Incidence of macrovascular disease in diabetes mellitus: the London cohort of the WHO Multinational Study of Vascular Disease in Diabetics

Summary We report on the incidence of new macrovascular disease among the 497 members of the London Cohort of the WHO Multinational Study of Vascular Disease in Diabetics (aged 35–54 years at recruitment) over a mean 8.33 year follow-up period. Overall at the end of the follow-up period the prevalence of macrovascular disease in the cohort was 45%; 43% of the subjects showed evidence of ischaemic heart disease, 4.5% of cerebrovascular disease and 4.2% of peripheral vascular disease. The incidence rates for new disease in those subjects who were free at baseline expressed per 1000 patient years of follow-up were: ischaemic ECG abnormality 23.6 (patients with insulin-dependent diabetes 19.8, patients with non-insulin-dependent diabetes 28.1), myocardial infarction 17.6 (patients with insulin-dependent diabetes 16.5, patients with non-insulin-dependent diabetes 18.8), all ichaemic heart disease 31.7 (patients with insulin-dependent diabetes 30.3, patients with non-insulin-dependent diabetes 33.4), cerebrovascular disease 5.9 and peripheral vascular disease 5.2. Incidence rates were generally similar among men and women except for myocardial infarction in patients with non-insulin-dependent diabetes where men had a significantly higher incidence rate. Macrovascular disease is a major problem in patients with diabetes and in this age group is mainly manifested as ischaemic heart disease.     

Increasing incidence and prevalence with limited survival gains among rural Albertans with diabetes: a retrospective cohort study, 1995–2006

Objective To compare recent trends of diabetes prevalence, incidence and mortality between men and women living in urban and rural Alberta, Canada. Methods We tracked population trends in diabetes in adults based on diagnostic codes from provincial administrative health records from 1995 to 2006. Location of residence was defined by registered postal codes. Sex‐stratified logistic regression with interactions was used to compare increases in rates over the past decade by location of residence, adjusting for age. Results Men in rural residences had the greatest increases in prevalence, at 61%, from 3.6 per 100 in 1995 to 5.8 per 100 in 2006, compared with a 55% increase in urban men, from 3.9 per 100 in 1995 to 6.0 per 100 in 2006 (P < 0.001). Diabetes incidence in rural men increased 61% while urban men had a similar increase of 59% (P = 0.177). Incidence was lower in women in both urban and rural locations, at 5.6 and 5.3 per 1000 in 2006. Overall, mortality rates decreased by 34% for urban men and 8% for rural men with diabetes (P = 0.006). Women with diabetes in rural areas had no decline in overall mortality, compared with a 28% reduction in urban women (P < 0.001). Conclusions Diabetes prevalence remains highest in men, with the greatest increases seen in men living in rural residences. While mortality rates have declined substantially over the past decade for those people with diabetes living in urban settings, declines in mortality in rural areas have been much more modest (for men) or non‐existent (for women).     

Impact of gender on relative rates of cardiovascular events in patients with diabetes

AimTo investigate whether diabetes confers higher relative risks of cardiovascular events in women compared with men using contemporary data and also whether such gender-differences are dependent on age.MethodsAll patients discharged from French hospitals in 2013 with at least 5 years of follow-up and no history of major adverse cardiovascular events including heart failure (MACE-HF; heart failure, myocardial infarction, ischaemic stroke, cardiovascular death) were identified and categorized by diabetes status. Overall and age-stratified incidence rates, hazard ratios (HRs) and women-to-men ratios (WMRs) for MACE-HF leading to hospitalization were also calculated. Adjustments were then made for age and baseline characteristics according to cardiovascular risk factors and non-cardiovascular comorbidities.ResultsThe study included 2,953,816 subjects, among whom 349,928 (11.9%) had diabetes. Of those with diabetes, the absolute rate of MACE-HF was higher in men than in women (96 vs 66 per 1000 person-years); corresponding absolute rates in men and women without diabetes were 44 vs 27 per 1000 person-years. Comparing those with and without diabetes, women had a higher unadjusted HR of MACE-HF (2.45, 95% CI: 2.42–2.47) than men (2.15, 95% CI: 2.14–2.17), with an adjusted WMR of 1.13 (95% CI: 1.12–1.15). HRs of MACE-HF related to diabetes were highest in women aged around 45 years and in the youngest men and decreased with advancing age in both these groups. However, HRs were higher in women of all ages > 40 years. After adjustment, this effect was more apparent for myocardial infarction (adjusted WMR: 1.43, 95% CI: 1.38–1.48) than for either ischaemic stroke (adjusted WMR: 1.10, 95% CI: 1.07–1.14) or heart failure (adjusted WMR: 1.13, 95% CI: 1.11–1.14).ConclusionAlthough men have higher absolute risks of cardiovascular complications, the relative risks of cardiovascular complications associated with diabetes are higher in women than in men.     

Descriptive epidemiology of osteoarthritis in British Columbia, Canada

OBJECTIVE: Osteoarthritis (OA) is a highly prevalent and often disabling disease. Data on the incidence of OA in the general population are limited. Our objectives were (1) to estimate OA prevalence and incidence rates by age and sex in a geographically defined population of 4 million people [British Columbia (BC), Canada] using an administrative database; and (2) to determine the effects of different administrative definitions of OA and observation (run-in) time on such estimates. METHODS: We used data on all visits to health professionals and hospital admissions covered by the Medical Services Plan (MSP) of BC for the fiscal years 1991-92 through 2000-01. OA was defined based on International Classification of Diseases, 9th Revision, diagnostic codes required for administrative purposes. RESULTS: The overall prevalence of OA in 2001 was 10.8%: 8.9% in men and 12.6% in women. Prevalence was higher in women in all age groups. By age 70-74 years, about one-third of men and 40% of women had OA. Incidence rates in 2000-01 were 11.7 per 1000 person-years in the total population, 10.0 in men and 13.4 in women. Rates increased linearly with age between 50 and 80 years. Both prevalence and incidence depended strongly on the definition of OA and the run-in period. CONCLUSION: Prevalence of physician-diagnosed OA in BC was slightly lower than self-reported prevalence of arthritis in population surveys. Routinely collected administrative data could be a valuable source of information for OA surveillance, but more research is needed on the validity of OA diagnosis in administrative databases.     

Crohn’s disease in Italy: A critical review of the literature using different data sources

BackgroundIncidence and prevalence of Crohn’s disease (CD) have increased during the last decades in several world areas. Italian data on CD are scattered between various administrative, educational and scientific sources, and findings are poorly summarized.AimsWe conducted a review focusing not only on prevalence and incidence of CD in Italy, but also on mortality, treatments, delayed diagnosis and hospitalization.MethodsIn October 2015, we searched for quantitative epidemiological data of CD using PubMed/Medline, EMBASE, and the Cochrane Database of Systematic Reviews. We also conducted searches on selected web resources for databases and educational publications.ResultsSixteen studies reporting data on incidence of CD from Italy were found. Incidence rates of CD in the early 2010’s in Italy were 3.5–4 cases per 100,000 inhabitants per year. Ten investigations provided data on CD prevalence, with large variability between Italian areas. Most studies considering data at two or more time points or across consecutive time periods reported increasing incidence or prevalence of CD.ConclusionThis review of Italian epidemiological data indicates that CD incidence and prevalence are continuing to (moderately) increase. Diagnostic delay, treatments, hospitalization and surgery for CD in Italy were also reviewed and quantified, though information is somewhat limited.     

Incidence of vertebral fractures in Thai women and men: A prospective population‐based study

Background: Vertebral fracture is the most common but the least well‐investigated osteoporotic fracture. A population‐based prospective study was conducted to determine incidence of vertebral fracture in Thai older adults. Methods: Lateral thoracic and lumbar spine radiographs obtained in 1997 and 2002 of 322 participants were evaluated morphometrically. Incidence of fracture was considered if the vertebra was determined as normal at baseline and any of the anterior, central, posterior vertebral heights on the follow‐up film showed a decrease of at least 20% or 4 mm compared with baseline height. Results: Incidences of vertebral fracture in women and men were 32.1/1000 and 54.5/1000 person‐year, respectively. Incident rates in men were higher than those in women in all age groups. Incidence increased with age, ranging from 27.4/1000 person‐year at ages 50–59 years to 46.1/1000 person‐year at ages of 70 years or more for women, and 42.3/1000 person‐year at ages 50–59 years to 66.7/1000 person‐year at ages of 70 years or more in men. The incidence was markedly high compared with other studies conducted in white older adults. Thai older adults with incidental vertebral fractures had a much higher proportion of having multiple‐level fractures compared with white older adults. Conclusions: This study showed a remarkably high incidence of vertebral fractures in a Thai population, particularly in men. The main contributing factor for incidental vertebral fracture was likely to be trauma or micro‐trauma associated with strenuous physical activity or work rather than osteoporosis, particularly among the younger age group and men.     

The incidence of cholelithiasis and cholecystitis in Rochester, Minn, 1950 through 1969

During the period 1950 through 1969, 2344 persons (755 men and 1589 women) in Rochester, Minn, met diagnostic and residency criteria for cholelithiasis. The age-adjusted average annual incidence rates per 100,000 population were 217 for men and 370 for women (adjusted rates were 255 and 276, respectively). Incidence rates increased with age in both sexes, but more rapidly so for men, so that by 70 years of age the rate for men was higher than that for women. For the decades covered in this study, no secular trend in incidence was detected for the two sexes combined or separately.     

Incidence of newly diagnosed heart failure in UK general practice

AIM: To estimate the incidence rate of heart failure in the general population and to assess risk factors associated with the occurrence of newly diagnosed heart failure. METHODS: From the source population that was derived from the UK General Practice Research Database, we identified patients aged 40--84 years newly diagnosed with heart failure in 1996, and estimated incidence rates. We sent questionnaires to a random sample of heart failure patients (N=1200) and performed a nested case-control analysis to assess risk factors for heart failure. RESULTS: The overall incidence rate for heart failure was 4.4 per 1000 person-years in men and 3.9 per 1000 person-years in women. The incidence increased steeply with age in both sexes. The relative risk of heart failure was 2.1 (95% C.I.: 1.7--2.6) among men compared with women less than 65 years old and 1.3 (95% C.I.: 1.2--1.4) above the age of 65. Slightly more than half of the cases were categorized in NYHA III--IV at the time of the first diagnosis. Within one month of initial diagnosis 62% of the men and 50% of the women were referred to specialists and/or hospitalized for heart failure. Smoking, hypertension, diabetes, obesity were independently associated with heart failure as well as history of distant dyspnoea. Coronary heart disease was the most common cause of heart failure with a greater relative prevalence in men than women. CONCLUSION: Incident heart failure cases mainly comprised elderly men and women frequently burdened with several diseases in general practice. Women had a lower incidence of heart failure than men. However, traditional risk factors such as smoking, hypertension, obesity, diabetes and dyspnoea appeared to confer the same relative increase in heart failure risk among women and men.     

Is the type 2 diabetes epidemic plateauing in France? A nationwide population-based study

AimNationwide data on the evolution of diabetes incidence and prevalence are scarce in France. For this reason, our objectives were to determine type 2 diabetes prevalence and incidence rates between 2010 and 2017, stratified by gender, age and region, and to assess annual time trends over the study period in adults aged ≥ 45 years.MethodsDiabetes cases in the National Health Data System (SNDS), which covers the entire French population (66 million people), were identified through a validated algorithm. Gender- and age-specific prevalence and incidence rates were estimated. Negative binomial models, adjusted for gender, age and region, were used to assess annual time trends for prevalence and incidence throughout the study period.ResultsDuring 2017, 3,144,225 diabetes cases aged ≥ 45 years were identified. Over the study period, prevalence increased slightly (men from 11.5% to 12.1%, women from 7.9% to 8.4%) whereas incidence decreased (men from 11 to 9.7, women from 7.2 to 6.2 per 1000 person-years). In only four groups did prevalence rates decrease: men aged 45–65 years; women aged 45–60 years; women in Reunion; and women in Martinique. An increasing annual time trend was observed for prevalence (men: +0.9% [95% CI: +0.7%, +1%]; women: +0.4% [95% CI: +0.2%, +0.6%]) with a decreasing annual time trend for incidence in both genders (men: −2.6% [95% CI: −3.1%, −2.0%]; women: −3.9% [95% CI: −4.5%, −3.4%]).ConclusionFurther efforts towards diabetes prevention are required to ensure that incidence rates in France continue to diminish, as the disorder continues to represent an important public-health burden.     

Aspergillosis among people infected with human immunodeficiency virus: incidence and survival. Adult and Adolescent Spectrum of HIV Disease Project.

Aspergillosis is a life-threatening fungal infection in immunocompromised people, including people infected with human immunodeficiency virus (HIV). We determined the incidence of aspergillosis among HIV-infected people and survival after aspergillosis diagnosis by use of a national HIV surveillance database. Among 35,252 HIV-infected patients, the incidence of aspergillosis was 3.5 cases per 1000 person-years (p-y; 95% confidence interval [CI], 3.0-4.0 per 1000 p-y). Incidence was higher among people aged > or =35 years (4.1 per 1000 p-y, 95% CI, 3. 5-4.8), among people with CD4 counts of 50-99 cells/mm(3) (5.1 per 1000 p-y, 95% CI, 2.8-7.3), or CD4 counts of <50 cells/mm(3) (10.2 per 1000 p-y, 95% CI, 8.0-12.2), versus people with CD4 counts of >200 cells/mm(3), people with > or =1 acquired immune deficiency syndrome-defining opportunistic illness (8.6 per 1000 p-y, 95% CI, 7.4-9.9), and people who were prescribed at least one medication associated with neutropenia (27.7 per 1000 p-y, 95% CI, 21.0-34.3). Median survival time after diagnosis of aspergillosis was 3 months, and 26% survived for > or =1 year. These findings suggest that aspergillosis is uncommon, occurs especially among severely immunosuppressed or leukopenic HIV-infected people, and is associated with poor survival.     

The incidences of and consultation rate for lower extremity complaints in general practice

OBJECTIVE: To estimate the incidence and consultation rate of lower extremity complaints in general practice. METHODS: Data were obtained from the Second Dutch National Survey of General Practice, in which 195 general practitioners (GPs) in 104 practices recorded all contacts with patients during 12 consecutive months in computerised patient records. GPs classified the symptoms and diagnosis for each patient at each consultation according to the International Classification of Primary Care (ICPC). Incidence densities and consultation rates for different complaints were calculated. RESULTS: During the registration period 63.2 GP consultations per 1000 person-years were attributable to a new complaint of the lower extremities. Highest incidence densities were seen for knee complaints: 21.4 per 1000 person-years for women and 22.8 per 1000 person-years for men. The incidence of most lower extremity complaints was higher for women than for men and higher in older age. CONCLUSIONS: Both incidences of and consultation rates for lower extremity complaints are substantial in general practice. This implies a considerable impact on the workload of the GP.     

High incidence of type 2 diabetes and increasing conversion rates from impaired fasting glucose and impaired glucose tolerance to diabetes in Mauritius

OBJECTIVE: To describe the incidence of different stages of glucose intolerance in a population from Mauritius followed over 11 years. RESEARCH DESIGN, METHODS AND SUBJECTS: Population-based surveys were undertaken in the multi-ethnic nation of Mauritius in 1987, 1992 and 1998 with 5083, 6616 and 6291 participants, respectively. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. Three cohorts aged between 25 and 79 years with classifiable glucose tolerance data were identified; 3680 between 1987 and 1992, 4178 between 1992 and 1998, and 2631 between 1987 and 1998. Glucose tolerance was classified according to WHO 1999 criteria. RESULTS: The incidence rate of type 2 diabetes was higher between 1992 and 1998 than between 1987 and 1992. In men, the incidence was similar between cohorts (24.5 and 25.4 per 1000 person-years) whereas the incidence increased in women (23.3 and 16.4 per 1000 person-years). The incidence of diabetes peaked in the 45-54 year age group and then plateaued or fell. The incidences of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) decreased in both men and women. Of normoglycaemic subjects at baseline, more women than men developed IGT and more men than women developed IFG. Of those labelled as IFG in 1987, 38% developed diabetes after 11 years. The corresponding figure for IGT was 46%. CONCLUSIONS: In this study, we report changes in incidence rates of glucose intolerance over a 11-year period. In particular, differences between men and women were observed. The increased incidence of IGT in women compared with men, and increased incidence of IFG in men compared with women was consistent with, and explains the sex biases seen in the prevalences of these states.     

Increased risk of severe acute pancreatitis in patients with diabetes

Aims We prospectively assessed the age‐ and sex‐specific incidence rates and relative risks of overall and severe acute pancreatitis in Taiwanese with diabetes. Methods The study cohort included age‐ and‐sex‐matched groups of patients with (n = 547 554) and without (n = 584 373) diabetes. Incidence rate was estimated under Poisson assumption and relative risks of acute pancreatitis and severe acute pancreatitis, based on modified Atlanta criteria, were indicated by hazard ratios estimated from Cox proportional hazard regression models. Results Over an 8‐year follow‐up period, the incidence of acute pancreatitis was 2.98 and 1.68 per 1000 person‐years for patients with and without diabetes, respectively, representing a covariate adjusted hazard ratio of 1.53 (95% confidence interval 1.49–1.58). Diabetes was associated with a significantly elevated risk of acute pancreatitis in all sex and age stratifications, with the highest hazard ratio noted for study subjects aged < 45 years (men 2.37; women 2.95). Diabetes was also significantly associated with an increased hazard ratio of severe acute pancreatitis [1.46 (1.36–1.57)], and especially of acute pancreatitis with local complications [1.65 (1.14–2.39)]. Conclusions Diabetes is associated with an increased risk of overall and severe acute pancreatitis, and the relation is stronger in women and young patients.     

10-year follow-up of subclinical cardiovascular disease and risk of coronary heart disease in the Cardiovascular Health Study

BACKGROUND: The incidence of coronary heart disease (CHD) is very high among individuals 65 years or older. METHODS: We evaluated the relationships between measurements of subclinical disease at baseline (1989-1990) and at the third-year follow-up examination (1992-1993) and subsequent incidence of cardiovascular disease and total mortality as of June 2001. Approximately 61% of the participants without clinical cardiovascular disease at baseline had subclinical disease based on our previously described criteria from the Cardiovascular Health Study. RESULTS: The incidence of CHD was substantially increased for participants with subclinical disease compared with those who had no subclinical disease: 30.5 per 1000 person-years with and 16.3 per 1000 person-years without for white individuals, and 31.2 per 1000 person-years with and 12.5 per 1000 person-years without for black individuals. The risk persisted over the entire follow-up period. Incidence rates were higher for men than for women with or without subclinical disease, but there was little difference in rates for black individuals and white individuals. CONCLUSIONS: In multivariable models, subclinical disease at baseline remained a significant predictor of CHD in both men and women; the hazard ratios (95% confidence intervals) of their relative risks were 1.64 (1.30-2.06) and 1.49 (1.21-1.84), respectively. The presence of subclinical disease substantially increased the risk of subsequent CHD for participants with hypertension, diabetes mellitus, or elevated C-reactive protein. In summary, subclinical disease is very prevalent among older individuals, is independently associated with risk of CHD even over a 10-year follow-up period, and substantially increases the risk of CHD among participants with hypertension or diabetes mellitus.     

Trends in absolute and relative risk of acute myocardial infarction in people with type 2 diabetes in Scotland: a national retrospective cohort study

BackgroundWhether more rigorous monitoring and evidence-based treatment of type 2 diabetes has led to improvements in cardiovascular outcomes is unclear. We aimed to explore trends in incidence rates of acute myocardial infarction in the Scottish adult population with type 2 diabetes compared with the non-diabetic population.MethodsIncidence rates of acute myocardial infarction (first admissions and deaths in and out of hospital) between Jan 1, 2001, and Dec 31, 2010, for adults aged 35–84 years were derived from Scottish Morbidity Records and linked death records. Diabetes diagnoses were ascertained by linkage to the Scottish diabetes register. Trends were analysed with negative binomial regression adjusted for age and an area-based measure of socioeconomic deprivation, and then expressed as annual percentage change in rates.FindingsOf 118 340 incident acute myocardial infarctions, 15 798 (13%) were in people with type 2 diabetes 1·88 million (4%) of 50·7 million person-years at risk were in people with type 2 diabetes. In men and women with and without type 2 diabetes, incidence of acute myocardial infarction decreased over time. Incidence was higher among people with than without type 2 diabetes, with higher relative risks in women than in men. The mean annual fall in rate of acute myocardial infarction was 3·7% (95% CI 3·2–4·2) and 2·3% (2·0–2·7) in women and men without diabetes, respectively; and 5·6% (4·6–6·7) and 4·4% (3·6–5·2) in women and men with type 2 diabetes. Relative risks for acute myocardial infarction declined for people with type 2 diabetes compared with people without type 2 diabetes from 1·5 (1·4–1·7) to 1·2 (1·1–1·3) for men and 1·8 (1·6–2·1) to 1·5 (1·3–1·6) for women between 2001 and 2010.InterpretationRates of acute myocardial infarction decreased over time in all population groups with more pronounced declines among people with than without type 2 diabetes. Secular trends in risk factors and improved primary and secondary prevention of cardiovascular disease are potential explanations for the observed time trends.FundingData linkage of the Scottish population-based register of people with diagnosed diabetes to national hospital admission and mortality records and data management was funded by the Scottish Government through the Scottish Diabetes Group, which had no role in the writing of the abstract or the decision to submit for publication.