1. 1 Northeast Massachusetts Regional Health Dialogue Massachusetts Department of Public Health June 4, 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 Northeast Region

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. Lawrence 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 Population in Communities Northeast Region: 2005 Smallest 3,142 Largest 105,749 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

9. 9 Race and Ethnic Breakdown of Population Northeast Region and Massachusetts: 2005 NortheastMassachusetts White* 80.7% Black* 3.1% Hispanic 10.4% Asian* 5.6% * Non-Hispanics White* 81.0% Black* 6.0% Hispanic 7.9% Asian* 4.9% Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program American Indian* 0.2% Total Population: 1,255,346Total Population: 6,349,097

10. 10 Race and Ethnic Breakdown of Population Lowell, Lawrence, and Lynn : 2005 Lowell * Non-Hispanics Lawrence Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program Total Population: 105,167 Total Population: 81,591 Total Population: 92,186 Lynn

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

12. 12 Spanish Spoken at Home Northeast Region: 2000 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

13. 13 Socio-Demographic Indicators Northeast Region and Massachusetts: 2000 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

14. 14 Highest and Lowest Per Capita Income by Community 1 in Northeast Region: 2000 High Low 1 Selected among communities with at least 10,000 population Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

15. 15 Birth Indicators A major concern with infant deaths

16. 16 Infant Mortality Rates by Race/Ethnicity Northeast Region and Massachusetts: 2003-2005 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

17. 17 Infant Mortality Rate (IMR) Northeast Region and Massachusetts: 1990-2005 Massachusetts Northeast Region Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program Infant Mortality Rate: deaths of infants less than one year of age per 1000 live births

18. 18 Adequate Prenatal Care by Northeast Region Cities: 2005 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program * * Based on Adequacy of Prenatal Care Utilization (APNCU) Index. Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state * ** *

19. 19 Teen Birth Rate Northeast Region and Massachusetts: 1990-2005 Massachusetts Northeast Region Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program Teen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19.

20. 20 Teen Birth Rates by City/Town Northeast Region: 2005 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program Teen Birth Rate MA: 21.7 Northeast: 22.9

21. 21 Teen Birth Rates by Race and Ethnicity Northeast Region and Massachusetts: 2005 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program ** Teen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19. Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state * *

22. 22 Leading Causes of Death

23. 23 Leading Causes of Death Northeast Region and Massachusetts:2005 Source: MDPH, Health Information, Statistics, Research and 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% Northeast Region N=10,485 Cancer 2,70125.8% Heart Disease 2,59224.7% Stroke 5425.2% All Injuries5385.1% Chronic Lower Respiratory Disease (formerly COPD) 4934.7% Influenza and pneumonia 3553.4% Alzheimer's 3453.3% Nephritis 2702.6% Diabetes 2232.1% Septicemia 1701.6%

24. 24 Chronic Disease Outcomes and Overweight/Obesity

25. 25 Adults who are Overweight 1 by EOHHS Region, Massachusetts: 1995 & 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 than state- Green (**) statistically better than state

26. 26 Heart Disease Mortality Rates by EOHHS Region Massachusetts: 2003-2005 Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program * ** * Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

27. 27 Diabetes Hospital Discharges 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. Inpatient Hospital Discharge Database * ** * Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

28. 28 Diabetes Mortality Rate by Race/Ethnicity Northeast Region and Massachusetts: 2003-2005 Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

29. 29 Cancer

30. 30 Incidence Rates for Invasive Colorectal Cancer by EOHHS Region, Massachusetts: 1999-2003 Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Cancer Registry ** * Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state *

31. 31 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 and Evaluation Bureau, Cancer Registry * Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state ** **

32. 32 Lung Cancer Incidence Rates by Race and Ethnicity, Northeast Region & Massachusetts: 2003-2005 Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003- 2005. Hospital Discharges

33. 33 Adults who Currently Smoke by EOHHS Region, Massachusetts: 2005 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Health Survey Program ** Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

34. 34 Percent of Mothers Smoking During Pregnancy for Largest Communities Northeast Region: 2005 % Smokers Births Massachusetts 7.2%5,55576,653 Northeast Region 7.2%1,14015,924 Lowest Melrose 3.2%** 9 285 North Andover 2.8%** 9 324 Andover 2.0%** 6 292 Highest Gloucester 12.5%* 34 272 Dracut 11.8%* 44 372 Lowell 11.4%* 190 1,667 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

35. 35 Indicator MA Total Western Central North East Metro West South East Boston % Men † PSA (2004) 56.149.152.3 62.556.366.2 % Men † DRE (2004) 62.759.560.063.064.562.669.0 % Blood Stool Test † 30.034.229.933.530.926.420.7 % Adults Sigmoidoscopy or Colonoscopy † 58.853.960.253.268.55558.9 % Women Clinical Breast Exam (2004) 86.685.085.590.087.185.685.7 % Women* Mammography 84.186.983.083.487.182.080.1 Summary Indicators for Cancer Screening by EOHHS Regions, Massachusetts: 2005 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

36. 36 Indicator MA Total Western Central Northeast Metro West South East Boston Prostate Cancer Incidence 181.9170.3159.7180.5178.4202.5191.3 Female Breast Cancer Incidence 138.9135.3127.8139.8146.7139.6134.9 Colorectal Cancer Incidence 58.956.255.261.857.259.763.6 Lung Cancer Incidence 72.067.269.976.765.177.577.7 Summary Invasive Cancer Incidence Rates by EOHHS Regions, Massachusetts: 1999-2003 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Cancer Registry Better Outcome (significantly different from state)Worse Outcome (significantly different from state)

37. 37 Substance Abuse

38. 38 Any Illicit Drug Use in Past Month Persons Aged 12+ by EOHHS Region, Massachusetts: 2002- 2004 Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004. Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

39. 39 Opioid-Related Emergency Department Visit Rates by EOHHS Region Massachusetts: 2003-2005 ** * * * Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003- 2005. Emergency Department Visits

40. 40 Opioid-Related Emergency Department Visit Rates by Race/Ethnicity Lawrence, Lowell, and Lynn vs. Massachusetts: 2003-2005 * * Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003- 2005. Emergency Department Visits ** *

41. 41 Opioid-Related Fatal Overdoses by EOHHS Region, Massachusetts: 2003-2005 ** * * * Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

42. 42 Injury/Violence

43. 43 Causes of Injury Deaths Northeast Region and Massachusetts: 2005 Northeast Region Total Injuries = 538 Source: Massachusetts Department of Public Health, Center for Health Information, Statistics, Research, and Evaluation Massachusetts Total Injuries = 2,657 Poisonings 30% Firearm 8% Falls 11% Suffocation, Hanging, or Strangulation 13% Motor Vehicle- related 18% Other 20% Poisonings 34% Firearm 8% Suffocation, Hanging, or Strangulation 12% Motor Vehicle- related 17% Falls 10% Other 19%

44. 44 Hospitalization Rates for Fall-Related Injuries Ages 65+ by EOHHS Region Massachusetts: 2003-2005 Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

45. 45 Hospital Discharge 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 Visits Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

46. 46 Infectious Diseases

47. 47 HIV/AIDS Death Rate by Race/Ethnicity Northeast Region and Massachusetts: 2003-2005 NA Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

48. 48 Indicator MA Total Western Central North East Metro West South East Boston Chlamydia Incidence (crude rates, 2005) 225.7369.4145.4178.0106.1169.7588.5 Gonorrhea Incidence (crude rates, 2005) 39.655.916.622.420.335.4126.2 Syphilis Incidence (crude rates, 2005) 6.33.11.74.94.72.722.7 Tuberculosis Incidence (crude rates, 2004) 4.41.94.24.84.32.011.4 Lyme Disease Incidence (crude rates, 2004) 24.727.319.718.421.248.44.0 Hep C Incidence Infection (crude rates, 2006) 114.095.0123.092.049.082.0150.0 Pneumonia/ Influenza Hospital Discharges (age-adjusted, 2005) 377.0346.0392.7384.4341.5406.7415.8 Summary Infectious Disease Indicators by EOHHS Regions Source: MDPH, Center for Health Information, Statistics, Research & Evaluation, Research & Epidemiology Program Best Outcome (significantly different from state) Worse Outcome (significantly different from state)

49. 49 Asthma indicators

50. 50 Pediatric Asthma Prevalence Among School Children, Grades K-8 by EOHHS Region Massachusetts: 2005-2006 Source: MDPH, Center for Environmental Health, Pediatric Asthma Surveillance (2005-2006) * * ** Statistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than state

51. 51 Asthma Emergency Department Visit Rates Children Ages 0-14 Northeast Region and Massachusetts: 2005 ** Source: Division of Health Care Finance and Policy. Calendar Year 2005. Emergency Visits Statistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than state **

52. 52 Source: Division of Health Care Finance and Policy. Calendar Year 2005. Emergency Visits Pediatric Asthma Emergency Visit Rates by Towns* Among Children Ages <5 Northeast Region – Massachusetts 2004-2005

53. 53 Refugee Health Indicators

54. 54 Refugee Arrivals: Northeast Region Fiscal Year 2002-2006 1,312 refugees resettled over 5 years Increasing diversity in population 45% age <19 at arrival Cities/Towns with largest number of arrivals: Lowell, Lynn, Malden Source: MDPH, Refugee and Immigrant Health Program and the Bureau of Communicable Disease Control Office of Integrated Surveillance and Informatics

55. 55 Refugee Health Concerns: Northeast Region Fiscal Year 2002-2006 High rates of latent TB infection (LTBI) –1,237 refugees tested: 44% positive –Intensive follow-up in partnership with TB clinics, local health and DPH to assure testing, evaluation and treatment –Rapid assessment identifies active disease early to prevent spread Risk of lead poisoning among refugee children –37 refugee children identified with elevated blood lead levels at arrival –Poor nutritional status puts children at risk of increased absorption of lead post-resettlement Need for bilingual, bicultural services to promote access to care Source: MDPH, Refugee and Immigrant Health Program and the Bureau of Communicable Disease Control Office of Integrated Surveillance and Informatics

56. 56 Summary Excluding the larger communities, the Northeast region is a relatively healthy place to live: –Hypertension and diabetes hospitalizations are lower than the State –Homicides, STDs, HIV/AIDS, and pediatric asthma are lower than the State –Injuries related to motor vehicles, firearms, and falls have lower rates than the State Residents of larger communities are disproportionately affected by: –Lack of access to adequate prenatal care, especially in Lawrence, Lowell, and Lynn –Infant mortality –Colorectal and lung cancer –Opioid related ER visits and fatal overdoses

57. 57 Health Disparities –Asians: IMR; access to prenatal care; teen birth rate –Blacks: IMR; HIV/AIDS mortality rates; diabetes mortality; asthma –Latinos: IMR; teen birth rate; HIV/AIDS mortality rates; diabetes mortality; asthma; opioid-related ER visits –Refugees: high TB rates; increased lead poisoning among children

58. 58 Key health observations in Northeastern Massachusetts –Racial and ethnic disparities are major factors: Blacks, Latinos and Asians experience health disparities across several indicators –Overweight/obesity is an increasing health risk - contributes to rising diabetes incidence –Lowell, Lynn, and Malden have the highest number of refugee arrivals who need bilingual and bicultural access to care –We need to examine local variation and subgroups in the population to get a more complete picture of the health of the Northeast region

59. 59 How Can You Access these Data? Hard Copies: (617) 624-5674 Data Questions: (617) 624-5640 TDD/TTY: (617) 624-6001 DPH Website: mass.gov/dph/bhsre/resep/resep.htm For other questions or suggestions: Laura.Innis@state.ma.us, 617-624-6021 For more detailed community data: http://masschip.state.ma.us/

60. 60 Q/A