Mobility limitation among persons aged > or =40 years with and without diagnosed diabetes and lower extremity disease--United States, 1999-2002

Diabetes increases the risk for mobility limitation, especially among older persons. Lower extremity disease (LED), which includes peripheral arterial disease (PAD) and peripheral neuropathy (PN), also increases the risk for mobility limitation. To assess the prevalence of mobility limitation among persons with diagnosed diabetes, persons with LED, and persons with both or neither condition, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 for adults aged > or =40 years. This report summarizes the preliminary findings, which indicated that the national prevalence of mobility limitation is higher among persons with either diagnosed diabetes or LED than those without the conditions, and that adults with both conditions have a higher prevalence of mobility limitation than those with either condition alone. Monitoring the prevalence of diabetes, LED, and associated risk factors and identifying effective LED prevention strategies will help reduce the burden of mobility limitation in the United States.     

Prevalence of self-reported cardiovascular disease among persons aged > or =35 years with diabetes--United States, 1997-2005

Adults with diabetes are at greater risk for dying from heart disease than adults without diabetes. Heart disease and stroke account for approximately 65% of deaths among persons with diabetes. During 1997-2005, the age-adjusted prevalence of diagnosed diabetes in the United States increased 43%, from 3.7% in 1997 to 5.3% in 2005. To assess trends in prevalence of heart disease, stroke, and other cardiovascular diseases (CVDs) among persons with diabetes, CDC analyzed data from the National Health Interview Survey (NHIS). This report summarizes the results of that assessment, which indicated that although the number of persons aged > or =35 years with diagnosed diabetes who reported having CVD increased 36% during 1997-2005, the age-adjusted prevalence decreased 11%; however, the decrease in CVD prevalence did not occur in all subpopulations with diabetes. The decrease in CVD prevalence indicates that the increase in the number of persons with diagnosed diabetes exceeded the increase in the number of persons with diagnosed diabetes who reported having a CVD. Continued interventions are needed to reduce modifiable CVD risk factors among persons with diabetes, better control diabetes, and decrease CVD prevalence further.     

Prevalence of visual impairment and selected eye diseases among persons aged >/=50 years with and without diabetes--United States, 2002

Visual impairment and blindness affect an estimated 3.4 million U.S. adults aged >/=40 years. The leading causes of visual impairment and blindness are diabetic retinopathy and age-related eye diseases (e.g., cataracts, macular degeneration, and glaucoma). Diabetes affects approximately 18 million U.S. adults, of whom an estimated 30% have undiagnosed diabetes, and imposes an increased risk for eye disease. To characterize the prevalence of visual impairment and selected eye diseases (i.e., diabetic retinopathy, cataracts, macular degeneration, and glaucoma) among persons aged >50 years with and without diabetes, CDC analyzed data from the 2002 National Health Interview Survey (NHIS). This report summarizes the findings of that analysis, which identified a substantially higher prevalence of visual impairment and eye disease among those with diabetes compared with those without diabetes. Measures are needed to increase comprehensive eye examinations, especially among adults at high risk for blindness and visual impairment (e.g., persons aged >/=65 years and those with diabetes).     

Influenza vaccination levels among persons aged > or =65 years and among persons aged 18-64 years with high-risk conditions--United States, 2003

Influenza vaccination is an effective tool for preventing hospitalization and death among persons aged > or =65 years and among persons aged 18-64 years with medical conditions that increase the risk for influenza-related complications. Two national health objectives for 2010 are to increase influenza vaccination coverage to 90% among persons aged > or =65 years and to 60% among persons aged 18-64 years who have one or more high-risk conditions (objectives 14-29a and 14-29c, respectively). To determine influenza vaccination coverage among persons in both targeted groups, CDC analyzed data from the 2003 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which determined that influenza vaccination coverage among persons aged > or =65 years and persons aged 18-64 years with high-risk conditions remains substantially below 2010 target levels. In addition, racial/ethnic disparities in coverage levels persist in both targeted populations. To improve overall influenza vaccination coverage and reduce racial/ethnic disparities, combinations of evidence-based effective interventions should be implemented, and the influenza vaccine supply should be stabilized.     

Influenza and pneumococcal vaccination coverage among persons aged > or =65 years and persons aged 18-64 years with diabetes or asthma--United States, 2003

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy for preventing associated morbidity and mortality in the United States. Risk factors include older age and medical conditions that increase the risk for complications from infections. During the 1990-1999 influenza seasons, more than 32,000 deaths each year among persons aged > or =65 years were attributed to complications from influenza infection. National health objectives for 2010 call for 90% influenza and pneumococcal vaccination coverage among noninstitutionalized persons aged > or =65 years and 60% coverage among noninstitutionalized persons aged 18-64 years who have risk factors (e.g., diabetes or asthma) for complications from infections. To estimate influenza and pneumococcal vaccination coverage among these populations, CDC analyzed data from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that 1) influenza vaccination levels among adults aged 18-64 with diabetes or asthma, 2) pneumococcal vaccination levels among adults aged 18-64 years with diabetes, and 3) influenza and pneumococcal vaccination levels among adults aged > or =65 years all were below levels targeted in the national health objectives for 2010. Moreover, vaccination coverage levels varied among states for both vaccines and both age groups. Innovative approaches and adequate, reliable supplies of vaccine are needed to increase vaccination coverage, particularly among adults with high-risk conditions.     

Correctable visual impairment among persons with diabetes--United States, 1999-2004

Persons with diabetes are more likely to be visually impaired than persons without the disease. In 2005, CDC estimated that 14.6 million persons in the United States had diagnosed diabetes and an additional 6.2 million had undiagnosed diabetes. Despite the importance of detecting and treating vision problems caused by refractive errors (i.e., correctable visual impairment [CVI]), a limited number of studies have attempted to determine the proportion of persons with diabetes whose poor vision could be corrected with accurately prescribed glasses or contact lenses. To estimate that proportion, CDC analyzed 1999-2004 data from the National Health and Nutrition Examination Survey (NHANES). This report describes the results of that analysis, which indicated that among U.S. adults aged > or =20 years with diabetes, 11.0% had visual impairment (i.e., presenting visual acuity worse than 20/40 in their better-seeing eye while wearing glasses or contact lenses, if applicable) and approximately 65.5% of these cases of visual impairment were correctable. Health-care providers and persons with diabetes should be more aware that poor vision often is correctable and that visual corrections can reduce the risk for injury and improve the quality of life for persons with diabetes.     

Incidence of end-stage renal disease among persons with diabetes--United States, 1990-2002

Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) (i.e., kidney failure requiring dialysis or transplantation) in the United States, accounting for 44% of new cases of treated ESRD in 2002. To examine trends in ESRD attributed to diabetes mellitus (ESRD-DM) in the United States, CDC analyzed 1990-2002 data from the United States Renal Data System (USRDS) and the National Health Interview Survey (NHIS). This report summarizes the findings of that analysis, which indicated that, although the number of new cases of ESRD-DM increased overall, the incidence of ESRD-DM among persons with diabetes is not increasing among blacks, Hispanics, men, and persons aged 65-74 years, and is declining among persons aged <65 years, women, and whites. Continued interventions to reduce the prevalence of risk factors for kidney disease and improve diabetes care are needed to sustain and improve these trends.     

History of foot ulcer among persons with diabetes--United States, 2000-2002

Foot ulcers and lower extremity amputations (LEAs) are disabling complications of diabetes and lower extremity disease. In the United States, approximately 60% of all LEAs occur among persons with diabetes; of these LEAs, approximately 85% are preceded by a foot ulcer. To estimate the percentage of U.S. adults with diabetes who had a history of a foot ulcer, CDC analyzed data from the 2000-2002 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the findings of that analysis, which indicate that persons with longer duration of diabetes who used insulin and who smoked were most likely to have a history of foot ulcer. Persons with diabetes can benefit from interventions that prevent or delay foot ulcer and LEAs.     

Self-reported heart disease and stroke among adults with and without diabetes--United States, 1999-2001

Heart disease and stroke are the first and third leading causes of death among U.S. adults. Adults with diabetes have a twofold to fourfold greater risk for dying from cardiovascular diseases than adults without diabetes. In addition, although the annual incidence of deaths attributed to cardiovascular diseases declined substantially among U.S. adults during 1970-1994, it decreased less among those with diabetes. To compare the prevalence of heart disease and stroke among adults with and without diabetes, CDC analyzed data from the 1999-2001 National Health Interview Surveys (NHIS). This report summarizes the results of that analysis, which indicate that the age-adjusted prevalence of heart disease and stroke is approximately two to three times greater among adults with diabetes than among adults without diabetes. Increased efforts are needed to prevent diabetes and reduce the prevalence of cardiovascular disease risk factors (e.g., hypertension and high cholesterol) in the United States, particularly among adults with diabetes.     

Use of mammograms among women aged > or = 40 years--United States, 2000-2005

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related death (after lung and bronchial cancer) among women in the United States. In 2002, at least 182,125 women in the United States had a diagnosis of invasive breast cancer, and 41,514 died from the disease. Screening mammography can reduce mortality from breast cancer by approximately 20%-35% in women aged 50-69 years and approximately 20% in women aged 40-49 years. Organizations including the American Medical Association, American College of Obstetricians and Gynecologists, and American Cancer Society support mammography screening beginning at age 40 years, although these groups vary in their recommendations regarding intervals for rescreening. The U.S. Preventive Services Task Force, an independent panel of private-sector experts in prevention and primary care convened by the Department of Health and Human Services, recommends that women aged < or = 40 years be screened for breast cancer with a mammogram every 1-2 years. Although mammogram use increased substantially during the 1990s, results from a recent cohort study of health maintenance organization members revealed declining screening rates during 1999-2002. This report describes Behavioral Risk Factor Surveillance System (BRFSS) findings that indicate a similar decreasing trend in self-reported use of mammograms among women aged < or = 40 years during 2000-2005. Continued declines in mammography use might result in increased breast cancer mortality.     

Influenza and pneumococcal vaccination coverage among persons aged > or = 65 years--United States, 2004-2005

Vaccination of persons at increased risk for complications from influenza and pneumococcal disease is a key public health strategy in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or = 65 years. In 1998, an estimated 3,400 adults aged > or = 65 years died as a result of invasive pneumococcal disease. One of the Healthy People 2010 objectives is to achieve 90% coverage of noninstitutionalized adults aged > or = 65 years for both influenza and pneumococcal vaccinations (objective 14-29). To assess progress toward this goal, this report examines vaccination coverage for persons interviewed in the 2004 and 2005 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The 2004-05 influenza season was characterized by an influenza vaccine shortage. As a result, the Advisory Committee on Immunization Practices (ACIP) issued recommendations that influenza vaccine be reserved for persons in priority groups, including persons aged > or = 65 years, and that others should defer vaccination until supply was sufficient. The results of this assessment indicated that, overall, influenza vaccination coverage was lower in the 2005 survey year than in 2004, whereas pneumococcal vaccination coverage was nearly unchanged from 2004 to 2005. In both years, influenza and pneumococcal vaccination coverage varied from state to state. Continued measures are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

Public health and aging: influenza vaccination coverage among adults aged > or =50 years and pneumococcal vaccination coverage among adults aged > or =65 years--United States, 2002

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy in preventing morbidity and mortality in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or =65 years. In 1998, an estimated 3,400 adults aged > or =65 years died as a result of invasive pneumococcal disease. One of the national health objectives for 2010 is to achieve 90% coverage of noninstitutionalized adults aged > or =65 years for both influenza and pneumococcal vaccinations (objective no. 14.29). In 2000, the Advisory Committee on Immunization Practices (ACIP) broadened the universal recommendations for influenza vaccination to include adults aged 50-64 years in addition to adults aged > or =65 years. To assess progress toward achieving the 2010 national health objective and implementing the ACIP recommendations, CDC analyzed data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that influenza and pneumococcal vaccination levels among adults aged > or =65 years and influenza vaccination levels among adults aged 50-64 years varied widely among states/areas and racial/ethnic populations. Innovative approaches are needed to increase vaccination coverage, particularly among certain populations.     

Colorectal cancer test use among persons aged > or = 50 years--United States, 2001

Colorectal cancer is the second leading cause of cancer-related death in the United States. The lifetime risk for having colorectal cancer diagnosed is 6%. Screening measures decrease the incidence and mortality of colorectal cancer by detecting early disease and removing precancerous lesions. The U.S. Preventive Services Task Force recommends routine cancer screening for U.S. adults aged > or = 50 years with one or a combination of the following screening options: annual home fecal occult blood testing (FOBT), sigmoidoscopy every 5 years, colonoscopy every 10 years, or double contrast barium enema every 5 years. To estimate rates and evaluate trends for colorectal cancer test use among U.S. adults aged > or = 50 years, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) on the use of FOBT and sigmoidoscopy/colonoscopy and compared the data for 2001 with those for 1997 and 1999. This report summarizes the results of that analysis, which indicate that despite small increases in the self-reported use of colorectal cancer tests, screening rates remain low. Efforts to increase awareness and encourage regular colorectal cancer screening should continue.     

Self-reported falls and fall-related injuries among persons aged > or =65 years--United States, 2006

Each year, an estimated one third of older adults fall, and the likelihood of falling increases substantially with advancing age. In 2005, a total of 15,802 persons aged > or =65 years died as a result of injuries from falls. However, the number of older adults who fall and are not injured or who sustain minor or moderate injuries and seek treatment in clinics or physician offices is unknown. To estimate the percentage of older adults who fell during the preceding 3 months, CDC analyzed data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that approximately 5.8 million persons aged > or =65 years, or 15.9% of all U.S. adults in that age group, fell at least once during the preceding 3 months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least 1 day. The percentages of women and men who fell during the preceding 3 months were similar (16.4% versus 15.2%, respectively), but women reported significantly more fall-related injuries than men (35.7% versus 24.6%, respectively). The effect these injuries have on the quality of life of older adults and on the U.S. health-care system reinforces the need for broader use of scientifically proven fall-prevention interventions.     

Influenza and pneumococcal vaccination levels among persons aged > or = 65 years--United States, 2001

Two vaccine-preventable diseases, influenza and pneumococcal disease, contribute to the mortality of older persons in the United States. Influenza caused an average of 20,000 deaths per year during influenza epidemics in the United States from 1969 to 1996; persons aged > or = 65 years accounted for approximately 90% of these deaths. Pneumococcal disease caused approximately 3,400 deaths among persons aged > or = 65 years in the United States in 1998. National health objectives for 2010 include increasing influenza and pneumococcal vaccination levels to > or = 90% among persons aged > or = 65 years (objective nos. 14.29a and 14.29b, respectively). To assess progress toward achieving these objectives, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results, which indicate that the estimated point prevalences of influenza and pneumococcal vaccination were <80% among persons aged > or = 65 years in all reporting areas. Influenza vaccination levels during 2000-2001 decreased from 1998-1999 levels in 27 of 52 reporting areas; pneumococcal vaccination prevalence increased a median of 7 percentage points from 1999 to 2001. Continued efforts are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

Prevalence of overweight and obesity among adults with diagnosed diabetes--United States, 1988-1994 and 1999-2002

Obesity in persons with diabetes is associated with poorer control of blood glucose levels, blood pressure, and cholesterol, placing persons with diabetes at higher risk for both cardiovascular and microvascular disease. Conversely, intentional weight loss is associated with reduced mortality among overweight persons with diabetes. CDC analyzed the prevalence of overweight and obesity among U.S. adults aged >/=20 years with previously diagnosed diabetes by using data from two surveys: the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994, and NHANES 1999-2002. This report summarizes the results of that analysis, which indicated that most adults with diagnosed diabetes were overweight or obese. During 1999-2002, the prevalence of overweight or obesity was 85.2%, and the prevalence of obesity was 54.8%. Encouraging patients to achieve and maintain a healthy weight should be a priority for all diabetes-care programs.     

Total tooth loss among persons aged > or =65 years--selected states, 1995-1997

Loss of all natural permanent teeth (edentulism) substantially reduces quality of life, self-image, and daily functioning. Although loss of teeth results from oral diseases such as dental caries and periodontitis, it also reflects patient and dentist attitudes, availability and accessibility of dental care, and the prevailing standard of care. One of the national health objectives for 2000 is to reduce to no more than 20% the proportion of persons aged > or =65 years who have lost all their natural teeth (objective 13.4). Edentulism has been declining in the United States since the 1950s, but few state-specific data are available on adult tooth loss. To estimate the prevalence of edentulism among persons aged > or =65 years, CDC analyzed data from the 46 states that participated in the oral health module of the 1995-1997 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the findings from this analysis, which indicate a large state-specific variation in edentulism and that many states have not yet achieved the national health objective for preventing total tooth loss.     

Preventive-care practices among persons with diabetes--United States, 1995 and 2001

Effective interventions are available to persons with diabetes that can prevent or delay the development of serious health complications such as lower limb amputation, blindness, kidney failure, and cardiovascular disease. However, the use of preventive-care practices is lower than recommended, and the national health objectives for 2010 aim to improve care for all persons with diabetes. To assess progress toward meeting these goals, CDC analyzed data on selected diabetes-related preventive-care practices, including influenza and pneumococcal vaccination coverage, from the Behavioral Risk Factor Surveillance System (BRFSS) from 1995 and 2001. This report presents the findings of these analyses, which indicate that levels of preventive-care practices among persons with diabetes in the United States increased from 1995 to 2001. Further efforts are needed to improve care among persons with diabetes, reduce the burden of diabetes-related complications, and achieve the national health objectives, including continued surveillance of diabetes-related preventive-care practices and collaboration with community-based organizations, health-care providers, public health officials, and persons with diabetes.     

Racial/ethnic disparities in influenza and pneumococcal vaccination levels among persons aged > or =65 years--United States, 1989-2001

Influenza and pneumococcal diseases are key causes of mortality among persons aged > or =65 years, accounting for approximately 36,000 and 3,400 deaths per year, respectively, during 1990-1999. Substantial racial/ethnic disparities in adult vaccination have been documented in national surveys. Although the national health objective for 2000 of 60% receipt of influenza vaccination during the preceding 12 months by persons aged > or =65 years (objective no. 20.11) was met in 1997, and the objective of 60% for pneumococcal vaccination was nearly met in 2000, vaccine coverage levels among non-Hispanic blacks and Hispanics were 31% and 30%, respectively, compared with 57% for non-Hispanic whites. To characterize these disparities, CDC analyzed data from the 2000 and 2001 National Health Interview Surveys (NHIS) and examined trends in NHIS results for 1989-2001. This report summarizes the results of these analyses, which indicate that marked differences in vaccination coverage by race/ethnicity are observed even among persons most likely to be vaccinated (e.g., persons with the highest education level and persons with frequent visits to health-care providers). Racial/ethnic disparities in influenza and pneumococcal vaccination coverage have persisted over time. Several approaches to reduce these disparities are needed, including increasing demand for vaccination among racial/ethnic minority populations and the use of standing orders and other systems changes that promote vaccination.     

Dental visits among dentate adults with diabetes--United States, 1999 and 2004

One of the major complications of diabetes is periodontal disease, a chronic infection of tissues supporting the teeth and a major cause of tooth loss. Adults with diabetes have both a higher prevalence of periodontal disease and more severe forms of the disease, contributing to impaired quality of life and substantial oral functional disability. In addition, periodontal disease has been associated with development of glucose intolerance and poor glycemic control among adults with diabetes. Regular dental visits provide opportunities for prevention, early detection, and treatment of periodontal disease among dentate adults (i.e., those having one or more teeth); moreover, regular dental cleaning improves glycemic control in patients with poorly controlled diabetic conditions. One of the national health objectives for 2010 is to increase the proportion of persons with diabetes who have an annual dental examination to 71% (revised objective 5-15). To estimate the percentage of dentate U.S. adults aged > or =18 years with diabetes who visited a dentist within the preceding 12 months, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys for 1999 and 2004. This report describes the results of that analysis, which indicated that, in 2004, age-adjusted estimates in only seven states exceeded 71% and estimated percentages for four states and District of Columbia (DC) increased significantly from their levels in 1999. The findings underscore the need to increase awareness and support for oral health care among adults with diabetes, including support for national and state diabetes care management programs.