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Jeffrey A. Johnson, PhD Stephanie U. Vermeulen, MSc. University of Alberta &

Jeffrey A. Johnson, PhD Stephanie U. Vermeulen, MSc. University of Alberta & Institute of Health Economics August 30, 2007. Key Messages…. Alberta Diabetes Atlas 2007 provides trends over time, across age and regional variation for DM & related conditions.

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Jeffrey A. Johnson, PhD Stephanie U. Vermeulen, MSc. University of Alberta &

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  1. Jeffrey A. Johnson, PhD Stephanie U. Vermeulen, MSc. University of Alberta & Institute of Health Economics August 30, 2007

  2. Key Messages… • Alberta Diabetes Atlas 2007 provides trends over time, across age and regional variation for DM & related conditions. • The prevalence & incidence of DM are increasing in Alberta, and especially among older adults. • People with DM have significantly higher rates of CV disease, eye disease, kidney disease, mental health disorders and overall health care use than people without diabetes. • ADSS can be used locally to accurately assess what the burden of DM and it’s comorbidities are across Alberta. • Creation of an ADSS interactive web site will allow individuals to access rates of DM by region/community in real time.

  3. ADSS – A Public Health Service… “Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timelydissemination of these data to those who need to know. . . . A surveillance system includes a functional capacity for data collection, analysis and dissemination…” -CDC Surveillance Update, 1988

  4. National Diabetes Surveillance System

  5. ADSS • AHW & IHE/ACHORD partnership • Deliverables • ADSS Newsletter • Regular updates and issue-specific focus • Alberta Diabetes Atlas • 2007, 2009, 2011 • ADSS Website • Timely, region-specific information

  6. ADSS Steering Committee Kidney Disease WG Mental Health WG CVD WG ACHORD/IHE Jeff Johnson Stephanie Vermeulen Greg Hugel Sheri Pohar Sherry Lydynuik ADSS Staff ACHORD/IHE Eye Disease Epi WG HC Utilization WG First Nations WG AHW ADSS Organization Structure

  7. Alberta Diabetes Atlas 2007 Acknowledgments 1. Background & Methods 2. Epidemiologic Trends, 1995-2005 3. DM & Health Care Utilization 4. DM & Cardiovascular Disease 5. DM & Lower Limb Amputations 6. DM & Kidney Disease 7. DM & Eye Disease 8. DM & Mental Health 9. DM & First Nations People 10. Key Findings & Policy Options Glossary

  8. Diabetes Prevalence(Age-Adjusted Rates) After standardizing for age, prevalence increased from 3.8% in 1995 to 5.3% in 2005 in ages 20 years and over

  9. Diabetes Prevalence*(Case Counts) * Adult Population

  10. Chinook: Diabetes Prevalence*(Case Counts) *Adult Population

  11. Diabetes PrevalenceAge-Specific Rates, 2005

  12. Diabetes Prevalence* Age-Adjusted Rates, 2005 Average Provincial rate = 5.3% Chinook rate = 5.6% * Adult Population

  13. Diabetes Incidence (Age-Adjusted Rates) In 2005, the overall incidence was 5.6 per 1000 adult residents. This was an average of 5.1 for females and 6.2 for males.

  14. Diabetes Incidence*(Case Counts) * Adult Population

  15. Chinook-Diabetes Incidence*(Case Counts) * Adult Population

  16. Diabetes Incidence*Age-Adjusted Rates, 2005 Average Provincial Rate = 5.6 per 1000 Chinook Rate = 6.0 per 1000 * Adult Population

  17. Diabetes & Mortality*(Age-Adjusted Rates) * Adult Population

  18. Diabetes Health Care UtilizationPhysician Visits, 1995-2005 General Practitioners Specialists*

  19. Diabetes Health Care UtilizationPhysician Visits, 2005 Chinook Diabetes Average = 10.0 General Practitioners Chinook Diabetes Average = 2.8 Specialists*

  20. Diabetes Health Care UtilizationEmergency Department Visits, 2005 Chinook Diabetes Average = 1.4

  21. Diabetes & CVDAcute Coronary Syndrome, 1995-2005

  22. Diabetes & CVDAcute Coronary Syndrome, 1995-2005

  23. Diabetes & CVDAge-Adjusted Rates of Acute Coronary Syndrome by Region, 2005

  24. Diabetes & Eye DiseaseEye Examinations*, 1995-2005 * Eye examinations by an Ophthalmologist

  25. Diabetes & Eye DiseaseEye Examinations*, 2005 * Eye examinations by an Ophthalmologist

  26. Crude Rates of Eye Examination*, 1995-2005 Chinook average in 2005: 37% Palliser average in 2005: 53% * Eye examinations by an Ophthalmologist

  27. Diabetes & Eye DiseaseLaser Photocoagulation, 2005

  28. Crude Rates of Retinal Laser Treatment (Photocoagulation), 1995-2005 Chinook average in 2005: 101/10,000 Palliser average in 2005: 375/10,000

  29. Diabetes and First Nations First Nations People living in Chinook have much higher rates of diabetes and have the highest age-specific rates of diabetes.

  30. Diabetes and the Under 20 Population

  31. Under 20: Crude Diabetes Prevalence Rates by Region, 2005 Average Provincial Rate = 0.23 Chinook Rate = 0.29

  32. Alberta Diabetes Atlas 2007 Other topics included: DM & Lower Limb Amputation DM & Kidney Disease • Incidence & prevalence of ESRD • Kidney transplants DM & Mental Health • Affective disorders • Anxiety disorders • Psychoses (organic & non-organic) • Substance abuse disorders

  33. Alberta Diabetes Atlas 2007Key Findings & Policy Options Key Findings & Options: 1. Primary prevention to reduce rising prevalence. 2. Secondary prevention to reduce complications. 3. Enhance Quality of Primary Care. 4. Enhance Access to Primary Care. 5. Recognize mental health burden. 6. Enhanced eye care for diabetes. 7. Diabetes in First Nations People. 8. Enhance scope and depth of DM surveillance.

  34. ADSS - what is missing…? - what is next…? Conditions: • DM & pregnancy • DM & foot disease • DM & cancer New data: • Laboratory surveillance • Drug Utilization • Risk factor surveillance

  35. How YOU can use the ADSS… • ADSS can be used by the Regions to more accurately assess what the burden of DM and it’s comorbidities are. • Diabetes is one of the conditions expected in performance reports for all health regions in Alberta. • ADSS provides important information and specific numbers that can be included in Regional Health Authority business plans/performance reports.

  36. ADSS Dissemination* 1. Active dissemination to Regions: • Local presentations • Regional Administration • MOH/PCNs/DECs • Public 2. Ongoing Newsletters 3. ADSS Website *ADSS Dissemination Sub-Committee: J. Johnson, C. Andres, A. Edwards, D. Friesen, R. Lewanczuk

  37. ADSS Administrative Access Ability to generate more tailored/specific queries • Health Professional / Regional Access • Interactive health region/community level data • Ability to generate some tailored queries • Links to diabetes resources for health professionals • Public Access • Who We Are and ADSS Structure • Goal/objectives of ADSS • Health region/community level data as presented in Atlas • ADSS Newsletters • Links to diabetes information ADSS Website

  38. ADSS Website: Search Criteria All of Alberta Regional Health Authority Sub-Region Community Rates/Cases from 1995-2005 DM alone or DM & Disease First Nations Status All Ages 20-34 years 35-49 years 50-64 years 65-74 years 75 + years Both Sexes Male Female

  39. ADSS – Health Research Potential … Clinical and health policy research questions are often stimulated by health surveillance activities. Creation of Atlas 2007 lead to a number of important questions which should be addressed through more in-depth investigation: • Are there differences in health care utilization by socioeconomic status throughout Alberta (across and within health regions)? • Have recently established diabetic nephropathy prevention programs lead to reductions in rates of end-stage renal disease in Alberta? • Do regions with higher rates of eye examinations or eye disease procedures have lower rates of blindness? • Is there a better way to define mental illnesses using the administrative databases? • How many Albertans will be living with diabetes in the next 10 years?

  40. ADSS – Health Research Potential … DM Incidence Primary Prevention Intervention Control No Intervention

  41. DOVE Diabetes Outreach Van Enhancement Study ADSS – Health Research Potential … Incidence of MI/Stroke Quality Improvement Intervention Control No Intervention … a province-wide health services research laboratory!

  42. Key Messages… • Alberta Diabetes Atlas 2007 provides trends over time, across age and regional variation for DM & related conditions. • The prevalence & incidence of DM are increasing in Alberta, and especially among older adults. • People with DM have significantly higher rates of CV disease, eye disease, kidney disease, mental health disorders and overall health care use than people without diabetes. • ADSS can be used locally to accurately assess what the burden of DM and it’s comorbidities are across Alberta. • Creation of an ADSS interactive web site will allow individuals to access these numbers in real time.

  43. Questions… ? jeff.johnson@ualberta.ca svermeulen@ihe.ca www.ACHORD.ca

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