Epidemiological Problem: Diabetes in Illinois

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Table of Contents

Introduction
Background and Significance of the Disease
Current Surveillance Methods
Epidemiological Analysis of Diabetes
Screening and Diagnosis
Plan for Action
Conclusion
Reference List

Introduction

According to the 2012 population estimates, Cook County had a population of 5,194, 675 people. This figure makes it the most populous county in the state of Illinois, which has a population of 12,880,580 (Public Health, 2012). Among the health challenges that the population faces, Diabetes is a major disease in this county. It is indeed one of the major causes of death. To gain a better understanding of health problems that a specific population faces, epidemiological studies offer crucial insights that relate to the health problems. Such insights assist policymakers and stakeholders of population health to establish the correct measures to address the problem. In this paper, the focus is on the evaluation of diabetes in Cook County in the State of Illinois.

Background and Significance of the Disease

Diabetes can be defined as a chronic and progressive condition, which indicates the lack of or deficiency of insulin or reduced ability of the body to digest insulin (Estrada, Danielson, Drum, & Lipton, 2009). In case of diabetes is not controlled, glucose and fats (lipids), which the body fails to absorb, remain in the bloodstream. These substances not only damage vital body organs but also lead to heart disease, vision loss, stroke, nerve damage, and kidney disease. Diabetes appears in three categories, which include type-1, type-2, and -gestational diabetes. Type-1 diabetes, which is also referred to as insulin reliant, infantile inception diabetes, or immune-mediated diabetes, is responsible for 10% of all diabetes cases in Cook County. In this diabetes category, the immunity system attacks and kills the pancreas’ beta cells that are responsible for producing insulin, which cuts down or eradicates the production of insulin in the body (Saudek et al., 2013). While individuals of any age can suffer from type 1 diabetes, the ailment is common in teenagers and kids. For survival, patients must receive a daily injection of insulin to control their blood sugar (glucose). On the other hand, type-2 diabetes is the most widespread category that is responsible for up to 93% of all instances that are reported in any population. This type of diabetes is also referred to as non-insulin-reliant diabetes or adult-onset diabetes. It is common in people who are above 40 years, although it can also occur earlier. In this diabetes, the main characteristics include insulin confrontation and comparative insulin insufficiency. The last type of diabetes is gestational diabetes, which is also referred to as gestational diabetes mellitus (GDM). It primarily occurs during pregnancy (Public Health, 2012). It is a transitory condition of heightened blood levels in a mother during late pregnancy. However, it usually disappears after pregnancy. If unmanaged, GDM can lead to negative consequences for the mother and the child. The situation increases the likelihood of developing diabetes later in life. It can also affect a baby to the extent of leading to a condition that is referred to as macrosomia, which is the big-baby disorder. Approximately, 50% of women who have gestational diabetes develop type-2 diabetes within 5 to 10 years after delivery (Khare et al., 2012). The indicators of diabetes include frequent releasing of urine, particularly during the night, tremendous weariness, deep and recurrent dehydration, speedy and inexplicable mass loss, genital burning and thrush, protracted curing of cuts and injuries, and distorted visualization.

Based on the report by the Illinois Performance Threat Factor Inspection System findings, cases of individuals who have suffered from the ailment diabetes in Illinois have increased dramatically in the last two decades. Approximately 800,000 people had been diagnosed as of 2012 while more than 500,000 people were unaware that they had the disease (Public Health, 2012). In Cook County alone, more than 278,000 have been diagnosed with the disease. In the United States, diabetes is a significant health concern. The disease is the seventh-leading cause of death in the nation. Further, according to the Center for Disease Control and Prevention (CDC), approximately 25.8 million people or 8.3% of the US population have the disease while a further 7 million people are not aware that they have the condition (Estrada et al., 2009). This situation puts them at a very high risk of developing other health complications because of unmanaged diabetes (Estrada et al., 2009). The table below shows the prevalence rate of diabetes in Cook County as compared to Illinois and the US between 1998 and 2012.

Table of Diabetes Prevalence
Year	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012
Cook	6.3%	6.2%	6.1%	6.4%	6.8%	6.9%	7.3%	7.8%	8.2%	8.6%	8.4%	8.2%	8.4%	8.7%	8.9%
Illinois	6.2%	6.4%	6.2%	6.6%	6.9%	7.3%	6.0%	7.9%	8.1%	8.8%	8.3%	8.2%	8.5%	8.6%	8.7%
United States	5.4%	5.7%	6.2%	6.6%	6.8%	7.2%	7.1%	7.3%	7.5%	8.1%	8.3%	8.4%	8.3%	8.8%	9.3%

The following is a graph representing the diabetes trends in the Cook County as compared to Illinois and USA:

Prevalence Rate

Diabetes is among the primary roots of fatality in Cook County, as well as Illinois State. For instance, in 2009, the mortality rate from diabetes in Cook County was 21 per 100,000 as compared to Illinois whose rate was 20.5 per 100,000. The national rate was 20.9 per 100,000. As of 2012, the mortality rate in Cook County from diabetes was 22.7 per 100,000 as compared to 22.5 per 100,000 deaths that were recorded for the Illinois State (Khare et al., 2012). The death rate from diabetes increases with age. For instance, in Illinois, the death rate for individuals who are beyond the age of 87 whose death results from the disease is approximately 300 per 100,000 and 200 per 100,000 for 70 to 90-year-old persons.

Current Surveillance Methods

The first check-up technique is the Behavioral Threat Factor Inspection Structure, which is a universally nationally sponsored structure that examines health threats (Public Health, 2012). For Cook County, the BRSS surveillance method is applied through the Illinois BRFSS, which covers all counties in the region. Through the system, the state can gather information on behaviors and conditions that relate to primary causes of death in the whole state. In this surveillance method, random telephone numbers are picked for handset interviews concerning diseases and health behaviors. The information that is collected annually is used as a reflection of the identified conditions concerning the whole population.

The second method of surveillance is the use of Hospital Discharge Data. In Cook County, hospice emancipation is used to denote all inpatient individuals who are released from non-governmental or sensitive care health facilities in the county. Mortality data is a very crucial surveillance method for diabetes in Cook County. It shows the causes of death of individuals. Cook County obtains such facts from the National Center for Health Statistics (Public Health, 2012). The last surveillance method is the Adverse Pregnancy Outcomes Reporting System (APORS). Through APORS, registry records indicate infants who are born with defects from mothers who had gestational diabetes. The APORS is the most inclusive foundation of facts concerning delivery imperfections in the entire Illinois region.

Epidemiological Analysis of Diabetes

The first risk factor is prediabetes. In this case, individuals who have impaired fasting glucose (IFG) or Impaired Glucose Tolerance (IGT) are referred to as prediabetics. They have an elevated risk of developing diabetes. Prediabetics have high levels of glucose compared to normal levels. However, their levels are not enough to show diabetes (Saudek et al., 2013). The primary category of diabetes that these people are likely to develop is type-2 diabetes. They are also more likely to develop stroke and heart diseases. Approximately 79 million Americans aged 20 years and above had prediabetes as of 2010 (Public Health, 2012). In Illinois, about 10% of people above 65 years are prediabetic. The risk of developing prediabetes also varies based on race. Non-Whites have a higher risk at 6.4% compared to Whites at 4.9% (Saudek et al., 2013). Gender is also a major risk factor where females are more likely to develop prediabetes at 5.8% as compared to males at 4.7% and/or non-Hispanics/Latinos at 5.4% as compared to Hispanics/Latinos at 3.6% (Public Health, 2012).

The use of tobacco and alcohol is also a risk factor for developing diabetes. In Illinois, 13% comprises current smokers who have diabetes while 38% comprises former smokers (Khare et al., 2012). On the other hand, chronic use of alcohol leads to unremitting inflammation of the pancreas. The irritation, which affects the ability of the pancreas to secrete insulin, results in diabetes (Saudek et al., 2013). Diabetes is very costly not only to the individual but also to the county, state, and national economies. For instance, victims of diabetes incur 2.3 times higher medical expenditures compared to those who do not have the ailment (Saudek et al., 2013). In Illinois, the cost of diabetes was USD$7.3 billion in 2006. The figure included USD$ 4.8 billion in excess costs of care and USD$ 2.5 billion in lost productivity (Public Health, 2012).

Screening and Diagnosis

Various methods of screening and diagnosis are used for the purpose of diabetes. The table below highlights the various screening and diagnosis approaches in addition to the related sensitivities and costs for the tests. The universal testing methods in Cook County are the Random Blood Glucose Level and A1C Levels (Public Health, 2012).

	TEST	SENSITIVITY (%)	SPECIFITY (%)	PPV*	NPV*	COSTS
	OGTT (2 hr)	Reference Standard				$19
	Random blood glucose level
	≥140 mg per dL (7.8 mmol per L)	55	92	30.5	97	$6
	≥150 mg per dL (8.3 mmol per L	50	95	39.9	96.7	$6
	≥160 mg per dL (8.9 mmol per L)	44	96	41.2	96.4	$6
	≥170 mg per dL (10.0 mmol per L)	42	97	47.2	96.3	$6
	≥180 mg per dL (9.4 mmol per L)	39	98	55.5	96	$6
	A1C Levels (%)
	6.1	63.2	97.4	60.8	97.6	$14 serum test or point of care test
	6.5	42.8	99.6	87.2	96.5
	7.0	28.3	99.9	94.7	95.6
	Diabetes Risk Calculator	78.2-88.2	66.8-74.9	6.3-13.6	99.2-99.3	Free
NPV=Negative predictive value; OGTT=Oral glucose tolerance test; PPV=positive predictive value

Plan for Action

Diabetes is very costly to an individual, as well as the economy of a society. In this case, it is very vital to take initiatives at both individual and societal levels to fight against the disease. One of the best approaches for action is the creation of awareness in the population concerning risk factors for the disease and the recommended actions for reducing the risks. In this case, I plan to be actively engaged in awareness activities in the county concerning this chronic disease. The second approach that I will adopt is the campaign for early diagnosis and treatment of the disease. Early diagnosis allows the medication to begin early. Hence, it guarantees an individual a better and prolonged normal living with the disease. The last strategy is the involvement of the community in health awareness-related activities. For instance, at an individual level, I will be at the forefront in suggesting the best approaches to ensuring community participation in awareness initiatives.

Conclusion

Diabetes is a chronic disease, which accounts for a high number of deaths in Cook County and in the whole of the USA. Although the disease affects people of all ages, it is common among older people above 40 years. The paper has revealed the three types of diabetes, which include type-1, type-2, and gestational diabetes. Type-2 diabetes is the most widespread in Cook County where it accounts for up to 90% of all cases. The disease costs the state of Illinois USD$7.3 billion, including USD$ 4.8 billion in extra costs and USD$ 2.5 billion in lost productivity. The most regular screening and testing methods are the Random Blood Glucose Level and A1C Levels. Consequently, there is a need to have initiatives that will help in reducing the prevalence of this disease in Cook County.

Reference List

Estrada, C., Danielson, K., Drum, M., & Lipton, R. (2009). Hospitalization is subsequent to diagnosis in young patients with diabetes in Chicago, Illinois. Pediatrics, 124(3), 926-934.

Khare, M., Carpenter, R., Huber, R., Bates, J., Cursio, F., Balmer, W., & Loo, K. (2012). Lifestyle intervention and cardiovascular risk reduction in the Illinois WISEWOMAN Program. Journal of Women’s Health, 21(3), 294-301.

Public Health. (2012). The Burden of Diabetes in Illinois: Prevalence, Mortality, and Risk Factors. Illinois: Illinois Department of Public Health.

Saudek, D., Herman, H., Sacks, B., Bergenstal, M., Edelman, D., & Davidson, B. (2013). A New Look at Screening and Diagnosing Diabetes Mellitus. The Journal of Clinical Endocrinology & Metabolism, 18(2), 24-36.

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