1. Jeffrey A. Johnson, PhD Stephanie U. Vermeulen, MSc. University of Alberta & Institute of Health Economics August 30, 2007

2. Alberta Diabetes Atlas 2007 provides trends over time, across age and regional variation for DM & related conditions. The prevalence & incidence of DM are increasing in Alberta, and especially among older adults. People with DM have significantly higher rates of CV disease, eye disease, kidney disease, mental health disorders and overall health care use than people without diabetes. ADSS can be used locally to accurately assess what the burden of DM and it’s comorbidities are across Alberta. Creation of an ADSS interactive web site will allow individuals to access rates of DM by region/community in real time. Key Messages…

5. ADSS – A Public Health Service… “Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know.... A surveillance system includes a functional capacity for data collection, analysis and dissemination…” -CDC Surveillance Update, 1988

6. National Diabetes Surveillance System

7. ADSS AHW & IHE/ACHORD partnership Deliverables  ADSS Newsletter  Regular updates and issue-specific focus  Alberta Diabetes Atlas  2007, 2009, 2011  ADSS Website  Timely, region-specific information

8. ADSS Organization Structure ADSS Steering Committee ACHORD/IHE Jeff Johnson Stephanie Vermeulen Greg Hugel Sheri Pohar Sherry Lydynuik ADSS Staff ACHORD/IHE Epi WG HC Utilization WG First Nations WG Eye Disease Kidney Disease WG Mental Health WG CVD WG AHW

9. Alberta Diabetes Atlas 2007 Acknowledgments 1.Background & Methods 2.Epidemiologic Trends, 1995-2005 3.DM & Health Care Utilization 4.DM & Cardiovascular Disease 5.DM & Lower Limb Amputations 6.DM & Kidney Disease 7.DM & Eye Disease 8.DM & Mental Health 9.DM & First Nations People 10.Key Findings & Policy Options Glossary

11. Diabetes Prevalence (Age-Adjusted Rates) After standardizing for age, prevalence increased from 3.8% in 1995 to 5.3% in 2005 in ages 20 years and over

12. Diabetes Prevalence* (Case Counts) * Adult Population

13. Chinook: Diabetes Prevalence* (Case Counts) *Adult Population

14. Diabetes Prevalence Age-Specific Rates, 2005

15. Diabetes Prevalence* Age-Adjusted Rates, 2005 Average Provincial rate = 5.3% Chinook rate = 5.6% * Adult Population

16. Diabetes Incidence (Age-Adjusted Rates) In 2005, the overall incidence was 5.6 per 1000 adult residents. This was an average of 5.1 for females and 6.2 for males.

17. Diabetes Incidence* (Case Counts) * Adult Population

18. Chinook-Diabetes Incidence* (Case Counts) * Adult Population

19. Diabetes Incidence* Age-Adjusted Rates, 2005 Average Provincial Rate = 5.6 per 1000 Chinook Rate = 6.0 per 1000 * Adult Population

20. Diabetes & Mortality* (Age-Adjusted Rates) * Adult Population

22. Diabetes Health Care Utilization Physician Visits, 1995-2005 General Practitioners Specialists*

23. Diabetes Health Care Utilization Physician Visits, 2005 Specialists* General Practitioners Chinook Diabetes Average = 10.0 Chinook Diabetes Average = 2.8

24. Diabetes Health Care Utilization Emergency Department Visits, 2005 Chinook Diabetes Average = 1.4

26. Diabetes & CVD Acute Coronary Syndrome, 1995-2005

28. Diabetes & CVD Diabetes & CVD Age-Adjusted Rates of Acute Coronary Syndrome by Region, 2005

30. Diabetes & Eye Disease Eye Examinations*, 1995-2005 * Eye examinations by an Ophthalmologist

31. Diabetes & Eye Disease Eye Examinations*, 2005 * Eye examinations by an Ophthalmologist

32. Crude Rates of Eye Examination*, 1995-2005 * Eye examinations by an Ophthalmologist Chinook average in 2005: 37% Palliser average in 2005: 53%

33. Diabetes & Eye Disease Laser Photocoagulation, 2005

34. Crude Rates of Retinal Laser Treatment (Photocoagulation), 1995-2005 Chinook average in 2005: 101/10,000 Palliser average in 2005: 375/10,000

36. Diabetes and First Nations First Nations People living in Chinook have much higher rates of diabetes and have the highest age-specific rates of diabetes.

37. Diabetes and the Under 20 Population

38. Under 20: Crude Diabetes Prevalence Rates by Region, 2005 Average Provincial Rate = 0.23 Chinook Rate = 0.29

39. Alberta Diabetes Atlas 2007 Other topics included: DM & Lower Limb Amputation DM & Kidney Disease - Incidence & prevalence of ESRD - Kidney transplants DM & Mental Health - Affective disorders - Anxiety disorders - Psychoses (organic & non-organic) - Substance abuse disorders

40. Alberta Diabetes Atlas 2007 Key Findings & Policy Options Key Findings & Options: 1.Primary prevention to reduce rising prevalence. 2.Secondary prevention to reduce complications. 3.Enhance Quality of Primary Care. 4.Enhance Access to Primary Care. 5.Recognize mental health burden. 6.Enhanced eye care for diabetes. 7.Diabetes in First Nations People. 8.Enhance scope and depth of DM surveillance.

41. ADSS - what is missing…? - what is next…? Conditions:  DM & pregnancy  DM & foot disease  DM & cancer New data:  Laboratory surveillance  Drug Utilization  Risk factor surveillance

42. How YOU can use the ADSS… ADSS can be used by the Regions to more accurately assess what the burden of DM and it’s comorbidities are. Diabetes is one of the conditions expected in performance reports for all health regions in Alberta. ADSS provides important information and specific numbers that can be included in Regional Health Authority business plans/performance reports.

43. ADSS Dissemination* 1.Active dissemination to Regions:  Local presentations  Regional Administration  MOH/PCNs/DECs  Public 2.Ongoing Newsletters 3.ADSS Website *ADSS Dissemination Sub-Committee: J. Johnson, C. Andres, A. Edwards, D. Friesen, R. Lewanczuk

44. ADSS Website ADSS Administrative Access Ability to generate more tailored/specific queries ADSS Administrative Access Ability to generate more tailored/specific queries Health Professional / Regional Access Interactive health region/community level data Ability to generate some tailored queries Links to diabetes resources for health professionals Health Professional / Regional Access Interactive health region/community level data Ability to generate some tailored queries Links to diabetes resources for health professionals Public Access Who We Are and ADSS Structure Goal/objectives of ADSS Health region/community level data as presented in Atlas ADSS Newsletters Links to diabetes information Public Access Who We Are and ADSS Structure Goal/objectives of ADSS Health region/community level data as presented in Atlas ADSS Newsletters Links to diabetes information

45. ADSS Website: Search Criteria All of Alberta Regional Health Authority Sub-Region Community Both Sexes Male Female All Ages 20-34 years 35-49 years 50-64 years 65-74 years 75 + years Rates/Cases from 1995-2005 DM alone or DM & Disease First Nations Status

46. ADSS – Health Research Potential … Clinical and health policy research questions are often stimulated by health surveillance activities. Creation of Atlas 2007 lead to a number of important questions which should be addressed through more in-depth investigation:  Are there differences in health care utilization by socioeconomic status throughout Alberta (across and within health regions)?  Have recently established diabetic nephropathy prevention programs lead to reductions in rates of end-stage renal disease in Alberta?  Do regions with higher rates of eye examinations or eye disease procedures have lower rates of blindness?  Is there a better way to define mental illnesses using the administrative databases?  How many Albertans will be living with diabetes in the next 10 years?

47. DM Incidence Primary Prevention Intervention Control No Intervention ADSS – Health Research Potential …

48. Incidence of MI/Stroke Quality Improvement Intervention Control No Intervention … a province-wide health services research laboratory! DOVE Diabetes Outreach Van Enhancement Study ADSS – Health Research Potential …

49. Alberta Diabetes Atlas 2007 provides trends over time, across age and regional variation for DM & related conditions. The prevalence & incidence of DM are increasing in Alberta, and especially among older adults. People with DM have significantly higher rates of CV disease, eye disease, kidney disease, mental health disorders and overall health care use than people without diabetes. ADSS can be used locally to accurately assess what the burden of DM and it’s comorbidities are across Alberta. Creation of an ADSS interactive web site will allow individuals to access these numbers in real time. Key Messages…

50. ? jeff.johnson@ualberta.ca svermeulen@ihe.ca www.ACHORD.ca Questions…