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Healthiest Wisconsin 2020 Baseline and Health Disparities Report People with Disabilities

Healthiest Wisconsin 2020 Baseline and Health Disparities Report People with Disabilities. Chapter outline. Chapter Outline. Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Context Key points Data Demographic and socioeconomic data

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Healthiest Wisconsin 2020 Baseline and Health Disparities Report People with Disabilities

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  1. Healthiest Wisconsin 2020 Baseline and Health Disparities Report People with Disabilities

  2. Chapter outline Chapter Outline Background • Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report • Context • Key points Data • Demographic and socioeconomic data • Access to and use of health care services • Risk behaviors and health outcomes 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. Summary People with disabilities: context • Healthiest Wisconsin 2020 focuses on the elimination of health disparities. For the first time, people with disabilities are included in the plan as a population that experiences significant disparities in health and health care access. • People with disabilities can be healthy and well; however, many face social, structural and environmental barriers that restrict participation  in daily activities and/or access to care. • Gaining a better understanding of these barriers can assist public health, health care providers, and the public in reducing health disparities for people with disabilities.

  11. Key points Key Points: Adults with disabilities • One in six (16%) adults ages 18-64 and 28% of adults ages 65 and older in Wisconsin are living with a disability. • Compared to people without a disability, adults with a disability are more likely to: • Be low-income. • Have less access to health care. • Report higher health risk factors such as tobacco use, secondhand smoke exposure, obesity, and obesity-related chronic conditions. • The presence of a chronic condition, such as diabetes or asthma, may be the reason some people report having a disability.

  12. Key points Key Points: Children and youth with special health care needs (CYSHCN) • About 22% of Wisconsin children have a special health care need. • Compared to children and youth without a special health care need, CYSHCN: • Have more unmet medical/dental needs and more difficulty getting specialty care, despite being more likely to have a medical home and to receive preventive care. • Have two or more adverse childhood experiences (ACEs). • Have lower school attendance and engagement. • Parents of CYSHCN are: • More likely than other parents to be stressed and to have their work life affected by childcare issues. Source: National Survey of Children’s Health, 2011/2012.

  13. Adults living with a disability

  14. Demographic characteristics

  15. Demographic and socioeconomic data Percent of adults with disabilities by age group, Wisconsin, 2009-2011 Sources: American Community Survey, 2009-2011; Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 landline-cellphone combined dataset.

  16. Demographic and socioeconomic data Percent of Wisconsin adults ages 18-64 with disabilities, 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.

  17. Demographic and socioeconomic data Percent of Wisconsin adults ages 18-64 with disabilities, by income level, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

  18. Access to health care and health status

  19. Access to health care Use of and barriers to health care among Wisconsin adults ages 18-64, by disability status, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.

  20. Health status Rates of fair or poor health by disability status, Wisconsin adults ages 18-64, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset Note: Health status questions only asked 2009-2011.

  21. Health risk factors and outcomes

  22. Physical activity Rate of physical inactivity among Wisconsin adults, by disability status, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.

  23. Nutrition Rates of overweight and obesity by disability status, Wisconsin adults ages 18-64, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.

  24. Chronic diseases Rates of diabetes by disability status, Wisconsin adults ages 18-64, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line 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.

  25. Chronic diseases Rates of high cholesterol and blood pressure by disability status, Wisconsin adults ages 18-64, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.

  26. Alcohol and other drug use Rates of binge drinking and heavy drinking by disability status, Wisconsin adults ages 18-64, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.

  27. Mental health Rate of Adverse Childhood Experiences (ACEs) by disability status, Wisconsin adults ages 18-64, 2010-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.

  28. Mental health Rates of insufficient sleep and emotional support by disability status, Wisconsin adults ages 18-64, 2008-2010 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.

  29. Oral health Rates of tooth removal and dental visits in the past year, by disability status, Wisconsin adults ages 18-64, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Tooth removal question asked in 2008, 2010, and 2011. Dentist visit question asked in 2008 and 2010.

  30. Tobacco use and exposure Smoking status among Wisconsin adults ages 18-64, by disability status, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset. Note: Menthol question was asked in 2009 and 2010; smokeless tobacco question was asked in 2009-2011.

  31. Tobacco use and exposure Secondhand smoke exposure among Wisconsin adults ages 18-64, by disability status, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset. Note: Smoking at work question was only asked in 2009 and 2010.

  32. Reproductive and sexual health HIV testing and risk behaviors among Wisconsin adults ages 18-64, by disability status, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 land-line only dataset.

  33. Immunizationamong older adults Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by disability status, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.

  34. Children and Youth with Special Health Care Needs (CYSHCN)

  35. Demographics Percentage of children with special health care needs, Wisconsin and the United States, 2011-2012 Source: National Survey of Children’s Health, 2011-2012

  36. Demographics Percentage of children with special health care needs, by age, Wisconsin, 2011-2012 Source: National Survey of Children’s Health, 2011-2012.

  37. Oral health Percentage of children with oral health needs, by disability status, Wisconsin, 2011-2012 Source: National Survey of Children’s Health, 2011-2012

  38. Nutrition Percentage of children ages 10-17, who are obese, by disability status, Wisconsin, 2011-2012 Source: National Survey of Children’s Health, 2011-2012

  39. Missed school Percentage of children ages 6-17 who missed school because of illness or injury, by disability status, Wisconsin, 2011-2012 Source: National Survey of Children’s Health, 2011-2012

  40. Mental health Percentage of children with parents who report usually or always feeling stressed from parenting and parents who have had to cut back hours or quit a job because of child care issues Source: National Survey of Children’s Health, 2011-2012

  41. Access to health care Percentage of children ages 6-17 covered by public health insurance and whose health insurance (public and/or private) was inadequate, by disability status, Wisconsin, 2011-2012 Source: National Survey of Children’s Health, 2011-2012

  42. Access to health care Percentage of children who saw health care providers for preventive medical and dental care during the past 12 months, Wisconsin, 2011-2012 Source: National Survey of Children’s Health, 2011-2012

  43. Access to health care Percentage of children who have a medical home and percentage of children who have problems getting specialist care, by disability status, Wisconsin, 2011-2012 Source: National Survey of Children’s Health, 2011-2012

  44. Tobacco use and exposure Percentage of children who live with someone who uses tobacco and are exposed to secondhand smoke at home, by disability status, Wisconsin, 2011-2012 Source: National Survey of Children’s Health, 2011-2012

  45. Mental health Percentage of children who had two or more adverse childhood experiences (ACEs), by disability status, Wisconsin, 2011-2012 Source: National Survey of Children’s Health, 2011-2012

  46. 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 • Where in health is disability? Public health practices to include people with disabilities, 2012: http://www.cdc.gov/about/grand-rounds/archives/2012/December2012.htm • 2011-2012 National Survey of Children’s Health, Sampling and Survey Administration, Child and Adolescent Health Measurement Initiative (2012): http://www.childhealthdata.org/docs/drc/2011-12-nsch-sampling-and-administration.pdf

  47. References • U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans Midcourse Report: Strategies to Increase Physical Activity Among Youth: http://www.health.gov/paguidelines/midcourse/pag-mid-course-report-final.pdf • CDC. Overweight and obesity among people with disabilities. http://www.cdc.gov/ncbddd/disabilityandhealth/documents/obesityfactsheet2010.pdf • CDC. Alcohol Use and Health. http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm • CDC. Adverse Childhood Experience Study. http://www.cdc.gov/ace • CDC. Insufficient sleep is a public health epidemic. http://www.cdc.gov/features/dssleep • CDC. Health-related quality of life: Well-being concepts. http://www.cdc.gov/hrqol/wellbeing.htm#four • CDC. Smoking and Tobacco Use: Secondhand Smoke Facts. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm • Health Resources and Services Administration (HRSA). 2009/10 NS-CSHCN: Health Conditions and Functional Difficulties. Data Resource Center: http://www.childhealthdata.org/docs/cshcn/2009-cshcn-conds-func-diff.pdf • HRSA. Fast Facts: 2011/12 National Survey of Children’s Health. http://childhealthdata.org/learn/NSCH

  48. References • Child and Adolescent Health Measurement Initiative (2002). Approaches to Identifying Children and Adults with Special Health Care Needs. http://cahmi.org/ViewDocument.aspx?DocumentID=120 • HRSA. Children with Special Health Care Needs in Context: A Portrait of States and the Nation 2007. http://mchb.hrsa.gov/nsch/07cshcn/moreinfo/pdf/cshcn11covintrotot.pdf • Felitti, et al., (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine - May 1998 (Vol. 14, Issue 4, Pages 245-258).

  49. References Links to additional reports and resources Wisconsin Department of Health Services (DHS): • Disabilities and Impairments, http://www.dhs.wisconsin.gov/disabilities/ • Children and Youth with Special Health Care Needs Program, http://www.dhs.wisconsin.gov/health/children/ Centers for Disease Control and Prevention (CDC) • Disability and Health Data System, http://dhds.cdc.gov/ • National Survey of Children with Special Health Care Needs, http://www.cdc.gov/nchs/slaits/cshcn.htm • Families with Special Needs, http://www.cdc.gov/family/specialneeds/ University of Wisconsin-Madison, Waisman Center http://www.waisman.wisc.edu/about.htm

  50. Contacts Contacts Bureau of Community Health Promotion Division of Public Health Department of Health Services Sharon Fleischfresser, MD, MPH Medical Director Children and Youth with Special Health Care Needs Program Email: Sharon.Fleischfresser@dhs.wisconsin.gov Elizabeth Oftedahl, MPH CYSHCN Epidemiologist Maternal and Child Health Program Family Health Section Email: Elizabeth.Oftedahl@dhs.wisconsin.gov Jessica Seay, MPH State Systems Development Initiative Coordinator Maternal and Child Health Program Family Health Section Email: Jessica.Seay@dhs.wisconsin.gov

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