Introduction: In high-income countries, mortality rates have a twofold increment in subjects with diabetes compared to the general population. Few prospective studies have evaluated the impact of diabetes on mortality in low- and middle-income countries. In Mexico, a five-fold higher mortality due to diabetes was recently reported. Limited access to medical care could explain this poor prognosis.
Hypothesis: Among women with healthcare coverage in Mexico, diabetes confers a mortality risk similar to what is observed in high-income countries.
Methods: We evaluated diabetes in relation to all cause and cause-specific mortality in a prospective cohort of 111,300 disease-free women (except for diabetes) with healthcare coverage in the Mexican Teachers’ Cohort. We identified 5,514 (5%) participants who self-reported a diagnosis of diabetes at baseline in 2006-08. Between 2006 and 2015 we identified deaths using the employer’s database and next of kin reports and obtained date and cause of death of 802 women from national mortality databases. In multivariable Cox models we adjusted for sociodemographic factors, healthcare institution, use of preventive health services, body mass index, hypertension, smoking, and physical activity.
Results: Among participants (42 ± 7.5 years), age-adjusted mortality rate was 4.59 per 1000 person-years (95%CI 3.27, 5.92) for women with diabetes and 1.28 per 1000 person-years (95%CI 1.01, 1.54) for women without diabetes. In multivariable models comparing diabetics versus non diabetics, the hazard ratio (HR) for all-cause mortality was 3.27 (95%CI 2.73, 3.90). The HR for cardiovascular mortality was 3.78 (95%CI 2.46, 5.54), for renal disease mortality 16.89 (95%CI 9.78, 29.4), and for death from infections 7.55 (95%CI 3.58, 15.3).
Conclusions: In women with healthcare coverage in Mexico, diabetes was associated with a worse prognosis than what is observed in high-income countries, particularly for deaths due to renal disease and infections.