cardiovascular disease (cvd) in texas philip huang, md, mph texas department of state health...
TRANSCRIPT
![Page 1: Cardiovascular Disease (CVD) in Texas Philip Huang, MD, MPH Texas Department of State Health Services](https://reader034.vdocuments.site/reader034/viewer/2022051819/551567e855034691418b4d4e/html5/thumbnails/1.jpg)
Cardiovascular Disease (CVD) in Texas
Philip Huang, MD, MPHTexas Department of State Health Services
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Overview Burden of CVD
Mortality Morbidity Economic Cost
Risk Factors Quality/Performance
HEDIS EMS
Strategies to Address
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Burden of CVD Leading cause of death in Texas
and in the United States 34% of all deaths in Texas 1,422,000 Texas adults reported
that they have had heart disease or stroke in 2005
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MORTALITY DATA
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Mortality Data Death certificate data were
compiled and tabulated by the Statistical Services Division of the Texas Vital Statistical Unit (VSU)
All death rates are age-adjusted using the 2000 US standard population
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LEADING CAUSES OF DEATH, TEXAS, 2004
35,027
2,420
2,557
3,198
4,331
5,426
7,387
8,270
9,831
33,836
40,091
0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000
Other Causes
Septicemia
Nephritis, Nephrotic Syndrome, Nephrosis
Influenza and Pneumonia
Alzheimer's Disease
Diabetes Mellitus
Chronic Lower Respiratory Diseases
Accidents [Injuries]
Cerebrovascular Disease [Stroke]
Malignant Neoplasms [Cancer]
Diseases of the Heart
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004
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LEADING CAUSES OF DEATH, Whites, 2004
22,667
1,512
1,758
2,356
2,935
3,654
5,329
6,384
6,983
24,380
29,173
0 5,000 10,000 15,000 20,000 25,000 30,000 35,000
Other Causes
Nephritis, Nephrotic Syndrome, Nephrosis
Intentional Self harm
Influenza and Pneumonia
Diabetes Mellitus
Alzheimer's Disease
Accidents [Injuries]
Chronic Lower Respiratory Diseases
Cerebrovascular Disease [Stroke]
Malignant Neoplasms [Cancer]
Diseases of the Heart
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004
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LEADING CAUSES OF DEATH, African American, 2004
4,493
411
432
462
476
488
862
902
1,336
4,200
4,985
0 1,000 2,000 3,000 4,000 5,000 6,000
Other Causes
Septicemia
Human Immunodeficiency Virus disease
Assault (Homicide)
Chronic Lower Respiratory Diseases
Nephritis, Nephrotic Syndrome, Nephrosis
Diabetes Mellitus
Accidents
Cerebrovascular Disease [Stroke]
Malignant Neoplasms [Cancer]
Diseases of the Heart
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004
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LEADING CAUSES OF DEATH, Hispanics, 2004
6841
527
529
532
557
841
1,512
1,629
2,039
5,256
5,933
0 1000 2000 3000 4000 5000 6000 7000 8000
All Other Cause
Chronic Lower Respiratory Diseases
Septicemia
Assault (Homicide)
Nephritis, Nephrotic Syndrome, Nephrosis
Chronic Live diseases and cirrhosis
Cerebrovascular Disease [Stroke]
Diabetes Mellitus
Accidents
Malignant Neoplasms [Cancer]
Diseases of the Heart
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004
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Trends of Heart Disease
DISEASES OF THE HEART (OVERALL)
0
100
200
300
400
500
600
1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
YEAR
Ag
e-a
dju
ste
d M
ort
ality
Rate
s p
er
100,0
00
U.S.
Texas
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1969-2004
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Trends of Stroke
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1969-2004
STROKE (OVERALL)
0
20
40
60
80
100
120
140
160
180
1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
YEAR
Ag
e-a
dju
ste
d M
ort
ality
Rate
s
per
100,0
00
U.S.
Texas
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Trends in Selected Causes of Death----1990-2004, Texas
0
50
100
150
200
250
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Age-
adju
sted
Rat
es P
er 1
00,0
00
ICD 10Ischemic Heart Disease
Stroke
ICD 9
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1990-2004
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ISCHEMIC HEART DISEASETexas, 1999-2004
0.0
50.0
100.0
150.0
200.0
250.0
300.0
Ag
e-ad
just
ed M
ort
ality
Rat
es P
er
100,
000
1999
2000
2001
2002
2003
2004
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1999-2004
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Mortality Data-Ischemic Heart Disease
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1999-2004
Ischemic Heart Disease6 Year Average Age-Adjusted Mortality Rates, 1999-2004
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STROKETexas, 1999-2004
0.0
20.0
40.0
60.0
80.0
100.0
120.0
Ag
e-ad
just
ed M
ort
alit
y R
ates
Per
100
,000
1999
2000
2001
2002
2003
2004
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1999-2004
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Mortality Data-Stroke
Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1999-2004
Stroke 6-Year Average Age-Adjusted Mortality Rates,1999-2004
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Hospital Discharge Data
2000 - 2004
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Hospital Discharge Data
Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2005
Number of Selected First-List Hospital Discharges--2005
118,771
82,150
71,685
53,052
44,376
29,026
24,835
24,801
9,747
4,206
0 20,000 40,000 60,000 80,000 100,000 120,000 140,000
Ischemic Heart Disease
Cancer (Any Type)
Congestive Heart Failure
Stroke (Ischemic or Hemorragic)
Osteoarthritis
Type 2 Diabetes
Hypertension
Asthma
Type 1 Diabetes
Alzheimers Disease
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Number of Selected First-Listed Diagnoses for Hospital Discharges Texas 2000-2004
59,995
55,345
7,376
127,954
58,603
8,136
136,863
67,121
59,142
8,251
134,304
71,432
58,589
8,220
129,578
72,424
45,110
8,681
126,597
64,387
- 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000
CHF
Isch Stroke
Hge Stroke
IHD
Number of Cases
2000 2001 2002 2003 2004
Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2000-2003
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Estimated Hospital Charges
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Estimated Average Hospital Charge Per Day Texas 2000-2004
$3,025
$2,742
$3,833
$6,240
$3,293
$3,014
$4,228
$6,803
$3,665
$3,288
$4,377
$7,469
$4,476
$3,835
$5,425
$8,995
$5,143
$4,199
$5,969
$10,223
$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000
CHF
Isch Stroke
Hge Stroke
IHD
Average Daily Charge in Dollars
2000 2001 2002 2003 2004
Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2000-2003
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Total Hospital Charges Texas 2000-2004
$1,092,952,960
$906,349,120
$277,945,984
$3,761,979,904
$1,307,297,152
$1,061,718,272
$335,220,512
$4,405,183,488
$1,580,782,208
$1,215,433,600
$375,700,544
$5,031,501,824
$1,769,506,393
$1,300,267,809
$420,543,242
$5,215,958,793
$2,287,495,232
$1,217,124,457
$486,242,171
$5,845,981,928
$0 $1,000,000,000 $2,000,000,000 $3,000,000,000 $4,000,000,000 $5,000,000,000 $6,000,000,000 $7,000,000,000
CHF
Isch Stroke
Hge Stroke
IHD
Total Charges in Dollars
2000 2001 2002 2003 2004Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2000-2003
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Medicaid Claims Data for Cardiovascular Disease Texas, 2005
The data is based on paid Medicaid claims for Fee-For-Service (FFS) and Patient Care Case Management (PCCM) clients. It does not include information on individuals served by Medicaid HMOs or those served by STAR+PLUS.
This information is derived from paid or partially paid Medicaid claims and does not include data on denied or pending claims.
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Primary CVD Diagnoses, Inpatient Cost, Texas, 2005
Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients
Hypertension $2,132,630
Hypertensive heart disease $1,655,524
Ischemic Heart Disease $47,697,130
Stroke $20,071,425
Congestive Heart Failure $30,885,743
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Primary CVD Diagnoses, Outpatient Cost, Texas, 2005
Hypertension $1,640,395
Hypertensive heart disease $1,061,310
Ischemic Heart Disease $18,415,949
Stroke $9,944,830
Congestive Heart Failure $11,801,680
Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients
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Primary CVD Diagnoses, Emergency Department Cost Texas, 2005
Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients
Hypertension $6,561,670
Ischemic Heart Disease $7,348,006
Stroke $3,248,339
Congestive Heart Failure $3,762,690
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Total Medicaid Paid Claims Due to CVD, Texas, 2005
Inpatient Emergency Department
Outpatient
Medicaid Paid Amount for CVD
$182,524,852.67 $42,641,919.19 $103,351,622.91
Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients
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Risk Factor Surveillance
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BRFSS Ongoing telephone survey
sponsored by DSHS in partnership with CDC
Conducted on a monthly basis of 500 randomly selected Texans 18 years or older are asked questions about their health habits
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BRFSS Behavioral Risk Factors Medical Risk Factors Preventive Health Practices
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Texas Adult Current Smoking Rates
15.0%
17.0%19.0%
21.0%23.0%
25.0%
1998 1999 2000 2001 2002 2003 2004 2005 2006
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Adult Cigarette SmokingPrevalence – 2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006
19.6%17.9%
20.5%
15.4%17.4%
25.0%
16.3%
21.3%
17.3%20.2%
9.8%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Wei
ghte
d pe
rcen
t %
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Adult Cigarette SmokingHealth Service Region – 2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006
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Cigarette Smoking Among Youth – 2001 & 2005
Percent of Students Who Smoked One or More Cigarettes in the Past 30 Days
0
10
2030
40
50
60
7080
90
100
Male Female White Black Hispanic Texas
We
igh
ted
Pe
rce
nt
%
2001
2005
Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005(Excluding Houston ISD) High School Survey
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Overweight/Obesity
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Overweight or Obesity Texas and US Adults, 1995-2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2006
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
We
igh
ted
pe
rce
nt
%
US Texas
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Overweight or Obesity Texas, BRFSS,- 2006
61.5% 62.3%68.6%
55.8%60.3%
72.9%65.4%
49.9%
66.3% 67.8%62.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Wei
gh
ted
Per
cen
t %
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006
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Overweight or Obesity Health Service Region-2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006
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Overweight
0
10
20
30
40
50
60
70
80
90
100
Male Female White Black Hispanic Texas
We
igh
ted
Pe
rce
nt
%
2001
2005
Overweight among
Youth Prevalence – 2001 & 2005
Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005(Excluding Houston ISD) High School Survey
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Lack of Physical Activity
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Lack of Physical Activity* Texas & US Adults, 1995-2006
* During the past 30 days, did you participate in any physical activities or exercise? % of adults who did not participate in any physical activities during the past 30 days
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2006
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
We
igh
ted
Pe
rce
nt
%
US Texas
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Lack of Physical Activity* Adults, Prevalence – 2006
* During the past 30 days, did you participate in any physical activities or exercise? % of adults who did not participate in any physical activities during the past 30 days
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006
24.2%28.4%
25.8%
31.0%
23.7%
33.9%38.1%
27.4%25.3%
29.3%
34.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Wei
ghte
d P
erce
nt %
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Lack of Physical Activity* Adults, Prevalence – 2006
* During the past 30 days, did you participate in any physical activities or exercise? % of adults who did not participate in any physical activities during the past 30 days
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006
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Poor Nutrition
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Poor Nutrition* Adults, Prevalence – 2005
75.8% 77.4%81.8%
73.1% 76.1% 78.3% 79.5% 81.7% 79.2% 75.7%69.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
We
igh
ted
Pe
rce
nt
%
•*% of adults who reported eating fewer than 5 servings of fruits and vegetables per day
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005
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Poor Nutrition* Health Service Region – 2005
•*% of adults who reported eating fewer than 5 servings of fruits and vegetables per day
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005
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•*% of students who reported eating 5 or more servings of fruits and vegetables per day
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005
Nutrition*
Public High School Students – 2001,2005
Ate 5 or More Servings of Fruits or Vegetables in Past 7 Days
0
10
20
30
40
50
60
70
80
90
100
Male Female White AfricanAmerican
Hispanic Texas
We
igh
ted
Pe
rce
nt
%
2001
2005
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Medical Risk Factors
DiabetesHigh CholesterolHigh Blood Pressure
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DiabetesTexas and U.S Adult - 1995-2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2006
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
We
igh
ted
Pe
rce
nt
%
US Texas
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DiabetesPrevalence - 2006
8.1% 8.0% 8.0% 7.9% 7.8%10.3%
8.0%
0.9%
3.5%
12.8%
19.4%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Wei
ghte
d Pe
rcen
t %
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006
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Diabetes Prevalence Health Service Region– 2006
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006
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High CholesterolTexas and U.S Adult-1995-2005
0
5
10
15
20
25
30
35
40
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Years
Wei
gh
ted
Per
cen
t %
US Texas
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2005
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High CholesterolPrevalence - 2005
35.9% 34.0% 32.8%35.1% 36.7%
30.4% 28.2%
9.9%
24.2%
43.4%49.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Wei
ghte
d pe
rcen
t %
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005
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High Cholesterol Health Service Region– 2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005
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High Blood PressureTexas and U.S Adult -1995-2005
0
510
15
2025
30
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Years
Wei
ghte
d Pe
rcen
t %
US Texas
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2005
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High Blood PressurePrevalence - 2005
26.2% 24.5% 24.2% 24.8%28.2%
33.9%
16.7%
5.0%
14.1%
36.3%
56.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Wei
ghte
d pe
rcen
t %
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005
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High Blood Pressure Health Service Region--- 2005
Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2005
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HEDIS
Health Plan Employer Data and Information Set
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HEDIS Standardized performance
measures designed for comparing the quality of care of managed care organizations
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Result from HEDIS. Texas, 2001-2006
Measures 2001 2002 2003 2004 2005 2006
Controlling High BP 1 47.8 50.9 57.9 59.2 64.5 64.5
Beta Blocker Treatment After a Heart Attack2 NA 90.3 86.9 85.2 83.3 84.3
LDL-C Screening after acute CV event3 72.4 76.2 77.1 77.9 79.4 75.6
LDL-C Level < 130 mg/dL4 42.6 57.7 56.3 55.8 46.8
Data Source: http://www.opic.state.tx.us/page.php?p_sub_page_id=582001-2006
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STRATEGIES Surveillance, Data and Outcome
Management Health Education and Outreach Clinical Prevention and Treatment
Services Community Policy and
Environmental Changes