Disparities in mortality among adults with and without diabetes by sex and race

Objective: The aim of this study was to examine whether the reduction in the mortality gap between individuals with and without diabetes varies by sex and race/ethnicity. Methods: We analyzed data in adults from the National Health and Nutrition Examination Survey (NHANES) 1999–2010 and their linked mortality data through 2015. Cox proportional hazards models were used to examine the risk of all-cause and cause-specific mortality among participants with diabetes as compared to those without diabetes by sex and race/ethnicity in 1999–2004 and 2005–2010. Results: The risk of all-cause mortality was significantly higher in women with diabetes compared to those without diabetes in both study periods (HR 1.6, 95% CI: 1.2, 2.2; HR 1.5, 95% CI: 1.1, 2.0). Among men, the risk of all-cause mortality was significantly higher in men with compared to men without diabetes in 1999–2004 but not in 2005–2010. There was no significant association between diabetes and CVD mortality among men in 2005–2010, while the association was significant among women in both study periods (HR 2.5, 95% CI: 1.6, 3.7; HR 2.8, 95% CI: 1.3, 5.9). The association between diabetes and all-cause mortality was similar across racial/ethnic groups in 1999–2004, but was significantly higher among non-Hispanic blacks and Mexican Americans in 2005–2010. Conclusions: Progress in reducing mortality among individuals with diabetes has been more significant among men and non-Hispanic whites. Sex and racial/ethnic disparities in mortality among individuals with diabetes still persist.