The diabetes epidemic is taking a large and growing toll on New York City, a new Health Department report shows, as death rates, debilitating complications, and hospitalization costs soar. Some 500,000 New Yorkers - one out of eight adults - have been diagnosed with diabetes. Another 200,000 have diabetes but don't yet know it. The death rate from diabetes rose by 75% between 1990 and 2003.
The new publication, which synthesizes research findings from the past several years, is available at www.nyc.gov/health. In addition to charting the impact of diabetes in NYC, it exposes unacceptable disparities among neighborhoods and racial/ethnic groups.
- New Yorkers in East Harlem, Williamsburg-Bushwick and certain parts of the South Bronx are hospitalized for diabetes at 10 times the rate of people living on the Upper East Side.
- Residents in the most affected areas also die from diabetes at seven times the rate of New Yorkers in the least affected neighborhoods.
- Among racial/ethnic groups, black New Yorkers have the highest death rate from diabetes, dying at three times the rate of white New Yorkers.
"Diabetes is hitting the city hard," said Dr. Thomas R. Frieden, New York City Health Commissioner. "Tragically, it is hurting our low-income communities much more than others. With good management, we can prevent devastating complications of diabetes, such as heart disease, blindness, leg amputations and kidney failure."
New Yorkers with diabetes are now hospitalized at a rate nearly 80% higher than the national rate. And the cost of these hospitalizations has skyrocketed in recent years, hitting $481 million in 2003, up from $242 million in 1990. Figures drawn from national estimates of total diabetes costs, including lost productivity and other non-medical costs, suggest that the economic impact of diabetes in New York City exceeds $6 billion annually.
"Diabetes is not only hurting our health, it's hurting our wallets," said Frieden. "The cost of treating diabetes is an unsustainable burden on our health system and economy. But even worse, behind these statistics are tragic individual stories that challenge our city and our health system to respond."
Diabetes Management is Key
Many diabetes hospitalizations and deaths can be prevented by better management of the disease. Dr. Shadi Chamany, director of the Health Department's Diabetes Prevention and Control program, emphasized that people with diabetes can live long and healthy lives if they carefully manage their blood sugar (an A1C level of less than 7%), blood pressure (less than 130 over 80) and bad cholesterol (LDL level below 100 mg/dL).
While most New Yorkers with diabetes are accessing health care, the report finds that both patients and providers could do much better. Among New Yorkers with diabetes:
- Most had a check-up in the past year, but more than one third did not receive an eye or foot exam.
- About 80% had their blood sugar tested in the past year, but only 16% knew their blood sugar level.
- About 45% had poor control of blood sugar, putting them at risk of serious health complications.
- One in five New Yorkers with diabetes is a smoker
The Health Department monitors blood sugar control citywide by requiring clinical laboratories to report blood sugar (A1C) test results to a central registry. This registry - the first of its kind in the nation - will enable the Health Department to give clinicians and patients feedback and resources that can improve the quality of care and quality of life for New Yorkers with diabetes.
The New York City Health and Nutrition Examination Survey, conducted by the Health Department in 2004, provided the first-ever estimates on diabetes prevalence and blood sugar control by using interviews, blood tests, and medical exams. This survey provided baseline data for tracking diabetes over time.
- The Department's Primary Care Information Project is working to improve health outcomes by helping primary care providers adopt electronic health records that make it easier to track and manage diabetes and other chronic conditions. The first phase of this initiative is now under way in the South Bronx, where the Health Department is working with providers who care for low-income patients.
- The Diabetes Public Health Detailing Campaign, completed in 2006, engaged more than 5,000 primary health care providers citywide to improve care and treatment of people with diabetes.
- The Diabetes Quality Improvement Collaborative works with clinics and hospitals in the City's highest-risk neighborhoods to improve care for people with diabetes.
- The Department has also launched programs to promote physical activity as part of a healthy lifestyle. SPARK is a training initiative for daycare and school staff to incorporate physical activity into education. Shape Up New York is a free family fitness program offered at parks, community centers and housing sites around the City.
- The Department also promotes healthy eating through the Healthy Bodegas Initiative and the Health Bucks program, aimed at increasing the accessibility of healthy food in the city.
The report drew upon numerous city and state data sources. Data on risk factors and health care indicators came from the New York City Community Health Survey (CHS), an annual telephone survey of 10,000 New York City adults. The survey derives health information from self-report.
Diabetes prevalence was assessed in the New York City Health and Nutrition Examination Survey (NYC-HANES) using a one-time blood test.
Hospitalization data come from the Statewide Planning and Research Cooperative System (SPARCS; New York State Department of Health, 2006) and consists of hospital discharge records for acute care hospitals in New York State.
Data were also complied from the 2000 Census, Medicare, and Medicaid records. A complete list of sources is available at the conclusion of the report.