Healthy Development Measurement Toolkit

Health Outcome HO.2 Diabetes hospitalization rate per 10,000

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Data Source

Hospitalization data by individual zip code for 2007-2009 were provided by the administrators of the Health Matters in San Francisco website: http://www.healthmattersinsf.org/index.php. Health Matters in SF compiled the data from California Office of Statewide Health Planning and Development (OSHPD). For more information on these preventable hospitalizations, visit: http://www.oshpd.ca.gov/hid/products/preventable_hospitalizations/pdfs/PH_REPORT_WEB.pdf

Explanation and Limitations

This indicator shows San Francisco's hospitalization rate due to uncontrolled diabetes, and short-term and long-term complications from diabetes combined. Data are age-adjusted per 10,000 population. Rates were calculated using population figures from the 2000 U.S. Census. Age standardization allows comparisons across counties or by zip codes that differ in size or age composition.

From the Health Matters in SF website, "According to National Diabetes Education Program, 'diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.' Diabetes can have a harmful effect on most organ systems in the human body; it is a frequent cause of renal disease and lower-extremity amputation, and a leading cause of blindness among working age adults. Persons with diabetes are also at increased risk for ischemic heart disease, neuropathy, and stroke.

The prevalence of diagnosed type 2 diabetes increased sixfold in the latter half of the last century according to the CDC. Diabetes risk factors such as obesity and physical inactivity have played a major role in this dramatic increase. Age, race, and ethnicity are also important risk factors. The CDC estimates the direct economic cost of diabetes in the United States to be about $100 billion per year. This figure does not take into account the indirect economic costs attributable to potential work time lost to diabetes- related illness or premature death."

Diabetes is considered an "Ambulatory Care Sensitive Condition" (ACSC). "ACSCs are ‘diagnoses for which timely and effective outpatient care can help to reduce the risks of hospitalization by either preventing the onset of an illness or condition, controlling an acute episodic illness or condition, or managing a chronic disease or condition. (J. Billings, et al., "Impact of Socioeconomic Status on Hospital Use in New York City," Health Affairs, 1993, 12(1): 162-173.)'"

The data shown here do not identify what barriers are responsible for the different hospitalization rates, nor do they identify whether the barriers are in the health care system or in the preferences and practices of individuals or communities.

Geographic differences in ACSC hospitalizations are just one indicator of inadequate access to health care in San Francisco. Other factors such as health insurance coverage, transportation to and from the health facility, cultural competency or cultural humility of health care providers, hours of operation, length of reimbursement period, cultural and linguistic competency of administrative and intake staff, availability of child care, availability of prevention programs, and employer requirements are among many factors impeding reliable, continuous access to affordable, quality health care.

Why is this a Community Health Indicator?

Ambulatory care sensitive (ACS) conditions such as asthma, diabetes, chronic obstructive pulmonary disease and congestive heart failure are conditions for which hospitalization can usually be prevented when they have been effectively managed in outpatient settings. High hospitalization rates for ACS conditions indicate poor access to outpatient health care.