Disease and disability: future trends

By 2018 it is estimated that there will be 7 million older people who cannot walk up a flight of stairs without resting, and 1 million people aged 75+ who find it very difficult to get to their local hospital¹.

'By 2030, the number of older people with care needs – such as help with washing and dressing, is predicted to rise from 2.5 million (2010) to 4.1 million – an increase of 61 per cent².'

More than 70 per cent of people aged over 70, and 55 per cent of people aged over 60 are deaf or hard of hearing. As the population ages the prevalence of hearing loss will grow; by 2031 there are predicted to be 14.5 million people with hearing loss³.

Almost 2 million people in the UK are currently living with sight loss; it is predicted that this could double to nearly 4 million by 2050. This is being driven both by the ageing population – 20 per cent of people aged 75 and 50 per cent of people aged 90 have sight loss – and a growing incidence in some of the underlying causes of sight loss, such as obesity and diabetes⁴.

It is estimated that there are more than 570,000 people with dementia in England, and over the next 30 years that is expected to more than double to 1.4 million⁵.

Dementia is becoming a critically important issue, in terms of both the high personal and social costs related to the disease, and the wider impact on other parts of the health and care system.

Demographic change will drive significant growth in the number of people with dementia, even though the percentage of older people developing some types of dementia (particularly vascular dementia) may decline as a result of reductions in hypertension and other risk factors⁶.

'Research suggests that approximately one in four patients in acute hospitals have dementia – and that these needs are not currently well responded to⁷.'

Staff in acute settings and care homes may need extra training in caring for people with dementia and delirium.

The cost of dementia will rise by 61 per cent to £24 billion by 2026 (at 2007 prices), with most of this cost being met by social care and by individuals and families rather than the NHS⁸. Development of effective preventive interventions could save significant sums of money.

Projected UK dementia trends

Source: Knapp M, Prince M (2007). Report. Dementia UK London School of Economics, King’s College London and The Alzheimer’s Society

1. Magee H, Parsons S, Askham J (2008). Report. Measuring dignity in care for older people. A research report for help the aged Picker Institute Europe and Age UK

2. Snell T, Wittenberg R, Fernandez J L, Malley J, Comas-Herrera A, King D (2011). Discussion Paper. Future Demand for Social Care, 2010 to 2030: Projections of Demand for Social Care and Disability Benefits for Younger Adults in England: Report to the Commission on Funding of Care and Support, PSSRU 2800/2.

3. Action on hearing loss (2012). Statistical Bulletin. Facts and figures on hearing loss

4. Royal National Institute of Blind People (2012). Statistical Bulletin. Key information and statistics

5. Department of Health (2009). Report. Living well with dementia. A national dementia strategy

6. Snell T, Wittenberg R, Fernandez JL, Malley J, Comas-Herrera A, King D (2011). Report. Projections of Demand for Social Care and Disability Benefits for Younger Adults in England. Report of Research Conducted for the Commission on Funding of Care and Support. PSSRU Discussion paper 2800/3.

7. Lakey (2009). Report. Counting the Costs. Caring for people with dementia on hospital wards. Alzheimer’s Society

8. McCrone P, Dhanasiri S, Patel A, Knapp M, Lawton-Smith S (2008). Report. Paying the Price. The costs of mental health care to 2026. The King’s Fund

Infant mortality rates (deaths under one year old) have decreased from 63.1 per 1,000 live births in 1930 to 4.5 per 1,000 in 2010, the lowest on record. Neonatal mortality rates (deaths under 28 days old) have also fallen from 31.5 per 1,000 live births in 1930 to 3.1 per 1,000 in 2010¹. However, not all groups in society have benefited equally from this improvement.

Population-based vaccination programmes have greatly reduced the burden of infectious diseases. In the UK, children at two years of age should receive doses of  vaccination against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type B². The percentage of those who complete these routine vaccinations ranged from 85.3 per cent to 99.2 per cent across primary care trusts in England in 2009/10. A triple vaccine was produced for mumps, measles and rubella (MMR), but after some adverse publicity, take-up ranged from 73 per cent to 96.7 per cent³. These variable rates have triggered recent outbreaks of measles and whooping cough⁴.

By 2030 it is estimated that the number of younger adults with learning disabilities (aged 18-64) may rise by 32.2 per cent⁵; mortality among people with learning disabilities and children with severe and complex needs has reduced in recent years⁶.

1. Sweet D (2011). Report. Social Trends 41 – Health. Office for National Statistics

2. Department of Health (2010). Report. Routine childhood immunisation from November 2010

3. Rightcare (2012). Report. NHS Atlas of variation in health care for children and young people

4. Health Protection Agency (2012). Press release. HPA reports continued increase in whooping cough cases

5. Snell T, Wittenberg R, Fernandez J-L, Malley J, Comas-Herrera A, King D (2011). Report. Projections of Demand for Social Care and Disability Benefits for Younger Adults in England. Report of Research Conducted for the Commission on Funding of Care and Support. PSSRU Discussion paper 2800/3

6. Emerson and Hatton (2008). Report. Estimating future need for adult social care services for people with learning disabilities in England

As well as affecting personal wellbeing, relationships and family life, sexually transmitted infections are a major cause of serious health problems, including pelvic inflammatory disease, ectopic pregnancy, infertility and cervical cancer.

Incidence of sexually transmitted infections is high and has been increasing in England for the past 20 years¹.

Almost half a million people in the UK have a sexually transmitted disease and one in ten young people diagnosed with a sexually transmitted infections become re-infected within a year¹.

Rates are also increasing among older groups – where the incidence rate has more than doubled to 13,000 (for those aged 45 and over between 2000 and 2009)². Traditionally public health campaigns are not aimed at older age groups^2,3.

A key concern in the treatment of sexually transmitted infections is the emergence of multi-drug resistant gonorrhoea⁴.

The number of people living with HIV has more than doubled in the past 10 years, but the number of cases of AIDS has remained stable.

HIV (human immunodeficiency virus) is a virus that infects and gradually destroys the cells of the body's immune system. When the number of these cells drops so low that the immune system is weakened, the patient is vulnerable to multiple diseases, such as cancer and pneumonia, a condition that is called late-stage HIV or AIDS (acquired immune deficiency syndrome)^5,6.

More than 6,000 new cases of HIV are diagnosed every year in the UK, and despite sexual health promotion, a recent decline appears to be levelling out⁶. Just over half of people diagnosed in the UK acquired the infection here¹.

HIV and AIDS diagnoses and people living with diagnosed HIV in the United Kingdom, 2001-2010

Source: Health Protection Agency (2011). Report. HIV in the United Kingdom

However, the number of people dying due to late-stage HIV or AIDS has not risen since 1998, mainly because of the effectiveness of HIV drugs. There is a rising number of people living with HIV – more than double the number 10 years ago⁶ – who have an ongoing need for health and social care.

HIV has a greater impact in urban areas, and this is unlikely to change. About 40 per cent of HIV cases are within London, with certain boroughs having a particularly high prevalence⁷.

New or re-emerging infectious diseases are unpredictable in their timing and impact.

The impact of new and re-emerging infectious diseases in the future is uncertain.

SARS emerged in Guangdong province in China in 2002 and rapidly spread to many other countries, including the UK, causing more than 700 deaths worldwide⁸. But new strains of flu will not neccessarily transmit to humans: bird flu first emerged as a threat in 1997 and again in 2003, but has not yet caused a pandemic, while swine flu caused an immediate pandemic in 2009^9,10.

There are also threats from re-emerging communicable diseases, such as tuberculosis (TB), which were previously thought to be controlled in the UK¹¹. The highest rates of TB are in London, with major problems in certain boroughs: homeless people, prisoners and problem drug users are at particular risk¹². Rates are also 21 times higher in those born outside the UK than those born in the UK, with most people affected by TB coming from South Asia and sub-Saharan Africa¹¹. Although migration is high in London, other urban areas have significant problems with TB – for example, 11 per cent of cases in 2010 were in the West Midlands¹¹.

Drug resistant disease

Antibiotics kill or interfere with the growth of micro-organisms, especially bacteria. Since the introduction of penicillin in the 1940s, antimicrobial medicines have been used to treat many infectious diseases including pneumonia and TB.

Antimicrobial medicines also help reduce the risk of complications after surgery and chemotherapy and support the care of premature babies.

In recent years microbes have emerged that are resistant to antimicrobial medicines, making these treatments ineffective and enabling infection to spread. Some bacteria are naturally resistant; new resistances also arise spontaneously and then multiply. An estimated 25,000 patients die in the EU each year from multi-drug resistant bacteria¹³.

The more antibiotics are used, the greater the risk of resistant strains developing. The resistant bacteria then spread through direct contact. Resistance is a particular problem in hospitals and places like care homes for older people, where vulnerable people are gathered together. Patients in hospital also often need antibiotics, and intensive use means resistant bacteria are more likely to emerge. The problem is compounded by failure to develop new antibiotics that can deal with the new resistant strains.

The European Union and the World Health Organisation have both identified antimicrobial resistance as a priority. The current focus is on improving surveillance, reducing unnecessary prescribing of antibiotics and supporting the search for new antibiotics¹³.

The impact of infectious diseases in the future is uncertain, it is also possible that some existing communicable diseases may be eradicated.

1. Health Protection Agency (2011). Report. Annual Report and Accounts 2010/11. London: The Stationery Office

2. Family Planning Association (2010). Report. ‘FPA warns of rising STIs and poor sexual health in the over 50s’

3. Bodley-Tickell AT, Olowokure B, Bhaduri S, White DJ, Ward D, Ross JDC, Smith G, Duggal HV, Goold P on behalf of West Midlands STI Surveillance Project (2008). Report. ‘Trends in sexually transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system’. Sexually Transmitted Infections, vol 84, pp 312-7

4. World Health Organization (2011). Factsheet. Emergence of Multi-Drug Resistant Neisseria Gonorrhoeae - Threat of Global Rise in Untreatable Sexually Transmitted Infections

5. Terrence Higgins Trust (2012). Report. ‘What are HIV and AIDS?’. Terrence Higgins Trust website

6. Health Protection Agency (2011). Report. HIV in the United Kingdom: 2011 report. London: Health Protection Services, Colindale.

7. Ruf M, Korkodilos M, Harris J, Foreman C (2011). Report. London Adult HIV Health Needs Assessment: Executive Summary. London: NHS London

8. World Health Organization (2004). Report. ‘Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003.’

9. Department of Health (2011). Report. UK Influenza Pandemic Preparedness Strategy 2011

10. Health Protection Agency (2012). Report. Pandemic influenza

11. Health Protection Agency (2011). Report. Tuberculosis in the UK: 2011 report

12. National Institute for Health and Clinical Excellence (2012). Identifying and managing tuberculosis among hard-to-reach groups. NICE public health guidance 37

13. ECDC/EMEA (2009). Report. The bacterial challenge: time to react

About 15 million people in England have a long-term condition (1). Long-term conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment, for example: diabetes, chronic obstructive pulmonary disease, arthritis and hypertension.

Long-term conditions are more prevalent in older people (58 per cent of people over 60 compared to 14 per cent under 40) and in more deprived groups (people in the poorest social class have a 60 per cent higher prevalence than those in the richest social class and 30 per cent more severity of disease)¹.

'People with long-term conditions now account for about 50 per cent of all GP appointments, 64 per cent of all outpatient appointments and over 70 per cent of all inpatient bed days.'

Treatment and care for people with long-term conditions is estimated to take up around £7 in every £10 of total health and social care expenditure¹.

Projections for the future of long-term conditions are not straightforward. The Department of Health (based on self-reported health) estimates that the overall number of people with at least one long-term condition may remain relatively stable until 2018. However, analysis of individual conditions suggests that the numbers are growing, and the number of people with multiple long-term conditions appears to be rising¹.

Most individual long-term conditions are more common in people from lower socio-economic groups, and are usually more severe even in conditions where prevalence is lower – for example, stroke. General Household Survey data (2006), analysed by the Department of Health below, shows those from unskilled occupations (52 per cent) suffer from long-term conditions more than groups from professional occupations (33 per cent).

Key: I Professional, etc, occupations, II Managerial and technical occupations, III Skilled occupations, (N) Non-manual, (M) Manual, IV Partly skilled occupations, V Unskilled occupations.

Source: Department of Health analysis of General Household Survey 2006

'Some people living in a deprived area will have multiple health problems 10–15 years earlier than people in affluent areas'

The number of people with three or more long-term conditions is predicted to rise from 1.9 million in 2008 to 2.9 million in 2018¹.

The ageing population and increased prevalence of long-term conditions have a significant impact on health and social care and may require £5 billion additional expenditure by 2018¹. 

Multi-morbidity is more common among deprived populations – especially those that includes a mental health problem² – and there is evidence that the number of conditions can be a greater determinant of a patient's use of health service resources than the specific diseases³.

There will be rising demand for the prevention and management of multi-morbidity rather than of single diseases².

Patterns of selected co-morbities between most affluent and most deprived deciles

Source: Barnett K, Mercer SW, Norbury M, Watt G, Wyke S and Guthrie B (2012). Research paper. Epidemiology of multi-morbidity and implications for health care, research and medical education: a cross-sectional study The Lancet online

1. Department of Health (2012). Report. Long-term conditions compendium of Information: 3rd edition

2. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012). Research paper. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study The Lancet online

3. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S and Guthrie B (2012). Research paper. Epidemiology of multi- morbidity and implications for health care, research and medical education: a cross- sectional studyThe Lancet online

Physical health problems significantly increase the risk of poor mental health, and vice versa.

Around 30 per cent of all people with a long-term physical health condition also have a mental health problem, most commonly depression/anxiety¹.

Mental health problems can seriously exacerbate physical illness, affecting outcomes and the cost of treatment. The effect of poor mental health on physical illnesses is estimated to cost the NHS at least £8 billion a year².

'Medically unexplained physical symptoms often have a basis in poor mental health and are estimated to cost the NHS £3 billion each year³.'

People with severe mental illnesses also have significantly higher rates of physical illness – with a dramatic effect on life-expectancy.

Overlap between long-term conditions and mental health problems in England

Source: Naylor C, Parsonage M, McDaid D, Knapp M, Fossey M, Galea A (2012). Report. Long-term conditions and mental health. The cost of co- morbiditiesThe King's Fund and Centre for Mental Health

The prevalence of most adult mental health problems has remained roughly constant over the past 20 years. However, there is evidence that child mental health problems have become more common.

Prevalence of mental health problems in England

Source: Adult figures: Green H, McGinnity A, Meltzer H, Ford T, Goodman R (2005). Report. Mental health of children and young people in Great Britain. Crown Copyright.  Basingstoke: Palgrave Macmillan. Children figures: McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R (2009). Research paper. Adult Psychiatry Morbidity in England, 2007: Results of a household survey. Leeds: NHS Information Centre.

Prolonged economic instability can be expected to increase demand for mental health services, as there is a close link between unemployment, debt and mental health problems – particularly depression and anxiety⁴.

Time trends in prevalence of depression/anxiety disorders in England

Source: Maybin J and Thorlby R (2010). Report. A high performing NHS? A review of progress 1997- 2010 The King’s Fund 

Many of those with diagnosable mental health problems receive no formal treatment, which raises the question of whether current service models are fit for purpose and whether resourcing is adequate.

1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012). Research paper. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study The Lancet online 

2. Naylor C, Parsonage M, McDaid D, Knapp M, Fossey M, Galea A (2012). Report. Long-term conditions and mental health. The cost of co- morbiditiesThe King's Fund and Centre for Mental Health

3. Bermingham et al (2010). Research paper. The cost of somatisation among the working-age population in England for the year 2008–09’. Mental Health in Family Medicine Vol 7, no 2, pp 71–84

4. Bungum T (2012). Research paper. The Impact of Unemployment on Mental and Physical Health, Access to Health Care and Health Risk Behaviors. ISRN Public Health 10.5402/2012/483432

Advances in diagnosis and treatment have led to reductions in premature deaths from major causes such as heart disease, strokes, respiratory disease and infectious disease, as clearly seen in the trend graphs below.

Male age-standardised mortality rates by major cause, England and Wales 1951-2010

Source: Office for National Statistics (2011). Data. Social trends 41

Female age-standardised mortality rates by major cause, England and Wales 1951-2010

Source: Office for National Statistics (2011). Data. Social trends 41

It is estimated that there are 2 million people in the UK with a major neurological condition¹ – including about 600,000 with epilepsy² and 127,000 with Parkinson's disease³.

'The burden on health and social care is high: 1 million people are disabled by their neurological condition and 350,000 require help with daily activities⁴ – and as many as 1 in 10 emergency medical admissions are for neurological problems⁵.'

Some neuro-developmental disorders such as epilepsy and Parkinson's disease are more common in old age – the number of people in the UK with Parkinson's disease is estimated to rise by 27 per cent between 2009 and 2020³.

Prevalence rates for Parkinson's disease in the UK, 2009

Source: Parkinson’s UK (2009). Report. Parkinson's Prevalence in the UK

Musculoskeletal disease is one of the most prevalent long-term conditions, affecting 137 people per 1,000 reporting a long-term condition⁶.

Osteoarthritis (a degenerative disease of joints, causing pain and stiffness, and leading to a decline in physical function) is the most common reason for hip or knee replacement⁷.

Back pain affects 4 out of 5 people at some time in their life; 2 out of 5 have had back pain for more than a day during the past year⁸.

Osteoporosis (a reduction in bone mineral density which increases the risk of bone fractures especially after falls) is estimated to cause one in two women and one in five men over the age of 50 to break a bone⁹. In the future computer-aided diagnosis could become useful in the detection of osteoporosis.

Musculoskeletal problems already account for up to 30 per cent of all GP appointments, and 60 per cent of people on long-term sick leave have a musculoskeletal condition⁸.

There are currently no cures for many musculoskeletal diseases – intervention for osteoarthritis, for example, concentrates on trying to avoid or delay the need for joint replacement.

Current trends

• Musculoskeletal problems are expected to rise significantly between now and 2030 with the ageing population, increasing rates of obesity and low rates of physical activity. For example, the number of people with arthritis in the UK is expected to rise from 8.5 million to 17 million, causing an increased demand for joint replacement⁷.

• Admissions for hip fracture could rise by as much as 40 to 57 per cent over the next 20-25 years⁹. The health and social care risks from hip fracture are high – nearly 1 in 10 people die within 1 month after a hip fracture¹⁰ and only 46 per cent return to their usual residence¹¹.

The major respiratory diseases are asthma, chronic obstructive pulmonary disease (COPD), pneumonia, tuberculosis, cystic fibrosis, lung cancer, occupational lung disease, sleep apnoea and scarring lung diseases.

'Respiratory diseases kill one in five people in the UK and cost the NHS more than £6 billion.'

In 2004, an estimated 1 million hospital admissions, 24 million GP consultations  and more than 62 million prescriptions were for respiratory diseases, and respiratory conditions are the most commonly reported long-term illness in children and babies¹².

Mortality rates from respiratory disease are higher in the UK than both the European and EU average. In addition, more than two in five of all deaths (44 per cent) from respiratory diseases are associated with social class inequalities¹².

Chronic obstructive pulmonary disease

Around 835,000 people in the UK have been diagnosed with COPD, but there may be an additional 2 million people living with the disease who have not been diagnosed. The prevalence of COPD is projected (model-based) to rise from 1.6 million in England in 2010 (including undiagnosed cases) to 1.8 million in 2020¹³.

The most important risk factor for COPD is smoking. The decline in smoking rates overall may reflect in the future incidence and prevalence of COPD. However, the higher prevalence of smoking in more deprived areas may lead to greater inequality in the prevalence of COPD. Mortality rates for COPD has declined from 36 per 100,000 in 1993 to 25.2 per 100,000 in 2010. This trend is expected to continue as a result of  improvements in prevention and treatment¹³.

Asthma

It is estimated that 5.4 million people in the UK are currently receiving treatment for asthma – 1.1 million children and 4.3 million adults. The number of children with asthma has declined since the early 1990s, as has the prevalence in adults. A risk factor for asthma is deprivation, with prevalence highest in the lowest income quintiles. The number of deaths from asthma is relatively small – 955 in England in 2010 (14).

The major diseases of the heart and circulatory system – coronary heart disease and stroke – are the biggest causes of death in the UK.

Coronary heart disease and stroke are caused by the same condition – atherosclerosis, which is the narrowing of the arteries with fatty materials called atheroma. Other heart and circulatory conditions can be caused by congenital heart problems or infections, or follow a heart attack. Heart failure is one of the most common long-term conditions, affecting around 670,000 people in the UK¹⁵.

Coronary heart disease

The prevalence of coronary heart disease increases with age, and lifestyle factors such as diet, physical inactivity, obesity, high blood pressure, smoking and alcohol significantly increase the risk, with smoking the most significant risk factor.

'The prevalence of coronary heart disease is projected to rise from 2.4 million in 2010 to 2.8 million in 2020 in England¹⁶.'

But the mortality rates have more than halved between 1993 and 2010.

More than half of this reduction (58 per cent) is attributable to reductions in major risk factors, principally smoking, and the rest to treatments, including secondary prevention¹⁶.

As in many disease areas, the prevalence and incidence of coronary heart disease is not equally distributed in the population, and 32 per cent of people with heart disease in the most deprived areas also have a co-existing condition versus 16 per cent in the most affluent areas¹⁷.

Medication can lower cholesterol levels and blood pressure and reduce the risk of heart attacks; an estimated 4.2 million people in England are taking statins to reduce their cholesterol levels¹⁸. Recent clinical trials indicate that a 'poly pill' may reduce the risk of heart attacks and stroke by up to 80 per cent¹⁹. In the past 10 years the proportion of patients over 75 who suffered from heart disease and had heart bypass surgery increased from 2.2 per cent to 10 per cent¹⁵.

In the longer term, stem cells may allow hearts or other tissue to be grown for transplantation²⁰; gene and cytokine therapies could become an alternative to angioplasty or bypass surgery, and may even do away with the need for some drugs²¹.

Stroke

Prevalence of stroke increases with age, but other key risk factors are high blood pressure and obesity. Nearly 40 per cent of men and more than 30 per cent of women in England have high blood pressure, and the prevalence of obesity is expected to rise in the future.

Mortality rates from stroke halved from 1993 to 2010, and this trend is expected to continue as a result of continued improvements in treatment. Many conditions that contribute to the risk of stroke can also be managed with medication²².

Implications

There is likely to be a growing burden of heart and circulatory disease arising from the ageing population and lifestyle factors. However, modest reductions in cholesterol levels, blood pressure and smoking could reduce deaths from cardiovascular disease. Reducing obesity would also make an impact.

It is estimated that over 1 in 20 people in England has diabetes (diagnosed and undiagnosed)²³.

Diabetes mellitus is characterised by raised blood glucose levels. There are two types, type 1 and type 2:

• Type 1 diabetes occurs when there is an absolute lack of the hormone insulin, which means that glucose cannot be converted and used by the body. Generally, this occurs before the age of 40. It is the less common type, affecting around 15 per cent of those with diabetes.

• Type 2 diabetes develops when there is a varying combination of insulin deficiency and resistance. In most cases, this is linked with being overweight. It usually affects people over the age of 40, though in South Asian people, it often appears after the age of 25²³.

An increasing number of children are being diagnosed with diabetes. There are almost 23,000 people under the age of 17 with diabetes in England (97 per cent have type 1 diabetes, 1.5 per cent type 2 and 1.5 per cent are recorded as 'other')²⁴.

Effective disease management is critical to the success of current treatment regimes. The development of remote monitoring devices will support this²⁵.

Complications and risks from diabetes

When diabetes is poorly managed, it can have serious complications, including heart disease, stroke, blindness, kidney disease, nerve damage and amputations, leading to disability and premature mortality²⁶.

Treatment aims to prevent or slow down the progress of complications. Diabetes also increases the damage done by some of the major risk factors for coronary heart disease – smoking, high blood pressure and high cholesterol. Average life expectancy is therefore reduced, by 20 years in people with type 1 and by 10 years in those with type 2 diabetes²³. The mortality rate for diabetes in England has fallen recently, but more than one in ten (11.6 per cent) deaths among 20-79-year-olds can be attributed to diabetes²⁷.

Future trends for diabetes

'The number of people diagnosed with diabetes rose from 1.4 million in 1996 to 3.1 million in 2010, and by 2025 it is estimated that it will rise to  more than 4 million, a 29 per cent rise²⁶.'

Type 2 diabetes has a strong association with obesity, and the prevalence of obesity is increasing in the adult population in England (from 20 per cent in 1993 to 26 per cent in 2010, with an estimated 37 per cent of men and 34 per cent of women likely to be obese by 2020)²⁶. During the next 20 years, obesity-attributable disease risks are predicted to add an excess of 544,000-668,000 cases of diabetes²⁸.

Treatment options

A number of medical advances aim to improve prevention and health outcomes for diabetes. Clinical trials are under way for artificial pancreas systems, which deliver insulin and glucagon in response to blood sugar levels, while transplantation of insulin-producing islet cells or pancreatic stem cells could provide a cure for type 1 diabetes. Personalised genomic profiling will be able to indicate a pre-disposition to diabetes and suggest appropriate preventive measures. Alternative methods of delivering insulin, including inhalation and oral administration, could replace the need for injections. Research into the regulation of insulin gene expression and the process of insulin synthesis could identify pharmacological means to enhance insulin output in type 2 diabetes²⁴.

Implications

Overall there will be a growing burden of disease linked to the increased prevalence of diabetes, caused by both the condition itself and its associated complications. This burden can be reduced by tackling the high prevalence of obesity and by good management of diabetes.

There are more than 200 types of cancer that can occur anywhere in the body; each has different causes, different symptoms and requires different treatment. Evidence suggests that half of all cases of cancer could be avoided if people made changes to their lifestyle. Tobacco smoking alone is estimated to cause more than a quarter of all deaths from cancer²⁹. The other major factor is age: 63 per cent of cases are diagnosed in people aged 65 and over³⁰.

Cancer incidence and mortality

'Around 300,000 people are diagnosed with cancer in the UK each year and around 130,000 people in England die from cancer annually³⁰.'

Overall incidence of cancer has increased by almost a third since the mid 1970s, but the rates have been fairly stable since the late 1990s and are expected to remain so. This is because the incidence of some cancers has reduced as the incidence of others has risen. For example, there have been large increases in the incidence of some potentially avoidable cancers over recent years – such as malignant melanoma, liver and oral cancers – but a reduction in male lung cancer and stomach and bladder cancers³⁰. See the percentage change in incidence rates for the 20 most common cancers

Actual and predicted incidence in the UK of all cancers

While incidence rates are stable for different ages groups, the number of new cases of cancer is predicted to rise significantly between 2011 and 2030, mainly due to the ageing population. Deaths from cancer in the UK have fallen by 20 per cent over the past 30 years and by 9 per cent over the past decade. If England was to achieve cancer survival rates at the European average, an additional 5,000 lives would be saved per year and at the European best, an additional 10,000 lives. The current strategy is to save an additional 5,000 lives each year by 2014/15³¹.

Living with cancer

At present there are approximately 1.8 million people living with a diagnosis of cancer in England. The number of cancer survivors in England is expected to nearly double to 3 million by 2030. This rise is significant as people who have survived cancer often have worse health overall than the rest of the population and make more use of all types of health care. The effects of cancer treatment can persist for years- lymphoedema, bladder and bowel problems, and infertility. Cancer also often leads to psychosocial problems³¹.

The effects of living with cancer

Source: Department of Health, Macmillan Cancer Support, NHS Improvement (2010). Report. National cancer survivorship initiative vision cancer treatment

Scientists are optimistic about the future of cancer treatment. Expanding knowledge of genetics can help to predict an individual's risk of developing cancer, detect and diagnose cancer early, and select treatments that are most likely to be effective³¹. Increased understanding of the underlying cellular processes would also enable treatment to fix the specific molecular problems in a tumour that drive its growth. Ultimately the genetic revolution may lead to ways of preventing cancer, such as cancer vaccines³². 

Within the next decade new imaging techniques and computer-assisted diagnosis should be able to detect irregular growth very early, while treatments such as high-intensity, focused ultrasound and the CyberKnife could be used more widely to target tumours without damaging healthy cells³³.

Implications

While the incidence of cancer is relatively stable, the number of cases is rising. Cancer, once fatal disease, is becoming a chronic disease with a burden of long-term ill health associated with it.

1. National Audit Office (2011). Report. Services for people with neurological conditions

2. Joint Epilepsy Council of the UK and Ireland (2011). Report. Epilepsy Prevalence, Incidence and Other Statistics

3. Parkinson’s UK (2009). Report. Parkinson’s Prevalence in the UK

4. The Neurological Alliance (2003). Report. Neuro Numbers: A brief review of the numbers of people in the UK with a neurological condition

5. Royal College of Physicians (2011). Report. Local Adult Neurology Services for the Next Decade. Report of a working party.

6. Office for National Statistics (2009). Statistical Bulletin. General Lifestyle Survey - Health Tables 2009. Tables 7.11

7. Arthritis Care (2011). Report. Understanding Arthritis   

8. Department of Health (2006). Report. The Musculoskeletal Services Framework

9. Age UK (2012). Report. Later Life in the United Kingdom

10. National Institute for Health and Clinical Excellence (2011). Report. Hip Fracture: The management of hip fracture in adults. Clinical guideline 124

11. Association of Public Health Observatories (2008). Report. Indications of Public Health in the English Regions 9: Older People

12. British Thoracic Society (2006). Report. The Burden of Lung Disease: A statistics report from the British Thoracic Society

13. Association of Public Health Observatories (2008). Data. Modelled estimates and projections of COPD for PCTs in England

14. Hall J, Mindell J (2011). Report. Health Survey for England 2010. Chapter 2: Respiratory symptoms and disease in adults

15. Department of Health (2005). Report. The Coronary Heart Disease National Service Framework; Leading the way- progress report 2005

16. Association of Public Health Observatories. Data.  Disease prevalence models

17. Wald NJ, Law MR (2003). Research paper. A strategy to reduce cardiovasular disease by more than 80%

18. National Institute of Health and Clinical Excellence (2007). Report. NICE implementation uptake report: statins

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