PATTERNS OF HEALTHY BEHAVIOR AND DIABETES MEDICAL OUTCOME

Transcription

1 PATTERNS OF HEALTHY BEHAVIOR AND DIABETES MEDICAL OUTCOME Isabel Corcos, PhD, MPH 1, Leslie Ray, MPH, MPPA, MA 1,2, Ryan Smith, MPH 2, Barbara M. Stepanski, MPH, Joshua Smith, PhD, MPH 1, Sanaa Abedin, MPH 2, Amelia Kenner-Brininger, MPH, CPH 1, Maria Pena, MPH 2, Kimberley De Vera, BS 1. 1 County of San Diego Health and Human Services Agency, Public Health Services, Emergency Medical Services 2 County of San Diego Health and Human Services Agency, Public Health Services, Community Health Statistics Unit

2 SAN DIEGO COUNTY, CALIFORNIA 5 th largest county in the U.S. (4,200 sq. mi.) 18 cities, 3.1 million residents Major tourist destination, 5 climate zones! 41 communities (aggregated census tracts) Reflect diverse population, lifestyles, urbanicity across county Allow consistent analysis of demographic & health data over time Excluding military population which is part of a different medical system

3 THE VISION Building Better Health Living Safely Thriving 3

4 TODAY S PRESENTATION FOCUS Continues work presented at 2014 ESRI Health GIS conference Showed that health-related data from a large consumer marketing survey correlated plausibly with diabetes medical outcomes

5 WHAT WE KNOW ABOUT DIABETES IN SAN DIEGO COUNTY Hospitalization 200 San Diego County Medical Outcome Rates per 100,000 population, ED Discharge Hospitalization Emergency Department (ED) Discharge Death Death General spatial trends: Lower rates in north coastal, north central & north inland areas Higher rates in the southern, eastern areas In some communities, rates often too statistically unstable to calculate *Sources: Patient Hospitalization Discharge Database (CA OSHPD), County of San Diego, Health & Human Services Agency, Public Health Services, Epidemiology & Immunization Services Branch. SANDAG, Current Population Estimates, Emergency Department Discharge Database (CA OSHPD), County of San Diego, Health & Human Services Agency, Public Health Services, Emergency Medical Services. SANDAG, Current Population Estimates, LOOKED TO ALTERNATIVE SOURCES FOR HEALTH-RELATED DATA Death Statistical Master Files (CDPH), County of San Diego, Health & Human Services Agency, Public Health Services, Epidemiology & Immunization Services Branch. SANDAG, Current Population Estimates, 2012.

6 USE OF MARKET POTENTIAL DATA TO PROFILE COMMUNITIES Market Potential (2013) data purchased from ESRI Derived from large, national consumer spending/use survey Estimates the likely demand for goods & services Used by business to understand & target consumers Many questions relate to diet, exercise, smoking, medication, medical services use Critical factors to course of most chronic diseases Available at census tract level

7 LIMITATIONS Based on survey, projected behaviors of adults Subject to bias/error on part of those surveyed Variables collected for business purposes, targeting consumers, not for assessing population health Relationship with medical outcome is correlative HOWEVER, WE CAN USE THIS INFORMATION TO UNDERSTAND WHO S DOING WHAT AND WHERE, AND WHO WILL PROBABLY DO IT AGAIN

8 TODAY S PRESENTATION FOCUS Data related to prevalence of diabetes Spatial patterns of health behaviors Community health profiles beyond medical outcome rates

9 VARIABLES CORRELATED WITH DIABETES MEDICAL OUTCOME PERCENT OF ADULTS IN SAN DIEGO COUNTY WHO BUY/USE GOODS & SERVICES (OR DO BEHAVIOR) GREEN: SIGNIFICANT NEGATIVE CORRELATION WITH MEDICAL OUTCOME RED: SIGNIFICANT POSITIVE CORRELATION WITH MEDICAL OUTCOME Category Variable County % Smoking Smoked cigarettes in last 12 months 16.5% Smoked 9+ packs of cigarettes in last 7 days 2.8% Method used to stop smoking/12 mo: Cold Turkey 2.7% Category Variable County % Food Choices Went to fast food/drive-in restaurant 9+ times/mo 39.7% Used white bread in last 6 months 38.1% Drank cola (regular) in last 6 months 44.7% Used artificial sweetener in last 6 months 25.9% Try to eat healthy w/nutrition focus 36.6% Rarely check food ingredients before buying 13.3% Frequently check food ingredients before buying 38.5% Diet Intent Presently controlling diet 35.6% Diet control for blood sugar level 6.6% Diet control for cholesterol level 8.8% Diet control to maintain weight 11.2% Diet control for physical fitness 11.1% Diet control for weight loss 13.3% Used exercise program for diet method 8.4% Product labeling Buy foods specifically labeled as fat-free 13.0% Buy foods specifically labeled as high protein 6.1% Buy foods specifically labeled as low-calorie 10.6% Buy foods specifically labeled as low-carb 6.0% Buy foods specifically labeled as low-cholesterol 6.8% Buy foods specifically labeled as low-fat 12.3% Buy foods specifically labeled as sugar-free 10.1% Category Variable County % Exercise frequency Spend 6+ hours exercising per week 23.8% Spend 3-5 hours exercising per week 23.5% Spend 1-2 hours exercising per week 19.5% Spend no time exercising during a typical week 32.6% Exercise routine Usually follow a regular exercise routine 26.6% Frequently follow a regular exercise routine 33.9% Occasionally follow a regular exercise routine 26.6% Rarely follow a regular exercise routine 12.3% Exercise location Exercise at club 2+ times per week 16.1% Exercise at other facility (not club) 2+ times/wk 8.1% Exercise at home 2+ times per week 27.9% Home equipment Own elliptical 3.9% Own stationary bicycle 5.1% Own treadmill 9.1% Own weight lifting equipment 12.6% Category Variable County % Doctor Visits Visited doctor in last 12 months 73.3% 1-2 times 23.3% 3-5 times 20.8% 6+ times 29.3% Health Professional General/Family 38.4% Dentist 35.8% Eye 19.2% Dermatologist 8.3% Internist 7.2% Chiropractor 6.3% Cardiologist 6.1% Physical Therapist 4.6% Ear/Nose/Throat 4.6% Gastroenterologist 3.9% Nurse Practitioner 3.8% Urologist 3.6% Podiatrist 3.0% Allergist 2.1%

10 DATA RELATED TO DIABETES PREVALENCE Diet control for blood sugar level Prescription drug use for diabetes (insulin dependent) Prescription drug use for diabetes (non-insulin dependent) Indicators of diagnosed disease Positively correlated with diabetes medical outcomes Similar to State survey: 7.8% of San Diego County adults ever diagnosed with diabetes (California Health Interview Survey, 2011) 10.0% 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 6.6% Diet control for blood sugar level Used prescription drug for diabetes (insulin dependent) Used prescription drug for diabetes (non-insulin dependent) 1.7% 3.4% 5.1% 0.4% 2.6% 9.0% 2.4% 4.3% County % Community Min (%) Community Max (%) Data reflect diagnosed diabetes, and are particularly helpful for communities where rates for medical encounter cannot be calculated

11 SPATIAL PATTERNS: HOT SPOT ANALYSIS BY CENSUS TRACT Finds where high values & low values cluster Red: hot spot, high values group Blue: cold spot, low values group Intensity of color reflects degree of confidence in results Hospitalization rates by community shown for reference

12 SPATIAL PATTERNS: HOT SPOT ANALYSIS OF PREVALENCE-RELATED VARIABLES Top to bottom: Used prescription for insulin dependent diabetes Used prescription for non-insulin dependent diabetes Diet control for blood sugar Significant clustering Pattern consistent across 3 variables Hot/cold spots correlated with higher/lower rates of all medical outcomes

13 SPATIAL PATTERNS: HOT SPOT ANALYSIS OF 6 HEALTH BEHAVIOR VARIABLES County mean proportion (%), & the range of values across communities Behavior Percentage of Adults County Minimum (%) Maximum (%) Try to eat healthy w/nutrition focus 36.6% 29.3% 43.1% Frequently check food ingredients before buying 38.5% 35.3% 40.8% Spend 3-5 hours exercising per week 23.5% 18.9% 28.1% Rarely follow a regular exercise routine 12.3% 8.6% 16.0% Went to fast food/drive-in restaurant 9+ times/mo 39.7% 28.0% 46.6% Smoked 9+ packs of cigarettes in last 7 days 2.8% 1.8% 5.4% Diet, exercise & smoking are major players in chronic disease Correlated with diabetes medical outcomes Spatial patterns helpful in understanding these key behaviors

14 SPATIAL PATTERNS: HOT SPOT ANALYSIS BY CENSUS TRACT Try to eat healthy w/ a nutrition focus Frequently check ingredients before buying Spend 3-5h exercising per week Hot spots for high percentage of healthy choices in coastal central and inland valleys Cold spots in the south. Unhealthy choices show the opposite patterning Went to fast food/drive-in 9+ times/mo Smoked 9+ packs of cigarettes last 7 days Rarely follow regular exercise routine Spatial patterns correlate generally with diabetes hospitalization

15 SPATIAL PATTERNS: CLUSTER & OUTLIER ANALYSIS BY CENSUS TRACT Similar to Hot Spot Analysis Identifies clusters of, high (HH) low values (LL) Outliers areas that differ from others within a specified distance: HL- high values near low (orange); LH- low values near high (white)

16 SPATIAL PATTERNS: CLUSTER & OUTLIER ANALYSIS Try to eat healthy w/ a nutrition focus Frequently check ingredients before buying Spend 3-5h exercising per week Clustering similar to hot spot analysis Outliers within communities Many tracts are outliers for multiple variables Went to fast food/drive-in 9+ times/mo Smoked 9+ packs of cigarettes last 7 days Rarely follow regular exercise routine Understanding neighborhood differences can assist in supporting healthy choices, or find areas for targeted outreach

17 PROFILING HEALTHY COMMUNITIES Objective: Identify communities where more people make very healthy choices Identify communities where fewer healthy choices are made Identify which behaviors need support or need change Category Variable County % Exercise frequency Spend 6+ hours exercising per week 23.8% Category Variable County % Spend 3-5 hours exercising per week 23.5% Doctor Visits Visited doctor in last 12 months 73.3% Spend 1-2 hours exercising per week 19.5% 1-2 times 23.3% Spend no time exercising during a typical week 32.6% 3-5 times Exercise routine 20.8% Usually follow a regular exercise routine 26.6% 6+ times 29.3% Health Professional General/Family 38.4% Dentist 35.8% Category Variable EyeCounty % 19.2% Food Choices Went to fast food/drive-in restaurant 9+ times/mo Dermatologist 39.7% 8.3% Frequently follow a regular exercise routine 33.9% Occasionally follow a regular exercise routine 26.6% Rarely follow a regular exercise routine 12.3% Exercise location Exercise at club 2+ times per week 16.1% Used white bread in last 6 months Internist 38.1% 7.2% Exercise at other facility (not club) 2+ times/wk 8.1% Drank cola (regular) in last 6 months Chiropractor 44.7% 6.3% Exercise at home 2+ times per week 27.9% Used artificial sweetener in last 6 months 25.9% Cardiologist Home equipment 6.1% Own elliptical 3.9% Try to eat healthy w/nutrition focus 36.6% Rarely check food ingredients before buying Physical 13.3% Therapist 4.6% Own stationary bicycle 5.1% Frequently check food ingredients before buying Ear/Nose/Throat 38.5% 4.6% Own treadmill 9.1% Diet Intent Presently controlling diet Gastroenterologist 35.6% 3.9% Own weight lifting equipment 12.6% Diet control for blood sugar level Nurse 6.6% Practitioner 3.8% Diet control for cholesterol level Urologist 8.8% 3.6% Diet control to maintain weight 11.2% Podiatrist 3.0% Diet control for physical fitness 11.1% Diet control for weight loss 13.3% Used exercise program for diet method 8.4% Product labeling Buy foods specifically labeled as fat-free 13.0% Buy foods specifically labeled as high protein 6.1% Buy foods specifically labeled as low-calorie 10.6% Buy foods specifically labeled as low-carb 6.0% Buy foods specifically labeled as low-cholesterol 6.8% Buy foods specifically labeled as low-fat 12.3% Buy foods specifically labeled as sugar-free 10.1% Allergist Category 2.1% Variable County % Smoking Smoked cigarettes in last 12 months 16.5% Smoked 9+ packs of cigarettes in last 7 days 2.8% Method used to stop smoking/12 mo: Cold Turkey 2.7%

18 PROFILING HEALTHY COMMUNITIES Ranked communities in deciles from healthiest to least healthy for each variable Buy lowcalorie foods Diet for physical fitness Category Variable County % Exercise frequency Spend 6+ hours exercising per week 23.8% Category Variable County % Spend 3-5 hours exercising per week 23.5% Doctor Visits Visited doctor in last 12 months 73.3% Spend 1-2 hours exercising per week 19.5% 1-2 times 23.3% Spend no time exercising during a typical week 32.6% 3-5 times Exercise routine 20.8% Usually follow a regular exercise routine 26.6% 6+ times 29.3% Health Professional General/Family 38.4% Dentist 35.8% Category Variable EyeCounty % 19.2% Food Choices Went to fast food/drive-in restaurant 9+ times/mo Dermatologist 39.7% 8.3% Frequently follow a regular exercise routine 33.9% Occasionally follow a regular exercise routine 26.6% Rarely follow a regular exercise routine 12.3% Exercise location Exercise at club 2+ times per week 16.1% Used white bread in last 6 months Internist 38.1% 7.2% Exercise at other facility (not club) 2+ times/wk 8.1% Drank cola (regular) in last 6 months Chiropractor 44.7% 6.3% Exercise at home 2+ times per week 27.9% Used artificial sweetener in last 6 months 25.9% Cardiologist Home equipment 6.1% Own elliptical 3.9% Try to eat healthy w/nutrition focus 36.6% Rarely check food ingredients before buying Physical 13.3% Therapist 4.6% Own stationary bicycle 5.1% Frequently check food ingredients before buying Ear/Nose/Throat 38.5% 4.6% Own treadmill 9.1% Diet Intent Presently controlling diet Gastroenterologist 35.6% 3.9% Own weight lifting equipment 12.6% Diet control for blood sugar level Nurse 6.6% Practitioner 3.8% Diet control for cholesterol level Urologist 8.8% 3.6% Diet control to maintain weight 11.2% Podiatrist 3.0% Diet control for physical fitness 11.1% Diet control for weight loss 13.3% Used exercise program for diet method 8.4% Product labeling Buy foods specifically labeled as fat-free 13.0% Buy foods specifically labeled as high protein 6.1% Buy foods specifically labeled as low-calorie 10.6% Buy foods specifically labeled as low-carb 6.0% Buy foods specifically labeled as low-cholesterol 6.8% Buy foods specifically labeled as low-fat 12.3% Buy foods specifically labeled as sugar-free 10.1% Allergist Category 2.1% Variable County % Smoking Smoked cigarettes in last 12 months 16.5% Smoked 9+ packs of cigarettes in last 7 days 2.8% Method used to stop smoking/12 mo: Cold Turkey 2.7% Frequently check ingredients Diet Medical services Exercise Smoking Composite profile for each category Healthy Community Profile

19 PROFILING HEALTHY COMMUNITIES Most to Least Healthy Overall profile, by health behavior category, and by medical outcome Healthy behaviors cluster Community Healthy Community Profile Composite Healthy Behaviors Ranks Diet Exercise Medical Services Medical Outcome Smoking Death Hospitalization ED Discharge Poway San Dieguito North San Diego Jamul Carlsbad Coastal Valley Center Del Mar-Mira Mesa Sweetwater Alpine Elliott-Navajo Harbison Crest Peninsula Coronado Fallbrook Ramona Santee University Kearny Mesa Palomar-Julian Spring Valley La Mesa San Marcos Oceanside Central San Diego Anza-Borrego Springs Escondido Pauma Laguna-Pine Valley Lakeside Vista Lemon Grove El Cajon Mountain Empire South Bay Southeastern San Diego Chula Vista Mid-City National City Communities with lower medical outcome rates also have more health-oriented adults (correlative) Outliers are apparent Jamul (healthy, but more disease University (less healthy, low disease)

20 WHAT THIS ADDS TO OUR GOAL OF BUILDING BETTER HEALTH Census tract-level data for detailed analysis of community Estimates of diagnosed diabetes prevalence Verification that correlations have a significant spatial component Evaluate community health in areas where medical outcome rates are not calculable

21 WHAT THIS ADDS TO OUR GOAL OF BUILDING BETTER HEALTH Enriched evidence base for data-driven decision-making Ability to monitor trends & forecast challenges to population health Insight into collective impact of key health behaviors

22 For more information please contact Dr. Isabel Corcos County of San Diego, Health & Human Services Agency Public Health Services, Emergency Medical Services