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Tracking the Correlation Between Health Disparities and Social Determinants with Chronic Disease Prevalence Burden in Maryland Community by Zip Codes

Monday, June 10, 2013: 5:00 PM
106 (Pasadena Convention Center)
Xiao-Ying Yu , Maryland Department Of Health And Mental Hygiene, Baltimore, MD
Michael Crupain , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Helio Lopez , Maryland Department of Health and Mental Hygiene, Baltimore, MD
Khosrow Heidari , South Carolina Department of Health and Environmental Control, Columbia, SC
Rashid Malik , Maryland Department of Health and Mental Hygiene, Baltimore, MD
Sara Barra , Maryland Department of Health and Mental Hygiene, Baltimore, MD
Maria Prince , Maryland Department of Health and Mental Hygiene, Baltimore, MD
Donald Shell , Maryland Department of Health and Mental Hygiene, Baltimore, MD
BACKGROUND: Chronic disease disparities have previously only been available at the jurisdiction level in Maryland. Our previous report has indicated there is an association between the burden of heart disease, stroke, and diabetes and socio-economic factors by jurisdiction. Tracking the chronic disease inequalities in the populations by zip codes at different social determinant conditions is critical for us to identify our focus for programmatic efforts and resources.

METHODS: This study compared the prevalence of heart disease, stroke and diabetes; risk factors such as smoking and physical inactivity; and social determinants (income, employment, education, and health insurance status) from 5 years weighted percentages aggregated from 2005-2009 and 2006-2010. Statistical descriptive and comparison analyses for each variable between 2005-2009 and 2006-2010 by zip codes were conducted with paired Student T-test and regression analyses. The association of chronic disease disparities with risk factors, social economic factors, and access of health care was performed with multiple regression analyses by controlling for age, gender, and race respectively with STATA.

RESULTS: The results showed that the prevalence of stroke (2.4% +/-95% CI 2.1-2.6 vs. 2.7% +/-95% CI 2.3-3.1), diabetes (8.3% +/-95% CI 7.8-8.9 vs. 8.9% +/-95% CI 8.4-9.4) and obesity by zip codes were significantly reduced (p<0.001-0.02) in 2006-2010 compared to 2005-2009 (paired Student T-test).  However, there was correlation for all variables (p<0.001) between these two time periods, except asthma prevalence. Risk factors, such as physical inactivity and smoking were significantly associated with heart disease, stroke, diabetes, obesity, and physical/mental ill health (8-30 days/month) in both time periods (p<0.001-0.01). In addition, the social determinants of lack of health insurance and annual income less than $ 15,000 both were significantly linked to higher rates of chronic disease prevalence for both time periods. Unemployment was also correlated with increasing prevalence of various chronic diseases, but only for 2006-2010.

CONCLUSIONS: Comparing 2005-2009 and 2006-2010 five-year weighted estimates, the results provided consistent burden information related to large population zip codes, and also generated detailed insight related to the small population zip codes. This study showed that unemployment, annual income less than $15,000 and lack of health insurance were the most important social determinants factors associated with health disparities. Further analyses in sensitivity, volatility, and validity in chronic disease prevalence in zip codes will direct us to track the zip code’s health burden and identify program priorities designed to reduce chronic disease/risk factor disparities among populations of differing social determinants conditions.

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