Chronic Disease in Missouri: Progress and Challenges

1. Chronic Disease in Missouri: Progress and Challenges Shumei Yun, MD, PhD Public Health Epidemiologist and Team Leader Chronic Disease and Nutritional Epidemiology Team Section of Epidemiology for Public Health Practices July 12, 2012

2. Acknowledgement • Chronic Disease and Nutritional Epidemiology Team (CDNET) members • Jiaqing Li, MD, PhD • Noaman Kayani, PhD • Dave McBride, PhD • Arthur Pashi, PhD • Janet Wilson, MEd, MPA • Sherri Homan, RN, FNP, PhD

3. Acronyms List • AA – African-American • BRFSS - Behavioral Risk Factor Surveillance System • CDC – Centers for Disease Control and Prevention • CLS – Missouri 2007 County-level Study • DHSS - Missouri Department of Health and Senior Services • F & V <5 - Fruit and vegetable consumption less than 5 times per day • HP2020 - Healthy People 2020 Objective • HS - High School • Low SES – Low Socioeconomic Status • MICA - Missouri Information for Community Assessment • MO – State of Missouri • PedNSS - Missouri Pediatric Nutrition Surveillance System • US – United States of America • WONDER – Wide-ranging Online Data for Epidemiological Research • YRBS - Youth Risk Behavior Survey • YTS - Youth Tobacco Survey

4. Chronic Diseases in the US • Almost 1 out of every 2 adults has at least one chronic illness. • Chronic diseases are the number one cause of death and disability in the US. • Treating patients with chronic diseases accounts for 75 percent of the nation’s health care spending.

5. Chronic Diseases in the US • Chronic diseases share major risk factors beyond genetics and social inequalities: • Tobacco use – Unhealthy diet • Physical inactivity – Heavy drinking • Lack of access to preventive care • The vast majority of cases of chronic disease could be better prevented or managed. • Some populations have a greater burden of chronic disease than others.

6. Leading Causes of DeathMissouri, 2009 Source: Missouri Department of Health and Senior Services, Missouri Information for Community Assessment

7. Heart Disease Mortality Rates*Missouri and US, 2000-2009 Source: Missouri Information for Community Assessment, CDC-WONDER *Age-adjusted using 2000 US standard population

8. Heart Disease Mortality Rates* By Race and Sex Missouri, 2000-2009 Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population

9. Cerebrovascular Disease Mortality Rates* Missouri and US Source: Missouri Information for Community Assessment, CDC-WONDER, HP2020 *Age-adjusted using 2000 US standard population

10. Cerebrovascular Disease Mortality Rates* By Race and Sex, Missouri, 2000-2009 Source: Missouri Information for Community Assessment *Age-adjusted using 2000 US standard population

11. Major Risk Factors for Cardiovascular Diseases • Behaviors • Tobacco use • Unhealthy diets • Physical inactivity • Heavy drinking • Chronic conditions/disease • Hypertension • Dyslipidemia • Obesity • Diabetes • Lack of chronic disease management and self-management

12. Risk Behaviors

13. Current Smoking Among Adults Missouri and US Source: Behavioral Risk Factor Surveillance System

14. Current Smoking among Adults By Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

15. Current Smoking Among Adults By Education Level, Missouri Source: Behavioral Risk Factor Surveillance System

16. Current Smoking Among AdultsBy Insurance Status, Missouri, 2007 Source: Missouri 2007 County-Level Study

17. Current Smoking Among Middle School StudentsBy Race, Missouri Source: Youth Tobacco Survey

18. Current Smoking Among High School Students Missouri and US Source: Youth Risk Behavior Survey

19. Current Smoking Among High School Students By Race, Missouri Source: Youth Tobacco Survey

20. Fruit and Vegetable Intake <5 Times Per Day Among Adults, Missouri and US Source: Behavioral Risk Factor Surveillance System

21. Fruit and Vegetable Intake <5 Times Per Day Among Adults, By Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

22. No Leisure-time Physical Activity Among Adults Missouri and US Source: Behavioral Risk Factor Surveillance System

23. No Leisure-time Physical Activity Among Adults By Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

24. Did not meet CDC Physical Activity Recommendations Among Adults Missouri and US Source: Behavioral Risk Factor Surveillance System

25. Did not meet CDC Physical Activity Recommendations Among AdultsBy Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

26. Heavy Drinking Among Adults Missouri and US Source: Behavioral Risk Factor Surveillance System

27. Heavy Drinking Among AdultsBy Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

28. Chronic Conditions

29. Prevalence of Hypertension Among Adults Missouri and US Source: Behavioral Risk Factor Surveillance System

30. Prevalence of Hypertension Among AdultsBy Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

31. Prevalence of High Cholesterol Among Adults Missouri and US Source: Behavioral Risk Factor Surveillance System

32. Prevalence of High Cholesterol Among AdultsBy Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

33. Prevalence of Obesity Among AdultsMissouri and US Source: Behavioral Risk Factor Surveillance System

34. Prevalence of Obesity Among AdultsBy Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

35. Prevalence of Obesity* Among Children aged 2 to 5 Years Enrolled in WIC, Missouri, 2009

36. Prevalence of Obesity Among Middle School Students Missouri Source: Youth Tobacco Survey

37. Prevalence of Obesity Among Middle School Students By Race and Sex, Missouri Source: Youth Tobacco Survey

38. Prevalence of Obesity Among High School Students Missouri and US Source: Youth Risk Behavior Survey

39. Prevalence of Obesity Among High School StudentsBy Race, Missouri Source: Youth Risk Behavior Survey

40. Prevalence of Diabetes Among AdultsMissouri and US Source: Behavioral Risk Factor Surveillance System

41. Prevalence of Diabetes Among AdultsBy Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

42. Education, Risk Behaviors and Health Conditions Missouri, 2010 Source: Behavioral Risk Factor Surveillance System

43. Chronic Disease Self-management

44. Ever Attended a Diabetes Self-management Class Among Adults with Diabetes Missouri and US Source: Behavioral Risk Factor Surveillance System

45. Ever Attended a Diabetes Self-management Class Among Adults with Diabetes By Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

46. Daily Self-Monitoring of Blood GlucoseAmong Adults with DiabetesMissouri and US Source: Behavioral Risk Factor Surveillance System

47. Daily Self-Monitoring of Blood GlucoseAmong Adults with DiabetesBy Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

48. Ever Taken a Course to Learn How to Manage Arthritis or Joint Symptoms Among Adults with Arthritis Missouri and US Source: Behavioral Risk Factor Surveillance System

49. Ever Taken a Course to Learn How to Manage Arthritis or Joint Symptoms Among Adults with ArthritisBy Race and Sex, Missouri Source: Behavioral Risk Factor Surveillance System

50. Current Smoking Among Adults with Chronic Disease Missouri 2008-2010