The rate of premature death among American men with diabetes has dropped dramatically over the last few decades, but the same can’t be said for women with the disease, a study by the Centers for Disease Control and Prevention has found.
The proportion of early deaths among diabetic women remained unchanged between 1971 and 2000, say CDC researchers, whose findings were published online Monday in the Annals of Internal Medicine.
“Among men we found very encouraging trends,” said Edward Gregg, an epidemiologist at the CDC who led the study. “Among women, however, we found no improvement at all . . . So women with diabetes seem to be left behind in this improvement in health.”
Analyzing data for 20,000 people from across the United States, researchers found that annual death rates from all causes in men with diabetes fell to 24.4 per 1,000 from 42.6 per 1,000 - a 43 per cent reduction.
The death rate from cardiovascular disease (CVD), the most common cause of death in diabetics, fell for men to 12.8 per 1,000 from 26.4. These drops paralleled declining death rates among both men and women without diabetes in the U.S. population (down to 9.5 per 1,000 from 14.4) over the three-decade period.
Not only have mortality rates for women with diabetes not declined, but the difference in death rates for diabetic and non-diabetic women has actually widened over the three decades as females without diabetes started living longer.
Gregg said the gender disparity came as somewhat of a surprise to researchers, and they aren’t sure why it exists.
A number of reasons have been postulated, including the suggestion that overall, doctors are less aggressive in treating cardiovascular disease and its risk factors in women.
“The other possibility is that cardiovascular disease among women - and for that matter diabetes - may take a slightly different form biologically than it does in men and the treatments that we have don’t quite match that as well as they do in men,” Gregg said Monday from Atlanta.
The gender gap found in the U.S. diabetic population can’t necessarily be extrapolated to Canada, said Toronto endocrinologist Dr. Lorraine Lipscombe.
In a study she co-authored as a researcher at the Institute for Clinical Evaluative Sciences, published in March, Lipscombe said death due to the complications of diabetes in Ontario fell for both men and women between 1995 and 2005.
“In our study we did not find any difference between men and women and we found an overall decline of about 25 per cent,” said Lipscombe.
Because the Ontario research contained more recent data than the U.S. study, it might reflect more current medical practices, she said. “Maybe we are getting better at taking care of women with diabetes.”
Medical practice in Canada and the U.S. may also vary somewhat, reflecting public versus private health-care systems.
“There is a lot of evidence from the United States that men are more aggressively treated . . . We also know that doctors are more likely to think of cardiovascular disease in men,” she said.
“Evidence thus far from Ontario suggests that there isn’t that same gender disparity in Canada.”