Declining mortality rate among people with diabetes in North Dakota, 1997-2002.

Both the increasing prevalence (1,2) and the high lifetime risk for diabetes (3) have enormous implications for the future; this disease is a major cause of premature mortality, and people with diabetes die at about twice the rate of people without diabetes (4). Efforts to track mortality trends have been difficult because death certificates, as currently structured, are inadequate to assess diabetes mortality, as less than half of diabetic decedents have diabetes listed (4). To improve the tracking of mortality among people with diabetes, North Dakota added a check box to its death certificate in 1992 that asked whether the decedent had diabetes. The period of 1992–1996 has been reported previously (5). In this study, we use the check box to aid in calculating the number of decedents with diabetes and in examining mortality rates among those with diabetes from 1997 through 2002.