1 southeast massachusetts regional health dialogue massachusetts department of public health june 7,...

1

Southeast Massachusetts Regional Health Dialogue

Massachusetts Department of Public Health

June 7, 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

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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 & Evaluation Bureau, Research & Epidemiology Program

Executive Office of Health and Human Services (EOHHS) Regions

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. Cape 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

FREETOWNROCHESTER

TRURO

DIGHTON

EDGARTOWN

HALIFAX

CHILMARK

HANSON

BERKLEY

WEST TISBURY

MARION

WELLFLEET

ORLEANS

EASTHAM

PLYMPTON

CHATHAM

MATTAPOISETT

AVON

TISBURY

GOSNOLD

WEST BRIDGEWATER

PROVINCETOWN

OAK BLUFFS

GAY HEAD (AQUINNAH)

PLYMOUTH

TAUNTON

CARVER

BARNSTABLE

FALMOUTH

SANDWICH

NANTUCKET

WAREHAM

EASTON

FALL RIVER

LAKEVILLE

NORTON

SWANSEA

ATTLEBORO

BREWSTER

DARTMOUTHWESTPORT

REHOBOTH

MIDDLEBOROUGH

BOURNEDENNIS

MASHPEE

HARWICH

DUXBURY

YARMOUTH

MARSHFIELD

RAYNHAM

PEMBROKE

BRIDGEWATER

SEEKONK

BROCKTON

KINGSTON

MANSFIELD

ACUSHNET

HANOVER

NEW BEDFORD

STOUGHTON

FAIRHAVEN

ABINGTONROCKLAND

EAST BRIDGEWATER

NORTH ATTLEBOROUGH

SOMERSET

WHITMAN

HOLBROOK

2005 Population by Communities Southeast Region: 2005

SmallestGosnold: 86

LargestBrockton:100,366


Population > 10,000

9

Race and Ethnic Breakdown of PopulationSoutheast Region and Massachusetts: 2005

Southeast Region Massachusetts

White*

89.5%

Black*

5.2%

Hispanic

3.4%

Asian*

1.5%

* Non-Hispanics

White*

81.0%

Black*

6.0%

Hispanic

7.9%

Asian*

4.9%


American Indian*

0.3%

American Indian*

0.2%

Population Total = 1,278,245 Population Total = 6,436,940

10

Race/Ethnicity Proportions in the Largest Cities Southeast: 2005

Brockton Fall River New Bedford

56.4 77.331.1

13.44.3

8.8

4.3 0.23.3

7.5

0.4 0.63.1

88.1

1.1


White Non-Hispanic Hispanic Asian Non-HispanicBlack Non-HispanicNative American Non-Hispanic

11

Language Spoken at Home,Southeast Region and Massachusetts: 2000

Southeast

Region Massachusetts

Overall

Only English 85.4 81.3

Spanish or Spanish Creole 2.5 6.2 Portuguese or Portuguese Creole 7.4 2.7 French 1.3 1.4 Chinese 0.2 1.2 Italian 0.4 1.0 French Creole 0.7 0.7 Russian 0.1 0.6

Vietnamese 0.1 0.5

Polish 0.2 0.5

Other languages 1.7 3.9


12

Socio-Demographic IndicatorsSoutheast Region and Largest Cities: 2000

Brockton Fall

River New

Bedford

Southeast w/o 3 Largest

Cities MA

Per Capita Income $17,163 $16,118 $15,602 $24,695 $25,952

Persons living below 100% poverty

14.5% 17.1% 20.2% 5.6% 9.3%

Children < 18 living below 100% poverty

19.4% 25.4% 29.0% 6.2% 12.0%

Less than a High School Education

24.1% 43.4% 42.4% 12.8% 15.2%

Foreign born 18.4% 19.8% 19.6% 9.0% 12.2%

Speak language other than English at home

28.4% 34.6% 37.8% 5.6% 18.7%

Unemployed 6.7% 8.1% 8.4% 2.9% 5.1%


13

Birth Indicators

14Infant Mortality Rate Southeast, Largest Cities, & Massachusetts

2002-2005

4.8

3.9

7.07.1

6.2

4.9

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

Brockton Fall River New Bedford Southeastw/o 3 Cities

Southeast MA

Infa

nt

De

ath

s

pe

r 1

,00

0 L

ive

Bir

ths


Infant Mortality Rate: deaths of infants less than one year of age per 1000 live births

Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better

**

15

Infant Mortality Rate by Race/EthnicitySoutheast Region and Massachusetts: 2002-2005


6.6

4.8

11.2

7.0

3.0

4.94.2

10.5

4.1

0.0

2.0

4.0

6.0

8.0

10.0

12.0

White Non-Hispanic

Black Non-Hispanic

Hispanic Asian Non-Hispanic

Overall

De

ath

s p

er

10

00

liv

e b

irth

s


NA


16

Indicator MA

Total (n=76,824)

Brockton (n=1,541)

Fall River (n=1,196)

New Bedford (n=1,391)

Southeast (n=14,681)

Adequate Prenatal Care (Kotelchuck index)

84.0 74.6 85.7 77.4 83.6

Cesareans 32.3 36.7 34.4 27.7 34.6

Low Birth Weight (<5.5 lb)

7.9 11.5 7.9 10.6 8.3

Breastfeeding 79.3 77.3 44.7 54.5 71.5

Public Pay for Prenatal Care 32.6 60.8 61.9 59.1 34.7

Smoking during pregnancy 7.1 10.2 18.4 16.1 10.2

Summary Birth Indicators Largest Communities, Southeast, Massachusetts: 2005


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

17

Teen Birth Rate Largest Communities, Southeast, Massachusetts: 2005



Indicator MA

Total Brockton Fall River

New Bedford

Southeast

Teen birth rate (2005) (births to women ages 15-19 per 1000 women

ages 15-19)

21.7 40.7 49.5 58.9 23.1

18

Leading Causes of Death

19Leading Causes of Death

Southeast 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%

Southeast RegionN=11,675

Heart Disease 3,023 25.9%*

Cancer 2,766 23.7%

Stroke 647 5.5%

All Injuries 614 5.3%

Chronic Lower Respiratory Disease (formerly COPD) 586 5.0%

Influenza and pneumonia

437 3.7%

Alzheimer's 387 3.3%

Nephritis 290 2.5%

Diabetes 258 2.2%

Septicemia 202 1.7%Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better

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Chronic Disease Outcomes and Overweight/Obesity

21

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

57.8

45.1

35.7

50.244.643.545.7

49.5

56.152.655.9

60.857.5

52.0

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 Obesity: BMI greater than or equal to 25


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Adults who are Obese Southeast, Cities, Cape, and Massachusetts: 2006

15.9

25.6

20.2 20.3

26.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Cape &Islands

Fall River New Bedford SoutheastRegion

MA

Per

cen

t

*

Obesity: BMI greater than or equal to 30



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Heart Disease Mortality RatesSoutheast, Cities, and Massachusetts: 2003-2005

187.2 182.5195.1

230.2217.5

228.6

0.0

50.0

100.0

150.0

200.0

250.0

Brockton Fall River NewBedford

SE: wo TopCities

Southeast MA

Ag

e-A

dju

ste

d R

ate

pe

r 1

00

,00

0

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


* * *

*

24Heart Disease Death Rate by Race/Ethnicity

Southeast Region and Massachusetts: 2003-2005

184.7209.4

98.3 103.7115.1

68.4

194.1

286.3

0

50

100

150

200

250

300

350


De

ath

s

pe

r 1

00

,00

0

White non-Hispanic Black non-Hispanic

Hispanic Asian non-Hispanic


*


*

25

Prevalence of Diabetes Massachusetts: 1995-2005

3.8

5.6

6.4

5.6

5.8

3.8

0

2

4

6

8

10

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Per

cen

t


26

Diabetes Mortality RatesSoutheast, Cities, and Massachusetts:

2003-2005

23.8

18.2 18.416.5

26.324.9

0.0

10.0

20.0

30.0

40.0

50.0

Brockton Fall River NewBedford

SE w/oTop Cities

Southeast MA

De

ath

s

pe

r 1

00

,00

0

* *

**



27

Diabetes Hospital Discharge Rate by Race/Ethnicity

Southeast Region Massachusetts: 2003-2005

367.7

120.1 114.3

315.7

242.0215.4

46.3 45.2

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0


Dis

ch

arg

es

pe

r 1

00

,00

0

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

Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database

**

Statistically different from State (p ≤.05) Red (*) = Statistically higher; Green (**) = Statistically lower

*

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Cancer

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Percent of Mothers Smoking During Pregnancy for Largest Communities Southeast Region: 2005

% Smokers Births

Massachusetts 7.2% 5,55576,653Southeast Region 10.2%* 1,486 14,681

LowestMarshfield 2.4%** 8 290Easton 3.0%** 6 205Stoughton 4.6%** 13 283

HighestWareham 19.7%* 50 254Fall River 18.4%* 220 1,196Taunton 17.1%* 126 737New Bedford 16.1%* 224 1,391



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Adults who Currently Smoke by EOHHS Region, Massachusetts: 2005

18.821.2

18.320.4 19.5 18.1

12.4

0.0

10.0

20.0

30.0

40.0

50.0


Southeast Boston MA

Pe

rce

nt

**



31

Indicator(age-adjusted per

100,000)

MA

Total Western

Central

North East

Metro West

Southeast 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: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

32

Substance Abuse

33

Indicator

(Crude Rates per 100,000)

MA

Total Brockton

Fall River

New Bedford

Southeast

Substance Abuse Treatment Program

Admissions Rate1,601 2,551.6 3,426.1 3,057.1 1,724


Admissions Rate--Alcohol661 1,142.8 1,239.7 1,071.9 821

Substance Abuse Treatment Program Admissions Rate—

Cocaine

62 121.5 183.5 208.5 88


Admissions Rate—Heroin609 792.1 1,406.9 1,297.3 504

Summary Substance Abuse Indicators Largest Communities in the Southeast Region: 2005

Statistically lower than state Statistically higher than state

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Indicator (age-adjusted rate per

100,000)

MA

Total Brockton Fall River

New Bedford

Southeast

Opioid-related Emergency Department Visit Rate

181 272 450 283 196

Opioid-related fatal overdose

rate8.1 10.9 24.6 27.1 10.1

Summary Opioid Indicators Largest Communities Southeast Massachusetts: 2003-2005

Statistically lower than state Statistically higher than state

35

Injury and Violence

36 Motor Vehicle-Related Death Rates by EOHHS Region

Massachusetts: 2003-2005

10.7

7.7

5.46.4

10.2 9.8

4.6

0

5

10

15

20

Western Central Northeast Metro West Southeast Boston MA

Dea

ths

per

100

,000

po

pu

lati

on

**


* *

**

*

**


37 Emergency Department Visit Rates for Fall-Related Injuries by EOHHS Region

Massachusetts: 2003-2005

3,191

2,750

2,410

2,7132,913 2,860

2,511

0

500

1,000

1,500

2,000

2,500

3,000

3,500


Southeast Boston MA

Vis

its

pe

r 1

00

,00

0

**

*

***

Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Department Visits

***


38

Firearm Death Rates in Selected Communities Southeast and Massachusetts: 2003-2005

3.13.4 3.2

8.58.0

0.0

2.0

4.0

6.0

8.0

10.0

Brockton Fall River New Bedford SoutheastRegion

Massachusetts

De

ath

s

pe

r 1

00

,00

0 p

op

ula

tio

n



**

39

Infectious Diseases

40

Indicator

MA

Total BrocktonFall

RiverNew

Bedford

Southeast

Persons living with HIV (2005) (Crude rates

per 100,000)247.1 336.8 226.9 483.6 170.9

HIV Incidence (2005) (Crude rates per 100,000)

12.6 20.9 5.4 15.9 7.7

Persons living with AIDS (2005) (Crude rates

per 100,000)133.2 194.3 123.8 285.7 95.2

AIDS Incidence (2005) (Crude rates per 100,000)

8.0 12.9 5.4 21.2 6.3

HIV/AIDS Mortality (2003-2005) (Age-

Adjusted per 100,000)3.1 6.7 5.5 10.7 2.5

Summary HIV/AIDS Indicators Selected Communities, Southeast Region

and Massachusetts


41

Lyme Disease Incidence by EOHHS Region Massachusetts: 2004

24.7

48.5

21.218.4

27.3

19.7

4.0

0

10

20

30

40

50

60


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

op

ula

tio

n

*

**


****

Source: MDPH Bureau of Communicable Disease Control, ISIS

42

Lyme Disease Incidence Southeast, Cape & Islands, and Massachusetts: 2004

30.924.7

48.5

119.5

0

20

40

60

80

100

120

140

Cape & Islands SE (not inc. Cape) Southeast All MA

Cas

es p

er 1

00,0

00 p

op

ula

tio

n


Source: MDPH Bureau of Communicable Disease Control, ISIS

*

*

43

Indicator

MA

Total BrocktonFall

RiverNew

BedfordSoutheast

Chlamydia Incidence (crude rates, 2005)

225.7 448.4 304.1 315.3 169.7

Gonorrhea Incidence (crude rates, 2005)

39.6 70.7 86.8 46.6 35.4

Pneumonia/ Influenza Hospital Discharges

(age-adjusted, 2005)377.0 654.1 574.7 549.5 406.7

Summary Infectious Disease Indicators Selected Communities, Southeast Region

and Massachusetts


44

Asthma

45Asthma ER Visits (All Ages)Southeast, Largest Cities, and

Massachusetts: 2005

1,235.4

3,636.6

1,647.5

1,175.91,006.5

0.0

500.0

1000.0

1500.0

2000.0

2500.0

3000.0

3500.0

4000.0

Brockton Fall River New Bedford SoutheastTotal

MA

Ag

e-A

dju

sted

Vis

its

per

100

,000

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

Statistically different from State (p ≤.05) Red (*) = Statistically higher; Green (**) = Statistically lower

*

**

*

46

BOURNE1709.6

FALL RIVER1476.1

BROCKTON1649

STOUGHTON1646.5

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

South East 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 Department Visits

Pediatric (Ages < 5) Asthma ER Visit Rates by Community, Southeast Region: 2004-2005

*

47

Summary

• Residents of larger communities like Brockton, Fall River, and New Bedford have poorer socio-economic and health outcomes than the state does, for example:– Brockton, Fall River, and New Bedford have poorer birth outcomes and

much higher teen birth rates.

– Fall River has a higher obesity percentage.

– Heart disease and diabetes mortality rates are higher for Brockton, Fall River, and New Bedford.

– Admission rates to substance abuse treatment rates are higher for Brockton, Fall River, and New Bedford.

– Firearm death rates and HIV mortality are higher for Brockton and New Bedford.

– Asthma ER rates and high STD incidences in the Southeast and the top three cities are higher than those of the state.

– Smoking during pregnancy is higher in Fall River, New Bedford, and Taunton.

48

• Blacks– Heart disease mortality– IMR

• Hispanics– IMR– Teen birth rate– Smoking during pregnancy

• Whites– Smoking during pregnancy– Hypertension & Heart disease – Diabetes– Motor vehicle-related deaths

Health Disparities by Race/Ethnicity Southeast Region

49

Summary-Cape & Islands• Socio-demographics difference impact health status

– Older population – Socio-demographic indicators are better than the State – Mostly white non-Hispanics– Majority speak only English

• In general, the Cape & Islands is a relatively healthy place to live:– Birth indicators are better than the State– Heart disease and diabetes mortality are low– Homicides, firearm, STDs lower than the State

• Some indicators are worse than the State :– Cancer incidence is higher for breast and prostate cancer – Higher motor vehicle deaths and suicides than the State– Higher Lyme Disease incidence than the State– Higher Emergency Department Visit rates for opioid-related and for asthma for

children ages 10-14 years– Higher Substance Abuse Treatment Program Admission rates than State

• We need to examine local variation and subgroups in the population to get a more complete picture of the health of the Cape & Islands region

• These are resident data and do not reflect the impact of visitors on the Cape & Islands

50

How Can You Access these Data?

• Hard Copies: (617) 624-5674

• TDD/TTY: (617) 624-6001

• Questions: (617) 624-6021

[email protected]

• For more detailed community data:http://masschip.state.ma.us

• DPH Website: http://www.mass.gov/dph/comm/health_dialogues.htm

51

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