Overview of Major Health Indicators

1. Overview of Major Health Indicators Southeastern Washington Accountable Communities of Health (SWACH) October 9, 2014

2. Age-Adjusted Death Rates • No county in the SWACH reported a significantly higher death rate compared to the whole state. • This measure includes deaths from all causes in a given year, adjusted for age. • Nationally, higher county-level mortality rates have been associated with lower county-level income, education and population density and higher adult smoking rates. • In Washington, stroke, heart disease, chronic lower respiratory disease and cancer cause proportionately more deaths among the elderly, while unintentional injuries cause more deaths among the young. • During 2009–2011 combined, Washington’s 10 leading causes of death were: cancer, heart disease, Alzheimer’s disease, chronic lower respiratory disease, unintentional injury, cerebrovascular disease, diabetes, suicide, and influenza and pneumonia. • The 2011 age-adjusted death rate for Washington was 695 per 100,000 people, one of the lowest in the past 30 years. Washington’s death rates have been consistently lower than the U.S. rates. Source: Washington State Death Certificate data: Washington State Department of Health, Vital Registration System Annual Statistical Files, Deaths 1980–2011, released September 2012

3. Self-Reported Fair or Poor Health • Asotin and Franklin residents were more likely to report fair or poor health compared to the whole state. • Self-reported current health status is a good predictor of future disability, hospitalization and mortality. • Older adults in Washington were more likely to report fair or poor health than younger adults. • Education and income were associated with health status, even after accounting for other factors such as age. • Smokers, overweight/obese individuals and people with asthma, diabetes or disabilities were more likely to report fair or poor health. • Hispanic, American Indian/Alaska Native and blacks were more likely to report fair or poor health • Evidence-based programs that help people prevent or manage chronic diseases and disability, if sustained over time, lead to a reduction in the percentage of people reporting fair or poor health. • Programs to reduce smoking, increase physical activity and healthy eating, and promote early diagnosis and effective management of chronic diseases can affect a large portion of Washingtonians. • Improvements in social, economic and environmental conditions can positively affect health, and thus also influence self-reported health status. Source: BRFSS, 2008-2010

4. Poor Mental Health • No county in the SWACH reported a significantly higher percentage of individuals with poor mental health compared to the whole state. Garfield reported a lower percentage. • This measure assesses adults reporting poor mental health 14 days or more in a previous month. • Women and younger people reported poor mental health more often than men and older people. • Studies consistently show a negative association between socioeconomic status and mental illness: The lower an individual’s socioeconomic status, the higher the risk of mental illness. • Respondents with less education reported higher rates of poor mental health. These patterns persisted after adjusting for age. • Mental and physical health are strongly related. Public mental health clients have higher rates of mortality and morbidity than the general population. • American Indians and Alaska Natives reported significantly higher rates of poor mental health than other racial or ethnic group. Source: BRFSS: 1994–2005; 2003–2005 data weighted to reflect county over-sample, November 2006.

5. Disability Prevalence: Ages Five and Older • Columbia and Asotin reported a significantly higher rate of individuals with disabilities compared to the whole state. • People with disabilities are those who report being limited in any way in any activities because of physical, mental, or emotional problems, or who have health problems that require them to use special equipment. • Census data from 2000 show rural counties on the edges of the state had higher age-adjusted disability prevalence. • The differences in prevalence reflected the education, age, and income differences among counties rather than rural and urban differences. Disability prevalence in Washington rose with age and was highest among people 75 years and older. Disability prevalence did not differ by gender except among youth younger than 16 years old. • Counties with more wealth, larger populations, and more young people had the lowest disability prevalence. Source: Census 2000

6. Domestic Violence • Asotin and Franklin reported a significantly higher rate of domestic violence offenses compared to the whole state. Columbia and Benton reported a significantly lower rate. • Domestic violence is a pattern of assault and coercion, including physical, sexual, and psychological abuse, as well as economic coercion, that adults or adolescents use against their intimate partners. This report measures domestic violence as domestic violence-related offenses reported to the Washington Association of Sheriffs and Police Chiefs. • Domestic violence is an important cause of injury and death in women. Women who are victims of domestic violence generally have poorer overall physical and mental health. They also have more injuries, and use health services more than other women. • Women living in low-income households are at heightened risk of domestic violence. • Children exposed to domestic violence are at risk for problems in their social, emotional and cognitive development and for family violence as adults. • The highest rates of domestic violence injuries are among American Indians and Alaska Natives and blacks, and the lowest rates are among Asians. Source: WASPC, 2009-2011

7. Child Abuse and Neglect • Asotin, Garfield, Columbia, Walla Walla and Benton reported a significantly higher rate of children in CPS accepted referrals compared to the whole state. Franklin reported a significantly lower rate. • Child abuse and neglect are behaviors by a parent or caregiver that result in harm or potential harm to a child. These include physical, sexual and psychological abuse and neglect. This report measures child abuse and neglect as the number of children in referrals accepted for investigation by Child Protective Services per 1,000 children. • Child maltreatment causes immediate suffering and affects long-term physical and emotional well-being. It increases the risks of delinquency, youth violence, teen pregnancy, substance abuse, suicide attempts, HIV-risk behaviors, poor health and premature death. • Parental poverty, unemployment and lack of education have been consistently shown to increase risk of child abuse. • The highest rates of child maltreatment were among children ages five and younger. Source: Washington State, 2009-2011

8. Teen Pregnancy (15-17 years) • Franklin reported a significantly higher teen pregnancy compared to the whole state. • Pregnancy among teens younger than 15 is a rare event, and teens older than 17 are at lower risk for poor birth outcomes. Teen pregnancies are estimated by combining reported births, induced abortions, and fetal losses for females ages 15–17. • Individual, family, community and cultural factors influence rates of teenage pregnancy and childbearing. • Teen childbearing can result in poor health for both mothers and children. • Birth rates were highest for Washington’s Hispanic and American Indian and Alaska Native teens and lowest for Asian followed by white teens. • Teen birth rates were higher in geographic areas with higher concentrations of poverty and lower levels of college completion. • Teens who become mothers are more socially and economically disadvantaged than other teens and are more likely to have low educational achievement, poor school performance, parents with low educational attainment, and limited family economic resources. Source: County Data, Vital Statistics 2009-2011

9. Adults Smoking • Asotin reported a significantly higher rate of adult smokers compared to the whole state. Franklin reported a significantly lower rate. • Tobacco use includes the intake of tobacco smoke from cigarettes, cigars, pipes, and hookahs either by the individual smoking or the oral absorption of nicotine and related toxins through smokeless/spit tobacco (chew, dip, snus, or snuff). An adult who has smoked at least 100 cigarettes in his or her lifetime and currently smokes every day or some days is defined as a current smoker. • Smoking prevalence peaked from late adolescence through age 34. The prevalence of current smoking among males in 12th grade and males ages 18–34 was higher than among females in the same age groups. Otherwise, the percentage of smokers was similar among males and females. • The prevalence of current smoking decreased as levels of education and household income increased. • Higher proportions of American Indians and Alaska Natives and blacks reported smoking cigarettes than did whites, Hispanics and Asians. Smoking rates for Asians were lower than rates for all other groups. Source: BRFSS, 2008-2010

10. Obesity Prevalence • Columbia reported a significantly higher rate of obesity compared to the whole state. • CDC defines overweight for adults as body mass index (BMI) of 25–29.9 and obesity as a BMI of 30 or higher. Children with BMIs in the 85–94th percentiles on BMI-for-age growth charts are considered overweight; children with BMIs at the 95th percentile or higher are obese. • About one-quarter of children ages two through four in low-income families served by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were overweight or obese. • Obesity and overweight risk is highest in middle age. Overweight or obese children are more likely than children with normal weights to become obese adults. Adults who are obese or overweight are more likely to develop a number of serious diseases and to die at younger ages than people who are not obese or overweight. • Obese women are at higher risk of health complications during pregnancy, and are less likely to breastfeed. Gaining more weight during pregnancy than recommended can cause poor birth outcomes and increases the risk of retaining extra weight after the baby is born. Source: BRFSS 2010-2012

11. Diabetes Prevalence • Asotin and Columbia reported a significantly higher rate of diabetes incidence compared to the whole state. • This measure uses self-reported diabetes from BRFSS to measure diabetes and prediabetes. Gestational diabetes is not included. • The percent of adults reporting diabetes increased with age, up to 85 years old. • People of lower socioeconomic position are more likely to develop diabetes. The age-adjusted percent of adults who reported diabetes increased with decreasing income and decreasing levels of education. Differences in health behaviors, effects of stress, and access to care may account for the relationship between socioeconomic position and diabetes. • White adults reported lower age-adjusted percent of diabetes than all other groups. Source: BRFSS, 2010-2012

12. Stroke Deaths • Asotin reported a significantly higher rate of deaths due to stroke compared to the whole state. Franklin county had an age-adjusted death rate that was lower than the state rate. • This measure includes death from both Ischemic stroke and hemorrhagic stroke. • Stroke death rates in Washington increase rapidly with age. Disability not only affects the lives of stroke patients, but also their family and caregivers, compounding the impact of stroke on people and communities. • Individuals in lower socioeconomic groups have higher rates of stroke deaths than those in higher groups. Living in lower socioeconomic neighborhoods may also be associated with a shorter survival period following a stroke, regardless of individual socioeconomic position or traditional risk factors. • Stroke is a leading cause of serious, long-term disability in Washington and the nation. Source: Death Certificates 2009-2011

13. Colorectal Cancer Incidence • Benton reported a significantly higher rate of colorectal cancer incidence compared to the whole state. • Colorectal cancer incidence in this report includes in situ and invasive diagnoses. Colorectal cancer deaths are coded to ICD-9 codes 153.0–154.1, and 159.0 for 1992 -1998 and ICD-10 codes C18–C20 and, C26.0 for 1999-2011. • Colorectal cancer is rare in people younger than age 40, after which incidence rates increase with age. Although colorectal cancer affects both women and men, incidence rates are consistently higher for men. • People of Hispanic origin had the lowest rate of newly diagnosed colorectal cancer. The rate for American Indians and Alaska Natives was higher than that for all groups except blacks. • High intake of red and processed meat is associated with an increased risk of colorectal cancer. • Obesity is strongly associated with increased risk of colorectal cancer, and the association is stronger for colon cancer than rectal cancer. • Smokers are at increased risk of colorectal cancer, especially rectal cancer, and heavy smokers are at significantly increased risk. Source: Cancer Registry, 2008-2010

14. Adult Tooth Loss • Columbia, Franklin and Asotin reported a significantly higher rate of adult tooth loss compared to the whole state. • This measures the percentage of people who have lost six or more permanent teeth increases with age among both males and females. • Blacks, American Indians and Alaska Natives, and Hispanics experienced more tooth loss than whites and Asians and Pacific Islanders. • Income and education are inversely related to amount of tooth loss. • Non-white, low-income, and non-English-speaking children had the highest levels of dental disease and the lowest levels of dental sealants. • Fluoride is an effective method of preventing caries in both children and adults, and a fluoridated water system is the most cost-effective method of providing fluoride. Source: BRFSS, 2004, 2006

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