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¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
Epidemiology of Diabetes: Prevalence, Complications and
Health Services DisparitiesRosa Pérez Perdomo, MD, MPH, PhD
Dean Graduate School of Public HealthMedical Sciences Campus
Director of the Diabetes Management Center
Diabetes Management Center
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 dataScientific Investigations Publication of journals, bulletins and scientific articles
Estado Libre Asociadode Puerto Rico
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Objetives
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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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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
Methodology
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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DiabetesPrimary 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
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Global Prevalence Estimates, 2000 and 2030
0.0% 1.0% 2.0% 3.0% 4.0% 5.0%
2000
2030 4.4 %
2.8 %
Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Diabetes in the World
millions
India
31.731.7
China
20.820.8
USA
17.717.7
Indonesia
8.48.4
Japan
6.86.8
YearYear20002000
Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Diabetes in the World
millions
India
79.479.4
China
42.342.3
USA
30.330.3
Indonesia
21.321.3
Japan
8.98.9
YearYear20102010
Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Diabetes by Country
11.0
7.4 7.1 7.0
5.0
Prev
alen
ce (%
)
Puerto Rico(2003)*
Australia(2002)**
UnitedStates (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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Diabetes in Adults United States, BRFSS* 1998 - 2003
7.16.76.5
6.15.65.4
0.01.02.03.04.05.06.07.08.0
1998 1999 2000 2001 2002 2003
Prev
alen
ce (M
ean
%)
* 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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
Prevalence of Diabetes in Adults United States, BRFSS
1990
No Data <4% 4%-6% 6%-8% 8%-10% >10%
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
1991-92
No Data <4% 4%-6% 6%-8% 8%-10% >10%
Prevalence of Diabetes in Adults United States, BRFSS
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
1993-94
No Data <4% 4%-6% 6%-8% 8%-10% >10%
Prevalence of Diabetes in Adults United States, BRFSS
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
1995-96
No Data <4% 4%-6% 6%-8% 8%-10% >10%
Prevalence of Diabetes in Adults United States, BRFSS
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
1995
No Data <4% 4%-6% 6%-8% 8%-10% >10%
Prevalence of Diabetes in Adults United States, BRFSS
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
1997-98
No Data <4% 4%-6% 6%-8% 8%-10% >10%
Prevalence of Diabetes in Adults United States, BRFSS
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
1999
No Data <4% 4%-6% 6%-8% 8%-10% >10%
Prevalence of Diabetes in Adults United States, BRFSS
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
2000
No Data <4% 4%-6% 6%-8% 8%-10% >10%
Prevalence of Diabetes in Adults United States, BRFSS
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Reference: Mokdad et al., Diabetes Care 2000;23:1278-83.
2001
No Data <4% 4%-6% 6%-8% 8%-10% >10%
Prevalence of Diabetes in Adults United States, BRFSS
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Incidence Estimates of Diabetes Crude and Adjusted Rate by Age, United States 1997 - 2002
7.0
6.56.0
5.45.1
4.9
7.16.7
6.2
5.65.35.1
4.04.44.85.25.66.06.46.87.27.68.0
1997 1998 1999 2001 2001 2002
Year
Inci
denc
e (x
1,0
00)
CrudeAdjusted
Reference: http://www.cdc.gov/diabetes/statistics/incidence/Fig2.htm
Prevalence of Diabetes in Puerto Rico
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Diabetes in Puerto Rico, Household Health Interview Survey 1966 - 1994
Reference: Household Health Interview Survey, Puerto Rico Health. Department, 1966-1994
0
1
2
3
4
5
6
7
1966
1971
1974
1976
1981
1983
1985
1987
1989
1993
Year
Prev
alen
ce(%
)
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Diabetes in Puerto Rico using different Data Sources, 1998 - 2003
9.4
9.68.5
9.810.5
11.0
4.54.9
6.9
Prevalence (%)
BRFSS (1998)**
BRFSS (1999)**
BRFSS (2000)**
BRFSS (2001)**
BRFSS (2002)**
BRFSS (2003)**
Health Insurances (2000)*
Health Insurances (2001)*
Health Insurances +18 (2001)*
* 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 comercialversus 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.
Prevalence of Diabetes by Region, Puerto Rico, BRFSS* 1999
Rincón
Añasco
MocaAguada
Aguadilla Isabela
CaboRojo
Lajas
MayaguezHormigueros
Saba
naG
rand
e
Yauco
Maricao
Las Marías
Gua
yani
lla
Quebradillas
Camuy
Hat
illo
Arecibo
Ponce
Florida
Barceloneta
Juana Díaz
Orocovis
Vega
Baj
a
Cataño
Vieques
SanSebastián Lares
Utuado
AdjuntasPe
ñuel
as
Manatí
Jayuya
Ciales
Comerío
Arroyo
Patillas
Cidra
TrujilloAlto
Caguas
Maunabo
Yabucoa
Junc
osLa
s Pi
edra
s
Humacao
Naguabo
Morovis
VegaAlta
ToaAlta
Naranjito
Barran-quitas
Bay
amón
Dor
ado
ToaBaja
Villalba Aibonito
AguasBuenas
Gua
ynab
o
San
Juan
CarolinaC
anóvanas
LoízaRíoGrande
Ceiba
Faja
rdo
Luquillo
Salinas
Corozal
Cayey
Gurabo
SanLorenzoSan
Germán
SantaIsabel
Coamo
GuayamaGuánica
Culebra
Este
Suroeste
Sureste
San Juan
Oeste
8.91 – 15.9612.447.86 – 14.1911.03
4.01 – 11.007.504.91 – 14.329.62
3.20 – 10.176.685.98 – 11.168.57
5.57 – 11.368.469.05 – 16.4312.74
5.27 – 12.779.026.26 – 11.909.08
IC 95%PrevalenceRegionIC 95%PrevalenceRegion
Nordeste
Noroeste
Metropolitana Norte
Norte
Montaña
* 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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Diabetes by Sex and Year, Puerto Rico BRFSS* 1997, 2001 - 2003
9.511.1
9.010.5 10.5 10.4 10.8 11.2
Prev
alen
ce (%
)
1997 2001 2002 2003Year
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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Diabetes by Age Group, Puerto Rico BRFSS* 1997, 2001 - 2003
26.8
22.1
1.2
23.2
1.0
8.2
26.2
23.7
2.3
8.7
23.6
1.4
7.4
24.2
8.5
25.1
0
5
10
15
20
25
18-34 35-54 55-74 >74
Año
Prev
alen
ce (%
)
1997 2001 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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Diabetes by Age Groups,Health Insurance Companies in Puerto Rico 2000* y 2001**
3.25
8.38
16.21
7.99
14.65
1.470.630.17
15.9115.31
0.3
3.61
0.72
1.65
0
2
4
6
8
10
12
14
16
<18 18-24 25-34 35-44 45-54 55-64 >64Age group
Prev
alen
ce (%
)
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 comercialversus 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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Diabetes by Employment Status, Puerto Rico BRFSS* 1996 - 2000
4.7
14.3
11.6
13.2
14.414.4
6.8
3.9
6.0 5.8
3
5
7
9
11
13
15
1996 1997 1998 1999 2000Age Group
Prev
alen
ce (%
)
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
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Diabetes Related Complications by Health Insurances, Puerto Rico 2001
2.61.8
0.20.6
0 0 00.1
0.9
1.8
0.4 0.3
4.9
3.6
8.5
7.8
1.71.2
Cerebrov
ascular
Acci
dents
Amputations
Artropath
y
Dupuitren
Diagnosti
cRen
al Fail
urePoly
neurit
isReti
nopathy
Ischem
ic Hea
rt Dise
aseAthero
sclero
sis
Private Health Insurance Companies 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: Grupocomercial 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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Diabetes Related Complications by Age and Health Sector, Puerto Rico 2000
01020304050607080
< 17 18-24 25-34 35-44 45-54 55-64 > 64
Age
Prev
alen
ce (x
1,0
00)
01020304050607080
< 17 18-24 25-34 35-44 45-54 55-64 > 64
Age
Private Health Group Public Health Group
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.
Cerebrovascular Accidents AmputationsRenal Failure Retinopathy
Diabetes Mortality in Puerto Rico
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Leading Causes of Death in Puerto Rico, 2001
18.0
16.3
8.3
5.8
4.2
Percentage (%)
Heart
Cancer
Diabetes
Hypertension
Cerebrovascularaccidents
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
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Mortality Rate by Sex, Puerto Rico 2001
60.064.8
Rat
e (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
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Utilization of Clinical Services among Diabetic Patients by Health Insurance, Puerto Rico 2001
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: Grupocomercial 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.
7.23.3
87.562.5
11.84.6
0.0 20.0 40.0 60.0 80.0 100.0
Percentage (%)
Hospital Admissions
Visit to physicians office
Visit to emergencyroom
Public Health Insurance Private Health Insurance
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Utilization of Clinical Services among Diabetic Patients by Sex Health Insurance, Puerto Rico 2001
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: Grupocomercial 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.
5.46.5
78.481.6
8.510.7
0.0 20.0 40.0 60.0 80.0 100.0
Percentage (%)
HospitalAdmissions
Visit to physician office
Visit to emergency room
Male Female
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Utilization of Pharmacy Services among Diabetic Patients by Health Insurance, Puerto Rico 2001
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: Grupocomercial 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.
31.0
13.9
46.2
49.6
Percentage (%)
Insulin
Oral Agent
Public Health Insurance Private Health Insurance
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Utilization of Pharmacy Services among Diabetic Patients by Sex Health Insurance, Puerto Rico 2001
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.
24.1
27.6
50.0
45.0
Percentage(%)
Insulin
Oral Agent
Male Female
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Utilization of Laboratory Services among Diabetic Patients by Health Insurance, Puerto Rico 2001
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.
19.8
57.2
3.2
48.6
Percentage (%)
Glucose Test
GlycosylatedHemoglobin
Public Health Insurance Private Health Insurance
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Utilization of Laboratory Service among Diabetic Patients by Sex Health Insurance, Puerto Rico 2001
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.
31.4
30.1
13.6
9.1
Percentage (%)
Glucose Test
GlycosylatedHemoglobin
Male Female
Economic Cost of Diabetes
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Economic Cost Related with Diabetes by Health Sector, Puerto Rico 2000
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.
$9,648,415.42
$7,669,238.19
Public Sector
Private Sector
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Average Cost in Diabetic Patients by Health Sector, Puerto Rico 2000
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.
$229.36
$356.08
Public Sector
Private Sector
Factors Associated with Diabetesin Puerto Rico
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Association of Clinical and Demographics Characteristics and Diabetes Prevalence by Age Group, Puerto Rico BRFSS 1999
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.
2.16
1.46 1.481.13 1.04
3.22
2.11 2.121.76 1.7
4.81
3.04 3.032.75 2.8
Education (<12) Hypertension Hypercholesterolemia Obesity Female Sex
POR
(IC
95%
)
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Factors Associated with Diabetes, Puerto Rico BRFSS* 2003
45.2%
63.6%
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
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Cardiovascular Conditions in a Insured Population by Age, Puerto Rico, 2001
1.5 0.37.1
2.7
14.67.2
29.9
17.4
47.8
30.9
61.7
41.4
61.3
51.2
0
10
20
30
40
50
60
70Pr
eval
ence
(%)
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 transientischemic attack. ** P-value <0.001 Difference by age was statistically significant.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Specific Cardiovascular Conditions by Age Group and Health Sector, Puerto Rico, 2001
0.84,4370.31,4202.011,17211.061,857Overall
8.16103.828614.71,11244.53,364≥ 75
4.98011.627212.01,97445.37,45665-74
2.31,3340.84456.93,91235.420,18155-64
1.18770.32533.12,51021.517,28445-54
0.54250.1981.11,0449.58,75435-44
0.32340.04390.54484.03,54925-34
0.11560.01270.081720.61,269≤ 24
PrevalenceNPrevalenceNPrevalenceNPrevalenceN
CerebrovascularAccident/Transient
Ischemic Attack
Congestive Heart Failure
Coronary Artery Disease
HypertensionAge group (years)
Health Sector: Private
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Specific Cardiovascular Conditions by Age Group and Health Sector, Puerto Rico, 2001
0.15430.96,6871.39,7848.766,037Overall
0.62426.32,6407.63,17531.413,151≥ 75
0.31452.91,4325.52,76729.014,49365-74
0.1941.81,2953.12,27624.918,15355-64
0.1440.97401.299714.711,96945-54
0.0190.43380.43256.15,39535-44
0.0180.21530.11262.32,02925-34
0.010.03890.041180.3847≤ 24
PrevalenceNPrevalenceNPrevalenceNPrevalenceN
CerebrovascularAccident/Transient
Ischemic Attack
Congestive Heart Failure
Coronary Artery Disease
HypertensionAge group (years)
Health Sector: Public
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
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Prevalence of Cardiovascular Conditions in an Insured Population by Sex, Puerto Rico, 2001
(11.68-15.44)13.5177,830(12.57-12.74)12.777,276(14.16-14.32)14.2100,421Both
(11.62-11.77)11.788,668(10.2-10.4)10.335,801(15.72-16.00)15.952,867Public
(15.98-16.08)16.089,162(12.80-13.00)12.941,608(15.97-16.24)16.147,554Private
CI 95%PrevalenceNCI 95%PrevalenceNCI 95%PrevalenceN
TotalMaleFemaleHealth Sector
Sex
* Cardiovascular Conditions included the following: hypertension, coronary artery disease, congestive heart failure, cerebrovascular accident, transientischemic attack, and other cardiovascular-related claims.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
Disdier
Conclusions
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 glycosylatedhemoglobin 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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
Disdier
References
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. BoletínEstadístico 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.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
Disdier
References
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 andEpidemiology, Graduate School of Public Health, Medical SciencesCampus, 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 EstadísticasWild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.
¡Viva la Vida con Salud! Centro de Diabetes para Puerto Rico
Disdier
ReferencesDunstan DW, Zimmet PZ, Welborn TA, Courten MP, Cameron AJ, SicreeRA, 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.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 Asociadode Puerto Rico
Estado Libre Asociadode Puerto Rico