Summary of Slide Content Trends in Mortality……………………………………….Slides 8-13 Low Birthweight……………………………………………Slide 14 Self-Reported Health…………………………………….Slide 15 Health Behaviors…………………………………………..Slides 16-19 Smoking Obesity Excessive Drinking Teen Birth Rate Health Insurance………………………………………….Slides 20-21 Social & Economic Factors………………………......Slides 22-25 Physical Environment………………………………..…Slide 26

How Progress is Assessed We calculated the annual percent change (APC) for each of the 19 health indicators during the last 10 years. An increasing APC indicates a worsening health trend, while a decreasing APC indicates an improving health trend. Using these baseline trends, we determined what the expected current rate would be for each indicator if the previous 10-year trend continued. We compared this expected rate to the current observed rate to see if it fared better or worse. Current progress was determined by calculating the percent difference between the observed and expected rates.

How Progress is Assessed

Health Outcomes Each health outcome’s baseline trend line is color coded to represent the progress that indicator has over a 10-year period. Progress is coded in the following ways: the two shades of green denote improvement, yellow represents no change, and the two shades of red denote a worsening trend. Each indicator also has a color-coded circle to indicate the status of its current rate (as opposed to its expected rate). Current rates are depicted as either a red circle (denoting worse progress), a yellow circle (denoting no change), or a green circle (denoting better progress).

Health Factors Each health factor’s baseline trend line is color coded to represent the progress that indicator has over a 10-year period. Progress is coded in the following ways: the two shades of green denote improvement, yellow represents no change, and the two shades of red denote a worsening trend. Each indicator also has a color-coded circle to indicate the status of its current rate (as opposed to its expected rate). Current rates are depicted as either a red circle (denoting worse progress), a yellow circle (denoting no change), or a green circle (denoting better progress).

How to Interpret the Report The known data points for the prior 10 years are graphed, and a best fit linear regression is added to the graph and color-coded according to the measure’s APC baseline trend progress. A decreasing line indicates improvement (for example, the graph above shows a reduction in infant deaths). The line is extended in grey in order to show the expected value if Wisconsin continued with the same trend as it had the previous 10 years. The current observed value (shown as a yellow dot) is included, along with its 90% statistical confidence interval. Comparing this point to the expected trend line provides a comparison of how well Wisconsin is performing currently compared to the expectation. The following equation is used to calculate the difference: Percent Difference= (observed value – expected value) / expected value ×100 For the infant death rate example above, the baseline trend shows that infant mortality rates decreased 1.0% per year (i.e., an improving trend). This is good news for Wisconsin, as the trend is improving. However, the current rate (from 2013, the most recent year for which data is available), is 4.1% more than expected (6.2 vs. 6.0). This difference – at a p=0.1 level – is not significant, indicating that Wisconsin performed approximately as expected.

All Ages Death Health Outcome Trends The 10-year trend line shows that the all-ages mortality rate is improving, even though the current rate is higher than expected.

Premature Death Health Outcome Trends The 10-year trend line shows that the rate of premature death is improving, even though the current rate is higher than expected.

Infant Death Health Outcome Trends The 10-year trend line shows that the overall infant mortality rate is improving, and the current rate indicates no change.

1-24 Year Old Death Health Outcome Trends The 10-year trend line shows that the 1-24 year old mortality rate is improving, even though the current rate indicates no change.

25-64 Year Old Death Health Outcome Trends The 10-year trend line shows that the 25-64 year old mortality rate is constant. The current rate is higher than expected.

65+ Year Old Death Health Outcome Trends The 10-year trend line shows that the 65+ year old mortality rate is improving, even though the current rate is higher than expected.

Low Birthweight Health Outcome Trends The 10-year trend line shows that the overall low birthweight rate is constant, and the current rate indicates improvement.

Self-Reported Health Health Outcome Trends The 10-year trend line shows that the rate of the overall percentage of adults who report fair or poor health is getting worse. 1. Due to methodological changes to sampling methods of the Behavioral Risk Factor Surveillance System (BRFSS), data from 2013 – the “current observed value” – and data from 2012 is not directly comparable to that of previous years. The BRFSS methodology changed in 2011, but the dataset maintained a “landline only” weighted variable, allowing for a 2011 variable that is comparable to previous years. For more information, please read the BRFSS Methodological Documents: http://www.cdc.gov/surveillancepractice/reports/brfss/brfss.html. A diamond is used instead of a circle for the 2012 and 2013 values to convey this discrepancy.

Health Behavior Trends Adult Smoking Health Behavior Trends The 10-year trend line shows that the overall adult smoking rate is improving. 1. Due to methodological changes to sampling methods of the Behavioral Risk Factor Surveillance System (BRFSS), data from 2013 – the “current observed value” – and data from 2012 is not directly comparable to that of previous years. The BRFSS methodology changed in 2011 but the dataset maintained a “landline only” weighted variable, allowing for a 2011 variable that is comparable to previous years. For more information, please read the BRFSS Methodological Documents: http://www.cdc.gov/surveillancepractice/reports/brfss/brfss.html. A diamond is used instead of a circle for the 2012 and 2013 values to convey this discrepancy.

Health Behavior Trends Adult Obesity Health Behavior Trends The 10-year trend line shows that the overall adult obesity rate is getting worse. 1. Due to methodological changes to sampling methods of the Behavioral Risk Factor Surveillance System (BRFSS), data from 2013 – the “current observed value” – and data from 2012 is not directly comparable to that of previous years. The BRFSS methodology changed in 2011 but the dataset maintained a “landline only” weighted variable, allowing for a 2011 variable that is comparable to previous years. For more information, please read the BRFSS Methodological Documents: http://www.cdc.gov/surveillancepractice/reports/brfss/brfss.html. A diamond is used instead of a circle for the 2012 and 2013 values to convey this discrepancy.

Adult Excessive Drinking Health Behavior Trends The 10-year trend line shows that the rate of overall adult excessive drinking is improving. 1. Due to methodological changes to sampling methods of the Behavioral Risk Factor Surveillance System (BRFSS), data from 2013 – the “current observed value” – and data from 2012 is not directly comparable to that of previous years. The BRFSS methodology changed in 2011 but the dataset maintained a “landline only” weighted variable, allowing for a 2011 variable that is comparable to previous years. For more information, please read the BRFSS Methodological Documents: http://www.cdc.gov/surveillancepractice/reports/brfss/brfss.html. A diamond is used instead of a circle for the 2012 and 2013 values to convey this discrepancy.

Health Behavior Trends Teen Birth Rate Health Behavior Trends The 10-year trend line shows that the overall teen birth rate is improving. The current rate is lower than expected. 1. Due to methodological changes to sampling methods of the Behavioral Risk Factor Surveillance System (BRFSS), data from 2013 – the “current observed value” – and data from 2012 is not directly comparable to that of previous years. The BRFSS methodology changed in 2011 but the dataset maintained a “landline only” weighted variable, allowing for a 2011 variable that is comparable to previous years. For more information, please read the BRFSS Methodological Documents: http://www.cdc.gov/surveillancepractice/reports/brfss/brfss.html. A diamond is used instead of a circle for the 2012 and 2013 values to convey this discrepancy.

No Health Insurance (0-17 years) Clinical Care Trends The 10-year trend line shows that the overall health insurance rate for individuals ages 0-17 is improving. 2. Due to changes to the sampling methods of the Family Health Survey data occurring in 2012, the data from 2014 – the “current observed value” – and data from 2012 is not directly comparable to that of previous years. For more information, read the Family Health Survey Technical notes for 2012: http://www.dhs.wisconsin.gov/publications/P4/p45369b-12.pdf. A diamond is used instead of a circle for the 2012 and 2014 values to convey this discrepancy.

No Health Insurance (18-64 years) Clinical Care Trends The 10-year trend line shows that the overall health insurance rate for individuals ages 18-64 is getting worse. 2. Due to changes to the sampling methods of the Family Health Survey data occurring in 2012, the data from 2014 – the “current observed value” – and data from 2012 is not directly comparable to that of previous years. For more information, read the Family Health Survey Technical notes for 2012: http://www.dhs.wisconsin.gov/publications/P4/p45369b-12.pdf. A diamond is used instead of a circle for the 2012 and 2014 values to convey this discrepancy.

Social and Economic Trends High School Drop-Outs Social and Economic Trends The 10-year trend line shows that the overall high school drop-out rate is getting worse. However, for the past four consecutive years, there is indication of a trend going in the opposite direction. 3. Due to a lack of comparability, the High School Drop-out data does not include the 2003-2004 school year. 4. Linear trends are used in this report in order to have a standard method for assessing progress across different measures. However, the limitations of using 10-year linear trends are evident in several measures. Using trend lines may have several issues, namely, 1) trends within trends (e.g., caused by a specific policy change) are not visible, 2) linearity may not be appropriate, and 3) the indicators use point estimates yet may have large confidence intervals, which means using a trend line may misrepresent the actual trend.

Social and Economic Trends Unemployment Rate Social and Economic Trends The 10-year trend line shows that the overall unemployment rate is getting worse. However, for the past six consecutive years, there is indication of a trend going in the opposite direction. 4. Linear trends are used in this report in order to have a standard method for assessing progress across different measures. However, the limitations of using 10-year linear trends are evident in several measures. Using trend lines may have several issues, namely, 1) trends within trends (e.g., caused by a specific policy change) are not visible, 2) linearity may not be appropriate, and 3) the indicators use point estimates yet may have large confidence intervals, which means using a trend line may misrepresent the actual trend.

Social and Economic Trends Children in Poverty Social and Economic Trends The 10-year trend line shows that the overall child poverty rate is getting worse. However, for the past four consecutive years, there is indication that this trend may reverse.

Social and Economic Trends Violent Crime Rate Social and Economic Trends The 10-year trend line shows that the violent crime rate is getting worse although in more recent years it appears this trend may be reversing. 4. Linear trends are used in this report in order to have a standard method for assessing progress across different measures. However, the limitations of using 10-year linear trends are evident in several measures. Using trend lines may have several issues, namely, 1) trends within trends (e.g., caused by a specific policy change) are not visible, 2) linearity may not be appropriate, and 3) the indicators use point estimates yet may have large confidence intervals, which means using a trend line may misrepresent the actual trend.

Physical Environment Trends Air Pollution Physical Environment Trends The 10-year trend line shows that the rate of air pollution is not changing, though the current rate is better than expected. 4. Linear trends are used in this report in order to have a standard method for assessing progress across different measures. However, the limitations of using 10-year linear trends are evident in several measures. Using trend lines may have several issues, namely, 1) trends within trends (e.g., caused by a specific policy change) are not visible, 2) linearity may not be appropriate, and 3) the indicators use point estimates yet may have large confidence intervals, which means using a trend line may misrepresent the actual trend.

Current health trends in health outcomes and health factors are markedly different for various subgroups within the state’s population. Efforts to improve health in Wisconsin must consider the full array of factors that influence how long and how well we live. They must begin with an analysis of the circumstances that may produce longer, healthier lives for some – but not all – of the state’s residents.

Funding for this project was provided by the Wisconsin Partnership Program, University of Wisconsin School of Medicine and Public Health.

Contact Information University of Wisconsin Population Health Institute Department of Population Health Sciences University of Wisconsin School of Medicine and Public Health 575 WARF Building 610 Walnut Street Madison, WI 53726-2397   http://uwphi.pophealth.wisc.edu