Prevalence and Incidence Trends for Diagnosed Diabetes Among Adults Aged 20 to 79 Years, United States, 1980-2012
What are the long-term trends in prevalence and incidence of diagnosed diabetes, and have there been periods of acceleration or deceleration in rates?
The 1980-2012 data for 664,969 adults ages 20-79 years from the National Health Interview Survey (NHIS) were analyzed to estimate incidence and prevalence rates for the overall civilian, non-institutionalized, US population, and by demographic subgroups (age group, sex, race/ethnicity, and educational level). Primary outcome was the annual percentage change (APC) in rates of the prevalence and incidence of diagnosed diabetes (type 1 and type 2 combined).
The APC for age-adjusted prevalence and incidence of diagnosed diabetes did not change significantly during the 1980s, but each increased sharply each year during 1990-2008 before leveling off with no significant change during 2008-2012. The prevalence per 100 persons was 3.5 (95% confidence interval [CI], 3.2-3.9) in 1990, 7.9 (95% CI, 7.4-8.3) in 2008, and 8.3 (95% CI, 7.9-8.7) in 2012. The incidence per 1,000 persons was 3.2 (95% CI, 2.2-4.1) in 1990, 8.8 (95% CI, 7.4-10.3) in 2008, and 7.1 (95% CI, 6.1-8.2) in 2012. Incidence rates among non-Hispanic black and Hispanic adults continued to increase (for interaction, p = 0.03 for non-Hispanic black adults and p = 0.01 for Hispanic adults) at rates significantly greater than for non-Hispanic white adults. The rate of increase in prevalence was inversely related to education.
Analyses of nationally representative data from 1980 to 2012 suggest a doubling of the incidence and prevalence of diabetes during 1990-2008, and a plateauing between 2008 and 2012.
The increase in diabetes among non-Hispanic black and Hispanic subpopulations and those with less education portends an increase in excess risk of amputation, blindness, end-stage renal disease, disability, mortality, and health care costs in the lower socioeconomic groups in the United States. As the authors suggest, diabetes will remain a major public health problem that demands effective prevention and management programs.
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