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Healthiest Wisconsin 2020 Baseline and Health Disparities Report Chronic Disease Prevention and Management. Chapter outline. Chapter Outline. Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Healthiest Wisconsin 2020 objectives and indicators - PowerPoint PPT PresentationTRANSCRIPT
Wisconsin Department of Health Services
January 2014 P-00522E
Healthiest Wisconsin 2020 Baseline and Health Disparities Report
Chronic Disease Prevention and Management
CHRONIC DISEASE
Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities
Report • Healthiest Wisconsin 2020 objectives and indicators• Rationale• Key points
Data• Cardiovascular disease and risk factors• Diabetes• Cancer and screening• Arthritis and joint pain
References
Links to additional reports and resources
Contacts
Chapter Outline
Chapter outline
2
CHRONIC DISEASE
Report Overview
• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf
• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.
• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.
• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf
Report overview
3
CHRONIC DISEASE
Report Format
Full Report• Format: PDF • Intended use: reference document
Chapters• Format: Annotated PowerPoint slide set• Intended uses: presentations to
– Decision-makers– Service providers– Community leaders– The public
Sample annotated slide
Report overview
4
CHRONIC DISEASE
Report Outline
Executive Summary
Section 1: Introduction
Section 2: Demographic overview
Section 3: Health focus areas
Section 4: Infrastructure focus areas
Section 5: Data summaries by population
Section 6: Technical notes
Report overview
5
CHRONIC DISEASE
Report Outline: Detail
Section 3: Health focus areas
• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure
Section 4: Infrastructure focus areas• Access to health care
Report overview
6
CHRONIC DISEASE
Report Outline: Detail
Section 5: Data summaries by population
Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics
People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography
Report overview
7
CHRONIC DISEASE
Data notes
• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf
• The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution.
• Population estimates that are considered unreliable are excluded.
• Misclassification of racial/ethnic groups may affect the accuracy of rates.
• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.
Report overview
8
CHRONIC DISEASE
Factors that influence health
Social determinants
of health
Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach
Report overview
9
CHRONIC DISEASE
Objective 1
By 2020, increase sustainable funding and capacity for chronic disease prevention and management programs that reduce morbidity and mortality.
Objective 1 Indicators
• State and federal funding for chronic disease prevention and management.
• Medicaid spending related to prevention of chronic disease.
• Insurance coverage for chronic disease prevention and management.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Chronic Disease Prevention and Management Focus Area Profile.
Healthiest Wisconsin 2020 objectives and indicators
HW2020 objectives
10
CHRONIC DISEASE
Objective 2
By 2020, increase access to high-quality, culturally competent, individualized chronic disease management among disparately affected populations of differing races, ethnicities, sexual identities and orientations, gender identities, and educational or economic status.
Objective 2 Indicators
• Population group-specific incidence of chronic disease (heart disease and cancer), hospitalization and emergency department utilization rates (asthma).
• Incidence of risk factors (e.g., obesity, smoking), early detection (e.g., blood pressure, diabetes and cancer screening), and chronic disease management (e.g., proportion of diabetic patients with A1c value under 7 percent).
• Proportion of asthma patients receiving seasonal influenza vaccinations (Survey of the Health of Wisconsin (SHOW)).Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Chronic Disease Prevention and Management Focus Area Profile.
Note: Data pertaining to asthma are included in the Environmental and Occupational Health chapter.
Healthiest Wisconsin 2020 objectives and indicators
HW2020 objectives
11
CHRONIC DISEASE
Objective 3
By 2020, reduce the disparities in chronic disease experienced among populations of differing races, ethnicities, sexual identities and orientations, gender identities, and educational or economic status.
Objective 3 Indicators
• Chronic disease (heart disease and cancer) and hospitalization and emergency department utilization rates (asthma).
• Risk factors (e.g., obesity, smoking), early detection (e.g., blood pressure, diabetes and cancer screening), and chronic disease management (e.g., proportion of diabetic patients with A1c value under 7 percent).
• Asthma patients receiving seasonal influenza vaccinations (Survey of the Health of Wisconsin (SHOW)).
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Chronic Disease Prevention and Management Focus Area Profile.Note: Data on the four primary risk factors are included in the chapters on nutrition, physical activity, tobacco, and alcohol and other drug use. Data pertaining to asthma are included in the Environmental and Occupational Health chapter.
Healthiest Wisconsin 2020 objectives and indicators
HW2020 objectives
12
CHRONIC DISEASE
Rationale
• Chronic diseases are defined by the National Center for Health Statistics and the World Health Organization as illnesses that persist for a long time, or last at least three months. Chronic diseases are rarely cured, and often are progressive, resulting in disability later in life.
• Chronic diseases, such as heart disease, stroke, cancer, diabetes, asthma, and arthritis, are among the most common and costly of all health problems in the United States; however, they are also among the most preventable.
• Four modifiable health risk behaviors are responsible for much of the illness, suffering, and early death related to chronic diseases: (1) unhealthy diet; (2) insufficient physical activity; (3) tobacco use and secondhand smoke exposure; and (4) excessive alcohol consumption.6
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Chronic Disease Prevention and Management Focus Area Profile.
Rationale
13
CHRONIC DISEASE
Key pointsCardiovascular disease
• Coronary heart disease, stroke, and congestive heart failure constitute the majority of cardiovascular disease deaths.
• Cardiovascular disease is the leading cause of death in Wisconsin.
• Death rates from coronary heart disease and stroke declined by more than 30% from 2000 to 2010; death rates from congestive heart failure have remained relatively stable.
• Significant disparities by race/ethnicity exist in the rates of premature death from stroke and coronary heart disease.
• Significant disparities by household income exist in the prevalence of heart attack, stroke, high blood pressure, and high cholesterol (those with lower incomes have a higher prevalence).
Key points
14
CHRONIC DISEASE
Key pointsDiabetes
• Diabetes prevalence is significantly higher among Blacks and American Indians than in Whites.
• Significant disparities exist for the prevalence of diabetes by household income: those with lower incomes have a higher prevalence.
• In 2009, the direct costs associated with diabetes in Wisconsin were estimated to be $4.07 billion, while the indirect costs were estimated at $2.04 billion ($6.10 billion total).
• Blacks with diabetes are far more likely to be hospitalized for short- and long-term complications than are their White counterparts. Hispanics with diabetes are much more likely than non-Hispanic Whites to be hospitalized for long-term complications and for end-stage renal disease.
Key points
15
CHRONIC DISEASE
Key pointsCancer mortality
• Although cancer mortality rates declined during 1995-2010, disparities between racial/ethnic groups have persisted in Wisconsin. In 2010, the highest cancer incidence and mortality rates in Wisconsin occurred among Blacks and American Indians.
• Significant disparities exist in cancer mortality by race/ethnicity. For example:o Lung cancer mortality was significantly higher for Blacks and American Indians
than for Whites, Hispanics, and Asians.o Colorectal cancer mortality was significantly higher among Blacks than in any
other race/ethnicity.o Breast cancer mortality was significantly higher among Black women than White
women.o Prostate cancer mortality was significantly higher among Black men than in any
other race/ethnicity.
Key points
16
CHRONIC DISEASE
Key points
Cancer diagnosis and screening
• Black women in Wisconsin were more likely to have breast cancer diagnosed at a later, distant stage and less likely to have breast cancer diagnosed at an earlier, localized stage compared to White women.
• Overall, cancers in the Hmong population were diagnosed at later stages than cancers in the White population.
• People with less than a high school education were significantly more likely to have not received recommended cancer screenings than were those with more than a high school education.
Key points
17
CHRONIC DISEASE
Key points
Arthritis
• Arthritis is the most common cause of disability in the United States; one in four adults in Wisconsin has been diagnosed with arthritis.
• Nearly half of Wisconsin residents with arthritis report that it limits their activity.
• Blacks have a significantly higher prevalence of arthritis than Whites and, of those with arthritis, are more likely to report activity limitation.
• Significant disparities exist in the prevalence of arthritis by household income: those with lower incomes have a higher prevalence.
Key points
18
CHRONIC DISEASE
Cardiovascular disease and risk factors
19
CHRONIC DISEASE
Cardiovascular disease mortality (leading causes), age-adjusted rates per 100,000, Wisconsin, 2000-2010
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.
Cardiovascular disease and risk factors
2000 2002 2004 2006 2008 20100
20
40
60
80
100
120
140
160
180 Coronary heart diseaseStroke
Year
Age-
adju
sted
rate
per
100
,000
pop
u-la
tion
20
CHRONIC DISEASE
Percentage of coronary heart disease deaths under the age of 75, by race/ethnicity and sex, Wisconsin, 2006-2010
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.
Male Female0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
42% 19%73% 54%68% 48%71% 35%73% 50%
White Black
Hispanic Asian
American Indian
Cardiovascular disease and risk factors
21
CHRONIC DISEASE
Percentage of stroke deaths under age 75, by race/ethnicity and sex, Wisconsin, 2006-2010
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.
Male Female0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
28% 15%66% 53%59% 46%68% 43%64% 40%
White Black
Hispanic Asian
American Indian
Cardiovascular disease and risk factors
22
CHRONIC DISEASE
Rates of heart attack and stroke among Wisconsin adults, by sex, 2009-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset.
Ever had a heart attack Ever had a stroke0%
5%
10%
4% 2%5% 2%3% 2%
TotalMaleFemale
Cardiovascular disease and risk factors
23
CHRONIC DISEASE
Age-adjusted rates of heart attack and stroke among Wisconsin adults, by race/ethnicity, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Ever had a heart attack Ever had a stroke0%
5%
10%
3% 2%4% 6%
White Black
Cardiovascular disease and risk factors
24
CHRONIC DISEASE
Age-adjusted rates of heart attack and stroke among Wisconsin adults, by household income, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.
Cardiovascular disease and risk factors
Ever had a heart attack Ever had a stroke0%
5%
10%
7% 5%3% 2%3% 2%
Low income (<$20,000)
Middle income ($20,000-$74,999)
High income ($75,000+)
25
CHRONIC DISEASE
Age-adjusted rates of heart attack and stroke among Wisconsin adults, by level of urbanization, 2008-2011
Cardiovascular disease and risk factors
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.
Ever had a heart attack Ever had a stroke0%
5%
10%
4% 3%3% 2%4% 2%
Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties
26
CHRONIC DISEASE
Rates of heart attack and stroke among Wisconsin adults, by sexual orientation, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.
Cardiovascular disease and risk factors
Ever had a heart attack Ever had a stroke0%
5%
10%
3% 2%4% 3%
Sexual majority
Sexual minority
27
CHRONIC DISEASE
Rates of high cholesterol and high blood pressure among Wisconsin adults, by sex, 2009 and 2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset. Note: Questions only asked in 2009 and 2011.
Cardiovascular disease and risk factors
Ever been told you have high cholesterol Ever been diagnosed with high blood pressure0%
10%
20%
30%
40%
50%
60%
36% 29%37% 28%36% 30%
TotalMaleFemale
28
CHRONIC DISEASE
Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by race/ethnicity, 2009 and 2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Questions only asked in 2009 and 2011.Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Ever been told you have high cholesterol Ever been diagnosed with high blood pressure0%
10%
20%
30%
40%
50%
60%
31% 25%40% 39%28% 35%23% 38%
White Black
Hispanic American Indian
Cardiovascular disease and risk factors
29
CHRONIC DISEASE
Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by household income, 2009 and 2011
Ever been told you have high cholesterol Ever been diagnosed with high blood pressure0%
10%
20%
30%
40%
50%
60%
40% 36%32% 27%28% 22%
Low income (<$20,000)Middle income ($20,000-$74,999)High income ($75,000+)
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Questions only asked in 2009 and 2011.
Cardiovascular disease and risk factors
30
CHRONIC DISEASE
Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by level of urbanization, 2009 and 2011
Ever been told you have high cholesterol
Ever been diagnosed with high blood
pressure
0%
10%
20%
30%
40%
50%
60%
30% 23%30% 27%
Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Questions only asked in 2009 and 2011.
Cardiovascular disease and risk factors
31
CHRONIC DISEASE
Rates of high cholesterol and high blood pressure among Wisconsin adults ages 18-64, by disability status, 2009 and 2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline only dataset.Note: Questions only asked in 2009 and 2011.
Cardiovascular disease and risk factors
Ever been told you have high cholesterol
Ever been diagnosed with high blood
pressure
0%
10%
20%
30%
40%
50%
60%
48% 39%
No disabilityDisability
HIV
32
CHRONIC DISEASE
Rates of high cholesterol and high blood pressure among Wisconsin adults, by sexual orientation, 2009 and 2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Questions only asked 2009 and 2011.
Ever been told you have high cholesterol Ever been diagnosed with high blood pressure
0%
10%
20%
30%
40%
50%
60%
37% 28%30% 30%
Heterosexual
Lesbian, gay, bisexual
Cardiovascular disease and risk factors
33
CHRONIC DISEASE
Diabetes
34
CHRONIC DISEASE
Rates of diabetes and prediabetes among Wisconsin adults, by sex, 2009-2011
Diabetes
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset.Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes.
Ever been diagnosed with diabetes Ever been told you have prediabetes0%
5%
10%
15%
20%
25%
8% 6%9% 7%8% 5%
TotalMaleFemale
35
CHRONIC DISEASE
Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by race/ethnicity, 2008-2011
Diabetes
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Ever been diagnosed with diabetes Ever been told you have prediabetes0%
5%
10%
15%
20%
25%
7% 6%17% 7%10% 8%16%
WhiteBlackHispanicAmerican Indian
36
CHRONIC DISEASE
Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by household income, 2008-2011
Diabetes
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes.
Ever been diagnosed with diabetes Ever been told you have prediabetes0%
5%
10%
15%
20%
25%
13% 9%7% 6%5% 5%
Low income (<$20,000)
Middle income ($20,000-$74,999)
High income ($75,000+)
37
CHRONIC DISEASE
Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by level of urbanization, 2008-2011
Diabetes
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes.
Ever been diagnosed with diabetes Ever been told you have prediabetes0%
5%
10%
15%
20%
25%
9% 7%7% 6%8% 6%
Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties
38
CHRONIC DISEASE
Rates of diabetes and prediabetes among Wisconsin adults ages 18-64, by disability status, 2008-2011
Diabetes
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes.Prediabetes question was only asked in years 2009-2011.
Ever been diagnosed with diabetes Ever been told you have prediabetes0%
5%
10%
15%
20%
25%
4% 4%14% 10%
No disability
Disability
39
CHRONIC DISEASE
Rates of diabetes and prediabetes among Wisconsin adults, by sexual orientation, 2008-2011
Diabetes
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes.
Ever been diagnosed with diabetes Ever been told you have prediabetes0%
5%
10%
15%
20%
25%
8% 6%9% 8%
Sexual majoritySexual minority
40
CHRONIC DISEASE
Estimated prevalence of diabetes among Wisconsin adults, age-adjusted percentage, by county, 2008-2010
Source: Wisconsin Department of Health Services, Division of Public Health, Wisconsin Diabetes Prevention and Control Program, The 2011 Burden of Diabetes in Wisconsin.
Diabetes
Estimated prevalence of diabetesStatewide = 10.1%
7.0 - 8.8%
8.9 - 9.2%
9.3 - 9.8%
9.9 - 10.6%
10.7 - 36.1%
41
CHRONIC DISEASE
Hospitalizations due to short-term diabetes complications and uncontrolled diabetes among Wisconsin adults, age-adjusted rate per 10,000, by race/ethnicity, 2010
Diabetes
Source: Wisconsin Inpatient Hospitalization Discharges, 2010.Note: Hospitalization rates considered unreliable are excluded.
0
5
10
15
20
25
30
4.2 0.621.9 3.76.0 4.6
White Black
Hispanic Other
Age-
adju
sted
rate
per
10,
000
popu
latio
n
42
CHRONIC DISEASE
Hospitalizations due to long-term complications from diabetes among Wisconsin adults, age-adjusted rate per 10,000, by race/ethnicity, 2010
Source: Wisconsin Inpatient Hospitalization Discharge file, 2010.Note: Hospitalization rates considered unreliable are excluded.
0.0
5.0
10.0
15.0
20.0
25.0
30.0
5.6 2.026.3 7.414.9
White Black
Hispanic
Age-
adju
sted
rate
per
10,
000
popu
latio
n,
age
18 a
nd o
lder
Diabetes
43
CHRONIC DISEASE
Incidence of end-stage renal disease incidence among Wisconsin adults, by race/ethnicity, age-adjusted rate per 100,000, 2009
Incidence of end-stage renal disease with diabetes as primary diagnosis0
10
20
30
40
50
60
8.7 45.1 44.3
WhiteBlackHispanic
Age-
adju
st ra
te p
er 1
00,0
00 p
opul
ation
Source: United States Renal Data System (USRDS), Renal Data Extraction and Referencing (RenDER) System.Note: Incidence rates considered unreliable are excluded.
Diabetes
44
CHRONIC DISEASE
Cancer and screening
45
CHRONIC DISEASE
Age-adjusted cancer mortality (all sites) by race/ethnicity, rate per 100,000, Wisconsin, 1995-2010
Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanic s include all races. Rates for American Indians and Asian may fluctuate more dramatically due to potential misclassification and small numbers of deaths.
Cancer and screening
1995 1997 1999 2001 2003 2005 2007 20090
50
100
150
200
250
300
350 WhiteBlackAmerican IndianAsian
Year
Age-
adju
sted
rate
per
100
,000
pop
ulati
on
46
CHRONIC DISEASE
Cancer incidence and mortality (all sites) age-adjusted rate per 100,000, by race/ethnicity, Wisconsin, 2010
Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services; and National Center for Health Statistics, Wisconsin mortality file 1995-2102, Vital Statistics Cooperative Program, 2013.Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
Cancer and screening
Incidence Mortality0
100
200
300
400
500
600
437 171532 244323 95288 106504 230
White Black
Hispanic Asian
American Indian
Age-
adju
sted
rate
per
100
,000
pop
ulati
on
47
CHRONIC DISEASE
Stage of disease at diagnosis, all cancers, White and Hmong populations, Wisconsin, 1995-2010
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2013 .Note: Percentages exclude cases for which stage was unknown or that were not staged.
Localized Regional Distant/Systemic0%
10%
20%
30%
40%
50%
60%
70%
52% 24% 24%31% 29% 40%
WhiteHmong
Stage at diagnosis
Cancer and screening
48
CHRONIC DISEASE
Lung and bronchus cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States, 2006-2010
Sources: Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013.Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
White Black Hispanic Asian American Indian0
10
20
30
40
50
60
70
80
90
100
46 70.4 15.3 13.8 85.950.2 53.5 21.3 25.5 33
WisconsinUnited States
Age-
adju
sted
rate
per
100
,000
pop
ulati
onCancer and screening
49
CHRONIC DISEASE
Colorectal cancer mortality age-adjusted rate per 100,000, by race/ethnicity, Wisconsin and United States, 2006-2010
White Black Hispanic Asian American Indian0
5
10
15
20
25
14.8 23.0 9.1 4.8 13.715.9 22.8 12.7 11.2 12.6
WisconsinUnited States
Age-
adju
sted
rate
per
100
,000
pop
ulati
on
Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013.Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
Cancer and screening
50
CHRONIC DISEASE
Female breast cancer mortality age-adjusted rate per 100,000, by race/ethnicity Wisconsin and United States, 2006-2010
White Black Hispanic Asian American Indian
0
5
10
15
20
25
30
35
21.1 29.1 6.7 9.8 23.222.1 30.8 14.8 11.5 12.5
WisconsinUnited States
Age-
adju
sted
rate
per
100
,000
fem
ale
popu
latio
n
Sources: Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013.Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
Cancer and screening
51
CHRONIC DISEASE
Stage of disease at diagnosis, female breast cancer, White and Black populations, Wisconsin, 2008-2010
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services.Note: Percentages exclude cases for which stage was unknown or that were not staged. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
Localized Regional Distant/Systemic0%
10%
20%
30%
40%
50%
60%
70%
64% 30% 5%65% 30% 5%51% 39% 10%
TotalWhiteBlack
Stage at diagnosis
Cancer and screening
52
CHRONIC DISEASE
Prostate cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States, 2006-2010
White Black Hispanic Asian American Indian0
10
20
30
40
50
60
24.1 42.1 12.6 34.821.2 50.9 19.1 10.1 16.9
WisconsinUnited States
Age-
adju
sted
rate
per
100
,000
mal
e po
pu-
latio
n
Source: National Center for Health Statistics, Wisconsin mortality file 1995-2102, Vital Statistics Cooperative Program, 2013.Note: Rate not displayed when based on fewer than 10 cases. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
Cancer and screening
53
CHRONIC DISEASE
Cervical cancer incidence by race/ethnicity, age-adjusted rate per 100,000, Wisconsin, 2006-2010
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Wisconsin Department of Health Services.Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
White Black Hispanic Asian American Indian0
2
4
6
8
10
12
14
16
18
20
5.3 9.8 9.9 6.9 18.6
Rate
per
100
,000
fem
ale
popu
latio
nCancer and screening
54
CHRONIC DISEASE
Cancer screening among Wisconsin adults, 2010
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset.Note: Questions were only asked in 2010.
Cancer and screening
No sigmoid/colonoscopy, ages
50+
No PSA test in past two years, males
ages 40+
No Pap in past three years, females ages
18+
No mammogram in past two years,
females ages 50+
0%
10%
20%
30%
40%
50%
60%
55
CHRONIC DISEASE
Cancer screening among Wisconsin adults, by household income, 2008 and 2010
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline only dataset.Note: Questions were only asked in 2008 and 2010.
Cancer and screening
No sigmoid/colonoscopy, ages
50+
No PSA test in past two years, males
ages 40+
No Pap test in past three years, females
ages 18+
No mammogram in past two years,
females ages 50+
0%
10%
20%
30%
40%
50%
60%
70%
80%
42% 60% 23% 29%33% 49% 20% 23%30% 51% 7% 12%
Low income (<$20,000)
Middle income ($20,000-$74,999)
High income ($75,000+)
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CHRONIC DISEASE
Cancer screening among Wisconsin adults, by education level, 2008 and 2010
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Questions were only asked in 2008 and 2010.
No sigmoid/colonoscopy,
ages 50+
No PSA test in past two years, males ages 40+
No Pap test in past three years,
females ages 18+
No mammogram in past two
years, females ages 50+
0%
10%
20%
30%
40%
50%
60%
70%
80%
33% 50% 19% 22%28% 45% 9% 15%
Less than high schoolHigh school graduate to some collegeCollege graduate or more
Cancer and screening
57
CHRONIC DISEASE
Arthritis and joint pain
58
CHRONIC DISEASE
Rate of arthritis among adults, and percent of those with arthritis whose activity is limited due to joint pain, by sex, 2009-2011
Arthritis and joint pain
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell datasetNote: Arthritis question was asked in 2009-2011. Question about limited activity due to joint pain was asked in 2009 and 2011.
0%
10%
20%
30%
40%
50%
60%
70%
80%
26% 46%22% 42%30% 49%
Total MaleFemale
59
CHRONIC DISEASEAge-adjusted rate of arthritis among adults, and percent of those with arthritis whose activity is limited due to joint pain, by race/ethnicity, 2009-2011
0%
10%
20%
30%
40%
50%
60%
70%
80%
23% 40%29% 50%23% 39%23%
WhiteBlackHispanicAmerican Indian
Arthritis and joint pain
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Arthritis question was asked in 2009-2011. Question about limited activity due to joint pain was asked in 2009 and 2011. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
60
CHRONIC DISEASEAge-adjusted rate of arthritis among adults, and percent of those with arthritis whose activity is limited due to joint pain, by household income, 2009-2011
Arthritis and joint pain
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Arthritis question was asked in 2009-2011. Question about limited activity due to joint pain was asked in 2009 and 2011.
Ever been told you have some form of arthritis
Among those with arthritis, percent whose activity is limited due to joint pain
0%
10%
20%
30%
40%
50%
60%
70%
80%
36% 63%24% 36%21% 29%
Low income (<$20,000)Middle income ($20,000-$74,999)High income ($75,000+)
61
CHRONIC DISEASE Arthritis and joint painAge-adjusted rate of arthritis among adults, and percent of those with arthritis whose activity is limited due to joint pain, by level of urbanization, 2009-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Arthritis question was asked in 2009-2011. Question about limited activity due to joint pain was asked in 2009 and 2011.
Ever been told you have some form of arthritis
Among those with arthritis, percent whose activity is limited due to joint pain
0%
10%
20%
30%
40%
50%
60%
70%
80%
26% 49%23% 36%23% 38%
Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties
62
CHRONIC DISEASE
Rate of arthritis among adults, and percent of those with arthritis whose activity is limited due to joint pain, by sexual orientation, 2008-2010
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Arthritis question was asked in 2009-2011. Question about limited activity due to joint pain was asked in 2009 and 2011.
Arthritis and joint pain
0%
10%
20%
30%
40%
50%
60%
70%
80%
25% 46%27% 56%
Sexual majority
Sexual minority
63
CHRONIC DISEASE
References1. University of Wisconsin Population Health Institute. County Health Rankings, 2013.
http://www.countyhealthrankings.org/our-approach 2. Center for Urban Population Health. Milwaukee Health Report, 2011.
http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf 3. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health
Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
4. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/
5. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf
6. Centers for Disease Control and Prevention (CDC). Chronic Diseases and Health Promotion. http://www.cdc.gov/chronicdisease/overview/index.htm
7. Wisconsin Department of Health Services (DHS), Wisconsin Heart Disease and Stroke Prevention Program. The Burden of Heart Disease and Stroke in Wisconsin, 2010. http://www.dhs.wisconsin.gov/publications/P0/P00146.pdf
8. CDC. Achievements in Public Health 1900- 1999, Decline in Deaths from Heart Disease and Stroke. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4830a1.htm
9. CDC. Health Inequalities Report, 2011. http://www.cdc.gov/mmwr/pdf/other/su6001.pdf
References
64
CHRONIC DISEASE
10. CDC. Disparities in Premature Mortality Between High- and Low-Income U.S. Counties. http://www.cdc.gov/pcd/issues/2012/11_0120.htm
11. CDC. Racial/Ethnic and Socioeconomic Disparities in Multiple Risk Factors for Heart Disease and Stroke --- United States, 2003. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5405a1.htm
12. Wisconsin Department of Health Services (DHS). Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Accessed August 2012. http://www.dhs.wisconsin.gov/wish/
13. National Stroke Association. African Americans and Stroke. http://www.stroke.org/site/PageServer?pagename=aamer
14. CDC. Cholesterol. http://www.cdc.gov/cholesterol/15. CDC. High Blood Pressure Facts. http://www.cdc.gov/bloodpressure/facts.htm16. CDC. National diabetes fact sheet: National estimates and general information on
diabetes and prediabetes in the United States, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf
17. National Institute of Diabetes and Digestive and Kidney Disease. National Diabetes Statistics, 2011. http://diabetes.niddk.nih.gov/dm/pubs/statistics/
18. Agency for Healthcare Research and Quality (AHRQ). National Healthcare Disparities Report, 2011. http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf
19. Community Health Data Profile: Michigan, Minnesota, and Wisconsin Tribal Communities, 2010. http://www.glitc.org/forms//epi/profiles/Final%202010%20CHP.pdf
References
65
CHRONIC DISEASE
20. DHS. The Burden of Diabetes in Wisconsin, 2011. http://www.dhs.wisconsin.gov/publications/P0/P00284.pdf
21. Agency for Healthcare Research and Quality (AHRQ). Diabetes short-term complications admission rate (area-level): rate per 100,000 population. http://www.qualitymeasures.ahrq.gov/content.aspx?id=38550
22. AHRQ. Diabetes mellitus: hospital admission rate for uncontrolled diabetes. http://www.qualitymeasures.ahrq.gov/content.aspx?id=38568
23. AHRQ. Diabetes mellitus: hospital admission rate for long-term complications. http://www.qualitymeasures.ahrq.gov/content.aspx?id=38559
24. Ward MM, et al. Access to care and the incidence of end-stage renal disease due to diabetes. http://care.diabetesjournals.org/content/32/6/1032.full.pdf+html
25. Jemal A, et al. The National Cancer Institute. Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in Human Papillomavirus (HPV)–associated cancers and HPV. http://jnci.oxfordjournals.org/content/early/2013/01/03/jnci.djs491.full.pdf+html
26. Eheman C, et al. The National Cancer Institute. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. http://onlinelibrary.wiley.com/doi/10.1002/cncr.27514/pdf
References
66
CHRONIC DISEASE
27. Siegel R, et al. CA: A Cancer Journal for Clinicians: Cancer Statistics, 2013. http://onlinelibrary.wiley.com/doi/10.3322/caac.21166/pdf
28. CDC. Vital Signs: Racial Disparities in Breast Cancer Severity — United States, 2005–2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6145a5.htm?s_cid=mm6145a5_w
29. Journal of the National Cancer Institute. Racial and Ethnic Disparities in the Receipt of Cancer Treatment. http://jnci.oxfordjournals.org/content/94/5/334.long
30. National Cancer Institute. Fact Sheet: Cancer Health Disparities. http://www.cancer.gov/cancertopics/factsheet/disparities/cancer-health-disparities
31. National Cancer Institute. Cancer Staging. http://www.cancer.gov/cancertopics/factsheet/detection/staging
32. DHS. Wisconsin Minority Health Report, 2001-2005 (PPH-5716), pages 79-108 (“Asians”). http://www.dhs.wisconsin.gov/health/minorityhealth/ReportPDF/asians.pdf
33. Foote M, Matloub J. Comprehensive Cancer Control Program Surveillance Brief. Determining Practices for Reporting Hmong Cancer Cases in Wisconsin. Special Supplement: Cancer Incidence Data for Hmong. http://www.wicancer.org/uploads/pub_34566.pdf
34. United States Cancer Statistics. 1999-2008 Incidence and Mortality Web-based Report. http://apps.nccd.cdc.gov/uscs/toptencancers.aspx
References
67
CHRONIC DISEASE
35. CDC. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses - United States, 2000—2004. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm
36. CDC. Racial/Ethnic Disparities and Geographic Differences in Lung Cancer Incidence -- 38 States and the District of Columbia, 1998-2006. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5944a2.htm
37. American College of Chest Physicians. Racial Disparities in Lung Cancer. http://69.36.35.38/accp/article/chest-physician/racial-disparities-lung-cancer
38. Bliss A, et al. Lung Cancer Incidence Among American Indians and Alaska Natives in the United States, 1999–2004. http:/onlinelibrary.wiley.com/doi/10.1002/cncr.23738/pdf/
39. CDC. Basic Information about Colorectal Cancer. http://www.cdc.gov/cancer/colorectal/basic_info/index.htm
40. White Al, et al. Racial Disparities in Colorectal Cancer Survival: To What Extent Are Racial Disparities Explained by Differences in Treatment, Tumor or Hospital Characteristics? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946464
41. Loconte NK, et al. Increasing disparity in colorectal cancer incidence and mortality among African Americans and whites: A state's experience. http://www.ncbi.nlm.nih.gov/pubmed/21712962
42. Perdue DG, et al. Regional differences in colorectal cancer incidence, stage, and subsite among American Indians and Alaska Natives, 1999-2004. http://onlinelibrary.wiley.com/doi/10.1002/cncr.23726/abstract
References
68
CHRONIC DISEASE
43. Wingo PA, et al. Breast Cancer Incidence Among American Indian and Alaska Native Women: U.S., 1999–2004. http://onlinelibrary.wiley.com/doi/10.1002/cncr.23725/pdf
44. Breastcancer.org. Stages of Breast Cancer. http://www.breastcancer.org/symptoms/diagnosis/staging
45. CDC. MMWR. Vital Signs: Racial Disparities in Breast Cancer Severity — United States, 2005–2009. http://www.cdc.gov/media/releases/2012/docs/dpk-breast-cancer-disparities-MMWR.pdf
46. PubMed Health. Prostate cancer. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001418/
47. CDC. Cervical Cancer. http://www.cdc.gov/cancer/cervical/48. CDC. Arthritis. http://www.cdc.gov/arthritis/49. CDC. Arthritis. http://www.cdc.gov/arthritis/basics/risk_factors.htm
References
69
CHRONIC DISEASE
Links to additional reports and resources
• The Burden of Heart Disease and Stroke in Wisconsin, 2010: http://www.dhs.wisconsin.gov/publications/P0/P00146.pdf
• The Epidemic of Chronic Disease in Wisconsin: http://www.dhs.wisconsin.gov/publications/P0/P00238.pdf
• Wisconsin Cancer Health Disparities Surveillance Reports: Trends in Cancer Disparities Among African Americans and Whites in Wisconsin: http://chdi.wisc.edu/sites/chdi.wisc.edu/files/attachments/Trends_AAW_FINALFIN_0.pdf
• The 2011 Burden of Diabetes in Wisconsin: http://www.dhs.wisconsin.gov/publications/P0/P00284.pdf
• Wisconsin Diabetes Surveillance Report, 2012 http://www.dhs.wisconsin.gov/publications/P4/P43084.pdf
Links
70
CHRONIC DISEASE
Contacts
Mark Wegner, MDChronic Disease Medical DirectorBureau of Community Health PromotionDivision of Public HealthDepartment of Health ServicesEmail: [email protected]
Cardiovascular DiseaseInterim Director: Mark Wegner, MDEmail: [email protected]
DiabetesInterim Director: Mark Wegner, MDEmail: [email protected]
CancerMary Foote, MSEpidemiologistWisconsin Cancer Reporting SystemOffice of Health InformaticsDivision of Public HealthDepartment of Health ServicesEmail: [email protected]
ArthritisNancy Chudy, MPHEpidemiologistWisconsin Arthritis ProgramBureau of Community Health PromotionDivision of Public HealthDepartment of Health ServicesEmail: [email protected]
Contacts
71