Estimation of the mortality caused by diabetes mellitus in Panama and its relationship to gender and cardiovascular risk factors

Jorge Motta1, Carlos Gordón1, Beatriz Gómez1, Eva Castillo1, Víctor Herrera Ballesteros1

INTRODUCTION

Although diabetes mellitus is among the top 5 leading causes of death in the Republic of Panama, little information is available that relate the mortality from this disease to biological risk factors such as age, gender, obesity, hypertension, hyper- cholesterolemia, and socioeconomic factors.

OBJECTIVES

To characterize the status of diabetes mellitus mortality in Panama and its relationship with risk factors present in the population.

MATERIALS AND METHODS

The methodology involved compilation and anlaysis of data from the National Survey of Quality of Life and Health, Living Standards Survey obtained in a sample of 25,748 individuals, data from the National Population Census of 2000 and 2010 and the National Registries of mortality from all causes for the years 2001 to 2009. We generated indicators of crude, adjusted and specific rates of mortality from diabetes and compared these rates with the presence of risk factors such as obesity, hypertension and elevated cholesterol at provincial, district and county levels. Regression coefficients were derived from multivariate analysis of biologic and socioeconomic factors known to be related to the risk of dying from diabetes.

RESULTS

After compiling and analizing the data for mortality from diabetes mellitus for the years 2001 – 2009, for biologic risk factors and socioeconomic factors from different regions of Panama and inserting these in a geographic information system, we find that women have a higher mortality from diabetes than men in Panama. Women also have a higher prevalence of obesity and also a higher prevalence of self-reported hypertension and of elevated cholesterol. Certain provinces like Los Santos and Colon have higher crude mortality rate than the rest of the country. The biological risks factors found to be most related to diabetes mortality were obesity, hypertension, hyperlipidemia and being 55 years of age or older. For the socio-economic analysis the factors found to be most related to diabetes mortality were the following: having less than 6 years of schooling and being unemployed.

CONCLUSIONS

During the years 2001 - 2009, women sufered a higher mortality from diabetes than men. Women had a higher prevalence of obesity than men. Mortality was higher in both sexes after reaching 45 or more years of age. Some provinces exhibited a higher mortality rates from diabetes probably because they had a greater number of older inhabitants, and a higher prevalence of obesity and hypertension. Unemployement and less education appear also to be related to mortality from diabetes.

1Instituto Conmemorativo Gorgas de Estudios de la Salud

ICGES. Panamá, Ave. Justo Arosemena y calle 35. Tel.: (507) 527 - 4811 Fax: (507) 527 - 4889Apartado Postal: Nº 0816 – 02593. email: igorgas@gorgas.gob.pa Panamá, República de Panamá

http://www.gorgas.gob.pa/

The Compound Index was derived from a factorial analysis of the following variables: Ethnicity (indigenous and afro) population, monthly income less thant 100 U.S., unemployed status, gender, % of the population with less than 6 years of education and % of the population with an age greater or equal to 65 years. The socioeconomic factors most related to diabetes mortality in Panama were: % of the population with less than 6 years of education, % of unemployed population and the % of the population aged over 65 years. Additionally, a multiple linear regression analysis yielded the following coefficients for these variables, -0.86 (-4.48) 0.52 (4.72) and 1.18 (10.04) respectively. Values in parentheses are the t statistics - student. The coefficient r2 was 0.283 and the correlation 0.532. The dependent variable was the crude mortality rate for diabetes mellitus.

Source: Population and Housing Census 2010 / Life Events from 2001 to 2009

Analysis of socioeconomic factors related to mortality from diabetes mellitus by counties. Panama. 2001 to 2009.

N = 3,405,813

Source: ENSCAVI 2007

Analysis of biological risk factors related to mortality from diabetes mellitus by district. Panama. 2007.

The Compound Index was derived from a factorial analysis. The four biological risks factors that were found to be most related to diabetes mortality were obesity, hypertension, hyperlipidemia and having an age of 55 years or more. Additional analysis included four separate regressions for each of the explanatory variables and the coefficients obtained were the following: obesity 0.932 (6.048, 0.346), hypertension 1.136 (5.985, 0.338), hyperlipidemia 0.599 (4.485, 0.234),) and age greater or equal to 55 years of age 1.078 (3.273, 0.133). Values in parentheses represent the student-t and the r2.

n = 25,748

Diabetes mellitus Hypertension Overweigth Hypercholesterolemia0

5

10

15

20

25

30

4.35

17.76

6.44 7.026.02

24.83

12.099.89

MenWomen

Risks factors

% P

opul

atio

n

Percentage diferences by gender of subjects studied in ENSCAVI who answered “yes” or “no” if they had been diagnosed by a doctor in the last year as having the named risk factors. 2007.

n = 25,748

Source: ENSCAVI 2007

P<0.00|01

P<0.0001

P<0.0001

P<0.0001

18-29 30-39 40-49 50-59 60-64 65-74 75 y más0

5

10

15

20

25

30

35

9.5

16.9

20

16.815.6

13.7

7.6

13

20.6

29.9 30.2

27.3

29.9

12.8

MenWomen

Group ages

% O

bese

pop

ulat

ion

Prevalence of obesity in the adult population based on BMI,by age and gender. ENV 2003. Panama

BM

I equ

al o

r gre

ater

than

30.

0

Source: Living Standards Survey, MEF, 2003

n = 7,121

n = 7,365

14% of men and 21% of women in Panama had a BMI equal or greather than 30.

0- 4 5 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 y más0

100

200

300

400

500

600

700

800

900

MenWomen

Age groups

Spe

cific

rate

s/ 1

00,0

00 in

habs

Age-specific death rate from Diabetes Mellitus(CIE/10: E10-E14) by gender in Panama, 2001 - 2009

Source: Life Events. 2001- 2009. INEC

98% of deaths occur after age 45

Total number of deaths due to Diabetes Mellitus (ICD/10: E10-E14)by counties. Panama. 2001 to 2009.

Source: Life Events ( Mortality 2001- 2009)

PANAMACHIRIQUI

COLONCOCLE

VERAGUASLOS SANTOS

HERRERABOCAS DEL TORO

C. GUNA YALADARIEN

C. NGABE BUGLEC. EMBERA

0

1000

2000

3000

4000

50003,862

1,063 684 428 328 283 240 142 22 21 12 0

Provinces

Dea

ths

for D

iabe

tes

mel

litus

n = 7,085 Average subregistres of deaths: 16.68%

LOS SANTOSCOLON

CHIRIQUIPANAMA

HERRERACOCLE

VERAGUASBOCAS DEL TORO

DARIENC. GUNA YALA

C. NGABE BUGLEC. EMBERA

0.05.0

10.015.020.025.030.035.040.0 35.3 32.8

29.526.5 24.2

21.216.3 15.0

5.31.4 0.7 0.0

Provinces

Rat

es 1

00,0

00 in

habs

Crude death rate for diabetes mellitus (ICD/10: E10-E14)by provinces. Panama. 2001 to 2009.

National Crude Rate = 24.3/100,000

Source: Life Events: Mortality, 2001- 2009

Estimated proportional mortality by major causes of death in Panamaaccording to gender, 2001-2009.

Men Women

Source: Life Events: Mortality, 2001 - 2009. INEC

gene

Fact Sheet: Republic of Panama

Population: 3,405,813 inhab.

Area: 75,510 km2

PIB:20,862.9 millions US dollars

PIB per capita:5,953 US dollars

%

Age structrure (%)

0- 14 years: 29.215- 64 years: 63.464 years and over: 7.4

Sex sctructure101.1 men/ 100 women

Life expectancy at birth

Both sexs: 75.9 yearsMale: 73.3 yearsWomen: 78.6

Mortality

Crude rate: 4.5/ 1,000 inhabts.Infant mortality rate: 12.2/ 1,000 inhabts

Annual % of growth:7.5%

Poverty population: 32%

Indigeneous population (%):12.3%

Afro population (%)9.2%

Economic, Social and Health Indicators of Republic of Panama. 2010.

Source: INEC/ MINSA

geneEstimated mortality rate for diabetes mellitus (ICD/10: E10-E14)

in Panama and other selected countries, 1996-2008

Source: Organización Panamericana de la Salud. http://www.paho.org/Spanish/SHA/coredata/tabulator/newTabulator.htm

(10.8%)

(5.7%)

(5.4%)

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 20080.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

22.4 22.724.6

28.5 28.330.4

35.033.4 32.1

27.330.9

29.231.5

15.1 16.414.8 15.7 16.7 17.0

19.7 19.621.2 21.9 21.4 20.3 21.1

41.6 42.8

49.6

55.1 54.4

58.9

63.7

68.3

73.1 72.975.8

65.668.3

PanamaChileCosta RicaUnited States of AmericaMexico

Years

Rat

es 1

00,0

00 in

habs

Note: C = Comarca. Subregistres of deaths in indigenous regions correspond to Darien 53%, Ngabe Bugle 53%, Emberá 72% and Guna Yala (15%)