Projection of diabetes burden in the US adult population through 2060

During the past three decades, the number of U.S. adults with diagnosed diabetes has more than tripled (from 5.5 million in 1980 to 19.6 million in 2011). Accurate projections of the future burden of this costly and increasingly common condition are needed to help policymakers plan and prioritize the allocation of health care resources. Previous studies projected through 2050 at most. We updated the estimates of the future number of persons with diagnosed diabetes through year 2060 using more recent population and disease information.  We developed a Markov model to project the number of persons with diagnosed diabetes. In our model, individuals in categories defined by cross-classified age (18, 19,…, 83, 84, ≥85 years), sex, and race (white, black and other) transit yearly among three states: non-diabetes (including undiagnosed diabetes), diagnosed diabetes, and death. The transition probabilities depend on group membership and are based on the rates of diabetes prevalence and incidence and mortality rates for persons with and without diabetes. U.S. Census projections were used for current population size and future changes, including birth, death and migration. We fit logistic regression models to data from the 2006-2012 National Health Interview Survey (NHIS) to project diabetes incidence and prevalence and Poisson regression models to the NHIS 1986-2004 mortality follow-up data to project mortality rates.  By 2060, the number of adults with diagnosed diabetes is projected to reach 59.8 million (17.9% of the population), nearly a threefold increase from year 2012 (21.3 million, 8.8%). 18.4% of women and 17.3% of men will have diagnosed diabetes. The race-specific prevalence rates will be 16.9% (white), 23.1% (black) and 17.2% (“other” race). Black women will have the highest prevalence rate (24.0%), and men of “other” race will have the lowest (16.4%). From 2012 to 2060, women of “other” race will experience the greatest increase in both prevalence rate (8.1% to 17.9%), and absolute number of cases (0.8 to 4.8 million).  White men will have the smallest increase in number (8.1 million to 19.5 million) and black men the least increase in rate (11.7% to 22.2%). Persons with diabetes who are 65 or older will increase from 8.4 million to 33.3 million; in 2060, this age group will comprise 55.7% of the total diabetes population. The number of persons with diabetes aged 18 to 44 will grow from 2.8 million to 6.0 million (10.0% of the 2060 diabetes population); and of those aged 45 to 64, from 10.0 million to 20.5 million (34.2%).  Without intervention, the burden of diabetes is expected to increase continually in the future. The population of persons with diabetes will become older. Increases will affect men and women, and persons of all races, but will be greatest among black women and women of “other” race. Widespread implementation of effective strategies and interventions to reduce the incidence of diabetes is critical for moderating the impact of the diabetes epidemic.