1. Healthiest Wisconsin 2020 Baseline and Health Disparities Report American Indian Population
This chapter summarizes demographic and socioeconomic data for American Indians and Alaska Natives in Wisconsin and highlights health risk behaviors and outcomes where American Indians experience disparities compared to other racial and ethnic groups.
In the 2010 Census, “American Indian or Alaska Native” refers to a person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. The American Indian and Alaska Native population includes people who marked the “American Indian or Alaska Native” checkbox or reported entries such as Navajo, Blackfeet, Inupiat, Yup’ik, or Central American Indian groups or South American Indian groups. 1 Demographic data are for American Indians alone, not in combination with other groups.
There is significant diversity among American Indians in Wisconsin but because of relatively small numbers, health risk and outcome data cannot be broken down by tribal affiliation, geography, sex, or other characteristics.
In the data presented in this report, a person counted as Hispanic is not also counted by their race. Therefore, data in this chapter refer to non-Hispanic American Indians. The text for many of the figures in this chapter compares rates for American Indians to those of Whites.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

2. Chapter Outline Chapter outline Background
Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report
Key points
Data quality
Data
Demographic characteristics
Risk factors
Health outcomes
Protective factors
Youth outcomes
Mental health
References
Links to additional reports and resources
Contacts
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

3. Report Overview Report overview
This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the 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:
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

4. Report Format Full Report Chapters Format: PDF
Report overview
Report Format
Sample annotated slide
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
The report is available in two formats. The first, intended to serve as a reference document, is a PDF of annotated slides, as shown in this slide. The second is a series of slide sets, each of which is a chapter in the report. The purpose for providing slide sets is to foster sharing of the data in presentations to decision-makers, service providers, community leaders, and the public.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

5. Report Outline Executive Summary Section 1: Introduction
Report overview
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
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

6. Report Outline: Detail
Report overview
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
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

7. Report Outline: Detail
Report overview
Report Outline: Detail
Section 5: Data summaries by population
Racial/ethnic minority populations
American Indians
Asians
Blacks
Hispanics
People of lower socioeconomic status
People with disabilities
Lesbian, gay, bisexual, and transgender populations
Geography
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

8. Data notes Report overview
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.
Source: University of Wisconsin Population Health Institute. County Health Rankings 2013,
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

9. Factors that influence health
Report overview
Factors that influence health
Social determinants of health drive at least 50% of morbidity and mortality rates.2 Social determinants of health include socioeconomic status (SES), usually measured by income, employment, education, or housing. Groups with lower SES typically have significantly shorter life expectancy, higher rates of infant mortality, higher rates of chronic disease, and significantly lower self-rated health status.3
Health inequities are costly. The Joint Center for Political and Economic Studies estimates that the combined costs of health inequalities and premature death in the United States during were $1.24 trillion.4 Further, addressing social determinants of health is an essential component of several key principles of the Public Health Code of Ethics which frame the ethical practice of public health.5
Healthiest Wisconsin 2020, the State Health Plan, lists two crosscutting focus areas: 1) Health Disparities, and 2) Social, Economic and Educational Factors that Influence Health.6 These broad focus areas have the potential to affect both the health focus area and public health infrastructure components of the plan and help set priorities in order to achieve large, equitable changes in health outcomes while saving health care dollars in Wisconsin.
Social determinants of health
Source: University of Wisconsin Population Health Institute. County Health Rankings 2013,
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

10. Report overview
Historical trauma
Historical trauma is the cumulative exposure to traumatic events that not only affect the individual exposed, but continue to affect subsequent generations.
Descendants of those who experienced the traumatic stressor may still exhibit symptoms.
Populations affected by historical trauma include American Indians, African Americans/Blacks, Hispanics/Latinos, Asians, immigrants and refugees, war veterans, and families experiencing intergenerational poverty.
Current manifestations may include:
Mistrust of health care, legal, and educational systems;
Higher rates of risk behaviors such as alcohol and drug abuse, suicide, homicide, and domestic violence; and
Higher rates of chronic diseases.
Sources: SAMHSA, Fact Sheet: Historical Trauma
Texas Department of Health Services, Trauma Informed Care Training,
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

11. Summary
Key Points
American Indians in Wisconsin are younger than the general population and more likely to live in rural areas.
American Indians in Wisconsin are more likely to live in poverty, less likely to be in a married couple household, and less likely to have a college degree compared to Whites.
Key health issues for American Indian adults include: consequences from alcohol use, tobacco use and exposure, asthma, diabetes, intentional injury, premature death from coronary heart disease, and cancer.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

12. Summary
Key Points
Key health issues for American Indian youth include: obesity, motor vehicle crashes, school violence, and teen pregnancy.
Better data on American Indians are needed due to small sample size, racial misclassification, and data access issues.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

13. Data quality issues: American Indian population
Data issues
Data quality issues: American Indian population
Data on American Indians are limited due to five major issues:
Data access
Inconsistent measures used for race and ethnicity
Racial misclassification
Small population size
Other data quality considerations
Strategies to address these data issues include:
Working with the state vital statistics and disease registry programs to standardize data access, connection, reporting, and surveillance
Promoting primary data collection by individual tribes
Combining multiple years of data to increase sample size
Developing new guidelines on racial/ethnic classification in vital statistics records and disease registries
Oversampling and expanding the sampling timeframe
Standardizing racial classification using OMB directives
These suggestions were compiled by the Great Lakes Inter-Tribal Epidemiology Center in an unpublished report 7, based on findings from a federal report. 8
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

14. Demographic and socioeconomic data
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

15. Demographic Characteristics
Demographics and socioeconomic data
Demographic Characteristics
Wisconsin’s American Indian population is younger than the White population, more rural than other racial/ethnic groups, and increasing in numbers.
Wisconsin's American Indian population, 2010: 48,511; 0.9% of state total
Change in the American Indian population, 2000 to 2010: 13% increase
Median age, 2010: American Indian, 30 years (Whites, 41.5 years)
The median age is the age at which half the population is older and half is younger.
American Indians living in non-metropolitan counties: 41% (Whites, 33%)
Sources: and U.S. Census Bureau.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

16. Demographics and socioeconomic data
Wisconsin’s American Indian population has higher poverty rates and less education compared to Whites.
Median household income in Wisconsin, : American Indians, $35,000 (Whites, $53,000)
Poverty rate, 2010: American Indian, 29% (Whites, 10%)
The poverty rate is the percent living below the federal poverty level.
Bachelor’s degree or more education (age 25 and older), : American Indian, 11% (Whites, 27%)
Married-couple households as a percent of family households, : American Indian, 52% (other racial/ethnic groups range from Blacks, 33% to Whites, 82%)
Source: and U.S. Census Bureau.
Regarding family households, a family is a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family. A family household is a household maintained by a householder who is in a family, and includes any unrelated people who may be residing there (
The distribution of family households varied by race/ethnicity. In , about half of American Indian family households in Wisconsin were married-couple households, 35% were female-headed and 13% were male-headed.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

17. American Indian population by county, Wisconsin, 2010
Demographics and socioeconomic data
American Indian population by county, Wisconsin, 2010
There were 48,511 American Indians living in Wisconsin in 2010, 0.9% of the state’s population. Wisconsin’s American Indian population increased by 13% from 2000 to Nationally, there was an even larger increase (27%) in people identifying themselves as American Indians, either alone or in combination with another race.9
Menominee County had the highest proportion of American Indian residents—84%—since the Menominee Indian Reservation and the county share boundaries. American Indians constituted more than 9% of residents in several other counties in northern Wisconsin, although the largest numbers of American Indian residents live in Milwaukee and Brown counties.
Source: U.S. Census, 2010.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

18. American Indian Tribes in Wisconsin
Demographics and socioeconomic data
American Indian Tribes in Wisconsin
This map shows the locations of Wisconsin’s 11 American Indian Tribal Areas, including 6 bands of Lake Superior Chippewa (also referred to as Ojibwe).
Tribes are listed below with their headquarters cities.
Bad River Band of Lake Superior Chippewa, Odanah
Forest County Potawatomi, Crandon
Ho-Chunk Nation, Black River Falls
Lac Court Oreilles Band of Lake Superior Chippewa, Hayward
Lac du Flambeau Band of Lake Superior Chippewa, Lac du Flambeau
Menominee Indian Tribe, Keshena
Oneida Tribe of Indians, Oneida
Red Cliff Band of Lake Superior Chippewa, Bayfield
St. Croix Chippewa Indians, Hertel
Sokaogan Mole Lake Community, Crandon
Stockbridge Munsee Community, Bowler
Source: Great Lakes Inter-Tribal Council, Inc.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

19. Poverty rate by race/ethnicity, Wisconsin, 2010
Demographics and socioeconomic data
Poverty rate by race/ethnicity, Wisconsin, 2010
Total, 13%
The Census Bureau uses a set of income thresholds that vary by family size and composition to determine who is in poverty. If the household income for a family or unrelated individual falls below the relevant poverty threshold, then the family (and all its members) or unrelated individual is considered to be in poverty.10
In 2010, 13% of Wisconsin residents were living in poverty. Blacks had the highest rate (39%), followed by American Indians (29%). One in ten Whites was living in poverty in 2010.
Source: American Community Survey, 2010.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

20. Risk Factors in Youth and Adults
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

21. Physical health
Age-adjusted indicators of poor health status among Wisconsin adults by race/ethnicity,
BRFS respondents were asked to describe their health as one of the following: excellent; very good; good; fair; or poor. More than one in six (17%) American Indian adults in Wisconsin described their health as fair or poor, a rate that is significantly higher than among Whites (12%).
Forty-six percent of American Indian adults said their physical health was not good on at least one day during the past month, compared to 35% of White adults. Of these, nearly two-thirds reported that poor health limited usual activities on at least one day in the past month, a rate that does not differ significantly from that of White adults.
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset.
Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

22. Nutrition
Obesity among children (ages 2-4 years) enrolled in WIC, by race/ethnicity, Wisconsin, 2001 and 2010
Childhood obesity disproportionately affects low-income and minority children. Children who are obese in their preschool years are more likely to be obese in adolescence and adulthood and to develop chronic diseases, such as diabetes, hypertension, hyperlipidemia, asthma, and sleep apnea.11
In 2010, 14% of children (ages 2-4 years) enrolled in WIC were obese (data not shown). American Indian children enrolled in WIC had a significantly higher rate of obesity than any other population group. More than one in four (27%) low-income American Indian children ages 2-4 was obese.
From 2001 to 2010, the rate of obesity among low-income children in this age group increased significantly for every racial and ethnic group except Asians. American Indians experienced the greatest increase in early childhood obesity (47%), followed by Blacks (35%), Whites (16%), and Hispanics (14%) (percent change not shown).
Source: Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance Survey 2010.
Note: Based on >= 95th growth chart percentiles for Body Mass Index for age. WIC is the Supplemental Nutrition Program for Women, Infants, and Children.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

23. Nutrition
Age-adjusted rates of overweight and obesity among Wisconsin adults by race/ethnicity,
The Wisconsin Behavioral Risk Factor Survey (BRFS) is an annual telephone survey of state residents ages 18 and older carried out by the Wisconsin Department of Health Services in conjunction with the Centers for Disease Control and Prevention (CDC). Estimates for the total adult population and by sex and age use a combined landline and cellphone sampling design from years Estimates by race/ethnicity, income, education, geography, disability status, and sexual orientation are from the landline-only sample population from years For more information, refer to the Technical Notes chapter.
In , approximately 70% of American Indians were either overweight or obese and 38% were obese, rates significantly higher than among Whites.
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset.
Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

24. Alcohol and other drugs
Rates of early initiation of alcohol and marijuana use among Wisconsin high school students, by race/ethnicity,
The Youth Risk Behavior Survey (YRBS) is a biennial survey administered by the Wisconsin Department of Public Instruction in conjunction with the Centers for Disease Control and Prevention (CDC) as part of a national effort to monitor health risk and protective behaviors of high school students.
Early initiation of alcohol and other drug use is defined as any use before the age of 13. Youth who start drinking before age 15 are five times more likely to develop alcohol dependence later in life compared to people who start drinking at or after age Recent studies suggest that early initiation of marijuana use may result in a decline in cognitive ability, due to long-lasting changes during brain development.13
Nearly one in four American Indian students in Wisconsin started drinking alcohol before age 13, a rate not significantly different from that of White students. Early initiation of marijuana use was significantly higher among American Indian students than among White students.
Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

25. Alcohol and other drugs
Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by race/ethnicity,
Binge drinking rates were significantly higher among American Indian and White adults than among Black adults. More than one-quarter of American Indians were binge drinkers in the previous month.
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset.
Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

26. Injury and violence
Motor vehicle risk behaviors among Wisconsin high school students, by race/ethnicity,
The Youth Risk Behavior Survey (YRBS) is a biennial survey administered by the Wisconsin Department of Public Instruction in conjunction with the Centers for Disease Control and Prevention (CDC) as part of a national effort to monitor health risk and protective behaviors of high school students.
Motor vehicle crashes are the leading cause of death among U.S. adolescents. Compared to other age groups, teens have the lowest rates of seat belt use and a greater risk of being involved in a motor vehicle crash at all levels of blood alcohol concentration (BAC).14
In , students were asked whether in the past month they rode with someone who had been drinking alcohol and whether they drove after drinking alcohol. More than one in three American Indian high school students reported riding with a driver who had been drinking. One in five reported driving after drinking. Differences in motor vehicle risk behaviors did not differ significantly between American Indians and Whites; however, findings should be interpreted with caution because the sample size for American Indian students is relatively small.
Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

27. Injury and violence
Exposure to school violence among Wisconsin high school students, by race/ethnicity,
School violence includes bullying, fighting, electronic aggression, and gang violence; and can occur on school property, on the way to or from school, during a school-sponsored event, or traveling to or from a school-sponsored event. Violence may result in physical and emotional harm, can disrupt the learning process, and have a negative effect on students, the school itself, and the broader community.15,16
American Indian students were significantly more likely to report having been in a fight at school during the past year than were White students.
Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.
Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

28. Reproductive and sexual health
Estimated prevalence of sexual risk behaviors among Wisconsin high school students by race/ethnicity,
Many adolescents engage in sexual risk behaviors that can result in unintended health outcomes, such as pregnancy and sexually transmitted diseases.17
The prevalence of sexual risk behaviors did not differ significantly between American Indian and White students.
Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.
Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

29. Mental Health
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

30. Mental health
Protective factors among Wisconsin high school students, by race/ethnicity,
Protective factors are individual or environmental characteristics, conditions, or behaviors that reduce the effects of stressful life events; increase a person’s ability to avoid risks or hazards; and promote social and emotional competence to thrive in all aspects of life in the present and in the future. School connectedness is a promising protective factor, defined as the belief by students that adults and peers in the school care about their learning as well as about them as individuals. Youth who feel connected to their school are less likely to engage in risk behaviors such as alcohol and other drug use, tobacco use, early sexual initiation, and violence. Additionally, students who feel connected to their school are more likely to succeed academically. Family support is also an important protective factor that promotes health and well-being.18
American Indian students were significantly less likely to receive A’s and B’s and to strongly agree that they are loved and supported by family, compared to White students. Differences between American Indian and White students in agreeing that teachers care and that the students belongs at school were not significant.
Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS).
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

31. Mental health
Depression among Wisconsin high school students, by race/ethnicity,
The Youth Risk Behavior Survey (YRBS) asks students if they ever felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities.
One in three American Indian students reported this depressive symptom, a rate that did not differ significantly from that of White students.
In Wisconsin, Hispanic youth are the only racial/ethnic group to show a significant decline from 2001 to 2011 in the percent that felt sad or hopeless for at least two weeks (data not shown).19
According to the federal Office of Adolescent Health, approximately one out of five adolescents in the United States has a diagnosable mental health disorder, and one in four adolescents shows at least mild symptoms of depression. Mental health disorders can disrupt school performance, harm relationships, and lead to suicide.20 Additionally, depressed youth are at a higher risk for poor health outcomes as adults.21 Persistent sadness and hopelessness are symptoms of, and possible predictors of, clinical depression.
Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS).
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

32. Mental health
Suicide risk during past 12 months among Wisconsin high school students, by race/ethnicity,
Nationally, suicide is the third leading cause of death among adolescents after accidents (unintentional injury) and homicide.22 Suicidal behavior is not only associated with a range of mental health problems such as depression, anxiety, eating disorders, substance abuse, and behavior disorders, but may also be associated with physical health problems as well.23
In Wisconsin, American Indian students were the most likely to report suicidal ideation and behavior, while White and Hispanic youth were the least likely. An estimated one out of four American Indian students and one out of five Asian students considered suicide, proportions that were significantly higher than among White students. Black and American Indian students were significantly more likely to plan and to attempt suicide compared to White students.
Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS).
Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

33. Mental health
Suicide deaths, age-adjusted rate per 100,000, by race/ethnicity, Wisconsin,
During , the suicide rate among American Indians and Whites was significantly higher than among Hispanics and Blacks.
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates..
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

34. Health Outcomes
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

35. Chronic diseases
Percentage of coronary heart disease deaths under the age of 75, by race/ethnicity and sex, Wisconsin,
Despite the overall decline in coronary heart disease mortality in Wisconsin, disparities by race/ethnicity have persisted, particularly for premature deaths — those that occur before age 75.
In , the percentage of CHD deaths that occurred before age 75 was much lower among Whites — both male and female — than among Blacks, Hispanics, Asians, and American Indians. In other words, deaths from CHD were much more likely to be premature among Black, Hispanic, Asian, and American Indian populations in Wisconsin. The majority of White males who died from CHD were 75 years or older, while the majority of Black, Hispanic, Asian, and American Indian males who died from CHD were younger than 75. These differences may be attributed to disparities in the prevalence of cardiovascular risk factors among population groups at early ages, such as diabetes, poor nutrition, lack of physical activity, tobacco use, and obesity.24 Additionally, the prevalence of having multiple risk factors, resulting in an increased risk of disease, is associated with lower levels of income and education.25,26
In 2006, disparities in premature CHD death were greater in Wisconsin than in the U.S. as a whole. White males and females in Wisconsin were significantly less likely to die of CHD between the ages of 45 and 74 than were White males and females nationwide.24,27 Numbers of deaths for the American Indian population were too small to report percentages.
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

36. Chronic diseases
Percentage of stroke deaths under the age of 75, by race/ethnicity and sex, Wisconsin,
As with coronary heart disease, similar disparities were observed for premature stroke deaths in Wisconsin during Among people who died from stroke, American Indian males and females were significantly more likely than White males and females to die before the age of 75.
Nationally, American Indians and Blacks have higher rates of stroke compared to other racial/ethnic groups.28
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

37. Chronic diseases
Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by race/ethnicity, 2009 and 2011
In 2009 and 2011, rates of high cholesterol in American Indian adults did not differ significantly from those of White adults. However, a significantly higher proportion of American Indians than Whites had been diagnosed with high blood pressure.
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset.
Note: Questions only asked in 2009 and 2011.Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

38. Chronic diseases
Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by race/ethnicity,
In , approximately one in six American Indian adults was diagnosed with diabetes, a significantly higher proportion than among Whites.
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. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

39. Chronic diseases
Cancer incidence and mortality (all sites) by race/ethnicity, age-adjusted rate per 100,000, Wisconsin, 2010
In 2010, the highest cancer incidence and mortality rates in Wisconsin occurred among Blacks and American Indians. Compared to Whites, Blacks had significantly higher incidence and mortality rates, while rates among Hispanics and Asians were significantly lower. Differences in incidence may be influenced by socioeconomic, demographic, and behavioral factors; access to services; and rates of screening.29 Late detection and post-diagnosis factors, such as access to effective treatment and adherence to treatment, may contribute to the disparities in mortality.30,31
While overall cancer incidence and mortality rates have declined over the past decade in Wisconsin, disparities have persisted. From 2000 to 2010, the disparity in cancer incidence increased between Whites and non-Whites. During this time, the incidence rate declined among Whites, but increased among Blacks, Hispanics, Asians, and American Indians. The cancer mortality rate declined for both Whites and Blacks, but increased among Hispanics, Asians, and American Indians (data not shown).
The National Cancer Institute identifies low socioeconomic status (SES) and lack of health care coverage as the most important factors contributing to cancer disparities among racial and ethnic groups.32
Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services; and National Center for Health Statistics, Wisconsin mortality file , Vital Statistics Cooperative Program, 2013.
Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

40. Chronic diseases
Lung and bronchus cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States,
Lung cancer is the leading cause of cancer death and second most diagnosed cancer in both men and women in the United States.33
Compared to national lung cancer mortality rates, Wisconsin mortality rates were significantly higher (more than double) for American Indians. American Indians in Wisconsin were also more than twice as likely as their national counterparts to be diagnosed with lung cancer (data not shown).
Smoking accounts for nearly 80% of lung cancer deaths and at least 30% of all cancer deaths.34 Several factors may contribute to the disparities in lung cancer mortality among different racial/ethnic populations, including smoking prevalence, differing metabolism of tobacco smoke products, susceptibility to tobacco-induced lung cancer, receipt of timely and appropriate treatment, and socioeconomic status.35,36 Radon is a naturally occurring gas; exposure to radon is the second leading cause of lung cancer.
Nationally, there are considerable geographic differences in lung cancer incidence and mortality among American Indians. During , Northern Plains Indians (including Wisconsin) experienced the highest rate of lung cancer incidence among the Indian Health Service (IHS) regions, as well as high rates of commercial tobacco use.37
Sources: Source: National Center for Health Statistics. Wisconsin mortality data file , Vital Statistics Cooperative Program, 2013.
Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

41. Chronic diseases
Female breast cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States,
Breast cancer is the most common cancer and the second leading cause of cancer-related death among women in United States, following lung and bronchus cancer.30 Although breast cancer can occur in both males and females, it is rare among males.
During , the breast cancer mortality rate of American Indian women in Wisconsin did not differ significantly from that of White, Black, or Asian women in the state but was significantly higher than the national rate for American Indian women.
Breast cancer care begins with regular screening, continuing with timely follow-up and appropriate treatment; disparities exist at each phase of this continuum of care.30 The National Cancer Institute identifies lack of health care coverage, barriers to detection and screening, and unequal access to improvements in cancer treatment as contributors to the differing trends in breast cancer incidence and mortality among women.32
From 1999 to 2004, Northern Plains Indians (including Wisconsin) had the second highest incidence rate of female breast cancer among the Indian Health Service (IHS) regions, following Alaska.38
Sources: Source: National Center for Health Statistics. Wisconsin mortality data file , Vital Statistics Cooperative Program, 2013.
Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

42. Chronic diseases
Cervical cancer incidence by race/ethnicity, age-adjusted rate per 100,000, Wisconsin,
Cervical cancer is a slow-growing cancer that forms in the tissues of the cervix, the lower part of the uterus that connects to the vagina. Cervical cancer can be prevented or detected early with regular Pap tests. Pap tests check for precancers, or cell changes, on the cervix that may become cervical cancer if they are not treated. Cervical cancer is almost always caused by human papillomavirus (HPV) infection and can be prevented with HPV vaccination in youth.39,40
During , American Indian women had significantly higher cervical cancer incidence rates compared to White women; numbers of deaths were too small to reliably report mortality rates. Disparities in cervical cancer incidence are largely attributed to a lack of screening and unequal access to care.32 The HPV vaccine is becoming more widely available, potentially reducing cervical cancer incidence and related disparities.32
Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Wisconsin Department of Health Services.
Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

43. Chronic diseases
Prostate cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States,
Prostate cancer is the most common cancer among men and is the second leading cause of cancer-related death among men, following lung and bronchus cancer.33
During , the prostate cancer mortality rate among American Indian men in Wisconsin did not differ from that of White men in Wisconsin or American Indian men nationwide. The rate for this population should be interpreted with caution because of small numbers. Prostate cancer incidence rates were significantly higher for American Indians in Wisconsin than American Indians nationwide (131 and 77 per 100,000, respectively; data not shown).
Prostate cancer is rarely seen among men younger than 40 and is the most common cause of death from cancer among men over The National Cancer Institute suggests that genetic factors might contribute to the high rates of prostate cancer among Black men. Additionally, barriers to screening and early detection of the disease, such as low socioeconomic status, lack of health care coverage, and unequal access to health care services and primary care providers may contribute to the disproportionate differences in prostate cancer mortality.29
Source: National Center for Health Statistics, Wisconsin mortality file , Vital Statistics Cooperative Program, 2013.
Note: Rate not displayed when based on fewer than 10 cases. In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

44. Chronic diseases
Alcoholic liver disease deaths by race/ethnicity, age-adjusted rate per 100,000, Wisconsin,
In Wisconsin in 2010, at least 1,732 people died (3% of all deaths), 3,511 were injured, and 67,345 were arrested as a direct result of alcohol use and misuse.
Alcoholic liver disease is defined as damage to the liver and its function due to alcohol abuse, and accounted for approximately 17% of alcohol-related deaths in Wisconsin in Alcohol consumption may result in liver inflammation and swelling (hepatitis), which, over time, can lead to irreversible scarring of the liver and poor liver function (cirrhosis). Cirrhosis is the final phase of alcoholic liver disease.42
In Wisconsin, the overall death rate due to alcoholic liver disease has increased by 28% since 2001 (data not shown). During , Whites had the greatest number of deaths (721); followed by American Indians (35); Blacks (34); and Hispanics (21). American Indians had the highest age-adjusted death rate from alcoholic liver disease (24.4 per 100,000).
These disparities mirror those at the national level. During , the national age-adjusted mortality rate per 100,000 from alcoholic liver disease was 21.6 among American Indians, followed by Hispanics (6.7), Whites (4.6), Blacks (3.1), and Asians (1.1).43
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.
Note: WISH suppresses small numbers (when cell size is less than 5) to comply with Wisconsin vital records data privacy guidelines; this means a rate may not be presented for every population group.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

45. Injury and violence
Unintentional injury deaths (leading causes) by race/ethnicity, age-adjusted rates per 100,000, Wisconsin,
During , American Indians had the highest age-adjusted death rate from all causes of unintentional injury in Wisconsin, a rate significantly higher than that of any other racial/ethnic group (67 per 100,000; data not shown).44
American Indians were more than twice as likely to be killed in a motor vehicle crash than people in any other racial/ethnic group in Wisconsin, and were also more likely than Whites to die from unintentional poisoning.
Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.
Note: WISH suppresses small numbers (when cell size is less than 5) to comply with Wisconsin vital records data privacy guidelines.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

46. Reproductive and sexual health
Births to teens ages as a percent of all births, by race/ethnicity, Wisconsin,
Percent of all births
According to the Centers for Disease Control and Prevention (CDC), childbearing by teenagers is a matter of public concern because of the elevated health risks for teen mothers and their infants, as well as significant public costs.45
In Wisconsin, the percentage of births to teens declined in all racial/ethnic groups from 2000 to Births to teens continue to make up a considerable proportion of births in some groups. In 2010, 16% of births to American Indian women were to teen mothers ages In 2009, Milwaukee’s percentage of births to teens (16%) was the sixth highest of the nation’s 49 largest metropolitan areas.46
The teen birth rate is the rate of births to teens ages per 1,000 females in this age group. From 2000 to 2010, there was a significant decline in the teen birth rate in Wisconsin for each racial and ethnic group except American Indians (data not shown). The overall rate decline was 26%, from 35 per 1,000 in 2000 to 26 per 1,000 in The teen birth rate fluctuated among American Indians. In 2010, American Indians and Blacks had the highest teen birth rates, with no significant difference between the two populations (78 and 72 per 1,000, respectively). Both rates were more than four times higher than the White teen birth rate (17 per 1,000).
Source:  Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics:  Births to Teens in Wisconsin, 2010.  January 2012.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

47. Communicable diseases
Confirmed cases of invasive Streptocococcus pneumoniae and group B streptococcal (GBS) disease, rate per 100,000, by race/ethnicity, Wisconsin,
During , Blacks and American Indians in Wisconsin were more than twice as likely to be infected with invasive Streptococcus pneumoniae than were Whites. Certain populations are at increased risk for invasive pneumococcal disease. These include people over 65 years of age; cigarette smokers; people with chronic heart, pulmonary, liver, or renal disease; and the immunocompromised.47 Risk is increased among children with HIV or functional or anatomic asplenia, especially sickle cell disease; children who attend child care; children with cochlear implants; as well as among Black and American Indian children.47
Blacks and American Indians in Wisconsin were also more likely to be infected with group B streptococcal (GBS) disease than were Whites during Disparities in GBS infection may be attributed to differences in maternal transmission to newborns; higher prevalence of medical conditions that lead to weakened immune systems, such as HIV infection, diabetes, cancer, or liver disease; and differences in the proportion of elderly populations residing in nursing homes.48,49
Definitions for the infections described here are provided in the Technical Notes.
Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System.
Note: Data were not available for Hispanics.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

48. References References
2010 Census Briefs: The American Indian and Alaska Native Population:
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 Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
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
Great Lakes Inter-Tribal Epidemiology Center, Data Challenges and Strategies, 2012, unpublished.
U.S. Department of Health and Human Services, Gaps and Strategies for Improving AI/AN/NA Data,
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

49. References
American Community Survey. S_10_3YR_S0201&prodType=table
American Community Survey Glossary. .htm
Centers for Disease Control and Prevention (CDC). Obesity Prevalence Among Low- Income, Preschool-Aged Children - United States,
CDC. Fact sheets - Underage drinking. sheets/underage-drinking.htm
National Institute on Drug Abuse. Drug Facts: Marijuana.
CDC. Teen Drivers: Fact Sheet.
CDC. Understanding School Violence.
CDC. About School Violence. ml
CDC. Sexual Risk Behavior: HIV, STD and Teen Pregnancy Prevention.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

50. References
CDC. School Connectedness: Strategies for Increasing Protective Factors Among Youth.
CDC. Youth Risk Behavior Surveillance System.
Office of Adolescent Health. Mental Health. health-topics/mental-health/home.html
Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. Journal of Adolescent Health.
CDC. Mortality Among Teenagers Aged Years: United States,
National Institute of Mental Health. Many Teens Considering Suicide Do Not Receive Specialized Mental Health Care news/2012/many-teens-considering-suicide-do-not-receive-specialized-mental- health-care.shtml
CDC. Health Inequalities Report,
CDC. Disparities in Premature Mortality Between High- and Low-Income U.S. Counties.
CDC. Racial/Ethnic and Socioeconomic Disparities in Multiple Risk Factors for Heart Disease and Stroke --- United States,
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

51. References
DHS. Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Accessed August
CDC. Stroke Facts.
Siegel R, et al. CA: A Cancer Journal for Clinicians: Cancer Statistics,
CDC. Vital Signs: Racial Disparities in Breast Cancer Severity — United States, 2005–
Journal of the National Cancer Institute. Racial and Ethnic Disparities in the Receipt of Cancer Treatment.
National Cancer Institute. Fact Sheet: Cancer Health Disparities.
United States Cancer Statistics Incidence and Mortality Web-based Report.
CDC. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses - United States, 2000—
CDC. Racial/Ethnic Disparities and Geographic Differences in Lung Cancer Incidence States and the District of Columbia,
American College of Chest Physicians. Racial Disparities in Lung Cancer.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

52. References
Bliss A, et al. Lung Cancer Incidence Among American Indians and Alaska Natives in the United States, 1999–
Wingo PA, et al. Breast Cancer Incidence Among American Indian and Alaska Native Women: U.S., 1999–
Jemal A, et al. The National Cancer Institute. Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in Human Papillomavirus (HPV)–associated cancers and HPV.
CDC. Cervical Cancer.
PubMed Health. Prostate cancer.
National Institutes of Medicine, Medline Plus. Alcoholic Liver Disease.
CDC. CDC WONDER.
DHS. Wisconsin Interactive Statistics on Health: Injury-related Mortality Module.
CDC. Birth Rates for the United States: Teenagers Reach Historic Lows for All Age and Ethnic Groups.
National Center for Health Statistics. Child Trends analysis of Natality microdata files from Centers for Disease Control and Prevention. &ind=4&dtm=252&tf=38
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

53. References
CDC. The Pink Book: Pneumococcal disease.
The Mayo Clinic. Group B strep disease. strep/DS01107/DSECTION=risk-factors
CDC. Perinatal Group B Streptococcal Disease After Universal Screening Recommendations—United States, 2003—
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

54. Links to additional reports and resources
Great Lakes Inter-Tribal Council Epidemiology Center:
United States National Library of Medicine: American Indian Health:
Indian Health Services(IHS):
Wisconsin Tribal Health Centers (DHS website listing):
Centers for Disease Control and Prevention (CDC). American Indian & Alaska Native Populations:
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

55. Contacts
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
Healthiest Wisconsin 2020 Baseline and Health Disparities Report