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ABSTRACT

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ABSTRACT

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  1. COMMUNITY CORRELATES OF BACTERIAL PNEUMONIA HOSPITALIZATIONS, 65+, TEXAS BORDER COUNTIESFrank C. Lemus, M.A., Predoctoral Student, Alai Tan, M.D., Ph.D., Carlos Reyes-Ortiz, M.D., Ph.D., Daniel H. Freeman Jr., Ph.D., Jean L. Freeman, Ph.D.APHA 134th Annual Meeting and ExpositionNovember 4-8, 2006Boston, MA

  2. ABSTRACT We estimated baseline hospitalization rates in the 32 Texas Border Counties toward achieving Healthy Border 2010 Focus Area 1: Improve access to primary care and Focus Area 6: Improve rates of immunization and reduce rates of infectious diseases by tracking Healthy People 2010 Objective 1.9c: Reduce hospitalization rates for the following ambulatory care sensitive condition (ACSC) & Agency on Healthcare Research & Quality (AHRQ) prevention quality indicator (PQI): immunization-preventable bacterial pneumonia-persons aged 65+. Hospitalization rates based on data from Texas Health Care Information Council (THCIC) hospital discharge data system for 3 years 1999, 2000, 2001, & population counts from 2000 U.S. Census.

  3. PURPOSE • Estimate baseline hospitalization rates for bacterial pneumonia, 65+, Texas Border Counties • Learn if contextual (county) characteristics associated with ACSC & PQI bacterial pneumonia • Methodology to assess progress of Texas Border Counties toward achieving Healthy Border 2010 Focus Areas 1: and 6: and Healthy People 2010 Objective 1.9c.

  4. AIMS Estimate hospitalization rates for ACSC & PQI -Immunization preventable bacterial pneumonia (persons 65+) Identify association of contextual (county) characteristics with bacterial pneumonia hospitalizations -race/ethnic concentration, income Study 3 major racial/ethnic groups (non-Hispanic White, Black, Latino) Target 32 Texas Border Counties defined by La Paz Agreement (1983) and Public Law 103-400 (1994)

  5. Healthy Border & Healthy People 2010 Overarching Goals Increase Quality & Years of Healthy Life • Help individuals of all ages increase life expectancy and improve their quality of life Eliminate Health Disparities • Eliminate health disparities among different segments of the population

  6. United States–Mexico Border Region • Legally defined by La Paz Agreement (1983) and Public Law 103-400 • 2000 mile long (California/Baja California to Texas/Tamaulipas) • 62 miles (100 kilometers) within either side of United States and Mexico • 1,248 mile Texas/Mexico border • Rio Grande River one of most polluted rivers in North America, and primary source of drinking water for many border communities.

  7. Source: U.S.-Mexico Border Health Commission: 2004 Immunization Week Preparatory Workshop, Quito, Ecuador: http://www.paho.org/English/DD/PIN/285,3,Slide 3

  8. Texas Office Of Border Health http://www.dshs.state.tx.us/borderhealth/border_health_map.shtm

  9. Border Facts • Latinos 41% of border population, without San Diego County 71%, (historically permanent home or “in-transition” home) • Over 90% border population concentrated in or near 14 sister or twin cities on both sides of border • Double-digit population growth rate between 1970 and 2000, over 2.7 million to over 6 million • 36% of Latino border population <18 years compared to 19% of non-Latinos, yet 65+ in US = 12.4%; TX = 9.9%, 32 Border Counties = 13.3% • Maquiladoras (assembly plants), NAFTA, Colonias are major influences on border health

  10. WHY ACSCs/PQIs? Providebaseline information about a community Mechanism to evaluate the progress of a community in achieving the goals of Healthy Border 2010 & Healthy People 2010 ACSCs/PQIs based on hospital inpatient data, but provide insight into the quality of the health care system outside the hospital setting

  11. DATA & RESOURCES • Texas Health Care Information Council (THCIC) hospital discharge database (32 Texas Border Counties) Years 1999, 2000, 2001 • 2000 U.S. Census Summary File 1 (SF 1) State population counts for targeted communities by age, sex, race, ethnicity • International Classification of Diseases, 9th Revision Clinical Modification (ICD-9-CM) • Healthy Border 2010 report & Healthy People 2010 report

  12. THCIC DISCHARGE DATA • Administrative data– demographics & clinical (ICD-9-CM) • 2.57 million discharge records per year • Public use data for years 1999, 2000, and 2001 • Helps Texas consumers and researchers make informed health care decisions • Data source for health services research on hospital care in Texas

  13. 2000 U.S. CENSUS Summary File 1 (SF 1): Presents data for the United States, the 50 states, and the District of Columbia. Contains 286 detailed tables including state population counts by targeted communities for: • Age • Income • Race • Ethnicity

  14. Hospitalizations, Persons 65+, 32 Texas Border Counties (THCIC) Year 1999: 255,414 Year 2000: 262,145 Year 2001: 270,516 Total Records: 788,075 Bacterial Pneumonia Discharges, 65+, 32 Texas Border County Records: 10,749

  15. METHODOLOGY FOR RATE CALCULATIONS • Followed HP 2010 protocol for rate calculation for each county • Numerator = discharge data x 10,000 • Denominator = U.S. Census data x 3 • = Rate

  16. Followed HP 2010 Protocol & Methodology for Rate Calculation Bacterial pneumonia rate per 10,000 persons in Duval County = 386.29/10,000 persons 10,000 x persons 65+ years hospitalized in Duval Co (213), ICD-9-CM Codes Bacterial Pneumonia, (THCIC 1999-2001) Population 65+ years in Duval Co, 2000 (1838) X 3 (2000 US Census (SF 1))

  17. COUNTY POPULATION BY COUNTY BACTERIAL PNEUMONIA RATES • Counties by population 65+ with 4 lowest rates/10,000 • Kenedy: 44 0 • Kinney: 822 16.22 • Val Verde: 4913 23.75 • Zavala: 1307 38.26 • Counties by population 65+ with 4 mid range rates/10,000 • La Salle: 682 151.52 • Hidalgo: 55274 160.53 • Cameron: 37375 161.60 • Jeff Davis: 359 167.13 • Counties by population 65+ with 4 highest rates/10,000 • Brewster: 1297 246.72 • Hudspeth: 331 302.11 • Brooks: 1150 318.84 • Duval: 1838 386.29

  18. Bacterial pneumonia hospitalization rates/ 10,000, 65+ yrs by Mdn Hshld Inc,1999-2001

  19. Bacterial pneumonia hospitalization rates per 10,000 by % White, 65+ yrs,1999-2001

  20. Bacterial pneumonia hospitalization rates per 10,000 by % Hispanic, 65+ yrs,1999-2001

  21. GLOBAL FINDINGS Disparity between Whites and Latinos Income gradients correlated with rates of bacterial pneumonia LIMITATIONS: Administrative data Reporting of race/ethnicity Variation in coding practices

  22. IMPLICATIONS Provides baseline estimate of bacterial pneumonia hospitalization rates, persons 65+, in 32 Texas Border Counties (future comparability health studies of Texas counties, 4 U.S. & 6 Mexico Border States) (CA, AZ,NM, TX) (BC, Sonora, Chihuahua, Nuevo Leon, Coahuila, Tamaulipas) 32 Texas Border County stakeholders can assess health status of population & sets basis to target interventions using community based participatory research techniques Demonstrates use of hospital discharge data for community based health services research

  23. DIRECTIONS Extend baseline estimates & analysis of AHRQ quality of care indicators - QIs (population health) • bacterial pneumonia hospitalizations (PQI) • pneumonia inpatient mortality (IQI) • all Texas counties • 65+, all Texas counties fclemus@utmb.edu 409-762- 5140 Primary Funding Source: University of Texas Medical Branch, Division of Epidemiology and Biostatistics Educational Enhancement Fund.

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