Future number of people with diagnosed type 1 diabetes in Germany until 2040: an analysis based on claims data

Future prevalence of type 2 diabetes in Germany: a projection until 2040 including incidence trends observed during the SARS-CoV-2 pandemic

Introduction

Previous studies indicate that the prevalence of type 2 diabetes (T2D) will increase substantially over the coming decades. One projection from 2019 estimated an increase in prevalence in Germany by 54% to 77% (depending on future trends in incidence and mortality) between 2015 and 2040. We aim to update this projection by incorporating recently published trends in T2D incidence in Germany that include the changes during the SARS-CoV-2 pandemic.

Materials and methods

We used a partial differential equation that describes the illness-death model to project the age- and sex-specific T2D prevalence among adults between 2015 and 2040. This required input data for the age- and sex-specific incidence, mortality of the general population, mortality rate ratio of people with vs. without T2D and prevalence in the initial year of the projection. We considered five scenarios with different future trends in incidence and their impact on prevalence. Using the most recently available data on T2D incidence, we assumed that the incidence remains constant as observed in 2021 for the whole projection horizon (first scenario). In further scenarios, we assumed that the observed age- and sex-specific trends in incidence between 2015 and 2021 would continue until 2025 (second scenario), 2030 (third scenario), 2035 (fourth scenario) and 2040 (fifth scenario). One additional scenario assumed that the age-specific prevalence remains constant.

Results

Observed trends in incidence suggest a decrease between 2015 and 2017, and a slight upward trend thereafter until 2021 in most age groups. Depending on how long these observed increases in incidence continue, the number of people with T2D in Germany will increase from 6.8 million in 2015 to between 10.9 million and 14.2 million in 2040. These numbers correspond to increases in prevalence from 10.5% in 2015 to between 15.5% and 20.1% in 2040. In the constant prevalence scenario, the overall prevalence and number of people with T2D in 2040 was 11.4% and 8.1 million, respectively.

Conclusions

The future prevalence of T2D in Germany strongly depends on how long the recently observed increasing trend in T2D incidence will continue, which warrants close monitoring of these trends in post-pandemic years.

Increasing trend of childhood type 1 diabetes incidence: 20-year observation from Greater Poland Province, Poland

AIM

Type 1 diabetes is one of the fastest-growing chronic health conditions. Estimating the incidence rate of childhood type 1 diabetes will allow to aid in adequate planning of health care resources. The study's aim was to assess the incidence rate of type 1 diabetes in children below 15 years of age from Greater Poland (Poland) between 2006 and 2018, and then to compare obtained data to records collected between 1998 and 2003 in pediatric population aged 0-14 years from the same area.

METHODS

In this cohort study covering the period from January 1998 to December 2018, data were collected for children and adolescents below 14 years of age with newly diagnosed type 1 diabetes living in Greater Poland. The overall population size was taken from the Statistical Office of Poland. Total, sex-, and age-specific incidence rates per 100,000 person-years were calculated for each calendar year.

RESULTS

Over a 20-year period, the incidence rate of type 1 diabetes in children aged 0-14 years rose around 3.6-fold, from 8.4/100,000 in 1998 to 30.8/100,000 in 2018, with the peak incidence recorded in last year of the study. A clear male predominance of type 1 diabetes was seen in all ages. The rate of type 1 diabetes incidence growth was comparable between all age groups, while the highest incidence rate was mostly observed in children aged 5-9 and 10-14 years.

CONCLUSIONS

The incidence of type 1 diabetes in children aged 0-14 years is rapidly increasing in Greater Poland.

Projected number of people in need for long-term care in Germany until 2050

Introduction

Current demographic trends predict continuously growing numbers of individuals reliant on care, which has to be accounted for in future planning of long-term care-resources. The projection of developments becomes especially necessary in order to enable healthcare systems to cope with this future burden and to implement suitable strategies to deal with the demand of long-term care. This study aimed to project the prevalence of long-term care and the number of care-dependent people in Germany until 2050.

Methods

We used the illness-death model to project the future prevalence of long-term care in Germany until 2050 considering eight different scenarios. Therefore, transition rates (incidence rate and mortality rates) describing the illness-death model are needed, which have been studied recently. Absolute numbers of people in need for long-term care were calculated based to the 15th population projection of the Federal Statistical Office.

Results

Numbers of people in need for long-term care will increase by at least 12%, namely 5.6 million people, in the period of 2021 until 2050. Assuming an annual incidence-increase of 2% from 2021 to 2050 the number of care-dependent individuals could potentially rise up to 14 million (+180%).

Conclusion

Our projections indicated a substantial rise in the number of care-dependent individuals. This is expected to lead to raising economic challenges as well as a stronger demand for healthcare and nursing personnel.

Projected number of people with multiple sclerosis in Germany between 2015 and 2040

BACKGROUND

The global prevalence of multiple sclerosis has shown a marked rise in recent decades, with Germany reporting the highest prevalence among European countries. This study aims to project the future number of people with multiple sclerosis in Germany until 2040 which is necessary for effective resource allocation and health care planning.

METHODS

Based on data from the German statutory health insurance, the age- and sex-specific prevalence of multiple sclerosis was estimated applying mathematical relations between prevalence, incidence rate, and mortality rate. Subsequently, the projected prevalence was applied to the age structure of the German population between 2015 and 2040 to calculate the future number of people with multiple sclerosis. Several temporal trend scenarios pertaining to the incidence and mortality rate were compared.

RESULTS

Application of current age-specific prevalence estimates combined with the projected population structure in 2040, results in a decline of 8% in the number of people with multiple sclerosis. More realistic scenarios that reflect on trends in mortality and incidence rates, project between 453,000 (+75%) and 477,000 (+85%) multiple sclerosis cases in 2040. It is expected that females will be affected nearly 2.5 times more frequently than males in 2040.

CONCLUSION

The findings indicate a substantial rise in the prevalence of multiple sclerosis, ranging from 75% to 85% in 2040 compared to 2015. Assuming a constant age-specific prevalence between 2015 and 2040 without any temporal trends in mortality and incidence rates may underestimate the actual number of cases and consequently, future requirements for healthcare resources.

Projecting the economic burden of type 1 and type 2 diabetes mellitus in Germany from 2010 until 2040

BACKGROUND

The aim is to estimate age- and sex-specific direct medical costs related to diagnosed type 1 and type 2 diabetes in Germany between 2010 and 2040.

METHODS

Based on nationwide representative epidemiological routine data from 2010 from the statutory health insurance in Germany (almost 80% of the population's insurance) we projected age- and sex-specific healthcare expenses for type 1 and 2 diabetes considering future demographic, disease-specific and cost trends. We combine per capita healthcare cost data (obtained from aggregated claims data from an almost 7% random sample of all German people with statutory health insurance) together with the demographic structure of the German population (obtained from the Federal Statictical Office), diabetes prevalence, incidence and mortality. Direct per capita costs, total annual costs, cost ratios for people with versus without diabetes and attributable costs were estimated. The source code for running the analysis is publicly available in the open-access repository Zenodo.

RESULTS

In 2010, total healthcare costs amounted to more than €1 billion for type 1 and €28 billion for type 2 diabetes. Depending on the scenario, total annual expenses were projected to rise remarkably until 2040 compared to 2010, by 1-281% for type 1 (€1 to €4 billion) and by 8-364% for type 2 diabetes (€30 to €131 billion). In a relatively probable scenario total costs amount to about €2 and €79 billion for type 1 and type 2 diabetes in 2040, respectively. Depending on annual cost growth (1% p.a. as realistic scenario vs. 5% p.a. as very extreme setting), we estimated annual per capita costs of €6,581 to €12,057 for type 1 and €5,245 to €8,999 for type 2 diabetes in 2040.

CONCLUSIONS

Diabetes imposes a large economic burden on Germany which is projected to increase substantially until 2040. Temporal trends in the incidence and cost growth are main drivers of this increase. This highlight the need for urgent action to prepare for the potential development and mitigate its consequences.

Incidence of Parkinson's disease in Germany based on prevalence data from 70 million patients of the statutory health insurance

BACKGROUND

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and nonmotor system manifestations and psychiatric symptoms. The aim of this study was to estimate the age- and sex-specific incidence of PD in Germany using an illness-death model and a corresponding partial differential equation (PDE) based on prevalence and mortality data.

METHODS

Based on a PDE that describes the dynamics in an illness-death model, the age- and sex-specific incidence of PD in Germany was estimated using published prevalence and mortality rates. Prevalence rates were provided by the Central Institute for Statutory Health Insurance (Zi) for the period from 2010 to 2019. Parkinson's related mortality was estimated based on comparable population data from Norway. Bootstrapping was used for incidence estimation (median of 5000 samples) and to obtain 95% confidence intervals to interpret the accuracy of the incidence estimation.

RESULTS

Men had higher incidences of PD than women at all ages. The highest incidences (median of 5000 bootstrap samples) for both groups were estimated for the age of 85 years with an incidence of 538.49 per 100,000 person-years (py) in men and 284.09 per 100,000 py in women, with an increasing width of bootstrapping 95% CIs showing greater uncertainty in the estimation at older ages.

CONCLUSION

The illness-death model and the corresponding PDE, which describes changes in prevalence as a function of mortality and incidence, can be used to estimate the incidence of PD as a chronic disease. As overestimation of incidence is less likely with this method, we found incidence rates of Parkinson's disease that are suitable for further analyses with a lower risk of bias.

Projected incidence trends of need for long-term care in German men and women from 2011 to 2021

Background

The German Federal Statistical Office routinely collects and reports aggregated numbers of people in need of long-term care (NLTC) stratified by age and sex. Age- and sex-specific prevalence of NLTC from 2011 to 2021 is reported as well. One estimation of the incidence rate of NLTC based on the age- and sex-specific prevalence exists that did not explore possible trends in incidence [based on MRR (mortality rate ratio)], which is important for an adequate projection of the future number of people with NLTC.

Objective

We aim to explore possible trends in age-specific incidence of NLTC in German men and women from 2011 to 2021 based on different scenarios about excess mortality (in terms of MRR).

Methods

The incidence of NLTC was calculated based on an illness-death model and a related partial differential equation based on data from the Federal Statistical Office. Estimation of annual percent change (APC) of the incidence rate was conducted in eight scenarios.

Results

There are consistent indications for trends in incidence for men and women aged 50-79 years with APC in incidence rate of more than +9% per year (up to nearly 19%). For ages 80+ the APC is between +0.4% and +12.5%. In all scenarios, women had higher age-specific APCs than men.

Conclusion

We performed the first analysis of APC in the age- and sex-specific incidence rate of NLTC in Germany and revealed an increasing trend in the incidences. With these findings, a future prevalence of NLTC can be estimated which may exceed current prognoses.