Diabetes Increases Mortality Among Elderly Patients

Annual mortality rate for patients with diabetes age 65 or older was 10%. A study of almost 300,000 people by researchers at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., found that In comparison, the annual mortality rate for people in the same age group who do not have diabetes is 6%.

The researchers, led by Alain Bertoni, MD, MPH, said that these findings were important because many doctors had previously underestimated mortality rates among elderly patients with diabetes. Several prior studies had indicated that diabetes may be somewhat “less deadly” among elderly patients than it is among younger patients.

Bertoni and his colleagues said these results are particularly alarming because diabetes is becoming more prevalent among patients age 65 and older.

The researchers said these new findings suggest that prevention of diabetes among the elderly should be a priority. Bertoni noted that studies have shown that diabetes can be prevented, even in higher-risk patients, such as the elderly. Bertoni said the Diabetes Prevention Program demonstrated that elderly patients who lost a modest amount of weight and increased their physical activity were 71% less likely to develop diabetes than elderly patients who did not make these changes.

Bertoni and his colleagues analyzed a 5% national sample of Medicare claims in 1994 for this retrospective cohort study. The cohort included 148,562 patients age 65 or older who had at least one hospitalization or two outpatient visits for diabetes. The researchers also analyzed a control group of 148,562 people who did not have diabetes but were well matched for age, gender and race.

The patients were followed through the end of 1999. During that time, 59,369 — or 40% — of patients with diabetes died. In comparison, 39,220 patients — or 26% — of people who did not have diabetes died during the follow-up period.

The researchers calculated the mortality rate for both groups. The mortality rate was 100.2 per 1,000 person years among elderly patients with diabetes and 60.6 per 1,000 person years among the elderly people who did not have diabetes.

For further analysis, the researchers divided the two groups into five-year subgroups based on age. This analysis showed that in each age-based subgroup, elderly patients with diabetes still had a higher mortality rate than elderly people who did not have diabetes. The difference in mortality rates between patients with diabetes and the control group decreased as age increased, but mortality rates remained higher among patients with diabetes at every age.

Bertoni and his colleagues also found there were differences in mortality rates among different ethnic and racial groups.
The researchers said diabetes was associated with a 60% increased risk of death among blacks and an 80% increased risk of death among whites. But among Hispanic and Native American patients, the disease was associated with a 100% increased risk of death.

Bertoni A, Kirk J, Goff D, et al. Excess mortality related to diabetes mellitus in elderly Medicare beneficiaries. Ann Epidemiol. 2004;5:362-367.

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