ArticlesTrends in lifetime risk and years of life lost due to diabetes in the USA, 1985–2011: a modelling study
Introduction
Lifetime risk of diagnosed diabetes for an American born in 2000 is estimated to be 33% for men and 39% for women, whereas the average 50 year old diagnosed with diabetes will lose an estimated 8·8 years of their lifespan.1 Those estimates were the first to be reported for lifetime risk of diabetes, and a subsequent study from Australia reported slightly higher estimates.2 The high lifetime risk of diabetes in the USA reflected the high incidence the disease had attained by the year 2000.3 However, since that time, incidence of diagnosed diabetes in the USA has continued to increase in almost all age, sex, and race and ethnic strata, whereas mortality has declined in the population with and without diabetes.4, 5 Overall increases in new cases of diabetes have been driven mostly by cases diagnosed in middle age and older age, which are likely to be type 2 rather than type 1 disease.3 Similar incidence trends have been reported in Canada, the UK, and Finland, and global prevalence estimates suggest incidence is increasing in most countries worldwide.6, 7, 8, 9 The simultaneous changes in incidence and mortality warrant re-examination of lifetime risk of diabetes and life-years lost due to diabetes. The new availability of long-term mortality data from the National Health Interview Survey (NHIS) now allows the first comprehensive assembly of data for diabetes incidence and mortality risk from a nationally representative study in the USA.10, 11
Estimates of lifetime risk provide a unique and important perspective, and their use is increasingly being encouraged for clinical decision making and to prioritise public health interventions.12 In this study, we used nationally representative diabetes surveillance data to provide updated estimates for the lifetime probability of development of diabetes, and to assess changes in incidence and mortality on lifetime risk and life-years lost due to diabetes in the USA.11
Section snippets
Study design and data sources
We obtained data for diabetes incidence for 1985–2011 from the NHIS, a continuous, yearly cross-sectional, nationally representative health survey of the US non-institutionalised population undertaken by the National Center for Health Statistics of the Centers for Disease Control and Prevention.13 The NHIS uses a multistage probability strategy to sample roughly 75 000 new adults every year. We measured mortality by linking yearly NHIS data to the National Death Index, from the date of NHIS
Results
Our estimates are based on data for 598 216 adults (22 156 per year) sampled between 1985 and 2011. Between 1985–89 and 2000–11, incidence of diagnosed diabetes increased across the three decades in both men and women, with the greatest absolute increases noted in middle-aged and older adults between 1990–99 and 2000–11 (figure 1). For example, in 60–64 year olds, incidence increased from 0·73% (95% CI 0·28–1·18) to 1·65% (1·31–1·99) in men, and from 0·71% (0·32–1·10) to 1·51 (1·24–1·79) in
Discussion
Our findings show that, for the average American born between 2000 and 2011, the probability of developing diagnosed diabetes during life is 40%, substantially higher than previous estimates that were based on incidence and mortality from the 1990s. The increased lifetime risk was driven mainly by the increase in incidence of diagnosed diabetes, and to a lesser extent, the decline in mortality of the general population. During the same time, a large reduction in mortality rates in the US
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