Healthiest Wisconsin 2020 Baseline and Health Disparities Report
Healthiest Wisconsin 2020 Baseline and Health Disparities Report Communicable Disease Prevention and Control Wisconsin Department of Health Services January 2014 P-00522 F
COMMUNICABLE DISEASE Chapter outline Chapter Outline Background • Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report • Healthiest Wisconsin 2020 objectives and indicators • Rationale • Key points Data • Immunization among youth • Immunization among older adults • Incidence of communicable diseases References Links to additional reports and resources Contacts 2
COMMUNICABLE DISEASE 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 (HW 2020) and identify health disparities in the state. The full report is available at: http: //www. dhs. wisconsin. gov/publications/P 0/p 00522. pdf • The report is designed to address the Health Focus Areas in HW 2020. 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/P 0/p 00522 y. pdf 3
COMMUNICABLE DISEASE Report Format Report overview Sample annotated slide Full Report • Format: PDF • Intended use: reference document Chapters • Format: Annotated Power. Point slide set • Intended uses: presentations to – – Decision-makers Service providers Community leaders The public 4
COMMUNICABLE DISEASE 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 5
COMMUNICABLE DISEASE Report overview Report Outline: Detail Section 3: Health focus areas • • • Alcohol and other drug use Chronic disease prevention and management Communicable diseases Environmental and occupational health Healthy growth and development Injury and violence Mental health Nutrition and healthy foods Oral health Physical activity Reproductive and sexual health Tobacco use and exposure Section 4: Infrastructure focus areas • Access to health care 6
COMMUNICABLE DISEASE Report overview Report Outline: Detail Section 5: Data summaries by population Racial/ethnic minority populations o American Indians o Asians o Blacks o Hispanics People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography 7
COMMUNICABLE DISEASE 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/P 0/p 00522 y. 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. 8
COMMUNICABLE DISEASE 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 9
COMMUNICABLE DISEASE HW 2020 objectives Healthiest Wisconsin 2020 objectives and indicators Objective 1 By 2020, protect Wisconsin residents across the life span from vaccinepreventable diseases through vaccinations recommended by the U. S. Advisory Committee on Immunization Practices (ACIP). Objective 1 Indicator • Proportion of population fully immunized according to ACIP recommendations among children aged 0 -12 years, teens aged 13 -17 years, and adults aged 18 years and older. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Communicable Disease Focus Area Profile. 10
COMMUNICABLE DISEASE HW 2020 objectives Healthiest Wisconsin 2020 objectives and indicators Objective 2 By 2020, implement strategies focused to prevent and control reportable communicable diseases and reduce disparities among populations with higher rates. Objective 2 Indicator • Population-specific incidence rates of reportable conditions by race and ethnicity, sexual identities and orientations, gender identities, educational or economic status, and other characteristic associated with health disparities. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Communicable Disease Focus Area Profile. 11
COMMUNICABLE DISEASE Rationale • Communicable diseases (infectious diseases) are illnesses caused by bacteria, viruses, fungi, or parasites that may be transmitted from human to human or from animal to human. • Advances in clean water, refrigeration, and sanitation, and the development of safe and effective vaccines, have greatly reduced the threat of communicable diseases; however, common diseases still cause outbreaks and new communicable diseases emerge. • Vaccines protect more than the individual immunized; they prevent the spread of disease within the population. With persistently low adult immunization rates, new efforts are needed to encourage vaccination across the life span and increase access in all communities to eliminate disparities in immunization rates. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Communicable Disease Focus Area Profile. 12
COMMUNICABLE DISEASE Key points Immunization • In 2011, for most age groups, vaccination rates for children living in Wisconsin were comparable to or higher than those of children nationally. o A higher percentage of Wisconsin children ages 19 -35 months living below poverty received the recommended vaccination coverage compared to their peers nationally. • During 2009 -2011, 65% of adults ages 65 and older received an influenza (flu) vaccination in the previous 12 months. o Low-income seniors had lower flu vaccination rates compared to middle- and high-income seniors. • During 2009 -2011, 73% of adults ages 65 and older had ever received a pneumonia vaccination. 13
COMMUNICABLE DISEASE Key points Key findings Incidence of disease • Since 2002, the incidence of meningococcal disease in Wisconsin has declined; however, disparities exist by race/ethnicity. • During 2007 -2010, the rates of infection of both Streptococcis pneumonieae and group B streptococcal (GBS) among Blacks and American Indians were considerably higher than among Whites. • During 2012, Blacks in Wisconsin had a higher rate of influenza hospitalization compared to other racial/ethnic groups. • Asians have the highest rates of Hepatitis B and Tuberculosis of any racial/ethnic group in Wisconsin. 14
COMMUNICABLE DISEASE Immunization among youth 15
COMMUNICABLE DISEASE Immunization among youth Vaccination coverage with recommended series among children ages 19 -35 months, Wisconsin and United States, 2011 100% Wisconsin United States 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 73% 79% Total 79% 76% At or above poverty Source: National Immunization Survey for Children, 2011. 87% 70% Below poverty 16
COMMUNICABLE DISEASE Immunization among youth Vaccination coverage with selected vaccines among adolescents ages 13 -17, Wisconsin and United States, 2011 100% Wisconsin 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 90% 75% 78% TDa. P* 71% Men. ACWY** Total 66% 53% HPV, 1 or more 46% 35% HPV, 3 or more Female only Source: National Immunization Survey for Teens, 2011. Note: * To protect against tetanus, diphtheria, and pertussis. ** To protect against meningococcal disease. 17
COMMUNICABLE DISEASE Immunization among youth Vaccination coverage with selected vaccines among adolescents ages 13 -17, by federal poverty level (FPL), Wisconsin and the United States, 2011 Wisconsin U. S. 100% 90% 80% Percent 70% 60% 50% 40% 30% 20% 10% 0% 91% 80% 81% At or above FPL Tdap 74% Below FPL 73% 71% At or above FPL 81% 69% Below FPL ≥ 1 Men. ACWY Source: National Immunization Survey for Teens, 2011. Note: * To protect against tetanus, diphtheria, and pertussis. ** To protect against meningococcal disease. 18
COMMUNICABLE DISEASE Immunization among older adults 19
COMMUNICABLE DISEASE Immunization among older adults Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by sex, 2009 -2011 100% Total Male Female 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 65% 63% 66% Flu vaccination in past 12 months 73% 68% 76% Ever received pneumonia vaccination Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009 -2011 landline-cellphone combined dataset. 20
COMMUNICABLE DISEASE Immunization among older adults Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by race/ethnicity, 2008 -2011 100% 90% 80% White Black Hispanic American Indian 70% 60% 50% 40% 30% 20% 10% 0% 67% 57% 66% 69% Flu vaccination in past 12 months 72% 64% 70% 75% Ever received pneumonia vaccination 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 21 may not be presented for every population group.
COMMUNICABLE DISEASE Immunization among older adults Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by household income, 2008 -2011 100% Low income (<$20, 000) Middle income ($20, 000 -$74, 999) 90% High income ($75, 000+) 80% 70% 60% 50% 40% 30% 20% 10% 0% 68% 73% Flu vaccination in past 12 months 69% 73% 65% Ever received pneumonia vaccination Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. 22
COMMUNICABLE DISEASE Immunization among older adults Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by level of urbanization, 2008 -2011 100% Milwaukee County Smaller metropolitan counties Non-metropolitan counties 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 70% 67% 65% Flu vaccination in past 12 months 74% 71% Ever received pneumonia vaccination Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. 23
COMMUNICABLE DISEASE Immunization among older adults Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by disability status, 2008 -2011 100% No disability Disability 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 65% 70% Flu vaccination in past 12 months 68% 78% Ever received pneumonia vaccination Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. 24
COMMUNICABLE DISEASE Incidence of communicable diseases 25
COMMUNICABLE DISEASE Incidence of communicable disease Meningococcal disease cases, Wisconsin, 2002 -2011 60 Number of cases 50 40 30 20 10 0 2002 Wisconsin bill passed Menactra licensed 2004 Booster dose recommended 2006 Year 2008 Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. 2010 26
COMMUNICABLE DISEASE Incidence of communicable disease Meningococcal disease by race/ethnicity, crude rate per 100, 000, Wisconsin, 2007 -2011 White Black Asian Rate per 100, 000 population 1. 20 1. 00 0. 80 0. 60 0. 40 0. 20 0. 00 0. 32 1. 00 0. 15 0. 74 Meningococcal disease Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. Note: Data were not available for Hispanics. 27
COMMUNICABLE DISEASE Incidence of communicable disease Haemophilis influenzae type B (Hib) cases in Amish and non. Amish children <5 years old, Wisconsin, 2002 -2011, (n=10 cases) Amish residents by county, Wisconsin, 2010 Non-Amish 30% 70% Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. Source: Clifford Grammich, Kirk Hadaway, Richard Houseal, Dale E. Jones, Alexei Krindatch, Richie Stanley, and Richard H. Taylor. 2012. 2010 U. S. Religion Census: Religious Congregations & Membership Study. Association of Statisticians of American Religious Bodies. 28
COMMUNICABLE DISEASE Incidence of communicable disease Incidence of invasive Streptocococcus pneumoniae and group B streptococcal (GBS) disease, Wisconsin, 2002 -2011 Streptococcus pneumoniae Streptococcal disease, group B (GBS) 700 600 Number of cases 500 400 300 200 100 0 2002 2004 2006 2008 Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. 2010 29
COMMUNICABLE DISEASE Incidence of communicable disease Confirmed cases of Streptocococcus pneumoniae and group B streptococcal (GBS) disease, rate per 100, 000, by race/ethnicity, Wisconsin, 2007 -2011 18 White Black Asian American Indian Rate per 100, 000 population 16 14 12 10 8 6 4 2 0 7. 0 14. 4 2. 8 17. 0 Streptococcus pneumoniae 4. 0 6. 9 1. 5 10. 0 Streptococcal disease, group B Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. Note: Data were not available for Hispanics. 30
COMMUNICABLE DISEASE Incidence of communicable disease Incidence of and mortality from invasive group B streptococcal (GBS) disease among infants less than 90 days old, by race/ethnicity, rates per 100, 000 live births, Wisconsin, 2002 -2011 140 White Black Rate per 100, 000 live births 120 100 80 60 40 20 0 38 130 Incidence 3 16 Mortality Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System. Note: Data were not available for other races/ethnicities. 31
COMMUNICABLE DISEASE Incidence of communicable disease Influenza hospitalizations by race/ethnicity, rate per 100, 000, Wisconsin, 2012 14 White Black Hispanic Asian American Indian Rate per 100, 000 population 12 10 8 6 4 2 0 4. 9 12. 4 4. 5 7. 8 1. 5 Influenza hospitalizations Source: Wisconsin Department of Health Services, Bureau of Communicable Diseases and Emergency Response, Wisconsin hospital inpatient database (unpublished data). Note: Racial groups include Hispanics. 32
COMMUNICABLE DISEASE Incidence of communicable disease Chronic hepatitis B cases by race/ethnicity, Wisconsin, 2010 -2012 White; 18. 4% American Indian, 0. 3% Hispanic; 2. 3% Asian; 42. 8% Black, 15. 7% Source: Wisconsin Electronic Disease Surveillance System (WEDSS), 2010 -2012. Note: Includes chronic hepatitis B virus cases, confirmed or probable. 33
COMMUNICABLE DISEASE Incidence of communicable disease Tuberculosis cases by race/ethnicity and foreign-born status, Wisconsin, 2006 -2012 180 160 Number of cases 140 120 Foreign-Born, Not Refugee Foreign-Born Refugee U. S. Born 100 80 60 40 20 0 White Black Hispanic Source: Wisconsin Electronic Disease Surveillance System (WEDSS), 2010 -2012. Asian American Indian 34
COMMUNICABLE DISEASE References 1. University of Wisconsin Population Health Institute. County Health Rankings, 2013. http: //www. countyhealthrankings. org/our-approach 2. Center for Urban Population Health. Milwaukee Health Report, 2011. http: //www. cuph. org/mhr/2011 -milwaukee-health-report. pdf 3. La. Veist 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%20 Economic% 20 Burden%20 of%20 Health%20 Inequalities%20 in%20 the%20 United%20 States. pdf 4. 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/PMC 1447186/ 5. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http: //www. dhs. wisconsin. gov/publications/P 00187. pdf 6. Centers for Disease. Control and Prevention (CDC). How Vaccines Prevent Disease. http: //www. cdc. gov/vaccines/vac-gen/howvpd. htm#why 7. Healthy People 2020. Immunization and Infectious Disease. http: //www. healthypeople. gov/2020/topicsobjectives 2020/overview. aspx? topic. Id=23 8. CDC. Preteen and Teen Vaccines. http: //www. cdc. gov/vaccines/who/teens/forparents. html 35
COMMUNICABLE DISEASE References 9. Pediatrics. Middle School Vaccination Requirements and Adolescent Vaccination Coverage. http: //pediatrics. aappublications. org/content/early/2012/05/02/peds. 20112641. full. pdf 10. Centers for Medicare and Medicaid Services. Immunizations. http: //www. cms. gov/Medicare/Prevention/Immunizations/index. html? redirect=/immuni zations/ 11. Wisconsin Department of Health Services (DHS). Meningococcal Disease Factsheet. http: //www. dhs. wisconsin. gov/publications/P 42072. pdf 12. DHS. Wisconsin Epi Express, April 2011. http: //www. dhs. wisconsin. gov/communicable/Wi. Epi. Express/PDFfiles/2011 WEE/2011 WEE 0420. pdf 13. National Foundation for Infectious Disease. Meningococcal Vaccination: Improving Rates in Adolescents and Reducing Racial, Ethnic and Socioeconomic Disparities. http: //stopmeningitis. nfidinitiatives. org/professional-resources/meningococcal-cta. pdf 14. CDC. Active Bacterial Core Surveillance (ABCs): Emerging Infections Program Network. http: //www. cdc. gov/abcs/reports-findings/survreports/mening 10. html 15. Wisconsin Department of Health Services. Haemophilus influenzae. http: //www. dhs. wisconsin. gov/immunization/hib. htm 16. CDC. The Pink Book: Haemophilus influenzae Type b. http: //www. cdc. gov/vaccines/pubs/pinkbook/hib. html 17. Pediatrics. Haemophilus influenzae Type b Disease Among Amish Children in Pennsylvania: Reasons for Persistent Disease http: //pediatrics. aappublications. org/content/108/4/e 60. full. pdf 36
COMMUNICABLE DISEASE References 18. Wisconsin Department of Health Services. Streptococcus pneumoniae, Invasive (Pneumococcal disease). http: //www. dhs. wisconsin. gov/publications/p 42093. pdf 19. Wisconsin Department of Health Services. Group B Streptococcal Infections (GBS), Invasive: http: //www. dhs. wisconsin. gov/publications/p 42049. pdf 20. CDC. The Pink Book: Pneumococcal disease. http: //www. cdc. gov/vaccines/pubs/pinkbook/pneumo. html 21. American Journal of Public Health. Socioeconomic and Racial/Ethnic Disparities in the Incidence of Bacteremic Pneumonia Among US Adults. http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 2936986/ 22. CDC. Group B Strep Prevention in Newborns. http: //www. cdc. gov/groupbstrep/about/prevention. html 23. The Mayo Clinic. Group B strep disease. http: //www. mayoclinic. com/health/group-bstrep/DS 01107/DSECTION=risk-factors 24. CDC. Perinatal Group B Streptococcal Disease After Universal Screening Recommendations—United States, 2003— 2005. http: //www. cdc. gov/mmwr/preview/mmwrhtml/mm 5628 a 1. htm 25. Wisconsin Department of Health Services. Influenza (Flu) http: //www. dhs. wisconsin. gov/communicable/influenza/ 26. World Health Organization (WHO). Hepatitis B. http: //www. who. int/mediacentre/factsheets/fs 204/en/ 27. WHO. Tuberculosis (TB). http: //www. who. int/topics/tuberculosis/en/ 37
COMMUNICABLE DISEASE Links to additional reports and resources • Wisconsin Immunization Program: http: //www. dhs. wisconsin. gov/immunization/index. htm • National Immunization Survey: http: //www. cdc. gov/nchs/nis. htm • Wisconsin Department of Health Services: Invasive bacteria. http: //www. dhs. wisconsin. gov/communicable/Invasive. Bacteria/Index. htm 38
COMMUNICABLE DISEASE Contacts Bureau of Communicable Diseases and Emergency Response Division of Public Health Wisconsin Department of Health Services Immunizations: Influenza: Stephanie Schauer, Ph. D Wisconsin Immunization Program Epidemiologist Email: Stephanie. Schauer@dhs. wisconsin. gov Tom Haupt, MS Influenza Surveillance Coordinator Wisconsin Department of Health Services Email: Thomas. Haupt@dhs. wisconsin. gov Dan Hopfensperger Wisconsin Immunization Program Director Email: Dan. Hopfensperger@dhs. wisconsin. gov Invasive Bacterial Disease: Tuberculosis: Susann Ahrabi-Fard, MS Communicable Disease Epidemiologist Email: Susann. Ahrabi. Fard@dhs. wisconsin. gov Lorna Will, RN, MA Director Tuberculosis Control Program Wisconsin Department of Health Services Email: Lorna. Will@dhs. wisconsin. gov 39
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