2013 diabetes and smoking data summary [Mar. 2013]

The Georgia Department of Public Health

2013 Diabetes and Smoking Data Summary

Smoking may increase the risk of diabetes1,2 and diabetes complications, including cardiovascular disease-related mortality3-5, coronary artery disease6, stroke7, nephropathy8, neuropathy9, and retinopathy10. Diabetics who smoke have an increased prevalence of peripheral artery disease, which can lead to lower extremity amputations.11
Smoking among diabetics decreases blood glucose control and increases insulin resistance.12-14 Additionally, tobacco use increases hemoglobin A1C levels, an indicator of chronically-elevated blood glucose.15

SMOKING AMONG ADULT GEORGIA DIABETICS

Healthy People 2020 has the objective of reducing the national prevalence of current cigarette smokers to 12.0%.16 In 2011, of the approximately 10.2% (734,200 persons) of Georgia adults
that had been diagnosed with diabetes, 16.8% (123,000 persons) were current smokers.
(Table 1)

Table 1. Smoking Status among Adult Georgia Diabetics, 2011

Percent

Estimated Number of Diabetics

% (95% CI)

Current Smoker

16.8 (14.1, 20.0)

123,000

Former Smoker

34.6 (31.2, 38.2)

253,400

Never Smoked

48.6 (45.0, 52.2)

355,600

Time Trend

Figure 1. Prevalence of Smoking among Georgia Adult Diabetics by Year, 2000-2010

Percent (%)

30 19 20

23

18

14

10

20

15

19

19

14

21

10

0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Data Source: Behavioral Risk Factor Surveillance System (2000-2010)

Year

Although the prevalence of adult Georgia diabetics who currently smoke had significant fluctuations between 2000 and 2010, the difference in the prevalence of adult Georgia diabetics currently smoking in 2010 was not significantly different than the smoking prevalence in 2000

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March 2013

2013 Diabetes and Smoking Data Summary

Geography

Map 1. Prevalence of Currently Smoking among Adult Diabetics, by Health District, Georgia, 2011

The following Public Health Districts had the highest prevalence of adult diabetics who currently smoked cigarettes in 2011 (Map 1): 4 (LaGrange) at 24.2%, or 14,300 persons 9-2 (Waycross) at 23.3%, or 12,300 persons 1-2 (Dalton) at 22.5%, or 7,800 persons 7 (Columbus) at 21.6%, or 7,500 persons 9-1 (Savannah) at 21.3%, or 9,000 persons

The following Public Health Districts had the lowest prevalence of adult diabetics who currently smoked cigarettes in 2011 (Map 1): 10 (Athens) at 5.8%, or 2,000 persons 2 (Gainesville) at 9.5%, or 4,700 persons 3-2 (Fulton) at 9.7%, or 4,000 persons 5-2 (Macon) at 9.7%, or 4,200 persons 3-1 (Cobb-Douglas) at 10.9%, or 4,300
persons

Demographics

Figure 2. Prevalence of Smoking among Adult Diabetics by Demographic, Georgia, 2011

30

26

20

17

16

19

14

20

10

9

0

Prevalence (%) Male Female White, NonHispanic Black, NonHispanic 18-44 45-64 65+

Gender

Race/Ethnicity Demographic

Data Source: Behavioral Risk Factor Surveillance System (2011)

Age Group (years)

There were no significant differences in the prevalence of smoking among adult Georgia diabetics by gender or race/ethnicity. (Figure 2)
Adult diabetics that were 18-44 years old (26%; 29,900 persons) or 45-64 (20%; 69,000 persons) years old had 3 and 2.3 times the prevalence of currently smoking than adult diabetics 65 years of age or older, respectively.

2013 Diabetes and Smoking Data Summary

Figure 3. Prevalence of Smoking among Adult Diabetics by

Sociodemographic, Georgia, 2011

30

28

26

25 23

23

21

20

18

17

18

15

12

10

13

9

10

5

0

Prevalence (%) Less than High School High School Graduate Some college or more
Less than $25,000 $25,000 -$50,000 Greater than $50,000
Employed Out of Work Unable to Work
Other* Any Health Coverage No Health Coverage

Education

Annual Income

Employment Status

Insurance Status**

Sociodemographic
*Other Employment Status includes homemakers, students and retired individuals **Adult diabetics 65 years of age and older were excluded Data Source: Behavioral Risk Factor Surveillance System (2011)

Adult diabetics that had not graduated from high school (23%; 45,900 persons) had a 95% greater prevalence of smoking than diabetics that had some college or more (12%; 202,100 persons). (Figure 3)
Adult diabetics with annual incomes less than $25,000 (23%; 74,200 persons) and incomes of $25,000-$50,000 (17%; 29,300 persons) had a 144% and 84% greater prevalence of smoking, respectively, than diabetics with annual incomes greater than $50,000 (9%; 12,100 persons).
Adult diabetics that were employed (18%; 37,600 persons) did not have a significantly different prevalence of smoking than diabetics who were out of work (13%; 5,100 persons), unable to work (28%; 49,700 persons), or with other (10%; 29,600 persons) employment statuses.
There was not a significant difference in the prevalence of smoking among adult Georgia diabetics by insurance status.

REFERENCES
1Rimm E, Manson J et al. "Cigarette smoking and the risk of diabetes in women." American Journal of Public Health 83: 211-214, 1993. 2Rimm E, Chan J et al. "Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men." British Medical Journal 310: 555-559, 1995. 3Moy C et al. "Insulin-dependent diabetes mellitus mortality: the risk of cigarette smoking." Circulation 82: 37-43, 1990. 4Sowers J. "Diabetes Mellitus and cardiovascular disease in women." Archives of Internal Medicine 158:617-621, 1998. 5Stamler J et al. "Diabetes, other risk risk factors, and 12-year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial." Diabetes Care 16:434-
444, 1993. 6Meigs J et al. "Metabolic Control and prevalent cardiovascular disease in non-insulin diabetes mellitus (NIDDM): the NIDDM patient outcomes research team." American
Journal of Medicine 102: 38-47, 1997. 7Tuomilehto J et al. "Diabetes Mellitus as a risk factor for death from stroke: prospective study of the middle-aged Finnish population." Stroke 27: 210-215, 1996. 8Sawicki P. "Smoking is associated with progression of diabetic nephropathy." Diabetes Care 17: 126-131, 1994. 9Sands M. "Incidence of distal symmetric (sensory) neuropathy in NIDDM: the San Luis Diabetes Study." Diabetes Care 20: 322-329, 1997. 10Muhlhauser I et al. "Cigarette smoking and progression of retinopathy and nephropathy in type 1 diabetes." Diabetic Medicine 13(6): 536-543, 1996. 11Norman PE. "Peripheral Arterial Disease and Risk of Cardiac Death in Type 2 Diabetes: The Fremantle Diabetes Study." Diabetes Care 29(3): 575-580. 12Solberg LI et al. "Diabetic Patients who Smoke: Are They Different?" Annals of Family Medicine 2(1), 2004: 26-32. 13Targher G et al. "Cigarette Smoking and Insulin Resistance in Patients with Noninsulin-Dependent Diabetes Mellitus." Journal of Clinical Endocrinology and Metabolism
82(11), 1997: 3619-3624. 14Rnnemaa T et al. "Smoking Is Independently Associated With High Plasma Insulin Levels in Nondiabetic Men." Diabetes Care 19(11), 1996: 1229-1232. 15Clair C et al. "Relationships of Cotinine and Self-Reported Cigarette Smoking with Hemoglobin A1c in the U.S." Diabetes Care (34), 2011: 2250-2255. 16U.S. Department of Health and Human Services. "Healthy People 2020." (Available at: http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx )