Dona Ana County Diabetes Profile

1. Dona Ana County Diabetes Profile A Presentation to the Dona Ana County Health and Human Services Alliance February 10, 2010 by Janet Flores, Dr.P.H. NMDOH, Public Health Epidemiologist Jacob Nevarez, M.S. Dona Ana County HHS Dept. Management Analyst

2. BACKGROUND In 2005, using data from the Healthy Gente/Healthy Border 2010 Indicators, DACHHS adopted diabetes as a community health priority At that time, available death data indicated that diabetes death rates had increased over time. Source: Border Epidemiology & Environmental Health (NMSU) www.nmsu.edu/~bec

3. Hospital Discharge Rates NM Health Policy Commission, Hospital Discharge Data, 2000 & 2003

4. During the Juntos por Cambios (2005-06) process, DAC medical leaders and key informants concurred that diabetes was a DAC health priority.

5. Age-Adjusted Diabetes Death Rate Trends 2004-2007 Sources: Deaths: Final data. National vital statistics reports, NCHS, 2004-2009, NM Vital Records and Health Statistics 2004-09, NM Bureau of Business & Economic Research NM State and County population estimates, 2004-2007

6. Available NM Sources for County Diabetes Data • NM Behavior Risk Factor Surveillance Survey (BRFSS) • NM Health Policy Commission (NMHPC) Hospital Inpatient Discharge Data (HIDD) • NM Vital Records and Health Statistics (NMVRHS) Death Data

7. NM Behavior Risk Factor Surveillance Survey (BRFSS) • Reports results by US, State, Region, County • Covers 21 different health topics, 18 specific health data modules (including diabetes) • Annual randomized land-line telephone survey DAC population • Diabetes module recurs annually with 12 questions • Frequency of self-management behaviors • Compliance with DM recommended medical care procedures, and monitoring exams • Limitations (Response bias: largely women & retired men, omits cell phone numbers, less representative of colonias)

8. Estimated Age-Adj. Average Total Prevalence DAC Adult Diabetes, 2004-2006range of % estimates : DAC(8.9-12.2), NM (8.6-9.7) Source: National BRFSS results, 2004-06; NMDOH Diabetes Prevention and Control Program County Prevalence Estimates, 2004-06 based on BRFSS data for DAC and NM

9. Estimated Prevalence Adult Diabetes Diagnosed in DAC, 2005 & 2007 Source: New Mexico BRFSS Diabetes Module data by County, 2005 & 2007

10. % Estimate of DAC Adults with Diabetes by Age (1,521 BRFSS respondents) Source: New Mexico BRFSS Diabetes Module data by County, 2005 & 2007

11. Diagnosed Adult Diabetes Associated with Ethnicity Source:New Mexico BRFSS Diabetes Module data by County, 2005 & 2007

12. Diabetes Prevalence Associated with Lowest Income (n = 1352) Source: New Mexico BRFSS Diabetes Module data by County, 2005 & 2007

13. Diabetes and Health Care Coverage(n=1523) Source: New Mexico BRFSS Diabetes Module data by County, 2005 & 2007

14. DAC Diabetes Associated with Little to No Physical Activity Source: New Mexico BRFSS Diabetes Module data by County, 2005 & 2007

15. Sources of Diabetes Data (cont.) • NM Health Policy Commission (NMHPC) Hospital Inpatient Discharge Data (HIDD) - Mandated reports from all non-federal hospitals: • Patient discharge numbers, demographics, diagnoses (ICD codes), procedures performed, payer information, & discharge status • Limitations: HIPAA restrictions limit access to data, timeliness of reports

16. DAC has +1 Day Longer Average Length of Hospital Stay for Diabetes Source: NMHPC Hospital Inpatient Discharge Data 2003-2007

17. % of Diabetes HospitalizationsBy Patient Age, 2003-2007 Source: NMHPC Hospital Inpatient Discharge Data 2003-2007

18. Payer Mix for Diabetes Hospitalizations Source: NMHPC Hospital Inpatient Discharge Data 2003-2007

19. Sources of DAC Diabetes Data (cont.) • New Mexico Vital Records and Health Statistics (VRHS) Death Data • Reports of all deaths per NM county of residence by: • Demographics • Causes of death (ICD 10)

20. DAC Resident Diabetes Deaths2002-2007 Source: New Mexico Vital Records and Health Statistics, 2003 - 2007

21. DAC Diabetes Deaths by Age & Gender Source: New Mexico Vital Records and Health Statistics, 2002 - 2007

22. DAC HF Summary of Diabetic Patients Source: Health Fund data collected for FY 08-09 1,964 visits and 804 unduplicated patients The youngest patient 21 and oldest patient seen was 85 Average age 55 Median age 57 8% of all diabetic visits were for individuals 40 and younger 30% of all diabetic visits were for individuals 50 and younger

23. Percent of DAC HF Diabetic Visits (n=13,119) Source: Health Fund data collected for FY 08-09

24. Percent of DAC HF Diabetic Patients/Age Category (n= 1,964) Source: Health Fund data collected for FY 08-09

26. Summary • DAC Diabetes prevalence is similar to NM & US. Diabetes prevalence . . . • Increases with age • Is greater among Hispanics and other ethnic groups • Is highest among the lowest-income groups • Is highest among the overweight & obese • Is lowest among those who get regular vigorous physical activity • DAC Diabetes hospital discharges nonsignificantly differ from NM & other NM counties . . . • Slightly longer (+1 day) average hospital stay/diabetes patient • Slightly greater % discharges for ages 45-64, and 65+ • Greater % which are charity care, private insurance, and self-pay pts. • 66% of diabetes patients served by the DAC Health Fund are 45-64 y.o. • DAC diabetes deaths declined from 7.2% in 2004 to 4.9% in 2006,then rose in 2007 to 5.7% of all deaths.

27. Conclusions Benefits to examining objective, population- based health data: • Can create a “visual” of health issue in county, state, country • Can provide basis for prioritizing issues/planning interventions/prevention • Gives baselines/benchmarks against which we measure intervention progress/success

28. Contact Janet Flores, Dr. PH. New Mexico Public Health Region 5 Epidemiologist Tel. (575) 528-5074 Slides # 2-22 Contact Jacob Nevarez, MS. Dona Ana County HHS Management Analyst Tel. (575) 525-5838 Slides # 23-26 Authors