1 Northeast Massachusetts Regional Health Dialogue Massachusetts Department of Public Health June 4, 2007.

Northeast Massachusetts Regional Health Dialogue

Massachusetts Department of Public Health

June 4, 2007

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

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

Socio-Demographic Indicators and Health Care Access

WesternRegion Central

Region

SoutheastRegion

Metro WestRegion

NortheastRegion

BostonRegion

Executive Office of Healthand Human Services Regions

Western Region

Central Region

North East Region

Metro West Region

South East Region

Boston Region

NortheastRegion

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. Lawrence vs. the rest of the region)

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

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

BOXFORD

NEWBURY

ROWLEY

HAMILTON

SALISBURY

DUNSTABLE

MIDDLETON

TOPSFIELD

WEST NEWBURY

WENHAM

GEORGETOWN

MERRIMAC

GROVELAND

ROCKPORT

MANCHESTER

NAHANT

IPSWICH

ANDOVER

HAVERHILL

WESTFORD

BILLERICA

DRACUT

METHUEN

LOWELL

PEABODY

BEVERLY

TEWKSBURY

CHELMSFORD

DANVERS

SAUGUS

AMESBURY

READING

MEDFORD

NORTH READING

MALDEN

NORTH ANDOVER

GLOUCESTER

TYNGSBOROUGH

LYNNFIELD

WAKEFIELD

LAWRENCE

STONEHAM

NEWBURYPORT

MELROSE

EVERETT

MARBLEHEAD

SWAMPSCOTT!.

Population > 10,000

Population in CommunitiesNortheast Region: 2005

Smallest3,142

Largest105,749

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

Race and Ethnic Breakdown of PopulationNortheast Region and Massachusetts: 2005

Northeast Massachusetts

White*

Black*

Hispanic 10.4%

Asian*

* Non-Hispanics

White*

Black*

Hispanic

Asian*

American Indian*

Total Population: 1,255,346 Total Population: 6,349,097

Race and Ethnic Breakdown of PopulationLowell, Lawrence, and Lynn : 2005

Asian*, 3.1%

Hispanic, 69.0%

Black*, 2.4%

White*, 25.2%

Amer. Indian*,

Asian*, 7.0%

Hispanic, 17.4%

Black*, 8.6% White*,

Amer. Indian*,

Lowell

* Non-Hispanics

Lawrence

Total Population:

105,167

Total Population:

81,591

Asian*, 8.4%

Hispanic, 23.3%

Black*, 12.2%

White*, 55.8%

Amer. Indian*,

Total Population:

92,186

Language Spoken at Home,Northeast Region and Massachusetts: 2000

Lawrence Lowell Northeast

Region Massachusetts

Only English 35.6% 59.3% 80.1% 81.3%

Spanish or Spanish Creole 55.3% 12.4% 7.9% 6.2%

Portuguese or Portuguese Creole

1.0% 5.4% 1.6% 2.7%

Italian 1.0% 0.2% 1.5% 1.0%

French (Incl. Patois, Cajun) 2.3% 3.2% 1.5% 1.4%

Mon Khmer, Cambodian 0.8% 9.6% 1.3% 0.4%

Chinese 0.7% 0.7% 0.9% 1.2%

Greek 0.0% 1.4% 0.8% 0.5%

Vietnamese 1.0% 1.3% 0.6% 0.5%

Russian 0.0% 0.1% 0.5% 0.5%

LOWELL 12.4%

LYNN 16.7%

SALEM 10.2%

LAWRENCE 55.3%

HAVERHILL 8.1%

METHUEN 8.2%

MIDDLETON 5.3%

EVERETT 9.6%

Spanish LanguageSpoken at Home (%)

Cities/Towns in North East Region

10.0% - 55.3%

5.0% - 9.9%

0.2% - 4.9%

North East Region

Spanish Spoken at Home Northeast Region: 2000

Socio-Demographic IndicatorsNortheast Region and Massachusetts: 2000

Lawrence Lowell Lynn Northeast

Region

MA Overall US Overall

Per Capita Income

$13,360

$17,557 $17,492 $25,748 $25,952 $21,587

Those living below 100% poverty

24.3% 16.8% 16.5% 8.3% 9.3% 12.4%

Children < 18 living below 100% poverty

31.7% 23.2% 22.9% 11.2% 12.0% 16.1%

Less than a High School Education

19.8% 12.9% 10.1% 15.7% 15.2% 19.6%

Speak language other than English at home

64.4% 40.7% 34.2% 19.9% 18.7% 17.9%

Foreign born

30.6% 22.1% 22.8% 12.6% 12.2% 11.1%

Unemployed

11.3% 6.9% 6.5% 6.6%

$13,360

$17,492

$17,557

$25,748

$25,952

$39,560

$41,133

$46,738

$0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000

Lawrence

Lowell

Northeast

Massachusetts

Lynnfield

Andover

Marblehead

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

1 Selected among communities with at least 10,000 population

Birth Indicators

A major concern with infant deaths

8.57.3

4.14.9

White non-Hispanic

Black non-Hispanic

Hispanic Asian Overall

Northeast Region

Massachusetts

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

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

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

)Infant Mortality Rate (IMR)

Northeast Region and Massachusetts: 1990-2005

Massachusetts

Northeast Region

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

Adequate Prenatal Care by Northeast Region Cities: 2005

86.682.0

73.871.1 68.2

Lawrence Lowell Lynn NortheastRegion

Northeastwithout

Lawrence,Lowell, and

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

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

Teen Birth RateNortheast Region and Massachusetts: 1990-2005

Massachusetts

Northeast Region

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

HAVERHILL30.9

LYNN47.3

LOWELL51.4

LAWRENCE71.7

LYNN47.3

Teen Birth Rates by Towns*North East Region Births 2005

Town Teen Birth Rateper 1000 15-19 Female Population

Significantly higher than state rate

Not different from state rate

Significantly lower than state rate

*Towns with less than 100 births were excluded.

Teen Birth Rates by City/Town Northeast Region: 2005

Teen Birth RateMA: 21.7

Northeast: 22.9

21Teen Birth Rates by Race and Ethnicity Northeast Region and Massachusetts: 2005

12.911.2

78.073.2

Northeast Region Massachusetts

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.

Leading Causes of Death

23Leading Causes of DeathNortheast Region and Massachusetts:2005

MassachusettsN=53,776

Heart Disease

13,248 24.6%

Cancer

13,159 24.5%

Stroke 2,979 5.5%

All Injuries 2,657 4.9%

Chronic Lower Respiratory Disease (formerly COPD)

2,643 4.9%

Influenza and pneumonia 1,932 3.6%

Alzheimer's 1,635 3.0%

Nephritis 1,403 2.6%

Diabetes 1,271 2.4%

Septicemia

982 1.8%

Northeast RegionN=10,485

Cancer 2,701 25.8%

Heart Disease 2,592 24.7%

Stroke 542 5.2%

All Injuries 538 5.1%

Chronic Lower Respiratory Disease (formerly COPD)

493 4.7%

Influenza and pneumonia

355 3.4%

Alzheimer's 345 3.3%

Nephritis 270 2.6%

Diabetes 223 2.1%

Septicemia 170 1.6%

Chronic Disease Outcomes and Overweight/Obesity

25Adults who are Overweight1 by EOHHS Region, Massachusetts:

1995 & 2005

49.5 45.7 43.5 44.6

52.057.5

55.952.6

Western Central Northeast MetroWest

Southeast Boston MA

1995 2005

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), Health Survey Program

1 Overweight: BMI greater than or equal to 25

26Heart Disease Mortality Ratesby EOHHS Region

Massachusetts: 2003-2005

182.5195.1

186.3188.8 196.8177.9

Southeast Boston MA

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

27Diabetes Hospital Discharges by EOHHS Region, Massachusetts: 2003-2005

130.7 132.5

110.8124.3

Southeast Boston MA

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

28Diabetes Mortality Rate by Race/EthnicityNortheast Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic

Hispanic Asian non-Hispanic

Cancer

30Incidence Rates for Invasive Colorectal Cancer by EOHHS Region, Massachusetts: 1999-2003

56.258.9

55.2 57.2

63.659.7

Southeast Boston MA

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

31Incidence Rates for Invasive Lung Cancer by EOHHS Region, Massachusetts: 1999-2003

72.076.7

67.2 69.965.1

77.777.5

Southeast Boston MA

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

Lung Cancer Incidence Rates by Race and Ethnicity, Northeast Region &

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

Adults who Currently Smoke by EOHHS Region, Massachusetts: 2005

20.418.1

18.318.821.2

Southeast Boston MA

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

Percent of Mothers Smoking During Pregnancy for Largest Communities

Northeast Region: 2005 % Smokers Births

Massachusetts 7.2% 5,555 76,653Northeast Region 7.2% 1,140 15,924

LowestMelrose 3.2%** 9 285North Andover 2.8%** 9 324Andover 2.0%** 6 292

HighestGloucester 12.5%* 34 272Dracut 11.8%* 44 372Lowell 11.4%* 190 1,667

Indicator MA

Total Western

Central North

East Metro West

South East

Boston

% Men†

PSA (2004)56.1 49.1 52.3 52.3 62.5 56.3 66.2

% Men†

DRE (2004)62.7 59.5 60.0 63.0 64.5 62.6 69.0

% Blood Stool Test † 30.0 34.2 29.9 33.5 30.9 26.4 20.7

% Adults Sigmoidoscopy or

Colonoscopy†

58.8 53.9 60.2 53.2 68.5 55 58.9

% Women Clinical Breast Exam (2004)

86.6 85.0 85.5 90.0 87.1 85.6 85.7

% Women* Mammography 84.1 86.9 83.0 83.4 87.1 82.0 80.1

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

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

*40 years and older, † 50 years and older

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

Indicator

Total Western

Central Northeast Metro

South East

Boston

Prostate Cancer

Incidence181.9 170.3 159.7 180.5 178.4 202.5 191.3

Female Breast Cancer

Incidence

138.9 135.3 127.8 139.8 146.7 139.6 134.9

Colorectal Cancer

Incidence58.9 56.2 55.2 61.8 57.2 59.7 63.6

Lung Cancer Incidence 72.0 67.2 69.9 76.7 65.1 77.5 77.7

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

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

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

Substance Abuse

Any Illicit Drug Use in Past Month Persons Aged 12+ by EOHHS Region,

Massachusetts: 2002- 2004

9.4 9.48.78.4

10.48.5

Southeast Boston MA

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

Opioid-Related Emergency Department Visit Rates by EOHHS Region

181196

Southeast Boston MA

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

40Opioid-Related Emergency Department Visit Rates

by Race/EthnicityLawrence, Lowell, and Lynn vs. Massachusetts: 2003-2005

187220

188237

207184

Lawrence Lowell Lynn Massachusetts

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

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

8.110.1

6.7 6.5

Western Central Northeast Metro West Southeast Boston MA

Injury/Violence

Causes of Injury Deaths Northeast Region and Massachusetts: 2005

Northeast Region Total Injuries = 538

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

Motor Vehicle-related

Other20%

Poisonings 34%

Firearm 8%

Suffocation, Hanging, or Strangulation

Motor Vehicle-related

Falls 10%

Other19%

Hospitalization Rates for Fall-Related Injuries Ages 65+ by EOHHS Region Massachusetts: 2003-2005

23332254 2311 2275

2146**

Western Central Northeast Metro West Southeast Boston MassachusettsTotal

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

380 379 375 374338 *

Western Central Northeast Metro West Southeast Boston MA

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

Infectious Diseases

47HIV/AIDS Death Rate by Race/EthnicityNortheast Region and Massachusetts: 2003-2005

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

Indicator

Total Western

Central

North East

Metro West

South East

Boston

Chlamydia Incidence (crude rates, 2005)

225.7 369.4 145.4 178.0 106.1 169.7 588.5

Gonorrhea Incidence (crude rates, 2005)

39.6 55.9 16.6 22.4 20.3 35.4 126.2

Syphilis Incidence (crude rates, 2005)

6.3 3.1 1.7 4.9 4.7 2.7 22.7

Tuberculosis Incidence (crude rates, 2004)

4.4 1.9 4.2 4.8 4.3 2.0 11.4

Lyme Disease Incidence (crude rates, 2004)

24.7 27.3 19.7 18.4 21.2 48.4 4.0

Hep C Incidence Infection (crude rates, 2006)

114.0 95.0 123.0 92.0 49.0 82.0 150.0

Pneumonia/ Influenza Hospital Discharges

(age-adjusted, 2005)377.0 346.0 392.7 384.4 341.5 406.7 415.8

Summary Infectious Disease Indicators by EOHHS Regions

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

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

Asthma indicators

50Pediatric Asthma Prevalence Among School Children, Grades K-8

by EOHHS Region Massachusetts: 2005-2006

10.5 10.69.4

Southeast Boston MA

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

** ****

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

51Asthma Emergency Department Visit Rates Children Ages 0-14

Northeast Region and Massachusetts: 2005

310415516

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

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

LYNN1570.8

LAWRENCE1494.5

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

North East Region - Massachusetts 2004-2005

Emergency Visit Rates by Townsper 100,000

Significantly higher than state rate

Not different from state rate

Significantly lower than state rate

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

Massachusetts State Total Rate: 1,136.2

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

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

Northeast Region – Massachusetts 2004-2005

Refugee Health Indicators

Refugee Arrivals: Northeast Region Fiscal Year 2002-2006

• 1,312 refugees resettled over 5 years

• Increasing diversity in population

• 45% age <19 at arrival

• Cities/Towns with largest number of arrivals: Lowell, Lynn, Malden

FY02 FY03 FY04 FY05 FY06

Africa E/SEAsia

Eur/CAsia Am/Carib

NrE/SAsia

Source: MDPH, Refugee and Immigrant Health Program and the Bureau of Communicable Disease Control Office of Integrated Surveillance and Informatics

Refugee Health Concerns: Northeast Region Fiscal Year 2002-2006

• High rates of latent TB infection (LTBI)– 1,237 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– 37 refugee children identified with elevated blood lead levels

at arrival– Poor nutritional status puts children at risk of increased

absorption of lead post-resettlement

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

Source: MDPH, Refugee and Immigrant Health Program and the Bureau of Communicable Disease Control Office of Integrated Surveillance and Informatics

Summary

• Excluding the larger communities, the Northeast region is a relatively healthy place to live:– Hypertension and diabetes hospitalizations are lower

than the State– Homicides, STDs, HIV/AIDS, and pediatric asthma are

lower than the State– Injuries related to motor vehicles, firearms, and falls

have lower rates than the State• Residents of larger communities are

disproportionately affected by:– Lack of access to adequate prenatal care, especially in

Lawrence, Lowell, and Lynn– Infant mortality– Colorectal and lung cancer– Opioid related ER visits and fatal overdoses

Health Disparities

– Asians: IMR; access to prenatal care; teen birth rate

– Blacks: IMR; HIV/AIDS mortality rates; diabetes mortality; asthma

– Latinos: IMR; teen birth rate; HIV/AIDS mortality rates; diabetes mortality; asthma; opioid-related ER visits

– Refugees: high TB rates; increased lead poisoning among children

Key health observations in Northeastern Massachusetts

– Racial and ethnic disparities are major factors: Blacks, Latinos and Asians experience health disparities across several indicators

– Overweight/obesity is an increasing health risk - contributes to rising diabetes incidence

– Lowell, Lynn, and Malden have the highest number of refugee arrivals who need bilingual and bicultural access to care

– We need to examine local variation and subgroups in the population to get a more complete picture of the health of the Northeast region

How Can You Access these Data?• Hard Copies: (617) 624-5674

• Data Questions: (617) 624-5640

• TDD/TTY: (617) 624-6001

• DPH Website:

mass.gov/dph/bhsre/resep/resep.htm

• For other questions or suggestions:

Laura.Innis@state.ma.us, 617-624-6021

• For more detailed community data:

http://masschip.state.ma.us/

1 Northeast Massachusetts Regional Health Dialogue Massachusetts Department of Public Health June 4, 2007.

health information

massachusetts slide

lynn slide

local health

population source

health care access slide

evaluation bureau

important health indicators

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