Change in Diabetes Prevalence and Control among New York City Adults: NYC Health and Nutrition Examination Surveys 2004–2014
National examination surveys provide trend information on diabetes prevalence, diagnoses, and control. Few localities have access to such information. Using a similar design as the National Health and Nutrition Examination Survey (NHANES), two NYC Health and Nutrition Examination Surveys (NYC HANES) were conducted over a decade, recruiting adults ≥ 20 years using household probability samples (n = 1808 in 2004; n = 1246 in 2013–2014) and physical exam survey methods benchmarked against NHANES. Participants had diagnosed diabetes if told by a health provider they had diabetes, and undiagnosed diabetes if they had no diagnosis but a fasting plasma glucose ≥ 126 mg/dl or A1C ≥ 6.5%. We found that between 2004 and 2014, total diabetes prevalence (diagnosed and undiagnosed) in NYC increased from 13.4 to 16.0% (P = 0.089). In 2013–2014, racial/ethnic disparities in diabetes burden had widened; diabetes was highest among Asians (24.6%), and prevalence was significantly lower among non-Hispanic white adults (7.7%) compared to that among other racial/ethnic groups (P < 0.001). Among adults with diabetes, the proportion of cases diagnosed increased from 68.3 to 77.3% (P = 0.234), and diagnosed cases with very poor control (A1C > 9%), decreased from 26.9 to 18.0% (P = 0.269), though both were non-significant. While local racial/ethnic disparities in diabetes prevalence persist, findings suggest modest improvements in diabetes diagnosis and management.
KeywordsDiabetes Control diabetes Biomonitoring Health inequalities
Support for NYCHANES 2013–2014 was primarily provided by the de Beaumont Foundation with additional support from the Robert Wood Johnson Foundation, Robin Hood, the New York State Health Foundation, Quest Diagnostics, and the Doris Duke Charitable Foundation, NYC Department of Health and Mental Hygiene, Hunter College Office of the Provost, the City University of New York (CUNY) Vice Chancellors Office of Research, and the CUNY School of Public Health Dean’s Office. Additional support was provided by the Centers for Disease Control and Prevention-funded NYU-CUNY Prevention Research Center (U48DP005008). The contents of this paper are solely the responsibility of the authors and do not represent the official views of the funders.
The authors thank the many people at CUNY and the New York City Health Department who provided support to the survey, including our dedicated field staff team, as well as study participants who made the study possible. We are also grateful to Charon Gwynn, James Hadler, Sonia Angell, Katherine Sutkowi, Winfred Wu, and Sandra Echeverria for their valuable suggestions for this manuscript.
All authors have contributed to the conception, analysis, interpretation, writing, and final approval of the manuscript and will take public responsibility for its content. LT, SP, and AF designed the study being described; RK, LT, CC, and JRL cleaned, analyzed, and verified the data; LT and RK drafted most sections of this manuscript; and SC and SP led the editing and refinement process. All authors reviewed and commented on the manuscript.
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