Diabetes and Ischemic Heart Disease Death in People Age 25–54: A Multiple‐Cause‐of‐Death Analysis Based on Over 400 000 Deaths From 1990 to 2008 in New York City

Abstract Background Over the past decade, ischemic heart disease ( IHD ) mortality trends have been less favorable among adults age 25–54 than age ≥55 years. Hypothesis Disorders associated with IHD such as diabetes, chronic inflammatory and infectious diseases, and cocaine use are important contributors to premature IHD mortality. Methods Multiple‐cause‐of‐death analysis was performed using the New York City ( NYC ) Vital Statistics database. Frequencies of selected contributing causes on death records with IHD as the underlying cause for decedents age ≥25 were assessed (n = 418,151; 1990–2008). Concurrent Telephone risk‐factor surveys ( NYC Community Health Survey, Centers for Disease Control Behavioral Risk Factor Survey in New York State) were analyzed. Results In sum, a prespecified contributing cause was identified on 13.6% of death certificates for IHD decedents age 25–54. Diabetes was reported more frequently for younger IHD decedents (15% of females and 10% of males age 25–54 vs 6% of both sexes age ≥ 55). In contrast, concurrent diabetes prevalence in New York State was 3.4% for those age 25–54 and 13.6% for those age >55 ( P  < 0.0001). Systemic lupus erythematosus, human immunodeficiency virus, and cocaine were also more likely to contribute to IHD death among younger than older people. Conclusions Diabetes may be a potent risk factor for IHD death in young people, particularly young women, in whom it was reported on IHD death records at a rate 5× higher than local prevalence. The high frequency of reporting of studied contributing causes in younger IHD decedents may provide a focus for further IHD mortality‐reduction efforts in younger adults.