Early mortality in EURODIAB population-based cohorts of type 1 diabetes diagnosed in childhood since 1989

• Published in: Diabetologia 2007-12, Vol.50 (12), p.2439-2442
• Main Authors: Patterson, C. C, Dahlquist, G, Harjutsalo, V, Joner, G, Feltbower, R. G, Svensson, J, Schober, E, Gyürüs, E, Castell, C, Urbonaité, B, Rosenbauer, J, Iotova, V, Thorsson, A. V, Soltész, G
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age of Onset; Biological and medical sciences; Cause of Death; Child; Child, Preschool; Cohort; Cohort Studies; Diabetes; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - mortality; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Europe - epidemiology; Female; Follow-Up Studies; GDP; Gross Domestic Product; Hospitals; Humans; Infant; Infant, Newborn; insulin-dependent diabetes mellitus; Male; Medical sciences; Mortality; Pediatrics; Public health; Registries; Standardised mortality ratio
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-007-0824-8

Aims/hypothesis The aims of this study were to provide a contemporary picture of mortality and causes of death in Europe following a diagnosis of type 1 diabetes made before the 15th birthday, and to examine excess mortality by country for possible links to incidence level or national prosperity. Methods Thirteen population-based EURODIAB registers in 12 countries followed-up 28,887 children diagnosed since 1989, either by record linkage to population registers or through contact with doctors providing care. Results There were 141 deaths in the cohort during 219,061 person-years of follow-up compared with 69.1 deaths expected from national mortality rates, a standardised mortality ratio (SMR) of 2.0 (95% CI 1.7-2.4). The SMR varied from 0 to 4.7 between countries, but showed little relationship with the country's incidence rate or gross domestic product (US$ per capita). The SMR did not change significantly with attained age, calendar period or time since diagnosis. The female SMR (2.7; 95% CI 2.0-3.5) was greater than the male SMR (1.8; 95% CI 1.4-2.2), although absolute numbers of excess deaths were similar in the two sexes. One-third of deaths were classified as directly attributable to diabetes (many with mention of ketoacidosis) and half were unrelated to diabetes. There was a non-significant excess of accidental/violent deaths (48 observed vs 40.7 expected; SMR 1.2; 95% CI 0.9-1.6) but little excess in suicides (11 observed, 10.2 expected; SMR 1.1; 95% CI 0.5-1.9). Conclusions/interpretation Before the onset of late complications, significant excess mortality existed following the diagnosis of type 1 diabetes in childhood, even in recent years. Variation between countries in this excess could not be explained.