Methods and Limitations
The National Center for Health Statistics at the Centers for Disease Control and Prevention compiles and codes information on all deaths in the United States and releases annual underlying-cause-of-death datasets. These datasets include decedents' age, race, sex, state of residence, and the underlying cause of death. Beginning in 1999, causes of death for each decedent are classified and coded according to the International Classification of Diseases, Tenth Revision (ICD-10). Prior to 1999, the International Classification of Diseases, Ninth Revision (ICD-9) was used to classify and code causes of death.
We used underlying-cause-of-death data to extract information on, and examine trends in, deaths with hyperglycemic crises as the underlying cause of death (ICD-10 codes E10.0, E10.1, E11.0, E11.1, E12.0, E12.1, E13.0, E13.1, E14.0, and E14.1; ICD-9 code 250.1 and 250.2). Rates were calculated using estimates of the population with diabetes from National Health Interview Survey (NHIS) and resident population from census. Three-year averages were used to improve the precision of NHIS estimates of the population with diabetes. Rates were adjusted to the 2000 U.S. Standard Population using 4 age groups (0–44, 45–64, 65–74, and 75+).
Diabetes is underreported on death certificates. Among persons known to have diabetes, only about 40% have diabetes listed as a cause of death and only 10% have diabetes recorded as the underlying cause of death. However, the extent of underreporting for hyperglycemic crises is unknown.(1)
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- Saydah SH, Geiss LS, Tierney E, Benjamin SM, Engelgau M, Brancati F. Review of the performance of methods to identify diabetes cases among vital statistics, administrative, and survey data. Ann Epidemiol. 2004;14:507–516.