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Healthiest Wisconsin 2020 Baseline and Health Disparities Report Chronic Disease Prevention and Management

Healthiest Wisconsin 2020 Baseline and Health Disparities Report Chronic Disease Prevention and Management. Chapter outline. Chapter Outline. Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Healthiest Wisconsin 2020 objectives and indicators

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Healthiest Wisconsin 2020 Baseline and Health Disparities Report Chronic Disease Prevention and Management

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  1. Healthiest Wisconsin 2020 Baseline and Health Disparities ReportChronic Disease Prevention and Management

  2. Chapter outline Chapter Outline Background • Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report • Healthiest Wisconsin 2020 objectives and indicators • Rationale • Key points Data • Cardiovascular disease and risk factors • Diabetes • Cancer and screening • Arthritis and joint pain References Links to additional reports and resources Contacts

  3. Report overview Report Overview • This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf • The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included. • Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations. • Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

  4. Report overview Report Format Sample annotated slide Full Report • Format: PDF • Intended use: reference document Chapters • Format: Annotated PowerPoint slide set • Intended uses: presentations to • Decision-makers • Service providers • Community leaders • The public

  5. Report overview Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes

  6. Report overview Report Outline: Detail Section 3: Health focus areas Section 4: Infrastructure focus areas

  7. Report overview Report Outline: Detail Section 5: Data summaries by population

  8. Report overview Data notes • Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf • The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. • Population estimates that are considered unreliable are excluded. • Misclassification of racial/ethnic groups may affect the accuracy of rates. • Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.

  9. Report overview Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

  10. Objective 1 By 2020, increase sustainable funding and capacity for chronic disease prevention and management programs that reduce morbidity and mortality. Objective 1 Indicators State and federal funding for chronic disease prevention and management. Medicaid spending related to prevention of chronic disease. Insurance coverage for chronic disease prevention and management. HW2020 objectives Healthiest Wisconsin 2020 objectives and indicators Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Chronic Disease Prevention and Management Focus Area Profile.

  11. Objective 2 By 2020, increase access to high-quality, culturally competent, individualized chronic disease management among disparately affected populations of differing races, ethnicities, sexual identities and orientations, gender identities, and educational or economic status. Objective 2 Indicators Population group-specific incidence of chronic disease (heart disease and cancer), hospitalization and emergency department utilization rates (asthma). Incidence of risk factors (e.g., obesity, smoking), early detection (e.g., blood pressure, diabetes and cancer screening), and chronic disease management (e.g., proportion of diabetic patients with A1c value under 7 percent). Proportion of asthma patients receiving seasonal influenza vaccinations (Survey of the Health of Wisconsin (SHOW)). HW2020 objectives Healthiest Wisconsin 2020 objectives and indicators Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Chronic Disease Prevention and Management Focus Area Profile. Note: Data pertaining to asthma are included in the Environmental and Occupational Health chapter.

  12. HW2020 objectives Healthiest Wisconsin 2020 objectives and indicators Objective 3 By 2020, reduce the disparities in chronic disease experienced among populations of differing races, ethnicities, sexual identities and orientations, gender identities, and educational or economic status. Objective 3 Indicators • Chronic disease (heart disease and cancer) and hospitalization and emergency department utilization rates (asthma). • Risk factors (e.g., obesity, smoking), early detection (e.g., blood pressure, diabetes and cancer screening), and chronic disease management (e.g., proportion of diabetic patients with A1c value under 7 percent). • Asthma patients receiving seasonal influenza vaccinations (Survey of the Health of Wisconsin (SHOW)). Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Chronic Disease Prevention and Management Focus Area Profile. Note: Data on the four primary risk factors are included in the chapters on nutrition, physical activity, tobacco, and alcohol and other drug use. Data pertaining to asthma are included in the Environmental and Occupational Health chapter.

  13. Rationale Rationale • Chronic diseases are defined by the National Center for Health Statistics and the World Health Organization as illnesses that persist for a long time, or last at least three months. Chronic diseases are rarely cured, and often are progressive, resulting in disability later in life. • Chronic diseases, such as heart disease, stroke, cancer, diabetes, asthma, and arthritis, are among the most common and costly of all health problems in the United States; however, they are also among the most preventable. • Four modifiable health risk behaviors are responsible for much of the illness, suffering, and early death related to chronic diseases: (1) unhealthy diet; (2) insufficient physical activity; (3) tobacco use and secondhand smoke exposure; and (4) excessive alcohol consumption.6 Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Chronic Disease Prevention and Management Focus Area Profile.

  14. Cardiovascular disease Coronary heart disease, stroke, and congestive heart failure constitute the majority of cardiovascular disease deaths. Cardiovascular disease is the leading cause of death in Wisconsin. Death rates from coronary heart disease and stroke declined by more than 30% from 2000 to 2010; death rates from congestive heart failure have remained relatively stable. Significant disparities by race/ethnicity exist in the rates of premature death from stroke and coronary heart disease. Significant disparities by household income exist in the prevalence of heart attack, stroke, high blood pressure, and high cholesterol (those with lower incomes have a higher prevalence). Key points Key points

  15. Diabetes Diabetes prevalence is significantly higher among Blacks and American Indians than in Whites. Significant disparities exist for the prevalence of diabetes by household income: those with lower incomes have a higher prevalence. In 2009, the direct costs associated with diabetes in Wisconsin were estimated to be $4.07 billion, while the indirect costs were estimated at $2.04 billion ($6.10 billion total). Blacks with diabetes are far more likely to be hospitalized for short- and long-term complications than are their White counterparts.  Hispanics with diabetes are much more likely than non-Hispanic Whites to be hospitalized for long-term complications and for end-stage renal disease. Key points Key points

  16. Cancer mortality Although cancer mortality rates declined during 1995-2010, disparities between racial/ethnic groups have persisted in Wisconsin. In 2010, the highest cancer incidence and mortality rates in Wisconsin occurred among Blacks and American Indians. Significant disparities exist in cancer mortality by race/ethnicity. For example: Lung cancer mortality was significantly higher for Blacks and American Indians than for Whites, Hispanics, and Asians. Colorectal cancer mortality was significantly higher among Blacks than in any other race/ethnicity. Breast cancer mortality was significantly higher among Black women than White women. Prostate cancer mortality was significantly higher among Black men than in any other race/ethnicity. Key points Key points

  17. Cancer diagnosis and screening Black women in Wisconsin were more likely to have breast cancer diagnosed at a later, distant stage and less likely to have breast cancer diagnosed at an earlier, localized stage compared to White women. Overall, cancers in the Hmong population were diagnosed at later stages than cancers in the White population. People with less than a high school education were significantly more likely to have not received recommended cancer screenings than were those with more than a high school education. Key points Key points

  18. Arthritis Arthritis is the most common cause of disability in the United States; one in four adults in Wisconsin has been diagnosed with arthritis. Nearly half of Wisconsin residents with arthritis report that it limits their activity. Blacks have a significantly higher prevalence of arthritis than Whites and, of those with arthritis, are more likely to report activity limitation. Significant disparities exist in the prevalence of arthritis by household income: those with lower incomes have a higher prevalence. Key points Key points

  19. Cardiovascular disease and risk factors

  20. Cardiovascular disease and risk factors Cardiovascular disease mortality (leading causes), age-adjusted rates per 100,000, Wisconsin, 2000-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

  21. Cardiovascular disease and risk factors Percentage of coronary heart disease deaths under the age of 75, by race/ethnicity and sex, Wisconsin, 2006-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

  22. Cardiovascular disease and risk factors Percentage of stroke deaths under age 75, by race/ethnicity and sex, Wisconsin, 2006-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

  23. Cardiovascular disease and risk factors Rates of heart attack and stroke among Wisconsin adults, by sex, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset.

  24. Cardiovascular disease and risk factors Age-adjusted rates of heart attack and stroke among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  25. Cardiovascular disease and risk factors Age-adjusted rates of heart attack and stroke among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

  26. Cardiovascular disease and risk factors Age-adjusted rates of heart attack and stroke among Wisconsin adults, by level of urbanization, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

  27. Cardiovascular disease and risk factors Rates of heart attack and stroke among Wisconsin adults, by sexual orientation, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

  28. Cardiovascular disease and risk factors Rates of high cholesterol and high blood pressure among Wisconsin adults, by sex, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset. Note: Questions only asked in 2009 and 2011.

  29. Cardiovascular disease and risk factors Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by race/ethnicity, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions only asked in 2009 and 2011.Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  30. Cardiovascular disease and risk factors Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by household income, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions only asked in 2009 and 2011.

  31. Cardiovascular disease and risk factors Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by level of urbanization, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions only asked in 2009 and 2011.

  32. Cardiovascular disease and risk factors HIV Rates of high cholesterol and high blood pressure among Wisconsin adults ages 18-64, by disability status, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline only dataset. Note: Questions only asked in 2009 and 2011.

  33. Cardiovascular disease and risk factors Rates of high cholesterol and high blood pressure among Wisconsin adults, by sexual orientation, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions only asked 2009 and 2011.

  34. Diabetes

  35. Diabetes Rates of diabetes and prediabetes among Wisconsin adults, by sex, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes.

  36. Diabetes Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by race/ethnicity, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

  37. Diabetes Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes.

  38. Diabetes Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by level of urbanization, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes.

  39. Diabetes Rates of diabetes and prediabetes among Wisconsin adults ages 18-64, by disability status, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Prediabetes question was only asked in years 2009-2011.

  40. Diabetes Rates of diabetes and prediabetes among Wisconsin adults, by sexual orientation, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes.

  41. Diabetes Estimated prevalence of diabetes among Wisconsin adults, age-adjusted percentage, by county, 2008-2010 Source: Wisconsin Department of Health Services, Division of Public Health, Wisconsin Diabetes Prevention and Control Program, The 2011 Burden of Diabetes in Wisconsin.

  42. Diabetes Hospitalizations due to short-term diabetes complications and uncontrolled diabetes among Wisconsin adults, age-adjusted rate per 10,000, by race/ethnicity, 2010 Source: Wisconsin Inpatient Hospitalization Discharges, 2010. Note: Hospitalization rates considered unreliable are excluded.

  43. Diabetes Hospitalizations due to long-term complications from diabetes among Wisconsin adults, age-adjusted rate per 10,000, by race/ethnicity, 2010 Source: Wisconsin Inpatient Hospitalization Discharge file, 2010. Note: Hospitalization rates considered unreliable are excluded.

  44. Diabetes Incidence of end-stage renal disease incidence among Wisconsin adults, by race/ethnicity, age-adjusted rate per 100,000, 2009 Source: United States Renal Data System (USRDS), Renal Data Extraction and Referencing (RenDER) System. Note: Incidence rates considered unreliable are excluded.

  45. Cancer and screening

  46. Cancer and screening Age-adjusted cancer mortality (all sites) by race/ethnicity, rate per 100,000, Wisconsin, 1995-2010 Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics;Hispanic s include all races. Rates for American Indians and Asian may fluctuate more dramatically due to potential misclassification and small numbers of deaths.

  47. Cancer and screening Cancer incidence and mortality (all sites) age-adjusted rate per 100,000, by race/ethnicity, Wisconsin, 2010 Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services; and National Center for Health Statistics, Wisconsin mortality file 1995-2102, Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

  48. Cancer and screening Stage of disease at diagnosis, all cancers, White and Hmong populations, Wisconsin, 1995-2010 Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services, 2013 . Note: Percentages exclude cases for which stage was unknown or that were not staged.

  49. Cancer and screening Lung and bronchus cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States, 2006-2010 Sources: Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

  50. Cancer and screening Colorectal cancer mortality age-adjusted rate per 100,000, by race/ethnicity, Wisconsin and United States, 2006-2010 Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

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