Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2002 Jan;56(1):18–23. doi: 10.1136/jech.56.1.18

Estimation of the prevalence of diagnosed diabetes from primary care and secondary care source data: comparison of record linkage with capture-recapture analysis

J Harvey 1, L Craney 1, D Kelly 1
PMCID: PMC1731996  PMID: 11801615

Abstract

Study objective: To compare multiple source linkage and capture-recapture analysis in determining the current age and gender specific prevalence of type 1 and type 2 diabetes in a UK white population. To assess whole population trends in diabetes prevalence and treatment by comparison with previous studies.

Design: Data were obtained from hospital sources and all 74 general practices in the study population. Analyses were carried out both by record linkage and by use of a two source capture-recapture model to correct for incomplete ascertainment.

Setting: County of Clwyd, North Wales: total population 418 200.

Main results: By record linkage the age adjusted prevalence of all diabetes was 2.04 (95% confidence intervals 2.00 to 2.09)% . Using the capture-recapture method it was 2.29 (2.24 to 2.33)%. From capture-recapture data the age adjusted prevalence of type 1 diabetes was 0.40 (0.37 to 0.43)% in men and 0.28 (0.25 to 0.30)% in women; the prevalence of type 2 was 2.03 (1.97 to 2.09)% in men and 1.67 (1.62 to 1.72)% in women. These figures represent an increase compared with previous surveys. The age specific prevalence of type 2 diabetes was greater in men in a ratio of approximately 1.5:1 and there were more patients treated by diet alone.

Conclusions: Record linkage using multiple sources underestimates the prevalence of diabetes compared with capture-recapture estimates. The results suggest the prevalence of known diabetes in the UK has approximately doubled in less than 20 years. There is an increasing preponderance of male patients and of patients treated currently with diet alone.

Full Text

The Full Text of this article is available as a PDF (102.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benett I. J., Lambert C., Hinds G., Kirton C. Emerging standards for diabetes care from a city-wide primary care audit. Diabet Med. 1994 Jun;11(5):489–492. doi: 10.1111/j.1464-5491.1994.tb00312.x. [DOI] [PubMed] [Google Scholar]
  2. Bingley P. J., Gale E. A. Rising incidence of IDDM in Europe. Diabetes Care. 1989 Apr;12(4):289–295. doi: 10.2337/diacare.12.4.289. [DOI] [PubMed] [Google Scholar]
  3. Chesover D., Tudor-Miles P., Hilton S. Survey and audit of diabetes care in general practice in south London. Br J Gen Pract. 1991 Jul;41(348):282–285. [PMC free article] [PubMed] [Google Scholar]
  4. Croxson S. C., Burden A. C., Bodington M., Botha J. L. The prevalence of diabetes in elderly people. Diabet Med. 1991 Jan;8(1):28–31. doi: 10.1111/j.1464-5491.1991.tb01512.x. [DOI] [PubMed] [Google Scholar]
  5. Currie C. J., Kraus D., Morgan C. L., Gill L., Stott N. C., Peters J. R. NHS acute sector expenditure for diabetes: the present, future, and excess in-patient cost of care. Diabet Med. 1997 Aug;14(8):686–692. doi: 10.1002/(SICI)1096-9136(199708)14:8<686::AID-DIA434>3.0.CO;2-D. [DOI] [PubMed] [Google Scholar]
  6. Dunn N. R., Bough P. Standards of care of diabetic patients in a typical English community. Br J Gen Pract. 1996 Jul;46(408):401–405. [PMC free article] [PubMed] [Google Scholar]
  7. Falconer D. S., Duncan L. J., Smith C. A statistical and genetical study of diabetes. I. Prevalence and morbidity. Ann Hum Genet. 1971 May;34(4):347–369. doi: 10.1111/j.1469-1809.1971.tb00248.x. [DOI] [PubMed] [Google Scholar]
  8. Fleming D. M. Diabetes registers in general practice. College reports higher prevalence. BMJ. 1994 Jan 8;308(6921):134–134. doi: 10.1136/bmj.308.6921.134a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Forrest R. D., Jackson C. A., Yudkin J. S. Glucose intolerance and hypertension in north London: the Islington Diabetes Survey. Diabet Med. 1986 Jul-Aug;3(4):338–342. doi: 10.1111/j.1464-5491.1986.tb00776.x. [DOI] [PubMed] [Google Scholar]
  10. Gardner S. G., Bingley P. J., Sawtell P. A., Weeks S., Gale E. A. Rising incidence of insulin dependent diabetes in children aged under 5 years in the Oxford region: time trend analysis. The Bart's-Oxford Study Group. BMJ. 1997 Sep 20;315(7110):713–717. doi: 10.1136/bmj.315.7110.713. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gatling W., Budd S., Walters D., Mullee M. A., Goddard J. R., Hill R. D. Evidence of an increasing prevalence of diagnosed diabetes mellitus in the Poole area from 1983 to 1996. Diabet Med. 1998 Dec;15(12):1015–1021. doi: 10.1002/(SICI)1096-9136(1998120)15:12<1015::AID-DIA719>3.0.CO;2-K. [DOI] [PubMed] [Google Scholar]
  12. Gatling W., Houston A. C., Hill R. D. The prevalence of diabetes mellitus in a typical English community. J R Coll Physicians Lond. 1985 Oct;19(4):248–250. [PMC free article] [PubMed] [Google Scholar]
  13. Gibbins R. L., Saunders J. Characteristics and pattern of care of a diabetic population in mid-Wales. J R Coll Gen Pract. 1989 May;39(322):206–208. [PMC free article] [PubMed] [Google Scholar]
  14. Higgs E. R., Kelleher A., Simpson H. C., Reckless J. P. Screening programme for microvascular complications and hypertension in a community diabetic population. Diabet Med. 1992 Jul;9(6):550–556. doi: 10.1111/j.1464-5491.1992.tb01837.x. [DOI] [PubMed] [Google Scholar]
  15. Howitt A. J., Cheales N. A. Diabetes registers: a grassroots approach. BMJ. 1993 Oct 23;307(6911):1046–1048. doi: 10.1136/bmj.307.6911.1046. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. LaPorte R. E., McCarty D., Bruno G., Tajima N., Baba S. Counting diabetes in the next millennium. Application of capture-recapture technology. Diabetes Care. 1993 Feb;16(2):528–534. doi: 10.2337/diacare.16.2.528. [DOI] [PubMed] [Google Scholar]
  17. Mather H. M., Keen H. The Southall Diabetes Survey: prevalence of known diabetes in Asians and Europeans. Br Med J (Clin Res Ed) 1985 Oct 19;291(6502):1081–1084. doi: 10.1136/bmj.291.6502.1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Meadows P. Variation of diabetes mellitus prevalence in general practice and its relation to deprivation. Diabet Med. 1995 Aug;12(8):696–700. doi: 10.1111/j.1464-5491.1995.tb00572.x. [DOI] [PubMed] [Google Scholar]
  19. Morgan C. L., Currie C. J., Stott N. C., Smithers M., Butler C. C., Peters J. R. Estimating the prevalence of diagnosed diabetes in a health district of Wales: the importance of using primary and secondary care sources of ascertainment with adjustment for death and migration. Diabet Med. 2000 Feb;17(2):141–145. doi: 10.1046/j.1464-5491.2000.00221.x. [DOI] [PubMed] [Google Scholar]
  20. Morris A. D., Boyle D. I., MacAlpine R., Emslie-Smith A., Jung R. T., Newton R. W., MacDonald T. M. The diabetes audit and research in Tayside Scotland (DARTS) study: electronic record linkage to create a diabetes register. DARTS/MEMO Collaboration. BMJ. 1997 Aug 30;315(7107):524–528. doi: 10.1136/bmj.315.7107.524. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Neil H. A., Gatling W., Mather H. M., Thompson A. V., Thorogood M., Fowler G. H., Hill R. D., Mann J. I. The Oxford Community Diabetes Study: evidence for an increase in the prevalence of known diabetes in Great Britain. Diabet Med. 1987 Nov-Dec;4(6):539–543. doi: 10.1111/j.1464-5491.1987.tb00926.x. [DOI] [PubMed] [Google Scholar]
  22. Onkamo P., Vänänen S., Karvonen M., Tuomilehto J. Worldwide increase in incidence of Type I diabetes--the analysis of the data on published incidence trends. Diabetologia. 1999 Dec;42(12):1395–1403. doi: 10.1007/s001250051309. [DOI] [PubMed] [Google Scholar]
  23. Reid D. D., Brett G. Z., Hamilton P. J., Jarrett R. J., Keen H., Rose G. Cardiorespiratory disease and diabetes among middle-aged male Civil Servants. A study of screening and intervention. Lancet. 1974 Mar 23;1(7856):469–473. doi: 10.1016/s0140-6736(74)92783-4. [DOI] [PubMed] [Google Scholar]
  24. Robles S. C., Marrett L. D., Clarke E. A., Risch H. A. An application of capture-recapture methods to the estimation of completeness of cancer registration. J Clin Epidemiol. 1988;41(5):495–501. doi: 10.1016/0895-4356(88)90052-2. [DOI] [PubMed] [Google Scholar]
  25. Simmons D., Williams D. R., Powell M. J. The Coventry Diabetes Study: prevalence of diabetes and impaired glucose tolerance in Europids and Asians. Q J Med. 1991 Dec;81(296):1021–1030. doi: 10.1093/qjmed/81.3.1021. [DOI] [PubMed] [Google Scholar]
  26. Vanderpump M. P., Tunbridge W. M., French J. M., Appleton D., Bates D., Rodgers H., Evans J. G., Clark F., Tunbridge F., Young E. T. The incidence of diabetes mellitus in an English community: a 20-year follow-up of the Whickham Survey. Diabet Med. 1996 Aug;13(8):741–747. doi: 10.1002/(SICI)1096-9136(199608)13:8<741::AID-DIA173>3.0.CO;2-4. [DOI] [PubMed] [Google Scholar]
  27. Williams D. R., Wareham N. J., Brown D. C., Byrne C. D., Clark P. M., Cox B. D., Cox L. J., Day N. E., Hales C. N., Palmer C. R. Undiagnosed glucose intolerance in the community: the Isle of Ely Diabetes Project. Diabet Med. 1995 Jan;12(1):30–35. doi: 10.1111/j.1464-5491.1995.tb02058.x. [DOI] [PubMed] [Google Scholar]
  28. Wittes J., Sidel V. W. A generalization of the simple capture-recapture model with applications to epidemiological research. J Chronic Dis. 1968 Aug;21(5):287–301. doi: 10.1016/0021-9681(68)90038-6. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES