Epidemiology of Diabetes: Prevalence, Complications and Health Services Disparities Rosa Pérez Perdomo, MD, MPH, PhD Dean Graduate School of Public Health Medical Sciences Campus Director of the Diabetes Management Center
Diabetes Management Center Estado Libre Asociado de Puerto Rico Diabetes Management Center of the Diabetes Center for Puerto Rico Is a repository of information and data related with diabetes mellitus, specially in Puerto Rico Principal Objectives of the Diabetes Management Center To obtain, analyze and disseminate data Scientific Investigations Publication of journals, bulletins and scientific articles
Objetives Disdier To discuss diabetes prevalence estimates at world and local level. To discuss diabetes complications, prevalence estimates and health service utilization rate. To analyze disparities by age and sex between persons living with diabetes that received services from private and public health insurance companies between 2000-2001 in Puerto Rico.
Methodology Disdier Analysis of several sources of data, including: Behavioral Risk Factor Surveillance System (BRFSS) Health Insurance Companies in Puerto Rico Private and Public (Reform) Four insurance companies (39.4%) Revision of recent studies
Diabetes Disdier Primary Goal for 2010 Through prevention programs, reduce the disease incidence, its complications and its economic impact, in addition, to improve quality of life for all those persons that had diabetes or that are at risk to develop the disease. Reference: U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000.
Global Prevalence of Diabetes
Global Prevalence Estimates, 2000 and 2030 2030 4.4 % 2000 2.8 % 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
Diabetes in the World Disdier 31.7 India Year 2000 17.7 20.8 China 8.4 Indonesia USA millions 6.8 Japan Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
Diabetes in the World Disdier 79.4 India Year 2010 30.3 42.3 China 21.3 Indonesia USA millions 8.9 Japan Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
Prevalence of Diabetes by Country Disdier 11.0 Prevalence (%) 7.4 7.1 7.0 5.0 Puerto Rico (2003)* Australia (2002)** United States (2003)* Arabia (1999)*** Alaska (2003)* * > 18 years only. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1999-2003. Atlanta, GA: United States, Department of Health and Human Services. ** Dunstan DW, Zimmet PZ, Welborn TA, Courten MP, Cameron AJ, Sicree RA, et al. The raising prevalence of diabetes and impaired glucose tolerance. Diabetes Care. 2002; 25(5): 829-834. *** Warsy AS, el-hazmi MA. Diabetes mellitus, hypertension and obesity-common multifactorial disorders in Saudis. Eastern Mediterranean Health Journal. 1999; 5(6): 1236-42.
Prevalence (M ean % ) Prevalence of Diabetes in Adults United States, BRFSS * 1998-2003 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 5.4 5.6 6.1 6.5 6.7 1998 1999 2000 2001 2002 2003 * BRFSS = Behavioral Risk Factor Surveillance System (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1998-2003. Atlanta, GA: United States, Department of Health and Human Services. 7.1
Prevalence of Diabetes in Adults United States, BRFSS 1990 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
Prevalence of Diabetes in Adults United States, BRFSS 1991-92 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
Prevalence of Diabetes in Adults United States, BRFSS 1993-94 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
Prevalence of Diabetes in Adults United States, BRFSS 1995-96 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
Prevalence of Diabetes in Adults United States, BRFSS 1995 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
Prevalence of Diabetes in Adults United States, BRFSS 1997-98 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
Prevalence of Diabetes in Adults United States, BRFSS 1999 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
Prevalence of Diabetes in Adults United States, BRFSS 2000 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
Prevalence of Diabetes in Adults United States, BRFSS 2001 No Data <4% 4%-6% 6%-8% 8%-10% >10% Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
Prevalence of Diabetes in Adults, United States and territories, BRFSS * 2002 * BRFSS = Behavioral Risk Factor Surveillance System (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1998-2003. Atlanta, GA: United States, Department of Health and Human Services.
Incidence (x 1,000) Incidence Estimates of Diabetes Crude and Adjusted Rate by Age, United States 1997-2002 8.0 7.6 7.2 6.8 6.4 6.0 5.6 5.2 4.8 4.4 4.0 5.1 4.9 5.3 5.1 5.6 5.4 6.2 6.0 Reference: http://www.cdc.gov/diabetes/statistics/incidence/fig2.htm 6.7 6.5 7.1 7.0 1997 1998 1999 2001 2001 2002 Year Crude Adjusted
Prevalence of Diabetes in Puerto Rico
Prevalence of Diabetes in Puerto Rico, Household Health Interview Survey 1966-1994 7 6 Prevalence(%) 5 4 3 2 1 0 1966 1971 1974 1976 1981 1983 1985 1987 1989 1993 Year Reference: Household Health Interview Survey, Puerto Rico Health. Department, 1966-1994
Prevalence of Diabetes in Puerto Rico using different Data Sources, 1998-2003 Health Insurances +18 (2001)* Health Insurances (2001)* Health Insurances (2000)* BRFSS (2003)** BRFSS (2002)** BRFSS (2001)** BRFSS (2000)** BRFSS (1999)** BRFSS (1998)** 4.5 4.9 6.9 8.5 11.0 10.5 9.8 9.6 9.4 Prevalence (%) * Some health insurances in Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2000-2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003 ** BRFSS = Behavioral Risk Factor Surveillance System (>18 años). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1998-2003. Atlanta, GA: United States, Department of Health and Human Services.
Quebradillas Prevalence of Diabetes by Region, Puerto Rico, BRFSS * 1999 Barceloneta Cataño Dorado Rincón Hormigueros Aguadilla Aguada Cabo Rojo Moca Añasco Mayaguez San Germán Lajas Isabela Sabana Grande San Sebastiá n Las Marías Maricao Guánica Camuy Lares Yauco Hatillo Guayanilla Arecibo Utuado Adjuntas Peñuelas Florida Jayuya Ponce Manatí Ciales Vega Baja Morovis Orocovis Villalba Juana Díaz Vega Alta Santa Isabel Corozal Coamo Toa Baja Toa Alta Barranquitas Naranjito Salinas Comerío Aibonito Bayamón Guaynabo Cidra Cayey Guayama Aguas Buenas Arroyo San Juan Caguas Patillas Trujillo Alto Maunabo Carolina Gurabo San Lorenz o Loíza Canóvanas Juncos Yabucoa Río Grande Las Piedras Humacao Luquillo Fajardo Ceiba Naguabo Vieques Culebra Region Prevalence IC 95% Region Prevalence IC 95% Montaña 9.08 6.26 11.90 Oeste 9.02 5.27 12.77 Norte 12.74 9.05 16.43 San Juan 8.46 5.57 11.36 Metropolitana Norte 8.57 5.98 11.16 Sureste 6.68 3.20 10.17 Noroeste 9.62 4.91 14.32 Suroeste 7.50 4.01 11.00 Nordeste 11.03 7.86 14.19 Este 12.44 8.91 15.96 * BRFSS = Behavioral Risk Factor Surveillance System (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1999. Atlanta, GA: United States, Department of Health and Human Services.
Prevalence of Diabetes by Sex and Year, Puerto Rico BRFSS * 1997, 2001-2003 Prevalence (%) 9.5 11.1 9.0 10.5 10.5 10.4 10.8 11.2 1997 2001 2002 2003 Year Male Female * BRFSS = Behavioral Risk Factor Surveillance System (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1997-2003. Atlanta, GA: United States, Department of Health and Human Services.
Prevalence of Diabetes by Age Group, Puerto Rico BRFSS * 1997, 2001-2003 Prevalence (%) 25 20 15 10 5 0 26.8 25.126.2 24.2 23.7 23.6 23.2 22.1 8.7 8.5 8.2 7.4 2.3 1.4 1.2 1.0 18-34 35-54 55-74 >74 1997 2001 Año 2002 2003 * BRFSS = Behavioral Risk Factor Surveillance System (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1997-2003. Atlanta, GA: United States, Department of Health and Human Services.
Prevalence of Diabetes by Age Groups, Health Insurance Companies in Puerto Rico 2000 * y 2001 ** Disdier 16 14 15.31 14.65 16.21 15.91 Prevalence (%) 12 10 8 6 8.38 7.99 4 2 0 0.17 0.3 0.72 0.63 1.65 1.47 3.61 <18 18-24 25-34 35-44 45-54 55-64 >64 Age group 3.25 2000 2001 * Pérez R, Pérez CM, Disdier OM. Health Disparities between Diabetic Patients under Private and Public Health Coverage in Puerto Rico, 2000. PR Health Sci J. 2003;22:363-368. ** Some health insurances of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.
Prevalence of Diabetes by Employment Status, Puerto Rico BRFSS * 1996-2000 15 14.4 14.4 14.3 13 13.2 Prevalence (%) 11 9 7 6.8 6.0 5.8 11.6 5 3.9 4.7 3 1996 1997 1998 1999 2000 Age Group Unemployed Employed * BRFSS = Behavioral Risk Factor Surveillance System (>18 years). Pérez R, Pérez CM, Disdier OM, Rodríguez LA. Estado de salud de la población adulta de Puerto Rico basado en características seleccionadas del sistema de vigilancia de los factores de riesgo asociados a la conducta: 1996-2000. Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; September 2004.
Diabetes Related Complications
Prevalence of Diabetes Related Complications by Health Insurances, Puerto Rico 2001 8.5 7.8 4.9 Cerebrovascular Accidents 2.6 1.8 Amputations 0.6 0.2 Artropathy 0 0 0 0.1 0.9 Dupuitren Diagnostic Renal Failure Private Health Insurance Companies 3.6 1.8 1.7 1.2 0.4 0.3 Polyneuritis Retinopathy Ischemic Heart Disease Atherosclerosis Public Health Insurance Companies Reference: Some health insurances in Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.
Prevalence (x 1,000) 80 70 60 50 40 30 20 10 0 Prevalence of Diabetes Related Complications by Age and Health Sector, Puerto Rico 2000 Private Health Group < 17 18-24 25-34 35-44 45-54 55-64 > 64 Age Cerebrovascular Accidents Renal Failure 80 70 60 50 40 30 20 10 0 Public Health Group < 17 18-24 25-34 35-44 45-54 55-64 > 64 Amputations Retinopathy Age Reference: Pérez R, Pérez CM, Disdier OM. Health Disparities between Diabetic Patients under Private and Public Health Coverage in Puerto Rico, 2000. PR Health Sci J. 2003;22:363-368.
Diabetes Mortality in Puerto Rico
Leading Causes of Death in Puerto Rico, 2001 Disdier Cerebrovascular accidents 4.2 Hypertension 5.8 Diabetes 8.3 Cancer 16.3 Heart 18.0 Percentage (%) Reference: Estado Libre Asociado de Puerto Rico. Informe Anual de Estadísticas Vitales, 1999-2001. Secretaría Auxiliar de Planificación, Evaluación, Estadísticas, y Sistemas de Información. División de Estadísticas4
Mortality Rate by Sex, Puerto Rico 2001 60.0 64.8 Rate (x 100,000) Male Female Reference: Estado Libre Asociado de Puerto Rico. Informe Anual de Estadísticas Vitales, 1999-2001. Secretaría Auxiliar de Planificación, Evaluación, Estadísticas, y Sistemas de Información. División de Estadísticas
Utilization of Medical Services, Pharmacy and Laboratories among Diabetic Patients in Puerto Rico
Utilization of Clinical Services among Diabetic Patients by Health Insurance, Puerto Rico 2001 Visit to emergency room 4.6 11.8 Visit to physicians office 62.5 87.5 Hospital Admissions 3.3 7.2 0.0 20.0 40.0 60.0 80.0 100.0 Percentage (%) Public Health Insurance Private Health Insurance Reference: Some health insurances in Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.
Utilization of Clinical Services among Diabetic Patients by Sex Health Insurance, Puerto Rico 2001 Visit to emergency room 10.7 8.5 Visit to physician office 81.6 78.4 Hospital Admissions 6.5 5.4 0.0 20.0 40.0 60.0 80.0 100.0 Percentage (%) Male Female Reference: Some health insurance of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.
Utilization of Pharmacy Services among Diabetic Patients by Health Insurance, Puerto Rico 2001 Disdier Oral Agent 46.2 49.6 Insulin 13.9 31.0 Percentage (%) Public Health Insurance Private Health Insurance Reference: Some health insurance of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.
Utilization of Pharmacy Services among Diabetic Patients by Sex Health Insurance, Puerto Rico 2001 Oral Agent 45.0 50.0 Insulin 24.1 27.6 Percentage(%) Male Female Reference: Some health insurance services of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.
Utilization of Laboratory Services among Diabetic Patients by Health Insurance, Puerto Rico 2001 Disdier Glycosylated Hemoglobin 3.2 48.6 Glucose Test 19.8 57.2 Percentage (%) Public Health Insurance Private Health Insurance Reference: Some health insurance companies of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.
Utilization of Laboratory Service among Diabetic Patients by Sex Health Insurance, Puerto Rico 2001 Glycosylated Hemoglobin 9.1 13.6 Glucose Test 30.1 31.4 Percentage (%) Male Female Reference: Some health insurance companies of Puerto Rico. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003.
Economic Cost of Diabetes
Economic Cost Related with Diabetes by Health Sector, Puerto Rico 2000 Private Sector $7,669,238.19 $9,648,415.42 Public Sector Reference: Pérez R, Pérez CM, Disdier OM. Health Disparities between Diabetic Patients under Private and Public Health Coverage in Puerto Rico, 2000. PR Health Sci J. 2003;22:363-368.
Average Cost in Diabetic Patients by Health Sector, Puerto Rico 2000 Private Sector $356.08 Public Sector $229.36 Reference: Pérez R, Pérez CM, Disdier OM. Health Disparities between Diabetic Patients under Private and Public Health Coverage in Puerto Rico, 2000. PR Health Sci J. 2003;22:363-368.
Factors Associated with Diabetes in Puerto Rico
Association of Clinical and Demographics Characteristics and Diabetes Prevalence by Age Group, Puerto Rico BRFSS 1999 4.81 POR (IC 95%) 3.22 2.16 3.04 3.03 2.11 2.12 1.46 1.48 2.75 2.8 1.76 1.7 1.13 1.04 Education (<12) Hypertension Hypercholesterolemia Obesity Female Sex Age < 65 Age 65 Reference: Pérez CM, Pérez R. Prevalence and associated factors of diabetes mellitus in Puerto Rican adults: Behavioral Risk Factor Surveillance System, 1999. PR Health Sci J. 2001;20(2):147-155.
Prevalence of Factors Associated with Diabetes, Puerto Rico BRFSS * 2003 63.6% 45.2% 27.3% Physical Inactivity Overweight / Obesity Hypertension * BRFSS = Behavioral Risk Factor Surveillance System (>18 years). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 2003. Atlanta, GA: United States, Department of Health and Human Services.
Health Disparities in Cardiovascular Conditions
Prevalence of Cardiovascular Conditions in a Insured Population by Age, Puerto Rico, 2001 Disdier Prevalence (%) 70 60 50 40 30 20 10 0 61.7 61.3 51.2 47.8 41.4 29.9 30.9 17.4 14.6 7.1 7.2 1.5 2.7 0.3 0-24 25-34 35-44 45-54 55-64 65-74 75> Age Private Sector Public Sector * Cardiovascular Conditions included the following: hypertension, coronary artery disease, congestive heart failure, cerebrovascular disease and transient ischemic attack. ** P-value <0.001 Difference by age was statistically significant.
Prevalence of Specific Cardiovascular Conditions by Age Group and Health Sector, Puerto Rico, 2001 Health Sector: Private Age group (years) Hypertension Coronary Artery Disease Congestive Heart Failure Cerebrovascular Accident/Transient Ischemic Attack N Prevalence N Prevalence N Prevalence N Prevalence 24 1,269 0.6 172 0.08 27 0.01 156 0.1 25-34 3,549 4.0 448 0.5 39 0.04 234 0.3 35-44 8,754 9.5 1,044 1.1 98 0.1 425 0.5 45-54 17,284 21.5 2,510 3.1 253 0.3 877 1.1 55-64 20,181 35.4 3,912 6.9 445 0.8 1,334 2.3 65-74 7,456 45.3 1,974 12.0 272 1.6 801 4.9 75 3,364 44.5 1,112 14.7 286 3.8 610 8.1 Overall 61,857 11.0 11,172 2.0 1,420 0.3 4,437 0.8
Prevalence of Specific Cardiovascular Conditions by Age Group and Health Sector, Puerto Rico, 2001 Health Sector: Public Age group (years) Hypertension Coronary Artery Disease Congestive Heart Failure Cerebrovascular Accident/Transient Ischemic Attack N Prevalence N Prevalence N Prevalence N Prevalence 24 847 0.3 118 0.04 89 0.03 1 0.0 25-34 2,029 2.3 126 0.1 153 0.2 8 0.01 35-44 5,395 6.1 325 0.4 338 0.4 9 0.01 45-54 11,969 14.7 997 1.2 740 0.9 44 0.1 55-64 18,153 24.9 2,276 3.1 1,295 1.8 94 0.1 65-74 14,493 29.0 2,767 5.5 1,432 2.9 145 0.3 75 13,151 31.4 3,175 7.6 2,640 6.3 242 0.6 Overall 66,037 8.7 9,784 1.3 6,687 0.9 543 0.1
Prevalence of Cardiovascular Conditions in an Insured Population by Sex, Puerto Rico, 2001 Sex Health Sector Female Male Total N Prevalence CI 95% N Prevalence CI 95% N Prevalence CI 95% Private 47,554 16.1 (15.97-16.24) 41,608 12.9 (12.80-13.00) 89,162 16.0 (15.98-16.08) Public 52,867 15.9 (15.72-16.00) 35,801 10.3 (10.2-10.4) 88,668 11.7 (11.62-11.77) Both 100,421 14.2 (14.16-14.32) 77,276 12.7 (12.57-12.74) 177,830 13.5 (11.68-15.44) * Cardiovascular Conditions included the following: hypertension, coronary artery disease, congestive heart failure, cerebrovascular accident, transient ischemic attack, and other cardiovascular-related claims.
Conclusions Disdier Prevalence of diabetes in Puerto Rico is higher than in United States and exceeds the estimates at world level. Economic and human cost of diabetes are huge and represent a real problem for public health. Low rate of laboratory services utilization for glycosylated hemoglobin test could be an indicator of poor prevention measures in both sectors, but specially in the public sector. Many factors related with the development of diabetes are modifiable and controllable, therefore effectives strategies of prevention are recommended.
References Disdier Pérez R, Pérez CM, Disdier OM. Health Disparities between Diabetic Patients under Private and Public Health Coverage in Puerto Rico, 2000. PR Health Sci J. 2003;22:363-368. Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2000. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 1, January 2002.
References Disdier Pérez R, Pérez CM, Rodriguez LA, Disdier OM. Boletín Estadístico del Centro para el Manejo de Datos de Diabetes - Prevalencia de diabetes, complicaciones y uso de servicios relacionados a la diabetes en Puerto Rico: Grupo comercial versus reforma de salud, año 2001. Puerto Rico Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; volume 2, June 2003. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1996-2003. Atlanta, GA: United States, Department of Health and Human Services. Estado Libre Asociado de Puerto Rico. Informe Anual de Estadísticas Vitales, 1999-2001. Secretaría Auxiliar de Planificación, Evaluación, Estadísticas, y Sistemas de Información. División de Estadísticas Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
References Disdier Dunstan DW, Zimmet PZ, Welborn TA, Courten MP, Cameron AJ, Sicree RA, et al. The raising prevalence of diabetes and impaired glucose tolerance. Diabetes Care. 2002; 25(5): 829-834. Warsy AS, el-hazmi MA. Diabetes mellitus, hypertension and obesitycommon multifactorial disorders in Saudis. Eastern Mediterranean Health Journal. 1999; 5(6): 1236-42. Pérez CM, Pérez R. Prevalence and associated factors of diabetes mellitus in Puerto Rican adults: Behavioral Risk Factor Surveillance System, 1999. PR Health Sci J. 2001;20(2):147-155. Pérez R, Pérez CM, Disdier OM, Rodríguez LA. Estado de salud de la población adulta de Puerto Rico basado en características seleccionadas del sistema de vigilancia de los factores de riesgo asociados a la conducta: 1996-2000. Diabetes Data Management Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico; September 2004.
Estado Libre Asociado de Puerto Rico Estado Libre Asociado de Puerto Rico