Research articleChanges in Incidence of Diabetes in U.S. Adults, 1997–2003
Introduction
Recent national survey data indicate that the prevalence and incidence of self-reported diagnosed diabetes is increasing in the United States.1 These trends could be a function of several major factors, including recent changes to the diagnostic criteria for diabetes,2 enhanced case detection, increasing survival among prevalent cases, change in demographics of the U.S. population, and a true increase in disease incidence. Each of these factors could change the characteristics of incident cases and eventually change the characteristics of the population of people with diagnosed diabetes. Although the probable impact of new diagnostic criteria on the phenotype of incident cases in the United States has not been well studied, a recent European study suggested that shifting from oral glucose tolerance tests to fasting glucose tests to diagnose diabetes may be more likely to diagnose diabetes in younger people and those who are obese.3 Similarly, enhanced case detection could yield a healthier and younger diabetic population by detecting diabetes among younger people and earlier in the course of their disease, before complications develop. In addition, obesity, a major risk factor for diabetes, is increasing in the United States,4, 5 and could result in a true increase in diabetes incidence, as well as an increase in the number of incident cases who are obese. Further, the prevalence of obesity in incident cases may have increased if, as a recent study suggests, enhanced detection of diabetes is occurring in the most obese individuals (those with a body mass index [BMI] of 35 kg/m2 or more).6
Limitations of national surveillance systems prevent the examination of whether true incidence has changed, as this would require repeated physiological measures on a national representative sample. However, closer examination of whether the characteristics of newly diagnosed cases of diabetes have changed could provide additional clues to the factors most responsible for the diabetes epidemic, while at the same time providing information to public health decision makers to help them effectively manage the growing population with diabetes. Thus, the purpose of this study was to use nationally representative data to examine recent trends in the incidence of self-reported diagnosed diabetes and whether the characteristics of incident cases have changed. Factors associated with the incidence of diagnosed diabetes among U.S. adults were also identified.
Section snippets
Methods
Data from the National Health Interview Survey (NHIS) in 1997 through 2003 of the National Center for Health Statistics, Centers for Disease Control and Prevention, were used to perform the analyses. Using a multistage cluster sample design, the NHIS surveys the non-institutionalized, civilian U.S. population each year to provide health and risk factor information.7 A major redesign of NHIS implemented in 1997 resulted in a sufficient sample size for annual estimates of diabetes incidence.
All
Trends from 1997 to 2003
From 1997 to 2003, the incidence of self-reported diagnosed diabetes increased 41%, from 4.9 to 6.9 per 1000 population (p <0.01 for linear trend) (Figure 1). This increase was only slightly greater than the 37% increase in age-adjusted incidence, from 5.2 per 1000 in 1997 to 7.1 per 1000 in 2003 (p <0.01). Throughout the time period, incidence was strongly associated with age and tended to increase over time in each age group. From 1997 to 2003, incidence increased from 2.1 to 2.5 per 1000 (p
Conclusion
Among U.S. adults aged 18 to 79 years, the incidence of diagnosed diabetes increased 41% from 1997 to 2003. During this period of rapid change, incidence increased at a greater rate among obese people, resulting in obesity being more prevalent among incident cases at the end of the time period than at the beginning. In a multivariate analysis of 2001–2003 incidence, obese adults had the highest multivariate-adjusted incidence, and overweight and obesity had a stronger association with diabetes
References (30)
- Centers for Disease Control and Prevention. National Diabetes Surveillance System. Available at:...
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
Diabetes Care
(1997)Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes?. Reanalysis of European epidemiological data
BMJ
(1998)- et al.
The spread of the obesity epidemic in the United States, 1991–1998
JAMA
(1999) - et al.
Mean body weight, height, and body mass index, United States 1960–2002
Adv Data
(2004) - et al.
Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the U.S
Diabetes Care
(2004) - et al.
Design and estimation for the National Health Interview Survey, 1995–2004
Vital Health Stat 2
(2000) - et al.
Analysis of health surveys
(1999) - et al.
Relative contributions of incidence and survival to increasing prevalence of adult-onset diabetes mellitusa population-based study
Am J Epidemiol
(1997) - et al.
Rapid rise in the incidence of type 2 diabetes from 1987 to 1996
Arch Intern Med
(1999)
Impact of case ascertainment on recent trends in diabetes incidence in Rochester, Minnesota
Am J Epidemiol
Tracking diabetesprevalence, incidence and risk factors
Health Rep
Determinants of incident non-insulin-dependent diabetes mellitus among blacks and whites in a national sample. The NHANES I Epidemiologic Follow-up Study
Am J Epidemiol
Risk factors for non–insulin-dependent diabetes mellitus requiring treatment in the elderly
J Am Geriatr Soc
Incidence of non-insulin-dependent diabetes mellitus and its risk factors in Japanese-Americans living in Hawaii and Los Angeles
Diabet Med
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