Lessons from New York City-how diabetes might be affecting overall rates of coronary heart disease

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SYNOPSISBACKGROUNDThe age-adjusted rate of death caused by coronary heart disease (CHD) has persistently declined in the US. CHD is the major cause of death in patients with diabetes but there are no population-based data available to assess how the increasing incidence of diabetes is affecting rates of death caused by CHD or other common diseases.OBJECTIVESTo compare the annual causes (in particular, acute myocardial infarction [AMI]) and rates of death among diabetic and nondiabetic residents of New York City (NYC) in 1990 and 2000.DESIGNThe authors retrospectively examined three sources of data to compare 2000 with 1990: US Census Bureau data from 1990 and 2000; NYC Department of Health mortality records from 1989-1991 and 1999-2001; and Department of Health Statewide Planning and Research Cooperative System (SPARCS) data from patients hospitalized in 1988-1992 or 1998-2002. Only individuals aged 35 years or older were included in either study group.OUTCOME MEASURESThe authors determined age-adjusted and sex-adjusted overall mortality and cause-specific mortality using diagnostic International Classification of Diseases (ICD) codes from the mortality records of all deaths in NYC, and identified deaths due to cancer, cardiovascular disease, CHD, AMI, stroke, or diabetes. Rates of in-hospital mortality and morbidity caused by diabetes-associated AMI were determined from SPARCS data.RESULTSThe mean age of residents aged 35 years or over was 54.7 years in 1990 and 53.9 years in 2000; 47.8% and 49.4% of subjects, respectively, were male. Mortality decreased by 30% for men and 21% for women between 1990 and 2000. In this time, the overall mortality and mortality due to cancer, cardiovascular disease, CHD, AMI, and stroke all decreased; however, diabetes-associated mortality increased by 61% for men (from 30.5 to 49.1 per 100,000 people) and 52% for women (from 26.0 to 39.5 per 100,000 people). Overall hospitalization rates for diabetes and its complications increased by 44% from 1990 to 2000. Rates for all of the complications examined, except for ketoacidosis and ophthalmic disorders, increased. Overall age-adjusted hospitalization rates for AMI were unchanged from 1989-1991 to 1999-2001. Admissions for AMI among patients without diabetes decreased; but, this was offset by a 65% increase of AMI among patients with diabetes (from 186 to 286 per 100,000 people). In-hospital, AMI-associated mortality decreased from 1988 to 2002 among both diabetic and nondiabetic patients. Overall, the number of days spent in hospital also decreased in both groups; however, because more diabetics were hospitalized, there was a 51% increase in the number of days patients with diabetes spent in hospital.CONCLUSIONIn NYC, the number of nondiabetic patients dying or being hospitalized because of AMI and other common diseases, and the time spent in hospital by this group decreased between 1990 and 2000. These decreases were not seen in the diabetic population; this group showed increased morbidity and mortality, particularly that caused by cardiovascular complications.

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