DIABETES CARE PROGRAM OF NOVA SCOTIA
NOVA SCOTIA DIABETES STATISTICS REPORT 2016
June 2016 Published by: Diabetes Care Program of Nova Scotia 1276 South Park St, Bethune Building, Suite 548 Halifax, NS B3H 2Y9
Tel: 902-473-3219 Fax: 902-473-3911 E-mail:
[email protected] Website: http://diabetescare.nshealth.ca
NOVA SCOTIA DIABETES STATISTICS REPORT
2016
NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
THE DIABETES CARE PROGRAM OF NOVA SCOTIA The Diabetes Care Program of Nova Scotia (DCPNS) works closely with the Nova Scotia Health Authority, the IWK Health Centre, the Department of Health and Wellness, and diabetes care providers from across the province. The Program advises on service delivery models; establishes, promotes, and monitors adherence to diabetes care guidelines; provides support, services, and resources to diabetes healthcare providers; and collects, analyzes, and distributes diabetes-related data for Nova Scotia.
MISSION To improve, through leadership and partnerships, the health of Nova Scotians living with, affected by, or at risk of developing diabetes.
VISION The DCPNS is a trusted and respected program that values partnerships, and supports integrated approaches to the prevention and management of diabetes. We envision a Nova Scotia where there are fewer cases of diabetes, complication rates for those with diabetes are reduced, and where all Nova Scotians with diabetes have access to the resources they need to live well.
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ACKNOWLEDGEMENTS The Diabetes Care Program of Nova Scotia (DCPNS) would like to acknowledge and thank those directly involved in the development of this document. The preparation of this report reflects many hours of dedicated work to provide the Nova Scotia Department of Health and Wellness and the Nova Scotia Health Authority with data to support quality diabetes care in Nova Scotia.
Special Thanks: Jennifer Payne, Epidemiologist, Project Lead & Editor Diabetes Care Program of Nova Scotia Robin Read, Data/Surveillance Consultant Diabetes Care Program of Nova Scotia Ann Dent, Data Analyst Diabetes Care Program of Nova Scotia Pam Talbot, Diabetes Surveillance/Project Consultant Diabetes Care Program of Nova Scotia Peggy Dunbar, Provincial Program Manager Diabetes Care Program of Nova Scotia
Additional Thanks: The Public Health Agency of Canada (Canadian Chronic Disease Surveillance System) for the financial support to enable the preparation and broad-based distribution of this report. Business Intelligence & Analytics Health Information Office Nova Scotia Department of Health and Wellness
Assistant Editor: Andrea Estensen Diabetes Care Program of Nova Scotia
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TABLE OF CONTENTS E X E C U T IV E S U M M A RY ..................................................................................................... 1 IN T R O D U C T IO N .................................................................................................................. 5 SECTION 1 - B U R D E N C HAPTER 1: P REVALENCE ........................................................................... 7 C HAPTER 2: I NCIDENCE ............................................................................ 13 C HAPTER 3: M ORTALITY ........................................................................... 19 SECTION 2 - C O M O R B ID IT Y C HAPTER 4: H YPERTENSION ..................................................................... 25 SECTION 3 - HEALTH SERVICES UTILIZATION C HAPTER C HAPTER C HAPTER C HAPTER C HAPTER
5: 6: 7: 8: 9:
T OTAL H OSPITAL D AYS ........................................................................... 31 H OSPITAL A DMISSIONS ........................................................................... 37 ADMISSION L ENGTH OF S TAY .................................................................... 43 P RIMARY C ARE O FFICE V ISITS .............................................................. 49 S PECIALIST P HYSICIAN O FFICE V ISITS ................................................. 55
APPENDICES Appendix A: The CANADIAN CHRONIC DISEASE SURVEILLANCE SYSTEM......................... 63 Appendix B: COMPARISON OF CRUDE MEASURES OF DIABETES BURDEN, COMORBIDITY, AND HEALTH SERVICES UTILIZATION BY ZONE AND FORMER DISTRICT HEALTH AUTHORITIES (DHAS), RELATIVE TO NOVA SCOTIA ......................... 67 Appendix C: PREVALENT CASES BY AGE GROUP AND SEX FOR NOVA SCOTIA, THE ZONES, AND THE FORMER DISTRICT HEALTH AUTHORITIES (DHAS), 2013/14 ........................................................................................ 69 Appendix D: CRUDE AND AGE-STANDARDIZED RATES AND RATE RATIOS IN NOVA SCOTIA, THE ZONES, AND THE FORMER DISTRICT HEALTH AUTHORITIES (DHAS), 2013/14 ................................................................... 71
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EXECUTIVE SUMMARY This report provides an overview of the estimated burden of diabetes in Nova Scotia to March 31, 2014. Derived from the Canadian Chronic Disease Surveillance System (CCDSS), this report provides information on the population age 20+ in Nova Scotia and includes figures related to prevalence (all current cases of diabetes) and incidence (newly diagnosed cases). Mortality, morbidity (hypertension), and health services utilization (hospitalizations and visits to primary care providers and specialist physicians) are provided for the population with diabetes as compared to the population without diabetes. Key Findings In Nova Scotia By March 2014, approximately 11.4% (1 in 9), or 93,000, adults aged 20+ were living with diabetes. The crude prevalence varied across Zones, from 9.7% to 13.6%, with the highest figure for the Eastern Zone. The crude prevalence of diabetes increased with increasing age and as a result, more than one in four adults over the age of 70 had diabetes. The crude prevalence of diabetes in Nova Scotia increased from 9.9% in 2008/09 to 11.4% in 2013/14, an increase of 15.2% in 5 years. More than 5,400 new cases of diabetes were identified in 2013/14 (approximately 450 new cases per month). There was less variation in the crude incidence of diabetes by Zone (6.2 per 1000 to 10.0 per 1000 than there was in prevalence of diabetes by Zone (9.7% to 13.1%). People with diabetes, as compared to people without diabetes in 2013/14: •
Were 3 times more likely to have hypertension.
•
Made twice as many visits to primary care (9.4 visits).
•
Made twice as many visits to specialist physicians (4.4 visits) and accounted for 25% of all specialist physician visits.
•
Were 3 times as likely to be hospitalized.
•
Spent on average 4 more days in hospital.
There were considerable variations in the burden of diabetes across age groups: •
Crude prevalence rates were highest in those aged 70-79 and 80+ at approximately 32% for males (1 in 3) and 26% for females (1 in 4).
•
Crude incidence rates peaked for those aged 60-69 at 17 per 1000 for males and 12 per 1000 for females.
•
Crude mortality rates were highest in those aged 20-49 at 4.2 times that of the non-diabetes population.
•
Those aged 20-39 were 7 times more likely to have hypertension than those without diabetes.
•
Those aged 20-39 and 40-49 had the highest rate of specialist physician visits, relative to those without diabetes, most likely reflective of pregnancy and reproductive issues.
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Directions/Call To Action Individuals with diabetes are living longer. This is the most likely explanation for the growth in the prevalence of diabetes. As diabetes is well known to be a progressive disease, longer duration of diabetes confers more complex treatment regimens (multiple medications, initiation of insulin therapy), as well as increases the risk of diabetes-related complications and comorbidities. Action: •
Improved diabetes management, including glycemia, blood pressure, blood lipids, smoking avoidance/cessation, and disease distress/stress management/reduction early and throughout the disease process have been shown to reduce diabetes complications. Information systems in support of quality improvement should be used to define high-risk populations in support of targeted interventions. (See DCPNS Registry and on-site reports.)
•
Timely access and more intensive approaches to both lifestyle modifications and pharmacological treatments are recommended in most individuals, along with the continued and renewed focus on self-care. (See DCPNS Triage and Discharge Guidelines in support of timely self-management and the DCPNS Insulin Dose Adjustment Policies & Guidelines to support timely initiation and titration of insulin, and DCPNS Insulin Pump Initiation for Children and Youth Guidelines and DCPNS Insulin Pump Initiation for Young Adults/Adults.)
•
Care guidelines that address safety and quality of life, using a frailty lens, are essential with the aging of Nova Scotia’s population and the reported growth in prevalence in the oldest age groups. (See DCPNS Diabetes Guidelines for Frail Elderly Residents in or Awaiting Long-Term Care.)
•
Continued support of Provincial initiatives focused on hypertension awareness, prevention, and management is essential to provide timely and necessary focus for those with or at risk of diabetes, stroke, cardiovascular, and renal diseases. (See My Blood Pressure Card Initiative and My Blood Pressure Challenge.)
•
Targeted interventions, aimed at our younger age groups, are strongly recommended. These need to focus on improved glycemia and blood pressure management to reduce the heightened risk of foot, eye, and kidney disease. (See DCPNS Insulin Dose Adjustment Polices & Guidelines Manual, 2016 as well as Patient Self-Adjustment of Insulin resources.)
•
Engaging persons with diabetes in individual treatment plans that address blood glucose as well as blood pressure and blood lipids is an important way to improve overall diabetes management with a renewed focus on selfmanagement.
The incidence of diabetes in Nova Scotia remains a concern, particularly in certain subgroups of the population. Action: •
Health promotion and disease prevention messages and policies are key to the future of a healthy Nova Scotia.
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•
Delaying the onset of the disease in at-risk individuals and their families, as well as slowing its progression in those with established disease, would result in significant benefit to individuals, families, and the health care system.
•
Provincial initiatives focused on wellness and risk factor reduction are required to impact incidence rates (prevention or delayed development of diabetes), complications progression, and provide added support for diabetes self-management.
•
The growing emphasis on integrated chronic disease management and prevention through team-based care and the Health Home will help to ensure upstream messaging and the delivery of risk-reduction programming at the community level.
•
Initiatives aimed at women of reproductive age will improve birth outcomes and reduce risks of subsequent diabetes and metabolic abnormalities in both the woman and her infant. These initiatives should promote planned pregnancy, preconception care/counseling, early screening for diabetes, individualized care plans, breastfeeding, and routine postpartum care and screening (See DCPNS Pregnancy and Diabetes Guidelines: Approaches to Practice, 2014).
•
There is continued concern regarding the burden of diabetes in vulnerable populations including First Nations, African Canadians, and new immigrant communities. These populations may require different resources to support both primary prevention as well as disease management initiatives. -
Women of reproductive age who are also members of these vulnerable communities are deserving of more active and targeted initiatives aimed at improving outcomes for them and their children.
People with diabetes have much greater risks of complications and comorbidities; this is most significant in our youngest age groups. Action: •
Nova Scotia must continue to refine its approach to the adolescent and young adult populations with diabetes to ensure that programs, services, and supports are in place to provide continued access to required health care services and specialty teams.
•
As the majority of the cases in the youngest age groups are predominately type 1 cases, seamless transitional care from pediatric to adult care is required as well as continued, easily accessible supports throughout the lifespan. (See DCPNS Moving on…with Diabetes Adolescent Transition Resources [provider, patient, and parent/caregiver materials].)
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INTRODUCTION The Diabetes Care Program of Nova Scotia (DCPNS) is pleased to provide this fourth report about the burden of diabetes in Nova Scotia and each of the four Health Management Zones. This report is aimed primarily at decision-makers within the NSHA, Health Management Zones, and Diabetes Centres. However, it is also intended that this document will act as a resource for those working in the area of diabetes prevention and management, and that the report will help stimulate further discussion around the information needs of decision-makers to create, envision, and deliver policies that will better serve the residents of Nova Scotia. Many aspects of this report remain the same as those in the earlier version, Nova Scotia Diabetes Statistics Report 2011; however, some changes are also noted below. Some of these changes will make comparison to earlier reports difficult. Structure of the Report In keeping with the 2011 version, the report is broken into chapters that are organized into three sections: burden, comorbidity, and health services utilization. Each chapter is formatted in a similar manner with summary text at the front, followed by the exhibits. All chapters begin by focusing on the most recent year of data, 2013/14, and results are presented by Zone, age group, and sex for the province as a whole, followed by time trends (2009/10 to 2013/14) for the province and each Zone. Both crude and standardized rates are presented so that Zones can understand their absolute burden of diabetes in real numbers (i.e., crude rates represent real people) as well as compare their rates against other jurisdictions where populations may differ in age structure (i.e., standardized rates). Each chapter also contains data for each of the former District Health Authorities, compared to their Zone, creating a bridge between the results of this report with the 2011 report. The case rules for several comorbidities/complications are currently under review by the CCDSS Scientific Committee. Therefore, in the comorbidity section, there is only one chapter remaining, which focuses on hypertension. Appendices B, C and D contain information for each of the former District Health Authorities as well as the new Health Management Zones, providing a bridge to the 2011 report. •
Appendix B contains a summary table of results across the chapters showcasing crude rather than standardized figures displayed in the 2011 report.
•
Appendix C contains current prevalence figures by age group and sex.
•
Appendix D provides current crude and age-standardized figures for hypertension and health services utilization.
Analyses The analyses in this report are based on the methodology of the CCDSS, first developed by the Public Health Agency of Canada in 1997 as part of the original National Diabetes Surveillance System. This system takes advantage of administrative health data (practitioner billings, hospital discharge) available across all provinces and territories to develop a long-term monitoring system to estimate the combined burden of type 1 and type 2 diabetes. This report was produced using the CCDSS software, version 2015. More detail is provided in Appendix A. NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
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Exclusion of Children and Youth (Under Age 20) In contrast with the CCDSS methodology and national reporting, this report restricts analyses to those aged 20+ years. The DCPNS believes that children and adolescents with diabetes represent a very special population. •
The majority of these individuals have type 1 diabetes.
•
Management with insulin is often complex and variable during these years of rapid growth; and interdisciplinary team-based support is necessary and essential.
•
While preventing long-term complications is the ultimate goal, avoidance of acute complications (hypoglycemia, hyperglycemia, and diabetic ketoacidosis) is of the utmost, immediate importance.
Diabetes in those under age 20 is relatively rare (there were approximately 800 cases (including types 1, 2 and prediabetes categories) in Nova Scotia to December 31, 20151), and the comorbidities usually associated with diabetes, if found in this young population, are not likely related to diabetes. The DCPNS feels strongly that the story of this disease and its progression in the young population would be lost if combined with that of the general diabetes population as reported by the CCDSS (i.e., the population aged 1+).
1
Source: Diabetes Care Program of Nova Scotia Registry. Halifax, NS; 2016
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CHAPTER 1 PREVALENCE Prevalence is defined as the number of individuals (new and existing) with a diagnosed disease in a given population at a given point in time. Prevalence is affected by both the number of new cases of a disease (incidence) and the death rate (mortality) among existing cases. Nova Scotia (2013/14) As of March 31, 2014, approximately 93,000 (11.4%) of Nova Scotia adults aged 20+ were living with diabetes. In 2013/14, there was substantial variation in the crude prevalence of diabetes in the population aged 20+ across Zones, ranging from 9.7% to 13.6% (Exhibits 1-1 and 1-2). Comparison of agestandardized prevalence figures across the Zones revealed both smaller values and less variation (8.1% to 9.6%), indicating that differences in population structure (e.g., older versus younger population) accounted for some of the variation between Zones. •
Analyses by age group and sex revealed that the crude prevalence of diabetes was similar for both males and females in the 20-29 through 40-49 age groups and increased in a similar manner with increasing age. In the 50-59 age group and thereafter, males were more likely than females to have diabetes (Exhibit 1-3).
•
It is striking that even by age 40-49, both males and females had more than a 5% chance of having diabetes, and this risk increased substantially with each increasing 10-year age group through to the 70-79 age group (prevalence of approximately 28%).
•
The largest increase in crude prevalence across the age groups occurred when moving from the 50-59 age group to the 60-69 age group, with the overall prevalence almost doubling from 12% to 21%.
•
The highest crude prevalence for both males and females was in the 70-79 and 80+ age groups, at approximately 32% for males and 26% for females.
Nova Scotia Time Trends (2009/10 to 2013/14) Trends in the age-standardized prevalence of diabetes revealed an increase over time, from 8.2% to 8.6% (Exhibit 1-4). •
The crude prevalence figures were stable over time for those aged 20-49 (Exhibit 1-5). There was a small increase in prevalence over time for those aged 50-69 and a larger increase over time for those aged 70 and older.
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Zone Time Trends (2009/10 to 2013/14) Analyses of time trends revealed an increase in age-standardized prevalence over time for each Zone (Exhibits 1-4 and 1-6 to 1-9). •
NOTE:
Over the last five years, the age-standardized prevalence figures for the Eastern and Western Zones were consistently higher than those for Nova Scotia, whereas the figures for the Central Zone were lower than for the province. Data about diabetes prevalence were derived from the Canadian Chronic Disease Surveillance Strategy (CCDSS) (see Appendix A). Given that the CCDSS figures were derived from administrative health data, caution should be used in interpreting the exact figures, and more emphasis should be placed on interpreting relative trends.
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EXHIBITS Exhibit 1-1
Crude and Age-Standardized Diabetes Prevalence for the Population Aged 20+ in Nova Scotia, the Zones, and the Former District Health Authorities (DHAs), 2013/14
Province and Zones and former DHAs
Number of Diabetes Cases
NOVA SCOTIA
Population Aged 20+
Crude Diabetes Prevalence (%)
Age-Standardized Diabetes Prevalence (%)
93,424
821,083
11.4
8.6
Western South Shore Southwest Annapolis Valley
22,542 6,667 7,349 8,526
171,862 50,525 51,948 69,389
13.1 13.2 14.1 12.3
8.9 8.5 9.7 8.6
Northern Colchester East Hants Cumberland Pictou County
15,229 7,038 3,614 4,577
129,835 61,964 28,134 39,737
11.7 11.4 12.8 11.5
8.5 8.6 8.5 8.2
Eastern Guysborough Antigonish Strait Cape Breton
19,824 4,667 15,157
145,954 38,427 107,527
13.6 12.1 14.1
9.6 8.4 10.0
Central
35,760
367,486
9.7
8.1
Exhibit 1-2
Crude Diabetes Prevalence for the Population Aged 20+ in Nova Scotia, the Zones, and the Former District Health Authorities, 2013/14
NOVA SCOTIA Western VA SCOTIA South Shore Southwest Annapolis Valley
Northern Colchester East Hants
DM
Cumberland
No DM
Pictou County
Eastern Guysborough Antigonish Strait Cape Breton
Central
0
2
4
6
8
10
12
14
16
Crude Diabetes Prevalence (%)
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Crude Diabetes Prevalence (%)
Exhibit 1-3
Crude Diabetes Prevalence for the Population Aged 20+ in Nova Scotia by Age Group and Sex, 2013/14
35.0 30.0 25.0
Male
20.0
Female
15.0
Combined
10.0 5.0 0.0 20-‐29
30-‐39
40-‐49
50-‐59
60-‐69
70-‐79
80+
Total
Age Group
Exhibit 1-4
Trend in Age-Standardized Diabetes Prevalence for the Population Aged 20+ in Nova Scotia and the Zones, 2009/10 to 2013/14
Age-‐Standardized Diabetes Prevalence (%)
12.0 10.0
NOVA SCOTIA
8.0
Western
6.0
Northern
4.0
Eastern
2.0
Central
0.0 2009/10
2010/11
2011/12
2012/13
2013/14
Year
Crude Diabetes Prevalence (%)
Exhibit 1-5
Trend in Crude Diabetes Prevalence for the Population Aged 20+ in Nova Scotia by Age Group, 2009/10 to 2013/14
30.0
20-‐29
25.0
30-‐39
20.0
40-‐49
15.0
50-‐59
10.0
60-‐69
5.0
70-‐79
0.0 2009/10
2010/11
2011/12
2012/13
2013/14
80+
Year
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Exhibit 1-6
Trend in Age-Standardized Diabetes Prevalence for the Population Aged 20+ in Nova Scotia, Western Zone, and its Former District Health Authorities, 2009/10 to 2013/14
Age-‐Standardized Diabetes Prevalence (%)
12.0 10.0
NOVA SCOTIA
8.0
Western
6.0
SSH SWH
4.0
AVH
2.0 0.0 2009/10
2010/11
2011/12
2012/13
2013/14
Year
Exhibit 1-7
SSH: South Shore SWH: Southwest AVH: Annapolis Valley
Trend in Age-Standardized Diabetes Prevalence for the Population Aged 20+ in Nova Scotia, Northern Zone, and its Former District Health Authorities, 2009/10 to 2013/14
Age-‐Standardized Diabetes Prevalence (%)
12.0 10.0
NOVA SCOTIA
8.0
Northern
6.0
CEHHA
4.0
CHA PCHA
2.0 0.0 2009/10
2010/11
2011/12 Year
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2012/13
2013/14 CEHHA: Colchester East Hants CHA: Cumberland PCHA: Pictou County
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Exhibit 1-8
Trend in Age-Standardized Diabetes Prevalence for the Population Aged 20+ in Nova Scotia, Eastern Zone, and its Former District Health Authorities, 2009/10 to 2013/14
Age-‐ Standardized Diabetes Prevalence (%)
12.0 10.0 NOVA SCOTIA
8.0
Eastern
6.0
GASHA 4.0
CBDHA
2.0 0.0 2009/10
2010/11
2011/12
2012/13
Year
Exhibit 1-9
2013/14 GASHA: Guysborough Antigonish Strait CBDHA: Cape Breton
Trend in Age-Standardized Diabetes Prevalence for the Population Aged 20+ in Nova Scotia and Central Zone, 2009/10 to 2013/14
Age-‐Standardized Diabetes Prevalence (%)
12.0 10.0 8.0
NOVA SCOTIA
6.0
Central
4.0 2.0 0.0 2009/10
2010/11
2011/12
2012/13
2013/14
Year
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CHAPTER 2 INCIDENCE Incidence rate is defined as the proportion of new cases of a disease diagnosed in a given population during a given time period (i.e., annual occurrence of new cases). Note: In this chapter, time trends are shown for 10-year periods (all other chapters focus on the most recent 5-year period). Time trends in the diabetes incidence rates over the last 10 years reveal a slow decline that began approximately five years ago (2009/10). There is concern that this stems from changes in coding of diabetes on practitioner billings, rather than indicating a true decrease in incidence. Caution should be exercised in interpreting absolute values. Rather, the focus should be on interpreting relative trends, i.e., by age group, sex, and over time. Nova Scotia (2013/14) In 2013/14, more than 5,400 new cases of diabetes were diagnosed among adults aged 20+ in Nova Scotia (7.4 per 1000 population). In 2013/14, there was variation in the crude incidence rates of diabetes in the population aged 20+ across Zones, ranging from 6.2 to 10.0 per 1000 population (Exhibits 2-1 and 2-2). Comparison of age-standardized incidence rates across Zones revealed both smaller figures and less variation in incidence of diabetes (5.5 to 6.8 per 1000), indicating that differences in population structure (e.g., older versus younger population) accounted for some of the variation between Zones. •
Analyses by age group and sex revealed that the crude incidence rate of diabetes was similar for both males and females in the 20-29 and 30-39 age groups and increased in a similar manner with increasing age. In the 40-49 age group and thereafter, males were more likely than females to be newly diagnosed with diabetes (Exhibit 2-3).
•
The largest increase in the crude incidence rate across the age groups occurred when moving from the 40-49 age group to the 50-59 age group, during which the risk of being newly diagnosed with diabetes approximately doubled from 5.6 per 1000 to 10.2 per 1000.
•
The highest crude incidence rate for males and females was in the 60-69 age group at approximately 17 per 1000 for males and 12 per 1000 for females.
Nova Scotia Time Trends (2004/05 to 2013/14) Time trends in the age-standardized diabetes incidence rate revealed little change over time during the first five years of the period, hovering at approximately 7.8 per 1000 (Exhibit 2-4). However, this rate appeared to steadily decrease over the following five years. •
The crude incidence figures were stable over time for those under age 50, ranging from approximately 1 per 1000 for those in the 20-29 age group to approximately 6 per 1000 for those in the 40-49 age group. There was evidence of a decrease in incidence over time for all
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age groups over 50, starting in approximately 2009/10. The rate of decrease appears to increase with increasing age, i.e., the biggest decreases are in the oldest age groups (Exhibit 2-5). Zone Time Trends (2009/10 to 2013/14) Analyses of time trends revealed stable age-standardized incidence rates for all Zones during the first five years of the ten-year period, and then a steady decrease after 2009/10 (Exhibits 2-4 and 2-6 to 29). •
NOTE:
Over the ten-year period, the age-standardized diabetes incidence rates for Eastern and Western Zones were consistently higher than those for Nova Scotia, whereas the figures for Central Zone were lower than for the province. Data about diabetes incidence were derived from the Canadian Chronic Disease Surveillance System (CCDSS) (see Appendix A). Given that the CCDSS figures were derived from administrative health data, caution should be used in interpreting the exact figures, and more emphasis should be placed on interpreting relative trends.
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EXHIBITS Exhibit 2-1
Crude and Age-Standardized Diabetes Incidence Rates for the Population Aged 20+ in Nova Scotia, the Zones, and the Former District Health Authorities (DHAs), 2013/14
Province and Zones and former DHAs
Number of New Diabetes Cases
At-Risk Population Aged 20+*
Age-Standardized Diabetes Incidence Rate (per 1000)
Crude Diabetes Incidence Rate (per 1000)
NOVA SCOTIA
5,417
733,076
7.4
6.1
Western South Shore Southwest Annapolis Valley
1,339 346 450 543
150,659 44,204 45,049 61,406
8.9 7.8 10.0 8.8
6.8 5.7 7.6 6.9
950 455 229 266
115,556 55,381 24,749 35,426
8.2 8.2 9.3 7.5
6.6 6.8 7.0 5.8
1,046 231 815
127,176 33,991 93,185
8.2 6.8 8.7
6.5 5.3 7.0
6.2
5.5
Northern Colchester East Hants Cumberland Pictou County Eastern Guysborough Antigonish Strait Cape Breton
Central 2,076 333,802 * Equivalent to population in 2013/14 less prevalent diabetes cases in 2012/13
Exhibit 2-2
Crude Diabetes Incidence Rates for the Population Aged 20+ in Nova Scotia, the Zones, and the Former District Health Authorities, 2013/14
NOVA SCOTIA Western VA SCOTIA South Shore Southwest Annapolis Valley
Northern Colchester East Hants
DM
Cumberland
No DM
Pictou County
Eastern Guysborough Antigonish Strait Cape Breton
Central
0
2
4
6
8
10
12
Crude Diabetes Incidence Rate (per 1000) NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
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Crude Diabetes Incidence Rate (per 1000)
Exhibit 2-3
Crude Diabetes Incidence Rates for the Population Aged 20+ in Nova Scotia by Age Group and Sex, 2013/14
20.0 16.0 Male
12.0
Female
8.0
Combined
4.0 0.0 20-‐29
30-‐39
40-‐49
50-‐59
60-‐69
70-‐79
80+
Total
Age Group
Age-‐Standardized Diabetes Incidence Rate (per 1000)
Exhibit 2-4
Trend in Age-Standardized Diabetes Incidence Rates for the Population Aged 20+ in Nova Scotia and the Zones, 2004/05 to 2013/14
12.0 NOVA SCOTIA
10.0 8.0
Western
6.0
Northern
4.0
Eastern
2.0
Central
0.0
Year
Crude Diabetes Incidence Rate (per 1000)
Exhibit 2-5
Trend in Crude Diabetes Incidence Rates for the Population Aged 20+ in Nova Scotia by Age Group, 2004/05 to 2013/14 25.0
20-‐29
20.0
30-‐39
15.0
40-‐49 50-‐59
10.0
60-‐69
5.0
70-‐79
0.0
80+
Year NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
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Age-‐Standardized Diabetes Incidence Rate (per 1000)
Exhibit 2-6
Trend in Age-Standardized Diabetes Incidence Rates for the Population Aged 20+ in Nova Scotia, Western Zone, and its Former District Health Authorities, 2004/05 to 2013/14
12.0 10.0
NOVA SCOTIA
8.0
Western
6.0
SSH
4.0
SWH
2.0
AVH
0.0
Year
Exhibit 2-7
SSH: South Shore SWH: Southwest AVH: Annapolis Valley
Trend in Age-Standardized Diabetes Incidence Rates for the Population Aged 20+ in Nova Scotia, Northern Zone, and its Former District Health Authorities, 2004/05 to 2013/14
Age-‐Standardized Diabetes Incidence Rate (per 1000)
12.0 10.0
NOVA SCOTIA
8.0
Northern
6.0
CEHHA
4.0
CHA
2.0
PCHA
0.0
Year
NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
CEHHA: Colchester East Hants CHA: Cumberland PCHA: Pictou County
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Exhibit 2-8
Trend in Age-Standardized Diabetes Incidence Rates for the Population Aged 20+ in Nova Scotia, Eastern Zone, and its Former District Health Authorities, 2004/05 to 2013/14
Age-‐Standardized Diabetes Incidence Rate (per 1000)
12.0 10.0 NOVA SCOTIA
8.0
Eastern
6.0
GASHA
4.0
CBDHA
2.0 0.0
Year
Exhibit 2-9
GASHA: Guysborough Antigonish Strait CBDHA: Cape Breton
Trend in Age-Standardized Diabetes Incidence Rates for the Population Aged 20+ in Nova Scotia and Central Zone, 2004/05 to 2013/14
Age-‐Standardized Diabetes Incidence Rate (per 1000)
12.0 10.0 8.0 6.0 NOVA SCOTIA
4.0
Central
2.0 0.0
Year
NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
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SECTION I - BURDEN
CHAPTER 3 MORTALITY Mortality rate is defined as the proportion of people diagnosed with a disease in a given population in a given time period who died. A comparison of mortality rates can highlight whether people in one group die at a younger age than people in another group. Mortality is affected by both the progression and management of the disease, including the existence of one or more comorbid diseases secondary to diabetes (e.g., heart disease). Nova Scotia (2013/14) In 2013/14, approximately 3.2% of Nova Scotia adults aged 20+ with diabetes died, compared to less than 1.0% of adults without diabetes. In 2013/14, there was little variation in the crude mortality rates in the population aged 20+ with diabetes across Zones, ranging from 2.9% to 3.6% (Exhibits 3-1 and 3-2). Comparison of agestandardized mortality rates across Zones revealed both smaller figures and less variation in mortality in the population with diabetes (1.0% to 1.2%), indicating that differences in population structure (e.g., older versus younger population) accounted for most of the variation between Zones. •
The age-standardized mortality rate ratios revealed a 1.8 to 1.9 times greater risk of death in the population with diabetes, relative to the population without diabetes.
•
Analysis by age group and sex revealed that in 2013/14, those with diabetes were more likely to die than those without diabetes, and this finding was true for both males and females and for all age groups (Exhibit 3-3).
•
The crude mortality rates for males were higher than for females within age groups, and this finding was true for both the populations with and without diabetes (Exhibit 3-3).
•
In 2013/14, people with diabetes were twice as likely to die as those without diabetes until age 70, at which point the differences in mortality rate diminished with age.
Nova Scotia Time Trends (2009/10 to 2013/14) Time trends in the age-standardized mortality rate ratios revealed virtually no change over time, hovering at approximately 2.0 (Exhibit 3-4). Individuals with diabetes had a 2 times greater risk of dying in a given year than individuals without diabetes. •
The crude mortality rate ratios decreased with increasing age (Exhibit 3-5). The most recent ratios were approximately 4.3 for those in the 20-49 age group and 1.3 for those 80 years of age and older. Caution should be exercised when interpreting the results for those in the 20-49 age group because of the small number of deaths.
NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
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SECTION I - BURDEN
•
Over time, the crude mortality rate ratios were consistently higher for each younger age group and remained stable over time. Caution should be exercised when interpreting the results for those in the 20-49 age group because of the small number of deaths.
•
The crude mortality rate ratios were stable over time for those aged 50 and over, with evidence of unstable values for those aged 20-49.
Zone Time Trends (2009/10 to 2013/14) Analyses of time trends revealed no overall difference in the age-standardized mortality rate ratios for all Zones, although there was some instability in the values (Exhibits 3-4 and 3-6 to 3-9). •
NOTE:
The age-standardized mortality rate ratios for the Zones were virtually no different than those for the province as a whole, and over time. Data about mortality among those with and without diabetes were derived from the Canadian Chronic Disease Surveillance Strategy (CCDSS) (see Appendix A). Given that the CCDSS figures were derived from administrative health data, caution should be used in interpreting the exact figures, and more emphasis should be placed on interpreting relative trends.
NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
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EXHIBITS Exhibit 3-1
Crude and Age-Standardized Mortality Rates and Rate Ratios for the Population Aged 20+, with/without Diabetes, in Nova Scotia and the Zones, 2013/14
Province and Zones
Diabetes status (1=yes)
Number of Deaths
NOVA SCOTIA
1
3,002
93,424
3.21
0
5,626
727,659
0.77
1
784
22,542
3.48
0
1,306
149,320
0.87
1
479
15,229
3.15
0
1,056
114,606
0.92
1
712
19,824
3.59
0
1,191
126,130
0.94
1
1,027
35,760
2.87
0
2,070
331,726
0.62
Western Northern Eastern Central
Exhibit 3-2
Crude Mortality Rate (%)
Population Aged 20+
Crude Mortality Rate Ratio
AgeStandardized Mortality Rate (%)
4.2
AgeStandardized Mortality Rate Ratio
1.08
1.9
0.58 4.0
1.03
1.9
0.55 3.4
1.16
1.9
0.62 3.8
1.18
1.9
0.63 4.6
1.00
1.8
0.56
Crude Mortality Rates for the Population Aged 20+, with/without Diabetes (DM), in Nova Scotia, the Zones, and the Former District Health Authorities, 2013/14 NOVA SCOTIA VA SCOTIA Western South Shore Southwest
Annapolis Valley
Northern Colchester East Hants
DM
Cumberland
No DM
Pictou County
Eastern Guysborough Antigonish Strait Cape Breton
Central
0
0.5
1
1.5
2
2.5
3
3.5
4
Crude Mortality Rate (%) NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
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SECTION I - BURDEN
Exhibit 3-3
Crude Mortality Rates for the Population Aged 20+, with/without Diabetes (DM), in Nova Scotia by Age Group and Sex, 2013/14
Crude Mortality Rate (%)
12.0 10.0 8.0
M -‐ DM DM
6.0
M -‐ No DM
4.0
F -‐ DM
2.0
F -‐ No DM
0.0 20-‐49
50-‐59
60-‐69
70-‐79
80+
Total
Age group
Age-‐Standardized Mortality Rate RaKo
Exhibit 3-4
Trend in Age-Standardized Diabetes Mortality Rate Ratios for the Population Aged 20+, with/without Diabetes, in Nova Scotia and the Zones, 2009/10 to 2013/14
3.0 2.5
NOVA SCOTIA
2.0
Western
1.5
Northern
1.0
Eastern
0.5
Central
0.0 2009/10
2010/11
2011/12
2012/13
2013/14
Year
Crude Mortality Rate RaKo
Exhibit 3-5
Trend in Crude Diabetes Mortality Rate Ratios for the Population Aged 20+, with/without Diabetes, in Nova Scotia by Age Group, 2009/10 to 2013/14
8.0 20-‐49
6.0
50-‐59 60-‐69
4.0
70-‐79
2.0
80+
0.0 2009/10
2010/11
2011/12
2012/13
2013/14
Year NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
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SECTION I - BURDEN
Age-‐Standardized Mortality Rate RaKo
Exhibit 3-6
Trend in Age-Standardized Mortality Rate Ratios for the Population Aged 20+, with/without Diabetes, in Nova Scotia, Western Zone, and its Former District Health Authorities, 2009/10 to 2013/14
3.0 2.5
NOVA SCOTIA
2.0
Western
1.5
SSH
1.0
SWH AVH
0.5 0.0 2009/10
2010/11
2011/12
2012/13
2013/14
Year
Age-‐Standardized Mortality Rate RaKo
Exhibit 3-7
SSH: South Shore SWH: Southwest AVH: Annapolis Valley
Trend in Age-Standardized Mortality Rate Ratios for the Population Aged 20+, with/without Diabetes, in Nova Scotia, Northern Zone, and its Former District Health Authorities, 2009/10 to 2013/14
3.0 2.5
NOVA SCOTIA
2.0
Northern
1.5
CEHHA
1.0
CHA PCHA
0.5 0.0 2009/10
2010/11
2011/12 Year
NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
2012/13
2013/14 CEHHA: Colchester East Hants CHA: Cumberland PCHA: Pictou County
23
SECTION I - BURDEN
Age-‐Standardized Mortality Rate RaKo
Exhibit 3-8
Trend in Age-Standardized Mortality Rate Ratios for the Population Aged 20+, with/without Diabetes, in Nova Scotia, Eastern Zone, and its Former District Health Authorities, 2009/10 to 2013/14
3.0 2.5 NOVA SCOTIA
2.0
Eastern
1.5
GASHA
1.0
CBDHA
0.5 0.0 2009/10
2010/11
2011/12
2012/13
Year
Age-‐Standardized Mortality Rate RaKo
Exhibit 3-9
2013/14 GASHA: Guysborough Antigonish Strait CBDHA: Cape Breton
Trend in Age-Standardized Mortality Rate Ratios for the Population Aged 20+, with/without Diabetes, in Nova Scotia and Central Zone, 2009/10 to 2013/14
3.0 2.5 2.0
NOVA SCOTIA
1.5
Central
1.0 0.5 0.0 2009/10
2010/11
2011/12
2012/13
2013/14
Year
NOVA SCOTIA DIABETES STATISTICS REPORT 2016 DIABETES CARE PROGRAM OF NOVA SCOTIA
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SECTION 2 – COMORBIDITY
CHAPTER 4 HYPERTENSION Hypertension (HTN), or high blood pressure, is a very common comorbidity in people with diabetes and is a potent risk factor for diabetes-related microvascular and macrovascular diseases. Accordingly, clinical practice guidelines recommend frequent monitoring of blood pressure and aggressive management of HTN to reach a target of
