Diabetes in the Bronx
Diabetes is a chronic disease and has a significant effect on regulating blood sugar or glucose. Type 2 diabetes is often less severe or, in other words, less mild than type one (Janghorbani et al., 2007). However, it can still result in serious health problems, such as eyes, kidneys, and nerves. In other cases, it increases the risk of stroke and heart disease.
Type 1 diabetes often begins in childhood, so it used to be referred to as juvenile-onset diabetes. The condition comes when the body produces antibodies that attack the pancreas resulting in the organ being damaged and unable to perform its role of making insulin (Dabelea et al., 2014). Type 1 diabetes diagnosis involves frequent and random blood sugar tests to know the risk of complications.
Type 2 diabetes is commonly seen in adults, but more cases have been reported in teens and children in the last few years. Most of these young people are obese or overweight (Eppens et al., 2006). Some of the early symptoms of this disease include increased thirst, feeling very tired, frequent urination, blurry vision, pain in the hands or feet, slow healing of wounds, and cuts, among others (Cervin et al., 2008). Unfortunately, most individuals with this type of diabetes do not have signs for many years, and the symptoms usually develop slowly over time. Type 2 diabetes treatments mainly involve a change in lifestyle, diabetes medications, blood sugar levels, and insulin.
Health care practitioners use the system to code and group all diagnoses and symptoms recorded in conjunction with hospital care in the US. For example, the ICD-10 diagnosis code for diabetes mellitus is E08-E13 (Duncan et al., 2011). The diagnosis code for Type 1 Diabetes, w/o complication, is E10.9. The diagnosis code for Type 1 Diabetic Ketoacidosis, w/o Coma is E10.10. E11.22 is the diagnosis code for type 2 diabetes mellitus with kidney disease (Duncan et al., 2011). The diagnosis code for Type 2 Diabetes with Hyperosmolar coma is E11.01, and the diagnosis code for Diabetes, Neurological Complication is E10.43.
The other types of codes are the procedure codes. These are codes used to identify specific diagnostic, medical, or surgical interventions (Newton et al., 2019). In addition, procedure codes are non-medical related codes for insurance reimbursement purposes (Gulliford et al., 2006). Examples of such codes include E08 due to an underlying condition, E09 for Diabetes mellitus induced through chemicals, E10 for diabetes mellitus type 1, E11 diabetes mellitus type 2, E13 for different specified diabetes mellitus.
The highest number of deaths from diabetes happens in the Bronx. The Bronx is the poorest borough in New York, and the residents opt for cheaper foods that are mostly unhealthy. With their low income, they will prefer buying fast foods which are harmful and, in most cases, causes diabetes (Tabaei et al., 2018). The Bronx has diverse types of foods, and the residents are left to choose what they can afford, and in most cases, one will decide to buy cheaper food and leave costly ones like vegetables which are healthy.
Diabetes, a chronic illness whose blood sugar levels are above average, is a significant global health issue. The World Health Organization (2016) recognized it as debilitating and costly, and the disease is associated with critical complications that pose severe risks and lower the quality of life. These complications include stroke, nerve damage, and kidney damage (Papatheodorou et al., 2016). In addition, the high worldwide burden of diabetes has an adverse economic effect on individuals, healthcare systems, and countries.
Diabetes is becoming a dangerous rising epidemic in the Bronx. To understand the magnitude of the issue, compared to the number of Americans suffering from the illnesses, which is estimated at 8.3% by the American Diabetes Association (2021), the percentage for the Bronx is higher, with the area recording the highest diabetes rates. In addition, the Bronx has the worst neighborhoods for diabetes-related deaths, with Brownsville, Mott Haven, and East Tremont reporting 177, 159, and 134 deaths per 100 000 persons, respectively (Cunningham, 2013). These staggering statistics are associated with the Bronx’s culturally diverse and poor socioeconomic environment: common diabetes risk factors.
In the Bronx, adults of 45- 65 years are at risk of getting diabetes. Healthcare providers in the Bronx are trying their best to curb the increased rate of diabetes (Powers et al., 2017). They are now providing educational programs that cover people’s diet, the importance of physical activities, and overall health knowledge on diabetes. The strategy of educating people in the Bronx is proving to be effective, but some people are faced with socioeconomic barriers. The majority of the people in the Bronx live below the poverty line, which means they cannot afford medical care and healthy food.
Healthcare providers should ensure that their patients understand the importance of food choices in their well-being and the implications of unhealthy food intake. In the Bronx, people tend to neglect advice on healthy food because they do not have the opportunity to change their diet. Educational interventions are now trying to teach the people in the Bronx how to create more nutritious dietary plans without spending much. Diabetes can be deadly if not treated because it can cause blindness, amputation, heart attack, kidney failure, and stroke.
Researchers have investigated residential factors and interrelated health consequences in many epidemiological studies. There is sufficient indication associating improved access to high-quality residential resources with enhanced health and reduced frequency and occurrence of illness. In addition, residential socioeconomic disadvantage, which is commonly measured by poverty, racial composition, and household earnings, has been linked to cardiovascular diseases, hypertension, and higher body mass index, independent of characteristics at the individual level.
The Bronx in the City, as aforementioned, is specially placed at the dangerous face of the rising diabetes epidemic. The disease is most widespread among low-income populations. Furthermore, it is prevalent among minorities, including Hispanics, blacks, and Asians. In an article by Mejia (2019) examining the rising diabetes epidemic in the Bronx, the author associates the high illness prevalence and incidence with the area’s poor socioeconomic and diverse cultural environment. According to the author, the Bronx is a fusion of varied cultures with various ethnicities and races. Hispanics, blacks, Asians, and whites live in the area. There is diverse cuisine from several cultures and a prevalence of fast foods and restaurants. This lifestyle, in turn, means that the region is prone to some overweight and diabetic individuals.
People living in the area get the lowest income in New York City, and that is why they cannot afford healthy food. They also do not have efficient access to adequate healthcare. The Bronx is among the poorest areas in the city, with Mejia (2019) reporting that an estimated 50% of households in the region live below the poverty level. In a news article by Cunningham (2013), the area is among the poorest boroughs in New York City. According to Cunningham (2013), the Bronx has the highest diabetes death rate, with Brooklyn, Mott Haven, and East Tremont reporting 177, 159, and 134 deaths per 100 000 persons, respectively. High Bridge, Morrisania, and Hunts have 131, 130, and 117 deaths per 100 000 persons. It can further result in complications including heart diseases, stroke, nerve damage, kidney damage, and death in some fatal situations. If treated late, diabetes results in costly expenses for individuals suffering from the disease, health insurers, and the local and federal governments.
Results from the reviewed studies suggest that the residential environment is the major diabetes risk factor in the Bronx. Diabetes is a largely preventable illness. Access to healthy food, consistent primary care, and physical activity can lessen diabetes onset and complications. According to Wadden et al. (2012), lifestyle modifications result in long-term loss of weight, enhanced fitness, and sustained advantageous effects on risk factors in persons with diabetes. Effective lifestyle intervention programs characteristically entail caloric balance using diet, physical activity, weight self-monitoring, exercise, and behavioral modification (Mumu et al., 2014). As such, a change of the region through implementing a lifestyle modification program may enhance the health of the population and lower disparities by increasing healthy behaviors and reducing harmful exposures.
The Bronx has the highest number of diabetic individuals in New York City, and the majority of these people do not know that they have the disease. Most of the residents of the Bronx have pre-diabetes, and if they do not change their diet and lifestyle, they will end up with diabetes (Tercero et al., 2021). Most of the food accessible in the Bronx is high in carbohydrates and less expensive, thus being a better choice for the people of Bronx. Some people with diabetes never know they have the disease until they encounter symptoms like a heart attack or a very dangerous stroke.
The objective of every health center, especially in the Bronx, is to reduce cases of diabetes, complications, and deaths. Diabetes is now the seventh leading death cause, and the most affected people are the ethnic or racial minorities (Arevalo, 2017). It has been proven that pre-diabetic individuals who go through lifestyle change programs to the end lower their risk of getting diabetes. Adults with diabetes can die earlier than younger people because of complications like heart attacks or kidney failures linked to diabetes. Treating diabetes can help prevent such deaths and reduce complication risks in diabetic individuals. When a person with diabetes has a fluctuating blood glucose level, the healthcare provider should consider changing the treatment plan and medication (Arevalo, 2017). Apart from treatment, a diabetes team should look into other ways to help in guiding a patient to effective outcomes that are healthy.
One should have a good meal plan to help keep blood sugar levels in the target range. An appropriate meal plan should include; non-starchy vegetables, fewer refined grains, and added sugars and avoid highly processed foods by focusing on whole foods. A patient with diabetes should constantly visit the doctor for regular tests and documentation of progress in treatment and medication (Arevalo, 2017). Setting Limits for meals and keeping track of the number of carbs taken effectively control blood sugar levels (Arevalo, 2017). A diabetic person should have frequent preventive checkups than any other person, and this may cost a fortune, but the visits to the doctor are essential for protecting your health. New York City should start an initiative to raise the income and living standards of the people living in the Bronx because these will help in one way or another to control diabetes.
The project’s main objective is to evaluate the impact of a structured lifestyle modification in reducing the rate of diabetes and its associated complication within the community in the Bronx, New York City, and enhancing diabetes management and prevention. A community-based lifestyle modification project is the most cost-effective technique to prevent diabetes in the region (Wadden et al., 2012). The two key objectives of the program will be to evaluate diabetes and pre-diabetes prevalence in the Bronx and assess the effectiveness of a lifestyle modification program in reducing risk factors and improving disease self-management. In addition, the project will aim to enhance awareness of diabetes management at the grassroots level by employing an inclusive environment of the entire Bronx region with a population-based strategy. Practical and straightforward lifestyle modifications will be tailored to educate the community on the risk factors of diabetes and self-care. The goals of the projects are:
- Reduced hospital admissions as a result of diabetes exacerbations or complications
- A reported dietary modification mainly increased consumption of fruits and vegetables.
- A reported increase in the participation of recommended moderate level of physical activity
- A reduced number of obese and overweight individuals
Five-year Trend Analysis
In the early days, part of the Bronx, mainly in the low-income community, was one of the most challenging and neglected in New York City. However, the Bronx has surfaced as an example of urbanization by community-driven efforts. As a result, life has changed in many ways, even though there is still much work to do. Nevertheless, people in the Bronx still live sicker and die earlier than they should from heart disease, diabetes, obesity, high blood pressure, and other chronic disorders. The data analysis and charts show that the number of people diagnosed with diabetes in the Bronx keeps fluctuating (Palmer, 2021). As the people’s socioeconomic status in the Bronx rise, the number of diabetes patients decreases. Nutrition therapy and other major training programs bring change to the Bronx because of the reducing number of diabetic patients. However, from the diversity of cultures and interests of people in the Bronx, the people cannot have a common goal of curbing the disease (Palmer, 2021). Everyone is trying to make ends meet and bring food to the table; thus, there is no time to think of nutrition and its effects on their bodies. Neglecting the body’s wellness is very dangerous because of diseases like diabetes. From the people’s lifestyles in the Bronx, it is hard to control diabetes fully, and thus, the numbers only decrease slightly (Palmer, 2021). The demographic and behavioral characteristics of the people in the Bronx show that they do not give much attention to their health, and if they did, they could not afford healthcare services. The limitations show that the disease will always be in the Bronx; it can only reduce but not ended.
Assessing diabetes and its preventive measures can be put into the process. Therefore, it is essential to structure the research design by investigating specific questions. Although the general context of diabetes link with self-management, the prominent determinant can be the controlling measures taken over obesity. The onset of diabetes is complicated to find in the Bronx youth. However, the traces can be in the digital era and society’s evolution in the first few decades of the 20th century. The rise of restaurant businesses operating in the region also set the meal patterns. It promoted the outbreak of diabetes in the Bronx is associated with an unhealthy lifestyle, lack of access to nutritious food, and the absence of regular exercise, for example, can be taken from the development of the South West Bronx social community.
Data analysis by Age from 2015-2019.
Based on the above table, the age bracket of 72 between 2015 and 2017, there was a complex number of cases of Type 2 diabetes in this age bracket compared to the rest of the age bracket. Age is also essential, especially when it comes to the incidence and prevalence of cases of noncommunicable diseases. It’s crucial to note that the cases of diabetes in the Bronx increase due to population growth and the increasing prevalence of obesity and physical inactivity. One is more likely to develop type 2 diabetes if one is 45 or older. In 2018 at the age bracket of 68-69 was the highest age group to have the cases of diabetes type 2 compared to 2015, where at the age of 72 was reported the highest cases of diabetes. In 2018, the age limit bracket with cases of diabetes was around 68 to 69 years old, which means that in this particular year, the senior citizen did not have significant diabetes cases compared to 2015 to 2017. We can analyze that as time goes on, more aged people are leaving behind the habit of eating in the fast-food restaurant found almost every block in the Bronx.
Analysis by Facility
Analyzing the above chart, we can see that: in 2019, BXLEB had the highest cases of Type 2 diabetes mellitus, while SBH and UCHC had the lowest. However, in 2018, BRLEB marked the highest DM type 2. From 2015 to 2019, BXLEB has observed the highest cases of Diabetes Mellitus within the health facilities of Bronx. Bronx Care provides health care services to a large, densely populated area comprised of a diverse population. This population faces various economic barriers, social issues, and special needs. Most of the service area population is ethnic/racial minorities and contains young (0-19) people. Based on US Census forecasts through 2021, 32 percent of South and Central Bronx residents are under 20 years of age.1 More than one out of every three people living in the Bronx is foreign-born, a factor also associated with lack of health insurance (with the majority from Latin America). The largest concentration of New York City’s African immigrants, 56,000, reside in the Bronx.
The Bronx Care service area is characterized by high poverty, unemployment, and homelessness, with significant unmet health needs and health disparities. While only 19 percent of New York City residents have less than high school education, the Bronx Care service area averages 38 percent. Still, it is as high as 41 percent in some sections. In Bronx Care’s service area, one in three adults considers themselves fair or poor health. Social determinants of health, economic factors affecting health status, and physical environment also place the service area among the most challenging in New York City. The chart above demonstrates that from 2015-to 2016, the cases of diabetes in these facilities are not very significant compared to 2017-2019.
Furthermore, Diabetes in Bronx care hospitals is increasing year by year simply because from 2015 to 2019 data set shows a significant increase of Diabetes cases in the Bronx. More than 700,000 adult New Yorkers are diagnosed with diabetes. An additional 164,000 are estimated to have diabetes but are not yet aware of it. As many as 22 percent of Bronx Care service area adults have a diabetes diagnosis compared to 11 percent in New York City. The four New York City neighborhoods with the highest rates of diabetes are in Bronx Care’s service area. However, most of these cases are seen at Bronx Care hospital, commonly known as Bronx Lebanon Hospital. The childhood obesity rate is 24 percent in the Bronx compared to 20 percent in New York City. More than 32 percent of Bronx Care’s service area residents have one or more sugary drinks daily, compared to 23 percent in New York City. However, this increase causes most of the cases of diabetes Mellitus. Above all, most of the patients does see at Bronx care hospital. Individuals from the minority group are more likely to develop Type 2 diabetes (insulin-resistant) than Caucasians; however, most people live around Bronx Care Hospital.
Analyzing the Gender
The females living with diabetes are more in number than in males. Thus, diabetes cases increase due to population growth and the increasing prevalence of obesity and physical inactivity. Globally, according to literature, type 2 diabetes is more common in males than females. However, females often have more severe complications and a greater risk of death due to increased insulin resistance. Weight gain and poor diet are two major factors contributing to type 2 diabetes are also frequently found in men between the age of 35-54. However, from the chart above, in 2019, females had the highest cases of Diabetes mellitus type 2 compared to the rest of the years. In the year 2018, there were increased DM type 2 in females compared to the male cases in the rest of the other years. Women are, however, more likely to transmit type 11 diabetes to their offspring. From 2015 to 2016, the Data analysis above shows low cases of diabetes mellitus type 2 compared to the rest of the remaining years of 2017 to 2019. However, in the Bronx, there are multiple fast-food restaurants, like McDonald’s, Popeyes, burger king. The list goes on, which in general are used mainly by females compared to males, especially the middle age females; women also develop Gestational Diabetes. Not only those with diabetes should visit a doctor for screening, but we all should make an effort to get a checkup (Tabaei, B. P. 2020). In the past, diabetes was very uncommon, but today it is constantly reported in the news and health centers. The primary thing that has led to the increased rate of diabetes is taking an unhealthy diet because people love fast foods nowadays. Because of our busy schedule, we never get the time to prepare healthy food and exercise to help the body. The economic constraints have also contributed to people choosing fast foods over other healthy foods they cannot afford. The Bronx has an alarming number of diabetes patients because of the popularity of fast foods in the area and the low income of the people (Tabaei, B. P. 2020). New York is ranked as the highest in diabetes patients, and the Bronx is the leading town because it is the poorest borough in New York. Due to the poverty level of the Bronx, people cannot afford to have diabetes, and in several cases, this has led to death.
If the Bronx could be better than it is economically, people would choose to buy vegetables and healthy food, which will help reduce the rate of diabetes in the place (Tabaei, B. P. 2020). Unfortunately, all they can afford now is fast food, killing most of them slowly. Most food companies care about the amount of money they are making and are careless about the consumers’ health. There are ways to have a better lifestyle, including those in the Bronx. If only the government could provide alternative food of high nutrition that costs less, the people would be safe from diabetes. It has been proven that Hispanic and black people are highly affected by diabetes than Asian and white people (Tabaei, B. P. 2020). Diabetes is now the most significant cause of death globally, and that is why we should try and avoid it at all costs. Eating healthy, exercising, and always looking out for any signs of diabetes should be a must-do for everyone.
Figure 4: Percentage of adults with diagnosed diabetes, by county. (Information for Action Report, 2016).
From Figure 4, it could be seen that New York had 8.5 percent of adults diagnosed with diabetes in 2016. However, it does not necessarily mean that only a percentage of adults have diabetes; instead, it shows that not all cases are diagnosed. Such statistics are one of the limitations in Public Health since they do not show the actual percentage of those diseased people who do not do medical check-ups.
In the past, diabetes was very uncommon, but today it is constantly reported in the news and health centers. The primary thing that has led to the increased rate of diabetes is taking an unhealthy diet because people love fast foods nowadays. The economic constraints have contributed to people choosing fast foods over other healthy foods they cannot afford. The Bronx has an alarming number of diabetes patients because of the popularity of fast foods in the area and the low income of the people. New York is ranked as the highest in diabetes patients, and the Bronx is the leading town because it is the poorest borough in New York. Due to the poverty level of the Bronx, people cannot afford to have diabetes, and in several cases, this has led to death. Diabetes is a cause of death globally, and that is why both people and stakeholders should adequately address the problem.
America Diabetes Association (2021). Greater NYC/NJ | ADA. Diabetes.org. https://www.diabetes.org/community/local-offices/greater-nycnj
Arevalo, S. (2017). But, unfortunately, it takes a village to control diabetes. AADE in Practice, 5(3), 28-32.
Cervin, C., Lyssenko, V., Bakhtadze, E., Lindholm, E., Nilsson, P., & Tuomi, T. et al. (2008). Genetic similarities between latent autoimmune diabetes in adults, type 1 diabetes, and type 2 diabetes. Diabetes, 57(5), 1433-1437. https://doi.org/10.2337/db07-0299
Cunningham, J. (2013). Five of the worst neighborhoods for Diabetes care in the Bronx. Daily News. https://www.nydailynews.com/new-york/bronx/bronx-diabetes-central-article-1.1369789
Dabelea, D., Mayer-Davis, E., Saydah, S., Imperatore, G., Linder, B., & Divers, J. et al. (2014). Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA, 311(17), 1778. https://doi.org/10.1001/jama.2014.3201
Duncan, I., Ahmed, T., Li, Q., Stetson, B., Ruggiero, L., & Burton, K. et al. (2011). Assessing the value of the diabetes educator. The Diabetes Educator, 37(5), 638-657. https://doi.org/10.1177/0145721711416256
Eppens, M., Craig, M., Cusumano, J., Hing, S., Chan, A., & Howard, N. et al. (2006). Prevalence of diabetes complications in adolescents with type 2 compared with type 1 diabetes. Diabetes Care, 29(6), 1300-1306. https://doi.org/10.2337/dc05-2470
Gulliford, M., Charlton, J., & Latinovic, R. (2006). Risk of diabetes associated with prescribed glucocorticoids in a large population. Diabetes Care, 29(12), 2728-2729. https://doi.org/10.2337/dc06-1499
Information for Action Report. 2016. Percentage of adults with diagnosed diabetes, by county. New York.
Janghorbani, M., Van Dam, R., Willett, W., & Hu, F. (2007). Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. American Journal of Epidemiology, 166(5), 495-505. https://doi.org/10.1093/aje/kwm106
Mejia, L. (2019). Diabetes: A rising epidemic in the Bronx | ENG 110: Mapping New York City. Eng110michael.commons.gc.cuny.edu. https://eng110michael.commons.gc.cuny.edu/diabetes-a-rising-epidemic-in-the-bronx/
Mumu, S. J., Saleh, F., Ara, F., Afnan, F., & Ali, L. (2014). Non-adherence to lifestyle modification and its factors among type 2 diabetic patients. Indian journal of public health, 58(1), 40.
Newton, K., Wagner, E., Ramsey, S., McCulloch, D., Evans, R., Sandhu, N., & Davis, C. (2019). The use of automated data to identify complications and comorbidities of Diabetes. Journal of Clinical Epidemiology, 52(3), 199-207. https://doi.org/10.1016/s0895-4356 (98)00161-9
Ono, Y., Taneda, Y., Takeshima, T., Iwasaki, K., & Yasui, A. (2020). Validity of Claims Diagnosis codes for cardiovascular diseases in diabetes patients in Japanese Administrative Database</p>. Clinical Epidemiology, Volume 12, 367-375. https://doi.org/10.2147/clep.s245555
Palmer, J. (2021). Diabetes in the Bronx: the epicenter of an epidemic. The Riverdale Press. https://riverdalepress.com/stories/diabetes-in-the-bronx-epicenter-of-an-epidemic,52855
Papatheodorou, Konstantinos; Papanas, Nikolaos; Banach, Maciej; Papazoglou, Dimitrios; Edmonds, Michael (2016). Complications of Diabetes 2016. Journal of Diabetes Research, 2016(), 1–3. doi:10.1155/2016/6989453
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53. https://doi.org/10.1177%2F0145721716689694
Tabaei, B. P., Rundle, A. G., Wu, W. Y., Horowitz, C. R., Mayer, V., Sheehan, D. M., & Chamany, S. (2018). Associations of residential socioeconomic, food, and built environments with glycemic control in persons with Diabetes in New York City from 2007–2013. American journal of epidemiology, 187(4), 736-745.
Tercero, F. S., Herszenson, D., Soares, E., Hackley, B., Sarmiento, A., Ikeda, S., Zhang, J., Hamilton, L., Thomas, R., Pabon, O., Stange, M., Martinez, F.C., Vega, M.A., & Grullon, Z. (2021). Working in partnership with individuals with diabetes and community organizations to prevent disruption of preventative care during the COVID19 Pandemic. Journal of the Academy of Nutrition and Dietetics, 121(9), A81. https://dx.doi.org/10.1016%2Fj.jand.2021.06.314
United States Department of Agriculture Economic Research Service. 2016.
Wadden, T. A., Webb, V. L., Moran, C. H., & Bailer, B. A. (2012). Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation, 125(9), 1157-1170.