Status of Health in DeKalb Report opportunities for prevention and community service

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1 2005 Status of Health in DeKalb Report opportunities for prevention and community service Presented by the Status of Health in DeKalb Committee and the DeKalb County Board of Health

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3 2005 Status of Health in DeKalb Report opportunities for prevention and community service For updates on the Status of Health in DeKalb Report, visit DeKalb County Board of Health online at

4 Acknowledgements The DeKalb County Board of Health and the Status of Health in DeKalb Committee would like to thank the following individuals for their time and expertise in the creation of this report: Data analysis and report development by the Division of Health Assessment and Promotion and the Center for Public Health Preparedness: Chris Crane Sara Forsting, M.S.P.H. Charlie Ishikawa, M.S.P.H. Mary Patrick, M.P.H. Van Tong, M.P.H. Design and production by the Office of Public Relations: James Carver Vickie Elisa Beth Ruddiman, M.S. Julie Smith Contributors and expert reviewers: Elise M. Beltrami, M.D., M.P.H. Jyotsna M. Blackwell, M.P.H. Robert Blake, M.P.H. Stuart Brown, M.D. Janice Buchanon, M.A. Ryan Cira, M.P.H. Kathleen Collomb Susan Cookson, M.D., M.P.H. Frank Coye, M.A. Teresa Daub William Dyal Christena Hancock Christopher Holliday, M.P.H. Edna Holloway, M.Ed. Marlon Hunter, M.A. Mohamed Koita Alawode Oladele, M.D., M.P.H. Ariane Reeves, R.N. Mehrdad Sabzehi Marie Jose Schwartz, R.N., M.P.H. Robin Tanner Robert Taylor, M.Ed. Ann Ussery-Hall, M.P.H. Scott Wetterhall, M.D., M.P.H. Sharon Wilson, M.S.P.H. The DeKalb County Board of Health and the Status of Health in DeKalb Committee also thank the Healthy DeKalb Steering Council and the North DeKalb Health Center Advisory Board for reviewing the report. We offer special recognition to the following community members for their constructive feedback: Fred Agel Kathy Brooks Carolyn Galvin Arlene Parker Goldson Victor Lui, M.D. Melissa Manrow Nynikka Palmer Alice Smith Paula Swartzberg Tingsen Xu, M.D.

5 The DeKalb County Board of Health Crawford Lewis, Ph.D. Leonard Thrower Vernon Jones Darold Honore / County school superintendent; ex officio Consumer representing the needy, underprivileged or elderly Chief executive officer of DeKalb County; ex officio Chief executive officer of any municipality in county appointed by county governing authority; mayor of Lithonia J. Frederick Agel Anthony George, Jr. Victor Lui, M.D. Consumer appointed by county governing authority; chair Public health consumer appointed by governing authority of largest municipality; appointed by the mayor of Atlanta; vice chair Physician appointed by county governing authority "Here for Your Health" At the DeKalb County Board of Health, we envision safe, healthy communities in which all individuals have access to quality, affordable health services. Our mission is to promote and provide quality preventive and primary care. The prevention of disease, injury, disability and premature death is the primary purpose of the DeKalb County Board of Health. We unite individuals, families and communities to serve the people who live, work and play in DeKalb. Stuart Brown, M.D. Interim Director DeKalb County Board of Health

6 In Memory of Two Staunch Public Health Supporters Manuel Maloof Member of the DeKalb County Board of Health from 1981 to 1992, both as a County Commissioner and as the County Chief Executive Officer Mr. Maloof tackled tough issues in human services by appointing task forces to study day care, affordable housing and the problems of youth and the elderly. His personal concern over teenage pregnancy led to the creation of the Task Force on Teenage Pregnancy, staffed by a full-time coordinator. It would be difficult to find an elected official with more compassion and understanding of health care for needy populations. Mr. Maloof was unyielding in his advocacy and used his official position to provide support for important health initiatives. He was a man with very strong convictions and a soft and caring heart. He will be missed by all who had the privilege of knowing him. Lou Walker DeKalb County Commissioner, Super District 7, Commissioner Walker was elected to the Board of Commissioners in a special election in August A long-time community activist, Commissioner Walker lived and worked in the south DeKalb community for more than 25 years. A former member of the DeKalb County Primary Care Task Force, he supported the DeKalb clean indoor air ordinance. Commissioner Walker will be missed, but he leaves a legacy of service to this community.

7 Table of Contents Introduction Demographics of DeKalb County 2000 U.S. Census data 2 Public schools in DeKalb County 3 Community Health Assessment Areas 4 Health priority areas Nutrition and physical activity 8 Tobacco use prevention 10 Injury prevention 11 Health disparities elimination 13 Trends in births and teen pregnancies Live births 16 Teen pregnancy 16 Health behaviors Youth Risk Behavior Survey 20 Behavioral Risk Factor Survey 21 Infectious diseases and leading causes of hospitalizations Infectious diseases 24 Vaccine-preventable diseases 24 Immunization coverage 25 Hepatitis A 25 Gastrointestinal infections 26 Sexually transmitted diseases 26 Tuberculosis 27 HIV/AIDS 27 Leading causes of hospitalizations 29 Causes of death Leading causes of death 32 Infant mortality 32 Adults age 65 and over 35 Leading causes of premature death, ages Trends over time 36 Trends by race/ethnicity and gender 37 County-wide trends and community-specific rates 43 Opportunities for prevention Appendices Methodology 68 Glossary of terms 71 References Status of Health in DeKalb Report, 2005

8 Introduction Developing and sustaining a healthy community requires the efforts of many diverse civic, commercial and community organizations, as well as the efforts of individuals who live, work and play in DeKalb County. An essential function of county boards of health is to assess the status of health in their communities and to present this information to the public in order to identify opportunities for health promotion and disease prevention. This report is the sixth in a series produced by the DeKalb County Board of Health that describes time and geographic patterns of diseases and injuries, birth trends, leading causes of death and premature death, and health behaviors. The purpose of the Status of Health report series is to identify priority areas for health improvement and to serve as a catalyst for community action. In 1990, the DeKalb County Board of Health established the Status of Health Committee to provide a community voice in setting health priorities for the county. The purpose of the Status of Health Committee is to assist in the assessment and analysis of community health needs and risk factors, to facilitate community-based interventions, to evaluate the interventions and to promote broad implementation of effective interventions. The Small Grants Program was created by the Status of Health Committee to stimulate and support grassroots prevention. Since 2001, the Small Grants Program has focused its efforts on promoting healthy eating and physical activity and reducing tobacco use among school-aged children. This program, now based in schools, begins with a school self-assessment, using the Centers for Disease Control and Prevention s School Health Index for Physical Activity, Healthy Eating and Tobacco Free Lifestyle. Schools use the index as a self-assessment and planning tool to improve their health and safety policies and programs. After completing the assessment, they develop action plans for improving school health that have been funded through competitive grants awarded by the DeKalb County Board of Health. To date, 40 schools have received funds through this program. In addition, the DeKalb County Board of Education has adopted physical education and nutrition policy changes and procedure revisions to support schools in their health improvement efforts. In 2001, DeKalb County began a community-wide strategic planning process for health improvement. This effort led to Healthy DeKalb, which has a vision of healthy people living in healthy communities. Participants in this planning process reviewed data and trends in health status, developed action plans and encouraged community collaboration to positively impact health. Healthy DeKalb identified three strategic issues: (1) healthy behaviors, (2) health disparities and (3) strengthening community partnerships for healthy communities. Status of Health in DeKalb Report, 2005

9 Action groups were established to develop, implement and evaluate activities to support progress toward these strategic issues. The Physical Activity and Nutrition Action Group seeks to improve behaviors to reduce obesity, to improve nutrition and to increase physical activity. In addition, this group endorses efforts to reduce tobacco use behaviors. The Cultural Competency and Disparities Action Group focuses on improving cultural competency among health care providers serving immigrant and refugee populations and supports efforts to reduce health disparities. The Community Network Committee has sought to strengthen partnerships to improve progress toward community health goals. The 2005 Status of Health in DeKalb Report analyzes available data through 2003 on the leading health issues and some of the risk factors associated with these issues in DeKalb County. This report emphasizes information related to identified priority areas and provides specific opportunities for prevention in these areas. Status of Health in DeKalb Report, 2005

10 Status of Health in DeKalb Report, 2005

11 Demographics of DeKalb County 2000 U.S. Census Data Public schools in DeKalb County Community Health Assessment Areas

12 2000 U.S. Census Data Based on the 2000 U.S. Census, DeKalb County has grown and become more racially and ethnically diverse since The total population of DeKalb County grew 22% from 545,837 in 1990 to 665,865 in 2000 (Table 1). The proportion of males to females has remained the same, with 52% of the population female. The population aged 65 years and over grew the least at 15% compared to growth of the population of other ages. The 2000 Census was modified from previous censuses to allow respondents to check more than one race and also divided the Asian and Pacific Islander group into two separate groups: (1) Asian and (2) Native Hawaiian and Other Pacific Islander. As a result, the data on race in the 2000 Census are not directly comparable to those collected in previous years, and changes in population by race may be a result of changes in the classification of the race categories. In 2000, 14,121 (2%) of DeKalb residents identified themselves as more than one race. The Hispanic population more than tripled from 15,619 in 1990 to 52,542 in Asians and Pacific Islanders, blacks, and American Indians and Alaska Natives also experienced an increase in population from 1990 to Table 1. Demographic characteristics of DeKalb County residents from the 1990 and 2000 U.S. Census DeKalb County, Georgia % change General Characteristics Total Population 545, ,865 22% Male 261, ,780 23% Female 284, ,085 21% Under 5 years 38,657 47,357 23% 5 to 17 years 90, ,621 28% 18 to 64 years 369, ,663 21% 65 years and over 46,456 53,224 15% Race: White 292, ,521-18% Black or African American 230, ,111 57% American Indian and Alaska Native 998 1,548 55% Asian and Pacific Islander* 16,266 27,047 66% Other races 5,838 23, % Two or more races** - 14,121 Hispanic or Latino (of any race) 15,619 52, % Average household size % Average family size % Social Characteristics % High school graduate or higher (25 and older) 83.9% 85.1% 1% % Bachelor's degree or higher (25 years and older) 32.7% 36.3% 11% % Foreign Born 6.7% 15.2% 127% % Speak a language other than English at home (5 years and older) 8.6% 17.4% 102% Economic Characteristics In Labor Force (16 years and older) 318, ,086 15% Median household income (dollars) 35,721 49,117 38% Median family income (dollars) 41,495 54,018 30% Per capita income (dollars) 17,115 23,968 40% *Includes Native Hawaiian **New to the 2000 Census Data Source: U.S. Census Bureau 2 Status of Health in DeKalb Report, 2005

13 There was no change in the proportion of residents who were high school graduates. The proportion of residents who had a bachelor's degree or higher increased 11% from 1990 to DeKalb County had an influx of immigrants and refugees during this time period. The proportion of the population that identified themselves as foreign-born more than doubled from 6.7% in 1990 to 15.2% in In addition, the proportion of people who spoke a language other than English at home also more than doubled from 8.6% in 1990 to 17.4% in Public Schools in DeKalb County In the academic school year, a total of 104,490 students were enrolled in the public schools in DeKalb County (Table 2). The majority of students were black/african American (78%), twice the state proportion. DeKalb had a higher proportion of students who have limited English proficiency, are eligible for free/reduced meals and are economically disadvantaged compared to the state. The DeKalb graduation rate and average SAT score were lower than the state averages, and the average SAT score was lower than the national average score of Table 2. Profile of Public Schools in DeKalb County* Academic School Year Demographics and Other Factors DeKalb State Total enrollment 104,490 1,496,012 Male 51% 51% Female 49% 49% Asian/Pacific Islander 3% 2% Black/African American 78% 39% Hispanic 6% 7% Multiracial 2% 2% Native American <1% <1% White/Non-Hispanic 10% 50% Students with disabilities 10% 13% Limited English proficiency 11% 4% Eligible for free/reduced meals 59% 45% Economically disadvantaged 57% 44% Students absent 15 or more days 13% 14% Graduate rate 59% 63% Average SAT score * Includes DeKalb County School System, City of Decatur Schools and Alonzo A. Crim High School feeder school system of the Atlanta Public Schools Data Source: Governor's Office of Student Achievement Status of Health in DeKalb Report,

14 Community Health Assessment Areas The Board of Health has divided the county into 13 geographic areas called Community Health Assessment Areas, or CHAAs (see Methodology section), for the purposes of health planning. These areas are based on natural communities of the local DeKalb County high schools. The demographic profile of the CHAAs is provided in Table 3. Since the Board of Health first began using CHAAs to display geographic differences in health status, there have been changes in the distribution of high schools in DeKalb County. For example, Shamrock and Henderson high schools are now middle schools, and Martin Luther King, Jr. and Stephenson are new high schools. The original census tracts for the CHAAs, based on the school districts, continue to be used in this report to compare health status trends by communities over time (Figure 1). Table 3. Demographic profile of DeKalb Community Health Assessment Areas (CHAAs) from the 2000 U.S. Census DeKalb County, Georgia, 2000 Community Health 2000 Population % All % Hispanic % White % Black Assessment Areas # % Others Ethnicity Atlanta 28, % Avondale/Towers/Columbia 70, % Chamblee/Cross Keys 85, % Clarkston 30, % Decatur 18, % Druid Hills/Lakeside 75, % Dunwoody 43, % Lithonia 63, % McNair/Cedar Grove 65, % Redan 51, % Southwest DeKalb/MLK Jr. 32, % Stone Mountain/Stephenson 43, % Tucker 57, % Total 665, % Data Source: U.S. Census Bureau 4 Status of Health in DeKalb Report, 2005

15 Figure 1. Status of Health in DeKalb Report,

16 6 Status of Health in DeKalb Report, 2005

17 Health Priority Areas Nutrition and physical activity Tobacco use prevention Injury prevention Health disparities elimination

18 Nutrition and Physical Activity Lifestyle choices made early in life have a significant impact on the patterns of chronic disease developed in adulthood. In the U.S., poor diet and physical inactivity lead to 300,000 deaths each year second only to tobacco use (1). People who are overweight or obese increase their risk for cardiovascular disease, diabetes, high blood pressure, arthritis-related disabilities and some cancers. Chronic diseases are the leading causes of death among DeKalb residents. In 2002, cancer, cardiovascular disease, diabetes and liver disease accounted for 51% of premature deaths (death before age 65) and 10,043 years of potential life lost (1,642 years per 100,000 population). 1 Avoiding alcohol, tobacco and other drugs; choosing healthy diets (e.g., increasing fruit and vegetable consumption) and engaging in regular physical activity (30 minutes per day at least five days per week) substantially improves health. Compared to national averages, DeKalb County high school students, grades 9-12, are overweight, have poorer dietary habits and are less physically active (2). In 2003, 17% were overweight, and 12% of students were 2,3 obese (Figure 2). Hispanic students (21%) were more likely to be obese than other races/ethnicities. Eightythree percent (83%) of high school students did not eat at least five fruits and vegetables per day (compared to the U.S. rate Figure 2. Overweight and obesity among DeKalb County high school students DeKalb County, Georgia, 2003 Total Male Female White Black Hispanic All other races Multiple races Overweight Obese Percent Data Source: DeKalb County Youth Risk Behavior Survey, 2003 of 78%) (Figure 3). Female students were less likely to eat five or more fruits and vegetables per day compared to males. White and black students were less likely to eat five or more fruits and vegetables per day compared to other races/ethnicities. 1 Years of potential life lost (YPLL) is an index of premature death. It is calculated by subtracting the age of death from Overweight is defined as at or above the 85 th and below the 95 th percentile for body mass index by age and sex. 3 Obese is defined as at or above the 95 th percentile for body mass index by age and sex. 8 Status of Health in DeKalb Report, 2005

19 Only 23% of students engaged in moderate physical activity Figure 3. Nutrition and physical activity factors of DeKalb (compared to the U.S. rate of County high school students 25%), and 58% of students engaged in vigorous physical Total DeKalb County, Georgia, 2003 Ate 5 or more fruits and activity (compared to the U.S. Male vegetables 4,5 Moderate rate of 63%). Sixty-six percent Female physical activity (66%) of students did not attend White Vigorous physical activity physical education class on a Black daily basis (compared to the U.S. rate of 56%). In addition, 56% of students watched more Hispanic All other races Mutiple races than three hours a day of television (compared to the Percent Data Source: DeKalb County Youth Risk Behavior Survey, 2003 U.S. rate of 38%). The nutrition and physical activity behaviors indicate that our DeKalb youth are at increased risk for cardiovascular disease and cancer-related problems later in life. Approximately 35% of DeKalb County adults are overweight and 21% are obese (Figure 4) 6,7 (3). Thirty-six percent (36%) of adults reported trying to lose weight, and 60% were trying to maintain their current weight. Twenty-four percent (24%) of adults consumed five or more fruit and vegetable servings per day. Males and non-whites were least likely to consume five or more fruit and vegetable servings per day compared to females and whites. Seventy-two percent (72%) of DeKalb County adults reported that their jobs involved mostly sitting or standing. Twenty-two percent (22%) of adults reported being physically inactive outside of work. Less than half of adults reported that they engaged in vigorous physical activities (e.g., running, aerobics). Of these, males (57%) were more likely than females (36%) to engage in vigorous physical activity. Figure 4. Nutrition and physical activity, ages 18 and over percent of population % overweight % obese % > _ 5 fruit/veggie per day Data Source: DeKalb County Behavioral Risk Factor Survey, 2001 DeKalb County, Georgia, 2001 Total Male Female White Non-White % physically inactive 4 Moderate physical activity is defined as participation in physical activities that do not make individuals sweat or breathe hard for at least 30 minutes on five or more of the past seven days (e.g., fast walking, slow bicycling, skating, pushing a lawn mower or mopping floors). 5 Vigorous physical activity is defined as exercised or participated in physical activities for at least 20 minutes that made them sweat and breathe hard on three or more of the past seven days (e.g., basketball, soccer, running, swimming laps, fast bicycling, fast dancing or similar aerobic activities). 6 Overweight is defined as body mass index (BMI) greater than 25 kg/m 2 and less than 30 kg/m 2. To calculate your BMI, visit 7 Obese is defined as body mass index 30 kg/m 2 and greater. Status of Health in DeKalb Report,

20 Tobacco Use Prevention Each year, tobacco kills more than 10,000 Georgians and results in $2 billion in health care costs. Tobacco use has caused a tremendous burden of disease for DeKalb County residents. In 2002, tobacco-related diseases (cardiovascular disease; oral, throat and lung cancers; stroke; asthma and emphysema) caused 1,603 total deaths (40% of all deaths in DeKalb County) and nearly 5,500 years of potential life lost. 8 Figure 5. Tobacco use among DeKalb County high school students DeKalb County, Georgia, 2003 Female Fifty-one percent (51%) of DeKalb Hispanic County high school students have All other races tried smoking cigarettes, and Multiple races 10% report current cigarette use (Figure 5) (2). Males were Percent slightly more likely to try Data Source: DeKalb County Youth Risk Behavior Survey, 2003 smoking compared to females, and Hispanic students were significantly more likely to engage in cigarette smoking behavior compared to other races/ethnicities. Twenty percent (20%) of underage smokers (less than 18 years) purchase cigarettes at a store or gas station. Thirteen percent (13%) of DeKalb County high school students began smoking cigarettes before the age of 13 years. Total Male White Black Ever tried smoking Current tobacco use Thirty-five percent (35%) of DeKalb County adults (18 years and older) have smoked at least 100 cigarettes in their lifetime (Figure 6) (3). Seventeen percent (17%) of all DeKalb County adults currently smoke either every day or some days. The average age of initiation of smoking is 16 years, and the average age of initiation of regular smoking is 19 years. Of those who have smoked, just over half have quit, and of those who currently smoke, 61% have tried to quit within the past year. Figure 6. Adults who have smoked at least 100 cigarettes in their entire life DeKalb County, Georgia, 2001 Total Male Female White Non-White 18 to to to to to Percent Data Source: DeKalb County Behavioral Risk Factor Survey, The Status of Tobacco Control in DeKalb County 2003 is available at 10 Status of Health in DeKalb Report, 2005

21 Injury Prevention Injuries are a significant problem in DeKalb County. Unintentional injuries, suicide and homicide ranked in the top eight leading causes of premature death in DeKalb County from 1994 to Not only do injuries result in death, but injuries lead to disability, chronic pain, loss of normal functioning, and excessive medical and therapy costs. In 2002, injuries were the fourth leading cause of hospitalization. Fortunately, most injuries are preventable, and there are lifestyle and environmental changes that can reduce the chances of becoming injured (e.g., wearing seatbelts, using child safety seats, wearing a helmet, constructing pedestrian crosswalks, locking firearms). The leading cause of unintentional injuries in DeKalb County is motor vehicle crashes. From 1994 to 2002, a total of 821 DeKalb residents were killed in motor vehicle crashes. Each year, approximately 350 pedestrians are hit by a motor vehicle in DeKalb County. Between 2001 and 2003, 28% of 678 pedestrian/motor vehicle crashes occurred on five state highways in DeKalb: Buford Highway, Memorial Drive, Glenwood Road, Candler Road and Covington Highway (4). These five roads combined were responsible for 47% of the 62 pedestrian fatalities in the county. Since state highways represent only 8% of all roads in DeKalb County, these five highways account for an overburden of motor vehicle crashes and fatalities. Motor vehicle crashes are caused by a number of factors, such as driver distraction, speeding or reckless driving, or being under the influence of alcohol or drugs. Among DeKalb County high school students, 5% of students drove a vehicle when they had been drinking alcohol, and 24% rode in a vehicle driven by someone who had been drinking alcohol (2). Safety behaviors that can reduce serious injuries in an accident include wearing a seat belt and wearing a helmet when bicycling. However, 5% of students rarely or never wore a seatbelt when riding in a car, and 87% of students rarely or never wore a helmet when bicycling. Suicide claimed 1,384 years of potential life annually among DeKalb residents. A risk factor of suicide is feelings of depression. Twenty-nine percent (29%) of DeKalb high school students felt depressed, and 14% seriously considered attempting suicide in the past year. Though females were more likely to think about suicide and attempt suicide, males were more likely to die from suicide. Males lost 390 years of potential life compared to 85 years in females. Specifically, white males had the highest premature death rate compared to females and other races.. Status of Health in DeKalb Report,

22 Homicide claimed 2,779 years of potential life annually among DeKalb residents. Adolescents aged 13 to 19 years had a higher homicide mortality rate than other age groups (Figure 7). Homicide premature death rates were four to five times higher for black males than for white males or black females. High levels of violence were reported in DeKalb County high schools. Thirty-seven percent (37%) of students had a physical fight in the last year (compared to the U.S. rate of 33%), and 3% of students in fights required medical Figure 7. Nine-year age-specific mortality rates for homicide and suicide DeKalb County, Georgia, Deaths per 100,000 population Homicide Infancy (<1) Child (1-12) Adolescence (13-19) Early Adult (20-44) Middle Adult (45-59) Later Adult (60-74) Older Adult (75+) Suicide treatment. Students who were male, Hispanic or black were more likely to be in a fight than other students. Fifteen percent (15%) of students carried a weapon to school, and 6% of students did not go to school in the 30 days preceding the survey because they felt unsafe. Injuries are also a significant problem among the elderly in DeKalb County. Suicide mortality rates were the highest among this age group compared to other age groups (Figure 7). From 1994 to 2002, adults aged 75 and over had the highest mortality rate due to unintentional injury; 174 deaths per 100,000 population, which was four times higher than the age group with the second highest rate (Figure 8). Figure 8. Nine-year age-specific mortality rates for unintentional injuries Deaths per 100,000 population Infancy (<1) Child (1-12) Adolescence (13-19) Early Adult (20-44) Middle Adult (45-59) Later Adult (60-74) Older Adult (75+) DeKalb County, Georgia, Age group 12 Status of Health in DeKalb Report, 2005

23 Health Disparities Elimination A Healthy People 2010 goal is to eliminate health disparities among segments of the 9 population (5). Health disparities are differences in health status based on certain characteristics (race/ethnicity, gender, education, income, disability, geographic location, sexual orientation, etc.). Because of DeKalb County's diverse population, health disparities are priorities of concern. The following are examples of the notable health disparities in DeKalb County: South DeKalb: Based on 2000 U.S. Census data, communities in south DeKalb County have a higher proportion of African Americans, persons with lower educational attainment and lower economic status than the northern part of the county (Table 4). Communities in south DeKalb have a higher rate of premature death due to chronic diseases such as cancer, diabetes and heart disease. Overall, premature death rates from cancer are higher in blacks than whites. The premature death rate of diabetes is 1.7 times greater in south DeKalb when compared to the remainder of the county. The premature death rate for heart disease is 2.3 times higher for black females than for white females. North DeKalb: Communities in north DeKalb have a higher proportion of Hispanics and Asians than the southern part of the county. Residents in north DeKalb are more likely to be foreign-born, to speak a language other than English at home and to be linguistically isolated. Hispanic high school students are more likely to be overweight than other races/ethnicities and less likely to engage in vigorous physical activities. Hispanic students also report a higher percentage of current tobacco use. Hispanics and Asians face numerous challenges, such as language and cultural barriers and limited access to adequate health care. It is suspected that additional health disparities affect immigrants and refugees, but details are lacking because existing data sources do not record whether a person is an immigrant or refugee. Gender: Among all Community Health Assessment Areas (CHAAs), injuries and homicide are the leading causes of premature death among males, while cancer is the leading cause of premature death among females. This pattern of mortality may reflect riskier behaviors among males than females. Suicide: The rate of premature death from suicide is highest in the Chamblee/Cross Keys and Tucker CHAAs. Males had a premature death rate 4.6 times higher than females, and white males had the highest rate of suicide. Infant Mortality: Infant mortality is higher among blacks than any other race/ethnicity. The black infant mortality rate was 2.5 times higher than the white infant mortality rate. Infant mortality rates are highest in south DeKalb. 9 Healthy People 2010 is the prevention agenda for the United States. It is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats ( Status of Health in DeKalb Report,

24 HIV/AIDS: HIV/AIDS predominantly affects males and African Americans in DeKalb. From 1994 to 2002, the majority of AIDS cases were male (81%) and black (76%). From 1992 to 1999, males and blacks were more likely to test positive for HIV than females and other races. Table 4. Demographic characteristics of south versus north DeKalb County residents, Census 2000 South DeKalb * North DeKalb ** General Characteristics No. No. Total population 327, ,710 Race: White 34, ,141 Black or African American 280,252 80,859 American Indian and Alaska Native Asian and Pacific Islander 3,073 23,874 Other race 3,511 20,106 Two or more races 5,388 8,733 Hispanic or Latino (of any race) 7,537 45,005 Average household size Average family size No. family households (with >1 own children <18yrs) 52,169 35,796 Married couple family 27,192 23,259 Single parent (male) 3,779 2,934 Single parent (female) 21,198 9,603 Social Characteristics % High school graduate or higher (25 years and older) 67.5% 84.9% % Bachelor's degree or higher (25 years and older) 14.8% 46.2% % Foreign-born 14.7% 22.8% % Speak a language other than English at home (5 years and older) 8.2% 26.2% No. linguistically-isolated households (5 years and older) 1,837 10,836 Economic Characteristics In labor force (16 years and older) 170, ,983 Median household income 1999 $40,935 $51,619 Median family income 1999 $41,513 $58,788 Median per capita income 1999 $18,099 $30,486 No. households with public assistance income 3,310 2,133 * Includes Community Health Assessment Areas of Avondale/Towers/Columbia, Lithonia, McNair/Cedar Grove, Redan, Southwest DeKalb/MLK Jr. and Stone Mountain/Stephenson. ** Includes Community Health Assessment Areas of Atlanta, Decatur, Druid Hills/Lakeside, Clarkston, Dunwoody, Chamblee/Cross Keys and Tucker. Data Source: U.S. Census Bureau 14 Status of Health in DeKalb Report, 2005

25 Trends in Births and Teen Pregnancies Live births Teen pregnancy

26 Live Births The general fertility rate (GFR), used to measure birth rate of a population, takes into account the age and sex structure of the population and is defined as the total number of births per 1,000 females age 15 to 44 years. The total GFR for DeKalb increased 11% from 58.7 live births per 1,000 in 1994 to 65.2 in 2002 (Figure 9). Between 1994 and 2002, the average Hispanic GFR was live births per 1,000 compared to whites (59.5), blacks (65.1) and Asians (62.8). Figure 9. General fertility rate per 1,000 females age 15 to 44 years by race/ethnicity Rate per 1, DeKalb County, Georgia, Year Total White Black Hispanic Asian Teen Pregnancy Between 1994 and 2002, the total teen pregnancy rates of females aged 15 to 19 years declined in Georgia and nationally (6). In DeKalb County, the total teen pregnancy rate of females aged 10 to 19 years declined 31% from 55.1 pregnancies per 1,000 in 1994 to 38.2 pregnancies in 2002 (Figure 10). Hispanic teen pregnancies increased 37%, and whites and Asians had smaller increases. Black teen pregnancies decreased 42% between 1994 to The total live birth rate among females aged 10 to 19 years decreased 22% from 31.4 live births per 1,000 in 1994 to 24.5 in 2002 (Figure 11). Total teen abortion rates also declined 42% from 23 induced abortions per 1,000 females in 1994 to 13.4 per 1,000 in 2002 (Figure 12). 16 Status of Health in DeKalb Report, 2005

27 Figure 10. Pregnancy rate per 1,000 females age years by race/ethnicity DeKalb County, Georgia, Rate per 1, Year Total White Black Hispanic Asian Figure 11. Live birth rates per 1,000 females age years by race/ethnicity 100 DeKalb County, Georgia, Rate per 1, Year Total White Black Hispanic Asian Status of Health in DeKalb Report,

28 Figure 12. Induced abortion rates per 1,000 females aged years by race/ethnicity DeKalb County, Georgia, Rate per 1, Year Total White Black Hispanic Asian 18 Status of Health in DeKalb Report, 2005

29 Health Behaviors Youth risk behavior survey Behavioral risk factor survey

30 Youth Risk Behavior Survey, The 2003 DeKalb County Youth Risk Behavior Survey (YRBS) was conducted in the DeKalb County School System among students in grades 9 through 12. The survey assesses risky health behaviors contributing to the leading causes of illness, injury and death. The system monitors six categories of priority health-risk behaviors that contribute to: (1) unintentional injuries and violence, (2) tobacco use, (3) alcohol and other drug use, (4) sexual behaviors that contribute to unintentional pregnancy and sexually transmitted diseases, (5) unhealthy dietary behaviors and (6) physical inactivity. Table 5: Comparison of DeKalb Youth Risk Behavior Survey to State and National Results (%), 2003 Risk Behavior DeKalb Georgia National Unintentional injuries and violence Rarely/never wore seatbelt when riding in a car 5.4 a Rarely/never wore a bicycle helmet Carried a weapon in past 30 days 14.5 b Did not go to school on >1 of past 30 days because felt unsafe One or more physical fights during past 12 months 37.4 b Tobacco use Used any tobacco during past 30 days 13.6 a Smoked cigarettes on >1 of past 30 days 9.5 a Alcohol use Had at least one drink of alcohol on >1 day during lifetime 69.5 c Drank alcohol on >1 of past 30 days 28.7 a Sexual behaviors Have ever had sexual intercourse 53.3 c Had sexual intercourse for the first time before age 13 years 14.5 c Nutrition Ate >5 servings of fruits and vegetables per day 17.2 c Drank >3 glasses of milk per day 8.2 a Physical activity Participated in vigorous physical activity Participated in moderate physical activity Participated in insufficient amount of physical activity Watched >3 hours/day of TV 55.8 a a Result is statistically different from Georgia and National. Result is statistically different from Georgia. Result is statistically different from National. ---Data not available. Data Sources: DeKalb County Youth Risk Behavior Survey (2003), Georgia Student Health Survey Report (2003) and National YRBS (2003). 1 The DeKalb County Youth Risk Behavior Survey 2003 is available at 20 Status of Health in DeKalb Report, 2005

31 Behavioral Risk Factor Survey, 2001 Modeled after the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS), DeKalb County conducted its own Behavioral Risk Factor Survey in 2001 to provide county-level data about its residents aged 18 years and older. The survey focuses on individual behaviors linked to chronic diseases, such as lack of physical activity; eating high-fat, low-fiber diets; using tobacco and alcohol and lack of preventive medical care. Table 6. Comparison of DeKalb Behavioral Risk Factor Survey to State and National Results (%), 2001 Risk Behavior DeKalb Georgia National Health care access No health care coverage Of those with coverage, no coverage for any time during the past months Health status High blood pressure High blood cholesterol Diabetes Asthma Disabilities (physical, mental or emotional) Preventive services Blood cholesterol checked Received a flu shot in past 12 months Mammogram for females Clinical breast exam for females Pap smear for females Blood stool test Sigmoidoscopy or colonoscopy exam HIV test Nutrition Consumed 5 or more fruits and vegetables per day Physical activity Participated in vigorous physical activities Participated in moderate physical activities Participated in any physical activities Tobacco and alcohol use Currently smoke Binge drinking (5 or more drinks on an occasion) State data from 2002; National data from Data not available. Data Sources: DeKalb County Behavioral Risk Factor Survey (2001), Georgia BRFSS (2001) and National BRFSS (2001). Status of Health in DeKalb Report,

32 22 Status of Health in DeKalb Report, 2005

33 Infectious Diseases and Leading Causes of Hospitalizations Infectious diseases Vaccine-preventable diseases Immunization coverage Hepatitis A Gastrointestinal infections Sexually transmitted diseases Tuberculosis HIV/AIDS Leading causes of hospitalizations

34 Table 7. Number of selected vaccine-preventable diseases by year of diagnosis Infectious Diseases All Georgia laboratories, physicians and health care providers are required by law to report certain infectious diseases or conditions to their county, district or state health department (see for reporting requirements). This section provides an overview of some of the more commonly reported and/or important infectious diseases or conditions of DeKalb County residents between 1994 and Vaccine-Preventable Diseases In DeKalb County, the overall incidence of childhood vaccine-preventable disease was low across the ten-year period from 1994 to 2003 (Table 7). Six cases of Haemophilus influenzae Group B (Hib) have been reported since Four cases of measles have been reported since 1997; three cases were imported from other countries and one case could not be located for interview. On average, one case of mumps and five cases of pertussis (whooping cough) were reported each year. One case of imported rubella (German measles) was reported in Table 7. Number of selected vaccine-preventable diseases by year of diagnosis DeKalb County, Georgia, Disease Total Haemophilus influenzae (Grp B) Measles Mumps Pertussis Rubella Numbers in 2003 are based on data received by April 30, The 2003 rates are calculated based on population estimates in Status of Health in DeKalb Report, 2005

35 Immunization Coverage The Georgia Immunization Study assesses the immunization coverage rates of twoyear-old children throughout the state (7). In 2002, 84.6% of children in DeKalb County were adequately immunized, compared to 83.9% for children statewide. 2 Since 1997, DeKalb s immunization coverage has increased steadily from 58.3% to 84.6% (Figure 13). Figure 13. Immunization coverage of two-year-old children in Georgia and DeKalb County, Georgia DeKalb Percent Years Table 8. Number of cases of selected notifiable diseases by year of diagnosis DeKalb County, Georgia, Disease Total Hepatitis A Gastrointestinal infections ,109 Syphilis Chlamydia ,899 3,282 3,428 3,772 4,130 3,490 21,001 Gonorrhea ,306 2,165 2,264 1,946 2,163 1,719 12,563 Tuberculosis Hepatitis A Between 1994 and 2003, 663 people were newly diagnosed with Hepatitis A (Table 8). Seventy-seven percent were male, and 63% were aged years. Prior to 1996, the incidence of Hepatitis A was less than one per 100,000 annually. In 1996, the incidence increased dramatically due to an outbreak in an apartment complex. Between 1997 and 2000, a steady decrease in incidence occurred. In 2001, a metrowide outbreak occurred. Cases were primarily male (86%), and of those interviewed, 54% identified themselves as either bisexual or homosexual (8). Men who have sex with men were targeted for an intervention plan that focused on 2 Adequate immunization status is based on meeting the 4:3:1 schedule of four DTP/DTaP (diphtheria, tetanus and pertussis), three OPV/IPV (polio) and one MMR (measles, mumps and rubella). Status of Health in DeKalb Report,

36 education and immunization. Following this campaign, the incidence of Hepatitis A decreased from 18.8 cases per 100,000 population in 2001 to 7.2 cases in Gastrointestinal Infections Reports of gastrointestinal diseases have increased in the past decade due to improved disease surveillance. Since 1995, DeKalb County has been a sentinel site for the Centers for Disease Control and Prevention s (CDC) Emerging Infections Program, which conducts active surveillance for nine gastrointestinal pathogens (9). Between 1994 and 2003, 4,109 cases of gastrointestinal illnesses were reported in DeKalb County residents (Table 8). 3 Fifty-seven percent of cases were male, and 31% were in children aged 1-9 years. The incidence of gastrointestinal infections declined from 83.7 per 100,000 in 1994 to 57.3 per 100,000 in Giardia has been the most frequently reported infection, in part due to the routine screening of immigrants and refugees. Sexually Transmitted Diseases In recent years, Georgia has ranked in the top ten among all states for reported cases of sexually transmitted diseases (STDs), with gonorrhea and chlamydia being the two most frequently reported (10). Serious early consequences of gonorrhea and chlamydia infections include pelvic inflammatory disease, infertility, ectopic pregnancy and chronic pelvic pain (11). Between 1994 and 2003, 647 cases of primary and secondary syphilis were reported in DeKalb County residents (Table 8). Seventy-five percent of cases were among males, and 90% of cases occurred among persons years. Between 1998 and 2003, 21,001 cases of chlamydia were reported in DeKalb County residents (Table 8). Eighty percent of cases were among females, and 85% of cases occurred among persons years. Chlamydia cases increased from cases per 100,000 in 1998 to in Between 1998 and 2003, 12,563 cases of gonorrhea were reported in DeKalb County residents (Table 8). Fifty-four percent of cases were among males, and 45% of cases occurred among persons years. Gonorrhea cases decreased from per 100,000 in 1998 to per 100,000 in Gastrointestinal illnesses include Campylobacter, Cyclospora, Cryptosporidia, Escherichia coli O157:H7, Giardia, Listeria, Salmonella, Shigella, Vibrio and Yersinia. 26 Status of Health in DeKalb Report, 2005

37 Tuberculosis Since 1992, national rates of tuberculosis (TB) have shown a dramatic decline, decreasing 44% by Despite declining trends, Georgia was ranked seventh in the nation for the highest TB case rates in 2002, and DeKalb County reported the second highest number of cases among all Georgia counties (12). Between 1994 and 2003, 930 cases of TB were reported in DeKalb County residents (Table 8). Sixty-two percent of cases were male, and 66% were African American. The TB cases decreased from 19.1 cases per 100,000 population in 1994 to 12.3 per 100,000 in The percentage of people with TB who were foreign- - born increased from 26% in 1994 to 42% in Countries of origin most frequently reported included Vietnam, Somalia, Ethiopia, Mexico and India. Sixty-two percent of cases had multiple TB risk factors, such as HIV, being foreign-born, homelessness, substance abuse, or living in correctional institutions or long-term care facilities. Of 471 TB cases for which HIV status was known, 26% were HIV positive. Of 664 bacteria samples tested, 51 (8%) were resistant to a single antibiotic, and 10 (2%) were resistant to multiple antibiotics. HIV/AIDS Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS), a disease that leaves a person vulnerable to life-threatening infections. From 1981 to 2002, there were 3,795 diagnosed cases of AIDS and 2,049 deaths caused by AIDS in DeKalb County. AIDS decreased from 55.1 cases per 100,000 in 1994 to 26.3 cases per 100,000 in 2002, while deaths due to AIDS decreased from 31.1 deaths per 100,000 in 1994 to 3.4 in 2002 (Figure 14). In 1994, 56% of diagnosed AIDS cases died that same year. By 2002, the number of diagnosed cases who died in that same year decreased to 13%. Figure 14. AIDS case and death rates by year of diagnosis Rate per 100,000 population DeKalb County, Georgia, Cases 50 Deaths Year Status of Health in DeKalb Report,

38 From 1994 to 2002, the majority of AIDS cases were male (81%) and black (76%). During this time, the rate of disease decreased in all gender and race categories (Figure 15). The numbers of AIDS cases were very small for Hispanics and Asians with a total of 63 cases and 1 case reported, respectively, from 1994 to The exposure categories associated with the most AIDS cases were men who have sex with men (46%), injecting drug use (15%) and heterosexual contact (14%). Between 1994 and 2002, 90% of AIDS cases were between the ages of 20 to 49 years, with the highest proportion aged years (46%). Pediatric AIDS cases (ages 0 to Figure 15. AIDS rates by sex and race Rate per 100,000 population DeKalb County, Georgia, Males Females Black White Year 12 years) represent a very small proportion of total AIDS cases, with nine reported cases in DeKalb County from 1994 to 1995 and only three cases from 1996 to Status of Health in DeKalb Report, 2005

39 Leading Causes of Hospitalizations In 2002, 66,752 hospitalizations of DeKalb County residents were reported by nonfederal hospitals (Table 9). The leading causes of hospitalizations, in rank order, were: (1) complications of pregnancy and childbirth (18%), (2) major cardiovascular diseases (11%) and (3) bone and muscle conditions (3%). Of major cardiovascular diseases, heart disease accounted for the majority of hospitalizations (72%) with a rate of hospitalizations per 100,000 population. Females accounted for 63% of hospitalizations. The leading cause of hospitalization for females was pregnancy and childbirth complications, and major cardiovascular diseases were the second leading cause. The leading cause of hospitalization for males was major cardiovascular diseases with heart disease accounting for 65% of those hospitalizations. Table 9. Hospital discharges and rates per 100,000 population DeKalb County, Georgia, 2002 Female Male Total Principle Diagnosis No. Rate No. Rate No. Rate Pregnancy & childbirthing complications 11, , , ,184.8 Major cardiovascular diseases 3,775 1, ,732 1, ,507 1,108.9 Bone & muscle diseases 1, , Accidents , , Cancers 1, , Pneumonia , Infectious & parasitic diseases , Diabetes , Blood diseases Asthma Kidney disease Drug overdoses Homicide Birth defects Fetal & infant conditions Suicide Chronic liver disease & cirrhosis Alzheimer's disease Parkinson's disease Emphysema Flu Other causes 19,229 5, ,334 4, ,563 4,957.6 All causes 42,196 12, ,556 7, ,752 9,860.0 Status of Health in DeKalb Report,

40 30 Status of Health in DeKalb Report, 2005

41 Causes of Death Leading causes of death Infant mortality Adults age 65 and over Leading causes of premature death, ages 1-64 Trends over time Trends by race/ethnicity and gender County-wide trends and community-specific rates

42 Leading Causes of Death Mortality rates, which are the number of deaths per population at risk, are used to describe the leading causes of death. Mortality rates provide a measure of magnitude of deaths within a population. However, behaviors and exposures to hazardous agents often take many years to impact health outcomes, like exposure to tobacco smoke and the development of lung cancer. In this report, mortality rates are presented for infants (less than 1 year) and for persons age 65 and over. Deaths occurring between ages 1-64 are presented in the Leading Causes of Premature Death section which follows. Infant Mortality In 2001, Georgia had the ninth highest infant mortality rate in the United States with a rate of 8.6 deaths per 1,000 live births (13). Infant mortality rates in DeKalb County have been increasing slightly from 9.9 deaths per 1,000 live births in 1994 to 10.5 in 2002 (Figure 16). From 1994 to 2002, there was an average of 12 black infant deaths per 1,000 live births and 4.7 white infant deaths per 1,000 live births. However, the infant mortality rate of whites increased 84% from 3.5 deaths per 1,000 per live births in 1994 to 6.8 in Because of small annual numbers of deaths to Asian and Hispanic infants, a detailed analysis of these groups is not possible. Compared to whites and blacks, Asians and Hispanics had the lowest nine-year average infant mortality rates from 1994 to 2002 (Table 10). Rate per 1,000 live births Figure 16. Infant mortality rates by race, age 0-1 year DeKalb County, Georgia, Year Total White Black 32 Status of Health in DeKalb Report, 2005

43 Table 10. Average nine-year infant mortality rates* DeKalb County, Georgia, Post-Neonatal No. of No. of Race/Ethnicity Neonatal Rate Rate Total Rate Infant Deaths Infant Births White ,649 Black ,961 Asian ,196 Hispanic ,832 * Per 1,000 live births Of the 13 Community Health Assessment Areas, McNair/Cedar Grove and Lithonia have the highest infant mortality rate of 13.5 deaths per 1,000 live births (Figure 17). The communities with infant mortality rates higher than the county average are concentrated in the southeastern part of DeKalb: Avondale/Towers/Columbia, Clarkston, Lithonia, McNair/Cedar Grove, Stone Mountain/Stephenson and Southwest DeKalb/MLK Jr. Dunwoody had the lowest infant mortality rate of 2.6 infant deaths per 1,000 live births. The overall DeKalb trend in infant mortality appears to be representative of a national trend (14). It has been suggested that the rise in infant mortality reflects a trend among women toward delaying motherhood. Status of Health in DeKalb Report,

44 Figure Status of Health in DeKalb Report, 2005

45 Adults Age 65 and Over For the nine-year period from 1994 through 2002, the five leading causes of death to DeKalb County residents ages 65 and over were heart disease, cancer, stroke, neurologic disease and chronic lung disease (Figure 18). An average of 2,552 residents aged 65 and over died in each of these nine years. Of these, 1,487 (58%) were female and 1,812 (71%) were white. The five leading causes of death account for an average of 1,747 deaths per year, or 68% of all deaths in this age range, for the period of 1994 to The neurologic mortality rate, which includes Parkinson s and Alzheimer s diseases, increased the most, by 128% (Table 11). Figure 18. Trends in mortality among residents aged 65 and over Deaths per 100, DeKalb County, Georgia, Year Heart disease Cancer Stroke Neurologic disease Chronic lung disease Table 11. Mortality rates of residents aged 65 and over DeKalb County, Georgia, Nine-year % change from Cause of Death avg rate* 1994 to 2002 Heart disease % Cancer % Stroke % Neurologic disease % Chronic lung disease % * Per 100,000 population The majority of heart disease deaths in this age group were due to ischemic heart disease (34%), heart attacks (23%) and heart failures (10%). For women, the major types of cancer-related deaths were lung cancer (23%), breast cancer (14%) and colon cancer (12%). For men, lung cancer (31%), prostate cancer (18%) and colon cancer (9%) were the leading cancer death types. Status of Health in DeKalb Report,

46 Leading Causes of Premature Death, Ages 1-64 For persons ages one to 64 years, years of potential life lost (YPLL) is used to describe leading causes of premature death. Years of potential life lost is a statistic that measures the total number of years lost due to premature death in a population from a certain cause. Premature death is defined as death at an age less than 65 years. YPLL is calculated by subtracting the age of death from 65 years. The YPLL rate is the number of years of potential life lost before age 65 per 100,000 population ages one to 64. For example, a person who dies at age 27 in a motor vehicle accident has 38 years (65 27 = 38) of potential life lost, but a person who dies at age 56 of heart disease has nine years (65 56 = 9) of potential life lost. YPLL emphasizes the impact of a disease on the length of life for younger individuals; it does not describe the numbers of deaths. Trends Over Time From 1994 to 1996, HIV/AIDS was the leading cause of premature death (Figure 19). After 1995, HIV/AIDS premature death rates decreased due to improved testing and early treatment of people with HIV infection (10). The HIV/AIDS premature death rate decreased 70% from 1,377 per 100,000 in 1994 to 411 in 2002, dropping to become the fifth leading cause of premature death in DeKalb County. Unintentional injury, heart disease, homicide and suicide had less dramatic decreases in premature death rates from 1994 through 2002, and there was a small increase in premature death rates of cancer during the same period. Figure 19. Trends in premature deaths among those age 1-64 YPLL rate per 100, DeKalb County, Georgia, Year Cancer Injury Heart Disease Homicide HIV/AIDS Suicide 36 Status of Health in DeKalb Report, 2005

47 Trends by Race/Ethnicity and Gender Black females From 1994 to 2002, the leading causes of premature death for black females, in rank order, were: (1) cancer, (2) heart disease, (3) HIV/AIDS, (4) unintentional injuries and (5) homicide (Table 12). Cancer was the leading cause of premature death in all females, regardless of race/ethnicity (Figure 20). Racial disparities exist in the premature death rates among females. Black females had a heart disease premature death rate 2.3 times higher, an HIV/AIDS premature death rate 8.7 times higher and a homicide premature death rate 3.5 times higher than white females. Table 12. Premature death rate in black females DeKalb County, Georgia, Nine-year avg % change from Cause of Premature Death YPLL rate 1994 to 2002 Cancer % Heart disease % HIV/AIDS % Unintentional injuries % Homicide % Figure 20. Trends in premature deaths among black females age DeKalb County, Georgia, YPLL rate per 100, Year Cancer Heart Disease HIV/AIDS Injury Homicide Breast and lung cancer contributed 33% and 13%, respectively, to the total cancer years of potential life lost from 1994 to 2002 (Figure 21). Breast cancer deaths fluctuated and slightly increased 5% from 1994 to Lung cancer deaths increased 11% from 32.5 deaths per 100,000 females in 1994 to 35.6 deaths in Lung cancer deaths among black females increased 39% from 1994 to Status of Health in DeKalb Report,

48 Figure 21. Breast and lung cancer age-adjusted mortality rates among females by race Deaths per 100,000 females DeKalb County, Georgia, Year Breast Cancer - White Breast Cancer - Black Lung Cancer - White Lung Cancer - Black H White females From 1994 to 2002, the leading causes of premature death for white females, in rank order, were: (1) cancer, (2) unintentional injuries, (3) heart disease, (4) suicide and (5) stroke (Table 13). There was a significant increase of heart disease premature death rates, which increased by 75% from 209 in 1994 to 365 in 2002 (Figure 22). Though fluctuating throughout the nine-year period, stroke premature death rates decreased 83% from 1994 to Table 13. Premature death rate in white females DeKalb County, Georgia, Nine-year avg % change from Cause of Premature Death YPLL rate 1994 to 2002 Cancer % Unintentional injuries % Heart disease % Suicide % Stroke % Figure 22. Trends in premature deaths among white females age 1-64 YPLL rate per 100, DeKalb County, Georgia, Year Cancer Injury Heart Disease Suicide Stroke 38 Status of Health in DeKalb Report, 2005

49 Data Source: Georgia Division of Public Black males From 1994 to 2002, the leading causes of premature death for black males, in rank order, were: (1) HIV/AIDS, (2) homicide, (3) unintentional injuries, (4) heart disease and (5) cancer (Table 14). The greatest change from 1994 to 2002 was in HIV/AIDS premature death rates with a 61% decrease (Figure 23). Cancer was the only cause of premature death that experienced an increase in rates. Black males are more likely to die prematurely due to injuries, both intentional and unintentional, as opposed to chronic diseases. Table 14. Premature death rate in black males DeKalb County, Georgia, Nine-year avg % change from Cause of Premature Death YPLL rate 1994 to 2002 HIV/AIDS % Homicide % Unintentional injuries % Heart disease % Cancer % Figure 23. Trends in premature deaths among black males age DeKalb County, Georgia, YPLL rate per 100, Year HIV/AIDS Homicide Injury Heart Disease Cancer Status of Health in DeKalb Report,

50 White males From 1994 to 2002, the leading causes of premature death for white males, in rank order, were (1) HIV/AIDS, (2) unintentional injuries, (3) cancer, (4) heart disease and (5) suicide (Table 15). The greatest change from 1994 to 2002 was in HIV/AIDS premature death rates with an 87% decrease (Figure 24). Table 15. Premature death rate in white males DeKalb County, Georgia, Nine-year avg % change from Cause of Premature Death YPLL rate 1994 to 2002 HIV/AIDS % Unintentional injuries % Cancer % Heart disease % Suicide % Figure 24. Trends in premature deaths among white males age 1-64 YPLL rate per 100, DeKalb County, Georgia, Year HIV/AIDS Injury Cancer Heart Disease Suicide 40 Status of Health in DeKalb Report, 2005

51 Hispanics and Asians It is difficult to analyze trends in premature deaths in the Hispanic and Asian populations of DeKalb County because of the small number of total deaths in these groups and a lack of age-specific population figures. However, an analysis of the leading causes of years of potential life lost (YPLL) for the years of 1998 to 2002 by gender gives a basic understanding of the major causes of premature deaths. Generalizations should not be made from these data because the total number of deaths associated with these years of life lost is very small. Hispanic females Cancer claimed 492 years of potential life or 29% of the premature deaths for Hispanic females from 1998 to 2002 (Figure 25). Leukemia accounted for 54% of premature death due to cancer, while breast and lung cancer accounted for 7% and 4%, respectively. Unintentional injuries (i.e., motor vehicle and other injuries) claimed 440 YPLL. Motor vehicle injuries represented 64% of injury YPLL among Hispanic females. The third leading cause of death among Hispanic females was homicide, accounting for 251 YPLL or 15% of premature death. Hispanic males The leading cause of premature death among Hispanic males from 1998 to 2002 was unintentional injuries, accounting for 1,630 YPLL or 37% of all premature deaths (Figure 26). Motor vehicle injuries represented the majority of these injuries, accounting for 59% of all premature deaths due to injuries and claiming 968 YPLL. The second leading cause of premature death among Hispanic males was homicide, which claimed 966 YPLL. Heart disease was the third leading cause of death representing nine percent of premature deaths and 424 YPLL. Figure 25. Premature deaths among Hispanic females DeKalb County, Georgia, Figure 26. Premature deaths among Hispanic males DeKalb County, Georgia, Congenital Anomalies 3% Stroke Pregnancy/Childbirth 4% Complications 5% Neurologic Disease 6% All Others 6% Cancer 29% Ill-Defined 3% HIV/AIDS 5% Cancer 7% All Others 10% Unintentional Injuries 37% Heart Disease 6% Suicide 8% Homicide 15% Total years of potential life lost = 1,715 Unintentional Injuries 26% Heart Disease 9% Homicide 21% Total years of potential life lost = 4,530 Status of Health in DeKalb Report,

52 Asian females Cancer was the leading cause of premature death among Asian females, accounting for 38% of premature death (Figure 27). From 1998 to 2002, a total of 332 years of potential life (YPLL) were claimed by cancer. Brain, ovarian and liver cancers were the most prevalent of all types of cancers, representing 33% of cancer YPLL. The second leading cause of premature death was unintentional injuries with 143 YPLL. Motor vehicle injuries accounted for 71% of YPLL due to injuries. Heart disease had the third highest YPLL of 92 or 10% of total YPLL for Asian females. Asian males Unintentional injuries were the leading cause of premature death among Asian males (Figure 28). Injuries claimed 498 YPLL or 24% of premature deaths. Motor vehicles accounted for 50% of injuries to Asian males. The second leading cause of premature death among Asian males was cancer, accounting for 19% of YPLL. From 1998 to 2002, cancer claimed 384 YPLL of Asian males. Brain cancer claimed the majority of YPLL, 28% of all cancers. The third leading cause of premature death among Asian males was suicide. A total of 325 years of potential life was lost from 1998 to 2002, representing 16% of all premature deaths. Figure 27. Premature deaths among Asian females DeKalb County, Georgia, Figure 28. Premature deaths among Asian males DeKalb County, Georgia, Muscoskeletal & Connective Tissue Disease 4% Stroke 4% Pregnancy/Childbirth Complications 5% Homicide 7% All Others 9% Cancer 38% All Others Infectious Diseases 10% 3% Stroke 5% Heart Disease 10% Unintentional Injuries 24% Suicide 7% Heart Disease 10% Total years of potential life lost = 894 Unintentional Injuries 16% Homicide 13% Cancer 19% Suicide 16% Total years of potential life lost = 2, Status of Health in DeKalb Report, 2005

53 County-Wide Trends and Community-Specific Rates In this section, years of potential life lost (YPLL) is used to compare the causes of premature death among the 13 Community Health Assessment Areas (CHAAs) within DeKalb County. Analysis by CHAA is provided for a five-year period because of the availability of census tract data of the CHAAs, and time-trend data is provided for a nine-year period. Based on five-year average YPLL rates, the eight leading causes of premature death are highlighted in this section (Table 16). Table 16. Leading causes of premature death, ages 1-64 DeKalb County, Georgia, Five-year Cause of Premature Death YPLL rate* Cancer 732 Unintentional injuries 698 Heart disease 577 Homicide 461 HIV/AIDS 457 Suicide 225 Stroke 148 Infectious diseases 123 *Per 100,000 population Each CHAA has a unique population, with needs that may be different than the populations of other areas. These differences may be a result of geographic, economic, social or cultural factors that influence the health of communities. Comparison of the average 1998 to 2002 YPLL rates (five-year average) for leading causes of premature death (e.g., cancer or stroke) among CHAAs provides a starting point for developing prevention strategies for these communities. Status of Health in DeKalb Report,

54 Cancer Between 1998 and 2002, cancer was the leading cause of premature death among DeKalb residents. The cancer premature death rate was 732 per 100,000 population. The overall trend for cancer premature death rates did not change significantly from 1994 to 2002 (Figure 29). Lung cancer caused the highest proportion of premature death among males, and breast cancer caused the highest proportion of premature death among females (Table 17). Cancer premature death rates were highest in the McNair/Cedar Grove CHAA, with a premature death rate of 1,008 per 100,000 population (Figure 30). Chamblee/Cross Keys CHAA has the lowest premature death rate of 549 per 100,000. McNair/Cedar Grove CHAA s premature death rate was approximately 84% higher than the Chamblee/Cross Keys rate. Figure 29. Cancer premature death rates, ages 1-64 YPLL per 100,000 population DeKalb County, Georgia, Year Table 17. Leading causes of premature death due to cancer based on YPLL DeKalb County, Georgia, Males* Percent Females** Percent Lung cancer 22% Breast cancer 32% Colon cancer 10% Lung cancer 13% Leukemia 8% Colon cancer 8% Ill-defined 8% Ill-defined 6% Brain cancer 8% Brain cancer 6% Other 44% Other 35% * Total male YPLL = 19,042; ** Total female YPLL = 19, Status of Health in DeKalb Report, 2005

55 Figure 30. Status of Health in DeKalb Report,

56 Unintentional injuries Injuries were the second leading cause of premature death in DeKalb County, with a premature death rate of 698 per 100,000 population from 1998 to The unintentional injuries premature death rate decreased 11% from 793 in 1994 to 704 in 2002 (Figure 31). Between 1994 and 2002, the leading cause of premature death due to unintentional injuries for both males and females was motor vehicle crashes, accounting for 64% of the years of potential life lost (Table 18). From 1994 to 2002, a total of 821 DeKalb residents were killed in motor vehicle crashes. Premature death due to unintentional injuries was highest in the McNair/Cedar Grove and Chamblee/Cross Keys CHAAs, with an average premature death rate of 861 and 833 per 100,000 population, respectively (Figure 32). The Decatur CHAA had the lowest premature death due to unintentional injuries with a rate of 423 per 100,000 population. Figure 31. Unintentional injuries premature death rates, ages 1-64 DeKalb County, Georgia, YPLL per 100,000 population Year Table 18. Leading causes of premature death due to unintentional injuries based on YPLL DeKalb County, Georgia, Males* Percent Females** Percent Motor vehicle 64% Motor vehicle 64% Poisoning 12% Poisoning 12% Other accidents 7% Other accidents 11% Drowning 6% Fire 4% Falls 5% Drowning 3% Other 6% Other 6% * Total male YPLL = 28,370; ** Total female YPLL = 9, Status of Health in DeKalb Report, 2005

57 Figure 32. Status of Health in DeKalb Report,

58 Heart disease From 1998 to 2002, the third leading cause of premature death in DeKalb County was heart disease, with a premature death rate of 577 per 100,000 population. Overall, there was a 12% decline in the premature death rate due to heart disease from 1994 to 2002 (Figure 33). The premature death rate was 626 per 100,000 population in 1994 and 548 in The majority of premature death due to heart disease was categorized as ischemic heart disease, which excludes heart attacks (Table 19). Ischemic heart disease accounted for 33% and 18% of years of potential life lost for males and females, respectively. Heart disease premature deaths were highest in Atlanta and the McNair/Cedar Grove CHAAs, with premature death rates of 967 and 947 per 100,000 population, respectively (Figure 34). The Druid Hills/Lakeside CHAA had the lowest heart disease premature death rate of 293 per 100,000. Figure 33. Heart disease premature death rates, ages 1-64 DeKalb County, Georgia, YPLL per 100,000 population Year Table 19. Leading causes of premature death due to heart disease based on YPLL DeKalb County, Georgia, Males* Percent Females** Percent Ischemic excluding heart attack 33% Ischemic excluding heart attack 18% Cardiomyopathy 14% Hypertensive 16% Heart attack 13% Cardiomyopathy 13% Ill-defined 12% Pulmonary 11% Hypertensive 10% Ill-defined 11% Other 18% Other 31% * Total male YPLL = 20,023; ** Total female YPLL = 10, Status of Health in DeKalb Report, 2005

59 Figure 34. Status of Health in DeKalb Report,

60 Homicide As the fourth leading cause of premature death from 1998 to 2002, homicide claimed an average of 461 years of potential life per 100,000 population. From 1994 to 2002, the homicide premature death rate decreased 16% from 541 per 100,000 population in 1994 to 456 in 2002 (Figure 35). Firearms were the leading method of homicide for both males and females, accounting for 83% and 46% of years of potential life lost, respectively (Table 20). Premature death due to homicide was highest in Atlanta and the Avondale/Towers/ Columbia CHAAs, with premature death rates of 951 and 802 per 100,000 population, respectively (Figure 36). The Druid Hills/Lakeside CHAA had the lowest homicide premature death rate with a premature death rate of 73 per 100,000 population. Figure 35. Homicide premature death rates, ages 1-64 YPLL per 100,000 population DeKalb County, Georgia, Year Table 20. Leading methods of homicide based on YPLL DeKalb County, Georgia, Males* Percent Females** Percent Firearm 83% Firearm 46% Other/unspecified 10% Other/unspecified 19% Sharp object 5% Hanging/strangulation 15% Hanging/strangulation 1% Sharp object 15% Other 1% Other 5% * Total male YPLL = 20,709; ** Total female YPLL = 4, Status of Health in DeKalb Report, 2005

61 Figure 36. Status of Health in DeKalb Report,

62 HIV/AIDS From 1998 to 2002, HIV/AIDS dropped to the fifth leading cause of premature death after being the leading cause of premature death from 1994 to The premature death rate due to HIV/AIDS was 457 per 100,000 population from 1998 to Overall, the HIV/AIDS premature death rate decreased 70% from 1994 to 2002 (Figure 37). The HIV/AIDS premature death rate reached a high of 1,510 per 100,000 in 1995, but declined to 411 per 100,000 in The HIV/AIDS premature death was, by far, the highest in the Atlanta CHAA, with a rate of 1,498 per 100,000 population (Figure 38). The premature death rate of Atlanta was more than double that of the McNair/Cedar Grove CHAA, which had the second highest rate of 693 per 100,000. The Dunwoody CHAA had the lowest HIV/AIDS premature death rate of 120 per 100,000 population. Figure 37. HIV/AIDS premature death rates, ages 1-64 YPLL per 100,000 population DeKalb County, Georgia, Year 52 Status of Health in DeKalb Report, 2005

63 Figure 38. Status of Health in DeKalb Report,

64 Suicide Suicide was the sixth leading cause of premature death from 1998 to 2002, with a premature death rate of 225 per 100,000 population. From 1994 to 2002, the suicide premature death rate declined 15% (Figure 39). The premature death rate was 294 per 100,000 population in 1994 and 250 in Similar to homicide, firearms were the leading method of suicide, accounting for 66% and 60% of years of potential life lost due to suicide among males and females, respectively (Table 21). Premature death due to suicide was the highest in the Chamblee/Cross Keys and Tucker CHAAs, with rates of 365 and 333 per 100,000 population, respectively (Figure 40). The Decatur CHAA had the lowest premature death rate due to suicide of 72 per 100,000 population. Figure 39. Suicide premature death rates, ages 1-64 YPLL per 100,000 population DeKalb County, Georgia, Year Table 21. Leading methods of suicide based on YPLL DeKalb County, Georgia, Males* Percent Females** Percent Firearm 66% Firearm 60% Hanging 17% Drug overdose 19% Drug overdose 6% Hanging 14% Carbon monoxide 4% Jumping 5% Jumping 4% Carbon monoxide 2% Other 3% * Total male YPLL = 10,198; ** Total female YPLL = 2, Status of Health in DeKalb Report, 2005

65 Figure 40. Status of Health in DeKalb Report,

66 Stroke As the seventh leading cause of premature death from 1998 to 2002, stroke claimed an average of 148 years of potential life lost annually. Premature death rates due to stroke declined 6% from 1994 to 2002 (Figure 41). The premature death rate was 145 per 100,000 population in 1994 and 136 in Premature death due to stroke was highest in the Avondale/Towers/Columbia, Atlanta and McNair /Cedar Grove CHAAs, with premature death rates of 245, 226 and 224 per 100,000 population, respectively (Figure 42). The Chamblee/Cross Keys CHAA had the lowest stroke premature death rate of 73 per 100,000 population. Figure 41. Stroke premature death rates, ages 1-64 DeKalb County, Georgia, YPLL per 100,000 population Year 56 Status of Health in DeKalb Report, 2005

67 Figure 42. Status of Health in DeKalb Report,

68 Infectious diseases 1 Infectious diseases were the eighth leading cause of premature death from 1998 to 2002 in DeKalb. The premature death rate from infectious diseases was 123 per 100,000 population. From 1994 to 2002, the premature death rate for infectious diseases increased 16% from 113 in 1994 to 131 in 2002 (Figure 43). The premature death rate peaked in 1998 at 158 per 100,000, and it decreased the following year to 97. Since 1999, premature death rates due to infectious diseases have been increasing slightly each year. For 1998 to 2002, premature death due to infectious diseases was highest in the Atlanta and Avondale/Towers/Columbia CHAAs, with rates of 234 and 206 per 100,000 population, respectively (Figure 44). The Dunwoody CHAA had the lowest infectious diseases premature death rate of 39 per 100,000. Figure 43. Infectious diseases premature death rates, ages 1-64 YPLL per 100,000 population DeKalb County, Georgia, Year 1 Infectious diseases include blood poisoning, tuberculosis and meningitis; HIV/AIDS is excluded. 58 Status of Health in DeKalb Report, 2005

69 Figure 44. Status of Health in DeKalb Report,

70 Summary From a map summarizing the eight leading causes of premature death by Community Health Assessment Area (CHAA), associations can be made between causes of deaths and the DeKalb communities most greatly affected (Figure 45). For the most part, the south DeKalb communities have a higher degree of premature death due to chronic disease (cancer and heart disease), HIV/AIDS, homicide, infectious disease and stroke. Suicide and unintentional injuries are more prevalent in the Chamblee/Cross Keys CHAA, and unintentional injuries are high in the McNair/Cedar Grove CHAA. Strategies for prevention should focus on geographic, economic, social and cultural factors that play a role in making these areas susceptible to higher death rates. 60 Status of Health in DeKalb Report, 2005

71 Figure 45. Status of Health in DeKalb Report,

72 62 Status of Health in DeKalb Report, 2005

73 Opportunities for Prevention

74 Opportunities for Prevention There are opportunities for preventing diseases and premature death throughout DeKalb County and its communities. They may be found where disparities in health are observed. These disparities are seen where rates of health behaviors, disease or death vary widely among demographic groups (by age, sex, race/ethnicity) or among geographic regions (Community Health Assessment Areas). Many aspects of community life contribute to health. Opportunities for prevention can be found among any of the factors that affect health status: personal lifestyle choices, the health care system, policies, and the physical and social environments. These factors are not independent of each other, and changes in one factor may complement or support changes in another. For example, individuals who decide to eat more fruits and vegetables will need accessible and affordable food choices in their community and workplace for this lifestyle change to be effective. In this example, a lifestyle choice would be supported by changes in policies and the environment. Based on the Status of Health priority areas (promoting healthy eating and physical activity, reducing tobacco use, preventing injuries and eliminating health disparities) and the four factors of health status (personal lifestyle choices, the health care system, policies, and the physical and social environments), the following are just a few examples of opportunities for prevention in DeKalb County: Actions for Healthy Lifestyles Increase physical activity and eat better - Take the stairs, take the dog for a walk, drink more water, eat five fruits and vegetables a day. See or for more ideas on incorporating movement into your everyday life and improving your diet. Avoid tobacco - If you smoke, stop; if you don't smoke, don't start. Call the toll-free Georgia Tobacco Quit Line ( STOP) to get help to quit smoking. Drive responsibly and practice injury prevention - Wear your seatbelt, use child-safety seats, limit driver distractions, don't drink and drive. See for more safety tips. Actions for the Health Care System Increase culturally competent resources - Provide translation services, train health care staff on cultural competency issues. See about cultural competence issues. Promote a comprehensive plan for health promotion and disease prevention - Partner with other providers, implement weight control and disease management strategies. 64 Status of Health in DeKalb Report, 2005

75 Actions for Healthy Policies Support clean indoor air ordinances - Don't allow smoking in confined areas, advocate for local and state ordinances. Contact the Prevention Alliance for Tobacco Control and Health (PATCH) coalition to find out about clean indoor air ordinances in DeKalb County: Develop healthy workplaces - Provide healthy food options in cafeterias, promote use of stairs, provide time for physical fitness. Implement a plan for healthy schools - Support implementation of the nutrition and physical activity policy in all DeKalb County schools, advocate for policies to keep our children healthy. See for information on school health. Actions for a Healthy Environment Build and maintain safe communities - Improve lighting on roads and sidewalks and construct sidewalks, pedestrian refuge islands and crosswalks. See for information about making your community safer. Participate in partnerships with community groups - Work to improve the social and physical environment of areas suffering from health disparities. See for information about community partnerships. Healthy communities mean more than the absence of disease and early death. Intact, supportive families; economic vitality leading to quality jobs; clean and safe environments; and trusted and effective institutions (school, faith, health, government and business), social associations and alliances that respect diversity all contribute to the quality of life in DeKalb County. Community assets are the essential building blocks for preventing disease and premature deaths. These same assets are the resources that also preserve the advances that have occurred in health status. Healthy people grow up and live in healthy communities. Status of Health in DeKalb Report,

76 Prevention Opportunities Premature mortality is preventable. Experts estimate that more than 50% of the disease and conditions that lead to early death can be eliminated. A practical approach focuses on the risk factors that lead to disease. By identifying and reducing risk factors, communities reduce premature death. The following table depicts the relationship between several important risk factors and the diseases and conditions described in this report. Table 22. Risk reduction by disease or condition Prevention by Risk Reduction Eat a healthy diet HIV/AIDS Injuries Cancer Homicide Heart Disease Suicide Stroke Infant Health Teen Pregnancy X X X X Maintain normal body weight X X X Exercise regularly X X Control blood pressure X X Control blood sugar X X X Reduce cholesterol X X Avoid tobacco use X X X X X X Reduce alcohol consumption X X X X X X Avoid drug use X X X X X X X Avoid sexual risks X X X Avoid violence/stress X X X X Limit availability of guns X X X Use seatbelts X Use car seats X Avoid sun exposure X Perform breast self exam X Perform testicular self exam X Have a colorectal exam X Have a mammogram X Have a Pap smear X Plan families X X 66 Status of Health in DeKalb Report, 2005

77 Appendices Methodology Glossary of terms References

78 Methodology The method of data analysis chosen for the Status of Health in DeKalb: Opportunities for Prevention and Community Service, 2005 presents the results in a format that is compatible with the previous documents in this series. All health data presented in this report were the latest available data released from the Georgia Department of Human Resources or from the DeKalb County Board of Health. The birth and death data were compiled from official birth and death certificate data from the Georgia Division of Public Health, Office of Health Information and Policy. The data were checked for errors and missing information and geographically coded to census tracts within Community Health Assessment Areas (CHAAs). Using the International Classification of Diseases, 9th Edition (ICD-9) and 10th Edition (ICD-10), primary causes of death found on the death certificates were grouped into cause of death categories (Table 23). The causes of death groups used in this report were those recommended by the Assessment Protocol for Excellence in Public Health (APEX-PH), developed in 1991 by the National Association of County Health Officials (now known as the National Association of County and City Health Officials). The whole county population estimates were obtained from the U.S. Bureau of the Census and were broken down by year, age, race, sex and ethnic origin. The population estimates for each of the CHAAs in DeKalb County were derived from 2000 U.S. Census Bureau census tract estimates. DeKalb County has large numbers of people who identify themselves as Asians or of Hispanic origin compared to other counties in Georgia. However, the total populations for each of these groups are small for statistical purposes and make analysis by age or sex problematic. Therefore, only limited analysis of these groups is included in this report. All birth-related rates were computed per 1,000 females, and infant mortality rates were computed per 1,000 live births. All disease and mortality-related rates were computed per 100,000 population. This was done so that the statistics would be consistent with those presented by other sources and to make comparisons across populations. Years of potential life lost (YPLL) rate is used to show comparative causes of premature death to specific populations. The YPLL rates were calculated per 100,000 population between the ages of one and 64 years of age. We computed separate lifestage-specific mortality rates for populations in DeKalb County age 65 and older. Lifestage-specific age groupings were adopted to calculate age-specific mortality rates. These categories are the same as those presented in the Georgia Vital Statistics Report, printed by the Georgia Division of Public Health, and were used to help facilitate comparisons with this significant source. 68 Status of Health in DeKalb Report, 2005

79 Table 23. Cause of death grouping by International Classification of Diseases, 9th Edition and 10th Edition ICD-9 ICD-10 Category B20-24 AIDS, HIV infection C00-C97 Cancer C71-C72 Brain cancer C50 Breast cancer C18-C21 Colon/rectal cancer C91-C95 Leukemia 155 C22 Liver cancer 162 C34 Lung cancer 183 C56 Ovarian cancer C43-C44 Skin cancer I60-I69 Cerebrovascular Disease J40-J47 Chronic Obstructive Pulmonary Disease 250 E10-E14 Diabetes , K00-K67, K80-87, K90-93 Digestive tract conditions N00-N99 Genitourinary disease I00-I52 Heart disease 410 I21 Heart attack I20-I25 Other ischemic heart disease I10-I15 Hypertensive disease , I00-I09, I26-I52 Other heart disease E960-E969 X85-Y09, Y87.1 Homicide E965 X93-X95 Firearm E963 X91 Hanging , A00-A99, B00-B19, B25-B99 Infectious & parasitic diseases K70-K77 Liver disease F00-F99 Mental and behavioral disorders M00-M99 Musculoskeletal & connective tissue diseases , G00-G99 Neurological diseases , E00-E07, E15-E16, E20-E35, E40-E46, Nondiabetic endocrine diseases E50-E68, E70-E J10-J18 Pneumonia/Influenza E950-E959 X60-X84, Y87 Suicide E952.0, E952.1 X67 Carbon monoxide E950 X60-X64 Drug overdose E955 X72-X74 Firearm E953 X70 Hanging E957-E958.0 X80-X81 Jumping E958.8 X69, X76, X83, Y87.0 Other method E800-E949 V01-X59, Y85-Y86 Unintentional injuries E810-E819 V03-V04, V09, V13-V14, V19.4, V19.6, V23- V24, V27-V29, V43-V44, V47-V49, V57- V59, V68-V69, V86-V87, V89 Motor vehicle accidents E910 W65-W74 Drowning E880-E888 W00-W19 Falls E890-E899 X00-X09 Fire/smoke V81.2, V89.9, V90.6, V95.9, W28, W31, W40, W75, W76, W78, W79, W80, W83, W84, W85, W86, W94, X11, X30, X31, X53, X57, X58, X59, Y85, Y86 E830.0, E830.9, E832.9, E838.9, E841.2, E841.3, E841.5, E844.7, E848, E900.0, E901.0, E901.9, E906.8, E907, E911, E912, E913.0, E913.8, E913.9, E919.0, E919.2, E919.8, E920.8, E924.0, E925.0, E925.1, E927, E928.9, E929.0, E929.3, E929.5 Other accidents E850-E858 X40-X49 Poisoning , P00-P04, P10-P15, P20-P21 Newborn complications , 769 P05, P07, P22 Prematurity and respiratory distress syndrome 770 P23-P29 Other perinatal respiratory conditions 771 P35-P39 Perinatal infections 760, 766, P00, P08, P50-P61, P70-P78, P80-P83, Other perinatal conditions P90-P Q00-Q99 Congenital anomalies 798 R95 Sudden Infant Death Syndrome Status of Health in DeKalb Report,

80 Community Health Assessment Areas Information for geographic areas within the county were calculated by totaling data from census tracts, using the senior high school districts as a guide to create 13 Community Health Assessment Areas (CHAAs). The boundaries of the CHAAs are not identical to the school district lines, but they conform to the census tract boundaries that are the "best fit" to the high school districts. Though the senior high districts have changed (e.g., M.L. King, Jr., and Stephenson high schools are new senior high schools, and Shamrock and Henderson have been converted into middle schools), the original CHAAs have been maintained to provide consistency in reporting and allow comparisons between Status of Health in DeKalb reports. Table 3 provides population estimates of the CHAAs, based on data provided by the U.S. Bureau of the Census. The CHAA maps were created using ArcGIS software. The CHAA maps show the average five-year (1998 to 2002) infant mortality and premature death rates. The causes of premature death selected were those conditions that ranked among the top eight for the county: cancer, unintentional injuries, heart disease, homicide, HIV/AIDS, suicide, stroke and infectious diseases. For the five-year time period and each cause of death, the average number of years of potential life lost (YPLL) were calculated per 100,000 persons per CHAA. Based on natural breaks in the data set, the YPLL rates were partitioned into five subsets. Finally, each CHAA was charted with a shade of color indicative of the value of its YPLL rate; CHAAs with YPLL rates in the lower subsets have a lighter shade of color than those in the higher subsets. 70 Status of Health in DeKalb Report, 2005

81 Glossary of Terms Adolescence: 13 to 19 years of age. Age-Specific Mortality Rate: Total deaths in a specified age group per 100,000 total population in that age group. AIDS: Acquired immunodeficiency syndrome is a weakening of the immune system caused by the HIV virus. APEX-PH: Assessment Protocol for Excellence in Public Health. BMI: Body Mass Index is a relationship between weight and height that is associated with body fat and health risk. BRFSS: Behavioral Risk Factor Surveillance System. Cancer: Includes all types of cancer. Cause-Specific Mortality Rate: Total deaths from a specific cause per 100,000 total population. CDC: Centers for Disease Control and Prevention. CHAA: See Community Health Assessment Area. Community Health Assessment Area (CHAA): A group of adjacent census tracts combined, used in geographic mapping, based on senior high school district boundaries. Child: One to 12 years of age. Chronic Liver Disease: Examples include cirrhosis of the liver and chronic hepatitis. Chronic Lung Disease: Examples include asthma, chronic bronchitis, emphysema and chronic obstructive pulmonary disease. Early Adult: 20 to 44 years of age. Ethnicity: See Race. General Fertility Rate: Total live births per 1,000 women 15 to 44 years of age. Heart Disease: Includes acute myocardial infarction, atherosclerosis, chronic rheumatic heart disease, diseases of arteries/capillaries, diseases of veins, hypertensive disease, ischemic heart disease and other forms of heart disease. Highway: Roadways that are part of the Georgia Department of Transportation state road system. Usually a four-lane divided highway, but can have fewer than four lanes and a divider. HIV: The human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS). ICD-9: International Classification of Diseases, 9 th Edition. ICD-10: International Classification of Diseases, 10 th Edition. Induced Abortion: Intentional termination of a pregnancy. Infancy: Under one year of age. Infant Mortality: A death occurring to a person less than one year of age. Infant Mortality Rate: Total infant deaths per 1,000 live births. Later Adult: 60 to 74 years of age. Middle Adult: 45 to 59 years of age. Morbidity: Illness or injury due to a particular cause. Mortality: Deaths to a specific geographic population over a specific period of time. Motor Vehicle Injuries: Includes all injuries where a motor vehicle was involved. Neurological Disease: Diseases related to the brain, such as meningitis, encephalitis and multiple sclerosis. Obese: At or above the 95 th percentile for body mass index by age and sex. Older Adult: 75 years of age and older. Overweight: At or above 85 th and below the 95 th percentile for body mass index by age and sex. Pedestrian Deaths: Motor vehicle-related deaths to individuals not in a motorized vehicle. Pediatric: Related to infants and children. Premature Mortality: Death before age 65. Race: Racial/ethnic classifications are tabulated into mutually exclusive Asian, black, Hispanic, Native American, and white groups. Because of the way population estimates are computed, members of "other" populations are estimated as part of the white group. Refugee: Person admitted to the U.S. who has been persecuted or has fear of persecution on account of race, religion, nationality, membership in a particular social group or political opinion. SOH: Status of Health. Stroke: All cerebrovascular disease. Caused by blockage of blood flow to the brain or bleeding into the brain. Teenage: 10 to 19 years of age. Teen Birth Rate: Total live births to females 10 to 19 years of age per 1,000 females 10 to 19 years of age. Teen Pregnancy Rate: Total pregnancies to females 10 to 19 years of age per 1,000 females 10 to 19 years of age. Unintentional Injuries: Injuries that are a result of an unplanned action or are accidental (e.g., motor vehicle accidents, falls, drowning, fire/smoke exposure, poisoning). It excludes homicide and suicide. YPLL: See Years of Potential Life Lost. Years of Potential Life Lost (YPLL): Years of potential life lost after one year of age and prior to age 65 is an index used to determine the relative number of potential years lost for a specific cause of mortality. This index is calculated by subtracting the age of death from 65. YPLL Rate: Years of potential life lost after one year of age and prior to age 65 per 100,000 population. YRBS: Youth Risk Behavior Survey. Status of Health in DeKalb Report,

82 References 1. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Improving Nutrition and Increasing Physical Activity. Retrieved January 22, 2004, from 2. DeKalb County Board of Health. DeKalb County Youth Risk Behavior Survey DeKalb County Board of Health. DeKalb County Behavioral Risk Factor Survey Schwartz M, Jacob AE. DeKalb County Pedestrian Crash Report, DeKalb County, Georgia, August Report available on 5. Healthy People 2010 Goals. Retrieved July 9, 2004, from 6. Maternal and Child Health Epidemiology Section, Epidemiology Branch, Division of Public Health, Georgia Department of Human Resources. Trends in Pregnancy Rates in Year Old Females in Georgia, January 15, Retrieved January 26, 2004, from 7. Hoban CA. Georgia Immunization Study 2002 Final Report. Retrieved January 27, 2004, from 8. Georgia Epidemiology Report. Vol. 17, No. 11. November Retrieved May 11, 2004, from 9. Centers for Disease Control and Prevention, Foodborne and Diarrheal Diseases Branch. Campylobacter, Cyclospora, Cryptosporidia, E.coli O157:H7, Listeria, Salmonella, Shigella, Vibrio and Yersinia. Retrieved May 11, 2004, from Georgia Department of Human Resources, Division of Public Health. Georgia HIV/STD Report Retrieved May 11, 2004, from Georgia Department of Human Resources, Division of Public Health. An Overview of Gonorrhea and Chlamydia in Georgia. Retrieved September 14, 2004, from Georgia Department of Human Resources, Division of Public Health Georgia Tuberculosis Report. Retrieved May 11, 2004, from National Vital Statistics Reports. Vol. 52, No Retrieved December 29, 2003, from Kochanek KD, Smith BL. Deaths: Preliminary Data for National Vital Statistics Reports. Vol. 52, No. 13. Hyattsville, Maryland, National Center for Health Statistics Retrieved March 9, 2004, from 72 Status of Health in DeKalb Report, 2005

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84 We appreciate your comments regarding The Status of Health in DeKalb Report Direct inquiries and comments to : DEKALB COUNTY BOARD OF HEALTH Division of Health Assessment and Promotion 445 Winn Way, P.O. Box 987 Decatur, GA (404) Info@dekalbhealth.net The DeKalb County Board of Health gratefully acknowledges the supporters of the Status of Health in DeKalb Report: Children's Healthcare of Atlanta DeKalb Medical Center Grady Health System Kaiser Permanente Check out the Status of Health in DeKalb Report online at