Risky Business: Setting the stage with regional data

1. Risky Business:Setting the stage with regional data Improving Data & Enhancing Access (IDEA-NW) Project Sujata Joshi, Project Director sjoshi@npaihb.org 503-416-3261 Airway Heights, WA 5/14/2013

2. Quiz Rank these health events in order of importance for American Indians/Alaska Natives in Washington: • Cancer • STDs • Diabetes • Suicide • Unintentional injuries • Sexual Assault IT DEPENDS! Northwest Portland Area Indian Health Board

3. Same data, different story? Data source: CDC WISQARS (http://www.cdc.gov/injury/wisqars/index.html) Northwest Portland Area Indian Health Board

4. Northwest Portland Area Indian Health Board

5. Incidence and Prevalence Incidence Prevalence Existing cases in a population at a given point in time Often measured as “percent” Examples: STDs, Diabetes, Smoking • New cases in a population per year • Often measured as a rate - “per 100,000” • Examples: Deaths, Cancer, Injuries, STDs Northwest Portland Area Indian Health Board

6. Which is it…? • Number of AI/AN breast cancer diagnoses in 2009 in Washington • Incidence • Number of car crash deaths in Whatcom County in 2011 • Incidence • Number of AI/ANs living with HIV in the U.S. • Prevalence • Number of highschoolers at Chemawa Indian School who started smoking during the 2012-2013 school year • Incidence Northwest Portland Area Indian Health Board

7. Regional data Northwest Portland Area Indian Health Board

8. Cancer • The second leading cause of death for American Indians in Washington • For all cancer sites, AI/AN had lower incidence rates but higher mortality rates compared to non-Hispanic Whites in Washington • Leading cancer sites: • Breast (in women) • Prostate (in men) • Lung and bronchus • Colorectal • Blood Cancers Data source: Washington State Cancer Registry & IDEA-NW Project Northwest Portland Area Indian Health Board

9. Diabetes • Affects 12-14% of AI/AN in Washington • AI/AN diabetics in Washington: • 2x higher death rate than non-Hispanic Whites • Less likely to have a regular healthcare provider than other groups Data source: WADOH. Washington State Diabetes Disparities, 2006. Northwest Portland Area Indian Health Board

10. STDsand HIV/AIDS Data source: a CDC WONDER, Sexually Transmitted Diseases Interactive Data; b HIV/AIDS Epidemiology Unit, Seattle/King County/WADOH. HIV/AIDS Epidemiology Report, First Half 2012: Vol. 80. • STDs a • 3x higher rates for some STDS • Higher burden among women • HIV/AIDS b • ~1% of incident and prevalentcases in Washington (lower than other groups) • Higher burden among men Northwest Portland Area Indian Health Board

11. Unintentional Injuries • Leading cause of death for AI/AN between the ages of 1-54 • Higher rates compared to ID and OR, largest disparity when compared to white population • Driven by: • Motor Vehicle Crashes • Accidental Poisonings • Falls (among elderly) Data source: NPAIHB. Northwest American Indian and Alaska Native Mortality Report, 2012. Northwest Portland Area Indian Health Board

12. Suicide • Suicides among AI/AN in Washington: • Young • Male • Used a firearm Data source: NPAIHB. Northwest American Indian and Alaska Native Mortality Report, 2012. Northwest Portland Area Indian Health Board

13. got risk?

14. Risk and preventive factors • A characteristic that increases (or decreases) a person’s chances of getting a disease or outcome • An association, but not necessarily a cause Northwest Portland Area Indian Health Board

15. Risk factors Smoking Physical activity Alcohol & drug use Genetics Helmet use Fruit & vegetable intake Condom use Obesity Gender Cancer screening Seatbelt & child safety seat use Health Outcomes Diabetes STDs Unintentional injuries Cardiovascular disease Cancer Suicide Northwest Portland Area Indian Health Board

16. Leading Causes vs. Actual Causes Northwest Portland Area Indian Health Board

17. In Washington… • AI/AN adults are more likely to be current smokers than other racial/ethnic groups in Washington (2010: 33% vs. 15% for the state as a whole).a • AI/AN youth are most likely to report smoking compared to other groups. b • AI/AN women were more likely to report smoking before pregnancy (41% vs. 20% for the state). b • Increased risk for smoking during pregnancy, or quitting and starting again The biggie . . . Tobacco Data sources: a. CDC 2010 BRFSS Data (accessed through Web-Enabled Analysis Tool). b. Health of Washington Report: Tobacco Use, 2012. Northwest Portland Area Indian Health Board

18. Bronchitis Emphysema Coronary Heart Disease Cirrhosis of the liver Low birth-weight babies SIDS Miscarriage Cardiovascular disease Pneumonia Impotence and Infertility Lip cancer Tongue cancer Gum cancer Larynx cancer Lung cancer Peptic ulcer Bladder cancer

19. Physical Activity 35.3%of NW Tribal respondents report an activity level meeting recommendations Data source: Health of Washington State Report: Physical Activity (2007) The CDC and the American College of Sports Medicine recommend that adults accumulate at least 30 minutes of moderate physical activity on at least five days per week or at least 20 minutes of vigorous activity on at least three days per week. Data source: NPAIHB, 2001 NW Tribal BRFSS Project, Aggregate Final Report Northwest Portland Area Indian Health Board

20. 2001 Northwest Tribal BRFSS Diet & nutrition 6.1% Data source: NPAIHB, 2001 NW Tribal BRFSS Project, Aggregate Final Report Five to nine servings of fruits and vegetables per day are recommended to reduce the risk of heart disease, diabetes, and certain types of cancers. --American Cancer Society Data source: Health of Washington State Report: Nutrition (2007) Northwest Portland Area Indian Health Board

21. Screening and preventive care 2010 Portland Area GPRA, IHS • For certain cancers, lack of appropriate screening is a big risk factor • Breast & cervical screening can detect pre-cancerous and cancerous conditions early • Colorectal screening can both detect cancer early and prevent cancer by removal of polyps (colonoscopy) 2010 IHS goal: 90% 2010 IHS goal: 70% 2010 IHS goal: 50% Northwest Portland Area Indian Health Board

22. Hooray for data! • Data inform our prevention/intervention efforts • Helps us understand: • The incidence/prevalence of health events in our communities • Which risk factors are associated with which health outcomes • The prevalence of modifiable risk factors in our communities • Prioritize our programs, policies, and dollars • Measure the impact of interventions • Data are a powerful tool to share with policymakers, community advocates, and funders Northwest Portland Area Indian Health Board

23. Data are not perfect • Surveillance data is collected at the state or national level • May not apply to every tribe or community • American Indians and Alaska Natives are not always classified correctly • Racial misclassification under-reports the impact of health events for AI/AN • You are the experts! Northwest Portland Area Indian Health Board

24. got data?