Epidemiology Paper Mazurah Smith University of Phoenix According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, “[By 1993] death certificates listed diabetes as the fifth leading cause of death for Blacks aged 45 to 64, and the third leading cause of death for those aged 65 and older in 1990. ” (Bailey, 2007). These statistics show how serious the problem of diabetes has become in the black community. Epidemiological studies can focus the efforts of the healthcare community to effective interventions aimed at lowering the prevalence and incidence of diabetes among African Americans.
This paper will explore the role of epidemiology in the surveillance of the incidence of diabetes in the morbidity and mortality of Americans of African descent. This paper will also discuss the definition and purpose of epidemiology, epidemiological methods, the epidemiological triangle and levels of prevention as they relate to diabetes in the African American community. Definition and purpose of epidemiology The definition of epidemiology is very important if one is to use the definition to describe its purpose. A common definition of epidemiology is the study of the distribution and determinants of disease frequency in human populations. ” (Savitz, et al, 1999). Scott and Marshall (2008) do a better job when they describe epidemiology as “the analysis of the incidence and spread of disease within populations, with the aim of establishing causality. ” The purpose of epidemiology is to find the causes of diseases that affect a population. The discipline of epidemiology influences the practices of both clinical medicine and public health.
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Epidemiology can be used as a major determinant of evidence based practice because the outcome of surveillance is often used to guide changes in how these disciplines practice. Epidemiological studies can also influence the types of services offered by community agencies if those agencies survey the types of services that would benefit the community. Another purpose of epidemiology is to predict the occurrence of diseases in the future including where and under what circumstances diseases may occur and who will be affected. (Lukes, 2007).
This type of foresight assists those serving that population to provide educational resources in order to avoid the negative impact of disease on that population. A sufficiently large group must be studied to provide reliable results in such an undertaking. Once this is achieved, the resulting information is a valuable tool in the prevention of morbidity and mortality in populations at risk for certain diseases or injuries. Epidemiological methods There are several methods that are used by modern epidemiologists. One such method is the morbidity survey.
The morbidity survey is a gathering of morbidity data of both the sick and the well. One of the limits of this type of data gathering is that only general data can be gathered. In San Bernardino County, one way data is collected is by use of a retrospective cohort study. Data is gathered from the participants then results are divided according to groups. Participants self report the data gathered so instances of diabetes in California may be higher than those reported. The incidence of a disease is compared to the prevalence.
The incidence is the number of new cases of a particular disease over a period of time. The prevalence is the total number of new cases of that disease. The epidemiologist then compares the results of studies to determine the incidence of diabetes, identifies related trends, and suggests ways to control the morbidity and mortality related to the disease. Based on the results of the California Health Interview Survey, San Bernardino County published a prevalence and risk factor report in 2005 regarding diabetes and county residents. African Americans had a prevalence rate of 6. 5 % in relation to having diabetes. 55. 51 % were overweight. 28. 34% were considered obese. 80. 16% reported a sedentary lifestyle. 59. 63% reported eating less than five fresh fruits and vegetables a day. (California Diabetes Program, 2005). Epidemiological Triangle The epidemiology triangle has three sides. The sides consist of the host, the agent and the environment. The host is the person who is affected by the disease. The agent is the organism causing the disease. “In the case of type II diabetes, the agent could be the absence of a substance. ” (McMurray, 2006).
The agent interacts with the host and the environment to cause the disease. The environment is all the outside conditions that make the host susceptible to the agent. One condition of the environment could be the health of the host. An example of this would be a host who is an African American woman. The agent is type II diabetes or insulin resistance. The environment is a family history of diabetes along with poor diet, sedentary lifestyle and obesity. The interplay of the factors of agent, host and environment would result in the host developing type II diabetes. Methods Used in Epidemiology
Observational epidemiology is a study of disease where “the investigator ascertains exposure and outcome without assignment to an intervention” Observational studies have made important contributions to the knowledge and understanding of health-related conditions. These studies usually involve a large group of individuals as in a community. The purpose of this type of study is to determine the relationship between a disease and exposure to that disease. Descriptive epidemiology is the who, what, when and why of the discipline. Descriptive epidemiology asks who gets a disease and under what circumstances.
Once these questions are answered, the causality of the disease can become the focus of further investigation. Levels of Prevention Although it is widely believed that type 2 diabetes mellitus is the result of a complex interplay between genetic and environmental factors, compelling evidence from epidemiologic studies indicates that the current worldwide diabetes epidemic is largely due to changes in diet and lifestyle. “Prospective cohort studies and randomized clinical trials have demonstrated that type 2 diabetes can be prevented largely through moderate diet and lifestyle modifications. (Schultz , 2004). Excess adipose tissue is the most important risk factor for diabetes, so maintaining a healthy body weight and avoiding weight gain during adulthood is the most important way to facilitate primary diabetes prevention. Increasing physical activity and reducing sedentary behaviors such as prolonged TV watching are important both for maintaining body weight and improving insulin sensitivity. This is an important step in reducing mortality because “some studies report higher death rates among racial/ethnic minorities and among those in the lower socioeconomic strata. (Akinabami, et al, 2007). The goal of primary prevention is to engage in behaviors that cause the host to avoid development of the disease. An example would be to maintain a healthy weight to avoid the development of diabetes. In some instances, this intervention would be all that is needed to stave off the development of the disease. Secondary prevention of diabetes in the black community would consist of “the early detection and prevention of complications, therefore reducing the need for treatment. ” (IDF, 2008).
This could be accomplished by regular screening of hemoglobin A1C by primary healthcare providers to evaluate adequacy of maintenance, foot exams, and regular evaluation of blood chemistries to assess kidney function in addition to cardiovascular checks. Cardiovascular complications are well known to be associated with diabetes. Secondary prevention aids the person with diabetes to control the disease to a point where it is managed well so complications related to having diabetes do not arise. These interventions include being aware of possible omplications of diabetes so effective surveillance can be maintained against these complications. Some interventions could be foot exams, hemoglobin A1C testing at regular intervals, weight loss, dietary changes and a regular exercise program. Tertiary prevention would consist of appropriate rehabilitation for complications of diabetes. For instance, blacks have a higher than normal incidence of limb amputations as a result of diabetes. The plan would be to provide needed assistance to ensure a return to the highest level of functioning after an intervention such as amputation.
Tertiary prevention is related to managing the complications of diabetes efficiently to permit achievement of the highest level of functioning. The patient having foot exams to facilitate effective treatment of skin ulcers not felt due to diabetic neuropathy would be an example of this level of prevention. If primary interventions are met with success, the threat of the development in African Americans diabetes can be lessened considerably. This would result in both a lessening of the physical and economic impact of the disease of diabetes among African Americans.
For instance, diabetes has an economic impact due to lost productivity from days of work missed. The effective management of diabetes would result in greater productivity as well as the added benefit of health insurance coverage for diabetics who are employed full time. Health insurance coverage ensures that the diabetic patient has assistance with at least some of the cost of maintaining an optimal state of health. This becomes very important in relation to compliance issues. Many patients are less compliant if they cannot afford diabetic medicines or the types of foods that would assist them to maintain acceptable blood sugar levels.
Conclusion Diabetes in the African American community is one of the major causes of illness and disability. As of 2005, diabetes was the third leading cause of death in African Americans in the United States. This paper examined the approach of epidemiologists to the study of this phenomenon. Part of the work of the epidemiologist may have included a study such as a retrospective cohort study where data is gathered from the cases of subjects who are divided into groups. The prevalence and incidence of diabetes in blacks could be compared to those of Whites, Hispanics or Native Americans. From here, risk factors are sorted out.
To come to conclusions about the risk factors, epidemiologists determined the relationship between African Americans, environmental factors and the incidence of diabetes using the epidemiology triangle of agent, host and environment. When the risk of diabetes was determined using the triangle, then preventive strategies could be addressed. This was because the circumstances under which an African American could develop diabetes were identified. From there, the relationships between the factors which make up the epidemiology triangle could be interrupted in order to lower the incidence of diabetes in blacks.
The first step in this preventive strategy would be education of the population about lifestyle changes aimed at lowering the chances of developing diabetes. References Akinbami,L. , Saydah,S. , Eberhardt, L. , Polawski, L. (2007, November 16). Racial disparities in diabetes among persons aged 1-19 years. Morbidity and Mortality Weekly Report. 56 (45) p. 1187. Retrieved September 28, 2008 from EBSCOHOST database. Bailey, Simone (2007,November 27-December4). Black women are the hardest hit by diabetes. The Miami Times. Retrieved September 24, 2008 from http://proquest. mi. com. ezproxy. apollolibrary. com/pqdlink? index=99&did=1401939991&SrchMode=1&sid=6&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1222570822&clientId=13118. Brooks, Gary ( 2002, December. ). Basic principles of observational epidemiology”. Cardiopulmonary Physical Therapy Journal. Retrieved September 28, 2008 from http://findarticles. com/p/articles/mi_qa3953/is_200212/ai_n9156794. California Diabetes Program. (2005). Diabetes in California Counties;prevealence, risk factors and resource. Retrieved September 22, 2008 from http://www. caldiabetes. org.
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