How Diabetes Affects Missouri Communities Differently: Opportunities to Promote Health Equity
Health disparities and inequalities occur when notable differences in health factors or health outcomes are observed between different populations. In the U.S., significant differences exist between populations of different demographic, socioeconomic and geographic strata in key health outcomes, such as average life expectancy. The study of health disparities dates to 1714 Italy, when Bernardino Ramazzini observed and documented an abnormally high incidence of breast cancer among a group of Catholic nuns compared to married women. The first known linkage of health disparities to social determinants of health occurred in 1840 when statistician Edwin Chadwick quantified significantly lower life expectancy for the working poor in Liverpool, England.
Although the U.S. spends more on health care than any other World Health Organization member nation — 17 percent of gross domestic product in 2012 — health parity remains elusive. The U.S. consistently ranks last in an annual comparison of the health systems of 11 developed countries in terms of quality, access, efficiency, expenditures, health-related quality of life and health equity. Health disparities are powerful determinants of poor health outcomes and excessive health expenditures in the U.S. A notable health disparity in Missouri is that black patients are overrepresented in hospital utilization compared to the total population.
Diabetes has a significant direct and indirect role in health disparities. Cardiovascular disease is the most common cause of death for the entire population in the U.S. The risk of premature death from heart disease or stroke is 50 percent higher for black males than for white males. Moreover, there is a strong correlation between diabetes and cardiovascular health. Cardiovascular death rates are 2 to 4 times higher for individuals with diabetes, and the primary cause of death for 65 percent of all patients with diabetes is heart disease or stroke. One in 10 health care dollars is attributed to diabetes care in the U.S. The total economic burden of diabetes in the U.S. was estimated to be $245 billion in 2012. Adjusting this figure for the Missouri population with diabetes (Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System), suggests the total economic burden of diabetes for Missouri may be in excess of $5.1 billion annually.
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