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Diabetes mellitus: trends, avoidable mortality and inequalities

Diabetes mellitus is a chronic non-communicable disease with a high prevalence in the Region of the Americas which causes an average of 242,000 deaths each year (110,000 males and 132,000 females).

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Mortality risk by Diabetes mellitus

Situation:  Diabetes mellitus accounts for 242,000 deaths each year (110,000 males and 132,000 females).

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In 2007, 22,000 deaths caused by diabetes mellitus (8% overall) were considered as avoidable because they occurred in people under 50 years old[1]. This proportion was higher among males (10%) compared to females (7%). The mortality risk due to diabetes mellitus among males and females was similar in the Region (32.7 and 33.0/100,000 pop. respectively).  

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Avoidable mortality by Diabetes mellitus

Situation: In 2007, 22,000 deaths caused by Diabetes mellitus (8% overall) were considered as avoidable because they occured in people under 50 years old.    

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Trend of mortality by Diabetes mellitus

Risk varies among countries of the Americas. Three group of countries were classified according to the magnitude of mortality by diabetes mellitus as low risk (mortality rate less than 25/100,000 pop.); middle risk (25-49/100,000 pop) and high risk (50/100,000pop and over).     

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The mortality trend in the last years did not change markedly in the Region: the mortality risk men due to diabetes increased until 2003, and become stable, while the risk for women has been stable during the study period . In the group of countries with low risk the trend decreased or stabilized for most countries. Argentina's rate has declined among males and female, as well as Canada and the United States' rate among females. On the other hand, Cuba's rate increased in males and females. Among those countries with middle risk, the mortality trend has been rising in Brazil, particularly in males, Ecuador and El Salvador (males and females); in Colombia there has been an slight decline (males and females) and in Puerto Rico and Panama the rate declined in among fenmales. In the group with higher mortality risk, Mexico's rate showed a rise in males and females and Nicaragua in males.

A correlation was observed among mortality and the proportion of avoidable death by diabetes mellitus (r=0.53). In the low rate group of countries, half of countries have proportion of avoidable mortality less than <5%, while the middle and high risk groups showed proportion of avoidable deaths higher than 5%. Thre were some exceptions such as Trinidad and Tobago whose rates were among the highest of the Region but ist proportion of avoidable death was below the average. Peru showed low mortality rates with a proportion of avoidable deaths above the mean of the Region.

Map of Proportion of avoidable mortality due to diabetes mellitus, 2007 - 2009


Considering the level of per capita income adjusted by purchasing power, the inequality of mortality rates has not changed substantialy between 2001 and 2007. The poorest 20% of the population accumulates almost 30% of all deaths due to diabetes whereas the 20% richest 14% of these deaths (concentrating index = -0.13). The total magnitude of inequality throughout the socioeconomic hierarchy, from the soicially extreme most disadvantageous to the most advantageuos, represents an excess  of 25 deaths  from diabetes in 100,000 people. The poorest  population of the Region with strong indigenous or Afro-descendent composition that live in a situation of vulnerability  would have greater exposure to risk factors for diabetes and less access to health services, therefore there is a higher risk of premature death from diabetes.

The countries that have high mortality rates with increased trends and high proportion of avoidable deaths should continue strengthening the prevention, early diagnosis, effective coverage of health services, health promotion and access to essential drugs.

Bibliographic reference

1. Nolte E, McKee CM. Does health care save lives?: avoidable mortality revisited. The Nurfield Trust, London, 2004.

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