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1 F A Diabetes Impact in Colorado acts for ction: Chronic Diseases and Related Risk Factors in Colorado Diabetes is becoming more common The adult of diagnosed increased 157%, from 4.7% to 7.4%, in the past decade. The adult of obesity, a key risk factor for type 2 also increased significantly. of adult Coloradans with and obesity Obesity Prevalence (%) Diabetes Prevalence (%) An estimated 1 in 3 U.S. adults has pre. Only 6% of adult Coloradans were aware of having pre in % of people with pre will likely develop within 5 years. 1 in 3 6% 15-30% s s s s 1 in 4 people with are undiagnosed. 1 More than 19,000 adult Coloradans were diagnosed with in More than half of people with were diagnosed when they were years of age. More than 100,000 Coloradans could be unaware that they have. of adult Coloradans with by income & education. Age Diabetes disparities exist of adult Coloradans with by age In 2012, the increased significantly with age. In addition, Black and Hispanic adults were twice as likely to have compared with White adults in Data source: Behavioral Risk Factor Surveillance System. Education Income $50,000+ $35-49,999 $25-34,999 $15-24,999 <$15,000 College graduate Some post-high school High school or GED <High school In 2012, was significantly more prevalent among adults with less education and less income. Diabetes Impact November in Colorado

2 Diabetes by geographic region, Colorado, SEDGWICK MOFFAT ROUTT JACKSON LARIMER WELD LOGAN PHILLIPS Lowest quartile ( %) MESA RIO BLANCO GARFIELD DELTA PITKIN EAGLE GUNNISON LAKE GRAND SUMMIT CHAFFEE GILPIN CLEAR CREEK PARK BOULDER BROOMFIELD JEFFERSON TELLER DENVER DOUGLAS ARAPAHOE EL PASO ADAMS ELBERT MORGAN WASHINGTON LINCOLN YUMA KIT CARSON CHEYENNE Second quartile ( %) Third quartile ( %) Highest quartile ( %) Statistically lower than average Statistically higher than average State average: 6.4% (95% C.I.: ) MONTROSE FREMONT CROWLEY KIOWA SAN MIGUEL DOLORES MONTEZUMA OURAY HINSDALE SAN JUAN LA PLATA MINERAL ARCHULETA SAGUACHE ALAMOSA RIO GRANDE CONEJOS CUSTER COSTILLA HUERFANO PUEBLO OTERO LAS ANIMAS BENT PROWERS BACA Southeastern Colorado bears the largest burden of, with as high as 13%, almost twice the state average and similar to the highest nationally ranked state. F 41% 2.3x 14% 8th Total costs of diagnosed in the United States in 2012 were $245 billion a 41% increase since Medical expenditures for people with dabetes are 2.3 times higher than for those without. 2 The total cost of care per patient with was over $12,000 in Colorado in In Colorado, 14% of hospital discharges in 2012 were related to. There were 22 hospital discharges for every 100 persons with diagnosed Diabetes is the 8th leading cause of death in Colorado. Every day in Colorado, 2 people die from. Diabetes is costly Diabetes is costly in terms of medical expenditures, hospitalizations and deaths. Medical expenditures are increasing along with the of nationally and in Colorado. However, in recent years, the hospital discharge rate per population with and the death rate have both significantly decreased. Data sources: Behavioral Risk Factor Surveillance System; Colorado All Payer Claims Database; Hospital Discharge Dataset Colorado Hospital Association; Colorado Health Information Dataset (death data). 2 Facts for Action: Chronic Diseases and Related Risk Factors in Colorado

3 People with also have other health conditions 91% of adult Coloradans with had at least one other chronic health condition in % of obese people with have high blood pressure. 50% of people with are obese. 65% of people with have high blood pressure. 62% of people with have high cholesterol. 50% 65% 62% In 2012, after adjusting for age differences between groups, the following conditions were more likely among people with than people without. Obese Diagnosed with heart attack Diagnosed with angina or coronary heart disease Diagnosed with stroke Diagnosed with kidney disease Lost 6 or more teeth due to tooth decay or gum disease Trouble seeing, even with glasses Ever diagnosed with depression Current depression People with People without As the number of chronic conditions a person has increases, so does the risk of: 3 Mortality Adverse drug events Poor functional status Duplicative tests Unnecessary hospitalizations Conflicting medical advice Data source: Behavioral Risk Factor Surveillance System. Diabetes Impact in Colorado 3

4 People with have disease management needs Diabetes increases risk for many serious health problems, including eye and foot complications. With the correct treatment and lifestyle changes, the onset of complications can be prevented or delayed. In 2012, among adult Coloradans with, only: 56% checked their blood glucose daily. 84% had their A1C checked in the past year. 64% had their A1C checked more than once. 83% had a medical visit for in the past year. 67% had an eye exam in the past year. 73% had a foot exam by a health professional in the past year. In 2012, after adjusting for age differences between groups, the following were more likely among people with than people without. Have a personal doctor Medicaid health insurance Medicare health insurance Usually seek care at a community health center Not see a doctor because of cost in past year Received care at emergency department in past year Had cholesterol checked in past year Had a flu shot in past year Ever had a pneumonia shot The following were less likely among people with than people without Physically active Had a dental visit in past year People with People without References 1. Centers for Disease Control and Prevention. National fact sheet: national estimates and general information on and pre in the United States, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, American Diabetes Association. Economic costs of in the U.S. in Diabetes Care 2013;36: U.S. Department of Health and Human Services. Multiple Chronic Conditions A Strategic Framework: Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions. Washington, DC. December Facts for Action: Chronic Diseases and Related Risk Factors in Colorado

5 Appendix: Data Tables Table 1. Adult of and obesity (crude and age-adjusted), Colorado, Crude Crude obesity obesity ( ) 16.0 ( ) 5.0 ( ) 15.9 ( ) ( ) 16.8 ( ) 4.6 ( ) 16.6 ( ) ( ) 17.8 ( ) 5.1 ( ) 17.7 ( ) ( ) 18.2 ( ) 5.5 ( ) 18.2 ( ) ( ) 19.3 ( ) 5.6 ( ) 19.1 ( ) ( ) 19.1 ( ) 6.1 ( ) 18.9 ( ) ( ) 19.0 ( ) 5.9 ( ) 18.7 ( ) ( ) 21.4 ( ) 6.1 ( ) 21.2 ( ) ( ) 20.7 ( ) 6.6 ( ) 20.5 ( ) ( ) 20.5 ( ) 7.2 ( ) 20.2 ( ) estimates are weighted based on proportions of persons in specific age groups compared with 2000 U.S. Standard Population. estimates allow for comparison of different populations while accounting for different age and represent the true (estimated). % (95% CI)* % (95% CI)* % (95% CI)* % (95% CI)* Table 2. Age at diagnosis, Colorado adults Age at diagnosis (95% CI)* Less than ( ) ( ) ( ) ( ) ( ) Don t know 4.9 ( ) Diabetes Impact in Colorado 5

6 Table 3. Adult of (crude and age-adjusted) by age, sex, race/ethnicity, annual household income, and education level, Colorado, Age (years) Sex NA ( ) ( ) ( ) ( ) ( ) Female 6.6 ( ) 6.3 ( ) Male 8.2 ( ) 8.3 ( ) Race/ethnicity White 6.1 ( ) 5.5 ( ) Black 12.1 ( ) 13.1 ( ) Hispanic 11.5 ( ) 14.6 ( ) Other 7.1 ( ) 8.8 ( ) Income Less than $15, ( ) 13.2 ( ) $15,000-24, ( ) 10.8 ( ) $25,000-34, ( ) 9.3 ( ) $35,000-49, ( ) 8.2 ( ) $50, ( ) 5.0 ( ) Education Crude Less than high school 12.6 ( ) 13.8 ( ) High school or GED 8.3 ( ) 7.7 ( ) Some college 7.6 ( ) 7.6 ( ) College graduate 4.9 ( ) 4.6 ( ) estimates are weighted based on proportions of persons in specific age groups compared with 2000 U.S. Standard Population. estimates allow for comparison of different populations while accounting for different age and represent the true (estimated). NA: Data not available. (95% CI)* % (95% CI)* % 6 Facts for Action: Chronic Diseases and Related Risk Factors in Colorado

7 Table 4. Adult of (crude and age-adjusted) by region, Colorado, Crude % (95% CI)* % (95% CI)* Colorado 6.4 ( ) 6.4 ( ) Region 1: Logan, Morgan, Phillips, Sedgwick, Washington, Yuma 8.3 ( ) 7.1 ( ) 2: Larimer 4.5 ( ) 4.6 ( ) 3: Douglas 3.3 ( ) 4.3 ( ) 4: El Paso 6.7 ( ) 6.7 ( ) 5: Cheyenne, Elbert, Kit Carson, Lincoln 8.8 ( ) 8.0 ( ) 6: Baca, Bent, Crowley, Huerfano, Kiowa, Las Animas, Otero, Prowers 13.2 ( ) 11.3 ( ) 7: Pueblo 11.7 ( ) 10.2 ( ) 8: Alamosa, Conejos, Costilla, Mineral, Rio Grande, Saguache 5.8 ( ) 4.6 ( ) 9: Archuleta, Dolores, La Plata, Montezuma, San Juan 6.5 ( ) 6.3 ( ) 10: Delta, Gunnison, Hinsdale, Montrose, Ouray, San Miguel 6.4 ( ) 5.2 ( ) 11: Jackson, Moffat, Rio Blanco, Routt 4.9 ( ) 4.4 ( ) 12: Eagle, Garfield, Grand, Pitkin, Summit 3.9 ( ) 4.3 ( ) 13: Chaffee, Custer, Fremont, Lake 8.9 ( ) 7.6 ( ) 14: Adams 6.6 ( ) 7.4 ( ) 15: Arapahoe 7.1 ( ) 7.2 ( ) 16: Boulder, Broomfield 6.3 ( ) 6.0 ( ) 17: Clear Creek, Gilpin, Park, Teller 5.0 ( ) 4.0 ( ) 18: Weld 5.8 ( ) 6.1 ( ) 19: Mesa 6.2 ( ) 5.8 ( ) 20: Denver 7.7 ( ) 8.1 ( ) 21: Jefferson 4.9 ( ) 4.7 ( ) estimates are weighted based on proportions of persons in specific age groups compared with 2000 U.S. Standard Population. estimates allow for comparison of different populations while accounting for different age and represent the true (estimated). Diabetes Impact in Colorado 7

8 Table 5. Prevalence of health conditions among people with and people without (crude and ageadjusted), Colorado, People with Crude People without Crude People with People without Obese 47.8 ( ) 18.3 ( ) 49.1 ( ) 18.1 ( ) Diagnosed with heart attack 11.2 ( ) 2.3 ( ) 8.6 ( ) 2.5 ( ) Diagnosed with angina or coronary heart disease 11.0 ( ) 2.4 ( ) 7.8 ( ) 2.6 ( ) Diagnosed with stroke 5.4 ( ) 1.6 ( ) 3.5 ( ) 1.6 ( ) Diagnosed with kidney disease 8.0 ( ) 1.5 ( ) 8.5 ( ) 1.5 ( ) Lost 6 or more teeth due to tooth decay or gum disease 28.0 ( ) 9.8 ( ) 18.4 ( ) 10.2 ( ) Trouble seeing, even with glasses 29.8 ( ) 12.4 ( ) 32.4 ( ) 12.3 ( ) Ever diagnosed with depression 25.9 ( ) 16.6 ( ) 28.2 ( ) 16.5 ( ) Current depression 15.0 ( ) 7.1 ( ) 15.6 ( ) 7.0 ( ) estimates are weighted based on proportions of persons in specific age groups compared with 2000 U.S. Standard Population. estimates allow for comparison of different populations while accounting for different age and represent the true (estimated). % (95% CI)* % (95% CI)* % (95% CI)* % (95% CI)* 8 Facts for Action: Chronic Diseases and Related Risk Factors in Colorado

9 Table 6. Prevalence of health care access and health behaviors among people with and people without (crude and age-adjusted), Colorado, People with Crude People without Crude People with People without Have personal doctor 90.3 ( ) 75.9 ( ) 87.9 ( ) 75.8 ( ) Have Medicaid health insurance 17.2 ( ) 7.4 ( ) 21.9 ( ) 7.8 ( ) Have Medicare health insurance 53.3 ( ) 21.2 ( ) 25.7 ( ) 20.7 ( ) Usually seek care at a community health center 17.4 ( ) 11.4 ( ) 21.4 ( ) 11.5 ( ) Did not see a doctor because of cost in past year 20.1 ( ) 15.6 ( ) 28.0 ( ) 15.5 ( ) Received care at emergency department in past year 33.2 ( ) 19.2 ( ) 32.5 ( ) 19.4 ( ) Had cholesterol checked in past year 84.7 ( ) 50.0 ( ) 75.9 ( ) 50.0 ( ) Had flu shot in past year 58.2 ( ) 38.6 ( ) 51.1 ( ) 39.1 ( ) Ever had pneumonia shot 62.3 ( ) 26.6 ( ) 56.2 ( ) 27.1 ( ) Physically active 68.5 ( ) 84.1 ( ) 70.4 ( ) 84.0 ( ) Had dental visit in past year 59.2 ( ) 65.8 ( ) 57.8 ( ) 65.6 ( ) estimates are weighted based on proportions of persons in specific age groups compared with 2000 U.S. Standard Population. estimates allow for comparison of different populations while accounting for different age and represent the true (estimated). % (95% CI)* % (95% CI)* % (95% CI)* % (95% CI)* Diabetes Impact in Colorado 9

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