The Health of Harford County Presentation to UM Upper Chesapeake - - PowerPoint PPT Presentation

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The Health of Harford County Presentation to UM Upper Chesapeake - - PowerPoint PPT Presentation

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The Health of Harford County Presentation to UM Upper Chesapeake Health Russell Moy, MD, MPH, Health Officer September 19, 2018 Protecting the publics health: Emergency Preparedness The impact of cancer on the health of Harford

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The Health of Harford County

Presentation to UM Upper Chesapeake Health Russell Moy, MD, MPH, Health Officer September 19, 2018

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  • Protecting the public’s health:

Emergency Preparedness

  • The impact of cancer on the health of

Harford County residents

  • What are the other contributory factors

affecting the County’s health?

2
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How far is the Peach Bottom nuclear power plant from Bel Air, Maryland?

Distance between Peach Bottom plant in Delta, PA and downtown Bel Air, MD is: (A) 21 miles (B) 31 miles (C) 41 miles (D) 51 miles

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Peach Bottom Nuclear Power Station Delta, PA (21 miles from Bel Air, MD)

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Peach Bottom Nuclear Plant 10-mile Plume Exposure Emergency Planning Zone (EPZ)

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Front of Building – Main Parking Lot on Thomas Run Road

Mini Map

Harford Community College

P Reception Area

Back Driveway with Parking

Susquehanna Center Interior Layout

Clean traffic Dirty EMS Thyroid Check

R Chesapeake Center and parking Stadium and parking Tennis Courts

Side Driveway Side Driveway

Men’s Locker Rm Women’s Locker Rm Shelter Buses

R

Greeter ICS-Report Auxiliary Gym
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50-mile Ingestion Exposure Pathway Emergency Planning Zone (EPZ)

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How healthy are Harford County residents?

Of Maryland’s 24 jurisdictions, what is Harford County’s health ranking? (A) # 1 (most healthy) (B) # 8 (C) # 12 (D) # 16 (E) # 24 (least healthy)

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Health is not just medical care

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80%

  • f what influences your

health and life expectancy happens outside of the healthcare system

From Tony Iton, MD, “Is Your Zip Code More Important Than Your Zip Code,” 2015 lecture
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Health Outcomes Rankings

By Maryland Jurisdiction, 2018

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Montgomery Howard Carroll Calvert Frederick

  • St. Mary's

Anne Arundel Harford Queen Anne's Talbot Charles Worcester Baltimore Prince George's Garrett Kent Cecil Washington Wicomico Allegany Dorchester Caroline Somerset Baltimore City

8th Healthiest for Health Outcomes:

Birth outcomes Death rates Quality of life

Source: County Health Rankings, RWJF, 2018
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Health Factors Rankings

By Maryland Jurisdiction, 2018

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Howard Montgomery Carroll Frederick Calvert Queen Anne's Talbot Harford Anne Arundel

  • St. Mary's

Baltimore Charles Kent Garrett Worcester Prince… Washington Allegany Wicomico Cecil Caroline Dorchester Somerset Baltimore City

8th Healthiest for Health Factors:

Health behaviors Access to care Socio-economics Environment

Source: County Health Rankings, RWJF, 2017
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Harford County ranks 185th healthiest among the 3,000 counties nationwide

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What are the leading causes of mortality in Harford County?

What is the leading cause of death in Harford County in 2016? (A) Heart Disease (B) Cancer (C) Stroke (D) Chronic Obstructive Pulmonary Disease (E) Accidents

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What are the leading causes of mortality in Harford County?

What is the leading cause of death in Harford County in 2016? (A) Heart Disease (B) Cancer (C) Stroke (D) Chronic Obstructive Pulmonary Disease (E) Accidents

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Top 10 Causes of Death Harford County, 2016

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526 475 111 108 93 84 56 55 41 31

100 200 300 400 500 600 # of Deaths

Source: Maryland Vital Statistics, 2016 Source: * Maryland Drug and Alcohol-Related Intoxication Deaths, 2016
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SLIDE 19 223 201 200 190 188 184 181 180 175 172 170 169 168 168 165 165 164 163 162 162 153 153 152 148 128 118

50 100 150 200 250

Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/ 19

Cancer Mortality Rates

By Maryland Jurisdiction, 2011-2015

Harford County has the 14th highest mortality rate.

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Cancer Mortality Rates

Harford County & Maryland, 2012-2016

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172 168 171 166 169 167 164 162 159 157 150 160 170 180 2010-12 2011-13 2012-14 2013-15 2014-16 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates worse than the State.

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Cancer Mortality Rates, By Site

Harford County & Maryland, 2011-2015

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11.9 20.1 22.4 35.4 13.2 17.8 22.8 39.0 10 20 30 40 Colorectal Prostate Breast Lung Per 100,000 Population Harford Maryland

Harford County rates worse for most cancers than the State.

Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/
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Cancer Mortality Rates, By Race

Harford County & Maryland, 2011-2015

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169.1 181.2 160.0 182.8 150 160 170 180 190 White Black Age-Adjusted Rate Per 100,000 Population Harford Maryland

Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/
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SLIDE 23 530 505 491 489 487 486 480 479 477 476 471 465 462 462 457 446 442 442 441 441 436 435 409 406 402

300 350 400 450 500 550

Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/ 23

Cancer Incidence Rates

By Maryland Jurisdiction, 2011-2015

Harford County has the 3rd highest incidence rate.

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Cancer Incidence Rates, By Site

Harford County & Maryland, 2011-2015

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37.0 52.4 125.7 131.7 39.6 70.4 131.0 137.0 50 100 150 Colorectal Lung Prostate Breast Per 100,000 Population Harford Maryland

Harford County rates worse for than the State.

Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/
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Cancer Incidence Rates, By Race

Harford County & Maryland, 2011-2015

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494.5 500.5 453.1 444.5 400 450 500 550 White Black Age-Adjusted Rate Per 100,000 Population Harford Maryland

Age-Adjusted Rates Source: https://statecancerprofiles.cancer.gov/
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TERTIARY PREVENTION

Limiting the progression of disease

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SECONDARY PREVENTION

Percent Screened

Colorectal Cancer Screening Rates, Harford & Maryland, 2008-2014 Screening and Early Detection

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Preventing disease before it occurs

PRIMARY PREVENTION

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The Leading Actual Underlying Causes of Death

Source: Mokdad et al, “Actual Causes of Death in the U.S., 2000” JAMA, 3/19/2004
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The Rise and Decline of Cigarette Smoking

Source: AHRQ.gov
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Community Norms Have Changed Over the Past 50 Years

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There was a time when it seemed OK for babies …

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… and OK for kids…

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OK for future presidents …

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OK for doctors who preferred the toasted taste …

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OK for the Flintstones to light up in front of the kids …

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SLIDE 37 37 … but finally a culture change
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1950s-1970s Anti-Smoking Ads: Moralistic, Logical

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1980s-1990s Anti-Smoking Ads: Sharper Tone, More Emotional

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1990s-Present Anti-Smoking Ads:

Shock value to “break through the fog” of denial

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Maryland ranks 7th in adult smoking rates, 22nd in adolescent tobacco use rates

Source: CDC BRFSS Website 2016

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Adult Smoking Rates

Harford County & Maryland, 2012-2016

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21.7 16.9 18.9 20.7 16.7 16.2 16.4 14.6 15.1 13.7 10 20 30 2010-12 2011-13 2012-14 2013-15 2014-16 Percent Harford Maryland

Source: CDC Maryland Behavioral Risk Factor Surveillance System (BRFSS)

Harford County rates worse than the State.

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Adolescent Tobacco Use Rates*

Harford County & Maryland, 2010-2016

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26.8 20.2 19.2 14.9 24.8 16.9 16.4 23.0 10 20 30 2010 2013 2014 2016 Percent Harford Maryland

Harford County rates better than the State.

Source: Maryland Youth Risk Behavior Survey (YRBS) Note: Students, Gr 9-12 who smoked at least 1 cigarette in the past 30 days * Data gap between 2010-2013 and 2014-2016
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From Varvel, G, Indianapolis Star, 9.14.18

Teen smoking may be replaced with teen vaping one day

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Adolescent E-Vaping Rates

Harford County & Maryland, 2016

46 Source: Maryland Youth Risk Behavior Survey (YRBS), 2016 Note: Students, Gr 9-12 who drank at least 1 drink of alcohol in the past 30 days

14.3 13.3 5 10 15 Percent Harford Maryland

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Source: NPR.org, 9/15/18 and 4/18/14

Dangers of Synthetic Cannabinoids

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Synthetic Cannabinoid is Not Marijuana

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(a) (a) White te men (b) (b)White te women en (c) (c) Black ck men (d) (d)Black ck women en Since 1999, all of the following population groups in Harford County have reduced their death rates, EXCEPT:

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(a) White men: 12% decrease (b) (b)White te women: en: 9% increa rease se (c) Black men: 55% decrease (d)Black women: 34% decrease Since 1999, all of the following population groups in Harford County have reduced their death rates, EXCEPT:

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8/31/16

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Death Rate Change for White Women

Ages 45-54, Since 1999, By Maryland Jurisdiction

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  • 22 -17 -13 -9
  • 4
  • 3
  • 3
  • 3
  • 1

3 9 9 10 15 15 18 18 21 21 23 33 40 90

  • 40
  • 20

20 40 60 80 100 Montgomery Garrett Caroline Charles Queen Anne's Dorchester Talbot Kent Anne Arundel Wicomico Calvert Harford Baltimore City Worcester Frederick Baltimore County Cecil Carroll Somerset Howard Prince George's St Mary's Washington Allegany Percent Rate Change

Source: Keating, Elliott & Shapiro, “White women are dying faster all over America – but what about where your live?” Washington Post, 8/31/16
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Black mortality rates exceed White mortality rates by:

  • 13% for Cancer
  • 15% for Heart Disease
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Black : White Health Disparities Exist

Black E.D. visit rates exceed White E.D. visit rates by:

  • 35% for Addictions-Related
  • 46% for Alzheimer’s/dementia
  • 187% for Diabetes
  • 267% for High Blood Pressure
  • 306% for Asthma
Source: ship.md.networkofcare.org/ph/
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Which population group (ages 45-54) is dying at the fastest rate?

Source: Case and Deaton, “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century,” PNAS 12/8/15

US White US Hispanic U.S. White population has had a marked increase in all-cause mortality between 1999-2013.

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Are just people ages 45-54 dying faster?

U.S. White population, ages 30-64, are all dying at a faster rate.

Source: Case and Deaton, “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century,” PNAS 12/8/15
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Are both men and women dying faster?

U.S. White women are dying at a faster rate than men.

Source: Case and Deaton, “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century,” PNAS 12/8/15
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Why are people dying so fast?

Poisonings or drug and alcohol intoxication deaths are increasing the most.

Source: Case and Deaton, “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century,” PNAS 12/8/15
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SLIDE 60 Source: Case and Deaton, PNAS (Proceedings of the National Academy of Sciences), 12/8/15

New York Times, 11/2/15 “Death Rates Rising for Middle-Aged White Americans, Study Finds: Something startling is happening to middle-aged white Americans. Unlike every other age group, unlike every other racial and ethnic group, unlike their counterparts in other rich countries, death rates in this group have been rising, not falling . . .”

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SLIDE 61 61 Stein et al, AJPH, October 2017
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Drug-related deaths reach all-time high in 2017 In the U.S.

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Drug-related deaths reach all-time high in 2017 In Maryland

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Drug & Alcohol Intoxication Deaths

By place of occurrence, Harford County, 2013-2017

36 43 50 84 101

20 40 60 80 100 120 2013 2014 2015 2016 2017 Number of Deaths

All Drugs/Alcohol Heroin Fentanyl

Source: Maryland Vital Statistics: Drug- and Alcohol-Related Intoxication Deaths in Maryland
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Top 10 Causes of Death Harford County, 2016

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526 475 111 108 93 84 56 55 41 31

100 200 300 400 500 600 # of Deaths

Source: Maryland Vital Statistics, 2016 Source: * Maryland Drug and Alcohol-Related Intoxication Deaths, 2016
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Drug-Induced Mortality Rates

Harford County & Maryland, 2012-2016

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17.1 17.9 19.2 20.2 25.9 12.3 13.3 15.2 17.7 24.1 0.0 10.0 20.0 30.0 2010-12 2011-13 2012-14 2013-15 2014-16 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates increased by 51% over the past 5 years.

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Rate of Hospital Encounters for Newborns Born with Maternal Drug/Alcohol Exposure in Harford County and Maryland, 2000-2017*

4.5 5.6 8.8 5.1 5.9 12.6 12.1 9.5 12.3 19.916.9 29.6 26.4 36.7 29.1 28.5 38.0 35.0 11.8 11.3 12.4 11.9 10.2 12.6 13.1 13.3 14.5 14.7 16.0 17.6 18.621.0 20.4 22.8 33.3 31.0

10 20 30 40 Rate Exposed Per 1,000 Newborns Year Harford County Maryland

* 2017 DATA IS PRELIMINARY – Data compiled by MCHB/MDH. Chart prepared by HCHD. Source: HSCRC Hospital Data, 2000-17, Maryland resident births only, does not include Maryland resident births born out of state. 67 NOTE: ICD 9 Codes used 760.70, 760.71. 760.72, 760.73, 760.75, 760.77, 779.5 ICD 10 Codes used P04.3, P04.4, P04.41, P04.49, P04.8, P04.9, P96.1

Harford County rates increased by 268%

  • ver the past 10 years.
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The reason this epidemic is so deadly

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Short-term, Narcan (naloxone) spray can reverse an opioid overdose and save lives

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Intermediate-term, more substance use disorder medication treatment services are needed

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Intermediate-term, more substance use disorder crisis and care coordination services are needed

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Health consequences of drug misuse affect both mental and physical health

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Relationship between untreated substance abuse disorders and suicide

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Suicide is the top cause of death in young people, ages 15-29

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Suicide Mortality Rates

Harford County & Maryland, 2012-2016

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11.3 10.7 11.6 11.6 12.3 8.8 9.0 9.2 9.1 9.2 8 9 10 11 12 13 14 2010-12 2011-13 2012-14 2013-15 2014-16 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports

Harford County rates have increased by 9% over past 5 years.

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A Case Study: How the opioid epidemic sparked an HIV, hepatitis, and STD outbreak

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Harm reduction strategies helped turn around this HIV epidemic

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STDs have dramatically increased in the U.S.

  • ver the past 5 years
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Chlamydia Rates

Harford County & Maryland, 2013-2017

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173 189 280 321 322 481 459 457 510 552 100 200 300 400 500 600 700 2013 2014 2015 2016 2017 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports
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Gonorrhea Rates

Harford County & Maryland, 2013-2017

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22 30 51 62 84 101 102 114 158 181 100 200 2013 2014 2015 2016 2017 Per 100,000 Population Harford Maryland

* Age-Adjusted Rates Source: Maryland Vital Statistics Reports
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Chlamydia & Gonorrhea Cases by High School Attendance Area, Harford County, 2016-2017, Ages 15-19

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The opioid epidemic is also linked to the increase in Hepatitis C infections

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Hepatitis C is a Leading Cause of Liver Cancer

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HPV Vaccine Coverage

What percent of Maryland teens, ages 13- 17, have received at least one HPV vaccine? (A) 88.9% (B) 70.7% (C) 64.5% (D) 60.4% (E) 43.4%

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HPV Vaccine Coverage

What percent of Maryland teens, ages 13- 17, have received at least one HPV vaccine? (A) 88.9% - Rhode Island (B) 70.7% - Delaware (C) 64.5% - Maryland (D) 60.4% - U.S. average (E) 43.4% - Wyoming

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We know that smoking contributes to cancer…

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… but some of the most preventable cancers are caused by HPV …

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… and HPV can be prevented by a vaccine.

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Source: Widdice et al, “Prevalence of HPV in Young Women,” Archives of Pediatric and Adolescent Medicine, Aug 2012

HPV can be transmitted sexually, but also non-sexually

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Factor Harford 2017 Harford 2018 MD 2018 Harford Trend Premature death 5,900/100K 5,800/100K 6,500/100K Improving Low birthweight 7% 7% 9% Stable Food environment index 8.8 8.9 9.1 Improving Access to exercise 94% 97% 93% Improving Alcohol-driving deaths 24% 21% 30% Improving Teen births 15/1,000 12/1,000 21/1,000 Improving Uninsured 6% 4% 7% Improving Dentists 1,630:1 1,590:1 1,320:1 Improving Preventable hospital stays 50 490 47 Improving Diabetes monitoring 85% 85% 85% Stable Air pollution –particulate matter 10.9 10.9 9.5 Stable

Source: www.countyhealthrankings.org

In 2018, Harford County trend data has improved/stayed stable for 23 of 35

  • indicators. . .
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Source: www.countyhealthrankings.org

Factor Harford 2017 Harford 2018 MD 2018 Harford Trend High school graduation 90% 90% 87% Stable Some college 72% 72% 69% Stable Unemployment 5.0% 4.1% 4.3% Improving Children in poverty 10% 9% 13% Improving Income inequality index 4.0 4.0 4.6 Stable Children in single-parent house 28% 27% 34% Improving Social associations 7.9/10K 7.9/10K 8.9/10K Stable Violent crime 263/100K 263/100K 465/100K Stable Driving alone to work 83% 83% 74% Stable Long commute – driving alone 50% 50% 49% Stable Drinking water violations Yes Yes Yes Stable Severe housing problems 13% 13% 17% Stable

In 2018, Harford County trend data has improved/stayed stable for 23 of 35

  • indicators. . .
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Factor Harford 2017 Harford 2018 MD 2018 Harford Trend Adult smoking 14% 15% 14% Worsening Adult obesity 28% 29% 29% Worsening Physical inactivity 21% 23% 22% Worsening Excessive drinking 17% 18% 17% Worsening Sexually trans infections 189.8/100K 280.7/100K 459,3/100K Worsening Primary care physicians 1,630:1 1,680:1 1,140:1 Worsening Mental health providers 740:1 680:1 460:1 Worsening Injury deaths 61/100K 66/100K 64/100K Worsening Poor or fair health 12% 13% 14% Worsening Poor physical health days 3.1 days/mo 3.3 days/mo 3.1 days/mo Worsening Poor mental health days 3.5 days/mo 3.6 days/mo 3.5 days/mo Worsening Mammography screening 65% 64% 64% Worsening

Source: www.countyhealthrankings.org

…But 2018 Harford County trends have worsened for 12 of 35 health indicators

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September is National Recovery Month

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