Ischemic heart disease as a multiple contributing cause of death among diabetes mellitus deaths, and their association with demographic and clinical factors

Introduction Comparability of mortality statistics between countries is a global public health challenge, in particular for cause-of-death assignment of diabetes mellitus (here after diabetes) in relation to cardiovascular disease including ischemic heart disease (IHD). Diabetes increases risk of IHD. As the underlying cause of death (UCD) becomes the cause of death, the multiple contributing causes of death (MCD) representing comorbidity are not used to classify mortality cause. The demographic and clinical factors for having IHD as an MCD among diabetes deaths were determined in this study to aid in policy making for preventing IHD deaths as comorbidity of diabetes. Methods Originally from the Centers for Disease Control and Prevention (CDC) in the US for years 2012–2015, and from Sistema de Informacao sobre Mortalidade in Brazil for years 2006–2009 and 2011–2013, causes of death data from death records were accessed through the World Health Organization. A logistic regression analysis was conducted to determine factors associated with having IHD as an MCD among deaths with diabetes as the UCD. Results Ischemic heart disease emerged as an MCD in 38% and 16% of 305,885 deaths in the US, and 367,717 deaths in Brazil that were deaths with diabetes as the UCD, respectively. Marital status, age, place of death, existence of autopsy, smoking, and high cholesterol were significantly associated to having IHD as an MCD in both countries. In the US, race was significantly associated to having IHD as an MCD. In Brazil, significant factors also included assistance of medical staff, education, having hypertension, and obesity ( P -values  Conclusion Multiple contributing causes of death could play an important role in better characterizing diabetes mortality estimates. Differences in the existence of IHD as comorbidity of diabetes deaths were recognized between the US and Brazil. Factors identified in this study could aid in detecting population subgroups with masked IHD among diabetes deaths. Representation of IHD comorbidity among diabetes deaths is needed for adequate public health efforts to be taken, contributing to lower mortality through a more target-specific intervention for non-communicable disease.