Healthiest Wisconsin 2020 Baseline and Health Disparities Report
Healthiest Wisconsin 2020 Baseline and Health Disparities Report People with Disabilities Wisconsin Department of Health Services January 2014 P-00522 V
PEOPLE WITH DISABILITIES Chapter outline Chapter Outline Background • Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report • Context • Key points Data • Demographic and socioeconomic data • Access to and use of health care services • Risk behaviors and health outcomes References Links to additional reports and resources Contacts 2
PEOPLE WITH DISABILITIES 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
PEOPLE WITH DISABILITIES 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
PEOPLE WITH DISABILITIES 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
PEOPLE WITH DISABILITIES 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
PEOPLE WITH DISABILITIES 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
PEOPLE WITH DISABILITIES 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
PEOPLE WITH DISABILITIES 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
PEOPLE WITH DISABILITIES Summary People with disabilities: context • Healthiest Wisconsin 2020 focuses on the elimination of health disparities. For the first time, people with disabilities are included in the plan as a population that experiences significant disparities in health and health care access. • People with disabilities can be healthy and well; however, many face social, structural and environmental barriers that restrict participation in daily activities and/or access to care. • Gaining a better understanding of these barriers can assist public health, health care providers, and the public in reducing health disparities for people with disabilities. 10
PEOPLE WITH DISABILITIES Key points Key Points: Adults with disabilities • One in six (16%) adults ages 18 -64 and 28% of adults ages 65 and older in Wisconsin are living with a disability. • Compared to people without a disability, adults with a disability are more likely to: – Be low-income. – Have less access to health care. – Report higher health risk factors such as tobacco use, secondhand smoke exposure, obesity, and obesity-related chronic conditions. • The presence of a chronic condition, such as diabetes or asthma, may be the reason some people report having a disability. 11
PEOPLE WITH DISABILITIES Key points Key Points: Children and youth with special health care needs (CYSHCN) • About 22% of Wisconsin children have a special health care need. • Compared to children and youth without a special health care need, CYSHCN: – Have more unmet medical/dental needs and more difficulty getting specialty care, despite being more likely to have a medical home and to receive preventive care. – Have two or more adverse childhood experiences (ACEs). – Have lower school attendance and engagement. • Parents of CYSHCN are: – More likely than other parents to be stressed and to have their work life affected by childcare issues. Source: National Survey of Children’s Health, 2011/2012. 12
PEOPLE WITH DISABILITIES Adults living with a disability 13
PEOPLE WITH DISABILITIES Demographic characteristics 14
PEOPLE WITH DISABILITIES Demographic and socioeconomic data Percent of adults with disabilities by age group, Wisconsin, 2009 -2011 50% American Community Survey 45% Behavioral Risk Factor Survey 40% 35% 30% 25% 20% 15% 10% 5% 0% 12% 26% All Adults 9% 22% Ages 18 -64 32% 35% Ages 65+ Sources: American Community Survey, 2009 -2011; Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009 -2011 landline-cellphone combined dataset. 15
PEOPLE WITH DISABILITIES Demographic and socioeconomic data Percent of Wisconsin adults ages 18 -64 with disabilities, by race/ethnicity, 2008 -2011 40% White Black Hispanic American Indian 35% 30% 25% 20% 15% 10% 5% 0% 21% 28% 20% 24% 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. 16
PEOPLE WITH DISABILITIES Demographic and socioeconomic data Percent of Wisconsin adults ages 18 -64 with disabilities, by income level, 2008 -2011 70% Low income (<$20, 000) 60% Middle income ($20, 000 -$74, 999) 50% High income ($75, 000+) 40% 30% 20% 10% 0% 44% 20% 13% Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. 17
PEOPLE WITH DISABILITIES Access to health care and health status 18
PEOPLE WITH DISABILITIES Access to health care Use of and barriers to health care among Wisconsin adults ages 18 -64, by disability status, 2008 -2011 50% No disability 45% Disability 40% 35% 30% 25% 20% 15% 10% 5% 0% 38% 31% Did not have a doctor's visit in past year 19% 11% Do not have a personal doctor 10% 24% Unable to obtain medical care due to cost Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset. 19
PEOPLE WITH DISABILITIES Health status Rates of fair or poor health by disability status, Wisconsin adults ages 18 -64, 2008 -2011 60% 50% No disability Disability 40% 30% 20% 10% 6% 40% 0% Fair or poor health Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset Note: Health status questions only asked 2009 -2011. 20
PEOPLE WITH DISABILITIES Health risk factors and outcomes 21
PEOPLE WITH DISABILITIES Physical activity Rate of physical inactivity among Wisconsin adults, by disability status, 2008 -2011 50% 45% No disability Disability 40% 35% 30% 25% 20% 15% 10% 5% 0% 19% 36% 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 land-line only dataset. 22
PEOPLE WITH DISABILITIES Nutrition Rates of overweight and obesity by disability status, Wisconsin adults ages 18 -64, 2008 -2011 100% No disability Disability 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 61% 74% Overweight or Obese 25% 43% Obese Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset. 23
PEOPLE WITH DISABILITIES Chronic diseases Rates of diabetes by disability status, Wisconsin adults ages 18 -64, 2008 -2011 25% No disability Disability 20% 15% 10% 5% 0% 4% 14% Ever been diagnosed with diabetes 4% 10% Ever been told you have prediabetes Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Prediabetes question was only asked in years 2009 -2011. 24
PEOPLE WITH DISABILITIES Chronic diseases Rates of high cholesterol and blood pressure by disability status, Wisconsin adults ages 18 -64, 2009 and 2011 100% 90% No disability 80% Disability 70% 60% 50% 40% 30% 20% 10% 0% 29% 48% Ever been told you have high cholesterol 18% 39% Ever been diagnosed with high blood pressure Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset. 25
PEOPLE WITH DISABILITIES Alcohol and other drug use Rates of binge drinking and heavy drinking by disability status, Wisconsin adults ages 18 -64, 2008 -2011 50% No disability 45% Disability 40% 35% 30% 25% 20% 15% 10% 5% 0% 28% 19% Binge drinking 9% 8% Heavy drinking Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset. 26
PEOPLE WITH DISABILITIES Mental health Rate of Adverse Childhood Experiences (ACEs) by disability status, Wisconsin adults ages 18 -64, 2010 -2011 50% No disability 45% Disability 40% 35% 30% 25% 20% 15% 10% 5% 0% 14% 29% Four or more ACEs Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset. 27
PEOPLE WITH DISABILITIES Mental health Rates of insufficient sleep and emotional support by disability status, Wisconsin adults ages 18 -64, 2008 -2010 50% No disability 45% Disability 40% 35% 30% 25% 20% 15% 10% 5% 0% 20% 34% Insufficient sleep 14% 30% Sometimes, rarely, or never receive emotional support Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset. 28
PEOPLE WITH DISABILITIES Oral health Rates of tooth removal and dental visits in the past year, by disability status, Wisconsin adults ages 18 -64, 2008 -2011 100% No disability 90% Disability 80% 70% 60% 50% 40% 30% 20% 10% 0% 29% 52% Had at least 1 permanent tooth removed 26% 35% Did not visit dentist within past year Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 landline-only dataset. Note: Tooth removal question asked in 2008, 2010, and 2011. Dentist visit question asked in 2008 and 2010. 29
PEOPLE WITH DISABILITIES Tobacco use and exposure Smoking status among Wisconsin adults ages 18 -64, by disability status, 2008 -2011 50% No disability 45% Disability 40% 35% 30% 25% 20% 15% 10% 5% 0% 21% 35% Current smoker Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset. Note: Menthol question was asked in 2009 and 2010; smokeless tobacco question was asked in 2009 -2011. 30
PEOPLE WITH DISABILITIES Tobacco use and exposure Secondhand smoke exposure among Wisconsin adults ages 18 -64, by disability status, 2009 -2011 50% No disability 45% Disability 40% 35% 30% 25% 20% 15% 10% 5% 0% 21% 33% Smoking allowed at home 13% 23% Exposed to others' smoke at home 13% 11% Smoking permitted at work Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset. Note: Smoking at work question was only asked in 2009 and 2010. 31
PEOPLE WITH DISABILITIES Reproductive and sexual health HIV testing and risk behaviors among Wisconsin adults ages 18 -64, by disability status, 2008 -2011 50% No disability 45% Disability 40% 35% 30% 25% 20% 15% 10% 3% 5% 0% 31% 42% Ever been tested for HIV 5% Ever been in any HIV high risk situations Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008 -2011 land-line only dataset. 32
PEOPLE WITH DISABILITIES 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. 33
PEOPLE WITH DISABILITIES Children and Youth with Special Health Care Needs (CYSHCN) 34
PEOPLE WITH DISABILITIES Demographics Percentage of children with special health care needs, Wisconsin and the United States, 2011 -2012 40% Wisconsin United States 35% 30% 25% 20% 15% 10% 5% 0% 22% 20% Children with special health care needs Source: National Survey of Children’s Health, 2011 -2012 35
PEOPLE WITH DISABILITIES Demographics Percentage of children with special health care needs, by age, Wisconsin, 2011 -2012 60% 0 -5 years 6 -11 years 50% 12 -17 years 40% 30% 20% 10% 0% 11% Source: National Survey of Children’s Health, 2011 -2012. 27% 26% 36
PEOPLE WITH DISABILITIES Oral health Percentage of children with oral health needs, by disability status, Wisconsin, 2011 -2012 40% Children with no special health care needs 35% Children with special health care needs 30% 25% 20% 15% 10% 5% 0% 4% 9% Fair or poor teeth Source: National Survey of Children’s Health, 2011 -2012 14% 19% One or more oral health problems 37
PEOPLE WITH DISABILITIES Nutrition Percentage of children ages 10 -17, who are obese, by disability status, Wisconsin, 2011 -2012 40% Children with no special health care needs 35% Children with special health care needs 30% 25% 20% 15% 10% 5% 0% 12% 18% Obese Source: National Survey of Children’s Health, 2011 -2012 38
PEOPLE WITH DISABILITIES Missed school Percentage of children ages 6 -17 who missed school because of illness or injury, by disability status, Wisconsin, 2011 -2012 20% 18% 16% Children with no special health care needs Children with special health care needs 14% 12% 10% 8% 6% 4% 2% 0% 3% 11% Missed 11 or more days of school in past month because of illness or injury Source: National Survey of Children’s Health, 2011 -2012 39
PEOPLE WITH DISABILITIES Mental health Percentage of children with parents who report usually or always feeling stressed from parenting and parents who have had to cut back hours or quit a job because of child care issues 60% 50% Children with no special health care needs Children with special health care needs 40% 30% 20% 10% 0% 5% 20% Parents usually/always stressed from parenting Source: National Survey of Children’s Health, 2011 -2012 10% 35% Parent's work life affected by child-care issues 40
PEOPLE WITH DISABILITIES Access to health care Percentage of children ages 6 -17 covered by public health insurance and whose health insurance (public and/or private) was inadequate, by disability status, Wisconsin, 2011 -2012 100% Children with no special health care needs 90% Children with special health care needs 80% 70% 60% 50% 40% 30% 20% 10% 0% 32% 43% Public insurance Source: National Survey of Children’s Health, 2011 -2012 23% 30% Current insurance not adequate 41
PEOPLE WITH DISABILITIES Access to health care Percentage of children who saw health care providers for preventive medical and dental care during the past 12 months, Wisconsin, 2011 -2012 100% 90% Children with no special health care needs Children with special health care needs 80% 70% 60% 50% 40% 30% 20% 10% 0% 66% 77% Received both routine preventive medical and dental care visits during the past 12 months Source: National Survey of Children’s Health, 2011 -2012 42
PEOPLE WITH DISABILITIES Access to health care Percentage of children who have a medical home and percentage of children who have problems getting specialist care, by disability status, Wisconsin, 2011 -2012 100% Children with no special health care needs 90% Children with special health care needs 80% 70% 60% 50% 40% 30% 20% 10% 0% 3% 68% 61% Children who receive coordinated, ongoing, comprehensive care within a medical home Source: National Survey of Children’s Health, 2011 -2012 10% Children who needed or received specialist care and who had some problem getting specialist care 43
PEOPLE WITH DISABILITIES Tobacco use and exposure Percentage of children who live with someone who uses tobacco and are exposed to secondhand smoke at home, by disability status, Wisconsin, 2011 -2012 40% Children with no special health care needs 35% Children with special health care needs 30% 25% 20% 15% 10% 5% 0% 19% 24% Household member uses tobacco Source: National Survey of Children’s Health, 2011 -2012 44
PEOPLE WITH DISABILITIES Mental health Percentage of children who had two or more adverse childhood experiences (ACEs), by disability status, Wisconsin, 2011 -2012 60% Children with no special health care needs Children with special health care needs 50% 40% 30% 20% 10% 0% 19% 35% Experienced 2 or more adverse childhood experiences Source: National Survey of Children’s Health, 2011 -2012 45
PEOPLE WITH DISABILITIES 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. Where in health is disability? Public health practices to include people with disabilities, 2012: http: //www. cdc. gov/about/grandrounds/archives/2012/December 2012. htm 7. 2011 -2012 National Survey of Children’s Health, Sampling and Survey Administration, Child and Adolescent Health Measurement Initiative (2012): http: //www. childhealthdata. org/docs/drc/2011 -12 -nsch-sampling-andadministration. pdf 46
PEOPLE WITH DISABILITIES References 8. U. S. Department of Health and Human Services. Physical Activity Guidelines for Americans Midcourse Report: Strategies to Increase Physical Activity Among Youth: http: //www. health. gov/paguidelines/midcourse/pag-mid-course-report-final. pdf 9. CDC. Overweight and obesity among people with disabilities. http: //www. cdc. gov/ncbddd/disabilityandhealth/documents/obesityfactsheet 2010. pdf 10. CDC. Alcohol Use and Health. http: //www. cdc. gov/alcohol/fact-sheets/alcoholuse. htm 11. CDC. Adverse Childhood Experience Study. http: //www. cdc. gov/ace 12. CDC. Insufficient sleep is a public health epidemic. http: //www. cdc. gov/features/dssleep 13. CDC. Health-related quality of life: Well-being concepts. http: //www. cdc. gov/hrqol/wellbeing. htm#four 14. CDC. Smoking and Tobacco Use: Secondhand Smoke Facts. http: //www. cdc. gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_f acts/index. htm 15. Health Resources and Services Administration (HRSA). 2009/10 NS-CSHCN: Health Conditions and Functional Difficulties. Data Resource Center: http: //www. childhealthdata. org/docs/cshcn/2009 -cshcn-conds-func-diff. pdf 16. HRSA. Fast Facts: 2011/12 National Survey of Children’s Health. http: //childhealthdata. org/learn/NSCH 47
PEOPLE WITH DISABILITIES References 17. Child and Adolescent Health Measurement Initiative (2002). Approaches to Identifying Children and Adults with Special Health Care Needs. http: //cahmi. org/View. Document. aspx? Document. ID=120 18. HRSA. Children with Special Health Care Needs in Context: A Portrait of States and the Nation 2007. http: //mchb. hrsa. gov/nsch/07 cshcn/moreinfo/pdf/cshcn 11 covintrotot. pdf 19. Felitti, et al. , (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine - May 1998 (Vol. 14, Issue 4, Pages 245 -258). 48
PEOPLE WITH DISABILITIES References Links to additional reports and resources Wisconsin Department of Health Services (DHS): • Disabilities and Impairments, http: //www. dhs. wisconsin. gov/disabilities/ • Children and Youth with Special Health Care Needs Program, http: //www. dhs. wisconsin. gov/health/children/ Centers for Disease Control and Prevention (CDC) • Disability and Health Data System, http: //dhds. cdc. gov/ • National Survey of Children with Special Health Care Needs, http: //www. cdc. gov/nchs/slaits/cshcn. htm • Families with Special Needs, http: //www. cdc. gov/family/specialneeds/ University of Wisconsin-Madison, Waisman Center http: //www. waisman. wisc. edu/about. htm 49
PEOPLE WITH DISABILITIES Contacts Bureau of Community Health Promotion Division of Public Health Department of Health Services Sharon Fleischfresser, MD, MPH Medical Director Children and Youth with Special Health Care Needs Program Email: Sharon. Fleischfresser@dhs. wisconsin. gov Elizabeth Oftedahl, MPH CYSHCN Epidemiologist Maternal and Child Health Program Family Health Section Email: Elizabeth. Oftedahl@dhs. wisconsin. gov Jessica Seay, MPH State Systems Development Initiative Coordinator Maternal and Child Health Program Family Health Section Email: Jessica. Seay@dhs. wisconsin. gov 50
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