Secular Trends in Admissions and Mortality Rates from Diabetes Mellitus in the Central Belt of Ghana: A 31-Year Review

Introduction: Diabetes Mellitus is currently a leading cause of morbidity and mortality throughout the world, particularly in sub-Saharan Africa where a significant proportion of diabetes cases are now found. Longitudinal profiling of in-patient admissions and mortality trends from diabetes provide useful insights into the magnitude of the burden of diabetes, serve as a sentinel on the state of out-patient diabetes care and provide effective tools for planning, delivering and evaluating the health care needs relating to the disease in sub-Saharan Africa.

Objective: To evaluate the 31-year trend in diabetic admissions and mortality rates in central Ghana.

Methods: This is a retrospective analysis of data on diabetes admissions and deaths at a tertiary referral hospital in central Ghana between 1983 and 2014. Rates of diabetes admissions or deaths were expressed as diabetes admissions or deaths divided by the total number of admissions or deaths respectively. Yearly crude fatality rates for diabetes were calculated. Trends were analysed for in patient diabetes admissions and mortality for the period. Predictors of diabetes mortality were determined using multiple logistic regression.

Results: A total of 11,414 diabetes patients were admitted over the period with a female predominance; female:male ratio of 1.3:1.0. Over the study period, diabetes admission rates increased significantly from 2.36 per 1000 admissions in 1983 to 14.94 per 1000 admissions in 2014 (p<0.0001for linear trend), representing a 633% rise over the 31-year period. In-patient diabetes fatality rates increased from 7.6 per 1000 deaths in 1983 to 30 per 1000 deaths in 2012. The average 28-day mortality rate was 18.5%. The median age of patients increased significantly over the period. So was the proportion of females admitted over the years. Predictors of in-patient mortality were increasing age- aOR of 1.23 (CI: 1.15-1.32) for age > 80 years compared with < 20 years, admissions in 2000s compared to 1980s-aOR of 1.56 (1.21-2.01), male gender-aOR of 1.45 (1.19-1.61), the presence of glycemic complications such as ketoacidosis- aOR-2.67(CI: 2.21-3.21), hyperosmolar hyperglycemic states- aOR 1.52 (1.33-1.73) symptomatic hypoglycemia- aOR 1.64 (1.24-2.17) and presence of end organ complications including peripheral neuropathic ulcers- aOR 1.31 (1.12-1.56), nephropathy- aOR -1.11 (1.03-1.23), cerebrovascular disease-aOR-1.52 (1.32-1.98), coronary artery disease- aOR-3.21 (1.91-5.15) and peripheral artery disease- aOR-1.15 (1.12-1.21) were associated with increased risk of death compared with normoglycemic diabetic admissions and admissions without end organ complications respectively.

Conclusion: Diabetes admission and mortality rates have increased significantly over the past three decades in central Ghana. More intensive education on the risk factors for diabetes, acute diabetes care as well as instituting hospital guidelines for diabetes control and reduction of modifiable risk factors for diabetes are urgently needed to reduce the poor case fatality associated with diabetes in resource-limited settings.