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F ocus Area 21: Oral Health Progress Review March 17, 2004
<ul><li>Estimated new cases of oral/pharyngeal cancers in U.S. will affect  28,000 +   persons in 2004 </li></ul><ul><li>P...
<ul><li>Reduction in decay among U.S. teens in the 1990s (NHANES 1988-94 to 1999-2000) saved more than  30 million  teeth ...
Improving Cannot assess (limited data) Oral Health Objectives Getting worse 21-16 Oral and craniofacial State-based survei...
21-16 Oral and craniofacial State-based surveillance system 21-7 Annual exams for oral and  pharyngeal cancers Improving C...
Children 2-4 years Children 6-8 years Adolescents 15 years 21-1 Dental caries experience Improving Cannot assess (limited ...
21-7 Annual exams for oral and  pharyngeal cancers Improving Getting worse Cannot assess (limited data) Oral Health Object...
21-1  Dental caries experience in children 21-3  No permanent tooth loss in adults 21-6  Early detection of oral and phary...
21-1  Dental caries experience in children 21-3  No permanent tooth loss in adults 21-6  Early detection of oral and phary...
Obj. 21-1c Adolescents 12-18 Years Who Ever Had Caries in Permanent Teeth, 1988-94 Total Black Mexican American White Male...
Obj. 21-1c Adolescents 12-18 Years Who Ever Had Caries in Permanent Teeth, 1988-94 and 1999-2000 Note:  Target is for adol...
Obj. 21-1a Note: Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. S...
Obj. 21-1a Children 2-4 Years Who Have Ever Had Caries in Primary Teeth, 1988-94 and 1999-2000 Note: Black and white exclu...
Note: from Niendorff & Jones, JPHD 2000: 60: 245. Data are for IHS service areas.  Source: 1991 Patient Survey, IHS. Early...
Early Childhood Caries  (ECC) in American Indian/Alaska Native Children 0-4 Years  Note: from Niendorff & Jones, JPHD 2000...
Dental Sealants
Note: Targets are for children 8 years and 14 years.  Black and white exclude persons of Hispanic origin. Persons of Mexic...
Total 2010 Targets 6-11 Years 12-18 Years Black Mexican American White Total Black Mexican American White Dental Sealants:...
Obj. 21-3 Total Black Mexican American White Male Female 1988-94 2010 Target Note:  Black and white exclude persons of His...
Obj. 21-3 Note:  Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. S...
Obj. 21-6 Early Detection of Oral and Pharyngeal Cancers: 1990-95 1990-95 2010 Target Note: Data are for Stage 1 (localize...
Obj. 21-6 Early Detection of Oral and Pharyngeal Cancers: 1990-95 and 1996-2000 1990-95 1996-2000 2010 Target Note: Data a...
2010 Target = 57% 1996 Obj. 21-12 Note:  Data are for children under 19 years.  Low income is less than 200% of poverty le...
2010 Target = 57% 1996 2000 Receipt of Preventive Services by Low Income Children Obj. 21-12 Note:  Data are for children ...
Annual Dental Visits: 1996 Obj. 21-10 Note:  Data are for ages 2 years and over, age adjusted to the 2000 standard populat...
Annual Dental Visits: 1996 Hispanic Obj. 21-10 1996 Race/ethnicity Disability status Percent 2010 Target Note:  Data are f...
Annual Dental Visits: 1996 and 2000 Obj. 21-10 Total White Black Hispanic 1996 2000 With Without Percent 2010 Target Note:...
 
Community Health Centers with Onsite Dental Services  Obj. 21-14 Source: Bureau of Primary Health Care, HRSA. 1997 1998 19...
Community Health Centers with Onsite Dental Services  Number Obj. 21-14 Percent  2010 Target Source: Bureau of Primary Hea...
Annual Dental Visits for Persons with Diabetes: 2002 Obj. 5-15 Note:  Data are for ages 2 years and over, age adjusted to ...
Annual Dental Visits for Persons with and without Diabetes: 2002 Obj. 5-15 Note:  Data are for ages 2 years and over, age ...
Annual Dental Visits for Persons with and without Diabetes: 1997-2002 Obj. 5-15 Note:  Data are for ages 2 years and over,...
Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm
12 IHS Service Areas
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Data Presentation [PPT - 381 KB] - PowerPoint Presentation

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  • -Welcome to our progress review.
  • 1. Incidence CA: The 5-year survival rate in whites is 56% and only 34% in blacks. 2. Disparities: Over half of children age 5-9 have at least one cavity or filling, dental caries in children is 5 times more common than asthma. 3. insurance: Children living in poverty have more severe and untreated decay and Americans w/out dental insurance are more likely to have unmet dental needs compared to those with insurance
  • -The focus area of Oral Health has 17 objectives
  • -Trends indicate improvement for some objectives; for example the proportion of children aged 6-15 with dental caries experience and with untreated decay. -Also, a greater proportion of adults aged 35-44 years are keeping all of their teeth and have lower levels of destructive periodontal disease. -A greater proportion of children are getting dental sealants -A greater percentage of Americans are served by fluoridated water systems -More low income children are getting preventive dental services, and -More community based health centers have an oral health component
  • -Where are things getting worse? The proportion of children aged 2-4 who have experienced dental caries and the percentage who have untreated decay has increased slightly. -Also the use of the oral health care system has decreased slightly
  • -In summary, for most of the objectives for which we have data, trends are moving in the right direction. Other objectives will be assessed at the Mid Course Review.
  • -We selected 7 objectives to highlight at this review. Our presentation will focus on reducing disparities. We have chosen objectives for children, for adults, and objectives involving the health care system and its utilization
  • -We are highlighting one related objective- Diabetes and dental visits. This is related to STEPs for a healthier USA. -I would like to mention that when we talk about dental caries, sealants, tooth loss, we need to be cautious with our interpretations. The Baseline data base (NHANES3) for these objectives had 6 years of data. The recent data base we are using to measure our progress since baseline is smaller, it has less than two years of data. Therefore, estimates are imprecise and unstable. We can speak more confidently at Mid Course Review when we have added two more years of data.
  • Early Childhood Caries is a very serious, rapidly destructive presentation of dental decay that involves multiple teeth, including anterior teeth. Left untreated, this decay can destroy the entire dentition. Treatment often involves general anesthesia in the operating room, incurring both risk to patient and high economic cost. Although the US Preventive Services Task Force on preventive clinical services has found the evidence to support a periodic health exam for the early detection of oral cancer to be inconclusive, the Task Force on Community Preventive Services has recently recommended that (1) more widespread use of effective strategies to reduce tobacco use and excessive alcohol consumption and (2) periodic oral exams of people at high risk should be undertaken. Moreover, this same Task Force has also recommended implementing other considerations discussed in the 1998 MMWR: Preventing and Controlling Oral and Pharyngeal Cancer . Reference source: The Guide to Community Preventive Services, Interventions to Prevent Dental caries, Oral and Pharyngeal Cancers, and Sports-Related Craniofacial Injuries , systematic reviews of evidence, recommendations from the Task Force on Community Preventive Services, and expert commentary. In Supplement to American Journal of Preventive Medicine July 2002.
  • Native American children have significantly more &amp;quot;baby bottle tooth decay&amp;quot; or &amp;quot;early childhood dental caries&amp;quot; than the general U.S. population of children. The prevalence of this disease in the general U.S. population is about 2%, compared to 24% among children examined by IHS dentists. The epidemic of early childhood decay in Native American children is the one greatest oral health disparity among Native Americans.
  • A dental sealant (also called a pit and fissure sealant) is a plastic, professionally-applied material that is put on the chewing surfaces of back teeth to prevent cavities. Sealants provide a physical barrier so that cavity-causing bacteria cannot invade the pits and fissures on the chewing surfaces of teeth. Dental sealants effectively protect the pits and fissures on the biting surfaces of teeth, the surfaces most prone to dental decay. Sealants do not protect the smooth surfaces of teeth.
  • -For dental sealants at baseline (1988-94) both younger and older children were well under the target of 50% prevalence and there were disparities by race/ethnic group. - Fewer Black and Mexican American children had sealants than white children.
  • There is some good news. By 1999-2000, there has been an increase in sealants for all groups. -The biggest increase has been for blacks and Mexican American and also for children in the older age group -This is one objective in which there is some reduction in disparities, although they still remain. - It was mentioned earlier in this presentation that caries in permanent teeth is moving in the right direction. -One reason is that the increase in sealants has contributed to a decrease in caries in permanent teeth.
  • -At baseline, about 30% of adults had no permanent tooth loss due to disease, yet fewer blacks (12%) reported no tooth loss. -This was a large disparity.
  • -All groups have moved toward the target of keeping more of their teeth, Blacks have made a bigger jump so this disparity has been reduced somewhat. -Males have reached the 2010 target of 42% keeping all permanent teeth. -This may be due to the fact that males use dental services less frequently than females and therefore did not visit a dentist to have a tooth extracted. -Data are not shown here, but even though more adults in this age group are keeping their teeth, one–third of them have untreated decay in the teeth they are keeping.
  • Although the US Preventive Services Task Force on preventive clinical services has found the evidence to support a periodic health exam for the early detection of oral cancer to be inconclusive, the Task Force on Community Preventive Services has recently recommended that (1) more widespread use of effective strategies to reduce tobacco use and excessive alcohol consumption and (2) periodic oral exams of people at high risk should be undertaken. Moreover, this same Task Force has also recommended implementing other considerations discussed in the 1998 MMWR: Preventing and Controlling Oral and Pharyngeal Cancer . Reference source: The Guide to Community Preventive Services, Interventions to Prevent Dental caries, Oral and Pharyngeal Cancers, and Sports-Related Craniofacial Injuries , systematic reviews of evidence, recommendations from the Task Force on Community Preventive Services, and expert commentary. In Supplement to American Journal of Preventive Medicine July 2002.
  • -20% of low income children received a preventive dental service in 1996. Preventive services are defined as a check-up. X-ray, fluoride treatment, cleaning or sealant application.
  • -This has increased to 31% in 4 years, making some progress towards the target that 57% of low income children should preventive services. -This increase from is likely due to positive changes from 1996 to 2000 in the dental Medicaid program for children. Still, 2/3 of low income children are not receiving these services.
  • -At baseline in 1996, all groups were below the target of 56%. -56% of persons ages 2 and over should have an annual dental visit. -There were large disparities by race/ethnicity in annual dental visits, with blacks and Hispanics behind whites
  • -In addition, at baseline in 1996, fewer persons with disabilities had dental visits than those without disabilities.
  • -From 1996 to 2000, annual dental visits dropped for nearly all groups. - Disparities have persisted among race ethnic groups. -The greatest drop was observed among those with a disability. Disability defined: IADL, ADL, Work/school limitations (5+ yrs), Cognitive limitations (18+yrs).
  • -The proportion of community based health centers with a dental component has increased from 1997 to 2002. -These centers serve groups that traditionally have limited access to dental services; minorities, persons with low income and persons living in rural areas.
  • -The proportion of community based health centers with a dental component has increased from 1997 to 2002. -These centers serve groups that traditionally have limited access to dental services; minorities, persons with low income and persons living in rural areas.
  • -Persons with diabetes are more likely to get periodontal disease and periodontal disease makes glycemic control more difficult. -Persons with diabetes should have annual dental visits. -The biggest disparity here is by income.
  • -Persons with diabetes are more likely to get periodontal disease and periodontal disease makes glycemic control more difficult. -Persons with diabetes should have annual dental visits. -The biggest disparity here is by income.
  • -The last slide shows that dental visits among persons with diabetes have remained stable since baseline (see legend).
  • Additional data germane to objective 21-8. The placement of dental sealants throughout the Indian Health Service has increased dramatically in recent years. Total number of sealants placed in 2003 approached ¼ million. This is a 74% increase in annual production over the last five years. In 2004, IHS will likely exceed 1/4 million sealants placed. The prevalence of IHS patients age 8 with dental sealants exceeds 60%. This estimate exceeds the HP2010 target for dental sealants, which postulates a 50% prevalence.
  • Transcript of "Data Presentation [PPT - 381 KB] - PowerPoint Presentation"

    1. 1. F ocus Area 21: Oral Health Progress Review March 17, 2004
    2. 2. <ul><li>Estimated new cases of oral/pharyngeal cancers in U.S. will affect 28,000 + persons in 2004 </li></ul><ul><li>Profound disparities exist in disease levels and receipt of care </li></ul><ul><li>100+ million Americans lack dental insurance </li></ul>The Burden of Oral Disease
    3. 3. <ul><li>Reduction in decay among U.S. teens in the 1990s (NHANES 1988-94 to 1999-2000) saved more than 30 million teeth from decay and almost $3 billion in treatment costs </li></ul>Progress:
    4. 4. Improving Cannot assess (limited data) Oral Health Objectives Getting worse 21-16 Oral and craniofacial State-based surveillance system 21-7 Annual exams for oral and pharyngeal cancers Children 2-4 years Children 6-8 years Adolescents 15 years 21-1 Dental caries experience Children 2-4 years Children 6-8 years Adolescents 15 years Adults 35-44 years 21-2 Untreated dental decay 21-3 No permanent tooth loss 21-4 Complete loss 21-5 Periodontal diseases 21-6 Early detection of oral and pharyngeal cancers 21-8 Dental sealants 21-9 Community water fluoridation 21-12 Dental services of for low-income children 21-13 School-based health centers with oral health components 21-14 Health centers with oral health service components Children 8 years Adolescents 14 years 21-10 Use of oral health care system 21-11 Use of oral health system by long- term care facilities residents 21-15 Referral for cleft lip or palate 21-17 Tribal, State & local programs
    5. 5. 21-16 Oral and craniofacial State-based surveillance system 21-7 Annual exams for oral and pharyngeal cancers Improving Cannot assess (limited data) Oral Health Objectives Getting worse Oral Health Objectives Children 2-4 years Children 6-8 years Adolescents 15 years 21-1 Dental caries experience Children 2-4 years Children 6-8 years Adolescents 15 years Adults 35-44 years 21-2 Untreated dental decay 21-3 No permanent tooth loss 21-4 Complete loss 21-5 Periodontal diseases 21-6 Early detection of oral and pharyngeal cancers 21-8 Dental sealants 21-9 Community water fluoridation 21-12 Dental services of for low-income children 21-13 School-based health centers with oral health components 21-14 Health centers with oral health service components Children 8 years Adolescents 14 years 21-10 Use of oral health care system 21-11 Use of oral health system by long- term care facilities residents 21-15 Referral for cleft lip or palate 21-17 Tribal, State & local programs
    6. 6. Children 2-4 years Children 6-8 years Adolescents 15 years 21-1 Dental caries experience Improving Cannot assess (limited data) Children 2-4 years Children 6-8 years Adolescents 15 years Adults 35-44 years 21-2 Untreated dental decay 21-3 No permanent tooth loss 21-4 Complete loss 21-5 Periodontal diseases 21-6 Early detection of oral and pharyngeal cancers 21-7 Annual exams for oral and pharyngeal cancers 21-8 Dental sealants 21-9 Community water fluoridation 21-12 Dental services of for low-income children 21-13 School-based health centers with oral health components 21-14 Health centers with oral health service components Children 8 years Adolescents 14 years 21-10 Use of oral health care system 21-11 Use of oral health system by long- term care facilities residents 21-15 Referral for cleft lip or palate 21-16 Oral and craniofacial State-based surveillance system Oral Health Objectives Getting worse 21-17 Tribal, State & local programs
    7. 7. 21-7 Annual exams for oral and pharyngeal cancers Improving Getting worse Cannot assess (limited data) Oral Health Objectives Children 2-4 years Children 6-8 years Adolescents 15 years 21-1 Dental caries experience Children 2-4 years Children 6-8 years Adolescents 15 years Adults 35-44 years 21-2 Untreated dental decay 21-3 No permanent tooth loss 21-4 Complete loss 21-5 Periodontal diseases 21-8 Dental sealants 21-9 Community water fluoridation 21-12 Dental services of for low-income children 21-13 School-based health centers with oral health components 21-14 Health centers with oral health service components Children 8 years Adolescents 14 years 21-10 Use of oral health care system 21-11 Use of oral health system by long- term care facilities residents 21-15 Referral for cleft lip or palate 21-16 Oral and craniofacial State-based surveillance system 21-17 Tribal, State & local programs Oral Health Objectives 21-6 Early detection of oral and pharyngeal cancers
    8. 8. 21-1 Dental caries experience in children 21-3 No permanent tooth loss in adults 21-6 Early detection of oral and pharyngeal cancers 21-8 Sealants 21-10 Use of oral health care system 21-12 Dental services of for low-income children 21-14 Health centers with oral health services Highlighted Objectives
    9. 9. 21-1 Dental caries experience in children 21-3 No permanent tooth loss in adults 21-6 Early detection of oral and pharyngeal cancers 21-8 Sealants 21-10 Use of oral health care system 21-12 Dental services of for low-income children 21-14 Health centers with oral health services 5-15 Dental visits among persons with diabetes Highlighted Objectives
    10. 10. Obj. 21-1c Adolescents 12-18 Years Who Ever Had Caries in Permanent Teeth, 1988-94 Total Black Mexican American White Male Female Percent 2010 Target 1988-94 Note: Target is for adolescents 15 years old. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC.
    11. 11. Obj. 21-1c Adolescents 12-18 Years Who Ever Had Caries in Permanent Teeth, 1988-94 and 1999-2000 Note: Target is for adolescents 15 years old. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Total Black Mexican American White Male Female Percent 2010 Target 1988-94 1999-2000
    12. 12. Obj. 21-1a Note: Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Total Black Mexican American White Male Female Percent 2010 Target 1988-94 Children 2-4 Years Who Have Ever Had Caries in Primary Teeth, 1988-94
    13. 13. Obj. 21-1a Children 2-4 Years Who Have Ever Had Caries in Primary Teeth, 1988-94 and 1999-2000 Note: Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Total Black Mexican American White Male Female 2010 Target 1988-94 1999-2000 Percent
    14. 14. Note: from Niendorff & Jones, JPHD 2000: 60: 245. Data are for IHS service areas. Source: 1991 Patient Survey, IHS. Early Childhood Caries (ECC) in American Indian/Alaska Native Children 0-4 Years 1991
    15. 15. Early Childhood Caries (ECC) in American Indian/Alaska Native Children 0-4 Years Note: from Niendorff & Jones, JPHD 2000: 60: 245. and Kaste et al., JPHD 1999; 59: 199. Source: 1991 Patient Survey, IHS; National Health and Nutrition Examination Survey, NCHS, CDC. 1991 Less than 2% of all U.S. children 1-2 years in 1988-94 had ECC
    16. 16. Dental Sealants
    17. 17. Note: Targets are for children 8 years and 14 years. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Total Percent 2010 Targets 6-11 Years 12-18 Years Black Mexican American White Total Black Mexican American White Dental Sealants: 1988-94 Obj. 21-8 1988-94 1988-94
    18. 18. Total 2010 Targets 6-11 Years 12-18 Years Black Mexican American White Total Black Mexican American White Dental Sealants: 1988-94 and 1999-2000 Obj. 21-8 1999-2000 1999-2000 1988-94 1988-94 Note: Targets are for children 8 years and 14 years. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Percent Unreliable estimate, relative standard error >30%.
    19. 19. Obj. 21-3 Total Black Mexican American White Male Female 1988-94 2010 Target Note: Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Percent No Permanent Tooth Loss in Adults 35-44 Years: 1988-94
    20. 20. Obj. 21-3 Note: Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. No Permanent Tooth Loss in Adults 35-44 Years: 1988-94 and 1999-2000 2010 Target Total Black Mexican American White Male Female 1988-94 1999-2000 Percent
    21. 21. Obj. 21-6 Early Detection of Oral and Pharyngeal Cancers: 1990-95 1990-95 2010 Target Note: Data are for Stage 1 (localized) tumors, excluding Kaposi Sarcoma tumors. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: Surveillance, Epidemiology, and End Results Program, NIH, NCI. Percent Total Black Hispanic White Male Female
    22. 22. Obj. 21-6 Early Detection of Oral and Pharyngeal Cancers: 1990-95 and 1996-2000 1990-95 1996-2000 2010 Target Note: Data are for Stage 1 (localized) tumors, excluding Kaposi Sarcoma tumors. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: Surveillance, Epidemiology, and End Results Program, NIH, NCI. Percent Total Black Hispanic White Male Female
    23. 23. 2010 Target = 57% 1996 Obj. 21-12 Note: Data are for children under 19 years. Low income is less than 200% of poverty level. Preventive services include examinations, cleaning, x-rays, fluoride treatments and sealant applications. Source: Medical Expenditure Panel Survey, AHRQ. Receipt of Preventive Services by Low Income Children
    24. 24. 2010 Target = 57% 1996 2000 Receipt of Preventive Services by Low Income Children Obj. 21-12 Note: Data are for children under 19 years. Low income is less than 200% of poverty level. Preventive services include examinations, cleaning, x-rays, fluoride treatments and sealant applications. Source: Medical Expenditure Panel Survey, AHRQ.
    25. 25. Annual Dental Visits: 1996 Obj. 21-10 Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: Medical Expenditure Panel Survey, AHRQ. 2010 Target 1996 Race/ethnicity Percent Total White Black Hispanic
    26. 26. Annual Dental Visits: 1996 Hispanic Obj. 21-10 1996 Race/ethnicity Disability status Percent 2010 Target Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: Medical Expenditure Panel Survey, AHRQ. Total White Black With Without
    27. 27. Annual Dental Visits: 1996 and 2000 Obj. 21-10 Total White Black Hispanic 1996 2000 With Without Percent 2010 Target Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: Medical Expenditure Panel Survey, AHRQ. Race/ethnicity Disability status
    28. 29. Community Health Centers with Onsite Dental Services Obj. 21-14 Source: Bureau of Primary Health Care, HRSA. 1997 1998 1999 2000 2001 2002 Number Dental Services at Center Health Centers
    29. 30. Community Health Centers with Onsite Dental Services Number Obj. 21-14 Percent 2010 Target Source: Bureau of Primary Health Care, HRSA. 1997 1998 1999 2000 2001 2002 Dental Services at Center Health Centers
    30. 31. Annual Dental Visits for Persons with Diabetes: 2002 Obj. 5-15 Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: National Health Interview Survey, NCHS, CDC. Total Black Hispanic White Rural Urban Persons with diabetes Race/ethnicity 100-199 >200 <100 Poverty level (%) Percent 2010 Target Urbanicity
    31. 32. Annual Dental Visits for Persons with and without Diabetes: 2002 Obj. 5-15 Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Source: National Health Interview Survey, NCHS, CDC. Total Black Hispanic White Rural Urban Persons with diabetes Race/ethnicity Urbanicity 100-199 >200 <100 Persons without diabetes Percent 2010 Target Poverty level (%)
    32. 33. Annual Dental Visits for Persons with and without Diabetes: 1997-2002 Obj. 5-15 Note: Data are for ages 2 years and over, age adjusted to the 2000 standard population. Source: National Health Interview Survey, NCHS, CDC. 2010 Target Persons with diabetes Percent Persons without diabetes
    33. 34. Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm
    34. 35. 12 IHS Service Areas
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