Delaware Children’s Health Chartbook Executive Summary · 2020-05-21 · 2 Introduction Nemours Health and Prevention Services (NHPS) is pleased to present the Delaware Children’s

Delaware Children’s Health Chartbook

Executive Summary

2005 Edition

2

Introduction

Nemours Health and Prevention Services (NHPS) is pleased to present the Delaware Children’s Health Chartbook. Relying on many sources of data, the chartbook offers a more in-depth view of the health status, behaviors and health care utilization of Delaware children than has previously been available in a single document.

Our goal in publishing the document is to broaden our collective capacity for gathering and analyzing data by making existing data more accessible as well as presenting new information on emerging issues related to children’s health in Delaware. The chartbook is designed to enhance and complement existing reports such as the annual KIDS COUNT report and the Annual Vital Statistics Report.

For purposes of the chartbook, we define health in its broadest terms to include: • Physical, mental, socio-emotional and behavioral health;• Social determinants of health, including the influence

of economics on health; and• The environmental and community context that

contributes to well-being.

In developing the chartbook, we worked closely with a number of agencies that are leading advocates for children. Organizations that provided data upon which the chartbook is based include:• Delaware Health Statistics Center, Division of Public

Health• Delaware Division of Medicaid and Medical Assistance• Delaware Department of Education• University of Delaware• Quality Insights of Delaware• Delaware KIDS COUNT• State of Maryland Department of Health and Mental

Hygiene• Rhode Island Department of Health• Center for Health Program Development and

Management, University of Maryland, Baltimore County• National Center for Health Statistics, Centers for

Disease Control and Prevention

The chartbook was prepared in conjunction with The Lewin Group, Inc., a health care and human services consulting firm in Northern Virginia, and The Child and Adolescent Health Measurement Initiative (CAHMI) at Oregon Health and Science University.

What’s in This Chartbook

The chartbook presents information for Delaware’s children and youth, ages 0 through 17, with respect to: • Demographic Characteristics, with information on

population size, family structure, and aspects of the social, economic, and community context;

• Health Status, including indicators of physical, mental and emotional well-being, and causes of morbidity, including some health conditions that are amenable to prevention;

• Health Services Utilization, including inpatient and outpatient utilization, and highlights the use of some preventive health services; and

• Childhood Overweight and Related Conditions, a special section devoted to exploring the prevalence of overweight, behaviors that may contribute to the condition, and associated co-morbidities.

To stimulate a process of continuous improvement in health care and related services for children, data on Delaware children are presented alongside data for a range of comparison groups including the nation, the states of Maryland and Rhode Island, the HRSA Mid-Atlantic region, and where appropriate, Healthy People 2010 objectives. The national average serves as a reference point throughout the majority of the chartbook against which to compare the experience of Delaware’s children, potentially helping the Delaware community to identify opportunities for improvement.

For many indicators, Delaware is given a rating of “Healthier,” “Comparable,” or “Less Healthy” relative to the nation. For measures of health care utilization, the ratings of “Higher,” “Comparable,” and “Lower,” are assigned. These ratings are only intended to provide relative comparisons for the Delaware community to consider, and should not be interpreted as a report card for Delaware or other communities. Additionally, a rating of “Healthier” in no way implies that there is no room for improvement. More information on how these ratings were determined can be found in the chartbook.

The chartbook presents an analysis of Delaware data drawn from:• National Survey of Children’s Health (NSCH), a new

source of parent-reported data on child and family health in the context of communities, schools and neighborhoods;

• Nemours Electronic Medical Record (EMR) Data, drawn from electronic medical records for nearly 25,000 children cared for in Nemours primary and

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specialty care outpatient facilities. These data were used to analyze the occurrence of overweight and related conditions in children;

• Youth Risk Behavioral Surveillance System (YRBSS), high school student-reported data on health risk behaviors associated with adverse outcomes in youth and adulthood;

• State Hospital Discharge Data, aggregated patient-level data associated with inpatient discharges presented for children in Delaware, Maryland, Rhode Island and the nation; and

• State Medicaid Data, claims and enrollment data for children enrolled in Medicaid in Delaware and Maryland.

While we are excited to share data from new sources, such as the National Survey of Children’s Health and Nemours electronic medical records, we acknowledge that there are still critical gaps in the data available on children and youth. Our intent with the chartbook is to provide an overall picture of children’s health in Delaware, but we do not believe this is a complete picture. State and national indicators are lacking, particularly in the areas of mental health and socio-emotional health, as well as with respect to social and environmental factors, which can have a large influence on children’s health (e.g., sustained poverty, abuse and neglect).

NHPS plans to produce a series of chartbooks that will build on the data presented in each edition to ultimately provide a complex view of child health from a variety of perspectives. In addition to the basic and recurring sections of the chartbook, such as the demographics section and the description of health status, each chartbook will contain a module exploring a particular health concern. The next chartbook will explore children’s emotional and behavioral health.

Additionally, in 2006 NHPS will administer the first in a regular series of household surveys within the state of Delaware to try and begin to address current gaps in data on health status. The first survey will focus primarily on general indicators of health status as well as issues related to overweight. These data will be incorporated into future chartbooks on children’s health.

Overview of Nemours Health and Prevention Services

In 2003, Nemours redefined its business and programs to include a more holistic approach to the child: health as well as health care. As a result, the Nemours Division of Health and Prevention Services (NHPS) was created,

becoming operational in Delaware in 2004. The division is devoted to child health promotion and disease prevention.

Our mission is to improve children’s health over time through an integrated model that includes developing effective programs, building on the community’s current resources, evaluating programs, and providing business support services and technical assistance to non-profit and health-related organizations serving children. While our primary focus will be in Delaware initially, our goal is to eventually become a national resource in the area of child health promotion.

We have reached out to numerous Delaware and national partners to engage in intensive needs assessments and program planning to shape our initial community-based program strategies. Our approach is based on a broad, multifaceted view of health, and an appreciation for the many interrelated influences on health. The daisy diagram illustrates this view.

Through our program development,

we are planting the seeds that will help children practice

healthy lifestyles, supported by health

promoting environments and preventive health care.

Because a number of chronic health conditions are thought to have their roots in behaviors and lifestyle-related choices during childhood (e.g., overweight, type 2 diabetes), NHPS believes that its focus on health promotion and disease prevention for children will reap a significant return on investment in the form of a healthier future generation of adults.

With the vision of achieving optimal child health and development for Delaware’s children, NHPS is initiating programs in two priority focus areas: 1) childhood overweight – promoting healthy eating and physical activity, and 2) child emotional and behavioral health. NHPS’ efforts to build a health promotion and disease prevention system for children based on sound information, theory and evidence-based practice are enhanced by this children’s health chartbook.

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Demographic Characteristics for Delaware’s Children and Youth

This section is intended to provide basic information about the overall characteristics of children and youth living in Delaware. Delaware’s population of children and youth is described with respect to age, gender, race and ethnicity, household income, health insurance coverage, and the prevalence of special health care needs.

The data used in this section are from the National Survey of Children’s Health (NSCH), a survey module under the State and Local Area Integrated Telephone Survey (SLAITS).

Age and Gender

There are 198,401 children and youth under the age of 18 living in Delaware, comprising approximately 23.7 percent of Delaware’s total population. Nationally, children and youth under 18 make up 24.7 percent of the total population. The percentage of children and youth in Delaware within each age category (ages 0 through 5; 6 through 11; and 12 through 17) is comparable to the nation, with the three age groups each representing approximately one-third of the under 18 population. Similar to the nation, there are slightly more boys than girls in Delaware.

Race and Ethnicity

While Americans’ overall health status has been improving, disparities remain in the prevalence of illness and death experienced by minority populations, as compared to the U.S. population as a whole. These disparities affect children as well as adults.

Overall, Delaware has larger proportions of white and African American children and youth, but a smaller proportion of Hispanic children than the nation. Despite being a relatively small segment of the population currently, the Hispanic population is growing rapidly within Delaware.

Household Income

Household income level can have a significant impact on the health status of children. For example, children living in low-income households may not have adequate health insurance or access to primary care. Household income is divided into four categories based on the Federal Poverty Guidelines. The Federal Poverty Guidelines are issued by the U.S. Department of Health and Human Services and are designed to help estimate the number of Americans who live in poverty. In the chartbook, households are assigned into categories according to the year they were surveyed, either in 2002 or 2003. In 2003, a family of four with an income of less than $18,400 would have been considered living under the Federal Poverty Level (FPL). A family of four with an income of $36,800 would have been at 200 percent of the FPL, or twice the poverty level.

Overall, a smaller percentage of children and youth in Delaware live under the FPL when compared to the national rate of children in poverty. Over 60 percent of Delaware’s children and youth live in households with incomes at or above 200 percent of the poverty level.

Children and Youth with Special Health Care Needs

The federal Maternal and Child Health Bureau (MCHB) defines children and youth with special health care needs (CYSHCN) as “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” The term CYSHCN typically includes, but is not limited to, children and youth with diabetes, asthma, cerebral palsy, cystic fibrosis, sickle cell disease, spina bifida, epilepsy, attention deficit hyperactivity disorder, and mental retardation.

In Delaware, parents report nearly one in five children and youth ages 0 through 17 (19.2 percent) have some type of chronic condition resulting in a limitation of activity or an elevated need for or use of medical care, therapeutic services, or prescription drugs. This is somewhat higher than for children nationally (17.6 percent). Children and youth ages 6 through 11 in Delaware are more than twice as likely to have special health care needs than children under age six. This proportion includes children who currently have a special health care need and does not include children at risk or children who do not experience current health or health care service need consequences for an ongoing health condition.

Figure 1: Percentage of Children and Youth Ages 0 – 17, by Race and Ethnicity

Data Source: National Survey of Children’s Health, 2003; Note: All data are parent reported.

64.3%

23.5%

7.4%

17.6%14.4%

60.7%

0%

10%

20%

30%

40%

50%

60%

70%

White African American Hispanic

Nation

Delaware

Nation

Delaware

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Health Status of Delaware’s Children and Youth

This section examines the health of Delaware’s children, youth and families across a range of health status indicators. In addition, it includes some measures of access to health services for children and youth in Delaware. The indicators selected do not present a comprehensive view of the issues, but rather serve as dashboard measures to help identify areas that may need more study or programmatic attention.

On the majority of indicators, Delaware is either healthier or comparable to the selected comparison states and the nation. Specifically:• Approximately 85 percent of parents report their

children are in excellent or very good health; • Over 95 percent of children and youth have current

health insurance and nearly 90 percent have continuous health insurance coverage; and

• Eight out of ten children receive one or more preventive medical visits per year, and over 50 percent have a medical home, described by the American Academy of Pediatrics as a model in which the child has a personal doctor or nurse who ensures that the child has access to comprehensive health care services that are coordinated, family centered, compassionate, and culturally sensitive.

Reading to young children every day and participating in early childhood school are both recognized as key elements to helping children become ready for school. Nearly 70 percent of Delaware’s children and youth attend early childhood school and over half are read to each day in the home.

However, several noteworthy income-related as well as racial and ethnic disparities are evident with respect to health status. For example, only 68 percent of Hispanic children and youth have continuous health insurance coverage, compared to over 90 percent of white children. In addition, parents from low-income households are less likely to report that their children have excellent or very good health status, a medical home, or health insurance coverage.

Young children in Delaware are more prepared for school than their peers nationally.Figure 2: Percentage of Children Who Are Read to Every Day (Ages 0-5) and Who Attend Early Childhood School (Ages 3-5), as Reported by Parents


Nation

Delaware

Nation

Delaware

52.8%

69.3%

47.8%

60.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Read to Every Day Attend Early Childhood School

While overall Delaware’s children’s health status is comparable to or better than the nation, some health status indicators for Delaware’s children and youth indicate greater opportunities for improvement. In particular:• Nearly 11 percent of young children in Delaware

experience injuries requiring medical attention, compared to 9.4 percent nationally. Unintentional injuries, such as falls, burns and choking, are the most common causes of death for young children throughout the nation;

• Fewer children in Delaware are breastfed compared to children in other areas. Only 62 percent of children ages 0 through 5 in Delaware were ever fed breast milk, compared to the national average of 72 percent. Children from low-income households are less than half as likely to have been fed breast milk at some time in their early life compared to children from Delaware’s highest income households;

Fewer children and youth from lower income households have excellent or very good health status.Figure 3: Percentage of Delaware Children and Youth Ages 0 - 17 with Parent-described Excellent or Very Good Health, by Household Income


70.1%

79.6%

89.7%92.9%

0%

20%

40%

60%

80%

100%

0 - 99% FPL 100 - 199% FPL 200 - 399% FPL 400% FPL or more

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About one-third of Delaware’s children are exposed to secondhand smoke in the home.Figure 5: Percentage of Children and Youth Ages 0-17 Who Live in a Household in Which Someone Smokes Tobacco, as Reported by Parents


29.5%

32.8%

0% 10% 20% 30% 40%

Nation

Delaware

• Delaware parents report that about 23 percent of children ages 1 through 5 are at risk for developmental, behavioral, or social problems, and almost 9 percent have moderate or severe socio-emotional difficulties; and

• Nearly 20 percent of children and youth in Delaware have special health care needs, slightly higher than the nation. Over 27 percent of these children have inadequate health care coverage and nearly a quarter have moderate or severe socio-emotional difficulties.

Parents of Delaware’s children and youth ages 6 through 17 also report higher overall rates of asthma compared to children nationally. Asthma is a chronic condition often contributing to school absenteeism and is linked with numerous other chronic conditions including upper respiratory infections, ear infections, and obesity.

In addition, parents report that about one-third of Delaware’s children and youth live in households in which someone smokes tobacco, slightly higher than children nationally. Over 13 percent of pregnant women in Delaware smoke during pregnancy, which is comparable to the national average. Children and youth who live in households where someone smokes are far more likely to be affected by diseases related to tobacco use, including respiratory tract infections (e.g., pneumonia), middle ear infections, as well as more severe asthma and increased chance of developing asthma.

The safety and supportiveness of a child’s neighborhood can have a significant impact on their well being. In Delaware, about seven out of ten children and youth (70.4 percent) live in supportive neighborhoods that are described by parents as “usually or always” safe. This is comparable to children and youth nationally (72.6 percent). However, children and youth who live in low-income households are less likely to live in supportive neighborhoods that are “usually or always” safe.

Children and youth in Delaware have a higher prevalence of asthma compared to children and youth nationally.Figure 4: Percentage of Children and Youth Ages 6 - 17 Whose Parents Report They Have Current Asthma

8.9%

11.9%

0% 5% 10% 15%

Nation

Delaware


Children and youth living in lower income households are much less likely to live in supportive and safe neighborhoods.Figure 6: Percentage of Children and Youth Ages 0 - 17 Who Live in Supportive Neighborhoods in Which They Are Usually or Always Safe, by Household Income, as Reported by Parents


45.4%

58.5%

74.1%

85.9%

0%

20%

40%

60%

80%

100%

0 - 99% FPL 100 - 199% FPL 200 - 399% FPL 400% FPL or More

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Health Services Utilization of Delaware’s Children and Youth

Children’s use of health care is influenced by a number of factors, including socioeconomic and demographic factors, as well as their overall health status. Examining health services utilization for children and youth can help communities answer questions about the overall treatment needs in a community, costs and volume of treatment, physician practice patterns, and trends in use of and access to health services in specific populations. The first chartbook provides data to help begin to understand these relationships, and provides background for future studies about the relationship between chronic disease, health services and costs, and the potential cost benefit of preventive services.

To assess hospital inpatient utilization, three indicators are calculated using hospital discharge data including: 1) inpatient admissions per 1,000 children and youth; 2) inpatient hospital days per 1,000 children and youth; and 3) average length of stay, in days, per admission (ALOS). Admissions and days provide a sense of overall service volume and can serve as a barometer of access to care, while average length of stay may reflect the intensity of care required or overall physician practice patterns.

Standard measures of outpatient utilization include the number of office visits, emergency department (ED) visits, and screenings. Each of these types of outpatient utilization provides a different picture of services accessed by children and youth. Conditions treated in EDs may tend to be more acute or serious in nature, requiring a higher intensity of care.

State hospital discharge data are used to analyze trends in inpatient utilization, while findings on outpatient utilization are based on Medicaid claims data. National comparisons are not available for outpatient claims analysis. Approximately a third of children and youth who live in Delaware are enrolled in the state’s Medicaid program.

Overall, inpatient utilization for Delaware’s children and youth is lower than or comparable to the nation. Admissions (86.3 per 1,000 children and youth) and days (305.9 per 1,000 children and youth) are lower for children and youth in Delaware, relative to the nation, while the average length of stay is comparable (3.5 days per admission in Delaware versus 3.6 days per admission in the nation).

African American children and youth in Delaware have higher inpatient utilization relative to white children. This may be partially related to a higher prevalence of prematurity, low birth weight and other neonatal conditions among African American infants.

Note: Inpatient utilization for diagnoses related to labor and delivery and V&E codes are excluded from this analysis.Data Source: Delaware Hospital Discharge data, 2003

One way to determine causes of hospital admissions is to examine utilization within diagnosis categories, which are broad groupings of diagnoses based on organ systems (e.g., diseases of the respiratory system) or types of conditions (e.g., mental disorders). Overall, the top five diagnostic categories account for nearly 60 percent of all admissions and 46 percent of all inpatient days for Delaware children and youth ages 0 through 17. Excluding utilization for labor and delivery, the top reasons for admissions for children and youth in Delaware include: diagnoses related to respiratory conditions (e.g., asthma, pneumonia, and bronchitis); injuries and poisonings; endocrine, nutritional and metabolic diseases (e.g., diabetes); and digestive illnesses (e.g., gastroenteritis).

For the majority of diagnostic categories, including but not limited to, diseases of the circulatory system, digestive system, respiratory system, endocrine, nutritional, and metabolic diseases (e.g., diabetes), neoplasms (e.g., skin cancer), injuries, poisonings, and mental disorders, Delaware children and youth have comparable or lower inpatient utilization (admissions and days) relative to the nation. They have higher utilization for diseases of the musculoskeletal system, diseases of the blood and blood forming organs (e.g., sickle cell anemia), and complications of pregnancy and childbirth (e.g., miscarriages among pregnant youth).

African American children and youth have higher rates of inpatient utilization compared to whites.Figure 7: Inpatient Admissions and Days per 1,000 Children and Youth, by Race

White African AmericanWhite African American

27.5

100.9

159.8

38.6

0

20

40

60

80

100

120

140

160

180

Admissions per 1,000 Children Days per 1,000 Children

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Respiratory conditions constitute the largest proportion of inpatient utilization for Delaware’s children and youth, comprising over a quarter of all admissions and nearly one-fifth of inpatient hospital days. Within this category, asthma and bronchitis are among the most common reasons children in Delaware are hospitalized.

Asthma and bronchitis are among the most common reasons Delaware’s children are hospitalized.Figure 8: Percent of Admissions for Specific Conditions Related to Diseases of the Respiratory System

Data Source: Delaware Hospital Discharge data, 2003

Asthma38.3%

Acute Bronchitis &Bronchiolitis

22.0%

Pneumonia,Organism

Unspecified17.2%

Acute Laryngitis & Tracheitis

4.2%

Influenza2.9%

Viral Pneumonia2.3%

Other9.3%

Other Diseasesof Lung1.8%

Chronic Diseaseof the Tonsils &

Adenoids2.0%

Children ages 0 through 4 in Delaware’s Medicaid program have higher rates of physician office visits for respiratory conditions.Figure 9: Office Visits for Respiratory Conditions per 1,000 Delaware Children and Youth Enrolled in Medicaid Ages 0 - 17, by Age

Data Source: Delaware Medicaid Outpatient Encounter data, 2003

1,045.0

906.7

656.3

490.7

400.4

0

200

400

600

800

1,000

1,200

<1 1 - 4 5 - 9 10 - 14 15 - 17

ED visits related to injury and poisoning are highest for young children ages 1 through 4 enrolled in Delaware’s Medicaid program.Figure 10: ED Visits for Injury and Poisoning per 1,000 Delaware Children and Youth Enrolled in Medicaid Ages 0 - 17, by Age


86.1

203.1

153.7

200.7 201.6

0

25

50

75

100

125

150

175

200

225

<1 1 - 4 5 - 9 10 - 14 15 - 17

Respiratory conditions are also a leading cause of outpatient utilization. Accounting for over a third of office visits, respiratory conditions are the number one reason Delaware children and youth enrolled in Medicaid visit physician offices. This may be due in part to the high prevalence of asthma in the community, as noted in the Health Status section. Respiratory-related conditions also account for nearly 21 percent of emergency department visits for Delaware’s children and youth.

Overall, children under 1 year of age in Delaware account for the greatest number of Medicaid office visits for respiratory-related conditions.

Injury and poisoning-related conditions are the number one reason Delaware’s children and youth enrolled in Medicaid visit the emergency department. Notably, parents of young children in Delaware also report that their children have higher rates of injuries requiring medical attention compared to children nationally.

Generally, Delaware children and youth enrolled in Medicaid ages 1 through 4 and 10 through 17 have the highest rates of ED visits for injury and poisoning-related conditions compared to other age groups. Boys and girls enrolled in Medicaid also differ in their utilization of ED visits for injuries and poisonings, with boys accounting for a greater share of overall ED visits (200.9 visits per 1,000 boys versus 150.8 visits per 1,000 girls).

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Focus on Childhood Overweight, Related Health Behaviors, and Health Complications

Obesity has become an epidemic in our country and children are not immune to this problem. In the past two decades, the prevalence of overweight in children has more than tripled nationally.

Overweight children and youth are more likely to become overweight or obese adults; this concern is greatest among adolescents. Type 2 diabetes, abnormal blood lipids, hypertension, liver disease, asthma, early maturation, menstrual irregularities, sleep apnea, orthopedic problems, and psychological disorders such as depression and anxiety occur with increased frequency in overweight youth. Preventing overweight in Delaware’s children and youth is a priority for NHPS and the data in the chartbook provide important baseline information for our efforts in this area.

Expert committees and advisory groups have recommended Body Mass Index (BMI) percentile for age and sex as the standard measure for assessing overweight status among children and adolescents. BMI is a measure of weight in relation to height. BMI correlates with total body fat content for the majority of individuals. BMI has some limitations, in that it can overestimate body fat in persons who are very muscular. In children and adolescents, overweight has been defined as a BMI at or above the 95th percentile for age and sex. At risk for overweight has been defined as a BMI at or above the 85th up to the 95th percentile for age and sex.

This section examines the prevalence of overweight and at risk for overweight among Delaware’s children and youth as well as important behaviors associated with this condition. In addition, some of the health complications related to overweight in children and youth (e.g., type 2 diabetes and abnormal blood lipids) are explored to better understand the broader health implications of overweight in children and youth.

Prevalence of Overweight

Approximately one-third of children and youth seen in a Nemours pediatric outpatient primary care and subspecialty clinic ages 2 through 17 are either at risk for overweight or overweight (i.e., BMI for-age-and-sex at or above 85th percentile). Twenty percent are overweight (i.e., BMI for-age-and-sex at or above 95th percentile).

Self-reported data from high-school students also highlights the challenges Delaware’s children and youth face in this area. Nearly 16 percent of Delaware’s high school students are at risk for overweight and an additional 13 percent are overweight, comparable to the nation. However, this prevalence exceeds both state and national Healthy People 2010 objectives for overweight among children and youth.

The prevalence of overweight varies considerably by age, gender, race, and ethnicity. Nemours outpatient electronic medical record data indicate that youth ages 10 through 17 have a higher prevalence of overweight and at risk for overweight compared to younger children, based on BMI analysis. In addition, according to data from the Youth Risk Behavior Surveillance System, more African American and Hispanic high school students in Delaware are overweight or at risk for overweight relative to white high school students.

Health Behaviors Affecting Overweight

Behavioral and environmental factors provide the greatest opportunity to prevent unhealthy weight gain. Children and youth can reduce their risk for overweight and a variety of preventable diseases if:• Five or more fruits and vegetables are consumed each day;• Screen time (television, videos and computer) is limited

to less than two hours each day;• Children are physically active for at least one hour each

day; and• Sugar-sweetened beverages, specifically soft drinks,

fruit drinks and sports drinks, are limited to no more than two servings each week.

Underweight (BMI < 5th Percentile)3.3%

Healthy Weight(BMI < 85th Percentile)

60.6%

At Risk forOverweight

(BMI 85th – 95th

Percentile)16.2%

Overweight(BMI > 95th

Percentile)19.9%

More than one-third of Delaware children and youth seen at a Nemours outpatient clinic are overweight or at risk for overweight, while one-fifth are considered overweight.Figure 11: Percentage of Delaware Children and Youth Ages 2 - 17 Seen at a Delaware Nemours Outpatient Clinic, by Weight Status

Data Source: Nemours Delaware Outpatient and Specialty Care Electronic Medical Record Data, 2003; Note: Data is not adjusted for demographics or co-morbid conditions.

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From these recommendations, Nemours Health and Prevention Services has adopted the 5-2-1-Almost None lifestyle modification theme. Communities and parents who support children in meeting these goals will enhance their ability to achieve energy balance and overall good health.

Similar to the nation, only one-fifth of all high school students report eating five or more fruits and vegetables per day, which is important for promoting healthy development and may help prevent weight gain.

Healthy Lifestyle ThemeFigure 12: Five—Two—One—Almost None

5 FRUITS AND VEGETABLES

PER DAY

2 HOURS OR LESS OF SCREEN TIME

PER DAY

1 HOUR OR MORE OF PHYSICAL ACTIVITY

PER DAY

ALMOST NO SUGAR- SWEETENED BEVERAGES

2 OR LESS PER WEEK

Nemours Health and Prevention Services

5 FRUITSAND VEGETABLES

PER DAY

2 HOURS OR LESSOF SCREEN T IME

PER DAY

1 HOUR OR MORE OF PHYSICAL ACT IV ITY

PER DAY

ALMOST NO SUGAR-SWEETENED BEVERAGES2 OR LESS PER WEEK

Healthy Lifestyle Theme:

Five–Two–One–Almost None!

five two one almost none

In addition, nearly half of Delaware’s youth watch two or more hours of TV per day. Children and youth who are overweight or at risk for overweight report watching more hours of TV per day compared to non-overweight children.

High rates of screen time may be contributing to decreased physical activity. Nearly 15 percent of Delaware’s high school students report no participation in either moderate or vigorous physical activity. In addition, Delaware’s high school students who report less days of moderate physical activity (30 minutes or more of physical activity per day) are more likely to be overweight. Over 60 percent of Delaware’s high school students who are overweight also report that they engage in two or fewer days of moderate physical activity per week.

Health Complications Related to Overweight

The connection between overweight and certain co-morbidities, such as type 2 diabetes, high blood pressure, and asthma, is more well-established for certain conditions than others. This is an area that needs further research, but the data presented in the chartbook offer important insights into these relationships.

Compared to children of a healthy weight, overweight children and youth seen at a Nemours Delaware outpatient clinic are:• three times more likely to have high blood pressure

(hypertension);• seven times more likely to have abnormal lipid levels

(e.g., cholesterol); and• four times more likely to have sleep apnea.


Overweight children and youth in Delaware report watching more hours of television per day than non-overweight children and youth.Figure 13: Percentage of Delaware Children and Youth Ages 6 - 17 Who Report Watching Two or More Hours of Television Per Day, by Weight Status

Perc

enta

ge W

ho W

atch

2 o

r M

ore

Hou

rs o

f Te

levi

sion

Overweight ChildrenBMI > 95th Percentile

Healthy Weight or Underweight ChildrenBMI ≤ 85th Percentile

At Risk forOverweight Children

BMI 85th – 95th Percentile

40.3%

59.3% 61.1%

0%

10%

20%

30%

40%

50%

60%

70%

11

These data also indicate that children who are at-risk for overweight are more likely to be affected by these types of co-morbidities.

Data from Nemours electronic medical records also indicate that type 2 diabetes is more prevalent among overweight children and youth compared to non-overweight children and youth. These findings are consistent with other data that demonstrate a dramatic increase in type 2 diabetes in overweight children.

Children and youth who are overweight or at risk for overweight are also more likely to have asthma than non-overweight children. Numerous studies have documented that overweight is more prevalent among children and youth with asthma. However, it is unclear whether a cause and effect relationship exists between the two conditions.

Children and youth seen at a Delaware Nemours outpatient clinic who are overweight are more likely to have asthma compared to non-overweight children and youth.Figure 14: Percentage of Children and Youth Ages 2 - 17 Seen at a Delaware Nemours Outpatient Clinic with Asthma, by Weight Status

Data Source: Nemours Delaware Outpatient and Specialty Care Electronic Medical Record Data, 2003; Note: Data is not adjusted for demographics or co-morbid conditions.

Overweight ChildrenBMI > 95th Percentile

Healthy Weight or Underweight ChildrenBMI ≤ 85th Percentile

At Risk forOverweight Children

BMI 85th – 95th Percentile

Perc

enta

ge w

ith A

sthm

a

8.9%

10.8%

13.8%

0%

2%

4%

6%

8%

10%

12%

14%

16%


Children and youth enrolled in Delaware’s Medicaid program with a diagnosis of obesity have almost twice as many office visits and 1.5 times as many emergency department visits than the general Medicaid population of children and youth.Figure 15: Office and ED Visits per 1,000 Children and Youth Enrolled in Medicaid Ages 0 - 17, by Obesity Diagnosis Status

ED Visits per 1,000 Office Visits per 1,000ED Visits per 1,000 Office Visits per 1,000

650.8972.9

2,797.9

5,160.1

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

5,500

All Children and Youth Overweight Children and Youth

Overweight and Health Services Utilization

Overweight and its associated co-morbidities are generally chronic in nature, requiring continued treatment, monitoring and management to prevent further adverse outcomes and inpatient hospitalizations. As such, these

conditions are typically managed in outpatient settings, such as physician offices or community health centers.

Children and youth enrolled in Delaware’s Medicaid program with a primary or secondary diagnosis of overweight generally have higher utilization than the overall population. Overweight children and youth enrolled in Medicaid have nearly twice as many doctors’ office visits and 1.5 times as many emergency department visits than the general Medicaid pediatric population. Boys enrolled in Delaware’s Medicaid program with a primary or secondary diagnosis of obesity have slightly more physician office visits compared to girls; however, boys have fewer visits to the emergency department.

Rates of higher utilization among Delaware’s overweight population are due in part to higher outpatient utilization for certain co-morbidities of overweight. Overweight children and youth in Delaware’s Medicaid program have over 10 times as many doctor visits for diabetes and 20 times as many doctor visits for hypertension compared to the general Medicaid population. In addition, overweight children and youth enrolled in Medicaid visit the emergency department nearly eight times as often for diabetes-related concerns.

Nemours Health and Prevention Services252 Chapman Road, Christiana Bldg, Suite 200

Newark, DE 19702Telephone: (302) 444-9100

Fax: (302) 444-9200www.nemours.org

•

The Lewin Group, Inc.3130 Fairview Park Drive

Suite 800Falls Church, VA 22042

Telephone: (703) 269-5500Fax: (703) 269-5501

www.lewin.com

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The Child and Adolescent Health Measurement InitiativeOregon Health & Science University

Department of Pediatrics, School of Medicine707 SW Gaines Road, Mail Code CDRCP

Portland, OR 97239-2998Telephone: (503) 494-1930

Fax: (503) 494-2475www.cahmi.org

www.childhealthdata.org

Website and Contact InformationFor more information about the Delaware Children’s Health Chartbook or to download the full document, visit:

http://www.nemours.org/internet?url=no/nhps/pubs/index.html

For more information about Nemours Health and Prevention Services, visit:

http://www.nemours.org

We welcome your feedback and suggestions for future chartbooks. To Request a copy of the chartbook or to provide comments, please call Nemours Health and Prevention Services at 302-444-9100.

Delaware Children’s Health Chartbook Executive Summary · 2020-05-21 · 2 Introduction Nemours Health and Prevention Services (NHPS) is pleased to present the Delaware Children’s

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