Diabetes Prevalence in Sweden at Present and Projections for Year 2050

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Abstract

Background

Data on the future diabetes burden in Scandinavia is limited. Our aim was to project the future burden of diabetes in Sweden by modelling data on incidence, prevalence, mortality, and demographic factors.

Method

To project the future burden of diabetes we used information on the prevalence of diabetes from the national drug prescription registry (adults ≥20 years), previously published data on relative mortality in people with diabetes, and population demographics and projections from Statistics Sweden. Alternative scenarios were created based on different assumptions regarding the future incidence of diabetes.

Results

Between 2007 and 2013 the prevalence of diabetes rose from 5.8 to 6.8% in Sweden but incidence remained constant at 4.4 per 1000 (2013). With constant incidence and continued improvement in relative survival, prevalence will increase to 10.4% by year 2050 and the number of afflicted individuals will increase to 940 000. Of this rise, 30% is accounted for by changes in the age structure of the population and 14% by improved relative survival in people with diabetes. A hypothesized 1% annual rise in incidence will result in a prevalence of 12.6% and 1 136 000 cases. Even with decreasing incidence at 1% per year, prevalence of diabetes will continue to increase.

Conclusion

We can expect diabetes prevalence to rise substantially in Sweden over the next 35 years as a result of demographic changes and improved survival among people with diabetes. A dramatic reduction in incidence is required to prevent this development.

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Most cited references 10

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The Danish National Diabetes Register: trends in incidence, prevalence and mortality.

, B Carstensen, P Ottosen … (2008)

The aim of the study was to describe trends in the incidence rate, prevalence and mortality rate for diabetes in Denmark. Healthcare registers at the National Board of Health were used to compile a register of diabetic patients in the Danish population (5.4 million people). Age- and sex-specific prevalence, incidence rates, mortality rates and standardised mortality ratios relative to the non-diabetic part of the population were calculated. The register contains records for about 360,000 persons with diabetes; 230,000 were alive at 1 January 2007, corresponding to an overall prevalence of 4.2%. The prevalence increased by 6% per year. In 2004 the incidence rates were 1.8 per 100,000 at age 40 years and 10.0 per 100,000 at age 70 years. The incidence rate increased 5% per year before 2004 and then stabilised. The mortality rate in the diabetic population decreased 4% per year, compared with 2% per year in the non-diabetic part of the population. The mortality rate decreased 40% during the first 3 years after inclusion in the register. The standardised mortality ratio decreased with age, from 4.0 at age 50 years to 2.5 at age 70 years and just under 2 at age 85 years, identically for men and women. The standardised mortality ratio decreased 1% per calendar year. The lifetime risk of diabetes was 30%. The prevalence of diabetes in Denmark rose in 1995-2006, but the mortality rate in diabetic patients decreased faster than that of the non-diabetic population. The mortality rate decreased markedly just after inclusion in the register. Incidence rates have shown a tendency to decrease during the last few years, but this finding should be viewed with caution.

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Trends in Death Rates Among U.S. Adults With and Without Diabetes Between 1997 and 2006

Edward Gregg, Yiling J Cheng, Sharon H. Saydah … (2012)

OBJECTIVE To determine whether all-cause and cardiovascular disease (CVD) death rates declined between 1997 and 2006, a period of continued advances in treatment approaches and risk factor control, among U.S. adults with and without diabetes. RESEARCH DESIGN AND METHODS We compared 3-year death rates of four consecutive nationally representative samples (1997–1998, 1999–2000, 2001–2002, and 2003–2004) of U.S. adults aged 18 years and older using data from the National Health Interview Surveys linked to National Death Index. RESULTS Among diabetic adults, the CVD death rate declined by 40% (95% CI 23–54) and all-cause mortality declined by 23% (10–35) between the earliest and latest samples. There was no difference in the rates of decline in mortality between diabetic men and women. The excess CVD mortality rate associated with diabetes (i.e., compared with nondiabetic adults) decreased by 60% (from 5.8 to 2.3 CVD deaths per 1,000) while the excess all-cause mortality rate declined by 44% (from 10.8 to 6.1 deaths per 1,000). CONCLUSIONS Death rates among both U.S. men and women with diabetes declined substantially between 1997 and 2006, reducing the absolute difference between adults with and without diabetes. These encouraging findings, however, suggest that diabetes prevalence is likely to rise in the future if diabetes incidence is not curtailed.

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The incidence of diabetes among 0–34 year olds in Sweden: new data and better methods

Araz Rawshani, Mona Landin-Olsson, Ann-Marie Svensson … (2014)

Aims/hypothesis We reassessed the validity of previously reported incidence rates for type 1 diabetes in 0–34 year olds in Sweden. We estimated new incidence rates through three nationwide registers. Methods We used capture–recapture methods to assess ascertainment in the Diabetes Incidence Study in Sweden (DISS) and estimated incidence rates in the 20–34 year age group for 2007–2009. We examined whether incidence rates in patients aged 34 and younger could be estimated through the Prescribed Drug Register (PDR) via a proxy for diagnosis of type 1 diabetes; men with at least one and women with at least three prescriptions for insulin were included if they had not been given oral glucose-lowering drugs. We scrutinised the proxy by comparing incidence rates in patients aged 14 and younger with the Swedish Childhood Diabetes Register (SCDR), which has 95–99% ascertainment, and by assessing diabetes type among 18–34 year olds in the National Diabetes Register (NDR). Results Incidence rates were two to three times higher than previously reported. The absolute number of cases (2007–2009, age 20–34) was 435 in the DISS, 923 in the NDR, 1,217 in the PDR, 1,431 in all three and 1,617 per the capture–recapture method. Ascertainment in the DISS was ~29% for 2007–2009. The proxy diagnosis in the PDR was highly reliable, while the capture–recapture method presumably generated an overestimate. Conclusions/interpretation The incidence of type 1 diabetes in patients aged 34 and younger was two to three times higher than previously reported. The PDR can be used to reliably assess incidence rates in this age group. Electronic supplementary material The online version of this article (doi:10.1007/s00125-014-3225-9) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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Author and article information

Contributors

Andrea Icks: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 30 November 2015

Publication date Collection: 2015

Volume: 10

Issue: 11

Electronic Location Identifier: e0143084

Affiliations

[1 ]Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

[2 ]Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden

Heinrich-Heine University, Faculty of Medicine, GERMANY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Analyzed the data: TA. Wrote the paper: TA AA SC.

* E-mail: Sofia.carlsson@ 123456ki.se

Article

Publisher ID: PONE-D-15-10780

DOI: 10.1371/journal.pone.0143084

PMC ID: 4664416

PubMed ID: 26619340

SO-VID: e62ca59c-cab3-4b2b-af6e-e9cd2609682c

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 11 March 2015

Date accepted : 2 November 2015

Page count

Figures: 3, Tables: 2, Pages: 10

Funding

The authors have no support or funding to report.

Custom metadata

Data Availability The analysis are based on publicly available data from the Swedish prescription registry: http://www.socialstyrelsen.se/statistik/statistikdatabas/lakemedel.

Diabetes Prevalence in Sweden at Present and Projections for Year 2050

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Most cited references 10

The Danish National Diabetes Register: trends in incidence, prevalence and mortality.

Trends in Death Rates Among U.S. Adults With and Without Diabetes Between 1997 and 2006

The incidence of diabetes among 0–34 year olds in Sweden: new data and better methods

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