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
NYC DOHMH PCSI Initiative
NYC DOHMH PCSI Initiative
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
2009 gonorrhea cases/100,000
0 - 175.8
175.9 - 351.6
351.7 - 527.5
0 1.5 3 6 Miles
²
Source: NYC DOHMH Bureau of STD 2009 surveillance data
NYC DOHMH PCSI Initiative
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
Source: NYC DOHMH Bureau of STD 2009 surveillance data
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
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 DOHMH PCSI Initiative
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 DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
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 DOHMH PCSI Initiative
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 DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
NYC DOHMH PCSI Initiative
Bureau of Drug and Alcohol Prevention, Care and Treatment
Source: OVS/OCME; analysis by DOHMH
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
Source: Mapping the Innovation in Correctional Health Care Service Delivery in NYC 2008
Data from the Department of Corrections, 2005
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
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
NYC DOHMH PCSI Initiative
#
#
#
#
#
#
##
##
#
#
# #
#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
2009 DOHMH Surveillance Data: Bureaus of STD, TB, HIV and Communicable Disease
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
NYC DOHMH PCSI Initiative
2009 DOHMH Surveillance Data: Bureaus of STD, TB, HIV and Communicable Disease; 2011 HRSA funded FQHCs
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
NYC DOHMH PCSI Initiative
[ 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
2009 DOHMH Surveillance Data: Bureaus of STD, TB, HIV and Communicable Disease
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
NYC DOHMH PCSI Initiative
2009 DOHMH Surveillance Data: Bureaus of STD, TB, HIV and Communicable Disease; 2011 HRSA funded FQHCs
NYC DOHMH PCSI Initiative
For more information about PCSI at NYC DOHMH
• Ann Drobnik, PCSI Analyst, 347‐396‐2406
Jennifer Fuld, PCSI Coordinator, 347‐396‐2412
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