NR514: EPIDEMIOLOGY & POPULATION HEALTH
When considering the risks associated with pediatric obesity, one of the biggest concerns is the development of diabetes mellitus (DM).
In 2016, the prevalence in thousands of individuals diagnosed with DM was 383,453. The incidence in thousands of those diagnosed with DM was 20,828. The YDL in thousands was 28,584. This created a 23.6% change between 2006-2016, a ten year span. Further, it created a -1.2 YLDs (years lived with disability) change in age-standarized rates between the same ten year time frame, 2006-2016 (Vos et al., 2017). NR514: EPIDEMIOLOGY & POPULATION HEALTH
When considering these numbers related to DM, it is important to remember that this study was a survey of global health. With that, mortality rates are declining, life expectancy is increasing, and populations are aging differently than the used to. This is due to a number of factors, most of which have to do with the access and advancement of treating chronic health issues for a longer amount of time. Diabetes is one of the chronic health issues that has continued to increase across the globe, in both incidence and YLD rates (Vos et al., 2017).
The ability to understand and read these trends is valuable in determining how healthcare systems can make changes to help prevent diabetes. Pediatric obesity is so closely linked to the prevention of diabetes, particularly early onset. However, treating pediatric obesity is a process of lifestyle changes that can be all encompassing for a family (Chobot et al., 2018).
As providers, which lifestyles changes do you think are most important for a pediatric patient to make in order to prevent chronic issues such as diabetes from developing? What recommendations would you make for a family that struggles with weight control or eating healthy? This applies to all of our communities.
Chobot, A., Górowska-Kowolik Katarzyna, Sokołowska, M., & Jarosz-Chobot, P. (2018). Obesity and diabetes—not only a simple link between two epidemics. Diabetes/Metabolism Research and Reviews, 34(7). https://doi.org/10.1002/dmrr.3042
Vos, T., Amanuel, A. A., Kalkidan, H. A., et al. (2017). Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1211-1259. http://dx.doi.org/10.1016/S0140-6736(17)32154-2
Opioid use disorders affect over 16 million people worldwide, over 2.1 million in the United States, and there are over 120,000 deaths worldwide annually attributed to opioids. Examples of opioids include heroin, morphine, codeine, and synthetic opioids such as fentanyl and oxycodone. Opioid use disorder includes dependence and addiction with addiction representing the most severe form of the disorder (Dydyk, et al., 2022). The CDC reports that over 81,000 drug overdose deaths occurred in the United States in the 12 months ending in May 2020, the highest number of overdose deaths ever recorded in a 12-month period, according to recently obtained data (2021). Of those, incidences involved 42,687 overdose deaths involving fentanyl in the 12 months leading up to May 2020.
Fentanyl is a synthetic opioid made in a laboratory and overdose rates are rising 2.5 times faster than heroin overdoses. Fentanyl overdoses outpace prescription opioid overdoses by 550.94% (over 500%). Fentanyl OD rates increased by 1,105% from 2012 to 2018 according to the National Center for Drug Abuse (2022). Naltrexone may be useful to prevent relapse and is used to treat opioid overdose, although repeated and higher doses may be needed than are practically available in a Fentanyl OD.
Patients with opioid problems may have extended periods of abstinence and can function in society, however, there is a chronic risk of accidental overdose, trauma, suicide, and infectious diseases (Dydyk, et al., 2022). I am saddened and surprised by the fentanyl statistics. I am aware of how extremely severe this problem is and why it needs a rapid and robust crisis response. It is difficult to determine the life span of someone with an opioid addiction due to the variable of overdose death.
Two relevant implications for prevention or intervention are harm reduction tactics such as mental health treatment and medication-assisted therapy (MAT). According to the Substance Abuse and Mental Health Services Administration (SAMSHA), the following approaches can be utilized to reduce the health consequences of addiction:
- Connect individuals to overdose education, counseling, and referral to treatment for infectious diseases and substance use disorders.
- Distribute opioid overdose reversal medications (e.g., naloxone) to individuals at risk of overdose, or to those who might respond to an overdose.
- Lessen harms associated with drug use and related behaviors that increase the risk of infectious diseases, including HIV, viral hepatitis, and bacterial and fungal infections.
- Reduce infectious disease transmission among people who use drugs, including those who inject drugs by equipping them with accurate information and facilitating referral to resources.
- Reduce overdose deaths, promote linkages to care, and facilitate co-location of services as part of a comprehensive, integrated approach.
- Reduce stigma associated with substance use and co-occurring disorders
- Promote a philosophy of hope and healing by utilizing those with lived experience of recovery in the management of harm reduction services, and connecting those who have expressed interest to treatment, peer support workers and other recovery support services (SAMSHA, 2022).
Centers for Disease Control (2020). Press release, newsroom. Overdose deaths accelerating during COVID-19, expanded prevention efforts needed, https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html
Dydyk, A. M., Jain, N. K., & Gupta, M. (2022). Opioid Use Disorder. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/31985959/
National Center for Drug Abuse Statistics (2022). https://drugabusestatistics.org/fentanyl-abuse-statistics/?msclkid=41a23aa9b3b511ecae9caf63e6694703
Substance Abuse and Mental Health Services Administration, (2022). Harm reduction. From https://www.samhsa.gov/find-help/harm-reduction?msclkid=a745230ab3bb11ec92e56617a288bd13
As a significant risk factor for burden of mortality and morbidity, alcohol use has been linked to alcoholic liver disease (ALD) and alcohol use disorders (AUD) (Rehm et al., 2019). The burden of disease differs between ALD and AUD. The burden of disease for ALD is due to premature death, while for AUD, it is mainly due to disability resulting from alcohol use (Rehm et al., 2019). According to the 2018 World Health Organization’s (WHO) Global Status Report, the harmful use of alcohol caused 3 million deaths worldwide, more than diabetes and hypertension combined (WHO). According to the WHO, the mean lifetime prevalence of alcohol use globally was 80% combined, ranging from 3.8% to 97%, with AUD prevalence much higher for men than women. It is essential to point out that mental health disorders (MHD) preceded the onset of AUD for most comorbidity combinations, and high-income households, married and educated, were associated with a lower risk for lifetime AUD (Glantz et al., 2020).
Glantz, M.D., Bharat, C., Degenhardt, L., Sampson, N.A., Scott, K.M., Lim, C., Al-Hamzawi, A., Jordi, A., Andrade, L.H., Cardoso, G., De Girolamo, G., Gureje, O., He, Y., Hinkov, H., Karam, E.G., Kovess-Masfety, V., Lasebikan, V., Lee, S., Levinson, D., McGrath, J., Medina-Mora, M., Mihaescu-Pintia, C., Mneimneh, Z., Moskalewicz, J., Navarro-Mateu, F., Posada-Villa, J., Rapsey, C., Stagnaro, J.C., Tachimori, H., Ten Have, M., Tintle, N., Torres, Y., Williams, D.R., Ziv, Y., Kessler, R.C. (2020). The epidemiology of alcohol use disorders cross-nationally: Findings from the World Mental Health Surveys,AddictiveBehaviors,Volume 107,2020,106128,ISSN 0306-4603. https://doi.org/10.1016/j.addbeh.2019.106128.
Rehm, J., Shield., K.D. (2019). Global burden of alcohol use disorders and alcohol liver disease. Biomedicines 2019, 7(4), 99. https://doi.org/10.3390/biomedicines7040099
The Global Burden of Diseases, Injuries and Risk Factors Study (GBD) (2016) is a global effort to quantify non-fatal outcomes using a standardized evaluation and collection methodology. The report allows comparisons between fatal and non-fatal outcomes of a comprehensive list of diseases and injuries and is the only global report of this nature. The GBD (2016) offers a comprehensive comparison of the prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016 (pp.1212 – 1213).
The GBD (2016) reported slower progress in addressing non-fatal compared with fatal health outcomes and ageing of populations. Non-fatal diseases such as diabetes make years lived with a disability (YLDs) an ongoing fundamental aspect of global disability-adjusted life-years (DALYs) (p. 1229).
Prevalence, Incidence and Trends
Factors that have contributed to the increase in the prevalence of diabetes are the ageing of populations and lifestyle-related risk factors such as high BMI and obesity. Together they have increased the incidence of diabetes in almost all countries except Taiwan and China. Improvements in treatment options of diabetes have increased the life expectancy which increases the prevalence rate. An increase in prevalence increases the economic burden on health-care systems. In the United States, diabetes was responsible for the largest health-care spending and the greatest increase over the past two decades among 155 health conditions (GBD, 2016 pp. 1243-1245; AHRQ 2021; OMH, 2021).
In the leading 30 Level 4 causes of global prevalence of disease, diabetes was ranked 9th in 2006, and 8th in 2016 (see Appendix) (GBD, p.1231).
The GBD (2016) established criteria for diabetes prevalence was the proportion of a population with fasting plasma glucose greater than 7 mmol/L or on diabetes treatment. Overall, the trend for diabetes is the prevalence and incidence rates are approximately the same. However, the YLDs slightly improved in wealthier countries due to new medications and treatments available.
Agency for Healthcare Research and Quality. (2021). NHQDR Web Site – National Diabetes Benchmark Details. Nhqrnet.Ahrq.Gov. Retrieved April 04, 2022, from https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/table/Diseases_and_Conditions/Diabetes#far
Office of Minority Health. (2021, March 1). Diabetes and Native Hawaiians/Pacific Islanders – The Office of Minority Health. Minorityhealth.Hhs.Org. Retrieved April 4, 2022, from https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=78
Vos, T., Abajobir, A., Abate, K., … et. al. (2017). Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. [Library Link]