Essex County Trend 2006-2010 - Greater Newark Healthcare

Transcript Essex County Trend 2006-2010 - Greater Newark Healthcare

Community Health Needs Assessment Essex County Health Indicators

Health Outcomes Mortality Years of potential life lost Infant mortality Low birth weight General health status Mental health status Morbidity Health Factors Health Behaviors Access to Clinical Care Clinical Care Measures Social and Economic Physical Environment Behavioral Health

Health Outcomes Mortality Years of potential life lost Infant mortality Low birth weight General health status Mental health status Morbidity Heart disease Cancer Stroke Septicemia Diabetes Health Status fair or poor Physically unhealthy days Disability Mentally unhealthy days Suicide Alcohol & Drug related Deaths Disease incidence Notifiable communicable diseases

Health Factors Health Behaviors Screenings Vaccinations Maternal Health High Risk Sexual Behavior Tobacco use Alcohol/Drug Diet and Exercise High Blood Pressure Cholesterol Mammogram Pap test Colon Cancer Screening Adult flu Pneumonia Children 19-35 mo Prenatal Care- First Trimester No Prenatal Care STD rates Teen birth rate HIV rate Heavy Drinker Binge Drinkers Drug use Obesity Exercise Fruits and vegetables SNAP

Health Factors Access to Clinical Care Clinical Care Measures Physical Environment Violent Crime & Injury Prevention Behavioral Health Social and Economic Physician Rate Health Insurance Coverage Emergency Dept. use ACS Inpatient Readmission Rates Cesarean Section Air Quality Ozone Lead Paint Access to Healthy Foods Access to Recreation Admission Rates Emergency Dept. use Unemployme nt per capita Median income Poverty Education

MORTALITY

Indicator Healthy People 2020 Target County Health Rankings Benchmark Deaths due to Diseases of the Heart: Age-Adjusted Rate per 100,000 Population

N/A

New Jersey Age-Adjusted Rate per 100,000 Population Deaths due to Malignant Neoplasms (Cancer): Age-Adjusted Rate per 100,000 Population Deaths due to Malignant Neoplasms (Cancer) (Black, Non Age-Adjusted Rate per 100,000 Population Deaths due to Cerebrovascular Disease (Stroke): Age-Adjusted Rate per 100,000 Population Deaths due to Cerebrovascular Disease (Stroke) (Black, Non Age-Adjusted Rate per 100,000 Population

N/A N/A RED: statistically worse than comparison statistic at 95% confidence level YELLOW: no statistical difference between county and GREEN: statistically better than comparison statistic at 95% confidence level comparison statistics at 95% confidence level

MORTALITY

Indicator Age-Adjusted Rate per 100,000 Population Age-Adjusted Rate per 100,000 Population Age-Adjusted Rate per 100,000 Population Age-Adjusted Rate per 100,000 Population Healthy People 2020 Target County Health Rankings Benchmark New Jersey

MORTALITY

>>Top 10 Causes of Death in Essex County: Age-Adjusted Rate per 100,000 Population Cause 2004 Rate 2008 Rate Essex County, 2008 Heart Disease 227.0

206.4

Heart Disease Cancer Stroke 192.6

44.5

186.5

36.0

Cancer 206,4 186,5 Stroke Septicemia 27.6

31.1

36,0 Septicemia 31,1 Diabetes Mellitus Chronic Lower Respiratory Disease 34.6

26.4

29.5

29.0

Diabetes Mellitus Chronic Lower Respiratory… 29,5 29,0 Nephritis 23,3 Nephritis HIV Influenza and Pneumonia 21.6

27.4

19.0

23.3

19.6

17.0

HIV Influenza and Pneumonia 19,6 17,0 Alzheimer's Disease 14,1 Alzheimer’s Disease 14.1

14.1

0 100 200

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Age-adjusted death rates declined for most of the top ten causes of death. Exceptions include Septicemia, COPD, and Nephritis. Cancer and Heart Disease mortality rates have declined, but remain by far the primary causes of death.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data

300

MORTALITY

>>Deaths due to Diseases of the Heart: Age-Adjusted Rate per 100,000 Population Essex County Trend 2004-2008 250 200 150 100 50 221,8 227,0 210,3 223,3 201,5 206,5 192,0 205,2 191,2 206,4 177,8 192,6 2008 2007 2006 2005 2004 0 50 100 150 Essex County 2008: 206.4

200 206,4 196,5 206,5 218,1 227,0 250 0 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County Baseline: 126.0 Target: 108.8

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All geographies have seen a decline in the rate of death due to heart disease over the studied period. The age-adjusted death rate due to Heart Disease decreased 9.1% between 2004 and 2008 in Essex County but remains significantly higher then the statewide rate. The Essex County rate is worse (higher) than the Healthy People 2020 target. In 2011 the rate for Newark was 176.2. (not shown)

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data, Newark DCFWB Health Planning Division 9

MORTALITY

>>Deaths due to Diseases of the Heart by Race/Ethnicity: Age-Adjusted Rate per 100,000 Population (2008) Essex County Trends 2004-2008 250 200 150 100 50 0 196,2 224,7 116,3 198,7 225,8 128,0 174,7 244,0 116,0 New Jersey Essex County White, non-Hispanic Union County Black, non-Hispanic 205,8 179,3 111,4 Middlesex County Hispanic 2008 128,0 225,8 198,7 2007 2006 2005 2004 0 50 100 Hispanic White, non-Hispanic 150 200 100,1 227,3 188,2 87,1 243,8 194,0 130,8 240,8 210,7 114,5 270,6 211,5 250 Black, non-Hispanic 300 Despite the decline in deaths due to heart disease among blacks in Essex County between

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2004 and 2008 , black residents had the highest rate of heart disease related deaths in Essex County. The rate of heart disease deaths increased among Hispanics.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data 10

MORTALITY

>>Deaths due to Malignant Neoplasms (Cancer): Age-Adjusted Rate per 100,000 Population Essex County Trend 2004-2008 250 2008 183,6 200 150 187,4 191,5 181,7 185,0 180,0 177,6 169,5 170,7 174,6 183,6 170,8 159,3 2007 2006 185,2 177,6 2005 181,0 100 50 2004 0 191,5 50 100 150 Essex County 2008: 183.6

200 250 0 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County Baseline: 178.4 Target: 160.6

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All geographies have had a decline in the rate of deaths due to cancer over the studied period. Essex County saw a rate decrease of 7.9 points (-4.1%) from 2004 to 2008. Although the age-adjusted rate for Cancer deaths has declined, it is still worse (higher) than the target rate for Healthy People 2020. In 2011, the rate for Newark was 147.5 per 100,000. (not shown)

Source: NJ Department of Health and Senior Services, New Jersey Cancer Registry, Newark DCFWB Health Planning Division 11

MORTALITY

>>Deaths due to Malignant Neoplasms (Cancer) by Race/Ethnicity: Age-Adjusted Rate per 100,000 Population (2008) Essex County Trends 2004-2008 250 235,2 210,9 207,8 2008 106,8 235,2 167,8 200 190,5 182,1 167,8 175,6 172,3 2007 109,8 203,6 184,9 150 100 105,8 106,8 101,1 104,4 2006 2005 95,1 204,7 180,0 92,1 215,9 179,7 50 2004 109,4 218,6 191,2 0 50 100 150 200 250 0 New Jersey Essex County White, non-Hispanic Union Black, non-Hispanic Middlesex Hispanic Hispanic White, non-Hispanic Black, non-Hispanic While cancer death rates in Essex County decreased for white residents and Hispanics between 2005 and 2008, it rose by 16.6 points (+7.6%) for black residents and was significantly higher than the rate for all county residents.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data 12

MORTALITY

>>Deaths due to Cerebrovascular Disease (Stroke): Age-Adjusted Rate per 100,000 Population 50 Essex County Trend 2004-2008 45 40 40,8 44,5 43,1 40,1 35 36,1 35,8 36,2 36,0 32,9 36,0 33,9 2008 2007 36,0 42,0 30 29,4 2006 40,1 25 2005 45,1 20 2004 44,5 15 10 0 10 20 30 Essex County 2008: 36.0

40 50 5 0 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County Baseline: 42.2 Target: 33.8

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All geographies have seen a decline in the rate of stroke related deaths over the studied period. Deaths due to Stroke remains the third leading cause of death in Essex County. The rate in Essex County declined 19.1% between 2004 and 2008, and is not statistically different from the Healthy People 2020 target. In 2011, the rate for Newark was 38.4 per 100,000. (not shown)

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data, Newark DCFWB Health Planning Division 13

MORTALITY

>>Deaths due to Cerebrovascular Disease (Stroke) by Race/Ethnicity: Age-Adjusted Rate per 100,000 Population (2008) Essex County Trends 2004-2008 60 56,4 50 40 50,2 45,6 48,7 2008 2007 24,1 45,6 29,3 24,6 52,3 36,5 30 31,6 29,3 31 25,5 28,3 2006 22,3 24,1 23,4 49,1 33,8 20 2005 67,4 35,3 10 0 New Jersey White, non-Hispanic Essex Union Black, non-Hispanic Middlesex Hispanic 2004 62,2 35,5 0 20 Hispanic White, non-Hispanic 40 60 Black, non-Hispanic 80 Stroke death rates in Essex County dropped among Blacks and Whites between 2004 and 2008. Rates among Hispanics decreased from 2007 to 2008*. Black residents continue to have the highest rate of stroke deaths.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data Note: *2004, 2005, and 2006 rates for Hispanics did not meet standards of reliability. 14

10 5 0

MORTALITY

>>Deaths due to Septicemia: Age-Adjusted Rate per 100,000 Population 40 Essex County Trend 2004-2008 35 30,7 31,1 2008 31,1 30 27,6 25 22,8 2007 30,8 20,6 19,6 20,9 21,7 20,2 20 18,0 18,3 17,0 2006 30,7 15 2005 2004 32,7 27,6 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County 0 10 20 30 40 The death rate from Septicemia in Essex County increased 12.7% between 2004 and 2008, and is significantly higher than the rate statewide.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data 15

MORTALITY

>>Deaths due to Septicemia by Race/Ethnicity: Age-Adjusted Rate per 100,000 Population (2008) Essex County Trends 2004-2008 60 51,0 2008 51,0 19,4 50 44,4 40 30 36,2 27,3 2007 2006 47,8 22,1 37,8 52,9 16,2 23,7 19,4 21,2 2005 20 16,8 17,9 57,6 20,5 14,3 15,0 12,6 10 0 New Jersey White, non-Hispanic Essex Union Black, non-Hispanic Middlesex Hispanic 2004 41,0 21,4 0 20 Hispanic White, non-Hispanic 40 60 Black, non-Hispanic 80

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Septicemia death rates for black residents in Essex County rose by 10/100,000 (+24.4%) between 2004 and 2008. Black residents have higher Septicemia death rates than other racial/ethnic groups.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data Note: 2004, 2005, 2007, and 2008 rates for Hispanics did not meet standards of reliability. 16

10 5 0

MORTALITY

>>Deaths due to Diabetes Mellitus: Age-Adjusted Rate per 100,000 Population 40 36,8 Essex County Trend 2004-2008 34,6 35 30,5 29,0 29,5 2008 30 28,3 27,5 26,1 25,6 25 23,1 23,7 21,3 2007 20 29,5 31,9 15 2006 36,8 2005 2004 35,6 34,6 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County 0 10 20 30 40 All geographies have seen a decline in the rate of deaths from Diabetes between 2004 and 2008. The

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rate in Essex County decreased 14.7%, but remains significantly higher than the rate statewide. In 2011 the rate for Newark was 37.5 per 100,000. (not shown)

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data, Newark DCFWB Health Planning Division 17

MORTALITY

>>Deaths due to Diabetes Mellitus by Race/Ethnicity: Age-Adjusted Rate per 100,000 Population (2008) Essex County Trends 2004-2008 60 50 40 30 20 10 0 20,2 48,2 23,2 18,8 42,1 32,9 18,5 55,6 22,6 New Jersey White, non-Hispanic Essex Union Black, non-Hispanic 19,8 53,7 23,1 Middlesex Hispanic 2008 2007 2006 2005 2004 0 10 20 Hispanic White, non-Hispanic 30 40 50 Black, non-Hispanic 32,9 42,1 18,8 30,8 46,7 22,6 41,8 55,8 23,8 43,8 54,2 23,0 30,2 56,6 22,0 60

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The death rate from Diabetes Mellitus in Essex County declined for black residents by 14.5/100,000 (-25.6%), increased for Hispanics, and decreased for white residents. Essex County black residents have a lower death rate from diabetes than black residents statewide and in comparative counties. The mortality rate for black residents was significantly higher than all county residents.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data 18

YEARS OF POTENTIAL LIFE LOST

Indicator Age-Adjusted Rate per 100,000 Population Healthy People 2020 Target County Health Rankings Benchmark New Jersey

RED: statistically worse than comparison statistic at 95% confidence level YELLOW: no statistical difference between county and GREEN: statistically better than comparison statistic at 95% confidence level comparison statistics at 95% confidence level

YEARS OF POTENTIAL LIFE LOST

>>Premature Death: Years of Potential Life Lost Before Age 75 per 100,000 Population (Age Adjusted) Essex County Trend 2004-2006 10 000 9 144

2006-2008

8 866 9 000 8 410 2006 - 2008 8 000 8 410 7 000 6 000 5 000 6 294 6 179 5 159 6 170 6 143 5 033 5 987 5 904 4 914 2005 - 2007 2004 - 2006 8 866 9 144 4 000 0 2 000 4 000 6 000 8 000 10 000 3 000 2 000 Essex County 2006 - 2008: 8,410 1 000 0 2004 - 2006 New Jersey Essex County 2005 - 2007 Union County 2006 - 2008 Middlesex County National Benchmark: 5,466

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All geographies studied saw a decline in the years of potential life lost (YPLL) between 2004 and 2008. The number in Essex County declined by 734 but remains significantly higher than the statewide number and higher than that of comparative counties. The rate of YPLL in Essex County was far worse (higher) than the national benchmark.

Source: County Health Rankings, National Vital Statistics System

Note: Every death occurring before the age of 75 contributes to the total number of years of potential life lost.

INFANT MORTALITY

Indicator Healthy People 2020 Target County Health Rankings Benchmark Infant Mortality Rate: Rate of Infant (Under 1 year) Deaths per 1,000 Live Births

N/A

New Jersey Rate of Infant (Under 1 year) Deaths per 1,000 Live Births

INFANT MORTALITY

>>Infant Mortality Rate: Rate of Infant (under 1 year) Deaths per 1,000 Live Births Essex County Trend 2004-2008 9 8,5 8 7,6 7 2008 2007 8.5 7.4 6 5 5,7 5,5 4,6 5,3 5,8 4,9 5,0 5,3 4,6 2006 2005 5.8 6.3 3,9 4 2004 7.6 3 2 0 2 4 6 Essex County 2008: 8.5

8 10 1 0 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County Baseline: 6.7 Target: 6.0 The infant mortality rate in Essex County rose 11.8% from 2004 to 2008 and remains

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significantly higher than the rate statewide.

The Essex County Infant Mortality rate is worse (higher) than the Healthy People 2020 target.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data 22

INFANT MORTALITY

>>Infant Mortality Rate: Rate of Infant (Under 1 Year) Deaths per 1,000 Live Births by Race 16 14 12 10 8 6 4 2 3,6 2,9 3,9 4 12,7 13,4 9 8,1 4,4 6,7 4,5 5,9 0 White, non-Hispanic Black, non-Hispanic New Jersey Essex County Hispanic Union County 5,3 8,5 4,6 3,9 Total Middlesex County 2008 2007 2006 2005 2004 2003 0 Essex County Trends 2003-2008 Total 5 Hispanic 10 Black, non-Hispanic 8,5 6,7 13,4 7,4 6,8 10,4 5,8 9,6 6,3 9,5 7,6 9,6 9,3 14,5 15 The infant mortality rate for black residents in Essex County is higher than the rates for all other races, and has been increasing since 2006.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data Note: Rates for white for all years and for Hispanics for 2003 through 2006 did not meet standards of reliability. 23

LOW BIRTH WEIGHT

Indicator Healthy People 2020 Target County Health Rankings Benchmark Low (<2500 grams) Birth Weight: Percentage of Live Births

N/A

New Jersey

N/A

Percentage of Live Births Very Low (<1500 grams) Birth Weight: Percentage of Live Births

N/A N/A

Percentage of Live Births

LOW BIRTH WEIGHT

>> Low Birth Weight: Percent of Live Births with Low and Very Low Birth Weight (2008) Essex County Trends 2004-2008 12% 2008 10,0% 10% 2007 8,4% 8,1% 2006 8% 6% 4% 2% 1,5% 2,0% 1,7% 1,4% 7,7% 2005 2004 0% 2% 4% <1500 grams <1500 - Essex County 2008: 2.0% 6% 8% 10% 2,0% 10,0% 2,4% 10,4% 2,5% 10,9% 2,4% 10,3% 2,1% 9,7% 12% <2500 grams <2500 - Essex County 2008: 10.0% 0% <1500 grams <2500 grams New Jersey Union County Essex County Middlesex County Baseline: 1.5% Target: 1.4% Baseline: 8.2% Target: 7.8% The percentage of very low birth weight infants declined in Essex County between 2004 and

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2008 by 0.1 percentage points, low birth weight infants increased by 0.3 percentage points. In Essex County the rates for low birth weight and very low birth weight infants are higher (worse) than the Healthy People 2020 targets and significantly higher than the statewide averages.

Source: : NJ Department of Health and Senior Services, Bureau of Vital Statistics and Registration, N.J. Birth Certificate Database

Note: Percentages are based on the total number of live births for county and state.

LOW BIRTH WEIGHT

>> Percent of Live Births with Low and Very Low Birth Weight in Essex County by Mother’s Race/Ethnicity 15% Essex County Low Birth Weight by Race 14,7% 13,8% 13,5% 13,6% 15% Essex County Very Low Birth Weight by Race 10% 5% 7,0% 7,1% 7,7% 8,6% 0% 2004 White, non-Hispanic 7,9% 2006 Black, non-Hispanic 8,6% 7,5% 6,9% 10% Hispanic 2008 Other 5% 1,1% 3,3% 1,4% 1,8% 1,8% 3,8% 1,4% 2,2% 1,8% 3,8% 1,4% 2,2% 0% 2004 2006 2008 White, non-Hispanic Black, non-Hispanic Hispanic Other Low and very low birth weight infants among African-Americans in Essex County remains significantly higher than other racial/ethnic groups.

Source: : NJ Department of Health and Senior Services, Bureau of Vital Statistics and Registration, N.J. Birth Certificate Database 26

GENERAL AND MENTAL HEALTH STATUS

Indicator Healthy People 2020 Target County Health Rankings Benchmark New Jersey

N/A

Percentage of Respondents Average Age-Adjusted Number Percent of Total Population Mentally Unhealthy Days Reported in the Past 30 Days: Average Age-Adjusted Number

N/A

Deaths due to Suicide: Age-Adjusted Rate per 100,000 Population

N/A N/A

Age-Adjusted Rate per 100,000 Population Drug-Related Deaths: Age-Adjusted Rate per 100,000 Population

N/A RED: statistically worse than comparison statistic at 95% confidence level YELLOW: no statistical difference between county and GREEN: statistically better than comparison statistic at 95% confidence level comparison statistics at 95% confidence level

GENERAL HEALTH STATUS

>> Percent of Respondents Reporting Their Health as "Fair or Poor" Essex County Trend 2006-2010 25% 18,2% 20% 15% 16,2% 19,5% 15,6% 18,9% 18,4% 14,7% 14,7% 18,2% 13,6% 15,3% 14,1% 14,7% 2010 2009 17,8% 10% 2008 15,3% 5% 2007 18,5% 0% 2006 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2010 Essex County Union County United States 2006 0% 19,5% 5% 10% 15% 20% 25%

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The percent of Essex County residents reporting their health as poor or fair has declined. It remains above the percentages reported statewide, in the MMSA, and in comparison counties but is not statistically different than the statewide rate.

Source: CDC, Behavioral Risk Factor Surveillance System

Note: MMSA: Metropolitan and Micropolitan Statistical Areas

GENERAL HEALTH STATUS

>>Average Age-Adjusted Number of Physically Unhealthy Days Reported in the Past 30 Days 4,0 Essex County Trend 2002-2008 -

2004-2010

3,5 3,3 3,2 3,4 3,1 3,4 3,3 3,5 3,2 3,4 3,3 3,3 3,2 2004 - 2010 3,3 3,0 2,5 2,0 2003 - 2009 3,3 2002 - 2008 3,2 1,5 1,0 0 1 2 3 Essex County 2004 - 2010: 3.3

4 0,5 0,0 2002 - 2008 New Jersey Essex County 2003 - 2009 Union County 2004 - 2010 Middlesex County National Benchmark: 2.6

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Essex County residents report an average of 3.3 physically unhealthy days per month, which was worse (higher) than the national benchmark of 2.6. This was an increase over 2008, but is in line with increasing trends statewide.

Source: County Health Rankings, National Center for Health Statistics Note: The poor physical health measure is based on response to the question: “Thinking about your physical health, which includes physical illness and injury, how many days during the past 30 days was your physical health not good?” 29

GENERAL HEALTH STATUS

>>Total Population With Any Disability 25% 23% 21% 21,9% Essex County Trend 2000-2010 2010 9,4% 19% 17% 18,0% 18,1% 16,2% 15% 13% 2005 11,5% 12,0% 11,5% 11,7% 11% 9% 9,0% 9,7% 9,4% 8,2% 8,0% 7% 2000 21,9% 5% 2000 New Jersey Essex County 2005 Union County 2010 Middlesex County 0% 5% 10% 15% 20% 25% All geographies have seen a decline in the percentage of people reporting a disability over

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the studied period. The percent of Essex County residents with a disability declined by 12.5 percentage points between 2000 and 2010.

This indicator was not statistically different from the statewide percentage.

Source: U.S. Census Bureau, American Community Survey

Note: Percentages are based on the total civilian non-institutionalized population 5 years and older in each region.

MENTAL HEALTH STATUS

>> Average Number of Mentally Unhealthy Days Reported in the Past 30 Days 4,0 3,5 3,0 2,5 2,0 1,5 1,0 0,5 0,0 3,3 3,4 3,0 3,0 3,3 3,6 3,0 3,1 3,3 3,6 3,0 3,0 Essex County Trend 2002-2008 -

2004-2010

2004 - 2010 2003 - 2009 2002 - 2008 0 1 2 3 Essex County 2004 - 2010: 3.6

3,6 3,6 3,4 4 2002 - 2008 New Jersey Essex County 2003 - 2009 Union County 2004 - 2010 Middlesex County National Benchmark (2009): 2.3

Essex County residents reported an increase in the number of mentally unhealthy days

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between 2002 - 2008 and 2004 - 2010, from 3.4 to 3.6 per month.

The number of mentally unhealthy days in Essex County is worse (higher) than the National Benchmark.

Source: County Health Rankings, National Center for Health Statistics

Note: The poor physical health measure is based on response to the question: “Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”

MENTAL HEALTH STATUS

>>Deaths due to Suicide: Age-Adjusted Rate per 100,000 Population 8 Essex County Trend 2004-2008 7 6,8 5,9 6,4 6,7 6,1 2008 3,3 6 5,6 2007 4,6 5,2 4,9 5,0 4,9 5 2006 4,4 4,4 4 2005 4,0 3,3 3 2004 5,9 2 0 2 4 Essex County 2008: 3.3

6 1 0 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County Baseline: 11.3 Target: 10.2

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The Essex County suicide rate decreased by 44.1% between 2004 and 2008. Essex County has a lower suicide rate than the Healthy People 2020 target, and significantly lower (better) than the statewide rate.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data 32

MENTAL HEALTH STATUS

>>Alcohol and Drug-Related Deaths: Age-Adjusted Rate per 100,000 Population (2007) 12 Essex County Trends 2006-2007 10,2 10 8,5 2007 10,2 4,4 8 2006 15,3 4,1 6 4 4,6 4,4 0 5 Drug-related 10 15 Alcohol-related Essex County Drug-related Deaths 2007: 10.2

2 20 0 Alcohol-related New Jersey Essex County Drug-related Baseline: 12.6 Target: 11.3

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Drug related deaths were down between 2006 and 2007 in Essex County and the state. Drug related deaths were not statistically different from the Healthy People 2020 target or the statewide average.

Alcohol related death rates increase over the period but were not significantly different from the State.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data 33

MORBIDITY

Indicator Cardiovascular Disease: Were You Ever Told You Had Angina or Coronary Heart Disease? %=Yes Healthy People 2020 Target County Health Rankings Benchmark New Jersey

N/A N/A

Cardiovascular Disease: Were You Ever Told You Had a Heart Attack (Myocardial Infarction)? %=Yes Cardiovascular Disease: Have You Ever Been Told You Had a Stroke? %=Yes

N/A N/A N/A N/A

Asthma: Adults Who Have Ever Been Told They Have Asthma %=Yes

N/A N/A

Diabetes: Have You Ever Been Told by a Doctor that You Have Diabetes? %=Yes Arthritis: Adults Who Have Been Told They Have Arthritis %=Yes

N/A N/A N/A N/A N/A

Age-Adjusted Rate per 100,000 Population

MORBIDITY

N/A

Age-Adjusted Rate per 100,000 Population Notifiable Communicable Diseases - Campylobacteriosis: Rate per 100,000 Population

N/A

Notifiable Communicable Diseases - Aseptic Meningitis: Rate per 100,000 Population

N/A N/A N/A N/A N/A N/A N/A N/A

Rate per 100,000 Population

MORBIDITY

>> Cardiovascular Disease: Were You Ever Told You Had Angina or Coronary Heart Disease? %=Yes Essex County Trend 2007-2010 6% 5,0% 5% 4,7% 4,1% 4,4% 4,1% 2010 3,4% 4% 3,8% 3,3% 3,7% 3,9% 3,4% 3,6% 2009 3,4% 3% 2,7% 2% 2008 4,2% 1% 0% 2007 3,8% 2007 New Jersey Newark-Union, NJ-PA MMSA Middlesex County Essex County 2010 Union County United States 0% 1% 2% 3% 4% 5% The percent of Essex County residents reporting coronary heart disease declined between 2007 and

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2010 by 0.4 percentage points .

At 3.4%, it is not statistically different from the rate statewide. In 2009, 8% of Newark residents reported Angina or Coronary Heart Disease. (not shown)

Source: CDC, Behavioral Risk Factor Surveillance System, Newark DCFWB Health Planning Division 36

MORBIDITY

>>Cardiovascular Disease: Were You Ever Told You Had a Heart Attack (Myocardial Infarction)? %=Yes Essex County Trend 2007-2010 5,0% 4,5% 4,5% 4,2% 4,0% 4,2% 4,0% 3,9% 3,8% 2010 3,1% 3,4% 3,5% 3,2% 3,0% 3,1% 3,0% 2,7% 2,6% 2009 4,0% 2,5% 2,0% 1,5% 1,0% 0,5% 2008 3,1% 0,0% 2007 New Jersey Newark-Union, NJ-PA MMSA Middlesex County Essex County Union County United States 2010 2007 attack. (not shown)

Source: CDC, Behavioral Risk Factor Surveillance System, Newark DCFWB Health Planning Division

0% 1% 2% 3% 4% 2,7% The percent of Essex County residents reporting heart attacks increased by 0.4 percentage

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points between 2007 and 2010 from 2.7% to 3.1%.

This rate was not statistically different than the statewide rate.

In 2009, 6% of Newark residents, or nearly double the county rate reported a heart 5%

MORBIDITY

>> Cardiovascular Disease: Have You Ever Been Told You Had a Stroke? %=Yes 4,0% 3,6% Essex County Trend 2007-2010 3,4% 3,5% 3,5% 2010 3,0% 2,7% 2,7% 2,6% 2,4% 2,4% 2,5% 3,6% 2,0% 1,8% 1,6% 1,8% 2009 1,6% 1,5% 1,2% 1,0% 2008 3,3% 0,5% 0,0% 2007 1,8% 2007 New Jersey Newark-Union, NJ-PA MMSA Middlesex County Essex County 2010 Union County United States 0% 1% 2% 3% 4%

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The percent of Essex County residents reporting they had a stroke rose by 1.8% to 3.6%. The percent of Newark residents reporting a stroke was not statistically different than the statewide rate.

In 2009, 4% of Newark residents reported having a stroke. (not shown)

Source: CDC, Behavioral Risk Factor Surveillance System, Newark DCFWB Health Planning Division 38

MORBIDITY

>>Asthma: Adults Who Have Ever Been Told They Have Asthma. %=Yes Essex County Trend 2006-2010 10% 9% 8% 3% 2% 1% 0% 7% 6% 5% 4% 7,6% 8,2% 6,9% 6,1% 7,1% 8,5% 8,7% 8,3% 7,5% 6,3% 7,5% 9,1% 2010 2009 2008 2007 8,3% 7,2% 10,5% 6,7% 2006 New Jersey Newark-Union, NJ-PA MMSA Middlesex County Essex County Union County United States 2010 2006 0% 2% 4% 6% 8% 10% 8,2% 12%

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The percent of adults reporting they have asthma has risen in all the geographies studied.

Essex County experienced among the smallest increase and is now statistically no different from the statewide percentage. In 2009, 16% of Newark residents reported asthma. (not shown)

Source: CDC, Behavioral Risk Factor Surveillance System 39

MORBIDITY

>>Diabetes: Have You Ever Been Told by a Doctor that You Have Diabetes? %=Yes 12% Essex County Trend 2006-2010 10% 9,2% 10,2% 9,6% 11,2% 9,7% 8,7% 2010 10,2% 8% 7,5% 7,8% 7,3% 7,7% 7,9% 7,5% 2009 8,9% 6% 2008 8,8% 4% 2% 2007 12,0% 0% 2006 New Jersey Newark-Union, NJ-PA MMSA Middlesex County Essex County Union County United States 2010 2006 0% 5% 10% 7,8%

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Diabetes is on the increase in all the geographic areas studied. In Essex County the percent of people reporting diabetes increased from 7.8% in 2006 to 10.2% in 2010.

At 10.2% the percent of people reporting diabetes in Essex County was not statistically different than the state. In 2009, 17% of Newark residents reported being told by a doctor that they have Diabetes. (not shown)

Source: CDC, Behavioral Risk Factor Surveillance System, Newark DCFWB Health Planning Division

15%

MORBIDITY

>>Arthritis: Adults Who Have Been Told They Have Arthritis. %=Yes 30% Essex County Trend 2005-2009 25% 20% 24,4% 19,5% 21,5% 21,5% 22,5% 27,0% 22,7% 18,0% 20,6% 22,7% 22,5% 26,0% 2009 18,0% 15% 10% 2007 22,4% 5% 0% 2005 19,5% 2005 New Jersey Newark-Union, NJ-PA MMSA Middlesex County Essex County Union County 2009 United States 0% 5% 10% 15% 20% 25% Between 2005 and 2009 the percent of Essex County residents reporting Arthritis declined

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from 19.5% to 18.0%. The percentage reporting Arthritis in Essex County is significantly lower than the rate in the state.

Source: CDC, Behavioral Risk Factor Surveillance System 41

MORBIDITY

>>Overall Invasive Cancer Incidence: Age-Adjusted Rate per 100,000 Population 600 500 508,9 486,9 539,0 497,6 519,2 492,1 519,7 496,5 487,2 427,2 458,5 475,9 2009 Essex County Trend 2005-2009 427,2 400 2008 462,1 300 2007 492,1 200 2006 497,5 100 0 2005 New Jersey Essex County 2007 Union County 2009 Middlesex County 2005 0 486,9 100 200 300 400 500 600

•

All geographies have seen declines in the cancer incidence rate between 2005 and 2009.

Essex County has a significantly lower cancer incidence rate than the state.

Source: New Jersey Department of Health and Human Services, New Jersey Cancer Registry

Note: The rate for prostate cancer is based on 100,000 males, and the rate for breast cancer is based on 100,000 females

MORBIDITY

>>Invasive Cancer Incidence by Site: Age-Adjusted Rate per 100,000 Population (2009) 80 60 40 20 0 200 180 160 140 120 100 2009 2008 2007 2006 Essex County Trends 2005-2009 New Jersey Essex County Union County Middlesex County Prostate 158,5 171,9 169,5 143,6 Breast 130,3 110,0 126,2 135,8 Lung 59,9 48,4 44,4 56,4 Colon/Rectu m 44,7 37,8 44,8 40,1 Melanoma 20,2 11,6 14,1 16,3 2005 0 50 Melanoma Breast 100 150 Colon/Rectum Prostate 200 Lung 250

• • • •

Prostate and Breast cancers are the two most frequently occurring cancers in Essex County. Between 2005 and 2009 the incidence rate of prostate cancer declined while the rate of breast cancer rose. Cancer incidence rates for breast and melanoma were significantly better than the state.

Cancer incidence for prostate, lung, and colon were statistically no different from the statewide average.

2011 rates for Newark: Prostate - 147.3, Breast (f) - 130.6, Lung - 51.3(f) 59 (m), colon/rectum 36.5 (f) 43.8(m). (not shown).

Source: New Jersey Department of Health and Human Services, New Jersey Cancer Registry, Newark DCFWB Health Planning Division 43

MORBIDITY

>>Notifiable Communicable Diseases: Rate per 100,000 (2010) 12 10,8 Essex County Trends 2006-2009 10 9,1 8,9 8,1 2009 0,6 0,3 9,1 8 6 2008 1,0 0,3 10,1 4 2007 2,5 0,0 9,7 1,9 2 0,3 0,3 0,4 0,1 0,6 1,5 1,0 2006 1,7 0,1 8,1 0 Campylobacteriosis Aseptic Meningitis Pertussis 0 2 4 6 8 10 12 New Jersey Essex County Union County Middlesex County Pertussis Aseptic Meningitis Campylobacteriosis The rate of Campylobacteriosis and Aseptic Meningitis in Essex County were both up between 2006 and 2009, only the rate for Pertussis declined.

•

None of the reported communicable disease rates were significantly different from the statewide average.

Bloomfield reported 6 confirmed cases of Campylobacteriosis in 2005, 3 in 2006, 1 in 2007, 6 in 2008, 5 in 2009, 6 in 2010, and 11 in 2011 Bloomfield reported: 1 confirmed case of Pertussis in 2005, 2 in 2006, and zero in 2007, 2008, 2009, 2010, 2011 Caldwell reported: 1 confirmed case of Campylobacteriosis in 2005, 2006, 2007 and 20011 Source: N.J. Department of Health and Human Services, Division of Communicable Disease Service, New Jersey Reportable Communicable Disease Report, 2010, 2009, 2008, 2007; U.S. Census Bureau, American Community Survey 44

SCREENINGS

Indicator Hypertension Awareness: Adults Who Have Been Told They Have High Blood Pressure Cholesterol Awareness: Adults Who Have Had Their Cholesterol Checked and Told It Was High Healthy People 2020 Target County Health Rankings Benchmark New Jersey

N/A N/A

Percent of Women Age 40+ Who Have NOT Had a Mammogram Within Past Two Years Percent of Women 18 Years and Over Who have Had a Pap Test in the Past 3 years

N/A N/A

Percent of Adults 50 Years and Over Who Have Ever Had a Sigmoidoscopy or Colonoscopy Percent of Diabetic Medicare Enrollees that Receive HbA1c Screening

SCREENINGS

>>Hypertension Awareness: Adults Who Have Been Told They Have High Blood Pressure 35% Essex County Trend 2005-2009 30% 25% 25,4% 24,5% 23,1% 21,6% 22,1% 25,5% 28,1% 27,5% 28,4% 30,6% 27,5% 28,7% 2009 2007 27,5% 30,1% 20% 15% 2005 10% 5% 0 0,1 0,2 0,3 Essex County 2009: 27.5% 0% 2005 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2009 Essex County Union County United States Baseline: 29.9% Target: 26.9% The percent of people reporting high blood pressure has increased in all geographies

•

studied. The rate in Essex County is not significantly different than the Healthy People 2020 target or the statewide rate.

Source: CDC, Behavioral Risk Factor Surveillance System

24,5% 0,4

SCREENINGS

>> Cholesterol Awareness: Adults Who Have Had Their Cholesterol Checked and Told It Was High Essex County Trend 2005-2009 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 36,7% 30,6% 34,5% 41,1% 38,5% 35,6% 37,0% 36,7% 37,7% 37,2% 36,9% 37,5% 2009 2007 2005 0% 10% 20% 30% 40% Essex County 2009: 36.7% 36,7% 39,0% 30,6% 50% 2005 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2009 Essex County Union County United States Baseline: 15.0% Target:13.5%

• •

Between 2005 and 2009, adults with high cholesterol rose from 30.6% to 36.7%. The percentage of people reporting high cholesterol in Essex County is worse than (higher-by nearly three times) the Healthy People 2020 target. This indicator was not statistically different from the statewide percentage.

Source: CDC, Behavioral Risk Factor Surveillance System 47

SCREENINGS

>>Percent of Women Age 40+ Who Have NOT Had a Mammogram Within Past Two Years 35% Essex County Trend 2004-2010 30% 25% 25,1% 27,6% 27,2% 30,0% 25,1% 25,2% 22,7% 19,4% 21,5% 22,3% 24,1% 24,8% 2010 2008 20% 2006 19,4% 22,5% 23,7% 15% 2004 27,6% 10% 5% 0% 5% 10% 15% 20% Essex County 2010: 19.4% 25% 30% 0% 2004 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2010 Essex County Union County United States Baseline: 26.3% Target: 18.9% The number of Essex County women 40+ and older who have not had a mammogram

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within the past 2 years has decreased by 8.2 percentage points. It is not statistically different from the Healthy People 2020 target or the statewide percentage.

Source: CDC, Behavioral Risk Factor Surveillance System 48

SCREENINGS

>>Percent of Women 18 Years and Over Who have Had a Pap Test in the Past 3 years 100% 90% 86,8% 84,3% 87,0% 86,8% 81,1% 86,0% 84,1% 81,3% 82,8% 83,4% 84,7% 84,0% 2010 Essex County Trend 2004-2010 81,3% 80% 70% 60% 2008 83,5% 2006 84,8% 50% 40% 30% 2004 86,8% 0% 25% 50% 75% 100% 20% 10% Essex County 2010: 81.3% 0% 2004 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2010 Essex County Union County United States Baseline: 84.5% Target: 93.0%

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The percent of women who had a pap test declined between 2004 and 2010. The percent of Essex County women having a pap test was worse (lower) than the Healthy People 2020 target. The percent of women who had a pap test was not statistically different than the stateside percentage.

Source: CDC, Behavioral Risk Factor Surveillance System

Note: Healthy People 2020 goal is to, “increase the proportion of women who receive a cervical cancer screening based on the most recent guidelines.”

SCREENINGS

>> Percent of Adults 50 Years and Over Who Have Ever Had a Sigmoidoscopy or Colonoscopy 80% Essex County Trend 2004-2010 70% 60% 56,6% 62,3% 59,6% 59,5% 53,3% 65,6% 65,6% 67,8% 65,6% 66,6% 70,5% 65,2% 2010 67,8% 2008 60,5% 50% 40% 2006 58,3% 30% 2004 62,3% 20% 10% 0% 20% 40% 60% Essex County 2010: 67.8% 80% 0% 2004 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2010 Essex County Union County United States Baseline: 54.2% Target: 70.5% All geographies have seen a percentage increase in the number of sigmoidoscopies or

•

colonoscopies (among adults age 50+) over the studied period. The percentage in 2010 is not statistically different from the statewide average or the Healthy People 2020 target.

Source: CDC, Behavioral Risk Factor Surveillance System 50

60% 50% 40% 30% 20% 10% 0%

SCREENINGS

>>Percent of Diabetic Medicare Enrollees that Receive HbA1c Screening.

100% 90% Essex County Trend 2003-2006 2009 80% 70% 76,0% 71,0% 75,0% 79,0% 78,0% 74,0% 78,0% 80,0% 80,0% 78,0% 80,0% 82,0% 2009 78,0% 2006 - 2007 2003 - 2006 0% 25% 50% 75% Essex County 2009: 78% 74,0% 71,0% 100% 2003 - 2006 New Jersey Essex County 2006 - 2007 Union County 2009 Middlesex County National Benchmark: 89% The percentage of diabetic Medicare enrollees receiving a HbA1c screening in all of the studied geographies increased.

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The percentage of diabetic Medicare enrollees in Essex County receiving HbA1c screenings is not statistically different from the statewide average or County Health Rankings benchmark.

Source: County Health Rankings, Medicare/Dartmouth Atlas of Health Care

Note: Diabetic screening is calculated as the percentage of diabetic Medicare patients whose blood sugar control was screening in the past year using a test of their glycated hemoglobin (HbA1c) levels.

VACCINATIONS

Indicator Percent of Adults Age 65+ Who Have NOT Had a Flu Shot in the Past Year Healthy People 2020 Target County Health Rankings Benchmark

N/A

New Jersey Percent of Adults Age 65+ Who Have NOT Ever Had a Pneumonia Vaccination. Biennial Childhood Immunization for Ages 19-35 Months for 4:3:1:3 Vaccination Series

N/A N/A N/A RED: statistically worse than comparison statistic at 95% confidence level YELLOW: no statistical difference between county and GREEN: statistically better than comparison statistic at 95% confidence level comparison statistics at 95% confidence level

VACCINATIONS

>> Percent of Adults Age 65+ Who Have NOT Had a Flu Shot in the Past Year 50% 47,7% Essex County Trend 2006-2010 45% 40% 35% 30% 33,7% 42,6% 38,7% 27,1% 30,4% 34,3% 37,5% 34,1% 29,5% 30,8% 32,5% 2010 2009 2008 37,5% 39,6% 40,1% 25% 2007 27,4% 20% 2006 42,6% 15% 0% 10% 20% 30% 40% 50% 10% Essex County 2010: 37.5% 5% 0% 2006 2010 New Jersey Newark-Union, NJ-PA MMSA Middlesex County Essex County Union County United States Baseline: 33% Target: 10%

• •

The percentage of adults 65+ who did not have a flu shot in the past year decreased in Essex County.

The percent of Seniors who did not have a flu shot in Essex County is higher (worse) than the Health People 2020 target.

The percentage of Essex County Seniors who did not receive a flu shot is not statistically different from the statewide percentage.

Source: CDC, Behavioral Risk Factor Surveillance System 53

VACCINATIONS

>> Percent of Adults Age 65+ Who Have NOT Ever Had a Pneumonia Vaccination. %=Not Had 60% Essex County Trend 2006-2010 50% 40% 30% 33,6% 41,2% 42,2% 48,8% 33,1% 35,7% 45,2% 36,5% 29,0% 23,9% 31,2% 2010 2009 2008 2007 2006 20% 10% 18,2% 0% 10% 20% 30% 40% Essex County 2010: 45.2% 50% 45,2% 50,7% 41,8% 43,9% 41,2% 60% 0% 2006 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2010 Essex County Union County United States Baseline: 40% Target: 10%

•

The percent of seniors who have never had a pneumonia shot rose by 4 percentage points between 2006 and 2010.

It is higher (worse) than the Healthy People 2020 target.

Source: CDC, Behavioral Risk Factor Surveillance System 54

VACCINATIONS

>> Biennial Childhood Immunization for Ages 19-35 Months for 4:3:1:3 Vaccination Series 100% Essex County Trend 1999-2008 90% 80% 76,0% 74,8% 78,6% 77,8% 79,7% 76,0% 82,6% 84,6% 77,0% 75,0% 81,2% 79,0% 2007-2008 75,0% 70% 60% 50% 40% 30% 2005-2006 2003-2004 78,9% 76,0% 20% 10% 2001-2002 68,1% 0% 1999-2000 74,8% 1999 - 2000 2003 - 2004 2007 - 2008 New Jersey Essex County Union County Middlesex County 0% 20% 40% 60% 80% 100%

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Childhood immunization rates rose in each of the 3 study counties between 1999 and 2008. The rate in Essex County rose only by 0.2 percentage points and remains lower than

•

Union and Middlesex County.

The Essex County rate is not statistically different than the statewide rate.

Bloomfield / Caldwell Health Dept. reported immunizing a total of: 269 children in 2005, 1,392 in 2006, 888 in 2007, 1,016 in 2008, 1,996 in 2009, 742 in 2010, and 695 in 2011 Source: CDC, Department of Health and Human Services, County-Level Trends in Vaccination Coverage Among Children Aged 19–35 Months — United States, 1995–2008 55

MATERNAL HEALTH

Indicator Healthy People 2020 Target County Health Rankings Benchmark First Trimester Prenatal Care: Percentage of Live Births

N/A

New Jersey

N/A

Percentage of Live Births

MATERNAL HEALTH

>> Percentage of Live Births with First Trimester Prenatal Care 90% 80% 70% 74,1% 62,4% 71,5% 80,7% 75,6% 67,4% 73,4% 83,3% 81,1% 69,3% 2010 Essex County Trend 2006-2010 69,3% 60% 2008 67,4% 50% 40% 2006 62,4% 30% 20% 0% 20% 40% 60% 80% Essex County 2010: 69.3% 100% 10% 0% 2006 New Jersey Essex County 2008 Union County 2010 Middlesex County Baseline: 70.8% Target: 77.9% The percentage of births with first trimester prenatal care in Essex County rose 6.9%

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points between 2006 and 2010. The Essex County percentage was significantly below the statewide percentage and lower (worse) than the Healthy People 2020 target.

Source: NJ Department of Health and Senior Services, Bureau of Vital Statistics and Registration, N.J. Birth Certificate Database, US Census Bureau, American Community Survey

Note: Percentages are based on total number of live births for county and state.

MATERNAL HEALTH

>> Percentage of Live Births with No Prenatal Care 3,5% 3,0% 2,5% 2,0% 1,5% 1,0% 0,5% 0,0% 1,1% 2,7% 1,4% 0,7% 1,1% 2,6% 1,5% 0,7% 0,9% 2,1% 2006 New Jersey Essex County 2008 Union County 2010 Middlesex County 2010 2008 Essex County Trend 2006-2010 2,1% 2,6% 2006 2,7% 0,0% 0,5% 1,0% 1,5% 2,0% 2,5% 3,0% The percentage of births with no prenatal care in Essex County declined 0.6% points between 2006 and 2010. It remains significantly higher (worse) than the statewide percentage.

Source: NJ Department of Health and Senior Services, Bureau of Vital Statistics and Registration, N.J. Birth Certificate Database

Note: Percentages are based on the total number of live births for county and state.

HIGH RISK SEXUAL BEHAVIOR

Indicator Healthy People 2020 Target County Health Rankings Benchmark New Jersey Rate per 100,000 Population Rate per 100,000 Population Rate per 100,000 Population

N/A N/A

Rate per 1,000 Female Popultion Teen Birth Ages 15-17: Rate per 1,000 Female Popultion

N/A N/A

Rate per 100,000 Population

N/A

Rate per 100,000 Population

HIGH RISK SEXUAL BEHAVIOR

>> Sexually Transmitted Diseases per 100,000 Population (2010) 800 700 600 500 400 300 297,3 681,1 337,7 214,1 218,2 2010 2009 2008 0 Essex County Trends 2008-2010 200 Syphilis 400 Gonorrhea 600 Chlamydia 29,3 218,2 681,1 31,2 189,3 651,2 42,9 215,7 643,6 800 200 Chlamydia - Essex County 2010: 681.1

100 66,8 62,4 32,6 0 Chlamydia New Jersey Essex County Gonorrhea Union County 10,8 29,3 14,7 5,6 Syphilis Middlesex County National Benchmark (2009): 84.0

The rates for Chlamydia and Gonorrhea in Essex County increased between 2008 and 2010, while the

• •

rate for Syphilis declined. The rate for Chlamydia, Gonorrhea, and Syphilis are all significantly worse than the statewide rate. The Chlamydia rate in Essex County is eight times higher (worse) than the National Benchmark.

Source: N.J Department of Health and Senior Services, Division of HIV, STD, and TB Services, Sexually Transmitted Diseases Program, U.S. Census Bureau, American Community Survey 60

50 40 30 20 10 0

HIGH RISK SEXUAL BEHAVIOR

>>Teen Birth Rate per 1,000 Female Population Trends for Ages 15-19, 2006-2008 27 42 30 20 26 41 29 19 25 39 27 18 2000 - 2006 New Jersey Essex County 2001 - 2007 Union County 2002 - 2008 Middlesex County 15- 19 Essex County 2002 - 2008: 39 50 40 30 20 10 0 Trends for Ages 15-17, 2006-2008 12,1 21,2 15,3 8,5 12,4 22,3 14,3 7,0 12,0 21,0 11,9 8,3 2006 New Jersey Essex County 2007 Union County 15-17 Essex County 2008: 21.0

2008 Middlesex County National Benchmark: 22 Baseline: 40.2 Target: 36.2

Teen birth rates categorized by 15 to 17 year olds and 15 to 19 year olds declined statewide as well as in

• • •

Essex County and the surrounding counties. Births to teens in both groups remain statistically higher for Essex County than statewide rates.

The rate of birth to teens 15-19 in Essex County is nearly twice (worse) than the National Benchmark The rate for those 15-17 is better (lower) than the Healthy People 2020 target.

Source: National Center for Health Statistics, County Health Rankings; N.J. Department of Health and Senior Services, Center for Health Statistics, State Health Assessment Data 61

HIGH RISK SEXUAL BEHAVIOR

>>HIV/AIDS Prevalence (2010) 1 400 Overall Prevalence Rate per 100,000 Population 1253,0 1 200 1 000 800 600 400 200 0 409,8 499,2 255,1 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% New Jersey Union County 2010 Essex County Middlesex County 22,1% 53,7% 22,5% Prevalence by Race/Ethnicity 6,9% 77,8% New Jersey Essex White, non-Hispanic 14,2% 20,0% 61,0% 19,0% Union Black, non-Hispanic 25,0% 37,0% 36,0% Middlesex Hispanic

• •

Essex County’s rate of HIV/AIDS prevalence in 2010 was significantly higher (more than 3 times) the statewide rate, and higher than both comparative counties. Black residents constitute the majority of HIV/AIDS cases in all geographies, and 77.8% in Essex County. As of December 2011 the HIV/AIDS prevalence rate was 2053.6 per 100,000 for Newark Residents (not shown).

Source: New Jersey Department of Health and Senior Services, Division of HIV, STD, and TB Services, HIV/AIDS Reporting System, Newark DCFWB Health Planning Division.

Note: Prevalence indicates amount of people living with HIV/AIDS at the time.

HIGH RISK SEXUAL BEHAVIOR

>>HIV/AIDS: New Cases Reported per 100,000 Population 70 61,2 60 2010 50 47,4 Essex County Trend 2006-2010 30,4 2009 50,5 40 30,4 30 25,2 2008 47,4 20,0 20 15,5 16,4 15,4 13,4 11,2 2007 9,4 48,1 10 6,5 0 2006 61,2 2006 New Jersey Essex County 2008 Union County 2010 Middlesex County 0 25 50 75 The rate of new HIV/AIDS cases reported per 100,000 declined by more than 50% in Essex County between 2005 and 2010, but remains significantly higher than the statewide rate and higher than both comparative counties.

Source: New Jersey Department of Health and Senior Services, Division of HIV, STD and TB Services, HIV/AIDS Reporting System, U.S. Census, American Community Survey.

Note: New cases reported indicates new cases per year.

TOBACCO USE

Indicator Tobacco Use: Adults who are Current Smokers Healthy People 2020 Target County Health Rankings Benchmark New Jersey

TOBACCO USE

>>Tobacco Use: Adults who are Current Smokers 25% 20% 15% 18,0% 16,1% 16,5% 20,0% 14,2% 20,1% 14,4% 14,8% 14,1% 12,8% 12,8% 17,3% 10% 5% Essex County Trend 2006-2010 2010 2009 2008 14,8% 14,6% 13,0% 2007 18,3% 2006 16,1% 0% 5% Essex County 2004 - 2010: 16% 10% 15% 20% Essex County 2010: 14.8% 0% 2006 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2010 Essex County Union County United States National Benchmark: 14% Baseline: 20.6% Target: 12.0%

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All geographies have seen a percentage decrease in adults who are smokers over the studied period. The percent of smokers in Essex County is worse (higher) than the County Health Ranking benchmark but not significantly different from the Health People 2020 target or the New Jersey State rate.

Source: CDC, Behavioral Risk Factor Surveillance System 65

ALCOHOL/DRUG USE

Indicator Excessive Drinking: Heavy Drinkers Plus Binge Drinkers Healthy People 2020 Target County Health Rankings Benchmark New Jersey

N/A

Treatment Admissions for Alcohol: Percentage of Total Treatment Admissions

N/A

Treatment Admissions for Heroin/Other Opioids: Percentage of Total Treatment Admissions

N/A N/A N/A N/A

Percentage of Total Treatment Admissions

N/A

Percentage of Total Treatment Admissions Treatment Admissions for Other Drugs: Percentage of Total Treatment Admissions

N/A N/A N/A

Rate per 100,000 Population

ALCOHOL/DRUG USE

>>Excessive Drinking: Heavy Drinkers Plus Binge Drinkers 25% 20% 15% 10% 5% 19,0% 16,8% 18,5% 19,2% 13,6% 20,3% 18,1% 15,4% 16,4% 17,6% 13,7% 20,4% 2010 2009 2008 2007 2006 0% Essex County Trends 2006-2010 12,6% 3,8% 15,0% 4,4% 12,7% 4,7% 14,6% 4,4% 13,8% 4,7% 5% Binge Drinkers 10% 15% Heavy Drinkers 20% Essex County 2004 - 2010: 14% 0% 2006 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2010 Essex County Union County United States National Benchmark: 8%

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Total Excessive Drinking fell in Essex County by 1.4 percentage points between 2006-2010. The percentage of excessive drinkers in Essex County was not statistically different than the statewide percentage in 2010, but nearly twice as high (worse) than the National Benchmark.

Source: CDC, Behavioral Risk Factor Surveillance System

Note: Heavy drinkers are defined as adult men who have more than 2 drinks per day and adult women who have more than one drink per day. Binge drinkers are defined as adult men who have 5 or more drinks on one occasion and females who have 4 or more drinks on one occasion.

ALCOHOL/DRUG USE

>> Primary Drug for Treatment Admissions (2010) 60% Essex County Trends 2007-2010 50% 40% 30% 20% 10% 0% New Jersey Essex County Union County Middlesex County Alcohol 34% 22% 31% 40% Heroin & Other Opioids 40% 50% 40% 36% Cocaine 7% 8% 8% 5% Marijua na 16% 16% 19% 16% Other Drugs 3% 4% 2% 3% 2010 2009 2008 2007 0% 4% 8% 16% 2% 8% 15% 22% 20% 2% 8% 12% 20% 1% 9% 9% 16% 20% Other Drugs Cocaine Alcohol 40% 50% 56% 58% 60% 64% 80% Marijuana Heroin & Other Opioids

• • •

The most common drug being treated in Essex County in 2010 was heroin and other opioids, comprising 50% of all treatment admissions. Heroin, cocaine, and other drug treatment admissions in Essex County were significantly higher than statewide. The admission rate for alcohol in Essex County is statistically lower than the statewide average.

Admissions for marijuana were not statistically different from the statewide rate.

Source: NJ Department Human Services, Division of Addiction Services, New Jersey Drug and Alcohol Abuse Treatment

Note: The percentages are based on the total number of treatment admissions for all primary drugs.

ALCOHOL/DRUG USE

>>Total Substance Abuse Treatment Admissions per 100,000 Population 1200 Essex County Trend 2007-2010 1 040,8 1000 864,5 817,5 892,4 2010 892 800 738,1 600 630,8 562,1 542,6 654,2 556,9 2009 1 006 423,3 400 344,1 2008 1 041 200 2007 1 096 0 2006 New Jersey Essex County 2008 Union County 2010 Middlesex County 0 200 400 600 800 1 000 1 200 The overall rate of substance abuse treatment admissions declined between 2007 and 2010, but remains significantly higher than the statewide rate.

Source: NJ Department Human Services, Division of Addiction Services, New Jersey Drug and Alcohol Abuse Treatment, U.S. Census, American Community Survey 69

DIET AND EXERCISE

Indicator Obesity: Percent with Reported BMI of >= 30 Adults with 30+ Minutes of Moderate Physical Activity 5 or More Days/Week, or Vigorous Physical Activity for 20+ Minutes 3 or More Days/Week During the Past Month, Did You Participate in Any Physical Activities? %=Yes Adults Who Have Consumed Fruits and Vegetables Five or More Times/Day Healthy People 2020 Target County Health Rankings Benchmark New Jersey

N/A N/A N/A N/A

Percent of Population Receiving SNAP

N/A N/A

Percent of Children Receiving SNAP

DIET AND EXERCISE

>> Obesity: Percent with Reported BMI of >= 30 30% 25% 20% 15% 10% 5% 22,6% 24,2% 21,7% 22,4% 22,5% 25,1% 24,8% 27,3% 23,9% 20,4% 23,0% 27,5% Essex County Trend 2006-2010 2010 2009 2008 2007 2006 0% 10% Essex County 2010: 27.3% 27,3% 25,3% 26,0% 24,3% 24,2% 20% 30% Essex County 2010: 27.3% 0% 2006 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2010 Essex County Union County United States National Benchmark: 25% Baseline: 34.0% Target: 30.6%

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Obesity in Essex County rose between 2006 and 2010. In 2010 the Essex County percentage was higher than all other geographies except the national percentage. Obesity In Essex County is statistically similar to the statewide average, Healthy People 2020 target and the County Health rankings benchmark.

Source: CDC, Behavioral Risk Factor Surveillance System 71

DIET AND EXERCISE

>> Adults with 30+ Minutes of Moderate Physical Activity 5 or More Days/Week, or Vigorous Physical Activity for 20+ Minutes 3 or More Days/Week. 60% 54,8% 54,2% Essex County Trend 2005-2009 50% 40% 45,9% 46,0% 40,5% 49,1% 47,5% 43,1% 43,1% 39,2% 49,3% 51,0% 2009 43,1% 2007 52,0% 30% 2005 46,0% 20% 0% 10% 20% 30% 40% 50% 60% 10% Essex County 2009: 43.1% 0% 2005 2009 New Jersey Newark-Union, NJ-PA MMSA Middlesex County Essex County Union County United States Baseline: 43.5% Target: 47.9% The percent of Essex County adults engaging in adequate physical activity declined by 2.9

• •

percentage points between 2005 and 2009. In 2009 it was worse than (below) the Healthy People 2020 target.

The percent of Essex County adults engaging in adequate physical activity is not statistically different than the statewide percentage.

Source: CDC, Behavioral Risk Factor Surveillance System

Note: Healthy People 2020 baseline and target are defined as, “moderate intensity for at least 150 minutes/week, or 75/minutes/week of vigorous intensity, or an equivalent combination.”

DIET AND EXERCISE

>> During the Past Month, Did You Participate in Any Physical Activities? %=Yes 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 73,0% 70,7% 72,1% 70,0% 74,8% 77,4% 73,4% 70,9% 73,9% 69,9% 70,9% 76,1% 2010 2009 2008 2007 2006 0% Essex County Trend 2006-2010 25% 50% 75% Essex County 2009: 72% 0% 2006 2010 New Jersey Newark-Union, NJ-PA MMSA Middlesex County Essex County Union County United States National Benchmark: 79%

• •

The percentage of Essex County residents reporting any exercise activity rose only 0.2 percentage points between 2005 and 2010, it is statistically no different from the statewide percentage. The percent of Essex County residents participating in any physical activity was lower (worse) than the County Health rankings Benchmark In 2011, 69% of Newark residents reported participating in physical activities during the past month. (not shown)

Source: CDC, Behavioral Risk Factor Surveillance System, Newark DCFWB Health Planning Division

70,9% 70,7% 71,9% 73,0% 70,7% 100%

DIET AND EXERCISE

>>Adults Who Have Consumed Fruits and Vegetables Five or More Times/Day Essex County Trend 2005-2009 35% 30% 25% 25,9% 28,5% 27,7% 26,6% 24,0% 23,2% 20% 15% 10% 5% 0% 2005 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 28,6% 26,4% 28,1% 28,1% 24,6% 23,4% 2009 Essex County Union County United States 2009 2007 2005 0% 10% 20% 28,1% 26,5% 28,5% 30%

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The percentage of Essex County residents reporting fruit and vegetable consumption 5 or more times a day declined 0.4% points between 2005 and 2009. This indicator is not statistically different from the statewide percent.

Source: CDC, Behavioral Risk Factor Surveillance System 74

DIET AND EXERCISE

>>Percent of Population Receiving SNAP (2011) 35% 30,4% 30% 25% 20% 18,5% 16,2% 15% 10% 9,1% 14,7% 8,1% 5,5% 11,6% 5% 0% New Jersey Total Essex County Union County Children Middlesex County 2011 2009 2007 0% Essex Trends 2007-2011 30,4% 14,7% 26,7% 10,9% 10% 20% Children Total 30% 19,9% 9,5% 40% The percent of Essex County residents receiving food stamps increased by 5.2 percentage points

•

between 2006 and 2011 and the percentage of children receiving food stamps increased 10.5 points. Essex County has significantly higher percentages of SNAP recipients (Total and Children) than the state.

Source: NJ Department of Human Services, Division of Family Development, Current Program Statistics, 2011; U.S. Census, ACS, Claritas 2011-2017 Projection / Intervening Year: Straight Line Method. Note: The total percentages are based on the total and the percentages of children are based on the number of children (<18 years). Percentages are for December of each year given.

ACCESS TO CLINICAL CARE

Indicator Healthy People 2020 Target County Health Rankings Benchmark New Jersey Rate per 100,000 Population Rate per 100,000 Population Health Care Access/Coverage: Do You Have Any Kind of Coverage? %=No.

Rate per 1,000 Population Total ACSC ED Visits for Children (Age 0-17) - ENT: Rate per 1,000 Population

N/A

Total ACSC ED Visits for Children (Age 0-17) - Asthma: Rate per 1,000 Population

N/A N/A N/A N/A N/A

Rate per 1,000 Population

N/A

Rate per 1,000 Population

ACCESS TO CLINICAL CARE

Indicator Healthy People 2020 Target County Health Rankings Benchmark Total ACSC ED Visits for Children (Age 0-17) - New Jersey Rate per 1,000 Population

N/A

Rate per 1,000 Population

N/A

Rate per 1,000 Population

N/A

Rate per 1,000 Population

N/A

Rate per 1,000 Population Total ACSC ED Visits for Adults (Age 18+) - Kidney/Urinary Tract Infection:

N/A

Rate per 1,000 Population

N/A

Rate per 1,000 Population Rate per 1,000 Population

ACCESS TO CLINICAL CARE

>> Rate of Physicians per 100,000 Population (2008) Primary Care Physicians 125 100 75 50 25 0 92,9 99,7 84,9 107,9 350 300 250 200 150 New Jersey Essex County Union County Middlesex County 100 Essex County 2008: 99.7

50 National Benchmark (2009): 158.5

252,9 Total Physicians 305,2 216,9 280,3 0 New Jersey Essex County Union County Middlesex County

• • •

Primary care physicians represent less than one third of the physicians practicing in Essex County. Essex County has a significantly higher proportion of total physicians than are available statewide, but is below (worse) than the CHR national benchmark for primary care physicians.

The percentage of primary care physicians in Essex County is not statistically different than the statewide average.

In 2011, 84% of Newark Residents reported having a doctor.

Source: New Jersey Council of Teaching Hospitals, New Jersey Physician Workforce Task Force Report, 2008 78

ACCESS TO CLINICAL CARE

>>Health Care Access/Coverage: Do You Have Any Kind of Coverage? %=No 25% Essex County Trend 2006-2010 20% 15% 10% 5% 14,2% 19,1% 14,5% 17,3% 13,9% 14,5% 11,5% 19,1% 14,1% 15,2% 10,5% 15,0% 2010 2009 2008 2007 2006 0% 19,1% 19,0% 20,7% 17,2% 5% 10% 15% Essex County 2010: 19.1% 20% 19,1% 25% 0% 2006 New Jersey Newark-Union, NJ-PA MMSA Middlesex County 2010 Essex County Union County United States Baseline: 16.8% Target: 0.0%

•

A significantly higher percentage of Essex County residents lack any kind of health care coverage when compared to the state. The Essex County rate is higher than the Healthy People 2020 target.

Source: CDC, Behavioral Risk Factor Surveillance System 79

ACCESS TO CLINICAL CARE

>>Total ACSC ED Admissions – Rate/1000 Population Ambulatory Care Sensitive Conditions (ACSCs) are medical problems that are potentially preventable. With proper medication and management of care, most people should not need to be hospitalized for these conditions.

Higher rates of ACSC conditions in Emergency Departments may indicate primary care access issues, poor(er) preventative care among the population and, in some instances, health barriers related to socio-economic status.

At right, the total ACSC Emergency Department Rate is shown by County. Dark Red shading represents the counties with the 5 highest rates in the State. White Shading represents the counties with the 5 lowest rates in the State. Pink Shading represents counties between the highest and lowest “Top 5s”. Rates, ranked highest to lowest by County and Statewide, are shown below.

ACSC - ED Rate/1000 COUNTY CUMBERLAND CAMDEN ATLANTIC ESSEX MERCER SALEM CAPE MAY PASSAIC UNION OCEAN HUDSON NJ 2010 95.68

87.67

84.67

82.64

77.35

75.56

70.88

66.21

65.98

63.88

62.98

ACSC - ED Rate/1000 COUNTY GLOUCESTER MONMOUTH MIDDLESEX BURLINGTON WARREN

SUSSEX MORRIS BERGEN SOMERSET HUNTERDON

STATEWIDE RATE NJ 2010 51.32

50.66

48.54

47.24

42.62

35.85

32.55

30.43

27.02

21.92

57.55

Source: NJDHSS 2008-2010 UB-04 Data – NJ Residents Population: United States Census 80

ACCESS TO CLINICAL CARE

>>Total ACSC ED Visits for Children (Age 0-17): Rate per 1,000 Population.

140 Essex County Trend 2008-2010 119,8 120 104,0 98,3 100 96,0 2010 104,0 83,4 77,5 78,2 80,8 80 60 40 20 0 2009 2008 135,2 119,8 2008 New Jersey Essex County Middlesex 2010 Union 0 50 100 150

•

Shown here are total Emergency Department ACSC Rates/1000 population for age 0-17.

While the Essex County ACSC ED visit rate for children decreased from 2008-2010, it remains significantly higher than the NJ Statewide rate.

Source: NJDHSS 2008-2010 UB-04 Data – NJ Residents, U.S. Census Bureau, American Community Survey 81

ACCESS TO CLINICAL CARE

>>Total ACSC ED Visits for Children (Age 0-17): Rate per 1,000 Population. Top 5 Conditions (2010) Essex County Trend 2008-2010 60 54,9 56,1 50 40 41,5 48,6 2010 3,7 4,8 11,8 15,6 54,9 30 2009 5,3 5,2 13,7 17,1 78,6 20 10 9,5 15,6 6,8 9,6 7,6 11,8 7,4 9,8 4,1 4,8 2,5 4,0 3,9 3,7 3,3 4,4 2008 4,2 5,0 14,1 16,3 65,9 0 0 20 40 60 80 100 ENT Asthma New Jersey GI Obstruction Essex County Cellulitis Middlesex Bacterial Pneumonia Union Bacterial Pneumonia GI Obstruction ENT Cellulits Asthma

•

Essex County’s ACSC ED rate for ENT was statistically higher than the statewide rate. Its rates for Asthma, GI Obstruction, Cellulitis, and Bacterial Pneumonia were not statistically different the state.

Source: NJDHSS 2008-2010 UB-04 Data – NJ Residents, U.S. Census Bureau, American Community Survey 82

30 20 10 0 60 50 40

ACCESS TO CLINICAL CARE

>>Total ACSC ED Visits for Adults (Age 18+): Rate per 1,000 Population.

80 76,1 75,4 Essex County Trend 2008-2010 70 47,7 38,0 50,7 51,2 38,9 55,4 2010 2009 2008 75,4 81,3 76,1 2008 New Jersey Essex County Middlesex 2010 Union 0 20 40 60 80 100

•

Shown here are total Emergency Department ACSC Rates/1000 population for adults. The rate for Essex County marginally decreased from 2008-2010 but remains significantly higher than the Statewide rate.

Source: NJDHSS 2008-2010 UB-04 Data – NJ Residents, U.S. Census Bureau, American Community Survey 83

ACCESS TO CLINICAL CARE

>>Total ACSC ED Visits for Adults (Age 18+): Rate per 1,000 Population. Top 5 Conditions (2010) Essex County Trend 2008-2010 14 12,6 12 10 9,4 10,3 9,3 9,0 2010 8,1 9,0 9,3 10,3 12,6 8,0 8,1 8 6 4 2 7,2 4,9 3,7 5,3 7,5 4,7 7,1 6,7 6,0 7,8 6,1 4,4 4,7 2009 2008 7,7 9,4 9,2 10,9 16,5 7,3 9,2 9,0 10,9 13,6 0 0 5 10 15 20 ENT Asthma New Jersey Cellulitis Essex County Kidney/Urinary Tract Infection Middlesex Union Dental Conditions Dental Conditions Cellulitis ENT Kidney/UT Infection Asthma Essex County had the highest ACSC ED visit rate of all the studied geographies and for the top 5

•

conditions.

Between 2008 and 2010 only Asthma had a consistently declining rate, but it remains the only ACSC condition with a significantly higher ED visit rate than the statewide rate.

Source: NJDHSS 2008-2010 UB-04 Data – NJ Residents, U.S. Census Bureau, American Community Survey 84

ACCESS TO CLINICAL CARE

160 140 120 100 80 60 40 20 0 >>ED Visits by Adults (18 to 64 years) For Primary Care Conditions: Aggregated Rate per 1,000 Population (2010) Essex County Trend 2006-2010 200 178,1 180 136,9 2010 2008 2006 New Jersey 2010 Essex County 0 50 100 150 178,1 173,7 162,8 200 ED visits by adults for Primary Care conditions in Essex County were significantly higher than the state and have been on the rise since 2006.

Source: New Jersey Discharge Data Collection System, Uniform Billing Data

Note: Unadjusted crude rates show hospital emergency department treat-and-release visits by each age category for select primary care conditions as primary diagnoses during 2006, 2008, and 2010, calculated based on total population for each age category and expressed per 1,000 population.

CLINICAL CARE MEASURES

Indicator Healthy People 2020 Target County Health Rankings Benchmark New Jersey

N/A

Rate per 1,000 Population ACSC IP Admissions by Top 5 Conditions - Congestive Heart Failure:

N/A

Rate per 1,000 Population

N/A

Rate per 1,000 Population

N/A

Rate per 1,000 Population ACSC IP Admissions Rate by Top 5 Conditions - Rate per 1,000 Population

N/A

Rate per 1,000 Population

CLINICAL CARE MEASURES

Indicator Healthy People 2020 Target County Health Rankings Benchmark New Jersey Rate per 1,000 Medicare Beneficiaries Rate per 1,000 Medicare Beneficiaries 30 Day Hospital Readmissions by Primary Diagnosis - Rate per 1,000 Medicare Beneficiaries 30 Day Hospital Readmissions by Primary Diagnosis -

N/A

Rate per 1,000 Medicare Beneficiaries Primary C-Section Rate: Percent of Total Live Births

N/A N/A

Percent of Total Live Births

CLINICAL CARE MEASURES

>> Total Inpatient & ED Admissions – Rate/1000 Population STATEWIDE CAPE MAY OCEAN SALEM HUDSON WARREN MONMOUTH CUMBERLAND ATLANTIC ESSEX PASSAIC MERCER CAMDEN SUSSEX BERGEN UNION MIDDLESEX GLOUCESTER BURLINGTON MORRIS HUNTERDON SOMERSET 0,00 100,00 200,00 INPATIENT 2010 ED 2010 300,00 400,00 500,00 Cape May County has the highest Inpatient Use Rate in NJ, while Somerset has the lowest. However, among ED Use Rates, more populated and urbanized counties rank first second and third. Hunterdon and Somerset Counties have the lowest use rates in the State for both Inpatient and ED utilization.

HOSPITAL USE RATE BY COUNTY - Rate/1000 COUNTY STATEWIDE CAPE MAY OCEAN SALEM HUDSON WARREN MONMOUTH CUMBERLAND ATLANTIC ESSEX PASSAIC MERCER CAMDEN SUSSEX BERGEN UNION MIDDLESEX GLOUCESTER BURLINGTON MORRIS HUNTERDON SOMERSET INPATIENT 2010 171.81

229.04

226.26

200.04

197.72

197.55

195.15

188.63

181.80

180.86

174.51

172.76

169.42

163.21

157.95

157.21

155.91

149.24

147.63

141.60

132.41

126.51

IP RANK 1 2 3 4 17 18 19 20 21 5 6 7 8 9 10 11 12 13 14 15 16 ED 2010 316.17

371.83

364.47

335.66

330.50

312.05

295.44

403.47

432.35

413.67

359.37

387.01

442.96

250.99

216.70

332.01

260.47

303.98

280.35

216.97

189.40

176.71

ED RANK 6 7 9 11 13 15 18 20 21 12 14 4 2 3 8 5 1 17 19 10 16

Source: NJDHSS 2008-2010 UB-04 Data – NJ Residents 88

CLINICAL CARE MEASURES

>>Total ACSC IP Admissions – Rate/1000 Population Ambulatory Care Sensitive Conditions (ACSCs) are medical problems that are potentially preventable. With proper medication and management of care, most people should not need to be hospitalized for these conditions.

Higher rates of ACSC conditions among inpatient care may indicate primary care access issues, poor(er) preventative care among the population and, in some instances, health barriers related to socio-economic status.

At right, the total ACSC Inpatient Rate/1000 is shown by County. Dark Orange shading represents the counties with the 5 highest rates in the State. White Shading represents the counties with the 5 lowest rates in the State. Light Orange Shading represents counties between the highest and lowest “Top 5s”. Rates, ranked highest to lowest by County and Statewide, are shown below.

ACSC - IP Rate/1000 COUNTY SALEM CAPE MAY CUMBERLAND OCEAN HUDSON CAMDEN ESSEX ATLANTIC MERCER PASSAIC WARREN NJ 2010 33.97 31.16 30.15 28.60 28.28 26.27 25.15 24.97 23.09 22.76 22.76 ACSC - IP Rate/1000 COUNTY MONMOUTH GLOUCESTER BURLINGTON SUSSEX UNION

MIDDLESEX BERGEN HUNTERDON MORRIS SOMERSET

STATEWIDE RATE NJ 2010 22.57 20.88 20.52 20.20 19.00

18.84 18.07 14.84 14.51 13.77

22.65

Source: NJDHSS 2008-2010 UB-04 Data – NJ Residents Population: United States Census 89

10 5 0

CLINICAL CARE MEASURES

>> Total ACSC Inpatient Admissions Rate per 1,000 Population 35 Essex County Trend 2008-2010 30 29,0 28,3 25 23,5 23,6 22,6 25,2 2010 25,2 21,1 21,0 20,7 20,2 20 19,0 18,8 15 2009 28,3 2008 29,0 2008 New Jersey Essex County 2009 Union County 2010 Middlesex County 0 10 20 30 40

•

The overall rate of ACSC inpatient admissions among inpatients decreased in Essex County, the State and comparative counties between 2008 and 2010. The rate in Essex County is not statistically different than the statewide rate.

Source: NJDHSS 2008-2010 UB 04 Data – NJ Residents; U.S. Census, American Community Survey 90

CLINICAL CARE MEASURES

>> ACSC Inpatient Admissions Rate by Top 5 Conditions per 1,000 Population (2010) 6 Essex County Trends 2008-2010 5,0 5 4 3,8 4,4 3,4 3,4 3,9 2010 2,5 2,7 2,9 3,4 4,4 3,2 3 2 2,1 2,0 2,5 1,8 2,9 1,9 2,8 2,7 2,6 2,4 2,5 1,8 2009 2,8 3,5 3,3 3,1 4,8 1 1,4 2008 2,8 3,6 3,1 3,3 4,9 0 Congestive Diabetes Asthma Bacterial Cellulitis 0 1 2 3 4 5 Heart Failure Pneumonia Cellulits Bacterial Pneumonia New Jersey Essex County Union County Middlesex County Asthma Diabetes Congestive Heart Failure Congestive heart failure is the most common condition for ACSC inpatient care in all geographies

•

studied for 2010. The rates for congestive heart failure, bacterial pneumonia, and cellulitis saw consistent declines during the 3 year time frame.

•

None of the rates for the Top 5 ACSC conditions were statistically different than the statewide rates.

Source: NJDHSS 2008-2010 UB 04 Data – NJ Residents; U.S. Census, American Community Survey

CLINICAL CARE MEASURES

>> 30 Day Hospital Readmissions per 1,000 Medicare Beneficiaries by Primary Diagnosis (2010) 8 7,5 Essex County Trends 2006-2010 7 6 5 5,9 2010 2,4 3,0 7,5 2,1 4 3 2 1,8 2,1 2,3 3,0 2,1 2,4 2008 2,8 3,0 8,9 2,0 1 0 2006 2,1 3,9 10,2 2,0 Heart Attack COPD New Jersey Heart Failure Essex County Pneumonia 0 2 Pneumonia 4 6 Heart Failure 8 COPD 10 12 Heart Attack Thirty day readmission rates are higher in Essex County than statewide for heart attack,

•

heart failure, Pneumonia and COPD, but were not statistically different from the statewide average. Between 2006 and 2010 only the COPD rate saw a consistent decline.

Source: Healthcare Quality Strategies, Inc. (HQSI), Report of Medicare FFS claims for New Jersey, 2011 92

CLINICAL CARE MEASURES

>> C-Section Rates (2010) 30% 25% 20% 15% 10% 5% 12,0% 13,2% 27,4% 27,3% Essex County Trends 2006-2010 2010 2008 2006 0% 5% 10% 15% 20% 25% Repeat Primary Primary C-Section Essex County 2010: 13.2% 27,3% 13,2% 27,0% 14,0% 25,1% 14,2% 30% 0% Primary Cesarean New Jersey Repeat Cesarean Essex County Baseline: 26.5% Target: 23.9%

• • •

C-section rates in Essex County are over 40% of all deliveries. The Primary C-section rate in Essex County is statistically higher than the statewide average.

The Primary C-section rates in Essex County is better (below) than the Healthy People 2020 target.

Repeat C-Section rates in Essex County were statistically no different than the statewide rate.

Source: N.J. Department of Health and Senior Services, Bureau of Vital Statistics and Registration, N.J. Birth Certificate Database

Note: Percentages are based on the total number of live births for county and state.

PHYSICAL ENVIRONMENT

Indicator Annual Number of Unhealthy Air Quality Days Due to Fine Particulate Matter Healthy People 2020 Target County Health Rankings Benchmark

N/A

New Jersey

N/A

Annual Number of Unhealthy Air Days Due to Ozone Blood Lead Levels of Children (less than 17 years) Tested for Lead Poisoning: 10-19 ug/DL Blood Lead Levels of Children (less than 17 years) Tested for Lead Poisoning: 20+ ug/DL Housing Built Before 1950 with Possible Lead-based Paint Hazard

N/A N/A N/A N/A N/A N/A

Rate per 100,000 Population People Who Are Low Income and Do Not Live Close to a Percent of Total Population Percent of all Restuarants

N/A N/A

Rate per 100,000 Population

PHYSICAL ENVIRONMENT

>>Annual Number of Unhealthy Air Quality Days Due to Fine Particulate Matter Essex County Trend 2005-2007 16 14 14 14 14 12 10 9 7 8 8 6 5 4 4 4 2 0 2005 New Jersey Essex County 2006 Union County 5 8 4 2007 Middlesex County 2007 2006 2005 0 2 4 6 Essex County 2007: 8 National Benchmark: 0 8

•

The number of unhealthy air quality days due to fine particulate matter decreased between 2005 and 2007 in Essex County. The number of unhealthy air quality days was worse (higher) than the National Benchmark.

Source: County Health Rankings, PHASE project, a collaborative effort between the CDC and EPA

8 8 9 10

PHYSICAL ENVIRONMENT

>> Annual Number of Unhealthy Air Days Due to Ozone 25 22 20 2007 Essex County Trend 2005-2007 9 2006 15 14 12 12 10 5 11 9 9 13 11 9 9 13 2005 0 2 4 6 8 Essex County 2007: 9 10 9 12 12 14 0 2005 New Jersey Essex County 2006 Union County 2007 Middlesex County National Benchmark: 0

• •

Improvement has been made in the reduction of unhealthy days due to ozone.

The number of days of unhealthy air quality due to ozone is worse (higher) than the national benchmark. This indicator was not significantly different than the statewide number.

Source: County Health Rankings, PHASE project, a collaborative effort between the CDC and EPA 96

PHYSICAL ENVIRONMENT

>> Blood Lead Levels of Children (less than 17 years) Tested for Lead Poisoning (2010) 1,2% Essex County Trends 2006-2010 1,0% 1,0% 0,8% 2010 0,2% 1,0% 0,6% 0,5% 0,5% 0,4% 2008 0,4% 1,7% 0,4% 0,2% 0,1% 0,2% 0,1% 0,2% 2006 0,1% 3,5% 0,0% New Jersey 10 - 19 ug/dL Essex County Union County 20 + ug/dL Middlesex County 0,0% 1,0% 20 + ug/dL 2,0% 3,0% 10 - 19 ug/dL 4,0% Essex County’s children have significantly higher blood lead levels than found in children statewide.

•

This was true for blood lead levels ranging from 10-19 ug/dL and for levels over 20 ug/dL.

The Bloomfield / Caldwell Health Dept. reported: 1 case of lead poisoning amongst children in

2005, 11 in 2006, 4 in 2007, 0 in 2008, 8 in 2009, 1 in 2010, and 5 in 2011.

Source: NJ Department of Health and Senior Services, Division of Family Health Services , Maternal and Child Health Services, Child and Adolescent Health Program, Centers for Disease Control

Note: The CDC defines a blood lead level of 10 ug/dL as the threshold that should prompt public health actions.

PHYSICAL ENVIRONMENT

>>Housing Built Before 1950 with Possible Lead-based Paint Hazard/Access to Recreational Facilities Rate of Recreational Facilities per 100,000 Population Housing Built Before 1950 20,0 70% 66,0% 60,8% 64,3% 65,3% 15,0 15,0 14,0 15,0 14,0 10,0 11,0 10,0 11,0 60% 10,0 50% 47,5% 5,0 40% 43,2% 37,9% 40,6% 38,30% 0,0 30% 27,3% 2008 New Jersey Union County 2009 Essex County Middlesex County 20% Essex County 2009: 10 10% 0% New Jersey 2000 Essex County Newark 2010 Irvington East Orange National Benchmark: 16

•

Essex County and its major cities continue to have a significantly larger amount of housing built before 1950 than exists statewide. The rate of recreational facilities per thousand is not statistically different than the statewide average or the national benchmark.

Bloomfield / Caldwell Health Dept. reported 9, 624 possible lead hazards in all 1-4 family buildings Source: U.S. Census Bureau, County Health Rankings, United States Department of Agriculture (USDA), Food Environment Atlas 98

PHYSICAL ENVIRONMENT

>>Limited Access to Healthy Foods Percent of population who are low income and do not live close to a grocery store (2006) Percent of all restaurants that are fast food establishments (2009) New Jersey 4.0% 50.0% Number of liquor stores per 100,000 population (2006) 20.0

Essex County 1.0% 53.0% 25.0

Union County 1.0% 46.0% 23.0

Middlesex County 3.0% 44.0% 16.0

Essex County 2006: 1% National Benchmark: 0% Essex County 2009: 53% National Benchmark: 25%

• • •

In 2006, 1% of low income Essex County residents did not live close to a grocery store compared to 4% statewide. In 2009, 53% of all restaurants in Essex County were fast food restaurants compared to 50% statewide. This is worse (more than double) the national benchmark. The higher rate of liquor stores per 100,000 residents was not statistically different than the statewide average

Source: County Health Rankings, U.S. Census Bureau’s County Business Patterns, United States Department of Agriculture Food Environment Atlas 99

BEHAVIORAL HEALTH

Indicator Healthy People 2020 Target County Health Rankings Benchmark New Jersey Rate per 1,000 Population ED Visits for Mental/Behavioral Health Conditions by Age: Rate per 1,000 Population ED Visitis by Adult for Primary Care Conditions by Alcohol Rate per 1,000 Population ED Visits by Adults for Primary Care Conditions by Other Mental Disorders: Rate per 1,000 Population

N/A N/A N/A N/A N/A RED: statistically worse than comparison statistic at 95% confidence level YELLOW: no statistical difference between county and GREEN: statistically better than comparison statistic at 95% confidence level comparison statistics at 95% confidence level

100

BEHAVIORAL HEALTH

>> Hospital Admissions for Mental/Behavioral Health Conditions by Age: Rate per 1,000 Population (2010) 16 Essex County Trend 2006-2010 14,5 14 12 10 10,8 9,9 2010 5,6 14,5 3,7 10,8 8 6 7,4 5,6 2008 4,7 11,7 0,8 8,1 4,1 3,7 4 2 2,3 2006 5,9 12,5 2,6 9,2 0 Total Children Adults Elderly 0 5 10 15 New Jersey Essex County Elderly Adults Children Total 20

•

Hospital admissions for mental health conditions in Essex County exceeds the state’s rate but was not statistically higher. Rates in Essex County have increased among all age groups except for the elderly.

Source: New Jersey Discharge Data Collection System, 2011; N.J. Department of Human Services, Division of Mental Health Services, Mental Health Subsidy Allocation, 2011, U.S. Census, American Community Survey. Note: Mental/Behavioral health conditions include MCD 19 Mental Diseases and Disorders and MDC 20 Alcohol/Drug Use and Alcohol/Drug-Induced Organic Mental Disorders.

BEHAVIORAL HEALTH

>> ED Visits for Mental/Behavioral Health Conditions by Age: Rate per 1,000 Population (2010) Essex County Trend 2006-2010 25 23,8 20 18,4 19,6 2010 9,2 23,8 9,0 18,4 15,4 15 10 8,9 9,0 9,2 2008 8,7 23,6 8,3 17,9 7,4 5 2006 5,7 17,1 5,5 12,7 0 Total Children New Jersey Adults Essex County Elderly 0 5 Elderly 10 Adults 15 Children 20 Total 25

• •

Adults have the highest rate of ED visits in both Essex County and statewide. From 2006 to 2010 the rate of ED visits for behavioral health conditions rose for each age group. Total ED visits for mental health conditions were not statistically different than the statewide rate.

15 10 5 0

BEHAVIORAL HEALTH

>> ED Visits by Adults (18 to 64 Years) for Primary Care Conditions: Rate per 1,000 Population (2010) 30 Essex County Trend 2006-2010 23,9 25 21,7 2010 13,4 21,7 20 13,4 2008 12,5 22,6 8,8 2006 13,5 20,7 Alcohol Dependence New Jersey Other Mental Disorders Essex County 0 5 10 Other Mental Disorders 15 20 Alcohol Dependence 25

•

Essex County has a lower rate of ED visits by adults for alcohol dependence than the state but a higher rate for ED visits for mental disorders.

Neither rate was statistically different from the statewide rate.

Source: New Jersey Discharge Data Collection System

Note: Other mental disorders excludes drug or alcohol dependence and includes metal retardation. Alcohol dependence and other mental disorders represent two of the top ten ED visits for primary care conditions for adults.

103

SOCIAL AND ECONOMIC FACTORS

Indicator Percent of Labor Force Unemployed Healthy People 2020 Target County Health Rankings Benchmark New Jersey

N/A N/A

Per Capita Income

N/A N/A

Median Household Income Percent of Total Population with Income in the Past Year Below Federal Poverty Level Percent of Families with Income in the Past Year Below Federal Poverty Level Percent of Children with Income in the Past Year Below Federal Poverty Level Percent of Seniors with Income in the Past Year Below Federal Poverty Level

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A RED: statistically worse than comparison statistic at 95% confidence level YELLOW: no statistical difference between county and GREEN: statistically better than comparison statistic at 95% confidence level comparison statistics at 95% confidence level

104

SOCIAL AND ECONOMIC FACTORS

Indicator Percent of Total Population Receiving TANF Percent of Children Receiving TANF Healthy People 2020 Target County Health Rankings Benchmark New Jersey

N/A N/A N/A N/A

Rate per 1,000 Population Educational Attainment: No High School Diploma Limited English Proficiency (LEP) Population

N/A N/A N/A N/A RED: statistically worse than comparison statistic at 95% confidence level YELLOW: no statistical difference between county and GREEN: statistically better than comparison statistic at 95% confidence level comparison statistics at 95% confidence level

105

SOCIAL AND ECONOMIC FACTORS

>> Percent of Labor Force Unemployed 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% New Jersey Essex County Newark-Union, NJ-PA Newark Irvington East Orange 2000 3,7% 4,5% 3,6% 8,0% 6,5% 6,6% 2005 4,5% 5,6% 4,5% 8,3% 6,8% 7,3% 2010 9,6% 11,1% 9,4% 15,4% 13,7% 13,9% 2011 9,3% 10,8% 9,2% 15,2% 13,2% 10,8% 2011 2010 2009 2008 2005 2000 0% Essex County Trend 2000-2011 2% 4% 6% 8% Essex County 2011: 10.8% 10% 10,8% 11,1% 10,2% 6,6% 5,6% 4,5% 12% National Benchmark (2010): 5.4%

•

Unemployment rates are higher in Essex County and its major cities than statewide. The Essex County unemployment rate is worse (higher) than the rate statewide.

Source: New Jersey Department of Labor, New Jersey Labor Force Estimates by Area

Note: The data represents unadjusted annual averages.

106

SOCIAL AND ECONOMIC FACTORS

>> Per Capita Income $40 000 $35 000 $30 000 $25 000 $20 000 $15 000 $10 000 $5 000 $0 New Jersey Essex County Newark Irvington East Orange 2000 $27 006 $24 943 $13 009 $16 874 $16 488 2005 $31 471 $28 232 $15 346 $19 936 $16 525 2010 $33 555 $29 674 $17 147 $19 380 $20 874 2010 2005 2000 Essex County Trend 2000-2010 $31 120 $28 232 $24 943 $0 $10 000 $20 000 $30 000 $40 000 Per Capita income though rising for Essex County residents remains significantly lower than the per capita income of residents statewide, and income per capita in all of Essex County’s major cities is lower than the county figure.

Source: U.S. Census Bureau, American Community Survey 107

SOCIAL AND ECONOMIC FACTORS

>> Median Household Income $80 000 $70 000 $60 000 $50 000 $40 000 $30 000 $20 000 $10 000 $0 New Jersey Essex County Newark Irvington East Orange 2000 $55 146 $44 944 $26 913 $36 575 $32 346 2005 $61 672 $49 460 $30 665 $46 262 $29 691 2010 $67 681 $52 394 $34 816 $39 166 $40 312 2010 2005 2000 Essex County Trend 2000-2010 $54 252 $49 460 $44 944 $0 $10 000 $20 000 $30 000 $40 000 $50 000 $60 000 While median income in Essex County significantly lags behind the statewide average, median income in the county’s major cities lags behind both the county and state.

Source: U.S. Census Bureau, American Community Survey 108

SOCIAL AND ECONOMIC FACTORS

>> Percent of Population With Income in the Past Year Below Federal Poverty Level (2009) 40% Essex County Trends 2000-2009 35% 30% 25% 2009 12,2% 21,0% 11,9% 14,5% 20% 15% 10% 2005 12,0% 19,1% 12,3% 14,7% 5% 0% New Jersey Essex County Newark Irvington East Orange People 9,4% 14,5% 23,9% 17,7% 20,0% Families 7,0% 11,9% 21,2% 16,2% 17,6% Children 13,5% 21,0% 33,4% 25,3% 35,4% Seniors 7,9% 12,2% 15,6% 22,0% 16,5% 2000 0% 5% Seniors 10% Children 15% Families 12,2% 20,8% 12,8% 15,6% 20% People 25% Poverty rates for Essex County children increased from 20.8% to 21.0% between 2000 and

•

2009. Poverty rates for people and families decreased. The rate for seniors remained static. The rates for all groups are significantly higher than the statewide average.

Source: U.S. Census Bureau, American Community Survey

Note: People are defined as the entire population in each geographic area, children are defined as the population under 18 years, and seniors are defined as the population over 65 years.

109

2% 1% 0% 5% 4% 3%

SOCIAL AND ECONOMIC FACTORS

>>Percent of Population Receiving TANF (2011) 8% 7,5% 7% 6% 1,2% 2,9% 1,0% 0,5% 3,4% 2,7% 1,5% Percent of Total Population New Jersey Essex County Percent of Children Union County Middlesex County 2011 2009 2007 Essex Trends 2007-2011 7,5% 2,9% 7,5% 2,8% 6,9% 2,8% 0% 2% Children 4% Total 6% 8%

• • • •

The percent of Essex County residents receiving Temporary Assistance for Needy Families (TANF) benefits is significantly higher than the state rate. The same can be said of the percent of Essex County children receiving TANF benefits.

The percentage of Newark families and children receiving various types of public assistance is twice that of the US average and three times that of the State of New Jersey (not shown). In 2011, 18.3% of Newark households received SSI, Cash Public Assistance, or SNAP in the last 12 months (not shown).

In 2011, 35.6% of children living in households received SSI, Cash Public Assistance, or SNAP in the last 12 months (not shown).

Source: NJ Department of Human Services, Division of Family Development, Current Program Statistics, U.S. Census, American Community Survey; Claritas 2011-2017 Projection / Intervening Year: Straight Line Method. 110

8 6 4 2 0

SOCIAL AND ECONOMIC FACTORS

>>Estimated Homelessness Rate per 1,000 Population 14 12,8 12 10 2012 Essex County Trends 2009-2012 4,1 7,4 4,8 3,3 3,3 4,1 4,1 2011 2010 2009 4,2 4,2 4,8 New Jersey 2009 Essex County Union County 2012 Middlesex County 0 1 2 3 4 5 6

•

In 2012 the homeless population estimate rate per 1,000 for Essex County was not statistically different from the statewide rate. The rate for Essex County declined by 0.7 percentage points between 2009 and 2012.

Source: Corporation for Supportive Housing, 2010 New Jersey Point in Time Count of the Homeless Data Report, U.S. Census Bureau, American Community Survey, Claritas 2011-2017 Projection / Intervening Year: Straight Line Method.

Note: The rates are based on the total population in each age group. New Jersey data for 2009 was unavailable.

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SOCIAL AND ECONOMIC FACTORS

>> Educational Attainment (2009) 40% 35% 34,5% 31,0% 29,4% 30,4% 30% 25% 23,6% 22,1% 20% 15% 12,6% 16,5% 10% 5% 0% No High School Diploma High School Graduate New Jersey Some College, Associate's Degree Essex County Bachelors, Professional, or Graduate Degree 2009 2005 2000 No High School Diploma Trends 2000 2009 0% East Orange 10% Irvington 20% Newark 30% New Jersey 40% 50% Essex County Essex County 2009: 16.5% Baseline: 11.0% Target: 2.1% The percentage of residents with no high school diploma has decreased in New Jersey,

•

Essex County, and in the major cities in Essex County between 2000 and 2009. The percent of Essex County residents without a high school diploma is significantly higher than the statewide average.

Source: U.S. Census Bureau, American Community Survey 112

SOCIAL AND ECONOMIC FACTORS

>>Limited English Proficiency (LEP) Population 30% Essex County Trend 2000-2009 24,8% 25% 22,4% 22,0% 2009 15,1% 20% 15% 13,3% 11,1% 11,4% 14,2% 11,5% 11,7% 15,1% 12,1% 15,1% 2005 14,2% 10% 6,0% 5% 2000 13,3% 0% 2000 New Jersey Essex County 2005 Newark Irvington 2009 East Orange 0% 5% 10% 15% The percent of Essex County residents with limited English proficiency (LEP) rose between 2000 and 2009.

•

In 2009 the percentage in Essex County was significantly higher than statewide percentage

•

with LEP. Nearly 25% of Newark’s population had LEP.

Source: U.S. Census, American Community Survey.

Note: The U.S. Census Bureau defines LEP Population as persons who reported speaking English less than “very well.“ Data for East Orange for 2005 and 2009 is unavailable. 20%

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VIOLENT CRIME AND INJURY PREVENTION

Indicator Healthy People 2020 Target County Health Rankings Benchmark New Jersey Rate per 100,000 Population Deaths due to Assault (Homicide)

N/A N/A

Rate per 1,000 Population Rate per 1,000 Population Children Reported for Abuse/Neglect:

N/A

Rate per 1,000 Population Percent of Children with Abuse/Neglect Reports Substantiated

N/A N/A N/A

Rate per 1,000 Children

114

VIOLENT CRIME AND INJURY PREVENTION

Indicator Healthy People 2020 Target County Health Rankings Benchmark Children (under 18 years) Under DYFS Supervision Receiving New Jersey Rate per 1,000 Children Children (under 18 years) Under DYFS Supervision Receiving Rate per 1,000 Children Deaths due to Motor Vehicle Crashes: Rate per 100,000 Population Deaths due to Falls: Rate per 100,000 Population

N/A

Deaths due to Poisoning: Rate per 100,000 Population

115

VIOLENT CRIME AND INJURY PREVENTION

>>Violent Crime Rate per 100,000 Population 900 780,5 800 704,6 700 673,6 2010 2009 600 2008 500 402,6 437,7 466,5 2007 400 350,1 325,7 2006 309,1 300 218,2 194,8 179,4 200 0 Essex County Trend 2006-2010 200 400 600 Essex County 2007 - 2009: 679 800 673,6 667,6 704,6 686,6 780,5 1000 100 0 2006 New Jersey Essex County 2008 Union County 2010 Middlesex County National Benchmark: 73 Between 2006 and 2010 the violent crime rate decreased in Essex County, Middlesex

• •

County and the state as a whole. Essex County’s violent crime rate is significantly higher than the statewide rate.

Essex violent crime rate was higher (worse) than the national benchmark.

Source: NJ Department of Law and Public Safety, Division of State Police, Uniform Crime Reporting Unit, U.S. Census, American Community Survey 116

VIOLENT CRIME AND INJURY PREVENTION

>>Deaths due to Assault (Homicide): Age-Adjusted Rate per 100,000 Population 20,0 18,8 Essex County Trend 2004-2008 17,9 18,0 2008 16,0 13,2 14,0 13,2 12,0 2007 17,4 10,0 8,1 18,8 8,0 6,0 4,8 5,3 2006 4,4 4,4 5,2 19,1 4,0 3,0 3,0 2005 2,6 2,0 0,0 2004 17,9 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County 0 5 10 15 20 25

•

The homicide rate decreased between 2004 and 2008 statewide and in Essex County.

However, the Essex County rate is significantly (nearly 3 times) higher than the state rate.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data 117

2 1 0

VIOLENT CRIME AND INJURY PREVENTION

>>Burglary Rate per 1,000 Population 8 6,7 7 6,7 6,0 6 2010 5,1 5 4,5 4,6 4,4 4,5 4,3 4,0 3,9 4 3,1 2008 3 Essex County Trend 2006-2010 6,0 6,7 2006 6,7 2006 New Jersey Essex County 2008 Union County 2010 Middlesex County 0 2 4 6 8

•

Between 2006 and 2010 burglary rates declined in Essex County as well as in Middlesex County and the state as a whole. The Essex County rate was not significantly different than the statewide rate.

Source: NJ Department of Law and Public Safety, Division of State Police, Uniform Crime Reporting Unit, U.S. Census, American Community Survey 118

VIOLENT CRIME AND INJURY PREVENTION

>>Total Domestic Violence Arrests, Rate per 1,000 Population 3,0 Essex County Trend 2006-2010 2,6 2,5 2,6 2,5 2,4 2,2 2,2 2,2 2010 2,2 2,1 2,0 2,0 1,9 1,8 1,7 2009 2,1 1,5 2008 1,9 1,0 2007 0,5 1,9 0,0 2006 New Jersey Essex County 2008 Union County 2010 Middlesex County 2006 2,0 0,0 0,5 1,0 1,5 2,0 2,5 3,0

•

Domestic violence rates were up in Essex County between 2006 and 2010, while they remained stable statewide and declined in comparative counties. The Essex County rate was not significantly different than the statewide rate.

Source: NJ Department of Law and Public Safety, Division of State Police, Uniform Crime Reporting Unit, U.S. Census, American Community Survey 119

20 10 0

VIOLENT CRIME AND INJURY PREVENTION

>> Rate of Children Reported for Abuse/Neglect per 1,000 Population (2010) 90 Essex County Trend 2006-2010 80 75,5 73,2 77,0 70 2010 49,8 60 49,8 50 45,4 40 34,1 34,7 2008 44,0 30 2006 45,6 New Jersey Essex Union Middlesex Newark Irvington East Orange 0 10 20 30 40 50 60

• •

For Essex County’s major cities, child abuse reports are well above the county’s rate. The rate of reports in Essex county increased between 2006 and 2010 but was not statistically different from the statewide rate. The rate of reports in Essex County’s major cities is 1.5 times that of the county.

Source: N.J. Department of Children and Families, Child Abuse and Neglect Substantiations, U.S. Census Bureau, American Community Survey 120

VIOLENT CRIME AND INJURY PREVENTION

>>Percent of Children with Abuse/Neglect Reports Substantiated (2010) 16% Essex County Trend 2006-2010 14,3% 14% 13,1% 11,6% 12% 11,1% 2010 11,1% 10,3% 10,0% 10% 8,2% 8% 2008 12,4% 6% 4% 2% 0% New Jersey Essex Union Middlesex Newark Irvington East Orange 2006 0% 5% 10% 15% 15,9% 20%

•

The percent of child abuse reports substantiated in Essex County is not statistically different from the statewide percentage. The highest rate of substantiated reports occurred in East Orange.

Source: N.J. Department of Children and Families, Child Abuse and Neglect Substantiations, U.S. Census Bureau, American Community Survey Notes: Percentages are based on the total number of children with abuse/neglect reported.

121

VIOLENT CRIME AND INJURY PREVENTION

>>Children (under 18 years) Under DYFS Supervision per 1,000 Children (2010) 35 Essex County Trend 2006-2010 30,5 30 25 21,9 24,2 2010 6,3 24,2 30,5 20 18,4 15 2008 10,2 24,1 34,3 10 5 3,5 6,3 2006 12,3 35,1 47,4 0 Total In-Home Services New Jersey Essex County Out-of-Home Services 0 10 20 Out-of-Home Services 30 40 In-Home Services Total 50 The rate of children under DYFS supervision was down in Essex County between 2006 and 2010, but still exceeded the statewide rate though it was statistically no different than the state rate..

Source: NJ Department of Children and Families, Division of Youth and Family Services 122

VIOLENT CRIME AND INJURY PREVENTION

>>Motor Vehicle Crash Death Rate: Age-Adjusted Rate per 100,000 Population 14,0 Essex County Trend 2004-2008 12,0 10,0 8,0 6,0 4,0 9,0 9,3 11,0 8,7 8,6 8,0 8,4 8,0 6,4 6,2 7,2 5,7 2008 2007 2006 2005 2004 0 2 Essex County 2002 - 2008: 8.0

4 6,2 6,4 7,8 8,2 9,0 6 8 10 Essex County 2008: 6.2

2,0 0,0 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County National Benchmark: 12.0

Baseline: 13.8 Target: 12.4

The motor vehicle crash death rate declined in Essex County and all geographies studied

•

between 2004 and 2008. The Essex County motor vehicle crash death rate was better (lower) than the Healthy People 2020 target and the County Health rankings benchmark.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data

Note: Rates are calculated per 100,000 population of the county and state and are age-adjusted to the 2000 U.S. standard million population.

123

VIOLENT CRIME AND INJURY PREVENTION

>>Deaths due to Falls: Age-Adjusted Rate per 100,000 Population 5,0 Essex County Trend 2004-2008 4,5 4,5 4,5 4,4 4,4 4,2 4,2 4,2 2008 4,0 3,5 3,7 2007 3,5 3,3 3,0 2006 3,0 2,7 2005 2,5 2004 2,0 0 1 2 3 4 5 1,5 Essex County 2008: 4.4

1,0 4,4 4,5 4,2 5,3 3,0 6 0,5 0,0 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County Baseline: 7.0 Target: 7.0

Deaths due to falls increased between 2004 and 2008 in New Jersey, Essex County, and

•

Middlesex County. The 2008 Essex County rate is even with the statewide rate, at 4.4 per 100,000. This is better (lower) than the Healthy People 2020 target.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data

Note: The Healthy People 2020 goal is to, “prevent an increase in fall-related deaths.” 2004 Essex Data not Statistically Significant due to too few cases.

124

VIOLENT CRIME AND INJURY PREVENTION

>>Deaths due to Poisoning: Age-Adjusted Rate per 100,000 Population 14 Essex County Trend 2004-2008 12,7 2008 12 10,2 2007 10 9,2 9,2 8,7 9,0 2006 8 7,6 2005 6,5 6 5,4 5,6 5,8 2004 4,7 0 5 10 15 4 Essex County 2008: 8.7

2 8,7 8,8 12,7 19,0 9,2 20 0 2004 New Jersey Essex County 2006 Union County 2008 Middlesex County Baseline: 13.1 Target: 13.1

• •

Deaths due to poisoning per 100,000 decreased in Essex County between 2004 and 2008.

The rate of deaths due to poisoning was lower (better) than the Healthy People 2020 target . The rate of poisoning deaths was not statistically different than the statewide rate.

Source: NJ Department of Health and Senior Services, Center for Health Statistics, NJ State Health Assessment Data

Note: The Healthy People 2010 goal is to, “prevent an increase in the rate of poisoning deaths.”

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DEMOGRAPHICS

Population Change: 2000 - 2010 6% 4% 2% 4,5% 1,3% 0% -2% -4% -1,2% -6% -8% -8,0% -10% -12% New Jersey Essex County Newark -11,1% Irvington East Orange Geography 2000 New Jersey 8,414,350 8,521,427 8,791,894 4.5% Essex County Newark Irvington Population Change 793,633 273,546 60,695 East Orange 69,824 2005 769,628 265,375 59,532 62,240 2010 783,969 277,140 53,926 64,270 % Change -1.2% 1.3% -11.1% -8.0%

•

Essex County’s population is stagnating behind statewide growth. Irvington and East Orange are facing significant population declines, while Newark is seeing slight growth.

Source: U.S. Census Bureau, American Community Survey 126

DEMOGRAPHICS

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2010 Population by Race/Ethnicity New Jersey Essex County Newark Irvington East Orange White 68,6% 42,6% 26,3% 5,6% 4,1% Black/African Americans 13,7% 40,9% 52,4% 85,4% 88,5% Hispanic/Latino 17,7% 20,3% 33,8% 10,6% 7,9% Asian 8,3% 4,6% 1,6% 0,9% 0,7% Ethnicity White Black Essex County Trends 2000 2010 % Change 352,859 333,868 -5.4% 327,324 320,479 -2.1% Asian 29,429 Native Amer.

1,861 35,789 21.6% 3,056 64.2% Two or more 27,155 Hispanic 122,347 24,804 -8.7% 159,117 30.1% Essex County and its major cities had higher percentages of African-American and Hispanic populations than New Jersey as a whole.

Source: U.S. Census Bureau, American Community Survey Note: Numbers may not add up to 100%. 127

DEMOGRAPHICS

35% 30% 25% 20% 15% 10% 5% 0% New Jersey Essex County Newark Irvington East Orange 0 -17 23,5% 24,9% 25,6% 25,4% 25,7% 2010 Population by Age 18 - 24 8,7% 9,5% 11,9% 10,6% 10,2% 25 - 44 26,7% 27,5% 31,9% 30,0% 27,8% 45 - 64 27,7% 25,7% 22,1% 25,1% 24,6% 65 - 84 11,5% 9,9% 7,7% 8,1% 10,3% 85 + 2,0% 1,7% 0,8% 0,9% 1,5% Age 0 – 17 18 – 24 25 – 44 45 – 64 65 – 84 85 + Essex County Trends 2000 2010 206,950 74,308 247,139 170,856 82,069 12,311 194,918 74,126 223,876 200,762 76,660 13,627 New Jersey Essex County Newark Irvington East Orange Median Age (2010) 39.0

36.4

32.3

34.0

35.0

% Change -5.8% -0.2% -9.4% 17.5% -6.6% 10.7% The population age cohorts with the highest growth between 2000 and 2010 in Essex County were those 45 – 64 and 85+.

Source: U.S. Census Bureau, American Community Survey 128

Essex County Health Issues identified by Secondary Data

• •

Heart Disease

Age adjusted mortality rate higher than the Healthy People (HP) 2020 target.



The rate of cardiovascular disease, heart attack, and diabetes among Newark residents is almost twice as high as the county rates

Essex County residents report higher cholesterol levels at a rate (3 times) higher than the HP 2020 target.

• •

Cancer

The age adjusted rates above the HP 2020 target.



Mortality rates among blacks in Essex County were significantly higher than the rate county wide.

The percent of women who had a pap smear in the last 3 years was 11.7% points below the HP 2020 target

.

129

Essex County Health Issues identified by Secondary Data

•

Septicemia and Diabetes

Mortality rates for Septicemia and diabetes were significantly higher in Essex County than statewide.



Blacks had significantly higher mortality rates for septicemia and diabetes than residents county wide.

•

Years of Potential Life Lost

Essex County residents had a higher rate of premature deaths than residents statewide and far worse than the county health ranking (CHR) national benchmarks.

• • •

Maternal and Child Health

Infant mortality rates higher than the state.

The rate of low birth weight and very low birth weight infants higher than the HP 2020 target and the state average.



The rates for both indicators were higher among blacks than all County residents.

The percent of Essex County women receiving 1 was 8.6% points below HP 2020 target.

st trimester care

130

Essex County Health Issues identified by Secondary Data

• • • The percent of women receiving no prenatal care was significantly higher than the statewide rate.

Teen births 15-19 were nearly double the CHR benchmark.

Primary C-section rates were significantly higher than the statewide rate

.

• • •

Health and Behavioral Health Status and Prevention

Essex County residents report significantly more mentally and physically unhealthy days than the CHR benchmarks.

Immunizations for flu and pneumonia were 27.5% and 35.2% points lower than HP 2020 target.

Essex County adults reporting any physical activity in the last month 7% points below the benchmark.



Newark 10% below benchmark.

131

Essex County Health Issues identified by Secondary Data

• • •

Substance Abuse and Mental Health

Tobacco use 2.8% points higher than HP 2020 target.

Excessive drinking reported 6.0% points higher CHR benchmark.

Admission rates for heroin/other opiods, cocaine ,and other drugs significantly higher than statewide rates.

• • •

High Risk Sexual Behaviors

STD rates significantly higher than the state rate.



Chlamydia seven times higher than CHR benchmark.

HIV/AIDS prevalence in Newark twice the County rate.



Three times higher than state



Blacks represent 77.8% cases.



The prevalence rate in Newark is nearly twice the county rate.

New HIV/AIDS cases declined between 2006 and 2010 by 50% but remain significantly higher than the State.

132

Essex County Health Issues identified by Secondary Data

• • • • •

Health Care Access

Lack of Primary Care Physicians 

Essex County has significantly fewer primary care physicians (99.7/100,000) than the national benchmark (158.5/100,000).

19.1% of adults 18-64 report being without insurance coverage.

Essex County ranks third statewide in ED utilization Adult ED visits for primary Care conditions in Essex County were significantly higher than statewide.

ACSC visits among children and adults significantly higher than statewide.

 

Top 5 ACSC among children – ENT, asthma, GI obstruction, cellulites, and bacterial pneumonia Top 5 ACSC conditions among adults ENT, asthma, cellulites, kidney/UTI, dental conditions.

133

Essex County Health Issues identified by Secondary Data

• • •

Physical Environment

Air Quality

 Number of unhealthy air quality days for fine particulate matter and ozone significantly higher than CHR benchmark.

Lead Paint Hazard

 Aging infrastructure poses lead-based paint hazard.

 The percentage of Essex County children with high and very high blood lead levels significantly higher than statewide

.

Ready access to Fast Food and liquor – limited access to Recreation.



53% of all restaurants fast food benchmarks 25%



High concentration of liquor stores.



Less recreational facilities than statewide.

134

Essex County Health Issues identified by Secondary Data

• • •

Social and Economic Factors

Low income, high poverty and unemployment compared to state.



Essex County has significantly higher percentage of SNAP residents than the state.

The percentage of Newark families receiving various types of public assistance is two times the national average and three times that of New Jersey.

Education and Health Literacy 

16.5% of Essex County Residents did not complete high school.



East Orange, Irvington, and Newark report 1.5 to two times the county level.



Increasing number of residents with limited English Proficiency.

135

Essex County Health Issues identified by Secondary Data

• • •

Violence & Injury Prevention

Safety is a major concern, violent crime rate are two times the state rate ten times the national benchmark.

Homicide rates three times the state rate.

Rate of Children under DYFS supervision is significantly higher that the statewide average.

136