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