4.5 Diabetes Prevalence

Transcription

1 4.5 Diabetes Prevalence Definition: the percent of residents aged 19 and older with diabetes (type 1 or 2) in a three year period as defined by either: at least one hospitalization with a diagnosis with an ICD 9 CM code of 250 or an ICD 10 CA code of E10 E14, or at least two physician visits with an ICD 9 CM code listed above, or at least one prescription for diabetes medication (Anatomic, Therapeutic, Chemical (ATC) code A10; see Glossary) Prevalence was calculated for 2004/ /07 and 2009/ /12 and was age and sex adjusted to the Manitoba population aged 19 and older in the first time period. See Glossary for further details. Key Findings Diabetes prevalence increased over time in Manitoba from 8.99% to 9.96% of the population aged 19 and older. This increase was reflected in almost all regions, districts, and Winnipeg sub areas, though in some areas the increase was not statistically significant. Diabetes prevalence values were related to PMR, with lower prevalence values in healthier areas and higher prevalence values in less healthy areas. However, this relationship was not linear: the prevalence in Northern was much higher than that in all other regions, in both time periods. Some of this difference is attributable to the higher proportion of Aboriginal peoples living in the Northern health region, as diabetes rates have been shown to be significantly higher among First Nations, Metis, and Inuit residents (Canadian Institute for Health Information, 2009; Martens, Bartlett, Burland, Prior, Burchill, Huq, Romphf, Sanguins, Carter & Bailly, 2010a; Martens, Bond, Jebamani, Burchill, Roos, Derksen, Beaulieu, Steinbach, MacWilliam, Wald, Dik & Sanderson, 2002). Among the districts of the rural regions, there was almost ten fold variation in diabetes prevalence from about 6% to almost 50%. There was less variation across NCs within Winnipeg, though some had higher and some had lower than average rates. There were strong relationships between income and diabetes prevalence in urban and rural areas in both time periods: diabetes prevalence was higher among residents of lower income areas. Among rural residents, the gap across income groups widened over time (Appendix 2). Comparison to Other Findings These results are consistent with and extend those shown in the 2009 Atlas (Fransoo et al., 2009). Diabetes prevalence continues to increase, though the rate of increase appears to be slowing over time. These increases in prevalence are likely related to a combination of two influences: first, longer survival of people with diabetes related to improvements in medical and self care and second, continuing efforts around awareness and earlier identification of cases. The values shown here may be different from those provided by reports using the Canadian Chronic Disease Surveillance System (CCDSS) definition (Public Health Agency of Canada, 2008; Public Health Agency of Canada, 2009). CCDSS uses physician visits and hospitalizations to define cases over a two year period. Our definition similarly used physician visits and hospitalizations, but covers a three year period, and also includes residents receiving prescription drugs for diabetes (to take advantage of data available in Manitoba; see Glossary). There are also differences regarding the standard population used for adjustment and accumulation of cases over time. umanitoba.ca/faculties/medicine/units/mchp Chapter 4 page 85

2 Figure 4.5.1: Diabetes Prevalence by RHA, and Current RHAs Southern (1,2,t) Prairie Mountain (t) Interlake-Eastern (1,2,t) Northern (1,2,t) MB Avg MB Avg Manitoba (t) Former RHAs South Eastman (1,2) Central (1,2,t) Assiniboine (t) Brandon (t) Interlake (t) North Eastman (1,2,t) Parkland (1,2,t) Churchill (1,2) Nor-Man (1,2,t) Burntwood (1,2,t) 1 indicates area's rate was statistically different from Manitoba average in first time period 2 indicates area's rate was statistically different from Manitoba average in second time period t indicates change over time was statistically significant for that area s indicates data suppressed due to small numbers page 86 Chapter 4

3 Figure 4.5.2: Diabetes Prevalence by District, and Southern RHA M MacDonald (1,2) W Stanley (1,2) W Altona (1,2) E Hanover (1,2) W Roland/Thompson N Cartier/SFX (1,2) E Niverville/Richot (1,2) E Steinbach (2) W Winkler (1,2) M Morris (2) M Carman (1,2) E Ste Anne/LaBroquerie M St. Pierre/DeSalaberry (2) W Morden (2) E Tache (1,2) W Lorne/Louise/Pembina (t) N MacGregor (2) M Notre Dame/St Claude (2) E Rural East N Rural Portage (t) M Red River South N City of Portage N Seven Regions (1,2) MB Avg MB Avg Prairie Mountain RHA Bdn South End Bdn West End (t) S Turtle Mountain Bdn North Hill S Spruce Woods (1) S Whitemud S Souris River (t) N Riding Mountain (t) S Little Saskatchewan S Asessippi (t) N Duck Mountain N Dauphin (t) N Agassiz Mountain (1,2) Bdn East End N Swan River N Porcupine Mountain (1,2) Bdn Downtown (1,2) Interlake-Eastern RHA S Springfield (1,2) S Stonewall/Teulon E Pinawa/LDB W Gimli (1) S Wpg Beach/St. Andrews (1,2) E Beausejour E Whiteshell W Arborg/Riverton (t) S St. Clements W St. Laurent N Eriksdale/Ashern (1,2) Selkirk (t) N Fisher/Peguis (1,2,t) N Powerview/PF (1,2) Northern Remote (1,2,t) Northern RHA Z1 Flin,Snow,Cran,Sher Z1 Thompson,Mystery Lake (1,2,t) Z1 The Pas/OCN,Kelsey (1,2,t) Z1 Gillam,Fox Lake CN (1,2) Z1 Bay Line (1,2) Z1 LL/MC,LR,O-P(SIL),PN(GVL) (1,2) Z2 Cross Lake/Pimi CN (1,2) Z2 SayD(TL),Bro/BL,NoL(Lac) Z2 GR/Mis,ML/Mos,Eas/Che (1,2) Z2 Bu(OH),MS(GR),GLN/GLFN (1,2) Z2 Norway House/NHCN (1,2) Z2 Puk/MatCol CN (1,2) Z3 Island Lake (1,2,t) Z2 Sham,York FN,Tat(SPL) (1,2) Z2 Nelson House/NCN (1,2) T1=40.3 T2=49.5 umanitoba.ca/faculties/medicine/units/mchp Chapter 4 page 87

4 Figure 4.5.3: Diabetes Prevalence by Winnipeg NC, and Fort Garry S (1,2) Fort Garry N (1,2) Assiniboine South (1,2,t) St. Vital S (1,2) St. Vital N MB Avg MB Avg St. Boniface E (1,2) St. Boniface W Transcona River Heights W (1,2) River Heights E (1,2) River East N (1,2) River East E River East W (2) River East S St. James-Assiniboia W St. James-Assiniboia E (2) Seven Oaks N Seven Oaks W (1) Seven Oaks E (t) Inkster W (2,t) Inkster E (1,2) Downtown W Downtown E (1,2) Point Douglas N (2) Point Douglas S (1,2) Churchill (1,2) Manitoba (t) page 88 Chapter 4

5 Appendix Table 2.14: Diabetes Prevalence Among Residents Aged 19+ Regional Health Number CRUDE Number CRUDE Winnipeg Number CRUDE Number CRUDE ADJUSTED Authority observed percent observed percent Neighbourhood observed percent observed percent Income Quintile percent Cluster Current RHAs Fort Garry S Income Unknown Southern Fort Garry N Lowest Rural R1 Winnipeg Assiniboine South R2 Prairie Mountain St. Vital S R3 Interlake-Eastern St. Vital N R4 Northern St. Boniface E Highest Rural R5 Manitoba St. Boniface W Lowest Urban U1 Former RHAs Transcona U2 South Eastman River Heights W U3 Central River Heights E U4 Assiniboine River East N Highest Urban U5 Brandon River East E linear trend rural T1 <.0001 Winnipeg River East W linear trend rural T2 <.0001 Interlake River East S compare rural trends over time North Eastman St. James-Assiniboia W linear trend urban T1 <.0001 Parkland St. James-Assiniboia E linear trend urban T2 <.0001 Churchill Seven Oaks N Nor-Man Seven Oaks W Burntwood Seven Oaks E Inkster W bold trend = significant Inkster E Downtown W Downtown E Point Douglas N Point Douglas S Churchill page 388 Appendix