Diabetes Treatments

Many studies have shown that diabetes and its complica government’s Healthy People 2010 goals by encouraging people with diabetes to seek …

REPORT ON DIABETES
S U N Y D OW N STAT E M E D I C A L C E N T E R

LETTER FROM THE PRESIDENT

Fellow residents and friends of Brooklyn: A recent survey by the New York City Department of Health and Mental Hygiene found that nearly one in every ten people living in Brooklyn reports having diabetes The number may be even higher–an estimated one third of Brooklyn residents may have diabetes without knowing it Clearly, we are facing a public health problem of epidemic proportions

Nearly one in every ten people living in Brooklyn reports having diabetes

As the data presented in this Report on Diabetes show, diabetes is the sixth leading cause of death in Brooklyn and across the nation It is also a major contributing factor in hospitalizations and deaths due to heart disease, stroke, kidney failure, pneumonia, and influenza Residents of Brooklyns poorer neighborhoods are more likely to be diagnosed with diabetes Making matters worse, residents in neighborhoods with the highest rates of diabetes often do not have access to the preventive care and medical treatment needed to avoid major complications from the disease We must do more to address this problem Besides the human toll of
diabetes, the costs to communities are enormous The American Diabetes Association estimates that direct medical costs have more than doubled in five years, from 44 billion in 1997 to 918 billion in 2002 Indirect costs due to lost workdays, permanent disabilities, and death bring the total even higher The Report on Diabetes is intended to encourage greater action in preventing and treating this terrible disease Many studies have shown that diabetes and its complications–high blood pressure, heart disease and stroke, miscarriage, eye damage, and other serious conditions–can be prevented or controlled through better eating habits, exercise, and medical care By taking strong action, we can help more Brooklynites and other New Yorkers protect themselves from diabetes We can also support the federal governments Healthy People 2010 goals by encouraging people with diabetes to seek preventive care: yearly eye exams to prevent blindness; foot exams to prevent amputations; treatment for high blood pressure; and annual vaccinations against flu and pneumonia, two leading causes of death in people with diabetes Please help us to halt the spread of diabetes While it affects people of all ages,
races, and nationalities nationwide, Blacks and Hispanics bear a greater burden of illness Working together, we can find new avenues for education, treatment, and prevention, and advocate for better research John C LaRosa, MD President

1

W H AT I S D I A B E T E S ?

People with diabetes mellitus have a shortage of insulin, or their bodies cannot use it properly Insulin is a hormone produced by the pancreas, an organ next to the stomach that converts the sugar from the foods we eat into energy for the bodys cells When diabetes is left untreated, glucose, a form of sugar, builds up in the blood and then, instead of being used to power the cells, is flushed out in the urine Over time, uncontrolled diabetes can damage the kidneys, eyes, and blood vessels as well as lead to strokes, heart attacks, and eventual death There are four types of diabetes: TYPE 1 DIABETES Known as juvenile diabetes, type 1 diabetes appears in people under 30, most often during childhood or adolescence In type 1 diabetes, the ability of the pancreas to produce insulin is destroyed People with this condition need to take insulin regularly to stay alive and well For this reason, type 1 diabetes is also called
insulin dependent diabetes mellitus IDDM Approximately 5 to 10 percent of all diabetes cases are diagnosed as type 1 diabetes TYPE 2 DIABETES Also known as non-insulin dependent diabetes mellitus, type 2 diabetes occurs when the body is unable to use insulin properly It usually targets people over the age of 40 In recent years, however, growing numbers of children and teens have been diagnosed with type 2 diabetes More common among Blacks, Hispanics, and Native Americans than Whites, type 2 diabetes is often found in people who are overweight and physically inactive, who have high blood pressure, or whose bodies do not produce enough insulin About 90 to 95 percent of all diabetes cases are type 2 GESTATIONAL DIABETES This form of diabetes mellitus develops in women during pregnancy Even though the pancreas is producing enough insulin, midway through pregnancy the growing placenta which joins the unborn baby to the mothers uterus, or womb starts producing hormones that prevent the insulin from working normally Most women begin to produce extra insulin to combat this resistance, but in 2 to 5 percent of all pregnancies, they become diabetic The diabetes usually disappears after the
baby is born, but women with gestational diabetes have an increased risk of developing type 2 diabetes later in life OTHER TYPES OF DIABETES Inherited abnormalities, diseases of the pancreas cancer and liver cirrhosis, and certain medications are associated with the development of diabetes

2

D E AT H S D U E T O D I A B E T E S
Diabetes is the sixth leading cause of death in Brooklyn and throughout the nation It is also a major contributing factor in deaths due to heart disease, cerebrovascular disease stroke, kidney disease, and other serious illnesses Forty percent of all deaths due to ischemic heart disease caused by narrowing of the arteries that lead to the heart are linked to type 2 diabetes, and persons with diabetes are twice as likely to die of pneumonia or influenza All told, estimates suggest that diabetes has a role in one out of every five deaths in the United States

Ten Leading Causes of Death, 1999 Brooklyn
Heart Disease All Cancers Pneumonia Influenza Cerebrovascular Disease HIV Infection/AIDS Diabetes Mellitus Chronic Lower Respiratory Disease Nephritis and Other Kidney Diseases Homicide Drug Dependence Other Causes of Deaths 0 10 20 30 40 50

New York State
excluding NYC

Heart Disease All Cancers

Cerebrovascular Disease Chronic Lower Respiratory Disease Pneumonia Influenza Diabetes Mellitus Septicemia Nephritis and Other Kidney Diseases Motor Vehicle Accidents Chronic Liver Disease Cirrhosis Other Causes of Deaths 0 10 20 30 40 50

United States

Heart Disease All Cancers

Cerebrovascular Disease Chronic Lower Respiratory Disease Unintentional Injuries Accidents Diabetes Mellitus Pneumonia Influenza Alzheimers Disease
Sources: 1999 Vital Statistics Report of New York State, 2001 Health United States, US Dept of Health and Human Services

Nephritis and Other Kidney Diseases Septicemia Other Causes of Deaths 0 10 20 30 40 50

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Diabetes Deaths by Race/Ethnicity, 1999
Across all racial groups, the death rate due to diabetes, adjusted for age and sex, is higher in Brooklyn than in the rest of New York City and New York State Throughout the New York area, Blacks have the highest death rate from diabetes, and Hispanics have the lowest In Brooklyn, Hispanics have a slightly lower death rate from diabetes than Whites, but on the national level data not shown, Hispanics have a higher death rate than Whites While not shown here, Brooklyn
has a larger percentage of Blacks and Hispanics who are at risk for getting diabetes Black and Hispanics are more likely to have diabetes at a younger age and die earlier, which increases the overall death rate for the borough

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Brooklyn New York City New York State excluding New York City

25
Crude death rate per 100,000 population

20

15

Source: Vital Statistics of New York State, 1999 Includes deaths from type 1 and type 2 diabetes Note: The number of deaths due to diabetes for Asian and Pacific Islanders living in Brooklyn and New York City is too small to calculate accurately; however, national statistics show that they have lower death rates than Whites, Blacks, and Hispanics

10

5

0 White Black Hispanic

4

Diabetes Deaths by Race among Older Brooklyn Residents, 1999
Among all racial and ethnic groups, the danger of dying from diabetes, or from complications of diabetes, increases with age Although not shown in the chart below, women from all racial and ethnic groups are more likely to die of diabetes than men Type 2 diabetes is the fourth leading cause of death among Black women, the fifth leading cause among Hispanic and American Indian women, and the seventh
leading cause of death among White women Diabetes in America, 2nd edition, NIH Publication No 95-1468, 1995 Studies have shown that the age at which a person develops diabetes has a major impact on his or her life expectancy That is why proper diet and exercise, as well as seeing a doctor regularly, are so important for preventing or delaying the onset of diabetes

White Black 350

Age-specific death rate per 100,000 population

300 250 200 150 100 50 0 Age 55-65 Age 65-74 Age 75

Data Source: Bureau of Biometrics, NYSDOH US Census 2000 Includes deaths from type 1 and type 2 diabetes Note: The number of deaths due to diabetes among Hispanics and Asian and Pacific Islanders living in Brooklyn is too small to calculate age-specific death rates or to draw comparisons to Whites and Blacks

5

Diabetes Death Rates in Brooklyn Health Center Districts, 2000
Three of Brooklyns Health Center Districts have crude death rates for diabetes that are much higher than those in the boroughs seven other districts The higher death rates in Fort Greene, Red HookGowanus, and Bedford may be due, in part, to the larger numbers of African- and Caribbean-American residents who live there Local and
national data show that Blacks are at greater risk for developing heart disease and other complications of diabetes than are members of any other racial group

Brooklyn Sunset Park Bay Ridge Flatbush Williamsburg-Greenpoint Bushwick Gravesend Brownsville Fort Greene Red Hook-Gowanus Bedford 0
Source: Summary of Vital Statistics, The City of New York, NYC Dept of Health, 2000 Crude death rates have not been adjusted to take into account the effects of age or other differences such as sex or race/ethnicity among groups of people

5

10

15

20

25

30

35

40

45

Crude diabetes death rate per 100,000 population

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D I A B E T E S I N T H E P O P U L AT I O N

People Living with Diabetes in Brooklyn, 2002
Among the United Hospital Fund UHF neighborhoods surveyed by the New York City Department of Health in Brooklyn, three have much higher percentages of residents reported to have diabetes than New York City and the rest of Brooklyn WilliamsburgBushwick has the highest percentage, with almost 1 in 7 residents living with diabetes, compared to 1 in 11 for Brooklyn as a whole East New York and Bedford StuyvesantCrown Heights also have very high rates: about 1 in 8 residents have
diabetes In Brooklyn, the disease is most widespread in poor neighborhoods Obesity, heart disease, and other complications of diabetes are more widespread in these neighborhoods, as well
New York City Brooklyn Bensonhurst, Bay Ridge Downtown, Heights, Park Slope Coney Island, Sheepshead Bay Greenpoint Sunset Park Canarsie, Flatlands East Flatbush, Flatbush Borough Park Bedford Stuyvesant, Crown Heights East New York Williamsburg, Bushwick 0
Source: Community Health Survey, NYC Dept of Health, 2002 Includes type 1 and type 2 diabetes

4 6 8 10 12 14 2 Age-adjusted prevalence of reported diabetes per 100 persons

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7

S P E C I A L P O P U L AT I O N S W I T H D I A B E T E S

Diabetes among New Mothers, 1998
A form of diabetes, known as gestational diabetes mellitus GDM, occurs in as many as one out of every 20 pregnancies Mothers-to-be who have a history of diabetes, or who first develop it during pregnancy, have a greater risk of miscarriage and pre-term labor and delivery As a precaution, women who know they have type 2 diabetes should ask their doctor for advice before they become pregnant Pregnancies in diabetic women are also more likely to be complicated by hypertension
high blood pressure and other medical problems associated with diabetes In particular, women with GDM often have very large babies that need to be delivered by Cesarean section If not properly controlled, GDM can also cause major birth defects GDM is increasingly common in the United States In 1998, Brooklyn had a higher percentage of new mothers who had GDM or pre-existing diabetes than the rest of the city and state GDM occurs more often among Black, Hispanic, and American Indian women It is also more common among obese extremely overweight women and those with a family history of diabetes Although GDM often disappears after the baby is born, women with gestational diabetes have a 20 to 50 percent chance of developing diabetes in the next five to ten years A careful diet and regular exercise can lessen this risk Maresh, M, Diabetes in Pregnancy, Current Opinion in Obstetrics and Gynecology 13:103-107, 2001

Percent of Live Births to Mothers with Diabetes, 1998 40 35 30
Percent of live births

25 20 15 10 05 0 Brooklyn New York City excluding Brooklyn New York State excluding New York City

Source: Diabetes Surveillance in New York State, New York State Dept of Health, 2001
Summary of Vital Statistics, NYC DOH, 1998; and Vital Statistics of NYS, NYSDOH, 1998

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M E D I C A L C O M P L I C AT I O N S D U E T O D I A B E T E S

Rate of Lower Extremity Amputations LEA in People with Diabetes, 1995 and 1999
Poor blood flow due to diabetes can cause severe nerve damage to the legs and feet Nerve damage lessens a persons ability to feel heat or pain, which can lead to further damage and loss of the use of the legs and feet When there is severe nerve damage, it may become necessary to amputate surgically remove the affected limb More than 60 percent of all lower extremity leg or portion of a leg amputations happen among people with diabetes It happens most often among the elderly While amputations due to diabetes declined in Brooklyn and New York City from 1995 to 1999, they rose for the rest of New York State Overall, Brooklynites continue to have a higher rate of amputation than other New York City residents Limited access to care and information on how to prevent severe nerve damage may be part of the cause

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1995 1999

7
Rate of LEA per 1,000 population with diabetes

6

5

4

3

2

Source: Diabetes Surveillance in New York State, New York State Dept
of Health, 2001 Note: These rates are not adjusted for age

1

0 Brooklyn New York City excluding Brooklyn New York State excluding New York City

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Diabetes and Blindness
Recent hospitalization data show that approximately 3 to 5 percent of all hospitalizations for diabetes in Brooklyn and the rest of the city are for diabetic retinopathy damage to the blood vessels in the retina, the membrane that coats the back of the eye Left untreated, or if treated too late, such a condition can lead to blindness Diabetic retinopathy is the number one cause of preventable blindness in the United States Diabetic retinopathy is one of several diabetic eye diseases or problems that people who have type 2 diabetes are more likely to face Other complications include cataract, the clouding of the eyes lens, and glaucoma, an increase in fluid pressure inside the eye These two eye problems can also lead to blindness Although cataracts and glaucoma can affect anyone, people with diabetes have a greater risk of getting these complications

Retina Vitreous fluid Blood vessels

Cornea

Lens

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The Rate of End-Stage Renal Disease in People with Diabetes, 1998
Diabetes causes the build up of sugar and
other chemicals in the body and kidneys This can damage the kidneys and cause kidney failure end-stage renal disease or ESRD Diabetes is the major cause of end-stage renal disease People who experience kidney failure need to have a transplant operation to receive a new kidney or receive dialysis treatment to clean wastes from the blood for the rest of their lives Not all people on dialysis have diabetes, but their risk of dying from ESRD is greater if they do Compared to the rest of the city and state, Brooklyn has a higher number of new cases and a greater total number of cases of end-stage renal disease caused by diabetes The numbers of new and ongoing cases of ESRD in Brooklyn mirrors the high percentage of residents in Brooklyn with diabetes Blacks and the elderly are most likely to have ESRD Over the past two decades, the number of individuals receiving treatment for end-stage renal disease has increased dramatically Approximately 40 percent of all patients who started dialysis in 2000 had diabetes listed as the cause of their renal disease

Brooklyn New York City excluding Brooklyn New York State excluding New York City
Rate of ESDR per 1,000 persons with diabetes

14 12 10 8
6 4 2 0 New Cases Total Cases

Source: Diabetes Surveillance in New York State,; New York State Dep t of Health, 2001 ESRD with diabetes as the primary diagnosis

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Diabetes and Hypertensive Disease
Persons with type 2 diabetes are more likely to have hypertension high blood pressure Blacks with type 2 diabetes are more likely to have high blood pressure than Whites and Hispanics, and women are at greater risk than men Uncontrolled high blood pressure can lead to stroke and possible death The risk for stroke is 2 to 4 times higher among people with diabetes than in the general population

Persons Hospitalized for Diabetes Who Also Have Hypertensive Disease, 2001 16

Rate of diabetes with hypertensive disease per 10,000 population

14 12 10 8 6 4 2 0 Brooklyn New York City excluding Brooklyn

Data Source: Health Care Association of New York State, 2001 Includes type 1 and type 2 diabetes

Diabetes and Ischemic Heart Disease
The risk of heart disease increases with age for everyone, but for people who have diabetes, heart disease may develop earlier in life It is also more likely to be fatal for persons with diabetes Heart disease is as common among women with diabetes as it is
among diabetic men The percentage of diabetic women who develop heart disease and stoke is twice that of other women, and they are four times as likely to be hospitalized for heart problems
Persons Hospitalized for Diabetes Who Also Have Ischemic Heart Disease, 2001

5
Rate of diabetes with ischemic heart disease per 10,000 population

4

3

2

Data Source: Health Care Association of New York State, 2001 Includes type 1 and type 2 diabetes

1

0 Brooklyn New York City excluding Brooklyn

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Diabetes Effects on Other Major Diseases
High blood pressure, ischemic heart disease, and stroke are the leading causes or contributors to death in Brooklyn, the city, and the nation In 2001, approximately a third of all patients hospitalized in Brooklyn for these three major diseases also had diabetes Having diabetes can increase medical complications while hospitalized This adds to the patients suffering and increases medical costs As a person ages, the likelihood of suffering from or dying of high blood pressure, ischemic heart disease, and stroke increases a great deal Preventing the onset of diabetes or controlling it is critical in lowering hospitalizations for these diseases and for
diabetes

Persons Hospitalized for Hypertensive Disease, Ischemic Heart Disease, and Stroke Who Have Diabetes, Brooklyn 2001 40 35 30 25 20 15 10 5 0 Hypertensive Disease Ischemic Heart Disease Stroke

Data Source: Health Care Association of New York State, 2003 Includes type 1 and type 2 diabetes

Percent of hospitalizations

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H O S P I TA L I Z AT I O N R AT E S F O R D I A B E T E S

Hospitalization rates for diabetes have increased over the past five years in Brooklyn, New York City, and New York State Brooklyn regularly has had higher rates of hospitalizations for diabetes than the city or state In addition, the absolute number of hospitalizations for diabetes in Brooklyn is higher than in any of the citys other boroughs data not shown The increase in hospitalizations for diabetes can mean many things It may show that many Brooklynites are becoming older A majority of those hospitalized for diabetes are over 50 years of age In addition, many may be having problems controlling their diabetes This may be due to a lack of health information or access to preventive and outpatient medical care

Brooklyn New York City excluding Brooklyn New York State excluding New York City
Rate
of diabetes hospitalizations per 1,000 population

20 18 16 14 12 10 8 6 4 2 0 1995 1999

Data Source: Diabetes Control Program, New York State Dept of Health, 1997 and 2001 Includes type 1 and type 2 diabetes as any diagnosis

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Average Costs of Diabetes Hospitalizations, 1999
The average hospitalization cost for patients with diabetes is higher in Brooklyn and New York City than it is in the rest of the state While not shown in this chart, Brooklynites who have diabetes spend an additional day, on average, in the hospital compared to other residents of New York State These higher average charges, and longer average stays, may be the result of delayed treatment or limited access to preventive and outpatient services Higher costs for hospital care divert limited health resources at the local level away from better health education to teach patients how to self-monitor and control their condition, treatment, and outreach services in communities The most recent data from the federal government estimate that the average health care costs for a person with diabetes in the United States in 1997 was 10,071 compared to 2,699 for a person who does not have diabetes This is much less than
the average costs to care for people living with diabetes in Brooklyn and New York City and just below the average cost for New York State

20,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Brooklyn New York City excluding Brooklyn New York State excluding New York City

Source: Diabetes Surveillance in New York State, New York State Dept of Health, 2001 Includes type 1 and type 2 diabetes

Average costs per diabetes hospitalization

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Insurance Coverage for Diabetes Hospitalizations, 1999
Compared to other New Yorkers, a greater percentage of Brooklynites pay out-of-pocket, or rely on Medicaid, to pay for diabetes hospitalizations top chart The majority of selfpaying uninsured Brooklynites are African-American and other non-white residents bottom chart Among the uninsured, the majority are immigrants who work at jobs that do not pay for health insurance, who do not qualify for government assistance, and who cannot afford to buy insurance themselves

Type of Insurance for Diabetes Hospitalizations, 1999
Percent coverage for diabetes hospitalizations

50 45 40 35 30 25 20 15 10 5 0 Medicare Medicaid Blue Cross Other Commercial Self-Pay Self-Insured Brooklyn New
York City excluding Brooklyn

Data Source: Hospital Association of New York State, 2002

Out-of-Pocket Costs for Diabetes Hospitalizations by Race and Age in Brooklyn, 1999 45
Percent of self-paid hospitalizations

40 35 30 25 20 15 10 5 0 White Black Other

Under 65 Years Over 65 Years

Data Source: Hospital Association of New York State, 2002 Note: Total self-paid hospitalizations 1,573

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Asian Pacific Islander

Native American

S O U R C E S O F D I A B E T E S I N F O R M AT I O N

American Diabetes Association, 149 Madison Avenue, Room 701, New York, NY, 10016; 212-725-4925 or 888- DIABETES; http://wwwdiabetesorg Arthur Ashe Institute for Urban Health, 450 Clarkson Avenue, Box 1232, Brooklyn, NY 11203; 718-270-2600; http://wwwarthurasheinstituteorg Diabetes Club of Downstate, 395 Lenox Road, Brooklyn, NY 11203; 718-270-2020 Open to the public, the Diabetes Club is a joint effort between SUNY Downstate Medical Centers Center for Community Health Promotion and Wellness, Nursing Services, and the Division of Endocrinology in the Department of Medicine Meetings are staffed by certified diabetes educators Eye Care America provides referrals for free dilated eye exams for
people with diabetes who are 65 or older Call 800-272-EYES 3937 Juvenile Diabetes Research Foundation International, 120 Wall Street, New York, NY 10005-4001; 212-689-2860; http://wwwjdrforg Take Charge of Your Diabetes is a guide for persons with diabetes Available in English and Spanish, it provides information about the need for teamwork to control blood sugar levels, the value of community and family support, and steps to help prevent complications from diabetes The guide is available on the Internet at http://wwwcdcgov/diabetes or you can call 1-877-CDC-DIAB 232-3422 toll free for more information and a copy of the book

Other Important Internet Sites:
American Academy of Ophthalmology http://wwwaaoorg American Association of Diabetes Educators http://wwwaadenetorg American Indian Community House http://wwwaichorg Indian Health Service http://wwwihsgov National Center for Chronic Disease Prevention and Health Promotion, Diabetes Public Health Resources http://wwwcdcgov/diabetes National Center for Health Statistics http://wwwcdcgov/nchs National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of
Health http://wwwniddknihgov New York City Department of Public Health Diabetes Report http://wwwnycgov/health/survey Office of Minority Health, US Department of Health and Human Services http://wwwomhrcgov Veterans Health Administration Diabetes Program http://wwwvagov/health/diabetes 17

G LO SSA RY

Medical and Related Terms

Cardiovascular disease: Disease related to the heart and blood vessels arteries and veins of the body Cerebrovascular disease: A disease caused by problems of not getting enough blood to the brain Stroke is a major form of cerebrovascular disease Complications of diabetes: Diabetes can lead to other serious illnesses, such as heart problems, blindness, kidney failure and amputations Diabetes mellitus: The two most common forms of this condition are type 1 diabetes, in which the pancreas is not able to produce enough insulin, and type 2 diabetes, in which the body is resistant to the effects of available insulin Type 2 is also called non-insulin dependent diabetes Dialysis: The process of cleaning wastes from the blood is normally done by the kidneys If the kidneys fail, the blood must be cleaned artificially with special equipment The two major forms of
dialysis are hemodialysis removing blood from an artery, purifying and adding vital substances to it, and returning it to the body through a vein and peritoneal dialysis dialysis done in the abdominal region Dilated eye exam: Eye drops are used to enlarge the pupils to allow the eye care professional to see more of the inside of the eyes when checking for signs of disease End-stage renal disease: A condition where the kidneys fail and are no longer able to remove wastes from the blood Gestational diabetes: A type of diabetes that develops during pregnancy Healthy People 2010: A national health agenda sponsored by the US Department of Health and Human Services It is designed to identify the most serious and preventable threats to health and to establish national goals to reduce these threats Hypertension: High blood pressure Hypertensive disease: Diseases of the heart associated with or resulting from high blood pressure Insulin: A hormone manufactured by the pancreas an organ next to the stomach to convert glucose, also known as blood sugar, into energy for the bodys cells and tissues Ischemic heart disease: The narrowing of the arteries leading to the heart Juvenile diabetes:
Another name for type 1 diabetes, since it most often affects children and young adults Lower extremity amputation: Surgically removing a foot or leg Transplantation: The surgical replacement of a damaged or diseased organ with another from a different person

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Numerical Calculations Rates

Rate: A calculated number that is used to express the number of events deaths or cases within a group of individuals in a given period of time For example, 150 events per 100,000 people per year Age-adjusted rate: A rate that has been calculated in a way that eliminates the effect of age differences between populations when comparing rates among different groups of people Crude rate: A simple rate that presents the number of events deaths or cases of a specific disease in a group divided by the number of people in the group or population This rate does not take other factors, such as age, into account Incidence: Number of new cases of, or people who have been newly diagnosed with, a condition Prevalence: Total number of people who are known to have a condition or disease Generally expressed as the percentage of the population that has the disease

Technical Notes

The hospitalization data for
this report come from the Statewide Planning and Research Cooperative System SPARCS, New York State Department of Health NYSDOH This database contains inpatient hospital information from all hospitals statewide for each calendar year Additional information regarding medical complications due to diabetes is from Diabetes Surveillance in New York State, a report compiled by the Office of Diabetes Control, NYSDOH Death data for this report come from Vital Statistics of New York State, 2000, a compendium of mortality and health-related conditions reported by cities and counties to the Bureau of Biometrics, NYSDOH City and borough data come from Summary of Vital Statistics of the City of New York, 2000, Office of Vital Statistics, NYCDOH National death information is from Health, United States, 2001, with Health and Aging Chartbook, published by the National Center for Health Statistics We calculated age-specific rates and other nonadjusted rates using the appropriate populations derived from the 2000 US Census Rates were not calculated for certain populations because the number of deaths reported was too small to provide an accurate depiction of that disease for the given population
Efforts to analyze local data for particular diseases, such as diabetes, can present the researcher with considerable difficulties For example, death certificates filled out at the time of death provide the primary cause of death but often leave out contributing causes The death certificate may cite stroke as the primary cause of death but not include diabetes as a major factor contributing to that death Another problem faced by the researcher is that the number of deaths reported for a disease in a borough may be so few that breaking out deaths by age, sex, or race/ethnicity produces numbers too small to calculate reliable rates and percentages This is the case for most diabetes deaths in Brooklyn The documentation of hospitalization rates by race and ethnicity varies from hospital to hospital and from year to year Hospitalizations for Hispanics, in particular, are underdocumented State authorities are attempting to address these and related concerns but there are still serious shortcomings in the ways data are collected Another problem is the age distribution of a population and the impact of disease at certain ages For example, diabetes, like other chronic diseases, causes more
deaths in later years see page 5 of this report In addition, if a population is large and has a younger age profile, as is true of Hispanics living in Brooklyn and New York City, the number of diabetes deaths can be expected to be much smaller compared to Whites and Blacks, who have an older age profile Therefore, when we calculate crude death rates, the death rate for Hispanics will be lower than for Whites or Blacks In these situations, one would age-adjust the death rate; however, the lack of data on diabetes deaths by age for Hispanics prevents us from performing this calculation Please refer to page 4, which illustrates this phenomenon Nevertheless, we have made every effort to accurately portray the information at the borough level

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SUNY Downstate Medical Center would like to thank the following individuals for their help in preparing the Report on Cancer RESEARCH Steven D Ritzel, MPH, MIA Director for Regional Planning and Public Health Research, Office of Planning Clinical Assistant Professor of Preventive Medicine and Community Health Priya Naman, MPH Data Analyst Manager, Office of Planning ADVISORY COMMITTEE Elizabeth Boskey, PhD, MPH Assistant Professor of
Preventive Medicine and Community Health Judith LaRosa, PhD, RN Professor of Preventive Medicine and Community Health Doris Youdelman Senior Editor/Writer, Office of Institutional Advancement REVIEWERS Pascal J Imperato, MD, MPH TM SUNY Distinguished Service Professor and Chair, Department of Preventive Medicine and Community Health Mary Ann Banerji, MD, FACP Associate Professor of Medicine, Division of Endocrinology Luther T Clark, MD, FACC Professor of Clinical Medicine Chief, Division of Cardiovascular Medicine Barbara G Delano, MD, MPH Professor of Medicine, Division of Renal Diseases Professor of Preventive Medicine and Community Health Kevin C Greenidge, MD, MPH Professor and Chair, Department of Ophthalmology Richard C Troutman, MD, Distinguished Chair in Ophthalmology and Ophthalmic Microsurgery Samy I McFarlane, MD, FACP Associate Professor of Medicine Director, Fellowship Program, Endocrinology, Diabetes and Hypertension Ruth C Browne, ScD, MPH, MPP Executive Director Arthur Ashe Institute for Urban Health James R Sowers, MD, FACP, FAHA Professor of Medicine, Cell Biology, and Biochemistry Director, Division of Endocrinology, Diabetes and Hypertension

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Design: Frank
Fasano, cover photos: Ernest A Cuni, Division of Biomedical Communications Published by SUNY Downstate Medical Center, 2003

Source:downstate.edu