Massachusetts Department of Public Health June 26, 2007

1

Boston Regional Health Dialogue

Massachusetts Department of Public Health

June 26, 2007

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

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

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

Socio-Demographics Indicators and Health Care

Access

6

WesternRegion Central

Region

SoutheastRegion

Metro WestRegion

NortheastRegion

BostonRegion

Executive Office of Healthand Human Services Regions

Western Region

Central Region

North East Region

Metro West Region

South East Region

Boston Region

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. Boston 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

Largest:BOSTON558,435

REVERE45,551

BROOKLINE56,422

CHELSEA34,128

Smallest:WINTHROP

17,067

Population in Cities ofBoston Region: 2005

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

9

Race and Ethnic Breakdown of PopulationCities in Boston Region and Massachusetts: 2005

Racial Hispanic

Group

City of Boston

Brookline Chelsea Revere Winthrop Boston Region

MA Total

White* 49.9% 73% 35.9% 81.6% 93.9% 54.1% 81%

Black* 25% 4.2% 5.6% 2.5% 1.5% 20.4% 6%

Hispanic 16.4% 4.8% 53.3% 10.5% 3.1% 16.6% 7.9%

Asian* 8.4% 17.9% 5% 5.2% 1.3% 8.6% 4.9%

American Indian*

0.3% 0.1% 0.3% 0.2% 0.2% 0.3% 0.2%

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

* Non-Hispanics

10

Population by Age Group Cities in Boston Region and Massachusetts: 2005

Ages City of Boston


MA Total

0-19 years

24% 19% 30% 23% 21% 23% 26%

20-24 years

11% 10% 7% 5% 5% 10% 7%

25-44 years

35% 34% 35% 33% 34% 35% 29%

45-64 years

20% 25% 18% 23% 25% 20% 25%

65+ years

11% 12% 11% 16% 16% 11% 13%


11

Language Spoken at Home,Cities in Boston Region and Massachusetts: 2000


As % of all persons ages>5

City of Boston


MA Total

Only English 66.6% 71% 41.6% 71% 87.1% 66.6% 81.3%

Spanish or Spanish Creole

13.6% 3.6% 43.8% 9% 3.6% 13.7% 6.2%

Chinese 3.2% 5.7% 0.6% 0.6% 0.1% 3% 1.2%

French Creole 3.5% 0.4% 0.8% 0.3% 0.1% 2.8% 0.7%

Portuguese or Port. Creole

2.3% 0.7% 2.1% 2.4% 1.4% 2.1% 2.7%

Vietnamese 1.8% 0.1% 1.9% 1% 0% 1.6% 0.5%

Italian 1.2% 0.4% 1% 6.8% 3% 1.5% 1%

French (Incl. Patois, Cajun)

1.4% 1.4% 0.9% 0.6% 1% 1.3% 1.4%

Russian 1.1% 4.4% 0.1% 0.5% 0% 1.2% 0.6%

Mon Khmer, Cambodian

0.1% 0.3% 0.9% 2.5% 0.1% 0.3% 0.4%

Hebrew 0.1% 2.1% 0.1% 0% 0.2% 0.3% 0.1%

Serbo Croatian 0.1% 0.1% 2% 0.9% 0% 0.2% 0.1%

12


City of Boston


MA Total

Per Capita Income

$23,353 $44,327 $14,628 $19,698 $27,374 $24,413 $25,952

Those living below 100% poverty

19.5% 9.3% 23.3% 14.6% 5.5% 18.2% 9.3%

Less than a High School Education

21.1% 3.7% 40.5% 23.3% 10% 20.3% 15.2%

Speak language other than English at home

33.4% 29.0% 58.4% 29.1% 12.9% 21.9% 18.7%

Foreign born 25.8% 26.6% 36.1% 21% 8.7% 25.6% 12.2%

Unemployed 5.5% 3% 7.5% 6.3% 5.1% 5.4% 5.1%

Socio-Demographic IndicatorsCities in Boston Region and Massachusetts: 2000

13

Birth Indicators

14

5.1

7.0

9.4

5.8

10.2

4

5

6

7

8

9

10

11

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Infa

nt

De

ath

s p

er

10

00

Liv

e B

irth

s

MA Boston Region City of Boston

Infant Mortality Rate (IMR) Boston Region and Massachusetts: 1990-2005

MA

BostonRegion


Infant Mortality Rate: deaths of infants less than one year of age per 1000 live births

*

*

City of Boston

Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better

15

Infant Mortality Rates by EOHHS Region Massachusetts: 2003-2005

4.8 4.9

4.0**4.7

5.6 5.45.7

0

1

2

3

4

5

6

7

8

9

10

Western Central Northeast Metrowest Southeast BostonRegion

MA

Infa

nt

De

ath

s p

er

10

00

Liv

e B

irth

s


Infant Mortality Rate: deaths of infants less than one year of age per 1000 live births


16Infant Mortality Rates by Race/Ethnicity

Boston Region and Massachusetts: 2003-2005


11.2

3.24.1

11.6

7.06.2

2.13.0

0

2

4

6

8

10

12

14

Boston Region Massachusetts

Infa

nt

Dea

ths

per

100

0 L

ive

Bir

ths

White non-Hispanic Black non-HispanicHispanic Asian non-Hispanic

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

17

Teen Birth Rates by Cities in Boston Region & Massachusetts: 2003-2005

2230

44

29

73

0

25

50

75

100

City of Boston Chelsea Revere BostonRegion

MA

Bir

ths

pe

r 1

,00

0 w

om

en

ag

es

15

-19


*

Teen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19.


*

*

*

18

Public Source of Prenatal Care Payment byCities in Boston Region & Massachusetts: 2003-2005

30.7

44.8

23.9

5.8

66.1

46.2

52.1

0

10

20

30

40

50

60

70

City ofBoston

Brookline Chelsea Revere Winthrop BostonRegion

MA

Pe

rce

nt

(%)


Statistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than state

**

*

*

Public: Government programs including Commonhealth, Healthy Start, Medicaid/MassHealth, or free care

*

*

**

19

Leading Causes of Death

20

Leading Causes of DeathBoston Region and Massachusetts:2005


Massachusetts N=53,776

Heart Disease

13,248 24.6%

Cancer

13,159 24.5%

Stroke 2,979 5.5%

All Injuries 2,657 4.9%

Chronic Lower Respiratory Disease

2,643 4.9%

Influenza and Pneumonia 1,932 3.6%

Alzheimer's 1,635 3.0%

Nephritis 1,403 2.6%

Diabetes 1,271 2.4%

Septicemia

982 1.8%

Boston RegionN=5,394

Cancer 1,293 24.0%

Heart Disease 1,180

21.9%**

All Injuries 315 5.8%*

Stroke 292 5.4%

Chronic Lower Respiratory Disease 230 4.3%

Influenza and Pneumonia 212 3.9%

Nephritis 165 3.1%

Septicemia 140 2.6%*

Diabetes 139 2.6%

Alzheimer’s 107 2.0%

21

Chronic Disease Outcomes and Overweight/Obesity

22

Adults who are Overweight1 by EOHHS Region, Massachusetts:

1995 & 2005

57.8

49.5 45.7

43.5 44.6

50.2

35.7

45.1

52.0

57.560.8

55.952.6

56.1

0

10

20

30

40

50

60

70

Western Central Northeast MetroWest

Southeast BostonRegion

MA

Per

cen

t

1995 2005

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), Health Survey Program

1 Obesity: BMI greater than or equal to 25


23

Hospital Discharge Rates for Hypertension byCities in Boston Region & Massachusetts: 2003-2005

39

85

3438

77

96

45

0

50

100

150

City ofBoston


MA

Ho

sp

ita

liza

tio

ns

pe

r 1

00

,00

0


*

*

Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database

*

24Hospital Discharge Rate for Hypertension

by Race/EthnicityBoston Region & Massachusetts: 2003-2005

176

2838

207

11489

3345

0

50

100

150

200

250


Ho

sp

ita

liza

tio

ns

pe

r 1

00

,00

0

White non-Hispanic Black non-Hispanic

Hispanic Asian non-Hispanic


*

*


25

Prevalence of Diabetes Massachusetts: 1994-2005

3.8

5.6

6.46.25.8

5.6

5.8

4.9

4.3

4.7

3.8

0

1

2

3

4

5

6

7

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Per

cen

t

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), Health Survey Program

26

Diabetes Hospital Discharges byCities in Boston Region & Massachusetts: 2003-2005

132.5

208.1

118.4

77.4

194.6

230.2

188.6

0

100

200

300

City ofBoston


MA

Ho

sp

ita

liza

tio

ns

pe

r 1

00

,00

0


*

*


*

**

*

27

Diabetes Hospital Discharge Rate by Race/Ethnicity


368

114136

416

239 242

4554

0

50

100

150

200

250

300

350

400

450


Ho

spit

aliz

atio

ns

per

100

,000




*


*

28

Cancer

29

Prostate Cancer Incidence Rates byCities in Boston Region & Massachusetts: 1999-2003

181.9191.3

213.6200.0

129.3

198.9

143.0

0

50

100

150

200

250

City ofBoston


MA

Ne

w c

as

es

pe

r 1

00

,00

0

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program


*

****

30

Lung Cancer Mortality Rate byCities in Boston Region & Massachusetts: 2003-2005

52.956.0

85.4

32.1

65.9

55.6

66.6

0

10

20

30

40

50

60

70

80

90

City ofBoston


MA

De

ath

s p

er

10

0,0

00



**

Age-adjusted to the 2000 US standard population

*

*

31

Adults who Currently Smoke by EOHHS Region, Massachusetts: 2005

20.418.1

12.4

18.318.821.2

19.5

0

5

10

15

20

25

30

Western Central Northeast Metro West Southeast BostonRegion

MA

Per

cen

t

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Health Survey Program

**


32

Substance Abuse

33

Substance Abuse Treatmentsby EOHHS Region, Massachusetts: 2005

1,7241,601

871

1,379

2,044

1,393

3,035

0

500

1000

1500

2000

2500

3000

3500

Western Central Northeast MetroWest

Southeast BostonRegion

MA

Tre

atm

en

ts p

er

10

0,0

00

*

** **

**

*

*

Source: Massachusetts Department of Public Health. BSAS Substance Abuse Treatment Programs 2005.

Statistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than stateCrude rates

34Substance Abuse Treatments Alcohol Primary Substance by

Cities in Boston Region & Massachusetts: 2005

661

437

1216

486

220

451

1034

0

200

400

600

800

1000

1200

1400

City ofBoston


MA

Tre

atm

ents

per

100

,000


*

**

*

****

**

Crude ratesStatistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than state

35

609

1484

897

73

633

1713

1284

0

200

400

600

800

1000

1200

1400

1600

1800

City ofBoston


MA

Tre

atm

ents

per

100

,000


**

*

*

Substance Abuse Treatments Heroin Primary Substance by

Cities in Boston Region & Massachusetts: 2005

*

*

Crude ratesStatistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than state

36Opioid-related Emergency Visit Rates by Race/Ethnicity


188

348

187

275300

237

20 100

50

100

150

200

250

300

350

400


Vis

its

per

100

,000



*

*

*

*

Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Department Visits


37

Opioid-Related Fatal Overdoses byCities in Boston Region & Massachusetts: 2003-2005

8.1

20.4

22.6

10.5 10.8

0

5

10

15

20

25

City of Boston Chelsea Revere Boston Region MA

De

ath

s p

er

10

0,0

00



*


* *

*

38

Injury/Violence

39

2.6

8.6

7.3

1.9

0

2

4

6

8

10

City of Boston Region exc. City ofBoston

Boston Region MA

De

ath

s p

er

10

0,0

00



Age-adjusted to the 2000 US standard population

*

*

Homicides in Boston Regionand Massachusetts: 2003-2005

40

Homicide Rates by Race/EthnicityBoston Region and Massachusetts: 2003-2005

1

15

86

4

22

23

0

5

10

15

20

25

30


De

ath

s p

er

10

0,0

00




*

*


41Emergency Department Visit Rates for Firearm Injuries by Race/Ethnicity


38

1 2

46

1419

3

0

5

10

15

20

25

30

35

40

45

50


Vis

its

per

100

,000



**

Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Department Visits

NA


42

Firearm Death Rates by Race/EthnicityBoston Region and Massachusetts: 2003-2005

2 2

13

54

1

21

0

5

10

15

20

25


De

ath

s p

er

10

0,0

00




NA

*


43

Infectious Diseases

44

HIV Incidence byCities in Boston Region & Massachusetts : 2005

13

23 22

45

39

0

5

10

15

20

25

30

35

40

45

50

City of Boston Chelsea Revere Boston Region MA

Ne

w c

as

es

pe

r 1

00

,00

0

*

*


Source: MDPH, BCDC HIV/AIDS Files as of 09/01/06Crude rates

45

HIV/AIDS Death Rate by Race/EthnicityBoston Region and Massachusetts: 2003-2005

2

20

16

13

1

5

9

0

5

10

15

20

25


De

ath

s p

er

10

0,0

00

White non-Hispanic Black non-HispanicHispanic Asian non-Hispanic

NA

*



46

Tuberculosis Incidence by EOHHS Region Massachusetts: 2006

4.1

2.7

4.3

3.02.6

4.2

27.7

0

2

4

6

8

10

12


MA

New

cas

es p

er 1

00,0

00 p

op

ula

tio

n

*


Source: MDPH Bureau of Communicable Disease Control, ISIS

47

Asthma

48

Pediatric Asthma Prevalence Among School Children, Grades K-8

by EOHHS Region Massachusetts: 2005-2006

10.5 10.69.4

10.1

12.7

9.8

13.0

0

5

10

15

20


MA

Pe

rce

nt

Source: MDPH, Center for Environmental Health, Pediatric Asthma Surveillance (2005-2006)

**

** ****


49Asthma Emergency Visit Rates,Children Ages 0-14

by EOHHS Region, Massachusetts: 2005

808697

584594

995

811

1,771

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000


MA

Vis

its

pe

r10

0,0

00

Source: Division of Health Care Finance and Policy. Calendar Year 2005. Emergency Visits

** **

*

*

**


50

516

2,096

356

726454

1,557

3,130

1,573

1,799

659623310

0

500

1,000

1,500

2,000

2,500

3,000

3,500

City of Boston Boston Region, exc Cityof Boston

MA

Vis

its

per

100

,000



*

Source: Division of Health Care Finance and Policy. Calendar Year 2005. Emergency Department Visits

*

*

Asthma Emergency Visit Rates by Race/Ethnicity Children Ages 0-14


*

**

****


51

Source: Division of Health Care Finance and Policy. Calendar Year 2005. Hospital Discharges

BOSTON646.8

REVERE403.5

BROOKLINE359.8

WINTHROP593

CHELSEA208.8

Hospitalization Rates by Townsper 100,000

Significantly higher than state rate

Not different from state rate

Significantly lower than state rate

Massachusetts State Total: 337.5

Pediatric Asthma Hospitalization Rates by TownsAmong Children Ages <5

Boston Region - Massachusetts 2004-2005

52

Summary

Residents of large cities are disproportionately affected by, including the following:

Boston: Teen pregnancies, diagnosis of prostate cancer & HIV, hospitalizations for hypertension & diabetes, admissions for substance abuse treatment, emergency visits of children with asthma, deaths to diabetes, opioid- related fatal overdoses, firearm injuries, and homicides

Chelsea: Teen pregnancies, hospitalizations for hypertension and diabetes, deaths to diabetes and to opioid-related fatal overdoses

Revere: Teen pregnancies, hospitalizations for diabetes, admissions for substance abuse treatment, deaths to lung cancer and to opioid-related fatal overdoses

Winthrop: Deaths to lung cancer, admissions for heroin abuse treatment

53

Health Disparities

The following groups of the Boston region, when compared with those at the state level, have higher rates of:

Blacks: hospitalizations for hypertension & diabetes, homicides, deaths to firearm injuries and HIV

Whites: hospitalizations for hypertension & diabetes, homicides

Refugees: high TB rates; increased lead poisoning among children

54

How Can You Access these Data?

• Hard Copies: (617) 624-5674

• TDD/TTY: (617) 624-6001

• DPH Website:

mass.gov/dph/bhsre/resep/resep.htm

• For other questions or suggestions:

[email protected], 617-624-6021

• For more detailed community data:

http://masschip.state.ma.us/

55

Q/A

Massachusetts Department of Public Health June 26, 2007

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