Swiss Re Institute Symposium Insurance at the crossroad of technology development and growth opportunities. 31 October 2017

Transcription

1 Swiss Re Institute Symposium Insurance at the crossroad of technology development and growth opportunities 31 October 2017

2 This event may be photographed, videotaped, filmed and/or recorded. A summary of the event, pictures and/or a video of the event in which you may appear may be posted and made available on Swiss Re s internal and external websites and in printed materials.

3 Afternoon Session 2: Challenges of diabetes Subu Subramanian, Harvard T.H. Chan School of Public Health Christoph Nabholz, Head L&H R&D, Swiss Re

4 Distribution of Diabetes in India S (Subu) V Subramanian, PhD Professor of Population Health and Geography Harvard University SWISS RE INSTITUTE SYMPOSIUM October 31, 2017, Singapore

5 Scientific Collaborators Daniel Corsi, William Joe, Sunil Rajpal, Akshay Swaminathan Partner

6 Outline 1. Distribution of Diabetes Mean differences between population groups (e.g., States, Wealth Groups) Dispersion (between-individuals) within population groups 2. Composition of the diabetics (Wealth groups, and Body Mass Index groups) 3. Coverage Gaps 4. Predicting Diabetes

7 Mean Differences between Groups Data Source: District Level Household and Facility Survey 2013; National Family Health Survey 2015, National Sample Survey Organization 2014

8 Prevalence of diabetes (2015)

9 State-wise prevalence of diabetes (2015)

10 District differences in prevalence of diabetes (2015)

11 Prevalence of diabetes by household wealth (2013) Non fasting Fasting 2 0 Poorest Q2 Q3 Q4 Richest Wealth

12 Prevalence of self-reported diabetes by household income (2013) % % % % 0.47% 0 Lowest Quintile Second Quintile Third Quintile Fourth Quintile Highest Quintile

13 Message 1 Diabetes in India strongly patterned by socioeconomic status, and by geography

14 Between-Individual Differences Data Source: District Level Household and Facility Survey 2013

15 r=0.77 r=0.72

16 Wealth-wise dispersion in blood glucose (2013)

17 Message 2 Richer households have higher mean glucose BUT also have higher variance States/Districts with higher mean glucose also have higher variance

18 Who are the Diabetics? Data Source: District Level Household and Facility Survey 2013; National Sample Survey Organization 2014

19 Distribution of Wealth Status Among Diabetics (>140 mg/dl) 2013 ~70% non-poor

20 Distribution of Wealth Status Among Self-reported Diabetics % non-poor

21 Distribution of BMI categories Among Diabetics (>140 mg/dl) 2013 ~60% High-BMI

22 Message 3 Majority of the diabetics are better-off individuals; characterized by high body mass index

23 Coverage Gaps Data Source: National Sample Survey Organization 2014

24 Percent with insurance (2014) 90 84% % Government Insurance 1% 1% 1% Employer Insurance Household Insurance Other Insurance No Insurance

25 Percent with insurance by income (2014) Insurance Percentage (%) Government supported Employer supported Private purchase Any insurance No insurance Lowest Second Middle Fourth Highest MPCE quintiles

26 Percent without insurance by states (2014) All India MIZORAM ANDHRA PRADESH TELENGANA KERALA CHHATTISGARH NAGALAND RAJASTHAN TAMIL NADU MEGHALAYA ODISHA D & N HAVELI DELHI WEST BENGAL DAMAN & DIU GUJARAT GOA TRIPURA CHANDIGARH KARNATAKA HIMACHAL JAMMU & KASHMIR HARYANA MAHARASHTRA BIHAR PUDUCHERRY PUNJAB ARUNACHAL JHARKHAND UTTAR PRADESH ASSAM SIKKIM MADHYA PRADESH LAKSHADWEEP MANIPUR A & N ISLANDS UTTARANCHAL

27 Insurance Status Among Diabetics 2014

28 Message 4 Huge financial burden on households for health care (for chronic conditions this can lead to substantial reductions in household standard of living)

29 Predicting Diabetes: A Challenge Data Source: District Level Household and Facility Survey 2013; National Family Health Survey 2015

30 Blood Glucose Distribution (2013) Districts Betweenindividuals Betweenpopulation States

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32 Source: Authors calculation from District Level Household and Facility Survey, , Age standardized for adult men and women 18 years of age and older. r=0.55

33 Source: Authors calculation from District Level Household and Facility Survey, , Age standardized for adult men and women 18 years of age and older. r=0.36

34 Source: Authors calculation from District Level Household and Facility Survey, , Age standardized for adult men and women 18 years of age and older. r=0.16

35 r=0.40 r=0.61 % Diabetes and % Overweight (2015)

36 Diet and Cardiovascular Events (RR: 0.80) Cardiovascular Events No Yes Total Diet Mediterranean 4997 Control 2450 Total Estruch, Ramón, et al. "Primary prevention of cardiovascular disease with a Mediterranean diet." New England Journal of Medicine (2013):

37 Diet and Cardiovascular Events (RR: 0.80) Cardiovascular Events No Yes Total Diet Mediterranean (3.5%) 4997 Control 2450 Total Estruch, Ramón, et al. "Primary prevention of cardiovascular disease with a Mediterranean diet." New England Journal of Medicine (2013):

38 Diet and Cardiovascular Events (RR: 0.80) Cardiovascular Events No Yes Total Diet Mediterranean (3.5%) 4997 Control (4.4%) 2450 Total Estruch, Ramón, et al. "Primary prevention of cardiovascular disease with a Mediterranean diet." New England Journal of Medicine (2013):

39 Diet and Cardiovascular Events (RR: 0.80) Cardiovascular Events No Yes Total Diet Mediterranean 4818 Control (62%) 109 (38%) Total Estruch, Ramón, et al. "Primary prevention of cardiovascular disease with a Mediterranean diet." New England Journal of Medicine (2013):

40 Danaei G, Friedman AB, Oza S, Murray CJL, Ezzati M. Diabetes prevalence and diagnosis in US states: analysis of health surveys. Population Health Metrics Sep 25; 7:16 United States

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42 Take Home Message India-wide picture misleading higher socioecnonomic groups (states/individuals) at higher risk 2/3 rd of diabetics are from higher socioeconomic groups Significant unmet need less than 20% have insurance coverage including those from higher socioecnomic groups) Predicting diabetes is challenging (especially at individual level)

43 Thank You