DEKALB MEDICAL NORTH DECATUR 2013 Community Health Assessment

Transcription

1 DEKALB MEDICAL NORTH DECATUR 2013 Community Health Assessment

2 Table of Contents Page METHODOLOGY 1 DEKALB MEDICAL AT NORTH DECATUR 6 Profile Population 8 Healthcare 9 Economics 10 Education 11 Housing 11 Households 12 Labor 12 Crime 13 Disability 13 Leading Causes Leading Causes of Hospitalization 15 Leading Causes of Mortality 15 Chronic Diseases Overview 18 Cancers* 18 Cardiovascular Diseases* 23 DeKalb Medical: Primary Stroke Program 28 Diabetes* 30 Asthma* 33 Infectious Diseases Injuries* Overview 37 Vaccine-Preventable Diseases 37 Sexually Transmitted Diseases* 39 HIV/AIDS* 43 Hepatitis 47 Foodborne, Waterborne, and Environmental Diseases 50 Invasive Bacterial Diseases 54 Respiratory Diseases 60 DeKalb Medical: Immunizations against Respiratory Diseases 63 West Nile Virus 65 Overview 67 Leading Types of Injury 67 Deaths by Type of Injury 69 Emergency Room Visits 70 i

3 Behavioral Health* Overview 75 Mental Illness and Addictive Disease 75 Developmental Disability 76 Maternal and Child Health* Overview 80 Pregnancy 80 Low Birthweight 81 Infant Mortality 81 Refugee Health Page Overview 85 Arrivals by Country of Origin 85 Health Screenings 86 APPENDICES Differences in Health Status, Access to Healthcare, and Environment Acknowledgements Index of Tables and Figures Sources Resources and Services 97 * Indicates that this section includes a focus on related risk factors and behaviors. ii

4 METHODOLOGY 1

5 Methodology Understanding a community s health needs helps health care organizations, like DeKalb Medical, develop programs and services to improve the health status of the populations they serve. The 2013 Community Health Assessment Report uses the latest demographic, health and risk behavior data to describe the health status of DeKalb County and Hillandale area (i.e., Lithonia and Redan) residents. DEMOGRAPHIC DATA SOURCES The county s population estimates were obtained from the U.S. Census Bureau s 2010 American Community Survey and The Georgia County Guide for 2010 through HEALTH DATA SOURCES DeKalb Community Service Board The DeKalb Community Service Board provided all of the data for the Behavioral Health in DeKalb County section. DeKalb County Board of Health The DeKalb County Board of Health s Division of Environmental Health provided data on West Nile virus for the Infectious Diseases in DeKalb County section. Georgia Department of Public Health Georgia Comprehensive Cancer Registry The Georgia Comprehensive Cancer Registry collects all cancer cases diagnosed among Georgia residents since January 1, The registry staff provided cancer data for the Chronic Diseases in DeKalb County section. HIV/AIDS Epidemiology Section The section staff provided HIV/AIDS data for the Infectious Diseases in DeKalb County section. Online Analytical Statistical Information System (OASIS) OASIS is a set of web-based tools for analyzing Georgia s public health data. Data from OASIS is used throughout the report. Refugee Program The program staff provided all of the data for the Refugee Health in DeKalb County section. State Electronic Notifiable Disease Surveillance System (SENDSS) SENDSS is a web-based reporting system that collects information pertaining to notifiable diseases in Georgia. State law requires that healthcare providers notify the state s public health system of diagnosed cases of over 50 diseases and conditions. 2

6 RISK BEHAVIOR DATA SOURCES The DeKalb County Board of Health conducts two surveys to assess residents health-related risk behaviors. One is the Behavioral Risk Factor Surveillance System survey of adults and the other is the Youth Risk Behavior Survey of high school students. Behavioral Risk Factor Surveillance System (BRFSS) Survey DeKalb County residents were interviewed by telephone. Telephone numbers were randomly dialed and respondents were randomly selected from the adult members of each household. Participation was voluntary and anonymous, and the sample did not include institutionalized individuals, households without telephones, and households that use only cellular telephones. Trained telephone interviewers administered the questionnaire. Data were weighted to represent the age, race/ethnicity and gender distributions of adults in DeKalb County. Logistic regression was used to compare age groups and trends over time. Youth Risk Behavior Survey (YRBS) A sample of students from all 20 traditional DeKalb County public high schools completed a written questionnaire. The number of participating classes varied depending on the population size of the school. Classes were randomly chosen from among all second period classes (excluding English as a Second Language and special education). All students within a selected class were eligible to participate. Passive consent forms were sent home for parents to sign if they did not want their child to participate. All students without a signed form were encouraged to participate. Participation was anonymous and voluntary and data are reported only in aggregate form. DCBOH employees administered the survey. Results were weighted, are representative of all students in DeKalb County public high schools, and are comparable to state and national YRBS data. Logistic regression analysis was used to analyze trends over time. STATISTICAL METHODS Percentages For the most part, disease and death-related data are analyzed using percentages instead of rates (e.g., number of cases per 100,000 population). Percentages are accessible to the general public and facilitate comparison between DeKalb County and the Hillandale area. Years of Potential Life Lost (YPLL) Years of potential life lost is used to compare causes of premature death. YPLL was calculated by subtracting the age of death from 75 years. The age of 75 years is used as the cut-off as it is close to life expectancy (78 years) in the United States. For example, a person who dies at age 27 has lost 75 minus 27, or 48 years, of potential life. A person who dies at age 72 has lost 75 minus 72, or 3 years, of potential life. Together, these two people contribute 48 plus 3, or 51 years, of potential life lost. The top ten leading causes of premature death are listed in the Leading Causes sections for DeKalb County and the Hillandale area. However, death data in other sections include people of all ages. 3

7 HILLANDALE AREA The Hillandale area was defined using the following census tracts from 2000: , , , , , 232.1, , , , , , 233.1, , , and LIMITATIONS Statistical limitation regarding some racial/ethnic groups Most of the report uses the racial categories of white, black, and other. Since the sizes of the Asian and Hispanic populations are too small for statistical purposes, these groups are included in the other category. Lack of some community-level prevalence data Much of the health data is defined using the International Classification of Diseases, Ninth Revision (ICD-9). The ICD-9 includes hospital data on individuals who went to an emergency room and/or were admitted. Since it does Created by: DeKalb County Board of Health (2012) Sources: DeKalb Medical and the Atlanta Regional Commission Hillandale Area Census Tracts Remaining DeKalb County Census Tracts Miles 4

8 not capture individuals who did not access a hospital for care, it does not fully reflect the extent of some conditions and diseases in the community. For example, the prevalence of high blood pressure in DeKalb County and Hillandale is analyzed using the number of individuals who were discharged after a hospital stay for this condition. Since many individuals do not seek hospital care for high blood pressure, they are not captured. Lack of 2009 death data by cause of death The data on the county s 2009 deaths analyzed by cause of death are not available from OASIS. Lack of some data at the census tract level A number of census tract maps are included in the report to demonstrate the geographic distribution of health issues affecting DeKalb County residents. However, not all health data is available at the census tract level. 5

9 DEKALB MEDICAL AT NORTH DECATUR

10 PROFILE OF DEKALB COUNTY 7

11 Profile of DeKalb County This section provides an overview of the characteristics of DeKalb County, Georgia, residents. DeKalb Medical at North Decatur serves all who live in the county. POPULATION Table 1: Population Profile of DeKalb County, 2010 Total 2010 estimate 691,893 % Female 52.1 % Male 47.9 % Under 5 years of age 7.3 % 65 years of age and over 9.1 Median age (years) 34.3 % Born outside the United States 16.9 Source:s U.S. Census Bureau, 2010 American Community Survey. In DeKalb County from 2005 to 2010: The total population increased from 662,973 to 691,893, an increase of 4.4 percent. Figure 2: Population Estimate (in percentages) by Race/Ethnicity, DeKalb County, Black/African American (non-hispanic) White (non-hispanic) 53.6 Hispanic or Latino (of any race) Asian (non-hispanic) 29.4 Other Source: U.S. Census Bureau, 2010 American Community Survey. In DeKalb County from 2005 to 2010: The number of blacks/african Americans decreased from 54.9 percent to 53.6 percent of the total population. The number of Asians increased from 3.9 percent to 5.1 percent of the total population. 8

12 HEALTHCARE Table 2: Healthcare Profile of DeKalb County General hospitals, Bed capacity 1,681 Average stay in days 5.7 Emergency room visits 198,382 Inpatient admissions from emergency room 30,451 General nursing homes, state fiscal year 2010* 16 Bed capacity 2,368 % Occupancy 82.5 Total practicing physicians, ,334 % Family practice 8.1 % Internal medicine 11.9 % Pediatrics 10.1 % Obstetrics and gynecology 3.3 % General surgery 2.5 Persons per physician (all types) ratio, Source: The 2012 Georgia County Guide. *July 2009 June In DeKalb County from 2005 to 2010: The bed capacity in general hospitals decreased from 1,293 to 1,376, an increase of 6.4 percent. The number of emergency room visits increased from 159,192 to 198,382, an increase of 24.7 percent. 9

13 Figure 3: Health Insurance Coverage, DeKalb County, % 60% 50% 40% 30% 20% 10% 0% 57.2 With private insurance With public insurance* No coverage Source: U.S. Census Bureau, 2010 American Community Survey. Note: Percentages total more than 100% because an individual may have two types of insurance. For example, someone on Medicare (i.e., public insurance) may also have supplemental private insurance. *Public insurance includes federal programs such as Medicare, Medicaid, VA Health Care, the Children s Health Insurance Program (e.g., PeachCare for Kids), and individual state health plans. ECONOMICS Table 3: Economic Profile of DeKalb County, 2010 Median household income $46,812 Per capita income $25,813 % Families living below federal poverty level 14.7 % Persons living below federal poverty level 19.2 Bankruptcy filings 7,091 Source: U.S. Census Bureau, 2010 American Community Survey; The 2012 Georgia County Guide. Note: The U.S. Census Bureau uses a set of money income thresholds that vary by family size and composition to determine who is in poverty. If a family s total income is less than the family threshold, then that family and every individual in it is considered in poverty. In DeKalb County: The number of families living below the federal poverty level increased from 12.4% in 2005 to 14.7% in Approximately 28% of families with a female head of household and no husband present were living below the federal poverty level in

14 EDUCATION Table 4: Educational Profile of DeKalb County, School Year Total enrollment, K - 12th grade 120,119 % Qualifying for free/reduced price lunch 71.3 % Students with disabilities 9.8 High school dropouts per 100 students enrolled in grades Source: The 2012 Georgia County Guide. In DeKalb County: Of the students who entered ninth grade in 2005, 79.2 percent graduated four years later. Figure 4: Educational Attainment (25 years of age and older), DeKalb County, % 20% % 10% 5% % Less than 9th grade 9th to 12th grade, no diploma High school diploma/ged Some college, no degree Associate s degree Bachelor s degree Graduate or professional degree Source: U.S. Census Bureau, 2010 American Community Survey. Note: Percentages do not add to 100 due to rounding. HOUSING Table 5: Housing Profile of DeKalb County, 2010 Total housing units 304,968 % Occupied housing units 89.1 % Occupied housing units occupied by owner 56.9 Source: U.S. Census Bureau, 2010 American Community Survey. 11

15 HOUSEHOLDS Table 6: Household Profile of DeKalb County, 2010 Total households 271,809 % Family households 59.4 % Family households with children under age % Husband-wife family households with children under age % Female householder, no husband present with children under age 18* 18.3 % Nonfamily households 40.6 % Householder living alone 31.4 Average household size 2.5 Average family size 3.2 Source: U.S. Census Bureau, 2010 American Community Survey. *A householder is the head of a household. LABOR Table 7: Labor Profile of DeKalb County, 2010 Population 544,659 Civilian employed population 317,645 % Private wage and salary workers 77.5 % Government workers 15.5 % Self-employed in own not incorporated business workers 6.9 % Unpaid family workers 0.2 % Unemployed 11.9 Residents average one-way travel time to work in minutes 30.6 Source: U.S. Census Bureau, 2010 American Community Survey. Note: Profile is of residents 16 years of age and over. 12

16 CRIME Table 8: Crime Profile of DeKalb County, 2010 Index crimes reported* 1,048 % Violent crimes 12.4 % Property crimes 87.6 Arrests for index crimes 343 % Juvenile arrests 37.6 State prison inmates from DeKalb County 2,968 % Incarcerated for violent/sex crimes 71.7 % Incarcerated for property crimes 15.8 % Incarcerated for drug/dui crimes** 9.6 Sources: The 2012 Georgia County Guide; The 2011 Georgia County Guide. *Index crimes are violent and property crimes. Violent index crimes are those committed directly against a person (i.e., homicide, sexual assault, robbery, aggravated assault/battery). Property index crimes are those in which there is no direct threat or harm to a person (i.e., burglary, theft, motor vehicle theft, arson). **DUI stands for driving under the influence. DISABILITY Table 9: Disability Profile of DeKalb County, 2010 With a disability 66,433 % With a disability 9.7 With a disability by age % Under 18 years of age 8.9 % 18 to 64 years of age 58.1 % 65 years of age and older 33.1 With a disability by sex % Female 54.7 % Male 45.3 With a disability by race % Black/African American 62.6 % White 32.7 % Hispanic or Latino (of any race) 2.4 % Asian 1.5 % Other 0.7 Source: U.S. Census Bureau, 2010 American Community Survey. Note: Data do not include the civilian, institutionalized population within DeKalb County. 13

17 LEADING CAUSES 14 IN DEKALB COUNTY

18 Leading Causes in DeKalb County LEADING CAUSES OF HOSPITALIZATION The leading causes of hospitalization are the ten most common reasons people are admitted to the hospital. There were a total of 424,171 hospitalizations in DeKalb County between 2005 and The table below displays the top ten leading causes of these hospitalizations. Table 10: Top Ten Leading Causes of Hospitalization, DeKalb County, Cause Number of Hospitalizations 15 Percentage* 1. Pregnancy and childbirth complications 75, Cardiovascular diseases** 52, Respiratory diseases 28, Digestive system diseases 28, Mental and behavioral disorders 22, Cancers 19, Injuries 15, Genitourinary system diseases 15, Musculoskeletal system and connective tissue diseases 14, Endocrine, nutritional, and metabolic diseases 14, Other causes 137, Total 424, Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. *Percentages are based on the total of all hospitalizations in DeKalb County. *Cardiovascular disease hospitalizations include hospitalizations for all diseases of the circulatory system. In DeKalb County from 2005 to 2010: The leading cause of hospitalization was pregnancy and childbirth complications. These complications are health problems that occur during or after pregnancy and involve the mother s health or the mother s and the baby s health. LEADING CAUSES OF MORTALITY Mortality is another word for death. A cause of death is the underlying disease or injury that initiated a series of events leading directly to death. This section provides the leading cause of premature death and death for DeKalb County residents. Premature Death A premature death is when a person dies before the age of 75. The age of 75 years is used as the cut-off as it is close to the average life expectancy of 78 years in the United States. Premature death is measured using Years of Potential Life Lost (YPLL). This is used to compare causes of premature death among specific populations. YPLL is calculated by subtracting the age at death from 75 years. Table 11 displays the top ten leading causes of premature death.

19 Table 11: Leading Causes of Premature Death, DeKalb County, , 2010 Cause YPLL Percentage* 1. Injuries 57, Cardiovascular diseases 47, Cancers 43, Infectious and parasitic diseases 19, Fetal and infant Conditions** 16, Respiratory system diseases 9, Digestive system diseases 7, Endocrine, nutritional, and metabolic diseases 7, Congenital malformations and chromosomal abnomalities 6, Nervous system diseases 5, Other causes 23, Total 245, Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. Note: 2009 data are not available. *Percentages are based on the total of all YPLLs for premature deaths. **Fetal and infant deaths occur before the age of 1 year and therefore each death contributes 74 years of potential life lost. Death There were a total of 20,379 deaths in DeKalb County between 2005 and 2010 (excluding 2009). The following table shows the top ten leading causes of death during these years. Table 12: Leading Causes of Death, DeKalb County, , 2010 Cause Number of Deaths Percentage* 1. Cardiovascular diseases 5, Cancers 4, Respiratory diseases 1, Injuries 1, Mental and behavioral disorders 1, Infectious and parasitic diseases 1, Nervous system diseases Digestive system diseases Genitourinary system diseases Endocrine, nutritional, and metabolic diseases Other causes 1, Total 20, Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. Note: 1) 2009 data are not available. 2) Death data include premature deaths (i.e., death before age 75). *Percentages are based on the total of all deaths. Percentages do not add to 100 due to rounding. 16

20 CHRONIC DISEASES IN DEKALB COUNTY 17

21 Chronic Diseases in DeKalb County OVERVIEW Chronic diseases (e.g., cancer, heart disease, and diabetes) are among the most common, costly, and preventable of all health problems in the U.S. Chronic disease are diseases of long duration and generally slow progression. Approximately one out of every two adults has a chronic disease and seven out of ten deaths are from chronic diseases. Individuals can avoid many chronic diseases by adopting the following behaviors: being moderately physically active, eating a healthy diet, limiting alcohol consumption, and not using tobacco products. The Behavioral Risk Factor Surveillance System (BRFSS) collects information on the health-related behaviors of adults. The Youth Risk Behavior Survey (YRBS) captures information on these behaviors among high school students. Table 13: Chronic Disease Risk Factors, DeKalb County, 2010 and 2011 Risk Factors among Adults* Percentage % Overweight 38.3 % Obese 27.6 % Eat the recommended five servings of fruits and vegetables daily 14.3 % Physically active during leisure time 76.2 % Smoke cigarettes 18.8 % Exposed to secondhand smoke 31.0 Risk Factors among High School Students** % Overweight 17.7 % Obese 13.0 % Eat the recommended five servings of fruits and vegetables daily 21.3 % Physical activity at least 60 minutes on five or more days per week 37.2 % Smoke cigarettes in the past 30 days 6.8 % Exposed to secondhand smoke in the past 7 days 34.7 *Source: 2011 Behavioral Risk Factor Surveillance System. **Source: 2010 Youth Risk Behavior Survey. Note: Overweight and obesity ranges are determined by using weight and height to calculate a number called the body mass index (BMI). BMI is used because, for most people, it correlates with their amount of body fat. An adult who has a BMI between 25 and 29.9 is considered overweight. An adult who has a BMI of 30 or higher is considered obese. CANCERS Cancer is the uncontrolled growth and spread of abnormal cells and can affect almost any part of the body. Many cancers can be prevented by avoiding exposure to common risk factors, such as tobacco smoke. In addition, a significant proportion of cancers can be successfully treated or eliminated through surgery, radiotherapy or chemotherapy, especially if they are detected early. 18

22 Leading Types of Cancers According to the Georgia Comprehensive Cancer Registry, the top five cancers diagnosed in DeKalb County are prostate, breast, lung, colon, and skin cancers (Figure 5). Together, these cancers accounted for 59.2 percent of the cancer cases among county residents in 2005 through Figure 5: Leading Types of Cancer Diagnosed as a Percentage of All Cancer Cases, DeKalb County, % 20% % % Prostate Breast Lung Colon Skin Source: Georgia Comprehensive Cancer Registry, Georgia Department of Public Health. Notes: 2010 data are not available. Table 14: Cancers among Blacks, DeKalb County, Type of Cancer Percentage 1. Prostate Lung (incl. bronchial) Colon (incl. rectal) Breast Non-Hodgkin lymphoma 3.4 Other cancers 33.9 Table 15: Cancers among Whites, DeKalb County, Type of Cancer Percentage 1. Prostate Lung (incl. bronchial) Skin (melanoma) Colon (incl. rectal) Bladder 5.5 Other cancers 40.5 Source: Georgia Comprehensive Cancer Registry, Georgia Department of Public Health. Note: 2010 data are not available. In DeKalb County from 2005 to 2009: The first and second leading types of cancers were the same among blacks and whites. Colon cancer was the third leading type of cancer for blacks, but fourth for whites. Blacks had high percentages of breast cancer and non-hodgkin lymphoma, while whites had high percentages of skin and bladder cancers. 19

23 Table 16: Cancers among Males, DeKalb County, Type of Cancer Percentage 1. Prostate Lung (incl. bronchial) Colon (incl. rectal) 8.7 4/5. Non-Hodgkin lymphoma 4.6 4/5. Skin 4.6 Other cancers 34.1 Table 17: Cancers among Females, DeKalb County, Type of Cancer Percentage 1. Breast Lung (incl. bronchial) Colon (incl. rectal) Uterine Non-Hodgkin lymphoma 3.7 Other cancers 37.3 Source: Georgia Comprehensive Cancer Registry, Georgia Department of Public Health. Note: 2010 data are not available. In DeKalb County from 2005 to 2009: Prostate cancer was the most common type of cancer among males and breast cancer was the most common type among females. Lung and colon cancers were the second and third most common types of cancer for both males and females. The fourth and fifth leading causes of cancer were different for males (i.e., non-hodgkin lymphoma and skin cancer) and females (i.e., uterine cancer and non-hodgkin lymphoma). Deaths by Type of Cancer Figure 6: Cancer Deaths by Type as a Percentage of All Cancer Deaths, DeKalb County, % % 10% % Lung Breast Colon Pancreas Prostate Source: Georgia Comprehensive Cancer Registry, Georgia Department of Public Health. Note: 2009 and 2010 data are not available. In DeKalb County from 2005 to 2008: Lung, breast, colon, pancreatic and prostate cancers together accounted for 57.5 percent of all cancer deaths. 20

24 Hospital Discharges of Cancer Patients The map below presents cancer hospital discharges as a percentage of all hospital discharges by census tracts. Figure 7: Cancer Hospital Discharges, DeKalb County, Displayed by Census Tracts Rate per 1,000 hospital discharges* Miles Created by: DeKalb County Board of Health (2012) Sources: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health and the Atlanta Regional Commission *Rate per 1,000 hospital discharges equals number of hospital discharges for cancer from for each census tract divided by all hospital discharges from for each census tract multiplied by 1,000 21

25 Focus: Lung Cancer and Youth Risk Behaviors Lung cancer is the leading cause of cancer deaths in DeKalb County. Smoking, which often begins during youth, is one of the main causes of lung cancer. Table 18: Tobacco Use among High School Students, DeKalb County, Risk Behavior % Ever tried cigarette smoking, even one or two puffs* % Smoked cigarettes in the past 30 days % Current smoker who smoked more than 10 cigarettes per day in the past 30 days* % Smoked cigars, cigarillos, or little cigars in past 30 days* Source: 2010 Youth Risk Behavior Survey. *Trend is statistically significant. The 2010 Youth Risk Behavior Survey reveals that from 2005 to 2010: The percentage of DeKalb County high school students who have tried smoking decreased. The percentage of youth smokers who smoke over ten cigarettes a day decreased. The percentage of youth who smoke tobacco products other than cigarettes increased. While the percentage of youth who smoke increased from 2005 to 2010, the 2010 percentage is less than the 2009 percentage. Cancer and You What may put you at risk? Having a family history of cancer. Engaging in risk behaviors such as smoking, excessive alcohol use and sun exposure, exposure to environmental factors (e.g., some chemicals), and being overweight or obese. What can you do? Get screened for cancers as recommended. Go for regular doctor visits, at least once a year. For women, perform breast self exams and call your doctor if you feel a lump. Aim for and keep a healthy weight. Avoid tobacco products, smoking, and secondhand smoke. Limit alcohol intake. Protect your skin from the sun and avoid tanning beds. Stay physically active. Eat plenty of fruits and vegetables. For more information: American Cancer Society: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention: National Cancer Institute: 22

26 CARDIOVASCULAR DISEASES Cardiovascular diseases are the leading causes of death in the United States and in DeKalb County. They affect the heart or blood vessels. Although a number of cardiovascular diseases and conditions affect DeKalb County residents, only the following are reviewed in this section: High blood pressure (or hypertension) is indicated by a systolic blood pressure consistently over 140 or a diastolic blood pressure consistently over 90. Hypertensive heart disease is a late complication of high blood pressure that affects the heart. Obstructive heart disease (includes heart attack) causes weakened heart pumps, due to previous heart attacks or current blockages of the coronary arteries. Stroke is the sudden, severe onset of the loss of muscular control, with reduced or complete loss of sensation and consciousness, due to the rupture or blocking of a cerebral blood vessel. Cardiovascular Disease Hospital Discharges by Type, Race, and Sex The following figure and tables analyze cardiovascular disease hospital discharges among DeKalb County residents by type of disease, race, and sex. Figure 8: Leading Types of Cardiovascular Disease Hospital Discharges as a Percentage of All Cardiovascular Disease Hospital Discharges, DeKalb County, % 20% % % Obstructive heart disease Stroke High blood pressure 1.2 Hypertensive heart disease Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. 23

27 Table 19: Cardiovascular Diseases among Blacks, DeKalb County, Type of Cardiovascular Disease Percentage 1. Obstructive heart disease Stroke High blood pressure Hypertensive heart disease Other cardiovascular diseases 56.9 Table 20: Cardiovascular Diseases among Whites, DeKalb County, Type of Cardiovascular Disease Percentage 1. Obstructive heart disease Stroke High blood pressure Hypertensive heart disease Other cardiovascular diseases 56.0 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. In DeKalb County in 2005 to 2010: Obstructive heart disease was the most common form of cardiovascular disease among both blacks and whites. Whites had a higher percentage of obstructive heart disease than blacks. Blacks had a higher percentage of high blood pressure than whites. Table 21: Cardiovascular Diseases among Males, DeKalb County, Type of Cardiovascular Disease Percentage 1. Obstructive heart disease Stroke High blood pressure Hypertensive heart disease Other cardiovascular diseases 53.7 Table 22: Cardiovascular Diseases among Females, DeKalb County, Type of Cardiovascular Disease Percentage 1. Obstructive heart disease Stroke High blood pressure Hypertensive heart disease Other cardiovascular diseases 58.1 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. In DeKalb County in 2005 to 2010: Obstructive heart disease was the most common form of cardiovascular disease among both males and females. Although males with a cardiovascular disease had a higher percentage of obstructive heart disease, females had a higher percentage of stroke. 24

28 Deaths by Type of Cardiovascular Disease Figure 9: Cardiovascular Disease Deaths by Type as a Percentage of All Cardiovascular Disease Deaths, DeKalb County, , % % % 4.8 0% Obstructive heart disease Stroke Hypertensive heart disease High blood pressure Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. Note: 2009 data are not available. 25

29 Hospital Discharges of Cardiovascular Disease Patients The map below presents cardiovascular disease hospital discharges as a percentage of all hospital discharges by census tracts. Figure 10: Cardiovascular Disease Hospital Discharges, DeKalb County, Displayed by Census Tracts Rate per 1,000 hospital discharges* Miles Created by: DeKalb County Board of Health (2012) Sources: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health and the Atlanta Regional Commission *Rate per 1,000 hospital discharges equals number of hospital discharges for cardiovascular disease from for each census tract divided by all hospital discharges from for each census tract multiplied by 1,000 26

30 Focus: Cardiovascular Diseases and Youth Risk Behaviors Despite their prevalence, many cardiovascular diseases can be avoided, controlled or eliminated with healthy lifestyle choices. Adopting healthy behaviors, like exercising, early in life might reduce the chance of developing a cardiovascular disease. The following information describes physical activity among DeKalb youth. Table 23: Physical Activity among High School Students, DeKalb County, Risk Behavior % Met current recommendations for physical activity (at least 60 minutes on five or more days per week)* % Watched three or more hours of TV per day on an average school day* % Attended physical education classes daily in an average week Source: 2010 Youth Risk Behavior Survey. *Trend is statistically significant. The 2010 Youth Risk Behavior Survey reveals that from 2005 to 2010: The percentage of students that met the recommendations for physical activity increased. The percentage of students that watched three or more hours of TV per day on a school day decreased. Cardiovascular Diseases and You What may put you at risk? Having a family history of cardiovascular disease. Having diabetes. Getting older. For women, being menopausal or post-menopausal. What can you do? Avoid tobacco use and secondhand smoke. Aim for and keep a healthy weight. Eat plenty of fruits and vegetables. Stay physically active. Reduce your stress level. Ask your doctor about your risk for cardiovascular diseases. Get your cholesterol level and blood pressure checked. Maintain healthy cholesterol and blood pressure levels. For more information: American Heart Association: National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention: National Heart, Lung, and Blood Institute: The Brain Attack Coalition: 27

31 PRIMARY STROKE PROGRAM DeKalb Medical s Primary Stroke Program offers a variety of services and resources to prevent and treat stroke among DeKalb County residents. These include, but are not limited to, the following: Early detection and stroke prevention through the Vascular Lab The Wellness Center and health education programs Physician lectures and community screenings A dedicated emergency stroke team Inpatient and outpatient rehabilitation Support group for patients and their families Leading-edge stroke research Among stroke patients receiving care at DeKalb Medical at North Decatur, the following National Hospital Inpatient Quality Measures are assessed: Venous Thromboembolism (VTE) Prophylaxis (STK-1) Patients are given VTE prophylaxis or have documentation of why no VTE prophylaxis was given the day of or the day after hospital admission. Antithrombolytic at Discharge (STK-2) Patients are given antithrombotic therapy at hospital discharge to reduce stroke mortality and morbidity. Anticoagulation Therapy for Atrial Fibrillation/Flutter (STK-3) Patients with atrial fibrillation/flutter are prescribed anticoagulation therapy at hospital discharge. Thrombolytic Therapy (STK-4) Patients who arrive at the hospital within two hours of time last known well are given an intravenous recombinant tissue plasminogen activator (IV r-tpa or t-pa) within one hour of arrival. Antithrombolytic by End of Hospital Day 2 (STK-5) Antithrombotic therapy should be administered within two days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity. Discharged on Statin Medication (STK-6) Patients with low-density lipoprotein (LDL) greater than or equal to 100 mg/dl, or LDL not measured, or who were on a lipid-lowering medication prior to hospital arrival are prescribed statin medication at hospital discharge. Stroke Education (STK-8) Patients and their caregivers are given educational materials during the hospital stay that address the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke. Assessed for Rehabilitation Services (STK-10) Patients should be assessed for rehabilitation services in order to enhance the recovery process. 28

32 Table 24 describes the above National Hospital Inpatient Quality Measures critical to the treatment of stroke patients receiving services at DeKalb Medical at North Decatur. Table 24: Stroke Performance Measures, DeKalb Medical at North Decatur, Percentage of Stroke Patients Receiving Service Type of Service Venous Thromboembolism (VTE) Prophylaxis (STK-1) Not Available 79.5 Antithrombolytic at Discharge (STK-2) Anticoagulation Therapy for Atrial Fibrillation/Flutter (STK-3) Not Available Thrombolytic Therapy (STK-4) Antithrombolytic by End of Hospital Day 2 (STK-5) Discharged on Statin Medication (STK-6) Stroke Education (STK-8) Assessed for Rehabilitation Services (STK-10) Source: DeKalb Medical. 29

33 DIABETES Diabetes is a disease in which the blood glucose (sugar) level is above normal. Insulin takes glucose from the blood in to the cells. When one has diabetes, the body either does not make enough insulin or can not use its own insulin as well as it should. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. There are several types of diabetes: Type 1 diabetes is a form of diabetes typically diagnosed in children and young adults. It was previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes. Type 2 diabetes is the most common form of diabetes. It was previously called non-insulin-dependent diabetes mellitus or adult-onset diabetes. Gestational diabetes is a type of diabetes that only pregnant women develop. If not treated, it can cause problems for the mother and the baby. Other types of diabetes result from genetic syndromes, surgery, drug use, malnutrition, infections, and other illnesses. Diabetes Hospital Discharges by Race and Sex Tables 25 and 26 analyze diabetes hospital discharges among DeKalb County residents by race and sex. Table 25: Diabetes by Race, DeKalb County, Race Percentage Black 81.8 White 15.1 Other 3.1 Table 26: Diabetes by Sex, DeKalb County, Sex Percentage Male 48.2 Female 51.8 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. In DeKalb County in 2005 to 2010: About 82 percent of residents with diabetes were black. However, in 2010, only 54 percent of residents were black. The number of men and women with diabetes was about equal. Deaths due to Diabetes There were 422 deaths from diabetes in DeKalb County in 2005 to 2008 and

34 Hospital Discharges of Diabetes Patients The map below presents diabetes hospital discharges as a percentage of all hospital discharges by census tracts. Figure 11: Diabetes Hospital Discharges, DeKalb County, Displayed by Census Tracts Rate per 1,000 hospital discharges* Insufficient data Miles Created by: DeKalb County Board of Health (2012) Sources: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health and the Atlanta Regional Commission *Rate per 1,000 hospital discharges equals number of hospital discharges for diabetes from for each census tract divided by all hospital discharges from for each census tract multiplied by 1,000 31

35 Focus: Diabetes and Youth Risk Behaviors Being overweight or obese is a risk factor for developing type 2 diabetes. The excess fat tissue interferes with the body s ability to use insulin, a hormone that controls blood glucose (sugar) levels. Learning as a youth to maintain a healthy weight will control one s blood glucose level and reduce one s risk for type 2 diabetes throughout life. The following information describes the self-perception of weight and weight loss behaviors among youth. Table 27: Self-Perception of Weight and Weight Loss Behaviors among High School Students, DeKalb County, Risk Behavior % Described themselves as slightly or very overweight % Were trying to lose weight* % Exercised to lose weight or to keep from gaining weight during the past 30 days Source: 2010 Youth Risk Behavior Survey. *Trend is statistically significant. The 2010 Youth Risk Behavior Survey reveals that from 2005 to 2010: The percentage of students trying to lose weight increased. Diabetes and You What may put you at risk? Being overweight or obese. Having a parent, brother, or sister with diabetes. Having a prior history of gestational diabetes or birth of at least one baby weighing more than nine pounds. Having blood pressure measuring 140/90 or higher. Having abnormal cholesterol with a high-density lipoprotein ( good ) cholesterol level of 35 or lower or a triglyceride level of 250 or higher. Being physically inactive. What can you do? Maintaining a healthy weight and active lifestyle to avoid type 2 diabetes. For diabetics, controlling blood sugar and avoiding complications by visiting your doctor at least four times a year and following instructions about medications, diet, and exercise. For more information: American Diabetes Association: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention: Juvenile Diabetes Research Foundation: 32

36 ASTHMA Asthma is a disease that affects the lungs. It causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning. During an asthma attack, airways become inflamed, making it hard to breathe. Most of the causes of asthma are unknown. Asthma Hospital Discharges by Race and Sex Tables 28 and 29 analyze asthma cases among DeKalb County residents by race and sex. Table 28: Asthma by Race, DeKalb County, Race Percentage Black 93.4 White 5.4 Other 1.2 Table 29: Asthma by Sex, DeKalb County, Sex Percentage Male 40.2 Female 59.8 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. In DeKalb County in 2005 to 2010: Over 90 percent of residents with asthma were black. However, in 2010, only about 54 percent of residents were black. The majority of residents with asthma were female. Deaths due to Asthma There were 12 deaths from asthma in DeKalb County in 2005 to 2008 and

37 Hospital Discharges of Asthma Patients The map below presents asthma hospital discharges as a percentage of all hospital discharges by census tracts. Figure 12: Asthma Hospital Discharges, DeKalb County, Displayed by Census Tracts Rate per 1,000 hospital discharges* Insufficient data Miles Created by: DeKalb County Board of Health (2012) Sources: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health and the Atlanta Regional Commission *Rate per 1,000 hospital discharges equals number of hospital discharges for asthma from for each census tract divided by all hospital discharges from for each census tract multiplied by 1,000 34

38 Focus: Asthma and Youth Many of the causes of asthma are unknown. However, smoking is a known risk behavior for asthma and is discussed in the Focus: Lung Cancer and Youth Risk Behaviors section. Although asthma affects people of all ages, it is most common in children. The following information describes the percentages of high school students that have ever been told by a doctor or a nurse that they have asthma. Table 30: Asthma among High School Students, DeKalb County, Diagnosis % Had ever been told by a doctor or nurse that they had asthma Source: 2010 Youth Risk Behavior Survey. The 2010 Youth Risk Behavior Survey reveals that: In 2010, more than one in four DeKalb County high school students had been told they have asthma. Asthma and You What may put you at risk? Smoking. Having a family history of asthma. What can you do? Do not smoke. For those with asthma, preventing attacks by avoiding smoke, air pollution, mold, pets, dust mites, and cockroaches. For more information: U.S. Environmental Protection Agency: Georgia Department of Public Health, Environmental Health: envservices/index.asp. 35

39 INFECTIOUS DISEASES 36 IN DEKALB COUNTY

40 Infectious Diseases in DeKalb County OVERVIEW There are certain diseases that laboratories, physicians, and other healthcare providers are required, by law, to report to their county, district, or state health department. These are referred to as notifiable diseases. This section provides information on specific notifiable infectious diseases. VACCINE-PREVENTABLE DISEASES Vaccine-preventable diseases are illnesses caused by bacteria and viruses that can be prevented by routine immunizations. The vaccine-preventable diseases discussed in this section are spread from person to person by respiratory droplets. Respiratory droplets can be released when a person coughs, sneezes, spits, drools, or has a runny nose. The following vaccine-preventable diseases are reviewed in this section: Measles is a disease that causes fever, runny nose, cough, and a rash all over the body. Mumps is a disease that starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite, and is followed by the swelling of salivary glands. Pertussis (whooping cough) is a disease caused by a bacterium. It is known for uncontrollable, violent coughing which often makes it hard to breathe. After fits of many coughs, someone with pertussis often needs to take deep breaths which result in a whooping sound. Pertussis most commonly affects infants and young children and can be fatal, especially in babies less than one year of age. Rubella is a disease that causes a fever and rash. Children generally have few symptoms, but adults may experience a fever, headache, general discomfort, and a runny nose before the rash appears. Vaccine-Preventable Disease Cases by Type There were a total of 28 cases of the four vaccine-preventable diseases between 2005 and 2010 in DeKalb County. Pertussis was the most common of these in DeKalb County during this time period. Table 31 analyzes the four vaccine preventable diseases as reported in the county. Table 31: Vaccine-Preventable Diseases, DeKalb County, Disease Cases Pertussis (whooping cough) 27 Mumps 0 Measles 1 Rubella 0 Total 28 Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. 37

41 Deaths due to Vaccine-Preventable Diseases The number of deaths due to vaccine-preventable diseases is not available from the surveillance systems (e.g., OASIS, SENDSS) used for this report. Vaccine-Preventable Diseases and You What may put you at risk? Not washing your hands frequently. Being near someone who is sick. What can you do? Get vaccinations according to the recommended schedule. Vaccines, such as the MMR vaccine for measles, mumps, and rubella, are proven to be safe. Wash your hands regularly with soap and water or hand sanitizer. Cover your coughs and sneezes with your elbow or sleeve. Avoid direct contact with others who are sick, which includes not sharing eating utensils or drinking glasses. If caring for someone who is sick, avoid face-to-face contact and wash hands frequently. For more information: Centers for Disease Control and Prevention, Measles (Rubeola): html. U.S. National Library of Medicine, Measles: PMH /. Centers for Disease Control and Prevention, Mumps: U.S. National Library of Medicine, Mumps: Centers for Disease Control and Prevention, Rubella: U.S. National Library of Medicine, Rubella: Centers for Disease Control and Prevention, Pertussis: U.S. National Library of Medicine, Pertussis: 38

42 SEXUALLY TRANSMITTED DISEASES Sexually transmitted diseases (STDs) are infections that you can get from having sex with someone who has the infection. STDs are caused by bacteria, parasites, and viruses, and are transmitted during vaginal, anal, or oral sex, as well as from an infected mother to her baby during childbirth. There are more than 20 types of STDs. The following diseases are reviewed in this section: Chlamydia is the most commonly reported STD in the U.S. Symptoms of chlamydia are usually mild or absent. However, serious complications that cause irreversible damage, including infertility, can occur silently before a woman ever recognizes a problem. Chlamydia can also cause discharge from the penis of an infected man. Gonorrhea is a very common STD that typically does not cause symptoms. However, men with gonorrhea may have pain when urinating and discharge from the penis. If untreated, gonorrhea can cause epididymitis in men, which affects the testicles and can lead to infertility. In women, gonorrhea can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. It can also cause problems with pregnancy and infertility. Syphilis is an STD that is transmitted from person to person by direct contact with sores. The sores are firm, round, small, and painless and found on the genitals, anus, or mouth. Individuals may also experience a rash on the body, especially on the palms of the hands or the soles of the feet. Additionally, pregnant women with the disease can pass it to their unborn children. Syphilis can cause long-term complications and/or death if not adequately treated. Chlamydia, Gonorrhea, and Syphilis Cases by Type, Race, and Sex There were a total of 44,812 cases of chlamydia (28,142 cases), gonorrhea (13,425 cases), and syphilis (3,245 cases) in DeKalb County between 2005 and Figure 13: Chlamydia, Gonorrhea, and Syphilis Cases as a Percentage of All STD Cases of These Three Diseases, DeKalb County, % 60% 50% 40% 30% 20% 10% 0% Chlamydia Gonorrhea Syphilis Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. 39

43 Tables 32 and 33 analyze chlamydia, gonorrhea, and syphilis cases among DeKalb County residents by race and sex. Table 32: Chlamydia, Gonorrhea, and Syphilis Cases by Race, DeKalb County, Type of STD by Race Percentage* Chlamydia Black 44.6 White 1.5 Other 53.8 Total 99.9* Gonorrhea Black 58.2 White 1.7 Other 40.1 Syphilis Black 75.8 White 14.1 Other 10.1 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. *Percentages do not add to 100 due to rounding. Table 33: Chlamydia, Gonorrhea, and Syphilis Cases by Sex, DeKalb County, Type of STD by Sex Percentage Chlamydia Male 28.7 Female 70.2 Sex Unknown 1.1 Gonorrhea Male 51.3 Female 47.9 Sex Unknown 0.8 Syphilis Male 85.3 Female 14.6 Sex Unknown 0.1 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. In DeKalb County in 2005 to 2010: The highest percentages of chlamydia, gonorrhea, and syphilis cases were among blacks. More than 75 percent of the syphilis cases were among blacks. The percentage of females with chlamydia was almost 2.5 times higher than males. The percentage of males and females with gonorrhea was more equally distributed than chlamydia and syphilis. Over 85 percent of syphilis cases were among males. Deaths due to Chlamydia, Gonorrhea, and Syphilis There were no deaths from chlamydia, gonorrhea, or syphilis in DeKalb County in 2005 to 2008, and

44 Focus: STDs and Youth Risk Behaviors A number of behaviors, such as having multiple sexual partners and not consistently using a condom, put individuals at risk for acquiring a sexually transmitted disease. DeKalb County s Youth Risk Behavior Survey shows that high school students in DeKalb County are engaging in both of these behaviors. Table 34: Sexual Risk Behaviors among High School Students, DeKalb County, 2010 Risk Behavior Percentage Had sexual intercourse with four or more people during their lifetime 17.5 Of those who had sex in the past three months, used a condom during last sexual intercourse 65.6 Source: 2010 Youth Risk Behavior Survey. According to the 2010 Youth Risk Behavior Survey among DeKalb County youth: More than one in six has had sexual intercourse with at least four people. About a third of those who had sex in the past three months did not use a condom during their last sexual intercourse. Unfortunately, some high school students have already acquired an STD. Table 35: STD Diagnoses among High School Students, DeKalb County, 2010 Diagnosis Percentage Had ever been told by a doctor or nurse that they had an STD 5.3 Source: 2010 Youth Risk Behavior Survey. According to the 2010 Youth Risk Behavior Survey among DeKalb County youth: More than one in 20 youth has been clinically diagnosed with an STD. 41

45 STDs and You What may put you at risk? Having multiple sex partners. Not using a condom. Not being in a mutually monogamous relationship. What can you do? Practice abstinence. Use a condom each time you have sex. Know the status of your sexual partner. Parents: Talk to your teens. Teens: Talk to your parents. For more information: Centers for Disease Control and Prevention, Division of STD Prevention: Georgia Department of Public Health, Division of Health Protection, Epidemiology Branch, Sexually Transmitted Disease Section: health.state.ga.us/programs/std/index.asp. Centers for Disease Control and Prevention, Division of STD Prevention, Chlamydia: std/chlamydia/default.htm. Centers for Disease Control and Prevention, Division of STD Prevention, Gonorrhea: std/gonorrhea/default.htm. Centers for Disease Control and Prevention, Division of STD Prevention, Syphilis: syphilis/default.htm. 42

46 HIV/AIDS Human immunodeficiency virus (HIV) is the virus that causes Acquired Immumodeficiency Syndrome (AIDS). The virus weakens the immune system and leaves a person vulnerable to other potentially life-threatening infections. HIV is spread person to person. There were 13,495 people living with HIV (not AIDS) and 14,491 people living with AIDS in DeKalb County between 2005 and Only specific fluids (blood, semen, vaginal secretions, and breast milk) from an HIV-infected person can transmit HIV. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the blood stream for transmission to possibly occur. The following information below describes the methods of transmission that are reviewed in this section: Men who have sex with men (MSM) are gay, bisexual, and other men who have sex with men. Injection drug users (IDU) are individuals with a history of injection drug use. Men who have sex with men/injection drug users (MSM/IDU) are gay, bisexual, and other men who have sex with men and a history of injection drug use. High risk heterosexual contact (HRH) describes heterosexual contact with a person known to have, or to be at high risk for, HIV infection. Perinatal transmission is HIV transmission from mother to child during pregnancy, labor and delivery, or breastfeeding. No risk reported/no identified risk factor (NRR/NIR) cases are those reported to the state and local health departments with no risk specified. Any case that remains NRR for 12 or more months is considered to have no identified risk factor (NIR). HIV/AIDS Cases by Method of Transmission, Race, and Sex Figure 14: Persons Newly Diagnosed with HIV by Method of Transmission as a Percentage of All Persons Newly Diagnosed with HIV, DeKalb County, % Percentage 40% 30% 20% 10% 0% MSM NRR/NIR HRH MSM/IDU IDU Perinatal Source: HIV/AIDS Epidemiology Section, Division of Health Protection, Georgia Department of Public Health. Note: Percentages do not add to 100 due to rounding. 43

47 Tables 36 and 37 analyze the method of HIV transmission among DeKalb County residents newly diagnosed with HIV by race and sex. Table 36: Method of HIV Transmission by Race, DeKalb County, Method of Transmission by Race Percentage Men who have sex with men Black 62.1 White 28.8 Other 9.1 Injection drug use Black 83.3 White 16.7 Other 0.0 MSM/IDU Black 57.1 White 38.1 Other 4.8 High risk heterosexual Black 82.2 White 2.2 Other 15.5 Total 99.9* Perinatal Black 60.0 White 20.0 Other 20.0 No risk reported/no identified risk factor Black 83.3 White 11.6 Other 5.1 Source: HIV/AIDS Epidemiology Section, Division of Health Protection, Georgia Department of Public Health. *Percentages do not add to 100 due to rounding. 44

48 Table 37: Method of HIV Transmission by Sex, DeKalb County, Method of Transmission by Sex Percentage Men who have sex with men Male Female NA Injection drug use Male 50.0 Female 50.0 MSM/IDU Male Female NA High risk heterosexual Male 50.0 Female 50.0 Perinatal Male 50.0 Female 50.0 No risk reported/no identified risk factor Male 26.1 Female 73.9 Source: HIV/AIDS Epidemiology Section, Division of Health Protection, Georgia Department of Public Health. In DeKalb County in 2005 to 2010: The percentage of newly diagnosed females with HIV from high risk heterosexual contact was more than 2.8 times higher than males. Deaths due to AIDS There were 423 deaths from AIDS in DeKalb County in 2005 to 2008, and

49 Focus: HIV/AIDS and Youth Risk Behaviors As reported in the Focus: STDs and Youth Risk Behaviors section, DeKalb County s youth are in danger of acquiring HIV by engaging in risky sexual behaviors (e.g., having multiple sexual partners, inconsistently using condoms). Additionally, youth can put themselves at risk for HIV infection by injecting illegal drugs if they share needles. Table 38: Injection Drug Use among High School Students, DeKalb County, 2010 Risk Behavior Percentage Used a needle to inject an illegal drug into their body one or more times during their lifetime 2.7 Source: 2010 Youth Risk Behavior Survey. According to the 2010 Youth Risk Behavior Survey among DeKalb County youth: Almost three percent have injected an illegal drug. Despite the fact that youth are engaging in behaviors that put them at risk for HIV infection, not all youth are taught about HIV/AIDS. This may influence youths decision to engage in risk-taking behavior. Table 39: HIV/AIDS Education among High School Students, DeKalb County, 2010 Risk Behavior Percentage Had ever been taught in school about AIDS or HIV infection 87.6 Source: 2010 Youth Risk Behavior Survey. According to the 2010 Youth Risk Behavior Survey among DeKalb County youth: More than ten percent have not received HIV/AIDS education. HIV/AIDS and You What may put you at risk? Engaging in anal, vaginal, or oral sex with men who have sex with men, multiple partners, or anonymous partners without using a condom. Injecting drugs or steroids where needles/syringes are shared. Having an STD. Engaging in unprotected sex with someone who has any of the risk factors listed above. Being exposed to the virus as a fetus or infant before or during birth or through breastfeeding from a mother infected with HIV. Continued... 46

50 What can you do? Practice abstinence. Know your status. Get tested for HIV. Know the HIV status of your sexual partner. Use condoms each time you have sex. Limit the number of sexual partners. Do not share needles. For more information: U.S. Department of Health & Human Services: aids.gov/hiv-aids-basics/. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention: Centers for Disease Control and Prevention, Act Against AIDS: Centers for Disease Control and Prevention, National HIV Testing Resources: Default.aspx. HEPATITIS Hepatitis is an inflammation of the liver and a major cause of liver disease in the U.S. Infectious hepatitis can be caused by one of five viruses (named A through E). However, this section will only review cases of Hepatitis A, B, and C because they are the most common in the U.S. and in Georgia. There were a total of 2,201 cases of Hepatitis A, B, and C in DeKalb County between 2005 and Hepatitis A: Is spread through contact with the feces of an infected person via, for example, contaminated water, contaminated food, and certain sexual practices. Can last from a few weeks to six months. Is preventable through vaccination. Hepatitis B: Is spread through infected blood and other body fluids or from an infected mother to her newborn baby. Causes an infection that ranges in severity from a mild illness, lasting a few weeks (acute), to a serious longterm (chronic) illness that can lead to liver disease or liver cancer. Can result in liver cancer and cirrhosis (scarring of the liver). Is preventable through vaccination. Hepatitis C: Is spread through exposure to the blood of an infected person or from an infected mother to her newborn baby. Sometimes causes an acute illness, but most often causes a chronic condition that can lead to cirrhosis of the liver and liver cancer. Is not preventable through vaccination. 47

51 Hepatitis Cases by Type, Race, and Sex Figure 15: Hepatitis A, B, and C Cases by Type as a Percentage of All A, B, and C Hepatitis Cases, DeKalb County, % 80% 70% 60% 50% 40% 30% 20% 10% 0% 82.9 Hepatitis B (chronic) 10.6 Hepatitis C (chronic) Hepatitis B (acute) Hepatitis A Hepatitis C (acute) Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. Note: Percentages do not add to 100 due to rounding. 48

52 Tables 40 and 41 analyze hepatitis cases among DeKalb County residents by race and sex. Table 40: Hepatitis by Type and Race, DeKalb County, Type of Hepatitis by Race Percentage Hepatitis A Black 42.9 White 25 Other 32.1 Hepatitis B (acute) Black 76.7 White 6.7 Other 16.7 Hepatitis B (chronic) Black 43.1 White 8.3 Other 48.7 Hepatitis C (acute) Black 40.0 White 60.0 Other 0.0 Hepatitis C (chronic) Black 61.4 White 31.5 Other 7.1 Table 41: Hepatitis by Type and Sex, DeKalb County, Type of Hepatitis by Sex Percentage Hepatitis A Male 71.0 Female 29.0 Hepatitis B (acute) Male 64.2 Female 35.8 Hepatitis B (chronic) Male 61.1 Female 38.9 Hepatitis C (acute) Male 80.0 Female 20.0 Hepatitis C (chronic) Male 69.3 Female 30.4 Unknown 0.3 Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. *Percentages do not add to 100 due to rounding. In DeKalb County in 2005 to 2010: Blacks had the highest percentages of Hepatitis A, acute Hepatitis B, and chronic Hepatitis C. Males had larger percentages of all types of hepatitis cases than women. 49

53 Deaths due to Hepatitis The number of deaths due to hepatitis is not available from the surveillance systems (e.g., OASIS, SENDSS) used for this report. Hepatitis and You What may put you at risk: For Hepatitis A? If an infected person does not wash his or her hands properly after using the bathroom. If a parent or caregiver does not properly wash his or her hands after changing diapers or cleaning up the stool of an infected person. If you are engaging in certain sexual activities, such as oral-anal contact with an infected person. For Hepatitis B and C? If you are having unprotected sex with an infected person. If you have shared needles, razors or toothbrushes with an infected person. If you received a body piercing or tattoo from non-sterile instruments. What can you do? Wash your hands regularly with soap and water or hand sanitizer. Get vaccinations according to the recommended schedule. Practice safe sex (use a condom). Avoid sharing needles, razors or toothbrushes with others (or anything that might have blood on it). If you are pregnant, get tested for hepatitis. For more information: Centers for Disease Control and Prevention, Division of Viral Hepatitis: Georgia Department of Public Health, Division of Health Protection: disease/hepatitis/. FOODBORNE, WATERBORNE, AND ENVIRONMENTAL DISEASES The following section provides an overview of the following foodborne, waterborne, and environmental diseases found among DeKalb County residents. The following infections are reviewed in this section: Giardiasis is a diarrheal disease that causes a variety of intestinal symptoms such as diarrhea, flatulence, greasy stool, stomach or abdominal cramps, upset stomach or nausea, and dehydration. Giardiasis is caused by the microscopic parasite Giardia. Giardia is found on surfaces and in soil, food, and water that has been contaminated with feces from infected humans or animals. Shigellosis is an infectious disease that causes bloody diarrhea, fever, and stomach cramps a day or two after 50

54 exposure to the bacterium Shigella. Most Shigella infections are the result of the bacteria passing from the stool or soiled fingers of one person to the mouth of another person. Salmonellosis is a bacterial infection that causes diarrhea, fever, and abdominal cramps 12 to 72 hours after exposure. The illness usually lasts four to seven days, and most people recover without treatment. Salmonellosis may spread from the intestines to the blood stream, and then to other body sites. It can cause death unless the person is treated promptly with antibiotics. The infection is caused by the bacterium Salmonella. Cryptosporidiosis is a diarrheal disease. The most common symptom is watery diarrhea, but other symptoms include stomach cramps or pain, dehydration, nausea, vomiting, fever, and weight loss. Symptoms generally begin two to ten days (average seven days) after becoming infected and last one to two weeks. Some people have no symptoms at all. The disease is caused by the microscopic parasite Cryptosporidium which is passed in the stool. Campylobacteriosis is an infectious disease that causes diarrhea, cramping, abdominal pain, and fever within two to five days after exposure. The illness typically lasts one week. Some infected persons do not have any symptoms. The infection is caused by the bacterium Campylobacter. Escherichia coli (E. coli) is a bacteria that normally lives in the intestines of people and animals. Most E. coli strains are harmless and actually are an important part of a healthy human intestinal tract. However, some strains can cause illness. The symptoms of an E. coli infection vary, but often include severe stomach cramps, bloody diarrhea, and vomiting. Most people get better within five to seven days. The strains of E. coli that can cause diarrhea can be transmitted through contaminated water or food, or through contact with animals or persons. In order for these diseases to be identified, a stool specimen must be submitted for laboratory testing. Since this does not happen with every illness, many cases of foodborne, waterborne, and environmental diseases go undetected and unreported. Therefore, the numbers below most likely represent a small percentage of these diseases. Foodborne, Waterborne, and Environmental Disease Cases by Type, Race, and Sex Figure 16: Cases of Six Foodborne, Waterborne, and Environmental Disease Cases by Type as a Percentage of All Cases of the Six Diseases, DeKalb County, % % 30% 20% 10% 05 Giardiasis Salmonellosis Shigellosis Campylobacteriosis Cryptosporidiosis 0.3 E. coli 51 Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. Note: Percentages do not add to 100 due to rounding.

55 Tables 42 and 43 analyze selected foodborne, waterborne, and environmental disease cases among DeKalb County residents by race and sex Table 42: Foodborne, Waterborne, and Environmental Diseases by Race, DeKalb County, Disease by Race Percentage Giardiasis Black 34.3 White 30.3 Other 35.4 Salmonellosis Black 46.2 White 24.7 Other 29.1 Shigellosis Black 61.7 White 11.4 Other 26.9 Cryptosporidiosis Black 65.9 White 20.8 Other 13.3 Campylobacteriosis Black 23.0 White 44.7 Other 32.3 E. coli Black 90.0 White 10.0 Other 0.0 Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. 52

56 In DeKalb County in 2005 to 2010: Blacks had higher percentages of giardiasis, salmonellosis, shigellosis, cryptosporidiosis, and E. coli than other races. Whites had a larger percentage of campylobacteriosis than other races. Table 43: Foodborne, Waterborne, and Environmental Diseases by Sex, DeKalb County, Disease by Race Percentage Giardiasis Male 61.6 Female 38.4 Salmonellosis Male 51.2 Female 48.8 Shigellosis Male 56.7 Female 43.3 Cryptosporidiosis Male 76.0 Female 24.0 Campylobacteriosis Male 52.5 Female 47.5 E. coli Male 50.0 Female 50.0 Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. In DeKalb County in 2005 to 2010: Males had higher percentages of most foodborne, waterborne, and environmental diseases than females. 53

57 Deaths Due to Foodborne, Waterborne, and Environmental Diseases The number of deaths due to foodborne, waterborne, and environmental diseases is not available from the surveillance systems (e.g., OASIS, SENDSS) used for this report. Foodborne, Waterborne, and Environmental Diseases and You What may put you at risk? Being very young or elderly. Having a weakened immune system due to: Being pregnant. Undergoing chemotherapy or radiation. Being HIV positive. Not washing your hands regularly with soap and water or hand sanitizer. Not cleaning cooking surfaces after preparing meals with raw meats, dairy products, and eggs. Swallowing untreated water (from creeks, lakes, or streams). What can you do? Wash your hands regularly with soap and water or hand sanitizer. Avoid swallowing untreated water (from creeks, lakes, or streams). Practice safe food preparation and avoid cross contamination. Go to the doctor if you have symptoms of a gastrointestinal disease (nausea, diarrhea, and/or vomiting). For more information: Centers for Disease Control and Prevention, Giardia: Centers for Disease Control and Prevention, Shigellosis: diseases/shigellosis/. Centers for Disease Control and Prevention, Salmonella: Centers for Disease Control and Prevention, Cryptosporidium: Centers for Disease Control and Prevention, Campylobacter: diseases/campylobacter/. Centers for Disease Control and Prevention, E. coli: INVASIVE BACTERIAL DISEASES Invasive bacterial diseases occur when bacteria cause an infection in a part of the body that is typically protected from them. Examples include blood, cerebrospinal fluid, and fluid around the joints (elbow, wrist, knee, etc.). These diseases can cause severe illness and death. Group A Streptococcal (GAS) Disease: Usually causes relatively mild illnesses such as strep throat and impetigo. Can be life threatening if bacteria get into parts of the body where they usually are not found. Is spread through direct contact with mucus from the nose or throat of infected persons. Can be treated with antibiotics. Is caused by the bacterium Group A Streptococcus. 54

58 Group B Streptococcal (GBS) Disease: Is also known as baby strep because it most commonly causes sepsis (severe infection of the blood), pneumonia, and sometimes meningitis in newborns. However, it can cause illness in people of all ages. In newborns can be prevented by giving the mother antibiotics during labor. Is caused by the bacterium Group B Streptococcus. Haemophilus influenzae Type B (Hib) Infection: Usually strikes children under the age of five years old. Can lead to meningitis, bacteremia, and pneumonia. Is vaccine preventable. Is spread from person to person by sneezing, coughing, or speaking closely. Meningococcal Disease (Meningitis): Is a rare but serious illness. Is spread through contact with respiratory droplets. Is vaccine preventable. Is caused by the bacterium Neisseria meningitidis. Methicillin-resistant Staphlyococcus aureus (MRSA) Infection: Can cause many different types of illnesses, from skin infections (such as lesions, boils, and abscesses) to respiratory illnesses (such as pneumonia) to more invasive diseases (such as meningitis and bactermia). Is spread most commonly by skin-to-skin contact or by hands contaminated with fluid from a draining lesion. It also can be spread when an infected person uses and then shares an item like a towel, soap, razor, or athletic equipment without first sanitizing it. Is caused by a type of Staphylococcus aureus (also called Staph ) that has become resistant to some commonly used antibiotics. Pneumococcal Disease: Is the most common cause of ear infections in children. Can result in illnesses such as meningitis (infection of the lining of the brain and spinal cord) and bacteremia (infection of the blood). Is also a common cause of pneumonia (infection of the lungs). Has many strains that have become resistant to commonly used antibiotics. Is caused by the bacterium Streptococcus pneumonia. 55

59 Invasive Bacterial Disease Cases by Type, Race, and Sex There were 1,269 deaths from the six selected invasive bacterial disease cases among DeKalb County residents between 2005 and Figure 17: Cases of Six Invasive Bacterial Disease Cases as a Percentage of All Cases of the Six Diseases, DeKalb County, % % 30% % 10% 0% Pneumococcal Disease Group B Streptococcal Disease 10 MRSA 6.6 Hib Infection 5.1 Group A Streptococcal Disease 0.7 Meningococcal Disease Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. 56

60 Tables 44 and 45 analyze invasive bacterial disease cases among DeKalb County residents by race and sex. Table 44: Invasive Bacterial Diseases by Race, DeKalb County, Disease by Race Percentage Group A Streptococcal Disease Black 56.5 White 41.7 Other 1.1 Group B Streptococcal Disease Black 72.5 White 25.2 Other 2.3 Hib Infection Black 60.7 White 33.9 Other 5.4 Meningococcal Disease Black 77.8 White 22.2 Other 0.0 MRSA Black 62.7 White 33.3 Other 4.0 Pnenumococcal Disease Black 67.3 White 30.0 Other 2.7 Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. 57

61 In DeKalb County in 2005 to 2010: Blacks had higher percentages of invasive bacterial diseases than other races. Table 45: Invasive Bacterial Diseases by Sex, DeKalb County, Disease by Sex Percentage Group A Streptococcal Disease Male 49.6 Female 50.4 Group B Streptococcal Disease Male 52.8 Female 47.2 Hib Infection Male 51.6 Female 48.4 Meningococcal Disease Male 44.4 Female 55.6 MRSA Male 66.2 Female 33.8 Pnenumococcal Disease Male 52.6 Female 47.4 Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. In DeKalb County in 2005 to 2010: Males had larger percentages of Group B streptococcal disease, Hib infection, MRSA, and pneumococcal disease than women. Women had higher percentages of Group A streptococcal disease and meningococcal disease than men. 58

62 Deaths due to Invasive Bacterial Diseases The number of deaths due to invasive bacterial diseases is not available from the surveillance systems (e.g., OASIS, SENDSS) used for this report. Invasive Bacterial Diseases and You What may put you at risk? Not washing your hands regularly. Coming in contact with the respiratory droplets of an infected person. Sharing personal items with an infected person. What can you do? Wash your hands regularly with soap and water or hand sanitizer. Cover your coughs and sneezes with your elbow or sleeve. Avoid direct contact with others who are sick (this includes not sharing eating utensils or drinking glasses). If caring for someone who is sick, avoid face-to-face contact and wash hands frequently. Avoid sharing personal items such as towels, razors, soap, and athletic equipment. Get recommended vaccinations. For more information: Centers for Disease Control and Prevention, Group A Streptococcal (GAS) Disease: ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm. Centers for Disease Control and Prevention, Group B Streptococcal (GBS): index.html. Centers for Disease Control and Prevention, Hib Vaccination: hib/default.htm. Centers for Disease Control and Prevention, Bacterial Meningitis: bacterial.html. Centers for Disease Control and Prevention, Methicillin-resistant Staphylococcus aureus (MRSA) Infections: Centers for Disease Control and Prevention, Streptococcus pneumoniae Disease: ncidod/dbmd/diseaseinfo/streppneum_t.htm. Georgia Department of Public Health, Invasive Bacterial Disease Unit: bacterial//. Georgia Department of Public Health, Methicillin-Resistant Staphylococcus aureus (MRSA): health.state.ga.us/mrsa/. 59

63 RESPIRATORY DISEASES Tuberculosis Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis that usually attacks the lungs. If not treated properly, TB can be fatal. Tuberculosis is spread through the air from one person to another. According to the Georgia Department of Public Health, there were 438 cases of TB reported in DeKalb County from 2005 to Tuberculosis Hospital Discharges by Race and Sex There were 208 hospital discharges resulting from tuberculosis among DeKalb County residents in 2005 to Table 46 analyze tuberculosis hospital discharges among DeKalb County residents by race and sex. Table 46: Tuberculosis Hospital Discharges by Race and Sex, DeKalb County, TB by Race and Sex Percentage Race Black 60.6 White 15.9 Other * Sex Male 62.0 Female 38.0 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. *Percentages do not add to 100 due to rounding. In DeKalb County in 2005 to 2010: The percentage of hospital discharges for tuberculosis of blacks was almost four times that of whites. The percentage of hospital discharges for tuberculosis of men was higher than that of women. Deaths due to Tuberculosis There were eight deaths from tuberculosis in DeKalb County in 2005 to 2010, excluding

64 Influenza Seasonal influenza (flu) is a contagious respiratory illness caused by influenza viruses that infect the respiratory tract. Influenza Hospital Discharges by Race and Sex There were 233 hospital discharges due to influenza among DeKalb County residents in 2005 to Table 47 analyzes hospital discharges among DeKalb County residents by race and sex. Table 47: Influenza Hospital Discharges by Race and Sex, DeKalb County, TB by Race and Sex Percentage Race Black 55.8 White 37.8 Other 6.5.1* Sex Male 54.5 Female 45.5 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. * Percentages do not add to 100 due to rounding. In DeKalb County in 2005 to 2010: Blacks had the highest percentage of hospital discharges for influenza compared to other races. Deaths due to Influenza There were 11 deaths from influenza in DeKalb County in 2005 to 2010, excluding

65 Respiratory Diseases and You What may put you at risk? Having a compromised immune system. Not practicing good hygiene. Being near someone who is infectious. What can you do? Get tested for TB. Get a flu shot. Cover your coughs and sneezes. Avoid contact with others who are sick. If you have TB, take all medications prescribed by your doctor. For more information: Centers for Disease Control and Prevention, Division of Tuberculosis Elimination: Centers for Disease Control and Prevention, Seasonal Influenza (Flu): U.S. Department of Health & Human Services, Flu.gov: 62

66 Immunizations Against Respiratory Diseases DeKalb Medical offers immunizations against pneumonia and influenza each year to its pneumonia patients. Pneumococcal Immunization of Pneumonia Patients In 2005 through 2010, the National Hospital Inpatient Quality Measures used the following performance measure to assess pneumococcal immunizations among pneumonia patients: Pneumococcal Vaccination (PN-2) Pneumonia patients, age 65 and older, who were screened for pneumococcal vaccine status and were administered the vaccine prior to discharge, if indicated. Table 48 describes the above National Hospital Inpatient Quality Measure at DeKalb Medical at North Decatur and Hillandale from 2005 to Table 48: Pneumococcal Immunizations of Pneumonia Patients, DeKalb Medical at North Decatur and Hillandale, Service by Location DeKalb Medical at North Decatur NA* 60.7%* 76.7% 85.1% 88.6% 93.7% DeKalb Medical at Hillandale 50.0%** 29.5% 73.3% 84.0% 85.5% 93.6% Source: DeKalb Medical. *DeKalb Medical at North Decatur data do not include data from 2005 or from January through June **DeKalb Medical at Hillandale data do not include data from January through June Influenza Immunization of Pneumonia Patients In 2005 through 2010, the following performance measure was used to assess influenza immunizations among hospitalized patients: Influenza Immunization (PN-7) Pneumonia patients age 50 years and older, hospitalized during October through March, who were screened for influenza vaccine status and were vaccinated prior to discharge, if indicated. 63

67 Table 49 describes the National Hospital Inpatient Quality Measure mentioned above for hospitalized pneumonia inpatients that were administered immunizations against influenza at DeKalb Medical at North Decatur and Hillandale. Table 49: Influenza Immunizations of Pneumonia Patients DeKalb Medical at North Decatur and HIllandale, Service by Location DeKalb Medical at North Decatur NA* 53.9%* 75.3% 88.0% 87.9% 90.0% DeKalb Medical at Hillandale 16.7%** 26.5% 75.0% 85.5% 87.8% 93.8% Source: DeKalb Medical. Note: Since influenza is seasonal, immunizations are routinely given only in October through March. *DeKalb Medical at North Decatur data do not include data from 2005 or from January through March **DeKalb Medical at Hillandale data do not include data from January through March

68 WEST NILE VIRUS West Nile virus (WNV) is a mosquito-borne virus that affects the central nervous system and can cause serious and even fatal disease. The virus usually infects birds, but it can be spread to humans by mosquitoes that feed on infected birds and then bite humans. Human West Nile Virus Cases by Race and Sex West Nile Virus and You Table 50: West Nile Virus Cases by Race and Sex, DeKalb County, WNV by Race and Sex Cases Race Black 13 White 6 Other 0 Total 19 Sex Male 11 Female 8 Total 19 Source: State Electronic Notifiable Disease Surveillance System (SENDSS), Georgia Department of Public Health. What may put you at risk? Being outside at dawn and dusk. Not wearing mosquito repellent. Having standing water near your home (for example, in flower pots and pet dishes). What can you do? Use mosquito repellent. The most effective repellents contain DEET, picaridin, or oil of lemon eucalyptus. Apply permethrin to clothing, shoes, bed nets, and camping gear, but not to skin. Avoid mosquitoes, especially at dawn and dusk. Remove standing water where mosquitoes can lay eggs. For more information: Centers for Disease Control and Prevention, Division of Vector-Borne Diseases: CDC-INFO ( ), Georgia Department of Public Health, Epidemiology Branch, Zoonotic and Vector-Borne Diseases: , 65

69 INJURIES 66 IN DEKALB COUNTY

70 Injuries in DeKalb County OVERVIEW Injuries are a frequently overlooked public health issue. However, injuries cause suffering, disability, and death. Between 2005 and 2010, injuries were responsible for 228,491 emergency room (ER) visits, 15,235 hospitalizations, and at least 1,787 deaths. These represent 18.9 percent of all ER visits, 3.6 percent of all hospitalizations, and at least 11.7 percent of all deaths in DeKalb County. Injuries are grouped as unintentional or intentional. Unintentional injuries are injuries that are unplanned, such as falls, motor vehicle crashes, and accidental poisonings. In DeKalb County from 2005 to 2010, falls resulted in 58,614 ER visits, 5,805 hospitalizations, and at least 214 deaths. Motor vehicle crashes were responsible for 37,947 ER visits, 2,923 hospitalizations, and at least 394 deaths. Accidental poisonings resulted in 2,677 ER visits, 1,093 hospitalizations, and at least 165 deaths. Intentional injuries are injuries that result from behaviors meant to cause harm to another person or to oneself, such as assault and intentional self-harm. In DeKalb County from 2005 to 2010, assaults resulted in 14,015 ER visits, 1,609 hospitalizations, and at least 510 deaths (homicides). Intentional self-harm resulted in 1,625 ER visits, 1,159 hospitalizations, and at least 267 deaths (suicides). LEADING TYPES OF INJURY Figure 18: Leading Injuries by Type as a Percentage of All Injury-Related Emergency Room Visits, DeKalb County, % 30% % % 0% Falls Motor vehicle crashes 6.1 Assaults Accidental poisonings Intentional self-harm Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. 67

71 Tables 51 through 54 analyze injury-related emergency room visits among DeKalb County residents by race and sex. Table 51: Injuries among Blacks, DeKalb County, Type of Injury Percentage 1. Falls Motor vehicle crashes Assaults Accidental poisonings Intentional self-harm 0.6 Other injuries 49.9 Table 52: Injuries among Whites, DeKalb County, Type of Injury Percentage 1. Falls Motor vehicle crashes Assaults Accidental poisonings Intentional self-harm 0.8 Other injuries 49.8 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. In DeKalb County from 2005 to 2010: The leading types of injury were the same for blacks and whites. Whites experienced a higher percentage of falls than blacks. Blacks experienced higher percentages of motor vehicle crashes and assaults than whites. Table 53: Injuries among Males, DeKalb County, Type of Injury Percentage 1. Falls Motor vehicle crashes Assaults Accidental poisonings Intentional self-harm 0.6 Other injuries 54.3 Table 54: Injuries among Females, DeKalb County, Type of Injury Percentage 1. Falls Motor vehicle crashes Assaults Accidental poisonings Intentional self-harm 0.9 Other injuries 44.7 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. In DeKalb County from 2005 to 2010: The leading types of injury were the same for males and females. Males experienced a higher percentage of assaults than females. Females experienced a higher percentage of motor vehicle crashes than males. 68

72 DEATHS BY TYPE OF INJURY Figure 19: Injury Deaths by Type as a Percentage of All Injury-Related Deaths, DeKalb County, , % 40% 30% 20% 10% % Assaults Motor vehicle crashes Intentional self-harm Falls Accidental poisonings Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. Notes: 2009 data are not available. In DeKalb County, between 2005 and 2010, excluding 2009: Half of the injury-related deaths were due to assaults and motor vehicle accidents. Two of the top three injury-related causes of death were intentional: assaults and intentional self-harm (suicide). 69

73 EMERGENCY ROOM VISITS OF INJURY PATIENTS The map below presents the number of emergency room visits of injuries between 2005 and 2010 by census tract. Figure 20: Emergency Room Visits for Injury, DeKalb County, Displayed by Census Tracts Rate per 1,000 emergency room visits* Miles Created by: DeKalb County Board of Health (2012) Sources: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health and the Atlanta Regional Commission *Rate per 1,000 emergency room visits equals number of emergency room visits for injury from for each census tract divided by all emergency room visits from for each census tract multiplied by 1,000 70

74 FOCUS: INJURIES AND YOUTH RISK BEHAVIORS According to the 2010 Youth Risk Behavior Survey, many high school students engage in risk behaviors that can lead to injury and death. Table 55: Injury Risk Behavior among High School Students, DeKalb County, Risk Behavior % Never or rarely wore a seatbelt when riding in a car driven by someone else* % In the past 30 days, rode in a car driven by a driver drinking alcohol* % In the past 30 days, drove a car or other vehicle when you had been drinking NA NA NA 3.3 alcohol % In the past 30 days, drove a motor vehicle while talking on a cell phone NA NA NA 18.4 % In the past 30 days, drove a motor vehicle while texting or ing NA NA NA 15.6 % Of those who rode a bicycle in the past 12 months, those who rarely/never wore a bicycle helmet NA NA NA 86.4 Source: 2010 Youth Risk Behavior Survey Report. *Trend is statistically significant. Note: NA means not available. The 2010 Youth Risk Behavior Survey revealed that in 2010: Almost one in five students rode in a car driven by a driver drinking alcohol in the 30 days prior to completing the survey. Only about 14 percent of high school bicyclists sometimes, most of the time, or always wear a helmet. 71

75 INJURIES AND YOU What may put you at risk: For falls? Having poor lighting in rooms, halls, and stairways. Placing furniture or other objects in walking paths. Not securing area rugs. For motor vehicle crashes? Driving over the posted speed limit. Driving while tired. Driving while distracted. For assaults? Walking or driving in unsafe areas. Having a firearm at home that is not correctly stored. Living with someone who is prone to violence. For accidental poisoning? Improperly storing medications and household products. Using another person s prescribed medication. Taking larger and/or more frequent doses of medication than prescribed. For intentional self-harm? Feeling there is no reason for living or having no sense of purpose in life. Feeling trapped, like there is no way out. Feeling sad or depressed. What can you do: To prevent falls? Properly install, secure, and use hand rails. Do not wear loose-fitting shoes and slippers. Keep sidewalks and steps in good repair. To prevent motor vehicle crashes? Never drive under the influence of drugs or alcohol. Designate a sober driver, call a cab or remain where you are if you have been drinking. Never text or use a cell phone while driving. Always buckle up. No exceptions. To prevent assault? Report suspicious activities and persons to authorities. Strengthen community involvement. Start a Neighborhood Watch program. Reduce children s and teens access to firearms. Continued... 72

76 To prevent accidental poisoning? Store all medicines and household products away and out of sight, for example, in a cabinet where a child cannot reach them. Take only prescription medications that are prescribed for you by a healthcare professional. Follow your doctor s instructions when taking prescription medications. To prevent intentional self-harm? Pay attention to warning signs and threats. Keep all medications and guns securely locked away. Listen and get help. For more information: About falls National Council on Aging, Falls Prevention - Centers for Disease Control and Prevention, Falls Older Adults: HomeandRecreationalSafety/Falls/index.html. Centers for Disease Control and Prevention, Falls Children: HomeandRecreationalSafety/Falls/children.html. About motor vehicle crashes Mothers Against Drunk Driving: National Highway Traffic Safety Administration: Network of Employers for Traffic Safety: About assault National Center for Victims of Crime: FYI-CALL, National Teen Dating Abuse Hotline: , Violence Education Tools Online: About accidental poisoning American Association of Poison Control Centers: U.S. Food and Drug Administration: Substance Abuse & Mental Health Services Administration: About intentional self-harm National Suicide Prevention Lifeline: TALK ( ). Suicide Prevention Resource Center: Self-Injury Foundation: 73

77 BEHAVIORAL HEALTH 74 IN DEKALB COUNTY

78 Behavioral Health in DeKalb County OVERVIEW Behavioral health refers to how one s mental well-being affects his or her actions and ability to function. Major areas within behavioral health are mental illness, addictive disease, mental illness coexisting with addictive disease, and developmental disabilities. The behavioral health status of DeKalb County residents is unknown. There is no survey that captures this information. Therefore, it is not possible to report the extent of mental illnesses, addictive diseases, and developmental disabilities in the county. However, to provide some insight in to this important aspect of health, this section presents data on clients of the DeKalb Community Service Board. The DeKalb Community Service Board (CSB) is the county s public provider of behavioral health services. MENTAL ILLNESS AND ADDICTIVE DISEASE Crisis The DeKalb Crisis Center provides crisis stabilization services to clients with severe mental illness and/or a substance abuse disorder. It is a 42-bed unit that handles approximately 1,200 admissions a year. CSB Enrolled Clients and New Clients Figure 21 describes the CSB s total enrolled clients and new clients from 2005 to There were 59,324 enrolled clients receiving mental illness and addictive disease services and 26,639 new clients. Figure 21: Number of Clients Served by CSB Outpatient Services, DeKalb County, Number of Clients 12,000 10,000 8,000 6,000 4,000 2, Total Enrolled Clients New Clients Source: DeKalb Community Service Board. 75

79 Table 56 below presents the categories of mental health disorders seen at the DeKalb Community Service Board. Table 56: Mental Health Disorder Category* for New Clients as a Percentage of All New Clients, DeKalb Community Service Board, Disorder Attention Deficit Hyperactivity Disorder Adjustment Disorder Anxiety Disorder Childhood and Adolescent Disorders NA NA NA Mood Disorder Psychotic Disorder Substance Abuse/Dependence Disorder Other Total Source: DeKalb Community Service Board. Notes: (1) NA means not available. (2) Percentages do not always add to 100 due to rounding. *Primary Diagnosis on DSM-IV Axis I. DEVELOPMENTAL DISABILITY Developmental disabilities include mental retardation, autism, and similar disabilities. The following table displays the types of developmental disabilities diagnosed by the CSB. Table 57: Developmental Disability Cases by Severity as a Percentage of All Developmental Disability Cases, DeKalb Community Service Board, Disorder Mild Mental Retardation Moderate Mental Retardation Severe Mental Retardation Profound Mental Retardation Other Source: DeKalb Community Service Board (New cases using outpatient services). Notes: (1) Cases are primary diagnosis on DSM-IV Axis II. (2) The degree of retardation is based partly on IQ score. An IQ score between 50 and 69 is considered mild, 35 to 49 moderate, 20 to 34 severe and below 20 profound. However, the mental retardation diagnosis is not based only on IQ score. A person s adaptive functioning is also taken in to account. 76

80 FOCUS: BEHAVIORAL HEALTH AND YOUTH RISK BEHAVIORS Many teens suffer from sadness or hopelessness, at least occasionally. A surprising number have suicidal thoughts and even attempt suicide. Table 58: Suicidal Thoughts and Behaviors among High School Students, DeKalb County, Behavior Percentage During the past 12 months, felt so sad or hopeless every day for two or more weeks in a row that 28.1 they stopped doing some usual activities During the past 12 months, seriously considered attempting suicide 15.0 During the past 12 months, attempted suicide 9.0 During the past 12 months, committed suicide attempt that resulted in injury, poisoning, or 3.6 overdose and treated by a doctor or nurse Source: 2010 Youth Risk Behavior Survey. According to the 2010 Youth Risk Behavior Survey among DeKalb County youth: More than one-fourth experienced sadness or hopelessness to the degree that it kept them from doing some of their usual activities. More than one in seven seriously considered attempting suicide. Nine in 100 youth actually attempted suicide. 77

81 BEHAVIORAL HEALTH AND YOU What may put you at risk: For a mental illness? Having a family history of mental illness. Social factors such as severe family discord, death of someone close, abuse, and exposure to violence. For an addictive disease? Going through a significant social transition (like graduating from high school or losing a job). Having a history of conduct problems. Experiencing depression and other serious emotional problems. Having a family history of alcoholism. Being in contact with others who are substance abusers. For a developmental disability? Having a genetic abnormality. Being born to a mother who smoked, drank or had an infection during pregnancy. Being exposed to an environmental toxin, such as lead. What can you do: For mental illness and addictive disease? Take care of your mind, body, and soul. Notice behavior changes in friends and loved ones. Talk to them, be empathetic and ask if they want help. If symptomatic, seek evaluation by a licensed professional. If diagnosed, continue treatment regimen and find a support group. For a developmental disability? If concerned, make sure your child receives a developmental screening. Eliminate environmental toxins. If pregnant, maintain good health and avoid behaviors that could harm your baby. For more information: American Association on Intellectual and Developmental Disabilities: Substance Abuse and Mental Health Services Administration: , National Alliance on Mental Illness Georgia: , Georgia Department of Behavioral Health and Developmental Disabilities: or 24-hour Crisis and Access Line

82 MATERNAL AND CHILD HEALTH IN DEKALB COUNTY 79

83 Maternal and Child Health in DeKalb County OVERVIEW Safe motherhood begins before conception with good nutrition and a healthy lifestyle. It continues with appropriate prenatal care. The ideal result is a full-term pregnancy without unnecessary interventions, the delivery of a healthy baby, and a healthy infancy. These are fostered by an environment that supports the physical and emotional needs of the mother, baby, and family. PREGNANCY There were 96,866 pregnancies in DeKalb County between 2005 and Table 59 analyzes all pregnancies among DeKalb County residents by race and separates out pregnancies to females under age 20. Table 59: Pregnancies by Race, DeKalb County, Race (All Ages) Percentage Black 53.5 White 18.1 Other 28.4 Race (10-19 Years of Age) Percentage Black 73.9 White 15.6 Other 10.5 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. In DeKalb County from 2005 to 2010: While about half of all pregnancies were among blacks, about three-fourths of pregnancies among females ages 19 and younger were among blacks. 80

84 LOW BIRTHWEIGHT Babies delivered with low birthweight (less than 5.5 pounds) are at an increased risk for illness and death. There were 7,196 low birthweight babies born in DeKalb County between 2005 and Table 60 analyzes low birthweight babies in DeKalb County by race. Table 60: Low Birthweight Babies by Race, DeKalb County, Race Percentage Black 65.0 White 15.1 Other 19.9 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. In DeKalb County from 2005 to 2010: The percentage of black low birthweight babies was more than four times that of white babies. INFANT MORTALITY The death of a baby before his or her first birthday is called infant mortality. Between 2005 and 2010 (excluding 2009), there were 443 deaths of DeKalb County infants. Table 61 analyzes DeKalb County s infant deaths by race. Table 61: Infant Deaths by Race, DeKalb County, , 2010 Race Percentage Black 70.2 White 18.5 Other 19.9 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. Note: 2009 data are not available. In DeKalb County from 2005 to 2010, excluding 2009: The percentage of black infant deaths was almost four times that of white infants. Infant deaths result from a number of factors, such as birth defects and Sudden Infant Death Syndrome (SIDS). SIDS is defined as the sudden death of an infant less than one year of age that cannot be explained. There were 51 cases of SIDS in DeKalb County from 2005 to 2010, excluding Table 62 analyzes DeKalb County s SIDS deaths by race. 81

85 Table 62: Sudden Infant Death Syndrome (SIDS) Deaths by Race, DeKalb County, , 2010 Race Percentage Black 86.3 White 11.8 Other 1.9 Source: Online Analytical Statistical Information System (OASIS), Georgia Department of Public Health. Note: 2009 data are not available. In DeKalb County from 2005 to 2010, excluding 2009: The percentage of black SIDS deaths was more than seven times than of white SIDS deaths. FOCUS: MATERNAL AND CHILD HEALTH AND YOUTH RISK BEHAVIORS According to the 2010 Youth Risk Behavior Survey, many high school students engage in risk behaviors that can lead to pregnancy. Teen pregnancy and childbearing bring substantial social and economic costs for teen parents, their families, and their children. These effects remain for the teen mother and her child even after adjusting for factors that increased the teen s risk for pregnancy. They include growing up in poverty or in a single-parent family, having parents with low levels of education, or performing poorly in school. Table 63: Sexual Behaviors among High School Students, DeKalb County, Risk Behavior % Had sexual intercourse for the first time before age 13 years* % Had sexual intercourse with four or more people during their life % Used a condom during their last sexual intercourse* % Used birth control pills before last sexual intercourse Source: 2010 Youth Risk Behavior Survey Report. *Trend is statistically significant. The 2010 Youth Risk Behavior Survey Report revealed that from 2005 to 2010: The percentage of students who had sex for the first time before the age of 13 years decreased. The percentage of students who used a condom during their last sexual intercourse decreased. 82

86 MATERNAL AND CHILD HEALTH AND YOU 83 What may put you at risk: For a pregnancy complication or a poor outcome? Not eating a healthy diet. Using tobacco products or alcohol. Not controlling your blood sugar level and blood pressure. Taking medications. Being a pre-teen or teen. For an infant death? Placing an infant on his or her stomach to sleep. Placing an infant in your bed to sleep. Exposing an infant to tobacco smoke. Letting an infant get overheated. What can you do: For a healthy pregnancy? Take folic acid every day, before and during pregnancy. Do not smoke cigarettes or other tobacco-related products. Do not drink alcohol. Talk to your doctor about vaccinations. Control diabetes and high blood pressure. Talk to a doctor or pharmacist about any medications you are taking. To prevent infant deaths? Deliver at a special hospital if there is a risk of delivering a very small or very sick baby. Always place babies on their backs to sleep during naps and at nighttime. Don t place babies to sleep on adult beds, chairs, sofas, waterbeds, or cushions. Keep the crib and bassinet free of toys, soft bedding, blankets, and pillows. Do not expose the infant to tobacco smoke. Avoid letting the baby get too hot during sleep. For more information: About pregnancy Office on Women s Health, U.S. Department of Health and Human Services: womenshealth.gov/pregnancy/. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention: American Pregnancy Association: About Sudden Infant Death Syndrome (SIDS) March of Dimes: American SIDS Institute: CJ Foundation for SIDS:

87 REFUGEE HEALTH 84 IN DEKALB COUNTY

88 Refugee Health in DeKalb County OVERVIEW A refugee is a person who is outside their country of origin and cannot return out of fear of persecution because of their race, religion, nationality, political opinion, or membership in a particular social group. DeKalb County receives more refugees than any other county in Georgia. Between 2005 and 2010, 15,998 refugees arrived in Georgia; 13,929 (87.1 percent) of these settled in DeKalb County. ARRIVALS BY COUNTRY OF ORIGIN Refugees arriving in DeKalb County have come from over 80 countries around the world. Table 64 shows the top ten countries of origin of refugees residing in DeKalb County. Table 64: Refugee Arrivals by Country of Origin as a Percentage of All Refugee Arrivals, DeKalb County, Country of Origin Percentage 1. Burma Nepal Bhutan Somalia Thailand Iraq Ethiopia Uzbekistan Malaysia Cuba 3.4 Other 28.7 Source: Refugee Health Program, Georgia Department of Public Health. 85

89 HEALTH SCREENINGS A U.S. medical examination is strongly recommended for all refugees arriving in the country. Of the total number of refugees arriving in DeKalb County from 2005 to 2010, 11,989 refugees (86.1 percent) received health screenings. Refugees are screened for the following: Anemia Blood lead level Dental issues Diabetes Disability Hearing issues Hepatitis B Human Immunodeficiency Virus Hypertension Immunization status Malnutrition Mental health issues Parasites Parasite ova (eggs) Pregnancy Sexually transmitted diseases Tuberculosis (TB) Vision issues Figure 22: Leading Causes of Abnormal Screening Results as a Percentage of All Refugees Screened, DeKalb County, % 40% % 20% 10% % Dental issues TB Parasites Parasite ova Vission issues Source: Refugee Health Program, Georgia Department of Public Health. Tables 65 and 66 analyze the leading causes of abnormal screening results among DeKalb County refugees by sex. Table 65: Leading Causes of Abnormal Screening Results among All Male Refugees Screened, DeKalb County, Type Percentage 1. Dental issues TB Parasite ova Parasites Hepatitis B

90 Table 66: Leading Causes of Abnormal Screening Results among All Female Refugees Screened, DeKalb County, Type Percentage 1. Dental issues TB /4. Parasite Ova /4. Parasites Vision issues 8.6 Source: Refugee Health Program, Georgia Department of Public Health. In DeKalb County from 2005 to 2010: The leading four causes of abnormal screening results were the same for refugee males and females. The fifth leading cause of abnormal screening results were different for males (i.e., Hepatitis B) and females (i.e., vision issues) REFUGEE HEALTH AND YOU What can you do? If you are a refugee, get your health screening soon after arriving in the U.S. Increase your knowledge of differences between yourself and those from other countries. Accept cross-cultural differences and develop cross-cultural skills. Be sensitive to refugees losses. For more information: U.S. Department of Health and Human Services, Office of Refugee Resettlement: programs/orr/. Centers for Disease Control and Prevention, Immigrant and Refugee Health: immigrantrefugeehealth/. Refugee Health Information Network: Georgia Department of Public Health, Refugee Health Program: refugeehealth/index.asp. 87

91 APPENDICES 117