The Diabetes Atlas
July 07, 2010
Gary A. Puckrein, PhD
Through persistence over the years, the National Minority Quality Forum has built a database of over 700 million de-identified patient records. These data have provided us with a unique understanding of how diseases vary across the US population. Most diseases have a spatial quality: They tend to aggregate in certain parts of the country. Disease aggregation is sometimes simply explained by the concentration of people in certain areas, or there may be signals that other forces, such as genetics or the environment, are at play.
It has taken a decade to collect all of these data, and we are now making summary analyses available in a series of online atlases. The D ATLAS is the first in the series. This project has been supported by the Amylin/Lilly Alliance. We have been grateful to them for thinking out of the box by nurturing an idea that had no real precursor.
The D ATLAS is a unique tool that enables users to map health disparities in diagnosed type 2 diabetes and obesity. It maps the prevalence of, and the costs associated with, diabetes, as well as the prevalence of obesity, by race/ethnicity, age, or gender in the United States, by individual state or by legislative district. The ability to create customized maps that localize diabetes disparities is a compelling reference source. These maps may be generated and disseminated to support educational, advocacy, and public-affairs initiatives.
We believe that the D ATLAS is available at a propitious moment. We cannot solve problems without a means to define and measure them. The United States is facing a diabetes epidemic. According to the Centers for Disease Control and Prevention (CDC), between 1990 and 2007, the number of people living with diagnosed diabetes grew from 6.6 million to 17.9 million, with an additional 5.7 million whose diabetes was not yet diagnosed and more than 57 million prediabetics (National Diabetes Fact Sheet, 2007, http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf). Every 24 hours, 3,600 new cases of diabetes are diagnosed. Almost 25% of the population over the age of 65 is diabetic. In the minority community, the numbers are completely out of hand. CDC estimates that in 2007, 14.7 percent of African Americans had diagnosed or undiagnosed diabetes. A diabetes nation has emerged, whose needs for products and services threaten not only to overwhelm our medical system but also to divert resources from education, energy, and military preparedness.
Using a color-coded system, the D ATLAS allows users to identify high-prevalence communities. The D ATLAS suggests where we need to marshal our resources as we strive toward bringing diabetes under control. Legislators can use the D ATLAS to understand the burden of diabetes on constituents.
Our current health-care system is not designed to cope with a challenge of this magnitude. It is an acute-care system that treats prevention as a poor investment. It prefers to spend its resources on acute events, more often than not on hospitalizations, rather than on preventative services. It makes great noises about quality and performance measures that are often translated into guidelines for which no one has calculated the costs or patients’ ability or means to comply, no matter how diligent the physician.
It is our sincere hope that the D ATLAS and its companion atlases (for cardiovascular disease, HIV/AIDS, chronic kidney disease, and peripheral arterial disease) begin a movement toward a proactive healthcare system—one that not only understands communities’ and patients’ needs but also anticipates those needs before they become acute.
As we begin to measure and map our health problems, we open the way to aligning our resources to reduce the incidence of chronic diseases, to improve the quality of care for those living with these diseases, and, yes, to reduce costs by eliminating preventable hospitalizations.
Gary Puckrein is the President and Chief Executive Officer of the National Minority Quality Forum.
For more related articles, click Diabetes Perspectives.