Diabetes Disparities & Its Effects on Minority Populations Appathurai Balamurugan, MD, MPH Section...
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Transcript of Diabetes Disparities & Its Effects on Minority Populations Appathurai Balamurugan, MD, MPH Section...
Diabetes Disparities & Its Effects on Minority
Populations
Appathurai Balamurugan, MD, MPHSection Chief, Chronic Disease Epidemiology, ADHHS
Assistant Professor, Department of Epidemiology, UAMS College of Public Health
Objectives
To discuss the Burden
To elucidate the Disparities & Its Effects on Minority Populations
To evaluate the risk Factors
To offer some possible solutions
Source: International Diabetes Federation (2003) The Diabetes Atlas.
Crude prevalence (%)
9.0 and above
6.8 to 8.9
4.9 to 6.7
2.6 to 4.8
2.5 and less
No data available
Prevalence of Diabetes, 2003, The WorldPrevalence of Diabetes, 2003, The World
Prevalence of Diabetes Among Adults in the United States, 2004Prevalence of Diabetes Among Adults in the United States, 2004
Diabetes Prevalence (%)
4.8 - 5.7
5.7 - 6.5
6.5 - 7.6
7.6 - 8.7
8.7 - 10.2
Source: CDC
Alaska
Diabetes Prevalence in Arkansas, 2005Diabetes Prevalence in Arkansas, 2005
Source: 2005 BRFSS
Estimated Number of Adult Arkansans with Diabetes, 2005Estimated Number of Adult Arkansans with Diabetes, 2005
165,611
67,644
Diagnosed Undiagnosed
Source: 2005 BRFSS & CDC
Diabetes Prevalence by Race in Arkansas, 2005Diabetes Prevalence by Race in Arkansas, 2005
7.3%10.1%8.0%
0%
3%
6%
9%
12%
15%
Caucasian non-Hispanic
African Americannon-Hispanic
Hispanic
Per
cen
tag
e
Source: 2005 BRFSS
Estimated Prevalence of Diabetes in People Aged 18 Years or Older, By Race and Age Group, Arkansas, 2006
Estimated Prevalence of Diabetes in People Aged 18 Years or Older, By Race and Age Group, Arkansas, 2006
Source: 2006 BRFSS
2.8%
10.3%
16.1%
2.9%
16.3%
22.3%
15.1%
27.6%
3.8%
0%
5%
10%
15%
20%
25%
30%
18-44 45-64 65 +
Perc
en
tag
e
Caucasian African American Hispanic
Estimated Prevalence of Diabetes in People Aged 18 Years or Older, by Race and Gender Group, Arkansas, 2006
Estimated Prevalence of Diabetes in People Aged 18 Years or Older, by Race and Gender Group, Arkansas, 2006
Source: 2006 BRFSS
8.7%
7.4%
9.7%
8.9%9.2%
7.3%
0%
2%
4%
6%
8%
10%
12%
Male Female
Per
cen
tag
e
Caucasian African American Hispanic
Age-adjusted Diabetes Mortality Rate per 100,000 Arkansans by Race, 2000-2005Age-adjusted Diabetes Mortality Rate per 100,000 Arkansans by Race, 2000-2005
Source: CDC wonder
22
2724
61 60
54
0
20
40
60
80
2001 2003 2005
Rate
per
100,0
00 P
op
ula
tio
n
Caucasian African American
Age-adjusted Diabetes Mortality Rate per 100,000 Arkansans by Race and Gender, 2002-2004
Age-adjusted Diabetes Mortality Rate per 100,000 Arkansans by Race and Gender, 2002-2004
Source: CDC wonder
28
22
5660
0
20
40
60
80
Males Females
Rat
e p
er 1
00,0
00 P
op
ula
tio
n
Caucasian African American
New cases of diabetes in US, by Race and Gender (age-adjusted incidence)New cases of diabetes in US, by Race and Gender (age-adjusted incidence)
Per
cen
tag
e
Source: Lipton et al. Am J Epidemiol, 1993.
7.0% 6.9%
10.9%
15.0%
0%
2%
4%
6%
8%
10%
12%
14%
16%
Males Females
Per
cen
tag
e
Caucasian African American
Diabetes & Heart Disease
Frequency of MI was 3 times higher among African Americans with diabetes compared to whites.
64% of African Americans with Diabetes were diagnosed with Hypertension compared to 54% in Whites.
35%
63%
0% 20% 40% 60% 80% 100%
AfricanAmerican
White
Newly Diagnosed Chronic ESRD
Diabetic Kidney Disease
Source: ESRD Network, 2005
49%
51%
0% 20% 40% 60% 80% 100%
AfricanAmerican
White
Dialysis Prevalence
Diabetic Eye Disease
Race and Sex Relative Risk compared with Diabetic white males
White males 1.00
White females 1.25
Nonwhite males 1.27
Nonwhite females 3.86
Age-adjusted Relative Risk of Blindness due to Diabetes
Source: Kahn et al, Am J Oph 1974
Diabetic foot disease
Risk Factors
Non-modifiable: Genetic (Thrifty genotype), race, age
Modifiable: Unhealthy eating habits, physical inactivity, tobacco use, access to care
Risk Factors in Adult Arkansans by Race, 2005Risk Factors in Adult Arkansans by Race, 2005
Source: 2005 BRFSS
43.4% 42.7%
23.6%26.4% 28.6%
24.1%16.2%
39.8%
28.1%
0%
10%
20%
30%
40%
50%
BMI ≥30 Physically Inactive Current Smoker
Caucasian African American Hispanic
Per
cen
tag
e
Percent of Arkansans by Race and Ethnic Origin without Health Insurance, 2005Percent of Arkansans by Race and Ethnic Origin without Health Insurance, 2005
16.4%
27.9%
48.6%
0% 20% 40% 60%
Caucasian non-Hispanic
African Americannon-Hispanic
Hispanic
Percentage of Population
Source: 2005 BRFSS
Percentage of Adults with diabetes that obtained preventive care services by racePercentage of Adults with diabetes that obtained preventive care services by race
48%
66%
72%
23%
21%
40%
44%
77%
32%
60%
57%
61%
63%
36%
55%
0% 20% 40% 60% 80% 100%
Flu shot
Eye exam
Foot exam
HbA1c test
Pneumonia vaccination
Caucasian African American Hispanic
Source: 2005 BRFSS
Possible solutions
Primary Prevention – Increase awareness, risk factor reduction
Secondary Prevention - Promote access to quality diabetes care
Tertiary Prevention - Use of preventive care services
Socio-ecological Model
Public Policy
Community
Organizational
Interpersonal
Individual