Healthiest Wisconsin 2020 Baseline and Health Disparities Report
Healthiest Wisconsin 2020 Baseline and Health Disparities Report Black Population Wisconsin Department of Health Services January 2014 P-00522 Q
BLACK POPULATION Chapter outline Chapter Outline Background • Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report • Key points Data • • • Demographic and socioeconomic data Access to health care Overall health and mental health Risk behaviors Chronic disease outcomes Reproductive and sexual health References Links to additional reports and resources Contacts 2
BLACK POPULATION Report overview Report Overview • This chapter is part of a larger report created by the Wisconsin Department of Health Services to track the progress on 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
BLACK POPULATION 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
BLACK POPULATION 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
BLACK POPULATION 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 services 6
BLACK POPULATION 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
BLACK POPULATION 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
BLACK POPULATION 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
BLACK POPULATION Report overview Historical trauma • Historical trauma is the cumulative exposure to traumatic events that not only affect the individual exposed, but continue to affect subsequent generations. • Descendants of those who experienced the traumatic stressor may still exhibit symptoms. • Populations affected by historical trauma include American Indians, African Americans/Blacks, Hispanics/Latinos, Asians, immigrants and refugees, war veterans, and families experiencing intergenerational poverty. • Current manifestations may include: • Mistrust of health care, legal, and educational systems; • Higher rates of risk behaviors such as alcohol and drug abuse, suicide, homicide, and domestic violence; and • Higher rates of chronic diseases. Sources: SAMHSA, Fact Sheet: Historical Trauma http: //gainscenter. samhsa. gov/cms-assets/documents/93078 -842830. historical-trauma. pdf, Texas Department of Health Services, Trauma Informed Care Training, http: //www. dfps. state. tx. us/Training/Trauma_Informed_Care/page 35. asp 10
BLACK POPULATION Key points Key Points: Black population • Demographics: The Black population in Wisconsin is younger than the general population and is concentrated in the Southeastern part of the state. • Socioeconomic status: Blacks in Wisconsin are more likely to live in poverty and less likely to have a college degree compared to Whites. • Access to health care: Blacks have lower rates of health insurance and dental care coverage, similar rates of cancer screening, and higher rates of doctor visits compared to Whites. 11
BLACK POPULATION Key points Key Points: Black population Health risk behaviors and outcomes: Blacks face significant health disparities compared to Whites, and in some cases compared to other racial/ethnic groups. • Worse overall health and mental health outcomes. • Less of a sense of safety at school, neighborhood, and personal levels. • Higher rates of risk behaviors that bear upon chronic disease, such as obesity, lack of exercise, and smoking, but lower rates of binge drinking. 12
BLACK POPULATION Key points Key Points: Black population Health risk behaviors and outcomes (continued): • Worse chronic disease outcomes, including for stroke, diabetes, high cholesterol, and asthma. • Higher rates of cancer incidence and mortality. • Higher rates of reproductive and sexual risk behaviors and outcomes, including unintended pregnancies, sexually transmitted diseases, and HIV. • Higher infant mortality rates, despite a significant decrease in recent years. 13
BLACK POPULATION Demographic and socioeconomic data 14
BLACK POPULATION Demographics and socioeconomic data Demographic Characteristics • Wisconsin's Black population, 2010: 336, 056; 6. 2% of state total • Change in the Black population, 2000 to 2010: 20% increase • Median age, 2010: Black, 27 years (White, 41. 5 years) The median age is the age at which half the population is older and half is younger. • Percent of Blacks who are living with a disability, 2010: 28% (White, 21%) • Percent of Blacks who are foreign-born, 2010: 3% (Total population, 4%) Source: http: //www. dhs. wisconsin. gov/health/Minority. Health/Report. htm and U. S. Census Bureau. 15
BLACK POPULATION Demographics and socioeconomic data Socioeconomic data Wisconsin’s Black population has a higher poverty rate and less education compared to Whites. • Median household income in Wisconsin, 2008 -2010: Blacks, $27, 400 (Whites, $53, 000) • Poverty rate, 2010: Blacks, 39% (Whites, 10%) The poverty rate is the percent living below the federal poverty level. • Bachelor’s degree or more education (age 25 and older), 2007 -2010: Blacks, 14% (Whites, 27%) • Married couple households as a percent of family households, 2008 -2010: Blacks: 33% (other racial/ethnic groups range from American Indians, 52% to Whites, 82%) Source: http: //www. dhs. wisconsin. gov/health/Minority. Health/Report. htm and U. S. Census Bureau, American Community Survey. 16
BLACK POPULATION Demographics and socioeconomic data Black population by county, Wisconsin, 2010 Source: U. S. Census, 2010. 17
BLACK POPULATION Demographics and socioeconomic data Level of urbanization of Wisconsin residents, by race/ethnicity, 2007 -2011 Milwaukee County Smaller metropolitan counties Non-metropolitan counties 80% 70% 60% 50% 40% 30% 20% 10% 0% 11% 59% 30% 67% 28% 4% 12% 39% 49% 24% 66% 10% 37% 48% 15% White Black American Indian Asian Hispanic Source: American Community Survey, 2007 -2011. . 18
BLACK POPULATION Access to health care 19
BLACK POPULATION Access to health care Lack of health insurance coverage and Medicaid enrollment among Wisconsin adults, by race/ethnicity, 2008 -2011 60% White Black Hispanic American Indian 50% 40% 30% 20% 10% 0% 13% 19% 35% 19% No health insurance coverage, ages 18 -64 12% 39% 21% 27% Receive Medicaid or Badger. Care, all adults 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. 20
BLACK POPULATION Access to health care Public health insurance coverage and inadequacy of health insurance among children ages 6 -17, by race/ethnicity, Wisconsin, 2011 -2012 100% White 90% Black 80% Hispanic 70% 60% 50% 40% 30% 20% 10% 0% 27% 71% Public insurance 51% 26% 22% Current insurance not adequate Source: 2011 -2012 National Survey of Children's Health. Note: Wisconsin estimates were only available for White, Black, and Hispanic children. 21
BLACK POPULATION Access to health care Lack of routine preventive medical and dental care among children, by race/ethnicity, Wisconsin, 2011 -2012 70% White Black 60% Hispanic 50% 40% 30% 20% 10% 0% 30% 42% 41% Did not receive routine preventive medical and dental care during the past 12 months Source: 2011 -2012 National Survey of Children's Health. Note: Wisconsin estimates were only available for White, Black, and Hispanic children. 22
BLACK POPULATION Access to health care Age-adjusted rates of use of and barriers to health care among Wisconsin adults, by race/ethnicity, 2008 -2011 60% White Black Hispanic Asian American Indian 50% 40% 30% 20% 10% 0% 35% 21% 33% 25% 33% 16% 20% 17% 16% Did not have a doctor's visit in past year Do not have a personal doctor 10% 18% 20% 21% Unable to obtain medical care due to cost 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. 23
BLACK POPULATION Access to health care Emergency room utilization among Wisconsin residents, by race/ethnicity, 2008 -2010 40% White Black Hispanic Asian American Indian 35% 30% 25% 20% 15% 10% 5% 0% 15% 23% 16% 6% 19% Treated in emergency room during past year Source: Wisconsin Department of Health Services, Family Health Survey, 2008 -2010. 24
BLACK POPULATION Physical health and safety and mental health 25
BLACK POPULATION Physical health Age-adjusted indicators of poor health status among Wisconsin adults by race/ethnicity, 2008 -2011 100% 90% 80% 70% White Black Hispanic Asian American Indian 60% 50% 40% 30% 20% 10% 0% 12% 31% 23% 17% 35% 49% 42% 32% 46% 67% 68% 75% 78% 64% Fair or poor health Physical health not good on at Of those with at least one day of least one day during past month poor health, percent whose poor health limited usual activities on at least one day during past month 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. 26
BLACK POPULATION Environmental health Neighborhood environment of children less than 18 years of age, by race/ethnicity, Wisconsin, 2011 -2012 100% 90% 80% White Black Hispanic 70% 60% 50% 40% 30% 20% 10% 0% 55% 63% 55% 94% 61% 86% Children living in neighborhoods with sidewalks, Children living in neighborhoods their parents feel libraries, recreation centers, and parks* are usually or always safe Source: 2011 -2012 National Survey of Children's Health. *Neighborhoods that include all four of these amenities. Data were not available for other racial/ethnic groups. 27
BLACK POPULATION Injury and violence Perceptions of school safety among Wisconsin high school students, by race/ethnicity, 2007 -2011 30% 25% White Black Hispanic Asian American Indian 20% 15% 10% 5% 0% 3% 8% 7% Skipped school because felt unsafe 4% 12% 6% 12% Felt threatened at school 7% 21% 19% 13% Rarely feel safe from physical harm while at school Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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. 28
BLACK POPULATION Injury and violence Intentional injury deaths by race/ethnicity, age-adjusted rates per 100, 000, Wisconsin, 2008 -2010 25 White Black Hispanic Asian American Indian Rate per 100, 000 population 20 15 10 5 0 13. 5 7. 3 5. 9 Suicide 10. 1 16. 0 1. 5 19. 2 3. 8 2. 7 Homicide Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. 4. 8 29
BLACK POPULATION Injury and violence Partner violence among Wisconsin high school students, by race/ethnicity, 2007 -2011 50% White Black Hispanic Asian American Indian 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 7% 15% 8% 7% Hit by boyfriend or girlfriend in past 12 months 9% 12% 10% 9% 9% Ever forced into having sex Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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. 30
BLACK POPULATION Mental health Age-adjusted rate of four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by race/ethnicity, 2010 and 2011 40% White Black Hispanic 35% 30% 25% 20% 15% 10% 5% 0% 15% 23% 21% Four or more ACEs Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset Note: Question asked in 2010 and 2011. 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. 31
BLACK POPULATION Mental health Age-adjusted rate of frequent mental distress among Wisconsin adults, by race/ethnicity, 2009 -2011 40% White Black Hispanic American Indian 35% 30% 25% 20% 15% 10% 5% 0% 9% 18% 11% Frequent mental distress Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. Note: Question asked in 2009 -2011. 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. 32
BLACK POPULATION Mental health Depression among Wisconsin high school students by race/ethnicity, 2007 -2011 60% 50% White Black Hispanic Asian American Indian 40% 30% 20% 10% 0% 28% 28% 32% Felt sad/hopeless for at least 2 weeks and stopped doing usual activities Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS). Note: 95% confidence intervals are denoted by the error bars; larger confidence interval s may indicate less reliable estimates that should be interpreted with caution. 33
BLACK POPULATION Mental health Suicide risk during past 12 months among Wisconsin high school students by race/ethnicity, 2007 -2011 50% White Black Hispanic Asian American Indian 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 13% 17% 14% 20% 25% 10% 13% 22% Considered suicide Planned suicide 5% 12% 9% 16% Attempted suicide Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS). Note: 95% confidence intervals are denoted by the error bars; larger confidence interval s may indicate less reliable estimates that should be interpreted with caution. 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. 34
BLACK POPULATION Risk behaviors for chronic disease 35
BLACK POPULATION Physical activity and sedentary behaviors among Wisconsin high school students by race/ethnicity, 2007 -2011 White Black 100% Hispanic 90% Asian 80% American Indian 70% 60% 50% 40% 30% 20% 10% 0% 48%35%29%37%49% 55%43%46%54%54% 21%49%34%28%20% 19%26%25%31%24% Exercise 1+ hour, 5 Attended physical Watch 3+ hours of Play 3+ hours of out of 7 days education at least TV on average video/computer once in past 7 days school day games on average school day Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. 36
BLACK POPULATION Physical activity Age-adjusted rate of physical inactivity among Wisconsin adults, by race/ethnicity, 2008 -2011 White Black Hispanic Asian American Indian 60% 50% 40% 30% 20% 10% 0% 22% 37% 33% 28% 26% Did not participate in any physical activity in past month, other than at job Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset 37
BLACK POPULATION Nutrition Age-adjusted rates of overweight and obesity among Wisconsin adults, by race/ethnicity, 2008 -2011 100% White Black Hispanic Asian American Indian 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 63% 78% 67% 45% Overweight or Obese 71% 27% 44% 29% 38% Obese 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. 38
BLACK POPULATION Tobacco use and exposure Age-adjusted smoking rates among Wisconsin adults, by race/ethnicity, 2008 -2011 50% 45% 40% 35% White Black Hispanic American Indian 30% 25% 20% 15% 10% 5% 0% 29% 27% 34% Current smoker 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. . 39
BLACK POPULATION Tobacco use and exposure Rates of secondhand smoke exposure among Wisconsin adults, by race/ethnicity, 2008 -2011 60% 50% White Black Hispanic 40% 30% 20% 10% 0% 23% 39% 26% 30% Smoking allowed at home 13% 24% 15% 24% 12% 15% 36% Exposed to others' smoke at Smoking permitted at work home Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. Note: The smoking at work question was only asked in years 2009 and 2010. 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. 40
BLACK POPULATION Alcohol and other drug abuse Rates of current drinking, binge drinking, and marijuana use among Wisconsin high school students, by race/ethnicity, 2007 -2011 50% White Black Hispanic Asian 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 45% 30% 39% 34% 29% 8% 15% 9% 18% 33% 20% 14% Drank alcohol in last 30 days Binge drank in last 30 days Used marijuana in last 30 days Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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. 41
BLACK POPULATION Alcohol and other drug abuse Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by race/ethnicity, 2008 -2011 50% White Black Hispanic American Indian 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 25% 15% 21% Binge drinking 28% 9% 7% Heavy drinking 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. 42
BLACK POPULATION Chronic disease outcomes 43
BLACK POPULATION Environmental health Age-adjusted rates of asthma among Wisconsin adults, by race/ethnicity, 2008 -2011 30% White Black 25% Hispanic American Indian 20% 15% 10% 5% 0% 13% 23% 10% Have ever been told you have asthma 9% 16% 9% Currently have asthma 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. 44
BLACK POPULATION Environmental health Asthma hospitalizations by race/ethnicity, age-adjusted rate per 10, 000, Wisconsin, 2010 35. 0 30. 0 25. 0 20. 0 15. 0 10. 0 5. 0 0. 0 6. 1 31. 4 6. 6 12. 4 11. 3 8. 1 White Black Asian American Indian Hispanic Non-Hispanic Source: Wisconsin Inpatient Hospitalization Discharge file, 2010. Note: Race groups include both Hispanic and non-Hispanic people; Hispanics may include people of various races. 45
BLACK POPULATION Chronic diseases Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by race/ethnicity, 2008 -2011 25% White Black Hispanic American Indian 20% 15% 10% 5% 0% 7% 10% 16% Ever been diagnosed with diabetes 6% 7% 8% Ever been told you have prediabetes Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2. diabetes. 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. 46
BLACK POPULATION Chronic diseases Hospitalizations due to long-term complications from diabetes among Wisconsin adults, age-adjusted rate per 10, 000, by race/ethnicity, 2010 Age-adjusted rate per 10, 000 population, age 18 and older 30. 0 White Black 25. 0 Hispanic 20. 0 15. 0 10. 0 5. 0 0. 0 5. 6 26. 3 14. 9 Hospitalizations for long-term complications of diabetes Source: Wisconsin Inpatient Hospitalization Discharge file, 2010. Note: Hospitalization rates considered unreliable are excluded. 2. 0 7. 4 Hospitalizations for lower-extremity amputation among patients with diabetes 47
BLACK POPULATION Chronic diseases Incidence of end-stage renal disease incidence among Wisconsin adults, age-adjusted rate per 100, 000, by race/ethnicity, 2009 60. 0 Age-adjusted rate per 100, 000 population, ages 18 and older 50. 0 40. 0 White Black Hispanic 30. 0 20. 0 10. 0 8. 7 45. 1 44. 3 Incidence of end-stage renal disease with diabetes as primary diagnosis Source: United States Renal Data System (USRDS), Renal Data Extraction and Referencing (Ren. DER) System. Note: Incidence rates considered unreliable are excluded. 48
BLACK POPULATION Chronic diseases Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by race/ethnicity, 2009 and 2011 60% White Black Hispanic American Indian 50% 40% 30% 20% 10% 0% 31% 40% 28% 23% Ever been told you have high cholesterol 25% 39% 35% 38% Ever been diagnosed with high blood pressure Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. Note: Questions only asked in 2009 and 2011. Estimates that are unreliable (based on Relative Standard Error or small sample size) 49 are not shown; this means an estimate may not be presented for every population group.
BLACK POPULATION Chronic diseases Age-adjusted rate of arthritis among adults, and percent of those with arthritis whose activity is limited due to joint pain, by race/ethnicity, 2009 -2011 80% White Black Hispanic American Indian 70% 60% 50% 40% 30% 20% 10% 0% 23% 29% 23% 40% 50% 39% Ever been told you have some form of arthritis Among those with arthritis, percent whose activity is limited due to joint pain Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. Note: Arthritis question was asked in 2009 -2011. Question about limited activity due to joint pain question was asked in 2009 and 2011. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate 50 may not be presented for every population group.
BLACK POPULATION Chronic diseases Age-adjusted rate per 100, 000 population Cancer incidence and mortality (all sites) age-adjusted rate per 100, 000, by race/ethnicity, Wisconsin, 2010 White Black Hispanic Asian American Indian 600 500 400 300 200 100 0 436. 9 532. 3 322. 8 287. 7 503. 6 Incidence 171. 4 243. 9 95. 0 106. 2 229. 7 Mortality Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services; and National Center for Health Statistics, Wisconsin mortality file 1995 -2102, Vital Statistics Cooperative Program, 2013. Note: Racial groups include both Hispanics and non-Hispanics; Hispanics include all races. 51
BLACK POPULATION Chronic diseases Colorectal cancer mortality age-adjusted rate per 100, 000, by race/ethnicity, Wisconsin and United States, 2006 -2010 Age-adjusted rate per 100, 000 population 30 Wisconsin United States 25 20 15 10 5 0 14. 8 15. 9 23. 0 22. 8 9. 1 12. 7 4. 8 11. 2 13. 7 12. 6 White Black Hispanic Asian American Indian Source: National Center for Health Statistics. Wisconsin mortality data file 1995 -2010, Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races. 52
BLACK POPULATION Chronic diseases Female breast cancer mortality age-adjusted rate per 100, 000, by race/ethnicity, Wisconsin and United States, 2006 -2010 Age-adjusted rate per 100, 000 female population 40 Wisconsin United States 35 30 25 20 15 10 5 0 21. 1 22. 1 29. 1 30. 8 6. 7 14. 8 9. 8 11. 5 23. 2 12. 5 White Black Hispanic Asian American Indian Sources: Source: National Center for Health Statistics. Wisconsin mortality data file 1995 -2010, Vital Statistics Cooperative Program, 2013. Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races. 53
BLACK POPULATION Sexual risk and reproductive behaviors and health outcomes 54
BLACK POPULATION Reproductive and sexual health Estimated prevalence of sexual risk behaviors among Wisconsin high school students by race/ethnicity, 2007 -2011 100% White 90% Black 80% Hispanic Asian 70% American Indian 60% 50% 40% 30% 20% 10% 0% 39% 70% 43% 32% 50% Ever had sexual intercourse 2% 18% 7% 29% 47% 35% 20% 35% 9% 28% 12% 9% 20% Had intercourse before Intercourse in last three Four or more lifetime age 13 months partners Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined 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. 55
BLACK POPULATION Reproductive and sexual health Births to teens ages 15 -19 as a percent of all births, by race/ethnicity, Wisconsin, 2000 -2010 30% 2000 2010 Percent of all births 25% 20% 15% 10% 5% 0% 25% 20% 22% 16% 19% 13% 24% 12% 7% 5% 6% 3% Black American Indian Hispanic Laotian/Hmong White Other Asian Source: Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics: Births to Teens in Wisconsin, 2010. 56 January 2012.
BLACK POPULATION Healthy growth and development Unintended pregnancy as a percent of births, by race/ethnicity, Wisconsin, 2009 -2011 80% White Black 70% Hispanic 60% 50% 40% 30% 20% 10% 0% 32% 65% 43% Percent of births in which pregnancy was unintended Source: Wisconsin Department of Health Services, Division of Public Health, PRAMS, 2009 -2011. 57
BLACK POPULATION Healthy growth and development Percentage of births to mothers who received prenatal care during the first trimester, by race/ethnicity, Wisconsin, 2010 100% White Black Hispanic Laotian/Hmong American Indian 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 88% 74% 75% 66% 72% Prenatal care during first trimester Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates. 58
BLACK POPULATION Healthy growth and development Percentage of low birthweight (<5. 5 pounds) births, by maternal race/ethnicity, Wisconsin, 2008 -2010 20% White Black Hispanic Laotian/Hmong American Indian 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 6. 0% 13. 7% 6. 1% 7. 1% 6. 8% Low birthweight Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates. 59
BLACK POPULATION Healthy growth and development Infant mortality by race/ethnicity, rate per 1, 000 births, Wisconsin, 2001 -2010 25 Black American Indian Laotian/Hmong Hispanic White Rate per 1, 000 births 20 15 10 5 0 2002 2004 2006 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. 2008 2010 60
BLACK POPULATION Reproductive and sexual health Reported cases of selected sexually transmitted diseases, rate per 100, 000, by race/ethnicity, Wisconsin, 2010 676 White Black Hispanic Asian 46 17 American Indian 144 22 Gonorrhea 1, 859 25 621 144 377 222 5 1 Chlamydia Source: Wisconsin Department of Health Services, Sexually Transmitted Diseases Program. 3 2 Syphilis 61
BLACK POPULATION Reproductive and sexual health Rates of HIV testing and age-adjusted risk behaviors among Wisconsin adults, by race/ethnicity, 2008 -2011 100% White Black Hispanic American Indian 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 7% 29% 66% 41% 37% Ever been tested for HIV 2% Ever been in any HIV high-risk situations Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. Note: Testing rates are not age-adjusted; rates of exposure to high-risk situations are age-adjusted. 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. 62
BLACK POPULATION Reproductive and sexual health Estimated prevalence of HIV in selected demographic groups, ages 1559, by race/ethnicity, Wisconsin, as of December 31, 2012 Estimated HIV prevalence within demographic group 30% Black Hispanic White 27% 25% 20% 15% 10% Less than 1. 5% 7% 5% 3% 1. 2% 0. 4% 0. 2% 0. 7% 0. 2% 0. 0% Non-MSM males Females 0% MSM Demographic Group Source: Wisconsin Department of Health Services, Wisconsin HIV Surveillance System. Note: MSM = Men who have sex with men. The estimated prevalence is adjusted to account for the CDC’s estimate that 18% of HIV-infected persons are unaware of their infection and therefore not reported. The MSM population for each racial/ethnic group uses the CDC’s estimate that 4% of adult males are MSM 63
BLACK POPULATION References 1. 2010 Census Briefs: Blacks/African Americans. http: //www. census. gov/prod/cen 2010/briefs/c 2010 br-06. pdf 2. University of Wisconsin Population Health Institute. County Health Rankings, 2013. http: //www. countyhealthrankings. org/our-approach 3. Center for Urban Population Health. Milwaukee Health Report, 2011. http: //www. cuph. org/mhr/2011 -milwaukee-health-report. pdf 4. 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 5. 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/ 6. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http: //www. dhs. wisconsin. gov/publications/P 00187. pdf 7. CDC. Health Care: See Why Being Insured Matters. http: //www. cdc. gov/features/vitalsigns/Healthcare. Access/ 8. Gindi RM, Cohen RA, Kirzinger WK. Emergency room use among adults aged 18– 64: Early release of estimates from the National Health Interview Survey, January–June 2011. National Center for Health Statistics. May 2012. Available from: 64 http: //www. cdc. gov/nchs/nhis/releases. htm
BLACK POPULATION References 9. Kaiser Commission on Medicaid and the Uninsured. Next Steps in Covering Uninsured Children. Findings from the Kaiser Survey of Children’s Health Coverage. http: //kaiserfamilyfoundation. files. wordpress. com/2013/01/7844. pdf 10. CDC. Regular Check-Ups Are Important. http: //www. cdc. gov/family/checkup/ 11. RAND Corporation. The Evolving Role of Emergency Departments in the United States. http: //www. rand. org/content/dam/rand/pubs/research_reports/RR 200/RR 280/RAND_ RR 280. pdf 12. CDC. State Indicator Report on Physical Activity, 2010. http: //www. cdc. gov/physicalactivity/downloads/PA_State_Indicator_Report_2010. pdf 13. CDC. Understanding Teen Dating Violence. http: //www. cdc. gov/Violence. Prevention/pdf/Teen. Dating. Violence 2012 -a. pdf 14. CDC. Adverse Childhood Experiences Study. http: //www. cdc. gov/ace/ 15. O’Connor C, Finkbiner C, & Watson L. (2012). Adverse Childhood Experiences in Wisconsin: Findings from the 2010 Behavioral Risk Factor Survey. Madison, Wisconsin: Wisconsin Children’s Trust Fund and Child Abuse Prevention Fund of Children’s Hospital & Health System. http: //wichildrenstrustfund. org/index. php? section=adverse-childhood 16. Centers for Disease Control and Prevention (CDC). Self-Reported Frequent Mental Distress Among Adults --- United States, 1993— 2001. http: //www. cdc. gov/mmwr/preview/mmwrhtml/mm 5341 a 1. htm 65
BLACK POPULATION References 17. Office of Adolescent Health. Mental Health. http: //www. hhs. gov/ash/oah/adolescenthealth-topics/mental-health/home. html 18. Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. Journal of Adolescent Health. http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 2034364/ 19. CDC. Mortality Among Teenagers Aged 12 -19 Years: United States, 1999 -2006. http: //www. cdc. gov/nchs/databriefs/db 37. htm 20. National Institute of Mental Health. Many Teens Considering Suicide Do Not Receive Specialized Mental Health Care. 2012. http: //www. nimh. nih. gov/news/sciencenews/2012/many-teens-considering-suicide-do-not-receive-specialized-mental-healthcare. shtml 21. CDC. Adolescent and School Health: Physical Activity. http: //www. cdc. gov/healthyyouth/physicalactivity/facts. htm 22. CDC. Association Between Sedentary Behavior, Physical Activity, and Obesity: Inactivity Among Active Kids. http: //www. cdc. gov/pcd/issues/2009/jan/07_0242. htm 23. CDC: Physical Activity. http: //www. cdc. gov/physicalactivity/everyone/guidelines/index. html 24. National Cancer Institute: Menthol and Tobacco. http: //cancercontrol. cancer. gov/tcrb/research_topic-menthol. html 25. CDC. Smoking and Tobacco Use: Secondhand Smoke Facts. http: //www. cdc. gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_f acts/index. htm 66
BLACK POPULATION References 26. DHS. Bringing Everyone Along: A Strategic Plan to Eliminate Tobacco-Related Disparities in Wisconsin http: //www. dhs. wisconsin. gov/tobacco/pdffiles/DHSReport 2008 Low. Res. pdf 27. CDC. Underage Drinking. http: //www. cdc. gov/alcohol/fact-sheets/underagedrinking. htm 28. National Institute on Drug Abuse. Drug Facts: Marijuana. http: //www. drugabuse. gov/publications/drugfacts/marijuana 29. DHS. Burden of Asthma in Wisconsin, 2010. http: //www. dhs. wisconsin. gov/eh/asthma/pdf/Burdenof. Asthma 2010 Web. pdf 30. Agency for Healthcare Research and Quality (AHRQ). Diabetes mellitus: hospital admission rate for long-term complications. http: //www. qualitymeasures. ahrq. gov/content. aspx? id=38559 31. National Institute of Diabetes and Digestive and Kidney Disease. National Diabetes Statistics, 2011. http: //diabetes. niddk. nih. gov/dm/pubs/statistics/ 32. Ward MM, et al. Access to care and the incidence of end-stage renal disease due to diabetes. http: //care. diabetesjournals. org/content/32/6/1032. full. pdf+html 33. Siegel R, et al. Cancer Statistics, 2013. A Cancer Journal for Clinicians. http: //onlinelibrary. wiley. com/doi/10. 3322/caac. 21166/pdf 34. CDC. Vital Signs: Racial Disparities in Breast Cancer Severity — United States, 2005 – 2009. http: //www. cdc. gov/mmwr/preview/mmwrhtml/mm 6145 a 5. htm? s_cid=mm 6145 a 5_w 67
BLACK POPULATION References 35. Journal of the National Cancer Institute. Racial and Ethnic Disparities in the Receipt of Cancer Treatment. http: //jnci. oxfordjournals. org/content/94/5/334. long 36. National Cancer Institute. Fact Sheet: Cancer Health Disparities. http: //www. cancer. gov/cancertopics/factsheet/disparities/cancer-health-disparities 37. CDC. Basic Information about Colorectal Cancer. http: //www. cdc. gov/cancer/colorectal/basic_info/index. htm 38. White A, et al. Racial Disparities in Colorectal Cancer Survival: To What Extent Are Racial Disparities Explained by Differences in Treatment, Tumor or Hospital Characteristics? http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 2946464 39. Loconte NK, et al. Increasing disparity in colorectal cancer incidence and mortality among African Americans and Whites: A state's experience. http: //www. ncbi. nlm. nih. gov/pubmed/21712962 40. Perdue DG, et al. Regional differences in colorectal cancer incidence, stage, and subsite among American Indians and Alaska Natives, 1999 -2004. http: //onlinelibrary. wiley. com/doi/10. 1002/cncr. 23726/abstract 41. CDC. Sexual and Reproductive Health of Persons Aged 10– 24 Years. http: //www. cdc. gov/healthyyouth/sexualbehaviors/srh. htm 42. CDC. Birth Rates for the United States: Teenagers Reach Historic Lows for All Age and Ethnic Groups. http: //www. cdc. gov/nchs/databriefs/db 89. pdf 68
BLACK POPULATION References 43. National Center for Health Statistics. Child Trends analysis of 1990 -2009 Natality microdata files from Centers for Disease Control and Prevention. http: //datacenter. kidscount. org/data/acrossstates/Rankings. aspx? loct=3&by=v&order =d&ind=4&dtm=252&tf=38 44. CDC. Unintended Pregnancies. http: //www. cdc. gov/reproductivehealth/Unintended. Pregnancy/ 45. CDC. During Pregnancy. http: //www. cdc. gov/pregnancy/during. html 46. CDC. Is low birthweight a health problem? http: //www. cdc. gov/pednss/how_to/interpret_data/case_studies/low_birthweight/what. htm 47. CDC. PNSS Health Indicators. http: //www. cdc. gov/pednss/what_is/pnss_health_indicators. htm#Smoking/Drinking Indicators 48. National Center for Health Statistics. National Vital Statistics Reports. Deaths: Preliminary Data for 2010. http: //www. cdc. gov/nchs/data/nvsr 60/nvsr 60_04. pdf 49. U. S. Department of Health and Human Services. Infant Mortality Fact Sheet. http: //www. hhs. gov/news/factsheet/infant. html 50. Lieb S, et al. Statewide estimation of populations of MSM in the United States. Public Health Reports 2011; 126(1): 60– 72. 51. CDC. HIV in the United States: At A Glance, 2013. http: //www. cdc. gov/hiv/resources/factsheets/PDF/stats_basics_factsheet. pdf 69
BLACK POPULATION Links to additional reports and resources • Centers for Disease Control and Prevention, Minority Health, Black or African American Populations: http: //www. cdc. gov/minorityhealth/populations/REMP/black. html • U. S. Department of Health and Human Services, Office of Minority Health, African Americans: http: //www. minorityhealth. hhs. gov/templates/browse. aspx? lvl=3&lvlid=23 70
BLACK POPULATION Contacts Evelyn Cruz, Minority Health Officer Wisconsin Division of Public Health, Office of Policy and Practice Alignment E-mail: Evelyn 2. Cruz@dhs. wisconsin. gov Karl Pearson, Demographer Wisconsin Division of Public Health, Office of Health Informatics E-mail: Karl. T. Pearson@dhs. wisconsin. gov 71
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