A. Green, C. Sortsø, P.B. Jensen, M. Emneus

Transcription

1 A. Green, C. Sortsø, P.B. Jensen, M. Emneus European Diabetes Epidemiology Group EDEG 2015, Chantilly, April 25-27, 2015

2 The Diabetes Impact Study 2013 uses all available register information on diabetes in Denmark and is initiated to provide An epidemiological characterization of diabetes in Denmark, with scenarios for the projections of the future prevalence An appraisal of the current and future burden of diabetes for patients and societies in terms of costs attributable to diabetes Diabetes Impact Study 2013 is operated on behalf of the Danish Diabetes Association by Institute of Applied Economics and Health Research (ApEHR) Odense Patient data Exploratory Network (OPEN) Centre of Health Economics Research (COHERE)

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4 Danish National DRG/DAGS Register Statistics Denmark Data Bank Employment Income and social data And many other data Danish National Civil Registration System Births Deaths Migrations and moves Danish National Patient Register Danish National Diabetes Register (*) Danish National Health Service Register Danish National Prescription Registry Danish Register of Causes of Death *: Established Assumed to cover all patients with diabetes alive Jan. 1st 1996 and onwards

5 Administrative data (Personal ID, survival status, address) Prescribed drugs in National Prescription Registry Relevant events in National Health Service Register Blood glucose measurements (but no results!) Chiropody Date of diagnosis: Date first diabetes-specific encounter has been registered Date of developing complications: First date a relevant code has been registered

6 PREVALENCE, Minor complications (CS1): MORBIDITY PREVALENCE, Major complications (CS2): MORBIDITY MORTALITY PREVALENCE, No complications (CS0) The size of the boxes provides for estimates of prevalence and patientyears experienced by a calendar year INCIDENCE Population at risk (ie. without diabetes or with undetected diabetes) The model is updated annually based on registered annual transitions between the boxes

7 Minor complications (CS1): Uncompl. AMI Ulcer treatment Amputations below ancle Eye surgery. MORBIDITY MORBIDITY Major complications (CS2): ESRD, Blindness Amputations above ancle. MORTALITY No complications (CS0) INCIDENCE Population at risk (ie. without diabetes or with undetected diabetes) The model is updated annually based on registered annual transitions between the boxes

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9 Note: The huge imbalance between incidence and mortality > doubling in prevalence over 12 years for all complication groups Numbers by complication status (CS) CS0 CS1 CS2 Total Prevalence by the end of ,261 27,061 32, ,465 New cases (incl.) 214,091 29,280 46, ,648 Deaths (incl.) 29,603 19,073 73, ,693 Progressions (incl.) - -> 95,290 -> 72, ,468 Prevalence by the end of ,635 59,813 77, ,624

10 Adjusted rate (per 10,000 person years) 50 CompStatus CompStatus 1 CompStatus Note: Increasing standardized incidence rate regardless of complication status at diagnosis, but most pronounced for persons without evidence of complications Source: Diabetes Impact Study 2013 Year

11 10 9 Adjusted rate (per 100 patient years) 8 7 CompStatus CompStatus Note: Decreasing rate of developing complications, regardless of severity Year Source: Diabetes Impact Study 2013

12 15 Adjusted rate (per 100 patient years) CompStatus 2 Note: Decreasing mortality rates regardless of complication status 10 5 CompStatus 1 Overall CompStatus Source: Diabetes Impact Study 2013 Year

13 400, , , , , , ,000 Prevalence (numbers) Note: Exponentially increasing prevalence regardless of complication status CS0+CS1+ CS2 CS0+ CS1 CS0 50, End of year Source: Diabetes Impact Study 2013

14 The epidemiology of diabetes in Denmark is changing by Increasing incidence Overall, decreasing risk of developing complications Overall, decreasing risik of dying in all complication groups => Exponentially increasing prevalence, even for patients with complications

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16 DIABETES EPIDEMIOLOGY IN DENMARK (App. 5.5 mill. inhabitants) Year 2000 PREVALENCE, end of 1999: 141,465 patients Deaths: DEATHS: 8,314 Incidence: 18,376 Year 2011 PREVALENCE, end of 2011: 306,624 patients Deaths: 11,901 Incidence: 31,821 Note: Doubling in the gap between incidence and mortality over 12 years

17 Driver Contribution to prevalence increase (Numbers) Cumulative numbers % of increase Cumulative % Changes in demography ,956 7, Changes in incidence rates ,201 56, Changes in complication rates ,916 63, Changes in mortality rates ,103 84, Epidemiological disequilibrium (*) 83, , Total 168, , * Epidemiological disequilibrium: Note: The consequence of the imbalance between input (new cases) and output (deaths) for the disease during the specified period Half of the increase in the prevalence from end of 1999 to end of 2011 has been unavoidable being driven by the level of epidemiological disequilibrium at the end of 1999.

18 1,500,000 1,250,000 1,000,000 Prevalence (numbers) Note: The prevalence will continue to increase exponentially This applies regardless of complication status Current doubling time: 15 years CS0+CS1+ CS2 750,000 CS0+ CS1 500,000 CS0 250, End of year Source: Diabetes Impact Study 2013

19 1,500,000 Prevalence (numbers) 1,250,000 Realistic scenario 1,000, , , , End of year Source: Diabetes Impact Study 2013

20 1,500,000 Prevalence (numbers) 1,250,000 Realistic scenario 1,000,000 Incidence rate constant from 2011, otherwise as realistic 750, , , End of year Source: Diabetes Impact Study 2013

21 1,500,000 Prevalence (numbers) 1,250,000 Realistic scenario 1,000,000 Incidence rate constant from 2011, otherwise as realistic 750, , ,000 All rates kept contant from End of year Note: Source: Diabetes Impact Study Prevalence 2013 will increase further for the next many decades This even applies under the unrealistic assumptions of no further increase in incidence and no further improvement in prognosis

22 The epidemiology of diabetes in Denmark is changing by Increasing incidence Overall, decreasing risk of developing complications Overall, decreasing risik of dying in all complication groups => Exponentially increasing prevalence, even for patients with complications The increasing trend in prevalence will continue Even if no further increase in incidence will be seen Even if no further improvements in prognosis will be seen

23 Strengths Long-term coverage of a complete population Data extracted from existing administrative health registers Limitations The Danish National Diabetes Register Is built on existing administrative health data without direct clinical input or validation of diagnosis and complication status May contain up to 20% false-positives (*) No nationwide data available (yet) on HbA1c-measurements Microalbuminuria Readings of retinal photos * Green et al.: Validationof the Danish National Diabetes Register. Clin Epidemiol, 2014

24 Estimating the likely impact on the future prevalence of systematic screening means of primary prevention in diabetes Using epidemiological scenarios for estimating future capacity for managing diabetes and its complications future cost of illness Cross-country collaboration to study the extent to which the drivers of the current and future prevalence are similar and thus generally valid