Community Health. Status

Transcription

1 2001 Gwinnett eport Working Together For A ier Gwinnett County Department Julie Schuitema, MPH, MSW Prevention Specialist Gwinnett County Department 324 West Pike Street P.O. Box 897 Lawrenceville, GA Martha H. Jordan, RN, BS Clinical Planning Analyst Gwinnett System 100 Medical Center Blvd., Suite 257 Lawrenceville, GA

2 executive Summary Gwinnett is great. Success lives here. These are the words proclaimed to all who drive along I 85 through Gwinnett County. For these words to be true, it requires the effort of all who live and work in Gwinnett County. Strong leaders, caring neighbors, and a celebration of diversity are important to make a community great and successful. Both greatness and success can be defined in various ways depending on one s perspective. From a healthcare and public health perspective, success may be defined as increasing the levels of childhood immunizations, decreasing the infant mortality rate, or even increasing levels of physical activity to prevent obesity and chronic conditions. The t is a tool for providing the information necessary to evaluate the county s achievements regarding the health of its residents. This instrument also gives the community an opportunity to develop areas of health improvement. The 2001 t provides demographics for Gwinnett County based on the newly released 2000 U.S. Census data. Updated mortality rates for the leading causes of death in Gwinnett County are presented including comparisons to the State and y People 2010 objectives. In addition, two new sections have been added to this s report: an extended maternal and child health section and a section highlighting morbidity rates for selected notifiable diseases, including comparative rates for Gwinnett County and the State. The 2001 report presents statistics on additional risk behaviors from the county-wide Behavior Risk Factor Surveillance System (BRFSS) conducted in early Finally, this s report was designed with a much stronger visual element, including over 70 color graphs, tables, and maps. As in past s, Gwinnett has much to be proud of when it comes to the health of its residents. For many causes of death and disease, Gwinnett has consistently lower rates than the State, as in the case of heart disease or AIDS. However, there are some areas, such as tuberculosis and Chronic Obstructive Pulmonary Disease (COPD), where Gwinnett s rates are increasing or are similar to State rates. It is important to recognize and celebrate the success and progress we are making in improving community health. However, it is equally important to acknowledge we have not yet reached our goal. There is always room for improvement in health status. Recent events in our country have reaffirmed the importance of a strong public health and healthcare system. Together the health department and hospital system are committed to providing needed health services and to improving the health status of our community. This updated t is just one example of the continued collaboration between public health and the hospital system. We hope you find it both useful and informative. Awareness of our current health status is just the beginning of working together to ensure a healthy, successful and great Gwinnett! Franklin M. Rinker President and CEO Gwinnett System Alan J. Sievert, M.D. Director Gwinnett County Department 2 eport

3 Table of Contents Page I. Introduction Executive Summary 2 Table of Contents 3 Methods of Data Collection 5 II. Gwinnett Demographics 6 Population Access to Care and Insurance. 8 Economics/Employment. 9 Income and Poverty Levels. 10 Housing and Household Size Education 11 III. Mortality 13 Controllable Risk and Protective Factors Leading Causes of Death Heart Disease.. 18 Cerebrovascular Disease (Stroke).. 19 Malignant Neoplasms (Cancer) HIV/AIDS Suicide 24 Accidents and Adverse Effects Pneumonia and Influenza Chronic Obstructive Pulmonary Disease (COPD). 27 Diabetes.. 28 IV. Maternal and Child 30 Infant Mortality Rate Low Birth Weight Rate. 31 Teen Pregnancy Rate V. Gwinnett County 1999 BRFSS 34 VI. Morbidity for Select Notifiable Diseases 35 Streptococcal Disease. 36 Tuberculosis (TB) Chlamydia and Gonorrhea.. 38 Syphilis HIV/AIDS Hepatitis Food and Water Borne Infections Vaccine Preventable Diseases VII. Challenge 48 VIII. Appendices t Card Glossary Georgia Notifiable Diseases List of Tables and Figures Facilities and Services Guide References eport 3

4 We would appreciate your comments and questions regarding this report. Copying and/or other use of this document is encouraged, but please reference sources appropriately. For additional copies of this document, contact Heidi A. Davidson, MPH, District Epidemiologist, Gwinnett County Department at , or download the pdf version from or Gwinnett System, 4 eport

5 Methods of Data Collection The data for the t were collected from several different sources. Demographic information, such as age, race, and income, was obtained from the U.S. Census Bureau, the 2000 Georgia County Guide, the Atlanta Regional Commission, and the Georgia Institute of Technology State Data and Research Center. Vital statistics, including birth and death data, were collected from the Georgia Vital Statistics ts from the Georgia Department of Human Resources, Division of Public. Inpatient discharge data were obtained from the Hospital Discharge Database managed by Care Information Analyst (HCIA). Medicare and Medicaid data were provided by Centers for Medicare and Medicaid Services (CMS) and the Department of Medical Assistance (DMA), as well as the Georgia County Guide. Since parts of this report are based on information collected by other sources using various methodologies, timeliness and detail are sometimes limited. The most recent data available at the time of publication are presented. Where appropriate, data have been age-adjusted to account for age differences within the population. Percentages have been rounded to the appropriate decimal and, therefore, do not always sum to 100 percent. This s report has two new and significant changes in how data are presented and reported. These adjustments are a result of national and international changes in how data are age-adjusted using updated population standards and how causes of death are categorized and coded using the International Classification of Diseases (ICD). Age-adjustment is an important tool used as a control for the changing age distribution of the population. It is useful for comparing rates over time or between populations. Prior to 1999, mortality data have been ageadjusted to the 1940 population standard. Beginning with 1999 data, age-adjustment will use the 2000 population standard. For most causes of death, this change in population standard will primarily affect the magnitude of age-adjusted death rates rather than the trend. According to the National Center for Statistics, The ageadjusted rate based on the 2000 standard is larger because the 2000 population standard, which has an older age structure, gives more weight than the 1940 standard to death rates at the older ages where mortality is higher. (Vol. 47, No. 3) Also starting in 1999, mortality data began to be classified and coded using the Tenth Revision of the International Classification of Diseases (ICD-10). Previous to this, the ICD-9 was used from 1979 through 1998 to classify and code causes of death. Some of the new changes will affect the classification of death. ICD-10 is more detailed than ICD-9 with almost 3,000 more categories for classifying causes of death. Additionally, in ICD-10, chapters have been added and rearranged and cause-of-death titles have been changed and regrouped. In contrast to the change in age-adjusting, ICD coding changes have the potential to significantly impact trend data. For example, pneumonia is less likely to be selected as the underlying cause of death under ICD-10 than under ICD-9. As a result, several other conditions, including some heart diseases, cerebrovascular diseases, complications of diabetes, malignant neoplasms, and other wasting diseases, when listed with pneumonia, are more likely to be selected as the underlying cause of death. The National Center for Statistics notes that The classification and rule changes between ICD-10 and ICD-9 have a considerable impact on some of the major causes of death in the United States. (Vol. 49, No. 2) As 1999 mortality data are analyzed and compared to data from previous s, it is important to look at how trends may begin to change for specific causes of death. Additional s of data are necessary to determine any true changes in mortality trends for specific causes of death. eport 5

6 GWINNETT DEMOGRAPHICS POPULATION Ø Gwinnett County s population has grown from 352,910 in 1990 to 588,448 according to U.S. Census 2000 figures; this is a population increase of about 66.7%. U.S. Census Bureau, 2001 Ø Projected population growth suggests that Gwinnett County will be home to 749,448 by the Georgia County Guide, (projected) Gwinnett County Population , , , , ,903 Figure 1. U.S. Census Bureau, , , , , , , , ,000 total population Ø In 2000, the median age for an individual living in Gwinnett County was 32.5 s old. U.S. Census Bureau, 2001 Ø In 2000, 74.3% of Gwinnett s population was under the age of 45. U.S. Census Bureau, 2001 percent Age Distributions for Gwinnett County and Georgia, y 05-09y 10-14y 15-19y 20-24y 25-34y 35-44y 45-54y 55-59y 60-64y 65-74y 75-84y 85+y age group Georgia Gwinnett Figure 2. U.S. Census Bureau, eport

7 GWINNETT DEMOGRAPHICS Gwinnett County Population by Race, 2000 White 72.7% Black 13.3% API 7.2% Other 4.3% Two or more races 2.2% Ø According to 2000 Census, the Gwinnett County population was comprised of 72.7% White, 13.3% Black, 7.2% Asian/Pacific Islander (API), 4.3% other race and 2.2% two or more races. U.S. Census Bureau, 2001 Figure 3. U.S. Census Bureau, Population Comparisons Gwinnett County and Georgia, percent Hispanic Ethnicity, Gwinnett County, White Black API Other Hispanic Gwinnett Georgia race/ethnicity Figure 4. U.S. Census Bureau, 2001 Non Hispanic 89% Hispanic 11% Ø U.S. Census figures for 2000 indicate 10.9% of Gwinnett s residents were of Hispanic origin. However, this may be an underestimate of the number of Hispanics living in Gwinnett County. (Because Hispanic is not a racial category, Hispanics may fall into any of the racial categories discussed above.) U.S. Census Bureau, 2001 Figure 5. U.S. Census Bureau, 2001 eport 7

8 GWINNETT DEMOGRAPHICS Gwinnett County Population by Age Group and Sex, 2000 Age Male Female Total Percent by Age by Age under 5 s 24,234 22,841 47, % 5-14 s 47,556 45,321 92, % s 41,597 35,448 77, % s 53,355 51, , % s 58,116 57, , % s 40,119 41,118 81, % s 19,013 19,195 38, % s 8,489 10,458 18, % s 3,519 6,285 9, % 85 plus s 751 2,097 2, % Total by sex 296, , ,448 10% Table 1. U.S. Census Bureau, 2001 ACCESS TO CARE AND HEALTH INSURANCE Hospitals: 4 Emory Eastside Medical Center Gwinnett Medical Center Joan Glancy Memorial Hospital SummitRidge Center for Behavioral Ø Bed Capacity: 521 Ø Average Occupancy: 65.8% Ø Average length of stay: 4.5 days Division of Planning, State of Georgia, 2001 Nursing Homes: 9 Buford Manor Nursing Home Delmar Gardens of Gwinnett Gwinnett Extended Care Center Life Care Center of Gwinnett Life Care Center of Lawrenceville Lilburn Geriatric Center Medical Arts Facility New London Center Parkwood Nursing Home and Rehabilitaion Center Ø Bed Capacity: 1148 Ø Average Occupancy: 94% Centers for Medicare & Medicaid Services, 2001 Number of People Receiving Medicare and Medicaid in Gwinnett County, Medicare Recipients (unduplicated aged and disabled) Percentage of County Population receiving Medicare Medicaid Recipients (unduplicated) Percentage of County Population receiving Medicaid Table 2. Care Financing Administration and Georgia County Guide, ,589 25,615 27,373 29,051 N/A 5.3% 5.6% 5.5% 5.6% N/A 24,459 26,802 31,859 32,126 38, % 5.6% 6.4% 6.2% 7.1% N/A = Not Available 8 eport

9 GWINNETT DEMOGRAPHICS ECONOMICS/EMPLOYMENT Number of People Employed in Gwinnett County, Year Employment 48,514 89, , , , , , , ,840 number Civilian Labor Force N/A N/A N/A N/A 260, , , , ,809 Table 3. Georgia County Guide, 2000 N/A = Not Available Ø In 1998, Gwinnett County was ranked fourth in the region in employment base. This region includes 10 counties: Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, and Rockdale. Atlanta Regional Commission, Figure 6. Georgia County Guide, 2000 Employment Gwinnett County, ,514 89, , , , , , , , , , ,000 number employed Ø In 1999, Georgia s unemployment rate was 2.4%. Georgia Department of Labor, 2000 Number of Unemployed People in Gwinnett County, Number of Unemployed Adults 9,737 8,563 7,934 8,022 7,969 Unemployment Rate (per 100 in work force) Table 4. Georgia County Guide, 2000 eport 9

10 GWINNETT DEMOGRAPHICS INCOME AND POVERTY LEVELS Ø In 1995, the median household income was $54,083 and the 1998 per capita income was $30,657. Georgia Institute of Technology State Data and Research Center, 1999; Georgia County Guide, 2000 Ø In 1995, approximately 25,245 residents or 5.2% of the population lived below the poverty level. This was up from 3.6% in Georgia Institute of Technology State Data and Research Center, 1999 Ø In 1995, there were 9,814 children (7.2%) under the age of 18 that lived in poverty. U.S. Census Bureau, 1999 Temporary Aid to Needy Families (TANF) is commonly known as welfare and formerly known as Aid to Families with Dependent Children (AFDC). TANF is the monthly cash assistance program for poor families with children under age 18. TANF is administered by the Georgia Department of Human Resources Division of Family and Children Services. Number of People Receiving Public Assistance in Gwinnett County, TANF (AFDC) Caseloads 1,821 1,836 1, TANF (AFDC) Avg. 4,587 4,662 3,576 2,340 1,608 Recipients/Month Food Stamps: Avg. Cases/Month 4,386 4,675 4,132 3,561 3,393 Food Stamps: Avg. Participants/Month 11,092 11,736 10,160 8,796 7,741 Table 5. Georgia County Guide, 2000 HOUSING AND HOUSEHOLD SIZE Ø In 2000, there were 202,317 estimated households (up from 126,971 in 1990) in Gwinnett County. U.S. Census Bureau, 2001 Ø In 2000, there were 152,296 families, which was up from 96,369 families in 1990 (families are households with at least one adult and one child under 18 s). U.S. Census Bureau, 2001 Ø Of these families, females headed 6.3% of the households with children under 18 s. (This is down from 7.3% in 1999.) U.S. Census Bureau, 2001 Ø In 2000, 24.7% of households were non-family households. U.S. Census Bureau, 2001 Ø As of 1999, the average household size in Gwinnett was 2.9. (This is up slightly since 1990.) U.S. Census Bureau, 2001 Ø Total housing units in 2000: 218,247 (single family units: 165,180 / 75.7%; multifamily units: 47,887 / 21.9%; mobile home units: 5,180 / 2.4%). Atlanta Regional Commission, 2000 Ø Renter-occupied housing units in 2000: 32.5%; Owner-occupied housing units: 67.5%. U.S. Census Bureau, 2001 Ø About 20% of Gwinnett s residents live in incorporated cities and towns. Atlanta Regional Commission, 2000 Ø Gwinnett is the region s fifth most densely populated county, with 1.89 people living per acre of land, and fourth in the region for total county population. This region includes 10 counties: Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, and Rockdale. Atlanta Regional Commission, eport

11 GWINNETT DEMOGRAPHICS EDUCATION Ø It is estimated there are more than 50 languages of origin, other than English, spoken by students in the Gwinnett County Public School System; after English, Spanish is the most frequent language of origin. Gwinnett County Public School System, Enrollment 80,270 84,555 88,596 93,209 98,478 High School Graduation Rate (per 100 N/A 81.7% 81.5% 80.7% 82.2% students) High School Dropout Rate (per % 5.2 % 4.5% 4.5% 4.3% students, grades 9-12) Free/Reduced Lunch Rate (per 100 students) 11.9% 13.4% 14.3% 15.7% 16.4% * The rates and numbers are for Gwinnett County Public Schools and do not include City of Buford Public Schools or private schools in Gwinnett County. Table 6. Georgia County Guide, 2000 Gwinnett County Public School System, * N/A = Not Available Map Berkmar Schools 2. Brookwood Schools 3. Central Gwinnett Schools 4. Collins Hill Schools 5. Dacula Schools 6. Duluth Schools 7. Meadowcreek Schools 8. Norcross Schools 9. North Gwinnett Schools 10. Parkview Schools 11. Shiloh Schools 12. South Gwinnett Schools 13. Grayson Schools * Buford City Schools For more information visit: eport 11

12 Gwinnett County, Georgia Parks & Recreation Map Best Friend Park 2. Bethesda Park/Senior Center 3. Bogan Park 4. Cemetery Field 5. Collins Hill Park 6. Dacula Park 7. George Pierce Park 8. Gwinnett Historic Courthouse 9. Harmony Grove Soccer Complex 10. Jones Bridge Park 11. Lanier Museum of Natural History 12. Lawrenceville Female Seminary, home of Gwinnett History Museum 13. Lenora Park 14. Lillian Webb Field 15. Lucky Shoals Park 16. Mountain Park Park 17. Pinckneyville Arts Center 18. Pinckneyville Soccer Complex 19. Rhodes Jordan Park 20. Shorty Howell Park 21. Singleton Road Activity Building 22. Springbrook Golf, Tennis & Aquatic Complex 23. Tribble Mill Regional Park 24. Yellow River Regional Park For more information visit: 12 eport

13 MORTALITY Mortality data presented in this report include the leading causes of death for Gwinnett County for s Most data are reported for the population as a whole; however, when the numbers (or rates) are large enough, age-specific and race-specific data are provided. (see page 29 and page 17, respectively.) Chronic diseases including heart disease, cancer, and cerebrovascular disease continue to be the leading causes of death for the population as a whole. Cancer and heart disease are also the leading causes of premature death. (Premature death is counted as death that occurs prior to the age of 65.) As noted in the Methods of Data Collection (page 5), two new changes age-adjusting and ICD coding affect the methodology for the way in which data are presented and reported in this s report. Both of these changes are important to consider when examining, analyzing, and using the data for community planning purposes. Graphs and charts in the mortality section of this report reflect the changes in age-adjusting and ICD coding. Mortality data have been age-adjusted to both the 1940 standard as well as the 2000 standard; therefore, two trend lines will be seen. The dotted lines seen between s 1998 and 1999 represent the change in ICD coding from version 9 to version 10. This dotted line indicates that whatever trend has been seen from 1994 to 1998 may change with the newer ICD coding. Throughout this section, Gwinnett rates are compared to both State rates and y People 2010 objectives. y People 2010 objectives have been established by the Department of and Human Services (DHHS) in collaboration with various public health partners to achieve two main goals: 1) Increase quality and s of healthy life and 2) Eliminate health disparities. According to DHHS, individuals and organizations can use the objectives to build an agenda for community health improvement and can monitor results over time. By comparing Gwinnett s rates to the y People 2010 objectives, the community is able to see how close (or far) we are to achieving national health goals. (see page 53) In the past, Gwinnett s rates have shown that our county is relatively healthy in comparison to the rest of the state and the nation. As a result of these changes, however, Gwinnett s rates now appear to be more similar to those of the state and the nation for certain causes of death. This new way of coding may show areas where prevention and intervention efforts need to be focused in Gwinnett County. eport 13

14 Mortality CONTROLLABLE RISK AND PROTECTIVE FACTORS While death is an inevitable part of life, there are some health behaviors that can put one at risk for premature death. In contrast, other health behaviors may be protective and may prevent premature death. The following is a list of some risk and protective factors for causes of death presented in this report. CONTROLLABLE RISK FACTORS PROTECTIVE FACTORS HEART DISEASE - sedentary lifestyle - increasing physical activity - high blood cholesterol - lowering consumption of alcohol, - high blood pressure saturated fat and salt - being overweight - increasing consumption of fruits and - diabetes vegetables - stress - lowering stress - smoking - quitting smoking - drug use - not using illicit drugs - high blood cholesterol - high blood pressure - heart disease - smoking - recent heart attack - diabetes - stress - not wearing seatbelt - driving while intoxicated - driving while sleepy - driving while distracted - slippery surfaces - poor lighting - no smoke detector in home - not using bicycle helmets - not using protective devices while biking - unlocked (and loaded) firearm in the home - unprotected sexual intercourse - multiple sex partners - sharing needles CEREBROVASCULAR DISEASE (STROKE) INJURIES/ACCIDENTS HIV/STDs - increasing physical activity - lowering consumption of alcohol, saturated fat and salt - quitting smoking - increasing consumption of fruits and vegetables - lowering stress - wearing a seatbelt - avoiding alcohol consumption before or while driving - being aware of your surroundings - keeping surfaces clean, well lit and free of ice or debris - installing a smoke detector with working batteries in homes - using bicycle helmets or sport protective devices - locking up (and unloading) firearms - taking a firearms safety course - using a latex condom - abstinence or reducing the number of sex partners - avoiding needle sharing 14 eport

15 Mortality CONTROLLABLE RISK FACTORS PROTECTIVE FACTORS FLU/PNEUMONIA - contact with infected persons - flu/pneumonia vaccine - poor diet - avoiding contact with infected persons - chronic illness - good diet - high stress - frequent handwashing - smoking - keeping stress levels low - avoiding smoking or second hand smoke - being overweight/obesity - sedentary lifestyle - smoking - chronic respiratory infections - air pollution - allergies DIABETES - increasing physical activity - lowering consumption of alcohol, saturated fat and salt - increasing consumption of fruits and vegetables CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) - quitting smoking - avoiding environments that cause irritation to the lungs - treating bronchitis promptly - living healthy lifestyle (proper diet, exercise and rest) - hopelessness - alcohol and/or substance abuse - chronic illness - barriers to accessing mental health treatment - relational, social, work, or financial loss - isolation, feeling cut off from other people - easy access to highly lethal methods of suicide, especially guns - high fat, low fiber diet - smoking or second hand smoke - obesity - late childbearing/childlessness - exposure to asbestos, radiation Table 7. Epidemiology Unit, East Metro District SUICIDE CANCER - effective and appropriate treatment for mental, physical and substance abuse disorders - learning problem solving, conflict resolution, and coping skills - having access to strong social support system - restricted access to highly lethal methods of suicide - proper diet - quitting smoking - regular check-ups and self exams - reducing exposure to potential toxins eport 15

16 Mortality Leading Causes of Death, Percentage of Total Deaths Gwinnett County, Other accidents & adverse effects 7.5% Cerebrovascular Disease 8.1% Pneumonia/Influenza 3.9% COPD 6.6% Diabetes 3.2% Suicide 3.0% Nephritis, nephrotic syndrome & nephrosis 1.6% Septicemia 1.5% Malignant Neoplasms 31.4% Heart disease 33.1% Figure 7. Epidemiology Unit, East Metro District Note: See table on page 29 for age-specific rankings for leading causes of death. Ø Chronic diseases account for four out of five of the leading causes of death for Gwinnett County for s , as well as two of the top five leading causes of premature death. LEADING CAUSES OF PREMATURE DEATH Based on Years of Potential Life Lost (YPLL) Gwinnett County, #1 Accidents and Adverse Effects (including motor vehicle accidents) 16,794 #2 Cancer 15,739 Table 8. Epidemiology Unit, East Metro District Ø Accidents and adverse effects top the list of leading causes of premature death. The majority of deaths due to accidents and adverse effects occur in younger age groups, therefore contributing a greater number of s of potential life lost. #3 Heart Disease 10,523 #4 Suicide 6,703 #5 HIV/AIDS 3,725 Deaths prior to age 65 are included in YPLL calculations. Table 9. Epidemiology Unit, East Metro District 16 eport

17 Mortality Ø Cancer and heart disease are the top two causes of death for all four racial and ethnic groups listed here; however, the percentage of deaths for cancer and heart disease differs by racial and ethnic group. Ø Accidents and adverse effects ranked third or fourth for all four racial and ethnic groups listed here. The percentages, however, vary considerably by racial or ethnic group. Ø HIV/AIDS appears in the top ten list for Blacks and Hispanics, but not for Whites or Asians. Ø Homicide and legal intervention appear on the top ten list for all racial and ethnic groups except for Whites. LEADING CAUSES OF DEATH Gwinnett County, Whites 1. Heart Disease 26.0% 2. Cancer 24.7% 3. Cerebrovascular Disease (Stroke) 6.2% 4. Accidents and Adverse Effects 5.5% 5. COPD 5.3% 6. Pneumonia and Influenza 3.2% 7. Diabetes 2.5% 8. Suicide 2.4% 9. Nephritis, nephrotic syndromes 1.3% and nephrosis 10. Septicemia 1.2% Percentage of all deaths to Whites, * Table 10. Epidemiology Unit, East Metro District LEADING CAUSES OF DEATH Gwinnett County, Blacks 1. Heart Disease 2% 2. Cancer 18.9% 3. Accidents and Adverse Effects 10.4% 4. Cerebrovascular Disease (Stroke) 5.3% 5. Conditions Originating in the Perinatal Period 4.9% 6. HIV/AIDS 4.3% 7. Homicide and Legal Intervention 4.2% 8. Diabetes 3.2% 9. Congenital Anomalies 2.5% 10. COPD 2.4% Percentage of all deaths to Blacks, * Table 11. Epidemiology Unit, East Metro District LEADING CAUSES OF DEATH Gwinnett County, Hispanics 1. Cancer 19.3% 2. Heart Disease 18.8% 3. Accidents and Adverse Effects 17.4% 4. Homicide and Legal Intervention 8.2% 5. Conditions Originating in the Perinatal Period 5.3% 6. Cerebrovascular Disease (Stroke) 4.3% 7. HIV/AIDS 3.9% 8. COPD 1.9% Pneumonia and Influenza 1.9% Diabetes 1.9% Congenital Anomalies 1.9% Percentage of all deaths to Hispanics, * Table 12. Epidemiology Unit, East Metro District LEADING CAUSES OF DEATH Gwinnett County, Asians 1. Cancer 24.4% 2. Heart Disease 23.0% 3. Cerebrovascular Disease (Stroke) 7.6% Accidents and Adverse Effects 7.6% 5. COPD 4.1% Homicide and Legal Intervention 4.1% 7. Suicide 3.8% 8. Conditions Originating in the Perinatal Period 2.7% 9. Congenital Anomalies 2.4% 10. Diabetes 2.1% Percentage of all deaths to Asians, * Table 13. Epidemiology Unit, East Metro District *Due to rounding and inclusion of approximately the top ten causes of death, percentages may not total 100%. eport 17

18 Mortality HEART DISEASE Heart disease includes acute rheumatic fever, chronic rheumatic heart disease, hypertensive disease, diseases of pulmonary circulation, other forms of heart disease, and diseases of the arteries, capillaries and veins. Ø Heart disease was the top cause of death for s and the third leading cause of premature death for s (see page 50) Ø For s : heart disease was the leading cause of death for ages and ages 85+; the second leading cause of death for ages 45-54, 55-64, and 65-74; and the third leading cause of death for ages (see page 29) Deaths due to Heart Disease Gwinnett County, Adjusted Rate Adjusted Rate HP 2010 Objective Ø There has been slight overall decrease in the heart disease death rate from 1994 to Despite this decrease, the rate (when adjusted to the 2000 population) exceeds the y People 2010 objective: no more than deaths per 100,000 due to heart disease. Figure 8. Epidemiology Unit, East Metro District Ø From 1994 to 1999, Gwinnett consistently had lower heart disease death rate than the State. This may be due, in part, to Gwinnett s population distribution. Gwinnett has a smaller percentage of older people than the State. Deaths due to Heart Disease Gwinnett County & Georgia, Figure 9. Epidemiology Unit, East Metro District age-adjusted to 2000 population Gwinnett County Georgia eport

19 Mortality CEREBROVASCULAR DISEASE (STROKE) Ø Cerebrovascular disease (stroke or brain attack) is the third leading cause of death for s Since this disease primarily affects older adults, it does not rank in the top five causes of premature death for (see page 50) Ø Stroke is the third leading cause of death for ages and ages 85+. It is the fourth leading cause of death for ages and for s (see page 29) Deaths due to Cerebrovascular Disease (Stroke) Gwinnett County, Adjusted Rate Adjusted Rate HP 2010 Objective Ø From 1994 to1998, Gwinnett had cerebrovascular death rate higher than the y People 2010 objective. There has been a steady decrease since 1996 and in 1999 Gwinnett came close to achieving the y People 2010 objective. Figure 10. Epidemiology Unit, East Metro District Ø From 1994 to 1999, there has been a small fluctuation in the rates of death due to cerebrovascular disease for both Gwinnett and Georgia. Gwinnett, however, continues to have a rate lower than the State for all s from 1994 to Deaths due to Cerebrovascular Disease (Stroke) Gwinnett County & Georgia, age-adjusted to 2000 population Gw innett County Georgia Figure 11. Epidemiology Unit, East Metro District eport 19

20 Mortality MALIGNANT NEOPLASMS (CANCER) Cancer is the uncontrolled growth and spread of abnormal cells. There may be as many as 200 different kinds of malignant neoplasms, including leukemias. Ø Cancer was the second leading cause of death for s It was also the second leading cause of premature death for the same time period. (see page 50) Ø Cancer was the leading cause of death for four age groups for s : ages 35-44, 45-54, 55-64, and It was the second leading cause of death for another four age groups for the same time period: ages 1-4, 5-14, 75-84, and 85+. This means that cancer is either the leading or second leading cause of death for 8 of 11 age groups for s The only age groups in which cancer does not rank as highly are ages and (see page 29) Percent of Deaths by Type of Malignant Cancer Gwinnett County, All Other Malignant Sites 38.4% Leukemia 4.0% Prostate 5.0% Figure 12. Epidemiology Unit, East Metro District does not include benign neoplasms Stomach Colon 2.2% 7.7% Pancreas 4.8% Ovary 2.6% Breast 9.1% Trachea, Bronchus, Lung 26.2% Ø Cancer of the trachea, bronchus, and lung account for over one-quarter of all cancer deaths for s This is almost three times the rate of the next highest ranking cancer, breast cancer. Many cases of lung cancer could be prevented or delayed by reducing or eliminating the use of tobacco products or exposure to second-hand tobacco smoke. LEADING CANCER DEATHS Percent of cancer deaths by individual cancers Gwinnett County, Trachea, Bronchus & Lung 26.2% 2. Breast 9.1% 3. Colon 7.7% 4. Prostate 5.0% 5. Pancreas 4.8% 6. Leukemia 4.0% 7. Ovary 2.6% 8. Stomach 2.2% Ranked by total number of cancer deaths Table 14. Epidemiology Unit, East Metro District 20 eport

21 Mortality Deaths due to Malignant Neoplasms (Cancer) Gwinnett County, Adjusted Rate Adjusted Rate HP 2010 Objective Ø From 1994 to 1998, there was an overall decrease in the rate of deaths due to cancer. From 1998 to 1999 the rate increased slightly, but the increase may be due, in part, to changes in the way deaths are coded. As data from future s becomes available, a better trend can be established. Figure 13. Epidemiology Unit, East Metro District Ø From 1994 to 1999, Gwinnett consistently had a lower cancer death rate than the State. From 1994 to 1998, Gwinnett experienced a sharper decline in the cancer death rate than the State Deaths due to Malignant Neoplasms (Cancer) Gwinnett County & Georgia, age -adjusted to 2000 population Gw innett Georgia Figure 14. Epidemiology Unit, East Metro District eport 21

22 Mortality CANCER INCIDENCE DATA Ø These numbers show the rates of (new) cancer diagnoses for Gwinnett for s Ø Males have a higher incidence rate than females for all cancer sites, cancer of the lung and bronchus, and cancer of the colon and rectum. Ø For both males and females, Blacks have a higher incidence rate than Whites for most cancers listed. Malignant Cancer Incidence Rates by Site Gwinnett County, MALES All Races Whites Blacks All Sites Lung and Bronchus Colon and Rectum *** Prostate FEMALES All Races Whites Blacks All Sites Lung and Bronchus *** Colon and Rectum Breast Cervix *** *** Less than 20 cases reported, rates not calculated Rates are per 100,000 and age-adjusted to the 1970 U.S. Standard Table 15. Georgia Division of Public Cancer Incidence Rates Gwinnett County, rates age-adjusted to 1970 U.S. standard Male Female Ø For all cancers combined, , males have a higher incidence rate than females. Ø There is not a clear trend for cancer incidence for either males or females from 1980 to Figure 15. Georgia Division of Public 22 eport

23 Mortality HIV/AIDS Human Immunodeficiency Virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). HIV is transmitted by contact with infected blood or body fluids, typically through sexual intercourse or sharing needles. According to CDC: Since 1992, scientists have estimated that about half the people with HIV develop AIDS within 10 s after becoming infected. This time varies greatly from person to person and can depend on many factors, including a person s health status and their health-related behaviors. Ø HIV/AIDS does not currently rank in the top ten overall causes of death for s It does, however, rank as the fifth leading cause of premature death for the same time period. (see page 50) Ø HIV/AIDS was the third leading cause of death for ages and the fourth leading cause of death for ages for s (see page 29) Ø While the rate of death from HIV/AIDS is declining or remaining relatively constant, the number of newly diagnosed cases of HIV (incidence rate) continues to grow. Ø Improvements in HIV drugs have allowed those affected to live longer and healthier lives. This has lead to a lower death rate, but does not mean the disease has gone away. Deaths due to HIV/AIDS Gwinnett County, Adjusted Rate Adjusted Rate HP 2010 Objective Figure 16. Epidemiology Unit, East Metro District Ø Since 1994, the HIV/AIDS death rate has decreased with the most dramatic decline from 1995 to The decrease from 1998 to 1999 may be due, in part, to changes in death coding. Ø Despite the decreases, Gwinnett s HIV/AIDS death rate exceeds the y People 2010 objective. Ø HIV/AIDS death rate for Gwinnett continues to be smaller than the State rate for s Since 1994, Gwinnett s death rate due to HIV/ AIDS has decreased by almost two-thirds; Georgia s rate has decreased by one-half Deaths due to HIV/AIDS Gwinnett County & Georgia, age-adjusted to 2000 population Gw innett Georgia Figure 17. Epidemiology Unit, East Metro District eport 23

24 Mortality SUICIDE Suicide is an action usually caused by a complex combination of behavioral factors. According to the Surgeon General s Call to Action (1999), research shows that almost all people who kill themselves have a diagnosable mental or substance abuse disorder or both, and that the majority have depressive illness. Studies also indicate that the most promising way to prevent suicide and suicidal behavior is through the early recognition and treatment of depression and other psychiatric illnesses. Ø Suicide ranked as the eighth leading cause of death for s It was the fourth leading cause of premature death for the same time period. (see page 50) Ø Younger age groups tend to have the greatest number of suicide deaths. Suicide ranked as the second leading cause of death for age groups and and the third leading cause of death for age group 5-14 for s (see page 29) Ø Since 1994, the suicide death rate in Gwinnett has decreased. Despite the decreases, the suicide death rate exceeds the y People 2010 objective Deaths due to Suicide Gwinnett County, Adjusted Rate Adjusted Rate HP 2010 Objective Figure 18. Epidemiology Unit, East Metro District Deaths due to Suicide Gwinnett County & Georgia, age-adjusted to 2000 population Gw innett Georgia Figure 19. Epidemiology Unit, East Metro District Ø From , Georgia s rate of death due to suicide slightly exceeded Gwinnett s rate. Both Gwinnett and Georgia have experienced a slight decrease in suicide death rates since eport

25 Mortality ACCIDENTS AND ADVERSE EFFECTS (UNINTENTIONAL INJURIES) This category covers a wide variety of issues and circumstances including motor vehicle injuries, water injuries, poisonings, falls, fires, drownings, firearms, and other injuries. These are referred to as unintentional injuries, while suicide and homicide are referred to as intentional injuries. Ø Accidents and adverse effects (including motor vehicle accidents [MVA]) were the fourth leading cause of death for s (see page 50) Ø Accidents and adverse effects were the leading cause of premature death for s One of the reasons this occurs is the higher number of people in younger age groups that die from accidents and adverse effects each. (see page 50) Ø For age groups 1-4, 5-14, 15-24, and 25-34, accidents and adverse effects were the leading cause of death for s (see page 29) Deaths due to Accidents & Adverse Effects (including MVA) Gwinnett County, Figure 20. Epidemiology Unit, East Metro District 1940 Adjusted Rate Adjusted Rate HP 2010 Objective Ø From 1995 to 1998, Gwinnett experienced a decline in the rate of deaths due to accidents and adverse effects. At this time it is unknown whether the increase in 1999 is due to a true increase in deaths or due to changes in how deaths are coded. Additional s of data are needed to determine true changes in the trend. Ø From 1994 to 1999, Gwinnett s rate of death due to accidents and adverse effects was consistently lower than the State rates Deaths due to Accidents & Adverse Effects Gwinnett County & Georgia, age-adjusted to 2000 population Gwinnett Georgia Figure 21. Epidemiology Unit, East Metro District eport 25

26 Mortality PNEUMONIA AND INFLUENZA Pneumonia is a bacterial or viral infection that causes lung tissue to swell and fill with fluid. Primary pneumonia results from inhaling or aspirating the causative agent; however, secondary pneumonia may follow lung damage caused by the spread of bacteria from another area of the body or from noxious chemicals. Influenza, commonly known as flu, is a highly contagious viral infection of the respiratory tract that occurs most often in the winter and early spring. The virus is spread through the air and transmitted through inhaling droplets in the air or by handling items contaminated by an infected person. The flu most severely affects infants, the elderly, and people with chronic conditions. Ø Pneumonia and influenza were the sixth leading cause of death for s Together they rank as the twelth leading cause of premature death for the same time period. (see page 50) Ø Pneumonia and influenza have the greatest impact on populations that are very young or very old, but are particularly deadly among the elderly. Pneumonia and influenza were the fourth leading cause of death for age group 85+. They ranked fifth and sixth for age groups and respectively. (see page 29) Deaths due to Pneumonia & Influenza Ø From 1994 to 1998, the Gwinnett County, death rate due to pneumonia and influenza decreased slightly. The more dramatic decrease seen from 1998 to 1999 is most likely due to changes in how deaths are coded. Additional s of data are needed to establish a more accurate trend Adjusted Rate Adjusted Rate Figure 22. Epidemiology Unit, East Metro District Deaths due to Pneumonia & Influenza Gwinnett County & Georgia, age-adjusted to 2000 population Ø Georgia continued to have a higher rate of death due to pneumonia and influenza than Gwinnett for s Gw innett Georgia Figure 23. Epidemiology Unit, East Metro District 26 eport

27 Mortality CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) COPD is characterized by an increasing loss of elasticity in the lungs, usually resulting in a chronic cough, shortness of breath, and difficulty tolerating exercise; this condition may be persistent or episodic and recurrent. Ø COPD was the fifth leading cause of death for s COPD ranks as the tenth leading cause of premature death. (see page 50) Ø COPD was the third leading cause of death for age groups and and the fourth leading cause of death for ages for s (see page 29) Deaths due to COPD Gwinnett County, Figure 24. Epidemiology Unit, East Metro District 1940 Adjusted Rate Adjusted Rate HP 2010 Objective Ø Since 1994, the COPD death rate has continued to decrease, with the exception of Despite the slight increase in 1999, Gwinnett s rate remains well below the y People 2010 objective. Ø For s 1995 through 1997, Gwinnett and Georgia experienced similar rates of death due to COPD Deaths due to COPD Gwinnett County & Georgia, age-adjusted to 2000 population Gwinnett Georgia Figure 25. Epidemiology Unit, East Metro District eport 27

28 Mortality DIABETES Diabetes mellitus prevents the body from producing or properly using insulin which is needed to convert starches, sugars, and other foods into energy to fuel the body. Often people first become aware they have diabetes when they develop a life-threatening complication such as heart disease, stroke, blindness, kidney disease, or nerve disease. Diabetes can often be an underlying cause in deaths due to heart disease or stroke. Ø Diabetes was the seventh leading cause of death for s It was the ninth leading cause of premature death for the same time period. (see page 50) Ø Middle age and older populations have the highest rates of death due to diabetes. For age groups 45-54, and 75-84, diabetes was the sixth leading cause of death and the fifth leading cause of death for age group for s (see page 29) Ø The diabetes death rate for Gwinnett increased slightly from 1994 to The more significant increase from 1998 to 1999 may be due, in part, to changes in how deaths are coded. During this time Gwinnett s diabetes death rate remained well below the y People 2010 objective. Deaths due to Diabetes Gwinnett County, Adjusted Rate Adjusted Rate HP 2010 Objective Figure 26. Epidemiology Unit, East Metro District Deaths due to Diabetes Gwinnett County & Georgia, age-adjusted to 2000 population Gw innett Georgia Figure 27. Epidemiology Unit, East Metro District Ø Both Gwinnett and Georgia have experienced increases in death rates due to diabetes from 1994 to In 1999, Gwinnett s rate of deaths due to diabetes exceeded that of the State. Additional s of data are necessary to determine whether this is a new trend or whether it is due to changes in how deaths are coded. 28 eport

29 Rank Gwinnett County, Leading Causes of Death ( ) Ranked by Number of Deaths Age Groups < eport Perinatal Conditions Congenital Anomalies Accidents & Adverse Effects (3)**,*** Heart Disease (3) Accidents & Adverse Effects*** Cancer (2)** Congenital Anomalies (2)** Accidents & Adverse Effects*** * * * Causes of death in which there were less than 5 deaths were not included in these analyses. Those excluded deaths are indicated by the gray areas. ** Diseases which have the same number of deaths as the disease listed directly above/below it. The number in parenthesis is the rank in which they are tied. *** Accidents & Adverse Effects includes ICD9 codes , This includes unintentional injuries as well as misadventures to patients during surgical and medical care, surgical and medical procedures as the cause of abnormal reaction of patient or later complication, and drugs, medicinal and biological substances causing adverse effects in therapeutic use. Figure 28. Epidemiology Unit, East Metro District Accidents & Adverse Effects*** Accidents & Adverse Effects*** Cancer Suicide Suicide Suicide Homicide HIV Heart Disease 5 * * * Cancer 6 * * * * Cancer Cancer Cancer Cancer Accidents & Adverse Effects*** Heart Disease Heart Disease Accidents & Adverse Effects*** Cancer HIV Stroke Heart Disease (5)** Homicide (5)** 7 * * * * Stroke Heart Disease Heart Disease Heart Disease Cancer Heart Disease Cancer COPD COPD Stroke Stroke Accidents & Adverse Effects*** Stroke Suicide Suicide Stroke Diabetes Chronic Liver Disease (6)** Homicide (6)** Diabetes Chronic Liver Disease 8 * * * * * Stroke COPD 9 * * * * * Diabetes HIV 10 * * * * * Total All Causes Pneumonia & Influenza Nephritis, Nephrotic Syndrome, Nephrosis Diabetes Suicide Chronic Liver Disease Pneumonia & Influenza Nephritis, Nephrotic Syndrome, Nephrosis Pneumonia & Influenza Accidents & Adverse Effects*** Nephritis, Nephrotic Syndrome, Nephrosis COPD Pneumonia & Influenza Diabetes Accidents & Adverse Effects*** Nephritis, Nephrotic Syndrome, Nephrosis Pneumoni & Influenz COPD Alzheimer Accidents Adverse Effects** Diabetes Septicemia Alzheimer s Septicemi Chronic Liver Disease Septicemia Hypertensi Mortality

30 Maternal and Child INFANT MORTALITY RATE Infant mortality is death that occurs in a child during the period from birth through 364 days of life. Infant mortality is sometimes divided into two categories: neonatal death and post-neonatal death. Neonatal death is a death that occurs to a live born infant who is less than 28 days. Post-neonatal death is a death that occurs to an infant who is between 28 and 364 days old. Ø Gwinnett s infant mortality rate from 1994 to 1999 exceeds the y People 2010 objective (in all infants less than one, no more than 4.5 infant deaths per 1,000 live births). Ø The closest Gwinnett has come to achieving this objective was in 1998 when the infant mortality rate fell to 4.6 deaths per 1,000 live births. Ø From 1994 to 1999, there has been a slight decrease in infant mortality rate, with 1994 recording the highest rate and 1998 the lowest rate of the six- period. rate per 1,000 live births Infant Mortality Rates (Infants <1 Year) Gwinnett County, Neonatal Post-Neonatal Total Infant <1Year y People n/a n/a Figure 29. Epidemiology Unit, East Metro District n/a = not available rate per 1,000 live births Infant Mortality Rates (Infants <1 Year) Gwinnett County, Black White Total Figure 30. Epidemiology Unit, East Metro District n/a = not available n/a n/a Ø From 1994 to 1998, Blacks had higher infant mortality rates than Whites with the exception of The infant mortality rate for both groups has decreased from 1994 to eport