+ 121.4 111.6 117.7 124.8 89.6
Total 111.6 112.8 112.3 116.7 95.6
Age-adjusted 111.6 113.7 113.3 117.5 96.8
Table 4.12 Hospital Discharge Rate for Diabetes as Primary Diagnosis
per 1,000 Diabetic Population, by Age and Year,
United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 144.0 145.7 115.7 140.1
45-64 68.5 55.9 58.9 54.6
65-74 51.7 67.4 54.1 53.2
75+ 68.2 56.2 61.9 69.2
Total 75.9 72.5 69.6 71.5
Age-adjusted 77.2 74.6 68.0 71.3
4.13 1,000 Diabetic Pop., by Age & Year, U.S., 80-88, White Male
Table 4.13 Hospital Discharge Rate for Diabetes as Primary Diagnosis
per 1,000 Diabetic Population, by Age and Year,
White Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 157.7 156.5 167.5 140.7 152.8
45-64 68.2 76.2 72.4 73.1 66.7
65-74 54.1 82.1 88.3 93.4 54.3
75+ 92.4 123.1 83.9 77.0 77.6
Total 80.5 96.3 94.8 91.1 79.5
Age-adjusted 83.7 98.8 94.9 90.8 80.1
Table 4.13 Hospital Discharge Rate for Diabetes as Primary Diagnosis
per 1,000 Diabetic Population, by Age and Year,
White Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 112.9 145.6 84.6 97.9
45-64 53.7 33.8 37.9 46.3
65-74 33.8 44.1 36.4 50.8
75+ 54.0 50.0 37.7 56.4
Total 58.0 52.0 47.3 59.6
Age-adjusted 58.9 58.4 45.6 58.0
4.14 1,000 Diabetic Pop., by Age/Year, U.S., 80-88, White Female
Table 4.14 Hospital Discharge Rate for Diabetes as Primary Diagnosis
per 1,000 Diabetic Population, by Age and Year,
White Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 120.0 168.5 141.4 180.7 132.8
45-64 98.8 96.6 103.6 92.4 68.7
65-74 88.3 120.5 84.6 117.2 73.9
75+ 105.5 107.2 125.7 132.6 88.8
Total 100.9 116.1 108.3 119.5 84.0
Age-adjusted 100.7 117.0 108.5 120.3 84.2
Table 4.14 Hospital Discharge Rate for Diabetes as Primary Diagnosis
per 1,000 Diabetic Population, by Age and Year,
White Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 120.4 91.2 108.8 146.9
45-64 62.8 55.9 54.6 45.9
65-74 46.3 67.8 55.6 45.6
75+ 59.4 48.2 69.4 68.6
Total 67.0 63.7 67.8 64.0
Age-adjusted 68.0 64.0 66.5 66.8
4.15 1,000 Diabetic Pop., by Age & Year, U.S., 80-88, Black Male
Table 4.15 Hospital Discharge Rate for Diabetes as Primary Diagnosis
per 1,000 Diabetic Population, by Age and Year,
Black Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 184.3 226.4 202.0 422.9 277.2
45-64 114.7 106.5 92.8 78.3 68.0
65-74 76.6 91.6 94.4 63.0 64.5
75+ 109.6 190.6 78.7 129.2 78.9
Total 122.1 131.9 112.0 114.2 97.5
Age-adjusted 116.1 136.0 110.2 142.0 105.2
Table 4.15 Hospital Discharge Rate for Diabetes as Primary Diagnosis
per 1,000 Diabetic Population, by Age and Year,
Black Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 204.9 206.5 175.4 244.5
45-64 64.3 77.5 56.4 54.7
65-74 36.9 70.4 55.0 41.5
75+ 99.3 68.8 98.6 71.9
Total 81.8 100.8 84.1 87.1
Age-adjusted 86.9 96.9 83.1 86.9
4.16 1,000 Diabetic Pop., by Age/Year, U.S., 80-88, Black Female
Table 4.16 Hospital Discharge Rate for Diabetes as Primary Diagnosis
per 1,000 Diabetic Population, by Age and Year,
Black Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 159.1 202.7 206.3 116.5 127.6
45-64 142.7 132.3 90.6 88.9 101.8
65-74 136.0 112.8 114.2 82.5 89.7
75+ 128.2 107.8 68.6 116.4 93.0
Total 142.9 136.4 109.8 94.9 101.4
Age-adjusted 141.7 135.8 113.7 96.1 101.8
Table 4.16 Hospital Discharge Rate for Diabetes as Primary Diagnosis
per 1,000 Diabetic Population, by Age and Year,
Black Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 169.9 199.1 98.0 121.5
45-64 73.4 74.8 86.0 65.5
65-74 83.9 87.7 55.9 83.0
75+ 70.6 55.3 43.0 54.5
Total 89.4 90.8 72.3 78.4
Age-adjusted 92.6 97.0 73.8 78.2
4.17-4.21 Discharge Rate for Diabetes as Any Listed Diagnosis
4.17 1,000 Diabetic Pop., by Age & Year, U.S., 80-88
Table 4.17 Hospital Discharge Rate for Diabetes as Any Listed Diagnosis
per 1,000 Diabetic Population, by Age and Year,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 313.4 353.7 369.3 388.4 391.3
45-64 334.0 310.8 331.3 335.8 380.3
65-74 397.7 474.2 450.5 565.4 455.2
75+ 589.2 579.4 719.9 764.8 660.5
Total 385.2 400.0 422.0 461.6 452.6
Age-adjusted 385.2 401.3 427.2 469.3 443.7
Table 4.17 Hospital Discharge Rate for Diabetes as Any Listed Diagnosis
per 1,000 Diabetic Population, by Age and Year,
United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 355.5 354.3 287.3 338.5
45-64 358.2 296.7 338.1 348.7
65-74 398.8 501.6 470.1 473.6
75+ 602.7 546.3 592.0 679.6
Total 412.2 401.1 405.4 437.5
Age-adjusted 404.8 397.9 401.8 429.1
4.18 1,000 Diabetic Pop., by Age & Year, U.S., 80-88, White Male
Table 4.18 Hospital Discharge Rate for Diabetes as Any Listed Diagnosis
per 1,000 Diabetic Population, by Age and Year,
White Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 284.5 280.7 291.4 265.7 313.0
45-64 270.4 269.5 288.4 313.8 360.6
65-74 312.8 420.2 520.1 561.9 414.5
75+ 505.4 704.7 567.5 617.3 623.5
Total 313.5 355.7 376.7 402.2 408.7
Age-adjusted 319.0 376.0 391.5 415.9 405.6
Table 4.18 Hospital Discharge Rate for Diabetes as Any Listed Diagnosis
per 1,000 Diabetic Population, by Age and Year,
White Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 252.2 316.3 176.3 214.7
45-64 328.0 218.6 262.3 327.0
65-74 361.4 437.8 381.1 518.2
75+ 527.3 507.0 483.3 577.4
Total 355.4 328.9 308.3 390.0
Age-adjusted 353.2 336.3 311.5 395.0
4.19 1,000 Diabetic Pop., by Age/Year, U.S., 80-88, White Female
Table 4.19 Hospital Discharge Rate for Diabetes as Any Listed Diagnosis
per 1,000 Diabetic Population, by Age and Year,
White Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 269.3 350.3 302.5 407.1 355.9
45-64 325.6 328.3 342.4 329.9 331.2
65-74 365.5 519.0 411.4 560.0 460.8
75+ 523.7 562.5 722.8 777.5 670.3
Total 364.5 429.6 416.1 478.0 440.9
Age-adjusted 355.8 417.2 410.2 470.6 420.1
Table 4.19 Hospital Discharge Rate for Diabetes as Any Listed Diagnosis
per 1,000 Diabetic Population, by Age and Year,
White Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 300.3 240.8 304.9 393.3
45-64 346.0 289.0 331.3 321.9
65-74 360.7 494.8 459.4 390.1
75+ 568.7 513.3 660.0 748.0
Total 388.3 376.3 425.2 436.5
Age-adjusted 375.0 368.2 409.4 415.8
4.20 1,000 Diabetic Pop., by Age & Year, U.S., 80-88, Black Male
Table 4.20 Hospital Discharge Rate for Diabetes as Any Listed Diagnosis
per 1,000 Diabetic Population, by Age and Year,
Black Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 309.2 389.8 354.3 770.3 461.8
45-64 276.1 284.2 247.7 260.9 277.8
65-74 330.3 329.6 332.6 302.3 333.6
75+ 413.7 623.8 521.4 479.2 466.0
Total 304.1 336.1 305.2 339.5 332.8
Age-adjusted 316.6 365.1 329.4 393.2 352.6
Table 4.20 Hospital Discharge Rate for Diabetes as Any Listed Diagnosis
per 1,000 Diabetic Population, by Age and Year,
Black Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 423.6 385.6 347.3 445.1
45-64 278.9 291.1 247.4 248.0
65-74 290.1 341.9 312.0 434.9
75+ 637.9 623.6 675.9 485.8
Total 332.8 352.2 317.5 342.8
Age-adjusted 360.6 370.5 345.7 367.0
4.21 1,000 Diabetic Pop., by Age/Year, U.S., 80-88, Black Female
Table 4.21 Hospital Discharge Rate for Diabetes as Any Listed Diagnosis
per 1,000 Diabetic Population, by Age and Year,
Black Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 343.8 502.1 513.6 365.0 370.8
45-64 349.1 373.4 308.6 291.9 355.7
65-74 405.1 413.2 288.3 291.7 392.6
75+ 372.4 416.2 464.5 422.0 448.6
Total 361.8 409.0 347.8 319.5 381.3
Age-adjusted 366.4 412.7 362.3 324.0 381.9
Table 4.21 Hospital Discharge Rate for Diabetes as Any Listed Diagnosis
per 1,000 Diabetic Population, by Age and Year,
Black Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 511.2 598.6 391.2 327.1
45-64 301.1 342.0 366.6 403.4
65-74 353.4 493.4 435.9 533.4
75+ 352.5 358.4 272.2 316.9
Total 354.6 414.4 364.7 399.9
Age-adjusted 359.2 429.1 375.1 411.4
4.22 Hosp. Discharges & Rates with Diabetes as Primary Diagnosis
Table 4.22 Number of Discharges with Diabetes as Primary Diagnosis
and Hospital Discharge Rate per 10,000 Population, by
Region and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Region
Northeast Number (a) 152 143 150 144 137
Rate 31.0 29.1 30.4 29.0 27.7
Adjusted Rate (b) 26.8 28.2 26.4 24.9 21.9
North Number 185 179 180 185 152
Central Rate 31.4 30.3 30.6 31.3 25.7
Adjusted Rate 27.8 31.1 28.6 28.7 23.8
South Number 232 254 245 255 219
Rate 30.7 32.9 31.3 32.0 27.1
Adjusted Rate 28.0 31.7 29.1 30.4 23.8
West Number 76 79 86 91 84
Rate 17.4 17.9 18.9 19.8 17.9
Adjusted Rate 16.2 19.0 18.0 16.9 16.0
(a) In thousands
(b) Adjusted for age and race
Table 4.22 Number of Discharges with Diabetes as Primary Diagnosis
and Hospital Discharge Rate per 10,000 Population, by
Region and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Region
Northeast Number (a) 119 94 99 96
Rate 24.0 18.8 19.7 19.0
Adjusted Rate (b) 21.8 16.9 17.4 17.4
North Number 115 128 126 120
Central Rate 19.5 21.7 21.1 20.1
Adjusted Rate 18.0 18.9 18.8 18.2
South Number 172 191 167 172
Rate 21.1 23.0 20.0 20.2
Adjusted Rate 17.8 19.5 16.9 18.0
West Number 73 78 82 66
Rate 15.2 15.9 16.4 13.0
Adjusted Rate 13.3 15.0 14.1 9.7
(a) In thousands
(b) Adjusted for age and race
4.23 Hosp. Discharges/Rates w/ Diabetes as Any Listed Diagnosis
Table 4.23 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population, by
Region and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Region
Northeast Number (a) 571 558 594 618 649
Rate 116.1 113.2 120.5 124.9 130.7
Ajusted Rate (b) 99.9 107.2 105.2 108.8 111.0
North Number 641 661 699 719 741
Central Rate 108.8 111.9 118.6 121.9 125.3
Ajusted Rate 96.1 113.1 108.6 109.8 113.9
South Number 732 802 860 950 1029
Rate 96.6 104.0 109.6 119.1 127.3
Ajusted Rate 88.5 102.7 104.1 113.6 117.0
West Number 284 304 330 382 387
Rate 65.3 68.5 73.1 82.9 82.6
Ajusted Rate 60.7 72.6 66.1 73.3 76.2
(a) In thousands
(b) Adjusted for age and race
Table 4.23 Number of Discharges with Diabetes as Any Listed Diagnosis
and Hospital Discharge Rate per 10,000 Population, by
Region and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Region
Northeast Number (a) 672 635 648 680
Rate 134.8 126.9 128.9 134.8
Ajusted Rate (b) 118.0 111.0 111.9 117.2
North Number 664 707 736 723
Central Rate 112.2 119.3 123.5 121.1
Ajusted Rate 103.6 105.7 108.0 108.3
South Number 864 954 918 1011
Rate 105.5 114.9 109.4 118.8
Ajusted Rate 92.8 100.3 96.1 108.0
West Number 405 421 460 364
Rate 84.8 86.3 92.6 72.0
Ajusted Rate 74.7 75.5 79.6 54.3
(a) In thousands
(b) Adjusted for age and race
CARDIOVASCULAR DISEASE
Introduction
Cardiovascular disease is the leading cause of mortality among
persons with diabetes. The last analysis of national mortality
data that examined the toll of cardiovascular disease mortality among
the diabetic population was from 1978 (Harris & Entmacher, 1985).
We examine the latest national data concerning mortality and hospitalizations
from cardiovascular disease among people with diabetes. Using national
vital statistics data from 1980 to 1986, we determined the nu
age-specific mortality rates and crude and age-adjusted mortality
rates by calendar year, age, and race-sex groups. Using the National
Hospital Discharge Survey (NHDS) data from 1980 through 1987, we calculated
the number of persons with diabetes who were hospitalized for major
CVD, IHD, and stroke and we calculated age-specific hospital discharge
rates and crude and age-adjusted hospital discharge rates by calendar
year, age, and race-sex groups.
Methods
For the years 1980-1986, the number of deaths from major CVD
(ICD-9 390-448), IHD (ICD-9 410-414), and stroke (ICD-9 430-434,
436-438) coded as the underlying cause of death and diabetes (ICD-9
250) as a contributing cause of death were determined. For the years
1980-1987, we determined, using data from the NHDS, the number of
hospital discharges with major CVD (ICD-9-CM 390-448), IHD (ICD-9-CM
410-414), and stroke (ICD-9-CM 430-434, 436-438) listed as the primary
diagnosis and diabetes (ICD-9-CM 250) listed as a secondary diagnosis.
Rates of mortality and hospitalization were calculated using the estimated
number of persons with diabetes determined from the 1980-1987 National
Health Interview Surveys (Chapter 2). Crude, age-adjusted, and age-specific
rates were calculated. Age-standardization was done using the direct
method with the 1980 diabetic population of the United States as the
standard.
Results
Major CVD Mortality
The total number of deaths coded with major CVD as the underlying
cause and diabetes as a contributing cause increased during the
7-year period with 75,594 such deaths reported in 1980 compared
with 80,129 in 1986 (Table 5.1, Figure 5.1).
Despite this increase in the absolute number of major CVD deaths among
persons with diabetes, the age-adjusted mortality rate declined, in
general, during the 7-year period, although the rates increased in
1982 and 1983 (Figure 5.2). The rate in 1986 was about 16% lower than
the rate in 1980. Although the age-specific mortality rates vary greatly,
the decrease occurred primarily among persons with diabetes who were
75 years or older, for whom the mortality rate in 1986 was 27% lower
than that in 1980 (Table 5.1). A 28% increase in mortality rates occurred
in persons aged 44 years or younger. Furthermore, all four race-sex
groups had lower CVD mortality rates in 1986 than in 1980 (Tables
5.2-5.5).
The mortality rate from major CVD increased sharply with age, with
persons with diabetes aged 75 years or older experiencing mortality
rates from CVD that were about 30 to 50 times higher than those of
persons with diabetes who were aged 44 years or younger. During the
7-year period, the age-adjusted mortality rate was highest for white
males and was followed by that of white females, black males, and
black females in order of decreasing rank (Figure 5.3). The age-specific
rates for white males were higher than those for black males at every
age group except for those 0-44 years old. The age-specific rates
for the two oldest age groups of white females exceeded those of black
females.
When the mortality rates are calculated based on the number of deaths
with diabetes and major CVD listed anywhere on the death certificate,
the trends are the same. The magnitude of the age-adjusted rate, however,
is about 60% higher in this situation (data not shown).
IHD Mortality
Because IHD constitutes the bulk of CVD among persons with diabetes,
the patterns described for major CVD previously also hold for IHD
(Tables 5.6-5.10, Figures 5.1-5.2).
Stroke Mortality
The number of deaths with stroke as the underlying cause of death
and diabetes as a contributing cause of death decreased from 12,735 in
1980 to 11,705 in 1986 (Table 5.11, Figure 5.1). The age-adjusted
mortality rate declined from 220 deaths per 100,000 diabetic population
in 1980 to 156 deaths per 100,000 diabetic population in 1986, a 29%
decline (Figure 5.2). The age-specific rates suggest that this decrease
occurred primarily in persons aged 45 years and older with the steepest
decline (38%) occurring in persons with diabetes who were 75 years
or older. Stroke mortality rates remained essentially unchanged in
the 0- to 44-year-old age group. With advancing age, the age-specific
stroke mortality rates increased sharply. The decreases in stroke
mortality occurred in all four race-sex groups (Tables 5.12-5.15).
Furthermore, during the 7-year period, the mortality rates for stroke
were similar for the four race-sex groups.
The mortality rates calculated based on the number of deaths with
diabetes and stroke listed anywhere on the death certificate were
from 2.15 to 2.41 times higher than those based on stroke as the underlying
cause of death and diabetes as a contributing cause. The trends, however,
are the same (data not shown).
Major CVD Hospitalizations
The number of hospital discharges with major CVD as the primary
diagnosis and diabetes as a co-diagnosis increased in every
year from 1980 through 1987 except in 1985. In 1987, an estimated
902,000 such hospitalizations were recorded (Table 5.16, Figure 5.4).
From 1980 to 1987, the overall age-adjusted hospital discharge rate
increased (Table 5.16, Figure 5.5). In 1987, the overall age-adjusted
hospital discharge rate was 34% higher than in 1980. In every year
from 1980 to 1987, rates of hospital discharge increased with age,
with rates among persons 75 years or older 8 to 12.5 times higher
than rates among persons less than 45 years. Increases occurred in
all age groups (Table 5.16) and in each of the four race-sex groups
(Table 5.17). Hospital discharge rates for white males and females
exceeded those for black males and females in every year.
IHD Hospitalizations
In 1980, an estimated 245,000 hospitalizations with IHD as the
primary diagnosis and diabetes as a co-diagnosis were recorded
(Table 5.18, Figure 5.4). By 1987, this number had increased to 390,000.
In general, the IHD hospitalization rate follows the same patterns
as that for major CVD (Table 5.18, Figure 5.5). In 1987, the overall
age-adjusted hospital discharge rate was 38% higher than in 1980.
Hospitalization rates for IHD increased rapidly with increasing age
and were greatest for white males, followed by those for white females
(Table 5.19, Figure 5.6). Hospital discharge rates for black males
and females were similar and were appoximately half those of white
males and females. Among white males and females, hospital discharge
rates peaked in 1984 and 1983, respectively, whereas among black males
and females hospital discharge rates were stable before 1984 and increased
thereafter.
Stroke Hospitalizations
The total number of hospitalizations for stroke as the primary diagnosis
and diabetes as a co-diagnosis also increased between 1980 and 1987,
with an estimated 77,000 such hospitalizations occurring in 1980 and
128,000 in 1987 (Table 5.20). The age-adjusted hospital discharge rate
increased from 1980 through 1983 and subsequently leveled off (Table 5.20,
Figure 5.5). In 1983, the overall age-adjusted hospital discharge rate
was 38% higher than in 1980. In every age group, hospitalizations
for strokes appear to have increased during the 8-year period. Hospital
discharge rates increased with age, with hospital discharge rates
among those older than 74 years of age exceeding the rates among those
less than 45 years old by a factor ranging from 11 to 56. Hospital
discharge rates among the four race-sex groups are similar (Table
5.21). Hospital discharge rates among white females, black males,
and black females generally increased during the 8-year period, whereas
hospital discharge rates for white males increased from 1980 to 1983
and then stabilized.
Discussion
The analysis of national mortality data suggests that mortality
rates from major CVD, IHD, and stroke among persons with diabetes
decreased between 1980 and 1986 and that this decline occurred
among all four race-sex groups and all age groups except for those
less than 45 years of age. Hospital discharge data, on the other hand,
indicate that hospitalization rates for major CVD, IHD, and stroke
among people with diabetes increased between 1980 and 1987. In general,
these increases were observed among all four race-sex groups and all
age groups.
Interpreting the mortality data is complicated by several potential
problems. Death certificate data are known to have limitations. For
example, as many as 16% of IHD deaths and 40% of stroke deaths may
not be identified as such on death certificates (Kuller et al., 1969;
Matsumoto et al., 1973; Corwin et al., 1982; Fortmann et al., 1986;
Folsom et al., 1987). Furthermore, in as many as half of all deaths
among persons with diabetes, the death certificate fails to mention
diabetes (Harris & Entmacher, 1985).
The National Health Interview Survey results may underestimate the
diabetic population by half further complicating the interpretation
of the mortality data (Harris et al., 1987). Consequently, the absolute
magnitude of the mortality rate remains only an approximation. If
the sources of variation remained constant during the 7-year period,
and we have no reason to believe that they did not, the temporal trends
and relative differences between groups reported herein should be
generally valid.
As with the mortality data, sources of error affect the estimates
of both the numerator and denominator of the hospital discharge rate.
Changes in the type and frequency of diagnostic procedures and the
introduction of new treatments may have affected the number of hospitalized
patients who were diagnosed with coronary heart disease (Kuller, 1988).
For example, increased utilization of coronary arteriography in patients
with acute myocardial infarction has been reported (Gore et al., 1988).
Data from the NHDS have also shown large increases in the number and
rates of cardiac catheterization in the 1980s. In addition, how the
increased use of CAT-scans has influenced the diagnosis of stroke
is unknown. Changes in referral patterns might have contributed to
changing trends, but no data are available to evaluate this possible
influence. A major change, however, occurred when diagnosis related
groups (DRGs) were introduced in 1983. DRGs have complicated the
interpretation of trend data. Between 1980 and 1987, the co-diagnosis
of diabetes increased from 12.4% to 17.4% of hospitalizations for CVD,
from 13.7% to 18.0% of hospitalizations for IHD, and from 12.8% to 18.7%
of hospitalizations for stroke.
National data have demonstrated decreases in CVD mortality in the
population of the United States (Sempos et al., 1988). From 1980 to
1986, the age-adjusted mortality rates for major CVD, IHD, and cerebrovascular
disease decreased by about 15.3%, 20.7%, and 24.0%, respectively (NCHS,
1983, 1988a). Compared with 1980, mortality rates in 1986 among persons
with diabetes were 16% lower for CVD, 17.5% lower for IHD, and 29%
lower for stroke. Thus, persons with diabetes appear to have shared
in the decline in CVD-related mortality in the general population.
Whereas hospitalization rates for major CVD, IHD, and stroke among
people with diabetes have increased, mortality rates have decreased
for these same conditions during the same period. The same trends
have been described for the total population (CDC, 1989). Although
DRGs may explain some of the increase in hospitalization rates, other
explanations include changes in hospital use and better survival from
IHD and stroke with subsequent readmission for the same conditions.
Unfortunately, the NHDS cannot separate repeat hospitalizations from
incident hospitalizations.
Mortality rates for major CVD and IHD were higher among diabetic men
than diabetic women regardless of race. Hospitalization rates among
persons with diabetes also were higher among white men than white
women but were similar among black men and black women. This contrasts
with the higher CVD and IHD mortality rates among men in the general
population. Among diabetic persons of both races, the mortality rates
and hospitalization rates for stroke were similar among men and women.
White persons with diabetes have higher age-adjusted mortality rates
for major CVD and IHD but a similar age-adjusted mortality rate for
stroke. Similarly, whites are hospitalized at higher rates for major
CVD and IHD than blacks and at the same rate for stroke. Reasons for the
lower hospitalization rates among blacks could include fewer complications
from diabetes among blacks, inaccessability to hospitals, or higher
out-of- hospital mortality rates.
During this decade, the mortality rates for major CVD, IHD, and stroke
among persons with diabetes have decreased. The decreases in mortality
have occurred in all age groups older than 44 years and have occurred
among black males and females and white males and females. In contrast,
the hospitalization rates for these conditions have increased during
the same period among all four groups.
Update
This section updates data presented in previous sections in light of one
additional year of hospitalization data and two additional years of mortality
data. For a complete description of the methods and operational definitions
and for a discussion of the implications of the findings, see previous
sections.
Among persons with diabetes, age-standardized mortality rates attributed
to major cardiovascular disease (CVD), ischemic heart disease, and stroke
increase dramatically with age. Mortality rates from these diseases were
lower in 1988 than in 1980, with most of the decline occurring between 1983
and 1984 (Figure 1.7, Tables 5.1, 5.6, and 5.11). The declines for these two
years were apparent among persons with diabetes who were 65 years of age or
older. Cardiovascular mortality among persons with diabetes younger than 45
years of age tended to increase rather than decrease.
Of the four race-sex groups examined, white males had the highest age-
standardized mortality rates for CVD (Figure 1.8, Tables 5.2-5.5). Rates for
black males exceeded those for white males among persons younger than age 45.
Although the age-standardized rates for white females were higher than those
for black females, black females under the age of 65 had higher rates than
white females.
Detailed Tables
5.1-5.5 Deaths w/ Cardiovascular Disease as Underlying Cause
5.1 Mortality Rate per 100,000 Diabetic Pop., Age & Year, 80-88
Table 5.1 Number of Deaths with Major Cardiovascular Disease
as Underlying Cause and Mortality Rate per 100,000 Diabetic
Population, by Age and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 834 860 859 955 1057
Rate 82.6 90.3 87.3 95.3 106.3
45-64 Number 14931 15201 14875 15248 15246
Rate 624.9 597.5 579.6 586.6 646.4
65-74 Number 23024 22775 22905 23656 23880
Rate 1512.5 1668.8 1501.5 1812.6 1359.3
75+ Number 36802 36206 37002 38527 38812
Rate 4273.2 3820.9 4565.6 4407.3 3559.9
Total Number 75594 75044 75657 78397 78999
Rate 1307.3 1292.0 1285.3 1356.2 1274.2
Age-adjusted Rate 1307.2 1271.1 1330.0 1392.6 1173.7
Table 5.1 Number of Deaths with Major Cardiovascular Disease
as Underlying Cause and Mortality Rate per 100,000 Diabetic
Population, by Age and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 995 1110 1139 1120
Rate 95.8 106.0 83.5 102.6
45-64 Number 15317 15205 15100 14813
Rate 657.4 534.0 591.8 602.1
65-74 Number 24379 23910 24527 24221
Rate 1317.0 1500.8 1440.5 1421.4
75+ Number 39322 39895 39885 40716
Rate 3572.5 3106.7 3341.9 3721.7
Total Number 80023 80129 80658 80876
Rate 1266.2 1183.3 1184.1 1273.6
Age-adjusted Rate 1167.2 1097.0 1136.1 1195.2
5.2 Mortality Rate per 100,000 Diabetic Pop., White Males
Table 5.2 Number of Deaths with Major Cardiovascular Disease
as Underlying Cause and Mortality Rate per 100,000 Diabetic
Population, by Age and Year, White Males, United States,
1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 386 386 371 481 503
Rate 124.1 104.6 96.5 117.9 142.2
45-64 Number 7150 7215 7104 7103 7090
Rate 779.4 709.3 727.1 771.9 871.6
65-74 Number 9794 9831 10052 10119 10328
Rate 1646.5 1777.3 2339.2 2429.1 1745.6
75+ Number 12088 11952 11959 12681 12864
Rate 4727.5 5237.6 3975.2 3863.8 3970.8
Total Number 29419 29384 29491 30387 30787
Rate 1415.0 1355.6 1409.7 1465.9 1478.2
Age-adjusted Rate 1481.2 1559.3 1525.1 1554.5 1435.9
Table 5.2 Number of Deaths with Major Cardiovascular Disease
as Underlying Cause and Mortality Rate per 100,000 Diabetic
Population, by Age and Year, White Males, United States,
1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 432 514 523 509
Rate 110.2 170.7 90.4 105.2
45-64 Number 7189 6942 6956 6638
Rate 823.2 561.3 660.9 709.0
65-74 Number 10640 10497 10586 10713
Rate 1566.7 1679.5 1501.5 1921.6
75+ Number 12846 12964 13142 13679
Rate 3666.3 3200.7 3129.3 3545.7
Total Number 31109 30921 31208 31541
Rate 1355.6 1204.2 1132.4 1334.6
Age-adjusted Rate 1317.9 1180.6 1150.2 1345.3
5.3 Mortality Rate per 100,000 Diabetic Pop., White Females
Table 5.3 Number of Deaths with Major Cardiovascular Disease
as Underlying Cause and Mortality Rate per 100,000 Diabetic
Population, by Age and Year, White Females, United States,
1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 248 242 269 230 310
Rate 52.1 57.6 56.6 57.0 70.7
45-64 Number 5108 5136 4914 5128 5215
Rate 521.3 514.9 498.5 474.4 499.1
65-74 Number 10271 10144 10012 10422 10334
Rate 1370.9 1644.4 1276.1 1655.4 1287.8
75+ Number 21808 21440 22108 22549 22588
Rate 4205.7 3601.6 5200.6 4922.9 3811.3
Total Number 37436 36962 37309 38333 38448
Rate 1374.6 1405.6 1397.1 1490.3 1335.6
Age-adjusted Rate 1211.8 1192.1 1326.4 1375.0 1125.2
Table 5.3 Number of Deaths with Major Cardiovascular Disease
as Underlying Cause and Mortality Rate per 100,000 Diabetic
Population, by Age and Year, White Females, United States,
1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 302 332 306 311
Rate 60.3 56.2 59.9 87.4
45-64 Number 5027 5117 4936 4846
Rate 550.4 477.8 516.8 525.1
65-74 Number 10348 9872 10390 9914
Rate 1168.8 1459.0 1395.5 1198.5
75+ Number 22911 23123 22917 22897
Rate 3859.2 3396.0 4280.5 4472.5
Total Number 38594 38446 38553 37970
Rate 1334.2 1273.4 1403.9 1450.6
Age-adjusted Rate 1120.5 1097.1 1228.9 1213.9
5.4 Mort. Rate per 100,000 Diabetic Pop., Black Males
Table 5.4 Number of Deaths with Major Cardiovascular Disease
as Underlying Cause and Mortality Rate per 100,000 Diabetic
Population, by Age and Year, Black Males, United States,
1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 97 121 97 118 125
Rate 132.9 188.0 157.2 321.5 226.4
45-64 Number 1049 1154 1097 1243 1179
Rate 563.7 622.2 609.4 608.5 547.4
65-74 Number 949 967 928 1084 1077
Rate 1541.6 1429.9 1313.8 1270.8 1221.1
75+ Number 784 734 797 904 873
Rate 2673.4 3186.6 3191.0 3701.9 2489.9
Total Number 2879 2976 2920 3350 3254
Rate 822.7 874.0 865.7 955.3 826.2
Age-adjusted Rate 1060.1 1141.0 1100.4 1193.5 958.0
Table 5.4 Number of Deaths with Major Cardiovascular Disease
as Underlying Cause and Mortality Rate per 100,000 Diabetic
Population, by Age and Year, Black Males, United States,
1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 118 134 159 157
Rate 187.9 161.5 175.1 195.0
45-64 Number 1297 1249 1319 1305
Rate 584.1 612.8 629.3 528.7
65-74 Number 1166 1197 1220 1230
Rate 1180.2 1320.5 1176.2 1448.3
75+ Number 891 1026 1028 1043
Rate 2594.3 2623.9 2939.7 2028.4
Total Number 3472 3607 3726 3736
Rate 830.6 865.9 848.5 805.7
Age-adjusted Rate 971.2 1019.8 1038.1 935.9
5.5 Mortality Rate per 100,000 Diabetic Pop., Black Females
Table 5.5 Number of Deaths with Major Cardiovascular Disease as Underlying
Cause and Mortality Rate per 100,000 Diabetic Population, by Age
and Year, Black Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 91 98 106 113 101
Rate 81.2 101.3 123.6 97.4 92.7
45-64 Number 1469 1541 1569 1552 1546
Rate 584.2 543.1 486.8 515.8 549.3
65-74 Number 1799 1661 1652 1770 1871
Rate 1739.3 1212.9 1033.1 885.5 1004.1
75+ Number 1802 1794 1798 2045 2102
Rate 2530.6 2546.1 2652.1 2446.5 2280.9
Total Number 5162 5096 5129 5483 5621
Rate 959.1 866.9 806.7 782.8 840.4
Age-adjusted Rate 1090.4 940.6 889.7 827.6 847.2
Table 5.5 Number of Deaths with Major Cardiovascular Disease as Underlying
Cause and Mortality Rate per 100,000 Diabetic Population, by Age
and Year, Black Females, United States, 1980-1984
Year
1985 1986 1987 1988
Age
0-44 Number 117 111 126 127
Rate 128.1 127.4 115.7 94.0
45-64 Number 1552 1630 1593 1690
Rate 599.7 581.3 569.6 694.6
65-74 Number 1905 2039 1992 1991
Rate 1041.8 1417.0 1398.1 1288.0
75+ Number 2258 2343 2337 2590
Rate 1918.1 1853.0 1594.2 1842.1
Total Number 5834 6125 6050 6399
Rate 896.5 960.2 892.7 950.1
Age-adjusted Rate 830.1 911.4 861.0 916.9
5.6-5.10 Deaths w/ Ischemic Heart Disease as Underlying Cause
5.6 Mort. Rate per 100,000 Diabetic Pop., Age & Year, 80-88
Table 5.6 Number of Deaths with Ischemic Heart Disease as Underlying Cause
and Mortality Rate per 100,000 Diabetic Population, by Age and
Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 506 509 565 584 637
Rate 50.1 53.5 57.4 58.3 64.1
45-64 Number 10448 10511 10398 10530 10329
Rate 437.2 413.1 405.1 405.1 437.9
65-74 Number 15487 15178 15618 15755 15899
Rate 1017.4 1112.2 1023.8 1207.2 905.0
75+ Number 21725 21519 21951 23002 22867
Rate 2522.6 2270.9 2708.5 2631.3 2097.4
Total Number 48169 47719 48539 49876 49734
Rate 833.0 821.5 824.6 862.8 802.2
Age-adjusted Rate 833.0 811.1 850.4 887.3 742.8
Table 5.6 Number of Deaths with Ischemic Heart Disease as Underlying Cause
and Mortality Rate per 100,000 Diabetic Population, by Age and
Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 613 671 656 630
Rate 59.1 64.1 48.1 57.7
45-64 Number 10204 9975 9815 9485
Rate 438.0 350.3 384.7 385.5
65-74 Number 16084 15624 15925 15640
Rate 868.9 980.7 935.3 917.8
75+ Number 23170 23518 23166 23677
Rate 2105.0 1831.4 1941.1 2164.3
Total Number 50074 49793 49566 49433
Rate 792.3 735.3 727.7 778.4
Age-adjusted Rate 733.5 686.9 702.7 733.3
5.7 Mort. Rate per 100,000 Diabetic Pop., White Males
Table 5.7 Number of Deaths with Ischemic Heart Disease as Underlying Cause
and Mortality Rate per 100,000 Diabetic Population, by Age and
Year, White Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 278 269 273 336 345
Rate 89.3 72.9 71.0 82.4 97.5
45-64 Number 5411 5455 5360 5316 5152
Rate 589.8 536.3 548.6 577.7 633.3
65-74 Number 6979 6936 7258 7170 7298
Rate 1173.2 1253.9 1689.0 1721.2 1233.5
75+ Number 7530 7586 7552 8044 8101
Rate 2944.9 3324.3 2510.3 2451.0 2500.6
Total Number 20199 20246 20446 20868 20898
Rate 971.5 934.0 977.3 1006.7 1003.4
Age-adjusted Rate 1006.8 1059.5 1057.6 1071.2 975.9
Table 5.7 Number of Deaths with Ischemic Heart Disease as Underlying Cause
and Mortality Rate per 100,000 Diabetic Population, by Age and
Year, White Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 300 345 330 322
Rate 76.5 114.6 57.0 66.6
45-64 Number 5192 4962 4887 4638
Rate 594.5 401.2 464.3 495.4
65-74 Number 7406 7280 7290 7358
Rate 1090.5 1164.8 1034.0 1319.8
75+ Number 8037 8174 8115 8472
Rate 2293.8 2018.1 1932.3 2196.0
Total Number 20936 20763 20623 20790
Rate 912.3 808.6 748.3 879.7
Age-adjusted Rate 887.7 793.0 761.8 890.8
5.8 Mort. Rate per 100,000 Diabetic Pop., White Females
Table 5.8 Number of Deaths with Ischemic Heart Disease as Underlying Cause
and Mortality Rate per 100,000 Diabetic Population, by Age and
Year, White Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 144 151 178 138 183
Rate 30.3 36.0 37.5 34.2 41.7
45-64 Number 3645 3527 3488 3593 3632
Rate 372.0 353.6 353.9 332.4 347.6
65-74 Number 6984 6776 6876 6970 6954
Rate 932.2 1098.4 876.4 1107.1 866.6
75+ Number 12825 12522 13025 13312 13146
Rate 2473.3 2103.5 3063.9 2906.3 2218.1
Total Number 23599 22976 23569 24014 23915
Rate 866.5 873.7 882.6 933.6 830.8
Age-adjusted Rate 772.8 754.8 839.8 867.6 709.4
Table 5.8 Number of Deaths with Ischemic Heart Disease as Underlying Cause
and Mortality Rate per 100,000 Diabetic Population, by Age and
Year, White Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 193 208 194 184
Rate 38.6 35.2 38.0 51.7
45-64 Number 3441 3398 3300 3204
Rate 376.8 317.3 345.5 347.2
65-74 Number 6868 6513 6792 6463
Rate 775.8 962.6 912.2 781.3
75+ Number 13364 13493 13243 13275
Rate 2251.1 1981.7 2473.6 2593.0
Total Number 23867 23614 23532 23127
Rate 825.1 782.1 856.9 883.5
Age-adjusted Rate 701.9 685.8 758.0 744.4
5.9 Mort. Rate per 100,000 Diabetic Pop., Black Males
Table 5.9 Number of Deaths with Ischemic Heart Disease as Underlying Cause
and Mortality Rate per 100,000 Diabetic Population, by Age and
Year, Black Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 41 49 53 58 51
Rate 56.2 76.1 85.9 158.0 92.4
45-64 Number 545 653 575 682 627
Rate 292.9 352.1 319.4 333.9 291.1
65-74 Number 509 510 464 568 544
Rate 826.8 754.1 656.9 665.9 616.8
75+ Number 396 388 367 444 437
Rate 1350.3 1684.5 1469.4 1818.2 1246.4
Total Number 1491 1600 1459 1753 1659
Rate 426.0 469.9 432.5 499.9 421.2
Age-adjusted Rate 549.6 608.2 538.8 611.6 484.4
Table 5.9 Number of Deaths with Ischemic Heart Disease as Underlying Cause
and Mortality Rate per 100,000 Diabetic Population, by Age and
Year, Black Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 53 65 59 67
Rate 84.4 78.3 65.0 83.2
45-64 Number 665 639 670 638
Rate 299.5 313.5 319.6 258.5
65-74 Number 622 622 651 601
Rate 629.6 686.1 627.6 707.7
75+ Number 449 496 487 468
Rate 1307.3 1268.5 1392.6 910.2
Total Number 1789 1822 1867 1774
Rate 428.0 437.4 425.2 382.6
Age-adjusted Rate 498.9 512.8 516.1 443.2
5.10 Mort. Rate per 100,000 Diabetic Pop., Black Females
Table 5.10 Number of Deaths with Ischemic Heart Disease as Underlying Cause
and Mortality Rate per 100,000 Diabetic Population, by Age and
Year, Black Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 38 35 53 45 46
Rate 33.9 36.2 61.8 38.8 42.2
45-64 Number 740 781 846 799 784
Rate 294.3 275.3 262.5 265.5 278.5
65-74 Number 884 849 855 891 931
Rate 854.7 620.0 534.7 445.8 499.6
75+ Number 810 874 821 1007 960
Rate 1137.5 1240.4 1211.0 1204.7 1041.7
Total Number 2473 2541 2577 2743 2721
Rate 459.5 432.2 405.3 391.6 406.8
Age-adjusted Rate 521.9 468.0 440.4 413.3 409.2
Table 5.10 Number of Deaths with Ischemic Heart Disease as Underlying Cause
and Mortality Rate per 100,000 Diabetic Population, by Age and
Year, Black Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 56 41 55 51
Rate 61.3 47.0 50.5 37.8
45-64 Number 745 813 776 802
Rate 287.9 289.9 277.4 329.6
65-74 Number 975 1023 980 981
Rate 533.2 710.9 687.8 634.6
75+ Number 1090 1115 1070 1181
Rate 925.9 881.8 729.9 840.0
Total Number 2867 2993 2881 3015
Rate 440.6 469.2 425.1 447.7
Age-adjusted Rate 407.9 446.5 413.2 435.0
5.11-5.15 Deaths with Stroke as Underlying Cause
5.11 Mort. Rate per 100,000 Diabetic Pop., Age & Year, 80-88
Table 5.11 Number of Deaths with Stroke as Underlying Cause and Mortality
Rate per 100,000 Diabetic Population, by Age and Year,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 87 102 68 102 108
Rate 8.6 10.7 6.9 10.2 10.9
45-64 Number 1630 1584 1514 1469 1566
Rate 68.2 62.3 59.0 56.5 66.4
65-74 Number 3410 3397 3005 3264 3145
Rate 224.0 248.9 197.0 250.1 179.0
75+ Number 7608 7042 7145 7125 7265
Rate 883.4 743.2 881.6 815.1 666.4
Total Number 12735 12125 11734 11961 12085
Rate 220.2 208.7 199.3 206.9 194.9
Age-adjusted Rate 220.2 203.8 208.7 212.4 175.7
Table 5.11 Number of Deaths with Stroke as Underlying Cause and Mortality
Rate per 100,000 Diabetic Population, by Age and Year,
United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 103 93 98 101
Rate 9.9 8.9 7.2 9.2
45-64 Number 1480 1549 1468 1461
Rate 63.5 54.4 57.5 59.4
65-74 Number 3257 3112 3032 2982
Rate 175.9 195.3 178.1 175.0
75+ Number 7083 6949 7084 7107
Rate 643.5 541.1 593.6 649.6
Total Number 11925 11705 11683 11653
Rate 188.7 172.9 171.5 183.5
Age-adjusted Rate 170.1 156.0 160.3 169.0
5.12 Mort. Rate per 100,000 Diabetic Pop., White Males
Table 5.12 Number of Deaths with Stroke as Underlying Cause and Mortality
Rate per 100,000 Diabetic Population, by Age and Year, White
Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 28 28 23 40 44
Rate 9.0 7.6 6.0 9.8 12.4
45-64 Number 611 562 552 545 599
Rate 66.6 55.3 56.5 59.2 73.6
65-74 Number 1283 1296 1147 1233 1166
Rate 215.7 234.3 266.9 296.0 197.1
75+ Number 2306 2055 2101 2115 2152
Rate 901.9 900.5 698.4 644.4 664.3
Total Number 4228 3941 3823 3933 3961
Rate 203.4 181.8 182.7 189.7 190.2
Age-adjusted Rate 220.2 220.0 198.7 200.1 183.4
Table 5.12 Number of Deaths with Stroke as Underlying Cause and Mortality
Rate per 100,000 Diabetic Population, by Age and Year, White
Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 34 44 39 43
Rate 8.7 14.6 6.7 8.9
45-64 Number 572 556 530 529
Rate 65.5 45.0 50.4 56.5
65-74 Number 1236 1183 1164 1105
Rate 182.0 189.3 165.1 198.2
75+ Number 2087 1980 2064 2157
Rate 595.6 488.8 491.5 559.1
Total Number 3930 3764 3797 3834
Rate 171.3 146.6 137.8 162.2
Age-adjusted Rate 165.2 143.8 138.6 160.3
5.13 Mort. Rate per 100,000 Diabetic Pop., White Females
Table 5.13 Number of Deaths with Stroke as Underlying Cause and Mortality
Rate per 100,000 Diabetic Population, by Age and Year, White
Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 34 35 24 30 31
Rate 7.1 8.3 5.1 7.4 7.1
45-64 Number 552 560 492 478 530
Rate 56.3 56.1 49.9 44.2 50.7
65-74 Number 1488 1529 1292 1423 1346
Rate 198.6 247.9 164.7 226.0 167.7
75+ Number 4558 4338 4313 4281 4363
Rate 879.0 728.7 1014.6 934.6 736.2
Total Number 6632 6462 6123 6213 6271
Rate 243.5 245.7 229.3 241.5 217.8
Age-adjusted Rate 207.7 198.4 216.0 218.3 176.0
Table 5.13 Number of Deaths with Stroke as Underlying Cause and Mortality
Rate per 100,000 Diabetic Population, by Age and Year, White
Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 32 26 16 26
Rate 6.4 4.4 3.1 7.3
45-64 Number 479 539 493 472
Rate 52.4 50.3 51.6 51.1
65-74 Number 1437 1332 1298 1260
Rate 162.3 196.9 174.3 152.3
75+ Number 4206 4176 4209 4058
Rate 708.5 613.3 786.2 792.6
Total Number 6155 6073 6016 5817
Rate 212.8 201.1 219.1 222.2
Age-adjusted Rate 171.0 164.7 184.9 180.6
5.14 Mort. Rate per 100,000 Diabetic Pop., Black Males
Table 5.14 Number of Deaths with Stroke as Underlying Cause and Mortality
Rate per 100,000 Diabetic Population, by Age and Year, Black
Males, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 12 15 11 12 17
Rate 16.4 23.3 17.8 32.7 30.8
45-64 Number 168 156 160 157 158
Rate 90.3 84.1 88.9 76.9 73.4
65-74 Number 189 184 190 209 206
Rate 307.0 272.1 269.0 245.0 233.6
75+ Number 175 163 197 180 176
Rate 596.7 707.7 788.7 737.1 502.0
Total Number 544 518 558 558 557
Rate 155.4 152.1 165.4 159.1 141.4
Age-adjusted Rate 209.9 215.8 228.1 211.8 171.9
Table 5.14 Number of Deaths with Stroke as Underlying Cause and Mortality
Rate per 100,000 Diabetic Population, by Age and Year, Black
Males, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 12 12 23 12
Rate 19.1 14.5 25.3 14.9
45-64 Number 159 159 163 177
Rate 71.6 78.0 77.8 71.7
65-74 Number 197 189 191 217
Rate 199.4 208.5 184.1 255.5
75+ Number 180 200 202 220
Rate 524.1 511.5 577.6 427.9
Total Number 548 560 579 626
Rate 131.1 134.4 131.9 135.0
Age-adjusted Rate 163.5 165.8 171.1 163.2
5.15 Mort. Rate per 100,000 Diabetic Pop., Black Female
Table 5.15 Number of Deaths with Stroke as Underlying Cause and Mortality
Rate per 100,000 Diabetic Population, by Age and Year, Black
Females, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 11 19 10 19 15
Rate 9.8 19.6 11.7 16.4 13.8
45-64 Number 289 284 284 253 250
Rate 114.9 100.1 88.1 84.1 88.8
65-74 Number 415 355 334 359 380
Rate 401.2 259.2 208.9 179.6 203.9
75+ Number 479 405 448 463 486
Rate 672.7 574.8 660.8 553.9 527.4
Total Number 1194 1063 1076 1094 1131
Rate 221.9 180.8 169.2 156.2 169.1
Age-adjusted Rate 255.0 198.6 191.9 167.4 171.3
Table 5.15 Number of Deaths with Stroke as Underlying Cause and Mortality
Rate per 100,000 Diabetic Population, by Age and Year, Black
Females, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 21 10 19 19
Rate 23.0 11.5 17.4 14.1
45-64 Number 245 257 250 249
Rate 94.7 91.6 89.4 102.3
65-74 Number 341 363 334 350
Rate 186.5 252.3 234.4 226.4
75+ Number 530 501 510 562
Rate 450.2 396.2 347.9 399.7
Total Number 1137 1132 1114 1181
Rate 174.7 177.5 164.4 175.3
Age-adjusted Rate 159.3 165.3 153.5 163.9
5.16-5.17 Discharges & Rates for Major Cardiovascular Disease
5.16 1,000 Diabetic Pop., by Age and Year, U.S., 80-88
Table 5.16 Number of Discharges for Major Cardiovascular Disease as
Primary Diagnosis and Hospital Discharge Rate per 1,000
Diabetic Population, by Age and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number (a) 16 21 20 27 26
Rate 15.9 22.2 20.4 27.0 25.9
45-64 Number 198 195 226 232 255
Rate 83.1 76.5 88.1 89.3 108.1
65-74 Number 193 205 226 237 263
Rate 126.6 150.4 148.3 181.9 149.9
75+ Number 166 189 207 235 249
Rate 193.0 199.1 255.6 269.1 228.4
Total Number 573 610 680 732 793
Rate 99.2 104.9 115.5 126.6 127.9
Age-adjusted Rate 99.2 104.7 117.1 129.6 122.7
(a) In thousands
Table 5.16 Number of Discharges for Major Cardiovascular Disease as
Primary Diagnosis and Hospital Discharge Rate per 1,000
Diabetic Population, by Age and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number (a) 27 28 26 31
Rate 26.1 26.5 18.8 28.5
45-64 Number 246 268 296 288
Rate 105.6 94.2 116.0 117.2
65-74 Number 260 298 310 311
Rate 140.4 187.1 182.0 182.3
75+ Number 231 255 270 278
Rate 210.0 198.3 226.5 254.1
Total Number 764 849 902 908
Rate 120.9 125.3 132.4 143.0
Age-adjusted Rate 116.4 122.3 132.9 139.2
(a) In thousands
5.17 1,000 Diabetic Pop., by Race, Sex, and Year, U.S., 80-88
Table 5.17 Number of Discharges for Major Cardiovascular Disease as
Primary Diagnosis and Hospital Discharge Rate per 1,000
Diabetic Population, by Race, Sex, and Year, United States,
1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Number (a) 197 217 244 257 264
Rate 95.0 100.0 116.5 124.2 126.9
Adjusted Rate (b) 95.2 107.3 123.5 130.5 125.3
Female Number 245 305 293 333 362
Rate 89.8 116.1 109.7 129.6 125.7
Adjusted Rate 85.0 108.6 106.4 124.8 114.5
Black Male Number 21 20 21 26 34
Rate 59.0 58.1 61.6 74.7 86.0
Adjusted Rate 65.5 69.8 65.4 81.2 89.9
Female Number 36 53 51 53 60
Rate 67.4 90.5 79.9 75.6 89.2
Adjusted Rate 72.9 92.6 82.4 76.0 88.3
Total Total Number 573 610 680 732 793
Rate 99.2 104.9 115.5 126.6 127.9
Adjusted Rate 99.2 104.7 117.1 129.6 122.7
(a) In thousands
(b) Adjusted for age
Table 5.17 Number of Discharges for Major Cardiovascular Disease as
Primary Diagnosis and Hospital Discharge Rate per 1,000
Diabetic Population, by Race, Sex, and Year, United States,
1985-1988
Year
1985 1986 1987 1988
Race Sex
White Male Number (a) 271 300 314 335
Rate 118.0 116.9 114.0 141.5
Adjusted Rate (b) 116.4 114.8 117.5 146.2
Female Number 323 359 374 372
Rate 111.5 118.8 136.4 142.3
Adjusted Rate 104.5 115.4 129.9 129.2
Black Male Number 35 38 39 38
Rate 82.7 91.9 89.3 81.3
Adjusted Rate 89.8 102.3 102.6 87.5
Female Number 58 65 68 78
Rate 89.8 101.3 100.0 115.9
Adjusted Rate 86.7 102.7 101.6 121.1
Total Total Number 764 849 902 908
Rate 120.9 125.3 132.4 143.0
Adjusted Rate 116.4 122.3 132.9 139.2
(a) In thousands
(b) Adjusted for age
5.18-5.19 Hosp. Discharges & Rates for Ischemic Heart Disease
5.18 1,000 Diabetic Pop., by Age and Year, U.S., 80-88
Table 5.18 Number of Discharges for Ischemic Heart Disease as
Primary Diagnosis and Hospital Discharge Rate per 1,000
Diabetic Population, by Age and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number (a) 9 8 10 9 11
Rate 9.1 7.9 10.2 8.9 11.5
45-64 Number 98 90 111 111 130
Rate 41.0 35.5 43.3 42.6 55.1
65-74 Number 76 73 91 94 113
Rate 49.9 53.8 59.8 72.0 64.4
75+ Number 62 65 78 89 86
Rate 71.5 68.6 96.4 101.5 79.3
Total Number 245 236 290 302 341
Rate 42.3 40.7 49.3 52.3 55.0
Age-adjusted Rate 42.3 40.4 49.8 53.2 53.5
(a) In thousands
Table 5.18 Number of Discharges for Ischemic Heart Disease as
Primary Diagnosis and Hospital Discharge Rate per 1,000
Diabetic Population, by Age and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number (a) 12 13 12 16
Rate 11.4 12.3 9.1 15.0
45-64 Number 117 137 156 144
Rate 50.3 48.0 61.0 58.7
65-74 Number 111 124 134 129
Rate 59.8 77.8 78.9 75.8
75+ Number 80 91 87 96
Rate 72.6 71.1 73.2 87.9
Total Number 320 365 390 386
Rate 50.6 53.9 57.2 60.8
Age-adjusted Rate 49.3 53.1 58.4 59.9
(a) In thousands
5.19 1,000 Diabetic Pop., by Race, Sex, and Year, U.S., 80-88
Table 5.19 Number of Discharges for Ischemic Heart Disease as
Primary Diagnosis and Hospital Discharge Rate per 1,000
Diabetic Population, by Race, Sex, and Year, United States,
1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Number (a) 96 98 116 122 133
Rate 46.0 45.0 55.5 59.1 63.6
Adjusted Rate (b) 45.8 46.9 57.9 61.5 63.4
Female Number 103 112 127 136 149
Rate 37.9 42.7 47.6 52.8 51.6
Adjusted Rate 36.5 40.2 46.7 51.0 48.0
Black Male Number 6 6 5 7 13
Rate 18.2 17.6 14.8 19.1 32.7
Adjusted Rate 20.0 19.7 15.8 18.7 31.9
Female Number 10 14 15 14 18
Rate 19.0 23.7 23.4 20.6 27.6
Adjusted Rate 21.4 23.8 24.3 20.8 27.2
Total Total Number 245 236 290 302 341
Rate 42.3 40.7 49.3 52.3 55.0
Adjusted Rate 42.3 40.4 49.8 53.2 53.5
(a) In thousands
(b) Adjusted for age
Table 5.19 Number of Discharges for Ischemic Heart Disease as
Primary Diagnosis and Hospital Discharge Rate per 1,000
Diabetic Population, by Race, Sex, and Year, United States,
1985-1988
Year
1985 1986 1987 1988
Race Sex
White Male Number (a) 125 141 153 160
Rate 54.3 55.1 55.7 67.9
Adjusted Rate (b) 54.0 53.9 57.8 70.5
Female Number 132 155 163 158
Rate 45.8 51.3 59.2 60.3
Adjusted Rate 44.3 51.3 58.3 56.7
Black Male Number 10 13 14 10
Rate 24.3 32.3 31.1 21.9
Adjusted Rate 25.0 35.7 34.3 22.0
Female Number 18 18 19 19
Rate 26.9 28.9 28.3 28.9
Adjusted Rate 25.6 29.3 30.2 30.2
Total Total Number 320 365 390 386
Rate 50.6 53.9 57.2 60.8
Adjusted Rate 49.3 53.1 58.4 59.9
(a) In thousands
(b) Adjusted for age
5.20-5.21 Hosp. Discharges/Rates for Stroke as Primary Diagnosis
5.20 1,000 Diabetic Pop., by Age & Year, U.S., 80-88
Table 5.20 Number of Discharges for Stroke as Primary Diagnosis and
Hospital Discharge Rate per 1,000 Diabetic Population, by
Age and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number (a) 1 1 1 3 1
Rate 1.2 1.0 1.1 3.3 0.8
45-64 Number 18 19 21 25 27
Rate 7.6 7.4 8.1 9.5 11.5
65-74 Number 30 36 31 36 39
Rate 19.8 26.3 20.3 28.0 22.2
75+ Number 28 31 40 41 49
Rate 32.4 32.6 49.1 46.5 44.9
Total Number 77 87 93 105 116
Rate 13.4 14.9 15.7 18.2 18.7
Age-adjusted Rate 13.4 15.0 16.2 18.8 17.4
(a) In thousands
Table 5.20 Number of Discharges for Stroke as Primary Diagnosis and
Hospital Discharge Rate per 1,000 Diabetic Population, by
Age and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number (a) 3 3 2 1
Rate 2.8 2.9 1.7 1.2
45-64 Number 28 27 32 32
Rate 12.2 9.5 12.4 13.1
65-74 Number 47 46 46 38
Rate 25.1 28.7 27.1 22.4
75+ Number 41 41 48 43
Rate 36.9 31.9 40.1 39.1
Total Number 118 117 128 114
Rate 18.7 17.2 18.8 18.0
Age-adjusted Rate 17.6 16.7 18.5 17.3
(a) In thousands
5.21 1,000 Diabetic Pop., by Race, Sex, and Year, U.S., 80-88
Table 5.21 Number of Discharges for Stroke as Primary Diagnosis and
Hospital Discharge Rate per 1,000 Diabetic Population, by
Race, Sex, and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Number (a) 26 27 33 38 32
Rate 12.5 12.2 15.9 18.3 15.2
Adjusted Rate (b) 12.8 13.2 17.1 19.8 14.8
Female Number 33 45 38 44 54
Rate 12.0 17.0 14.2 17.2 18.8
Adjusted Rate 11.0 15.7 13.5 16.4 16.1
Black Male Number 3 4 4 5 5
Rate 7.2 10.4 12.5 13.4 12.7
Adjusted Rate 9.6 13.5 13.9 15.5 13.7
Female Number 5 9 6 7 11
Rate 9.7 14.7 9.7 10.6 16.3
Adjusted Rate 10.8 16.1 10.1 10.9 16.3
Total Total Number 77 87 93 105 116
Rate 13.4 14.9 15.7 18.2 18.7
Adjusted Rate 13.4 15.0 16.2 18.8 17.4
(a) In thousands
(b) Adjusted for age
Table 5.21 Number of Discharges for Stroke as Primary Diagnosis and
Hospital Discharge Rate per 1,000 Diabetic Population, by
Race, Sex, and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Race Sex
White Male Number (a) 37 40 36 36
Rate 16.2 15.4 13.0 15.3
Adjusted Rate (b) 15.8 15.5 13.3 15.7
Female Number 52 43 55 46
Rate 18.0 14.3 20.0 17.8
Adjusted Rate 15.9 13.2 18.3 15.2
Black Male Number 6 5 7 5
Rate 15.4 11.9 15.3 10.1
Adjusted Rate 16.9 13.2 17.1 11.8
Female Number 11 15 11 11
Rate 17.0 23.6 16.3 16.3
Adjusted Rate 16.4 24.4 16.6 17.6
Total Total Number 118 117 128 114
Rate 18.7 17.2 18.8 18.0
Adjusted Rate 17.6 16.7 18.5 17.3
(a) In thousands
(b) Adjusted for age
LOWER EXTREMITY AMPUTATIONS
Introduction
Diabetes is the leading cause of lower extremity amputation (LEA)
in the United States. The relative risk for a LEA among persons with
diabetes is about 15 times that of persons without diabetes. About
half of all nontraumatic LEAs occur among persons with diabetes (Bild
et al., 1989). We examine hospitalization trends for LEA among persons
with diabetes in the United States during 1980-1987. When appropriate,
we present LEA hospitalization rates categorized by age, race, sex,
region, and calendar year. We determine LEA rates for the general
United States population, as well as rates among persons with diabetes.
Methods
The methods have been described previously (Chapter 4). Data for
amputations were obtained from the National Hospital Discharge
Survey (NHDS), and the diabetic population was estimated using data
from the National Health Interview Survey (Chapter 2). LEAs were
identified using International Classification of Diseases-9th Revision
(ICD-9) procedure code 84.1. Traumatic amputations of the toe, foot,
or leg (ICD-9 disease codes 895, 896, and 897) were excluded from
the analysis. Thus, for our purposes, the term LEA refers to nontraumatic
amputations. Diabetes-related discharges were identified by selecting
for ICD-9 disease code 250. Because of small sample sizes, when calculating
race-specific rates, we combined results for males and females. Similarly,
when calculating sex-specific rates, we combined results for all races.
Results
The number of LEAs performed among persons with diabetes was
relatively stable from 1980 to 1982, increased about 50% in 1983,
and then leveled off through 1987 (Figure 6.1). A similar pattern
was seen for the LEA rates in the diabetic population (Figure 6.2)
and within each age category (Table 6.1).
Hospital discharge rates for LEA increased with age. In 1987, 68%
of the discharges occurred among those persons older than 64 years of
age and 95% were among those 45 years of age or older (Table 6.1). Rates
among males and females exhibited the same temporal trends as noted
in the total diabetic population (Figure 6.3, Table 6.2). Discharge
rates for LEA among males with diabetes were from 10% to 64% higher
than among females with diabetes.
From 1980 to 1987, blacks accounted for 13% to 25% of all hospital
discharges for LEAs related to diabetes (Table 6.3). The hospital
discharge rates for blacks with diabetes were consistently higher
than those for whites with diabetes, particularly from 1980 to 1981
and 1984 to 1987, when the rates were 1.5 to 2 times higher (Figure
6.4, Table 6.3).
Using the general population as the denominator resulted in similar
trends as seen using diabetic population denominators (Tables 6.4-6.6).
Because stable diabetic population estimates were not available by region,
we calculated region-specific rates using general population denominators
only. Discharge rates for LEAs varied by geographic region (Table 6.7).
Unadjusted rates and rates adjusted for age and race were consistently
highest in the Northeast and, for the most part, lowest in the West.
Discussion
One of the most striking findings from this analysis was
the dramatic increase in numbers and rates of LEAs among persons with
diabetes that occurred in 1983. In 1983, Medicare instituted the
prospective payment system with diagnosis-related groups for reimbursement.
This reimbursement change may have influenced the listing of diabetes on
hospital records as a contributing cause for LEA and may, in part,
be responsible for the increases seen in hospital discharges for LEA
related to diabetes in 1983.
The hospital discharge rates for LEA among persons with diabetes were
higher for males than for females and for blacks than for whites. These
findings are consistent with the findings of previous research, which
has shown that the risk of LEA in blacks (as well as certain groups
of Native Americans) with diabetes is 2 to 4 times higher than the
corresponding risk in whites, and that the risk among males is 1.5
to 3 times higher than among females (Bild et al., 1989).
The rate of LEA related to diabetes also increased with age. The
major pathogenetic mechanisms by which diabetes can lead to a LEA
are peripheral vascular disease and peripheral neuropathy. Both of
these conditions are more prevalent with increasing age and with longer
duration of diabetes. Other factors that can lead to LEA among persons
with diabetes are infection, hyperglycemia, improper foot care, extant
foot lesions, and a history of a previous amputation (Most & Sinnock,
1983).
LEA is a significant contributor to morbidity, mortality, disability,
and costs among persons with diabetes. The direct cost of an amputation
has been estimated to be 8,000 to 12,000 dollars. Therefore, the
56,000 LEAs that were performed among persons with diabetes in 1987
represent a direct cost of about 500 million dollars. Intensive glycemic
and hypertension control, coupled with proper foot care, have been
shown to be effective in reducing the frequency of amputations among
persons with diabetes (Davidson et al., 1981). Applying these measures
among patients with diabetes could result in substantial savings in
morbidity and costs.
Update
This section updates data presented in previous sections in light of one
additional year of hospitalization data. For a complete description of the
methods and operational definitions and for a discussion of the implications
of the findings, see previous sections.
Among persons with diabetes, the number and rate of hospital discharges
coded with lower extremity amputation (LEA) were relatively stable from 1980
to 1982, increased dramatically in 1983 (see Chapter 6 for discussion), and
then leveled off (Figure 1.9, Table 6.1). Hospital discharge rates for LEA
increased with age and were higher for males than for females (Table 6.2) and
for blacks than for whites (Table 6.3).
Detailed Tables
6.1-6.7 Nontraumatic Lower Extremity Amputation
6.1 No./Rate of Discharges per 1,000 Diabetic Pop., Age & Year
Table 6.1 Number of Discharges for Nontraumatic Lower Extremity Amputation
and Hospital Discharge Rate per 1,000 Diabetic Population, by Age
and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number (a) 2 2 2 3 2
Rate 1.6 1.6 1.6 2.8 2.4
45-64 Number 11 10 10 16 17
Rate 4.7 3.8 3.9 6.1 7.2
65-74 Number 12 9 9 17 14
Rate 7.6 6.4 6.0 13.1 8.0
75+ Number 12 10 10 12 14
Rate 13.5 10.5 12.6 13.2 12.9
Total Number 36 30 31 47 47
Rate 6.3 5.1 5.3 8.2 7.6
Age-adjusted Rate 6.3 5.1 5.4 8.4 7.4
(a) In thousands
Table 6.1 Number of Discharges for Nontraumatic Lower Extremity Amputation
and Hospital Discharge Rate per 1,000 Diabetic Population, by Age
and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number (a) 4 2 3 3
Rate 4.2 2.3 2.1 2.5
45-64 Number 19 15 15 20
Rate 8.1 5.4 5.8 8.0
65-74 Number 16 17 20 13
Rate 8.6 10.5 12.0 7.5
75+ Number 14 13 18 20
Rate 12.4 10.2 14.8 18.0
Total Number 53 48 56 55
Rate 8.4 7.1 8.2 8.6
Age-adjusted Rate 8.2 6.9 8.1 8.4
(a) In thousands
6.2 No./Rate of Discharges per 1,000 Diabetic Pop., Sex & Year
Table 6.2 Number of Discharges for Nontraumatic Lower Extremity Amputation
and Hospital Discharge Rate per 1,000 Diabetic Population, by Sex
and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
SEX
Male Number (a) 19 15 15 23 22
Rate 7.9 5.7 6.1 9.5 8.8
Age-adjusted Rate 8.3 6.4 6.5 10.3 8.8
Female Number 17 15 16 24 25
Rate 5.1 4.7 4.7 7.2 6.8
Age-adjusted Rate 4.9 4.5 4.7 7.2 6.6
Total Number 36 30 31 47 47
Rate 6.3 5.1 5.3 8.2 7.6
Age-adjusted Rate 6.3 5.1 5.4 8.4 7.4
(a) In thousands
Table 6.2 Number of Discharges for Nontraumatic Lower Extremity Amputation
and Hospital Discharge Rate per 1,000 Diabetic Population, by Sex
and Year, United States, 1985-1988
Year
1985 1986 1987 1988
SEX
Male Number (a) 24 27 28 35
Rate 8.6 9.0 8.6 11.9
Age-adjusted Rate 8.7 9.0 8.8 12.2
Female Number 29 21 28 20
Rate 8.2 5.5 7.8 5.8
Age-adjusted Rate 7.7 5.5 7.4 5.3
Total Number 53 48 56 55
Rate 8.4 7.1 8.2 8.6
Age-adjusted Rate 8.2 6.9 8.1 8.4
(a) In thousands
6.3 No./Rate of Discharges per 1,000 Diabetic Pop., Race & Year
Table 6.3 Number of Discharges for Nontraumatic Lower Extremity
Amputation and Hospital Discharge Rate per 1,000
Diabetic Population, by Race and Year, United States
1980-1984
Year
1980 1981 1982 1983 1984
Race
White Number (a) 23 24 24 36 32
Rate 4.7 4.9 5.0 7.7 6.5
Age-adjusted 4.6 4.8 5.0 7.9 6.3
Black Number 8 6 4 8 10
Rate 9.2 6.2 4.5 7.3 9.0
Age-adjusted 10.7 7.0 4.6 8.7 9.4
Total Number 36 30 31 47 47
Rate 6.3 5.1 5.3 8.2 7.6
Age-adjusted 6.3 5.1 5.4 8.4 7.4
(a) In thousands
Table 6.3 Number of Discharges for Nontraumatic Lower Extremity
Amputation and Hospital Discharge Rate per 1,000
Diabetic Population, by Race and Year, United States
1985-1988
Year
1985 1986 1987 1988
Race
White Number (a) 32 29 35 38
Rate 6.3 5.1 6.4 7.6
Age-adjusted 6.2 5.1 6.3 7.3
Black Number 13 12 10 9
Rate 12.2 11.6 8.6 8.2
Age-adjusted 12.4 11.8 8.7 8.1
Total Number 53 48 56 55
Rate 8.4 7.1 8.2 8.6
Age-adjusted 8.2 6.9 8.1 8.4
(a) In thousands
6.4 Discharge Rate (Diabetes Listed Diagnosis), by Age & Year
Table 6.4 Hospital Discharge Rate for Nontraumatic Lower Extremity Amputation
With Diabetes as a Listed Diagnosis per 10,000 Population, by Age
and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 0.1 0.1 0.1 0.2 0.1
45-64 2.5 2.1 2.3 3.5 3.8
65-74 7.4 5.5 5.6 10.4 8.4
75+ 11.6 9.7 9.6 10.6 12.5
Total 1.6 1.3 1.3 2.0 2.0
Age-adjusted Rate 1.6 1.3 1.3 2.0 2.0
Table 6.4 Hospital Discharge Rate for Nontraumatic Lower Extremity Amputation
With Diabetes as a Listed Diagnosis per 10,000 Population, by Age
and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 0.3 0.1 0.2 0.2
45-64 4.2 3.4 3.3 4.3
65-74 9.3 9.7 11.5 7.1
75+ 11.9 11.1 14.5 15.8
Total 2.2 2.0 2.3 2.2
Age-adjusted Rate 2.2 1.9 2.2 2.1
6.5 Discharge Rate (Diabetes Listed Diagnosis), by Sex & Year
Table 6.5 Hospital Discharge Rate for Nontraumatic Lower Extremity Amputation
with Diabetes as a Listed Diagnosis per 10,000 Population, by Sex
and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
SEX
Male Rate 1.8 1.3 1.3 2.0 1.9
Age-adjusted Rate 2.0 1.5 1.5 2.3 2.1
Female Rate 1.4 1.3 1.3 2.0 2.1
Age-adjusted Rate 1.3 1.2 1.2 1.8 1.9
Total Rate 1.6 1.3 1.3 2.0 2.0
Age-adjusted Rate 1.6 1.3 1.3 2.0 2.0
Table 6.5 Hospital Discharge Rate for Nontraumatic Lower Extremity Amputation
with Diabetes as a Listed Diagnosis per 10,000 Population, by Sex
and Year, United States, 1985-1988
Year
1985 1986 1987 1988
SEX
Male Rate 2.1 2.3 2.4 2.9
Age-adjusted Rate 2.3 2.5 2.6 3.2
Female Rate 2.4 1.7 2.2 1.6
Age-adjusted Rate 2.1 1.5 1.9 1.3
Total Rate 2.2 2.0 2.3 2.2
Age-adjusted Rate 2.2 1.9 2.2 2.1
6.6 Discharge Rate (Diabetes Listed Diagnosis), by Race & Year
Table 6.6 Hospital Discharge Rate for Nontraumatic Lower Extremity
Amputation With Diabetes as a Listed Diagnosis per 10,000
Population, by Race and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Race
White Rate 1.2 1.2 1.2 1.8 1.6
Age-adjusted 1.1 1.1 1.1 1.7 1.5
Black Rate 3.0 2.1 1.6 2.8 3.4
Age-adjusted 4.2 2.8 2.1 3.7 4.5
Total Rate 1.6 1.3 1.3 2.0 2.0
Age-adjusted 1.6 1.3 1.3 2.0 2.0
Table 6.6 Hospital Discharge Rate for Nontraumatic Lower Extremity
Amputation With Diabetes as a Listed Diagnosis per 10,000
Population, by Race and Year, United States, 1980-1984
Year
1985 1986 1987 1988
Race
White Rate 1.6 1.4 1.7 1.8
Age-adjusted 1.5 1.3 1.6 1.7
Black Rate 4.5 4.2 3.2 3.1
Age-adjusted 5.8 5.5 4.3 4.0
Total Rate 2.2 2.0 2.3 2.2
Age-adjusted 2.2 1.9 2.2 2.1
6.7 Discharge Rate/No. (Diabetes Listed Diagnosis),Region & Year
Table 6.7 Number of Discharges for Nontraumatic Lower Extremity
Amputation With Diabetes as a Listed Diagnosis and Hospital
Discharge Rate per 10,000 Population, by Region and Year,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Region
Northeast Number (a) 13 10 11 12 13
Rate 2.6 2.0 2.3 2.5 2.7
Adjusted Rate (b) 2.2 2.0 1.9 2.2 2.3
North Number 7 9 10 13 13
Central Rate 1.2 1.6 1.6 2.2 2.2
Adjusted Rate 1.0 1.6 1.4 2.1 1.9
South Number 11 7 7 16 16
Rate 1.4 0.8 0.9 2.0 2.0
Adjusted Rate 1.2 0.8 0.8 1.9 1.8
West Number 5 4 3 6 5
Rate 1.3 0.9 0.7 1.2 1.0
Adjusted Rate 1.1 1.1 0.6 1.2 1.0
(a) In thousands
(b) Adjusted for age and race
Table 6.7 Number of Discharges for Nontraumatic Lower Extremity
Amputation With Diabetes as a Listed Diagnosis and Hospital
Discharge Rate per 10,000 Population, by Region and Year,
United States, 1985-1988
Year
1985 1986 1987 1988
Region
Northeast Number (a) 12 9 11 13
Rate 2.4 1.8 2.2 2.7
Adjusted Rate (b) 2.1 1.6 1.9 2.3
North Number 14 14 13 16
Central Rate 2.3 2.4 2.3 2.6
Adjusted Rate 2.1 2.4 2.0 2.1
South Number 18 14 20 20
Rate 2.2 1.7 2.4 2.3
Adjusted Rate 1.8 1.3 2.0 1.9
West Number 9 10 11 6
Rate 1.9 2.1 2.3 1.2
Adjusted Rate 1.3 2.2 1.5 0.7
(a) In thousands
(b) Adjusted for age and race
DIABETIC KETOACIDOSIS
Introduction
Diabetic ketoacidosis (DKA) is an acute, life-threatening disorder
that can strike a person with diabetes at any age. Expert
consensus regards DKA morbidity and mortality as largely preventable
(Schlade and Eaton, 1979). Prevention strategies include improved
compliance with glucose control regimens, early recognition of symptoms
and signs of DKA, and prompt treatment of any precipitating medical
conditions, such as infections (National Diabetes Advisory Board,
1983).
We examine hospitalization and mortality trends for DKA in the United
States during the years 1980-1987. Data on overall diabetic hospitalizations
and mortality, and on the other complications of diabetes, are presented
elsewhere. We present DKA hospitalization and mortality rates categorized
by age, race, region, and calender year. We determine DKA rates for
the general U.S. population, as well as rates among people with diabetes
(diabetes-specific rates).
Methods
We used information from the National Hospital Discharge Survey
(NHDS) to determine the annual number of hospitalizations for
DKA (Chapter 4). Rubric 250.1 (diabetes with ketoacidosis) from the
clinical modification of the 9th revision of the International
Classification of Diseases (ICD9-CM) was used to identify discharges
in which DKA was listed as either a primary or secondary diagnosis.
To calculate denominators for annual rates in the general population,
we used intercensal estimates based on 1980 census data. To calculate
denominators for diabetes-specific rates, we estimated the U.S. diabetic
population using information from National Health Interview Surveys
(Chapter 2).
ICD-9 rubric 250.1 was also used to identify deaths in which DKA was
listed as either an underlying or a contributing cause on mortality
records supplied by the National Center for Health Statistics. Methods
(Chapter 3) for calculating general population and diabetes-specific
mortality rates were similar to those used for hospitalization rates.
For both hospital discharge and mortality analyses, general population
rates were age- and race-adjusted using the direct method, with the
1980 U.S. resident population as the standard. To adjust diabetes-specific
rates, we used the estimated 1980 U.S. population of persons with
diabetes as the standard.
Results
Hospital Discharges for DKA in the General Population
In 1987, the latest year for which data are available, there
were about 110,000 hospitalizations in which DKA was listed as a
discharge diagnosis (Figure 7.1). In 1980 there were about 70,000
hospital discharges with DKA as a listed diagnosis.
The number and rate of hospital discharges with DKA as a primary diagnosis
has steadily increased during 1980-1987 (Figure 7.2). The age-adjusted
rate was 2.6 discharges per 10,000 population in 1980, whereas the
corresponding rate in 1987 was 3.8 per 10,000, an average annual increase
of 7% (Table 7.1). Age-specific data indicate that rising rates among
persons less than 45 years old account for much of this overall increase.
Discharge rates were relatively unchanged among those in older age groups
(Table 7.1).
Hospital discharge rates for DKA were consistently higher among blacks
than among whites (Table 7.2). In 1987, the age-adjusted rate for
black males, 7.8 discharges per 10,000, was 2.7-fold higher than the
corresponding rate of 2.8 for white males. Similarly, the rate of
discharges for black females, 5.6 per 10,000, was 1.8-fold higher
than the rate of 3.2 per 10,000 for white females. Among white males
and females, the temporal trends were comparable, with each group
showing increases in rates of DKA as a primary hospital discharge
diagnosis. Among blacks, the temporal trends were less evident because
of sizable year-to-year variability resulting from smaller sample
sizes.
In each of four geographic regions, hospital discharge rates for DKA
as a primary diagnosis exhibited similar trends--a gradual secular
increase (Table 7.3). Rates were generally lower in the Northeast
and higher in the South. In all regions and for each year, age- and
race-adjusted discharge rates were lower than the corresponding unadjusted
rates (Table 7.3).
During the period 1980 through 1987, most (greater than 78%) hospital
records that mention DKA as a discharge diagnosis list this condition
as the primary diagnosis (Figure 7.2). Thus, although hospital discharge
rates are roughly 20% higher for DKA as any listed diagnosis, the
rate trends parallel those for hospital discharges in which DKA is
the primary diagnosis. Age-specific rates for DKA as any listed diagnosis
are presented in Table 7.4, race- and sex-specific rates in Table
7.5, and region-specific rates in Table 7.6.
Hospital Discharges for DKA Among Persons With Diabetes
During 1980-1987, the age-adjusted rate (per 1,000 persons with diabetes)
of hospital discharges for DKA as a primary diagnosis has shown an
overall gradual increase (Figure 7.3). The age-adjusted rate, which
was 10.3 discharges per 1,000 persons in 1980, peaked at 14.6 discharges
per 1,000 in 1984 and then declined slightly to 12.5 per 1,000 in
1987. The overall increase during this period resulted from rising
rates within the 0- to 44-year age category (Table 7.7). Within this
age group, rates increased yearly--from 36.6 discharges per 1,000
persons with diabetes in 1980--until 1985, when they peaked at
58.6 per 1,000 and then declined to 49.9 per 1,000 in 1987. In contrast,
rates within older age categories were stable during this time. In
each year, rates were highest in the youngest age category and decreased
with age.
During this period, black males consistently had the highest annual
DKA hospital discharge rates whereas, with few exceptions, white males
had the lowest rates (Table 7.8). In 1987, for example, the age-adjusted
rate among black males, 24.7 per 1,000 persons with diabetes, was
nearly threefold higher than the corresponding rate of 8.7 per 1,000
among white males. In contrast, rates among black females were only
slightly higher than those among white females. Regarding temporal
trends, the most striking rate increases were seen among black males,
although there was considerable variability, particularly during 1983-1984,
because of small sample sizes. Temporal trends were less discernible
in other race-sex categories.
In general, the trends in hospital discharge rates for DKA as any
listed diagnoses were similar to those for which DKA was listed as
the primary diagnosis. One exception, however, was that the discharge
rate for DKA as any listed diagnosis increased during 1980-1987 in
the 45- to 64-year age group, as well as in the 0- to 44-year age
group (Table 7.9). Race- and sex-specific rates are also presented
(Table 7.10).
DKA Mortality in the General Population
From 1980 to 1986, age-adjusted rates declined for DKA
as an underlying cause of death (Figure 7.4) The mortality rate declined
from 1.60 per 100,000 population in 1980 to 1.37 per 100,000 in 1986,
an average annual decrease of 2%. During this period, however, the
temporal trends varied by age group (Table 7.11). Mortality rates
remained the same, about 0.2 per 100,000, in persons less than 45
years old<197>meanwhile, they decreased in all older age categories. Within
each year, mortality rates increased with age. In 1987, for example,
the mortality rate was 0.23 per 100,000 for those persons 0 to 44
years old, 0.88 for those 45 to 64 years old, 2.06 for those 65 to
74 years old, and 5.02 for those more than 74 years old.
For mortality resulting from DKA as an underlying cause, each race
and sex category showed similar temporal trends: gradual declines
since 1980 (Table 7.12). In all years, black males and females had
the highest rates, whereas white males had the lowest rates. Declining
rates were seen in each geographic region (Table 7.13). In all years,
the unadjusted mortality rate for DKA as an underlying cause was lowest
in the West. After rates were standardized for age and race, regional
differences in mortality were less pronounced (Table 7.13).
Total DKA-related mortality reflects those deaths in which DKA is
listed on the death certificate as either an underlying or contributing
cause. In 1986, of the 2,969 total DKA-related deaths, there were
1,735 deaths (58%) for which DKA was the underlying cause (Tables
7.11 and 7.14). During 1980-1985, DKA as an underlying cause of death
constituted a similar proportion of total DKA-related deaths.
Temporal trends in total DKA-related mortality rates resemble those
for which DKA is listed as the underlying cause of death (Figure 7.4,
Tables 7.14-7.16). Overall, the age-adjusted mortality rate has slightly
declined (Table 7.14). Although age-specific rates appear to have
declined for older age groups, rate declines were less evident for
persons less than 45 years old. From 1980 to 1986, rates declined
in all race-sex categories (Table 7.15), as well as in all geographic
regions (Table 7.16).
DKA Mortality in Persons with Diabetes
During 1980 through 1986, among persons with diabetes, mortality
rates for DKA as either an underlying or contributing cause of
death declined (Figure 7.5). For DKA as an underlying cause, the
age-adjusted mortality rate of 30.6 per 100,000 persons with diabetes
in 1980 fell to 25 per 100,000 by 1986--an annual average decrease
of 3% (Table 7.17). Temporal trends in age-specific rates among persons
with diabetes resembled rate trends among persons in the general population:
there was little change in rates for persons aged 0 to 44 years, whereas
rates declined among all older age categories. Among the 45- to 64-year
age group, the rate dropped from 21.2 per 100,000 in 1980 to 13.9
per 100,000 in 1986, an average annual decline of 5.7%.
In contrast to rates based on the general population, the lowest
age-specific mortality rates for DKA among persons with diabetes were
not in persons less than 45 years old (Table 7.17). Rather, average
age-specific mortality rates were lowest among the 45- to 64-year
age group, and only the rate among persons 75 years and older exceeded
the rate among the youngest age group (Figure 7.6).
Mortality rates for DKA as an underlying cause of death declined
among all race-sex groups during 1980-1986 (Table 7.18). Within each
year, the lowest rates were seen among white males and females (Figure
7.7). For black males and females, DKA mortality rates decreased,
on average, 4.3% annually. The corresponding average annual rate
decreases for white males and females were 3.4% and 1.7%, respectively.
Total DKA-related mortality rates among persons with diabetes are
shown for each age group and for each race-sex group (Tables 7.19-7.20).
Because total DKA-related mortality includes those deaths in which
DKA is listed on the death certificate as a contributing cause, rates
are higher than those based solely on DKA as the underlying cause
of death (Figure 7.5). Temporal trends for total DKA-related mortality
were similar to those for underlying-cause mortality, with declining
rates in persons older than 45 years old and in each race-sex category.
Discussion
We present hospital discharge and mortality rates for DKA during
1980 through 1987. Overall, mortality rates for DKA in the general
population have declined during this period. At the same time, however,
hospitalization rates for DKA have increased. One difficulty in
interpreting these data is that the increasing prevalence of diabetes,
as described in Chapter 2, may be influencing these findings. Because
DKA, by definition, is a condition restricted to those with diabetes,
examining diabetes-specific data provides more useful information
about temporal patterns within the appropriate population-at-risk
for this largely preventable condition. Thus, more emphasis should
be placed on examining rates in the diabetic population.
We found that mortality rates for DKA among persons with diabetes
varied by race. Although mortality rates declined in each race and
sex group during this period, blacks consistently had higher mortality
rates than whites. For DKA as an underlying cause of death, the 1986
age-adjusted mortality rates among black males and females were 2.7
to 2.9 times higher than the corresponding rates in white males and
females. Because these are diabetes-specific rates, these rate ratios
are not influenced by the higher prevalence of diabetes among blacks.
Thus, differences in patient and provider actions (Fishbein, 1985) or
other elements related to health care use may account for the higher
rates seen among blacks with diabetes.
Among persons with diabetes, the age-adjusted rate of hospital discharges
for DKA has gradually increased during 1980-1987. Whether DKA is
listed as a primary or secondary diagnosis, similar patterns are seen.
Hospital discharge rates for DKA were highest in 1984 and have declined
slightly since then, but were still higher during 1985-1987 than they
were during 1980-1983. This temporal increase can be attributed primarily
to rising rates of hospitalization among persons less than 45 years
old. In contrast, hospitalization rates were relatively unchanged
in older age groups during these years.
At the same time, overall age-adjusted mortality rates for DKA among
persons with diabetes have been declining. Yet, as with hospital
discharge trends, the secular mortality experience has varied by age.
Among persons older than 45 years old, mortality rates from DKA as
an underlying cause of death have clearly declined during this decade.
The same is not true, however, for those younger. For persons less than
45 years old, mortality rates for DKA as an underlying cause of death
have not changed. Similar age-specific patterns are seen when total
DKA-related mortality is examined.
Hospital discharge and mortality rates may vary over time for several
reasons. Changes in reporting practices may influence the enumeration
of episodes of DKA. Prospective payment mechanisms with diagnostic
related groups (DRGs) were implemented in 1983. Such a reimbursement
system might alter diagnostic coding practices for certain conditions,
but probably has less impact on recording serious, life-threatening
disorders, such as DKA. Further, if DRGs influenced DKA diagnoses,
similar relative changes should occur within all age categories, which
is not the case. Reporting artifacts unlikely influence the secular
trends seen in DKA mortality rates, because reporting and coding practices
for death certificates did not change during this time.
Other factors that may influence trends in DKA morbidity and mortality
include changes in medical care access and treatment. Medical care
treatment changes include improved and more widespread use of self-care
techniques designed to prevent ketoacidosis and avert hospitalization
(National Diabetes Advisory Board, 1983), as well as technological
advances, such as life support techniques for the critically ill. That
hospital discharge rates for DKA in older persons stayed the same
while the corresponding mortality rates declined would suggest that
advances in hospital treatment, or perhaps improving access to them,
is responsible for these trends.
Unlike their older counterparts with diabetes, persons less than 45
years old have unchanging mortality rates but increasing hospitalization
rates for DKA. Together, these findings suggest that, although certain
advances may have occurred in preventing and treating DKA among certain
groups, DKA remains a significant source of morbidity among younger
persons with diabetes. Additional studies should be directed toward
identifying any subgroups within this age group who are at increased
risk for DKA. Identifying these subgroups would help to target resources
to reduce morbidity, as well as mortality, from this largely preventable
complication of diabetes.
Update
This section updates data presented in previous sections in light of one
additional year of hospitalization data and two additional years of mortality
data. For a complete description of the methods and operational definitions
and for a discussion of the implications of the findings, see previous
sections.
Among the diabetic population, the age-standardized rates of hospital
discharge for diabetic ketoacidosis (DKA) as a primary diagnosis and as any
listed diagnosis increased between 1980 and 1984, decreased slightly in 1985,
and then leveled off (Tables 7.7 and 7.9). DKA hospital discharge rates for
both primary cause and any listed cause were highest among persons with
diabetes younger than 45 years of age. Among the race-sex groups examined,
discharge rates were highest among black males, followed by black females,
white females, and white males (Tables 7.8-7.9).
During the period 1980-1987, among persons with diabetes, mortality
rates for DKA as both an underlying and any listed cause of death declined
(Figure 1.10, Tables 7.17 and 7.19). These declines were followed by
increases in 1988. Temporal trends were similar by age except for rates among
persons younger than age 45, which showed little change between 1980 and 1987.
The highest mortality rates for DKA as either an underlying or any listed
cause of death were found among persons 75 years of age and older. Among the
race-sex groups examined, mortality rates were highest among black males,
followed by black females and then by whites, with little difference between
the sexes (Tables 7.18 and 7.20).
Detailed Tables
7.1-7.3 Discharges w/ Diabetic Ketoacidosis as Primary Diagnosis
7.1 10,000 Pop., by Age and Year, U.S., 80-88
Table 7.1 Number of Discharges with Diabetic Ketoacidosis as Primary
Diagnosis and Hospital Discharge Rate per 10,000 Population,
by Age and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 16 15 16 20 21
Rate 2.2 2.0 2.3 2.9 3.0
20-44 Number 21 23 24 31 37
Rate 2.5 2.7 2.6 3.4 4.0
45-64 Number 12 18 15 12 16
Rate 2.8 4.0 3.3 2.6 3.7
65+ Number 10 8 6 9 10
Rate 3.9 3.2 2.2 3.1 3.7
Total Number 59 64 60 72 85
Rate 2.6 2.8 2.6 3.1 3.6
Age-adjusted Rate 2.6 2.8 2.6 3.1 3.6
(a) In thousands
Table 7.1 Number of Discharges with Diabetic Ketoacidosis as Primary
Diagnosis and Hospital Discharge Rate per 10,000 Population,
by Age and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 21 21 29 25
Rate 3.0 2.9 4.0 3.6
20-44 Number 32 37 39 39
Rate 3.4 3.8 4.0 4.0
45-64 Number 16 16 13 9
Rate 3.6 3.6 2.9 2.0
65+ Number 11 11 11 10
Rate 3.9 3.9 3.8 3.3
Total Number 81 85 93 84
Rate 3.4 3.5 3.8 3.4
Age-adjusted Rate 3.4 3.5 3.8 3.4
(a) In thousands
7.2 10,000 Pop., by Race, Sex, and Year, U.S., 80-88
Table 7.2 Number of Discharges with Diabetic Ketoacidosis as Primary
Diagnosis and Hospital Discharge Rate per 10,000 Population,
by Race, Sex and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Number (a) 16 18 18 17 23
Rate 1.6 1.8 1.8 1.8 2.3
Age-adjusted Rate 1.7 1.8 1.8 1.8 2.3
Female Number 27 29 24 33 35
Rate 2.7 2.9 2.4 3.3 3.4
Age-adjusted Rate 2.7 2.8 2.4 3.3 3.4
Black Male Number 5 6 6 8 12
Rate 4.2 4.9 4.3 6.2 9.0
Age-adjusted Rate 4.8 5.6 4.6 6.1 9.8
Female Number 7 10 7 8 7
Rate 4.8 6.8 4.6 5.4 4.7
Age-adjusted Rate 5.0 7.1 4.9 5.7 5.1
Total Total Number 59 64 60 72 85
Rate 2.6 2.8 2.6 3.1 3.6
Age-adjusted Rate 2.6 2.8 2.6 3.1 3.6
(a) In thousands
Table 7.2 Number of Discharges with Diabetic Ketoacidosis as Primary
Diagnosis and Hospital Discharge Rate per 10,000 Population,
by Race, Sex and Year, United States, 1980-1984
Year
1985 1986 1987 1988
Race Sex
White Male Number (a) 24 23 28 21
Rate 2.4 2.3 2.7 2.0
Age-adjusted Rate 2.4 2.3 2.8 2.0
Female Number 32 32 34 28
Rate 3.1 3.0 3.2 2.6
Age-adjusted Rate 3.1 3.0 3.2 2.7
Black Male Number 6 10 10 12
Rate 4.7 7.2 7.3 8.6
Age-adjusted Rate 4.6 7.4 7.8 8.5
Female Number 11 12 8 11
Rate 7.0 7.6 5.2 6.8
Age-adjusted Rate 7.4 8.0 5.6 6.7
Total Total Number 81 85 93 84
Rate 3.4 3.5 3.8 3.4
Age-adjusted Rate 3.4 3.5 3.8 3.4
(a) In thousands
7.3 10,000 Pop., by Region and Year, U.S., 80-88
Table 7.3 Number of Discharges with Diabetic Ketoacidosis as Primary
Diagnosis and Hospital Discharge Rate per 10,000 Population
by Region and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Region
Northeast Number (a) 12 12 12 13 17
Rate 2.5 2.4 2.3 2.7 3.4
Adjusted Rate (b) 2.3 2.3 2.1 2.7 3.2
North Number 19 16 14 20 18
Central Rate 3.2 2.7 2.3 3.3 3.1
Adjusted Rate 3.0 2.7 2.1 3.2 2.9
South Number 19 24 24 23 30
Rate 2.5 3.2 3.0 2.9 3.7
Adjusted Rate 2.3 2.8 2.8 2.6 3.4
West Number 9 12 11 16 20
Rate 2.2 2.8 2.4 3.5 4.2
Adjusted Rate 2.1 2.9 2.3 3.3 3.9
(a) In thousands
(b) Adjusted for age and race
Table 7.3 Number of Discharges with Diabetic Ketoacidosis as Primary
Diagnosis and Hospital Discharge Rate per 10,000 Population
by Region and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Region
Northeast Number (a) 16 15 16 14
Rate 3.1 3.1 3.1 2.9
Adjusted Rate (b) 3.0 2.8 3.0 2.8
North Number 17 21 24 24
Central Rate 2.9 3.6 4.0 4.1
Adjusted Rate 2.6 3.3 3.5 3.4
South Number 30 32 31 33
Rate 3.7 3.8 3.7 3.9
Adjusted Rate 3.4 3.2 3.3 3.3
West Number 18 17 22 13
Rate 3.8 3.5 4.4 2.5
Adjusted Rate 3.6 3.1 3.9 2.1
(a) In thousands
(b) Adjusted for age and race
7.4-7.6 Discharges w/ Diabetic Detoacidosis as Listed Diagnosis
7.4 10,000 Pop., by Age and Year, U.S., 80-88
Table 7.4 Number of Discharges with Diabetic Ketoacidosis as Any Listed
Diagnosis and Hospital Discharge Rate per 10,000 Population
by Age and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 Number (a) 17 16 17 22 23
Rate 2.4 2.2 2.4 3.1 3.2
20-44 Number 24 26 25 35 42
Rate 2.8 3.0 2.8 3.8 4.5
45-64 Number 15 21 18 14 22
Rate 3.3 4.7 4.0 3.2 4.9
65+ Number 15 11 9 12 18
Rate 5.7 4.3 3.5 4.5 6.5
Total Number 70 74 70 84 105
Rate 3.1 3.2 3.0 3.6 4.4
Age-adjusted Rate 3.1 3.2 3.0 3.6 4.4
(a) In thousands
Table 7.4 Number of Discharges with Diabetic Ketoacidosis as Any Listed
Diagnosis and Hospital Discharge Rate per 10,000 Population
by Age and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 Number (a) 22 22 29 26
Rate 3.1 3.1 4.0 3.7
20-44 Number 38 44 45 43
Rate 4.0 4.6 4.6 4.4
45-64 Number 20 22 19 17
Rate 4.6 4.8 4.2 3.7
65+ Number 18 19 17 17
Rate 6.3 6.7 5.8 5.5
Total Number 98 108 110 103
Rate 4.1 4.5 4.5 4.2
Age-adjusted Rate 4.1 4.4 4.5 4.2
(a) In thousands
7.5 10,000 Pop., by Race, Sex, and Year, U.S., 80-88
Table 7.5 Number of Discharges with Diabetic Ketoacidosis as Any Listed
Diagnosis and Hospital Discharge Rate per 10,000 Population
by Race, Sex, and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Number (a) 19 20 21 20 29
Rate 2.0 2.1 2.2 2.1 2.9
Age-adjusted Rate 2.0 2.1 2.2 2.1 2.9
Female Number 31 35 28 39 45
Rate 3.1 3.5 2.7 3.8 4.4
Age-adjusted Rate 3.1 3.4 2.8 3.7 4.2
Black Male Number 6 6 7 9 13
Rate 4.9 5.0 5.0 7.1 9.5
Age-adjusted Rate 5.5 5.8 5.6 7.3 10.4
Female Number 8 11 7 9 8
Rate 5.9 7.5 5.1 6.0 5.2
Age-adjusted Rate 6.1 8.0 5.4 6.3 5.6
Total Total Number 70 74 70 84 105
Rate 3.1 3.2 3.0 3.6 4.4
Age-adjusted Rate 3.1 3.2 3.0 3.6 4.4
(a) In thousands
Table 7.5 Number of Discharges with Diabetic Ketoacidosis as Any Listed
Diagnosis and Hospital Discharge Rate per 10,000 Population
by Race, Sex, and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Race Sex
White Male Number (a) 29 30 32 25
Rate 2.9 3.0 3.2 2.5
Age-adjusted Rate 3.0 3.0 3.2 2.5
Female Number 39 41 40 36
Rate 3.8 4.0 3.8 3.4
Age-adjusted Rate 3.7 3.8 3.7 3.4
Black Male Number 7 11 12 15
Rate 5.3 8.0 8.5 10.1
Age-adjusted Rate 5.2 8.2 9.4 10.5
Female Number 12 13 10 14
Rate 8.0 8.4 6.7 8.7
Age-adjusted Rate 8.6 8.8 7.4 8.9
Total Total Number 98 108 110 103
Rate 4.1 4.5 4.5 4.2
Age-adjusted Rate 4.1 4.4 4.5 4.2
(a) In thousands
7.6 10,000 Pop., by Region and Year, U.S., 80-88
Table 7.6 Number of Discharges with Diabetic Ketoacidosis as Any Listed
Diagnosis and Hospital Discharge Rate per 10,000 Population
by Region and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Region
Northeast Number (a) 15 13 14 15 20
Rate 3.1 2.7 2.9 3.0 4.0
Adjusted Rate (b) 2.8 2.6 2.6 3.0 3.7
North Number 21 19 16 22 23
Central Rate 3.6 3.2 2.7 3.8 3.9
Adjusted Rate 3.4 3.3 2.5 3.6 3.7
South Number 23 29 28 28 39
Rate 3.0 3.7 3.5 3.5 4.8
Adjusted Rate 2.7 3.4 3.2 3.2 4.3
West Number 11 13 12 19 23
Rate 2.5 3.0 2.7 4.1 4.9
Adjusted Rate 2.4 3.1 2.6 3.6 4.5
(a) In thousands
(b) Adjusted for age and race
Table 7.6 Number of Discharges with Diabetic Ketoacidosis as Any Listed
Diagnosis and Hospital Discharge Rate per 10,000 Population
by Region and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Region
Northeast Number (a) 19 19 20 18
Rate 3.9 3.7 3.9 3.6
Adjusted Rate (b) 3.7 3.4 3.6 3.5
North Number 19 27 28 29
Central Rate 3.3 4.5 4.6 4.9
Adjusted Rate 3.0 4.1 4.1 4.4
South Number 37 41 37 40
Rate 4.5 5.0 4.4 4.7
Adjusted Rate 4.1 4.3 3.9 4.2
West Number 22 21 25 15
Rate 4.6 4.3 5.1 3.0
Adjusted Rate 4.3 3.9 4.6 2.7
(a) In thousands
(b) Adjusted for age and race
7.7-7.8 Discharge for Diabetic Ketoacidosis as Primary Diagonsis
7.7 1,000 Diabetic Pop., by Age and Year, U.S., 80-88
Table 7.7 Hospital Discharge Rate for Diabetic Ketoacidosis as Primary
Diagnosis per 1,000 Diabetic Population, by Age and Year,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 36.6 39.7 40.3 51.5 58.6
20-44 5.2 7.1 5.7 4.5 6.9
45-64 4.2 3.6 2.5 3.9 3.6
Total 10.3 11.0 10.2 12.4 13.7
Age-adjusted Rate 10.3 11.3 10.4 12.4 14.6
Table 7.7 Hospital Discharge Rate for Diabetic Ketoacidosis as Primary
Diagnosis per 1,000 Diabetic Population, by Age and Year,
United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 51.7 55.2 49.9 59.3
20-44 6.9 5.7 5.2 3.8
45-64 3.8 3.9 3.9 3.6
Total 12.8 12.6 13.6 13.2
Age-adjusted Rate 13.4 13.6 12.5 13.4
7.8 1,000 Diabetic Pop., by Race, Sex, and Year, U.S., 80-88
Table 7.8 Hospital Discharge Rate for Diabetic Ketoacidosis as
Primary Diagnosis per 1,000 Diabetic Population,
by Race, Sex and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Rate 7.5 8.1 8.5 8.3 10.9
Age-adjusted Rate 8.3 8.1 8.1 7.7 11.2
Female Rate 9.9 11.0 9.1 13.0 12.1
Age-adjusted Rate 9.9 11.6 9.1 14.0 13.3
Black Male Rate 15.2 18.5 16.7 23.5 30.9
Age-adjusted Rate 13.1 16.5 16.1 35.1 36.0
Female Rate 12.7 16.6 10.5 11.5 10.5
Age-adjusted Rate 11.3 16.4 11.5 11.8 10.7
Total Total Rate 10.3 11.0 10.2 12.4 13.7
Age-adjusted Rate 10.3 11.3 10.4 12.4 14.6
Table 7.8 Hospital Discharge Rate for Diabetic Ketoacidosis as
Primary Diagnosis per 1,000 Diabetic Population,
by Race, Sex and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Race Sex
White Male Rate 10.3 8.8 10.0 8.7
Age-adjusted Rate 10.6 11.8 8.7 7.9
Female Rate 11.1 10.5 12.4 10.7
Age-adjusted Rate 11.3 9.9 12.0 12.9
Black Male Rate 15.4 23.9 23.4 26.6
Age-adjusted Rate 16.9 21.1 21.1 26.8
Female Rate 16.4 18.4 12.0 16.0
Age-adjusted Rate 18.4 21.0 12.4 14.7
Total Total Rate 12.8 12.6 13.6 13.2
Age-adjusted Rate 13.4 13.6 12.5 13.4
7.9-7.10 Discharge for Diabetic Ketoacidosis as Listed Diagnosis
7.9 1,000 Diabetic Pop., by Age and Year, U.S., 80-88
Table 7.9 Hospital Discharge Rate for Diabetic Ketoacidosis as Any
Listed Diagnosis per 1,000 Diabetic Population,
by Age and Year, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-19 40.7 44.0 43.3 56.6 65.1
20-44 6.1 8.3 7.0 5.6 9.2
45-64 6.1 4.9 4.0 5.7 6.4
Total 12.1 12.8 11.9 14.5 16.9
Age-adjusted Rate 12.1 13.1 12.1 14.5 17.8
Table 7.9 Hospital Discharge Rate for Diabetic Ketoacidosis as Any
Listed Diagnosis per 1,000 Diabetic Population,
by Age and Year, 1985-1988
Year
1985 1986 1987 1988
Age
0-19 57.3 63.5 53.7 63.7
20-44 8.8 7.6 7.5 6.8
45-64 6.1 6.8 6.0 6.0
Total 15.5 15.9 16.1 16.2
Age-adjusted Rate 16.1 17.0 15.0 16.4
7.10 1,000 Diabetic Pop., by Race, Sex, and Year, U.S., 80-88
Table 7.10 Hospital Discharge Rate for Diabetic Ketoacidosis as
Any Listed Diagnosis per 1,000 Diabetic Population,
by Race, Sex and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Rate 9.1 9.3 10.0 9.7 13.7
Age-adjusted Rate 9.9 9.3 9.7 9.2 14.1
Female Rate 11.5 13.3 10.4 15.0 15.6
Age-adjusted Rate 11.5 14.0 10.4 16.1 16.7
Black Male Rate 17.7 19.0 19.5 26.9 32.3
Age-adjusted Rate 15.2 17.0 19.0 38.1 37.3
Female Rate 15.4 18.4 11.6 12.7 11.5
Age-adjusted Rate 14.1 18.3 12.8 13.0 11.8
Total Total Rate 12.1 12.8 11.9 14.5 16.9
Age-adjusted Rate 12.1 13.1 12.1 14.5 17.8
Table 7.10 Hospital Discharge Rate for Diabetic Ketoacidosis as
Any Listed Diagnosis per 1,000 Diabetic Population,
by Race, Sex and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Race Sex
White Male Rate 12.7 11.6 11.6 10.7
Age-adjusted Rate 13.0 15.2 10.2 9.8
Female Rate 13.5 13.7 14.6 13.6
Age-adjusted Rate 13.8 13.0 14.3 16.0
Black Male Rate 17.4 26.7 27.3 31.3
Age-adjusted Rate 19.3 23.5 25.5 32.2
Female Rate 18.8 20.2 15.4 20.4
Age-adjusted Rate 20.8 22.9 15.8 19.5
Total Total Rate 15.5 15.9 16.1 16.2
Age-adjusted Rate 16.1 17.0 15.0 16.4
7.11-7.13 Deaths w/ Diabetic Ketoacidosis as Underlying Cause
7.11 Mortality Rate per 100,000 Pop., Age & Year, U.S., 80-88
Table 7.11 Number of Deaths with Diabetic Ketoacidosis as Underlying
Cause and Mortality Rate per 100,000 Population, by Age
and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 321 309 308 334 352
Rate 0.20 0.19 0.19 0.21 0.22
45-64 Number 506 511 434 451 403
Rate 1.14 1.15 0.97 1.01 0.90
65-74 Number 392 334 384 318 374
Rate 2.50 2.10 2.37 1.93 2.23
75+ Number 553 552 574 566 553
Rate 5.50 5.35 5.40 5.18 4.93
Total Number 1772 1707 1700 1669 1682
Rate 0.78 0.74 0.73 0.71 0.71
Age-adjusted Rate 0.78 0.74 0.73 0.70 0.70
Table 7.11 Number of Deaths with Diabetic Ketoacidosis as Underlying
Cause and Mortality Rate per 100,000 Population, by Age
and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 331 388 375 457
Rate 0.20 0.23 0.22 0.27
45-64 Number 407 396 404 435
Rate 0.91 0.88 0.89 0.95
65-74 Number 358 357 296 341
Rate 2.11 2.06 1.68 1.91
75+ Number 590 594 584 572
Rate 5.12 5.02 4.81 4.59
Total Number 1686 1735 1660 1805
Rate 0.71 0.72 0.68 0.73
Age-adjusted Rate 0.69 0.70 0.66 0.71
7.12 Mortality Rate per 100,000 Pop., Race,Sex,Year, U.S., 80-88
Table 7.12 Number of Deaths With Diabetic Ketoacidosis as Underlying
Cause and Mortality Rate per 100,000 Population, by Race,
Sex, and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Number 582 535 569 504 553
Rate 0.61 0.56 0.59 0.52 0.56
Age-adjusted Rate 0.67 0.61 0.63 0.55 0.60
Female Number 733 755 743 749 695
Rate 0.73 0.75 0.73 0.73 0.67
Age-adjusted Rate 0.63 0.64 0.61 0.62 0.56
Black Male Number 185 160 157 187 192
Rate 1.46 1.24 1.20 1.41 1.42
Age-adjusted Rate 2.00 1.63 1.60 1.90 1.87
Female Number 246 237 212 213 219
Rate 1.74 1.65 1.46 1.44 1.46
Age-adjusted Rate 2.07 1.95 1.72 1.69 1.70
Total Total Number 1772 1707 1700 1669 1682
Rate 0.78 0.74 0.73 0.71 0.71
Age-adjusted Rate 0.78 0.74 0.73 0.70 0.70
Table 7.12 Number of Deaths With Diabetic Ketoacidosis as Underlying
Cause and Mortality Rate per 100,000 Population, by Race,
Sex, and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Race Sex
White Male Number 541 549 597 607
Rate 0.55 0.55 0.59 0.60
Age-adjusted Rate 0.58 0.58 0.62 0.62
Female Number 755 762 666 723
Rate 0.73 0.73 0.63 0.68
Age-adjusted Rate 0.60 0.60 0.51 0.55
Black Male Number 148 174 166 210
Rate 1.08 1.25 1.18 1.47
Age-adjusted Rate 1.44 1.59 1.51 1.80
Female Number 219 224 204 241
Rate 1.44 1.45 1.30 1.52
Age-adjusted Rate 1.67 1.69 1.51 1.73
Total Total Number 1686 1735 1660 1805
Rate 0.71 0.72 0.68 0.73
Age-adjusted Rate 0.69 0.70 0.66 0.71
7.13 Mortality Rate per 100,000 Pop., Region & Year, U.S., 80-88
Table 7.13 Number of Deaths With Diabetic Ketoacidosis as Underlying
Cause and Mortality Rate per 100,000 Population, by Region
and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Region
Northeast Number 417 353 378 354 370
Rate 0.85 0.72 0.77 0.72 0.74
Adjusted Rate (a) 0.81 0.68 0.71 0.67 0.69
North Number 434 429 424 443 389
Central Rate 0.74 0.73 0.72 0.75 0.66
Adjusted Rate 0.75 0.73 0.71 0.75 0.65
South Number 645 652 608 598 645
Rate 0.85 0.85 0.77 0.75 0.80
Adjusted Rate 0.77 0.78 0.71 0.68 0.72
West Number 276 273 290 274 278
Rate 0.64 0.62 0.64 0.59 0.59
Adjusted Rate 0.75 0.73 0.73 0.68 0.69
(a) Adjusted for age and race
Table 7.13 Number of Deaths With Diabetic Ketoacidosis as Underlying
Cause and Mortality Rate per 100,000 Population, by Region
and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Region
Northeast Number 354 371 348 370
Rate 0.71 0.74 0.69 0.73
Adjusted Rate (a) 0.65 0.68 0.63 0.66
North Number 430 412 393 412
Central Rate 0.73 0.69 0.66 0.69
Adjusted Rate 0.70 0.67 0.64 0.68
South Number 614 663 617 667
Rate 0.75 0.80 0.74 0.78
Adjusted Rate 0.67 0.72 0.66 0.69
West Number 288 289 302 356
Rate 0.60 0.59 0.61 0.70
Adjusted Rate 0.67 0.66 0.69 0.80
(a) Adjusted for age and race
7.14-7.16 Deaths w/ Diabetic Ketoacidosis as Any Listed Cause
7.14 Mort. Rate per 100,000 Pop., by Age & Year, U.S., 80-88
Table 7.14 Number of Deaths with Diabetic Ketoacidosis as Any Listed
Diagnosis and Mortality Rate per 100,000 Population, by Age
and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 Number 413 391 393 413 442
Rate 0.26 0.25 0.24 0.25 0.27
45-64 Number 818 857 725 767 696
Rate 1.84 1.92 1.63 1.72 1.55
65-74 Number 719 665 699 653 748
Rate 4.59 4.18 4.32 3.96 4.47
75+ Number 965 940 948 1033 1045
Rate 9.60 9.11 8.92 9.45 9.31
Total Number 2915 2855 2765 2866 2931
Rate 1.28 1.24 1.19 1.22 1.24
Age-adjusted Rate 1.28 1.24 1.18 1.20 1.21
Table 7.14 Number of Deaths with Diabetic Ketoacidosis as Any Listed
Diagnosis and Mortality Rate per 100,000 Population, by Age
and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 Number 428 483 472 561
Rate 0.26 0.29 0.28 0.33
45-64 Number 720 694 669 741
Rate 1.60 1.54 1.48 1.61
65-74 Number 734 691 635 664
Rate 4.32 3.99 3.60 3.71
75+ Number 1097 1101 1102 1045
Rate 9.52 9.31 9.07 8.39
Total Number 2979 2969 2879 3012
Rate 1.25 1.23 1.18 1.23
Age-adjusted Rate 1.21 1.19 1.13 1.17
7.15 Mort. Rate per 100,000 Pop., Race, Sex, Year, U.S., 80-88
Table 7.15 Number of Deaths with Diabetic Ketoacidosis as Any Listed
Cause and Mortality Rate per 100,000 Population, by Race
Sex, and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Number 984 880 942 904 944
Rate 1.03 0.92 0.97 0.93 0.96
Age-adjusted Rate 1.13 1.00 1.05 1.00 1.03
Female Number 1234 1305 1208 1305 1277
Rate 1.23 1.29 1.19 1.28 1.24
Age-adjusted Rate 1.05 1.10 0.99 1.06 1.01
Black Male Number 270 265 244 282 300
Rate 2.13 2.06 1.87 2.12 2.23
Age-adjusted Rate 2.96 2.77 2.56 2.88 3.02
Female Number 391 376 340 341 369
Rate 2.77 2.62 2.33 2.31 2.46
Age-adjusted Rate 3.32 3.12 2.76 2.74 2.90
Total Total Number 2915 2855 2765 2866 2931
Rate 1.28 1.24 1.19 1.22 1.24
Age-adjusted Rate 1.28 1.24 1.18 1.20 1.21
Table 7.15 Number of Deaths with Diabetic Ketoacidosis as Any Listed
Cause and Mortality Rate per 100,000 Population, by Race
Sex, and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Race Sex
White Male Number 990 972 989 1013
Rate 1.00 0.97 0.98 1.00
Age-adjusted Rate 1.07 1.03 1.03 1.03
Female Number 1327 1309 1213 1241
Rate 1.28 1.25 1.15 1.17
Age-adjusted Rate 1.04 1.01 0.91 0.93
Black Male Number 252 265 269 320
Rate 1.84 1.91 1.91 2.23
Age-adjusted Rate 2.55 2.50 2.53 2.85
Female Number 367 383 363 388
Rate 2.41 2.48 2.32 2.44
Age-adjusted Rate 2.82 2.90 2.71 2.81
Total Total Number 2979 2969 2879 3012
Rate 1.25 1.23 1.18 1.23
Age-adjusted Rate 1.21 1.19 1.13 1.17
7.16 Mort. Rate per 100,000 Pop., by Region & Year, U.S., 80-88
Table 7.16 Number of Deaths With Diabetic Ketoacidosis as Any Listed
Cause and Mortality Rate per 100,000 Population, by Region
and Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Region
Northeast Number 716 619 665 652 666
Rate 1.46 1.26 1.35 1.32 1.34
Adjusted Rate (a) 1.39 1.18 1.25 1.22 1.23
North Number 742 721 690 729 698
Central Rate 1.26 1.22 1.17 1.24 1.18
Adjusted Rate 1.29 1.23 1.16 1.22 1.16
South Number 996 1059 970 1039 1103
Rate 1.31 1.37 1.24 1.30 1.37
Adjusted Rate 1.21 1.27 1.13 1.20 1.24
West Number 461 456 440 446 464
Rate 1.06 1.03 0.97 0.97 0.99
Adjusted Rate 1.26 1.24 1.13 1.10 1.12
(a) Adjusted for age and race
Table 7.16 Number of Deaths With Diabetic Ketoacidosis as Any Listed
Cause and Mortality Rate per 100,000 Population, by Region
and Year, United States, 1985-1988
Year
1985 1986 1987 1988
Region
Northeast Number 693 682 657 672
Rate 1.39 1.36 1.31 1.33
Adjusted Rate (a) 1.26 1.23 1.17 1.19
North Number 755 739 675 688
Central Rate 1.28 1.25 1.13 1.15
Adjusted Rate 1.23 1.20 1.09 1.11
South Number 1032 1077 1084 1113
Rate 1.26 1.30 1.29 1.31
Adjusted Rate 1.13 1.17 1.15 1.16
West Number 499 471 463 539
Rate 1.04 0.97 0.93 1.06
Adjusted Rate 1.17 1.10 1.07 1.20
(a) Adjusted for age and race
7.17-7.18 Mort. for Diabetic Ketoacidosis as Underlying Cause
7.17 100,000 Diabetic Population, by Age & Year, U.S., 80-88
Table 7.17 Mortality Rate for Diabetic Ketoacidosis as Underlying
Cause per 100,000 Diabetic Population, by Age and Year,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 31.8 32.5 31.3 33.3 35.4
45-64 21.2 20.1 16.9 17.4 17.1
65-74 25.8 24.5 25.2 24.4 21.3
75+ 64.2 58.3 70.8 64.7 50.7
Total 30.6 29.4 28.9 28.9 27.1
Age-adjusted Rate 30.6 29.1 29.6 29.0 26.4
Table 7.17 Mortality Rate for Diabetic Ketoacidosis as Underlying
Cause per 100,000 Diabetic Population, by Age and Year,
United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 31.9 37.1 27.5 41.8
45-64 17.5 13.9 15.8 17.7
65-74 19.3 22.4 17.4 20.0
75+ 53.6 46.3 48.9 52.3
Total 26.7 25.6 24.4 28.4
Age-adjusted Rate 25.9 25.0 23.2 27.7
7.18 100,000 Diabetic Population, Race, Sex, Year, U.S., 80-88
Table 7.18 Mortality Rate for Diabetic Ketoacidosis as Underlying
Cause per 100,000 Diabetic Population, by Race, Sex, and
Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Rate 28.0 24.7 27.2 24.3 26.6
Age-adjusted Rate 29.7 27.0 28.1 24.3 26.5
Female Rate 26.9 28.7 27.8 29.1 24.1
Age-adjusted Rate 25.2 26.2 26.9 27.9 22.0
Black Male Rate 52.9 47.0 46.5 53.3 48.8
Age-adjusted Rate 58.4 53.0 53.4 67.7 55.2
Female Rate 45.7 40.3 33.3 30.4 32.7
Age-adjusted Rate 47.3 41.7 36.7 32.0 33.1
Total Total Rate 30.6 29.4 28.9 28.9 27.1
Age-adjusted Rate 30.6 29.1 29.6 29.0 26.4
Table 7.18 Mortality Rate for Diabetic Ketoacidosis as Underlying
Cause per 100,000 Diabetic Population, by Race, Sex, and
Year, United States, 1985-1988
Year
1985 1986 1987 1988
Race Sex
White Male Rate 23.6 21.4 21.7 25.7
Age-adjusted Rate 23.6 23.5 20.9 24.6
Female Rate 26.1 25.2 24.3 27.6
Age-adjusted Rate 23.5 22.5 22.0 25.8
Black Male Rate 35.4 41.8 37.8 45.3
Age-adjusted Rate 41.1 43.3 39.7 46.2
Female Rate 33.7 35.1 30.1 35.8
Age-adjusted Rate 33.5 35.0 28.9 34.2
Total Total Rate 26.7 25.6 24.4 28.4
Age-adjusted Rate 25.9 25.0 23.2 27.7
7.19-7.20 Mort. for Diabetic Ketoacidosis as Any Listed Cause
7.19 100,000 Diabetic Pop., by Age & Year, U.S., 80-88
Table 7.19 Mortality Rate for Diabetic Ketoacidosis as Any Listed
Cause per 100,000 Diabetic Population, by Age and Year,
United States, 1980-1984
Year
1980 1981 1982 1983 1984
Age
0-44 40.9 41.1 39.9 41.2 44.5
45-64 34.2 33.7 28.2 29.5 29.5
65-74 47.2 48.7 45.8 50.0 42.6
75+ 112.1 99.2 117.0 118.2 95.8
Total 50.4 49.2 47.0 49.6 47.3
Age-adjusted Rate 50.4 48.7 48.1 50.2 45.4
Table 7.19 Mortality Rate for Diabetic Ketoacidosis as Any Listed
Cause per 100,000 Diabetic Population, by Age and Year,
United States, 1985-1988
Year
1985 1986 1987 1988
Age
0-44 41.2 46.1 34.6 51.4
45-64 30.9 24.4 26.2 30.1
65-74 39.7 43.4 37.3 39.0
75+ 99.7 85.7 92.3 95.5
Total 47.1 43.8 42.3 47.4
Age-adjusted Rate 45.2 42.3 40.4 45.9
7.20 100,000 Diabetic Pop., by Race, Sex, & Year, U.S., 80-88
Table 7.20 Mortality Rate for Diabetic Ketoacidosis as Any Listed
Cause per 100,000 Diabetic Population, by Race, Sex, and
Year, United States, 1980-1984
Year
1980 1981 1982 1983 1984
Race Sex
White Male Rate 47.3 40.6 45.0 43.6 45.3
Age-adjusted Rate 49.7 44.4 46.8 44.3 44.8
Female Rate 45.3 49.6 45.2 50.7 44.4
Age-adjusted Rate 42.2 45.4 43.6 48.3 39.8
Black Male Rate 77.2 77.8 72.3 80.4 76.2
Age-adjusted Rate 86.8 89.0 83.8 98.7 86.1
Female Rate 72.6 64.0 53.5 48.7 55.2
Age-adjusted Rate 76.9 66.6 58.8 50.9 55.9
Total Total Rate 50.4 49.2 47.0 49.6 47.3
Age-adjusted Rate 50.4 48.7 48.1 50.2 45.4
Table 7.20 Mortality Rate for Diabetic Ketoacidosis as Any Listed
Cause per 100,000 Diabetic Population, by Race, Sex, and
Year, United States, 1985-1988
Year
1985 1986 1987 1988
Race Sex
White Male Rate 43.1 37.9 35.9 42.9
Age-adjusted Rate 42.9 40.1 35.2 41.8
Female Rate 45.9 43.4 44.2 47.4
Age-adjusted Rate 40.9 38.8 39.9 43.2
Black Male Rate 60.3 63.6 61.3 69.0
Age-adjusted Rate 71.2 66.4 66.9 71.3
Female Rate 56.4 60.0 53.6 57.6
Age-adjusted Rate 55.8 59.5 51.9 55.5
Total Total Rate 47.1 43.8 42.3 47.4
Age-adjusted Rate 45.2 42.3 40.4 45.9
END-STAGE RENAL DISEASE
Introduction
End-stage renal disease (ESRD), which requires dialysis or
transplantation for survival, is a leading complication of diabetes.
Because Medicare supplies reimbursement for more than 90% of ESRD
treatment in the United States, its information system is a basis
for surveillance of ESRD (Eggers et al., 1984). To examine trends
in treating ESRD attributed to diabetes (ESRD-DM) in the United States
during 1980-1986, we evaluate the numbers and rates of ESRD by calendar
year, age, sex, race, and state of residence. We present rates based
on both general and diabetic population denominators.
Methods
Data on when ESRD treatment began were provided by the Bureau of
Data Management and Strategy, Health Care Financing Administration,
from the ESRD program's management and medical information system,
which includes demographic information on beneficiaries treated for
ESRD. This data set is frequently updated. Thus, the results in
our tables differ slightly from those in other reports (U.S. Renal
Data System, 1989; Eggers, 1988). We use the term "incidence"
to mean initiation of treatment for ESRD.
The Chronic Renal Disease Medical Evidence Report, filled out by
treatment providers, is the source for the "primary diagnosis". While
this designation was often missing in earlier years, since 1982 it
is available for over 90% of cases.
We used estimates of the resident population of the United States
as the denominators in calculating general population rates of ESRD-DM.
We used estimates of the diabetic population from the National Health
Interview Survey (NHIS) in calculating rates among persons with diabetes
(Chapter 2).
We standardized rates according to the direct method. We used the
1980 U.S. resident population to standardize general population rates
and the estimated 1980 U.S. diabetic population to standardize rates
among persons with diabetes.
Results
The number of persons being treated for ESRD-DM increased from 5,955
in 1980 to 27,919 in 1986 (Table 8.1). The increase was greater for
blacks and other races. During this period, their percentage of the
total increased from 29.4% to 34.0%.
The number of incident ESRD-DM cases steadily increased each year
from 2,202 in 1980 to 8,994 in 1986 (Figure 8.1). The age-adjusted
incidence rate of ESRD-DM increased from 9.6 to 36.7 per 1,000,000
(Table 8.2). This increase was more prominent among older age groups
(Figure 8.2). The rate of increase was similar among different sex
and race groups (Figure 8.3, Tables 8.3-8.8).
The 1986 incidence rate of ESRD-DM in the resident population increased
with age, except for the 75+ group (Table 8.2). For males, the age-adjusted
incidence among blacks was 2.9 times and among other races 3.4 times
the incidence among whites (Tables 8.3, 8.5, and 8.7). For females,
the black and other race rate ratios were 4.3 and 4.4, respectively
(Tables 8.4, 8.6, and 8.8). The sex differences varied by race: the
incidence among white males was 1.2 times that for white females,
whereas the incidence for black males was 0.8 times that of black
females.
Using the estimated diabetic population in the denominator, the
age-adjusted incidence rate per 100,000 of ESRD-DM increased from 37.9
in 1980 to 138.0 in 1986 (Table 8.9). This increase was also more
prominent in older age groups (Figure 8.4), whereas the rate of increase
was similar for the different sex and race groups (Figure 8.5 and Tables
8.10-8.13). In 1986, compared with white females, the age-adjusted
incidence ratios were 2.2 for black females, 2.1 for black males,
and 1.3 for white males. The largest age-specific male-female ratio
(2.8) was for whites less than 45 years old.
We present the state-specific prevalence and incidence of ESRD-DM
(Tables 8.14-8.15). We also present the age- and race-standardized
incidence rates by state and grouped by quartile based on the average
annual rates for the years 1980-1986 (Figure 8.6).
Discussion
There has been a striking increase in treatment for ESRD-DM in the
United States. In 1982, the classification of primary etiology of ESRD
in the Medicare system improved (U.S. Renal Data System, 1989). From
1982 through 1986, the proportion of new ESRD treatment attributed
to diabetes increased from 23.0% to 28.9%. In this period, the incidence
of ESRD-DM increased 11.8% per year.
Rates of ESRD-DM based on general population denominators are influenced
by diabetes prevalence in the population, disease severity, and treatment
access and use. From 1982 to 1986, in the general population, the
rates of ESRD-DM increased most in older age groups, reflecting both
the higher prevalence of diabetes with increasing age, as well as
the more frequent occurrence of complications with increasing age.
Rates of ESRD-DM calculated using the population of people known to
have diabetes as the denominator are not affected by prevalence of
diabetes, but rather are dependent on disease severity and health
care utilization. From 1982 to 1986, the rates of ESRD-DM per 100,000
persons with diabetes increased by 67.5%. The age-specific rates
of ESRD-DM were highest in the youngest age group (0-44 years old),
reflecting the higher proportion with insulin-dependent relative to
non-insulin-dependent diabetes mellitus (NIDDM). The rates increased
most, however, in older age groups, suggesting that ESRD related to
NIDDM is a faster growing public health problem (Centers for Disease
Control, 1989).
We noted some differences in ESRD-DM according to race and sex. When
calculated using general population denominators, the incidence of
ESRD-DM was higher among blacks than among whites. The incidence was
highest among black females and lowest among white males. The rates
for black males were about 3 times those for white males, and the
rates for black females were about 4 times those for white females.
When ESRD-DM rates were calculated using diabetic population denominators,
the rates for black males and females were more than twice those for
white males and females, respectively. These results suggest that
the higher rates of ESRD-DM seen among blacks in the general population
are not only due to higher prevalence of diabetes among blacks relative
to whites. Differences in severity of diabetes and higher prevalence
of hypertension are potential co-factors that might account for the
higher rates seen in blacks.
The large male-female ratio in whites in the less than 45-year age
group suggests that males are at particular risk for ESRD associated
with IDDM.
The methods we used had some limitations that need to be considered
when interpreting our results. First, ESRD is defined by treatment
with dialysis or transplantation. In two recent population studies,
approximately 30% of persons with advanced renal failure received
neither therapy (Humphrey et al., 1989; Nelson et al., 1988). Regarding
the observed increase in ESRD-DM, we cannot distinguish increased
disease incidence from increased availability and use of treatment.
Renal mortality investigations (Geiss et al., 1985) and additional
cohort studies may clarify disease incidence trends.
Second, because Medicare reimburses approximately 90% of treatment
for ESRD in the United States, its ESRD program incidence slightly
underestimates the U.S. total. Third, diabetes as the primary diagnosis
of ESRD may be imprecisely classified. In one clinical series, 8%
of advanced renal disease among persons with diabetes was attributed
to other etiologies (Balakuntalam et al., 1983). Fourth, the rates
using the diabetic population were calculated from estimates derived
from the NHIS and, thus, represent persons with diagnosed diabetes.
Approximately one-half of persons with diabetes, however, do not know
they have the disease (Harris et al., 1987).
Despite these limitations, the Medicare ESRD program provides useful
indicators of the morbidity and public health burden related to ESRD-DM
in the United States. The rapidly increasing number of persons treated
for ESRD represents growing costs (estimated $4.4 billion in 1987,
more than $1 billion for ESRD-DM) (U.S. Renal Data System, 1989
of renal disease and improving blood pressure control in persons with
diabetes (Herman et al., 1989). Recent studies of ESRD in Mexican-Americans
in Texas (Pugh et al., 1988) and Native Americans in the United States
(Newman et al., in press), have revealed excessive incidence of ESRD-DM
among these groups compared with the corresponding white populations. In
addition to blacks, these populations are appropriate high-risk target
groups for public health interventions.
Update
This section updates data presented in previous sections in light of
three additional years of Medicare data on end-stage renal disease. In
addition, Medicare data on end-stage renal disease for years 1980-1986 have
been updated in the detailed tables.
Based on treatment reimbursed by the Medicare program, the number of new
U.S. cases of end-stage renal disease attributed to diabetes (ESRD-DM)
increased fivefold during the 1980s, from 2,220 in 1980 to 13,332 in 1989
(Table 8.2). Similarly, the age-standardized incidence rate of ESRD-DM among
persons with diabetes increased from 38.39 to 201.98 per 100,000 diabetic
population (Table 8.9). Age differences in incidence rates tended to decrease
during this decade (Table 8.9). Rates were higher among blacks than among
whites (Figure 1.11, Tables 8.10-8.13). Among both races, males had higher
rates than females, until 1985, when rates for black females rates began to
exceed those for black males.
Detailed Tables
8.1 Persons Undergoing Treatment for End-stage Renal Disease
Table 8.1 Number of Persons Undergoing Treatment for End-Stage Renal
Disease (ESRD) Related to Diabetes, by Race, Sex, and Year,
United States, 1980-1985
Race and Sex 1980 1981 1982 1983 1984 1985
White Males 2361 3189 4423 5649 7074 8567
White Females 1767 2620 3748 4939 6135 8816
Black Males 631 915 1275 1725 2148 2777
Black Females 909 1318 1943 2609 3379 4142
Other Males 15 41 106 187 268 349
Other Females 21 57 143 231 312 439
Total 5704 8140 11638 15340 19316 23699
Table 8.1 Number of Persons Undergoing Treatment for End-Stage Renal
Disease (ESRD) Related to Diabetes, by Race, Sex, and Year,
United States, 1986-1989
Race and Sex 1986 1987 1988 1989
White Males 10079 11494 12978 14965
White Females 8816 10260 11737 13669
Black Males 3341 3818 4457 5090
Black Females 4886 5773 6564 7608
Other Males 436 541 658 787
Other Females 566 655 816 988
Total 28124 32541 37210 43107
8.2-8.8 Persons Initiating Treatment for ESRD Rel. to Diabetes
8.2 1,000,000 Pop., Age & Year, U.S., 80-89
Table 8.2 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
United States, 1980-1985
Age 1980 1981 1982 1983 1984 1985
0-34 Number 415 615 798 824 950 1053
Rate 3.2 4.6 6.0 6.2 7.1 7.9
35-44 Number 334 523 673 808 979 1066
Rate 12.9 19.8 24.0 27.6 32.1 33.6
45-54 Number 421 653 919 1042 1179 1401
Rate 18.5 28.9 40.9 46.4 52.4 62.0
55-64 Number 598 1017 1430 1703 2044 2282
Rate 27.5 46.3 64.7 76.6 91.7 102.3
65-74 Number 375 679 903 1169 1456 1779
Rate 24.0 42.7 55.8 70.9 87.0 104.6
75+ Number 77 96 200 250 360 479
Rate 7.7 9.3 18.8 22.9 32.1 41.6
Total Number 2220 3583 4923 5796 6968 8060
Rate 9.8 15.6 21.2 24.7 29.5 33.8
Age-adjusted Rate 9.8 15.6 21.2 24.6 29.2 33.4
Table 8.2 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
United States, 1986-1989
Age 1986 1987 1988 1989
0-34 Number 1080 1077 1018 1204
Rate 8.1 8.0 7.6 9.0
35-44 Number 1199 1233 1316 1499
Rate 36.3 35.9 37.3 41.1
45-54 Number 1553 1683 1897 2245
Rate 68.1 72.3 78.5 90.2
55-64 Number 2527 2859 3142 3593
Rate 113.8 129.9 144.1 166.4
65-74 Number 2221 2512 2975 3619
Rate 128.2 142.2 166.3 199.1
75+ Number 576 745 832 1172
Rate 48.7 61.3 66.8 91.6
Total Number 9156 10109 11180 13332
Rate 38.0 41.5 45.5 53.7
Age-adjusted Rate 37.5 40.9 44.7 52.6
8.3 1,000,000 Pop., Age & Year, U.S., 80-89, White Males
Table 8.3 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
White Males, United States, 1980-1985
Age 1980 1981 1982 1983 1984 1985
0-34 Number 195 285 391 375 458 477
Rate 3.5 5.1 7.0 6.7 8.2 8.5
35-44 Number 176 264 339 389 501 518
Rate 15.9 23.3 28.1 30.9 38.2 38.0
45-54 Number 166 257 308 351 433 497
Rate 17.0 26.6 32.1 36.7 45.3 51.9
55-64 Number 184 253 412 516 622 703
Rate 20.1 27.4 44.4 55.4 66.5 75.2
65-74 Number 118 182 287 327 417 538
Rate 19.3 29.2 45.1 50.4 63.2 80.0
75+ Number 25 28 53 84 115 135
Rate 7.7 8.4 15.6 24.1 32.1 36.8
Total Number 864 1269 1790 2042 2546 2868
Rate 9.1 13.2 18.5 20.9 25.9 29.0
Age-adjusted Rate 9.1 13.2 18.5 20.9 25.7 28.8
Table 8.3 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
White Males, United States, 1986-1989
Age 1986 1987 1988 1989
0-34 Number 523 503 471 565
Rate 9.3 9.0 8.4 10.1
35-44 Number 564 602 631 691
Rate 39.8 41.0 41.9 44.4
45-54 Number 540 568 672 800
Rate 55.9 57.7 65.6 75.8
55-64 Number 788 871 937 1088
Rate 84.9 95.0 103.2 121.2
65-74 Number 657 719 868 1137
Rate 95.5 102.3 121.9 156.8
75+ Number 178 226 268 352
Rate 47.3 58.4 67.4 85.9
Total Number 3250 3489 3847 4633
Rate 32.6 34.7 37.9 45.3
Age-adjusted Rate 32.3 34.3 37.4 44.7
8.4 1,000,000 Pop., Age & Year, U.S., 80-89, White Females
Table 8.4 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
White Females, United States, 1980-1985
Age 1980 1981 1982 1983 1984 1985
0-34 Number 151 235 290 323 351 408
Rate 2.8 4.3 5.3 5.9 6.5 7.5
35-44 Number 97 163 194 247 261 292
Rate 8.6 14.1 15.8 19.3 19.6 21.2
45-54 Number 99 173 282 287 318 368
Rate 9.7 17.1 28.1 28.8 31.9 36.9
55-64 Number 178 354 468 547 681 696
Rate 17.2 34.0 44.8 52.3 65.1 66.7
65-74 Number 112 224 327 444 522 631
Rate 14.0 27.7 39.8 53.3 61.9 74.0
75+ Number 29 33 61 87 123 193
Rate 4.9 5.4 9.7 13.4 18.5 28.3
Total Number 666 1182 1622 1935 2256 2588
Rate 6.7 11.7 16.0 18.9 21.9 24.9
Age-adjusted Rate 6.4 11.2 15.2 17.8 20.5 23.2
Table 8.4 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
White Females, United States, 1986-1989
Age 1986 1987 1988 1989
0-34 Number 393 397 362 435
Rate 7.3 7.3 6.7 8.1
35-44 Number 377 367 372 417
Rate 26.4 24.8 24.6 26.7
45-54 Number 427 437 498 568
Rate 42.6 42.8 47.0 52.0
55-64 Number 804 881 1014 1160
Rate 77.8 86.4 100.9 117.2
65-74 Number 811 936 1132 1358
Rate 93.7 106.5 127.7 151.4
75+ Number 194 309 323 459
Rate 27.8 43.1 44.1 61.2
Total Number 3006 3327 3701 4397
Rate 28.8 31.6 34.9 41.2
Age-adjusted Rate 26.6 28.9 31.8 37.3
8.5 1,000,000 Pop., Age & Year, U.S., 80-89, Black Males
Table 8.5 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
Black Males, United States, 1980-1985
Age 1980 1981 1982 1983 1984 1985
0-34 Number 31 46 47 54 72 85
Rate 3.6 5.2 5.3 6.0 7.9 9.2
35-44 Number 28 47 68 86 93 121
Rate 22.5 37.1 51.3 62.3 64.3 80.0
45-54 Number 56 86 118 162 165 227
Rate 54.5 83.3 113.7 154.4 155.3 210.9
55-64 Number 70 122 173 185 217 283
Rate 81.5 139.3 193.5 203.0 234.2 301.2
65-74 Number 35 76 80 120 143 175
Rate 61.4 131.3 136.0 200.7 235.2 282.0
75+ Number 3 11 27 18 33 47
Rate 10.6 37.9 90.5 58.8 105.1 146.9
Total Number 223 388 513 625 723 938
Rate 17.6 30.1 39.2 47.1 53.7 68.6
Age-adjusted Rate 22.6 39.6 52.1 61.8 70.7 90.3
Table 8.5 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
Black Males, United States, 1986-1989
Age 1986 1987 1988 1989
0-34 Number 68 72 83 90
Rate 7.3 7.7 8.8 9.4
35-44 Number 125 123 157 167
Rate 78.5 74.1 90.5 91.9
45-54 Number 234 265 281 350
Rate 214.3 237.4 245.5 299.2
55-64 Number 307 326 404 441
Rate 322.8 339.4 417.1 452.5
65-74 Number 211 220 265 291
Rate 333.5 340.5 401.4 430.7
75+ Number 42 47 63 85
Rate 128.4 140.4 184.8 243.2
Total Number 987 1053 1253 1424
Rate 71.0 74.6 87.5 97.9
Age-adjusted Rate 94.2 98.8 115.7 129.6
8.6 1,000,000 Pop., Age & Year, U.S., 80-89, Black Females
Table 8.6 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
Black Females, United States, 1980-1985
Age 1980 1981 1982 1983 1984 1985
0-34 Number 13 29 58 61 57 64
Rate 1.4 3.2 6.2 6.5 6.0 6.7
35-44 Number 21 36 54 71 97 103
Rate 14.0 23.6 33.8 42.7 55.8 56.7
45-54 Number 72 106 164 188 223 229
Rate 57.2 83.6 128.5 145.6 170.6 172.7
55-64 Number 128 218 311 368 428 501
Rate 120.2 201.4 282.6 329.4 378.3 437.7
65-74 Number 71 141 182 227 324 346
Rate 91.0 177.4 225.3 276.7 389.4 409.9
75+ Number 13 15 52 51 72 75
Rate 27.6 30.8 102.9 97.7 133.3 134.8
Total Number 318 545 821 966 1201 1318
Rate 22.5 38.0 56.3 65.3 80.1 86.7
Age-adjusted Rate 27.1 45.7 67.4 78.1 95.8 103.7
Table 8.6 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
Black Females, United States, 1986-1989
Age 1986 1987 1988 1989
0-34 Number 75 79 81 92
Rate 7.8 8.2 8.3 9.4
35-44 Number 94 116 109 159
Rate 49.3 58.2 52.5 73.3
45-54 Number 260 321 328 396
Rate 192.9 233.5 232.3 273.5
55-64 Number 512 623 599 692
Rate 442.6 535.1 511.8 589.1
65-74 Number 431 498 568 651
Rate 502.5 571.5 641.5 722.9
75+ Number 126 128 127 211
Rate 218.9 215.8 207.8 335.7
Total Number 1498 1765 1812 2201
Rate 97.1 112.8 114.1 136.6
Age-adjusted Rate 116.1 134.9 136.4 162.2
8.7 1,000,000 Pop., Age & Year,U.S.,80-89, Non-Black/White Males
Table 8.7 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
Other than White or Black Males, United States, 1980-1985
Age 1980 1981 1982 1983 1984 1985
0-34 Number 1 5 3 3 4 8
Rate 0.6 2.7 1.5 1.4 1.8 3.5
35-44 Number 1 3 11 5 16 14
Rate 3.0 8.4 28.3 12.0 35.6 29.1
45-54 Number 0 2 23 27 23 39
Rate 0.0 8.7 93.3 103.3 82.2 130.3
55-64 Number 3 10 17 36 36 36
Rate 20.0 62.2 98.8 197.7 186.1 177.2
65-74 Number 1 6 9 22 16 29
Rate 10.5 59.7 82.9 193.9 132.6 227.0
75+ Number 0 0 4 6 9 13
Rate 0.0 0.0 72.9 100.2 140.3 182.3
Total Number 6 26 67 99 104 139
Rate 2.3 9.4 22.6 31.7 31.6 40.0
Age-adjusted Rate 3.3 13.4 31.8 49.2 46.5 59.0
Table 8.7 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
Other than White or Black Males, United States, 1986-1989
Age 1986 1987 1988 1989
0-34 Number 10 7 7 4
Rate 4.2 2.8 2.7 1.5
35-44 Number 18 16 25 33
Rate 34.6 28.7 42.0 51.8
45-54 Number 38 43 55 71
Rate 118.2 125.8 150.4 181.6
55-64 Number 39 54 70 70
Rate 181.4 240.7 297.7 284.9
65-74 Number 29 49 51 56
Rate 210.7 331.6 319.4 332.0
75+ Number 15 11 21 27
Rate 196.5 135.1 234.9 288.1
Total Number 149 180 229 261
Rate 40.7 46.9 56.9 62.0
Age-adjusted Rate 58.8 69.3 82.3 87.8
8.8 1,000,000 Pop., Age/Year,U.S.,80-89, Non-White/Black Females
Table 8.8 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
Other than White or Black Females, United States, 1980-1985
Age 1980 1981 1982 1983 1984 1985
0-34 Number 3 4 7 6 7 5
Rate 1.7 2.1 3.5 2.9 3.2 2.2
35-44 Number 2 2 7 8 10 14
Rate 5.6 5.2 16.6 17.5 20.1 26.0
45-54 Number 6 8 19 23 12 35
Rate 23.8 30.0 67.6 77.7 38.6 106.1
55-64 Number 1 15 41 40 55 50
Rate 5.8 79.9 200.9 180.9 231.5 196.6
65-74 Number 0 6 11 24 29 53
Rate 0.0 54.3 89.8 181.0 202.9 341.8
75+ Number 0 1 2 3 6 16
Rate 0.0 15.7 29.1 39.7 73.4 176.2
Total Number 12 36 87 104 119 173
Rate 4.5 12.5 28.3 32.0 34.7 47.8
Age-adjusted Rate 4.6 16.9 37.4 43.0 47.4 65.0
Table 8.8 Number of Persons Initiating Treatment for ESRD Related to
Diabetes and Rate per 1,000,000 Population, by Age and Year,
Other than White or Black Females, United States, 1986-1989
Age 1986 1987 1988 1989
0-34 Number 5 7 12 11
Rate 2.1 2.9 4.8 4.2
35-44 Number 14 5 16 21
Rate 24.1 8.1 24.2 29.8
45-54 Number 42 37 48 47
Rate 119.8 99.4 120.6 110.4
55-64 Number 60 77 91 112
Rate 221.1 266.6 298.7 353.7
65-74 Number 64 63 77 95
Rate 376.6 344.0 387.0 444.6
75+ Number 15 19 24 32
Rate 153.4 177.8 203.6 246.9
Total Number 200 208 268 318
Rate 52.4 51.9 63.7 72.2
Age-adjusted Rate 69.8 69.6 81.8 92.3
8.9-8.13 Rate Initiation of Treatment for ESRD Rel. to Diabetes
8.9 100,000 Diabetic Pop., Age & Year, U.S., 80-89
Table 8.9 Rate of Initiation of Treatment for ESRD Related to Diabetes
per 100,000 Diabetic Population, by Age and Year, United
States, 1980-1985
Age 1980 1981 1982 1983 1984 1985
0-44 74.19 119.52 149.51 162.83 193.99 204.13
45-64 42.64 65.64 91.52 105.61 136.64 158.08
65-74 24.63 49.75 59.20 89.57 82.88 96.11
75+ 8.94 10.13 24.68 28.60 33.02 43.52
Total 38.39 61.68 83.63 100.26 112.39 127.54
Age-adjusted Rate 38.39 62.60 83.18 99.91 117.07 132.74
Table 8.9 Rate of Initiation of Treatment for ESRD Related to Diabetes
per 100,000 Diabetic Population, by Age and Year, United
States, 1980-1989
Age 1986 1987 1988 1989
0-44 217.68 169.37 213.73 220.91
45-64 143.29 178.01 204.83 215.65
65-74 139.41 147.53 174.59 221.76
75+ 44.85 62.42 76.05 106.90
Total 135.21 148.41 176.06 200.21
Age-adjusted Rate 140.59 151.26 179.24 201.98
8.10 100,000 Diabetic Pop., Age & Year, U.S., 80-89, White Males
Table 8.10 Rate of Initiation of Treatment for ESRD Related to Diabetes
per 100,000 Diabetic Population, by Age and Year, White
Males, United States, 1980-1985
Age 1980 1981 1982 1983 1984 1985
0-44 119.23 148.75 189.92 187.26 271.14 253.87
45-64 38.15 50.14 73.69 94.22 129.69 137.41
65-74 19.84 32.90 66.79 78.50 70.48 79.22
75+ 9.78 12.27 17.62 25.59 35.50 38.53
Total 41.56 58.54 85.56 98.51 122.24 124.98
Age-adjusted Rate 43.26 57.18 83.81 96.10 124.77 127.69
Table 8.10 Rate of Initiation of Treatment for ESRD Related to Diabetes
per 100,000 Diabetic Population, by Age and Year, White
Males, United States, 1986-1989
Age 1986 1987 1988 1989
0-44 360.98 191.02 227.77 302.37
45-64 107.38 136.72 171.85 174.78
65-74 105.12 101.98 155.69 212.40
75+ 43.95 53.81 69.47 136.78
Total 126.56 126.60 162.77 202.47
Age-adjusted Rate 141.61 124.71 162.11 201.30
8.11 100,000 Diabetic Pop., Age/Year, U.S., 80-89, White Females
Table 8.11 Rate of Initiation of Treatment for ESRD Related to Diabetes
per 100,000 Diabetic Population, by Age and Year, White
Females, United States, 1980-1985
Age 1980 1981 1982 1983 1984 1985
0-44 52.12 94.78 101.88 141.23 139.51 139.87
45-64 28.27 52.83 76.09 77.16 95.61 116.50
65-74 14.95 36.31 41.68 70.52 65.05 71.27
75+ 5.59 5.54 14.35 18.99 20.75 32.51
Total 24.45 44.95 60.74 75.23 78.37 89.46
Age-adjusted Rate 25.55 48.76 62.34 77.93 84.08 96.16
Table 8.11 Rate of Initiation of Treatment for ESRD Related to Diabetes
per 100,000 Diabetic Population, by Age and Year, White
Females, United States, 1980-1985
Age 1986 1987 1988 1989
0-44 130.35 149.50 206.39 155.64
45-64 114.95 137.99 163.84 165.42
65-74 119.86 125.71 136.85 169.58
75+ 28.49 57.72 63.09 71.25
Total 99.56 121.15 141.39 144.78
Age-adjusted Rate 106.05 124.81 149.16 150.78
8.12 100,000 Diabetic Pop., Age & Year, U.S., 80-89, Black Males
Table 8.12 Rate of Initiation of Treatment for ESRD Related to Diabetes
per 100,000 Diabetic Population, by Age and Year, Black
Males, United States, 1980-1984
Age 1980 1981 1982 1983 1984 1985
0-44 80.83 144.48 186.39 381.41 298.90 327.95
45-64 67.71 112.15 161.66 169.88 177.36 229.66
65-74 56.86 112.38 113.26 140.68 162.13 177.13
75+ 10.23 47.76 108.10 73.71 94.12 136.85
Total 63.72 113.95 152.08 178.22 183.58 224.39
Age-adjusted Rate 58.58 108.26 145.26 184.80 182.17 219.17
Table 8.12 Rate of Initiation of Treatment for ESRD Related to Diabetes
per 100,000 Diabetic Population, by Age and Year, Black
Males, United States, 1980-1989
Age 1986 1987 1988 1989
0-44 232.59 214.71 298.11 311.56
45-64 265.43 281.95 277.53 286.57
65-74 232.76 212.11 312.04 335.94
75+ 107.41 134.40 122.52 156.68
Total 236.95 239.79 270.23 285.15
Age-adjusted Rate 227.56 229.85 267.12 284.58
8.13 100,000 Diabetic Pop., Age/Year, U.S., 80-89, Black Females
Table 8.13 Rate of Invitation of Treatment for ESRD Related to Diabetes
per 100,000 Diabetic Population, by Age and Year, Black
Females, United States, 1980-1989
Age 1980 1981 1982 1983 1984 1985
0-44 30.33 67.20 130.55 113.75 141.39 182.83
45-64 79.53 114.19 147.37 184.77 231.30 282.07
65-74 68.65 102.96 113.82 113.57 173.88 189.22
75+ 18.26 21.29 76.70 61.01 78.13 63.71
Total 59.09 92.71 129.13 137.92 179.56 202.54
Age-adjusted Rate 58.95 89.20 125.08 135.19 177.67 207.78
Table 8.13 Rate of Invitation of Treatment for ESRD Related to Diabetes
per 100,000 Diabetic Population, by Age and Year, Black
Females, United States, 1980-1989
Age 1986 1987 1988 1989
0-44 193.93 179.03 140.70 191.17
45-64 275.29 337.51 381.03 481.14
65-74 299.53 349.52 367.44 369.56
75+ 99.65 87.31 90.33 156.38
Total 234.83 260.44 269.04 329.24
Age-adjusted Rate 241.31 275.74 292.20 352.77
8.14 Undergoing Treatment for ESRD, State of Residence & Year
Table 8.14 Number of People Undergoing Treatment for End-stage Renal
Disease Related to Diabetes, by State of Residence and Year,
1980-1985
1980 1981 1982 1983 1984 1985
Alabama 74 93 127 187 258 316
Alaska 4 4 6 8 13 15
Arizona 123 144 198 280 354 417
Arkansas 21 37 59 91 132 165
California 506 875 1315 1791 2243 2805
Colorado 67 76 101 149 187 233
Connecticut 115 149 190 239 306 389
Delaware 20 25 36 37 47 65
Dist of Columbia 43 61 89 109 140 194
Florida 188 360 557 737 947 1165
Georgia 168 268 379 464 569 695
Hawaii 74 95 108 109 106 137
Idaho 16 19 30 43 51 55
Illinois 327 458 623 799 952 1180
Indiana 144 205 249 344 406 473
Iowa 59 92 127 174 215 273
Kansas 60 83 120 153 193 225
Kentucky 70 96 135 184 249 296
Louisian 84 127 182 227 310 389
Maine 17 24 36 48 55 73
Maryland 92 153 219 280 368 482
Massachusetts 199 250 306 357 402 442
Michigan 200 310 439 595 726 891
Minnesota 144 197 267 342 429 496
Mississippi 47 75 109 139 194 244
Missouri 60 125 218 288 372 479
Montana 16 25 27 35 53 65
Nebraska 55 78 91 113 127 137
Nevada 12 18 33 41 50 60
New Hampshire 16 21 29 39 49 57
New Jersey 233 325 452 615 738 869
New Mexico 23 32 62 104 138 154
New York 455 636 901 1140 1397 1635
North Carolina 171 218 301 393 486 641
North Dakota 20 21 26 41 55 57
Ohio 378 496 645 800 953 1158
Oklahoma 67 89 135 182 237 275
Oregon 35 55 102 150 170 219
Pennsylvania 457 535 672 832 1085 1288
Rhode Island 20 32 36 44 55 70
South Carolina 93 132 186 244 322 437
South Dakota 14 27 35 44 62 81
Tennessee 66 101 159 237 305 359
Texas 415 601 892 1159 1447 1802
Utah 55 72 83 106 157 186
Vermont 13 20 34 31 36 46
Virginia 156 201 289 396 521 660
Washington 107 121 155 194 266 362
West Virginia 42 56 78 119 144 170
Wisconsin 196 226 300 360 446 499
Wyoming 7 11 19 21 26 35
Table 8.14 Number of People Undergoing Treatment for End-stage Renal
Disease Related to Diabetes, by State of Residence and Year,
1986-1989
1986 1987 1988 1989
Alabama 383 488 542 683
Alaska 20 26 29 39
Arizona 526 606 725 855
Arkansas 200 238 293 341
California 3422 3836 4241 5056
Colorado 326 388 441 512
Connecticut 430 491 512 571
Delaware 81 97 131 163
Dist of Columbia 205 208 220 231
Florida 1440 1752 1945 2129
Georgia 818 970 1076 1256
Hawaii 178 246 293 330
Idaho 75 91 115 132
Illinois 1408 1598 1762 1953
Indiana 515 644 753 814
Iowa 318 336 369 427
Kansas 236 252 307 340
Kentucky 354 416 461 518
Louisiana 482 570 717 883
Maine 79 105 116 129
Maryland 544 623 693 839
Massachusetts 507 551 604 726
Michigan 1086 1204 1378 1640
Minnesota 582 678 748 839
Mississippi 278 319 396 475
Missouri 549 634 741 861
Montana 75 90 110 144
Nebraska 160 182 211 264
Nevada 84 113 122 157
New Hampshire 68 89 101 128
New Jersey 1029 1111 1222 1356
New Mexico 195 226 293 347
New York 1969 2257 2597 2907
North Carolina 751 905 1012 1196
North Dakota 70 88 103 132
Ohio 1365 1593 1841 2022
Oklahoma 346 402 516 591
Oregon 267 335 379 432
Pennsylvania 1515 1756 2005 2254
Rhode Island 72 96 116 136
South Carolina 509 579 661 768
South Dakota 89 105 128 136
Tennessee 436 527 612 751
Texas 2079 2450 2936 3568
Utah 220 242 277 303
Vermont 55 60 65 76
Virginia 732 808 919 1061
Washington 413 475 577 691
West Virginia 206 244 280 311
Wisconsin 582 671 772 915
Wyoming 37 46 47 58
8.15 Initiating Treatment for ESRD, State of Residence & Year
Table 8.15 Number of Persons Initiating Treatment for End-stage Renal
Disease Related to Diabetes and Rate per 100,000 Population,
by State of Residence and Year, 1980-1983
State 1980 1981 1982 1983
No. Rate No. Rate No. Rate No. Rate
Alabama 23 0.59 38 0.97 59 1.50 85 2.14
Alaska 2 0.49 0 0.00 4 0.90 2 0.41
Arizona 46 1.68 41 1.46 83 2.88 114 3.86
Arkansas 6 0.26 21 0.91 28 1.21 46 1.98
California 188 0.79 446 1.84 588 2.37 707 2.79
Colorado 24 0.83 25 0.84 41 1.33 65 2.06
Connecticut 26 0.84 61 1.95 62 1.98 94 2.99
Delaware 7 1.18 12 2.01 14 2.33 10 1.65
Dist of Columbia 11 1.72 23 3.63 43 6.86 38 6.09
Florida 94 0.95 189 1.85 250 2.39 279 2.59
Georgia 46 0.84 127 2.28 149 2.64 149 2.60
Hawaii 23 2.35 36 3.67 32 3.21 31 3.04
Idaho 8 0.84 9 0.93 15 1.53 21 2.12
Illinois 136 1.19 185 1.61 253 2.20 288 2.51
Indiana 43 0.78 78 1.42 77 1.40 132 2.41
Iowa 26 0.89 48 1.64 50 1.72 69 2.38
Kansas 19 0.80 32 1.34 52 2.16 50 2.06
Kentucky 36 0.98 45 1.22 50 1.35 76 2.05
Louisiana 32 0.76 57 1.33 76 1.73 72 1.62
Maine 7 0.62 11 0.97 15 1.32 17 1.48
Maryland 33 0.78 74 1.74 93 2.18 113 2.63
Massachusetts 61 1.06 78 1.36 101 1.76 104 1.81
Michigan 71 0.77 149 1.62 181 1.98 233 2.57
Minnesota 29 0.71 63 1.53 82 1.98 111 2.68
Mississippi 23 0.91 34 1.34 44 1.71 46 1.78
Missouri 16 0.33 72 1.46 116 2.35 101 2.03
Montana 4 0.51 14 1.76 4 0.50 12 1.47
Nebraska 14 0.89 32 2.02 27 1.70 35 2.19
Nevada 3 0.37 9 1.06 15 1.71 14 1.56
New Hampshire 6 0.65 8 0.85 10 1.05 14 1.46
New Jersey 87 1.18 133 1.80 200 2.69 233 3.12
New Mexico 10 0.76 13 0.97 36 2.63 51 3.64
New York 189 1.08 273 1.55 382 2.17 434 2.46
North Carolina 68 1.15 79 1.33 123 2.04 147 2.42
North Dakota 4 0.61 5 0.76 7 1.04 15 2.20
Ohio 143 1.32 198 1.83 254 2.36 278 2.59
Oklahoma 26 0.85 39 1.25 64 1.98 77 2.32
Oregon 18 0.68 24 0.90 55 2.06 57 2.14
Pennsylvania 176 1.48 184 1.55 253 2.13 305 2.56
Rhode Island 9 0.95 13 1.37 13 1.36 15 1.57
South Carolina 42 1.34 52 1.63 76 2.36 88 2.70
South Dakota 1 0.14 15 2.17 9 1.30 18 2.58
Tennessee 33 0.72 45 0.97 74 1.59 93 1.98
Texas 131 0.91 252 1.71 388 2.52 414 2.62
Utah 31 2.11 32 2.11 26 1.67 41 2.57
Vermont 5 0.98 7 1.36 15 2.88 4 0.76
Virginia 59 1.10 73 1.34 120 2.19 167 3.00
Washington 44 1.06 39 0.92 58 1.36 71 1.65
West Virginia 19 0.97 22 1.12 33 1.68 54 2.75
Wisconsin 61 1.30 63 1.33 113 2.38 101 2.13
Wyoming 1 0.21 5 1.01 10 1.96 5 0.97
Table 8.15 Number of Persons Initiating Treatment for End-stage Renal
Disease Related to Diabetes and Rate per 100,000 Population,
by State of Residence and Year, 1984-1986
State 1984 1985 1986
No. Rate No. Rate No. Rate
Alabama 100 2.50 110 2.74 131 3.23
Alaska 6 1.19 3 0.57 11 2.07
Arizona 122 4.01 135 4.28 182 5.55
Arkansas 61 2.60 63 2.67 71 3.00
California 790 3.06 1010 3.83 1164 4.31
Colorado 70 2.19 79 2.44 128 3.92
Connecticut 106 3.36 150 4.73 130 4.07
Delaware 18 2.93 24 3.86 30 4.74
Dist of Columbia 46 7.37 70 11.23 53 8.48
Florida 348 3.15 409 3.60 539 4.61
Georgia 189 3.23 216 3.62 256 4.20
Hawaii 27 2.61 57 5.42 75 7.04
Idaho 18 1.80 16 1.59 28 2.79
Illinois 329 2.86 433 3.75 458 3.97
Indiana 126 2.29 150 2.73 153 2.78
Iowa 65 2.24 86 2.98 101 3.54
Kansas 67 2.74 64 2.61 51 2.07
Kentucky 107 2.87 95 2.55 112 3.01
Louisiana 132 2.96 120 2.68 175 3.89
Maine 20 1.73 23 1.97 25 2.13
Maryland 136 3.13 179 4.07 160 3.59
Massachusetts 113 1.95 118 2.03 154 2.64
Michigan 268 2.96 306 3.37 371 4.06
Minnesota 134 3.22 128 3.05 147 3.49
Mississippi 74 2.85 80 3.06 86 3.28
Missouri 135 2.70 172 3.42 166 3.28
Montana 19 2.31 20 2.42 19 2.33
Nebraska 33 2.06 39 2.43 45 2.82
Nevada 18 1.96 23 2.46 35 3.62
New Hampshire 15 1.53 21 2.10 18 1.75
New Jersey 249 3.32 303 4.01 345 4.52
New Mexico 46 3.22 45 3.10 74 5.00
New York 509 2.87 517 2.91 666 3.74
North Carolina 173 2.80 232 3.70 228 3.60
North Dakota 17 2.48 11 1.61 22 3.24
Ohio 337 3.14 388 3.61 437 4.07
Oklahoma 89 2.69 95 2.87 126 3.81
Oregon 51 1.91 74 2.76 84 3.11
Pennsylvania 424 3.57 425 3.58 504 4.24
Rhode Island 20 2.08 23 2.38 20 2.05
South Carolina 123 3.73 163 4.89 151 4.47
South Dakota 23 3.26 31 4.38 21 2.97
Tennessee 112 2.37 119 2.50 135 2.81
Texas 529 3.29 609 3.72 638 3.82
Utah 60 3.69 50 3.04 61 3.67
Vermont 10 1.89 16 2.99 11 2.03
Virginia 202 3.58 233 4.09 197 3.40
Washington 98 2.25 134 3.04 110 2.46
West Virginia 55 2.82 55 2.84 83 4.33
Wisconsin 141 2.96 123 2.58 162 3.39
Wyoming 8 1.56 15 2.94 7 1.38
Table 8.15 Number of Persons Initiating Treatment for End-stage Renal
Disease Related to Diabetes and Rate per 100,000 Population,
by State of Residence and Year, 1987-1989
State 1987 1988 1989
No. Rate No. Rate No. Rate
Alabama 169 4.14 167 4.05 234 5.68
Alaska 9 1.71 8 1.48 17 3.22
Arizona 184 5.43 222 6.31 271 7.62
Arkansas 104 4.35 100 4.16 115 4.78
California 1190 4.30 1239 4.39 1696 5.83
Colorado 117 3.55 131 3.92 159 4.79
Connecticut 149 4.64 125 3.86 166 5.13
Delaware 29 4.50 44 6.75 53 7.88
Dist of Columbia 42 6.75 42 6.78 59 9.76
Florida 584 4.86 575 4.68 605 4.78
Georgia 308 4.95 290 4.55 390 6.06
Hawaii 103 9.52 97 8.81 98 8.79
Idaho 31 3.11 36 3.58 44 4.34
Illinois 490 4.23 496 4.27 548 4.70
Indiana 224 4.05 238 4.29 219 3.92
Iowa 72 2.54 98 3.49 124 4.37
Kansas 76 3.07 90 3.62 100 3.98
Kentucky 140 3.76 134 3.59 142 3.81
Louisiana 187 4.19 247 5.51 317 7.23
Maine 39 3.29 29 2.42 33 2.70
Maryland 192 4.23 195 4.24 270 5.75
Massachusetts 146 2.49 161 2.74 245 4.14
Michigan 345 3.75 444 4.80 548 5.91
Minnesota 182 4.29 170 3.98 198 4.55
Mississippi 98 3.73 125 4.72 147 5.61
Missouri 207 4.06 222 4.32 263 5.10
Montana 26 3.21 29 3.59 49 6.08
Nebraska 52 3.26 64 4.02 83 5.15
Nevada 43 4.27 38 3.69 55 4.95
New Hampshire 30 2.84 29 2.67 39 3.52
New Jersey 338 4.41 394 5.09 425 5.49
New Mexico 64 4.27 115 7.46 102 6.67
New York 688 3.86 811 4.55 866 4.82
North Carolina 295 4.60 285 4.38 383 5.83
North Dakota 26 3.87 32 4.78 47 7.12
Ohio 496 4.60 540 5.00 550 5.04
Oklahoma 129 3.94 193 5.89 179 5.55
Oregon 105 3.86 107 3.91 126 4.47
Pennsylvania 536 4.49 581 4.87 659 5.47
Rhode Island 39 3.96 45 4.56 42 4.21
South Carolina 180 5.26 192 5.54 241 6.86
South Dakota 34 4.79 39 5.49 28 3.92
Tennessee 178 3.67 189 3.86 254 5.14
Texas 756 4.50 930 5.44 1169 6.88
Utah 61 3.63 71 4.15 62 3.63
Vermont 15 2.74 15 2.71 22 3.88
Virginia 209 3.54 272 4.54 315 5.17
Washington 124 2.73 179 3.90 213 4.47
West Virginia 75 3.95 88 4.67 90 4.85
Wisconsin 179 3.72 206 4.28 253 5.20
Wyoming 14 2.86 11 2.23 19 4.00
DISABILITY
Introduction
Disability, an important component of the morbidity associated
with diabetes, reflects the inability of persons to perform their
social roles and to function independently. The disruption of social
functioning caused by disability has profound social and economic
costs for both society and the afflicted individuals. Measuring
disability among people with diabetes provides another means of
assessing the health burden of the disease.
In this chapter, we present data on the prevalence of disability among
non-institutionalized persons with diagnosed diabetes. Using National
Health Interview Survey (NHIS) data, we examine trends from 1983 through
1989, and where possible, we present data categorized by age, race, and
sex. Data for the non-institutionalized population of the U.S. have
been published in Current Estimates from the National Health Interview
Survey, a series of publications of the National Center for Health
Statistics (Vital and Health Statistics, Series 13).
Methods
Disability indicators were derived from the 1983-1989 NHIS. (See
Chapter 2, Prevalence and Incidence, for a description of NHIS
methodology.) In 1982, the core of the NHIS interview underwent
substantial changes in the measurement of several health-related
variables, including changes in disability indicators. Since disability
indicator data prior to these changes are not comparable to data
collected after these changes, the present analysis begins with 1983
NHIS data. Although the NHIS provides a stable source of annual
estimates of disability, it does not sample the institutionalized U.S.
population, which accounts for a significant proportion of all
disability. Therefore, estimates of disability derived from NHIS
underestimate the total amount of disability.
This chapter analyzes four disability indicators used in the NHIS:
activity limitation, work limitation, need for assistance in personal
care and other routine activities, and activity restriction. These
indicators are defined below. For the analyses of the first three
indicators, we pooled three years of data to develop more precise
estimates. These estimates were obtained by calculating three-year
moving averages among the one-sixth subsamples asked about diabetes.
For analyses of activity restriction, we also pooled three years of data
to develop more precise estimates, but used the full rather than the
one- sixth samples. This decision resulted in more conservative
estimates of the number of persons with restricted activity (i.e., full
sample estimates were roughly 10% lower than one-sixth sample
estimates).
Calculation of rates and their relative standard errors were performed
using the SESUDAAN computer software package (Shah, 1981). Rates were
age-adjusted by direct standardization, using estimates of the 1980
diabetic population as the standard.
Definitions of the major disability indicators examined in this chapter
are as follows and are briefly repeated in the results section.
Activity Limitation
In the NHIS, activity limitation reflects a long-term reduction in
activity resulting from one or more chronic diseases or impairments.
Persons reporting more than one cause of activity limitation are asked
to indicate the primary cause of the limitation. Activity limitation
reflects a person's capacity to perform activities normal for a person's
age-sex group. Major activities normal for a person's age-sex group are
defined as (1) "ordinary play" for children under 5 years of age, (2)
"going to school" for children 5 to 17 years of age, (3) "working at a
job or business" or "keeping house" for persons 18-69 years of age, and
(4) independent performance of basic life activities (e.g., bathing,
eating, shopping) for persons 70 years of age and older. In terms of
these activities, persons can be categorized as being (1) unable to
perform their major activity, (2) able to perform their major activity
but limited in the kind or amount of this activity, (3) not limited in
major activity but limited in other activities, and (4) not limited in
activity. Using these categories, our analysis of activity limitation
examines persons limited in activity (categories 1-3), limited in major
activity (categories 1-2), and unable to perform major activity
(category 1). Our analysis also examines the proportion of respondents
who attribute activity limitation to their having diabetes.
Work Limitation
Persons between the ages of 18 and 69 are asked about their ability
to work at a job or business. Responses can classify persons into four
work limitation categories (which parallel the four activity limitation
categories described in the preceding paragraph): (1) persons unable to
work, (2) persons limited in kind or amount of work, (3) persons limited
in other activities, and (4) persons not limited. Our analysis examines
persons limited in work (categories 1-2) and persons unable to work
(category 1). Our analysis also examines the proportion of respondents
who attribute work limitation to their having diabetes.
Need for Assistance in Personal Care and Other Routine Activities
Beginning with the 1984 NHIS, persons between the ages of 5 and 59
who report an activity limitation and persons between the ages of 60 and
69 (regardless of activity limitation) are asked whether they need help
in performing personal care (e.g., eating, bathing, dressing) or are
limited in performing other routine activities (e.g., shopping, doing
household chores). Responses to these questions are combined as a
measure of the need for personal assistance in personal care and other
routine activities. Because of sample size limitations, we only present
crude rates of this measure.
Activity Restriction
Activity restriction refers to a reduction in activity due to
either short-term or long-term conditions. It is measured in NHIS as
school-loss days (among children between the ages of 5 and 17),
work-loss days (among the currently employed between the ages of 18 and
69), cut-down days (days in which persons reduce or cut down on the
things they usually do), and bed days. The total number of restricted
activity days is the total number of days that a person experiences at
least one of the above types of days. Because of small sample sizes, we
only present data on total restricted activity days and bed days.
Results
Activity Limitation
Limited in Activity
Unable to perform major activity, or limited in the kind or amount
of major activity, or limited in other activities normal for a
person's age-sex group
In the United States, approximately half of all persons with diabetes
reported that they were limited in activity (Table 9.1). Among persons
with diabetes, the number increased from 3.1 million in 1983 to 3.3
million in 1989, but the proportion decreased from 53% to 50% (Figure
9.1, Table 9.1). This decline over time occurred primarily among
persons 65 years of age and older. In each year, the proportion
reporting that they were limited in activity increased with increasing
age, with a tendency to level off after age 64.
In general, rates of being limited in activity were greater among blacks
than among whites, and among females than among males (Figure 9.2,
Tables 9.2- 9.5). Rates among black males averaged 1.3 times that of
white males, and rates among black females averaged 1.2 times that of
white females. From 1983 to 1989, rates were relatively stable among
white males and decreased 7% among white females. Rates decreased 10%
among black males and 12% among black females. Marked decreases were
noted for white males over 74 years of age, for black males under 45
years of age and between the ages of 65 and 74 years, and for females
between 65 and 74 years of age.
Between 1983 and 1989, the proportion of persons with diabetes reporting
being limited in activity due to diabetes averaged 34% percent (Table
9.6). Thus, 60% of all those limited in activity attribute it to
diabetes. This attribution of being limited in activity due to diabetes
was more common among blacks than whites and among females than males
(Table 9.7). Between 1983 and 1989, the age-adjusted prevalence of
those limited in activity due to diabetes decreased modestly, largely
because of a 27% decrease in rates among black males and an 21% decrease
in rates among black females.
Limited in Major Activity
Unable to perform major activity or limited in the kind or amount
of major activity normal for a person's age-sex group
Almost 40% of all persons with diabetes (approximately 75% of those
limited in activity) reported being limited in their major activity
(Table 9.8). The age-adjusted prevalence decreased slightly over the
seven-year period, primarily because of decreases among persons 75 years
of age and older. Being limited in major activity was most often
reported by those 45 to 74 years of age. Although no clear temporal
trends among age-specific rates were evident for whites, dramatic
decreases were noted for blacks under the age of 45 years and over the
age of 74 (Tables 9.9-9.10).
The prevalence of being limited in major activity varied by race and sex
(Figure 9.3, Table 9.11). The age-adjusted prevalence was higher among
blacks than whites. Over the seven-year period, age-adjusted rates
decreased 19% among black females. By 1988, the rate among black
females approached that of white females, but the rate among black males
in 1989 was 1.3 times that of white males.
Unable to Perform Major Activity
Unable to perform the major activity normal for a person's age-sex
group
About 20% of persons with diabetes reported that they are unable to
perform their major activity (Table 9.12). This proportion fluctuated
very little over the seven-year period but varied by age. It increased
considerably from persons younger than 45 years of age to persons
between 45 and 64 years, and then leveled off or declined for persons 65
years of age or older.
Age-specific trends differed by race (Tables 9.13-9.14). The only
temporal trend evident among whites was an increase in rates among those
under 45 years of age. Among blacks, rates increased for those under 75
years of age, particularly for those between the ages of 65 and 74.
These increases were offset by dramatic decreases for blacks older than
74 years of age.
Race-sex differences were also noted (Figure 9.4, Table 9.15). In
general, rates among males were greater than rates among females, and
rates among blacks were greater than rates among whites. For the
seven-year period, the age-adjusted rate averaged 35.5% for black males,
26.8% for black females, 20.4% for white males, and 16.4% for white
females.
Work Limitation
Work Limitation Among Persons Between the Ages of 18 and 69
Limited in Work
Unable to work, or limited in kind or amount of work
Among persons with diabetes between the ages of 18 and 69, the
prevalence of being limited in work was high (averaging 43%) but
decreased modestly over the seven-year period (Table 9.16). The rate
was greatest among black females, followed in descending order by black
males, white females, and white males. Over half of those limited in
work attributed their limitation to having diabetes (Table 9.17).
Unable to Work
Unable to work at a job or business
Persons unable to work accounted for over 70% of all those limited in
work (Table 9.18). As with the prevalence of being limited in work, the
prevalence of being unable to work was greatest among black females,
followed in descending order by black males, white females, and white
males. With the exception of white males, the prevalence was lower in
1989 than in 1983 for all race-sex groups (Figure 9.5).
Need for Assistance in Personal Care and Other Routine Activitie
Unable to perform personal care needs (e.g., eating, bathing,
dressing) or limited in performing other routine activities (e.g.,
shopping, housekeeping)
Approximately 13% of persons with diabetes between the ages of 5 and 69
required help with personal care or other routine activities. Rates
were similar for black males and white males, but were somewhat greater
for black females than white females (Table 9.19). Rates for black
females and white females averaged, respectively, 2.8 and 1.6 times that
of their male counterparts.
Activity Restriction
Total Restricted Activity Days
Number of days a person experiences at least one the of four types
of restricted activity days (i.e., bed days, work-loss days,
school-loss days, and cut-down days)
The total number of restricted activity days due to both acute and
chronic conditions among people with diabetes increased from 199 million
days in 1983 to 233 million days in 1989 (Figure 9.6, Table 9.20).
Between 1983 and 1989, the age-adjusted rate was relatively stable,
averaged 34 days, and generally increased with increasing age. In this
time period, the number of restricted activity days was 1.4 times
greater among blacks than among whites (Figure 9.7, Tables 9.21-9.22).
Among blacks, the number of days per person decreased markedly for those
under 45 years of age and over 74 years of age, but increased for those
between the ages of 65 and 74.
Bed Days
Inpatient hospital days or days in which a person stayed in bed for
more than half a day because of illness or injury
About half of all restricted activity days among persons with diabetes
were bed days (Figure 9.6, Table 9.23). Between 1983 and 1989, the
number of bed days was 1.5 times greater among blacks than among whites
(Figure 9.7, Tables 9.24-9.25). Age-specific trends over time were not
observed among whites, but increases among blacks between 45 and 74
years of age were partially offset by decreases among those younger than
45 years and older than 74 years.
Discussion
For the period 1983-1989, the prevalence of disability among
non-institutionalized people with diabetes was high. About 50% of
persons with diabetes reported being limited in activity; about 40% of
persons with diabetes reported being limited in their major activity;
and about 20% reported being unable to perform their major activity.
The prevalence of work limitation was of similar magnitude. Forty-three
percent reported being limited in work and 30% reported being unable to
work. In addition, 13% of persons with diabetes between the ages of 5
and 69 required help with personal care or other routine activities.
More than 60% of respondents attribute being limited in activity and in
work to their diabetes. Since diabetes-related disability is often due
to complications that may not be perceived as diabetes-related, however,
this proportion is likely to be underestimated. Regardless of type of
limitation, the prevalence of disability was greater among blacks than
whites. This disparity may reflect greater severity of disease among
blacks, poorer access to health care, greater likelihood of types of
work or activity that do not accommodate physical disability, fewer work
options based on skills, training, or opportunity, or some combination
of these factors.
With the exception of inability to perform major activity, measures of
activity limitation were higher among females than males. The higher
prevalence of these types of disability among females may be due to the
same factors suggested above to explain the higher prevalence among
blacks. Females may have a lower prevalence of inability to perform
their major activity because they have changed their major activity from
work at a job or business to managing a household or other activities
that may be more accommodating or less physically demanding.
Inability to perform major activity and inability to work are two of the
most severe forms of disability examined. Examination of temporal
trends of inability to perform major activity suggests that this type of
disability is increasing for persons with diabetes under the age of 45.
In contrast, for persons over 74 years of age, the prevalence of
inability to perform major activity decreased (due primarily to a
dramatic decrease among blacks). This finding might be explained by
improved health status or increased institutional care and increased
mortality among diabetic persons. Although the prevalence of inability
to work could not be examined by age, there was a paradoxical trend
toward decreasing prevalence among those aged 18-69.
Restricted activity days, because they measure both acute and chronic
disability, provide the most inclusive but least descriptive disability
information. Between 1983 and 1989, persons with diabetes averaged 34
restricted activity days per year. Half of these days were bed days.
In all age categories, blacks averaged a greater number of restricted
activity days than whites. This disparity could be explained by poorer
health among blacks with diabetes or by more difficult daily activities
for blacks, with a resulting increase in the need to restrict activity.
In general, the prevalence of disability among non-institutionalized
persons with diabetes is very high but appears to be declining among the
elderly, blacks, and white females. Despite these declines, the actual
number of persons reporting disability is increasing, because of the
increasing prevalence of diabetes. Although some measures of disability
show evidence of improvement, decreasing the net burden of disability
presented by diabetes will remain a challenge.
Detailed Tables
9.1-9.5 Limited in Activity, Persons with Diabetes
9.1 Limited in Activity, by Age & Year
Table 9.1 Prevalence of Being Limited in Activity Among Persons with
Diabetes, per 100 Diabetic Population, by Age and Year,
United States, 1983-1986
Age 1983 1984 1985 1986
0-44 Number (a) 368 363 387 351
Rate 36.7 36.5 37.3 33.6
45-64 Number 1327 1232 1244 1512
Rate 51.1 52.2 53.4 53.1
65-74 Number 805 1068 1089 934
Rate 61.7 60.8 58.8 58.7
75+ Number 564 690 684 727
Rate 64.5 63.3 62.1 56.6
Total Number 3065 3354 3403 3525
Rate 53.0 54.1 53.9 52.1
Adjusted Rate (b) 53.4 53.4 53.3 51.7
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.1 Prevalence of Being Limited in Activity Among Persons with
Diabetes, per 100 Diabetic Population, by Age and Year,
United States, 1987-1989
Age 1987 1988 1989
0-44 Number (a) 461 352 432
Rate 33.8 32.2 35.3
45-64 Number 1329 1252 1383
Rate 52.1 50.9 51.1
65-74 Number 952 927 854
Rate 55.9 54.4 52.3
75+ Number 654 609 663
Rate 54.8 55.7 60.4
Total Number 3397 3140 3332
Rate 49.9 49.4 50.0
Adjusted Rate (b) 50.3 49.3 50.1
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.2 Limited in Activity, by Age & Year, White Males
Table 9.2 Prevalence of Being Limited in Activity Among Persons with
Diabetes, per 100 Diabetic Population, by Age and Year,
White Males, United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 129 115 120 93
Rate 31.7 32.4 30.5 31.0
45-64 Number 387 358 429 612
Rate 42.1 44.0 49.1 49.5
65-74 Number 207 316 360 341
Rate 49.8 53.4 53.1 54.5
75+ Number 197 195 205 203
Rate 60.1 60.3 58.5 50.1
Total Number 921 985 1114 1249
Adjusted Rate (b) 44.4 47.3 48.5 48.6
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.2 Prevalence of Being Limited in Activity Among Persons with
Diabetes, per 100 Diabetic Population, by Age and Year,
White Males, United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 193 160 156
Rate 33.4 33.2 37.5
45-64 Number 498 428 478
Rate 47.3 45.8 44.3
65-74 Number 383 320 317
Rate 54.3 57.5 59.1
75+ Number 187 171 115
Rate 44.6 44.4 44.7
Total Number 1261 1080 1066
Adjusted Rate (b) 45.8 45.7 46.6
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.3 Limited in Activity, by Age & Year, White Females
Table 9.3 Prevalence of Being Limited in Activity Among Persons with
Diabetes, per 100 Diabetic Population, by Age and Year,
White Females, United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 145 154 180 180
Rate 36.0 35.1 36.0 30.5
45-64 Number 585 590 501 596
Rate 54.1 56.5 54.9 55.6
65-74 Number 399 488 516 399
Rate 63.4 60.8 58.3 59.0
75+ Number 302 375 364 393
Rate 65.9 63.2 61.3 57.7
Total Number 1432 1607 1561 1568
Rate 55.7 55.8 54.0 51.9
Adjusted Rate (b) 55.2 54.9 53.4 52.4
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.3 Prevalence of Being Limited in Activity Among Persons with
Diabetes, per 100 Diabetic Population, by Age and Year,
White Females, United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 159 112 198
Rate 31.1 31.5 36.1
45-64 Number 516 510 585
Rate 54.0 55.3 56.0
65-74 Number 398 424 371
Rate 53.5 51.2 46.4
75+ Number 309 311 430
Rate 57.6 60.7 66.7
Total Number 1382 1357 1584
Rate 50.3 51.8 52.2
Adjusted Rate (b) 50.4 50.9 51.6
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.4 Limited in Activity, by Age & Year, Black Males
Table 9.4 Prevalence of Being Limited in Activity Among Persons with
Diabetes, per 100 Diabetic Population, by Age and Year,
Black Males, United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 19 29 30 44
Rate 51.5 51.7 47.9 52.5
45-64 Number 121 113 122 102
Rate 59.5 52.3 54.8 50.2
65-74 Number 79 75 76 63
Rate 92.4 85.4 77.1 69.7
75+ Number 11 14 13 24
Rate 47.0 39.8 38.6 62.4
Total Number 231 230 241 234
Rate 65.8 58.5 57.7 56.1
Adjusted Rate (b) 64.9 59.0 57.0 57.6
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.4 Prevalence of Being Limited in Activity Among Persons with
Diabetes, per 100 Diabetic Population, by Age and Year,
Black Males, United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 41 29 24
Rate 44.8 36.0 28.8
45-64 Number 121 145 183
Rate 58.0 58.7 66.3
65-74 Number 70 56 57
Rate 67.0 66.2 66.3
75+ Number 24 31 31
Rate 67.2 61.1 57.1
Total Number 255 261 295
Rate 58.1 56.4 59.1
Adjusted Rate (b) 59.4 57.1 58.4
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.5 Limited in Activity, by Age & Year, Black Females
Table 9.5 Prevalence of Being Limited in Activity Among Persons with
Diabetes, per 100 Diabetic Population, by Age and Year,
Black Females, United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 52 50 56 43
Rate 45.2 46.2 61.8 49.3
45-64 Number 195 177 173 179
Rate 64.9 62.9 66.7 63.8
65-74 Number 142 136 132 102
Rate 71.2 72.9 72.0 71.0
75+ Number 65 75 94 79
Rate 78.2 81.4 79.5 62.6
Total Number 455 438 454 403
Rate 65.0 65.5 69.8 63.2
Adjusted Rate (b) 65.1 65.4 69.2 63.0
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.5 Prevalence of Being Limited in Activity Among Persons with
Diabetes, per 100 Diabetic Population, by Age and Year,
Black Females, United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 46 46 48
Rate 42.3 34.4 36.6
45-64 Number 190 147 133
Rate 67.8 60.3 58.7
65-74 Number 97 91 105
Rate 67.8 58.6 59.5
75+ Number 95 86 101
Rate 64.6 61.2 74.5
Total Number 427 370 386
Rate 63.0 54.9 57.8
Adjusted Rate (b) 62.9 55.5 57.4
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.6-9.7 Limited in Activity Attributed to Diabetes
9.6 Limited in Activity, by Age & Year
Table 9.6 Prevalence of Being Limited in Activity Attributed to
Diabetes, per 100 Diabetic Population, by Age and Year,
United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 240 243 240 236
Rate 23.9 24.4 23.2 22.5
45-64 Number 900 854 890 1116
Rate 34.6 36.2 38.2 39.2
65-74 Number 512 677 622 548
Rate 39.2 38.6 33.6 34.4
75+ Number 305 431 475 531
Rate 34.9 39.6 43.2 41.4
Total Number 1957 2205 2227 2432
Rate 33.9 35.6 35.2 35.9
Adjusted Rate (b) 34.0 35.3 35.1 35.4
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.6 Prevalence of Being Limited in Activity Attributed to
Diabetes, per 100 Diabetic Population, by Age and Year,
United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 299 232 287
Rate 21.9 21.3 23.5
45-64 Number 947 882 923
Rate 37.1 35.9 34.1
65-74 Number 567 605 549
Rate 33.3 35.5 33.7
75+ Number 434 319 321
Rate 36.4 29.2 29.3
Total Number 2247 2039 2081
Rate 33.0 32.1 31.2
Adjusted Rate (b) 33.3 32.2 31.4
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.7 Limited in Activity, by Race, Sex, & Year
Table 9.7 Prevalence of Being Limited in Activity Attributed to
Diabetes, per 100 Diabetic Population, By Race, Sex, and
Year, United States, 1983-1989
Race and Sex 1983 1984 1985 1986
White Males Number (a) 566 612 696 797
Rate 27.3 29.4 30.3 31.1
Adjusted Rate (b) 27.4 29.3 30.6 30.2
White Females Number 838 995 1014 1076
Rate 32.6 34.6 35.0 35.6
Adjusted Rate (b) 32.6 34.1 34.6 35.8
Black Males Number 187 179 166 177
Rate 53.2 45.4 39.6 42.6
Adjusted Rate (b) 53.7 44.8 38.0 41.9
Black Females Number 358 355 327 312
Rate 51.1 53.0 50.2 49.0
Adjusted Rate (b) 51.2 52.9 49.8 49.2
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.7 Prevalence of Being Limited in Activity Attributed to
Diabetes, per 100 Diabetic Population, By Race, Sex, and
Year, United States, 1983-1989
Race and Sex 1987 1988 1989
White Males Number (a) 808 676 691
Rate 29.3 28.6 30.2
Adjusted Rate (b) 29.6 29.2 29.5
White Females Number 894 853 932
Rate 32.5 32.6 30.7
Adjusted Rate (b) 32.9 32.3 30.6
Black Males Number 191 188 201
Rate 43.4 40.6 40.3
Adjusted Rate (b) 44.8 41.1 39.4
Black Females Number 298 277 271
Rate 44.0 41.1 40.5
Adjusted Rate (b) 44.1 41.9 40.2
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.8-9.11 Limited in Major Activity
9.8 By Age & Year
Table 9.8 Prevalence of Being Limited in Major Activity Among People
with Diabetes, per 100 Diabetic Population, by Age and
Year, United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 287 280 262 238
Rate 28.6 28.2 25.2 22.7
45-64 Number 1111 1042 1104 1314
Rate 42.8 44.2 47.4 46.1
65-74 Number 535 737 772 688
Rate 41.0 42.0 41.7 43.2
75+ Number 395 470 448 459
Rate 45.2 43.1 40.7 35.7
Total Number 2328 2529 2586 2698
Rate 40.3 40.8 40.9 39.8
Adjusted Rate (b) 40.2 40.6 41.0 39.7
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.8 Prevalence of Being Limited in Major Activity Among People
with Diabetes, per 100 Diabetic Population, by Age and
Year, United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 321 283 350
Rate 23.5 25.9 28.6
45-64 Number 1115 999 1099
Rate 43.7 40.6 40.6
65-74 Number 726 737 676
Rate 42.6 43.3 41.4
75+ Number 408 366 400
Rate 34.2 33.4 36.5
Total Number 2570 2384 2525
Rate 37.7 37.5 37.9
Adjusted Rate (b) 38.5 37.7 38.1
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.9 By Age & Year, Whites
Table 9.9 Prevalence of Being Limited in Major Activity Among People
with Diabetes, per 100 Diabetic Population, by Age and
Year, Whites, United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 214 212 202 180
Rate 26.4 26.7 22.6 20.1
45-64 Number 829 801 814 1032
Rate 41.4 43.1 45.6 44.7
65-74 Number 408 552 599 527
Rate 39.0 39.6 38.3 40.5
75+ Number 326 371 360 358
Rate 41.3 40.5 38.1 32.9
Total Number 1778 1936 1975 2097
Rate 38.2 39.0 38.1 37.5
Adjusted Rate (b) 38.2 38.9 38.5 37.6
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.9 Prevalence of Being Limited in Major Activity Among People
with Diabetes, per 100 Diabetic Population, by Age and
Year, Whites, United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 231 219 294
Rate 21.2 26.1 30.5
45-64 Number 853 744 845
Rate 42.5 40.1 39.8
65-74 Number 577 582 533
Rate 39.8 42.0 39.9
75+ Number 299 292 336
Rate 31.0 32.4 37.4
Total Number 1960 1838 2009
Rate 35.6 36.9 37.7
Adjusted Rate (b) 36.4 37.0 37.9
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.10 By Age & Year, Blacks
Table 9.10 Prevalence of Being Limited in Major Activity Among
People with Diabetes, per 100 Diabetic Population, by
Age and Year, Blacks, United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 54 54 60 64
Rate 35.2 32.6 39.0 37.4
45-64 Number 256 244 273 261
Rate 50.6 49.1 56.7 53.8
65-74 Number 140 148 163 138
Rate 49.0 53.8 57.8 58.7
75+ Number 76 80 83 77
Rate 70.2 62.6 54.4 46.4
Total Number 527 526 579 539
Rate 49.9 49.4 54.1 51.1
Adjusted Rate (b) 50.4 49.5 53.6 51.1
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.10 Prevalence of Being Limited in Major Activity Among
People with Diabetes, per 100 Diabetic Population, by
Age and Year, Blacks, United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 71 58 51
Rate 35.3 26.6 23.9
45-64 Number 260 236 253
Rate 53.2 48.2 50.4
65-74 Number 140 126 137
Rate 56.7 52.5 52.2
75+ Number 80 69 61
Rate 44.4 35.8 32.3
Total Number 551 488 502
Rate 49.3 42.9 43.0
Adjusted Rate (b) 49.7 43.7 43.5
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.11 By Race, Sex, & Year
Table 9.11 Prevalence of Being Limited in Major Activity Among
People with Diabetes, per 100 Diabetic Population, by
Race, Sex, and Year, United States, 1983-1989
Race and Sex 1983 1984 1985 1986
White Males Number (a) 711 728 781 904
Rate 34.3 35.0 34.0 35.2
Adjusted Rate (b) 34.1 35.1 34.3 34.0
White Females Number 1065 1213 1194 1200
Rate 41.4 42.1 41.3 39.8
Adjusted Rate 41.1 41.8 41.7 40.5
Black Males Number 196 192 205 207
Rate 55.8 48.7 49.1 49.6
Adjusted Rate 55.5 48.3 46.2 49.9
Black Females Number 332 333 373 332
Rate 47.4 49.8 57.3 52.1
Adjusted Rate 48.3 49.8 56.7 51.7
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.11 Prevalence of Being Limited in Major Activity Among
People with Diabetes, per 100 Diabetic Population, by
Race, Sex, and Year, United States, 1983-1989
Race and Sex 1987 1988 1989
White Males Number (a) 920 840 855
Rate 33.4 35.5 37.4
Adjusted Rate (b) 34.2 36.4 37.2
White Females Number 1036 989 1174
Rate 37.7 37.8 38.6
Adjusted Rate 38.3 37.5 38.4
Black Males Number 222 229 246
Rate 50.5 49.4 49.2
Adjusted Rate 50.5 49.6 47.8
Black Females Number 329 260 257
Rate 48.6 38.5 38.4
Adjusted Rate 48.8 39.8 39.1
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.12-9.15 Unable to Perform Major Activity
9.12 By Age & Year
Table 9.12 Prevalence of Being Unable to Perform Major Activity Among
People with Diabetes, per 100 Diabetic Population, By Age
and Year, United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 88 84 74 79
Rate 8.8 8.4 7.1 7.5
45-64 Number 594 561 623 739
Rate 22.8 23.8 26.7 26.0
65-74 Number 245 355 380 383
Rate 18.8 20.2 20.5 24.0
75+ Number 198 203 234 234
Rate 22.6 18.7 21.2 18.2
Total Number 1125 1204 1311 1435
Rate 19.5 19.4 20.7 21.2
Adjusted Rate (b) 19.3 19.4 20.9 21.1
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.12 Prevalence of Being Unable to Perform Major Activity Among
People with Diabetes, per 100 Diabetic Population, By Age
and Year, United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 139 125 165
Rate 10.2 11.5 13.5
45-64 Number 617 541 586
Rate 24.2 22.0 21.7
65-74 Number 414 424 371
Rate 24.3 24.9 22.7
75+ Number 245 183 203
Rate 20.5 16.8 18.5
Total Number 1414 1274 1326
Rate 20.8 20.1 19.9
Adjusted Rate (b) 21.2 20.1 20.1
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.13 By Age & Year, Whites
Table 9.13 Prevalence of Being Unable to Perform Major Activity
Among People with Diabetes, per 100 Diabetic Population,
by Age and Year, Whites, United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 67 63 53 56
Rate 8.3 7.9 5.9 6.3
45-64 Number 432 404 425 541
Rate 21.6 21.7 23.8 23.5
65-74 Number 192 259 279 277
Rate 18.3 18.6 17.8 21.2
75+ Number 136 141 189 194
Rate 17.2 15.3 20.1 17.8
Total Number 826 867 946 1068
Rate 17.8 17.5 18.2 19.1
Adjusted Rate (b) 17.7 17.5 18.5 19.0
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.13 Prevalence of Being Unable to Perform Major Activity
Among People with Diabetes, per 100 Diabetic Population,
by Age and Year, Whites, United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 95 84 120
Rate 8.8 10.1 12.4
45-64 Number 461 377 417
Rate 23.0 20.3 19.6
65-74 Number 309 319 269
Rate 21.3 23.0 20.1
75+ Number 185 131 150
Rate 19.2 14.5 16.7
Total Number 1050 912 956
Rate 19.1 18.3 18.0
Adjusted Rate (b) 19.5 18.4 18.1
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.14 By Age & Year, Blacks
Table 9.14 Prevalence of Being Unable to Perform Major Activity
Among People with Diabetes, per 100 Diabetic Population,
by Age and Year, Blacks, United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 18 19 22 22
Rate 11.9 11.7 14.1 12.9
45-64 Number 149 160 194 180
Rate 29.4 32.3 40.3 37.3
65-74 Number 64 80 92 94
Rate 22.4 29.2 32.5 40.0
75+ Number 63 52 46 38
Rate 58.3 41.2 30.6 23.0
Total Number 294 313 354 334
Rate 27.9 29.4 33.1 31.7
Adjusted Rate (b) 28.8 29.2 32.2 31.6
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.14 Prevalence of Being Unable to Perform Major Activity
Among People with Diabetes, per 100 Diabetic Population,
by Age and Year, Blacks, United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 32 36 39
Rate 16.2 16.7 18.4
45-64 Number 155 157 170
Rate 31.7 32.0 34.0
65-74 Number 98 89 95
Rate 39.8 37.2 36.0
75+ Number 52 53 51
Rate 28.9 27.6 26.7
Total Number 338 335 355
Rate 30.3 29.4 30.4
Adjusted Rate (b) 30.7 30.0 30.7
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.15 By Race, Sex, & Year
Table 9.15 Prevalence of Being Unable to Perform Major Activity
Among People with Diabetes, per 100 Diabetic Population,
By Race, Sex, and Year, United States, 1983-1989
Race and Sex 1983 1984 1985 1986
White Males Number (a) 364 393 455 594
Rate 17.5 18.8 19.8 23.2
Adjusted Rate (b) 17.7 18.9 20.1 21.7
White Females Number 462 473 490 489
Rate 18.0 16.4 16.9 16.2
Adjusted Rate 17.7 16.4 16.6 15.9
Black Males Number 133 142 143 152
Rate 37.9 35.9 34.2 36.6
Adjusted Rate 35.1 34.1 31.2 38.0
Black Females Number 160 172 211 182
Rate 22.9 25.7 32.4 28.5
Adjusted Rate 24.3 25.7 32.1 28.3
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Tables 9.15 Prevalence of Being Unable to Perform Major Activity
Among People with Diabetes, per 100 Diabetic Population,
By Race, Sex, and Year, United States, 1983-1989
Race and Sex 1987 1988 1989
White Males Number (a) 585 493 475
Rate 21.2 20.9 20.7
Adjusted Rate (b) 21.9 21.7 20.7
White Females Number 468 410 485
Rate 17.0 15.7 16.0
Adjusted Rate 16.8 15.4 16.0
Black Males Number 152 179 180
Rate 34.6 38.5 36.0
Adjusted Rate 36.2 38.9 34.7
Black Females Number 186 157 176
Rate 27.5 23.3 26.3
Adjusted Rate 27.6 23.7 26.2
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.16-9.17 Limited in Work Between 18 & 69 Years of Age
9.16 Persons with Diabetes, By Race, Sex, & Year
Table 9.16 Prevalence of Being Limited in Work Among Persons with
Diabetes Between 18 and 69 Years of age, per 100 Diabetic
Population, By Race, Sex, and Year, United States, 1983-1989
Race and Sex 1983 1984 1985 1986
White Males Rate (a) 36.5 38.3 40.3 40.4
White Females Rate 45.8 47.1 43.6 42.8
Black Males Rate 58.8 48.9 49.0 46.9
Black Females Rate 52.6 54.2 61.0 58.3
Total Rate 43.9 44.8 44.2 43.4
(a) Three-year moving average.
Table 9.16 Prevalence of Being Limited in Work Among Persons with
Diabetes Between 18 and 69 Years of age, per 100 Diabetic
Population, By Race, Sex, and Year, United States, 1983-1989
Race and Sex 1987 1988 1989
White Males Rate (a) 39.2 39.1 38.4
White Females Rate 39.9 41.0 40.3
Black Males Rate 49.9 50.2 52.1
Black Females Rate 56.3 48.2 46.8
Total Rate 41.5 41.0 40.5
(a) Three-year moving average.
9.17 Attributed to Diabetes, By Race, Sex, & Year
Table 9.17 Prevalence of Being Limited in Work Attributed to Diabetes
Among Persons with Diabetes Between 18 and 69 Years of Age,
per 100 Diabetic Population, by Race, Sex, and Year, United
States, 1983-1989
Race and Sex 1983 1984 1985 1986
White Males Rate (a) 23.1 25.5 28.3 27.5
White Females Rate 26.7 28.5 25.2 27.1
Black Males Rate 50.4 44.0 42.2 42.4
Black Females Rate 36.5 39.4 41.8 43.9
Total Rate 27.9 29.8 29.2 29.9
(a) Three-year moving average.
Table 9.17 Prevalence of Being Limited in Work Attributed to Diabetes
Among Persons with Diabetes Between 18 and 69 Years of Age,
per 100 Diabetic Population, by Race, Sex, and Year, United
States, 1983-1989
Race and Sex 1987 1988 1989
White Males Rate (a) 26.7 26.7 27.2
White Females Rate 24.0 25.2 22.1
Black Males Rate 35.6 35.0 33.8
Black Females Rate 37.7 32.9 29.7
Total Rate 27.1 26.8 25.3
(a) Three-year moving average.
9.18 Unable to Work, Ages 18-69
Table 9.18 Prevalence of Being Unable to Work Among Persons with
Diabetes Between 18 and 69 Years of Age, per 100 Diabetic
Population, By Race, Sex, and Year, United States, 1983-1989
Race and Sex 1983 1984 1985 1986
White Males Rate (a) 21.4 23.4 25.9 26.9
White Females Rate 33.7 33.7 29.9 31.3
Black Males Rate 48.0 37.7 34.9 31.2
Black Females Rate 45.8 48.8 52.2 48.4
Total Rate 31.4 31.8 30.8 31.0
(a) Three-year moving average.
Table 9.18 Prevalence of Being Unable to Work Among Persons with
Diabetes Between 18 and 69 Years of Age, per 100 Diabetic
Population, By Race, Sex, and Year, United States, 1983-1989
Race and Sex 1987 1988 1989
White Males Rate (a) 26.0 24.8 23.3
White Females Rate 30.1 28.9 26.7
Black Males Rate 34.4 39.1 38.9
Black Females Rate 44.2 38.4 39.0
Total Rate 29.8 28.6 27.3
(a) Three-year moving average.
9.19 Needing Help with Personal Care, Ages 5-69
Table 9.19 Prevalence of Needing Help with Personal Care or Limited
in Performing Other Routine Activities Among Persons with
Diabetes Between 5 and 69 Years of Age, per 100 Diabetic
Persons, by Race, Sex, and Year, United States, 1984-1989
Race and Sex 1984 1985 1986 1987 1988 1989
White Males Rate (a) 8.2 9.6 9.5 9.9 9.2 9.8
White Females Rate 17.2 15.2 15.0 13.3 14.6 15.1
Black Males Rate 6.0 7.9 4.8 7.1 8.7 11.6
Black Females Rate 20.8 26.3 25.8 21.4 16.6 16.4
Total Rate 13.4 13.6 13.1 12.1 12.0 12.7
(a) Three-year moving average.
9.20-9.22 Total Number of Restricted Activity Days
9.20 By Age & Year
Table 9.20 Total Number of Restricted Activity Days Due to Acute and
Chronic Conditions and Average Number of Days per Person
Among People with Diabetes, by Age and Year, United States,
1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 24183 20034 17457 16900
Average 24.1 20.1 16.8 16.1
45-64 Number 83860 79898 78594 97646
Average 32.3 33.9 33.7 34.3
65-74 Number 48300 61025 61454 57268
Average 37.0 34.7 33.2 35.9
75+ Number 42752 49041 46983 51225
Average 48.9 45.0 42.7 39.9
Total Number 199095 209998 204488 223039
Average 34.4 33.9 32.4 32.9
Adjusted Average (b) 34.6 33.4 32.0 32.4
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.20 Total Number of Restricted Activity Days Due to Acute and
Chronic Conditions and Average Number of Days per Person
Among People with Diabetes, by Age and Year, United States,
1983-1989
Age 1987 1988 1989
0-44 Number (a) 24717 22495 27520
Average 18.1 20.6 22.5
45-64 Number 87668 82516 90119
Average 34.4 33.5 33.3
65-74 Number 66655 70747 68099
Average 39.1 41.5 41.7
75+ Number 48708 46135 47072
Average 40.8 42.2 42.9
Total Number 227747 221893 232811
Average 33.4 34.9 35.0
Adjusted Average (b) 33.7 34.7 35.1
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.21 By Age & Year, Whites
Table 9.21 Total Number of Restricted Activity Days Due to Acute and
Chronic Conditions and Average Number of Days per Person
Among People With Diabetes, by Age and Year, Whites,
United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 16468 13792 12279 11695
Average 20.3 17.4 13.7 13.1
45-64 Number 59083 56364 52798 69812
Average 29.5 30.3 29.6 30.3
65-74 Number 39051 47737 51459 44831
Average 37.3 34.2 32.9 34.4
75+ Number 36386 39538 40614 44336
Average 46.1 43.1 43.0 40.8
Total Number 150988 157430 157150 170675
Average 32.5 31.7 30.3 30.5
Adjusted Rate (b) 32.4 31.0 29.7 29.9
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.21 Total Number of Restricted Activity Days Due to Acute and
Chronic Conditions and Average Number of Days per Person
Among People With Diabetes, by Age and Year, Whites,
United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 17202 15752 21272
Average 15.8 18.8 22.1
45-64 Number 62289 57106 65150
Average 31.0 30.7 30.7
65-74 Number 54947 54912 53549
Average 37.9 39.6 40.1
75+ Number 40020 37179 36037
Average 41.6 41.2 40.1
Total Number 174457 164948 176007
Average 31.7 33.1 33.1
Adjusted Rate (b) 31.8 32.5 33.1
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.22 By Age & Year, Blacks
Table 9.22 Total Number of Restricted Activity Days Due to Acute and
Chronic Conditions and Average Number of Days per Person
Among People with Diabetes, by Age and Year, Blacks,
United States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 6104 5330 4884 5203
Average 39.6 32.3 31.6 30.6
45-64 Number 22765 24086 24834 24684
Average 45.0 48.5 51.7 51.0
65-74 Number 9956 10511 9239 11009
Average 34.8 38.1 32.7 46.9
75+ Number 6940 7282 6155 6148
Average 64.3 57.3 40.5 37.2
Total Number 45766 47209 45111 47043
Average 43.4 44.3 42.2 44.6
Adjusted Rate (b) 44.2 44.2 41.5 44.3
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.22 Total Number of Restricted Activity Days Due to Acute and
Chronic Conditions and Average Number of Days per Person
Among People with Diabetes, by Age and Year, Blacks,
United States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 5497 5985 5615
Average 27.5 27.6 26.2
45-64 Number 23905 23010 23550
Average 48.8 47.0 47.0
65-74 Number 11433 13485 13940
Average 46.4 56.3 53.0
75+ Number 6374 8319 9223
Average 35.2 43.4 48.8
Total Number 47208 50798 52329
Average 42.3 44.7 44.8
Adjusted Rate (b) 42.5 45.5 45.2
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.23-9.25 Total Number of Bed Days
9.23 By Age & Year
Table 9.23 Total Number of Bed Days Due to Acute and Chronic
Conditions and Average Number of Bed Days per Person
Among People with Diabetes, by Age and Year, United
States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 13896 10878 9014 7960
Average 13.9 10.9 8.7 7.6
45-64 Number 39851 35580 33607 43473
Average 15.3 15.1 14.4 15.3
65-74 Number 24731 30801 29748 28953
Average 19.0 17.5 16.1 18.2
75+ Number 26539 27271 27681 27900
Average 30.4 25.0 25.1 21.7
Total Number 105017 104531 100050 108286
Average 18.2 16.9 15.8 16.0
Adjusted Rate (b) 18.3 16.5 15.5 15.7
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.23 Total Number of Bed Days Due to Acute and Chronic
Conditions and Average Number of Bed Days per Person
Among People with Diabetes, by Age and Year, United
States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 12559 11784 14918
Average 9.2 10.8 12.2
45-64 Number 43790 43349 47081
Average 17.2 17.6 17.4
65-74 Number 35092 36821 35229
Average 20.6 21.6 21.6
75+ Number 27525 23087 23137
Average 23.1 21.1 21.1
Total Number 118966 115041 120366
Average 17.5 18.1 18.1
Adjusted Rate (b) 17.6 18.0 18.1
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.24 By Age & Year, Whites
Table 9.24 Total Number of Bed Days Due to Acute and Chronic
Conditions and Average Number of Days per Person Among
People with Diabetes, by Age and Year, Whites, United
States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 8968 6981 5578 4884
Average 11.0 8.8 6.2 5.5
45-64 Number 28854 24217 21414 28688
Average 14.4 13.0 12.0 12.4
65-74 Number 20161 23040 24053 21716
Average 19.3 16.5 15.4 16.7
75+ Number 23599 22867 24787 24571
Average 29.9 24.9 26.2 22.6
Total Number 81582 77106 75832 79859
Average 17.5 15.5 14.6 14.3
Adjusted Rate (b) 17.4 15.0 14.0 13.8
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.24 Total Number of Bed Days Due to Acute and Chronic
Conditions and Average Number of Days per Person Among
People with Diabetes, by Age and Year, Whites, United
States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 8345 8321 11693
Average 7.7 9.9 12.1
45-64 Number 30446 28914 33436
Average 15.2 15.6 15.7
65-74 Number 29370 28851 27968
Average 20.3 20.8 20.9
75+ Number 22701 18360 17462
Average 23.6 20.3 19.4
Total Number 90863 84446 90559
Average 16.5 16.9 17.0
Adjusted Rate (b) 16.5 16.7 17.0
(a) In thousands; three-year moving average.
(b) Adjusted for age.
9.25 By Age & Year, Blacks
Table 9.25 Total Number of Bed Days Due to Acute and Chronic
Conditions and Average Number of Days per Person Among
People with Diabetes, by Age and Year, Blacks, United
States, 1983-1989
Age 1983 1984 1985 1986
0-44 Number (a) 3663 3194 3012 3070
Average 23.8 19.3 19.5 18.0
45-64 Number 9781 11336 11694 13031
Average 19.3 22.8 24.3 26.9
65-74 Number 4710 6204 5243 6756
Average 16.4 22.5 18.6 28.8
75+ Number 3283 3139 2719 2969
Average 30.4 24.7 17.9 18.0
Total Number 21437 23872 22668 25825
Average 20.3 22.4 21.2 24.5
Adjusted Rate (b) 21.0 22.4 21.0 24.5
(a) In thousands; three-year moving average.
(b) Adjusted for age.
Table 9.25 Total Number of Bed Days Due to Acute and Chronic
Conditions and Average Number of Days per Person Among
People with Diabetes, by Age and Year, Blacks, United
States, 1983-1989
Age 1987 1988 1989
0-44 Number (a) 3118 3179 3106
Average 15.6 14.7 14.5
45-64 Number 13033 13714 13333
Average 26.6 28.0 26.6
65-74 Number 5925 7178 7605
Average 24.1 30.0 28.9
75+ Number 3575 4174 4470
Average 19.8 21.8 23.7
Total Number 25650 28245 28514
Average 23.0 24.8 24.4
Adjusted Rate (b) 23.0 25.3 24.6
(a) In thousands; three-year moving average.
(b) Adjusted for age.
CONCLUSIONS
Diabetes mellitus is a major cause of morbidity and premature mortality
in the United States. Surveillance data describing the magnitude of the
disease burden of diabetes and its complications can be used to help formulate
health care policy, target high-risk groups, develop strategies to reduce the
burden associated with diabetes, and evaluate progress in disease prevention
and control. We have established a diabetes surveillance system to serve such
purposes. This system compiles and analyzes periodic and representative data
on the disease burden associated with diabetes and its complications in the
United States. The results of these analyzes have been summarized in Chapters
2 through 9.
Although national data are available for many of the complications of
diabetes, there are some important gaps. Diabetes is the leading cause of new
cases of blindness among adults in the United States, but recent national data
are not available on eye disease and blindness related to diabetes. And
although women with diabetes are known to be at increased risk for adverse
outcomes of pregnancy, national data are not available for monitoring
pregnancy outcomes among these women. Nor are periodic, national data
available on health care practices and behaviors that could prevent many of
the complications of diabetes. Data are also lacking on minority groups, such
as Hispanics and Native Americans, who are at increased risk for both diabetes
and its complications. In the future, we will build upon our diabetes
surveillance system by identifying and analyzing additional data sources and
topics that describe the disease burden of diabetes and its complications.
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