H e alth his to r y. Chapter 3 Health history. s29

Transcription

1 3 H e alth his to r y My mama died from undetected kidney disease in Oct. 22. It was only after 2 years of being treated for high blood pressure, a blood test [was done] to check on her kidneys. She went on dialysis but died a few months later. That s why I got involved and got screened. Thank you for coming and helping us! Participant: Screening date, December, 25 d i a b e t e s h y p e r t e n s i o n c a r d i o v a s c u l a r d i s e a s e o b e s i t y s m o k i n g e v i d e n c e o f k i d n e y d i s e a s e f a m i l y h i s t o r y & c o m o r b i d i t y i n t e r v e n t i o n Chapter 3 Health history s29

2 t i i t i t l f t diabetes e d D M - r e p o r h s e P e r c e n t w Age Gender Race/ethnicity NHANES 99-2 All Male Female White Black Other Hisp s n a p c r a f p t o n i t t e l he program s primary focus is the early detection of CKD in individuals a known history of diabetes or hypertension, or a family history of diabetes, hypertension, or kidney disease. Over 25% of eligible participants report having diabetes or diabetic retinopathy. Rates are highest in older participants. Of the participants who report having diabetes, 38% are prehypertensive, based on criteria from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7); the percent self-reported diabetes increases the severity of hypertension. 3.1 Self-reported diabetes in & NHANES participants, by age, gender, & race/ethnicity c r e P N= 55,22, age & Hispanics; 55,143, gender; 54,11, race. NHANES N= 11, Diabetic Non-diabetic NHANES 99-2 Forty-eight percent of participants who report having diabetes were fund to have an elevated blood sugar, defined as a fasting glucose greater than 126 mg/dl or a non-fasting glucose exceeding 139 mg/dl. 3.2 Normal Pre HTN Stage 1 Stage 2 Normal Pre HTN Stage 1 Stage 2 Blood pressure stages (JNC 7) in & NHANES participants, by self-reported diabetic status N= 53,785. NHANES N= 1,89. Elevated blood pressure is more pronounced in black and NHANES participants compared to whites and people of other races, regardless of diabetic status. Elevated blood pressure occurs in 71 and 33%, respectively, of Hispanic participants and out diabetes. e d B P e v a h e P e r c e n t w 1 Diabetic White Black OtherHispanic Male Female Non-diabetic NHANES 99-2 White Black OtherHispanic Male Female A measured glucose greater than the normal limit is nearly eight times more evident in participants who report having diabetes than in those who report no diabetes. 3.3 Elevated blood pressure (JNC 7) in & NHANES participants, by race/ethnicity, gender, & self-reported diabetic status N= 54,35, gender; 53,182, race. NHANES N= 9,421. s3 National Kidney Foundation Kidney Early Evaluation Program 26

3 self-reported DM NHANES Normal Prehypertension Stage 1 Stage Self-reported diabetes in & NHANES participants, by blood pressure stage (JNC 7) N= 54,32. NHANES N= 1,89. glucose > NL Age Gender Race/ethnicity Self-reported DM No self-reported DM All Male Female White Black Other Hisp 3.5 Measured glucose > normal limit in participants, by age, gender, race/ethnicity, & self-reported diabetic status N= 53,217, age & Hispanic; 53,152, gender; 52,95, race. diabetes SR : Age Race/ethnicity NHANES 99-2: Age Race/ethnicity * * * * White Black Other Hispanic * * * 3.6 of & NHANES participants self-reported diabetes, by education & insurance status, age, & race/ethnicity N= 51,954, age & Hispanics; 5,952, race. NHANES N= 11,165. *Sample size less than 3 or coefficient of variation not less than 3%. Chapter 3 Health history s31

4 hypertension HTN self-reported Age Gender Race/ethnicity NHANES All Self-reported hypertension in & NHANES participants, by age, gender, & race/ethnicity N= 54,56, age & Hispanics; 54,433, gender; 53,353, race. NHANES N= 11,271. Male Female White Black Other Hisp glucose > than NL NHANES 99-2 Self-rep. HTN No self-rep.htn Measured glucose greater than the normal limit in and NHANES participants, by self-reported hypertension N= 53,62. NHANES N= 9,717. elevated glucose 3 2 Self-reported HTN No self-reported HTN NHANES White Black OtherHispanic Male Female White Black OtherHispanic Male Female 3.9 Measured glucose greater than the normal limit in & NHANES participants, by gender, race/ethnicity, & self-reported hypertension status N= 51,956 race; 52,997, gender. NHANES N= 9,717. ver 52% of participants report having hypertension, compared to one-quarter of individuals in the general population. Proportions of participants self-reported hypertension increase age, are comparable in males and females, and are slightly higher in blacks compared to whites, individuals of other races, and Hispanics. Elevated blood glucose a measure glucose greater than the normal limit is more evident in participants who report having hypertension compared to those not reporting the condition, and is s32 National Kidney Foundation Kidney Early Evaluation Program 26

5 HTN self-reported NHANES Normal glucose Glucose >NL Self-reported hypertension in and NHANES participants, by glucose level N= 53,62. NHANES N= 9,717. BP Stage Age Gender Race/ethnicity Self-reported HTN No self-reported HTN All Male Female White Black Other Hispanic Measured blood pressure Stage 1 hypertension (JNC 7), in participants, by age, gender, race/ethnicity, & self-reported hypertension N= 53,623, age; 53,554, gender; 52,485 race. SR hypertension 1 : Age Race/ethnicity White NHANES 99-2: Age Race/ethnicity Black 61+ Other 6 Hispanic Self-reported hypertension in & NHANES participants, by education & insurance status, age, & race/ethnicity N= 51,796, age; 5,88, race. NHANES N= 9,717. *Sample size less than 3 or coefficient of variation not less than 3%. * most prominent in males and individuals of other races. The percent of participants a measured blood pressure greater than Stage 1 (JNC 7) is four times higher in those who report being hypertensive, increases age, and is highest in blacks, at 25.2%, compared to 2, 17.3, and 18.2%, respectively, in whites, individuals of other races, and Hispanics. In both the and NHANES populations, and across all age and race/ethnicity groups, rates of self-reported hypertension are highest in participants less than a high school education. Chapter 3 Health history s33

6 cardiovascular disease % cardiovascular disease Age All Gender Race/ethnicity Male Female White Black Other Hispanic 3.13 Cardiovascular disease in participants, by age, gender, & race/ethnicity N= 54,173, age; 54,111, gender; 53,3, race. % cardiovascular disease Age CKD No CKD All Gender Race/ethnicity Male Female White Black Other Hispanic 3.14 Cardiovascular disease in participants & out CKD, by age, gender, & race/ethnicity N= 45,311 age & gender; 44,4, race. early 18% of participants report a history of cardiovascular disease (CVD), including a heart attack, bypass surgery, angioplasty, stroke, heart failure, peripheral vascular disease, or arrhythmia. Rates are most pronounced in older participants, and reach 35% in those age 75 and older. Twenty percent of white participants report having CVD, compared to 17, 15.5, and 15.1%, respectively, of blacks, individuals of other races, and Hispanics. Nearly 27% of participants CKD report a diagnosis of CVD, compared to 15% in those out the disease. By race/ethnicity, rates of CVD are 1 13% higher in participants CKD compared to those not having the diagnosis. The most common risk factor for cardiovascular disease reported by participants CKD is an elevated blood pressure nearly 77% of participants cardiovascular disease have associated elevated blood pressure. Rates of cardiovascular disease are highest in participants who have less than a high school education. s34 National Kidney Foundation Kidney Early Evaluation Program 26

7 risk factor With cardiovascular disease CKD No CKD SRDM BMI 3 Elv BP Hist of Smoking WHO Anemia Without cardiovascular disease SRDM BMI 3 Elv BP Hist of Smoking WHO Anemia 3.15 Reported risk factors in participants & out cardiovascular disease N= 41,354. disease cardiovascular : Age Race/ethnicity NHANES 99-2: Age Race/ethnicity White Black Other Hispanic of & NHANES participants cardiovascular disease, by education & insurance status, age, & race/ethnicity N=52,398, age; 51,381, race. NHANES N= 9,99, participants age 2 and older. *Sample size less than 3 or coefficient of variation not less than 3%. * * * * * * * * * * Chapter 3 Health history s35

8 obesity NHANES 99-2 OW: 32.9 N: 21.7 UW:.8 N: 33.6 UW: 2. EO: 8.8 OW: 34.2 EOB: 4.9 OB: 35.8 OB: distribution of & NHANES participants, by BMI category N= 54,466. NHANES N= 1,132. participants NHANES 99-2 Underweight Normal Overweight Obese Extremely obese of 2 1 Male Female Male Female 3.18 BMI in & NHANES participants, by gender & BMI category N= 54,396. NHANES N=1,132. participants 6 4 NHANES 99-2 Underweight Normal Overweight Obese Extremely obese participants 5 Underweight Normal 4 Overweight 3 Obese Extremely obese of 2 of 2 1 White Black Other Hispanic White Black Other Hispanic Northeast Midwest South West 3.19 BMI in & NHANES participants, by race/ethnicity N= 53,292. NHANES N=1, BMI in participants, by U.S. Census Region N= 54,446. s36 National Kidney Foundation Kidney Early Evaluation Program 26

9 % self-reported DM or HTN NHANES 99-2 Diabetes Hypertension * UW N OW OB EOB Diabetes Hypertension of participants NHANES 99-2 BMI<25 (kg/m 2 ) BMI 25-<3 (kg/m 2 ) BMI 3+ (kg/m 2 ) NormalPre HTNStage 1 Stage 2 NormalPre HTNStage 1 Stage & NHANES participants self-reported diabetes or hypertension, by BMI category N= 53,321; NHANES N= 1,127, diabetes; 9,998, hypertension. *Sample size less than 3 or coefficient of variation not less than 3% BMI in & NHANES participants, by measured blood pressure (JNC 7) N= 53,626. NHANES N= 9,781. BMI 3 kg/m : Age Race/ethnicity NHANES 99-2: Age Race/ethnicity White Black Other Hispanic of & NHANES participants a BMI 3 kg/m 2, by age, race/ethnicity, education, & insurance status N= 51,723, age; 5,732, race. NHANES N= 9,959. ver three-fourths of participants are classified as being overweight to extremely obese, compared to a 64% rate in the general population. Of eligible participants, 8% of males and 76% of females are, at the least, overweight, and females have a higher rate of overall obesity than males, at 47 and 4%, respectively. By race/ethnicity, over 4% of black participants are classified as obese and 12% are extremely obese, compared to 33.3 and 7.3% of whites. By Census region, the percent of participants who are obese to extremely obese ranges from 39% in the West to 48% in the Midwest. Obesity is more evident in participants selfreported hypertension compared to those selfreported diabetes 61.1% compared to 31.3%, while 56% of participants diagnosed Stage 2 hypertension (JNC 7) have a BMI equal to or exceeding 3 kg/m 2. Irrespective of insurance and educational status, the highest rates of obesity are generally found in participants age 46 6, and black participants are more prone to this condition. Chapter 3 Health history s37

10 smoking history patients of NHANES 99-2 Smoking Used to smoke Never smoked 3.24 distribution of & NHANES participants, by smoking status N= 51,88. NHANES N= 1,261. of participants NHANES 99-2 Never smoked Used to smoke Smoking White Black Other Hispanic White Black Other Hispanic 3.25 Smoking status in & NHANES participants, by race/ethnicity N= 5,726. NHANES N= 1,261. self-reported DM NHANES Smoking Used to smoke Never smoked 3.26 Self-reported diabetes in & NHANES participants, by smoking status N= 51,336. NHANES N=1,258, participants age 2 and older. s38 National Kidney Foundation Kidney Early Evaluation Program 26

11 self-reported HTN NHANES 99-2 CKD NHANES 99-2 Smoking Used to smoke Never smoked Smoking Used to smoke Never smoked 3.27 Self-reported hypertension in & NHANES participants, by smoking status N= 51,181. NHANES N= 1,137, participants age 2 and older CKD in & NHANES participants, by smoking status N= 42,571. NHANES N= 8,7. smoking history : Age Race/ethnicity NHANES 99-2: Age Race/ethnicity White Black Other Hispanic 3.29 & NHANES participants a history of smoking, by education & insurance status, age, & race/ethnicity N= 48,92. NHANES N= 1,45. hirteen percent of participants report that they currently smoke, compared to 25% of the general population. Nearly 3% used to smoke, and 57.4% report never having smoked. In the population, smoking is most common in individuals of other races. Almost 31% of those who used to smoke report having diabetes, compared to 24% who never smoked and 22% who currently smoke. Close to 6% of participants who used to smoke report being hypertensive, compared to 51% who never smoked and 46% who currently smoke. One-third of eligible participants who used to smoke report a diagnosis of CKD, in comparison to 28% of those who never smoked, and 24% who currently smoke. In both the and NHANES populations, the percent of participants a history of smoking is greatest in those less than a high school education. Chapter 3 Health history s39

12 evidence of kidney disease condition Number condition 5, 4, 3, 2, 1, Total in category 15 in category Kidney disease Kidney stones 12 Kidney dis./stones 9 condition 6 3 Kidney disease Kidney stone Both All Male Female All Male Female 3.3 Self-reported kidney problems in participants N= 53, Self-reported kidney problems in participants, by gender N= 53,489. condition 5, 4, 3, Total in category Kidney disease Kidney stones Both condition in category condition 5, 4, 3, Total in category Kidney disease Kidney stones Both condition in category Number 2, 1, 6 3 Number 2, 1, 6 3 All White Black Hispanic Other All White Black Hispanic Other All NE MW S W All NE MW S W 3.32 Self-reported kidney problems in participants, by race/ethnicity N= 52, Self-reported kidney problems in participants, by U.S. Census Region N= 53,526. f eligible participants, more than 4,1 report having kidney stones (8.%), while 2.2% report having kidney problems. Kidney stones are more common in males than in females. Eleven percent of white participants report kidney stones, compared to 4, 7, and 7.6%, respectively, of blacks, individuals of other races, and Hispanics. Kidney stones are reported by 8.% of participants living in the South and West, 7.4% in the Northeast, and 6.5% in the Midwest. In the population, 13.5% of whites are classified as having Stage 2 CKD. Stage 2 CKD is evenly distributed in blacks, people of other races, and Hispanics, ranging form %. In NHANES participants, Stage 3 CKD is more prominent in whites, at 2.1%, followed by blacks, individuals of other races, and Hispanics, at 15.5, 14., and 12.%, respectively. s4 National Kidney Foundation Kidney Early Evaluation Program 26

13 8 6 Stage 1 Stage 2 Stage 3 Stages participants of NHANES * * All White Black Other Hispanic 3.34 CKD in & NHANES participants, by CKD stage & race/ethnicity N= 12,7, NHANES N= 1,55. *Sample size less than 3 or coefficient of variation not less than 3%. CKD : Age Race/ethnicity NHANES 99-2: Age Race/ethnicity White Black Other Hispanic * * 3.35 CKD in & NHANES participants, by education & insurance status, age, & race/ethnicity N= 43,8, age; 42,24, race. NHANES N=9,567. *Sample size less than 3 or coefficient of variation not less than 3%. Chapter 3 Health history s41

14 family history & comorbidity 6 CKD Diabetes (SR) HTN (SR) Obesity Smoking risk factor Northeast Midwest South West 3.36 Risk factors in participants, by U.S. Census Region Across all U.S. Census Regions, hypertension is the most commonly reported risk factor for participants, ranging from %. N= 41, DM (family history) family history HTN (family history) KD (family history) Self-rep DM Self-rep NDM 3.37 Family history of diabetes, hypertension, or kidney disease in participants, by self-reported diabetic status N= 5,381. n participants, hypertension is the most commonly reported risk factor in all U.S. Census Regions, ranging from 47.4% in the West to 55.4% in the South. Proportions of diabetes are similar across all regions, ranging from %, and approaching 3% in participants CKD. Eighty-two percent of participants who report no diabetes have a family history of hypertension; in those self-reported diabetes, a family history of hypertension is evident in 74%. The percent of participants a family history of either diabetes, hypertension, or kidney disease does not appear to be related to the severity of hypertension and participant family members are more likely than participants to experience a cardiac event. Two-thirds of participants Stage 1 (JNC 7) hypertension report a family history of diabetes, and 8% report a family history of hypertension. And participant family members are far more likely than participants to have undergone a cardiac procedure or have experienced a cardiac event. s42 National Kidney Foundation Kidney Early Evaluation Program 26

15 family history DM (fam. history) HTN (fam. history) KD (fam. history) Normal Prehypertension Stage 1 Stage Family history of diabetes, hypertension, or kidney disease in participants, by measured blood pressure (JNC 7) N= 49,994. cardiac event Family member Participant family history DM (fam. history) HTN (fam. history) KD (fam. history) 1 HA BPS Angio Stroke HF Arrhyth PVD 2 Normal Stage 1 Stage 2 Stage 3 Stage participants a family member who has had a cardiac event & who have suffered the same cardiac event as a family member N= 53,76, heart attack; 1,117, heart bypass surgery; 1,22, heart angioplasty; 53,651, stroke; 1,7, heart failure; 1,94, arrhythmia; 55,22, PVD. family member N= 52,281, heart attack; 7,95, heart bypass surgery; 51,881, stroke; 7,535, heart failure; 7,24 arrhythmia; 55,22, PVD. 3.4 Family history of diabetes, hypertension, or kidney disease in participants, by CKD stage N= 41,643. Chapter 3 Health history s43

16 intervention % of completing followup form All returning followup form Yes No NA 3.41 participants who complete their followup forms, by year N= 16, participants who return their followup forms, by seeing a physician N= 16,194. who saw a physician BP Glucose Urine CR CCR Hgb Oth Other reasons Not recommended I have no time No insurance I don't believe it is necessary Cannot afford No physician 3.43 Reason for seeing a physician about test results among participants who return their followup forms N= 1,889. Not able to get to appt Don't know Cannot take time off MD said not necessary 3.44 No transportation of participants Reasons why participants do not see a physician after receiving abnormal test results N=4,758. s44 National Kidney Foundation Kidney Early Evaluation Program 26

17 medical intervention OTC medications Prescription Injection Other 3.45 participants who learn they have anemia, & have a medical intervention N= 352. medical intervention Monitor BS Diet adjust. Drug therapy Insulin Other medical intervention Monitored BP Diet adjust. Drug therapy Other 3.46 participants who learn they have diabetes, & have a medical intervention N= 1, participants who learn they have high blood pressure, & have a medical intervention N= 2,248. ntervention following the evaluation is an integral part of the program. On their study followup forms, 67% of participants report seeing a physician after the study. Of these individuals, 5% have seen a physician because of abnormal blood pressure results, while 46.8% have consulted a physician because of an abnormal urine test. For a variety of reasons, some participants do not see a physician after receiving notification of an abnormal test; of these, 12.5% report having no insurance while 12% do not believe the visit is necessary. In participants who learn they have anemia, 32% are placed on over-thecounter medications and 2% receive a prescription drug. Forty-two percent of participants who learn they have diabetes are told to monitor their blood sugar, while 39% undergo drug therapy; in participants who learn they have high blood pressure, 42.6% are told to monitor their blood pressure, and 47% are placed on prescription drugs. Chapter 3 Health history s45

18 chapter highlights Figure 3.1 Over 25% of eligible participants report having diabetes or diabetic retinopathy. Rates are highest in older participants. Figure 3.4 The percent self-reported diabetes increases the severity of hypertension. Figure 3.7 Proportions of participants self-reported hypertension increase age, are comparable in males and females, and are slightly higher in blacks compared to whites, individuals of other races, and Hispanics. Figure 3.1 The proportion of and NHANES participants who report having hypertension is greatest in those an elevated glucose. Figure 3.13 Nearly 18% of participants report a history of cardiovascular disease. Figure 3.17 Over three-fourths of participants are classified as being overweight to extremely obese, compared to a 64% rate in the general population. Figure 3.24 Thirteen percent of participants report that they currently smoke, compared to 25% of the general population. Nearly 3% used to smoke, and 57.4% report never having smoked. Figure 3.42 On their study followup forms, 67% of participants report seeing a physician after the study. JNC 7 Hypertension Normal systolic <12 mmhg & diastolic <8 mmhg Prehypertension systolic mmhg or diastolic 8-89 mmhg Stage 1 systolic mmhg or diastolic 9-99 mmhg Stage 2 systolic 16 mmhg or diastolic 1 mmhg Elevated blood pressure (EBP) (JNC 7) DM or CKD: systolic: 13 mmhg or diastolic: 8 mmhg No DM or CKD: systolic: 14 mmhg or diastolic: 9 mm Hg Diabetes Self-reported diabetes Elevated blood sugar Glucose greater than the normal limit Fasting: >126 mg/dl Non-fasting: >139 mg/dl Risk factors for Cardiovascular disease Diabetes BMI 3 kg/m 2 Smoking history Anemia (WHO definition) Elevated blood pressure CVD definition: Participant reporting any of the following cardiac events: heart attack, heart by-pass surgery, heart angioplasty, stroke, heart failure, stroke, PVD, or arrhythmia CVD definition (NHANES) Participant reporting any of the following cardiac diseases: congestive heart failure, coronary heart disease, angina/angina pectoris, heart attack, or stroke CKD Definition If egfr by K/DOQI MDRD <6 ml/min/1.73 m 2 or egfr 6 ml/min/1.73 m 2 and abnormal albumin/creatinine ratio (ACR 3mg/g) CKD Stages Stage 1: egfr 9, ACR 3 mg/g Stage 2: egfr 6 89, ACR 3 mg/g Stage 3: egfr 3 59 Stage 4: egfr Stage 5: egfr <15 or dialysis U.S. Census Regions NE: Northeast MW: Midwest S: South W: West Body Mass Index Categories UW: underweight, BMI <18.5 N: normal, BMI OW: overweight, BMI OB: obese, BMI EOB: extremely obese, BMI 4 Education & insurance <HS&NIns: Less than a high school education, & no insurance <HS&Ins: Less than a high school education, & insurance HS+&NIns: High school education or greater, & no insurance HS+&Ins: High school education or greater, & insurance Cardia Event definitions HA: Heart Attack BPS: Heart by-pass surgery Angio: Angioplasty HF: Heart failure Arrhyth: Arrhythmia PVD: Peripheral vascular disease s46 National Kidney Foundation Kidney Early Evaluation Program 26