Prevalence and Incidence of Diabetes Mellitus-- United States, 1980-1987

From 1980 through 1987, the number of persons in the United States who self-reported* having diabetes mellitus (DM) increased by more than 17%--from an estimated 5.8 million to an estimated 6.8 million persons. These estimates of DM were derived from data from the National Health Interview Survey (NHIS), an annual household survey of approximately 120,000 U.S. residents. This report summarizes data on DM incidence and prevalence from the NHIS for 1980-1987.

From 1980 through 1987, the number of white males with DM increased by 33% (from 2.1 million to 2.8 million). The number of white females with DM remained about the same (2.7 million). During this period, the number of black males with DM increased by 16% (from 350,000 to 406,000), and black females, 24% (from 538,000 to 669,000). A doubling of cases among persons aged greater than or equal to 75 years (from 71,000 to 146,000) contributed to the large increase among black females.

From 1980 through 1987, the annual prevalence of DM (age-standardized to the 1980 U.S. resident population) increased 9%, from 25.4 to 27.6 per 1000 U.S. residents. Each year, prevalence was higher for blacks than for whites (Figure 1). In 1987, prevalence for black females was more than twice that for white females (50.9 compared with 23.4 per 1000 persons); for black males, the prevalence was about one third higher than for white males.

Diabetes incidence was calculated by counting only persons who reported having been told during the 12 months preceding the survey that they have diabetes. Three-year moving averages** were used to improve precision of the incidence estimates. The annual number of incident cases increased from 541,000 in 1980 to 731,000 in 1987. For females, the number of cases increased from 327,000 to 445,000; for white females, however, the annual number decreased from 279,000 to 264,000. Similarly, the number of incident cases for males increased from 215,000 to 286,000; for white males, the number decreased from 203,000 to 192,000. Incidence was not calculated separately for other races because of small sample sizes.

The overall age-standardized incidence per 1000 persons was 2.4 in 1980, 3.0 in 1983, and 2.9 in 1987. Incidence was consistently higher for females than for males (Figure 2). For females, annual incidence per 1000 residents steadily increased, from 2.4 in 1980 to 3.4 in 1987; for women aged greater than or equal to 65 years, the annual incidence increased from 6.3 to 10.6 during the same period. In most years, the rate for white females was lower than that for all females. For all males, the rate was relatively stable (an average of 2.3 per 1000 persons per year); for white males, however, the rate declined from 2.3 in 1980 to 2.0 in 1987. Reported by: Div of Diabetes Translation, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Persons with DM are at increased risk for lower-extremity amputations, cardiovascular disease, diabetic eye disease, and end-stage renal disease (1). For 1987, the annual health-care costs (direct costs from medical care and lost productivity) associated with diabetes were an estimated $20.4 billion (2). Based on the increase in the number of persons with DM, the substantial economic and health-care burden associated with DM is expected to increase.

The estimates in this report are based only on self-reported diabetes; they do not include persons with either undiagnosed DM or impaired glucose tolerance, all of whom are at increased risk for macrovascular complications (e.g., coronary heart disease) (3). Since approximately half of all prevalent cases may have been undiagnosed (4), the total number of persons with DM in 1987 may have been almost 14 million. As the population grows and the proportion of elderly persons increases (5), the number of persons with DM can be expected to increase.

Minority groups (e.g., blacks, Hispanics, and Native Americans) are at increased risk for DM and its complications (6). For both males and females, the incidence of DM for all races combined was higher than that for whites; thus, the higher rate for all races combined reflects the higher incidence of DM among races other than white, who constitute about 15% of the U.S. population. Although race-specific estimates of disease incidence assist in surveillance, planning, and evaluation, national data usually do not provide adequate designation of persons of Hispanic or Native American descent. Furthermore, the sample sizes in most national surveys are too small to provide stable estimates for minority groups.

The year 2000 national health objectives target overall DM prevalence at less than or equal to 25 per 1000 persons and incidence at less than or equal to 2.5 per 1000 persons (7). For blacks, the year 2000 objective for DM prevalence is 32 per 1000 persons. Achieving these objectives will require development and implementation of strategies for the primary prevention of noninsulin-dependent DM (NIDDM), the predominant form of the disease. About half of NIDDM cases are thought to result from obesity. Although measures to reduce overweight and prevent obesity, particularly among high-risk groups, may prevent or delay the onset of NIDDM, this strategy has not been proven by clinical trials. The targeted 15% decrease in DM incidence from the 1987 baseline level assumes that obesity-control efforts will be directed toward persons at high risk for DM (7).

To monitor progress toward meeting these objectives, as well as those for diabetic complications, CDC has established an ongoing national diabetes surveillance system (8) based on data from the NHIS, the National Hospital Discharge Survey, the Health Care Financing Administration, and state vital statistics. These data provide national estimates of the prevalence and incidence of DM and of the rates of diabetic complications. Copies of Diabetes Surveillance, 1980-1987, which presents these estimates, are available from the Division of Diabetes Translation, Mailstop F48, Center for Chronic Disease Prevention and Health Promotion, CDC, 1600 Clifton Road, NE, Atlanta, GA 30333.

References

1. Herman WH, Teutsch SM, Geiss IM. Closing the gap: the problem of diabetes mellitus in the United States. Diabetes Care 1985;8:391-406.

2. Center for Economic Studies in Medicine. Direct and indirect costs of diabetes in the United States in 1987. Alexandria, Virginia: American Diabetes Association, 1988.

3. Jarrett RJ, McCartney P, Keen H. The Bedford Survey: ten year mortality rates in newly diagnosed diabetics, borderline diabetics, and normoglycaemic controls and risk indices for coronary heart disease in borderline diabetics. Diabetologia 1982;22:79-84.

4. Harris MI, Hadden WC, Knowler WC, Bennett PH. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20-74 years. Diabetes 1987;36:523-34.

5. Schneider EL, Guralnik JM. The aging of America: impact on health care costs. JAMA 1990;263:2335-40.

6. Department of Health and Human Services. Report of the Secretary's Task Force on Black and Minority Health. Vol VII. Chemical dependency and diabetes. Washington, DC: US Department of Health and Human Services, 1986:193-270.

7. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Conference ed. Washington, DC: US Department of Health and Human Services, Public Health Service, 1990:438-58.

8. CDC. Diabetes surveillance, 1980-1987. Atlanta: US Department of Health and Human Services, Public Health Service, 1990.

• Participants were asked, "During the past 12 months, did anyone in the family have diabetes?"

** Incorporates data from the previous and the following year to calculate the value for a given year.

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