Contributing Causes of Health Challenges Table of Contents I. Chronic Diseases Arthritis ……………………………………………………………………………………………………………………………..2 Asthma ………………………………………………………………………………………………………………………………9 Breastfeeding …………………………………………………………………………………………………………………….14 Cancer ……………………………………………………………………………………………………………………………….22 Diabetes …………………………………………………………………………………………………………………………….33 Heart Disease and Stroke …………………………………………………………………………………………………..42 Nutrition …………………………………………………………………………………………………………………………….47 Obesity ……………………………………………………………………………………………………………………………….54 Physical Activity ………………………………………………………………………………………………………………....60 Tobacco ………………………………………………………………………………………………………………………………67 II. Health of Women, Infants and Children Maternal and Women’s Health …………………………………………………………………………………………78 Perinatal and Infant Health ………………………………………………………………………………………………….81 Child and Adolescent Health ………………………………………………………………………………………………..84 III. Mental Health/Substance Use Disorders Well-Being ……………………………………………………………………………………………………………………………97 Mental and Substance Use Disorders …………………………………………………………………………………..98 Capacity and Infrastructure ………………………………………………………………………………………………….106 IV. Healthy Environment Childhood Lead …………………………………………………………………………………………………………………….114 Exposure to Radon ……………………………………………………………………………………………………………….118 Foodborne Diseases ……………………………………………………………………………………………………………..121 Injuries and Violence …………………………………………………………………………………………………………….125 Legionella ……………………………………………………………………………………………………………………………..132 Water Quality ……………………………………………………………………………………………………………………….138 Work-related Injuries and Occupational Health …………………………………………………………………….142 V. Communicable Diseases Antibiotic Resistance and Healthcare-associated Infections ………………………………………………….153 HIV, Sexually-Transmitted Diseases, and Hepatitis C ……………………………………………………………..161 Vaccine Preventable Diseases ……………………………………………………………………………………………….167 Chronic Disease Contributing Causes of Health Challenges Page 1 Prevention Agenda Toward the Healthiest State Progress Report 2018 Arthritis BACKGROUND Arthritis is a term used to describe more than 100 chronic diseases and conditions that affect the joints, surrounding tissues, and other connective tissues. Common types of arthritis include osteoarthritis, rheumatoid arthritis, gout, bursitis, and tendinitis. Symptoms of these conditions include stiffness in the joints, pain, and swelling. Some types of arthritis, such as rheumatoid arthritis, involve the immune system, causing widespread symptoms and impacting multiple organs. The severity and location of symptoms varies, depending on the form of arthritis.1 Often, opioids are prescribed to relieve arthritis pain, contributing to the growing opioid use epidemic.2,3 Nationally, arthritis affects 25.5% of adults, approximately 63.6 million people.4 In New York State (NYS), 3.6 million adults (23.7%) reported being told by a health care provider that they had some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia*.5 In some cases, the risk for arthritis is associated with specific demographic characteristics, such as age or sex. In others, it may be influenced by risk factors such as obesity, lack of physical activity, and joint injuries. These risk factors can be addressed to reduce the risk of arthritis or to mitigate the impact arthritis symptoms have on adults’ overall quality of life.1 In addition to its high burden, arthritis is costly. In 2013, medical costs and lost earnings associated with arthritis reached $304 billion nationally, including $65 billion for ambulatory care and $31 billion in drug prescriptions. 6 Osteoarthritis is also the leading cause for total joint replacement procedures. Eighty-two percent of all total hip replacements and 94.8% for all total knee replacements are attributed to this condition.7 There is no known cure for arthritis, but its onset can be delayed by addressing risk factors such as, maintaining a healthy weight, engaging in regular physical activity, and avoiding activities that could cause joint injury. BURDEN Data on arthritis prevalence and arthritis management are collected periodically through the New York State Behavioral Risk Factor Surveillance System (BRFSS). Data from the BRFSS show that arthritis is more common among women, older adults, and adults with a disability. It is also more common in adults with other chronic conditions, such as diabetes, cancer, asthma, and cardiovascular disease. More than half of adults with two or more chronic conditions also have arthritis which can lead to difficulties in the management and control of those other conditions (Figure 1). * In BRFSS 2016, arthritis prevalence is calculated based on the question: Has a doctor, nurse, or other health professional EVER told you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia? Page 2 Figure 1: Percent of adults with arthritis only, and prevalence of arthritis among adults with one, or two or more other chronic conditions, BRFSS, 2016 Arthritis and its symptoms affect quality of life and productivity. Among adults who have arthritis, 48.3% report activity limitations due to their symptoms.8 Approximately 30.9% of adults with arthritis report a 7-10 level of pain on a 1-10 scale where 10 is pain or aching as bad as it can be.9 Forty-six percent of adults with arthritis report experiencing some to a lot of disruption to their normal social activities, such as going shopping or attending social gatherings due to their arthritis and joint symptoms. Additionally, 33.3% of adults with arthritis report that their symptoms affect the type and amount of work they do, showing an association between arthritis and work productivity.10 Maintaining a healthy weight and engaging in regular physical exercise can help control arthritis and joint symptoms. Forty-one percent of adults with arthritis report that their doctor suggested they lose weight and 63.3% report that their doctor suggested they use physical activity or exercise to control their arthritis and joint symptoms.11 Evidence-based chronic disease self-management programs may help adults with arthritis manage their symptoms and improve their quality of life. Yet, only 10.6% of adults with arthritis have taken a class specifically to learn how to manage their arthritis and its symptoms.12 Arthritis risk is associated with body weight. The prevalence of arthritis among adults who are obese (34.6%) is two times greater than the prevalence among adults who are neither overweight nor obese (16.7%). Among those who do not engage in leisure-time physical activity the prevalence of arthritis is 31% (Figure 2).13 Page 3 Figure 2: Prevalence of arthritis by Body Mass Index (BMI) category and leisure-time physical activity, BRFSS, 2016 Geographic distribution The prevalence of arthritis varies based on geographic location. The percent of adults with arthritis varies widely across counties in NYS, from 14.8% (New York City) to 38.0% (Montgomery County). The five counties with the highest prevalence are: Montgomery (38.0%), Fulton (30.9%), Cattaraugus (36.2%), Franklin (35.5%), and Hamilton (35.3%). The five counties with the lowest prevalence are: New York (14.8%), Rockland (18.8%), Kings (19.3%), Queens (19.6%), and Bronx (19.9%). The prevalence of arthritis in these counties is below the state average. Yet its impact is high because these counties have a large population size. Figure 3: Percentage of adults with arthritis, by county, BRFSS, 2016 Page 4 DATA TRENDS The prevalence of arthritis in the United States and NYS has remained relatively constant over the past five years. In 2016, 23.7% of New Yorkers reported that they have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia (Figure 4). Figure 4: Prevalence of arthritis in the United States and in New York State, BRFSS, 2011-2016 Arthritis is the most prevalent chronic condition among New Yorkers. Its prevalence (23.7%) is more than two times higher than the next most prevalent chronic conditions, diabetes (10.5%) and asthma (9.5%) (Figure 5).14 Figure 5: Prevalence of chronic disease among New York State adults, BRFSS, 2016 Page 5 DISPARITIES Age and sex In NYS, approximately 50% of adults 65 years and older have arthritis. Adults who report having arthritis are more likely to be women and 65 years and older. Twenty-seven percent of women and 19.3% of men in NYS have arthritis. Although, the prevalence of arthritis is higher among females across all age groups, the gap in the prevalence between females and males increases with age (Figure 6).15 Figure 6: Percentage of adults living with arthritis who are female and male by age group, New York State adults, BRFSS, 2016 Race and ethnicity The prevalence of arthritis varies by race and ethnicity. White non-Hispanic adults are two times more likely to have arthritis than Hispanic adults (28.5% versus 16.8%) (Figure 7).16 35% 28.5% 30% 25% 19.8% 16.8% 20% 14.9% 15% 10% 5% 0% White, Non- Black, Non- Hispanic Other, Non- Hispanic Hispanic Hispanic Figure 7: Prevalence of arthritis among adults, by Race/Ethnicity, New York State, Behavioral Risk Factor Surveillance System, 2016 Page 6 Disability Arthritis is more prevalent among adults with a disability, adults who report having difficulty with self-care, independent living, cognition, mobility, vision, or hearing. Adults with a disability are more than three times as likely (50.5%) to have arthritis than adults without a disability (16.4%) (Figure 8).17 Figure 8: Prevalence of arthritis