Certification of deaths from diabetes mellitus and obesity in England: trends into the twenty-first century.

BACKGROUND Most cases of Type 2 diabetes are attributable to excess weight and physical inactivity. We investigated trends in mortality based on doctors' certification of diabetes and obesity. METHODS Analysis of a national data set of all certified causes of death, i.e. underlying cause and contributing causes ('mentions'), in England 1995-2010. RESULTS Diabetes exhibited divergent trends for mortality based on underlying cause and mentions. Underlying cause rates were 107.2 per million population [95% confidence interval (CI): 105.7-108.6] in 1995, but only 68.9/10(6) (CI: 67.9-69.9) in 2010. Mortality rates for mentions of diabetes were 403.1/10(6) (CI: 400.4-405.8) in 1995, increasing to 478.4/10(6) (CI: 475.7-481.0) in 2010. Underlying cause mortality for obesity was 3.7/10(6) (CI: 3.2-4.1) in 1995 and 7.5 (CI: 7.0-8.0) in 2010. The corresponding rates for mentions of obesity were 13.2/10(6) (CI: 12.6-13.9) and 34.5/10(6) (CI: 33.6-35.4), respectively. 24.0% of death certificates with a mention of obesity also had diabetes recorded on the same certificate. CONCLUSIONS Multiple-cause mortality statistics provide a more accurate picture than underlying cause of the total mortality burden attributed on death certificates to diabetes and obesity. Rates for both increased substantially: analysis by underlying cause alone would have missed this for diabetes.