1. 1 Southeast – Cape & Islands Regional Health Dialogue Massachusetts Department of Public Health June 7, 2007

2. 2 Goals for Holding Regional Dialogues Introduce new DPH leadership Present latest health data on your particular region Talk with residents and providers about data and identify areas of need Gather feedback to inform process of setting DPH priorities

3. 3 Goals of New DPH leadership Use data and community input to set new priorities & reshape the Department Rely on science and evidence-based process to guide the work Strengthen ties with and support for local health and local agencies Increase resources to and visibility of Public Health in Massachusetts

4. 4 Timetable Hold 8 regional dialogues with comprehensive data review and identification of key health concerns (by July) Identify short list of top priorities by end of August Hold second round of community dialogues to discuss action plans/results by end of calendar year

5. 5 Socio-Demographic Indicators and Health Care Access

6. 6 Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program Executive Office of Health and Human Services (EOHHS) Regions

7. 7 A few comments about the limitations of this presentation A regional analysis has its drawbacks Variability within a region – urban vs. rural/suburban (i.e. Cape vs. the rest of the region) Variability by sub-population – race matters, poverty matters Our data don’t reflect all the important health indicators

8. 8 2005 Population by Communities Southeast Region: 2005 Smallest Gosnold: 86 Largest Brockton:100,366 Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program Population > 10,000

9. 9 Race and Ethnic Breakdown of Population Cape & Islands and Massachusetts: 2005 Cape & IslandsMassachusetts White* 94.3% Black* 2.6% Hispanic 1.7% Asian* 0.9% * Non-Hispanics White* 81.0% Black* 6.0% Hispanic 7.9% Asian* 4.9% Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program American Indian* 0.6% American Indian* 0.2% Total = 252,204Total = 6,436,940

10. 10 Towns by Percent Native American Population Massachusetts: 2000 > 1% MA population <= 1% MA population Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

11. 11 Language Spoken at Home Southeast Region and Massachusetts: 2000 Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

12. 12 Cape & Islands Massachusetts 0-19 years 20.4% Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program Population by Age Group Cape & Islands and Massachusetts: 2005 20-24 years 5.0% 25-44 years 25.2% 45-64 years 27.4% 65+ years 21.9% 0-19 years 25.5% 20-24 years 6.7% 25-44 years 29.4% 45-64 years 25.3% 65+ years 13.3% Total = 252,204 Total = 6,436,940 20-24 years 5.0% Southeast (non-Cape) 0-19 years 26.5% 20-24 years 5.9% 25-44 years 29.1% 45-64 years 25.8% 65+ years 12.7% Total = 1,026,041

13. 13 Socio-Demographic Indicators Southeast Region and Massachusetts Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

14. 14 Highest and Lowest Per Capita Income Cape & Islands Communities: 2000 High Low Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

15. 15 Birth Indicators

16. 16 Infant Mortality Rates by EOHHS Region Massachusetts: 2002-2005 Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program Infant Mortality Rate: deaths of infants less than one year of age per 1000 live births Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better

17. 17 Indicator (as % of race group births) MA Total (n=76,824) Southeast (n=14,681) Southeast (not incl. the Cape) (n=12,450) Cape & Islands (n=2,311) Adequate Prenatal Care (Kotelchuck index) 84.083.683.086.7 Cesareans 32.334.635.330.7 Low Birth weight (<5.5 lb) 7.98.38.66.4 Breastfeeding 79.371.569.183.9 Public Pay for Prenatal Care 32.634.734.833.5 Smoking during pregnancy 7.110.210.1 Summary Birth Indicators Southeast Region and Massachusetts: 2005 Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program Better Outcome (significantly different from state)Worse Outcome (significantly different from state)

18. 18 Leading Causes of Death

19. 19 Leading Causes of Death Cape & Islands and Massachusetts: 2005 Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program Massachusetts N=53,776 Heart Disease 13,24824.6% Cancer 13,15924.5% Stroke 2,9795.5% All Injuries 2,6574.9% Chronic Lower Respiratory Disease (formerly COPD) 2,6434.9% Influenza and pneumonia 1,9323.6% Alzheimer's 1,6353.0% Nephritis 1,4032.6% Diabetes 1,2712.4% Septicemia 9821.8% Cape & Islands N=2,869 Heart Disease 72125.1% Cancer 70724.6% Stroke 1685.9% Chronic Lower Respiratory Disease (formerly COPD) 1455.1% Alzheimer's 1354.7%* All Injuries 1284.5% Influenza and pneumonia 963.3% Nephritis 642.2% Diabetes 602.1% Parkinson's Disease 361.3% Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better

20. 20 Chronic Disease Outcomes and Overweight/Obesity

21. 21 Adults who are Overweight 1 by EOHHS Region, Massachusetts: 1995 and 2005 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), Health Survey Program 1 Overweight: BMI greater than or equal to 25 Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better

22. 22 Cancer

23. 23 Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better Smoking During Pregnancy by EOHHS Region Massachusetts: 2005 * ** * * *

24. 24 Smoking During Pregnancy Cape & Islands and Massachusetts: 1990-2005 Massachusetts Cape & Islands Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

25. 25 Smoking During Pregnancy by Race and Ethnicity Cape & Islands and Massachusetts: 2005 Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program * Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better NA

26. 26 Adults who Currently Smoke Southeast Region and Massachusetts: 2006 * Obesity: BMI greater than or equal to 30 Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), Health Survey Program * *

27. 27 Incidence Rates for Invasive Lung Cancer by EOHHS Region, Massachusetts: 1999-2003 Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry * Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better ** * * *

28. 28 Incidence Rates for Invasive Prostate Cancer by EOHHS Region, Massachusetts: 1999-2003 Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry ** * Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better ** *

29. 29 Indicator MA Total Fall River New Bedford Cape & Islands Southeast % Blood Stool Test † 28.432.233.835.228.8 % Adults Sigmoidoscopy or Colonoscopy † 57.450.248.156.558.5 % Women* Mammography 84.880.683.885.783.4 Summary Indicators for Cancer Screening by Southeast Region and Massachusetts: 2006 Better Outcome (significantly different from state)Worse Outcome (significantly different from state) *40 years and older, † 50 years and older Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

30. 30 Indicator MA Total Southeast Southeast (not including Cape & Islands) Cape & Islands Prostate Cancer 181.9202.5187.5239.4 Female Breast Cancer 138.9139.6132.8161.5 Colorectal Cancer 58.959.759.360.6 Lung Cancer 72.077.578.973.2 Total Cancer 517.0543.1528.7582.5 Summary Cancer Incidence Rates Southeast Region and Massachusetts: 1999-2003 Better Outcome (significantly different from state)Worse Outcome (significantly different from state) Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

31. 31 Substance Abuse

32. 32 Opioid-related Emergency Department Visit Rates by EOHHS Region Massachusetts: 2003-2005 ** * * * Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Department Visits Statistically different from State (p ≤.05) Red (*) = Statistically higher; Green (**) = Statistically lower

33. 33 Indicator MA Total Southeast Cape & Islands Substance Abuse Treatment Program Admissions Rate (crude rate) 1,6011,7242,015 Substance Abuse Treatment Program Admissions Rate—Alcohol (crude rate) 6618211,147 Substance Abuse Treatment Program Admissions Rate—Cocaine (crude rate) 628892 Substance Abuse Treatment Program Admissions Rate—Heroin (crude rate) 609504389 Summary Substance Abuse Indicators Southeast Region, Cape & Islands and Massachusetts: 2005 Source: Massachusetts Department of Public Health. BSAS Substance Abuse Treatment Programs 2005. Statistically lower than state Statistically higher than state

34. 34 Injury and Violence

35. 35 Hospital Discharge Rates for Motor Vehicle-related Injuries by EOHHS Region Massachusetts: 2003-2005 Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database

36. 36 Emergency Department Visit Rates for Fall-related Injuries by EOHHS Region Massachusetts: 2003-2005 ** * * Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Department Visits * ** Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better * *

37. 37 Emergency Department Visit Rates for Fall-related Injuries by Race/Ethnicity Cape & Islands and Massachusetts: 2003-2005 * ** Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Department Visits Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better *

38. 38 Suicide Rates by EOHHS Region Massachusetts: 2003-2005 ** Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better

39. 39 Hospital Discharge Indicator Rates (age-adjusted, per 100,000) MA Total Southeast Southeast (not including Cape & Islands) Cape & Islands All Injuries 836859876812 Fall-related injury hospitalizations 374375378371 Traumatic Brain Injuries 8073 72 Motor vehicle-related 77888793 Self-Inflicted 6566NA63 Assault 2821NA18 Summary Injury/Violence Hospitalization Indicators Southeast Region, Cape & Islands and Massachusetts: 2003-2005 Better Outcome (significantly different from state) Worse Outcome (significantly different from state) Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database

40. 40 Infectious Diseases

41. 41 Indicator Crude rate, per 100,000 MA Total Southeast Cape & Islands Persons living with HIV (2005) 247.1170.9235.9 HIV Incidence(2005) 12.67.710.3 Persons living with AIDS (2005) 133.295.2124.9 AIDS Incidence (2005) 8.06.37.1 HIV/AIDS Mortality (2003-2005) 3.12.52.4 Summary HIV/AIDS Indicators Southeast Region, Cape & Islands and Massachusetts Better Outcome (significantly different from state)Worse Outcome (significantly different from state)

42. 42 Lyme Disease Incidence Cape & Islands, Southeast Region, and Massachusetts: 2004 * ** Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better ** Source: MDPH Bureau of Communicable Disease Control, ISIS ** *

43. 43 Indicator MA Total Southeast Southeast (not including Cape & Islands) Cape & Islands Chlamydia Incidence (crude rates, 2005) 225.7169.7184.5103.5 Gonorrhea Incidence (crude rates, 2005) 39.635.436.230.9 Syphilis Incidence (crude rates, 2005) 6.32.72.14.8 Tuberculosis Incidence (crude rates, 2004) 4.42.0NA Lyme Disease Incidence (crude rates, 2004) 24.748.430.9119.5 Average Hep C Incidence Infection (crude rates, 2006) 114.082.0NA Pneumonia/ Influenza Hospital Discharges (age-adjusted, 2005) 377.0406.7488.8285.2 Summary Infectious Disease Indicators Southeast Region, Cape & Islands and Massachusetts Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

44. 44 Asthma

45. 45 Indicator MA Total Southeast Southeast (not including Cape & Islands) Cape & Islands Asthma ER Visits Ages 0-4 (age adjusted per100,000) 1,130854846884 Asthma ER Visits Ages 5-9 (age adjusted per100,000) 775687656825 Asthma ER Visits Ages 10-14 (age adjusted per100,000) 533571533755 Asthma ER Visits Ages 0-14 (age adjusted per100,000) 808697671816 Summary Asthma Indicators Southeast Region, Cape & Islands and Massachusetts: 2005 Source: Division of Health Care Finance and Policy. Calendar Year 2005. Emergency Department Visits Statistically lower than state Statistically higher than state

46. 46 Summary-Cape & Islands Socio-demographics difference impact health status –Older population –Socio-demographic indicators are better than the State –Mostly white non-Hispanics –Majority speak only English In general, the Cape & Islands is a relatively healthy place to live: –Birth indicators are better than the State –Heart disease and diabetes mortality are low –Homicides, firearm, STDs lower than the State Some indicators are worse than the State : –Cancer incidence is higher for breast and prostate cancer –Higher motor vehicle deaths and suicides than the State –Higher Lyme Disease incidence than the State –Higher Emergency Department Visit rates for opioid-related and for asthma for children ages 10-14 years –Higher Substance Abuse Treatment Program Admission rates than State We need to examine local variation and subgroups in the population to get a more complete picture of the health of the Cape & Islands region These are resident data and do not reflect the impact of visitors on the Cape & Islands

47. 47 Health Disparities by Race/Ethnicity Cape & Islands –Blacks on the Cape & Islands have higher Emergency Visit Rates for fall- related injuries than Blacks in MA –White mothers on the Cape & Islands have higher rates for smoking during pregnancy than whites in MA

48. 48 How Can You Access these Data? Hard Copies: (617) 624-5674 TDD/TTY: (617) 624-6001 Questions: (617) 624-6021 Laura.Innis@State.ma.us For more detailed community data: http://masschip.state.ma.us DPH Website: http://www.mass.gov/dph/comm/health_dialogues.htm

49. 49 Q/A