The Burden of Diabetes in South Carolina 2009

Chapter 1. Demographics and Access to Health Care

Figure 1.1. South Carolina Estimated Population Distribution as of July 1, 2007 Data Source: ORS, Generated by DHEC Chronic Disease Epidemiology & Evaluation February 2009

Figure 1.2. Trends in Race/Ethnic Populations (other than white and African American) Data Source: ORS, Generated by DHEC Chronic Disease Epidemiology & Evaluation February 2009

Figure 1.3. Age Distribution of Estimated Population as of July 1, 2008 Data Source: ORS, Generated by DHEC Chronic Disease Epidemiology & Evaluation February 2009

Oconee Pickens Anderson Abbeville Greenville Spartanburg Cherokee Laurens Union Edgefield Greenwood McCormick Newberry Saluda Aiken Chesterfield Fairfield Kershaw Lancaster Lexington Chester York DarlingtonDillon Florence Georgetown Horry Marion Marlboro Williamsburg Beaufort Berkeley Charleston Colleton Dorchester Hampton Jasper Allendale Bamberg Barnwell Orangeburg CalhounClarendon Lee RichlandSumter Figure 1.4. Urban, Rural and Very Rural Counties Based on Size of Largest Town Urban Rural Very Rural Data Source: ORS, Generated by DHEC Chronic Disease Epidemiology & Evaluation February 2009

Figure 1.5. South Carolina Primary Care Health Professional Shortage Assessment by Type, as of June 2007 Generated by DHEC Chronic Disease Epidemiology & Evaluation Data Source: February 2009

Fig 1.6. Physicians Employed in South Carolina, County Total Data Source: ORS, Generated by DHEC Chronic Disease Epidemiology & Evaluation February 2009

Fig Number of Certified Diabetes Educators by County, 2008 < 8.9% % > 10.3% State Rate: 9.6% Diabetes Prevalence Data Source: AADE, Generated by Chronic Disease Epidemiology and Evaluation February 2009

Fig 1.8. Pharmacists Employed in South Carolina, 2005 Data Source: ORS, Generated by DHEC’s Chronic Disease Epidemiology & Evaluation February 2009

Figure 1.9. South Carolina DPCP* Diabetes Coalitions Beaufort Clarendon Spartanburg Cherokee Union Greenville Pickens Oconee Anderson Abbeville Greenwood McCormick Laurens Saluda York Chester Fairfield Newberry Edgefield Lancaster Kershaw Richland ● Lexington Aiken Calhoun Sumter Lee Barnwell Bamberg Allendale Hampton Horry Colleton Charleston Dorchester Berkeley Georgetown Jasper Williamsburg Chesterfield Marlboro Dillon Darlington Florence Marion Orangeburg ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● Data Source: Diabetes Prevention and Control Program February 2009 Active Non-Active * Coalitions are considered “Non-Active” if no activity has been reported in one year.

Chapter 2. Risk Factors

Chapter 2.a Risk Factors in the General Population

Figure 2.1. Prevalence of Overweight or Obese among Adults by Race-Sex, SC, Percent Data Source: SC BRFSS, Generated by DHEC’s Chronic Disease Epidemiology & Evaluation February 2009

Figure 2.2. Prevalence of Overweight or Obese among Adults, 2007

Figure 2.3. Prevalence of Physical Inactivity among Adults by Race-Sex, SC, Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 2.4. Prevalence of Physical Inactivity among Adults, SC BRFSS, % Physical Inactivity Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 2.5. Prevalence of Consuming Fruits and Vegetables Less Than 5-A-Day among Adults by Race-Sex, SC, % Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Percent Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009 Figure 2.6. Prevalence of Consuming Fruits and Vegetables Less than 5-A-Day among Adults, SC BRFSS, 2007

Figure 2.7. Prevalence of Current Cigarette Smoking among Adults with Diabetes by Race-Sex, SC, 2007 % Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Oconee Pickens Anderson Abbeville Greenville Spartanburg Cherokee Laurens Union Edgefield Greenwood McCormic k Newberry Saluda Aiken Chesterfield Fairfield Kershaw Lancaster Lexington Chester York DarlingtonDillon Florence Georgetown Horry Marion Marlboro Williamsburg Beaufort Berkeley Charleston Colleton Dorchester Hampton Jasper Allendale Bamberg Barnwell Orangeburg Calhoun Clarendon Lee Richland Sumter Percent of Smokers Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009 Figure 2.8. Prevalence of Smoking among Adults, SC BRFSS, 2007

Figure 2.9. Age-Specific Prevalence of Major Behavioral Risk Factors among Adults, SC BRFSS, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Chapter 2.b Diabetes Management and Control

Figure Prevalence of Taking Insulin or Diabetes Pills Among People with Diabetes by Race and Sex, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of Taking Insulin and Diabetes Pills by Age among People with Diabetes, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of Having Blood Glucose Checked among People with Diabetes by Race, Sex, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of Having HbA1c Checked among People with Diabetes, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of Having Eyes Examined among People with Diabetes by Race-Sex, SC BRFSS, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of Eyes Being Affected by Diabetes among People with Diabetes, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of Having Taken a Course for Managing Diabetes among People with Diabetes, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of Receiving Flu Shot in Past 12 Months and Ever Received Pneumonia Vaccine among People with Diabetes, SC, Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of Having Feet Checked by a Health Professional in the Last Year among People with Diabetes, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of Self-Checking Feet for Sores or Irritations among People with Diabetes, By Race, Sex, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of Seeing a Health Professional for Diabetes in Past Year, SC, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Chapter 3. Diabetes Morbidity

Figure 3.1. Prevalence of Self-reported Diabetes by Race-Sex, SC Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 3.2. Prevalence of Self-Reported Diabetes among Adults by Age, SC Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 3.3. Age of Diagnosis of Diabetes among People with Diabetes, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 3.4. Prevalence of Diabetes among Adults, 2007 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 3.5. Proportion of Hospitalizations with Diabetes of All Hospitalizations by Race-Age 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 3.6. Total Number of Hospitalizations for Diabetes as the Primary Diagnosis, SC, Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 3.7. Number of Hospital Discharges with Diabetes as the Primary Diagnosis by Age, SC, 1997, 2001 and 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 3.8. Rate of Hospitalizations with Diabetes as Primary or Secondary Diagnosis, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 3.9. Age-Standardized Rate of Hospitalizations for Diabetes, (Primary Diagnosis), SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Total Hospital Charges (Million Current & Constant $) for Diabetes as the Primary Diagnosis, SC, Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 3.8. Rate of Hospitalizations with Diabetes as Primary or Secondary Diagnosis, 2006 (Rate per 100,000) Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Total Charges for Hospitalization among Patients with Diabetes by Race-Sex, 1987, 1997, 2001, and 2006 Male Female White Black Primary Diagnosis Secondary Diagnosis $1,000,000 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Average Hospital Charge for Diabetes as Primary Diagnosis by Age, SC, Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Sources of Payment for Hospitalization among Patients with Diabetes as the Primary Diagnosis, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Total Length of Hospital Stay for Patients with Diabetes as the Primary Diagnosis, Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Prevalence of CVD and Stroke by Diabetes Status, SC, BRFSS 2006 Data Source: SC BRFSS; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Number of Hospitalizations for Major Diseases & Procedures by Diabetes Status, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Distribution of Complications among Inpatients with Diabetes as Primary Diagnosis, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Age-Adjusted Hospitalization of Diabetic Ketoacidosis by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Age-specific Hospitalization Rates of Diabetic Ketoacidosis by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Age-Adjusted Hospitalization Rate of Diabetic Renal Failure by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Age-Specific Hospitalization Rate of Diabetic Renal Failure by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Dialysis Prevalence with Diabetes as Major Diagnosis, SC, Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Age-Adjusted Hospitalization Rate of Diabetic Dialysis by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Age-Adjusted Hospitalization Rate of Diabetic Lower Extremity Amputation by Race-Sex, SC, Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Age-Specific Hospitalization Rates for Diabetic Foot Amputation by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Percent of Live Births by Mother's Diabetes Status, SC, Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Age-Adjusted Hospitalization Rate of Gestational Diabetes, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Age-Adjusted Rate of ER Visits for Diabetes as the Primary Diagnosis by Race-Sex, SC, Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Rates of ER Visits with Diabetes as the Primary Diagnosis by Age, SC, 1997, 1999, 2001 and 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Age-Standardized Rate of ER Visits for Diabetes, (Primary Diagnosis), SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Number of ER Visits with Selected Diabetic Complications by Race-Sex, SC, 2006 Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure Total Charges for ER Visits with Diabetes as the Primary Diagnosis by Age, SC, Data Source: SC Office of Research and Statistics; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Chapter 4. Diabetes Mortality

Figure 4.1. Age Adjusted Mortality Rate for Diabetes as the Underlying Cause of Death, SC, Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation February 2009

Figure 4.2. Age Adjusted Mortality Rates for Diabetes as the Underlying Causes of Death by Race, Sex, SC, Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation May 2009

Figure 4.3. Age-Specific Crude Mortality Rate for Diabetes as the Underlying Cause of Death, SC, 2006 Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation May 2009

County 3 Year Mortality Rate per 100,0000 Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation February 2009 Figure 4.4. Age-Adjusted Mortality of Diabetes (Underlying Cause of Death), SC,

Figure 4.5. Racial Rate Ratio of Diabetes as the Underlying Cause of Death, SC,

Figure 4.6. Total Number of Years of Potential Life Lost for Diabetes as Underlying Cause of Death by Race-Sex, SC, Before the age of 75 Data Source: SCDHEC SCAN; Generated by Chronic Disease Epidemiology and Evaluation May 2009