With the recent launch of the Diabetes and Hypertension Surveillance Systems, two powerful new tools designed to track and better understand these health conditions across Dallas County, data is showing that more than one million residents are living in very high vulnerability for these harmful chronic illnesses.
These data tools combine clinical indicators with income, education, food insecurity, access to green space and other factors along with geographic information to guide policy decisions and strategies.
Since the surveillance systems’ launch in September, we’ve already uncovered some key insights, with the diabetes tool, also known as DiSS, finding 19 ZIP codes in the very high vulnerability range, affecting more than 521,400 residents. The leading root causes for this increased risk include a high number of emergency department visits for diabetes in the last 12 months, the density of people with diabetes in the community, and lack of walkable space in the neighborhoods.
Similarly, on the hypertension front, the tool, also known as HySS, found that more than 519,530 residents live in 19 ZIP codes ranked with very high vulnerability for this condition. The leading factors for vulnerability include recent emergency department visits for hypertension in the last 12 months, the prevalence of mental and behavioral health diagnosis in the community, and overall community social vulnerability.
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Importantly, however, we also see how neighboring ZIP codes with similar social vulnerability levels might have very different drivers of risk. For example, ZIP code 75216, in Oak Cliff, has a very high vulnerability for diabetes, primarily driven by the high prevalence of obesity, hypertension and mental and behavioral health issues in the community.
The adjacent ZIP code, 75241, in South Dallas also has very high vulnerability to diabetes, but while the prevalence of obesity and hypertension remains a leading driver of vulnerability, the lack of internet connectivity plays a more significant role.
The DiSS and HySS dashboards were developed in collaboration with Parkland Health, the Dallas County Health Department, and the Parkland Center for Clinical Innovation, and are publicly accessible on the DCHHS Chronic Disease Prevention webpage. Both systems are powered by a combination of PCCI’s Community Vulnerability Compass indicators and clinical factors, which uniquely provide insights from social and health data to anticipate a community’s susceptibility to and identify inequities across adverse outcomes from diabetes and hypertension. The diabetes and hypertension vulnerability indexes rank communities from very low to very high risk, indicating the risk of poor outcomes from both diseases in the community.
Patients who either can’t obtain necessary medication or infrequently use their medication are more likely to have poorly controlled hypertension or diabetes, which can lead to complications such as stroke, heart attacks, kidney disease, and frequent emergency room visits and hospitalizations. This is why medical adherence or how patients follow their prescriptions is a key indicator.
These eye-opening insights only scratch the surface of what the surveillance systems can tell us. The deeper insights come from the fact that we can go into neighborhoods at the census tract level, where we have seen neighborhoods of very high vulnerability separated from a very low vulnerability census tract by only a single street.
By identifying where risks are concentrated, public health leaders and community-based organizations can target and tailor outreach to the neighborhoods most in need, ensuring more effective, efficient and equitable interventions to maximize our collective impact. We’re excited to make these tools available to the Dallas community and beyond.
Dr. Yolande Pengetnze is the Parkland Center for Clinical Innovation senior vice president of Clinical Leadership.