Michigan S Health Profile Chartbook

Health Profile Chartbook

Region 1

(Clinton, Eaton, Gratiot, Hillsdale, Ingham,

Jackson, Lenawee, Livingston, Shiawassee)

Draft – Last updated April 29, 2018

1 Draft – Last updated April 29, 2018

2 Table of Contents Introduction Indicators Page 1 Demographics: Population Distribution by Age ...... 4 2 Demographics: Population Distribution by Gender...... 5 3 Racial Distribution 6

4 Workforce – Primary Care Physicians 7

5 Access to Care 8

6 Leading Causes of Death 9

7 Years of Potential Life Lost 10

8 Cancer 11

9 Breast Cancer Screening 12

10 Cervical Cancer Screening 13

11 Colorectal Cancer Screening 14

12 Cardiovascular Disease: Prevalence 15

13 Cardiovascular Disease: Mortality 16

14 Cardiovascular Disease: Hospitalizations 17

15 Diabetes Prevalence 18

16 Diabetes Mortality 19

17 Overweight and Obesity 20

18 Nutrition 21

19 Physical Activity 22

20 Smoking 23

21 Binge Drinking 24

3 22 Controlled Blood Pressure 25

23 Infant Mortality 26

24 Teen Pregnancy...... 27 25 Low Birth Weight...... 28 26 Very Low Birth Weight...... 29 27 Adult Immunizations 30

28 Pediatric Immunizations 31

29 Gonorrhea 32

30 Chlamydia...... 33 31 Injury Mortality 34

32 Mental Health 35

Appendix A: Sources for Indicator Overview/Definition...... 36

4 Statewide Community Health Assessment Regions

Keweenaw

Houghton 8

Ontonagon

Baraga Gogebic Marquette Luce Alger Chippewa Iron Mackinac Schoolcraft Dickinson Delta

Emmet Menominee Cheboygan Presque Isle Charlevoix 7 Alpena Antrim Otsego Leelanau

Crawford Alcona Grand Benzie Traverse Kalkaska Oscoda

Iosco 3

Manistee Wexford Missaukee Ogemaw

Arenac Mason Lake Osceola Clare Gladwin Huron

Mecosta Midland Oceana Isabella Bay Newaygo 6 Tuscola 3 Sanilac

Muskegon Montcalm Saginaw 2 Gratiot St. Lapeer Genesee Clair Ionia Clinton Shiawassee Ottawa Kent

Macomb

Livingston Oakland Allegan Barry Eaton Ingham 6 1 2N 5 Wayne Van Calhoun Buren Kalamazoo Jackson Washtenaw

Monroe St. Joseph Berrien Cass Lenawee Branch Hillsdale 2S

5 Region 1 Demographics: Population Distribution by Age Indicator Definition/Overview:  The general age of the population of Region 1 has increased from 1990 to 2009.  In 1990, there were more people aged 30-39 than any other age group in Region 1. In 2009, there were more people aged 40-49 than any other age group in Region 1.  With the aging population, there is greater need for health care services that the elderly population relies on.

Healthy People 2020 Target: Region 1 Population Distribution by Age, 1990 & 2009 n/a

60-69 s r a e

Y 50-59

u 40-49 o r G

e 30-39 Data Source: g

A Michigan Department of 20-29 Community Health, Division of Vital Records and Health Statistics. 10_19

Under 10

0 2 4 6 8 10 12 14 16 18 Percentage of Population

1990 2009

Draft – Last updated April 29, 2018 6 Region 1 Demographics: Population Distribution by Gender Indicator Definition/Overview:  From 1990 to 2009, the female population has steadily decreased by just over a half percent, whereas the male population has steadily increased just over a half percent.  There is still a higher percentage of the female population than the male population, but the population is closer to being equally distributed in 2009 than 1990.  Region 1’s gender distribution trends follow the same pattern as Michigan’s trends.

Healthy People 2020 Target: n/a Region 1 Population Distribution by Gender, 1990-2009

n 50.5 o i t a l

u 50.0 p o P

f 49.5 o

e g a t 49.0 n e

c Data Source: r

e Michigan Department of

P 48.5 Community Health, Division of Vital Records and Health Statistics. 48.0

Male Female

Draft – Last updated April 29, 2018 7 Region 1 Racial and Ethnic Distribution Indicator Definition/Overview:  Region 1 has a higher percentage of White individuals than the state as a whole.  Region 1 has a lower percentage of Black and Hispanic individuals than the state as a whole.  Note: Hispanic is not a mutually exclusive ethnic category, and could include individuals from any race category.

Healthy People 2020 Target: Percent Distribution by Race and Ethnicity, n/a Region 1 and Michigan, 2009 100 90 80 n o i t

a 70 l u

p 60 o P

f 50 o

g 40 a t Data Source: n

c Michigan Department of r

e Community Health, Division of Vital

P 20 Records and Health Statistics. 10 0 White Black Asian & Pacific American Indian Hispanic Islander

Race/Ethnicity

Michigan Region 1

Draft – Last updated April 29, 2018 8 MICHIGAN Workforce – Primary Care Physicians Indicator Definition/Overview:  Michigan and the U.S. will soon be presented with serious shortages of primary care physicians as an increased number of medical students are choosing specialties as opposed to primary care.  Nearly one in five Americans lacks sufficient access to primary care due to physician shortages.  Physicians employed by the federal government are not included in this count. A federal physician is defined as full-time employment by the federal government, including the Army, Navy, Air Force, Veteran's Administration, the Public Health Service and other federally funded agencies.

Healthy People 2020 Target: Primary Care Physicians (MD - 2008, DO - 2007) and An increased primary care workforce is included in the Access their Specialties in Region 1 and Michigan to Health Services section of the Healthy People 2020 objectives.

n However, no target has as yet been o i

t 100 identified. a l u

p 80 o P 60 0 0 0 , 40 0 Data Source: 0 1

Area Resource File (ARF). 2009-

e 2010. United States Department of p

Health and Human Services, Health

e 0 t Resources and Services a MD DO MD DO MD DO MD DO MD DO

R Administration, Bureau of Health Professions, Rockville, MD. Total Primary Care General/Family Internal Medicine Pediatrics OB/GYN Physicians Practice

Michigan Region 1

Draft – Last updated April 29, 2018 9 Region 1 Access to Care Indicator Definition/Overview: . Unmet healthcare need is an indicator commonly used to portray problems in access to health care services, including lack of health insurance and limited availability of providers. . Unmet healthcare need is also associated with greater emergency room use and disadvantaged individuals delay care for conditions that are associated with longer hospital stays and poorer health outcomes.

Healthy People 2020 Target: The HP 2020 target for individuals Percentage of Adults Who Did Not Receive Needed who were unable to obtain or delayed in obtaining necessary Healthcare Due to Cost, Region 1 and Michigan medical care, dental care, or prescription medicines is 9.0 16 percent. 14 Please note that baseline data for 12 HP 2020 targets may be derived e

g 10 from a different source than is used a t in this chartbook. n 8 e c r 6 e P 4 Data Source: Michigan Department of 2 Community Health, Michigan 0 Behavioral Risk Factor Surveillance 2003 2004 2005 2006 2007 2008 2009 2010 System, 2003‐2010. Year

Region 1 Michigan

Draft – Last updated April 29, 2018 10 Region 1 Leading Causes of Death Indicator Definition/Overview:  Heart disease is the leading cause of death, and cancer is the second leading cause for both Region 1 and Michigan.  Region 1 has slightly higher age-adjusted death rates for chronic respiratory diseases, Alzheimer’s Disease, and suicide than Michigan.  Michigan has higher age-adjusted death rates for Heart Disease, Cancer, Stroke, and Diabetes than Region 1.

Healthy People 2020 Target: n/a Age-Adjusted Death Rates for the Ten Leading Causes of Death, Region 1 and Michigan, 2009 n o

i 250 t a l

u 200 p o P 150 0 0 0 ,

0 100 0 1

Data Sources: r 50 e Michigan Department of p Community Health, Division of Vital e t 0 a Records and Health Statistics. R

Region 1 Michigan

Draft – Last updated April 29, 2018 11 Region 1 Years of Potential Life Lost Indicator Definition/Overview:  Years of potential life lost is a measure of mortality that emphasizes the causes of death that are most prevalent among persons under age 75.  The number of years of potential life lost is calculated as the number of years between the age at death and 75 years of age for persons dying before their 75th year.  Cancer and heart disease are the leading conditions that have caused years of potential life lost before age 75 in both Michigan and Region 1.

Rates of Years of Potential Life Lost below Age 75 Due to Selected Causes of Death, Healthy People 2020 Target: Region 1 and Michigan residents, 2009 n/a

n 1600 o i t

a 1400 l u

p 1200 o P

0 1000 0 0 , 800 0 0 1

600 r e p

400 Data Source: e t a 200 Michigan Department of R Community Health, Division of Vital 0 Records and Health Statistics.

Region 1 Michigan

Draft – Last updated April 29, 2018 12 Region 1 Cancer Mortality Indicator Definition/Overview:  Though survival rates for many types of cancer have increased recently, cancer remains the second leading cause of mortality in Michigan.  Preventative measures, such as avoidance of tobacco, maintaining a healthy weight, and utilizing sun protection, can result in fewer cancers.

 Medically underserved populations are at higher risk of being diagnosed at a later stage of cancer, thus decreasing the likelihood of survival.

Healthy People 2020 Target: The HP 2020 target for cancer Cancer Mortality, All Sites, Age-adjusted Rates, mortality is 160.6 deaths per Region 1 and Michigan 100,000 population. 350

300 n o i

t 250 a l u p

o 200 P

0 Data Sources:

0 150 ,

0 Michigan Department of 0 1

Community Health, Division of Vital r 100 e

p Records and Health Statistics.

a 50 R

0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year Region 1 White Region 1 Black Region 1 Total Michigan White

Michigan Black Michigan Total HP 2020 Target

Draft – Last updated April 29, 2018 13 Region 1 Breast Cancer Screening Indicator Definition/Overview:  Screening mammograms are used to periodically check for breast cancer in women who have exhibited no signs of the disease. Mammograms may also be used as a diagnostic tool, after a mass has been detected or other symptoms arise.  Current National Cancer Institute guidelines state that women over 40 should have mammograms every one to two years.

Healthy People 2020 Target: The HP 2020 target for individuals Had a Mammogram in the Past Two Years Among Women who receive a breast cancer screening based on the most recent Aged 40 Years and Older, Region 1 and Michigan guidelines is 81.1 percent. 84 Please note that baseline data for 82 HP 2020 targets may be derived from a different source than is used 80 in this chartbook. r a

e 78 Y 76

74 Data Sources: Michigan Department of 72 Community Health. Michigan 2002 2004 2006 2008 2010 Behavioral Risk Factor Surveillance System, 2002 - 2010. Percentage Region 1 Michigan HP 2020 Target

Draft – Last updated April 29, 2018 14 Region 1 Cervical Cancer Screening Indicator Definition/Overview:  Pap tests detect abnormalities in cervical cells that may lead to cancer.  Women aged 21 to 30 years should be screened for cervical cancer every two years, while women 30 years and older who have had three consecutive normal test results may be screened once every three years.

Healthy People 2020 Target: The HP 2020 target for individuals who receive a cervical cancer Had a Pap Test in the Past Three Years Among Women screening based on the most recent guidelines is 93 percent. Aged 18 Years and Older, Region 1 and Michigan 94 Please note that baseline data for HP 2020 targets may be derived 92 from a different source than is used 90 in this chartbook.

e 88 g a

t 86 n

e 84 c r

e 82 P 80 Data Sources: 78 Michigan Department of 76 Community Health. Michigan 2002 2004 2006 2008 2010 Behavioral Risk Factor Surveillance System, 2002 - 2010. Year

Region 1 Michigan HP 2020 Target

Draft – Last updated April 29, 2018 15 Region 1 Colorectal Cancer Screening Indicator Definition/Overview:  Colorectal cancer is the third most common type of non-skin cancer in both men and women in the United States.  In general, individuals should be tested for colorectal cancer beginning at age 50.  Up to 60 percent of deaths from colorectal cancer could be prevented through regular screening.

Healthy People 2020 Target: Colorectal Cancer Screening Among Adults Aged 50 The HP 2020 target for individuals who receive a colorectal cancer Years and Older, Region 1 and Michigan screening based on the most recent guidelines is 70.5 percent. 80 Please note that baseline data for 70 HP 2020 targets may be derived 60 from a different source than is used e

g 50 in this chartbook. a t

n 40 e c

r 30 e

P 20 10 Data Source: 0 Michigan Department of 2002 2004 2006 2008 2010 Community Health. Michigan Behavioral Risk Factor Surveillance Year System, 2002‐2010. Had a Blood Stool Test in the Past Two Years - Region 1 Had a Blood Stool Test in Past Two Years - Michigan Had a Sigm oidoscopy or Colonoscopy in the Past Five Years - Region 1 Had a Sigm oidoscopy or Colonoscopy in the Past Five Years - Michigan HP 2020 Target

Draft – Last updated April 29, 2018 16 Region 1 Cardiovascular Disease - Prevalence Indicator Definition/Overview:  The term “cardiovascular disease” encompasses any irregular functioning of the heart or blood vessels, most commonly manifesting as a heart attack or stroke.  Risk factors for cardiovascular disease include obesity, smoking, and physical inactivity, among others.

Healthy People 2020 Target: An HP 2020 target does not exist Cardiovascular Disease Among Adults, Region 1 and Michigan for cardiovascular disease incidence. There are HP 2020 7 targets related to coronary heart 6 disease and stroke mortality. 5 e g a

t 4 n e

c 3 r e

P 2 1 0 Data Source: 2005 2006 2007 2008 2009 2010 Michigan Department of Community Health. Michigan Year Behavioral Risk Factor Surveillance System, 2005‐2010. Ever Told Heart Attack - Region 1 Ever Told Heart Attack - Michigan

Ever Told Stroke - Region 1 Ever Told Stroke - Michigan

Draft – Last updated April 29, 2018 17 Region 1 Cardiovascular Disease - Mortality Indicator Definition/Overview:  Cardiovascular disease accounts for over one-third of deaths in the United States, surpassing cancer, accidents, and respiratory illnesses.  Stroke is the third leading cause of death for both men and women.  Heart disease is the leading cause of death for both men and women.

Healthy People 2020 Target: An HP 2020 target does not exist Age-adjusted Heart Disease and Stroke Mortality Rates, for overall heart disease mortality, Region 1 and Michigan only for coronary heart disease mortality. The HP 2020 target for 300 stroke mortality is a rate of 33.8 per 100,000 population. 250

0 Please note that baseline data for

0 200 n , o

0 HP 2020 targets may be derived i 0 t a 1 from a different source than is l

r 150 u e

p used in this chartbook. p o

e P t 100 a R 50 Data Sources: 0 Michigan Department of 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Community Health, Division of Vital Records and Health Year Statistics. Heart Disease - Region 1 Stroke - Region 1 Heart Disease - Michigan Stroke - Michigan HP 2020 Stroke Mortality Target

Draft – Last updated April 29, 2018 18 Region 1 Cardiovascular Disease - Hospitalizations Indicator Definition/Overview:  The cost of cardiovascular disease in the United States was estimated to be more than $503 billion in 2010, a figure that is expected to increase as the population ages.  Hospitalization for heart disease is classified under the International Classification of Diseases 9 (ICD-9), codes 391-392, 393-398, 402, 404, 410-416, 420-429. Hospitalization for stroke is classified as codes 430-438.

Healthy People 2020 Target: An HP 2020 target does not exist for overall heart disease Heart Disease and Stroke Hospitalization Rates, hospitalization, nor for stroke Region 1 and Michigan hospitalization. 180 160

0 140 0

, 120 o 0 i 0 t 100 1 a

e 80 p p o e

P 60 t Data Sources: a

R 40 Michigan Department of 20 Community Health, Division of Vital 0 Records and Health Statistics. 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year

Heart Disease Hospitalization - Michigan Heart Disease Hospitalization - Region 1 Stroke Hospitalization - Michigan Stroke Hospitalization - Region 1

Draft – Last updated April 29, 2018 19 Region 1 Diabetes Prevalence Indicator Definition/Overview:  The prevalence of diabetes in Region 1 and Michigan has seen an overall increase over the past ten years.  Uncontrolled diabetes can lead to heart attack or stroke.  This indicator is measured as a non-age-adjusted three-year moving average with the midpoint as the reported year.

Healthy People 2020 Target: An HP 2020 target does not exist Adult Diabetes Prevalence, for overall diabetes prevalence. There are HP 2020 targets related Region 1 and Michigan to new diabetes diagnoses only. 12

8 e g a t

n 6 e c r

e Data Sources:

P 4 Michigan Department of Community Health. Michigan 2 Behavioral Risk Factor Surveillance System, 2001 – 2010. 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year Region 1 Michigan

Draft – Last updated April 29, 2018 20 Region 1 Diabetes Mortality Indicator Definition/Overview:  Diabetes is the sixth leading cause of death in Region 1 and Michigan.  Rates are per 100,000 population.  The risk for death among people with diabetes is about double that of people in the same age group who do not have diabetes.

Healthy People 2020 Target: The HP 2020 target for diabetes- related mortality is 65.8 deaths per Age-adjusted Diabetes-related Mortality Rates, Region 1 and Michigan 100,000 population. 250 Please note that baseline data for HP n

o 2020 targets may be derived from a i

t 200 a

l different source than is used in this u

p chartbook. o 150 P

0 0 0 ,

0 100 0 1

t Data Source: a

R Michigan Department of Community 0 Health, Division of Vital Records and 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Health Statistics. Year Region 1 White Region 1 Black Region 1 Hispanic Region 1 Total Michigan White Michigan Black Michigan Hispanic Michigan Total HP 2020 Diabetes-related Target

Draft – Last updated April 29, 2018 21 Region 1 Overweight and Obesity Indicator Definition/Overview:  Overweight is defined as the percentage of adults reporting a body mass index between 25.0 and 29.9. Obesity is defined as the percentage of adults reporting a body mass index of ≥ 30.  Obesity is one of today’s most pressing public health issues. The rates of obesity have risen dramatically over the past 30 years. Nationwide, obesity prevalence doubled among adults between 1980 and 2004, from 15 percent to 32.2 percent.  Obesity has been shown to be associated with several poor health outcomes, including: hypertension, osteoarthritis, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, sleep apnea and respiratory problems, and some cancers (i.e., endometrial, breast, and colon).

Healthy People 2020 Target: The HP 2020 target for obesity is Overweight and Obesity Among Region 1 and Michigan Adults 30.8 percent of adults aged 20 and Aged 20 Years and Older older. 45 Please note that baseline data for HP 2020 targets may be derived 40 from a different source than is used in this chartbook. e g a t

n 35 e c r e P 30 Data Source: Michigan Department of 25 Community Health. Michigan Behavioral Risk Factor Surveillance 2005 2006 2007 2008 2009 2010 System, 2005‐2010. Year Overweight - Region 1 Obese - Region 1 Overweight - Michigan Obese - Michigan HP 2020 Target - Obesity

Draft – Last updated April 29, 2018 22 Region 1 Nutrition Indicator Definition/Overview:  Dietary factors are associated with cardiovascular disease, stroke, cancer and diabetes, which are estimated to cost society billions of dollars each year in healthcare and lost productivity.  Good nutrition is especially important in early childhood development.  State-level monitoring of the nutrition status of Michigan residents includes program analysis, such as the Women, Infants and Children (WIC) Program, and evaluating statewide data from the Michigan Behavioral Risk Factor Survey (MiBRFS) focusing on fruit and vegetable consumption.  Inadequate fruit and vegetable consumption is defined as consuming fruits and vegetables, on average, fewer than five times per day over the past seven days.

Healthy People 2020 Target: An HP 2020 target does not exist for inadequate fruit and vegetable Inadequate Fruit and Vegetable Consumption Among consumption. However, targets do Adults, Region 1 and Michigan exist for the proportion of fruits and vegetables in relation to total diet. 82

e 78 g a t

n 76 e c r

e 74 Data Sources: P Michigan Department of Community 72 Health. Michigan Behavioral Risk Factor Surveillance System, 2003‐ 70 2009. 2003 2005 2007 2009 Year

Region 1 Michigan

Draft – Last updated April 29, 2018 23 Region 1 Physical Activity Indicator Definition/Overview:  Moderate to higher levels of regular physical activity lowers mortality rates for both older and younger adults.  Regular physical activity is associated with decreased risk of developing conditions such as diabetes, colon cancer, and high blood pressure.  Regular physical activity reduces feelings of depression and anxiety; helps control weight; helps build and maintain healthy bones, muscles, and joints; helps older adults become stronger and better able to move about; and promotes psychological wellbeing.  This indicator is measured as the percentage of adults and children grades 9-12 not meeting recommendations for physical activity as of the time of survey distribution.

Healthy People 2020 Target: The HP 2020 target for adults Sufficient Physical Activity Among Adults, Region 1 and Michigan meeting recommendations for aerobic and muscle strengthening activity is 20.1 percent. The HP 60 2020 target for adolescents meeting recommendations for 50 aerobic activity is 20.2 percent. A target incorporating muscle e 40 g strengthening activity is under a t development. n 30 e c r

P Data Sources: 10 Michigan Department of Community Health. Michigan 0 Behavioral Risk Factor Surveillance 2003 2005 2007 2009 System, 2003‐2009. Year

Draft – Last updated April 29, 2018 24 Region 1 Smoking Indicator Definition/Overview:  Smoking is a leading cause of death and disability and is an important modifiable risk factor.  Smoking contributes to the development of many kinds of chronic conditions including cancers, respiratory diseases, and cardiovascular diseases, and “remains the leading preventable cause of premature death in the United States.” It has been estimated that smoking costs the United States $193 billion in annual health-related economic losses and 5.1 million years of potential life lost each year.  Smoking is also associated with cardiovascular disease. Risk of stroke doubles for those who smoke as compared to those who do not.  The Dr. Ron Davis Smoke-Free Air Law, which went into effect on May 1, 2010, protects all Michigan residents and visitors from exposure to secondhand tobacco smoke in all restaurants, bars, and businesses.

Healthy People 2020 Target: Adult Cigarette Smoking Prevalence, Region 1 and Michigan The HP 2020 target for cigarette smoking is 12 percent. 30 Please note that baseline data for HP 2020 targets may be derived 25 from a different source than is used in this chartbook. 20 e g a t

n 15 e c r e

P 10 Data Source: Michigan Department of 5 Community Health. Michigan Behavioral Risk Factor Surveillance 0 System, 2000 - 2010. 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

Draft – Last updated April 29, 2018 25 Region 1 Binge Drinking Indicator Definition/Overview:  Approximately 79,000 people die each year in the United States as a result of excessive alcohol use, making its use the third leading behavior-related cause of death for the nation.  Excessive alcohol consumption has both immediate consequences: miscarriage, stillbirth, birth defects, unintentional injuries, and violence; and long-term consequences: neurological problems; cardiovascular problems; psychiatric problems; social problems including family problems, lost productivity, and unemployment; cirrhosis; and worsening of liver function for persons with hepatitis C virus.  Binge drinking is defined as the consumption of five or more drinks per occasion (for men) or four or more drinks per occasion (for women) at least once in the previous month.

Healthy People 2020 Target: The HP 2020 target for binge drinking is 24.3 percent. Percentage of Adults Reporting Binge Drinking in Past Month, Region 1 and Michigan Please note that baseline data for HP 2020 targets may be derived 30 from a different source than is used in this chartbook. 25

e 20 g a t

n 15 e c r

e 10 Data Source: P Michigan Department of 5 Community Health. Michigan Behavioral Risk Factor Surveillance 0 System, 2001‐2010. 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

Draft – Last updated April 29, 2018 26 Region 1 Controlled Blood Pressure Indicator Definition/Overview:  Approximately one of three adults in the United States has high blood pressure – also known as hypertension – which is a risk factor for heart disease and stroke.  During the past ten years, more people with high blood pressure have become aware of the disease and received treatment.  This indicator is measured as the percentage of adults who were ever told they had high blood pressure and are currently taking medication to control it.

Healthy People 2020 Target: The HP 2020 target for adults with controlled hypertension is 77.4 Percentage of Adults with Controlled Hypertension, percent. Region 1 and Michigan Please note that baseline data for 82 HP 2020 targets may be derived 80 from a different source than is used in this chartbook. 78 e

g 76 a t

n 74 e c r 72 e P 70 Data Source: 68 Michigan Department of Community Health. Michigan 66 Behavioral Risk Factor Surveillance 2001 2003 2005 2007 2009 System, 2001‐2009. Year

Draft – Last updated April 29, 2018 27 Region 1 Infant Mortality Rate Indicator Definition/Overview:  Infant mortality is used as an indicator of the level of child health and overall development and is often used to identify disparities among populations within a specific county.  Rate is calculated as number of deaths per 1,000 live births.

Healthy People 2020 Target: The HP 2020 target for infant Infant Mortality Rates by Race/Ethnicity,Region 1 mortality is 6.0 deaths per 1,000 live births. 25 s

h Please note that baseline data for t r i 20 HP 2020 targets may be derived B

e from a different source than is used v i 15 in this chartbook. L

0 0 0 , 10 1

5 e t a Data Source: R 0 Michigan Department of 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- Community Health, Division of Vital 2002 2003 2004 2005 2006 2007 2008 2009 Records and Health Statistics. Years

White Black Hispanic Total HP 2020 Target

Draft – Last updated April 29, 2018 28 Region 1 Teen Pregnancy Indicator Definition/Overview:  Nearly two-thirds of births to women younger than age 18 are the result of unintended pregnancy.  The children of teenage mothers are less likely to graduate from high school, more likely to suffer health problems, and more likely to encounter problems with the law.  Only about 50 percent of teenage mothers earn a high school diploma by age 22, in contrast with nearly 90 percent of their peers who had not given birth during their teenage years.

Healthy People 2020 Target: Teen Pregnancy Rates, Region 1 and Michigan The HP 2020 target for teen pregnancies among 15 – 17 year 120 olds is 36.2 per 1,000 females. The HP 2020 target for teen

100 pregnancies among 18 – 19 year n i

olds is 105.9 per 1,000 females. p s e u l o a r 80 Please note that baseline data for m G

e HP 2020 targets may be derived F g 0

A 60 from a different source than is used

, in this chartbook. e 1 i f i r c

e 40 e p

p e t S Data Source: a 20 R Michigan Department of Community Health, Division of Vital 0 Records and Health Statistics. 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year

Ages 15-17, Region 1 Ages 18-19, Region 1 Ages 15-17, Michigan Ages 18-19, Michigan HP 2020 Target, Ages 15-17 HP 2020 Target, Ages 18-19

Draft – Last updated April 29, 2018 29 Region 1 Low Birth Weight Indicator Definition/Overview:  Low birth weight is defined as fewer than 2,500 grams, or a maximum of approximately 5 pounds, 8 ounces.  Low birth weight is a major cause of neonatal mortality (death before 28 days of age).  Data are reported as three-year moving averages due to small sample sizes in some groups.

Healthy People 2020 Target: Low Birth Weight - Region 1 The HP 2020 target for low birth weight is 7.8 percent of live births. 16 14 s h t

r 12 i B 10 e v i L

t 6 n e c

P 2 Data Source: 0 Michigan Department of 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 Community Health, Division of Vital Records and Health Statistics. Year White Black American Indian Asian/Pacific Islander Hispanic HP 2020 Target

Draft – Last updated April 29, 2018 30 Region 1 Very Low Birth Weight Indicator Definition/Overview:  Very low birth weight is defined as under 1,500 grams, or 3 pounds, 4 ounces.  Very low birth weight infants are at a significantly increased risk of severe health problems, including physical, visual, cognitive, and developmental difficulties.  Data are reported as three-year moving averages due to small sample sizes in some groups.

Healthy People 2020 Target: Very Low Birth Weight - Region 1 The HP 2020 target for very low birth weight is 1.4 percent of live 4.0 births.

s 3.0 h t r i B

2.5 e v i L

2.0 f o

n 1.5 e c r e 1.0 Data Source: P Michigan Department of 0.5 Community Health, Division of Vital Records and Health Statistics. 0.0 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 Year White Black American Indian Asian/Pacific Islander Hispanic HP 2020 Target

Draft – Last updated April 29, 2018 31 Region 1 Adult Immunizations Indicator Definition/Overview:  Rates of severe illness and death from the influenza virus are highest among children less than two years old, people aged 65 years and older and those with chronic medical conditions.  Between 1976 and 2006, estimates of national annual flu‐associated deaths range about 3,000 to 49,000 people. Pneumococcal disease can also result in chronic problems, such as brain damage, hearing loss, limb loss, or death.  This indicator is measured as the percentage of adults, age 65 years and older, who have had a flu vaccine in the past year and a pneumonia vaccine ever, respectively.

Healthy People 2020 Target: The HP 2020 target for both Flu and Pneumonia Vaccination Among Adults Aged pneumococcal and flu vaccines in the adult population ages 65 and 65 Years and Older, Region 1 and Michigan above is 90 percent. 100 Please note that baseline data for 90 HP 2020 targets may be derived from a different source than is used in this chartbook. e 80 g a t

n 70 e c r e

P 60 Data Source: 50 Michigan Department of Community Health. Michigan 40 Behavioral Risk Factor Surveillance 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 System, 2001‐2010. Year Flu - Region 1 Flu - Michigan Pneumonia - Region 1 Pneumonia - Michigan HP 2020 Target

Draft – Last updated April 29, 2018 32 Region 1 Pediatric Immunizations Indicator Definition/Overview:  The development of vaccines has resulted in a significant drop in incidence for many infectious diseases. Because many vaccine‐preventable diseases primarily affect young children and infants, immunizations are given early in life. High rates of childhood immunization are important to protect not only individual children, but also outbreaks of disease among communities.

Healthy People 2020 Target: Percent of Region 1 Children Aged 19-35 Months An HP 2020 target does not exist Immunized with the 4:3:1:3:3:1 Series for the 4:3:1:3:3:1 series. 90 80 70

e 60 g a

t 50 n

e 40 c r

e 30 P 20 Data Source: Michigan Department of 10 Community Health, Division of 0 Immunization, National Immunization Survey. 2002 2003 2004 2005 2006 2007 2008 2009 Year

Region 1 Michigan

Draft – Last updated April 29, 2018 33 Region 1 Gonorrhea Indicator Definition/Overview:  The CDC estimates that less than half of incident gonorrheal infections are reported to them.  In the United States, sexually active teenagers, young adults, and African Americans report the highest rate of infections.  Left untreated, gonorrhea increases the chance of having an ectopic pregnancy.

Healthy People 2020 Target: The HP 2020 target for females is Gonorrhea Incidence Rates by Age Group, Region 1 and Michigan no more than 257 incident cases per 100,000 population aged 15- 1000 44 years be reported per year. The HP 2020 target for males is 900 no more than 198 incident cases n

o 800 i per 100,000 population aged 15- t a l 44 years be reported per year.

u 700 p

o 600 P

0 500 0 , 0

0 400 Data Source: 1

e 300 Michigan Department of p Community Health, Division of e

t 200 a Vital Records and Health R 100 Statistics. 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year

15-19 Years, Michigan 20-24 Years, Michigan 25-29 Years, Michigan 15-19 Years, Region 1 20-24 Years, Region 1 25-29 Years, Region 1

Draft – Last updated April 29, 2018 34 Region 1 Chlamydia

Indicator Definition/Overview:  Chlamydia is the most commonly reported bacterial sexually transmitted disease in the United States.  Many people with Chlamydia are not aware of their infection, which means that the true incidence is higher than reported.  Left untreated, Chlamydia can negatively impact a woman’s ability to have children.

Healthy People 2020 Target: Chlamydia Incidence Rates by Age Group, Region 1 and Michigan The HP 2020 target for females is no more than 11.5 percent of the 3000 population aged 24 years and under who are enrolled in the

n 2500 National Job Training Network in o i t the last 12 months test positive a l

u 2000 per year. The HP 2020 target for p

o males is no more than 6.3 percent P

0 of the population aged 24 years 0 1500 0

, and under who are enrolled in the 0

0 National Job Training Network in 1

r 1000 the last 12 months test positive e p

per year. e t a 500 R

Data Source: 0 Michigan Department of 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Community Health, Division of Year Vital Records and Health Statistics. 15-19 Years, Michigan 20-24 Years, Michigan 25-29 Years, Michigan 15-19 Years, Region 1 20-24 Years, Region 1 25-29 Years, Region 1

Draft – Last updated April 29, 2018 35 Region 1 Injury Mortality Indicator Definition/Overview:  Injuries are a major cause of death and disability.  Injury death and disability create a large economic burden. The estimated cost of injuries in the United States – including medical care and lost productivity – was $406 billion in 2005.  Like diseases, injuries and violence are preventable – they do not occur at random. The same scientific methods used to prevent disease are also successfully applied to prevent injuries and violence.  Injury mortality is reported in crude rates.

Healthy People 2020 Target: HP 2020 targets for fatal injuries are as follows: Injury Mortality in Region 1, By Cause  Suicide = 10.2 per 100,000  Poisoning = 13.1 per 100,000  Falls = 7 per 100,000 14  Suffocation = 1.7 per 100,000 12  Drowning = 1.1 per 100,000 0

0  Motor Vehicle Traffic Crash-Related = 13.8 0

0 per 100,000 0 8 1

e 6 The HP 2020 target for deaths related to residential p fires is .86 per 100,000. This chartbook measures all

a burn/fire/flame as one indicator. The HP 2020 target

R 2 for firearm-related deaths is 9.2 per 100,000 and 0 does not break deaths into intentional and unintentional.

Please note that baseline data for HP 2020 targets may be derived from a different source than is used in this chartbook.

Data Source: Michigan Department of Community Health, Division 2004-2008 Annual Average Rate 2009 Rate HP 2020 Target of Vital Records and Health Statistics.

Draft – Last updated April 29, 2018 36 Region 1 Mental Health Indicator Definition/Overview:  Forty percent of the top ten leading causes of disability in the United States are mental disorders.  The National Institute of Mental Health estimates that 25 percent of adults endure a mental health disorder in a given year.  The cost of untreated mental illness exceeds100 billion dollars per year in the United States.

Healthy People 2020 Target: An HP 2020 target does not exist for Percentage of Adults Reporting Poor Mental Health on At Least 14 of adults reporting poor mental health. the Past 30 Days, Region 1 and Michigan

e 8 g a t

n 6 e c r e 4 P Data Source: 2 Michigan Department of Community Health, Michigan Behavioral Risk 0 Factor Surveillance System, 2004‐ 2010. 2004 2005 2006 2007 2008 2009 2010 Year

Region 1 Michigan

Draft – Last updated April 29, 2018 37 Appendix A: Sources for Indicator Overview/Definition

Primary Care American Academy of Family Physicians, 2011. http://www.aafp.org/online/en/home/policy/policies/p/primarycare.html

Piggott, Kevin, Ann Batdorf-Barnes, Dana Watt, and Dennis Paradis. "Primary Care Is in Crisis." Michigan Primary Care Consortium. http://www.mipcc.org/sites/mipcc.org/files/u4/crisis_part1_web.pdf

National Association of Community Health Centers, 2009. http://www.nachc.com/client/documents/pressreleases/PrimaryCareAccessRPT.pdf

Access to Care Institute of Medicine, State of the USA Report, 2009.

Leading Causes of Centers for Disease Control and Prevention, 2011. http://www.cdc.gov/nchs/fastats/lcod.htm Death

Years of Potential Gardner, J. W., and J. S. Sanborn. "Years of Potential Life Lost (YPLL)--what Does It Measure?" Epidemiology 1.4 (1990): Life Lost 322-29.

All Cancer Sites Centers for Disease Control and Prevention, 2007. http://www.cdc.gov/nchs/fastats/lcod.htm

American Cancer Society, Cancer Facts and Figures, 2010. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026238.pdf

National Cancer Institute, 2008. http://www.cancer.gov/cancertopics/factsheet/disparities/cancer-health-disparities

Mammogram National Cancer Institute, 2010. http://www.cancer.gov/cancertopics/factsheet/detection/mammograms

Pap Test National Cancer Institute, 2010. http://www.cancer.gov/cancertopics/factsheet/detection/Pap-test

Colorectal Cancer National Cancer Institute, 2008. http://www.cancer.gov/cancertopics/factsheet/detection/colorectal-screening Screening Centers for Disease Control and Prevention, 2011. http://www.cdc.gov/cancer/colorectal/statistics/screening_rates.htm

Draft – Last updated April 29, 2018 38 Cardiovascular Centers for Disease Control and Prevention, 2007. http://www.cdc.gov/nchs/fastats/lcod.htm Disease Centers for Disease Control and Prevention, 2010. http://www.cdc.gov/chronicdisease/resources/publications/AAG/dhdsp.htm

Diabetes Centers for Disease Control and Prevention, 2011. http://www.cdc.gov/diabetes/

Obesity Institute of Medicine, State of the USA Report, 2009.

Childhood Daniels, S. R., Arnett, D. K., Eckel, R. H., Gidding, S. S., Hayman, L. L., Kumanyika, S., …Williams, C. L. (2005). Overweight Overweight in children and adolescents: Pathophysiology, consequences, prevention, and treatment. Circulation, 111, 1999-2012.

Nutrition Institute of Medicine, State of the USA Report, 2009.

Physical Activity Institute of Medicine, State of the USA Report, 2009.

Smoking Institute of Medicine, State of the USA Report, 2009.

Binge Drinking Institute of Medicine, State of the USA Report, 2009.

Controlled Blood Centers for Disease Control and Prevention, 2011. http://www.cdc.gov/bloodpressure/ Pressure

Infant Mortality Institute of Medicine, State of the USA Report, 2009.

Teen Pregnancy Centers for Disease Control and Prevention, 2011. http://www.cdc.gov/TeenPregnancy/AboutTeenPreg.htm

Low Birth Weight Health Resources and Services Administration, 2009. http://mchb.hrsa.gov/chusa08/hstat/hsi/pages/202lbw.html and Very Low Birth Weight Health Resources and Services Administration, 2009. http://mchb.hrsa.gov/chusa08/hstat/hsi/pages/203vlbw.html

Immunizations Institute of Medicine, State of the USA Report, 2009.

Gonorrhea Centers for Disease Control and Prevention, 2011. http://www.cdc.gov/std/Gonorrhea/

Chlamydia Centers for Disease Control and Prevention, 2011. http://www.cdc.gov/std/chlamydia

Draft – Last updated April 29, 2018 39 Injury Mortality Institute of Medicine, State of the USA Report, 2009.

Finkelstein, E.A., Corso, P.S., & Miller, T.R. (2006). Incidence and economic burden of injuries in the United States. New York, NY: Oxford University Press.

Mental Health National Alliance on Mental Illness, 2011. http://www.nami.org/template.cfm?section=about_mental_illness

Draft – Last updated April 29, 2018 40