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Risky Business: Setting the stage with regional data

Risky Business: Setting the stage with regional data. Improving Data & Enhancing Access (IDEA-NW) Project Sujata Joshi, Project Director sjoshi@npaihb.org 503-416-3261. Portland, OR 5/21/2013. Quiz.

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Risky Business: Setting the stage with regional data

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  1. Risky Business:Setting the stage with regional data Improving Data & Enhancing Access (IDEA-NW) Project Sujata Joshi, Project Director sjoshi@npaihb.org 503-416-3261 Portland, OR 5/21/2013

  2. Quiz Rank these health events in order of importance for American Indians/Alaska Natives in the Northwest • Cancer • STDs • Diabetes • Suicide • Unintentional injuries • Sexual Assault IT DEPENDS! Northwest Portland Area Indian Health Board

  3. Same data, different story? Data source: CDC WISQARS (http://www.cdc.gov/injury/wisqars/index.html) Northwest Portland Area Indian Health Board

  4. Northwest Portland Area Indian Health Board

  5. Incidence and Prevalence Incidence Prevalence Existing cases in a population at a given point in time or time period Often measured as “percent” Useful for measuring chronic conditions or getting a “snapshot” of how many people are affected Combines both incidence and survival Examples: Chronic conditions such as cancer, diabetes, heart disease, STDs, smoking, etc. • New cases in a population during a specific time period • Often expressed as a rate (i.e. “per 100,000” population per year) • Useful for measuring health events that happen at one point in time, or measuring how many “new” people could be at risk • Examples: Injury, mortality, suicide, stroke, STDs, new tobacco users, etc. Northwest Portland Area Indian Health Board

  6. Which is it…? • New cases of breast cancer among AI/AN in Washington in 2009 • Incidence • Mortality rate from car crashes in Umatilla County in 2011 • Incidence • Number of AI/ANs currently living with HIV in Idaho • Prevalence • Number of highschoolers at Chemawa Indian School who started smoking during the 2012-2013 school year • Incidence Northwest Portland Area Indian Health Board

  7. Regional data Northwest Portland Area Indian Health Board

  8. Cancer • Second leading cause of death for AI/ANs in ID and WA; leading cause in OR • In all three states, AI/AN had lower cancer incidence rates (all sites combined) compared to non-Hispanic Whites • Leading cancer sites: • Breast (in women) • Prostate (in men) • Lung and bronchus • Colorectal • Blood Cancers • In OR and WA, AI/AN had higher mortality rates compared to non-Hispanic Whites • Disparities in lung/bronchus cancer and colorectal cancer mortality rates compared to non-Hispanic Whites Northwest Portland Area Indian Health Board Data source: OR, WA, and ID Cancer Registries & IDEA-NW Project

  9. Diabetes • Major cause of heart disease and stroke; leading cause of kidney failure, nontraumatic amputations, new cases of blindness • AI/AN death rate due to diabetes 1.6 times higher than general US population3 • 20% of AI/ANs aged 15 years or older had pre-diabetes in 2001-20044 • Affects 12-14% of AI/AN in the Northwest (vs. 6-7% of non-Hispanic Whites) • Major modifiable risk factors: • Physical activity • Maintaining healthy weight Data sources: 1CDC 2010 BRFSS Data (accessed through Web-Enabled Analysis Tool). 2WADOH. Washington State Diabetes Disparities, 2006. 3Indian Health Service Special Diabetes Program for Indians (SDPI). 4CDC National Diabetes Fact Sheet, 2011. Northwest Portland Area Indian Health Board

  10. STDs and HIV/AIDS Data source: 1CDC WONDER, Sexually Transmitted Diseases Interactive Data; 2 CDC Division of HIV/AIDS Prevention. HIV Surveillance Report, 2011. • STDs 1 • 3x higher rates for some STDS • Higher burden among women • HIV/AIDS 2 • HIV infection rate 1.3 times higher for AI/ANs compared to whites in 2011 (9.3 vs. 7.0 per 100,000 population) • Higher burden among males Northwest Portland Area Indian Health Board

  11. Unintentional Injuries • Leading cause of death for AI/AN between the ages of 1-54 • Higher unintentional injury mortality rates in Washington compared to Oregon and Idaho; largest disparity when compared to white population • Driven by: • Motor Vehicle Crashes • Accidental Poisonings • Falls (among elderly) Data source: NPAIHB. Northwest American Indian and Alaska Native Mortality Report, 2012. Northwest Portland Area Indian Health Board

  12. Suicide • Majority of AI/AN suicides occurred in the young adult range (20-39 years old) • Largest disparities seen among the youngest age categories • Nearly half of all AI/AN suicides were completed using firearms, followed by suffocation (primarily hanging), then poisoning (primarily drug overdose) • Higher burden among males Data source: NPAIHB. Northwest American Indian and Alaska Native Mortality Report, 2012. Northwest Portland Area Indian Health Board

  13. got risk?

  14. Risk and preventive factors • A characteristic that increases (or decreases) a person’s chances of getting a disease or outcome • An association, but not necessarily a cause Northwest Portland Area Indian Health Board

  15. Risk factors Smoking Physical activity Alcohol & drug use Genetics Helmet use Fruit & vegetable intake Condom use Obesity Gender Cancer screening Seatbelt & child safety seat use Health Outcomes Diabetes STDs Unintentional injuries Cardiovascular disease Cancer Suicide Northwest Portland Area Indian Health Board

  16. Leading Causes vs. Actual Causes Northwest Portland Area Indian Health Board

  17. In Oregon, Idaho, and Washington… • AI/AN adults are more likely to be current smokers than other racial/ethnic groups • Higher rates of tobacco use among youth • More mothers who smoke before or during pregnancy • Oregon: 24% of AI/AN births vs 12% of all births in state in 2005 The biggie . . . Tobacco Data sources: Oregon Tobacco Prevention and Education Program. American Indian/Alaska Native Data Report – 2007 CDC 2010 BRFSS Data (accessed through Web-Enabled Analysis Tool) Northwest Portland Area Indian Health Board

  18. Bronchitis Emphysema Coronary Heart Disease Cirrhosis of the liver Low birth-weight babies SIDS Miscarriage Cardiovascular disease Pneumonia Impotence and Infertility Lip cancer Tongue cancer Gum cancer Larynx cancer Lung cancer Peptic ulcer Bladder cancer

  19. Physical Activity 35.3%of NW Tribal respondents report an activity level meeting recommendations Data source: Health of Washington State Report: Physical Activity (2007) The CDC and the American College of Sports Medicine recommend that adults accumulate at least 30 minutes of moderate physical activity on at least five days per week or at least 20 minutes of vigorous activity on at least three days per week. Data source: NPAIHB, 2001 NW Tribal BRFSS Project, Aggregate Final Report Northwest Portland Area Indian Health Board

  20. 2001 Northwest Tribal BRFSS Diet & nutrition 6.1% Data source: NPAIHB, 2001 NW Tribal BRFSS Project, Aggregate Final Report Five to nine servings of fruits and vegetables per day are recommended to reduce the risk of heart disease, diabetes, and certain types of cancers. --American Cancer Society Data source: Health of Washington State Report: Nutrition (2007) Northwest Portland Area Indian Health Board

  21. Screening and preventive care 2010 Portland Area GPRA, IHS • For certain cancers, lack of appropriate screening is a big risk factor • Breast & cervical screening can detect pre-cancerous and cancerous conditions early • Colorectal screening can both detect cancer early and prevent cancer by removal of polyps (colonoscopy) 2010 IHS goal: 90% 2010 IHS goal: 70% 2010 IHS goal: 50% Northwest Portland Area Indian Health Board

  22. Hooray for data! • Data inform our prevention/intervention efforts • Helps us understand: • The incidence/prevalence of health events in our communities • Which risk factors are associated with which health outcomes • The prevalence of modifiable risk factors in our communities • Prioritize our programs, policies, and dollars • Measure the impact of interventions • Data are a powerful tool to share with policymakers, community advocates, and funders Northwest Portland Area Indian Health Board

  23. Data are not perfect • Surveillance data is collected at the state or national level • May not apply to every tribe or community • American Indians and Alaska Natives are not always classified correctly • Racial misclassification under-reports the impact of health events for AI/AN • You are the experts! Northwest Portland Area Indian Health Board

  24. Contact Us! IDEA-NW Project Staff • Sujata Joshi, Project Director, sjoshi@npaihb.org • Jenine Dankovchik, Biostatistician, jdankovchik@npaihb.org • Kristyn Bigback, Biostatistician, kbigback@npaihb.org Project Website: http://www.npaihb.org/epicenter/project/improving_data_enhancing_access_northwest_idea_nw/ Northwest Portland Area Indian Health Board

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