Burden of diabetes in Belgium and Spain : a cross-country evaluation of data availability and quality

Introduction and objective Diabetes mellitus is a chronic metabolic disease and one of the most important non-communicable public health concern. Indeed, in 2030, there would be 366 million people affected of diabetes in the world. The cost due to diabetes is estimated to be 5 to 20% of the total health expenditure worldwide. It is, consequently, a huge public health problem. Epidemiological and clinical information are necessary to help policy makers to establish efficient measures and develop health strategies. DALYs are one of the most appropriate indicator that englobes morbidity and mortality and summarize the burden of the disease. The aim of this thesis is to identify data sources of indicators in two countries, Belgium and Spain, and to assess and compare their quality and usability for estimating DALYs. Method A list of available data sources were identified and reviewed in both countries. Data and indicators were gathered and described. Finally, a check list from The Eurostat Pilot Project Diagnosis-Specific Morbidity Statistics was used and every data source was analyzed following 6 criteria: relevance, accuracy, timeliness, accessibility, comparability and coherence. Results were presented by country and discussed. Results Concerning mortality, Belgium and Spain have similar data bases, while indicators are a bit different. In 2014, Belgian adjusted mortality rate was 14.29/100 000 and that of Spain was 31.35/100 000 in 2015, which doubled the Belgian rate. Men rates are higher than that of women. Most reliable morbidity data bases are the National Health Surveys and Sentinel Network in primary care in both countries. Prevalence was estimated around 5% in Belgium and around 7% in Spain. It was higher in women than in men. The most evident bias detected in the data analysis were misclassification and incomplete coverage in both countries. Conclusions Belgium and Spain generate lots of data about diabetes from similar sources of information. Some of the indicators have standardized procedures, are comprehensive and can be easily used for comparisons between countries, particularly, the mortality indicators and the data from health surveys. However, incidence and prevalence estimates published in scientific research articles or data form registries are often no comparable. Sentinel networks are one of the surveillance system that provides useful and comparable information, although the lack of continuity over the time. DALYs are considered one of the best tools to help policy makers and stake holders to establish measures to control this important public health problem. Improving and supporting standard methods of collecting diabetes information are the only way to get reliable and comparable estimates of the disease in order to calculate DALYs.