Keeping Brooklyn Healthy by Assessing Population Health and Driving Innovation Neighborhood Health Profiles 2015

Downtown Brooklyn Brooklyn Heights-Park Slope 11201, 11205, 11215, 11217, 11231 Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Neighborhood at a glance…  Population: 224,199  TBHC Service Areas: Primary service area: 11201, 11205 Secondary service area: 11217

Population pyramid with panes showing gender/age groups, color shows details about race. The marks are labeled by population counts for males and females across age groups in year 2010 Source: New York City Department of Health and Mental Hygiene. Epiquery: NYC Interactive Health Data System - NYC 2010 Census. http://nyc.gov/health/epiquery ® The Brooklyn Hospital Center Ambulatory Health 11201 Care Network ® ① ②u®③ ④ TBHCu® 11205 ①· Main Hospital Building:121 Dekalb Ave., 11201 ⑤ u® ②· Ambulatory Care Center: 121 Dekalb Ave., 11201 11217 ③· Family Medicine Practice Center: 240 Willoughby St., 11201 11231 ④· Path Center Downtown: 121 Dekalb Ave., 11201 ⑤· Rockwell Dialysis Services: 19 Rockwell Pl., 11217 u® 11215 ® ® ® ® ® Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Socioeconomic Conditions Economic Conditions

Zipcode 11201 Median Household I ncom e Below Poverty Level Below Poverty Level Unem ploym ent Level 11205 ( I ndividual) ( Fam ily) 11215 11217 35.6%

3 11231 4

100, 000 9 35 8 6 1 , , 3 3 9 9 $ $

90, 000 30. 3% 1

30 9 5 , 8 7

80, 000 $ 9 9 9 , 1 7 $

25 70, 000

) 60, 000 ) % $ (

(

20 n e o i t m a o l c u n p 4

I 50, 000 o 3 P 4

16. 3% , 2 4

15. 0% $ 15 13.9% 13. 7% 40, 000

11. 4% 10.3% 30, 000 10 9. 6% 8.6% 8. 1% 8. 0% 7. 2% 6. 5% 20, 000 5. 6% 5

10, 000

0 0 1 1 1 1 1 7 7 7 7 5 5 5 5 5 5 5 5 1 1 1 3 0 3 3 3 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Percentage of population in each zip code representing the various economic indicators Source: U.S. Census Bureau. 2012 American Community Survey 5-year estimates

Median income ranges from $42,434 to $93,693 across the five zip codes Zip code 11205 has a higher proportion of people living in poverty at 35.6% compared to 8.6% in zip code 11215

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Nativity and Language

Less than one-fifth of the population in all five zip codes is foreign born

Over 59% of the population in every zip code speaks only English in the household, making it the most common primary language for the neighborhood

Percentage of foreign born population and primary language spoken in each zip code Source: U.S. Census Bureau. 2012 American Community Survey 5-year estimates

Educational Attainment

Over 60% of the population in zip codes 11201, 11215, 11217, and 11231 has a post-secondary degree (Associate’s, Bachelor’s, or Graduate) compared to 39.4% of the population in zip code 11205

Highest level of education attained by population 18 years and over Source: U.S. Census Bureau. 2012 American Community Survey 5-year estimates

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Health Insurance Status: 2002-2012

Trends in health insurance types from 2002-2012, by percentage of population within each category Source: Community Health Survey. 2002-2012. New York City Department of Health & Mental Hygiene

Each year, private insurance has comprised at least half of the neighborhood’s health coverage

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Health Conditions Self-reported Health Status: 2002-2012

Trends in self-reported health from 2002-2012, by percentage of population within each category Source: Community Health Survey, 2002-2012. New York City Department of Health & Mental Hygiene

About 20% of the population reported excellent health in each of the survey years

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Prevalence of Diabetes Body Weight: 2002-2012

Trends in self-reported medical conditions based on diagnosis through lab results or having been told by a physician from 2002-2012 Source: Community Health Survey. 2002-2012. New York City Department of Health & Mental Hygiene In 2012, 10.3% of the population reported having diabetes compared to 11.8% of Brooklyn’s overall population Nearly 50% of the population is considered overweight or obese with a reported BMI above the normal range Burden of Illness: 2002-2012

Trends in self-reported medical conditions based on diagnosis through lab results or having been told by a physician from 2002-2012 Source: Community Health Survey. 2002-2012. New York City Department of Health & Mental Hygiene

Compared to asthma and high cholesterol, the prevalence of hypertension increased the most over a 10 year (2002-2012) time frame from 15 to 22% Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 People living with HIV/AIDS by Race/Ethnicity: 2006-2011 2006 2007 2008 Race/Ethnicity All 1, 336. 2 1, 350. 4 1, 350. 4 All Black 3, 193. 0 3, 384. 6 3, 537. 1 Black Hispanic 1, 819. 8 1, 884. 8 1, 929. 7 Hispanic White 655. 6 652. 5 644. 5 White Asian/Pacific I slander 267. 2 264. 6 268. 6 Asian/Pacific I slander Multiracial 85. 2 60. 4 56. 6 Multiracial Native Am erican 1, 575. 2 Native Am erican

0 2, 000 4, 000 0 2, 000 4, 000 0 2, 000 4, 000 per 100, 000 per 100, 000 per 100, 000

2009 2010 2011 All 1, 344. 6 1, 355. 1 1, 373. 9 Black 3, 659. 3 3, 836. 6 3, 902. 7 Hispanic 1, 968. 0 2, 018. 7 2, 026. 0 White 637. 6 630. 1 641. 2 Asian/Pacific I slander 271. 9 277. 3 287. 8 Multiracial 53. 3 34. 1 31. 7 Native Am erican 1, 612. 0 1, 609. 8 1, 883. 4

0 2, 000 4, 000 6, 000 0 2, 000 4, 000 6, 000 0 2, 000 4, 000 6, 000 per 100, 000 per 100, 000 per 100, 000 People living with HIV/AIDS per 100,000 from 2006-2011, by race/ethnicity Source: HIV/AIDS Surveillance Data, New York City Department of Health & Mental Hygiene

Between 2006-2011, the prevalence of HIV/AIDS within racial/ethnic groups has remained fairly consistent in Downtown Brooklyn with African-Americans and Hispanics having the highest burden of disease

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 All-Cause Mortality: 2000-2011

Trend in all-cause mortality (age-adjusted per 1,000) from 2000-2011 Source: Deaths Epiquery, 2000-2011. NYC Vital Statistics. New York City Department of Health & Mental Hygiene

Since 2000, the all-cause age-adjusted mortality rate declined by 32% (p<0.0001) to 6.3 per 1,000 residents in 2011

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Cigarette Smoking Status: 2002-2012

Trends in self-reported cigarette smoking status from 2002-2012, by percentage of population within each category Source: Community Health Survey, 2002-2012. New York City Department of Health & Mental Hygiene

Between 2002-2012, the percentage of current smokers declined and approximately 50% of the population self-identified as a ‘never smoker’ in each of the survey years Cancer Screening: 2002-2012

Trends in self-reported breast and colon cancer screening from 2002-2012 Source: Community Health Survey. 2002-2012. New York City Department of Health & Mental Hygiene

Colon cancer screening increased significantly from 53% in 2002 to 74% in 2012 (p<0.01) In contrast, breast cancer screening declined by 12.6% over the same time period Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Access to Healthcare Services: 2002-2012

Trends in self-reported HIV testing and having a ‘personal doctor’ from 2002-2012 Source: Community Health Survey. 2002-2012. New York City Department of Health & Mental Hygiene

In 2012, 79% of the population reported having a ‘personal doctor’ and 70% of the population underwent HIV testing

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Technical Notes

Data Sources: The data presented in these Brooklyn Neighborhood Health Profiles (BNHP) is public use data, made available from the New York City Department of Health and Mental Hygiene as well as U.S. Census Bureau via the American Community Survey (ACS) estimates.

The Community Health Survey (CHS) is a telephone survey conducted annually by the New York City Department of Health and Mental Hygiene since 2002. It is a cross-sectional survey providing self-reported data from an annual sample of approximately 8,500 randomly selected adults aged 18 years and older from New York City. For the purpose of these profiles, data for indicators related to vital statistics, health out- comes, health services, health behaviors, built environment, education and insurance were obtained from CHS.

The U.S. Census Bureau’s ACS is an ongoing survey that provides data every year related to age, sex, race, family and relationships, income, health insurance, education, veteran status, disabilities, commute and housing. Most of the socioeconomic and demographic data is obtained with zip codes as statistical areas from the ACS. Geographic area definitions: For the purpose of Phase 1 of BNHP, we have used United Hospital Fund definitions (UHF) to define the eleven neighborhoods throughout Brooklyn. The CHS uses stratified random sampling according to UHF neighborhood descriptions to collect data. We have also used the zip code statistical areas to retrieve data from ACS. These two different geographic areas are combined to present data in UHF neighborhood defini- tions with the aid of an equivalency table. Domains and Indicators: A total of thirty-eight indicators are included in BNHP and categorized within eight domains, each describ- ing the social environment of an individual (Table 1). To develop the Health Needs Index using the social indicators approach and for ranking the neighborhoods based on unmet needs, we shortlisted fourteen indicators across seven domains using a correlation matrix to eliminate skewing from highly correlated indicators (Table 2). Data for indicators obtained from CHS is age-adjusted.

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Table 1: Domains and Indicators:

Domain Subdomain Indicator Year/Period

1. Demographics Population Population 2010

Veterans 2008-2012

Birth Birth data 2000-2007

Fertility data 2000-2007

Mortality Age adjusted mortality rate 2000-2011

Migration Foreign born 2008-2012

2. Socioeconomic Economic Median household income 2008-2012

Unemployment status 2008-2012

Below poverty level (individuals) 2008-2012

Below poverty level (families) 2008-2012

Education Educational attainment 2008-2012

Language Language spoken at home 2008-2012

Insurance Health insurance type 2002-2012

3. Health outcomes Morbidity Prevalence of diabetes 2002-2012

Prevalence of asthma 2002-2012

Prevalence of obesity 2002-2012

Prevalence of hypertension 2002-2012

Disability status 2002-2012

Serious psychological distress 2002-2012

4. Health services Preventive services Flu vaccination 2002-2012

Colon cancer screening 2002-2012

Breast cancer screening 2002-2012

Treatment related services Mental health counseling or treatment 2002-2012

Personal doctor 2002-2012

HIV testing 2002-2012

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Table 1: Domains and Indicators (cont):

Domain Subdomain Indicator Year/Period

5. Health behaviors Health awareness Rode bicycle in past year 2002-2012

Last routine health check up 2002-2012

Exercise 2002-2012

Condom use 2002-2012

Nutrition Healthy diet 2002-2012

Consumption of fruits and vegetables 2002-2012

Economic Heavy drinking 2002-2012

Binge drinking 2002-2012

Smoking Smoking status 2002-2012

Quit smoking attempts 2002-2012

Health related quality of life Self-reported health status 2002-2012 Indicators6. Quality of life used to develop theHealth Needs Index 7. Environmental health Air quality Secondhand smoke 2002-2012

Transport Walk/bike for transport 2002-2012 Table 2: Indicators used to develop Health Needs Index:

Domain Subdomain Indicator Year

1. Demographics Migration Foreign born 2011

2. Socioeconomic Economic Below poverty level (individuals) 2011

Education High school graduates 2012

Insurance Health insurance - Medicaid 2012

3. Health Outcomes Morbidity Prevalence of diabetes 2012

Prevalence of asthma 2012

Prevalence of hypertension 2012

4. Health services Treatment related services HIV testing 2012

5. Health behaviors Health awareness Condom use 2012

(Healthy) Nutrition Consumption of fruits and vegetables 2012

5. Health behaviors (Un- Economic Heavy drinking 2012

healthy) Smoking Quit smoking attempts 2012

6. Quality of life Health related quality of life Self-reported health status 2012

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Table 3: Neighborhood Ranks based on Health Needs Index (from highest need to lowest need)

Neighborhood Rank

Williamsburg/Bushwick 1

East New York/New Lots 2

Greenpoint 3

Sunset Park 4

Borough Park 5

Canarsie and Flatlands 6

Bedford Stuyvesant/Crown Heights 7

Coney Island 8

Flatbush 9

Bay Ridge/Bensonhurst 10 Brooklyn Neighborhood Health Needs Index Downtown Brooklyn/Heights/Slope 11

Neighborhood Rank (.. 1 11

11222

11211

11237 11206 11201 11205 11221

11217 11238 11216 11231 11233

11213 11207 11215 11225 11212 11208

11232 11203 11226 11218 11239 11220 11236 11219 11210 11209 11230 11204 11228

11234

11214 11229 11223

11235 11224

Map based on Longitude (generated) and LatitudeNeighborhood (generated). Color shows ave Healthrage of Ranks. Profiles The marks are labeled 2015 by Zip. Downtown Brooklyn - Brooklyn Heights - Park Slope Neighborhood Profiles 2015 : Williamsburg - Bushwick 11206, 11221, 11237 Acknowledgments

We are grateful to the Young Leadership Council of The Brooklyn Hospital Center, for providing seed funding for development of the Brooklyn Neighborhood Health Profiles. The Profiles would not have been feasible without grant funding from the New York State Vital Access Program and the Everest Foundation. We are indebted to the Prevention Steering Committee for providing guidance and feedback throughout development of the Profiles. Above all, we are grateful to each person who will use the Profiles toward keeping Brooklyn healthy

Neighborhood Health Profiles 2015 Downtown Brooklyn - Brooklyn Heights - Park Slope HSR TEAM

Jean Ford, MD Founding Director

Carlos Castillo-Salgado, MD, JD, DrPH Director of the Global Public Health Observatory, The Johns Hopkins Bloomberg School of Public Health, Consultant

Manuel Vidaurre, MCSc Principal Information Technology Consultant

Sam Amirfar, MD, MS Suggested Citation: Health Situation Room, The Brooklyn Hospital Center: Director of Medical Informatics Brooklyn Neighborhood Health Profiles 2015, Downtown Brooklyn-Brooklyn Heights-Park Slope. Brooklyn, New York, USA. 2015 Heather Mavronicolas, PhD, MPH Director of Research Training

Tanyka Sam, MD, MPH Director of Research in Community-Oriented Principal Investigator: Jean Ford Primary Care Design by: Manuel Vidaurre

Tejal Shah, MBBS, MPH Graphs by: Tejal Shah Data Analyst Text by: Tejal Shah, Aracelis Torres, Deeby Zivari, Rebecca Schwarz and Tanyka Sam

Health Needs Index by: Carlos Castillo-Salgado Allyson Ho, MPH Education Manager Photographs by: Deeba Zivari, Allyson Ho, & Rebecca Schwarz Some pictures are from the Wikimedia Commons, the free media repositor. For Deeba Zivari, MS Communications Strategist and Research author attribution please check our website Coordinator Health Situation Room Aracelis Torres, MPH, PhD Candidate Research Assistant The Brooklyn Hospital Center 121 Dekalb Avenue Karina Christiansen , MPP, PhD Candidate Maynard Building, Suite 14D Research Assistant Brooklyn, NY 11201 [email protected]