Community Health Assessment Ontario County Chronic Diseases

Transcription

1 Community Health Assessment Ontario Chronic Diseases Chronic diseases, such as heart disease, diabetes and cancer, did not rank in the overall top 25 personal, community or unmet needs in the survey as major problems. When looking further at the results for health related factors only the results for these three categories are represented in the charts below. Top ten personal health needs: 30% 25% 20% 15% 10% 5% 0% Availability of doctors and medical facilities Access to dental services Accessibility of health insurance Availability of doctors who accept Medicaid/Medicare Programs for obesity and overweight Medicaid eligibility assistance Support for caregivers Programs for Diabetes Programs for lung disease and asthma Programs for stopping smoking and tobacco use Top ten community health needs: 70% 60% 50% 40% 30% 20% 10% 0% Accessibility of health insurance Programs for obesity and overweight Availability of doctors who accept Medicaid/Medicare Support for caregivers Programs for children s mental health Access to dental services Programs for adult mental health Hospice or end of life services Programs for Alzheimer s and memory loss Alcohol/substance abuse prevention and intervention 122

2 Community Health Assessment Ontario Top ten unmet health needs: 12% 10% 8% 6% 4% 2% 0% Accessibility of health insurance Availability of doctors who accept Medicaid/Medicare Availability of doctors and medical facilities Programs for children s mental health Programs for obesity and overweight Hospice or end of life services Support for caregivers Alcohol/substance abuse prevention and intervention Access to dental services Programs for adult mental health Three year rates for cardiovascular disease, diseases of the heart, coronary heart disease, congestive heart disease and cerebrovascular disease are in general better than New York State rates. Hospitalization rates for coronary heart disease and pre-transport mortality rates for cerebrovascular disease are worse than State rates. The 2008 BRFSS data for adults with cardiovascular disease has the Ontario percentage at 10.2% compared to the NYS rate of 7.8%. The vital statistics data has the county rate lower than the NYS rate. The coronary heart disease rates for Ontario are 9.3% compared to the NYS 6.2% rate according to the 2008 BRFSS. BRFSS data for adults with high blood pressure is higher in the at 32% compared to 25.8% in NYS and that of those with high blood pressure only 71.2% in the county are on medication compared to the 80.4% NYS rate. Various charts follow and whether or not rates are higher or lower than NYS averages chronic disease is a health issue in our county that we believe we can have a positive impact on with our efforts. Public Health staff offers neutral leadership to, or actively participates in, a variety of coalitions promoting healthy behaviors and / or screenings for early detection of chronic illnesses. Members include hospital wellness directors and educators, a variety of community organizations and other departments of county government. The purpose of these groups is coordination and therefore to increase the power of individual efforts toward a healthy community with healthy behavior. 123

3 Community Health Assessment Ontario HEART DISEASE AND STROKE ONTARIO COUNTY Indicator CARDIOVASCULAR DISEASE Mortality rates per 100,000 (ICD10 I00- I99) 3 Year Total Rate NYS Rate Sig.Dif. NYS Rate exc Ranking HP2010 NYC Sig.Dif. Quartile Goal HP2010 Goal Met? Crude No Yes 2nd N/A N/A Age-adjusted Yes Yes 1st N/A N/A Premature death (ages 35-64) No 99.6 No 2nd N/A N/A Pretransport mortality No No 2nd N/A N/A Hospitalization rates per 10,000 (ICD ) Crude 6, Yes Yes 2nd N/A N/A Age-adjusted 6, Yes Yes 2nd N/A N/A DISEASE OF THE HEART Mortality rates per 100,000 (ICD10 I00- I09, I11, I13, I20- I51) Crude Yes Yes 2nd N/A N/A Age-adjusted Yes Yes 1st N/A N/A Premature death (ages 35-64) Pretransport mortality Hospitalization rates per 10,000 (ICD , 402, ) No 81.7 No 2nd N/A N/A No No 2nd N/A N/A Crude 4, Yes No 3rd N/A N/A Age-adjusted 4, No No 3rd N/A N/A CORONARY HEART DISEASE Mortality rates per 100,000 (ICD10 I11, I20-I25) Crude Yes Yes 2nd N/A N/A Age-adjusted Yes Yes 1st 166 Yes 124

4 Community Health Assessment Ontario Heart Disease and Stroke Ontario [cont] Indicator Premature death (ages 35-64) Pretransport mortality Hospitalization rates per 10,000 (ICD9 402, , 429) 3 Year Total Rate NYS Rate Sig.Dif. NYS Rate exc Ranking HP2010 NYC Sig.Dif. Quartile Goal HP2010 Goal Met? No 63.0 No 3rd N/A N/A Yes No 2nd N/A N/A Crude 2, Yes 66.5 Yes 3rd N/A N/A Age-adjusted 2, No 59.1 No 3rd N/A N/A CONGESTIVE HEART FAILURE Mortality rates per 100,000 (ICD10 I50) Crude No 19.8 No 2nd N/A N/A Age-adjusted No 16.5 No 2nd N/A N/A Premature death (ages 35-64) Pretransport mortality Hospitalization rates per 10,000 (ICD9 428) s 0.8* 1.8 No 2.1 No 1st N/A N/A No 9.5 No 2nd N/A N/A Crude Yes 34.3 Yes 1st N/A N/A Age-adjusted Yes 29.9 Yes 1st N/A N/A CEREBROVASCULAR DISEASE (STROKE) Mortality rates per 100,000 (ICD10 I60- I69) Crude Yes 43.6 No 3rd N/A N/A Age-adjusted Yes 37.0 No 3rd 48 Yes Premature death (ages 35-64) Pretransport mortality Hospitalization rates per 10,000 (ICD ) * 11.4 No 11.4 No 3rd N/A N/A Yes 17.0 Yes 3rd N/A N/A Crude Yes 30.4 Yes 2nd N/A N/A Age-adjusted Yes 26.8 Yes 2nd N/A N/A 125

5 Heart Disease and Stroke Ontario [cont] Indicator Behavior/Risk Indicator (2003) Livingston & Ontario % of adults with diagnosis of heart attack, stroke, or angina % of adults with cholesterol checked in the last 5 years % of adults ever told they have high blood pressure 3 Year Total Rate Rate NYS Rate Sig.Dif. CI # NYS Rate NYS Rate exc NYC Sig.Dif. CI # Upstate CI # Ranking HP2010 Quartile Goal HP2010 Goal Met? 7.2 ± ± ± 0.5 2nd N/A N/A 75.9 ± ± 1.5 N/A N/A 3rd 80 No 25.2 ± ± 1.3 N/A N/A 3rd 16 No s: Total suppressed for confidentiality *: Fewer than 20 events in the numerator; therefore the rate is unstable #: 95% confidence interval for BRFSS/Expanded BRFSS indicators Source: Ontario : Health Assessment Indicators, NYSDOH-HIN Years of Potential Life Lost ,600 1,400 Ontario & Comparison Areas YPLL Per 100,000 Pop. 1,200 1, Cancer Accidents Suicide Congenital COPD HIV Heart Perinatal Homicide Stroke Diabetes Flu & Pneu. Renal Ontario Co. Central Subarea FL Region 126

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7 250 Major Causes of Death Ontario Co. & Comparison Areas Deaths per 100,000 Population Heart Cancer Stroke CLRD Accidents Diabetes Homicide FLu & Pneumonia Suicide HIV/AIDS Upstate FLHSA Central Subarea Ontario Rates are age-sex adjusted to the 2000 standard U.S. population Data Source: NYS Department of Health, Vital Statistics files 128

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9 Cerebrovascular Disease(Stroke) - Deaths and Death Rates Per 100,000 Residents Source: Vital Statistics Data as of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2004 Rate Rate Reg-1 Western New York Allegany , Region Total 1, ,867 1,572, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total ,104 1,265, New York State Total 7,219 6,855 6,538 20,612 19,227, Revised: June 2008 Cardiovascular Disease - Deaths and Death Rates Per 100,000 Residents Source: Vital Statistics Data as of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2004 Rate Rate Reg-1 Western New York Allegany , Region Total 6,748 6,118 6,070 18,936 1,572, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben ,061 98, Wayne , Yates , Region Total 4,094 3,853 3,753 11,700 1,265, New York State Total 66,346 62,725 61, ,979 19,227, Revised: June

10 Diseases of The Heart - Deaths and Death Rates Per 100,000 Residents Source: Vital Statistics Data as of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2004 Rate Rate Reg-1 Western New York Allegany , Region Total 5,288 4,757 4,671 14,716 1,572, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total 3,043 2,910 2,855 8,808 1,265, New York State Total 55,253 52,131 51, ,859 19,227, Revised: June 2008 HEART DISEASE AND STROKE MORTALITY ADJUSTED RATE PER 100,000 RESIDENTS Health Indicator Heart Disease and Stroke Yates Steuben Ontario Schuyler Allegany Cardiovascular disease mortality Disease of the heart mortality Cerebrovascular disease mortality Adjusted Rates are age adjusted to the 2000 US Population Source: Health Assessment Indicators Seneca Wayne Upstate New York NY State

11 Blood Cholesterol Checked Finger Lakes Region, Percent of Population Seneca, Wayne* Chemung, Schuyler** Livingston, Ontario Steuben, Yates Monroe*** Had blood cholesterol checked in the past 5 years ever had their blood chlesterol checked * Survey sampling also included Cayuga county ** Survey sampling also included Tioga county *** Monroe data is from Monroe DOH BRFSS, conducted in Cancer 132

12 In analyzing all of the several pages of cancer data that follows, a few simple conclusions can be drawn with implications for recommendations. The incidence and death rates for lung and bronchus cancer are above the state and regional averages according to both the Cancer Registry and Vital Statistics. Statistics for tobacco use, a main contributor to these numbers will be detailed in a later section, but this clearly is an area requiring further investigation. Secondly, breast cancer requires further attention. The incidence rates are lower than regional averages, but higher than state rates and the mortality rates for breast cancer exceed both the State and regional averages. This data speaks to the need for regular screening and early treatment. While screening rates for breast cancer are increasing statewide, education regarding the need for screening should continue and be emphasized in the. The new BRFSS data indicates that Ontario mammogram screening percentages are better than NYS averages, but emphasis on their importance must continue. Cancer Services Partnership of Ontario, Seneca and Yates The New York State Department of Health and the Centers for Disease Control and Prevention, fund a grant for cancer screening and diagnostic services. The program focuses on early detection and education for breast, cervical, and colorectal cancer. Prior to 2008, Ontario and Yates worked collaboratively to provide these services. Beginning 2008, Ontario became the grant holder for the Cancer Services Partnership of Ontario, Seneca, and Yates Counties. Each county manages the services for their communities; however Ontario is the official grant holder for this program. The partnership outreaches to find uninsured and underinsured individuals that financially qualify. Clinical breast exams and pap smears are provided through the client s private physician. All area hospitals provide mammograms and breast diagnostic services for the partnership. The program sends Fecal Immunochemical Tests (F.I.T. kits) to all who qualify to test for colorectal cancer. The program also provides case management for clients who have barriers to receiving screenings or diagnostic services. People diagnosed with breast, cervical, or colorectal cancer through the partnership, are eligible to apply for a special Medicaid program that assists with treatment of their cancer. In 2008, the partnership screened 113 individuals for colorectal cancer. Number of Women Screened for Cervical and Breast Cancer by Year # Screened for Breast Cancer # Screened for Cervical Cancer Number of Women Year Prior to 2008 services were provided to Ontario and Yates county residents. Beginning in 2008, the service area was extended to include Seneca women. Over the past 8 years, the Cancer Services Partnership has provided 2085 breast cancer screenings and 1766 cervical cancer screenings to women. CANCER INDICATORS - ONTARIO COUNTY Indicator 5 NYS Sig.Dif. NYS Rate Sig.Dif. Ranking HP2010 HP

13 AGE-ADJUSTED INCIDENCE (per 100,000) Year Total Rate Rate exc NYC Quartile Goal Goal Met? Oral Cavity and Pharynx No 10.0 No 3rd N/A N/A Colon and Rectum No 55.5 No 1st N/A N/A Lung and Bronchus Yes 72.7 No 3rd N/A N/A Female Breast No No 4th N/A N/A Cervix Uteri * 8.9 No 7.6 No 2nd N/A N/A Ovary No 15.1 No 1st N/A N/A Prostate No Yes 1st N/A N/A AGE-ADJUSTED MORTALITY (per 100,000) Oral Cavity and Pharynx * 2.4 No 2.3 No 4th 2.7 No Colon and Rectum No 19.4 No 1st 13.9 No Lung and Bronchus Yes 53.1 No 3rd 44.9 No Melanoma of the Skin * 2.2 No 2.7 No 3rd 2.5 No Female Breast No 25.5 No 2nd 22.3 No Cervix Uteri 6 1.9* 2.6 No 2.2 No 1st 2.0 Yes Ovary No 9.6 No 2nd N/A N/A Prostate No 25.4 No 3rd 28.8 Yes PERCENT EARLY STAGE - Oral Cavity and Pharynx N/A 31% 36% No 38% No 4th N/A N/A Colon and Rectum N/A 43% 41% No 43% No 2nd 50% No Lung and Bronchus N/A 17% 21% No 21% Yes 3rd N/A N/A Melanoma of the Skin N/A 84% 83% No 83% No 2nd 90% No Female Breast N/A 72% 63% Yes 65% Yes 1st 75% No Cervical N/A 47%* 51% No 54% No 3rd 65% No Ovary N/A 22% 19% No 19% No 2nd N/A N/A Prostate N/A 80% 87% Yes 88% Yes 4th 95% No Cancer Incidence per 100,000 NY State Steuben Schuyler Site of Femal Femal Mal Cancer Male e Male e e All Invasive Malignant 571. Tumors Femal e Seneca Femal Male e Wayne Male Ontario Femal e Male Female Oral cavity and pharynx Esophagus Stomach Colorectal Colon excluding rectum Cancer Incidence per 100,000 continued- Site of Cancer NY State Steuben Schuyler Seneca Wayne Ontario 134

14 Male Femal e Male Femal e Mal e Femal e Male Femal e Male Femal e Male Female Pancreas Larynx Lung and 110. bronchus Cancer Incidence per 100,000 [cont] NY State Steuben Schuyler Seneca Wayne Ontario Site of Cancer Male Femal e Male Femal e Mal e Femal e Male Femal e Male Fema le Male Female breast NA NA Corpus uterus and NOS NA 27.7 NA Ovary NA 14.7 NA Prostate Urinary bladder (incl. in situ) New York State Department of Health, New York State Cancer Registry Cancer Incidence and Mortality by and Gender, Indicator Behavior/Risk Indicator (2003) Livingston & Ontario % women 18+ years with pap smear in past 3 years % women 40+ years with mammography screening in past 2 years 5 Year Total Rate Rate NYS Sig.Dif. Rate CI # NYS Rate NYS Sig.Dif. Ranking HP2010 Rate exc NYC Quartile Goal CI # Upstate CI # HP Goal HP2010 Goal Met? HP Goal Met? 89.7 ± ± 1.9 N/A N/A 1st 90 No 81.6 ± ± ± 1.5 1st 70 Yes s: Total suppressed for confidentiality *: Fewer than 20 events in the numerator; therefore the rate is unstable #: 95% confidence interval for BRFSS/Expanded BRFSS indicators Source: Ontario : Health Assessment Indicators, NYSDOH-HIN 135

15 Percent of cancers diagnosed at an early stage by county, Males Females /Region Oral Colorectal Lung Melanoma Prostate Testis Oral Colorectal Lung Melanoma Breast Cervix Uterus Ovary New York State NYS excl NYC Allegany 44.4 * ~ ~ * 61.1 ~ * Ontario ~ 37.5 * * 72.0 ~ Schuyler ~ ~ 85.5 ~ ~ ~ 68.1 ~ 81.0 * ~ Seneca ~ * 84.4 ~ ~ ~ 63.2 ~ 52.9 ~ Steuben * ~ * * Wayne * 85.2 ~ ~ * 69.9 ~ Yates ~ ~ 84.0 ~ ~ * ~ 71.7 ~ 58.8 * ~ ~ Percent could not be calculated (fewer than 3 cases per year). * Percent should be used with caution. Source: NYS Cancer Registry Cancer Incidence and Mortality for Ontario, Incidence Mortality Males Females Males Females Site of Cancer Average Rate per 95% Average Rate per 95% Average Rate per 95% Average Rate per Annual 100,000 CI Annual 100,000 CI Annual 100,000 CI Annual 100,000 Cases Males (+/-) Cases Females (+/-) Deaths Males (+/-) Deaths Females All Invasive Malignant Tumors Oral cavity 9.6 and pharynx Esophagus Stomach Colorectal Colon excluding rectum Rectum & rectosigmoid Liver / intrahepatic bile duct Pancreas Larynx Lung and bronchus Melanoma of 13.6 the skin Female breast Cervix uteri Cancer Incidence and Mortality for Ontario, [cont] 95% CI (+/-) 136

16 Site of Cancer Average Annual Cases Incidence Mortality Males Females Males Rate per 95% Average Rate per 95% Average Rate per 95% Average 100,000 CI Annual 100,000 CI Annual 100,000 CI Annual Males (+/-) Cases Males (+/-) Cases Males (+/-) Cases Rate per 100,000 Males Corpus uterus and NOS Ovary Prostate Testis Urinary bladder (incl. in situ) Kidney and renal pelvis Brain and other nervous system Thyroid Hodgkin lymphoma Non-Hodgkin 12.0 lymphomas Multiple myeloma Leukemias Source: New York State Cancer Registry Notes Incidence data are provisional, November % CI (+/-) Rates are per 100,000 persons, age-adjusted to the 2000 US standard population, with 95% confidence intervals. Rates based on fewer than 4 cases or deaths per year are unstable and should be used with caution. NOS = Not otherwise specified. Cancer Mortality per 100,000 NY State Yates Steuben Schuyler Allegany Seneca Wayne Ontario Site of Cancer All Invasive Malignant Male Female Tumors Male Female Male Female Male Female Male Female Male Oral cavity and pharynx Esophagus Stomach Colorectal Female Male Female Male Female 137

17 Cancer Mortality per 100,000 [cont] NY State Yates Steuben Schuyler Allegany Seneca Wayne Ontario Site of Cancer Colon excluding rectum Male Female Male Female Male Female Male Pancreas Larynx Lung and bronchus Female breast Corpus uterus and NOS Ovary Prostate Urinary bladder (incl. in situ) New York State Department of Health, New York State Cancer Registry Cancer Incidence and Mortality by and Gender, Lung & Bronchus Cancer - Cases And Incidence Rates Per 100,000 Residents SOURCE: CANCER REGISTRY DATA AS OF APRIL, 2008 Adjusted Rates Are Age Adjusted to The 2000 United States Population Cases Female Male Female Male Female Male Female Male Population Crude Adjusted Region/ Total 2003 Rate Rate Reg-1 Western New York Allegany , Region Total 1,462 1,398 1,455 1,443 1,387 7,145 1,577, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total ,842 1,266, New York State 12,840 13,026 13,044 13,048 12,929 64,887 19,190, Total Lung & Bronchus Cancer - Cases And Incidence Rates Per 100,000 Residents Source: Cancer Registry Data As Of January, 2007 Female 138

18 Adjusted Rates Are Age Adjusted to The 2000 United States Population Cases Population Crude Adjusted Region/ Total 2002 Rate Rate Reg-1 Western New York Allegany , Region Total 1,464 1,467 1,403 1,453 1,424 7,211 1,581, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total ,793 1,267, New York State Total Revised: June ,101 12,888 13,024 13,030 12,893 64,936 19,157, Lung & Bronchus Cancer - Deaths And Death Rates Per 100,000 Residents SOURCE: VITAL STATISTICS DATA AS OF APRIL, 2008 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2004 Rate Rate Reg-1 Western New York Allegany , Region Total 1,171 1,104 1,115 1,058 1,072 5,520 1,572, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total ,819 1,265, New York State Total 9,625 9,467 9,364 9,279 9,176 46,911 19,227,

19 Lung & Bronchus Cancer - Deaths And Death Rates Per 100,000 Residents Source: Vital Statistics Data As Of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2003 Rate Rate Reg-1 Western New York Allegany , Region Total 1,147 1,171 1,104 1,115 1,055 5,592 1,577, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total ,774 1,266, New York State Total 9,513 9,625 9,467 9,364 9,275 47,244 19,190, Revised: June 2008 Upstate NY FLHSA Region Steuben Schuyler Chemung Yates Wayne Seneca Ontario Livingston Monroe Lung Cancer Mortality Rates Annual Av erage by Sex Deaths per 100,000 Population Males Females Rates are age adjusted to the standard 2000 U.S. population Data Source: NYS Dept of Health, Vital Statistics files 140

20 Female Breast Cancer - Cases And Incidence Rates Per 100,000 Female Residents SOURCE: CANCER REGISTRY DATA AS OF APRIL, 2008 Adjusted Rates Are Age Adjusted to The 2000 United States Population Cases Population Crude Adjusted Region/ Total 2003 Rate Rate Reg-1 Western New York Allegany , Region Total 1,278 1,345 1,305 1,333 1,248 6, , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total 1,016 1,083 1, , , New York State Total 13,801 13,802 13,800 13,665 13,584 68,652 9,913, Female Breast Cancer - Cases And Incidence Rates Per 100,000 Female Residents Source: Cancer Registry Data As Of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Cases Population Crude Adjusted Region/ Total 2002 Rate Rate Reg-1 Western New York Allegany , Region Total 1,271 1,276 1,343 1,290 1,317 6, , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total 1,006 1,013 1,084 1, , , New York State Total Revised: June ,014 13,779 13,754 13,689 13,482 68,718 9,906, Female Breast Cancer - Deaths And Death Rates Per 100,000 Female Residents SOURCE: VITAL STATISTICS DATA AS OF APRIL, 2008 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted 141

21 Region/ Reg-1 Western New York Tot al 2004 Rate Rate Allegany , Region Total ,39 0 Reg-2 Finger Lakes 809, Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , Female Breast Cancer - Deaths And Death Rates Per 100,000 Female Residents Source: Vital Statistics Data As Of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2003 Rate Rate Reg-1 Western New York Allegany , Region Total , , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , New York State Total 3,125 2,976 2,990 2,884 2,842 14,817 9,913, Revised: June 2008 Uterine Cervical Cancer - Cases And Incidence Rates Per 100,000 Female Residents SOURCE: CANCER REGISTRY DATA AS OF APRIL, 2008 Adjusted Rates Are Age Adjusted to The 2000 United States Population Cases Population Crude Adjusted Region/ Total 2003 Rate Rate Reg-1 Western New York 142

22 Allegany , Region Total , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , New York State Total ,627 9,913, Uterine Cervical Cancer - Cases And Incidence Rates Per 100,000 Female Residents Source: Cancer Registry Data As Of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Cases Population Crude Adjusted Region/ Total 2002 Rate Rate Reg-1 Western New York Allegany , Region Total , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , New York State Total 1, ,649 9,906, Revised: June 2008 Uterine Cervical Cancer - Deaths And Death Rates Per 100,000 Female Residents SOURCE: VITAL STATISTICS DATA AS OF APRIL, 2008 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2004 Rate Rate Reg-1 Western New York Allegany , Region Total , Reg-2 Finger Lakes Ontario ,

23 Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , New York State Total ,419 9,922, Uterine Cervical Cancer - Deaths And Death Rates Per 100,000 Female Residents Source: Vital Statistics Data As Of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2003 Rate Rate Reg-1 Western New York Allegany , Region Total , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , New York State Total ,424 9,913, Revised: June 2008 Colorectal Cancer - Cases And Incidence Rates Per 100,000 Residents SOURCE: CANCER REGISTRY DATA AS OF APRIL, 2008 Adjusted Rates Are Age Adjusted to The 2000 United States Population Cases Population Crude Adjusted Region/ Total 2003 Rate Rate Reg-1 Western New York Allegany , Region Total 1,070 1,086 1, ,083 1,577, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben ,

24 Wayne , Yates , Region Total ,686 1,266, New York State Total 11,353 11,281 10,960 10,754 10,116 54,464 19,190, Colorectal Cancer - Deaths And Death Rates Per 100,000 Residents SOURCE: VITAL STATISTICS DATA AS OF APRIL, 2008 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2004 Rate Rate Reg-1 Western New York Allegany , Region Total ,775 1,572, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total ,286 1,265, New York State Total 4,106 3,948 3,770 3,501 3,504 18,829 19,227,

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33 Diabetes As stated earlier, diabetes did not rank in the overall top 25 personal, community or unmet needs in the survey as a major problem. When looking further at the results for health related factors only the results show that diabetes was only ranked in the top ten of personal needs. As can be seen in the mortality section diabetes rates for years of potential life loss and major causes of death is higher in the than NYS averages. This is an increase over statistics. Both 2003 and 2008 BRFSS data indicate lower rates of physician diagnosed diabetes rates for Ontario compared to NYS rates. Ontario Public Health is a member of the Genesee Valley Regional Diabetes Coalition of the New York State Department of Health. Because of the size of this coalition, it is sub-divided into several smaller geographic clusters. Ontario works most closely with representatives from Yates, Wayne, and Seneca Counties to increase the awareness of diagnosis and treatment of diabetes and its sequelae. Members of the coalition work together to improve diabetes awareness among citizens of the Finger Lakes area. F.F. Thompson Health, Finger Lakes Health Care System, and Clifton Springs Hospital all offer training and support groups to those already diagnosed with diabetes. Patients of Ontario Public Health and all residents of the county are encouraged to participate in these events. In 2008, the Ontario Public Health Educator held six educational forums on diabetes prevention and management at county-wide senior citizen meal site locations. Ontario also sponsored a snack n chat for school nurses that focused on their role in the management of type 1 diabetes in schools. The s Health Educator has begun to accrue a small library of diabetes educational materials to be used with both patients and groups. Literacy levels of these materials are varied, reflecting our diverse audiences. 154

34 Diabetes prevention and management remain important topics in light of an emerging diabetes epidemic. Work in this field will continue in the future. CIRRHOSIS/DIABETES ONTARIO COUNTY Indicator CIRRHOSIS Mortality rates per 100,000 (ICD10 K70,K73- K74) 3 Year Total Rate NYS Rate Sig.Dif. NYS Rate exc NYC Sig.Dif. Ranking HP2010 Quartile Goal HP2010 Goal Met? Crude * 6.4 No 7.0 No 1st N/A N/A Age-adjusted * 6.0 No 6.3 No 1st N/A N/A Hospitalization rates per 10,000 (ICD9 571) Crude Yes 2.7 Yes 1st N/A N/A Age-adjusted Yes 2.5 Yes 1st N/A N/A DIABETES Mortality rate per 100,000 (ICD10 E10-E14) Crude No 19.9 No 3rd N/A N/A Age-adjusted No 17.4 No 3rd N/A N/A Hospitalization rate per 10,000 (Primary dx ICD9 250) Crude Yes 14.9 Yes 2nd N/A N/A Age-adjusted Yes 14.0 Yes 2nd N/A N/A Hospitalization rate per 10,000 (Any dx ICD9 250) Crude 5, Yes Yes 1st N/A N/A Age-adjusted 5, Yes Yes 1st N/A N/A Behavior/Risk Indicator (2003) Livingston & Ontario Rate CI # NYS Rate CI # Upstate CI # Diabetes prevalence rate per 100 adults 5.3 ± ± ± 0.5 1st N/A N/A s: Total suppressed for confidentiality *: Fewer than 20 events in the numerator; therefore the rate is unstable #: 95% confidence interval for BRFSS/Expanded BRFSS indicators Source: Ontario : Health Assessment Indicators, NYSDOH-HIN 155

35 Diabetes - Deaths and Death Rates Per 100,000 Residents Source: Vital Statistics Data as of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2004 Rate Rate Reg-1 Western New York Allegany , Region Total ,251 1,572, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total ,265, New York State Total 4,234 3,916 4,043 12,193 19,227, Revised: June

36 DIABETES - DEATHS AND DEATH RATES PER 100,000 RESIDENTS SOURCE: VITAL STATISTICS DATA AS OF AUGUST, 2004 ADJUSTED RATES ARE AGE ADJUSTED TO THE 2000 UNITED STATES POPULATION DEATHS POPULATION CRUDE ADJUSTED REGION/COUNTY TOTAL 2001 RATE RATE REG-1 WESTERN NEW YORK ALLEGANY , REGION TOTAL ,201 1,584, ONTARIO , SCHUYLER , SENECA , STEUBEN , WAYNE , YATES , REGION TOTAL ,264, NEW YORK STATE TOTAL Revised: July ,979 3,819 3,918 11,716 19,084, Diabetes Related Hospitalizations, Average Total Rate Count Rate Count Rate Count Rate Count Rate Std. Dev. count From state Average Std. Dev. From county Allegany Ontario Schuyler Seneca Steuben Wayne Yates Source: SPARCS data query 157

37 Physician Diagnosed Diabetes By Counties, 2003 New York State Steuben, Yates Monroe Liv ingston, Ontario* Chemung, Schuyler, Tioga Cayuga, Seneca, Wayne Source:NYS DOH, Expanded BRFSS, % 2% 4% 6% 8% 10% 158

38 MONROE WAYNE Diabetes Prevention Quality Indicators Hospitalizations per 100,000 by Zip Code LIVINGSTON ONTARIO YATES STEUBEN SENECA Combination of: Diabetes short-term complications Diabetes long-term complications Uncontrolled diabetes Diabetes Hospitalizations per 100, to 1, to to to to 60 none SCHUYLER CHEMUNG "The PQIs are a set of measures that can be used with hospital inpatient discharge data to identify "ambulatory care sensitive concitions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. Even though these indicators are based on hospital inpatient data, they provide insight into the quality of [and access to] the health care system outside the hospital setting. These tools serve as a screening tool rather than as definitive measures of quality problems. They can provide intitial information about potential problems in the community that may require further, more in-depth analysis." (Guide to Prevention Quality Indicators version 3.1, March 2007) Rates are age adjusted Data Source: NYS DOH SPARCS files 159

39 Participated in Leisure-Time Physical Activity or Exercise During the Past 30 Days Demographic Groups n¹ Yes %² n No % C.I.³ NYS Total Cayuga, Seneca, Wayne Chemung, Schuyler, Tioga Livingston, Ontario Steuben, Yates ¹Percents based on row denominators of less than 50 are unstable and should be used with caution ²Weighted Percent ³95% Confidence Interval Source: Expanded BRFSS, New York State Department of Health 160

40 Participation in Physical Activity Finger Lakes Region, Percent of population Seneca, Wayne* Chemung, Schuyler** Livingston, Ontario Monroe Steuben, Yates Using excercise to lose or maintain weight Participate in leisure time physical activity or exercise during the past 30 days * Survey sampling also included Cayuga county ** Survey sampling also included Tioga county Obesity Statistics in Ontario Ontario Women, Infants and Children (WIC) Indicators Indicator % Pregnant Women in WIC Who Were Prepregnancy Overweight (BMI 26-29), Low SES ( ) % Pregnant Women in WIC Who Were Prepregnancy Very Overweight (BMI Over 29), Low SES ( ) 3 Year Total Rate State Rate % Overweight Children in WIC, 2-4 years, Low SES ( ) % of Children in WIC, 0-4 years, viewing TV 2 hours per day ( ) 1, % of WIC mothers breastfeeding at 6 months ( ) Source: Ontario Behavior/Risk Indicators (2003) Indicator Rate CI # State Rate CI # % Adults Overweight or Obese (BMI 25+) 60.5 ± ± 1.2 % Adults Who Participated in Leisure Time Physical Activity in Last 30 Days 80.7 ± ± 1.0 % Adults Eating 5 or More Fruits or Vegetables per Day 29.3 ± ± 1.4 % Adults with Physician Diagnosed Diabetes 5.3 ± ± 0.6 % Adults with Physician Diagnosed Angina, Heart Attack or Stroke 7.2 ± ± 0.5 % Adults with Physician Diagnosed Arthritis 28.7 ± ± 1.0 Source: 161

41 Respiratory disease rates in the are better than NYS rates except for CLRD(COPD) where the county has an age adjusted rate of 4837 compared to the NYS rate of RESPIRATORY DISEASES ONTARIO COUNTY Indicator CLRD (COPD) mortality rate per 100,000 3 Year Total Rate NYS Rate Sig.Dif. NYS Rate exc NYC Sig.Dif. Ranking HP2010 Quartile Goal HP2010 Goal Met? Crude Yes 45.2 Yes 2nd N/A N/A Age-Adjusted Yes 39.3 Yes 3rd N/A N/A COPD (CLRD) hospitalization rate per 10,000 Crude Yes 31.7 Yes 1st N/A N/A Age-Adjusted Yes 29.6 Yes 1st N/A N/A Asthma Hospitalization rates per 10,000 Total Population - Crude Total Population - Ageadjusted Yes 12.4 Yes 1st N/A N/A Yes 12.4 Yes 1st N/A N/A 0-4 years Yes 37.8 Yes 1st 25.0 Yes 0-17 years Yes 16.6 Yes 1st 17.3 Yes 5-64 years Yes 9.3 Yes 1st 7.7 Yes 65+ years Yes 19.5 No 2nd 11.0 No Asthma mortality rate per 1,000,000 Crude s 6.4* 14.2 No 9.5 No 2nd N/A N/A Age-Adjusted s 4.8* 13.4 No 8.6 No 1st N/A N/A Behavior/Risk Indicator (2003) Livingston Ontario & Rate CI # NYS Rate CI # Upstate CI # % of adults with current asthma 8.1 ± ± ± 0.6 2nd N/A N/A s: Total suppressed for confidentiality *: Fewer than 20 events in the numerator; therefore the rate is unstable #: 95% confidence interval for BRFSS/Expanded BRFSS indicators Source: Ontario : Health Assessment Indicators, NYSDOH-HIN 162

42 Chronic Lower Respiratory Disease - Deaths and Death Rates Per 100,000 Residents Source: Vital Statistics Data as of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2004 Rate Rate Reg-1 Western New York Allegany , Region Total ,553 1,572, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total ,854 1,265, New York State Total 6,704 6,742 6,783 20,229 19,227, Revised: June 2008 MONROE WAYNE Chronic Obstructive Pulmonary Disease Adult Prevention Quality Indicator Hospitalizations per 100,000 by Zip Code LIVINGSTON ONTARIO YATES SENECA COPD Prevention Quality Indicator Hospitalizations 500 to 1, to to to to 70 0 to 0 STEUBEN SCHUYLER CHEMUNG "The PQIs are a set of measures that can be used with hospital inpatient discharge data to identify "ambulatory care sensitive concitions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. Even though these indicators are based on hospital inpatient data, they provide insight into the quality of [and access to] the health care system outside the hospital setting. These tools serve as a screening tool rather than as definitive measures of quality problems. They can provide intitial information about potential problems in the community that may require further, more in-depth analysis." (AHRQ Guide to Prevention Quality Indicators version 3.1, March 2007) Rates are age-adjusted Data Source: NYS DOH SPARCS files 163

43 Asthma Asthma is not the problem in Ontario that it is in many parts of the State and throughout the nation. Both 2003 and 2008 BRFSS data and death and hospitalization rates for asthma are significantly better than the State and regional rates. 164

44 Asthma - Deaths and Death Rates Per 1,000,000 Residents Source: Vital Statistics Data as of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Deaths Population Crude Adjusted Region/ Total 2004 Rate Rate Reg-1 Western New York Allegany , Region Total ,572, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total ,265, New York State Total ,227, Revised: June 2008 Asthma(Total) - Discharge Rate Per 10,000 Population 165

45 Source: SPARCS Data as of January, 2007 Adjusted Rates Are Age Adjusted to The 2000 United States Population Discharges Population Crude Adjusted Region/ Total 2004 Rate Rate Reg-1 Western New York Allegany , Region Total 1,874 1,877 2,101 5,852 1,572, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total 1,475 1,317 1,375 4,167 1,265, New York State Total 45,700 42,001 39, ,219 19,227, Asthma (Age 15-24) - Discharge Rate Per 10,000 Population Age Source: SPARCS Data as of January, 2007 Discharges Population Crude Region/ Total 2004 Rate Reg-1 Western New York Allegany , Region Total , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , New York State Total 2,720 2,232 2,098 7,050 2,606, Revised: June 2008 Asthma (Age 25-44) - Discharge Rate Per 10,000 Population Age Source: SPARCS Data as of January,

46 Discharges Population Crude Region/ Total 2004 Rate Reg-1 Western New York Allegany , Region Total , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , New York State Total 8,315 7,159 6,665 22,139 5,626, Revised: June 2008 Asthma (Age 45-64) - Discharge Rate Per 10,000 Population Age Source: SPARCS Data as of January, 2007 Discharges Population Crude Region/ Total 2004 Rate Reg-1 Western New York Allegany , Region Total , , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , , New York State Total 10,875 10,274 10,276 31,425 4,710, Revised: June 2008 Asthma (Age 65+) - Discharge Rate Per 10,000 Population Age 65+ Source: SPARCS Data as of January,

47 Discharges Population Crude Region/ Total 2004 Rate Reg-1 Western New York Allegany , Region Total , , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , New York State Total 7,336 7,496 7,615 22,447 2,492, Revised: June 2008 Asthma (Age 0-4) - Discharge Rate Per 10,000 Population Age 0-4 Source: SPARCS Data as of January, 2007 Discharges Population Crude Region/ Total 2004 Rate Reg-1 Western New York Allegany , Region Total ,149 88, Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , New York State Total 9,371 8,405 7,251 25,027 1,246, Revised: June 2008 Asthma (Age 5-14) - Discharge Rate Per 10,000 Population Age 5-14 Source: SPARCS Data as of January, 2007 Discharges Population Crude 168

48 Region/ Total 2004 Rate Reg-1 Western New York Allegany , Region Total , Reg-2 Finger Lakes Ontario , Schuyler , Seneca , Steuben , Wayne , Yates , Region Total , New York State Total 7,083 6,435 5,613 19,131 2,544, Revised: June 2008 Asthma Hospitalizations Ages 0-14 By FLHSA Subareas - 3 Yr Avg Rate Yr.Avg. Hospitalization Rate/ North Central Southern Data Source: NYS Dept of Health, SPARCS 0-14 Age Rates to US Population Finger Lakes Health Systems Agency Lifetime Asthma Diagnosed by a Medical Professional Demographic Groups n¹ Yes n No C.I.³ %² % NYS Total Cayuga, Seneca, Wayne Chemung, Schuyler, Tioga Livingston, Ontario Steuben, Yates ¹Percents based on row denominators of less than 50 are unstable and should be used with caution ²Weighted Percent ³95% Confidence Interval Source: Expanded BRFSS, New York State Department of Health Current Asthma Diagnosed by a Medical Professional 169

49 Demographic Groups n¹ Yes %² n No % C.I.³ NYS Total Cayuga, Seneca, Wayne Chemung, Schuyler, Tioga Livingston, Ontario Steuben, Yates ¹Percents based on row denominators of less than 50 are unstable and should be used with caution ²Weighted Percent ³95% Confidence Interval Source: Expanded BRFSS, New York State Department of Health Arthritis In both the 2003 and 2008 BRFSS survey data Ontario respondents reported a higher level of incidence for arthritis than New York State averages. Arthritis Diagnosed by a Medical Professional Demographic Groups n¹ Yes %² n No % C.I.³ 170

50 NYS Total Cayuga, Seneca, Wayne Chemung, Schuyler, Tioga Livingston, Ontario Steuben, Yates ¹Percents based on row denominators of less than 50 are unstable and should be used with caution ²Weighted Percent ³95% Confidence Interval Source: Expanded BRFSS, New York State Department of Health Doctor Diagnosed Arthritis or Possible Arthritis (Chronic Joint Symptoms Only) Demographic Groups n¹ Doctor C.I.³ n Possible C.I. n No C.I. Diagnose d %² Arthritis (CJS Only) % Arthritis or CJS % NYS Total Cayuga, Seneca, Wayne Chemung, Schuyler, Tioga Livingston, Ontario Steuben, Yates ¹Percents based on row denominators of less than 50 are unstable and should be used with caution ²Weighted Percent ³95% Confidence Interval Source: Expanded BRFSS, New York State Department of Health 171

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52 Tobacco Use According to the survey, programs for stopping smoking and tobacco use was not ranked in the overall top 25 needs. When looking at only the health related factors that were ranked these programs only made the top ten under the personal needs category and it was tenth. These numbers are expected to be understated, since survey respondents were more likely to be female, better educated, older and of greater means (higher income) than the general population in Ontario. It could also be as a result of the funds NYSDOH has made available in recent years due to the tobacco settlements to support the state wide tobacco cessation efforts. The 2003 BRFSS rates appear to have improved when compared to 2008 BRFSS responses. Although Ontario tobacco use data is not extremely out of line with state averages and appears to have improved over the last five years, the incidence and death rates for lung and bronchus cancer are above the state and regional averages and the rates of chronic lower respiratory disease have been above the State average for some time, and exceed both the State and regional average for the most recent three year period for both crude and adjusted rates. This is clearly an area that needs addressing. Ontario is a member of the Tobacco Action Coaltion of the Finger Lakes(TACFL) which is a community partnership coalition made up of organizations and private citizens who live or work in Wayne, Seneca, Wayne and Yates counties. TACFL is dedicated to reducing the risk of cancer, heart disease and other tobacco related illnesses by lowering the prevalence of tobacco use, advertising, sponsorship and promotion through education, media and advocacy. Their goal is to implement strategies and programs that will decrease the social acceptability of tobacco use. 60 Cigarette Smoking Rates Finger Lakes Region, 2003 Percent of Population Seneca, Wayne* Chemung, Schuyler** Livingston, Ontario Monroe Steuben, Yates Current smoker Everyday smoker Ever attempted to quit (among current smokers) * Survey sampling also included Cayuga county ** Survey sampling also included Tioga county Source: BRFSS, NYS Department of Health,

53 Home Smoking Finger Lakes region, Percent of Population Seneca, Wayne* Chemung, Schuyler** Livingston, Ontario Monroe Steuben, Yates Home smoking is not allowed * Survey sampling also included Cayuga county ** Survey sampling also included Tioga count Ever Smoked 100 Cigarettes in Your Lifetime Demographic Groups n¹ Yes %² n No % NYS Total Cayuga, Seneca, Wayne Chemung, Schuyler, Tioga Livingston, Ontario Steuben, Yates ¹Percents based on row denominators of less than 50 are unstable and should be used with caution ²Weighted Percent ³95% Confidence Interval Source: Expanded BRFSS, New York State Department of Health Current Smoker Demographic Groups n¹ Yes %² n No % NYS Total Cayuga, Seneca, Wayne Chemung, Schuyler, Tioga Livingston, Ontario Steuben, Yates ¹Percents based on row denominators of less than 50 are unstable and should be used with caution ²Weighted Percent ³95% Confidence Interval Source: Expanded BRFSS, New York State Department of Health C.I.³ C.I.³ 174

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55 Status of Cigarette Smoking Demographic Groups n¹ Everyday Smoker %² C.I.³ n Someday Smoker % C.I. n Former or Never Smoked % NYS Total Cayuga, Seneca, Wayne Chemung, Schuyler, Tioga Livingston, Ontario Steuben, Yates ¹Percents based on row denominators of less than 50 are unstable and should be used with caution ²Weighted Percent ³95% Confidence Interval Source: Expanded BRFSS, New York State Department of Health C.I. 176