Broome County Indicators for Tracking Public Health Priority Areas, 2016-2018 Yvonne Johnston, DrPH, MPH, MS, RN, FNP Broome County CHA Coordinator CHA Steering Committee Broome County Health Department May 12, 2016 . With Special Thanks to Chelsea Reome

IMPROVE HEALTH STATUS AND REDUCE HEALTH DISPARITIES PRIORITY AREA NYS QUAR-TILE PA 2018 Percentage of premature death (before age 65 years)   Q3  Ratio of Black non-Hispanics to White non-Hispanics Q4 Ratio of Hispanics to White non-Hispanics Age-adjusted preventable hospitalizations rate per 10,000 - Ages 18+ years   Q1 Percentage of adults with health insurance - Ages 18-64 years Q3/Q4 Age-adjusted percentage of adults who have a regular health care provider - Ages 18+ years Q2 SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2018 [~ 2008-2013 data]

Percentage of premature death (before age 65 years) Data Year(s) Percentage PA 2018 2008 20.6 21.8 2009 20.2 2010 2011 21.3 2012 22.4 2013 22.6 The number of deaths occurring before age 65 per 100 total deaths in the time period.

Premature death: Ratio of Black non-Hispanics to White non-Hispanics Data Year(s) Ratio of percentages PA 2018 2008-2010 3.09 1.87 2009-2011 2.93 2010-2012 2.68 2011-2013 2.75 The percentage of premature deaths before age 65 is calculated for both Black and White non-Hispanics. Then, the ratio is the Black non-Hispanic rate divided by the White non-Hispanic rate.

Premature death: Ratio of Hispanics to White non-Hispanics Data Year(s) Ratio of percentages PA 2018 2008-2010 2.40 1.86 2009-2011 2.65 2010-2012 2.69 2011-2013 2.57 The percentage of premature deaths before age 65 is calculated for Hispanics and White non-Hispanics. Then the ratio is the Hispanic rate divided by the White non-Hispanic rate.

Age-adjusted preventable hospitalizations rate per 10,000 - Aged 18+ years Data Year(s) Age-adjusted rate PA 2018 2008 146.7 122 2009 150.5 2010 135.5 2011 142.4 2012 135.2 2013 132.2 The number of preventable hospitalizations per 10,000 population aged 18+ years. The Prevention Quality Indicators (PQIs) are a set of measures developed by the federal Agency for Healthcare Research and Quality (AHRQ) for use in assessing the quality of outpatient care for "ambulatory care sensitive conditions" (ACSCs). This indicator is defined as the combination of the 12 PQIs that pertain to adults: (1)Short-term complication of diabetes (2)Long-term complication of diabetes (3)Uncontrolled diabetes (4)Lower-extremity amputation among patients with diabetes (5)Hypertension (6)Congestive heart failure (7)Angina (8)Chronic obstructive pulmonary disease (9)Asthma (10)Dehydration (11)Bacterial pneumonia (12)Urinary tract infection. Because the PQIs estimate the number of potentially avoidable hospital admissions, a lower rate is desirable.

Ratio of age-adjusted rates Preventable hospitalizations: Ratio of Black non-Hispanics to White non-Hispanics Data Year(s) Ratio of age-adjusted rates PA 2018 2008-2010 1.79 1.85 2009-2011 1.68 2010-2012 1.70 2011-2013 1.74 The rate of preventable hospitalization is calculated for both Black and White non-Hispanics. Then, the ratio is the Black non-Hispanic rate divided by the White non-Hispanic rate.

Ratio of age-adjusted rates Preventable hospitalizations: Ratio of Hispanics to White non-Hispanics Data Year(s) Ratio of age-adjusted rates PA 2018 2008-2010 0.44 1.38 2009-2011 0.46 2010-2012 0.68 2011-2013 0.72 The rate of preventable hospitalization is calculated for both Hispanics and White non-Hispanics. Then, the ratio is the Hispanic rate divided by the White non-Hispanic rate.

Percentage of adults (aged 18-64) with health insurance Data Year(s) Percentage (CI) PA 2018 2008 85.9 ( 84.6 - 87.2) 100 2009 86.4 ( 85.2 - 87.6) 2010 86.0 ( 84.7 - 87.3) 2011 85.8 ( 84.5 - 87.1) 2012 87.1 ( 85.9 - 88.3) 2013 88.2 ( 87.1 - 89.3) The percentage of adults (aged 18-64) who reported that they had health insurance coverage.

Age-adjusted percentage (CI) Age-adjusted percentage of adults who have a regular health care provider - Aged 18+ years Data Year(s) Age-adjusted percentage (CI) PA 2018 2008-2009 86.3 ( 81.4 - 91.2) 90.8 2013-2014 83.4 ( 79.4 - 87.3) Age-adjusted percentage of adults who have a regular health care provider - Aged 18+ years 

PROMOTE A HEALTHY AND SAFE ENVIRONMENT PRIORITY AREA NYS QUAR-TILE PA 2018 Rate of hospitalizations due to falls per 10,000 - Ages 65+ years  Q4 Rate of emergency department visits due to falls per 10,000 – Ages 1-4 years Q3 Assault-related hospitalization rate per 10,000   Ratio of Black non-Hispanics to White non-Hispanics Ratio of Hispanics to White non-Hispanics Ratio of low income ZIP codes to non-low income ZIP codes Q1/Q2 Rate of occupational injuries treated in ED per 10,000 adolescents – Ages 15-19 years   Percentage of population that lives in a jurisdiction that adopted the Climate Smart Communities pledge Q3/Q4 Percentage of commuters who use alternate modes of transportation to work or work from home Percentage of population with low-income and low access to a supermarket or large grocery store Percentage of homes in Healthy Neighborhood Program that have fewer asthma triggers during the home revisits Percentage of residents served by community water systems with optimally fluoridated water Data suppressed Data not available SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2018 [~ 2008-2013 data]

Rate of hospitalizations due to falls per 10,000 - Aged 65+ years Data Year(s) Hospitalization rate PA 2018 2008 254.2 204.6 2009 241.2 2010 237.2 2011 244.5 2012 248.8 2013 221.1 The number of hospitalizations (inpatient, aged 65 years and older) with primary diagnosis ICD-9CM external cause of injury codes E880-E888 (excluding E887) per 10,000 population aged 65 and older.

Rate of emergency department visits due to falls per 10,000 - Aged 1-4 years Data Year(s) ED visit rate PA 2018 2008 617.0 429.1 2009 582.3 2010 576.3 2011 571.3 2012 527.0 2013 496.8 The number of emergency department visits (aged 1-4 years) with primary diagnosis ICD-9CM external cause of injury codes E880-E888 (excluding E887) per 10,000 population aged 1 to 4 years.

Assault-related hospitalization rate per 10,000 Data Year(s) Hospitalization rate PA 2018 2008-2010 2.7 4.3 2009-2011 2.6 2010-2012 2.4 2011-2013 2.5 The number of hospitalizations with primary diagnosis ICD-9CM external cause of injury codes E960-E968 per 10,000 population.

Assault-related hospitalization: Ratio of Black non-Hispanics to White non-Hispanics Data Year(s) Ratio of rates PA 2018 2008-2010 6.84 6.69 2009-2011 8.45 2010-2012 9.13 2011-2013 7.26 The rate of assault hospitalization is calculated for both Black and White non-Hispanics. Then, the ratio is the Black non-Hispanic rate divided by the White non-Hispanic rate.

Assault-related hospitalization: Ratio of low income ZIP codes to non-low income ZIP codes  Data Year(s) Ratio of rates PA 2018 2008-2010 1.31 2.92 2009-2011 1.51 2010-2012 2.04 2011-2013 3.06 The rate of assault hospitalization is calculated for residents of low-income and non-low-income ZIP code areas. Then, the ratio is the low-income ZIP code rate divided by the non-low-income ZIP code rate.

Rate of occupational injuries treated in ED per 10,000 adolescents - Aged 15-19 years Data Year(s) Rate PA 2018 2008 43.6 33 2009 38.4 2010 27.3 2011 46.6 2012 30.4 2013 30.8 The number of emergency department visits with primary payer coded as workers' compensation per 10,000 adolescents - aged 15-19 years.

Percentage of population that lives in a jurisdiction that adopted the Climate Smart Communities pledge Data Year(s) Percentage PA 2018 2012 23.6 32 2013 2014 Climate Smart Communities is a state-local partnership to reduce greenhouse gas emissions, save taxpayer dollars, and advance community goals for health and safety, economic vitality, energy independence and quality of life.

Percentage of employed civilian workers age 16 and over who use alternate modes of transportation to work or work from home Data Year(s) Percentage PA 2018 2005-2009 19.6 49.2 2006-2010 20.0 2007-2011 20.5 2008-2012 20.8 2009-2013 Alternate modes of transportation include public transportation, carpool, bike, walk, and telecommute.

Percentage of population with low-income and low access to a supermarket or large grocery store Data Year(s) Percentage PA 2018 2010 4.76 2.24 Low access is defined as greater than one mile from a supermarket or large grocery store in urban areas or greater than ten miles from a supermarket or large grocery store in rural areas.

Percentage of residents served by community water systems with optimally fluoridated water The Water Fluoridation Reporting System (WFRS) is an online tool that helps states manage the quality of their water fluoridation programs. WFRS information is also the basis for national surveillance reports that describe the percentage of the U.S. population on community water systems who receive optimally fluoridated drinking water. Data Year(s) Percentage PA 2018 2012 75.5 78.5 2013 75.6 2014 75.8

PREVENT CHRONIC DISEASE PRIORITY AREA NYS QUAR-TILE PA 2018 Age-adjusted percentage of adults who are obese  Q3 Percentage of children and adolescents who are obese Age-adjusted percentage of cigarette smoking among adults Percentage of adults who receive a colorectal cancer screening based on the most recent guidelines - Ages 50-75 years   Q2 Asthma emergency department visit rate per 10,000   Asthma emergency department visit rate per 10,000 - Ages 0-4 years Q1/Q2 Age-adjusted heart attack hospitalization rate per 10,000 Q4 Rate of hospitalizations for short-term complications of diabetes per 10,000 - Ages 6-17 years Rate of hospitalizations for short-term complications of diabetes per 10,000 – Ages 18+ years SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2018 [~ 2008-2013 data]

Percentage of adults who are obese Data Year(s) Percentage (CI) PA 2018 2008-2009 24.5 ( 20.0 - 29.0) 23.2 2013-2014 30.4 ( 25.3 - 35.5) The percentage of survey respondents (18 years and older) who are obese. Obesity is defined as having a body mass index (BMI) of 30.0 or greater. BMI is calculated as weight in kilograms divided by the square of height in meters (w/h2).

Percentage of children and adolescents who are obese Data Year(s) Percentage PA 2018 2010-2012 18.6 16.7 2012-2014 19.4 The percentage of public school children who are obese. Obesity is defined as weight category greater than or equal to 95th percentile. Counties outside NYC: Grades Pre-K, K, 2nd, 4th, 7th, 10th; NYC boroughs: Grades K-8th.

Percentage of cigarette smoking among adults Data Year(s) Percentage (CI) PA 2018 2008-2009 20.3 ( 15.4 - 25.1) 12.3 2013-2014 22.3 ( 17.7 - 26.9) The percentage of adults who report currently smoking cigarettes.

Percentage of adults who received a colorectal cancer screening based on the most recent guidelines - Aged 50-75 years Data Year(s) Percentage (CI) PA 2018 2008-2009 69.0 ( 62.8 - 74.5) 80 2013-2014 65.5 ( 57.9 - 73.2) The percentage of adults (aged 50-75 years) who received a colorectal cancer screening exam (used a blood stool test at home in the past year; and/or, sigmoidoscopy in the past 5 years and blood stool test in the past 3 years; and/or, had a colonoscopy in the past 10 years).

Asthma emergency department visit rate per 10,000 population Data Year(s) ED visit rate PA 2018 2008 49.0 75.1 2009 45.2 2010 41.7 2011 50.6 2012 53.3 2013 47.9 The number of emergency department visits with primary diagnosis ICD-9CM code 493 per 10,000 population.

Asthma emergency department visit rate per 10,000 - Aged 0-4 years Data Year(s) ED visit rate PA 2018 2008 82.8 196.5 2009 68.8 2010 75.4 2011 82.0 2012 87.3 2013 75.9 The number of emergency department visits with primary diagnosis ICD-9CM code 493 per 10,000 population aged 0-4 years.

Age-adjusted heart attack hospitalization rate per 10,000 Data Year(s) Age-adjusted rate PA 2018 2008 20.5 14 2009 18.6 2010 19.6 2011 22.3 2012 21.1 2013 18.8 The number of hospitalizations (inpatient) with a principal diagnosis ICD-9CM code 410 per 10,000 population. The rate is adjusted for age.

Rate of hospitalizations for short-term complications of diabetes per 10,000 - Aged 6-17 years Data Year(s) Hospitalization rate PA 2018 2008-2010 5.8 3.06 2009-2011 5.9 2010-2012 6.6 2011-2013 7.5 The number of hospitalizations (inpatient, aged 6-17 years) with a principal diagnosis ICD-9CM code: 25010, 25011, 25012, 25013, 25020, 25021, 25022, 25023, 25030, 25031, 25032, 25033 per 10,000 population aged 6-17 years.

Rate of hospitalizations for short-term complications of diabetes per 10,000 - Aged 18+ years Data Year(s) Hospitalization rate PA 2018 2008-2010 5.1 4.86 2009-2011 5.2 2010-2012 5.6 2011-2013 The number of hospitalizations (inpatient, aged 18 years and older) with a principal diagnosis ICD-9CM code: 25010, 25011, 25012, 25013, 25020, 25021, 25022, 25023, 25030, 25031, 25032, 25033 per 10,000 population aged 18 years and older.

Data not available for meaningful distribution PREVENT HIV/STDS, VACCINE PREVENTABLE DISEASES, AND HEALTHCARE ASSOCIATED INFECTIONS PRIORITY AREA NYS QUAR-TILE PA 2018 Percentage of children with 4:3:1:3:3:1:4 immunization series - Ages 19-35 months  No data (Q3/Q4)  Percentage of adolescent females with 3-dose HPV immunization - Ages 13-17 years Age-adjusted percentage of adults with flu immunization - Ages 65+ years   Q1 Newly diagnosed HIV case rate per 100,000   Q3 Difference in rates (Black and White) of new HIV diagnoses + Difference in rates (Hispanic and White) of new HIV diagnoses + Q1/2 Gonorrhea case rate per 100,000 women - Ages 15-44 years Q4 Gonorrhea case rate per 100,000 men - Ages 15-44 years Chlamydia case rate per 100,000 women - Ages 15-44 years Primary and secondary syphilis case rate per 100,000 males * Primary and secondary syphilis case rate per 100,000 females  Data not available for meaningful distribution + Fewer than 10 events in at least one of the numerators of the rates, therefore the rate difference is unstable. * Fewer than 10 events in the numerator, therefore the rate is unstable. SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2018 [~ 2008-2013 data]

Percentage of children with 4:3:1:3:3:1:4 immunization series - Aged 19-35 months Data Year(s) Percentage (CI) PA 2018 2009 48.9 80 2010 57.1 2011 57.5 2012 57.6 2013 64.5 The percentage of children (aged 19-35 months) who received their 4:3:1:3:3:1:4 immunization series (4 DTaP, 3 polio, 1 MMR, 3 hep B, 3 Hib, 1 varicella, 4 PCV13).

Percentage of adolescent females with 3 or more doses of HPV immunization - Aged 13-17 years Data Year(s) Percentage (CI) PA 2018 2009 25.4 50 2010 28.7 2011 28.9 2012 29.7 2013 The percentage of females (aged 13-17 years) who received their 3 or more doses of Human Papillomavirus (HPV) immunization vaccine.

Percentage of adults with flu immunization - Aged 65+ years Data Year(s) Percentage (CI) PA 2018 2008-2009 76.1 ( 70.2 - 82.0) 70 2013-2014 68.0 ( 58.6 - 77.4) The percentage of survey respondents (aged 65+ years) who received their influenza immunization (flu shot) in the past year.

Newly diagnosed HIV case rate per 100,000 Data Year(s) Newly diagnosed case rate PA 2018 2008-2010 5.6 16.1 2011-2013 5.5 The number of people newly diagnosed with human immunodeficiency virus (HIV), regardless of concurrent or subsequent AIDS diagnosis, per 100,000 population. The discrepancy in totals is due to the exclusion of prisoner cases for counties outside NYC, but not for NYC or for the NYS total.

Difference in rates (Black and White) of newly diagnosed HIV cases The newly diagnosed HIV case rate is calculated for both Black and White non-Hispanics. Then, the difference is the Black non-Hispanic rate minus the White non-Hispanic rate. Data Year(s) Difference in rates PA 2018 2008-2010 21.2+ 46.8 2011-2013 25.3+ + Fewer than 10 events in at least one of the numerators of the rates, therefore the rate difference is unstable.

Difference in rates (Hispanic and White) of newly diagnosed HIV cases Data Year(s) Difference in rates PA 2018 2008-2010 48.9+ 26.6 2011-2013 10.9+ The newly diagnosed HIV case rate is calculated for Hispanics and White non-Hispanics. Then, the difference is the Hispanic rate minus the White non-Hispanic rate. + Fewer than 10 events in at least one of the numerators of the rates, therefore the rate difference is unstable.

Gonorrhea case rate per 100,000 women - Aged 15-44 years Data Year(s) Case rate PA 2018 2008 127.7 183.4 2009 94.1 2010 49.2 2011 60.4 2012 191.1 2013 134.4 The number of women (aged 15-44 years) diagnosed with gonorrhea per 100,000 women (aged 15-44 years).

Gonorrhea case rate per 100,000 men - Aged 15-44 years Data Year(s) Case rate PA 2018 2008 112.6 199.5 2009 83.7 2010 22.3* 2011 50.6 2012 150.5 2013 129.8 The number of men (aged 15-44 years) diagnosed with gonorrhea per 100,000 men (aged 15-44 years).

Chlamydia case rate per 100,000 women - Aged 15-44 years Data Year(s) Case rate PA 2018 2008 738.6 1,458 2009 864.8 2010 1,007.9 2011 1,094.9 2012 1,255.6 2013 1,196.5 The number of women (aged 15-44 years) diagnosed with chlamydia per 100,000 women (aged 15-44 years).

Primary and secondary syphilis case rate per 100,000 men Data Year(s) Case rate PA 2018 2008 2.1* 10.1 2009 2010 3.0* 2011 1.0* 2012 0.0* 2013 5.2* The number of men diagnosed with primary or secondary syphilis per 100,000 men. * Fewer than 10 events in the numerator, therefore the rate is unstable.

PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN PRIORITY AREA NYS QUAR-TILE PA 2018 Percentage of preterm births   Q1/Q2 Ratio of Black non-Hispanics to White non-Hispanics  Ratio of Hispanics to White non-Hispanics Ratio of Medicaid births to non-Medicaid births Percentage of infants exclusively breastfed in the hospital Q3/Q4 Q2 Maternal mortality rate per 100,000 births * Q1 * Fewer than 10 events in the numerator, therefore the rate is unstable. SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2018 [~ 2008-2013 data]

PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN PRIORITY AREA NYS QUAR-TILE PA 2018 Percentage of children who have had the recommended number of well child visits in government sponsored insurance programs  Q1 Percentage of children ages 0-15 months who have had the recommended number of well child visits in government sponsored insurance programs   Percentage of children ages 3-6 years who have had the recommended number of well child visits in government sponsored insurance programs Percentage of children ages 12-21 years who have had the recommended number of well child visits in government sponsored insurance programs Percentage of children with any kind of health insurance - Ages 0-19 years Q3/Q4 SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2018 [~ 2008-2013 data]

PROMOTE HEALTHY WOMEN, INFANTS, AND CHILDREN PRIORITY AREA NYS QUAR-TILE PA 2018 Percentage of third-grade children with evidence of untreated tooth decay  Q4 Ratio of low-income children to non-low income children ~   Q3 Adolescent pregnancy rate per 1,000 females - Ages 15-17 years Ratio of Black non-Hispanics to White non-Hispanics Q1/Q2 Ratio of Hispanics to White non-Hispanics Percentage of unintended pregnancy among live births   Ratio of Medicaid births to non-Medicaid births Percentage of women with health coverage - Ages 18-64 years Q3/Q4 Percentage of live births that occur within 24 months of a previous pregnancy ~ At least one of the percentages has margin of error greater than 10%, therefore the ratio is unstable. SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2018 [~ 2008-2013 data]

Percentage of preterm births Data Year(s) Percentage PA 2018 2008 10.1 10.2 2009 11.2 2010 11.4 2011 9.7 2012 10.4 2013 The number of infants born at less than 37 weeks gestation among infants with known gestational age.

Premature births: Ratio of Black non-Hispanics to White non-Hispanics Data Year(s) Ratio of percentages PA 2018 2008-2010 1.44 1.42 2009-2011 1.34 2010-2012 1.41 2011-2013 1.50 The percentage of preterm births is calculated for both Black and White non-Hispanics. Then, the ratio is the Black non-Hispanic percentage divided by the White non-Hispanic percentage.

Percentage of infants exclusively breastfed in the hospital Data Year(s) Percentage PA 2018 2008 65.7 48.1 2009 64.1 2010 68.6 2011 67.7 2012 67.6 2013 69.8 The number of infants exclusively fed breast milk in the hospital divided by the number of infants with known breastfeeding status.

Maternal mortality rate per 100,000 births Data Year(s) Mortality rate PA 2018 2008-2010 16.2* 21 2009-2011 2010-2012 2011-2013 0.0* The number of deaths to women from any causes related to or aggravated by pregnancy or its management that occurred while pregnant or within 42 days of termination of pregnancy (ICD-10 codes O00-95, O98-O99, and A34 (obstetrical tetanus)) per 100,000 live births. * Fewer than 10 events in the numerator, therefore the rate is unstable.

Percentage of children who have had the recommended number of well child visits in government sponsored insurance programs Data Year(s) Percentage PA 2018 2010 57.4 76.9 2011 56.4 2012 53.7 2013 54.8 The percentage of children aged 0-15 months, 3-6 years and 12-21 years in the Medicaid and Child Health Plus programs who have had the recommended number of well-child visits.

Percentage of children aged 0-15 months who have had the recommended number of well child visits in government sponsored insurance programs Data Year(s) Percentage PA 2018 2010 77.7 91.3 2011 87.9 2012 87.6 2013 84.2 The percentage of children, in the Medicaid and Child Health Plus programs, who had five or more well-child visits with a primary care provider in their first 15 months of life.

Percentage of children aged 3-6 years who have had the recommended number of well child visits in government sponsored insurance programs Data Year(s) Percentage PA 2018 2010 73.1 91.3 2011 71.1 2012 67.7 2013 70.1 The percentage of children aged 3-6 years, in the Medicaid and Child Health Plus programs, who had one or more well-child visits with a primary care provider during the measurement year.

Percentage of children aged 12-21 years who have had the recommended number of well child visits in government sponsored insurance programs Data Year(s) Percentage PA 2018 2010 44.6 67.1 2011 42.7 2012 40.8 2013 42.1 The percentage of children aged 12-21 years, in the Medicaid and Child Health Plus programs, who had at least one comprehensive well-care visit with a primary care provider during the measurement year.

Percentage of children (aged under 19 years) with health insurance Data Year(s) Percentage (CI) PA 2018 2008 94.5 ( 93.3 - 95.7) 100 2009 95.6 ( 94.6 - 96.6) 2010 94.4 ( 93.1 - 95.7) 2011 95.4 ( 94.4 - 96.4) 2012 96.0 ( 95.1 - 96.9) 2013 95.8 ( 94.8 - 96.8) The percentage of children (aged under 19 years) with health insurance coverage.

Percentage of third-grade children with evidence of untreated tooth decay Data Year(s) Percentage (CI) PA 2018 2009-2011 42.3 ( 34.8 - 49.8) 21.6 The percentage of third-grade children with evidence of untreated dental caries.

Tooth decay: Ratio of low-income children to non-low income children The percentage of untreated tooth decay is calculated separately for low and non-low income children. Then, the ratio is the low income percentage divided by the non-low income percentage. Data Year(s) Ratio of percentages PA 2018 2009-2011 2.02+ 2.21 + At least one of the percentages has margin of error greater than 10%, therefore the ratio is unstable.

Adolescent pregnancy rate per 1,000 females - Aged 15-17 years Data Year(s) Pregnancy rate PA 2018 2008 27.0 25.6 2009 27.4 2010 22.2 2011 22.6 2012 20.2 2013 19.3 Pregnancies are the sum of the number of live births, induced terminations of pregnancies, and all fetal deaths. Pregnancy rates are the number of pregnancies per 1,000 females aged 15-17 years. NOTE: pregnancy data for Essex and Hamilton counties were combined for confidentiality purposes.

Adolescent pregnancy: Ratio of Black non-Hispanics to White non-Hispanics Data Year(s) Ratio of rates PA 2018 2008-2010 2.91 4.9 2009-2011 3.29 2010-2012 3.03 2011-2013 2.94 The pregnancy rate is calculated for both Black and White non-Hispanics aged 15-17. Then, the ratio is the Black non-Hispanic rate divided by the White non-Hispanic rate.

Adolescent pregnancy: Ratio of Hispanics to White non-Hispanics Data Year(s) Ratio of rates PA 2018 2008-2010 4.19 4.1 2009-2011 3.06 2010-2012 2.12 2011-2013 1.73 The pregnancy rate is calculated for both Hispanics and White non-Hispanics aged 15-17 years. Then, the ratio is the Hispanic rate divided by the White non-Hispanic rate.

Percentage of unintended pregnancy among live births Data Year(s) Percentage PA 2018 2008 38.5 23.8 2009 39.4 2010 36.1 2011 36.2 2012 32.5 2013 34.7 The number of unintended pregnancies (current pregnancy indicated as 'Wanted Later' or 'Wanted Never') among live births with known pregnancy intendedness.

Unintended pregnancy: Ratio of Black non-Hispanic to White non-Hispanic Data Year(s) Ratio of percentages PA 2018 2008 1.44 1.9 2009 1.30 2010 1.47 2011 1.43 2012 1.67 2013 1.57 The percentage of unintended pregnancy is calculated for both Black and White non-Hispanics. Then, the ratio is the Black non-Hispanic percentage divided by the White non-Hispanic percentage.

Unintended pregnancy: Ratio of Hispanics to White non-Hispanics Data Year(s) Ratio of percentages PA 2018 2008 1.52 1.43 2009 1.47 2010 2011 1.40 2012 1.67 2013 The percentage of unintended pregnancy is calculated for Hispanics and White non-Hispanics. Then, the ratio is the Hispanic percentage divided by the White non-Hispanic percentage.

Unintended pregnancy: Ratio of Medicaid births to non-Medicaid births Data Year(s) Ratio of percentages PA 2018 2008 1.58 1.54 2009 1.56 2010 1.59 2011 2012 1.63 2013 1.40 The percentage of unintended pregnancy is calculated for Medicaid and non-Medicaid births. Then, the ratio is the non-Medicaid percentage divided by the Medicaid percentage.

Percentage of women (aged 18-64) with health insurance Data Year(s) Percentage (CI) PA 2018 2008 87.3 ( 85.5 - 89.1) 100 2009 88.8 ( 87.3 - 90.3) 2010 88.5 ( 86.9 - 90.1) 2011 87.6 ( 85.9 - 89.3) 2012 89.4 ( 87.9 - 90.9) 2013 90.2 ( 88.8 - 91.6) The percentage of women (aged 18-64) who reported that they had health insurance coverage.

Percentage of live births that occur within 24 months of a previous pregnancy Data Year(s) Percentage PA 2018 2008 26.1 17 2009 23.7 2010 24.7 2011 23.4 2012 26.3 2013 26.6  The number of live births that occur within 24 months of a previous pregnancy among all live births.

PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE PRIORITY AREA NYS QUAR-TILE PA 2018 Age-adjusted percentage of adults with poor mental health for 14 or more days in the last month  Q1/Q2 Age-adjusted percentage of adult binge drinking during the past month Q4 Age-adjusted suicide death rate per 100,000 Q3 SOURCE: NYSDOH, Broome County Indicators for Tracking Public Health Priorities, 2013-2018 [~ 2008-2013 data]

Age-adjusted percentage (CI) Age-adjusted percentage of adults with poor mental health for 14 or more days in the last month Data Year(s) Age-adjusted percentage (CI) PA 2018 2008-2009 12.9 ( 9.2 - 16.7) 10.1 2013-2014 11.7 ( 8.6 - 14.9) The percentage of survey respondents (aged 18 years and older) who reported experiencing poor mental health for 14 or more days in the last month. The percentage is adjusted for age.

Age-adjusted percentage of adult binge drinking during the past month Data Year(s) Age-adjusted percentage (CI) PA 2018 2008-2009 19.5 ( 14.1 - 24.8) 18.4 2013-2014 20.3 ( 15.7 - 24.8) The percentage of respondents (aged 18 years and older) reporting binge drinking on one or more occasions in the past 30 days. Binge drinking is defined as men having 5 or more drinks or women having 4 or more drinks on one occasion. The percentage is adjusted for age.

Age-adjusted suicide death rate per 100,000 Data Year(s) Age-adjusted rate PA 2018 2008-2010 8.3 5.9 2009-2011 11.3 2010-2012 12.4 2011-2013 12.9 The number of deaths with an ICD-10 primary cause of death code: X60-X84 or Y87.0 per 100,000 population. The rate is adjusted for age.

Survey Results: Revisions to CHA Priority Setting Tool

Use of 2013-2017 Tool 13 9 The majority of respondents (59% of 13 total) felt that the priority-setting tool should be used as is- unchanged from when it was used for setting 2013-2017 priorities. 41% felt that the existing tool should be used, but modifications should be made to it for setting 2016-2018 priorities.

Use of Existing Rating Factors 2 1 2 3 2 1 2 2 Of the nine participants who felt that changes should be made to the 2013-2017 tool, two did not complete the survey. The following questions regarding revisions that should be made thus reflect the responses of seven participants. The existing factor that participants had the most consensus on omitting for the 2016-2018 priority-setting process were “Work Time Lost or Disability”. Three respondents indicated that this factor should be omitted. However, the same number of participants felt that all factors should be kept. 2 2 3

Use of PHIP Priorities as Rating Factors 5 4 Five respondents felt that transportation should be added to the existing rating factors and four felt that mental health should be added. One respondent added an explanation of why he or she did not think we should use PHIP priorities as rating factors: “I don't think the PHIP items are applicable. MH should be labeled Behavioral Health as that is more broad and as an indicator should stand on it's own as a health status issue. Transportation is a social determinant that should be addressed in an intervention. By asking this question, it presupposes that PHIP's priorities "drive" our decision tool for community priorities. The PHIP priorities (of which transportation is not a health status issue, but a social determinant) should be considered as a data input.” 1

Use of DSRIP Goals as Rating Factors 4 3 Four respondents felt that we should add “Addresses Medicaid Health Disparity” and three felt that we should add “Benefited by Population Health Management”. One respondent felt that we should not add DSRIP goals and one elaborated on why he/ she felt that we should not add DSRIP goals: “See above. DSRIP is a data input, not part of a decision matrix. Medicaid would already be included under socioeconomic” 1 1

Use of Existing Rating Weighting System 5 Five respondents felt that we should use the same weighting method as was used in the 2013-2017 process. One said we should not use this method and one said we should use it, but with modifications. The modifications that the latter proposed were: “Need dialogue with group and to run through examples relative to rating as people interpreted the ratings differently. Suggest ratings be done at a meeting.” 1 1