Sex
There are significantly more men than women with diabetes in Scotland. This pattern is repeated across all areas of Scotland apart from Orkney. Unfortunately, six boards were unable to provide a sex breakdown for a significant number of their patients, consequently, sex is not known for over 8% of the registered population in this year's Survey.
Figure 8: Diabetes register: percentage sex breakdown
Note: D&G - not recorded/not known data includes all paediatric patients. Lanarkshire - data only available for secondary care. Shetland - No data submitted
Figure 9: Comparison - Scotland 2001 & 2002. Sex of people on register
Age
Over 80% of those included in the Survey are aged 45 or over, and nearly half (47.9%) are aged 65 or over. The registered population is older in 2002 than in 2001. There has been a fall in the number of registered patients aged 85 or older. This is likely to represent improved data validation with people who have died being removed from the register.
Figure 10: Diabetes register: percentage age breakdown
Note: Lanarkshire - data only available for secondary care. Shetland - no data submitted
Figure 11: Diabetes register: prevalence in Scotland by age group
Note: Lanarkshire - data only available for secondary care. Shetland - no data submitted
It is widely recognised that much of the increased prevalence of diabetes is related to an increase of Type 2 diabetes, which tends to occur in older people. However, there is an increasing incidence of Type 1 diabetes in children. This group of patients have very specific care needs. Annex B describes the work of the Scottish Study Group for the Care of Diabetes in the Young.
Ethnic Group
Studies in the UK have shown diabetes prevalence rates of 11-20% in Asian Indian, 15% in Afro-Caribbean and 1-5% in white Caucasians. The age distribution of the disease also varies significantly, with Type 2 diabetes presenting in Asians at a younger age than in Europeans.
(14) Generally, Type 2 diabetes is up to four times more common in British south Asians than in the indigenous white population. South Asians develop diabetes up to ten years earlier
(15) and are more likely to develop renal and cardiac complications.
(16, 17)
The 2002 Survey asked for the first time whether the ethnicity of the people on local registers had been identified. In part this item was included as a means of highlighting this issue and to encourage all areas to collect this important piece of information. As anticipated, few areas have been recording ethnicity routinely. The Survey shows that by September 2002 only six boards had made a start in collecting ethnicity data. Overall, ethnic group has been recorded for 30.9% of those included in the Survey.
Figure 12: Diabetes register: percentage with ethnic group identified
Note: D&G and Fife - do not record ethnic group Lanarkshire - data only available for secondary care
Orkney - this information was not collected in 2001 Survey
In general, despite some examples of good practice, relatively little attention was paid to the specific health care needs of black and minority ethnic groups by the NHS in Scotland until the publication of Fair for All.
(18) This deficiency is now being addressed. An important project is currently being undertaken by the National Resource Centre for Ethnic Minorities (NRCEM) to look at the issues in the context of diabetes, (see box below).
The Scottish Diabetes Core Dataset
(6) includes within it the ethnic groupings used by the Census and which should be adopted throughout Scotland. Ethnicity can be a sensitive issue and people should be asked to self-identify their own ethnic group. Guidance about capturing ethnicity data will be included as part of the NRCEM report.
Epidemiology of Diabetes amongst Black Minority and Ethnic Groups in Scotland The National Resource Centre for Ethnic Minorities (NRCEM), funded by the Scottish Executive Health Department, has been set up within NHS Health Scotland (formerly the Public Health Institute of Scotland) to support NHS Boards meet their responsibilities to deliver culturally competent services and promote race equality. The NRCEM has five core principles that underpin its activities: community development, competence, openness, reliability and equity. The resource centre works as a catalyst encouraging open discussion on the race agenda between participants to foster trust, offer practical advice and facilitate a creative and an innovative environment. As part of its work short term networks will be set up to address specific areas of work. These networks will be inclusive, recognising the wide range of professions, statutory and voluntary organisations and community groups which have the capacity to influence the health of black minority and ethnic groups in specific targeted areas. The networks will aim to develop and strengthen practice, by encouraging working across traditional boundaries. When appropriate networks will include informed patient/s who would be willing to contribute their personal experiences to the specific work. Themed networks will contribute to the overall national development of black minority and ethnic groups health policy by acting as reliable and respected source of advice and in the provision of reports. In response to a recommendation in the Scottish Diabetes Framework the NRCEM has established a Diabetes Themed Network. Its main aim is to actively support the work of NRCEM in the production of a report on the epidemiology of diabetes amongst Scotland's ethnic minorities by providing expertise, strategic direction and approval of the Report for the Scottish Executive. The report is scheduled to be published in September 2003. |