Local Health Improvement Coalition Annual Meeting, October 26, 2017 - PowerPoint PPT Presentation

Local Health Improvement Coalition Annual Meeting, October 26, 2017 Russell Moy, MD, MPH Acting Health Officer

Local Health Improvement Coalition (LHIC) Today’s Update • Reviewing the data • Discussion • Selecting the priorities 2

Harford County Local Health Improvement Coalition (LHIC) • Organized in 2011 • Selected 3 Health Priorities • Community Efforts Organized Around These Priorities Obesity Tobacco Use Behavioral Prevention / Prevention / Health / Healthy Eating Tobacco-Free Substance Use & Active Living Living & Mental Health 3

Harford County ranks better than the State average in 23 of 39 Maryland SHIP measures in 2017 . . . • Infant mortality • Heart disease mortality Low birth weight rates Annual seasonal flu vaccines • • Teen birth rates Persons with a usual primary care • • provider • Early prenatal care HIV incidence rate • Uninsured E.D. visits • • Chlamydia incidence rate E.D. visit rates for diabetes, • hypertension, asthma, dental and Pedestrian injury rate on public • mental health care roads • Hospitalization rate for Alzheimer’s • And many other conditions Disease Source: ship.md.networkofcare.org/ph/ Note: Data reflects SHIP year, not year data collected 4

Harford County still ranks worse than the State average in 16 of 39 2017 SHIP measures . . . Measure 2017 MD MD Harford Harford Goal 2016 2017 2016 2017 Drug-induced death rate (per 100,000) 12.6 15.2 17.7 19.2 20.2 E.D. visit rate for addictions (per 100K) 1400.9 1474.6 1591.3 1462.1 1673.6 Adults who currently smoke (%) 15.5 14.6 15.1 18.9 20.7 Fall-related death rate (per 100,000) 7.7 8.5 8.8 10.1 11.8 Domestic violence* (per 100,000 crimes) 445.0 455.8 510.9 384.6 512.6 Sudden Unexpected Infant Death* 0.86 0.82 1.03 0.82 1.55 (SUID per 1,000 lives births) Adults at a healthy weight* (%) 36.6 35.1 35.0 40.6 27.7 Source: ship.md.networkofcare.org/ph/ Note: Data reflects SHIP year, not year data collected 5

Harford County still ranks worse than the State average in 16 of 39 2017 SHIP measures (continued) Measure 2017 MD MD Harford Harford Goal 2016 2017 2016 2017 Suicide death rate (per 100,000) 9.0 9.2 9.1 11.6 11.4 Cancer death rate (per 100,000) 147.4 162.0 159.3 170.9 165.6 Adolescents use tobacco products (%) 15.2 16.9 16.4 20.2 19.2 Child maltreatment (per 1,000 < age 18) 8.3 9.9 7.3 14.1 11.7 Increased physical activity (% 150 min/wk) 50.4 48.0 52.9 46.4 51.2 Adolescent wellness checkups (% 12 mo) 57.4 54.7 56.0 50.3 52.0 Children’s dental care (% 12 mo) 64.6 63.2 64.3 58.3 60.2 Children blood lead screening (%12-15mo) 69.5 62.0 62.6 51.4 52.7 Affordable housing 54.4 46.1 48.2 40.3 41.0 Source: ship.md.networkofcare.org/ph/ Note: Data reflects SHIP year, not year data collected 6

Impact of the opioid overdose crisis

Harford County rates 30.0 worse than the State, up 35% over past 6 yrs. Per 100,000 Population 20.2 19.2 20.0 17.9 17.1 16.2 15.6 15.0 17.7 Harford 15.2 Maryland 13.3 12.9 12.3 12.1 10.0 11.9 0.0 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 * Age-Adjusted Rates Source: Maryland Vital Statistics Reports 8

1,800 1,674 Harford County rates worse than the State, Per 100,000 Population 1,600 up 44% over past 6 yrs. 1,591 1,462 1,382 1,475 1,400 1,398 1,245 Harford 1,179 1,164 Maryland 1,200 1,238 1,108 1,122 1,056 1,000 1,026 800 2008 2009 2010 2011 2012 2013 2014 * Age-Adjusted Rates Source: Maryland Vital Statistics Reports 9

All Drugs/Alcohol Heroin Fentanyl 84 Harford County had a Per 100,000 Population 68% increase in overdose 50 deaths from 43 43 2015-2016. 39 38 36 35 Preliminary 33 data for 2017 indicate a possible 100% increase from 2016-2017. 2008 2009 2010 2011 2012 2013 2014 2015 2016 Source: Maryland Vital Statistics: Drug- and Alcohol-Related Intoxication Deaths in Maryland, 2016 10

The Leading Causes of Death Harford County, 2015 600 At the current rate, 498 overdose deaths may 482 500 become the 3 rd leading 400 # of Deaths cause of death in 2017. 300 Potential 100% increase in overdose 200 deaths by 2017 110 95 80 100 61 50 48 46 33 32 0 Source: Maryland Vital Statistics, 2015 11

The reason this epidemic is so deadly 12

2010 2015 Harford Morphine Milligram Equivalents (MME) County ranks 8 th worst in 1,566 1,401 the State. 1,275 1,119 1,113 949 913 913 900 883 866 817 785 742 740 712 690 640 546 550 519 495 356 353 283 Kent Allegany Washington Calvert Cecil Talbot Carroll Harford Wicomico Baltimore Co Charles Garrett St. Mary's Frederick Anne Arundel Worcester Queen Anne's U.S. Average Dorchester Somerset Baltimore City Caroline Montgomery Howard Prince George's Source: Dinsmore, “How Maryland measured up in opioid prescribing,” Baltimore Sun, 7/8/17 – citing CDC data 13

40 38.2 >7-fold increase in newborn exposure to drugs/alcohol Rate Exposed Per 1,000 Newborns 36.7 over the past 16 years for Harford County residents 29.4 33.3 29.6 26.4 29.1 30 19.9 16.9 20 21.0 20.4 20.1 12.6 13.1 13.3 14.5 14.7 16.0 17.6 18.6 11.8 11.3 12.4 11.9 10.2 12.6 12.1 10 12.3 9.5 8.8 5.1 5.9 4.5 5.6 0 Year NOTE: ICD Codes used 760.70, 760.71. Harford County Maryland 760.72, 760.73, 760.75, 760.77, 779.5 Source: HSCRC Hospital Data, 2000-16,Maryland resident births only, does not include Maryland resident births born out of state. 14

Heroin increased by 62% Fentanyl increased by 229% From 2015 to 2016. Source: “Drug and Alcohol Related Intoxication Deaths in Maryland, 2016,” Maryland Vital Statistics

45-54 yr olds impacted most. AGE (years) 25-34 yr olds impacted next most. <25 years 25-34 years 35-44 years 45-54 years 500 55+ years Number of deaths 400 300 200 100 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Source: “Drug and Alcohol Related Intoxication Deaths in Maryland, 2016,” Maryland Vital Statistics

Stein et al, AJPH, October 2017 17

18 Harford County rates have worsened by 13% 17 17 over the past 5 years. 16 16 16 16 Harford County Maryland 15 15 15 15 15 Percentage 2012 2013 2014 2015 2016 2017 * Consumed ≥ 5 drinks (male) or 4 drinks (female) on a single occasion in past 30 days Source: www.countyhealthrankings.org 18

25 Harford County rates are 44% worse than 20.8 18.8 the State average. 20 17 15 Percent 13.1 Harford 10 Maryland 5 0 2013 2014 * Students Grades 9- 12 consumed ≥ 5 drinks on a single occasion in past 30 days Source: Maryland YRBS, 2014 19

22 Harford County rates 21.2 are 13% worse than 21 the State average. 19.8 20 Percent 19.6 Harford 18.8 Maryland 19 18 17 2013 2014 * Students Grades 9- 12 who used marijuana ≥1 time during past 30 days Source: Maryland YRBSS, 2014 20

13 Harford County rates 27% worse than the State. 11.9 Per 100,000 Population 12 11.6 11.6 11.3 11.2 10.7 11 Harford Maryland 10 9 9.1 9.2 9.0 8.9 8.8 8.8 8 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 * Age-Adjusted Rates Source: Maryland Vital Statistics Reports 21

Impact of tobacco and obesity

The Leading Actual Underlying Causes of Death Smoking, obesity and alcohol are the leading actual causes of death. Source: Mokdad et al, “Actual Causes of Death in the U.S., 2000” JAMA, 3/19/2004 23

Harford 24 County adult 21.7 22 use rates 20.7 increased by 20 18.6 18.9 10% over the past 5 years. Percent 18 16.9 Harford 16 Maryland 14 12 10 2011 2012 2013 2014 2015 Source: phpa.health.maryland.gov MD BRFSS, 2011-15 24

Harford Maryland 25 Harford 20.2 County youth 19.2 20 use rates are 16.9 16.4 17% higher 15 Percent than the State average. 10 5 0 2013 2014 Note: Students Grades 9-12 who used any tobacco products in the past 30 days Source: Maryland YRBSS, 2013 and 2014: 25

42 41.4 Plus Harford 41 County youth e-cig use rate 40 is 10% higher Percent than the State 39 Harford average. Maryland 38 37.6 37 36 35 2014 * Students Grades 9-12 who have ever used electronic vapor products (e.g., e-cigarettes, e-pipes, e-hookahs) Source: Maryland YRBSS, 2014 26

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55% of all cancers in women and 24% of cancers in men are associated with obesity. 28

Harford County 45 rates have 40.6 40 decreased by 35.3 3% over the 35 past 4 years. 28.4 30 27.7 Percent 25 Harford County 20 Maryland 15 10 5 0 2012 2013 2014 2015 Note: Adult BMI 18.5-24.9 Source: Maryland BRFSS, 2012-2015 29

35 32.8 Harford County 30.1 25.9 30 rates have 25.5 increased by 25 9% over the Percent past 4 years. 20 Harford 15 Maryland 10 5 0 2012 2013 2014 2015 Note: Adult BMI 30 and above Source: Maryland BRFSS, 2011-2014 30

Harford Harford Maryland County youth 12.0 11.5 use rates are 11.0 15% better 10.7 11.0 than the State 10.0 10.0 average. Percent 9.0 8.0 7.0 6.0 2013 2014 Note: High school students who self- report BMI ≥ 95 th percentile for age and gender Source: Maryland YRBSS, 2013 and 2014: 31

10% Improvement in Childhood Obesity Among WIC Participants, 2010-2014 Source: MMWR, 2016, CDC 32