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Diabetes mortality in Serbia, 1991–2015 (a nationwide study): A joinpoint regression analysis

Published:September 17, 2016DOI:https://doi.org/10.1016/j.pcd.2016.08.019

      Highlights

      • This study is the first nationwide estimates of diabetes mortality in Serbia.
      • Diabetes kills about 2500 people annually in Serbia.
      • The mortality rate from diabetes places Serbia among the countries with the highest diabetes mortality rates in Europe.
      • Overall diabetes mortality has undergone a significant increase in the last decades.
      • Particularly worrisome is the increased trend in mortality due to diabetes type 1 in men.

      Abstract

      Purpose

      The aim of this study was to analyze the mortality trends of diabetes mellitus in Serbia (excluding the Autonomous Province of Kosovo and Metohia).

      Methods

      A population-based cross sectional study analyzing diabetes mortality in Serbia in the period 1991–2015 was carried out based on official data. The age-standardized mortality rates (per 100,000) were calculated by direct standardization, using the European Standard Population. Average annual percentage of change (AAPC) and the corresponding 95% confidence interval (CI) were computed using the joinpoint regression analysis.

      Results

      More than 63,000 (about 27,000 of men and 36,000 of women) diabetes deaths occurred in Serbia from 1991 to 2015. Death rates from diabetes were almost equal in men and in women (about 24.0 per 100,000) and places Serbia among the countries with the highest diabetes mortality rates in Europe. Since 1991, mortality from diabetes in men significantly increased by +1.2% per year (95% CI 0.7–1.7), but non-significantly increased in women by +0.2% per year (95% CI −0.4 to 0.7). Increased trends in diabetes type 1 mortality rates were significant in both genders in Serbia. Trends in mortality for diabetes type 2 showed a significant decrease in both genders since 2010.

      Conclusion

      Given that diabetes mortality trends showed different patterns during the studied period, our results imply that further observation of trend is needed.

      Keywords

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      References

        • World Health Organization
        WHO methods and data sources for global causes of death 2000–2012.
        Global Health Estimates, Technical Paper WHO/HIS/HSI/GHE/2014.7. World Health Organization, 2014
        • Chen L.
        • Magliano D.J.
        • Zimmet P.Z.
        The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives.
        Nat. Rev. Endocrinol. 2011; 8: 228-236
        • Mathers C.D.
        • Loncar D.
        Projections of global mortality and burden of disease from 2002 to 2030.
        PLoS Med. 2006; 3: e442https://doi.org/10.1371/journal.pmed.0030442
        • WHO Global Infobase Team
        The SuRF Report 2. Surveillance of Chronic Disease Risk Factors: Country-level Data and Comparable Estimates.
        WHO, Geneva2005 (Available at: https://www.who.int/ncd_surveillance/infobase/web/surf2/ (accessed 27.02.16))
        • World Health Organization
        European Health for all Database.
        WHO Regional Office for Europe, Copenhagen, Denmark2016
        • Patterson C.C.
        • Gyürüs E.
        • Rosenbauer J.
        • et al.
        Trends in childhood type 1 diabetes incidence in Europe during 1989–2008: evidence of non-uniformity over time in rates of increase.
        Diabetologia. 2012; 55: 2142-2147
        • Liao P.J.
        • Lin Z.Y.
        • Huang J.C.
        • et al.
        The relationship between type 2 diabetic patients’ early medical care-seeking consistency to the same clinician and health care system and their clinical outcomes.
        Medicine (Baltimore). 2015; 94: e554https://doi.org/10.1097/MD.0000000000000554
        • Writing Group for the DCCT/EDIC Research Group
        • Orchard T.J.
        • Nathan D.M.
        • Zinman B.
        • et al.
        Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality.
        JAMA. 2015; 313: 45-53
        • Patterson C.C.
        • Dahlquist G.
        • Soltész G.
        • Green A.
        • EURODIAB ACE Study Group. Europe and Diabetes
        Is childhood-onset type I diabetes a wealth-related disease? An ecological analysis of European incidence rates.
        Diabetologia. 2001; 44: B9-B16
        • Ilic M.
        • Ilic I.
        Gender disparities in mortality from infectious diseases in Serbia, 1991–2014: a time of civil wars and global crisis.
        Epidemiol. Infect. 2016; 144: 2473-2484
        • Ilic M.
        • Ilic I.
        Suicide in Serbia.
        J. Affect. Disord. 2016; 193: 187-193
        • Mathers C.D.
        • Ma Fat D.
        • Inoue M.
        • et al.
        Counting the dead and what they died from: an assessment of the global status of cause death data.
        Bull. World Health Organ. 2005; 83: 171-177
        • Statistical Office of the Republic of Serbia
        Statistical Yearbook of the Republic of Serbia for 1991–2014.
        Statistical Office of the Republic of Serbia, Belgrade2015
        • Kim H.J.
        • Fay M.P.
        • Feuer E.J.
        • et al.
        Permutation tests for joinpoint regression with applications to cancer rates.
        Stat. Med. 2000; 19: 335-351
        • Clegg L.X.
        • Hankey B.F.
        • Tiwari R.
        • et al.
        Estimating average annual per cent change in trend analysis.
        Stat. Med. 2009; 28: 3670-3682
        • Kim H.J.
        • Fay M.P.
        • Yu B.
        • et al.
        Comparability of segmented line regression models.
        Biometrics. 2004; 60: 1005-1014
      1. The Impact of UN Security Council Sanctions on the Health of the Population of FR Yugoslavia.
        Federal Institute for Public Health, Belgrade, Serbia1993
        • Kunitz S.J.
        The making and breaking of Yugoslavia and its impact on health.
        Am. J. Public Health. 2004; 94: 1894-1904
        • Ministry of Health, Republic of Serbia
        National Health Survey, Serbia 2006.
        Ministry of Health, Republic of Serbia, Belgrade2007
        • Sipetić S.B.
        • Vlajinac H.D.
        • Kocev N.I.
        • et al.
        The Belgrade childhood diabetes study: a multivariate analysis of risk determinants for diabetes.
        Eur. J. Public Health. 2005; 15: 117-122
        • McEwen L.N.
        • Karter A.J.
        • Curb J.D.
        • et al.
        Temporal trends in recording of diabetes on death certificates: results from Translating Research Into Action for Diabetes (TRIAD).
        Diabetes Care. 2011; 34: 1529-1533
        • Roglic G.
        • Unwin N.
        Mortality attributable to diabetes: estimates for the year 2010.
        Diabetes Res. Clin. Pract. 2010; 87: 15-19
        • Krag M.Ø.
        • Hasselbalch L.
        • Siersma V.
        • et al.
        The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: a 13 year follow-up study.
        Diabetologia. 2016; 59: 275-285
        • Lin W.H.
        • Wang M.C.
        • Wang W.M.
        • et al.
        Incidence of and mortality from type I diabetes in Taiwan from 1999 through 2010: a nationwide cohort study.
        PLoS One. 2014; 9: e86172https://doi.org/10.1371/journal.pone.0086172.eCollection
        • Wild S.
        • Roglic G.
        • Green A.
        • et al.
        Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
        Diabetes Care. 2004; 27: 1047-1053
        • Wändell P.E.
        • Carlsson A.C.
        Time trends and gender differences in incidence and prevalence of type 1 diabetes in Sweden.
        Curr. Diabetes Rev. 2013; 9: 342-349
        • Lawrence J.M.
        • Imperatore G.
        • Dabelea D.
        • et al.
        Trends in incidence of type 1 diabetes among non-Hispanic white youth in the U.S., 2002–2009.
        Diabetes. 2014; 63: 3938-3945
        • Sipetic S.
        • Maksimovic J.
        • Vlajinac H.
        • et al.
        Rising incidence of type 1 diabetes in Belgrade children aged 0–14 years in the period from 1982 to 2005.
        J. Endocrinol. Investig. 2013; 36: 307-312
        • James W.P.T.
        • Jackson-Leach R.
        • Ni Mhurchu C.
        • et al.
        Overweight and obesity (high body mass index).
        in: Ezzati M. Lopez A. Rodgers A. Murray C.J.L. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. WHO, Geneva2004
        • Bach J.F.
        The effect of infections on susceptibility to autoimmune and allergic diseases.
        N. Engl. J. Med. 2002; 347: 911-920
        • Thurner S.
        • Klimek P.
        • Szell M.
        • et al.
        Quantification of excess risk for diabetes for those born in times of hunger, in an entire population of a nation, across a century.
        Proc. Natl. Acad. Sci. U. S. A. 2013; 110: 4703-4707
      2. Commissariat for Refugees and Migration of the Republic of Serbia: Process of Voluntary Repatriation of Refugees to the Republic of Croatia and Bosnia and Herzegovina.
        United Nations High Commissioner for Refugees (UNHCR), Belgrade2010 (Available at: http://www.kirs.gov.rs/ (accessed 07.08.16))
        • Lukic V.
        Two Decades of Refuge in Serbia: Census of Population, Households and Dwellings 2011 in the Republic of Serbia.
        Statistical Office of the Republic of Serbia, Belgrade2015
        • Litvinjenko S.
        Migration and health.
        Srp. Arh. Celok. Lek. 1997; 125 (Article in Serbian): 191-196
        • DesMeules M.
        • Gold J.
        • McDermott S.
        • et al.
        Disparities in mortality patterns among Canadian immigrants and refugees, 1980–1998: results of a national cohort study.
        J. Immigr. Health. 2005; 7: 221-232
        • Wagner J.
        • Berthold S.M.
        • Buckley T.
        • et al.
        Diabetes among refugee populations: what newly arriving refugees can learn from resettled Cambodians.
        Curr. Diabetes Rep. 2015; 15: 56https://doi.org/10.1007/s11892-015-0618-1
        • Mateen F.J.
        • Carone M.
        • Al-Saedy H.
        • et al.
        Medical conditions among Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System.
        Bull. World Health Organ. 2012; 90: 444-451
        • Bruno G.
        • Maule M.
        • Merletti F.
        • et al.
        Age-period-cohort analysis of 1990–2003 incidence time trends of childhood diabetes in Italy: the RIDI study.
        Diabetes. 2010; 59: 2281-2287
        • Adeghate E.
        • Schattner P.
        • Dunn E.
        An update on the etiology and epidemiology of diabetes mellitus.
        Ann. N. Y. Acad. Sci. 2006; 1084: 1-29
        • Morrish N.J.
        • Wang S.L.
        • Stevens L.K.
        • et al.
        Mortality and causes of death in the WHO Multinational Study of vascular disease in diabetes.
        Diabetologia. 2001; 44: S14-S21