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Trends and space-time analysis of mortality due to diabetes mellitus in Ecuador, 2001-2016

Abstract:

Introduction: Diabetes mellitus mortality is a growing public health problem in the world. Objectives: To analyze the temporal and spatial patterns of mortality by diabetes mellitus in Ecuador during the period 2001-2016. Methods: A mixed ecological study was performed. There were calculated the specific mortality rates and they were adjusted by age for the period 2001-2016 in Ecuador. It was used a joinpoint´s regression analysis for the assessment of trends and it was used the methodology developed by Kulldorf for the analysis of time-space clusters. Results: During the period 2001-2016 there were 57 788 deaths from diabetes mellitus in Ecuador. In the joinpoint analysis, age-adjusted rates in men reported a significant increase in the percentage of annual change of 2.4% (2001-2016; p<0.001) and in women increased to 1.50% (2001-2016; p<0.001). In the time-space analysis identified, there were identified two clusters of statistically significant high mortality: the first conglomerate formed by the provinces Santa Elena, Guayas, Manabí and Los Ríos (p< 0.001); and the second conglomerate formed by the province of Santo Domingo de los Tsáchilas (p< 0.001). Conclusions: Mortality by diabetes mellitus in Ecuador was significantly increased in most age groups and provinces during the period 2001-2016. The provinces of Santa Elena, Guayas, Manabí, Los Ríos and Santo Domingo accumulated the biggest number of deaths due to this cause. This forces decision makers to address the design and implementation of health policies that allow improving the registration systems for an adequate epidemiological surveillance.