Use of Local Surveys in NYC

Transcription

1 Population-Based Surveys to Conduct CVD and Chronic Disease Surveillance Use of Local Surveys in NYC Lorna Thorpe, PhD Associate Professor Director, Epi & Bios Dept City University of New York School of Public Health

2 At the NYC Dept of Health and Mental Hygiene. Until 2002, virtually no infrastructure for chronic disease epidemiology or programs No local surveillance of chronic health conditions or risk behaviors

3 The Gap in Funding $45 CDC Funding ($ Mill.) Deaths < CDC Funding ($ Millions) $40 $35 $30 $25 $20 $15 $10 $ NYC Deaths Under Age 65 $0 Vaccine Prev Diseases Bioterrorism HIV TB STDs Lead Poisoning Communicable Disease Diabetes CVD Tobacco Cancer 0 Source: NYC Dept of Health, Office of the Commissioner

4 In 2002, Smoking Killed An Estimated 10,000 NYers # of Deaths Suicide Homicide Kidney Disease Psychoactive Subs Accident Diabetes* HIV/AIDS Stroke* Flu/Pneumonia* Smoking (All Causes) Source: NYC Dept of Health and Mental Hygiene * Total includes smoking-related deaths (2002)

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6 Building Local Surveillance to Address Leading Causes New systemsto monitor health and health programs Community Health Survey (telephone) NYC HANES (biomarker and exam-based) Youth Behavior Risk Survey (self-administered) Childhood obesity Height and weight surveys (periodic) Fitnessgram (annual school exam) HbA1C Registry (electronic laboratory reporting) Subsidized electronic health records Source: NYC Dept of Health and Mental Hygiene

7 A Need for Small Area Data Community Health Survey Initiated in 2002 Random digit dial telephone survey Sampling frame = 33 NYC Neighborhoods Robust estimates by neighborhood Disparity focus Questions Based on the Behavioral Risk Factor Surveillance Survey (BRFSS) Healthy People 2010 goals in mind

8 % of adults NYC Adult Smoking Prevalence yr average 3-yr average 3-yr average 21.6% 21.5% 21.7% 21.6% 19.2% City and State tax increases Smoke-free workplaces Free patch programs Media campaigns 18.9% 18.4% 17.5% 16.9% 15.8% Source: CDC BRFSS; NYC Dept of Health and Mental Hygiene, Community Health Survey

9 Current Smoking in NYC, 2002

10 Self-Reported Diabetes Prevalence Up 250% in the Past Decade 12 % Reporting Diabetes US (2006)=7.5% Sources: CDC, BRFSS, ; NYC Dept of Health and Mental Hygiene, Community Health Survey,

11 Self-Reported Diabetes by Neighborhood Source: NYC Dept of Health and Mental Hygiene CHS,

12 Chronic Disease Management in NYC Diabetes Profile from CHS Among NYC adults with diagnosed diabetes: 24% smoked (higher rate than overall NYC average) 77% did not take aspirin to prevent heart disease 60% did not get physical activity at least 3x/wk 60% did not receive a flu shot in the last year Only 11% of adults with diabetes knew their A1C level. Of these: Most (82%) reported an A1C >7%, or poorly controlled 68% reported poor lipid control 43% reported poor blood pressure control Source: NYC Dept of Health and Mental Hygiene

13 What we still wanted to know Extent of undiagnosed chronic conditions among NYC residents Full distribution of CVD risk factors (BP, chol, glucose), and identification of groups at high risk of developing disease Population-based information on successful disease management among those diagnosed

14 Local Surveillance Taken One Step Further New York City Health and Nutrition Examination Survey

15 NYC HANES Objectives 1) To estimate the prevalence of selected health conditions in NYC using objective measures 2) To estimate city-wide awareness, treatment, and control of selected health conditions 3) To monitor prevalence of environmental exposures in NYC

16 2004 NYC HANES Design Time Frame:June December 2004 Population:non-institutionalized NYC adult residents aged 20+ years Sampling: Population-based, cross-sectional, 3- stage cluster sample across 144 randomly selected neighborhoods Recruitment, Interview and Examination:Data were collected in participants homes and at four field clinics

17 Sampling Design and Response Rate SEGMENT ~20,000 Segments in NYC HOUSEHOLD 144 Segments randomly selected 4026 households approached Response Rate 3388/4026 = 84% 3388 completed eligibility interview 638 did not complete eligibility interview Overall Response Rate 84% x 66% = 55% PARTICIPANT 3047 participants identified Response Rate 1999/3047 = 66% 1999 participants examined 1048 participants refused Source: NYC Dept of Health and Mental Hygiene

18 2004 Recruitment Effort by Borough 10 Mean Attempts/Household Total Visits = 26,538 Total Calls = 9,099 Total Letters Sent = 2,268 Visits Letters Calls 1 0 Bronx Brooklyn Manhattan Staten Island Source: NYC Dept of Health and Mental Hygiene Queens Overall

19 Procedures Exam Blood Pressure Anthropometry (BMI, waist circumference) Blood draw Urine collection

20 2004 NYC HANES Lab Tests Whole Blood Glychohemoglobin Heavy metals Urine Pesticides Trace Metals Mercury Repository Sera Cholesterol Cotinine HSV HCV Repository Plasma Fasting Glucose

21 Thorpe et al, Diabetes Care 2009 Diagnosed and Undiagnosed Diabetes Prevalence, NYC HANES % Total Diabetes = 12.5% (95% Confidence Interval, 10.2% %) 25% 9.5% Undiagnosed Diabetes Diagnosed Diabetes 20% Percent 15% 10% 5% 0% 2.4% 4.7% 5.1% 3.8% 4.2% 3.5% 3.4% 3.3% 18.8% 4.6% 3.4% 4.6% 3.2% 12.1% 11.4% 11.9% 8.7% 9.2% 9.8% 8.4% 9.0% 8.8% 8.1% 0.6% 6.2% 5.9% 1.9% US Born Asian Hispanic Black White > Women Men Total Foreign Born <$20,000 Undiagnosed (ref) --- (ref) p<0.01 p<0.001 (ref) (ref) (ref) Diagnosed (ref) --- (ref) p<0.001 p<0.001 (ref) p< (ref) --- p<0.01 (ref)

22 Distribution of Glucose Levels among NYC Adults, NYC HANES % Impaired Fasting Glucose (100<=FPG <=125) Diabetes (FPG>125 or self-report) 12.5% Normal (FPG<100) 64% Thorpe et al, Diabetes Care 2009

23 70 60 Adjusted Prevalence of Diabetes and IFG, by BMI and Race* Non-Hisp White Non-Hisp Black 57 c 58 d 60 Percent Non-Hisp Asian Hispanic 37 a b Normal Weight Overweight Obese a Estimate is higher than all other racial/ethnic groups at p<0.05 b Estimate is higher than whites at p<0.05 c Estimate is higher than whites (p<0.001) and Hispanics (p<0.05) d Estimate is higher than blacks at p<0.05 BMI Category Models adjusted for sex, age, place of birth, income and physical activity

24 A1C Control among Adults with Diagnosed Diabetes, NYC HANES % 17% >9 7-9 <7 Of adults with diagnosed diabetes, only 12% reported being on insulin (with or without oral agents) 38% 16% of adults with diagnosed diabetes were not taking any medication Source: Thorpe et al Diabetes Care 2009

25 How did we do NYC HANES? Reassigned Health Dept staff as field screeners and interviewers Paid overtime to school nurses and other staff to run clinics 100% internally funded with significant inkind and contracted support from NCHS Costs spread over 3 fiscal years >$3 million in direct costs, near $5 million total Institutional leadership support

26 Dissemination of Local Survey Data Web-based query systems Public use data sets Calls for proposals to use serum repository Press releases Reports for the public Peer-review literature

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29 NYC HANES Web Site Designing and Implementing a Community HANES- Manual NYC HANES Datasets Questionnaires and related documents NYC HANES publications and presentations Solicitation Notice for NYC HANES Repository Proposals

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31 TAKE CARE NEW YORK: 10 steps to live longer, healthier lives. 1. Have a Regular Doctor or Other Health Care Provider 2. Be Tobacco Free 3. Keep Your Heart Healthy 4. Know Your HIV Status 5. Get Help for Depression 6. Live Free of Dependence on Alcohol and Drugs 7. Get Checked for Cancer 8. Get the Immunizations You Need 9. Make Your Home Safe and Healthy 10. Have a Healthy Baby

32 Opportunities High level of interest and trust in neighborhood and objective data from local communities Triangulation between self-report and objective measure surveys is informative Repeat cross-sectional studies are powerful designs to set priorities and evaluate structural policies or programmatic initiatives Important resources for broad research community

33 Challenges Many local jurisdictions lack capacity NYC HANES, as designed, is costly to repeat. Consider Alternate designs New partnerships Uncertainty regarding ideal interval of periodicity Difficult to design messages involving 2 different prevalence estimates Are such systems justified if some conditions have levels comparable to national prevalence?