1. Lorna Perez, Ethan Gough
Diabetes Mortality and Morbidity in Belize
Lorna Perez, Ethan Gough
Basic Level, Field Epidemiology Training Program, Ministry of Health, Belmopan, Belize
South Africa, December 2010

2. Background Demographics
Diabetes is a pandemic disease
The Americas account for over 25% in the world
13 million diabetics in Latin America and Caribbean
Diabetes attributed to 4% in all deaths
6th leading cause of deaths
In Belize:
In 2007, 13% prevalence among those >20 years
In 2008, ranked as 5th leading cause of hospitalizations and 1st underlying cause of deaths
, 3 to 5 times higher among the older age groups and 65 years and older

3. Belize Located in Central America
Population density: 30.9 inhabitants per square mile (2003)
Demography: 333,200 inhabitants
Population growth rate: 2.7%
The population is comprised of a mix of ethnicity and cultures
Mestizos 49%
Creoles 25%
However, due to its location Spanish is widely spoken The percentage of the population over 65 years is 4.3% and that less than 15 years was 40.9%.
creoles 24.9%, Mayas 10.6%, Garinagu 6.1%, Mennonite 3.6%, and East Indians 3.0%. The remainder of the population (3.1%) is made up of Chinese, Arabs, Africans and white Caucasians.
English is the official language of the country but several other languages including Spanish are widely spoken

4. Objectives
To describe diabetes and its complications by analyzing routinely collected surveillance data on diabetes in Belize.
To increase recognition of the public health burden of diabetes guiding the
formulation of health-care policies
identification of high-risk groups
development of strategies to reduce the burden of this disease
evaluation of disease prevention and control.

5. Methods Study type: Descriptive
Sources of data:
Admission and discharge records, medical certificates of deaths, aggregated data of hospitalizations and deaths
Electronic records Belize Health Information System 2009
Variables: age, sex, district, ethnicity, educational level, main and other discharge diagnoses, and underlying causes of death
Only 1st listed hospitalization diagnosis used
Analysis: Data described using rates and proportions
Disrepancies in age , occupation

6. Methods (2) Discharge Diagnoses/UCD
ICD 10 classification for hospitalization discharges and underlying cause of deaths had 4 categories: Insulin-dependent, Non-insulin dependent, other specified and unspecified diabetes mellitus and further described by the contributing cause as follows:
Cardiovascular
Nephropathy
Hypertension
Peripheral Vascular Complications
Others
130 death records
599 hospitalization records for 449 patients

7. Diabetes Hospitalization and Death Rate by Sex, Belize 2004-2009
Hospitalization Rate by Sex
Death Rate by Sex
Hospitalizations: average rate: 163/100,000 per yr……….highest peak in 2007 (219/100,000) AND although it fell to 169/100,000 in 2008 it increased again to 180/100,000 in 2009 Females more affected than males at 1.9:1
Deaths: Average death rate 35/100,000 per year with the highest in /100,000 Females more affected than males at 1.4:1

8. Frequency of Diabetes Hospitalization by Ethnicity and Education, Belize 2009
 Level
N= 479
Percentage (%)
None 43 9
Preschool
Primary
325 68
Secondary 33 7
Tertiary 14 3
Others 5 1
Unknown 57 12
Ethnicity
 Ethnic Group
N= 479
Percentage (%)
Creole
163 34
Mestizo
201 42
Garifuna 53 11
Maya 14 3
East Indian 19 4
Others 10 2
Unknown
The group most affected are the Mestizos accounting for 42% of those hospitalized with Diabetes followed by the Creoles at 34% and 68% reported their highest level of education as primary school

9. Hospitalization rate by age
Diabetes Hospitalization and Mortality Rate by Age Group, Belize
Mortality rate by age
Hospitalization rate by age
Age Group
(Years)
Per 100,000 population
2004
2005
2006
2007
2008
2009
<40 40 48 51 52 41 43
40-64
618
639
662
669
496
461
65+
1509
1298
1398
1320
1076
1177
Age Group
(Years)
Per 100,000 population
2004
2005
2006
2007
2008
2009
<40 2 1
40-64 74 81 92 66 73
102
65+
455
482
573
458
363
353

10. Diabetes Death Rate, Belize 2004-2009

11. Frequency of Hospitalization Diagnoses, Belize 2009
Main Condition (583)
Contributing Cause
Cardiovascular Complication %
Peripheral Circulatory Complications
Nephropathy
Essential Hypertension
Others
Insulin Dependent(160) 2 1 25 16 10 58 36 59 37
Non-Insulin Dependent (230) 14 6 68 30 27 12 33 88 38
Other Specified DM (83) 55 66 3 4 17
Unspecified DM (110) 23 21 35 32 47 43
Average 5 26 34 52

12. Frequency of Diabetes Death Diagnoses, Belize 2009
Main Condition (n130)
Contributing Cause
Cardiovascular Complication %
Peripheral Circulatory Complication
Nephropathy
Insulin Dependent (n6) 2 33 4 67
Non-Insulin Dependent (n47) 15 32 3 6 29 62
Other Specified DM (n61) 48 7 11 25 41
Unspecified DM (n16) 19 1 12 75
Average 38 8 18 54

13. Conclusion Diabetes is affecting these sub-groups: Females
65 years and older
Mestizo population
Mostly residents of urban Belize and rural Corozal
Majority dying of preventable conditions- years to develop
Complications are comparable to Central America and the Caribbean (nephropathy, CV complications)

14. Limitations No outpatient/ private clinic data
Sample limited to hospital data
ICD 10 classification- broad
Incomplete description of diagnoses

15. Recommendations Prevention strategies (lifestyle change)
Education and support
Diet and exercise (obesity, diet, hypertension and life style are all reversible and controllable)
Prevention of complications
Supportive services: dialysis, specialist services
Further studies:
Why rural/urban?, cost of the disease

16. Acknowledgements CDC-CAP MOH Ifeoma Adimora Nweke Health Care Workers
National AIDS Program
Epidemiology Unit
Thanks