MOVING UPSTREAM: ECONOMIC HARDSHIP AND LIFE EXPECTANCY David Sweat, MPH Chief of Epidemiology and Infectious Diseases Shelby County Health Department
SHELBY COUNTY TN Population Estimate 937,750 (2015 ACS 5 years Estimate). Predominant races Black and White (52% B, 41%W, 6 % other) 33 Zip Codes in Shelby County Deaths ~8,000 (2015)
POPULATION DISTRIBUTION IN SHELBY COUNTY 2010 VS 2015
NUMBER OF DEATHS TREND OF DEATHS IN SHELBY COUNTY TN 2015 8200 8000 7800 7600 7400 7200 7000 2007 2008 2009 2010 2011 2012 2013 2014 2015 YEARS Number of deaths Data Source: Vital Statistics Death Data 2015
LEADING CAUSES OF DEATH IN SHELBY COUNTY 2015 Disease of the Heart** Malignant Neoplasms** 1727 1947 Unintentional Injuries Cerebrovascular Disease** Alzheimer's Disease** Chronic Lower Respiratory Disease** Diabetes** Influenza Pneumonia Homicide Septicemia 478 439 423 343 247 188 163 160 0 500 1000 1500 2000 2500 Number of Deaths Data Source: Vital Statistics Death Data 2015 ** Chronic conditions
LIFE EXPECTANCY IN SHELBY COUNTY 2015 Map by Office of Epidemiology and Infectious Diseases- Ogari Data source- Vital statistics Death Data TDH
LE at Birth Years YEARS Life Expectancy in Shelby County by Race Life Expectancy in Shelby County by Sex 85 80 78 80 75 70 Life Expectancy white Black 84.5 75.4 76 74 72 70 Life Expectancy Male Females 73.3 79 Life Expectancy at Birth in Shelby County TN 2015 85.00 80.00 75.00 70.00 65.00 60.00 LE at birth_2015 Zip Codes
FACTS ABOUT CHRONIC CONDITIONS Leading causes of death in US 86% of all health care spending goes chronic medical conditions. ( CDC 2010) As of 2012 almost half of adults in the United States had one or more chronic conditions (CDC 2012) Long Latent period Most chronic conditions are preventable. As a result of complex interaction between health behavior, social determinants and genetic components.
ECONOMIC HARDSHIP INDEX EHI focuses on 6 key social determinants that are critical for one s health. These include: Unemployment: The percent of the civilian population over the age of 16 who were unemployed Dependency: The percentage of the population that are under the age of 18 or over the age of 64 Education: The percentage of the population over the age of 25 who have less than a high school education Income Level: The per capita income Crowded Housing: The percent of occupied housing units with more than one person per room Poverty: The percent of people living below the federal poverty level. Richard P. Nathan and Charles F. Adams, Jr 1976
WHY EHI Uses multiple social determinants indicators to determine EHI Gives a comprehensive look on Economic Hardship Allows easy comparison with Mortality and Morbidity Rates. Data easily available through American Community Survey.
EHI CALCULATIONS For the calculation of all variables except for income. X = ((Y-Ymin)/(Ymax Ymin))*100 where: X = standardized value of component variable (for example, unemployment rate) for each area to be computed. Y = unstandardized value of component variable for each city. Ymin = the minimum value for Y across all area Ymax = the maximum value for Y across all area For the calculation of Income: X = ((Y-Ymax)/(Ymin Ymax))*100 Note: The Index represents the average of the standardized ratios of all six component variables Higher value indicating higher hardship.
Map by Office of Epidemiology and Infectious Diseases- Ogari Data source- American Community Survey 5-year Estimates EHI IN SHELBY COUNTY 2015
EHI DRIVERS IN SELECT SHELBY COUNTY TN ZIP CODES 2015 17% 38106+38126 17% 17% 16% 16% 17% unemployment EHI Dependency EHI Education EHI Income EHI Crowded Housing EHI Poverty EHI 19% 38112+38122 8% 16% 19% 19% 19% unemployment EHI Dependency EHI Education EHI Income EHI Crowded Housing EHI Poverty EHI 38107+38108 38103+38104+38105 19% 16% 17% 11% 20% 17% unemployment EHI Dependency EHI Education EHI Income EHI Crowded Housing EHI Poverty EHI 27% 16% 4% 13% 19% 21% unemployment EHI Dependency EHI Education EHI Income EHI Crowded Housing EHI Poverty EHI
CORRELATION BETWEEN EHI AND LE IN SHELBY COUNTY TN ZIP CODES 2015 Map by Office of Epidemiology and Infectious Diseases- Ogari Data source- Vital statistics Death Data TDH and American Community Survey 5-year Estimates
CORRELATION BETWEEN EHI AND LE IN SHELBY COUNTY TN ZIP CODES 2015 Map by Office of Epidemiology and Infectious Diseases- Ogari Data source- Vital statistics Death Data TDH and American Community Survey 5-year Estimates
LE AT BIRTH CORRELATION BETWEEN EHI AND LE IN SHELBY COUNTY TN ZIP CODES 2015 Correlation between LE and EHI 90 80 P= -0.7875 70 60 50 LE at birth_2015 Expon. (LE at birth_2015) 40 30 20 0 20 40 60 80 100 120 EHI Map by Office of Epidemiology and Infectious Diseases- Ogari Data source- Vital statistics Death Data TDH and American Community Survey 5-year Estimates
CORRELATION BETWEEN EHI AND ED VISITS DUE TO HEART CONDITION 2015 P= 0.627 Map By Office of Epidemiology and Infectious Diseases-Ogari Data Source: ACS and ESSENSE
CORRELATION BETWEEN EHI AND MORTALITY RATE DUE TO HEART CONDITION P= 0.459 Map By Office of Epidemiology and Infectious Diseases-Ogari Data Source: ACS and Vital Statistics
EHI IN CHICAGO
CONTACT INFORMATION David Sweat, MPH Chief of Epidemiology and Infectious Diseases Shelby County Health Department David.Sweat@shelbycountytn.gov Lilian Ogari PhD, MPH Chronic Disease Epidemiologist Shelby County Health Department Lilian.Ogari@shelbycountytn.gov