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Abstract
Objectives: We investigated changes in the prevalence of disabilities among individuals with type 2 diabetes and analyzed the contribution of comorbidities on this change. Methods: Data were drawn from the Survey of Health, Ageing, and Retirement in Europe (SHARE). We estimated predicted probabilities of impaired (instrumental) activities of daily living (IADL and ADL) by means of logistic regression. Multivariate decomposition was employed for analyzing the impact of comorbidities on changes in disability rates. Results: Among people with diabetes, ADL difficulties rose significantly from 11.3% (2004) to 19.1% (2015), while IADL difficulties increased among younger diabetics from 11.5% to 18.3%. Decomposition analysis revealed that the parallel increase in comorbidities contributed to the rise in disabilities. Discussion: We found disability rates among people with diabetes in Germany to be increasing over time, pointing toward a growing demand of tertiary prevention for these individuals to maintain functional health and quality of life.
Highlights
Different hypotheses have been proposed to describe the dynamics of health changes in the population within the context of increasing life expectancy
A third hypothesis, the “dynamic equilibrium” postulates that longer survival is associated with an increase of life years in morbidity, but due to medical advances and healthier lifestyles, time spent in severe disability will decline (Manton, 1982)
We aimed to investigate the temporal change of disability prevalence among people with diabetes in Germany by taking changes in comorbidity into account
Summary
Different hypotheses have been proposed to describe the dynamics of health changes in the population within the context of increasing life expectancy. A third hypothesis, the “dynamic equilibrium” postulates that longer survival is associated with an increase of life years in morbidity, but due to medical advances and healthier lifestyles, time spent in severe disability will decline (Manton, 1982). This assumption implies that individuals are able to master everyday life increasingly well in spite of chronic conditions. It is globally estimated that between 1980 and 2014, agestandardized prevalence among adult men doubled and increased by 60% in women (Krug, 2016) These trends were accompanied by large reductions of mortality rates leading to an increasing number of years spent with diabetes (Rowley et al, 2017). The projection of number of future type 2 diabetes cases indicates a relative increase in the number of diabetes cases of between 54% and 77% from 2015 to 2040 (Tonnies et al, 2019)
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