The prevalence of diabetes on the island of Ireland: Application of the PBS Model

Transcription

1 Deleted: The prevalence of diabetes on the island of Ireland: Application of the PBS Model Working Draft January 2006 The Irish Diabetes Prevalence Working Group Ireland and Northern Ireland s Population Health Observatory Institute of Public Health in Ireland HSE logo IPH logo EHSSB logo Rationale for Phase II estimates

2 Preface By who? (two charities? two departments?, HSE?) 2

3 Deleted: The prevalence of diabetes on the island of Ireland: Application of the PBS Model Prepared by Dr. Kevin Balanda Ms Lorraine Fahy Dr. Angela Jordan Dr. Eleanor McArdle On behalf of The Irish Diabetes Prevalence Working Group Ireland and Northern Ireland s Population Health Observatory Institute of Public Health in Ireland HSE logo IPH logo EHSSB logo 3

4 Acknowledgements The Institute of Public Health in Ireland would like to express their appreciation to the Diabetes Prevalence Model (PBS Model) Working Group for allowing us to use their model within Ireland. In particular David Merrick of Yorkshire & Humber Public Health Observatory. We need to also thank the Limerick study group (including Ray Connor and Frank Houghton) and the Analysis and Information Directorate in DHSSPS (Martin Mayock in particular) Vincent Kennedey (IMU) supplied CSA population data Population data was obtained from the Northern Ireland Statistics & Research Agency ( Crown copyright material is reproduced with the permission of the Controller of HMSO. 4

5 Preface Acknowledgements Summary Part 1 An Introduction to Diabetes Contents A Clinical Overview of Diabetes Public Health Dimension of Diabetes The policy context on the island Part 2 Estimating the prevalence of diabetes The importance of good population prevalence estimates Existing estimates on the island of Ireland The PBS Diabetes Population Prevalence Model (PBS DPPM)l Part 3 The prevalence of diabetes in Northern Ireland Data sources in Northern Ireland The prevalence of diabetes in Northern Ireland Undiagnosed cases in Northern Ireland Part 4 The prevalence of diabetes in the Republic of Ireland Data sources in the Republic of Ireland The prevalence of diabetes in the Republic of Ireland Undiagnosed cases in the Republic of Ireland Part 5 Data issues The key data issues Locally available data Analysis of the options Data recommendations Formatted: Bullets and Numbering Formatted: Bullets and Numbering Formatted: Bullets and Numbering Formatted: Bullets and Numbering Formatted: Bullets and Numbering Deleted: Contents Preface Acknowledgements Summary Part 1 An Introduction to Diabetes <#>A Clinical Overview of Diabetes <#>Public Health Dimension of Diabetes <#>The policy context on the island Part 2 Estimating the prevalence of diabetes <#>The importance of good population prevalence estimates <#>Existing estimates on the island of Ireland <#>The PBS Diabetes Population Prevalence Model (PBS DPPM)l Part 3 The Prevalence of diabetes in Northern Ireland <#>Data sources in Northern Ireland <#>The prevalence of diabetes in Northern Ireland Part 4 The prevalence of Diabetes in the Republic of Ireland <#>Data sources in the Republic of Ireland <#>The prevalence of diabetes in the Republic of Ireland Part 5 Data issues <#>The key data issues <#>Locally available data <#>Analysis of the options... [1] 5

6 Appendices Appendix 1. Population estimates Appendix 2. Full prevalence estimates for Northern Ireland Appendix 3. Full prevalence estimates for the Republic of Ireland Appendix 4. Membership of the Irish Diabetes Prevalence Working Group 6

7 SUMMARY An introduction to diabetes Diabetes mellitus is a common chronic illness that can cause significant morbidity and mortality if not well controlled. It is associated with a range of serious complications the treatment of which represents a major cost to the Health and Social Services. The number of people with diabetes is known to be increasing due to population growth, aging and the rising prevalence of obesity. This is particularly evident in type 2 diabetes which is now diagnosed in children in whom it was previously unheard. Good estimates of the population prevalence of diabetes are essential to plan and develop services and to aid allocation of resources. They will also enable better assessment of need and allow the numbers of people with diabetes who remain undiagnosed within an area to be estimated informing awareness raising and screening initiatives. Accurate estimates of population prevalence will aid the implementation of the recommendations from the Taskforces which have been set up on the Island to tackle diabetes. Estimating the prevalence of diabetes The PBS model is a spreadsheet that generates estimates of expected total numbers of cases of diabetes (diagnosed and undiagnosed) at various population levels. It was developed by Brent NHS Primary Care Trust, York and Humber Public health Observatory (YHPHO) and University of Sheffield School of Health and Related Research (ScHARR). Age, sex and ethnic group specific estimates of diabetes prevalence rates, derived from UK epidemiological population studies, are applied to resident populations. Population figures have been taken from the regional census. Key findings Population prevalence of diabetes in Northern Ireland The PBS model estimates that 60,661 people within Northern Ireland have both Type 1 and Type 2 diabetes. This represents 3.6% of the population. 7

8 The model estimates a higher prevalence for women than for men (4.33% compared to 2.90%). As expected prevalence increases significantly with age from 0.3% in 0-29 year olds to 2.9% in year olds and 13.2% in the population over 60 years. The prevalence also varies by ethnic background. Prevalence within the population with a White background is 3.6% compared to 5.6% of the population with a Black background and 8.0% of the population from an Asian background. Prevalence varies slightly across the Health and Social Services Board areas. Prevalence is highest within the Eastern Board at 3.8%. This probably reflects the higher numbers of people from ethnic minority groups and a greater percentage of older people within the Eastern Board. Population prevalence of diabetes in the Republic of Ireland Current census data does not record information regarding a persons ethnicity hence the estimates of diabetes prevalence in the Republic of Ireland assume an all white population thereby implying zero ethnicity. With this assumption, the PBS model, applied to Ireland data, estimates that 126,906 persons have Type 1 and Type 2 diabetes. This represents 3.2% of the population. The model estimates higher prevalence rates for women than men (3.8% compared to 2.7%). Furthermore, estimated prevalence increases significantly with age from 0.3% amongst 0-29 year olds to 2.9% amongst year olds and 13.0% amongst those aged 60 years and over. Prevalence varies across the Health Service Executive regions. Prevalence is highest in the Western Region at 3.5% and lowest in Dublin Mid Leinster Region at 3.0%; this probably reflects corresponding differences in the percentages of older people in these regions as well as the differences in socio-economic deprivation. 8

9 Data recommendations <List our recommendations here including: Ethnicity in Ireland Inclusion of an inequalities (deprivation score for patients) dimension into QOF data in NI Impacts of local socio-economic circumstances in prevalence of diabetes in Ireland> Ethnicity in Ireland Ethnicity is one of the three major components required in the model to estimate diabetes population prevalence. However since persons ethnic background will not be collected until the Census of April 2006, the estimates of diabetes prevalence in Ireland assume an all white population thus ignoring the ethnicity variable. Ethnicity is accounted for in the Census of Northern Ireland. On looking at the prevalence estimates with respect to ethnicity in Northern Ireland, ethnicity does not play a significant role, possibly due to a small ethnic population (0.5% of the total population of Northern Ireland). Hence by implying zero ethnicity to the Ireland population data, this will not have a significant impact on the estimates. Inclusion of an inequalities (deprivation score for patients) dimension into QOF data in NI Impacts of local socio-economic circumstances in prevalence of diabetes in Ireland> Forthcoming work of the Irish Diabetes Prevlence Working Group <Including implied undiagnosed and untreated cases and forecasts> 9

10 PART 1 AN INTRODUCTION TO DIABETES 1.1 A clinical Overview of Diabetes Diabetes Mellitus is a group of metabolic disorders characterised by chronic hyperglycaemia. The body is unable to control the amount of sugar present in the blood due to an absence of insulin or because the body shows resistance to the insulin produced. There are two main types of diabetes: Type 1: Destruction of the beta cells in the pancreas leads to insufficient insulin production. The patients are usually younger and onset can be rapid resulting in an acute emergency admission with ketoacidosis. Type 2: This can range from predominately insulin resistance were the body has reduced sensitivity to circulating insulin to a predominately secretory defect with or without insulin resistance. It usually occurs in older people. Onset is slower than in Type 1 and people may be asymptomatic for years presenting only when complications occur. The pathogenesis of Type 1 diabetes involves environmental triggers that may activate autoimmune mechanisms in genetically susceptible individuals. It accounts for approximately 10-15% of cases of diabetes in European populations i. Type 2 diabetes constitutes approximately 85% of all cases of diabetes in developed countries i. There is an enormous variation in the prevalence of Type 2 diabetes between populations with higher rates in populations with modern as opposed to traditional lifestyles. Different prevalence rates are also seen across different ethnic groups. Whilst there is a genetic susceptibility to Type 2 diabetes it is clear that environmental risks such as nutritional factors, physical activity and central and overall obesity are associated with increased risk. Diabetes is a lifelong condition and can be associated with a range of serious macro and micro vascular complications such as nephropathy, retinopathy and neuropathy (Figure 1). 10

11 Figure 1: Complications of Diabetes Source: Diagram adapted from Audit commission Report - Testing Times The Public Health Dimension of Diabetes <In this section we need to emphasise the importance of early diagnosis and the benefits of proper management, and the the fact that increasing obesity rates will mean diabetes will become more important. These will then set up the context for the WG s next reports> Diabetes mellitus affects large numbers of people and current trends and future predictions suggest that numbers will continue to increase at alarming rates, particularly for Type 2 diabetes iii. This rise is linked to a marked increase in the prevalence of risk factors for Type 2 diabetes such as obesity, as well as changing demographics including aging populations in modern European societies. Type 2 diabetes can however be prevented by lifestyle changes including appropriate diet and exercise and maintaining an ideal body weight. Micro and macro vascular complications can also be prevented or reduced by good control and early detection. Lifestyle choices such as smoking cessation and decreased alcohol consumption also reduce the risk of complications. 11

12 Thus the prevention of Type 2 diabetes and the micro and macro vascular complications of both types of diabetes are essential components of strategies to improve the health of the population. However given the current increase in numbers of people with diabetes, and the predicted explosion of Type 2 diabetes the demand for services is likely to increase and public health departments will need to plan for this. Effective planning, development of services and appropriate resource allocation requires good estimates of population prevalence both regionally and locally. 1.3 The policy context on the island 12

13 PART 2 ESTIMATING THE PREVALENCE OF DIABETES 2.1 The importance of good population prevalence estimates POTENTIAL USES OF THE MODEL The Model has a number of potential uses across the island of Ireland: Strategic Planning The model estimates expected numbers of diagnosed and undiagnosed people with diabetes within various regions. Quantifying the numbers of people with diabetes now and in the future is critical to allow rational planning, development of services and allocation of resources at regional and Health Board level and locally. Taskforces have been set up within Northern Ireland and the Republic of Ireland to tackle diabetes. Accurate estimates of prevalence will aid the implementation of their work at both regional and local level. Needs Assessment Good estimates of population prevalence will allow more accurate assessment of needs within populations and comparison to current service provision. Comparisons to clinical data The model estimates both diagnosed and undiagnosed cases within regions. It may be possible to compare expected numbers to actual recorded numbers of people with diabetes within areas. This will be useful to drive the quality information agenda and to inform the development of awareness raising and screening initiatives USES OF THE MODEL WITHIN ENGLAND The model has become the accepted methodology for generating estimates of population prevalence of diabetes within England. Results have been used within Diabetes-E to generate estimates of expected numbers of people with diabetes within a PCT or practice. The National Clinical Audit Support Programme also uses PBS figures as estimates of expected numbers of people with diabetes within an area and compares these with actual registrations. 2.2 Existing estimates on the island of Ireland <Distinguish diagnosed and undiagnosed cases> 13

14 2.3 The PBS Diabetes Population Prevalence Model (PBS DPPM) INTRODUCTION The PBS model is a spreadsheet which estimates total population prevalence of diabetes, observing both diagnosed & undiagnosed cases. The model applies age/sex/ethnic - group specific estimates of diabetes prevalence rates, derived from UK epidemiological population studies, to resident populations, based on census data. The Model uses population figures from the regional census. No attempt is made to correct for any errors/anomalies. The model was developed by Yorkshire & Humber Public Health Observatory (YHPHO), Brent Primary Care Trust, and University of Sheffield School of Health and Related Research (ScHARR). It allows the user to input data relating to the size of the population, the ethnic group distribution and the age/sex distribution. It then calculates the expected number of people with Type 1 & Type 2 diabetes in the chosen geographical area assuming one third of cases are undiagnosed. The model s prevalence rates are derived from a number of key UK epidemiological studies. No single study could be found that provides diabetes population prevalence rates in all ethnic groups for both Type 1 and Type 2 diabetes. The studies used are listed below. <Include flow chart> REFERENCE STUDIES FOR THE PBS-DPPM 1. Coventry Diabetes Study iii The White and Asian prevalence rates for Type 2 diabetes used in the model were those found in the European White and South Asian populations in the Coventry diabetes study. These rates included those with previously known Type 2 diabetes, as well as newly diagnosed cases of Type 2 diabetes, diagnosed by the Oral Glucose Tolerance Test (OGTT). This study was chosen as it was the only study to report the prevalence of diagnosed and undiagnosed prevalence by age and sex for such a wide range of age groups. The same prevalence figures are used for Indian, Bangladeshi and Pakistani populations as the 1999 Health Survey for England confirms that all these ethnic groups have a similar high prevalence and more detailed ethnic groups estimates by age and sex were not available. 2. London (Brent) Study & Coventry Diabetes Study1 iii Type 2 prevalence rates for Black populations used in the model were those observed in the European white population in the Coventry study, multiplied by (age & sex specific) excess diabetes risk ratios derived from a comparison of Black African-Caribbean and European white populations in a London (Brent) study. 14

15 3. Welsh Study?ref Prevalence rates for Type 1 diabetes (age & sex specific) came from a study in Wales which estimated the prevalence of diagnosed cases. The model assumes that the prevalence of Type 1 diabetes is the same for all ethnic groups UPDATES TO THE REFERENCE STUDIES Two adjustment factors were applied to the Type 2 prevalence rates to reflect the difference in time and place between the Coventry Study ( ) and England Type 2 prevalence rates were downwardly adjusted to reflect the fact that there were higher levels of obesity in Coventry than in England as a whole in Type 2 prevalence rates were then upwardly adjusted using the prevalence of obesity and overweight as a proxy. This reflected the estimated increases in the national Type 2 diabetes rates between the time of the Coventry study and PHASE I ESTIMATES Phase I of the PBS model generated estimates for prevalence of total diabetes (diagnosed and undiagnosed) by age, gender and ethnicity at different geographical levels. The PBS model showed that prevalence was highest among the following three at-risk groups namely, female population, those aged over 60 years, and within the Asian community. Of the three at risk groups age is the most potent with respect to diabetes prevalence PHASE II ESTIMATES (ADJUSTMENT FOR LOCAL DEPRIVATION SCORE Many studies have identified a strong positive association between socioeconomic deprivation and the prevalence of Type 2 diabetes. The Working Group who developed the PBS Model have added an adjustment for socioeconomic status using population weights from the NCASP (National Clinical Audit Support Programme) study. The NCASP study was chosen due to the following factors: it is one of the most recent studies the diabetes prevalence rates are adjusted for age, sex and ethnicity to be representative of the whole England population structure in 2001 it has a large sample size of persons registered with diabetes in comparison with other studies the registers on which the study is based covers areas with diverse demographics 15

16 2.3.7 GENERAL ASSUMPTIONS Several assumptions are made within the Model: Prevalence rates for South Asian & Black populations are similar to those found in Coventry and Brent studies. Obesity levels are assumed to be the same for those observed in England in Rates of Type 1 diabetes are the same for all ethnic groups. The association between diabetes, and obesity & overweight applies across all ethnic groups. The ONS (Office National Statistics) resident population estimates are an accurate representation for each area The model assumes all areas of England have the same age and gender specific prevalence rates of Type 1 diabetes as those found in Welsh study LIMITATIONS FOR USE WITHIN IRELAND The model assumes zero prevalence in childhood and may therefore underestimate prevalence in a younger population. The Coventry study ( ) was undertaken in one of most deprived wards in England, where the rates of obesity were higher for England & Wales. The model has made adjustments for obesity levels and diabetes rates, however these adjustments may not compare with Northern Ireland The classification of diabetes used in the Coventry study is different from that used today and prevalence rates may therefore be underestimated in the PBS model. 16

17 PART 3 THE PREVALENCE OF DIABETES IN NORTHERN IRELAND 3.1 Data sources in Northern Ireland Data Population data from the 2001 census broken down by age, sex and ethnicity NCASP deprivation specific rates Estimates presented at national and sub-national levels, namely Northern Ireland, Local Government District Level and Health Board Locality level See chapter 5 for further explanation of the above data sources 3.2 The prevalence of Diabetes in Northern Ireland <We need to decide what results to put into this section and section 4.2 for Ireland. Can I suggest we include only: The summary you have below The 5 worst and 5 best tables (Do people really expect these? Do these have meaning without any indication of statistical significance?) A map (I think people expect these. Do these have meaning without any indication of statistical significance?) Comparison with any other existing estimates for NI> KEY FINDINGS Table : Prevalence rates in Northern Ireland from PBS model by Health Board Area Northern Ireland Population Persons Male Female Type 1 and Type 2 Estimated Prevalence 0-29 yrs yrs 60+ yrs White Black Asian Other 1,685, % 2.92% 4.25% 0.31% 2.88% 13.23% 3.60% 5.58% 8.01% 1.77% EHSSB 665, % 3.01% 4.49% 0.31% 2.90% 13.36% 3.82% 5.37% 6.33% 1.72% NHSSB 426, % 2.84% 4.04% 0.31% 2.90% 13.16% 3.64% 7.00% 9.90% 1.85% SHSSB 311, % 2.83% 4.09% 0.30% 2.86% 13.13% 3.41% 6.13% 8.13% 1.81% WHSSB 281, % 2.88% 4.08% 0.30% 2.84% 13.10% 3.21% 4.88% 10.26% 1.95% 17

18 Full results are shown in Appendix xx. Key findings are detailed below. The PBS model estimates that 60,661 people within Northern Ireland have both Type 1 and Type 2 diabetes. This represents 3.6% of the population. The model estimates a higher prevalence for women than for men, with 36,706 women estimated to have the disease compared with 23,955 for men. These figures account for 4.3% of the female population compared with 2.9% of the male population. The prevalence of diabetes amongst 0-29 year olds in Northern Ireland is estimated at 0.3% of the population. This rises to 2.9% for the year olds and dramatically increases to 13.2% for the population over the age of 60 years. The age variation in prevalence rates is fairly consistent across the health boards and one can observe how the prevalence increases with age. Ethnic background affects the prevalence of diabetes. 3.6% of the population within Northern Ireland who are of White origin are estimated to suffer from diabetes. This increases to 5.6% of the population from a Black background and further increases to 8.0% from an Asian background. The Eastern Board has the highest prevalence at 3.8%. The remaining three Health Boards have a prevalence of approximately 3.5% for both male and females. The higher prevalence of diabetes within the EHSSB probably reflects higher numbers of people from ethnic minority groups and a greater percentage of older people. Despite the WHSSB having the youngest population it has a high prevalence possibly due to the fact that it is the most deprived of the four Health Boards in Northern Ireland. 18

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20 3.2.2 COMPARISONS WITH OTHER ESTIMATES <Any others?> The prevalence of diabetes within Northern Ireland is less than that in England (3.64% as opposed to 4.4%) (Figure 2) as the NI population is younger and contains lower numbers of people from minority ethnic groups compared with the population of England. 20

21 PART 4. THE PREVALENCE OF DIABETES IN IRELAND 4.1 Data sources in Ireland Population data from 2002 census broken down by age and sex Ethnicity ignored due to data issues NCASP deprivation specific rates Estimates presented at national and sub-national levels, namely Ireland, Health Service Executive Regions, and Community Service Areas See chapter 5 for further explanation of the above data sources 4.2 The prevalence of diabetes in Ireland <We need to decide what results to put into this section and section 3.2 for NI. Can I suggest we include only: The summary you have below The 5 worst and 5 best tables (Do people expect these? Do these really have meaning without any indication of statistical significance?) A map (I think people expect these. Do these really have meaning without any indication of statistical significance?) Comparison with any other existing estimates for Ireland> KEY FINDINGS Table : Prevalence rates in Ireland from PBS model by Health Board (assuming zero ethnicity) Area Population Type 1 and Type 2 Estimated Prevalence Persons Male Female 0-29 yrs yrs 60+ yrs Whit Ireland 3,917, % 2.71% 3.82% 0.32% 2.88% 13.18% 3.27% Dublin Mid Leinster 1,139, % 2.53% 3.62% 0.33% 2.82% 13.23% 3.09% Dublin North East 958, % 2.59% 3.65% 0.33% 2.82% 13.15% 3.12% Southern 877, % 2.85% 4.00% 0.32% 2.93% 13.15% 3.43% Western 941, % 2.92% 4.07% 0.32% 2.97% 13.18% 3.49% 21

22 Ethnicity is one of the three major components required in the model to estimate diabetes population prevalence. However since persons ethnic background will not be collected in the census until April 2006, the estimates of diabetes prevalence in Ireland assume an all white population thus ignoring the ethnicity variable. With this assumption, the PBS model, applied to Ireland data, estimates that 126,906 persons have Type 1 and Type 2 diabetes. This represents 3.2% of the population. The model estimates higher prevalence rates for women than men (3.8% compared to 2.7%). Furthermore, estimated prevalence increases significantly with age from 0.3% amongst 0-29 year olds to 2.9% amongst year olds and 13.0% amongst those aged 60 years and over. Prevalence varies across the Health Service Executive regions. Prevalence is highest in the Western Region at 3.5% and lowest in Dublin Mid Leinster Region at 3.0%; this probably reflects corresponding differences in the percentages of older people in these regions as well as the differences in socio-economic deprivation. 22

23 4.2.2 COMPARISONS WITH OTHER ESTIMATES DIABETES FEDERATION OF IRELAND Diabetes Federation of Ireland carried out a report to give a general overview of the current situation for persons with diabetes in Ireland. The data for the report was collected in November 2003 and therefore reflects any change from the data collected in November 2001 for the Diabetes Care; Securing the Future report Findings of the prevalence of diabetes: The total population of Ireland based on the 2002 census is 3,917,336 persons. The prevalence rate of diabetes internationally is put at 2-7% with the rate for Europe recognised as 6.9%. However, as Ireland has both a larger than average percentage of children and older persons, a truer picture is given by using age groups to work out an Irish prevalence rate. In the 0-25 age group of which population = 1, Prevalence is 0.2% = 2,984 In the age group of which population = 2,150,491 Prevalence is 7.8% = 167,731 In the 75 + age group population = 174,531 Prevalence is 15% = 26,175 Total 196,930 23

24 PART 5 DATA ISSUES 5.1 The key data issues These are: The relevance of the reference studies to the island: The Coventry study ( ) was undertaken in one of most deprived wards in England, where the rates of obesity were higher for England & Wales. The model has made adjustments for obesity levels and diabetes rates, however these adjustments may not compare with Ireland. The classification of diabetes used in the Coventry study is different from that used today and prevalence rates may therefore be underestimated in the PBS model. The definition for the diagnosis of diabetes according to the criteria of the WHO 1985 which was used up to 1997 by clinicians is used in the PBS model. The American Diabetes Association (ADA) revised the definition in 1997 and there are now three different definitions that may be used, namely, WHO 1985 criteria, ADA 1997 criteria, WHO 1999 criteria. If WHO 1999 criteria is increasingly used in the future, overall a small increase in the prevalence may be likely due to the change in definition. Thus studies using WHO 1985 criteria is likely to underestimate prevalence. Population estimates o ethnic minority population estimates o impact of local socio-economic circumstances on the risk of diabetes local deprivation 24

25 5.2 Locally available data There is no alternative to the reference studies for the PBS model available. However the following small studies have been carried out thus can obtain some indication of the prevalence of diabetes: Limerick 280,000 total population (Limerick & Clare) 27 GP s responded (52% response rate) 70,779 estimated practice population Type 1 crude rate = 0.3% Type 2 crude rate (aged under 50 years) = 0.17% Type 2 crude rate (aged over 50 years) = 3.32% Donegal 130,000 total population 13 group practices responded out of single GP s responded out of 11 Type 1 and Type 2 crude rate = 1.33% Type 1 crude rate (all ages) = 0.24% Type 1 crude rate (0-29 years) = 0.07% Type 1 crude rate (30-59 years) = 0.10% Type 1 crude rate (60+ years) = 0.07% Type 2 crude rate = 4.6% Limitations with Limerick data: populations not divided into equal sized population quintiles data broken down by age, however overall there is no age/gender/ethnic profile Nevertheless the Limerick study concludes that diabetes mellitus is related to socio-economic status. The risk is present for both Type 1 and Type 2 25

26 diabetes but the order of magnitude of the increased risk is much higher for the Type 2 disease. Limitations with Donegal data: populations are not divided into equal sized population quintiles have age/gender profile however no ethnic breakdown However one can compare the prevalence of diabetes with respect to deprivation in Donegal with another Community Service Area or county, due to the fact that Donegal is one of the most deprived areas in the country. 26

27 5.3 ETHNICITY Analysis of options In order to apply the PBS model to the island we need to take into account ethnicity and the way prevalence varies with the local deprivation score. The table below summarises the options we had. Table 1: Options for handling ethnicity and deprivation adjustments ETHNICITY ZERO ETHNICITY ETHNICITY (NI) ETHNICITY (IRELAND) Ignore adjustment for deprivation - use Phase 1 estimates Ireland Northern Ireland Ireland DEPRIVATION ADJUSTMENT QOF NCASP Ireland Ireland Northern Ireland Northern Ireland Ireland Ireland Limerick Ireland 27

28 5.4 Details of available data sources Details about the available data sources are given in Table 2. Table 2: Description of available data sources: Data Sources Region Age Diabetes Type Ignore deprivation North & South >= 0 1 & 2 independently QOF North (South?) >= 17 1 & 2 combined NCASP North? / South? >= 0 2 Limerick South (North?) >= 0 1 & 2 independently Limitations of data sources QOF: Does not reflect socio economic variation in the prevalence of diabetes Does not distinguish between Type 1 and Type 2 diabetes No ethnic profile NCASP Data relates to England Limerick Populations not divided into equal sized population quintiles No ethnic profile 28

29 5.5 Sensitivity analysis The impact of these options was explored in a sensitivity analysis involving five areas in Northern Ireland and five areas in the Republic of Ireland.. Table 3: Type 2 prevalence rates in Northern Ireland for each option (ethnicity data has been incorporated) NI ARDS BELFAST COOKSTOWN BANBRIDGE DERRY DEPRIVATION ADJUSTMENT IGNORE ADJUSTMENT (PHASE 1) 3.30% 3.58% 3.55% 2.98% 3.17% 2.68% QOF 3.26% 3.49% 3.57% 2.95% 3.09% 2.70% NCASP 3.26% 3.15% 3.97% 3.13% 2.75% 3.03% Rationale for Phase II estimates

30 Table 4: Type 2 prevalence rates in Northern Ireland for each option (ethnicity data has not been incorporated) NI ARDS BELFAST COOKSTOWN BANBRIDGE DERRY IGNORE ADJUSTMENT (PHASE 1) 3.29% 3.57% 3.54% 2.97% 3.17% 2.66% DEPRIVATION ADJUSTMENT QOF 3.25% 3.48% 3.56% 2.95% 3.09% 2.69% NCASP 3.25% 3.15% 3.95% 3.12% 2.74% 3.01% 30

31 Table 5: Type 2 prevalence rates in the Republic of Ireland for each option ZERO ETHNICITY ETHNICITY INCORPORATED Ireland North Cork Area 02 Cavan Monaghan Tipperary SR Donegal Ireland North Cork Area 02 Cavan Monaghan Tipperary SR Donegal IGNORE ADJUSTMENT (PHASE 1) 2.93% 3.38% 3.12% 3.18% 3.19% 3.14% 2.94% 3.39% 3.14% 3.19% 3.21% 3.15% DEPRIVATION ADJUSTMENT QOF 2.90% 3.32% 3.02% 3.14% 3.18% 3.18% 2.91% 3.33% 3.03% 3.15% 3.20% 3.19% NCASP 2.90% 3.20% 2.56% 3.14% 3.34% 3.67% 2.91% 3.21% 2.56% 3.15% 3.35% 3.68% Limerick 2.90% 3.19% 2.05% 3.26% 3.49% 4.23% The results in Table 5 above include two options, one to omit ethnicity in the prevalence estimates and one to include ethnicity in the prevalence estimates. Since there is no ethnicity data collected in the most recent Census, in order to obtain an ethnic profile for the South, the ethnic profile of the North was mapped to the South, thereby assuming that the North and the South have the same ethnic profile. Thereby the model was ran for both options to see what impact ethnicity, if any, would have on the estimates in the South. As can be seen from table 5, ethnicity has no significant impact on the estimates. Rationale for Phase II estimates

32 5.6 CONCLUSIONS AND RATIONALE Ethnicity Ethnicity is one of the three major components required in the model to estimate diabetes population prevalence. However since persons ethnic background will not be collected until the Census of April 2006, the estimates of diabetes prevalence in Ireland assume an all white population thus ignoring the ethnicity variable. Initially to overcome the lack of ethnic data in Ireland, the ethnic population profile of Northern Ireland was mapped to the population data from Ireland, hence assuming Ireland had the same ethnic profile as Northern Ireland as well as assuming that ethnic minority populations are uniformly distributed across all counties However, the Working group were of the opinion that Northern Ireland and Ireland did not have similar ethnic profiles. Hence it is proposed to ignore ethnicity in the South when obtaining estimates. Even though ethnicity is accounted for in the Census of Northern Ireland, on looking at the prevalence estimates ethnicity does not appear to make a difference in the estimates. From the sensitivity analysis (Tables 3 & 4), by omitting ethnicity in Northern Ireland, the estimates varied by approximately 0.01% - not very significant. This is possibly due to a small ethnic population (0.5% of the total population of Northern Ireland). Hence by implying zero ethnicity to the Ireland population data, this does not appear to have a significant impact on the estimates. 5.7 Deprivation-specific prevalence rates Deprivation is important The NCASP (National Clinical Audit Support Programme) study in England provided evidence of the quantitative relationship between Type 2 diabetes prevalence and socio-economic deprivation. The Limerick study undertook to estimate the effect of a person s socioeconomic status on their chances of having diabetes mellitus. The overall response rate was 52% representing a patient population of 280,000 approximately. The study concluded that the chances of having diabetes mellitus are related to socioeconomic status with the relationship being more marked for type 2 disease. QOF does not appear to make much difference to the estimates - this was apparent from the shallow gradient in the deprivation-specific prevalence rates. Thus, applying the QOF estimates to the model to obtain an adjustment factor made no difference to the overall estimates and suggested no quantitative relationship between Type 2 diabetes prevalence and socio- Draft diabetes prevalence report 28 Dec 2005

33 economic deprivation. This is not unexpected as the range of the adjustment factor was found to be +/-2%. The range of the adjustment factor when using NCASP rates was found to be a more credible +/-18%. As a result this had a significant effect on the prevalence of Type 2 diabetes whereby, adjustment factors greater than 100%, indicating more deprived areas, showed an increased prevalence in the Phase I estimates and adjustment factors less than 100%, indicating more affluent areas, showed a decreased prevalence in the Phase I estimates. Hence one can observe a significant relationship between prevalence of type 2 diabetes and socioeconomic deprivation QOF data is not helpful here Initially QOF (Quality Outcomes Framework) estimates from Northern Ireland were used to obtain deprivation adjustment rates for Northern Ireland as well as for the Republic of Ireland. Similar estimates of prevalence of deprivation cannot be sourced in a similar manner to QOF in the South. QOF assumes that the socioeconomic profile of the diabetes cases is the same as the socioeconomic profile of the practice patients hence there is zero correlation between deprivation and diabetes. Conclusion: It is not possible to use QOF data to estimate the way in which prevalence varies with deprivation score. It was decided to apply the NCASP deprivation-specific rates to the model for Ireland and Northern Ireland rather than using the QOF estimates What to use? QOF does not seem to make much difference to the overall prevalence irrespective of what is done about ethnicity. Thus the alternative is to use the rates from the NCASP study. A number of UK studies were examined as a possible use as the source of deprivation adjustment rates in the PBS model, however the NCASP study was chosen because it was one of the most recent (carried out in 2001) of all the studies looked at as well as having a large sample size. Also the diabetes prevalence rates are adjusted for age, gender and ethnicity such that they are representative of the overall England population structure in The study sampled 57,800 persons with registered diabetes across seven practice registers Some cautionary notes: NCASP study representative of the whole England population structure in 2001 The study covers areas with diverse demographics 33

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35 REFERENCES 1 Oxford textbook 1 Audit commission 1 Coventry study 35

36 APPENDIX 1. POPULATION ESTIMATES Table : Comparisons of the populations of Republic of Ireland & Northern Ireland Gender Age-group Region Persons No. Males No. Females % Males % Females 0-29 yrs yrs 60 REPUBLIC OF IRELAND 3,917,203 1,946,164 1,971, % 50.3% 45.5% 39.4% 1 NORTHERN IRELAND 1,685, , , % 51.3% 43.0% 39.4% 1 Table : Population Breakdown of Republic of Ireland & HSE Regions by Sex & Age Gender Agegroup Region Male Female 0-29 yrs yrs 60+ yrs Republic of Ireland 49.7% 50.3% 45.5% 39.4% 15.1% Dublin Mid Leinster 49.1% 50.9% 46.5% 39.8% 13.7% Dublin North East 49.6% 50.4% 46.5% 39.3% 14.2% Southern 49.9% 50.1% 44.1% 39.7% 16.2% Western 50.2% 49.8% 44.4% 39.0% 16.6% Figure 2 : Comparison of the populations in Northern Ireland and England Category Northern Ireland England Persons 1,685,267 49,138,831 Male 821,449 23,922,144 Female 863,818 25,216, % 37.7% % 41.5% % 20.8% White 99.5% 92.2% Black 0.1% 2.3% Asian 0.2% 4.6% Other 0.3% 0.9% Source: Census data

37 Table : The population of Northern Ireland by Health Board and Local Government District Population by Health Board and Local Government District Area SEX AGE ETHNICITY Persons Male Female 0-29 yrs yrs 60+ yrs White Black Asian Other NORTHERN IRELAND 1,685, , , % 39.4% 17.6% 99.5% 0.1% 0.2% 0.3% EHSSB 665, , , % 39.4% 19.0% 99.2% 0.1% 0.2% 0.5% ARDS 73,242 35,760 37, % 42.9% 18.7% 99.6% 0.0% 0.1% 0.3% BELFAST 277, , , % 36.4% 19.7% 99.0% 0.1% 0.3% 0.6% CASTLEREAGH 66,492 31,674 34, % 42.1% 21.2% 98.9% 0.1% 0.3% 0.7% DOWN 63,837 31,630 32, % 39.5% 17.0% 99.6% 0.1% 0.0% 0.3% LISBURN 108,703 52,985 55, % 41.0% 16.1% 99.5% 0.1% 0.1% 0.3% NORTH DOWN 76,337 36,828 39, % 42.1% 21.1% 99.4% 0.1% 0.2% 0.3% NHSSB 426, , , % 40.4% 17.9% 99.5% 0.0% 0.1% 0.3% ANTRIM 48,368 24,246 24, % 41.7% 14.8% 99.5% 0.1% 0.2% 0.3% BALLYMENA 58,612 28,580 30, % 41.0% 19.3% 99.6% 0.0% 0.1% 0.2% BALLYMONEY 26,894 13,327 13, % 39.7% 18.0% 99.7% 0.0% 0.1% 0.2% CARRICKFERGUS 37,648 18,231 19, % 42.1% 17.7% 99.5% 0.0% 0.1% 0.4% COLERAINE 56,313 26,877 29, % 39.4% 19.2% 99.4% 0.1% 0.2% 0.3% COOKSTOWN 32,565 16,176 16, % 38.0% 15.6% 99.7% 0.0% 0.0% 0.2% LARNE 30,845 15,126 15, % 42.2% 19.8% 99.8% 0.0% 0.1% 0.1% MAGHERAFELT 39,791 20,044 19, % 37.8% 15.2% 99.6% 0.0% 0.2% 0.2% MOYLE 15,948 7,835 8, % 39.0% 19.6% 99.8% 0.0% 0.1% 0.1% NEWTOWNABBEY 79,985 38,654 41, % 40.9% 18.9% 99.2% 0.1% 0.2% 0.5% SHSSB 311, , , % 39.1% 16.5% 99.7% 0.0% 0.1% 0.2% ARMAGH 54,273 26,930 27, % 38.7% 16.6% 99.8% 0.0% 0.0% 0.1% BANBRIDGE 41,371 20,697 20, % 41.1% 16.8% 99.8% 0.0% 0.0% 0.1% CRAIGAVON 80,657 39,747 40, % 40.1% 17.1% 99.4% 0.0% 0.3% 0.3% DUNGANNON 47,732 23,624 24, % 37.6% 16.7% 99.7% 0.1% 0.1% 0.2% NEWRY AND MOURNE 87,063 43,097 43, % 38.1% 15.7% 99.8% 0.0% 0.0% 0.1% WHSSB 281, , , % 38.4% 15.1% 99.6% 0.1% 0.1% 0.2% DERRY 105,070 51,136 53, % 38.0% 13.6% 99.5% 0.1% 0.2% 0.2% FERMANAGH 57,539 28,829 28, % 39.2% 18.1% 99.7% 0.1% 0.1% 0.1% LIMAVADY 32,429 16,501 15, % 39.2% 13.6% 99.5% 0.3% 0.0% 0.2% OMAGH 47,941 24,020 23, % 38.2% 15.4% 99.7% 0.0% 0.1% 0.1% STRABANE 38,246 19,129 19, % 38.1% 15.9% 99.8% 0.0% 0.1% 0.1% <What about LHSCG? What about RoI?> 37

38 Table : The population of Northern Ireland by Health Board and Health Board Locality Population by Health Board and Health Board Locality SEX AGE ETHNICITY Persons Male Female 0-29 yrs yrs 60+ yrs White Black Asian AREA Northern Ireland 1,685, , , % 39.4% 17.6% 99.5% 0.1% 0.2% EHSSB 665, , , % 39.4% 19.0% 99.2% 0.1% 0.2% Ards 73,242 35,760 37, % 42.9% 18.7% 99.6% 0.0% 0.1% Down 63,837 31,630 32, % 39.5% 17.0% 99.6% 0.1% 0.0% Lisburn 108,703 52,985 55, % 41.0% 16.1% 99.5% 0.1% 0.1% North Down 76,337 36,828 39, % 42.1% 21.1% 99.4% 0.1% 0.2% North & West Belfast 143,534 67,306 76, % 36.2% 19.3% 99.5% 0.1% 0.2% South & East Belfast 200,345 94, , % 38.4% 20.4% 98.6% 0.1% 0.3% NHSSB 426, , , % 40.4% 17.9% 99.5% 0.0% 0.1% Antrim&Ballymena 106,980 52,826 54, % 41.3% 17.3% 99.5% 0.1% 0.2% Causeway 99,155 48,039 51, % 39.4% 18.9% 99.6% 0.1% 0.1% East Antrim 148,478 72,011 76, % 41.5% 18.8% 99.4% 0.0% 0.2% Mid-Ulster 72,356 36,220 36, % 37.9% 15.4% 99.7% 0.0% 0.1% SHSSB 311, , , % 39.1% 16.5% 99.7% 0.0% 0.1% Armagh & Dungannon 102,005 50,554 51, % 38.2% 16.6% 99.7% 0.0% 0.1% Craigavon & Banbridge 122,028 60,444 61, % 40.4% 17.0% 99.5% 0.0% 0.2% Newry & Mourne 87,063 43,097 43, % 38.1% 15.7% 99.8% 0.0% 0.0% WHSSB 281, , , % 38.4% 15.1% 99.6% 0.1% 0.1% Northern Group 162,270 79,866 82, % 38.3% 13.8% 99.5% 0.1% 0.2% Southern Group 118,955 59,749 59, % 38.6% 17.0% 99.7% 0.0% 0.1% 38

39 Table : The population of Ireland by HSE Region and Community Service Area Population by HSE Region and Community Service Area SEX AGE ETHNICITY Persons Male Female 0-29 yrs yrs 60+ yrs White AREA Republic of Ireland 3,917,203 1,946,164 1,971, % 39.4% 15.1% 100.0% Dublin Mid Leinster 1,139, , , % 39.8% 13.7% 100.0% Area ,814 60,842 67, % 39.7% 18.1% 100.0% Area ,068 49,681 55, % 39.4% 16.3% 100.0% Area ,493 62,940 67, % 38.7% 13.1% 100.0% Area ,765 70,965 74, % 38.6% 13.1% 100.0% Area ,747 61,981 63, % 40.1% 10.2% 100.0% Kildare 178,515 90,138 88, % 41.7% 9.9% 100.0% Laois/Offaly 122,437 62,316 60, % 39.1% 15.2% 100.0% Longford/Westmeath 102,926 51,754 51, % 39.1% 15.6% 100.0% Wicklow 100,105 49,397 50, % 41.2% 13.9% 100.0% Dublin North East 958, , , % 39.3% 14.2% 100.0% Area ,919 77,063 80, % 38.8% 12.4% 100.0% Area ,075 60,261 64, % 36.4% 17.1% 100.0% Area , , , % 40.5% 13.1% 100.0% Cavan/Monaghan 109,139 55,821 53, % 38.4% 16.9% 100.0% Louth 101,821 50,489 51, % 39.2% 14.1% 100.0% Meath 134,005 67,733 66, % 41.3% 12.0% 100.0% Carlow/Kilkenny 126,353 63,943 62, % 39.6% 15.1% 100.0% Southern 877, , , % 39.7% 16.2% 100.0% Kerry 132,527 66,572 65, % 40.5% 18.3% 100.0% North Cork 73,511 37,103 36, % 39.8% 18.0% 100.0% North Lee 149,833 74,950 74, % 39.9% 13.5% 100.0% South Lee 173,682 84,493 89, % 39.1% 14.8% 100.0% Tipperary (S.R.) 79,121 39,999 39, % 39.6% 16.9% 100.0% Waterford 101,546 50,672 50, % 39.1% 16.2% 100.0% West Cork 50,803 25,771 25, % 39.9% 20.1% 100.0% Wexford 116,596 58,170 58, % 39.6% 16.0% 100.0% Western 941, , , % 39.0% 16.6% 100.0% Clare 103,277 52,063 51, % 40.8% 16.0% 100.0% Donegal 137,575 69,016 68, % 38.1% 16.8% 100.0% Galway 209, , , % 38.4% 15.2% 100.0% Limerick 175,304 87,631 87, % 38.4% 14.9% 100.0% Mayo 117,446 59,149 58, % 39.2% 19.1% 100.0% Roscommon 53,774 27,583 26, % 39.7% 19.9% 100.0% Sligo/Leitrim 83,999 42,095 41, % 39.4% 18.4% 100.0% Tipperary (N.R.) 61,010 30,864 30, % 39.5% 17.5% 100.0% 39

40 APPENDIX 2. FULL PREVALENCE ESTIMATES FOR NORTHERN IRELAND Estimates of population prevalence of Type 1 and Type 2 diabetes - LGD Type 1 + Type 2 Area Estimated Number Estimated Prevalence Persons Male Female Persons Male Female yrs yrs yrs White Black Asian Other ni 60,666 23,957 36, % 2.92% 4.25% 0.31% 2.88% 13.23% 3.6% 5.6% 8.0% 1.8% EHSSB 25,195 9,586 15, % 3.01% 4.49% 0.31% 2.90% 13.36% 3.8% 5.4% 6.3% 1.7% ARDS 2,559 1,027 1, % 2.87% 4.09% 0.31% 3.01% 13.19% 3.9% 6.7% 3.4% 1.5% BELFAST 11,919 4,320 7, % 3.33% 5.15% 0.33% 2.87% 13.49% 3.8% 5.3% 6.0% 1.7% CASTLEREAGH 2, , % 2.89% 4.18% 0.29% 2.81% 13.35% 4.1% 6.6% 7.3% 1.6% DOWN 2, , % 2.71% 3.94% 0.30% 2.89% 13.16% 3.5% 5.1% 10.3% 2.0% LISBURN 3,467 1,387 2, % 2.62% 3.73% 0.30% 2.83% 13.15% 3.4% 5.5% 7.1% 2.0% NORTH DOWN 2,757 1,051 1, % 2.85% 4.32% 0.31% 3.08% 13.47% 4.2% 4.9% 7.2% 2.3% NHSSB 14,742 5,939 8, % 2.84% 4.04% 0.31% 2.90% 13.16% 3.6% 7.0% 9.9% 1.8% ANTRIM 1, % 2.57% 3.57% 0.30% 2.82% 12.99% 3.2% 8.9% 7.8% 2.2% BALLYMENA 2, , % 2.90% 4.16% 0.31% 2.95% 13.20% 3.9% 1.2% 10.2% 2.8% BALLYMONEY % 2.92% 4.21% 0.30% 2.86% 13.19% 3.6% 10.5% 14.3% 1.4% CARRICKFERGUS 1, % 2.69% 3.83% 0.30% 2.82% 13.23% 3.7% 7.6% 7.5% 1.7% COLERAINE 2, , % 2.99% 4.22% 0.31% 2.95% 13.18% 3.8% 9.9% 10.0% 2.0% COOKSTOWN 1, % 2.87% 4.05% 0.30% 2.90% 13.09% 3.3% 0.0% 16.8% 2.7% LARNE 1, % 3.11% 4.43% 0.30% 2.95% 13.15% 4.0% 3.2% 8.2% 2.7% MAGHERAFELT 1, % 2.44% 3.42% 0.30% 2.81% 13.05% 3.2% 4.7% 13.3% 1.9% MOYLE % 3.39% 4.95% 0.30% 3.03% 13.21% 3.9% 6.0% 6.9% 4.6% NEWTOWNABBEY 2,795 1,111 1, % 2.87% 4.08% 0.31% 2.90% 13.21% 3.8% 7.0% 8.9% 1.5% SHSSB 10,784 4,361 6, % 2.83% 4.09% 0.30% 2.86% 13.13% 3.4% 6.1% 8.1% 1.8% ARMAGH 1, , % 2.74% 3.94% 0.30% 2.91% 13.17% 3.4% 3.5% 12.3% 1.4% BANBRIDGE 1, % 2.52% 3.65% 0.30% 2.80% 13.08% 3.5% 1.9% 6.4% 3.3% Draft diabetes prevalence report 28 Dec 2005

41 CRAIGAVON 2,889 1,158 1, % 2.91% 4.23% 0.30% 2.85% 13.13% 3.5% 4.4% 7.1% 1.7% DUNGANNON 1, % 2.83% 4.10% 0.30% 2.89% 13.16% 3.4% 6.4% 9.1% 1.4% NEWRY AND 3.60% 2.95% 4.23% 0.30% 2.84% 13.12% 3.3% 11.5% 9.8% 1.6% MOURNE 3,131 1,271 1,861 WHSSB 9,797 4,025 5, % 2.88% 4.08% 0.30% 2.84% 13.10% 3.2% 4.9% 10.3% 2.0% DERRY 3,543 1,428 2, % 2.79% 3.92% 0.31% 2.79% 13.10% 3.0% 5.5% 9.6% 2.1% FERMANAGH 2, , % 3.01% 4.30% 0.30% 2.97% 13.18% 3.7% 9.0% 10.0% 1.7% LIMAVADY % 2.57% 3.60% 0.31% 2.78% 13.03% 3.0% 1.8% 26.0% 1.3% OMAGH 1, % 2.75% 3.95% 0.30% 2.87% 13.14% 3.3% 4.8% 11.2% 2.5% STRABANE 1, % 3.31% 4.66% 0.30% 2.84% 12.99% 3.3% 13.8% 10.1% 2.4% 41

42 Estimates of the population prevalence of type 2 diabetes - LGD Area Type 2 Estimated Number Estimated Prevalence Persons Male Female Persons Male Female NORTHERN 55,003 20,748 34, % 2.53% 3.97% IRELAND EASTERN 22,970 8,344 14, % 2.62% 4.21% ARDS 2, , % 2.47% 3.80% BELFAST 11,003 3,822 7, % 2.94% 4.86% CASTLEREAGH 2, , % 2.49% 3.90% DOWN 1, , % 2.32% 3.66% LISBURN 3,098 1,179 1, % 2.23% 3.44% NORTH DOWN 2, , % 2.46% 4.04% NORTHERN 13,299 5,115 8, % 2.45% 3.76% ANTRIM 1, % 2.17% 3.28% BALLYMENA 1, , % 2.51% 3.88% BALLYMONEY % 2.52% 3.93% CARRICKFERGUS 1, % 2.29% 3.54% COLERAINE 1, , % 2.60% 3.94% COOKSTOWN 1, % 2.48% 3.76% LARNE 1, % 2.71% 4.15% MAGHERAFELT 1, % 2.05% 3.13% MOYLE % 3.00% 4.67% NEWTOWNABBEY 2, , % 2.48% 3.79% SOUTHERN 9,739 3,760 5, % 2.44% 3.81% ARMAGH 1, , % 2.35% 3.66% BANBRIDGE 1, % 2.13% 3.37% CRAIGAVON 2,617 1,002 1, % 2.52% 3.95% DUNGANNON 1, % 2.44% 3.82% NEWRY AND 2,841 1,105 1, % 2.56% 3.95% MOURNE WESTERN 8,848 3,482 5, % 2.49% 3.79% DERRY 3,188 1,230 1, % 2.41% 3.63% FERMANAGH 1, , % 2.62% 4.02% LIMAVADY % 2.17% 3.31% OMAGH 1, % 2.36% 3.67% STRABANE 1, % 2.92% 4.38% Draft diabetes prevalence report 28 Dec 2005

43 Estimates of the population prevalence of Type 1 diabetes - LGD Area Type 1 Estimated Number Estimated Prevalence Persons Male Female Persons Male Female NORTHERN 5,663 3,209 2, % 0.39% 0.28% IRELAND EASTERN 2,226 1, % 0.39% 0.28% ARDS % 0.40% 0.28% BELFAST % 0.38% 0.28% CASTLEREAGH % 0.39% 0.28% DOWN % 0.39% 0.28% LISBURN % 0.39% 0.29% NORTH DOWN % 0.40% 0.28% NORTHERN 1, % 0.39% 0.28% ANTRIM % 0.40% 0.29% BALLYMENA % 0.39% 0.28% BALLYMONEY % 0.39% 0.28% CARRICKFERGUS % 0.40% 0.29% COLERAINE % 0.39% 0.28% COOKSTOWN % 0.38% 0.29% LARNE % 0.40% 0.28% MAGHERAFELT % 0.39% 0.28% MOYLE % 0.39% 0.28% NEWTOWNABBEY % 0.40% 0.29% SOUTHERN 1, % 0.39% 0.28% ARMAGH % 0.39% 0.28% BANBRIDGE % 0.40% 0.29% CRAIGAVON % 0.39% 0.28% DUNGANNON % 0.39% 0.28% NEWRY AND % 0.39% 0.28% MOURNE WESTERN % 0.39% 0.29% DERRY % 0.39% 0.29% FERMANAGH % 0.39% 0.28% LIMAVADY % 0.40% 0.29% OMAGH % 0.39% 0.28% STRABANE % 0.39% 0.28% 43