1. Compare the incidences of diabetes within each region of the U.S. for the past year and identify which state has the highest burden of this disease.

According to the Centers for Disease Control and Prevention (CDC) (2012), there are 25.8 million people, or 8.3% of the U.S. population, living with diabetes. 18.8 million people have been diagnosed with diabetes while 7.0 million remain undiagnosed. During a period of 1994 until 2011, (Centers for Disease Control and Prevention, 2011) the prevalence of diagnosed diabetes has increased across the states in the United States. In 1994, twenty-five states had prevalence less than 4.5%, twenty-four states had prevalence of 4.5%–6.0%, and only one state had prevalence greater than 6.0%. In 2010, all states had prevalence greater than 6.0%, fifteen of these exceeded 9.0%. The eastern United States had a much higher prevalence than the western states. The south continues to have many more occurrences than the rest of the county. The southeastern quadrant of the United Sates appears to lead the way with morbidity issues. For example, the southeastern portion of the US is known as the Bible belt because of its socially conservative evangelical Protestantism. Sadly, it is also known as the stoke belt and is considered a part of stroke ally by public health authorities for having an unusually high incidence of stroke and other forms of cardiovascular disease. Multiple studies have shown (Jorgensen, 1994) that people with diabetes are at greater risk for stroke compared to people without diabetes -- regardless of the number of health risk factors they have. Age-standardized diabetes prevalence (Goodarz, Friedman, Oza, Murray, & Ezzatil, 2009) was highest in Mississippi, West Virginia, Louisiana, Texas, South Carolina, Alabama, and Georgia (15.8 to 16.6% for men and 12.4 to 14.8% for women). Vermont, Minnesota, Montana, and Colorado had the lowest prevalence (11.0 to 12.2% for men and 7.3 to 8.4% for women). As of 2011 (United Health Foundation, 2011) using a scale of one to fifty with one being the best Alabama raked fifty with highest instances of those diagnosed with diabetes. Mississippi is forty-nine and was fiftieth in 2010. 2. Analyze and explain the modifiable and stable characteristics in which morbidity and mortality rates can be observed. Include biological or genetic factors associated with any disparities.
Fleeming (2008) explained each person has characteristics and behaviors that give them a predisposition for having certain diseases or being more or less likely to develop them in the future. The factors (Fleeming , 2008) can be broadly categorized into those that are modifiable which include but are not limited to behaviors such as eating and drinking in excess, smoking, and socioeconomic status. Illustrations of unmodifiable or stable characteristics (Fleeming , 2008) are gender and race. Age is unmodifiable but progressive.
Harvard Medical School (Havard Medical School, 2012) published a report that that indicated Heart disease is the leading cause of death among women — and one of the most preventable. In a survey conducted by the American Heart Association, about half of the women interviewed knew that heart disease is the leading cause of death in women, yet only 13% said it was their greatest personal health risk. Other survey data suggest that on a day-to-day basis, women still worry more about getting breast cancer — even though heart disease kills six times as many women every year. Heart disease in women in often misdiagnosed because the symptoms present themselves differently in women and the systems are often attributed to stress, panic, and even hypochondria. Racial makeup is a (Fleeming , 2008) characteristic associated with different patterns of disease and mortality. This position has all but eliminated the view that race has no bearing on disease. A (Wade, 2012) study done by the geneticist, Dr. Neil Risch of Stanford University, says that genetic differences have arisen among people living on different continents and that race, referring to geographically based ancestry, is a valid way of categorizing these differences. For example, (Childerhose, 2008) Ashkenazim Jews (of European descent) are more inclined to have Tay-Sachs disease, while cystic fibrosis haunts White people. Latin Americans and African rooted people are particularly vulnerable to type 2 diabetes, 90% and 60 % more than White people. Hypertension plagues Afro-Caribbean descent at a higher rate than other populations.
With age a plethora health related issues can ensue. Some are very mild morbidity issues and others can lead to mortality. As (Rattan & Kassem, 2006) a biosocial issue, aging is the underlying basis of almost all major human disease, such as atherosclerosis, cancer, cardiovascular defects, cataract, diabetes, dementia, muscular degeneration, neurodegeneration, osteoporosis and sarcopenia. There are any number of modifiable and well as unmodifiable things associated with how one ages and life expectancy such as education, access to healthcare, environment and, race, sex and genes. 3. Suggest how the incidence and prevalence of diabetes varies across dimension of time, both in the short and long term.

Mortality rates associated with diabetes (Fleeming , 2008) can be compared across time, place or population groups, which are the dimensions from which epidemiologist describe important patters and make inference regarding risk factors, disease, and longevity.
Based on the rate of diagnosed cases of diabetes researchers are predicting (UnitedHealth Center for Health Reform & Modernization, 2010) diabetes will be an epidemic and will affect half of the US by 2020. The research found that by 2020 fifteen percent of adults will have diabetes and thirty-seven percent will have prediabetes, compared with twelve percent and twenty-eight percent today, respectively. Because the risk of diabetes increases due to poor nutrition and lack of physical activity, the report by UnitedHealth Center for Health Reform & Modernization (2010) suggest Enrolling adults with prediabetes in the Diabetes Prevention Programs. Intensive lifestyle intervention utilizing community-based coaches, a data-driven tracking system, and a large network of YMCA and both public and private could potentially reduce the number of individuals who move from prediabetes to diabetes by three million by the end of the decade.
In a report issued by the CDC (Centers for Disease Control and Prevention, 2011) showed the trend in diagnosed diabetes among people of all ages in the United States from 1958 through 2010. The percentage with diagnosed diabetes increased from 0.93% in 1958 to 6.95% in 2010. In 2010, 21.1 million people had diagnosed diabetes, compared to only 1.6 million in 1958. There were a number of years that no statistics were kept which may account for lack of concern for diabetes becoming a growing health risk. 4. Propose the risk factors and causes associated with diabetes, as well as the means or methods of transmission, based on short-term and long-term trends.
The US National Library ( (PubMed Health , 2012) of Medicine states diabetes can be caused by too little insulin, resistance to insulin, or both. Diabetes affects more than 20 million Americans. Over 40 million Americans have pre-diabetes which often comes before type 2 diabetes. The disease is not communicable, that is, transmitted person-to person. According to the (American Diabetes Association, 2011)American Diabetes Association (ADA), 25.8 million adults and children in the United States have diabetes. 18.8 million have been diagnosed, 7.0 million are undiagnosed, 79 million are prediabetes while 1.9 million new cases of diabetes are diagnosed in people age twenty years and older in 2010.
Concerning morbidity and mortality the ADA (American Diabetes Association, 2011)sites in 2007, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths. There are many known complications associated with diabetes such as cardiovascular disease, hypertension, loss of sight, kidney disease and amputation of limbs. Medical cost associated diabetes was more than $174 billion on 2006 according to the ADA. 5. Analyze and explain how Diabetes Technology During the Past 30 Years: A Lot of Changes and Mostly for the Better has changed in the past 50 years and what this tells you about the causes of the disease. During the past 50 years, the (Deeb, 2012)management of diabetes has seen changes in glucose measurement, insulin administration, and types of insulin with the result being an improvement of the lives of those living with diabetes. With all of the advances in technology and medicine one would tend to believe the rate and incidences of the disease would decline but the statistics show a different outcome. According to the CDC (Centers for Disease Control and Prevention, 2011) in 1962 1.6 percent or 192 million people of U.S. population with diagnosed diabetes. By 2010, which is the latest data available 6.95 percent or 21.13 billion were diagnosed with this disease. A new CDC report predicts that the number of new diabetes cases each year will increase from eight per 1,000 people in 2008, to 15 per 1,000 in 2050.
Several factors have been the catalyst for an increase in diabetes in the US. (Centers for Disease Control and Prevention, 2011) The aging population, an increase in minority groups and obesity, being the leading cause. Obesity is most likely the most prevalent cause in insulin resistance. Over the last 50 years the US economy has seen many more years of economic prosperity and advancement in technology that has removed the need for most task requiring manual labor therefore less physical activity was needed. Increased salary has also translated into increased waistlines resulting in obesity.
The same could also apply during recession as poor people attempt to budget they will purchase what is most cost effective in order to feed more people. While health professionals encourage the consumption of fresh fruit, vegetables, wholegrain, and non-processed food the cost of these items can be a challenge for those with limited funds. Food choices contribute the weight and overall health. Those without healthcare living with undiagnosed diabetes maybe making choices that are detrimental to their health.
6. Identify diabetes patterns across the U.S and within specific areas and formulate a theory for this pattern. CDC scientists (Centers for Disease Control and Prevention, 2011) have identified a diabetes belt located mostly in the southern portion of the United States. The diabetes belt consists of 644 counties in 15 states. The CDC also reported states with a portion of their counties in the diabetes belt are Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia. The entire state of Mississippi is included in the belt. Sadly, the southeaster portion continues to be one of the unhealthiest places to live being a part of the stroke belt, the obesity belt, as well as the diabetic belt. New England outranked the Mid-West, West, and South with six of its states falling into the healthiest category. A proposed theory for this pattern has to do with behavior, race, and socioeconomic status. Mississippi has been recognized as the unhealthiest state in the US. This is because the most chronically ill, poorest, and uneducated in the nation reside there. According to a study done by WebMD (Martin, 2012) Mississippi has an obesity rate of 34.9%. Four out of 10 Mississippi high school students drink at least one sugary soda a day, and the state’s adults were most likely to be physically inactive. This is a stark contrast to states such as Vermont and Oregon that have been touted as healthiest states because of the residence access to parks, walking trails and propensity for exercise and leading healthier lifestyles. Mississippi is also the most impoverished state. About (Kaiser Family, 2011) 57% of Mississippians live at or below the poverty line. Out of that 15% of it white citizens and 42% of blacks are living in poverty. This is as astronomical number because black citizens only make up 37% of Mississippi’s population. The median income in Mississippi is $39,078 whereas the national average is $50,443 with an unemployment rate of 9.2%, which is 1.4% higher than the national average. Social service programs such as Medicare provide health care for those over 65 or have a disability. Medicare and other state programs such as Children’s Health Insurance Programs (CHIP) offer coverage for children of low-income parents. As of the 2010 US Census (Kaiser Family, 2011) 23% of adult Mississippians had no insurance and little access to healthcare. This may account for so many undiagnosed cases of diabetes and cardiovascular issues.

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