Incidence, prevalence, and burden of type 2 diabetes in China: Trend and projection from 1990 to 2050

Abstract

Background: The epidemiological pattern and disease burden of type 2 diabetes have been shifting in China over the past decades. This analysis described the epidemiological transition of type 2 diabetes in the past three decades and projected the trend in the future three decades in China.

Methods: Age-, sex-, and year-specific incidence, prevalence, death, and disability-adjusted life years (DALYs) for people with 15 years or older and diabetes or high fasting glucose in China and related countries from 1990 to 2021 were obtained from the Global Burden of Disease. We obtained the trends of age-, sex-, and year-specific rates and absolute numbers of incidence, prevalence, deaths, and DALYs attributable to type 2 diabetes in China from 1990 to 2021. Using the Lee-Carter model, we projected the incidence, prevalence, death, and DALYs attributable to type 2 diabetes to 2050 stratified by age and sex.

Results: The age-standardized incidence of type 2 diabetes was 341.5 per 100,000 persons (1.6 times in 1990) and the age-standardized prevalence was 9.96% (9960.0 per 100,000 persons, 2.5 times in 1990) in China 2021. In 2021, there were 0.9 million deaths and 26.8 million DALYs due to type 2 diabetes or hyperglycemia, as 2.9 and 2.7 times the data in 1990, respectively. The age-standardized rates of type 2 diabetes and hyperglycemia were projected to raise to 449.5 per 100,000 persons for incidence, 18.17% for prevalence, 244.6 per 100,000 persons for death, and 4720.2 per 100,000 persons for DALYs by 2050. The incidence of type 2 diabetes kept growing among individuals under the age of 20 years in the past three decades (128.7 per 100,000 persons in 1990 and 439.9 per 100,000 persons in 2021) and estimating 1870.8 per 100,000 in 2050.

Conclusions: The incidence, prevalence, and disease burden of type 2 diabetes grew rapidly in China in the past three decades. The prevention of type 2 diabetes in young people and the care for elder adults will be the greatest challenge for the country.

Keywords: Burden; Death; Disability-adjusted life years; Incidence; Prevalence; Projections; Type 2 diabetes.

Figure 1

Age-specific number and rate for incidence, prevalence, deaths, DALYs due to type 2 diabetes in males and females aged 15 years and above in China in 2021. (A) Age-specific number and rate for incidence due to type 2 diabetes in males and females in China. (B) Age-specific number and rate for prevalence due to type 2 diabetes in males and females in China. (C) Age-specific number and rate for death due to type 2 diabete in males and females in China. (D) Age-specific number and rate for DALYs due to type 2 diabetes in males and females in China. In all panels (A–D), the bars represent the number of cases (incidence, prevalence, deaths, or DALYs; left Y-axis), and the lines represent the corresponding rates per 100,000 population (right Y-axis). DALYs: Disability-adjusted life years.

Figure 2

The epidemiology trend of type 2 diabetes in population aged 15 years and above in China and other countries from 1990 to 2050. (A) The age-standardized rate for incidence of type 2 diabetes in China and other countries from 1990 to 2050. (B) The age-standardized rate for prevalence of type 2 diabetes in China and other countries from 1990 to 2050. (C) The age-standardized rate for death of type 2 diabetes in China and other countries from 1990 to 2050. (D) The age-standardized rate for DALYs of type 2 diabetes in China and other countries from 1990 to 2050. DALYs: Disability-adjusted life years.

Figure 3

Historical and projected trends in the proportions of type 2 diabetes incidence, prevalence, deaths, and DALYs by age group in population aged 15 years and above in China from 1990 to 2050. (A) The age-specific proportion of incidence of type 2 diabetes in China from 1990 to 2050. (B) The age-specific proportion of prevalence of type 2 diabetes in China from 1990 to 2050. (C) The age-specific proportion of deaths due to type 2 diabetes in China from 1990 to 2050. (D) The age-specific proportion of DALYs due to type 2 diabetes in China from 1990 to 2050. DALYs: Disability-adjusted life years.

Figure 4

Ranks of causes for deaths and DALYs attributable to type 2 diabetes in China from 1990 to 2021. (A) Ranks of causes for death attributable to type 2 diabetes from 1990 to 2021. (B) Ranks of causes for DALYs attributable to type 2 diabetes from 1990 to 2021. DALYs: Disability-adjusted life years.

Figure 5

The projected age-standardized rates for incidence, prevalence, deaths, DALYs due to type 2 diabetes among population aged <30 years, 30–50 years, and >50 years, stratified by sex in China, 2022 and 2050. (A) The projected ASR for incidence of type 2 diabetes in China from 2022 to 2050 by sex and age groups. (B) The projected ASR for prevalence of type 2 diabetes in China from 2022 to 2050 by sex and age groups. (C) The projected ASR for deaths due to type 2 diabetes in China from 2022 to 2050 by sex and age groups. (D) The projected ASR for DALYs due to type 2 diabetes in China from 2022 to 2050 by sex and age groups. ASR: Age standardized rate; DALYs: Disability-adjusted life years.