Acta Médica Costarricense
version ISSN 0001-6012
LACLE-MURRAY, Adriana. Causes of Death In A Diabetic Population Of Costa Rica And The Quality Of Their Death Certificates. Acta méd. costarric [online]. 2012, vol.54, n.1, pp. 23-30. ISSN 0001-6012.
Background and aim: In Latin America, diabetes kills 45,000 people every year. It is likely that the actual figures are closer to 300,000 because of underreporting problems that exist in the cause of death. In Costa Rica, which has the lowest rate according to PAHO, this would increase by 56% if deaths from cardiovascular disease in people with diabetes were considered. This study aimed to recall the causes of death in a diabetic population of Costa Rica and the quality of their death certificates. Methods: We analyzed the cause of death of 101 people that died of a cohort of 572 diabetics, using the diagnoses of death certificates issued by doctors and the final diagnoses recoded by the National Institute of Statistics and Census of Costa Rica (INEC). The quality of the death certificates were analyzed by comparing these two sources of basic death causes and the percentage of under- diagnosis of diabetes in pathologies associated with diabetes or cardiovascular disease. Results: According to the INEC, causes of death were distributed: 24% for cardiovascular diseases, 23% for neoplasms and 24% for complications of diabetes. Diabetes was omitted in over 50% of the death certificates; it was not even mentioned as a secondary cause. The basic cause of death of the death certificates issued by doctors matched only in 66% with those of the INEC. Conclusion: The omission of diabetes as a cause of death or as a secondary cause in the death certificates leads to an underestimation of its importance in the countries’ vital statistics. Diabetes as a secondary cause is disregarded in vital statistics, contributing also to this underestimation. Analysis of secondary causes in vital statistics and better education of physicians to increase awareness of the importance of the inclusion of diabetes as a death cause in the death certificate would help to see better the impact of diabetes as a cause of death, especially associated with cardiovascular disease; this would visualize diabetes as a priority in public health in Costa Rica.
Keywords : Type 2 diabetes; death causes; death certificate.