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The US-Mexico Border Diabetes Prevention and Control Project
FIRST REPORT
OF
RESULTS
Partners in Phase I of the Project
Mexico
Ministry of Health of Mexico Centro Nacional de Vigilancia Epidemiológica y Control de Enfermedades Mexican Diabetes Association in Nogales, Sonora Mexican Diabetes Association in the State of Chihuahua State Diabetes Prevention and Control Program in Baja California, State Diabetes Prevention and Control Program in Chihuahua, State Diabetes Prevention and Control Program in Coahuila, State Diabetes Prevention and Control Program in Nuevo León, State Diabetes Prevention and Control Program in Sonora State Diabetes Prevention and Control Program in Tamaulipas Local Health Departments in all Border Cities
AbAbstractt strac
T
he goal of the US-Mexico Border Diabetes Prevention and Control Project is to reduce the impact of diabetes on the residents living along the US-Mexico border, through a model of participation and shared leadership along the border region The first phase of the project was to conduct a prevalence survey of diabetes and related biological and behavioral risk factors The survey was administred from February 2001 to October 2002 to a
stratified, random sample of 4,027 individuals, representative of the non-institutionalized population aged 18 years or older living in the US-Mexico border region Diabetes is defined by self-report or fasting plasma glucose FPG 126 mg/dl; prediabetes as having FPG in the range 100-125 mg/dl and no diagnosis of diabetes underweight was defined as body mass index BMI 185 kg/m2, normal weight as BMI 185-249 kg/m2, overweight as BMI 250-299 kg/m2, and obesity as BMI 300 kg/m2 Results show that among the 75 million persons 18 years and older living at the US-Mexico border, 157, or approximately 12 million have diabetes Of these adults, 500,000 live on the Mexican side of the border and about 700,000 live on the US side The prevalence of prediabetes is 14 Prediabetes affects approximately one million people; more than half 51 are women It is estimated that 53 million adults are overweight or obese Among the obese, 1 million live on the Mexican side of the border, and 15 million on the US side Obese individuals on the US side of the border have a 28 times greater risk of having type 2 diabetes than individuals with normal weight; on the Mexican side, the risk is 22 times
greater
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First Report of Results
Introduction Introduction T
he goal of the US-Mexico Border Diabetes Prevention and Control Project is to reduce the impact of diabetes among residents along the US-Mexico border, through a model of participation and shared leadership throughout the US-Mexico border region Non-communicable or chronic diseases are of major importance in the US-Mexico border region, along with the burden they represent in terms of disability for individuals and costs to health systems and communities Until now, most of the known information about diabetes on the border has been from mortality data In México, between 1980 and 2001 the national mortality rate for type 2 diabetes increased from 20 to nearly 50 deaths per 100,000 inhabitants For the Mexican border municipalities, 6 out of 14 municipalities report a higher mortality rate than the national level In the US, diabetes was the sixth leading cause of death in 2003, with a national rate of 254 deaths per 100,000 inhabitants In 2002, diabetes was the 4th leading cause of death among Hispanics in Texas and in New Mexico, the 5th leading cause of death in El Paso, Texas, and the 6th in Dona Ana, New
Mexico
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The adult population of the US-Mexico border region is now approximately 75 million Eighty percent of the population in the US border counties is of Hispanic or Latino origin, ranging from 27 in San Diego, California to 95 in Presidio and Webb Counties, Texas The poverty rates are also high, with an average of 27 of the families in the US border region living below the federal poverty level
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BackBackground ground I
n 1995, the Division of Diabetes Translation DDT at the Centers for Disease Control and Prevention established the National Hispanic/Latino Initiative for Action The goal of this initiative was to address the disproportionate impact of diabetes, in a culturally and linguistically appropriate manner, among the Hispanic/Latino population DDT convered at group of Hispanic/Latino experts that made two vital recommendations: a increase and improve data collection, surveillance, and program evaluation in Hispanic populations, and b in states with high Hispanic/Latino population, implement interventions programs to reach out to the Hispanic/Latino population The US-Mexico Border Diabetes Prevention and Control Project was created in 1997 and 1998 by a
collaborative effort of the Diabetes Prevention and Control Programs from the health departments of Arizona, California, New Mexico, Texas, the Diabetes Programs from the states of Baja California, Sonora, Chihuahua, Coahuila, Nuevo León, and Tamaulipas; the Mexican Secretariat of Health; the Paso del Norte Foundation; and the El Paso Diabetes Association Representatives from other agencies and offices, such as the California Endowment/Project Concern and the states border health offices were also involved in this collaboration
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The project was funded in 1999 In the first phase, the collaborators designed and conducted a prevalence study of diabetes and related biological and behavioral factors, including prediabetes, overweight and obesity, and preventive health practices In the second phase, the project will undertake a pilot study of the effectiveness of an intervention model aimed at improving the self-management of diabetes among those individuals living with type 2 diabetes, and to prevent or delay the onset of diabetes among those at high risk
Some important principles that have guided this collaboration and the project are to:
1 Consider the US-Mexico border region as
one epidemiological unit 2 Involve representatives from both countries in the planning, implementation, and evaluation of the project 3 Gather all data through a randomized household survey
A Binational Executive Committee was formed to manage the project and provide guidance and oversight to the project This Committee makes recommendations regarding administrative procedures and scientific policies related to the implementation of the project and makes decisions pertaining to the projects functioning and funding The Executive
Committee has two working committees Scientific and Intervention Advisory, supported in turn by workgroups responsible for tasks agreed upon in coordination with the Executive Committee
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This project has received financial and human resources support from border cities, counties, and municipalities, from state and federal entities in the US and Mexico, and from nongovernmental organizations The involvement of these many entities, at all different levels, has made this project very challenging, but it has also made it very successful with a strong scientific and programmatic integrity
MethMethodology odology A
diabetes prevalence survey was conducted
from February 2001 to October 2002 using a stratified, random sample of 4,027 individuals 1,905 on the US side and 2,122 on the Mexican side representative of the non-institutionalized population aged 18 years or older living in the US-Mexico border region A multistage, cluster sample design was designed with strata: state and county in California and Texas, and ethnicity on the US side Within each stratum, census tracts and census blocks were randomly selected; then, within each block US or AGEB Mexico households were randomly selected and, within each household, adult members were randomly selected
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The survey was conducted in 44 border communities: 28 in Mexico and 16 in the US The questionnaire had 65 questions about diabetes, gene 
ral health, access to health care, hypertension, physical activity, diet, eating habits, tobacco use, alcohol consumption, reproductive health, social culture aspects, acculturation, education, work history, and demographic variables, including ethnicity
The survey also included anthropometric weight, height, waist and hip circumferences and blood pressure measurements In the final part of the survey, a fasting blood sample was collected by a
certified phlebotomist to estimate fasting plasma glucose and hemoglobin A1C levels
Persons who reported having been told by a health professional that they had diabetes were classified as having diagnosed diabetes Persons without previous diagnosed diabetes were those who reported that they had never been told and women who were told only during pregnancy Undiagnosed diabetes was defined as a fasting plasma glucose FPG 126 mg/dl among persons without diagnosed diabetes Total diabetes is the sum of diagnosed and undiagnosed cases Prediabetes was defined as having no diabetes and FPG in the range 100-125 mg/dl Underweight was defined as body mass index BMI 185 kg/m2 normal weight as BMI 185-249 kg/m2 overweight as BMI 250-299 kg/m2 and obesity as BMI 300 kg/m
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Results Results
A
total of 4,027 questionnaires were completed, 1,905 473 on the US side of the border and 2,122 527 on the Mexican side The number of surveys conducted in the four US border states were: California 652, Arizona 324, New Mexico 342, and Texas 587 In the six Mexico border states, the distribution of the surveys was as follows: 326 in Baja California, 352 in Sonora, 444 in Chihuahua, 338 in Coahuila, 331 in
Nuevo León, and 331 in Tamaulipas Among the participants, the mean age was 411 169 years of age; 292 were male, and 882 n3,550 identified themselves as Hispanic
Completed Surveys by Country State
US 1905 California 652 Arizona 324 New Mexico 342 Texas 587 México 2122 Baja California 326 Sonora 352 Chihuahua 444 Coahuila 338 Nuevo León 331 Tamaulipas 331 4,027 Total
Selected Characteristics United States-Mexico Border Region Study Population
Characteristics Total Country México United States Age years 18-29 30-39 40-49 50-59 60- Sex Male Female Ethnicity Hispanic Non-Hispanic BMI Kg/m2 Underweight: 185 Normal: 185-249 Overweight: 250-299 Obesity:30 N 4027 2122 1905 934 938 773 579 803 1177 2850 3550 475 49 942 1469 1525 1000 527 473 232 233 192 144 199 292 708 882 118 1 236 369 383
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US-Mexico Border Region Prevalence of Diabetes
Among residents of the border region, the total self-reported and diagnosed through the study prevalence of diabetes was 157 More than eleven percent 114 reported having been told by a health professional that they had diabetes and an additional 43 did not know that they had diabetes at the time of the study
Prevalence of prediabetes
In the total
border population, the prevalence of prediabetes was 139
Prevalence of Diabetes and Pre-diabetes United States-Mexican Border
Prevalence of overweight and obesity
157 139 704
Body Mass Index BMI was used to classify the participants as Normal underweight, normal, overweight or 100 mg/dl obese By these criteria, it was found that less than 1 of the border populaPrevalence of Overweight and Obesity, tion was underby Sex, United States-Mexican Border weight, 236 was 45 409 40 normalweight, 356 343 33 35 287 30 259 369 was over25 20 weight, and 383 15 10 was obese In the 5 14 002 0 Normal Overweight Obese border area, men Underweight Female Male were more overweight than women 409 vs 356, where as women were more obese than men 343 vs 33
Diabetes 126 mg/dl Pre-diabetes 125 mg/dl 100 mg/dl
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Mexico Border Area Prevalence of Diabetes
In the Mexico border area, the total prevalence diagnosed and undiagnosed of diabetes was 151 Almost nine percent 85 of the participants reported having been told by a health professional that they had diabetes and 66 did not know that they had diabetes at the time of the survey
Prevalence of Prediabetes
Along the Mexican border, the
percentage of individuals that had levels of blood glucose between 100 and 125mg/dl of blood glucose was 143
Prevalence of Diabetes and Pre-diabetes Mexico Border
151 143 706
Diabetes 126 mg/dl Pre-diabetes 125 mg/dl 100 mg/dl
Overweight and Obesity
Using the BMI measurements Normal 100 mg/dl as explained before, it was found that 16 of the population in the Mexican border was underweight, 267 was normalweight, Prevalence of Overweight and Obesity 394 was overby Sex, Mexico Border weight and 322 50 4370 was obese When 40 3777 3517 data was analyzed 30 2755 2666 2594 20 by sex, men were 10 more overweight 112 209 0 than women 437 Normal Overweight Obese Underweight Female Male vs 351, whereas women were more obese than men 378 vs 267
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US Border Area Prevalence of Diabetes
In the US border area, the total prevalence self-reported and diagnosed through the study of diabetes was 161 135 reported having been told by a health professional that they had diabetes, and 26 did not know that they had diabetes at the time of the survey
Prevalence of Prediabetes
In the US border area, the prevalence of prediabetes was 136
Prevalence of Diabetes and Pre-diabetes United States
Border
Overweight and Obesity
In the US border area, less than 10 of inhabitants were underweight, 270 were normal weight, 374 were overweight, and 347 were obese Men were more overweight 389 vs 359 and more obese 377 vs 319 than women
161 136 703
Diabetes 126 mg/dl Pre-diabetes 125 mg/dl 100 mg/dl Normal 100 mg/dl
50 40 30 20 10 0 171
Prevalence of Overweight and Obesity by Sex, United States Border
389 305 2329 3593 3186 3768
013 Normal Overweight Female Obese Male
Underweight
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Conclusions Conclusions
C
urrently, along the US-Mexico border there are 75 million adults Approximately 12 million of them have type 2 diabetes 157 The diabetes prevalence study showed that
nearly 500,000 of the individuals living with diabetes are on the Mexican side of the border and more than 700,000 are on the US side It is estimated that 53 million adults in the US-Mexico border
region are overweight or obese One million of the obese individuals live on the Mexican side of the border, and 15 million live on the US side Obese individuals along the US side of the border have 28 times greater risk of developing diabetes than individuals with normal weight, and on the Mexican side,
the risk is 22 times greater The prevalence of prediabetes in the US-Mexico border is 14 in the total adult population Prediabetes affects approximately one million individuals 51 of women and 49 of men
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Partners in Phase I of the Project
United States
United States Department of Health and Human Services Health Resources and Services Administration Centers for Disease Control and Prevention Arizona Department of Health Services California Department of Health Services New Mexico Department of Health Texas Department of State Health Services Pan American Health Organization US-Mexico Border Health Association Paso del Norte Health Foundation The California Endowment Project Concern International California Diabetes Control Program Arizona Diabetes Control Program New Mexico Diabetes Control Program Texas Diabetes Control Program El Paso Diabetes Association University of Missouri, School of Medicine Center for Border Health Research Primus Corporation RE Thomason Hospital, El Paso, TX Rio Grande Council of Governments New Mexico State University at Las Cruces Doña Ana County Community College Arizona Health Border Office Local Border Health Departments County of San Diego
Public Health Laboratory Gateway Community Health Center Southwest Arizona Health Education University of Texas at Houston School of Public Health at El Paso College of Public Health University of Arizona Western Arizona Area Health Education Center
Partners
