Demography of Diabetes

DATA PRESENTATION | DEC 7, 2010

Stanley Ellicott
Yusuke Kato
Mark Reinardy
Katherine Short
Why Diabetes?
 Diabetes is a metabolic disease: type I/II and gestational forms
 23.6 million US adults and children have diabetes
 Diabetes is the 7th leading cause of death (2006)
 Diabetes cost $174 billion in 2007: $116 billion for direct medical
costs, and $58 billion for indirect costs (disability, loss of work,
premature mortality)
 The most common form of diabetes, “type II,” is almost entirely
preventable through diet and exercise
Source: American Diabetes Association, http://www.diabetes.org/diabetes-basics/diabetes-statistics
Research Questions
1: Are diabetes and level of income/food stamp participation
independent?
2: Is the frequency of diabetes equal across differing levels of
educational attainment?
3: Is there a difference between regions with low/high rates of
exercise with respect to diabetes prevalence?
Data Sources
Education and Food Security
Data are from the 2007 California Health Interview Survey
 51,048 survey participants
 453 variables, including:
 Respondents affirmed “I have been told by a doctor I have
diabetes,” and did not disambiguate Type I/II
 Household income
 Educational attainment
 Data are “Population-based random-digit dial telephone survey
of California’s population conducted every other year since 2001”
 Data gatherers actively sought to fight response bias
Data Sources, cont.
Exercise
National diabetes prevalence rates are from the National Center
for Chronic Disease Prevention & Health Promotion, Behavioral
Risk Factor Surveillance System (2006)
 Respondents affirmed “I have been told by a doctor I have
diabetes,” and did not disambiguate Type I/II

Exercise rates are from the Department of Labor, Bureau of Labor

Statistics, American Time Use Survey (2003-2006)
 Rates are averages from individuals aged 15 and older, by region,
over the 2003-2006 period
 Regions were grouped by exercise rate, and rates are percent of
people aged 15 and older who engaged in exercise on an average
day, by region, 2003-2006 period
Test 1: Summary Statistics
 Test 1: Food Security
HYPOTHESIS: Incidence of diabetes and qualifying for food stamp
benefits are independent
STATISTICAL TEST: Chi-Square test for independence

RESULTS: X2 = 320.52 (DF: 1)

EFFECT SIZE: Phi = .08

INTERPRETATION: With p<.001, we have sufficient evidence to

conclude incidence of diabetes and claiming food
stamp benefits are dependent
Test 1: Food Security, cont.
Two related tests:
1: One-tailed T-test for proportions of those who qualify/do not
qualify for food stamps with diabetes
 Hypothesize proportions are equal
 People qualifying for FS with diabetes: 14.23% + 0.5%
 People not qualifying for FS with diabetes: 9.13% + 0.3%
 Z=17.90
Thus, we conclude there is a significant, positive correlation
between qualifying for food stamps and being diagnosed with
diabetes/pre-diabetes (p<.0001)
Test 1: Food Security, cont.
Two related tests:
2: Chi-Square Test for Independence between two food stamp
classifications: qualified claimers, qualified non-claimers and
status of diabetes: diabetic and pre-diabetic
 Hypothesize independence between categories
 X2 = 4.7704 (DF: 1), P=.029
 Effect Size: Phi = .01
 We have sufficient evidence to conclude receiving food
stamps is not independent of diabetes or pre-diabetes (p<.05)
Test 1: Food Security, cont.
Two related tests:
2A: Two-Sample Test of Proportions to determine the significance
and direction of the difference
 Hypothesize independence between categories
 Z=2.184
 We have sufficient evidence to conclude that among those who
qualify for food stamps, there is a negative relationship between
receiving food stamps and being diagnosed with diabetes/pre-
diabetes (p<.05).
 Food stamp recipients with diabetes/pre-diabetes: 12.13% + 1.81%
 Qualified food stamp recipients who do not claim benefits with
diabetes/pre-diabetes: 14.37% + 0.50%
 Test 2: Education
HYPOTHESIS: Frequency of diabetes cases within levels of
education are equal
STATISTICAL TEST: Chi-Square test for goodness of fit

RESULTS: X2 = 1,303.15 (DF: 6)

EFFECT SIZE: .1599

INTERPRETATION: At p<.0001, we can conclude there is a statistically

significant difference between education levels and
incidence of diabetes
Test 2: Summary Statistics
Test 2: Summary Statistics
Test 3: Summary Statistics
 Area with a low exercise level (yellow & orange), proportion of
people who were told to have diabetes=.089, Sample size=100,589
 Area with a high exercise level (blue & dark blue), proportion of
people who were told to have diabetes=.074, Sample size=128,407
 Test 3: Exercise
HYPOTHESIS: P(diabetes rate in area of low exercise level)
≤ P(diabetes rate in area of high exercise level)

STATISTICAL TEST: 1 Tailed Z test

RESULTS: Z = 12.96, p<.01

INTERPRETATION: Given that P<.01, we have sufficient evidence to

conclude that the diabetes rate in the area of low
exercise level is higher than the diabetes rate in the
area of a high exercise level

Exercise habits have a strong relationship with

diabetes rates
Policy Recommendations
 Increased efforts to enroll qualified participants in food stamp
programs would play an important role in fighting diabetes
among lower income brackets
 Given the disproportionate variability of incidents of diabetes
among groups with lower levels of education attainment, it might
argue for a seminar or program in high schools to inform students
of healthy eating and lifestyle habits
 Restore funding to physical education programs in public
schools to encourage development of healthy exercise habits
Thank you!
Questions?