Methods and Limitations

Methodology

The National Center for Health Statistics at the Centers for Disease Control and Prevention compiles and codes information on all deaths in the United States and releases annual underlying-cause-of-death datasets. Data in these datasets include decedents" age, race, sex, state of residence, and the underlying cause of death. Beginning in 1999, causes of death for each decedent are classified and coded according to the International Classification of Diseases, Tenth Revision (ICD-10). Prior to 1999, the International Classification of Diseases, Ninth Revision (ICD-9) was used to classify and code causes of death.

We used underlying-cause-of-death data to extract information on and examine trends in deaths with diabetes ketoacidosis (DKA) as the underlying cause of death (ICD-10 codes E10.1, E11.1, E12.1, E13.1, and E14.1; ICD-9 code 250.1). Rates were calculated using estimates of the population with diabetes from National Health Interview Survey (NHIS) and resident population estimates. Three-year averages were used to improve the precision of NHIS estimates of the population with diabetes. Rates were adjusted to the 2000 U.S. Standard Population using four age groups (0-44, 45-64, 65-74, and 75+).

Limitations

Diabetes is underreported on death certificates. Among persons known to have diabetes, only about 40% have diabetes listed as a cause of death and only 10% have diabetes recorded as the underlying cause of death ⁽¹⁾. However, the extent of underreporting for DKA is unknown. Deaths and census estimates are underestimated for minority populations ⁽²⁾.

References

1. Bild DE, Stevenson JM. Frequency of recording of diabetes on U.S. death certificates: analysis of the 1986 National Mortality Followback Survey. J Clin Epidemiol 1992;45:275–81.
2. Rosenberg HM, Maurer JD, Sorlie PD, Johnson NJ, et al. Quality of death rates by race and Hispanic origin: A summary of current research, 1999. National Center for Health Statistics. Vital Health Stat 2(128). 1999.