A Growing Disparity in Diabetes-Related Mortality. U.S. Trends, 1989-2005

Background: Whether a disparity in diabetes-related death across education levels is widening, narrowing, or stable is not known. This analysis examined trends in diabetes-related death by education levels over a 17-year period. Methods: The first part of the analysis calculated diabetes-related mortality rates for adults aged 40-64 years and adults aged 65-79 years using U.S. Vital Statistics data from 1989 to 2005 to provide the number of deaths per year in the U.S. (the numerator) and also U.S. Census data to provide the population size (the denominator). The second part of the analysis examined trends by education level in possible mechanisms that link education and diabetes-related mortality using the U.S. National Health and Nutrition Examination Surveys (NHANES) program in 1988-1994 and 1999-2004. Results: Disparity in diabetes-related mortality across education levels widened from the late 1980s to 2005 overall and in the subgroups of men, women, blacks, whites, and Hispanics. Analysis of NHANES data indicated that progress in diabetes care and management (as indicated by HbA1c levels less than 8%) has helped people of all education levels but has been of greater benefit to those with higher education. Conclusions: The reduction of disparities in diabetes-related mortality requires improved policies and interventions that redress the slower pace of improvement in diabetes care and self-management among people with lower education.