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Slide 1: Coronary heart disease statistics: diabetes supplement 2001 edition Mike Rayner1, Sophie Petersen1, Chris Buckley1 and Vivienne Press2 1 British Heart Foundation Health Promotion Research Group Department of Public Health, University of Oxford 2 British Heart Foundation Coronary heart disease statistics: diabetes supplement 1
Slide 2: Scientific advisors for this supplement Dr Philip Clarke Research Fellow Health Economics Research Centre, Department of Public Health, University Oxford Dr Andrew Farmer Clinical Scientist Department of Primary Health Care, University of Oxford Professor Rury Holman Professor of Diabetic Medicine Diabetes Trials Unit, University of Oxford Dr Andrew Neil University Lecturer in Clinical Epidemiology Department of Public Health, University of Oxford Coronary heart disease statistics: diabetes supplement 2
Slide 3: Contents Page Foreword Summary Introduction 1. Prevalence of diabetes Prevalence of diagnosed diabetes by sex and age, 1998, England Prevalence of diagnosed diabetes by age, 1999, Tayside Estimates of numbers of people with diabetes by sex and age, 1999, United Kingdom Table 1.4 Prevalence of diagnosed and undiagnosed diabetes and impaired glucose tolerance, by sex and age, 1993, North London Table 1.5 Prevalence of diagnosed diabetes by sex and age, 1991-1998, England Figure 1.5 Prevalence of diagnosed diabetes amongst adults aged 16 and over 1991-1998, England Table 1.6 Prevalence of non-insulin treated diabetes by sex, age and region, 1994/98, England and Wales Table 1.7 Prevalence of non-insulin treated diabetes by sex, age and deprivation category, 1994/98, England and Wales Figure 1.7 Prevalence of non-insulin treated diabetes by deprivation category, 1994/98, England and Wales Table 1.8 Prevalence of diagnosed diabetes by sex, age and ethnic group, 1999, England Figure 1.8 Prevalence of diagnosed diabetes by ethnic group, 1999, England Table 1.9 Numbers of people with diabetes, 2000 and 2010, selected countries Figure 1.10 Prevalence of diabetes, 2000, the World Table 1.1 Table 1.2 Table 1.3 5 6 7 9 12 12 13 13 14 14 15 16 16 17 17 18 20 2. Mortality from diabetes Table 2.1 Table 2.2 Deaths by cause, sex and age, 1999, United Kingdom Percentage of deaths by cause by in people with diabetes by sex and age, 1972/99, United Kingdom, compared with the general population, 1999, United Kingdom Deaths by cause in people with diabetes, men aged 40-59, 1972/99, United Kingdom Deaths by cause in people with diabetes, women aged 40-59, 1972/99, United Kingdom Deaths by cause in the general population, men aged 40-59, 1999, United Kingdom Deaths by cause in the general population, women aged 40-59, 1999, United Kingdom 21 22 23 24 24 25 25 Figure 2.2a Figure 2.2b Figure 2.2c Figure 2.2d Coronary heart disease statistics: diabetes supplement 3. Morbidity from diabetes Table 3.1 Prevalence of complications of diabetes amongst people with newly diagnosed diabetes, 1977/91, United Kingdom 26 27 3
Slide 4: 4. Prevalence of risk factors for CVD in people with diabetes Table 4.1 Prevalence of hypertension amongst people with newly diagnosed diabetes by sex and age, 1977/89, United Kingdom; compared with the general population, 1991, England Mean body weight as a percentage of ideal body weight for people with newly diagnosed diabetes by sex and age, around 1982, United Kingdom; compared with the general population, 1984, Great Britain 28 29 Table 4.2 29 5. Treatment of diabetes and prevention of CVD in people with diabetes Table 5.1 Table 5. 2 Table 5.3 Table 5.4 Consultations with a GP for selected diseases by sex and age, 1991/92, England and Wales Treatment of patients with diabetes in the previous 12 months, general practices, 1995/96, England and Wales Inpatient cases by main diagnosis, sex and age, National Health Service hospitals, 1999/2000 England Estimates of numbers of inpatient cases and days in hospital due to diabetes by age, National Health Service hospitals, 1999/2000, England 30 32 32 33 34 6. Prevalence of behavioural risk factors for Type 2 diabetes in the general population Body Mass Index by sex and age, 1998, England Prevalence of a raised waist-hip ratio by sex and age, 1998, England Prevalence of obesity and overweight in children by sex and age, 1996, England Table 6.4 Prevalence of overweight and obesity by sex, 1986/87-1999, England Figure 6.4 Prevalence of overweight and obesity amongst adults aged 16-64, 1986/87-1999, England Table 6.5 Prevalence of morbid obesity, obesity and overweight by sex and social class, 1998, England Table 6.6 Prevalence of a raised waist-hip ratio by sex and social class, England, 1998 Table 6.7 Prevalence of obesity by sex and ethnic group, 1999, England Table 6.8 Prevalence of a raised waist-hip ratio by sex and ethnic group, 1999, England Figure 6.9 Body Mass Index by sex, 1960-1999, all available countries Figure 6.9 Prevalence of obesity, latest available data, all available countries Table 6.10 Physical activity level, by sex and age, 1994 and 1998, England Figure 6.10a Physical activity levels amongst men, 1998, England Figure 6.10b Physical activity levels amongst women, 1998, England Table 6.11 Number of hours spent participating in various physical activities in a typical week, 1997, European Union countries Figure 6.11 Percentage of adults aged 15 and over who do no physical activity in a typical week, 1997, European Union countries Table 6.1 Table 6.2 Table 6.3 35 39 39 40 41 41 42 42 43 43 44 46 47 47 47 48 48 Coronary heart disease statistics: diabetes supplement 4
Slide 5: Foreword Over the past 20 years there has been a steady decrease in the numbers of people in the UK dying from cardiovascular disease (CVD). However, this publication sounds a warning that the decrease may be about to slow down. The cause will be the rapidly increasing numbers of people with Type 2 diabetes. Recent research has shown that people with diabetes are at greatly increased risk of CVD. For example, women aged 40-59 with diabetes are eight times more likely to die of CVD than women without diabetes. However, neither the increase in numbers of people developing diabetes nor the increased risk of people with diabetes dying from CVD are inevitable. Both can be largely prevented by lifestyle changes and effective management of diabetes. People who are neither overweight nor obese and who are physically active have less risk of developing Type 2 diabetes. If diabetes does develop, good glucose control is essential but it is not sufficient to prevent CVD. Close management of the other major risk factors for CVD is also essential. These include, blood pressure, lipid levels, overweight and obesity, physical inactivity and smoking. However, many people in the UK are not receiving the regular assessment of these risk factors that is needed. Diabetes also needs to be diagnosed earlier. There are currently as many people in the UK with undiagnosed diabetes as there are with diagnosed diabetes. By the time people know they have diabetes, one in four already have CVD. The aim of this publication is to highlight the increasing burden in the UK of CVD due to diabetes, and to provide statistics to help those planning prevention and healthcare services. However, good management of diabetes can only be achieved through effective partnerships between people with diabetes and their healthcare professionals. Therefore, to coincide with this publication, the BHF and Diabetes UK have also published an information booklet for people with diabetes and their families, called Diabetes and Your Heart. Our predicted doubling of diabetes by 2010 and the resulting rise in CVD are not inevitable. We know how to prevent them. Now is the time to act together to save lives. Dr Vivienne Press Assistant Medical Director British Heart Foundation Mrs Suzanne Lucas Director of Care Diabetes UK Coronary heart disease statistics: diabetes supplement 5
Slide 6: Summary ■ There are about 1.4 million people with diagnosed diabetes in the UK and about a further 1 million people with undiagnosed diabetes. ■ There will be about 3 million people with diabetes in the UK by the year 2010. ■ There are about 150 million people with diabetes worldwide and there will be about 221 million by the year 2010. ■ There are about 33,000 deaths in the UK each year that are attributable to diabetes – about one in seven of all deaths. At least a half of these deaths are from cardiovascular disease (CVD). ■ About a quarter of people with newly diagnosed diabetes already have CVD. ■ In the UK about 3% of years of life lost in disability are due to diabetes. ■ In the UK 5% of all days spent in hospital are due to diabetes. About 60% of these days are because of CVD. ■ About 46% men and 32% of women are overweight or obese in the UK. About two thirds of cases of diabetes could be prevented if no one was overweight. Coronary heart disease statistics: diabetes supplement 6
Slide 7: Introduction The aims of this publication Diabetes is a cause of serious morbidity and significant premature mortality both in its own right and as a major risk factor for cardiovascular diseases (CVD) – coronary heart disease (CHD), stroke and peripheral vascular disease. This supplement presents statistics on the burden of diabetes alone but its focus is on the burden of CVD due to diabetes. It aims to characterise the burden of diabetes to individuals and to UK society as a whole in terms of both mortality and morbidity. Each section gives as far as is possible UK data by sex, age, socio-economic group, ethnic origin and geographical region. The supplement also examines trends and likely trends in the burden of diabetes over time and compares the burden in the UK with that in other countries. There are two main types of diabetes: Type 1 and Type 2 diabetes. CVD due to diabetes is largely preventable. This supplement describes patterns and trends in obesity and physical inactivity – the two major behavioural risk factors for Type 2 diabetes and risk factors it shares with CVD. The complications of diabetes, including CVD, can be delayed or helped by a combination of appropriate treatment and lifestyle changes. This supplement presents some statistics on the treatment of diabetes focusing on the prevention of CVD in people with diabetes. What is diabetes? Diabetes is characterised by high blood glucose levels. It arises when the pancreas fails to make enough insulin or when the body cannot effectively make use of the insulin produced or both. The chronic high blood glucose levels (hyperglycaemia) that result are associated with long-term damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. Type 1 diabetes results from an autoimmune destruction of the cells in the pancreas which produce insulin. People with Type 1 diabetes must take daily injections of insulin for survival. Type 2 diabetes, which accounts for about 90% of all diabetes, is characterised by an inability on the part of the body to respond to insulin (insulin resistance) and/or abnormal insulin secretion. People with Type 2 diabetes are treated with glucose lowering medication. There are a number of other less common types of diabetes including gestational diabetes. This occasionally occurs during pregnancy in women not previously diagnosed with diabetes and is a marker of greater risk of developing Type 2 diabetes in later life. For the purposes of this report, ‘diabetes’ refers to all types of diabetes (IDC-9 code 250 and ICD-10 codes E10-E14) unless otherwise stated. Impaired glucose tolerance is a condition closely related to Type 2 diabetes. It occurs when the Coronary heart disease statistics: diabetes supplement blood glucose level is higher than normal, but not high enough to be classified as diabetes. As in Type 2 diabetes, insulin is produced in lesser amounts or is less effective. People with impaired glucose tolerance are at a greater risk of developing Type 2 diabetes in the future. 7
Slide 8: Good glucose control is essential for preventing the long-term problems of diabetes, such as damage to the eyes, kidneys and feet. Diabetes as a risk factor for CVD Diabetes increases the risk of CVD but it also magnifies the effect of other risk factors for CVD such as raised cholesterol levels, raised blood pressure, smoking and obesity. Furthermore, people with diabetes are more likely to develop many of these other risk factors for CVD, further magnifying their risk. It is therefore important to target people with diabetes for advice about diet, physical activity and smoking and for treatment of raised blood pressure and blood cholesterol levels. Behavioural risk factors for diabetes Both genetic and environmental factors are responsible for diabetes. Type 1 diabetes is believed to be triggered by exposure to environmental factors, although these are not known. The development of Type 2 diabetes is influenced significantly by obesity and a lack of physical activity. Methods for this publication Various sources of information have been used in compiling this supplement. The sources of data can be divided into routinely collected national data, national studies and local studies. Data from different sources are collected in different ways and with different degrees of validity and reliability. Most sources only provide data on one or two aspects of diabetes. Not all sources supply data for all ages or even both sexes. Sample sizes of studies vary considerably as do sampling methods. This limits the extent to which the information can be combined, modelled or even compared. Nevertheless there are many sources that provide detailed and valuable information in their own areas. In compiling this supplement we have aimed to investigate all possible sources of recent data relating to the burden of diabetes and its major behavioural risk factors but have presented data, and calculated estimates of numbers, only from studies which give the widest coverage in terms of age, sex, geographical location, etc. and which used valid and reliable methods of data collection. We have not included data from outside of the UK (except when making international comparisons). We have aimed to include the most recent data available. Coronary heart disease statistics: diabetes supplement 8
Slide 9: 1. Prevalence of diabetes Overall prevalence Determining the prevalence of diabetes in the population is difficult. Studies of the prevalence of diabetes have generally had to rely either on self-reports of a diagnosis of diabetes or on extracting data on diagnoses of diabetes from general practitioner (GP) or hospital records. Both these methods are limited because they omit cases of undiagnosed diabetes and the criteria used by health professionals in making diagnoses vary. The best source of data on the prevalence of diagnosed diabetes in the UK would appear to be the Health Survey for England. This survey – while it relies on self-reports of a doctor-diagnosis of diabetes – is a large study involving a nationally representative sample of adults. The Health Survey for England suggests that the prevalence of diagnosed diabetes amongst adults (aged 16 and above) is about 3% (Table 1.1). This means that for the whole population (including children) the prevalence of diagnosed diabetes in the UK is about 2.2% (Tables 1.3). A recent study of the prevalence of diabetes in Tayside also found that the prevalence of diagnosed diabetes for the whole population was about 2.2% (Table 1.2). The Tayside study – while it is only of a small local population – used electronic record linkage of multiple data sources – and is therefore likely to be more comprehensive than previous prevalence studies. Using the age and sex-specific prevalence rates from the Health Survey for England we estimate that there are about 1.3 million people with diagnosed diabetes in the UK (Table 1.3). This estimate is nearly the same as the Diabetes UK estimate of 1.4 million derived from the Tayside study1. About 90% of people with diabetes have Type 2 diabetes (Table 1.3). It is clear however that not all diabetes is diagnosed. Estimates vary for the percentage of diabetes which is undiagnosed. Diabetes UK estimate that there are around 1 million people in the UK who have diabetes which has yet to be diagnosed1. Studies which have examined the total prevalence of diabetes (both diagnosed and undiagnosed) suggest that nearly a half of diabetes may be undiagnosed. For one example see Table 1.4. People with impaired glucose tolerance are at a greater risk of developing Type 2 diabetes in the future. In a recent randomised controlled trial of lifestyle advice aimed at preventing diabetes in middle-aged, overweight people with impaired glucose tolerance, about a quarter of the control group went on to develop diabetes within four years2. Table 1.4 suggests that about 4% of adults Coronary heart disease statistics: diabetes supplement without known diabetes have an impaired glucose tolerance. 9
Slide 10: Age and sex differences For both men and women, the proportion of people with diabetes increases with age. The Health Survey for England suggests that less than 1% of men aged 15-44 years have diagnosed diabetes compared with around 9% of those aged 75 and over (Table 1.1). This pattern is similar in women, although rates are slightly lower at most ages than for men. Temporal trends Various studies suggest that the prevalence of diabetes is increasing. The Health Survey for England suggests that the prevalence of diagnosed diabetes rose by 65% for men and by 25% for women between 1991 and 1998 (Table 1.5 and Figure 1.5). Using the Health Survey for England data (Table 1.5) it is estimated that the there will be about 2 million people with diagnosed diabetes in the UK by the year 2010. The Audit Commission – following a previous estimate from the International Diabetes Institute, Australia - estimate that the number of people with diabetes (both diagnosed and undiagnosed) will increase to about 3 million in the UK by the year 20103,4. Regional differences Whether there are significant regional differences in the prevalence of diabetes and whether these follow any pattern is difficult to say. Key Health Statistics from General Practice give statistics on the prevalence of diabetes in England and Wales as recorded by GPs. They do not give separate figures for Type 1 and Type 2 diabetes but for insulin-treated and non-insulin treated diabetes. Table 1.6 suggests that regional differences in the prevalence of non-insulin treated diabetes are small, and that there is no obvious pattern to these differences. Socio-economic differences Various sources suggest that the prevalence of diabetes is higher amongst low socio-economic groups. Key Statistics from General Practice indicate that the prevalence of diagnosed non-insulin treated diabetes is 36% higher amongst men living in the most deprived parts of the country than for men living in the most affluent areas. For women it is almost nearly twice as high (Table 1.7 and Figure 1.7). Ethnic differences The prevalence of diabetes is much higher amongst some ethnic minority communities than in the general population. The Health Survey for England suggests that for Pakistani and Bangladeshi men and women the prevalence of diagnosed diabetes is at least three times that in the general population. For African Caribbean men it is two and a half times as high and for African Caribbean women it is four times as high (Table 1.8). International differences Diabetes is now one of the most common non-communicable diseases globally. The International Diabetes Federation using data from the International Diabetes Institute, Australia, estimates that there are currently about 150 million people with diabetes worldwide (Table 1.9)5. Coronary heart disease statistics: diabetes supplement 10
Slide 11: Prevalence rates in the UK are average for developed countries (Table 1.9). In general developed countries currently have higher rates than developing countries (Figure 1.9). It is estimated that by the year 2010 there will be about 221 million people with diabetes worldwide with the greatest increases occurring in developing countries in Asia and Africa where diabetes rates are projected to rise to two or three times those experienced today (Table 1.9). 1. 2. Diabetes UK (2001) Fact sheet No 2 – Diabetes: the figures. http://www.diabetes.org.uk/ Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalain H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine 344: 1343-50. Audit Commission (2000) Testing times: a review of diabetes services in England and Wales. Audit Commission: London. Amos AF, McCarty DJ, Zimmet P (1997) The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabetic Medicine 14: S7-S85. See also International Diabetes Federation (2000) Diabetes Atlas 2000. IDF: Brussels. This publication presents new world-wide estimates of numbers of people with diabetes from the International Diabetes Institute. The results of the IDI’s earlier study are presented here because it gives projections to the year 2010, but the two studies give very similar figures for current rates. Coronary heart disease statistics: diabetes supplement 3. 4. 5. 11
Slide 12: Table 1.1 Prevalence of diagnosed diabetes by sex and age, 1998, England All ages % 16-24 % 0.1 875 0.8 1,006 25-34 % 0.7 1,338 0.7 1,630 35-44 % 1.6 1,305 0.9 1,573 45-54 % 2.9 1,289 1.6 1,484 55-64 % 5.8 987 3.1 1,148 65-74 75 & over % % 7.0 837 6.6 967 8.7 562 6.6 907 3.3 7,193 2.5 8,715 MEN Base WOMEN Base Self-reported diagnosis of either Type 1 or Type 2 diabetes. Source: Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office: London. Table 1.2 Prevalence of diagnosed diabetes by age, 1999, Tayside All ages % 0-14 % 0.14 0.00 0.14 15-24 % 0.41 0.01 0.42 25-34 % 0.47 0.10 0.57 35-44 % 0.45 0.58 1.03 45-54 % 0.29 1.70 2.00 55-64 % 0.18 4.20 4.40 65-74 % 0.06 6.60 6.70 75-85 85 & over % % 0.03 7.06 7.10 0.00 5.10 5.10 8,473 0.27 1.90 2.17 385,184 Type 1 Type 2 Total Population 64,113 49,718 55,020 56,840 51,213 41,264 35,928 22,615 Throughout this supplement, table column and/or row percentages may add up to 99% or 101% because of rounding. Source: Tayside Regional Diabetes Network (1999) Annual Report: Demographics. http://www.diabetes-healthnet.ac.uk Coronary heart disease statistics: diabetes supplement 12
Slide 13: Table 1.3 Estimates of numbers of people with diabetes by sex and age, 1999, United Kingdom Total population in the UK (000s) 5,840 12,766 6,848 2,284 1,559 29,298 5,552 12,252 6,952 2,647 2,802 30,204 11,392 25,018 13,800 4,931 4,361 59,502 Prevalence of all diabetes Numbers of people with diabetes in the UK (000s) 8 102 298 160 136 704 8 98 163 175 185 629 16 200 461 335 321 1333 Numbers of people with Type 1 diabetes in the UK (000s) 8 66 24 2 0 99 8 64 13 2 0 88 16 130 37 3 0 187 Numbers of people with Type 2 diabetes in the UK (000s) 0 36 274 158 136 605 0 34 150 173 185 541 0 70 424 331 321 1146 Proportion with Type 2 (%) 0.00 0.35 0.92 0.99 1.00 0.86 0.00 0.35 0.92 0.99 1.00 0.86 0.00 0.35 0.92 0.99 1.00 0.86 Age group MEN 0-14 15-44 45-64 65-74 75 & over Total 0-14 15-44 45-64 65-74 75 & over Total 0-14 15-44 45-64 65-74 75 & over Total 0.1 0.8 4.4 7.0 8.7 2.4 0.1 0.8 2.4 6.6 6.6 2.1 0.1 0.8 3.4 6.8 7.7 2.2 WOMEN BOTH Prevalence rates 0-14 and proportions with Type 2 diabetes from Tayside Regional Diabetes Network; prevalence rates 15+ from Health Survey for England; population data from Coronary heart disease statistics Morbidity supplement, Appendix 3. The estimates for the number of people with diabetes in the UK were derived from multiplying the age-specific prevalence rates by the numbers in the population. Sources: Tayside Regional Diabetes Network (1999) Annual Report: Demographics. http://www.diabetes-healthnet.ac.uk Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office: London. Rayner M, Petersen S, Moher M, Wright L, Lampe F (2001) Coronary heart disease statistics. Morbidity supplement. British Heart Foundation: London. Table 1.4 Prevalence of diagnosed and undiagnosed diabetes and impaired glucose tolerance, by sex and age, 1993, North London MEN WOMEN Undiagnosed diabetes % 0 0 2.7 1.9 5.6 2.2 6.3 2.3 Impaired glucose tolerance in subjects without known diabetes % 3.9 4.0 0 2.9 4.6 6.5 8.4 4.2 Diagnosed diabetes % 0.8 0.8 0.6 3.6 4.1 6.3 5.8 2.6 Undiagnosed diabetes % 0.9 1.7 1.9 1.4 4.1 3.2 3.6 2.2 Impaired glucose tolerance in subjects without known diabetes % 1.3 2.3 1.9 6.2 4.8 5.6 3.6 3.4 Diagnosed diabetes % Age group 40-44 45-49 50-54 55-59 60-64 65-69 70-75 Total Source: 0.9 1.2 2.5 4.7 8.7 8.1 5.1 3.4 Yudkin JS, Forrest RD, Jackson CA, Burnett SD, Gould MM (1993) The prevalence of diabetes and impaired glucose tolerance in a British population. Diabetes Care 16: 1530. Coronary heart disease statistics: diabetes supplement 13
Slide 14: Table 1.5 Prevalence of diagnosed diabetes by sex and age, 1991-1998, England All ages % 16-24 % 25-34 % 35-44 % 45-54 % 55-64 % 65-74 75 & over % % MEN 1991 1993 1994 1998 Base 1998 WOMEN 1991 1993 1994 1998 Base 1998 2.0 2.0 1.9 2.5 8,715 0.0 0.0 0.6 0.8 1,006 1.0 1.0 0.3 0.7 1,630 1.0 1.0 0.9 0.9 1,573 2.0 2.0 1.5 1.6 1,484 4.0 4.0 2.5 3.1 1,148 6.0 5.0 4.8 6.6 967 5.0 5.0 5.2 6.6 907 2.0 3.0 2.9 3.3 7,193 0.0 0.0 0.8 0.1 875 0.0 1.0 0.8 0.7 1,338 0.0 1.0 1.0 1.6 1,305 1.0 3.0 2.5 2.9 1,289 4.0 6.0 6.4 5.8 987 6.0 7.0 5.8 7.0 837 7.0 8.0 7.5 8.7 562 Self-reported diagnosis of either Type 1 or Type 2 diabetes. Source: Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office: London. Figure 1.5 3.5 Prevalence of diagnosed diabetes amongst adults aged 16 and over, 1991-1998, England 3.0 Prevalence of diabetes % 2.5 2.0 1.5 1.0 Men Women 0.5 0.0 1991 1992 1993 1994 1995 1996 1997 1998 1999 Year Coronary heart disease statistics: diabetes supplement 14
Slide 15: Table 1.6 0-4 5-15 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85 & over % 2.76 4.52 3.54 5.14 2.72 3.65 4.83 4.55 4.38 4.70 4.40 2.67 3.29 3.34 2.97 2.60 3.20 3.23 3.21 0.24 0.21 0.06 0.24 0.72 0.71 0.72 1.97 2.45 1.99 3.09 3.46 3.11 2.97 3.70 4.22 3.23 3.50 3.66 3.59 3.53 3.54 3.49 3.54 3.93 4.35 3.95 2.79 3.27 4.53 2.18 3.05 3.40 3.29 2.85 3.17 3.43 3.19 % 3.59 4.11 4.70 4.40 4.76 4.45 4.42 4.76 % 4.06 4.09 4.18 4.64 3.78 4.72 4.04 4.16 4.22 4.53 4.23 % 2.72 2.80 2.74 3.18 2.46 2.76 2.95 3.12 2.85 3.23 2.87 1.95 1.92 1.80 2.29 1.43 1.82 2.33 2.10 % 1.02 1.06 0.98 1.36 0.96 0.93 1.13 1.12 1.06 1.34 1.07 0.74 0.67 0.62 0.95 0.68 0.57 0.83 0.78 % 0.26 0.23 0.27 0.50 0.24 0.33 0.40 0.30 0.31 0.41 0.32 0.25 0.23 0.16 0.24 0.18 0.22 0.34 0.26 % 0.04 0.05 0.08 0.07 0.07 0.05 0.05 0.05 0.05 0.07 0.05 0.05 0.05 0.08 0.06 0.06 0.06 0.06 0.05 0.06 0.03 % 0.01 0.01 0.00 0.01 0.00 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.02 0.01 0.01 0.00 0.02 0.01 0.01 0.01 0.02 0.01 % 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 % 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 MEN WOMEN Northern and Yorkshire Trent Anglia and Oxford North Thames South Thames South and West West Midlands North West *Age-standardised using the European Standard Population. Source: Coronary heart disease statistics: diabetes supplement 15 Prevalence of non-insulin treated diabetes by sex, age and region, 1994/98, England and Wales Number of cases All ages* % Northern and Yorkshire Trent Anglia and Oxford North Thames South Thames South and West West Midlands North West 3,430 3,315 2,561 2,023 2,120 4,700 4,001 5,121 0.90 0.95 0.95 1.13 0.88 0.99 1.01 1.03 England Wales 27,271 1,726 0.98 1.11 England and Wales 28,997 0.99 3,076 2,996 2,414 1,650 1,822 4,118 3,672 4,565 0.66 0.72 0.73 0.76 0.60 0.69 0.80 0.74 England Wales 24,313 1,521 0.71 0.78 England and Wales 25,834 0.72 Office for National Statistics (2000) Key Health Statistics from General Practice. The Stationery Office: London.
Slide 16: Table 1.7 Prevalence of non-insulin treated diabetes by sex, age and deprivation category, 1994/98, England and Wales 0-4 % 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5-15 % 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 16-24 % 0.01 0.00 0.01 0.00 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 25-34 % 0.04 0.06 0.05 0.06 0.07 0.05 0.02 0.05 0.06 0.04 0.08 0.06 35-44 % 0.22 0.27 0.27 0.33 0.47 0.32 0.13 0.17 0.20 0.27 0.39 0.24 45-54 % 0.85 0.92 0.99 1.14 1.44 1.07 0.44 0.55 0.69 0.76 1.13 0.72 55-64 % 2.36 2.33 2.82 3.04 3.65 2.87 1.23 1.69 1.94 2.11 2.76 1.99 65-74 75-84 85 & over % 3.74 4.29 4.24 4.18 4.55 4.23 2.30 3.21 3.11 3.05 3.62 3.11 % 4.76 4.69 4.11 4.31 4.26 4.40 3.06 3.67 3.61 3.69 3.43 3.54 % 4.65 3.48 3.80 4.37 3.64 3.95 3.54 3.25 3.24 3.30 2.68 3.19 % Deprivation category Number of cases All ages* MEN Q1: least deprived Q2 Q3 Q4 Q5: most deprived All 3,466 5,430 6,752 6,818 6,451 28,997 2,456 4,974 6,204 6,304 5,864 25,834 0.86 0.90 0.95 1.01 1.17 0.99 0.50 0.66 0.71 0.74 0.91 0.72 WOMEN Q1: least deprived Q2 Q3 Q4 Q5: most deprived All * Age-standardised using the European Standard Population; deprivation categories were derived frrom quintiles of Townsend Material Deprivation Scores for the wards in which general practices were located. Source: Office for National Statistics (2000) Key Health Statistics from General Practice: The Stationery Office: London. Figure 1.7 1.4 Prevalence of non-insulin treated diabetes by deprivation category, 1994/98, England and Wales 1.2 prevalence of diabetes (%) Men Women 1.0 0.8 0.6 0.4 0.2 0.0 Q1: least deprived Q2 Q3 Q4 Q5: most deprived Level of deprivation Coronary heart disease statistics: diabetes supplement 16
Slide 17: Table 1.8 Prevalence of diagnosed diabetes by sex, age and ethnic group, 1999, England Base * All ages ** % 16-34 % 1.9 0.7 0.8 2.4 1.6 0.5 0.4 0.6 1.1 0.4 1.6 1.3 35-54 % 3.2 8.0 9.6 10.6 2.2 0.8 2.2 3.9 4.4 7.4 12.1 0.7 1.9 3.4 55 & over % 17.6 19.2 39.0 30.6 16.1 11.8 6.9 25.7 15.3 28.3 26.0 11.8 5.9 5.3 MEN Black Caribbean Indian Pakistani Bangladeshi Chinese Irish General population 547 626 620 533 301 537 7,198 748 657 643 563 361 708 8,715 8.3 9.8 17.9 19.0 4.8 4.5 3.3 10.5 7.2 14.0 14.6 5.3 2.6 2.5 WOMEN Black Caribbean Indian Pakistani Bangladeshi Chinese Irish General population * ** Unweighted base; Age standardised prevalence rates (Standardised risk ratios x prevalence in general population). Joint Health Surveys Unit (2001) Health Survey for England. The Health of Minority Ethnic Groups 1999. The Stationery Office: London. Source: Figure 1.8 20.0 18.0 16.0 Prevalence of diagnosed diabetes by ethnic group, 1999, England prevalence of diabetes (%) 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 Black Caribbean Indian Pakistani Bangladeshi Chinese Irish General population Men Women Ethnic group Coronary heart disease statistics: diabetes supplement 17
Slide 18: Table 1.9 Numbers of people with diabetes, 2000 and 2010, selected countries Population (000s) 2000 Type 1 (000s) 4,423 103 27 36 9 15 5 10 7 0 0 0 1 2 0 0 0 0 4 0 0 6 0 1 2 1 0 1 0 0 0 0 0 0 0 1 3 0 1 0 2 24 0 0 0 23 0 162 4 10 1 2 1 6 14 10 9 9 2 2 0 11 18 59 2 2 1,218 1 5 1,053 89 14 5 0 8 5 7 5 27 74 0 0 35 10 1 6 1 13 8 Type 2 (000s) 146,804 5,383 545 3,549 136 534 396 218 4 1,194 30 52 2 76 7 101 36 7 18 53 14 43 661 47 25 22 1,261 28 3 8 18 283 131 77 46 91 97 40 29 50 81 185 40 56 333 42 56 15 28 11 2 6 173 1,100 16 22 21 1,032 9 6,150 74 123 40 30 6 146 305 231 162 97 124 111 48 1,131 420 2,750 179 173 35,056 295 1,786 25 23,588 915 341 65 3 294 6,986 312 73 58 317 12,312 14 72 22 6,676 35 835 403 2,252 245 1,126 632 Total Crude prevalence (000s) % 151,222 5,485 572 3,586 145 549 401 228 4 1,201 30 52 2 77 7 103 36 7 18 54 14 43 665 47 25 23 1,268 28 3 8 18 284 133 77 46 91 97 40 29 50 81 185 40 57 335 42 57 15 28 11 2 6 175 1,123 16 23 21 1,055 9 6,312 77 133 40 33 8 152 319 241 171 106 127 112 49 1,142 438 2,809 181 175 36,273 296 1,791 25 24,641 1,004 356 69 3 294 6,993 317 80 63 343 12,386 14 72 22 6,710 35 845 404 2,259 247 1,138 640 2.7 3.5 2.0 5.8 2.7 2.1 1.5 2.5 1.6 0.5 0.5 0.5 0.6 0.5 0.6 0.6 0.5 0.6 0.7 0.5 0.6 0.4 0.6 0.5 0.6 0.5 0.6 0.5 0.5 1.3 0.6 0.5 0.5 0.5 0.5 8.2 0.6 6.1 0.6 0.5 0.4 0.6 0.5 0.5 0.4 0.4 0.4 0.5 0.4 0.4 0.5 0.6 0.4 2.4 1.1 1.1 1.3 2.5 1.1 3.8 2.1 1.8 7.2 4.4 1.0 2.8 1.6 4.4 3.2 6.3 4.2 5.1 8.9 6.3 3.1 4.6 8.2 1.2 2.7 1.5 1.5 1.4 2.7 1.5 2.1 1.6 1.2 1.4 5.1 1.8 1.4 1.5 1.5 2.6 4.8 0.7 2.7 3.4 0.7 4.2 0.9 3.3 7.4 2.0 0.9 2010 Type 1 (000s) 5,446 154.1 38.6 53.5 18.9 21.2 9.3 12.6 13.7 0.1 0.2 0.2 0.7 2.7 0.1 0.2 0.7 1.2 7.1 0.1 0.1 0.3 9.5 0.1 0.1 1.1 3.9 1.0 0.2 0.5 0.3 0.4 0.1 0.2 0.4 0.5 0.1 0.6 4.3 0.2 0.8 0.1 0.1 3.1 37.8 0.4 0.7 0.2 36.2 0.3 222.3 3.5 11.5 0.7 2.7 2.3 6.4 24.7 10.8 15.3 9.7 2.3 2.7 0.5 18.2 26.9 78.2 1.8 4.1 1,746.3 1.4 8.5 1,508.2 132.6 17.7 5.8 0.1 0.8 13.2 5.3 9.8 6.5 36.4 92.8 0.2 0.2 50.7 0.1 10.8 1.6 6.9 1.1 11.4 9.8 Type 2 (000s) 215,272 8,098.9 1,083.9 4,810.8 267.6 972.5 542.1 416.3 5.7 1,678.1 49.5 75.3 3.5 126.0 10.0 165.7 55.1 8.8 30.0 80.0 22.5 62.0 842.3 79.1 35.5 32.8 1,888.1 37.6 8.0 13.9 24.6 407.1 198.5 119.8 62.6 117.8 139.2 69.6 38.4 75.2 109.1 323.0 61.3 82.4 530.9 70.1 89.9 21.8 42.6 15.6 2.7 8.3 279.9 1,737.0 27.4 36.0 34.4 1,624.0 15.2 11,130.2 105.4 196.5 58.2 34.8 15.1 180.2 501.8 299.1 369.7 162.1 252.2 162.7 63.2 1,785.5 961.0 5,404.7 243.2 334.8 55,733.4 530.5 2,780.1 38.0 37,976.6 1,559.1 511.0 110.2 4.5 409.0 10,554.2 420.3 141.1 107.0 591.8 19,384.3 28.8 113.0 33.9 9,773.4 56.8 1,435.2 638.0 3,878.8 334.4 2,095.0 997.0 Total (000s) 220,718 8,253.0 1,122.5 4,864.3 286.5 993.7 551.4 428.9 5.7 1,691.8 49.6 75.5 3.7 126.7 10.0 168.4 55.2 8.8 30.2 80.7 22.5 63.2 849.4 79.2 35.6 33.1 1,897.6 37.7 8.1 13.9 24.6 408.2 202.4 120.8 62.8 118.3 139.5 70.0 38.5 75.4 109.5 323.5 61.4 83.0 535.2 70.3 90.7 21.8 42.7 15.6 2.7 8.4 283.0 1,774.8 27.8 36.7 34.6 1,660.2 15.5 11,352.5 108.9 208.0 58.9 37.5 17.4 186.6 526.5 309.9 385.0 171.8 254.5 165.4 63.7 1,803.7 987.9 5,482.9 245.0 338.9 57,479.7 531.9 2,788.6 38.0 39,484.8 1,691.7 528.7 116.0 4.6 409.8 10,567.4 425.6 150.9 113.5 628.2 19,477.1 29.0 113.2 33.9 9,824.1 56.9 1,446.0 639.6 3,885.7 335.5 2,106.4 1,006.8 5,697,038 158,078 28,109 62,096 5,407 26,524 26,707 8,987 248 221,589 5,720 11,087 406 14,230 1,169 18,338 7,614 1,112 2,467 11,480 2,392 9,788 118,369 8,672 4,428 4,317 221,242 6,064 612 601 3,171 56,404 27,150 14,874 9,673 1,117 17,260 655 5,184 9,491 19,689 30,026 8,081 11,190 83,138 10,816 13,192 3,273 6,335 2,593 400 1,076 45,453 47,333 1,450 2,027 1,536 41,464 856 167,687 3,632 7,531 557 745 792 5,450 20,095 5,525 5,373 1,691 3,009 2,207 548 18,255 14,203 60,838 2,210 15,026 1,366,865 19,661 118,229 1,770 929,004 68,364 16,817 4,460 254 21,456 136,257 17,928 5,828 4,075 22,762 481,920 293 10,024 814 197,460 4,882 20,140 45,106 67,839 3,327 58,242 73,793 World North Africa Algeria Egypt Libyan Arab Jamahiriya Morocco Sudan Tunisia Western Sahara Western Africa Benin Burkina Faso Cape Verde Cote d'Ivoire Gambia Ghana Guinea Guinea-Bissau Liberia Mali Mauritania Niger Nigeria Senegal Sierra Leone Togo Eastern Africa Burundi Comoros Djibouti Eritrea Ethiopia Kenya Madagascar Malawi Mauritius Mozambique Reunion Rwanda Somalia Uganda United Rep. of Tanzania Zambia Zimbabwe Middle Africa Angola Cameroon Central African Rep. Chad Congo Equatorial Guinea Gabon Zaire Southern Africa Botswana Lesotho Namibia South Africa Swaziland Western Asia Armenia Azerbaijan Bahrain Cyprus Gaza Strip Georgia Iraq Israel Jordan Kuwait Lebanon Oman Qatar Saudi Arabia Syrian Arab Rep. Turkey United Arab Emirates Yemen South-Central Asia Afghanistan Bangladesh Bhutan India Iran (Islamic Rep. of) Kazakhstan Kyrgyzstan Maldives Nepal Pakistan Sri Lanka Tajikistan Turkmenistan Uzbekistan South-East Asia Brunei Darussalam Cambodia East Timor Indonesia Lao (People's Dem. Rep.) Malaysia Myanmar (Burma) Philippines Singapore Thailand Vietnam Coronary heart disease statistics: diabetes supplement 18
Slide 19: Population (000s) East Asia China (Dem. People's Rep. of) Korea Hong Kong Japan Macau Mongolia Republic of Korea North America Canada United States Central America Belize Costa Rica El Salvador Guatemala Honduras Mexico Nicaragua Panama Caribbean Bahamas Barbados Cuba Dominican Republic Guadeloupe Haiti Jamaica Martinique Netherlands Antilles Puerto Rico Trinidad and Tobago Southern America Argentina Bolivia Brazil Chile Colombia Ecuador Guyana Paraguay Peru Surinam Uruguay Venezuela Northern Europe Denmark Estonia Finland Iceland Ireland Latvia Lithuania Norway Sweden United Kingdom Western Europe Austria Belgium France Germany Luxembourg Netherlands Switzerland Eastern Europe Belarus Bulgaria Czech Rep. Hungary Poland Rep.of Moldova Romania Russian Federation Slovakia Ukraine Southern Europe Albania Bosnia and Herzegovina Croatia Greece Italy Malta Portugal Slovenia Spain The FYR Macedonia Yugoslavia Oceania Australia Fiji French Polynesia Guam New Caledonia New Zealand Papua New Guinea Samoa Solomon Islands Vanuatu 1,421,314 1,220,224 220,097 6,123 125,068 430 2,463 44,909 296,517 29,402 267,115 123,473 213 3,424 5,662 10,621 5,654 91,145 4,123 2,631 34,904 279 260 10,964 7,823 424 7,124 2,468 380 194 3,701 1,287 317,327 34,768 7,414 159,014 14,210 35,814 11,460 830 4,828 23,532 427 3,186 21,844 93,102 5,223 1,487 5,107 268 3,546 2,536 3,736 4,332 8,788 58,079 180,925 8,045 10,127 58,104 81,594 407 15,482 7,166 310,505 10,352 8,509 10,263 10,106 38,556 4,437 22,728 148,460 5,338 51,756 143,255 3,383 3,569 4,505 10,454 57,204 366 9,815 1,925 39,627 2,156 10,251 27,774 17,866 784 219 150 181 3,561 4,301 165 378 169 2000 Type 1 (000s) 154 96 4 3 45 0 7 1,019 77 942 19 1 1 1 1 13 1 1 34 0 0 11 8 1 1 3 1 0 8 2 336 49 1 213 7 26 9 0 2 2 0 6 21 336 25 2 35 1 16 2 5 19 42 190 342 13 19 89 174 1 36 10 279 14 9 16 10 37 3 11 159 9 11 225 2 6 5 12 82 1 14 2 84 1 15 83 69 14 - Type 2 (000s) 29,385 19,335 456 407 7,121 20 21 2,026 13,174 1,207 11,967 4,918 7 154 218 367 192 3,725 135 120 1,482 13 23 582 247 23 79 178 35 17 218 70 8,776 1,201 153 4,320 489 912 259 28 92 605 14 113 590 3,226 195 66 237 10 87 88 125 148 406 1,863 6,755 310 339 1,876 3,354 16 574 285 8,940 300 272 293 307 1,042 107 662 4,210 135 1,612 6,405 74 131 165 514 2,824 22 445 69 1,744 65 352 956 703 46 13 7 5 133 35 6 3 5 Total Crude prevalence (000s) % 29,539 19,431 459 410 7,165 20 22 2,032 14,193 1,283 12,910 4,938 7 155 219 369 193 3,738 136 121 1,517 13 23 592 254 23 80 181 35 17 226 71 9,112 1,250 154 4,533 497 938 267 28 94 607 14 119 611 3,562 220 68 273 11 103 90 129 167 449 2,053 7,097 323 359 1,965 3,528 17 610 295 9,218 314 281 309 317 1,088 110 673 4,369 144 1,623 6,630 76 137 171 526 2,906 23 458 72 1,829 66 366 1,039 772 46 13 7 5 147 35 6 3 5 2.1 1.6 0.2 6.7 5.7 4.7 0.9 4.5 4.8 4.4 4.8 4.0 3.3 4.5 3.9 3.5 3.4 4.1 3.3 4.6 4.3 4.6 9.0 5.4 3.2 5.5 1.1 7.4 9.3 8.8 6.1 5.5 2.9 3.6 2.1 2.9 3.5 2.6 2.3 3.4 2.0 2.6 3.3 3.7 2.8 3.8 4.2 4.5 5.3 4.0 2.9 3.6 3.5 3.9 5.1 3.5 3.9 4.0 3.5 3.4 4.3 4.2 3.9 4.1 3.0 3.0 3.3 3.0 3.1 2.8 2.5 3.0 2.9 2.7 3.1 4.6 2.2 3.8 3.8 5.0 5.1 6.4 4.7 3.7 4.6 3.1 3.6 3.7 4.3 5.8 5.8 4.8 2.9 4.1 0.8 3.8 0.7 3.0 2010 Type 1 (000s) 179.6 115.9 4.4 3.2 48.5 0.2 7.4 1,174.8 87.0 1,087.8 22.5 0.1 1.2 1.7 2.4 2.0 12.8 1.4 0.9 38.3 0.3 0.3 9.9 9.9 0.6 1.2 3.7 0.5 0.3 9.8 1.8 418.4 52.6 2.3 275.0 7.4 33.8 11.7 0.2 3.0 2.5 0.4 7.0 22.5 329.8 26.0 2.6 34.2 0.7 14.8 2.7 5.0 18.5 41.9 183.4 331.5 12.5 18.7 85.4 168.8 1.1 34.9 10.1 365.6 15.4 10.4 17.3 13.5 40.7 3.4 14.8 227.1 10.3 12.7 218.0 2.2 6.1 5.9 11.3 76.7 1.2 14.4 2.2 79.7 1.2 17.1 87.0 71.8 15.2 - Type 2 (000s) 43,808.2 30,870.1 848.7 544.1 8,708.6 42.2 32.8 2,761.7 16,360.2 1,506.1 14,854.1 7,364.0 11.8 230.9 322.4 551.7 300.4 5,554.6 215.2 177.0 1,864.6 19.0 26.2 722.9 297.0 31.8 147.8 217.8 39.7 20.7 254.8 86.9 12,883.6 1,471.4 263.4 6,121.8 724.9 1,530.7 465.8 39.4 180.8 964.3 19.0 132.8 919.3 4,601.8 241.4 65.3 238.9 15.1 147.0 109.2 165.1 194.8 540.6 2,884.4 9,125.4 408.8 498.3 2,784.3 4,244.7 20.9 787.0 381.4 10,614.7 361.0 313.5 358.8 352.1 1,299.7 133.6 792.6 4,911.6 170.9 1,920.9 7,278.5 121.2 198.6 214.1 568.3 3,172.6 26.6 463.4 93.2 1,859.4 97.4 463.7 1,241.0 875.5 69.6 18.5 13.2 8.9 165.2 62.4 10.0 6.0 11.7 Total (000s) 43,987.8 30,986.0 853.1 547.3 8,757.1 42.2 33.0 2,769.1 17,535.0 1,593.1 15,941.9 7,386.5 11.9 232.1 324.1 554.1 302.4 5,567.4 216.6 177.9 1,902.9 19.3 26.5 732.8 306.9 32.4 149.0 221.5 40.2 21.0 264.6 88.7 13,252.0 1,524.0 265.7 6,396.8 732.3 1,564.5 477.5 39.6 183.8 966.8 19.4 139.8 941.8 4,931.6 267.4 67.9 273.1 15.8 161.8 111.9 170.1 213.3 582.5 3,067.8 9,456.9 421.3 517.0 2,869.7 4,413.5 22.0 821.9 391.5 10,980.3 376.4 323.9 376.1 365.6 1,340.4 137.0 807.4 5,138.7 181.2 1,933.6 7,496.5 123.4 204.7 220.0 579.6 3,249.3 27.8 477.8 95.4 1,939.1 98.6 480.8 1,328.0 947.3 69.6 18.5 13.2 8.9 180.4 62.4 10.0 6.0 11.7 Source: Amos AF, McCarty DJ, Zimmet P (1997) The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabetic Medicine 14: S7-S85. Coronary heart disease statistics: diabetes supplement 19
Slide 20: Figure 1.9 Prevalence of diabetes, 2000, the World % 4.6 to 9.3 3.4 to 4.6 2.1 to 3.4 0.6 to 2.1 0.2 to 0.6 Coronary heart disease statistics: diabetes supplement 20
Slide 21: 2. Mortality from diabetes The number of deaths attributed to diabetes in national mortality statistics is likely to be a huge underestimate of the actual number of deaths caused by diabetes (Table 2.1). This is because other diseases caused by diabetes - such as CVD - are normally given as the cause of death in the death certificates of people with diabetes. Various studies have sought to determine the total number of deaths attributable to diabetes. The best known study is that of the World Health Organization’s Global Burden of Disease Project1. This suggests that in Established Market Economies such as the UK there are about five times as many deaths indirectly attributable to diabetes as directly attributable. This would mean that there are about 33,000 deaths a year attributable to diabetes – about one in seven of all deaths2. CVD is by far the most common cause of death amongst people with diabetes. For example in the British Diabetic Association Cohort Study – a study of 23,752 patients with insulin treated diabetes diagnosed under the age of 30 years from throughout the UK3- 63% of deaths in men with diabetes aged 40-59 were from CVD compared with 35% of men in the general population. For women with diabetes aged 40-59, 52% of deaths were from CVD compared with 20% in the general population (Table 2.2, Figures 2.2a, 2.2b, 2.2c and 2.2d)4. In the British Diabetic Association Cohort Study men with diabetes aged 40-59 were three times more likely to die of any cause and five times more likely to die of CVD than people without diabetes. Women with diabetes were four times more likely to die of any cause and eight times more likely to die of CVD5. 1. 2. 3. Murray CJL, Lopez AD (1996) The Global Burden of Disease. WHO: Geneva. I.e. 6,697 (from Table 2.1) multiplied by five. Laing SP, Swerdlow AJ, Slater SD, Botha JL, Burden AC, Waugh NR, Smith AWM, Hill RD, Bingley PJ, Patterson CC, Qiao Z, Keen H (1999) The British Diabetic Association Cohort Study, 1: all-cause mortality in patients with insulin-treated diabetes mellitus. Diabetic Medicine 16: 459-465. Note that in Table 2.2 and in Tables 4.1 and 4.2 the general population data were collected in a different way, and comparisons with the study data should therefore be treated with caution. Laing SP, Swerdlow AJ, Slater SD, Botha JL, Burden AC, Waugh NR, Smith AWM, Hill RD, Bingley PJ, Paterson CC, Qiao Z, Keen H (1999) The British Diabetic Association Cohort Study, II: cause-specific mortality in patients with insulin-treated diabetes mellitus. Diabetic Medicine 16: 466-471. Coronary heart disease statistics: diabetes supplement 4. 5. 21
Slide 22: Table 2.1 Deaths by cause, sex and age, 1999, United Kingdom All ages Under 35 35-44 6,857 4,337 11,194 1,556 650 2,206 936 205 1,141 246 238 484 3 3 6 51 41 98 25 12 37 1,188 1,869 3,057 90 108 198 159 147 306 681 681 296 256 552 2,046 579 2,625 1,695 930 2,625 45-54 15,753 10,340 26,093 5,342 1,920 7,262 3,747 783 4,530 683 595 1,278 13 11 24 160 79 237 41 24 65 4,976 5,489 10,465 493 367 860 1,110 794 1,904 1,730 1,730 908 651 1,559 1,686 551 2,237 2,640 1,626 4,266 55-64 32,996 20,878 53,874 12,955 5,293 18,248 9,285 2,813 12,098 1,654 1,298 2,952 78 44 122 386 270 656 89 49 138 12,372 10,367 22,739 1,359 850 2,209 3,513 1,975 5,488 2,261 2,261 2,848 2,078 4,926 1,182 492 1,674 3,164 2,329 5,493 65-74 75 & over 73,244 51,978 125,222 31,084 18,708 49,792 20,429 10,141 30,570 4,993 4,492 9,485 296 174 470 885 672 1,557 349 233 582 24,859 19,064 43,923 2,730 1,892 4,622 7,627 4,434 12,061 2,790 2,790 9,543 7,459 17,002 1,065 746 1,811 5,459 5,096 10,555 158,954 236,679 395,633 67,401 102,810 170,211 37,245 45,206 82,451 16,018 33,769 49,787 944 1,642 2,586 1,633 2,435 4,068 1,243 1,546 2,789 35,178 37,030 72,208 3,831 4,868 8,699 8,617 5,691 14,308 5,347 5,347 34,261 49,401 83,662 2,157 3,758 5,915 17,081 39,699 56,780 Men Women Total Men Women Total 298,317 329,675 627,992 118,887 129,741 248,628 71,773 59,188 130,961 23,719 40,510 64,229 1,334 1,876 3,210 3,173 3,524 6,697 1,764 1,883 3,647 79,444 74,646 154,090 8,536 8,112 16,648 21,038 13,051 34,089 12,947 12,947 48,253 60,125 108,378 12,506 7,315 19,821 34,290 52,441 86,731 10,513 5,463 15,976 549 360 909 131 40 171 125 118 243 1 2 3 52 27 79 17 19 36 871 827 1,698 33 27 60 12 10 22 138 138 397 280 677 4,370 1,189 5,559 4,257 2,761 7,018 All causes All diseases of the circulatory system (390-459) Coronary heart disease Men (410-414) Women Total Stroke (430-438) Peripheral vascular disease (443) Diabetes (250) Men Women Total Men Women Total Men Women Total Men Women Total Men Women Total Men Women Total Men Women Total Women Total Men Women Total Men Women Total Men Women Total Renal disease (581-586) Cancer (140-239) Colo-rectal cancer (153, 154) Lung cancer (162) Breast cancer (174) Respiratory disease (460-519) Injuries and poisoning (800-999) All other causes ICD (9th revision) codes in parentheses. Sources: Office for National Statistics (2000) Deaths registered in 1999 by cause, and area of residence. Personal communication; General Register Office (2000) Annual Report 1999. General Register Office: Edinburgh; General Register Office (2000) Annual Report 1999. Statistics and Research Agency: Northern Ireland. Coronary heart disease statistics: diabetes supplement 22
Slide 23: Table 2.2 British Diabetic Association cohort General population 30-39 40-49 50-59 All ages 1-9 10-19 % 0 1 3 2 0 0 6 4 8 14 11 5 10 11 78 53 139 97 7 7 79 46 1 6 3 4 73 41 26 27 19 6 22 14 46,428 28,438 0 0 5 4 5 4 7 5 80 61 2,999 2,246 3 3 0 0 4 3 11 8 53 18 28 18 1,399 717 % 0 0 % 1 0 27 10 % 4 12 71 49 6 12 8 2 % 5 2 56 56 14 12 4 7 3 10 % 20 13 27 35 13 24 4 7 3 2 24 9 20-29 % 1 0 5 4 0 0 3 2 8 7 61 13 23 11 3,575 1,312 30-39 % 1 0 14 7 0 0 4 3 13 19 43 11 26 12 5,547 2,922 All ages 1-9 10-19 20-29 % 30 24 10 16 6 12 7 5 3 2 29 15 14 25 % 37 49 6 11 0 2 3 6 5 2 38 17 10 13 13 12 % 46 67 8 8 0 0 8 25 15 0 8 0 15 0 79 49 % Men Women 22 23 30 29 7 12 5 6 4 5 22 11 10 14 461 298 Men Women Men Women Men Women Men Women Men Women Men Women Men Women Diabetes and hypoglycaemia (250-251) CVD (390-459) Renal disease (580-593) Respiratory disease; (460-519) Cancer (140-239) Accidents and violence (800-999) All other causes Total numbers of deaths ICD (9th revision) codes in parentheses. Sources: Coronary heart disease statistics: diabetes supplement 40-49 % 1 1 30 12 0 0 5 4 24 33 18 6 21 13 9,660 6,528 50-59 % 1 1 37 13 0 0 7 5 36 34 6 2 13 8 23,248 14,713 23 Percentage of deaths by cause in people with diabetes by sex and age, 1972/99, United Kingdom compared with the general population, 1999, United Kingdom Laing SP, Swerdlow AJ, Slater SD, Botha JL, Burden AC, Waugh NR, Smith AWM, Hill RD, Bingley PJ, Paterson CC, Qiao Z, Keen H (1999) The British Diabetic Association Cohort Study, II: cause-specific mortality in patients with insulin-treated diabetes mellitus. Diabetic Medicine 16: 466-471. Office for National Statistics (2000) Deaths registered in 1999 by cause, and area of residence. Personal communication; General Register Office (2000) Annual report 1999. General Register Office: Edinburgh; General Register Office (2000) Annual report 1999. Statistics and Research Agency: Northern Ireland.
Slide 24: Figure 2.2a Deaths by cause in people with diabetes, men aged 40-59, 1972/99, United Kingdom All other causes 5% Accidents and violence 6% Cancer 5% Respiratory disease 6% Diabetes 5% Renal disease 10% CVD 63% Figure 2.2b Deaths by cause in people with diabetes, women aged 40-59, 1972/99, United Kingdom All other causes 6% Accidents and violence 6% Diabetes 8% Cancer 12% Respiratory disease 4% Renal disease 12% CVD 52% Coronary heart disease statistics: diabetes supplement 24
Slide 25: Figure 2.2c Deaths by cause in the general population, men aged 40-59, 1999, United Kingdom All other causes 15% Diabetes 1% CVD 35% Accidents and violence 10% Cancer 33% Renal disease 0% Respiratory disease 6% Figure 2.2d Deaths by cause in the general population, women aged 40-59, 1999, United Kingdom All other causes 15% Diabetes 1% CVD 20% Accidents and violence 5% Renal disease 0% Respiratory disease 7% Cancer 52% Coronary heart disease statistics: diabetes supplement 25
Slide 26: 3. Morbidity from diabetes Diabetes causes severe morbidity. Complications of diabetes can be divided into three categories: ■ metabolic complications of low blood glucose levels (hypoglycaemia) and of high glucose sugar levels (hyperglycaemia). Diabetic coma is one such metabolic complication of a particularly severe nature; ■ damage to small blood vessels (microvascular complications) leading in turn to damage to the retina (retinopathy), kidney (nephropathy) and nerves (neuropathy); ■ damage to the larger arteries (macrovascular complications) leading in turn to damage to the brain (stroke), the heart (coronary heart disease) or to the legs and feet (peripheral vascular disease). The Global Burden of Disease Project estimates that in Established Market Economies such as the UK 3% of years of life lost in disability are due to diabetes. This is only slightly less that the years of life lost in disability due to cancer at 4%1. The UK Prospective Diabetes Study (UKPDS) – a multi-centre prospective randomised intervention trial where the subjects are people with newly diagnosed Type 2 diabetes - has found that nearly half of the people with diabetes recruited to the trial had one or more micro or macrovascular complication2. Table 3.1 shows that about a quarter already had CVD3. 1. 2. Murray CJL, Lopez AD (1996) The Global Burden of Disease. WHO: Geneva. See also Table 2.2. Rayner M, Petersen S (2000) European cardiovascular disease statistics. British Heart Foundation: London. United Kingdom Prospective Diabetes Study Group (1990) United Kingdom Prospective Diabetes Study (UKPDS) IV. Characteristics of newly diagnosed type 2 diabetic patients and their association with different clinical and biochemical risk factors. Diabetes Research 13: 1-11. Note UKPDS subjects were people with newly diagnosed diabetes and therefore might be expected to be relatively healthy compared with people who had had diabetes for longer. 3. Coronary heart disease statistics: diabetes supplement 26
Slide 27: Table 3.1 Prevalence of complications of diabetes amongst people with newly diagnosed diabetes, 1977/91, United Kingdom Retinopathy Abnormal electro-cardiogram Myocardial infarction Angina Intermittent claudication Stroke/trasient ischaemic attack Absent foot pulses/ischaemic feet Impaired reflexes/decreased sense of vibration Number of patients % 21 18 2 3 3 1 14 7 4,072 Source: UK Prospective Diabetes Study Group (1991) UK Prospective Diabetes Study (UKPDS) VIII. Study design, progress and performance. Diabetologia 34: 877-890. Coronary heart disease statistics: diabetes supplement 27
Slide 28: 4. Prevalence of risk factors for CVD in people with diabetes Various studies report that people with diabetes are more likely to have other risk factors for CVD. The UKPDS, for example, report that 35% of men and 47% of women aged 25-64 with newly diagnosed Type 2 diabetes are hypertensive compared with about 17% of men and 15% of women in the general population (Table 4.1). The UKPDS also reports that the mean body weight of men with newly diagnosed diabetes is 23% above the ideal compared with 12% for the general population and for women with newly diagnosed diabetes it is 42% above the ideal compared with 16% for the general population (Table 4.2). In the latest results of the Tayside study 42% of Type 1 patients and 52% of Type 2 patients were current or ex-smokers, and 58% of Type 1 patients and 64% of Type 2 patients had a total cholesterol level greater than 5 mmol/l1. Coronary heart disease statistics: diabetes supplement 1. Tayside Regional Diabetes Network (1999) Annual Report: Demographics. http://www.diabetes-healthnet.ac.uk/report/main.htm 28
Slide 29: Table 4.1 Prevalence of hypertension amongst people with newly diagnosed diabetes by sex and age, 1977/89, United Kingdom; compared with the general population, 1991, England UKPDS subjects All ages % 25-34 % 3 10 14 96 35-44 % 7 21 28 339 45-54 % 12 22 34 781 55-64 % 19 21 40 920 General population All ages % 7 10 17 835 25-34 % 1 4 5 245 35-44 % 2 7 9 230 45-54 % 8 13 21 189 55-64 % 21 20 41 171 MEN On therapy for hypertension Hypertensive (untreated) All hypertensive Base WOMEN On therapy for hypertension Hypertensive (untreated) All hypertensive Base 14 21 35 2,136 24 22 47 1,512 3 13 17 60 15 21 37 192 21 23 44 524 31 23 53 736 8 7 15 946 1 2 3 266 3 4 7 268 8 6 14 207 24 19 43 205 Hypertensive: for UKPDS subjects: systolic > 160 mmHg and/or diastolic > 90 mmHg; for general population: systolic > 160 mmHg and/or diastolic > 95 mmHg. Sources: The Hypertension in Diabetes Study Group (1992) Hypertension in Diabetes Study (HDS): 1. Prevalence of hypertension in newly presenting type 2 diabetic patients and the association with risk factors for cardiovascular and diabetic complications. Journal of Hypertension 11: 309325; Office of Population Censuses and Surveys, Social Survey Division (1993) Health Survey for England, 1991. HMSO: London. Table 4.2 Mean body weight as a percentage of ideal body weight for people with newly diagnosed diabetes by sex and age, around 1982, United Kingdom; compared with the general population, 1984, Great Britain UKPDS subjects All ages % 25-35 % 122 48 118 19 36-45 % 124 147 148 85 46-55 % 124 367 147 228 56-65 % 122 357 138 297 116 110 116 120 121 General population All ages % 112 25-35 % 109 36-45 % 113 46-55 % 114 56-65 % 113 MEN Base WOMEN Base Source: 123 919 142 629 UK Prospective Diabetes Study Group (1988) UK Propsective Diabetes Study. IV. Characteristics of newly presenting Type 2 diabetic patients: male preponderance and obesity at different ages. Diabetic Medicine 5: 154-159. Coronary heart disease statistics: diabetes supplement 29
Slide 30: 5. Treatment of diabetes and prevention of CVD in people with diabetes General practice consultations Statistics collected by GPs suggest that diabetes is managed at nearly 1% of all general practice consultations (Table 5.1). However there is wide variation between practices in the proportion of people with diabetes who receive routine examinations and a wide variation in what tests GPs carry out during those examinations (Table 5.2). Prevention of CVD should be a priority for people with diabetes but a survey of patients with diabetes carried out in 1995/96 found that only 38% of patients seen by GPs in England and Wales had their blood cholesterol tested within the last 12 months. Assessment of smoking and testing for raised blood pressure was somewhat better: 71% of patients had been assessed for whether they smoked or not and 88% had had their blood pressure tested. Only 62% of patients had had their diet reviewed in the last 12 months and the survey did not examine the extent to which patients were advised about physical activity (Table 5.2). Just over a half of patients with diabetes are cared for by their GPs, about 20% are under the care of a hospital and about 30% receive shared care1. Hospitalisations Hospital Episode Statistics suggests that there are about 70,000 hospitalisations each year in England where diabetes is the principal diagnosis (over 0.6% of all hospitalisations) leading to a total of over 350,000 days of in-patient care (Table 5.3). Coronary heart disease statistics: diabetes supplement 30
Slide 31: When hospitalisations for diabetes as the principal diagnosis are combined with hospitalisations for complications of diabetes, the total number of hospitalisations due to diabetes rises to 266,000 and 1.1 million days of in-patient care (2% of all hospitalisations and 5% of all days of inpatient care) (Table 5.4). CVD is the principal cause of all admissions due to diabetes. About 67% of all days spent in hospital due to diabetes are because of CVD (Table 5.4). In the UK men are slightly more likely to be hospitalised for diabetes (as the principal diagnosis) than women (Table 5.3). Hospitalisations due to diabetes (as either the principal cause or because of complications of diabetes) increase steadily with age (Table 5.4). Coronary heart disease statistics: diabetes supplement 1. Khunti K, Baker R, Rumsey M, Lakhani M (1999) Quality of care of patients with diabetes: collation of data from multi-practice audits of diabetes in primary care. Family Practice 16: 54-59. 31
Slide 32: Table 5.1 Rate per 10,000 All conditions Consultations with a GP for selected diseases by sex and age, 1991/92, England and Wales All ages Men Women Men Women Men Women Men Women 27,194 42,071 534 326 133 128 292 256 0-4 51,027 48,288 1 1 3 5-15 20,142 22,954 0 1 12 10 16-24 17,198 43,186 1 0 3 4 55 35 25-44 19,290 42,846 63 24 5 7 113 86 45-64 30,622 43,291 1,157 461 163 95 544 394 65-74 43,138 47,478 2,223 1,191 577 337 1,053 858 75-84 85 & over 51,708 54,301 2,169 1,513 1,066 798 1,164 932 57,761 55,247 1,688 1,241 1,587 1,259 778 496 Coronary heart disease (410-414) Stroke (430-438) Diabetes (250) ICD (9th revision) codes in parentheses. Source: Royal College of General Practitioners, the Office of Population Censuses and Surveys and the Department of Health (1995) Morbidity Statistics from General Practice, Fourth National Study 1991-1992, HMSO: London. Table 5. 2 Treatment of patients with diabetes in the previous 12 months, general practices, 1995/96, England and Wales No. of groups using criterion 16 12 12 11 11 10 7 5 7 5 4 3 3 No. of patients 22,633 15,613 16,253 20,912 17,183 14,223 7,403 10,450 7,622 4,814 2,544 4,764 3,402 % compliance with criterion 73 68 66 88 68 71 53 73 63 49 38 84 62 Range between groups 25-89 58-87 28-80 77-97 40-91 22-86 26-68 66-77 52-74 40-67 16-47 81-90 48-92 Checked within last 12 months HbA1c or fructosamine Fundi Urine Blood pressure Feet Smoking BMI Weight Visual acuity Creatinine Lipids Blood sugar Diet 17 audit groups were surveyed representing 495 general practices. Source: Khunti K, Baker R, Rumsey M, Lakhani M (1999) Quality of care of patients with diabetes: collation of data from multi-practice audits of diabetes in primary care. Family Practice 16: 54-59. Coronary heart disease statistics: diabetes supplement 32
Slide 33: Table 5.3 Inpatient cases by main diagnosis, sex and age, National Health Service hospitals, 1999/2000 England Admissions Men Women 6,904,767 473,919 129,765 60,349 33,449 30,714 55,497 76,209 32,856 530,606 68,456 29,947 135,354 21,206 123,449 356,447 651,207 507,174 1,178,797 354,010 2,696,302 Total 12,167,574 1,057,499 364168 145,642 90,111 112,421 110,367 144,221 72,241 1,066,220 163,268 79,305 136,105 82,841 231,055 741,876 1,297,477 801,024 1,178,797 758,587 4,962,798 Days in hospital Total days 49,419,319 6,966,985 1,648,973 564,750 546,357 446,080 1,018,253 2,326,501 354,280 3,785,343 569,012 394,479 288,171 211,026 1,738,488 3,753,123 3,192,180 1,992,169 2,033,258 4,228,171 21,375,322 All diagnoses All diseases of the circulatory system (I00-I99) Coronary heart disease (I20-I25) Angina pectoris (I20) Acute myocardial infarction (I21) Chronic coronary heart disease (I25) Heart failure (I50) Stroke (I60-I69) Diabetes (E10-E14) All cancer (C00-D48) Colo-rectal cancer (C18-C21) Lung cancer (C33-C34) Breast cancer (C50) Bladder cancer (C67) All diseases of the nervous system (G00-G99) All diseases of the respiratory system (J00-J99) All diseases of the digestive system (K00-K93) All diseases of the genitourinary system (N00-N99) Complications of pregnancy and childbirth (O00-O99) Injury and poisoning (S00-T98) All other diagnoses 5,262,807 583580 234,403 85,293 56,662 81,707 54,870 68,012 39,385 535,614 94,812 49,358 751 61,635 107,606 385,429 646,270 293,850 0 404,577 2,266,496 ICD codes (10th revision) in parentheses; ordinary admissions and day cases combined. Source: Department of Health (2001) Hospital Episode Statistics. http://www.doh.gov.uk/hes/ Coronary heart disease statistics: diabetes supplement 33
Slide 34: Table 5.4 Admissions Days in hospital Age group 0-14 15-59 60-74 75 & over Total Total days 49,419,319 354,280 508,537 323,384 5,487 7,553 49,565 1,248,806 2,308,477 12,141,481 13,392 72,219 93,568 20,038 13,515 28,759 11,659 239,757 33,815 10,856 4,910 17,413 3,302 83,689 2,463,174 23,089 36,638 6,288 5,720 8,899 4,135 84,770 5,687,806 30,622 22,774 2,834 2,816 2,383 3,903 65,332 1,682,024 5,116 340 60 69 63 319 5,967 Estimates of numbers of inpatient cases and days in hospital due to diabetes by age, National Health Service hospitals, 1999/2000, England All diseases and conditions Diabetes as a direct cause (E10-E14) Complications of diabetes due to: Heart disease (I20-I25, I10-I15, I26-I28, I30-I52) Cerebrovascular disease (I60-I69) Peripheral vascular disease (I70-I79) Ophthalmic complications (H25-H28) Renal disease (N17-N19) All diabetes (as a direct cause or complications due to diabetes) The estimates for the numbers of admissions due to complications of diabetes (and days in hospital) were derived by multiplying the total numbers of admissions (or days in hospital) due to the complications (from Hospital episode statistics) by the percentages of admissions in diabetic patients (from the study by Currie et al). Sources: Department of Health (2001) Hospital Episode Statistics. http://www.doh.gov.uk/hes/ Currie CJ, Williams DRR, Peters JR (1996) Patterns of in and out-patient activity for diabetes: a district survey. Diabetic Medicine 13: 273-280. Coronary heart disease statistics: diabetes supplement 34
Slide 35: 6. Prevalence of behavioural risk factors for Type 2 diabetes in the general population 6.1 Overweight and obesity Overweight and obesity increase the risk of developing Type 2 diabetes. The risk increases continuously with Body Mass Index (BMI) and decreases with weight loss. It has been estimated that just under two-thirds of cases of Type 2 diabetes in men and three-quarters of cases in women could be prevented if everyone had a BMI under 251. The adverse effect of excess weight is more pronounced when the fat is concentrated mainly in the abdomen. This is known as central obesity and can be identified by a high waist to hip ratio. Overall prevalence In England about 46% of men and 32% of women are overweight (a BMI of 25-30 kg/ m2), and an additional 17% of men and 21% of women are obese (a BMI of more than 30 kg/m2) (Table 6.1). Central obesity (a waist-hip ratio of 0.95 and over in men and 0.85 and over in women) is also common among adults in England. Around 28% of men and 20% of women have central obesity (Table 6.2). Coronary heart disease statistics: diabetes supplement Age and sex differences Overweight and obesity increase with age. About 28% of men and 27% of women aged 16-24 are overweight or obese but 76% of men and 68% of women aged 55-64 are 35
Slide 36: overweight or obese (Table 6.1). The prevalence of central obesity also increases with age, especially in men. About 7% of both men and women aged 16-34 have central obesity but 46% of men and 23% of women aged 55 and over have central obesity (Table 6.2). The prevalence of obesity increases with age throughout childhood (Table 6.3). In 1996, around 13% of 8 year olds and 17% of 15 year olds in England were obese2. Temporal trends Overweight and obesity are increasing. The percentage of adults who are obese has roughly doubled since the mid 1980’s (Table 6.4 and Figure 6.4). The high levels of overweight and obesity among children are likely to exacerbate the trend towards overweight and obesity in the adult population: compared to thin children, obese children have a high risk of becoming overweight adults3. Socio-economic differences Obesity is more common in adults employed in manual occupations, particularly women. A quarter of women working in unskilled manual occupations have a BMI of more than 30 kg/m2 compared to one in seven of those employed in a professional role. Both men and women working in unskilled manual occupations are over four times as likely as those in professional employment to be classified as morbidly obese (a BMI over 40) (Table 6.5). In both men and women, the prevalence of central obesity is higher in people from manual social classes (IIIM, IV and V) than from non-manual classes (I, II and IIINM). However, as in general obesity, the social class patterning of central obesity is more evident in women, in whom the prevalence of central obesity increases from 18% in social class I to 27% in social class V (Table 6.6). Ethnic differences Levels of general and central obesity vary with ethnicity in both men and women in England. Compared with the general population, levels of general obesity are much lower in Pakistani, Indian, Chinese, and, most markedly, Bangladeshi men, who are three times less likely to be obese than men in the general population (Table 6.7). Despite low levels of general obesity, Pakistani, Indian and Bangladeshi men, have relatively high levels of raised waist to hip ratio, with 41% of Indian men classified as centrally obese compared to 28% of men in the general population. African Caribbean and Chinese men are less likely to have a raised waist hip ratio (Table 6.8). Among women, obesity prevalence is high for African Caribbean and Pakistani women and low for Bangladeshi and Chinese women (Table 6.7). However, all female minority ethnic groups have levels of central obesity well above that of the general female population, with African Caribbean and Pakistani women two times, and Bangladeshi women over three times, as likely to have a raised waist to hip ratio as women in general (Table 6.8). Coronary heart disease statistics: diabetes supplement 36
Slide 37: International differences Data from national surveys of overweight and obesity collected by Professor Boyd Swinburn and his colleagues at Deakin University, Victoria, Australia show that the prevalence rates for overweight and obesity in the UK are some of the highest in the world. For example the prevalence of obesity is the eighth highest for men (out of 40 countries) and the eleventh highest for women (out of 41 countries) (Table 6.9 and Figure 6.9). Levels of overweight and obesity are increasing in all countries – both developed and developing (Table 6.9). 6.2 Physical activity People who are physically active have a much lower risk of developing Type 2 diabetes than sedentary people. The Government recommendation on physical activity is that adults should participate in a minimum of 30 minutes of at least moderate intensity activity (such as brisk walking, cycling or climbing the stairs) on five or more days of the week4. Age and sex differences Physical activity levels are low in the UK: only 37% of men and 25% of women meet the current guidelines (30 minutes moderate activity on five or more days a week) suggested by the government (Table 6.10). In addition, over one third of adults are currently inactive, that is do less than one occasion of 30 minutes of physical activity a week (Table 6.10). Physical activity declines rapidly with age. Whereas 58% of men and 33% of women aged 16-24 are physically active for 30 minutes or more at least five days a week, this declines to 17% of men and 12% of women in the 65-74 age group (Table 6.10 and Figures 6.10a and 6.10b). It is recommended that all children and young people aged 5-18 participate in physical activity of at least moderate intensity for one hour a day5. In England, only 55% of boys and 39% of girls aged 2-15 are active for at least an hour on five or more days a week6. Participation rates decline with age after around 8-10 years, with the steepest decline in girls. By the age of 15, less than one in five girls reach the recommended level of activity6. Temporal trends It is generally thought that over the last 20 years physical activity levels have declined in the UK7. Since 1994 the proportion meeting the current recommended level of physical activity has remained stable at 37% in men and increased slightly, from 22% to 25%, in women; but the proportion classified as sedentary (less than one occasion of physical activity of thirty minutes a week) has increased from 30% in 1994 to 35% in 1998 in men, and from 35% to 41% in women (Table 6.10). Coronary heart disease statistics: diabetes supplement Socio-economic differences Socio-economic differences in physical activity are complex. In men, overall activity levels are greater in manual social classes than in non-manual classes: half of those working in unskilled manual jobs meet current recommended levels compared to just under a third 37
Slide 38: of those in professional jobs. In women, however, there is no clear pattern according to social class in the proportion meeting the recommended activity level6. The type of activity, however, does vary with social class in men and women, with a greater incidence of work related activity in manual (especially in men) and sports activity (especially in women) in non-manual classes8. Ethnic differences Compared with the general population, South Asian and Chinese men and women are less likely to participate in physical activity, with the lowest levels found in the Bangladeshi community. Only 18% of Bangladeshi men and 7% of Bangladeshi women meet the current recommended physical activity levels (30 minutes activity on five or more days a week). African Caribbean men and woman are the most likely to be physically active at the recommended level9. International differences Levels of activity vary across Europe, with levels of activity in the UK falling below the average for the European Union (Table 6.11 and Figure 6.11). 1. 2. World Health Organization (1998) Obesity. Preventing and Managing the Global Epidemic. In children and adolescents, obesity and overweight cannot be classified in the same way as in adults, where age-independent body mass index cut off points are utilised (i.e. a BMI 25-30 for overweight and a BMI over 30 for obese). Due to growth spurts during development, BMI changes substantially with age in children and needs to be assessed using age-related reference curves. Because of these different classification systems for adults and children, Table 6.1 and Table 6.3 are not directly comparable. Serdula M, Ivery D, Coates R, Freedman D, Williamson D, Byers T (1993) Do obese children become obese adults? A review of the literature. Preventive Medicine 22: 167-177. Department of Health (1996) Strategy Statement on Physical Activity. DH: London. However it should be noted that the recommended activity levels for Northern Ireland, and Scotland are age-related and combine the guidelines on vigorous and moderate intensity activity. Biddle S, Sallis J, Cavill N (eds) (1998) Young and Active? Young people and health enhancing physical activity – evidence and implications. Health Education Authority: London. Petersen S, Rayner M, Press V (2000) Coronary heart disease statistics. British Heart Foundation: London. Prentice AM, Jebb SA (1995) Obesity in Britain: gluttony or sloth? British Medical Journal 311: 437-9. Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office: London. Petersen S, Rayner M (in press) Coronary heart disease statistics 2002. British Heart Foundation: London. 3. 4. 5. 6. 7. 8. 9. Coronary heart disease statistics: diabetes supplement 38
Slide 39: Table 6.1 2 Body Mass Index by sex and age, 1998, England All ages 16-24 % 25-34 % 35-44 % 45-54 % 55-64 % 65-74 75 & over % % Body mass index (kg/m ) % MEN 20 or less Over 20-25 Over 25-30 Over 30-40 Over 40 All over 30 (obese) Base WOMEN 20 or less Over 20-25 Over 25-30 Over 30-40 Over 40 All over 30 (obese) Base Source: 4 34 46 17 1 17 6,600 14 59 23 5 0 5 825 3 41 40 15 1 16 1,261 2 33 48 16 1 17 1,229 2 25 52 20 1 21 1,197 1 24 52 22 1 23 910 2 22 55 20 1 21 745 4 32 48 16 0 16 433 7 40 32 19 2 21 7,730 19 54 17 10 1 11 903 8 49 27 15 2 16 1,433 4 45 30 18 3 21 1,449 4 36 36 22 2 24 1,373 3 29 39 26 2 29 1,043 5 25 41 27 2 29 853 7 35 37 20 1 21 676 Joint Health Surveys Unit (1999) Health Survey for England. 1998. The Stationery Office: London. Table 6.2 Prevalence of a raised waist-hip ratio by sex and age, 1998, England All ages % 16-34 % 7 2,213 7 2,636 35-54 % 27 2,594 17 3,057 55 & over % 46 2,386 34 3,022 MEN Base WOMEN Base 28 7,193 20 8,715 A raised waist-hip ratio for men is defined as 0.95 and over and for women is 0.85 and over. Source: Joint Health Surveys Unit (2001) Health Survey for England. The Health of Minority Ethnic Groups 1999. The Stationery Office: London. Coronary heart disease statistics: diabetes supplement 39
Slide 40: Table 6.3 Prevalence of obesity and overweight in children by sex and age, 1996, England Age (years) 6 7 26 9 144 8 24 12 136 9 25 13 131 10 23 10 135 11 25 14 122 12 28 12 126 13 25 12 131 14 30 14 136 15 33 16 140 BOYS % overweight % obese Base GIRLS % overweight % obese Base BOTH % overweight % obese Base 22 10 298 22 10 280 22 13 295 22 11 247 23 10 252 25 13 256 28 15 246 27 14 263 30 15 249 31 17 244 22 9 144 18 12 136 21 13 159 19 10 116 24 11 117 24 11 134 28 18 120 28 16 132 29 13 113 29 17 104 22 12 154 Health Survey for England 1996 data. Children were defined as overweight if their BMI was above the 85th centile of the 1990 Body Mass Index reference curves for the UK, and obese if above the 95th centile. Source: Reilly J, Dorosty A (1999) Epidemic of obesity in UK children. Lancet; 354:1874-75. Coronary heart disease statistics: diabetes supplement 40
Slide 41: Table 6.4 Body Mass Index by sex, 1986/87-1999, England Body mass index (kg/m2) MEN 20 or less Over 20-25 Over 25-30 More than 30 Bases WOMEN 20 or less Over 20-25 Over 25-30 More than 30 Bases Adults aged 16–64. Sources: From 1993 , Health Survey for England. See Department of Health. Website: http://www.doh.gov.uk/public/summary1.htm Earlier figures, Central Health Monitoring Unit, Department of Health, personal communication. 1986/87 % 6 49 38 7 n/a 1991/92 % 6 41 40 13 n/a 1993 % 5 39 43 13 5,998 1994 % 5 39 43 13 5,597 1995 % 5 38 43 15 5,471 1996 % 5 36 43 16 5,731 1997 % 4 35 43 17 3,078 1998 % 4 35 44 17 5,422 1999 % 5 34 42 18 2,626 11 53 24 12 n/a 9 50 26 15 n/a 8 47 30 16 6,389 8 47 29 16 6,147 7 46 30 17 6,180 7 44 31 17 6,401 7 43 30 19 3,424 5 41 33 22 6,201 8 41 31 20 3,004 Figure 6.4 Prevalence of overweight and obesity amongst adults aged 16-64, 1986/87-1999, England 50 45 Men - overweight 40 35 Women - overweight 30 % 25 Women - obese 20 Men - obese 15 10 5 0 1986/87 1991/92 1993 1994 1995 1996 1997 1998 1999 Year Coronary heart disease statistics: diabetes supplement 41
Slide 42: Table 6.5 Body mass index (kg/m2) Prevalence of morbid obesity, obesity and overweight by sex and social class, 1998, England I Professional % II Intermediate % IIIN Skilled non-manual % IIIM Skilled manual % IV Partly skilled manual % V Unskilled manual % MEN 25-30 (overweight) Over 30 (obese) Over 40 (morbid obesity) Base WOMEN 25-30 (overweight) Over 30 (obese) Over 40 (morbid obesity) Base Adults aged 16 and over. Age-standardised percentages; see source for method of age-standardisation. Source: Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office: London. 46 12 0 461 47 16 1 2,031 43 16 0 662 44 20 1 2,072 44 16 1 938 40 18 2 301 30 14 1 471 33 18 2 2,231 31 18 1 1193 32 24 2 1,983 32 25 3 1,201 32 28 3 429 Table 6.6 Prevalence of a raised waist-hip ratio by sex and social class, England, 1998 Social class of head of household I Professional % II Intermediate % 24 1,896 IIIN Skilled non-manual % 23 601 IIIM Skilled manual % 31 1,926 IV Partly skilled manual % 28 863 V Unskilled manual % 29 27 MEN 20 Base WOMEN 18 Base Adults aged 16 and over. Raised waist-hip ratio for men is 0.95 and over and for women is 0.85 and over; age-standardised percentages; see source for method of age-standardisation. Source: Joint Health Surveys Unit (1999) Health Survey for England 1998. The Stationery Office: London. 418 18 2,062 18 1,098 22 1,836 24 1,117 27 390 432 Coronary heart disease statistics: diabetes supplement 42
Slide 43: Table 6.7 Prevalence of obesity by sex and ethnic group, 1999, England General population % Black Caribbean % 19 466 33 618 Indian % 12 527 21 572 Pakistani Bangladeshi % 14 556 34 550 % 6 409 13 408 Chinese % 7 284 4 339 Irish % 20 481 22 631 MEN Base WOMEN Base Adults aged 16 and over. 19 3,204 21 3,699 Obesity: a BMI of over 30; age-standardised percentages; see source for method of age-standardisation. Source: Joint Health Surveys Unit (2001) Health Survey for England. The Health of Minority Ethnic Groups.1999. The Stationery Office: London. Table 6.8 Prevalence of a raised waist-hip ratio by sex and ethnic group, 1999, England General population % Black Caribbean % 17 363 42 513 Indian % 41 467 34 461 Pakistani Bangladeshi % 42 387 56 403 % 37 273 72 288 Chinese % 21 196 36 249 Irish % 32 408 27 540 MEN Base WOMEN Base Adults aged 16 and over. 28 6,095 20 7,135 A raised waist-hip ratio for men is defined as 0.95 and over and for women is 0.85 and over; age-standardised percentages; see source for method of age-standardisation. Source: Joint Health Surveys Unit (2001) Health Survey for England. The Health of Minority Ethnic Groups.1999. The Stationery Office: London. Coronary heart disease statistics: diabetes supplement 43
Slide 44: Table 6.9 Country Australia Year 1980 1983 1989 1995 1991 Body Mass Index by sex, 1960-1999, all available countries Base 5603 7615 6097 10652 NR 11302 95062 15585 10680 10911 9241 1269 17858 12318 NR NR 3981 3981 54006 4920 30063 4668 5812 17294 4225 9111 4125 6025 3850 4618 3575 4329 3371 13942 1941 15106 4790 5335 5311 7410 7124 9215 14281 2875 16113 39143 21361 177841 72284 63046 50692 13048 NR 17858 NR 16195 16822 NR 16210 52307 NR 2836 22354 6480 2067 3435 4053 4747 28737 5021 5111 19022 2042 NR BMI - Men Age Mean ≥25 (y) (kg/m2) (%) 25-64 25-64 25-64 19+ 20+ 25-74 20+ 20+ 20+ 20-69 20-69 19-69 18-74 20-64 20-64 15+ 20-45 22-47 20+ 20-45 20-59 16+ 15+ 15+ 15-64 25-64 15-64 25-64 15-64 25-64 15-64 25-64 15-64 20+ 16-50 20+ 25-69 25-69 25-69 25-69 18-79 20-65 30-82 25-74 18+ 18+ 18+ 18+ 15+ 20-69 15+ 15+ 20+ 30-69 20+ 30-69 30-69 20+ 30-69 15-84 20+ 25+ 30+ 15+ 18+ 18+ 18-59 18-64 20+ 25-74 25-74 Adults Adults 20+ 24.6 24.7 26.3 24.8 26.7 25.0 26.8 25.4 27.1 25.4 24.6 23.5 24.7 26.5 26.5 26.8 26.8 26.9 20.8 27.9 24.3 26.0 18.6 18.9 19.8 24.6 26.3 25.1 25.1 21.0 22.7 21.4 22.9 22.9 22.0 23.0 22.8 22.5 27.1 22.8 22.6 25.0 27.5 23.6 23.4 22.7 22.8 24.1 25.4 22.9 22.6 45.7 67.5 30.6 28.7 24.1 26.1 35.7 50.0 14.9 32.3 4.2 4.7 4.0 3.4 5.3 11.0 2.3 38.0 57.2 2.3 2.7 4.3 41.2 46.2 46.1 5.0 16.5 0.2 0.2 0.3 7.1 7.0 6.5 0.7 0.9 1.3 22.1 1.8 1.8 32.7 5.3 8.3 42.0 61.0 43.0 65.4 45.0 64.9 50.0 67.4 50.0 39.4 40.8 15.4 17.5 19.9 20.1 6.4 6.5 15.1 14.7 17.2 25.3 25.3 25.7 26.7 25.0 25.9 22.3 23.3 24.3 25.3 24.6 23.2 26.0 26.1 26.2 25.9 20.4 21.4 21.4 20.9 23.7 24.9 58.6 49.9 49.1 55.6 64.5 BMI - Women ≥30 Mean ≥25 (%) (kg/m2) (%) 9.3 9.1 11.5 17.9 8.3 12.1 2.4 4.7 6.9 9.4 6.1 9.0 15.0 13.5 13.3 0.3 0.4 0.7 8.2 23.7 24.1 24.7 26.0 24.1 26.0 22.8 24.3 24.6 23.8 23.1 24.8 25.0 24.8 24.5 24.6 20.9 21.9 21.7 20.9 24.7 23.3 28.5 25.3 24.3 25.8 24.3 26.2 24.5 26.1 25.1 26.2 25.0 23.2 22.1 23.3 25.8 25.8 26.2 26.3 26.3 22.1 28.0 24.0 27.3 18.8 19.0 19.4 23.4 26.4 23.6 23.7 22.0 22.8 21.9 22.9 22.8 22.0 22.6 22.5 21.9 30.6 23.4 21.7 27.5 29.0 24.2 23.0 23.1 24.2 25.7 22.9 26.9 25.2 30.2 57.0 72.9 35.0 26.0 29.0 37.9 47.7 25.0 58.0 30.3 From randomly 40.6 selected clinics 10.7 7.9 Mixed ethnic groups 7.6 Mixed ethnic groups 10.4 Mixed ethnic groups 15.1 Mixed ethnic groups Uncertain sampling methods 23.0 14.6 34.0 61.7 3.4 4.1 4.6 28.9 30.6 31.3 7.0 19.6 0.5 Mainly rural areas 0.5 Mainly rural areas 0.6 Uncertain sampling methods 7.6 9 surveys pooled 6.1 6.3 2.8 2.6 2.8 20.6 2.6 2.6 59.8 Uncertain sampling methods 18.1 53.6 28.2 32.5 38.3 49.2 ≥30 Notes (%) 8.0 6 main cities 10.5 6 main cities 13.2 6 main cities 16.7 9.0 8 regions 18.4 7.0 NE & SE regions 12.0 NE & SE regions 12.5 NE & SE regions 12.1 8.1 9.2 15.0 15.7 11.8 0.9 8 provinces (same 0.9 people in 1989 & 1991) 0.7 Parents from children's survey 7.0 35.1 17.4 36.0 50.0 36.0 52.3 38.0 51.9 43.0 52.4 42.0 26.8 27.5 16.6 3 regions 20.3 3 regions 20.0 3 regions 19.2 3 regions 6.3 1272 men, 669 women 7.0 16.5 17.2 19.3 Austria Belgium Brazil 1979-84 1974-5 1989 1996-97 1981 1985 1988 1986-90 1994 1996 1998-9 1989 1991 1992 1993 1982 1994 1993 1966-72 1978-80 1982 1985-7 1987 1988-90 1992 1994-6 1997 1999 1980-81 1988 1991-2 1984-5 1987-8 1990-1 1992 1998 1987-9 1993-9 1995-6 1986-8 1974-9 1988-90 1995-6 1983 1978-87 1991 1994 1976 1980 1982 1983 1986 1987 1989 1990-4 1993 1994-6 1990 1995 1980 1993 1993 1990 1996 1987 1992 1988 1995 1984 42.5 47.9 37.4 56.0 59.2 56.0 6.4 8.9 11.9 9.0 31.5 44.2 51.3 40.6 36.7 38.0 37.2 38.0 11.7 13.1 17.0 12.0 39.4 28.0 71.9 Canada China Cuba Denmark Egypt Finland France Germany Ghana Greece Hong Kong Hungary India 0.6 6.1 Uncertain sampling methods Baseline of cohort study Italy Japan Jordan Korea Kuwait Kyrgyzstan Malaysia Mauritius Mexico Morocco Coronary heart disease statistics: diabetes supplement 44
Slide 45: Country Netherlands Year 1981 1982 1982-4 1984 1985 1985-7 1987 1988 1987-91 1989-91 1993-5 1993-5 1995 1996-8 1993-4 1992-4 1989 1997 1994 1995 1993 1978 1991 1990-3 1987 1994 1982-5 1992 1979 1998 1989-94 1980-1 1988-9 1996-7 1992-3 1997 1986 1976-81 1990 1990 1980 1986 1988 1991 1993 1994 1995 1996 1997 1998 1960-2 1971-4 1976-80 1982-7 1988 1987-91 1988-94 1998 1981-5 1987-9 Base ~9000 ~9000 ~9000 ~9000 ~9000 ~9000 ~9000 ~9000 36266 ~9000 12905 ~9000 4601 21764 2248 6503 3204 4636 3144 1404 9585 1484 1729 10165 1078 806 2143 3568 7187 13827 5388 14474 12387 11417 15288 79311 4443 5613 NR 3689 8434 2319 1747 NR 15284 14679 14436 15061 7939 14330 ~7800 ~28000 20325 14407 1892 114954 ~40000 900 12800 12442 BMI - Men Age Mean ≥25 (y) (kg/m2) (%) 20+ 20+ 20+ 20+ 20+ 20+ 20+ 20+ 20-59 20+ 20-59 20+ 20-59 20+ 18+ 30-59 15+ 15+ 16-79 25+ 20+ 25-74 25-74 20+ 25-64 35-64 18-69 18-69 15-64 15+ 25-60 16-84 16-84 16-84 15+ 15+ Adults 20+ Adults 20+ 20-64 16-64 16-50 16-64 16+ 16+ 16+ 16+ 16+ 16+ 20-74 20-74 20-74 25-74 16-50 25-74 20-74 18+ 18+ 18+ 23.7 23.6 24.3 23.7 23.6 24.3 23.8 24.0 24.9 24.5 25.8 24.7 25.5 24.8 26.0 27.1 25.3 26.2 24.6 22.1 21.5 27.1 30.5 25.6 23.9 24.5 22.5 23.0 26.0 23.4 25.6 24.2 24.4 25.0 24.5 24.7 22.0 23.2 22.8 25.1 24.8 24.9 23.8 25.7 25.9 26.0 26.1 26.3 26.5 26.5 25.2 25.6 25.5 25.6 24.9 26.0 26.3 26.0 19.1 19.3 43.0 45.0 57.6 58.1 59.3 61.0 62.2 62.8 48.2 52.9 51.4 35.7 38.2 45.9 39.2 42.1 14.6 22.4 17.4 27.5 56.6 28.5 50.9 12.7 53.0 55.1 42.0 BMI - Women ≥30 Mean ≥25 (%) (kg/m2) (%) 3.9 3.5 3.7 3.9 3.6 3.8 4.1 4.6 7.4 5.1 8.0 5.9 10.0 6.5 18.7 10.0 14.7 5.0 1.7 27.5 46.8 17.8 4.2 23.4 23.3 23.5 23.4 23.3 23.6 23.4 23.5 24.3 23.8 25.0 24.0 24.8 24.3 28.3 28.6 24.7 26.1 23.4 23.9 21.5 29.1 33.2 26.9 26.2 28.0 23.1 22.6 14.7 9.1 11.5 4.7 5.2 6.8 6.1 6.7 2.6 2.4 9.0 8.0 8.0 12.7 13.2 13.8 15.3 16.4 17.0 17.3 10.4 11.8 12.3 25.8 26.5 25.3 23.4 23.4 24.0 22.4 23.3 23.0 25.2 24.9 26.3 24.0 24.6 23.2 25.3 25.7 25.8 25.9 26.0 26.2 26.4 24.6 24.7 25.1 27.8 24.1 26.9 26.1 25.9 19.1 19.2 34.0 36.0 48.6 48.7 50.4 52.0 52.5 53.3 38.6 39.8 40.8 27.6 27.9 33.6 21.8 28.0 22.8 41.0 30.4 24.9 54.9 70.4 40.0 49.3 26.0 35.9 15.2 74.8 56.0 ≥30 Notes (%) 6.2 5.9 6.0 6.2 6.0 6.3 6.3 6.8 9.0 3 municipalities 7.1 10.0 3 municipalities 7.4 10.3 3 municipalities 9.1 36.2 Curacao Mixed ethnic groups 13.0 Mixed ethnic groups 19.2 Mixed ethnic groups 5.0 1 urban, 1 rural area 3.4 48.5 3 regions 66.1 3 regions 26.6 20.9 Mahe, mixed ethnic groups Mahe, mixed ethnic groups Mixed ethnic groups Mixed ethnic groups 18.0 Whites, SW Cape 29.4 15.2 4 regions 5.4 5.6 7.2 4.7 6.9 3.5 Urban 1 urban, 1 rural region 8.3 21.7 9.0 12.0 Men oversampled 15.0 16.4 17.3 17.5 18.4 19.7 21.2 15.0 NHES I 16.2 NHANES I 16.5 NHANES II 37.0 38.3 29.4 30.0 39.3 42.0 53.3 43.5 31.3 33.3 38.9 36.5 Neth Antilles New Caledonia New Zealand Norway Pakistan Philippines Samoa Saudi Arabia Seychelles Singapore South Africa Spain Sweden Switzerland Togo Tunisia Turkey United Kingdom United States 59.4 57.0 20.0 17.0 49.8 49.0 24.9 NHANES III 19.0 Montevideo 10 rural areas Urban, rural Uruguay Vietnam For references to the original studies from which these data are extracted contact the authors of this supplement or Professor Boyd Swinburn (swinburn@deakin.edu.au) Source: Professor Boyd Swinburn, Deakin University, Victoria, Australia, personal communication. Coronary heart disease statistics: diabetes supplement 45
Slide 46: Figure 6.9 Coronary heart disease statistics: diabetes supplement 46 % 10 20 30 40 50 60 70 0 India Ghana China Philippines Japan Morocco Tunisia Togo Mauritius Kyrgyzstan Seychelles Malaysia Hong Kong Norway France Italy Netherlands Switzerland Sweden Brazil Denmark Austria Turkey South Africa Mexico Spain Belgium Canada New Zealand Kuwait Hungary Uruguay Germany United Kingdom Saudi Arabia Australia Neth Antilles United States Finland Jordan Samoa Men Women Prevalence of obesity, latest available data, all available countries
Slide 47: Table 6.10 Physical activity level by sex and age, 1994 and 1998, England All ages % MEN 1994 Group 1 - Low Group 2 - Medium Group 3 - High 1998 Group 1 - Low Group 2 - Medium Group 3 - High Bases WOMEN 1994 Group 1 - Low Group 2 - Medium Group 3 - High 1998 Group 1 - Low Group 2 - Medium Group 3 - High Bases 1994 1998 35 43 22 41 34 25 8,627 8,715 27 44 29 33 35 32 1,080 1,006 24 49 28 28 41 31 1,723 1,630 25 49 27 29 39 32 1,520 1,573 27 46 27 34 37 30 1,300 1,484 37 43 21 42 37 21 1,059 1,148 51 39 10 61 28 12 1,120 967 75 21 5 82 14 4 825 907 1994 1998 30 34 37 35 28 37 7,177 7,193 17 33 50 16 26 58 968 875 19 36 45 22 30 48 1,434 1,338 24 33 43 28 29 43 1,329 1,305 28 32 40 33 31 36 1,127 1,289 37 33 30 44 24 32 1,001 987 46 38 16 52 31 17 877 837 67 26 7 72 21 7 441 562 16-24 % 25-34 % Summary activity level* 35-44 45-54 55-64 % % % 65-74 75 & over % % Adults aged 16 and over. * Group 3= 30 minutes or more on at least 5 days a week; Group 2= 30 minutes or more on 1 to 4 days a week; Group 1= less than one occasion of 30 minutes a week. Source: Joint Health Surveys Unit (1999) Health Survey for England 1998 The Stationery Office: London. Figure 6.10a 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 16-24 25-34 Physical activity levels, men, 1998, England Group 1 - Low Group 2 - Medium Group 3 - High 35-44 45-54 55-64 65-74 75 and above Age group Figure 6.10b 100% 90% 80% 70% 60% 50% 40% Physical activity levels, women, 1998, England Group 1 - Low Group 2 - Medium Group 3 - High Coronary heart disease statistics: diabetes supplement 30% 20% 10% 0% 16-24 25-34 35-44 45-54 55-64 65-74 75 and above Age group 47
Slide 48: Table 6.11 Number of hours spent participating in various physical activities in a typical week, 1997, European Union countries None % Austria Belgium Denmark Finland France Germany Greece Ireland Italy Luxembourg Netherlands Portugal Spain Sweden United Kingdom EU average* Adults aged 15 and over. * weighted according to population size Source: Institute of European Food Studies, Trinity College, Dublin (1999) A Pan-EU Survey on Consumer Attitudes to Physical Activity, Body-weight and Health. IEFS: Dublin. <1hour % 4 7 6 5 7 6 4 5 7 8 6 7 11 4 7 7 1-3 hours % 18 18 16 18 20 19 18 16 20 19 18 15 17 16 17 18 3-5 hours % 20 15 22 26 20 19 22 28 19 21 18 11 21 23 25 21 > 5hours % 42 14 30 41 16 24 16 37 14 30 38 5 12 45 27 21 16 42 24 10 36 31 40 14 39 20 19 61 37 12 24 32 Figure 6.11 Percentage of adults aged 15 and over who do no physical activity in a typical week, 1997, European Union countries 70 60 50 40 % 30 20 10 0 United Kingdom EU average Sweden Ireland Austria Netherlands Luxembourg Denmark Germany Belgium Portugal Finland France Spain Italy Greece Coronary heart disease statistics: diabetes supplement 48