Cancer in Maine: Using Data to Direct Actions 2018 Challenge Cancer Conference May 1, 2018
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1 Cancer in Maine: Using Data to Direct Actions 2018 Challenge Cancer Conference May 1, 2018 Tim Cowan, MSPH Director, Data Reporting and Evaluation Center for Health Improvement MaineHealth
2 All Cancer Mortality Rates (Age-adjusted rates, using U.S. population in 2014 as standard population) 10 Peer States: Identified Using Five SES & Rurality Metrics Age- 65+ yr. olds % Population Live in Rural Communities Education Attainment Among 25+ yr. olds- % College (4 yrs.) or higher Living In Poverty- % <18 yr. olds Median Household Income
3 Health Behaviors That Can Reduce Risk of Cancers Sources: Maine Cancer Surveillance Report (produced by the Maine Cancer Consortium); Updates via Maine Cancer Registry (Molly Schwenn)- April 2018 Avoid Tobacco Maintain Healthy Weight Be Physically Active Eat Healthy Diet Limit Alcohol Lung and Bronchus Colon and Rectum Breast (Females) (*=post menopause) * * Prostate (Males) Urinary Bladder Kidney & Renal Pelvis Pancreas Get Appropriate Screenings Oral Cavity and Pharynx Esophagus Liver/Intrahepatic Bile Duct Stomach Larynx Acute Myeloid Leukemia Cervix (Females) Uterus (Females) Gastric Cardia Gallbladder Multiple myeloma Ovary Meningioma Thyroid Melanoma Avoid Excessive UV Exposure
4 Leading Causes of Cancer Deaths in Maine (2016) Among Females (1,537 deaths) Among Males (1,738 deaths) 32% 27% 25% 29% 13% 19% 9% 10% 29% 7% Lung/bronchus* Colon/rectum* Other Tobacco-related* Breast All other cancers Lung/bronchus* Colon/Rectum* Other Tobacco-related* Prostate All other cancers * Tobacco use can cause these cancers. The Other Tobacco-related cancers include: liver, laryngeal, oral cavity/pharynx, esophageal, stomach, pancreatic, kidney/renal pelvis, urinary bladder, cervical and acute myeloid leukemia. Source: US Centers for Disease Control & Prevention, National Center for Health Statistics. CDC WONDER Online Database
5 Cancer Death Rates Compared Across Maine Counties
6 Mortality Due to All Types of Cancers Combined Lowest Age-adjusted Mortality Rates in were in: Hancock County Cumberland County Hancock County s rate is statistically significantly lower than rates in: Somerset County Piscataquis County Washington County Cumberland County s rate is statistically significantly lower than rates in: Kennebec County Androscoggin County Oxford County Somerset County Piscataquis County Washington County Maine Statewide
7 Cancer Death Rates Compared Across Maine Counties
8 Cancer Death Rates Compared Across Maine Counties
9 Cancer Incidence and Mortality in Maine Lung & Other Tobacco-Related Cancers*: 3-Year Rolling Averages Age-Adjusted Rates per 100,000 Population Lung and Bronchus - Incidence Lung and Bronchus - Mortality Tobacco-Related (excluding colorectal) - Incidence Tobacco-Related (excluding colorectal) - Mortality *Tobacco Related Cancers -excludes Lung/bronchus and Colorectal cancers, includes cancers of the Oral Cavity/Pharynx, Esophagus, Stomach, Pancreas, Larynx, Cervix, Urinary Bladder, Kidney and Renal Pelvis, Acute Myeloid Leukemia, Liver, and Bladder
10 Tobacco-Related Cancers, by site Source: Maine CDC Cancer Registry (April Data not yet published) Maine Rate Statistically Significantly Higher Than U.S. Maine Rate Statistically Significantly Lower Than U.S. Tobacco-Related Cancers By site Incidence Rate (age-adjusted /100,000) U.S. Maine Whites Mortality Rate (age-adjusted/100,000) U.S. Maine Whites Lung and Bronchus Colon and Rectum Urinary Bladder Kidney and Renal Pelvis Pancreas Oral Cavity and Pharynx Esophagus Stomach Liver and Intrahepatic Bile Duct Acute Myeloid Leukemia Larynx Cervix
11 Cigarette Tax and Cigarette Use by High School Students Percent Who Smoked Cigarettes on 1 Day During 30 Days Prior to Survey 18% 16% 22%23% 20% 8% 39% 25% 21% 19% 16%15% 13%11% 13%15% 42%29%25% 28% 35%29% 14% 22% 36% 18% 19% 16% 11% 43% 38% 35% 35% $0.74 Maine U.S. Best State (Rhode Island) Worst State (West Virgina) $ % $0.55 State Tobacco Taxes as of 2015: RI- $3.75 ( 3 rd highest)- increased in 2015 ME- $2.00 (14 th )- Since 2005! WV- $0.55 (33 rd )- Since 2003! $1.00 $1.32 $1.71 $2.46 $2.00 $3.46 $ % 5% 9% 7% : Maine had the 19 th lowest rate out of 24 states 2007: Maine had the 5 th lowest rate out of 40 states 2015: Maine had the 22nd lowest rate out of 37 states Tax data retrieved from Cigarette use from Youth Risk Behavior Surveillance System ( ) estimated percent
12 Cigarette use among adults % of year-olds who smoke daily or some days Behavioral Risk Factor Surveillance System ( ) estimated percentage 28.2% 20.3% 19.6% 9.5% Worst state: W. Virginia Best state: Utah U.S. Maine 24.8% 19.8% 17.1% 10.6% 8.8% states significantly higher rates 16 states significantly lower rates 4 states significantly higher rates 24 states significantly lower rates
13 Smoking Status Among Adults in 50 States in 2016 Source: Behavioral Risk Factor Survey Other States Peer States Maine Never A Smoker EVER SMOKERS Former Smoker (Now Quit) Currently Smokes Some Days Currently Smokes Everyday Percent
14 Adult Smokers by Gender in 50 States in 2016 Source: Behavioral Risk Factor Survey Other States Peer States Maine Male Female Percent
15 Adult Smokers by Age Group Source: Behavioral Risk Factor Survey (2016) States Peer States Maine Percent
16 Adult Smokers by Education in 50 States in 2016 Source: Behavioral Risk Factor Survey Other States Peer States Maine College Graduate Some post- High School High School or G.E.D. Less than High School Percent
17 Adult Smokers by Income Source: Behavioral Risk Factor Survey (2016) States Peer States Maine $50k+ $35000-$49,999 $25,000-$34,999 $15,000-$24,999 < $15, Percent
18 Patterns of Prevalence and Quitting Not Same Adults Smoking Daily or Some Days MaineHealth Service Area All Adults (18+ y.o.) Female Male Made Quit Attempt in Past 12 Months MaineHealth Service Area All Adults (18+ y.o.) Female Male Less than $15,000 $15,000-24,999 $25,000-34,999 $35,000-49,999 $50,000-74,999 $75, Less than $15,000 $15,000-24,999 $25,000-34,999 $35,000-49,999 $50,000+ $75,000+ Less than H.S. H.S. or G.E.D. Some post-h.s. College graduate 0% 10% 20% 30% 40% 50% Less than H.S. H.S. or G.E.D. Some post-h.s. College graduate 0% 20% 40% 60% 80% 100%
19 Patterns of Prevalence and Quitting Not Same = County Rate Significantly Higher than rates in Knox & Cumberland
20 Percent of Adults Who Are Obese in Maine Counties by Body Mass Index Categories Morbidly Obese- BMI Severely Obese BMI Obese: BMI Percent Behavioral Risk Factor Surveillance System ( ) estimated percent
21
22 Obesity Prevalence- Adults and High School Students
23 Breast Cancer Screening, Incidence, and Mortality The percentage of women 40+ years old who have been screened for breast cancer in the past 2 years: Maine: 75.8% US: 72.5% Rate of Newly Diagnosed Breast Cancer (2014) 140 Rate of Breast Cancer Deaths (2016) Rate per 100,000 people Rate per 100,000 People Maine US 0 Maine US Screening derived from Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health., BRFSS Prevalence & Trends Data [online] [accessed Apr 24, 2018]. URL: Incidence and Mortality derived from the National Center for Health Statistics CDC WONDER online database.
24 Cancer Incidence and Mortality in Maine Prostate and Breast Cancers: 3-Year Rolling Averages Age-Adjusted Rates per 100,000 Population Prostate (M)-Mortality Prostate (M)-Incidence Breast (F)-Incidence Breast (F)-Mortality
25 Five-year Relative Survival Rates, U.S Cancer Facts & Figures 2018 All Stages Local Regional Distant Lung/Bronchus* Colon/Rectum Breast-Female Uterine Cervix Prostate 99 >99 >99 30 * screening test available only for those with high-risk
26 Colorectal Cancer Screening % aged met U.S. Preventive Services Task Force recommendations Source: Behavioral Risk Factor Surveillance Survey 10 Peer States: Based on SES & Rurality
27 Colorectal Cancer Screening Source: Behavioral Risk Factor Surveillance Survey % Adults yrs old who had colonoscopy in past 10 years % Adults yrs old who had blood stool test in past year All Adults (50-75 yrs old) Female Male All Adults (50-75 yrs old) Female Male Less than $15,000 $15,000-24,999 $25,000-34,999 $35,000-49,999 $50,000+ Less than $15,000 $15,000-24,999 $25,000-34,999 $35,000-49,999 $50,000+ Less than H.S. H.S. or G.E.D. Some post-h.s. College graduate 0% 20% 40% 60% 80% 100% Less than H.S. H.S. or G.E.D. Some post-h.s. College graduate 0% 5% 10% 15% 20%
28 Cancer screening rates by county Breast Cancer Colorectal Cancer 82.6% Source: Maine Behavioral Risk Factor Surveillance System (BRFSS), Maine Center for Disease Control 34
29 Cancer Incidence and Mortality in Maine Colorectal Cancer: 3-Year Rolling Averages Age-Adjusted Rates per 100,000 Population Maine-Incidence Maine Mortality
30 Age-Adjusted Incidence Rates All Cancer Sites, by County Where One Lives Matters Average Round-Trip Distance For All Cancer Related Care by Municipality Madden, P., Charles, J. Maine Cancer Foundation Transportation Needs Assessment Summary Report. 2017, Sept. Market Decisions
31 Minimum travel distance to receive chemotherapy treatment Where One Lives Matters Minimum travel distance to receive radiation treatment Madden, P., Charles, J. Maine Cancer Foundation Transportation Needs Assessment Summary Report. 2017, Sept. Market Decisions
32 Three-quarters of organizations use volunteer drivers to provide rides Services provided to cancer patients Volunteer Drivers Paid Staff Drivers Public Transportation (ex. bus Reimbursement for family Taxis Other 27% 23% 23% 18% 50% 77% While organizations provide many different types of services to patients, volunteer drivers make up the backbone of many transportation service providers in the state Reimbursement for patient 14% Gas Cards for patient 14% Gas Cards for patient family or 5% 40
33 Nearly half of the organizations surveyed could not meet the need in their area during the past year Could you help every cancer patient who contacted your program in the past 12 months? 47% Yes 53% No How are services advertised to patients Given the high need for transportation, some organizations do not need to advertise their services and find that word of mouth is sufficient. Provider offices and hospitals Community outreach and education Referrals Local advertising
34 Cancer & Financial Toxicity Having a cancer diagnosis is associated with a 2.65-times greater likelihood of declaring personal bankruptcy. A 2013 study found cancer patients who declared bankruptcy had a 79% greater mortality risk than those who had not. Zafar, SY J Natl Cancer Inst Dec 11;108(5). pii: djv370. doi: /jnci/djv370. Print 2016 May
35 What Data is Missing for Maine? What Data Points do You Wish You Knew?
36 Questions and comments? Visit is welcome & encouraged
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