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Epidemiology of Diabetes: Prevalence, Complications and Health Services Disparities

Epidemiology of Diabetes: Prevalence, Complications and Health Services Disparities. Rosa Pérez Perdomo, MD, MPH, PhD Dean Graduate School of Public Health Medical Sciences Campus Director of the Diabetes Management Center. Centro de Diabetes para Puerto Rico. Centro para el Manejo de Datos.

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Epidemiology of Diabetes: Prevalence, Complications and Health Services Disparities

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  1. Epidemiology of Diabetes: Prevalence, Complications and Health Services Disparities Rosa Pérez Perdomo, MD, MPH, PhD Dean Graduate School of Public Health Medical Sciences Campus Director of the Diabetes Management Center

  2. Centro de Diabetes para Puerto Rico Centro para el Manejo de Datos Estado Libre Asociado de Puerto Rico Diabetes Management Center • Diabetes Management Center of the Diabetes Center for Puerto Rico • Is a repository of information and data related with diabetes mellitus, specially in Puerto Rico • Principal Objectives of the Diabetes Management Center • To obtain, analyze and disseminate data • Scientific Investigations • Publication of journals, bulletins and scientific articles

  3. Objetives • To discuss diabetes prevalence estimates at world and local level. • To discuss diabetes complications, prevalence estimates and health service utilization rate. • To analyze disparities by age and sex between persons living with diabetes that received services from private and public health insurance companies between 2000-2001 in Puerto Rico.

  4. Methodology • Analysis of several sources of data, including: • “Behavioral Risk Factor Surveillance System” (BRFSS) • Health Insurance Companies in Puerto Rico • Private and Public (Reform) • Four insurance companies (39.4%) • Revision of recent studies

  5. DiabetesPrimary Goal for 2010 • Through prevention programs, reduce the disease incidence, its complications and its economic impact, in addition, to improve quality of life for all those persons that had diabetes or that are at risk to develop the disease. Reference: U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000.

  6. Global Prevalence of Diabetes

  7. Global Prevalence Estimates, 2000 and 2030 4.4 % 2.8 % Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.

  8. 31.7 20.8 Indonesia 17.7 Japan China 8.4 6.8 India USA Diabetes in the World Year2000 millions Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.

  9. 79.4 42.3 Indonesia 30.3 Japan China 21.3 8.9 India USA Diabetes in the World Year2010 millions Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.

  10. Prevalence of Diabetes by Country * > 18 years only. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1999-2003. Atlanta, GA: United States, Department of Health and Human Services. ** Dunstan DW, Zimmet PZ, Welborn TA, Courten MP, Cameron AJ, Sicree RA, et al. The raising prevalence of diabetes and impaired glucose tolerance. Diabetes Care. 2002; 25(5): 829-834. *** Warsy AS, el-Hazmi MA. Diabetes mellitus, hypertension and obesity-common multifactorial disorders in Saudis. Eastern Mediterranean Health Journal. 1999; 5(6): 1236-42.

  11. Prevalence of Diabetes in Adults United States, BRFSS* 1998 - 2003 * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1998-2003. Atlanta, GA: United States, Department of Health and Human Services.

  12. No Data <4% 4%-6% 6%-8% 8%-10% >10% Prevalence of Diabetes in Adults United States, BRFSS 1990 Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.

  13. No Data <4% 4%-6% 6%-8% 8%-10% >10% Prevalence of Diabetes in Adults United States, BRFSS 1991-92 Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.

  14. No Data <4% 4%-6% 6%-8% 8%-10% >10% Prevalence of Diabetes in Adults United States, BRFSS 1993-94 Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.

  15. No Data <4% 4%-6% 6%-8% 8%-10% >10% Prevalence of Diabetes in Adults United States, BRFSS 1995-96 Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.

  16. No Data <4% 4%-6% 6%-8% 8%-10% >10% Prevalence of Diabetes in Adults United States, BRFSS 1995 Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.

  17. No Data <4% 4%-6% 6%-8% 8%-10% >10% Prevalence of Diabetes in Adults United States, BRFSS 1997-98 Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.

  18. No Data <4% 4%-6% 6%-8% 8%-10% >10% Prevalence of Diabetes in Adults United States, BRFSS 1999 Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.

  19. No Data <4% 4%-6% 6%-8% 8%-10% >10% Prevalence of Diabetes in Adults United States, BRFSS 2000 Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.

  20. No Data <4% 4%-6% 6%-8% 8%-10% >10% Prevalence of Diabetes in Adults United States, BRFSS 2001 Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.

  21. Prevalence of Diabetes in Adults, United States and territories, BRFSS* 2002 * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1998-2003. Atlanta, GA: United States, Department of Health and Human Services.

  22. Incidence Estimates of Diabetes Crude and Adjusted Rate by Age, United States 1997 - 2002 Reference: http://www.cdc.gov/diabetes/statistics/incidence/Fig2.htm

  23. Prevalence of Diabetes in Puerto Rico

  24. 7 6 5 4 Prevalence(%) 3 2 1 0 1966 1971 1974 1976 1981 1983 1985 1987 1989 1993 Year Prevalence of Diabetes in Puerto Rico, Household Health Interview Survey 1966 - 1994 Reference: Household Health Interview Survey, Puerto Rico Health. Department, 1966-1994

  25. Prevalence of Diabetes in Puerto Rico using different Data Sources, 1998 - 2003 * Some health insurances in Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2000 - 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003 ** BRFSS = “Behavioral Risk Factor Surveillance System” (>18 años). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1998-2003. Atlanta, GA: United States, Department of Health and Human Services.

  26. Montaña Prevalence of Diabetes by Region, Puerto Rico, BRFSS* 1999 Quebradillas Barceloneta Cataño Aguadilla Toa Baja Loíza Dorado Manatí Isabela Arecibo Vega Alta Hatillo Vega Baja Camuy Florida Aguada Carolina Moca Toa Alta San Juan Trujillo Alto Bayamón Guaynabo Luquillo RíoGrande Canóvanas Rincón Fajardo San Sebastián Ciales Corozal Utuado Morovis Añasco Naranjito Lares Gurabo Aguas Buenas Ceiba Juncos LasMarías Comerío Barran- quitas Jayuya Hormigueros Mayaguez Orocovis Caguas Adjuntas Naguabo Las Piedras Maricao Cidra San Lorenzo Villalba Aibonito San Germán Humacao Sabana Grande Cabo Rojo Coamo Cayey Yauco Culebra Yabucoa Guayanilla Peñuelas Maunabo JuanaDíaz Lajas Ponce Patillas Salinas Arroyo Guánica Santa Isabel Guayama Vieques Region Prevalence IC 95% Region Prevalence IC 95% Oeste 9.08 6.26 – 11.90 9.02 5.27 – 12.77 Norte San Juan 12.74 9.05 – 16.43 8.46 5.57 – 11.36 Metropolitana Norte Sureste 8.57 5.98 – 11.16 6.68 3.20 – 10.17 Noroeste Suroeste 9.62 4.91 – 14.32 7.50 4.01 – 11.00 Nordeste Este 11.03 7.86 – 14.19 12.44 8.91 – 15.96 * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1999. Atlanta, GA: United States, Department of Health and Human Services.

  27. Prevalence of Diabetes by Sex and Year, Puerto Rico BRFSS* 1997, 2001 - 2003 * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1997-2003. Atlanta, GA: United States, Department of Health and Human Services.

  28. Prevalence of Diabetes by Age Group, Puerto Rico BRFSS* 1997, 2001 - 2003 * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1997-2003. Atlanta, GA: United States, Department of Health and Human Services.

  29. Prevalence of Diabetes by Age Groups,Health Insurance Companies in Puerto Rico 2000* y 2001** * Pérez R, Pérez CM, Disdier OM. Health Disparities between Diabetic Patients under Private and Public Health Coverage in Puerto Rico, 2000. PR Health Sci J. 2003;22:363-368. ** Some health insurances of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.

  30. Prevalence of Diabetes by Employment Status, Puerto Rico BRFSS* 1996 - 2000 * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Pérez R, Pérez CM, Disdier OM, Rodríguez LA. Estado de salud de la población adulta de Puerto Rico basado en características seleccionadas del sistema de vigilancia de los factores de riesgo asociados a la conducta: 1996 - 2000. Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; September 2004.

  31. Diabetes Related Complications

  32. Prevalence of Diabetes Related Complications by Health Insurances, Puerto Rico 2001 Reference: Some health insurances in Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.

  33. Prevalence of Diabetes Related Complications by Age and Health Sector, Puerto Rico 2000 Private Health Group Public Health Group Reference: Pérez R, Pérez CM, Disdier OM. Health Disparities between Diabetic Patients under Private and Public Health Coverage in Puerto Rico, 2000. PR Health Sci J. 2003;22:363-368.

  34. Diabetes Mortality in Puerto Rico

  35. Leading Causes of Death in Puerto Rico, 2001 Reference: Estado Libre Asociado de Puerto Rico. Informe Anual de Estadísticas Vitales, 1999-2001. Secretaría Auxiliar de Planificación, Evaluación, Estadísticas, y Sistemas de Información. División de Estadísticas4

  36. Mortality Rate by Sex, Puerto Rico 2001 Reference: Estado Libre Asociado de Puerto Rico. Informe Anual de Estadísticas Vitales, 1999-2001. Secretaría Auxiliar de Planificación, Evaluación, Estadísticas, y Sistemas de Información. División de Estadísticas

  37. Utilization of Medical Services, Pharmacy and Laboratories among Diabetic Patients in Puerto Rico

  38. 4.6 Visit to emergency 11.8 room 62.5 Visit to physicians 87.5 office 3.3 Hospital Admissions 7.2 0.0 20.0 40.0 60.0 80.0 100.0 Percentage (%) Public Health Insurance Private Health Insurance Utilization of Clinical Services among Diabetic Patients by Health Insurance, Puerto Rico 2001 Reference: Some health insurances in Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.

  39. 10.7 Visit to emergency 8.5 room 81.6 Visit to physician 78.4 office 6.5 Hospital 5.4 Admissions 0.0 20.0 40.0 60.0 80.0 100.0 Percentage (%) Male Female Utilization of Clinical Services among Diabetic Patients by Sex Health Insurance, Puerto Rico 2001 Reference: Some health insurance of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.

  40. Utilization of Pharmacy Services among Diabetic Patients by Health Insurance, Puerto Rico 2001 49.6 OralAgent 46.2 13.9 Insulin 31.0 Percentage (%) Public Health Insurance Private Health Insurance Reference: Some health insurance of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.

  41. Utilization of Pharmacy Services among Diabetic Patients by Sex Health Insurance, Puerto Rico 2001 45.0 Oral Agent 50.0 27.6 Insulin 24.1 Percentage(%) Male Female Reference: Some health insurance services of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.

  42. 48.6 Glycosylated Hemoglobin 3.2 57.2 Glucose Test 19.8 Percentage (%) Public Health Insurance Private Health Insurance Utilization of Laboratory Services among Diabetic Patients by Health Insurance, Puerto Rico 2001 Reference: Some health insurance companies of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.

  43. 9.1 Glycosylated Hemoglobin 13.6 30.1 Glucose Test 31.4 Percentage (%) Male Female Utilization of Laboratory Service among Diabetic Patients by Sex Health Insurance, Puerto Rico 2001 Reference: Some health insurance companies of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.

  44. Economic Cost of Diabetes

  45. $7,669,238.19 PrivateSector $9,648,415.42 PublicSector Economic Cost Related with Diabetes by Health Sector, Puerto Rico 2000 Reference: Pérez R, Pérez CM, Disdier OM. Health Disparities between Diabetic Patients under Private and Public Health Coverage in Puerto Rico, 2000. PR Health Sci J. 2003;22:363-368.

  46. $356.08 PrivateSector PublicSector $229.36 Average Cost in Diabetic Patients by Health Sector, Puerto Rico 2000 Reference: Pérez R, Pérez CM, Disdier OM. Health Disparities between Diabetic Patients under Private and Public Health Coverage in Puerto Rico, 2000. PR Health Sci J. 2003;22:363-368.

  47. Factors Associated with Diabetes in Puerto Rico

  48. 4.81 3.22 POR (IC 95%) 3.04 3.03 2.8 2.75 2.16 2.11 2.12 1.76 1.7 1.48 1.46 1.13 1.04 Education (<12) Hypertension Hypercholesterolemia Obesity Female Sex Association of Clinical and Demographics Characteristics and Diabetes Prevalence by Age Group, Puerto Rico BRFSS 1999 Age < 65 Age  65 Reference: Pérez CM, Pérez R. Prevalence and associated factors of diabetes mellitus in Puerto Rican adults: Behavioral Risk Factor Surveillance System, 1999. PR Health Sci J. 2001;20(2):147-155.

  49. Prevalence of Factors Associated with Diabetes, Puerto Rico BRFSS* 2003 * BRFSS = “Behavioral Risk Factor Surveillance System” (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 2003. Atlanta, GA: United States, Department of Health and Human Services.

  50. Health Disparities in Cardiovascular Conditions

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