emily miller, fred croom, tene franklin hamilton, kimberly glenn

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  • Slide 1
  • Emily Miller, Fred Croom, Tene Franklin Hamilton, Kimberly Glenn
  • Slide 2
  • This project is intended for the Office of Minority Health and Disparities Elimination in the Tennessee Department of Health as a product of a student internship. The work will be presented to East Tennessee State University as a sign of completing objectives defined by the College of Public Health for the required internship for the Masters program and is a part of the students culminating experience.
  • Slide 3
  • This study hopes to address the link between cardiac deaths and access to healthy foods for Knox County, TN
  • Slide 4
  • Definition For this study we used Death Statistical Systems data from Vital Records in the Tennessee Department of Health ICD-10 codes for myocardial infarction, heart failure, stroke, and coronary artery disease. The events were selected as being the Underlying Cause of Death, which includes codes: I21.0-I21.4, I21.9-122.1, I22.8- I23.6, I23.8; I11.0, I13.0, I42.0-I42.9, I50.0, I50.1, I50.9, I51.7; I60.0-I60.9, I61.0-I61.9, I63.0-I63.9, I64, I65.0- I65.9; I20.0, I20.8, I20.9, I21.0-I25.9 and I51.6.
  • Slide 5
  • Age-Adjustment Since age is a risk factor associated with cardiac deaths it is important that we use age-adjusted rates in order to compare two populations
  • Slide 6
  • Data from the 2010 census was used for demarcating populations within Knox County This was better than zip code data since these lines fall outside of county boundaries
  • Slide 7
  • Census Data from 2010 was used for this report
  • Slide 8
  • Healthy Food Financing Initiative (HFFI) Low-income Census tracts that meet the Treasury Departments New Markets Tax Credit (NMTC) Low Access A substantial number of residence with low access to a supermarket or large grocery store
  • Slide 9
  • Using the Healthy Food Financing Initiative (HFFI) criteria to define the Census Tracts in Knox County that are considered a food desert.
  • Slide 10
  • Quantile Distribution Using the cardiac death rates found they were then classified into 5 levels
  • Slide 11
  • Age adjusted cardiac death rates were calculated using SAS for each census tract. A quantile distribution of rates were used to classify into 5 levels
  • Slide 12
  • Comparing Rates between Census Tracts Using ArcMap to export data to excel a two-tailed t-test was used to assess the cardiac rates in census tracts considered to be food deserts and cardiac death rates in census tracts not considered to be a food desert
  • Slide 13
  • Cardiac Death Rates compared between census tracts considered to be a food desert and those that were not.
  • Slide 14
  • Comparing Rates between Census Tracts T-test resulted in a p-value of 0.078252 This shows significance with alpha= 0.10 Therefore we have 90% confidence that there is a significant difference between cardiac death rates for the food desert tracts compared to the non-food desert tracts However, we are not 95% confident
  • Slide 15
  • To gain understanding of healthy food access, the location of healthy food retailers were obtained via communication with the Department of Agriculture
  • Slide 16
  • List of all Food Retailers for Knox County was provided by the Department of Agriculture Food Retailers included in the study based upon definition of food retailers by the Department of Agriculture
  • Slide 17
  • Inclusion: 23-Retail Fish Market-Deli 43-Meat Market-Deli 51-Market W Meat Dept & Deli 52-Market W Meat Dept & Deli, 50 or more seats 81-Market 82-Market W Food Service 101-Retail Produce Market 103-Retail Produce Market W Deli 141-Health Food Store
  • Slide 18
  • Geocode Addresses The list of food retailers include addresses which were used to geocode their locations
  • Slide 19
  • The stars on the map depict the healthy food locations designated by the definition for type of food retail they get from the Department of Agriculture
  • Slide 20
  • One mile buffer was assigned to each healthy food retailer to better understand the healthy food distribution in Knox County
  • Slide 21
  • The healthy food retailers were added to the map in order to understand their relationship with cardiac deaths and with food deserts.
  • Slide 22
  • There is a significant difference in the rate of cardiac deaths for individuals living within a food desert compared to those living outside a food desert at the 90% confidence level.
  • Slide 23
  • Difficulty in defining food deserts
  • Slide 24
  • Because of the geographical nature of Knox county identifying food deserts can be difficult. Walkability improves access to retailers Increased
  • Slide 25
  • CDC. Heart Disease facts. (2015) Heart Disease. Last updated: February 19, 2015. Retrieved from: http://www.cdc.gov/heartdisease/facts.htm. WHO. Cardiovascular diseases (CVDs). Media centre. Fact sheet N317. Updated January 2015. Retrieved from: http://www.who.int/mediacentre/factsheets/fs317/en/. Mayo Clinic. Heart Disease. (2014) Diseases and Conditions. Retrieved from: http://www.mayoclinic.org/diseases-conditions/heart-disease/basics/definition/con-20034056. Definition of a food desert. United States Department of Agriculture. Economic Research Service. http://www.ers.usda.gov/dataFiles/Food_Access_Research_Atlas/Download_the_Data/Archived_Version/archived_documentation.pdf. Heath, G. W., & Troped, P. J. (2012). The role of the built environment in shaping the health behaviors of physical activity and healthy eating for cardiovascular health. Future Cardiology, 8(5), 677+. (doi: 10.2217/fca.12.52) Retrieved from: http://go.galegroup.com.ezproxy.etsu.edu:2048/ps/i.do?id=GALE%7CA303403368&v=2.1&u=tel_a_etsul&it=r&p=EAIM&sw=w&asid=a483820e0d805935703afc06fdc40841. Pedigo AS; Odoi A. Investigation of Disparities in Geographic Accessibility to Emergency Stroke and Myocardial Infarction Care in East Tennessee Using Geographic Information Systems and Network Analysis. Annals of Epidemiology, Volume 20, Issue 12, 924 930 Retrieved from: http://www.sciencedirect.com.ezproxy.etsu.edu:2048/science/article/pii/S104727971000164X. Erwin, P. C.; Fitzhugh, E. C.; Brown, K. C.; Looney, S.; Forde, T.(2010). Health Disparities in Rural Areas: The Interaction of Race, Socioeconomic Status, and Geography. Journal of Health Care for the Poor and Underserved 21(3), 931-945. The Johns Hopkins University Press. Retrieved from: https://muse-jhu- edu.ezproxy.etsu.edu:3443/journals/journal_of_health_care_for_the_poor_and_underserved/v021/21.3.erwin.html. Botchwey, N. D., Falkenstein, R., Levin, J., Fisher, T., & Trowbridge, M. (2014). The Built Environment and Actual Causes of Death Promoting an Ecological Approach to Planning and Public Health. Journal of Planning Literature, 0885412214561337. Auchincloss, A. H., Mujahid, M. S., Shen, M., Michos, E. D., WhittGlover, M. C., & Diez Roux, A. V. (2013). Neighborhood healthpromoting resources and obesity risk (the multiethnic study of atherosclerosis). Obesity, 21(3), 621-628. doi: 10.1002/oby.20255. Retrieved from: http://onlinelibrary.wiley.com/doi/10.1002/oby.20255/epdf. Diez Roux, A. V.; Merkin, S. S.; Arnett, D. ; Chambless, L.; Massing, M.; Nieto, F. J.; Sorlie, P.; Szklo, M.; Tyroler, H. A.; Watson, R. L. Neighborhood of Residence and Incidence of Coronary Heart Disease.. N Engl J Med 2001; 345:99-106July 12, 2001DOI: 10.1056/NEJM200107123450205. Retrieved from: http://www.nejm.org/doi/full/10.1056/NEJM200107123450205. Swinburn B, Sacks G, Gortmaker S, et al. The global obesity pandemic: shaped by global drivers and local environments. The Lancet [serial online]. 2011;(9793):804. Available from: InfoTrac Health Reference Center Academic, Ipswich, MA. https://www-clinicalkey-com.ezproxy.etsu.edu:3443/#!/content/playContent/1-s2.0-S0140673611608131.https://www-clinicalkey-com.ezproxy.etsu.edu:3443/#!/content/playContent/1-s2.0-S0140673611608131 The Appalachian Region (2015). Appalachian Regional Commission. Retrieved from: http://www.arc.gov/appalachian_region/TheAppalachianRegion.asp.