title: The diabesity health economic crisis-the size of the crisis in a European island state following a cross-sectional study.
abstract: BACKGROUND
  Diabetes type 2 and obesity are well-established global epidemics and contributors to clinical, social and economic health burdens. The prevalence rates of these diseases are still on the rise among countries resulting in a corresponding public health burden. The Mediterranean island of Malta, known for it's high diabetes and obesity rates, provides a good fundamental basis to portray the economical health burden of these diseases.
  
  
  METHODS
  A recent randomised stratified representative cross-sectional survey conducted in Malta tackling diabetes, obesity and other determinants, was used to work out the population prevalence of these diseases. The cost burden of diabetes and obesity, based on published data, was incorporated to the established population prevalence rates, in order to estimate the Maltese economical burden. Projections to the year 2050 by a bottom-up prevalence based design were performed.
  
  
  RESULTS
  One eight of the Maltese adults (25 to 64 years) suffered from diabetes out of which approximately 10,000 adults were unaware of the disease. Alarmingly, more than a third of the Maltese population suffer from obesity. The approximate health care costs (direct and indirect) for the diabetic adult population was of €29,159,217 (€21,994,676 - €38,919,121) annually, amounting to 3.64% (2.75-4.875%) of the total health expenditure in Malta. The obesity cost burden was of €23,732,781 (€21,514,972-€26,049,204) annually contributing for 2.97% (2.69-3.26%) of the total health expenditure. The projected prevalence and costs for 2050 exhibited an estimated cost burden increase of €33,751,487 (€25,458,606-€45,048,473) for the diabetes mellitus population and €46,532,294 (€42,183,889-€51,074,049) for the obese population. These projected cost burdens are expected to increase exponentially the total health care expenditure in Malta by 2050.
  
  
  CONCLUSIONS
  Having an understanding of the prevalence and the economic cost burden of diabetes and obesity within a country, along with projections of the expected burden will enable policy and public health officials to clearly visualize this growing problem. It also helps in establishing effective preventive strategies and screening programs targeting these epidemics.
authors.affiliation: Department of Anatomy, Faculty of Medicine and Surgery, Biomedical Building, University of Malta, Msida, MSD 2080 Malta.
authors.forename: Sarah
authors.identifier: 0000-0003-2012-9234
authors.initials: S
authors.lastname: Cuschieri
authors.affiliation: Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
authors.forename: Josanne
authors.initials: J
authors.lastname: Vassallo
authors.affiliation: Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
authors.forename: Neville
authors.initials: N
authors.lastname: Calleja
authors.affiliation: Department of Anatomy, Faculty of Medicine and Surgery, Biomedical Building, University of Malta, Msida, MSD 2080 Malta.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Pace
authors.affiliation: Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
authors.forename: Janice
authors.initials: J
authors.lastname: Abela
authors.affiliation: Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
authors.forename: Bader A
authors.initials: BA
authors.lastname: Ali
authors.affiliation: Faculty of Dental Surgery, University of Malta, Msida, Malta.
authors.forename: Fatemah
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: Mater Dei Hospital, Msida, Malta.
authors.forename: Elizier
authors.initials: E
authors.lastname: Zahra
authors.affiliation: Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
authors.forename: Julian
authors.initials: J
authors.lastname: Mamo
keywords: Burden of illness; Diabetes mellitus; Economic burden of disease; Malta; Obesity