Chronic Disease in Missouri: Progress and Challenges Shumei Yun, MD, PhD Public Health Epidemiologist and Team Leader Chronic Disease and Nutritional Epidemiology.

Chronic Disease in Missouri: Progress and Challenges

Shumei Yun, MD, PhDPublic Health Epidemiologist and Team LeaderChronic Disease and Nutritional Epidemiology Team Section of Epidemiology for Public Health PracticesJuly 12, 2012

Acknowledgement

• Chronic Disease and Nutritional Epidemiology Team (CDNET) members– Jiaqing Li, MD, PhD– Noaman Kayani, PhD– Dave McBride, PhD– Arthur Pashi, PhD– Janet Wilson, MEd, MPA – Sherri Homan, RN, FNP, PhD

Acronyms List• AA – African-American • BRFSS - Behavioral Risk Factor Surveillance System• CDC – Centers for Disease Control and Prevention• CLS – Missouri 2007 County-level Study • DHSS - Missouri Department of Health and Senior Services• F & V <5 - Fruit and vegetable consumption less than 5 times per day • HP2020 - Healthy People 2020 Objective • HS - High School• Low SES – Low Socioeconomic Status• MICA - Missouri Information for Community Assessment • MO – State of Missouri • PedNSS - Missouri Pediatric Nutrition Surveillance System• US – United States of America• WONDER – Wide-ranging Online Data for Epidemiological Research• YRBS - Youth Risk Behavior Survey• YTS - Youth Tobacco Survey

Chronic Diseases in the US• Almost 1 out of every 2 adults has at least one

chronic illness.

• Chronic diseases are the number one cause of death and disability in the US.

• Treating patients with chronic diseases accounts for 75 percent of the nation’s health care spending.

Chronic Diseases in the US• Chronic diseases share major risk factors beyond

genetics and social inequalities:– Tobacco use – Unhealthy diet– Physical inactivity – Heavy drinking– Lack of access to preventive care

• The vast majority of cases of chronic disease could be better prevented or managed.

• Some populations have a greater burden of chronic disease than others.

Leading Causes of DeathMissouri, 2009

11,9948571,2261,3261,3461,719

2,8683,0133,436

12,43513,845

0 5,000 10,000 15,000

All other causesSuicide

Kidney diseaseDiabetes

Pneumonia & influenzaAlzheimer's disease

Unintentional injuriesCerebrovascular disease (Stroke)

Chronic lower respiratory diseasesCancer

Heart disease

Number of deaths

Source: Missouri Department of Health and Senior Services, Missouri Information for Community Assessment

Heart Disease Mortality Rates*Missouri and US, 2000-2009

Source: Missouri Information for Community Assessment, CDC-WONDER *Age-adjusted using 2000 US standard population

Heart Disease Mortality Rates* By Race and Sex Missouri, 2000-2009

Source: Missouri Information for Community Assessment

*Age-adjusted using 2000 US standard population

Cerebrovascular Disease Mortality Rates* Missouri and US

Source: Missouri Information for Community Assessment, CDC-WONDER, HP2020*Age-adjusted using 2000 US standard population

Cerebrovascular Disease Mortality Rates* By Race and Sex, Missouri, 2000-2009

Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population

Major Risk Factors for Cardiovascular Diseases

• Behaviors– Tobacco use– Unhealthy diets– Physical inactivity– Heavy drinking

• Chronic conditions/disease– Hypertension– Dyslipidemia– Obesity– Diabetes

• Lack of chronic disease management and self-management

Risk Behaviors

Current Smoking Among Adults Missouri and US

Source: Behavioral Risk Factor Surveillance System

Current Smoking among Adults By Race and Sex, Missouri


Current Smoking Among Adults By Education Level, Missouri


Current Smoking Among AdultsBy Insurance Status, Missouri, 2007

Source: Missouri 2007 County-Level Study

Current Smoking Among Middle School StudentsBy Race, Missouri

Source: Youth Tobacco Survey

Current Smoking Among High School Students Missouri and US

Source: Youth Risk Behavior Survey

Current Smoking Among High School Students By Race, Missouri


Fruit and Vegetable Intake <5 Times Per Day Among Adults, Missouri and US


Fruit and Vegetable Intake <5 Times Per Day Among Adults, By Race and Sex, Missouri


No Leisure-time Physical Activity Among Adults Missouri and US


No Leisure-time Physical Activity Among Adults By Race and Sex, Missouri


Did not meet CDC Physical Activity Recommendations Among Adults

Missouri and US


Did not meet CDC Physical Activity Recommendations Among Adults

By Race and Sex, Missouri


Heavy Drinking Among Adults Missouri and US


Heavy Drinking Among AdultsBy Race and Sex, Missouri


Chronic Conditions

Prevalence of Hypertension Among Adults Missouri and US


Prevalence of Hypertension Among AdultsBy Race and Sex, Missouri


Prevalence of High Cholesterol Among Adults Missouri and US


Prevalence of High Cholesterol Among AdultsBy Race and Sex, Missouri


Prevalence of Obesity Among AdultsMissouri and US


Prevalence of Obesity Among AdultsBy Race and Sex, Missouri


Prevalence of Obesity* Among Children aged 2 to 5 Years Enrolled in WIC, Missouri, 2009

Prevalence of Obesity Among Middle School Students Missouri


Prevalence of Obesity Among Middle School Students By Race and Sex, Missouri


Prevalence of Obesity Among High School Students Missouri and US


Prevalence of Obesity Among High School StudentsBy Race, Missouri


Prevalence of Diabetes Among AdultsMissouri and US


Prevalence of Diabetes Among AdultsBy Race and Sex, Missouri


Education, Risk Behaviors and Health Conditions Missouri, 2010


Chronic Disease Self-management

Ever Attended a Diabetes Self-management Class Among Adults with Diabetes

Missouri and US


Ever Attended a Diabetes Self-management Class Among Adults with Diabetes By Race and Sex, Missouri


Daily Self-Monitoring of Blood GlucoseAmong Adults with Diabetes

Missouri and US


Daily Self-Monitoring of Blood GlucoseAmong Adults with Diabetes



Ever Taken a Course to Learn How to Manage Arthritis or Joint Symptoms Among Adults with

Arthritis Missouri and US


Ever Taken a Course to Learn How to Manage Arthritis or Joint Symptoms Among Adults with Arthritis



Current Smoking Among Adults with Chronic Disease Missouri 2008-2010

Current Smoking Among Adults with Chronic Disease/Conditions

By Insurance Status, Missouri, 2007

Source: Missouri 2007 County-Level Study

Current Smoking Among Adults with Chronic Diseases By Education Level, Missouri, 2008-2010


Physical Inactivity Among Adults with Chronic Disease/Conditions

Missouri, 2009


Chronic Disease Management and Care

Had 2 or More A1c Tests in the Last Year Among Adults with Diabetes

Missouri and US


Had 2 or more A1c Tests in the Last Year Among Adults with Diabetes

Missouri and US


Had a Foot Exam in the Last Year Among Adults with Diabetes

Missouri and US


Had a Foot Exam in the Last Year Among Adults with Diabetes



Had a Dilated Eye Exam in the Last Year Among Adults with Diabetes

Missouri and US


Had a Dilated Eye Exam in the Last YearAmong Adults with Diabetes



Had a Flu Shot in the Last Year Among Adults with Diabetes

Missouri and US


Had a Flu Shot in the Last YearAmong People with Diabetes



Ever Had a Pneumococcal VaccinationAmong Adults with Diabetes

Missouri and US


Ever Had a Pneumococcal Vaccination Among Adults with Diabetes



Good Job!

• Chronic disease management and self-management– Chronic disease self-management education– Self-monitor blood glucose– Foot exam– Vaccinations among people with diabetes

Cancer

• Cancer affects three out of four Missouri families.

• Cancer is the leading cause of death for individuals younger than 80 years of age and the leading cause of premature death.

• In 2010, cancer cost $263.8 billion, including $102.8 billion for direct medical costs.

• Cancer screening is very important.

Cancer

• Incidence• Mortality• Screening

All-Cancer Incidence Rates*by SexMissouri and US

Source: Missouri Information for Community Assessment, CDC-WONDER

*Age-adjusted using the 2000 US standard population

All-cancer Incidence Rates* by Race and Sex Missouri

*Age-adjusted using the 2000 US standard populationSource: Missouri Information for Community Assessment

All-cancer Mortality Rates* by Sex Missouri and US


All-cancer Mortality Rates* by Race and Sex Missouri


Lung Cancer Incidence Rates*by SexMissouri and US


Lung Cancer Incidence Rates* by Race and Sex Missouri


Lung Cancer Mortality Rates*Missouri and US


Lung Cancer Mortality Rates*by Race and Sex Missouri


Breast Cancer Incidence Rates* Among Women Missouri and US


Breast Cancer Incidence Rates* Among Women By Race, Missouri


Breast Cancer Mortality Rates* Among Women Missouri and US


Breast Cancer Mortality Rates*by RaceMissouri

Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population

Had Mammogram Within the Past Two Years Among Women Age 40+

Missouri and US


Had Mammogram Within the Past Two Years Among Women Age 40+

By Race, Missouri


Prostate Cancer Incidence Rates*Missouri and US

Source: Missouri Information for Community Assessment, CDC-WONDER*Age-adjusted using 2000 US standard population

Prostate Cancer Incidence Rates* by Race Missouri


Prostate Cancer Mortality Rates*Missouri and US

Source: Missouri Information for Community Assessment, CDC-WONDER*Age-adjusted using 2000 US standard population

Prostate Mortality Rates* by Race Missouri


Colorectal Cancer Incidence Rates* by Sex Missouri and US


Colorectal Cancer Incidence Rates* By Race and Sex, Missouri


Colorectal Cancer Mortality Rates*Missouri and US


Colorectal Cancer Mortality Rates* By Race and Sex, Missouri


Ever had a Sigmoidoscopy or Colonoscopy Among Adults Age 50+

Missouri and US


Ever had a Sigmoidoscopy or Colonoscopy Among Adults Age 50+ by Race and Sex

Missouri


Cervical Cancer Incidence Rates*Missouri and US

Missouri Information for Community Assessment, CDC-WONDER*Age-adjusted using 2000 US standard population

Cervical Cancer Incidence Rates* by Race Missouri


Cervical Cancer Mortality Rates* Missouri and US

Source: Missouri Information for Community Assessment , CDC-WONDER *Age-adjusted using 2000 US standard population

Cervical Cancer Mortality Rates* by Race Missouri


Had a Pap Test Within the Past 3 Years Among Women Age 18+

Missouri and US


Had a Pap Test Within the Past 3 Years Among Women Age 18+ by Race

Missouri


Similar to or Better than the US• Heavy drinking • Chronic disease management and self-management (better)

– Diabetes self-management education – Daily self-monitoring blood glucose– Having a foot exam in the last year among adults with diabetes– Flu shoot and pneumococcal vaccination among adults with diabetes

• Breast cancer screening (better)• Colorectal cancer screening • Cervical cancer screening • All-cancer incidence (better)• Breast cancer incidence • Cervical cancer incidence • Prostate cancer incidence and mortality (better)

Worse than the US

• Risk behaviors (except heavy drinking) • Disease and conditions• Cancer incidence (lung, colorectal)• A1C test and dilated eye exam among adults

with diabetes• Heart disease, cancer, and stroke mortality

Progress• Behaviors

– Current smoking prevalence among youth and adults (white men)

– Not meeting CDC physical activity recommendation (white men and women)

– Heavy drinking among AA men

– Colorectal cancer screening (white men and women)– Diabetes self-management education, especially AA women– Self-monitoring blood glucose up to 2008– Flu shot among AA men with Diabetes– Pneumococcal Vaccination among adults with diabetes,

especially AA men

Progress• Cancer Incidence

– Colorectal cancer incidence (except AA men)– Lung cancer incidence ( white and AA men) and racial disparity– Cervical cancer incidence and racial disparity– Breast cancer incidence

• Mortality– Heart disease and stroke mortality rates– All cancer mortality rates and racial disparity– Colorectal cancer mortality (white men and women) – Lung cancer mortality (white and AA men) and racial disparity– Breast cancer mortality and racial disparity– Prostate cancer mortality and racial disparity

Challenges• Smoking

– Burden– Disparity (low education, on Medicaid, no insurance,

AA men)• Physical inactivity

– Burden – Disparity (Low SES, AA)

• Inadequate fruit and vegetable consumption (healthy eating)– Burden

Challenges• Hypertension

– Burden– Trend– Disparity ( Low SES, AA)

• High cholesterol– Burden– Trend

• Obesity– Burden– Trend– Disparity (Low SES, AA)

• Diabetes – Burden– Trend– Disparity (Low SES, AA)

Challenges

• Chronic disease self-management– Smoking prevalence among people with chronic

disease/conditions (especially those who are on Medicaid, Low SES)

– Physical inactivity among people with chronic disease/conditions

– A1C test among people with diabetes– Annual dilated eye exam among people with

diabetes

Challenges• All-cancer incidence

– Disparity (white men and AA men)• Lung cancer incidence

– Burden– Disparity

• Colorectal cancer incidence– Burden– Disparity (especially among men)

• Prostate cancer incidence– Racial disparity

Challenges• All-cancer mortality

– Burden– Disparity (white and AA)

• Lung cancer mortality– Burden

• Breast cancer mortality– Burden

• Colorectal cancer mortality– Burden– Disparity

• Cervical cancer mortality– Burden and disparity

• Prostate Cancer mortality– Disparity

• Data gaps

Highlights

• Progress– Tobacco control

• Adults and youth smoking prevalence has declined

– Colorectal cancer prevention and control

• Screening increased• Incidence decreased• Mortality decreased

• Challenges– Tobacco control

• People with less than high school education

• People who are on Medicaid and who are uninsured

– Colorectal cancer prevention and control

• Incidence and mortality higher than the US

• Racial disparities

Highlights

• What Mo did well– Secondary and tertiary

prevention

• What Mo did not do well– Primary prevention

• High prevalence risk behaviors

• High prevalence chronic conditions/diseases

Highlights

Physical inactivityUnhealthy dietTobacco use

ObesityHigh cholesterolHigh blood pressureDiabetes

Heart attackStroke

Primary Prevention

Resource List• DHSS – Missouri Department of Health and Senior Services• MICA – Missouri Information for Community Assessment• CDC – Centers for Disease Control and Prevention• WONDER – Wide-ranging Online Data for Epidemiological Research• AA – African-American• HP2020 – Healthy People 2020 Objectives• BRFSS – Behavioral Risk Factor Surveillance System• CLS – Missouri 2007 County-level Study• YTS – Youth Tobacco Survey• YRBS – Youth Risk Behavior Survey• PedNSS – Missouri Pediatric Nutrition Surveillance System• HS – High School• F & V <5 – Fruit and vegetable consumption less than 5 times per day• Low SES – Low Socio-econimic Status

Thank You

Shumei Yun, MD, [email protected]

Chronic Disease in Missouri: Progress and Challenges Shumei Yun, MD, PhD Public Health Epidemiologist and Team Leader Chronic Disease and Nutritional Epidemiology.

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