State Data Report. ASTHO Breast Cancer Learning Community: Using Data to Address Disparities in Breast Cancer Mortality at the State Level

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1 State Data Report STATE HEALTH DEPARTMENT NAME: WV Bureau for Public Health Dr. Rahul Gupta, Commissioner ASTHO Breast Cancer Learning Community: Using Data to Address Disparities in Breast Cancer Mortality at the State Level ADDRESS: 350 Capitol Street, Room 702 PHONE: Charleston, WV MAIN POINT(S) OF CONTACT: GeorgeAnn Grubb, Director, WV Breast and Cervical Cancer Screening Program 350 Capitol Street, Room 427 Charleston, WV Phone: DATA SOURCES USED IN REPORT: WV Cancer Registry WV Health Statistics Center CDC WONDER US Department of Agriculture American Community Survey CountyHealthRankings.org Bonnie s Bus Mobile Mammography Program State Cancer Profiles STAKEHOLDERS (list organization names): WV Bureau for Public Health Office of Maternal, Child and Family Health Perinatal and Women s Health Division WV Breast and Cervical Cancer Screening Program WV Office of Minority Health WV Cancer Registry, Bureau for Public Health WV Comprehensive Cancer Control Program WV Health Statistics Center WV WISEWOMAN Program Bonnie s Bus Mobile Mammography Program, WV University Marshall University School of Medicine Breast Cancer Center, Edwards Cancer Center, Cabell-Huntington Hospital Bureau for Medical Services-Medicaid Charleston Area Medical Center Research Institute West Virginia Breast Cancer Learning Community Data Report 1

2 State Data Report ABSTRACT/DESCRIPTION (300 WORDS OR LESS): The West Virginia Breast Cancer Learning Community initially focused on acquiring ArcGIS software and licenses. These were not received until April ArcGIS training has begun and will be expanded in the coming months. Stakeholders were selected and convened with ASTHO in West Virginia in March The stakeholder network has been actively engaged in setting goals and objectives for the current grant period and will continue to be involved for Priority was given to mapping WV breast cancer incidence and mortality data. Due to the small numbers of African Americans in the state (3.6%), socio-economic indicators (poverty/education) were mapped to pinpoint areas with breast cancer disparities. Data and maps presented in the ASTHO State Data Report meeting in May were prepared in partnership with the WV Cancer Registry. Final Report: -Purchased online GIS training -Revised data maps and additional maps are attached to this report. -Contractual arrangement with Cancer Registry Epidemiologist has been approved and implemented. -Epidemiologist is in process of completing online GIS training. LESSONS LEARNED: West Virginia Breast Cancer Learning Community Data Report 2

3 State Data Report Acquire ArcGIS software/training as early as possible to avoid delays in data mapping, analysis and planning. Hire project coordinator to alleviate burden of work for existing staff. NEXT STEPS: Continue and expand ArcGIS training. Hire project coordinator. Continue to engage stakeholders in project strategic planning, project development and implementation. Share data maps with stakeholders, provider network, WV Comprehensive Cancer Coalition, and other state and local partners. Engage WVBCCSP outreach staff in expanded awareness/education efforts in target areas. Expand collaboration with Bonnie s Bus Mobile Mammography Unit to use data mapping findings to expand the reach in underserved areas. Utilize data maps to more effectively allocate WVBCCSP resources and outreach efforts. Final Report Next Steps: -Review of payer guidelines for time from diagnosis to treatment -Compare map of FQHCs in WV to areas of screening, late diagnosis and late treatment -Survey patients and hospitals in the Huntington WV area to learn the reason for delay in treatment -Expand and improve quality of services provided by Bonnie s Bus Mobile Mammography Program -Scheduled follow-up Stakeholders meeting for September 27, 2016 AT THE TIME OF THIS REPORT, ALL 55 COUNTIES ARE REPRESENTED IN THE DATA SETS. (LIST THE COUNTIES HERE) Barbour Berkeley Boone Braxton Brooke Grant Greenbrier Hampshire Hancock Hardy Logan Marion Marshall Mason McDowell Nicholas Ohio Pendleton Pleasants Pocahontas Summers Taylor Tucker Tyler Upshur West Virginia Breast Cancer Learning Community Data Report 3

4 State Data Report Cabell Calhoun Clay Doddridge Fayette Gilmer Harrison Jackson Jefferson Kanawha Lewis Lincoln Mercer Mineral Mingo Monongalia Monroe Morgan Preston Putnam Raleigh Randolph Ritchie Roane Wayne Webster Wetzel Wirt Wood Wyoming Hancock Mineral Ritchie Hardy Mingo Roane Lincoln Pendleton Wayne AT THE TIME OF THIS REPORT, THE FOLLOWING DATA SOURCES WERE INCLUDED IN THIS ANALYSIS: (LIST DATA SOURCES HERE) DATA SOURCE DATA RANGE YEARS WV Cancer Registry WV Health Statistics Center CDC WONDER US Department of Agriculture 2013 American Community Survey CountyHealthRankings.org 2013 Bonnie s Bus Mobile Mammography Program State Cancer Profiles West Virginia Breast Cancer Learning Community Data Report 4

5 Metro/Rural Areas, West Virginia, 2013 Most of West Virginia is considered rural or non-metro by the USDA. The panhandles and the west central parts of the state are considered metro areas. There are few mammography facilities within the rural counties. Rurality - Beale Code Scale 8-9 (Rural) 4-7 (Non-metro) 1-3 (Metro) Source: United States Department of Agriculture

6 % of People Below Poverty Level by County, West Virginia, High rates of poverty exist in the southwestern and central portions of West Virginia. There is generally less poverty in the panhandles, and in the Charleston and Parkersburg areas. Charleston % Below Poverty Level 11.2 to to to 36.3 West Virginia average: 17.9% Source: American Community Survey

7 % with a High School Education or Higher by County, West Virginia, Lower levels of education also exist in the southwestern and central portions of West Virginia. Education levels are higher in the panhandles, and in the Charleston, Morgantown, and Parkersburg areas. Parkersburg Morgantown Charleston % HS Education or Higher 63.1 to to to 91.2 West Virginia average: 83.9% Source: American Community Survey

8 Mammography Screening % by County, West Virginia, Mammography screening percentages are lowest in the Charleston area, and in the southwest and east central portions of the state. Charleston Mammography Screening % 43.6 to to to 85.5 West Virginia average: N/A Source: CountyHealthRankings.org

9 % of Distant Stage Female Breast Cancers by County, West Virginia, A higher percentage of distant stage cancers are found in the east central border counties, and scattered throughout the state. % Distant Stage 0.0 to to to 16.4 West Virginia average: 6.1% Source: WV Cancer Registry

10 Average Annual Age-Adjusted Female Breast Cancer Mortality Rates* by County, West Virginia, Higher mortality rates are found in the east central counties, the northern panhandle, and the Huntington area. Huntington Mortality Rate per 100, to to to 40.0 * Due to low case counts in some areas, rate estimates may not be reliable for all counties. Source: West Virginia Health Statistics Center

11 Female Breast Cancer Age-Adjusted Mortality/Incidence Ratio* by County, West Virginia, Higher mortality/incidence ratios are found in the east central counties, and scattered throughout the state. MIR to to to * Due to low case counts in some areas, rate estimates may not be reliable for all counties. Source: West Virginia Health Statistics Center

12 % Female Breast Cancer Cases Receiving Treatment >90 Days from Diagnosis Date by County, West Virginia, The percentage of patients receiving treatment more than 90 days after diagnosis was higher in the western and southwestern portions of the state, and in the eastern panhandle. % Treatment Delay > 90 Days 0.00 to to to 9.72 CoC Hospitals Source: WV Cancer Registry

13 West Virginia University Mobile Mammography Program Visits by County, West Virginia, Bonnie s Bus Mobile Mammography Program has done a very good job of providing screening in areas that do not have an accredited mammography facility. 0 visits 1-10 visits visits visits 31 or more visits Source: West Virginia University Mobile Mammography Program

14 Female Breast Cancer Mortality-Incidence Age-Adjusted Rate Ratio by Race and Diagnosis Date, WV and US WV US Race Race Diagnosis Date White Black White Black Difference Source: CDC Wonder The difference in mortality/incidence ratio between whites and blacks in West Virginia has decreased significantly since For the time period, the mortality/incidence ratio for blacks in West Virginia was lower than the mortality/incidence ratio for blacks in the United States overall.

15 Characteristics of Female Breast Cancer Patients by Time from Diagnosis to Treatment, WV, </= 60 Days from > 60 Days from Diagnosis to Diagnosis to Treatment Treatment Characteristic (n=6,136) (n=510) Race White 5963 (97.2) 494 (96.7) Black 173 (2.8) 16 (3.1) Stage Early 4050 (66.0) 313 (61.4) Late 2054 (33.5) 197 (38.6) Unknown 32 (0.5) 0 (0.0) Rurality Metro 3458 (56.4) 299 (58.6) Nonmetro 2365 (38.5) 181 (35.5) Rural 313 (5.1) 30 (5.9) Age Group < (17.1) 92 (18.0) (82.9) 418 (82.0) Primary Payer Private 2722 (44.4) 200 (39.2) Medicaid 575 (9.4) 76 (14.9) Medicare 2637 (43.0) 211 (41.4) Not insured 98 (1.6) 10 (2.0) Other 43 (0.7) 10 (2.0) Unknown 61 (1.0) 3 (0.6) Source: WV Cancer Registry For those patients receiving delayed treatment, a higher percentage have a late stage diagnosis, live in a metro area, and have Medicaid insurance.