Wisconsin Department of Health Services January 2014 P-00522V Healthiest Wisconsin 2020 Baseline and...

Wisconsin Department of Health ServicesJanuary 2014 P-00522V

Healthiest Wisconsin 2020 Baseline and Health Disparities Report

People with Disabilities

PEOPLE WITH DISABILITIES

Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities

Report • Context• Key points

Data• Demographic and socioeconomic data• Access to and use of health care services• Risk behaviors and health outcomes

References

Links to additional reports and resources

Contacts

Chapter Outline

Chapter outline

2


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: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf

• 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: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

Report overview

3

http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf

http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf



Report Format

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

Sample annotated slide

Report overview

4


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

Report overview

5


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

Report overview

6


Report Outline: Detail

Section 5: Data summaries by population

Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics

People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography

Report overview

7


Data notes

• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

• 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.

Report overview

8



Factors that influence health

Social determinants

of health

Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

Report overview

9


People with disabilities: context

Summary

10

• Healthiest Wisconsin 2020 focuses on the elimination of health disparities. For the first time, people with disabilities are included in the plan as a population that experiences significant disparities in health and health care access.

• People with disabilities can be healthy and well; however, many face social, structural and environmental barriers that restrict participation in daily activities and/or access to care.

• Gaining a better understanding of these barriers can assist public health, health care providers, and the public in reducing health disparities for people with disabilities.


Key Points: Adults with disabilities

• One in six (16%) adults ages 18-64 and 28% of adults ages 65 and older in Wisconsin are living with a disability.

• Compared to people without a disability, adults with a disability are more likely to: – Be low-income.– Have less access to health care. – Report higher health risk factors such as tobacco use, secondhand

smoke exposure, obesity, and obesity-related chronic conditions.

• The presence of a chronic condition, such as diabetes or asthma, may be the reason some people report having a disability.

Key points

11


Source: National Survey of Children’s Health, 2011/2012.

Key Points: Children and youth with special health care needs (CYSHCN)

• About 22% of Wisconsin children have a special health care need.

• Compared to children and youth without a special health care need, CYSHCN: – Have more unmet medical/dental needs and more difficulty

getting specialty care, despite being more likely to have a medical home and to receive preventive care.

– Have two or more adverse childhood experiences (ACEs).– Have lower school attendance and engagement.

• Parents of CYSHCN are:– More likely than other parents to be stressed and to have their

work life affected by childcare issues.

12

Key points


Adults living with a disability

13


Demographic characteristics

14


Percent of adults with disabilities by age group, Wisconsin, 2009-2011

Sources: American Community Survey, 2009-2011; Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 landline-cellphone combined dataset.

Demographic and socioeconomic data

15

All Adults Ages 18-64 Ages 65+0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

12% 9% 32%26% 22% 35%

American Community Survey

Behavioral Risk Factor Survey


Percent of Wisconsin adults ages 18-64 with disabilities, by race/ethnicity, 2008-2011

Series10%

5%

10%

15%

20%

25%

30%

35%

40%

21% 28% 20% 24%

WhiteBlackHispanicAmerican Indian

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 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.

16



Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.17


Percent of Wisconsin adults ages 18-64 with disabilities, by income level, 2008-2011

Series10%

10%

20%

30%

40%

50%

60%

70%

44% 20% 13%

Low income (<$20,000)

Middle income ($20,000-$74,999)

High income ($75,000+)


Access to health care and health status

18


Use of and barriers to health care among Wisconsin adults ages 18-64, by disability status, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.

Access to health care

Did not have a doctor's visit in past year

Do not have a personal doctor Unable to obtain medical care due to cost

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

38% 19% 10%31% 11% 24%

No disability

Disability

19


Rates of fair or poor health by disability status, Wisconsin adults ages 18-64, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only datasetNote: Health status questions only asked 2009-2011.

Health status

Fair or poor health0%

10%

20%

30%

40%

50%

60%

6%

40%

No disability

Disability

20


Health risk factors and outcomes

21


Rate of physical inactivity among Wisconsin adults, by disability status, 2008-2011

Physical activity


Did not participate in any physical activity in past month, other than at job0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

19% 36%

No disabilityDisability

22


Rates of overweight and obesity by disability status, Wisconsin adults ages 18-64, 2008-2011

Nutrition


Overweight or Obese Obese0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

61% 25%74% 43%

No disabilityDisability

23


Rates of diabetes by disability status, Wisconsin adults ages 18-64, 2008-2011

Chronic diseases

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Prediabetes question was only asked in years 2009-2011. 24

Ever been diagnosed with diabetes Ever been told you have prediabetes0%

5%

10%

15%

20%

25%

4% 4%14% 10%

No disability

Disability


Rates of high cholesterol and blood pressure by disability status, Wisconsin adults ages 18-64, 2009 and 2011


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

48% 39%

No disability

Disability

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Chronic diseases


Rates of binge drinking and heavy drinking by disability status, Wisconsin adults ages 18-64, 2008-2011

Alcohol and other drug use

Binge drinking Heavy drinking0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

28% 9%19% 8%

No disability

Disability

26Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.


Rate of Adverse Childhood Experiences (ACEs) by disability status, Wisconsin adults ages 18-64, 2010-2011

Mental health


Four or more ACEs0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

29%

No disability Disability


Rates of insufficient sleep and emotional support by disability status, Wisconsin adults ages 18-64, 2008-2010

Mental health

Insufficient sleep Sometimes, rarely, or never receive emotional support0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

20% 14%34% 30%

No disability

Disability



Rates of tooth removal and dental visits in the past year, by disability status, Wisconsin adults ages 18-64, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Tooth removal question asked in 2008, 2010, and 2011. Dentist visit question asked in 2008 and 2010.

Had at least 1 permanent tooth removed Did not visit dentist within past year0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

29% 26%52% 35%

No disability

Disability

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Oral health


Smoking status among Wisconsin adults ages 18-64, by disability status, 2008-2011

Tobacco use and exposure


Note: Menthol question was asked in 2009 and 2010; smokeless tobacco question was asked in 2009-2011.

Current smoker0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

21% 35%

No disability

Disability

30


Secondhand smoke exposure among Wisconsin adults ages 18-64, by disability status, 2009-2011



Note: Smoking at work question was only asked in 2009 and 2010.

Smoking allowed at home Exposed to others' smoke at home

Smoking permitted at work0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

21% 13% 13%33% 23% 11%

No disability

Disability

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HIV testing and risk behaviors among Wisconsin adults ages 18-64, by disability status, 2008-2011

Reproductive and sexual health


Ever been tested for HIV Ever been in any HIV high risk situations0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

31%3%

42% 5%

No disability

Disability

32


Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by disability status, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

Immunization among older adults

Flu vaccination in past 12 months Ever received pneumonia vaccination0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

65% 68%70% 78%

No disability

Disability

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Children and Youth with Special Health Care Needs (CYSHCN)

34


Percentage of children with special health care needs, Wisconsin and the United States, 2011-2012

Children with special health care needs0%

5%

10%

15%

20%

25%

30%

35%

40%

22% 20%

WisconsinUnited States

Source: National Survey of Children’s Health, 2011-2012

Demographics

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Percentage of children with special health care needs, by age, Wisconsin, 2011-2012

Source: National Survey of Children’s Health, 2011-2012.

Series1

-10%

0%

10%

20%

30%

40%

50%

60%

11% 27% 26%

0-5 years

6-11 years

12-17 years

Demographics

36


Percentage of children with oral health needs, by disability status, Wisconsin, 2011-2012

Fair or poor teeth One or more oral health problems0%

5%

10%

15%

20%

25%

30%

35%

40%

4% 14%9% 19%

Children with no special health care needs

Children with special health care needs

Oral health

37Source: National Survey of Children’s Health, 2011-2012


Percentage of children ages 10-17, who are obese, by disability status, Wisconsin, 2011-2012

Obese0%

5%

10%

15%

20%

25%

30%

35%

40%

12% 18%



Nutrition



Percentage of children ages 6-17 who missed school because of illness or injury, by disability status, Wisconsin, 2011-2012

Missed 11 or more days of school in past month because of illness or injury0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

3% 11%



Missed school



Percentage of children with parents who report usually or always feeling stressed from parenting and parents who have had to cut back hours or quit a job because of child care issues

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Mental health


Parents usually/always stressed from parenting

Parent's work life affected by child-care issues-10%

0%

10%

20%

30%

40%

50%

60%

5%

10%20% 35%




Percentage of children ages 6-17 covered by public health insurance and whose health insurance (public and/or private) was inadequate, by disability status, Wisconsin, 2011-2012

Public insurance Current insurance not adequate0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

32% 23%43% 30%






Percentage of children who saw health care providers for preventive medical and dental care during the past 12 months, Wisconsin, 2011-2012

Received both routine preventive medical and dental care visits during the pas...0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

66% 77%



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Percentage of children who have a medical home and percentage of children who have problems getting specialist care, by disability status, Wisconsin, 2011-2012

Children who receive coordinated, ongoing, com-prehensive care within a medical home

Children who needed or received specialist care and who had some problem getting specialist care

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

68%3%

61% 10%



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Percentage of children who live with someone who uses tobacco and are exposed to secondhand smoke at home, by disability status, Wisconsin, 2011-2012


44

Household member uses tobacco 0%

5%

10%

15%

20%

25%

30%

35%

40%

19% 24%





Percentage of children who had two or more adverse childhood experiences (ACEs), by disability status, Wisconsin, 2011-2012

Experienced 2 or more adverse childhood experiences

-10%

0%

10%

20%

30%

40%

50%

60%

19% 35%



Mental health



References

1. University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach

2. Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf

3. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

4. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/

5. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

6. Where in health is disability? Public health practices to include people with disabilities, 2012: http://www.cdc.gov/about/grand-rounds/archives/2012/December2012.htm

7. 2011-2012 National Survey of Children’s Health, Sampling and Survey Administration, Child and Adolescent Health Measurement Initiative (2012): http://www.childhealthdata.org/docs/drc/2011-12-nsch-sampling-and-administration.pdf

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References

http://www.countyhealthrankings.org/our-approach

http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf

http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/

http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

http://www.cdc.gov/about/grand-rounds/archives/2012/December2012.htm



http://www.childhealthdata.org/docs/drc/2011-12-nsch-sampling-and-administration.pdf

http://www.childhealthdata.org/docs/drc/2011-12-nsch-sampling-and-administration.pdf


8. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans Midcourse Report: Strategies to Increase Physical Activity Among Youth: http://www.health.gov/paguidelines/midcourse/pag-mid-course-report-final.pdf

9. CDC. Overweight and obesity among people with disabilities. http://www.cdc.gov/ncbddd/disabilityandhealth/documents/obesityfactsheet2010.pdf

10. CDC. Alcohol Use and Health. http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm

11. CDC. Adverse Childhood Experience Study. http://www.cdc.gov/ace

12. CDC. Insufficient sleep is a public health epidemic. http://www.cdc.gov/features/dssleep

13. CDC. Health-related quality of life: Well-being concepts. http://www.cdc.gov/hrqol/wellbeing.htm#four

14. CDC. Smoking and Tobacco Use: Secondhand Smoke Facts. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm

15. Health Resources and Services Administration (HRSA). 2009/10 NS-CSHCN: Health Conditions and Functional Difficulties. Data Resource Center: http://www.childhealthdata.org/docs/cshcn/2009-cshcn-conds-func-diff.pdf

16. HRSA. Fast Facts: 2011/12 National Survey of Children’s Health. http://childhealthdata.org/learn/NSCH

47

References

http://www.health.gov/paguidelines/midcourse/pag-mid-course-report-final.pdf



http://www.cdc.gov/ncbddd/disabilityandhealth/documents/obesityfactsheet2010.pdf



http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm

http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm

http://www.cdc.gov/ace

http://www.cdc.gov/ace

http://www.cdc.gov/features/dssleep



http://www.cdc.gov/hrqol/wellbeing.htm



http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm



http://www.childhealthdata.org/docs/cshcn/2009-cshcn-conds-func-diff.pdf

http://childhealthdata.org/learn/NSCH

http://childhealthdata.org/learn/NSCH


17. Child and Adolescent Health Measurement Initiative (2002). Approaches to Identifying Children and Adults with Special Health Care Needs. http://cahmi.org/ViewDocument.aspx?DocumentID=120

18. HRSA. Children with Special Health Care Needs in Context: A Portrait of States and the Nation 2007. http://mchb.hrsa.gov/nsch/07cshcn/moreinfo/pdf/cshcn11covintrotot.pdf

19. Felitti, et al., (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine - May 1998 (Vol. 14, Issue 4, Pages 245-258).

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References

http://cahmi.org/ViewDocument.aspx?DocumentID=120

http://mchb.hrsa.gov/nsch/07cshcn/moreinfo/pdf/cshcn11covintrotot.pdf

http://mchb.hrsa.gov/nsch/07cshcn/moreinfo/pdf/cshcn11covintrotot.pdf


Links to additional reports and resources

Wisconsin Department of Health Services (DHS):• Disabilities and Impairments, http://www.dhs.wisconsin.gov/disabilities/• Children and Youth with Special Health Care Needs Program,

http://www.dhs.wisconsin.gov/health/children/

Centers for Disease Control and Prevention (CDC)• Disability and Health Data System, http://dhds.cdc.gov/• National Survey of Children with Special Health Care Needs, http://

www.cdc.gov/nchs/slaits/cshcn.htm• Families with Special Needs, http://www.cdc.gov/family/specialneeds/

University of Wisconsin-Madison, Waisman Center

http://www.waisman.wisc.edu/about.htm

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References

http://www.dhs.wisconsin.gov/disabilities/





http://dhds.cdc.gov/

http://dhds.cdc.gov/

http://www.cdc.gov/nchs/slaits/cshcn.htm

http://www.cdc.gov/nchs/slaits/cshcn.htm

http://www.cdc.gov/family/specialneeds/






ContactsBureau of Community Health Promotion

Division of Public Health

Department of Health Services

Sharon Fleischfresser, MD, MPH

Medical Director

Children and Youth with Special Health Care Needs Program

Email: [email protected]

Elizabeth Oftedahl, MPH

CYSHCN Epidemiologist

Maternal and Child Health Program

Family Health Section


Jessica Seay, MPH

State Systems Development Initiative Coordinator

Maternal and Child Health Program

Family Health Section


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Contacts

mailto:[email protected]



Wisconsin Department of Health Services January 2014 P-00522V Healthiest Wisconsin 2020 Baseline and...

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