chronic disease in missouri: progress and challenges shumei yun, md, phd public health...
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Chronic Disease in Missouri: Progress and Challenges
Shumei Yun, MD, PhDPublic Health Epidemiologist and Team LeaderChronic Disease and Nutritional Epidemiology Team Section of Epidemiology for Public Health PracticesJuly 12, 2012
Acknowledgement
• Chronic Disease and Nutritional Epidemiology Team (CDNET) members– Jiaqing Li, MD, PhD– Noaman Kayani, PhD– Dave McBride, PhD– Arthur Pashi, PhD– Janet Wilson, MEd, MPA – Sherri Homan, RN, FNP, PhD
Acronyms List• AA – African-American • BRFSS - Behavioral Risk Factor Surveillance System• CDC – Centers for Disease Control and Prevention• CLS – Missouri 2007 County-level Study • DHSS - Missouri Department of Health and Senior Services• F & V <5 - Fruit and vegetable consumption less than 5 times per day • HP2020 - Healthy People 2020 Objective • HS - High School• Low SES – Low Socioeconomic Status• MICA - Missouri Information for Community Assessment • MO – State of Missouri • PedNSS - Missouri Pediatric Nutrition Surveillance System• US – United States of America• WONDER – Wide-ranging Online Data for Epidemiological Research• YRBS - Youth Risk Behavior Survey• YTS - Youth Tobacco Survey
Chronic Diseases in the US• Almost 1 out of every 2 adults has at least one
chronic illness.
• Chronic diseases are the number one cause of death and disability in the US.
• Treating patients with chronic diseases accounts for 75 percent of the nation’s health care spending.
Chronic Diseases in the US• Chronic diseases share major risk factors beyond
genetics and social inequalities:– Tobacco use – Unhealthy diet– Physical inactivity – Heavy drinking– Lack of access to preventive care
• The vast majority of cases of chronic disease could be better prevented or managed.
• Some populations have a greater burden of chronic disease than others.
Leading Causes of DeathMissouri, 2009
11,9948571,2261,3261,3461,719
2,8683,0133,436
12,43513,845
0 5,000 10,000 15,000
All other causesSuicide
Kidney diseaseDiabetes
Pneumonia & influenzaAlzheimer's disease
Unintentional injuriesCerebrovascular disease (Stroke)
Chronic lower respiratory diseasesCancer
Heart disease
Number of deaths
Source: Missouri Department of Health and Senior Services, Missouri Information for Community Assessment
Heart Disease Mortality Rates*Missouri and US, 2000-2009
Source: Missouri Information for Community Assessment, CDC-WONDER *Age-adjusted using 2000 US standard population
Heart Disease Mortality Rates* By Race and Sex Missouri, 2000-2009
Source: Missouri Information for Community Assessment
*Age-adjusted using 2000 US standard population
Cerebrovascular Disease Mortality Rates* Missouri and US
Source: Missouri Information for Community Assessment, CDC-WONDER, HP2020*Age-adjusted using 2000 US standard population
Cerebrovascular Disease Mortality Rates* By Race and Sex, Missouri, 2000-2009
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Major Risk Factors for Cardiovascular Diseases
• Behaviors– Tobacco use– Unhealthy diets– Physical inactivity– Heavy drinking
• Chronic conditions/disease– Hypertension– Dyslipidemia– Obesity– Diabetes
• Lack of chronic disease management and self-management
Risk Behaviors
Current Smoking Among Adults Missouri and US
Source: Behavioral Risk Factor Surveillance System
Current Smoking among Adults By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Current Smoking Among Adults By Education Level, Missouri
Source: Behavioral Risk Factor Surveillance System
Current Smoking Among AdultsBy Insurance Status, Missouri, 2007
Source: Missouri 2007 County-Level Study
Current Smoking Among Middle School StudentsBy Race, Missouri
Source: Youth Tobacco Survey
Current Smoking Among High School Students Missouri and US
Source: Youth Risk Behavior Survey
Current Smoking Among High School Students By Race, Missouri
Source: Youth Tobacco Survey
Fruit and Vegetable Intake <5 Times Per Day Among Adults, Missouri and US
Source: Behavioral Risk Factor Surveillance System
Fruit and Vegetable Intake <5 Times Per Day Among Adults, By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
No Leisure-time Physical Activity Among Adults Missouri and US
Source: Behavioral Risk Factor Surveillance System
No Leisure-time Physical Activity Among Adults By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Did not meet CDC Physical Activity Recommendations Among Adults
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Did not meet CDC Physical Activity Recommendations Among Adults
By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Heavy Drinking Among Adults Missouri and US
Source: Behavioral Risk Factor Surveillance System
Heavy Drinking Among AdultsBy Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Chronic Conditions
Prevalence of Hypertension Among Adults Missouri and US
Source: Behavioral Risk Factor Surveillance System
Prevalence of Hypertension Among AdultsBy Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Prevalence of High Cholesterol Among Adults Missouri and US
Source: Behavioral Risk Factor Surveillance System
Prevalence of High Cholesterol Among AdultsBy Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Prevalence of Obesity Among AdultsMissouri and US
Source: Behavioral Risk Factor Surveillance System
Prevalence of Obesity Among AdultsBy Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Prevalence of Obesity* Among Children aged 2 to 5 Years Enrolled in WIC, Missouri, 2009
Prevalence of Obesity Among Middle School Students Missouri
Source: Youth Tobacco Survey
Prevalence of Obesity Among Middle School Students By Race and Sex, Missouri
Source: Youth Tobacco Survey
Prevalence of Obesity Among High School Students Missouri and US
Source: Youth Risk Behavior Survey
Prevalence of Obesity Among High School StudentsBy Race, Missouri
Source: Youth Risk Behavior Survey
Prevalence of Diabetes Among AdultsMissouri and US
Source: Behavioral Risk Factor Surveillance System
Prevalence of Diabetes Among AdultsBy Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Education, Risk Behaviors and Health Conditions Missouri, 2010
Source: Behavioral Risk Factor Surveillance System
Chronic Disease Self-management
Ever Attended a Diabetes Self-management Class Among Adults with Diabetes
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Ever Attended a Diabetes Self-management Class Among Adults with Diabetes By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Daily Self-Monitoring of Blood GlucoseAmong Adults with Diabetes
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Daily Self-Monitoring of Blood GlucoseAmong Adults with Diabetes
By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Ever Taken a Course to Learn How to Manage Arthritis or Joint Symptoms Among Adults with
Arthritis Missouri and US
Source: Behavioral Risk Factor Surveillance System
Ever Taken a Course to Learn How to Manage Arthritis or Joint Symptoms Among Adults with Arthritis
By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Current Smoking Among Adults with Chronic Disease Missouri 2008-2010
Current Smoking Among Adults with Chronic Disease/Conditions
By Insurance Status, Missouri, 2007
Source: Missouri 2007 County-Level Study
Current Smoking Among Adults with Chronic Diseases By Education Level, Missouri, 2008-2010
Source: Behavioral Risk Factor Surveillance System
Physical Inactivity Among Adults with Chronic Disease/Conditions
Missouri, 2009
Source: Behavioral Risk Factor Surveillance System
Chronic Disease Management and Care
Had 2 or More A1c Tests in the Last Year Among Adults with Diabetes
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Had 2 or more A1c Tests in the Last Year Among Adults with Diabetes
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Had a Foot Exam in the Last Year Among Adults with Diabetes
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Had a Foot Exam in the Last Year Among Adults with Diabetes
By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Had a Dilated Eye Exam in the Last Year Among Adults with Diabetes
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Had a Dilated Eye Exam in the Last YearAmong Adults with Diabetes
By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Had a Flu Shot in the Last Year Among Adults with Diabetes
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Had a Flu Shot in the Last YearAmong People with Diabetes
By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Ever Had a Pneumococcal VaccinationAmong Adults with Diabetes
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Ever Had a Pneumococcal Vaccination Among Adults with Diabetes
By Race and Sex, Missouri
Source: Behavioral Risk Factor Surveillance System
Good Job!
• Chronic disease management and self-management– Chronic disease self-management education– Self-monitor blood glucose– Foot exam– Vaccinations among people with diabetes
Cancer
• Cancer affects three out of four Missouri families.
• Cancer is the leading cause of death for individuals younger than 80 years of age and the leading cause of premature death.
• In 2010, cancer cost $263.8 billion, including $102.8 billion for direct medical costs.
• Cancer screening is very important.
Cancer
• Incidence• Mortality• Screening
All-Cancer Incidence Rates*by SexMissouri and US
Source: Missouri Information for Community Assessment, CDC-WONDER
*Age-adjusted using the 2000 US standard population
All-cancer Incidence Rates* by Race and Sex Missouri
*Age-adjusted using the 2000 US standard populationSource: Missouri Information for Community Assessment
All-cancer Mortality Rates* by Sex Missouri and US
Source: Missouri Information for Community Assessment, CDC-WONDER *Age-adjusted using 2000 US standard population
All-cancer Mortality Rates* by Race and Sex Missouri
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Lung Cancer Incidence Rates*by SexMissouri and US
Source: Missouri Information for Community Assessment, CDC-WONDER *Age-adjusted using 2000 US standard population
Lung Cancer Incidence Rates* by Race and Sex Missouri
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Lung Cancer Mortality Rates*Missouri and US
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Lung Cancer Mortality Rates*by Race and Sex Missouri
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Breast Cancer Incidence Rates* Among Women Missouri and US
Source: Missouri Information for Community Assessment, CDC-WONDER *Age-adjusted using 2000 US standard population
Breast Cancer Incidence Rates* Among Women By Race, Missouri
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Breast Cancer Mortality Rates* Among Women Missouri and US
Source: Missouri Information for Community Assessment, CDC-WONDER *Age-adjusted using 2000 US standard population
Breast Cancer Mortality Rates*by RaceMissouri
Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Had Mammogram Within the Past Two Years Among Women Age 40+
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Had Mammogram Within the Past Two Years Among Women Age 40+
By Race, Missouri
Source: Behavioral Risk Factor Surveillance System
Prostate Cancer Incidence Rates*Missouri and US
Source: Missouri Information for Community Assessment, CDC-WONDER*Age-adjusted using 2000 US standard population
Prostate Cancer Incidence Rates* by Race Missouri
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Prostate Cancer Mortality Rates*Missouri and US
Source: Missouri Information for Community Assessment, CDC-WONDER*Age-adjusted using 2000 US standard population
Prostate Mortality Rates* by Race Missouri
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Colorectal Cancer Incidence Rates* by Sex Missouri and US
Source: Missouri Information for Community Assessment, CDC-WONDER *Age-adjusted using 2000 US standard population
Colorectal Cancer Incidence Rates* By Race and Sex, Missouri
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Colorectal Cancer Mortality Rates*Missouri and US
Source: Missouri Information for Community Assessment, CDC-WONDER *Age-adjusted using 2000 US standard population
Colorectal Cancer Mortality Rates* By Race and Sex, Missouri
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Ever had a Sigmoidoscopy or Colonoscopy Among Adults Age 50+
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Ever had a Sigmoidoscopy or Colonoscopy Among Adults Age 50+ by Race and Sex
Missouri
Source: Behavioral Risk Factor Surveillance System
Cervical Cancer Incidence Rates*Missouri and US
Missouri Information for Community Assessment, CDC-WONDER*Age-adjusted using 2000 US standard population
Cervical Cancer Incidence Rates* by Race Missouri
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Cervical Cancer Mortality Rates* Missouri and US
Source: Missouri Information for Community Assessment , CDC-WONDER *Age-adjusted using 2000 US standard population
Cervical Cancer Mortality Rates* by Race Missouri
Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population
Had a Pap Test Within the Past 3 Years Among Women Age 18+
Missouri and US
Source: Behavioral Risk Factor Surveillance System
Had a Pap Test Within the Past 3 Years Among Women Age 18+ by Race
Missouri
Source: Behavioral Risk Factor Surveillance System
Similar to or Better than the US• Heavy drinking • Chronic disease management and self-management (better)
– Diabetes self-management education – Daily self-monitoring blood glucose– Having a foot exam in the last year among adults with diabetes– Flu shoot and pneumococcal vaccination among adults with diabetes
• Breast cancer screening (better)• Colorectal cancer screening • Cervical cancer screening • All-cancer incidence (better)• Breast cancer incidence • Cervical cancer incidence • Prostate cancer incidence and mortality (better)
Worse than the US
• Risk behaviors (except heavy drinking) • Disease and conditions• Cancer incidence (lung, colorectal)• A1C test and dilated eye exam among adults
with diabetes• Heart disease, cancer, and stroke mortality
Progress• Behaviors
– Current smoking prevalence among youth and adults (white men)
– Not meeting CDC physical activity recommendation (white men and women)
– Heavy drinking among AA men
– Colorectal cancer screening (white men and women)– Diabetes self-management education, especially AA women– Self-monitoring blood glucose up to 2008– Flu shot among AA men with Diabetes– Pneumococcal Vaccination among adults with diabetes,
especially AA men
Progress• Cancer Incidence
– Colorectal cancer incidence (except AA men)– Lung cancer incidence ( white and AA men) and racial disparity– Cervical cancer incidence and racial disparity– Breast cancer incidence
• Mortality– Heart disease and stroke mortality rates– All cancer mortality rates and racial disparity– Colorectal cancer mortality (white men and women) – Lung cancer mortality (white and AA men) and racial disparity– Breast cancer mortality and racial disparity– Prostate cancer mortality and racial disparity
Challenges• Smoking
– Burden– Disparity (low education, on Medicaid, no insurance,
AA men)• Physical inactivity
– Burden – Disparity (Low SES, AA)
• Inadequate fruit and vegetable consumption (healthy eating)– Burden
Challenges• Hypertension
– Burden– Trend– Disparity ( Low SES, AA)
• High cholesterol– Burden– Trend
• Obesity– Burden– Trend– Disparity (Low SES, AA)
• Diabetes – Burden– Trend– Disparity (Low SES, AA)
Challenges
• Chronic disease self-management– Smoking prevalence among people with chronic
disease/conditions (especially those who are on Medicaid, Low SES)
– Physical inactivity among people with chronic disease/conditions
– A1C test among people with diabetes– Annual dilated eye exam among people with
diabetes
Challenges• All-cancer incidence
– Disparity (white men and AA men)• Lung cancer incidence
– Burden– Disparity
• Colorectal cancer incidence– Burden– Disparity (especially among men)
• Prostate cancer incidence– Racial disparity
Challenges• All-cancer mortality
– Burden– Disparity (white and AA)
• Lung cancer mortality– Burden
• Breast cancer mortality– Burden
• Colorectal cancer mortality– Burden– Disparity
• Cervical cancer mortality– Burden and disparity
• Prostate Cancer mortality– Disparity
• Data gaps
Highlights
• Progress– Tobacco control
• Adults and youth smoking prevalence has declined
– Colorectal cancer prevention and control
• Screening increased• Incidence decreased• Mortality decreased
• Challenges– Tobacco control
• People with less than high school education
• People who are on Medicaid and who are uninsured
– Colorectal cancer prevention and control
• Incidence and mortality higher than the US
• Racial disparities
Highlights
• What Mo did well– Secondary and tertiary
prevention
• What Mo did not do well– Primary prevention
• High prevalence risk behaviors
• High prevalence chronic conditions/diseases
Highlights
Physical inactivityUnhealthy dietTobacco use
ObesityHigh cholesterolHigh blood pressureDiabetes
Heart attackStroke
Primary Prevention
Resource List• DHSS – Missouri Department of Health and Senior Services• MICA – Missouri Information for Community Assessment• CDC – Centers for Disease Control and Prevention• WONDER – Wide-ranging Online Data for Epidemiological Research• AA – African-American• HP2020 – Healthy People 2020 Objectives• BRFSS – Behavioral Risk Factor Surveillance System• CLS – Missouri 2007 County-level Study• YTS – Youth Tobacco Survey• YRBS – Youth Risk Behavior Survey• PedNSS – Missouri Pediatric Nutrition Surveillance System• HS – High School• F & V <5 – Fruit and vegetable consumption less than 5 times per day• Low SES – Low Socio-econimic Status
Thank You
Shumei Yun, MD, PhDShumei.yun@health.mo.gov
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