Presentation on theme: "The National Diabetes Management Strategy: Diabetes Facts and Figures By using these slides, you agree to the terms on the next slide. The development."— Presentation transcript:
The National Diabetes Management Strategy: Diabetes Facts and Figures By using these slides, you agree to the terms on the next slide. The development of these slides was made possible through financial support by Merck.
Diabetes is a Canadian Problem
Diabetes is the Sixth Leading Cause of Death in Canada Cause of deathRankNumber All causes of death226,584 Cancer166,947 Heart diseases252,000 Stroke314,626 Chronic lower respiratory diseases410,041 Accidents (unintentional injuries)58,986 Diabetes67,823 Influenza and pneumonia75,729 Alzheimers disease85,536 Suicide93,613 Kidney diseases103,541 All other causes47,742 Statistics Canada. Leading causes of death in Canada, 2000 to 2004.
Canada has one of the highest prevalence of diabetes amongst OECD member countries * Although there are 30 OECD member countries, some countries had equal age-adjusted prevalence, so in this table of selected countries, the ranking ranges from only 1 to 20. ** Age-standardized prevalence adjusts the national prevalence to the age profile of the world and is useful for comparing prevalence between nations. Source: Prevalence of diabetes in OECD countries, 2010. Available at http://www.ecosante.fr/OCDEENG/68.html Accessed June 21, 2011http://www.ecosante.fr/OCDEENG/68.html
Canada Has a Chronic Disease Surveillance System The Canadian Chronic Disease Surveillance System (CCDSS) uses population-based administrative data from every province and territory. In each province and territory, the health insurance registry database is linked to physician billing and hospitalization databases An individual is identified as having diagnosed diabetes, if: –At least one hospitalization with diagnosis of diabetes; or –At least two physician visits with a diagnosis of diabetes within a 2-year period –Gestational diabetes mellitus excluded Current national database includes summary data on individuals 1 year or older at time of diabetes diagnosis from all provinces and territories from 1995/96 to 2008/09 Age-standardized data are adjusted to 1991 Census data Cant distinguish between type 1 and type 2 Validated methodology Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011.
Prevalence of Diagnosed Diabetes Overall prevalence: 6.8% (N=2,359,252) –Males: 7.2% (n=1,238,826) –Females: 6.4% (n=1,120,426) Age standardized prevalence: 5.6% The prevalence of diagnosed diabetes in Canada in 2008–2009 was 6.8% (approximately 2.4 million people aged 1 year or older). Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011.
Diabetes Prevalence Increases With Age Prevalence increase with age and sharply increases in middle age: –35-39 years: 2.6% –50-54 years: 8.4% –75-79 years: 25.5% Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011.
Increase in Prevalence of Diagnosed Diabetes After adjusting for differences in age distributions among the provinces between 1998/99 and 2008/09, the prevalence of diabetes: increased by 70% was higher in men than women Increased in every age category The prevalence of diabetes in Canada is expected to increase 3.7 million by 2018/19 Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011.
Prevalence of Diagnosed Diabetes Varies by Province Province/territoryPrevalence Newfoundland and Labrador6.5 Nova Scotia6.1 Ontario6.0 New Brunswick5.9 Manitoba5.9 Prince Edward Island5.6 Northwest Territories5.5 Saskatchewan5.4 British Columbia5.4 Yukon5.4 Quebec5.1 Alberta4.9 Nunavut4.4 Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011.
Implications of Variable Provincial Diabetes Prevalence Rates Implications for provincially specific: –human and financial resource planning –population-based prevention strategies –individual risk factor reduction –screening for diabetes and pre-diabetes, and –management
The Incidence of Diabetes in Canada is Increasing The overall incidence of diabetes in 2008/09 was 6.3 per 1000 people (or 203,018 Canadians). Among people aged 1 year or older, 203,018 individuals were given a new diagnosis of diabetes: –6.3 per 1000 individuals –5.7 per 1000 girls/women –6.8 per 1000 boys/men Rates of new diagnosis of diabetes show a similar trend as prevalence with rates that rise steeply after age 45 and peak among those aged 70–74 for both men and women. Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011.
Diabetes in Canada: 2007 to 2017 Between 2007 and 2017, an estimated 1.9 million Canadians (aged 20 years and older) will be newly diagnosed with diabetes. This means that about nine out of every 100 Canadians are predicted to be newly diagnosed with diabetes during the 10-year period. Manuel DG, et al. Toronto, ON: Institute for Clinical Evaluative Sciences; 2010.
Diabetes in Ontario In Ontario from 1995 to 2005, the number of adults with diabetes increased by 113%, while the population grew by only 17%. 1 The prevalence of diabetes is increasing in Ontario at a rate of approximately 6% per year. 1 There are currently an estimated 1.2 million people (8.2% of the population) diagnosed with diabetes in Ontario. 2 This is projected to increase to more than 1.9 million people (11.9% of the population) by 2020. 2 Lipscombe LL, Hux JE. Lancet. 2007;369:750-756. Canadian Diabetes Association. The Burden of Diabetes in Ontario. http://www.diabetes.ca/get-involved/news/diabetes-cost- model-released-in-ontario/http://www.diabetes.ca/get-involved/news/diabetes-cost- model-released-in-ontario/
Incidence of Diabetes in Ontario Factors that may have affected prevalence in Ontario from 1995–2005: –Longevity: People with and without diabetes are living longer: 25% reduction in standardized mortality from 1995 to 2005. –Obesity: In Canada alone, rates have increased by 20 to 30% in the last decade. WHO diabetes prevalence estimates were based on the unwarranted assumption that obesity rates would remain constant. Lipscombe LL, Hux JE. Lancet. 2007;369:750-756.
Incidence of Diabetes in Ontario (contd) Other factors that may have affected prevalence in Ontario from 1995–2005: –Immigration: Ontario had a 51% increase in immigrants from South Asia from 1995 to 2001. –Incidence: Record rise of 31% from 1997 to 2003. –Guidelines: Publication of diabetes guidelines may have enhanced screening and detection rates. The implications... The size of the diabetes epidemic is far greater than was anticipated. Lipscombe LL, Hux JE. Lancet. 2007;369:750–756.
Factors Affecting the Prevalence and Incidence of Diabetes in Canada
An Aging Population The prevalence of diabetes begins to increase steadily after age 40. The proportion of senior citizens in Canadas overall population is increasing. 1 –In 2006, seniors accounted for 13.7% of the total population. 2 –By 2031, seniors will account for approximately 24% (almost double 2006 levels). 2 1.Canadian Diabetes Association Clinical Practices Guidelines Expert Committee. Can J Diabetes. 2008;32(suppl 1) :S1–S201. 2.Statistics Canada. Population projections 2005–2031. 3.Statistics Canada. 2006 Census: Age and Sex.
An Aging Population (contd) By the year 2056, the median age of Canadians will be 45–50 years. 1 Guidelines recommend screening starting at age 40. Therefore… over half the population will have at least one risk factor (age >40) and should be regularly screened for diabetes. 2 1.Statistics Canada. 2006 Census: Age and Sex. 2.Canadian Diabetes Association Clinical Practices Guidelines Expert Committee. Can J Diabetes. 2008;32(suppl 1) :S1–S201.
An Aging Population (contd) Aging trends vary by province, with important implications for regional healthcare planning and policy. Proportion of seniors according to the 2006 Census: –National average: 13.5% –Saskatchewan: 15.4% (highest) –Alberta: 10.7% (lowest) Statistics Canada. 2006 Census: Age and Sex.
Increasing Immigration From High-risk Populations Most recent immigrants come from populations at high risk for developing diabetes Of immigrants who came to Canada from 2001– 2006, approximately 80% were from populations at increased risk of developing diabetes: –58.3% came from Asia –10.6% came from Africa –10.8% came from Central/South America and the Caribbean Statistics Canada. 2006 Census: Immigration, citizenship, language, mobility and migration.
Implications of Immigration Patterns for Diabetes Prevalence and Incidence Healthcare system will need to respond to the specific healthcare needs of these populations with culturally and linguistically relevant prevention, screening and management practices. Major cities (Toronto, Vancouver, Montreal) are home to the majority of recent immigrants (69%), with implications for local healthcare planning. Statistics Canada. 2006 Census: Immigration, citizenship, language, mobility and migration.
Percentage of Foreign-born Canadians is Increasing By 2031, between 25% and 28% of the population could be foreign-born. Between 29% and 32% of the population could belong to a visible minority group, as defined in the Employment Equity Act. This would be nearly double the proportion reported by the 2006 Census. Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031.
The Percentage of Foreign-born Canadians Is Increasing (contd) About 55% of this population would be born in Asian countries, which have a very high incidence and prevalence of type 2 diabetes. In addition, Canadas Black and Filipino populations could double, and Arab and West Asian groups could more than triple. Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031.
Increasing Prevalence of Adult and Childhood Obesity In 2008, of adult Canadians: –51% being overweight –17% reported being obese. 1 From 2003 to 2008, obesity rates rose: –from 16% to 18% in men –from 15% to 16% in women The highest rate of obesity (22%) was among 55 to 64 year olds –24% of men –21% of women 1 In boys and girls aged 2–17 years, prevalence of obesity from 1978/1979 to 2004 increased from 3% to 8%. 2 1. Statistics Canada. Canadian Community Health Survey, 2008. 2. Lau DCW, et al. CMAJ. 2007;176(8 Suppl):S1–13.
Overweight, Obesity and Diabetes Between 2007 and 2017, it is estimated that people who are overweight (BMI 25–30 kg/m 2 ) will comprise the greatest number of new cases of diabetes (712,000) While those who are overweight have lower baseline risk than those who are obese (BMI 30–35 kg/m 2 ) or morbidly obese (BMI >35 kg/m 2 ), there are more more Canadians who are overweight than obese Manuel DG, et al. Toronto, ON: Institute for Clinical Evaluative Sciences; 2010.
Low Levels of Physical Activity In 2008, only 51% of Canadians reported being at least moderately active during their leisure time. Moderately active is equivalent to walking at least 30 minutes a day or taking an hour-long exercise class at least 3 times a week. Statistics Canada. Canadian Community Health Survey, 2008.
Socioeconomic & Environmental Impact on Health: Canadians Living in Poverty Health follows a social gradient: populations in a lower position in the social hierarchy experience the worst health More than 12% of the working-age population lives in poverty. 1 People who live in poverty are: –often unable to meet basic housing, food and security needs –have a greater risk of health problems than people who do not live in poverty Compared to those in the highest-income neighbourhoods, life expectancy in the lowest-income quintile neighbourhoods in Canada is: –5 years shorter for men –1.6 years shorter for women 2 1.Canadas Record on Poverty Among The Worst of Developed CountriesAnd Slipping. Available at: http://www.conferenceboard.ca. 2.Ontario Medical Review. 2008;May:32-37.
Socioeconomic & Environmental Factors Diabetes Disproportionately Affects the Poor Diabetes is disproportionately clustered: 1 –in the lower socioeconomic status quintiles –in neighbourhoods with: lower average household incomes high proportions of visible minorities and/or recent immigrants In 2007, the self-reported age-standardized diabetes prevalence rate was highest among adults with a household income of <$20,000 (8%) This rate was double that of the group with an income of $60,000 (4%). 2 1.Hux JE, et al. In: Diabetes in Ontario: An ICES Practice Atlas: Institute for Clinical and Evaluative Sciences. 2.Canadian Institute for Health Information. Diabetes Care Gaps and Disparities in Canada December 2009.
Socioeconomic & Environmental Factors Diabetes Disproportionately Affects the Poor People in lower income brackets and with fewer years of education also report the following (all of which are risk factors for diabetes): –Higher rates of smoking –Less physical activity; and –Higher rates of overweight Statistics Canada. National Population Health Survey – Household Component Longitudinal, 1998–1999.
Socioeconomic & Environmental Factors Diabetes Disproportionately Affects the Poor The poor are disproportionately affected by some diabetes risk factors. Some risk factors for type 2 diabetes are more common among Canadians in the lowest income quintiles compared with those in the highest income quintiles. These include: –physical inactivity –inadequate fruit and vegetable consumption –daily smoking Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011.
Socioeconomic Status Also Affects Diabetes Care In 2007, people with higher household incomes were more likely to receive: –an A1C test –a urine test for protein –a dilated eye exam –a foot exam –all 4 recommended tests The age-standardized percentage of adults with diabetes receiving all 4 recommended tests was: –highest in the highest household income group (42%) –lowest in the lowest household income group (21%) Canadian Institute for Health Information. Diabetes Care Gaps and Disparities in Canada; December 2009.