Health Disparities 2014

http://www.sanantonio.gov/health/

Fernando A. Guerra, M.D., M.P.H. Public Health Consultant

San Antonio Metropolitan Health District

Social Determinants Of Health and Health Disparities

Bexar County

0200,000400,000600,000800,000

1,000,0001,200,0001,400,0001,600,000

2000 2005 2010 2015 2020 2025 2030 2035 2040

White NH African Am Hispanic Other

Projected Population of Bexar Co. by Race/Ethnicity & Migration

Source: Texas State Data Center, 2010 2

2010 Age Distribution Bexar County Hispanic White NH

Population Source: U.S. Census Bureau, 2010

MaleFemaleAfrican Am. NH

MaleFemale MaleFemale

35000 15000 5000 25000Age 0 to 4 yrs

Age 10 to 14 yrs

Age 20 to 24 yrs

Age 30 to 34 yrs

Age 40 to 44 yrs

Age 50 to 54 yrs

Age 60 to 64 yrs

Age 70 to 74 yrs

Age 80 to 84 yrs

50000 30000 10000 10000 30000 50000Age 0 to 4 yrs

Age 10 to 14 yrs

Age 20 to 24 yrs

Age 30 to 34 yrs

Age 40 to 44 yrs

Age 50 to 54 yrs

Age 60 to 64 yrs

Age 70 to 74 yrs

Age 80 to 84 yrs

10000 5000 0 5000 10000Age 0 to 4 yrs

Age 10 to 14 yrs

Age 20 to 24 yrs

Age 30 to 34 yrs

Age 40 to 44 yrs

Age 50 to 54 yrs

Age 60 to 64 yrs

Age 70 to 74 yrs

Age 80 to 84 yrs

3

2010 Median Household Income Bexar County

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

Median household income

African American Hispanic NH White Total

4Population Source: U.S. Census Bureau, 2010 4

0%5%

10%15%20%25%30%35%40%

Non Hisp White Hispanic African Am. Total

2013 Lack of Health InsuranceAges 18 to 64 years and Race/Ethnicity

Bexar County

52013 American Community Survey 1-Year Estimates

6

Education Is One Of The Strongest Predictors Of Health*

• Health problems associated with dropping out of school are pregnancy, substance abuse, mental illness and behavioral problems.*

• The more schooling people have the more money they can earn, enabling them to purchase better housing in safer neighborhoods, healthier food, better medical care and health insurance, each of these is associated with improved health.*

• Math is the "gatekeeper" course for students seeking higher education and/or for those seeking employment. San Antonio Collage.

* Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Dis 2007;4(4). www.cdc.gov/pcd/issues/2007/oct/07_0063.htm 6

SAT Mean Total Score by School District 2013

800 1,000 1,200 1,400 1,600 1,800

Edgewood

Somerset

South San Antonio

San Antonio

Southside

Harlandale

Southwest

East Central

Judson

Northside

Ft Sam Houston

Lackland

North East

Randolph Field

Alamo Heights

% Economically Disadvantaged Children by School District 2013

020406080100Source: Texas Education Agency

2010 Educational Attainment: Bachelor's degree or higher Bexar County

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Bachelor's degree or higher

White NH Hispanic African Am. Total

8(Population 25 Years and Over)

Bexar County Scorecard – Maternal Health 2013Maternal Indicators

* Rate per 1000, Preliminary data subject to change.

Bexar County

9

Total Births 26,590Mother's Age 15 to 19 2,558 39.7*

Low Birth Weight <2500g 2,399 9.0%Late or No Prenatal Care 10,049 40.7%

Single Mother births 12,315 46.3%Premature (<37 Weeks) births 3,033 11.4%

Medicaid Funded Births 13,164 49.5%

Mothers BMI 30 + before pregnancy 7,664 28.8%

Births within < 24 mos previous birth 4,383 16.5%Mothers with < HS / GED edu 7,513 19.5%

Subsequent Births to Mothers Age 15-19 527 20.6%26.6*

United States

Infant Mortality 160 6.02*

11.4%

8.0%

40.6%

Births to Mothers <20 Yrs. by Birth Order and Age, Bexar County 2013

10

Birth Order Age of Mother 1 2 3 4 5 6 Total

12 - - - - - - - 13 4 - - - - - 4 14 26 2 - - - - 28 15 104 5 - - - - 109 16 224 17 1 1 - - 243 17 365 48 9 - - - 422 18 542 131 16 - - - 689 19 796 252 42 4 1 - 1,095

Total 2,061 455 68 5 1 - 2,590

% Late or No Prenatal Care Births By Zip Code Bexar

County 2013

Zip codes with Less than 20 Births not includeddue to small numbers

I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N

I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N

Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604

I.H. 10 I.H. 10 I.H. 10 I.H. 10 I.H. 10 I.H. 10 I.H. 10 I.H. 10 I.H. 10


I.H. 35 N

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I.H. 37 S.

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N

FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604


I.H. 10I.H. 10I.H. 10

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Loop 410Loop 410Loop 410

Loop 410Loop 410

Loop 410Loop 410Loop 410Loop 410

Loop

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I.H. 10I.H. 10I.H. 10

I.H. 10I.H. 10

I.H. 10I.H. 10I.H. 10I.H. 10

I.H. 35 S.

I.H. 35 S.

I.H. 35 S.I.H. 35 S.

I.H. 35 S.I.H. 35 S.

I.H. 35 S.

I.H. 35 S.I.H. 35 S.

48% to 55%43% to 47%34% to 42%25% to 33%10% to 24%

% Medicaid Funded Births By Zip Code Bexar

County 2013I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N





I.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 37 S.

I.H. 37 S.

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I.H. 37 S.

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I.H. 37 S.

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281

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U.S.

281

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U.S.

281

NU.

S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

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Loop 410Loop 410


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I.H. 10I.H. 10I.H. 10

I.H. 10I.H. 10

I.H. 10I.H. 10I.H. 10I.H. 10

I.H. 35 S.

I.H. 35 S.

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I.H. 35 S.I.H. 35 S.

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71.0% to 83 .2%60 .8% to 70.9%38 .6% to 60 .7%21 .7% to 38 .5%

1.4% to 21 .6%

% Births to mothers BMI ≥ 30 Before

Pregnancy By Zip Code Bexar County

2013


I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N





I.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 37 S.

I.H. 37 S.

I.H. 37 S.

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I.H. 37 S.

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I.H. 37 S.

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U.S.

281

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S. 2

81 N

U.S.

281

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S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

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Loop 410Loop 410


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I.H. 10I.H. 10I.H. 10

I.H. 10I.H. 10

I.H. 10I.H. 10I.H. 10I.H. 10

I.H. 35 S.

I.H. 35 S.

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36.8% to 43.4%31.1% to 36.7%25.1% to 31.0%17.2% to 25.0%

7.5% to 17.1%

% Teen Births ages 15 to 19 By Zip Code Bexar

County 2013


I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N





I.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 37 S.

I.H. 37 S.

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U.S.

281

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81 N

U.S.

281

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U.S.

281

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S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

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I.H. 10I.H. 10I.H. 10I.H. 10


Loop 410Loop 410


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I.H. 10I.H. 10I.H. 10

I.H. 10I.H. 10

I.H. 10I.H. 10I.H. 10I.H. 10

I.H. 35 S.

I.H. 35 S.

I.H. 35 S.I.H. 35 S.

I.H. 35 S.I.H. 35 S.

I.H. 35 S.

I.H. 35 S.I.H. 35 S.

14.3% to 22.3%

11.0% to 14.2%

7.5% to 10.9%

3.6% to 7.4%

0 to 3.5%

Birth rates for Females aged 15-19 years, by race and Hispanic origin of mother: United States and

Bexar County 2012

Rates per 1,000 women in specified age and race and Hispanic origin 15http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_09.pdf

Concentration of Health DisparitiesBirth Indicators Ten Zip Codes 2013

25% of 2010 Total Population 87% Hispanic 9% African American 3% White Non Hispanic

In 2002, Metro Health identified 10 Zip Codes of 72 (area in Red), as high-risk areas due to concentrations of Medicaid births, single mothers and teen mothers in proportion of population. 78221, 78201, 78242, 78211, 78210, 78223, 78237, 78227, 78228, and 78207.

Zip Codes selected for high numbers of single and teen mothers

Ten zip codes

Bexar County

% of total

Total Births 7,356 26,590 28%Mothes <age 18 400 804 50%Births to mothers 15 to 19 1,112 2,558 43%Births to Single Mothers 4,754 12,315 39%Late or no Prenatal Care 3,433 10,049 34%Low Birth Weight Births <2500 Grams 702 2,399 29%Estimated Premature <37 Weeks 878 3,033 29%Medicaid Payment 5,182 13,164 39%Births within 24 months of Previous Birth 1,371 4,383 31%Births to moms less than HS / GED 2,460 5,173 48%Births to moms BMI 30 + before pregnancy 2,627 7,664 34%Infant Deaths 47 160 29%

16

Confirmed 2012 Child Abuse/Neglect Cases In Texas

* Counties with a Population of 200,000 or more 17

Child Confirmed Cases rate per 1,000

Population

Bexar 477,922 6,205 13.0

Travis 259,016 3,045 11.8

Tarrant 517,952 5,598 10.8

Hidalgo 276,110 2,685 9.7

Texas 7,054,634 64,366 9.1

EL Paso 244,164 2,081 8.5

Dallas 667,394 5,107 7.7

Harris 1,171,213 5,383 4.6

Collin 237,706 1,082 4.6

Unduplicated Confirmed VictimsBexar County

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

18Source: Texas Department of Family And Protective Services, Management Reporting and Statistics by Fiscal Year

Neonatal Abstinence Syndrome (NAS) Neonatal Withdrawal of Opiates by

Year, Texas and Bexar County

Source: Source: Texas Hospital Inpatient Discharge Public Use Data File, Texas and San Antonio Hospitals, Diagnosis code 779.5, drug withdrawal syndrome in newborn, primary or contributing cause-Hospital Discharge Data

Year TexasSan

Antonio% of total Texas charges

San Antonio charges

San Antonio Length of Stay (days)

San Antonio Average LOS (days)

2013 913 291 32% $ 157,968,047 $ 38,706,912 8,044 27.62012 855 300 35% 138,713,777$ 55,955,510$ 9,498 31.72011 804 298 37% $ 129,372,333 $ 41,798,540 8,571 28.82010 704 252 36% $ 103,751,015 $ 31,300,507 6,913 27.42009 656 260 40% $ 74,563,545 $ 29,595,216 6,928 26.6Total 3,932 889 23% $ 604,368,717 $ 197,356,685 39,954 44.9

Rate of Juveniles on Probation Bexar

County 2013

20

Rate per 1000 by zip code

zip codes with <20 cases were not included

2009-2013 American Community Survey 5-Year Estimates population ages <18

I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N





I.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 37 S.

I.H. 37 S.

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I.H. 37 S.

I.H. 37 S.

I.H. 37 S.

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U.S.

281

NU.

S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

N



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Loop 410Loop 410


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I.H. 10I.H. 10I.H. 10

I.H. 10I.H. 10

I.H. 10I.H. 10I.H. 10I.H. 10

I.H. 35 S.

I.H. 35 S.

I.H. 35 S.I.H. 35 S.

I.H. 35 S.I.H. 35 S.

I.H. 35 S.

I.H. 35 S.I.H. 35 S.

24.0 to 47 .416 .3 to 23.912 .6 to 16 .2

8 .5 to 12 .52 .7 to 8.4

Rate of Domestic Violence callsSan Antonio

2013Rate per 1000 by

zip code

zip codes with <20 cases were not included

212009-2013 American Community Survey 5-Year Estimates population all ages

I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N





I.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 37 S.

I.H. 37 S.

I.H. 37 S.

I.H. 37 S.

I.H. 37 S.

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Loop

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U.S.

281

NU.

S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

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Loop 410Loop 410


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I.H. 10I.H. 10I.H. 10

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I.H. 35 S.

I.H. 35 S.

I.H. 35 S.I.H. 35 S.

I.H. 35 S.I.H. 35 S.

I.H. 35 S.

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11 .2 to 71 .28 .5 to 11 .16 .2 to 8.43 .3 to 6.11 to 3.2

Diabetic Amputations

Prepared by Metro Health EPI§Texas Hospital Inpatient Discharge Public Use Data File. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas. 2011*2009 is the most recent year available for national data.http://www.cdc.gov/diabetes/statistics/lea/fig1.htm

Rat

e pe

r 100

0 w

ith D

X o

f Dia

bete

s

§§*

22

http://www.cdc.gov/diabetes/statistics/lea/fig1.htm

Rate of Diabetic Amputations in Select Texas Counties 2009 & 2011

rate

per

10,

000

Prepared by Metro Health EPITexas Hospital Inpatient Discharge Public Use Data File, [quarter and year of data]. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas. 2006, 2009 & 2011 23

Hospital Inpatients Diagnosed with Diabetes or Diabetic Amputation, Bexar County, 2011

24

PopulationDx of

DiabeticsRate per 1,000

Diabetics Amputations

Rate per 1,000

Hispanic 1,033,722 27,651 26.7 1,316 47.6

White non Hispanic 548,965 11,932 21.7 389 32.6

African Am 132,487 3,690 27.9 137 37.1

Other 40,979 2,734 66.7 102 37.3

Total 1,756,153 46,007 26.2 1,944 42.3

Bexar County Resident, Hospital Discharge principal or other Diagnosis of diabetes or surgical or other procedure, Texas Hospital Inpatient Discharge Public Use Data File. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas

Rate of Diabetic Amputations by Zip Code, Bexar County, 2011

Rate per 1,000 Diabetic Inpatients

Note: The CDC, National Center for Health Statistics does not publish or release rates based on fewer than 20 observations, because they feel these

data do not meet their requirement for a minimum degree of accuracy.

I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N





I.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 35 N

I.H. 35 NI.H. 35 N

I.H. 37 S.

I.H. 37 S.

I.H. 37 S.I.H

. 37 S.I.H. 37 S.

I.H. 37 S.

I.H. 37 S.

I.H. 37 S.I.H

. 37 S.

Loop

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U.S.

281

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S. 2

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U.S.

281

NU.

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81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

NU.

S. 2

81 N

U.S.

281

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Loop 410Loop 410


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I.H. 10I.H. 10I.H. 10

I.H. 10I.H. 10

I.H. 10I.H. 10I.H. 10I.H. 10

I.H. 35 S.

I.H. 35 S.

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I.H. 35 S.I.H. 35 S.

I.H. 35 S.

I.H. 35 S.I.H. 35 S.

50.1 to 68.846.1 to 50.040.7 to 46.036.6 to 40.630 to 36.5

Bexar County Resident, Hospital Discharge principal or other Diagnosis of diabetes or surgical or other procedure, Texas Hospital Inpatient Discharge Public Use Data File. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas 25

Infant Mortality Rateby Race & Ethnicity

Live Births to Bexar County Residents

0

24

68

10

1214

16

1999to

2001

2000to

2002

2001to

2003

2002to

2004

2003to

2005

2004to

2006

2005to

2007

2006to

2008

2007to

2009

2008to

2010

2009to

2011

2010to

2012

2011to

2013

Hispanic White NH Black NH Other NH

Rate per 1,000 births/Three-Year Moving Average 26

Rat

e pe

r 1,0

00 b

irths

Rate of Death by Gender ages 45 to 64 by Race and Ethnicity, Bexar County 2013

0

50

100

150

200

250

300

HispanicMales

White NHMales

Black Males HispanicFemales

White NHFemales

BlackFemales

Cancer Heart Disease Diabetes27

rate

per

100

k

Note: The CDC, National Center for Health

Statistics does not publish or release rates based on

fewer than 20 observations, because

they feel these data do not meet their requirement for

a minimum degree of accuracy.

% Death Before Age 65

Not included

Premature Deaths (<65 yrs) by Race & Ethnicity Bexar County 2012

39%

26%24%19%

42% 44%

32%

24%

0%5%

10%15%20%25%

30%35%40%45%50%

All Deaths Heart Disease

Hispanic White NH African Am All

5

Pre

mat

ure

Dea

ths

(<65

yrs

)

78211

78214

78221

78219

78217

78247

78258

78230

78201

78227

78109

78148

78202

7820478207

78209

78210

78212

7821378216

78218

78220

78222

7822378224

78225

78228

78229

78232

78233

78237

78238

7823978240

78242

78244

78245

78249

78250

7825178253

78254

78259

30% to 42%25% to 29%19% to 24% 0% to 18%

Premature Heart Disease Deaths (<age 65) by Zip Codes

Bexar County 2012

28

What Is The Consequence of not Addressing Health Disparities?

• Health disparities among minorities have long accounted for higher infant mortality, premature death and disease burden, and lower quality of health care when compared with the national average.

• Health disparities impacts us all by escalating health care spending and adversely affecting the health care system for everyone.

29The Public Health Approach to the Elimination of Disparities in Health. - David Satcher, M.D., Ph.D.

Health Disparities 2014

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Transcript of Health Disparities 2014