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DIABETES FACTS

DIABETES IS A CANADIAN PROBLEM

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Diabetes is the sixth leading cause of death in Canada.
Ranking and number of deaths for the 10 leading causes, Canada 2004
  2004
Cause of death rank number
All causes of death ... 226,584
Cancer 1 66,947
Heart diseases 2 52,000
Stroke 3 14,626
Chronic lower respiratory diseases 4 10,041
Accidents (unintentional injuries) 5 8,986
Diabetes 6 7,823
Influenza and pneumonia 7 5,729
Alzheimer's disease 8 5,536
Suicide 9 3,613
Kidney diseases 10 3,541
All other causes ... 47,742

Source
: Statistics Canada. Leading causes of death in Canada, 2000 to 2004 (Catalogue 84-215-X) Ottawa: Statistics Canada, 2008. Available at http://www.statcan.gc.ca/daily-quotidien/081204/t081204c1-eng.htm
Accessed June 15, 2011.
Canada has one of the highest prevalence of diabetes amongst OECD member countries

Ranking and estimates of prevalence of diabetes in the population aged 20-79 years in selected OECD member countries, 2010

  Ranking*
(Age-standardized prevalense [World standard population])
Age-standardized prevalence (%)
(World standard population)**
National prevalence
(%)
Mexico 1 10.8 10.1
USA 2 10.3 12.3
Canada 3 9.2 11.6
Germany 4 8.9 12.0
France 9 6.7 9.4
Australia 14 5.7 7.2
Netherlands 16 5.3 7.7
New Zealand 17 5.2 6.5
Japan 18 5.0 7.3
United Kingdom 19 3.6 4.9
Iceland 20 1.6 2.1

OECD = Organization for Economic Co-operation and Development

* Although there are 30 OECD member countries, some countries had equal age-adjusted prevalence, so in this table of selected countries, the ranking ranges from only 1 to 20. 

** Age-standardized prevalence adjusts the national prevalence to the age profile of the world and is useful for comparing prevalence between nations.

Source: Prevalence of diabetes in OECD countries, 2010. Available at http://www.ecosante.fr/OCDEENG/68.html
Accessed June 21, 2011

Canada has a Chronic Disease Surveillance System that includes diabetes surveillance
The Canadian Chronic Disease Surveillance System (CCDSS) uses population-based administrative data from every province and territory. In each province and territory, the health insurance registry database is linked to physician billing and hospitalization databases
  • An individual is identified as having diagnosed diabetes, if:
    • At least one hospitalization with diagnosis of diabetes; or
    • At least two physician visits with a diagnosis of diabetes within a 2-year period
    • Gestational diabetes mellitus excluded
  • Current national database includes summary data on individuals 1 year or older at time of diabetes diagnosis from all provinces and territories from 1995/96 to 2004/05
  • Age-standardized data are adjusted to 1991 Census data
  • Can’t distinguish between type 1 and type 2
  • Validated methodology
Source:
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011. Available at: http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php?utm_source=Stakeholders&utm_medium=email_eng&utm_campaign= DiabetesReport2011 Accessed January 3, 2012.
The prevalence of diagnosed diabetes in Canada in 2008-2009 was 6.8% (~approximately 2.4 million people).

In 2008–2009, ~2.4 million Canadians aged 1 year or older had diabetes

  • Overall prevalence: 6.8% (N=2,359,252)
    • Males: 7.2% (n=1,238,826)
    • Females: 6.4% (n=1,120,426
  • Age standardized prevalence: 5.6%
  • Prevalence increases with age and increases sharply in middle age:
    • Age 35-39: 2.6%
    • Age 50-54: 8.4%
    • Age 75-79: 25.5%
Source:
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011. Available at: http://www.phac-aspc.gc.ca/cd-mc/publications/DiabetesReport2011 Acessed January 3, 2012

The prevalence of diagnosed diabetes increased by 70% from 1998/99 to 2008/09.
After adjusting for differences in age distributions among the provinces over time, the prevalence increased by 70% between 1998/99 and 2008/09. The prevalence over this time period was higher in men than women, and increased in every age category.

Source:
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011. Available at: http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php?utm_source=Stakeholders& amp;utm_medium=email_eng&utm_campaign=DiabetesReport2011 Accessed January 3, 2012.
The prevalence of diagnosed diabetes varies by province.
Prevalence varies by province, which has implications for human and financial resource planning, for population-based prevention strategies, individual risk factor reduction, screening for diabetes and pre-diabetes, and management.

Province/Territory Prevalence
Newfoundland and Labrador 6.5
Nova Scotia 6.1
Ontario 6.0
New Brunswick 5.9
Manitoba 5.9
Prince Edward Island 5.6
Northwest Territories 5.5
Saskatchewan 5.4
British Columbia 5.4
Yukon 5.4
Quebec 5.1
Alberta 4.9
Nunavut 4.4

Source:
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011. Available at: http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php?utm_source=Stakeholders&utm_medium=email_eng&utm_campaign=DiabetesReport2011 Accessed January 3, 2012.
There are approximately 1.2 million people with diabetes in Ontario.

There are currently an estimated 1.2 million people (8.2% of the population) diagnosed with diabetes in Ontario. This is projected to increase to more than 1.9 million people (11.9% of the population) by 2020.

Source: Canadian Diabetes Association. The Burden of Diabetes in Ontario. September 23, 2010. Available at: http://www.diabetes.ca/get-involved/news/diabetes-cost-model-released-in-ontario/ Accessed June 15, 2011.

The number of Canadians with diabetes is expected to increase to 3.7 million by 2018/19.
If incidence and mortality rates remain stable (at 2008/09 levels), it is estimated that by 2018/19, 3.7 million Canadians will have diabetes.

Source:
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011. Available at: http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php?utm_source=Stakeholders&utm_medium=email_eng&utm_campaign=DiabetesReport2011 Accessed January 3, 2012.

The overall incidence of diabetes in 2008/09 was 6.3 per 1000 people (or 203,018 Canadians).
Among people aged 1 year or older, 203,018 individuals were
given a new diagnosis of diabetes:
  • 6.3 per 1000 individuals
  • 5.7 per 1000 girls/women
  • 6.8 per 1000 boys/men
Rates of new diagnosis of diabetes show a similar trend as prevalence with rates that rise steeply after age 45 and peak among those aged 70–74 for both men and women.

Source:
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011. Available at: http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php?utm_source=Stakeholders&utm_medium=email_eng&utm_campaign=DiabetesReport2011 Accessed January 3, 2012.
Between 2007 and 2017, it is estimated that 1.9 million Canadians (aged 20 and older) will be newly diagnosed with diabetes.
This means that about nine out of every 100 Canadians are predicted to be newly diagnosed with diabetes during the 10-year period.
  • Using a validated Diabetes Population Risk Tool, an individual’s 10-year risk of developing diabetes can be estimated based on that person’s baseline risk factors. The following two case scenarios demonstrate how risk factors greatly affect risk of diabetes.
    • Individual A: Female, 33 years old, BMI=22 kg/m2, no hypertension, white, not immigrant, post-secondary education. Ten-year risk of being diagnosed with diabetes is 1.2%.
    • Individual B: Male, 55 years old, BMI=38 kg/m2, hypertensive, white, does not have heart disease, smoker, less than secondary school education. Ten-year risk of being diagnosed with diabetes is 44%.
Sources:
Manuel DG, Rosella LCA, Tuna M, Bennett C. How many Canadians will be diagnosed with diabetes between 2007 and 2017? Assessing population risk. ICES Investigative Report. Toronto: Institute for Clinical Evaluative Sciences; 2010.
In Ontario from 1995 to 2005, the number of adults with diabetes increased by 113%, while the population grew by only 17%.
The prevalence of diabetes is increasing in Ontario at approximately 6% per year. If this trend continues, more than 10% of adults in Ontario will have diabetes by 2010.

Factors that may have impacted prevalence in Ontario from 1995–2005
  • Longevity: People with and without diabetes are living longer: 25% reduction in standardized mortality from 1995 to 2005.
  • Obesity: In Canada alone, rates have increased by 20 to 30% in the last decade. WHO diabetes prevalence estimates were based on the unwarranted assumption that obesity rates would remain constant.
  • Immigration: Ontario had a 51% increase in immigrants from South Asia from 1995 to 2001.
  • Incidence: Record rise of 31% from 1997 to 2003.
  • Guidelines: Publication of diabetes guidelines may have enhanced screening and detection rates.
The implications . . . The size of the diabetes epidemic is far greater than was anticipated.

Source:
Lipscombe LL, Hux JE. Trends in diabetes prevalence, incidence and mortality in Ontario, Canada 1995–2005: a population-based study. Lancet. 2007;369:750–756.
A number of different factors are impacting on diabetes prevalence and incidence in Canada including:
- An aging population
The prevalence of diabetes begins to increase steadily after the age of about 40. The proportion of senior citizens in Canada’s overall population is increasing.
  • In 2006, seniors accounted for 13.7% of the total population
  • By 2031, seniors will account for ~24% (almost double 2006 levels)
  • By the year 2056, the median age of Canadians will be 45–50 years
  • Guidelines recommend screening for diabetes every 1 to 3 years starting at age 40. Therefore, over half the population will have at least one risk factor (age >40) and should be regularly screened
  • The implications of screening half the population for a single disease are staggering
Aging trends vary by province, with important implications for regional healthcare planning and policy. For example, according to 2006 Census results:
  • Proportion of seniors:
    • National average: 13.5%
    • Saskatchewan: 15.4% (highest)
    • Alberta: 10.7% (lowest)
Sources:
Canadian Diabetes Association Clinical Practices Guidelines Expert Committee. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2008;32(suppl 1) :S1–S201. Available at: http://www.diabetes.ca/for-professionals/resources/2008-cpg/.
Accessed June 15, 2011.

Statistics Canada. Population projections 2005–2031. The Daily. Thursday, December 14, 2005. Available at: http://www.statcan.ca/Daily/
English/051215/d051215b.htm
.
Accessed June 15, 2011.

Statistics Canada. 2006 Census: Age and Sex. The Daily. Tuesday, July 17, 2007. Available at: http://www.statcan.ca/Daily/
English/070717/d070717a.htm
.
Accessed June 15, 2011.
- Increasing immigration from high-risk populations
Most recent immigrants come from high-risk populations
Of immigrants who came to Canada from 2001–2006, approximately 80% were from populations at increased risk of developing diabetes:
  • 58.3% came from Asia
  • 10.6% came from Africa
  • 10.8% came from Central/South America and the Caribbean
Our healthcare system will have to be able to respond to the specific healthcare needs of these populations with culturally and linguistically relevant prevention, screening and management practices. In addition, major metropolitan cities (Toronto, Vancouver, Montreal) are home to the majority of recent immigrants (69%), with implications for local healthcare planning.

Source:
Statistics Canada. The Daily. December 4, 2007. 2006 Census: Immigration, citizenship, language, mobility and migration. Statistics Canada - Cat. No. 11-001-XIE. Available at: http://www.statcan.ca/Daily/
English/071204/td071204.htm
.
Accessed June 15, 2011.

The percentage of foreign-born Canadians is increasing
By 2031, between 25% and 28% of the population could be foreign-born, and between 29% and 32% of the population could belong to a visible minority group, as defined in the Employment Equity Act. This would be nearly double the proportion reported by the 2006 Census. About 55% of this population would be born in Asian countries, which have a very high incidence and prevalence of type 2 diabetes. In addition, Canada’s Black and Filipino populations could double, and Arab and West Asian groups could more than triple. The vast majority of people belonging to a visible minority group will continue to live in Toronto, Montreal and Vancouver.

Source:
Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031. The Daily. Tuesday, March 9, 2010. Catalogue 11-001-XIE ISSN 1205-9137. Available at http://www.statcan.gc.ca/
Accessed June 15, 2011.
- Aboriginal population growth
Type 2 diabetes has reached epidemic proportions among Canadian Aboriginal peoples. The national age-adjusted prevalence is 2.5 to 5 times higher than that of the general population, and age-adjusted prevalence rates as high as 26% have been found in individual communities. Aboriginal peoples are diagnosed with type 2 diabetes at a much younger age, with high rates of diabetes in children and adolescents. Due primarily to a high birth rate, from 1996 to 2003, the Aboriginal population grew by 45%, nearly 6 times the growth rate of non-Aboriginals.

Sources:
Dyck R, Osgood N, Lin TS, Gao A, Stang MR. Epidemiology of diabetes mellitus among First Nations and non-First Nations adults. CMAJ. 2010; 182(3):249-256.

Green C, Blanchard J, Young TK, et al. The epidemiology of diabetes in the Manitoba-registered First Nation population: current patterns and comparative trends. Diabetes Care. 2003;26:1993–1998.

Harris SB, Gittelsohn J, Hanley A, et al. The prevalence of NIDDM and associated risk factors in Native Canadians. Diabetes Care. 1997;20:185–187.

Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr. 2000;136:664–672.

Statistics Canada. Aboriginal population in 2017. The Daily. Tuesday, June 28, 2005. Available at: http://www.statcan.ca/Daily/English/050628/d050628d.htm
Accessed June 15, 2011
- Increasing prevalence of adult and childhood obesity
  • In 2008, 51% of adult Canadians reported being overweight and 17% reporting being obese. (1)
  • From 2003 to 2008, obesity rates were from 16% to 18% in men, and from 15% to 16% in women. The highest rate of obesity (22%) was among 55 to 64 year olds (24% of men and 21% of women). (1)
  • Prevalence of obesity from 1978/79 to 2004 increased from 3% to 8% in boys and girls aged 2–17 years. (2)
  • Between 2007 and 2017, it is estimated that people who are overweight (BMI 25–30 kg/m2) will compromise the greatest number of new cases of diabetes (712,000), even though their baseline risk is lower than for people who are obese (BMI of 30–35 kg/m2) or morbidly obese (BMI >35 kg/m2). This is because there are more Canadians who are overweight than obese. (3)

Sources:

  1. Statistics Canada. Canadian Community Health Survey, 2008. The Daily. Thursday, June 25, 2009. Available at: http://www.statcan.gc.ca/. Accessed June 15, 2011

  2. Lau DCW, Douketis JD, Morrison K, et al; Obesity Canada Clinical Practice Guidelines Expert Panel. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007;176(8 Suppl):S1–13. [For the complete set of guidelines, http://www.cmaj.ca/] Accessed June 15, 2011.

  3. Manuel DG, Rosella LCA, Tuna M, Bennett C. How many Canadians will be diagnosed with diabetes between 2007 and 2017? Assessing population risk. ICES Investigative Report. Toronto: Institute for Clinical Evaluative Sciences; 2010

- Low levels of physical activity
In 2008, only 51% of Canadians reported being at least moderately active during their leisure time. This is equivalent to walking at least 30 minutes a day or taking an hour-long exercise class at least three times a week.

Source:
Statistics Canada. Canadian Community Health Survey, 2008. The Daily. Thursday, June 25, 2009. Available at: http://www.statcan.gc.ca/.
Accessed June 15, 2011.
- Socioeconomic and environmental factors
Canadians living in poverty
  • More than 12% of the working age population lives in poverty
  • People who live in poverty are often unable to meet basic housing, food and security needs, and they have a greater risk of health problems than people who do not live in poverty.
  • Health follows a social gradient: populations in a lower position in the social hierarchy experience, as a group, the worst health
  • Life expectancy in the lowest-income quintile neighborhoods in Canada is 5 years shorter for men and 1.6 years shorter for women than those in the highest-income neighborhoods
Sources:
Canada’s Record on Poverty Among The Worst of Developed Countries—And Slipping. Available at: http://www.conferenceboard.ca/insideedge/2009/october-2009/oct26-how-canada-performs.aspx  
Accessed June 15, 2011.

The Ontario Physicians Poverty Work Group. Why poverty makes us sick. Ontario Medical Review. May 2008:32-37. Available at: http://www.stonegatechc.org/assets/files/Povertyandhealth1.pdf 
Accessed June 15, 2011.

Diabetes disproportionately affects the poor
  • Diabetes is disproportionately clustered:
    • In the lower socioeconomic status quintiles (1)
    • In neighborhoods with lower average household incomes, high proportions of visible minorities and/or recent immigrants (1)

  • In 2007, the self-reported age-standardized diabetes prevalence rate was highest among adults with a household income of less than $20,000 (8%); this rate was double that of the group with an income of $60,000 and over (4%). (2)
  • People in lower income brackets and with fewer years of education also report the following (3) (all of which are risk factors for diabetes):
    • Higher rates of smoking
    • Less physical activity; and
    • Higher rates of overweight
  • People with less than secondary education have more than double the risk of developing diabetes risk compared with people with at least some post-secondary education. (4)
Sources:
Hux JE, Tang M. Patterns of Prevalence and Incidence of Diabetes. In: Hux JE, Booth GL, Slaughter PM, Laupacis A (eds). Diabetes in Ontario: An ICES Practice Atlas: Institute for Clinical and Evaluative Sciences. 2003:1.1–1.18.

Canadian Institute for Health Information. Diabetes Care Gaps and Disparities in Canada December 2009. Available at www.cihi.ca
Accessed June 15, 2011.

Statistics Canada. National Population Health Survey – Household Component Longitudinal, 1998–1999. Ottawa, ON: Statistics Canada; 2000. Available at: http://www.statcan.ca/
Accessed June 15, 2011.

Manuel DG, Rosella LCA, Tuna M, Bennett C. How many Canadians will be diagnosed with diabetes between 2007 and 2017? Assessing population risk. ICES Investigative Report. Toronto: Institute for Clinical Evaluative Sciences; 2010.

The poor are disproportionately affected by some diabetes risk factors

Some risk factors for type 2 diabetes are more common among Canadians in the lowest income quintiles compared with those in the highest income quintiles. These include physical inactivity, inadequate fruit and vegetable consumption, and daily smoking.

Source:
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011. Available at: http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php?utm_source=Stakeholders&utm_medium=email_eng&utm_campaign=DiabetesReport2011 Accessed January 3, 2012.

Socioeconomic status also affects diabetes care

In 2007, people with higher household incomes were more likely to receive an A1C test, a urine test for protein, a dilated eye exam and a foot exam, and to receive all four recommended tests. The age-standardized percentage of adults with diabetes receiving all four recommended care tests was highest in the highest household income group (42%) and lowest in the lowest household income group (21%).

Source:
Canadian Institute for Health Information. Diabetes Care Gaps and Disparities in Canada December 2009. Available at www.cihi.ca Accessed June 15, 2011.

Diabetes:
Did You Know…?

These facts paint a picture of the impact of diabetes on our health, healthcare system and economy.


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