The Health of King County

2006
Jim Krieger, MD, MPH
Epidemiology, Planning &
Evaluation Unit
 Acknowledgements
• PROJECT STAFF • We would also like to thank
(from the Epidemiology, reviewers and contributors
Planning and Evaluation Unit, from PHSKC, other local,
Public Health – Seattle & King state and national agencies
County) and the University of
 Susan Barkan, PhD Washington.
 Ann Glusker, PhD
 James Krieger, MD, MPH
 Amy Laurent, MPH
 Genevieve Rowe, MS
 Mike Smyser, MPH
 David Solet, PhD
 Lin Song, PhD
 ((in alphabetical order)
Where This Talk is Heading…

• Key findings
• Trends
• Health disparities
• Improving health
 Determinants of Health
Public Health
Social
Environment

Behaviors &
Physical
Biologic
Health &
Environment Disease
Response

Genetic
Endowment
Health Care

Adapted from Evans, et al

 The Health of King County

• Comprehensive, web-based report

 Health outcomes
 Health-related behaviors
• Data sources
 Vital records
 Surveys
 Hospital discharge data
 Reportable conditions
 US census
 Other
Public Health – Seattle & King County
Data Reports

• Core Indicators
• Communities Count
• HIV/AIDS Epi Monthly Report
• Medical Examiner’s Annual Report
• CD Annual Summary Report
• Epilog
• Data Watches
• Drug Abuse Trends
 #1
Chronic Diseases:
The Leading Cause of Death and Illness

 Common chronic diseases include:

 Cancer
 Heart disease
 Stroke
 Chronic lung diseases (e.g. asthma, COPD)
 Diabetes
 21,000 hospitalizations / $531 million in 2004
 Cancer, heart disease and stroke alone:
56% of all deaths
 Chronic Diseases:
The Leading Cause of Death and Illness

 Affect many residents

 Asthma: 9% of adults and 6% of children
 Heart disease: 5% of adults
 Diabetes 5% of adults
 Arthritis: 16% of adults
 Will become more common as population
ages
 Diabetes

• Prevalence among
adults has doubled in
the past decade.
• Hospitalizations,
which can often be
avoided with good
diabetes
management, are
increasing.
Chronic disease risk factors
Common and increasing

60
54

50

40
percent adults

36

31
30
22
20 18
15

10

0
overweight obesity high bp high chol inactive smoking
 #2
HIV infection has now become a
chronic condition

• AIDS moved from the

8th to 14th leading
cause of death.
 AIDS:
Incidence declining, prevalence rising

• Increasing
numbers of people
living with HIV and
AIDS, leading to a
steady rise in the
prevalence of
these conditions.
 #3
Some STD rates are increasing
 #4
Pandemic Influenza
• The risk of an influenza pandemic may be
increasing.
• “Medium-level” pandemic in the U.S.
could cause
 89,000 to 207,000 deaths
 314,000 to 734,000 hospitalizations
 18 to 42 million outpatient visits
 #5
Access to care decreasing

• Highest rate of
uninsurance
since data
collection
began in King
County
 #6
Mental Health
• Residents report
increased poor mental
health days
• Hospitalizations for
psychosis, but not
depression, have
increased since 1987
 #7
Alcohol

 Excessive alcohol use is higher in King County

than the rest of Washington and the nation.
• Binge drinking
 15.7% of all adults during the past month.
• Drinking and driving
 4.2% of all adults during the past month
• Heavy drinking
 5.9% of all adults
 Increased significantly from 3.4% to 5.6% in past decade
• Rates are 2-3 times higher among young adults
age 18-24
 #8
Illicit Drug Use
 Deaths from prescription opiates now
exceed deaths from heroin
 Prescription opiate deaths increased four-fold
since 1997
 Deaths related to prescription depressant
drugs (e.g. valium) and methamphetamines
are also on the rise
Improvements
 Mortality decreasing

• Life expectancy at
birth is 78.0 years
for males and 82.5
for females
• Higher than 11 of
the 14 other large
U.S. counties
• Increased 4.9
years since 1980
 Smoking declining

Current Smoker Among King County Adults, 1987-2004

30
25
20
Percent

15
10
5
0
87

88

89

90

91

92

93

94

95

96

97

98

99

00

01

02

03

04
19

19

19

19

19

19

19

19

19

19

19

19

19

20

20

20

20

20
Source: Behavioral Risk Factor Survey
Produced by: Public Health - Seattle & King County, Epidemiology, Planning, and Evaluation
Asthma control improving
Motor vehicle injuries dropping
Firearm deaths lower
Infant mortality meets Healthy
People 2010 goal early

Healthy
People
2010 Goal
Hepatitis rates down

• Hepatitis A
 1997: 441 cases
 2004: 14 cases
• Hepatitis B
 1995: 85 cases
 2004: 23 cases
Adolescent Births Declining
 Immunizations increase but still
short of goal
 Childhood
 Coverage increasing since 2001
 81% of kids have full coverage
 HP 2010 objective of 90% not yet met
 Adults 65 years and older
 Pneumonia vaccination has increased to 65%
 Influenza immunization rate static at 70%
 Both rates below the HP 2010 objective of 90%.
Air quality improving
 Health Disparities

• There are large and persistent disparities

in health status and access to health care
across
 Racial/ethnic groups
 Income groups
 Areas of the county
 Sexual orientation
• While some disparities are diminishing,
many are increasing.
Racial/Ethnic Disparities
 Disparities widespread among
African Americans and
American Indians/Alaska Natives
• Mortality
• Birth outcomes
• Chronic diseases
• Risk factors for chronic disease
 Smoking
 Overweight
 Physical inactivity
 Lack of screening
• Injuries
• HIV
• Mental distress
• Alcohol use and drug-induced deaths
• Access to medical care
 Disparities also affect
Hispanic/Latinos

• Adolescent births
• Physical inactivity
• Mental distress
• HIV
• Access to care
 Mortality
African Americans and AI/AN

• Life expectancy among AA and AI/AN males

 8 years lower than white expectancy
 Less than white expectancy in 1980
• Trends in gap over past decade
 African Americans: no change
 AI/AN: increasing
• Excess deaths
 African Americans: 158 per year
 AI/AN: 37 per year
 Diabetes Mortality
180
African
160 American
Age-adjusted rate per 100,000 persons

140
American
Indian/
120 Alaska
Native
100
Asian/
80 Pacific Islander

Latino/Hispanic
60

White
40

20

0
80-82
81-83
82-84
83-85
84-86
85-87
86-88
87-89
88-90
89-91
90-92
91-93
92-94
93-95
94-96
95-97
96-98
97-99
98-00
99-01
00-02
01-03
Source: Death Certificate Data: Washington State Department of Health, Center for Health Statistics.
Access to Care
 Sexual minorities

• Health-related behaviors
 Smoking rates nearly 2 times higher
 Binge and heavy drinking X times higher
• Cancer screening among lesbian/bisexual women
 Mammography: 50% rate vs. 75%
• HIV and AIDS
 Still predominantly affect gay males,
 Slowly increasing in other groups
• Frequent mental distress
 Twice as common
Income
 Income disparities

• Mortality
• Birth outcomes
• Adolescent births
• All chronic diseases and risk factors
• HIV
• Mental health
• Alcohol use and drug-related deaths
• Access to care.
Infant Mortality by Neighborhood
Poverty Level
Chronic Disease Risk Factors:
Physical Inactivity
Mental health
Geographic Disparities

Sprawl
 Geographic disparities

• South Seattle/South County Region

 Downtown, Central and Southeast Seattle
 Beacon Hill
 Delridge
 White Center/Boulevard Park
 Tukwila/Sea Tac
 Kent
 Auburn
 Features of the region
affecting health

• Changing SES and racial/ethnic mix

• Sprawl/built environment
• Challenges in funding community and
govt. services
• Norms around prevention and healthy
behaviors
 South Seattle/South County Area
Disparities
• Death rate
• Birth outcomes
• Chronic diseases and risk factors
• Motor vehicle and firearm injuries
• Mental health problems
• Complications of illicit drug use
• Access to care
Infant Mortality
Chronic disease
Diabetes
Access to care
 Investment in the health of the
public pays off
• Reductions in smoking
• Increased seat belt use
• Improved control of asthma
• Improved access to prenatal care
• Reductions in infant deaths from SIDS as
more infants are placed on their backs to
sleep
 Investment in the health of the
public pays off
• Lower adolescent birth rates
• Increased screening for breast and
cervical cancer
• Control of tuberculosis outbreak
• Increased immunizations
 Improving the
Health of King County
 Implementation of effective community health
interventions
• community heath workers
• home visits (newborns, asthma, diabetes)
• care coordination and case management
• support groups ( physical activity, chronic disease)
• outreach ( immunizations, screening for cancer and
chronic disease risk factors)
• community education to promote healthy behaviors
 Assuring universal health insurance coverage
and access to health care/medical home
 Improving the
Health of King County
 Improvement of the quality of care for chronic
conditions, especially among providers who
serve disparity populations
 Systems integration and partnerships
 Supporting people with chronic diseases
• Self-management education and support
• Social support
 Building homes and communities which
support physical activity and provide healthy
indoor environments
 Improving the
Health of King County
 Making healthy foods more readily accessible
in schools, worksites and communities
 Increased resources to monitor trends and
disparities
 Addressing social factors that affect health
• Unemployment
• Low wages
• Lack of educational attainment
• Inadequate childcare and early childhood education
• Discrimination in all forms.