Diabetes as a Tracer Condition in International Benchmarking of Health Systems
- Ellen Nolte, PHD1,
- Chris Bain, MBBS23 and
- Martin McKee, MD1
- 1European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, U.K
- 2Division of Epidemiology and Social Medicine, School of Population Health and Queensland Institute of Medical Research, University of Queensland, Brisbane, Australia
- 3Department of Social Medicine, University of Bristol, Bristol, U.K
- Address correspondence and reprint requests to Dr. Ellen Nolte, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT London, U.K. E-mail: ellen.nolte{at}lshtm.ac.uk
Abstract
OBJECTIVE—To assess the performance of health systems using diabetes as a tracer condition.
RESEARCH DESIGN AND METHODS—We generated a measure of “case-fatality” among young people with diabetes using the mortality-to-incidence ratio (M/I ratio) for 29 industrialized countries using published data on diabetes incidence and mortality. Standardized incidence rates for ages 0–14 years were extracted from the World Health Organization DiaMond study for the period 1990–1994; data on death from diabetes for ages 0–39 years were obtained from the World Health Organization mortality database and converted into age-standardized death rates for the period 1994–1998, using the European standard population.
RESULTS—The M/I ratio varied >10-fold. These relative differences appear similar to those observed in cohort studies of mortality among young people with type 1 diabetes in five countries. A sensitivity analysis showed that using plausible assumptions about potential overestimation of diabetes as a cause of death and underestimation of incidence rates in the U.S. yields an M/I ratio that would still be twice as high as in the U.K. or Canada.
CONCLUSIONS—The M/I ratio for diabetes provides a means of differentiating countries on quality of care for people with diabetes. It is solely an indicator of potential problems, a basis for stimulating more detailed assessments of whether such problems exist, and what can be done to address them.
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted February 14, 2006.
- Received August 18, 2005.
- DIABETES CARE
