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DIABETES DATA PRESENTATIONDECEMBER 20, 2012
Agenda Overview
New BRFSS data weighing Pre-diabetes Prevalence Incidence Eyes and kidneys Diabetes and smoking Diabetes Self-Management Quality of Care Conclusions
Raking (new method) versus Post-stratification (old method)
Post-stratification – landline telephones only survey data weighted (or normalized to
census data) by: sex and age groups by region
BRFSS Data Weighing Changes
Raking (new method) versus Post-stratification (old method)Raking – landline telephones and cell phones (starting in 2011) survey data weighted (or normalized to census data) by:
Age group by sex Race Education level Marital Status Home ownership or renter Sex by race Age group by race Telephone source/type (respondent has cell-only, landline-only, or both cell and
landline) Region Region by age group Region by sex Ethnicity
BRFSS Data Weighing Changes
13.1% 9.7%
20.5%19.9%
10.3% 10.3%
8.2% 9.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pop 2000 BRFSS 2000
Age Distribution of Alaska BRFSS Respondents Compared to Adult Population by Age Group, 2000
65+
55-64
45-54
35-44
25-34
18-24
14.3%4.5%
19.7%
13.3%
16.4%
23.5%
10.5%17.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pop 2010 BRFSS 2010
Age Distribution of Alaska BRFSS Respondents Compared to Adult Population by Age Group, 2010
65+
55-64
45-54
35-44
25-34
18-24
Why capture cell phones and better adjust the data?
In recent years, the old method under-represents important segments of the population
Pre-diabetes
0%
2%
4%
6%
8%
10%
6% 6%
7%6% 7% 6%
7%6%
5%
Perc
ent
of
adult
Ala
skans
Adult Alaskans with pre-diabetes by race and AK BRFSS region, 2009-2011- Post Strat
Adult Alaskans with pre-diabetes by race and AK BRFSS region, 2009-2011- Raked
0%
2%
4%
6%
8%
10%
0.064425 0.06157
0.084758
0.057618 0.0650970.0642380.0768120.068172
0.052144
Perc
ent
of
adult
Ala
skans
Adult Alaskans with pre-diabetes by race and AK BRFSS region, 2009-2011- Raked
0%
2%
4%
6%
8%
10%
0.064425 0.06157
0.0847580000000001
0.057618
0.06509700000000010.064238
0.0768120.068172
0.052144
Perc
ent
of
adult
Ala
skans
Percent of Adult Alaskans with Pre-diabetes by Leisure-time exercise and BMI levels 2009-2011
Exerc
ise
No
Exer-
cis
e
Exerc
ise
No
Exer-
cis
e
Exerc
ise
No
Exer-
cis
e
Healthy Weight Overweight Obese
0%
5%
10%
15%
20%
25%
3.3% 5.2% 4.2%6.1%
14.8%16.8%
Perc
en
t of
Ad
ult
A
laskan
s
0%
20%
40%
60%
80%
100%
49% 64%
0.6669 0.6557
old data methodnew data method
Perc
ent O
verw
eigh
t or O
bese
Source: AK BRFSS
Prevalence of Overweight/Obesity from 1991-2011
Diabetes Prevalence
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
1
2
3
4
5
6
7
8
9
4%
7%
POST STRAT
Pe
rce
nt
Ad
ult
Ala
sk
an
s w
ith
Di-
ab
ete
s
Diabetes Prevalence, Old Data Method 2000-2011
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
1
2
3
4
5
6
7
8
9
4%
7%6%8%
POST STRAT
RAKED
Pe
rce
nt
Ad
ult
Ala
sk
an
s w
ith
Di-
ab
ete
s
Diabetes Prevalence, Old / New Data Method 2000-2011
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
1
2
3
4
5
6
7
8
9
4%
7%6%8%
POST STRAT
RAKED
Pe
rce
nt
Ad
ult
Ala
sk
an
s w
ith
Di-
ab
ete
s
Diabetes Prevalence, Old / New Data Method 2000-2011
Diabetes incidence
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
2
4
6
8
10
12
14
4.0
4.5
3.1
5.4 5.2 5.2
9.79.1
5.3
6.1
3.8
5.6
Calculated Diabetes Incidence, 2000-2011
Incidence
Upper 95% CL
Lower 95% CL
Ne
w C
ase
s p
er
10
00
Po
pu
lati
on
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
2
4
6
8
10
12
3.9
4.34.6
5.2
6.7
8.0 8.0
6.8
5.05.2
Diabetes Incidence, 2001-2010, 3-year rolling average
Incidence
Upper 95% CL
Lower 95% CL
Ne
w C
ase
s p
er
10
00
Po
pu
lati
on
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
2
4
6
8
10
12
3.94.3 4.6
5.2
6.7
8.0 8.0
6.8
5.0 5.2
7.6
5.5 5.5
Diabetes Incidence, 2001-2010, 3-year rolling average. Old and New Weighing
Incidence
Raked In-cidence
Ne
w C
ase
s p
er
10
00
Po
pu
lati
on
Age at diabetes diagnosis by race, 2009-2011
18-24 25-34 35-44 45-54 55-64 >= 650%
5%
10%
15%
20%
25%
30%
35%
40%
28%
27%28% 29%
35%
White AI/ANOther
Perc
en
t of
Ad
ult
Ala
skan
s
wit
h D
iab
ete
s
Age at diabetes diagnosis by BMI category, 2009-2011
18-24 25-34 35-44 45-54 55-64 >= 65
0%
5%
10%
15%
20%
25%
30%
35%
40%
31%33%34%
<25 BMI25 to <30BMI>= 30 BMI
Perc
en
t of
Ad
ult
A
laskan
s w
ith
Dia
bete
s
Vision loss likely related to diabetes increased in US adults from1.4 percent in 1999 through 2002 to 1.7 percent in 2005 through 2008, an increase of 21 percent within less than a decade in the U.S..
Dr. David Friedman from the Wilmer Eye Institute of Johns Hopkins University School of Medicine in Baltimore
Fang K, Vitale S, Chou C, Cotch MF, Saaddine J, Friedman D. Prevalence of Nonrefractive Visual Impairment in US Adults and Associated Risk Factors, 1999-2002 and 2005-2008.
JAMA. 2012;308(22):2361-2368. doi:10.1001/jama.2012.85685.
Eyes and Kidneys
Kid
ne
y p
rob
lem
s
Eye
sig
ht
tro
ub
le
Kid
ne
y p
rob
lem
s
Eye
sig
ht
tro
ub
le
Alaska Public Alaskans with Diabetes
0%
5%
10%
15%
20%
25%
30%
35%
2%
22% 21%
14%
Percent of Alaskans with and without Diabetes with Kidney or Eyesight
Problems 2011
Percent of Alaskans With and Without Diabetes Who Have or Have Had
Cataracts 2011
Alaskans Alaskans w diabetes0%
10%
20%
30%
40%
50%
13%
32%
Perc
en
t W
ho H
ave o
r H
ave H
ad
Cata
racts
Diabetes and tobacco use
Diabetes Pre-diabetes No Diabetes0%
10%
20%
30%
40%
50%
60%
Current Smoker
Perc
en
t of
Ad
ult
A
laskan
sPercentages of adult Alaskans with diagnosed diabetes, pre-diabetes or no diabetes by smoking status, 2009-2011
Diabetes Pre-Diabetes No Diabetes0%
20%
40%
60%
80%
100%
63%
36% 39%
Perc
ent
of
Dia
bete
s Sta
-tu
sHealth care provider advised stop smoking within previous year by diabetes diagnosis group, 2009-2011
Diabetes Self-Management
2000-2011 trend in percentages of Alaskans with diabetes with diabetes education (had ever taken a diabetes self-management class)
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110%
20%
40%
60%
80%
100%
52% 51% 50% 51%59% 64% 61%
52% 59% 56%60% 63%
Perc
ent
of
adult
A
lask
ans
wit
h
dia
bete
s
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
0.2
0.4
0.6
0.8
1
52% 51% 50% 51%59% 64% 61%
52% 59% 56%60% 63%
RakedPost StratificationPe
rcent
of
adult
A
lask
ans
wit
h
dia
bete
s2000-2011 trend in percentages of Alaskans with diabetes with diabetes education (had ever taken a diabetes self-management class) Post Strat v. Raked
Quality of Care
2004 2005 2006 2007 2008 2009 2010 20110%
10%
20%
30%
40%
50%
9% 10%
24%
15%
32%37%
35%37%
0 QOC Activities 1 QOC Activities 2 QOC Activities 3 QOC Activities
Perc
en
t of
Ala
skan
s w
ith
Di-
ab
ete
sTrends in percentages of Alaskans with diabetes that had received 0, 1, 2 or 3 quality of care activities (dilated eye exam, foot
exam and/or at least 2 A1c tests) in the previous year, 2004-2011
Trends in percentages of Alaskans with diabetes that had received 0, 1, 2 or 3 quality of care activities (dilated eye exam, foot
exam and/or at least 2 A1c tests) in the previous year, 2004-2011
2004 2005 2006 2007 2008 2009 2010 20110%
10%
20%
30%
40%
50%
0 QOC Activities 3 QOC Activities
Perc
en
t of
Ala
skan
s w
ith
D
iab
ete
s
Trends in percentages of Alaskans with diabetes that had received 0, 1, 2 or 3 quality of care activities (dilated eye exam, foot
exam and/or at least 2 A1c tests) in the previous year, 2004-2011
2004 2005 2006 2007 2008 2009 2010 20110%
10%
20%
30%
40%
50%
POST-STRAT RAKED
Perc
en
t of
Ala
skan
s w
ith
D
iab
ete
s
Percentages of Alaskans with diabetes that had received 0, 1, 2 or 3 quality of care activities (dilated eye exam, foot exam and/or at least 2 A1c
tests) in the previous year by race /insurance status, 2009-2011
White AI/AN Other Races Yes No0%
10%
20%
30%
40%
50%
60%
10%
21%
35%34%
15%
16%
29%
39%
10%
23%
37%30%
8%
21%
35%36%
26%
32%
29%
14%
Perc
en
t of
Ala
skan
s w
ith
Di-
ab
ete
s
Health Insurance
0 1 2 3
Conclusions
Conclusions• The new data weighting method, or raking, does change Percentages – but doesn’t change or detract from major findings• Alaska Natives have higher rates of prediabetes than whites• Southeast Alaska has higher rates of prediabetes than Fairbanks• Obese Alaskans have higher rates of prediabetes than overweight and healthy weight Alaskans• Diabetes prevalence essentially doubled over last 20 years• Age of diabetes diagnoses influenced by race and age, but not obesity• Alaskans with diabetes have more kidney problems and cataracts• Greater percentage of Alaskans with diabetes are former smokers versus pre-diabetes and no diabetes groups• Health insurance seems to be a factor in whether or not diabetes receive recommended quality of care activities.
Questions? Gail [email protected] C St., #722Anchorage, AK 99503
Clint [email protected] Willoughby Ave, Ste. 110Juneau, AK 99801
