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ADSS Update for Steering Committee
June 24, 2008Jeff Johnson PhD.
Stephanie Vermeulen MSc.
ADSS DeliverablesADSS Deliverables
AHW & IHE/ACHORD partnership Deliverables
Alberta Diabetes Atlas 2007, 2009, 2011
ADSS Newsletter Regular updates and issue-specific focus
ADSS Website Timely, region-specific information
Alberta Diabetes Atlas 2007 Alberta Diabetes Atlas 2007 Debut: June 2007Debut: June 2007
Alberta Diabetes Atlas 2007Alberta Diabetes Atlas 2007
Acknowledgments
1. Background & Methods
2. Epidemiologic Trends, 1995-2005
3. DM & Health Care Utilization
4. DM & Cardiovascular Disease
5. DM & Lower Limb Amputations
6. DM & Kidney Disease
7. DM & Eye Disease
8. DM & Mental Health
9. DM & First Nations People
10. Key Findings & Policy Options
Glossary
ADSS NewslettersADSS Newsletters
January 2007
“What is the ADSS?”
August 2007
“Diabetes and Eye Disease”
Fall 2007
“Diabetes and the Under 20”
February 2008
“Diabetes and First Nations”
June 2008
“Active Dissemination of the ADSS”
Future ADSS NewslettersFuture ADSS Newsletters
Healthcare Utilization and Costs
Health Region/Community- Specific Profiling
Diabetes and Pregnancy
ADSS Fact Sheet 2008ADSS Fact Sheet 2008
www.albertadiabetes.ca
All of Alberta
Regional Health Authority
Sub-Region
Community
Both Sexes
Male
Female
All Ages
20-34 years
35-49 years
50-64 years
65-74 years
75 + years
Rates/Cases from
1995-2005
DM alone or DM & Disease
First Nations Status
FIGURES FROM DATABASE
ADSS Website- Interactive AspectADSS Website- Interactive Aspect
Active Dissemination EffortsActive Dissemination Efforts
Answered an RFP from the Public Health Agency of Canada:
“Local Community Dissemination for the ADSS”
On January 15th, MP Laurie Hawn announced funding for this initiative ~$150,000
and presented Jeff and IHE
with a “large cheque”.
Active Dissemination EffortsActive Dissemination Efforts
Lethbridge (Chinook Region) was our first stop in August 07.
Presented to: Building Healthy Lifestyles Team
(DEC) RHA and PCN Leadership The public Hospital Health Care Providers
(including a group of internists)
Active Dissemination EffortsActive Dissemination Efforts
Brooks and Medicine Hat (Palliser Region) was our second stop in January 08.
Brooks: Living Healthy Team (DEC) The public and diabetes
association board members Medicine Hat:
Seniors/the Public Health Care Providers Physicians
Active Dissemination EffortsActive Dissemination Efforts
Second visit to Medicine Hat (Palliser Region) February 08. Committee of the Board for Palliser
Health (including the Director of CDM, CEO and VP of the region)
Health Care Professionals- from Medicine Hat and Oyen and Bow Island were telehealthed in.
Third visit to Medicine Hat April 08. Diabetes Collaborative Workshop
(PCN Staff)
Active Dissemination Efforts Active Dissemination Efforts
Red Deer (David Thompson Health Region) March 08 HC Professionals, Regional folks and
the public Fort McMurray (Municipality of Wood
Buffalo/ Northern Lights Region) April 08 HC Professionals, PCN folks, MOH,
the public Westlock (Aspen) June 23.08
PCN staff and Primary Health Care Committee
Grande Prairie (Peace Country) TBA Camrose (East Central) TBA
Diabetes Prevalence in PalliserDiabetes Prevalence in Palliser(Case Counts)(Case Counts)
Prevalence Rates by CommunityPrevalence Rates by Community(Age-Adjusted, 2006)(Age-Adjusted, 2006)
Diabetes Prevalence Rates for OyenDiabetes Prevalence Rates for Oyen(Age-Adjusted, 1995-2006)(Age-Adjusted, 1995-2006)
Incidence Rates by CommunityIncidence Rates by Community(Age-Adjusted, 2006)(Age-Adjusted, 2006)
Diabetes and Eye DiseaseDiabetes and Eye DiseaseCrudeCrude Laser Photocoagulation, 2006Laser Photocoagulation, 2006
Crude Rates of Laser PhotocoagulationCrude Rates of Laser Photocoagulation((1995-20061995-2006))
Chinook rate in 2006: 99/10,000
Palliser rate in 2006: 558/10,000
Local Information for Local PlanningLocal Information for Local Planning
ADSS can be used by the Regions to more accurately assess what the burden of DM and it’s comorbidities are.
ADSS provides important information and specific numbers that can be included in Regional Health Authority business plans/performance reports.
Diabetes is one of the conditions expected in performance reports for all health regions in Alberta.
ADSS can help regions plan and evaluate new programs.
Calgary Health Region, 2006Calgary Health Region, 2006(Age/Sex Adjusted)(Age/Sex Adjusted)
Capital Health Region, 2006Capital Health Region, 2006(Age/Sex Adjusted)(Age/Sex Adjusted)
ADSS: Capital and CalgaryADSS: Capital and Calgary
Sub-region prevalencePCNs
St. Albert/SturgeonSouthside
Quality indicators….Dashboard reportingHow ADSS can supplement this
St. Albert – Sturgeon PCN St. Albert – Sturgeon PCN Age-Adjusted Prevalence (St. Albert)Age-Adjusted Prevalence (St. Albert)
St. Albert – Sturgeon PCN St. Albert – Sturgeon PCN Age-Adjusted Prevalence (Morinville)Age-Adjusted Prevalence (Morinville)
1. Active dissemination to Regions: Local presentations
Regional Administration MOH/PCNs/DECs Public
2. Ongoing Newsletters
3. ADSS Website (www.albertadiabetes.ca)
*ADSS Dissemination Sub-Committee: J. Johnson, C. Andres, A. Edwards, K.McLaughlin, R. Lewanczuk
ADSS DisseminationADSS Dissemination
ADSS OutputsADSS Outputs
Abstracts CAPT Conference Halifax and CSEB
Conference Calgary (May 07):• Epidemiological Trends• DM & Kidney Disease
EASD Conference Amsterdam (Sept 07):• DM & Mental Health
CDA Vancouver (Oct 07):• DM and Eye Disease (oral)• DM and Mental Health (oral)• DM and First Nations• DM and Kidney Disease
ADSS OutputsADSS Outputs
Abstracts con’t SPH Symposium (Nov 07)
• DM and Mental Health (oral)• DM & Eye Disease• Epidemiological Trends
AMHB Banff (Nov 07)• DM & Mental Health (oral)
ADA San Francisco (June 08)• DM & the Under 20 years (oral)
ADSS OutputsADSS Outputs
Submitted Abstracts CDPAC Ottawa (Nov 08)
• Active Dissemination of the ADSS
CDA Montreal (Oct 08)• Increasing Inc and Prev of DM in First Nations• Urban and Rural differences of DM (non-FN)• ADSS vs. Denmark DM registry• Active Dissemination of the ADSS• Introduction of Teleophthalmology in N. AB• Epi trends in the Under 20 population.
ADSS OutputsADSS Outputs
Manuscripts Submitted
• Increasing Inc & Prev of DM among Status Aboriginal Men in Urban and Rural Alberta (submitted to CJPH)
In Progress• Non-FN Urban-Rural trends• U20 epi trends• Teleophthalmology in N. AB• Active Dissemination of the ADSS (case study)• ADSS vs. Danish NDR
ADSS Ethics ConsiderationsADSS Ethics Considerations
November 06 Request for Ethics submitted (Panel B)
Reply indicated that the surveillance that we were about to complete did not constitute research and therefore did not require an ethics review or approval.
Necessary to submit subsequent individual research projects for consideration by the HREB
(i.e. amendment to the ADSS ethics application)
May 08 Letter submitted to HREB to obtain approval to move
ahead with GDM project.
Outcome???
The incidence and prevalence of diabetes is more than twice as high among First Nations people, for both males and females, compared to non-First Nations people.
The increased incidence and prevalence of diabetes for First Nations compared to non-First Nations has remained constant from 1995 to 2005.
Among First Nations people, the incidence and prevalence of diabetes are higher among females compared to males.
Diabetes and First NationsDiabetes and First Nations
Diabetes Prevalenceby First Nations Status
by Urban-Rural
Diabetes Prevalence, 1995-2006 FN vs Non-FN, Rural & Urban
Diabetes Prevalence 1995-2006FN People by Sex, Rural and Urban
Prevalence (Increase from 1995 – 2006)Female Male Total
Urban 11.5% 40.4% 22.4%Rural 30.0% 42.8% 35.0%
Diabetes Incidence, 1995-2006 FN vs Non-FN, Rural & Urban
Diabetes Incidence 1995-2006FN People by Sex, Rural and Urban
Incidence (Increase from 1995 – 2006)Female Male Total
Urban 24.8% 44.7% 33.8%Rural -3.9% 34.6% 12.5%
First Nations
• In rural areas DM is more prevalent for FN, and incidence is increasing faster;
• FN women in rural areas have the highest prevalence of DM;
• FN men have had greatest increases in incidence.
Non-First Nations
• Among non-FN, prevalence is similar between urban and rural;
• Men in rural settings have had greatest increase in incidence and prevalence (~60%).
Key Messages…
Objectives
1. Evaluate epi trends for diabetes among the under 20 population in Alberta, Canada;
Incidence Prevalence
2. Compare age-specific trends over past 10 yrs;
3. Further assessment of validity of NDSS/ADSS case definition in under 20 population.
DM in the Under 20 year old Population
Prevalent Cases, 2006Prevalent Cases, 2006
2,301 cases(28 per 10,000)
Diabetes Prevalence, 1995-2005 Under 20
30%
42%
51%*
93%*
*p=0.005
Diabetes Incidence, 1995-2006 Under 20
ARP (shadow billing)ICD9 ICD10CA
Diabetes Incidence, 1995-2006 U20 by Age Category
Incidence rate per 1,000
1995 2002 2006
Age Gp Incidence Incidence % Increase Incidence % Increase
15-19 0.28 0.37 32.6% 0.28 2.9%
10-14 0.24 0.42 75.0% 0.34 42.7%
5-9 0.20 0.42 106.1% 0.34 *68.3%
1-4 0.15 0.22 43.6% 0.25 *67.9%
Total 0.22 0.37 66.6% 0.31 40.1%
*p=0.034
ADSS Accomplishments (07- 08)ADSS Accomplishments (07- 08)
Deliverables Alberta Diabetes Atlas 2007 ADSS Newsletter ADSS Website
Active Dissemination PHAC funded Local presentations
Research outputs Presentations at scientific meetings Manuscripts
