1 Southeast – Cape & Islands Regional Health Dialogue Massachusetts Department of Public Health June 7, 2007.

1

Southeast – Cape & Islands Regional Health Dialogue

Massachusetts Department of Public Health

June 7, 2007

2

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

3

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

4

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

5

Socio-Demographic Indicators and Health Care Access

6

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

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

Executive Office of Health and Human Services (EOHHS) Regions

7

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. Cape vs. the rest of the region)

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

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

8

FREETOWNROCHESTER

TRURO

DIGHTON

EDGARTOWN

HALIFAX

CHILMARK

HANSON

BERKLEY

WEST TISBURY

MARION

WELLFLEET

ORLEANS

EASTHAM

PLYMPTON

CHATHAM

MATTAPOISETT

AVON

TISBURY

GOSNOLD

WEST BRIDGEWATER

PROVINCETOWN

OAK BLUFFS

GAY HEAD (AQUINNAH)

PLYMOUTH

TAUNTON

CARVER

BARNSTABLE

FALMOUTH

SANDWICH

NANTUCKET

WAREHAM

EASTON

FALL RIVER

LAKEVILLE

NORTON

SWANSEA

ATTLEBORO

BREWSTER

DARTMOUTHWESTPORT

REHOBOTH

MIDDLEBOROUGH

BOURNEDENNIS

MASHPEE

HARWICH

DUXBURY

YARMOUTH

MARSHFIELD

RAYNHAM

PEMBROKE

BRIDGEWATER

SEEKONK

BROCKTON

KINGSTON

MANSFIELD

ACUSHNET

HANOVER

NEW BEDFORD

STOUGHTON

FAIRHAVEN

ABINGTONROCKLAND

EAST BRIDGEWATER

NORTH ATTLEBOROUGH

SOMERSET

WHITMAN

HOLBROOK

2005 Population by Communities Southeast Region: 2005

SmallestGosnold: 86

LargestBrockton:100,366


Population > 10,000

9

Race and Ethnic Breakdown of PopulationCape & Islands and Massachusetts: 2005

Cape & Islands Massachusetts

White*

94.3%

Black*

2.6%

Hispanic

1.7%

Asian*

0.9%

* Non-Hispanics

White*

81.0%

Black*

6.0%

Hispanic

7.9%

Asian*

4.9%


American Indian*

0.6%

American Indian*

0.2%

Total = 252,204 Total = 6,436,940

10

TOLLAND1.2%

MASHPEE3.1%

LAWRENCE2%

TISBURY: 1.4%

GAY HEAD (AQUINNAH)39.5%

OAK BLUFFS1.5%

American Indian Populationby Cities and Towns, Massachusetts 2000

American Indian Population by Town

> 1% of Total Population

<= 1% of total population

Towns by Percent Native American Population Massachusetts: 2000

> 1% MA population

<= 1% MA population


11

Language Spoken at HomeSoutheast Region and Massachusetts: 2000

Cape & Islands

Southeast (not including

Cape & Islands)

Southeast Region

Massachusetts Overall

Only English 93.0 83.7 85.4 81.3

Spanish or Spanish Creole 1.5 2.7 2.5 6.2

Portuguese or Portuguese Creole

1.8 8.7 7.4 2.7

French 1.0 1.3 1.3 1.4

Chinese 0.1 0.2 0.2 1.2

Italian 0.4 0.3 0.4 1.0

French Creole 0.1 0.8 0.7 0.7

Russian 0.1 0.1 0.1 0.6

Vietnamese - 0.1 0.1 0.5

Polish 0.1 0.2 0.2 0.5

Other languages 1.9 1.9 1.7 3.9


12


0-19 years 20.4%


Population by Age Group Cape & Islands and Massachusetts: 2005

20-24 years 5.0%

25-44 years

25.2%

45-64 years

27.4%

65+ years 21.9%

0-19 years 25.5%

20-24 years 6.7%

25-44 years

29.4%

45-64 years

25.3%

65+ years 13.3%

Total = 252,204 Total = 6,436,940

20-24 years 5.0% Southeast

(non-Cape)

0-19 years 26.5%

20-24 years 5.9%

25-44 years

29.1%

45-64 years

25.8%

65+ years 12.7%

Total = 1,026,041

13

Socio-Demographic IndicatorsSoutheast Region and Massachusetts

Cape & Islands


Cape & Islands)

Southeast Region

Massachusetts Overall

Per Capita Income (2000) $25,619

$21,520

$22,273

$25,952

Persons living below 100% poverty (2000)

6.9% 8.5% 8.3% 9.3%

Children < 18 living below 100% poverty (2000)

8.5% 10.9% 10.5% 11.6%

Less than a High School Education (2000)

8.3% 20.4% 18.0% 15.2%

Foreign born (2000) 5.1% 9.5% 8.7% 12.2%

Speak language other than English at home (2000)

7.0% 16.3% 14.6% 18.7%

Unemployed (2004) 4.6% 5.7% 5.5% 5.1%


14

$15,265

$21,420

$22,092

$22,789

$25,952

$30,029

$31,021

$31,314

$0 $10,000 $20,000 $30,000 $40,000

Gosnold

Gay Head

Bourne

Southeast

Massachusetts

Chilmark

West Tisbury

Nantucket

Highest and Lowest Per Capita Income Cape & Islands Communities: 2000

High

Low


15

Birth Indicators

16

Infant Mortality Rates by EOHHS Region Massachusetts: 2002-2005

4.8 4.7

5.7

4.9

4.0**

4.7

5.6 5.44.8

0

2

4

6

8

Western Central Northeast MetroWest

Southeast Cape &Islands

Southeast(Non-Cape)

Boston MA

Infa

nt

De

ath

s

pe

r 1

,00

0 L

ive

Bir

ths


Infant 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

17

Indicator (as % of race group births)

MA Total (n=76,824) Southeast

(n=14,681)

Southeast (not incl. the

Cape)(n=12,450)

Cape & Islands (n=2,311)

Adequate Prenatal Care (Kotelchuck index)

84.0 83.6 83.0 86.7

Cesareans 32.3 34.6 35.3 30.7

Low Birth weight (<5.5 lb) 7.9 8.3 8.6 6.4

Breastfeeding 79.3 71.5 69.1 83.9

Public Pay for Prenatal Care 32.6 34.7 34.8 33.5

Smoking during pregnancy 7.1 10.2 10.1 10.1

Summary Birth Indicators Southeast Region and Massachusetts: 2005


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

18

Leading Causes of Death

19Leading Causes of Death

Cape & Islands 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%

Cape & IslandsN=2,869

Heart Disease 721 25.1%

Cancer 707 24.6%

Stroke 168 5.9%

Chronic Lower Respiratory Disease (formerly COPD) 145 5.1%

Alzheimer's 135 4.7%*

All Injuries 128 4.5%

Influenza and pneumonia 96 3.3%

Nephritis 64 2.2%

Diabetes 60 2.1%

Parkinson's Disease 36 1.3%Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better

20

Chronic Disease Outcomes and Overweight/Obesity

21

Adults who are Overweight1 by EOHHS Region, Massachusetts: 1995 and 2005

57.8

45.1

35.7

50.244.643.545.7

49.5

56.152.655.9

60.857.5

52.0

0

10

20

30

40

50

60

70


Southeast Boston MA

Per

cen

t

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


22

Cancer

23

7.3

10.1

3.9

10.2

3.2

7.2

13.5

7.6

10.1

0

5

10

15

20

25

Western Central Northeast Metro West Southeast Cape &Islands

Southeast(Non-Cape)

Boston MA

Pe

rce

nt



Smoking During Pregnancy by EOHHS Region Massachusetts: 2005

*

**

*

**

* *

24

21.8

7.2

21.9

10.1

0

5

10

15

20

25

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

Pe

rce

nt

Smoking During PregnancyCape & Islands and Massachusetts: 1990-2005

Massachusetts

Cape & Islands


25Smoking During Pregnancy by Race and Ethnicity

Cape & Islands and Massachusetts: 2005

6.1

8.4

10.1

13.0

5.95.2

1.4

0

2

4

6

8

10

12

14


Per

cen

t

White non-Hispanic Black non-Hispanic

Hispanic Asian non-Hispanic


*


NA

26

Adults who Currently Smoke Southeast Region and Massachusetts: 2006

17.8

22.0

26.4

19.0

26.5

0

5

10

15

20

25

30

35

40

Cape & Islands Fall River New Bedford SoutheastRegion

MA

Per

cen

t

*

Obesity: BMI greater than or equal to 30


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

**

27Incidence Rates for Invasive Lung Cancer by EOHHS Region, Massachusetts: 1999-2003

72.078.9 77.776.7

67.2 69.965.1

73.277.5

0

25

50

75

100



Southeast(Non-Cape)

Boston MA

Cas

es p

er 1

00,0

00 p

op

ula

tio

n

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

*


*** *

**

*

28Incidence Rates for Invasive Prostate Cancer by EOHHS Region, Massachusetts: 1999-2003

180.5 187.5 191.3 181.9170.3 159.7178.4

239.4

202.5

0

50

100

150

200

250

300



Southeast(Non-Cape)

Boston MA

Cas

es p

er 1

00,0

00 p

op

ula

tio

n

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

**

*


**

*

29

Indicator MA

Total Fall

RiverNew

Bedford

Cape & Islands

Southeast

% Blood Stool Test † 28.4 32.2 33.8 35.2 28.8

% Adults Sigmoidoscopy or

Colonoscopy†

57.4 50.2 48.1 56.5 58.5

% Women* Mammography 84.8 80.6 83.8 85.7 83.4

Summary Indicators for Cancer Screening by Southeast Region and Massachusetts: 2006


*40 years and older, † 50 years and older

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

30

Indicator

MA

Total Southeast


Cape & Islands)

Cape & Islands

Prostate Cancer 181.9 202.5 187.5 239.4

Female Breast Cancer 138.9 139.6 132.8 161.5

Colorectal Cancer 58.9 59.7 59.3 60.6

Lung Cancer 72.0 77.5 78.9 73.2

Total Cancer 517.0 543.1 528.7 582.5

Summary Cancer Incidence Rates Southeast Region and Massachusetts: 1999-2003


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

31

Substance Abuse

32 Opioid-related Emergency Department Visit Rates by EOHHS Region

Massachusetts: 2003-2005

186.3 181.1

309.3

195.7

126.1

223.5

114.0

168.6

238.0*

0

50

100

150

200

250

300

350


Southeast(Non-Cape)

Boston MA

Vis

its

per

100

,000

**

**

*

*

*

**

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

Statistically different from State (p ≤.05) Red (*) = Statistically higher; Green (**) = Statistically lower

33

Indicator MA

Total Southeast Cape &

Islands

Substance Abuse Treatment Program Admissions Rate (crude rate) 1,601 1,724 2,015

Substance Abuse Treatment Program Admissions Rate—Alcohol (crude rate) 661 821 1,147

Substance Abuse Treatment Program Admissions Rate—Cocaine (crude rate) 62 88 92

Substance Abuse Treatment Program Admissions Rate—Heroin (crude rate) 609 504 389

Summary Substance Abuse Indicators Southeast Region, Cape & Islands and

Massachusetts: 2005

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

Statistically lower than state Statistically higher than state

34

Injury and Violence

35

Hospital Discharge Rates for Motor Vehicle-related Injuries by EOHHS Region Massachusetts: 2003-2005

73 74 77

87*93*

88 *

57 **

91 *93 *

0

20

40

60

80

100


Southeast(Non-Cape)

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

36 Emergency Department Visit Rates for Fall-related Injuries by EOHHS Region


3,191

2,5112,750

3,133

2,410

2,7132,913 2,860

3,414

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000


Southeast(Non-Cape)

Boston MA

Vis

its

pe

r 1

00

,00

0

**

*

***


*

**


**

37Emergency Department Visit Rates for Fall-related Injuries by Race/Ethnicity

Cape & Islands and Massachusetts: 2003-2005

2,504

3,169

2,783

4,265

1,870

2,502

896 784

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500


Vis

its

pe

r 1

00

,00

0

White non-Hispanic Black non-Hispanic

Hispanic Asian non-Hispanic

*

**



*

38

Suicide Rates by EOHHS Region Massachusetts: 2003-2005

6.9 6.35.5

6.65.3

7.47.9 7.2

9.5*

0

5

10

15

20



Southeast(Non-Cape)

Boston MA

Dea

ths

per

100

,000

po

pu

lati

on

**

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


39

Hospital Discharge Indicator Rates

(age-adjusted, per 100,000)

MA

Total Southeast Southeast (not including Cape & Islands)

Cape & Islands

All Injuries 836 859 876 812

Fall-related injury hospitalizations 374 375 378 371

Traumatic Brain Injuries 80 73 73 72

Motor vehicle-related 77 88 87 93

Self-Inflicted 65 66 NA 63

Assault 28 21 NA 18

Summary Injury/Violence Hospitalization Indicators Southeast Region, Cape & Islands and



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

40

Infectious Diseases

41

Indicator

Crude rate, per 100,000

MA

Total Southeast

Cape & Islands

Persons living with HIV (2005) 247.1 170.9 235.9

HIV Incidence(2005) 12.6 7.7 10.3

Persons living with AIDS (2005) 133.2 95.2 124.9

AIDS Incidence (2005) 8.0 6.3 7.1

HIV/AIDS Mortality (2003-2005) 3.1 2.5 2.4

Summary HIV/AIDS Indicators Southeast Region, Cape & Islands

and Massachusetts


42Lyme Disease Incidence Cape & Islands, Southeast Region, and

Massachusetts: 2004

30.924.7

4.0

48.5

21.218.427.3

19.7

119.5

0

20

40

60

80

100

120

140



Southeast(Non-Cape)

Boston MA

Ca

se

s

pe

r 1

00

,00

0 p

op

ula

tio

n

*

**


**

Source: MDPH Bureau of Communicable Disease Control, ISIS

**

*

43

Indicator

MA

Total Southeast Southeast

(not including Cape & Islands)

Cape & Islands

Chlamydia Incidence (crude rates, 2005) 225.7 169.7 184.5 103.5

Gonorrhea Incidence (crude rates, 2005) 39.6 35.4 36.2 30.9

Syphilis Incidence (crude rates, 2005) 6.3 2.7 2.1 4.8

Tuberculosis Incidence (crude rates, 2004)

4.4 2.0 NA NA

Lyme Disease Incidence (crude rates, 2004)

24.7 48.4 30.9 119.5

Average Hep C Incidence Infection (crude rates, 2006)

114.0 82.0 NA NA

Pneumonia/ Influenza Hospital Discharges (age-adjusted, 2005)

377.0 406.7 488.8 285.2

Summary Infectious Disease Indicators Southeast Region, Cape & Islands and Massachusetts


44

Asthma

45

Indicator

MA

Total Southeast Southeast

(not including Cape & Islands)

Cape & Islands

Asthma ER Visits Ages 0-4 (age adjusted per100,000)

1,130 854 846 884


775 687 656 825


533 571 533 755


808 697 671 816

Summary Asthma Indicators Southeast Region, Cape & Islands and

Massachusetts: 2005

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

Statistically lower than state Statistically higher than state

46

Summary-Cape & Islands• Socio-demographics difference impact health status

– Older population – Socio-demographic indicators are better than the State – Mostly white non-Hispanics– Majority speak only English

• In general, the Cape & Islands is a relatively healthy place to live:– Birth indicators are better than the State– Heart disease and diabetes mortality are low– Homicides, firearm, STDs lower than the State

• Some indicators are worse than the State :– Cancer incidence is higher for breast and prostate cancer – Higher motor vehicle deaths and suicides than the State– Higher Lyme Disease incidence than the State– Higher Emergency Department Visit rates for opioid-related and for asthma for

children ages 10-14 years– Higher Substance Abuse Treatment Program Admission rates than State

• We need to examine local variation and subgroups in the population to get a more complete picture of the health of the Cape & Islands region

• These are resident data and do not reflect the impact of visitors on the Cape & Islands

47

Health Disparities by Race/Ethnicity Cape & Islands

– Blacks on the Cape & Islands have higher Emergency Visit Rates for fall-related injuries than Blacks in MA

– White mothers on the Cape & Islands have higher rates for smoking during pregnancy than whites in MA

48

How Can You Access these Data?

• Hard Copies: (617) 624-5674

• TDD/TTY: (617) 624-6001

• Questions: (617) 624-6021

[email protected]

• For more detailed community data:http://masschip.state.ma.us

• DPH Website: http://www.mass.gov/dph/comm/health_dialogues.htm

49

Q/A

1 Southeast – Cape & Islands Regional Health Dialogue Massachusetts Department of Public Health June 7, 2007.

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