Epidemiology of Diabetes in Puerto Rico: An Update Professor Orville M. Disdier, BS, MS Epidemiologist Assessor of the Secretary of Health Health Department of Puerto Rico Version: November 13, 2007
Topics General Characteristics, Morbidity, & Mortality of the Puerto Rican Population. Epidemiology of cardiovascular diseases. Epidemiology of diabetes. The metabolic syndrome in Puerto Rico. 2
General Characteristics, Morbidity, & Mortality of the Puerto Rican Population 3
Aging indicator, Puerto Rico, 1980-2000 1980 1990 2000 Aging index* 25 36 47 Age median (years) 24.6 28.5 32.1 *Number of people 65 years old per 100 people under 15 years old. 4
Prevalence estimates of the first 15 health conditions/diseases Puerto Rico, 2003 Hypertension Asthm a 12.23 14.76 #1 Diabetes Arthritis Sinusitis (chronic) 7.27 7.12 7.73 #3 Allergic rhinitis Lipoproteins problem s 5.39 5.28 Migraine Circulatory problems Myopia and astigm atism Intervertebral discs problem s Depressive episode Acute rinofaringitis Gastritis Back disability 4.29 3.67 3.29 2.98 2.88 2.79 2.50 2.43 #9 #12 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 Prevalence (%) 5
Principal causes of death, Puerto Rico, 2004 Alzheimer 4.2 Hypertension 5.3 #4 Diabetes 8.8 #3 Cancer Heart disease 16.6 17.3 #1 Porcentaje (%) Estado Libre Asociado de Puerto Rico. Informe Anual de Estadísticas Vitales, 2004. Secretaría Auxiliar de Planificación, Evaluación, Estadísticas, y Sistemas de Información. División de Estadísticas 6
Epidemiology of Diabetes 7
Prevalence (%) Prevalence of diabetes in adults, Puerto Rico BRFSS *, 1996 2005 12 10 8 10.8 10.5 9.4 9.6 8.5 9.8 10.5 11.0 10.6 12.5 6 4 2 1996 1997 1998 1999 2000 2001 Healthy People 2010 = <2.5% Year 2002 2003 2004 2005 * BRFSS = Behavioral Risk Factor Surveillance System (>18 años). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1996-2004. Atlanta, GA: United States, Department of Health and Human Services. 8
Prevalence of diabetes in adults, United States, BRFSS 2003 2004 2005 7.1% 7.0% 7.3% Centros para la Prevención y Control de Enfermedades. Departamento de Salud y Servicios Humanos. Disponible en: http://apps.nccd.cdc.gov/gisbrfss/map.aspx. 9
Prevalence (%) Accumulative Prevalence of diabetes mellitus by age and sex, 2000-2003 40.3 35.9 32.1 31.1 30.0 27.6 24.4 22.2 Female Male 14.3 12.4 8.0 4.9 8.3 6.2 3.1 2.4 <18 18-24 25-34 35-44 45-54 55-64 65-74 >74 Age (in years) Pérez CM, Pérez R, Mattei H, Disdier OM, Rodríguez LA. Perfil sociodemográfico y análisis de morbilidad asociada a causas selectas en la población asegurada de Puerto Rico, 2000 2003. 2005. 10
Percent (%) Distribution of diabetes mellitus claims (ICD9: 250) by age & sex, ASES 2005 34.4 31.4 20.9 22.3 Female 12.1 14.3 13.9 Male 14.3 9.2 8.0 3.0 4.1 2.9 2.3 5.3 5.8 <18 18-24 25-34 35-44 45-54 55-64 65-74 >74 Age (in years) 11
Mortality rate (x 100,000) for diabetes mellitus by time period, Puerto Rico, 2000-2004 69 68.8 68 67 66.1 66 66 65 64.8 64.2 65.6 64 65.9 63 62 62.5 63.3 62.6 63.3 61 61.2 60 59 59.6 60 58 57 57.8 total hombres mujeres 2000 2001 2002 2003 2004 Fuente: Departamento de Salud, SAPEESI, División de Esatdísticas, 2000-2003 12
Mortality rate (x 100,000) for diabetes TASA DE MORTALIDAD POR DIABETES, mellitus by municipality, PUERTO RICO Puerto 2004 Rico, 2004 Aguadilla Isabela Quebradillas Barceloneta Vega Baja Hatillo Dorado Toa Baja Cataño Camuy Manati Loiza Arecibo Vega Alta San Juan Moca Florida Aguada Toa Alta Guaynabo Carolina Bayamon Rio Grande Luquillo Rincon San Sebastian Trujillo Alto Canovanas Morovis Corozal Fajardo Anasco Ciales Naranjito Lares Utuado Gurabo Aguas Buenas Ceiba Las Marias Naguabo Mayaguez Jayuya Orocovis Comerio Juncos Barranquitas Caguas Las Piedras Maricao Adjuntas Cidra Hormigueros San Lorenzo Villalba Aibonito Humacao Coamo Cayey San German Yauco Sabana Grande Penuelas Ponce Juana Diaz Guayanilla Yabucoa Lajas Patillas Salinas Cabo Rojo Guanica Santa Isabel Guayama Arroyo Maunabo Culebra Leyenda 0.0-43.4 43.5-62.3 62.4-79.7 79.8-100.8 100.9-128.1 Vieques FUENTE: DEPARTAMENTO DE SALUD, SECRETARÍA AUXILIAR DE PLANIFICACIÓN Y DESARROLLO, DIVISIÓN DE ANÁLISIS ESTADÍSTICO, SAN JUAN, PUERTO RICO 13
Related Risk Factors 14
Prevalence (%) Overweight and obesity in the Puerto Rican adult population BRFSS *, 1996 2005 70 65 60 55 50 45 40 35 53.5 1996 1997 57.4 56.3 58.4 61.0 62.8 61.6 Healthy People 2010 = 40% 1998 1999 2000 2001 Year 63.6 63.3 62.8 2002 2003 2004 2005 * BRFSS = Behavioral Risk Factor Surveillance System (>18 años). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1996-2003. Atlanta, GA: United States, Department of Health and Human Services. 15
Overweight and obesity in the Puerto Rican adult population with Diabetes BRFSS *, 2004 Obese 35.7 Overweight 43.9 Normal 20.4 0 5 10 15 20 25 30 35 40 45 50 Normal (BMI < 24.9) Overweight (25 < BMI < 29.9) Obese (BMI > 30) Percent (%) * BRFSS = Behavioral Risk Factor Surveillance System (>18 años). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 1996-2003. Atlanta, GA: United States, Department of Health and Human Services. 16
Physical activity, Puerto Rico 2001 Unknown 14% Yes 17% No 69% Estudio Continuo de Salud. Departamento de Salud de Puerto Rico. Universidad de Puerto Rico, Escuela Graduada de Salud Pública, 2001. 17
Daily Fruits and vegetables consumption (5 or more servings), BRFSS, Puerto Rico, 2003 Yes 15% No 85% * BRFSS = Behavioral Risk Factor Surveillance System (>18 años). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 2003. Atlanta, GA: United States, Department of Health and Human Services. 18
Prevalence (%) Prevalence of the metabolic syndrome and its components according, Puerto Rico 2005 38.2 49.0 48.7 45.6 31.2 30.8 MS Abdominal O besity Elevated Glucose Low HDL-C Elevated Triglycerides Hypertension Prevalence of the metabolic syndrome and its individual components in the adult population of the San Juan metropolitan Area. C. Pérez, PhD*, A. Ortiz, PhD*, M. Estrella, MPH*, N. Pérez, MS*, Y. Valle, MPH*, M. Guzmán, MD, L. Haddock, MD, E. Suárez, PhD*, Graduate School of Public Health* and School of Medicine, University of Puerto Rico. 19