Public Health Surveillance of Diabetes in the United States

Desai, Jay; Geiss, Linda S.; Mukhtar, Qaiser; Harwell, Todd S.; Benjamin, Stephanie M.; Bell, Ronny A.; Tierney, Ed

doi:10.1097/00124784-200311001-00008

Cited by 18 publications

(13 citation statements)

References 11 publications

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“…However, if changes in these factors were playing an important role in the diabetes epidemic above and beyond their effects on obesity, we would expect to see changes in total diabetes prevalence in groups with similar BMI. A third implication of our findings is that because much diabetes surveillance is based on self-report of diabetes, a simultaneous increase in obesity prevalence and the detection of diabetes among the most obese could complicate our interpretation of historical trend data (1,3,8,13,14). In light of these observations, it is possible that the observed increases in self-reported diagnosed diabetes have slightly overestimated the true increase in total diabetes prevalence (1).…”

Section: Results -mentioning

confidence: 98%

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Trends in the Prevalence and Ratio of Diagnosed to Undiagnosed Diabetes According to Obesity Levels in the U.S.

et al. 2004

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FRANK VINICOR, MD, MPH 1OBJECTIVE -To examine trends in the prevalence of diagnosed and undiagnosed diabetes and the proportion of total cases previously diagnosed, according to obesity status in the U.S. over the past 40 years.RESEARCH DESIGN AND METHODS -We assembled data from five consecutive cross-sectional national surveys: National Health Examination Survey I (1960Survey I ( -1962, National Health and Nutrition Examination Survey (NHANES) I (1971-1974), NHANES II (1976-1980, NHANES III (1988), and NHANES 1999-2000. Diagnosed diabetes was ascertained, and height and weight were measured in adults aged 20 -74 years in all surveys. In NHANES II, NHANES III, and NHANES 1999 -2000, a fasting glucose level Ն126 mg/dl was used to identify cases among individuals not reporting diabetes. Design-based analyses and Bayesian models estimate the probability that prevalence of diabetes increased within four BMI groups (Ͻ25, 25-29, 30 -34, and Ն35 kg/m 2 ). 1976 -1980 and 1999 -2000, significant increases in the prevalence of diagnosed diabetes (3.3-5.8%, probability Ͼ99.9%) were accompanied by nonsignificant increases in undiagnosed diabetes (2.0 -2.4%, 66.6%). This resulted in an increase in total diabetes (5.3-8.2%, Ͼ99.9%) and a modest nonsignificant increase in the proportion of cases that were diagnosed (62-70%, 62.4%). However, these trends varied considerably by BMI level. In individuals with BMI Ն35 kg/m 2 , diagnosed diabetes increased markedly (from 4.9% in 1960, to 8.6% during 1976 -1980, to 15.1% in 1999 -2000; probability Ͼ99.9%), whereas undiagnosed diabetes declined considerably (12.5% during 1976 -1980 to 3.2% in 1999 -2000, probability of increase 4.5%) Therefore, the proportion of total diabetes cases that were diagnosed increased from 41 to 83% (probability 99.9%) among individuals with BMI Ն35 kg/m 2 . By comparison, changes in prevalence within BMI strata Ͻ35 kg/m 2 were modest and there was no increase in the percent of total cases that were diagnosed. RESULTS -In the U.S. population aged 20 -74 years betweenCONCLUSIONS -National surveys over the last several decades have found large increases in diagnosed diabetes, particularly in overweight and obese individuals, but this has been accompanied by large decreases in undiagnosed diabetes only among individuals with BMI Ն35 kg/m 2 . This suggests that improvements in diabetes awareness and detection are most prominent among this subgroup.

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Section: Results -mentioning

confidence: 98%

“…In addition, because many diabetes surveillance data depend on self-reports (1,3,8,(13)(14)(15), the estimated prevalence of diabetes may be affected by an increase in the proportion that is diagnosed.…”

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confidence: 99%

Trends in the Prevalence and Ratio of Diagnosed to Undiagnosed Diabetes According to Obesity Levels in the U.S.

et al. 2004

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“…Moreover, while LHDs with behavioral risk factor surveillance were more likely to have obesity prevention programming, suggesting that surveillance may bolster activities in prevention, there was no association with local area obesity prevalence (results not shown), reiterating the need for local data to drive local action. 40, 41 …”

Section: Discussionmentioning

confidence: 99%

Where Is Obesity Prevention on the Map?

Stamatakis

Leatherdale²,

Marx³

et al. 2012

Journal of Public Health Management and Practice

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Context The system of local health departments (LHD) in the US has potential to advance a locally-oriented public health response in obesity control and reduce geographic disparities. However, the extent to which obesity prevention programs correspond to local obesity levels is unknown. Objective This study examines the extent to which LHDs across the US have responded to local levels of obesity by examining the association between jurisdiction level obesity prevalence and the existence of obesity prevention programs. Design Data on LHD organizational characteristics from the Profile Study of Local Health Departments and county-level estimates of obesity from the Behavioral Risk Factor Surveillance System were analyzed (n=2,300). Since local public health systems are nested within state infrastructure, multilevel models were used to examine the relationship between county-level obesity prevalence and LHD obesity prevention programming and to assess the impact of state-level clustering. Setting 2,300 local health department jurisdictions defined with respect to county boundaries Participants Practitioners in local health departments who responded to the 2005 Profile Study of Local Health Departments. Main Outcome Measures Likelihood of having obesity prevention activities and association with area-level obesity prevalence Results The existence of obesity prevention activities was not associated with prevalence of obesity in the jurisdiction. A substantial portion of the variance in LHD activities was explained by state-level clustering. Conclusions This paper identified a gap in the local public health response to the obesity epidemic and underscores the importance of multilevel modeling in examining predictors of LHD performance.

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“…Mortality from diabetes is one of the important indicators in the state diabetes surveillance system initiated by the Centers for Disease Control and Prevention, Division of Diabetes Translation (1). If, however, certifying physicians in different states were found to have different practices in reporting cause-of-death (COD) causal sequences in Part I of the death certificate, the comparability of diabetes death rates across states would be in doubt (2).…”

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confidence: 99%

State Differences in the Reporting of Diabetes-Related Incorrect Cause-of-Death Causal Sequences on Death Certificates

Cheng

Kawachi

2012

Diabetes Care

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OBJECTIVETo examine state differences in the reporting of diabetes-related incorrect cause-of-death (COD) causal sequences on death certificates in the U.S.RESEARCH DESIGN AND METHODSWe conducted a cross-sectional descriptive study to determine the prevalence of two types of incorrect COD causal sequences with data from the Multiple Cause Mortality File of the year 2004.RESULTSAmong deaths in which diabetes was reported as the first diagnosis on line a, b, c, or d in Part I of the death certificate in the U.S., 21% had below diabetes placement error (ranged from 30% in Maryland to 7% in Hawaii) and 11% had above diabetes placement error (ranged from 18% in Kentucky to 5% in California). The net effects of the two types of error ranged from −0.7% in Nevada to 19.6% in the District of Columbia.CONCLUSIONSBecause the rates of incorrect reporting of diabetes-related COD causal sequence varied across states, the comparability of the diabetes death rate between states may have been compromised.

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Public Health Surveillance of Diabetes in the United States

Cited by 18 publications

References 11 publications

Trends in the Prevalence and Ratio of Diagnosed to Undiagnosed Diabetes According to Obesity Levels in the U.S.

Trends in the Prevalence and Ratio of Diagnosed to Undiagnosed Diabetes According to Obesity Levels in the U.S.

Where Is Obesity Prevention on the Map?

State Differences in the Reporting of Diabetes-Related Incorrect Cause-of-Death Causal Sequences on Death Certificates

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