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Factors Affecting the Prevalence and Incidence of Diabetes in Canada

An Aging Population The prevalence of diabetes begins to increase steadily after age 40. The proportion of senior citizens in Canada’s overall population is increasing. 1 –In 2006, seniors accounted for 13.7% of the total population. 2 –By 2031, seniors will account for approximately 24% (almost double 2006 levels). 2 1.Canadian Diabetes Association Clinical Practices Guidelines Expert Committee. Can J Diabetes. 2008;32(suppl 1) :S1–S Statistics Canada. Population projections 2005– Statistics Canada Census: Age and Sex.

An Aging Population (cont’d) By the year 2056, the median age of Canadians will be 45–50 years. 1 Guidelines recommend screening starting at age 40. Therefore… over half the population will have at least one risk factor (age >40) and should be regularly screened for diabetes. 2 1.Statistics Canada Census: Age and Sex. 2.Canadian Diabetes Association Clinical Practices Guidelines Expert Committee. Can J Diabetes. 2008;32(suppl 1) :S1–S201.

An Aging Population (cont’d) Aging trends vary by province, with important implications for regional healthcare planning and policy. Proportion of seniors according to the 2006 Census: –National average: 13.5% –Saskatchewan: 15.4% (highest) –Alberta: 10.7% (lowest) Statistics Canada Census: Age and Sex.

Increasing Immigration From High-risk Populations Most recent immigrants come from populations at high risk for developing diabetes Of immigrants who came to Canada from 2001– 2006, approximately 80% were from populations at increased risk of developing diabetes: –58.3% came from Asia –10.6% came from Africa –10.8% came from Central/South America and the Caribbean Statistics Canada Census: Immigration, citizenship, language, mobility and migration.

Implications of Immigration Patterns for Diabetes Prevalence and Incidence Healthcare system will need to respond to the specific healthcare needs of these populations with culturally and linguistically relevant prevention, screening and management practices. Major cities (Toronto, Vancouver, Montreal) are home to the majority of recent immigrants (69%), with implications for local healthcare planning. Statistics Canada Census: Immigration, citizenship, language, mobility and migration.

Percentage of Foreign-born Canadians is Increasing By 2031, between 25% and 28% of the population could be foreign-born. Between 29% and 32% of the population could belong to a visible minority group, as defined in the Employment Equity Act. This would be nearly double the proportion reported by the 2006 Census. Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031.

The Percentage of Foreign-born Canadians Is Increasing (cont’d) About 55% of this population would be born in Asian countries, which have a very high incidence and prevalence of type 2 diabetes. In addition, Canada’s Black and Filipino populations could double, and Arab and West Asian groups could more than triple. Statistics Canada. Study: Projections of the diversity of the Canadian population, 2006 to 2031.

Aboriginal Population Growth Type 2 diabetes has reached epidemic proportions among Canadian Aboriginal peoples. The national age-adjusted prevalence is 2.5 to 5 times higher than that of the general population, and age-adjusted prevalence rates as high as 26% have been found in individual communities. 1-3 Aboriginal peoples are diagnosed with type 2 diabetes at a much younger age, with high rates of diabetes in children and adolescents. 4 Due primarily to a high birth rate, from 1996 to 2003, the Aboriginal population grew by 45%, nearly 6 times the growth rate of non-Aboriginals Dyck R, et al. CMAJ. 2010; 182(3): Green C, et al. Diabetes Care. 2003;26:1993– Harris SB, et al. Diabetes Care. 1997;20:185– Fagot-Campagna A, et al. J Pediatr. 2000;136:664– Statistics Canada. Aboriginal population in 2017.

Diabetes Surveillance System for First Nations Communities The First Nations Diabetes Surveillance System is a web-based surveillance application that will track type 2 diabetes and complication rates over time in First Nations communities. This information will allow the monitoring of the diabetes burden in each partnering community and can be used to inform and evaluate new quality improvement initiatives in communities. The goal of the Surveillance System is to monitor and track diabetes rates so that informed decisions can be made to improve community care. First Nations Surveillance System Newsletter. November 2010.

Diabetes Surveillance System for First Nations Communities Similar programs in Aboriginal settings in the United States and Australia have been associated with sustained improvements in quality of care for people diagnosed with diabetes. Although this program is currently a 2-year pilot program, it is hoped that in the future the system will be expanded to include other communities, and that ongoing financial support will help sustain the program. The Surveillance System has been generously funded by the Aboriginal Diabetes Initiative, First Nations and Inuit Health Branch at Health Canada. First Nations Surveillance System Newsletter. November 2010.

Canada Has a National Diabetes Surveillance System In each province and territory, the health insurance registry database is linked to physician billing and hospitalization databases An individual is identified as having diagnosed diabetes, if: –At least one hospitalization with diagnosis of diabetes; or –At least two physician visits with a diagnosis of diabetes within a 2-year period. –Gestational diabetes mellitus excluded. Current national database includes summary data on individuals 1 year or older at time of diabetes diagnosis from all provinces and territories from 1995/96 to 2004/2005. Age-standardized data are adjusted to 1991 Census data. Can’t distinguish between type 1 and type 2 diabetes. Validated methodology. Public Health Agency of Canada; Available at:

Increasing Prevalence of Adult and Childhood Obesity In 2008, of adult Canadians: –51% being overweight –17% reported being obese. 1 From 2003 to 2008, obesity rates rose: –from 16% to 18% in men –from 15% to 16% in women The highest rate of obesity (22%) was among 55 to 64 year olds –24% of men –21% of women 1 In boys and girls aged 2–17 years, prevalence of obesity from 1978/1979 to 2004 increased from 3% to 8% Statistics Canada. Canadian Community Health Survey, Lau DCW, et al. CMAJ. 2007;176(8 Suppl):S1–13.

Overweight, Obesity and Diabetes Between 2007 and 2017, it is estimated that people who are overweight (BMI 25–30 kg/m 2 ) will comprise the greatest number of new cases of diabetes (712,000) While those who are overweight have lower baseline risk than those who are obese (BMI 30–35 kg/m 2 ) or morbidly obese (BMI >35 kg/m 2 ), there are more more Canadians who are overweight than obese Manuel DG, et al. Toronto, ON: Institute for Clinical Evaluative Sciences; 2010.

Low Levels of Physical Activity In 2008, only 51% of Canadians reported being at least moderately active during their leisure time. “Moderately active” is equivalent to walking at least 30 minutes a day or taking an hour-long exercise class at least 3 times a week. Statistics Canada. Canadian Community Health Survey, 2008.

Socioeconomic & Environmental Impact on Health: Canadians Living in Poverty Health follows a social gradient: populations in a lower position in the social hierarchy experience the worst health More than 12% of the working-age population lives in poverty. 1 People who live in poverty are: –often unable to meet basic housing, food and security needs –have a greater risk of health problems than people who do not live in poverty Compared to those in the highest-income neighbourhoods, life expectancy in the lowest-income quintile neighbourhoods in Canada is: –5 years shorter for men –1.6 years shorter for women 2 1.Canada’s Record on Poverty Among The Worst of Developed Countries−And Slipping. Available at: 2.Ontario Medical Review. 2008;May:32-37.

Socioeconomic & Environmental Factors Diabetes Disproportionately Affects the Poor Diabetes is disproportionately clustered: 1 –in the lower socioeconomic status quintiles –in neighbourhoods with: lower average household incomes high proportions of visible minorities and/or recent immigrants In 2007, the self-reported age-standardized diabetes prevalence rate was highest among adults with a household income of <$20,000 (8%) This rate was double that of the group with an income of  $60,000 (4%). 2 1.Hux JE, et al. In: Diabetes in Ontario: An ICES Practice Atlas: Institute for Clinical and Evaluative Sciences. 2.Canadian Institute for Health Information. Diabetes Care Gaps and Disparities in Canada December 2009.

Socioeconomic & Environmental Factors Diabetes Disproportionately Affects the Poor People in lower income brackets and with fewer years of education also report the following (all of which are risk factors for diabetes): –Higher rates of smoking –Less physical activity; and –Higher rates of overweight Statistics Canada. National Population Health Survey – Household Component Longitudinal, 1998–1999.

Socioeconomic Status Also Affects Diabetes Care In 2007, people with higher household incomes were more likely to receive: –an A1C test –a urine test for protein –a dilated eye exam –a foot exam –all 4 recommended tests The age-standardized percentage of adults with diabetes receiving all 4 recommended tests was: –highest in the highest household income group (42%) –lowest in the lowest household income group (21%) Canadian Institute for Health Information. Diabetes Care Gaps and Disparities in Canada; December 2009.