背景與目的：目前世界各國的疾病別死亡率都是以原死因死亡率為統計基礎。然而，研究顯示，僅以原死因統計糖尿病死亡率，會低估糖尿病的死亡負擔，因此有學者主張，以多重死因統計法來輔助分析糖尿病對死亡的貢獻。過去的研究多為橫斷面設計，而原死因與多重死因間的相對關係是會隨年代而改變的。因此，我們以1987-2007年台灣的死因資料庫為基礎，分析糖尿病在過去20年來的原死因及多重死因死亡率的趨勢變化，並與美國的糖尿病死亡率趨勢做比較。
研究材料與方法：本研究是死亡率的年代趨勢分析，所使用的來源有二：(一)衛生署統計室1987，1992，1997，2002以及2007年的糖尿病多重死因死亡資料檔。(二)美國國家衛生統計資料中心，1985，1990，1995，2000以及2005年的糖尿病多重死因資料檔。糖尿病定義為第十版國際疾病分類碼E10-E14，以美國國立衛生統計中心所發展的電腦化原死因選取資訊系統，來選取原死因。最後以卜瓦松迴歸模型分析不同年代死亡率比及95%信賴區間。
研究結果：本研究的主要發現為：1987-2007年，台灣糖尿病原死因死亡率趨勢是下降的但多重死因死亡率卻是上升，相較於美國，1985-2005年間糖尿病原死因與多重死因死亡率皆有上升趨勢。台灣糖尿病原死因死亡率在1987-2007年間下降了0.86倍，而多重死因死亡率上升了1.31倍，美國1985-2005年間糖尿病原死因死亡率上升了1.42倍，多重死因死亡率上升了1.10倍。進一步分析，台灣跟美國，第一部份提及糖尿病中有八成左右會被選為原死因，這樣的比例在不同年代不同國家有相似的結果。台灣糖尿病原死因死亡率下降是因為糖尿病被填報在第一部份的比例下降。
結論：台灣糖尿病原死因死亡率呈下降趨勢，多重死因死亡率為上升趨勢，而美國原死因跟多重死因死亡率皆呈現上升趨勢。在兩國的死亡率趨勢比較時，原死因死亡率趨勢是相反的，但多重死因死亡率則呈現一致上升的趨勢。提及糖尿病中做為原死因的比例在台灣有顯著下降的趨勢，在美國則呈現的上升趨勢。這可能導因於糖尿病在台灣的致死性的下降，但醫師填報習慣的改變及競爭死因的增加也可能是造成趨勢下降的原因。因此，我們建議，糖尿病的死亡率趨勢分析時，須同時提供原死因及多重死因死亡率才能做更完整的比較。

Background and aims：At present time, mortality rates are based on underlying cause-of-death(UCD). However, relying only on underlying cause-of-death will underestimate the diabetes-related mortality contributed to death. Therefore, multiple cause-of-death(MCD) data was complied to provide a more complete picture of mortality. Some cross-sectional studies compare diabetes mortality rate using MCD and UCD but the relative relationship between underlying cause-of-death and multiple cause-of-death may changed over time. This study analysis diabetes mortality trends using underlying-cause and multiple-cause statistics and comparison the difference between Taiwan and the USA.
Methods：Multiple causes of death data of Taiwan and USA are used to exam trends in diabetes mortality and ratios of diabetes certified as underlying cause and anywhere on the death certificate. To analyses the past two decade mortality trends, data of year 1987, 1992, 1997, 2002 and 2007 was extracted from Taiwan mortality file and year of 1985, 1990, 1995, 2000, and 2005 was extracted from USA vital statistic file. To eliminate inter-coder variability, the UCD were selected through automated coding system. Diabetes is defined as the 10th edition of international classification of Disease coded E10-E14. We also examined the relative risk by Poisson regression model of during this period.
Result： In Taiwan, 1987-2007, the patterns of diabetes mortality trends are reverse between UCD and MCU. Mortality trends of UCD is declined with relative risk of 0.86 but MCD is increased with relative risk of 1.31, in Taiwan. Contrarily, the trends of UCD and MCD is consistent in the USA with relative risk of 1.42 and 1.10 respectively. The ratio of diabetes reported as underlying cause to multiple causes was decreased in Taiwan but increased in the USA over the study period. We found that declined in reporting of diabetes in part I of the death certificate is one of the major factors that affect diabetes mortality trends in Taiwan. Other factors, such as, increased in competing cause-of-death or rigorous pharmacological therapy in diabetes must take into account.
Conclusion： Analysis of mortality trends based on underlying cause-of-death alone will be misleading the burden of diabetes mortality. To design an effective public health interventions, we recommended that both the UCD and MCD must take into account.

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