Lakes Region Health Data Collaborative Regional Health Data Report

Transcription

1 Lakes Region Health Data Collaborative 2013 Regional Health Data Report Lakes Region Data Collaborative Participants Lakes Region Partnership for Public Health - Coordinating Agent Central NH VNA and Hospice Community Action Program, Belknap and Merrimack Counties Genesis Behavioral Health Granite United Way Health First Family Care Center Lakes Region Community Services LRGHealthcare NH Community Health Institute Technical Support Lakes Region Partnership for Public Health 1

2 Lakes Region Health Data Collaborative 2013 Regional Health Data Report Table of Contents Demographics and social determinants of health Page 4 General population characteristics 4 Income, poverty and unemployment 5 Education 7 Teen Birth Rate 8 Housing 9 Language 9 Transportation 9 Disability Status 10 Access to Care Page 11 Health Insurance Coverage 11 Ambulatory Medical Care Capacity 12 Behavioral Health Care Capacity 13 Oral Health Care Capacity 15 Disease Prevention Page 17 Fruit and Vegetable Intake 17 Physical Activity 18 Vaccine Preventable Disease 19 Post Hospital Discharge Events 20 Illness and Injury Page 21 Premature Mortality 21 Obesity 22 Heart Disease 24 Diabetes 26 Asthma 28 Emergency Department Utilization and Injury 29 Substance Abuse Page 31 Adult Substance Abuse 31 Youth Substance Abuse 33 Public Safety Page 40 Substance Abuse-Related Crime 40 Assault 41 Domestic Violence 42 Lakes Region Partnership for Public Health 2

3 Lakes Region Health Data Collaborative 2013 Regional Health Data Report This report compiles a variety of data describing the health of the resident population of the Lakes Region of New Hampshire. Included in this data-based portrait are selected indicators of social and economic determinants of health, access to health services, health promotion and disease prevention, illness and injury, substance abuse and public safety. This report is not intended as an exhaustive set of all possible measures of population health, but instead focuses on specific priority measures identified by the Lakes Region Health Data Collaborative. For the purposes of this report, the Lakes Region (see map below) is comprised of the following New Hampshire municipalities: Moultonborough, Sandwich and the 11 municipalities of Belknap County - Alton, Barnstead, Belmont, Center Harbor, Gilford, Gilmanton, Laconia, Meredith, New Hampton, Sanbornton, and Tilton. In a number of instances throughout this report, data is only available at the county level and is identified in those tables as referring to Belknap County. Lakes Region Partnership for Public Health 3

4 DEMOGRAPHICS AND SOCIAL DETERMINANTS OF HEALTH The demographic and social characteristics of a population, including such factors as prosperity, education, and housing influence the health status of the population. Similarly, factors such as age, disability, language and transportation can have a determining role in the characteristics of health and social services needed by communities. GENERAL POPULATION CHARACTERISTICS Compared to the New Hampshire population overall, the population of the Lakes Region is somewhat older, growing at a slightly slower rate, and lives in a more rural (less densely populated) setting. General Population Characteristics Total Population Total Land (Square Miles) Population Density (Per Square Mile) Lakes Region 65, New Hampshire 1,313,939 8, Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Total Population, By Gender Male Female Percent Male Percent Female Lakes Region 32,286 33, % 50.9% New Hampshire 648, , % 50.6% Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Population Trend and Selected age Categories Population Growth Trend Percent of Population Age 65 Years and Over Percent of Population Under 20 Years of Age Lakes Region +5.1% 17.0% 22.9% New Hampshire +6.9% 13.3% 25.2% Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates and 2000 Census. Lakes Region Partnership for Public Health 4

5 INCOME, POVERTY AND UNEMPLOYMENT The correlation between economic prosperity and good health status is well established. Inversely, the lack of economic prosperity, or poverty, can be associated with barriers to accessing health services, healthy food, and healthy physical environments that contribute to good health. The majority of Lakes Region communities have median household incomes less than the median for New Hampshire overall. A related observation is that a higher proportion of people, including children, are living near or below the federal poverty level. Median Income and Percent of Families in Poverty by Municipality Median Household Income % of Families in Poverty Moultonborough $71, % Barnstead $65, % State of NH $64, % Gilmanton $63, % Gilford $63, % Sanbornton $61, % New Hampton $60, % Alton $60, % Center Harbor $58, % Belmont $58, % Meredith $56, % Sandwich $53, % Tilton $53, % Laconia $48, % Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Unemployment Unemployment is measured as the percent of the civilian labor force, age 16 and over that is unemployed, but seeking work. Percent Unemployment Total Unemployed Individuals Belknap County 6.3% 1,940 New Hampshire 6.0% 44,640 NH Employment Security, Local Unemployment Statistics (LAUS) Report, March 2013 Lakes Region Partnership for Public Health 5

6 Population Below 200% of Poverty Level This indicator reports the percentage of the population living under 200% of the Federal Poverty Level. Total Population (For Whom Poverty Status is Determined) Population with Income Below 200% Poverty Level Percent Population with Income Below 200% Poverty Level Belknap County 59,176 14, % New Hampshire 1,273, , % Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Children in Poverty Children in poverty is the percent of children under age 18 living below 100% of the Federal Poverty Line. Percent of Children Under Age 18 in Poverty Belknap County 11.4% New Hampshire 10.8% Data Source: U.S. Census Bureau, American Community Survey 3-Year Estimates. Lakes Region Partnership for Public Health 6

7 EDUCATION Educational attainment is also considered a key driver of health status with lower levels of education linked to both poverty and poor health. Belknap County has a higher on-time graduation rate in recent years compared to New Hampshire overall, but a slightly higher proportion of the general population who do not have a high school diploma or equivalent. High School Graduation Rate This indicator reports the average freshman graduate rate, which measures the percentage of students receiving their high school diploma within four years. Average Freshman Base Enrollment Estimated Number of Diplomas Issued On-Time Graduation Rate Belknap County New Hampshire 17,510 14, Data Source: The University of Wisconsin, Population Health Institute, County Health Rankings, 2012 and the U.S. Department of Education, National Center for Education Statistics (NCES), Common Core of Data, Public School Universe Survey Data, , and Population with No High School Diploma This indicator reports the percentage of the population aged 25 and older without a high school diploma (or equivalency) or higher. Report Total Population (For Whom Educational Attainment is Determined) Population with No High School Diploma Percent Population with No High School Diploma Belknap County 43,122 4, % New Hampshire 895,399 81, % Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Lakes Region Partnership for Public Health 7

8 TEEN BIRTH RATE Teen pregnancy is closely linked to economic prosperity, educational attainment, and overall infant and child well-being. The teen birth rate in the Lakes Region is higher than the New Hampshire overall rate. Teen Birth Rate per 1,000 Women Age Lakes Region 20.5* New Hampshire 15.7 Data source: NH Division of Vital Records Administration birth certificate data; *Rate is statistically different and higher than the overall NH rate LANGUAGE An inability to speak English well can create barriers to accessing services, communication with service providers, and ability to understand and apply health information (health literacy). Linguistically Isolated Population This indicator reports the percentage of the population aged 5 and older who speak a language other than English at home and speak English less than "very well." Total Population (For Whom Linguistic Isolation is Determined) Total Linguistically Isolated Population Percent Linguistically Isolated Population Belknap County 57, % New Hampshire 1,241,642 30, % Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Lakes Region Partnership for Public Health 8

9 HOUSING Housing characteristics, including housing qualities and location, cost burden as a proportion of income, transiency and community affinity can influence the health of families and communities. Belknap County has a higher homeownership rate and somewhat less transient population than New Hampshire overall. Home Ownership Rate Living in Same House 1 Year or More Percent of households with housing costs >= 30% of household income Belknap County 77.0% 89.1% 38.0% New Hampshire 72.5% 86.6% 38.0% Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. TRANSPORTATION Individuals with limited transportation options also have limited employment options, greater difficulty accessing services and more challenges to leading independent, healthy lives. Percent of Workers 16 years and over in Households with No Vehicle Available Level Belknap County 1.1% New Hampshire 1.6% Data Source: U.S. Census Bureau, American Community Survey 5-Year Estimates. Lakes Region Partnership for Public Health 9

10 DISABILITY STATUS Disability is defined as the product of interactions among individuals bodies; their physical, emotional, and mental health; and the physical and social environment in which they live, work, or play. Disability exists where this interaction results in limitations of activities and restrictions to full participation at school, at work, at home, or in the community. In an attempt to capture a variety of characteristics that encompass the definition of disability, the US Census Bureau (American Community Survey) identifies people reporting serious difficulty with four basic areas of functioning hearing, vision, cognition, and ambulation. Percent of Population with a Disability New Hampshire Belknap County Males 11.4% 10.5% Females 14.0% 15.3% Under 5 years: 0.6% 0.0% 5 to 17 years: 5.7% 3.6% 18 to 34 years: 5.8% 6.5% 35 to 64 years: 10.5% 9.9% 65 to 74 years: 22.7% 18.4% 75 years and over: 47.9% 44.5% Data Source: U.S. Census Bureau, American Community Survey 3-Year Estimates.. Lakes Region Partnership for Public Health 10

11 ACCESS TO CARE Access to care refers to the ease with which an individual can obtain needed services. Access is influenced by a variety of factors including affordability of and insurance coverage for services, provider capacity in relationship to population need and demand for services, and related concepts of availability, proximity and appropriateness of services. HEALTH INSURANCE COVERAGE (2012 ESTIMATE) The estimated proportion of the population under 65 years of age without health insurance is higher for the Lakes Region (15.1%) than for New Hampshire overall (12.5%) and is higher in every individual Lakes Region municipality. ZCTA* Corresponding Post Office Uninsured Population Under 65 years of age % Uninsured under 65 years of age Center Sandwich % Laconia 2, % Center Harbor % New Hampton % Belmont 1, % Meredith % Alton % Alton Bay % Gilford % Gilmanton Iron Works % Gilmanton % Center Barnstead % Tilton % Barnstead % Moultonborough % Sanbornton % LAKES REGION TOTAL 8, % New Hampshire 138, % *Zip Code Tabulation ; Data Source: NH Community Health Institute/JSI analysis of American Community Survey Data 1 and 5 year estimates, ; Lakes Region Partnership for Public Health 11

12 AMBULATORY MEDICAL CARE CAPACITY Primary Care Provider Availability This indicator reports the number of area residents per primary care physician. A shortage of primary care health professionals can contribute to reduced access and lower health status. Service Total Population Total Primary Care Providers Ratio of population per PCP Belknap County 60, New Hampshire 1,316,470 1, Data Source: U.S. Health Resources and Services Administration Resource File, Adults Without a Personal Health Care Provider This indicator reports the percentage of adults aged 18 and older who self-report that they do not have at least one person who they think of as a personal doctor or health care provider. This indicator may highlight insufficient access or availability of medical providers, a lack of awareness or health knowledge or other barriers preventing formation of a relationship with a particular medical care provider. Percent of adults who report not having a personal doctor or health care provider Belknap County 12.9% New Hampshire 10.2% Data Source: NHDHHS, Behavioral Risk Factor Surveillance System 2009 and County rate is not significantly different than the overall NH rates. Lakes Region Partnership for Public Health 12

13 Preventable Hospitalization Hospitalization for diagnoses treatable in outpatient services suggests that access to or quality of care in the outpatient setting was not optimal. The measure may also represent a tendency to overuse hospitals as a main source of care. Preventable hospital stays are measured here as the hospital discharge rate for ambulatory care-sensitive conditions per 1,000 Medicare enrollees. This rate is lower for Belknap County than New Hampshire overall suggesting somewhat better access to or quality of primary care and other outpatient services. Hospitalization rate for ambulatorycare sensitive conditions per 1,000 Medicare enrollees Belknap County 46.7* New Hampshire 56 Dartmouth Atlas of Health Care, 2010 Medicare data *Denotes regional rate is significantly different than overall NH rate BEHAVIORAL HEALTH CARE CAPACITY Behavioral Health Care Provider Availability This indicator reports the number of Lakes Region residents per Behavioral Health Care Provider (Includes Psychiatrists, Psychologists, Pastoral Psychologists, Clinical Social Workers, Clinic Mental Health Counselors, Marriage and Family Therapists and LADCs). A shortage of behavioral health professionals can contribute to reduced access and poorer health outcomes. Service Total Population Total Behavioral Health Care Providers Ratio of population per Behavioral Health Provider Lakes Region 65, New Hampshire 1,316,470 3, Source: NH Board of Mental Health Practice/ NH Board of Licensing of AOD Use Professionals, Certified Recovery Support Workers/New Hampshire Board of Medicine licensure list 10/22/2010. Lakes Region Partnership for Public Health 13

14 Emergency Department Utilization for Mental Health Conditions Overutilization or dependence on emergency departments for care of individuals with mental health conditions can be an indication of limited access to or capacity of outpatient mental health services. Utilization of emergency departments for mental health conditions is higher overall for Lakes Region communities compared to New Hampshire. This higher utilization is observed particularly for older teens and young adults, but utilization of the emergency department for child mental health services is apparently lower in the Lakes Region. Mental Health Condition ED Visits and Observation Stays (per 100,000 people) All Ages Ages 5-14 Ages Ages Lakes Region * 541.9* * * New Hampshire Data Source: NH DHHS Hospital Discharge Data Collection System, *Rates are statistically different; rates in bold are significantly higher than the overall NH rate (Other age ranges not displayed do not differ from the state rate at a threshold of statistical significance) Adequate Social or Emotional Support This indicator reports the percentage of adults aged 18 and older who self-report receiving sufficient social and emotional support all or most of the time. Social and emotional support is essential for navigating the challenges of daily life as well as for good mental health. Social and emotional support is also linked to educational achievement, economic stability and communities with high levels of social capital. Report Surveyed Population (Age 18 ) Adults Reporting Adequate Social or Emotional Support Percent Adults Reporting Adequate Social or Emotional Support Belknap County 2,644 2, % New Hampshire 43,049 35, % Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Lakes Region Partnership for Public Health 14

15 Suicide This indicator reports the rate of death due to intentional self-harm (suicide) per 100,000 people. Suicide rates can be an indicator of access to mental health care. Report Total Population, Average Annual Deaths, Average Age-Adjusted Death Rate (Per 100,000 Pop.) Belknap County 60, New Hampshire 1,313, Data Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Underlying Cause of Death, ORAL HEALTH CARE CAPACITY Dental Provider Availability This indicator reports the number of residents per dentist. A shortage of dental professionals can contribute to reduced access and lower oral health status. Service Total Population Total Dentists Ratio of population per dentist Belknap County 60, New Hampshire 1,316, Data Source: U.S. Health Resources and Services Administration Resource File, The next three indicators highlight insufficient access to preventive oral health care, a lack of health knowledge or other barriers preventing utilization of dental services by adults and children. Lakes Region Partnership for Public Health 15

16 Dental Care Utilization (Adult) This indicator reports the percentage of adults aged 18 and older who self-report that they have not visited a dentist, dental hygienist or dental clinic within the past year. Report Total Population (Age 18 ) Number Adults with No Dental Exam Percent Adults with No Dental Exam Belknap County 47,141 13, % New Hampshire 1,017, , % Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Poor Dental Health This indicator reports the percentage of adults age 18 and older who self-report that six or more of their permanent teeth have been removed due to tooth decay, gum disease, or infection. Total Population (Age 18 ) Number Adults with Poor Dental Health Percent Adults with Poor Dental Health Belknap County 47,141 8, % New Hampshire 1,017, , % Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Children in Need of Dental Care Percent of 3 rd Grade Students in Need of Dental Treatment Percent of 3 rd Grade Students in Urgent Need of Dental Treatment Belknap and Merrimack Counties 14.9% 1.4% New Hampshire 12.0% 1.0% Data Source: NH Third Grade Healthy Smiles-Healthy Growth Survey, NH DHHS. Regional rates are not significantly different than overall NH rate. Lakes Region Partnership for Public Health 16

17 Disease Prevention Adopting healthy practices, such as immunization, and behaviors can prevent or control the effects of disease and injury. For example, regular physical activity not only builds fitness, but helps to maintain balance, promotes relaxation, and reduces the risk of disease. Similarly, eating a healthy diet rich in fruits, vegetables and whole grains can reduce risk for diseases like heart disease, certain cancers, diabetes, and osteoporosis. Fruit and Vegetable Intake Inadequate Fruit/Vegetable Consumption (Adult) This indicator reports the percentage of adults aged 18 and older who self-report consuming less than 5 servings of fruits and vegetables each day. Unhealthy eating habits contribute to significant health issues such as obesity and diabetes. Total Population (Age 18 ) Population Consuming Few Fruits or Vegetables Percent Consuming Few Fruits or Vegetables Belknap County 48,150 35, % New Hampshire 96,349 68, % Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Lakes Region Partnership for Public Health 17

18 Physical Activity Physical Activity and Inactivity (Adult) This indicator reports the percentage of adults aged 18 and older who self-report leisure time physical activity, based on the question: "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?". Lack of physical activity can lead to significant health issues such as obesity and poor cardiovascular health. About 1 in 5 adults in Belknap County can be considered physically inactive a rate similar to the rest of New Hampshire. Moderate or vigorous physical activity, % of adults Physical inactivity, % of adults Belknap County 52.0% 22.0% New Hampshire 54.0% 21.0% Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Lakes Region Partnership for Public Health 18

19 Vaccine Preventable Diseases Pneumonia and Influenza Vaccinations (Adults) This indicator reports the percentage of adults who self-report that they have ever received a pneumonia vaccine or received influenza vaccine in the past year. In addition to measuring the population proportion receiving preventive vaccines, this indicator can also highlight a lack of access to preventive care, a lack of health knowledge, or other barriers preventing utilization of services. Adults 18 years and older who have received a flu shot in past 12 months and those who ever received a pneumococcal vaccination Influenza Vaccination Pneumococcal Vaccination Belknap County 73.0% 72.2% New Hampshire 73.5% 71.8% Data Source: NH DHHS, New Hampshire Immunization Data 2012 Behavioral Risk Factor Surveillance System Update. Differences are not statistically significant. Adults 65 years or older, who have received a flu shot in the past 12 months and those who ever received a pneumococcal vaccination Influenza Vaccination Pneumococcal Vaccination Belknap County 43.3% 32.7% New Hampshire 48.0% 28.5% Data Source: NH DHHS, New Hampshire Immunization Data 2012 Behavioral Risk Factor Surveillance System Update. Differences are not statistically significant. Lakes Region Partnership for Public Health 19

20 Post Hospital Discharge Events An additional aspect of prevention incorporates the concept of effective patient care coordination across a continuum of care settings including hospitals, primary care, home health care, rehabilitation and skilled nursing facilities, and hospice. High quality care coordination can help prevent individuals with significant disease or injury requiring hospital admission from experiencing unnecessary hospital readmission or emergency department utilization post discharge. Thus, hospital readmissions and emergency department utilization can be sentinel events signaling system of care gaps or disorganization that result in decreased capacity for secondary and tertiary prevention of poor health outcomes. The next two tables display recent data describing the experiences of Medicare beneficiaries from Belknap County who were admitted to the hospital for medical reasons, such as pneumonia, COPD, or heart failure, or surgical reasons, such as joint replacement or heart surgery. Belknap County New Hampshire Post Hospital Discharge Events Medical Cohort Medical discharges per 1,000 Medicare beneficiaries Percent seeing a primary care physician within 14 days of discharge to home Percent having an emergency room visit within 30 days of discharge Percent readmitted within 30 days of discharge % 21.0% 15.4% % 19.7% 15.0% Dartmouth Atlas of Health Care, 2010 Medicare Data, except discharges per 1,000 beneficiaries (2009 data) Rates are not significantly different Belknap County New Hampshire Post Hospital Discharge Events Surgical Cohort Surgical discharges per 1,000 Medicare beneficiaries Percent seeing a primary care physician within 14 days of discharge to home Percent having an emergency room visit within 30 days of discharge Percent readmitted within 30 days of discharge % 14.5% 9.2% % 13.6% 11.3% Dartmouth Atlas of Health Care, 2010 Medicare Data, except discharges per 1,000 beneficiaries (2009 data) Rates are not significantly different Lakes Region Partnership for Public Health 20

21 Illness and Injury Traditional measures of population health status focus on rates of illness or disease (morbidity) and death (mortality) from specific causes. Advances in public health and medicine through the 20 th Century have reduced infectious disease and complications of child birth as major contributors to or causes of death and disease. Chronic diseases, such as heart disease, cancer, respiratory disease and diabetes, along with injury and violence, are now the primary burdens on the health and wellbeing of individuals, families and communities. In addition to considering the absolute magnitude of specific disease burdens in a population, examination of disparities in disease rates can help to identify areas of need and opportunities for intervention. Premature Mortality An overall measure of the burden of disease is premature mortality or years of potential life lost. The indicator below expresses premature mortality as the rate of death, regardless of cause, where age is less than 65 years at the time of death. During the period 2006 through 2008 (the most current information available), the rate of premature death in the Lakes Region significantly exceeded the rate for New Hampshire overall. Premature Mortality (Deaths per 100,000 People Under Age 65) Lakes Region 192.8* New Hampshire Data source: NH Division of Vital Records Administration death certificate data; *Rate is statistically different and higher than the overall NH rate Lakes Region Partnership for Public Health 21

22 Obesity Excess weight has become a prevalent problem in the United States. Being overweight or obese can indicate an unhealthy lifestyle that puts individuals at risk for a variety of further health issues including hypertension, heart disease and diabetes. Adult Obesity These indicators report the percentage of adults aged 18 and older who self-report that they have a Body Mass Index (BMI) greater than 30.0 (obese) or greater than 25.0 (overweight or obese). The chart at the bottom of the page displays the recent trend in the Lakes Region toward increasing prevalence of obesity in the adult population. Total Population (Age 20 ) Percent Obese Percent Overweight or Obese Belknap County 46, % 64.2% New Hampshire 993, % 62.7% Data Source: NHDHHS, Behavioral Risk Factor Surveillance System 2009 and County rates are not significantly different than the overall NH rates. Male Female Percent Obese Percent Overweight or Obese Percent Obese Percent Overweight or Obese Belknap County 23.6% 73.8% 24.8% 54.5% New Hampshire 27.9% 71.9% 24.0% 53.4% Data Source: NHDHHS, Behavioral Risk Factor Surveillance System 2009 and County rates are not significantly different than the overall NH rates. Men are significantly more likely than women to report being overweight. Percent of Adults; Age Adjusted Proportion of Adults Who Are Obese Belknap County; Year Lakes Region Partnership for Public Health 22

23 Childhood Obesity Healthy lifestyles begin at an early age and can be linked to a number of factors including the social and physical environment. The societal trend toward unhealthy body weight has also occurred among children. The indicator below displays the rates of obesity for children from lower income families in Belknap County who are served by federally funded WIC and maternal and child health programs. The indicator on the next page displays the results of a sample of third grade students from Belknap and Merrimack Counties combined. In each case, the proportion of overweight or obese children is the highest of any county in New Hampshire. Low Income Children, ages 2-5 Percent Obese Percent Overweight or Obese Belknap County % 36.7% New Hampshire 8, % 31.5% Data Source: Centers for Disease Control and Prevention, Pediatric Nutrition Surveillance System,2011 Third Grade Students (sample) Percent Obese Percent Overweight or Obese Belknap and Merrimack Counties % 41.7% New Hampshire 3, % 33.4% Data Source: NH Third Grade Healthy Smiles-Healthy Growth Survey, NH DHHS. Regional rates are not significantly different than overall NH rate. Lakes Region Partnership for Public Health 23

24 Heart Disease Coronary heart disease is a leading cause of death in the United States and is closely related to unhealthy weight, high blood pressure, high cholesterol, and heart attacks. Heart Disease Prevalence This indicator reports the percentage of adults aged 18 and older who have ever been told by a doctor that they have coronary heart disease or angina. The second table reports this statistic by gender. Total Population (Age 18 ) Number of Adults with Heart Disease (self-reported) Percent of Adults with Heart Disease (self-reported) Belknap County 48,919 2, % New Hampshire 1,026,180 43, % Data Source: NH DHHS, Behavioral Risk Factor Surveillance System, Adults with Heart Disease, Percentage by Gender Male Female Belknap County 6.4% 4.6% New Hampshire 5.6% 3.0% Data Source: NH DHHS, Behavioral Risk Factor Surveillance System, Cholesterol Screening High levels of total cholesterol and low density lipoprotein-cholesterol (LDL-C) and low levels of high density lipoprotein-cholesterol (HDL-C) are important risk factors for coronary heart disease. Periodic cholesterol screening for adults, particularly those with other risk factors, is a beneficial procedure for early identification of heart disease that can be treated with preventive therapy. The table on the next page displays the proportion of adults who report that they have had their cholesterol levels checked at some point within the past 5 years. Lakes Region Partnership for Public Health 24

25 Percent of adults who have had their cholesterol levels checked within the past 5 years Belknap County 75.8% New Hampshire 83.0% Data Source: NHDHHS, Behavioral Risk Factor Surveillance System County rate is not significantly different than the overall NH rates. Heart Disease Morbidity and Mortality The rate of inpatient hospital utilization due to heart disease is lower among Lakes Region residents compared to the New Hampshire population overall, while the rate of emergency department utilization resulting from heart disease is similar. The rate of death due to heart disease among Lakes Region residents is also similar to the overall rate for New Hampshire. Heart Disease-Related Emergency Department and Inpatient Utilization (per 100,000 people) Heart Disease Inpatient Discharges, age adjusted Heart Disease ED Visits and Observation Stays, age adjusted Lakes Region 177.0* 41.5 New Hampshire Data Source: NH DHHS Hospital Discharge Data Collection System, for inpatient discharges; for ED visits and observation stays. *Denotes regional rate is significantly different than overall NH rate. Heart Disease Deaths (per 100,000 people) All Ages Lakes Region New Hampshire Data Source: NH DHHS Hospital Discharge Data Collection System, Regional rate is not significantly different than overall NH rate Lakes Region Partnership for Public Health 25

26 Diabetes Diabetes is an increasingly prevalent chronic health condition that puts individuals at risk for further health complications, but is also amenable to control through diet and adequate clinical care. Diabetes Prevalence This indicator reports the percentage of adults aged 20 and older who have ever been told by a doctor that they have diabetes. About 8.0% of Belknap County adults, equivalent to more than 4,000 people, report having been told by a health professional that they have diabetes Adults with Diabetes, Percentage (Age-Adjusted) Total Adult Population with Diabetes (age 20+) Percent of Adults with Diabetes Belknap County 4, % New Hampshire 81, % Data Source: Centers for Disease Control and Prevention, National Diabetes Surveillance System, Population by Gender, Adults with Diabetes, Percentage (Age-Adjusted) Male Female Belknap County 8.9% 7.2% New Hampshire 8.5% 6.6% Data Source: Centers for Disease Control and Prevention, National Diabetes Surveillance System, Lakes Region Partnership for Public Health 26

27 Diabetes-related Morbidity and Mortality The rate of emergency department utilization due to diabetes is higher among Lakes Region residents compared to the New Hampshire population overall, particularly for children and for adults ages Inpatient utilization resulting from diabetes is higher in the Lakes Region than for the New Hampshire population overall, while inpatient utilization for diabetes-related conditions is lower except for children with diabetes. The rate of death due to diabetes among Lakes Region residents is lower than the overall rate for New Hampshire. Diabetes ED Visits and Observation Stays (per 100,000 people) All Ages Ages 5-14 Ages Lakes Region 218.1* 79.8* 428.7* New Hampshire Data Source: NH DHHS Hospital Discharge Data Collection System, *Rate is significantly different than overall NH rate (Other Age ranges not significantly different) Diabetes and Diabetes-Related Inpatient Utilization (per 100,000 people) Diabetes Inpatient Discharges, All Ages Diabetes Related Inpatient Discharges, All Ages Diabetes Related Inpatient Discharges, Ages 5-14 Diabetes Related Lower Extremity Amputation Inpatient Discharges Lakes Region 137.3* 1,343.5* 102.7* 24.1 New Hampshire , Data Source: NH DHHS Hospital Discharge Data Collection System, *Rates are statistically different; rates in bold are significantly higher than the overall NH rate Deaths due to Diabetes or Diabetes as an Underlying Cause (per 100,000 people) Diabetes Deaths Diabetes Underlying Cause and Related Deaths Lakes Region * New Hampshire Data Source: NH DHHS Hospital Discharge Data Collection System, *Rate is significantly different than Overall NH rate Lakes Region Partnership for Public Health 27

28 Asthma Asthma is a prevalent condition that can be exacerbated by poor environmental conditions. Asthma Prevalence This indicator reports the percentage of adults aged 18 and older who self-report that they have ever been told by a doctor, nurse, or other health professional that they had asthma. Number Adults with Asthma Percent Adults with Asthma Belknap County 8, % New Hampshire 155, % Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Asthma-related Morbidity The rate of utilization of the emergency department for asthma care can indicate a variety of concerns including poor environmental conditions, limited access to primary care, and difficulties with asthma self-management skills. The rate of emergency department utilization for asthma care by Lakes Region residents is similar to the overall New Hampshire rate. Asthma ED Visits and Observation Stays (per 100,000 people) All Ages Lakes Region New Hampshire Data Source: NH DHHS Hospital Discharge Data Collection System, Rates are Not Significantly Different Lakes Region Partnership for Public Health 28

29 Emergency Department Utilization and Injury Rates of Emergency Department utilization have been displayed previously as indicators of health care access and the burden of disease for several conditions and categories of health including mental health, heart disease and asthma. The chart below shows the top 5 most common reasons for emergency department utilization in the Lakes Region and compares the utilization rates for those conditions to the state rates. In each case, the rate of emergency department utilization in the Lakes Region significantly exceeds the overall state rate (note: crude rates are not adjusted to account for variations in the age profile of comparison populations). Emergency Department Utilization Most Common Reasons for ED Visits and Observation Stays Per 100,000 People by Condition (All Ages) Outpatient Condition Lakes Region Crude Rate New Hampshire Crude Rate Difference Acute upper respiratory infection, excluding pharyngitis 5, Significant Contusion with intact skin surface 2, Significant Open wound, excluding head 2, Significant Abdominal pain Significant Chest pain 1, Significant Data Source: NH DHHS Hospital Discharge Data Collection System, Significant=Difference between regional rate and overall NH rate is statistically significant Lakes Region Partnership for Public Health 29

30 Unintentional Injury As shown by the table below, unintentional injuries causing emergency department visits and observation stays are also significantly higher for Lakes Region residents overall and for every age category. The chart at the bottom of the page displays categories of causes of unintentional injury leading to emergency department utilization such as falls, striking or being struck by an object (e.g. striking furniture, falling objects, sports injuries), and suffocation (e.g. choking on a foreign object). Again for each category of unintentional injury, rates of emergency department utilization among Lakes Region residents significantly exceeds overall state rates. Unintentional Injury ED Visits and Observation Stays per 100,000 People by Any Cause/Mechanism; Lakes Region* New Hampshire Adjusted Rate Events NH Adjusted Rate NH Events Statistical Test Overall 9, ,209 7, ,174 Sig Age-Specific Rate Events Age-Specific Rate Events Statistical Test 0 To 4 11, ,072 7, ,404 Sig 05 To 14 11, ,768 7, ,606 Sig 15 To 24 13, ,851 10, ,769 Sig 25 To 34 11, ,713 9, ,056 Sig 35 To 44 9, ,628 6, ,283 Sig 45 To 54 7, ,435 5, ,331 Sig 55 To 64 5, ,541 4, ,165 Sig 65 To 74 5, , ,325 Sig 75 To 84 6, , ,195 Sig 85 Plus 10, , ,040 Sig Total Crude 9, ,209 Data Source: NH DHHS Hospital Discharge Data Collection System, Unintentional Injury ED Visits and Observation Stays by Cause/Mechanism per 100,000 People; *Fall *Struck by or against *Suffocation *Overexertion *Cut/pierce *Motor vehicle traffic *Natural, environmental *Fire or hot object, substance *Poisoning Lakes Region New Hampshire *Denotes regional and state rates are significantly different Lakes Region New Hampshire *Machinery Lakes Region Partnership for Public Health 30

31 SUBSTANCE ABUSE Substance abuse, involving alcohol, illicit drugs, misuse of prescription drugs, or combinations of all of these behaviors, is associated with a complex range of negative consequences for health and wellbeing of individuals, families and communities. In addition to contributing to both acute and chronic disease and injury, substance abuse is associated with destructive social conditions, including family dysfunction, lower prosperity, domestic violence and crime. Adult Substance Abuse Excessive drinking Excessive alcohol use, either in the form of heavy drinking (drinking more than two drinks per day on average for men or more than one drink per day on average for women), or binge drinking (drinking 5 or more drinks on an occasion for men or 4 or more drinks on an occasion for women), can lead to increased risk of health problems such as liver disease or unintentional injuries. Engaged in Binge Drinking in Past 30 days, Percent of Adults Male Female Total Belknap County 23.9% 8.4% 15.9% New Hampshire 20.1% 11.1% 15.5% Data Source: NHDHHS, Behavioral Risk Factor Surveillance System County rates are not significantly different than the overall NH rates. Heavy Alcohol Use Risk Factor, Percent of Adults Male Female Total Belknap County 8.0% 6.2% 7.1% New Hampshire 6.2% 5.8% 6.0% Data Source: NHDHHS, Behavioral Risk Factor Surveillance System County rates are not significantly different than the overall NH rates. Lakes Region Partnership for Public Health 31

32 Substance Abuse-related Morbidity The rate of utilization of the emergency department for substance abuse-related conditions can indicate a variety of concerns including prevalence of substance abuse in the community, community norms, and limited access to treatment. The rate of emergency department utilization for substance abuse related mental health conditions by Lakes Region residents is significantly higher than the overall New Hampshire rate, especially among young adults. Substance Abuse Related Mental Health Condition ED Visits and Observation Stays (per 100,000 people) All Ages Ages Lakes Region 549.1* 1,140.3* New Hampshire Data Source: NH DHHS Hospital Discharge Data Collection System, *Rate is significantly different than overall NH rate (Other Age ranges not significantly different) Cigarette Smoking Tobacco use is a primary contributor to leading causes of death such as lung cancer, respiratory disease and cardiovascular disease. This indicator reports the percentage of adults aged 18 and older who self-report currently smoking cigarettes some days or every day. Number Adults who are Current Smokers Percent of Adults who are Current Smokers Belknap County 8, % New Hampshire 168, % Data Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, Lakes Region Partnership for Public Health 32

33 Youth Substance Abuse In New Hampshire and nationally, significant attention is placed on early prevention of substance abuse problems through youth education to instill understanding of risks and skill building to promote risk reduction and resiliency strategies and abilities. A source of measurement of youth attitudes and practices regarding substance abuse is the biannual Youth Risk Behavior Survey (YRBS) administered in high schools. The following charts and tables display selected results from the 2011 YRBS and includes a sample of students from seven Lakes Region public high schools (Lakes Region total number of survey respondents=1,269 high school students). Past 30 Day Substance Use The chart and graph below displays the percentage of Lakes Region high school students who reported using certain substances at least once in the 30 days prior to the survey administration date. In each case, it can be noted that the rates of reported substance use among Lakes Region youth exceeds the overall New Hampshire rate. Use in Past 30 days Prescription Drug Cigarettes Alcohol Binge Drinking Marijuana Misuse Lakes Region 22.0% 42.0% 27.4% 31.0% 13.1% New Hampshire 18.7% 37.9% 24.3% 27.6% 10.4% Data Source: 2011 YRBS; New Hampshire Whole State Sample Lakes Region Partnership for Public Health 33

34 Percentage of high school aged youth who used substance in past 30 days 100% 80% 60% 40% 20% 0% 22.0% 18.7% Substance Use in the Past 30 Days High School Age Youth 42.2% 37.9% 27.4% 24.3% 31.0% 27.6% 13.1% 10.4% Cigarettes Alcohol Binge Drinking Marijuana Prescription Drug Misuse Source: New Hampshire Youth Risk Behavior Surveillance System (YRBSS), 2011 Lakes Region New Hampshire Early Initiation of Substance Use The chart and graph below displays the percentage of Lakes Region high school students who reported that they first began using certain substances before the age of 13. In each case, it can be noted that the proportion of Lakes Region youth initiating substance use before the age of 13 exceeds the overall New Hampshire rates. First Use Before Age of 13 Cigarettes Alcohol Marijuana Lakes Region 12.7% 20.1% 11.2% New Hampshire 9.7% 14.9% 8.0% Data Source: 2011 YRBS; New Hampshire Whole State Sample Lakes Region Partnership for Public Health 34

35 Percentage of high school aged youth who first used substance before age 13 50% 40% 30% 20% 10% 0% 12.7% Substance Use Before the Age of 13: High School Age Youth 9.7% 20.1% 14.9% 11.2% 8.0% Cigarettes Alcohol Marijuana Lakes Region New Hampshire Source: New Hampshire Youth Risk Behavior Surveillance System (YRBSS), 2011 Lakes Region Partnership for Public Health 35

36 Perception of Risk There is a substantial body of evidence demonstrating that youth substance use behavior is strongly correlated with the perceived risks entailed in using the substance. Youth who perceive a significant risk of negative consequences including physical harm are significantly less likely to engage in substance use behavior. The chart and graph below displays the percentage of Lakes Region high school students who reported perceiving great risk in using certain substances. It can be noted that the rates of reported risk perception among Lakes Region youth are similar to the overall New Hampshire rate except for the risk of alcohol use including binge drinking. The chart on the next page displays the relationship between perception of risk and substance abuse behavior where youth who perceive great risk in the behavior are substantially and significantly less likely to report engaging in that behavior. Perceive Great Risk of Use Binge Prescription Drug Cigarettes Alcohol Marijuana Drinking Misuse Lakes Region 64.7% 27.1% 31.5% 33.2% 60.9% New Hampshire 66.4% 32.3% 36.0% 32.9% 59.6% Data Source: 2011 YRBS; New Hampshire Whole State Sample Percentage of high school age youth who perceive great risk in substance use 100% 80% 60% 40% 20% 0% Perception of Great Risk in Substance Use: High School Age Youth 64.7% 66.4% 32.3% 27.1% 36.0% 31.5% 33.2% 32.9% 60.9% 59.6% Cigarettes Alcohol Binge Drinking Marijuana Prescription Drug Misuse Source: New Hampshire Youth Risk Behavior Surveillance System (YRBSS), 2011 Lakes Region New Hampshire Lakes Region Partnership for Public Health 36

37 Percentage of high school aged youth who used substance in past 30 days 100% 80% 60% 40% 20% 0% 36.9% Association Between Perception of Risk and Substance Use 13.7% 47.6% 27.6% Youth who do not perceive "great risk" of harm Youth who perceive "great risk" of harm 35.8% 8.3% 24.3% Used cigarettes Used alcohol Binge drank Misused prescription drugs 43.6% 5.9% 5.3% Used marijuana Lakes Region Partnership for Public Health 37

38 Perception of Parental Disapproval As with perception of risk, there is also a substantial body of evidence demonstrating that youth substance use behavior is strongly correlated with their perceptions of parental values with respect to substance use by youth. Youth who perceive that their parent(s) consider the behavior to be wrong are less likely to engage in substance use behavior. The chart and graph below displays the percentage of Lakes Region high school students who reported perceiving that their parents think it is either very wrong or wrong for youth to use certain substances. It can be noted that the rates of reported risk perception among Lakes Region youth are similar, but slightly lower in each case, to the overall New Hampshire rates. It is interesting to note that perception of parental disapproval is lowest for marijuana use both regionally and statewide. The chart on the next page displays the relationship between perception of parental disapproval and substance abuse behavior where youth who perceive parental disapproval in the behavior are substantially and significantly less likely to report engaging in that behavior than youth who do not perceive parental disapproval. Perception of Parental Disapproval of Use (Parents think it is very wrong or wrong for someone your age to use substance) Prescription Drug Cigarettes Alcohol Marijuana Misuse Lakes Region 82.6% 81.0% 77.0% 90.6% New Hampshire 85.0% 83.6% 82.1% 92.1% Data Source: 2011 YRBS; New Hampshire Whole State Sample Percentage of high school age youth who perceive parents think use is wrong or very wrong 100% 80% 60% 40% 20% 0% Perception of Parental Disapproval of Use: High School Age Youth 82.6% 85.0% 81.0% 83.6% 82.1% 77.0% 90.6% 92.1% Cigarettes Alcohol Marijuana Prescription Drug Misuse Source: New Hampshire Youth Risk Behavior Surveillance System (YRBSS), 2011 Lakes Region New Hampshire Lakes Region Partnership for Public Health 38

39 100% Association Between Perception of Parental Disapproval and Substance Use Percentage of high school aged youth who used substance in past 30 days 80% 60% 40% 20% 53.0% 15.4% 72.3% 35.0% Do not perceive parental disapproval Perceive parental disapproval 58.3% 40.2% 10.3% 5.8% 0% Used cigarettes Used alcohol Used marijuana Misused prescription drugs Lakes Region Partnership for Public Health 39

40 Public Safety Community health and public safety are closely intertwined in that many of the same social and environmental factors which correlate with health and wellbeing also correlate with variation in crime rates. The sense of a safe community is associated with higher levels of social capital and social organization. Inversely, the effects of higher rates of crime and reduced perceptions and experiences regarding personal and public safety include negative consequences for acute as and chronic measures of physical and mental health. Substance Abuse-Related Crime As described in the prior section, substance abuse behavior contributes to criminal behavior. The chart below displays the rate of arrests per capita in 2011 for selected substance-abuse related crimes. A comparison of the Lakes Region (12 of 13 municipalities reporting representing 98% of the population) with the overall New Hampshire rates shows that the rates are similar in each instance except arrests for drunkenness, which is more than double the overall state rate Substance Abuse-Related Crime Arrest Rate per 1,000 population; 2011 Rate per 1,000 population Drunkenness Simple Assault Liquor Law Violations Drug, Narcotic Violations Driving Under The Influence Destruction, Damage,Van dalism of Property Disorderly Conduct Drug Equipment Violations New Hampshire Lakes Region Arrest Data, National Incident-Based Reporting System (NIBRS) Uniform Crime Reporting Lakes Region Partnership for Public Health 40

41 Assault Emergency department utilization by Lakes Region residents where assault is listed as the cause of the visit or observation stay is significantly higher than the overall state rate. Further and more specifically, the rate of emergency department utilization caused by assault injury is substantially higher for residents in the age group. Assault Injury ED Visits and Observation Stays (per 100,000 people) All Ages Ages Lakes Region 305.4* 918.4* New Hampshire Data Source: NH DHHS Hospital Discharge Data Collection System, *Rates are Significantly Higher Lakes Region Partnership for Public Health 41

42 Domestic Violence Between 2001 and 2010, the homicide rate in Belknap County was 1.46 per 100,000 people (9 total homicides). This rate is somewhat higher than the statewide rate over the same period (1.29) and is the sixth highest rate among NH s 10 counties. Six of the homicides in Belknap County or two-thirds were domestic violence equivalent to a population rate of This rate is notably higher than the state rate for domestic violence homicides (0.58) and the second highest rate among NH counties (after Sullivan County). Source: State of New Hampshire, Governor s Commission on Domestic and Sexual Violence, Domestic Violence Fatality Review Committee, October Lakes Region Partnership for Public Health 42

43 The rate of domestic violence emergency orders granted in Belknap County in 2011 far exceeds the statewide rate (44 per 100,000 people). It should be noted that, in addition to this civil option for protection, a criminal bail protective order may also be issued following a domestic violence incident, which may account for the some of differences between counties. Belknap County also exceeds the state rate for the civil domestic violence petitions (cases) filed in The figure below reflects the rate at which these petitions were filed per 100,000 people in each county. The Belknap County rate was 444, third highest among NH counties and higher than the statewide rate of 351 petitions filed per 100,000 people (red line). Lakes Region Partnership for Public Health 43