Transcript Community Health Needs Assessment

Community Health
Needs Assessment
2010
A comprehensive look at Seton’s 11 County
Coverage Area
Seton Planning Department, 2010
Purpose
•
•
2
This assessment is provided to the Board help it gauge how Seton Family of
Hospitals current and planned services meet community needs – particularly unmet
needs.
This report supplements other information on the community and its needs and
characteristics that have been on the board strategic thinking agenda at previous
meetings. The Board Dinner discussion will include a recap of those other
community needs as well as highlights of the new information in this report. Links
to the Board Share Point site where those materials are available are also provided
below.
• Demographics
•
http://sharepoint.seton.org/sites/board/meetings_and_agendas/Lists/Agenda/DispForm.aspx?ID=1602&Sourc
e=http%3A%2F%2Fsharepoint%2Eseton%2Eorg%2Fsites%2Fboard%2Fmeetings%5Fand%5Fagendas%2Fdef
ault%2Easpx%3FInstanceID%3D29%26Paged%3DNext%26p%5FStartTimeUTC%3D20090610T170000Z%26
View%3D%257b83326A00%252d6108%252d46DF%252dA52A%252d70F8359EDCD7%257d
•
Behavioral health
•
http://sharepoint.seton.org/sites/board/Strategic%20Direction/Forms/AllItems.aspx?RootFolder=%2fsites%2f
board%2fStrategic%20Direction%2fBehavioral%20Health&View=%7b49C9D19F%2d2B4E%2d44B9%2d87EB
%2d62E90CE59B63%7d
•
Physician supply/shortage
•
http://sharepoint.seton.org/sites/board/meetings_and_agendas/Lists/Agenda/DispForm.aspx?ID=1493&Sourc
e=http%3A%2F%2Fsharepoint%2Eseton%2Eorg%2Fsites%2Fboard%2Fmeetings%5Fand%5Fagendas%2Fdef
ault%2Easpx%3FInstanceID%3D27%26Paged%3DNext%26p%5FStartTimeUTC%3D20090610T170000Z%26
View%3D%257b83326A00%252d6108%252d46DF%252dA52A%252d70F8359EDCD7%257d
•
Poor and vulnerable
•
http://sharepoint.seton.org/sites/board/Strategic%20Direction/Forms/AllItems.aspx?RootFolder=%2fsites%2f
board%2fStrategic%20Direction%2fPoor%20and%20Vulnerable&View=%7b49C9D19F%2d2B4E%2d44B9%2d
87EB%2d62E90CE59B63%7d
Note: Data in this report are for residents of the 11-county Central
Texas area that is the Seton Family of Hospital’s primary service
area for adults. Geographic details on that area can be found on
page 39.
Executive Summary
• Community needs an on-going strategic discussion by
Board
Needs of the Central Texas community have been at the heart
of many of board’s strategic discussions over the last several
years. Discussions of demographics have highlighted a rapidly
growing and increasingly diverse population to serve.
Residents’ difficulty in accessing care, whether due to financial
barriers or caused by an insufficient number of clinicians to
meet this area’s needs, has been at the core of discussions of
plans for graduate medical education and of needs of vulnerable
populations. And finally, on-going chronic conditions and the
fragmented system response to those, have highlighted needs
of the medically and socially vulnerable. These chronic
conditions were discussed in thinking about a behavioral health
strategy and in understanding the heavy resource use of some
of the vulnerable segments where underlying conditions such as
diabetes and hypertension are often present.
3
Executive Summary
• Causes of mortality and premature mortality highlight
additional needs
While mortality rates for the community as a whole continue to
decline (mortality rate for population as a whole), prevention
opportunities are still present for deaths from accidents,
suicide, cancer and cardio and cerebrovascular diseases.
Premature mortality rates are higher in the more rural east and
western regions of Central Texas. And an aging population
presents additional service needs highlighted by increasing
mortality from Alzheimer’s.
• Community indicators suggest other opportunities or
possible warning flags
4
Self-reported health status studies highlight an increasing
challenge in obesity, and residents are increasingly less likely to
say that their health status is “excellent.” Syphilis rates are
increasing and the number of children not immunized due to
conscience is increasing.
Executive Summary
• Community environment affect on health
The economic, education, and natural and built environment in
Central Texas also has impact on health. The relationships
among these factors are key findings in the Children’s Optimal
Health project as they affect children. For the community as a
whole, findings from the most recent Central Texas
Sustainability Indicators Project suggest additional efforts are
needed to address issues of safe families, quality of and access
to child care, equity among schools, water consumption and
quality, air quality, mental health, vehicle miles traveled, rural
land, cost of living, home loans and race relations.
5
Overview
• Purpose
• Summary
• Causes of mortality
Page 2
•
•
•
•
•
•
•
•
•
Page 17
6
Page 3
Page 7
• Cancer incidence
Premature mortality
Health Status
Communicable disease
Teen pregnancy
Lifestyle health indicators
Immunizations
Community Environment
Child Safety
Appendix
Page 22
Page 23
Page 29
Page 30
Page 34
Page 35
Page 37
Page 38
Mortality Rates As an Indicator
• One way to look at what a community’s health needs is to
identify the leading causes of death and investigate
changes in the mortality rate trends over time.
7
Causes of Mortality
• Cancer and cardiac
disease account for
nearly three out of
every five deaths in
Central Texas.
• Accidents, stroke and
chronic lower
respiratory diseases
together cause another
quarter of the deaths.
• The table on the following
page presents more detail on
these causes of mortality.
Suicide
3%
Influenza and Pneumonia
3%
Nephritis
2%
Septicemia
2%
Diabetes
3%
Alzheimer's
5%
Cancer
30%
Chronic Lower
Respiratory Diseases
(CLRD)
7%
Stroke
8%
Accidents
9%
Cardiac
28%
Texas Health Data, 2006
8
Mortality
Cause of death overview
Rank,
TX
2
1
4
Rank,
Central
1
2
3
3
4
443 Stroke
5
7
6
8
11
5
6
7
8
9
389
309
190
161
153
8
10
10
11
107 Nephritis
102 Septicemia
Rank,
TX
Rank,
Central
Texas
1
3
6
1
2
5
4
2
3
4
5
6
Number of Deaths in
Central Texas (2006)
Cause of Death
1693 Cancer (see detail below)
1608 Diseases of the Heart
489 Accidents
Points of interest
Age adjusted South region shows
downward trend
Down
45-64 age group shows upward
Chronic Lower Respiratory Diseases (CLRD)
Slightly down trend
Alzheimer's
Up
All changes occur in 65+ age
group
Diabetes
Slightly down Steadies
in later years
Influenza and Pneumonia
Down
Suicide
Slightly down While there is a slight downward
trend, it is relatively steady overal.
South shows downward trend.
Number of Deaths in
Central Texas (2006)
Slightly up
Steady
Cancer Types
Overall
Trend
840 Breast
747 Prostate
Steady
Upward
725
510
388
299
913
Steady
Steady
Upward
Upward
Upward
Respiratory System
Colon and Rectum
Urinary System
Gynecological
Other*
*Lymphoma, endocrine system, skin, karposi sarcoma, leukemia, oral
cavity and pharynx, myeloma, brain, soft tissue including heart
9
Overall
Trend
Down
Down
Steady
Points of interest
Upward in North
Down in West, exceptionally large
upward trend in East.
Down in West
Texas Health Data, 2006
Mortality Rates: The Big Picture
Central Texas Crude Death Rates by Cause
9
19 5
96
19
97
19
98
19
99
20
0
20 0
01
20
02
20
03
20
04
20
05
20
06
94
19
93
19
92
19
19
19
19
91
200
180
160
140
120
100
80
60
40
20
0
90
Rate per 100,000
• Downward trends
mortality rates in
Cancer, Diseases of the
Heart, Stroke, and
Influenza and
Pneumonia
Cancer
Central Texas Crude Death Rates by Cause
Diseases of the Heart
Rate per 100,000
60
50
40
30
20
10
10
Septicemia
Diabetes
Alzheimer's
*
Stroke
Influenza and Pneumonia
CLRD*
Nephritis
Suicide
Accidents
06
20
05
04
20
03
20
02
20
01
20
00
20
99
20
98
19
97
19
19
96
95
19
94
19
93
19
92
19
91
19
19
19
90
0
• Upward trend in
Alzheimer’s and
Nephritis
• Relatively steady in
Diabetes, Accidents,
Septicemia, and Suicide
*
Mortality data collected before 1999 uses ICD-9, after 1999 uses ICD-10. All mortality data
collected from the Texas Health Data, TDHHS. All age, race, and gender populations collected from
* Chronic Lower Respiratory Disease
the Texas Health Data, TDHHS.
Texas Health Data , 2006
Mortality Findings and Trends
• Cancer and cardiovascular disease are virtually tied for the top
cause of death in Central Texas. In recent years, cancer has
surpassed cardiac as the top cause. Crude mortality rates for
both show a decline since 1990.
Rate per 100,000
Central Texas Crude Death Rates by Cause
200
180
160
140
120
100
80
60
40
20
0
1
99
0
1
99
1
1
99
2
1
99
3
1
99
4
1
99
5
1
99
6
1
99
Cancer
7
1
99
8
1
99
9
2
00
0
2
00
1
2
00
2
2
00
3
2
00
4
2
00
5
2
00
6
Diseases of the Heart
Texas Health Data, 2006
11
Mortality data collected before 1999 uses ICD-9, after 1999 uses ICD-10. All mortality data
collected from the Texas Health Data, TDHHS. All age, race, and gender populations collected from
the Texas Health Data, TDHHS.
Mortality Findings and Trends
• Cerebrovascular diseases (Stroke)
•
Downward trend in Central Texas
• Ages 45-64, however, show opposite, slight upward trend in last nine
years of data
Cause of Death in Central Texas: Stroke
60
Rate per 100,000
50
40
30
20
10
All Ages
06
05
20
04
20
03
20
02
20
01
20
00
20
99
20
98
19
19
97
96
19
95
19
94
19
93
19
92
19
91
19
19
19
90
0
Central Texas 45-64
12
Mortality data collected before 1999 uses ICD-9, after 1999 uses ICD-10. All mortality data
collected from the Texas Health Data, TDHHS. All age, race, and gender populations collected from
the Texas Health Data, TDHHS.
Texas Health Data, 2006
Mortality Findings and Trends
• Alzheimer’s
•
Increasing trend overall, but persons of “white” racial/ethnic background show
the largest increase
Cause of Death in Central Texas: Alzheimer's
35
Rate per 100,000
30
Whites show majority of rate
increase
25
20
15
10
Note: The rate of
increase in
Alzheimer’s as a
cause of death
may be
attributed to
improved
diagnosis or to
other factors.
We cannot draw
conclusions from
these data.
5
0
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06
9
1 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20
All Races
White
Black
Hispanic
Texas Health Data, 2006
13
Mortality data collected before 1999 uses ICD-9, after 1999 uses ICD-10. All mortality data
collected from the Texas Health Data, TDHHS. All age, race, and gender populations collected from
the Texas Health Data, TDHHS.
Mortality Findings and Trends
• Accidents
•
While accidents are steady over all, there is downward trend in motor vehicle
accidents (MVAs) and an upward trend in falls, accidental poisonings and
exposure to noxious substances, and other causes.
14
Mortality data collected before 1999 uses ICD-9, after 1999 uses ICD-10. All mortality data
collected from the Texas Health Data, TDHHS. All age, race, and gender populations collected from
the Texas Health Data, TDHHS.
Texas Health Data, 2006
Causes of Cancer
Mortality
Central Texas
cancer mortality by
tumor site is shown
in the graph at
right.
Investigation of
cancer incidence in
Central Texas for
these tumor sites
shows some
increase in the
“other” category
and an increase
between 2002 and
2004 for prostate
cancer.
Incidence
increasing
Other*
20%
Breast
19%
Incidence
increasing
Gynecological
7%
Urinary
System
9%
Colon and
Rectum
12%
Prostate
17%
Respiratory
System
16%
A more detailed graph on
incidence trends can be
found on the following
page.
15
Cancer mortality data have been provided by the Texas Cancer Registry, Cancer Epidemiology and
Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th Street, Austin, Texas,
78756 , http://www.dshs.state.tx.us/tcr/default.shtm , or (512) 458-7523. Accessed 12/1/09
*”Other”
cancers
include:
Lymphoma,
endocrine system,
skin, karposi
sarcoma, leukemia,
oral cavity and
pharynx, myeloma,
brain, soft tissue
including heart
Cancer Incidence Rates
Note: Some
increase in
reported cancer
incidence may
be due to
improved
imaging and
other
technology
allowing earlier
diagnosis.
Increase in Prostate
cancer from 02-04
Upward trend in Other*
Year
Breast
Gyn
Respiratory
Prostate
Colon/Rectum
Other *
16
Cancer incidence data have been provided by the Texas Cancer Registry, Cancer Epidemiology and
Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th Street, Austin,
Texas, 78756 , http://www.dshs.state.tx.us/tcr/default.shtm , or (512) 458-7523.
Urinary
2
0
0
6
2
0
0
5
2
0
0
4
2
0
0
3
2
0
0
2
2
0
0
1
2
0
0
0
1
9
9
9
1
9
9
8
1
9
9
7
*”Other”
1
9
9
6
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
1
9
9
5
Rate per 100,000
All Regions Crude Incidence Rates by Cancer
Type, 1995-2006
cancers
include:
Lymphoma,
endocrine
system, skin,
karposi
sarcoma,
leukemia, oral
cavity and
pharynx,
myeloma,
brain, soft
tissue including
heart
Years of “potential” life lost
• Public health professionals sometimes use an indicator
that tracks causes of years of life lost before age 65* as
one way to focus prevention/intervention initiatives. This
indicator helps focus on causes of premature mortality.
17
*Many, including the author, question whether age 65 is the right
cutoff for “potential” life, but the focus this indicator puts on early
causes of death remains useful. Literature suggests a potential
move to age 75 as a better benchmark.
Years of Potential Life Lost (YPLL)
• There are four major
causes of years of life lost
before age 65: accidents,
cancer, cardiovascular
disease and suicide.
• Many of these years of life
lost are preventable;
accidents and suicide
clearly are largely
preventable. Lifestyle
changes can also prevent
some cancer and cardiac
disease.
Nephritis
2%
Chronic Lower
Respiratory Diseases
1%
Septicemia
Influenza and Pneumonia
1%
1%
Diabetes Mellitus
2%
Alzheimer's Disease
0%
Stroke
3%
Suicide
12%
Accidents
40%
Diseases of the
Heart
14%
• The following pages present
data on the trended rates of
these years of productive life
lost expressed against the
population under 65.
18
State of New Jersey Department of Health and Senior Services: Center for Health Statistics
Information for Local Health Officers. “How to calculate years of potential life lost before age 65.
http://www.state.nj.us/health/chs/localhealth/YPLL65.xls . Accessed 11/23/09.
Cancer
24%
Years of Potential Life Lost (YPLL)
• Accidents
•
•
From 2002 forward, the rate for the region as a whole dropped some, but
rebounded again in 2006
This rate of years lost to accidents is higher in the more rural west and east
regions. The south region has a declining rate.
Years of Potential Life Lost (YPLL) by Cause of
Death: Accidents
2500
YPLL Rates
2000
Higher rates in East and
West
1500
1000
500
Downward trend South
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
West
Source: Texas Health Data
population under age 65.
South
East
Central Texas
Years of Productive Life Lost (YPLL) rate: years of life lost before age 65 per 100,000
19
State of New Jersey Department of Health and Senior Services: Center for Health Statistics
Information for Local Health Officers. “How to calculate years of potential life lost before age 65.
http://www.state.nj.us/health/chs/localhealth/YPLL65.xls . Accessed 11/23/09.
Years of Potential Life Lost (YPLL)
• Malignant neoplasms (Cancer)
•
•
YPLL rates for cancer have gradually declined since 1966
Rates in the more rural west and east regions are higher than the region as a whole.
Years of Potential Life Lost (YPLL) by Cause of
Death: Cancer
1600
1400
YPLL Rate
1200
1000
800
600
400
200
0
19
96
19
97
19
98
19
99
20
00
West
Source: Texas Health Data
population under age 65.
20
01
20
East
02
20
03
20
04
20
05
20
06
Central Texas
Years of Productive Life Lost (YPLL) rate: years of life lost before age 65 per 100,000
20
State of New Jersey Department of Health and Senior Services: Center for Health Statistics
Information for Local Health Officers. “How to calculate years of potential life lost before age 65.
http://www.state.nj.us/health/chs/localhealth/YPLL65.xls . Accessed 11/23/09.
Years of Potential Life Lost (YPLL)
• Intentional Self-harm (Suicide)
•
Years lost to suicide have dropped a little, but like in many of the other
indicators, years lost in the more rural west and east regions are higher than
the region as a whole.
Years of Potential Life Lost (YPLL) by Cause of
Death: Suicide
600
YPLL Rate
500
400
300
200
100
0
19
96
19
97
19
98
19
99
20
00
West
Source: Texas Health Data
population under age 65.
20
01
20
East
02
20
03
20
04
20
05
20
06
Central Texas
Years of Productive Life Lost (YPLL) rate: years of life lost before age 65 per 100,000
21
State of New Jersey Department of Health and Senior Services: Center for Health Statistics
Information for Local Health Officers. “How to calculate years of potential life lost before age 65.
http://www.state.nj.us/health/chs/localhealth/YPLL65.xls . Accessed 11/23/09.
Health Status
• Self-reported health status (Would you say your health is…) for
residents of the five core counties in Central Texas suggests that
most believe their health is very good or excellent. The percent
reporting excellent, however, has dropped in recent years.
22
Central Texas Sustainability Indicators Project. Phone survey, MayJune 2008, 2,395 sample, using SF-36 health status questions.
Communicable Disease
• Another assessment of the community’s health is the
prevalence and incidence of communicable diseases.
Increasing trends in incidence should be addressed by
community and public health efforts.
• Travis County public health officials suggest examination
of data for HIV/AIDS, Syphilis, Tuberculosis, Pertussis
(whooping cough) and Meningococcal virus.
• Data for all but meningococcal virus are presented in the
following pages. The data set for meningococcal virus was
too small for meaningful conclusions.
23
HIV/AIDS
• People are living longer with HIV…
HIV Prevalance vs Incidence Rates by Region
Crude Rate per 100,000
160
HIV/AIDS:
140
120
• What is the difference?
100
• HIV is the
immunodeficiency
virus that causes
AIDS
80
60
40
20
0
2000
2001
2002
2003
2004
2005
Central Prevalence
Central Texas Prevalence
Central Incidence
Central Texas Incidence
2006
…while the number of new infections drop
24
Texas Department of State Health Services: HIV/STD Program, Statistics and Trends.
Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008.
http://www.dshs.state.tx.us/hivstd/stats/default.shtm.
• AIDS diagnosis is
made when T cell
count drops below
200
HIV/AIDS
• Dropping AIDS incidence rates tied with increasing HIV
prevalence suggests that medication and education are
making HIV/AIDS more of a chronic disease affecting
fewer new people each year.
HIV Prevalance Rates Central Texas 20002006
100
90
Crude Rate per 100,000
AIDS Incidence Rates Central Texas 2000-2006
Crude Rate per 100,000
18
16
14
12
10
8
6
80
70
60
40
30
20
10
Slight downward trend
0
2000
4
2
0
2000
25
Increasing prevalence with
decreasing incidence a sign of
longer survival. HIV/AIDS is
becoming a more chronic
disease.
50
2001
2002
2003
2004
2005
2006
Texas Department of State Health Services: HIV/STD Program, Statistics and Trends.
Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008.
http://www.dshs.state.tx.us/hivstd/stats/default.shtm.
2001
2002
2003
2004
2005
2006
Syphilis
• Syphilis incidence rates are increasing
Syphilis Prevalence Rates by Region 20002006
Crude Rate per 100,000
25
20
Steady increase in Central
Region and All Regions
15
10
5
0
2000
2001
2002
Central
26
2003
2004
Central Texas
Texas Department of State Health Services: HIV/STD Program, Statistics and Trends.
Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008.
http://www.dshs.state.tx.us/hivstd/stats/default.shtm.
2005
2006
TB
• TB incidence rates are dropping
Trends in Tuberculosis Incidence Rates by
Region 2003-2006
8
Notice that All follows Central's trend
Rate per 100,000
7
6
Downward trend in Central Region.
All others have small cell size.
5
4
3
2
1
0
2003
2004
Central
27
2005
Central Texas
Texas Department of State Health Services: HIV/STD Program, Statistics and Trends.
Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008.
http://www.dshs.state.tx.us/hivstd/stats/default.shtm.
2006
Pertussis
• Pertussis incidence rates (Whooping cough)
•
The trend here is up. Public health officials credit both an increase in incidence
and an aggressive outreach and education program for the increased reports of
incidence.
Trends in Pertussis Incidence Rates by Region
1999-2006
Trends in Pertussis Incidence Rates by Region
1999-2006
450
70
Large spike in West in 2002
350
Rate per 100,000
Rate per 100,000
400
300
250
200
150
100
A spike in 02 and 05
with an overall upward
60
50
40
30
20
10
50
0
0
1999
2000
West
28
Notice that All, generally, follows Central's trend
80
2001
North
2002
Central
2003
South
2004
East
2005
2006
Central Texas
Texas Department of State Health Services: HIV/STD Program, Statistics and Trends.
Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008.
http://www.dshs.state.tx.us/hivstd/stats/default.shtm.
1999
2000
North
2001
Central
2002
2003
South
East
2004
2005
Central Texas
2006
Teen Pregnancy Rates
• Teen pregnancy rates are relatively stable.
Rate per 1,000
Teen (13-17 yrs) Pregnancy Rates 2001-2006
40
35
30
25
20
15
10
5
0
2001
2002
2003
North
29
Central
Texas Department of State Health Services: Vital Statistics Annual Reports 2001-2006,
Births. Tables 14B. http://www.dshs.state.tx.us/CHS/VSTAT/annrpts.shtm. Accessed
11/11/09.
2004
Central Texas
2005
2006
Lifestyle Health Indicators
• Self-reported health risk factors for a community can also
be useful in assessing health and targeting prevention and
education efforts.
• While most factors have not changed during the period
analyzed there’s good news and bad news:
• There are more people reporting weight that puts them into
the overweight or obese categories. In 2008, that was more
than 60% of the survey respondents.
• Fewer people are smoking.
• Details for the key areas with changes follow.
30
Lifestyle Health Indicators
• Taken from Behavioral Risk Factor Surveillance System (BRFFS)*
• Includes Bastrop, Caldwell, Hays, Travis, and Williamson counties –
Adults only
• Youth Risk Behavior Survey results not offered for our coverage area
• Obesity
•
Overweight and obese show an increase
• Smoking
•
Decreased number of residents smoking
• Asthma
•
Small, steady decline
• Alcohol consumption
•
•
•
Binge drinking is on the rise slightly
Heavy drinking is relatively steady
Light drinking is relatively steady
• Diabetes
•
Remains steady, but at low rates
*Source: Texas Department of Health. Telephone survey of residents of Bastrop, Caldwell, Hays, Travis & Williamson
counties. Sample size: 2004, 560; 2005, 527; 2006, 524; 2007, 1,373; 2008, 933. http://www.dshs.state.tx.us/chs/brfss/
31
Lifestyle Health Indicators: Overweight/Obesity
• The percent of residents reporting overweight or obese status is
increasing.
Behavioral Risk Factor Surveillance Survey:
Percent Overweight or Obese
62%
Percent
60%
58%
56%
54%
52%
50%
2004
2005
2006
2007
2008
*Source: Texas Department of Health. Telephone survey of residents of Bastrop, Caldwell, Hays, Travis & Williamson
counties. Sample size: 2004, 560; 2005, 527; 2006, 524; 2007, 1,373; 2008, 933. http://www.dshs.state.tx.us/chs/brfss/
32
Lifestyle Health Indicators: Smoking
• Slightly fewer Central Texans are smokers
Behavioral Risk Factor Surveillance Survey: Level of
Smoking Status
30%
Percent
25%
20%
15%
10%
5%
0%
2004
2005
2006
2007
2008
*Source: Texas Department of Health. Telephone survey of residents of Bastrop, Caldwell, Hays, Travis & Williamson
counties. Sample size: 2004, 560; 2005, 527; 2006, 524; 2007, 1,373; 2008, 933. http://www.dshs.state.tx.us/chs/brfss/
33
Immunizations
• The level of immunization of a population is also an
indicator of potential health issues.
• Most counties in the region have good coverage, 96%100%, of all immunizations except for Hep A
•
•
•
Hep A immunizations were only required for “students attending a school located in a high
incidence geographic area as designated by the department” before the 09-10 school year;
Seton service area does not fall into this geographic area
Must have by 2nd birthday, therefore not tracked in 7th grade vaccination reports
Increases in Hep A immunizations in most counties; Llano sees a decrease, Bastrop stays
relatively stable
• Reason of Conscience under-reports immunizations
•
•
•
•
The data don’t include those who cite reason of conscience to refuse immunizations.
Students must present a medical exemption or “Reason of Conscience” if not immunized
• For “Reason of Conscience”, parents must request this document from the state,
complete the document and have it notarized, exemption is valid for two years
Number of students presenting a “Reason of Conscience” exemption continues to increase
every year
These students are listed in a separate category, not under delinquent immunizations
Note: Immunizations tracked in kindergarteners and 7th graders, but only consistently for Kindergarteners.
Diseases tracked: DTP, Hep A, Hep B, Measles 1, Measles 2, Mumps, Polio, Rubella, Varicella
34
Community Environment Impact on Health
• The community environment in Central Texas also has an
impact on health.
• Air and water quality are often public health concerns and
have been shown to impact health care costs1.
• Availability of recreational spaces and community walkability
design can encourage more active healthy lifestyles.
• Economic health2 and educational attainment have been
shown to have strong correlation to individual health status.
• A safe environment contributes not only to reduced accidents
but to a mental well-being of the community.
• The 2009 report from the Central Texas Sustainability
Indicators Project provides a useful summary of these
community indicators.
35
1
2
http://www.rand.org/health/projects/air-pollution-in-california/
http://www.centex-indicators.org/annual_rept.html, pg 112
Community Environment Impact on Health
• The 2009 report from the Central Texas Sustainability
Indicators Project1 provides a useful summary of these
community indicators.
• Most indicators show either a “red” or “yellow” flag status,
suggesting that continual monitoring or action is needed.
• Areas that are listed as doing well include higher education,
philanthropy/volunteerism and neighborliness.
• Areas that are shown to require action include safe families,
quality of and access to child care, equity among schools,
water consumption and quality, air quality, mental health,
vehicle miles traveled, rural land, cost of living, home loans
and race relations.
36
1
http://www.centex-indicators.org/annual_rept.html
Child Safety
• Falls (47%), motor vehicle collisions (MVC) (15%) and
sports (6%) are the top three drivers of accidental injury
of children at Dell Children’s Medical Center.
•
Accidental injury data are for patients held longer than 48 hrs
Top Three Causes of Pediatric Injury in 2008
Falls
Injury Type
Age
<1
1-4
MVC
5-9
10-14
Sports
0%
20%
40%
60%
37
Source: Dell Children’s Medical Center Injury Prevention Program;
Data for for 2008
80%
100%
Appendix
•
•
•
•
38
Geography of area assessed
Assessment limitations and notes
Explanation of prevalence and incidence
Acknowledgements
11 County
Service Area
• Broken down into
5 Regions
• West – Burnet,
Llano, Blanco
• North –
Williamson
• Central –
Travis
• South – Hays,
Caldwell
• East – Lee,
Bastrop,
Fayette,
Gonzales
39
Assessment Limitations and Notes
• International Classification of Diseases (ICD) change
• In 1999 the classification system changed from ICD-9 to ICD-10,
they cannot be compared over time (we look at 1990-2006)
• Sample sizes below 20 cannot be reliable for rate calculations
• Behavioral Risk Factors Surveillance System is self-reported and
only for adults
• Only available for certain counties in Seton’s coverage area
• Youth version, YRBS, is not available for any counties in Seton’s
coverage area
• Basic data analysis will indicate where to focus on more in-depth
statistical analysis
• Control charts showed no statistically significant trends
• Even though we have up and down trends, statistically we are steady
40
Communicable Diseases
• A crash course in incidence vs. prevalence
• Incidence rate
• number of new cases in population/population
• Prevalence rate
• total number of cases in population/population
41
Higginson, I, Constantini, M. Interactive Textbook on Clinical Symptom Research.
Chapter 19: Epidemiological Methods in Studies of Symptoms in Advanced Disease,
Pg. 6. http://symptomresearch.nih.gov/chapter_19/sec4/cihs4pg1.htm. Accessed
3/3/2010.
Resources
•
Air Quality. News 8 Austin. http://www.news8austin.com/Content/Weather/Air_Quality/AQIndex/. Accessed 2/9/10.
•
Cancer incidence data have been provided by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of
State Health Services, 1100 W. 49th Street, Austin, Texas, 78756 , http://www.dshs.state.tx.us/tcr/default.shtm , or (512) 458-7523. Accessed
12/1/09.
•
Cause of death data by age 90-98 from Janice Jackson. 11/5/09.
•
CensusScope: Language. http://www.censusscope.org/us/s48/chart_language.html. Accessed 12/7/09.
•
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, 2009.
•
Deaths, percent of total deaths, and death rates for the 15 leading causes of death: United States and each State. Accessed 11/9/09.
•
Goodhealth.com. Keep Kids Safe on Bike This Summer. http://www.goodhealth.com/articles/2007/06/29/keep_kids_safe_on_bikes_this_summer.
Posted 6/29/2007. Accessed 11/30/09.
•
Hays County’s 2006 Parks and Open Space Master Plan. http://parks.co.hays.tx.us/LinkClick.aspx?fileticket=HRCdjYKL2MM%3d&tabid=58.
Accessed 3/10/2010.
•
Health Insurance Coverage Status and Type of Coverage by State--Persons Under 65: 1999 to 2008 [XLS]. Source: U.S. Census Bureau, Housing
and Household Economic Statistics Division. http://www.census.gov/hhes/www/hlthins/historic/hihistt6.xls. Accessed 11/25/09.
•
Health Insurance Coverage in Texas: 1988 to 2001. U.S. Census Bureau. March Current Population Survey (CPS).
http://www.hhsc.state.tx.us/research/dssi/HIS/TXINSHIST.html. Accessed 11/25/09.
State of New Jersey Department of Health and Senior Services: Center for Health Statistics Information for Local Health Officers. “How to
calculate years of potential life lost before age 65. http://www.state.nj.us/health/chs/localhealth/YPLL65.xls. Accessed 11/23/09.
•
•
Higginson, I, Constantini, M. Interactive Textbook on Clinical Symptom Research. Chapter 19: Epidemiological Methods in Studies of Symptoms
in Advanced Disease, Pg. 6. http://symptomresearch.nih.gov/chapter_19/sec4/cihs4pg1.htm. Accessed 3/3/2010.
•
Strassman, Mark. CBS Evening News. Early Onset Alzheimer’s On The Rise.
http://www.cbsnews.com/stories/2008/03/08/eveningnews/main3919747.shtml. Accessed 2/9/10.
•
Texas Administrative Code. Title 25, Part 1, Chapter 97, Subchapter B, Rule 97.63 Immunization Requirements in Texas Elementary and
Secondary Schools. Texas Department of State Health Services.
http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=97&rl=
63. Accessed 2/5/10.
•
Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. HARS HIV/AIDS Cases Annual Data 2001-2005.
http://www.dshs.state.tx.us/hivstd/stats/default.shtm. Accessed 1/5/2010.
42
Resources Continued
•
Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. Meningococcal Invasive.
http://www.dshs.state.tx.us/idcu/disease/meningococcal_invasive/l. Accessed 1/5/10.
•
Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. Texas HIV/STD Surveillance Report 2008 Annual Report
2000-2008. http://www.dshs.state.tx.us/hivstd/stats/default.shtm. Accessed 1/5/10.
•
Texas Department of State Health Services: Infectious Disease Control Unit. Tuberculosis Statistics, Cases and Rates by County.
http://www.dshs.state.tx.us/idcu/disease/tb/statistics/default.asp. Accessed 12/21/09.
•
Texas Department of State Health Services: Substance-Related Statistics by County.
http://www.tcada.state.tx.us/research/statistics/region7.shtml. Accessed 12/10/09.
•
Texas Department of State Health Services: Texas Health Data, Death Data. Age groups. http://soupfin.tdh.state.tx.us/deathdoc.htm. Accessed
11/26-28.
•
Texas Department of State Health Services: Texas health data, Population data. http://soupfin.tdh.state.tx.us/people.htm. Accessed 11/10/09,
12/21/09.
•
Texas Department of State Health Services: Vital Statistics Annual Reports 2001-2006, Births. Tables 14B.
http://www.dshs.state.tx.us/CHS/VSTAT/annrpts.shtm. Accessed 11/11/09.
•
Texas Department of State Health Services: Vital Statistics Annual Reports 2001-2006, Death Tables 27.
http://www.dshs.state.tx.us/CHS/VSTAT/annrpts.shtm. Accessed 11/18/09.
•
Texas Department of State Health Services: Vital Statistics Annual Reports 2001-2006, Deaths. Tables 16.
http://www.dshs.state.tx.us/CHS/VSTAT/annrpts.shtm. Accessed 11/5/09.
•
Texas Department of State Health Services: Vital Statistics Annual Reports 2001-2006, Deaths. Tables 27-28B.
http://www.dshs.state.tx.us/CHS/VSTAT/annrpts.shtm. Accessed 12/9/09.
•
Texas Dept. of State Health Services. Cause of death rates by age and race 90-2006 from Janice Jackson. 11/18/09.
•
Texas Department of State health Services: Texas health data, Population data. http://soupfin.tdh.state.tx.us/people.htm. Accessed 11/10/09,
12/21/09, 1/8/10.
•
U.S. Census Bureau: Small Area Health Insurance Estimates. State and County by Demographic and Income Characteristics 2006, 2005, 2001.
http://www.census.gov/did/www/sahie/data/index.html. Accessed 11/27/09.
•
U.S. Census Bureau: State & County Quick Facts. http://quickfacts.census.gov/qfd/states/. Accessed 12/1/09.
•
US Census Bureau. http://www.census.gov/population/www/cen2000/briefs/phc-t20/tables/tab05.xls. Accessed 12/7/09.
•
US and Texas Cause of death. CDC/NCHS, National Vital Statistics System
http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=97&rl=
63. Accessed 2/5/10.
43
Special Thanks To….
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•
44
Ashton Cumberbatch
Braxton Beyer and Becky Botkin
Dave Cripe
Geronimo Rodriguez
John Hugg, Janice Jackson, David Risser, Lucille Palenapa, David Walsh, Rachel
Wiseman and Kenzi Guerrero at TDHHS
Kit Abney
Dr. Phillip Huang at ATCHHSD
Ryan Leslie and Mike Chapman
Tareka Wheeler and Paula Yuma
Dr. Tate Erlinger