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.