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Healthy People 2010 Focus Area 4

Healthy People 2010 Focus Area 4

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Healthy People 2010 Focus Area 4

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  1. Healthy People 2010Focus Area 4 Chronic Kidney Disease Progress Review November 20, 2002

  2. Chronic Kidney Disease Objectives Targets and Levels Achieved Direction of change desired 2010 Target Current level 334 217 145 82.6 66% Targets-to-be-determined 60% 50% 78 52 45% 26.3% 27.2% 21.3% 19.6% AV fistula use hemodialysis (new patients) % with counseling prior to start of renal replacement therapy ESRD ESRD due to diabetes CV deaths in persons with ESRD % on transplant wait list % transplanted within 3 yrs % of diabetics with exam / tests to prevent ESRD - - - - - Incidence - - - - - - (per 1,000,000 population) (per 1,000 patient years) Source: United States Renal Data System (USRDS)

  3. Diabetes Prevalence, 2000 Trends in ESRD: Incidence Rate per million population 334 (current) 217 (target) Incident rate Adjusted for age, gender, and race. 2010 Target Source: United States Renal Data System, (USRDS)

  4. End Stage Renal Disease Incident rate: 2000 Incident rate: 1990 Unadjusted, per million population 370+ (371) 300 to <370 213 to <300 156 to <213 below 156 (135) 370+ (452) 300 to <370 213 to <300 156 to <213 below 156 (136) Source: United States Renal Data System, (USRDS), modified maps from the USRDS 2002 Annual Data Report (ADR).

  5. Trends in ESRD Incident Rates, by Age and Race/Ethnicity ** * **Adjusted for age and gender. *Adjusted for gender and race. Source: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.

  6. Trends in ESRD Incident rates, by Primary Diagnosis Adjusted for age, gender, and race. Adjusted for age, gender, and race Source: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.

  7. IncidentRates of ESRD with Primary Diagnosis Diabetes 1990 2000 205+ (245) 125 to <205 57 to <125 49 to <57 below 49 (NA) 205+ (260) 125 to <205 57 to <125 49 to <57 below 49 (44) Unadjusted, per million population Source: United States Renal Data System, (USRDS), modified maps from USRDS 2002 Annual Data Report.

  8. Trends in Incident Rates of ESRD Due to Diabetes by Race/Ethnicity Adjusted for age and gender. Source: United States Renal Data System, (USRDS), graph from the USRDS 2002 Annual Data Report.

  9. Prevalence of Diagnosed Diabetes by Age: United States, 1980-1999 160 140 65-74 Years 120 75+ Years 100 80 45-64 Years 60 Total 40 20 0-44 Years Note: Data are three-year averages. Data from 1997 and later years my not be comparable with earlier years due to a redesign of the NHIS in 1997. Source: National Health Interview Survey (NHIS), CDC, NCHS.

  10. Diabetes Prevalence, 2000 Age-adjusted per 1,000 standard population 2010 Target White, not Hispanic American Indian/ Alaska Native Asian/Pacific Islander Hispanic Black, not Hispanic Source: National Health Interview Survey (NHIS), CDC, NCHS.

  11. Obesity*: Adults, Age 20 and Older by Race/Ethnicity 1988-94 1999-2000 2010 Target Black, not Hispanic White, not Hispanic Mexican American Total Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. *Body Mass Index > 30

  12. Trends in All-Cause and Cardiovascular Mortality Rates in ESRD Patients by Race/Ethnicity Source: United States Renal Data System, (USRDS), graphs from the USRDS 2002 Annual Data Report.

  13. Trends in Arteriovenous Fistula Use Incident Hemodialysis Patients (Age 20 and Older) Diabetes Prevalence, 2000 Percent of patients 50% (2010 target) 27.2% (current) New Patients Using AV fistulas Adjusted for age, gender, and race. 2010 Target Source: United States Renal Data System, (USRDS), modified graph from the 2002 USRDS ADR.

  14. Proportion of Dialysis Patients Registered on the Waiting List for Transplantation: by Race/Ethnicity, 2000 Diabetes Prevalence, 2000 Percent 2010 Target American Indian/ Alaska Native Asian/Pacific Islander Hispanic Black, not Hispanic White, not Hispanic Source: United States Renal Data System, (USRDS) Note: Patients younger than 70.

  15. Percent of Dialysis Patients Receiving a Transplant Within Three Years of Initiation of Therapy* Diabetes Prevalence, 2000 Percent of patients Adjusted for age, gender, and race. 2010 Target *Target to be determined Source: United States Renal Data System, (USRDS). Note: Patients younger than 70.

  16. Dialysis Patients Receiving a Transplant Within 3 years by Age, Gender, Race/Ethnicity and Diagnosis Source: United States Renal Data System, (USRDS). Note: Patients younger than 70, graphs from the USRDS 2002 ADR.

  17. Diabetic Patients Receiving All Three Preventive Tests (Age 67 and Older)* ** *Developmental objective, target to be determined **Pre-ESRD data: incident ESRD patients with diabetes one year prior to start of ESRD. Graphs from the 2002 USRDS ADR.

  18. Diabetes Prevalence, 2000 Counseling for Chronic Kidney Failure Care, by Race/Ethnicity, 1996 Percent of new ESRD persons who’ve had counseling at least a year before renal replacement therapy 2010 Target American Indian/ Alaska Native Asian/Pacific Islander Hispanic Black, not Hispanic White, not Hispanic 2010 Target Source: United States Renal Data System, (USRDS).

  19. Data Notes Full citation for USRDS data, graphs, and maps: U.S. Renal Data System, USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 2002. USRDS data are adjusted by the direct adjustment method with 1999 as the standard population. NCHS data are age adjusted by the direct adjustment method with 2000 as the standard population. For the NCHS data, the race/ethnicity groups, American Indian/Alaska Native and Asian/Pacific Islander includes persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. A detailed race/ethnicity description of the USRDS data can be found in the USRDS 2002 ADR. The graphs listed below have additional documentation in the 2002 ADR: Trends in arteriovenous fistula use in hemodialysis patients-Includes only patients for whom an access type is known. Dialysis patients receiving a transplant within three years…-”Medicare dialysis patients initiating therapy in the given year; patients older than 69 or with prior transplants are excluded. Cumulative percents are estimated using the Kaplan-Meier methodology. Followup is censored at death or the end of the three-year period.” Diabetic patients receiving all three preventive health tests…-”General Medicare data: individuals diagnosed with diabetes in 1997, 1998, or 1999, age 67 or older on December 31 of the diagnosis year, and continuously enrolled in Medicare during 1996-1997, 1997-1998, or 1998-1999. Patients diagnosed with ESRD during one of these three periods, enrolled in a managed care program, or with Medicare as secondary payor are excluded. Pre-ESRD data: incident ESRD patients with diabetes one year prior to start of ESRD. Patients enrolled in a managed care program or with Medicare as secondary payor are excluded. The three tests are (1) eye exam, (2) lipids, and (3) A1C test.