A decade of improvement in areas of chronic disease. Where do we go from here?

The last decade has seen significant progress in reduction of mortality rates from many chronic diseases on both a state and national level. Moreover, in general, Wisconsin has achieved levels below the United States for mortality. However, as suggested by Figures 1 and 2, preventive efforts in stroke and prostate cancer should become high priorities in this state. Additionally, it will be important to monitor the stabilization of death rates due to diabetes. Turning Point, anti-tobacco efforts by the Tobacco Control Board and the Thomas T. Melvin Program, and the upcoming Minority Health Report should reveal additional areas for DHFS and its statewide partners to address in the arena of chronic disease. Programs such as the Wisconsin Diabetes Control Program and the Wisconsin Well Woman Program will also continue to contribute significantly to other community and clinical efforts to control chronic diseases.

Progress in cancer control in Wisconsin.

INTRODUCTION: The burden of cancer in Wisconsin is significant, with cancer accounting for nearly 25% of all deaths in 1997. State and national trends indicate a decline in overall cancer mortality since the early 1990s. This report reviews the progress in cancer control in Wisconsin in the past decade and assesses progress toward reaching the 2000 cancer objectives outlined in the Wisconsin Public Health Agenda. METHODS: Mortality data were abstracted from CDC WONDER from 1984-1997 in a manner consistent with the data presented in the Wisconsin Public Health Agenda. Overall cancer mortality, as well as site-specific cancer mortality rates, was analyzed by calculating the percent change in the baseline period (1984-1986) versus the most recent available data (1995-1997). RESULTS: Overall cancer mortality rates in Wisconsin decreased 1% from 1984-1986 to 1995-1997, decreasing among those under age 65 but increasing among those 65 years of age and older. Rates declined in the white population, but increased among blacks and other races. Site-specific data indicate a 6% decrease in cervical cancer, an 18% decrease in breast cancer, and a 20% decrease in colorectal cancer occurred during this time period. Increases were seen in lung and prostate cancers, and in malignant melanoma. DISCUSSION: This analysis indicates progress in the reduction of overall cancer mortality among persons under age 65. Objectives for 2000 will be met in both breast and colorectal cancer, with some progress noted in reversing the steady increase in lung cancer mortality in the state.

Diabetes mortality trends in Wisconsin, 1979-1997: the increasing gap between whites and blacks.

Diabetes is a leading cause of morbidity and mortality in Wisconsin and the United States. We examined mortality trends for diabetes as an underlying cause of death for the years 1979-1997 for Wisconsin and the United States. Diabetes mortality rates in Wisconsin have increased over the past 18 years, from 13.5/100,000 in 1979 to 16.7/100,000 in 1997. Much of this increase is attributable to a change in the death certificate in 1989. Blacks in Wisconsin have a higher rate of diabetes mortality when compared with whites, especially among women and persons less than 65 years of age. This disparity has increased markedly over the decade. Public health efforts in Wisconsin need to focus on reducing diabetes mortality overall and on minimizing disparities in diabetes mortality between whites and blacks.

The Wisconsin Collaborative Diabetes Quality Improvement Project.

INTRODUCTION: Performance measurement is an important tool for improving the quality of diabetes care. In this report we describe the Wisconsin Collaborative Diabetes Quality Improvement Project, designed to assess the quality of diabetes care among 18 health care organizations in the state. METHODS: Fifteen health maintenance organizations, a tribal council, a health care provider, and an insurance corporation participated in the project. Each health care organization reported the percent of their diabetes population who had received selected measures of diabetes preventive care during the reporting year, using HEDIS performance indicators. RESULTS: The proportion of the population with diabetes receiving preventive care varied by indicator: retinal eye exam (ages > 31 years: 55%; ages 18-75 years: 48%), annual lipid profile (58%); hemoglobin A1c (81%); and nephropathy screening (27%). Rates also varied among health maintenance organizations for each indicator, with rates varying three-fold between organizations for the retinal eye exam indicator (ages > 31 years). CONCLUSIONS: These data demonstrate considerable variability in the delivery of preventive services to this population with diabetes. The collaborative group involved in this project is currently exploring further collaborative quality improvement opportunities.