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Cited by 84Diabetes and associated disordersDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

Secular trends in incidence of type 1 and type 2 diabetes in Hong Kong: A retrospective cohort study

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Luk, Andrea O. Y., Ke, Calvin, Lau, Eric S. H., Wu, Hongjiang, Goggins, William, Ma, Ronald C. W., Chow, Elaine, Kong, Alice P. S. +2 more·2020·PLOS Medicine
DOI 10.1371/journal.pmed.1003052PMC PMC7032690
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Abstract

BACKGROUND: There is very limited data on the time trend of diabetes incidence in Asia. Using population-level data, we report the secular trend of the incidence of type 1 and type 2 diabetes in Hong Kong between 2002 and 2015. METHODS AND FINDINGS: The Hong Kong Diabetes Surveillance Database hosts clinical information on people with diabetes receiving care under the Hong Kong Hospital Authority, a statutory body that governs all public hospitals and clinics. Sex-specific incidence rates were standardised to the age structure of the World Health Organization population. Joinpoint regression analysis was used to describe incidence trends. A total of 562,022 cases of incident diabetes (type 1 diabetes [n = 2,426]: mean age at diagnosis is 32.5 years, 48.4% men; type 2 diabetes [n = 559,596]: mean age at diagnosis is 61.8 years, 51.9% men) were included. Among people aged <20 years, incidence of both type 1 and type 2 diabetes increased. For type 1 diabetes, the incidence increased from 3.5 (95% CI 2.2-4.9) to 5.3 (95% CI 3.4-7.1) per 100,000 person-years (average annual percentage change [AAPC] 3.6% [95% CI 0.2-7.1], p < 0.05) in boys and from 4.3 (95% CI 2.7-5.8) to 6.4 (95% CI 4.3-8.4) per 100,000 person-years (AAPC 4.7% [95% CI 1.7-7.7], p < 0.05] in girls; for type 2 diabetes, the incidence increased from 4.6 (95% CI 3.2-6.0) to 7.5 (95% CI 5.5-9.6) per 100,000 person-years (AAPC 5.9% [95% CI 3.4-8.5], p < 0.05) in boys and from 5.9 (95% CI 4.3-7.6) to 8.5 (95% CI 6.2-10.8) per 100,000 person-years (AAPC 4.8% [95% CI 2.7-7.0], p < 0.05) in girls. In people aged 20 to <40 years, incidence of type 1 diabetes remained stable, but incidence of type 2 diabetes increased over time from 75.4 (95% CI 70.1-80.7) to 110.8 (95% CI 104.1-117.5) per 100,000 person-years (AAPC 4.2% [95% CI 3.1-5.3], p < 0.05) in men and from 45.0 (95% CI 41.4-48.6) to 62.1 (95% CI 57.8-66.3) per 100,000 person-years (AAPC 3.3% [95% CI 2.3-4.2], p < 0.05) in women. In people aged 40 to <60 years, incidence of type 2 diabetes increased until 2011/2012 and then flattened. In people aged ≥60 years, incidence was stable in men and declined in women after 2011. No trend was identified in the incidence of type 1 diabetes in people aged ≥20 years. The present study is limited by its reliance on electronic medical records for identification of people with diabetes, which may result in incomplete capture of diabetes cases. The differentiation of type 1 and type 2 diabetes was based on an algorithm subject to potential misclassification. CONCLUSIONS: There was an increase in incidence of type 2 diabetes in people aged <40 years and stabilisation in people aged ≥40 years. Incidence of type 1 diabetes continued to climb in people aged <20 years but remained constant in other age groups.

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  • In Hong Kong, annual type 1 diabetes mellitus incidence varied between 0.73 and 1.83 per 100,000 among men and between 0.64 and 1.09 per 100,000 among women aged ≥60 years between 2013 and 2015.

    “In a population-based Hong Kong study, annual incidence varied between 0.73 and 1.83 per 100,000 persons among men and between 0.64 and 1.09 per 100,000 persons among women aged ≥60 years19 between 2013 and 2015.”

    From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [19]

    The Results section (‘Trends in incidence of type 1 diabetes’; page unavailable) reports type 1 diabetes incidence by age and sex in Hong Kong and says incidence among adults remained stable over time. Our copy does not give the claimed 2013–2015 incidence ranges for men and women aged ≥60; the 0.73 in Table 1 is a p-value, not an incidence rate. (LLM, conf=0.82)

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Cited by

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Authors
Luk, A. O. Y., Ke, C., Lau, E. S. H., Wu, H., Goggins, W., Ma, R. C. W., Chow, E., Kong, A. P. S., So, W.-Y., & Chan, J. C. N.
Affiliations
  • Chinese University of Hong Kong (HK)
  • Hospital Authority (HK)
Corresponding author
Luk, Andrea O. Y.
ORCID
Venue
PLOS Medicine
Publisher
Public Library of Science (PLoS)
Published
2020-02-20
Volume
17
Issue
2
Pages
e1003052
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1003052
PMC
PMC7032690
OpenAlex
W3007112529
Cited by
84
References
1
Citations by year
2026: 5 · 2025: 13 · 2024: 14 · 2023: 17 · 2022: 14 · 2021: 11 · 2020: 10
FWCI
7.62
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • Amgen
  • Pfizer
  • AstraZeneca
  • Sanofi
  • Innovation and Technology Commission
  • Hospital Authority
  • Novo Nordisk
  • Chinese University of Hong Kong
  • Hong Kong Government
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 1 diabetes, type 2 diabetes, diabetes incidence, secular trends, Hong Kong, sex differences, age at diagnosis, diabetes surveillance, Asia, age-standardized incidence rate, joinpoint regression, diabetes prevention policy, public health policy evaluation, diabetes self-management education
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Hong Kong, Humans, Infant, Infant, Newborn, Male, Middle Aged, Population Growth, Regression Analysis, Retrospective Studies, Cohort Studies, Incidence, Age Distribution, Sex Distribution, Young Adult

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