Addressing diabetes disparities through sub-county analysis of multiple data sources

Diabetes continues to be a persistent source of health disparities in the US. These disparities are unevenly distributed throughout the US, within individual states and within local communities. Multiple sources of data provide insights into the impact of diabetes at the local level, including death certificate, clinical and survey data. Expanded sampling of BRFSS in the local community and adaptation of CDC weighting formulas for sub-county analysis facilitated the use of BRFSS for this analysis. Acquisition of Hospital Discharge, Emergency room utilization and vital statistics data also facilitated analyses supporting planning and policy development. Results of the analyses of the multiple sources of data including relative risk analysis and GIS mapping showed high minority areas of the community had approximately twice the relative risk of other areas of the community for mortality and self-reported prevalence. However, the same areas had four times the relative risk for hospital use and emergency room use for diabetic conditions. These analyses show that the burden of these disparities not only falls on the individuals and their families, but also on the community that is burdened with extensively disproportionate utilization and cost of care resulting from these disparities. This approach to local analysis applied in Jacksonville, Florida has profound implications for planning and policy development at the local level. These analyses illustrate how effectively addressing disparities will require informed policy development and comprehensive planning supported by analysis of data at the local level. Beyond planning and policy development, questions also emerged concerning BRFSS survey methods.