Increasing incidence and prevalence with limited survival gains among rural Albertans with diabetes: a retrospective cohort study, 1995 - 2006

Abstract

Objective To compare recent trends of diabetes prevalence, incidence and mortality between men and women living in urban and rural Alberta, Canada. Methods We tracked population trends in diabetes in adults based on diagnostic codes from provincial administrative health records from 1995 to 2006. Location of residence was defined by registered postal codes. Sex-stratified logistic regression with interactions was used to compare increases in rates over the past decade by location of residence, adjusting for age. Results Men in rural residences had the greatest increases in prevalence, at 61%, from 3.6 per 100 in 1995 to 5.8 per 100 in 2006, compared with a 55% increase in urban men, from 3.9 per 100 in 1995 to 6.0 per 100 in 2006 (P < 0.001). Diabetes incidence in rural men increased 61% while urban men had a similar increase of 59% (P = 0.177). Incidence was lower in women in both urban and rural locations, at 5.6 and 5.3 per 1000 in 2006. Overall, mortality rates decreased by 34% for urban men and 8% for rural men with diabetes (P = 0.006). Women with diabetes in rural areas had no decline in overall mortality, compared with a 28% reduction in urban women (P < 0.001). Conclusions Diabetes prevalence remains highest in men, with the greatest increases seen in men living in rural residences. While mortality rates have declined substantially over the past decade for those people with diabetes living in urban settings, declines in mortality in rural areas have been much more modest (for men) or non-existent (for women).