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  Vol. 295 No. 4, January 25, 2006 TABLE OF CONTENTS
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Leading Causes of Death in the United States

Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: The study of trends in the leading causes of death in the United States by Dr Jemal and colleagues1 reported a 45% increase in the death rate between 1987 and 2002 for those deaths in which diabetes was recorded as an underlying cause. The authors attribute this to an increase in the prevalence of obesity. However, we believe that there are alternative explanations.

Using underlying cause of death to assess diabetes mortality rates is problematic. Only 10% to 15% of persons with diabetes who die have diabetes listed as an underlying cause, and only about 50% have it listed as either an underlying or a contributing cause.2 Trends in diabetes-related mortality rates derived from death certificate data may be particularly affected by trends in coding artifacts and awareness or detection of diabetes.

Furthermore, assessing trends in the recording of diabetes as an underlying cause of death can . . . [Full Text of this Article]

Edward F. Tierney, MPH
ext5@cdc.gov

Edward W. Gregg, PhD; K. M. Venkat Narayan, MD
Division of Diabetes Translation
Centers for Disease Control and Prevention
Atlanta, Ga


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