“Analysis of the Social and Economic

Impact of Diabetes in Canada”

“Analysis of the Social and Economic Impact of Diabetes in Canada”

A. INTRODUCTION

Every nation’s focus is to give effective and efficient healthcare attention to its citizen

and to provide and equip them with the best knowledge to combat hand in hand the battle for a

healthy community. That is why it is evident that countries are allocating a big portion of their

yearly national budget to attain a sound healthcare system for its entire citizen. As different

approaches are adapted by each and every country, the management and prevention of Chronic

Diseases in a country, particularly in Canada remains one of the priorities of the Canadian

Government.

The aim of this paper is to give an overview of the past and current status of Diabetes in

Canada, and its impact not just to Canadians, but to Non-Canadians including Immigrants and

Workers in the jurisdiction of Canada. This paper targets to unfold the social and economic

impact of this Chronic Disease in Canada in the Macro and Micro Level; From the Government,

the State, the Healthcare providers, the Health Institutions and Hospital, the Community itself,

the families and the individuals involved.

B. DIABETES IN CANADA

B.1 HIGHLIGHTS FROM THE CANADIAN CHRONIC DISEASE SURVEILLANCE

SYSTEM

Diabetes is a chronic condition that affects Canadians of all ages. If left uncontrolled,

diabetes results in consistently high blood sugar levels (hyperglycemia), which can lead to

serious complications such as cardiovascular disease, vision loss, kidney failure, nerve damage,

and amputation. Fortunately, it is possible to remain healthy with diabetes through appropriate

management and care.

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

The Public Health Agency of Canada (PHAC), in collaboration with all provinces and

territories, conducts national surveillance of diabetes to support the planning and evaluation of

related policies and programs. This fact sheet presents an overview of diagnosed diabetes data

(type 1 or type 2 combined) from the Canadian Chronic Disease Surveillance System

B.2 WHAT IS DIABETES?

Diabetes is a chronic condition that occurs when the body loses its ability to produce or

properly use insulin, a hormone that controls sugar levels in the blood. There are three main

types of diabetes: type 1, type 2 and gestational diabetes. Other types are uncommon.

 Type 1 diabetes is an autoimmune disease. The immune system destroys the insulin-

producing cells of the pancreas, leaving the individual dependent on an external source of

insulin for life. It typically develops in children and youth, but it can also occur in adults.

 Type 2 diabetes is a metabolic disorder. It occurs when the pancreas does not produce

enough insulin and/or when the body does not properly use the insulin produced.

Individuals who are overweight or obese, physically inactive, or of certain ethnic origins,

and those who have a family history of diabetes are more likely to develop type 2

diabetes. It typically appears in adults older than 40 years, but it can also occur at a

younger age.

 Gestational diabetes occurs in pregnant women, if high blood sugar levels develop

during pregnancy. Although it usually disappears after the delivery, it increases the risk

of developing type 2 diabetes later.It has been estimated that 90% of diabetes cases

among Canadian adults are type 2, 9% type 1, and less than 1% of a different type, while

the large majority of diabetes cases among children and youth are type 1. Moreover,

gestational diabetes is reported in about 5.5% of births.

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

How many Canadians live with diabetes? (Prevalence)

According to the most recent data of Canadian Chronic Disease Surveillance System

(CCDSS), a collaborative network of provincial and territorial chronic disease surveillance

systems, led by the Public Health Agency of Canada (PHAC), about 3.0 million Canadians

(8.1%) were living with diagnosed diabetes in 2013–2014, representing 1 in 300 children and

youth (1–19 years), and 1 in 10 adults (20 years and older). The prevalence of diagnosed diabetes

generally increases with age and is higher among males (8.7%) than among females (7.6%), both

overall and in most age groups (Figure 1).

Figure 1: Prevalence of diagnosed diabetes (%), by age group and sex, Canada, 2013–2014

Data source: Public Health Agency of Canada, using Canadian Chronic Disease Surveillance System data files
contributed by provinces and territories, May 2017.

The CCDSS identifies chronic disease cases from provincial and territorial administrative

health databases, including physician billing claims and hospital discharge abstract records,

linked to provincial and territorial health insurance registry records using a unique personal

identifier. Data on all residents eligible for provincial or territorial health insurance (about 97%

of the Canadian population) are captured in health insurance registries.

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

While CCDSS data reflect the health status of the Canadian population, they may also

reflect changes in data collection methods, coding and classification systems, or clinical

guidelines (e.g. screening and diagnostic) and billing practices. These factors must also be taken

into consideration when interpreting time trends.

Canadians aged 1 year and older are identified as having diagnosed diabetes (type 1 or

type 2 combined) if they have: at least one hospitalization record or at least two physician claims

in a two-year period with an International Classification of Diseases (ICD-9 or ICD-10) code for

diabetes. Females aged 10 to 54 years diagnosed with diabetes 120 days preceding or 180 days

following a pregnancy-related visit are removed, to exclude possible cases of gestational

diabetes.

Figure 2: Prevalence of diagnosed diabetes (%), by age group and sex, Canada, 2013–2014

Data source: Public Health Agency of Canada, using Canadian Chronic Disease Surveillance System
data files contributed by provinces and territories, May 2017

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

Figure 1 and 2 shows the demographical data of persons with Diabetes, clustered by age

and by sex, for the period of one (1) calendar year from 2013-2014. It shows that as age is

increasing, the commonness or prevalence to acquire diabetes is also increasing.

C. THE TREND OF DIABETIS IN CANADA

In 2017, 7.3% of Canadians aged 12 and older (roughly 2.3 million people) reported being

diagnosed with diabetes. Between 2016 and 2017, the proportion of males who reported being diagnosed

with diabetes increased from 7.6% in 2016 to 8.4% in 2017.Note 2 The proportion of females remained

consistent between the two years.

Canadians with type 1 diabetes have been living with their diagnosis for an average of 20.2 years,

compared to 12.2 years for type 2 diabetes. Overall, males (8.4%) were more likely than females (6.3%)

to report that they had diabetes. Diabetes increased with age for males, with the highest prevalence among

those 75 years and older. The percentage of females reporting diabetes increased with age up to the age of

64, the prevalence did not increase significantly for those aged 75 and older (Figure 3).

Figure 3: Diabetes, by age group and sex, population aged 12 and older, 2017

Data Source: https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54982-eng.htm

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

The proportion of Canadians 12 and older who reported being diagnosed with diabetes

was lower than the national average (7.3%). The proportion who reported being diagnosed with

diabetes was higher than the national average in:

The proportion of residents who reported being diagnosed with diabetes was about the

same as the national average in all other provinces.

Canadians aged 18 and older who were either overweight or obese were more likely than

those who were classified as having a normal weight to report that they had been diagnosed with

diabetes. The prevalence of diabetes among obese Canadians was 13.7% in 2017, compared with

6.8% among overweight Canadians and 3.6% among those classified as having a normal weight.

D. DIABETES AMONG THE CANADIAN TERRITORY

Figure 4: Overall Estimate performance and Cost Burden on Key Indicators by Province and Territory.
2000- 2020, plus Government Response.

Data Source: https://www.diabetes.ca/CDA/media/documents/publications-and-newsletters/advocacy-

reports/canada-at-the-tipping-point-english.pdf

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

Figure 4 shows the Estimated Diabetes and Prediabetes Prevalence, Estimated Cost

Burden per Province/ Territory in Canada. Starting 2000 up to the forecasted year of 2020, New

Brunswick (NB), Nova Scotia (NS), and Newfoundland and Labrador (NL), are the three bottom

performers om terms of exiting prevalence rate, meaning that these provinces/ territory homes

the greatest number of people with Diabetes and the highest value in terms of cost- burden and

type 2 out-of-pocket costs, while the provinces of Alberta (AB), Saskatchewan (SK), and Quebec

(AC) hold the least number of people with diabetes, and shoulders the least burden of cost and

out- of pocket expenses. When it comes to measurement of the percentage increase overtime, the

provinces of British Columbia (BC), Alberta (AB), and Ontario (ON) yields the highest

percentage increase in the number of people with Diabetes, while Manitoba (MB), Saskatchewan

(SK), and Nova Scotia (NS) generates the lowest percentage increase.

E. CANADA AND OTHER COUNTRIES

Figure 5: Diabetes (types 1 and 2) prevalence in Canada and OECD peer countries

Note: OECD average includes 34 countries

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

Canada has one of the highest prevalence rates of diabetes among OECD countries, with

9.4%, or more than 3 million people, estimated to have the condition in 20141 (Figure 2). An

additional 5.7 million Canadians have prediabetes, a state of above-normal blood sugar levels,

which has a high chance of progressing to full diabetes.19 This report will focus on type 2

diabetes, which affects 90% of individuals living with diabetes.17 Thus from this point forward,

“diabetes” will refer to type 2 diabetes only. Without a shift in policies and priorities, the

prevalence of diabetes is expected to continue to grow.17 Children, in particular, are a

population with an increasing prevalence of diabetes.

While type 2 diabetes was once termed “adult-onset diabetes” due to its relationship with

age, between 1999 and 2009 the prevalence of type 2 diabetes nearly doubled in children and

adolescents younger than 20; increasing rates of overweight and obesity are thought to be a key

contributor to this.20 Diabetes prevalence varies by age, gender, income group and ethnicity.

For instance, in Canada, First Nations and Métis populations have particularly high rates

of diabetes. Aboriginal groups in Australia, New Zealand and the United States have a much

higher prevalence of diabetes than the general population.21–23 Additionally, Canadians of

South Asian descent are at an elevated risk of developing diabetes and are more likely to be

diagnosed at a younger age than those of other ethnicities.24 This report looks at how Canada’s

performance compares internationally in two areas: preventing new cases from developing and

better managing existing diabetes to reduce complications and improve health

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

F. THE ECONOMIC BURDEN AND COST OF DIABETES IN CANADA

Figure 6: Diabetes in Canada- A 20- year projection

The economic burden Diabetes is a personal crisis for people living with the disease, and

for their family. Diabetes is also a financial crisis for our healthcare system. It is consuming an

ever-larger share of provincial and territorial healthcare budgets, and will force an increase in

those expenditures. The economic burden of diabetes in Canada is expected to be about $12.2

billion in 2010, measured in inflation adjusted 2005 dollars. This is an increase of $5.9 billion or

nearly double its level in 2000. The cost of the disease is expected to rise by another $4.7 billion

by 2020. The direct cost of diabetes now accounts for about 3.5% of public healthcare spending

in Canada and this share is likely to continue rising given the expected increase in the number of

people living with diabetes in Canada.

Like prevalence, the cost of diabetes is approaching the tipping point. Factors responsible

for increased prevalence also account for the projected $4.3 billion increase over the next decade.

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

Direct costs of diabetes, which account for 21% of the total cost, are led by hospitalization but

also include general practitioners, specialists and medications. Indirect costs include loss of

economic output from illness or premature mortality.

Mortality and disability account for 79% of the total cost of diabetes (Figure 4). Diabetes

is also a significant burden for our economy, estimated at $11.7 billion in 2010.45 This is an

increase of $4.7 billion or nearly 70% since 2000 (Figure 5). 46 Declining mortality rates for

people with diabetes increase prevalence rates over this period and decrease costs associated

with premature mortality, thus resulting in higher estimated prevalence but a lower overall cost

burden than projected in 2009.47 Nevertheless, the cost of diabetes is expected to rise by over

130% from 2000 to 2020.

The demographic forces driving the increase in the number of people with diabetes

between 2010 and 2020 yield a similar distribution for each factor with respect to the economic

burden of diabetes. The increase in the population accounts for 11% of the increase in costs,

population aging for 8% and higher incidence rates for 14%, while the current demographic

structure accounts for 67% of the increase in costs.

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

G. CONCLUSION

Diabetes is one the chronic diseases that is rampant worldwide. It is one of the main

causes of death among human beings, especially when it becomes uncontrollable and tend to

yield so many complications like stroke, heart attacks, kidney failures, and non-traumatic limb

amputations. Canada is one country with high percentage of Diabetes Prevalence, not limiting to

Canadians only, but also to numerous immigrants from all parts of the world such as Southeast

Asia, Middle East, Australia, etc.

With the increasing percentage of Prevalence of Diabetes over the years, and the

inevitable consequences that may occur, persons afflicted with the disease, his/ her family, the

community, the state and the government is suffering, whether directly or indirectly.

With the increasing number of deaths and persons not being able to render full service

because of complications (stroke, heart attacks, kidney failures, and non-traumatic limb

amputations) arising from the disease, the country’s workforce is affected. Also, because of the

out-of-pocket cost being shouldered by the patient, and the government in the macro setting, a

big portion of a family’s income and the government budget is being allocated to maintain a

sound healthcare system to combat this chronic disease.

In the status quo, the Canadian Government is in its continuous effort to formulate

healthcare, economic, and social policies to help and render effective and efficient services to the

people affected by Diabetes. One of the economic policy formulated by the Canadian

Government is to levy tax on sugar-sweetened beverages and use the revenue that it will generate

for health promotion initiatives.

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“Analysis of the Social and Economic Impact of Diabetes in Canada”

In the long run, the government’s purpose is limit all the consequences arising from this

chronic disease, and to provide the most effective yet low cost healthcare service to its people.

Also, the state want to adopt measurable and feasible methods to prevent and treat diabetes, to

provide Canadians with a sound healthcare system.

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