Wisconsin Department of Health Services January 2014 P-00522U Healthiest Wisconsin 2020 Baseline and Health Disparities Report Socioeconomic Status

SOCIOECONOMIC STATUS Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Key points Data Demographic and socioeconomic data Access to health care Overall health and mental health Risk behaviors Chronic disease outcomes Reproductive and sexual health References Links to additional reports and resources Contacts Chapter Outline Chapter outline 2

SOCIOECONOMIC STATUS Report Overview This chapter is part of a larger report created by the Wisconsin Department of Health Services to track the progress on objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included. Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations. Technical notes are available at: Report overview 3

SOCIOECONOMIC STATUS Report Format Full Report Format: PDF Intended use: reference document Chapters Format: Annotated PowerPoint slide set Intended uses: presentations to –Decision-makers –Service providers –Community leaders –The public Sample annotated slide Report overview 4

SOCIOECONOMIC STATUS Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes Report overview 5

SOCIOECONOMIC STATUS Report Outline: Detail Section 3: Health focus areas Alcohol and other drug use Chronic disease prevention and management Communicable diseases Environmental and occupational health Healthy growth and development Injury and violence Mental health Nutrition and healthy foods Oral health Physical activity Reproductive and sexual health Tobacco use and exposure Section 4: Infrastructure focus areas Access to health services Report overview 6

SOCIOECONOMIC STATUS Report Outline: Detail Section 5: Data summaries by population  Racial/ethnic minority populations o American Indians o Asians o Blacks o Hispanics  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography Report overview 7

SOCIOECONOMIC STATUS Data notes Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. Population estimates that are considered unreliable are excluded. Misclassification of racial/ethnic groups may affect the accuracy of rates. Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non- Hispanic. Report overview 8

SOCIOECONOMIC STATUS Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, Report overview 9

SOCIOECONOMIC STATUS Key Points The poverty rate in Wisconsin increased from 2006 to Education and income are correlated. The higher the level of education in a population, the higher the level of income, for both males and females. On average, Black, Hispanic, and American Indian adults in Wisconsin have lower levels of education and income compared to White and Asian adults. Differences within groups, particularly Asians, may be masked by aggregate data. Key points 10 Access to health care

SOCIOECONOMIC STATUS Key Points: Compared to adults with higher levels of education and income, adults with lower levels of education have: –Less access to health and dental care, higher utilization of the emergency room, lower rates of prenatal care, and lower rates of cancer screening. –Higher rates of risk behaviors including binge drinking, obesity, and tobacco use and exposure. –Higher rates of poor physical and mental health. –Higher rates of chronic diseases such as asthma, diabetes, heart disease, high cholesterol and blood pressure, stroke, and arthritis. Key points 11

SOCIOECONOMIC STATUS Demographic data 12

SOCIOECONOMIC STATUS Source: American Community Survey, Poverty rate (percent living below the federal poverty level), Wisconsin, Demographic and socioeconomic data 13

SOCIOECONOMIC STATUS Percent of the population living in poverty, by county, Wisconsin, Source: American Community Survey, Demographic and socioeconomic data

SOCIOECONOMIC STATUS Median household income by race/ethnicity, Wisconsin, Source: American Community Survey, Demographic and socioeconomic data

SOCIOECONOMIC STATUS Median earnings in the previous 12 months, adults ages 25 and older, by sex and educational attainment, Wisconsin, 2010 Source: American Community Survey, Demographic and socioeconomic data

SOCIOECONOMIC STATUS Educational attainment of adults ages 25 and older, by race/ethnicity, Wisconsin, Source: American Community Survey, Demographic and socioeconomic data

SOCIOECONOMIC STATUS Educational attainment of Wisconsin adults, ages 25 and older, by level of urbanization, Source: American Community Survey, Demographic and socioeconomic data

SOCIOECONOMIC STATUS Income distribution among Wisconsin adults by level of urbanization, Source: American Community Survey, Demographic and socioeconomic data

SOCIOECONOMIC STATUS Rate of living with a disability, Wisconsin adults ages 18-64, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline only dataset 20 Demographic and socioeconomic data

SOCIOECONOMIC STATUS Access to health care 21

SOCIOECONOMIC STATUS Lack of health insurance coverage among Wisconsin adults ages 18-64, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Access to health care 22

SOCIOECONOMIC STATUS Public health insurance coverage and inadequacy of health insurance among children ages 6-17, by highest education level of adult in household, Wisconsin, Source: National Survey of Children's Health. Access to health care 23

SOCIOECONOMIC STATUS Age-adjusted rate of use of and barriers to health care among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Access to health care 24

SOCIOECONOMIC STATUS Lack of routine preventive medical and dental care and unmet medical and dental needs among children, by poverty status, Wisconsin, Source: National Survey of Children's Health. Note: Estimates were not available for all groups. FPL is the Federal Poverty Level, based on household size and income. Access to health care 25

SOCIOECONOMIC STATUS Lack of access to care within a medical home among children, by poverty status, Wisconsin, Source: National Survey of Children's Health. Note: FPL is the Federal Poverty Level, based on household size and income. Access to health care 26

SOCIOECONOMIC STATUS Emergency room utilization among Wisconsin residents, by poverty status, Source: Wisconsin Department of Health Services, Family Health Survey, Access to health care 27

SOCIOECONOMIC STATUS Percentage of births to mothers who received prenatal care during the first trimester, by maternal education level, Wisconsin, 2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates. Healthy growth and development 28

SOCIOECONOMIC STATUS Health risk factors 29

SOCIOECONOMIC STATUS Vaccination coverage with selected vaccines among adolescents ages 13-17, by federal poverty level (FPL), Wisconsin and the United States, 2011 Access to health care Source: National Immunization Survey for Teens, Note: * To protect against tetanus, diphtheria, and pertussis. ** To protect against meningococcal disease. 30

SOCIOECONOMIC STATUS Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Access to health care 31

SOCIOECONOMIC STATUS Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Alcohol and other drug use 32

SOCIOECONOMIC STATUS Age-adjusted rate of low vegetable consumption among Wisconsin adults, by education level, 2009 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Data from 2009 only. Nutrition 33

SOCIOECONOMIC STATUS Breastfeeding initiation by maternal income, Wisconsin, Source: Wisconsin PRAMS, Division of Public Health, Department of Health Services. 34 Nutrition

SOCIOECONOMIC STATUS Age-adjusted rate of physical inactivity among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset Physical activity 35

SOCIOECONOMIC STATUS Age-adjusted rates of tooth removal and dental visits in the past year among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Tooth removal question asked in 2008, 2010, and Dentist visit question asked in 2008 and Oral health 36

SOCIOECONOMIC STATUS Rates of HIV testing and age-adjusted risk behaviors among Wisconsin adults, by household income, Reproductive and sexual health Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Testing rates are not age-adjusted; rates of exposure to high-risk situations are age-adjusted. 37

SOCIOECONOMIC STATUS Age-adjusted rates of smoking among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Tobacco use and exposure 38

SOCIOECONOMIC STATUS Rates of secondhand smoke exposure among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: The “smoking at work” question was only asked in 2009 and Tobacco use and exposure 39

SOCIOECONOMIC STATUS Age-adjusted rate of seat belt non-use and rate of fall-related injuries among Wisconsin adults, by household income, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Questions were asked in 2008, 2010, and Rates of seat belt use are age-adjusted; rates of fall-related injury are not age-adjusted but are limited to the population 45 and older. Injury and violence 40

SOCIOECONOMIC STATUS Health Outcomes 41

SOCIOECONOMIC STATUS Age-adjusted rates of physical health among Wisconsin adults by income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline only dataset Note: Physical health and limited activities questions were only asked in Physical health Nutrition

SOCIOECONOMIC STATUS Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by household income, Chronic diseases Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. 43

SOCIOECONOMIC STATUS Age-adjusted rates of heart attack and stroke among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Chronic diseases 44

SOCIOECONOMIC STATUS Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by household income, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Questions only asked in 2009 and Chronic diseases

SOCIOECONOMIC STATUS Cancer screening among Wisconsin adults, by education level, 2008 and 2010 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Questions were only asked in 2008 and Chronic diseases

SOCIOECONOMIC STATUS Age-adjusted rate of arthritis among adults, and percent of those with arthritis whose activity is limited due to joint pain, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Arthritis question was asked in Question about limited activity due to joint pain was asked in 2009 and Chronic diseases

SOCIOECONOMIC STATUS Age-adjusted rates of asthma among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Environmental health 48

SOCIOECONOMIC STATUS Percentage of lead poisoning (10 mcg/dL or greater) among tested children under age six, by Medicaid enrollment, Wisconsin, 2010 Source: Wisconsin Department of Health Services, Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP). Environmental health 49

SOCIOECONOMIC STATUS Age-adjusted rate of frequent mental distress among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in Mental health 50

SOCIOECONOMIC STATUS Age-adjusted rate of four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by household income, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in 2010 and Mental health 51

SOCIOECONOMIC STATUS Percentage of children who have experienced two or more adverse childhood experiences (ACEs), by federal poverty level (FPL), Source: National Survey of Children’s Health. Mental health 52

SOCIOECONOMIC STATUS Age-adjusted rate of insufficient sleep and rate of poor emotional support among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Questions were not asked in Rates of insufficient sleep are age-adjusted; rates of poor emotional support are not age- adjusted. Mental health 53

SOCIOECONOMIC STATUS Age-adjusted rates of overweight and obesity among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Nutrition 54

SOCIOECONOMIC STATUS Percentage of low birthweight (<5.5 pounds) births, by maternal education, Wisconsin, Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates. Healthy growth and development 55

SOCIOECONOMIC STATUS References 1.University of Wisconsin Population Health Institute. County Health Rankings Center for Urban Population Health. Milwaukee Health Report LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. Accessible at: 0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 4.Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057– Wisconsin Department of Health Services (DHS). Healthiest Wisconsin United States Department of Health and Human Services (HHS). The 2011 HHS Poverty Guidelines References

SOCIOECONOMIC STATUS 7.American Community Survey Glossary U.S. Census Bureau: 9.Current Population Survey (CPS) Definitions Centers for Disease Control and Prevention (CDC). Health Care: See Why Being Insured Matters CDC. Regular Check-Ups Are Important Data Resource Center for Child and Adolescent Health. Indicator details RAND Corporation. The Evolving Role of Emergency Departments in the United States. RR280.pdf RR280.pdf 14.CDC. During Pregnancy CDC. Preteen and Teen Vaccines. parents.htmlhttp:// parents.html 57 References

SOCIOECONOMIC STATUS 16.Centers for Medicare and Medicaid Services. Immunizations. zations/ zations/ 17.CDC. Alcohol Use and Health. use.htmhttp:// use.htm 18.CDC. State Indicator Report on Fruits and Vegetables, pdf pdf 19.U.S. Department of Agriculture. ChooseMyPlate.gov DHS, Wisconsin PRAMS. What Moms Tell Us: Breastfeeding (August 2012) CDC: PRAMS and Breastfeeding Public Health Reports. Socioeconomic Status and Breastfeeding Initiation Among California Mothers CDC. Physical Activity University of Wisconsin Population Health Institute. County Health Rankings, References

SOCIOECONOMIC STATUS 25.CDC. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings CDC. Smoking and Tobacco Use: Secondhand Smoke Facts. cts/index.htm cts/index.htm 27.CDC. Asthma CDC. Adolescent and School Health: Asthma and Schools American Lung Association. Asthma and Children. disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.htmlhttp:// disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.html 30.DHS. The Legacy of Lead: Report on Childhood Lead Poisoning in Wisconsin CDC. Self-Reported Frequent Mental Distress Among Adults --- United States, 1993— CDC. Adverse Childhood Experiences Study O’Connor C, Finkbiner C, & Watson L (2012). Adverse Childhood Experiences in Wisconsin: Findings from the 2010 Behavioral Risk Factor Survey. Madison, Wisconsin: Wisconsin Children’s Trust Fund and Child Abuse Prevention Fund of Children’s Hospital & Health System References

SOCIOECONOMIC STATUS 34.CDC. The state of mental health in aging America CDC. Insufficient sleep is a public health epidemic CDC. Health-related quality of life: Well-being concepts CDC. About BMI for Adults CDC. Is low birthweight a health problem? References

SOCIOECONOMIC STATUS Centers for Disease Control and Prevention —Social Determinants of Health Policy Link: Robert Wood Johnson Foundation: o How Does Employment or Unemployment Affect Health? research/2012/12/how-does-employment--or-unemployment--affect- health-.html research/2012/12/how-does-employment--or-unemployment--affect- health-.html o How Social Factors Shape Health: Income, Wealth, and Health research/2011/04/how-social-factors-shape-health1.html research/2011/04/how-social-factors-shape-health1.html o Why Does Education Matter So Much to Health? research/2012/12/why-does-education-matter-so-much-to-health-.html research/2012/12/why-does-education-matter-so-much-to-health-.html Links to additional reports and resources 61 Links

SOCIOECONOMIC STATUS National Association of City and County Health Officials (NACCHO)— Health equity and social justice: Unnatural Causes: UW Madison Population Health Institute: World Health Organization Commission on Social Determinants of Health: Wisconsin Center for Health Equity: Healthiest Wisconsin 2020 Crosscutting Focus Area: Social, Economic, and Educational Factors that Influence Health: pdf pdf Centers for Disease Control and Prevention (CDC). Demographic status publications: Links to additional reports and resources 62 Links

SOCIOECONOMIC STATUS Contacts Evelyn Cruz, Minority Health Officer Wisconsin Division of Public Health, Office of Policy and Practice Alignment Karl Pearson, Demographer Wisconsin Division of Public Health, Office of Health Informatics 63 Contacts