The Health of Staten Island and New York City Thomas R. Frieden, M.D., M.P.H. Commissioner, New York City Department of Health and Mental Hygiene April.

The Health of Staten Island and New York City

Thomas R. Frieden, M.D., M.P.H.Commissioner, New York City

Department of Health and Mental HygieneApril 24, 2003

Community Health Survey

• First ever NYC health survey– 10,000 New Yorkers interviewed on health status

and lifestyle– Largest survey of its kind ever in NYC

• Data reported and broken down into many different categories– More than just traditional demographic information

(sex, age, ethnicity)

• Detail will allow us to target services at the community level on a neighborhood-by-neighborhood basis, as needed

Neighborhoods Most in Need:Harlem, So. Bronx, Central Brooklyn

25.3

21.719.6

21.7

27.0

20.8

0

5

10

15

20

25

30

Staten Island Bronx Manhattan Queens Brooklyn NYC

Pre

vale

nce

Prevalence of AdultCurrent SmokingNYC 2002, by borough

Healthy People 2010 Goal: 12%

Annual Deaths from Smoking Compared with Other Causes

NYC, 2001

0

2000

4000

6000

8000

10000

* Total includes smoking-related deaths# Total includes 265 AA587 deaths+ Total does not include 2,743 WTC deaths

Cancer Screening in Staten Island vs. NYC

8180

50

8077

50

0

20

40

60

80

100

Colon Screening Mammogram PAP Smear

Staten Island NYCHP 2010: 90%

Colon CancerDetection & Cure Rates

0

20

40

60

80

Colorectal Cancer Breast Cancer Prostate Cancer

Early-Stage Detection Rates Colorectal Cancer Cure Rates

0

20

40

60

80

100

Early stage Late-stage

HIV & AIDS Cases in Staten Island

Calendar Year 2001

108

1189

0

200

400

600

800

1000

1200

1400

# Living w/HIV & AIDS # New HIV Diagnoses

Figures as of 12/31/01

Rates of People Living w/HIV & AIDS in Staten Isl. vs. NYC vs. US

Calendar Year 2001 – Rates per 1,000 Pop.

1.3

4.1

5.1

2.7

9.2

3.2

1.1

0

2

4

6

8

10

Willo

wbroo

k

South

Bea

ch

Port R

ichm

ond

Staple

ton

Staten

Isl

NYC US

Figures as of 12/31/01

Rates of New HIV Diagnoses in Staten Island vs. NYC vs. US

Calendar Year 2001 – Rates per 1,000 Pop.

0.13

0.32

0.48

0.24

0.84

0.140.11

0.0

0.2

0.4

0.6

0.8

1.0

Will

owbro

ok

South

Bea

ch

Port R

ichm

ond

Stapl

eton

State

n Isl

NYC US

Figures as of 12/31/01

There Has Been a Resurgence of Risky Sexual Behavior

• Syphilis cases more than doubled between 2000 and 2001, increased another 50% in 2002

• Syphilis increase almost entirely among men, especially MSM

• Foreshadowing future rise in HIV rates?

0.51 0.51 0.66

10.75

7.50

3.07

02

468

1012

2000 2001 2002

Rat

e per

100,0

00

Females Males

Reported Primary and Secondary Syphilis Case Rates, NYC, 2000-2002

Diabetes Prevalence Has More than Doubled in NYC in the Past 8 Years Adults with Self-Reported Diabetes, NYC, 1994-2002

7.9

6.3

6.7

4.73.7

0

1

2

3

4

5

6

7

8

9

1994-95 1996-97 1998-99 2000-01 2002

% R

epo

rtin

g D

iab

etes

Percent of Overweight NYC Residents (BMI > 25), by Borough

43

52 5357

62

53

0

10

20

30

40

50

60

70

Manhattan Queens Brooklyn StatenIsland

Bronx NYC

% O

ve

rwe

igh

t (B

MI

> 2

5)

A woman 5’4” tall is considered overweight at 146 lbs.A man 5’10” tall is considered overweight at 174 lbs.

Percent of Obese NYC Residents (BMI > 30), by Borough

11.9

15.416.8

18.8

21.8

16.6

0

5

10

15

20

25

% O

bese (

BM

I >

30)

A woman 5’4” tall is considered obese at 175 lbs.A man 5’10” tall is considered obese at 209 lbs.

Percent of NYC Residents with Diagnosed Diabetes, by Borough

4.66.2

7.0

8.8

11.8

7.9

0

2

4

6

8

10

12

14

State

n Isl

and

Man

hatta

n

Queen

s

Brook

lyn

Bronx

NYC

% w

/Dia

gn

ose

d D

iab

etes

Diabetes Prevalence in NYCBy Ethnicity, 2002

5.0

6.8

10.8

12.2

7.9

0

2

4

6

8

10

12

14

White Asian Black Hispanic NYC

Healthy People 2010 Goal: 2.5%

Good Diabetes Management

• Patient education and participation– “Know your ABCs”

• A1c level below 7%• Blood pressure less than 130/80• Cholesterol (“bad” LDL cholesterol) less than 100

• Clinical best practices• Systematic monitoring of and accountability

for HbA1C, retinal, foot care• Cardiovascular disease prevention:

– Smoking, blood pressure, lipid control

On ABCs, USA Gets an “F”

• People with diabetes who have adequately controlled blood sugar – 11%

• People with hypertension who have adequately controlled blood pressure – 27%

• People with high cholesterol who have adequately controlled hyperlipidemia – 27%

Despite spending 1 out of every 7 dollars on health care!

Hospital Admissions in Staten Isl. Related to Mental Disorders

Age adjusted rates per 10,000 population, excluding alcohol-related, by UHF Neighborhood, 2000

40.3 41.0

95.4

126.9

71.166.5

0

20

40

60

80

100

120

140

Willowbrook SouthBeach

PortRichmond

Stapleton Staten Isl NYCHo

sp

ita

liza

tio

n R

ate

pe

r 1

0,0

00

Po

pu

lati

on

Percent of NYC Adults Who Report One or More Binge Drinking Episodes

>5 drinks at one time within past month (by Borough)

12.8 13.0

14.916.2

18.6

15.2

0

2

4

6

8

10

12

14

16

18

20

Brooklyn Bronx Staten Isl Queens Manhattan NYC

Healthy People 2010 Goal: 6%

Trends in Infant MortalityNYC, 1991-2001

11.4

6.1

10.2 10.2

9.08.8

7.87.1 6.8 6.9 6.7

0.0

2.0

4.0

6.0

8.0

10.0

12.0

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Per

1,0

00 L

ive

Bir

ths

HP 2010 Goal: 4.5

HP 2000 Goal: 7.0

NYC Infant Mortality Rate2001, by Borough

6.0

12.4

5.6

4.9 5.4 5.5

5.9

0

2

4

6

8

10

12

14Q

ue

en

s

Ma

nh

att

an

Sta

ten

Isl

.

Bro

nx

Bro

okl

yn

NY

CR

esi

de

nts

No

n-N

YC

Re

sid

en

ts

IMR

NYC average IMR: 6.1

HP 2010Goal: 4.5

Trends in NYC Asthma HospitalizationRates per 1,000 persons, 1990-2000, All Ages

3.44.03.7

4.3

4.64.64.65.1

4.74.34.0

0

1

2

3

4

5

6

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Rat

e pe

r 1,0

00 P

erso

ns

Asthma Hospitalization Is DecreasingBut Still More Prevalent Among Low-Income Neighborhoods

Trends in Asthma Hospitalization Rates, High- and Low-Income ZIP Codes, Children Aged 0-4, NYC 1988-2000

0

5

10

15

20

25

30

Ra

te p

er

1,0

00

Po

pu

lati

on

Low-Income

High-Income

Asthma Hospitalizations in Staten Isl.Hospitalization rate of children under age 15,per 1,000 population, by UHF neighborhood

1.6 1.6

3.8

2.5

6.1

3.8

0

2

4

6

8

Too Few People are Getting Flu Shots

NYC, 2001 Influenza Immunization Data

31

63

0

20

40

60

80

100

Ages 50-64 Ages 65+

% I

mm

un

ize

d

Healthy People 2010 Goal: 90%

Gender and Racial Disparities in Vaccinations

NYC, 2001 Influenza Immunization Data

59

6763

53 52

69

0

20

40

60

80

100

Male Female White Hispanic Black Asian

% Im

mu

niz

ed (

ove

r ag

e 65

)

Healthy People 2010 Goal: 90%

Gender and RacialDisparities in Vaccinations

NYC, 2001 Pneumococcus Immunization Data

4956

4642

31

53

0

20

40

60

80

100

Male Female White Hispanic Black Asian

% Im

mu

niz

ed (

ove

r ag

e 65

)

Healthy People 2010 Goal: 90%

10 Things Everyone Should Do to Stay Healthy

1. Have a regular doctor or nurse practitioner

2. Don’t smoke and don’t accept smoking around you or your children

3. Know your vital signs and keep them healthy (blood pressure, cholesterol, weight)

4. Know your HIV status and use condoms to protect against HIV and other STDs

5. Don’t live with depression – seek help

10 Things Everyone Should Do to Stay Healthy

6. Know the warning signs of drug/alcohol abuse – ask your doctor to help

7. Get screened for cancer, especially colon, cervical and breast

8. Get your shots – everyone needs immunizations9. Live in a home free of violence10. Be healthy before getting pregnant, plan your

pregnancy, and get early and regular prenatal care