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. 2023 May 26:11:1141452.
doi: 10.3389/fpubh.2023.1141452. eCollection 2023.

Projections of future burden of pharmacologically treated type 2 diabetes and associated life expectancies by income in Finland: a multi-state modeling study

Maria Guzman-Castillo  1 , Kaarina Korhonen  1 , Michael Murphy  2 , Pekka Martikainen  1
Affiliations

Projections of future burden of pharmacologically treated type 2 diabetes and associated life expectancies by income in Finland: a multi-state modeling study

Maria Guzman-Castillo et al. Front Public Health. .

Abstract

The burden of type 2 diabetes (T2D) differs between socioeconomic groups. The present study combines ongoing and plausible trends in T2D incidence and survival by income to forecast future trends in cases of T2D and life expectancy with and without T2D up to year 2040. Using Finnish total population data for those aged 30 years on T2D medication and mortality in 1995-2018, we developed and validated a multi-state life table model using age-, gender-, income- and calendar year-specific transition probabilities. We present scenarios based on constant and declining T2D incidence and on the effect of increasing and decreasing obesity on T2D incidence and mortality states up to 2040. With constant T2D incidence at 2019-level, the number of people living with T2D would increase by about 26% between 2020 and 2040. The lowest income group could expect more rapid increases in the number with T2D compared to the highest income group (30% vs. 23% respectively). If the incidence of T2D continues the recent declining trend, we predict about 14% fewer cases. However, if obesity increases two-fold, we predict 15% additional T2D cases. Unless, we reduce the obesity-related excess risk, the number of years lived without T2D could decrease up to 6 years for men in the lowest income group. Under all plausible scenarios, the burden of T2D is set to increase and it will be unequally distributed among socioeconomic groups. An increasing proportion of life expectancy will be spent with T2D.

Keywords: forecast; income; life expectancies; model; simulation modeling; socioeconomic data; type 2 diabetes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Probabilities of transition between the free of T2D and T2D states in 2019 by income quintile.
Figure 2
Figure 2
Probabilities of transition to death for people free of T2D and people with T2D in 2019 by income quintile. *The y axis scale has been transformed into a log scale base 10.
Figure 3
Figure 3
Number of prevalent T2D cases between 2019 and 2040 by income quintile under four different assumptions of T2D incidence trends.
Figure 4
Figure 4
Total life expectancy at 65 for men and women between 2019 and 2040 by income quintile under four different assumptions of T2D incidence trends.
Figure 5
Figure 5
Life expectancy with T2D at 65 for men and women between 2019 and 2040 by income quintile under four different assumptions of T2D incidence trends.
Figure 6
Figure 6
Life expectancy without T2D at 65 for men and women between 2019 and 2040 by income quintile under four different assumptions of T2D incidence trends.
Figure 7
Figure 7
Proportion of life expectancy without T2D at 65 for men and women between 2019 and 2040 by income quintile under four different assumptions of T2D incidence trends.
See this image and copyright information in PMC

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