Diabetes

Diabetes contributed to about 16,700 deaths in 2018 (10.5% of all deaths) according to the AIHW National Mortality Database. Diabetes was the underlying cause of death in around 4,700 deaths (28% of diabetes deaths). It was an associated cause of death in a further 12,000 deaths (72% of diabetes deaths).

Diabetes is far more likely to be listed as an associated cause of death rather than the underlying cause of death. This is because it is often not diabetes itself that leads directly to death, but one of its complications that will be listed as the underlying cause of death on the death certificate. When diabetes was examined as an associated cause of death, the conditions most commonly listed as the underlying cause of death were cancer, coronary heart disease and stroke.

Where diabetes was listed as the underlying and/or associated cause of death:

• 5% were due to type 1 diabetes (800 deaths)
• 56% were due to type 2 diabetes (9,500 deaths)
• 39% were due to other or unspecified diabetes (6,400 deaths).

Note: Examining only the underlying cause of death can underestimate the impact of diabetes on mortality (Harding et al. 2014). Further, deaths from diabetes are known to be under-reported in national mortality statistics, as diabetes is often omitted from death certificates as a cause of death (McEwen et al. 2011; Whittall 1990).

Trends

Diabetes death rates have remained relatively stable over the last 2 to 3 decades, both where diabetes is the underlying cause of death and where it is the underlying or associated cause of death. On average:

• diabetes was the underlying cause of death in around 3,300 deaths per year between 1985 and 2018, equating to death rates of 17–22 deaths per 100,000 population for males and 12–15 per 100,000 population for females.
• diabetes was the underlying or associated cause of death in around 13,300 deaths per year between 1997 and 2018, equating to death rates of 67–78 per 100,000 population for males and 41–49 per 100,000 population for females (Figure 1).

Figure 1: Trends in diabetes deaths (underlying or associated cause), by sex, 1997–2018

Age and sex

In 2018, diabetes death rates (as the underlying or associated cause):

• were 1.7 times as high for males as females (68 and 41 per 100,000 population, respectively). Age-specific rates for males were higher than females across all age groups.
• increased with age, with rates 2.8 times as high in those aged 85 and over (1,400 and 1,100 per 100,000 for males and females) compared with those 75–84 years (570 and 334 per 100,000 for males and females, respectively) (Figure 2).

Figure 2: Diabetes deaths (underlying or associated cause), by age group and sex, 2018

Variations between population groups

Diabetes death rates (as the underlying or associated cause) increased with remoteness and socioeconomic disadvantage:

The proportions in 2018 were:

• twice as high in Remote and very remote areas compared with Major cities (103 and 49 per 100,000 population, respectively). The difference was higher for females than males—2.7 times as high in Remote and very remote areas than in Major cities for females (104 and 38 per 100,000, respectively) and 1.6 times as high for males (101 and 64 per 100,000, respectively) (Figure 3).
• more than twice as high among those living in the lowest socioeconomic areas compared with those living in the highest socioeconomic areas (77 and 33 per 100,000, respectively). This gap was similar for males and females (Figure 3).

Figure 3: Diabetes deaths (underlying or associated cause), by remoteness and socioeconomic areas, 2018

Aboriginal and Torres Strait Islander people

Among Aboriginal and Torres Strait Islander people in 2018, there were 86 deaths per 100,000 population from diabetes (as the underlying or associated cause). The death rate was similar among Indigenous males and females (84 and 87 per 100,000, respectively). These data include people residing in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory only.

After adjusting for differences in the age structure of the populations, the rate was 4 times as high among Indigenous Australians as non-Indigenous Australians (210 and 52 per 100,000 population, respectively).

The gap in the death rates between Indigenous and non-Indigenous Australians was higher among females than males— 5 times as high for females (200 and 38 per 100,000, respectively) and 3 times as high for males (217 and 68 per 100,000, respectively).

Reference

Harding JL, Shaw JE, Peeters A, Guiver T, Davidson S, Magliano DJ 2014. Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997–2010. Diabetes Care 37.

McEwen L, Karter A, Curb J, Marrero D, Crosson J & Herman W 2011. Temporal trends in recording of diabetes on death certificates: results from Translating Research into Action for Diabetes (TRIAD). Diabetes Care 34: 1529–33.

Whittall DE, Glatthaar C, Knuiman MW & Welborn TA 1990. Deaths from diabetes are under-reported in national mortality statistics. Medical Journal of Australia 152: 598–600.