Western Michigan University, College of Health & Human Services, Interdisciplinary Health Sciences, Kalamazoo, MI 49008, USA.
Public Health Rep. 2013 May-Jun;128(3):212-20. doi: 10.1177/003335491312800311.
To efficiently help communities prevent and manage diabetes, health departments need to be able to target populations with high risk but low resources. To aid in this process, we mapped county-level diabetes-related rates and resources/use using publicly available secondary data to identify Michigan counties with high diabetes prevalence and low or no medical and/or community resources.
We collected county-level diabetes-related rates and resources from Web-based sources and mapped them using geographic information systems (GIS) software. Data included age-adjusted county diabetes rates, diabetes-related medical resource and resource use (i.e., the number of endocrinologists and percentage of Medicare patients with diabetes who received hemoglobin A1c testing in the past year), community resources (i.e., the number of certified diabetes self-management education and diabetes support groups), as well as population estimates and demographics (e.g., rural residence, education, poverty, and race/ethnicity). We created GIS maps highlighting areas that had higher-than-median rates of disease and lower-than-median resources. We also conducted linear, logistic, and Poisson regression analyses to confirm GIS findings.
There were clear regional trends in resource distribution across Michigan. The 15 counties in the Upper Peninsula were lacking in medical resources but higher in community resources compared with the 68 counties in the Lower Peninsula. There was little apparent association between need (diabetes prevalence) and diabetes-related resources/use. Specific counties with high diabetes prevalence and low resources were easily identified using GIS mapping.
Using public data and mapping tools identified diabetes health-service shortage areas for targeted public health programming.
为了有效地帮助社区预防和管理糖尿病，卫生部门需要能够针对高风险但资源有限的人群。为此，我们利用公共可用的二手数据绘制了县级糖尿病相关比率和资源/利用情况图，以确定密歇根州具有高糖尿病患病率、低或无医疗和/或社区资源的县。
我们从基于网络的来源收集了县级糖尿病相关比率和资源，并使用地理信息系统 (GIS) 软件对其进行了映射。数据包括年龄调整后的县糖尿病发病率、与糖尿病相关的医疗资源和资源利用情况（即，过去一年中内分泌科医生的数量以及医疗保险患者中接受糖化血红蛋白检测的比例）、社区资源（即，经认证的糖尿病自我管理教育和糖尿病支持小组的数量），以及人口估计和人口统计数据（例如，农村居住、教育、贫困和种族/族裔）。我们创建了 GIS 地图，突出显示了疾病发病率高于中位数且资源低于中位数的区域。我们还进行了线性、逻辑和泊松回归分析以确认 GIS 结果。
密歇根州的资源分布存在明显的区域趋势。上半岛的 15 个县缺乏医疗资源，但社区资源比下半岛的 68 个县更高。需要（糖尿病患病率）与糖尿病相关资源/利用之间似乎没有明显的关联。使用 GIS 制图很容易识别出具有高糖尿病患病率和低资源的特定县。
利用公共数据和映射工具确定了糖尿病卫生服务短缺地区，以便有针对性地开展公共卫生规划。
