Background

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(No Transcript)
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Background

• This report presents diabetes mellitus (DM)
  prevalence, incidence and mortality rates for
  Ontarians aged 20 years and older from 1995/96 to
  2004/05. Analyses were performed at the
  provincial, Local Health Integration Network
  (LHIN) and sub-LHIN planning area level.
• Criteria developed for the Ontario Diabetes
  Database (ODD) were used to capture patients with
  DM. Using anonymized administrative data,
  individuals were identified as having DM if they
  were admitted to hospital with a diagnosis of DM
  or had two Ontario Health Insurance (OHIP) claims
  for which DM was the recorded diagnosis (within
  two years). Additional information about the ODD
  is available in the Technical Appendices of
  ICES Practice Atlas Diabetes in Ontario, June
  2003 at www.ices.on.ca.

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Key Findings

• From 1995/96 to 2004/05, the incidence rates of
  DM in Ontarians aged 20 years and older increased
  and mortality rates decreased, resulting in an
  overall increase in prevalence rates.
• There was significant variation in prevalence,
  incidence, and mortality rates in persons with DM
  across LHINs and sub-LHIN planning areas.
• Further information on recent diabetes trends in
  Ontario is available in Lipscombe LL, Hux JE.
  Trends in diabetes prevalence, incidence, and
  mortality in Ontario, Canada 1995-2005 a
  population-based study, The Lancet 2007
  369750756.
• Factors influencing increased incidence rates
  include
• increasing obesity rates and,
• increasing immigration of populations more
  susceptible to type 2 diabetes (e.g., South
  Asian).

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Key Findings (continued)

• Factors influencing decreased mortality rates
  include
• enhanced screening and improved diagnostic
  criteria which allow for earlier and more
  accurate diagnoses and,
• improved treatments for DM and its complications.

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Interpretative Cautions

• The ODD-validated algorithm used to identify
  persons with DM has a sensitivity of 86, which
  means that some cases of DM are missed. Also, the
  algorithm can only detect persons with diagnosed
  DM, thus persons with undiagnosed DM are not
  captured. As a result, the true prevalence of DM
  is likely higher than stated.
• It is not possible to distinguish between type 1
  DM (decrease in, or the complete absence of,
  insulin production often presenting in
  childhood) and type 2 DM (decreased sensitivity
  of body tissues to insulin and decreased insulin
  production often adult onset). Type 2 DM,
  however, is believed to be the major contributor
  to the rise in diabetes incidence and prevalence.
• It is not possible to assess the impact of
  ethnicity, thought to be a contributing factor in
  the rising rates of diabetes in certain areas of
  Ontario (e.g., metropolitan Toronto).

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Interpretative Cautions (continued)

• For mortality rates in persons with DM, all
  deaths were included, whether or not diabetes was
  listed as the cause of death. Therefore, true
  mortality from confirmed DM-attributable causes
  may be slightly lower than stated.
• Caution should be used when interpreting rates at
  the sub-LHIN planning area level due to small
  populations resulting in low case volumes and
  unstable rates. To increase the stability of the
  mortality rate estimates at the sub-LHIN planning
  area level, results were averaged over a 5 year
  study period. 

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LHIN Summary Report
Trends in Diabetes Prevalance, Incidence and
Mortality 1995/962004/05
Updated February 2007
8
Age- and sex-adjusted prevalence rate of diabetes
mellitus (DM) per 100 Ontarians, and incidence
rate per 1,000 Ontarians, aged 20 years and
older, by LHIN and for Ontario, 2003/042004/05

• Prevalence rates of DM increased in all LHINs
  from 2003/04 to 2004/05.
• Incidence rates of DM increased in all LHINs
  except Champlain during the same period.
• Prevalence rates and incidence rates were lowest
  in the North Simcoe Muskoka LHIN and highest in
  the Toronto Central and Central West LHINs.

9
Age- and sex-adjusted mortality rate per 1,000
Ontarians with diabetes mellitus (DM) aged 20
years and older, by LHIN and for Ontario,
2003/042004/05

• Mortality rates in Ontarians with DM remained
  stable or decreased in all LHINs from 2003/04 to
  2004/05.
• Overall age- and sex-adjusted mortality rates in
  2004/05 were lowest in the Central West LHIN and
  highest in the North West LHIN.

10
Age-adjusted prevalence rate of diabetes mellitus
(DM) per 100 Ontarians aged 20 years and older,
by sex, 2004/05 by LHIN and for Ontario

• In 2004/05, prevalence rates of DM were higher in
  men than in women across LHINs except in the
  North West LHIN.
• The highest DM prevalence rate was seen in men in
  the Central West LHIN (10.3 per 100 Ontarians),
  while the lowest rate was seen in women in the
  North Simcoe Muskoka LHIN (5.8 per 100 Ontarians).

11
Age-adjusted prevalence rate of diabetes mellitus
(DM) per 100 Ontarians, and number of persons
with DM, aged 20 years and older, by sex and
Local Health Integration Network (LHIN), 2004/05

• In 2004/05, prevalence rates of DM were higher in
  men than in women across LHINs except in the
  North West LHIN.
• The highest DM prevalence rate was seen in men in
  the Central West LHIN (10.3 per 100 Ontarians),
  while the lowest rate was seen in women in the
  North Simcoe Muskoka LHIN (5.8 per 100 Ontarians).

12
Age- and sex-adjusted prevalence rate of diabetes
mellitus (DM) per 100 Ontarians and number of
persons with DM aged 20 years and older, by
Local Health Integration Network (LHIN),
2000/012004/05

• Prevalence rates of DM increased across all LHINs
  between 2000/01 and 2004/05, with the greatest
  rate increase seen in the Toronto Central LHIN.
• In 2004/05, DM prevalence rates were lowest in
  the North Simcoe Muskoka LHIN (6.1 per 100
  Ontarians) and highest in the Central West and
  Toronto Central LHINs (9.8 per 100 Ontarians).

13
Age-adjusted prevalence rate of diabetes mellitus
(DM) per 100 Ontarians aged 20 years and older,
by sex, 1995/962004/05 LHIN 10 (South East)
vs. Ontario

• Prevalence rates of DM in the South East LHIN
  increased between 1995/96 and 2004/05 but at a
  slightly slower pace than rates for Ontario
  overall, resulting in a widening in the disparity
  of prevalence rates.
• DM prevalence rates in the LHIN were lower than
  Ontario rates for both men and women throughout
  the study period.
• In the LHIN, DM prevalence rates were higher in
  men than in women.

14
Prevalence rate of diabetes mellitus (DM) per 100
Ontarians aged 20 years and older, by sex and
age group, 1995/962004/05 LHIN 10 (South East)
vs. Ontario

• Prevalence rates of DM in the South East LHIN and
  for Ontario overall increased between 1995/96 and
  2004/05 across sex and age groups.
• When all age groups were combined, LHIN rates
  were lower than Ontario rates for both men and
  women.
• DM prevalence rates in the LHIN and for Ontario
  increased with age, leveling off after 65 years
  of age.
• DM prevalence rates were higher in men than in
  women except in the youngest age group (2034
  years).

15
Prevalence rate of diabetes mellitus (DM) per 100
Ontarians aged 20 years and older, by sex and
age group, 2004/05 LHIN 10 (South East) vs.
Ontario

• In 2004/05, prevalence rates of DM in the South
  East LHIN and for Ontario overall increased with
  age, leveling off after 65 years of age.
• DM prevalence rates in the LHIN were generally
  lower than Ontario rates across sex and age
  groups.
• In the youngest age group (20-34), DM prevalence
  rates were higher in women than in men.

16
Age- and sex-adjusted prevalence rate of diabetes
mellitus (DM) per 100 Ontarians aged 20 years and
older, by neighbourhood income quintile,
1995/962004/05 LHIN 10 (South East) vs.
Ontario
(lowest income)
(highest income)
A measure of overall socioeconomic status

• From 1995/96 to 2004/05, prevalence rates of DM
  in the South East LHIN increased across all
  socioeconomic status (SES) groups.
• The lowest SES group (Q1) had the highest
  prevalence rates while the highest SES group (Q5)
  had the lowest prevalence rates throughout the
  study period and this difference remained
  relatively constant over time.

17
Prevalence rate of diabetes mellitus (DM) per 100
Ontarians aged 20 years and older, by sex, age
group and neighbourhood income quintile, 2004/05
LHIN 10 (South East) vs. Ontario
A measure of overall socioeconomic status.

• In 2004/05, prevalence rates of DM in the South
  East LHIN and for Ontario overall generally
  decreased with higher socioeconomic status (SES)
  across sex and age groups. When all age groups
  were combined, LHIN rates were slightly lower
  than Ontario rates for both men and women.
• Across SES groups, prevalence rates in the LHIN
  and for Ontario increased with age, leveling off
  after 65 years of age.
• DM prevalence rates in the LHIN were higher in
  men than in women for those aged 50 years and
  older.

18
Age- and sex-adjusted prevalence rate of diabetes
mellitus (DM) per 100 Ontarians aged 20 years
and older, by neighbourhood income quintile,
2004/05 LHIN 10 (South East) vs. Ontario
(lowest income)
(highest income)
A measure of overall socioeconomic status

• In 2004/05, prevalence rates of DM decreased with
  higher socioeconomic status (SES) in the South
  East LHIN and for Ontario overall, though the
  decrease was less in the LHIN.
• Across all SES groups, and particularly for the
  two lowest SES groups (Q1 and Q2), DM prevalence
  rates in the LHIN were lower than those for
  Ontario overall.

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Age-adjusted incidence rate of diabetes mellitus
(DM) per 1,000 Ontarians aged 20 years and
older, by sex, 2004/05 by Local Health
Integration Network (LHIN) and for Ontario

• In 2004/05, incidence rates of DM were higher in
  men than in women across all LHINs.
• The highest DM incidence rate was seen in the men
  of the Toronto Central LHIN (10.7 per 1,000
  Ontarians), while the lowest incidence rate was
  seen in the women of the North Simcoe Muskoka
  LHIN (5.3 per 1,000 Ontarians).
• The rate disparity between men and women was the
  greatest in the North West LHIN.

20
Age-adjusted incidence rate of diabetes mellitus
(DM) per 1,000 Ontarians, and number of persons
newly diagnosed with DM, aged 20 years and older,
by sex and Local Health Integration Network
(LHIN), 2004/05

• In 2004/05, incidence rates of DM were higher in
  men than in women across all LHINs.
• The highest DM incidence rate was seen in the men
  of the Toronto Central LHIN (10.7 per 1,000
  Ontarians), while the lowest incidence rate was
  seen in the women of the North Simcoe Muskoka
  LHIN (5.3 per 1,000 Ontarians).
• The rate disparity between men and women was the
  greatest in the North West LHIN.

21
Age- and sex-adjusted incidence rate of diabetes
mellitus (DM) per 1,000 Ontarians, and number of
persons newly diagnosed with DM, aged 20 years
and older, by Local Health Integration Network
(LHIN), 2000/012004/05

• Incidence rates of DM increased steadily from
  2000/01 to 2004/05 in the Toronto Central and
  Central East LHINs.
• In 2004/05, incidence rates of DM were lowest in
  the North Simcoe Muskoka LHIN (5.6 per 1,000
  Ontarians) and highest in the Central West and
  Toronto Central LHINs (10.0 per 1,000 Ontarians).

22
Age-adjusted incidence rate of diabetes mellitus
(DM) per 1,000 Ontarians aged 20 years and
older, by sex, 1995/962004/05 LHIN 10 (South
East) vs. Ontario

• Incidence rates of DM in the South East LHIN
  increased overall between 1995/96 and 1999/00,
  after which they leveled off.
• DM incidence rates in the LHIN were lower than
  Ontario rates for both men and women throughout
  the study period.
• DM incidence rates in the LHIN were generally
  higher in men than in women.

23
Incidence rate of diabetes mellitus (DM) per
1,000 Ontarians aged 20 years and older, by sex
and age group, 1995/962004/05 LHIN 10 (South
East) vs. Ontario

• Incidence rates of DM in the South East LHIN and
  for Ontario overall increased between 1995/96 and
  2004/05.
• When all age groups were combined, LHIN rates
  were lower than Ontario rates for both men and
  women.
• DM incidence rates in the LHIN increased with age
  until age 65 years but generally decreased
  thereafter.
• DM incidence rates were usually higher in men
  than in women except in the youngest age group
  (2034 years).

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Incidence rate of diabetes mellitus (DM) per
1,000 Ontarians aged 20 years and older, by sex
and age group, 2004/05 LHIN 10 (South East) vs.
Ontario

• In 2004/05, incidence rates of DM in the South
  East LHIN and for Ontario overall increased with
  age until age 65 but decreased thereafter for
  both men and women.
• DM incidence rates in the LHIN were lower than
  Ontario rates across all sex and age groups.
• In the youngest age group (20-34), incidence
  rates were higher in women than in men.

25
Age- and sex-adjusted incidence rate of diabetes
mellitus (DM) per 1,000 Ontarians aged 20 years
and older, by neighbourhood income quintile,
1995/962004/05 LHIN 10 (South East) vs. Ontario
(lowest income)
(highest income)
A measure of overall socioeconomic status

• From 1995/96 to 2004/05, incidence rates of DM in
  the South East LHIN were relatively stable across
  all socioeconomic status (SES) groups.
• The lowest SES group (Q1) had the highest
  incidence rates while the highest SES group (Q5)
  had the lowest incidence rates throughout most of
  the study period and this difference remained
  relatively constant over time.

26
Incidence rate of diabetes mellitus (DM) per
1,000 Ontarians aged 20 years and older, by sex,
age group and neighbourhood income quintile,
2004/05 LHIN 10 (South East) vs. Ontario
A measure of overall socioeconomic status.

• In 2004/05, overall incidence rates of DM in the
  South East LHIN and for Ontario decreased with
  higher socioeconomic status (SES). When all age
  groups were combined, LHIN rates were generally
  lower than Ontario rates for both men and women.
  
• Across SES groups, DM incidence rates in the LHIN
  generally increased with age until age 65 years.
  
• DM incidence rates in the LHIN were consistently
  higher in men than in women for those aged 5064
  years.

27
Age- and sex-adjusted incidence rate of diabetes
mellitus (DM) per 1,000 Ontarians aged 20 years
and older, by neighbourhood income quintile,
2004/05 LHIN 10 (South East) vs. Ontario
(lowest income)
(highest income)
A measure of overall socioeconomic status

• In 2004/05, incidence rates of DM generally
  decreased with higher socioeconomic status (SES)
  in the South East LHIN.
• Across all SES groups, and particularly for the
  two lowest SES groups (Q1 and Q2), DM incidence
  rates in the LHIN were lower than those for
  Ontario overall.

28
Age- and sex-adjusted mortality rate per 1,000
Ontarians with and without diabetes mellitus
(DM) aged 20 years and older, 2004/05 by LHIN
and for Ontario

• In 2004/2005, mortality rates in people with DM
  were almost twice as high as mortality rates in
  people without DM across all LHINs and for
  Ontario overall.
• The ratio between mortality rates in people with
  DM and people without DM was greatest in the
  Hamilton Niagara Haldimand Brant LHIN (16.0 vs.
  8.2 per 1,000) and least in the Central West LHIN
  (10.6 vs. 6.7 per 1,000).

29
Age- and sex-adjusted mortality rate per 1,000
Ontarians with and without diabetes mellitus (DM)
aged 20 years and older, and number of deaths,
by Local Health Integration Network (LHIN),
2002/032004/05

• Mortality rates in people with DM decreased
  steadily across LHINs between 2002/03 and
  2004/05, except in the Waterloo Wellington,
  Hamilton Niagara Haldimand, Mississauga Halton
  and North Simcoe Muskoka LHINs.
• However, overall mortality rates in people with
  DM were almost twice as high as the overall
  mortality rates in people without DM throughout
  the study period.

30
Age- and sex-adjusted mortality rate per 1,000
Ontarians with and without diabetes mellitus
(DM) aged 20 years and older, 2004/05 by LHIN
and for Ontario

• In 2004/05, mortality rates in people with DM
  were approximately twice as high as mortality
  rates in people without DM across all LHINs.
• Men with DM had similar or higher mortality rates
  than women with DM across all LHINs.
• The disparity in mortality rates between men and
  women was greatest in the North Simcoe Muskoka
  LHIN (17.5 vs. 14.0 per 1,000).

31
Age-adjusted mortality rate per 1,000 Ontarians
with and without diabetes mellitus (DM) aged 20
years and older, and number of deaths, by sex
and Local Health Integration Network (LHIN),
2004/05

• In 2004/05, mortality rates in people with DM
  were approximately twice as high as mortality
  rates in people without DM across all LHINs.
• Men with DM had similar or higher mortality rates
  than women with DM across all LHINs.
• The disparity in mortality rates between men and
  women was greatest in the North Simcoe Muskoka
  LHIN (17.5 vs. 14.0 per 1,000).

32
Age-adjusted mortality rate per 1,000 Ontarians
with diabetes mellitus (DM) aged 20 years and
older, by sex, 1995/962004/05 LHIN 10 (South
East) vs. Ontario

• Mortality rates in people with DM in the South
  East LHIN and for Ontario overall, decreased
  between 1995/96 and 2004/05.
• Mortality rates in the LHIN were higher than
  Ontario rates for both men and women throughout
  the study period.
• Due to the LHIN's small population size and
  resulting rate fluctuations, mortality rates of
  men and women could not be conclusively compared.

33
Age- and sex-adjusted mortality rate per 1,000
Ontarians with diabetes mellitus (DM) aged 20
years and older, by neighbourhood income
quintile, 2004/05 LHIN 10 (South East) vs.
Ontario
(lowest income)
(highest income)
A measure of overall socioeconomic status

• In 2004/05, mortality rates in people with DM in
  the South East LHIN were highest in the lowest
  socioeconomic status (SES) group (Q1) and lowest
  in the highest SES group (Q5).
• The greatest disparity between LHIN mortality
  rates and Ontario overall mortality rates was in
  the lowest SES group (Q1) where the LHIN rate was
  markedly higher than the rate for Ontario overall.

34
Sub-LHIN Planning Areas Summary Report
Trends in Diabetes Prevalance, Incidence and
Mortality 2000/012004/05
Updated July 2007
35
Prevalence rate of diabetes mellitus (DM) per 100
Ontarians aged 20 years and older, by sex, age
group and planning area, 2004/05 LHIN 10 (South
East) vs. Ontario
Note Overall LHIN and Ontario rates in planning
area exhibits differ slightly from other exhibits
since updated Registered Persons Database files
were used.
NR No data in this category or not reportable
due to small cell size

• In 2004/05, prevalence rates of DM in the South
  East LHIN (all planning areas combined) were
  slightly lower than those for Ontario.
• DM prevalence rates varied across planning
  areashighest in Tyendinaga Napanee (10.o) and
  lowest in Rideau Lakes (10.j).
• DM prevalence rates were generally higher in men
  than in women.

36
Age-adjusted prevalence rate of diabetes mellitus
(DM) per 100 Ontarians aged 20 years and older,
by sex and planning area, 2004/05 LHIN 10 (South
East) vs. Ontario
Note Overall LHIN and Ontario rates in planning
area exhibits differ slightly from other exhibits
since updated Registered Persons Database files
were used.

• In 2004/05, prevalence rates of DM in the South
  East LHIN and its planning areas were generally
  lower than those for Ontario.
• DM prevalence rates varied across planning
  areashighest in Tyendinaga Napanee (10.o) and
  lowest in Rideau Lakes (10.j).
• DM prevalence rates were generally higher in men
  than in women.

37
Age- and sex-adjusted prevalence rate of diabetes
mellitus (DM) per 100 Ontarians aged 20 years
and older, by neighbourhood income quintile and
planning area, 2004/05 LHIN 10 (South East) vs.
Ontario
Note Overall LHIN and Ontario rates in planning
area exhibits differ slightly from other exhibits
since updated Registered Persons Database files
were used.
NR No data in this category or not reportable
due to small cell size
A measure of overall socioeconomic status.

• In 2004/05, prevalence rates of DM decreased with
  higher socioeconomic status (SES) in the South
  East LHIN (all planning areas combined) and for
  Ontario.

38
Incidence rate of diabetes mellitus (DM) per
1,000 Ontarians aged 20 years and older, by sex,
age group and planning area, 2004/05 LHIN 10
(South East) vs. Ontario
Note Overall LHIN and Ontario rates in planning
area exhibits differ slightly from other exhibits
since updated Registered Persons Database files
were used.
NR No data in this category or not reportable
due to small cell size

• In 2004/05, incidence rates of DM in the South
  East LHIN (all planning areas combined) were
  lower than those for Ontario.
• DM incidence rates varied across planning
  areasrates were particularly high for men
  overall in Tyendinaga Napanee (10.o) and for
  women in North Hastings (10.g).
• Across planning areas, differences in rates
  between men and women varied.

39
Age-adjusted incidence rate of diabetes mellitus
(DM) per 1,000 Ontarians aged 20 years and
older, by sex and planning area, 2004/05 LHIN 10
(South East) vs. Ontario
Note Overall LHIN and Ontario rates in planning
area exhibits differ slightly from other exhibits
since updated Registered Persons Database files
were used.

• In 2004/05, incidence rates of DM in the South
  East LHIN and its planning areas were generally
  lower than those for Ontario.
• DM incidence rates varied across planning
  areasrates were particularly high for men in
  Tyendinaga Napanee (10.o), and for women in North
  Hastings (10.g).
• Across planning areas, differences in rates
  between men and women varied.

40
Age- and sex-adjusted incidence rate of diabetes
mellitus (DM) per 100 Ontarians aged 20 years and
older, by neighbourhood income quintile and
planning area, 2004/05 LHIN 10 (South East) vs.
Ontario
Note Overall LHIN and Ontario rates in planning
area exhibits differ slightly from other exhibits
since updated Registered Persons Database files
were used.
NR No data in this category or not reportable
due to small cell size
A measure of overall socioeconomic status.

• In 2004/05, incidence rates of DM generally
  decreased with higher socioeconomic status (SES)
  in the South East LHIN (all planning areas
  combined).

41
Mortality rate per 1,000 Ontarians with diabetes
mellitus (DM) aged 20 years and older, by sex,
age group and planning area, 2000/012004/05
LHIN 10 (South East) vs. Ontario
Note Overall LHIN and Ontario rates in planning
area exhibits differ slightly from other exhibits
since updated Registered Persons Database files
were used.
NR No data in this category or not reportable
due to small cell size

• In 2000/012004/05, overall mortality rates in
  people with DM in the South East LHIN and its
  planning areas were generally higher than those
  for Ontario.
• Mortality rates varied across LHIN planning areas.

42
Age- and sex-adjusted mortality rate per 1,000
Ontarians with and without diabetes mellitus
(DM) aged 20 years and older, by planning area,
2000/012004/05 LHIN 10 (South East) vs. Ontario
Note Overall LHIN and Ontario rates in planning
area exhibits differ slightly from other exhibits
since updated Registered Persons Database files
were used.

• In 2000/012004/05, mortality rates in people
  with DM in the South East LHIN and its planning
  areas were generally higher than those for
  Ontario.
• Mortality rates varied across LHIN planning
  areas.
• Mortality rates in people with DM were about
  twice as high as mortality rates in people
  without DM across all planning areas and three
  times higher in South Frontenac (10.m).

43
Age- and sex-adjusted mortality rate per 1,000
Ontarians with diabetes mellitus (DM) aged 20
years and older, by neighbourhood income
quintile and planning area, 2000/012004/05
LHIN 10 (South East) vs. Ontario
Note Overall LHIN and Ontario rates in planning
area exhibits differ slightly from other exhibits
since updated Registered Persons Database files
were used.
NR No data in this category or not reportable
due to small cell size
A measure of overall socioeconomic status.

• In 2000/012004/05, mortality rates in people
  with DM decreased with higher socioeconomic
  status (SES) in the South East LHIN (all planning
  areas combined) and for Ontario.