Cause-specific mortality in diabetes: retrospective hospital based data from south India.

BACKGROUND: India lacks comprehensive mortality data in individuals with diabetes. The present retrospective case-control study compared the causes of death in diabetic and non-diabetic inpatients in a tertiary care hospital in 2007. METHODS: Deaths in diabetic patients (n = 315) were compared with 307 randomly selected controls. Medical chart review established the primary cause of death, demographics, and clinical data. Data were summarized using descriptive statistics and comparative analyses were performed. RESULTS: Of the 79 067 inpatient admissions during 2007, diabetes of any type was recorded for 6517 (8.2%). There were 2017 inpatient deaths registered, 315 (15.6%) in diabetic patients and 1702 (84.4%) in non-diabetic patients, corresponding to mortality rates of 48.3/1000 admissions for diabetic patients and 23.4/1000 admissions for non-diabetic patients. The mean duration of hospitalization prior to death in diabetic versus non-diabetic patients was 6.4 vs 7.7 days (P = 0.015). Causes of death in diabetic patients were vascular disease (38.4%), infection (34.3%), renal failure (8.9%), and malignancy (8.9%); diabetic patients had significantly higher odds of death from vascular disease (odds ratio [OR] 4.05, 95% confidence interval [CI] 2.67-6.16; P ≤ 0.0001), renal causes (OR 7.39, 95%CI 2.53-29.27; P ≤ 0.001) and infection (OR 1.61, 95% CI 1.12-2.32; P ≤ 0.0001). Comparing cases and controls after stratifying by age (<56 and ≥56 years), the greater odds of vascular death among diabetics remained significant in both age categories. CONCLUSIONS: We report vascular disease as the leading cause of death among diabetic hospital inpatients in one tertiary care center in India, in contrast with previous hospital-based studies from India.

Medical response to hurricanes Katrina and Rita: local public health preparedness in action.

Like more than 150 communities in Texas, our community participated in disaster response for Gulf coast citizens evacuated from hurricanes Katrina and Rita. We implemented and adjusted emergency operations plans that were designed to respond to a local disaster. Lessons learned will strengthen our disaster preparedness in the future, including the importance of a robust medical presence at evacuation shelters; the value of an accurate and timely database of medical needs for shelter occupants; the usefulness of brief paperwork; the need for a preidentified and pretrained group of healthcare workers; the necessity of timely and accurate communications with medical partners in the community; the requirement that our local city government plan, open, and operate disaster shelters in our community; and the impact of ease of travel, frequent and honest communication, and sincere appreciation on maintaining morale in our volunteers.