Introduction: Large-scale prospective studies of diabetes and cause-specific mortality have been conducted mainly in high-income countries, where there is good access to healthcare. However, there is limited evidence on the effect of diabetes on mortality in low- and middle-income countries, such as Cuba.

Methods: From 1996-2002, we recruited 146,556 participants (aged ≥30) from the general population in Cuba into a prospective cohort study. We recorded the presence or absence of previously diagnosed diabetes, and monitored for deaths through December 31st, 2015. We estimated adjusted hazard ratios (HR) for cause-specific mortality at ages 30-84 years among participants who had diabetes at recruitment vs. those who did not have diabetes at recruitment; participants with prior chronic disease other than diabetes were excluded from the analyses.

Results: At recruitment, the overall prevalence of diabetes was 4% in men and 7% in women, and the mean age was 53 (SD13) years. Previously diagnosed diabetes was associated with about twice the risk of all-cause mortality (HR 1.89 [95% CI 1.79-1.99]; mean age at death 70 [SD12]). The association was stronger at younger ages, but did not differ by sex: HR 2.68 (2.29-3.14) at 30-59 years, 2.20 (2.03-2.38) at 60-74 years, and 1.56 (1.44-1.68) at 75-84 years. Diabetes was strongly associated with mortality from renal, cardiovascular and respiratory diseases, but not with cancer. The excess mortality associated with diabetes accounted for ∼10% of all premature deaths (<75 years) in Cuba for 2015; mostly from cardiovascular disease.

Conclusion: Despite limited resources in Cuba, the association of diabetes with all-cause mortality was similar to high-income countries and less extreme than in many other middle-income countries.


S.J.C. Charles: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at