The Health of King County 2006

1. The Health of King County2006 Jim Krieger, MD, MPH Epidemiology, Planning & Evaluation Unit

2. PROJECT STAFF (from the Epidemiology, Planning and Evaluation Unit, Public Health – Seattle & King County) Susan Barkan, PhD Ann Glusker, PhD James Krieger, MD, MPH Amy Laurent, MPH Genevieve Rowe, MS Mike Smyser, MPH David Solet, PhD Lin Song, PhD ((in alphabetical order) We would also like to thank reviewers and contributors from PHSKC, other local, state and national agencies and the University of Washington. Acknowledgements

3. Where This Talk is Heading… • Key findings • Trends • Health disparities • Improving health

4. Determinants of Health Public Health Social Environment Health & Disease Behaviors & Biologic Response Physical Environment Genetic Endowment Health Care Adapted from Evans, et al

5. The Health of King County • Comprehensive, web-based report • Health outcomes • Health-related behaviors • Data sources • Vital records • Surveys • Hospital discharge data • Reportable conditions • US census

6. Other Public Health – Seattle & King County Data Reports • Core Indicators • Communities Count • HIV/AIDS Epi Monthly Report • Medical Examiner’s Annual Report • CD Annual Summary Report • Epilog • Data Watches • Drug Abuse Trends

7. #1Chronic Diseases:The Leading Cause of Death and Illness • Common chronic diseases include: • Cancer • Heart disease • Stroke • Chronic lung diseases (e.g. asthma, COPD) • Diabetes • 21,000 hospitalizations / $531 million in 2004 • Cancer, heart disease and stroke alone: 56% of all deaths

8. Chronic Diseases:The Leading Cause of Death and Illness • Affect many residents • Asthma: 9% of adults and 6% of children • Heart disease: 5% of adults • Diabetes 5% of adults • Arthritis: 16% of adults • Will become more common as population ages

9. Diabetes • Prevalence among adults has doubled in the past decade. • Hospitalizations, which can often be avoided with good diabetes management, are increasing.

10. Chronic disease risk factors Common and increasing

11. #2HIV infection has now become a chronic condition • AIDS moved from the 8th to 14th leading cause of death.

12. AIDS:Incidence declining, prevalence rising • Increasing numbers of people living with HIV and AIDS, leading to a steady rise in the prevalence of these conditions.

13. #3Some STD rates are increasing

14. #4Pandemic Influenza • The risk of an influenza pandemic may be increasing. • “Medium-level” pandemic in the U.S. could cause • 89,000 to 207,000 deaths • 314,000 to 734,000 hospitalizations • 18 to 42 million outpatient visits

15. #5Access to care decreasing • Highest rate of uninsurance since data collection began in King County

16. #6Mental Health • Residents report increased poor mental health days • Hospitalizations for psychosis, but not depression, have increased since 1987

17. #7Alcohol • Excessive alcohol use is higher in King County than the rest of Washington and the nation. • Binge drinking • 15.7% of all adults during the past month. • Drinking and driving • 4.2% of all adults during the past month • Heavy drinking • 5.9% of all adults • Increased significantly from 3.4% to 5.6% in past decade • Rates are 2-3 times higher among young adults age 18-24

18. #8Illicit Drug Use • Deaths from prescription opiates now exceed deaths from heroin • Prescription opiate deaths increased four-fold since 1997 • Deaths related to prescription depressant drugs (e.g. valium) and methamphetamines are also on the rise

19. Improvements

20. Mortality decreasing • Life expectancy at birth is 78.0 years for males and 82.5 for females • Higher than 11 of the 14 other large U.S. counties • Increased 4.9 years since 1980

21. Smoking declining

22. Asthma control improving

23. Motor vehicle injuries dropping

24. Firearm deaths lower

25. Infant mortality meets Healthy People 2010 goal early Healthy People 2010 Goal

26. Hepatitis rates down • Hepatitis A • 1997: 441 cases • 2004: 14 cases • Hepatitis B • 1995: 85 cases • 2004: 23 cases

27. Adolescent Births Declining

28. Immunizations increase but still short of goal • Childhood • Coverage increasing since 2001 • 81% of kids have full coverage • HP 2010 objective of 90% not yet met • Adults 65 years and older • Pneumonia vaccination has increased to 65% • Influenza immunization rate static at 70% • Both rates below the HP 2010 objective of 90%.

29. Air quality improving

30. Health Disparities • There are large and persistent disparities in health status and access to health care across • Racial/ethnic groups • Income groups • Areas of the county • Sexual orientation • While some disparities are diminishing, many are increasing.

31. Racial/Ethnic Disparities

32. Disparities widespread among African Americans and American Indians/Alaska Natives • Mortality • Birth outcomes • Chronic diseases • Risk factors for chronic disease • Smoking • Overweight • Physical inactivity • Lack of screening • Injuries • HIV • Mental distress • Alcohol use and drug-induced deaths • Access to medical care

33. Disparities also affect Hispanic/Latinos • Adolescent births • Physical inactivity • Mental distress • HIV • Access to care

34. MortalityAfrican Americans and AI/AN • Life expectancy among AA and AI/AN males • 8 years lower than white expectancy • Less than white expectancy in 1980 • Trends in gap over past decade • African Americans: no change • AI/AN: increasing • Excess deaths • African Americans: 158 per year • AI/AN: 37 per year

35. Diabetes Mortality Source: Death Certificate Data: Washington State Department of Health, Center for Health Statistics.

36. Access to Care

37. Sexual minorities • Health-related behaviors • Smoking rates nearly 2 times higher • Binge and heavy drinking X times higher • Cancer screening among lesbian/bisexual women • Mammography: 50% rate vs. 75% • HIV and AIDS • Still predominantly affect gay males, • Slowly increasing in other groups • Frequent mental distress • Twice as common

38. Income

39. Income disparities • Mortality • Birth outcomes • Adolescent births • All chronic diseases and risk factors • HIV • Mental health • Alcohol use and drug-related deaths • Access to care.

40. Infant Mortality by Neighborhood Poverty Level

41. Chronic Disease Risk Factors:Physical Inactivity

42. Mental health

43. Geographic Disparities Sprawl

44. Geographic disparities • South Seattle/South County Region • Downtown, Central and Southeast Seattle • Beacon Hill • Delridge • White Center/Boulevard Park • Tukwila/Sea Tac • Kent • Auburn

45. Features of the region affecting health • Changing SES and racial/ethnic mix • Sprawl/built environment • Challenges in funding community and govt. services • Norms around prevention and healthy behaviors

46. South Seattle/South County Area Disparities • Death rate • Birth outcomes • Chronic diseases and risk factors • Motor vehicle and firearm injuries • Mental health problems • Complications of illicit drug use • Access to care

47. Infant Mortality

48. Chronic diseaseDiabetes

49. Access to care

50. Investment in the health of the public pays off • Reductions in smoking • Increased seat belt use • Improved control of asthma • Improved access to prenatal care • Reductions in infant deaths from SIDS as more infants are placed on their backs to sleep