Diabetes:Diabetes:Public Health Public Health ImplicationsImplications

Dr. Bruce GoodrowDr. Bruce Goodrow

East Tennessee State East Tennessee State UniversityUniversity

Burden of Chronic Burden of Chronic Disease:Disease:

More than 90 million More than 90 million persons in the U.S. live persons in the U.S. live with chronic illnesswith chronic illness

Public Health ImplicationsPublic Health Implications

More than 75% of the More than 75% of the nation’s 1.4 trillion health nation’s 1.4 trillion health care costs can be care costs can be attributed to chronic attributed to chronic illness.illness.

Public Health ImplicationsPublic Health Implications

Chronic disease prevention Chronic disease prevention and management must be and management must be based on behavioral based on behavioral change as a complement change as a complement to medical intervention.to medical intervention.

Public Health ImplicationsPublic Health Implications

Poor nutrition costs more Poor nutrition costs more than $33 billion per year in than $33 billion per year in medical care and $9 billion medical care and $9 billion in lost productivity because in lost productivity because of heart disease, cancer, of heart disease, cancer, stroke, and diabetes.stroke, and diabetes.

Public Health ImplicationsPublic Health Implications

Smoking costs more than Smoking costs more than $75 billion per year in $75 billion per year in direct medical care and direct medical care and $80 billion per year in lost $80 billion per year in lost productivity.productivity.

Public Health ImplicationsPublic Health Implications

Physical inactivity in 2000 Physical inactivity in 2000 cost more than $76 billion.cost more than $76 billion.

Public Health ImplicationsPublic Health Implications

Obesity in 2000 cost $117 Obesity in 2000 cost $117 billion --- $61 billion in billion --- $61 billion in direct medical costs and direct medical costs and $56 billion to lost $56 billion to lost productivity.productivity.

Public Health ImplicationsPublic Health Implications

Diabetes in 2002 cost 92 Diabetes in 2002 cost 92 billion in direct medical billion in direct medical care and 40 billion in care and 40 billion in indirect cost (disability, indirect cost (disability, work loss, and premature work loss, and premature mortality).mortality).

Public Health ImplicationsPublic Health Implications

Estimated 6.3% of U.S. Estimated 6.3% of U.S. population has diabetes --- population has diabetes ---

5.2 million undiagnosed.5.2 million undiagnosed.

Public Health ImplicationsPublic Health Implications

By 2050 an estimated 29 By 2050 an estimated 29 million Americans are million Americans are expected to have expected to have diagnosed diabetes.diagnosed diabetes.

Public Health ImplicationsPublic Health Implications

Using 2002 cost estimates Using 2002 cost estimates each case costs $13,243.each case costs $13,243.

Public Health ImplicationsPublic Health Implications

Do the mathDo the math

$13,243 X 29 million =$13,243 X 29 million =

Health Care Costs Out of Health Care Costs Out of ControlControl

Public Health ImplicationsPublic Health Implications

Diabetes does not impact Diabetes does not impact all populations equally. all populations equally. Health disparities exist Health disparities exist between racial groups and between racial groups and gender.gender.

Age-adjusted total prevalence of diabetes in people aged 20 years or older, by

race/ethnicity, U.S. , 2002

8.40%

11.40%

8.20%

14.90%

0% 5% 10% 15% 20%

Non-Hispanic whites

Non-Hispanic blacks

Hispanic/LatinoAmericans

AmericanIndians/Alaska Natives

Percent

Source: 1999-2001 National Health Interview Survey and 199-2000 National Health and Nutrition Examination Survey estimates projected to year 2002. 2002 outpatient database of the Indian Health Service.

Total prevalence of diabetes in people aged 20 years of older, by age group, U.S. 2002

0%

5%

10%

15%

20%

20-39 40-59 60+

Age Group

Source: 1999-2001 National Health Interview Survey and 1999-2000 National Health and Nutrition Examination Survey estimates projected to year 2002

Per

cen

t

Public Health ImplicationsPublic Health Implications

Morbidity and mortality Morbidity and mortality change radically by age change radically by age group.group.

Age Related MortalityYouth Aged 10-24 Years

Motor vehicle crash, 40%

Homicide, 13%Suicide, 10%

HIV infection, 2%

Other injury, 11%

Other causes, 24%

Age Related MortalityAdults Aged 25 Years and Older

Cardiovascular disease, 40%

Cancer, 23%

Chronic obstructive pulmonary

disease, 5%

Diabetes, 3%

Other causes , 29%

What are the What are the behavioral behavioral

trends?trends?

Obesity Trends* Among U.S. AdultsBRFSS, 1985

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1986

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1987

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1988

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1989

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1990

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1991

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1992

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1993

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1994

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1995

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1996

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1997

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1998

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1999

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2000

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2001

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10%–14 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2003

19961991

2003

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2003

(*BMI 30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

2003 2003 Tennessee Youth Tennessee Youth

Risk Behavior Risk Behavior Survey (YRBS)Survey (YRBS)

Risk Behavior ImplicationsRisk Behavior Implications

27% rode with a 27% rode with a drinking driver drinking driver during the past during the past monthmonth

Risk Behavior ImplicationsRisk Behavior Implications

41% drank alcohol 41% drank alcohol during the past during the past monthmonth

Risk Behavior ImplicationsRisk Behavior Implications

24% used 24% used marijuana during marijuana during the past monththe past month

Risk Behavior ImplicationsRisk Behavior Implications

36% had sexual 36% had sexual intercourse during intercourse during the past three the past three monthsmonths

Risk Behavior ImplicationsRisk Behavior Implications

62% have tried 62% have tried cigarette smokingcigarette smoking

Risk Behavior ImplicationsRisk Behavior Implications

28% smoked 28% smoked cigarettes during cigarettes during the past monththe past month

Risk Behavior ImplicationsRisk Behavior Implications

82% ate <5 servings 82% ate <5 servings of fruits and of fruits and vegetables per day vegetables per day during the past 7 during the past 7 daysdays

Risk Behavior ImplicationsRisk Behavior Implications

76% participated in 76% participated in insufficient insufficient moderate physical moderate physical activityactivity

Risk Behavior ImplicationsRisk Behavior Implications

61% were not 61% were not enrolled in a enrolled in a physical education physical education classclass

Risk Behavior ImplicationsRisk Behavior Implications

15% were “at risk” 15% were “at risk” for becoming for becoming overweightoverweight

Risk Behavior ImplicationsRisk Behavior Implications

15% were 15% were “overweight”“overweight”

Percentage of Overweight U.S. Percentage of Overweight U.S. Children and Adolescents is Children and Adolescents is

SoaringSoaring**

* >95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts**Data from 1963-65 for children 6-11 years of age and from 1966-70 for adolescents 12-17 years of ageSource: National Center for Health Statistics

18

Ages 12-19

Ages 6-11

54

1616

0

2

4

6

8

10

12

14

16

1963-70**

1971-74 1976-80 1988-94 1999-2002

Tennessee Coordinated School HealthGrade Level BMI 2003 - 2004

N = 18,197

5 3 2 2 1 1 2

6158

5451 50

52 55

16 1619 19 20 21 1918

2225 26 27

24 24

0

10

20

30

40

50

60

70

80

90

100

K 2 4 6 8 HS TN CSHP

Grade

ETSU Tennessee Coordinated School Health Evaluation 2004

Per

cen

t o

f S

tud

ents

Underweight Healthy Weight At Risk 85% Overweight 95%

Why focus on diabetes?Why focus on diabetes?

1.1. Excessive morbidity and mortalityExcessive morbidity and mortality

2.2. Comorbid relationship with other Comorbid relationship with other chronic illnesseschronic illnesses

3.3. Resolve health disparitiesResolve health disparities

4.4. Need for more effective patient self Need for more effective patient self management strategiesmanagement strategies

5.5. Reduce the impact of health care Reduce the impact of health care economics.economics.