Objective : Diabetes Mellitus (DM) is one of the most common chronic diseases worldwide. Puerto Rico has the highest age-adjusted prevalence of DM when compared to the USA (13.8% vs 9.5% respectively, CDC 2016). According to the Puerto Rico Health Department Annual Report (2016), in Puerto Rico DM is the third cause of death only preceded by malignancy and cardiovascular disease. However, DM is a known risk factor for these and other conditions. Thus, it’s real impact in mortality may be underestimated. This study aims to evaluate the impact of diabetes mellitus mortality as underlying cause of death and as multiple cause of death in Puerto Rico.
Methods : This is a cross sectional study of annual mortality. Public use multiple-cause-mortality files of the United States and its territories available online from the National Vital Statistics System, NCHS, CDC were used. Deaths in residents of Puerto Rico older than 19 years that occurred from 2003 through 2016 were included. Deaths with diabetes as the underlying cause of death (UCD) were defined as those having any of the ICD-10 codes for diabetes mellitus (E10 – E-14) in the underlying cause of death field. DM-associated deaths were defined as death records with any of these codes in at least one of the 20 fields of the record axis. Statistical analysis was performed with R and RStudio using packages R Commander and epiR. Age-adjusted rates for deaths with DM as an underlying cause of death vs DM-associated deaths were compared.
Results : The final dataset consisted of 398,026 records of deaths from residents of Puerto Rico older than 19 years that occurred in the island from 2003 through 2016. The age adjusted death rate of DM as UCD was 97.18 per 100,000 in 2003, and 91.81 per 100,000 in 2016. The age adjusted DM-associated death rate was 150.43 per 100,000 in 2003, increasing to 165.83 per 100,000 in 2016. Proportional mortality for DM as UCD was 9.2% in 2003 and increased to 10.8% in 2016. Proportional mortality for DM-associated death was 14.2% in 2003 and increased to 19.6% in 2016. Females had higher DM-associated proportional mortality when compared to males.
In Puerto Rico, mortality rates in subjects with diabetes mellitus from 2003 to 2016 had been stable when DM was considered as the UCD. However, when considered as a contributing factor mortality rates increased dramatically. Proportional mortality for DM almost doubled when DM was considered as a contributing factor.
Conclusion : These findings illustrate the full burden of DM mortality in Puerto Rico.
University of Puerto Rico School of Medicine - Endocrinology, Diabetes and Metabolism Division
San Juan, Puerto Rico
Loida A. Gonzalez-Rodriguez, MD is an Endocrinology, Diabetes & Metabolism specialist in San Juan, Puerto Rico. She graduated from University of Puerto Rico - School of Medicine in 2008, completed her specialty in Internal Medicine in 2011 and her sub-specialty in Endocrinology in 2014 at the University Hospital of Puerto Rico. Since then she has been Assistant Professor at the Endocrinology, Diabetes and Metabolism Division of the University of Puerto Rico. Dr. Gonzalez-Rodriguez also participates in different research projects in the area of endocrinology.
University of Puerto Rico School of Medicine – Biomedical Sciences
José G Conde, MD, MPH is a Professor at the University of Puerto Rico School of Medicine. He completed his MD degree and a Master’s degree in Public Health at the University of Puerto Rico School of Medicine. He also completed a Medical Internship in the Ramón Ruiz Arnau Hospital (Bayamón, Puerto Rico), and a medical specialty in Preventive Medicine in the School of Public Health of the Johns Hopkins University. Dr. Conde has collaborated with technical staff of the National Library of Medicine of the United States in the development of programs for remote teaching, and with the faculty of Vanderbilt University in the development of the REDCap program for the creation and management of research databases.