| BackgroundAs the country with the largest number of diabetes patients in the world,China accounts for nearly a quarter of the total number of diabetes patients in the world.In addition,diabetes mellitus consumes many medical resources and seriously affects people's quality of life.The study aimed to assess national and provincial prevalence,awareness.treatment and control status of diabetes among Chinese adults by using China Noncommunicable Disease Surveillance data,and to measure multilevel spatial heterogeneity of those diabetes related indicators.We also ananlysised the burden of diabetes in China from 1990 to 2016 and predicted the death of diabetes in 2030 under the different risk factors prevention and control objectives proposed by the World Health Organization.The results of this study can provide great significance for formulating diabetes prevention and control policies,promoting regional health equity and achieving the goal of healthy China.MethodsThe data of this study was from the 2013 survey of China Chronic Diseases and Risk Factors Surveillance among Chinese adults,which are representative of the national and provincial levels.The survey covers 297 counties/districts in 31 provinces of mainland China selected by multi-stage stratified clustering sampling methods.The survey collected information on demographic information,lifestyle related behavioral risk factors and diabetes management information through questionnaires.The height.weight,blood pressure,fasting plasma glucose and 2-hour oral glucose tolerance test(OGTT-2h)of the individuals were measured by a unified method.179 347 respondents were surveyed.After data checking and cleaning,173 304 subjects were included in this analysis.WHO diagnostic criteria(fasting blood glucose)7.0mmol/L and/or 2 hours after taking glucose?11.1 mmol/L)was applied to diagnose diabetes.National prevalence,treatment,awareness and control rates of diabetes were calculated by complex sampling and weighted processing,and the differences of each index among different populations were compared.We also analyzed those indicators in different provinces and explored the geographic variation and clustering at provincial level.Multilevel modeling were used to disentangle person and area-level contribution to the variation in each of outcome variables.The burden of the diabetes in China from 1990 to 2016 was analyzed using the data of the Global Burden of Disease Study 2016.The GBD 2016 study,which included 328 injuries and risk factors,covered 195 countries and territories between 1990 and 2016.In the present study,death,disability and related risk factors data of diabetes were selected to describe the changes of burden in 1990 and 2016 at national and provincial level.We used the data of diabetes from the Global Burden of Disease Study(GBD)and the theory of comparative risk assessment and the proportional change model,combined with the risk factor control target proposed by WHO,to predict the number of diabetic deaths and the probability of premature death in 2030 under different scenarios.The results could provide data support for the realization of "Healthy China 2030".Results1.According to the survey data of chronic diseases and risk factors in Chinese adults in 2013,the mean of fasting blood glucose and OGTT-2h in Chinese adults were(5.6± 1.4)mmol/L and(6.3±2.4)mmol/L respectively.The prevalence of diabetes in China was 10.1%,and the total number of diabetic patients is about 110 million.Of those with diabetes,36.8%were previously diagnosed,of those diagnosed 93.4%were treated,and of those treated,35.8%had their blood glucose properly controlled,resulting in an overall control rate 32.2%among all diabetes.There are great differences in provinces in terms of prevalence.awareness,treatment and control rates of diabetes.The prevalence of diabetes in 31 provincial administrative units ranged from 2.1%to 18.5%.Provinces in south and west region had lower prevalence rates relative to north part of China.The awareness and treatment rates of diabetes were 12.6%-61.7%and 7.3%-55.8%respectively.The treatment rate was lower in the southwest and higher in the north.Diabetes control in all provinces is not satisfactory,ranging from 19.7%to 42.7%.We failed to found the provincial distribution of control rate follows any specific pattern.Multilevel logistic regression analysis indicated that varying spatial heterogeneity of diabetes prevalence,awareness,treatment and control exsited at the level of provincial,county/district and township/street,with median odd ratios(MOR)ranging from 1.32-1.48,1.34-1.62,1.36-1.55 and 1.19-1.47.respectively.The spatial differences of the indicators further explained after personal and lifestyle factors were included in the model.2.The global burden of disease 2016 results shown that the number of deaths caused by diabetes in China increased by 96.4%,from 71694.9 to 140838.7.The mortality rate of diabetes rosed by 63.5%,from 63.3/100 000 to 10.3/100 000.Moreover the standardized mortality rate decreased by 7.4%,from 10.8/100.000 to 10.0/100 000.The mortality rates increasing more rapidly in men aged 15-49 years than in any other group.Between 1990 and 2016,the number of DALYs with diabetes increased by 95.0%,from 4274697.2 to 8337262.8.In addition,the DALY rate rosed by 62.1%,from 376.3 in 1990 to 609.9 per 100,000 in 2016.The DALY rate increased fastest in the age group of 15-49 years old,and the increase was greater in men than in women.Compared with 1990,the number of diabetes deaths and DALY increased in all provinces in 2016.The standardized mortality rate decreased in 27 provinces and increased in the west.From 1990 to 2016,rates of age standardized DALYs due to diabetes decreased in 14 provinces.but increased in 19 provinces.No obvious regional clustering was found.3.If the risk factors of diabetes(fasting plasma glucose,BMI,smoking and physical activity)follow the trend from 1990 to 2013(the natural trend scenario),there will be 433777.9 deaths due to diabetes in 2030.with the mortality rate of 30.6/100 000,the standardized mortality rate of 16.8/100 000,and the premature death probability of 0.6%.These indicators will increase by 230.6%,222.1%,78.7%and 50.0%,respectively compared with 2013.In 2030,the western and northern provinces of China would at a high level of standardized diabetes mortality rate,and the premature mortality in most provinces(31/33)showed an upward trend and 2 provinces remained unchanged.In all simulated scenarios.the death number will be 129367.2(38216.1 deaths between 30-70 years old),the mortality rate will be 9.1 in 100,000 and the premature death probability will be 0.19%in 2030,which can achieve the WHO target of 1/3 reduction compared with 2013.Compared with single risk factors controlscenarios,fasting plasma glucose scenarios will show the greatest reduction in diabetes death number,mortality rate and premature death probability.ConclusionIn 2013,the prevalence of diabetes in China was about one-tenth.Only one third of participants living with diabetes had been previously diagnosed,treated or could control their blood glucose well.Compared with prevalence,awareness and treatment and control rate in north China,it was poorest among southwest.It is extremely urgent to carry out effective measures improve diabetes awareness.treatment,control situation.Between 1990 and 2016,the burden of diabetes amons males and people aged 15-49 is increasing rapidly,which should taken as the key population for prevention and control.In order to achieve the goal proposed by WHO,it is necessary to strengthen the control of smokins,physical activity,especially overweight/obesity and blood glucose control.We should carry out various intervention activities according to local conditions to achieve the Goal of Healthy China. |
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