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Author Notes:

Nikkil Sudharsanan, Phone: 661-965-3471, Email: nsud@sas.upenn.edu

NS helped design the study and identify data sources, conducted the literature search and data analysis, created the tables and figures, and contributed to writing the overall manuscript.

MKA helped design the research question, identify data sources, and edited/revised the manuscript.

NKM provided guidance on all aspects of the study and edited initial drafts of the manuscript. KMVN contributed to study design, data interpretation, and writing. All authors read and approved the final manuscript.

Acknowledgements: Jason M. Hockenberry.

The authors declare that they have no competing interests.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Public, Environmental & Occupational Health
  • Diabetes
  • Population aging
  • Economic growth
  • Globalization
  • Urbanization
  • DIET

Population aging, macroeconomic changes, and global diabetes prevalence, 1990-2008


Journal Title:

Population Health Metrics


Volume 13, Number 1


, Pages 33-33

Type of Work:

Article | Final Publisher PDF


Background: Diabetes is an important contributor to global morbidity and mortality. The contributions of population aging and macroeconomic changes to the growth in diabetes prevalence over the past 20 years are unclear. Methods: We used cross-sectional data on age- and sex-specific counts of people with diabetes by country, national population estimates, and country-specific macroeconomic variables for the years 1990, 2000, and 2008. Decomposition analysis was performed to quantify the contribution of population aging to the change in global diabetes prevalence between 1990 and 2008. Next, age-standardization was used to estimate the contribution of age composition to differences in diabetes prevalence between high-income (HIC) and low-to-middle-income countries (LMICs). Finally, we used non-parametric correlation and multivariate first-difference regression estimates to examine the relationship between macroeconomic changes and the change in diabetes prevalence between 1990 and 2008. Results: Globally, diabetes prevalence grew by two percentage points between 1990 (7.4 %) and 2008 (9.4 %). Population aging was responsible for 19 % of the growth, with 81 % attributable to increases in the age-specific prevalences. In both LMICs and HICs, about half the growth in age-specific prevalences was from increasing levels of diabetes between ages 45-65 (51 % in HICs and 46 % in LMICs). After age-standardization, the difference in the prevalence of diabetes between LMICs and HICs was larger (1.9 % point difference in 1990; 1.5 % point difference in 2008). We found no evidence that macroeconomic changes were associated with the growth in diabetes prevalence. Conclusions: Population aging explains a minority of the recent growth in global diabetes prevalence. The increase in global diabetes between 1990 and 2008 was primarily due to an increase in the prevalence of diabetes at ages 45-65. We do not find evidence that basic indicators of economic growth, development, globalization, or urbanization were related to rising levels of diabetes between 1990 and 2008.

Copyright information:

© 2015 Sudharsanan et al.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).

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