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The Health of King County 2006. Jim Krieger, MD, MPH Epidemiology, Planning & Evaluation Unit. PROJECT STAFF (from the Epidemiology, Planning and Evaluation Unit, Public Health – Seattle & King County) Susan Barkan, PhD Ann Glusker, PhD James Krieger, MD, MPH Amy Laurent, MPH

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the health of king county 2006

The Health of King County2006

Jim Krieger, MD, MPH

Epidemiology, Planning & Evaluation Unit

acknowledgements
PROJECT STAFF (from the Epidemiology, Planning and Evaluation Unit, Public Health – Seattle & King County)

Susan Barkan, PhD

Ann Glusker, PhD

James Krieger, MD, MPH

Amy Laurent, MPH

Genevieve Rowe, MS

Mike Smyser, MPH

David Solet, PhD

Lin Song, PhD

((in alphabetical order)

We would also like to thank reviewers and contributors from PHSKC, other local, state and national agencies and the University of Washington.

Acknowledgements
where this talk is heading
Where This Talk is Heading…
  • Key findings
  • Trends
  • Health disparities
  • Improving health
determinants of health
Determinants of Health

Public Health

Social Environment

Health & Disease

Behaviors & Biologic Response

Physical Environment

Genetic Endowment

Health Care

Adapted from Evans, et al

the health of king county
The Health of King County
  • Comprehensive, web-based report
    • Health outcomes
    • Health-related behaviors
  • Data sources
    • Vital records
    • Surveys
    • Hospital discharge data
    • Reportable conditions
    • US census
other public health seattle king county data reports
Other Public Health – Seattle & King County Data Reports
  • Core Indicators
  • Communities Count
  • HIV/AIDS Epi Monthly Report
  • Medical Examiner’s Annual Report
  • CD Annual Summary Report
  • Epilog
  • Data Watches
  • Drug Abuse Trends
1 chronic diseases the leading cause of death and illness
#1Chronic Diseases:The Leading Cause of Death and Illness
  • Common chronic diseases include:
    • Cancer
    • Heart disease
    • Stroke
    • Chronic lung diseases (e.g. asthma, COPD)
    • Diabetes
  • 21,000 hospitalizations / $531 million in 2004
  • Cancer, heart disease and stroke alone:

56% of all deaths

chronic diseases the leading cause of death and illness
Chronic Diseases:The Leading Cause of Death and Illness
  • Affect many residents
    • Asthma: 9% of adults and 6% of children
    • Heart disease: 5% of adults
    • Diabetes 5% of adults
    • Arthritis: 16% of adults
  • Will become more common as population ages
diabetes
Diabetes
  • Prevalence among adults has doubled in the past decade.
  • Hospitalizations, which can often be avoided with good diabetes management, are increasing.
2 hiv infection has now become a chronic condition
#2HIV infection has now become a chronic condition
  • AIDS moved from the 8th to 14th leading cause of death.
aids incidence declining prevalence rising
AIDS:Incidence declining, prevalence rising
  • Increasing numbers of people living with HIV and AIDS, leading to a steady rise in the prevalence of these conditions.
4 pandemic influenza
#4Pandemic Influenza
  • The risk of an influenza pandemic may be increasing.
  • “Medium-level” pandemic in the U.S. could cause
    • 89,000 to 207,000 deaths
    • 314,000 to 734,000 hospitalizations
    • 18 to 42 million outpatient visits
5 access to care decreasing
#5Access to care decreasing
  • Highest rate of uninsurance since data collection began in King County
6 mental health
#6Mental Health
  • Residents report increased poor mental health days
  • Hospitalizations for psychosis, but not depression, have increased since 1987
7 alcohol
#7Alcohol
  • Excessive alcohol use is higher in King County than the rest of Washington and the nation.
  • Binge drinking
    • 15.7% of all adults during the past month.
  • Drinking and driving
    • 4.2% of all adults during the past month
  • Heavy drinking
    • 5.9% of all adults
    • Increased significantly from 3.4% to 5.6% in past decade
  • Rates are 2-3 times higher among young adults age 18-24
8 illicit drug use
#8Illicit Drug Use
  • Deaths from prescription opiates now exceed deaths from heroin
    • Prescription opiate deaths increased four-fold since 1997
  • Deaths related to prescription depressant drugs (e.g. valium) and methamphetamines are also on the rise
mortality decreasing
Mortality decreasing
  • Life expectancy at birth is 78.0 years for males and 82.5 for females
  • Higher than 11 of the 14 other large U.S. counties
  • Increased 4.9 years since 1980
hepatitis rates down
Hepatitis rates down
  • Hepatitis A
    • 1997: 441 cases
    • 2004: 14 cases
  • Hepatitis B
    • 1995: 85 cases
    • 2004: 23 cases
immunizations increase but still short of goal
Immunizations increase but still short of goal
  • Childhood
    • Coverage increasing since 2001
    • 81% of kids have full coverage
    • HP 2010 objective of 90% not yet met
  • Adults 65 years and older
    • Pneumonia vaccination has increased to 65%
    • Influenza immunization rate static at 70%
    • Both rates below the HP 2010 objective of 90%.
health disparities
Health Disparities
  • There are large and persistent disparities in health status and access to health care across
    • Racial/ethnic groups
    • Income groups
    • Areas of the county
    • Sexual orientation
  • While some disparities are diminishing, many are increasing.
disparities widespread among african americans and american indians alaska natives
Disparities widespread among African Americans and American Indians/Alaska Natives
  • Mortality
  • Birth outcomes
  • Chronic diseases
  • Risk factors for chronic disease
    • Smoking
    • Overweight
    • Physical inactivity
    • Lack of screening
  • Injuries
  • HIV
  • Mental distress
  • Alcohol use and drug-induced deaths
  • Access to medical care
disparities also affect hispanic latinos
Disparities also affect Hispanic/Latinos
  • Adolescent births
  • Physical inactivity
  • Mental distress
  • HIV
  • Access to care
mortality african americans and ai an
MortalityAfrican Americans and AI/AN
  • Life expectancy among AA and AI/AN males
    • 8 years lower than white expectancy
    • Less than white expectancy in 1980
  • Trends in gap over past decade
    • African Americans: no change
    • AI/AN: increasing
  • Excess deaths
    • African Americans: 158 per year
    • AI/AN: 37 per year
diabetes mortality
Diabetes Mortality

Source: Death Certificate Data: Washington State Department of Health, Center for Health Statistics.

sexual minorities
Sexual minorities
  • Health-related behaviors
    • Smoking rates nearly 2 times higher
    • Binge and heavy drinking X times higher
  • Cancer screening among lesbian/bisexual women
    • Mammography: 50% rate vs. 75%
  • HIV and AIDS
    • Still predominantly affect gay males,
    • Slowly increasing in other groups
  • Frequent mental distress
    • Twice as common
income disparities
Income disparities
  • Mortality
  • Birth outcomes
  • Adolescent births
  • All chronic diseases and risk factors
  • HIV
  • Mental health
  • Alcohol use and drug-related deaths
  • Access to care.
geographic disparities44
Geographic disparities
  • South Seattle/South County Region
    • Downtown, Central and Southeast Seattle
    • Beacon Hill
    • Delridge
    • White Center/Boulevard Park
    • Tukwila/Sea Tac
    • Kent
    • Auburn
features of the region affecting health
Features of the region affecting health
  • Changing SES and racial/ethnic mix
  • Sprawl/built environment
  • Challenges in funding community and govt. services
  • Norms around prevention and healthy behaviors
south seattle south county area disparities
South Seattle/South County Area Disparities
  • Death rate
  • Birth outcomes
  • Chronic diseases and risk factors
  • Motor vehicle and firearm injuries
  • Mental health problems
  • Complications of illicit drug use
  • Access to care
investment in the health of the public pays off
Investment in the health of the public pays off
  • Reductions in smoking
  • Increased seat belt use
  • Improved control of asthma
  • Improved access to prenatal care
  • Reductions in infant deaths from SIDS as more infants are placed on their backs to sleep
investment in the health of the public pays off51
Investment in the health of the public pays off
  • Lower adolescent birth rates
  • Increased screening for breast and cervical cancer
  • Control of tuberculosis outbreak
  • Increased immunizations
improving the health of king county
Improving the Health of King County
  • Implementation of effective community health interventions
    • community heath workers
    • home visits (newborns, asthma, diabetes)
    • care coordination and case management
    • support groups ( physical activity, chronic disease)
    • outreach ( immunizations, screening for cancer and chronic disease risk factors)
    • community education to promote healthy behaviors
  • Assuring universal health insurance coverage and access to health care/medical home
improving the health of king county53
Improving the Health of King County
  • Improvement of the quality of care for chronic conditions, especially among providers who serve disparity populations
  • Systems integration and partnerships
  • Supporting people with chronic diseases
    • Self-management education and support
    • Social support
  • Building homes and communities which support physical activity and provide healthy indoor environments
improving the health of king county54
Improving the Health of King County
  • Making healthy foods more readily accessible in schools, worksites and communities
  • Increased resources to monitor trends and disparities
  • Addressing social factors that affect health
    • Unemployment
    • Low wages
    • Lack of educational attainment
    • Inadequate childcare and early childhood education
    • Discrimination in all forms.
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