Regional Health Status Indicators Massachusetts

Deval L. Patrick, Governor Timothy P. Murray, Lieutenant Governor Judyann Bigby, MD, Secretary of Health and Human Services John Auerbach, Commissioner, Department of Public Health

Jerry O’Keefe, Associate Commissioner Health Information, Statistics, Research, and Evaluation Bureau Bruce Cohen, Director Division of Research and Epidemiology

Massachusetts Department of Public Health

June 2007

ACKNOWLEDGEMENTS

This report was prepared by Isabel Caceres, MS, Malena Orejuela-Hood, MPH, and James West, PhD of the Division of Research and Epidemiology and by Lauren Wooley, MPH, of the Health Survey Program, Center for Health Information, Statistics, Research, and Evaluation.

Special thanks go to Bruce Cohen, PhD, Director of the Division or Research and Epidemiology, and to all of the DPH Bureaus who have contributed to this report.

To obtain additional copies of this report, contact:

Massachusetts Department of Public Health Health Information, Statistics, Research and Evaluation Bureau 250 Washington Street, 6th Floor Boston, MA 02108

This and other Department of Public Health publications can be downloaded from the following website:

http://www.mass.gov/dph/resep

To obtain more information on the health of Massachusetts and other Department of Public Health data:

http://masschip.state.ma.us

Or call 888-MAS-CHIP (toll free in MA) or 617-624-5629

2 TABLE OF CONTENTS

NOTE TO READERS ...... 10

INTRODUCTION ...... 11 Goals for holding Regional Dialogues ...... 13 Goals of New DPH Leadership...... 13 Timetable...... 14

SOCIODEMOGRAPHIC INDICATORS...... 15 Executive Office of health and Human Services Regions ...... 17 Comments about the Limitations of this presentation...... 17 Population in Towns in Central Region: 2005 ...... 18 Race and Ethnic Breakdown of Population, Central Region and Massachusetts: 2005 ...... 18 Race and Ethnic Breakdown of Population, Worcester and Massachusetts: 2005...... 19 Population by Age Group, Central Region and Massachusetts: 2005 ...... 19 Language Spoken at Home, Western Region and Massachusetts: 2000 ...... 20 Spanish Spoken at Home, Central Region: 2000...... 20 Socio-Demographic Indicators, Central Region and Massachusetts: 2000 ...... 21 Highest and Lowest per Capita Income Communities in Central Region: 2000...... 21

HEALTH CARE ACCESS ...... 23 Adults who Have No Health Insurance by EOHHS Region, Massachusetts: 2005...... 25 Adults who Have No Health Insurance by Race and Ethnicity, Central Region and Massachusetts: 2005...... 25 Health Insurance Access, Central Region and Massachusetts: 2005...... 26 Summary Indicators for Health Insurance by EOHHS Regions, Massachusetts: 2005...... 26

BIRTH INDICATORS...... 27 Infant Mortality Rate (IMR) Central Region and Massachusetts: 1990-2005 ...... 29 Infant Mortality Rate by Race/Ethnicity, Central Region and Massachusetts: 2002-2005...... 29 Infant Mortality Rates by Race/Ethnicity, Central Region and Massachusetts: 2003-2005.... 30 Highest Infant Mortality Rates Among the 30 Largest Communities’, Massachusetts: 2005 . 30 Infant Mortality Rates (IMR) Worcester, Central Region, and Massachusetts: 1990-2005 .... 31 Infant Mortality Rates by Race and Ethnicity, Worcester: 1990-2005 ...... 31 Highest IMR – 3 Year Averages Among 30 Largest Communities’, Massachusetts: 2003- 2005...... 32 Low Birthweight by EOHHS Region, Massachusetts: 2005 ...... 32 Breastfeeding by EOHHS Region, Massachusetts: 2005 ...... 33 Teen Birth Rates, Central Region and Massachusetts: 1990-2005 ...... 33 Teen Birth Rates by EOHHS Regions, Massachusetts: 2005...... 34 Teen Birth Rates by EOHHS Region, Massachusetts: 2005...... 34 Teen Birth Rates by Community, Central Region: 2005...... 35 Teen Birth Rates by Race and Ethnicity, Central Region and Massachusetts: 2005...... 35 Adequate Prenatal Care by EOHHS Regions, Massachusetts: 2005 ...... 36 Public Source of Payment for Prenatal Care, Central Region and Massachusetts: 1990- 2005...... 36 Public Source of Payment for Prenatal Care, Central Region and Massachusetts: 2005...... 37 Smoking During Pregnancy, Central Region and Massachusetts: 1990-2005...... 37 Smoking During Pregnancy by EOHHS Regions, Massachusetts: 2005 ...... 38

3 Smoking During Pregnancy for Largest Communities, Central Region: 2005...... 38 Smoking During Pregnancy by Race and Ethnicity, Central Region and Massachusetts: 2005...... 39 Infants Delivered by C-Section, Central Region and Massachusetts: 1990-2005...... 39 Infants Delivered by C-Section by EOHHS Regions, Massachusetts: 2005...... 40 Percentage of Cesarean Births by EOHHS Regions, Massachusetts Births 2005 ...... 40 Summary of Birth Indicators by EOHHS Regions, Massachusetts: 2005...... 41 Summary of Birth Indicators by EOHHS Regions, Massachusetts: 2002-2005 ...... 41

LEADING CAUSES OF DEATH ...... 43 Leading Causes of Death, Central Region and Massachusetts: 2005 ...... 45

CHRONIC DISEASE OUTCOMES AND OVERWEIGHT/OBESITY...... 47 Example: Overweight and Obese by Height...... 49 Adults who are Overweight by EOHHS Region, Massachusetts: 1995 & 2005 ...... 49 Adults who are Obese by EOHHS Region, Massachusetts : 1995 & 2005...... 50 Obesity by Race and Ethnicity, Central Region and Massachusetts: 2005...... 50 Adults who Participate in Regular Physical Activity by EOHHS Region, Massachusetts: 2005...... 51 Adults who have 5+ Servings of Fruit or Vegetables by EOHHS Region, Massachusetts : 2005...... 51 Adults who had their Cholesterol Checked in Past 5 Years by EOHHS Region, Massachusetts: 2005...... 52 Adults who were Told by Health Care Provider that they had High Cholesterol, by EOHHS Region, Massachusetts: 2005 ...... 52 Adults who were Told by a Health Care Provider they have High Blood Pressure, by EOHHS Region, Massachusetts: 2005 ...... 53 Adults who take Medicine for High Blood Pressure, by EOHHS Region, Massachusetts : 2005...... 53 Hypertension Hospital Discharges by EOHHS Region, Massachusetts: 2003-3005 ...... 54 Hypertension Hospital Discharge Rates by Race/Ethnicity, Central Region, Massachusetts: 2003-2005 ...... 54 Heart Disease Mortality Rates by EOHHS Region, Massachusetts: 2003-2005...... 55 Heart Disease Death Rates by Race/Ethnicity, Central Region and Massachusetts : 2003- 2005...... 55 Prevalence of Diabetes, Massachusetts: 1994-2005 ...... 56 Diabetes Hospital Discharge Rates by EOHHS Region, Massachusetts: 2003-2005...... 56 Diabetes Hospital Discharge Rates by Race/Ethnicity, Central Region, Massachusetts: 2003-2005 ...... 57 Diabetes Mortality Rates by EOHHS Region, Massachusetts: 2003-2005 ...... 57 Diabetes Mortality Rates by Race/Ethnicity, Central Region and Massachusetts : 2003- 2005...... 58 Summary Indicators for Overweight/Obesity, by EOHHS Regions, Massachusetts : 2005 ... 58 Summary Indicators for Chronic Disease Outcomes for Overweight/Obesity by EOHHS Regions ...... 59

CANCER...... 61 Adults Ages 50+ who have had a Sigmoidoscopy or Colonoscopy in Past 5 Years by EOHHS Regions, Massachusetts: 2005 ...... 63 Incidence Rates for Invasive Colorectal Cancer by EOHHS Region, Massachusetts: 1990- 2003...... 63

4 Incidence Rates for Early Stage Colorectal Cancer, Males, by EOHHS Region, Massachusetts: 1999-2003 ...... 64 Incidence Rates for Early Stage Colorectal Cancer, Females, by EOHHS Region, Massachusetts: 1999-2003 ...... 64 Colorectal Cancer Mortality Rates by EOHHS Region, Massachusetts: 2005...... 65 Men Ages 50+ who had a Prostate-Specific Antigen Test in the Past 2 years by EOHHS Region, Massachusetts: 2004 ...... 65 Men Ages 50+ who had a Digital Rectal Exam in the Past Two Years by EOHHS Region, Massachusetts: 2004...... 66 Adults Ages 50+ who had a Blood Stool Test in the Past Two Years by EOHHS Region, Massachusetts: 2005...... 66 Incidence Rates for Invasive Prostate Cancer by EOHHS Region, Massachusetts: 1999- 2003...... 67 Incidence Rates for Early Stage Prostate Cancer by EOHHS Region, Massachusetts: 1999- 2003...... 67 Prostate Cancer Mortality Rates by EOHHS Region, Massachusetts: 2005...... 68 Women Ages 40+ who had a Clinical Breast Exam in the Past Two Years by EOHHS Region, Massachusetts: 2004 ...... 68 Women who had a Clinical Breast Exam in the Past Two Years by Race and Ethnicity, Central Region and Massachusetts : 2004...... 69 Women Ages 40+ who have had a Mammography in Past 2 Years by EOHHS Region, Massachusetts: 2005...... 69 Incidence Rates for Invasive Female Breast Cancer by EOHHS Region, Massachusetts: 1999-2003 ...... 70 Incidence Rates for Early Stage Female Breast Cancer by EOHHS Region, Massachusetts : 1999-2003 ...... 70 Female Breast Cancer Mortality Rates by EOHHS Region, Massachusetts : 2005...... 71 Incidence Rates for Invasive Lung Cancer by EOHHS Region, Massachusetts : 1999- 2003...... 71 Incidence Rates for Early Stage Lung Cancer, Males, by EOHHS Region, Massachusetts : 1999-2003 ...... 72 Incidence Rates for Early Stage Lung Cancer, Females, by EOHHS Region, Massachusetts: 1999-2003 ...... 72 Lung Cancer Mortality Rates by EOHHS Region, Massachusetts : 2005 ...... 73 Summary Indicators for Cancer Screening by EOHHS Regions, Massachusetts: 2005...... 73 Summary Cancer Indicators (Early Stage) by EOHHS Regions, Massachusetts: 1999- 2003...... 74 Summary Cancer Indicators (Late Stage) by EOHHS Regions, Massachusetts: 1999- 2003...... 74 Summary Cancer Incidence Rates by EOHHS Regions, Massachusetts: 1999-2003...... 75 Summary Cancer Mortality Indicators by EOHHS Regions, Massachusetts: 2005...... 75

SUBSTANCE ABUSE ...... 77 Alcohol Use in Past Month, Persons Aged 12 to 20 Years, by EOHHS Region, Massachusetts : 2002-2004 ...... 79 Binge Drinking in Past Month, Persons Aged 12 to 20 Years, by EOHHS Region, Massachusetts : 2002-2004 ...... 79 Any Illicit Drug Use in Past Month, Persons Aged 12+ Years, by EOHHS Region, Massachusetts: 2002-2004 ...... 80 Any Illicit Drug Use Other Than Marijuana use in Past Month, Persons Aged 12+ Years, by EOHHS Region, Massachusetts: 2002-2004 ...... 80

5 Alcohol Dependence or Abuse in Past Year, Persons Aged 12+ Years, by EOHHS Region, Massachusetts : 2002-2004 ...... 81 Dependence or Abuse of Any Illicit Drug or Alcohol in Past Year, Persons Aged 12+ Years by EOHHS Region, Massachusetts : 2002-2004 ...... 81 Adults who Binge Drink, by EOHHS Region, Massachusetts : 2005 ...... 82 Adults who Used Illicit Drugs in Past Month by EOHHS Region, Massachusetts : 2005 ...... 82 Adults who Currently Smoke, by EOHHS Region, Massachusetts : 2005 ...... 83 Current Smoker by Race and Ethnicity, Western Region and Massachusetts : 2005...... 83 Substance Abuse Treatment Program Admissions by EOHHS Region, Massachusetts : 2005...... 84 Substance Abuse Treatment Program Admissions, Alcohol Primary Substance, by EOHHS Region, Massachusetts : 2005 ...... 84 Substance Abuse Treatment Program Admissions, Cocaine Primary Substance, by EOHHS Region, Massachusetts : 2005 ...... 85 Substance Abuse Treatment Program Admissions, Heroin Primary Substance, by EOHHS Region, Massachusetts : 2005 ...... 85 Opioid-related Emergency Visit Rates by EOHHS Region, Massachusetts : 2003-2005 ...... 86 Opioid-related Emergency Department Visit Rate by Race/Ethnicity, Central Region and Massachusetts : 2003-2005 ...... 86 Massachusetts City and Town FY03-05, Total Number of Opioid Overdose Related Deaths ...... 87 Massachusetts City and Town FY03-05, Total Number of Opioid Overdose Related Deaths ...... 87 Opioid-related Fatal Overdoses by EOHHS Region, Massachusetts : 2003-2005 ...... 88 Opioid-related Fatal Overdoses by Race/Ethnicity, Central Region and Massachusetts : 2003-2005 ...... 88 Massachusetts City and Town FY03-05, Total Number of Poly-Drug Overdose related Events...... 89 Massachusetts City and Town FY03-05, Total Number of Poly-Drug Overdose related Deaths ...... 89 Summary Substance Abuse Indicators by EOHHS Regions...... 90 Summary Substance Abuse Indicators by EOHHS Region, Massachusetts: 2005 ...... 90 Summary Opioid Indicators by EOHHS Regions, Massachusetts: 2003-2005 ...... 91

INJURY, VIOLENCE, AND OCCUPATIONAL HEALTH ...... 93 Causes of Injury Deaths, Central Region and Massachusetts: 2005 ...... 95 Injury-related Hospital Discharge Rates by EOHHS Region, Massachusetts: 2003-2005..... 95 Injury-related Hospital Discharge Rates by Race and Ethnicity, Central Region and Massachusetts: 2003-2005 ...... 96 Emergency Department Visit Rates for Injuries and Poisonings by EOHHS Region, Massachusetts : 2003-2005 ...... 96 Emergency Department Visit Rates for Injuries & Poisonings by Race/Ethnicity, Central Region and Massachusetts : 2003-2005 ...... 97 Hospital Discharge Rates for Traumatic Brain Injuries by EOHHS Region, Massachusetts : 2003-2005 ...... 97 Hospital Discharge Rates for Traumatic Brain Injury by Race/Ethnicity, Central Region and Massachusetts : 2003-2005 ...... 98 Emergency Department Visit Rates for Traumatic Brain Injury, by EOHHS Region, Massachusetts : 2003-2005 ...... 98 Emergency Department Visit Rates for Traumatic Brain Injury by Race/Ethnicity, Central Region and Massachusetts : 2003-2005 ...... 99

6 Injury Death Rates by EOHHS Region, Massachusetts : 2003-2005...... 99 Hospital Discharge Rates for Assaults by EOHHS Region, Massachusetts : 2003-2005 .... 100 Hospital Discharge Rates for Assaults by Race/Ethnicity, Central Region and Massachusetts : 2003-2005 ...... 100 Homicides by EOHHS Region, Massachusetts : 2003-2005...... 101 Homicide Rates by Race/Ethnicity, Central Region and Massachusetts : 2003-2005 ...... 101 Hospital Discharge Rates for Self-Inflicted Injury, by EOHHS Region, Massachusetts : 2003- 2005...... 102 Hospital Discharge Rates for Self-Inflicted Injuries by Race/Ethnicity, Central Region and Massachusetts: 2003-2005 ...... 102 Suicide by EOHHS Region, Massachusetts: 2003-2005...... 103 Suicide Rates by Race/Ethnicity, Central Region and Massachusetts: 2003-2005 ...... 103 Hospital Discharge Rates for Motor Vehicle-related Injuries by EOHHS Region and Massachusetts : 2003-2005 ...... 104 Hospital Discharge Rates for Motor Vehicle-related Injuries by Race/Ethnicity, Central Region and Massachusetts: 2003-2005 ...... 104 Motor Vehicle-related Mortality Rates by EOHHS Region, Massachusetts : 2003-2005 ..... 105 Motor Vehicle-related Death Rates by Race/Ethnicity, Central Region and Massachusetts: 2003-2005 ...... 105 Emergency Department Visit Rates for Firearm Injuries, by EOHHS Region, Massachusetts: 2003-2005 ...... 106 Emergency Department Visit Rates for Firearm Injuries by Race/Ethnicity, Central Region and Massachusetts: 2003-2005 ...... 106 Firearm Death Rates by EOHHS Region, Massachusetts: 2003-2005 ...... 107 Firearm Death Rates by Race/Ethnicity, Central Region and Massachusetts: 2003-2005 .. 107 Hospital Discharge Rates for Fall-related Injuries, by EOHHS Region, Massachusetts : 2003- 2005...... 108 Hospital Discharge Rates for Fall-related Injuries, Ages 65+, by EOHHS Region, Massachusetts : 2003-2005 ...... 108 Hospital Rates for Fall-related Injuries by Race/Ethnicity, Central Region and Massachusetts : 2005...... 109 Emergency Department Visit Rates for Fall-related Injuries, by EOHHS Region, Massachusetts : 2003-2005 ...... 109 Emergency Department Visit Rates for Fall-related Injuries by Race/Ethnicity, Central Region and Massachusetts : 2003-2005 ...... 110 Fall-related Injury Mortality Rates by EOHHS Region, Massachusetts : 2003-2005...... 110 Fall-related Injury Mortality Rates by Race/Ethnicity, Central Region and Massachusetts : 2003-2005 ...... 111 Fall-related Injury Mortality Rates, Persons 65+ years, by EOHHS Region, Massachusetts : 2003-2005 ...... 111 Work-related Injuries, Emergency Department Visits per 100 Full Time Equivalents, Massachusetts Counties: 2004-2005 ...... 112 Work-related Injuries among Teens, Emergency Department Visits per 100 Full Time Equivalents, Massachusetts Counties: 2004-2005...... 112 Work-related Burn Injuries, Emergency Department Visits per 10,000 Full Time Equivalents, Massachusetts Counties: 2004-2005 ...... 113 Work-related Amputations, Emergency Department Visits per 10,000 Full Time Equivalents, Massachusetts: 2004-2005 ...... 113 Work-related Injuries, Hospitalizations per 10,000 Full Time Equivalents, Massachusetts Counties: 2004-2005 ...... 114 Number and Rate of Fatal Occupational Injuries by year, Massachusetts: 1991- 2005..... 114

7 Summary Injury/Violence Hospitalization Indicators by EOHHS Regions, Massachusetts : 2003-2005 ...... 115 Summary Injury/Violence Emergency Department Indicators by EOHHS Regions, Massachusetts : 2003-2005 ...... 115 Summary Injury/Violence Mortality Indicators by EOHHS Regions, Massachusetts : 2003- 2005...... 116

HIV/AIDS ...... 117 Persons Living with HIV, by EOHHS Region, Massachusetts: 2005...... 119 HIV Incidence, by EOHHS Region, Massachusetts: 2005 ...... 119 AIDS Incidence, by EOHHS Region, Massachusetts: 2005...... 120 Persons Living with AIDS, by EOHHS Region, Massachusetts : 2005 ...... 120 HIV/AIDS Mortality Rates, by EOHHS Region, Massachusetts : 2003-2005 ...... 121 HIV/AIDS Mortality Rates by Race/Ethnicity, Worcester and Central Regions vs. Massachusetts: 2003-2005 ...... 121 Summary HIV/AIDS Indicators by EOHHS Regions ...... 122

INFECTIOUS DISEASES ...... 123 Chlamydia Incidence, Central Region and Massachusetts : 1989-2005 ...... 125 Chlamydia Incidence by EOHHS Region, Massachusetts: 2005 ...... 125 Chlamydia Incidence Rate by Emergency Preparation Region, 2006...... 126 Gonorrhea Incidence by EOHHS Region, Massachusetts : 2005 ...... 126 Syphilis Incidence, Central Region and Massachusetts : 1989-2005...... 127 Syphilis Incidence, by EOHHS Region, Massachusetts : 2005...... 127 Tuberculosis Incidence, by EOHHS Region, Massachusetts : 2004...... 128 Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region, Massachusetts: 2006...... 128 Percent Confirmed Tuberculosis Cases by EOHHS Region, Massachusetts : 2006 ...... 129 Percent of Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region, Massachusetts : 2006...... 129 Tuberculosis Cases by EOHHS Region, Massachusetts : 1993-2006...... 130 Percent of Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region, Massachusetts : 2006...... 130 Hepatitis C Average Incidence Rates, by EOHHS Region, Massachusetts: 1992-2006...... 131 Massachusetts Hepatitis C Infection Average per Year, by Town, 1992-2006 ...... 131 Hepatitis C Incidence Rates, by EOHHS Region, Massachusetts : 2006 ...... 132 Massachusetts Hepatitis C Infection Average per Year, by Town, 2006...... 132 Massachusetts Hepatitis C Infection Average per Year, by Town (Youth less than 26 years, 2002-2006 ...... 133 Lyme Disease Incidence by EOHHS Region, Massachusetts: 2004 ...... 133 Massachusetts Lyme Disease Case Rates, by Town, 2005 ...... 134 Pneumonia and Influenza Hospital Discharges by EOHHS Region, Massachusetts: 2005. 134 Summary Infectious Disease Indicators, by EOHHS Regions ...... 135

ASTHMA...... 137 Asthma Hospital Discharges by EOHHS Region, Massachusetts: 2005...... 139 Asthma Emergency Department Visits, by EOHHS Region, Massachusetts: 2005...... 139 Emergency Department Visit Rates for Asthma by Race/Ethnicity, Central Region and Massachusetts: 2005...... 140 Adults who Currently have Asthma by EOHHS Region, Massachusetts: 2005 ...... 140 Asthma ER Visits, Children Ages 0-4, by EOHHS Region, Massachusetts : 2005 ...... 141

8 Asthma ER Visits, Children Ages 5-9, by EOHHS Region, Massachusetts : 2005 ...... 141 Asthma ER Visits, Children Ages 10-14, by EOHHS Region, Massachusetts : 2005 ...... 142 Asthma ER Visits, Children Ages 0-14, by EOHHS Region, Massachusetts : 2005 ...... 142 Asthma Emergency Department Visit Rates, Children ages 0-14, Central Region and Massachusetts : 2005...... 143 Pediatric Asthma Prevalence, by EOHHS Region, Massachusetts : 2005-2006 ...... 143 Pediatric Asthma Emergency Visit Rates by Towns, Among Children Ages <5, Massachusetts 2004-2005 ...... 144 Pediatric Asthma Emergency Visit Rates by Towns, Among Children Ages <5, Central Region, Massachusetts: 2004-2005 ...... 144 Pediatric Asthma Hospitalization Rates by Towns, Among Children Ages <5, Central Region, Massachusetts: 2004-2005 ...... 145 Summary Asthma Indicators, by EOHHS Regions, Massachusetts : 2005...... 145 Summary Asthma Indicators, by EOHHS Regions, Massachusetts : 2005...... 146

OTHER HEALTH INDICATORS ...... 147 Total Cases of Elevated Blood Lead Levels (>=15 µG/DL), by EOHHS Region, Massachusetts: 2005...... 149 Lead Poisoning Prevalence Rates (BLL≥ 25 µG/DL), Children 9-48 Months, by EOHHS Region, Massachusetts: 2006 ...... 149 Adults who Report Experiencing Intimate Partner Violence by Gender and EOHHS Region, Massachusetts: 2005...... 150 Adults who Report Having a Disability by EOHHS Region, Massachusetts : 2005...... 150 Adults who Report Having a Disability and needing help with activities, by EOHHS Region, Massachusetts : 2005...... 151 Adults with Fair or Poor Health, by EOHHS Region, Massachusetts : 2005...... 151 Adults who Reported Fair or Poor Health by Race and Ethnicity, Central Region and Massachusetts : 2005...... 152 Adults who Visited a Dentist in Past Year, by EOHHS Region, Massachusetts : 2004 .... 152 Adults who have lost 6 or More Teeth to Decay or Disease, by EOHHS Region, Massachusetts : 2004...... 153 Adults with Poor Mental Health for 15+ Days in Past Month, by EOHHS Region, Massachusetts : 2005...... 153 Summary Other Health Indicators, by EOHHS Regions ...... 154 Summary Other Health Indicators, by EOHHS Regions ...... 154 Refugee Arrivals : Central Region, Fiscal year 2002-2006 ...... 155 Refugee Health Concerns : Central Region, Fiscal year 2002-2006...... 155 Summary Refugees by EOHHS Regions, Massachusetts : 2002-2006...... 156 Premature Mortality Rate (PMR) ...... 156 Premature Mortality Rates (PMR) by Region, Massachusetts : 2005 ...... 157 PRM – Central Region by City/Town, Massachusetts : 2005...... 157 Median Household Income and PMR by EOHHS Region, Massachusetts : 2005...... 158 Premature Mortality Rate (PMR) by EOHHS Regions: 2005 ...... 158 Summary ...... 159

APPENDIX...... 161 Regions and Towns...... 163 Data Sources...... 171

NOTE TO READERS

Background This report presents important health indicators for your region, which were developed as background material for the Regional Health Dialogues being held across the Commonwealth in May and June 2007. These dialogues offer an opportunity for you to have a conversation with the Commissioner of Public Health, learn the latest health information for your region, identify your resources and areas of need, and together, with the Massachusetts Department of Public Health, shape a public health partnership.

Contents This report provides information about the socio-demographics, health care access, births, deaths, major chronic and infectious disease rates, substance abuse, and injury and violence for your region. Your region’s indicators are compared with those of other regions and to the state as a whole in order to provide you with a sense of the relative health of your region. Many indicators for your region are stratified by race, Hispanic ethnicity, and age in order help determine specific population groups that may require targeted health interventions. We have also provided information about the health status of one or more large communities in your region, which may be influencing your regional outcomes. We hope that this collection of important and diverse health indicators will stimulate discussions of local health priorities, as well as serving as a resource for health information and a reference for data that are available from the Massachusetts Department of Public Health. Please contact us with your comments and suggestions.

INTRODUCTION

12 Goals for holding Regional Dialogues

• Introduce new DPH leadership • Present latest health data on your particular region • Talk with residents and providers about data and identify areas of need • Gather feedback to inform process of setting DPH priorities

Goals of New DPH leadership

• Use data and community input to set new priorities & reshape the Department • Rely on science and evidence-based process to guide the work • Strengthen ties with and support for local health and local agencies • Increase resources to and visibility of public health in Massachusetts

13 Timetable

• Hold 8 regional dialogues with comprehensive data review and identification of key health concerns (by July) • Identify short list of top priorities by end of August • Hold second round of community dialogues to discuss action plans/results by end of calendar year

SOCIODEMOGRAPHIC INDICATORS

A few comments about the limitations of this presentation

• A regional analysis has its drawbacks • Variability within a region – urban vs. rural/suburban (i.e. Worcester vs. the rest of the region) • Variability by sub-population – race matters, poverty matters • Our data don’t reflect all the important health indicators

1 Executive Office of Health and Human Services Regions

Northeast Region

Western Central Boston Region Region Metro West Region Region

Southeast Region Western Region Central Region North East Region Metro West Region South East Region Boston Region

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

Population in Towns in Central Region: 2005 2

ASHBY WINCHENDON TOWNSEND PEPPERELL ASHBURNHAM

Smallest GROTON

FITCHBURG New Braintree: GARDNER LUNENBURG 1,090 TEMPLETON SHIRLEY AYER WESTMINSTER LEOMINSTER HARVARD HUBBARDSTON LANCASTER

PRINCETON STERLING BOLTON BARRE CLINTON Largest RUTLAND BERLIN WEST BOYLSTON HARDWICK BOYLSTON Worcester: OAKHAM HOLDEN 179,839 NEW BRAINTREE PAXTON

SHREWSBURY NORTH BROOKFIELD WORCESTER WEST BROOKFIELD SPENCER LEICESTER

EAST BROOKFIELD GRAFTON WARREN AUBURN .! BROOKFIELD MILLBURY UPTON Population > 10,000 MILFORD MEDWAY

BRIMFIELD CHARLTON SUTTON NORTHBRIDGE OXFORD HOPEDALE STURBRIDGE MENDON FRANKLIN BELLINGHAM WALES HOLLAND SOUTHBRIDGE UXBRIDGE DUDLEY DOUGLAS WEBSTER MILLVILLEBLACKSTONE

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

3 Race and Ethnic Breakdown of Population Central Region and Massachusetts: 2005

Central Region Massachusetts * Non-Hispanics American American Asian* Indian* Asian* Indian* Hispanic 3.3% 0.3% 7.3% 4.9% 0.2% Hispanic Black* 7.9% 3.2% Black* 6.0%

White* White* 86.0% 81.0%

Population Total = 844,700 Population Total =6,436,940

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

4 Race and Ethnic Breakdown of Population Worcester and Massachusetts: 2005

* Non-Hispanics Worcester Massachusetts American American Indian* Asian*, Indian*, Asian* 0.2% 7.0 0.4 Hispanic 4.9% 7.9% Hispanic, Black* 17.4 6.0%

Black*, 8.6 White* White* 66.7 81.0%

Population Total = 179,839 Population Total = 6,436,940

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

5 Population by Age Group Central Region and Massachusetts: 2005

Central Region Massachusetts

65+ years 65+ years 11.8% 13.3% 0-19 years 0-19 years 27.4% 25.5% 45-64 years 45-64 years 25.0% 25.3% 20-24 years 20-24 years 6.0% 6.7%

25-44 years 25-44 years 29.8% 29.4%

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

Language Spoken at Home, 6 Western Region and Massachusetts: 2000

Central Massachusetts

Region Overall Only English 85.7 81.3 Spanish or Spanish Creole 5.8 6.2 Portuguese or Portuguese Creole 0.7 2.7 French 1.9 1.4 Chinese 0.3 1.2 Italian 0.6 1.0 African Languages 0.4 0.2 Russian 0.2 0.6 Vietnamese 0.7 0.5 Polish 0.7 0.5

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

7 Spanish Spoken at CentralHome Region Central Region: 2000

FITCHBURG 13% Spanish Language SHIRLEY 8% Spoken at Home (%) LEOMINSTER 10% Cities/Towns in Central Region HARVARD 7% 10.0% - 55.3% LANCASTER 8% 5.0% - 9.9% 0.2% - 4.9% CLINTON 10%

WEST BOYLSTON 6%

WORCESTER 13%

Miles

SOUTHBRIDGE 17%

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

8 Socio-Demographic Indicators Central Region and Massachusetts: 2000 Central Massachusetts US Worcester Region Overall Overall

Per Capita Income $18,614 $22,775 $25,952 $21,587

Those living below 100% poverty 17.9% 8.8% 9.3% 12.4%

Children < 18 living below 100% poverty 25.5% 11.2% 12.0% 16.1%

Less than a High School Education 23.3% 16.2% 15.2% 19.6%

Foreign born 14.5% 7.4% 12.2% 11.1%

Unemployed 6.9% 5.4% 5.1% 5.5%

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

9 Highest and Lowest Per Capita Income Communities1 in Central Region: 2000

Shrewsbury $31,570 Holden High $27,971 Franklin $27,849

Massachusetts $25,952 Central $22,775

Worcester $18,614 Southbridge Low $18,514 Fitchburg $17,256

$0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000

1 Selected among communities with at least 10,000 population Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

HEALTH CARE ACCESS

24 10 Adults who Have No Health Insurance by EOHHS Region, Massachusetts: 2005

15 12.3 11.3 11.4

10 9.4 8.9 Percent 6.8

5 4.6*

0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

Adults who Have No Health Insurance 11 by Race and Ethnicity Central Region and Massachusetts: 2005

White non-Hispanic Black non-Hispanic Hispanic

25 23.8

15 12.7 11.5

Percent 10 7.0 5.2 5 NA NA 0 Central Region Massachusetts * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

25 12 Health Insurance Access Central Region and Massachusetts: 2005

100% 90% 90% 87% 80% Central Region 70% Massachusetts 60% 50% 40% 30% 20% 10% 9% 10% 0% Have personal health care provider Could not see doctor due to cost

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

13 Summary Indicators for Health Insurance by EOHHS Regions, Massachusetts: 2005

MA Western Central North Metro Indicator South Boston Total East West East % Adults with no health 8.9 12.3 6.8 9.4 4.6 11.3 11.4 insurance % Adults who have a personal 87.1 85.3 90.0 85.8 90.3 88.2 78.3 health care provider % Adults who were unable to 8.8 10.4 10.4 7.8 7.0 9.2 9.4 see a doctor due to cost

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

BIRTH INDICATORS

28 Infant Mortality Rate (IMR) 14 Central Region and Massachusetts: 1990-2005

8 7.7

7 Central Region 6.8 6 7.0

5 5.1 4 Massachusetts 3

2 IMR (# deaths/1,000 live births) live deaths/1,000 (# IMR 1

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year Infant Mortality Rate: deaths of infants less than one year of age per 1000 live births Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

Infant Mortality Rates by Race/Ethnicity 15 Central Region and Massachusetts: 2002-2005

White non-Hispanic Black non-Hispanic 20 18.9 Hispanic Asian non-Hispanic 18 16 14 11.2 12 10.6 10 8 7.0 6 4.4 4.1

Deaths per live 1000 births 4 3.0 2 NA 0 Central Region Massachusetts NA= Calculations based on less than 5 events are excluded

Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

16 Infant Mortality Rates by Race/Ethnicity Central Region and Massachusetts: 2003-2005

20 18.9 Central Region 18 Massachusetts 16 14 12 11.2 10.6 10 8 7.0 5.6 4.9 6 4.4 4.1 4 3.0 2 NA Deaths per 1000 live births 0 White non- Black non- Hispanic Asian Overall Hispanic Hispanic

* Statistically Significantly different from state (p ≤.05) NA= Calculations based on less than 5 events are excluded Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

17 Highest Infant Mortality Rates Among the 30 Largest Communities1 Massachusetts: 2005 IMR 95% CI2 Number of Deaths State 5.1 [4.6, 5.6] 391 Worcester 13.9* [9.4,18.4] 36

Malden 11.4 [4.0, 18.7] 9 Revere 10.9 [2.9, 18.9] 7 Springfield 10.6* [6.4, 14.7] 25

New Bedford 8.6 [3.8, 13.5] 12

1Selected among the 30 Massachusetts communities with the largest populations. IMR = infant deaths per 1,000 live births. 2A Confidence Interval for a population parameter is a range in which you are 95% certain that the true population estimate is within. It is a function of variability and the number of events.

18 Infant Mortality Rate (IMR) Worcester: 1990-2005

Worcester 16 Central MA, without Worcester 13.9* MA 14

10 7.7 8 7.0 7.6

Infant Deaths Deaths Infant 6 5.1

per infant 1000 births 4 4.5

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Rate = infant deaths per 1,000 live births * Statistically higher than state (p ≤.05) Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

19 Infant Mortality Rates by Race and Ethnicity Worcester: 1990-2005

White Black Hispanic Worcester non- non- (all races) Hispanic Hispanic 1990 6.7 -- 11.3 7.7 1991 5.8 28.4 18.8 9.5 1992 5.4 27.5 -- 7.4 1993 9.4 -- 8.8 6.2 1994 14.3 -- -- 12.1 1995 6.8 -- 11.6 8.8 1996 10.6 -- -- 9.8 1997 8.6 -- -- 8.2 1998 4.4 32.0 -- 7.0 1999 6.5 20.4 9.8 8.1 2000 6.6 31.5 -- 9.9 2001 5.3 29.5 -- 8.2 2002 6.9 19.5 10.3 8.8 2003 -- 17.4 -- 4.3 2004 -- 21.9 10.3 6.6 2005 11.1 15.7 24.2 13.9

Rate = infant deaths per 1,000 live births. -- Calculations based on less than 5 events are excluded. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

20 Highest IMR – 3 Year Averages Among the 30 Largest Communities1 Massachusetts: 2003-2005

2003-2005 Rate

Massachusetts 4.9 (n = 1,150)

Worcester 8.3 (n = 64) * Lowell 7.8 (n = 39) * Brockton 7.6 (n = 35) Lawrence 7.5 (n = 32) Weymouth 7.5 (n = 16) Springfield 7.1 (n = 51)

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

1Selected among the 30 Massachusetts communities with the largest populations. Rate = infant deaths per 1,000 live births Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

21 Low Birthweight by EOHHS Region Massachusetts: 2005

10 9.4* 9 8.3 8.2 7.9 8 7.5 7.6 7.1* 7 6 5 4 3

Percent of LBW Births (%) Births LBW Percent of 2 1 0 Western Central Mass Northeast Metro West Southeast Boston MA Mass Region

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Low birthweight: less than 2,500 grams or 5.5 pounds Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

22 Breastfeeding by EOHHS Region Massachusetts: 2005

100 * 86.9 * 90 88.4 79.5 79.3 80 77.6 * 68.7 * 71.5 70 60 50 Percent 40 30 20 10 0 Western Central Mass Northeast Metro West Southeast Boston MA Mass Region

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Mother was breastfeeding or intending to breastfeed at the time the birth certificate was completed. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

Teen Birth Rates 23 Central Region and Massachusetts: 1990-2005

45 41.9

40 35 Central Region 35.1 30

25 Massachusetts 22.6

20 21.7 15 Births per 1,000 women ages 15-19 ages women 10

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Teen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

24 Teen Birth Rates1 by EOHHS Regions Massachusetts: 2005

35 31.0 * 29.4* 30

25 23.1 22.6 23.0 21.7 20

15 Births per 1,000 1,000 per Births women ages 15-19 ages women 10 8.3*

0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state 1Teen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

26 TeenTeen Birth Birth Rates Rates by by Community Towns* CentralCentral Region Region: Births 2005 2005

FITCHBURG GARDNER 39.6 42

WORCESTER 37.2

Town Teen Birth Rate per 1000 15-19 Female Population Significantly higher than state rate

Not different from state rate SOUTHBRIDGE 64.5 Significantly lower than state rate

*Towns with less than 100 births were excluded. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

34 26 TeenTeen Birth Birth Rates Rates by by Community Towns* CentralCentral Region Region: Births 2005 2005

FITCHBURG GARDNER 39.6 42

WORCESTER 37.2

Town Teen Birth Rate per 1000 15-19 Female Population Significantly higher than state rate

Not different from state rate SOUTHBRIDGE 64.5 Significantly lower than state rate

*Towns with less than 100 births were excluded. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

27 Teen Birth Rates by Race and Ethnicity Central Region and Massachusetts: 2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

80 73.2 70 65.4

40 36.4 29.5 30

Births per 1,000 1,000 per Births 17.7 * women ages 15-19 ages women 20 12.9 15.3 10.3 10

0 Central Region Massachusetts

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Teen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

35 28 Adequate Prenatal Care by EOHHS Regions, Massachusetts: 2005

100 * 87.5 * 85.4 * 83.6 84.3 84.0 79.5* 82.0 80

60 Percent 40

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Based on Adequacy of Prenatal Care Utilization (APNCU) Index. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

29 Public Source1 of Payment for Prenatal Care Central Region and Massachusetts: 1990-2005

35 32.6

30 25.7 Massachusetts 25 27.9 24.1 20 Central Region

Percent 15

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

1Public: Government programs including Commonhealth, Healthy Start, Medicaid/MassHealth, or free care. Private: Commercial indemnity plan, commercial Managed care (HMO, PPO, IPP, IPA and other) or other private insurance. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

36 30 Public Source of Payment for Prenatal Care1 Central Region and Massachusetts: 2005

Central Massachusetts Region

* Public 28% Private 67% Public 33%

Private 72%*

* Statistically Significantly different from state (p ≤.05) 1Public: Government programs including Commonhealth, Healthy Start, Medicaid/MassHealth, or free care. Private: Commercial indemnity plan, commercial Managed care (HMO, PPO, IPP, IPA and other) or other private insurance. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

31 Cigarette Smoking During Pregnancy Central Region and Massachusetts: 1990-2005

25 20.4 20 19.3 Central Region 15

Massachusetts Percent Percent 10 7.6

5 7.2

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

37 32 Cigarette Smoking During Pregnancy by EOHHS Regions Massachusetts: 2005

15 13.5* Percent 10.2* 10 7.6 7.2 7.3 3.9 * 5 3.2*

0 Western Central Northeast Metro Southeast Boston MA West

33 Cigarette Smoking During Pregnancy for Largest Communities Central Region: 2005

% Smokers Births

Massachusetts 7.2% 5,555 76,653 Central Region 7.6% 797 10,512 Lowest Shrewsbury 1.6%* 7429 Grafton 2.7%* 7260 Holden 3.5%* 6171 Highest Gardner 22.9%* 54 236 Southbridge 14.2%* 34 240 Fitchburg 12.8%* 73 571

38 Cigarette Smoking During Pregnancy by 34 Race and Ethnicity Central Region and Massachusetts: 2005 White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

9 8.4 8.4 8 7 6.3 6.1 6 5.2 5 4.3 4 Percent 3 2 1.4

1 NA 0 Central Region Massachusetts

Infants Delivered by Caesarean 35 Central Region and Massachusetts: 1990-2005

34 32.3

30 29.5 26 22.5 Percent 22 Massachusetts Central Region

18 20.0

14 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

39 36 Infants Delivered by Caesarean by EOHHS Regions, Massachusetts: 2005

100

60 Percent 40 * * 34.6* * 34.4 34.2 29.9* 32.3 27.1* 29.5

0 Western Central Northeast Metro Southeast Boston MA West

37 Percentage of Cesarean Births by Executive Office of Health and Human Service (EOHHS) Regions, Massachusetts Births 2005

Northeast 34.4%

Western Boston Highest in 27.1% Central Metro 29.9% 29.5% West South East 34.2% Region

Southeast 34.6%

EOHHS Region's % Cesarean Births Significantly higher than state rate No different from state rate Significantly lower than state rate

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

40 38 Summary of Birth Indicators by EOHHS Regions, Massachusetts:2005

MA Indicator Western Central North Metro South Boston (as % of race Total East West East (n=9,644) group births) (n=76,824) (n=8,935) (n=10,532) (n=15,939) (n=17,093) (n=14,681) Adequate Prenatal Care 84.0 79.5 85.4 82.0 87.5 83.6 84.3 (Kotelchuck index) C-section 32.3 27.1 29.5 34.4 34.2 34.6 29.9 deliveries Low Birth 7.9 8.2 7.5 7.6 7.1 8.3 9.4 weight (<5.5 lb)

Breastfeeding 79.3 68.7 79.5 77.6 88.4 71.5 86.9

Public Pay for 32.6 47.4 27.9 33.7 17.2 34.7 46.4 Prenatal Care Smoking during 7.1 13.5 7.6 7.2 3.2 10.2 3.9 pregnancy

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

39 Summary of Birth Indicators by EOHHS Regions, Massachusetts:2002-2005

MA Indicator Western Central North Metro South Boston Total East West East

Infant Mortality Rate 4.9 5.6 5.4 4.7 4.0 4.8 5.7 (infant deaths per 1000 live births)

Teen birth rate (births to women 21.7 31.0 22.9 23.0 8.3 23.1 29.4 ages 15-19 per 1000 women ages 15-19)

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

LEADING CAUSES OF DEATH

44 Leading Causes of Death 40 Central Region and Massachusetts:2005 Central Region Massachusetts N=6,954 N=53,776 Heart Disease 1,753 25.2% Heart Disease 13,248 24.6% Cancer 1,644 23.6% Cancer 13,159 24.5% Stroke 405 5.8% Stroke 2,979 5.5% Chronic Lower Respiratory Disease (formerly COPD) 399 5.7%* All Injuries 2,657 4.9% Chronic Lower Respiratory All Injuries 329 4.7% Disease (formerly COPD) 2,643 4.9%

Influenza and pneumonia 263 3.8% Influenza and pneumonia 1,932 3.6%

Alzheimer's 204 2.9% Alzheimer's 1,635 3.0%

Diabetes 185 2.7% Nephritis 1,403 2.6%

Nephritis 148 2.1%** Diabetes 1,271 2.4%

Septicemia 108 1.6% Septicemia 982 1.8% * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

CHRONIC DISEASE OUTCOMES AND OVERWEIGHT/OBESITY

41 Example: Overweight and Obese by Height

Overweight Obesity Height BMI 25.0-29.9 BMI > 30

5’ 128 lbs. 153 lbs. 5’2’’ 136 164 5’4’’ 145 174 5’6’’ 155 186 5’8’’ 164 197 6’ 184 221 6’2” 195 234

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

42 Adults who are Overweight1 by EOHHS Region, Massachusetts: 1995 & 2005

1995 2005 70 60.8 57.5 57.8 60 55.9 56.1 52.6 52.0 49.5 50.2 50 45.7 43.5 44.6 45.1 40 35.7

Percent 30

0 Western Central Northeast Metro Southeast Boston MA West Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state

1 Overweight: BMI greater than or equal to 25 Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), Health Survey Program

43 Adults who are Obese1 by EOHHS Region, Massachusetts: 1995 & 2005

30 1995 2005

25 23.3 23.6 21.7 20.9 20.7 20 19.2 16.8 * 16.8 14.3 15

Percent 11.6 11.7 10.2 9.6 10 8.1

0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

1 Obesity: BMI greater than or equal to 30 Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

44 Obesity by Race and Ethnicity Central Region and Massachusetts: 2005

White non-Hispanic Black non-Hispanic Hispanic 40

35 32.7

30 27.4 24.1 25 22.1 19.9 20

Percent 15

5 NA 0 Central Region Massachusetts * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

45 Adults who Participate in Regular Physical Activity by EOHHS Region, Massachusetts: 2005

100 90 80 70 60 56.4 54.7 51.5 50.6 51.8 49.5 52.6 50 Percent 40 30 20 10 0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

46 Adults who have 5+ Servings of Fruit or Vegetables by EOHHS Region, Massachusetts: 2005

50 45 40 35 33.0 28.4 29.3 28.6 30 26.4 26.4 26.4 25 Percent 20 15 10 5 0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

47 Adults who had their cholesterol checked in Past 5 Years by EOHHS Region Massachusetts: 2005

100 90 84.8* 82.0 79.2 79.3 80 74.0 76.6 73.3 70 60 50 Percent 40 30 20 10 0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

48 Adults who were told by a health care provider that they have high cholesterol1 by EOHHS Region Massachusetts: 2005

50 45 38.4 40 35.9 36.5 35.7 34.2 34.5 35 31.2 30 25 Percent 20 15 10 5 0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05) 1 Among those who reported having their cholesterol checked Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

49 Adults who were told by a health care provider that they have high blood pressure by EOHHS Region Massachusetts: 2005

50 45 40 35 28.9 30 26.3 25.3 25.1 25.3 25 22.8 21.9 Percent 20 15 10 5 0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

50 Adults who take Medicine for High Blood Pressure1 by EOHHS Region Massachusetts: 2005

100 90 76.0 78.6 76.5 75.3 80 74.0 73.5 71.3 70 60 50 Percent 40 30 20 10 0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05) 1 Among those who reported having high blood pressure Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

51 Hypertension Hospital Discharges by EOHHS Region, Massachusetts: 2003-2005

90 84.6 * 80 70

60 50 * 38.7 38.7 40 35.0 * 33.0* * per100,000 30.9 31.0 30 Age-adjusted rate Age-adjusted 20 10 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database

52 Hypertension Hospital Discharge Rates by Race/Ethnicity Central Region Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

200 176 180 171 160 140 120 100 89 80 71 60 33 33 Discharges per 100,000 per Discharges 40 26 28 20 0 Central Region Massachusetts

Heart Disease Mortality Rates 53 by EOHHS Region Massachusetts: 2003-2005

300

196.8 * 195.1* 200 188.8 186.3 177.9 182.5 159.8 * Deaths Deaths per 100,000 100,000 per 100

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

54 Heart Disease Death Rates by Race/Ethnicity Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

250 209.4 198.3 * 200 186.2 184.7

152.2 * 150 103.7 100 76.7 68.4

Deaths per 100,000 per Deaths 50

0 Central Region Massachusetts * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Source: Preliminary 2005 MA Death file, Registry of Vital Records, MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

55 Prevalence of Diabetes Massachusetts: 1994-2005

7 6.2 6.4 5.8 5.8 6 4.9 4.7 5 5.6 5.6

4 4.3 3.8 3.8

Percent 3

0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), Health Survey Program

56 Diabetes Hospital Discharge Rates by EOHHS Region, Massachusetts: 2003-2005 250 208.1* 200

151.4* 150 * 130.7 132.5 * 124.3 * 114.3 110.8

per100,000 100 Age-adjusted rate Age-adjusted

0 Western Central Northeast Metro Southeast Boston MA West

57 Diabetes Hospital Discharge Rates by Race/Ethnicity Central Region Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

400 367.7 350 332.8 300 242.0 250 203.1 200

150 per100,000 107.9* 114.3 100 Age-adjusted rate Age-adjusted 45.2 50 34.8 0 Central Region Massachusetts * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database

58 Diabetes Mortality Rates by EOHHS Region Massachusetts: 2003-2005

30 22.6 * 21.9 *

Deaths Deaths 20.3 18.2 18.4

per 100,000 100,000 per 20 17.4 15.1*

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

59 Diabetes Mortality Rates by Race/Ethnicity Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic 60 Hispanic Asian non-Hispanic 49 50

40 37 37 39

29 30 *22 20 17

Deaths per 100,000 14

0 Central Region Massachusetts

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

60 Summary Indicators for Overweight/Obesity by EOHHS Regions, Massachusetts:2005

MA Western Central North Metro Indicator South Boston Total East West East % Obese 20.7 23.3 21.7 19.2 16.8 23.6 20.9 Adults % Adults Participation 52.6 56.4 51.5 50.6 54.7 51.8 49.5 in regular PA % Adults with 5+ servings 28.6 28.4 29.3 26.4 33.0 26.4 26.4 fruits/ vegetables % Adults who had 79.3 74.0 76.6 79.2 84.8 82.0 73.3 cholesterol checked % Adults with high 35.7 34.2 35.9 34.5 38.4 36.5 31.2 cholesterol

Better Outcome (significantly different from state) Worse Outcome (significantly different from state) Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

61 Summary Indicators for Chronic Disease Outcomes for Overweight/Obesity by EOHHS Regions

MA Western Central North Metro South Indicator Boston Total East West East % Adults with 25.3 26.3 25.3 22.8 25.1 28.9 21.9 HBP % Adults take 75.3 76.0 74.0 78.6 73.5 76.5 71.3 HBP medications Hypertension Hospital 38.7 35.0 30.9 32.9 31.0 38.7 84.6 Discharges (2003-2005) Heart Disease Death Rate 182.5 188.8 196.8 186.3 159.8 195.1 177.9 (2003-2005) Diabetes Hospital Discharges 132.5 151.4 114.3 124.3 110.8 130.7 208.1 (2003-2005) Diabetes Death 18.4 20.3 22.6 17.3 15.1 18.2 21.9 Rate (2003-2005)

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

CANCER

62 62 Adults Ages 50+ who have had a Sigmoidoscopy or Colonoscopy in Past 5 Years by EOHHS Region Massachusetts: 2005 100

80 68.5* 60.2 58.9 58.8 60 53.9 53.2 55.0 Percent 40

0 Western Central Northeast Metro Southeast Boston MA West

63 Incidence Rates for Invasive Colorectal Cancer by EOHHS Region, Massachusetts: 1999-2003

70 61.8 63.6* * 59.7 58.9 60 56.2 55.2* 57.2

10 Cases per 100,000 population Cases100,000 per 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

63 64 Incidence Rates for Early Stage Colorectal Cancer MALES by EOHHS Region, Massachusetts: 1999-2003

35 32.8 **33.1 31.0 29.0 30 27.9 26.3 * 25 22.1 * 20

5 Cases per 100,000 population Cases100,000 per 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

65 Incidence Rates for Early Stage Colorectal Cancer FEMALES by EOHHS Region, Massachusetts: 1999-2003

25 22.9 * 20.8 * 20 18.4 18.4 17.6 16.4 * 15.3 * 15

5 Cases per 100,000 population Cases100,000 per 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

64 66 Colorectal Cancer Mortality Rates by EOHHS Region, Massachusetts: 2005 30

20 18.2 18.3 18.4 17.5 17.2 17.4 16.5 Deaths

10 per 100,000 population

0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

67 Men Ages 50+ who had a Prostate-Specific Antigen Test in the Past Two Years by EOHHS Region, Massachusetts: 2004

70 66.2 62.5 60 56.3 56.1 52.3 52.3 49.1 50

40 Percent 30

65 68 Men Ages 50+ who had a Digital Rectal Exam in the Past Two Years by EOHHS Region Massachusetts: 2004

100 90 80 69.0 70 64.5 62.6 62.7 59.5 60.0 63.0 60 50 Percent 40 30 20 10 0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

69 Adults Ages 50+ who had a Blood Stool Test in the Past Two Years by EOHHS Region Massachusetts: 2005

50 45 40 34.2 35 33.5 29.9 30.9 30.0 30 26.4 25 20.7* Percent 20 15 10 5 0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

66 70 Incidence Rates for Invasive Prostate Cancer by EOHHS Region, Massachusetts: 1999-2003

250

202.5* 200 191.3 180.5 178.4 181.9 170.3 * 159.7 * 150

100

50 Cases per 100,000 population Cases100,000 per 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

71 Incidence Rates for Early Stage Prostate Cancer by EOHHS Region, Massachusetts: 1999-2003

200 180 174.6 * 156.6* 160 140.1 140.5 140 129.7* 128.5* 122.4* 120 100 80 60 40 20 Cases per 100,000 population Cases100,000 per 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

67 72 Prostate Cancer Mortality Rates by EOHHS Region, Massachusetts: 2005

30 27.7 25.0 24.0 22.9 21.8 Deaths 20 18.7 17.9

per 100,000 population 100,000 per 10

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

73 Women Ages 40+ who had a Clinical Breast Exam in the Past Two Years by EOHHS Region, Massachusetts: 2004

100 90.0 90 85.0 85.5 87.1 85.6 85.7 86.6 80 70 60 50 Percent 40 30 20 10 0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

68 74 Women who had a Clinical Breast Exam in the Past Two Years by Race and Ethnicity Central Region and Massachusetts: 2004

White non-Hispanic Black non-Hispanic Hispanic 100 86.3 87.9 90 83.1 80.8 78.4 80 70 60 50

Percent 40 30 20 10 NA 0 Central Region Massachusetts

75 Women Ages 40+ who have had a mammography in Past 2 Years by EOHHS Region Massachusetts: 2005

100 86.9 87.1 84.1 83.0 83.4 82.0 80.1 80

60 Percent 40

69 76 Incidence Rates for Invasive Female Breast Cancer by EOHHS Region, Massachusetts: 1999-2003

200

146.7* 150 135.3 139.8 139.6 134.9 138.9 127.8*

100

50 Cases per 100,000 population Cases100,000 per 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

77 Incidence Rates for Early Stage Female Breast Cancer by EOHHS Region, Massachusetts: 1999-2003

160 137.6 * 140 124.9* 119.8 118.6 120 112.9* 113.1* 105.3* 100

20 Cases per 100,000 population Cases100,000 per 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

70 78 Female Breast Cancer Mortality Rates by EOHHS Region, Massachusetts: 2005

30 population 25.5 24.6 23.2 23.1 22.5 23.0

Deaths 20.9 20

per 100,000 100,000 per 10

0 Western Central Northeast Metro West Southeast Boston MA

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

79 Incidence Rates for Invasive Lung Cancer by EOHHS Region, Massachusetts: 1999-2003

100

76.7 * 77.5**77.7 75 * 69.9 72.0 67.2 65.1*

25 Cases per 100,000 population Cases100,000 per 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

71 80 Incidence Rates for Early Stage Lung Cancer MALES by EOHHS Region, Massachusetts: 1999-2003

19.2 20 * 15.6 15.9* 15 13.9 11.3* 11.9* 11.4* 10

5 Cases per 100,000 population Cases100,000 per 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

81 Incidence Rates for Early Stage Lung Cancer FEMALES by EOHHS Region, Massachusetts: 1999-2003

16 15.0* 14 12.4 12 11.4* 11.2 9.6 10.0 10.0* 10 *

2 Cases per 100,000 population Cases100,000 per 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

72 82 Lung Cancer Mortality Rates by EOHHS Region, Massachusetts: 2005

70 56.0 55.4 57.3 60 52.1 54.2 52.4 50 44.6*

Deaths 40

per 100,000 population 20

0 Western Central Northeast Metro West Southeast Boston MA

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

83 Summary Indicators for Cancer Screening by EOHHS Regions, Massachusetts: 2005

MA Western Central North Metro Indicator South Boston Total East West East % Men† 56.1 49.1 52.3 52.3 62.5 56.3 66.2 PSA (2004) % Men† 62.7 59.5 60.0 63.0 64.5 62.6 69.0 DRE (2004) % Blood Stool Test † 30.0 34.2 29.9 33.5 30.9 26.4 20.7

% Adults Sigmoidoscopy or 58.8 53.9 60.2 53.2 68.5 55 58.9 Colonoscopy† % Women Clinical 86.6 85.0 85.5 90.0 87.1 85.6 85.7 Breast Exam (2004) % Women* 35.7 34.2 35.9 34.5 38.4 36.5 31.2 Mammography

*40 years and older, † 50 years and older

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Health Survey Program

73 Summary Cancer Indicators (Early Stage) 84 by EOHHS Regions, Massachusetts: 1999-2003

MA North South Western Central Metro Boston Indicator East East Total West

Prostate Cancer 140.5 129.7 122.4 140.1 128.5 156.6 174.6 Incidence Female Breast 118.6 112.9 105.3 124.9 119.8 113.1 137.6 Cancer Incidence

Colorectal Cancer 26.9 25.9 21.3 29.5 24.3 28.7 32.0 Incidence

Lung Cancer 14.4 12.0 12.7 15.3 12.4 16.1 19.6 Incidence

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

Summary Cancer Indicators (Late Stage) 85 by EOHHS Regions, Massachusetts: 1999-2003

MA North South Western Central Metro Boston Indicator East East Total West

Prostate Cancer 5.5 4.9 5.2 5.9 3.9 6.2 8.7 Incidence Female Breast 37.8 37.9 31.7 37.0 36.8 38.4 47.3 Cancer Incidence

Colorectal Cancer 33.8 30.6 32.9 35.2 30.6 34.4 42.7 Incidence

Lung Cancer 50.3 45.8 48.6 54.1 41.4 55.1 63.2 Incidence

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

74 Summary Cancer Incidence Rates 86 by EOHHS Regions, Massachusetts: 1999-2003

MA North South Boston Western Central Metro Indicator East East Total West

Prostate 181.9 170.3 159.7 180.5 178.4 202.5 191.3 Cancer

Female Breast 138.9 135.3 127.8 139.8 146.7 139.6 134.9 Cancer

Colorectal 58.9 56.2 55.2 61.8 57.2 59.7 63.6 Cancer

Lung 72.0 67.2 69.9 76.7 65.1 77.5 77.7 Cancer

Total 517.0 485.6 478.2 529.4 509.9 543.1 545.1 Cancer

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Cancer Registry

Summary Cancer Mortality Indicators 87 by EOHHS Regions, Massachusetts: 2005

MA North Western Central Metro South Boston Indicator Total East West East

Prostate Cancer Death 21.8 25.0 27.7 22.9 18.7 17.9 24.0 Rate Colorectal Cancer Death 17.4 18.2 18.3 17.5 16.4 17.2 18.4 Rate Female Breast 23.0 25.5 23.1 23.1 20.9 22.5 24.6 Cancer Death Rate

Lung Cancer 52.4 56.0 55.4 57.3 44.6 52.1 54.2 Death Rate

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

SUBSTANCE ABUSE

78 88 Alcohol Use in Past Month Persons Aged 12 to 20 years by EOHHS Region, Massachusetts: 2002-2004

40 36.7 35.3 33.5 34.0 33.6 34.1 31.2 30 Percent 20

0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

89 Binge Drinking1 in Past Month Persons Aged 12 to 20 years by EOHHS Region, Massachusetts: 2002-2004 50

30 27.2 24.6 24.7 24.1 24.1 22.6 21.0 Percent 20

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state 1 Binge Alcohol use is defined as drinking 5+ drinks on the same occasion on at least 1 day in the past 30 days Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

79 90 Any Illicit Drug Use in Past Month Persons Aged 12+ years by EOHHS Region, Massachusetts: 2002-2004 25

15 12.2 10.4 Percent 9.4 9.4 10 8.5 8.4 8.7

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

91 Any Illicit Drug Use Other than Marijuana in Past Month Persons Aged 12+ years by EOHHS Region, Massachusetts: 2002-2004 25

15 Percent 10

4.5 5 3.8 3.4 3.3 3.6 3.6 3.7

0 Western Central Northeast Metro Southeast Boston MA West

80 92 Alcohol Dependence or Abuse in Past Year Persons Aged 12+ years By EOHHS Region, Massachusetts: 2002-2004 25

Percent 9.7 10 8.6 8.7 8.3 8.0 7.6 7.9

0 Western Central Northeast Metro Southeast Boston MA West

93 Dependence or Abuse of Any Illicit Drug or Alcohol in Past Year Persons Aged 12+ years by EOHHS Region, Massachusetts: 2002-2004

15 12.1 10.6 10.3 Percent 10.0 9.7 10.2 9.7 10

0 Western Central Northeast Metro Southeast Boston MA West

81 94 Adults who Binge Drink by EOHHS Region, Massachusetts: 2005

20 18.1 16.4 15.8 16.0 15.3 15.7 15 14.5 Percent

95 Adults who Used Illicit Drugs in Past Month by EOHHS Region, Massachusetts: 2005

15 13.9 Percent

10 8.1 8.1 7.2 7.2 7.0 5.3 5

82 96 Adults who Currently Smoke by EOHHS Region, Massachusetts: 2005

25 21.2 20.4 19.5 20 18.8 18.3 18.1

15 * Percent 12.4

97 Current Smoker by Race and Ethnicity Western Region and Massachusetts: 2005

White non-Hispanic Black non-Hispanic Hispanic 20 19.1 19 18.4 19 17.9 18 17.7 18 16.9 17 17 16.2 Percent 16 16 15 15 Western Region Massachusetts

83 98 Substance Abuse Treatment Program Admissions by EOHHS Region, Massachusetts: 2005 3500 2,978* 3000

2500 2,044* 2000 1,724* 1,601 1,441**

Crude rate rate Crude 1500 1,379 per 100,000 per

1000 871*

500

0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: Massachusetts Department of Public Health. BSAS Substance Abuse Treatment Programs 2005.

99 Substance Abuse Treatment Program Admissions- Alcohol Primary Substance by EOHHS Region, Massachusetts: 2005

1200 1,010* 1000 921* 821* 800 661 571* 600 498 * 404* 400 Crude rate/100,000 Crude 200

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: Massachusetts Department of Public Health. BSAS Substance Abuse Treatment Programs 2005.

84 100 Substance Abuse Treatment Program Admissions- Cocaine Primary Substance by EOHHS Region, Massachusetts: 2005

120 99* 100 88* 80 65 62 58 60 44* 40 34 * Crude rate/100,000 Crude 20

0 Western Central Northeast Metro Southeast Boston MA West

101 Substance Abuse Treatment Program Admissions- Heroin Primary Substance by EOHHS Region, Massachusetts: 2005

1,600 1,453* 1,400

1,200

1,000

800 635 636 * * 583* 609 600 504*

400 Crude rate/100,000 Crude 286* 200

0 Western Central Northeast Metro Southeast Boston MA West

85 102 Opioid-related Emergency Visit Rates by EOHHS Region, Massachusetts: 2003-2005

350 309* 300

250 223* 196* 200 181 169* 150 * 114* 126 Visits per 100,000 100

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

103 Opioid-Related Emergency Department Visit Rate by Race/Ethnicity Central Region and Massachusetts: 2003-2005 * White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

450 422* 400

350 302 * 300 239 237 250 * * 196* 187 188 200 * 150 140* 150

Visits per 100,000 100 29 50 10 0 Worcester Central, no Worcester Massachusetts * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Bureau of Substance Abuse Services

86 104

105

87 106 Opioid-related Fatal Overdoses by EOHHS Region, Massachusetts: 2003-2005

20 Deaths Deaths 10.8* * 10.1* 10 9.5

per 100,000 population 8.1 6.7 6.5* 6.0 *

0 Western Central Northeast Metro West Southeast Boston MA

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

107 Opioid-related Fatal Overdoses by Race/Ethnicity Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic 10 9 9 9

8 7 7* 7 6 6 5 4 3 Deaths per 100,000 per Deaths 2 1 1 NA NA 0 Central Region Massachusetts * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

88 108

109

89 Summary Substance Abuse Indicators 110 by EOHHS Region

MA Western Central North Metro South Indicator Boston Total East West East Past Month Alcohol 34.1 36.7 31.2 33.5 35.3 34.0 33.6 12-20 years Past Month Binge 24.1 27.2 24.6 22.6 24.7 24.1 21.0 Drinking- 12-20 years

Any Illicit Drug Use 9.4 10.4 8.5 8.4 8.7 9.4 12.2 Past Month, Ages 12+

Any Illicit Drug Use Other than Marijuana 3.7 3.8 3.4 3.3 3.6 3.6 4.5 Past Month, Ages 12+ Alcohol Dependence or Abuse past Year, 8.3 8.6 8.0 7.6 8.7 7.9 9.7 Ages 12+ Dependence or Abuse of Alcohol or Any 10.3 10.6 10.0 9.7 10.2 9.7 12.1 Illicit Drug, Ages 12+

Better Outcome (significantly different from state) Worse Outcome (significantly different from state) Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and 2004.

111 Summary Substance Abuse Indicators by EOHHS Region, Massachusetts:2005

MA Western Central North Metro South Indicator Boston Total East West East % Adults Binge Drinking 15.7 16.4 15.8 16.0 14.5 15.3 18.1 % Adults Smoking 18.1 18.8 21.2 18.3 12.4 20.4 19.5 % Adults using illicit drugs 8.1 13.9 7.2 7.2 7.0 8.1 5.3

Substance Abuse Treatment 1,601 2,044 1,441 1,379 871 1,724 2,978 Program Admissions Rate

Substance Abuse Treatment Program Admissions Rate-- 661 921 571 498 404 821 1,010 Alcohol Substance Abuse Treatment Program Admissions Rate— 62 65 44 58 34 88 99 Cocaine Substance Abuse Treatment Program Admissions Rate— 609 635 636 583 286 504 1,453 Heroin

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

90 112 Summary Opioid Indicators by EOHHS Regions Massachusetts: 2003-2005

MA North Metro Western Central South Boston Indicator Total East West East

Opioid- related Emergency 181 114 169 223 126 196 309 Department Visit Rate

Opioid- related fatal 8.1 6.7 6.5 9.5 6.0 10.1 10.8 overdose rate

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

INJURY, VIOLENCE, AND OCCUPATIONAL HEALTH

94 113 Causes of Injury Deaths Central Region and Massachusetts: 2005

Central Region Massachusetts Total Injuries = 329 Total Injuries = 2,657

Other Other 20% 21% Poisonings 28% Poisonings 30% Firearm Firearm 7% 8% Falls Motor Vehicle- Falls 11% related Motor Vehicle- 20% 11% related 18%

Suffocation, Hanging, Suffocation, Hanging, or Strangulation or Strangulation 13% 13%

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

114 Injury-related Hospital Discharge Rates by EOHHS Region, Massachusetts: 2003-2005

1000 965.9* 872.4 * 858.9 * 830.4 835.9 836.3 800 753.2 *

600

400 Discharges per 100,000 100,000 per Discharges 200

0 Western Central Northeast Metro West Southeast Boston MA

95 115 Injury-related Hospital Discharge Rates by Race/Ethnicity, Central Region & Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic 1,000 900 818 821 804 * 812 831 800 704 700 600 500 400 321 301 300 200 Discharges per 100,000 per Discharges 100 0 Central Region Massachusetts

Emergency Department Visit Rates for 116 Injuries & Poisonings by EOHHS Region Massachusetts: 2003-2005

16000 13,996* 14000 12,323 * 12000 11,379* * 11,298 11,195 10,539* 10000 9,112*

8000

6000 Visits per 100,000 100,000 per Visits 4000

2000

0 Western Central Northeast Metro Southeast Boston MA West

96 117 Emergency Department Visit Rates for Injuries & Poisonings by Race/Ethnicity Central Region and Massachusetts: 2003-2005 White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

16,000 13,136 * 14,158 14,000 13,257 * 11,930 12,000 11,304* 10,930

10,000

8,000

6,000 3,583 Visits per 100,000 4,000 3,277

2,000

0 Central Region Massachusetts

118 Hospital Discharge Rates for Traumatic Brain Injuries by EOHHS Region, Massachusetts: 2003-2005

100 93 * 97 * 94 *

82 80 80 73 * 65 *

40 Discharges per 100,000 20

0 Western Central Northeast Metro West Southeast Boston MA

97 119 Hospital Discharge Rates for Traumatic Brain Injury by Race/Ethnicity, Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic 120 109 102 100 95* 82 85 80 76

60 39 40 32 Visits per 100,000 per Visits

0 Central Region Massachusetts * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Hospital Discharges

Emergency Department Visit Rates for 120 Traumatic Brain Injury by EOHHS Region, Massachusetts: 2003-2005 * 700 646* 662* 653 641* 604 600 563*

500 461*

400

300 Visits per 100,000 100,000 per Visits 200

100

0 Western Central Northeast Metro Southeast Boston MA West

98 121 Emergency Department Visit Rates for Traumatic Brain Injury by Race/Ethnicity Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

800 745 * 663 700 643 * 621 595 588 600

500

400

300 249 215

Visits per 100,000 200

100

122 Injury Death Rates by EOHHS Region Massachusetts: 2003-2005

50 46.3 * 45.1 * 45 43.7 * 38.9 39.1 40 38.5 35 29.1 * 30

Deaths 25 20

per 100,000 population 15 10 5 0 Western Central Northeast Metro West Southeast Boston MA

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

99 123 Hospital Discharge Rates for Assaults by EOHHS Region, Massachusetts: 2003-2005

80 72 * 70

40 34 * 30 28 24 * 23 * 21 * 20 14 * Discharges per 100,000 10

0 Western Central Northeast Metro Southeast Boston MA West

124 Hospital Discharge Rates for Assaults by Race/Ethnicity, Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic 150

118.4

95.6 100

72.3 69.2

50 Discharges per 100,000 21.6 16.8 16.1 11.8

100 125 Homicides by EOHHS Region Massachusetts: 2003-2005

7.3 *

Deaths Deaths 5 3.3

per 100,000 population 2.6 2.6 1.7* 1.8* 0.7*

0 Western Central Northeast Metro West Southeast Boston MA

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

126 Homicide Rates by Race/Ethnicity Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic 16 Hispanic Asian non-Hispanic 15 14

10 9 8 6 6 5

Deaths 100,000 per 4 2 2 1 1 NA 0 Central Region Massachusetts * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

101 127 Hospital Discharge Rates for Self-inflicted Injury by EOHHS Region, Massachusetts: 2003-2005

100 92*

80 68 63 66 65 65 60 48*

Discharges per 100,000 20

0 Western Central Northeast Metro Southeast Boston MA West

128 Hospital Discharge Rates for Self-inflicted Injuries by Race/Ethnicity, Central Region and Massachusetts: 2003-2005

100 White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

80 73 73 63 64 62 60 50

40 24 Discharges per 100,000 per Discharges 20 17

102 129 Suicides by EOHHS Region Massachusetts: 2003-2005

Deaths Deaths 10 7.9 7.2 7.4 6.9 6.6 5.5 per 100,000 population 5.3* 5

0 Western Central Northeast Metro West Southeast Boston MA

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

130 Suicide Rates by Race/Ethnicity Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic 10 Hispanic Asian non-Hispanic

8 8 7

6 5 5 4 4 4 Deaths 100,000 per 2

NA NA 0 Central Region Massachusetts * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

103 131 Hospital Discharge Rates for Motor Vehicle-related Injuries by EOHHS Region and Massachusetts: 2003-2005

100 93 * 91 * 88 * 77 80 73 74

57 * 60

40 Discharges per 100,000 20

0 Western Central Northeast Metro Southeast Boston MA West * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: Hospital Discharge Dataset System, Massachusetts Division of Health Care Finance and Policy

132 Hospital Discharge Rates for Motor Vehicle- related Injuries by Race/Ethnicity, Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

120 114

100 91* 90 80 81 80 72

60 50

40 33

Discharges per 100,000 per Discharges 20

104 133 Motor Vehicle-related Mortality Rates by EOHHS Region, Massachusetts: 2003-2005

* 10.7 * 10.2 9.8*

Deaths Deaths 10 7.7 6.4*

per 100,000 population 5.4* 4.6* 5

0 Western Central Northeast Metro West Southeast Boston MA

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

134 Motor Vehicle-related Mortality Rates by Race/Ethnicity Central Region and Massachusetts: 2003-2005

20 White non-Hispanic Black non-Hispanic 18 Hispanic Asian non-Hispanic 16 14

12 10 * 10 8 7 7 8 6 6 5 Deaths per 100,000 per Deaths 4 2 NA NA 0 Central Region Massachusetts

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

105 135 Emergency Department Visit Rates for Firearm Injuries by EOHHS Region, Massachusetts: 2003-2005 16

14 13* 13* 12

10 8 8 7 6* 6 5 * Visits per 100,000 100,000 per Visits 4 2 * 2

0 Western Central Northeast Metro Southeast Boston MA West

136 Emergency Department Visit Rates for Firearm Injuries by Race/Ethnicity Central Region and Massachusetts: 2003-2005 White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

40 38

25 22* 19 20 15 15

10 Visits per 100,000 5 3 2 3 NA 0 Central Region Massachusetts

106 137 Firearm Mortality Rates by EOHHS Region Massachusetts: 2003-2005

Deaths Deaths 10

5.9* per 100,000 population 5 4.1 3.4 3.1 2.9 3.2 1.3*

0 Western Central Northeast Metro West Southeast Boston MA

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

138 Firearm Mortality Rates by Race/Ethnicity Central Region and Massachusetts: 2003-2005

20 White non-Hispanic Black non-Hispanic 18 Hispanic Asian non-Hispanic 16

14 13 12 12

10 Deaths 8 per 100,000 per

6 4 4 4 3 2 2 1 NA 0 Central Region Massachusetts

Age-adjusted to the 2000 US standard population. * Statistically Significantly different from state (p ≤.05) Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

107 139 Hospital Discharge Rates for Fall-related Injuries by EOHHS Region, Massachusetts: 2003-2005

500 419 * 400 357 * 380 379 375 374 338 *

300

200 Discharges per 100,000 100,000 per Discharges 100

0 Western Central Northeast Metro West Southeast Boston MA

140 Hospital Discharge Rates for Fall-related Injuries by Race/Ethnicity, Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic 500

400 359 * 375

300 234221 234 216 200 141 144

Discharges per 100,000 per Discharges 100

108 141 Hospitalization Rates for Fall-Related Injuries Ages 65+ by EOHHS Region Massachusetts: 2003-2005

3000

2,443* 2500 2,333 2,254 2,311 2,275 2,146** 2,024 2000

1500

1000

500 Hospital Discharges per 100,000 0 Western Central Northeast Metro West Southeast Boston Massachusetts Total

Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program

Emergency Department Visit Rates for 142 Fall-related Injuries by EOHHS Region, Massachusetts: 2003-2005

3500 3,191* 3000 2,913 * 2,860 * 2,713* 2,750 2,511* 2500 2,410*

2000

1500 Visits per 100,000 100,000 per Visits 1000

500

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state

Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Visits

109

Emergency Department Visit Rates for 143 Fall-related Injuries by Race/Ethnicity Central Region and Massachusetts: 2003-2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

3,500 * 2,856 * 3,000 2,910 2,783 2,447 2,504 2,502 2,500

2,000

1,500

1,000 887 784 Visits per 100,000 per Visits 500

0 Central Region Massachusetts

144 Fall-related Injury Mortality Rates by EOHHS Region, Massachusetts: 2003-2005

Deaths Deaths 10

per 100,000 population 4.3 5 4.3 3.8 3.2 3.5 3.8 3.6

0 Western Central Northeast Metro West Southeast Boston MA

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

110

145 Fall-related Injury Mortality Rates by Race/Ethnicity Central Region and Massachusetts: 2003-2005 20

18 White non-Hispanic Black non-Hispanic 16 Hispanic Asian non-Hispanic 14

10 Deaths 8 per 100,000 per

6 4 4 3 3 3 2 2 NA NA NA 0 Central Region Massachusetts * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

Fall-related Injury Mortality Rates 146 Persons 65+ Years by EOHHS Region, Massachusetts: 2003-2005

30 26.8 24.7 25 23.6 23.5 21.4 22.5 20.1 20

Deaths Deaths 15

10 per 100,000 population

0 Western Central Northeast Metro West Southeast Boston MA

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

111

147

148

112

149

150

113

151

152 Number and Rate of Fatal Occupational Injuries by year, Massachusetts (1991- 2005) Number of fatalities Fatality Rates 100 5.0

90 86 4.5 82 83 80 78 78 4.0 74 72 69 70 70 67 66 3.5 3.0 62 2.7 60 2.6 3.0 54 2.3 2.5 2.2 50 2.2 46 2.5 2.0 44 2.4 2.4 2.2 2.2 40 2.0 1.4 1.6

Number of Fatal Injuries 30 1.5 1.4

20 1.0 Fatality rate per workers100,000

10 0.5

0 0.0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Years Data Source: Census of Fatal Occupational Injuries (CFOI) 1991-2005, Occupational Health Surveillance Program, MA Dept. of Public Health. MA employment data from BLS Current Population Survey (1991 - 2005) was used to calculate rates.

114

153 Summary Injury/Violence Hospitalization Indicators by EOHHS Regions, Massachusetts: 2003-2005

Hospital South MA North Metro Discharge Western Central East Boston Total East West Indicator Rates (age-adjusted) All Injuries 836 872 830 836 753 859 966 Fall-related injury 374 338 357 380 379 375 419 hospitalizations Traumatic Brain 80 93 97 82 65 73 94 Injuries Motor vehicle- 77 93 91 73 57 88 74 related

Self-Inflicted 65 92 63 68 48 66 65

Assault 28 34 24 23 14 21 72

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Hospital Discharges

154 Summary Injury/Violence Emergency Department Indicators by EOHHS Regions, Massachusetts: 2003-2005

MA North South Boston Indicator Western Central Metro Total East East Age-adjusted Rate West per 100,00

ER Visit Rate 11,298 12,323 11,379 11,195 9,112 13,996 10,539 for all Injuries

ER Visit Rate for Traumatic 604 461 646 662 563 653 640 Brain Injury

ER Visit Rate 7 13 5 6 2 8 13 for Firearm

ER Visit Rate for Fall-related 2,750 2,913 2,860 2,713 2,410 3,191 2,511 injuries

Better Outcome (significantly different from state) Worse Outcome (significantly different from state) Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Department Visits

115

155 Summary Injury/Violence Mortality Indicators by EOHHS Regions, Massachusetts: 2003-2005

Mortality MA North South Boston Western Central Metro Indicator Total East East Age-adjusted Rate West per 100,000 Homicide 2.6 3.3 1.7 1.8 0.7 2.6 7.3 Death Rate

Suicide Death 6.6 7.9 7.2 7.4 5.3 6.9 5.5 Rate Motor Vehicle- related Death 7.7 10.2 9.8 6.4 5.4 10.7 4.6 Rate

Firearm Death 3.2 4.1 3.1 2.9 1.3 3.4 5.9 Rate

Fall-related Injury Death 3.8 3.2 3.5 3.8 3.6 4.3 4.3 Rate

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

116

HIV/AIDS

117

118 156 Persons Living with HIV by EOHHS Region Massachusetts: 2005 800 729.2* 700

600

500

400

300 247.1 221.4* Persons per 100,000 ** 200 167.5* 179.4 170.9 133.2* 100

0 Western Central Northeast Metro West Southeast Boston MA N=1,845 N=1,415 N=2,297 N=1,982 N=2,185 N=5,189 N=15,907

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, BCDC HIV/AIDS Files as of 09/01/06

157 HIV Incidence by EOHHS Region Massachusetts: 2005

45 * 40 38.8

15 12.7 Persons per 100,000 11.2 10.3 10 8.3***8.5 7.7

0 Western Central Northeast Metro West Southeast Boston MA N=93 N=70 N=132 N=126 N=99 N=276 N= 814

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, BCDC HIV/AIDS Files as of 09/01/06

119 158 AIDS Incidence by EOHHS Region Massachusetts: 2005

25 21.1 * 20

10 8.0 7.3 Persons per 100,000 6.4 6.1 6.3 5.0 * 5

0 Western Central Northeast Metro West Southeast Boston MA N=61 N=54 N=78 N=75 N=81 N=150 N=516

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, BCDC HIV/AIDS Files as of 09/01/06

159 Persons Living with AIDS by EOHHS Region Massachusetts: 2005

450 395.7 * 400

350

300

250

200

150 133.3 Persons per 100,000 107.7 * 93.5* 100.0 * 95.2 * 100 71.8* 50

0 Western Central Northeast Metro West Southeast Boston MA N=897 N=790 N=1,281 N=1,069 N=1,217 N=2,816 N=8,577

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, BCDC HIV/AIDS Files as of 09/01/06

120 160 HIV/AIDS Mortality Rates by EOHHS Region, Massachusetts: 2003-2005

9 8.5* 8

5 4.4* Deaths Deaths 4 2.9 3.1 3 2.5 per 100,000 population 2.4 2 1.4* 1

0 Western Central Northeast Metro West Southeast Boston MA N=110 N=78 N=97 N=66 N=99 N=167 N=617

HIV/AIDS Mortality Rates by Race/Ethnicity 161 Worcester & Central Region vs. Massachusetts 2003-2005

45 White non-Hispanic Black non-Hispanic 39 Hispanic Asian non-Hispanic 40 *

25 24 20 20 16 15 13

Deaths perDeaths 100,000 10 10 4 5 * 2 001 1 0 * Worcester Central, no Worcester Massachusetts

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

121 Summary HIV/AIDS Indicators 162 by EOHHS Regions

Indicator MA North Metro Western Central South Boston Crude rate, per Total East West East 100,000

Persons living 247.1 221.4 167.5 179.4 133.1 170.9 729.2 with HIV (2005) HIV 12.6 11.2 8.3 10.3 8.5 7.7 38.8 Incidence(2005)

Persons living 133.2 107.7 93.5 100.0 71.8 95.2 395.7 with AIDS (2005)

AIDS Incidence 8.0 7.3 6.4 6.1 5.0 6.3 21.1 (2005)

HIV/AIDS Mortality 3.1 4.4 2.9 2.4 1.4 2.5 8.5 (2003-2005)

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

122

INFECTIOUS DISEASES

123

124 163 Chlamydia Incidence Central Region and Massachusetts: 1989-2005

250 225.7

200 169.0

opulation 145.4 150 Massachusetts

100 122.0

Central Region 50 Cases perCases 100,000 p

0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Source: MDPH, BCDC STD Files

164 Chlamydia Incidence by EOHHS Region, Massachusetts: 2005

700 588.5* 600

500

400 369.4 *

300 225.7 178.0* 169.7* 200 145.4 *

Cases perCases 100,000 population 106.1 * 100

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, BCDC STD Files

125 165

166 Gonorrhea Incidence by EOHHS Region, Massachusetts: 2005

140 126.2* 120

100

80 * 60 55.9 39.6 40 35.4 * Cases perCases 100,000 population 22.4 16.6* 20.3* 20

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, BCDC STD Files

126 167 Syphilis Incidence Central Region and Massachusetts: 1989-2005

15 17.9

10 Massachusetts 6.3

Cases perCases 100,000 population 5 4.9 1.7 Central Region 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Source: MDPH, BCDC STD Files

168 Syphilis Incidence by EOHHS Region Massachusetts: 2005

30 27.7*

10 6.3

Cases perCases 100,000 population 4.9 4.7 5 3.1 * 2.7* 1.7*

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, BCDC STD Files

127 169 Tuberculosis Incidence by EOHHS Region Massachusetts: 2004

12 27.7*

population 8

6 4.8 4.2 4.3 4.4 4

1.9 * 2.0* Cases per 100,000 2

170 Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region Massachusetts: 2006

EOHHS White non- Black non- Asian/Pacific Region Hispanic Hispanic Islander Hispanic

West <5 <5 8 <5

Central <5 6 14 10

Northeast 5 6 19 6

Metro Boston 21 20 21 13

Boston 8 26 19 8

Southeast 14 9 <5 8

Source: MDPH Bureau of Communicable Disease Control, ISIS

128 Percent of Confirmed Tuberculosis Cases 171 by EOHHS Region Massachusetts: 2006 (N = 259)

West N=20, 8%

Central Metro Boston N=33, 13% N=75, 28%

Southeast N=34, 13%

Northeast Boston N=36, 14% N=61, 24%

Source: MDPH Bureau of Communicable Disease Control, ISIS

172 Percent of Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region Massachusetts: 2006

100% 90% 80% 70% Southeast 60% Boston 50% Metro Boston 40% Northeast 30% Central West 20% 10% 0% White/NH (N=55) Black /NH (N=71) Asian/Pacific Hispanic (N=49) Islander (N=84)

Source: MDPH Bureau of Communicable Disease Control, ISIS

129 173 Tuberculosis Cases by EOHHS Region Massachusetts: 1993-2006

140

120

100

0 93 94 95 96 97 98 99 2000 01 02 03 04 05 06 YEAR

West Central Northeast Metro Boston Boston Southeast

Source: MDPH Bureau of Communicable Disease Control, ISIS

174 Percent of Confirmed Tuberculosis Cases by Race/Ethnicity and EOHHS Region Massachusetts: 2006

White/NH (N=55) Black/NH (N=71) Asian/Pacific Islander (N=84) Hispanic (N=49) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% West Central Northeast Metro Boston Boston Southeast

Source: MDPH Bureau of Communicable Disease Control, ISIS

130 175 Hepatitis C Average Incidence Rates by EOHHS Region, Massachusetts: 1992-20061

80 75.0

60 56.0 51.0 50.0 49.0 50 41.0 40 30.0 30

20 Cases per 100,000 population 100,000 per Cases 10

0 Western Central Northeast Outer Metro Inner Metro Boston Southeast Boston Boston

1 Data as of March 17, 2007 * Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH Bureau of Communicable Disease Control, ISIS

176

131 177 Hepatitis C Incidence Rates by EOHHS Region, Massachusetts: 2006

160 150.0

140 123.0 120 114.0

100 95.0 92.0 82.0 80

60 49.0 40 Cases per 100,000 population 20

0 Western Central Northeast Outer Metro Inner Metro Boston Southeast Boston Boston

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH Bureau of Communicable Disease Control, ISIS

178

132 179

180 Lyme Disease Incidence by EOHHS Region Massachusetts: 2004

48.5* 50

population 40

30 27.3 24.7 19.7 * 21.2 20 18.4 *

Cases per 100,000 10 4.0*

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH Bureau of Communicable Disease Control, ISIS

133 181

182 Pneumonia/Influenza Hospital Discharges by EOHHS Region Massachusetts: 2005

450 406.7* 415.8* 392.7 400 384.4 377.0 346.0 * * 350 341.6

300

250

200 per 100,000per

Age-adjusted rate rate Age-adjusted 150

100

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: Division of Health Care Finance and Policy. Calendar Year 2005. Inpatient Hospital Discharge Database

134 Summary Infectious Disease Indicators 183 by EOHHS Regions

MA North Metro South Boston Western Central Indicator Total East West East

Chlamydia Incidence 225.7 369.4 145.4 178.0 106.1 169.7 588.5 (crude rates, 2005)

Gonorrhea Incidence 39.6 55.9 16.6 22.4 20.3 35.4 126.2 (crude rates, 2005)

Syphilis Incidence 6.3 3.1 1.7 4.9 4.7 2.7 22.7 (crude rates, 2005)

Tuberculosis Incidence (crude rates, 2004) 4.4 1.9 4.2 4.8 4.3 2.0 11.4

Lyme Disease Incidence 24.7 27.3 19.7 18.4 21.2 48.4 4.0 (crude rates, 2004) Pneumonia/ Influenza Hospital Discharges 377.0 346.0 392.7 384.4 341.5 406.7 415.8 (age-adjusted, 2005)

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

135

136

ASTHMA

137

138 184 Asthma Hospital Discharges by EOHHS Region, Massachusetts: 2005

300

242* 250

200 161* 150 140 125* 131 133 per100,000 101*

Age-adjusted rate 100

0 Western Central Northeast Metro Southeast Boston MA West

185 Asthma Emergency Department Visits by EOHHS Region, Massachusetts: 2005

1000 897* 900 800 761*

700 655* 600 566 577 491*

Visits 500

per100,000 400 363* 300

200 100

0 Western Central Northeast Metro Southeast Boston MA West

139 Emergency Department Visit Rates 186 for Asthma by Race/Ethnicity Central Region and Massachusetts: 2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic 1,600 1,454 * 1,469 1,400 1,251 1,154 * 1,200

1,000

800

600 472* 434

Visits per 100,000 per Visits 400 165 * 200 141

0 Central Region Massachusetts

187 Adults who Currently have Asthma by EOHHS Region, Massachusetts: 2005

Percent 11.9 10.9 10.7 9.2 9.6 10 7.8 8.1

0 Western Central Northeast Metro Southeast Boston MA West

140 188 Asthma ER Visits, Children Ages 0-4 by EOHHS Region, Massachusetts: 2005

2,500 2,148*

2,000 1,618 * 1,500 1,241 1,130 1,000 854 * 815 * 809* Visits per100,000 Visits

500

0 Western Central Northeast Metro Southeast Boston MA West

189 Asthma ER Visits, Children Ages 5-9 by EOHHS Region, Massachusetts: 2005

2,000 1,812* 1,800 1,600 1,400 1,200 1,000 831 761 775 800 687 * 608

Visits per100,000 Visits ** 600 582 400 200 0 Western Central Northeast Metro Southeast Boston MA West

141 190 Asthma ER Visits, Children Ages 10-14 by EOHHS Region, Massachusetts: 2005

1,400 1,236* 1,200

1,000

800 632 * 571 600 533 470

Visits per100,000 Visits * 400 363 * 365

200

0 Western Central Northeast Metro Southeast Boston MA West

191 Asthma ER Visits, Children Ages 0-14 by EOHHS Region, Massachusetts: 2005

2,000 1,771* 1,800 1,600 1,400 1,200 995 * 1,000 811 808 800 697 * 594 Visits per100,000 Visits **584 600 400 200 0 Western Central Northeast Metro Southeast Boston MA West

142 192 Asthma Emergency Department Visit Rates Children Ages 0-14 Central Region and Massachusetts: 2005

White non-Hispanic Black non-Hispanic Hispanic Asian non-Hispanic

2,500 2,048 * 2,096 2,000 1,606 * 1,573 1,500

1,000 608 * Visits per 100,000 438 516 500 356

0 Central Region Massachusetts

193 Pediatric Asthma Prevalence by EOHHS Region, Massachusetts: 2005-2006

15 * 12.7 * 13.0 10.5 10.6 9.8 * 10.1 * 10 9.4* Percent

0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Center for Environmental Health, Pediatric Asthma Surveillance (2005-2006)

143 194 PediatricPediatric Asthma Asthma Emergency Emergency Visit Visit Rates Rates by by Towns* Towns* AmongAmong ChilldrenChildren Ages Ages <5 <5 MassachusettsMassachusetts 2004-20052004-2005

Massachusetts State Total Rate: 1,136.2 LAWRENCE 1494.5

GREENFIELD 1934.1

LYNN 1570.8 CLINTON 1897.1 CHICOPEE BOSTON 2239.8 2553.1 NORWOOD 1823.2 STOUGHTON HOLYOKE 1646.5 3168.7 BROCKTON 1649

SOUTHBRIDGE SPRINGFIELD 3614.8 2930.9 FRAMINGHAM 1639.3 WORCESTER BOURNE 2350.5 1709.6 Emergency Visit Rates by Towns per 100,000 FALL RIVER Significantly higher than state rate 1476.1 Not different from state rate Significantly lower than state rate

*Towns with less than 5 cases in the period were excluded. Source: Division of Health Care Finance and Policy. Calendar Year 2004-2005. Emergency Visits

195 PediatricPediatric Asthma Asthma Emergency Emergency Visit Visit Rates Rates by byTowns* Towns* AmongAmong ChilldrenChildren Ages Ages <5 <5 CentralCentral Region, Region - MassachusettsMassachusetts 2004-2005 2004-2005

Massachusetts State Total Rate: 1,136.2

CLINTON 1897.1

WORCESTER 2350.5

Emergency Visit Rates by Towns per 100,000 Significantly higher than state rate Not different from state rate Significantly lower than state rate

*Towns with less than 5 cases in the period were excluded. SOUTHBRIDGE 3614.8 Source: Division of Health Care Finance and Policy. Calendar Year 2004-2005. Emergency Visits

144 196 PediatricPediatric Asthma Asthma Hospitalization Hospitalization Rates Rates by Towns*by Towns* AmongAmong ChilldrenChildren Ages Ages <5 <5 CentralCentral Region, Region - MassachusettsMassachusetts 2004-2005 2004-2005

FITCHBURG GARDNER 362.5 250.5

HOLDEN 298

SHREWSBURY WORCESTER 120.7 Massachusetts State Total Rate: 337.5 422.1 GRAFTON Hospitalization Rates by Towns 218.6 MILFORD per 100,000 240.3

Significantly higher than state rate FRANKLIN BELLINGHAM SOUTHBRIDGE 180 WEBSTER UXBRIDGE 419.8 549.1 Not different from state rate 379.6 265.9 Significantly lower than state rate

*Towns with less than 5 cases in the period were excluded. Source: Division of Health Care Finance and Policy. Calendar Year 2004-2005. Hospital Discharges

Summary Asthma Indicators 197 by EOHHS Regions, Massachusetts: 2005

MA North Metro South Boston Western Central Indicator Total East West East

Asthma Hospital Discharges (age- 140.1 125.0 131.5 132.7 100.9 160.9 241.9 adjusted per100,000)

Asthma ER Visits (age-adjusted 576.9 760.9 565.9 491.4 363.0 654.5 897.1 per100,000)

% Adults who currently have 9.6 10.9 11.9 7.8 8.1 10.7 9.2 asthma (2005)

Asthma ER Visits Ages 0-14 (age- 808 995 811 594 584 697 1,771 adjusted per100,000)

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

145 Summary Asthma Indicators 198 by EOHHS Regions, Massachusetts: 2005

MA North Metro South Boston Western Central Indicator Total East West East

Asthma ER Visits Ages 0-4 1,130 1,618 1,241 815 809 854 2,148 (age adjusted per100,000) Asthma ER Visits Ages 5-9 775 831 761 608 582 687 1,812 (age adjusted per100,000) Asthma ER Visits Ages 10-14 533 632 470 363 365 571 1,236 (age adjusted per100,000)

Pediatric Asthma Prevalence 10.6 12.7 9.8 10.1 9.4 10.5 13.0 (2005-2006)

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

146

OTHER HEALTH INDICATORS

147

148

199 Total Cases of Elevated Blood Lead Levels (>=15 µg/dL) by EOHHS Region, Massachusetts: 2005

10 9 8 7 6 5 Per 1000 Per 4 * 3.1 * 3.2 Prevalence Rate Prevalence 3.0 3 2.1 2.2 2.3 2 1.0 * 1 0 Western Central Northeast Metro Southeast Boston MA West

* Statistically Significantly different from state (p ≤.05)– Red: Statistically worse than state- green: statistically better than state Source: MDPH, Childhood Lead Poisoning Prevention Program (CLPPP)

200 Lead Poisoning Prevalence Rates (BLL≥ 25 µg/dL), Children 9-48 Months by EOHHS Region, Massachusetts: 2006

1.0 0.9 0.8 0.7 0.6 0.6 0.5 0.5 0.5

Per 1000 Per 0.4 0.4 0.4 Prevalence Rate Rate Prevalence 0.3 0.3 0.2 0.2 0.1 0.0 Western Central Northeast Metro Southeast Boston MA West

149

201 Adults who Report Experiencing Intimate Partner Violence by Gender and EOHHS Region Massachusetts: 2005

Women Men 30 25.9 25.7 25 23.2 22.0 22.4 19.3 20 17.4 17.2 15.1 15.3 15 13.1 13.8 Percent 11.4 10.7 10

0 Western Central Northeast Metro Southeast Boston MA West

202 Adults who Report Having a Disability by EOHHS Region, Massachusetts: 2005

30 24.2 25 21.5 20.6 19.5 20 18.1 17.1 15.3 15 Percent 10

0 Western Central Northeast Metro Southeast Boston MA West

150

203 Adults who Report Having a Disability and needing help with activities EOHHS Region, Massachusetts: 2005

15 Percent 10 8.5 9.0 7.3 6.7 5.5 4.7 5.1 5

0 Western Central Northeast Metro Southeast Boston MA West

204 Adults with Fair or Poor Health by EOHHS Region, Massachusetts: 2005

20 14.6 15.2 14.3 14.7 15 13.4 13.2 Percent * 10 9.3

0 Western Central Northeast Metro Southeast Boston MA West

151

205 Adults who Reported Fair or Poor Health by Race and Ethnicity Central Region and Massachusetts: 2005

White non-Hispanic Black non-Hispanic Hispanic

25 23.5

20.0 20 16.5 14.7 15 12.3

Percent 10

NA 0 Central Region Massachusetts

206 Adults who Visited a Dentist in Past Year by EOHHS Region, Massachusetts: 2004

100 90 86.1* 78.2 80 75.4 75.1 76.3 76.8 74.1 70 60 50 Percent 40 30 20 10 0 Western Central Northeast Metro Southeast Boston MA West

152

207 Adults who Have Lost 6 or More Teeth to Decay or Disease by EOHHS Region, Massachusetts: 2004

Percent 18.8 20 16.5 17.4 15.4 13.7 15.1 10.5* 10

0 Western Central Northeast Metro Southeast Boston MA West

208 Adults with Poor Mental Health for 15+ days in Past Month by EOHHS Region, Massachusetts: 2005

15 Percent 11.2 10.5 10.2 9.5 8.8 10 8.0 5.3 * 5

153

209 Summary Other Health Indicators by EOHHS Regions

MA North Metro South Western Central Boston Indicator Total East West East

% Fair or Poor 13.2 14.6 15.2 13.4 9.3 14.3 14.7 Health (2005) Cases of Elevated Blood Lead levels 2.3 2.9 3.1 2.1 1.0 2.2 3.2 (Percent of All Children Screened Per 1000, 2005) % Visited Dentist 78.2 75.4 75.1 76.3 86.1 76.8 74.1 Past Year (2004) % 6+ Teeth 15.1 18.8 15.4 16.5 10.5 17.4 13.7 Missing (2004) % Poor Mental Health for 15 or more days in 8.8 11.2 10.5 8.0 5.3 10.2 9.5 Past Month (2005)

210 Summary Other Health Indicators by EOHHS Regions

MA North Metro South Western Central Boston Indicator Total East West East

% Adults reporting 19.5 21.5 20.6 18.1 15.3 24.2 17.1 having a disability (2005)

% Adults reporting having a disability and 6.7 7.3 8.5 5.5 4.7 9.0 5.1 needing help with activities (2005)

154

211 Refugee Arrivals: Central Region Fiscal Year 2002-2006

200 • 858 refugees 180 resettled over 5 160 years 140 120 • Increasing diversity 100 in population 80 • 51% age <19 at 60 arrival 40 20 • Nearly all 0 resettlement is in Worcester FY02 FY03 FY04 FY05 FY06 Africa Am/Carib E/SEAsia NrE/SAsia Eur/CAsia

Source: MDPH, BCDC STD Files

212 Refugee Health Concerns: Central Region Fiscal Year 2002-2006

• High rates of latent TB infection (LTBI) – 744 refugees tested: 33% positive – Intensive follow-up in partnership with TB clinics, local health and DPH to assure testing, evaluation and treatment – Rapid assessment identifies active disease early to prevent spread • Risk of lead poisoning among refugee children – 10 refugee children identified with elevated blood lead levels at arrival – Poor nutritional status puts children at risk of increased absorption of lead post-resettlement • Need for bilingual, bicultural services to promote access to care

Source: MDPH, BCDC STD Files

155

Summary Refugees by EOHHS Regions 213 Massachusetts: 2002-2006

Metro West Western Central North East Indicator and Boston Regions

Refugee Arrivals 2,204 858 1,312 2,843

African and European and Largest Group African South East African Central Asian Asian

% refugees 44% 51% 45% 39% 19 years or less

Boston, Greenfield, Cambridge, Springfield, West Lowell, Lynn, Chelsea, Everett, Largest Cities Worcester Springfield, Malden Quincy, Revere, Westfield Somerville, Waltham

%TB Positive 41% 33% 44% 47%

Source: MDPH, BCDC STD Files

214 Premature Mortality Rate (PMR)1

• Definition – deaths before age 75

• Rationale – two-thirds of deaths to persons ages 75+ – vast majority of deaths to persons age 75+ are due to chronic conditions associated with aging – deaths to persons less than 75 years may be more preventable

• Summary health statistic – excellent measure to reflect the health status of a population – used as a health status indicator that can be used to focus prevention initiatives and target programs

1 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population under 75 years of age. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau

156

215 PrematureMap 2. Premature Mortality Mortality Rates Rate (PMR) (PMR) by by Region Region Massachusetts:Massachusetts: 2005 2005

Massachusetts PMR= 317.0

Northeast 311.5

Boston Western Central 373.1 355 340 Metro West 248.9

Southeast PMR by Region 332.3 Significantly higher than state rate Not different from state rate Significantly lower than state rate

25 Miles

Rates are per 100,000 persons under 75 years of age, age-adjusted to the 2000 US standard population under 75 years of age. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

216

PMR- Central Region by City/Town Massachusetts: 2005

Massachusetts PMR= 317.0 Central Region PMR= 340.0

FITCHB. *R t 100 000 l ti

PMR by City/Town Lowest Significantly higher than state rate Mendon: 133.8 Not different from state rate WORCESTER

Significantly lower than state rate WARREN Less than 5 premature deaths.

BLACK Highest STONE Warren: 553.7 10 Miles

Rates are per 100,000 persons under 75 years of age, age-adjusted to the 2000 US standard population under 75 years of age. Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau

157

217 Median Household Income and PMR by EOHHS Regions, Massachusetts: 2005

400 PMR Median Household Income $100,000

$90,000 350

$80,000 300 $70,000

250 $60,000

200 $50,000 PMR

$40,000 150

$30,000 100 Median Household Income ($) Median Income Household $20,000

50 $10,000

0 $0 Boston Region Western Mass Central Mass Southeast Northeast Metro West

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program State Median Household Income: $66,365

218 Premature Mortality Rate (PMR) by EOHHS Regions: 2005

PMR Massachusetts 317.0

Western Region 355.0 Central Region 340.0 North East Region 311.5 Metro West Region 248.9 South East Region 332.3

Boston Region 373.1

Better Outcome (significantly different from state) Worse Outcome (significantly different from state)

Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program

158

219 Key Health Observations in Central Massachusetts

• Racial and Ethnic disparities are major factors - Latinos and Blacks health disparities across several indicators are a major concern • Overweight/obesity is an increasing health risk - contributes to rising diabetes incidence • The region’s residents are disproportionately affected by: – Infant mortality rates – Smoking rates – AIDS/HIV and Hep C – Heroin/opioid related incidents/deaths – Motor vehicle injuries

159

160

APPENDIX

161

162

REGIONS AND TOWNS

REGION TOWN COUNTY CHNA BOSTON BOSTON SUFFOLK Alliance for Community Health BROOKLINE NORFOLK Alliance for Community Health CHELSEA SUFFOLK Alliance for Community Health REVERE SUFFOLK Alliance for Community Health WINTHROP SUFFOLK Alliance for Community Health CENTRAL ASHBURNHAM WORCESTER Fitchburg/Gardner CHN ASHBY MIDDLESEX Fitchburg/Gardner CHN AUBURN WORCESTER Community Wellness Coalition AYER MIDDLESEX Fitchburg/Gardner CHN BARRE WORCESTER Fitchburg/Gardner CHN BELLINGHAM NORFOLK Community Partners for Health BERLIN WORCESTER Fitchburg/Gardner CHN BLACKSTONE WORCESTER Community Partners for Health BOLTON WORCESTER Fitchburg/Gardner CHN BOYLSTON WORCESTER Community Wellness Coalition BRIMFIELD HAMPDEN CHN of Southern Worcester County BROOKFIELD WORCESTER CHN of Southern Worcester County CHARLTON WORCESTER CHN of Southern Worcester County CLINTON WORCESTER Fitchburg/Gardner CHN DOUGLAS WORCESTER Community Partners for Health DUDLEY WORCESTER CHN of Southern Worcester County EAST BROOKFIELD WORCESTER CHN of Southern Worcester County FITCHBURG WORCESTER Fitchburg/Gardner CHN FRANKLIN NORFOLK Community Partners for Health GARDNER WORCESTER Fitchburg/Gardner CHN GRAFTON WORCESTER Community Wellness Coalition GROTON MIDDLESEX Fitchburg/Gardner CHN HARDWICK WORCESTER Fitchburg/Gardner CHN HARVARD WORCESTER Fitchburg/Gardner CHN HOLDEN WORCESTER Community Wellness Coalition HOLLAND HAMPDEN CHN of Southern Worcester County HOPEDALE WORCESTER Community Partners for Health HUBBARDSTON WORCESTER Fitchburg/Gardner CHN LANCASTER WORCESTER Fitchburg/Gardner CHN LEICESTER WORCESTER Community Wellness Coalition LEOMINSTER WORCESTER Fitchburg/Gardner CHN LUNENBURG WORCESTER Fitchburg/Gardner CHN MEDWAY NORFOLK Community Partners for Health MENDON WORCESTER Community Partners for Health MILFORD WORCESTER Community Partners for Health MILLBURY WORCESTER Community Wellness Coalition MILLVILLE WORCESTER Community Partners for Health NEW BRAINTREE WORCESTER Fitchburg/Gardner CHN NORTH BROOKFIELD WORCESTER CHN of Southern Worcester County NORTHBRIDGE WORCESTER Community Partners for Health OAKHAM WORCESTER Fitchburg/Gardner CHN

163 OXFORD WORCESTER CHN of Southern Worcester County PAXTON WORCESTER Community Wellness Coalition PEPPERELL MIDDLESEX Fitchburg/Gardner CHN PRINCETON WORCESTER Fitchburg/Gardner CHN RUTLAND WORCESTER Fitchburg/Gardner CHN SHIRLEY MIDDLESEX Fitchburg/Gardner CHN SHREWSBURY WORCESTER Community Wellness Coalition SOUTHBRIDGE WORCESTER CHN of Southern Worcester County SPENCER WORCESTER CHN of Southern Worcester County STERLING WORCESTER Fitchburg/Gardner CHN STURBRIDGE WORCESTER CHN of Southern Worcester County SUTTON WORCESTER Community Partners for Health TEMPLETON WORCESTER Fitchburg/Gardner CHN TOWNSEND MIDDLESEX Fitchburg/Gardner CHN UPTON WORCESTER Community Partners for Health UXBRIDGE WORCESTER Community Partners for Health WALES HAMPDEN CHN of Southern Worcester County WARREN WORCESTER CHN of Southern Worcester County WEBSTER WORCESTER CHN of Southern Worcester County WEST BOYLSTON WORCESTER Community Wellness Coalition WEST BROOKFIELD WORCESTER CHN of Southern Worcester County WESTMINSTER WORCESTER Fitchburg/Gardner CHN WINCHENDON WORCESTER Fitchburg/Gardner CHN WORCESTER WORCESTER Community Wellness Coalition METRO ACTON MIDDLESEX Greater Woburn/Concord/Littleton CHN WEST ARLINGTON MIDDLESEX Greater Cambridge/Somerville CHN ASHLAND MIDDLESEX CHN of Greater Metro West BEDFORD MIDDLESEX Greater Woburn/Concord/Littleton CHN BELMONT MIDDLESEX Greater Cambridge/Somerville CHN BOXBOROUGH MIDDLESEX Greater Woburn/Concord/Littleton CHN BRAINTREE NORFOLK Blue Hills Community Health Alliance BURLINGTON MIDDLESEX Greater Woburn/Concord/Littleton CHN CAMBRIDGE MIDDLESEX Greater Cambridge/Somerville CHN CANTON NORFOLK Blue Hills Community Health Alliance CARLISLE MIDDLESEX Greater Woburn/Concord/Littleton CHN COHASSET NORFOLK Blue Hills Community Health Alliance CONCORD MIDDLESEX Greater Woburn/Concord/Littleton CHN DEDHAM NORFOLK West Suburban Health Network DOVER NORFOLK West Suburban Health Network FOXBOROUGH NORFOLK CHN of Greater Metro West FRAMINGHAM MIDDLESEX CHN of Greater Metro West HINGHAM PLYMOUTH Blue Hills Community Health Alliance HOLLISTON MIDDLESEX CHN of Greater Metro West HOPKINTON MIDDLESEX CHN of Greater Metro West HUDSON MIDDLESEX CHN of Greater Metro West HULL PLYMOUTH Blue Hills Community Health Alliance LEXINGTON MIDDLESEX Greater Woburn/Concord/Littleton CHN LINCOLN MIDDLESEX Greater Woburn/Concord/Littleton CHN LITTLETON MIDDLESEX Greater Woburn/Concord/Littleton CHN MARLBOROUGH MIDDLESEX CHN of Greater Metro West

164 MAYNARD MIDDLESEX CHN of Greater Metro West MEDFIELD NORFOLK CHN of Greater Metro West MILLIS NORFOLK CHN of Greater Metro West MILTON NORFOLK Blue Hills Community Health Alliance NATICK MIDDLESEX CHN of Greater Metro West NEEDHAM NORFOLK West Suburban Health Network NEWTON MIDDLESEX West Suburban Health Network NORFOLK NORFOLK CHN of Greater Metro West NORTHBOROUGH WORCESTER CHN of Greater Metro West NORWELL PLYMOUTH Blue Hills Community Health Alliance NORWOOD NORFOLK Blue Hills Community Health Alliance PLAINVILLE NORFOLK CHN of Greater Metro West QUINCY NORFOLK Blue Hills Community Health Alliance RANDOLPH NORFOLK Blue Hills Community Health Alliance SCITUATE PLYMOUTH Blue Hills Community Health Alliance SHARON NORFOLK Blue Hills Community Health Alliance SHERBORN MIDDLESEX CHN of Greater Metro West SOMERVILLE MIDDLESEX Greater Cambridge/Somerville CHN SOUTHBOROUGH WORCESTER CHN of Greater Metro West STOW MIDDLESEX CHN of Greater Metro West SUDBURY MIDDLESEX CHN of Greater Metro West WALPOLE NORFOLK CHN of Greater Metro West WALTHAM MIDDLESEX West Suburban Health Network WATERTOWN MIDDLESEX Greater Cambridge/Somerville CHN WAYLAND MIDDLESEX CHN of Greater Metro West WELLESLEY NORFOLK West Suburban Health Network WESTBOROUGH WORCESTER CHN of Greater Metro West WESTON MIDDLESEX West Suburban Health Network WESTWOOD NORFOLK West Suburban Health Network WEYMOUTH NORFOLK Blue Hills Community Health Alliance WILMINGTON MIDDLESEX Greater Woburn/Concord/Littleton CHN WINCHESTER MIDDLESEX Greater Woburn/Concord/Littleton CHN WOBURN MIDDLESEX Greater Woburn/Concord/Littleton CHN WRENTHAM NORFOLK CHN of Greater Metro West NORTHEAST AMESBURY ESSEX Greater Haverhill CHN ANDOVER ESSEX Greater Lawrence CHN BEVERLY ESSEX Community Health Network North BILLERICA MIDDLESEX Greater Lowell CHN BOXFORD ESSEX Greater Haverhill CHN CHELMSFORD MIDDLESEX Greater Lowell CHN DANVERS ESSEX North Shore CHN DRACUT MIDDLESEX Greater Lowell CHN DUNSTABLE MIDDLESEX Greater Lowell CHN ESSEX ESSEX Community Health Network North EVERETT MIDDLESEX North Suburban Health Alliance GEORGETOWN ESSEX Greater Haverhill CHN GLOUCESTER ESSEX Community Health Network North GROVELAND ESSEX Greater Haverhill CHN HAMILTON ESSEX Community Health Network North HAVERHILL ESSEX Greater Haverhill CHN

165 IPSWICH ESSEX Community Health Network North LAWRENCE ESSEX Greater Lawrence CHN LOWELL MIDDLESEX Greater Lowell CHN LYNN ESSEX North Shore CHN LYNNFIELD ESSEX North Shore CHN MALDEN MIDDLESEX North Suburban Health Alliance MANCHESTER ESSEX Community Health Network North MARBLEHEAD ESSEX North Shore CHN MEDFORD MIDDLESEX North Suburban Health Alliance MELROSE MIDDLESEX North Suburban Health Alliance MERRIMAC ESSEX Greater Haverhill CHN METHUEN ESSEX Greater Lawrence CHN MIDDLETON ESSEX Greater Lawrence CHN NAHANT ESSEX North Shore CHN NEWBURY ESSEX Greater Haverhill CHN NEWBURYPORT ESSEX Greater Haverhill CHN NORTH ANDOVER ESSEX Greater Lawrence CHN NORTH READING MIDDLESEX North Suburban Health Alliance PEABODY ESSEX North Shore CHN READING MIDDLESEX North Suburban Health Alliance ROCKPORT ESSEX Community Health Network North ROWLEY ESSEX Greater Haverhill CHN SALEM ESSEX North Shore CHN SALISBURY ESSEX Greater Haverhill CHN SAUGUS ESSEX North Shore CHN STONEHAM MIDDLESEX North Suburban Health Alliance SWAMPSCOTT ESSEX North Shore CHN TEWKSBURY MIDDLESEX Greater Lowell CHN TOPSFIELD ESSEX Community Health Network North TYNGSBOROUGH MIDDLESEX Greater Lowell CHN WAKEFIELD MIDDLESEX North Suburban Health Alliance WENHAM ESSEX Community Health Network North WEST NEWBURY ESSEX Greater Haverhill CHN WESTFORD MIDDLESEX Greater Lowell CHN SOUTHEAST ABINGTON PLYMOUTH Greater Brockton CHN ACUSHNET BRISTOL Greater New Bedford CHN ATTLEBORO BRISTOL Health & Education Response AVON NORFOLK Greater Brockton CHN BARNSTABLE BARNSTABLE Cape and Islands CHN BERKLEY BRISTOL Health & Education Response BOURNE BARNSTABLE Cape and Islands CHN BREWSTER BARNSTABLE Cape and Islands CHN BRIDGEWATER PLYMOUTH Greater Brockton CHN BROCKTON PLYMOUTH Greater Brockton CHN CARVER PLYMOUTH South Shore Community Partners in Prevention CHATHAM BARNSTABLE Cape and Islands CHN CHILMARK DUKES Cape and Islands CHN DARTMOUTH BRISTOL Greater New Bedford CHN DENNIS BARNSTABLE Cape and Islands CHN DIGHTON BRISTOL Health & Education Response

166 DUXBURY PLYMOUTH South Shore Community Partners in Prevention EAST BRIDGEWATER PLYMOUTH Greater Brockton CHN EASTHAM BARNSTABLE Cape and Islands CHN EASTON BRISTOL Greater Brockton CHN EDGARTOWN DUKES Cape and Islands CHN FAIRHAVEN BRISTOL Greater New Bedford CHN FALL RIVER BRISTOL Partners for a Healthier Community FALMOUTH BARNSTABLE Cape and Islands CHN FREETOWN BRISTOL Greater New Bedford CHN GAY HEAD DUKES Cape and Islands CHN GOSNOLD DUKES Cape and Islands CHN HALIFAX PLYMOUTH South Shore Community Partners in Prevention HANOVER PLYMOUTH South Shore Community Partners in Prevention HANSON PLYMOUTH South Shore Community Partners in Prevention HARWICH BARNSTABLE Cape and Islands CHN HOLBROOK NORFOLK Greater Brockton CHN KINGSTON PLYMOUTH South Shore Community Partners in Prevention LAKEVILLE PLYMOUTH Health & Education Response MANSFIELD BRISTOL Health & Education Response MARION PLYMOUTH Greater New Bedford CHN MARSHFIELD PLYMOUTH South Shore Community Partners in Prevention MASHPEE BARNSTABLE Cape and Islands CHN MATTAPOISETT PLYMOUTH Greater New Bedford CHN MIDDLEBOROUGH PLYMOUTH Health & Education Response NANTUCKET NANTUCKET Cape and Islands CHN NEW BEDFORD BRISTOL Greater New Bedford CHN NORTH ATTLEBORO BRISTOL Health & Education Response NORTON BRISTOL Health & Education Response OAK BLUFFS DUKES Cape and Islands CHN ORLEANS BARNSTABLE Cape and Islands CHN PEMBROKE PLYMOUTH South Shore Community Partners in Prevention PLYMOUTH PLYMOUTH South Shore Community Partners in Prevention PLYMPTON PLYMOUTH South Shore Community Partners in Prevention PROVINCETOWN BARNSTABLE Cape and Islands CHN RAYNHAM BRISTOL Health & Education Response REHOBOTH BRISTOL Health & Education Response ROCHESTER PLYMOUTH Greater New Bedford CHN ROCKLAND PLYMOUTH South Shore Community Partners in Prevention SANDWICH BARNSTABLE Cape and Islands CHN SEEKONK BRISTOL Health & Education Response SOMERSET BRISTOL Partners for a Healthier Community STOUGHTON NORFOLK Greater Brockton CHN SWANSEA BRISTOL Partners for a Healthier Community TAUNTON BRISTOL Health & Education Response TISBURY DUKES Cape and Islands CHN TRURO BARNSTABLE Cape and Islands CHN WAREHAM PLYMOUTH Greater New Bedford CHN WELLFLEET BARNSTABLE Cape and Islands CHN WEST BRIDGEWATER PLYMOUTH Greater Brockton CHN WEST TISBURY DUKES Cape and Islands CHN

167 WESTPORT BRISTOL Partners for a Healthier Community WHITMAN PLYMOUTH Greater Brockton CHN YARMOUTH BARNSTABLE Cape and Islands CHN WESTERN ADAMS BERKSHIRE CHN of Berkshire AGAWAM HAMPDEN The Community Health Connection ALFORD BERKSHIRE CHN of Berkshire AMHERST HAMPSHIRE Partnership for Health in Hampshire County ASHFIELD FRANKLIN Upper Valley Health Web ATHOL WORCESTER Upper Valley Health Web BECKET BERKSHIRE CHN of Berkshire BELCHERTOWN HAMPSHIRE Partnership for Health in Hampshire County BERNARDSTON FRANKLIN Upper Valley Health Web BLANDFORD HAMPDEN The Community Health Connection BUCKLAND FRANKLIN Upper Valley Health Web CHARLEMONT FRANKLIN Upper Valley Health Web CHESHIRE BERKSHIRE CHN of Berkshire CHESTER HAMPDEN Four (For) Communities CHESTERFIELD HAMPSHIRE Partnership for Health in Hampshire County CHICOPEE HAMPDEN Four (For) Communities CLARKSBURG BERKSHIRE CHN of Berkshire COLRAIN FRANKLIN Upper Valley Health Web CONWAY FRANKLIN Upper Valley Health Web CUMMINGTON HAMPSHIRE Partnership for Health in Hampshire County DALTON BERKSHIRE CHN of Berkshire DEERFIELD FRANKLIN Upper Valley Health Web EAST LONGMEADOW HAMPDEN The Community Health Connection EASTHAMPTON HAMPSHIRE Partnership for Health in Hampshire County EGREMONT BERKSHIRE CHN of Berkshire ERVING FRANKLIN Upper Valley Health Web FLORIDA BERKSHIRE CHN of Berkshire GILL FRANKLIN Upper Valley Health Web GOSHEN HAMPSHIRE Partnership for Health in Hampshire County GRANBY HAMPSHIRE Partnership for Health in Hampshire County GRANVILLE HAMPDEN The Community Health Connection GREAT BARRINGTON BERKSHIRE CHN of Berkshire GREENFIELD FRANKLIN Upper Valley Health Web HADLEY HAMPSHIRE Partnership for Health in Hampshire County HAMPDEN HAMPDEN The Community Health Connection HANCOCK BERKSHIRE CHN of Berkshire HATFIELD HAMPSHIRE Partnership for Health in Hampshire County HAWLEY FRANKLIN Upper Valley Health Web HEATH FRANKLIN Upper Valley Health Web HINSDALE BERKSHIRE CHN of Berkshire HOLYOKE HAMPDEN Four (For) Communities HUNTINGTON HAMPSHIRE Four (For) Communities LANESBOROUGH BERKSHIRE CHN of Berkshire LEE BERKSHIRE CHN of Berkshire LENOX BERKSHIRE CHN of Berkshire LEVERETT FRANKLIN Upper Valley Health Web LEYDEN FRANKLIN Upper Valley Health Web

168 LONGMEADOW HAMPDEN The Community Health Connection LUDLOW HAMPDEN Four (For) Communities MIDDLEFIELD HAMPSHIRE Partnership for Health in Hampshire County MONROE FRANKLIN Upper Valley Health Web MONSON HAMPDEN The Community Health Connection MONTAGUE FRANKLIN Upper Valley Health Web MONTEREY BERKSHIRE CHN of Berkshire MONTGOMERY HAMPDEN The Community Health Connection MOUNT WASHINGTON BERKSHIRE CHN of Berkshire NEW ASHFORD BERKSHIRE CHN of Berkshire NEW MARLBOROUGH BERKSHIRE CHN of Berkshire NEW SALEM FRANKLIN Upper Valley Health Web NORTH ADAMS BERKSHIRE CHN of Berkshire NORTHAMPTON HAMPSHIRE Partnership for Health in Hampshire County NORTHFIELD FRANKLIN Upper Valley Health Web ORANGE FRANKLIN Upper Valley Health Web OTIS BERKSHIRE CHN of Berkshire PALMER HAMPDEN The Community Health Connection PELHAM HAMPSHIRE Partnership for Health in Hampshire County PERU BERKSHIRE CHN of Berkshire PETERSHAM WORCESTER Upper Valley Health Web PHILLIPSTON WORCESTER Upper Valley Health Web PITTSFIELD BERKSHIRE CHN of Berkshire PLAINFIELD HAMPSHIRE Partnership for Health in Hampshire County RICHMOND BERKSHIRE CHN of Berkshire ROWE FRANKLIN Upper Valley Health Web ROYALSTON WORCESTER Upper Valley Health Web RUSSELL HAMPDEN The Community Health Connection SANDISFIELD BERKSHIRE CHN of Berkshire SAVOY BERKSHIRE CHN of Berkshire SHEFFIELD BERKSHIRE CHN of Berkshire SHELBURNE FRANKLIN Upper Valley Health Web SHUTESBURY FRANKLIN Upper Valley Health Web SOUTH HADLEY HAMPSHIRE Partnership for Health in Hampshire County SOUTHAMPTON HAMPSHIRE Partnership for Health in Hampshire County SOUTHWICK HAMPDEN The Community Health Connection SPRINGFIELD HAMPDEN The Community Health Connection STOCKBRIDGE BERKSHIRE CHN of Berkshire SUNDERLAND FRANKLIN Upper Valley Health Web TOLLAND HAMPDEN The Community Health Connection TYRINGHAM BERKSHIRE CHN of Berkshire WARE HAMPSHIRE Partnership for Health in Hampshire County WARWICK FRANKLIN Upper Valley Health Web WASHINGTON BERKSHIRE CHN of Berkshire WENDELL FRANKLIN Upper Valley Health Web WEST SPRINGFIELD HAMPDEN The Community Health Connection WEST STOCKBRIDGE BERKSHIRE CHN of Berkshire WESTFIELD HAMPDEN Four (For) Communities WESTHAMPTON HAMPSHIRE Partnership for Health in Hampshire County WHATELY FRANKLIN Upper Valley Health Web

169 WILBRAHAM HAMPDEN The Community Health Connection WILLIAMSBURG HAMPSHIRE Partnership for Health in Hampshire County WILLIAMSTOWN BERKSHIRE CHN of Berkshire WINDSOR BERKSHIRE CHN of Berkshire WORTHINGTON HAMPSHIRE Partnership for Health in Hampshire County

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DATA SOURCES

Massachusetts Division of Health Care Finance and Policy

MDPH, Bureau of Communicable Disease Control

MDPH, Bureau of Substance Abuse Services

MDPH, Environmental Health Bureau

MDPH, Health Information, Statistics, Research & Evaluation Bureau

SAMHSA, Office of Applied Studies

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