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Public Health. 2018 Apr;157:43-49. doi: 10.1016/j.puhe.2017.12.023. Epub 2018 Feb 22.

Projected diabetes prevalence and related costs in three North American urban centres (2015-2040).

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HEOR Real-World Evidence, Novo Nordisk A/S, Vandtårnsvej 112, 2860 Søborg, Denmark. Electronic address:
Health Advocacy, Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark. Electronic address:
Nutrition Policy and Program Research, National Institute of Public Health, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor. CP. 62508, Mexico. Electronic address:



To explore the future implications of diabetes for urban centres, we projected the prevalence and cost of diabetes from 2015 to 2040 in three very different North American cities: Houston, Mexico City and Vancouver.


We use a simple demographic transition model using existing sources to project future prevalence and financial burden of diabetes.


Based on data from each individual city, projections of the diabetes prevalence and financial burden were created through a three-stage transition model where the likelihood of moving across stages is based on incidence rates for age and gender groups.


According to our projections from 2015 to 2040, diabetes prevalence will approximately double in Houston to 1,051,900 people and in Vancouver to 379,778 people and increase by >1 million to 3,080,013 people in Mexico City. Prevalence rates will increase from 8.5% to 11.7% in Houston, from 9.1% to 11.9% in Mexico City and from 7.2% to 11.3% in Vancouver. Associated costs will rise 1.9-fold to $11.5 billion (in US dollars) in Houston, 1.6-fold to $2.8 billion in Mexico City and 2.1-fold to $2.6 billion in Vancouver.


Unless actions are taken to decrease its incidence, diabetes is expected to increasingly contribute to the societal and financial burden, particularly for urban areas. Resources and policy actions are needed immediately to promote healthy lifestyles and to implement secondary prevention of diabetes complications.


City; Cost; Diabetes; Prevalence; Projection; Urban

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