Article Text
Abstract
Introduction Incidence rates of diabetes have been increasing and mortality rates have been decreasing. Our aim is the quantification of the effects of these on the prevalence and prediction of the future burden of diabetes.
Research design and methods From population-based registers of Denmark, we derived diabetes incidence and mortality rates and mortality rates for persons without diabetes for the period 1996–2016. Rates were modeled by smooth parametric terms using Poisson regression. Estimated rates were used to assess the relative contribution of incidence and mortality to changes in prevalence over the study period as well as for prediction of future rates and prevalence 2017–2040.
Results The major contributors to prevalence was increasing incidence (22%) and epidemiological imbalance between incidence and mortality (27%). The decrease in mortality rates over the period 1996–2016 contributes only 9% of the prevalent cases at 2016. We estimated that 467 000 persons in Denmark would be living with diabetes in 2030. The age distribution of patients in the period 2017–2030 is predicted to change toward older ages. The total number of persons needing diabetes care will increase by 67% over the next 13 years, an average annual increase of 4.0%.
Conclusions Lowering mortality among patients with diabetes even further is not likely to influence the prevalence substantially. Since the size and the increase in incidence of diabetes are major drivers of the increasing prevalence, the prevention of new cases of diabetes is required.
- epidemiology
- incidence
- mortality
- registries
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Footnotes
Contributors BC and MEJ conceived the structure of the underlying register and designed the study. PFR provided support for obtaining data access and contributed to data definition. BC detailed and developed the statistical methods needed, performed all data analysis and wrote a first draft of the manuscript. MEJ and PFR contributed substantially to the writing of the manuscript. All authors contributed to critical revision and take responsibility for the content. BC is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests BC and MEJ own shares in NovoNordisk. BC has received lecture and consultancy fees from NovoNordisk and LeoPharma. MEJ is PI on a trial sponsored by AstraZeneca, and received research grants from AMGEN AB, AstraZeneca, Sanofi Aventis and Boehringer Ingelheim. PFR has nothing to disclose.
Patient consent for publication Not required.
Ethics approval This study was approved by the Danish Data Protection Agency (registration no. 2015-41-4148). Ethical approval is not required for register-based studies in Denmark.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. The data for this study are population-wide registers, placed at our disposal on the servers of Statistics Denmark. They are barred from release to the public on grounds of confidentiality. A full documentation of the register is given in the electronic supplementary material.