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Marguerite McNeely, MD, MPH Division of General Internal Medicine

Marguerite McNeely, MD, MPH Division of General Internal Medicine University of Washington, Seattle, Washington, USA mcneely@u.washington.edu. NATIONAL DATA. The Behavioral Risk Factor Surveillance System (BRFSS) and The National Health Interview Study (NHIS). OVERVIEW. 1. Background:

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Marguerite McNeely, MD, MPH Division of General Internal Medicine

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  1. Marguerite McNeely, MD, MPH Division of General Internal Medicine University of Washington, Seattle, Washington, USA mcneely@u.washington.edu NATIONAL DATA The Behavioral Risk Factor Surveillance System (BRFSS) and The National Health Interview Study (NHIS)

  2. OVERVIEW 1. Background: - Overview of census data - Overview of diabetes - Description of national health surveys 2. Is Type 2 Diabetes more prevalent in Asian Americans and Pacific Islanders? - BRFSS data - NHIS data

  3. Hispanics (16.3%) included in above races BACKGROUND

  4. Reference: http://www.census.gov/prod/2004pubs/censr-17.pdf

  5. BACKGROUND: Asian Americans 31% were born in US • Range: 60.5% (Japanese) to 22.2 % (Thai) 80% speak a language other than English at home - 60% speak English “very well” Reference: http://www.census.gov/prod/2004pubs/censr-17.pdf

  6. BACKGROUND: Diabetes Affects ~25.8 million Americans (8.5% of US population) Type 1 Diabetes • autoimmune, most commonly occurs <age 30 Type 2 Diabetes • Most common form of diabetes (90-95%) • Risk factors include: older age, overweight/obesity, race/ethnicity • ~1/3 of people with type 2 diabetes are undiagnosed. References: Screening for Type 2 diabetes. Diabetes Care v27(suppl 1) Jan 2004 CDC National Diabetes Fact Sheet, available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

  7. BACKGROUND: National Data Behavioral Risk Factor Surveillance System (BFRSS) • State-based health department monthly telephone survey • Includes listed & unlisted residence phone numbers • Representative of each states’ population (survey sampling techniques) • Conducted in English and Spanish • No proxy responses; includes one adult over age 18 per household • Data from 50 states, Wash DC, Guam, Puerto Rico, US Virgin Islands compiled by US Centers for Disease Control & Prevention (CDC) Reference: http://www.cdc.gov/brfss/index.htm

  8. BRFSS 2001 data Prior to 2001: BRFSS combined Asians with Pacific Islanders. 2001 – 1st year that BRFSS released data where Asians and Pacific Islanders were categorized separately

  9. BRFSS 2001 results Number of Respondents ≥30 Years of Age Reference: McNeely & Boyko, Diabetes Care 27:66-69, 2004

  10. BRFSS 2001 results *P<0.001 compared with other groups, unadjusted comparisons Reference: McNeely & Boyko, Diabetes Care 27:66-69, 2004

  11. BRFSS 2001 results *P<0.001 compared with other groups, unadjusted comparisons Reference: McNeely & Boyko, Diabetes Care 27:66-69, 2004

  12. BRFSS 2001 results *P<0.001 compared with other groups, unadjusted comparisons Reference: McNeely & Boyko, Diabetes Care 27:66-69, 2004

  13. BRFSS 2001 results Odds of Prevalent Diabetes Adjusted for Age & Sex Reference: McNeely & Boyko, Diabetes Care 27:66-69, 2004

  14. BRFSS 2001 results Odds of Prevalent Diabetes Adjusted for Age, Sex & BMI Reference: McNeely & Boyko, Diabetes Care 27:66-69, 2004

  15. BACKGROUND: National Data National Health Interview Study (NHIS) • Conducted by the National Center of Health Statistics for CDC • Representative of US population (survey sampling techniques) • In-person household interviews of non-institutionalized civilians • Interviewers from the US Bureau of the Census • Includes adults and children from all 50 states and Wash DC • Includes proxy responses • Over-sampling: Blacks and Hispanics; now also Asians References: http://www.cdc.gov/nchs/nhis/about_nhis.htm

  16. NHIS: 2006-2008 Characteristics of Respondents ≥18 Years of Age Reference: Lee, Brancati and Yeh, Diabetes Care, 34:353-357, 2011

  17. NHIS: 2006-2008 Reference: Lee, Brancati and Yeh, Diabetes Care, 34:353-357, 2011

  18. NHIS: 2006-2008 Odds of Prevalent Diabetes in Asian Subgroups Versus Whites Adjusted for age, sex, BMI cat, education, nation of birth, income, smoking, alcohol, leisure activity Reference: Lee, Brancati and Yeh, Diabetes Care, 34:353-357, 2011

  19. NATIONAL DATA: Limitations • Non-English speaking people under-represented • Self-reported height, weight & diabetes status • Doesn’t capture undiagnosed diabetes • NHIS - no publically available data on Pacific Islanders

  20. NATIONAL DATA: Conclusions • BRFSS & NHIS: prevalent diabetes is ~ 60-70% higher in Asian Americans than whites, after taking into account age, sex and BMI. • BRFSS: prevalent diabetes is ~ 3 times higher in Pacific Islanders than whites. • NHIS: among Asian Americans, the risk of diabetes is especially high among Asian Indians and Filipinos.

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