Burden of Disease


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  • Data from the Texas CVD council Heart disease deaths 2004 includes: CHF, hypertensive heart dz, vavular dz Hospitalizations 2005 heart includes CHF
  • working with appropriate partners to educate consumers about the benefits of long-term, moderate reductions in sodium intake;
  • Source: BRFSS 2007
  • Source: BRFSS 2007
  • Source: BRFSS 2007
  • Source: BRFSS 2007
  • Report from the CDC, 31 Oct 08, on annual incidence of diagnosed diabetes. About ¼ of diabetics have not been diagnosed. Texas adults without diabetes have 1 per 100 each year get diagnosed in 2005-2007, more than doubling in a decade. Texas diabetes prevalence in adults is about 10%. Factors associated with an increased risk for diabetes included older age, lower educational attainment, physical inactivity, obesity, weight gain, and being categorized in a racial/ethnic minority population ( 3 ). Of these factors, obesity has been identified as a major risk factor in the increasing incidence of diabetes ( 3 ); the growth in diabetes prevalence has been concomitant with growth in obesity prevalence ( 7 ).
  • Source: YRBSS Students who are at or above the 95th percentile for Body Mass Index (BMI). http://wonder.cdc.gov/data2010/obj.htm
  • Source: YRBSS Students who are at or above the 95th percentile for Body Mass Index (BMI). http://wonder.cdc.gov/data2010/obj.htm
  • Source: YRBSS. @007 data for US is not yet available. The question for 2007 and previous years are not strictly comparable because it was changed from Students who exercised or participated in physical activities that made them sweat or breathe hard for 20 minutes or more on three or more of the past seven days To Percentage of students who were physically active for a total of at least 60 minutes per day on five or more of the past seven days.
  • Source: BRFSS Current smokers
  • Source: YRBSS Youth data for US for 2007 are not yet available US data -- http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5526a2.htm HP 20101 goal -- http://wonder.cdc.gov/data2010/obj.htm
  • BRFSS Aspirin 36%
  • Burden of Disease

    1. 1. Defining the Burden of Disease Meeting the Challenges of Chronic Disease at the Community Level 10 June 2009 Vincent P. Fonseca, MD, MPH
    2. 2. Overview <ul><li>How big a problem is CVD? </li></ul><ul><li>What does the data show us? </li></ul><ul><li>What can we do about it? </li></ul>
    3. 3. How big a problem is it? <ul><li>A third of all Texas deaths are due to CVD (2006): </li></ul><ul><ul><li>Heart disease: 41,000 </li></ul></ul><ul><ul><li>Stroke: 9,900 </li></ul></ul><ul><li>Hospitalizations in Texas (2006): >265,000 </li></ul><ul><ul><li>$11.4 billion </li></ul></ul><ul><ul><li>>$1 million every hour </li></ul></ul><ul><li>Texas adults (2008): have had a heart attack </li></ul><ul><ul><li>Men: 4.6% Women: 3.4% </li></ul></ul><ul><li>Texas adults (2008): have had a stroke </li></ul><ul><ul><li>Men: 2.2% Women: 2.7% </li></ul></ul>
    4. 4. Mortality Data Query <ul><li>http://soupfin.tdh.state.tx.us/death10.htm is the DSHS online query tool for mortality and rates </li></ul><ul><ul><li>By County or State </li></ul></ul><ul><ul><ul><li>Age group, race/ethnicity, sex </li></ul></ul></ul><ul><li>CDC Wonder: http://wonder.cdc.gov/ </li></ul><ul><ul><li>By County or State </li></ul></ul><ul><ul><ul><li>Age group, race/ethnicity, sex, urbanization </li></ul></ul></ul>
    5. 5. Hospitalization Discharges <ul><li>No online query tool </li></ul><ul><li>Public Use data file </li></ul><ul><li>Report: http://www.dshs.state.tx.us/THCIC/Publications/Hospitals/FactsandFigures.pdf </li></ul><ul><li>Preventable Hospitalizations </li></ul><ul><ul><li>County level </li></ul></ul><ul><ul><li>Angina, CHF, hypertension, diabetes </li></ul></ul>
    6. 6. BRFSS <ul><li>Behavioral Risk Factor Surveillance System </li></ul><ul><li>http:// www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm output by </li></ul><ul><ul><li>8 DSHS regions </li></ul></ul><ul><ul><li>7 metropolitan areas (MSAs) </li></ul></ul><ul><ul><li>Border 32 counties vs non-border </li></ul></ul><ul><ul><li>Sex, race/ethnicity group, age group, education group, income group </li></ul></ul><ul><li>www.cdc.gov/brfss state and 9 MSAs </li></ul>
    7. 7. What can we do about it? <ul><li>Prevent risk factors that lead to conditions that lead to heart disease (2007 BRFSS) </li></ul><ul><ul><li>Inadequate fruits and vegetables: 74.8% </li></ul></ul><ul><ul><li>Overweight and obesity: 65.7% </li></ul></ul><ul><ul><li>No physical activity: 28.3% </li></ul></ul><ul><ul><li>Smoking: 19.3% </li></ul></ul><ul><li>Detect & manage conditions leading to heart disease </li></ul><ul><ul><li>High cholesterol: 38.5% </li></ul></ul><ul><ul><li>High blood pressure: 27.8% </li></ul></ul><ul><ul><ul><li>Poor control, 60+ years: men-36%, women-54% </li></ul></ul></ul><ul><ul><li>Diabetes: 10.3% </li></ul></ul><ul><ul><li>Elevated global CVD risk: aspirin chemoprophylaxis </li></ul></ul><ul><li>Manage heart disease </li></ul>
    8. 8. (NHANES : 1999-2004). Source: NCHS and NHLBI. Extent of awareness, treatment and control of high blood pressure by age
    9. 9. (NHANES: 1999-2004). Source: NCHS and NHLBI. Awareness, Treatment and Control of High Blood Pressure by Race/Ethnicity
    10. 10. What can we do about it? <ul><li>A: Avoid tobacco </li></ul><ul><li>B: Be more active: 30 minutes of walking </li></ul><ul><ul><li>Improves blood pressure by 4-9 “points” </li></ul></ul><ul><ul><li>75 calories most days: 5 pounds a year </li></ul></ul><ul><li>C: Choose healthier foods: more fiber, less saturated fat, less salt </li></ul><ul><ul><li>Improves blood pressure: 10-15 “points” </li></ul></ul><ul><ul><li>Improves bad cholesterol: 20 “points” </li></ul></ul><ul><ul><li>10 pound weight loss improves bad cholesterol by 10 “points” </li></ul></ul>
    11. 11. What can “we” do about it? <ul><li>Make healthier choices the easier choices </li></ul><ul><li>More convenient </li></ul><ul><li>Lower cost </li></ul><ul><li>More access </li></ul><ul><li>More support </li></ul>Family, social Community Environment, Policies Living conditions
    12. 12. What can we do about it? <ul><li>A: Avoid tobacco </li></ul><ul><li>B: Be more active </li></ul><ul><li>C: Choose healthier foods </li></ul><ul><li>Behavior change is more likely when benefits are likely and quickly visible, and </li></ul><ul><li>Reasons for change are more important than reasons for not changing, and </li></ul><ul><li>Confidence to make the change </li></ul>
    13. 13. Decreasing sodium intake <ul><li>60% of adults have elevated blood pressure </li></ul><ul><li>Average intake: 4000 mg (~75% added)  2300 mg </li></ul><ul><li>Adequate intake: 1500 mg for healthy, 19-50 years </li></ul><ul><li>AMA adopts directives at annual meeting 2006 </li></ul><ul><li>FDA has been asked to revoke the &quot;generally recognized as safe&quot; status to a “food additive” </li></ul><ul><ul><li>a stepwise 50% reduction </li></ul></ul><ul><ul><li>improve labeling to assist consumers in understanding the amount of sodium </li></ul></ul><ul><ul><li>social marketing for consumer awareness </li></ul></ul><ul><li>150,000 fewer deaths a year by decreasing hypertension by 20% in ages 25-55 with a 50% reduction in sodium </li></ul>
    14. 14. AHA 2006: Dietary approaches to prevent and treat HTN <ul><li>Available data strongly support population-wide recommendations to lower salt intake. </li></ul><ul><li>Consumers should choose foods low in salt and limit the amount of salt added to food. </li></ul><ul><li>However, because >75% of consumed salt comes from processed foods </li></ul><ul><ul><li>any strategy to reduce salt intake must involve the efforts of food manufacturers and restaurants </li></ul></ul><ul><ul><li>should progressively reduce the salt added to foods by 50% over the next 10 years. </li></ul></ul>
    15. 15. Population-based Strategy Effects of Lowering SBP Distributions <ul><li>Stamler J. Hypertension </li></ul><ul><li>1991;17:I-16–I-20. </li></ul>Reduction in BP After intervention Before intervention Stroke CHD Total -6 -4 -3 -8 -5 -4 -14 -9 -7 Reduction in BP mm Hg 2 3 5 % Reduction in Mortality
    16. 16. Copyright ©2006 American Heart Association Appel, L. J. et al. Hypertension 2006;47:296-308 Mean systolic BP changes in the DASH-Sodium trial
    17. 17. Relative Risk of Developing CHD vs. Systolic Blood Pressure Systolic Blood Pressure Neaton JD. Arch Int Med 1992; 152:56-64.
    18. 18. Texas disparity views by age group, 2007 BRFSS
    19. 19. Texas disparity views by education, 2007 BRFSS
    20. 20. Texas disparity views by income group, 2007 BRFSS
    21. 21. Texas disparity views by health insurance status, 2007 BRFSS
    22. 22. Reduce adult obesity HP 2010 goal 15%
    23. 23. Reduce adult obesity, Texas, 2007 HP 2010 goal 15%
    24. 24. Adult obesity, Texas, 2007 HP 2010 goal 15%
    25. 25. Reduce youth obesity, YRBS HP 2010 goal 5%
    26. 26. Reduce youth obesity Texas 2007 YRBS HP 2010 goal 5%
    27. 27. Increase adult physical activity HP 2010 goal 50%
    28. 28. Increase adult physical activity, Texas, 2007 HP 2010 goal 50%
    29. 29. Adult adequate physical activity, Texas, 2007 HP 2010 goal 50%
    30. 30. Increase youth physical activity, YRBS HP 2010 goal 85%
    31. 31. Increase youth physical activity, Texas 2007 YRBS HP 2010 goal 85%
    32. 32. Reduce adult smoking, 2007 BRFSS HP 2010 goal 12%
    33. 33. Reduce adult smoking – Texas 2007 BRFSS HP 2010 goal 12%
    34. 34. Reduce youth tobacco use, YRBS HP 2010 goal 16%
    35. 35. Reduce Texas youth smoking 2007 YRBS HP 2010 goal 16%
    36. 36. Preventive Services, TX, 2007 BRFSS <ul><li>Tobacco smokers </li></ul><ul><ul><li>Advised to quit: 40% (Hispanic 27%) </li></ul></ul><ul><ul><li>Offered NRT: 22% (Hispanic 11%) </li></ul></ul><ul><li>Cholesterol screening, men: 78% (Hispanic 63%) </li></ul><ul><li>Received weight advice </li></ul><ul><ul><li>Obese: 34% </li></ul></ul><ul><ul><li>Overweight: 13% </li></ul></ul>
    37. 37. Cost calculators <ul><li>http://www.cdc.gov/nccdphp/dnpa/hwi/program_design/cost_calculators.htm </li></ul><ul><ul><li>Tobacco </li></ul></ul><ul><ul><li>Inactivity </li></ul></ul><ul><ul><li>Alcohol </li></ul></ul>
    38. 38. Smoking <ul><li>Smoking costs an estimated $92 billion per year in lost productivity in the US. </li></ul><ul><ul><li>Lost productivity due to smoking and smoking related illnesses cost employers $1,897 per smoking employee per year (2002 dollars) </li></ul></ul><ul><ul><li>If 20% of 250,000 employees smoke (50,000) then the annual loss is over $ 100 M per year </li></ul></ul><ul><ul><li>If 20% of 12,000 employees smoke (2,400) then the annual loss is over $4.5 M per year </li></ul></ul>
    39. 39. Physical Inactivity <ul><li>Regular physical activity reduces the risk of developing diabetes, high blood pressure and some cancers and promotes psychological wellbeing. </li></ul><ul><li>Productivity costs in 250,000: $579 M per year </li></ul><ul><li>Productivity costs in 12,000: $27.8 M </li></ul>http://www.ecu.edu/picostcalc/
    40. 40. Review <ul><li>CVD </li></ul><ul><ul><li>Common </li></ul></ul><ul><ul><li>Costly </li></ul></ul><ul><ul><li>Can be prevented </li></ul></ul><ul><li>Environmental change and behavior change </li></ul><ul><ul><li>Non-pharmacotherapy is key to prevention and management of conditions leading to CVD </li></ul></ul><ul><li>Opportunities for improvement </li></ul><ul><li>Engage community stakeholders </li></ul>