Certification of deaths from diabetes mellitus and obesity in England: trends into the twenty-first century

Most cases of Type 2 diabetes are attributable to excess weight and physical inactivity. We investigated trends in mortality based on doctors certification of diabetes and obesity. Analysis of a national data set of all certified causes of death, i.e. underlying cause and contributing causes (mentions), in England 19952010. Diabetes exhibited divergent trends for mortality based on underlying cause and mentions. Underlying cause rates were 107.2 per million population [95 confidence interval (CI): 105.7108.6] in 1995, but only 68.9/10(6) (CI: 67.969.9) in 2010. Mortality rates for mentions of diabetes were 403.1/10(6) (CI: 400.4405.8) in 1995, increasing to 478.4/10(6) (CI: 475.7481.0) in 2010. Underlying cause mortality for obesity was 3.7/10(6) (CI: 3.24.1) in 1995 and 7.5 (CI: 7.08.0) in 2010. The corresponding rates for mentions of obesity were 13.2/10(6) (CI: 12.613.9) and 34.5/10(6) (CI: 33.635.4), respectively. 24.0 of death certificates with a mention of obesity also had diabetes recorded on the same certificate. Multiple-cause mortality statistics provide a more accurate picture than underlying cause of the total mortality burden attributed on death certificates to diabetes and obesity. Rates for both increased substantially: analysis by underlying cause alone would have missed this for diabetes.