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Diabetes incidence decreases, prevalence plateaus among Medicare beneficiaries
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The prevalence of diabetes among adults aged at least 68 years has plateaued in recent years, and an analysis of Medicare claims data suggests diabetes incidence also has declined, according to findings published in Morbidity and Mortality Weekly Report.
In the analysis, researchers found that diabetes prevalence plateaued after 2012 and diabetes incidence decreased after 2006. In 2015 — the most recent year estimated — diabetes prevalence was 31.6%, and incidence was 3%, according to the report.
“These findings are consistent with survey-based estimates showing a flattening of prevalence after the year 2008 for all age groups and a decrease in incidence from 2009 to 2017 among all age groups,” Linda J. Andes, PhD, a mathematical statistician for the CDC, and colleagues wrote. “Several factors could explain these trends in diabetes prevalence and incidence. National data have suggested that some important risk factors, including total dietary intake, added sugar and sugar-sweetened beverage intake, and physical inactivity, might have decreased in the past decade.”
Andes and colleagues estimated annual prevalence and incidence of diabetes between 2001 and 2015 using claims data from 1999 through 2017, obtained from the Centers for Medicare & Medicaid Services Chronic Conditions Warehouse. Data included claims for hospital inpatient and outpatient, physician/provider (“carrier claims”), home health agency, and skilled nursing facility services for beneficiaries aged at least 68 years. Researchers defined a prevalent diabetes case as at least one inpatient claim in the index year or the preceding 2 years, or one outpatient diabetes claim in the index year and one inpatient or outpatient claim in the 2 years after the first claim. Researchers defined an incident diabetes case as a prevalent case with a 2-year period with no diabetes-related diagnosis codes at the beginning of the 5-year window. Prevalence and incidence rates were stratified by age, (68-69 years; 70-74 years; 75-79 years; 80-84 years; and 85 years), sex, and race.
Researchers found that overall national prevalence of diabetes among Medicare fee-for-service beneficiaries increased from 23.3% in 2001 to a high of 32.2% in 2012, and then stayed about level through 2015. Using joinpoint regression analyses, the researchers observed three prevalence trends. The average annual percentage change was 4% between 2001 and 2008, –1.4% between 2008 and 2012, and –0.7% between 2012 and 2015.
Diabetes prevalence was lower among whites than other racial groups and higher among men than women. However, in analyses stratified by race, researchers observed higher diabetes prevalence among black and Hispanic women vs. black and Hispanic men.
When estimating diabetes incidence, researchers noted two trends. From 2001 to 2006, the average annual percentage change was 4.5%; however, after 2006, incidence decreased by an average annual percentage change of –3.3%.
“Although incidence varied little by age, there were substantial differences by race/ethnicity and sex,” the researchers wrote. “As with prevalence, incidence among whites and Asians/Pacific Islanders was higher among men, although among blacks and Hispanics, incidence was similar among men and women.”
The researchers noted that the study sample may not reflect the total Medicare fee-for-service population, as beneficiaries were required to be enrolled in both Part A and Part B for 60 months continuously. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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