Diabetes (type 1 and type 2) and chronic kidney disease (CKD) can act as risk factors for other diseases such as coronary heart disease, stroke and dementia. The Australian Burden of Disease Study (ABDS) 2011 only reported on the direct burden of diseases. To fully account for the health loss attributable to a specific disease, a diseases-as-risks approach (linked disease) can be used to estimate their 'indirect' or additional burden. The direct and indirect burden can be added to estimate their collective burden.
Diabetes and CKD burden doubled when taking into account indirect burden
The ABDS 2011 reported that diabetes and CKD were responsible for 2.3% and 0.9% respectively of the total burden of disease and injury in Australia in 2011 (the direct burden). When the indirect burden due to linked diseases was taken into account:
- the collective burden due to diabetes was 1.9 times as high, and CKD was 2.1 times as high, as their direct burden;
- the indirect diabetes burden varied by sex, with males experiencing 31% more burden than females;
- the indirect burden due to diabetes and CKD occurred at a later age than direct burden, being responsible for over 50% of the collective diabetes burden and 65% of the collective CKD burden from age 75 onwards.
Of the 12 linked diseases examined for diabetes:
- the burden attributable to diabetes was highest for coronary heart disease, stroke and CKD—together accounting for 75% of the indirect diabetes burden measured;
- diabetes was responsible for 21% of the CKD burden, 14% of the stroke burden, 12% of the liver cancer burden and 11% of the coronary heart disease burden.
Of the 4 linked diseases examined for CKD:
- the burden attributable to CKD was highest for coronary heart disease—accounting for almost half (48%) of the indirect CKD burden measured;
- CKD was responsible for 19% of peripheral vascular disease burden, 8% of dementia burden and 7% of stroke burden.
Around one-fifth of future diabetes burden could be avoided if the current rise in diabetes is halted
If the current trends in diabetes and CKD prevalence and mortality continued to 2020, the estimated collective diabetes burden is projected to be 1.6 times as high as in 2011, and the estimated collective CKD burden is projected to be 1.4 times as high. This compares to rate ratios of 1.3 if prevalence and mortality rates are maintained at 2011 levels to 2020, (which reflects population growth and ageing). Put differently, if the current rise in these diseases is halted, 21% of future diabetes burden and 5% of future CKD burden could be avoided.
In terms of indirect burden, the greatest gains are expected to be made in those aged 65–94 for diabetes, and 65–84 for CKD, where around 36% of diabetes attributable burden and 15% of CKD attributable burden could be avoided by 2020 if the prevalence of these diseases is maintained at 2011 levels. Results from this study could be used to inform population health monitoring and may assist in the development of chronic disease policy.