- Email: [email protected]
Trends in the prevalence of diabetes mellitus among Hiroshima atomic bomb survivors
ELSEVIER
Diabetes Research and Clinical Practice. 24 Suppl. (1994) S29-S3S
Trends in the prevalence of diabetes mellitus among Hiroshima atomic bomb survivors
__ .__. -.-.__^-_.__.-._.._ -. ._.
~~.___ _~. ^)
.._ _
_
._ _
.. .-~._.-_--l.- ___.__
__._.__~__.~_~_.
Abstract Muss wxening for diabetes mcllitus has been conducted on td O(H)5 113O(H)atomic bomb survivors r&dent in Hiroshima City since 1961. The trends in the number of diabetes mcllitus patients from 1971 to 1992 based on the results of this mass screening and on death certificates are described. The prevalence of diabetes mellitus has shown an increase with age, but it peaked in the 8th decade and declined after the 9th decade. From 1971 to 1992 a 2.7-fold increase in the prevalence of diabetes mcllitus was observed in males and a 3.2-fold increase in females. By age, in males the increase was high in those of less than 49 years of age, and in females the increase was predominant in those of 80 years of age and over. In males the prevalcncc of diabetes mellitus estimates by death certificates was in good agreement with that observed by mass screening. but in females the prevalence observed by death certificates gave a higher value. During a period of two decades, a 2.1-fold increase was observed in males and a 2.0-fold increase in females.
Keywords: Prevalence of diabetes mellitlq
Trends of diabetes mellitus; Death certificate; Atomic bomb survivors; Diabetic deaths _____ -_-------.. _.__.___._._ ._.._._ _.._._-._
1. Introduction
2. Subjects and’ methods
According to Kosei-no-shihyo [1], a statistical publication of the Government of Japan, the prevalence of diabetes mellitus has shown a gradual increase from about 1965, but the increase after 1980 has been dramatic. This increase can be accounted for in part by the westernization of the diet, a decrease in physical activity, and an increase in mental stress, and in part by the early detection of previously undetected diabetes mellitus due to the extensive conduct of mass screening. This report describes the trends in the number of diabetic patients from 1971 to 1992 in a fixed population of atomic bomb survivors on whom health examination has been conducted twice a year from 1957 in accordance with the Atomic Bomb Medical Treatment Law.
Atomic bomb survivors, the subjects of the present study, are defined as individuals born before 31 May 1946 and exposed to the atomic bomb, and those exposed to the atomic bomb in utcro. The total number varies by year with the range being 64 000- 113 000. Health examination has been conducted from 1957, but examination for diabetes mellitus using the urine sugar test was commenced from 1961. The annual examination rate of this population has been 70%J on the average since the initiation of the health examination, but the with aging of the population it has rc.:ently declined to
01688227/94/$07.00
0 1994 Elsevier Science Ireland Ltd. All rights reserved
SSDI 0168-8227(94)00891-W
1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1385 1986 1987 1988 1989 1990 1991 1992
ye=
412.6 3294 2773 2803 2530 2149 2053 1838 3207 2786 2099 1648
5899 5425
5708 8959 6944 7203 7593 6531
tMBle1 - 49 Fiscal sm
90 123 117 109 130 139 141 185 156 126 120 98 73 &I 90 75 64 69 120 122 78 79
MO.
1.6 1.4 1.7 1.5 1.7 2.1 25 3.1 29 2.7 2.9 3.0 2.6 3.0 3.6 3.5 3.1 3.8 3.7 4.4 3.7 4.8
%
D~cases
3583 6224 5685 4754 4397
3117 3649 3662 3421 3878 3799 3629
2476 2237 2745
2522
2186
sabjcds
s-59
Prevalcaceof dktxtcs tD&ms w71-1992)
Table 1
46 3.2 3.3 3.6 4.9 5.2 5.4 6.1 6.0 5.6 5.1 53 5.4 6.7 7.2 6.1 7.1 7.0 6.7 8.0 8.2 8.2 8.1
No. 71 89 92 113 131 133 137 165 164 160 195 199 230 281 231 258 254 240 4% 466 389 355
DM-
3014 2530 2114 1981 1980 1988 2174 2485 7394 7943 8494 9130
3105 3318 3194
33a 3m 3165 3587
Ydjeczs
a-69
144 149 1% 164 212 209 200 265 235 216 232 176 174 166 177 187 187 204 722 756 042 897
No. 5.2 4.4 6.0 5.2 5.9 6.0 6.4 8.0 7.4 7.3 7.7 7.0 8.2 8.4 8.9 9.4 8.6 8.2 9.8 9.5 9.9 9.S
%
DMcascs
1966 1578 1775 1724 1684 1721 1709 6073 57a 5270 4535
2I30
2257 2282 2079
i810 2116 2233
Subjects
m-79
111 124 125 14; 147 148 169 151 140 153 158 148 155 150 122 147 152 585 595 568 477
xx
rao. 5.9 52 5.6 5.5 F.5 6.4 7.; 7.5 7.1 7.0 7.4 8.0 9.4 8.7 8.7 7.2 8.5 8.9 9.6 10.4 10.8 10.5
%
DMCZES
458 490 469 442 504 509 2574 2458 2273 2079
27% 351 378 376 387 423 413 as6 eHl &yj S’T ;;;
SuQjccts
HI-
3.2 2.6 2.6 0.5 0.8 2.1 3.9 4.7 5.5 45 4.8 5.4 7.0 4.7 5.5 6.8 7.9
%
145 149 139
5.9 6.6 6.7
1*,-1: 2:;
9 9 10 2 3 9 16 23 27 22 26 27 32 23 26 30 ;c c;
No.
DMcacs
10096 10124 25472 24612 22890 21789
12759 11474 15361 15273 16321 15in 13533 14704 14167 13221 13407 11952 10344 10927 10502
Subjects
TOtd
420 481 539 513 623 637 642 807 733 664 726 658 657 709 674 672 &92 700 2092
No.
DM
s
M
1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992
1971 1972 1973
[Total] FiSCd year
15713 22229 17628 17474 18052 14981 12740 13524 11643 9775 8748 7087 5696 5710 5096 4430 4275 3832 8685 7453 5750 4429
163 226 207 IS3 217 221 224 275 243 191 181 143 122 129 127 I06 105 97 210 199 130 127
1.0 LO 1.2 1.0 1.2 1.5 1.8 2.0 2.1 2.0 2.1 20 2.1 2.3 2.5 2.4 2.5 2.5 2.4 2.7 2.3 2.9 8654 8997 8758 8037 7892 7513 16630 14956 12852 12110
8614 10149 10444 ~XMO 10706
6912 S891 8603 8593
subicas
%
SUbjCCl$ DMw
N49.
30-59
- 49 D&i=
274 317 356 357 365 410 412 378 412 392 391 444 406 404 402 365 885 826 741 686
260
190
No. 27 2.9 3.2 3.7 3.7 3.9 4.2 4.0 3.9 3.8 3.8 3.9 4.5 4.9 4.6 5.0 5.1 4.9 5.3 5.5 5.8 5.7
%
8934 8109 8986 8643 8110 8526 7705 6461 6707 6781 6799 7300 7926 26420 26764 26383 25768
suiri_eat
60-69
290 310 409 381 460 446 469 578 550 546 587 543 500 492 540 540 515 522 1917 1901 1931 1942
4.2 3.7 4.8 4.5 4.9 5.c 5.8 6.4 6.4 6.7 6.5 7.u 7.7 7.3 8.0 7.9 7.1 6.6 73 7.1 7.3 75
Dictmsa -~ No. %
18403 17800 17059 15651
4377 4531
4014 4385
4989 4711 5394 5159 4926 5170
4837
3762 4445
Subjms
m-79
169 182 213 229 246 270 285 356 320 305 331 335 312 361 350 335 365 372 1521 3465 1459 l328
4.5 4.1 4.4 4.7 4.9 5.4 6.0 6.7 6.2 62 6.4 6.8 7.8 8.2 7.9 7.7 8.1 8.3 83 8.2 8.6 85
%
DMcases No. 595 734 m2 762 812 861 859 1039 1052 1016 1115 1012 879 903 900 889 1043 1104 6717 6456 6241 5513
!!h$xts
$o-
14 13 12 3 4 16 2.7 40 43 39 44 47 45 37 50 54 87 76 441 404 397 385
No.
2.4 1.8 1.5 0.4 0.5 1.9 3.1 3.8 4.1 3.8 3.9 4.6 5.1 4.1 5.6 6.1 83 6.9 6.6 6.3 6.4 6.6
%
--~ Dktcases
25704 26702 25939 24532 25041 24863 76855 73429 68285 63771
344265 30685
33964 44707 40394 40195 43021 38993 35033 39002 36941 33867
Subjects
TOtd DM
826 991 1115 1113 1283 1310 i3m 1659 1568 1459 1555 1460 1370 1463 1473 1439 1474 1432 4974 4795 4658 4469
No.
9
C. Ito /Diabetes Res. Clin. Pmt. 23 SuppI. WM~ S29-S.7.5
group up to the age of 49 years, 12 108 in the Xl-59 year age group, 1383G in the 60-69 year age group, 5213 in the ?O-79 year age group, and 3496 in the 80 years and over age group, while that in females was 5003, 13 127, 20800, 14304, and 8967, respectively. The male residents of Hiroshima City in this age range account for 23% of the male population, the female residents in this age range account for 33% of the female population, and the sexes combined account for 28% of the combined population. From 1965 a glucose tolerance test (G’IT) has been conducted on glycosurics, and from 1990 w urine sugar test and random blood glucose determination have been performed on all the cxaminecs. At the time of examination, the history of diabetes mellitus was investigated. Furthermore, statistical analysis was carried out on some of the examinees seen up to 198g,and on all of the exatninees seen after 1989. 3. Trends in the prevalence of diabetes mellitus Table 1 shows the prevalence of diabetes mellitus from 1971 to 1992 by sex and age. In males, the prevalence in the age group less than 49 years old, which was 1.6% in 1971, increased 3-fold to 4.8% in 1992. The increase was 2.5-fold in the 50-59 year age group, 1.9-fold in the 60-69 year age group, L&fold in the 70-79 year age group, and 2.1-fold in the 80 years and older age group, for an overall increase of 2.7”fold.The prevalence of diabetes mellitus was the highest in the 8th decade followed by the 7th decade and the 6th decade. The prevalence in the 80 years and older age group was 2-3% lower than that in the 8th decade. The trend was similar in the felnales with the rate of increase differing from 1.7 to 4.1-fold by age group, but the overall increase in females was 3.2-fold and slightly higher than that of the males. In addition, the increase in the 80 years and older age group was greater than that for the males. In all age groups, the prevalence of diabetes mellitus in maies was higher than that in females, but after 1988 the difference by sex was no longer apparent in those older than 80. The frequency of glycosurics in this population increased 2 to 3-fold from 1963 to 1992. The
s33
prevalence of diabetes mellitus reported in Koseino-shihyo shows a 2.4-fold increase from 1971 to 1987, a value close to that observed in this study. 4. Prevalence certificate3
of
diabetes mellitus based on death
The frequency of diabetes in subjects who died between 1970 2nd 1992 was estimated by the following method. The description rate of dia-
betes on death certificates of subjects who had been previously tested by GTT and known to have. FPG higher than 140 mg/dl was calculated. The description rate has gradually decreased rscently, presumably because of the increase in deaths due to malignancies and senility, hesa~ux the cohort was fixed and became older with time. Among 37042 death certificates, diabetes appeared in 1.3% as the cause of death, and in 3.6% as the cause of death and as an associated condition. The prevalence of diabetes among the deceased was estimated as 8.8%, by dividing the latter (ES)by the description rate of diabetes of known diabetics on death certificates (A). In taking into account the changes in the description rate of diabetes for each period, the estimated rate of diabetes in males was 5.4% among the deaths occurring in 1970-1974 and 11.4% in 1990- 1992, showing a 2.1-fold incrcasc. Similarly, in fcmalcs it increased 2.0-fold from 6.8% to 13.6%. The description rate of previously known diabetes on death certificates in the present study is close to that reported by Mihara et al. [2] (Table 2). 5. Discussion There are very few reports on the trend in the prevalence of diabetes mellitus followed in the same population for an extended period. The prevalence of diabctcs mcllitus based on the statistics compiled by the Government of Japan and reported in Kosei-no-shihya is r~*~~:rrkably low. Though it may not reflect the true picture 01 the prevalence of diabetes mcllitus, it is useful to know the trend in the rate of increase. The present study was conducted on a population corn--
c. I# /Lwesas Rcs c&R hlct. 24 supgd 0994) &m-s35
s34
ml82 BwinubLd rate of diabetes meWus ti YtcaOf zzz 0ndeat.b ccrtilkate~ W% 1970 - 1974 1975 m 1979 MO-19tM 19#~19@ 19w~1992 Total
data on death wtifkates
Number fromall causes
71.2 f 12.1 72.7 3: 12.1 74.2 f 12.0 74.7 k 12s 75,6 f 12,l 73.8 f 12.3
1.0 1.5 1.4 1.1 0.8 1.2
3.0 3.5 3.8 3.3 3.1 3.4
5.4 8.1 8.4 11.5 11.4 8.9
2312 3715 4355 5299 3317 18998
72.6 f: 12,s 74-3 f 12,o 76.3 zk11.5 78,Of 11.0 79.7 f 10.5 76.5 f 11.6
1.5 I.5 1.7 1.0 1.2 1.4
3.2 3.4 3.9 3.9 4.6 3.8
6.8 6.7 8s 9.8 13.6 8.9
1.3 1.5 1.6 1.0 1.0 1.3
3.1 3.5 3.8 3.6 3.9 3.6
6.0
9967 6093 37042
71.8 ): 735 i 75.3 f 76.4 f 77.8 f 75.2 f
:: 27,l 38.3
47,2 51.1 4&l 39.7 33.7 42,8
T&l 1970 c 1974 1975 5 1979 lWJO~1984 Nss-1989 1990-1992 TQUI
51.9 47.4 45.7 35.0 30.6 40.7
Estimated Rate of DM wJQ%
.-
55.6 43,4
fQ!male 1970 * 1974 1975 N 1979 1980-1984 1985 r* 1989 1990~1992 Total
Rate of diabetes ou death ccrtilkates (96) ___--.~.._..“.““Asacause _ Asacsuseof&atb andasan associated of death condition (BI
Ageof
12.3 121 11.8 11.8 11.5 12.0
7.4 8.3 10.3 12.7 8.8
DM: Diabctcs McWihlatFPG 2 140 q/d& ‘CakuJntud from death eertilkutee of aubjw& who had been previously examined by WIT.
of atomic bomb survivors. The effect of atomic bomb exposure an the development of diabetW mellitus could not be demonstrated [3-S], and thus the results may be regarded as representing those ot the general population of Hiroshima City. The examination response rate for tiris population has been extremely high, at an average annual rate of 70%. From 1965 GTT was formaliy introduced, and the data obtained using the same system for a six-year period were analyzed. It is thus considered that the trend in the prevalence of diabetes mellitus obtained in this study is reliable. Furthermore, in the estimated prevalence among the deceased, the mean age of death was in the 8th decade, and in the males the
prevalence of diabetes mellitus estimated from death ceztifica~eswas close to the prevalence of diabetes mellitus obtained by health examination. In females, the estimated prevalence based on death certificates was higher, but no difference could be observed in the trend for the 20-year period. It is apparent that diabetes mellitus in Hiroshima has increased 2 to 3-fold during the recent 20-year period and thus measures for primary prevention are needed. RCfWnceS 1 Health and Welfare Statistics Association (1990) Koscino-shihyo 37 (SuppI.), 440.
5 3
Rudnick, PA. md Ai~dersm, P.S. Jr. hbetes 11,533~543.
C1962)
Diabetes Research and Clinical Practice. 24 Suppl. (1994) S29-S3S
Trends in the prevalence of diabetes mellitus among Hiroshima atomic bomb survivors
__ .__. -.-.__^-_.__.-._.._ -. ._.
~~.___ _~. ^)
.._ _
_
._ _
.. .-~._.-_--l.- ___.__
__._.__~__.~_~_.
Abstract Muss wxening for diabetes mcllitus has been conducted on td O(H)5 113O(H)atomic bomb survivors r&dent in Hiroshima City since 1961. The trends in the number of diabetes mcllitus patients from 1971 to 1992 based on the results of this mass screening and on death certificates are described. The prevalence of diabetes mellitus has shown an increase with age, but it peaked in the 8th decade and declined after the 9th decade. From 1971 to 1992 a 2.7-fold increase in the prevalence of diabetes mcllitus was observed in males and a 3.2-fold increase in females. By age, in males the increase was high in those of less than 49 years of age, and in females the increase was predominant in those of 80 years of age and over. In males the prevalcncc of diabetes mellitus estimates by death certificates was in good agreement with that observed by mass screening. but in females the prevalence observed by death certificates gave a higher value. During a period of two decades, a 2.1-fold increase was observed in males and a 2.0-fold increase in females.
Keywords: Prevalence of diabetes mellitlq
Trends of diabetes mellitus; Death certificate; Atomic bomb survivors; Diabetic deaths _____ -_-------.. _.__.___._._ ._.._._ _.._._-._
1. Introduction
2. Subjects and’ methods
According to Kosei-no-shihyo [1], a statistical publication of the Government of Japan, the prevalence of diabetes mellitus has shown a gradual increase from about 1965, but the increase after 1980 has been dramatic. This increase can be accounted for in part by the westernization of the diet, a decrease in physical activity, and an increase in mental stress, and in part by the early detection of previously undetected diabetes mellitus due to the extensive conduct of mass screening. This report describes the trends in the number of diabetic patients from 1971 to 1992 in a fixed population of atomic bomb survivors on whom health examination has been conducted twice a year from 1957 in accordance with the Atomic Bomb Medical Treatment Law.
Atomic bomb survivors, the subjects of the present study, are defined as individuals born before 31 May 1946 and exposed to the atomic bomb, and those exposed to the atomic bomb in utcro. The total number varies by year with the range being 64 000- 113 000. Health examination has been conducted from 1957, but examination for diabetes mellitus using the urine sugar test was commenced from 1961. The annual examination rate of this population has been 70%J on the average since the initiation of the health examination, but the with aging of the population it has rc.:ently declined to
01688227/94/$07.00
0 1994 Elsevier Science Ireland Ltd. All rights reserved
SSDI 0168-8227(94)00891-W
1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1385 1986 1987 1988 1989 1990 1991 1992
ye=
412.6 3294 2773 2803 2530 2149 2053 1838 3207 2786 2099 1648
5899 5425
5708 8959 6944 7203 7593 6531
tMBle1 - 49 Fiscal sm
90 123 117 109 130 139 141 185 156 126 120 98 73 &I 90 75 64 69 120 122 78 79
MO.
1.6 1.4 1.7 1.5 1.7 2.1 25 3.1 29 2.7 2.9 3.0 2.6 3.0 3.6 3.5 3.1 3.8 3.7 4.4 3.7 4.8
%
D~cases
3583 6224 5685 4754 4397
3117 3649 3662 3421 3878 3799 3629
2476 2237 2745
2522
2186
sabjcds
s-59
Prevalcaceof dktxtcs tD&ms w71-1992)
Table 1
46 3.2 3.3 3.6 4.9 5.2 5.4 6.1 6.0 5.6 5.1 53 5.4 6.7 7.2 6.1 7.1 7.0 6.7 8.0 8.2 8.2 8.1
No. 71 89 92 113 131 133 137 165 164 160 195 199 230 281 231 258 254 240 4% 466 389 355
DM-
3014 2530 2114 1981 1980 1988 2174 2485 7394 7943 8494 9130
3105 3318 3194
33a 3m 3165 3587
Ydjeczs
a-69
144 149 1% 164 212 209 200 265 235 216 232 176 174 166 177 187 187 204 722 756 042 897
No. 5.2 4.4 6.0 5.2 5.9 6.0 6.4 8.0 7.4 7.3 7.7 7.0 8.2 8.4 8.9 9.4 8.6 8.2 9.8 9.5 9.9 9.S
%
DMcascs
1966 1578 1775 1724 1684 1721 1709 6073 57a 5270 4535
2I30
2257 2282 2079
i810 2116 2233
Subjects
m-79
111 124 125 14; 147 148 169 151 140 153 158 148 155 150 122 147 152 585 595 568 477
xx
rao. 5.9 52 5.6 5.5 F.5 6.4 7.; 7.5 7.1 7.0 7.4 8.0 9.4 8.7 8.7 7.2 8.5 8.9 9.6 10.4 10.8 10.5
%
DMCZES
458 490 469 442 504 509 2574 2458 2273 2079
27% 351 378 376 387 423 413 as6 eHl &yj S’T ;;;
SuQjccts
HI-
3.2 2.6 2.6 0.5 0.8 2.1 3.9 4.7 5.5 45 4.8 5.4 7.0 4.7 5.5 6.8 7.9
%
145 149 139
5.9 6.6 6.7
1*,-1: 2:;
9 9 10 2 3 9 16 23 27 22 26 27 32 23 26 30 ;c c;
No.
DMcacs
10096 10124 25472 24612 22890 21789
12759 11474 15361 15273 16321 15in 13533 14704 14167 13221 13407 11952 10344 10927 10502
Subjects
TOtd
420 481 539 513 623 637 642 807 733 664 726 658 657 709 674 672 &92 700 2092
No.
DM
s
M
1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992
1971 1972 1973
[Total] FiSCd year
15713 22229 17628 17474 18052 14981 12740 13524 11643 9775 8748 7087 5696 5710 5096 4430 4275 3832 8685 7453 5750 4429
163 226 207 IS3 217 221 224 275 243 191 181 143 122 129 127 I06 105 97 210 199 130 127
1.0 LO 1.2 1.0 1.2 1.5 1.8 2.0 2.1 2.0 2.1 20 2.1 2.3 2.5 2.4 2.5 2.5 2.4 2.7 2.3 2.9 8654 8997 8758 8037 7892 7513 16630 14956 12852 12110
8614 10149 10444 ~XMO 10706
6912 S891 8603 8593
subicas
%
SUbjCCl$ DMw
N49.
30-59
- 49 D&i=
274 317 356 357 365 410 412 378 412 392 391 444 406 404 402 365 885 826 741 686
260
190
No. 27 2.9 3.2 3.7 3.7 3.9 4.2 4.0 3.9 3.8 3.8 3.9 4.5 4.9 4.6 5.0 5.1 4.9 5.3 5.5 5.8 5.7
%
8934 8109 8986 8643 8110 8526 7705 6461 6707 6781 6799 7300 7926 26420 26764 26383 25768
suiri_eat
60-69
290 310 409 381 460 446 469 578 550 546 587 543 500 492 540 540 515 522 1917 1901 1931 1942
4.2 3.7 4.8 4.5 4.9 5.c 5.8 6.4 6.4 6.7 6.5 7.u 7.7 7.3 8.0 7.9 7.1 6.6 73 7.1 7.3 75
Dictmsa -~ No. %
18403 17800 17059 15651
4377 4531
4014 4385
4989 4711 5394 5159 4926 5170
4837
3762 4445
Subjms
m-79
169 182 213 229 246 270 285 356 320 305 331 335 312 361 350 335 365 372 1521 3465 1459 l328
4.5 4.1 4.4 4.7 4.9 5.4 6.0 6.7 6.2 62 6.4 6.8 7.8 8.2 7.9 7.7 8.1 8.3 83 8.2 8.6 85
%
DMcases No. 595 734 m2 762 812 861 859 1039 1052 1016 1115 1012 879 903 900 889 1043 1104 6717 6456 6241 5513
!!h$xts
$o-
14 13 12 3 4 16 2.7 40 43 39 44 47 45 37 50 54 87 76 441 404 397 385
No.
2.4 1.8 1.5 0.4 0.5 1.9 3.1 3.8 4.1 3.8 3.9 4.6 5.1 4.1 5.6 6.1 83 6.9 6.6 6.3 6.4 6.6
%
--~ Dktcases
25704 26702 25939 24532 25041 24863 76855 73429 68285 63771
344265 30685
33964 44707 40394 40195 43021 38993 35033 39002 36941 33867
Subjects
TOtd DM
826 991 1115 1113 1283 1310 i3m 1659 1568 1459 1555 1460 1370 1463 1473 1439 1474 1432 4974 4795 4658 4469
No.
9
C. Ito /Diabetes Res. Clin. Pmt. 23 SuppI. WM~ S29-S.7.5
group up to the age of 49 years, 12 108 in the Xl-59 year age group, 1383G in the 60-69 year age group, 5213 in the ?O-79 year age group, and 3496 in the 80 years and over age group, while that in females was 5003, 13 127, 20800, 14304, and 8967, respectively. The male residents of Hiroshima City in this age range account for 23% of the male population, the female residents in this age range account for 33% of the female population, and the sexes combined account for 28% of the combined population. From 1965 a glucose tolerance test (G’IT) has been conducted on glycosurics, and from 1990 w urine sugar test and random blood glucose determination have been performed on all the cxaminecs. At the time of examination, the history of diabetes mellitus was investigated. Furthermore, statistical analysis was carried out on some of the examinees seen up to 198g,and on all of the exatninees seen after 1989. 3. Trends in the prevalence of diabetes mellitus Table 1 shows the prevalence of diabetes mellitus from 1971 to 1992 by sex and age. In males, the prevalence in the age group less than 49 years old, which was 1.6% in 1971, increased 3-fold to 4.8% in 1992. The increase was 2.5-fold in the 50-59 year age group, 1.9-fold in the 60-69 year age group, L&fold in the 70-79 year age group, and 2.1-fold in the 80 years and older age group, for an overall increase of 2.7”fold.The prevalence of diabetes mellitus was the highest in the 8th decade followed by the 7th decade and the 6th decade. The prevalence in the 80 years and older age group was 2-3% lower than that in the 8th decade. The trend was similar in the felnales with the rate of increase differing from 1.7 to 4.1-fold by age group, but the overall increase in females was 3.2-fold and slightly higher than that of the males. In addition, the increase in the 80 years and older age group was greater than that for the males. In all age groups, the prevalence of diabetes mellitus in maies was higher than that in females, but after 1988 the difference by sex was no longer apparent in those older than 80. The frequency of glycosurics in this population increased 2 to 3-fold from 1963 to 1992. The
s33
prevalence of diabetes mellitus reported in Koseino-shihyo shows a 2.4-fold increase from 1971 to 1987, a value close to that observed in this study. 4. Prevalence certificate3
of
diabetes mellitus based on death
The frequency of diabetes in subjects who died between 1970 2nd 1992 was estimated by the following method. The description rate of dia-
betes on death certificates of subjects who had been previously tested by GTT and known to have. FPG higher than 140 mg/dl was calculated. The description rate has gradually decreased rscently, presumably because of the increase in deaths due to malignancies and senility, hesa~ux the cohort was fixed and became older with time. Among 37042 death certificates, diabetes appeared in 1.3% as the cause of death, and in 3.6% as the cause of death and as an associated condition. The prevalence of diabetes among the deceased was estimated as 8.8%, by dividing the latter (ES)by the description rate of diabetes of known diabetics on death certificates (A). In taking into account the changes in the description rate of diabetes for each period, the estimated rate of diabetes in males was 5.4% among the deaths occurring in 1970-1974 and 11.4% in 1990- 1992, showing a 2.1-fold incrcasc. Similarly, in fcmalcs it increased 2.0-fold from 6.8% to 13.6%. The description rate of previously known diabetes on death certificates in the present study is close to that reported by Mihara et al. [2] (Table 2). 5. Discussion There are very few reports on the trend in the prevalence of diabetes mellitus followed in the same population for an extended period. The prevalence of diabctcs mcllitus based on the statistics compiled by the Government of Japan and reported in Kosei-no-shihya is r~*~~:rrkably low. Though it may not reflect the true picture 01 the prevalence of diabetes mcllitus, it is useful to know the trend in the rate of increase. The present study was conducted on a population corn--
c. I# /Lwesas Rcs c&R hlct. 24 supgd 0994) &m-s35
s34
ml82 BwinubLd rate of diabetes meWus ti YtcaOf zzz 0ndeat.b ccrtilkate~ W% 1970 - 1974 1975 m 1979 MO-19tM 19#~19@ 19w~1992 Total
data on death wtifkates
Number fromall causes
71.2 f 12.1 72.7 3: 12.1 74.2 f 12.0 74.7 k 12s 75,6 f 12,l 73.8 f 12.3
1.0 1.5 1.4 1.1 0.8 1.2
3.0 3.5 3.8 3.3 3.1 3.4
5.4 8.1 8.4 11.5 11.4 8.9
2312 3715 4355 5299 3317 18998
72.6 f: 12,s 74-3 f 12,o 76.3 zk11.5 78,Of 11.0 79.7 f 10.5 76.5 f 11.6
1.5 I.5 1.7 1.0 1.2 1.4
3.2 3.4 3.9 3.9 4.6 3.8
6.8 6.7 8s 9.8 13.6 8.9
1.3 1.5 1.6 1.0 1.0 1.3
3.1 3.5 3.8 3.6 3.9 3.6
6.0
9967 6093 37042
71.8 ): 735 i 75.3 f 76.4 f 77.8 f 75.2 f
:: 27,l 38.3
47,2 51.1 4&l 39.7 33.7 42,8
T&l 1970 c 1974 1975 5 1979 lWJO~1984 Nss-1989 1990-1992 TQUI
51.9 47.4 45.7 35.0 30.6 40.7
Estimated Rate of DM wJQ%
.-
55.6 43,4
fQ!male 1970 * 1974 1975 N 1979 1980-1984 1985 r* 1989 1990~1992 Total
Rate of diabetes ou death ccrtilkates (96) ___--.~.._..“.““Asacause _ Asacsuseof&atb andasan associated of death condition (BI
Ageof
12.3 121 11.8 11.8 11.5 12.0
7.4 8.3 10.3 12.7 8.8
DM: Diabctcs McWihlatFPG 2 140 q/d& ‘CakuJntud from death eertilkutee of aubjw& who had been previously examined by WIT.
of atomic bomb survivors. The effect of atomic bomb exposure an the development of diabetW mellitus could not be demonstrated [3-S], and thus the results may be regarded as representing those ot the general population of Hiroshima City. The examination response rate for tiris population has been extremely high, at an average annual rate of 70%. From 1965 GTT was formaliy introduced, and the data obtained using the same system for a six-year period were analyzed. It is thus considered that the trend in the prevalence of diabetes mellitus obtained in this study is reliable. Furthermore, in the estimated prevalence among the deceased, the mean age of death was in the 8th decade, and in the males the
prevalence of diabetes mellitus estimated from death ceztifica~eswas close to the prevalence of diabetes mellitus obtained by health examination. In females, the estimated prevalence based on death certificates was higher, but no difference could be observed in the trend for the 20-year period. It is apparent that diabetes mellitus in Hiroshima has increased 2 to 3-fold during the recent 20-year period and thus measures for primary prevention are needed. RCfWnceS 1 Health and Welfare Statistics Association (1990) Koscino-shihyo 37 (SuppI.), 440.
5 3
Rudnick, PA. md Ai~dersm, P.S. Jr. hbetes 11,533~543.
C1962)