Talbert J, Wackerbarth SB, Hattman KB; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 40.
Martin School of Public Policy and Administration, University of Kentucky, 433 Patterson Office Tower, Lexington, KY 40506-0027; Tel: (859) 257-5742; Fax: (859) 323-1937; E-mail: jtalb1@uky.edu
RESEARCH OBJECTIVE: Type-II diabetes mellitus is now a recognized epidemic among American children, and its incidence continues to increase. Numerous studies of minority populations, drawing on data from diabetes clinics, have documented the emergence of the epidemic, which appears to be disproportionately concentrated in African American, Hispanic American, and Native American populations. Genetic factors aside, studies based on clinical data have proven the epidemic to be closely linked with obesity, a factor which hugely increases the likelihood that a child will develop the three leading risk factors for type-II diabetes: high insulin levels, high blood pressure, and elevated triglyceride levels. The close link between obesity and type-II diabetes is undisputed, and though studies of type-II diabetes in children have focused primarily on minority populations, ample evidence exists for the spread of the obesity epidemic among American children of all ethnicities. It is the lifestyle changes contributing to the obesity epidemic over the past several decades that are the primary environmental culprits in the diabetes epidemic. Our study relies on Kentucky Medicaid data to chart the epidemic over the past ten years within the population of poor white Kentucky children and adolescents. By showing that the rate of increase for type-II diabetes within this cohort is approximately equal to the corresponding statistic within minority populations examined in clinical studies, we demonstrate that in addition to genetic factors linked to ethnicity, the lifestyle of poverty is a central factor responsible for the epidemic. STUDY DESIGN: Statistical analysis of 8 years of Kentucky Medicaid claims data from 1994 to 2001. Trends of disease incidence were determined by calculating the portion of members with a primary or secondary diagnosis of type-II diabetes. In addition to tracking incidence rates over time, we then build yearly datasets for members with diabetes focusing on utilization and expenditures for diabetes related health services, and overall health services (inpatient, outpatient, ER, pharmacy). POPULATION STUDIED: Kentucky Medicaid recipients, aged 2 - 18, with recorded diagnoses of type-II (non-insulin dependent) diabetes mellitus (ICD-9-CM category 250 with fifth-digit subclassification 0 or 2). PRINCIPAL FINDINGS: During the years understudy, approximately 250,000 children received Medicaid services annually. During this timeframe the overall incidence of type-II diabetes was greater than the general population and comparable to the rates found in previously conducted studies of minority populations. Analysis of the incidence trend reveals that factors related to poverty are equivalent or exceed those factors related to genetic predisposition. CONCLUSIONS: The rate of increase for type-II diabetes within a white population (Kentucky children on Medicaid) is equivalent to the rate of increase within minority populations; thus poverty (and resulting obesity) should be included in development of overall policy decisions to address the type-II diabetes epidemic in children. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: By examining a sampling of data across the population of poor white Kentuckians (a genetically homogeneous group), this study illustrated the importance of various environmental factors linked to poverty, in the spread of diabetes in Kentucky children and adolescents. PRIMARY FUNDING SOURCE: Kentucky Department for Medicaid Services
Publication Types:
Keywords:
- Adolescent
- African Americans
- Child
- Diabetes Mellitus
- Diabetes Mellitus, Type 2
- Disease Outbreaks
- Ethnic Groups
- European Continental Ancestry Group
- Health Expenditures
- Hispanic Americans
- Humans
- Incidence
- Indians, North American
- Insulin
- Insulin Resistance
- Kentucky
- Medicaid
- Medical Records
- Minority Groups
- Obesity
- Poverty
- Risk Factors
- economics
- trends
- hsrmtgs
Other ID:
UI: 102273812
From Meeting Abstracts