1 central massachusetts regional health dialogue massachusetts department of public health may 30,...

1

Central Massachusetts Regional Health Dialogue

Massachusetts Department of Public Health

May 30, 2007

2

Goals for holding regional dialogues

• Introduce new DPH leadership

• Present latest health data on your particular region

• Talk with residents and providers about data and identify areas of need

• Gather feedback to inform process of setting DPH priorities

3

Goals of New DPH leadership

• Use data and community input to set new priorities & reshape the Department

• Rely on science and evidence-based process to guide the work

• Strengthen ties with and support for local health and local agencies

• Increase resources to and visibility of public health in Massachusetts

4

Timetable

• Hold 8 regional dialogues with comprehensive data review and identification of key health concerns (by July)

• Identify short list of top priorities by end of August

• Hold second round of community dialogues to discuss action plans/results by end of calendar year

5

Socio-Demographic Indicators and Health Care Access

6

WesternRegion Central

Region

SoutheastRegion

Metro WestRegion

NortheastRegion

BostonRegion

Executive Office of Healthand Human Services Regions

Western Region

Central Region

North East Region

Metro West Region

South East Region

Boston Region

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

7

A few comments about the limitations of this presentation

• A regional analysis has its drawbacks• Variability within a region – urban vs.

rural/suburban (i.e. Worcester vs. the rest of the region)

• Variability by sub-population – race matters, poverty matters

• Our data don’t reflect all the important health indicators

8

BARRE

SUTTON

DOUGLAS

RUTLAND

HARDWICK

ASHBY

BRIMFIELD

STERLING

WARREN

UPTON

PRINCETON

STURBRIDGE

ASHBURNHAMTOWNSEND

HARVARD

HUBBARDSTON

TEMPLETON

WESTMINSTER

BOLTON

OAKHAM

LANCASTER

WALES

MENDON

PAXTON

SHIRLEY

BERLIN

BOYLSTON

AYER

NEW BRAINTREE

HOLLAND

BROOKFIELD

WEST BROOKFIELDNORTH BROOKFIELD

BLACKSTONE

WEST BOYLSTON

EAST BROOKFIELD

MILLVILLE

HOPEDALE

HOLDEN

CHARLTON

GROTON

SPENCER

OXFORD

WINCHENDON

WORCESTER

UXBRIDGE

FRANKLIN

DUDLEY

FITCHBURG

GRAFTON

GARDNER

LEOMINSTER

LEICESTER

LUNENBURG

PEPPERELL

AUBURN

MILFORD

MILLBURY

WEBSTER

MEDWAY

SHREWSBURY

BELLINGHAMSOUTHBRIDGE

NORTHBRIDGE

CLINTON

!.

Population > 10,000

Population in Towns in Central Region: 2005

SmallestNew Braintree: 1,090

LargestWorcester:179,839


9

Race and Ethnic Breakdown of PopulationCentral Region and Massachusetts: 2005

Central Region Massachusetts

White*

86.0%

Black*

3.2%

Hispanic

7.3%

Asian*

3.3%

* Non-Hispanics

White*

81.0%

Black*

6.0%

Hispanic

7.9%

Asian*

4.9%


American Indian*

0.3%

American Indian*

0.2%

Population Total = 844,700 Population Total = 6,436,940

10

Black*6.0%

Hispanic7.9%

Asian*4.9%

White*81.0%

American Indian*0.2%

Race and Ethnic Breakdown of PopulationWorcester and Massachusetts: 2005

Black*, 8.6

Hispanic, 17.4

Asian*, 7.0

White* 66.7

American Indian*,

0.4

Worcester

* Non-Hispanics


Massachusetts

Population Total = 6,436,940Population Total = 179,839

11

WORCESTER 13%

FITCHBURG 13%

SOUTHBRIDGE 17%

HARVARD 7%

LANCASTER 8%

LEOMINSTER 10%

SHIRLEY 8%

WEST BOYLSTON 6%

CLINTON 10%

Spanish LanguageSpoken at Home (%)

Cities/Towns in Central Region

10.0% - 55.3%

5.0% - 9.9%

0.2% - 4.9%

Central Region

5

Miles

Spanish Spoken at Home

Central Region: 2000


9.9%

9.9%

12

Socio-Demographic IndicatorsCentral Region and Massachusetts: 2000

Worcester Central Region

Massachusetts Overall

US Overall

Per Capita Income

$18,614 $22,775 $25,952 $21,587

Those living below 100% poverty

17.9% 8.8% 9.3% 12.4%

Children < 18 living below 100% poverty

25.5% 11.2% 12.0% 16.1%

Less than a High School Education

23.3% 16.2% 15.2% 19.6%

Foreign born

14.5% 7.4% 12.2% 11.1%

Unemployed

6.9% 5.4% 5.1% 5.5%


13

$17,256

$18,514

$18,614

$22,775

$25,952

$27,849

$27,971

$31,570

$0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000

Fitchburg

Southbridge

Worcester

Central

Massachusetts

Franklin

Holden

Shrewsbury

Highest and Lowest Per Capita Income Communities1 in Central Region: 2000

High

Low

1 Selected among communities with at least 10,000 population


14

Birth Indicators

A major concern with infant deaths

15

4.4

18.9

10.6

5.64.1

3.04.9

7.0

11.2

02468

101214161820

White non-Hispanic

Black non-Hispanic

Hispanic Asian Overall

De

ath

s p

er

10

00

liv

e b

irth

s

Central Region

Massachusetts

NA

Infant Mortality Rates by Race/Ethnicity Central Region and Massachusetts: 2003-2005

NA= Calculations based on less than 5 events are excluded


* Statistically different from state (p ≤.05)

16

Highest Infant Mortality RatesAmong the 30 Largest Communities1

Massachusetts: 2005

1Selected among the 30 Massachusetts communities with the largest populations. IMR = infant deaths per 1,000 live births. 2A Confidence Interval for a population parameter is a range in which you are 95% certain that the true population estimate is within. It is a function of variability and the number of events.

IMR 95% CI2 Number of Deaths

State 5.1 [4.6, 5.6] 391

Worcester 13.9* [9.4,18.4] 36

Malden 11.4 [4.0, 18.7] 9Revere 10.9 [2.9, 18.9] 7Springfield 10.6* [6.4, 14.7] 25

New Bedford 8.6 [3.8, 13.5] 12


Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

17

Infant Mortality Rate (IMR)Worcester: 1990-2005

7.07.7

13.9*

7.6

4.5

5.1

0

2

4

6

8

10

12

14

16

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Infa

nt

Dea

ths

per

100

0 in

fan

t b

irth

s

Worcester

Central MA, without Worcester

MA


Rate = infant deaths per 1,000 live births

* Statistically higher than state (p ≤.05)

18

Leading Causes of Death

19Leading Causes of DeathCentral Region and Massachusetts:2005


MassachusettsN=53,776

Heart Disease

13,248 24.6%

Cancer

13,159 24.5%

Stroke 2,979 5.5%

All Injuries 2,657 4.9%

Chronic Lower Respiratory Disease (formerly COPD)

2,643 4.9%

Influenza and pneumonia 1,932 3.6%

Alzheimer's 1,635 3.0%

Nephritis 1,403 2.6%

Diabetes 1,271 2.4%

Septicemia

982 1.8%

Central RegionN=6,954

Heart Disease 1,753 25.2%

Cancer 1,644 23.6%

Stroke

405 5.8%

Chronic Lower Respiratory Disease (formerly COPD)

399 5.7%*

All Injuries 329 4.7%

Influenza and pneumonia

263 3.8%

Alzheimer's

204 2.9%

Diabetes

185 2.7%

Nephritis

148 2.1%**

Septicemia

108 1.6%

20

Chronic Disease Outcomes and Overweight/Obesity

21

Adults who are Overweight1 by EOHHS Region, Massachusetts: 1995 & 2005

57.8

45.1

35.7

50.244.643.545.7

49.5

56.152.6

55.960.8

57.552.0

0

10

20

30

40

50

60

70

Western Central Northeast MetroWest

Southeast Boston MA

Per

cen

t

1995 2005

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), Health Survey Program

1 Overweight: BMI greater than or equal to 25


22Heart Disease Mortality Ratesby EOHHS Region

Massachusetts: 2003-2005

182.5195.1

159.8

186.3188.8 196.8177.9

0

100

200

300


Southeast Boston MA

De

ath

s

pe

r 1

00

,00

0

Age-adjusted to the 2000 US standard population. Source: Hospital Discharge Dataset System, Massachusetts Division of Health Care Finance and Policy

*

**

*


23Heart Disease Death Rate by Race/EthnicityCentral Region and Massachusetts: 2003-2005

209.4

184.7198.3

186.2

152.2

103.7

68.476.7

0

50

100

150

200

250


De

ath

s p

er

10

0,0

00

pe

rso

ns

White non-Hispanic Black non-HispanicHispanic Asian non-Hispanic

Age-adjusted to the 2000 US standard population.

Source: Preliminary 2005 MA Death file, Registry of Vital Records MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

*


*

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Prevalence of Diabetes Massachusetts: 1994-2005

3.8

5.6

6.46.2

5.8

5.6

5.8

4.9

4.3

4.7

3.8

0

1

2

3

4

5

6

7

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Per

cen

t


25Diabetes Mortality Rates by EOHHS Region

Massachusetts: 2003-2005

18.2 18.415.1

17.420.3

22.6 21.9

0

10

20

30

40

50


Southeast Boston MA

De

ath

s

pe

r 1

00

,00

0

Age-adjusted to the 2000 US standard population.

Source: Preliminary 2005 MA Death file, Registry of Vital Records MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

*

**

*


26Diabetes Death Rate by Race/EthnicityCentral Region and Massachusetts: 2003-2005

17

37 39

49

29

37

14

22

0

10

20

30

40

50

60


De

ath

s p

er

10

0,0

00

White non-Hispanic Black non-Hispanic

Hispanic Asian non-Hispanic

Age-adjusted to the 2000 US standard population. Source: Preliminary 2005 MA Death file, Registry of Vital Records MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program


*

27

Cancer

28

Indicator

MA

Total Western

Central

North East

Metro West

South East

Boston

Prostate Cancer 181.9 170.3 159.7 180.5 178.4 202.5 191.3

Female Breast Cancer

138.9 135.3 127.8 139.8 146.7 139.6 134.9

Colorectal Cancer 58.9 56.2 55.2 61.8 57.2 59.7 63.6

Lung Cancer 72.0 67.2 69.9 76.7 65.1 77.5 77.7

Total Cancer 517.0 485.6 478.2 529.4 509.9 543.1 545.1

Summary Cancer Incidence Ratesby EOHHS Region, Massachusetts: 1999-2003

Source: Cancer Registry MDPH, Health Information, Statistics, Research and Evaluation Bureau, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

29

Indicator MA

Total Western

Central North

East Metro West

South East

Boston

% Men†

PSA (2004)56.1 49.1 52.3 52.3 62.5 56.3 66.2

% Men†

DRE (2004)62.7 59.5 60.0 63.0 64.5 62.6 69.0

% Blood Stool Test † 30.0 34.2 29.9 33.5 30.9 26.4 20.7

% Adults Sigmoidoscopy or

Colonoscopy†

58.8 53.9 60.2 53.2 68.5 55 58.9

% Women Clinical Breast Exam (2004)

86.6 85.0 85.5 90.0 87.1 85.6 85.7

% Women* Mammography 35.7 34.2 35.9 34.5 38.4 36.5 31.2

Summary Indicators for Cancer Screening by EOHHS Regions, Massachusetts: 2005

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

*40 years and older, † 50 years and older

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

30

Adults who Currently Smoke by EOHHS Region, Massachusetts: 2005

20.418.1

12.4

18.318.821.2

19.5

0

5

10

15

20

25

30


Southeast Boston MA

Per

cen

t


**

Statistically different from state (p ≤.05)– Red (*) Statistically worse than state, Green (**) statistically better than state

31

Percent of Mothers Smoking During Pregnancy for Largest Communities

Central Region: 2005 % Smokers Births

Massachusetts 7.2% 5,555 76,653Central Region 7.6% 797 10,512

LowestShrewsbury 1.6%** 7 429Grafton 2.7%** 7 260Holden 3.5%** 6 171

HighestGardner 22.9%* 54 236Southbridge 14.2%* 34 240Fitchburg 12.8%* 73 571



32

Substance Abuse

33

Adults who Used Illicit Drugs in Past Month by EOHHS Region, Massachusetts: 2005

8.1 8.17.07.2

13.9

7.25.3

0

5

10

15

20

25

30


Southeast Boston MA

Per

cen

t


Statistically different from state (p ≤.05)– *Red: Statistically worse than state- **green: statistically better than state

34Opioid-Related Emergency Department Visit Rate

by Race/EthnicityCentral Region and Massachusetts: 2003-2005

187196 188

237

2910

150

239

140

302

422

0

50

100

150

200

250

300

350

400

450

Worcester Central, no Worcester Massachusetts

Vis

its

per

100

,000



Age-adjusted to the 2000 US standard population. Source: MDPH, Bureau of Substance Abuse Services, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

*


**

** **

35

Injury/Violence

36

Causes of Injury Deaths Central Region and Massachusetts: 2005

Central Region Total Injuries = 329


Massachusetts Total Injuries = 2,657

Poisonings 30%

Firearm 8%

Falls 11%

Suffocation, Hanging, or Strangulation

13%

Motor Vehicle-related

18%

Other20%

Poisonings 28%

Firearm 7%

Suffocation, Hanging, or Strangulation

13%

Motor Vehicle-related

20%

Falls 11%

Other21%

37

Hospital Discharge Rates for Motor Vehicle-related Injuries

by EOHHS Region and Massachusetts: 2003-2005

73 74 77

88 *

57 **

91 *93 *

0

20

40

60

80

100


Southeast Boston MA

Dis

char

ges

per

100

,000

Age-adjusted to the 2000 US standard population. Source: Hospital Discharge Dataset System, Massachusetts Division of Health Care Finance and Policy


38

Hospitalization Rates for Fall-Related Injuries Ages 65+ by EOHHS Region Massachusetts: 2003-2005

2,024

2,3332,254 2,311 2,275

2,146**

2,443*

0

500

1000

1500

2000

2500

3000

Western Central Northeast Metro West Southeast Boston MassachusettsTotal

Ho

spit

al D

isch

arg

es p

er 1

00,0

00



39

Infectious Diseases

40

HIV/AIDS Death Rate by Race/EthnicityWorcester & Central Region vs. Massachusetts: 2003-2005

2

24

2016

13

0 0 11

4

10

39

0

5

10

15

20

25

30

35

40

45

Worcester Central, no Worcester Massachusetts

Dea

ths

per

100

,000

White non-Hispanic Black non-HispanicHispanic Asian non-Hispanic

*

Statistically different from state (p ≤.05)–Red (*) Statistically worse than state, Green (**) statistically better than state

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

***

41

Indicator

MA

Total Western

Central

North East

Metro West

South East

Boston

Chlamydia Incidence (crude rates, 2005)

225.7 369.4 145.4 178.0 106.1 169.7 588.5

Gonorrhea Incidence (crude rates, 2005)

39.6 55.9 16.6 22.4 20.3 35.4 126.2

Syphilis Incidence (crude rates, 2005)

6.3 3.1 1.7 4.9 4.7 2.7 22.7

Tuberculosis Incidence (crude rates, 2004)

4.4 1.9 4.2 4.8 4.3 2.0 11.4

Lyme Disease Incidence (crude rates, 2004)

24.7 27.3 19.7 18.4 21.2 48.4 4.0

Hep C Incidence Infection (crude rates, 2006)

114.0 95.0 123.0 92.0 49.0 82.0 150.0

Pneumonia/ Influenza Hospital Discharges

(age-adjusted, 2005)377.0 346.0 392.7 384.4 341.5 406.7 415.8

Summary Infectious Disease Indicators by EOHHS Regions

Source: MDPH, Center for Health Information, Statistics, Research & Evaluation, Research & Epidemiology Program

Best Outcome (significantly different from state) Worse Outcome (significantly different from state)

42

Asthma Indicators

43Pediatric Asthma Prevalence Among School Children, Grades K-8

by EOHHS Region, Massachusetts: 2005-2006

10.5 10.69.4

10.1

12.7

9.8

13.0

0

5

10

15

20


Southeast Boston MA

Pe

rce

nt

Source: MDPH, Environmental Health Bureau , Pediatric Asthma Surveillance (2005-2006)

**

** ****


44Asthma Emergency Department Visit Rates Children Ages 0-14

Central Region and Massachusetts: 2005

2,096

438608 516

1,606

2,048

1,573

356

0

500

1,000

1,500

2,000

2,500


Vis

its

per

100

,000



**

*

Source: Division of Health Care Finance and Policy. Calendar Year 2005. Emergency Visits


*

45

WORCESTER2350.5

SOUTHBRIDGE3614.8

CLINTON1897.1

Pediatric Asthma Emergency Visit Rates by Towns*Among Chilldren Ages <5

Central Region - Massachusetts 2004-2005

Emergency Visit Rates by Townsper 100,000

Significantly higher than state rate

Not different from state rate

Significantly lower than state rate

*Towns with less than 5 cases in the period were excluded.

Massachusetts State Total Rate: 1,136.2

Source: Division of Health Care Finance and Policy. Calendar Year 2004-2005. Emergency Visits

46

Key Health Observations in Central Massachusetts

• Racial and Ethnic disparities are major factors - Latinos and Blacks health disparities across several indicators are a major concern

• Overweight/obesity is an increasing health risk - contributes to rising diabetes incidence

• The region’s residents are disproportionately affected by:– Infant mortality rates– Smoking rates – AIDS/HIV and Hep C– Heroin/opioid related incidents/deaths– Motor vehicle injuries

47

How Can You Access these Data?

• Hard Copies: (617) 624-5674

• Data Questions: (617) 624-5640

• TDD/TTY: (617) 624-6001

• DPH Website:

mass.gov/dph/bhsre/resep/resep.htm

48

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