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Comparing Estimates of the Future Prevalence of Diabetes in England from Different Models
44 Pages Posted: 20 Jun 2019More...
Background: Two different types of model give projections of the prevalence of diabetes in adults. Epidemiological models use sample estimates of past prevalence (diagnosed and undiagnosed) rates by age and sex, and projected population changes. Markov chain models project the impacts of interventions to prevent Type 2 Diabetes (T2D) from estimated transition probabilities between states of risk and death.
Methods: Rapid reviews of epidemiological and Markov chain models. Comparing projections of the future prevalence T2D in England from: our review of epidemiological models; our own Markov chain models (based on our review); the trend in the prevalence of diabetes diagnosed reported by general practitioners, estimated by Ordinary Least Squares (OLS) regression analysis.
Findings: Methods of current epidemiological models are designed to underestimate the scale of increases in the future prevalence of T2D. Markov chain models used to assess the preventive interventions lack transparency and tests of validity. Projections of the prevalence of T2D in England in 2025 were (in millions, with 95% confidence intervals where available): by the epidemiological model of Public Health England (PHE) 3.95; from the trend in diagnosed diabetes, 4.91 (4.79 to 5.03); and by two Markov chain models, 5.64 and 9.10. Three heavily-cited global models give projections for the prevalence of diabetes for the UK for 2030 (2.55 and 3.65) and 2035 (3.62), that were below PHE's estimate for England for 2015 (3.81).
Interpretation: Current models neither indicate the urgency of tackling increases in the prevalence of T2D and nor give valid assessments of preventive interventions.
Funding Statement: London School of Economics and Political Science (GB and MJK) and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust (CDP and RR).
Declaration of Interests: The authors declared: "There are no conflicts of interest."
Ethics Approval Statement: Not required."
Suggested Citation: Suggested Citation