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Unnatural Deaths in a National Cohort of People Diagnosed With Diabetes
Univ Manchester, Inst Brain Behav & Mental Hlth, Ctr Mental Hlth & Risk, Manchester, Lancs, England..ORCID iD: 0000-0001-8532-2647
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..ORCID iD: 0000-0003-3037-5287
Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res & Educ, Stockholm, Sweden..
Univ Manchester, Inst Brain Behav & Mental Hlth, Ctr Mental Hlth & Risk, Manchester, Lancs, England..
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2014 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 37, no 8, 2276-2283 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE To examine risk of unnatural death among people diagnosed with diabetes irrespective of disease type. RESEARCH DESIGN AND METHODS We conducted a matched cohort study of the entire Swedish population using interlinked national registers. From the National Diabetes Register we identified 252,191 people diagnosed with diabetes (type 1 or 2) during 1996-2009. Each cohort member was matched for age, sex, and county of birth to five unaffected individuals randomly sampled from the Total Population Register. Mortality was examined with complete ascertainment, and risk ratios (RRs) for all unnatural deaths and for specific causes (suicide, accident, homicide, and iatrogenic effects) were estimated using conditional fixed-effects Poisson regression. RESULTS Risk of any unnatural death was elevated versus the general population: 77.3 versus 32.1 per 10,000 (RR 2.2 [95% CI 2.1-2.4]), and these deaths occurred at a younger age in the diabetes cohort. Risk was increased for suicide (RR 3.4 [95% CI 3.0-3.8]), accident (RR 2.0 [95% CI 1.9-2.1]), homicide (RR 3.1 [95% CI 1.6-6.1]), and iatrogenic effects (RR 2.4 [95% CI 1.9-3.2]). It was greatly elevated for fatal poisoning from a variety of agents, including psychotropic drugs and "other and unspecified medication," as well as narcotics, alcohol, and carbon monoxide. Almost 9% of all fatal poisoning cases in the diabetes cohort were identified as overdoses of insulin or oral hypoglycemic drugs. CONCLUSIONS Various causes of unnatural death, in particular deliberate and accidental poisonings, occur more frequently among diabetic patients. Before preventive strategies can be implemented, a deeper understanding of the risk factors and causal mechanisms explaining the marked elevations in risk is needed.

Place, publisher, year, edition, pages
2014. Vol. 37, no 8, 2276-2283 p.
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-56804DOI: 10.2337/dc14-0005ISI: 000340491800043PubMedID: 24848285OAI: oai:DiVA.org:oru-56804DiVA: diva2:1084305
Available from: 2017-03-24 Created: 2017-03-24 Last updated: 2017-03-24Bibliographically approved

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Webb, Roger T.Lichtenstein, PaulLudvigsson, Jonas F.Runeson, Bo
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