Data on Cardiovascular Disease, Hawaii By Kathleen Kromer Baker, Ph.D. Research Statistician Hawai`i...

Data on Cardiovascular Data on Cardiovascular Disease, Hawaii Disease, Hawaii

By Kathleen Kromer Baker, Ph.D.By Kathleen Kromer Baker, Ph.D.

Research StatisticianResearch Statistician

Hawai`i Department of HealthHawai`i Department of Health

Office of Health Status MonitoringOffice of Health Status Monitoring

Alvin T. Onaka, Chief and State RegistrarAlvin T. Onaka, Chief and State Registrar

Brian Horiuchi, Supervisor, Statistics and Brian Horiuchi, Supervisor, Statistics and SurveysSurveys

Courtesy of : Ronald Balajadia, Immunization Branch Chief, DOH

http://health.hawaii.gov/vitalstatistics/http://health.hawaii.gov/vitalstatistics/

Causes of Death 2009, Hawaii Causes of Death 2009, Hawaii By OrderBy Order

11.. Diseases of the HeartDiseases of the Heart 2301 2301

2.2. Malignant NeoplasmsMalignant Neoplasms 2190 2190

3.3. Cerebrovascular DiseaseCerebrovascular Disease654 654

Rate Per 100,000 Resident PopulationRate Per 100,000 Resident Population

55

Mortality Cardiovascular Mortality Cardiovascular DiseaseDisease

Hawaii State Department of Health. Hawaii’s Plan for the Prevention of Heart Disease and Stroke 2011-2016. Honolulu, HI: Hawaii State Department of Health, Heart Disease and Stroke Prevention Program; 2011.

66

Diseases of the Heart Mortality, Diseases of the Heart Mortality, HawaiiHawaii


77

Stroke Mortality, HawaiiStroke Mortality, Hawaii


88

Cardiovascular Disease and Cardiovascular Disease and EthnicityEthnicity

““Native Hawaiians and Filipinos of both genders Native Hawaiians and Filipinos of both genders

have higher CHD mortality rates than Whites and have higher CHD mortality rates than Whites and

Japanese.” Japanese.”

““Native Hawaiians and Filipinos have higher stroke Native Hawaiians and Filipinos have higher stroke

mortality rates than Whites and Japanese. Filipino mortality rates than Whites and Japanese. Filipino

females have a stroke mortality rate more than females have a stroke mortality rate more than

double that of Whites or Japanese.”double that of Whites or Japanese.”


99

The Effects of Climate Change The Effects of Climate Change on Cardiac Healthon Cardiac Health

““Changing temperature is the most valid model output of climate Changing temperature is the most valid model output of climate

change, so any important effects on health that are related to change, so any important effects on health that are related to

ambient temperature can be analyzed with some certainty. Other ambient temperature can be analyzed with some certainty. Other

expected climate change features, such as more violent and expected climate change features, such as more violent and

extreme weather events, the rise in sea level and the lack of extreme weather events, the rise in sea level and the lack of

water and food in large areas are also of importance to population water and food in large areas are also of importance to population

health, health, but are not as much related to cardiac but are not as much related to cardiac

health as the increasing heathealth as the increasing heat. This paper will focus on . This paper will focus on

the effects of increasing ambient heat on cardiac health.”the effects of increasing ambient heat on cardiac health.”

2015. De Blois, Kjellstrom, Agewall, Ezekowitz, Armstrong, and Atar. The Effects of Climate Change on Cardiac Health. Cardiology 2015;131:209–217.

1010

OutlineOutline

Sources of DataSources of Data

– EnvironmentalEnvironmental

– Health, CVDHealth, CVD

Baseline dataBaseline data

Identify and Locate Vulnerable PopulationsIdentify and Locate Vulnerable Populations

Identify Modifying Risk Markers and Risk Identify Modifying Risk Markers and Risk

FactorsFactors

Comparison of Environmental and Health Comparison of Environmental and Health

VariablesVariables

Climate Change, Hawaii – Climate Change, Hawaii – VariablesVariables

Finucane, M. L., Marra, J. J., Keener, V. W., & Smith, M. H. (2012). Pacific Islands Finucane, M. L., Marra, J. J., Keener, V. W., & Smith, M. H. (2012). Pacific Islands Region Overview. In V. W. Keener, J. J. Marra, M. L. Finucane, D. Spooner, & M. H. Region Overview. In V. W. Keener, J. J. Marra, M. L. Finucane, D. Spooner, & M. H. Smith (Eds.), Climate Change and Pacific Islands: Indicators and Impacts. Report for Smith (Eds.), Climate Change and Pacific Islands: Indicators and Impacts. Report for the 2012 Pacific Islands Regional Climate Assessment (PIRCA). Washington, DC: the 2012 Pacific Islands Regional Climate Assessment (PIRCA). Washington, DC: Island Press.Island Press.

Surface air temperature is rising. Air temperature has

increased throughout the region. In Hawai‘i, average

temperatures for all stations increased by 0.08°F per

decade over the period 1919 to 2006.

1212


1313

Increasing TemperatureIncreasing Temperature

For 2035, B1 values range from 0.56° to 1.11°C (For 2035, B1 values range from 0.56° to 1.11°C (1° to 1° to 2°F2°F), and A2 values range from 0.83° to 1.11°C (), and A2 values range from 0.83° to 1.11°C (1.5° to 1.5° to 2°F2°F) higher than values for 1971–2000. ) higher than values for 1971–2000.

For 2055, B1 values range from 0.83° to 1.39°C (For 2055, B1 values range from 0.83° to 1.39°C (1.5° to 1.5° to 2.5°F2.5°F), and A2 values range from 1.67° to 1.94°C (), and A2 values range from 1.67° to 1.94°C (3° to 3° to 3.5°F3.5°F) higher. ) higher.

Increases by 2085 are larger still, ranging from 1.39° to Increases by 2085 are larger still, ranging from 1.39° to 1.67°C (1.67°C (2.5° to 3°F2.5° to 3°F) for B1 and from 2.5° to 2.78°C () for B1 and from 2.5° to 2.78°C (4.5° 4.5° to 5°Fto 5°F) for A2 higher than 1971–2000 values. ) for A2 higher than 1971–2000 values.


1414

The Effects of Climate Change The Effects of Climate Change on Cardiac Healthon Cardiac Health

““In Taiwan, with a relatively hot summer season, In Taiwan, with a relatively hot summer season, a right-a right-

shifted, U-shaped relation between outdoor shifted, U-shaped relation between outdoor

temperature and mortality from coronary artery temperature and mortality from coronary artery

disease has been describeddisease has been described, with a rightward shift of the , with a rightward shift of the

lowest mortality temperature range (26–29 ° C) compared to lowest mortality temperature range (26–29 ° C) compared to

that of countries with colder climates.” that of countries with colder climates.”

(78.8-84.2(78.8-84.2 ° ° F) F)


1515

OutlineOutline






Identify Modifying risk markers and factorsIdentify Modifying risk markers and factors


VariablesVariables

Climate Change, Hawaii – Climate Change, Hawaii – VariablesVariables

Risk factor Risk factor – associated with an increased – associated with an increased

risk of disease not necessarily causal.risk of disease not necessarily causal.

Risk marker Risk marker – – associated with an associated with an

increased prevalence of disease not increased prevalence of disease not

causal. No manipulation of the marker is causal. No manipulation of the marker is

associated with altered outcomes and is associated with altered outcomes and is

not associated with disease progression.not associated with disease progression.

1717

Discussion Points – Sources of Discussion Points – Sources of DataData


– MorbidityMorbidity

– MortalityMortality

– HospitalHospital

– InsuranceInsurance

– Health ProfessionalsHealth Professionals

1818

Data SourcesData Sources

CDC – Surveys, NHIS, NHANES etc.

American Community Survey

Vital Records

Hawaii Surveys

Hawaii Health Survey

Behavioral Risk Factor Surveillance Survey

Others

Data Warehouse – repository of data

Hospital Records – Hawaii Health Information Corporation

Insurance Records

DOH, OHSM, HHSDOH, OHSM, HHS 1919

Survey Data for Hawaii’s Population

Hawaii Health Survey (HHS) – unique to

Hawaii - survey of Hawaii’s households,

adults, and children

Behavioral Risk Factor Surveillance Survey

– Adults (BRFSS) – All 50 States – survey of

adults (children’s asthma)

2020

Hawaii Health Survey (HHS)Hawaii Health Survey (HHS)

Originally modeled after the National Originally modeled after the National

Health Interview Survey as a ‘Face to Health Interview Survey as a ‘Face to

Face’ SurveyFace’ Survey

First conducted in 1968 and a telephone First conducted in 1968 and a telephone

survey since 1996survey since 1996

Include cell phones in 2010Include cell phones in 2010

2121

Cardiovascular Variables Chronic Health Conditions and Comorbidities

heart, stroke, diabetes, high blood pressure, high blood

cholesterol, lung, asthma, arthritis

Risk factors – high blood pressure, high blood cholesterol,

diabetes, smoker (risk behavior)

Risk markers (demographics, socio-economics, social

determinants) – year, gender, age, island, ZCTA, detailed

ethnicity variables, income/poverty, insurance status, marital

status, education, insurance, own/rent home, etc.

SF12 Mental and Physical Health Scores Respondent (Adults) -

Summary mental and physical health scores on a scale from

0-100

DOH, OHSM, HHSDOH, OHSM, HHS 2222

Variable Definitions Variables Available with the Hawai‘i Health Survey

QUESTIONS (for adult respondent): Has anyone in the household been told by a physician or medical professional that they have ___heart disease____?

What are the names (initials) of those household members?

2323

OutlineOutline






Identify Modifying Risk Markers and Risk Identify Modifying Risk Markers and Risk

FactorsFactors


VariablesVariables

Hawaii Health Survey Data, Morbidity Hawaii Health Survey Data, Morbidity CVDCVD

2424

Health Variable

2009-2012 Four Year Average

Number of Adults

% 95% CL% Age

Adjusted*

95% CL

Heart Disease 54,417

5.2 (4.8 - 5.6) 4.6 (4.2 - 4.9)

Stroke 22,469 2.2 (1.9 - 2.4) 1.9 (1.7 - 2.1)High Blood Cholesterol

259,907 24.8(23.9 -

25.8)22.6

(21.7 - 23.4)

High Blood Pressure 250,597 23.9(23.1 -

24.9)21.7

(20.9 - 22.6)

Diabetes 99,513 9.5 (8.9 - 10.1) 8.6 (8.1 - 9.2)

Obese 215,510

20.6(19.6 -

21.6)20.8

(19.7 - 21.8)

Sample size - 2009-2012- 20,469 adults; Population size - 1,051,362

*Age Adjusted, Census 2000

2525

Health Variable

2009-2012 Four Year Average2001-2004 Four Year

Average

Number of Adults

% Age Adjuste

d*95% CL

Number of Adults

% Age Adjuste

d*95% CL

Heart Disease 54,417

4.6 (4.2 - 4.9) not collected

Stroke 22,469

1.9 (1.7 - 2.1) not collected

High Blood Cholesterol

259,907

22.6(21.7 -

23.4) 200,539

20.7(19.7 -

21.6)High Blood Pressure

250,597

21.7(20.9 -

22.6) 199,597

20.6(19.7 -

21.7)

Diabetes 99,513

8.6 (8.1 - 9.2) 68,132

7.0(6.5 -

7.7)

Obese 215,510

20.8(19.7 -

21.8) 172,846

18.8(17.6 -

20)Sample size - 2009-2012- 20,469 adults; Population size - 1,051,362 Sample Size - 2001-2004 - 22,758 adults; Population size - 917,041*Age Adjusted, Census 2000

Hawaii Health Survey Data, Morbidity Hawaii Health Survey Data, Morbidity CVDCVD

2626

OutlineOutline








VariablesVariables

““Identify resources to support more timely and accurate Identify resources to support more timely and accurate statewide reporting and surveillance of health that can statewide reporting and surveillance of health that can prioritize needs and evaluate the effectiveness of prioritize needs and evaluate the effectiveness of interventions.”interventions.”

““Identify Identify resilience characteristicsresilience characteristics. . Use statistical Use statistical approaches to determine vulnerable subgroupsapproaches to determine vulnerable subgroups (i.e., by race/ethnic group, age, education level, income) (i.e., by race/ethnic group, age, education level, income) for regions or counties.”for regions or counties.”

2013. Preparing California for Extreme Heat. Guidance and Recommendations. :Developed by the Heat Adaptation Workgroup, a subcommittee of the Public Health Workgroup, California Climate Action Team (CAT). www.climatechange.ca.gov/.../Preparing_California_for_Extreme_Heat.pdf

Preparing California for Extreme Preparing California for Extreme HeatHeat

2828

Heart Disease Heart Disease Multivariate Regression, HHSMultivariate Regression, HHS

Heart Disease Hawaii Health Survey 2009-2012 Average

ContrastDegrees of Freedom

Wald FP-value Wald

F

Overall Model 30 164.56 <0.001

Model Minus Intercept 29 16.56 <0.001

Intercept . . .Gender 1 41.42 <0.001Age 3 72.69 <0.001Ethnicity 7 2.78 0.007Poverty 2 8.24 <0.001Marital Status 2 0.52 0.593Educational Status 2 0.7 0.499Hospital Service Area

12 2.51 0.003

SUDAAN Logistic Regression, Heart Disease Outcome Variable

2929

Heart Disease, Outcome Variable, Multivariate Logistic Regression

Hawaii Health Survey 2009-2012 Average


Wald FP-value Wald F

Overall Model 31 97.09 <0.001Model Minus Intercept 30 21.45 <0.001Intercept . . .Gender 1 26.35 <0.001Age 3 43.27 <0.001Ethnicity 7 4.86 <0.001Poverty 2 8.10 <0.001Hospital Service Area

12 2.33 0.006

High Blood Pressure

1 92.81 <0.001

High Blood Cholesterol

1 55.86 <0.001

Diabetes 1 22.57 <0.001Obese 1 2.67 0.1023Smoker 1 4.73 0.030

SUDAAN Logistic Regression, Heart Disease Outcome Variable

Heart Disease Heart Disease Multivariate Regression, HHSMultivariate Regression, HHS

Courtesy of : Ronald Balajadia, Immunization Branch Chief, DOH

Courtesy of : Ronald Balajadia, Immunization Branch Chief, DOHCourtesy of : Ronald Balajadia, Immunization Branch Chief, DOH

3232

StrokeStroke Multivariate Regression, HHS Multivariate Regression, HHS

Stroke Disease

Hawaii Health Survey 2009-2012 Average



Overall Model 30 227.02 <0.001

Model Minus Intercept 29 12.84 <0.001

Intercept . . .

Gender 1 0.85 0.356

Age 3 30.91 <0.001

Ethnicity 7 0.55 0.793

Poverty 2 9.45 <0.001

Marital Status 2 0.12 0.883

Educational Status 2 0.83 0.434

Hospital Service Area 12 1.12 0.335SUDAAN Logistic Regression, Stroke Disease Outcome Variable

3333

StrokeStroke Multivariate Regression, HHS Multivariate Regression, HHS

Stroke Disease Hawaii Health Survey 2009-2012 Average



Overall Model 31 204.32 <0.001Model Minus Intercept 30 26.37 <0.001Intercept . . .Gender 1 0.50 0.482Age 3 18.22 <0.001Ethnicity 7 1.66 0.113Poverty 2 5.48 0.004Hospital Service Area 12 0.73 0.722High Blood Pressure 1 50.12 <0.001High Blood Cholesterol

1 7.69 0.006

Diabetes 1 7.01 0.008Obese 1 1.37 0.242Smoker 1 4.41 0.036

SUDAAN Logistic Regression, Stroke Disease Outcome Variable

3434

Other Risk Factors, BRFSS HawaiiOther Risk Factors, BRFSS Hawaii

3535

OutlineOutline








VariablesVariables

GIS Based ComparisonsGIS Based Comparisons

““Nearly all climate research conducted in Nearly all climate research conducted in California is going to be place-based .”California is going to be place-based .”

““In the past, local and regional climate change research In the past, local and regional climate change research issues have been addressed using two methods. The issues have been addressed using two methods. The first method relies on statewide studies with enough first method relies on statewide studies with enough geographical resolution adequate to inform local and geographical resolution adequate to inform local and regional actors. For example, a statewide study looking regional actors. For example, a statewide study looking at potential changes in electricity demand under at potential changes in electricity demand under different climate scenarios estimated changes in different climate scenarios estimated changes in demand demand at at the ZIP code level the ZIP code level (Auffhammer and (Auffhammer and Aroonruengsawat 2012a).”Aroonruengsawat 2012a).”

““The second approach involves the production of local or The second approach involves the production of local or regional studies “regional studies “

2015. Climate Change Research Plan for California. California Environmental Protection Agency.www.climatechange.ca.gov/climate.../CAT_research_plan_2015.pdf

3737

CDC and GIS MapsNational Maps About Heart Disease and Stroke

(http://www.cdc.gov/dhdsp/maps/national_maps/index.htm)National maps showing deaths and hospitalizations related to heart disease and stroke are available by ethnic group. Each map contains a link to view a larger version in PDF format.

Data Trends and Maps(http://www.cdc.gov/dhdsp/ncvdss/index.htm)To meet national- and state-level needs for cardiovascular disease data, CDC developed a National Cardiovascular Disease Surveillance System. The system gathers data from many sources to share the public health burden of heart disease, stroke, and their risk factors.

Chronic Disease GIS Exchange(http://www.cdc.gov/dhdsp/maps/gisx/index.html)CDC’s Chronic Disease GIS Exchange has a community forum for policy makers, program managers, public health analysts, and map makers to share and explore maps that make an impact, to find geographic information systems (GIS) training, and to access a wide range of GIS resources.

http://www.cdc.gov/dhdsp/maps/gisx/index.html

GIS Maps and Association With Temperature

heart, stoke

CDC - Interactive Atlas of Heart and Stroke Prevention

Heart Disease Death Rate per 100,000, 35+, All Race, All Gender, 2011-2013

3838

Race or Ethnicity Heart Disease Death Rate per 100,000State National

All Race 261.5 332.7Black (Non-Hispanic) 205.6 421.3White (Non-Hispanic) 277.9 337.5Hispanic 355.1 238.8American Indian and Alaskan Native

Insufficient Data 302.9

Asian and Pacific Islander

254.9 182.9

US Dept. of Human Services. CDC-INFO http://nccd.cdc.gov/DHDSPAtlas/Reports.aspx

http://www.hawaii.gov/health/statistics/hhs/http://www.hawaii.gov/health/statistics/hhs/

Mortality from major cardiovascular diseases (International

Classification of Diseases, Tenth Revision (ICD-10) I00-I78)

includes deaths from

1.Diseases of heart (ICD-10 codes I00-I09, I11, I13, I20-

I51);

2.Essential hypertension and hypertensive renal disease (I10,

I12, I15) and

3.Cerebrovascular diseases (I60-169)

Mortality ICD-10 Codes Underlying Mortality ICD-10 Codes Underlying Cause of Death, Brian Horiuchi, OHSMCause of Death, Brian Horiuchi, OHSM

Comparison of Prevalence

of Heart Disease (morbidity

age ≥65 years) to Heart

Disease Mortality, Years

2009-2012Morbidity

Mortality

4646

Acknowledgements for Acknowledgements for TemperatureTemperature

Giambelluca, T.W., X. Shuai, M.L. Barnes, R.J. Alliss, R.J.

Longman, T. Miura, Q. Chen, A.G. Frazier, R.G. Mudd, L.

Cuo, and A.D. Businger. 2014. Evapotranspiration of

Hawai‘i. Final report submitted to the U.S. Army Corps of

Engineers—Honolulu District, and the Commission on

Water Resource Management, State of Hawai‘i.

4747

http://evapotranspiration.geography.hawaii.edu/assets/files/MapImages/AirTemp_MeanAnn.jpg

4848

Geographical ConsiderationsGeographical Considerations

““The impact of climate conditions, in particular ambient temperature, The impact of climate conditions, in particular ambient temperature,

both now and in the future, will vary according to both now and in the future, will vary according to local local

vulnerabilitiesvulnerabilities, geographical and sociopolitical situations and the , geographical and sociopolitical situations and the

promotion of protective measures.promotion of protective measures.

Elderly people Elderly people workers carrying out heavy physical labour in non-workers carrying out heavy physical labour in non-

cooled environments and people with pre-existing medical conditions – cooled environments and people with pre-existing medical conditions –

such as such as cardiovascular (CV) disease and heart failure (HF) cardiovascular (CV) disease and heart failure (HF) – are – are

expected to be particularly vulnerable to increasing temperatures.“expected to be particularly vulnerable to increasing temperatures.“Further information suggested website: www.ClimateCHIP.org. Further information suggested website: www.ClimateCHIP.org.


Balabis, A. Pobutsky, K. Kromer Baker, C. Tottori, F. Balabis, A. Pobutsky, K. Kromer Baker, C. Tottori, F.

Salvail. Salvail. The Burden of Cardiovascular Disease in The Burden of Cardiovascular Disease in

Hawaii 2007. Hawaii 2007. Hawaii State Department of Health.Hawaii State Department of Health.

Hawaii State Department of Health. Hawaii State Department of Health. Hawaii’s Plan Hawaii’s Plan

for the Prevention of Heart Disease and Stroke for the Prevention of Heart Disease and Stroke

2011-2016.2011-2016. Honolulu, HI: Hawaii State Honolulu, HI: Hawaii State

Department of Health, Heart Disease and Stroke Department of Health, Heart Disease and Stroke

Prevention Program; 2011. Prevention Program; 2011.

Stroke RegistryStroke Registry

2015 HB 589 (Act 211) Relating to Stroke Care 2015 HB 589 (Act 211) Relating to Stroke Care – establishes a – establishes a

state stroke data registrystate stroke data registry and requires hospitals to report and requires hospitals to report

stroke patient data. Through this registry, the state’s acute stroke patient data. Through this registry, the state’s acute

stroke hospitals will collect a uniform data set based on their stroke hospitals will collect a uniform data set based on their

stroke patients and will submit the date to the State Department stroke patients and will submit the date to the State Department

of Health. The data will help identify weaknesses in the state’s of Health. The data will help identify weaknesses in the state’s

stroke care system and work to improve the system’s response stroke care system and work to improve the system’s response

to and quality care of stroke patients.to and quality care of stroke patients.

http://governor.hawaii.gov/newsroom/news-release-governor-ige-signs-bills-supporting-health-initiatives-establishing-disaster-recovery-program/

5151

SURVEY QUESTIONS ON CHRONIC DISEASE AND SURVEY QUESTIONS ON CHRONIC DISEASE AND BEHAVIORSBEHAVIORS

EXAMPLE: DOH DIABETES EDUCATIONEXAMPLE: DOH DIABETES EDUCATION

Right now, I am able to keep my blood sugar Right now, I am able to keep my blood sugar under control. under control.

Right now, I am able to keep my weight under Right now, I am able to keep my weight under control. control.

I am able to handle my diet, exercise, and I am able to handle my diet, exercise, and medications without much trouble.medications without much trouble.

I don't have any trouble handling my feelings I don't have any trouble handling my feelings about my diabetes (like fear, worry, anger, about my diabetes (like fear, worry, anger, etc.). etc.).

5252

Discussion Points – Increasing Discussion Points – Increasing TemperatureTemperature

ComplexComplex

– Urban higher affect of heatUrban higher affect of heat

– Air ConditioningAir Conditioning

– Aging of PopulationAging of Population

– Increasing risk factorsIncreasing risk factors

High Blood Cholesterol and High Blood PressureHigh Blood Cholesterol and High Blood Pressure

DiabetesDiabetes

ObesityObesity

– Increasing PovertyIncreasing Poverty

– Mental StressMental Stress

5353

Discussion Points –DataDiscussion Points –Data

Need Need UPDATED CONTINUOUS BASELINE UPDATED CONTINUOUS BASELINE

DATADATA

– Sources of DataSources of Data

– Agreement of MeasuresAgreement of Measures

– Agreement of Comparisons to Agreement of Comparisons to

Environmental VariablesEnvironmental Variables

5454

Discussion Points – Additional Discussion Points – Additional Questions or Variables Not Yet Questions or Variables Not Yet MeasuredMeasured

Identify Modifying risk factorsIdentify Modifying risk factors

Questions – What should we be asking? Questions – What should we be asking?

More mental health questions.More mental health questions.

Data – More data sources?Data – More data sources?

5555

Hawaii’s Plan for the Prevention of Hawaii’s Plan for the Prevention of Heart Disease and Stroke 2011-2016Heart Disease and Stroke 2011-2016

Surveillance, Monitoring and Evaluation Surveillance, Monitoring and Evaluation Priority 1: Enhance the scientific capacity to Priority 1: Enhance the scientific capacity to define the burden of heart disease, stroke and define the burden of heart disease, stroke and related risk factors. related risk factors. Strategies: …..Strategies: …..• “• “Support the addition of questions on a statewide Support the addition of questions on a statewide surveillance survey (Hawai‘i Health Survey). surveillance survey (Hawai‘i Health Survey). • • Support the addition of modules to the annual Support the addition of modules to the annual Hawai‘i Behavioral Risk Factor Surveillance Survey Hawai‘i Behavioral Risk Factor Surveillance Survey (BRFSS).”(BRFSS).”


Data on Cardiovascular Disease, Hawaii By Kathleen Kromer Baker, Ph.D. Research Statistician Hawai`i...

Documents

Transcript of Data on Cardiovascular Disease, Hawaii By Kathleen Kromer Baker, Ph.D. Research Statistician Hawai`i...