Wake County Human Services Public Health Quarterly Report. July-September 2014

Transcription

1 Wake County Human Services Public Health Quarterly Report July-September 2014 Wake County Human Services Public Health Division 10 Sunnybrook Road P.O. Box Raleigh, NC Regina Petteway, Interim, Human Services Director Sue Lynn Ledford, Public Health Division Director Editor-in chief: Edie Alfano Sobsey, Public Health Epidemiologist Content : Roxanne Deter, Nurse Informatics Design and Layout: Yolanda McMillan, Public Health Educator Editor: Carla Piedrahita, Public Health Educator

2 Public Health Quarterly Table of contents... 2 Introduction... 3 Cancer of the Respiratory System and Digestive Track... 4 Smoking...5 Prostate Cancer... 7 Breast Cancer... 8 Heart Disease... 9 Diabetes Asthma Obesity Club Choice Obesity in Youth...16 Physical Activity Community Physical Activity Programs References 22 2

3 Introduction Persons with chronic diseases tend to have premature deaths. Nationally, according to the Center For Disease Control and Prevention, 75% of our health care dollars go to treatment of chronic diseases. These persistent conditions are the leading causes of death and disability in the US. Many of the deaths, lifelong disability, compromised quality of life, and burgeoning health care costs related to these conditions could be prevented (1). Leading Causes of Death The leading cause of death in Wake County, Mecklenburg County, and North Carolina is cancer, in contrast with heart disease, that is the leading cause of death in the US. In Wake County, cancer caused 5,435 deaths at a rate of (156.4/100,000 population) from (FIGURE 1) (2). FIGURE 1 Causes of Death in Wake County (Age-Adjusted Death Rate per 100,000 from ) Rate per 100, Cancer Diseases of Heart Cerebrovascular Disease Chronic Lower Respiratory Diseases Diabetes Mellitus Nephritis, Nephrotic Syndrome, and Nephrosis Chronic Liver Disease and Cirrhosis Source: North Carolina Center for State Statistics Compared to North Carolina overall, Wake County has lower mortality rates for each of the causes of death in Figure 1 (3). 3

4 Age-adjusted rate per 100,000 African American, non-hispanic males had the highest age-adjusted overall death rate per 100,000 from all reported cancers (colon, rectum, anus, pancreas, trachea, bronchus, lung, breast, prostate) (FIGURE 2): One and a half times more than white, non-hispanics males Three times more than other non-hispanic males Over two times more than Hispanic males Almost two times more than African American, non-hispanic females FIGURE 2 Cancer Death Rates in Wake County From : Racial Disparities Source: North Carolina Center for State Statistics, 2014 County Health Data Book, Cancers of the Respiratory System and Digestive Tract From in Wake County, cancer of the respiratory system accounted for the highest death rate of all cancers (3) accounting for: 1,376 deaths An overall death rate of 40.4 per 100,000 people Disparity: African American, non-hispanic males also have the highest death rate for all of the cancers in FIGURE 3 compared to African American, non-hispanic females and white non-hispanic males and females. 4

5 FIGURE 3 Dates Rates for Colon, Rectum, Anus, Pancreas, Trachea, Bronchus and Lung Cancer among Wake County African American, Non-Hispanic and White, Non-Hispanic Residents from Source: NC State Center for Health Statistics, 2014 County Health Data Book, Mortality, County Health Ranking for Adult Smoking One of the risk factors for developing chronic disease, including cancer, cardiovascular and respiratory conditions, is smoking. The County Health Rankings and Roadmaps estimates the percent of the adults that currently smokes every day or most days and has smoked at least 100 cigarettes in their lifetime. In Wake County, the percent of adults smoking on most days decreased from 16% during to 13% during (FIGURE 4). FIGURE 4 25% 20% 15% 10% 5% 0% 23% 20% 16% Prevelance of Adult Smoking County Health Rankings 20% 14% 13% Overall in North Carolina: Adult Smoking- Wake Top U.S. Performers: Source: County Health Rankings 5

6 Smoking and Wake County Public School System: Middle and High School Students Just over 4% (4.4) of WCPSS middle school students and 11.8% of high school students reported smoking at least one cigarette on at least one day during the past month. White high school students were significantly more likely to have smoked cigarettes during the past 30 days than Black students (4). Wake County Human Services Project ASSIST/Tobacco Prevention and Control Project ASSIST/Tobacco Prevention and Control Program was successful in helping to change policy in the following organizations. Three organizations adopted smoke free policies: impacting over one hundred and sixty-five people. Town of Apex increased health insurance premiums on smokers (effective 7/1/14) Project ASSIST provides Tobacco Prevention Outreach Programs and makes referrals to the NC Quitline which is a phone based counseling service that helps clients quit smoking. Partnering and collaborating with community partners enables tobacco prevention efforts to reach many citizens in Wake County. For the 2013 Great American Smoke-Out (GASO), Project ASSIST coalition targeted multi-housing properties, municipalities, local organization/businesses and health clinics. This annual event encourages tobacco users to quit for the day and in the future. Seventeen organizations and healthcare clinics in Wake County agreed to participate in GASO They were provided tool kits that included: a sample tobacco free policy, cessation materials, posters and an educational display to use to market GASO to their employees and patrons. ASSIST partnered with the County Parks and provided yard signs that were displayed in all eight parks. There were approximately 19,635 Wake County residents that were reached by the 2013 GASO. 6

7 Prostate Cancer The overall Mortality Rate from prostate cancer in Wake County was 26.2 per 100,000 from (3). The mortality rate for all minority males and Black non-hispanic males has been more than twice that of white males for over a decade ( FIGURE 5). FIGURE 5 Source: NC State Center for Health Statistics, 2014 County Health Data Book, Mortality, * These data include Blacks and other Non-White minority males compared to White males. ** These data include Black non-hispanic males only compared to White males. Source: accessed 12/5/14. 7

8 Breast Cancer From , 486 Wake County women died of breast cancer, with a death rate of 22.7 per 100,000 population (3). The death rate for African American, non-hispanic females (32.3/100,000) is one and a half times higher than for white, non-hispanic females (21.2/100,000) (FIGURE 6). FIGURE 6 Breast Cancer Death Rates for African American and White Non-Hispanic Females from Source: NC State Center for Health Statistics, 2014 County Health Data Book, Mortality, Mammogram and Cervical Cancer Screening through Wake County Human Services (WCHS) Early detection and treatment of breast cancer through mammography screening can reduce deaths. WCHS facilitates screenings through the North Carolina Breast and Cervical Cancer Screenings Programs (BCCCP) and the Susan G. Komen grant program. The NC Breast and Cervical Cancer Control Program (NC BCCCP) provides free or low-cost breast and cervical cancer screenings and follow-up to eligible women in North Carolina. NC BCCCP provides services to women who are uninsured or underinsured; are between ages for breast screening services and for cervical screening services; and have a household income at or below 250% of the federal poverty level. During fiscal year , WCHS Health Promotion Chronic Disease Prevention (HPCDP) provided a total of 449 mammography services (including mammograms, diagnostics and surgical evaluations). From these screenings, 17 breast cancers were detected for a total potential medical cost savings of $255,000 to $442,000. This is based on 17 times the estimated cost range of $15,000 - $26,000 per year of life expectancy saved for women age (5). Through the BCCCP Program HPCDP staff performed 58 cervical screenings and one case of cervical cancer was detected in FY

9 Age-adjusted rate per 100,000 Heart Disease From in Wake County, heart disease was the second leading cause of death and cerebro-vascular disease was the third leading cause of death. 4,356 deaths occurred from heart disease (3). The age-adjusted death rate (134/100,000) for heart disease in Wake County from is lower than that of North Carolina (174.4/100,000) (3). The age-adjusted death rate declined 41% in Wake County from 233.4/100,000 during to 137.5/100,000 during Compared to earlier years, there has been only a slight decrease from to (FIGURE 7). FIGURE 7 Death Rates from Heart Disease in Wake County from Source: North Carolina Center For State Statistics Disparity : African American, non-hispanic males had a higher age-adjusted death rate from heart attacks (47.4 per 100,000) compared to white, non-hispanic males (28.9/100,000) (FIGURE 8). FIGURE 8 Death Rate from Heart Attacks for African Americans and Whites from Source: North Carolina Center For State Statistics, 2014 County Health Data Book, Mortality,

10 Heart Disease and Wake County Human Services (WCHS) Health Promotion Chronic Disease Prevention Program (HPCDP) Cardiovascular Screenings WCHS HPCDP staff provide cardiovascular health screenings in the community with particular focus on low-income, low-resource populations. During FY this program screened 672 people and found 286 (43%) with pre-hypertension and 228 (34%) with hypertension (stage 1 and stage 2). Fifty-nine of those with hypertension, were found with blood pressures at the hypertension stage 2 (HTN2) level. The HPCDP nurse follows up with these clients to make sure they secure care from a medical provider. At follow up, 63% (37) of the patients with HTN2 had secured care, potentially preventing strokes. This is a potential medical cost savings of $3,832,312 based on 37 x $103,576 per average lifetime cost of a stroke event 6). Wisewoman WCHS HPCDP staff have been facilitating the WiseWoman Program for the past five years. The purpose of the WiseWoman Program is to provide expanded cardiovascular disease screenings, intervention, counseling and referral services to BCCCP eligible women aged years who are at or below 250% of the federal poverty level and are uninsured or underinsured. Women who have abnormal cardiovascular screening results are provided with nutrition, physical activity, other healthy lifestyle interventions as well as referrals for medical evaluation. During FY , 77 women were seen through the WISEWOMAN program. Sixty five (84%) of the WISEWOMAN participants were overweight, obese, or morbidly obese, 9 (12%) WISEWOMAN participants had hypertension and 13 (17%) WISEWOMAN participants had high cholesterol. Red Dress During February 2014, Heart Health Month, WCHS HPCDP staff sponsored a Red Dress campaign that included several activities. A healthy cooking demonstration program called Simple Cooking with Heart was sponsored by HPCDP in partnership with the American Heart Association and a local faith based organization (Church of God of Prophecy) and included 40 participants, 6 staff assistants and 4 church volunteers. Another program called Pretty Party in Red, sponsored by Duke Health Center in partnership with WCHS included a health fair with screenings, heart healthy cooking demonstrations, massages, exercise demonstrations, including line dancing and a heart healthy dinner. Twenty three people visited the educational booth and over 40 people participated in the line dance fitness session. 10

11 Cerebrovascular Disease (Stroke) Stroke was the third leading cause of death from People surviving a stroke are likely to have impairments or permanent disability, which is costly. From in Wake County: 1,340 people died (3) The death rate per 100,000 population was 43.4 (3). African American, non-hispanics were more likely to die of a stroke than white, non-hispanics. African American, non-hispanic males were one and a half times more likely to die of stroke than white, non-hispanics males. (FIGURE 9). FIGURE 9 Cerebrovascular (Stroke) Age-Adjusted Death Rate Wake County Source: North Carolina Center For State Statistics, 2014 County Health data Book Mortality, Diabetes In Wake County from , there were 570 deaths due to diabetes with a death rate of 17 per 100,000 population (3). The death rate for African American, non-hispanic males (50.4/100,000) was almost three times that of White, non-hispanic males (17.7/100,000). African American, non- Hispanic females death rate (35.9/100,000) was almost four times that of white, non-hispanic females (9.4/100,000) (FIGURE 10). 11

12 FIGURE 10 Age-adjusted Death Rate for Diabetes in Wake County Rate per 100,000 Source: North Carolina Center For State Statistics, 2014 County Health Data Book, Mortality, Diabetic Screening Managing diabetes through screening and early detection of complications may prevent progression of the disease and other health conditions related to diabetes such as hypoglycemia and hyperglycemic crisis, high blood pressure, high blood cholesterol, heart disease, stroke, blindness, eye problems, kidney disease, and amputations (7). In 2014, 90% of Medicare enrollees aged in Wake County had HbA1c screening compared to 88% in North Carolina (County Health Rankings and Roadmap, 2014). Beginning in 2012, Wake County became one of the top performing counties in the US for this indicator (FIGURE 11). FIGURE 11 12

13 Asthma Asthma continues to be a challenge in Wake County and is a major cause of chronic disease in school-age children. Hospital discharge data show a 12.6% increase in children ages 0-14 hospitalized due to asthma (TABLE 1). A higher percentage of black high school students (31.9%) have been diagnosed with asthma compared to White and Hispanic/Latino students (20%) in the Wake County Public School System (FIGURE 12). TABLE 1 ASTHMA HOSPITAL DISCHARGES (AGES 0-14) RATE PER 100,000 WAKE COUNTY Wake County, Base 2007 Wake County, 2012 Percent Change Trend North Carolina, 2007 Base North Carolina, 2012 Asthma hospital discharges per 100,000 children ages 0-14 (2007, 2012) % Worse Source: Wake, 2013 Health County Data Card, Wake.pdf, Data Source: NC Department of Health and Human Services, State Center for Health Statistics. "Asthma Hospital Discharges (Total and Ages 0-14) per 100,000 Population." FIGURE 12 Percent of High School Students Who Have Been Told by a Doctor or Nurse that They Have Asthma Source: North Carolina Youth Risk Behavior Survey, Wake County Public Schools, Data Trends 13

14 Obesity County Health Ranking Trend Data for Adult Obesity The County Health Rankings measures adult obesity as an indicator. Adult obesity is defined as the percent of the adult population that has a body mass index greater than or equal to 30. North Carolina has maintained a 29% obesity level from 2008 through However, in Wake County, the percent of adults with obesity has declined slightly from 27% in 2008 to 25% in (FIGURE 13). FIGURE 13 14

15 Club CHOICE Plus Is a Program Offered by Wake County Human Services As an eight-week series of nutrition education and exercise classes for English and Spanish speaking women and their children, the goal of Club CHOICE plus is to facilitate wellness, self-sufficiency and personal empowerment for Choosing Healthy Options In a Challenging Economy. Through the collaborative effort among WCHS, the University of North Carolina and Wake County 4-H Cooperative Extension, the nutrition education curriculum and Zumba classes promote weight loss and healthy lifestyles for families. During the spring 2014 session, 76 women and children participated in the program. The women lost an average of 2.6 pounds during the eight week program. Pre and post behavioral questionnaires indicated these women made the following statistically significant (p <0.5) changes: Decreased intake of sweetened beverages Changed to low-fat or skim milk Increased intake of healthier snacks Decreased intake of home baked cookies, cakes or pies Increased use of artificial sweeteners (versus sugar) They demonstrated positive transformations in their eating and exercise behaviors, weight loss and excitement, expressing their desire for additional classes beyond the current eight. 15

16 Obesity in Youth Obesity, overweight, healthy weight and underweight are classifications based on Body Mass Index (BMI). BMI is calculated from the child s height and weight and is an indicator of body fatness. Obesity in Children Ages 2-4 The majority of the children ages 2 through 4 included in the 2012 NC-NPASS data are from the Special Supplemental Nutrition Program for Women, Infants, and Children - better known as the WIC Program. The prevalence of obesity in children ages two to four decreased in Wake County from 17.4% in 2009 to 14.5% in 2012 as compared to North Carolina overall, where rates have been slowly, but steadily increasing (FIGURE 14). FIGURE 14 North Carolina Youth Risk Behavior Survey The North Carolina Youth Risk Behavior Survey was administered to a sample of Wake County Public School System (WCPSS) high school and middle school students in the spring of 2013 to measure a variety of behaviors including nutrition and physical health. Overall in 2013: 46% of WCPSS high school students and 41% of middle school students reported trying to lose weight 41% of WCPSS high school students and 45% of middle school students reported eating less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weight during the last 30 days 6% of WCPSS of high school students and 5% of middle school students reported vomiting or taking laxatives to lose weight or to keep form gaining weight 16

17 Gender Disparities: Female high school and middle school students compared to males were more likely to: Try to lose weight Eat less food, fewer calories or foods low in fat to lost weight or to keep form gaining weight Have vomited or taken laxatives to lose weight or to keep from gaining weight Ethnic/Racial disparities: White or Hispanic/ Latino compared to African American high school students were more likely to eat less food, fewer calories or foods low in fat to lost weight or to keep form gaining weight. Hispanic/ Latino or African American middle school students compared to whites were more likely to have gone without eating for 24 hours or more to lose weight or to keep from gaining weight Physical Activity County Health Rankings for Physical Inactivity Lack of exercise and poor diet are factors that contribute to obesity. Nineteen percent of adults over age 20 in Wake County reported spending no leisure time on physical activity in 2008 and again in 2010 (FIGURE 15). FIGURE 15 Physical Inactivity Adults aged 20 and over reporting no leisure time physical activity % 25% 20% Wake County 15% 10% 5% 0% Source: County Health Rankings and Roadmap. (2014). Retrieved August 2014, from County Health snapshot Time spent commuting to work in the Triangle may decrease the amount of time that could otherwise be spent for leisure activity. A 2012 study in the American Journal of Preventive Medicine found that the farther people commute by vehicle, the higher their blood pressure and body mass index (8). The percentage of individuals in Wake County who drive for longer than thirty minutes each day is twice (31%) the percentile of those in other US counties (15%) (9). 17

18 Physical Activity and WCPSS Middle School Students According to the Youth Risk Behavioral Survey, over one third of WCPSS middle school students (37.5%) were physically active for a total of 60 minutes per day on fewer than 5 of the past 7 days, which is slightly less than what is seen in North Carolina overall (43%) (FIGURE 16). Disparities within WCPSS (FIGURE 16). : Female students (41.4% ) were significantly less likely to have been physically active for a total of at least 60 minutes per day on fewer than 5 of the past 7 days compared to male students (33.3%). Black (45.0% ) and Hispanic/Latino (42.2%) students were significantly less likely to have been physically active for a total of at least 60 minutes per day on fewer than five of the past seven days compared to White students(29.6%). FIGURE 16 Percent of Middle School Students Who Were Physically Active for a Total of at Least 60 Minutes per Day on Fewer than 5 of the Past 7 Days Source: North Carolina Youth Risk Behavior Survey, Wake County Public Schools, Data Trends, Data and Accountability Department:

19 Physical Activity and WCPSS High School Students According to the Youth Risk Behavioral Survey, over half (59%) of WCPSS high school students reported being physically active for at least 60 minutes a day on fewer than five of the last seven days, which is slightly more than for North Carolina as a whole (53.5%) (FIGURE 17). Within WCPSS: (FIGURE 17). Female students (68%) were significantly less likely to be physically active on fewer than 5 of the past 7 days a week than male (50%), students. Students in 10th, 11th, and 12th grade (60.3%, 67%, 62.7%, respectively ) were significantly less likely to be physically active on fewer than 5 of the past 7 days a week than students in 9th grade (48.2%). FIGURE 17 Percent of High School Students Who Were Physically Active for a Total of at Least 60 Minutes per Day on Fewer than 5 of the Past 7 days 2013 Source: North Carolina Youth Risk Behavior Survey, Wake County Public Schools, Data Trends, Data and Accountability Department:

20 Physical Activity WCHS HPCDP works to increase access to physical activity in the community by partnering with other organizations to host physical activity programs. Community Physical Activity Programs Movin' & Groovin' During the Spring of 2011, Health Promotion and 4H Youth Development Staff specifically planned the Movin & Groovin series to encourage families living in the North Central and Eastern regions of Wake County to increase their physical activity in a free, fun and safe way. Designed to help fight the overweight/obesity epidemic, mini physical activity sessions as well as organized walking are facilitated weekly by Health Promotion Staff. 4-H Youth Development engages children by implementing an evidenced based physical activity module, Operation Fit Kids. The program was the recipient of a NCPHA Award in In the fall and spring of FY 13/14 there were 4 walking programs, 2 in Zebulon and 2 in Raleigh (Spring Forest Road) with a total of 161 participants. Results of a survey completed by 46 participants of Movin and Groovin demonstrated that: 89% increased other physical activity habits 96% improved nutrition habits 48% improved their weight 54% maintained their weight 39% improved their blood pressure 13% improved their blood cholesterol levels 7% improved their blood sugar levels This program partners with the Grocers on Wheels to bring fresh fruits and vegetables to Movin and Groovin Participants. Over $350 worth of Healthy Bucks were distributed to participants (adults and children) to purchase produce at a mobile market. More than 30 individuals participated and 320 pounds of food were purchased with the Healthy Bucks. Participants earned "Healthy Bucks" throughout the Movin and Groovin series by attending weekly sessions and submitting weekly activity and healthy behavior logs. 20

21 Couch to 5K program "Couch to 5k" is a free 9 week fitness and wellness program designed for inexperienced runners interested in working towards running a 5k or a 30 minute run. Participants receive a step by step plan preparing them to walk, jog and then run. Weekly running meetings allow for continued motivation, support and inspiration. An added bonus to this program is family involvement. Wake County 4-H and Raleigh Parks Recreation and Cultural Resources engage children, ages 7+, in physical activities preparing them to complete a 5K with their parent(s). At the end of the 9 weeks, families and participants can sign up for a local 5K to show off newly developed running ability. In Spring 2014 there were 27 participants. The Poe Center PlayWELL Park program included activities encouraging children and their parents to be more physically active and eat a healthy diet. From October September 2013, 177 adults and 331 children participated in this program. The Dancing in the Park program is hosted by Southeast Raleigh Assembly and WCHS HPCDP is a corporate sponsor. HPCDP staff provide nutrition and health information materials and displays for all 9 summer sessions during which over 1000 people participated. The Exercise as Medicine Prescription Pad Project is a project that encourages pediatricians to ask about physical activity during visits. To date, 7 physicians practices in Eastern Wake County have distributed 90 prescriptions and maps of facilities that promote or support physical activities, including parks and greenways. 21

22 References 1. Center for Disease Control and Prevention, Chronic Disease Prevention and Health Promotion, Retrieved November 17, North Carolina Center For State Statistics Cancer Mortality Rates Statistics, retrieved November 4, North Carolina Center For State Statistics County Health Data Book North Carolina Community Health Assessment Process, Race-Sex-Specific Age Adjusted Death Rates by County retrieved November 4, Townsend, M. (September, 2014) North Carolina Youth Risk Behavior Survey: 2013 WCPSS Middle School and High School Results; Data Trends, D&A Report No ad 14.07, and reports/2014/ms_nc_yrbs.pdf, Retrieved November 17, Screening Mammography Beginning at Age 40 Years: A Reappraisal of Cost Effectiveness", Rosenquist, et.al., Source: The Burden of CVD in NC-July 2010 update. p249901coll22/id/132976, retrieved 11/6/14 7. National Diabetes Statistics Report, (2014, June 2). Center for Disease Control and Prevention: retrieved 11/6/14 8. Christine M. Hoehner, P. M., Carolyn E. Barlow, M. A., & Mario Schootman, P. (2012, June). American Journal of Preventive Medicine. from Commuting Distance, Cardiorespiratory Fitness, and Metabolic Risk: Retrieved November, 17, County Health Rankings and Roadmap. (2014). Long Commute - Driving Alone. From County Health Rankings: county/outcomes/overall/snapshot, Retrieved November 17,