Projected burden of type 2 diabetes mellitus-related complications in Singapore until 2050: a Bayesian evidence synthesis

Ken Wei Tan, Borame Sue Lee Dickens, Alex R Cook, Ken Wei Tan, Borame Sue Lee Dickens, Alex R Cook

Abstract

Objective: We examined the effects of age, gender, and ethnicity on the risk of acute myocardial infarction, stroke, and end-stage renal disease according to type 2 diabetes mellitus status among adults aged 40-79 in Singapore.

Methods: A Bayesian inference framework was used to derive age-specific, gender-specific and ethnicity-specific prevalence of type 2 diabetes mellitus from the 2010 Singapore National Health Survey, and age-standardized gender and ethnicity-specific incidence rates of acute myocardial infarction, stroke and end-stage renal disease from the National Registry of Diseases Office. Population forecasts were used in tandem with incidence rates to project the future chronic disease burden until 2050.

Results: The highest relative risk of acute myocardial infarction was observed in the youngest age group (aged 40-44), with higher relative risk for women (men: 4.3 (2.7-6.4); women: 16.9 (9.3-28.3)). A similar trend was observed for stroke (men: 6.5 (4.2-9.7); women: 10.7 (6.0-17.4)). For end-stage renal disease, the highest relative risk was for men aged 45-50 (11.8 (8.0-16.9)) and women aged 55-60 (16.4 (10.7-24.0)). The annual incidence of acute myocardial infarction is projected to rise from 9300 (in 2019) to 16 400 (in 2050), the number of strokes from 7300 to 12 800, and the number of end-stage renal disease cases from 1700 to 2700.

Conclusions: Type 2 diabetes mellitus was associated with an increased risk of complications and is modulated by age and gender. Prevention and early detection of type 2 diabetes mellitus can reduce the increasing burden of secondary complications.

Keywords: biostatistics; chronic diabetic complications; disease modeling.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Prevalence estimates of diabetes mellitus (DM) by age, gender and ethnicity for Singaporeans aged 40–79 using data from the 2010 Singapore National Health Survey.
Figure 2
Figure 2
Relative risk of AMI, stroke and ESRD for DM versus non-DM by age and gender for Singaporeans aged 40–79 using estimated DM prevalence and data from Singapore’s myocardial infarction, stroke and renal registries. AMI, acute myocardial infarction; DM, diabetes mellitus; ESRD, end-stage renal disease.
Figure 3
Figure 3
Estimates of age-standardized incidence rates of AMI, stroke and ESRD by ethnicity, gender and DM status for Singaporean adults aged 40–79. AMI, acute myocardial infarction; DM, diabetes mellitus; ESRD, end-stage renal disease; F, female; M, male.
Figure 4
Figure 4
Projected annual number of new cases of AMI, stroke and ESRD in Singapore with MAPE from 1990 to 2050 using population forecasts from a previous modeling study of the number of Singaporeans with DM with constant age-specific prevalence at all time points. The incidence of AMI, stroke and ESRD for age 80 and above is assumed to be equal to that of those aged 75–79. AMI, acute myocardial infarction; DM, diabetes mellitus; ESRD, end-stage renal disease; MAPE, mean absolute percentage error.

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