Causes of the change in the rates of mortality and severe complications of diabetes mellitus: 1992-2012.
Abstract
OBJECTIVE: To quantify the causes of the changes in the rates of mortality and select
severe complications of diabetes mellitus, type 2 (T2D) among the elderly between
1992 and 2012. RESEARCH DESIGN: A retrospective cohort study design based on Medicare
5% administrative claims data from 1992 to 2012 was used. Traditional fee-for-service
Medicare beneficiaries, age 65 and older, diagnosed with T2D and living in the United
States between 1992 and 2012 were included in the study. Blinder-Oaxaca decomposition
was used to quantify the potential causes of the change in the rates of death, congestive
heart failure and/or acute myocardial infarction, stroke, amputation of lower extremity
and end-stage renal disease between 1992 and 2012. RESULTS: The number of beneficiaries
in the analysis sample diagnosed with T2D increased from 152,191 in 1992 to 289,443
in 2012. Over the same time period, rates of mortality decreased by 1.2, congestive
heart failure and/or acute myocardial infarction by 2.6, stroke by 1.6, amputation
by 0.6 while rates of end-stage renal disease increased by 1.5 percentage points.
Improvements in the management of precursor conditions and utilization of recommended
healthcare services, not population composition, were the primary causes of the change.
CONCLUSIONS: With the exception of end-stage renal disease, outcomes among Medicare
beneficiaries diagnosed with T2D improved. Analysis suggests that persons diagnosed
with T2D are living longer with fewer severe complications. Much of the improvement
in outcomes likely reflects more regular contact with health professionals and better
management of care.
Type
Journal articleSubject
Activities of Daily LivingAged
Cause of Death
Cohort Studies
Diabetes Complications
Diabetes Mellitus, Type 2
Female
Humans
Incidence
Male
Medicare
Patient Acceptance of Health Care
Prevalence
Quality Assurance, Health Care
Retrospective Studies
United States
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https://hdl.handle.net/10161/14809Published Version (Please cite this version)
10.1097/MLR.0000000000000309Publication Info
Yashkin, Arseniy P; Picone, Gabriel; & Sloan, Frank (2015). Causes of the change in the rates of mortality and severe complications of diabetes
mellitus: 1992-2012. Med Care, 53(3). pp. 268-275. 10.1097/MLR.0000000000000309. Retrieved from https://hdl.handle.net/10161/14809.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Arseniy Yashkin
Research Scientist, Senior

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