have diabetes, your body either doesn’t make enough insulin or can’t use its own Type 1, or juvenile diabetes, usually starts early in life. Type 2 diabetes …

The Burden of Diabetes in New Jersey: A Surveillance Report

New Jersey Department of Health and Senior Services Division of Family Health Services

Diabetes Control Program
Section I : Section II :
Jon S Corzine Governor

May 2005 December 2006
Fred M Jacobs, MD, JD Commissioner

The Burden of Diabetes in New Jersey: A Surveillance Report Section I - 2005 Section II - 2006

Jon S Corzine Governor State of New Jersey

Fred J Jacobs, MD, JD Commissioner New Jersey Department of Health and Senior Services

Eddy Bresnitz, MD, MS, Deputy Commissioner/State Epidemiologist Public Health Services Branch

Celeste Andriot Wood Assistant Commissioner Family Health Services

Doreleena Sammons-Posey, SM Director Chronic Disease Prevention and Control Services

Elizabeth Solan Research Scientist Wellness Promotion and Chronic Disease Prevention

Diabetes Prevention and Control Program Section I: May 2005 Section II: December 2006

This publication was supported by Cooperative Agreement 32/CCU22720-02 Systems Based Diabetes Prevention and Control Programs Its contents are solely the responsibility of the authors and do not necessarily represent the official views of Centers for Disease Control
and Prevention

Acknowledgments
The Diabetes Surveillance Report is a project that reflects the investment of time and expertise by many coworkers and colleagues It is not possible to include the names of all who have lent their support over the course of the development of this report, however, there are some contributors whose enthusiastic and generous assistance warrants special mention The efforts of Kenneth ODowd, PhD of the New Jersey Department of Health and Senior Services Center for Health Statistics, Rose Marie Martin, MPH of the Division of HIV/AIDS Services, Joseph N Bottalico, DO, FACOOG, and Giles Crane, MPH of Maternal, Child, and Community Health Services were crucial to this work Dr ODowd provided subsets of data from the New Jersey Behavioral Risk Factor Survey He and Giles Crane provided valuable assistance in solving technical problems in the analysis of the data Ms Martin provided guidance in developing the report and feedback on draft chapters Dr Bottalico provided valuable input and insight in our development of the Diabetes and Pregnancy Chapter

This report was developed and prepared by the members of the Diabetes Data Management Committee The committee
gives special acknowledgment to the members of the New Jersey Diabetes Council Their support and collaboration have been present in all stages of the project, from planning through final proofreading Without the assistance and support of these and many other individuals, this report would not have been possible Diabetes Data Management Committee Henry Sherel, MPA Research Scientist Diabetes Prevention and Control Program Elizabeth Solan, MPH Research Scientist Wellness Promotion and Chronic Disease Prevention Program Mary Ann Reiter, MA Acting Coordinator Diabetes Prevention and Control Program Marcia M Sass, ScD Assistant Professor, Department of Health Systems and Policy University of Medicine and Dentistry of New Jersey, School of Public Health

Contents

Introduction Section I Chapter 1 Demographics

Chapter 2 Prevalence

Chapter 3 Diabetes in Pregnancy Section II Chapter 4 Prevention

Chapter 5 Diabetes Mortality

Chapter 6 Diabetes Related Hospital Discharges

List of Tables and Illustrations Section I
New Jersey Demographics Table 1 Profile of General Demographic Characteristics for New Jersey and the United States: 2000 7 Changes in
Population by Race and Hispanic Origin, New Jersey, 1990 to 20008 Changes in Population by Age Group, New Jersey, 1990 to 20008 Changes in Population by Age Group and Gender, New Jersey, 1990 to 20009 Total Population and 45 and Over Population by Race and Gender, New Jersey, 2000 9 Population of Persons of Hispanic Origin by Age, New Jersey, 2000 10 Population of Persons of Hispanic Origin 45 Years and Over by Gender, New Jersey, 2000 10 Population by County, Race, and Percent of County Population, New Jersey, 2000 11 Population by County, Hispanic Origin, Percent of County Population, and Percent Change, New Jersey, 1990 to 200012 Population by Hispanic Ethnicity for the 15 Largest Municipalities, New Jersey, 1990 to 200013 Population by Race for the 15 Largest Municipalities in New Jersey, New Jersey, 2000 14 Percent of Population in Age Group by County, New Jersey, 2000 15 County Populations by Selected Age Groups and Percent Changes, New Jersey, 1990 to 200016 Population of Persons 45 Years and Older by Selected Races and County, New Jersey, 2000 17

Table 2

Table 3

Table 4

Table 5

Table 6

Table 7

Table 8A

Table 8B

Table 8C

Table 8D

Table 9A

Table 9B

Table
10A

Table 10B

Population of Persons of Hispanic Origin, Total, and 45 years and Older by County, New Jersey, 2000 18 Percentage of Households Where a Foreign Language is Spoken by County, New Jersey, 2000 19 Total Population of Persons 5 Years and Over Who Speak Selected Foreign Languages at Home by County, New Jersey, 200019 Total Households, Households Linguistically Isolated, and Foreign Language Spoken in Household by County, New Jersey, 2000 20 Changes in Poverty Rate by County, New Jersey, 1989 to 1999 21 Percent of Persons with no Health Insurance Coverage by Poverty Status, United States and New Jersey, 200022

Table 11A

Table 11B

Table 11C

Table 12 Figure 1

Prevalence of Diabetes Table 1 Estimated Diabetes Age Adjusted Prevalence Rates by Race/Ethnicity, New Jersey, 2001 through 200325 Estimated Number and Rate of Persons Diagnosed with Diabetes by Age, Gender, and Race/Ethnicity, New Jersey, 2001 through 200326 Estimated Prevalence of Persons Diagnosed with Diabetes by Race/Ethnicity, Gender, and Age, New Jersey, 2001 through 200327 Estimated Mean Age at the Time of Diagnosis of Diabetes by Race and Hispanic Origin, Persons 18 Years and Older, New Jersey, 2001
through 200327 Estimated prevalence of Diabetes by Race, New Jersey, 2001 through 200328 Estimated Age Adjusted Rate of Persons 18 Years and Over with Diagnosed Diabetes by County, New Jersey, 2001 through 200329 Estimated Number of Persons 18 Years and Over Diagnosed with Diabetes by County, New Jersey, 2001 through 200330 Diabetes Prevalence Rates by Education Level, New Jersey, 2001 through 200331 Diabetes Prevalence Rates by Income Level, New Jersey, 2001 through 200331

Table 2

Table 3

Table 4

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Estimated Prevalence of Diagnosed Diabetes in Individuals 18 Years and Older, New Jersey and the United States, 1991 to 200332 Estimated Number of Individuals Diagnosed with Diabetes by Age and Gender, New Jersey, 2001 through 2003 33 Diabetes and Obesity Prevalence, United States and New Jersey, 1991 to 200234

Figure 7

Figure 8

Diabetes in Pregnancy Table 1 Estimated Prevalence of Diabetes in Females 18 through 44 Years of Age Who Reported Having Diabetes Except During Pregnancy by Race and Ethnicity, New Jersey, 2000 through 2002 37 Total and Percentage of Birthing Mothers With and Without Diabetes as a Medical Risk
Factor of Pregnancy, and Rate of Diabetes as a Medical Risk Factor, by County, New Jersey, 2000 38 Estimated Rates of Females 18 Years Old and Over Who Reported Ever Having Been Diagnosed with Diabetes, but Only During Pregnancy, New Jersey, 1995 through 200239 Rates of Diabetes as a Medical Risk Factor of Pregnancy as Reported on Certificates of Live Birth, by Maternal Race and Hispanic Origin, New Jersey, 1998 - 2002 39 Number and Rates of Birthing Mothers with Diabetes as a Medical Risk Factor of Pregnancy as Reported on Certificates of Live Birth, by Year and Selected Age Groups New Jersey, 1998 to 2002 40 Diabetes as a Medical Risk for Birthing Mothers by Age Group, New Jersey, 2002 40 Numbers and Rates of Birthing Mothers and Birthing Mothers with Diabetes as a Medical Risk Factor of Pregnancy by Year, New Jersey, 1996 - 200041 Number and Rate of Labor and Delivery Complications and Primary Caesarian Section Deliveries for Birthing Mothers With and Without Diabetes as a Medical Risk Factor of Pregnancy, New Jersey, 2000 42 Number and Rate of Adverse Delivery Outcomes for Births with Mothers Having and not Having Diabetes as a Medical Risk Factor of Pregnancy, New Jersey,
200043

Table 2

Table 3

Table 4

Table 5

Figure 1

Table 6

Table 7

Table 8

Prevention

Section II

Figure 1

Trends in the Prevalence of Diabetes and Obesity among Adults for the United States and New Jersey, 1991 to 200247 Prevalence of Obesity and Physical Activity among Diabetic and Non-Diabetic Adults, New Jersey, 2003-2005 48

Figure 2

Table 1A Percentage of Women Having Less than Moderate Exercise by Race/Ethnicity, Age, and Diabetes Status, New Jersey, 2003 through 2005 49 Table 1B
Percentage of Men Having Less than Moderate Exercise by Race/Ethnicity, Age, and Diabetes Status, New Jersey, 2003 through 2005 50

Table 2A Percentage of Women Who are Obese by Race/Ethnicity, Age, and Diabetes Status,
New Jersey, 2003 through 2005 51

Table 2B Percentage of Men Who are Obese by Race/Ethnicity, Age, and Diabetes Status, New Jersey, 2003 through 200552 Table 3
Estimated Percentage of Adults Who Were Overweight non-Obese or Obese by County of Residence, New Jersey, 2003 through 2005 53

Figure 3

Percent of Population with Diabetes, Population without Diabetes, and Total Adult Population Receiving an Annual Flu Vaccination by Age Group, New Jersey, 2003 through 2005 54
Percent of Population with Diabetes, Population without Diabetes, and Total Adult Population Receiving a Pneumoccocal Vaccination by Age Group, New Jersey, 2003 through 2005 54
Percentage of Adult Population Diagnosed with Diabetes who had a Retinal Exam, a Foot Exam, or A1C Test within the Previous Year by Race/Ethnicity, New Jersey, 2003 through 200555

Figure 4

Table 4

Figure 5

Frequency of Blood Testing for Glucose Reported by Persons 18 and Over with Diabetes, New Jersey, 2003 through 2005 55

Table 5A Percentage of Adults with High Blood Pressure as a Risk Factor by Race/Ethnicity, and Diabetes Status, New Jersey, 2003 through 2005 56 Table 5B Percentage of Population Diagnosed with Diabetes, Population without Diabetes,
and Total Adult Population with a Cholesterol Risk Factor by Race/Ethnicity, New Jersey, 2003 through 200556

Figure 6

Adult Population Diagnosed with Diabetes, by Medication Type Used New Jersey, 2003 through 200557 Insulin Use for the Treatment of Diabetes by Time Period New Jersey, 1994 through 1996 and 2003 through 2005 57 Percentage of Hypertensive Adults Taking Blood Pressure Medication, by Age and Gender, and Diabetes Status, New Jersey, 2002 and
200458

Figure 7

Table 6

Diabetes Mortality Table 1 Average and Rank of Death Rates for Diabetes as any Listed Cause per 100,000 Population, by State, United States, 2000-200264 Diabetes Designated as the Underlying Cause of Death for Selected Years by Number of Deaths, Crude Rate, and Percent of Total, New Jersey Residents, 1999-2003 65 Diabetes Listed as the Underlying Cause of Death by Age, Gender and Percent, New Jersey Residents, 200265 Diabetes Listed as the Underlying Cause of Death by Gender, Age, Race, and Rate, New Jersey Residents, 200266 Years of Potential Life Lost YPLL Due to Diabetes as the Underlying Cause of Death by Gender and Race, New Jersey, 200266 Age-Adjusted Death Rates for Diabetes Designated as the Underlying Cause of Death by Race and Gender, New Jersey Residents, 2002 67 Age-Adjusted Death Rates for Diabetes Designated as Underlying Cause of Death by County, New Jersey Residents, 200268 Diabetes Listed as the Underlying Cause of Death by Gender and Subclassification, New Jersey Residents, 2002 69 Diabetes as a Mentioned Cause of Death on Death Certificates, New Jersey Residents, 2002 70

Table 2

Table 3

Table 4

Table 5

Table 6

Table 7

Table
8

Table 9

Table 10 Diabetes as a Listed Cause of Death, but not the Underlying Cause, by Order of Mention, New Jersey Residents, 2002 70 Table 11 Age-Adjusted Rates for Any Mention of Diabetes as a Cause

of Death by Gender, New Jersey, 2002 71

Table 12 Any Mention of Diabetes as Cause of Death by Age and Rate, New Jersey, 200271 Table 13 Any Mention of Diabetes as a Cause of Death by Underlying Cause, New Jersey Residents, 200272 Table 14 Any Mention of Diabetes as a Cause of Death by Underlying Cause, Gender, and Race, New Jersey Residents, 2002 73 Table 15 Age-Adjusted Rates for Any Mention of Diabetes as a Multiple Cause by Specific Underlying Condition, Gender and Race, New Jersey, 200274

Diabetes Related Hospital Discharges

Table 1

Hospital Discharges with Diabetes Listed as the Primary Diagnosis by Age, Gender, Rate, and Average Length of Stay, New Jersey and the United States, 2003 82 Hospital Discharges with Diabetes Listed as the Primary Diagnosis by Average Length of Stay and Age, New Jersey and the United States, New Jersey, 200383

Figure 1

Table 2 Hospital Discharges by Primary Diagnosis, Average Length of Stay in Days, and Average Charges in Dollars, New
Jersey, 200384 Table 3 Hospital Discharges by Primary Diagnosis, Mention or Absence of Diabetes, and Average Length of Stay, New Jersey, 2003 85 Hospital Discharges with Diabetes Listed as the Primary Diagnosis by Race, Ethnicity, Gender, Number of Discharges, Number of Days, and Average Length of Stay, New Jersey, 200386

Table 4

Table 5 Hospital Discharges with Any Mention of Diabetes as a Listed Diagnosis by Race, Ethnicity, Gender, Number of Discharges, Number of Days, Age-Adjusted Rates, and Average Length of Stay, New Jersey, 200387 Table 6 Hospital Discharge Rates with Any Mention of Diabetes as a Listed Diagnosis by Race, Ethnicity, Gender, and Age,

New Jersey, 2003 88 Table 7 Hospital Discharge Rates with Any Mention of Diabetes as Listed Diagnosis by County and Age, New Jersey, 200389 Table 8 Hospital Discharges with Any Mention of Diabetes as a Listed Diagnosis by County, Number of Discharges, Age-Adjusted Discharge Rates, Number of Days, and Average Length of Stay, New Jersey, 200390 Table 9 Hospital Discharges with Any Mention of Diabetes and End Stage Renal Disease ESRD as Listed Diagnoses by Race, Ethnicity, Gender, Number of Discharges, Average Length of Stay, and
Age-Adjusted and Crude Rates, New Jersey, 2003 91

Table 10 Hospital Discharges with Any Mention of Diabetes and End of Stage Renal Disease ESRD as Listed Diagnoses by County, Number of Discharges, Average Length of Stay, and Age-Adjusted and Crude Rates, New Jersey, 2003 92 Table 11 Hospital Discharges with Any Mention of Diabetes and Kidney Diseases as Listed Diagnoses by Race, Ethnicity, Gender, Number of Discharges, Average Length of Stay, and Age-Adjusted and Crude Rates, New Jersey, 2003 93 Table 12 Hospital Discharges with Any Mention of Diabetes and Selected Vision Disorders as Listed Diagnoses by Race, Ethnicity, Gender, Number of Discharges, Average Length of Stay, and Age-adjusted and Crude Rates, New Jersey, 2003 94 Table 13 Hospital Discharges with and without Diabetes Listed as a Diagnosis and Traumatic and Non-traumatic Amputations Listed as a Procedure by Number and Percent, New Jersey, 200395 Table 14 Hospital Discharges with Any Mention of Diabetes as a Listed Diagnosis and Non-Traumatic Amputations of the Lower Limb by Race, Ethnicity, Gender, Number of Discharges, Average Length of Stay, and Age-adjusted and Crude Rates, New Jersey, 200396 Table 15 Hospital
Discharges with Any Mention of Diabetes as a Listed Diagnosis and NonTraumatic Amputations of the Lower Limb by County, Number of Discharges, Average Length of Stay, and Age-adjusted and Crude Rates, New Jersey, 2003 97 Table 16 Hospital Discharges with Any Mention of Diabetes and Selected Cardiovascular Diseases as Listed Diagnoses by Race, Ethnicity, Gender,

Number of Mentions, Mean Length of Stay, and Crude and Age-Adjusted Rates, New Jersey, 2003 98 Table 17 Hospital Discharges with Any Mention of Diabetes and Selected Cardiovascular Diseases as Listed Diagnoses by County, Crude and Age-Adjusted Rates, and Average Length of Stay, New Jersey, 200399 Table 18 Hospital Discharges with Any Mention of Diabetes and Hypertensive Disease Listed as Diagnoses by Race, Ethnicity, Gender, Average Length of Stay, and Age-adjusted and Crude Rates, New Jersey, 2003 100 Table 19 Hospital Discharges with Any Mention of Diabetes and Hypertensive Disease Listed as Diagnoses by County, Number of Discharges, Average Length of Stay, and Age-adjusted and Crude Rates, New Jersey, 2003 101

Table 20 Hospital Discharges with Any Mention of Diabetes and Major Cardiovascular Diseases Listed as Diagnoses
by Race, Ethnicity, Gender, Average Length of Stay, and Age-Adjusted and Crude Rates, New Jersey, 2003 102 Table 21 Hospital Discharges with Any Mention of Diabetes and Major Cardiovascular Diseases Listed as Diagnoses by County, Number of Discharges, Average Length of Stay, Crude and Age-adjusted Rates New Jersey, 2003103 Table 22 Hospital Discharges with Any Mention of Diabetes and Cerebrovascular Disease Listed as Diagnoses by Race, Hispanic Ethnicity, Gender, Average Length of Stay, and Age-Adjusted and Crude Rates, New Jersey, 2003 104 Table 23 Hospital Discharges with Any Mention of Diabetes and Cerebrovascular Disease Listed as Diagnoses by County, Number of Discharges, Average Length of Stay, and Age-adjusted and Crude Rates, New Jersey, 2003 105 Table 24 Hospital Discharges with Any Mention of Diabetes and Pneumonia or Influenza Listed as Diagnoses by Race, Ethnicity, Gender, Average Length of Stay, and Age-adjusted and Crude Rates, New Jersey, 2003 106 Table 25 Hospital Discharges with Any Mention of Diabetes and Pneumonia or Influenza Listed as Diagnoses by County, Average Length of Stay, and Age-adjusted and Crude Rates, New Jersey, 2003107

Table 26 Hospital
Discharges with Any Mention and No Mention of Diabetes as a Listed Diagnosis 1st through 9th diagnosis by Primary Diagnosis and Average Length of Stay, Children 18 Years Old and Under, New Jersey, 2003 108 Table 27 Number of Hospitalizations with Any Mention of Diabetes and Average Length of Stay by Gender, Race, Ethnicity,, and Type of Diabetic Complication, New Jersey, 2003109 Proportion of Diabetes-Related Hospitalizations for Patients Under 65 Years of Age with Selected Diabetes-Related Ambulatory Care Sensitive ACS Conditions Identified as the Primary Discharge Diagnosis, by Race, Gender, and Hispanic Ethnicity, New Jersey, 2003111

Table 28

Table 29 Proportion of Hospital Discharges Under 65 Years of Age with Selected Ambulatory Care Sensitive ACS Diabetes Conditions Listed As the Primary Diagnosis by County of Residence, New Jersey, 2003 112

INTRODUCTION
Chances are everyone knows someone who has diabetes It is estimated that over 440,000 New Jerseyans have been diagnosed with diabetes1 and an additional 178,000 residents have the disease2 but are unaware of it These figures do not include people with prediabetes which is estimated to be double the number of people with
diagnosed and undiagnosed diabetes combined In New Jersey, diabetes is not only common, it is also costly and significant in its impact on health Direct and indirect costs associated with medical care, lost productivity and premature mortality attributable to diabetes total about 59 billion per year in the state3 As disturbing as this figure is, it reflects only the dollar figure This cost estimate does not speak to the suffering endured by people with diabetes and their high rates of heart disease, stroke, foot ulcers and lower-extremity amputations, kidney disease, neurological problems, and blindness Nor does it tell of the pain and loss experienced in relation to thousands of deaths annually in which diabetes is one of the listed causes The risk of diabetes is not evenly distributed among New Jerseyans Some segments of our population suffer disproportionately from this disease Blacks, Hispanics, Asians, and American Indians are far more heavily impacted than Whites People over 45 years of age are more likely to have diabetes than those who are younger People with a family history of diabetes; people who are obese; people with high blood pressure or high blood cholesterol; women
with a history of gestational diabetes; and women who have had a baby weighing over 9 pounds are all at greater risk of diabetes Although the data presented here may make the challenges that we face seem daunting, the intent of this report is not to overwhelm the reader Its purpose is, rather, to make known the many opportunities that exist to modify the negative impacts that diabetes has on the people of New Jersey Diabetes is controllable and much of its burden can be delayed or prevented Wellness enhancement eg proper nutrition, physical activity, control of blood pressure, and smoking cessation, early detection of diabetes, proper treatment and screening for complications at recommended intervals are critical factors in the prevention of complications In our efforts to define the scope of the problem of diabetes in New Jersey, we hope to increase awareness of this disease, draw attention to modifiable risk factors and methods of preventing complications, provide direction for action, and establish a basis for feedback on the success of efforts undertaken The New Jersey Diabetes Prevention and Control Programs Data Committee was originally formed to assess the extent of the
burden of diabetes in New Jersey The results of the United States Department of Health and Human Services-funded Diabetes Prevention Program study, published in 2002, conclusively showed that people with prediabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity In this update of The Burden of Diabetes in New Jersey: A Surveillance Report November 1999, the scope of the report has been expanded to include data relevant to primary prevention

Data provided in The Burden of Diabetes in New Jersey: A Surveillance Report - 2005 are not comparable to the data in the 1999 report Much of the data in the earlier report were synthesized using National Interview Survey Data NHIS, whereas parallel estimates provided in this report are based on Behavioral Risk Factor Survey BRFS data It is our hope that the information presented here is thought-provoking and will be used to help organizations and agencies in planning and developing coordinated intervention strategies to address diabetes issues and used in efforts to find a cure for diabetes The diabetes surveillance report is the culmination of those efforts The
New Jersey Diabetes Council provided guidance and support to the Committee throughout the process

1 New Jersey Behavioral Risk Factor Surveillance Survey BRFSS data from 2001 through 2003 The core BRFSS questionnaire gathers responses to the question: Have you ever been told by a doctor that you have diabetes? A follow-up question for females then clarifies whether the diabetes was present only during pregnancy 2 CDC, National Center for Chronic Disease Prevention and Health Promotion, Diabetes Public Health Resource, National Diabetes Fact Sheet, web site, http://wwwcdcgov/diabetes/pubs/estimateshtmasp, December 4, 2003 3 Coffey RM, Mathews TL, McDermot K Diabetes Care Quality Improvement: A resource Guide for State Action Prepared by The Medstat Group, Inc and The Council of State Governments under Contract No 290-00-0004 Rockville, MD: Agency of Healthcare Research and Quality, Department of Health and Human Services; September 2004 AHRQ Pub No 04-0072 Page 37

CHAPTER 1
Demographic, socioeconomic, and other factors, such as race, ethnicity, age, gender, obesity, family history, geographic location, income, and education affect the current and future health status of a given
population Not only do these factors influence prevalence and incidence of disease, they also impact disease treatment and prevention The effect that population characteristics can have on rates of disease in a community is particularly apparent for diabetes For example, substantial differences exist in rates of diabetes and quality care indicators for people in varying age categories, racial groups, and even for people with different insurance status The purpose of this chapter is to illustrate the demographics and other characteristics of New Jersey at the statewide and municipal levels This information will be useful in providing a frame of reference and context in which to interpret findings presented in subsequent chapters Data from the 2000 census indicate New Jerseys population was 8,414,350 people; this number represents an 89 increase over the 1990 estimate In comparison, the United States population increased 132 in that time frame to 281,421,906 people According to Census 2000 data, in the aggregate, New Jersey residents were older than United States residents About 132 of New Jerseyans were 65 or over Nationally, only 124 of residents were in that age group In the
year 2000, the median age of New Jersey residents was 367 years as compared to 353 years for United States residents Table 1 According to U S Census 2000 Bridged Population Data, and 1990 Census Modified Age, Race, and Sex Data, racial and ethnic groups have increased at different rates New Jerseys white population had the lowest percentage increase at 40, while the Asian and other Pacific Islander population increased by a staggering 856 For the same period of time, the black population increased by 153 and the total population of Hispanic origin increased by 494 Table 2 The percent change in the New Jersey resident population between 1990 and 2000 was not constant for all age groups There were age groups in which population size had dramatically increased, such as 5 through 14 year and men 45 through 54 year age groups The population increase in the 45 and over age group is particularly pertinent because the risk of developing diabetes increases considerably in this age group However, there were other age groups for which the population declined, such as the 20 through 24 year and the 60 through 64 year age groups Table 3 According to Census 2000 data, there were more female
residents 515 than male residents 485 in New Jersey Women had a longer life expectancy than men and this longevity may account for the difference However, the percentage changes from 1990 to 2000 in the male population exceeded the female percentage changes in each age group Table 4 Gender distribution among racial groups showed variability For white females and males of all ages, the percentages were identical to the statewide distribution of gender 3

However, black females represented 529 of the statewide black population, while females in the non-white and non-black category constituted 498 of that population Gender distribution was considerably different for the 45 years and older age groups In this age group, 547 of the statewide white population was female, 575 of the black population was female, and 527 of the non-white and non-black category was female Table 5 Census 2000 data suggested that the Hispanic population in New Jersey was younger than the statewide aggregate population Statewide, 787 of the Hispanic population was under 45 years of age Table 6, while 64 of the total statewide population was under 45 years of age Table 4 The percentage of Hispanic
females in the 45 years and over age group was greater than that of Hispanic males in the 45 and over age group About 233 of Hispanic females fell within this age group, while only 194 of Hispanic males were 45 years or older Table 7 More than 70 726 of New Jerseys residents were white Sussex County at 957 had the highest percentage of white residents Black residents made up 136 of the States population Essex County at 412 had the highest percentage of black residents Asian residents comprised 57 of New Jerseys residents Middlesex County at 139 had the highest percentage of Asian residents The county that had the highest percentage of individuals whose racial make-up was of two or more races was Hudson at 56 Table 8A According to Census 2000, New Jersey residents of Hispanic origin comprised 133 of New Jerseys population This was a considerable increase from 1990, at which time residents of Hispanic origin only comprised 95 of the population There was a total Hispanic population increase from 739,861 to 1,117,191, a 51 increase Hudson County had the highest percentage of Hispanic residents in 2000 at 398 Over 64 of New Jerseys Hispanic population resided in the counties of Hudson,
Passaic, Essex, Union, and Middlesex Table 8B At the turn of the 21st century, over 25 of New Jerseys Hispanic population resided in the States four most heavily populated municipalities: Newark, Jersey City, Paterson, and Elizabeth Since 1990, Clifton at 220 followed by Hamilton Township Mercer County at 123, had the greatest rates of growth in Hispanic residents among New Jerseys 15 most populous cities Table 8C A comparison by race of the 15 most populous municipalities indicated that Newark Essex had the largest number of black residents at 146,250 In comparison, Dover Township Ocean at 83,839 had the largest number of white residents The municipality that had the largest number of Asian residents was Jersey City Hudson at 38,881 In 2000, 417 of the black population resided in the 15 most populated municipalities in New Jersey In comparison, only 133 of the white population resided in these 15 municipalities These data suggest that the New Jersey white population tended to reside in less densely populated areas of the State while the black population resided in the more urban areas of the State Table 8 D 4

The three counties that had the highest percentage of
their total population over 74 years old were Ocean at 115, Cape May at 98, and Bergen at 75 Table 9 A While population for all age categories increased from 1990 to 2000 by 89, during the same period of time, the 45 and over age group population increased by 166 and the 65 and over age group increased only by 79 The county that had the greatest increase in population in the 45 and over age group was Sussex at 389 For the 65 and over age group, the county that showed the greatest change in population was Somerset with a 283 increase Table 9B Two out of five 401 New Jersey white residents were age 45 and above The county having the highest percentage of whites in the 45 years and older age group was Gloucester at 578 In contrast, only 280 of the black population in New Jersey was 45 years of age of older Salem County at 326 had the highest percentage of blacks in the 45 and over age group The Asian population in the 45 and above age grouping had statewide proportions similar to that of the black population; 264 of the Asian population was age 45 and above Salem County at 356 was the percentage leader for the Asian population in the 45 years and over age category Table 10A Among the
Hispanic population in New Jersey, 213 were age 45 years and above Hudson County at 264 had the highest percentage of Hispanics in the 45 years and above age grouping; while Salem had the lowest percentage 151 of Hispanics in that age group Table 10B There was a great amount of ethnic diversity in the population mix of New Jersey This diversity was demonstrated by the number of people speaking foreign languages In 2000, a foreign language was spoken in 255 of New Jerseys households The five counties that had the highest percentages of households in which a foreign language was spoken were Hudson at 561, Passaic at 419, Union at 352, Middlesex at 334, and Bergen at 324 Table 11A According to Census 2000 data, 2,001,690 residents of New Jersey aged 5 years and older spoke a language other than English Spanish, spoken by 967,741 residents of New Jersey, was the foreign language spoken most frequently Spanish speakers were followed by speakers of Italian, Chinese, Polish, Portuguese, Tagalog, Korean, Gujarathi, French, Arabic, and all other languages combined The three counties with the greatest number of residents over 5 years of age who spoke a foreign language were Hudson at
320,636, Bergen at 269,112, and Middlesex at 233,939 Table 11B Linguistic isolation may cause health access problems Table 11C demonstrates the extent of linguistic isolation in New Jersey According to the US Census Bureau, A linguistically isolated household is one in which no member 14 years old and over 1 speaks only English or 2 speaks a non-English language and speaks English very well In other words, all members 14 years old and over have at least some difficulty with English There were 99,625 Spanish speaking, 56,425 Indo-European, 26,915 Asian and Pacific Islander, and 6,158 other households that were linguistically isolated 5

Hudson County had the highest number of residents who were linguistically isolated Table11C New Jerseys statewide poverty rate, according to Census 2000 data, was 85 This figure represents a 75 increase in the poverty rate since 1989 The five New Jersey counties with the highest poverty rates in descending order were Essex at 156, Hudson at 155, Cumberland at 150, Passaic at 123, and Atlantic at 105 Coincidentally, these same counties in the same order had the highest rates of increase in their poverty rates between 1989 and 1999: Essex at
146, Hudson at 145, Cumberland at 140, Passaic at 113, and Atlantic at 95 Table 12 Figure 1 illustrates the percentage of uninsured persons by poverty level status for the year 2000 In the illustration, New Jersey figures are compared to United States figures The chart shows that for the year 2000, New Jersey residents with family incomes below the poverty level had a higher likelihood of not having health insurance then United States residents at that income level The chart also demonstrates that New Jersey residents with family incomes slightly above the poverty rate, a ratio of 100 to 13, possibly the working poor, had greater likelihood of being uninsured than the residents of the United States Additionally, at the family income and poverty level ratio of greater than 133, residents of the United States and New Jersey were comparably insured

Table 1 Profile of General Demographic Characteristics for New Jersey and the United States: 2000 New Jersey Year 2000 United States Number Distribution Total population SEX AND AGE Male Female Under 5 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 34 years 35 to 44 years 45 to 54 years 55 to 59 years 60 to 64
years 65 to 74 years 75 to 84 years 85 years and over Median age years 18 years and over Male Female 21 years and over 62 years and over 65 years and over Male Female RACE/ETHNICITY One race White Black or African American American Indian and Alaska Native Asian Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Native Hawaiian and Other Pacific Islander Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander Some other race Two or more races HISPANIC OR LATINO AND RACE Hispanic or Latino of any race 1,117,191 Mexican Puerto Rican Cuban Other Hispanic or Latino Not Hispanic or Latino White alone Source: US Bureau of the Census Prepared by the New Jersey State Data Center, New Jersey Department of Labor, June 2001 102,929 366,788 77,337 570,137 7,297,159 5,557,209 133 12 44 09 68 867 66 8,200,595 6,104,705 1,141,821 19,492 480,276 169,180 100,355 85,245 14,672 65,349 15,180 30,295 3,329 634 779 563 1,353 450,972 213,755 975 726 136 02 57 2 12 1 02 08 02 04 54 25 4,082,813 4,331,537 563,785 604,529 590,577 525,216 480,079 1,189,040 1,435,106 1,158,898 423,338 330,646 574,669 402,468 135,999 367 6,326,792 3,013,338 3,313,454 6,033,473 1,303,854 1,113,136
446,780 666,356 485 515 67 72 7 62 57 141 171 138 5 39 68 48 16 X 752 358 394 717 155 132 53 79 8,414,350 100 Total population SEX AND AGE Male Female Under 5 years 5 to 9 years 10 to 14 years 15 to 19 years 20 to 24 years 25 to 34 years 35 to 44 years 45 to 54 years 55 to 59 years 60 to 64 years 65 to 74 years 75 to 84 years 85 years and over Median age years 18 years and over Male 138,053,563 143,368,343 19,175,798 20,549,505 20,528,072 20,219,890 18,964,001 39,891,724 45,148,527 37,677,952 13,469,237 10,805,447 18,390,986 12,361,180 4,239,587 353 209,128,094 100,994,367 491 509 68 73 73 72 67 142 16 134 48 38 65 44 15 X 743 359 384 70 147 124 51 73 Number 281,421,906 Year 2000 Distribution 100

Female 108,133,727 21 years and over 62 years and over 65 years and over Male 196,899,193 41,256,029 34,991,753 14,409,625

Female 20,582,128 RACE/ETHNICITY One race White Black or African American American Indian and Alaska Native Asian Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Native Hawaiian and Other Pacific Islander Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander Some other race Two or more races HISPANIC OR LATINO AND RACE Hispanic
or Latino of any race Mexican Puerto Rican Cuban Other Hispanic or Latino Not Hispanic or Latino White alone 35,305,818 20,640,711 3,406,178 1,241,685 10,017,244 246,116,088 194,552,774 274,595,678 211,460,626 34,658,190 2,475,956 10,242,998 1,678,765 2,432,585 1,850,314 796,700 1,076,872 1,122,528 1,285,234 398,835 140,652 58,240 91,029 108,914 15,359,073 6,826,228

976 751 123 09 36 06 09 07 03 04 04 05 01 55 24

125 73 12 04 36 875 691

Table 2 Changes in Population by Race and Hispanic Origin New Jersey, 1990 to 2000 Change 1990 to 2000 Race and Ethnicity White Black Asian and Other Pacific Islander American Indian and Alaska Native All Races Hispanic Non-Hispanic New Jersey Total 1990 6,377,702 1,077,119 277,024 15,905 7,747,750 747,737 7,000,013 7,747,750 2000 6,629,830 1,241,469 514,273 28,778 8,414,350 1,117,191 7,297,159 8,414,350 Number 252,128 164,350 237,249 12,873 666,600 369,454 297,146 666,600 Percent 40 153 856 809 86 494 42 86

1990 Census Modified Race Data MARS, prepared by New Jersey Department of Labor 2000 US Census Bridged Population Data Prepared by the National Center for Health Statistics

Table 3 Changes in Population by Age Group New Jersey, 1990 to
2000 Age Group Under 5 years 5 - 9 years 10 - 14 years 15 - 19 years 20 - 24 years 25 - 34 years 35 - 44 years 45 - 54 years 55 - 59 years 60 - 64 years 65 - 74 years 75 - 84 years 85 years and over 1990 Census 532,637 493,044 480,983 505,388 566,594 1,360,651 1,196,659 843,009 355,677 363,521 610,192 326,286 95,547 2000 Census 563,785 604,529 590,577 525,216 480,079 1,189,040 1,435,106 1,158,898 423,338 330,646 574,669 402,468 135,999 8,414,350 367 6,033,473 1,303,854 Change 1990 - 2000 58 226 228 39 -153 -126 199 375 190 -90 -58 233 423 89 67 77 43 of Total 2000 67 72 70 62 57 141 171 138 50 39 68 48 16 1000 –717 155

New Jersey Total 7,730,188 Median age years 344 21 years and over 5,604,647 62 years and over 1,249,833 Source: US Bureau of the Census

Gender Male Female Age and Gender 17 years and under Male Female 18 years and older Male Female 45 years and older Male Female 65 years and older Male Female New Jersey Total

Table 4 Changes in Population by Age Group and Gender New Jersey, 1990 to 2000 1990 2000 Change Census Census 1990 to 2000 3,735,685 4,082,813 93 3,994,503 4,331,537 84 1,799,462 921,383 878,079 5,930,726 2,814,302 3,116,424 2,594,232 1,157,027
1,437,205 1,032,025 408,957 623,068 7,730,188 2,087,558 1,069, 1475 1,018,083 6,326,792 3,013,338 3,313,454 3,026,018 1,366,614 1,659,404 1,113,136 446,780 666,356 8,414,350 160 161 159 67 71 63 166 181 155 79 92 69 89

Distribution 2000 485 515 248 127 121 752 358 394 360 162 197 132 53 79 1000

Source: US Bureau of the Census

Table 5 Total Population and 45 and Over Population by Race and Gender New Jersey, 2000 Total 45 and Older Race/Gender Number Percent Number Percent White 6,104,705 1000 2,449,106 1000 Male 2,958,412 485 1,109,262 453 Female 3,146,293 515 1,339,844 547 Black 1,141,821 1000 319,927 1000 Male 538,209 471 135,907 425 Female 603,612 529 184,020 575 Other Includes Multiracial 1,167,824 1000 256,985 1000 Male 586,192 502 121,445 473 Female 581,632 498 135,540 527 Total 8,414,350 1000 3,026,018 1000 Male 4,082,813 485 1,366,614 452 Female 4,331,537 515 1,659,404 548 Source: US Bureau of the Census

Age 0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85

Table 6 Population of Persons of Hispanic Origin by Age New Jersey, 2000 Total Percent Cumulative Percent 99,371 89 89 187,002 167 256 194,460 174 430 213,141 191 621 184,971 166 787 114,738 103 889 66,795
60 949 36,959 33 982 15,270 14 996 4,484 04 1000 1000 1000

Total 1,117,191 Numbers may not add to total because of rounding Source: US Bureau of the Census

Gender Male Female

Table 7 Population of Persons of Hispanic Origin 45 Years and Over by Gender New Jersey, 2000 45 and Over 45 to 64 65 and Over Total 45 and Over Total Number Percent Number Percent Number Percent 65,545 51,646 86,617 94,916 153 172 162 23,120 33,593 56,713 41 61 51 109,737 128,509 238,246 194 233 213

Total 1,117,191 181,533 Source: US Bureau of the Census

Table 8A Population by County, Race, and Percent of County Population New Jersey, 2000 One Race American Indian or Alaska Native Number 669 26 1,336 15 898 21 1,300 26 186 18 1,419 97 1,861 23 487 19 2,547 42 169 14 688 20 1,521 20 879 14 572 12 702 14 2,166 44 226 35 375 13 161 11 1,215 23 115 11 19,492 23 Native Hawian Two or More and Other Some Races Other Race Pacific Islander Number Number Number 114 05 15,307 61 6,525 26 193 02 28,503 32 19,958 23 144 03 6,255 15 8,750 21 187 04 25,909 51 9,811 19 40 04 1,379 13 1,182 12 82 06 13,300 91 4,177 29 417 05 54,588 69 27,155 34 75 03 2,173 09 3,307 13 383 06 94,253 155 34,295 56 35 03 921 08
1,210 10 352 10 15,054 43 7,619 22 300 04 42,867 57 19,497 26 153 02 10,685 17 10,311 17 188 04 9,471 20 7,326 16 103 02 6,333 12 6,569 13 175 04 79,423 162 19,788 40 19 03 1,010 16 941 15 121 04 8,158 27 5,457 18 28 02 1,072 07 1,650 11 201 04 33,277 64 16,960 32 19 02 1,034 10 1,267 12 3,329 04 450,972 54 213,755 25

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren NJ Total

Total Population 252,552 884,118 423,394 508,932 102,326 146,438 793,633 254,673 608,975 121,989 350,761 750,162 615,301 470,212 510,916 489,049 64,285 297,490 144,166 522,541 102,437

White Total Number 246,027 172,632 684 864,160 693,236 784 414,644 331,898 84 499,121 360,756 09 101,144 93,700 16 142,261 96,478 659 766,478 352,859 445 251,366 221,742 871 574,680 338,457 556 120,779 114,563 939 343,142 240,206 685 730,665 513,298 684 604,990 519,261 844 462,886 410,042 872 504,347 475,391 930 469,261 304,786 623 63,344 52,195 812 292,033 236,042 793 142,516 138,015 957 505,581 342,302 655 101,170 96,846 945

Black or African American Number 44,534 176 46,568 53 64,071 151 92,059
181 5,178 51 29,585 202 327,324 412 23,084 91 82,098 135 2,743 22 69,502 198 68,467 91 49,609 81 13,181 28 15,268 30 64,647 132 9,498 148 22,396 75 1,502 10 108,593 208 1,914 19 1,141,821 136

Asian Number 12,771 51 94,324 107 11,378 27 18,910 37 661 06 1,397 10 29,429 37 3,805 15 56,942 94 2,348 19 17,340 49 104,212 139 24,403 40 29,432 63 6,550 13 18,064 37 396 06 24,941 84 1,738 12 19,993 38 1,242 12 480,276 57

8,414,350 8,200,595 6,104,705 726

Source: US Census Bureau, Census 2000, Redistricting Data Summary File Prepared by: New Jersey State Data Center, New Jersey Department of Labor, March 2001

Table 8B Population by County, Hispanic Origin, Percent of County Population, and Percent Change New Jersey, 1990 to 2000 1990 2000 Non Hispanic County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren Total 224,327 825,380 395,066 502,824 95,089 138,053 778,206 230,082 553,099 107,776 325,824 671,780 553,124 421,353 433,203 453,060 65,294 240,279 130,943 493,819 91,607 Hispanic Total 252,552 884,118 423,394 508,932 102,326 146,438 793,633 254,673 608,975
121,989 350,761 750,162 615,301 470,212 510,916 489,049 64,285 297,490 144,166 522,541 102,437 Non Hispanic Number 221,823 792,741 405,762 459,766 98,948 118,615 671,286 248,090 366,852 118,618 316,863 648,222 577,126 433,586 485,278 342,557 61,787 271,679 139,344 419,530 98,686 Hispanic Percent 122 103 42 97 33 190 154 26 398 28 97 136 62 78 50 300 39 87 33 197 37

Number Percent Number Percent 208,210 928 16,117 72 777,604 942 49,776 58 382,247 968 12,819 32 466,802 928 36,022 72 93,234 980 1,855 20 119,705 867 18,348 133 680,429 874 97,777 126 225,951 982 4,131 18 369,634 668 183,465 332 106,044 984 1,732 16 306,159 940 19,665 60 612,004 911 59,776 89 530,717 959 22,407 41 401,539 953 19,814 47 419,253 968 13,950 32 354,968 783 98,092 217 63,858 978 1,436 22 230,092 958 10,187 42 128,032 978 2,911 22 426,022 863 67,797 137 89,823 981 1,784 19 905 739,861 95

Percent Number 878 30,729 897 91,377 958 17,632 903 49,166 967 3,378 810 27,823 846 122,347 974 6,583 602 242,123 972 3,371 903 33,898 864 101,940 938 38,175 922 36,626 950 25,638 700 146,492 961 2,498 913 25,811 967 4,822 803 103,011 963 3,751

Change in Number of Hispanics 1990-2000 907 836 375 365 821 516 251 594 320 946
724 705 704 848 838 493 740 1534 656 519 1104 510

NJ Total 7,730,188 6,992,327 Source: US Bureau of the Census

8,414,350 7,297,159 867

1,117,191 133

Table 8C Population by Hispanic Ethnicity for the 15 Largest Municipalities New Jersey, 1990 to 2000 Percent Change in Number of Hispanics from 1990 to 2000 123 227 296 385 622 729 1094 1229 468 137 2200 708 288 102 460

1990

2000

Non Non Municipality County Hispanic Hispanic Hispanic Hispanic Newark city Essex 203,460 71,761 192,924 80,622 Jersey City city Hudson 173,142 55,395 172,103 67,952 Paterson city Passaic 83,180 57,711 74,448 74,774 Elizabeth city Union 66,952 43,050 60,941 59,627 Edison township Middlesex County 84,841 3,839 91,461 6,226 Woodbridge township Middlesex County 87,906 5,180 88,247 8,956 Dover township Ocean County 74,427 1,944 85,636 4,070 Hamilton township Mercer County 84,547 2,006 82,638 4,471 Trenton city Mercer 76,145 12,530 67,012 18,391 Camden city Camden 60,219 27,273 48,885 31,019 66,865 Clifton city Passaic 4,877 63,064 15,608 Brick township Ocean County 64,758 1,715 73,189 2,930 Cherry Hill township Camden County 67,968 1,380 68,187 1,778 East Orange city Essex 70,571 2,981 66,540 3,284
Passaic city Passaic 29,013 29,028 25,474 42,387 Source: US Census Bureau, Census 2000 Redistricting Data PL 94-171 Summary File, Table PL1

Table 8D Population by Race for the 15 Largest Municipalities in New Jersey New Jersey, 2000 One Race Native Hawaiian American and Indian Total Black or Other and Total One African Pacific Alaska Population Race White American Native Asian Islander Municipality County Newark city Essex 273,546 261,620 72,537 146,250 1,005 3,263 135 Jersey City city Hudson 240,055 226,044 81,637 67,994 1,071 38,881 181 Paterson city Passaic 149,222 140,008 45,913 49,095 901 2,831 84 Elizabeth city Union 120,568 113,507 67,250 24,090 580 2,830 55 Edison township Middlesex County 97,687 95,583 58,116 6,728 132 28,597 37 Woodbridge township Middlesex County 97,203 94,812 68,848 8,507 167 14,054 24 Dover township Ocean County 89,706 88,702 83,939 1,568 117 2,207 21 Hamilton township Mercer County 87,109 85,579 74,173 7,112 121 2,234 31 Trenton city Mercer 85,403 82,672 27,802 44,465 300 716 199 Camden city Camden 79,904 76,773 13,454 42,628 435 1,958 59 Clifton city Passaic 78,672 75,075 59,960 2,277 192 5,066 27 Brick township Ocean County 76,119 75,325 72,932
751 76 904 12 Cherry Hill township Camden County 69,965 69,152 59,240 3,121 71 6,205 24 East Orange city Essex 69,824 67,171 2,683 62,462 177 302 51 Passaic city Passaic 67,861 64,438 24,044 9,385 531 3,740 29 Source: US Census Bureau, Census 2000 Redistricting Data PL 94-171 Summary File, Table PL1

Some Other Race 38,430 36,280 41,184 18,702 1,973 3,212 850 1,908 9,190 18,239 7,553 650 491 1,496 26,709

Two or More Races 11,926 14,011 9,214 7,061 2,104 2,391 1,004 1,530 2,731 3,131 3,597 794 813 2,653 3,423

Table 9A Percent of Population in Age Group by County New Jersey, 2000 Age County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren NJ Total Under 18 253 230 252 268 223 254 261 264 226 257 240 237 261 248 233 261 256 255 279 249 261 248 18-44 387 373 390 386 319 397 405 393 460 371 408 423 373 383 326 406 357 397 377 392 376 392 45-64 224 245 233 221 256 219 215 226 200 271 225 217 241 253 219 213 242 235 253 221 235 227 65-74 72 78 69 65 104 66 62 63 60 56 64 65 65 63 106 62 73 60 49 68 66 68 75 Over 64 75 57 61 98 64 57 53 53 45 61 58 60 53 115 59 72
52 42 70 63 64

Total Population 252,552 884,118 423,394 508,932 102,326 146,438 793,633 254,673 608,975 121,989 350,761 750,162 615,301 470,212 510,916 489,049 64,285 297,490 144,166 522,541 102,437 8,414,350

Source: 2000 Census of Population and Housing, US Bureau of the Census, Summary File 1 Prepared by: New Jersey State Data Center, New Jersey Department of Labor, 2/03

Total County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren 1990 224,327 825,380 395,066 502,824 95,089 138,053 778,206 230,082 553,099 107,776 325,824 671,780 553,124 421,353 433,203 453,060 65,294 240,279 130,943 493,819 91,607 2000

Table 9B County Populations by Selected Age Groups and Percent Changes New Jersey, 1990 and 2000 45 and Over

65 and Over

1990 2000 Pop Change Number Percent Number Percent 252,552 126 75,164 335 90,998 360 884,118 71 317,721 385 351,708 398 423,394 72 120,684 305 151,823 359 508,932 12 155,184 309 176,237 346 102,326 76 38,336 403 46,827 458 146,438 61 45,138 327 51,107 349 793,633 20 250,794 322 265,236 334 254,673 107 67,390 293 87,354 343 608,975
101 176,874 320 191,307 314 121,989 132 33,671 312 45,326 372 350,761 77 106,370 326 123,218 351 750,162 117 210,665 314 255,296 340 615,301 112 184,233 333 225,397 366 470,212 116 140,257 333 173,324 369 510,916 179 178,731 413 225,247 441 489,049 79 146,932 324 163,066 333 64,285 -15 22,832 350 24,857 387 297,490 238 78,012 325 103,320 347 144,166 101 35,694 273 49,576 344 522,541 58 179,442 363 187,544 359 102,437 118 30,108 329 37,250 364 89 2,594,232 336 3,026,018 360

1990 2000 Pop Pop Change Number Percent Number Percent Change 211 32,594 145 34,437 136 57 107 126,359 153 134,820 152 67 258 42,188 107 53,218 126 261 136 61,191 122 63,769 125 42 221 19,131 201 20,681 202 81 132 18,657 135 19,087 130 23 58 98,321 126 94,380 119 -40 296 24,761 108 29,678 117 199 82 70,401 127 69,271 114 -16 346 10,201 95 12,228 100 199 158 42,229 130 44,140 126 45 212 78,817 117 92,590 123 175 223 70,387 127 76,923 125 93 236 44,422 105 54,530 116 228 260 100,408 232 113,260 222 128 110 58,435 129 59,033 121 10 89 9,558 146 9,311 145 -26 324 26,013 108 33,381 112 283 389 11,684 89 13,152 91 126 45 74,125 150 72,041 138 -28 237 12,143 133 13,206 129 88 79 166 1,032,025 134 1,113,136 132

NJ
Total 7,730,188 8,414,350 Source: US Bureau of the Census

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren

Table 10A Population of Persons 45 Years and Older by Selected Races and County, New Jersey, 2000 Whites 45 Over Blacks 45 Over Asians 45 Over of White of Black of Asian Number Population Number Population Number Population 70,907 300,908 127,033 139,651 44,581 40,306 145,886 77,861 128,095 43,790 95,618 204,169 199,857 157,714 216,833 121,458 21,181 88,767 48,091 140,418 35,982 411 434 383 387 476 418 413 578 378 382 398 398 385 385 456 406 376 376 348 410 372 12,752 15,236 18,666 24,601 1,592 6,756 94,006 7,287 20,660 428 19,260 17,227 14,714 4,134 4,071 16,800 3,094 6,236 406 31,485 516 319,927 286 22 291 267 307 228 287 316 252 156 277 252 297 314 267 260 326 278 270 290 270 280 3,498 25,452 3,480 5,629 231 496 8,532 1,139 15,180 725 4,674 23,020 6,993 8,345 1,941 5,068 141 6,090 474 5,611 296 127,015 274 270 306 298 349 355 290 299 267 309 270 221 287 284 296 281 356 244 273 281 238 264

NJ Total 2,449,106 401 Source: US Bureau of the
Census Prepared by the New Jersey State Data Center

Table 10B Population of Persons of Hispanic Origin, Total, and 45 years and Older by County, New Jersey, 2000 County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren NJ Total Total Hispanic 30,729 91,377 17,632 49,166 3,378 27,823 122,347 6,583 242,123 3,371 33,898 101,940 38,175 36,626 25,638 146,492 2,498 25,811 4,822 103,011 3,751 1,117,191 45 and Over Number 5,158 21,494 3,405 8,445 517 5,147 25,834 1,196 63,804 625 5,284 18,940 6,955 7,143 5,137 29,899 377 4,160 1,014 23,029 683 238,246 Percent 168 235 193 172 153 185 211 182 264 185 156 186 182 195 200 204 151 161 210 224 182 213

Source: 2000 Census of Population and Housing, US Bureau of the Census, Summary File 1 Prepared by: New Jersey State Data Center, New Jersey Department of Labor, 2/03

Table 11A Percentage of Households Where a Foreign Language is Spoken by County New Jersey, 2000 Spanish or Spanish Creole 26,047 79,959 15,483 40,475 2,917 22,898 108,723 5,324 214,949 2,750 29,167 85,403 30,137 31,704 20,058 127,055 2,153 22,593 3,949
92,910 3,087 967,741

Table 11B Total Population of Persons 5 Years and Over Who Speak Selected Foreign Languages at Home by County New Jersey, 2000 Portuguese or Portuguese Creole Polish 676 16,876 1,331 1,847 187 364 3,091 581 6,165 558 3,548 9,306 2,267 2,833 3,088 8,623 32 3,018 752 9,014 506 74,663 71 4,484 1,195 306 41 35 23,744 214 10,894 109 297 5,913 3,372 1,147 1,147 788 49 1,041 319 17,394 310 72,870 French incl Patois, Cajun 1,198 4,102 2,171 1,725 507 545 10,943 819 3,997 844 2,525 2,959 2,965 2,428 1,467 1,496 148 1,430 484 4,159 313 47,225

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren

Foreign Language Spoken in Household 203 324 103 156 66 204 297 65 561 86 202 334 147 197 109 419 63 229 83 352 84

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren NJ Total

Total 48,029 269,112 41,013 73,950 6,452 28,133 218,613 15,374 320,636 9,813 66,252 233,939 84,345 86,287 52,394 189,715 3,825 63,214 11,218 171,336 8,040
2,001,690

Italian 2,656 21,960 2,590 3,836 919 1,263 10,350 2,396 9,658 1,141 4,414 8,072 8,255 6,991 7,046 10,498 457 4,194 1,210 7,745 714 116,365

Chinese 2,055 11,402 1,283 3,693 66 185 5,630 620 6,150 491 4,270 19,387 8,102 8,392 939 1,680 60 6,312 201 3,279 148 84,345

Tagalog 1,745 11,637 1,461 2,740 230 128 5,772 916 15,912 143 715 8,969 2,417 2,429 1,896 2,644 60 2,184 270 4,499 84 66,851

Korean 539 32,803 1,698 1,473 8 74 2,290 284 2,815 120 1,428 4,513 1,417 2,071 244 1,384 46 1,077 70 943 43 55,340

Gujarathi 1,527 4,035 984 1,655 108 42 2,005 286 7,942 121 1,293 15,143 1,208 3,204 321 3,348 36 2,243 38 1,712 73 47,324

Arabic 747 6,753 726 766 89 72 2,627 278 11,302 73 1,279 7,080 1,697 1,294 609 7,892 35 1,375 388 1,873 97 47,052

Other 10,768 75,101 12,091 15,434 1,380 2,527 43,438 3,656 30,852 3,463 17,316 67,194 22,508 23,794 15,579 24,307 749 17,747 3,537 27,808 2,665 421,914

255 NJ Total Source: US Census Bureau, Census 2000 Summary File 3

Source: US Census Bureau, Census 2000 Summary File 3, QT-P16

Table 11C Total Households, Households Linguistically Isolated and Foreign Language Spoken in Household by County, New Jersey, 2000 Languages of Households
Linguistically Isolated Total Households 95,025 330,891 154,571 185,837 42,140 49,096 283,692 90,755 230,698 43,730 125,787 265,898 224,447 169,794 200,553 163,917 24,316 109,070 50,789 186,093 38,675 Other IndoEuropean 1,206 8,880 1,279 1,283 241 433 8,531 436 6,463 232 2,255 5,990 2,328 1,818 2,351 4,548 110 1,392 314 6,059 276 Asian and Pacific Islander 931 9,145 765 1,298 19 65 1,357 129 2,951 66 725 3,748 1,192 1,410 332 873 28 980 64 800 37 26,915 Other Languages 97 903 92 114 23 40 510 45 1,341 19 158 1,051 132 107 174 706 21 208 57 330 30 6,158

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren

Spanish 2,471 6,319 647 3,524 318 1,788 11,492 256 29,236 188 2,896 7,363 2,666 2,742 1,693 13,009 199 2,124 119 10,427 148

NJ Total 3,065,774 99,625 56,425 Source: USCensus Bureau, Census 2000, Summary File 3

Table 12 Changes in Poverty Rate by County New Jersey, 1989 to 1999 Poverty Rate 1989 1999 Change New Jersey 760 75 85 Atlantic 94 105 95 Bergen 39 50 40 Burlington 42 47 37 Camden 103 104 94 Cape May 83 86 76 Cumberland 130 150 140 Essex 143
156 146 Gloucester 62 62 52 Hudson 148 155 145 Hunterdon 26 26 16 Mercer 74 86 76 Middlesex 51 66 56 Monmouth 50 63 53 Morris 28 39 29 Ocean 60 70 60 Passaic 100 123 113 Salem 106 95 85 Somerset 26 38 28 Sussex 34 40 30 Union 72 84 74 Warren 54 54 44 Source: 2000 Census of Population Housing, Summary File 3 Prepared by: New Jersey State Data Center, New Jersey Department of Labor, August, 2002

Figure 1
Percent with no health insurance coverage by poverty status United States and New Jersey, 2000
400 350 300 300 287 261 250 United States 2000 200 150 108 100 50 00 100 100 - 133 133 111 New Jersey 2000

365

P ercen t u n in su red

Ratio of family income to federal poverty level

Source: Current Population Survey, March 2001 and March 2000

CHAPTER 2
The estimation of prevalence of diabetes is an important step in determining the burden of the disease on the population and provides guidance to what extent resources should be expended on diabetes relative to other health conditions Prevalence rates can also demonstrate which demographic population groups are most at risk for diabetes and plans can be made for allocating scarce resources for preventive and treatment
interventions Diabetes prevalence rates in New Jersey have been estimated for demographic, socioeconomic, and other characteristics, such as race, ethnicity, age, gender, obesity, residence, income, and education It is estimated that about 444,000 New Jersey residents have been diagnosed with diabetes The data tables presented in this chapter are confined to diagnosed diabetes Using model-based estimates calculated from the National Health and Nutrition Examination Survey NHANES, it is further calculated that about 178,000 have diabetes but are unaware that they have the disease New Jersey specific estimates of the number of people with pre-diabetes are also not presented in the tables People with pre-diabetes have an impaired fasting glucose in which the fasting blood sugar level is elevated 100 to 125 milligrams per deciliter or mg/dL, after an overnight fast, but is not high enough to be classified as diabetes According to the American Diabetes Association, nationally, about 41 million people, ages 40 to 74, have prediabetes This figure is more than double the combined national estimates for the number of people with diagnosed and undiagnosed diabetes We are rapidly approaching
the time when a half a million people in New Jersey will have been diagnosed with diabetes Yet, in considering the undiagnosed population and the population with pre-diabetes, the known diagnosed figure is truly just the tip of the iceberg According to Behavior Risk Factor Surveillance System BRFSS survey results for the time period 2001 through 2003, New Jersey had an estimated 444,000 persons 18 years and over diagnosed with diabetes, for an age adjusted rate of 65 of the adult population NonHispanic blacks had the highest age-adjusted rate of persons diagnosed with diabetes at 113 For the same time period, non-Hispanic whites had the lowest age adjusted rate at 54 Non-Hispanic Asian and Pacific Islanders had a rate of 92 Hispanic Americans in New Jersey had an age-adjusted rate of 66 Table 1 and Figure 1 Aggregate data from the 2001-2003 BRFSS surveys also indicated that New Jersey male residents had a higher rate of diagnosed diabetes 72 than female residents 66 Although rates were higher among males, there were a greater estimated number of New Jersey females diagnosed with diabetes 223,000 than males 221,000 Surprisingly, the BRFSS data indicate that the rate of individuals
diagnosed with diabetes for both genders in the 18 through 44 age group showed no difference at 23 The survey data also indicate that in the 45 through 64 year old age group, the black, nonHispanic race category had the highest estimated prevalence rate at 161, followed by Asian or Pacific Islanders, nonHispanic category at 139 The black, non-Hispanic race category also had the highest rate of diagnosed diabetes 29 in the 65 years and over age group Table 2 The 2001 through 2003 BRFSS survey results also showed that the highest rate of diagnosed diabetes in all race, gender, and age categories 349 was in the 65 and over black, non 23

Hispanic male group The second highest rate 257 was found among black, nonHispanic females in the same age group Table 3 The referenced survey results also indicated that New Jerseyans of Hispanic ethnicity had the lowest estimated mean age at the time of diabetes diagnosis at 412 years This may be due to factors such as the high rate of immigration and the age distribution of this population Table 4 The New Jersey BRFSS 2001 through 2003 survey data also suggested that Cumberland County had the highest age-adjusted rate of persons diagnosed with
diabetes at over 106, followed by Atlantic and Union counties Thirteen of New Jerseys 21 counties fall within the range of 48 to 67 Figure 2 The counties of Middlesex, Essex, and Bergen had the greatest number of residents diagnosed with diabetes, with each having about 33,000 or more residents with diabetes The Sussex, Salem, Hunterdon, Cape May, Somerset, and Warren counties had the least number of residents diagnosed with diabetes, ranging from 4,200 to 13,776 residents Figure 3 Further analysis of the BRFSS data showed that there was an inverse relationship between education and diabetes prevalence rates Individuals with less than a high school education had the highest diabetes prevalence rate at 125 and individuals that had at least a college education had a rate of only 47 Figure 4 An inverse relationship also existed between income level and the rate of diabetes diagnosis Individuals with an income level less than 15,000 had the highest diabetes prevalence rate at 153 and individuals with an income level of over 75,000 had a rate of only 36 Figure 5 New Jersey and United States BRFSS diabetes data reflected similar trends for the 1991 through 2003 time period The prevalence
of diabetes in the United States ranged from 48 in 1991 to 71 in 2003 Likewise, New Jersey rates ranged from 43 in 1991 to 71 in 2003 Figure 6 Although the rates of diagnosed diabetes had increased with age, the estimated number of persons diagnosed was highest in the 45 through 64 year age group because of the size of the age group The estimate for that age group was about 186,000 persons diagnosed as compared to 181,000 diagnosed for the 65 and over group Table 2 and Figure 7 For New Jersey and the nation as a whole, increases in the rates of diabetes have paralleled increases in rates of obesity between 1991 and 2002 Since 1991, the New Jersey rates of diagnosed diabetes and obesity increased by 42 and 92 respectively Nationally, the rates of diagnosed diabetes and obesity have increased by 40 and 75, respectively, since 1991 Figure 8

Table 1 Estimated Diabetes Age Adjusted Prevalence Rates by Race/Ethnicity New Jersey, 2001 through 2003 Race/Ethnicity All Racial/Ethnic Classifications White, Non-Hispanic Black, Non-Hispanic Asian or Pacific Islander, Non-Hispanic Other, Non-Hispanic Hispanic Source: New Jersey Behavioral Risk Factor Survey Number 441,062
270,354 82,098 21,934 14,154 44,147 Rate 65 54 113 92 97 66 95 CL 61-69 50-59 97-133 69-121 64-146 54-80

Table 2 Estimated Number and Rate of Persons Diagnosed with Diabetes by Age, Gender, and Race/Ethnicity New Jersey, 2001 through 2003
Age Gender Male Population Diagnosed Rate 95 Confidence Interval Female Population Diagnosed Rate 95 Confidence Interval Race/Ethnicity White, Not Hispanic Population Diagnosed Rate 95 Confidence Interval Black, Not Hispanic Population Diagnosed Rate 95 Confidence Interval Asian or Pacific Islander, Not Hispanic Population Diagnosed Rate 95 Confidence Interval Other, Not Hispanic Population Diagnosed Rate 95 Confidence Interval Hispanic Population Diagnosed Rate 95 Confidence Interval 18 - 44 1,617,215 37,484 23 18-30 1,605,068 36,540 23 18-29 45 - 64 984,172 100,589 102 89-117 1,042,851 85,511 82 71-94 65 Over 463,897 82,155 177 155-202 693,409 98,782 142 125-162 Total 3,089,609 221,107 72 65-79 3,393,334 227,727 66 60-72

1,895,636 38,054 20 16-26 382,282 13,847 36 25-51

1,401,450 100,985 72 64-81 232,983 337,479 161 125-205

940,007 131,316 140 126-155 106,092 30,772 290 222-368

4,279,710 272,324 64 59-69 726,999 82,449 113
95-134

239,339 3,989 17 08-33 76,137 3,503 46 14-142 587,022 11,113 19 12-29

100,189 13,883 139 90-207 52,436 5,475 104 598-178 218,040 25,202 116 89-149

16,390 21,107 5,175 245 128-418 60,941 7,832 129 85-190

360,956 21,934 61 44-84 151,648 14,190 94 61-142 868,618 44,147 51 42-62

NJ Total Population 3,222,283 2,027,022 1,157,306 6,482,943 Diagnosed 74,024 186,100 180,937 443,834 Rate 23 92 156 68 95 Confidence Interval 19-28 83-101 142-171 64-73 Source: New Jersey Behavioral Risk Factor Survey The estimated number of New Jersey residents sampled in this group was too small to provide estimates

Table 3 Estimated Prevalence of Persons Diagnosed with Diabetes by Race/Ethnicity, Gender, and Age New Jersey, 2001 through 2003 Asian or Pacific Islander, NonOther, White, Black, Hispanic Hispanic Non-Hispanic Age/Gender Non-Hispanic Non-Hispanic Male 18-44 20 32 25 19 14-29 17-57 11-54 87 23-278 10-35 45-64 87 144 153 86-257 105 45-227 144 90-223 74-102 90-223 65 163 141-188 349 236-483 123 54-254 All Ages 70 108 71 46-106 104 53-192 47 63-78 80-143 35-64 Female 18-44 20 40 05 19 14-28 26-61 02-19 10 02-48 11-32 45-64 57 173 129-229 117 62-211 104 48-210 112 78-159 48-69
65 124 107-143 257 178-355 131 81-206 All Ages 58 118 46 54 520-65 95-155 28-77 84 49-142 42-70 Source: New Jersey Behavioral Risk Factor Survey The number of New Jersey residents sampled in this group was too small to derive reliable prevalence estimates

Table 4 Estimated Mean Age at the Time of Diagnosis of Diabetes by Race and Hispanic Origin, Persons 18 Years and Older New Jersey, 2001 through 2003 Mean Age Gender, Race/Ethnicity 95 CI Male 506 480-531 Female 494 468-520 White, Non-Hispanic 514 492-535 Black, Non-Hispanic 511 472-550 Other 503 460-545 Hispanic 412 369-456 Total 499 Source: New Jersey Behavioral Risk Factor Survey 481-518

Figure 1

Source: New Jersey Behavioral Risk Factor Survey

Figure 2 Estimated Age Adjusted Rate of Persons 18 Years and Over with Diagnosed Diabetes by County New Jersey, 2001 through 2003

Source: New Jersey Behavioral Risk Factor Survey
Rate/100 population

Figure 3 Estimated Number of Persons 18 Years and Over Diagnosed with Diabetes by County New Jersey, 2001 through 2003

Source: New Jersey Behavioral Risk Factor Survey

Figure 4

Figure 5

Source: New Jersey Behavioral Risk Factor Survey

Figure 6

CDC:
Behavioral Risk Factor Survey System, 1991 to 2002

Figure 7

Source: New Jersey Behavioral Risk Factor Survey

Figure 8

CDC: Behavioral Risk Factor Surveillance System, 1991 to 2002

CHAPTER 3
Diabetes as a complication of pregnancy, whether pre-existing or gestational diabetes mellitus GDM, is an important public health concern Pre-existing diabetes comprises approximately ten percent of cases of diabetes in pregnancy; correspondingly the remaining 90 percent of cases are classified as gestational diabetes mellitus Increases in the prevalence of diabetes mellitus in the female population age 15-44 have been documented in national health statistics and New Jersey data as well 1 GDM is defined as any degree of glucose intolerance that either has its onset or is first recognized during pregnancy 2 This definition is used whether the mother is treated with diet modification alone or with insulin The diagnosis of GDM applies whether or not the condition persists after pregnancy It does not exclude the possibility that unrecognized glucose intolerance may have started before the pregnancy rather than concomitantly with the pregnancy In the United States, the current
guideline for detection and diagnosis of GDM calls for glucose testing in the presence of certain risk factors Pre-existing diabetes mellitus, whether type 1 or type 2, is associated with an increased risk of both maternal complications and adverse pregnancy outcomes affecting the fetus Higher rates of major congenital malformations, prematurity, fetal growth restrictions, and, to a lesser extent, spontaneous abortions are observed in pregnancies complicated by pre-existing diabetes 3 Congenital malformations occur in the first trimester; thus rates are not increased in GDM which usually has its onset in the latter half of pregnancy Fetal macrosomia excessively large infant is a potential adverse fetal effect of either preexisting or gestational diabetes Macrosomia increases the risk of birth trauma and is linked with an increased risk of childhood, and later, obesity Of growing concern is the fact that epidemiologic and experimental data are accumulating that identify interactions between the fetal genome and specific in-utero nutrient availabilities These interactions may result in the development of insulin receptors that are patterned in ways that may lead to insulin resistance
and adverse metabolic consequences later in life for offspring of diabetic mothers 4 There is also growing epidemiologic and metabolic study evidence that GDM is likely to represent a stage in a continuum from pre-pregnancy insulin resistance, to GDM while pregnant, to post-pregnancy type 2 diabetes Post-pregnancy type 2 diabetes may not be clinically manifest until a decade after the affected pregnancy in some women 5,6 Maternal risks for women with pre-existing diabetes include development or worsening of diabetic retinopathy, worsening of pre-existing nephropathy, and development of preeclampsia Optimal maternal medical care can reduce perinatal mortality rates for babies of women with diabetes to levels nearly equivalent to those observed in normal pregnancies Furthermore, there is evidence suggesting that tight control of diabetes prior to conception and throughout the first trimester reduces the rate of congenital malformations Thus, critical issues for women with pre-existing diabetes include pre-conception counseling and metabolic control as well as an early pregnancy diabetes control program 7 35

NJ DOH Data Diabetes Care, Vol 27, Supplement 1, Jan 2004; Gestational
Diabetes Mellitus- Clinical Practice Recommendations of the American Diabetes Association Diabetes Care, Vol 27, Supplement 1, Jan 2004; Preconception Care of Women with Diabetes- Clinical Practice Recommendations of the American Diabetes Association Van Assche F,Holemans K,Aerts L : Long Term consequences for offspring of diabetes during pregnancy British Medical Bulletin 2001;60:173-182 Verma, etal Insulin Resistance Syndrome in Women with Prior History of Gestational Diabetes Mellitus J Clin Endocrinol Metab 76:3227-3235, 2002 Kousta, etal Insulin Resistance and Beta Cell dysfunction in normoglycemic European women with a history of gestational diabetes Clinical Endocrinology 2003 59: 289-297 same as reference 5 Diabetes Care, Vol 27, Supplement 1, Jan 2004; Preconception Care of Women with Diabetes- Clinical Practice Recommendations of the American Diabetes Association

According to the New Jersey Behavior Risk Factor Surveillance System BRFSS, diabetes affected about 2 of women in their child bearing years This does not include females reported to have had diabetes only during pregnancy Black, nonHispanic females in the 18 years to 44 age group were
reported to have the highest rate of diabetes at 27 Table 1 Data from the New Jersey Department of Health and Senior Services, Center for Health Statistics for the year 2000 indicate that diabetes as a medical risk during pregnancy varied by county from 300 per 1,000 births in Cape May County to 56 per 1,000 births in Middlesex The differences among county rates possibly may be explained by county demographics and hospital data collection procedures Also small denominators may have artificially inflated or deflated some rate calculations Table 2 New Jersey BRFSS data from 1995 to 2002 for females indicated that females who reported ever having been told they had diabetes but only during pregnancy had ranged from a low of 11 per 100 respondents in 1995 to 39 per 100 respondents in 2002 Table 3 Data as reported on New Jerseys resident live birth certificates showed an increase in rates of diabetes as a medical risk during pregnancy from 40 per 1,000 New Jersey births in 1998 to 445 per 1,000 births in 2002 Asian and Pacific Islanders of nonHispanic ethnicity had the highest rate per 1,000 births; 790 per 1,000 New Jersey births in 1998 and 907 per 1,000 births in 2002 Table 4 Data on
the residents live birth certificates indicated that diabetes as a medical risk during pregnancy especially affected older birthing mothers In the 2002 data, only 23 per 1,000 birthing mothers in the 20 to 24 age group had diabetes as a medical risk during pregnancy In comparison, 86 per 1,000 birthing mothers in the 40 and over age group had diabetes as a medical risk for the same year Table 5 and Figure 1 36

Data from the residents live birth file for the five year time period 1996 to 2000 showed that the rates of diabetes as a medical risk were associated with the birthing mothers racial and ethnic make up For the years 1996 to 2000, Asian Indian birth mothers had the highest rate of diabetes as a medical risk of pregnancy 891 per 1,000 births of all racial groups The total New Jersey birthing mother population had a rate of 381 per 1,000 births over the same time period Table 6 The 2000 residents live birth file also indicated that birthing mothers with diabetes as a medical risk had an 118 increased risk of having a medical complication at delivery and a 516 increased risk of having a primary C-section delivery Table 7 New Jersey residents live birth certificates
data demonstrated that birthing mothers with diabetes as a medical risk during pregnancy had a 465 increased risk of having a macrocosmic child and 36 increased risk of delivering a low birth weight child Also, birthing mothers with diabetes during pregnancy had a 692 increased risk of having an outcome defined as Abnormal Condition of the Newborn such as anemia, birth injury, fetal alcohol syndrome, hyaline membrane disease, meconium aspiration syndrome, assisted ventilation, and seizures Table 8 New Jersey birthing mothers with diabetes during pregnancy had a 456 increased risk of having a delivery outcome defined as Congenital Anomaly such as anencephalus, spina bifida/meningocele, hydrocephalus, microcephalus, heart malformation, rectal atresia/stenosis, tracheo-esophageal fistula/esophageal atresia, omphalocele/gastroschisis, malformed genitalia, renal agenesis, cleft lip/palate, polydactyly/syndactyly/adactyly, club foot, diaphragmatic hernia, Downs syndrome, and other chromosomal anomalies Table 8

Table 1 Estimated Prevalence of Diabetes in Females 18 Through 44 Years of Age Who Reported Having Diabetes Except During Pregnancy by Race and Ethnicity, New Jersey, 2000
through 2002 Weighted Size 1,601,933 198,621 963,443 284,566 Number Diagnosed 30,641 5,350 18,541 3,029 Rate Diagnosed 19 27 19 11 03 95 Confidence Level 13 - 28 15 - 47 12 - 31 05 - 23 01 - 12

All Race/Ethnicity Categories Black, Non-Hispanic White, Non-Hispanic Hispanic

Other 133,388 385 Source: New Jersey Behavioral Risk Factor Surveillance System Rate/100 population

Table 2 Total and Percentage of Birthing Mothers With and Without Diabetes as a Medical Risk Factor of Pregnancy, and Rate of Diabetes as a Medical Risk Factor, by County, New Jersey, 2000 New Jersey Birthing Mothers with Diabetes New Jersey Birthing Mothers as a Medical Risk of Total of of Total of NJ NJ Birthing Birthing Mothers Rate of Diabetes as a Medical Risk County/Place Number Mothers with Diabetes Number 2,983 295 130 31 436 Atlantic 9,381 93 347 827 370 Bergen 4,216 417 144 343 342 Burlngton 5,702 564 206 491 361 Camden 901 089 27 064 300 Cape May 1,758 174 77 184 438 Cumberland 11,141 1102 500 1192 449 Essex 2,398 237 97 231 405 Gloucester 7,804 772 320 763 410 Hudson 1,190 118 40 095 336 Hunterdon 4,216 417 177 422 420 Mercer 9,546 944 535 1276 560 Middlesex 7,054 698 235 56 333 Monmouth 5,568
551 220 525 395 Morris 5,888 582 288 687 489 Ocean 7,394 731 268 639 362 Passaic 532 053 Salem 3,852 381 171 408 444 Somerset 1,451 143 77 184 531 Sussex 7,109 703 287 684 404 Union 1,034 102 36 086 348 Warren 101,118 100 4,194 100 415 Total Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Rate/1000 Births The estimated number of New Jersey residents in this group was too small to derive reliable rates

Table 3 Estimated Rates of Females 18 Years Old and Over Who Reported Ever Having Been Diagnosed with Diabetes, but Only During Pregnancy, New Jersey, 1995 through 2002 95 Year Rate Confidence Level 22 09 - 35 1995 1996 1997 1998 1999 2000 2001 2002 11 16 11 14 17 23 39 05 - 18 08 - 24 05 - 17 08 - 19 11 - 22 17 - 28 23 - 54

CDC Behavioral Risk Factor Surveillance System, New Jersey Data 1995 through 2002 Rate/100 Population

Table 4 Rates of Diabetes as a Medical Risk Factor of Pregnancy as Reported on Certificates of Live Birth, by Maternal Race and Hispanic Origin, New Jersey, 1998 - 2002 Asian/Pacific Islander, NonWhite, Non- Black, NonHispanic Year Total Hispanic Hispanic Hispanic 1998 400 360 400 420 790 1999 2000 2001 380
400 433 340 360 381 400 430 432 380 390 418 740 790 836

2002 445 370 440 457 907 Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Rate/1000 Births

Table 5 Number and Rates of Birthing Mothers with Diabetes as a Medical Risk Factor of Pregnancy as Reported on Certificates of Live Birth, by Year and Selected Age Groups New Jersey, 1998 - 2002 Total Rates of Diabetes as a Medical Risk by Age Group Number Rate 10 - 19 20 - 24 25 - 29 30 - 34 35 -39 40 4,564 40 12 22 36 45 61 83 1998 4,294 38 10 21 36 42 55 73 1999 4,657 40 10 21 36 46 59 80 2000 5,014 43 11 23 40 49 63 77 2001 5,095 44 11 23 43 49 63 86 2002 Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Rate/1000 Births

Figure 1

Diabetes as a Medical Risk for Birthing Mothers by Age Group New Jersey, 2002 10 9 8 7 6 5 4 3 2 1 0 10 - 19 20 - 24 25 - 29 30 - 34 Age Group 35 -39 40

Source: New Jersey Department of Health and Senior Services, Center for Health Statistics

Rate per 100 Birthing Mothers

Table 6 Numbers and Rates of Birthing Mothers and Birthing Mothers with Diabetes as a Medical Risk Factor of Pregnancy by Year New Jersey,
1996 - 2000 1996 1997 1998 1999 2000 Total 1996 - 2000
Frequency Frequency Diabetes as a Medical Risk Factor 1,956 648 496 94 10 82 215 19 17 58 10 38 699 83 273 32 300 11 3,852 Frequency Diabetes as a Medical Risk Factor 2,128 722 11 551 97 6 111 263 13 11 48 17 42 808 97 300 32 362 17 4,279 Frequency Diabetes as a Medical Risk Factor 1,926 705 539 93 0 96 257 15 14 60 15 39 760 118 259 28 346 9 3,987 Frequency Diabetes as a Medical Risk Factor 1,987 731 6 640 122 11 0 90 305 29 22 61 15 18 797 136 265 27 365 4,194 Frequency Avg Rate per Diabetes 1000 Births as a for Medical Five Risk Factor Years 10,008 337 3,411 380 29 407 2,640 484 38 458 1,217 94 75 270 68 158 3,718 498 1,363 158 1,655 44 20,032 727 761 308 435 702 891 260 505 802 396 654 378 369 406 385 360 375 381

Number of Diabetes as Number of Birthing a Medical Birthing Race Mothers Risk Factor Mothers 63,180 2,011 61,638 White, Non-Hispanic 18,413 605 18,285 Black, Non-Hispanic 183 140 Indian/American, Non-Hispanic Asian and Pacific Islander, Non6,575 414 6,886 Hispanic: 1,185 78 1,219 Chinese 273 7 250 Japaneese Hawiian, Samoan and 18 24 Guamian 1,274 79 1,312 Filipino 2,160 177 2,431 Asian Indian 731 18 732
Korean 245 11 284 Vietnamese 689 43 634 Other Asian/Pacific Islander Race not Stated Other Hispanic: Mexican Puerto Rican Cuban Central or South America Other Hispanic Country Total 329 418 18,773 2,252 6,927 819 8,608 167 107,871 11 21 654 64 266 39 282 3,720 262 505 18,934 2,357 6,687 855 8,809 226 106,650

Number of Birthing Mothers 60,597 18,263 132 7,190 1,265 256 17 1,322 2,746 679 277 628 373 611 19,638 2,645 6,773 833 9,081 306 106,804

Number of Birthing Mothers 57,213 17,710 131 7,471 1,249 236 13 1,312 3,018 654 332 657 396 612 20,365 3,058 6,696 788 9,554 269 103,898

Number of Birthing Mothers 54,540 17,030 127 8,204 1,445 220 20 1,300 3,302 813 346 758 356 271 20,590 3,199 6,457 807 9,921 206 101,118

Number of Birthing Mothers 297,168 89,701 713 36,326 6,363 1,235 92 6,520 13,657 3,609 1,484 3,366 1,716 2,417 98,300 13,511 33,540 4,102 45,973 1,174 526,341

Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Public use Birth Files 1996 through 2000 Events that occur five or fewer times are not reportable

Table 7 Number and Rate of Labor and Delivery Complications and Primary Caesarian Section Deliveries for Birthing
Mothers With and Without Diabetes as a Medical Risk Factor of Pregnancy New Jersey, 2000 Birthing Mothers Birthing Mothers Increased Risk without Diabetes with Diabetes for Mothers with Diabetes Complications/Method of Delivery Number Rate Number Rate 1,870 193 83 198 26 Febrile 100 F or 38 C 7,341 757 274 653 -137 Meconium, moderate/heavy Premature Rupture of Membrane 12 1,718 177 73 174 -18 Hours 593 61 31 74 208 Abruptio Placenta 399 41 19 45 100 Placenta Previa 1,623 167 101 241 438 Other Excessive Bleeding 18 Seizures During Labor 4,212 435 170 405 -67 Precipitous Labor 3 hrs 1,857 192 97 231 207 Prolonged Labor 20 hrs 1,258 130 83 198 525 Dysfunctional Labor 3,327 343 190 453 320 Breech/Malpresentation 1,603 165 90 215 298 Cephalopelvic Disproportion 208 21 16 38 778 Cord Prolapse 6,720 693 356 849 225 Fetal Distress 50 05 Anesthetic Complications 32,797 3382 1,586 3782 118 Total Complications: 15,044 1550 986 2350 516 Primary C - Section Source: New Jersey Department of Health and Senior Services, Center for Health Statistics, Public use birth files, data year 2000 Rate/1000 Births Number of New Jersey residents in this group was too small to provide reliable
rates

Table 8 Number and Rate of Adverse Delivery Outcomes for Births with Mothers Having and not Having Diabetes as a Medical Risk Factor of Pregnancy New Jersey, 2000 Adverse Outcomes of Live Births with Mothers not Having Diabetes Number Rate 10,466 1010 Adverse Outcomes of Live Births with Mothers Having Diabetes Number Rate 660 1480

Outcome Macrosomia: 4000 Grams Low Birth Weight: 2500 Grams Abnormal Conditions of Newborn: Congenital Anomalies:

Increased Risk 465

7,617

735

446

1000

360

2,021 1,445

195 134

147 87

330 195

692 456

Source: New Jersey Department of Health and Senior Services, Center for Health Statistics, Public use Birth files, Data year 2000 Rate/1000 Births

Chapter 4
Diabetes is a disease that can cause serious medical complications and premature death However, individuals can take steps to prevent or delay the development of the disease and prevent diabetes complications if the disease is present Factors such as genetics, obesity, life style, environment, and age may play a part in determining the individuals chance of developing diabetes mellitus Research has indicated that certain individuals may be genetically susceptible to type 1 or
type 2 diabetes Studies have shown that if a parent or sibling has type 1 diabetes then the risk of the individual for developing type 1 diabetes is 10 to 20 times the risk for the general population If a parent or sibling has type 2 diabetes, the risk of an individual developing type 2 diabetes is three times the risk of someone in the general population developing type 2 diabetes If both parents have type 2 diabetes, the risk of a child developing diabetes may be as high as 501 However, even though these genetic factors for type 2 diabetes may influence an individuals susceptibility to developing diabetes mellitus, other actions by an individual may delay or prevent the progression of the disease Studies have indicated that an increase in physical activity and weight loss may contribute to the prevention or delay of type 2 diabetes Although life style changes appear to be more effective in general, research has demonstrated that certain medications taken at the pre-diabetes stage may also prevent or delay the development of diabetes2 The US Preventative Services Task Forces Guide to Clinical Preventive Services 2d edition, 1996 defines primary prevention measures as those
provided to individuals provided to prevent the onset of a targeted condition pp xli Primary prevention measures include activities that help avoid a given health care problem Secondary prevention refers to early detection of disease eg, screening in people who are asymptomatic The prevention or delay of complications caused by diabetes is referred to as tertiary prevention Individuals who are diagnosed with diabetes have a high risk of developing serious medical complications, such as heart disease, stroke, kidney disease, eye complications, neuropathy, nerve damage, foot problems, skin disorders, gastroparesis, and acute respiratory disease Many of these conditions can be delayed or prevented by proper glucose control, diet, exercise, medication, control of cholesterol and blood pressure ranges, and the securing of pneumonia and annual flu vaccinations This chapter includes data that depict the prevalence of these risk factors among New Jersey residents with and without diabetes Obesity and sedentary life styles are risk factors that may impact primary prevention efforts3 Good nutritional habits have an impact on tertiary prevention4 The chapter also contains data that show the
status of the New Jersey Diabetes Prevention and Control Programs secondary prevention goals, including increasing the percentage of the diabetic population receiving eye exams, foot exams, A1C tests, and influenza vaccinations on an annual basis and having a one-time pneumococcal vaccination Also presented are data that measure how often New Jersey adults with diabetes monitor their blood glucose and indicate what medications they are prescribed by type and purpose

References:
1

Joslin Diabetes Center Genetics Diabetes: Whats Your Risk? Available at:

http://wwwjoslinorg/managing_your_diabetes_687asp
2

Centers for Disease Control and Prevention National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2003 Rev ed Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2004 Available at: http://wwwcdcgov/diabetes/pubs/factsheethtm
3

Centers for Disease Control and Prevention Overweight and Obesity Available at:

http://wwwcdcgov/nccdphp/dnpa/obesity/indexhtm
4

Centers for Disease Control and Prevention Take Charge of Your Diabetes 3rd edition Atlanta: US Department of Health and
Human Services, 2003

Nationally, the estimated prevalence of obesity among adults increased from 13 in 1991 to 22 in 2002 During the same time period in New Jersey, the estimated prevalence of obesity among adults increased from 10 to 19 Similarly, during the same time period, the estimated prevalence of diagnosed diabetes has increased from 5 to 7 nationally and from 4 to 6 in New Jersey Figure 1 According to the New Jersey Behavioral Risk Factor Survey NJBRFS for the time period 2003 through 2005, New Jersey adults diagnosed with diabetes have a significantly greater prevalence of obesity 50 and sedentary life style 68 than New Jersey adults without diabetes 20 and 53, respectively Figure 2 The estimates for both Hispanic and black, non-Hispanic adults tend to be higher than those for white, non-Hispanic adults, regardless of age and sex, but this is not necessarily true among diabetic adults tables 1a and 1b The same survey suggests that the age and gender group group with the highest prevalence of obesity is found among females in the 45 through 64 age group with New Jersey women diagnosed with diabetes at 58 and without diabetes at 22 The lowest prevalence of obesity is in
the male 65 and over age group at 30 for males diagnosed with diabetes, and 17 for males without diabetes Tables 2A and 2B According to NJBRFS results for the time period 2003 through 2005, an estimated 58 of New Jersey adults are in either the obese or the overweight non-obese weight categories Cumberland County had the highest percentage of obese and overweight non-obese residents 67 among all New Jersey counties while Salem County had the highest prevalence of obesity 31 among all State counties Table 3 The NJBRFS indicates that approximately 53 of New Jersey adults diagnosed with diabetes and 27 of New Jersey adults not diagnosed with diabetes have received an annual flu vaccination Among New Jersey residents aged 65 years and over, 45

approximately 71 of those diagnosed with diabetes and 65 of those not diagnosed with diabetes have received an annual flu vaccination Figure 3 The survey results show similar trends for pneumococcal vaccinations: 46 of New Jersey adults diagnosed with diabetes and 21 of New Jersey adults not diagnosed with diabetes have received a pneumococcal vaccination Among New Jersey residents aged 65 years and over, approximately 67 of those
diagnosed with diabetes and 63 of those not diagnosed with diabetes have received a pneumococcal vaccination Figure 4

The survey data show that 72 of the New Jersey adults diagnosed with diabetes had an annual retinal exam, 71 had an annual foot exam, and 78 had an annual A1C test The New Jersey Hispanic population had the lowest rate in the A1C testing category at 61 Table 4 Survey results point out that only 62 of New Jersey adults who were diagnosed with diabetes tested their blood glucose at least daily and 10 of residents did not test their blood glucose in the past year Figure 5 According to NJBRFS data, 63 of New Jersey residents diagnosed with diabetes had high blood pressure and 58 had high cholesterol as risk factors In comparison, only 24 the New Jersey residents who were not diagnosed with diabetes had high blood pressure and 33 of that group had high cholesterol as risk factors New Jersey white, non Hispanic residents who were diagnosed with diabetes had the highest prevalence of high blood pressure 64 and cholesterol 59 among all race/ethnicity groups Tables 5A and 5B NJBRFS results for the time period 2003 through 2005 show that 12 of the New Jersey adults
diagnosed with diabetes take insulin solely While, 61 of the adults with diabetes take oral medication, only 11 of the adults take a combination of insulin and oral medication At least 15 of the New Jersey adults diagnosed with diabetes take no diabetes-related medication Figure 6 NJBRFS results reveal that insulin use in the treatment of diabetes has decreased from 38 in the time period 1994 through 1996 to 24 in the time period 2003 through 2005 Figure 7 According to NJBRFS results for the time period 2002 through 2004, an estimated 88 of the New Jersey population diagnosed with both diabetes and hypertension are taking blood pressure medication compared to 74 of New Jersey adults diagnosed with hypertension alone Table 6

Figure 1

Source: Centers for Disease Control and Prevention,

Figure 2

Obesity Less than Moderate Exercise

With Diabetes 498 683

Without Diabetes 204 529

Source: New Jersey Behavioral Risk Factor Survey, data years 2003 through 2005

Table 1A Percentage of Women Having Less than Moderate Exercise by Race/Ethnicity, Age, and Diabetes Status New Jersey, 2003 through 2005
All Women Never Diagnosed with Diabetes
510 500 520 593 564
622 620 579 659 649 621 676

18-44 Never Diagnosed with Diabetes
450 432 468 538 498 578 621 568 671 626 590 660

45-64 Never Diagnosed with Diabetes
508 492 523 619 568 668 623 550 691 676 623 726

65 Never Diagnosed with Diabetes
634 616 652 750 671 815 635 469 774 769 677 841

Race/Ethnicity White, Non-Hispanic:
95 Confidence Interval

Any Diagnostic Status
521 511 531 605 578 632 623 583 661 658 632 684

Diagnosed with Diabetes
707 673 739 693 617 759 706 512 845 777 695 842

Any Diagnostic Status
451 433 469 543 503 582 618 566 669 627 592 661

Diagnosed with Diabetes
547 426 663 634 441 793 437 102 841 675 483 822

Any Diagnostic Status
520 505 535 621 574 666 631 561 696 687 638 733

Diagnosed with Diabetes
706 651 756 639 518 746 728 468 890 780 649 871

Any Diagnostic Status
647 630 664 766 703 819 654 504 779 790 715 850

Diagnosed with Diabetes
745 699 786 807 700 883 719 338 928 850 704 931

Black, Non-Hispanic:
95 Confidence Interval

Other, Non-Hispanic:
95 Confidence Interval

Hispanic:
95 Confidence Interval

All Race/Ethnicity Categories:
95 Confidence Interval

559 550 568

718 689 745

548 539 557

513 499
528

604 513 688

511 497 526

561 547 575

710 662 753

548 533 562

669 653 684

770 730 805

651 633 652

Source: New Jersey Behavioral Risk Factor Survey, data years 2003 through 2005

Table 1B Percentage of Men Having Less than Moderate Exercise by Race/Ethnicity, Age, and Diabetes Status, New Jersey, 2003 through 2005
All Men
Any Diagnostic Status
481 469 493 544 505 584 599 555 642 609 575 643

18-44
Never Diagnosed with Diabetes
468 455 480 532 490 574 595 548 640 600 564 635

45-64
Never Diagnosed with Diabetes
408 388 428 482 424 540 611 550 669 594 551 637

65
Never Diagnosed with Diabetes
501 482 520 565 494 633 560 474 642 622 552 687

Race/Ethnicity White, Non-Hispanic:
95 Confidence Interval

Diagnosed with Diabetes
639 602 674 631 511 -736 643 504 762 746 630 835

Any Diagnostic Status
411 391 431 488 431 545 611 551 668 599 556 641

Diagnosed with Diabetes
605 470 -726 631 338 852 588 259 854 792 560 920

Any Diagnostic Status
512 494 530 564 498 628 585 508 659 641 577 700

Diagnosed with Diabetes
620 563 673 562 388 721 703 514 841 757 589 871

Any Diagnostic Status
590 568 612 727 637 802 563 421 695 601 488
704

Diagnosed with Diabetes
675 622 723 746 555 874 536 301 756 664 426 840

Never Diagnosed with Diabetes
571 547 -595 719 614 804 569 405 718 585 457 703

Black, Non-Hispanic:
95 Confidence Interval

Other, Non-Hispanic:
95 Confidence Interval

Hispanic:
95 Confidence Interval

All Race/Ethnicity Categories:
95 Confidence Interval

518 507 529

651 617 684

507 495 518

481 464 498

646 539 739

506 483 - 529

539 522 556

641 589 690

525 507 543

600 578 621

671 622 716

583 559 607

Source: New Jersey Behavioral Risk Factor Survey, data years 2003 through 2005

Table 2A Percentage of Women Who are Obese by Race/Ethnicity, Age, and Diabetes Status, New Jersey, 2003 through 2005 All Women 18-44 45-64
Any Diagnostic Status
178 171 186

65
Any Diagnostic Status
196 183 210

Race/Ethnicity

Diagnosed with Diabetes
493 457 529

Never Diagnosed with Diabetes
160 153 167

Any Diagnostic Status
142 130 154

Diagnosed with Diabetes
482 364 603

Never Diagnosed with Diabetes
136 125 149

Any Diagnostic Status
212 200 224

Diagnosed with Diabetes
625 565 681

Never Diagnosed with Diabetes
187 176 199

Diagnosed with Diabetes
449 369 465

Never Diagnosed
with Diabetes
167 154 180

White, NonHispanic:
95 Confidence Interval

Black, NonHispanic:
95 Confidence Interval

360 335 385

553 479 624

333 307 360

317 284 353

484 298 674

309 275 345

431 386 476

594 477 702

395 348 445

361 303 424

536 432 637

296 229 373

Other, NonHispanic:
95 Confidence Interval

113 92 140 236 214 259

398 261 553 476 383 570

98 77 124 216 194 239

100 72 137 190 165 217

0 0 407 240 599

99 70 136 182 158 210

124 90 168 331 286 380

452 257 663 508 376 638

90 62 129 307 259 359

214 130 331 253 188 332

439 201 708 497 327 667

153 75 288 175 120 249

Hispanic:
95 Confidence Interval

All Race/Ethnicity Categories:
95 Confidence Interval

204 198 211

498 467 529

183 176 190

170 160 181

439 353 529

164 154 174

248 236 260

583 532 632

218 206 231

217 204 231

449 407 493

177 164 191

Source: New Jersey Behavioral Risk Factor Survey The number of New Jersey residents sampled in this group was too small to provide reliable prevalence estimates

Table 2B Percentage of Men Who are Obese by Race/Ethnicity, Age, and Diabetes Status, New Jersey, 2003 through 2005 All Men 18-44 45-64
Any
Diagnostic Status
224 222 241

65
Any Diagnostic Status
188 172 205

Race/Ethnicity

Diagnosed with Diabetes
418 416 488

Never Diagnosed with Diabetes
214 204 224

Any Diagnostic Status
205 191 221

Diagnosed with Diabetes
543 412 668

Never Diagnosed with Diabetes
199 185 215

Any Diagnostic Status
290 275 307

Diagnosed with Diabetes
601 545 654

Never Diagnosed with Diabetes
258 242 275

Diagnosed with Diabetes
292 250 339

Never Diagnosed with Diabetes
165 148 183

White, NonHispanic:
95 Confidence Interval

Black, NonHispanic:
95 Confidence Interval

298 265 333

378 282 484

287 252 324

311 264 362

459 216 723

305 257 357

308 254 369

359 227 516

298 239 364

223 156 308

366 220 542

154 96 237

Other, NonHispanic:
95 Confidence Interval

125 99 157 208 183 236

223 121 374 437 325 556

116 91 148 192 167 220

111 78 154 201 170 236

0 0 615 361 818

101 70 142 192 161 226

161 114 223 218 174 270

186 88 350 397 254 559

156 105 225 188 145 242

129 65 240 253 167 364

103 31 291 358 183 582

135 61 269 224 131 355

Hispanic:
95 Confidence Interval

All Race/Ethnicity Categories:
95 Confidence Interval

224 216
233

418 385 452

208 199 217

204 192 217

521 413 626

197 185 210

273 259 288

485 434 537

246 231 261

192 176 209

301 259 347

166 149 184

Source: New Jersey Behavioral Risk Factor Survey

Table 3 Estimated Percentage of Adults Who Were Overweight non-Obese or Obese by County of Residence, New Jersey, 2003-2005
Total Overweight and Obese Percent 619 534 584 607 630 671 602 595 585 504 572 561 554 539 604 626 665 534 598 571 636 582

Overweight Non obese Obese County Percent Percent 95 CI 95 CI 374 339 411 245 218 274 Atlantic 371 348 395 163 147 181 Bergen 364 336 393 220 195 247 Burlington 361 334 390 246 222 273 Camden 406 361 453 224 190 261 Cape May 388 344 434 283 244 325 Cumberland 355 331 379 247 226 269 Essex 351 320 384 244 214 276 Gloucester 357 329 386 228 204 253 Hudson 342 303 383 162 133 196 Hunterdon 340 310 372 232 206 261 Mercer 377 353 401 184 167 202 Middlesex 370 344 398 184 164 206 Monmouth 380 351 411 159 140 180 Morris 375 348 403 229 207 253 Ocean 408 377 441 218 196 243 Passaic 355 300 414 310 253 373 Salem 360 328 394 174 149 203 Somerset 346 308 386 252 205 279 Sussex 372 342 403 199 176 222
Union 391 343 441 245 209 286 Warren 370 363 377 212 206 217 Statewide Age adjusted estimates using US 2000 population as standard Source: New Jersey Behavioral Risk Factor Survey

Figure 3

Source: New Jersey Behavioral Risk Factor Survey

Figure 4

Source: New Jersey Behavioral Risk Factor Survey

Table 4 Percentage of Adult Population Diagnosed with Diabetes who had a Retinal Exam, a Foot Exam, or A1C Test within the Previous Year by Race/Ethnicity, New Jersey, 2003 Through 2005 Retinal Exam Foot Exam A1C Test Race/Ethnicity Percent 95 CI Percent 95 CI Percent 95 CI 721 684 - 755 707 668 - 744 776 776 - 844 All Races/Ethnicities 783 690 - 854 747 648 - 826 857 764 - 918 Black, Non Hispanic 717 673 - 757 727 683 - 767 841 802 - 873 White, Non Hispanic Asian Indian/Pacific Islander, Non 503 283 - 722 540 302 - 761 633 377 - 831 Hispanic 760 618 - 861 615 466 - 745 614 448 - 757 Hispanic Source: New Jersey Behavioral Risk Factor Survey

Figure 5

Source: New Jersey Behavioral Risk Factor Survey

Table 5A

Percentage of Adults with High Blood Pressure as a Risk Factor by Race/Ethnicity, and Diabetes Status, New Jersey, 2003 through 2005
Total Adult Population
Race/Ethnicity All Races/Ethnicities Black, Non Hispanic White, Non Hispanic Asian Indian/Pacific Islander, Non Hispanic Percent 267 353 276 13 95 CI 259 - 275 325 - 383 267 - 284 103 - 163 Adult Population Diagnosed with Diabetes Percent 628 675 643 424 95 CI 595 - 659 590 - 749 606 - 678 257 - 610 420 - 638 Adult Population without Diabetes Percent 240 309 251 114 187 95 CI 232 - 248 281 - 341 242 - 259 88 - 147 165 - 212

208 186 - 233 531 Hispanic Source: New Jersey Behavioral Risk Factor Surveillance System

Table 5B

Percentage of Adults with High Cholesterol as a Risk Factor by Race/Ethnicity, and Diabetes Status, New Jersey, 2003 through 2005
Total Race/Ethnicity All Races/Ethnicities Black, Non Hispanic White, Non Hispanic Other, Non Hispanic Percent 354 308 372 299 95 CI 346 - 362 281 - 335 363 - 381 264 - 336 With Diabetes Percent 578 546 585 515 570 95 CI 550 - 606 467 - 623 555 - 615 379 - 649 531 - 718 Without Diabetes Percent 333 268 355 283 243 95 CI 325 - 341 241 - 297 345 - 364 247 - 322 267 - 326

268 298 - 357 Hispanic Source: New Jersey Behavioral Risk Factor Survey

Figure 6

Source: New Jersey Behavioral Risk Factor Survey

Figure 7

Source: New Jersey
Behavioral Risk Factor Survey

Table 6 Percentage of Hypertensive Adults Taking Blood Pressure Medication, by Age and Gender, and Diabetes Status, New Jersey, 2002 and 2004 Total With Diabetes Without Diabetes Age/Gender Percent 95 CI Percent 95 CI Percent 95 CI Age 18 to 44 431 381 - 483 774 594 - 889 395 345 - 448 45 to 64 777 749 - 804 825 748 - 882 767 736 - 796 65 and Over 926 909 - 940 954 922 - 973 920 900 - 936 Gender Male Female

705 819

673 - 734 797 - 840

847 91

779 - 897 861 - 943

673 803

638 - 707 778 - 826

765 746 - 783 877 836 - 909 743 722 - 763 Total Source: New Jersey Behavioral Risk Factor Survey, data years 2002 through 2004

Chapter 5

Death certificate data are important in the measurement of a nation and/or states health These data provides a snapshot of a diseases impact on population mortality The disease that is identified as the underlying cause of death is considered to have a direct impact as a cause of death If the disease is a listed contributing cause but not identified as the underlying cause of death, the impact is considered to be indirect or contributory to the death of the individual Data from death certificates have become a major
source of information for evaluating the burden and impact of chronic diseases, such as diabetes, in specific population sets Public health policy makers use these mortality data to identify diseases and conditions that cause large numbers of deaths and allocate resources to reduce the impact of these conditions1 The collection and analysis of death certificate data is an important component in the surveillance of diabetes as a cause of death In reviewing diabetes death certificate data, the Surveillance Task Force of the New Jersey Diabetes Council found evidence to suggest that these data might not show the full impact of diabetes as an underlying or contributing cause of death Furthermore, Diabetes Surveillance, 1991, from the National Center for Chronic Disease Prevention and Health Promotion reports:2 In each year, the number of deaths from diabetes as any listed cause were about four times greater than the number of deaths from diabetes as an underlying cause Similarly, rates based on underlying cause of death, the usual measure of diabetes mortality, reflect only about one-quarter of the deaths to which diabetes may have contributed Total diabetes-related deaths, and the
corresponding mortality rates, more accurately reflect the considerable disease burden that diabetes imposes upon society In addition to the finding that diabetes is more frequently characterized on the death certificate as a contributing cause of death other than the underlying cause, studies have shown that there is a tendency toward underreporting of diabetes on the death certificate altogether Diabetes Surveillance 19912 reported findings from studies that showed that diabetes is recorded on the death certificate of only about 40 of the people who are known to have had diabetes Although reporting of diabetes on the death certificate may have improved from the time of these studies, underreporting is still believed to be a problem In an effort to better define diabetesassociated mortality, New Jersey added a check-off box on the death certificate in 2004 The check-off box asks whether the decedent had diabetes The addition of this item to the certificate made New Jersey one of only three states known to have this information on the death certificate The Surveillance Task Force will be investigating the best methodology for analyzing the resulting data References:
1

Mendlein,
James M, Lentzner, Harold R and Franks Adele L Using Chronic Disease Data: A Handbook for Public Health Practitioners US Department of Health and Human Services, Public Health Service Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Surveillance and Analysis 1992 Chapter 2, Mortality Data Atlanta, GA

Geiss LS, Editor Diabetes Surveillance, 1991 The Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion Diabetes Supplement, 1991

The Compressed Mortality File CMF produced by the Centers for Disease Control and Prevention and based on 2000-2002 NCHS multiple cause-of death records, contains data on any mention of diabetes listed as a contributing cause of death These data, ranked by state, were age adjusted and averaged for the years 2000 through 2002 New Jersey ranked 14th in age-adjusted rate of deaths in which diabetes was listed as a cause of death The highest rate was in Louisiana 418; second was West Virginia 376; the District of Columbia was third 368 and Utah was fourth 328 Hawaii was the state with the lowest rate of diabetes listed as a
contributing cause of death per 100,000 149 Table 1 Data on deaths of New Jersey residents from 1999 through 2003 show small annual fluctuations in the calculated rates of deaths per 100,000 population in which diabetes was listed as the underlying cause in the single cause of death file The annual proportion of total deaths that diabetes represents over this period has remained essentially unchanged, about 34 percent However, in terms of absolute numbers, there was an increase of 14 percent 2,436 in 1999 to 2,470 in 2003 in diabetesrelated deaths Table 2 For total deaths under age 45 in which diabetes was listed as the underlying cause in the 2002 New Jersey death certificate file, the percentage of females was lower than the percentage of males Females under age 45 ac counted for 493 percent of total diabetes deaths in that age range Of deaths due to diabetes in the 45 through 54 age group, 353 percent were attributed to females For the 55 through 64 age group, the figure was 414 percent After age 75, there was a reversal in the ratio of female to male deaths with diabetes as an underlying cause The percentage of deaths due to diabetes that are female surpasses that of males in
the older age groups In the 75 through 84 age group, 571 percent of diabetes deaths were female; while in the 85 and over age group, females represented 706 percent of deaths with diabetes as an underlying cause of death This shift is likely due to females having a longer life expectancy than males and the number of females in these age groups substantially exceeding the number of males Table 3 In the 2002 New Jersey death certificate file, about 799 percent of deaths in which diabetes was listed as the underlying cause were recorded among whites; slightly more than 183 percent were ascribed to blacks; and approximately 2 percent of diabetes deaths were attributed to persons of other racial classifications The rate of deaths in which diabetes was listed as the underlying cause was 301 per 100,000 population for whites, 401 per 100,000 population for blacks, and 79 per 100,000 population for other racial classifications Overall, males had a rate of 279 deaths with diabetes listed as the underlying cause per 100,000 population and females had a rate of 310 For males age 65 and over, the diabetes death rate was calculated at 1867 per 100,000 and for females in that age group the rate
was 1702 The highest rate among all race and age group categories was in black females aged 65 years and over with a diabetes death rate of 3007 per 100,000 population; white females of the 60

same age group had a rate less than half that of black females in the 65 and over group 1597 Table 4 Years of Potential Life Lost YPLL is a measure of premature death In this report YPLL is measured for persons who died before age 65 and is calculated by subtracting age at death in years from 65 In 2002, the total YPLL associated with diabetes deaths in New Jersey was 5,950 years The overall YPLL for males under age 65 with an underlying cause of death of diabetes was 3,490 For females, it was 2,460 The YPLL rate was 805 years per 100,000 population under age 65 The YPLL rate in males was 938 years of potential life lost per 100,000 population under age 65 Females had a substantially lower YPLL rate than males, 656 per 100,000 population These figures represented a 421 percent higher YPLL rate among males under age 65 than among females in that age group The YPLL rate from diabetes was highest among blacks, 1716 years per 100,000 black population under 65 years old The black YPLL rate
is more than twice that of whites 660 Table 5 The 2,532 deaths designated as having diabetes as an underlying cause of death occurring among New Jerseyans in 2002 reflect an age-adjusted rate of 278 per 100,000 standard population The age-adjusted death rate for diabetes as the underlying cause of death for males of all races was 314 diabetes deaths per 100,000 standard population, while the comparable figure for females was 249 A higher ageadjusted rate for diabetes deaths among males was also observed in the white population Among whites, males had an age-adjusted rate of 297 diabetes deaths per 100,000 standard population, while females had a rate of 219 The age-adjusted diabetes death rate for black females was very similar to that of their male counterparts, 515 and 517 per 100,000 standard population, respectively Blacks had the highest overall age-adjusted diabetes death rate of all racial and/or ethnic groups; over 51 deaths with diabetes listed as an underlying cause per 100,000 standard population Table 6 In 2002, five of the twenty-one New Jersey counties had age-adjusted diabetes-related death rates in excess of 34 deaths per 100,000 standard population These counties
were Atlantic 384 diabetes deaths per 100,000 standard population; Camden 373 Hudson 352 Essex 348; and Cumberland 343 There were six other counties with rates of diabetes-related deaths in excess of the state-wide rate of 278 deaths per 100,000 standard population They were Gloucester 332 diabetes deaths per 100,000 population, Passaic 330, Hunterdon 297, Warren 293, Monmouth 291, and Union 281 Table 7 Deaths having an underlying cause of diabetes may be analyzed further by subdividing the deaths according to associated complications The subclassification diabetes without mention of complications E109, 119, 129, 139 149 was indicated on 831 percent of the records in which diabetes was the underlying cause of death The subclassification diabetes with peripheral circulatory disorders E105, 115, 125, 135, 145 was indicated on 113 percent of records; diabetes with ketoacidosis E101, 111, 121, 131, 141 was listed on 21 percent of records; and diabetes with renal manifestations E102, 112, 122, 132, 142 was the designation given on 17 percent of the records Table 8

Females, while accounting for 541 percent of total diabetes-related deaths, also accounted for 54 percent
or more of deaths in all of the diabetes subclassifications except two This may be due, at least in part, to the larger number of older females see demographic chapter Deaths from diabetes subclassifications for females included: diabetes with coma - 667 percent; diabetes with ophthalmic or neurological manifestations combined with diabetes with other unspecified complications 625 percent; diabetes with other specified manifestations 600 percent; diabetes with renal manifestations 545 percent; diabetes without mention of complications - 540 percent; diabetes with peripheral circulatory disorders 540 percent; diabetes with ketoacidosis 519 percent, and diabetes with multiple complication 500 percent Table 8 In 2002, a total of 74,009 deaths of residents were recorded for New Jersey In 5,609 of those deaths 76, diabetes was designated in the causal chain or was mentioned as one of the contributory causes of death Table 9 In addition to identifying an underlying cause of death, the multiple cause of death file allows for designation of up to 20 mentioned contributing causes of death In 2002, the total number of New Jersey records for which diabetes was mentioned as a
contributing cause of death, but was not designated as the underlying cause, was 3,077 Table 10 Almost 97 percent 968 of the 2002 death records with diabetes as a mentioned but not underlying cause of death, had diabetes designated as one of the first six listed conditions There were no records of diabetes listed as one of the multiple causes beyond the 13th position Table 10 Diabetes was mentioned as a cause of death in 77 percent 2,663 of the 34,805 male deaths in 2002 Female deaths with any mention of diabetes as a cause of death represented 75 percent of all female deaths for that year 2,946 out of 39,204 Of the total number of deaths with any mention of diabetes, males represented 470 percent while females accounted for 530 percent This gender difference in the proportion of deaths related to diabetes may be attributed to the higher survival rates of females; ie there are more females than males at older ages Because of the greater number of older females, a higher number of diabetes deaths for females is a reasonable expectation Although females showed higher numbers of diabetes-related deaths than males, they had lower diabetes death rates than males when the figures were
adjusted for age In relative terms, the diabetes age-adjusted mortality rate is about 36 percent higher in males than in females The calculated age-adjusted rate for any mention of diabetes was 725 per 100,000 standard population for males and 533 for females For the total population, the age-adjusted rate was calculated at 638 deaths with any mention of diabetes per 100,000 standard population Table 11 About 978 percent of deaths with any mention of diabetes occurred among persons 45 years of age and older The under 45 age group had the lowest death rate for diabetes as a mentioned cause, 23 deaths per 100,000 population Persons 45 through 64 years of age had a rate of 481 diabetes-related deaths per 100,000 population The 65 through 84 age group had a diabetes-related mortality rate of 3366 per 100,000 population Those aged 85 years and over had the highest rate, 8185 deaths per 100,000 population Table 12

In New Jerseys 2002 multiple cause of death file, diabetes was mentioned as a cause of death in 5,609 records All heart diseases ICD-10 codes I00-51 was the underlying cause of death listed on 1,403 records with a mention of diabetes 250 Cerebrovascular
diseases stroke: ICD-10 codes I60-69 was the underlying cause listed on 218 records with a mention of diabetes 39 Pneumonia ICD-10 codes J10-18 was the underlying cause listed on 75 records of diabetes-related deaths 13 Diabetes was mentioned in 516 deaths in which malignant neoplasms or leukemia ICD-10 codes C00-97 was the underlying cause 92 Infectious disease ICD-10 codes A00-97, B01-99 was listed as the underlying cause in 123 deaths in which diabetes was mentioned among the causes of death 22 All other causes, including external causes, accounted for 742 death records with any mention of diabetes as a cause of death 132 Table 13 In 2002, there were 74,009 New Jersey resident deaths; 23,022 or 311 percent of them had heart disease ICD-10: I00-51 listed as the underlying cause2 Diabetes was a factor in 61 percent of the deaths due to heart disease Diabetes was mentioned in 29 percent of the 17,827 deaths having cancer as the underlying cause of death ICD10: C00-97; and in 54 percent of the 4,016 stroke deaths ICD-10: I60-69 In the 1,973 records with pneumonia or influenza given as the underlying cause ICD-10: J10-18, diabetes was mentioned in 75 or 38 percent of the records The
3,191 records with infectious or parasitic diseases listed as the underlying cause ICD-10: A00-97, B01-99 had a mention of diabetes in 39 percent of the records Table 13 Of the 5,609 deaths in which there was any mention of diabetes, that disease was designated as the underlying cause in 282 male deaths per 100,000 standard population and 312 female deaths per 100,000 standard population When diabetesrelated death records having a listed underlying cause of death of all heart disease, cerebrovascular disease, infectious diseases, pneumonia and influenza, malignant neoplasm, and all other causes, the death rates for males were 178, 18, 15, 8, 63, and 83, respectively, per 100,000 standard population A similar analysis of female death records with any mention of diabetes revealed that when diabetes-related death records had an underlying cause of death of all heart disease, cerebrovascular disease, infectious diseases, pneumonia and influenza, malignant neoplasm, and all other causes the death rates for females were 180, 28, 17, 9, 56, and 90, respectively, per 100,000 standard population Death records with any mention of diabetes for the black male population were higher than those
for whites in every classification except for all heart diseases 156 and 179, respectively and all other causes 75 and 90, respectively Black females had higher rates than whites in every category They had rates of 192 for all heart disease, 30 for cerebrovascular disease, 20 for infectious diseases, 15 for pneumonia and influenza, 80 for malignant neoplasm, and 99 for all other causes of death compared to the white female rates of 165, 29, 13, 12, 53, and 96, respectively, per 100,000 standard population Table 14 New Jersey death records for 2002 indicate that when combining all specific conditions with diabetes mentioned as a multiple cause, the black male population has the highest age-adjusted rate at 1134 per 100,000 standard population This is closely followed by the black female population at 1071, white males at 690, and white females at 475, per 100,000 population Table 15 63

Table 1 Rank of Crude and Age Adjusted Rates for Diabetes Listed as an Underlying Cause of Death per 100,000 Population, by State, United States, 2000 through 2002 State Crude Rate Rank Age Adjusted Rate Rank
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of
Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 310 133 208 280 187 148 206 262 362 279 180 158 238 242 274 236 266 284 388 301 278 219 268 250 234 273 245 233 150 238 297 292 204 263 320 330 298 278 307 258 280 258 295 255 227 268 220 235 444 247 253 6 51 43 14 46 50 44 25 3 16 47 48 34 33 19 36 23 13 2 8 17 42 21 30 38 20 32 39 49 35 10 12 45 24 5 4 9 18 7 26 15 27 11 28 40 22 41 37 1 31 29 302 238 210 258 216 184 183 260 368 217 224 149 259 249 277 196 250 287 418 263 301 201 272 249 244 256 225 213 169 244 282 312 197 276 264 315 288 266 254 224 288 225 298 316 328 256 240 252 376 233 266 8 35 44 24 42 48 49 22 3 41 39 51 23 30 15 47 29 13 1 21 9 45 17 31 32 25 37 43 50 33 14 7 46 16 20 6 11 18 27 40 12 38 10 5 4 26 34 28 2 36 19

Source: United States Department of Health and Human Services US DHHS, Centers for Disease
Control and Prevention CDC, National Center for Health Statistics NCHS, Compressed Mortality File CMF compiled from CMF 1968-1988, Series 20, No 2A 2000, CMF 1989-1998, Series 20, No 2E 2003 and CMF 1999-2002, Series 20, No 2H 2004 on CDC WONDER On-line Database

Table 2 Diabetes Designated as the Underlying Cause of Death for Selected Years by Number of Deaths, Crude Rate,1 and Percentage of Total, New Jersey Residents, 1999 through 2003 New Jersey Diabetes Deaths Population 2,436 8,143,412 2,483 8,414,347 2,556 8,506,267 2,532 8,577,250 2,470 8,642,416 Crude Rate 299 295 300 295 286 Total Deaths 73,981 74,800 74,710 74,009 73,410 Percent with Diabetes 33 33 34 34 34

Year 1999 2000 2001 2002 2003

Source: New Jersey Department of Health and Senior Services, Center for Health Statistics
1

Rate/100,000 population

Table 3 Diabetes Listed as the Underlying Cause of Death by Age and Gender, New Jersey Residents, 2002 Age Under 45 45-54 55-64 65-74 75-84 85 Total Male Number Percent 34 507 108 647 184 586 326 521 356 429 155 294 1,153 456 Female Number Percent 33 493 59 353 130 414 300 479 474 571 372 706 1,318 520 Total 67 167 314 626 830 527 2,531

Source: New Jersey Department
of Health and Senior Services, Center for Health Statistics

Table 4 Diabetes Listed as the Underlying Cause of Death by Gender, Age, Race and Rate, New Jersey Residents, 2002

Under 65 Race Gender White Male Female Black Male Female Other Male Female Total Male Female Deaths 375 238 137 161 78 83 13 2 11 549 318 231

65 and Over

Total Rate 301 291 311 401 310 407 79 78 79 295 279 310

Rate Deaths 65 1,647 83 714 48 933 137 302 137 110 136 192 23 34 07 21 39 13 74 1,983 85 845 62 1,138

Rate Deaths 1678 2,022 1798 952 1597 1,070 2918 463 2775 188 3007 275 938 47 1323 23 638 24 1773 2,532 1867 1,163 1702 1,369

Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Rate per 100,000 population

Table 5 YPLL to Age 65 Due to Diabetes as the Underlying Cause of Death by Gender and Race, New Jersey, 2002 Population Gender Total YPLL Under 65 Rate Male 3,490 3,721,307 938 Female 2,460 3,747,796 656 Race White 3,7850 5,731,499 660 Black 2,0200 1,177,312 1716 Other 1250 560,292 223 Total 5,950 7,469,103 805
Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Years of Potential Life Lost YPLL is a measure of
premature death In this report YPLL is measured for persons who died before age 65 and is calculated by subtracting age at death in years from 65 Rate per 100,000 population

Table 6 Age-Adjusted Death Rates for Diabetes Designated as the Underlying Cause of Death by Race and Gender, New Jersey Residents, 2002 Gender Deaths Rate Males 1,164 Females 1,368 Race/Gender 2,022 White Males 952 Females 1,070 463 Black Males 188 Females 275 Total 2,532

314 249 254 297 219 516 517 515 278

Sources: New Jersey Department of Health and Senior Services, Center for Health Statistics Rate/100,000 US standard population Numbers do not add to total due to omission of other races

Table 7 Age-Adjusted Death Rates for Diabetes Designated as the Underlying Cause of Death by County of Residence, New Jersey, 2002 County Total Rate Atlantic 107 384 Bergen 212 192 Burlington 109 245 Camden 193 373 Cape May 44 270 Cumberland 52 343 Essex 270 348 Gloucester 83 332 Hudson 196 352 Hunterdon 32 297 Mercer 87 237 Middlesex 179 239 Monmouth 187 291 Morris 96 207 Ocean 220 253 Passaic 157 330 Salem 20 272 Somerset 63 221 Sussex 28 216 Union 164 281 Warren 33 293 Total 2,532 278
Source: New Jersey
Department of Health and Senior Services, Center for Health Statistics Deaths/100,000 population

Table 8 Diabetes Listed as the Underlying Cause of Death by Gender and Subclassification, New Jersey Residents, 2002 Total Percent Number Male 2,104 52 18 44 460 481 333 455 Percent Female 540 519 667 545

Diabetes Subclassification Diabetes without mention of complications E109, 119, 129, 139 149 Diabetes with Ketoacidosis E101, 111, 121, 131, 141 Diabetes with coma E100, 110, 120, 130, 140 Diabetes with renal manifestations E102, 112, 122, 132, 142 Diabetes with ophthalmic or neurological manifestations or with unspecified complications E103, 103, 113, 123, 133, 143, E104, 114 124, 134, 144, E 108, 118, 128, 138, 148 Diabetes with peripheral circulatory disorders E105, 115, 125, 135, 145 Diabetes with other specified manifestations E106, 116, 126, 136, 14,6 Diabetes with multiple complications E107, 117, 127, 137, 147 Total

8 287 5 14 2,532

375 460 400 500 459

625 540 600 500 541

Source: United States Department of Health and Human Services US DHHS, Centers for Disease Control and Prevention CDC, National Center for Health Statistics NCHS, Compressed Mortality File
CMF compiled from CMF 1968-1988, Series 20, No 2A 2000, CMF 1989-1998, Series 20, No 2E 2003 and CMF 1999-2002, Series 20, No 2H 2004 on CDC WONDER On-line Database

Table 9 Diabetes as a Mentioned Cause of Death on Death Certificates, New Jersey Residents, 2002 Cause of Death Number Percent Any Mention of Diabetes 5,609 76 No Mention of Diabetes 68,400 924 Total Deaths 74,009 10000
Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Including diabetes as the underlying cause of death

Table 10 Diabetes as a Listed Cause of Death, but Not the Underlying Cause, by Order of Mention, New Jersey Residents, 2002 Cumulative Rank Number Percent Percent 1st Condition 2 01 01 2nd Condition 620 201 202 3rd Condition 1,067 347 549 4th Condition 722 235 784 5th Condition 397 129 913 6th Condition 172 56 968 7th Condition 61 20 988 8th Condition 20 06 995 9th Condition 9 03 998 10th Condition 5 02 999 11th Condition 1 00 1000 13th Condition 1 00 1000 Total 3,077 1000 1000
Source: New Jersey Department of Health and Senior Services, Center for Health Statistics

Table 11 Age-Adjusted Rates with Any Mention of Diabetes as a Cause of Death by Gender,
New Jersey, 2002 Gender Number Rate Total Male Deaths - Male Diabetes Deaths Total Female Deaths - Female Diabetes Deaths Total Deaths Total Diabetes Deaths 34,805 2,663 39,204 2,946 74,009 5,609 9597 725 6956 533 8088 638

Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Rate per 100,000 standard population

Table 12 Any Mention of Diabetes as a Cause of Death by Age and Rate, New Jersey, 2002 Diabetes Deaths New Jersey Age Population Number Rate Under 45 Years 5,405,167 123 23 45 - 64 Years 2,063,936 993 481 65 - 84 Years 972,277 3,273 3366 85 and Over 148,923 1219 8185 Not Stated 1 Total 8,590,303 5,609 653
Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Rate per 100,000 population

Table 13 Any Mention of Diabetes as a Cause of Death by Underlying Cause, New Jersey Residents, 2002 Any Mention of Diabetes Total Deaths of with a Total Mention of Underlying Cause of Death Diabetes Number Mentions Number
Diabetes Mellitus E10-14 All Heart Diseases I00-51 Malignant Neoplasms C00-97 Cerebrovascular Stroke: I60-69 Pneumonia and Influenza J10-18 Infectious Diseases A00-97, B01-99 All Other Causes,
Including External 2,532 1,403 516 218 75 123 742 5,609 451 250 92 39 13 22 132 1000 2,532 23,022 17,827 4,016 1,973 3,191 21,448 74,009 1000 61 29 54 38 39 35 76

Total Mentions

Source: New Jersey Department of Health and Senior Services, Center for Health Statistics

Table 14 Any Mention of Diabetes as a Cause of Death by Underlying Cause, Gender, and Race, New Jersey Residents, 2002
Male White Underlying Cause of Death
Diabetes Mellitus E10-14 Infectious Diseases A00-97, B01-99 Pneumonia and Influenza J10-18 Malignant Neoplasms C00-97 All Heart Diseases I00-51 Cerebrovascular Stroke: I60-69 All Other Causes, Including External

Female Other Total No
1,164 61 25 274 701 94 344

Black

White No
1,070 45 40 182 565 99 327

Black

Other

Total No
1,368 62 50 242 702 124 398 2,946

No
952 41 23 232 583 76 293

Rate No
291 13 07 71 179 23 90 188 18 38 93 17 45

Rate No Rate
315 30 64 156 28 75 24 6 25 6 82 21 62 21

Rate
282 15 08 63 178 18 83

Rate No Rate No Rate
313 13 12 53 165 29 96 68 275 13 10 53 128 20 66 565 413 20 15 80 192 30 99 849 23 7 9 5 5 53 79 65 182

Rate Total
312 17 09 56 180 28 90 673 2,532 123 75 516 1,403 218 742 5,609

Total 2,200 676 401
671 62 212 2,663 644 2,328 Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Numbers may not add to the totals because of the omission of small and missing values Small numbers Rate per 100,000 population

Table 15 Age-Adjusted Rates of Any Mention of Diabetes as a Multiple Cause by Specific Underlying Condition, Gender and Race, New Jersey Residents, 2002 Male Female Underlying White Black Other Total White Black Other Total Cause of Death No Rate No Rate No Rate No Rate No Rate No Rate No Rate No Rate Total
Diabetes Mellitus E10-14 Infectious Diseases A00-97, B01-99 Pneumonia and Influenza J10-18 Malignant Neoplasms C00-97 All Heart Diseases I00-51 Cerebrovascular Stroke: I60-69 All Other Causes, Including External 952 42 23 232 583 76 293 297 13 07 72 183 25 93 187 18 2 38 93 17 45 517 45 05 124 260 49 134 24 2 0 4 25 1 6 186 173 73 1,163 62 25 274 701 94 344 314 16 07 75 191 27 96 1,070 45 40 182 565 99 327 219 10 08 38 114 19 66 475 275 13 10 53 128 20 66 565 515 24 21 99 250 51 121 1071 23 4 0 7 9 5 5 53 157 23 0 43 58 31 35 318 1,368 62 50 242 702 124 398 2,946 249 12 09 45 126 22 71 557 2,531 124 75 516 1,403 218 742
5,609

Total 2,201 690 400 1134 62 487 2,663 725 2,328 Source: New Jersey Department of Health and Senior Services, Center for Health Statistics Rate per 100,000 population Numbers may not add to the totals because of the omission of small and missing values Small numbers

Chapter 6
Nearly a half of a million New Jerseyans are directly affected by diabetes Besides the physical impact of the disease on the individual, New Jerseyans in the 21st Century will be challenged as the result of the formidable psychological, sociological, and economic impacts of diabetes New Jersey diabetes surveillance data indicate that the burden of diabetes-related morbidity and mortality is enormous New Jersey Behavioral Risk Factor Survey estimates for the survey period of 2002 through 2004 suggest that about 444,000 New Jerseyans aged 18 years and over have diabetes1 In 2003, 48 of every 1,000 women who gave birth had diabetes as a medical risk factor Diabetes was the underlying cause of death for 2,484 New Jerseyans in 2003, ranking fifth among the leading causes of death in the state Diabetes should be diagnosed and treated in a timely and appropriate manner; if not severe damage to almost every
organ in the human body can result Diabetes is a leading cause of many diseases including blindness, heart disease, end-stage renal disease, lower-extremity amputations, and stroke However, many of the complications and deaths from diabetes are preventable with individual awareness, early diagnosis and appropriate management of the disease Early detection, proper medical treatment, and self-management are the best interventions to prevent complications of diabetes A study has shown that a 1 reduction in the hemoglobin A1C levels can reduce the risk for death related to diabetes by 21 percent, microvascular complications by 37 percent and heart attack by 14 percent2 Additional management of blood pressure and Cholesterol will further reduce these relative risks Nevertheless, social, cultural, and economic barriers limit access to proper nutrition, exercise, medication and disease management activities to promote the diagnosis and treatment in populations with diabetes These barriers, in combination with genetic and lifestyle factors, make up the pronounced racial and ethnic disparities seen in health status and outcomes of people with diabetes In response to this problem, federal
and state health-policy makers have formulated approaches to eliminate disparities in health outcomes associated with diabetes The New Jersey Diabetes Control Program NJDCP and its partner the New Jersey Diabetes Council NJDC were created to combine federal, state and private resources to reduce the burden of diabetes in New Jersey and, in part, to eliminate ethno-racial disparities associated with diabetes The NJDCP and NJDC are involved in diabetes surveillance, community interventions targeted at raising awareness of diabetes and prevention of its complications, and projects aimed at improving diabetes prevention and treatment in New Jersey References
1

New Jersey Behavioral Risk Factor Survey NJBRFS data from 2002 through 2004 The core BRFS questionnaire gathers responses to the question: Have you ever been told by a doctor that you have diabetes? A follow-up question for females clarifies whether the diabetes was present only during pregnancy Stratton IM, Adler AI, Neil HA, et al Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes UKPDS 35: prospective observational study BMJ 2000; 321:405-12 Adler AI, Stratton IM, Neil HA, et
al Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes UKPDS 36: prospective observational study BMJ 2000; 321:412-9

According to the National Hospital Discharge Survey NHDS, the United States had an estimated 597,000 hospital discharges 206 per 10,000 population with diabetes ICD-9CM-codes 2500-2509 listed as the primary diagnosis in 2003 Table 1 In the same year, New Jerseys UB-92 File showed 17,998 hospital discharges 214 per 10,000 population having diabetes ICD-9-CM codes 2500-2509 listed as the primary diagnosis Table 1 In 2003, the average length of stay LOS in hospitals for patients with diabetes was 21 days longer in New Jersey than in the nation as a whole New Jerseys LOS is 68 days per discharge while nationally, it is 47 days Also, New Jersey had an average LOS that was 30 days longer than the national average in the age group of 65 years and over Table 1 and Figure 1 Statewide and nationally, the average LOS in 2003 was nearly the same for males and females The national average was 48 days for males and 47 days for females New Jerseys LOS showed a similar gender pattern, 68 days for males and 69 for
females Table 1 In 2003, diabetes ICD-9-CM 2500-2509, 2513, 3572, 36201-36202, 36641, 6480064804, and 7751 was listed as the primary diagnosis for 18,554 hospital discharges in New Jersey Diabetes ranked eighth in terms of average LOS 67 days The diagnoses with longer LOS were chronic rheumatic heart disease ICD9-CM 393-398 with an average LOS of 88 days; nephritis, nephrotic syndrome, and nephrosis ICD-9-CM 580589 with 87 days; diseases of pulmonary circulation ICD-9-CM 415-417 with 80 days; infectious and parasitic diseases ICD-9-CM 001-139 with 79 days; mental disorders ICD-9-CM 290-319 with 71 days; conditions of the perinatal period ICD-9CM 760-779 with 70 days; and diseases of the arteries, arterioles, and capillaries ICD9CM 440-448 with 68 days Table 2 Of all hospital discharges recorded in 2003 in New Jersey hospitals, 207,900 or 137 percent had diabetes listed among the nine possible discharge diagnoses The average LOS for discharges with a mention of diabetes was 56 days compared to 37 days for discharges without a mention of diabetes Though these data were not adjusted for age, this implies that the presence of diabetes increased the average LOS by 19 days This is not
unexpected, as the presence of diabetes is often a complicating factor in recovery from other diseases Table 3 The LOS for hospital discharges with diabetes as the primary diagnosis was analyzed by race The average LOS was 67 days for whites and blacks, 53 for American Indians, 55 days for Asians, and 72 days for other races It is important to note that the numbers of discharges among American Indians and Asians are small With the small numbers in these groups, a few outlier lengths of stay may influence the results Among nonHispanics, the average LOS was 4 days longer than among Hispanics: 67 and 63 days respectively However, caution should be used in interpreting all of the ethnicity data The data for both Hispanics and non-Hispanics are probably understated due to the large number of discharges with unknown ethnicity Because of the small numbers associated with the Hispanic data, the relative degree of understatement is probably much greater for 76

Hispanic data than non-Hispanic data Table 4 Age-adjusted rates of hospital discharges with any mention of diabetes as a listed diagnosis showed blacks with the highest discharge rate, 3788 per 10,000 population This may
be reflective of higher rates of hypertension among blacks since hypertension often serves as a co-risk factor with diabetes for many of the long-term complications of diabetes myocardial infarction, renal disease, etc It may also be reflective of the socio-economic and racial factors that affect access to primary care for blacks Whites had 1834 discharges per 10,000 population and Asian/Pacific Islander had 785 discharges per 10,000 population Hispanics had 3549 discharges per 10,000 population and non-Hispanics 1771 Again, this difference may be reflective of the socio-economic factors that often serve as barriers to good diabetes care The average LOS for hospital discharges with any mention of diabetes was almost 8 days longer for blacks than for whites 63 and 55 days LOS for Hispanics was 55 days and for non-Hispanics, 57 Table 5 Not surprisingly, crude rates per 10,000 population for hospital discharges with any mention of diabetes increased with age The older a person gets, the more likely he or she is to be hospitalized In New Jersey, 50 percent of hospitalizations occur among Medicare patients Older people are more likely to have other chronic conditions as well as diabetes
mellitus, all of which contribute to higher rates of hospitalization Males in the age group 65 and over had the highest crude rate per 10,000 populations for hospital discharges with any mention of diabetes 1,1797 The rate for males 65 years and older was three times the rate for males 45 through 64 years old 3477 Hispanic rates were higher than non-Hispanics rates in most age and gender groups Table 6 The highest crude rates by county in New Jersey per 10,000 population for hospital discharges with any mention of diabetes were Essex County 3026, Cumberland 2991, Ocean 2895, Salem 2833, Cape May 2811, and Hudson 2744 The most striking demographic characteristics of the population in these counties are their relatively high proportions of elderly and/or minorities The increased likelihood of co-morbid illnesses in the elderly and the socio-economic barriers to access to care among minorities may both contribute to diabetes-related hospitalizations in these counties Contributing to higher rates in rural counties may be factors such as sparse resources, transportation gaps, and the presence of sub-populations of migrant workers who are largely uninsured and, therefore, seek care for
medical problems late Table 7 Essex County, with the second largest county population in the state, had by far the largest number of hospital discharges in 2003 with any mention of diabetes, 24,094 Essex also had the highest age-adjusted rate, 3114 per 10,000 population, and the second longest average LOS, 65 days The longest average LOS was found in Hudson County, 69 days Bergen had the second largest number of hospital discharges with any mention of diabetes 18,147 and Hudson and Cumberland had the second highest age-adjusted rate, 2939 per 10,000 population Table 8 There were 12,487 hospital discharges for end stage renal disease ESRD ICD-9-CM Procedure 3995 or 5560-5569 or Disease Code V420, V451, or 585 and any mention of diabetes The average LOS for ESRD and any mention of diabetes was 95 days, the age-adjusted rate was 137 per 10,000 standard population, and the crude rate per 10,000 diabetic population was 2838 The average LOS was similar for whites and blacks, 93 77

and 94 days respectively, however the age-adjusted rate of discharges per 10,000 standard population in blacks was more than four times that of whites 369 and 91 respectively Age-adjusted rates per
10,000 standard population were highest for black males 404, as was the crude rate per 10,000 diabetic population 4737 Crude rates per 10,000 diabetic population were approximately 79 percent higher in blacks than in whites, 4461, and 2495 respectively National studies have shown that blacks are less likely to receive kidney transplants They are also more likely to be hypertensive, obese, and uninsured; these are all factors that negatively influence the likelihood of good blood pressure, diabetes control and higher rates of ESRD Table 9 Hispanics discharged with ESRD and any mention of diabetes had a slightly higher average LOS than non-Hispanics, 96 and 93 respectively The age-adjusted discharge rate seen in Hispanics 243 was more than twice that of non-Hispanics 106 Table 9

Essex, Middlesex, Hudson, and Bergen counties combined accounted for 5,117 of the hospital discharges with ESRD and any mention of diabetes; while Essex, Cumberland, and Hudson Counties had the highest age-adjusted discharge rates The average LOS for ESRD and any mention of diabetes ranged from 66 days in Gloucester to 116 in Hudson County Table 10 In 2003, there were 20,509 discharges for other kidney
diseases and any mention of diabetes The average LOS for blacks and whites in this category were almost identical, 95 and 94 respectively, however the age-adjusted discharge rate for blacks was about three times that of whites 471 and 171 The crude rate per 10,000 diabetic population for this diagnostic category was about 20 percent higher for blacks 5677 than for whites 4750 Average LOS for non-Hispanics 93 days was somewhat shorter than for Hispanics 103 days The age-adjusted discharge rate for Hispanics 311 per 10,000 standard population was approximately 70 percent higher than that for nonHispanics 183 Table 11 There were 14,748 hospital discharges with any mention of diabetes as a listed diagnosis and selected vision disorders: diabetes with ophthalmic manifestations ICD-9-CM 2505 or disorders of the eye and adnexa ICD-9-CM 360-379 The average LOS for the selected vision disorders was 42 days, the age-adjusted discharge rate was 162 per 10,000 standard population, and the crude rate per 10,000 diabetic population was 3351 In terms of race, ethnicity, and gender, the average LOS was more than a day longer for black males than for white males However, the age-adjusted discharge
rate for blacks 268 was about twice that of whites 131 per 10,000 population Table 12 In 2003, New Jerseyans had 4,216 amputations of the lower limb amputations complete or partial of the toes, feet, or legs ICD-9-CM 895-897 and lower limb amputation, ICD-9CM Procedure Code 841 Diabetes was present as a diagnosis in 2,969 or 704 percent of all amputations of the lower limb Ninety-nine percent 4,206 of all lower limb amputations were non-traumatic Table 13 The average LOS for non-traumatic amputations for diabetics in New Jersey was 155 days Blacks had an average LOS that was 25 days longer than whites 170 and 145 respectively Black males had the highest age-adjusted rate of hospitalizations for nontraumatic amputations and diabetes 93 per 10,000 standard population For all blacks, the age-adjusted discharge rate was 74 per 10,000 standard population; for all whites, 78

this rate was 23 per 10,000 The crude rate per 10,000 diabetic population was 669 for whites, 867 for blacks, and 98 for Asian/Pacific Islanders The age-adjusted rate was 47 per 10,000 standard population for all Hispanics The average LOS was 19 days longer for Hispanics 169 days as compared to non-Hispanics
150 days Table 14 The age-adjusted discharge rate per 10,000 standard population for non-traumatic amputations and any mention of diabetes was highest in Essex County with 49 diabetesrelated amputations per 10,000 standard population Passaic had an age-adjusted rate of 40 amputations per 10,000 population, Camden County had 38 and Atlantic and Salem had rates of 37 each The rates per 10,000 diabetic population showed a similar ranking with Passaic County having the highest rate, by far, of 949 per 10,000 diabetic population Passaic was followed by Essex 935, Monmouth 813, Hudson 786, Ocean 767, Camden 762 and Bergen 746 In eight counties, the average LOS was over 16 days For Hunterdon it was 238 days, Hudson, 207, Essex 178 days, Middlesex 176 days, Mercer 166 days, Diabetes together with any of the following ICD9-CM cardiac diagnoses - hypertensive heart disease 402, ischemic heart disease 410-414, cardiomyopathy 425, and heart failure 428 - were mentioned in a total of 127,564 discharges in the 2003 New Jersey hospital discharge file When both gender and race are considered, the age-adjusted discharge rate for diabetes and hypertensive heart disease per 10,000 standard
population was highest for black females 175 as compared to a low rate of 48 for white males For ischemic heart disease, the highest rate was among black males 1121, as compared to a low rate of 513 for white males For heart failure, the highest age-adjusted rate was among black females 838, compared to the lowest rate of 370 for white females Table 16 For hypertensive heart disease with any mention of diabetes, Union County had the highest crude rate of discharges per 10,000 diabetic population 3144 Union also had the highest age-adjusted rate, 144 per 10,000 standard population Essex County had the longest average LOS for hypertensive heart disease, 81 days Hudson County had the highest age-adjusted rate for ischemic heart disease with any mention of diabetes, 1089 per 10,000 standard population followed closely by Cumberland County 1044 Hudson County also had the longest average LOS for ischemic heart disease, 67 days Cumberland County had the highest age-adjusted rate for heart failure with any mention of diabetes, 695 per 10,000 standard population The longest average LOS for heart failure was in Hudson County, 97 days Table 17 For discharges with diabetes and hypertensive
disease ICD-9-CM 401- 405, for blacks, the average LOS was over a day longer than that for whites 61 and 50 days respectively The age-adjusted discharge rate for New Jerseys black population was more than two times that of whites 2819 and 1150 per 10,000 standard population, respectively Table 18 Both the numbers and age-adjusted rates of discharges for hypertensive disease with any mention of diabetes were highest in Essex County with 16,663 discharges and an ageadjusted rate per 10,000 standard population of 2157 and a crude rate per 10,000 diabetic population of 41430 Essex also had the second-longest average LOS 63 days after Hudson County 66 days Table 19 There were 173,613 discharges for major cardiovascular diseases ICD9-CM 390-448 with any mention of diabetes in 2003 For blacks, the average LOS was longer than for 79

whites 64 and 56 days respectively The age-adjusted discharge rate for blacks was more than twice that of whites 3233 and 1530 per 10,000 standard population, respectively However, the crude rate per 10,000 diabetic population was higher for whites than blacks 4,2778 and 3,7630 respectively This may reflect the older age distribution of New Jerseys
white population Table 20 For discharges with any mention of diabetes and a major cardiovascular disease, the longest average LOS, found in Hudson County, was 72 days Essex County had the highest age-adjusted discharge rate per 10,000 standard population, 2578; and Hudson had the highest crude rate per 10,000 diabetic population, 5,5436 Table 21 In 2003, New Jersey had 15,594 hospital discharges for cerebrovascular disease stroke, ICD-9-CM 430-438 and diabetes By race, blacks had the longest average LOS, 79 days This compares to an average LOS of 65 for whites and 78 for other races The age-adjusted discharge rate per 10,000 standard population for blacks was more than twice that for whites 332 and 133 respectively When discharges were divided by the estimated diabetic population, the crude discharge rate was 3758 for whites, 3634 for blacks and 999 for Asian and Pacific Islanders Hispanics had an average LOS that was greater than that of non-Hispanics 72 and 69 days, respectively, and an age-adjusted discharge rate per 10,000 standard population that was more than twice of non-Hispanics 287 and 133 respectively Table 22 Hudson County had the highest age-adjusted rate of stroke
with diabetes as a comorbidity per 10,000 standard population 233 Essex County had the second highest rate 232, followed by Cumberland County with a rate of 213, Camden with a rate of 210, and Mercer at 200 The highest crude rate of stroke per 10,000 diabetic population was seen in Hudson, 5253 The longest lengths of stay were seen in three counties: Hudson 92, Essex 83, and Middlesex 76 Table 23 There were 12,994 hospital discharges with any mention of diabetes and pneumonia or influenza ICD-9-CM 4800-4878 In this category, the average LOS was 98 days, the age-adjusted rate per 10,000 standard population was 142, and the crude rate per 10,000 diabetic population was 2953 Blacks had an average LOS of 113 days, while for whites it was 94 days Age-adjusted discharge rates were higher for blacks 227 per 10,000 standard population than whites 116 per 10,000 standard population This relatively large variation may reflect differences in pneumoccocal and influenza immunization rates by race The crude discharge rate per 10,000 diabetics was highest for white patients 3294 per 10,000 diabetic population Hispanics had a longer average LOS 101 days than non-Hispanics 97 days, and a higher
age-adjusted rate per 10,000 standard population 211 than non-Hispanics 113 Table 24 Essex County had the highest age-adjusted discharge rate per 10,000 standard population 207 for diabetes and influenza or pneumonia The highest county rate per 10,000 diabetic population, 4577, was seen in Cape May County The longest average LOS was in Essex County, 123 days Table 25 In 2003, there were 1,146 discharges of children 18 years or younger with any mention of diabetes as one of the listed diagnoses Sixty-seven percent 773 of these had diabetes listed as the primary diagnosis The average LOS for children with diabetes was slightly longer than the average LOS of those with no mention of diabetes 36 and 32 80

days respectively Table 26 In 2003, there were 163,431 discharges involving diabetes mellitus without mention of complications ICD9-CM 2500 Of the ten conditions sub-coded within the diabetes ICD-9 grouping ICD9-CM 2500-2509, the diabetes diagnosis with the longest average LOS was diabetes with peripheral circulatory disorders ICD9-CM 2507, 116 days Hispanics had a longer average LOS for this diagnosis 118 days than did nonHispanics 114 days, and blacks had a longer stay,
on average, than whites 130 and 108, respectively The most frequently recorded complication of diabetes was ICD9CM 2504, diabetes with other specific manifestations, with 11,839 discharges Table 27 Diabetes with ketoacidosis ICD-9-CM 2501, diabetes with hyperosmolarity ICD-9CM 2502, and diabetes with other coma ICD-9-CM 2503 have been designated as Ambulatory Care Sensitive ACS conditions As such, it is believed that timely and effective ambulatory care in the 30-60 days prior to hospital admission might have prevented the hospitalization of patients having these ACS diagnoses For white patients under age 65, these ACS conditions accounted for 296 percent of discharges listing diabetes as the primary diagnosis For blacks, these potentially preventable discharges accounted for 315 percent of discharges listing diabetes as the primary diagnosis There were almost no differences between discharges of non-Hispanics and Hispanics for these conditions 304 and 305, respectively Table 28 In 2003, these three ACS conditions represented 302 percent of all hospital discharges for persons under age 65 that listed diabetes as the primary diagnosis Cumberland County had the highest proportion:
the three ACS conditions represented 352 percent of the discharges with diabetes listed as primary diagnosis Monmouth, Morris, and Camden, Counties also had relatively high proportions of discharges with ACS diabetes diagnoses 350, 349, and 347 respectively Table 29

Table 1 Hospital Discharges with Diabetes Listed as the Primary Diagnosis by Age, Gender, Rate and Average Length of Stay in Days, New Jersey and the United Sates, 2003 Discharges Days of Care Rate per 10,000 Population Number of Days Days per 10,000 Population Average length of stay in days

Age and Gender USA Age Under 15 years 31,000 51 83,700 139 27 15-44 years 156,000 126 608,400 490 39 45-64 years 204,000 297 1,040,400 1679 51 65 years and over 205,000 571 1,045,500 2988 51 Total 597,000 206 2,805,900 997 47 Gender Male 283,000 199 1,358,400 984 48 Female 314,000 212 1,475,800 1029 47 597,000 206 2,805,900 997 47 Total New Jersey Age Under 15 years 541 31 1,593 91 29 15-44 years 3,825 105 19,564 539 51 45-64 years 6,316 330 43,168 2257 68 65 years and over 7,316 657 58,858 5288 81 Total 17,998 208 123,183 1464 68 Gender Male 9,565 234 65,155 1596 68 Female 8,433 195 58,028 1340 69 17,998 214 123,183 1464
68 Total Source: Centers for Disease Control and Prevention, National Center for Health Statistics, 2003 Summary: National Hospital Discharge Survey, and the New Jersey Department of Health and Senior Services, New Jersey Hospital Discharge File UB-92 ICD-9-CM codes 2500 through Rates were calculated using US Census Bureau estimates of the civilian population based Number of Discharges do not total due to rounding

Number of Discharges

Figure 1

United States Under 15 years 15-44 years 45-64 years 65 years and over Total 27 39 51 51 47

New Jersey 29 51 68 81 68

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, 2003 Summary: National Hospital Discharge Survey, and the New Jersey Department of Health and Senior Services, New Jersey Hospital Discharge File UB-92
1

ICD-9-CM codes 2500 through 2509

Table 2 Hospital Discharges by Primary Diagnosis, Average Length of Stay in Days and Average Charges in Dollars, New Jersey, 2003 Length of Stay in Days Total Hospital Discharges 2,776 7,560 3,263 30,818 61,742 3,078 9,542 18,554 50 29,175 70,477 116,805 56,874 12,274 27,335 14,672 27,071 99,513 73,422 145,393 172,297 20,679
87,757 138,900 1,933 5,626 87,022 92,609 55,803 43,289 Number of Days 24,289 65,597 25,978 243,442 438,396 21,416 64,639 125,066 321 177,402 423,289 680,660 306,710 65,610 129,130 69,128 126,173 435,760 317,901 516,931 551,244 61,312 246,512 367,373 4,412 11,488 176,688 165,289 82,877 54,468 Average Number of Days 88 87 80 79 71 70 68 67 64 61 60 58 54 54 47 47 47 44 43 36 32 30 28 26 23 20 20 18 15 13 Charges in Dollars

Primary Diagnosis Chronic rheumatic heart disease 393-398 Nephritis, nephrotic syndrome, and nephrosis 580-589 Diseases of pulmonary circulation 415-417 Infectious parasitic diseases 001-139 Mental disorders 290-319 2 Conditions of Perinatal Period 760-779 Arteries, arterioles and capillaries diseases 440-448 1 Diabetes Acute rheumatic fever 390-392 Cerebrovascular disease 430-438 Other forms of heart disease 420-429 Diseases of the respiratory system 460-519 Malignant neoplasm 140-208 Hypertensive disease 401-405 Other endocrine, nutritional metabolic disorders 2512 279 Diseases of the blood blood-forming organs 280-289 Diseases of the skin and subcutaneous tissue 680-709 Injury and Poisoning 800-999 Ischemic heart disease 410-414 Factors influencing health
status/contact health services 3 V01-V82 Diseases of the digestive system 520-579 Veins, lymphatic other circulatory diseases 451-459 Symptoms, Signs Ill-defined Conditions 780-799 Complications in Pregnancy, Childbirth Purpureum 6302 677 Disorders of thyroid gland 240-246 Congenital Anomalies 740-759 Musculoskeletal and connective tissue diseases 710-739 Other diseases of the genitourinary system 590-629 2 Diseases of the nervous system sense organs 320-389 Other neoplasm 210-239

Total 233,541,148 485,317,715 195,813,666 1,764,302,417 1,458,283,487 126,406,308 608,315,010 862,401,605 2,317,600 1,392,574,183 3,820,415,487 4,828,662,815 2,492,380,297 541,678,113 906,345,970 501,045,028 794,213,770 3,720,069,030 4,349,007,018 2,116,438,841 4,421,991,762 456,794,156 1,930,946,948 1,954,580,303 39,110,170 118,903,391 1,906,801,610 1,455,203,920 802,293,223 583,138,698 44,869,293,689

Mean 84,12866 64,19546 60,01032 57,24909 23,61899 41,06768 63,75131 46,48063 46,35200 47,73176 54,20798 41,33952 43,82284 44,13216 33,15698 34,14974 29,33818 37,38274 59,23302 14,55668 25,66494 22,08976 22,00334 14,07185 20,23289 21,13462 21,91172 15,71342 14,37724 13,47083 29,59112

Total 1,516,309
5,979,501 39 Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92

1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 Except: 2513; 3572; 36201-36202; 36641; 64000-64804; or 7751 3 Supplementary classification of factors influencing health status and contact with health services V01-V82

Table 3 Hospital Discharges by Primary Diagnosis, Mention or Absence of Diabetes and Average Length of Stay, New Jersey, 2003
Total Discharges Mention of Non-Mention of Diabetes Diabetes Infectious parasitic diseases 001-139 Malignant neoplasm 140-208 Other neoplasm 210-239 Disorders of thyroid gland 240-246 Diabetes
1

Average Length of Stay in Days Mention of Non-Mention of Diabetes Diabetes 99 61 24 35 67 53 50 93 18 50 75 60 44 81 63 62 76 53 76 52 87 39 39 68 40 36 28 36 59 50 75 53 12 22 00 46 47 69 14 65 91 50 43 79 59 60 65 27 55 30 87 16 26 41 18 20 69 27 41 35

4,989 7,435 2,541 183 18,554 5,095 1,949 4,729
2

25,829 49,439
40,748 1,750 22,240 12,723 57,013 48,672 46 2,174 8,260 50,887 2,676 49,609 21,230 6,956 18,258 98,754 154,058 5,458 83,971 138,087 21,366 78,686 5,536 3,074 72,839 85,306 142,756

Other endocrine, nutritional metabolic disorders 251-2792 Diseases of the blood blood-forming organs 280-289 Mental disorders 290-319 Diseases of the nervous system sense organs 320-389 Acute rheumatic fever 390-392 Chronic rheumatic heart disease 393-398 Hypertensive disease 401-405 Ischemic heart disease 410-414 Diseases of pulmonary circulation 415-417 Other forms of heart disease 420-429 Cerebrovascular disease 430-438 Arteries, arterioles and capillaries diseases 440-448 Veins, lymphatic other circulatory diseases 451-459 Diseases of the respiratory system 460-519 Diseases of the digestive system 520-579 Nephritis, nephrotic syndrome, and nephrosis 580589 Other diseases of the genitourinary system 590-629 Complications in Pregnancy, Childbirth Purpureum 630-677 Diseases of the skin and subcutaneous tissue 680-709 Musculoskeletal and connective tissue diseases 710-739 Congenital Anomalies 740-759 Conditions of Perinatal Period 760-779
2 2

7,131 602 4,014 22,535 587 20,868 7,945 2,586 2,421
18,051 18,239 2,102 8,638 813 5,705 8,336 90 14,918 14,207 2,637

Symptoms, Signs Ill-defined Conditions 780-799 Injury and Poisoning 800-999 Factors influencing health status/contact health services V01-V823

207,900 1,308,401 56 37 Total Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 Except: 2513, 3572, 36201-36202, 36641, 64800-64804 and 7751
3

Supplementary classification of factors influencing health status and contact with health services V01-V82

Number of Hospital Discharges less than 5

Table 4 Hospital Discharges with Diabetes Listed as the Primary Diagnosis by Race, Ethnicity, Gender, Number of Discharges, Number of Days and Average Length of Stay, New Jersey, 2003 Race, Ethnicity, and Gender Race and Gender White Male Female Black Male Female American Indian Male Female Asian/Pacific Islander Male Female Other Male Female Unknown Male Female Hispanic
Ethnicity and Gender Non-Hispanic Male Female Hispanic Male Female Unknown Male Female Total Male Female 13,280 6,899 6,381 2,563 1,302 1,261 2,711 1,364 1,347 18,554 9,565 8,989 89,619 46,832 42,787 16,191 8,199 7,992 19,256 10,124 9,132 125,066 65,155 59,911 67 68 67 63 63 63 71 74 68 67 68 67
3 1

Number of Hospital Discharges 10,869 5,742 5,127 5,122 2,566 2,556 125 64 61 193 92 101 1,746 851 895 499 250 249

Total Number of Days 73,356 38,988 34,368 34,362 17,205 17,157 662 379 283 1,063 491 572 12,597 6,545 6,052 3,026 1,547 1,479

Average Length of Stay in Days2 67 68 67 67 67 67 53 59 46 55 53 57 72 77 68 61 62 59

Table 5 Hospital Discharges with any Mention of Diabetes1 Listed as a Diagnosis by Race, Ethnicity, Gender, Number of Discharges, Number of Days, Age-Adjusted Rate, and Average Length of Stay, New Jersey, 2003 Age-Adjusted Discharge Rate Per 10,000 Standard Population Average Length of Stay in Days2

Race, Ethnicity, and Gender Race and Gender White Male Female Black Male Female Asian/Pacific Islander Male Female Other Male Female Unknown Male Female Hispanic Ethnicity3 and Gender Non-Hispanic Male Female Hispanic Male Female Unknown Male Female Total

Number of Hospital Discharges

Total Number of Days

141,743 68,992 72,751 38,395 15,868 22,527 2,875 1,411 1,464 17,200 7,992 9,208 7,692 3,865 3,827 148,022 69,823 78,199 25,048 11,632 13,416 34,838 16,674 18,164 207,908

777 076 359,500 417,576 242,177 99,418 142,759 14,236 6,651 7,585 101,689 46,677 55,012 39,401 19,214 20,187

1834 2063 1659 3788 3730 3830 785 818 752 N/A N/A N/A N/A N/A N/A

55 52 57 63 63 63 50 47 52 59 58 60 51 50 53

850 598 383,752 466,846 138,197 62,273 75,924 185,795 85,438 100,357 1,174,590

1771 1928 1655 3549 3750 3408 N/A N/A N/A 2273

57 55 60 55 54 57
53 51 55 56

Table 6 Hospital Discharge Rates for Any Mention of Diabetes1 as a Listed Diagnosis by Race, Ethnicity, Gender, and Age, New Jersey, 2003 Race/Ethnicity
Race White Hospital Discharges Population Rate2 Black Hospital Discharges Population Rate
2

Males
0 - 19 20-44 45 - 64 65 Older 0 - 19

Females
20 - 44 45 - 64 65 Older

Total

336 882,146 38

4,671 1,153,969 405

22,683 829,841 2733

41,302 396,394 1,0419

357 838,777 43

4,818 1,126,743 428

18,838 873,425 2157

48,738 579,895 8405

141,743 6,681,190 2122

111 211,219 53

2,351 228,543
1029

7,145 114,952 6216

6,261 40,099 1,5614

157 204,943 77

2,937 248,409 1182

8,995 144,088 6243

10,438 64,447 1,6196

38,395 1,256,700 3055

Other Races Hospital Discharges Population Rate2 Unknown Hospital Discharges Population Rate2 Hispanic Ethnicity3 Non-Hispanic Hospital Discharges Population Rate
2

124 109,933 113

1,024 146,271 700

4,050 71,594 5657

4,145 18,651 2,2224

155 105,948 146

1,239 148,412 835

3,862 75,341 5120

5,416 24,356 2,2237

20,015 700,506 2857

21 N/A N/A

370 N/A N/A

1,509 N/A N/A

1,965 N/A N/A

22 N/A N/A

363 N/A N/A

1,198 N/A N/A

2,244 N/A N/A

7,692 N/A N/A

393 990,270 40

5,636 1,237,892 455

24,541 912,646 2689

39,253 425,977 7102

439 946,398 46

6,255 1,263,200 495

22,558 980,285 2301

48,947 627,292 7803

148,022 7,383,960 2005

Hispanic Hospital Discharges Population Rate
2

77 213,028 36

1,334 290,904 459

4,771 106,342 4486

5,450 29,167 1,8686

110 186,942 59

1,559 260,304 599

4,814 112,569 4276

6,933 41,406 1,6744

25,048 1,240,662 202

Unknown Hospital Discharges Population Rate2 Total Discharges Total Population Total Rate
1

122 N/A N/A 592 1,203,298 49

1,447 N/A N/A 8,417 1,528,796 551

6,115 N/A N/A 35,427
1,018,988 3477

8,990 N/A N/A 53,693 455,144 11797

142 N/A N/A 691 1,133,340 61

1,543 N/A N/A 9,357 1,523,504 614

5,522 N/A N/A 32,894 1,092,854 3010

10,957 N/A N/A 66,837 668,698 9995

34,838 N/A N/A 207,908 8,624,622 2411

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 3620136202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 Per 10,000 population 3 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicityspecific statistics in this table are therefore subject to revision N/A: Not applicable

Table 7 Hospital Discharge Rates for Any Mention of Diabetes1 as a Listed Diagnosis by County and Age, New Jersey, 2003 Hospital Discharges by Age and Rate per 10,000 Population County Atlantic Rate Bergen Rate Burlington Rate Camden Rate Cape May Rate Cumberland Rate Essex Rate Gloucester Rate Hudson Rate Hunterdon Rate Mercer Rate Middlesex Rate
Monmouth Rate Morris Rate Ocean Rate Passaic Rate Salem Rate Somerset Rate Sussex Rate Union Rate Warren Rate Unknown Rate Total Rate Under 15 15 27 60 35 19 21 33 30 10 32 97 55 17 31 65 55 6 23 14 19 75 48 76 57 34 34 58 56 61 54 25 37 10 31 54 48 10 44 13 N/A 755 37 15-24 79 234 88 89 42 73 164 236 20 165 63 31 197 188 33 85 90 119 9 60 55 104 129 126 127 165 44 82 71 115 139 208 24 270 50 154 27 140 71 111 22 168 35 N/A 1,579 124 25-34 126 383 242 229 130 230 380 592 35 351 131 609 687 622 136 418 409 364 16 128 204 429 325 282 245 354 135 246 250 401 293 438 34 466 93 245 38 233 235 348 30 238 124 N/A 4,298 326 35-44 481 1107 837 553 493 652 943 1152 164 1140 283 1209 1,837 1443 376 844 1,024 1005 111 487 608 1059 1,085 824 714 667 339 397 653 822 757 948 86 894 325 553 129 477 691 778 131 67 357 N/A 12,425 602 45-54 857 2283 1,915 1395 1,124 1725 1,887 2536 238 1605 673 3365 3,565 3275 795 1977 2,371 3052 165 727 1,311 2484 2,181 1978 1,866 1872 804 1063 1,394 2008 1,767 2648 272 2759 675 1372 344 1349 1,331 1773 318 1913 676 N/A 26,529 1711 55-64 1,322 5222 3,271 3296 1,843 4083 2,544 5135 515 4225 1,000 7176 5,436 7259 1,185 4594 3,573 6633 305 2011 1,744 5013 3,492
4842 2,711 4058 1,429 2593 2,606 4959 2,901 6254 402 5726 1,120 3600 555 3387 2,285 4438 436 3970 1117 N/A 41,792 4343 65-74 1,583 8833 4,679 7147 2,389 8214 3,148 1,0151 767 7649 1,032 1,1004 5,866 1,2577 1,645 1,0364 4,286 1,2298 371 4930 2,235 1,0278 4,242 9113 3,4640 8688 1,858 5984 4,236 8397 3,013 1,0338 472 1,0650 1,511 8571 577 7602 2,815 8615 652 9885 1394 N/A 52,235 7882 75-84 1,483 1,1416 5,221 1,0484 2,398 1,1649 3,115 1,3020 824 1,0733 975 1,3744 4,713 1,4418 1,518 1,3268 3,774 1,5895 458 9290 2,234 1,3538 4,383 1,2387 3,508 1,2366 1,874 9454 4,802 1,0137 2,797 1,3130 424 1,1850 1,397 1,1627 549 1,1445 2,881 1,0896 744 1,4698 1043 N/A 51,116 1,00780 85 525 1,1630 1,834 9566 625 9833 964 1,1679 298 1,0164 299 1,2076 1,696 1,3232 422 1,2081 1,075 1,1765 127 7587 753 1,2302 1,420 1,2443 1,312 1,2243 715 9910 1,740 9320 924 1,1157 122 9887 555 1,3262 163 9076 1,057 1,0224 267 1,3192 286 N/A 17,179 9337 207,906 2407 Total 6,471 2457 18,147 2022 9,063 2039 13,178 2564 2,863 2811 4,466 2991 24,094 3026 6,127 2295 16,667 2744 1,568 1222 9,158 2530 17,332 2219 14,023 2218 7,232 1497 15,810 2895 12,652 2539 1,837 2833 5,751 1846 2,392 1583 11,420 2157 2,610 2390 5,045

Hospital discharges were under 5 N/A: Not applicable

Table 8 Hospital Discharges with Any Mention of Diabetes1 as a Listed Diagnosis by County, Number of Discharges, Age-Adjusted Rates, Number of Days, and Average Length of Stay, New Jersey, 2003 Age-Adjusted Rate Per Average Number of 10,000 Length Hospital Standard Number of of Stay County Discharges Population Days in Days Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren Unknown Total 6,471 18,147 9,063 13,178 2,863 4,466 24,094 6,127 16,667 1,568 9,158 17,332 14,023 7,232 15,810 12,652 1,837 5,751 2,392 11,420 2,610 5,045 207,908 2309 1707 1958 2532 1987 2939 3114 2347 2939 1243 2498 2240 2116 1459 1640 2601 2507 1944 1769 1654 2295 N/A 22800 36,873
96,960 46,488 70,085 15,972 24,004 157,078 29,297 115,438 8,173 48,565 101,288 77,731 38,685 82,532 71,967 8,554 27,445 11,663 70,959 12,074 22,756 1,174,590 57 53 51 53 56 54 65 48 69 52 53 58 55 54 52 57 47 48 49 62 46 45 57

Table 9 Hospital Discharges with Any Mention of Diabetes1 and End Stage Renal Disease ESRD2 as Listed Diagnoses by Race, Ethnicity, Gender, Number of Discharges, Average Length of Stay, and Crude and Age-Adjusted Rates, New Jersey, 2003 Race, Ethnicity, and Gender Race and Gender White Male Female Black Male Female Asian/ Pacific Islander Male Female Other Male Female Unknown Male Female Non-Hispanic Male Female Hispanic Male Female Unknown Male Female Total 6,961 3,786 3,175 3,791 1,749 2,042 216 111 105 1,045 532 523 345 161 188 8,833 4,507 4,326 1,761 957 804 1,893 938 955
12,487 93 88 98 94 91 96 81 71 91 111 109 112 98 95 97 93 88 97 96 89 103 102 103 103 95 2495 2642 2341 4461 4737 4249 918 671 1500 N/A N/A N/A N/A N/A N/A 2280 2280 2279 3489 3861 3130 N/A N/A N/A 2838 91 113 74 369 404 345 57 61 52 N/A N/A N/A N/A N/A N/A 106 123 94 243 301 199 N/A N/A N/A 137 Number of Hospital Discharges Average3 Length of Stay Crude Rate per 10,000 Diabetic Population4 Age-Adjusted Rate per 10,000 Standard Population

Hispanic Origin5and Gender

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 6480064804 or Neonatal diabetes mellitus 7751 2 ICD-9-CM Procedure Codes for ESRD: Chronic Dialysis 3995 or Renal Transplantation 5560-5569, or Disease Codes V420, V451 or 585 3 Number of days divided by number of hospital discharges 4 Denominators were derived from New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 5 Due to a coding error, a significant
number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicity-specific statistics in this table are therefore subject to revision N/A: Not applicable or not available

Table 10 Hospital Discharges with Any Mention of Diabetes1 and End Stage Renal Disease ESRD2 as Listed Diagnoses by County, Number of Discharges, Average Length of Stay, and Crude and Age-Adjusted Rates, New Jersey, 2003 Number of Hospital Discharges 379 1,080 527 777 106 405 1,904 297 1,061 72 617 1,072 793 400 697 845 66 287 109 745 98 150 12,487 Average Length of Stay in Days3 74 81 76 81 71 93 101 66 116 112 92 109 96 99 90 92 71 84 104 112 85 73 95 Crude Rate per 10,000 Diabetic Population4 2382 2877 2402 2944 1777 4293 4734 2288 4301 1151 3538 2815 3084 1813 2284 4114 1807 1915 1394 2874 1666 N/A 2813 Age-Adjusted Rate Per 10,000 Standard Population 135 102 113 149 87 267 246 114 188 58 169 138 120 80 90 174 88 96 88 134 80 N/A 137

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren Unknown Total

Source: New Jersey Department of Health
and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804 or Neonatal diabetes mellitus 7751 2 ICD-9-CM Procedure Codes for ESRD: Chronic Dialysis 3995 or Renal Transplantation 5560-5569, or Disease Codes V420, V451 or 585 3 Number of days divided by number of hospital discharges 4 Denominators were derived from New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004t hat were smoothed by Bayesian estimation using Gibbs Sampling with BUGS software from the British Medical Research Council N/A: Not applicable

Table 11 Hospital Discharges with Any Mention of Diabetes1 and Kidney Diseases2 as Listed Diagnoses by Race, Ethnicity, Gender, Number of Discharges, Average Length of Stay, and Crude and Age-Adjusted Rates, New Jersey, 2003 Crude Rate per 10,000 Number of Average3 Length of Hospital Diabetic Age-Adjusted Rate per Stay Population4 Race/Ethnicity and Gender Discharges 10,000 Standard Population Race
and Gender White Male Female Black Male Female Asian/ Pacific Islander Male Female Other Male Female Unknown Male Female Hispanic Origin5and Gender Non-Hispanic Male Female Hispanic Male Female Unknown Male Female Total 13,251 6,923 6,328 4,824 2,232 2,592 317 163 154 1,487 732 755 501 268 233 94 90 99 95 93 97 80 68 93 107 99 115 99 94 106 4750 4831 4665 5677 6045 5394 1347 986 2200 N/A N/A N/A N/A N/A N/A 171 208 144 471 539 440 91 102 81 N/A N/A N/A N/A N/A N/A

15,350 7,789 7,561 2,201 1,095 1,106 2,958 1,508 1,450 20,509

93 89 98 103 97 110 101 98 105 95

3962 3941 3984 4361 4418 4306 N/A N/A N/A 4661

183 215 94 311 353 160 N/A N/A N/A 225

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804 or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes for Kidney Diseases: Diabetes with renal manifestations 2504, Nephrotic syndrome 58181, Nephritis and nephropathy 58381, Acute renal failure 584, Renal failure 586,
Renal sclerosis 587, Disorders resulting from impaired renal function 588 and Infections of kidney 590 3 Number of days divided by number of hospital discharges 4 New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 were used for denominators 5 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicity-specific statistics in this table are therefore subject to revision N/A: Not applicable or not available

Table 12 Hospital Discharges with Any Mention of Diabetes1 and Selected Vision Disorders2 as Listed Diagnoses by Race, Ethnicity, Gender, Number of Discharges Average Length of Stay and Age-Adjusted and Crude Rates, New Jersey, 2003 AgeAdjusted Crude Rate Rate per 10,000 Number of Average3 per 10,000 Hospital Length Diabetic Standard Discharges of Stay Population4 Population Race and Gender
White Male Female Black Male Female Asian/ Pacific Islander Male Female Other Male Female Unknown Male Female 1,0150 4,691 5,459 2,655 1,052 1,603 240 111 129 1,021 465 556 571 258 313 39 38 40 50 53 48 33 19 46 50 47 52 40 40 39 3639 3273 4025 3124
2849 3336 1020 671 1843 N/A N/A N/A N/A N/A N/A 131 141 124 268 257 277 64 66 62 N/A N/A N/A N/A N/A N/A

Hispanic Origin5and Gender NonHispanic 10,188 Male 4,609 Female 5,579 Hispanic 1,831 Male 861 Female 970 Unknown 2,729 Male 1168 Female 1561 Total 14,748

43 42 44 38 35 41 39 39 40 42

2630 2332 2940 3628 3474 3777 N/A N/A N/A 3351

122 128 117 267 287 254 N/A N/A N/A 162

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92
1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes for Vision Disorders: Diabetes with ophthalmic manifestation 2505, or Disorders of the eye and adnexa 360-379 3 Number of days divided by number of hospital discharges 4 New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 were used for denominators 5 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The
ethnicity-specific statistics in this table are therefore N/A: Not applicable or not available

Table 13 Hospital Discharges with and without Diabetes Listed as a Diagnosis and Traumatic, Nontraumatic and Major Amputations Listed as a Procedure by Number and Percent, New Jersey, 2003
Categories Traumatic amputations of the lower limb1 Without diabetes Percent With diabetes2 Percent Non-traumatic amputations of the lower limb3 Without diabetes Percent With diabetes Percent Total Amputations Without diabetes Percent With diabetes Percent Major Amputations of the Lower Limb4 Without Diabetes Percent With diabetes Percent Minor Amputations of the Lower Limb Without Diabetes Percent With diabetes Percent Number and Percent 10 10 100 0 0 4,206 1,237 294 2,969 706 4,216 1,247 296 2,969 704 871 426 489 445 511 3,345 821 25 2,524 75

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Procedure Code 841 and diagnosis Code Lower limb amputation ICD9-CM 895-897 2 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641,
Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 3 ICD-9-CM Codes: Injury and poisoning 895-897 with lower limb amputation procedure 841 4 ICD-9-CM Codes: Major amputation 8415 and 8417

Table 14 Hospital Discharges with Any Mention of Diabetes1 as a Listed Diagnosis and Non-Traumatic Amputations of the Lower Limb2 by Race, Ethnicity, Gender, Number of Discharges, Average Length of Stay, and Crude and Age-Adjusted Rates, New Jersey, 2003 Crude Rate 3 Number of Average per 10,000 Age-Adjusted Rate per Hospital Length of Diabetic 10,000 Standard 4 Stay Population Discharges Population Race and Gender White 1,866 145 669 23 Male 1,219 137 851 36 Female 647 160 477 15 Black 737 170 867 74 Male 400 165 1083 93 Female 337 175 701 60 Asian/ Pacific Islander 23 238 98 07 Male 13 218 79 10 Female 10 264 143 06 Other 236 184 N/A N/A Male 147 173 N/A N/A Female 89 202 N/A N/A Unknown 86 139 N/A N/A Male 46 135 N/A N/A Female 40 142 N/A N/A 5 Hispanic Origin and Gender Non-Hispanic Male Female Hispanic Male Female Unknown Male Female Total 2,182 1,352 830 333 200 133 454 290 164 2,969 150 142 162 169 157 188 169 161 183 155 563 684 437 660 807 518
N/A N/A N/A 675 26 37 18 47 62 35 N/A N/A N/A 32

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804 or Neonatal diabetes mellitus 7751 2 ICD-9-CM Procedure Code 841 and Diagnosis Code Lower limb amputation ICD9-CM 895-897 3 Number of days divided by number of hospital discharges 4 New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2001 through 2003 were used for denominators 5 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicity-specific statistics in this table are therefore subject to revision N/A: Not applicable or not available

Table 15 Hospital Discharges with Any Mention of Diabetes1 as a Listed Diagnosis and Non-Traumatic Amputations of the Lower Limb2 by County, Number of Discharges, Average Length of Stay, Crude, and Age-Adjusted Rates, New Jersey, 2003 Age-adjusted
Crude Rate4 Average3 Rate per per 10,000 Number of Length of 10,000 Stay in Diabetic Hospital Standard Days Population County Discharges Population Atlantic 104 128 654 37 Bergen 280 157 746 26 Burlington 149 120 679 32 Camden 201 150 762 38 Cape May 34 136 570 24 Cumberland 55 161 583 36 Essex 376 178 935 49 Gloucester 73 121 562 28 Hudson 194 207 786 35 Hunterdon 29 238 464 23 Mercer 116 166 665 32 Middlesex 234 176 614 30 Monmouth 209 134 813 31 Morris 107 150 485 21 Ocean 234 109 767 33 Passaic 195 165 949 40 Salem 25 106 712 37 Somerset 85 155 567 29 Sussex 29 129 371 20 Union 175 161 675 31 Warren 28 113 476 24 Unknown 37 136 N/A N/A Total 2,969 155 669 32
Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804 or Neonatal diabetes mellitus 7751 2 ICD-9-CM Procedure Code 841 and Diagnosis Code Lower limb amputation ICD9-CM 895-897 3 Number of days divided by number of hospital discharges 4 Denominators were
derived from New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 that were smoothed by Bayesian estimation using Gibbs Sampling with BUGS software from the British Medical Research Council

Table 16 Hospital Discharges with Any Mention of Diabetes1 and Selected Cardiovascular Diseases as Listed Diagnoses by Race, Ethnicity, Gender, Number of Mentions, Mean Length of Stay, Crude, and Age-Adjusted Rates, New Jersey, 2003 Selected Cardiovascular Diseases2 Hypertensive Heart disease
Race, Ethnicity, and Gender Crude Rate per 10,000 Diabetic Population4 AgeAdjusted Rate per 10,000 Standard Population

Ischemic Heart disease
Crude Rate per 10,000 Diabetic Population4 AgeAdjusted Rate per 10,000 Standard Population

Heart failure
Crude Rate per 10,000 Diabetic Population4 AgeAdjusted Rate Per 10,000 Standard Population

Number of Mentions

Mean LOS3

Number of Mentions

Mean LOS3

Number of Mentions

Mean LOS3

Race and Gender White Male Female Black Male Female Asian/PI Male Female Other Male Female Unknown Male Female 3,824 1,581 2,243 1,551 576 975 76 40 36 501 184 317 136 53 83 696 609 712 743 695 771 55 413 703 746 762 737
577 621 549 1371 1103 1654 1825 1560 2029 323 242 514 N/A N/A N/A N/A N/A N/A 48 48 48 165 150 175 27 33 22 N/A N/A N/A N/A N/A N/A 56,403 31,245 25,158 10,066 4,372 5,694 1,010 570 440 5,260 2,736 2,534 3,562 2,012 1,550 52 48 56 61 59 62 49 44 55 61 57 65 48 46 51 2,0219 2,1801 1,8548 1,1845 1,1841 1,1848 4291 3447 6286 N/A N/A N/A N/A N/A N/A 513 939 551 1089 1121 1011 293 345 247 N/A N/A N/A N/A N/A N/A 32,457 15,022 17,435 7,668 2,957 4,711 458 224 234 3,012 1,374 1,638 1,587 713 874 76 72 78 81 76 84 73 64 81 88 85 89 72 71 73 1,1635 1,0482 1,2854 9023 8009 9803 1946 1355 3343 N/A N/A N/A N/A N/A N/A 409 460 370 809 763 838 153 162 145 N/A N/A N/A N/A N/A N/A

Hispanic Origin5 and Gender NonHispanic 4,510 6947 Male Female Hispanic Male Female Unknown Male Female Total 1,810 2,700 703 284 419 855 340 515 6,068 635 735 644 607 669 725 68 756 693

1164 916 1423 1393 1146 1631 N/A N/A N/A 1379

53 51 54 116 103 123 N/A N/A N/A 67

55,119 29,521 25,598 8,340 4,382 3,958 12,855 7,032 5,821 76,314

54 50 59 53 50 57 50 46 55 53

1,4227 1,4937 1,3488 1,6525 1,7679 1,5411 N/A N/A N/A 1,7342

650 821 520 1306 1561 1113 N/A N/A N/A 1537

33,421 14,937 18,484 4,629 2,190 2,439 7,132
3,163 3,969 45,182

77 73 80 78 75 82 77 75 78 77

8626 7558 9739 9172 8836 9497 N/A N/A N/A 1,0267

392 424 368 757 844 710 N/A N/A N/A 493

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes for selected heart diseases: Hypertensive heart disease ICD-9-CM Code 402, Ischemic heart disease ICD-9-CM Codes 410 -414, and Heart failure ICD-9-CM Code 428 3 Number of days divided by number of hospital discharges 4 4New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 were used for denominators 5 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicity-specific statistics in this table are therefore subject to revision N/A: Not computed because of small numbers or population estimates were unavailable

Table 17 Hospital
Discharges with Any Mention of Diabetes1 and Selected Cardiovascular Diseases as Listed Diagnoses by County, Crude, and Age-Adjusted Rates, and Average Length of Stay, New Jersey, 2003
Selected Cardiovascular Diseases2 Hypertensive Heart disease AgeAdjusted Rate/10,000 Standard Population 132 35 40 60 62 48 133 28 86 07 96 85 58 37 38 49 86 35 55 144 30 66 Ischemic Heart disease AgeAdjusted Rate/10,000 Standard Population 845 624 788 480 702 1044 922 887 1089 485 874 920 875 500 853 807 862 740 624 786 898 835 Heart failure AgeAdjusted Rate/10,000 Standard Population 486 369 426 562 440 695 676 549 649 286 503 505 498 302 424 524 544 398 313 446 552 493

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren Total

Crude Rate per 10,000 Diabetic Population3 2351 996 825 1186 1425 763 2526 562 1950 128 2001 1704 1459 798 1124 1139 1780 667 844 3144 561 1367

Average Length of Stay in Days4 68 64 66 53 71 44 81 61 80 59 60 70 61 62 68 67 55 66 52 76 65 69

Crude Rate per 10,000 Diabetic Population3 1,5009 1,7946 1,6604 9765 1,8042 1,6896 1,7578 1,7650 2,4540 9658
1,8222 1,8543 2,2244 1,1160 2,2638 1,8992 1,7662 1,4263 1,0678 1,7022 1,71992 1,7194

Average Length of Stay in Days4 55 50 48 52 56 51 64 45 67 45 48 56 52 48 49 54 44 47 45 56 47 53

Crude Rate per 10,000 Diabetic Population3 8649 1,0743 8865 1,1053 1,1502 1,1236 1,2869 1,0801 1,4621 5389 1,0545 1,0150 1,2699 6587 1,2088 1,2356 1,1062 7505 4962 9772 1,0639 1,0180

Average Length of Stay in Days4 73 72 67 68 72 70 88 66 97 78 67 87 77 77 70 79 59 74 68 81 63 77

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes for selected heart diseases: Hypertensive heart disease ICD-9-CM Code 402, Ischemic heart disease ICD-9-CM Codes 410 -414, and Heart failure ICD-9-CM Code 428 3 Denominoators were derived from New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 that were smoothed by Bayesian estimation using
Gibbs Sampling with BUGS software from the British Medical Research Council 4 Number of days divided by number of hospital discharges

Table 18 Hospital Discharges with Any Mention of Diabetes1 and Hypertensive Disease2 Listed as Diagnoses by Race, Ethnicity, Gender, Average Length of Stay, and Ageadjusted and Crude Rates, New Jersey, 2003
Race, Number of Ethnicity, Hospital and Gender Discharges Race and Gender 89,491 White Male 42,306 Female 47,185 28,149 Black Male 11,324 Female 16,825 Asian/ PI 1,956 Male 941 Female 1,015 11,111 Other Male 5,026 Female 6,085 5,016 Unknown Male 2,472 Female 2,544 Hispanic Origin5 and Gender NonHispanic Male Female Hispanic Male Female Unknown Male Female Total 96,367 44,016 52,351 16,612 7,503 9,109 22,747 10,551 12,196 135,726 Average Length of Stay in Days3 50 48 66 61 60 61 48 45 50 58 58 59 48 46 49 Age-adjusted Rate Per 10,000 Standard Population 1150 1262 1058 2819 2714 2888 551 552 541 N/A N/A N/A N/A N/A N/A Crude Rate4 Per 10,000 Diabetic Population 3,2081 2,9519 3,4787 3,3124 3,0669 3,5011 8311 5691 1,4500 N/A N/A N/A N/A N/A N/A

54 52 56 53 51 55 51 49 53 53

1145 1210 1093 2437 2489 2393 N/A N/A N/A 1485

2,4873 2,2271 2,7584
3,2916 3,0271 3,5467 N/A N/A N/A 30843

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes: hypertensive disease 401 - 405 3 Number of days divided by number of hospital discharges 4 New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2001 through 2003 were used for denominators 5 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicity-specific statistics in this table are therefore N/A: Not computed because of small numbers or population estimates were unavailable

100

Table 19 Hospital Discharges with Any Mention of Diabetes1 and Hypertensive Disease2 Listed as Diagnoses by County, Number of Discharges, Average Length of Stay, Crude, and Age-adjusted and New Jersey, 2003 Number of Hospital Discharges 4,020 11,476 5,773 8,640 1,516
2,967 16,663 3,975 10,992 975 6,160 11,413 9,084 4,632 10,003 8,331 1,111 3,796 1,431 7,738 1,697 3,333 135,726 Average3 Length of Stay in Days 53 50 47 49 51 53 63 44 66 46 49 55 52 51 50 54 44 45 46 59 46 43 53 Crude Rate/10,000 Diabetic Population4 2,5267 3,0570 2,6313 3,2740 2,5419 3,1450 4,1430 3,0624 4,4556 1,5590 3,5321 2,9971 3,5216 2,0997 3,2786 4,0560 3,0422 2,5324 1,8299 2,9853 2,8841 N/A 3,0580 Age-adjusted Rate Per 10,000 Standard Population 1430 1072 1244 1658 1045 1953 2157 1524 1950 770 1681 1478 1360 935 1283 1717 1502 1288 1066 1381 1494 N/A 1485

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren Unknown Total

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes: hypertensive disease 401 - 405 3 Number of days divided
by number of hospital discharges 4 Denominators were derived from New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 that were smoothed by Bayesian estimation using Gibbs Sampling with BUGS software from the British Medical Research Council N/A: Not applicable or not available

101

Table 20 Hospital Discharges with Any Mention of Diabetes1 and Major Cardiovascular2 Diseases Listed as Diagnoses by Race, Ethnicity, Gender, Average Length of Stay, Crude, and Age-adjusted Rates, New Jersey, 2003 Crude Rate per 10,000 Average3 Length of Diabetic Stay in Days Population4

Race, Ethnicity, and Gender

Number of Discharges

Age-adjusted Rate per 10,000 Standard Population

Race and Gender White Male Female Black Male Female Asian/PI Male Female Other Male Female Unknown Male 119,331 58,476 60,855 31,978 12,972 19,006 2,354 1,155 1,199 13,450 6,241 7,209 6,497 3,291 56 53 59 64 63 65 51 49 53 62 61 63 52 50 54 58 56 61 57 55 59 55 53 57 58 4 277 8 4,0802 4,4866 3,7630 3,5133 3,9549 1,0002 6985 1,7129 N/A N/A N/A N/A N/A N/A 1530 1753 1356 3233 3160 3278 588 633 548 N/A N/A N/A N/A N/A N/A 1452 1631 1362 2982 3165 2844 N/A N/A N/A
1899

Female 3,206 Hispanic Origin5 and Gender Non124,582 Hispanic Male Female Hispanic Male Female Unknown Male Female Total 58,907 65,675 20,027 9,322 10,705 29,004 13,907 15,097 173,613

3 215 6 2,9805 3,4604 3,9683 3,7610 4,1681 N/A N/A N/A 3 945 3

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes: Major Cardiovascular Diseases 390-448 3 Number of days divided by number of hospital discharges 4 New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 were used for denominators 5 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicity-specific statistics in this table are therefore subject to revision

102

Table 21 Hospital Discharges with Any Mention of Diabetes1 and Major Cardiovascular Diseases2 Listed as Diagnoses
by County, Number of Discharges, Average Length of Stay, Crude, and Age-adjusted Rates, New Jersey, 2003 Average3 Length of Stay in Days 58 54 52 54 58 55 67 49 72 52 54 60 56 55 53 58 48 49 49 63 48 46 58 Crude Rate Per 10,000 Diabetic Population4 3,4111 4,0021 3,5119 4,1595 3,9152 3,9888 4,9436 3,9815 5,5436 2,1170 4,4312 3,8485 4,5862 2,7026 4,4277 5,0399 4,1402 3,1888 2,4693 3,7249 3,7525 N/A 3,9029 Age-adjusted Rate Per 10,000 Standard Population 1927 1399 1665 2108 1569 2473 2578 1988 2432 1062 2109 1900 1777 1207 1711 2134 2041 1630 1450 1719 1942 N/A 1899

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren Unknown Total

Number of Hospital Discharges 5,427 15,024 7,705 10,977 2,335 3,763 19,883 5,168 13,676 1,324 7,728 14,655 11,791 5,962 13,509 10,352 1,512 4,780 1,931 9,655 2,208 4,246 173,613

103

Table 22 Hospital Discharges with Any Mention of Diabetes1 and Cerebrovascular Diseases2 Listed as Diagnoses by Race, Hispanic Ethnicity, Gender, Average Length of Stay, Crude, and Age-Adjusted Rates, New Jersey, 2003 Average3 Length of Stay in Days 65 63 67 79 78 80 64 63 65 78 77 78 71 69 74 69 65 72 72 71 73 70 69 71 69 Crude Rate/10,000 Diabetic Population4 3758 3559 3968 3634 3261 3920 999 689 1729 N/A N/A N/A N/A N/A N/A 2915 2651 3189 3473 3365 3578 N/A N/A N/A 3544 Age-Adjusted Rate/10,000 Standard Population 133 156 116 332 318 339 71 73 69 N/A N/A N/A N/A N/A N/A 133 148 122 287 317 264 N/A N/A N/A 171

Race, Ethnicity, and Gender Race and Gender White Male Female Black
Male Female Asian/PI Male Female Other Male Female Unknown Male Female

Number of Hospital Discharges 10,483 5,101 5,382 3,088 1,204 1,884 235 114 121 1,202 563 639 586 305 281 11,292 5,240 6,052 1,753 834 919 2,549 1,213 1,336 15,594

Hispanic Origin5 and Gender Non-Hispanic Male Female Hispanic Male Female Unknown Male Female Total

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes: Cerebrovascular Disease Stroke: 430 - 438 3 Number of days divided by number of hospital discharges 4 New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 were used for denominators 5 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicity-specific statistics in this table are therefore subject to N/A: Not applicable or not
available

104

Table 23 Hospital Discharges with Any Mention of Diabetes1 and Cerebrovascular Disease2 Listed as Diagnoses by County, Number of Discharges, Average Length of Stay, Crude, and Age-adjusted Rates, New Jersey, 2003 Average3 Length of Stay in Days 61 62 57 66 62 67 83 56 92 51 64 76 68 66 57 74 60 59 63 74 48 66 69 Crude Rate/10,000 Diabetic Population4 3275 3458 3300 4127 3991 3445 4398 3344 5253 1311 4169 3401 4251 2189 4304 4085 3614 2889 2199 3260 2923 N/A 3513 Age-adjusted Rate Per 10,000 Standard Population 184 120 158 210 152 213 232 170 233 70 200 169 166 101 156 174 177 151 138 149 152 N/A 171

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren Unknown Total

Number of Hospital Discharges 521 1,298 724 1,089 238 325 1,749 434 1,296 82 727 1,295 1,093 483 1,313 839 132 433 172 845 172 334 15,594

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy
36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes: Cerebrovascular Disease Stroke:430 - 438 3 Number of days divided by number of hospital discharges 4 Denominators were derived from New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 that were smoothed by Bayesian estimation using Gibbs Sampling with BUGS software from the British Medical Research Council N/A: Not applicable or not available

105

Table 24 Hospital Discharges with Any Mention of Diabetes1 and Pneumonia or Influenza 2 Listed as Diagnoses by Race, Ethnicity, Gender, Average Length of Stay, Crude, and Age-adjusted Rates, New Jersey, 2003 Age-adjusted Rate Per 10,000 Standard Population 116 137 102 227 234 224 63 63 61 N/A N/A N/A N/A N/A N/A 113 130 102 211 219 205 N/A N/A N/A 142

Race, Ethnicity, and Gender

Number of Hospital Discharges

Average3 Length of Stay in Days 94 92 95 113 112 114 97 111 84 109 106 112 94 109 79 97 95 98 101 101 101 104 105 103 98

Crude Rate/10,000 Diabetic Population4 3294 3103 3497 2555 2432 2649 765 514 1357 N/A N/A N/A N/A N/A N/A 2489
2311 2674 2645 2409 2873 N/A N/A N/A 2953

Race and Gender 9,190 White Male 4,447 Female 4,743 2,171 Black Male 898 Female 1,273 Asian/PI 180 Male 85 Female 95 1,078 Other Male 183 Female 242 374 Unknown Male 189 Female 185 Hispanic Origin5 and Gender 9,642 Non-Hispanic Male 4,568 Female 5,074 1335 Hispanic Male 597 Female 738 2,017 Unknown Male 984 Female 1,033 Total 12,994

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy 36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes: Pneumonia and Influenza 4800-4878 3 Number of days divided by number of hospital discharges 4 New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 were used for denominators 5 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicity-specific statistics in this table are therefore subject to
revision N/A: Not applicable or not available

106

Table 25 Hospital Discharges with Any Mention of Diabetes1 and Pneumonia or Influenza 2 Listed as Diagnoses by County, Average Length of Stay, Crude, and Age-adjusted Rates, New Jersey, 2003 Crude Rate/10,000 Diabetic Population4 2533 2656 2612 3285 4577 2576 3958 2750 4293 2095 3033 2962 3411 1931 3110 3549 3341 2535 2442 2917 2753 N/A 2928 Age-adjusted Rate Per 10,000 Standard Population 143 92 125 166 181 160 207 139 189 109 144 147 134 88 115 151 164 133 155 132 142 N/A 142

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren Unknown Total

Number of Discharges 403 997 573 867 273 243 1,592 357 1,059 131 529 1,128 877 426 949 729 122 380 191 756 162 249 12,994

Average3 Length of Stay in Days 87 96 88 76 82 103 123 75 120 88 87 108 92 88 88 100 85 99 77 111 75 75 98

Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509, Postsurgical hypoinsulinemia 2513, Polyneuropathy in diabetes 3572, Diabetic retinopathy
36201-36202, Diabetic cataract 36641, Diabetes in pregnancy but not gestational 64800-64804, or Neonatal diabetes mellitus 7751 2 ICD-9-CM Codes: Pneumonia and Influenza 4800-4878 3 Number of days divided by number of hospital discharges 4 Denominators were derived from New Jersey Behavioral Risk Factor Survey diabetes prevalence estimates for survey periods 2002 through 2004 that were smoothed by Bayesian estimation using Gibbs Sampling with BUGS software from the British Medical Research Council N/A: Not applicable or not available

107

Table 26 Hospital Discharges with Any Mention and No Mention of Diabetes as a Listed Diagnosis 1st through 9th diagnosis by Primary Diagnosis and Average Length of Stay, and Children 18 Years Old and Under, New Jersey, 2003 No mention of Diabetes Any Mention of Diabetes1 Average Length of Stay in Days
29 80 N/A N/A 29 27 29 38 25 30 N/A N/A 30 21 49 80 81 13 N/A N/A N/A N/A N/A 10 1140 00 27 42 22 50 14 29 34 37 14 433 13 34 119 36 21 1 34 8 N/A N/A N/A N/A N/A 1 1 1 3 46 55 1 8 21 18 12 5 3 35 33 49 1,146

Primary Diagnosis
Infectious parasitic diseases 001-139 Malignant neoplasms 140-208 Other neoplasms 210-239 Disorders of thyroid gland
240-246 Diabetes Mellitus 2500-2509 DM without mention of complication 2500 DM with ketoacidosis 2501 DM with hyperosmolarity 2502 DM with other coma 2503 DM with renal manifestations 2504 DM with ophthalmic manifestations 2505 DM with neurological manifestations 2506 DM with other specified manifestations 2508 DM with unspecified complication 2509 Other endocrine, nutritional metabolic disorder 251-279 Diseases of the blood blood forming organs 280-289 Mental disorders 290-319 Diseases of the nervous system sense organs 320-389 Acute rheumatic fever 390-392 Chronic rheumatic heart disease 393-398 Hypertensive disease 401-405 Ischemic heart disease 410-414 Diseases of pulmonary circulation 415-417 Other forms of heart disease 420-429 Cerebrovascular disease 430-438 Arteries, arterioles and capillaries diseases 440-448 Veins, lymphatic other circulatory diseases 451-459 Diseases of the respiratory system 460-519 Diseases of the digestive system 520-579 Nephritis, nephrotic syndrome and nephrosis 580-589 Other diseases of the genitourinary system 590-629 Complications in pregnancy, childbirth purpureum 630-677 Diseases of the skin and subcutaneous tissue 680-709 Musculoskeletal
connective tissue diseases 710-739 Congenital anomalies 740-759 Conditions of perinatal period 760-779 Symptoms, signs ill-defined conditions 780-799 Injury and poisoning 800-999 Factors influencing health status/contact health services V01-V82 Total

Number of Discharges
15 2 N/A N/A 773 239 476 5 2 1 N/A N/A 34 16

Average Length of Stay in Days
30 77 05 20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 22 38 85 09 50 136 34 38 57 34 72 31 07 20 16 32 12 25 19 13 20 69 19 21 39 32

Number of Discharges
4,516 539 1,417 24 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 4,207 1,669 4,947 8,784 25 12 63 5 3 285 43 167 250 25,013 12,490 218 5,523 5,696 2,463 3,091 3,776 3,073 6,164 10,754 114,731 219,948

Total Number of Discharges 18 Under
4 531 541 1,417 24 773 239 476 5 2 1 N/A N/A 34 16 4,228 1,670 4,981 8,792 25 12 63 5 3 286 44 168 253 25,059 12,545 219 5,531 5,717 2,481 3,103 3,781 3,076 6,199 10,787 114,780 221,094

108

Table 27 Number of Hospitalizations with Any Mention of Diabetes and Average Length of Stay by Gender, Race, Ethnicity,, and Type of Diabetic Complication, New Jersey, 2003 DM with DM without mention of complication 2500 Race, Ethnicity, and Gender Number of Mentions Average Length of Stay in Days1 DM with ketoacidosis 2501 Number of Mentions Average Length of Stay in Days1 hyperosmolarity 2502 Number of Mentions Average Length of Stay in Days1 DM with other coma 2503 Number of Mentions Average Length of Stay in Days1 DM with renal manifestations 2504 Number of Mentions Average Length of Stay in Days1

Race and Gender White Male Female Black Male Female Asian/PI Male Female Other Male Female Unknown Male Female 112,903 54,302 58,601 29,217 11,119 17,098 2,364 1,162 1,202 13,502 6,165 7,337 6,442 3,237 3,205 49 46 52 56 54 57 44 43 46 50 49 51 46 45 47 1,617 793 824 918 489 429 31 19 12 362 179 183 71 39 32 52 51 53 59 58 61 58 50 71 51 49 54 51 52 49 399 191 208 287 148 139 6 3 3 77 28 49 28 14 14 85 77 92 78 74 82 157 227 87 89 57 107 85 55 116
113 51 62 56 25 31 1 0 1 13 5 8 1 0 1 94 89 98 65 60 69 40 00 40 101 118 90 80 00 80 4,810 2,633 2,177 2,231 1,051 1,180 143 73 70 657 322 335 184 100 84 84 79 91 86 81 90 71 65 77 102 93 111 89 83 96

Hispanic Origin2 and Gender Non Hispanic Male Female Hispanic Male Female Unknown Male Female 115,411 53,555 61,856 20,030 9,116 10,914 27,990 13,315 14,675 51 48 54 49 47 50 46 43 48 2,132 1,081 1,051 436 227 209 431 211 220 56 55 57 50 50 50 52 48 57 535 258 277 112 56 56 150 68 84 84 82 86 82 63 102 82 117 131 131 60 71 33 15 18 20 6 14 81 81 80 91 67 111 107 132 96 5,893 3,082 2,811 963 510 453 1,169 587 582 84 79 90 92 84 100 94 87 101

Total 163,431 50 2,999 54 889 108 184 85 8,025 86 Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB- 92 1 Number of days divided by number of hospital discharges 2 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicityspecific statistics in this table are therefore subject to revision

109

Table 27 Continued Number of Hospitalizations with Any Mention of Diabetes and Average Length of Stay by Gender,
Race, Ethnicity, and Type of Diabetic Complication, New Jersey, 2003 DM with Ophthalmic Manifestations 2505 Race, Ethnicity, and Gender Average Length of Stay in Days1 DM with Neurological Manifestations 2506 Average Length of Stay in Days1 DM with Peripheral Circulatory Disorders 2507 Average Length of Stay in Days1 DM with Other Specified Manifestations 2508 Average Length of Stay in Days1 DM with Unspecified Complications 2509 Average Length of Stay in Days1

Number of Mentions

Race and Gender White Male Female Black Male Female Asian/PI Male Female Other Male Female Unknown Male Female 2,233 1,078 1,155 698 286 412 75 39 36 228 137 91 133 57 76 46 42 50 50 48 51 56 25 90 64 55 77 51 50 53 8,204 3,867 4,337 1,998 816 1,182 93 52 41 915 425 490 374 188 186 73 70 75 79 76 81 65 52 82 84 82 86 79 78 79 2,906 1,713 1,193 937 461 476 33 17 16 419 230 189 115 57 58 108 105 111 130 126 133 156 183 127 136 127 147 112 105 118 7,752 4,060 3,692 2,753 1,354 1,399 110 41 69 948 487 461 276 148 128 83 81 85 89 90 88 80 83 71 96 103 89 85 78 78 619 273 346 222 108 114 8 5 3 37 11 26 54 24 30 70 67 73 71 68 74 87
66 20 58 47 62 96 78 110

Hispanic Origin2 and Gender Non Hispanic Male Female Hispanic Male Female Unknown Male Female 2,350 1,086 1,264 480 259 221 537 252 285 49 45 52 45 38 54 51 48 54 8,489 3,905 4,584 1,084 482 602 2,011 961 1050 74 70 77 77 77 77 77 78 77 3,208 1,825 1,383 511 287 224 691 366 325 114 111 117 118 110 128 123 117 129 6,953 4,592 4,296 1,260 641 619 1,691 857 834 83 82 85 89 90 89 91 95 87 763 344 419 81 33 48 96 44 52 70 66 73 63 72 56 86 69 100 71

Total 3,367 49 11,584 75 4,410 116 11,839 85 940 Source: New Jersey Department of Health and Senior Services, 2003 New Jersey Hospital Discharge File UB-92 1 Number of days divided by number of hospital discharges 2 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicity-specific statistics in this table are therefore subject to revision

110

Table 28 Proportion of Diabetes-Related Hospitalizations for Patients Under 65 Years of Age with Selected Diabetes-Related Ambulatory Care Sensitive ACS Conditions Identified as the Primary Discharge Diagnosis, by Race, Gender, and Hispanic Ethnicity, New Jersey, 2003 Number of Hospital
Discharges with Selected Diabetes Conditions Discharges with Diabetes Listed as Primary Diagnosis 1 5,666 3,316 2,350 3,462 1,953 1,509 112 60 52 1,080 597 483 286 170 116

Race, Ethnicity, and Gender White Male Female Black Male Female Asian/PI Male Female Other Male Female Unknown Male Female

DM 2501 2 1,474 749 725 867 486 381 25 18 7 306 157 149 64 34 30

DM 2502 3 158 99 59 196 115 81 1 0 1 40 17 23 9 6 3

DM 2503 4 46 28 18 28 14 14 0 0 0 6 3 3 2 1 1

Selected ACS Conditions5 296 264 341 315 315 315 232 300 154 326 296 362 262 241 293

Race and Gender

Hispanic Origin6 and Gender Non 7,531 Hispanic Male 4,360 Female 3,171 Hispanic 1,576 Male 888 Female 688 Unknown 1,575 Male 898 Female 677 Total 10,682

1,964 1,045 919 402 209 193 370 190 180 2,736

267 161 106 63 34 29 74 42 32 404

60 35 25 15 8 7 7 3 4 82

304 285 331 305 283 333 286 262 319 302

Source: New Jersey Department of Health and Senior Services 2003, New Jersey Hospital Discharge File UB-92 1 ICD-9-CM Codes: Diabetes 2500-2509 2 DM with ketoacidosis 2501 3 DM with hyperosmolarity 2502 4 DM with other coma 2503 5 Percentage of selected ACS conditions of the total discharges with diabetes listed as primary
diagnosis ICD9-CM 2500-2509 6 Due to a coding error, a significant number of non-Hispanics were counted as Hispanic in New Jersey hospital discharge statistics The ethnicity-specific statistics in this table are therefore subject to revision

111

Selected ACS Diabetes Conditions Total Discharges with Diabetes as Primary Diagnosis 438 685 394 848 132 264 1,629 295 1,072 63 507 823 686 278 481 742 103 261 103 558 107 213 10,682

County Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren Unknown Total

DM 2501 1 Discharges 126 166 72 258 29 83 401 81 183 20 144 169 212 82 141 177 27 61 28 168 27 81 2,736

DM 2502 2 Discharges 20 18 21 26 4 10 82 4 27 1 23 43 19 13 17 31 2 14 3 19 3 4 404

DM 2503 Discharges 4 6 3 10 0 0 15 1 8 0 4 6 9 2 1 7 0 2 1 3 0 3 82

Percentage of Selected ACS Diabetes4 Conditions 342 277 244 347 250 352 306 292 203 333 337 265 350 349 331 290
282 295 311 341 280 413 302

Source: New Jersey Department of Health and Senior Services 2003, New Jersey Hospital Discharge File UB-92 1 DM with ketoacidosis 2501 2 DM with hyperosmolarity 2502 3 DM with other coma 2503 4 ICD-9-CM Codes: Diabetes 2500-2509

112

Source:fda.gov

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