Prevalence of receiving multiple preventive-care services among adults with diabetes--United States, 2002-2004

An estimated 7% of the U.S. population has diabetes; however, only 70% of these persons have had the disease diagnosed. Recommended preventive-care services such as annual foot and eye examinations can prevent or delay amputation and blindness. Measurement of glycosylated hemoglobin (A1C) two or more times per year is important for glycemic control and diabetes management. Three national health objectives for 2010 are to increase the proportion of adults with diabetes who have an annual dilated eye examination (objective no. 5-13; target: 75%), an annual foot examination (objective no. 5-14; target: 75%), and A1C measurements at least twice each year (objective no. 5-12; target: 50%). To determine the percentage of U.S. adults with diabetes receiving each of these three preventive-care services and the percentage receiving all three services, CDC analyzed data from Behavioral Risk Factor Surveillance System (BRFSS) surveys for 2002-2004. This report summarizes the results of that analysis, which determined that four in 10 U.S. adults with diabetes reported receiving all three preventive-care services; persons with recently diagnosed diabetes and current smokers were least likely to receive all three preventive-care services. Increased understanding of barriers to receiving multiple preventive-care services and continued interventions to ensure their delivery can improve the health status of persons with diabetes.     

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.     

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.     

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.     

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-monitoring of blood glucose among adults with diabetes--United States, 1997-2006

Blood-glucose control is critical for managing diabetes and preventing diabetes-related complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathy. In addition to recommending that patients with diabetes have a glycated hemoglobin (HbA1c) measurement at least two times a year, the American Diabetes Association recommends self-monitoring of blood glucose (SMBG) as an integral part of diabetes management for patients who are treated with insulin and as a useful component for achieving glycemic goals for patients who use oral medications or medical nutrition therapy. One of the Healthy People 2010 national objectives is to increase to 61% the proportion of persons with diabetes who perform SMBG at least once a day (objective 5-17). To estimate the rates of SMBG and to track the progress of states during 1997-2006, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for that period. This report summarizes the findings of that analysis, which indicated that the proportion of adults with diabetes who check their blood glucose at least once a day increased at the national level, and 25 of the 38 states examined had statistically significant rate increases from 1997 to 2006. In 2006, the daily SMBG rate was 63.4% among all adults with diabetes and 86.7% among those treated with insulin. Collaborations to ensure adequate health insurance coverage, diabetes education and counseling to encourage more intensive medical care and self-management practices, and continued surveillance measures to track changes in SMBG rates are needed to improve and monitor SMBG trends.     

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.     

Prevalence of functional limitations among adults 60 years of age and over: United States, 1999-2002

In the 1999-2002 National Health and Nutrition Examination Survey (NHANES), participants were asked a series of questions designed to evaluate functional status. Some questions assessed performance on selected activities of daily living (ADLs) and instrumental activities of daily living (IADLs), while others assessed mobility, strength, endurance, and social participation. This report contains prevalence estimates and standard errors for adults, 60 years of age and over, who reported difficulty performing these activities without the aid of special equipment or who were not able to perform these activities. Results are reported by sex, age group, race and ethnicity, and body mass index (BMI). Assessment of functional status plays an important role in monitoring the health problems and needs of older Americans.     

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

Lower extremity disease (LED), including peripheral arterial disease (PAD) and peripheral insensate neuropathy (PN), is a chronic condition that disproportionately affects older persons and persons with diabetes. LED can result in disabling foot complications (e.g., ulcers, infection, gangrene, or amputation). PAD has been associated with increased risk for cardiovascular morbidity and mortality. For this report, CDC analyzed data collected during 1999-2002 from the National Health and Nutrition Examination Survey (NHANES) to update previously published estimates of the prevalence of LED among persons aged > or =40 years with and without diabetes. The results of this analysis indicated that approximately 18% of persons aged > or =40 years had LED and that LED was twice as prevalent among persons with diabetes as among those without diabetes. Approximately two thirds of persons with LED and half of those with both diabetes and LED were asymptomatic. Multiple complications of LED can be prevented if LED is detected early. Increasing knowledge among clinicians and the public of the prevalence of LED and associated risk factors might lead to early detection, intervention, and treatment to prevent disabling consequences.     

Self-rated fair or poor health among adults with diabetes--United States, 1996-2005

Diabetes mellitus affects nearly 21 million persons in the United States. Maintaining and improving health-related quality of life among persons with diabetes is a public health goal. Healthy People 2010 includes self-rated health as one of three surveillance tools that can be used to measure health-related quality of life. To assess the prevalence of self-rated fair or poor health among U.S. adults with diabetes and to identify factors associated with fair or poor health, CDC analyzed 1996-2005 Behavioral Risk Factor Surveillance System (BRFSS) data. This report summarizes the findings of that analysis, which indicated that self-rated fair or poor health was three times more common among adults with diabetes than among those without diabetes and that the prevalence increased during 1996-2005 among young adults (i.e., aged 18-44 years) with diabetes. The results underscore the need for 1) continued interventions to promote healthy behaviors and prevent diabetes and 2) interventions for persons with diabetes to help them better manage their diabetes and prevent diabetes complications, which can increase their perceived quality of life.     

Disparities in secondhand smoke exposure--United States, 1988-1994 and 1999-2004

No level of exposure to secondhand smoke (SHS) is safe. Breathing SHS can cause heart disease and lung cancer in nonsmoking adults and increases the risk for sudden infant death syndrome, acute respiratory infections, middle-ear disease, and exacerbation of asthma in children. In the United States, exposure to SHS declined approximately 70% from the late 1980s through 2002, most likely reflecting widespread implementation of laws and policies prohibiting smoking in indoor workplaces and public places during this period. Although the major sources of SHS exposure for nonsmoking adults are the home and workplace, the primary source of SHS exposure for children is the home; therefore, eliminating smoking in workplaces and public places is less likely to reduce children's exposure to SHS. This report examines changes in the prevalence of self-reported SHS exposure at home and changes in any exposure, as measured by serum cotinine (a biologic indicator of SHS exposure), in nonsmoking children, adolescents, and adults. The analysis was conducted using data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys (NHANES). The results indicated that self-reported SHS exposure at home and SHS exposure as measured by serum cotinine declined significantly (i.e., by 51.2% and 44.7%, respectively) in the U.S. population from 1988-1994 to 1999-2004; however, the decline was smaller for persons aged 4-11 years and 12-19 years. These results underscore the need to continue surveillance of SHS exposure and to focus on strategies to reduce children's SHS exposure.     

天津市社区成年人超重及肥胖现况分析

目的 了解天津市成年人超重和肥胖流行现状,为制定相应干预措施提供科学依据。方法 按分层整群随机抽样方法,抽取天津市内24个社区≥18岁常住居民进行问卷调查及身体检查。结果 调查对象超重率为34.3%(8 072/23 533),肥胖率为10.7%(2 518/23 533),按2000年全国人口标化后,标化超重率为30.2%,标化肥胖率为9.2%。高于2002年中国居民营养与健康状况调查结果;中年组超重率最高,为41.7%(3 099/7 431),老年组肥胖率最高,为13.9%(932/6 703),青年组超重率和肥胖率均为最低;中、老年组超重和肥胖合计>50%;调查对象腹型肥胖率最高,老年组腹型肥胖率男性为22.1%,女性为25.5%。结论 天津市社区居民超重和肥胖患病率较高,男性中老年人群应为防治重点。     

School-associated suicides--United States, 1994-1999

During 1994-1999, at least 126 students carried out a homicide or suicide that was associated with a private or public school in the United States. Although previous research has described students who commit school-associated homicides, little is known about student victims of suicide. To describe the psychosocial and behavioral characteristics of school-associated suicide victims, CDC analyzed data from school and police officials. The results of that analysis indicated that, among the 126 students who carried out school-associated homicides or suicides, 28 (22%) died by suicide, including eight who intentionally injured someone else immediately before killing themselves. Two (7%) of the suicide victims were reported for fighting and four (14%) for disobedient behavior in the year preceding their deaths; none were associated with a gang. However, potential indicators of suicide risk such as expressions of suicidal thoughts, recent social stressors, and substance use were common among the victims. These findings underscore the need for school staff to learn to recognize and respond to chronic and situational risk factors for suicide.     

Prevalence of obesity among adults with arthritis --- United States, 2003--2009

Obesity and arthritis are critical public health problems with high prevalences and medical costs. In the United States, an estimated 72.5 million adults aged ≥ 20 years are obese, and 50 million adults have arthritis. Medical costs are estimated at $147 billion for obesity and $128 billion for arthritis each year (1-3). Obesity is common among persons with arthritis (2) and is a modifiable risk factor associated with progression of arthritis, activity limitation, disability, reduced quality-of-life, total joint replacement, and poor clinical outcomes after joint replacement (4,5). To assess obesity prevalence among adults with doctor-diagnosed arthritis, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for the period 2003-2009. This report summarizes the results of that analysis, which determined that, among adults with arthritis, 1) obesity prevalence, on average, was 54% higher, compared with adults without arthritis, 2) obesity prevalence varied widely by state (2009 range: 26.9% in Colorado to 43.5% in Louisiana), 3) obesity prevalence increased significantly from 2003 to 2009 in 14 states and Puerto Rico and decreased in the District of Columbia (DC), and 4) the number of U.S. states with age-adjusted obesity prevalence ≥ 30.0% increased from 38 (including DC) in 2003 to 48 in 2009. Through efforts to prevent, screen, and treat obesity in adults, clinicians and public health practitioners can collaborate to reduce the impact of obesity on U.S. adults with arthritis.     

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).     

Prevalence of overweight and risk of overweight among 3- to 5-year-old Chicago children, 2002-2003

This article reports the first estimates of overweight prevalence in Chicago children entering school (aged 3-5 years). Chicago data are compared with those from the National Health and Nutrition Examination Survey (NHANES) and the Early Childhood Longitudinal Study (ECLS). Data were from 2 separate convenience samples of children aged 3-5 years attending either 18 Chicago Public Schools or 10 Chicago Catholic School pre-K programs (n = 1517). Data were taken from students' Certificate of Child Health Examination (CCHE), completed by a health professional. Overall, the prevalence of overweight subjects (body mass index >or=95th percentile) was 24%, more than twice that of the national prevalence of 10% for 2- to 5-year olds documented by NHANES (1999-2002) and 3 times that of the 1998-1999 ECLS prevalence estimate of 8% for 5- to 7-year olds in the Midwest region. The data reported here document that nearly one quarter of children entering school in Chicago are already overweight. This clearly establishes a need for local schools to develop protocols and procedures to support the physical and mental health needs of affected and at-risk children. The findings also make it plain that ongoing weight status monitoring is needed and that current plans to implement this should go forward.