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Journal of Diabetes Investigation logoLink to Journal of Diabetes Investigation
. 2024 Oct 4;15(12):1821–1837. doi: 10.1111/jdi.14232

Causes of death in Japanese patients with diabetes based on the results of a survey of 68,555 cases during 2011–2020: Committee report on causes of death in diabetes mellitus, Japan Diabetes Society (English version)

Jiro Nakamura 1,[Link],✉, Narihito Yoshioka 2, Hideki Katagiri 3, Kohjiro Ueki 4, Toshimasa Yamauchi 5, Nobuya Inagaki 6, Yukio Tanizawa 7, Eiichi Araki 8, Takeo Nakayama 9, Hideki Kamiya 10
PMCID: PMC11615696  PMID: 39363847

ABSTRACT

The principal causes of death among 68,555 patients with diabetes and 164,621 patients without diabetes who died in 208 hospitals throughout Japan between 2011 and 2020 were determined based on a survey of hospital records. The most frequent cause of death in patients with diabetes was malignant neoplasms (38.9%) (lung 7.8%, pancreas 6.5%, liver 4.1%), followed, in order of descending frequency, by infectious diseases (17.0%) and then vascular diseases (10.9%) (cerebrovascular diseases 5.2%, ischemic heart diseases 3.5%, renal failure 2.3%). The proportion of deaths from malignant neoplasms and vascular diseases has trended upward and downward, respectively. Almost all deaths from ischemic heart diseases were due to myocardial infarction, and the proportion of deaths from heart diseases other than ischemic heart diseases was relatively high (9.0%), with most cases due to heart failure. Diabetic coma associated with hyperglycemia accounted for only 0.3% of deaths. The proportion of deaths from malignant neoplasms, infectious diseases, renal failure, ischemic heart diseases, and heart failure was significantly higher in patients with diabetes than in those without diabetes, and the proportion of deaths from cerebrovascular diseases was significantly lower in patients with diabetes. With regard to the relationship between the age and cause of death in patients with diabetes, malignant neoplasms were the most frequent cause of death in all age groups, and the incidence was around 50% for those in their 50s and 60s. The incidence of death due to infectious diseases was highest in patients older than their 70s. The incidence of death due to vascular diseases for patients in their 40s and 50s was higher than that due to infectious diseases. The highest incidence of death due to ischemic heart diseases was observed for patients in their 40s, and that due to renal failure and heart failure in patients older than their 70s. Compared with patients without diabetes, patients with diabetes demonstrated a higher incidence of death due to pancreatic cancer, infectious diseases, renal failure, ischemic heart diseases, and heart failure, and a lower incidence of death due to cerebrovascular diseases in all age groups. The average age at death of patients with diabetes was 74.4 years old in men and 77.4 years old in women, which were lower than the average lifespan of the Japanese general population in 2020 by 7.2 and 10.3 years, respectively. However, these differences were smaller than in previous surveys. The average age at death due to all causes, especially due to ischemic heart diseases, cerebrovascular diseases, heart failure, infectious diseases, and diabetic coma, was lower in patients with ‘poorer’ glycemic control than in those with ‘better’ glycemic control. In the total survey population, the average age at death of patients with diabetes was significantly higher than that of patients without diabetes. The average age at death due to malignant neoplasms and cerebrovascular diseases was higher in patients with diabetes than in those without diabetes and that due to renal failure, ischemic heart diseases, and infectious diseases was lower in patients with diabetes than in those without diabetes.

Keywords: Average age at death, Cause of death, Malignant neoplasms

INTRODUCTION

The goal of diabetes treatment is to ensure ‘lifespan and quality of life (QOL) comparable to those of people without diabetes’. To achieve this, stigma must be eliminated by preventing the onset and progression of diabetic complications as well as concomitant diseases such as malignant neoplasms. Periodic surveys on the causes of, and age at, death of patients with diabetes are significant in examining whether recent advances in the treatment and management of diabetes and advocacy activities contribute to the achievement of this goal.

Studies on the pathological conditions of diabetes among Japanese individuals, specifically ‘Study on Prevention of Onset and Suppression of Progression of Vascular Complications in Diabetes’ (Japan Diabetes Complications [JDC] Study) 2 and ‘Large‐scale Observational Study to Investigate the Current Status of Diabetic Complications and Their Prevention’ (Japan Diabetes Complication and Prevention prospective [JDCP] study) 3 , 4 , have been conducted. The ‘Japan Diabetes Comprehensive Database Project Based on an Advanced Electronic Medical Record System’ (J‐DREAMS) 5 is in progress. These studies are expected to reveal further knowledge on diabetes in Japan. However, given the limited sample size, data on the causes of, and age at, death of patients with diabetes are insufficient.

Four large‐scale questionnaire surveys on the causes of death of patients with diabetes had been previously conducted at 10 year intervals 6 , 7 , 8 , 9 . The present questionnaire survey on the causes of death in patients with diabetes was conducted similarly to the four previous surveys by the Committee of the Japan Diabetes Society on the Causes of Death in Diabetes Mellitus from 2011 to 2020. The current study analyzed the results of the present survey and compared them with the results of the previous surveys. Further, the present survey enrolled patients without diabetes in addition to patients with diabetes; these patients were also compared.

METHODS

The present survey was conducted for 10 years from January 1, 2011, to December 31, 2020. Its contents were divided into two parts. The survey on the causes of death of patients with diabetes included 11 survey items: (1) sex, (2) age at death, (3) year and month of death, (4) estimated age at onset, (5) treatment duration, (6) disease type classification, (7) cause of death, (8) major complications/concomitant diseases before death, (9) methods to diagnose the cause of death, (10) treatment, and (11) the most recent hemoglobin A1c (HbA1c: National Glycohemoglobin Standardization Program [NGSP]) level. Five survey items (items 1, 2, 6, 7, and 10) were mandatory to answer. The survey on the causes of death of patients without diabetes included the mandatory items of sex, age at death, and cause of death. Although the composition of the survey items was slightly changed compared with the four previous surveys, the changes did not interfere with the comparison of analysis results.

As in the previous surveys, the present survey was distributed to 1,154 institutions that met the criterion of having presented papers at an Annual Meeting of the Japan Diabetes Society during the previous 5 years (2016–2020). While the present survey targeted patients who died in an entire institution including the requested departments, the institutions were requested to enroll all patients with diabetes to the extent possible and as many patients without diabetes as the enrolled patients with diabetes. A total of 233,176 patients (68,555 with diabetes and 164,621 without diabetes) were enrolled from 208 institutions (response rate: 18.0%). The survey items – excluding the mandatory items and the most recent HbA1c level – were omitted from the analyses in this study given the limited input data. Focusing on malignant neoplasms, vascular diseases (diabetic nephropathy, ischemic heart diseases [myocardial infarction and angina pectoris], and cerebrovascular diseases), and infectious diseases, which were the principal causes of death, the causes of and age at death were analyzed in association with age, glycemic control, and therapeutic strategies; the present results were compared with those from previous surveys and patients without diabetes.

The results of the surveys were tabulated separately according to patients with and without diabetes, sex, age groups, and glycemic control status (HbA1c: <8.4% vs ≥8.4%). Measures of central tendency were expressed as mean ± standard deviation. A Chi‐squared test was performed to compare the nominal variables. The Student's t‐test compared continuous variables. The level of significance (two‐sided) was defined as P < 0.05. The statistical software used was IBM SPSS Statistics (Ver. 28.0.1.1 (15)). This study was approved by the ethics committee of the Japan Diabetes Society (JDS Ethics 02‐013‐(2)).

RESULTS

Causes of death

Table 1 shows the causes of death among patients with and without diabetes in the present survey.

Table 1.

Causes of death in Japanese diabetic and non‐diabetic subjects

Number Diabetic Non‐diabetic P‐values
Total (%) 68,555 (n) Total (%) 1,64,621 (n)
Causes of death
Vascular diseases 10.9 7,489 11.3 18,607 0.008
Chronic renal failure 2.3 1,569 1.1 1,758 <0.001
Diabetic nephropathy 1.6 1,091
Non‐diabetic nephropathy 0.7 478
Ischemic heart diseases 3.5 2,378 3.0 4,881 <0.001
Myocardial infarction 3.3 2,279 2.9 4,703 <0.001
Angina pectoris 0.1 99 0.1 178 0.02
Cerebrovascular diseases 5.2 3,542 7.3 11,968 <0.001
Hemorrhage 2.1 1,419 2.7 4,438 <0.001
Infarction 2.0 1,388 1.9 3,187 0.159
Subarachnoid hemorrhage 0.5 318 1.8 2,908 <0.001
Others 0.6 417 0.9 1,435 <0.001
Heart diseases (other than ischemic heart diseases) 9.0 6,176 7.9 13,081 <0.001
Arrhythmia 0.9 585 0.8 1,258 0.027
Heart failure 6.0 4,133 4.4 7,313 <0.001
Others 2.1 1,458 2.7 4,510 <0.001
Diabetic coma 0.3 190 0.0 0 <0.001
Hypoglycemic coma 0.1 90 0.0 46 <0.001
Malignant neoplasia 38.9 26,644 35.4 58,354 <0.001
Esophagus 1.0 662 1.4 2,271 <0.001
Stomach 2.9 2,008 3.9 6,473 <0.001
Lung 7.8 5,314 7.0 11,446 <0.001
Colon 2.9 2,020 3.4 5,575 <0.001
Liver 4.1 2,842 2.6 4,360 <0.001
Pancreas 6.5 4,434 2.7 4,376 <0.001
Uterus 0.5 363 0.9 1,449 <0.001
Breast 0.8 570 1.3 2,210 <0.001
Leukemia/Lymphoma 3.6 2,488 2.6 4,315 <0.001
Others 8.7 5,943 9.6 15,879 <0.001
Infectious diseases 17.0 11,628 14.5 23,917 <0.001
Tuberculosis 0.1 95 0.1 237 <0.001
Pneumonia 11.4 7,819 10.8 17,833 <0.001
Others 5.4 3,714 3.6 5,847 <0.001
Liver cirrhosis 2.1 1,452 1.5 2,412 <0.001
Type B 0.1 89 0.1 124 <0.001
Type C 0.6 425 0.4 695 <0.001
NAFLD 0.2 153 0.1 103 <0.001
Others 1.1 785 0.9 1,490 <0.001
Suicide 0.2 132 1.0 1,674 <0.001
Others 18.0 12,353 23.2 38,248 <0.001
Unknown 3.5 2,401 5.0 8,282 <0.001
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Causes of death in patients with diabetes

In 68,555 patients with diabetes, the most frequent cause of death was malignant neoplasms, accounting for 26,644 patients (38.9%), followed by infectious diseases and vascular diseases (chronic renal failure, ischemic heart diseases, and cerebrovascular diseases), accounting for 11,628 (17.0%) and 7,489 (10.9%) patients, respectively. Among malignant neoplasms, lung cancer was most common, accounting for 5,314 patients (7.8%), followed by pancreatic and liver cancers accounting for 4,434 (6.5%) and 2,842 (4.1%) patients, respectively. Among vascular diseases, cerebrovascular diseases and ischemic heart diseases were reported in 3,542 patients (5.2%) and 2,378 patients (3.5%), respectively, while chronic renal failure was reported in 1,569 patients (2.3%). Among ischemic heart diseases, angina pectoris accounted for 0.1%, and most deaths from ischemic heart diseases were due to myocardial infarction. Among cerebrovascular diseases, cerebral hemorrhage and cerebral infarction were almost equally common, accounting for 1,419 patients (2.1%) and 1,388 patients (2.0%), respectively. Further, heart diseases other than ischemic heart diseases were reported in 6,176 patients (9.0%); most, accounting for 4,133 patients (6.0%), died from heart failure. Among infectious diseases, pneumonia was reported in 7,819 patients (11.4%), accounting for 67.2% of all the deaths from infections. Diabetic and hypoglycemic coma were reported in 190 (0.3%) and 90 (0.1%) patients, respectively.

Comparison of the causes of death between patients with and without diabetes

In patients without diabetes, the most frequent cause of death was also malignant neoplasms, followed by infectious and then vascular diseases. Although the distribution of the causes of death was similar to that of patients with diabetes, statistically significant differences were observed in all causes of death between patients with and without diabetes. Among the principal causes of death, the proportions of deaths from malignant neoplasms and infectious diseases were significantly higher in patients with diabetes than in patients without diabetes, but the proportion of deaths from vascular diseases was significantly lower in the patients with diabetes. Among malignant neoplasms, the proportions of deaths from lung, pancreatic, and liver cancers were all significantly higher in patients with diabetes; pancreatic cancer showed the largest difference between patients with and without diabetes. Among vascular diseases, the proportions of deaths from chronic renal failure and ischemic heart diseases were significantly higher in patients with diabetes. In contrast, the proportion of deaths from cerebrovascular diseases was significantly lower; the proportions of deaths from cerebral and subarachnoid hemorrhages were lower, but no significant difference existed in the proportion of deaths from cerebral infarction. The proportion of deaths from heart failure as a heart disease separate from ischemic heart diseases was also significantly higher in patients with diabetes.

Sex differences in the causes of death

The sex differences in the causes of death were comparable between patients with and without diabetes (Table 2). In patients with diabetes, malignant neoplasms were the most frequent cause of death in both men and women. The proportions of deaths from malignant neoplasms – especially esophageal, gastric, lung, and liver cancers – were higher in men than in women, whereas the proportion of deaths from pancreatic cancer was higher in women. The overall proportion of deaths from vascular diseases was higher in women than in men. The same tendency was observed for both chronic renal failure and cerebrovascular diseases, whereas no difference was observed for ischemic heart diseases. In addition, the proportion of deaths from heart failure as a heart disease separate from ischemic heart diseases was higher in women, whereas that from infectious diseases (especially pneumonia) was higher in men.

Table 2.

Causes of death in Japanese diabetic and non‐diabetic subjects: sex difference

Sex and number Diabetic Non‐diabetic
Male (%) 45,653 (n) Female (%) 22,902 (n) Male (%) 94,021 (n) Female (%) 70,600 (n)
Causes of death
Vascular diseases 10.3 4,716 12.1 2,773 10.5 9,888 12.3 8,719
Chronic renal failure 2.1 949 2.7 620 1.1 1,002 1.1 756
Diabetic nephropathy 1.5 674 1.8 417
Non‐diabetic nephropathy 0.6 275 0.9 203
Ischemic heart diseases 3.5 1,585 3.5 793 3.1 2,958 2.7 1,923
Myocardial infarction 3.3 1,508 3.4 771 3.0 2,851 2.6 1,852
Angina pectoris 0.2 77 0.1 22 0.1 107 0.1 71
Cerebrovascular diseases 4.8 2,182 5.9 1,360 6.3 5,928 8.6 6,040
Hemorrhage 2.1 974 1.9 445 2.7 2,503 2.7 1,935
Infarction 1.7 793 2.6 595 1.6 1,480 2.4 1,707
Subarachnoid hemorrhage 0.3 157 0.7 161 1.2 1,105 2.6 1,803
Others 0.6 258 0.7 159 0.9 840 0.8 595
Heart diseases (other than ischemic heart diseases) 8.0 3,640 11.1 2,536 7.1 6,635 9.1 6,446
Arrhythmia 0.9 414 0.7 171 0.8 762 0.7 496
Heart failure 5.1 2,346 7.8 1,787 3.7 3,448 5.5 3,865
Others 1.9 880 2.5 578 2.6 2,425 3.0 2,085
Diabetic coma 0.2 94 0.4 96 0.0 0 0.0 0
Hypoglycemic coma 0.1 54 0.2 36 0.0 25 0.0 21
Malignant neoplasia 40.6 18,528 35.4 8,116 36.9 34,736 33.5 23,618
Esophagus 1.3 585 0.3 77 2.0 1,918 0.5 353
Stomach 3.3 1,509 2.2 499 4.6 4,304 3.1 2,169
Lung 9.6 4,362 4.2 952 8.7 8,214 4.6 3,232
Colon 3.0 1,380 2.8 640 3.3 3,102 3.5 2,473
Liver 4.6 2,109 3.2 733 3.2 2,994 1.9 1,366
Pancreas 6.1 2,784 7.2 1,650 2.4 2,291 3.0 2,085
Uterus 0.0 2 1.6 361 0.0 9 2.0 1,440
Breast 0.0 13 2.4 557 0.0 27 3.1 2,183
Leukemia/Lymphoma 3.7 1,709 3.4 779 2.7 2,558 2.5 1,757
Others 8.9 4,075 8.2 1,868 9.9 9,319 9.3 6,560
Infectious diseases 17.4 7,933 16.1 3,695 15.4 14,445 13.4 9,472
Tuberculosis 0.1 56 0.2 39 0.2 157 0.1 80
Pneumonia 12.3 5,604 9.7 2,215 11.9 11,231 9.4 6,602
Others 5.0 2,273 6.3 1,441 3.3 3,057 4.0 2,790
Liver cirrhosis 2.0 915 2.3 537 1.5 1,428 1.4 984
Type B 0.1 55 0.1 34 0.1 86 0.1 38
Type C 0.6 252 0.8 173 0.4 340 0.5 355
NAFLD 0.2 80 0.3 73 0.0 34 0.1 69
Others 1.2 528 1.1 257 1.0 968 0.7 522
Suicide 0.2 96 0.2 36 1.1 988 1.0 686
Others 17.6 8,039 18.8 4,314 22.6 21,252 24.1 16,996
Unknown 3.6 1,638 3.3 763 4.9 4,624 5.2 3,658
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Causes of death in patients with diabetes according to age group

Table 3 shows the causes of death in patients with diabetes according to age group. Few patients were in their 20s or younger (0.2% of all patients). The analysis of the causes of death according to age group was thus performed in patients aged 30 years or older.

Table 3.

Causes of death at specified ages in Japanese diabetic subjects

Age at death (years) 0–9 10–19 20–29 30–39 40–49 50–59 60–69 70– All age
Sex and number Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total
15 100.0% 13 100.0% 28 100.0% 27 100.0% 17 100.0% 44 100.0% 54 100.0% 30 100.0% 84 100.0% 165 100.0% 99 100.0% 264 100.0% 838 100.0% 405 100.0% 1,243 100.0% 2,639 100.0% 1,118 100.0% 3,757 100.0% 9,447 100.0% 3,471 100.0% 12,918 100.0% 32,468 100.0% 17,749 100.0% 50,217 100.0% 45,653 100.0% 22,902 100.0% 68,555 100.0%
Causes of death
Vascular diseases 1 6.7 3 23.1 4 14.3 1 3.7 0 0.0 1 2.3 4 7.4 1 3.3 5 6.0 20 12.1 11 11.1 31 11.7 145 17.3 44 10.9 189 15.2 319 12.1 101 9.0 420 11.2 933 9.9 321 9.2 1,254 9.7 3,293 10.1 2,292 12.9 5,585 11.1 4,716 10.3 2,773 12.1 7,489 10.9
Chronic renal failure 0 0.0 0 0.0 0 0.0 1 3.7 0 0.0 1 2.3 0 0.0 1 3.3 1 1.2 3 1.8 2 2.0 5 1.9 13 1.6 6 1.5 19 1.5 34 1.3 10 0.9 44 1.2 148 1.6 70 2.0 218 1.7 750 2.3 531 3.0 1,281 2.6 949 2.1 620 2.7 1,569 2.3
Diabetic nephropathy 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 1.8 1 1.0 4 1.5 8 1.0 4 1.0 12 1.0 28 1.1 9 0.8 37 1.0 118 1.2 59 1.7 177 1.4 517 1.6 344 1.9 861 1.7 674 1.5 417 1.8 1,091 1.6
Non‐diabetic nephropathy 0 0.0 0 0.0 0 0.0 1 3.7 0 0.0 1 2.3 0 0.0 1 3.3 1 1.2 0 0.0 1 1.0 1 0.4 5 0.6 2 0.5 7 0.6 6 0.2 1 0.1 7 0.2 30 0.3 11 0.3 41 0.3 233 0.7 187 1.1 420 0.8 275 0.6 203 0.9 478 0.7
Ischemic heart diseases 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 5 3.0 1 1.0 6 2.3 60 7.2 10 2.5 70 5.6 114 4.3 33 3.0 147 3.9 333 3.5 97 2.8 430 3.3 1,073 3.3 652 3.7 1,725 3.4 1,585 3.5 793 3.5 2,378 3.5
Myocardial infarction 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 5 3.0 1 1.0 6 2.3 60 7.2 10 2.5 70 5.6 111 4.2 32 2.9 143 3.8 318 3.4 96 2.8 414 3.2 1,014 3.1 632 3.6 1,646 3.3 1,508 3.3 771 3.4 2,279 3.3
Angina pectoris 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 0.1 1 0.1 4 0.1 15 0.2 1 0.0 16 0.1 59 0.2 20 0.1 79 0.2 77 0.2 22 0.1 99 0.1
Cerebrovascular diseases 1 6.7 3 23.1 4 14.3 0 0.0 0 0.0 0 0.0 4 7.4 0 0.0 4 4.8 12 7.3 8 8.1 20 7.6 72 8.6 28 6.9 100 8.0 171 6.5 58 5.2 229 6.1 452 4.8 154 4.4 606 4.7 1,470 4.5 1,109 6.2 2,579 5.1 2,182 4.8 1,360 5.9 3,542 5.2
Hemorrhage 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.9 0 0.0 1 1.2 8 4.8 6 6.1 14 5.3 44 5.3 14 3.5 58 4.7 117 4.4 32 2.9 149 4.0 246 2.6 62 1.8 308 2.4 558 1.7 331 1.9 889 1.8 974 2.1 445 1.9 1,419 2.1
Infarction 0 0.0 1 7.7 1 3.6 0 0.0 0 0.0 0 0.0 2 3.7 0 0.0 2 2.4 1 0.6 2 2.0 3 1.1 13 1.6 7 1.7 20 1.6 28 1.1 14 1.3 42 1.1 136 1.4 38 1.1 174 1.3 613 1.9 533 3.0 1,146 2.3 793 1.7 595 2.6 1,388 2.0
Subarachnoid hemorrhage 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.9 0 0.0 1 1.2 1 0.6 0 0.0 1 0.4 12 1.4 3 0.7 15 1.2 11 0.4 9 0.8 20 0.5 28 0.3 36 1.0 64 0.5 104 0.3 113 0.6 217 0.4 157 0.3 161 0.7 318 0.5
Others 1 6.7 2 15.4 3 10.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 0 0.0 2 0.8 3 0.4 4 1.0 7 0.6 15 0.6 3 0.3 18 0.5 42 0.4 18 0.5 60 0.5 195 0.6 132 0.7 327 0.7 258 0.6 159 0.7 417 0.6
Heart diseases (other than ischemic heart diseases) 5 33.3 2 15.4 7 25.0 1 3.7 1 5.9 2 4.5 3 5.6 3 10.0 6 7.1 17 10.3 9 9.1 26 9.8 68 8.1 22 5.4 90 7.2 181 6.9 69 6.2 250 6.7 558 5.9 203 5.8 761 5.9 2,807 8.6 2,227 12.5 5,034 10.0 3,640 8.0 2,536 11.1 6,176 9.0
Arrhythmia 1 6.7 1 7.7 2 7.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 1.2 0 0.0 2 0.8 18 2.1 2 0.5 20 1.6 28 1.1 10 0.9 38 1.0 106 1.1 29 0.8 135 1.0 259 0.8 129 0.7 388 0.8 414 0.9 171 0.7 585 0.9
Heart failure 0 0.0 1 7.7 1 3.6 0 0.0 1 5.9 1 2.3 1 1.9 1 3.3 2 2.4 6 3.6 5 5.1 11 4.2 24 2.9 8 2.0 32 2.6 88 3.3 36 3.2 124 3.3 302 3.2 119 3.4 421 3.3 1,925 5.9 1,616 9.1 3,541 7.1 2,346 5.1 1,787 7.8 4,133 6.0
Others 4 26.7 0 0.0 4 14.3 1 3.7 0 0.0 1 2.3 2 3.7 2 6.7 4 4.8 9 5.5 4 4.0 13 4.9 26 3.1 12 3.0 38 3.1 65 2.5 23 2.1 88 2.3 150 1.6 55 1.6 205 1.6 623 1.9 482 2.7 1,105 2.2 880 1.9 578 2.5 1,458 2.1
Diabetic coma 0 0.0 0 0.0 0 0.0 2 7.4 0 0.0 2 4.5 2 3.7 1 3.3 3 3.6 4 2.4 1 1.0 5 1.9 10 1.2 4 1.0 14 1.1 11 0.4 3 0.3 14 0.4 13 0.1 3 0.1 16 0.1 52 0.2 84 0.5 136 0.3 94 0.2 96 0.4 190 0.3
Hypoglycemic coma 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 0.2 1 0.2 3 0.2 4 0.2 3 0.3 7 0.2 7 0.1 4 0.1 11 0.1 41 0.1 28 0.2 69 0.1 54 0.1 36 0.2 90 0.1
Malignant neoplasia 4 26.7 2 15.4 6 21.4 17 63.0 7 41.2 24 54.5 21 38.9 12 40.0 33 39.3 37 22.4 32 32.3 69 26.1 276 32.9 182 44.9 458 36.8 1,228 46.5 576 51.5 1,804 48.0 4,904 51.9 1,776 51.2 6,680 51.7 12,041 37.1 5,529 31.2 17,570 35.0 18,528 40.6 8,116 35.4 26,644 38.9
Esophagus 0 0.0 0 0.0 0 0.0 1 3.7 0 0.0 1 2.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 0.2 2 0.5 4 0.3 30 1.1 8 0.7 38 1.0 182 1.9 16 0.5 198 1.5 370 1.1 51 0.3 421 0.8 585 1.3 77 0.3 662 1.0
Stomach 1 6.7 1 7.7 2 7.1 0 0.0 0 0.0 0 0.0 1 1.9 0 0.0 1 1.2 1 0.6 2 2.0 3 1.1 10 1.2 7 1.7 17 1.4 77 2.9 24 2.1 101 2.7 398 4.2 88 2.5 486 3.8 1,021 3.1 377 2.1 1,398 2.8 1,509 3.3 499 2.2 2,008 2.9
Lung 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 4 2.4 1 1.0 5 1.9 31 3.7 8 2.0 39 3.1 215 8.1 45 4.0 260 6.9 1,162 12.3 189 5.4 1,351 10.5 2,950 9.1 709 4.0 3,659 7.3 4,362 9.6 952 4.2 5,314 7.8
Colon 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 27 3.2 5 1.2 32 2.6 108 4.1 54 4.8 162 4.3 369 3.9 135 3.9 504 3.9 876 2.7 446 2.5 1,322 2.6 1,380 3.0 640 2.8 2,020 2.9
Liver 0 0.0 0 0.0 0 0.0 1 3.7 0 0.0 1 2.3 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 16 1.9 2 0.5 18 1.4 155 5.9 23 2.1 178 4.7 568 6.0 127 3.7 695 5.4 1,369 4.2 581 3.3 1,950 3.9 2,109 4.6 733 3.2 2,842 4.1
Pancreas 1 6.7 1 7.7 2 7.1 0 0.0 0 0.0 0 0.0 1 1.9 0 0.0 1 1.2 5 3.0 1 1.0 6 2.3 62 7.4 22 5.4 84 6.8 244 9.2 84 7.5 328 8.7 796 8.4 352 10.1 1,148 8.9 1,675 5.2 1,190 6.7 2,865 5.7 2,784 6.1 1,650 7.2 4,434 6.5
Uterus 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 7 7.1 7 2.7 0 0.0 34 8.4 34 2.7 0 0.0 54 4.8 54 1.4 1 0.0 113 3.3 114 0.9 1 0.0 153 0.9 154 0.3 2 0.0 361 1.6 363 0.5
Breast 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 2.0 2 0.8 0 0.0 36 8.9 36 2.9 1 0.0 95 8.5 96 2.6 1 0.0 174 5.0 175 1.4 11 0.0 250 1.4 261 0.5 13 0.0 557 2.4 570 0.8
Leukemia/Lymphoma 2 13.3 0 0.0 2 7.1 9 33.3 6 35.3 15 34.1 13 24.1 9 30.0 22 26.2 20 12.1 11 11.1 31 11.7 73 8.7 23 5.7 96 7.7 154 5.8 54 4.8 208 5.5 403 4.3 155 4.5 558 4.3 1,035 3.2 521 2.9 1,556 3.1 1,709 3.7 779 3.4 2,488 3.6
Others 0 0.0 0 0.0 0 0.0 6 22.2 1 5.9 7 15.9 6 11.1 3 10.0 9 10.7 7 4.2 8 8.1 15 5.7 55 6.6 43 10.6 98 7.9 244 9.2 135 12.1 379 10.1 1,024 10.8 427 12.3 1,451 11.2 2,733 8.4 1,251 7.0 3,984 7.9 4,075 8.9 1,868 8.2 5,943 8.7
Infectious diseases 2 13.3 1 7.7 3 10.7 1 3.7 2 11.8 3 6.8 5 9.3 1 3.3 6 7.1 28 17.0 12 12.1 40 15.2 88 10.5 36 8.9 124 10.0 242 9.2 120 10.7 362 9.6 1,018 10.8 357 10.3 1,375 10.6 6,549 20.2 3,166 17.8 9,715 19.3 7,933 17.4 3,695 16.1 11,628 17.0
Tuberculosis 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 0.1 0 0.0 2 0.1 1 0.0 3 0.1 4 0.0 53 0.2 36 0.2 89 0.2 56 0.1 39 0.2 95 0.1
Pneumonia 1 6.7 1 7.7 2 7.1 1 3.7 2 11.8 3 6.8 4 7.4 0 0.0 4 4.8 13 7.9 3 3.0 16 6.1 36 4.3 14 3.5 50 4.0 109 4.1 46 4.1 155 4.1 580 6.1 152 4.4 732 5.7 4,860 15.0 1,997 11.3 6,857 13.7 5,604 12.3 2,215 9.7 7,819 11.4
Others 1 6.7 0 0.0 1 3.6 0 0.0 0 0.0 0 0.0 1 1.9 1 3.3 2 2.4 15 9.1 9 9.1 24 9.1 52 6.2 22 5.4 74 6.0 131 5.0 74 6.6 205 5.5 437 4.6 202 5.8 639 4.9 1,636 5.0 1,133 6.4 2,769 5.5 2,273 5.0 1,441 6.3 3,714 5.4
Liver cirrhosis 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.9 1 3.3 2 2.4 8 4.8 3 3.0 11 4.2 47 5.6 19 4.7 66 5.3 126 4.8 44 3.9 170 4.5 298 3.2 117 3.4 415 3.2 435 1.3 353 2.0 788 1.6 915 2.0 537 2.3 1,452 2.1
Type B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 4 0.5 2 0.5 6 0.5 5 0.2 1 0.1 6 0.2 14 0.1 9 0.3 23 0.2 32 0.1 22 0.1 54 0.1 55 0.1 34 0.1 89 0.1
Type C 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.6 0 0.0 1 0.4 6 0.7 1 0.2 7 0.6 29 1.1 8 0.7 37 1.0 83 0.9 26 0.7 109 0.8 133 0.4 138 0.8 271 0.5 252 0.6 173 0.8 425 0.6
NAFLD 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 7 0.8 0 0.0 7 0.6 9 0.3 3 0.3 12 0.3 26 0.3 14 0.4 40 0.3 38 0.1 56 0.3 94 0.2 80 0.2 73 0.3 153 0.2
Others 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.9 1 3.3 2 2.4 7 4.2 3 3.0 10 3.8 30 3.6 16 4.0 46 3.7 83 3.1 32 2.9 115 3.1 175 1.9 68 2.0 243 1.9 232 0.7 137 0.8 369 0.7 528 1.2 257 1.1 785 1.1
Suicide 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.9 1 3.3 2 2.4 4 2.4 2 2.0 6 2.3 9 1.1 6 1.5 15 1.2 19 0.7 5 0.4 24 0.6 20 0.2 8 0.2 28 0.2 43 0.1 14 0.1 57 0.1 96 0.2 36 0.2 132 0.2
Others 3 20.0 5 38.5 8 28.6 5 18.5 6 35.3 11 25.0 14 25.9 9 30.0 23 27.4 40 24.2 25 25.3 65 24.6 143 17.1 77 19.0 220 17.7 399 15.1 156 14.0 555 14.8 1,374 14.5 583 16.8 1,957 15.1 6,061 18.7 3,453 19.5 9,514 18.9 8,039 17.6 4,314 18.8 12,353 18.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 1 5.9 1 2.3 3 5.6 1 3.3 4 4.8 7 4.2 4 4.0 11 4.2 50 6.0 14 3.5 64 5.1 110 4.2 41 3.7 151 4.0 322 3.4 99 2.9 421 3.3 1,146 3.5 603 3.4 1,749 3.5 1,638 3.6 763 3.3 2,401 3.5
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Malignant neoplasms were the most frequent cause of death in each age group, accounting for approximately half of the deaths in patients in their 50s and 60s. The proportion of deaths from pancreatic cancer was high in relatively younger patients in their 30s to 50s. The proportion of deaths from infectious diseases was highest at 19.3% in patients aged 70 years or older, while in patients in their 30s, it was 15.2%, which was also higher than in other age groups. The proportions of deaths from vascular diseases did not greatly differ among age groups; however, in patients in their 40s and 50s, the proportions were 15.2% and 11.2%, respectively, exceeding those of infectious diseases. Among vascular diseases, the proportions of deaths from cerebrovascular diseases were high in all age groups. In patients in their 30s, 40s, and 50s, the proportions reached 7.6%, 8.0%, and 6.1%, respectively, possibly attributable to the high proportion of deaths from cerebral hemorrhage. Conversely, the proportion of deaths from cerebral infarction was the highest in patients aged 70 years or older. The proportion of deaths from ischemic heart diseases in patients in their 40s was 5.6%, which was higher than the proportions in other age groups. The proportion of deaths from chronic renal failure was the highest at 2.6% in patients aged 70 years or older, followed by patients in their 30s at 1.9%. The proportion of deaths from heart failure as a heart disease separate from ischemic heart diseases was the highest at 7.1% in patients aged 70 years or older; it was as high as 4.2% even in patients in their 30s.

Comparison of the causes of death between patients with and without diabetes according to age group

In patients with diabetes, the proportions of deaths from malignant neoplasms according to age group were almost the same as those in patients without diabetes. However, compared with patients without diabetes (Table 4), those proportions were slightly lower in patients with diabetes in their 30s to 60s and slightly higher in patients aged 70 years or older with diabetes. Although the proportions of deaths from lung cancer in patients with diabetes were similar to those in patients without diabetes, those from pancreatic cancer in patients with diabetes were markedly higher in all age groups than those in patients without diabetes; similarly, those from liver cancer were higher in patients aged 50 years or older with diabetes. The proportions of deaths from infectious diseases were higher in patients with diabetes than in patients without diabetes in all age groups; meanwhile, proportions in patients in their 50s or younger with diabetes were 2 to 3 times higher than those in patients without diabetes. Although the overall proportions of deaths from vascular diseases in patients with diabetes according to age group were similar to those in patients without diabetes, the proportions of deaths from chronic renal failure in patients with diabetes were markedly higher in all age groups. The proportions of deaths from ischemic heart diseases in patients with diabetes were also higher in all age groups than those in patients without diabetes, with the largest difference noted among patients in their 40s. Meanwhile, the proportions of deaths from cerebrovascular diseases in patients with diabetes were lower in all age groups than those in patients without diabetes. However, the proportions of deaths from cerebral hemorrhage and cerebral infarction in patients in their 40s or younger with diabetes were higher than those in patients without diabetes, whereas those from subarachnoid hemorrhage in patients with diabetes were markedly lower in all age groups than those in patients without diabetes. The proportions of deaths from heart failure as a heart disease separate from ischemic heart diseases in patients with diabetes were higher in all age groups than those in patients without diabetes; the largest difference was between patients in their 30s.

Table 4.

Causes of death at specified ages in Japanese non‐diabetic subjects

Age at death (years) 0–9 10–19 20–29 30–39 40–49 50–59 60–69 70– All age
Sex and number Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total
801 100.0% 642 100.0% 1,443 100.0% 391 100.0% 224 100.0% 615 100.0% 661 100.0% 408 100.0% 1,069 100.0% 1,208 100.0% 934 100.0% 2,142 100.0% 3,164 100.0% 2,422 100.0% 5,586 100.0% 6,697 100.0% 4,442 100.0% 11,139 100.0% 16,788 100.0% 9,051 100.0% 25,839 100.0% 64,307 100.0% 52,475 100.0% 116,782 100.0% 94,017 100.0% 70,598 100.0% 164,615 100.0%
Causes of death
Vascular diseases 28 3.5 10 1.6 38 2.6 18 4.6 15 6.7 33 5.4 37 5.6 30 7.4 67 6.3 155 12.8 72 7.7 227 10.6 552 17.4 247 10.2 799 14.3 950 14.2 451 10.2 1,401 12.6 1,721 10.3 865 9.6 2,586 10.0 6,427 10.0 7,028 13.4 13,455 11.5 9,888 10.5 8,718 12.3 18,606 11.3
Chronic renal failure 1 0.1 0 0.0 1 0.1 0 0.0 1 0.4 1 0.2 2 0.3 0 0.0 2 0.2 5 0.4 1 0.1 6 0.3 8 0.3 4 0.2 12 0.2 20 0.3 16 0.4 36 0.3 100 0.6 50 0.6 150 0.6 866 1.3 684 1.3 1,550 1.3 1,002 1.1 756 1.1 1,758 1.1
Diabetic nephropathy
Non‐diabetic nephropathy
Ischemic heart diseases 2 0.2 1 0.2 3 0.2 1 0.3 0 0.0 1 0.2 1 0.2 1 0.2 2 0.2 29 2.4 4 0.4 33 1.5 125 4.0 24 1.0 149 2.7 266 4.0 36 0.8 302 2.7 554 3.3 129 1.4 683 2.6 1,980 3.1 1,728 3.3 3,708 3.2 2,958 3.1 1,923 2.7 4,881 3.0
Myocardial infarction 2 0.2 1 0.2 3 0.2 1 0.3 0 0.0 1 0.2 1 0.2 1 0.2 2 0.2 27 2.2 4 0.4 31 1.4 118 3.7 24 1.0 142 2.5 258 3.9 36 0.8 294 2.6 531 3.2 127 1.4 658 2.5 1,913 3.0 1,659 3.2 3,572 3.1 2,851 3.0 1,852 2.6 4,703 2.9
Angina pectoris 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 0.2 0 0.0 2 0.1 7 0.2 0 0.0 7 0.1 8 0.1 0 0.0 8 0.1 23 0.1 2 0.0 25 0.1 67 0.1 69 0.1 136 0.1 107 0.1 71 0.1 178 0.1
Cerebrovascular diseases 25 3.1 9 1.4 34 2.4 17 4.3 14 6.3 31 5.0 34 5.1 29 7.1 63 5.9 121 10.0 67 7.2 188 8.8 419 13.2 219 9.0 638 11.4 664 9.9 399 9.0 1,063 9.5 1,067 6.4 686 7.6 1,753 6.8 3,581 5.6 4,616 8.8 8,197 7.0 5,928 6.3 6,039 8.6 11,967 7.3
Hemorrhage 11 1.4 4 0.6 15 1.0 4 1.0 5 2.2 9 1.5 6 0.9 15 3.7 21 2.0 56 4.6 20 2.1 76 3.5 154 4.9 71 2.9 225 4.0 334 5.0 142 3.2 476 4.3 480 2.9 211 2.3 691 2.7 1,458 2.3 1,467 2.8 2,925 2.5 2,503 2.7 1,935 2.7 4,438 2.7
Infarction 1 0.1 0 0.0 1 0.1 0 0.0 2 0.9 2 0.3 2 0.3 3 0.7 5 0.5 10 0.8 4 0.4 14 0.7 28 0.9 9 0.4 37 0.7 64 1.0 21 0.5 85 0.8 211 1.3 105 1.2 316 1.2 1,164 1.8 1,562 3.0 2,726 2.3 1,480 1.6 1,706 2.4 3,186 1.9
Subarachnoid hemorrhage 0 0.0 0 0.0 0 0.0 5 1.3 1 0.4 6 1.0 6 0.9 5 1.2 11 1.0 38 3.1 30 3.2 68 3.2 184 5.8 119 4.9 303 5.4 203 3.0 189 4.3 392 3.5 239 1.4 304 3.4 543 2.1 430 0.7 1,155 2.2 1,585 1.4 1,105 1.2 1,803 2.6 2,908 1.8
Others 13 1.6 5 0.8 18 1.2 8 2.0 6 2.7 14 2.3 20 3.0 6 1.5 26 2.4 17 1.4 13 1.4 30 1.4 53 1.7 20 0.8 73 1.3 63 0.9 47 1.1 110 1.0 137 0.8 66 0.7 203 0.8 529 0.8 432 0.8 961 0.8 840 0.9 595 0.8 1,435 0.9
Heart diseases (other than ischemic heart diseases) 80 10.0 91 14.2 171 11.9 24 6.1 14 6.3 38 6.2 60 9.1 22 5.4 82 7.7 90 7.5 38 4.1 128 6.0 220 7.0 94 3.9 314 5.6 355 5.3 135 3.0 490 4.4 830 4.9 368 4.1 1,198 4.6 4,976 7.7 5,683 10.8 10,659 9.1 6,635 7.1 6,445 9.1 13,080 7.9
Arrhythmia 3 0.4 5 0.8 8 0.6 4 1.0 2 0.9 6 1.0 21 3.2 4 1.0 25 2.3 23 1.9 10 1.1 33 1.5 39 1.2 14 0.6 53 0.9 78 1.2 12 0.3 90 0.8 125 0.7 47 0.5 172 0.7 469 0.7 402 0.8 871 0.7 762 0.8 496 0.7 1,258 0.8
Heart failure 22 2.7 27 4.2 49 3.4 9 2.3 7 3.1 16 2.6 17 2.6 9 2.2 26 2.4 21 1.7 14 1.5 35 1.6 62 2.0 38 1.6 100 1.8 103 1.5 65 1.5 168 1.5 302 1.8 165 1.8 467 1.8 2,912 4.5 3,539 6.7 6,451 5.5 3,448 3.7 3,864 5.5 7,312 4.4
Others 55 6.9 59 9.2 114 7.9 11 2.8 5 2.2 16 2.6 22 3.3 9 2.2 31 2.9 46 3.8 14 1.5 60 2.8 119 3.8 42 1.7 161 2.9 174 2.6 58 1.3 232 2.1 403 2.4 156 1.7 559 2.2 1,595 2.5 1,742 3.3 3,337 2.9 2,425 2.6 2,085 3.0 4,510 2.7
Diabetic coma 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Hypoglycemic coma 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 0.2 2 0.1 1 0.0 0 0.0 1 0.0 3 0.0 1 0.0 4 0.0 1 0.0 1 0.0 2 0.0 20 0.0 17 0.0 37 0.0 25 0.0 21 0.0 46 0.0
Malignant neoplasia 61 7.6 53 8.3 114 7.9 90 23.0 49 21.9 139 22.6 113 17.1 100 24.5 213 19.9 266 22.0 380 40.7 646 30.2 975 30.8 1,262 52.1 2,237 40.0 2,932 43.8 2,612 58.8 5,544 49.8 8,612 51.3 5,088 56.2 13,700 53.0 21,687 33.7 14,074 26.8 35,761 30.6 34,736 36.9 23,618 33.5 58,354 35.4
Esophagus 1 0.1 0 0.0 1 0.1 0 0.0 0 0.0 0 0.0 1 0.2 0 0.0 1 0.1 4 0.3 2 0.2 6 0.3 35 1.1 18 0.7 53 0.9 230 3.4 46 1.0 276 2.5 671 4.0 99 1.1 770 3.0 976 1.5 188 0.4 1,164 1.0 1,918 2.0 353 0.5 2,271 1.4
Stomach 0 0.0 1 0.2 1 0.1 0 0.0 1 0.4 1 0.2 5 0.8 7 1.7 12 1.1 25 2.1 37 4.0 62 2.9 109 3.4 99 4.1 208 3.7 339 5.1 188 4.2 527 4.7 1,068 6.4 476 5.3 1,544 6.0 2,758 4.3 1,360 2.6 4,118 3.5 4,304 4.6 2,169 3.1 6,473 3.9
Lung 1 0.1 1 0.2 2 0.1 1 0.3 1 0.4 2 0.3 8 1.2 2 0.5 10 0.9 19 1.6 9 1.0 28 1.3 172 5.4 75 3.1 247 4.4 579 8.6 238 5.4 817 7.3 1,968 11.7 689 7.6 2,657 10.3 5,466 8.5 2,217 4.2 7,683 6.6 8,214 8.7 3,232 4.6 11,446 7.0
Colon 1 0.1 0 0.0 1 0.1 0 0.0 0 0.0 0 0.0 3 0.5 12 2.9 15 1.4 28 2.3 23 2.5 51 2.4 104 3.3 94 3.9 198 3.5 333 5.0 250 5.6 583 5.2 853 5.1 558 6.2 1,411 5.5 1,780 2.8 1,536 2.9 3,316 2.8 3,102 3.3 2,473 3.5 5,575 3.4
Liver 1 0.1 0 0.0 1 0.1 0 0.0 1 0.4 1 0.2 3 0.5 2 0.5 5 0.5 22 1.8 7 0.7 29 1.4 71 2.2 22 0.9 93 1.7 229 3.4 64 1.4 293 2.6 766 4.6 242 2.7 1,008 3.9 1,902 3.0 1,028 2.0 2,930 2.5 2,994 3.2 1,366 1.9 4,360 2.6
Pancreas 0 0.0 1 0.2 1 0.1 0 0.0 0 0.0 0 0.0 2 0.3 0 0.0 2 0.2 9 0.7 7 0.7 16 0.7 75 2.4 42 1.7 117 2.1 233 3.5 140 3.2 373 3.3 636 3.8 437 4.8 1,073 4.2 1,336 2.1 1,458 2.8 2,794 2.4 2,291 2.4 2,085 3.0 4,376 2.7
Uterus 0 0.0 0 0.0 0 0.0 0 0.0 1 0.4 1 0.2 0 0.0 6 1.5 6 0.6 0 0.0 75 8.0 75 3.5 1 0.0 194 8.0 195 3.5 2 0.0 302 6.8 304 2.7 2 0.0 351 3.9 353 1.4 4 0.0 511 1.0 515 0.4 9 0.0 1,440 2.0 1,449 0.9
Breast 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 3 0.7 3 0.3 0 0.0 75 8.0 75 3.5 0 0.0 294 12.1 294 5.3 5 0.1 512 11.5 517 4.6 6 0.0 645 7.1 651 2.5 16 0.0 654 1.2 670 0.6 27 0.0 2,183 3.1 2,210 1.3
Leukemia/Lymphoma 24 3.0 23 3.6 47 3.3 35 9.0 20 8.9 55 8.9 35 5.3 17 4.2 52 4.9 39 3.2 23 2.5 62 2.9 107 3.4 60 2.5 167 3.0 234 3.5 133 3.0 367 3.3 533 3.2 334 3.7 867 3.4 1,551 2.4 1,147 2.2 2,698 2.3 2,558 2.7 1,757 2.5 4,315 2.6
Others 33 4.1 27 4.2 60 4.2 54 13.8 25 11.2 79 12.8 56 8.5 51 12.5 107 10.0 120 9.9 122 13.1 242 11.3 301 9.5 364 15.0 665 11.9 748 11.2 739 16.6 1,487 13.3 2,109 12.6 1,257 13.9 3,366 13.0 5,898 9.2 3,975 7.6 9,873 8.5 9,319 9.9 6,560 9.3 15,879 9.6
Infectious diseases 70 8.7 39 6.1 109 7.6 21 5.4 12 5.4 33 5.4 32 4.8 17 4.2 49 4.6 55 4.6 44 4.7 99 4.6 111 3.5 84 3.5 195 3.5 344 5.1 178 4.0 522 4.7 1,302 7.8 544 6.0 1,846 7.1 12,509 19.5 8,554 16.3 21,063 18.0 14,444 15.4 9,472 13.4 23,916 14.5
Tuberculosis 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 2 0.2 0 0.0 2 0.1 1 0.0 0 0.0 1 0.0 6 0.1 0 0.0 6 0.1 17 0.1 2 0.0 19 0.1 131 0.2 78 0.1 209 0.2 157 0.2 80 0.1 237 0.1
Pneumonia 20 2.5 16 2.5 36 2.5 8 2.0 6 2.7 14 2.3 16 2.4 10 2.5 26 2.4 24 2.0 21 2.2 45 2.1 50 1.6 37 1.5 87 1.6 182 2.7 103 2.3 285 2.6 837 5.0 301 3.3 1,138 4.4 10,093 15.7 6,108 11.6 16,201 13.9 11,230 11.9 6,602 9.4 17,832 10.8
Others 50 6.2 23 3.6 73 5.1 13 3.3 6 2.7 19 3.1 16 2.4 7 1.7 23 2.2 29 2.4 23 2.5 52 2.4 60 1.9 47 1.9 107 1.9 156 2.3 75 1.7 231 2.1 448 2.7 241 2.7 689 2.7 2,285 3.6 2,368 4.5 4,653 4.0 3,057 3.3 2,790 4.0 5,847 3.6
Liver cirrhosis 7 0.9 3 0.5 10 0.7 1 0.3 2 0.9 3 0.5 3 0.5 4 1.0 7 0.7 23 1.9 21 2.2 44 2.1 131 4.1 49 2.0 180 3.2 282 4.2 117 2.6 399 3.6 374 2.2 186 2.1 560 2.2 607 0.9 602 1.1 1,209 1.0 1,428 1.5 984 1.4 2,412 1.5
Type B 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.1 0 0.0 1 0.0 11 0.3 1 0.0 12 0.2 20 0.3 2 0.0 22 0.2 27 0.2 11 0.1 38 0.1 27 0.0 24 0.0 51 0.0 86 0.1 38 0.1 124 0.1
Type C 1 0.1 0 0.0 1 0.1 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.1 0 0.0 1 0.0 11 0.3 5 0.2 16 0.3 40 0.6 24 0.5 64 0.6 75 0.4 53 0.6 128 0.5 212 0.3 273 0.5 485 0.4 340 0.4 355 0.5 695 0.4
NAFLD 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.1 1 0.0 0 0.0 1 0.0 1 0.0 4 0.1 4 0.1 8 0.1 8 0.0 13 0.1 21 0.1 22 0.0 50 0.1 72 0.1 34 0.0 69 0.1 103 0.1
Others 6 0.7 3 0.5 9 0.6 1 0.3 2 0.9 3 0.5 3 0.5 4 1.0 7 0.7 21 1.7 20 2.1 41 1.9 109 3.4) 42 1.7) 151 2.7) 218 3.3) 87 2.0) 305 2.7) 264 1.6) 109 1.2) 373 1.4) 346 0.5) 255 0.5) 601 0.5) 968 1.0) 522 0.7) 1,490 0.9)
Suicide 0 0.0 0 0.0 0 0.0 40 10.2 29 12.9 69 11.2 116 17.5 71 17.4 187 17.5 126 10.4 82 8.8 208 9.7 146 4.6 107 4.4 253 4.5 154 2.3 116 2.6 270 2.4 148 0.9 107 1.2 255 1.0 258 0.4 174 0.3 432 0.4 988 1.1 686 1.0 1,674 1.0
Others 486 60.7 390 60.7 876 60.7 167 42.7 89 39.7 256 41.6 255 38.6 138 33.8 393 36.8 375 31.0 242 25.9 617 28.8 784 24.8 479 19.8 1,263 22.6 1,325 19.8 672 15.1 1,997 17.9 3,038 18.1 1,574 17.4 4,612 17.8) 14,820 23.0) 13,412 25.6) 28,232 24.2) 21,250 22.6) 16,996 24.1) 38,246 23.2)
Unknown 69 8.6 56 8.7 125 8.7 30 7.7 14 6.3 44 7.2 45 6.8 26 6.4 71 6.6 118 9.8 53 5.7 171 8.0 244 7.7 100 4.1 344 6.2 352 5.3 160 3.6 512 4.6 762 4.5 318 3.5 1,080 4.2 3,003 4.7 2,931 5.6 5,934 5.1 4,623 4.9 3,658 5.2 8,281 5.0
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Average age at death

Table 5 shows the average age at death from all causes and the average age at death according to the cause of death in patients with and without diabetes. Among the total survey population, the average age at death in patients with diabetes was significantly higher in both men and women than that in patients without diabetes despite an average difference of approximately 1 year. The average age at death in patients with diabetes was higher by 1.2 years for malignant neoplasms and lower by 2.9 years for infectious diseases, whereas no significant difference was observed for vascular diseases. Among vascular diseases, the average age at death in patients with diabetes was significantly lower by 3.3 and 2.2 years for chronic renal failure and ischemic heart diseases, respectively. Age at death in patients with diabetes was higher by 1.0 years for cerebrovascular diseases but lower by 0.9 and 2.5 years for cerebral hemorrhage and cerebral infarction, respectively. For subarachnoid hemorrhage, the average age at death was higher by 4 years in patients with diabetes. Furthermore, the average age at death from liver cirrhosis was lower than that from other causes. It was lower than the average age at death from all causes by 5.6 and 7.0 years in patients with and without diabetes, respectively.

Table 5.

Average age at death in Japanese diabetic and non‐diabetic subjects

Average age at death Male Female Total
Diabetic Non‐diabetic P‐values Diabetic Non‐diabetic P‐values Diabetic Non‐diabetic P‐values
Causes of death
Total 74.4 ± 10.7 73.5 ± 15.3 <0.001 77.4 ± 11.8 76.6 ± 16.4 <0.001 75.4 ± 11.1 74.8 ± 15.9 <0.001
Total (except for suicide, others and unknown) 74.2 ± 10.6 74.2 ± 13.5 0.331 77.1 ± 11.6 76.5 ± 15.0 <0.001 75.2 ± 11.0 75.1 ± 14.2 0.476
Vascular diseases 74.1 ± 11.3 72.9 ± 14.8 <0.001 79.0 ± 11.3 79.2 ± 13.7 0.432 76.0 ± 11.6 75.9 ± 14.6 0.550
Chronic renal failure 76.7 ± 10.2 80.1 ± 10.6 <0.001 80.2 ± 10.1 83.0 ± 10.3 <0.001 78.1 ± 10.3 81.4 ± 10.6 <0.001
Diabetic nephropathy 76.1 ± 10.0 79.3 ± 9.9 77.3 ± 10.1
Non‐diabetic nephropathy 78.3 ± 10.3 82.0 ± 10.1 79.9 ± 10.4
Ischemic heart diseases 73.5 ± 11.2 74.0 ± 13.2 0.153 79.0 ± 10.7 82.9 ± 10.7 <0.001 75.3 ± 11.3 77.5 ± 13.0 <0.001
Myocardial infarction 73.4 ± 11.3 74.1 ± 13.1 0.065 78.9 ± 10.8 82.9 ± 10.8 <0.001 75.2 ± 11.4 77.5 ± 13.0 <0.001
Angina pectoris 75.9 ± 8.9 72.7 ± 14.1 0.059 80.7 ± 9.8 84.2 ± 7.2 0.076 77.0 ± 9.3 77.3 ± 13.1 0.835
Cerebrovascular diseases 73.5 ± 11.8 71.1 ± 15.7 <0.001 78.5 ± 12.1 77.6 ± 14.6 0.011 75.4 ± 12.1 74.4 ± 15.5 <0.001
Hemorrhage 70.8 ± 12.4 70.5 ± 15.1 0.501 75.4 ± 12.6 76.7 ± 14.8 0.056 72.3 ± 12.6 73.2 ± 15.2 0.010
Infarction 76.3 ± 10.0 77.6 ± 11.7 0.006 81.8 ± 10.8 84.1 ± 10.4 <0.001 78.6 ± 10.7 81.1 ± 11.5 <0.001
Subarachnoid hemorrhage 71.8 ± 12.3 64.1 ± 15.6 <0.001 75.3 ± 10.8 73.0 ± 14.6 0.016 73.6 ± 11.7 69.6 ± 15.6 <0.001
Others 76.1 ± 11.7 70.5 ± 18.9 <0.001 78.5 ± 13.3 75.4 ± 17.7 0.016 77.0 ± 12.4 72.5 ± 18.6 <0.001
Heart diseases (other than ischemic heart diseases) 76.5 ± 11.4 75.6 ± 16.5 <0.001 81.7 ± 10.9 82.3 ± 15.6 0.017 78.6 ± 11.5 78.9 ± 16.4 0.074
Arrhythmia 72.5 ± 11.8 70.4 ± 17.0 0.011 76.8 ± 11.8 78.8 ± 17.0 0.082 73.8 ± 11.9 73.7 ± 17.5 0.461
Heart failure 78.2 ± 10.2 79.7 ± 13.9 <0.001 83.0 ± 10.1 84.7 ± 13.2 <0.001 80.2 ± 10.4 82.3 ± 13.8 <0.001
Others 73.8 ± 13.0 71.5 ± 18.2 <0.001 79.2 ± 12.1 78.6 ± 18.3 0.340 75.9 ± 12.9 74.8 ± 18.6 0.004
Diabetic coma 67.3 ± 19.1 80.7 ± 14.2 74.1 ± 18.1
Hypoglycemic coma 75.1 ± 11.4 75.6 ± 11.9 0.861 78.8 ± 12.8 81.0 ± 17.1 0.590 76.6 ± 12.0 78.1 ± 14.6 0.534
Malignant neoplasia 72.6 ± 9.7 72.0 ± 12.2 <0.001 73.8 ± 11.2 71.3 ± 14.3 <0.001 72.9 ± 10.2 71.7 ± 13.1 <0.001
Esophagus 72.3 ± 8.4 69.7 ± 9.9 <0.001 72.7 ± 10.7 70.2 ± 12.2 0.092 72.3 ± 8.7 69.8 ± 10.3 <0.001
Stomach 73.5 ± 9.1 72.7 ± 11.0 0.007 75.9 ± 10.9 73.0 ± 13.8 <0.001 74.1 ± 9.7 72.8 ± 12.0 <0.001
Lung 73.3 ± 8.6 73.3 ± 10.5 0.665 75.6 ± 9.6 74.5 ± 11.7 0.002 73.7 ± 8.8 73.6 ± 10.9 0.189
Colon 72.2 ± 9.6 71.1 ± 11.7 0.002 75.0 ± 10.6 73.0 ± 13.3 <0.001 73.1 ± 10.0 72.0 ± 12.5 <0.001
Liver 72.8 ± 9.2 72.6 ± 10.9 0.624 76.2 ± 8.6 75.8 ± 11.0 0.309 73.7 ± 9.2 73.6 ± 11.1 0.429
Pancreas 71.2 ± 9.6 71.3 ± 11.1 0.813 74.6 ± 9.9 74.7 ± 11.3 0.774 72.5 ± 9.9 72.9 ± 11.3 0.026
Uterus 72.5 ± 7.8 66.6 ± 13.3 0.568 66.5 ± 12.6 63.2 ± 14.6 <0.001 66.5 ± 12.6 63.2 ± 14.5 <0.001
Breast 75.9 ± 10.2 70.5 ± 9.6 0.109 68.1 ± 11.6 62.8 ± 13.3 <0.001 68.2 ± 11.7 62.9 ± 13.3 <0.001
Leukemia/Lymphoma 70.4 ± 12.8 69.9 ± 16.2 0.227 72.4 ± 13.6 71.7 ± 16.5 0.243 71.0 ± 13.1 70.6 ± 16.4 0.118
Others 73.3 ± 10.0 71.9 ± 13.7 <0.001 73.8 ± 11.4 71.1 ± 15.4 <0.001 73.5 ± 10.5 71.6 ± 14.4 <0.001
Infectious diseases 77.9 ± 10.1 80.3 ± 12.1 <0.001 80.4 ± 10.9 83.4 ± 12.4 <0.001 78.7 ± 10.4 81.6 ± 12.3 <0.001
Tuberculosis 81.3 ± 8.0 80.9 ± 12.0 0.783 80.9 ± 7.8 86.7 ± 7.1 <0.001 81.1 ± 7.9 82.8 ± 10.9 0.056
Pneumonia 79.2 ± 9.3 81.7 ± 10.3 <0.001 82.1 ± 10.1 84.6 ± 11.2 <0.001 80.0 ± 9.6 82.8 ± 10.7 <0.001
Others 74.6 ± 11.1 75.2 ± 16.0 0.090 77.8 ± 11.6 80.5 ± 14.4 <0.001 75.8 ± 11.4 77.7 ± 15.8 <0.001
Liver cirrhosis 68.1 ± 10.9 65.8 ± 13.4 <0.001 72.7 ± 11.1 70.6 ± 14.2 <0.001 69.8 ± 11.2 67.8 ± 13.9 <0.001
Type B 69.6 ± 10.7 63.7 ± 12.5 0.005 71.5 ± 9.4 72.6 ± 10.5 0.650 70.3 ± 10.2 66.5 ± 12.6 0.007
Type C 69.6 ± 9.8 71.6 ± 11.4 0.023 75.9 ± 8.5 75.5 ± 9.9 0.654 72.2 ± 9.8 73.6 ± 10.8 0.026
NAFLD 69.2 ± 12.6 72.4 ± 8.4 0.111 76.6 ± 8.8 75.5 ± 11.8 0.527 72.7 ± 11.5 74.5 ± 10.9 <0.001
Others 67.1 ± 11.0 63.8 ± 13.6 <0.001 69.5 ± 12.3 66.5 ± 15.8 0.003 67.9 ± 11.5 64.7 ± 14.5 <0.001
Suicide 64.9 ± 13.6 53.2 ± 20.4 <0.001 63.1 ± 17.0 53.9 ± 20.3 0.010 64.4 ± 14.5 53.5 ± 20.4 <0.001
Others 75.4 ± 10.9 72.6 ± 18.6 <0.001 78.3 ± 12.3 77.3 ± 18.9 <0.001 76.5 ± 11.5 74.7 ± 18.9 <0.001
Unknown 74.1 ± 11.4 71.8 ± 17.9 <0.001 77.9 ± 11.9 78.4 ± 17.5 0.315 75.3 ± 11.7 74.7 ± 18.0 0.036
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Glycemic control status and average age at death

Table 6 shows the relationship between glycemic control (divided into patients with an HbA1c level [NGSP] <8.4% and those with a level ≥8.4%) and the age at death among 37,299 patients with available HbA1c levels. The average age at death from all causes was lower by 1.6 years in patients with poorer (i.e., HbA1c ≥8.4%) than better (i.e., HbA1c <8.4%) glycemic control. For all vascular diseases, no difference existed in the average age at death between patients with poorer and better glycemic control. However, the average age at death from ischemic heart diseases, especially myocardial infarction, and cerebrovascular diseases, especially cerebral hemorrhage, was lower by 4.7 and 4.2 years, respectively, in patients with poorer glycemic control. In addition, the average age at death in patients with poorer glycemic control was lower by 3.7 years for heart diseases other than ischemic heart diseases, 1.6 years for infectious diseases, and 8.2 years for diabetic coma. The average age at death from malignant neoplasms did not significantly differ between patients with poorer and better glycemic control.

Table 6.

Causes of death, average age at death and glycemic control in Japanese diabetic subjects

Glycemic control Male Female Total
Better (n = 21,957) Poorer (n = 2,908) P‐values Better (n = 10,890) Poorer (n = 1,544) P‐values Better (n = 32,847) Poorer (n = 4,452) P‐values
Causes of death
Vascular diseases 72.9 ± 14.8 74.2 ± 11.3 <0.001 79.2 ± 13.7 79.0 ± 11.3 0.432 75.9 ± 14.6 76.0 ± 11.6 0.550
Chronic renal failure 76.2 ± 10.2 75.6 ± 10.4 0.746 81.1 ± 9.7 78.9 ± 7.8 0.309 78.1 ± 10.3 76.7 ± 9.7 0.296
Diabetic nephropathy 75.9 ± 10.1 74.3 ± 11.1 0.401 80.1 ± 9.7 76.5 ± 7.7 0.167 77.4 ± 10.1 75.0 ± 10.1 0.114
Non‐diabetic nephropathy 76.9 ± 10.5 79.3 ± 7.5 0.448 83.0 ± 9.3 84.7 ± 4.7 0.670 79.5 ± 10.5 81.1 ± 7.1 0.527
Ischemic heart diseases 74.0 ± 10.5 67.6 ± 12.9 <0.001 78.4 ± 10.4 76.8 ± 13.1 0.322 75.5 ± 10.7 70.9 ± 13.7 <0.001
Myocardial infarction 73.8 ± 10.6 67.7 ± 12.9 <0.001 78.4 ± 10.5 76.5 ± 13.2 0.242 75.4 ± 10.8 70.7 ± 13.7 <0.001
Angina pectoris 77.1 ± 8.7 63.0 76.5 ± 8.1 86.0 ± 4.2 0.132 76.9 ± 8.4 78.3 ± 13.6 0.785
Cerebrovascular diseases 73.6 ± 11.3 71.2 ± 13.5 0.034 79.1 ± 11.4 78.1 ± 14.3 0.447 75.7 ± 11.6 73.8 ± 14.2 0.039
Hemorrhage 71.0 ± 12.0 66.3 ± 14.3 0.011 76.1 ± 12.7 74.6 ± 12.5 0.577 72.6 ± 12.4 68.4 ± 14.4 0.008
Infarction 76.2 ± 9.7 74.9 ± 11.9 0.400 82.4 ± 9.9 79.3 ± 13.5 0.122 78.9 ± 10.2 76.8 ± 12.7 0.095
Subarachnoid hemorrhage 74.1 ± 9.8 70.3 ± 14.6 0.407 75.4 ± 10.1 81.8 ± 8.8 0.222 74.8 ± 10.0 73.2 ± 14.1 0.663
Others 75.7 ± 11.0 75.3 ± 10.9 0.895 79.1 ± 10.5 77.3 ± 20.8 0.631 76.9 ± 10.9 76.4 ± 16.7 0.823
Heart diseases (other than ischemic heart diseases) 76.7 ± 11.0 71.9 ± 13.7 <0.001 81.4 ± 10.5 78.2 ± 15.3 0.007 78.5 ± 11.0 74.8 ± 14.8 <0.001
Arrhythmia 72.1 ± 12.4 66.2 ± 11.7 0.053 77.4 ± 9.8 75.8 ± 14.4 0.693 73.6 ± 12.0 70.2 ± 13.6 0.140
Heart failure 78.4 ± 9.8 74.3 ± 13.5 <0.001 82.6 ± 10.1 80.2 ± 14.4 0.085 80.1 ± 10.2 77.1 ± 14.2 0.002
Others 74.2 ± 12.2 68.2 ± 13.6 0.001 79.1 ± 11.1 73.4 ± 17.0 0.035 76.1 ± 12.1 70.5 ± 15.3 <0.001
Diabetic coma 76.4 ± 16.5 62.4 ± 191 0.012 83.1 ± 15.4 81.0 ± 16.4 0.670 79.6 ± 16.1 71.4 ± 20.1 0.031
Hypoglycemic coma 77.7 ± 9.6 68.7 ± 14.5 0.140 78.6 ± 14.2 78.0 ± 19.8 0.956 78.0 ± 11.3 72.4 ± 15.1 0.306
Malignant neoplasia 72.5 ± 9.6 71.7 ± 10.4 0.015 73.6 ± 11.2 73.7 ± 11.0 0.869 72.9 ± 10.1 72.3 ± 10.6 0.055
Esophagus 71.9 ± 9.0 71.2 ± 8.8 0.651 74.9 ± 10.5 76.3 ± 10.5 0.815 72.2 ± 9.2 71.7 ± 9.0 0.725
Stomach 73.1 ± 8.8 74.3 ± 13.1 0.355 76.4 ± 11.1 69.1 ± 11.3 0.003 73.9 ± 9.5 72.7 ± 12.7 0.296
Lung 73.4 ± 8.4 72.3 ± 9.0 0.027 75.2 ± 9.9 73.0 ± 10.3 0.117 73.7 ± 8.7 72.4 ± 9.2 0.006
Colon 72.1 ± 9.2 71.0 ± 10.7 0.386 74.2 ± 10.6 72.9 ± 11.2 0.513 72.8 ± 9.7 71.5 ± 10.8 0.198
Liver 72.8 ± 9.1 71.1 ± 9.7 0.187 76.4 ± 8.7 77.4 ± 10.6 0.580 73.7 ± 9.2 73.2 ± 10.4 0.664
Pancreas 70.8 ± 9.8 71.0 ± 10.0 0.789 73.9 ± 9.8 75.2 ± 10.2 0.133 72.0 ± 9.9 72.7 ± 10.3 0.223
Uterus 78.0 66.2 ± 12.9 66.6 ± 14.0 0.883 66.2 ± 12.9 67.1 ± 13.9 0.744
Breast 78.4 ± 4.2 67.5 ± 11.6 66.8 ± 8.0 0.741 67.7 ± 11.6 66.8 ± 8.0 0.572
Leukemia/Lymphoma 71.0 ± 12.2 69.7 ± 11.8 0.369 73.2 ± 13.2 74.1 ± 12.2 0.702 71.7 ± 12.6 71.0 ± 12.0 0.598
Others 73.3 ± 10.1 72.6 ± 11.8 0.439 73.9 ± 11.3 75.6 ± 11.1 0.199 73.5 ± 10.5 73.4 ± 11.7 0.942
Infectious diseases 78.0 ± 9.6 75.5 ± 11.9 <0.001 80.6 ± 10.4 80.6 ± 11.2 0.098 78.9 ± 9.9 77.3 ± 11.9 <0.001
Tuberculosis 80.4 ± 8.9 85.0 80.7 ± 6.7 91.0 ± 7.0 0.022 80.5 ± 8.1 89.5 ± 6.5 0.034
Pneumonia 79.0 ± 9.0 77.7 ± 10.3 0.027 82.0 ± 9.8 81.7 ± 10.5 0.695 79.9 ± 9.3 78.9 ± 10.5 0.053
Others 75.5 ± 10.7 71.1 ± 13.5 <0.001 78.3 ± 11.0 79.0 ± 11.9 0.519 76.6 ± 10.9 74.4 ± 13.4 0.009
Liver cirrhosis 68.6 ± 11.0 66.4 ± 13.1 0.262 73.1 ± 10.9 72.8 ± 11.0 0.916 70.2 ± 11.2 69.1 ± 12.6 0.435
Type B 72.1 ± 10.6 72.0 ± 6.3 0.981 71.6 ± 9.1 73.5 ± 6.4 0.784 71.9 ± 9.7 72.5 ± 5.7 0.880
Type C 70.2 ± 9.2 72.7 ± 13.7 0.391 77.1 ± 8.0 72.9 ± 10.7 0.158 72.7 ± 9.4 72.8 ± 12.2 0.993
NAFLD 70.3 ± 13.9 63.3 ± 13.0 0.404 76.1 ± 8.8 77.8 ± 8.9 0.681 73.5 ± 11.7 72.4 ± 12.2 0.789
Others 67.2 ± 11.3 61.8 ± 12.5 0.046 69.2 ± 12.2 70.4 ± 12.9 0.771 67.9 ± 11.6 64.9 ± 13.1 0.191
Suicide 64.3 ± 13.0 56.6 ± 17.6 0.119 67.5 ± 13.1 65.2 ± 13.0 56.6 ± 17.6 0.065
Others 75.6 ± 10.7 73.6 ± 12.0 <0.001 78.5 ± 12.0 78.3 ± 12.3 0.775 76.6 ± 11.2 75.3 ± 12.3 0.006
Unknown 74.7 ± 10.7 70.7 ± 13.5 <0.001 77.8 ± 12.1 78.1 ± 10.8 0.851 75.7 ± 11.2 73.3 ± 13.1 0.012
All the causes 74.5 ± 10.4 72.2 ± 12.1 <0.001 77.3 ± 11.5 77.1 ± 12.5 0.423 75.5 ± 10.9 73.9 ± 12.5 <0.001
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Details of diabetes treatment and death from vascular diseases

Table 7 illustrates that patients who died from vascular diseases had been treated with diet therapy alone (21.7%), oral hypoglycemic therapy (51.8%), or insulin therapy (35.2%). The most administered treatment was the oral hypoglycemic agent, which had also been administered to 51.9% of patients who died from diabetic nephropathy. Insulin therapy was administered to 40.2% of patients who died from diabetic nephropathy, which was higher than 32.4% and 29.7% of patients who died from ischemic heart diseases and cerebrovascular diseases, respectively. The proportion of patients who had received diet therapy alone was slightly lower at 18.8% in patients who died from diabetic nephropathy, whereas 19.4% and 23.5% of patients who died from ischemic heart diseases and cerebrovascular diseases, respectively, received diet therapy alone. The sum of the proportions exceeds 100% because multiple options were marked for patients treated with insulin in combination with oral hypoglycemic agents or glucagon‐like peptide‐1 receptor agonists.

Table 7.

Treatment of diabetes and vascular diseases as cause of death in Japanese diabetic subjects

Causes of death Diabetic nephropathy Ischemic heart diseases Cerebrovascular diseases Others All
Myocardial infarction Angina pectoris Total Hemorrhage Infarction Subarachnoid hemorrhage Others Total
Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total
Treatment
Diet alone 131 74 205 (18.79%) 278 168 446 (19.57%) 12 3 15 (15.15%) 290 171 461 (19.39%) 208 113 321 (22.62%) 160 168 328 (23.63%) 41 45 86 (27.04%) 55 41 96 (23.02%) 464 367 831 (23.46%) 8,585 4,785 13,370 (21.72%) 9,470 5,397 14,867 (21.69%)
Oral hypoglycemic agents 359 207 566 (51.88%) 849 399 1,248 (54.76%) 39 13 52 (52.53%) 888 412 1,300 (54.67%) 489 206 695 (48.98%) 445 318 763 (54.97%) 70 73 143 (44.97%) 129 75 204 (48.92%) 1,133 672 1,805 (50.96%) 21,787 10,051 31,838 (51.73%) 24,167 11,342 35,509 (51.80%)
Insulin 260 179 439 (40.24%) 482 248 730 (32.03%) 29 12 41 (41.41%) 511 260 771 (32.42%) 314 132 446 (31.43%) 233 152 385 (27.74%) 39 44 83 (26.10%) 91 48 139 (33.33%) 677 376 1,053 (29.73%) 14,710 7,154 21,864 (35.53%) 16,158 7,969 24,127 (35.19%)
GLP‐1 receptor agonist 18 8 26 (2.38%) 23 7 30 (1.32%) 0 0 0 (0.00%) 23 7 30 (1.26%) 8 4 12 (0.85%) 10 8 18 (1.30%) 2 0 2 (0.63%) 3 2 5 (1.20%) 23 14 37 (1.04%) 469 242 711 (1.16%) 533 271 804 (1.17%)
Others 34 22 56 (5.13%) 117 66 183 (8.03%) 7 1 8 (8.08%) 124 67 191 (8.03%) 77 38 115 (8.10%) 64 33 97 (6.99%) 17 18 35 (11.01%) 16 14 30 (7.19%) 174 103 277 (7.82%) 2,415 1,271 3,686 (5.99%) 2,747 1,463 4,210 (6.14%)
Total 674 417 1,091 (118.42%) 1,508 771 2,279 (115.71%) 77 22 99 (117.17%) 1,585 793 2,378 (115.77%) 974 445 1,419 (111.98%) 793 595 1,388 (114.63%) 157 161 318 (109.75%) 258 159 417 (113.67%) 2,182 1,360 3,542 (113.02%) 41,212 20,332 61,544 (116.13%) 45,653 22,902 68,555 (115.99%)
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DISCUSSION

The present survey was composed of questions, including mandatory items, almost identical to those used in four prior surveys on diabetes. In the present survey, paper‐based questionnaire forms were not used, and patients were enrolled only through the web‐based questionnaire. Although the number of participating institutions in the present survey (208 institutions) was smaller than that in the previous survey (241 institutions), more than 68,000 patients with diabetes (an approximately 1.5‐fold increase) were enrolled. Further, more than 160,000 patients without diabetes were enrolled. This might be attributed to the fact that almost all medical institutions included in the present survey had introduced an electronic medical record system, which facilitated the extraction and enrollment of patients. Although many patients were enrolled, few data on the non‐mandatory items were provided as in the previous surveys. Other than the causes of and age at death, pathological conditions of patients with diabetes were not analyzed. Future surveys should consider implementing measures to request data on non‐mandatory items for certain patients.

The National Health and Nutrition Survey in 2019 10 showed that the number of patients with diabetes was 1.8 times greater in men than in women. The Outline of the Report of Vital Statistics in 2020 (Approximate Number) 11 showed that the number of deaths in the Japanese general population was 1.1 times greater in men than in women. However, in the present survey, the number of patients with diabetes was 2 times greater in men (45,653 patients) than in women (22,902 patients), and the number of all enrolled men (139,674 patients) was 1.5 times greater than that of all enrolled women (93,502 patients). Despite the biased male‐to‐female ratio in the enrolled patients, the results of the present survey generally reflect the causes of and age at death in patients with and without diabetes in the Japanese general population.

In the first and second surveys, the first‐ranked cause of death was vascular diseases, followed by malignant neoplasms and then infectious diseases. However, in the third survey, neoplasms and vascular diseases became the first‐ and second‐ranked causes, respectively. In the fourth survey, the resulting second‐ranked cause and the third‐ranked cause had switched. Consequently, vascular diseases became the third‐ranked cause of death. In the present survey, the proportion of deaths from vascular diseases further decreased. Notably, this proportion had decreased to approximately 1/4 in 40 years since the first survey. Low proportions of deaths resulted from diabetic and hypoglycemic comas: 190 and 90 patients, respectively, (in total 280 patients). On average, around two to three patients in Japan likely died each month even at medical institutions specializing in diabetes. If general medical institutions are included, the incidence of such deaths is assumed to increase considerably. This should be considered in future daily clinical practice.

A longitudinal comparison of periodically repeated questionnaire surveys on the causes of death of patients with diabetes with the results of surveys on the causes of death in the Japanese general population may aid in identifying the changes in the pathological conditions of patients with diabetes in Japan. Such comparison is also significant for the development of future directions. As shown in Table 8, the principal causes of death identified by the five surveys, including the present study, were compared with the causes of death in the Japanese general population in the same periods as reported by the Annual Statistical Report of the National Health Condition, published by the Health and Welfare Statistics Association 12 , 13 , 14 , 15 , and the Outline of the Report of Vital Statistics in 2020 (Approximate Number) 11 . The proportion of deaths from malignant neoplasms in patients with diabetes continued to increase from 25.3%, 29.2%, 34.1%, and 38.3% in the four previous surveys to 38.9% in the present survey. Meanwhile, the proportion of deaths from malignant neoplasms in the Japanese general population increased to 21.6%, 25.9%, and 31.0% every 10 years but decreased slightly to 29.5% in 2010. In 2020, the proportion decreased further to 27.6%, and the difference between patients with diabetes and the Japanese general population increased further to 11.3%. This may suggest the importance of prevention and management of malignant neoplasms as concomitant diseases in patients with diabetes. The breakdown of malignant neoplasms has also been examined since the third survey. The proportion of deaths from lung cancer has hardly changed in the Japanese general population but has been increasing in patients with diabetes. Based on the results of the present survey, the proportion of deaths in patients with diabetes was 1.4 times higher than the proportion in the Japanese general population. Although the decrease and increase in the proportion of deaths from liver and pancreatic cancer, respectively, are common trends in patients with diabetes and the Japanese general population, both proportions are higher in patients with diabetes than in the Japanese general population. In the present survey, the proportions of deaths from liver and pancreatic cancer were 2.3 and 2.4 times higher, respectively. These proportions remained higher than those in a pooled analysis performed with Japanese data by the Committee on Diabetes Mellitus and Cancer 16 .

Table 8.

Causes of death in Japanese general population and diabetic subjects – comparisons between 1971–1980, 1981–1990, 1991–2000, 2001–2010, and 2011–2020

Causes of death 1971–1980 1981–1990 1991–2000 2001–2010 2011–2020
General population 11 (n = 695,821) Diabetic subjects 5 (n = 9,737) General population 12 (n = 793,014) Diabetic subjects 6 (n = 11,648) General population 13 (n = 970,331) Diabetic subjects 7 (n = 18,385) General population 14 (n = 1,197,066) Diabetic subjects 8 (n = 45,708) General population 10 (n = 1,372,648) Diabetic subjects (n = 68,555)
Vascular diseases 31.7 41.5 24.6 39.3 22.7 26.8 18.8 14.9 14.4 10.9
Chronic renal failure 1.0 12.8 2.0 11.2 1.8 6.8 2.0 3.5 2.0 2.3
Ischemic heart diseases 6.6 12.3 6.4 14.6 7.3 10.2 6.5 4.8 4.9 3.5
Cerebrovascular diseases 24.1 16.4 16.2 13.5 13.6 9.8 10.3 6.6 7.5 5.2
Malignant neoplasia 21.6 25.3 25.9 29.2 31.0 34.1 29.5 38.3 27.6 38.9
Lung 5.6 5.3 5.8 7.0 5.5 7.8
Liver 3.5 8.6 2.7 6.0 1.8 4.1
Pancreas 2.0 4.8 2.3 5.7 2.7 6.5
Infectious diseases 6.2 9.2 8.4 10.2 9.2 14.3 12.1 17.0 10.3 17.0
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The decrease in the proportion of deaths from vascular diseases is a common phenomenon in patients with diabetes and the Japanese general population. In the fourth survey, for the first time, the proportion in patients with diabetes was lower than that in the Japanese general population. The present survey showed similar decreases in patients with diabetes and the Japanese general population. Compared with the results of the first survey, these proportions decreased to approximately 1/2 and 1/4 in the Japanese general population and patients with diabetes, respectively, possibly indicating a breakthrough in diabetes treatment.

Among vascular diseases, the proportion of deaths from ischemic heart diseases was substantially higher in patients with diabetes than in the Japanese general population in the first to third surveys, but the proportion of deaths among patients with diabetes was lower than that among the Japanese general population in the fourth survey. The present survey showed a further decrease in ischemic heart diseases as a cause of death to less than 1/4 of the highest proportion observed in the second survey. The decrease in the proportion of deaths from ischemic heart diseases in the entire Japanese population, including patients with diabetes, is presumably attributable to the widespread use of statins and other drugs for lipid control and antihypertensive agents for hypertension control, implementation of screening for ischemic heart diseases by coronary artery computed tomography and other modalities, and advances in interventions. Advances in diabetes management, mainly with antidiabetic agents, may have also contributed to the decrease in the proportion of deaths from ischemic heart diseases in patients with diabetes. Meanwhile, as in the Japanese general population, the proportion of deaths from cerebrovascular diseases in patients with diabetes has been decreasing. This proportion is always lower in patients with diabetes than that in the Japanese general population, thus blood pressure and blood lipid levels might be controlled more strictly in patients with diabetes than in the Japanese general population. The proportion of deaths from chronic renal failure has remained almost unchanged at approximately 2.0% for the past 40 years in the Japanese general population; among patients with diabetes, deaths due to chronic failure were at 12.8%, 11.2%, 6.8%, and 3.5% in the previous surveys. In the present survey, it decreased to 2.3%, which was nearly equal to the proportion in the Japanese general population. Possible factors for the marked decrease in the proportion of deaths from chronic renal failure in patients with diabetes include the use of renin‐angiotensin system agents, which may have a renoprotective effect, and stricter glycemic control due to advances in diabetes treatment.

The proportion of deaths from infectious diseases, which are the second most frequent cause of death, in patients with diabetes is increasing as in the Japanese general population. In the previous surveys, the proportion of infectious diseases as a cause of death was approximately 1.5 times higher in patients with diabetes. In the present survey, the proportion in patients with diabetes remained unchanged, whereas that in the Japanese general population decreased. Consequently, the differences between them increased. This may suggest the importance of daily clinical practice given the susceptibility to infectious diseases and the likelihood of progression to severe conditions of patients with diabetes.

Table 9 compares the average age at death in patients with diabetes who were enrolled in the five questionnaire surveys – including the present survey – and the average lifespan 17 of the Japanese general population at the time of each survey. The average age at death in patients with diabetes in the present survey was 74.4 years in men and 77.4 years in women. The average lifespan in the Japanese general population in 2020 was 81.6 years in men and 87.7 years in women. The four previous surveys revealed that the average age at death in patients with diabetes was younger than the average lifespan in the Japanese general population; the present survey continued to show this trend. However, in the four previous surveys, the difference between these values decreased from 10.3 to 8.2 years in men and from 13.9 to 11.2 years in women. In the present survey, the difference decreased to 7.2 years in men and 10.3 years in women. Forty years have passed since the first survey, and marked advances in the management and treatment of diabetes during this period have contributed to the improved prognosis of patients with diabetes.

Table 9.

Mean ages at death of Japanese diabetic subjects and life expectancy at birth of Japanese general population – comparisons between 1971–1980, 1981–1990, 1991–2000, 2001–2010, and 2011–2020

(1) 1971–1980 (2) 1981–1990 (3) 1991–2000 (4) 2001–2010 (5) 2011–2020 Differences between (2) and (1) Differences between (3) and (2) Differences between (4) and (3) Differences between (5) and (4)
Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female
A: General population (life expectancy in years) 73.4 15 78.8 15 75.9 15 81.9 15 77.6 15 84.6 15 79.6 15 86.3 15 81.6 15 87.7 15 +2.5 +3.1 +1.7 +2.7 +2.0 +1.7 +2.0 +1.4
B: Diabetic subjects (mean ages at death) 63.1 5 64.9 5 66.5 6 68.4 6 68.0 7 71.6 7 71.4 8 75.1 8 74.4 77.4 +3.4 +3.5 +1.5 +3.2 +3.4 +3.5 +3.0 +2.2
Differences between A and B (B−A) −10.3 −13.9 −9.4 −13.5 −9.6 −13.0 −8.2 −11.2 −7.2 −10.3
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The average age at death in patients with diabetes and the average lifespan in the Japanese general population are described above. Comparing these values is usually problematic. However, the data were compared and analyzed after each previous survey because of the lack of data on the average age at death in the Japanese general population. In the current survey, patients with and without diabetes who were treated at the same institution were enrolled. This allowed a direct comparison of the average age at death between these patients for the first time. The average age at death in patients with diabetes was significantly higher than that in patients without diabetes, albeit with a small difference. According to the principal causes of death, however, the average age at death in patients with diabetes was higher by 1.2 years for malignant neoplasms and lower by 2.9 years for infectious diseases. No significant difference was observed for vascular diseases between patients with and without diabetes. Given the great influence of the proportion of deaths from malignant neoplasms, which was twice that of infectious diseases, the average age at death from all causes appears to have increased in patients with, rather than without, diabetes. Conversely, among vascular diseases, the average age at death in patients with diabetes was lower by 3.3, 2.2, 0.9, and 2.5 years for chronic renal failure, ischemic heart diseases, cerebral hemorrhage, and cerebral infarction, respectively. This suggests the need for further attention to prevention of the onset and progression of various vascular diseases in future diabetes treatment. In the present survey, the sum of the proportions of deaths from suicide, other causes, and unknown causes was as high as 21.7% in patients with diabetes and 29.2% in patients without diabetes. Many institutions that enrolled patients were acute care hospitals; thus, the present survey may have included a considerable number of young patients who died in accidents and from other causes, consequently possibly affecting the average age at death. Indeed, the average age at death from other causes was 76.5 years in patients with diabetes and 74.7 years in patients without diabetes. The difference between them (1.8 years) was larger than the difference in the average age at death from all causes (0.6 years). In analysis excluding these causes of death, the average age at death was 75.2 years in patients with diabetes (74.2 years in men and 77.1 years in women) and 75.1 years in patients without diabetes (74.2 years in men and 76.5 years in women), showing no significant difference overall (Table 5). Based on data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), the average age at death was 79.3 years in patients with diabetes (77.4 years in men and 82.0 years in women) and 81.9 years in patients without diabetes (79.3 years in men and 84.4 years in women), showing a difference of approximately 2 years 18 . In a study on the life expectancy of patients with diabetes, the life expectancy of patients aged 40 years with diabetes was 39.2 years in men and 43.6 years in women, while the life expectancy of people aged 40 years in the Japanese general population based on the abridged life table was 39.0 years in men and 45.5 years in women. The difference was negligible 19 . Given these reports and the results of the present study, diabetes does not seem to adversely affect lifetime prognosis. This may ameliorate stigma in patients with diabetes, which has been attracting attention in recent years and includes social stigma, such as the inability to obtain life insurance or a mortgage.

A limitation of the data obtained from questionnaire surveys is the difficulty in standardizing the criteria for determining the causes of death. However, the data obtained from the periodically repeated surveys with nearly the same questions appear to be significant in detecting the changes in the pathological conditions of Japanese patients with diabetes. These data will hopefully be helpful for future daily clinical practice.

It is important to acknowledge as a limitation that while our data quality check was performed thoroughly, there remains the possibility of residual discrepancies in clinical features that may require additional scrutiny.

DISCLOSURE

The authors declare no conflict of interest. Dr Jiro Nakamura, Dr Kohjiro Ueki, Dr Toshimasa Yamauchi, Dr Nobuya Inagaki, Dr Yukio Tanizawa, Dr Eiichi Araki, Dr Hideki Kamiya are Editorial Board members of Journal of Diabetes Investigation and co‐authors of this article. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication.

Approval of the research protocol: N/A.

Informed consent: N/A.

Registry and the registration no. of the study/trial: N/A.

Animal studies: N/A.

ACKNOWLEDGMENTS

We sincerely apologize for causing great trouble for participants to collect, fill out, and provide data in the present survey. We would also like to express our deep appreciation for their cooperation. We were able to complete the present survey with some degree of success primarily because of the assistance of both members and non‐members of the Japan Diabetes Society. We would like to thank Honyaku Center Inc. for English language editing.

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