Type 2 diabetes mellitus among youth in Puerto Rico, 2003.

AIMS: To describe the clinical characteristics, and estimate the prevalence of type 2 diabetes mellitus among Puerto Rican youth, 1995-2003. METHODS: All patients aged less than 20 years with a confirmed diagnosis of type 2 diabetes were identified from pediatric endocrinologists' medical practices. Medical records of each patient were reviewed to confirm the diagnosis, classify the type of diabetes, and gather sociodemographic and clinical characteristics. From 1995 to 2003 a total of 32,444 records were reviewed. A total of 2,800 children with diabetes were identified, of which 2,702 were type 1 and 93 type 2; typel/type 2 ratio was 29:1. Frequency distributions were obtained for categorical variables, and summary measures (mean +/- standard deviation) for quantitative measure were computed. RESULTS: Mean age at first visit was 14 years. The majority of cases were females (69%), for a female/ male ratio of 2.2:1. 78.5% had a family history of the disease, 74.2% were overweight, and 48% had acanthosis nigricans. 64.5% of the cases were receiving some type of hypoglycemic therapy. 18.5% of the cases had severe hypertension while 17.5% had cholesterol levels considered at increased risk (e"200). The overall prevalence was 13.5 per 100,000 population. CONCLUSIONS: This study is the first that describes the frequency and clinical presentation of type 2 diabetes in children and adolescents in a sample of Puerto Ricans. Further investigations must be conducted to obtain a more precise estimate of the burden of type 2 diabetes in youth and to raise awareness of this condition among health care professionals.

Prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001.

OBJECTIVE To study the prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001. METHODS All medical claims for coronary heart disease (ICD-9 410-414), hypertension (ICD-9 401-405), congestive heart failure (ICD-9 428) and cerebrovascular accidents and transient ischemia (ICD-9:430-438.9) submitted for reimbursement purposes to an insurance company (private and public sector) in Puerto Rico in 2001 were identified. Prevalence and medical care utilization concerning cardiovascular conditions was estimated with 95% confidence. RESULTS Overall prevalence of cardiovascular conditions was 13.5% (95% CI: 11.68%-15.44%), being larger in the private sector (16.0%; 95% CI: 15.98%-16.08% vs. 11.7%; 95% CI: 11.62%-11.77%). Although in both sectors prevalence increased with age, at same age groups was two times higher in the private sector. Hypertension was the most prevalent condition (9.7; 95% CI: 8.14%-11.41%) being higher in females (10.4; 95% CI: 10.37%-10.51%) than in males (8.9; 95% CI: 8.81%-8.96%). The health service utilization (physician's office visits, emergency room visits, and hospital admissions) was higher in males. However, it varies by sectors. CONCLUSIONS Significant difference exists in the prevalence of cardiovascular conditions and health services utilization among private and public sectors in Puerto Rico. The observed differences among the private and public populations imply that there are factors such as socioeconomic status, education, lifestyles, environmental hazards in neighborhoods, and health habits that could be involved in the differences.

Prevalence and correlates of asthma in the Puerto Rican population: Behavioral Risk Factor Surveillance System, 2000.

The 2000 Behavioral Risk Factor Surveillance System (BRFSS) showed that Puerto Rico had the highest self-reported prevalence of asthma. Our objective was to estimate the self-reported prevalence of asthma among different population subgroups and determine its correlates in Puerto Rican adults as reported by the BRFSS. The BRFSS data gathered during 2000 were analyzed. To determine factors associated with self-reported prevalence of asthma, a simple unconditional logistic regression model was employed; then, to estimate adjusted weighted prevalence odds ratios, a multiple unconditional logistic regression model was used. The self-reported weighted prevalence of ever having asthma among Puerto Rican adults was 15.9% (14.8%-16.9%). Asthma prevalence was significantly higher in the following population subgroups: females (18.8%), educational attainment > 12 years (18.4%), having health coverage (16.3%), and obesity (21.0%). Asthma prevalence did not differ among age groups, region of residence, annual income, smoking at least 100 cigarettes in entire life, and physical activity. Almost half (45.6%) of asthmatics reported having children affected with the condition. The prevalence of asthma in any children of the interviewed was 33.2%, 51.3% were receiving treatment, and 30.6% and 24.3% reported having one to three visits to emergency departments and hospital admissions, respectively, resulting from asthma last year. Based on the logistic regression model, the following factors were significantly associated with asthma: sex, high educational attainment, health coverage and obesity. Consistent with previous studies in Puerto Ricans living in the mainland, a higher than expected prevalence of asthma was observed. The possibility of a genetic-environment interaction deserves further investigation.

Health disparities between diabetic patients under private and public health coverage in Puerto Rico, 2000.

OBJECTIVE: To examine health disparities between diabetic patients receiving services in private and public health sectors. METHODS: Insureds with service claims for diabetes (ICD-9 250-259) from two private insurance companies and two public health groups were selected. Personnel of the participant insurance companies were responsible for identifying medical claims that met the study inclusion criteria and providing the information in a computerized database file. RESULTS: Overall prevalence was 4.9%. Prevalence in the public sector (5.8%) was higher than that of the private sector (3.7%) (p < 0.0001). The overall prevalence among females of the public sector was nearly twice (6.3%) the prevalence in the private sector (3.3%) (p < 0.0001). The prevalence of the majority of services analyzed was larger in the public sector. However, prevalence of specific services (glucose and glycosilated hemoglobin tests) was larger in the private sector. Differences between sectors in the prevalence of complications were also observed. Prevalence and service utilization also varied by age and sex in both sectors. CONCLUSIONS: Significant difference exists in the prevalence of diabetes and health service utilization between the private and the public sector.

Prevalence of diabetes mellitus among pregnant women receiving health services at the Puerto Rico University Hospital, Puerto Rico, 1997-1998

OBJECTIVE: To estimate the prevalence and to describe the clinical characteristics of gestational diabetes mellitus (GDM) in pregnant women receiving health care services at the Puerto Rico University Hospital from 1997 to 1998. METHODS: The study design was cross-sectional. All medical records available of pregnant women diagnosed with GDM were retrospectively reviewed. Descriptive statistics such as frequency distributions and summary measures (mean and standard deviation) were used. Annual and 18-month period prevalences of GDM were calculated. Fisher's exact test was used to compare proportions. RESULTS: A total of 78 medical records were available during the 18-month study period (June 1997 to December 1998). The estimated prevalence of GDM was 2 for the total study period (18-month) as well as for the year 1998. The highest proportion (52.3) of GDM cases was found in the 30 years or less age group. Forty-eight percent had a body mass index (BMI) > or = 30 m/kg2 (obese) before pregnancy; however, the weight gained during the last pregnancy was higher than 15 pounds (57). Sixty-four percent of the cases had a family history of diabetes, meanwhile, 34.7 reported a history of GDM during previous pregnancies. During the first prenatal visit, 80.5 reflected glucose levels higher than 110 mg/ml. Preeclampsia (6.4) and macrosomia (14) were the most frequent complications for the mother and the fetus, respectively. DISCUSSION: More epidemiological studies about GMD in Puerto Rico need to be performed to better describe the prevalence of the condition in the island.

Prevalence and associated factors of diabetes mellitus in Puerto Rican adults: behavioral risk factor surveillance system, 1999

OBJECTIVE: To estimate the self-reported weighted prevalence of diabetes mellitus among different population subgroups and determine associated factors in Puerto Rico. METHODS: Data gathered from the Behavioral Risk Factor Surveillance Survey (BRFSS) during 1999 was analyzed. RESULTS: The weighted prevalence in Puerto Rico in 1999 was 9.6 (95 CI: 8.5-10.7), highest than reported nationally. It was higher among individuals with increasing age, female sex, decreasing annual income, decreasing educational attainment, being non-employed, having a health care coverage, high blood pressure, high blood cholesterol, and increasing body mass index. Health behaviors and co-morbid conditions significantly associated with diabetes among individuals aged less than 65 years were high blood pressure, high blood cholesterol, obesity and low educational attainment. However, the only significant characteristic associated with diabetes in individuals aged 65 years or more was female sex. Analysis of the data gathered in the diabetes module revealed that nearly 35 were using insulin, 57.4 were using insulin once a day, 14.4 self-monitored their blood glucose one to three times per day, 18.3 reported they have heard of the glycosylated hemoglobin test, and of these, 71.8 had their test performed between one and six times within the past year. Nearly 42 reported their feet were checked and 54.1 had a dilated eye examination last year. CONCLUSION: The high prevalence of diabetes in Puerto Rico underscores the need for developing integrated management strategies for improving quality of diabetes care.

Prevalence of diabetes and patterns of health services utilization: a comparative analysis between a private and a health reform group of insured, 1997-1998

OBJECTIVE: To compare the prevalence and health services utilization patterns of diabetes mellitus in a group of insured under the Puerto Rico Health Reform Act and the private sector of the same insurance company. METHODS: The medical claims of the public sector insured whose main diagnosis was diabetes mellitus (ICD9-250.0-9) were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: A total of 38,139 diabetic cases were identified during the study period. Overall prevalence was 6.23 (95 CI: 6.17-6.29); 5.22 among males (95 CI: 5.14-5.30) and 7.09 among females (95 CI: 7.00-7.18). The proportion of cases was larger in persons aged 65 years or more (60.3) and females (61.6). Overall, 84.7 of insured diabetics had medical office visits, while 7.8 had emergency room services and 1.3 had hospital admissions. Female cases had more physician office visits (62) and insulin prescriptions (65) compared to males (p < 0.05). The most reported complication was cerebrovascular accident (4.4). The prevalence of diabetes was higher in the public sector (6.23) when compared to the private sector (4.73) (p < 0.01). The mean number of oral hypoglycemic (32.77 +/- 0.40) and insulin (40.99 +/- 0.54) prescriptions were higher in the public sector (p < 0.01). Emergency room utilization rate was larger among males in the younger age groups of the private sector. However, hospital admissions were larger in both sexes of the younger age group of the public sector when compared with the private sector. CONCLUSIONS: A higher prevalence of diabetes and mean service utilization was observed in the public sector. An in-depth analysis of the health care of patients with diabetes in the public sector is needed.

Prevalence of diabetes mellitus among insured of a health insurance company in Puerto Rico: 1997-1998

OBJECTIVE: The purpose of this study was to determine the prevalence of diabetes mellitus in persons covered by a health insurance company. METHODS: The medical claims of persons insured with Triple S Health Insurance Co. of Puerto Rico, whose main diagnosis was diabetes (ICD9-250.0-9), were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: Overall prevalence was 4.73. Prevalence in the male population (5.07) was higher than that of females (4.43) in all age groups, but the difference was not statistically significant (p > 0.05). The proportion of diabetic cases was larger in the > 60 age group. 64 of the cases had 1 or more visits to a physician office, 2 were hospitalized, and almost 3 had emergency room visits. 29 of the cases had insulin prescriptions while 59 had oral prescriptions. The younger age group (< or = 44 years) had a larger utilization rate of emergency room and hospital admissions. Health service utilization varied by age and sex, however, the only significant difference was observed in glucose test services utilization (p < 0.05). CONCLUSIONS: The prevalence of diabetes in this group was lower than the prevalence reported in the Behavioral Risk Factor Surveillance System. This may be partially explained by the fact that the study group did not represent the composition of the Puerto Rican population. Prevalence studies using other groups will be helpful to determine the prevalence of diabetes in Puerto Rico.

The public health burden of diabetes: a comprehensive review

The review of several diabetes epidemiological studies confirms that diabetes is one of the most prevalent non-communicable diseases globally, and it is the fourth or fifth leading cause of death in most developed countries. Diabetes prevalence ranges from nearly 0 in New Guinea to 50 in the Indians of Arizona. No modifiable risk factors have been clearly established in persons with type 1 diabetes, but major environmental determinants have been suggested. Impaired glucose tolerance, gestational diabetes, insulin resistance, obesity and lack of physical activity have been consistently identified as risk factors for type 2 diabetes. The prevalence of diabetes increases with age, but a sex-specific tendency has not been consistent. In addition, the prevalence of diabetes is higher in African-Americans and Hispanics when compared to other ethnic groups. Diabetes affects almost all organs of the body and is the leading cause of blindness and amputations of legs, imposing both clinical and economic costs to patients and society.

Trends in diabetes mellitus mortality in Puerto Rico: 1980-1997

OBJECTIVE: To determine the characteristics and trends of diabetes mortality among the Puerto Rican population from 1980 through 1997. METHODS: Death certificates for Puerto Rican residents whose underlying cause of death was diabetes mellitus (ICD-9-250.0) were reviewed, and sociodemographic information was abstracted. The proportion mortality ratio (PMR) and 95 confidence intervals were calculated by gender, age group, educational level and period of time. Trend analysis in mortality was performed using a Poisson regression model. RESULTS: A total of 26,193 deaths (5.8) were primarily attributed to diabetes mellitus in the study period. Females accounted for 55.8 of all diabetes related deaths. Diabetes accounted for a higher proportion of deaths among persons aged 60-64 years (8.14), persons aged 65-74 (8.12), females (7.73) and those with 1-6 years of education (7.08). The PMR steadily increased from 4.55 in the 1980-85 period to 6.91 in the 1992-97 period. There was a higher mortality in male diabetic subjects aged < or = 64 than in females during the 18 year period. Between 1980 and 1991, females aged 65-74 had a higher mortality than males, however, mortality increased in males of the same age group during 1992-97. When the oldest age group (> or = 75) was examined, males had a higher mortality between 1986 and 1997, whereas females had a slightly higher rate between 1980 and 1985. CONCLUSIONS: Our results indicate that diabetes mortality has been markedly increasing in the Puerto Rican population, primarily in persons aged 65 years or more. Further analysis is needed to evaluate the determinants of mortality in diabetes.

An Epidemiologicaql review of tuberculosis in the Puerto Rican population

Past and recent developments related with tuberculosis (TB) epidemiology in the island were reviewed. Characteristics of the disease such as surveillance, incidence, mortality and the relation of TB with HIV infection were included. TB remains an important public health problem in Puerto Rico and in the Americas, particularly, in HIV-infected patients. From 1981 through 1998, a total of 1,000 AIDS/TB cases has been reported in the island accounting for 4.4 percent of the total of AIDS cases. 82 percent of the AIDS/TB cases were males. The incidence was highest among injecting drug users (IDUs) infected with HIV. The overall incidence of TB in recent years seems to reach a plateau. By the contrary, AIDS/TB cases have been increasing. However, problems of under-reporting must be taken into consideration when analyzing morbidity trends. Adequate and innovative solutions to maintain TB control in the community must be promptly implemented

Perfil sociodemográfico de un grupo de trabajadoras sexuales de Puerto Rico / Sociodemographic profile of a group of sex workers in Puerto Rico

This research explored the sociodemographic characteristics, the health perceptions and the distinctive aspects of the sexual work of a group of women sexual workers (n = 311). The study interest was generating data relative to the use of injectable drugs, the prevalence of sexually transmitted diseases (STD), the prevalence of HIV and the risk behaviors of this population group. A remarkable characteristic of the group of women studied was their history of pregnancies at and early age. A high proportion of illness apparently related to the presence of sexually transmitted diseases and limited health care was observed

Enfermedad renal permanente en Puerto Rico, tendencia de morbilidad y mortalidad 1970-1994 / Permanent renal disease in Puerto Rico, morbidity and mortality trends 1970-1994

To describe the characteristics and trends of the incidence and mortality of End-Stage Renal Diseases (ESRD) in Puerto Rico, a descriptive analysis of the data of all patients treated with dialysis between 1970 through 1994 was conducted. A total of 7,256 patients received dialysis treatment for ESRD in Puerto Rico. Of these, 61 percent were males and 39 percent were females. Diabetes (41.7 percent) and glomerulonephritis (18.3 percent) accounted for the largest number of cases followed by circulatory problems(8.3 percent). Hemodialysis was the predominant treatment modality (76 percent). The incidence trend was significant for the predictor variable period of time after adjusting by age and gender (Poisson). The mortality trend was significant for the predictor variables, period of time, gender and age (Poisson). A substantial increment in the incidence and mortality of persons receiving dialysis was found, particularly in the diabetics, males and elderly persons. The casual explanations of these findings requires further study

Diseño de un sistema de vigilancia epidemiológica para los XVII Juegos Deportivos Centroamericanos y del Caribe, Puerto Rico, 1993 / Development of a system for epidemiologic surveillance for the XVII Central American and Caribbean Sport Games, Puerto Rico, 1993

The probability of recording infectious diseases and injuries to the musculoskeletal system during sports events with a large number of participants is very high. From an historical perspective the distribution and trends of diseases that have an impact on public health have been evaluated by means of epidemiological surveillance systems. However, the application of these epidemiological methods to sports medicine is relatively recent. The utilization of an epidemiological surveillance system during sports events with a large number of participating athletes and countries has been reported in a limited number of competitions. In this article we describe the design of a system for epidemiological surveillance utilized during the XVII Central American and Caribbean Sports Games held in Puerto Rico in 1993, as an example of a surveillance system that could be regularly established in this type of event

Descripción de la morbilidad reportada en el sistema de vigilancia epidemiológica de los XVII Juegos Deportivos Centroamericanos y del Caribe, Puerto Rico, 1993 / Description of morbidity notified in the epidemiologic surveillance system of XVII Central American and Caribbean Sport Games, Puerto Rico, 1993

The objective of the epidemiological surveillance system for the XVII Central American and Caribbean Sports Games in 1993 in Puerto Rico was to estimate the morbidity related to infectious diseases and sports injuries during the competitions. In the village hospital a total of 794 medical consultations were reported; 57.7 per cent of the patients were athletes. Among athletes, the rate of consultation was 10.4 for every 100 participants. The consultations were more frequent in males (535, 67.4 per cent ). The analysis by country of origin revealed that the athletes from Guatemala (42, 9.2 per cent ) and Jamaica (35, 7.6 per cent ) used the services more frequently. The incidence of consultations by sport was higher in field hockey (47, 10.3 per cent ), followed by athletics (46, 10 per cent ), and softball (36, 7.9 per cent ). The most frequent diagnoses were injuries--302, 38.04 per cent ; of these 229 (75.8 per cent ) were athletes--,conditions of the respiratory system (180, 22.67 per cent ), problems of the skin and mucous membranes (85, 10.71 per cent ), and problems of the gastrointestinal tract (56, 7.05 per cent ). The severity of the majority of the conditions was mild and required primary care health professionals