Abstract
Aims/hypothesisThe relative contribution of increasing incidence and declining mortality to increasing prevalence of type 2 diabetes in Scotland is unclear. Trends in incidence and mortality rates are described for type 2 diabetes in Scotland between 2004 and 2013 by age, sex and socioeconomic deprivation.MethodsData for incident and prevalent cases of type 2 diabetes were obtained from the Scottish national diabetes register with number of deaths identified from linkage to mortality records. Population size and death data for Scotland by age, sex and socioeconomic deprivation were obtained from National Records of Scotland. Age- and sex-specific incidence and mortality rates stratified by year and deciles of socioeconomic status were calculated using Poisson models.ResultsThere were 180,290 incident cases of type 2 diabetes in Scotland between 2004 and 2013. Overall, incidence of type 2 diabetes remained stable over time and was 4.88 (95% CI 4.84, 4.90) and 3.33 (3.28, 3.32) per 1000 in men and women, respectively. However, incidence increased among young men, remained stable in young women, and declined in older men and women. Incidence rates declined in all socioeconomic groups but increased after 2008 in the most deprived groups. Standardised mortality ratios associated with diabetes, adjusted for age and socioeconomic group, were 1.38 (1.36, 1.41) in men and 1.49 (1.45, 1.52) in women, and remained constant over time.Conclusions/interpretationIncidence of type 2 diabetes has stabilised in recent years suggesting that increasing prevalence may be primarily attributed to declining mortality. Prevention of type 2 diabetes remains important, particularly among socioeconomically deprived populations.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-016-4054-9) contains peer-reviewed but unedited supplementary material, which is available to authorised users.
Highlights
Changing distribution of population demographic and anthropometric characteristics, improved diabetes detection and survival have contributed to the growing prevalence of type 2 diabetes in high-income countries
Incidence of type 2 diabetes was estimated by age, sex, Scottish Index of Multiple Deprivation (SIMD) decile and calendar year using population denominators based on numbers of people without diabetes, identified by subtraction of the numbers of people with diabetes from total population estimates
There were larger differences in Standardised mortality ratios (SMRs) between the most and least deprived men than for women, for whom SMRs were higher than for men in all SIMD deciles. Using this population-based register of people with diabetes in Scotland, we have reported contemporary rates and trends in type 2 diabetes incidence and mortality between 2004 and 2013 and examined the effect of age, sex and socioeconomic deprivation on these estimates
Summary
Changing distribution of population demographic and anthropometric characteristics, improved diabetes detection and survival have contributed to the growing prevalence of type 2 diabetes in high-income countries. To achieve the greatest reductions in absolute incidence and mortality, interventions need to target the populations at highest risk This requires an understanding of whether trends in incidence and mortality are consistent across age, sex and socioeconomic groups. Previous studies have reported higher incidence and mortality among men and the most deprived socioeconomic groups but contemporary data are lacking, in Scotland [3,4,5]. It is not clear whether the intensification of risk factor management during the last decade among people with type 2 diabetes has reduced disparities in type 2 diabetes mortality across different groups
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