Local Health Improvement Coalition Annual Meeting, October 26, 2017 - - PowerPoint PPT Presentation

Local Health Improvement Coalition

Annual Meeting, October 26, 2017 Russell Moy, MD, MPH Acting Health Officer

• Reviewing the data
• Discussion
• Selecting the priorities

2

Local Health Improvement Coalition (LHIC) Today’s Update

3

Harford County Local Health Improvement Coalition (LHIC)

• Organized in 2011
• Selected 3 Health Priorities
• Community Efforts Organized Around These Priorities

Obesity Prevention / Healthy Eating & Active Living Tobacco Use Prevention / Tobacco-Free Living Behavioral Health / Substance Use & Mental Health

• Infant mortality
• Low birth weight rates
• Teen birth rates
• Early prenatal care
• Uninsured E.D. visits
• E.D. visit rates for diabetes,

hypertension, asthma, dental and mental health care

• Hospitalization rate for Alzheimer’s

Disease

4

Source: ship.md.networkofcare.org/ph/ Note: Data reflects SHIP year, not year data collected

• Heart disease mortality
• Annual seasonal flu vaccines
• Persons with a usual primary care

provider

• HIV incidence rate
• Chlamydia incidence rate
• Pedestrian injury rate on public

roads

• And many other conditions

Harford County ranks better than the State average in 23 of 39 Maryland SHIP measures in 2017 . . .

Measure 2017 Goal MD 2016 MD 2017 Harford 2016 Harford 2017 Drug-induced death rate (per 100,000) 12.6 15.2 17.7 19.2 20.2 E.D. visit rate for addictions (per 100K) 1400.9 1474.6 1591.3 1462.1 1673.6 Adults who currently smoke (%) 15.5 14.6 15.1 18.9 20.7 Fall-related death rate (per 100,000) 7.7 8.5 8.8 10.1 11.8 Domestic violence*(per 100,000 crimes) 445.0 455.8 510.9 384.6 512.6 Sudden Unexpected Infant Death* (SUID per 1,000 lives births) 0.86 0.82 1.03 0.82 1.55 Adults at a healthy weight* (%) 36.6 35.1 35.0 40.6 27.7

5

Harford County still ranks worse than the State average in 16 of 39 2017 SHIP measures . . .

Source: ship.md.networkofcare.org/ph/ Note: Data reflects SHIP year, not year data collected

Measure 2017 Goal MD 2016 MD 2017 Harford 2016 Harford 2017 Suicide death rate (per 100,000) 9.0 9.2 9.1 11.6 11.4 Cancer death rate (per 100,000) 147.4 162.0 159.3 170.9 165.6 Adolescents use tobacco products (%) 15.2 16.9 16.4 20.2 19.2 Child maltreatment (per 1,000 < age 18) 8.3 9.9 7.3 14.1 11.7 Increased physical activity (% 150 min/wk) 50.4 48.0 52.9 46.4 51.2 Adolescent wellness checkups (% 12 mo) 57.4 54.7 56.0 50.3 52.0 Children’s dental care (% 12 mo) 64.6 63.2 64.3 58.3 60.2 Children blood lead screening(%12-15mo) 69.5 62.0 62.6 51.4 52.7 Affordable housing 54.4 46.1 48.2 40.3 41.0

6

Harford County still ranks worse than the State average in 16 of 39 2017 SHIP measures (continued)

Source: ship.md.networkofcare.org/ph/ Note: Data reflects SHIP year, not year data collected

Impact of the opioid overdose crisis

8

15.0 16.2 15.6 17.1 17.9 19.2 20.2 12.9 12.1 11.9 12.3 13.3 15.2 17.7 0.0 10.0 20.0 30.0 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates worse than the State, up 35% over past 6 yrs.

9

1,164 1,108 1,179 1,245 1,382 1,462 1,674 1,026 1,056 1,122 1,238 1,398 1,475 1,591

800 1,000 1,200 1,400 1,600 1,800 2008 2009 2010 2011 2012 2013 2014 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates worse than the State, up 44% over past 6 yrs.

10

35 33 43 38 39 36 43 50 84

2008 2009 2010 2011 2012 2013 2014 2015 2016 Per 100,000 Population All Drugs/Alcohol Heroin Fentanyl Harford County had a 68% increase in overdose deaths from 2015-2016. Preliminary data for 2017 indicate a possible 100% increase from 2016-2017.

Source: Maryland Vital Statistics: Drug- and Alcohol-Related Intoxication Deaths in Maryland, 2016

11 498 482 110 95 80 61 50 48 46 33 32

100 200 300 400 500 600 # of Deaths

Source: Maryland Vital Statistics, 2015

The Leading Causes of Death Harford County, 2015

At the current rate,

• verdose deaths may

become the 3rd leading cause of death in 2017.

Potential 100% increase in overdose deaths by 2017

12

The reason this epidemic is so deadly

13 1,566 1,401 1,275 1,119 1,113 949 913 913 900 883 866 817 785 742 740 712 690 640 546 550 519 495 356 353 283

Kent Allegany Washington Calvert Cecil Talbot Carroll Harford Wicomico Baltimore Co Charles Garrett

• St. Mary's

Frederick Anne Arundel Worcester Queen Anne's U.S. Average Dorchester Somerset Baltimore City Caroline Montgomery Howard Prince George's

Morphine Milligram Equivalents (MME)

2010 2015

Harford County ranks 8th worst in the State.

Source: Dinsmore, “How Maryland measured up in opioid prescribing,” Baltimore Sun, 7/8/17 – citing CDC data

14

4.5 5.6 8.8 5.1 5.9 12.6 12.1 9.5 12.3 19.9 16.9 29.6 26.4 36.7 29.1 29.4 38.2 11.8 11.3 12.4 11.9 10.2 12.6 13.1 13.3 14.5 14.7 16.0 17.6 18.6 21.0 20.4 20.1 33.3

10 20 30 40 Rate Exposed Per 1,000 Newborns Year Harford County Maryland

>7-fold increase in newborn exposure to drugs/alcohol

• ver the past 16 years for Harford County residents

NOTE: ICD Codes used 760.70, 760.71. 760.72, 760.73, 760.75, 760.77, 779.5 Source: HSCRC Hospital Data, 2000-16,Maryland resident births only, does not include Maryland resident births born out of state.

Source: “Drug and Alcohol Related Intoxication Deaths in Maryland, 2016,” Maryland Vital Statistics

Heroin increased by 62% Fentanyl increased by 229% From 2015 to 2016.

Source: “Drug and Alcohol Related Intoxication Deaths in Maryland, 2016,” Maryland Vital Statistics

45-54 yr olds impacted most. 25-34 yr olds impacted next most.

Number of deaths

500 400

AGE (years)

<25 years 25-34 years 35-44 years 45-54 years 55+ years

300 200 100

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

17 Stein et al, AJPH, October 2017

18

15 16 16 16 18 17 15 15 15 15 17 16 2012 2013 2014 2015 2016 2017 Percentage Harford County Maryland

* Consumed ≥ 5 drinks (male) or 4 drinks (female) on a single occasion in past 30 days Source: www.countyhealthrankings.org

Harford County rates have worsened by 13%

• ver the past 5 years.

19

20.8 18.8 17 13.1 5 10 15 20 25 2013 2014 Percent Harford Maryland

* Students Grades 9-12 consumed ≥ 5 drinks on a single occasion in past 30 days Source: Maryland YRBS, 2014

Harford County rates are 44% worse than the State average.

20

19.6 21.2 19.8 18.8 17 18 19 20 21 22 2013 2014 Percent Harford Maryland

* Students Grades 9-12 who used marijuana ≥1 time during past 30 days Source: Maryland YRBSS, 2014

Harford County rates are 13% worse than the State average.

21

11.9 11.2 11.3 10.7 11.6 11.6 8.8 8.9 8.8 9.0 9.2 9.1 8 9 10 11 12 13 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates 27% worse than the State.

Impact of tobacco and obesity

23

The Leading Actual Underlying Causes of Death

Source: Mokdad et al, “Actual Causes of Death in the U.S., 2000” JAMA, 3/19/2004

Smoking, obesity and alcohol are the leading actual causes

• f death.

24

18.6 21.7 16.9 18.9 20.7

10 12 14 16 18 20 22 24 2011 2012 2013 2014 2015 Percent Harford Maryland

Source: phpa.health.maryland.gov MD BRFSS, 2011-15

Harford County adult use rates increased by 10% over the past 5 years.

25 Note: Students Grades 9-12 who used any tobacco products in the past 30 days Source: Maryland YRBSS, 2013 and 2014:

20.2 19.2 16.9 16.4 5 10 15 20 25 2013 2014 Percent

Harford Maryland Harford County youth use rates are 17% higher than the State average.

26

41.4 37.6 35 36 37 38 39 40 41 42 2014 Percent Harford Maryland

Plus Harford County youth e-cig use rate is 10% higher than the State average.

* Students Grades 9-12 who have ever used electronic vapor products (e.g., e-cigarettes, e-pipes, e-hookahs) Source: Maryland YRBSS, 2014

27

28

55% of all cancers in women and 24% of cancers in men are associated with

• besity.

29

28.4 35.3 40.6 27.7 5 10 15 20 25 30 35 40 45 2012 2013 2014 2015 Percent

Harford County Maryland

Note: Adult BMI 18.5-24.9 Source: Maryland BRFSS, 2012-2015

Harford County rates have decreased by 3% over the past 4 years.

30

30.1 25.9 25.5 32.8 5 10 15 20 25 30 35 2012 2013 2014 2015 Percent

Harford Maryland Harford County rates have increased by 9% over the past 4 years.

Note: Adult BMI 30 and above Source: Maryland BRFSS, 2011-2014

31 Note: High school students who self-report BMI ≥ 95th percentile for age and gender Source: Maryland YRBSS, 2013 and 2014:

10.7 10.0 11.0 11.5 6.0 7.0 8.0 9.0 10.0 11.0 12.0 2013 2014 Percent

Harford Maryland Harford County youth use rates are 15% better than the State average.

32

10% Improvement in Childhood Obesity Among WIC Participants, 2010-2014

Source: MMWR, 2016, CDC

33

179 171 172 168 171 166 177 171 167 164 162 159 150 160 170 180 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates improving but worse than the State.

34 69 40 137 137 43 58 37 131 132 29 61 40 124 115 27

20 40 60 80 100 120 140 Lung Colo-rectal Breast (Female) Prostate (Male) Melanoma Per 100,000 Population Harford Maryland U.S.

Source: CDC and NCI at https://www.statecancerprofiles.cancer.gov/incidencerates/

Harford County rates worse with each different type of cancer.

35 70 40 130 76 49 232

50 100 150 200 250 Lung Cancer Colo-rectal Cancer Prostate Cancer (Male) Per 100,000 Population

White Black

Source: CDC and NCI at https://www.statecancerprofiles.cancer.gov/incidencerates/

Racial disparity exists for screenable cancers in Harford County.

36

47 41 38 37 37 39 36 35 34 33 31 31 20 30 40 50 60 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates worse than the State.

37 498 482 110 95 80 61 50 48 46 33 32

100 200 300 400 500 600 # of Deaths

Age-Adjusted Rates Source: Maryland Vital Statistics, 2015

The Leading Causes of Death Harford County, 2015

Cancer and COPD are 2

• f the 3 leading disease

causes of death in Harford County.

Other public health issues in Harford County

39

198 182 176 172 170 168 193 180 175 172 170 169 150 160 170 180 190 200 210 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates improving and comparable with the State.

40

43 40 38 34 37 35 40 39 37 37 36 37 30 40 50 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates improving and comparable with the State.

41

16.9 12.4 14.9 11.3 10.0 8.8 27.2 24.7 22.1 19.3 17.8 16.9 10 20 30 2010 2011 2012 2013 2014 2015 Per 1,000 Females, Ages 15-19 Harford Maryland

Source: Maryland Vital Statistics Reports

Harford County rates better than the State.

42

9.3 10.5 9.9 10.1 11.8 7.8 8.2 8.4 8.5 8.8

5 10 15 2009-11 2010-12 2011-13 2012-14 2013-15 Per 100,000 Population Harford Maryland

Harford County rates worse than the State average.

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

43

52.1 55.4 56.5 59.7 59.9 58.3 60.2 52.8 57.1 60.2 62.2 63.3 63.2 64.3

50 55 60 65 70 2009 2010 2011 2012 2013 2014 2015 Percent Harford Maryland

Source: Maryland Medicaid Service Utilization

Harford County rates worse than the State and the gap is widening.

44

243 228 251 270 196 188 206 307 441 422 459 475 460 464 476 479

100 200 300 400 500 600 700 2008 2009 2010 2011 2012 2013 2014 2015 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Although Harford County rate is better than the State average, it has increased by 57% between 2012-15. So far in 2017, chlamydia cases have increased by 11.5%, gonorrhea cases increased by 17.9% in Harford County.

45

243.0 253.2 239.3 384.8 384.6 512.6 310.6 312.4 299.3 468.6 456.8 510.9

100 200 300 400 500 600 2010 2011 2012 2013 2014 2015 Crimes Per 100,000 Population Harford Maryland

Source: Maryland Uniform Crime Reporting Program http://ship.md.networkofcare.org/ph/ship

Harford County 2015 rate now exceeds the State average.

46

0.74 0.75 0.63 0.65 0.52 0.82 1.65 0.95 0.93 0.92 0.93 0.89 0.82 1.03

0.0 0.5 1.0 1.5 2.0 Per 1,000 Live Births Harford Maryland

Harford County rate now worse than the State average.

Source: Maryland Vital Statistics Reports

47

5.5 3.7 5.3 5.2 4.8 3.3 6.7 6.7 6.3 6.6 6.5 6.7 2 4 6 8 10 2010 2011 2012 2013 2014 2015 Per 1,000 Live Births Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates improving and better than the State.

48

6.7 11.3 5.5 4.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0

All Black Hispanic White

Per 1,000 Live Births

All Black Hispanic White

Source: Maryland Vital Statistics, 2015

Infant mortality racial disparities exist in Maryland

49

16.9 22.8 42.7 9.1 0.0 10.0 20.0 30.0 40.0 50.0

All Black Hispanic White

Per 1,000 Females, Ages 15-19

All Black Hispanic White

Source: Maryland Vital Statistics, 2015

Racial disparities exist in Maryland teen birth rates

Black mortality rates exceed White mortality rates by:

• 13% for Cancer
• 15% for Heart Disease

50

Black : White Health Disparities Exist

Black E.D. visit rates exceed White E.D. visit rates by:

• 35% for Addictions-Related
• 46% for Alzheimer’s/dementia
• 187% for Diabetes
• 267% for High Blood Pressure
• 306% for Asthma

Source: ship.md.networkofcare.org/ph/

51

85.2 86.0 68.7 87.6 83.3 50 60 70 80 90 100

All Black Hispanic White Asian

Percent

All Black Hispanic White Asian

Source: Maryland Vital Statistics, 2015

Primary care provider availability does not explain disparities.

52

17.0 15.5 12.2 9.5 10.7 10.9 5.8 3.4

5 10 15 20 25 2008 2009 2010 2011 2012 2013 2014 2015 Percent Harford Maryland

Source: phpa.health.maryland.gov MD BRFSS, 2011-15

Insurance coverage availability does not explain disparities.

• Obesity, tobacco, and behavioral health

– are current LHIC priorities and continue to be problems in Harford County.

• High cancer, COPD, drug-related, and suicide

– mortality rates continue to be the result.

• Other health issues exist

– including access to care, health disparities, dental health, fall- related mortality, domestic violence and others, with limited resources for addressing.

53

Local Health Improvement Coalition (LHIC) In Summary

Harford County Local Health Improvement Coalition (LHIC)