Diabetes Burden in North Carolina and Caswell County 2004

1
Diabetes Burden in North Carolina and Caswell
County 2004

• The North Carolina Diabetes Prevention and
  Control Program
• N.C. Division of Public Health
• N.C. Department of Health and Human Services
• www.ncdiabetes.org

Edgardo Valeriano MD, MPH Janet Reaves RN,
MPH N.C. Diabetes Prevention and Control Program
2
Prevalence of Diagnosed Diabetes by Race in
N.C. from 1995-2003

• 76 increase in overall diabetes prevalence
• 102 increase in White diabetes prevalence
• 59 increase in African-American diabetes
  prevalence

Source N.C. State Center for Health
Statistics, BRFSS, 1995-2003
3
Prevalence of Diagnosed Diabetes by
Race/Ethnicity, N.C., BRFSS, 2003
Source N.C. State Center for Health Statistics,
BRFSS, 2003
4
Prevalence of Inactivity, Unhealthy Eating, and
Overweight/Obesity in People with Diabetes in
N.C.
Source N.C. State Center for Health Statistics,
BRFSS, 2003 Note Diagnosed Diabetes
5
Prevalence of Selected Health Care Indicators in
People with Diabetes in N.C., 1998-2003
Source N.C. State Center for Health Statistics,
BRFSS, 1998-2003 Note At least two Hemoglobin
A1C tests per year Pneumococcal
Vaccine
6
Diabetes Hospitalizations (Main Cause)
Discharges, and Costs, in N.C., 1990-2002

• Costs increased 176
• Discharge rate increased 18

14,557
13,915
12,995
11,944
10,194
9,868
9,817
Source N.C. Center for Health Statistics,
Hospitalization Data, 1990-2002 Notes Number of
discharges. Rate/100,000 population
7
Hospitalization in People with Diabetes
Discharges (Any Diagnosis) and Costs, N.C.,
1990-2002

• Costs increased 375
• Discharge rate increased 92

167,321
150,928
134,540
116,099
76,121
72,930
66,780
Source N.C. Center for Health Statistics,
Hospitalization Data, 1990-2002 Notes Number
of discharges. Rate/100 population
8
Lower Extremity Amputation (LEA) and Kidney
Failure/Dialysis in People with Diabetes in
N.C., from 1990 to 2002

• LEA rate increased 37
• Kidney Failure rate increased 362

8,831
8,409
5,945
5,461
2,456 2,060
1,923 2,069
3,034
3,124
2,792
2,914
1,701 1,522
Source N.C. Center for Health Statistics,
Hospitalization Data, 1990-2002 Notes LEA and
kidney failure/dialysis discharges Rates per
100,000 population
9
Changes in Diabetes Hospitalization Rates by
County 1990-95 vs. 1998-2002 in N.C.
Currituck 96
Camden 60
Gates 39
Northampton 83
Alleghany - 65
Ashe 15
40 Warren
Rockingham - 4
Stokes - 1
Person 29
-34 Hertford
Pasquotank 104
Surry 12
Caswell 37
Halifax 33
15 Vance
Wilkes 38
Watauga 33
17 Granville
Perquimans 46
Yadkin 4
Bertie - 3
Mitchell 29
Forsyth 15
Avery - 15
Franklin 0
Chowan 71
Orange 10
Guilford 7
Nash 0
Caldwell 6
Yancey 59
Durham 10
Alamance 13
Alexander 20
Davie - 27
Madison - 7
Tyrrel 48
Washing 9
Edgecombe 6
Martin 118
Dare 49
Burke - 6
Iredell 41
Davidson 12
Wake - 11
Catawba 14
- 12 McDowell
Buncombe 7
Chatham - 11
Wilson - 4
Rowan 15
Randolph 14
Swain 6
Haywood - 6
Beaufort 48
Pitt 45
Hyde 119
Lincoln 28
Rutherford 4
Graham 23
Lee 81
Johnston 20
Greene 78
Henderson 16
Cabarrus 60
Jackson - 22
Montgomery - 13
36 Cleveland
Gaston 34
Polk - 25
Wayne 64
Harnett 10
Stanley - 4
Lenoir 25
Moore 48
Cherokee 10
Craven 24
Macon - 22
61 Transylvania
55 Mecklenburg
Clay 97
Pamlico 25
Cumberland 52
Richmond 58
Jones - 17
Hoke 3
Sampson 68
Union 65
Carteret 43
Anson 46
Duplin 34
Diabetes Hospitalizations (Main Cause)
Rate/100,000 population. Increase 51 or
more Increase 0 to 50 Decrease 1 to
50 Decrease 51 or more
Scotland 48
Onslow 39
Robeson 35
Bladen 22
Pender 15
New Hanover 3
Columbus 8
Brunswick 45
Source N.C. State Center for Health Statistics,
Hospitalization Data, 1990-2001 Notes
1990-95 excludes one year 1994 for lack of data
10
Trends in Diabetes Mortality by
Race/Ethnicity, N.C., 1982-2002
White mortality rates increased 69 Minority
mortality rates increased 89
51.1
Death Rate per 100,000 Population
27
22
13
Year
Source N.C. State Center for Health Statistics,
Vital Statistics, Volume 2 1996-2002 Note
Rates are Age-adjusted to the 2000 US Standard
Population
11
Diabetes Age-adjusted Mortality (Main Cause) by
Race/Ethnicity in N.C., 1999-2002
26
29
5,440
127
771
Source N.C. State Center for Health Statistics,
Mortality Data, 2002 Notes
Number of deaths Rate/100,000 population
12
Estimated Number of Residents in Caswell County
with Diabetes Conditions
Source N.C. State Center for Health Statistics,
BRFSS, 2003 Notes Based on State prevalence
Number rounded to the nearest ten Women of
fertile age (18-45 years old)

13
Estimated Number of People with Diagnosed
Diabetes by Age in Caswell County

• People over 45 years old
• are at high risk of having
• diabetes screening is
• recommended
• Screening advised at
• younger age for those who are
  overweight or have other risk factors

Source N.C. State Center for Health Statistics,
BRFSS , 2003 Number rounded to the nearest ten
14
Impact of Diabetes in Caswell County
Sources N.C. State Center for Health Statistics
BRFSS, 2003 Hospitalization and Mortality
data 2002
15
Estimated Number of People with Diabetes Who
Did Not Receive the American Diabetes
Association Clinical Recommendations in Caswell
County, 2003
Source N.C. State Center for Health Statistics,
BRFSS, 2003 Note Rounded to the nearest ten
16
Estimated Number of People with Diabetes at
Risk of Complications Due to Lifestyle or
Socioeconomic Factors in Caswell County, 2003
Source N.C. State Center for Health Statistics,
BRFSS, 2003 Notes Rounded to the nearest ten
17
Estimated Number of People with Diabetes at
Risk of or with Cardiovascular Disease (CVD)in
Caswell County, 2003
Source N.C. State Center for Health Statistics,
BRFSS, 2003 Notes Rounded to the nearest ten
18
Diabetes Hospitalization (Main Cause), 1990-2002
Discharges and Costs in Caswell County
Discharge rates increased 37 Costs increased
263
803,400
531,800
221,500
Source N.C. State Center for Health Statistics,
1990-2002 Notes Costs rounded to the nearest
hundred Rate/100,000 population Number of
Discharges
19
Diabetes Hospitalization (Any Diagnosed),
1990-2002, Discharges and Costs in Caswell County
Discharge rates increased 65 Costs increased
200
11,775,300
9,104,600
3,930,700
Source N.C. State Center for Health Statistics,
1990-2002 Notes Costs rounded to the nearest
hundred Rate/100,000 population Number of
Discharges
20
Hospitalization Discharges and Costs among People
with Diabetes in Caswell County, 2002
Source N.C. Center for Health Statistics,
Hospitalization Data, 2002 Note Rounded to the
nearest hundred
21
References
American Diabetes Association. Annual Review of
Diabetes, 2002. American Diabetes Association.
Clinical Practice Recommendations, 2004. American
Diabetes Association. The prevention or delay of
type 2 diabetes. Diabetes Care 25742-749, 2002.
American Diabetes Association. Vital Statistics,
2001. Bell R, Page J. Focus on Diabetes in NC.
Diabetes Prevention and Control Unit, DHHS.
July, 2000. Centers for Disease Control and
Prevention, Behavioral Risk Factor Surveillance
System (BRFSS), 1990-2003. Diabetes Control and
Complications Trial Research Group. The effect
of intensive treatment of diabetes on the
development and progression of long-term
complications in insulin-dependent diabetes
mellitus. The New England Journal of Medicine
1993 329977-986. Diabetes Prevention and
Complication Trial Research Group Reduction in
the incidence of type 2 diabetes with life-style
intervention or metformin. The New England
Journal of Medicine 2002, 346393-403. Field A.,
et al. Impact of Overweight on the Risk of
Developing Common Chronic diseases during a 10
year period. Archives of Internal Medicine
20011611581-86. Finnish Diabetes Prevention
Study Group. Prevention of type 2 diabetes
mellitus by changes in lifestyle among subjects
with impaired glucose tolerance. The New England
Journal of Medicine 2001 344(18)1343-1350. North
Carolina Behavioral Risk Factor Surveillance
System NC, at http//www.schs.state.nc.us/SCHS/
brfss/index.html. North Carolina State Center for
Health Statistics, Department of Health and Human
Services, Raleigh Diabetes Hospitalization Data,
1990-2002. North Carolina State Center for Health
Statistics, Department of Health and Human
Services, Raleigh. Diabetes Mortality Data,
1980-2002. United Kingdom Prospective Diabetes
Study Group. Intensive blood glucose control
with sulphonylureas or insulin compared with
conventional treatment and risk of complications
in patients with type 2 diabetes (UKPDS 33).
Lancet 1998 352837-853. United Kingdom
Prospective Diabetes Study Group. Tight blood
pressure control and risk of macrovascular and
microvascular complications in type 2 diabetes
(UKPDS 38). British Medical Journal 1998
317-703-713. Vital Statistics, Vol. 1 and 2. NC
State Center for Health Statistics, Department of
Health and Human Services, Raleigh, NC
athttp//www.schs.state.nc.us/SCHS/.
22
2003 BRFSS Diabetes Module Questions Used in
this Presentation

• Have you even been told by a doctor that you have
  diabetes?
• Have you ever had any sores or irritation on your
  feet that took more than four weeks to heal?
• About how many times in the past 12 months has a
  doctor, nurse, or other health professional
  checked you for "A one C"?
• About how many times in the past 12 months has a
  health professional checked your feet for any
  sores or irritations?
• When was the last time you had an eye exam in
  which the pupils were dilated? This would have
  made you temporarily sensitive to bright light.
• Has a doctor ever told you that diabetes has
  affected your eyes or that you had retinopathy?
• Have you ever taken a course or class in how to
  manage your diabetes yourself?
• Have you ever had a blood test for high sugar or
  diabetes?
• How long since you had your last blood test for
  high sugar or diabetes?
• During the past 12 months was there any time that
  you did not have testing supplies (strips,
  lancets, meter) or diabetes medicines due to lack
  of money?
• For more information about the BRFSS Survey
• http//www.schs.state.nc.us/SCHS/brfss/index.html