Chronic Diseases

C

hronic diseases, such as diabetes, heart disease, stroke, and cancer, are currently the leading causes of both death and disability in the U.S. It is estimated that 70% of all deaths nationwide are due to chronic illnesses, and more than 90 million Americans currently live with chronic diseases. Although chronic diseases are some of the most prevalent and costly health problems in the U.S., they are also largely preventable. Healthy behaviors such as getting enough exercise, eating right, and avoiding tobacco can help to prevent many chronic diseases.1 Chronic disease mortality rates are presented as age-adjusted rates; prevalence of chronic diseases are presented as crude estimates.

Diabetes Diabetes is a group of diseases that result from the body’s inability to produce or correctly use insulin, a hormone that regulates sugar metabolism.2,3 Type 2 diabetes is the most common form of diabetes, accounting for 90 to 95% of all diagnosed Key Point: About 9% of South Texas cases. Type 2 diabetes usually results from adults have been diagnosed with insulin resistance, a disorder in which the diabetes, a higher percentage than in the body does not properly use insulin, as well rest of Texas and nation. South Texas as problems with insulin production. Hispanics also had a higher prevalence Diabetes is associated with numerous than Hispanics in the rest of Texas. serious health complications, such as cardiovascular disease, blindness, kidney failure, nervous system damage, and amputations.2 African-Americans, Hispanics, Native Americans, and Asian Americans are at higher risk for Type 2 diabetes than are nonHispanic whites.2 Risk factors for Type 2 diabetes include obesity, physical inactivity, a history of gestational diabetes, and a family history of diabetes.3

Diabetes Prevalence An estimated 20.8 million people in the U.S., about 7% of the total population, had diabetes in 2005. Unfortunately, more than six million of these individuals, more than one-third, were undiagnosed. In Texas, approximately 1.3 million adults (age 18 or older) were diagnosed with diabetes in 2005.4 The prevalence of diabetes increases with age. While still rare, the prevalence of Type 2 diabetes in children and adolescents is reported to be increasing, especially among African-Americans, Native Americans, and Hispanics. Approximately 176,500 people age 20 or younger in the U.S. had diabetes in 2005.2

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Diabetes Prevalence in South Texas An estimated 9% of adults who live in South Texas have been diagnosed with diabetes. The percentage of adults with diabetes in South Texas was higher than the percentage with diabetes in the rest of Texas, and was also higher than the nationwide BRFSS 20022005 diabetes estimate (nearly 8%). Hispanics in South Texas had a higher prevalence of diabetes than did Hispanics in the rest of Texas (Figure 7.1). Hispanics had a slightly higher, but not statistically significantly higher, prevalence of diabetes than non-Hispanic whites in South Texas (Figure 7.1). in South Texas and the Prevalence of Diabetes Rest of Texas, 2002-2005 South Texas

Rest of Texas

10 9 8

Percent

7 6 5 4 3 2 1 0 All Races

Hispanic

Non-Hispanic White

Figure 7.1. Estimated percent of the adult population with diabetes by location and race/ethnicity, 2002-2005. Source: Texas Behavioral Risk Factor Surveillance System Combined Year Dataset, Statewide BRFSS Survey, 20022005

Age patterns for diabetes prevalence in South Texas were the same as seen nationwide; the prevalence of diabetes in South Texas increased with age. For individuals 45 years old and older, the prevalence of diabetes was statistically significantly higher among Hispanics than among non-Hispanic whites. It was estimated that 31% of Hispanic adults ages 65 and older in South Texas were diagnosed with diabetes in 2002-2005 (Figure 7.2).

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Prevalence of Diabetes in South Texas by Age Group, 2002-2005 Hispanic

Non-Hispanic White

45-64

65+

35 30

Percent

25 20 15 10 5 0 18-29

30-44 Age Group

Figure 7.2. Estimated percent of the adult South Texas population with diabetes by age group and race/ethnicity, 2002-2005. Source: Texas Behavioral Risk Factor Surveillance System Combined Year Dataset, Statewide BRFSS Survey, 20022005

Overall, diabetes prevalence was higher in South Texas non-metropolitan counties (12.1%) thanDiabetes in metropolitan countiesin(8.7%). difference was and statistically Prevalence SouthThis Texas by Metro significantly greater among Hispanics, but not among non-Hispanic whites (Figure 7.3).

Nonmetro County Designation, 2002-2005 Metro Counties

Nonmetro Counties

16 14

Percent

12 10 8 6 4 2 0 All Races

Hispanic

Non-Hispanic White

Figure 7.3. Estimated percent of the adult South Texas population with diabetes by county designation and race/ethnicity, 2002-2005. Source: Texas Behavioral Risk Factor Surveillance System Combined Year Dataset, Statewide BRFSS Survey, 20022005 87 | T h e I n s t i t u t e f o r H e a l t h P r o m o t i o n R e s e a r c h

Diabetes Mortality Diabetes was the sixth-leading cause of death in both Texas and the nation in 2002-2004. This ranking was based on death certificates which listed diabetes as the underlying cause of death. Mortality from diabetes is believed to be underreported; it is listed as a contributing factor more often than it is listed as an underlying factor, and diabetes is often not listed at all on the death certificate.2,4

Diabetes Mortality in South Texas The 1999-2003 age-adjusted diabetes mortality rate in South Texas (with diabetes reported either as an underlying or contributing cause of death), was 104.3 deaths per 100,000 persons. The diabetes mortality rate in South Texas was higher than the ageadjusted diabetes mortality rate in the rest of Texas (87.9/100,000). Hispanics had a higher diabetes mortality rate than non-Hispanic whites, both in South Texas and the rest of Texas. The age-adjusted mortality rate for Hispanics in South Texas (142.3/100,000) was slightly higher than that for Hispanics in the rest of Texas (133.4/100,000); this pattern was reversed for non-Hispanic whites (Figure 7.4). Diabetes Mortality, Underlying and Contributing Causes, 1999-2003 South Texas

Rest of Texas

160

Rate per 100,000

140 120 100 80 60 40 20 0 All Races

Hispanic

Non-Hispanic White

Figure 7.4. Age-adjusted mortality rates for diabetes as an underlying or contributing cause, by location and race/ethnicity, 1999-2003. Source: Center for Health Statistics

As with diabetes prevalence, the diabetes mortality rate in South Texas increased with age, and diabetes mortality rates were higher for Hispanics than for non-Hispanic whites 88 | T h e I n s t i t u t e f o r H e a l t h P r o m o t i o n R e s e a r c h

at the older age groups (age 45 and older). South Texas Hispanics ages 75 or older had a diabetes mortality rate of 1,246.7/100,000 (Figure 7.5).

Diabetes Mortality in South TX, by Age group Hispanic

Non-Hispanic White

1400

Rate per 100,000

1200 1000 800 600 400 200 0 15-24

25-34

35-44

45-54

55-64

65-74

75+

Age Group

Figure 7.5. South Texas age-adjusted mortality rates for diabetes as an underlying or contributing cause, by age group and race/ethnicity, 1999-2003. Source: Center for Health Statistics

In South Texas, males had a higher diabetes mortality rate (114.9/100,000) than females (95.7/100,000). Residents of South Texas metropolitan counties had a slightly higher diabetes mortality rate (105.3/100,000) than did residents of non-metropolitan counties (98.8/100,000). Bexar County and Webb County both had higher diabetes mortality rates than South Texas, whereas the Lower Rio Grande Valley region had a lower mortality rate than South Texas (Figure 7.6).

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Diabetes Mortality in Specific South TX Locations 160

Rate per 100,000

140 120 100 80 60 40 20 0 South Texas

Bexar County

Webb County

Lower Rio Grande Valley

Location

Figure 7.6. Age-adjusted mortality rates for diabetes as an underlying or contributing cause in selected South Texas locations, 1999-2003. Source: Texas Health Data (http://soupfin.tdh.state.tx.us/birth.htm)

References 1. Chronic Disease Prevention. Centers for Disease Control and Prevention. 2007. Accessed 2007 May; http://www.cdc.gov/nccdphp/. 2. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2005. 2005. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 3. All About Diabetes. American Diabetes Association. 2007. Accessed 2007 May; http://www.diabetes.org/about-diabetes.jsp. 4. Texas Diabetes Council. Diabetes and Disparity: A Plan to Prevent and Control Diabetes in Texas, 2008-2009. Publication No. 45-10524. 2007. Austin: Texas Department of State Health Services.

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