San Francisco Burden of Disease & Injury Study:
Determinants of Health
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Contribution of Diabetes to SF Burden of Disease

Coronary heart disease is the leading cause of death in nearly every zip code and among every ethnic group in San Francisco. Diabetes--along with other risks such as age, smoking, high cholesterol, and hypertension--contributes to heart disease mortality. The Population Attributable Fraction (PAF) for mortality is the proportional reduction in a specific cause of death that would have been expected if the population had no exposure to a specific determinant. It is calculated from the relative risk from exposure (RR) to the determinant and the prevalence of exposure to the determinant in the population (P), expressed as PAF = P(RR-1)/[P(RR-1) + 1]. Though it has limitations, PAF is an important measure for public health planning.

A reasonable first estimate of the PAF for heart disease mortality among adults age 40 and older associated with diabetes is as follows:

Based on the 2001 California Health Interview Survey, a convervative estimate of the prevalence of diabetes among adult San Franciscans (age 40 and older) is approximately 7.3%

Assume the RR for heart disease mortality from diabetes is 2.5 (a recent meta-analysis of eight prospective studies found it to be 2.3 for men and 2.9 for women).

PAF = P(RR-1)/[P(RR-1) + 1] = 0.073(2.5 - 1)/0.073(2.5 - 1) + 1 = 0.109/1.109 = 0.9.8 = 9.8%

This estimate is very conservative, because it excludes unidagnosed diabetics (nearly a third of all diabetics) and it ingores the fact that the prevalence of type 2 diabetes is increasing (following the increase in obesity).



Contribution to overall disease burden in SF

Downstream (health consequences)

Upstream causes

What can be done?

Web resources

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Updated May 19, 2004

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