Harvard School of Public Health, Boston, Massachusetts, USA.
Popul Health Metr. 2009 Sep 25;7:16. doi: 10.1186/1478-7954-7-16.
Current US surveillance data provide estimates of diabetes using laboratory tests at the national level as well as self-reported data at the state level. Self-reported diabetes prevalence may be biased because respondents may not be aware of their risk status. Our objective was to estimate the prevalence of diagnosed and undiagnosed diabetes by state.
We estimated undiagnosed diabetes prevalence as a function of a set of health system and sociodemographic variables using a logistic regression in the National Health and Nutrition Examination Survey (2003-2006). We applied this relationship to identical variables from the Behavioral Risk Factor Surveillance System (2003-2007) to estimate state-level prevalence of undiagnosed diabetes by age group and sex. We assumed that those who report being diagnosed with diabetes in both surveys are truly diabetic.
The prevalence of diabetes in the U.S. was 13.7% among men and 11.7% among women >/= 30 years. Age-standardized diabetes prevalence was highest in Mississippi, West Virginia, Louisiana, Texas, South Carolina, Alabama, and Georgia (15.8 to 16.6% for men and 12.4 to 14.8% for women). Vermont, Minnesota, Montana, and Colorado had the lowest prevalence (11.0 to 12.2% for men and 7.3 to 8.4% for women). Men in all states had higher diabetes prevalence than women. The absolute prevalence of undiagnosed diabetes, as a percent of total population, was highest in New Mexico, Texas, Florida, and California (3.5 to 3.7 percentage points) and lowest in Montana, Oklahoma, Oregon, Alaska, Vermont, Utah, Washington, and Hawaii (2.1 to 3 percentage points). Among those with no established diabetes diagnosis, being obese, being Hispanic, not having insurance and being >/= 60 years old were significantly associated with a higher risk of having undiagnosed diabetes.
Diabetes prevalence is highest in the Southern and Appalachian states and lowest in the Midwest and the Northeast. Better diabetes diagnosis is needed in a number of states.
目前美国的监测数据通过国家层面的实验室检测和州层面的自我报告数据来估计糖尿病的患病率。自我报告的糖尿病患病率可能存在偏差，因为受访者可能不知道自己的患病风险。我们的目的是按州估计确诊和未确诊糖尿病的患病率。
我们使用国家健康和营养调查（2003-2006 年）中的逻辑回归来估计一组卫生系统和社会人口统计学变量的未确诊糖尿病患病率。我们将这种关系应用于行为风险因素监测系统（2003-2007 年）中的相同变量，以按年龄组和性别估计未确诊糖尿病的州级患病率。我们假设在两项调查中都报告患有糖尿病的人确实患有糖尿病。
美国 30 岁及以上男性的糖尿病患病率为 13.7%，女性为 11.7%。年龄标准化的糖尿病患病率最高的是密西西比州、西弗吉尼亚州、路易斯安那州、德克萨斯州、南卡罗来纳州、阿拉巴马州和佐治亚州（男性为 15.8%至 16.6%，女性为 12.4%至 14.8%）。佛蒙特州、明尼苏达州、蒙大拿州和科罗拉多州的患病率最低（男性为 11.0%至 12.2%，女性为 7.3%至 8.4%）。所有州的男性糖尿病患病率均高于女性。未确诊糖尿病的绝对患病率，占总人口的百分比，在新墨西哥州、德克萨斯州、佛罗里达州和加利福尼亚州最高（3.5%至 3.7%），在蒙大拿州、俄克拉荷马州、俄勒冈州、阿拉斯加州、佛蒙特州、犹他州、华盛顿州和夏威夷州最低（2.1%至 3%）。在没有确诊糖尿病的人群中，肥胖、西班牙裔、没有保险和年龄在 60 岁及以上与未确诊糖尿病的风险增加显著相关。
糖尿病的患病率在南部和阿巴拉契亚州最高，在中西部和东北部最低。一些州需要更好的糖尿病诊断。
