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CVD and Menarche

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					S.A. Denham, K.E. Remsberg, & L. Wood
      Ohio University, Athens, Ohio


   Diabetes: A Family Matter Conference
              March 18, 2009
   Graduate assistants who contributed to this project
    by distributing surveys and compiling data were:
       Cara Butcher
       Tammy Collier
       Eimi Lev
       Patricia Harris
       Stacey Hartman
       Tara O’Brien

   Funding sources:
       CDC’s National Diabetes Education Program,
       Ohio Department of Health Diabetes Prevention and Control
        Program
       Ohio University, Diabetes Research Initiative & Appalachian
        Rural Health Institute, College of Health & Human Services,
        School of Nursing
   Prevalence of diabetes, U.S. 2008 all ages*
       Total: about 24 million people (7.8% of the population)
       Diagnosed: 17.9 million people
       Undiagnosed: 5.7 million people

       1.5 million new cases diagnosed in 2005

   Mortality
       7th Leading cause of death
       Under-reported (only 35-40% with diabetes had it listed on
        death certificates)
       Twice as high as for others without diabetes

   (2007) Direct costs $116 Billion
              Indirect Costs $58 Billion
BRFSS [2006], CDC/Div. of Diabetes Translation   6.6 to 10.1% said yes to “Did a doctor tell you that
                                                 you have diabetes?”
               14
               12
               10
                8
                6
                4
                2
                0
                          1999                  2002                  2005

                         Greater Cincinnati   1st generation White Appalachian




2005 Greater Cincinnati Community Health Status Survey: White Appalachian Chart Book
                     18
                     16
                     14
                     12
                     10
                                                                            Diabetes
                      8
                      6
                      4
                      2
                      0
                             Greater      1st gen. White   2nd gen. White
                            Cincinnati         App.             App.




2005 Greater Cincinnati Community Health Status Survey: White Appalachian Chart Book
            12

            10

             8

             6                                                   Diabetes

             4

             2

             0
                 App. Ohio `06   Ohio BRFSS `04   US BRFSS `04




2006 ARHI
   US Prevalence
     About half of those with diabetes have taken a class on diabetes self-
      management, (52%)
     Those older than 65 years of age are less likely (46%)

   Diabetes Education and Insurance (under 65 years)
     Uninsured (42%)
     Medicare (46%)
     Medicaid/Indian Health Service (49%)
     Private Insurance (54%)
     Veterans Administration (79%)

   Other traits and Diabetes Education
     More likely
        Female
        African American
        Insulin Use
     Less likely
        Appalachian (Virginia Dept. Health, 2004)
Evaluate provider perceptions about the
  provision of diabetes education
  throughout the Appalachian region of
  the United States.
   Distressed County
       Poverty 1.5x national average
       Unemployment > 1.5x national average
       Per capita market income no more than 2/3 national
        average
       OR, poverty 2x national average, plus unemployment
        or PCMI


   At-Risk County
       Poverty ≥ 1.25x national average
       Unemployment ≥ 1.25x national average
       Per capita market income no more than 2/3 national
        average
       OR meeting 2 of 3 distressed criteria
   Federally Qualified Health Centers
       N = 135 (54 clinics/hospitals and 81 HD)
   Health Departments
       N = 82
   Diabetes Educators
       N = 47 (46 situated in hospitals/clinics and 1 in a
        HD)
   A 40-item questionnaire

   Information collected from the survey:
       Amount, type of diabetes education available
       Providers of education
       Patient barriers to receiving education
       Provider obstacles to delivering education
   Descriptive analyses of factors assessed by
    provider perceptions of Diabetes Education.

   Cross-sectional comparison of percentages
    according to Distressed-At-Risk County
    status

   P-values ≤ 0.05 were statistically significant
Variables                                DAR%    NDAR%    P-value

Level of Rural-Urban
                                                            < 0.001
 Rural                                   48.8%    3.0%
 Mixed                                   28.0%   30.0%
 Urban                                   23.2%   67.0%
Type of Site                                                    ns
 Clinic/Hospital                         48.8%   60.0%
 Health Department                       51.2%   40.0%




Percent of Population 0-17yo in 2000     23.9%   22.9%        0.007
Percent of Population in poverty, 2000   20.5%   12.9%       <0.001

Health, Social and Educational
Workers                                  19.9%   21.2%          ns

Physicians, mean # per 100,000           59.1     166.9     < 0.001
Variables                         DAR%    NDAR%   P-value


Any Diabetes Education Programs   59.4%   44.8%      0.101
Separate Type 1 and 2 classes     12.8%   27.5%      0.092
Family Participation              84.8%   78.3%         ns


Classes on a Single Day           51.2%   31.3%      0.054
Length of Classes, 1-2 hours      36.4%   34.8%         ns



Primary Educator, CDE             10.4%   30.9%      0.001
Primary Educator, Nurse           46.7%   35.1%         ns
Variables                   DAR%   NDAR%   P-value
Travel Time                 37.3    39.0        ns
Gas Money                   70.1    56.1     0.078

Literacy                    38.8    47.6        ns
Lack Public Transport       64.2    51.2        ns

Fail to Keep Appointments   67.2    78.0        ns

No Phone to Schedule        28.4    30.5        ns

No One to Drive Them        68.7    63.4        ns

Poor Personal Health        40.3    47.6        ns

Lack Insurance              40.3    64.6     0.003
Variables                 DAR%   NDAR%   P-value

Lack Staff                39.5    22.0     0.014
Lack Insurance            31.6    61.5   < 0.001


Lack Space                17.1     9.9        ns
Lack Time                 34.2    31.9        ns


Lack Teaching Resources   31.6    18.7     0.054

Patient Reading Level     13.2    12.1        ns
   Provision of Diabetes Education - Appalachia:
       DAR may not be worse than NDAR
       Provider needs: Lack of resources, medical specialists, staff
        and CDEs to provide diabetes education
       Patient barriers: Lack of transportation, insurance, literacy
   Perception/reality of increasing diabetes, costs
       Lead to further discrepancy between diabetes and
        education/care needed.
   Fewer CDEs available in DAR, educators more
    likely to be busy RNs
   CDEs more likely to be employed in hospitals
    than clinics and health departments
   Fewer people in the Appalachian region appear
    to be getting diabetes education than nationally
   Broad inclusion of family in diabetes education
   Barriers (e.g., costs, distance, etc.) need to be
    addressed locally
   Low literacy and health literacy

				
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