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Healthiest Wisconsin 2020 Baseline and Health Disparities Report Injury and Violence

Healthiest Wisconsin 2020 Baseline and Health Disparities Report Injury and Violence. 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

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Healthiest Wisconsin 2020 Baseline and Health Disparities Report Injury and Violence

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  1. Healthiest Wisconsin 2020 Baseline and Health Disparities ReportInjury and Violence

  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 • Youth risk behavior and exposure • Adult risk behavior and exposure • Injury mortality • Injury-related hospitalization 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, reduce the leading causes of injury (falls, motor vehicle crashes, suicide/self-harm, poisoning and homicide/assault) and violence through policies and programs that create safe environments and practices. Objective 1 Indicators Morbidity from falls, assaults, motor vehicle crashes, poisoning and self-harm. Mortality from falls, homicide, suicide, motor vehicle crashes and poisoning. Number of crash occupants (motor vehicles, trucks, motorcycles, bicycles, pedestrians with moving vehicle). HW2020 objectives Healthiest Wisconsin 2020 objectives and indicators Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Injury and Violence Focus Area Profile.

  11. Objective 2 By 2020, increase access to primary, secondary and tertiary prevention initiatives and services that address mental and physical injury and violence. Objective 2 Indicators Reimbursement for preventive services related to injury and violence (Medicaid/BadgerCare, medical service billing codes). HW2020 objectives Healthiest Wisconsin 2020 objectives and indicators Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Injury and Violence Focus Area Profile.

  12. Objective 3 By 2020, reduce disparities in injury and violence among populations of differing races, ethnicities, sexual identities and orientations, gender identities, and educational or economic status. Objective 3 Indicators Disparity ratios in hospitalizations from falls, poisoning and self-harm. Mortality from homicide, suicide, and motor vehicle crashes. HW2020 objectives Healthiest Wisconsin 2020 objectives and indicators Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Injury and Violence Focus Area Profile.

  13. Rationale Rationale • “Injury and violence” encompasses a broad array of topics. Unintentional injuries are often referred to as accidents despite being highly preventable. Intentional injuries are those that were purposely inflicted, and often involve a violent act. • Injuries are the leading cause of death among Wisconsin people aged 1-44 years and are a significant cause of morbidity and mortality at all ages. • Injuries and violence occur in all ages, races, and socioeconomic classes. However, some groups are more affected. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Injury and Violence Focus Area Profile.

  14. Key points Key points Youth Risk Behavior and Exposure • Significant disparities exist in the prevalence of youth risk behaviors for injury and exposure to violence. For example: • Black students were more likely to report being exposed to school violence, feeling unsafe at school, experiencing partner violence, rarely or never wearing a seat belt, and less likely to drink and drive than were their White counterparts. • White students had the lowest rate of feeling unsafe at school of all racial/ethnic groups. • Sexual minority students were more likely to be exposed to school violence, to be bullied, to feel unsafe at school, to experience partner violence, and to be forced into having sex.

  15. Key points Key points Adult Risk Behavior and Exposure • Approximately one-quarter of Wisconsin adults said they do not wear a seat belt when riding in a car. • Significant disparities exist in the prevalence of adult risk behaviors related to seat belt use. The following groups were significantly more likely to not wear a seat belt than their counterparts: • Males compared to females. • Adults ages 18-24 compared to adults ages 65 and older. • Low-income adults compared to middle and high income adults. • Adults without a high school diploma compared to adults with a high school education or more.

  16. Mortality Falls and suicide were the two leading causes of injury-related death in Wisconsin in 2010. The leading cause of injury-related death varied by age group: Less than one year: Suffocation. 1-4 years: Drowning. 5-24 years: Motor vehicle crashes. 25-64 years: Suicide. 65+ years: Falls. For some of the causes of injury-related death, one or two racial and ethnic groups had significantly higher age-adjusted mortality rates than other racial and ethnic groups: Falls: White. Motor vehicle crashes: American Indian. Unintentional poisoning: Black and American Indian. Homicide: Black. Suicide: American Indian. Key points Key points

  17. Youth risk behavior and exposure

  18. Youth risk behavior and exposure Motor vehicle risk behaviors among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

  19. Youth risk behavior and exposure Motor vehicle risk behaviors among Wisconsin high school students by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

  20. Youth risk behavior and exposure Exposure to school violence among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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.

  21. Youth risk behavior and exposure Exposure to school violence among Wisconsin high school students, by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

  22. Youth risk behavior and exposure Bullying and perception of school violence among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

  23. Youth risk behavior and exposure Bullying and perception of school violence among Wisconsin high school students, by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

  24. Youth risk behavior and exposure Perceptions of school safety among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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. Youth risk behavior and exposure Perceptions of school safety among Wisconsin high school students, by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

  26. Youth risk behavior and exposure Partner violence among Wisconsin high school students, by race/ethnicity, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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.

  27. Youth risk behavior and exposure Partner violence among Wisconsin high school students, by sexual minority status, 2007-2011 Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

  28. Adult risk behavior and exposure

  29. Adult risk behavior and exposure Non-use of seat belts and fall-related injuries among Wisconsin adults, by sex, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset. Note: Questions were asked in 2010 and 2011.

  30. Adult risk behavior and exposure Non-use of seat belts among Wisconsin adults, by age, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 combined landline-cell dataset. Note: Questions were asked in 2010 and 2011.

  31. Adult risk behavior and exposure Age-adjusted rate of seat belt non-use and rate of fall-related injuries among Wisconsin adults, by race/ethnicity, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted; rates of fall-related injury are not age-adjusted but are limited to the population 45 and older. 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.

  32. Adult risk behavior and exposure Age-adjusted rate of seat belt non-use and rate of fall-related injuries among Wisconsin adults, by household income, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted; rates of fall-related injury are not age-adjusted but are limited to the population 45 and older.

  33. Adult risk behavior and exposure Age-adjusted rate of seat belt non-use and rate of fall-related injuries among Wisconsin adults, by level of urbanization, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted; rates of fall-related injury are not age-adjusted but are limited to the population 45 and older.

  34. Adult risk behavior and exposure Age-adjusted rate of seat belt non-use among Wisconsin adults, by disability status, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted.

  35. Adult risk behavior and exposure Age-adjusted rate of seat belt non-use and rate of fall-related injuries among Wisconsin adults, by sexual orientation, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted; rates of fall-related injury are not age-adjusted but are limited to the population45 and older.

  36. Injury mortality

  37. Injury mortality Injury deaths (leading causes), age-adjusted rates per 100,000, Wisconsin, 2010 Unintentional injury Intentional injury Suicide Motor vehicle crashes Falls Poisoning Homicide Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

  38. Injury mortality Leading causes of injury death by age, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Note: Age groups were collapsed when the three leading causes were the same. * Number of deaths was too small to indicate cause.

  39. Injury mortality Unintentional injury deaths (leading causes) by race/ethnicity, age-adjusted rates per 100,000, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Note: WISH suppresses small numbers (when cell size is less than 5) to comply with Wisconsin vital records data privacy guidelines.

  40. Injury mortality Intentional injury deaths by race/ethnicity, age-adjusted rates per 100,000, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

  41. Injury mortality Unintentional injury deaths by county, age-adjusted rates per 100,000, Wisconsin, 2008-2010 Falls Motor vehicle crashes Statewide rate = 10 per 100,000 Statewide rate = 14 per 100,000 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

  42. Injury mortality Unintentional injury deaths by county, age-adjusted rates per 100,000, Wisconsin, 2008-2010 (continued) Poisoning Statewide rate = 9 per 100,000 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

  43. Injury mortality Intentional injury deaths by county, age-adjusted rates per 100,000, Wisconsin, 2008-2010 Homicide Suicide Statewide rate = 13 per 100,000 Statewide rate = 3 per 100,000 20 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

  44. Injury-related hospitalization

  45. Injury-related hospitalization Injury Pyramid Source: World Health Organization, Violence and Injury Prevention.

  46. Injury-related hospitalization Injury hospitalizations (leading causes), age-adjusted rates per 100,000, Wisconsin, 2010 Unintentional injury Intentional injury Falls Poisoning Assault Motor vehicle crashes Self-harm Source: Wisconsin Interactive Statistics on Health (WISH), Injury Hospitalizations Module, hospital inpatient discharge database

  47. Injury-related hospitalization Primary payer for injury-related hospitalizations, Wisconsin, 2010 N = 1,266 N = 24,312 N = 3,882 N = 2,738 N = 5,495 Source: Wisconsin Interactive Statistics on Health (WISH), Injury Hospitalizations Module, hospital inpatient discharge database

  48. References References • University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach • Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf • LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf • Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ • Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf • Centers for Disease Control and Prevention (CDC). Injury Prevention and Control: Motor Vehicle Safety. Teen Drivers. http://www.cdc.gov/motorvehiclesafety/teen_drivers/index.html • CDC. About School Violence http://www.cdc.gov/violenceprevention/youthviolence/schoolviolence/index.html

  49. References • CDC. Understanding School Violence. http://www.cdc.gov/violenceprevention/pdf/schoolviolence_factsheet-a.pdf • CDC. Understanding Bullying. http://www.cdc.gov/violenceprevention/pdf/bullying_factsheet-a.pdf • CDC. Teen Dating Violence. http://www.cdc.gov/violenceprevention/intimatepartnerviolence/teen_dating_violence.html • CDC. Understanding Teen Dating Violence. http://www.cdc.gov/ViolencePrevention/pdf/TeenDatingViolence2012-a.pdf • Wisconsin Department of Health Services (DHS). The Burden of Injury in Wisconsin. http://www.dhs.wisconsin.gov/publications/P0/P00283.pdf • DHS. Wisconsin Interactive Statistics on Health: Injury-related Mortality Module. http://www.dhs.wisconsin.gov/wish/main/InjuryMortality/InjuryMortality_home.htm

  50. The Burden of Injury in Wisconsin (2011): http://www.dhs.wisconsin.gov/publications/P0/P00283.pdf The Burden of Falls in Wisconsin (2010): http://www.dhs.wisconsin.gov/health/injuryprevention/pdffiles/FINAL_BOF_080210.pdf The Burden of Suicide in Wisconsin (2008): http://www.dhs.wisconsin.gov/health/injuryprevention/pdffiles/bosfinal9%205.pdf Centers for Disease Control and Prevention (CDC). Injury, violence, and safety: http://www.cdc.gov/InjuryViolenceSafety/ Links Links to additional reports and resources

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