Bernalillo County Health Assessment

Transcription

Prepared by the
Bernalillo County
Collective Impact for Neighborhood and County Health (CINCH)
Team
This health assessment was supported by Cooperative Agreement Number 1-U58DP003595-01.
The findings and conclusions in this report are those of the authors and do not necessarily
represent the official position of the Centers for Disease Control and Prevention.
ii
Contents
Acknowledgments.......................................................... iv
Chapter 1: Introduction .................................................. 1
Chapter 2: Chronic Disease Disparities in Bernalillo Co .. 4
Chapter 3: Tobacco-Free Living....................................... 9
Chapter 4: Healthy Eating and Active Living ................. 18
Chapter 5: High-Impact Clinical Preventive Services .... 25
Chapter 6: Conclusions ................................................. 34
References .................................................................... 35
iii
Acknowledgments
The CINCH staff gratefully acknowledges the
support and commitment of the CINCH
Leadership Team, Policy Advisory Team, and
Data Advisory Team. The insight and
guidance provided by our management was
invaluable, as was the support of our CDC
project officer, David Guthrie. Special thanks
to Andrew Gingerich, Will Athas, Tom
Scharmen, David Broudy, Gerald Montoya,
Srikanth Paladugu, and Samuel Swift.
iv
CHAPTER 1: INTRODUCTION
This report compiles the most
current available data related to
chronic disease and social
determinants of health for
Bernalillo County, New Mexico. The
Bernalillo County Office of
Environmental Health received a
Community Transformation Grant
(CTG) from the Centers for Disease
Control and Prevention (CDC) in
September 2011 to initiate a
capacity-building project. The purpose of the “Collective Impact for Neighborhood and
County Health” (CINCH) project is to create healthier communities by building capacity
to implement broad evidence- and practice-based policy, environmental, programmatic,
and infrastructure changes in order to prevent heart disease, stroke, cancer and other
leading causes of death or disability due to chronic disease. As a foundation for
development of a Community Transformation Implementation Plan in Program Year 2,
specific capacity-building activities have been undertaken in the first year, including this
assessment. Other activities included development of a policy scan, community
engagement with populations experiencing disparities, establishment of a training
academy, and creation of a multi-sectoral coalition. This report summarizes existing
community health data specific to population subgroups experiencing disparities in
chronic disease morbidity and mortality.
The CINCH Project
”Collective impact” refers to the process of effecting social change through coordination
and collaboration by change agents from multiple sectors.1 The CINCH project employs
a collective impact approach to addressing chronic disease, and focuses on
neighborhoods and sub-populations with the greatest health disparities.
All CTG awardees are required to address at least three of the following key strategic
directions: (1) tobacco-free living; (2) active living and healthy eating; (3) increased use
of high-impact quality clinical and other preventive services; (4) social and emotional
wellness; and (5) healthy and safe physical environments. One of the required activities
of the CINCH project is to collect indicator data on chronic diseases and chronic
conditions, including cancer, obesity/overweight, diabetes, stroke, and heart disease.
A key aim of the CINCH project is to improve long-term chronic disease outcomes
through policy change using CDC-recommended and evidence-based policy
interventions. Measurable outcomes of the program must align with Healthy People
2020,2 and with the following performance goals (long term objectives) from the
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP):3
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1
•
•
•
2
Reduce death and disability due to tobacco use by 5% in the implementation
area.
Reduce the rate of obesity through nutrition and physical activity interventions
by 5% in the implementation area.
Reduce death and disability due to heart disease and stroke by 5% in the
implementation area.
This health assessment is meant to provide a base-line for evaluating future changes in
chronic disease, social determinants of those diseases, and clinical preventive services.
The Problem
Cardiovascular disease, cancer, chronic lower respiratory diseases, stroke, and diabetes
rank among the leading causes of death in Bernalillo County (Table 1). Since 2006, over
70% of deaths in Bernalillo County were attributable to chronic disease.4, 5
Table 1. Death Rates* for Five Leading Causes of Chronic Disease Death, 2006-2010
Bernalillo
County
Cause of Death**
Heart disease (ICD10: I00-I09, I11, I13, I20I51)
Neoplasm, malignant (ICD10: C00-C97)
Chronic lower respiratory diseases (ICD10:
J40-J47)
Cerebrovascular diseases (ICD10: I60-I69)
Diabetes mellitus (ICD10: E10-E14)
*
New
Mexico
United
States
Rank
Rate
Rank
Rate
Rank
Rate
1
157.4
1
157.8
1
178.5
2
153.9
2
152.6
2
172.5
3
45.7
3
46.8
3
42.1
4
5
39.3
24.9
4
5
34.9
28.8
4
6
39.0
20.8
Rates are per 100,000 population and are age-adjusted to 2010 U.S. standard population
Based on the International Classification of Diseases, Tenth Revision, Second Edition, 2004
**
The cost in human lives from chronic disease is great. However chronic disease also
results in significant economic costs due to long-term disability, hospitalization, and
treatment, as well as loss of human potential. The Commonwealth Fund estimates that
2.4% of the national gross domestic product is lost because of chronic disease and
disability-related factors, “from the combination of not working, sick days, and subpar
productivity on the job.”6
Chronic disease has a similar economic impact in Bernalillo County. In 2007 the Milken
Institute estimated that significant reductions in obesity and other chronic diseaserelated risk factors could save New Mexico over $6 billion in treatment-related costs as
November 2012
well as costs due to lost work productivity by 2023.7 A 2009 report from the New
Mexico Department of Health (NMDOH) stated that, “an estimated $390 million was
spent overall in New Mexico on healthcare services for heart disease; lost productivity
amounted to an additional $780 million in New Mexico.”8 Roughly a third of New
Mexico’s population resides in Bernalillo County. Although there are no figures for how
much chronic disease costs Bernalillo County, we can extrapolate that the cost is
approximately a third of the costs borne by the state.
Some populations and neighborhoods in Bernalillo County suffer disproportionately
from chronic disease, with some areas of the county experiencing mortality rates that
are nearly double.9 This assessment suggests that poverty plays an important role in
susceptibility to disease. Race and ethnicity also play a role, as they interact with
poverty. Related to these are access to education and other factors that will be
discussed in the body of this report.
Methods and Report Layout
This report begins with a description of Bernalillo County and a synopsis of the nature of
health disparities and social determinants of health. The remainder of the report is
organized around the CDC strategic directions. Chapter Three discusses tobacco use
prevalence, lung cancer, chronic lower respiratory disease, and asthma. Chapter Four
discusses obesity, diabetes, and various cardiovascular diseases related to healthy
eating and active living. Chapter Five discusses clinical preventive services, including
screening data for various cancers, diabetes, high blood pressure, and cholesterol.
Unless otherwise noted, chronic disease rates and census data are presented for all ages
and both sexes, and are age-adjusted. Mortality rates are calculated based on a per100,000 person basis. Incidence rates are all calculated based on a per-100,000 person
basis. We have not performed statistical tests of significance on most comparisons. Data
are presented by multiple divisions of geography. In addition to zip codes, this report
will also incorporate the use of NMDOH “small areas.”
In Bernalillo County, NMDOH has designated 32 small areas, plus Kirtland Air Force
Base. The small areas are an aggregate of 2010 census tracts, each small area containing
several census tracts. There are several advantages to small areas over either zip codes
or census tracts. To some extent the small areas represent coherent neighborhoods.
There are also instances where it was most appropriate to present data at the
elementary school level or high school level. All maps are located in Appendix 1. Kirtland
Air Force Base has been removed from the analysis due to its small population, its
tendency to produce unstable rates due to denominator variation from year to year,
and the population’s transience and lack of representativeness.
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3
CHAPTER 2: CHRONIC DISEASE
DISPARITIES IN BERNALILLO COUNTY
Social determinants of health are factors such
as income, discrimination, access to
transportation, or living in a particular locality
that exposes one to greater environmental
risks. We speak about the social determinants
to acknowledge the ways that the organization
of society impacts the distribution of resources
and creates living conditions which are either
more or less advantageous to health.10 Social
determinants of health are best understood as
mutually reinforcing phenomena, not as
separate forces of greater and lesser
importance. For example, in Bernalillo County
(as in the rest of the United States) people who
are living in poverty are more likely to be people
of color and are less likely to attain education.
Although poverty is one of the most important
predictors of health, it cannot be completely
disentangled from the other societal forces
which may cause or be caused by poverty. Each
additional obstacle that a person faces decreases his/her life chances as each factor
works synergistically to disadvantage that person.
A Profile of Bernalillo County
Bernalillo County (Map 1) is the geographic and economic center of New Mexico. It is
bisected by the Rio Grande River, and by two major interstates, I25 and I40, which
subdivide the county roughly into quadrants. Albuquerque, the largest city in New
Mexico, is the seat of Bernalillo County, and comprises 545,852 of the County’s 662,564
residents (Figure 1).11, 12 The remaining 116,712 residents live in the unincorporated
areas of Bernalillo County. Between the 1990 and 2010 U.S. Census periods, the
population of Bernalillo County grew nearly 30%. Bernalillo County’s racial and ethnic
distribution is shown in Table 2.12
The population of Bernalillo County is not evenly distributed by race and ethnicity. NonHispanic Whites tend to be clustered near the University of New Mexico (UNM) and in
the Northeast Heights district of Albuquerque. American Indians are greater in number
in the far Southeast Heights, the “International District” (a neighborhood in the
Southeast Heights of Albuquerque), and along the south and west borders of the county
where the Isleta Pueblo, Laguna Pueblo, and Tohajiilee communities are located.
Hispanics tend to be clustered in the South Valley and the West Mesa (Map 2).
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4
5
545,852
600,000
448,607
500,000
300,000
384,736
116,712
100,000
108,071
200,000
95,841
Population
400,000
0
1990
2000
Albuquerque
2010
Other Communities
Figure 1. Bernalillo County Population by Year
Table 2. Bernalillo County Race/Ethnicity, 2010
RACE
Number
Total Population
662,564
White
459,660
Black or African American
19,652
American Indian and Alaska Native
31,744
Asian
15,525
Some Other Race and Two or More Races
135,983
HISPANIC OR LATINO
Total Population
Hispanic or Latino (of any race)
Not Hispanic or Latino
Percent
100
69.4
3.0
4.8
2.3
20.5
662,564
317,089
345,475
November 2012
100.0
47.9
52.1
Bernalillo County’s economy is diverse, but has a few key drivers. The largest single
employer in the county is UNM, with 20,210 employees in 2012.13 The county is also
home to Sandia National Laboratories (a national research and development laboratory)
and a number of other significant technology companies. As of December 2011, the
employed workforce in Bernalillo County was 310,200, a 0.8% drop from the previous
year.14 As of July 2012, the unemployment rate in Bernalillo County was 7.6%, compared
to the U.S. rate of 8.6%.15 During the same time period, the average weekly wage had
fallen in Bernalillo County by 2.7% to $829, while the national average was $955. 13
Albuquerque Public Schools (APS) is the only school district in Bernalillo County. APS
includes 13 high schools, 27 middle schools, and 89 elementary schools. Additionally,
the district has 33 charter schools and 11 alternative schools.16 A breakdown of the
schools’ racial and ethnic composition demonstrates the demographics of the youth
population of Bernalillo County (Figure 2).17
70%
50%
57.6%
40%
30%
30.90%
Percent Student Enrollment
60%
20%
2.50%
4%
5.10%
10%
0%
Hispanic
White(Caucasian) Native American African American
Asian/Pacific
Islander
Figure 2. Albuquerque Public Schools Student Enrollment
by Race/Ethnicity, 2008-2009
The Roots of Health Disparities
The causes of health disparities are complicated and diverse. Poverty, and its attendant
indicators such as unemployment and income, are social determinants. Poverty is
unevenly distributed in Bernalillo County (Map 3). For this map, poverty is calculated at
November 2012
6
7
100% of the federal poverty level, which is $23,050 annually for a family of four. 18 The
areas in darkest brown represent the areas with the greatest percentage of households
living in poverty.
Map 3 shows the percentage of families living below the Federal Poverty Level (FPL)
based on area of residence. The areas with the highest concentration of families below
the FPL include the International District, the South Valley, and the West Mesa.
Another measure of poverty is the percent of the population enrolled in the
Supplemental Nutrition Assistance Program (SNAP), or food stamp program (Map 4). A
comparison of Map 3 and Map 4 shows that household poverty overlaps with heavy
enrollment in SNAP.
Educational attainment is a strong predictor of health. Figure 3 19 shows how
educational attainment varies by race and ethnicity in Bernalillo County. More than 56%
of Hispanics have a high school education or less, compared to only 22.6% of nonHispanic Whites. Map 5 shows Bernalillo County residents aged 25 or older with a high
school diploma or greater.
50%
45%
43.2%
45.2%
Less than
High
School
31.5%
24.3%
13.5%
19.2%
28.1%
29.1%
3.4%
5%
13.2%
18.1%
10%
6.6%
15%
26.4%
22.9%
20%
12.8%
25%
16.0%
30%
26.1%
30.2%
35%
32.3%
22.2%
26.8%
Percent of Population
40%
High
School
Only
Bachelor's
Degree or
Higher
0%
Figure 3. Educational Attainment by Race/Ethnicity, Bernalillo County, 2009
November 2012
8
Major Health Disparities by Race and Ethnicity, Income, Education, and Geography
Having low income means having fewer options for getting and staying healthy. Map 3
of this report identifies small areas within the County with the highest poverty rate.
Map 4 and Map 5 show that about 20% of residents in the International District are
enrolled in SNAP and less than 75% of them have a high school diploma. The
International District is also one of the areas in Bernalillo County with the highest death
rate from chronic disease (Map 6). Map 7 shows the average age of death due to
chronic disease, and indicates that life expectancy is lower on the West Mesa, in the
South Valley, and on tribal lands.
Disparities occur in other health indicators besides mortality. Figure 420 shows results
from several health status questions asked on the Behavioral Risk Factor Surveillance
System (BRFSS) survey. Among BRFSS respondents from various racial and ethnic groups
in Bernalillo County, non-Hispanic Whites fared better than all other ethnic groups
among certain key measures, including access to care. American Indians are less likely to
have health insurance, while African Americans are most likely to encounter financial
barriers to obtaining health care. Overall, more than 20% of Bernalillo County’s
population is uninsured. New Mexico ranks third in the nation for number of uninsured
residents.
22.2%
Fair/Poor
Health
8.9%
5%
10.7%
17.2%
21.8%
23.8%
21.1%
19.6%
17.5%
21.7%
Don't
have
insurance
8.4%
10%
18.6%
15%
17.7%
20%
13.6%
Percent of Population
25%
25.8%
30%
0%
American
Indian/Alaska
Native
Asian/Pacific
Islander
Black/African
American
Hispanic/Latino
Cost
Barriers
to Health
Care
White
Figure 4. Racial and Ethnic Differences in Key Health Issues,
Bernalillo County, 2006-2010
November 2012
CHAPTER 3: TOBACCO-FREE
LIVING
The goal of this CDC-recommended
strategic direction is to prevent and
reduce tobacco use. Living tobaccofree means avoiding the use of all
types of tobacco products, such as
cigarettes, cigars, smokeless
tobacco, and hookahs, as well as
living free from secondhand smoke
exposure.
Commercial tobacco use (as opposed
to ceremonial use of tobacco by
American Indians, who comprise
4.8% of Bernalillo County’s
population) is strongly associated
with several leading causes of death,
many of which are preventable.21 While the association between tobacco use and lung
cancer is well known, research has established that tobacco use is also associated with
nearly as many deaths from heart disease and other diseases, including chronic
obstructive pulmonary disorder and stroke.22 Smoking-attributable mortality (SAM) is
calculated using nineteen distinct diseases that include various cancers, cardiovascular
diseases, and respiratory disorders.23
Youth Tobacco-Use Prevalence
Tobacco use typically begins in youth. According to the CDC, over 80% of smokers
started smoking before age eighteen.24 The best source of data for youth tobacco use is
the Youth Risk and Resiliency Survey (YRRS), which is administered to high school and
middle school students.
High School Population. In Bernalillo County 8,168 high school students participated in
the YRRS in 2009.25 Smoking rates were highest among American Indian high school
students in Bernalillo County followed by Hispanics, Asian/Pacific Islanders, nonHispanic Whites, and African Americans (Figure 5).
When compared with New Mexico, Bernalillo County’s tobacco use rate among high
school students was lower for almost every measure (Table 3). Results from the YRRS
also reveal certain disparities by zip code within Bernalillo County.
November 2012
9
10
20.3%
19.6%
20
21.7%
25
25.2%
30
Asian/Pacific
Islander
Non-Hispanic
White
14.3%
15
10
5
0
American Indian
Hispanic
African
American/Black
Figure 5. Percent of Current Cigarette Smoking by Race/Ethnicity,
Bernalillo County, 2009, High School
Table 3. Percent of High School Students Responding “Yes”
to Select YRRS Tobacco Questions, 2009
Zip Code
Bernalillo
New
Question
87108 87105 87121 87110
County
Mexico
Ever tried cigarette smoking?
45.4
56.1
64.1
52.9
53.4
58.0
Smoked cigarette before
age 13?
Current cigarette smoker?
13.8
15.8
24.9
13.5
15.8
16.8
14.6
19.3
23.5
24.8
20.9
24.0
High school students in zip code 87121 had the highest response rate to the question
“have you ever tried cigarette smoking?” while students in zip code 87108 had the
lowest response rate. Zip code 87121 includes Bernalillo County’s Southwest mesa and
zip code 87108 encompasses Albuquerque’s “International District” (including much of
the County’s urban-Indian population). High school students in zip code 87110
(Albuquerque’s Uptown area) had the highest response rates for the question, “are you
a current cigarette smoker?” (24.8%). By comparison, high school students in zip code
87108 had the lowest rates for being a current smoker (14.6%).
Middle School Population. When compared with New Mexico, fewer of Bernalillo
County’s middle school students reported ever trying a cigarette, smoking cigarettes
before age eleven, or being a current smoker (Table 4).25
November 2012
Table 4. Percent of Middle School Students Responding “Yes”
to Select YRRS Tobacco Questions, 2009
Zip Code
Bernalillo
Question
87111 87106 87108 87105
87107
County
Ever tried cigarette
10.6
13.4
28.3
32.5
37.1
23.9
smoking?
Smoked cigarette
0.9
2.7
5.8
7.5
11.5
5.6
before age 11?
Current cigarette
2.1
2.6
9.8
9.5
9.4
5.9
smoker?
New
Mexico
24.8
Middle school students in 87107 zip code, encompassing parts of Albuquerque’s North
Valley, had the highest response rate to the question “have you ever tried cigarette
smoking?” (37.1%), while middle school students in zip code 87111 in Albuquerque’s
Northeast Heights, had the lowest response rate (10.6%). Middle school students in the
87107 zip code had the highest response rate to the question “have you smoked
cigarette before age 11?” (11.5%), while students in zip code 87111 had the lowest
response rate (0.9%). Middle school students in 87108 had the highest response rate to
the question “are you a current smoker?” (9.8%), while middle school students in zip
code 87111 had the lowest response rate (2.1%).
Adult Tobacco-Use Prevalence
The best source of data for adult tobacco use is the BRFSS, a random-digit-dialed
telephone survey conducted annually in New Mexico.26 Bernalillo County and New
Mexico data on current cigarette smokers by race and ethnicity are presented in Figure
6.20
Within Bernalillo County, smoking rates for American Indians were higher than any
other racial/ethnic group, followed by Asian/Pacific islanders, African Americans,
Hispanics, and non-Hispanic Whites, respectively. In addition, American Indians in
Bernalillo County had considerably higher rates of smoking than American Indians in
New Mexico as a whole (24.6% and 20.5%, respectively).
November 2012
11
5.7
6.8
12
30%
10%
19.2%
16.0%
19.4%
18.9%
23.8%
20.2%
19.7%
21.5%
15%
20.5%
20%
24.0%
25%
Bernalillo County
5%
New Mexico
0%
Figure 6. Current Adult Cigarette Smokers by Race/Ethnicity, 2006-2010
Figure 7 shows the income disparity among smokers.20 Bernalillo County residents
making more than $50,000 per year smoke at a rate of 12.0%, while residents making
less than $15,000 per year smoke at a rate of 35.0%, suggesting that there is a positive
relationship between low income and high smoking rates in Bernalillo County.
40%
5%
12.5%
23.1%
23.1%
18.3%
Bernalillo County
12.0%
10%
15.7%
15%
26.2%
20%
26.2%
25%
33.2%
30%
35.0%
35%
New Mexico
0%
Figure 7. Adult Smoking by Income, 2006-2010
November 2012
Cancer in Bernalillo County
In 2011, there were 995 cancer deaths in Bernalillo County.27 Roughly 2,800 cancers are
newly diagnosed in Bernalillo County each year, with slightly more cases in males than
females.28 Smoking causes 85% of all lung cancers, and is a risk factor for cancers of the
lip, oral cavity, pharynx, esophagus, stomach, pancreas, larynx, trachea, lung, bronchus,
cervix uteri, kidney and renal pelvis, urinary bladder, and blood.29 This chapter presents
data for all cancers combined, and for lung cancer because of its strong association with
tobacco use.
All Cancers Combined in Bernalillo County
There are significant racial/ethnic differences in overall cancer incidence in Bernalillo
County, with the highest cancer rates seen in non-Hispanic Whites, followed by
Hispanics, and the lowest cancer rates seen in American Indians, African Americans, and
Asian/Pacific Islanders. Overall, cancer incidence rates among females have been
declining for all racial/ethnic groups, with the exception of Hispanic women, where rates
have increased (Figure 8).28
Figure 8. Trend in Female Incidence for All Cancers Combined by Race/Ethnicity,
Cancer mortality rates follow patterns similar to incidence rates across population
groups. However, the ratio of cancer mortality to incidence is disproportionately higher
among Hispanics, American Indians, and African Americans when compared to nonHispanic Whites (Table 5).27, 28 Hispanic males have the highest overall cancer mortality
rates despite incidence rates that are 20% lower than that of non-Hispanic White males
November 2012
13
14
(Table 5). 27, 28 Additionally, cancer mortality to incidence ratios (MIRs) vary by area
socioeconomics, strongly increasing with increasing area level poverty. The social
gradient in all cancer MIRs is most pronounced in males, where an approximate 50%
difference in the MIR is seen between low and high poverty areas (Figure 9). 27, 28 High
MIRs for all cancers combined are in the South Valley, the International District, the
West Mesa, and on tribal lands (Map 8). 27, 28
Table 5. Incidence Rates, Death Rates, and Mortality-to-Incidence Ratios (MIR) for All Cancer
Sites Combined by Race/Ethnicity and Gender, Bernalillo County, 2005-2009*
Males
Incidence
Females
Mortality
Incidence
Cases Rate Deaths Rate
MIR
All Races/
6,920 486.9
2,564
187.1 0.384
Ethnicities
White
4,480 524.7
1,598
187.0 0.356
Hispanic
1,977 432.8
823
193.5 0.447
American
103
264.3
49
140.5 0.532
Indian
African
145
296.1
64
175.6 0.593
American
Asian/Pacific
73
304.0
19
72.1
0.237
Islander
*Rates are age-adjusted and based on 100,000 population
Mortality
Cases
Rate
Deaths
Rate
MIR
6,832
399.8
2,372
132.6
0.332
4,005
2,005
431.9
368.9
1,525
704
138.5
125.6
0.321
0.340
140
244.3
47
86.4
0.354
125
287.7
56
139.2
0.484
83
215.6
34
92.4
0.429
0.417
0.383
0.469
0.408
0.327
0.2
0.354
0.3
0.395
0.4
0.515
0.5
0.339
Mortality-to-Incidence Ratio
0.6
Areas with families living at
or below 100% of the
federal poverty level.
<10%
0.1
10.0%-19.8%
0.0
20.0+%
Both Sexes
Male
Female
Figure 9. Mortality-to-Incidence Ratios (MIR) for All Cancer Sites Combined by Gender
and Poverty, Bernalillo County, 2005-2009
November 2012
15
Lung Cancer in Bernalillo County
Lung cancer accounts for roughly 10% of all newly diagnosed cancers in Bernalillo
County each year, and accounts for nearly 25% of all annual cancer deaths due to its
generally poor survival.28 Up to 85% of lung cancers are attributed to cigarette smoking,
and thus considered preventable.29 Given a latency period of thirty to forty years,
current trends in lung cancer incidence reflect historical smoking patterns within a given
population. In Bernalillo County, lung cancer incidence rates have been stable or
declining in males, and stable or slightly increasing in females. Regardless of gender,
lung cancer incidence is the highest in non-Hispanic Whites and Blacks, and the lowest
in American Indians (Table 6).27, 28
Table 6. Lung Cancer Incidence and Mortality Rates by Race/Ethnicity and Gender
Males
Incidence
All Races/Ethnicities
White
Hispanic
African American
Asian or /Pacific
Islander
American Indian
Females
Mortality
Incidence
Mortality
Cases
715
519
154
24
Rate
52.8
61
37.8
53.3
Deaths
563
411
121
19
Rate
41.6
47.6
30.6
57.7
Cases
657
457
161
20
Rate
37.8
42.6
29.8
45.3
Deaths
529
379
126
11
Rate
30
34.4
23
29.9
11
42.1
7
22.4
10
28.7
8
24.5
6
21.3
5
15.8
5
10.8
5
11.5
Lung cancer incidence also varies by area socioeconomics, with rates that generally
increase with increasing area level poverty (Figure 10)27, 28. The social gradient in lung
cancer incidence is most pronounced among non-Hispanic Whites, particularly males,
where a 50% difference in incidence rates exists between the most impoverished and
the most affluent areas of the county.
November 2012
16
Percent families in small area below 100% Federal Poverty Level (2006-2010)
10%-20%
>20%
27.8
Hispanic
23.8
27.4
47.3
51.6
38.3
White
39.5
37.8
All Race/Ethnicities
34.5
44.5
Hispanic
31.4
MALE
42.9
64.7
62.0
81.9
<10%
52.5
White
All Race/Ethnicities
100
90
80
70
60
50
40
30
20
10
0
47.8
55.7
Rate per 100,000
FEMALE
Figure 10. Lung Cancer Incidence by Ethnicity, Gender, and Poverty
Chronic Lower Respiratory Disease in Bernalillo County
Chronic lower respiratory disease (including asthma and emphysema) is the third
leading cause of chronic disease death in Bernalillo County (Table 1).4 Between 2006
and 2010, chronic lower respiratory disease caused 1,446 deaths in Bernalillo County.27
Asthma is a disease that disproportionally occurs among low-income individuals and
tends to strike children who live in substandard housing.30 There are many triggers for
asthma, including dust mites, pollution, cockroaches, mold, pets, and tobacco smoke. 31
Asthma incidence is important to this health assessment because it may be a proxy for
exposure to second hand smoke in multi-unit housing. Figure 1132 shows the 2006-2010
asthma hospitalizations in Bernalillo County, with 40% of hospitalizations occurring
among children age 1 to 14.
Second hand tobacco smoke can contribute to asthma in multi-unit housing because as
much as 65% of the air can be exchanged between housing units through ventilation,
cracks and plumbing.33 Map 9 shows asthma hospitalizations for all ages in Bernalillo
County.32 It also shows the location of multi-unit housing throughout the county. The
map area representing the greatest number of asthma hospitalizations with the largest
number of multi-unit housing parcels (and one of the county’s most impoverished areas)
is the International District.
November 2012
Number of Hospitalizations
516
600
417
500
400
262
300
185
200
100
17
113
193
239
152
136
57
46
0
Figure 11. Asthma Hospitalizations by Age Group, Bernalillo County, 2006-2010
November 2012
Chapter 4: Healthy Eating and Active Living
The goal of this CDC-recommended
strategic direction is to prevent and
reduce obesity, increase physical
activity, and improve nutrition. Healthy
eating and regular physical activity can
help lower blood pressure and prevent
a range of chronic diseases.34
Adult Obesity in Bernalillo County
The nation’s growing obesity epidemic
is responsible for an appreciable
amount of heart disease,
cerebrovascular disease, diabetes, and
cancer.34 Bernalillo County’s adult
overweight and obesity rates are
slightly lower than rates for New
Mexico (57.0% and 61.5%, respectively) (Figure 12).20 In 2011, New Mexico ranked 16th
in the nation for obesity, with 25.6% of the adult population defined as obese. 35
Body Mass Index (BMI) is a figure derived from height and weight measurements to
determine if a person is at a healthy weight. A BMI between 25 and 30 is considered
overweight and a BMI above 30 is considered obese. The data presented in this section
are for adults and are not based on actual measurements but on self-reported data
through the BRFSS. Figure 1220 shows that there is a positive relationship between
overweight/obesity and low income.
Figure 1320 shows that American Indians have the highest rates of overweight, followed
by African Americans and Hispanics. African Americans have the highest rate of obesity
followed by Hispanics and American Indians.
November 2012
18
19
70%
Percent Overwieght or Obese
60%
50%
40%
30%
20%
10%
0%
0$14,99
9
$15,00
0$24,99
9
$25,00
0$34,99
9
$35,00
0$49,99
9
$50,00
0 or
more
Bernalillo County BMI 25+
(Overweight or Obese)
62.10%
61%
59.30%
58.70%
53.80%
New Mexico BMI 25+
(Overweight or Obese)
65.90%
65%
63%
62.50%
57.80%
Total Overweight or Obese
New Mexico = 61.5%
Bernalillo County = 57.0%
Figure 12. Overweight/Obesity by Income, Bernalillo County & New Mexico,
2006-2010
45%
40%
36.70%
35%
25.30%
12.10%
5%
33.60%
17.50%
10%
34.80%
27%
15%
Overweight
27.80%
20%
24.50%
25%
41.50%
30%
0%
Figure 13. Adult Overweight/Obesity by Race/Ethnicity, Bernalillo County, 2006-2010
November 2012
Obese
20
Figure 1420 shows the distribution of overweight and obesity by age in Bernalillo County.
Obesity tends to decline above age 65. Overweight is most prevalent among adults age
50-64, while obesity is most prevalent among adults age 35-49.
45%
40%
35%
5%
16.4%
23.4%
24.8%
10%
20.3%
15%
26.4%
20%
36.7%
25%
40.3%
38.6%
30%
Overweight
Obese
0%
Age 18-34
Age 35-49
Age 50-64
Age 65+
Figure 14. Adult Overweight/Obesity by Age, Bernalillo County, 2006-2010
Physical activity is one of the CDC-recommended practices to reduce overweight and
obesity. Figure 1520 shows self-reported rates of physical inactivity by income for
Bernalillo County and New Mexico. The figure shows that as income decreases, so too
does physical activity.
25%
20%
15%
10%
5%
0%
0-$14,999
$15,000$24,999
$25,000$34,999
$35,000$49,999
$50,000 or
more
Bernalillo County No Physical
Activity
19.30%
15.80%
15%
5.40%
6.30%
New Mexico No Physical Activity
22.60%
16.30%
11.50%
7.60%
6.20%
Figure 15. Physical Activity by Income, Bernalillo County and New Mexico,
2005, 2007, 2009
November 2012
Childhood Overweight and Obesity in Bernalillo County
Childhood overweight and obesity has become a serious public health problem in recent
years. Overweight and obesity in childhood produce a variety of health consequences in
the immediate and long term.36, 37
The Healthy Weight Assessment Project (HWAP) 38 measures the BMI of nearly every
kindergarten, third-grade, fifth grade, and eighth-grade student in the APS district. Map
10 shows the results of the HWAP for the 2008-2009 school year for elementary schools
only.
The percentage of students who are overweight or obese within a given elementary
school ranges from 18.1% to 49.1%. Schools having the greatest percentages of
overweight/obese children are located along the main freeways, in the International
District, in the South Valley, and on Isleta Pueblo.
Heart Disease in Bernalillo County
Heart disease is a term for a number of related diseases that affect the heart and
circulatory system, including heart attack (myocardial infarction), atherosclerotic
cardiovascular disease, and congestive heart failure.
Figure 1627 shows Bernalillo County heart disease mortality rates by gender and
ethnicity for the ten-year period from 2000 to 2009. Heart disease mortality for males is
highest among Hispanics, non-Hispanic Whites, African Americans, and American
Indians, respectively.
Heart disease mortality for females is highest for African Americans, non-Hispanic
Whites, Hispanics and American Indians, respectively.
Map 11 shows heart disease deaths across Bernalillo County for the ten-year period
from 2000 to 2009. Darker areas represent higher mortality rates. Map 12 shows how
heart disease mortality rates have changed between 2000 to 2004 and 2005 to 2009.
Heart disease mortality has increased in the Uptown area, the North Valley, the South
Valley, the West Mesa, and on tribal lands.
November 2012
21
22
250
128.7
206.1
145.3
133.8
100.2
100
Male
57.3
50
184.3
199.7
152.8
150
98.0
Rate per 100,000
200
Female
0
Asian or Pacific American Indian
Islander
or Alaska Native
White
Black or African
American
Hispanic
Figure 16. Heart Disease Death Rate by Gender and Race/Ethnicity,
Diabetes in Bernalillo County
Diabetes is the fifth leading cause of death due to chronic disease in Bernalillo County
(Table 1). Figure 1727 shows the Bernalillo County diabetes mortality rate by gender and
by race/ethnicity for the ten-year period from 2000 to 2009.
Diabetes mortality for males is highest among African-Americans, Hispanics, and
American Indians, respectively. Diabetes mortality for females is highest among African
Americans, American Indians, and Hispanics, respectively.
Map 1327 shows diabetes mortality for the ten-year period from 2000 to 2009. Darker
areas represent higher mortality rates. Mortality is highest in the International District,
the South Valley, on the West Mesa, and on tribal lands.
Diabetes incidence rates were collected from the Hospital Inpatient Discharge Data
Surveillance (HIDDS) system. Hospitalization rates serve as a good proxy for measuring
the population’s disease burden from diabetes. Diabetes hospitalization rates in
Bernalillo County (10.5 per 10,000)32 are well below the national average (20.0 per
10,000) for the period 2000 to 2009.
November 2012
23
41.0
32.2
30
40.4
38.9
35
25
Female
15.2
10
22.6
15
21.2
Male
20
16.3
Rate per 100,000
40
45.4
45
40.6
50
5
0
Asian or Pacific
Islander
White
American Indian
or Alaska Native
Hispanic
Black or African
American
Figure 17. Diabetes Death Rate by Gender & Race/Ethnicity, Bernalillo County,
2000-2009
Stroke in Bernalillo County
Stroke is the fourth leading cause of chronic disease death in Bernalillo County, New
Mexico, and the United States (Table 1). Bernalillo County’s stroke related mortality rate
(39.3) is greater than the rate for New Mexico (34.9) and the United States (39.0). Figure
1827 shows the mortality rate for stroke in Bernalillo County between 2000 and 2009 by
race and ethnicity. Stroke mortality for males is highest among Asian/Pacific Islanders,
followed by African Americans, and Hispanics. Stroke mortality for females is highest
among African Americans, followed by Hispanics and non-Hispanic Whites.
70
10
47.9
57.2
47.0
47.6
21.6
20
Male
Female
23.4
30
39.7
35.1
40
41.5
50
21.2
Rate per 100,000
60
0
American Indian
or Alaska Native
White
Hispanic
Black or African Asian or Pacific
American
Islander
Figure 18. Stroke Death Rate by Gender and Race/Ethnicity, Bernalillo County,
2000-2009
November 2012
The Built Environment, Healthy Eating, and Active Living in Bernalillo County
Healthy eating and active living are influenced by more than a person’s decision to
either exercise or eat according to recommended guidelines. Aspects of the built
environment also influence how easy it is to eat healthy and be active; for example,
healthy food options need to be accessible and affordable. Similarly, places to exercise
must be accessible, safe, and inviting.
November 2012
24
Chapter 5: High-Impact
Clinical Preventive Services
Clinical preventive services
(including screening, disease
management, and immunization)
have the potential of decreasing
incidence and mortality associated
with chronic disease.39
Bernalillo County’s health care
network is comprised of five
hospitals, three federally qualified
community health clinics, one
major private medical group, a university-based medical group, and the Albuquerque
Area Indian Health Service, as well as numerous private health care providers.40 This
network of hospitals and clinics play an important role in the delivery of preventative
services to county residents.
When available, this chapter presents screening and diagnostic data from the New
Mexico BRFSS for the leading causes of death in Bernalillo County. Because
hypertension and elevated cholesterol levels increase the risk for heart disease and
stroke (two of the top five leading causes for chronic disease related death in the
county), data on these two health indicators are highlighted in this chapter.
Several Bernalillo County hospitals, health plans, and health care providers are members
of the Albuquerque Coalition for Health Care Quality. The Coalition is funded through
the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q)40 initiative,
which focuses on improving quality of care. Through this effort, the Coalition has
gathered data on heart disease, diabetes, breast, and cervical cancer care from five
medical groups.
High Blood Pressure in Bernalillo County
BRFSS hypertension diagnostic data show a higher percentage of doctor-diagnosed
hypertension among African Americans and Hispanics in the county (Figure 19).20
November 2012
25
26
40%
36.70%
35%
30%
17.10%
15%
22.40%
20%
22.70%
23.80%
25%
10%
Dr. Diagnosed High
Blood Pressure
5%
0%
Black/African Hispanic/Latino American
American
Indian/Alaska
Native
White
Asian/Pacific
Islander
Figure 19. High Blood Pressure by Race/Ethnicity, Bernalillo County, 2005, 2007, 2009
80.5%
75.9%
2.5%
17%
Cholesterol Check
in Past 5 Years
6.1%
18.0%
0.2%
18.7%
2.5%
30.90%
66.5%
5.7%
36%
58.3%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
81.0%
Cholesterol Screening in Bernalillo County
The American Heart Association recommends that all adults over the age of 20 should
have a fasting lipoprotein profile, which measures total cholesterol once every five
years.41 Cholesterol screening percentages in Bernalillo County vary according to
race/ethnicity and income (Figures 20 and 21).20 A positive relationship exists between
low cholesterol screening rates and low income. African Americans have the highest
cholesterol screening percentage of any racial or ethnic group in Bernalillo County.
American Indians and Hispanics have the lowest cholesterol screening percentages; 36%
of American Indians and nearly 31% of Hispanics report having never been screened.
Cholesterol Check
More Than 5 Years
Ago
Cholesterol Check
Never
Figure 20. Cholesterol Screening by Race/Ethnicity, Bernalillo County,
2005, 2007, 2009
November 2012
27
90%
80%
Cholesterol
Check in Past 5
Years
70%
60%
50%
Cholesterol
Check More
Than 5 Years
Ago
40%
30%
20%
Cholesterol
Check Never
10%
0%
Figure 21. Cholesterol Screening by Income, Bernalillo County, 2005, 2007, 2009
Diabetes in Bernalillo County
As highlighted in the previous chapter, Diabetes is the fifth leading cause of death due
to chronic disease in Bernalillo County. For the period 2000 to 2009, diabetes
hospitalization rates in Bernalillo County were 10.5 per 10,000, which is below the
national average of 20.0 per 10,000.32 African Americans report the highest percentage
of doctor-diagnosed diabetes, followed by American Indian/Alaska Natives (Figure 22).20
14%
2%
0%
4.60%
4%
9.70%
6%
11.50%
8%
10.90%
10%
11.40%
12%
Doctor Diagnosed Diabetes
Figure 22. Doctor-Diagnosed Diabetes by Race/Ethnicity, Bernalillo County, 2006-2010
November 2012
Cancer Screening in Bernalillo County
Cancer screening can reduce mortality by detecting some of the most common types of
cancer (including breast, cervical, and colorectal cancer) before symptoms appear.
Colorectal Cancer Screening. Cancer of the colon and rectum accounts for roughly 8% of
all cancers newly diagnosed in Bernalillo County each year, and is the cause of roughly
9% of annual cancer deaths.28 Screening can detect colorectal cancers as well as noncancerous polyps before they develop into malignancies. Colorectal cancer is more
treatable when it is found at an early stage, before it has had a chance to spread.
In Bernalillo County, a declining trend in colon and rectum cancer incidence has
occurred in non-Hispanic Whites, but a mixed picture is seen with other racial/ethnic
groups. In particular, incidence rates have modestly declined among Hispanic males
while slightly increasing in Hispanic females (Figure 23).28 Compared to non-Hispanic
Whites, Hispanics experience a higher overall incidence of colon and rectum cancer, as
well as a greater likelihood of being diagnosed with late-stage disease. Regardless of
race/ethnicity, persons living in the most impoverished areas of the county appear to be
at higher risk of colon and rectum cancer than their more affluent counterparts (Figure
24).28 The risk of late-stage diagnosis is disproportionately higher in the less affluent
and more impoverished areas of the county. Map 14 shows that more late-stage
tumors are found in small areas bordering the Rio Grande River, including the South
Valley and the North Valley.
Figure 23. Trend in Female Colon and Rectum Cancer Incidence Rates by
Race/Ethnicity, Bernalillo County, 2000-2009
November 2012
28
70
Percent families in small area below 100% Federal Poverty Level (2006-2010)
10%-20%
>20%
32.6
31.8
35.7
20
32.3
34.9
36.4
42.4
46.5
53.6
54.0
43.7
40.9
30
43.3
43.0
Rate per 100,000
50
57.9
<10%
31.6
37.7
39.2
60
40
29
White
Hispanic
10
0
All
Race/Ethnicities
White
MALE
Hispanic
All
Race/Ethnicities
FEMALE
Figure 24. Colon and Rectum Cancer Incidence by Race/Ethnicity, Gender, and Poverty
Non-Hispanic White patients over age 50 report being screened (including colonoscopy,
sigmoidoscopy, and FOBT) more frequently than other racial and ethnic groups (Table
7).20
Table 7. Colorectal Cancer Screening History Among Adults Age 50+ by Race/Ethnicity,
Bernalillo County, 2006, 2008, and 2010
(FOBT w/in Past Year or Sigmoidoscopy/Colonoscopy w/in Past 10 Years)
Positive Screening
Lower 95%
Upper 95%
History (%)
CI
CI
American Indian/Alaska Native
41.2
26.5
57.6
Hispanic
53.4
48.5
58.3
White
67.9
65.0
70.6
November 2012
Cervical Cancer and Screening. Cervical cancer incidence rates in Bernalillo County have
generally been stable or declining in recent years, with most cases occurring in nonHispanic White or Hispanic women. Among these two groups, cervical cancer occurs
more frequently in Hispanics than Whites, but relatively little difference in mortality is
observed, despite a higher likelihood in Hispanic women to be diagnosed with late-stage
disease (Table 8).28 Regardless of race/ethnicity, cervical cancer incidence rates increase
with increasing area poverty, with the social disparity being most pronounced with latestage disease. Communities with a disproportionately high percentage of late-stage
cervical cancer are distributed across the county, but tend to be localized to areas in the
southern portion of the county (Map 15), including the South Valley, the West Mesa,
and the East Mountains.28
Table 8. Cervical Cancer Incidence and Death Rates by Race/Ethnicity
Outcome
Late-Stage
Tumors*
Incidence
Mortality
Cases
Rate
Cases
Rate
Cases
%
All Races/Ethnicities
100
6.2
33
2.0
45
45.0%
White
45
5.7
19
2.1
19
42.2%
Hispanic
46
7.5
12
2.0
23
50.0%
American Indian
3
3.3
0
0.0
1
33.3%
African American
**
**
**
**
**
**
Asian or /Pacific Islander
3
9.2
1
2.8
1
33.3%
* Late-stage = tumor beyond body of cervix and/or positive lymph nodes.
**Small number of cases contributes to unstable rates.
Hospitals and clinics report cervical screening rates through HEDIS measures. Table 940
shows Bernalillo County providers for whom data is available on Papanicolaou (pap)
tests. The table divides patients from each provider into payer groups. First Choice, one
of the largest Federally Qualified Healthcare Centers serving Bernalillo County residents
is performing pap tests at or below the national average, as is the University of New
Mexico (UNM) Medical Group. First Nations (a Federally Qualified Healthcare Center
primarily serving the County’s urban Indian population) and Presbyterian Health Plan
are screening well above the national average.
November 2012
30
31
Table 9. Cervical Cancer Screening Among Bernalillo County Providers
(women 21 to 64 years who had a Pap test to screen for cervical cancer, 2008, 2009, or 2010)
Provider
First Choice Community Health
Care
First Nations Community Health
Source
Albuquerque Area Indian Health
Service Patients
Presbyterian Medical Group
UNM Medical Group
Type of Health
Care Coverage
Screened
(%)
State
Average
(%)
National
Average
(%)
Commercial
69
72
76
Medicaid
67
54
67
Medicaid
80
54
67
All
73%
N/A
N/A
Commercial
Medicaid
Medicare
Commercial
Medicaid
84
75
62
74
66
72
54
N/A
72
54
76
67
N/A
76
67
Breast Cancer Screening. Breast cancer is the most commonly diagnosed cancer in
Bernalillo County women, accounting for about one-third of all cancers newly diagnosed
each year.28 Incidence rates have been relatively stable over recent time; however, as
seen at both the national and state level, rates vary strongly by race/ethnicity. Figure
2528 shows a steady decline among non-Hispanic White women while the incidence
trend for Hispanics is flat or trending slightly upwards. Incidence is generally highest in
non-Hispanic White women, and lowest in American Indian and Asian/Pacific Islanders
(Figure 26).28 Regardless of race and ethnicity, breast cancer incidence tends to increase
with increasing affluence.28
November 2012
Source: NM Tumor Registry
Figure 25. Trend in Female Breast Cancer Incidence Rates by Race/Ethnicity,
Although other racial and ethnic groups are at lower overall risk, they are more likely to
be diagnosed with late-stage breast cancer, particularly African American women.28
Because survival is less favorable with more advanced disease, breast cancer mortality is
disproportionately higher among Hispanic, American Indian, and African American
women in the county compared to their non-Hispanic White counterparts. Communities
with disproportionately high levels of late-stage breast cancer diagnoses tend to be
located on the West Mesa, the International District, the North Valley, and on tribal
lands (Map 16).28
Breast cancer screening (mammography) is no longer recommended for premenopausal
women. Yet, more aggressive screening can detect smaller tumors before they spread.
Table 1040 shows HEDIS data for mammography screening among some of the providers
in Bernalillo County.
Mammography screening rates for First Choice Community Healthcare, Presbyterian
Healthcare Services, and the University of New Mexico Medical Group exceed the
national average. There was no comparison data available for Albuquerque Indian
Health Services.
November 2012
32
33
Table 10. Breast Cancer Screening Among Bernalillo County Providers
(women 40 to 69 years who had a mammogram to screen for breast cancer in 2009 or 2010)
State
National
Type of Health
Screened
Average Average
Provider
Care Coverage
(%)
(%)
(%)
First Choice Community Health
Commercial
71
64
69
Care
Medicaid
53
42
51
Albuquerque Area Indian
All
47
N/A
N/A
Health Service Patients
Presbyterian Medical
Commercial
76
64
69
Group
Medicaid
57
42
51
Medicare
76
N/A
68
UNM Medical Group
Commercial
81
64
69
Medicaid
67
42
51
Medicare
80
N/A
68
November 2012
Chapter 6:
Conclusions
The CINCH project aims
to reduce chronic disease
burden through policy,
environmental,
programmatic, and
infrastructure changes.
This health assessment
was intended to
document the most
recent and best quality
data to help inform the
Community
Transformation
Implementation Plan that
CINCH plans to write in
Program Year 2.
Bernalillo County is a
varied and diverse place. It is characterized by extremes of poverty and affluence, urban
and rural designations, and areas lacking infrastructure contrasted with advanced
development. It is unusual among metropolitan areas in the U.S. partly because of its
ethnic and racial mix: Bernalillo County is home to more Hispanics than non-Hispanic
Whites, while also having one of the country’s largest populations of urban American
Indians.
Chronic disease affects thousands of Bernalillo County residents each year and results in
millions of dollars in medical care and lost work productivity. Heart disease, stroke,
cancer, and diabetes are largely preventable. These diseases do not have an equal
impact on the people in Bernalillo County. Low-income communities and communities
of color are often disproportionately affected by chronic diseases.
The roots of health disparities are not found merely in poor decisions that people make,
but they are found in the social, economic and built environment. Policies have the
power to affect each of these environments and decrease the disparities described in
this report.
In Bernalillo County, the burden of chronic disease falls disproportionately on people
living in low-income neighborhoods, African Americans, Hispanics, and American
Indians. If you fit into one or more of these categories your life chances are less than
those of people who do not share these characteristics.
November 2012
34
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Appendix One: Maps Map 1 Map 2 Map 3
Map 4 Map 5 Map 6 Map 7 Map 8 Map 9 Map 10 Map 11 Map 12
Map 13 Map 14 Map 15 Map 16

Bernalillo County Health Assessment

Transcription

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