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Regional Health Status Indicators

Metrowest Massachusetts

Deval L. Patrick, Governor Timothy P. Murray, Lieutenant Governor

Judyann Bigby, MD, Secretary of Health and Human Services John Auerbach, Commissioner, Department of Public Health

Jerry O’Keefe, Associate Commissioner Health Information, Statistics, Research, and Evaluation Bureau

Bruce Cohen, Director Division of Research and Epidemiology

Massachusetts Department of Public Health

June 2007

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ACKNOWLEDGEMENTS

This report was prepared by Isabel Caceres, MS, Malena Orejuela-Hood, MPH, and James West, PhD of the Division of Research and Epidemiology and by Lauren Wooley, MPH, of the Health Survey Program, Center for Health Information, Statistics, Research, and Evaluation. Special thanks go to Bruce Cohen, PhD, Director of the Division or Research and Epidemiology, and to all of the DPH Bureaus who have contributed to this report.

To obtain additional copies of this report, contact:

Massachusetts Department of Public Health Health Information, Statistics, Research and Evaluation Bureau

250 Washington Street, 6th Floor Boston, MA 02108

This and other Department of Public Health publications can be downloaded

from the following website:

http://www.mass.gov/dph/resep

To obtain more information on the health of Massachusetts and other Department of Public Health data:

Register for the Department’s free, Internet-based public health information service,

MassCHIP, via the website at:

http://masschip.state.ma.us

Or call 888-MAS-CHIP (toll free in MA) or 617-624-5629

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TABLE OF CONTENTS

NOTE TO READERS.................................................................................................... 13 INTRODUCTION........................................................................................................... 15

Goals for holding Regional Dialogues ....................................................................... 17 Goals of New DPH Leadership ................................................................................. 17 Timetable .................................................................................................................. 18

SOCIODEMOGRAPHIC INDICATORS ........................................................................ 19 Executive Office of health and Human Services Regions ......................................... 21 Comments about the Limitations of this presentation................................................ 21 Population in Communities, Metrowest Region: 2005............................................... 22 Race and Ethnic Breakdown of Population, Metrowest Region and Massachusetts: 2005 .......................................................................................................................... 22 Race and Ethnic Breakdown of Population, Cambridge and Quincy: 2005............... 23 Race and Ethnic Breakdown of Population, Somerville and Framingham: 2005....... 23 Population by Age Group, Metrowest Region and Massachusetts: 2005.................. 24 Language Spoken at Home, Metrowest Region and Massachusetts: 2000 .............. 24 Spanish Spoken at Home, Metrowest Region: 2000................................................. 25 Socio-Demographic Indicators Metrowest Region and Massachusetts: 2000........... 25 Highest and Lowest per Capita Income Communities in Metrowest Region: 2000 ... 26

HEALTH CARE ACCESS............................................................................................. 27 Adults who Have No Health Insurance by EOHHS Region, Massachusetts: 2005 ... 29 Summary Indicators for Health Insurance by EOHHS Regions, Massachusetts: 2005 .......................................................................................................................... 29

BIRTH INDICATORS.................................................................................................... 31

Infant Mortality Rate (IMR) Metrowest Region and Massachusetts: 1990-2005........ 33 Infant Mortality Rates by EOHHS Region and Massachusetts: 2002-2005............... 33 Infant Mortality Rate (IMR) by Metrowest Region and Massachusetts: 1990-2005... 34 Infant Mortality Rates by Race/Ethnicity, Metrowest Region and Massachusetts: 2002-2005 ................................................................................................................. 34 Low Birthweight by EOHHS Region, Massachusetts: 2005 ...................................... 35 Low Birthweight Infants, Metrowest Cities and Massachusetts: 1990-2005....................35 Breastfeeding by EOHHS Region, Massachusetts: 2005.......................................... 36 Teen Birth Rates, Metrowest Region and Massachusetts: 1990-2005...................... 36 Teen Birth Rates by EOHHS Regions, Massachusetts: 2005 ................................... 37 Teen Birth Rates by EOHHS Region, Massachusetts: 2005..................................... 37 Teen Birth Rates by City/Town, Metrowest Region: 2005 ......................................... 38 Teen Births to White non-Hispanic Mothers, Metrowest Citites and Massachusetts: 2003-2005 ................................................................................................................. 38 Teen Births to Black non-Hispanic Mothers, Metrowest Citites and Massachusetts: 2003-2005 ................................................................................................................. 39

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Teen Birth Rates by Race and Ethnicity, Metrowest Region and Massachusetts: 2005 .......................................................................................................................... 39 Adequate Prenatal Care by EOHHS Regions, Massachusetts: 2005 ....................... 40 Public Source of Payment for Prenatal Care, Metrowest Region and Massachusetts: 1990- 2005 ................................................................................................................ 40 Public Source of Payment for Prenatal Care Metrowest Region and Massachusetts: 2005 .......................................................................................................................... 41 Public Source of Payment for Prenatal Care, Metrowest Cities and Massachusetts: 2003-2005 ................................................................................................................. 41 Smoking During Pregnancy, Metrowest Region and Massachusetts: 1990-2005 ..... 42 Smoking During Pregnancy by EOHHS Regions, Massachusetts: 2005 .................. 42 Smoking During Pregnancy by Race and Ethnicity, Metrowest Region and Massachusetts: 2005 ............................................................................................... 43 Percent of Mothers Smoking During Pregnancy for Largest Communities, Metrowest Region: 2005............................................................................................................. 43 Infants Delivered by C-Section, Metrowest Region and Massachusetts: 1990-2005 44 Infants Delivered by C-Section by EOHHS Regions, Massachusetts: 2005 ...................44 Percent of Cesarean Deliveries by Race and Ethnicity, Metrowest Region, Massachusetts: 2005 ................................................................................................ 45 Percentage of Cesarean Births by Community, EOHHS Region: 2005 .................... 45 Percentage of Cesarean Deliveries by City/Town, Metrowest Region: 2005 ............ 46 Summary of Birth Indicators by EOHHS Regions, Massachusetts: 2005.................. 46 Summary of Birth Indicators by EOHHS Regions, Massachusetts: 2005.................. 47

LEADING CAUSES OF DEATH................................................................................... 49

Leading Causes of Death, Metrowest Region and Massachusetts: 2005 ................. 51 CHRONIC DISEASE OUTCOMES AND OVERWEIGHT/OBESITY ............................ 53

Thresholds for Defining Overweight and Obesity ...................................................... 55 Adults who are Overweight by EOHHS Region, Massachusetts: 1995 & 2005......... 55 Adults who are Obese by EOHHS Region, Massachusetts : 1995 & 2005 ............... 56 Adults who Participate in Regular Physical Activity by EOHHS Region, Massachusetts: 2005 .............................................................................................. 56 Adults who have 5+ Servings of Fruit or Vegetables by EOHHS Region, Massachusetts : 2005 ............................................................................................... 57 Adults who had their Cholesterol Checked in Past 5 Years by EOHHS Region, Massachusetts: 2005 ................................................................................................ 57 Adults who were Told by Health Care Provider that they had High Cholesterol, by EOHHS Region, Massachusetts: 2005 ..................................................................... 58 Adults who were Told by a Health Care Provider they have High Blood Pressure, by EOHHS Region, Massachusetts: 2005 ..................................................................... 58 Adults who take Medicine for High Blood Pressure, by EOHHS Region, Massachusetts : 2005 ............................................................................................... 59 Hospital Discharge Rates for Hypertension by EOHHS Region, Massachusetts: 2003-3005 .......................................................................................................................... 59

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Hospital Discharge Rates for Hypertension by Metrowest Cities and Massachusetts: 2003-3005 ................................................................................................................. 60 Hypertension Hospital Discharge Rate by Race/Ethnicity, Metrowest Region, Massachusetts: 2003-2005 ....................................................................................... 60 Heart Disease Mortality Rates by EOHHS Region, Massachusetts: 2003-2005 ....... 61 Heart Disease Mortality Rates by Metrowest Cities and Massachusetts: 2003- 2005 .......................................................................................................................... 61 Heart Disease Death Rates by Race/Ethnicity, Metrowest Region and Massachusetts : 2003-2005 ...................................................................................... 62 Prevalence of Diabetes, Massachusetts: 1994-2005 ................................................ 62 Diabetes Hospital Discharges by Metrowest Region and Massachusetts: 2003- 2005 .......................................................................................................................... 63 Diabetes Hospital Discharges by Metrowest Cities and Massachusetts: 2003-2005 63 Diabetes Hospital Discharges by Race/Ethnicity Metrowest Region and Massachusetts: 2003-2005 ....................................................................................... 64 Diabetes Mortality Rates by EOHHS Region and Massachusetts: 2003-2005.......... 64 Diabetes Mortality Rates Metrowest Cities and Massachusetts: 2003-2005 ............. 65 Diabetes Mortality Rates by Race/Ethnicity Metrowest Region and Massachusetts: 2003-2005 ................................................................................................................. 65 Summary Indicators for Overweight/Obesity, by EOHHS Regions, Massachusetts : 2005 .......................................................................................................................... 66 Summary Indicators for Chronic Disease Outcomes for Overweight/Obesity by EOHHS Regions ....................................................................................................... 66

CANCER....................................................................................................................... 67

Adults Ages 50+ who have had a Sigmoidoscopy or Colonoscopy in Past 5 Years by EOHHS Regions, Massachusetts: 2005.................................................................... 69 Incidence Rates for Invasive Colorectal Cancer by EOHHS Region, Massachusetts: 1990-2003 ................................................................................................................. 69 Incidence Rates for Early Stage Colorectal Cancer, Males, by EOHHS Region, Massachusetts: 1999-2003 ....................................................................................... 70 Incidence Rates for Early Stage Colorectal Cancer, Females, by EOHHS Region, Massachusetts: 1999-2003 ....................................................................................... 70 Colorectal Cancer Mortality Rates by Metrowest Cities and Massachusetts: 2005... 71 Men Ages 50+ who had a Prostate-Specific Antigen Test in the Past 2 years by EOHHS Region, Massachusetts: 2004 ..................................................................... 71 Men Ages 50+ who had a Digital Rectal Exam in the Past Two Years by EOHHS Region, Massachusetts: 2004 ................................................................................... 72 Adults Ages 50+ who had a Blood Stool Test in the Past Two Years by EOHHS Region, Massachusetts: 2005 ................................................................................... 72 Incidence Rates for Invasive Prostate Cancer by EOHHS Region, Massachusetts: 1999- 2003 ................................................................................................................ 73 Incidence Rates for Early Stage Prostate Cancer by EOHHS Region, Massachusetts: 1999-2003 ................................................................................................................. 73 Prostate Cancer Mortality Rates by EOHHS Region, Massachusetts: 2005............. 74

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Women Ages 40+ who had a Clinical Breast Exam in the Past Two Years by EOHHS Region, Massachusetts: 2004 ................................................................................... 74 Women Ages 40+ who have had a Mammography in Past 2 Years by EOHHS Region, Massachusetts: 2005 ................................................................................... 75 Incidence Rates for Early Stage Female Breast Cancer by EOHHS Region, Massachusetts : 1999-2003 ...................................................................................... 75 Incidence Rates for Non-Invasive Female Breast Cancer by Race and Ethnicity, Metrowest Region, Massachusetts : 1999-2003 ....................................................... 76 Incidence Rates for Invasive Female Breast Cancer by EOHHS Region, Massachusetts: 1999-2003 ....................................................................................... 76 Incidence Rates for Invasive Female Breast Cancer by Race and Ethnicity, Metrowest Region, Massachusetts : 1999-2003 ....................................................... 77 Female Breast Cancer Mortality Rates by Race and Ethnicity, Metrowest Region, Massachusetts: 2001-2005 ....................................................................................... 77 Incidence Rates for Invasive Lung Cancer by EOHHS Region, Massachusetts: 1999-2003 .......................................................................................................................... 78 Incidence Rates for Early Stage Lung Cancer, Males, by EOHHS Region, Massachusetts : 1999-2003 ...................................................................................... 78 Incidence Rates for Early Stage Lung Cancer, Females, by EOHHS Region, Massachusetts: 1999-2003 ....................................................................................... 79 Lung Cancer Mortality Rates by EOHHS Region, Massachusetts: 2005 .................. 79 Lung Cancer Mortality Rates by Metrowest Region and Massachusetts: 2003-2005 80 Lung Cancer Mortality Rates by Race and Ethnicity, Metrowest Region and Massachusetts: 2001-2005 .....................................................................................................................80 Adults who Currently Smoke by EOHHS Regions, Massachusetts: 2005................ 81 Current Smoker by Race and Ethnicity, Metrowest Region and Massachusetts: 2005 .......................................................................................................................... 81 Summary Indicators for Cancer Screening by EOHHS Regions, Massachusetts: 2005 .......................................................................................................................... 82 Summary Cancer Indicators (Early Stage) by EOHHS Regions, Massachusetts: 1999- 2003 ................................................................................................................ 82 Summary Cancer Indicators (Late Stage) by EOHHS Regions, Massachusetts: 1999- 2003 .......................................................................................................................... 83 Summary Invasive Cancer Incidence Rates by EOHHS Regions, Massachusetts: 1999 - 2003 ............................................................................................................... 83 Summary Cancer Mortality Indicators by EOHHS Regions, Massachusetts: 2005 ... 84

SUBSTANCE ABUSE .................................................................................................. 85 Alcohol Use in Past Month, Persons Aged 12 to 20 Years, by EOHHS Region, Massachusetts : 2002-2004 ...................................................................................... 87 Binge Drinking in Past Month, Persons Aged 12 to 20 Years, by EOHHS Region, Massachusetts : 2002-2004 ...................................................................................... 87 Any Illicit Drug Use in Past Month, Persons Aged 12+ Years, by EOHHS Region, Massachusetts: 2002-2004 ....................................................................................... 88 Any Illicit Drug Use Other Than Marijuana use in Past Month, Persons Aged 12+ Years, by EOHHS Region, Massachusetts: 2002-2004 ............................................ 88

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Alcohol Dependence or Abuse in Past Year, Persons Aged 12+ Years, by EOHHS Region, Massachusetts : 2002-2004......................................................................... 89 Dependence or Abuse of Any Illicit Drug or Alcohol in Past Year, Persons Aged 12+ Years by EOHHS Region, Massachusetts : 2002-2004 ........................................... 89 Adults who Binge Drink, by EOHHS Region, Massachusetts : 2005......................... 90 Adults who Used Illicit Drugs in Past Month by EOHHS Region, Massachusetts : 2005 .......................................................................................................................... 90 Substance Abuse Treatment Program Admissions by EOHHS Region, Massachusetts : 2005 .............................................................................................. 91 Substance Abuse Treatment Program Admissions, Alcohol Primary Substance, by EOHHS Region, Massachusetts : 2005 .................................................................... 91 Abuse Treatment Program Admissions, Alcohol Primary Substance, by Metrowest Cities, Massachusetts: 2005 ..................................................................................... 92 Substance Abuse Treatment Program Admissions, Cocaine Primary Substance, by EOHHS Region, Massachusetts: 2005 ..................................................................... 92 Substance Abuse Treatment Program Admissions, Cocaine Primary Substance, by Metrowest Cities, Massachusetts: 2005.................................................................... 93 Substance Abuse Treatment Program Admissions, Crack Primary Substance, by Metrowest Cities, Massachusetts: 2005.................................................................... 93 Substance Abuse Treatment Program Admissions, Heroin Primary Substance, by Metrowest Cities, Massachusetts : 2005................................................................... 94 Substance Abuse Treatment Program Admissions, Heroin Primary Substance, by EOHHS Region, Massachusetts: 2005 ..................................................................... 94 Opioid-related Emergency Visit Rates by EOHHS Region, Massachusetts: 2003- 2005 .......................................................................................................................... 95 Opioid-related Emergency Department Visit Rate by Metrowest Cities and Massachusetts : 2005 ............................................................................................... 95 Opioid-related Emergency Department Visit Rates by Race and Ethnicity Metrowest Region, Massachusetts : 2003-2005......................................................................... 96 Opioid-related Emergency Department Visit Rates by Race and Ethnicity Quincy, Randolph, and Somerville vs. Massachusetts : 2003-2005 .....................................................96 Massachusetts City and Town FY03-05, Total Number of Opioid Overdose Related Deaths....................................................................................................................... 97 Massachusetts City and Town FY03-05, Total Number of Opioid Overdose Related Deaths....................................................................................................................... 97 Opioid-Related Fatal Overdoses by EOHHS Region, Massachusetts : 2003-2005 .. 98 Opioid-Related Fatal Overdoses by Race/Ethnicity, Metrowest Cities and Massachusetts : 2003-2005 ...................................................................................... 98 Massachusetts City and Town FY03-05, Total Number of Poly-Drug Overdose related Deaths....................................................................................................................... 99 Massachusetts City and Town FY03-05, Total Number of Poly-Drug Overdose related Deaths ...............................................................................................................................................................99 Summary Substance Abuse Indicators Percentages by EOHHS Regions.............. 100 Summary Substance Abuse Indicators by EOHHS Region, Massachusetts: 2005. 100 Summary Opioid Indicators by EOHHS Regions, Massachusetts: 2003-2005........ 101

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INJURY AND VIOLENCE ........................................................................................... 103 Causes of Injury Deaths, Metrowest Region and Massachusetts: 2005 ................. 105 Injury-Related Hospital Discharge Rates by Race and Ethnicity, Metrowest Region and Massachusetts: 2003-2005 .............................................................................. 105 Emergency Department Visit Rates for Injuries and Poisonings by EOHHS Region, Massachusetts : 2003-2005 .................................................................................... 106 Emergency Department Visit Rates for Injuries & Poisonings by Race/Ethnicity, Metrowest Region and Massachusetts : 2003-2005 ............................................... 106 Injury Death Rates by EOHHS Region and Massachusetts: 2003-2005................. 107 Hospital Discharge Rates for Traumatic Brain Injuries by EOHHS Region, Massachusetts : 2003-2005 .................................................................................... 107 Hospital Discharge Rates for Traumatic Brain Injury by Race/Ethnicity, Metrowest Region and Massachusetts : 2003-2005................................................................. 108 Emergency Department Visit Rates for Traumatic Brain Injury, Metrowest Cities and Massachusetts : 2003-2005 .................................................................................... 108 Emergency Department Visit Rates for Traumatic Brain Injury, by EOHHS Region, Massachusetts : 2003-2005 .................................................................................... 109 Emergency Department Visit Rates for Traumatic Brain Injury by Race/Ethnicity, Metrowest Region and Massachusetts : 2003-2005 ............................................... 109 Hospital Discharge Rates for Assaults, by EOHHS Region, Massachusetts: 2003-2005 ........................................................................................................................ 110 Hospital Discharge Rates for Assaults by Race/Ethnicity, Metrowest Region and Massachusetts: 2003-2005 ..................................................................................... 110 Homicides by EOHHS Region, Massachusetts : 2003-2005................................... 111 Homicide Rates by Race/Ethnicity, Metrowest Region and Massachusetts : 2003-2005 ........................................................................................................................ 111 Hospital Discharge Rates for Self-Inflicted Injury, by EOHHS Region, Massachusetts : 2003-2005 .................................................................................... 112 Hospital Discharge Rates for Self-Inflicted Injuries by Race/Ethnicity, Metrowest Region and Massachusetts: 2003-2005.................................................................. 112 Suicide by EOHHS Region, Massachusetts: 2003-2005......................................... 113 Suicide Rates by Race/Ethnicity, Metrowest Region and Massachusetts: 2003- 2005 ........................................................................................................................ 113 Hospital Discharge Rates for Motor Vehicle-Related Injuries by EOHHS Region and Massachusetts : 2003-2005 .................................................................................... 114 Hospital Discharge Rates for Motor Vehicle-Related Injuries by Race/Ethnicity, Metrowest Region and Massachusetts: 2003-2005 ................................................ 114 Emergency Department Visit Rates for Motor Vehicle-Related Injuries by Metrowest Cities and Massachusetts : 2003-2005 ................................................................... 115 Motor Vehicle-related Mortality Rates by EOHHS Region, Massachusetts : 2003-2005 ........................................................................................................................ 115 Motor Vehicle-related Death Rates by Race/Ethnicity, Metrowest Region and Massachusetts: 2003-2005 ..................................................................................... 116 Emergency Department Visit Rates for Firearm Injuries, by EOHHS Region, Massachusetts: 2003-2005 ..................................................................................... 116

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Emergency Department Visit Rates for Firearm Injuries, by Metrowest Cities and Massachusetts: 2003-2005 ..................................................................................... 117 Emergency Department Visit Rates for Firearm Injuries by Race/Ethnicity, Metrowest Region and Massachusetts: 2003-2005.................................................................. 117 Firearm Death Rates by EOHHS Region, Massachusetts: 2003-2005 ................... 118 Firearm Death Rates by Race/Ethnicity, Metrowest Region and Massachusetts: 2003-2005 ............................................................................................................... 118 Hospitalization Rates for Fall-Related Injuries Ages 65+, by EOHHS Region, Massachusetts : 2003-2005 .................................................................................... 119 Hospital Discharge Rates for Fall-Related Injuries by Race/Ethnicity, Metrowest Region and Massachusetts : 2003-2005................................................................. 119 Fall-Related Injury Death Rates Persons 65+ by EOHHS Region, Massachusetts : 2003-2005 ............................................................................................................... 120 Hospital Discharge Rates for Fall-Related Injuries by EOHHS Region and Massachusetts : 2003-2005 .................................................................................... 120 Hospital Discharge Rates for Fall-Related Injuries by Race/Ethnicity, Metrowest Region and Massachusetts : 2003-2005................................................................. 121 Emergency Department Visit Rates for Fall-Related Injuries, by EOHHS Region, Massachusetts : 2003-2005 .................................................................................... 121 Emergency Department Visit Rates for Fall-Related Injuries by Race/Ethnicity, Metrowest Region and Massachusetts : 2003-2005 ............................................... 122 Fall-Related Injury Mortality Rates by EOHHS Region, Massachusetts : 2003-2005122 Fall-Related Injury Mortality Rates by Race/Ethnicity, Metrowest Region and Massachusetts : 2003-2005 .................................................................................... 123 Work-related Injuries, Emergency Department Visits per 100 Full Time Equivalents, Massachusetts Counties: 2004-2005 ...................................................................... 123 Work-related Injuries among Teens, Emergency Department Visits per 100 Full Time Equivalents, Massachusetts Counties: 2004-2005.................................................. 124 Work-related Burn Injuries, Emergency Department Visits per 10,000 Full Time Equivalents, Massachusetts Counties: 2004-2005.................................................. 124 Work-related Amputations, Emergency Department Visits per 10,000 Full Time Equivalents, Massachusetts: 2004-2005................................................................. 125 Work-related Injuries, Hospitalizations per 10,000 Full Time Equivalents, Massachusetts Counties: 2004-2005 ...................................................................... 125 Number and Rate of Fatal Occupational Injuries by year, Massachusetts: 1991- 2005 ........................................................................................................................ 126 Summary Injury/Violence Hospitalization Indicators by EOHHS Regions, Massachusetts : 2003-2005 .................................................................................... 126 Summary Injury/Violence Emergency Department Indicators by EOHHS Regions, Massachusetts : 2003-2005 .................................................................................... 127 Summary Injury/Violence Mortality Indicators Southeast Region by EOHHS Regions, Massachusetts : 2003-2005 .................................................................................... 127

HIV/AIDS..................................................................................................................... 129

Persons Living with HIV, by EOHHS Region, Massachusetts: 2005....................... 131 HIV Incidence, by EOHHS Region, Massachusetts: 2005 ...................................... 131

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HIV Incidence, by Metrowest Cities, Massachusetts: 2005 ..................................... 132 Persons Living with HIV, by Metrowest Cities, Massachusetts: 2005 ..................... 132 Persons Living with AIDS, Metrowest Region and Massachusetts : 2005............... 133 AIDS Incidence, by EOHHS Region, Massachusetts: 2005 .................................... 133 Persons Living with AIDS, by EOHHS Region, Massachusetts : 2005 ................... 134 Living with AIDS, Metrowest Cities and Massachusetts : 2005 ............................... 134 HIV/AIDS Mortality Rates, by EOHHS Region, Massachusetts : 2003-2005 .......... 135 HIV/AIDS Mortality Rates, by Metrowest Cities, Massachusetts : 2003-2005 ......... 135 HIV/AIDS Death Rates by Race/Ethnicity, Metrowest Regions and Massachusetts: 2003 - 2005 ............................................................................................................. 136 Summary HIV/AIDS Indicators by EOHHS Regions ............................................... 136

INFECTIOUS DISEASES ........................................................................................... 137

Chlamydia Incidence, Metrowest Region and Massachusetts : 1989-2005 ............ 139 Chlamydia Incidence by EOHHS Region, Massachusetts: 2005 ............................ 139 Chlamydia Incidence, Metrowest Region and Massachusetts : 2003-2005 ............ 140 Chlamydia Incidence Rate by Emergency Preparation Region, 2006..................... 140 Gonorrhea Incidence by EOHHS Region, Massachusetts : 2005 ........................... 141 Syphilis Incidence, Metrowest Region and Massachusetts : 1989-2005................. 141 Syphilis Incidence, by EOHHS Region, Massachusetts : 2005 ............................... 142 Syphilis Incidence, Metrowest Cities and Massachusetts : 2003-2005 ................... 142 Tuberculosis Incidence, by EOHHS Region, Massachusetts : 2004 ....................... 143 Tuberculosis Incidence, by EOHHS Region, Massachusetts : 2006 ....................... 143 Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region, Massachusetts: 2006 .............................................................................................. 144 Percent Confirmed Tuberculosis Cases by EOHHS Region, Massachusetts : 2006144 Percent of Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region, Massachusetts : 2006 ............................................................................................. 145 Tuberculosis Cases by EOHHS Region, Massachusetts : 1993-2006 .................... 145 Percent of Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region, Massachusetts : 2006 ............................................................................................. 146 Hepatitis C Average Incidence Rates, by EOHHS Region, Massachusetts: 1992- 2006 ........................................................................................................................ 146 Massachusetts Hepatitis C Infection Average per Year, by Town, 1992-2006........ 147 Hepatitis C Incidence Rates, by EOHHS Region, Massachusetts : 2006................ 147 Massachusetts Hepatitis C Infection Average per Year, by Town, 2006................. 148 Lyme Disease Incidence by EOHHS Region, and Massachusetts: 2004................ 148 Massachusetts Lyme Disease Case Rates, by Town, 2005.................................... 149 Pneumonia and Influenza Hospital Discharges by EOHHS Region, Massachusetts: 2005 ........................................................................................................................ 149 Summary Infectious Disease Indicators, by EOHHS Regions................................. 150

ASTHMA..................................................................................................................... 151

Pediatric Asthma Prevalence Among School Children, Grades K-8, by EOHHS Region, Massachusetts : 2005-2006....................................................................... 153

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Pediatric Asthma Prevalence Among School Children, Grades K-8, by CHNA with Metrowest Region, Massachusetts : 2004-2005 ..................................................... 153 Asthma Hospital Discharges by EOHHS Region, Massachusetts: 2005................. 154 Asthma Emergency Department Visits, by EOHHS Region, Massachusetts: 2005 154 Emergency Department Visit Rates for Asthma by Race/Ethnicity, Metrowest Region and Massachusetts: 2005 ....................................................................................... 155 Adults who Currently have Asthma by EOHHS Region, Massachusetts: 2005....... 155 Hospital Discharge Rates for Asthma by Metrowest Cities, Massachusetts: 2005.. 156 Asthma ER Visits, Children Ages 0-4, by EOHHS Region, Massachusetts : 2005 . 156 Asthma ER Visits, Children Ages 5-9, by EOHHS Region, Massachusetts : 2005 . 157 Asthma ER Visits, Children Ages 10-14, by EOHHS Region, Massachusetts : 2005 ........................................................................................................................ 157 Asthma ER Visits, Children Ages 0-14, by EOHHS Region, Massachusetts : 2005 158 Asthma Emergency Department Visit Rates, Children Ages 0-14, Metrowest Region and Massachusetts : 2005 ...................................................................................... 158 Pediatric Asthma Prevalence Among School Children, Grades K-8, EOHHS Region and Massachusetts : 2005 ...................................................................................... 159 Pediatric Asthma Emergency Visit Rates by Towns Among Children, Ages <5, Metrowest Region and Massachusetts : 2004-2005 ............................................... 159 Pediatric Asthma Hospitalization Rates by Towns Among Children, Ages <5, Metrowest Region and Massachusetts : 2004-2005 ............................................... 160 Summary Asthma Indicators, by EOHHS Regions, Massachusetts : 2005............. 160 Summary Asthma Indicators, by EOHHS Regions, Massachusetts : 2005............. 161

OTHER HEALTH INDICATORS................................................................................. 163 Total Cases of Elevated Blood Lead Levels (>=15 µG/DL), by EOHHS Region, Massachusetts: 2005 .............................................................................................. 165 Lead Poisoning Prevalence Rates (BLL≥ 25 µG/DL), Children 9-48 Months, by EOHHS Region, Massachusetts: 2006 ................................................................................. 165 Adults who Report Experiencing Intimate Partner Violence by Gender and EOHHS Region, Massachusetts: 2005 ................................................................................. 166 Adults who Report Having a Disability by EOHHS Region, Massachusetts : 2005 . 166 Adults who Report Having a Disability and needing help with activities, by EOHHS Region, Massachusetts : 2005 ................................................................................ 167 Adults with Fair or Poor Health, by EOHHS Region, Massachusetts : 2005 ........... 167 Adults who Reported Fair or Poor Health by Race and Ethnicity, Metrowest Region and Massachusetts : 2005 ...................................................................................... 168 Adults who Visited a Dentist in Past Year, by EOHHS Region, Massachusetts : 2004 ........................................................................................................................ 168 Adults who have lost 6 or More Teeth to Decay or Disease, by EOHHS Region, Massachusetts : 2004 ............................................................................................. 169 Adults with Poor Mental Health for 15+ Days in Past Month, by EOHHS Region, Massachusetts : 2005 ............................................................................................. 169 Summary Other Health Indicators, by EOHHS Regions.......................................... 170 Summary Other Health Indicators, by EOHHS Regions.......................................... 170 Refugees Arrivals: Metrowest Region, FY02-FY06................................................. 171

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Refugees Health Assessment Findings: Metrowest Region, FY02-FY06................ 171 Premature Mortality Rate (PMR) ............................................................................. 172 Premature Mortality Rates (PMR) by EOHHS Region, Massachusetts : 2005........ 172 PMR – Metrowest Region by City/Town, Massachusetts : 2005 ............................. 173 Median Household Income and PMR by EOHHS Region, Massachusetts: 2005 ... 173 Premature Mortality Rate (PMR) by EOHHS Regions: 2005................................... 174

SUMMARY.................................................................................................................. 175 Summary................................................................................................................. 177 Health Disparities .................................................................................................... 177

APPENDIX.................................................................................................................. 179 Regions and Towns ................................................................................................ 181 Data Sources .......................................................................................................... 189

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NOTE TO READERS

Background This report presents important health indicators for your region, which were developed as background material for the Regional Health Dialogues being held across the Commonwealth in May and June 2007. These dialogues offer an opportunity for you to have a conversation with the Commissioner of Public Health, learn the latest health information for your region, identify your resources and areas of need, and together, with the Massachusetts Department of Public Health, shape a public health partnership. Contents This report provides information about the socio-demographics, health care access, births, deaths, major chronic and infectious disease rates, substance abuse, and injury and violence for your region. Your region’s indicators are compared with those of other regions and to the state as a whole in order to provide you with a sense of the relative health of your region. Many indicators for your region are stratified by race, Hispanic ethnicity, and age in order help determine specific population groups that may require targeted health interventions. We have also provided information about the health status of one or more large communities in your region, which may be influencing your regional outcomes. We hope that this collection of important and diverse health indicators will stimulate discussions of local health priorities, as well as serving as a resource for health information and a reference for data that are available from the Massachusetts Department of Public Health. Please contact us with your comments and suggestions.

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INTRODUCTION

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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

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

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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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SOCIODEMOGRAPHIC INDICATORS

21

1

WesternRegion Central

Region

SoutheastRegion

Metro WestRegion

NortheastRegion

BostonRegion

Executive Office of Healthand Human Services Regions

Western RegionCentral RegionNorth East RegionMetro West RegionSouth East RegionBoston Region

2

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. Cambridge vs. the rest of the region)

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

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

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3

STOW

DOVER

MILLIS

LINCOLN

LITTLETON CARLISLE

SHERBORN

PLAINVILLE

COHASSET

SOUTHBOROUGH

BOXBOROUGHACTON

SHARON

SUDBURY

CONCORD

HINGHAMHOPKINTON

CANTON

NATICK

WALPOLE

NORWELL

QUINCY

NEWTON

WESTON

FRAMINGHAM

WRENTHAM

MILTON

SCITUATEHOLLISTON

NORFOLK

MEDFIELD

LEXINGTON

FOXBOROUGH

BEDFORD

WALTHAM

MARLBOROUGH

HUDSON

ASHLAND

NEEDHAM

WAYLAND

WEYMOUTH

WOBURN

WESTBOROUGH

WILMINGTON

BRAINTREE

DEDHAM

NORTHBOROUGH

NORWOODRANDOLPH

WESTWOOD

BURLINGTON

WELLESLEY

CAMBRIDGE

MAYNARD

HULL

BELMONT

WINCHESTER

ARLINGTON

SOMERVILLE

WATERTOWN

BROOKLINE

Population in Communities Metrowest Region: 2005

Largest:Cambridge

101,529

Smallest:Sherborn

4,220

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

Population> 10,000

4Race and Ethnic Breakdown of Population

Metrowest Region and Massachusetts: 2005

Black* 6.0%

Hispanic 7.9%

White* 81.0%

Asian* 4.9%

Amer. Indian* 0.2%

Amer. Indian* 0.2%

Asian* 7.8%

White* 83.8%

Black* 4.3%

Hispanic 3.9%


* Non-Hispanics


Total Population: 1,488,582 Total Population: 6,349,097

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Black* 14.9%

Hispanic 8.2%

Asian* 15.3%

Amer. Indian* 0.3%

White* 61.3%

Asian*20.8%

Hispanic2.7%

Black*3.2%

White*73.2%

Amer. Indian*0.2%

Race and Ethnic Breakdown of PopulationCambridge and Quincy : 2005

Cambridge

* Non-Hispanics

Quincy


Total Population: 101,529 Total Population: 90,458

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White* 74.2%

Amer. Indian* 0.2%

Black* 5.8%

Hispanic 12.4%

Asian* 7.4%

Race and Ethnic Breakdown of PopulationSomerville and Framingham: 2005

Framingham

* Non-Hispanics


Total Population: 65,652

Asian*8.9%

Hispanic10.1%

Black*8.4% White*

72.4%

Amer. Indian*0.2%

Somerville

Total Population: 75,372

24

7

Population by Age Group Metrowest Region and Massachusetts: 2005

13.6%

26.6%

29.5%

5.9%

24.4%

Metro west

Region

10.6%

19.0%

39.3%

12.7%

18.4%

Somerville

12.9%

25.1%

32.1%

6.4%

23.5%

Framingham

13.3%15.9%9.3%65+ years

25.3%25.2%20.2%45-64 years

29.4%32.9%36.0%25-44 years

6.7%6.5%15.4%20-24 years

25.5%19.5%19.1%0-19 years

MA Total

QuincyCambridgeAges

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

8

Language Spoken at Home,Metrowest Region and Massachusetts: 2000

Cambridge Quincy Metrowest Region Massachusetts

Only English 68.8 76.2 82.4 81.3

Spanish or Spanish Creole 6.8 1.9 3.3 6.2

Chinese 3.7 10.5 2.3 1.2

Portuguese or Portuguese Creole

3.0 0.7 2.0 2.7

Italian 1.0 1.2 1.3 1.0

French (Incl. Patois, Cajun) 2.3 0.7 1.2 1.4

Russian 0.8 0.3 0.8 0.6

French Creole 2.9 0.2 0.7 0.7

Greek 0.5 0.5 0.7 0.5

German 0.8 0.4 0.5 0.3

Korean 1.5 0.1 0.4 0.2

Vietnamese 0.3 1.5 0.3 0.5


25

9

FRAMINGHAM 9.9%

NORFOLK 6%

MARLBOROUGH 5.3%

WALTHAM 7.5%CAMBRIDGE 6.8%

SOMERVILLE 7.8%

BROOKLINE 4%

Spanish LanguageSpoken at Home (%)

Cities/Towns in Metro West Region

10.0% - 55.3%

5.0% - 9.9%

0.2% - 4.9%

10

Miles

Spanish Spoken at Home in Metrowest Region: 2000


10

Socio-Demographic IndicatorsMetrowest Region and Massachusetts: 2000

4.1%

21.2%

29.2%

12.9%

8.1%

$27,758

Framingham

4.0%

29.3%

35.6%

19.4%

12.5%

$23,628

Somerville

5.1%

12.2%

18.7%

15.2%

9.3%

$25,952

MA

4.2%5.2%3.6%Unemployed

12.1%20.0%25.9%Foreign born

21.9%23.8%31.2%Speak language other than English at home

9.0%14.8%10.5%Less than a High School Educ.

5.3%7.3%12.9%Those living below 100% poverty

$34,341$26,001$31,156Per Capita Income

Metrowest

Region

QuincyCambridge

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

26

11

$23,413

$23,628

$24,976

$25,952

$34,341

$52,866

$53,285$79,640

$0 $20,000 $40,000 $60,000 $80,000

Randolph

Somerville

Weymouth

Massachusetts

Metro West

Wellesley

Sudbury

Weston

Highest and Lowest Per Capita Income by Community1 in Metrowest Region: 2000

High

Low

1 Selected among communities with at least 10,000 populationSource: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

27

HEALTH CARE ACCESS

29

12

Adults who Have No Health Insurance by EOHHS Region, Massachusetts: 2005

11.3

8.9

4.6

9.4

12.3

6.8

11.4

0

5

10

15

20

Western Central Northeast Metrowest Southeast Boston MA

Perc

ent

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

**

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

13

10.4

85.3

12.3

Western

9.2

88.2

11.3

South East

9.47.07.810.48.8% Adults who were unable to see a doctor due to cost

78.390.385.890.087.1

% Adults who have a

personal health care

provider

11.44.69.46.88.9% Adults with

no health insurance

BostonMetro West NortheastCentralMA

Total Indicator

Summary Indicators for Health Insurance by EOHHS Regions, Massachusetts: 2005

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


31

BIRTH INDICATORS

33

14

5.1

7.0

5.0

3.9

0

1

2

3

4

5

6

7

8

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

Year

IMR

(# d

eath

s/1,

000

live

birt

hs)

Infant Mortality Rate (IMR) Metrowest Region and Massachusetts: 1990-2005

Massachusetts

Metrowest Region

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology ProgramInfant Mortality Rate: deaths of infants less than one year of age per 1000 live births

15

Infant Mortality Rates by EOHHS Region Massachusetts: 2002-2005

4.8 4.9

4.0**4.7

5.6 5.4 5.7

0

1

2

3

4

5

6

7

8

9

10

Western Central Northeast Metrowest Southeast Boston MA

Infa

nt D

eath

s pe

r 1,0

00 L

ive

Birt

hs

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

34

16

Infant Mortality Ratesby Metrowest Cities and Massachusetts: 2000-2005

4.54.9

3.83.73.8

6.5

0

5

10

Cambridge Quincy Somerville Framingham Metrowest MA

Infa

nt d

eath

s pe

r 1,0

00

live

birt

hs



**

17

4.2

7.3

4.1

1.7

4.04.13.0

4.9

7.0

11.2

0

2

4

6

8

10

12

White non-Hispanic

Black non-Hispanic

Hispanic Asian Overall

Dea

ths

per 1

,000

live

birt

hs

Metrowest

Massachusetts

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

NA= Calculations based on less than 5 events are excludedSource: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program* Statistically Significantly different from state (p ≤.05)

35

18

Low Birthweight by EOHHS RegionMassachusetts: 2005

8.3 7.97.1

7.68.2

7.5

9.4

0

2

4

6

8

10

WesternMass

Central Mass Northeast Metro West Southeast BostonRegion

MA

Perc

ent o

f LB

W B

irths

(%)


**

*

Low birthweight: less than 2,500 grams or 5.5 pounds


19

7.3 7.9

13.9

7.2 7.1

0

2

4

6

8

10

12

14

16

Cambridge Quincy Sharon Metrowest Massachusetts

Perc

ent o

f LB

W B

irths

(%)

Low Birthweight byMetrowest Cities and Massachusetts: 2005



**

*

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

36

20

Breastfeeding by EOHHS Region Massachusetts: 2005

79.371.5

88.477.6

68.779.5

86.9

0

10

20

30

40

50

60

70

80

90

100

WesternMass

Central Mass Northeast Metro West Southeast BostonRegion

MA

Perc

ent


*

**

*

**

Mother was breastfeeding or intending to breastfeed at the time the birth certificate was completed.Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

21

21.7

35.1

13.0**

8.3**

0

5

10

15

20

25

30

35

40

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

Birt

hs p

er 1

,000

w

omen

age

s 15

-19

Teen Birth RateMetrowest Region and Massachusetts: 1990-2005

Massachusetts

Metrowest Region

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology ProgramTeen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19.Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

37

22

Teen Birth Rates1 by EOHHS Regions Massachusetts: 2005

23.1 21.7

8.3

23.0

31.0

22.6

29.4

0

5

10

15

20

25

30

35

Western Central Northeast MetroWest

Southeast Boston MA

Birt

hs p

er 1

,000

w

omen

age

s 15

-19


*

**

*

1Teen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19.Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

23

Central22.6

Southeast23.1

Northeast22.9

Western31.0

Boston29.4Metro

West8.3

Teen Birth Rates by Executive Office of Health and Human Service(EOHHS) Regions, Massachusetts Births 2005

EOHHS Teen Birth Rateper 1,000 15-19 Female Population

Significantly higher than state rateNot different from state rateSignificantly lower than state rate

Lowest


Teen Birth Rates by EOHHS Region Massachusetts: 2005

Teen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19.

State Teen Birth Rate: 21.7

38

24

Teen Birth Rates by Towns*Metro West Region Births 2005

Town Teen Birth Rateper 1000 15-19 Female Population


*Towns with less than 100 births were excluded.

Teen Birth Rates by City/Town Metrowest Region: 2005


Teen Birth RateMA: 21.7

Metrowest: 8.3**

25

Teen Births to White non-Hispanic Mothersby Metrowest Cities and Massachusetts: 2003-2005

16.4

13.5

20.6

15.9

6.1

0

5

10

15

20

25

Quincy Weymouth Marlborough Metrowest Massachusetts

Birt

hs p

er 1

,000

w

omen

age

s 15

-19



**

*

39

26

Teen Births to Black non-Hispanic Mothersby Metrowest Cities and Massachusetts: 2003-2005

26.1

36.8

95.1

15.4 18.6

0

25

50

75

100

Framingham Somerville Quincy Metrowest Massachusetts

Birt

hs p

er 1

,000

w

omen

age

s 15

-19



**

*

**

27Teen Birth Rates by Race and Ethnicity Metrowest Region and Massachusetts: 2005

36.4

12.95.8

20.1

38.4

73.2

15.3

2.50

10

20

30

40

50

60

70

80

Metrowest Region Massachusetts

Birt

hs p

er 1

,000

w

omen

age

s 15

-19

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


**

Teen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19.Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

**

**

**

40

28

Adequate Prenatal Care by EOHHS Regions Massachusetts: 2005

83.6 84.087.582.079.5

85.4 84.3

0

20

40

60

80

100


Southeast Boston MA

Perc

ent


*** * **

Based on Adequacy of Prenatal Care Utilization (APNCU) Index.


29

17.2**

12.1**

32.625.7

0

5

10

15

20

25

30

35

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

Perc

ent

Public Source1 of Payment for Prenatal CareMetrowest Region and Massachusetts: 1990-2005

Metrowest Region

Massachusetts


1Public: Government programs including Commonhealth, Healthy Start, Medicaid/MassHealth, or free care. Private: Commercial indemnity plan, commercial Managed care (HMO, PPO, IPP, IPA and other) or other private insurance.Statistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than state

41

30

Public Source of Payment for Prenatal Care Metrowest Region and Massachusetts: 2005

Private83%

Public17%


Public 33%

Private67%

31

Public Source of Prenatal Care Payment byMetrowest Cities and Massachusetts: 2003-2005

32.6

17.2

33.036.6

17.0

40.7

0

15

30

45

Cambridge Quincy Framingham Somerville Metrowest MA

Perc

ent o

f Pub

lic P

aym

ent B

irths

(%)


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

**

**

Public: Government programs including Commonhealth, Healthy Start, Medicaid/MassHealth, and free care

**

42

32

7.2

19.3

3.2**

13.1**

0

2

4

6

8

10

12

14

16

18

20

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

Perc

ent

Smoking During PregnancyMetrowest Region and Massachusetts:

1990-2005

Massachusetts

Metrowest Region



33

Smoking During Pregnancy by EOHHS Regions Massachusetts: 2005

10.27.3

3.2

7.2

13.5

7.6

3.9

0

5

10

15

20

25

30


Southeast Boston MA

Perc

ent


*

**

*

**


43

34Smoking During Pregnancy by Race and Ethnicity


8.4

6.1

3.83.4

5.2

1.9

0.3

1.4

0

1

2

3

4

5

6

7

8

9


Perc

ent




****

**

**

35Percent of Mothers Smoking During Pregnancy for Largest Communities

Metrowest Region: 2005


76,6535,5557.2%Massachusetts

17,0595513.2%**Metrowest

BirthsSmokers%

39251.3%**Watertown78881.0%**Newton418102.4%**Natick

Lowest

901495.4%**Somerville1136,504.4%**Quincy

692578.2%WeymouthHighest


44

36

34.2

23.3

32.3

22.5

15

20

25

30

35

40

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

Perc

ent

Infants Delivered by C-Section Metrowest Region and Massachusetts: 1990-2005

Massachusetts


Metrowest Region *


37

Infants Delivered by C-Section by EOHHS Regions Massachusetts: 2005

34.632.334.234.4

27.129.5 29.9

0

20

40


Southeast Boston MA

Perc

ent


**

*

***

***


45

38Percent of Cesarean Deliveries by Race and Ethnicity

Metrowest Region and Massachusetts : 2005

33.733.534.739.7

31.827.1 28.930.1

0

15

30

45


Perc

ent




*

**

*

39

Central29.5%

Southeast34.6%

Northeast34.4%

Western27.1%

Boston29.9%Metro

West34.2%

Percentage of Cesarean Births by Executive Office of Health and Human Service(EOHHS) Regions, Massachusetts Births 2005

EOHHS Region's % Cesarean BirthsSignificantly higher than state rateNo different from state rateSignificantly lower than state rate


State %Cesarean Births: 32.3

46

40

Percent of Cesarean Deliveries by City/Town Metrowest Region: 2005

% Cesarean BirthsState: 32.3% Metrowest: 34.2%*


SHARON42.0

FRAMINGHAM38.9

WEYMOUTH36.5

BRAINTREE38.3

NORWOOD37.7

RANDOLPH41.6

WESTWOOD41.9

WATERTOWN38.3

WEYMOUTH36.5

Town's % of Cesarean BirthsSignificantly higher than state rate

No different from state rate

Significantly lower than state rate

Towns with less than 100 births were excluded.

41

13.5

47.4

68.7

8.2

27.1

79.5

Western(n=8,935)

10.2

34.7

71.5

8.3

34.6

83.6

South East

(n=14,681)

3.93.27.27.67.1Smoking during

pregnancy

46.417.233.727.932.6Public Pay for Prenatal Care

86.988.477.679.579.3Breastfeeding

9.47.17.67.57.9Low Birth weight (<5.5 lb)

29.934.234.429.532.3C-section deliveries

84.387.582.085.484.0Adequate

Prenatal Care (Kotelchuck index)

Boston (n=9,644)

Metro West

(n=17,093)

Northeast(n=15,939)

Central(n=10,532)

MATotal

(n=76,824)

Indicator (as % of race group births)

Summary Birth Indicators by EOHHS Regions, Massachusetts:2005



47

42Summary Birth Indicators by EOHHS Regions



31.0

5.6

Western

23.1

4.8

South East

29.48.323.022.921.7

Teen birth rate

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

5.74.04.75.44.9

Infant Mortality

Rate (2002-2005)

(infant deaths per 1000 live

births)

BostonMetro West NortheastCentral

MATotal

Indicator

49

LEADING CAUSES OF DEATH

51

43Leading Causes of DeathMetrowest Region and Massachusetts:2005


MassachusettsN=53,776

1.8%982 Septicemia

2.4%1,271 Diabetes

2.6%1,403 Nephritis

3.0%1,635 Alzheimer's

3.5%1,883 Unintentional Injuries

3.6%1,932 Influenza and pneumonia

4.9%2,643 Chronic Lower Respiratory Disease (formerly COPD)

5.5%2,979 Stroke

24.5%13,159 Cancer

24.6%13,248 Heart Disease

3.7%423Influenza and pneumonia

Metrowest RegionN=11,437

1.9%221Septicemia

2.3%265Diabetes

2.6%302Nephritis

3.0%341Alzheimer's

3.0%344Unintentional Injuries

4.7%541Chronic Lower Respiratory Disease (formerly COPD)

5.7%656Stroke

24.2%2,771Heart Disease

25.2%2,881Cancer

53

CHRONIC DISEASE OUTCOMES AND OVERWEIGHT/OBESITY

55

44

Overweight ObesityHeight BMI 25.0-29.9 BMI > 30

5’ 128 lbs. 153 lbs.

5’2’’ 136 164

5’4’’ 145 1745’6’’ 155 186

5’8’’ 164 197

6’ 184 221

6’2” 195 234

Thresholds for Defining Overweight and Obesity


45Adults who are Overweight1

by EOHHS Region, Massachusetts: 1995 & 2005

57.8

49.5 45.7 43.5 44.6

50.2

35.7

45.1

52.057.5

60.855.9

52.656.1

0

10

20

30

40

50

60

70


Southeast Boston MA

Perc

ent

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


56

46Adults who are Obese1

by EOHHS Region, Massachusetts: 1995 & 2005

23.6

11.7

8.1

16.8

9.610.211.6

14.3

20.7

16.819.2

23.321.7 20.9

0

5

10

15

20

25

30


Southeast Boston MA

Perc

ent

1995 2005

**

1 Obesity: BMI greater than or equal to 30



47Adults who Participate in Regular Physical Activity by EOHHS Region, Massachusetts: 2005

51.8 52.654.750.656.4 51.5 49.5

0

10

20

30

40

50

60

70

80

90

100


Southeast Boston MA

Perc

ent

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Health Survey ProgramStatistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

57

48Adults who have 5+ Servings of Fruit or Vegetables by EOHHS Region, Massachusetts: 2005

26.4 28.633.0

26.428.4 29.3

26.4

0

5

10

15

20

25

30

35

40

45

50


Southeast Boston MA

Perc

ent



49

Adults who had their cholesterol checked in Past 5 Years by EOHHS Region Massachusetts: 2005

82.0 79.384.879.2

74.0 76.6 73.3

0

10

20

30

40

50

60

70

80

90

100


Southeast Boston MA

Perc

ent


**


58

50Adults who were told by a health care provider that they have high cholesterol1 by EOHHS Region

Massachusetts: 2005

36.5 35.738.434.534.2 35.9

31.2

0

5

10

15

20

25

30

35

40

45

50


Southeast Boston MA

Perc

ent


* Statistically Significantly different from state (p ≤.05) 1 Among those who reported having their cholesterol checked

51Adults who were told by a health care provider to have high blood pressure by EOHHS Region

Massachusetts: 2005

28.925.325.122.8

26.3 25.321.9

0

5

10

15

20

25

30

35

40

45

50


Southeast Boston MA

Perc

ent


59

52Adults who take Medicine for High Blood Pressure1

by EOHHS Region Massachusetts: 2005

76.5 75.373.578.676.0 74.0 71.3

0

10

20

30

40

50

60

70

80

90

100


Southeast Boston MA

Perc

ent

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Health Survey Program* Statistically Significantly different from state (p ≤.05) 1 Among those who reported having high blood pressure

53Hospital Discharge Rates for Hypertensionby EOHHS Regions and Massachusetts: 2003-2005

38.738.731.033.035.0 30.9

84.6

0

10

20

30

40

50

60

70

80

90


Southeast Boston MA

Dis

char

ges

per

100

,000

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

*

** ** ****


60

54

Hospital Discharge Rates for Hypertensionby Metrowest Cities and Massachusetts: 2003-2005

38.731.0

73.6

32.4

60.4

40.9

65.3

0

25

50

75

100

Cambridge Quincy Norwood Sharon Randolph Metrowest MA

Dis

char

ges

per 1

00,0

00


**

*

* *


55Hypertension Hospital Discharge Rate by Race/Ethnicity

Metrowest Region Massachusetts: 2003-2005

26 28

176

143

66

89

3322

0

20

40

60

80

100

120

140

160

180

200


Dis

char

ges

per 1

00,0

00




**

61

56Heart Disease Mortality Ratesby EOHHS Region

Massachusetts: 2003-2005

182.5195.1

159.8186.3188.8 196.8

177.9

0

100

200

300


Southeast Boston MA

Dea

ths

per 1

00,0

00


*

**

*


57

Heart Disease Mortality Rateby Metrowest Cities and Massachusetts: 2003-2005

185.7 182.5

231.2

161.6 159.8

0

50

100

150

200

250

Cambridge Quincy Randolph Metrowest Massachusetts

Dea

ths

per 1

00,0

00



**

*

**

Age-adjusted to the 2000 US standard population

62

58Heart Disease Death Rate by Race/EthnicityMetrowest Region and Massachusetts: 2003-2005

185187209

104

58 68

163

63

0

50

100

150

200

250

Metroewest Region Massachusetts

Dea

ths

per 1

00,0

00




**

**

59

Prevalence of Diabetes Massachusetts: 1994-2005

3.8

5.6

6.46.25.8

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

Perc

ent


63

60

Diabetes Hospital Discharges by EOHHS Region, Massachusetts: 2003-2005

130.7 132.5110.8

124.3

151.4

114.3

208.1

0

50

100

150

200

250


Southeast Boston MA

Dis

char

ges

per 1

00,0

00

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

*

** ****

*


61

Diabetes Hospital Discharges by Metrowest Cities and Massachusetts: 2003-2005

133

178

136

169178

186

111

0

25

50

75

100

125

150

175

200

Cambridge Quincy Weymouth Randolph Norwood Metrowest MA

Dis

char

ges

per 1

00,0

00


* *


*

**

*

64

62Diabetes Hospital Discharge Rate by Race/Ethnicity

Metrowest Region Massachusetts: 2003-2005

368

114105

301

151

242

4530

0

50

100

150

200

250

300

350

400


Dis

char

ges

per 1

00,0

00



**


**

**

**

63Diabetes 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

Dea

ths

per 1

00,0

00


*

**

*


65

64

Diabetes Mortality Rateby Metrowest Cities and Massachusetts: 2003-2005

25.5

18.415.1

7.7

28.9

0

5

10

15

20

25

30

35

Newton Norwood Randolph Metrowest Massachusetts

Dea

ths

per 1

00,0

00



**

**


65Diabetes Mortality Rate by Race/EthnicityMetrowest Region and Massachusetts: 2003-2005

17

38 39

19

29

14 1415

0

5

10

15

20

25

30

35

40

45

50


Dea

ths

per 1

00,0

00




**

66

66

34.2

74.0

28.4

56.4

23.3

Western

36.5

82.0

26.4

51.8

23.6

South East

31.238.434.535.935.7% Adults with

high cholesterol

73.384.879.276.679.3% Adults who

had cholesterol

checked

26.433.026.429.328.6% Adults with 5+ servings

fruits/ vegetables

49.554.750.651.552.6% Adults

Participation in regular PA

20.916.819.221.720.7% Obese Adults

BostonMetro West Northeast CentralMA

Total Indicator

Summary Indicators for Overweight/Obesityby EOHHS Regions, Massachusetts:2005



67

208.1130.7110.8124.3114.3151.4132.5Diabetes Hospital

Discharges (2003-2005)

20.3

188.8

35.0

76.0

26.3

Western

18.2

195.1

38.7

76.5

28.9

South East

21.915.117.322.618.4Diabetes Death Rate (2003-2005)

177.9159.8186.3196.8182.5Heart Disease

Death Rate (2003-2005)

84.631.032.930.938.7Hypertension

Hospital Discharges(2003-2005)

71.373.578.674.075.3% Adults take HBP medications

21.925.122.825.325.3% Adults with HBP


Total Indicator

Summary Indicators for Chronic Disease Outcomes by EOHHS Regions


67

CANCER

69

68Adults Ages 50+ who have had a Sigmoidoscopy or Colonoscopy in Past 5 Years by EOHHS Region

Massachusetts: 2005

55.0 58.868.5

53.253.960.2 58.9

0

20

40

60

80

100


Southeast Boston MA

Perc

ent

**



69Incidence Rates for Invasive Colorectal Cancer by EOHHS Region, Massachusetts: 1999-2003

56.2 58.961.8

55.2 57.263.6

59.7

0

10

20

30

40

50

60

70


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n

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

**

*


*

70

70Incidence Rates for Early Stage Colorectal Cancer MALES

by EOHHS Region, Massachusetts: 1999-2003

27.931.0

29.0

22.1

26.3

33.132.8

0

5

10

15

20

25

30

35


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


**

**

* *


71Incidence Rates for Early Stage Colorectal Cancer FEMALES


17.6 18.4 18.4

15.316.4

22.920.8

0

5

10

15

20

25


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n

****

**



71

72

Colorectal Cancer Mortality Rateby Metrowest Cities and Massachusetts: 2003-2005

19.418.017.1

7.6

21.5

0

5

10

15

20

25

30

35

Lexington Quincy Cambridge Metrowest Massachusetts

Dea

ths

per 1

00,0

00



**


73Men Ages 50 and Older who had a Prostate-Specific Antigen Test in the Past Two Years

by EOHHS Region, Massachusetts: 2004

56.3 56.162.5

52.349.152.3

66.2

0

10

20

30

40

50

60

70

80


Southeast Boston MA

Perc

ent

Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than stateSource: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Health Survey Program

72

74Men Ages 50 and Older who had a Digital Rectal Exam in the Past Two Years by EOHHS Region

Massachusetts: 2004

62.6 62.764.563.059.5 60.069.0

0

10

20

30

40

50

60

70

80

90

100


Southeast Boston MA

Perc

ent


75Adults Ages 50 and Older who had a Blood Stool Test in the Past Two Years by EOHHS Region

Massachusetts: 2005

26.430.030.9

33.534.229.9

20.7

0

5

10

15

20

25

30

35

40

45

50


Southeast Boston MA

Perc

ent

*



73

76Incidence Rates for Invasive Prostate Cancer by EOHHS Region, Massachusetts: 1999-2003

180.5 181.9170.3

159.7178.4

191.3202.5

0

50

100

150

200

250


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


**

*


**

77

Incidence Rates for Early Stage Prostate Cancer by EOHHS Region, Massachusetts: 1999-2003

140.1 140.5129.7 122.4 128.5

174.6156.6

0

20

40

60

80

100

120

140

160

180

200


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n

** ** **

**



74

78Prostate Cancer Mortality Rates


17.921.8

18.722.9

25.027.7

24.0

0

10

20

30

40

50


Southeast Boston MA

Dea

ths

per 1

00,0

00 p

opul

atio

n



79Women Ages 40 and Older who had a Clinical Breast Exam in the Past Two Years


85.6 86.687.190.085.0 85.5 85.7

0

10

20

30

40

50

60

70

80

90

100


Southeast Boston MA

Perc

ent


75

80Women Ages 40+ who have had a mammography in Past 2 Years by EOHHS Region

Massachusetts: 2005

82.0 84.187.183.486.9 83.0 80.1

0

20

40

60

80

100


Southeast Boston MA

Perc

ent


81Incidence Rates for Early Stage Female Breast Cancer


119.8 118.6105.3

113.1112.9124.9

137.6

0

20

40

60

80

100

120

140

160


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


** **

***

*


76

82

4937

3041

3132 28

57

0

25

50

75

100


Cas

es p

er 1

00,0

00 p

opul

atio

n


Incidence Rates for Non-invasive Female Breast Cancer by Race and Ethnicity,

Metrowest Region & Massachusetts: 1999-2003


*


83

139.8 138.9135.3 127.8146.7

134.9139.6

0

50

100

150

200


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


***


Incidence Rates for Invasive Female Breast Cancer by EOHHS Region,


77

84

142

95 10285 89

7561

149

0

25

50

75

100

125

150


Cas

es p

er 1

00,0

00 p

opul

atio

n


Incidence Rates for Invasive Female Breast Cancer by Race and Ethnicity,



*


85

25 2529

12 137 7

17

05

101520253035404550


Dea

ths

per 1

00,0

00 p

opul

atio

n


Female Breast Cancer Mortality Ratesby Race and Ethnicity,


Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than stateAge-adjusted to the 2000 US standard population.Source: Division of Health Care Finance and Policy. Calendar Year 2003- 2005. Hospital Discharges

**

78

86Incidence Rates for Invasive Lung Cancer by EOHHS Region, Massachusetts: 1999-2003

72.076.7

67.2 69.965.1

77.777.5

0

25

50

75

100


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


*


*** *

**

87Incidence Rates for Early Stage Lung Cancer MALES


13.915.9

19.2

15.6

11.3 11.9 11.4

0

5

10

15

20

25


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


**

*

*

** **


79

88Incidence Rates for Early Stage Lung Cancer FEMALES


10.0

12.411.2

15.0

11.4

9.6 10.0

0

2

4

6

8

10

12

14

16


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


**

*

***


89Lung Cancer Mortality Ratesby EOHHS Region, Massachusetts: 2005

52.1 52.444.6

57.356.0 55.4 54.2

0

10

20

30

40

50

60

70

80

90

Western Central Northeast Metro West Southeast Boston MA

Dea

ths

per 1

00,0

00 p

opul

atio

n


**


80

90

Lung Cancer Mortality Rateby Metrowest Cities and Massachusetts: 2003-2005

63.3

52.9

67.8

42.045.2

0

20

40

60

80

Framingham Weymouth Woburn Metrowest Massachusetts

Dea

ths

per 1

00,0

00



**


**

91

4941

54

1320

2529

55

0

10

20

30

40

50

60

70


Dea

ths

per 1

00,0

00 p

opul

atio

n


Lung Cancer Mortality Rates by Race and Ethnicity, Metrowest Region & Massachusetts:

2001-2005


**

81

92

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

Perc

ent


**


93

Current Smoker by Race and Ethnicity Metrowest Region and Massachusetts: 2005

16.218.4

12.9

18.2 17.9

0

5

10

15

20


Perc

ent

White non-Hispanic Black non-Hispanic Hispanic


NA

82

94

20.726.430.933.529.934.230.0% Blood Stool Test †

86.9

85.0

53.9

59.5

49.1

Western

82.0

85.6

55

62.6

56.3

South East

80.187.183.483.084.1% Women* Mammography

85.787.190.085.586.6% Women Clinical Breast Exam (2004)

58.968.553.260.258.8% Adults

Sigmoidoscopy or Colonoscopy†

69.064.563.060.062.7% Men†

DRE (2004)

66.262.552.352.356.1% Men†

PSA (2004)

BostonMetro West

North East

CentralMATotal

Indicator

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


*40 years and older, † 50 years and older

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

95

12.0

25.9

112.9

129.7

Western

16.1

28.7

113.1

156.6

South East

19.612.415.312.714.4Lung Cancer Incidence

32.024.329.521.326.9Colorectal

Cancer Incidence

137.6119.8124.9105.3118.6Female Breast Cancer

Incidence

174.6128.5140.1122.4140.5Prostate Cancer

Incidence

BostonMetro West

NortheastCentralMA

Total Indicator

Summary Cancer Indicators (Early Stage)by EOHHS Regions, Massachusetts: 1999-2003

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


83

96

45.8

30.6

37.9

4.9

Western

55.1

34.4

38.4

6.2

South East


42.730.635.232.933.8Colorectal

Cancer Incidence


Incidence

8.73.95.95.25.5Prostate Cancer

Incidence

BostonMetro West

NortheastCentralMA

Total Indicator

Summary Cancer Indicators (Late Stage)by EOHHS Regions, Massachusetts: 1999-2003



97

67.2

56.2

135.3

170.3

Western

77.5

59.7

139.6

202.5

South East


63.657.261.855.258.9Colorectal

Cancer Incidence


Incidence

191.3178.4180.5159.7181.9Prostate Cancer

Incidence

BostonMetro West

NortheastCentralMA

Total Indicator

Summary Invasive Cancer Incidence Ratesby EOHHS Regions, Massachusetts: 1999-2003



84

98

56.0

25.5

18.2

25.0

Western

52.1

22.5

17.2

17.9

South East

54.244.657.355.452.4Lung Cancer Death Rate

24.620.923.123.123.0Female Breast

Cancer Death Rate

18.416.417.518.317.4Colorectal

Cancer Death Rate

24.018.722.927.721.8Prostate

Cancer Death Rate

BostonMetro West

NortheastCentralMA

Total Indicator

Summary Cancer Mortality Indicators by EOHHS Regions, Massachusetts: 2005



85

SUBSTANCE ABUSE

87

99Alcohol Use in Past Month Persons Aged 12 to 20by EOHHS Region, Massachusetts: 2002, 2003, 2004

34.0 34.135.333.536.7

31.233.6

0

10

20

30

40

50


Southeast Boston MA

Perc

ent

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

100

Binge Drinking1 in Past Month Persons Aged 12 to 20by EOHHS Region, Massachusetts: 2002, 2003, 2004

24.1 24.124.722.627.2

24.621.0

0

10

20

30

40

50


Southeast Boston MA

Perc

ent

1 Binge Alcohol use is defined as drinking 5+ drinks on the same occasion on at least 1 day in the past 30 days

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.


88

101

Any Illicit Drug Use in Past Month Persons Aged 12+by EOHHS Region, Massachusetts: 2002, 2003, 2004

9.4 9.48.78.410.4

8.5

12.2

0

5

10

15

20

25


Southeast Boston MA

Perc

ent


102Any Illicit Drug Use Other than Marijuana in Past Month Persons Aged 12+ by EOHHS Region

Massachusetts: 2002, 2003, 2004

3.6 3.73.63.33.8 3.44.5

0

5

10

15

20

25


Southeast Boston MA

Perc

ent


89

103

Alcohol Dependence or Abuse in Past Year Persons Aged 12+ by EOHHS Region


7.9 8.38.77.68.6 8.09.7

0

5

10

15

20

25


Southeast Boston MA

Perc

ent


104

Dependence or Abuse of Any Illicit Drug or Alcohol in Past Year Persons Aged 12+ by EOHHS Region


9.7 10.310.29.710.6 10.012.1

0

5

10

15

20

25


Southeast Boston MA

Perc

ent


90

105Adults who Binge Drink by EOHHS Region, Massachusetts: 2005

15.3 15.714.5

16.016.4 15.818.1

0

5

10

15

20

25

30


Southeast Boston MA

Perc

ent


106

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

Perc

ent


91

107

Substance Abuse Admissions by EOHHS Region Massachusetts: 2005

1,724 1,601

871

1,379

2,044

1,441

2,978

0

500

1000

1500

2000

2500

3000

3500


Southeast Boston MA

Cru

de ra

te

per 1

00,0

00 *

** **

**

*

*

Source: Massachusetts Department of Public Health. BSAS Substance Abuse Treatment Programs 2005.Statistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than state

108Substance Abuse Admissions-Alcohol Primary Substance


571498

404

661

921821

1,010

0

200

400

600

800

1000

1200


Southeast Boston MA

Cru

de ra

te/1

00,0

00

Source: Massachusetts Department of Public Health. BSAS Substance Abuse Treatment Programs 2005.

*

** ****

*

*


92

109Substance Abuse Admissions-Alcohol Primary Substance

by Metrowest Cities, Massachusetts: 2005

661

404

925

710785

306

820

0

100

200

300

400

500

600

700

800

900

1000

Cambridge Quincy Dedham Westborough Framingham Metrowest MA

Cru

de ra

te p

er 1

00,0

00


*

**


**

**

110Substance Abuse Admissions-Cocaine Primary Substance


6558 62

4434

8899

0

20

40

60

80

100

120


Southeast Boston MA

Cru

de ra

te/1

00,0

00


****

**


93

111Substance Abuse Admissions-Cocaine Primary Substance


62

85

173

2334

0

25

50

75

100

125

150

175

200

Cambridge Quincy Dedham Metrowest MA

Cru

de ra

te p

er 1

00,0

00


*

**

*


**

112Substance Abuse Admissions-Crack Primary Substance


64

117

42

117

66

157

28

0

25

50

75

100

125

150

175

Cambridge Quincy Westborough Framingham Hopkinton Metrowest MA

Cru

de ra

te p

er 1

00,0

00


*

**

*

*


**

94

113Substance Abuse Admissions-Heroin Primary Substance


286

609

1651

690

270

612

0

250

500

750

1000

1250

1500

1750

Cambridge Quincy Framingham Westborough Metrowest MA

Cru

de ra

te p

er 1

00,0

00


**

*

*


114Substance Abuse Admissions-Heroin Primary Substance


609504

583

286

636635

1,453

0

200

400

600

800

1,000

1,200

1,400

1,600


Southeast Boston MA

Cru

de ra

te/1

00,0

00


*

**

**

*

* **


95

115Opioid-Related Emergency Department Visit Rates by EOHHS Region


181196

126

223

114

169

309

0

50

100

150

200

250

300

350


Southeast Boston MA

Visi

ts p

er 1

00,0

00

**

**

*

*

*

**

Statistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than stateAge-adjusted to the 2000 US standard population.Source: Division of Health Care Finance and Policy. Calendar Year 2003- 2005. Emergency Department Visits

116

Opioid-Related Emergency Department Visit Ratesby Metrowest Cities and Massachusetts: 2005

188

134

298

240

189

277

0

100

200

300

400

Cambridge Quincy Somerville Weymouth Metrowest MA

Visi

ts p

er 1

00,0

00


**


*

*


*

96

117Opioid-Related Emergency Department Visit Rates by Race/Ethnicity

Metrowest Region and Massachusetts: 2003-2005

187 188

237

10

141126

102

40

50

100

150

200

250


Visi

ts p

er 1

00,0

00White non-Hispanic Black non-HispanicHispanic Asian non-Hispanic

Statistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than stateAge-adjusted to the 2000 US standard population.Source: Division of Health Care Finance and Policy. Calendar Year 2003- 2005. Emergency Department Visits

**

**

****

118Opioid-Related Emergency Department Visit Rates by Race/Ethnicity Quincy, Randolph, and Somerville vs. Massachusetts: 2003-2005

187

67

188237

0 10

289238

379

84

575

112

345

0

100

200

300

400

500

600

700

Quincy Randolph Somerville Massachusetts

Visi

ts p

er 1

00,0

00 p

opul

atio

n


*

Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than stateAge-adjusted to the 2000 US standard population.Source: Division of Health Care Finance and Policy. Calendar Year 2003- 2005. Emergency Department Visits

**

*

**

*

**

97

119

120

98

121

Opioid-Related Fatal Overdosesby EOHHS Region, Massachusetts: 2003-2005

8.110.1

6.0

9.5

6.7 6.5

10.8

0

10

20


Southeast Boston MA

Dea

ths

per 1

00,0

00 p

opul

atio

n

** **

* **



122

Opioid-Related Fatal Overdoses byMetrowest Cities and Massachusetts: 2003-2005

8.77.7 8.1

6.0

15.1

0

5

10

15

20

Quincy Waltham Somerville MetrowestRegion

MA

Dea

ths

per

100

,000

pop

ulat

ion



**

*


99

123

124

100

125

9.77.98.77.68.08.68.3Alcohol Dependence or Abuse past Year,

Ages 12+

10.6

3.8

10.4

27.2

36.7

Western

9.7

3.6

9.4

24.1

34.0

South East

12.110.29.710.010.3Dependence or Abuse

of Alcohol or Any Illicit Drug, Ages 12+

4.53.63.33.43.7Any Illicit Drug Use

Other than Marijuana Past Month, Ages 12+

12.28.78.48.59.4Any Illicit Drug Use Past Month, Ages 12+

21.024.722.624.624.1Past Month Binge Drinking- 12-20 years

33.635.333.531.234.1Past Month Alcohol 12-20 years


Total Indicator

Summary Substance Abuse Indicators Percentages by EOHHS Region


Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

126

99883458446562Substance Abuse Treatment Program Admissions Rate—

Cocaine

1,010821404498571921661Substance Abuse Treatment Program Admissions Rate--

Alcohol

635

2,044

13.9

18.8

16.4

Western

504

1,724

8.1

20.4

15.3

South East

1,453286583636609Substance Abuse Treatment Program Admissions Rate—

Heroin

2,9788711,3791,4411,601Substance Abuse Treatment Program Admissions Rate

5.37.07.27.28.1% Adults using illicit drugs

19.512.418.321.218.1% Adults Smoking

18.114.516.015.815.7% Adults Binge Drinking

BostonMetro West

Northeast

CentralMATotal

Indicator

Summary Substance Abuse Indicators by EOHHS Region, Massachusetts: 2005


101

127

309196126223169114181

Opioid-related

Emergency Department Visit Rate

6.7

Western

10.1

South East

10.86.09.56.58.1

Opioid-related fatal

overdose rate


MATotal Indicator

Summary Opioid Indicators by EOHHS RegionsMassachusetts: 2003-2005


103

INJURY AND VIOLENCE

105

128Causes of Injury Deaths


Metrowest Region Total Injuries = 466

Source: Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation

Massachusetts Total Injuries = 2,657

Poisonings 30%Firearm

8%

Falls 11%

Suffocation, Hanging, or Strangulation

13%

Motor Vehicle-related

18%

Other20%

Poisonings 32%Firearm

4%

Suffocation, Hanging, or Strangulation

13%

Motor Vehicle-related

18%

Falls 12%

Other21%

129Injury-Related Hospital Discharge Rates by EOHHS Region


830.4 836.3

965.9*

858.9 *

753.2 **

872.4 * 835.9

0

200

400

600

800

1000


Dis

char

ges

per 1

00,0

00


106

130

812 831704

301

748**

590**520**

250**

0

250

500

750

1000


Dis

char

ges

per 1

00,0

00White non-Hispanic Black non-Hispanic HispanicAsian non-Hispanic Column 5

Injury-Related Hospital Discharge Rates by Race/Ethnicity,



131Emergency Department Visit Rates for Injuries & Poisonings by EOHHS Region


13,996

11,298

9,112

11,19512,323

11,37910,539

0

4000

8000

12000

16000


Southeast Boston MA

Visi

ts p

er 1

00,0

00 *

*

*

***


107

132Emergency Department Visit Rates for Injuries & Poisonings by Race/Ethnicity


14,158

10,9309,104

10,60211,930

8,952

3,2772,528

0

4,000

8,000

12,000

16,000


Visi

ts p

er 1

00,0


**


**

**

**

133

Injury Death Rates by EOHHS Region Massachusetts: 2003-2005

38.5 38.9 39.1

45.1 *46.3 *

29.1 **

43.7 *

0

5

10

15

20

25

30

35

40

45

50


Deat

hs

per

100,

000

popu

latio

n



108

134Hospital Discharge Rates for Traumatic Brain Injuries by EOHHS Region


82 80

94 *

73 *65 *

97 *93 *

0

20

40

60

80

100


Dis

char

ges

per 1

00,0

00


135Hospital Discharge Rates for Traumatic Brain Injury by Race/Ethnicity,


7682 85

39

63**58**

52**

39

0

10

20

30

40

50

60

70

80

90


Visi

ts p

er 1

00,0

00


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


109

136Emergency Department Visit Rates for Traumatic Brain Injury by EOHHS Region


604563

662

461

646 641

0

100

200

300

400

500

600

700


Southeast Boston MA

Visi

ts p

er 1

00,0

00 **

**

**

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

**


137Emergency Department Visit Rates for Traumatic Brain Injury by

Metrowest Cities and Massachusetts: 2003-2005

604563

1006

445

644

418

909

0

250

500

750

1000

1250

Cambridge Quincy Framingham Weymouth Marlborough Metrowest MA

Visi

ts p

er 1

00,0

00


**

*


*

*

** **


110

138Emergency Department Visit Rates for Traumatic Brain Injury by Race/Ethnicity


663

568** 595539** 496**

588

191** 215

0

100

200

300

400

500

600

700


Visi

ts p

er 1

00,0




139Hospital Discharge Rates for Assaults by EOHHS RegionMassachusetts: 2003-2005

2821 *

14 *

23 *24 *

72 *

34 *

0

10

20

30

40

50

60

70

80


Southeast Boston MA

Dis

char

ges

per 1

00,0

00



111

140Hospital Discharge Rates for Assaults by Race/Ethnicity, Metrowest Region and


16.1

118.4

69.2

11.811.1**

48.2**

24.4**

3.6**0

50

100

150


Dis

char

ges

per

100,

000




141Homicides by EOHHS RegionMassachusetts: 2003-2005

2.6 2.6

0.7

1.8

3.3

1.7

7.3

0

5

10


Dea

ths

per 1

00,0

00 p

opul

atio

n

**

**

*

**



112

142Homicide Rates by Race/Ethnicity


1

15

6

21**

6**

2**

0**0

2

4

6

8

10

12

14

16


Dea

ths

per 1

00,0

00




143Hospital Discharge Rates for Self-Inflicted Injury by EOHHS Region


68 66 65 6563

48**

92*

0

20

40

60

80

100


Southeast Boston MA

Dis

char

ges

per 1

00,0

00



113

144Hospital Discharge Rates for Self-Inflicted Injuries by Race/Ethnicity, Metrowest Region

and Massachusetts: 2003-2005

64 62

73

17

49**42** 39**

10**

0

20

40

60

80

100


Dis

char

ges

per 1

00,0




145

Suicides by EOHHS RegionMassachusetts: 2003-2005

6.9 6.65.3

7.47.9 7.25.5

0

5

10

15

20


Dea

ths

per 1

00,0

00 p

opul

atio

n

*



114

146Suicide Rates by Race/Ethnicity


7

2

4 4

7

5

6**

0

2

4

6

8

10


Dea

ths

per 1

00,0




147

Hospital Discharge Rates for Motor Vehicle-related Injuries by EOHHS Region


73 74 77

88 *

57 **

91 *93 *

0

20

40

60

80

100


Southeast Boston MA

Dis

char

ges

per 1

00,0

00



115

148Hospital Discharge Rates for Motor Vehicle-related Injuries by Race/Ethnicity,


72

90

65

81

33

54**68**

22**

0

20

40

60

80

100

120


Dis

char

ges

per 1

00,0

00




149Emergency Department Visit Rates for Motor Vehicle-related Injuries by


1465

956

2363

1204

1498

724

1660

0

500

1000

1500

2000

2500

Cambridge Quincy Framingham Norwood Randolph Metrowest MA

Visi

ts p

er 1

00,0

00


**

*

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

*

**

**

116

150Motor Vehicle-related Death Rates by EOHHS Region


10.7

7.7

5.46.4

10.2 9.8

4.6

0

5

10

15


Dea

ths

per 1

00,0

00 p

opul

atio

n

**


* *

**

*

**


151Motor Vehicle-related Death Ratesby Race/Ethnicity


8

5

787

3

56**

0

5

10

15


Dea

ths

per 1

00,0

00




117

152Emergency Department Visit Rates for Firearm Injuries by EOHHS Region


87

2

6

13

5

13

0

2

4

6

8

10

12

14

16


Southeast Boston MA

Visi

ts p

er 1

00,0

00

**

*

**

*


**


153Emergency Department Visit Rates for Firearm Injuries by


7

3 2

13

3

0

5

10

15

Cambridge Randolph Somerville Metrowest Massachusetts

Visi

ts p

er 1

00,0

00


**** **


118

154Emergency Department Visit Rates for

Firearm Injuries by Race/EthnicityMetrowest Region and Massachusetts: 2003-2005

38

1** 2

11**

3**

19

3

0

5

10

15

20

25

30

35

40


Visi

ts p

er 1

00,0

00


NA

**



155Firearm Death Rates by EOHHS RegionMassachusetts: 2003-2005

3.4 3.2

1.32.9

4.13.1

5.9

0

5

10

15

20


Dea

ths

per 1

00,0

00 p

opul

atio

n


*

**


119

156Firearm Death Rates by Race/Ethnicity


2

13

4

11**2**

0

2

4

6

8

10

12

14

16

18

20


Dea

ths

per 1

00,0

00



* Statistically Significantly different from state (p ≤.05)

NANA

157Hospitalization Rates for Fall-Related InjuriesAges 65+ by EOHHS Region Massachusetts: 2003-2005

2024

2333 2254 2311 22752146**

2443*

0

500

1000

1500

2000

2500

3000

Western Central Northeast Metro West Southeast Boston MassachusettsTotal

Hos

pita

l Dis

char

ges

per 1

00,0

00



120

158

2,128.42

925 865724 748

624 696

2,253*

0

500

1000

1500

2000

2500


Dis

char

ges

per 1

00,0

00


Hospital Discharge Rates for Fall-Related Injuries Ages 65+ by Race/Ethnicity,




159Fall-related Injury Death Rates Persons 65+ Years by EOHHS Region

Massachusetts: 2003-200526.8

23.523.622.521.4 20.1

24.7

0

5

10

15

20

25

30


Dea

ths

per 1

00,0

00 p

opul

atio

n



121

160Hospital Discharge Rates for Fall-Related Injuries by EOHHS Region Massachusetts: 2003-2005

380 379 375 374338 *

357 *419 *

0

100

200

300

400

500


Dis

char

ges

per 1

00,0

00



161

375

234194 216

133 144

380**

185**

0

100

200

300

400

500


Disc

harg

es p

er 1

00,0

00


Hospital Discharge Rates for Fall-Related Injuries by Race/Ethnicity,




122

162Emergency Department Visit Rates forFall-Related Injuries by EOHHS Region

Massachusetts: 2003-20053,191

2,750

2,4102,713

2,913 2,8602,511

0

500

1000

1500

2000

2500

3000

3500


Southeast Boston MA

Visi

ts p

er 1

00,0

00

**

*

***


***


163Emergency Department Visit Rates for Fall-Related Injuries by Race/Ethnicity


2,5042463**2,783

1,903**2,003**

2,502

713** 784

0

500

1,000

1,500

2,000

2,500

3,000


Visi

ts p

er 1

00,0

00




123

164Fall-Related Injury Mortality Rates by EOHHS Region


4.3 3.83.63.83.2 3.54.3

0

5

10

15

20


Dea

ths

per 1

00,0

00 p

opul

atio

n



165Fall-Related Injury Mortality Rates by Race/Ethnicity


4 43 2

3

0

2

4

6

8

10

12

14

16

18

20


Dea

ths

per 1

00,0

00



* Statistically Significantly different from state (p ≤.05)

NANA NA

124

166

167

125

168

169

126

170

171

Number and Rate of Fatal Occupational Injuries by year, Massachusetts (1991- 2005)

70

54

46

7872

7883

44

69

6266

74

86

67

82

2.2

1.61.4

2.42.2

2.4

3.0

1.4

2.72.5

2.22.0

2.2

2.62.3

0

10

20

30

40

50

60

70

80

90

100

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

Years

Num

ber o

f Fat

al In

jurie

s

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Fata

lity

rate

per

100

,000

wor

kers

Number of fatalities Fatality Rates

Data Source: Census of Fatal Occupational Injuries (CFOI) 1991-2005, Occupational Health Surveillance Program, MA Dept. of Public Health. MA employment data from BLS Current Population Survey (1991 - 2005) was used to calculate rates.

127

172

65664868639265Self-Inflicted

74885773919377Motor vehicle-related

72211423243428Assault

2,311 2,254 2,443 2,333 2,146 2,024 2,275Fall-related

Injury,Ages 65pls

93

872

Western

73

859

South East

9465829780Traumatic Brain Injuries

966753836830836All Injuries


MATotal

Hospital Discharge

Indicator Rates (age-adjusted)

Summary Injury/Violence Hospitalization Indicators by EOHHS Regions, Massachusetts: 2003-2005


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

173

2,5113,1912,4102,7132,8602,9132,750ER Visit Rate

for Fall-related injuries

138265137ER Visit Rate for Firearm

640653563662646461604ER Visit Rate for Traumatic Brain Injury

12,323

Western

13,996

South East

10,5399,11211,19511,37911,298ER Visit Rate for all Injuries

BostonMetro West

NortheastCentralMA

Total Indicator

Age-adjusted Rate per 100,00

Summary Injury/Violence Emergency Department Indicators

by EOHHS Regions, Massachusetts: 2003-2005


Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Department Visits

128

174

5.56.95.37.47.27.96.6Suicide Death Rate

4.610.75.46.49.810.27.7Motor Vehicle-related Death

Rate

7.32.60.71.81.73.32.6Homicide Death Rate

5.93.41.32.93.14.13.2Firearm Death Rate

3.2

Western

4.3

South East

4.33.63.83.53.8Fall-related Injury Death

Rate

BostonMetro West

NortheastCentralMA

Total Mortality Indicator

Age-adjusted Rate per 100,000

Summary Injury/Violence Mortality Indicators by EOHHS Regions, Massachusetts: 2003-2005



129

HIV/AIDS

131

175

170.9247.1

133.2179.4

221.4167.5

729.2

0

100

200

300

400

500

600

700

800


Pers

ons

per 1

00,0

00

Persons Living with HIV by EOHHS Region Massachusetts: 2005

Source: MDPH, BCDC HIV/AIDS Files as of 09/01/06

** **

*

**** **


N=15,907N=5,189N=2,185N=1,982N=2,297N=1,415N=1,845

Crude rates

176

HIV Incidence by EOHHS Region Massachusetts: 2005

12.7

7.78.510.311.2

8.3

38.8

0

5

10

15

20

25

30

35

40

45


Pers

ons

per 1

00,0

00

** ** **

*


N= 814N=276N=99N=126N=132N=70N=93

Source: MDPH, BCDC HIV/AIDS Files as of 09/01/06Crude rates

132

177

HIV Incidence by Metrowest Cities and Massachusetts : 2005

8.5

29.2

13.3

8.3

12.7

0

5

10

15

20

25

30

35

Quincy Cambridge Somerville Metrowest MA

Pers

ons

per 1

00,0

00

**

*



182

Persons Living with AIDS by Metrowest Cities and Massachusetts : 2005

71.8

208.3

117.2

177.3

133.3

0

50

100

150

200

250


Pers

ons

per 1

00,0

00

**

*



*

Crude rates

133

179

138

1136

781

85

1028

370

0

200

400

600

800

1000

1200


Pers

ons

per 1

00,0

00

White non-Hispanic Black non-HispanicHispanic


Persons Living with HIV by Race/Ethnicity Metrowest Region and Massachusetts : 2005

**


**

180

AIDS Incidence by EOHHS Region Massachusetts: 2005

6.38.0

5.06.1

7.3 6.4

21.1

0

5

10

15

20

25


Pers

ons

per 1

00,0

00

*

*


N=516N=150N=81N=75N=78N=54N=61


134

181

Persons Living with AIDS by EOHHS Region Massachusetts: 2005

95.2133.3

71.8100.0107.7 93.5

395.7

0

50

100

150

200

250

300

350

400

450


Pers

ons

per 1

00,0

00

**

*

********


N=8,577N=2,816N=1,217N=1,069N=1,281N=790N=897


182

Persons Living with AIDS by Metrowest Cities and Massachusetts : 2005

71.8

208.3

117.2

177.3

133.3

0

50

100

150

200

250


Pers

ons

per 1

00,0

00

**

*



*

Crude rates

135

183

HIV/AIDS Mortality Rates by EOHHS Region, Massachusetts: 2003-2005

2.53.1

1.4

2.4

4.4

2.9

8.5

0

1

2

3

4

5

6

7

8

9


Dea

ths

per 1

00,0

00 p

opul

atio

n


*

**

*


N=617N=167N=99N=66N=97N=78N=110

Age-adjusted to the 2000 US standard population.

184

HIV/AIDS Mortality Rates by Metrowest Cities, Massachusetts: 2003-2005

1.4

5.7

2.6

4.8

3.1

0

1

2

3

4

5

6

Cambridge Somerville Randolph Metrowest MA

Dea

ths

per 1

00,0

00 p

opul

atio

n


**

Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than stateAge-adjusted to the 2000 US standard population.

136

185HIV/AIDS Death Rate by Race/EthnicityMetrowest Region and Massachusetts: 2003-2005

2

16

13

11**

6**5**

0

2

4

6

8

10

12

14

16

18


Dea

ths

per 1

00,0

00


NA

Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than stateAge-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

186

38.87.78.510.38.311.212.6HIV Incidence(2005)

729.2170.9133.1179.4167.5221.4247.1Persons living with HIV (2005)

4.4

7.3

107.7

Western

2.5

6.3

95.2

South East

8.51.42.42.93.1HIV/AIDS Mortality (2003-2005)

21.15.06.16.48.0AIDS Incidence (2005)

395.771.8100.093.5133.2Persons living with AIDS (2005)


MATotal

Indicator Crude rate, per

100,000

Summary HIV/AIDS Indicators by EOHHS Regions


137

INFECTIOUS DISEASES

139

187Chlamydia Incidence


225.7

169.0

106.1

92.0

0

50

100

150

200

250

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Cas

es p

er 1

00,0

00 p

opul

atio

n

Massachusetts

Metrowest Region

Source: MDPH, BCDC STD Files

188

Chlamydia Incidence by EOHHS Region Massachusetts: 2005

169.7225.7

106.1

178.0

369.4

145.4

588.5

0

100

200

300

400

500

600

700


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


*

*

**

**

****


140

189

Chlamydia Incidence byMetrowest Cities and Massachusetts: 2003-2005

96

202

235

204

233

148

0

50

100

150

200

250

Cambridge Quincy Somerville Randolph Metrowest MA

Cas

es p

er 1

00,0

00


**

*

Crude rates

*


**

190

141

191

Gonorrhea Incidence by EOHHS Region Massachusetts: 2005

35.4 39.6

20.322.4

55.9

16.6

126.2

0

20

40

60

80

100

120

140


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


*

*

******


192Syphilis Incidence


6.3

17.9

4.7

6.0

0

5

10

15

20

25

30

35

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Cas

es p

er 1

00,0

00 p

opul

atio

n

Massachusetts

Metrowest Region


142

193

Syphilis Incidence by EOHHS Region Massachusetts: 2005

6.3

2.74.74.9

3.11.7

27.7

0

5

10

15

20

25

30


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


**

*

****


194

Syphilis Incidence byMetrowest Cities and Massachusetts: 2003-2005

7.9

16.7

14.5

6.0

18.3

0

5

10

15

20

Cambridge Randolph Somerville Metrowest MA

Cas

es p

er 1

00,0

00 p

opul

atio

n


**

*

Crude rates

*


143

195

Tuberculosis Incidence by EOHHS Region Massachusetts: 2004

4.4

2.0

4.34.8

1.9

4.2

27.7

0

2

4

6

8

10

12


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n

**

*

**


Source: MDPH Bureau of Communicable Disease Control, ISIS

196

Tuberculosis Incidence by EOHHS Region Massachusetts: 2006

4.1

2.7

4.3

3.02.6

4.2

27.7

0

2

4

6

8

10

12


Southeast Boston MA

Cas

es p

er 1

00,0

00 p

opul

atio

n

*

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


144

197Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region

Massachusetts: 2006

8<5914Southeast

819268Boston

13212021Metro Boston

61965Northeast

10146<5Central

<58<5<5West

HispanicAsian/Pacific

IslanderBlack non-Hispanic

White non-Hispanic

EOHHS Region


Percent of Confirmed Tuberculosis Cases by EOHHS Region

Massachusetts: 2006 (N = 259)

Metro WestN=63, 24%

BostonN=72, 28%

WesternN=21, 8%

CentralN=32, 12%

SoutheastN=33, 13%

NortheastN=38, 15%


145

199Percent of Confirmed Tuberculosis Cases by

Race/Ethnicity and EOHHS RegionMassachusetts: 2006

0%10%20%30%40%50%60%70%80%90%

100%

White/NH (N=55) Black /NH (N=71) Asian/PacificIslander (N=84)

Hispanic (N=49)

SoutheastBostonMetro BostonNortheastCentralWest


Tuberculosis Cases by EOHHS RegionMassachusetts: 1993-2006

0

20

40

60

80

100

120

140

93 94 95 96 97 98 99 2000 01 02 03 04 05 06

West Central NortheastMetro Boston Boston Southeast

YEAR


146

201

Percent of Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region

Massachusetts: 2006

0%10%20%

30%40%50%60%70%

80%90%

100%

West Central Northeast Metro Boston Boston Southeast

White/NH (N=55) Black/NH (N=71)Asian/Pacific Islander (N=84) Hispanic (N=49)


202Hepatitis C Average Incidence Rates by EOHHS Region, Massachusetts: 1992-20061

41.0

51.0

30.0

49.056.0

50.0

75.0

0

10

20

30

40

50

60

70

80

Western Central Northeast Outer MetroBoston

Inner MetroBoston

Boston Southeast

Cas

es p

er 1

00,0

00 p

opul

atio

n


1 Data as of March 17, 2007


147

203

204Hepatitis C Incidence Infection Rates by Region, Massachusetts: 2006

82.0

114.0

49.0

92.095.0

123.0

150.0

0

20

40

60

80

100

120

140

160

Western Central Northeast Outer MetroBoston

Inner MetroBoston

Boston Southeast

Cas

es p

er 1

00,0

00 p

opul

atio

n



148

205

206

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

opul

atio

n *

**


****


149

207

208Pneumonia/Influenza Hospital Discharges by

EOHHS Region Massachusetts: 2005

377.0406.7

341.6384.4

346.0392.7

415.8

0

50

100

150

200

250

300

350

400

450


Southeast Boston MA

Age

-adj

uste

d ra

te

per 1

00,0

00

Source: Division of Health Care Finance and Policy. Calendar Year 2005. Inpatient Hospital Discharge Database

** **

* *


150

209

4.048.421.218.419.727.324.7Lyme Disease Incidence(crude rates, 2004)

11.42.04.34.84.21.94.4Tuberculosis Incidence(crude rates, 2004)

126.235.420.322.416.655.939.6Gonorrhea Incidence (crude rates, 2005)

346.0

3.1

369.4

Western

406.7

2.7

169.7

South East

415.8341.5384.4392.7377.0Pneumonia/ Influenza Hospital Discharges

(age-adjusted, 2005)

22.74.74.91.76.3Syphilis Incidence (crude rates, 2005)

588.5106.1178.0145.4225.7Chlamydia Incidence (crude rates, 2005)


MATotal Indicator

Summary Infectious Disease Indicators by EOHHS Regions


151

ASTHMA

153

210Pediatric 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

Perc

ent

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

* *

** ** **


211

7

20

15

18

17

Asthma Prevalence for School Children, Grades K-8 byCommunity Health Network Areas (CHNA) withinMetrowest Region, MA Academic Year 2004-05

CHNA

7. Greater Framingham Area): 9.1%15. Greater Woburn/Concord/Littleton: 8.3%17. Greater Cambridge/Somerville Area: 7.7%18. West Suburban Area (Newton/Waltham): 8.5%20. Blue Hills Area (Quincy): 9.5%

Prevalence by CHNACHNA

Higher than state rate

Not different from state rate

Lower than state rate

Massachusetts Prevelance: 10.6%

Source: Environment Health Bureaus

154

212Asthma Hospital Discharges by EOHHS Region, Massachusetts: 2005

140161

101

133125 131

242

0

50

100

150

200

250

300


Southeast Boston MA

Age

-adj

uste

d ra

te

per1

00,0

00

Source: Division of Health Care Finance and Policy. Calendar Year 2005. Inpatient Hospital Discharge Database

****

*

*


213Asthma Emergency Department Visit Ratesby EOHHS Region, Massachusetts: 2005

655577

363

491

761

566

897

0

100

200

300

400

500

600

700

800

900

1000


Southeast Boston MA

Visi

tspe

r100

,000


*

**

**

*

*


155

214Emergency Department Visit Rates for Asthma by Race/Ethnicity


434

1,469

141323

916

1,251

613

880

200

400

600

800

1,000

1,200

1,400

1,600


Visi

ts p

er 1

00,0

00




**

**

**

**

215

Adults who Currently have Asthmaby EOHHS Region, Massachusetts: 2005

10.7 9.68.17.8

10.9 11.99.2

0

5

10

15

20

25

30


Southeast Boston MA

Perc

ent


156

216

Hospital Discharge Rates for Asthma byMetrowest Cities and Massachusetts: 2003-2005

101

144

211197

133 139

0

50

100

150

200

250

Cambridge Quincy Foxborough Hull Metrowest MA

Dis

char

ges

per 1

00,0

00


**


**

217

Asthma ER Visits, Children Ages 0-4by EOHHS Region, Massachusetts: 2005

1,130

854809815

1,618

1,241

2,148

0

500

1,000

1,500

2,000

2,500


Southeast Boston MA

Visi

ts p

er10

0,00

0

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

*

** ** **

*


157

218


775687

582608

831 761

1,812

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000


Southeast Boston MA

Visi

ts p

er10

0,00

0


** ****

*


219


571 533

365363

632

470

1,236

0

200

400

600

800

1,000

1,200

1,400


Southeast Boston MA

Visi

ts p

er10

0,00

0


** **

*

*


158

220


808697

584594

995811

1,771

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000


Southeast Boston MA

Visi

ts p

er10

0,00

0


** **

*

*

**


221Asthma Emergency Department Visit Rates Children Ages 0-14


2,096

283468** 516

1,564**

912**

1,573

356

0

500

1,000

1,500

2,000

2,500


Visi

ts p

er 1

00,0

00




159

222Pediatric 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

Perc

ent

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

* *

** ** **


223

FRAMINGHAM1639.3

NORWOOD1823.2

Pediatric Asthma Emergency Visit Rates by TownsAmong Children Ages <5

Metrowest Region - Massachusetts 2004-2005

Emergency Visit Rates by Townsper 100,000


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

Massachusetts State Total Rate: 1,136.2


160

224

HOPKINTON186.4 HINGHAM

318.8

CANTON494.7

WALPOLE304.1

FRAMINGHAM271.2

QUINCY378.6

HOLLISTON255.3

SCITUATE404.6

MILTON530.8

WEYMOUTH270.6

MARLBOROUGH233

LEXINGTON300.8

WESTBOROUGH270.7

BEDFORD434.3

WALTHAM229.4

WOBURN472.3

WILMINGTON299.5

ASHLAND510.8 DEDHAM

181.7

NORTHBOROUGH297.9

NORWOOD239.1

RANDOLPH453.4

BURLINGTON315

WESTWOOD336.8

WELLESLEY214.6

CAMBRIDGE368.2

WINCHESTER372.3

HULL529.9

WATERTOWN235.8

NATICK109.8

NEWTON211.5

Pediatric Asthma Hospitalization Rates by TownsAmong Children Ages <5

Metrowest Region - Massachusetts 2004-2005

Hospitalization Rates by Townsper 100,000


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

Massachusetts State Total Rate: 337.5

Source: Division of Health Care Finance and Policy. Calendar Year 2005. Hospital Discharges

225

9.210.78.17.811.910.99.6% Adults who currently have asthma (2005)

1,771697584594811995808Asthma ER Visits

Ages 0-14 (age-adjusted per100,000)

897.1654.5363.0491.4565.9760.9576.9Asthma ER Visits

(age-adjusted per100,000)

125.0

Western

160.9

South East

241.9100.9132.7131.5140.1Asthma Hospital Discharges (age-

adjusted per100,000)


MATotal Indicator

Summary Asthma Indicators by EOHHS Regions, Massachusetts: 2005


161

226

1,236571365363470632533Asthma ER Visits

Ages 10-14 (age adjusted per100,000)

1,812687582608761831775Asthma ER Visits


12.7

1,618

Western

10.5

854

South East

13.09.410.19.810.6Pediatric Asthma

Prevalence (2005-2006)

2,1488098151,2411,130Asthma ER Visits



MATotal Indicator

Summary Asthma Indicators by EOHHS Regions, Massachusetts: 2005


163

OTHER HEALTH INDICATORS

165

227Total Cases of Elevated Blood Lead Levels (>=15 µg/dL) by EOHHS Region

Massachusetts: 2005

2.2 2.3

1.0

2.13.0 3.1 3.2

0

1

2

3

4

5

6

7

8

9

10


Southeast Boston MA

Prev

alen

ce R

ate

Per 1

000

Source: MDPH, Childhood Lead Poisoning Prevention Program (CLPPP)

**

* *


228Lead Poisoning Prevalence Rates (BLL≥ 25 µg/dL) Children 9-48 Months


0.4 0.4

0.6

0.3

0.5 0.5

0.2

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0


Southeast Boston MA

Prev

alen

ce R

ate

Per 1

000

Source: MDPH, Childhood Lead Poisoning Prevention Program (CLPPP)Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

166

229Adults who Report Experiencing Intimate Partner Violence by EOHHS Region and Gender

Massachusetts: 2005

25.722.4

19.322.0

25.923.2

17.217.415.1 15.3

11.413.1

10.713.8

0

5

10

15

20

25

30


Southeast Boston MA

Perc

ent

Women Men


230

Adults who Report Having a Disability by EOHHS Region, Massachusetts: 2005

24.2

19.5

15.318.1

21.5 20.617.1

0

5

10

15

20

25

30


Southeast Boston MA

Perc

ent


167

231Adults who Report Having a Disability and needing help with activities

EOHHS Region, Massachusetts: 2005

9.06.7

4.75.57.3 8.5

5.1

0

5

10

15

20

25

30


Southeast Boston MA

Perc

ent


232

Adults with Fair or Poor Health by EOHHS Region, Massachusetts: 2005

14.3 13.2

9.3

13.414.6 15.2 14.7

0

5

10

15

20

25

30


Southeast Boston MA

Perc

ent

**



168

233Adults who Reported Fair or Poor Health by Race and Ethnicity


16.5

12.3

8.8

23.3 23.5

0

5

10

15

20

25


Perc

ent

White non-Hispanic Black non-Hispanic Hispanic


NA


234Adults who Visit a Dentist in Past Yearby EOHHS Region, Massachusetts: 2004

76.8 78.286.1

76.375.4 75.1 74.1

0102030405060708090

100


Southeast Boston MA

Perc

ent

**


169

235Adults who have lost 6 or more teeth to decay or disease by EOHHS Region, Massachusetts: 2004

17.415.1

10.5

16.518.8

15.4 13.7

0

10

20

30

40

50


Southeast Boston MA

Perc

ent

**


236Adults with Poor Mental Health for 15 or more days in Past Month by EOHHS Region

Massachusetts: 2005

10.2 8.8

5.38.0

11.2 10.5 9.5

0

5

10

15

20

25

30


Southeast Boston MA

Perc

ent

**



170

237

3.22.21.02.13.12.92.3

Cases of Elevated Blood

Lead levels (Percent of All

Children Screened Per 1000, 2005)

13.717.410.516.515.418.815.1% 6+ Teeth Missing (2004)

74.176.886.176.375.175.478.2% Visited Dentist Past Year (2004)

14.714.39.313.415.214.613.2% Fair or Poor Health (2005)

11.2

Western

10.2

South East

9.55.38.010.58.8% Poor Mental Health for 15 or

more days in Past Month (2005)

BostonMetro WestNortheastCentral

MATotal Indicator

Summary Other Health Indicators by EOHHS Regions


238

5.19.04.75.58.57.36.7

% Adults reporting having a

disability and needing help with activities

(2005)

17.124.215.318.120.621.519.5% Adults reporting having a

disability (2005)

Western South East

BostonMetro WestNortheastCentral

MATotal Indicator

Summary Other Health Indicators by EOHHS Regions



171

239

Refugee Arrivals: Metrowest RegionFY02-FY06

• 465 refugees resettled over 5 years

• Increasing diversity in population

• 34% age <19 at arrival• Cities/Towns with

largest number of arrivals: Newton, Quincy, Somerville, Waltham, Watertown

010203040506070

FY02 FY03 FY04 FY05 FY06

Africa Eur/CAsiaAm/Carib E/SEAsiaNrE/SAsia

240

Refugee Health Assessment Findings Metrowest Region: FY02-FY06

• High rates of latent TB infection (LTBI)– 395 refugees tested: 44% positive– Intensive follow-up in partnership with TB clinics, local health

and DPH to assure testing, evaluation and treatment– Rapid assessment identifies active disease early to prevent

spread• Risk of lead poisoning among refugee children

– 2 refugee children identified with elevated blood lead levels at arrival – 6% of children <7 years

– Poor nutritional status puts children at risk of increased absorption of lead post-resettlement

• Need for bilingual, bicultural services to promote access to care

172

241

Premature Mortality Rate (PMR)1

• Definition– deaths before age 75

• Rationale– two-thirds of deaths to persons ages 75+– vast majority of deaths to persons age 75+ are due to chronic

conditions associated with aging – Focusing on deaths to persons less than 75 years may be more

preventable

• Summary health statistic– excellent measure to reflect the health status of a population– used as a health status indicator that can be used to focus

prevention initiatives and target programs

1 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population under 75 years of age.


242


Western355 Central

340

Southeast332.3

Boston373.1

Northeast311.5

Metro West248.9

Map 2. Premature Mortality Rate (PMR) by RegionMassachusetts: 2005

Rates are per 100,000 persons under 75 years of age, age-adjusted to the 2000 US standard population under 75 years of age.

Massachusetts PMR= 317.0

25 Miles

PMR by RegionSignificantly higher than state rateNot different from state rateSignificantly lower than state rate

Premature Mortality Rates (PMR) by RegionMassachusetts: 2005

Lowest

173

243

Rates are per 100,000 persons under 75 years of age, age-adjusted to the 2000 US standard population under 75 years of age.

Metrowest Region PMR= 248.9

*R t 100 000 l ti

PMR by City/Town

Significantly higher than state rateNot different from state rateSignificantly lower than state rateLess than 5 premature deaths.

5Miles

Massachusetts PMR= 317.0


PMR- Metrowest Region by City/Town Massachusetts: 2005

244Median Household Income and PMR by EOHHS Regions, Massachusetts: 2005

State Median Household Income: $66,365

0

50

100

150

200

250

300

350

400

Boston Region Western Mass Central Mass Southeast Northeast Metro West

PMR

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

Med

ian

Hou

seho

ld In

com

e ($

)

PMR Median Household Income


174

245

Premature Mortality Rate (PMR)by EOHHS Regions: 2005



317.0Massachusetts

373.1Boston Region

332.3Southeast Region

248.9Metrowest Region311.5Northeast Region340.0Central Region

355.0Western Region

PMR

175

SUMMARY

177

246

Summary• The Metrowest region is a healthy place to live

• Residents of certain communities are affected disproportionately by health issues, including the following:Framingham: Access to private sources for prenatal care,

admissions for substance abuse, emergency visits by children ages <5 with asthma

Randolph: Hospitalizations for hypertension and diabetes, deaths to heart disease, emergency visits for motor vehicle injuries

Norwood: Hospitalizations for hypertension and diabetes, emergency visits for motor vehicle injuries and by children ages<5 with asthma

Quincy: Hospitalizations for diabetes, admissions for cocaine, emergency visits for opioid-related injuries

Somerville: Access to private sources for prenatal care, opioid-related emergency visits, persons living with HIV

Weymouth: Hospitalizations for diabetes, emergency visits for opioid-related injuries

Sharon: Hospitalizations for hypertensionCambridge: Persons living with HIV

247

The following groups of the Metrowest region, when compared with those at the state level, have higher rates of:Blacks & Latinos: emergency visits for

opioid-related injuriesWhites: incidence for female breast cancer;

hospitalizations for persons ages 65+ due to fall injuries

Refugees: high TB rates; increased lead poisoning among children

Health Disparities

179

APPENDIX

181

REGIONS AND TOWNS

REGION TOWN COUNTY CHNA BOSTON BOSTON

BROOKLINE CHELSEA REVERE WINTHROP

SUFFOLK NORFOLK SUFFOLK SUFFOLK SUFFOLK

Alliance for Community Health Alliance for Community Health Alliance for Community Health Alliance for Community Health Alliance for Community Health

CENTRAL ASHBURNHAM ASHBY AUBURN AYER BARRE BELLINGHAM BERLIN BLACKSTONE BOLTON BOYLSTON BRIMFIELD BROOKFIELD CHARLTON CLINTON DOUGLAS DUDLEY EAST BROOKFIELD FITCHBURG FRANKLIN GARDNER GRAFTON GROTON HARDWICK HARVARD HOLDEN HOLLAND HOPEDALE HUBBARDSTON LANCASTER LEICESTER LEOMINSTER LUNENBURG MEDWAY MENDON MILFORD MILLBURY MILLVILLE NEW BRAINTREE NORTH BROOKFIELD NORTHBRIDGE OAKHAM OXFORD

WORCESTER MIDDLESEX WORCESTER MIDDLESEX WORCESTER NORFOLK WORCESTER WORCESTER WORCESTER WORCESTER HAMPDEN WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER NORFOLK WORCESTER WORCESTER MIDDLESEX WORCESTER WORCESTER WORCESTER HAMPDEN WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER NORFOLK WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER

Fitchburg/Gardner CHN Fitchburg/Gardner CHN Community Wellness Coalition Fitchburg/Gardner CHN Fitchburg/Gardner CHN Community Partners for Health Fitchburg/Gardner CHN Community Partners for Health Fitchburg/Gardner CHN Community Wellness Coalition CHN of Southern Worcester County CHN of Southern Worcester County CHN of Southern Worcester County Fitchburg/Gardner CHN Community Partners for Health CHN of Southern Worcester County CHN of Southern Worcester County Fitchburg/Gardner CHN Community Partners for Health Fitchburg/Gardner CHN Community Wellness Coalition Fitchburg/Gardner CHN Fitchburg/Gardner CHN Fitchburg/Gardner CHN Community Wellness Coalition CHN of Southern Worcester County Community Partners for Health Fitchburg/Gardner CHN Fitchburg/Gardner CHN Community Wellness Coalition Fitchburg/Gardner CHN Fitchburg/Gardner CHN Community Partners for Health Community Partners for Health Community Partners for Health Community Wellness Coalition Community Partners for Health Fitchburg/Gardner CHN CHN of Southern Worcester County Community Partners for Health Fitchburg/Gardner CHN CHN of Southern Worcester County

182

PAXTON PEPPERELL PRINCETON RUTLAND SHIRLEY SHREWSBURY SOUTHBRIDGE SPENCER STERLING STURBRIDGE SUTTON TEMPLETON TOWNSEND UPTON UXBRIDGE WALES WARREN WEBSTER WEST BOYLSTON WEST BROOKFIELD WESTMINSTER WINCHENDON WORCESTER

WORCESTER MIDDLESEX WORCESTER WORCESTER MIDDLESEX WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER MIDDLESEX WORCESTER WORCESTER HAMPDEN WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER

Community Wellness Coalition Fitchburg/Gardner CHN Fitchburg/Gardner CHN Fitchburg/Gardner CHN Fitchburg/Gardner CHN Community Wellness Coalition CHN of Southern Worcester County CHN of Southern Worcester County Fitchburg/Gardner CHN CHN of Southern Worcester County Community Partners for Health Fitchburg/Gardner CHN Fitchburg/Gardner CHN Community Partners for Health Community Partners for Health CHN of Southern Worcester County CHN of Southern Worcester County CHN of Southern Worcester County Community Wellness Coalition CHN of Southern Worcester County Fitchburg/Gardner CHN Fitchburg/Gardner CHN Community Wellness Coalition

METRO WEST

ACTON ARLINGTON ASHLAND BEDFORD BELMONT BOXBOROUGH BRAINTREE BURLINGTON CAMBRIDGE CANTON CARLISLE COHASSET CONCORD DEDHAM DOVER FOXBOROUGH FRAMINGHAM HINGHAM HOLLISTON HOPKINTON HUDSON HULL LEXINGTON LINCOLN LITTLETON MARLBOROUGH MAYNARD

MIDDLESEX MIDDLESEX MIDDLESEX MIDDLESEX MIDDLESEX MIDDLESEX NORFOLK MIDDLESEX MIDDLESEX NORFOLK MIDDLESEX NORFOLK MIDDLESEX NORFOLK NORFOLK NORFOLK MIDDLESEX PLYMOUTH MIDDLESEX MIDDLESEX MIDDLESEX PLYMOUTH MIDDLESEX MIDDLESEX MIDDLESEX MIDDLESEX MIDDLESEX

Greater Woburn/Concord/Littleton CHN Greater Cambridge/Somerville CHN CHN of Greater Metro West Greater Woburn/Concord/Littleton CHN Greater Cambridge/Somerville CHN Greater Woburn/Concord/Littleton CHN Blue Hills Community Health Alliance Greater Woburn/Concord/Littleton CHN Greater Cambridge/Somerville CHN Blue Hills Community Health Alliance Greater Woburn/Concord/Littleton CHN Blue Hills Community Health Alliance Greater Woburn/Concord/Littleton CHN West Suburban Health Network West Suburban Health Network CHN of Greater Metro West CHN of Greater Metro West Blue Hills Community Health Alliance CHN of Greater Metro West CHN of Greater Metro West CHN of Greater Metro West Blue Hills Community Health Alliance Greater Woburn/Concord/Littleton CHN Greater Woburn/Concord/Littleton CHN Greater Woburn/Concord/Littleton CHN CHN of Greater Metro West CHN of Greater Metro West

183

MEDFIELD MILLIS MILTON NATICK NEEDHAM NEWTON NORFOLK NORTHBOROUGH NORWELL NORWOOD PLAINVILLE QUINCY RANDOLPH SCITUATE SHARON SHERBORN SOMERVILLE SOUTHBOROUGH STOW SUDBURY WALPOLE WALTHAM WATERTOWN WAYLAND WELLESLEY WESTBOROUGH WESTON WESTWOOD WEYMOUTH WILMINGTON WINCHESTER WOBURN WRENTHAM

NORFOLK NORFOLK NORFOLK MIDDLESEX NORFOLK MIDDLESEX NORFOLK WORCESTER PLYMOUTH NORFOLK NORFOLK NORFOLK NORFOLK PLYMOUTH NORFOLK MIDDLESEX MIDDLESEX WORCESTER MIDDLESEX MIDDLESEX NORFOLK MIDDLESEX MIDDLESEX MIDDLESEX NORFOLK WORCESTER MIDDLESEX NORFOLK NORFOLK MIDDLESEX MIDDLESEX MIDDLESEX NORFOLK

CHN of Greater Metro West CHN of Greater Metro West Blue Hills Community Health Alliance CHN of Greater Metro West West Suburban Health Network West Suburban Health Network CHN of Greater Metro West CHN of Greater Metro West Blue Hills Community Health Alliance Blue Hills Community Health Alliance CHN of Greater Metro West Blue Hills Community Health Alliance Blue Hills Community Health Alliance Blue Hills Community Health Alliance Blue Hills Community Health Alliance CHN of Greater Metro West Greater Cambridge/Somerville CHN CHN of Greater Metro West CHN of Greater Metro West CHN of Greater Metro West CHN of Greater Metro West West Suburban Health Network Greater Cambridge/Somerville CHN CHN of Greater Metro West West Suburban Health Network CHN of Greater Metro West West Suburban Health Network West Suburban Health Network Blue Hills Community Health Alliance Greater Woburn/Concord/Littleton CHN Greater Woburn/Concord/Littleton CHN Greater Woburn/Concord/Littleton CHN CHN of Greater Metro West

NORTHEAST AMESBURY ANDOVER BEVERLY BILLERICA BOXFORD CHELMSFORD DANVERS DRACUT DUNSTABLE ESSEX EVERETT GEORGETOWN GLOUCESTER GROVELAND HAMILTON HAVERHILL IPSWICH

ESSEX ESSEX ESSEX MIDDLESEX ESSEX MIDDLESEX ESSEX MIDDLESEX MIDDLESEX ESSEX MIDDLESEX ESSEX ESSEX ESSEX ESSEX ESSEX ESSEX

Greater Haverhill CHN Greater Lawrence CHN Community Health Network North Greater Lowell CHN Greater Haverhill CHN Greater Lowell CHN North Shore CHN Greater Lowell CHN Greater Lowell CHN Community Health Network North North Suburban Health Alliance Greater Haverhill CHN Community Health Network North Greater Haverhill CHN Community Health Network North Greater Haverhill CHN Community Health Network North

184

LAWRENCE LOWELL LYNN LYNNFIELD MALDEN MANCHESTER MARBLEHEAD MEDFORD MELROSE MERRIMAC METHUEN MIDDLETON NAHANT NEWBURY NEWBURYPORT NORTH ANDOVER NORTH READING PEABODY READING ROCKPORT ROWLEY SALEM SALISBURY SAUGUS STONEHAM SWAMPSCOTT TEWKSBURY TOPSFIELD TYNGSBOROUGH WAKEFIELD WENHAM WEST NEWBURY WESTFORD

ESSEX MIDDLESEX ESSEX ESSEX MIDDLESEX ESSEX ESSEX MIDDLESEX MIDDLESEX ESSEX ESSEX ESSEX ESSEX ESSEX ESSEX ESSEX MIDDLESEX ESSEX MIDDLESEX ESSEX ESSEX ESSEX ESSEX ESSEX MIDDLESEX ESSEX MIDDLESEX ESSEX MIDDLESEX MIDDLESEX ESSEX ESSEX MIDDLESEX

Greater Lawrence CHN Greater Lowell CHN North Shore CHN North Shore CHN North Suburban Health Alliance Community Health Network North North Shore CHN North Suburban Health Alliance North Suburban Health Alliance Greater Haverhill CHN Greater Lawrence CHN Greater Lawrence CHN North Shore CHN Greater Haverhill CHN Greater Haverhill CHN Greater Lawrence CHN North Suburban Health Alliance North Shore CHN North Suburban Health Alliance Community Health Network North Greater Haverhill CHN North Shore CHN Greater Haverhill CHN North Shore CHN North Suburban Health Alliance North Shore CHN Greater Lowell CHN Community Health Network North Greater Lowell CHN North Suburban Health Alliance Community Health Network North Greater Haverhill CHN Greater Lowell CHN

SOUTHEAST ABINGTON ACUSHNET ATTLEBORO AVON BARNSTABLE BERKLEY BOURNE BREWSTER BRIDGEWATER BROCKTON CARVER CHATHAM CHILMARK DARTMOUTH DENNIS DIGHTON DUXBURY

PLYMOUTH BRISTOL BRISTOL NORFOLK BARNSTABLE BRISTOL BARNSTABLE BARNSTABLE PLYMOUTH PLYMOUTH PLYMOUTH BARNSTABLE DUKES BRISTOL BARNSTABLE BRISTOL PLYMOUTH

Greater Brockton CHN Greater New Bedford CHN Health & Education Response Greater Brockton CHN Cape and Islands CHN Health & Education Response Cape and Islands CHN Cape and Islands CHN Greater Brockton CHN Greater Brockton CHN South Shore Community Partners in Prevention Cape and Islands CHN Cape and Islands CHN Greater New Bedford CHN Cape and Islands CHN Health & Education Response South Shore Community Partners in Prevention

185

EAST BRIDGEWATER EASTHAM EASTON EDGARTOWN FAIRHAVEN FALL RIVER FALMOUTH FREETOWN GAY HEAD GOSNOLD HALIFAX HANOVER HANSON HARWICH HOLBROOK KINGSTON LAKEVILLE MANSFIELD MARION MARSHFIELD MASHPEE MATTAPOISETT MIDDLEBOROUGH NANTUCKET NEW BEDFORD NORTH ATTLEBORO NORTON OAK BLUFFS ORLEANS PEMBROKE PLYMOUTH PLYMPTON PROVINCETOWN RAYNHAM REHOBOTH ROCHESTER ROCKLAND SANDWICH SEEKONK SOMERSET STOUGHTON SWANSEA TAUNTON TISBURY TRURO WAREHAM WELLFLEET WEST BRIDGEWATER WEST TISBURY WESTPORT

PLYMOUTH BARNSTABLE BRISTOL DUKES BRISTOL BRISTOL BARNSTABLE BRISTOL DUKES DUKES PLYMOUTH PLYMOUTH PLYMOUTH BARNSTABLE NORFOLK PLYMOUTH PLYMOUTH BRISTOL PLYMOUTH PLYMOUTH BARNSTABLE PLYMOUTH PLYMOUTH NANTUCKET BRISTOL BRISTOL BRISTOL DUKES BARNSTABLE PLYMOUTH PLYMOUTH PLYMOUTH BARNSTABLE BRISTOL BRISTOL PLYMOUTH PLYMOUTH BARNSTABLE BRISTOL BRISTOL NORFOLK BRISTOL BRISTOL DUKES BARNSTABLE PLYMOUTH BARNSTABLE PLYMOUTH DUKES BRISTOL

Greater Brockton CHN Cape and Islands CHN Greater Brockton CHN Cape and Islands CHN Greater New Bedford CHN Partners for a Healthier Community Cape and Islands CHN Greater New Bedford CHN Cape and Islands CHN Cape and Islands CHN South Shore Community Partners in Prevention South Shore Community Partners in Prevention South Shore Community Partners in Prevention Cape and Islands CHN Greater Brockton CHN South Shore Community Partners in Prevention Health & Education Response Health & Education Response Greater New Bedford CHN South Shore Community Partners in Prevention Cape and Islands CHN Greater New Bedford CHN Health & Education Response Cape and Islands CHN Greater New Bedford CHN Health & Education Response Health & Education Response Cape and Islands CHN Cape and Islands CHN South Shore Community Partners in Prevention South Shore Community Partners in Prevention South Shore Community Partners in Prevention Cape and Islands CHN Health & Education Response Health & Education Response Greater New Bedford CHN South Shore Community Partners in Prevention Cape and Islands CHN Health & Education Response Partners for a Healthier Community Greater Brockton CHN Partners for a Healthier Community Health & Education Response Cape and Islands CHN Cape and Islands CHN Greater New Bedford CHN Cape and Islands CHN Greater Brockton CHN Cape and Islands CHN Partners for a Healthier Community

186

WHITMAN YARMOUTH

PLYMOUTH BARNSTABLE

Greater Brockton CHN Cape and Islands CHN

WESTERN ADAMS AGAWAM ALFORD AMHERST ASHFIELD ATHOL BECKET BELCHERTOWN BERNARDSTON BLANDFORD BUCKLAND CHARLEMONT CHESHIRE CHESTER CHESTERFIELD CHICOPEE CLARKSBURG COLRAIN CONWAY CUMMINGTON DALTON DEERFIELD EAST LONGMEADOW EASTHAMPTON EGREMONT ERVING FLORIDA GILL GOSHEN GRANBY GRANVILLE GREAT BARRINGTON GREENFIELD HADLEY HAMPDEN HANCOCK HATFIELD HAWLEY HEATH HINSDALE HOLYOKE HUNTINGTON LANESBOROUGH LEE LENOX LEVERETT LEYDEN LONGMEADOW

BERKSHIRE HAMPDEN BERKSHIRE HAMPSHIRE FRANKLIN WORCESTER BERKSHIRE HAMPSHIRE FRANKLIN HAMPDEN FRANKLIN FRANKLIN BERKSHIRE HAMPDEN HAMPSHIRE HAMPDEN BERKSHIRE FRANKLIN FRANKLIN HAMPSHIRE BERKSHIRE FRANKLIN HAMPDEN HAMPSHIRE BERKSHIRE FRANKLIN BERKSHIRE FRANKLIN HAMPSHIRE HAMPSHIRE HAMPDEN BERKSHIRE FRANKLIN HAMPSHIRE HAMPDEN BERKSHIRE HAMPSHIRE FRANKLIN FRANKLIN BERKSHIRE HAMPDEN HAMPSHIRE BERKSHIRE BERKSHIRE BERKSHIRE FRANKLIN FRANKLIN HAMPDEN

CHN of Berkshire The Community Health Connection CHN of Berkshire Partnership for Health in Hampshire County Upper Valley Health Web Upper Valley Health Web CHN of Berkshire Partnership for Health in Hampshire County Upper Valley Health Web The Community Health Connection Upper Valley Health Web Upper Valley Health Web CHN of Berkshire Four (For) Communities Partnership for Health in Hampshire County Four (For) Communities CHN of Berkshire Upper Valley Health Web Upper Valley Health Web Partnership for Health in Hampshire County CHN of Berkshire Upper Valley Health Web The Community Health Connection Partnership for Health in Hampshire County CHN of Berkshire Upper Valley Health Web CHN of Berkshire Upper Valley Health Web Partnership for Health in Hampshire County Partnership for Health in Hampshire County The Community Health Connection CHN of Berkshire Upper Valley Health Web Partnership for Health in Hampshire County The Community Health Connection CHN of Berkshire Partnership for Health in Hampshire County Upper Valley Health Web Upper Valley Health Web CHN of Berkshire Four (For) Communities Four (For) Communities CHN of Berkshire CHN of Berkshire CHN of Berkshire Upper Valley Health Web Upper Valley Health Web The Community Health Connection

187

LUDLOW MIDDLEFIELD MONROE MONSON MONTAGUE MONTEREY MONTGOMERY MOUNT WASHINGTON NEW ASHFORD NEW MARLBOROUGH NEW SALEM NORTH ADAMS NORTHAMPTON NORTHFIELD ORANGE OTIS PALMER PELHAM PERU PETERSHAM PHILLIPSTON PITTSFIELD PLAINFIELD RICHMOND ROWE ROYALSTON RUSSELL SANDISFIELD SAVOY SHEFFIELD SHELBURNE SHUTESBURY SOUTH HADLEY SOUTHAMPTON SOUTHWICK SPRINGFIELD STOCKBRIDGE SUNDERLAND TOLLAND TYRINGHAM WARE WARWICK WASHINGTON WENDELL WEST SPRINGFIELD WEST STOCKBRIDGE WESTFIELD WESTHAMPTON WHATELY WILBRAHAM

HAMPDEN HAMPSHIRE FRANKLIN HAMPDEN FRANKLIN BERKSHIRE HAMPDEN BERKSHIRE BERKSHIRE BERKSHIRE FRANKLIN BERKSHIRE HAMPSHIRE FRANKLIN FRANKLIN BERKSHIRE HAMPDEN HAMPSHIRE BERKSHIRE WORCESTER WORCESTER BERKSHIRE HAMPSHIRE BERKSHIRE FRANKLIN WORCESTER HAMPDEN BERKSHIRE BERKSHIRE BERKSHIRE FRANKLIN FRANKLIN HAMPSHIRE HAMPSHIRE HAMPDEN HAMPDEN BERKSHIRE FRANKLIN HAMPDEN BERKSHIRE HAMPSHIRE FRANKLIN BERKSHIRE FRANKLIN HAMPDEN BERKSHIRE HAMPDEN HAMPSHIRE FRANKLIN HAMPDEN

Four (For) Communities Partnership for Health in Hampshire County Upper Valley Health Web The Community Health Connection Upper Valley Health Web CHN of Berkshire The Community Health Connection CHN of Berkshire CHN of Berkshire CHN of Berkshire Upper Valley Health Web CHN of Berkshire Partnership for Health in Hampshire County Upper Valley Health Web Upper Valley Health Web CHN of Berkshire The Community Health Connection Partnership for Health in Hampshire County CHN of Berkshire Upper Valley Health Web Upper Valley Health Web CHN of Berkshire Partnership for Health in Hampshire County CHN of Berkshire Upper Valley Health Web Upper Valley Health Web The Community Health Connection CHN of Berkshire CHN of Berkshire CHN of Berkshire Upper Valley Health Web Upper Valley Health Web Partnership for Health in Hampshire County Partnership for Health in Hampshire County The Community Health Connection The Community Health Connection CHN of Berkshire Upper Valley Health Web The Community Health Connection CHN of Berkshire Partnership for Health in Hampshire County Upper Valley Health Web CHN of Berkshire Upper Valley Health Web The Community Health Connection CHN of Berkshire Four (For) Communities Partnership for Health in Hampshire County Upper Valley Health Web The Community Health Connection

188

WILLIAMSBURG WILLIAMSTOWN WINDSOR WORTHINGTON

HAMPSHIRE BERKSHIRE BERKSHIRE HAMPSHIRE

Partnership for Health in Hampshire County CHN of Berkshire CHN of Berkshire Partnership for Health in Hampshire County

189

DATA SOURCES

Massachusetts Division of Health Care Finance and Policy MDPH, Bureau of Communicable Disease Control MDPH, Bureau of Substance Abuse Services MDPH, Environmental Health Bureau MDPH, Health Information, Statistics, Research & Evaluation Bureau SAMHSA, Office of Applied Studies

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