DefinitionThe diabetes death rate: the number of deaths attributed to diabetes per 100,000 people, age-adjusted to the 2000 U.S. population.
NumeratorNumber of deaths among New Mexico residents due to diabetes as the underlying cause of death.
DenominatorEstimated total number (population) of New Mexico residents.
Data Interpretation IssuesDiabetes deaths include those with ICD10 codes E10 - E14. The International Classification of Diseases (ICD) is a coding system that provides the rules for coding and classifying causes of death. Diseases listed on death certificates are assigned specific ICD codes. The ICD is developed collaboratively between the World Health Organization (WHO) and 10 international centers, such as the U.S. National Center for Health Statistics.
This system allows death data to be collected and compared among different areas. Under the ICD, the underlying cause of death is the disease or injury that started the sequence of events leading directly to death.
In addition, multiple causes of death can also be assigned; these are all the diseases or injuries which led to death. Diabetes can be one of the multiple causes of death in significant percentages of heart disease and stroke deaths. Thus the diabetes death rates shown here are an underestimate of the extent of diabetes-related deaths, since the rate is based only on the underlying cause and doesn't reflect its influence on heart disease or stroke deaths.
Why Is This Important?In 2017, diabetes was the 6th leading cause of death for New Mexicans and the 7th leading cause in the U.S. Diabetes complications, which are costly to individuals, families and to society, include premature death, cardiovascular disease, blindness, end stage kidney disease, and lower extremity amputations. People with diabetes are two to four times more likely to develop cardiovascular disease and stroke; about 65% of deaths in people with diabetes nationwide are due to these conditions. Costs of diabetes extend beyond medical costs, such as costs due to lower productivity, disability and loss of productive life due to premature death, and care-taking by family members. Effective and accessible diabetes prevention and management programs and resources are necessary to reverse the increasing rates of diabetes in our communities and reduce diabetes complications.
Healthy People Objective: D-3, Reduce the diabetes death rateU.S. Target: 66.6 deaths per 100,000 population
Other ObjectivesNew Mexico Community Health Status Indicator (CHSI)
How Are We Doing?Diabetes Mortality rates for both New Mexico, in 2017 and 2016, and the US, in 2016, were far below the HP 2020 target of 66.6 deaths per 100,000 population. New Mexico age-adjusted diabetes death rate was 27.2/100,000 in 2016 and 26.3/100,000 in 2017, down from 34.6/100,000 in 2003. National age-adjusted rates have been lower, 25.5/100,000 in 2003 and 21.0/100,000 in 2016, the most recent year available.
The number of New Mexico diabetes deaths (i.e., numerator) ranged from a low of 500 in 2000 to a high of 673 deaths in 2017. Recall, though, that the rate has declined. The increase in number of deaths is largely due to population increase. From 2000 to 2017, an annual average of 613 diabetes deaths occurred, with a total of 11,030 diabetes deaths over that 18 year period.
In 2017, the age-adjusted rate for females, 22.5/100,000, was statistically significantly lower than that for males, 30.5/100,000. This relationship varied, somewhat, by age group, however, as rates for males did not always differ significantly from that of females across age groups, even using three years of combined data, 2015-2017.
Race/Ethnicity Rates: During the period 2015-2017, the New Mexico American Indian population had the highest age-adjusted diabetes death rate, 71.0/100,000, and the White and Asian/Pacific Islander populations had the lowest diabetes death rates, 17.0/100,000 and 19.9/100,000, respectively. The American Indian rate was 3.5 times that of that of Asian/PI population, four times that of the white population, more than double the rates of the Hispanic population, 32.1/100,000, and 1.5 times that of the population with the second highest death rate, the Black/African American population, 43.1/100,000.
When looking at the race/ethnicity rates by sex, male rates are higher than female rates in all groups except Asian/Pacific Islander, where there was no significant difference. Among males, the American Indian/Alaska Native rate was four times, and the Black/African American rate was two times, higher than the White rate. The American Indian rate was two times higher than the Hispanic rate and the Black/African American rate. Among females, the American Indian/Alaska Native rate was almost five times higher than the White rate, and two times higher than the Hispanic rate. The Hispanic female rate, as with the male rate, was twice the White rate. All these differences are statistically significant.
Urban/Rural: Counties were categorized into Metropolitan, Small Metropolitan, Mixed Urban-Rural and Rural. In 2015-2017, the diabetes death rate was highest in the Mixed Urban-Rural and Rural areas ... 34.8/100,000 and 31.7/100,000, respectively. These rates were similar. The rates in the Metro and Small Metro areas, 21.3/100,000 and 22.9/100,000, respectively, while similar to each other, were statistically significantly lower than those of the Mixed Urban-Rural and Rural areas.
How Do We Compare With the U.S.?From 2000 to 2017 New Mexico rates were 15% to 25% higher than the U.S. rates. Poverty is a significant determinant of illness and death in any population. New Mexico poverty rates have been higher than the US for many decades. New Mexico has a higher proportion of American Indians and Hispanics compared to the US as a whole. For many decades these two populations have experienced higher poverty rates than New Mexico generally. These two New Mexico populations, and the Black/African American population, have had the highest rates of diabetes deaths since 2000. The diabetes death rates for the Black/African American and Hispanic populations were similar in the 3-year period 2015-2017. The diabetes death rate for the American Indian population was statistically significantly higher than all other groups.
What Is Being Done?The NM Department of Health Diabetes Prevention and Control Program (DPCP) works with health care providers and community partners, agencies and coalitions to provide multiple diabetes prevention and management services and programs. Services and programs include: professional development trainings and resources for diabetes prevention and management; the National Diabetes Prevention Program (National DPP), a proven community-based physical activity and nutrition intervention to prevent or delay diabetes in persons at high risk; community resources to help people manage their diabetes through skill building, such as the Chronic Disease Self-Management and Diabetes Self-Management Education Programs; Kitchen Creations cooking schools; and health system disease management interventions that improve blood glucose, blood pressure, and cholesterol.
The DPCP provides education, information, and resources about prediabetes and diabetes, particularly to health care providers, to increase screening, testing and referral to prevention and management programs. This includes a centralized referral and data system that helps providers easily make referrals to the above programs. DPCP?s partners support built environment improvements so people at risk for or with diabetes can be physically active and initiatives that increase access to healthy foods. Both are essential components of effective population-based diabetes prevention and control. The DPCP consults with populations that are disproportionately affected by diabetes and/or those that serve them to develop programs and services that are culturally appropriate for these populations.
Evidence-based PracticesDiabetes and its complications can be prevented, delayed and/or managed through participation in evidence-based programs, including the National Diabetes Prevention Program or NDPP (provided in a clinical, community, or web-based setting), the Diabetes Self-Management Education Program or DSMEP (provided in a community or web-based setting), and Diabetes Self-Management Education and Support programs or DSME/S (usually provided in a clinical setting). Improving the quality of clinical care for people with and at risk for diabetes is also an evidence-based practice. The following DPCP activities are in alignment with these accepted programs and practices:
1. Increase use of the NDPP to prevent or delay onset of type 2 diabetes among people at high risk by raising awareness about prediabetes and the NDPP, increasing delivery sites, facilitating the screening and referral process, and working to obtain health insurance coverage (including Medicaid) for the program.
2. Increase access to sustainable self-management education and support services (DSMEP and DSME/S) to improve control of A1C, blood pressure, and cholesterol, and to promote tobacco cessation, by increasing delivery sites, facilitating the referral process, and working to obtain health insurance coverage (including Medicaid) for the programs.
3. Implement evidence-based worksite programs and policies that help people prevent or manage diabetes and related chronic conditions, promote tobacco cessation, and help employees improve control of their A1C, blood pressure, and cholesterol.
4. Improve health outcomes for people with and at risk for diabetes by supporting health care organizations to improve quality of care through use of the Planned Care Model, Patient Centered Medical Home, and Electronic Health Record. Within these organizations, support policy and protocol implementation that institutionalize and help sustain quality care improvements.
5. Promote the sustainability of Community Health Workers (CHWs) involved in providing diabetes prevention and management services.