1. Health in the District of Columbia: Epidemiology and Trends John O. Davies-Cole, PhD, MPH, CPM State Epidemiologist DC Department of Health CHP HEALTH FORUM MAY 2008

2. Health Status The health status of the District of Columbia is a description of the health of its population. The information used to report health status comes from a variety of sources: - birth and death records - hospital discharge data - health information collected from health care records - personal interviews - telephone surveys.

3. African American, 56.5 % White, 38.4% Asian / Pacific Islander, 3.2% Hispanics, 8.2% Estimated Population by Race, District of Columbia, 2006 ( 581,530)

4. Life Expectancy Life expectancy at birth is strongly influenced by infant and child mortality District of Columbia was 72.6 in 2000 compared to 77.0 for the U.S. This was the lowest compared to all states Neighboring states: Maryland (76.3) and Virginia (76.9) were slightly below the national average.

5. Life Expectancy (2000) Years Place White Male Female Black Male Female US74.6 79.967.8 74.7 DC71.4 81.157.5 71.6

6. Age-Adjusted Death Rates for the 15 Leading Causes of Death in the United States, 2003 Source: National Vital Statistics Reports, Vol. 54. No.13, April 19,2006

7. DISTRICT OF COLUMBIA AND UNITED STATES TOP TEN AGE-ADJUSTED DEATH RATES, 2004 Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics. US: CDC, NHCS NVSS Vol. 55, No. 19, 8.21.2007. Notes: Top 10 causes of death account for 75.4% of all D.C. resident deaths. Ranking is based on DC deaths, US deaths are among top 15 deaths. *HIV//AIDS, hypertension and homicide not among top 10 for US.

8. DC US

9. CityMortality Rate*Ranking Baltimore, MD1, 1405 Detroit, MI1, 1038 Memphis, TN1, 04613 Atlanta, GA 97421 Washington, DC 96624 City Average 964 Overall Mortality Rates In 5 Selected Cities, 2004 Source: Big Cities Health Inventory 2003 Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population

10. Crude Death Rate from Heart Diseases by Ward, 2004 Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics.

11. CityHeart Disease Mortality Rate* Ranking Detroit, MI3704 Memphis3057 Baltimore, MD28710 Washington, DC27414 Atlanta, GA23033 City Average253 Heart Disease Mortality Rates In 5 Selected Cities, 2004 Source: Big Cities Health Inventory 2003 * Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population

12. Crude Death Rate from Hypertension by Ward, 2004 Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics

13. City Hypertension Mortality Rate* Washington, DC60 Baltimore, MD13 Memphis, TN13 St. Louis, MO9 Atlanta, GA8 Hypertension Mortality Rates in 5 Selected Cities, 2004 * Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population Sources: Big Cities Health Inventory 2007 DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics, “Major Causes of Death for the District of Columbia, U.S., and Selected Cities, 2002-2004” Georgia Department of Human Resources, Division of Public Health, http://health.state.ga.us/pdfs/ohip/vsr/mortality.06.pdfhttp://health.state.ga.us/pdfs/ohip/vsr/mortality.06.pdf Department of Health and Senior Services: http://www.dhss.mo.gov/cgi-bin/death1http://www.dhss.mo.gov/cgi-bin/death1

14. Crude Death Rate from Cancer by Ward, 2004 Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics

15. CityAll Cancer Mortality Rate* Ranking Baltimore, MD23115 Detroit, MI23016 Memphis, TN22619 Atlanta, GA21128 Washington, DC20633 City Average217 All Cancer Mortality Rates In 5 Selected Cities, 2004 Source: Big Cities Health Inventory 2003 * Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population

16. Crude Death Rate for Diabetes by Ward, 2004 Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics

17. City Diabetes Mortality Rate*Ranking Washington, DC408 Baltimore, MD3911 Memphis, TN3515 Detroit, MI3218 Atlanta, GA2050 City Average31 Diabetes Mortality Rates In 5 Selected Cities, 2004 Source: Big Cities Health Inventory 2003 * Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population

18. Crude Death Rate from Homicide by Ward, 2004 Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics

19. CityHomicide Rate*Ranking Baltimore, MD402 Detroit, MI373 Washington, DC284 Atlanta, GA227 Memphis, TN1810 City Average13.8 Homicide Rates In 5 Selected Cities, 2004 Source: Big Cities Health Inventory 2003 * Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population

20. Infant Mortality Rates by Ward, 2004 Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics

21. CityInfant Mortality Rate* Overall Rank Memphis, TN17.31 Detroit, MI16.42 Baltimore, MD12.84 St. Louis, MO12.75 Washington, DC10.510 City Average8.0 Ranking of Infant Mortality Rate in 5 Selected Cities, 2003 Source: Big Cities Health Inventory 2007 * * Infant death/ 1,000 live births

24. Crude Death Rates from HIV/AIDS by Ward, 2004 Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics

28. City HIV-Related Mortality Rate*Ranking Baltimore, MD512 Atlanta, GA423 Washington, DC414 Memphis188 Detroit, MI1214 City Average14 HIV-Related Mortality Rates In 5 Selected Cities, 2004 Source: Big Cities Health Inventory 2003 * Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population

32. Crude Death Rates from Unintentional Injures by Ward, 2004 Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics

33. Some Risk Behaviors

34. Current Smokers Prevalence by Ward, 2005 Source: DOH, CPPE, Behavioral Risk Factor Surveillance System

35. Obesity

36. Prevalence of Obesity by Race (1996 – 2003)

37. Obesity Prevalence by Ward, 2005 Source: DOH, CPPE, Behavioral Risk Factor Surveillance System

38. Health Disparities

39. Source: D.C. State Center for Health Statistics. National Center for Health Statistics. Hispanics include persons of all Hispanic origin of any race. **U.S. rates base on 2003 data ***Rates not computed due to small number of infant deaths and, therefore are likely to be unstable. *Healthy People 2010 targets for US and DC: rates per 1,000 live births. ------ 2010 Target (US) ------ 2010 Target (DC) US: 4.5* DC:8*

40. Breast and Cervical Cancer* Age-Adjusted Death Rates by Race: District of Columbia, 2004 Source: DC Department of Health. *Rates are per 100,000 and age-adjusted to the 2000 U.S. standard.

41. Incidence of Breast Cancer* Age-Adjusted Rates by Race: District of Columbia, 2003 Source: DC Department of Health, Cancer Registry *Rates are per 100,000 and age-adjusted to the 2000 U.S. standard.

42. Hypertension* Age-Adjusted Death Rates by Race: District of Columbia, 2004 Age-adjusted Rate per 100,000 Standard Population Rates are age-adjusted to the year 2000 standard population. Source: DC Department of Health, State Center for Health Statistics, 2004.

43. Diabetes* and Gestational Diabetes Prevalence by Race: District of Columbia, BRFSS 2004 Percent Source: 2004 DC BRFSS weighted data. DC Department of Health, Diabetes Control Program. *Healthy People 2010 targets for US and DC: rate per 100,000 deaths.

44. HIV/AIDS* Age-Adjusted Death Rates by Race: District of Columbia, 2004 Age-adjusted Rate per 100,000 Standard Population Rates are age-adjusted to the year 2000 standard population. Source: DC Department of Health, State Center for Health Statistics, 2004.

45. Homicide* Age-Adjusted Rates by Race : District of Columbia, 2004 Age-adjusted Rate per 100,000 Standard Population Rates are age-adjusted to the year 2000 standard population. Source: DC Department of Health, State Center for Health Statistics, 2006. US: 3.0*

46. Questions