Using NYC HIV, TB, STDs · 11234 11236 11207 11208 11235 11229 11226 11214 11203 11232 11223 11211...

Geographic analysis of PCSI diseases:

Using maps to identify NYC neighborhoods with high rates of co‐occuring HIV, TB, STDs

and viral hepatitis

PCSI, Division of Disease Control, NYC DOHMH, February 2012

NYC DOHMH PCSI Initiative

Why map disease data?

• Maps are a way to easily: – Observe geographic patterns – Communicate data effectively to a wide range of audiences

• Both co‐occurence and co‐infection provide information about disease ‘hotspots’ and provide information to target service integration activities – Co‐occurence = >1 disease in the same population

– Co‐infection = >1 disease in the same individual

Units of Geographic Analysis

• The unit of analysis depends on the data, the audience and question of interest

Smaller

Larger United Hospital Fund

Neighborhood

Zip Code

Surveillance data and most other DOHMH data are collected and reported this way

Community District

Census Tract

Census data are collected and reported this way



Why Zip Codes?

• Most DOHMH data are presented by United Hospital Fund (UHF) neighborhood – Group of several zip codes – Named neighborhoods are easy for the public to recognize

– Zip codes are smaller, more accurate representation

– UHF can obscure a health issue that impacts some zip codes and not others


²0 0.9 1.8 0.45 Miles

UHF boundary

# of diseases in the top quintile by zip code, 2009

2

3

4

5

6

7


Types of Maps Created

• Single disease maps for 7 diseases – More information about a specific disease: i.e. where high rates of THAT disease greatest

– More difficult to see the relationship to other diseases

• Quintile map – all 7 disease in one map – Easier to see where there is overlap in high morbidity

– Easier to observe patters in disease combinations

• All maps show 2009 rates/100,000 of newly reported cases

2009 chlamydia cases/100,000

0 - 715.4

715.5 - 1695.1

1695.2- 3333.3

0 1.5 3 6 Miles

²

Source: NYC DOHMH Bureau of STD 2009 surveillance data


2009 gonorrhea cases/100,000

0 - 175.8

175.9 - 351.6

351.7 - 527.5

0 1.5 3 6 Miles

²



2009 P&S syphilis cases/100,000

0 - 12.0

12.1- 57.2

57.3 - 158.5

0 1.5 3 6 Miles

²



²

Source: NYC DOHMH Bureau of TB 2009 surveillance data

2009 TB cases/100,000

0 - 9.5

9.6- 29.3

29.4 - 114.9

0 1.5 3 6 Miles


2009 Hepatitis B cases/100,000

0 - 140.7

140.8 - 695.5

695.6 - 1418.7

0 1.5 3 6 Miles

²

Source: NYC DOHMH Bureau of Communicable Disease 2009 surveillance data


2009 Hepatitis C cases/100,000

0 - 144.6

144.7 - 350.1

350.2 - 1424.1

0 1.5 3 6 Miles

²

Source: NYC DOHMH Bureau of Communicable Disease 2009 surveillance data


²

Source: NYC DOHMH HIV/AIDS 2009 surveillance data

2009 HIV cases/100,000

0 - 41.7

41.8- 112.6

112.7 - 258.2

0 1.5 3 6 Miles


Methodology: Quintile Map of PCSI Diseases

• 2009 surveillance data – rates/100,000 for 7 PCSI diseases

• Ranked highest to lowest rate by zip code

• Top quintile (20%) for each disease identified

• Zip codes in the top quintile for >1 disease identified

• Map created of zip codes with >1 disease (2‐7) • Maps created of specific disease combinations


²0 5 10 2.5 Miles

# of Diseases in the Top Quintile by Zip Code, 2009 2

3

4

5

6

7

NYC DOHMH PCSI Initiative Source: 2009 NYC DOHMH surveillance data

²0 5 10 2.5 Miles

# of Diseases in the Top Quintile by Zip Code, 2009 2

3

4

5

6

7


Harlem

Chelsea

Sunset Park Brooklyn

South Bronx

Flushing Queens

North ‐Central Brooklyn

Source: 2009 NYC DOHMH surveillance data

NYC Zip Codes with Hepatitis B and TB in the Top Quintile

²0 5 10 2.5 Miles

Legend Top 20% for Hep B and TB


NYC Zip Codes with HIV and TB in the Top Quintile

²0 5 10 2.5 Miles

Legend Top 20% for HIV and TB


NYC Zip Codes with Hepatitis B and C in the Top Quintile

²0 5 10 2.5 Miles

Legend Top 20% for Hep B and Hep C


Speakers of Select Foreign Languages, 2000

Legend Languages

1 Dot = 100

AFRICAN

CHINESE

FR_CREOLE

KOREAN

RUSSIAN

0 2.5 1.25 5 Miles ² Source: 2000 American Community Survey compiled by zip code by DOHMH Bureau of Epidemiology ServicesNYC DOHMH PCSI Initiative

NYC Zip Codes with Hepatitis C and HIV in the Top Quintile

²0 5 10 2.5 Miles

Legend Top 20% for HIV and Hep C


NYC Zip Codes with Chlamydia, Gonorrhea and HIV in the Top Quintile

²0 5 10 2.5 Miles

Legend Top 20% for HIV, CT and GC


NYC Zip Codes with P&S Syphilis and HIV in the Top Quintile

²0 5 10 2.5 Miles

Legend Top 20% for HIV and Syphilis



Bureau of Drug and Alcohol Prevention, Care and Treatment

Source: OVS/OCME; analysis by DOHMH


Percentage of Residents below Federal Poverty, 2000

²0 4 82 Miles

Legend <5% 5 to <10% 10 to <20% 20 to <30% 30 to <40% 40% or more

Text

Source: 2000 American Community Survey compiled by zip code by DOHMH Bureau of Epidemiology Services


Source: Mapping the Innovation in Correctional Health Care Service Delivery in NYC 2008

Data from the Department of Corrections, 2005


Using Maps to Target Services

Thousands of service providers in NYC 1. Which are the areas of greatest morbidity?

2. Are those in the right areas providing integrated services?

3. Do people that live in high‐morbidity neighborhoods get services where they live?

The Bronx: Zip codes with >1 disease in the top quintile and location and catchment of the DOHMH District Public Health Office

[ DPHO office

DPHO catchment area

Diseases in the top quintile by zip code ² 2

3 0 0.5 1 2Miles

4

5

6

7

[

10465

10471

10464 10467

10469

10461

10473

10466

10462

10463

10460

10474

10457

10458

10475 10468

10454

10472

10451

10456

10452

10453

10459

10470

10455

11370

10464

10475


2009 DOHMH Surveillance Data: Bureaus of STD, TB, HIV and Communicable Disease

The Bronx: Zip codes with >1 disease in the top quintile and Federally Qualified Health Centers in zip codes with 4 or more diseases in the top quintile


#

#

#

#

#

#

##

##

#

#

# #

#Bronxcare at Tiffany

Burnside Health Center

Bronx Care at 3rd Avenue

Bella Vista Health Center

Mount Hope Family Practice

Morris Heights HC @ Walton

Walton Family Helath Center

Morris Heights Health Center

Crotona Park Family Practice

Fulton Family Medicine Center

Union Community Health Center #2

Park Avenue Family Health Center

Comprehensive Health Care Center

Claremont Family Health Care Center

Martin Luther King Jr. Health Center

²# FQHCs in zip codes with 4 or more diseases in the top quintile

Diseases in the top quintile by zip code 2

3

4

5

6

7

0 0.7 1.4 0.35 Mile

2009 DOHMH Surveillance Data: Bureaus of STD, TB, HIV and Communicable Disease; 2011 HRSA funded FQHCs

Brooklyn: Zip codes with >1 disease in the top quintile and location and catchment of the DOHMH District Public Health Office

[

11234

11236

11207 11208

11235

11229

11226

11214

11203

11232

11223

11211

11209

11220

11230

11222

11210

11228

11212

11204

11219

11224

11231

11206

11201

11215

11221

11233

11225

11218

11205

11213

11238

11237

11216 11217

11239

11239

DPHO catchment area

Diseases in the top quintile by zip code

[ DPHO Office

2

3

4

5

6

7

0 1 2 4 Miles

² NYC DOHMH PCSI Initiative


Brooklyn: Zip codes with >1 disease in the top quintile and Federally Qualified Health Centers in zip codes with 4 or more diseases in the top quintile

#

7 #

#

#

# #

#

#

#

# # #

#

BMS @ Genesis

Care Management

BMS @ HELP WOMEN'S CENTE

Occupational Health Services

Dr. Betty Shabazz Health Cen

11207

5 Broadway Family Health Center

Park Ridge Family Heath Center

HELP/PSI Brooklyn Health Center

Family Physician Family Health Center Brooklyn-Chinese Family Health Center

11236

t

Bedford Stuyvesant Family Health Center

11234

11235

11229

11226

11214

11203

11232

11223

11209 11230

11210

11211

11228

11212

11204

11219

11224

11231 11233

11225

112

11220

11206

11201

11215

11221

11218

11205

11213

11238 1120

11237

11216 11217

11239

FQHCs in zip codes with 4 or more diseases in the top quintile

2

3

4

6

² 0 0.5 1 2 Miles



Manhattan:Zip codes with >1 disease in thetop quintile and location and catchment of the DOHMH District Public Health Office

[

10000

10034

10027

10002

10025

10029 10035

10032

10011

10019

10033

10001

10023

10009

10024

10013

10031

10035

10003 10014

10016

10040

10022

10021

10128

10026

10017

10012

10038

10036

10018

10010

10028

10065

10039

10030

10004

10037

10044

10007

10004

10075

10280

10282

10005 10006

10020


[ DPHO office

DPHO catchment area

Diseases in the top quintile by zip code 2

3

4

5

6

7

² 0 0.5 1 2Miles


Manhattan:Zip codes with >1 disease in the top quintile and Federally Qualified Health Centers in zip codes with 4 or more diseases in the top quintile

# FQHCs in zip codes with 4 or more diseases in the top quintile

2

3

4

5

6

7

² 0 0.5 1 2

#

# #

#

#

#

#

#

#

East Harlem Primary Care Helen B. Atkinson Center

Heritage Health and Housing

Community League Health Center

North General Family Health Center

Central Harlem PC and Dental Center

Settlement Health & Medical Services

Ryan/Chelsea/Clinton Community Health

Miles




For more information about PCSI at NYC DOHMH

• Ann Drobnik, PCSI Analyst, 347‐396‐2406

[email protected]

Jennifer Fuld, PCSI Coordinator, 347‐396‐2412

[email protected]

mailto:[email protected]

mailto:[email protected]

Using NYC HIV, TB, STDs · 11234 11236 11207 11208 11235 11229 11226 11214 11203 11232 11223 11211...

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