title: Forecasting the burden of type 2 diabetes in Singapore using a demographic epidemiological model of Singapore.
abstract: OBJECTIVE
  Singapore is a microcosm of Asia as a whole, and its rapidly ageing, increasingly sedentary population heralds the chronic health problems other Asian countries are starting to face and will likely face in the decades ahead. Forecasting the changing burden of chronic diseases such as type 2 diabetes in Singapore is vital to plan the resources needed and motivate preventive efforts.
  
  
  METHODS
  This paper describes an individual-level simulation model that uses evidence synthesis from multiple data streams-national statistics, national health surveys, and four cohort studies, and known risk factors-aging, obesity, ethnicity, and genetics-to forecast the prevalence of type 2 diabetes in Singapore. This comprises submodels for mortality, fertility, migration, body mass index trajectories, genetics, and workforce participation, parameterized using Markov chain Monte Carlo methods, and permits forecasts by ethnicity and employment status.
  
  
  RESULTS
  We forecast that the obesity prevalence will quadruple from 4.3% in 1990 to 15.9% in 2050, while the prevalence of type 2 diabetes (diagnosed and undiagnosed) among Singapore adults aged 18-69 will double from 7.3% in 1990 to 15% in 2050, that ethnic Indians and Malays will bear a disproportionate burden compared with the Chinese majority, and that the number of patients with diabetes in the workforce will grow markedly.
  
  
  CONCLUSIONS
  If the recent rise in obesity prevalence continues, the lifetime risk of type 2 diabetes in Singapore will be one in two by 2050 with concomitant implications for greater healthcare expenditure, productivity losses, and the targeting of health promotion programmes.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore.
authors.forename: Thao P
authors.initials: TP
authors.lastname: Phan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore ; Department of Statistics and Applied Probability , Faculty of Science, National University of Singapore , Singapore.
authors.forename: Leontine
authors.initials: L
authors.lastname: Alkema
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore ; Division of Endocrinology , National University Hospital and National University Health System , Singapore ; Yong Loo Lin School of Medicine, National University of Singapore and National University Health System , Singapore.
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore.
authors.forename: Kristin H X
authors.initials: KH
authors.lastname: Tan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore.
authors.forename: Qian
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore ; Ministry of Health , Singapore.
authors.forename: Wei-Yen
authors.initials: WY
authors.lastname: Lim
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore ; Department of Statistics and Applied Probability , Faculty of Science, National University of Singapore , Singapore ; Life Sciences Institute, National University of Singapore , Singapore.
authors.forename: Yik Ying
authors.initials: YY
authors.lastname: Teo
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore ; Department of Ophthalmology , Yong Loo Lin School of Medicine, National University of Singapore and National University Health System , Singapore ; Singapore Eye Research Institute , Singapore ; Center for Quantitative Medicine, Duke-NUS Graduate Medical School , Singapore.
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Cheng
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore.
authors.forename: Xu
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology , Yong Loo Lin School of Medicine, National University of Singapore and National University Health System , Singapore ; Singapore Eye Research Institute , Singapore.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore.
authors.forename: Kee Seng
authors.initials: KS
authors.lastname: Chia
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System , Singapore ; Department of Statistics and Applied Probability , Faculty of Science, National University of Singapore , Singapore ; Program in Health Services and Systems Research, Duke-NUS Graduate Medical School , Singapore ; Yale-NUS College , Singapore.
authors.forename: Alex R
authors.initials: AR
authors.lastname: Cook
keywords: Adult Diabetes; Demographics; Simulation; Statistical Methods