Health Outcomes in the SSHVS Population Study Loretta R Cain, MPH, PhD The University of Chicago
Background Objective measures to assess status of prevalent health conditions are needed to identify: Diagnosed disease Undiagnosed disease Pre-disease Undiagnosed and pre-disease states are important opportunities for intervention to improve health trajectories and reduce cost and disease burden in the population Objective measures carry more weight than self-report with health professionals and policymakers 2
Analytic Methods and Results 3
Hypertension Hypertension Categories No Hypertension If self-reported, physician diagnosed hypertension = No hypertension AND Systolic blood pressure < 120 mmhg and Diastolic blood pressure < 80 mmhg Pre-Hypertension Systolic blood pressure 120 mmhg and <140 mmhg and Diastolic blood pressure 80 mmhg and < 90 mmhg Diagnosed Hypertension If self-reported, physician diagnosed hypertension = Hypertension Undiagnosed Hypertension If self-reported, physician diagnosed hypertension = No hypertension AND Systolic blood pressure 140 mmhg or Diastolic blood pressure 90 mmhg NHLBI. (n.d.) What are High Blood Pressure and Prehypertension. Retrieved from http://www.nhlbi.nih.gov/hbp/hbp/whathbp.htm 4
Population Study Health Outcomes: Hypertension (n=264) 14% 15% 21% 1-NO HYPERTENSION 2-PRE-HYPERTENSION 3-DIAGNOSED HYPERTENSION 4-UNDIAGNOSED HYPERTENSION 50% 5
90.0% 80.0% 70.0% 60.0% 50.0% Hypertension Distribution by Age Group (n=264) 51.8% 84.4% 40.0% 30.0% 20.0% 20.9% 31.9% 29.7% 17.6% 15.8% 17.2% 15.2% 10.0% 5.4% 4.8% 5.4% 0.0% Ages 35-49 Ages 50-64 Ages 65+ 1-NO HYPERTENSION 2-PRE-HYPERTENSION 3-DIAGNOSED HYPERTENSION 4-UNDIAGNOSED HYPERTENSION 6
60.0% 50.0% Hypertension Distribution by Gender (n = 264) 47.4% 51.7% 40.0% 30.0% 20.0% 14.1% 23.0% 15.5% 16.7% 19.0% 12.6% 10.0% 0.0% Male 1-NO HYPERTENSION 3-DIAGNOSED HYPERTENSION 2-PRE-HYPERTENSION Female 4-UNDIAGNOSED HYPERTENSION 7
Diabetes Mellitus Diabetes Mellitus Categories No Diabetes If self-reported, physician diagnosed diabetes = No Diabetes AND HbA1c < 5.7% Pre-Diabetes HbA1c 5.7% - 6.4% Diagnosed Diabetes If self-reported, physician diagnosed diabetes = Diabetes Undiagnosed Diabetes If self-reported, physician diagnosed diabetes = No Diabetes AND HbA1c 6.5% NLM. (2014) A1c Test. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm 8
Population Study Health Outcomes: Diabetes (n=246) 7% 18% 51% 1-NO DIABETES 2-PRE-DIABETES 3-DIAGNOSED DIABETES 4-UNDIAGNOSED DIABETES 24% 9
70.0% 60.0% 59.8% Diabetes Distribution by Age Group (n=246) 50.0% 40.0% 45.0% 41.4% 30.0% 20.0% 10.0% 0.0% 28.1% 28.5% 23.5% 22.3% 22.7% 9.5% 10.0% 7.2% 2.0% Ages 35-49 Ages 50-64 Ages 65+ 1-NO DIABETES 2-PRE-DIABETES 3-DIAGNOSED DIABETES 4-UNDIAGNOSED DIABETES 10
60.0% 50.0% 51.5% Diabetes Distribution by Gender (n=246) 49.7% 40.0% 30.0% 20.0% 22.3% 19.2% 25.8% 17.8% 10.0% 6.9% 6.6% 0.0% Male Female 1-NO DIABETES 2-PRE-DIABETES 3-DIAGNOSED DIABETES 4-UNDIAGNOSED DIABETES 11
Body Mass Index BMI = weight (lb) / [height (in)] 2 x 703 NHLBI. (2014). Assessing Your Weight and Health Risk. Retrieved from http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/risk.htm 12
Population Study Health Outcomes: BMI (n = 255) 0% 17% UNDERWEIGHT NORMAL 53% 30% OVERWEIGHT OBESE 13
60.0% 50.0% BMI Distribution by Age Group (n=255) 55.1% 50.0% 52.9% 40.0% 30.0% 28.3% 29.7% 31.2% 20.0% 16.7% 19.5% 16.0% 10.0% 0.0% Ages 35-49 Ages 50-64 Ages 65+ UNDERWEIGHT NORMAL OVERWEIGHT OBESE 14
70.0% BMI Distribution by Gender (n=255) 60.0% 58.3% 50.0% 45.9% 40.0% 35.0% 30.0% 25.2% 20.0% 18.5% 16.5% 10.0% 0.0% 0.6% 0.0% Male Female UNDERWEIGHT NORMAL OVERWEIGHT OBESE 15
Depression No Depression If self-reported, physician diagnosed depression = No Depression Depression If self-reported, physician diagnosed depression = Depression 16
Population Study Health Outcomes: Self-Reported Depression (n = 267) 20% Yes No 80% 17
90.0% 80.0% Depression Distribution by Age Group (n = 267) 80.4% 80.1% 80.7% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 19.6% 19.8% 19.3% 10.0% 0.0% Ages 35-49 Ages 50-64 Ages 65+ DEPRESSION NO DEPRESSION 18
90.0% 80.0% Depression Distribution by Gender (n = 267) 80.2% 80.5% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 19.8% 19.5% 10.0% 0.0% Male DEPRESSION NO DEPRESSION Female 19
Conclusions Interpret the findings Hypertension (64%) Diabetes Mellitus (25%) BMI (53%) Burden of pre-disease Pre-hypertension (21%) Pre-diabetes (24%) Overweight (30%) Limitations Generalizability Recall Bias 20
Next Steps Today s workshop give us the opportunity to compare findings with NYC HANES data. What would we expect? Primary data collection at a population level is costly. Difficult to find funders who want to pay for these data in these communities. Is there a lower cost way to generate accurate estimates for disease and pre-disease in the population? Abel Kho and NYC Macroscope projects are going to help us answer this question 21