ECU, Center for Health Services Research and Development, Communicable Diseases

Transcription

1 Communicable Diseases

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3 COMMUNICABLE DISEASES The second edition of the Atlas includes a new section that brings together the AIDS and Pneumonia and Influenza discussions from the previous Atlas with discussions on tuberculosis (TB) and sexually transmitted diseases (STDs). The AIDS discussion has been expanded to include a consideration of HIV prevalence in Eastern North Carolina s population. Integrating these diseases into a group is useful because of their relationship to the socio-economic conditions and demography of Eastern North Carolina. STDs, TB and AIDS (and HIV) are often discussed together because there is considerable overlap of risk behaviors for each type of disease. HIV affects the immune system and can promote the spread of TB in high-risk populations. Lesions from syphilis and gonorrhea (STDs) can facilitate the transmission of HIV in addition to embattling immune systems and thereby exacerbating any co-morbid conditions. Eastern North Carolina shares the southern Coastal Plain pattern for these diseases which are strongly tied to the population characteristics of the region. STDs though high compared to the nation show strong signs of decreasing prevalence. Since the mid-1980s, high TB rates that virtually defined ENC s Coastal Plain are abating. However, the AIDS and HIV presence in ENC is growing in large part due to intravenous drug use and heterosexual contact patterns in certain sociodemographic groups. Pneumonia and influenza have the greatest impact on people 65 and older. Eastern North Carolina has older counties but also has younger counties that are affected by these diseases. These two diseases are preventable through vaccines so mortality could be an indication of problematic access and availability of treatment in ENC. IV.A.1

4 IV.A.2

5 AIDS and HIV ECU, Center for Health Services Research and Development, 1997

6 IV.A.4

7 AIDS Of all Human Immuno-deficiency Virus (HIV) infected people who have been infected for ten years or longer without treatment, about 50% of these people develop Acquired Immunodeficiency Syndrome (AIDS) and another 40% or more develop opportunistic infections and other associated clinical illnesses. For hemophiliacs and intravenous drug users, AIDS is the number one cause of death. For the population as a whole, AIDS is the seventh leading cause of years of potential life lost in the U.S. National data for 1996 indicate that women are most likely to acquire HIV through heterosexual contact followed by intravenous drug use. In men the dominant mode of transmission is through homosexual contact followed by intravenous drug use. The primary modes of HIV transmission will also vary geographically and racially. AIDS primarily affects people ages 25-44; this population comprises approximately 54% of the U.S. civilian workforce. According to 1990 final data regarding the year old population, the HIV ratefor men is 8.3 times the rate for women, while the rate for black men is 2.9 times the rate for white men. HIV morbidity is more difficult to measure than full-blown AIDS. HIV infection is recorded by screening members of high-risk exposure groups. Screening methods are not uniformly applied in all areas and the level of education about risk may also vary across areas and socio-demographic groups. Therefore any measurement with respect to HIV morbidity is an underestimate of its true prevalence in a population. AIDS is a result of HIV infection and is manifested in a wide variety of clinical illnesses. The diagnostic criteria for AIDS have changed in 1985, 1987, and These types of changes will affect comparisons of rates over time. Formerly HIV infection would ultimately lead to AIDS and then finally death from an AIDS related illness. Currently anti-retroviral and other therapies have the potential to stave off AIDS for an indefinite time period and prolong the lives of those who do have AIDS. These technological developments will change the annual rates of conversion of individuals with HIV to AIDS and the prevalence of AIDS in a population will change as survivorship increases. The sensitive nature of AIDS is reflected by discrimination in employment, housing, schools, and medical services. People with AIDS are often looked upon with distaste by society due to the behavioral risk factors associated with the disease. This magnifies the burden of the disease and its health implications. As a community, people must work together to combat this tremendous public health threat. Outreach programs to educate the public about the disease, the risk factors involved, how to prevent transmission and spread of the disease, and available treatment and support services are essential. In 1991, the state AIDS mortality rate increased 43%, following a mere 2% increase the preceding year. While an AIDS mortality analysis is informative, it is important to be aware of the limitations. AIDS patients often choose to return home to die, therefore, the death will be reported for the patient s home county, yet the disease may have been contracted in another place. The place of death does not imply that this condition or disease IV.A.5

8 is prevalent there. Crude versus age-adjusted mortality: HEALTHY PEOPLE 2000 GOAL HEALTH STATUS OBJECTIVE 18.1: Confine annual incidence of diagnosed AIDS cases to no more than 43 per 100,000 population. (Baseline: 17.0 per 100,000 in 1989) Note: Cases are by year of diagnosis and are corrected for delays in reporting and underreporting. HEALTH STATUS OBJECTIVE 18.1A: Special Population Target: Confine annual incidence of diagnosed AIDS cases among men who have sex with men to no more than 48,000 cases. (Baseline: An estimated 27,000 diagnosed cases in 1989) HEALTH STATUS OBJECTIVE 18.1B Special Population Target: Confine annual incidence of diagnosed AIDS cases among blacks to no more than 136 per 100,000 population. (Baseline: 44.4 per 100,000 in 1989) HEALTH STATUS OBJECTIVE 18.1C: Special Population Target: Confine annual incidence of diagnosed AIDS cases among Hispanics to no more than 76 per 100,000 population. (Baseline: 34.9 per 100,000 in 1989) HEALTH STATUS OBJECTIVE 18.1D: Special Population Target: Confine annual incidence of diagnosed AIDS cases among women to no more than 13 per 100,000 population. (Baseline: 3.5 per 100,000 in 1989) HEALTH STATUS OBJECTIVE 18.1E: Special Population Target: Confine annual incidence of diagnosed AIDS cases among injecting drug users to no more than 25,000. (Baseline: An estimated 10,300 diagnosed cases in 1989) HEALTHY PEOPLE 2000 GOAL HEALTH STATUS OBJECTIVE 18.2: Confine the prevalence of HIV infection to no more than 400 per 100,000 people. (Baseline: An estimated 400 per 100,000 in 1989) HEALTH STATUS OBJECTIVE 18.2A: Confine the prevalence of HIV infection among men who have sex with men to no more than 20,000 per 100,000. (Baseline: An estimated 15,000-61,800 per 100,000 in 1989) IV.A.6

9 HEALTH STATUS OBJECTIVE 18.2B: Confine the prevalence of HIV infection among injecting drug users to no more than 40,000 per 100,000 people. (Baseline: An estimated 0-48,200 per 100,000 in 1989) HEALTH STATUS OBJECTIVE 18.2C: Confine the prevalence of HIV infection among females giving birth to live-born infants to no more than 100 per 100,000. (Baseline: An estimated 160 per 100,000 in 1989) With regard to both crude and adjusted mortality, Hyde and Perquimans Counties report no deaths for the five- year period. However this does not imply that HIV is not present in those counties because it may be unreported. Pamlico County, however, experienced the highest crude and adjusted mortality rate in the region, 13.9 and 16.7 respectively. The highest AIDS mortality rates are scattered throughout the region with the ten leading sites of AIDS mortality (per crude rates) in descending order as follows, by county: Pamlico, Wilson, Sampson, Pitt, New Hanover, Washington, Wayne, Columbus, Beaufort, and Hoke. Additional Text Information: Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 1996; 8(no. 2). IV.A.7

10 AIDS Mortality Eastern North Carolina Race-Gender Specific Age-Adjusted Death Rates Crude Death White White Minority Minority County Population Deaths Rate Males Females Males Females Total Beaufort 42, Bertie 20, Bladen 28, Brunswick 54, Camden 7, Carteret 33, Chowan 31, Columbus 50, Craven 83, Cumberland 284, Currituck 14, Dare 23, Duplin 41, Edgecombe 56, Gates 9, Greene 16, Halifax 56, Harnett 70, Hertford 22, Hoke 24, Hyde 5, Johnston 86, Jones 9, Lenoir 57, Martin 25, Nash 79, New Hanover 127, Northampton 20, Onslow 150, Pamlico 11, Pasquotank 32, Pender 31, Perquimans 10, Pitt 112, Robeson 106, Sampson 48, Scotland 34, Tyrrell 3, Washington 13, Wayne 107, Wilson 66, County Region 1,166, County Region 2,113, North Carolina 6,629,248 3, United States 255,039,000 37, Number is for 1994 only 3 Health, United States, data Estimated Center for Health Services Research and Development East Carolina University Source NC Data: State Center for Health and Environmental Stat. US Data: Monthly Vital Stat. Report Vol. 41 No. 7(S) IV.A.8

11 AIDS Mortality Eastern North Carolina Crude Mortality Rates: ECU, Center for Health Services Research and Development, 1997 Per 100,000 Population under to to and above Age-Adjusted Mortality Rates: Per 100,000 Population under to to and above Center for Health Services Research and Development East Carolina University Source: NC State Center for Health & Environmental Statistics IV.A.9

12 AIDS Mortality Age-Adjusted Mortality Rates Per 100,000 Population White Males White Females under to to and above no cases none to to and above Nonwhite Males Nonwhite Females under to to and above no cases none to to and above Center for Health Services Research and Development East Carolina University IV.A.10 Source: NC State Center for Health & Environmental Statistics

13 IV.A.11

14 AIDS Morbidity Eastern North Carolina Total Morbidity Rate by Race and Sex Average Cases Crude White Nonwhite County Population (5 years) Rate Male Female Male Female Beaufort 42, Bertie 20, Bladen 29, Brunswick 54, Camden 6, Carteret 54, Chowan 13, Columbus 50, Craven 83, Cumberland 283, Currituck 14, Dare 23, Duplin 40, Edgecombe 56, Gates 9, Greene 15, Halifax 56, Harnett 70, Hertford 22, Hoke 24, Hyde 5, Johnston 86, Jones 9, Lenoir 58, Martin 36, Nash 79, New Hanover 127, Northampton 20, Onslow 148, Pamlico 11, Pasquotank 32, Pender 31, Perquimans 10, Pitt 112, Robeson 107, Sampson 48, Scotland 34, Tyrrell 3, Washington 13, Wayne 107, Wilson 66, County Region 1,178, County Region 2,125,887 1, North Carolina 6,769,014 4, United States 255,039,000 77, only Black only Center for Health Services Research and Development East Carolina University Source: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 1994; 6(2) IV.A.12

15 Total Morbidity Rates: AIDS Morbidity Eastern North Carolina ECU, Center for Health Services Research and Development, 1997 Per 100,000 Population under to to and above Center for Health Services Research and Development East Carolina University Source: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 1994; 6(2) IV.A.13

16 AIDS Morbidity Morbidity Rates Per 100,000 Population White Males White Females under to to and above no cases none to to and above Nonwhite Males Nonwhite Females under to to and above no cases none to to and above Center for Health Services Research and Development East Carolina University IV.A.14 Source: NC State Center for Health & Environmental Statistics

17 IV.A.15

18 HIV Morbidity Eastern North Carolina Total Morbidity Rate by Race and Sex Average Cases Crude White Nonwhite County Population (5 years) Rate Male Female Male Female Beaufort 42, Bertie 20, Bladen 29, Brunswick 54, Camden 6, Carteret 54, Chowan 13, Columbus 50, Craven 83, Cumberland 283, Currituck 14, Dare 23, Duplin 40, Edgecombe 56, Gates 9, Greene 15, Halifax 56, Harnett 70, Hertford 22, Hoke 24, Hyde 5, Johnston 86, Jones 9, Lenoir 58, Martin 25, Nash 79, New Hanover 127, Northampton 20, Onslow 148, Pamlico 11, Pasquotank 32, Pender 31, Perquimans 10, Pitt 112, Robeson 107, Sampson 48, Scotland 34, Tyrrell 3, Washington 13, Wayne 107, Wilson 66, County Region 1,167, County Region 2,115,256 1, North Carolina 6,769,014 5, United States 255,039,000 17, To Be Determined Center for Health Services Research and Development East Carolina University Source: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, 1994; 6(2) IV.A.16

19 Total Morbidity Rates: HIV Morbidity Eastern North Carolina ECU, Center for Health Services Research and Development, 1997 Per 100,000 Population under to to and above Center for Health Services Research and Development East Carolina University Source: Center for Disease Control and Prevention. HIV/AIDS Surveillance Report. 1994; 6(2) IV.A.17

20 HIV Morbidity Morbidity Rates Per 100,000 Population White Males White Females under to to and above no cases none to to and above Nonwhite Males Nonwhite Females under to to and above no cases none to to and above Center for Health Services Research and Development East Carolina University IV.A.18 Source: NC State Center for Health & Environmental Statistics

21 Tuberculosis ECU, Center for Health Services Research and Development, 1997

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23 TUBERCULOSIS In 1993 the World Health Organization (WHO) declared tuberculosis (TB) to be a Global Emergency. Within the next decade 300 million people will become infected with TB. The modern TB epidemic is compounded by the spread of the human immunodefiency virus (HIV) in selected populations throughout the world. Usually 5-10% of those individuals infected with TB becomes contagious, but accompanying HIV infection weakens the immune system that increases the likelihood of both illness and contagiousness. Once contagious, a single TB case can infect 10 to 15 individuals per year. The overall TB situation in the United States is improving. For 1995 the U.S. morbidity rate is 8.7 per 100,000 population. This is the lowest rate since national surveillance began in The rates for blacks and Hispanics have been declining since 1990 and 1991 respectively. Despite the recent general improvements in TB rates, the problem persists and is exacerbated in several sub-populations (i.e. high-risk groups) in the United States and North Carolina. High TB risk-groups include: 1) persons living in close contact with persons known to have TB; 2) persons infected with HIV; 3) high-risk drug injectors; 4) persons with other medical risk factors which increase risk of TB infection; 5) persons living in congregate settings such as prisons and other long term residential facilities; 6) health care workers who serve high-risk clients; 7) foreign born individuals from areas with high TB prevalence; 8) medically underserved low income populations; 9) locally defined high-risk racial or ethnic minoriy; 10) infants, children, and adolescents exposed to adults in high risk categories. Several of these high-risk groups are prominent in Eastern North Carolina. HEALTHY PEOPLE 2000 GOAL HEALTH STATUS OBJECTIVE 20.4: Reduce tuberculosis to an incidence of no more than 3.5 cases per 100,000 people. North Carolina s crude average rate for morbidity during the period is 9.3 per 100,000 population. Crude incidence rates for most of North Carolina s counties for this same period fall below this average figure. Eastern North Carolina s relatively high crude rate of 19.0 has the effect of skewing the state average, although the region s contribution has been declining over time (see time series maps). Eastern North Carolina is following the national pattern of declining morbidity rates. For the three time periods , , and there has been a steady and significant decrease in county rates for Eastern North Carolina, although all five of the highest ranking counties for TB rates can be found in this region. They include Northampton (34.3 cases per 100,000), Wilson (37.3), Lenoir (34.3), Greene (32.8), and Pitt (30.7) counties. The region also possesses some of the lowest rates found in the state with both Dare and Camden counties at 0.0. The spatial concentration of high rate counties in this region can be attributed to several of the high-risk groups previously listed (e.g., groups 1, 5, 6, 8, and 9). IV.B.1

24 North Carolina county crude mortality rates during the period are approximately one-third their respective morbidity rates across all four map rate categories. The mortality pattern underscores the highly regional character of TB morbidity and levels of indigence in the state. IV.B.2

25 IV.B.3

26 Tuberculosis Morbidity North Carolina Time Series of 5 Year Average Incidence Rates Crude Incidence Rates Crude Incidence Rates Per 100,000 Population under to to and above Crude Incidence Rates Center for Health Services Research and Development East Carolina University IV.B.4 Source: NC State Center for Health & Environmental Statistics

27 Tuberculosis Morbidity Eastern North Carolina ECU, Center for Health Services Research and Development, 1997 Time Series of 5 Year Average Incidence Rates Crude Incidence Rates Crude Incidence Rates Per 100,000 Population under to to and above Crude Incidence Rates Center for Health Services Research and Development East Carolina University Source: NC State Center for Health & Environmental Statistics IV.B.5

28 Tuberculosis Morbidity Per 100, County Cases Rates Beaufort Bertie Bladen Brunswick Camden Carteret Chowan Columbus Craven Cumberland Currituck Dare Duplin Edgecombe Gates Greene Halifax Harnett Hertford Hoke Hyde Johnston Jones Lenoir Martin Nash New Hanover Northampton Onslow Pamlico Pasquotank Pender Perquimans Pitt Robeson Sampson Scotland Tyrrell Washington Wayne Wilson County Region 1, County Region 1, North Carolina 3, United States Not Calculated Center for Health Services Research and Development East Carolina University Source: County Health Data Book, July 1995 IV.B.6

29 Tuberculosis Morbidity Eastern North Carolina Equal Count Categories for Total Morbidity Rates: Per 100,000 Population under to to and above Center for Health Services Research and Development East Carolina University Source: County Health Data Book, July 1995 IV.B.7

30 Tuberculosis Mortality Eastern North Carolina 14 Year Average Incidence for Year Tuberculosis Mortality 14 Year Total 14 Year Average Annual County Number of Deaths Population Average Mortality Beaufort 11 41, Bertie 10 20, Bladen 5 29, Brunswick 5 44, Camden 0 5, Carteret 1 48, Chowan 3 13, Columbus 6 50, Craven 8 77, Cumberland , Currituck 1 12, Dare 2 18, Duplin 12 40, Edgecombe 22 57, Gates 1 9, Greene 5 15, Halifax 28 55, Harnett 18 64, Hertford 14 23, Hoke 9 21, Hyde 0 5, Johnston 15 76, Jones 2 9, Lenoir 17 58, Martin 8 25, Nash 21 72, New Hanover , Northampton 15 21, Onslow 8 133, Pamlico 2 10, Pasquotank 5 29, Pender 1 25, Perquimans 1 9, Pitt 26 99, Robeson , Sampson 18 48, Scotland 6 33, Tyrrell 2 3, Washington 1 14, Wayne , Wilson 38 64, County Region 443 1,976, Center for Health Services Research and Development East Carolina University Source: Centers for Disease Control WONDER IV.B.8

31 Tuberculosis Mortality Eastern North Carolina 14 Year Average Incidence for Crude Mortality Rates: Per 100,000 Population under to to and above Center for Health Services Research and Development East Carolina University Source: Centers for Disease Control WONDER IV.B.9

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33 Sexually Transmitted Diseases

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35 SEXUALLY TRANSMITTED DISEASES Gonorrhea and syphilis are important diseases in the public health arena because of their relevance to antibiotic resistance issues, maternal and child health, the health of adolescents and young adults, and HIV transmission. The organism producing gonorrhea, Neisseria gonorrhoeae has been demonstrated to be increasingly penicillin and tetracycline resistant. Infection can cause blindness, infertility, pelvic inflammatory disease, cancer associated with human papillomavirus, fetal and infant deaths, and infected mothers can pass gonorrhea and syphilis to newborns which may result in congenital defects. Syphilis and gonorrhea also facilitate HIV transmission. One study shows that through effective treatment of syphilis in high rate areas a 40% reduction of HIV incidence may be possible. High rates of sexually transmitted diseases (STDs), including Chlamydia are strongly associated with certain minorities, age cohorts, and socio-economic groups. Many population characteristics have an underlying spatial distribution. Because of the association of STDs with certain population attributes, a distinctive geographic pattern emerges. Both gonorrhea and syphilis have a strong presence in the U.S. South, particularly in Mississippi and its neighboring states. While the rates in North Carolina are lower than the nation s geographic STD core the state, especially its eastern section, shares this southern pattern. The apparently high rates of STDs found in black--and to a lesser extent Hispanic populations--may be a major artifact of reporting bias. Poverty is more pervasive in the South and there is a greater dependence on public health facilities for people with limited resources. These facilities are required to report cases while private facilities may not necessarily report them. Another important consideration when interpreting STD rates is that an individual can be reported more than one infection through the course of a year. Therefore a sub-population of multi-case individuals can increase the STD rate. Variation in reporting between clinic types, patronized by distinct behavioral and socio-economic populations, explain a large portion of the rate differences. Gonorrhea In 1995, 392,848 cases of gonorrhea were reported for the entire U.S. population yielding a rate of cases per 100,000. This is the lowest overall rate since the 1960s. The rate for blacks decreased in 1995 to 1,086.9 per 100,000 from 1,200.7 the previous year. For all racial groups there has been a decline in rates. With the exception of blacks, all racial groups are below the HP 2000 goal of 100 cases per 100,000 in The overall rate for North Carolina during the period 1991 to 1993 is and declines to in A closer look at North Carolina shows that high gonorrhea rates are primarily a phenomenon of the eastern half of the state and western portions of the Piedmont urban crescent centered on Mecklenburg County (Charlotte). This is more evident in the geographic pattern for non-white rates. Eastern North Carolina reported a crude rate of per 100,000 in the period and a non-white rate of 1,496.3 for the same IV.C.1

36 period. In ENC the highest crude rates are found in both the southern and north-northwest areas of the region. The high rate counties of southern ENC are New Hanover (455.4), and the contiguous counties of Scotland (875.6), Hoke (761.4), Robeson (585.8), Cumberland (771.3), and Bladen (470.5). The highest crude rates in ENC are found in its northwest section with Edgecombe (1,498.9) and Wilson (1,295.2) counties taking the lead. Other high rate contiguous counties in this sub-region include Northampton (831.7), Halifax (560.2), Nash (605.7), Martin (738.9), Pitt (824.1), Greene (796.9), enoir (832.2), and the spatial outlier Pasquotank County (594.4). The only county that surpasses the HP 2000 goal (19.1) with respect to crude rates is Dare County with 68.3 cases per 100,000 population. The northeastern part of the region possesses a small cluster of counties that surpass the HP 2000 goal (19.1A) for non-white rates. They include Bertie (546.9), Gates (618.3), Hertford (455.1), Perquimans (540.8), and Washington (464.9). An examination of the non-white map for gonorrhea shows that the highest rates found in the northwest reflect, in part, the population geography of ENC with the highest non-white rate found in Wilson County (3,228.7). HEALTHY PEOPLE 2000 GOAL HEALTH STATUS OBJECTIVE 19.1: Reduce gonorrhea to an incidence of no more than 100 cases per 100,000 population. (Baseline: per 100,000 in 1989) HEALTH STATUS OBJECTIVE 19.1A: Reduce gonorrhea among blacks to an incidence of no more than 650 cases per 100,000. (Baseline: 1,990.0 per 100,000 in 1989) Syphilis The geographic pattern for syphilis is similar to gonorrhea for the U.S. with the highest rates found in the South. The following maps show the characteristic distribution of syphilis and STDs in general for the U.S. Like gonorrhea, syphilis is declining with recent rates the lowest since High syphilis rates are also associated with certain socio-demographic groups. The 1995 crude rate for the nation was 6.3 per 100,000 population, which is still above the HP 2000 objective of 4.0. In 1994, 68% of the counties in the U.S. reported no cases of syphilis. For North Carolina the 1995 crude rate is 15.7 per 100,000 population which is a marked decline from the period rate of The non-white rate for this period is 25.5 compared to the white rate of 2.5 per 100,000 population. Reported white cases exert little influence on the state rate, which is a reflection of sociodemographic pattern of syphilis. Eastern North Carolina s crude syphilis rate for the period is higher than the state s rate and is again driven by the non-white rate of 36.6 per 100,000 population. The region s white rate is substantially lower at 6.9 per 100,000 population, which is higher than the HP 2000 goal. For syphilis crude rates, a large contiguous group of counties form a large geographic cluster in the north-northwestern and central part of the region in of the highest rates. The leading county in this sub-region is Lenoir with a rate of per 100,000 population. Lenoir County also leads with respect to non-white rates as well at IV.C.2

37 448.1 cases per 100,000 population. Fourteen other counties make up this subregion of high rates in addition to New Hanover County. There are several counties in ENC whose crude rates fall below the HP 2000 goal. These include Carteret (3.0), Dare (0.0), Gates (3.5), Pamlico (2.9), and Pender (3.2). Again, these rates are a reflection of underlying socio-demographic characteristics. HEALTHY PEOPLE 2000 GOAL HEALTH STATUS OBJECTIVE 19.3: Reduce primary and secondary syphilis to an incidence of no more than 4 cases per 100,000 population. (Baseline: 18.1 per 100,000 in 1989) HEALTH STATUS OBJECTIVE 19.3A: Reduce primary and secondary syphilis among blacks to an incidence of no more than 30 cases per 100,000. (Baseline: per 100,000 in 1989) Additional Text Information: Division of STD Prevention. Sexually Transmitted Disease Surveillance, U.S. Department of Health and Human Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, September Figures: CDC Division of STD Prevention US Map: South Map: IV.C.3

38 Gonorrhea Eastern North Carolina, Total Nonwhite County Cases 1 Rates Cases 1 Rates Beaufort ,344.0 Bertie Bladen ,108.3 Brunswick Camden ,025.5 Carteret ,525.9 Chowan Columbus ,130.4 Craven 1, ,025 1,506.3 Cumberland 6, ,773 1,837.2 Currituck Dare ,021.2 Duplin ,175.3 Edgecombe 2,557 1, ,497 2,548.6 Gates Greene ,820.3 Halifax ,007.9 Harnett ,305.1 Hertford Hoke ,237.6 Hyde Johnston ,176.1 Jones Lenoir 1, ,407 2,003.7 Martin ,584.5 Nash 1, ,355 1,781.6 New Hanover 1, ,505 1,888.0 Northampton ,394.7 Onslow 1, ,515 1,448.1 Pamlico ,046.5 Pasquotank ,463.2 Pender Perquimans Pitt 2, ,626 2,273.3 Robeson 1, , Sampson ,130.7 Scotland ,847.4 Tyrrell Washington Wayne 1, , Wilson 2,596 1, ,498 3, County Region 20, ,199 1, County Region 35, ,803 1,496.3 North Carolina 87, ,453 1,583.6 United States T.B.D T.B.D ,3 1 County cases over 3 years. 3 Black only only Center for Health Services Research and Development East Carolina University Source: County Health Data Book, July 1995 US Data: CDC Wonder IV.C.4

39 Total Case Rates: Gonorrhea Eastern North Carolina ECU, Center for Health Services Research and Development, 1997 Per 100,000 Population under to to and above Nonwhite Case Rates: Per 100,000 Population under to to and above Center for Health Services Research and Development East Carolina University Source: County Health Data Book, July 1995 US data: CDC Wonder IV.C.5

40 Syphillis Eastern North Carolina Total White Nonwhite County Cases Rates Cases Rates Cases Rates Beaufort Bertie Bladen Brunswick Camden Carteret Chowan Columbus Craven Cumberland Currituck Dare Duplin Edgecombe Gates Greene Halifax Harnett Hertford Hoke Hyde Johnston Jones Lenoir Martin Nash New Hanover Northampton Onslow Pamlico Pasquotank Pender Perquimans Pitt Robeson Sampson Scotland Tyrrell Washington Wayne Wilson County Region County Region North Carolina 1, , United States Black Only, 1995 data Center for Health Services Research and Development East Carolina University Source: CDC Wonder IV.C.6

41 Syphilis Eastern North Carolina ECU, Center for Health Services Research and Development, 1997 Total Case Rates: Per 100,000 Population under to to and above Center for Health Services Research and Development East Carolina University Source: NC State Center for Health Statistics, 1996 IV.C.7

42 Syphilis Eastern North Carolina White Case Rates: Per 100,000 Population under to to and above Nonwhite Case Rates: Per 100,000 Population under to to and above Center for Health Services Research and Development East Carolina University Source: NC State Center for Health Statistics, 1996 IV.C.8

43 Pneumonia and Influenza

44 Pneumonia and Influenza Objective Based on Age-Adjusted Mortality Rates Pasquotank Camden Northampton Gates Currituck Halifax Hertford Nash Edgecombe Bertie Chowan Perquimans Wilson Martin Washington Tyrrell Dare Harnett Johnston Wayne Greene Pitt Beaufort Hyde Hoke Cumberland Sampson Duplin Lenoir Jones Craven Pamlico Scotland Robeson Bladen Onslow Carteret Pender Columbus 0 20 Miles 40 Brunswick Healthy People 2000 Goal Health Status Objective 20.2: New Hanover Reduce Epidemic Related Pneumonia and Influenza Deaths among People Aged 65 and Older to no more than 7.3 per 100,000 Population Reduction Necessary to Reach HP 2000 Objective 0.1% to 20.0% (1) 20.1% to 40.0% (6) 40.1% to 60.0% (23) 60.1% or more (11) Center for Health Services Research and Development East Carolina University Mortality Source: NC State Center for Health and Environmental Statistics IV.D.1

45 PNEUMONIA AND INFLUENZA Pneumonia and influenza strike all ages, but have the greatest impact on people 65 and older, the fastest growing age group in the population. Approximately 80-90% of all deaths attributed to pneumonia and influenza occur in people 65 years and over. The nation experienced six influenza epidemics between 1972 and 1982, with the majority of deaths occurring in the older population. Although influenza is theoretically preventable by vaccination, there are barriers to the provision and effectiveness of the vaccines. For some people, access to vaccination is hindered by cost and by difficulties in obtaining transportation to sites where it is offered. The vaccine itself may also prove ineffective in preventing influenza if new virus strains emerge. Moreover, the vaccine may not be completely protective in the most vulnerable members of the population, the elderly, because they have decreased immune responses, which limits the effectiveness of vaccinations. Crude mortality: In Eastern North Carolina Chowan County has the highest pneumonia and influenza death rate; its population is one of the most aged, but age alone may not explain this rate. Although Bertie, Tyrrell, Hyde, Beaufort, Bladen, and Columbus Counties have some of the highest mortality rates in the region, they have young populations, with approximately 30% of their residents 20 years and younger. While many of the northeastern-eastern counties have the highest pneumonia and influenza mortality rates, a small pocket of four southern counties also has comparatively high rates. Age-adjusted mortality by race and gender: HEALTHY PEOPLE 2000 GOAL HEALTH STATUS OBJECTIVE 20.2: Reduce epidemic-related pneumonia and influenza deaths among people aged 65 and older to no more than 15.9 per 100,000. (Baseline: Average of 19.1 per 100,000 during influenza season through influenza season) Note: Epidemic-related pneumonia and influenza deaths are those that occur above and beyond the normal yearly fluctuations of mortality. Because of the extreme variability in epidemic-related deaths from year to year, the target is a 3-year average. Currituck County s age-adjusted mortality rate for pneumonia and influenza is the highest in the region with a rate of In contrast, the lowest rate in the region is 8.9 in Carteret County. Currituck County s rate is 2.7 times greater than the rate of Carteret County. Hyde and Perquimans Counties have the lowest mortality rates (0.0) for nonwhite males and nonwhite females, respectively. High adjusted mortality rates are concentrated in a southern pocket of the region with high rates also scattered in the IV.D.2

46 north. The time series charts of age-adjusted rates by gender and race compare mortality rates between genders and between races. The largest disparities in pneumonia and influenza mortality are seen when men and women are compared. In the nonwhite population, the male mortality rate is 2.6 times greater than the rate for females. In the white population, males are 1.7 times more likely to die from pneumonia and influenza than females. Racial disparity in mortality also exists, but not to any great extent. In males, the mortality rate for nonwhites is 1.7 times greater than the rate for whites; in females, the mortality rate for nonwhites is 1.1 times greater than the rate for whites. females, respectively. High adjusted mortality rates are concentrated in a southern pocket of the region with high rates also scattered in the north. IV.D.3

47 Trends in Pneumonia and Influenza Pneumonia and Influenza - Female Mortality US and NC Age-Adjusted Rates, NC Race Specific, Age-Adjusted Mortality Rate / 100,000 Population NC White Females NC Nonwhite Females NC Total US Total 10.0 ENC Nonwhite ENC White HP 2000 Goal US Data NC Data Pneumonia and Influenza - Male Mortality US and NC Age-Adjusted Rates, NC Race Specific, Age-Adjusted Mortality Rate / 100,000 Population ENC Nonwhite ENC White NC White Males NC Nonwhite Males NC Total US Total 10.0 HP 2000 Goal US Data NC Data Sources: NC Five Year Averages - State Center for Health and Environmental Statistics. US Individual Years - Monthly Vital Statistics Report. HP 2000 Goal - Healthy People 2000: National Health Promotion and Prevention Objectives. US Department of Health and Human Services / Public Health Service. IV.D.4

48 Pneumonia and Influenza Eastern North Carolina Race-Gender Specific Age-Adjusted Death Rates Crude Death White White Minority Minority County Population Deaths Rate Males Females Males Females Total Beaufort 42, Bertie 20, Bladen 28, Brunswick 54, Camden 6, Carteret 54, Chowan 13, Columbus 50, Craven 83, Cumberland 283, Currituck 14, Dare 23, Duplin 40, Edgecombe 56, Gates 9, Greene 15, Halifax 56, Harnett 70, Hertford 22, Hoke 24, Hyde 5, Johnston 86, Jones 9, Lenoir 58, Martin 25, Nash 79, New Hanover 127, Northampton 20, Onslow 149, Pamlico 11, Pasquotank 32, Pender 31, Perquimans 10, Pitt 112, Robeson 107, Sampson 48, Scotland 34, Tyrrell 3, Washington 13, Wayne 107, Wilson 66, County Region 1,168,010 1, County Region 2,116,073 2, North Carolina 6,847,178 10, United States 255,039,000 82, Number is for 1994 only 3 NC DEHNR, data Estimated 4 Health, United States, data 1993 Center for Health Services Research and Development East Carolina University Source: CDC Wonder IV.D.5

49 Pneumonia and Influenza Eastern North Carolina Crude Mortality Rates: Per 100,000 Population under to to and above Age-Adjusted Mortality Rates: Per 100,000 Population under to to and above Center for Health Services Research and Development East Carolina University Source: NC State Center for Health & Environmental Statistics IV.D.6

50 Pneumonia and Influenza Age-Adjusted Mortality Rates Per 100,000 Population White Males White Females under to to and above under to to and above Nonwhite Males Nonwhite Females under to to and above under to to and above Center for Health Services Research and Development East Carolina University IV.D.7 Source: NC State Center for Health & Environmental Statistics