dallas county community health dashboard...

1

Dallas County Community Health Dashboard

Parkland Health & Hospital System

2

Model for Determining

Community Health Dashboard

3


Community Health

Dashboard

Health Outcomes

Mortality

Years of Potential Life Lost

Infant Mortality

Very Low Birth Weight Births

Morbidity

Mental Health Status

Diabetes Prevalence

Health Factors

Health Risk Behaviors

Cancer Screening

Mammogram

Pap Test

Colon Cancer Screening

Vaccinations

Flu Shots for Adults 65+

Child ages 19-35 months

Violence and Injury Prevention Mortality

ED Visits for Injury

High Risk Sexual Behavior HIV/STD Rates

Teen Birth Rate

Tobacco Use

Alcohol Use

Diet and Exercise

Over Weight and Obese

Access to Clinical Care

Percent Uninsured

Percent with Personal Physician

Physician-to-Population Ratio

Non-Emergent Emergency Department Use

Quality of Clinical Care

Prevention Quality Indicators

4

Access to care


Percent Uninsured



Non-emergent Emergency

Department Use

Dallas County

Compared to

Healthy

People 2020

Goal

Dallas County

Compared to

8 Peer

Counties

(Quartiles)

Dallas

County

Compared to

Past Years’

Data (CI)

N/A

N/A N/A

– Doing better than the benchmark

– Same as/not significantly different from the benchmark

– Worse than the benchmark

5

Access: Percent Without Health Insurance

Ages 0-64, 2006 to 2011 Other Peer Counties include:

Maricopa, Los Angeles, Miami-

Dade, Cook

2008-2011 data are from US Census American Community Survey, 2008-2011. 2005 and 2006 data are

from US Census Small Area Health Insurance Estimates 2005-6, accessed from the following web site

http://www.census.gov/did/www/sahie/data/2006/tables.html

Healthy People 2020 Objective AHS 1.1

http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=1

City of Dallas, EBRI, Special run by Ken McDonnell, EBRI and ASEC Program Director, 2004-2008

202-775-6367, 2009-11 data is from US Census American Community Survey, 2009-11

Dallas County Trend, Percent

Uninsured, Ages 0-64, 2005, 2006,

2008-2011

17

.3%

17

.9%

22

.5%

24

.6%

28

.2%

33

.4%

23

.3%

25

.9%

25

.4%

27

.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

2011 % Uninsured under 65 2006 % Uninsured under 65

U.S. Bexar County Harris County Tarrant County Dallas County Texas

20.0% - 34.9%

Other Peer Counties

Range, 2011

Percent with no health insurance

trend, City of Dallas, all ages

Healthy People 2020 goal is to decrease the

portion of persons without health insurance

to 0% (target based on total coverage ) Percent

Percent

Percent

29.1%

30.8%

33.2%

32.9%

31.1%

30.5%

0.0% 10.0% 20.0% 30.0% 40.0%

2005

2006

2008

2009

2010

2011

Dallas Co.

28.7%

31.0%

39.9%

42.5%

34.0%

36.1%

31.2%

32.3%

0.0% 20.0% 40.0% 60.0%

2004

2005

2006

2007

2008

2009

2010

2011

City of Dallas

http://www.census.gov/did/www/sahie/data/2006/tables.html


6

Source: BRFSS, Texas, 2004-2011, personal email from TX Dept of State Health

Services 3.18.13

Healthy People 2020. Objective AHS 3.


Dallas County Trend 2004 to 2011

Access: Percent of Adults With A

Personal Doctor, 2004-2011

This indicator shows the percentage of

adults that report that they do have

someone they think of as their personal

doctor or health care provider.

BRFSS Survey Question: Do you have one person you

think of as your personal doctor or health care provider?

(response includes: Yes one or yes more than one)

Percent

Percent

Healthy People 2020 goal is to increase the

proportion of persons with a usual primary

care provider. (target based on 10% improvement)

78

.0%

79

.6%

68

.3%

72

.1%

64

.7%

72

.3%

70

.1%

72

.1%

63

.3%

69

.3%

68

.4%

72

.5%

83.9% 83.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

2011 2004

U.S. Median Bexar Co. Harris Co.

Tarrant Co. Dallas Co. Texas

Healthy People 2020

69.3%

69.2%

69.4%

76.4%

73.6%

68.5%

73.8%

63.3%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Discontinuity: BRFSS began surveying cell phones in

2011, not comparable with previous years’ rates


7

Sources: Texas Bureau of Primary Care, http://www.dshs.state.tx.us/chs/hprc/tables/08PCshtm for

Texas counties

http://www.countyhealthrankings.org for Texas and Other Peer Counties

http://www.gao.gov/new.items/d08472t.pdf U.S. Comparison 2005 is base year

http://www.hschange.com/CONTENT/1192/1192.pdf Center for Health System Change, State Variation

in Primary Care Physician Supply: Implications for Health Reform Medicaid Expansions. Research

Brief No. 19 • March 2011 (U.S. comparison for most recent comparison year is 2008)


Access: Primary care physician to population

ratio (rate per 100,000), January 2012

This indicator shows the number of primary

care physicians per 100,000 population

Includes: Active primary care physicians with Texas practice

addresses and a practice type of direct patient care. Primary

Care Physicians are those physicians that indicate a primary

specialty of: Family Practice/Medicine, General Practice, Internal

Medicine, Pediatrics, Obstetrics and/or Gynecology, or Geriatrics

(Geriatrics was included for the first time in 2004).

Rate Per 100,000 Population

Rate Per 100,000 Population

Other Peer Counties

include: Maricopa, Los

Angeles, Miami-Dade, Cook

12

7.4

90

.0

10

2.9

76

.5

99

.0

79

.4

88

.2

73

.4

96

.7

79

.2

80

.9

68

.1

-

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

2012 2004

U.S. Median Bexar Co. Harris Co. Tarrant Co. Dallas Co. Texas

*

79.2

79.5

78.9

80.7

82.7

80.2

82.3

83.9

96.7

- 20.0 40.0 60.0 80.0 100.0 120.0

2004

2005

2006

2007

2008

2009

2010

2011

2012

Dallas Co.

The data on primary care providers for peer counties are obtained from

the Health Resources and Services Administration’s Area Resource File

(ARF) for 2010. The ARF data on practicing physicians come from the

AMA Master File (2010), and the population estimates are from the U.S.

Census Bureau’s 2010 decennial census. From the County Health

Rankings website.

Other Peer Counties

Range, 2010

67.1 to 90.2

http://www.dshs.state.tx.us/chs/hprc/tables/08PCshtm

http://www.countyhealthrankings.org/

http://www.gao.gov/new.items/d08472t.pdf

http://www.gao.gov/new.items/d08472t.pdf

http://www.hschange.com/CONTENT/1192/1192.pdf

8

Sources: DFWHC ERF Information Quality Services Center Regional Data, 2010.

Dallas-Fort Worth Hospital Council Education and Research Foundation, Information

and Quality Services Center, Irving, Texas. Nov 20 2012.

Dallas County Trend in Emergency

Department Visits for Non-Emergent

Conditions, 2006-2012

Access: Non-Emergent Use of

Emergency Departments, 2006-2012

The Dallas Fort Worth Hospital Council has established an

Emergency Department data set from more than 44

hospitals in the region. The data repository has over 3.6

million emergency department visits as of 2011. Analysis

of this data was based on the New York University’s

Emergency Department Algorithm. The NYU Algorithm

defines a non-emergent ED visit as – the patient’s initial

complaint, presenting symptoms, vital signs, medical

history and age indicated that immediate medical care was

not required within 12 hours.

Percent of ED Visits

Percent of ED Visits

29

.8%

33

.1%

31

.3%

34

.7%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

2012 2006

Tarrant Co. Dallas Co.

34.7%

33.9%

33.4%

33.1%

34.1%

33.2%

31.3%

0.0% 10.0% 20.0% 30.0% 40.0%

2006

2007

2008

2009

2010

2011

2012

Dallas Co.

9


Community Health

Dashboard

Health Outcomes

Mortality


Infant Mortality


Morbidity


Diabetes Prevalence

Health Factors


Cancer Screening

Mammogram

Pap Test


Vaccinations



Violence and Injury Prevention

Mortality



Teen Birth Rate

Tobacco Use

Alcohol Use

Diet and Exercise



Percent Uninsured






10

Quality of care

Quality of

Clinical Care

Prevention Quality

Indicators

Preventable Hospitalizations –

Diabetes PQIs

Diabetes Short Term Comp

Diabetes Long Term Comp

Diabetes Lower Extremity

Amputations

Uncontrolled Diabetes


Cardiovascular PQIs

Hypertension

Congestive Heart Failure

Angina w/o Procedure


Chronic Pulmonary PQIs

Adult Asthma

COPD

Preventable Hospitalizations – Acute/Infectious Disease PQIs

Urinary Tract Infection

Bacterial Pneumonia

Dehydration

Perforated Appendix

Dallas County

Compared to Four Peer

Counties (Quartiles)

Dallas County

Compared to

Past Years’ Data – Doing better than the benchmark



11

Source: Dallas Fort Worth Hospital Council Foundation, Data Initiative, Greg Shelton, data provided

5.16.13


Potentially Preventable

Hospitalizations, Adult Asthma,

2007 - 2011

Total risk adjusted rate

per 100,000 population

30

.0

36

.2

25

.4

26

.8

32

.5

36

.2

28

.7

39

.3

28

.7

35

.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

2011 2007

Bexar Co. Harris Co. Tarrant Co. Dallas Co. Texas

39.3

37.6

46.2

36.4

28.7

0.0 10.0 20.0 30.0 40.0 50.0

2007

2008

2009

2010

2011

Dallas Co.

The Prevention Quality Indicator (PQI) is a product of

the Agency for Health Research and Quality (AHRQ).

AHRQ has defined 13 adult PQIs that measure rates of

inappropriate hospital admissions for illnesses that

can be effectively managed with high-quality,

community-based primary care.

Risk Adjusted Rate per 100,000

12



Hospitalizations, Angina W/O

Procedure, 2007 - 2011


9.2

20

.7

7.1

16

.7

13

.0

20

.4

5.8

12

.6

10

.9

21

.4

0.0

5.0

10.0

15.0

20.0

25.0

2011 2007


12.6

8.9

8.7

6.6

5.8

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0

2007

2008

2009

2010

2011

Dallas Co.



Sources: Dallas Fort Worth Hospital Council Foundation, Data Initiative, Greg Shelton, data provided

5.16.13







13



Hospitalizations, Bacterial

Pneumonia, 2007 - 2011 2

02

.9

29

3.7

24

3.4

31

6.4

26

7.6

41

3.2

23

8.8

33

7.6

26

4.7

36

3.5

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0

450.0

2011 2007


337.6

276.6

259.0

262.2

238.8

0.0 100.0 200.0 300.0 400.0

2007

2008

2009

2010

2011

Dallas Co.





5.16.13







14


Potentially Preventable Hospitalizations,

Chronic Obstructive Pulmonary Disease

(COPD), 2007 - 2011 3

54

.8

30

8.3

39

6.6

39

6.1

42

4.2

45

5.5

43

2.7

43

2.0

39

4.7

40

9.5

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0

450.0

500.0

2011 2007


432.0

458.2

452.9

454.6

432.7

0.0 100.0 200.0 300.0 400.0 500.0

2007

2008

2009

2010

2011

Dallas Co.


5.16.13










15



Hospitalizations, Congestive Heart

Failure (CHF), 2007 - 2011 3

07

.5

42

6.7

36

6.5

45

2.8

32

6.1

36

2.3

36

9.3

44

1.8

31

6.4

40

5.0

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0

450.0

500.0

2011 2007


441.8

414.0

398.8

407.9

369.3

0.0 100.0 200.0 300.0 400.0 500.0

2007

2008

2009

2010

2011

Dallas Co.




5.16.13








16



Hospitalizations, Dehydration,

2007 - 2011 11

5.4

15

9.5

95

.8

15

4.5

12

4.9

13

8.9

12

5.7

15

6.5

11

9.2

15

9.4

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

2011 2007


156.5

140.1

122.2

119.9

125.7

0.0 50.0 100.0 150.0 200.0

2007

2008

2009

2010

2011

Dallas Co.





5.16.13







17



Hospitalizations, Diabetes Long-

Term Complications, 2007 - 2011 1

79

.5

16

4.9

14

6.3

13

4.3

12

4.7

11

6.8

15

3.9

15

4.8

12

8.6

12

9.6

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

200.0

2011 2007


154.8

141.0

142.2

159.4

153.9

0.0 50.0 100.0 150.0 200.0

2007

2008

2009

2010

2011

Dallas Co.



5.16.13




Agency for Health Research and Quality (AHRQ). AHRQ

has defined 13 adult PQIs that measure rates of




18



Hospitalizations, Diabetes Short-

Term Complications, 2007 - 2011 6

5.6

41

.2

49

.9

44

.6

73

.6

50

.8

66

.1

49

.9

53

.3

43

.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

2011 2007


49.9

54.2

55.3

60.1

66.1

0.0 20.0 40.0 60.0 80.0

2007

2008

2009

2010

2011

Dallas Co.



5.16.13




Agency for Health Research and Quality (AHRQ). AHRQ

has defined 13 adult PQIs that measure rates of




19



Hospitalizations, Lower Extremity

Amputations for Patients with

Diabetes, 2007 - 2011 3

2.5

32

.3

21

.2

22

.4

20

.5

22

.5

22

.6

24

.8

21

.1

23

.2

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

2011 2007


24.8

22.0

24.8

27.0

22.6

0.0 5.0 10.0 15.0 20.0 25.0 30.0

2007

2008

2009

2010

2011

Dallas Co.

Risk Adjusted Rate per 100,000 Total risk adjusted rate



5.16.13







20



Hospitalizations, Uncontrolled

Diabetes, 2007 - 2011 2

3.9

26

.5

13

.8

16

.5

13

.0

12

.8

17

.2

16

.5

16

.2

19

.9

0.0

5.0

10.0

15.0

20.0

25.0

30.0

2011 2007


16.5

17.5

17.6

20.2

17.2

0.0 5.0 10.0 15.0 20.0 25.0

2007

2008

2009

2010

2011

Dallas Co.





5.16.13







21



Hospitalizations, Hypertension,

2007 - 2011 8

7.3

66

.8

64

.9

74

.3

68

.4

66

.1

75

.7

85

.1

61

.6

64

.1

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

2011 2007


85.1

75.3

78.4

79.0

75.7

0.0 20.0 40.0 60.0 80.0 100.0

2007

2008

2009

2010

2011

Dallas Co.





5.16.13







22



Hospitalizations, Urinary Tract

Infections, 2007 - 2011 1

99

.9

18

4.1

23

4.7

22

5.6

22

2.2

21

2.0

21

4.9

21

7.5

21

6.0

21

2.6

0.0

50.0

100.0

150.0

200.0

250.0

2011 2007


217.5

200.3

209.2

222.4

214.9

0.0 50.0 100.0 150.0 200.0 250.0

2007

2008

2009

2010

2011

Dallas Co.


per 100,000 population Risk Adjusted Rate per 100,000


5.16.13







23



Hospitalizations, Perforated

Appendix, 2007 - 2011 2

6.9

31

.6

32

.5

28

.7

28

.7

28

.3

31

.9

31

.6

30

.0

29

.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

2011 2007


31.6

30.5

29.2

31.3

31.9

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0

2007

2008

2009

2010

2011

Dallas Co.


per 100,000 population Risk Adjusted Rate per 100,000


5.16.13







24


Community Health

Dashboard

Health Outcomes

Mortality


Infant Mortality


Morbidity


Diabetes Prevalence

Health Factors


Cancer Screening

Mammogram

Pap Test


Vaccinations






Teen Birth Rate

Tobacco Use

Alcohol Use

Diet and Exercise



Percent Uninsured






25

Health Risk Behaviors –

Cancer Screening

Cancer Screening

Mammogram

Pap Test


Dallas County

Compared to

Healthy People

2020 Goal

Dallas County

Compared to 8

Peer Counties

(Quartiles)

Dallas County

Compared to

Past Years’ Data

(CI)

N/A

N/A


– Same as/not significantly different from the

benchmark


26

Source: CDC BRFSS, 2004 - 2010, Texas 2010 data provided by Anna Vincent, Research

Specialist, Texas Dept. of State Health Services, via email 7.15.11

Healthy People 2020 Objective C-15



Screenings: Percent of women aged

18 and over who have had a Pap test

within the past three years, 2010


proportion of women who receive a cervical

cancer screening based on the most recent

guidelines. Baseline for the United States for

this measure is 84.5% of women aged 21 to 65

years received a cervical cancer screening

based on the most recent guidelines in 2008. (target based on 10% improvement or an increase to in

screening rates to 93.0%)

Percent Percent

Other Peer Counties


Angeles, Miami-Dade, Cook 8

1.1

%

86

.0%

78

.2%

83

.0%

77

.2%

83

.1%

84

.5%

87

.5%

76

.7%

86

.5%

79

.4%

82

.2%

93.0% 93.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

2010 2004



Healthy People 2020

86.5%

91.4%

85.6%

76.7%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

2004

2006

2008

2010

Dallas Co.

Other Peer Counties

Range

74.5% – 82.8%


27

Screenings: Percent of women aged 40+

who have had a mammogram within the

past two years, 2010

75

.6%

74

.9%

71

.9%

73

.5%

70

.9%

69

.8%

76

.9%

74

.6%

75

.4%

64

.3%

70

.1%

67

.8%

81.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

2010 2004

U.S. Bexar Co. Harris Co.


Healthy People 2020

64.3%

78.3%

77.3%

75.4%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

2004

2006

2008

2010

Dallas County

Percent


proportion of women who receive breast

cancer screening based on the most recent

guidelines. Baseline for the United States

for this measure is 73.7% of females 50 to

74 years of age received a breast cancer

screening based on the most recent

guidelines in 2008. (target based on 10%

improvement to a target of 81.1%) Source: CDC BRFSS, 2004 - 2010, Texas 2010 data provided by Anna Vincent, Research




Other Peer Counties include:

Maricopa, Los Angeles, Miami-Dade,

Cook

Other Peer Counties

Range

74.3% – 81.3%



28


Screenings: Percent of adults age 50 and

over who have ever had a sigmoidoscopy

or colonoscopy, 2010

Per cent

Percent

Other Peer Counties



65

.3%

53

.5%

70

.5%

59

.6%

60

.2%

48

.8%

69

.5%

48

.2%

60

.8%

47

.6%

61

.6%

48

.4%

70.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

2010 2004



Healthy People 2020

*

46.3%

47.6%

60.4%

56.0%

60.8%

0.0% 20.0% 40.0% 60.0% 80.0%

2002

2004

2006

2008

2010

Dallas Co.

Other Peer Counties Range

56.3% – 71.4%


proportion of adults aged 50-74 who

receive colorectal cancer screening based

on the most recent guidelines. Baseline for

the United States for this measure is 54.2%

of adults 50 to 74 years of age received a

colonoscopy or sigmoidoscopy based on

the most recent guidelines in 2008. (target

based modeling/projection) Source: CDC BRFSS, 2004 - 2010, Texas 2010 data provided by Anna Vincent, Research





29


Vaccinations

Vaccinations

Adult

Child age 19-35 months

Dallas County

Compared to

Healthy People

2020 Goal

Dallas County

Compared to 8

Peer Counties

(Quartiles)

Dallas County

Compared to

Past Years’ Data

(CI)


– Same as/not significantly different from the

benchmark


30

Immunization: Vaccinations for children

ages 19 to 35 months

77

.0%

73

.7%

71

.7%

71

.4%

73

.7%

63

.1%

76

.3%

69

.7%

80.0% 80.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

2011 2001

U.S. Median Bexar Co. Dallas Co.

Texas Healthy People 2020No peer county data available for the 2011 survey. The

only peer county available in 2010 was Los Angeles

County at 80.0% immunized in this age group.

Dallas County Trend for percent of

children receiving the appropriate

vaccinations for ages 19 to 35 months,

2001-2011

Source: Centers for Disease Control and Prevention, National Immunization Survey, 2001, 2002,

2004-2011.

http://www.cdc.gov/vaccines/stats-surv/nis/default.htm#nis

Percent

Percent

Healthy People 2020 Objective IID-8


Healthy People 2020 goal is to increase the proportion of

children aged 19 to 35 months who receive the recommended

doses of DTaP, polio, MMR, Hib, hepatitis B and varicella.

(Target based on consistency with national programs)

Vaccine recommendations based on the

4:3:1:3:3:1 schedule and at the

appropriate age.

63.1%

68.0%

67.1%

72.8%

73.3%

71.9%

74.2%

73.5%

72.6%

73.7%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

2001

2002

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

http://www.cdc.gov/vaccines/stats-surv/nis/default.htm





31

Immunization: Adults aged 65+ who

have had a flu shot/nasal vaccine

within the past year, 2011

60

.2%

67

.3%

61

.8%

65

.5%

56

.8%

58

.2%

62

.0%

60

.5%

63

.4%

59

.7%

59

.1%

61

.4%

90.0% 90.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2011 2001/2002

US Bexar Co. Harris Co.


Healthy People 2020

59.7%

71.4%

63.6%

72.8%

68.9%

70.3%

65.1%

63.4%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

2001/2

2003/4

2005/6

2007

2008

2009

2010

2011

Dallas County Trend for Adults aged

65+ who have had a flu shot within

the past 12 months Percent


proportion of adults who are vaccinated annually

against influenza. (Target based on better than best,

retention of Healthy People 2010 target)

Other Peer

Counties Range

Percent

Source: CDC BRFSS, 2001/2002 combined, 2003/2004 combined, 2005/2006 combined, 2007-11. Years were combined to ensure a sufficient

sample size. Data for Other Peer Counties is 2010, before implementation of cell phone sampling procedures.. Texas 2010-11 data provided

by Anna Vincent, Research Specialist, Texas Dept. of State Health Services, via email 3.18.13

Healthy People 2020 Objective IID-12.7 http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=1


Maricopa, Los Angeles, Cook,

Miami/Dade.

49.3% - 70.7%

Discontinuity: BRFSS began surveying cell

phones in 2011, not comparable with

previous years’ rates. Also in 2011, the

question was changed to include nasal

inoculation as well as injected vaccine.


32

Violence Mortality and ED Visits for Injury

All Unintentional Injuries Death Rate

Motor Vehicle Crash Death Rate

Falls Death Rate

Falls Death Rate Age 65+

Unintentional Poisoning Death Rate

Suicide Death Rate

Homicide Death Rate

ED Visits for Injuries

Health Risk Behaviors – Violence

and Injury Prevention Dallas County

Compared to

Healthy People

2020 Goal

Dallas County

Compared to

8 Peer

Counties

Dallas County

Compared to

Past Years’

Data (CI)

N/A N/A




33

Injuries: Age-Adjusted Unintentional

Injury Death Rate, per 100,000 population

38

.2

35

.7

43

.2

30

.9

35

.4

38

.1

29

.2

33

.3

35

.1

35

.1

39

.0

39

.3

36.0 36.0

0.0

10.0

20.0

30.0

40.0

50.0

2010 2001U.S. Median Bexar Co. Harris Co.


Healthy People 2020

Other Peer

Counties Range

Other Peer Counties include: Maricopa, Los


Dallas County Trend in Unintentional

Injury Death Rates, 2001 to 2011

20.2 – 44.1

Rate Per 100,000

Rate Per 100,000

Source: Texas Department of State Health Services website query system and special run by Lyudmila Baskin,

Ph.D, Research Specialist, Texas Dept of State Health Services

Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-

2007. CDC WONDER On-line Database, compiled from Compressed Mortality File 1999-2007 Series 20 No. 2M, 2010.

Accessed at http://wonder.cdc.gov/cmf-icd10.html on Jul 15, 2011 6:32:01 PM

Healthy People 2020 Objective IVP-11


U.S. 2009 data source: National Vital Statists Reports, Deaths: Preliminary data for 2009, March 2011 Vol. 59., No.4.

pp. 41-43

Healthy People 2020 goal is to reduce deaths caused

by unintentional injuries (Target based on 10 percent

improvement)

35.1

34.3

34.1

36.1

35.1

34.0

35.8

36.0

35.3

35.1

32.1

- 10.0 20.0 30.0 40.0

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Includes all unintentional injuries, including

motor vehicle accidents, falls, poisoning,

drowning/submersion, and others. Does

not include homicide and suicide. ICD10

codes for unintentional injury deaths

include: (V01-X59, Y85-Y86).

http://wonder.cdc.gov/cmf-icd10.html




34

Injuries: Age-Adjusted Motor Vehicle

Crash Death Rate, per 100,000 population

11

.7

15

.3

11

.6

11

.7

10

.7

16

.1

10

.3

13

.9

10

.9

16

.3

14

.3

18

.7

12.4 12.4

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

2010 2001



Healthy People 2020

Other Peer

Counties Range

Other Peer Counties include: Maricopa,

Los Angeles, Miami-Dade, Cook

Dallas County Trend in Motor Vehicle

Crash Death Rates, 2001-2011

6.1 – 10.9

Source: Texas Department of State Health Services website query system and special run by Lyudmila

Baskin, Ph.D, Research Specialist, Texas Dept of State Health Services

Rate Per 100,000

Rate Per 100,000

Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2007.

CDC WONDER On-line Database, compiled from Compressed Mortality File 1999-2007 Series 20 No. 2M, 2010.


Healthy People 2020 Objective IIVP 13.1


U.S. 2009 data source: National Vital Statists Reports, Deaths: Preliminary data for 2009, March 2011 Vol. 59., No.4. pp.

41-43

Healthy People 2020 goal is to reduce

deaths caused by motor vehicle crashes

(Target based on 10% improvement)

16.3

14.1

13.6

14.4

11.5

11.0

11.7

12.2

8.0

10.9

8.4

0.0 5.0 10.0 15.0 20.0

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

ICD10 Codes for Motor Vehicle Crashes

Includes V02-V04, V09.0, V09.2, V12-V14,

V19.0-V19.2, V19.4-V19.6, V20-V79, V80.3-

V80.5, V81.0-V81.1, V82.0-V82.1, V83-V86,

V87.0-V87.8, V88.0-V88.8, V89.0, V89.2





35

Injuries: Age-Adjusted Falls Death Rate,


7.5

5.3

15

.1

7.3

9.0

4.3

4.3

4.2

8.9

5.2

7.4

4.6

7.0 7.0

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

2010 2001



Healthy People 2020

Other Peer

Counties Range



Dallas County Falls Death Rates,

2001-2011

4.3 – 13.7

Rate Per 100,000

Rate Per 100,000

Healthy People 2020 goal prevent an

increase in the rate of fall-related deaths

(Target is to maintain the baseline rate)

5.2

4.8

6.4

7.4

6.6

7.3

8.4

7.9

10.2

8.9

6.5

0.0 2.0 4.0 6.0 8.0 10.0 12.0

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Includes falls deaths. ICD 10 W00-W19



Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2007. CDC

WONDER On-line Database, compiled from Compressed Mortality File 1999-2007 Series 20 No. 2M, 2010.


Healthy People 2020 Objective IIVP 23.1 http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=1

U.S. 2009 data source: National Vital Statists Reports, Deaths: Preliminary data for 2009, March 2011 Vol. 59., No.4. pp. 41-43





36

Injuries: Age Specific Fall Death Rates,

per 100,000 population for age 65

45

.2

33

10

5.6

46

.2

63

.2

21

.9

24

.7

23

.4

59

.3

30

.8

49

.5

25

.9

45.3 45.3

0

20

40

60

80

100

120

2010 2001



Healthy People 2020

30.8

28.4

38.8

45.1

42.4

44.1

58.5

51.2

65.8

59.3

43.9

0 20 40 60 80

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Dallas County Trend in Age-

Specific Falls Death Rates, 2001-

2011, age 65 and over

Other Peer Counties

Range Rate per 100,000 population

age 65 and over

Healthy People 2020 to prevent

an increase in the rate of fall-

related deaths (Target is to maintain

the baseline rate)

Source: Texas Department of State Health Services website query system and special run by Lyudmila Baskin, Ph.D,

Research Specialist, Texas Dept of State Health Services

Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2007. CDC WONDER

On-line Database, compiled from Compressed Mortality File 1999-2007 Series 20 No. 2M, 2010.


Healthy People 2020 Objective IVP-23.2 http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=1



Maricopa, Los Angeles,

Miami-Dade, Cook

Includes falls deaths. ICD 10 W00-W19

26.3 – 98.3





37

Injuries: Age-Adjusted Unintentional

Poisoning Death Rate, per 100,000

population 9

.9

9.9

10

.4

5.1

9.8

7.3

6.8

5.6

7.9

5.4

8.7

5.1

13.1 13.1

0

2

4

6

8

10

12

14

2010 2001



Healthy People 2020

Other Peer

Counties Range



Dallas County Trend in Poisoning

Death Rates, 2001-2011

3.4– 13.3

Rate Per 100,000

Rate Per 100,000

Healthy People 2020 goal is to Prevent an

increase in the rate of poisoning deaths

((Target is to maintain the baseline rate)

5.4

6.7

5.7

6.4

7.8

7.1

9.2

8.4

8.4

7.9

9.1

0 2 4 6 8 10

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Includes all unintentional

poisoning deaths. ICD 10 X40-

X49


Research Specialist, Texas Dept of State Health Services Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2007. CDC WONDER



Healthy People 2020 Objective IVP-9.1 http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=1






38

Injuries: Age-Adjusted Suicide Death Rate,


11

.7

10

.7

10

.9

10

.8

11

.0

10

.3

10

.5

9.9

11

.1

10

.8

11

.7

10

.8

10.2 10.2

0

2

4

6

8

10

12

14

16

2010 2001



Healthy People 2020

Other Peer Counties

Range



Dade, Cook

7.4 – 14.9

Includes all Suicides deaths. ICD 10 X60-x84, Y87.0

Dallas County Trend in Suicide


Rate per 100,000

Rate per 100,000


deaths the suicide rate (Target based on

10 percent improvement)

10.8

10.7

10.3

9.5

9.7

9.0

10.4

9.6

10.6

11.1

9.3

0 2 4 6 8 10 12

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.





Healthy People 2020 Objective MHMD-1 http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=1






39

Injuries: Age-Adjusted Homicide Death

Rate, per 100,000 population

5.5

6.0

6.1

7.7

8.8

8.7

5.8

6.5

7.4

12

.4

5.4

6.4

5.5 5.5

0

2

4

6

8

10

12

14

2010 2001



Healthy People 2020

Other Peer Counties

Range



Dade, Cook

6.3 – 10.3

Includes all homicide deaths. ICD 10 X85-Y09, Y87.1

Dallas County Trend in Homicide


Rate per 100,000

Rate per 100,000


homicides (Target based on 10 percent

improvement)

12.4

10.8

10.5

11.3

10.0

9.3

10.1

9.0

8.5

7.4

6.7

0 5 10 15

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.





Healthy People 2020 Objective IVP 29 http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=1






40

Sources: DFWHC ERF Information Quality Services Center Regional Data, 2010.

Dallas-Fort Worth Hospital Council Education and Research Foundation, Information

and Quality Services Center, Irving, Texas. Nov 20 2012. Denominator population

data from US Census Bureau, American Community Survey, 2011

Dallas County Trend in Emergency

Department Visits for Injuries, 2006-2012

Injuries: Emergency Department

Visits for Injuries, 2006-2012

The Dallas Fort Worth Hospital Council has established an

Emergency Department data set from more than 44

hospitals in the region. The data repository has over 3.6

million emergency department visits as of 2011.

Injury-Related ED Visits per 1,000 population

Rate per 1,000 population

72

.8

61

.3

65

.9

48

.0

-

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

2012 2008

Tarrant Co. Dallas Co.

54.1

53.5

48.0

48.4

58.5

60.8

65.9

- 10.0 20.0 30.0 40.0 50.0 60.0 70.0

2006

2007

2008

2009

2010

2011

2012

Dallas Co.

Health Risk Behaviors – High

Risk Sexual Behaviors

High Risk Sexual

Behavior

HIV/STD Rates

HIV Incidence

Chlamydia Incidence

Gonorrhea Incidence

Primary/ Secondary

Syphilis

Teen Birth Rates

Dallas

County

Compared

to Healthy

People

2020 Goal

Dallas

County

Compared

to 8 Peer

Counties

(Quartiles)

Dallas

County

Compared

to Past

Years’

Data (CI)

N/A

N/A

N/A

N/A

N/A

41




42

STD/HIV: Annual HIV Cases and

Rates, 2003-2011

36

1

31

6

1,2

34

1,1

42

22

7

19

8

88

3

1,0

81

4,4

02

4,5

12

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

2011 2004


Email from Ed Weckerly Epidemiologist TB/HIV/STD Epidemiology and Surveillance, MC 1873

7/20/11

The Texas HIV Surveillance Report 2011, Texas Department of State Health Services,

http://www.dshs.state.tx.us/hivstd/reports/default.shtm

Dallas County Trend for Rate of

New HIV Cases, 2003 to 2011

Cases per 100,000

Number of New Cases

46.0

46.2

44.3

35.5

34.2

32.7

34.4

38.3

34.8

0.0 10.0 20.0 30.0 40.0 50.0

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

34,247 new cases of HIV in 2009 in the

U.S.


43

STD/HIV: Chlamydia Cases per

100,000 population 2003-2011

40

9.2

31

6.5

71

2.2

46

8.8

51

4.8

33

0.7

42

2.2

29

5.2

68

4.8

37

2.8

47

3.0

31

2.1

0

100

200

300

400

500

600

700

800

2011 2004

U.S. Median (2009) Bexar Co. Harris Co. Tarrant Co. Dallas Co. Texas

Other Peer Counties

Range



Dade, Cook (2009 data)

Source: The Texas STD Surveillance Report 2011, Texas Department of State Health Services,



346.8 - 671.1

Cases per 100,000 Cases per 100,000

Healthy People 2020, STD-3.1 to 4.2. No overall target is available, all targets are age- and gender-

specific.

http://wonder.cdc.gov/controller/datarequest/D42

420.9

372.8

426.7

364.5

517.0

565.1

580.7

654.4

684.8

0.0 200.0 400.0 600.0 800.0

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.


44

STD/HIV: Gonorrhea Rate per

100,000 population 2003-2011

99

.1

11

2.4

20

8.9

13

8.3

13

7.3

12

8.1

11

6.8

14

1.9

20

9.0

18

1.5

11

7.8

10

8.2

0.0

50.0

100.0

150.0

200.0

250.0

2011 2004

U.S. Rate (2009) Bexar Co. Harris Co. Tarrant Co. Dallas Co. Texas

Other Peer Counties Range Other Peer Counties include:


Dade, Cook (2009 data) Dallas County Trend 2003 to 2011

57.1 to 251.8

Cases per 100,000

Cases per 100,000

205.8

181.5

219.0

198.7

260.4

212.3

183.2

211.7

209.0

0.0 100.0 200.0 300.0

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.


specific.





45

STD/HIV: Syphilis Primary and Secondary

Rate per 100,000 population, 2003-2011

4.6

2.7

11

.1

7.3

6.5

5.8

6.6

4.2

7.1

8.0

4.5

3.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

2011 2004

U.S. Rate (2008) Bexar Co. Harris Co. Tarrant Co. Dallas Co. Texas

Other Peer Counties Range Other Peer Counties include:


Dade, Cook (2010 data) Dallas County Trend for Syphilis

Rate, 2003 to 2011

3.9 – 25.5

Cases per 100,000

Cases per 100,000

7.3

8.0

7.5

8.9

6.6

9.0

12.1

7.5

7.1

0.0 5.0 10.0 15.0

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.


specific.





46

Teen Births: Teen Birth Rate, 2003 to 2010

(Number of births per 1,000 women ages

15 to 19) 3

4.3

45

.3

51

.76

67

.90

52

.1

63

.5

46

.5

62

.6

52

.3

76

.5

52

.2

67

.4

0

10

20

30

40

50

60

70

80

90

2010 2003

U.S. Rate Bexar Co. Harris Co. Tarrant Co. Dallas Co. Texas

(Other Peer Counties Range) Other Peer Counties include:

Maricopa, Los Angeles, Miami-Dade, Cook

Dallas County Trend for Teen

Birth Rate, 2003 to 2011

27.1 – 39.5

Cases per 1,000 women

Cases per 1,000

The Healthy People 2020 national health

target is to reduce pregnancies among

adolescent females ages 15-17 from 40.2

per 1,000 in 2005 to 36.2 per 1,000 in 2020

Healthy People 2020, FP 8.1 Source: CDC Wonder 2003, 2010

American Community Survey Population Estimates 2003-2011, Females 15 to 19

Rate for 2011 from email correspondence with Lyudmila Baskin, Ph.D. Research Specialist, Texas Department

of State Health Services

Peer County Data Source: CDC Wonder.

76.5

78.5

77.1

78.0

78.0

73.4

68.6

58.3

52.3

0 20 40 60 80 100

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.


Other High Risk Behaviors

Health Risks

Alcohol Use Binge Drinking

Diet and Exercise

Overweight and Obese

Recommended Physical Activity

Frequency of Five Fruits/

Vegetables per Day

Tobacco Use Current

Smokers

Dallas

County

Compared to

Healthy

People 2020

Goal

Dallas

County

Compared

to 8 Peer

Counties

(Quartiles)

Dallas

County

Compared

to Past

Years’ Data

(CI)

N/A

47




48

Diet and Exercise: Adults* with 30+ minutes of moderate

physical activity five or more days per week, or vigorous

physical activity for 20+ minutes three or more days per week

51

.4%

49

.1%

47

.2%

48

.7%

49

.1%

43

.0%

47

.9%

48

.8%

43

.3%

38

.8%

48

.2%

46

.7%

47.9% 47.9%

0%

10%

20%

30%

40%

50%

60%

2011 2005



Healthy People 2020

Other Peer Counties

Range



Dade, Cook

Dallas County Trend for Physical

Activity, 2003 to 2011

Healthy People 2020 goal is to increase the proportion

of adults who engage in aerobic physical activity of at

least moderate intensity for at least 150 minutes/week

or 75 minutes/week of vigorous intensity, or an

equivalent combination (Target set at 10 percent improvement)

39.3 – 50.0

Percent Percent

Source: CDC BRFSS, 2003, 2005, 2007, 2009 and 2011

Healthy People 2020 Objective PA 2.1


44.2%

38.8%

44.7%

42.6%

43.3%

0% 10% 20% 30% 40% 50%

2003

2005

2007

2009

2011

Dallas Co.

*Adults are described as 18 and over

Discontinuity: BRFSS began

surveying cell phones in 2011, not

comparable with previous years’ rates


49

Overweight and Obese: Adults* with a BMI

Greater Than 25 and Greater Than 30, 2006 to 2011

63

.3%

61

.6%

66

.3%

68

.3%

65

.0%

52

.7%

65

.4%

65

.5%

63

.8%

63

.0%

65

.8%

62

.4%

66.1% 66.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

2011 2006



Healthy People 2020

Dallas County Trend for

Overweight or Obese, 2006 -

2011

63.0%

57.3%

71.3%

60.3%

59.3%

63.8%

0% 20% 40% 60% 80%

2006

2007

2008

2009

2010

2011

Dallas Co.

Percent

Percent

61.3% – 66.4%



Dade, Cook

Other Peer Counties

Range

*Adults are defined as ages 18 and over


Healthy People 2020 Objective NWS-8


Healthy People 2020 goal is to increase

the proportion of adults who are at a

healthy weight. Baseline and target are

for adults over the age of 20. The data

source available here is for adults over

the age of 18. (Target is a 10% increase.

Baseline is at 30.8% of adults 20 and over at a

healthy weight . The target is to increase to 33.9%

of adults 20 and over at a healthy weight.)





50

Diet and Exercise: Adults* who have

consumed fruits or vegetables 5 or more

times per day, 2003-2011

18

.1%

23

.2%

18

.1%

21

.8%

21

.3%

23

.6%

21

.7%

21

.8%

16

.8%

20

.1%

18

.1%

22

.6%

0%

5%

10%

15%

20%

25%

30%

2011 2005


Other Peer Counties

Range


Maricopa, Los Angeles,

Miami-Dade, Cook

Dallas County Trend for Fruit and

Vegetable Consumption, 2003 to

2011

22.1% – 26.5%

Percent

Percent


25.5%

20.1%

25.5%

23.3%

16.8%

0% 20% 40%

2003

2005

2007

2009

2011

Dallas Co.


Healthy People 2020 goal is to

increase contribution of total

vegetables to the diets of the

population aged 2 years and older. (Target is 1.1 cup equivalents per 1,000

calories)




51

Alcohol Use: Binge Drinkers (Males over the age of 18

who have had 5 or more drinks on one occasion; females

who have had 4 or more drinks on one occasion)

18

.3%

15

.1%

21

.7%

17

.5%

19

.1%

18

.2%

20

.7%

10

.5%

17

.1%

16

.5%

18

.9%

15

.7%

24.3% 24.3%

0%

5%

10%

15%

20%

25%

30%

2011 2004



Healthy People 2020

Other Peer Counties

Range



Dade, Cook

Dallas County Trend for Binge

Drinking, 2004 to 2011

11.6%-18.8%

Percent

Percent

16.5%

10.6%

14.9%

17.2%

15.0%

8.7%

10.9%

17.1%

0% 5% 10% 15% 20%

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.


Healthy People 2020 goal is to reduce the

proportion of adults that engaged in binge drinking

during past month (Target set at 10% improvement)

Source: CDC BRFSS, 2004 – 2011

Healthy People 2020 Objective TU 1.1






52

Tobacco Use: Adults* who are Current

Smokers (Do you now smoke cigarettes every day,

some days, or not at all) 2

0.1

%

20

.9%

16

.8%

19

.0%

18

.2%

17

.1%

18

.9%

19

.7%

18

.9%

20

.8%

19

.2%

20

.5%

12.0% 12.0%

0%

5%

10%

15%

20%

25%

2011 2004



Healthy People 2020

Other Peer Counties

Range



Dade, Cook

Dallas County Trend for Rate of

Current Smokers, 2004 to 2011

10.2% - 18.3%

Percent

Percent

Source: CDC BRFSS, 2004 – 2011

Healthy People 2020 Objective TU 1.1


20.8%

16.7%

12.5%

15.8%

18.6%

22.4%

15.8%

18.9%

0% 5% 10% 15% 20% 25%

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.


Healthy People 2020 goal is to reduce tobacco use

by adults (Target set at 2010 goal)





53


Community Health

Dashboard

Health Outcomes

Mortality


Infant Mortality


Morbidity


Diabetes Prevalence

Health Factors


Cancer Screening

Mammogram

Pap Test


Vaccinations






Teen Birth Rate

Tobacco Use

Alcohol Use

Diet and Exercise



Percent Uninsured






54

Health Outcomes

Mortality

Heart Disease Death Rate

Cancer Death Rate

Stroke Death Rate

COPD Death Rate

Diabetes Death Rate

Diabetes Prevalence

Health Outcomes –

Mortality Dallas County

Compared to

Healthy

People 2020

Goal

Dallas County

Compared to

8 Peer

Counties

(Quartiles)

Dallas

County

Compared to

Past Years’

Data (CI)

N/A

N/A

N/A




55

Health Outcomes


Infant Mortality


Notifiable Communicable

Diseases

Campylobacteriosis

Aseptic Meningitis

Pertussis

Salmonellosis

General Health Status


Health Outcomes – Other

Outcomes Dallas

County

Compared to

Healthy

People 2020

Goal

Dallas

County

Compared

to 8 Peer

Counties

(Quartiles)

Dallas

County

Compared to

Past Years’

Data (CI)

N/A

N/A

N/A

N/A

N/A

N/A




56

Mortality: Deaths due to Heart Disease

2001-2010 (age adjusted rates per 100,000)

17

9.1

27

3.9

17

2.2

24

5.6

17

5.0

27

1.0

18

3.5

26

7.9

18

0.0

26

3.1

18

1.1

25

7.1

100.8 100.8

0.0

50.0

100.0

150.0

200.0

250.0

300.0

2010 2001



Healthy People 2020




Dade, Cook


141.5 – 192.7

Deaths per 100,000 Deaths per 100,000



Healthy People 2020 Objective HDS-2


263.1

260.4

244.4

229.2

225.6

206.7

205.2

195.3

198.0

180.0

179.1

0.0 100.0 200.0 300.0

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Healthy People 2020 goal is to reduce coronary

heart disease deaths (Target set at 20 percent improvement)

Centers for Disease Control and Prevention,

National Center for Health Statistics. Multiple

Cause of Death File 2001-2010. CDC WONDER

On-line Database, compiled from Multiple Cause

of Death File 2001-2010. Accessed at

http://wonder.cdc.gov/mortsql.html

ICD10 (l00-l09,l11,l13,l20-l51)


57

Mortality: Deaths due to Cancer


17

2.8

19

6.0

15

9.9

17

5.4

16

2.4

19

8.2

17

2.6

19

2.0

17

2.7

20

2.4

16

5.9

19

1.7

160.6 160.6

0

25

50

75

100

125

150

175

200

225

2010 2001



Healthy People 2020




Dade, Cook


143.3 – 181.0


202.4

195.0

191.5

187.6

192.0

187.5

180.8

176.6

179.3

172.7

168.8

0 50 100 150 200 250

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Healthy People 2020 goal is to reduce the overall

cancer death rate. (target set at 10% improvement)

ICD10 (C00-C97)







Cause of Death File 2001-2010. CDC WONDER On-

line Database, compiled from Multiple Cause of

Death File 2001-2010. Accessed at



58

Mortality: Deaths due to Stroke


39

.1

57

.8

44

.9

63

.3

43

.3

74

.7

51

.7

80

.5

48

.6

64

.8

44

.4

64

.4

33.8

33.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

2010 2001



Healthy People 2020




Dade, Cook


28.8 – 37.7




Healthy People 2020 Objective HDS-3


64.8

60.8

61.7

63.0

55.9

54.9

50.6

55.2

50.2

48.6

43.2

0 20 40 60 80

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Healthy People 2020 goal is to reduce stroke

deaths (Target set at 20 percent improvement)




On-line Database, compiled from Multiple

Cause of Death File 2001-2010. Accessed at


(ICD10 I60-I69)


59

Mortality: Deaths due to Chronic Lower

Respiratory Disease (COPD), 2001-2010 (age adjusted rates per 100,000)

42

.2

43

.7

36

.1

39

.2

33

.4

40

.1

48

.7

50

.2

41

.7

44

.9

43

.0

46

.4

50.1 50.1

0

10

20

30

40

50

60

2010 2001



Healthy People 2020




Dade, Cook


29.7 – 40.4


44.9

42.5

40.6

38.9

40.8

38.8

39.4

42.2

42.6

41.7

39.9

34 36 38 40 42 44 46

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Healthy People 2020 goal is to reduce COPD

deaths (Target set at the smallest improvement that results in a

statistically significant difference when tested against the baseline

value)



Cause of Death File 2001-2010. CDC WONDER On-

line Database, compiled from Multiple Cause of

Death File 2001-2010. Accessed at


(ICD10 J40-J47)



Healthy People 2020 Objective RD-11



60

Mortality: Deaths due to Diabetes


20

.8

25

.3

24

.7

42

.7

19

.6

29

.4

20

.5

28

.5

19

.4

22

.7

21

.6

31

.7

0

5

10

15

20

25

30

35

40

45

2010 2001


Other Peer Counties

Range



Dade, Cook


19.0 – 23.4


22.7

26.6

21.7

22.9

24.7

24.0

24.3

23.8

22.8

19.4

20.9

0 5 10 15 20 25 30

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Healthy People 2020 goal is to reduce deaths that were

related to diabetes to 65.8 age adjusted deaths per

100,000. This measure encompasses a broader range of

deaths than included here. (Target set at 10% improvement)




On-line Database, compiled from Multiple Cause

of Death File 2001-2010. Accessed at


(ICD10 E10-E14)



Healthy People 2020 Objective D-3



61

Estimated Diabetes Prevalence

(Diagnosed and Undiagnosed), 2010

.

Percent of Population 18

and Older with Diabetes 11

.3%

11

.7%

8.8

%

11

.8%

9.0

%

10

.3%

7.9

%

11

.7%

8.8

%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

2010 2004

US Bexar Co. Harris Co. Tarrant Co. Dallas Co.

Source: US Diabetes Index, National Minority Quality Forum and Centers for Disease Control and Prevention, 2013; based on NHANES

population prevalence estimates, 2010, http://maps.z-atlas.com/DiabetesSampleIndex/ . Denominator population data 2010 from

Nielson/Claritas, Inc. Pop Facts. Mid 2010 version. US prevalence estimates from CDC http://www.cdc.gov/diabetes/pubs/estimates11.htm#2

7.33%

7.61%

8.43%

8.82%

9.59%

9.23%

11.18%

11.16%

10.66%

11.78%

0 0 0 0

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

Dallas Co.

Dallas County Trend in

Incidence Rates, 2001 - 2010

Percent of the Population 18 and Older

Other Peer Counties

Range

8.9 – 13.7

http://maps.z-atlas.com/DiabetesSampleIndex/




http://www.cdc.gov/diabetes/pubs/estimates11.htm

http://www.cdc.gov/diabetes/pubs/estimates11.htm

62

Mortality: Infant Mortality Rate

2001 to 2010 6

.1

6.8

6.5

6.2

6.3

5.4

7.5

7.4

7.6

7.6

6.1

6.0

6.0 6.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

2010 2001



Healthy People 2020


Other Peer Counties include: Maricopa,

Los Angeles, Miami-Dade, Cook


4.4 – 7.2

Deaths per 1,000 live births

Deaths per 1,000 Live Births



http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_17.pdf


Healthy People 2020 Objective MCH-1.3


6.3

6.6

8.0

6.7

7.1

7.6

7.2

6.7

7.3

7.6

7.1

0 2 4 6 8 10

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Healthy People 2020 goal is to reduction in

infant deaths (Target based on 10% improvement)

Source: Infant Mortality Report: California Department of Public

Health, Center for Health Statistics, OHIR Vital Statistics Section,

1999-2008

Maricopa County health Status Report 2005-2009 page 26.

Illinois Department of Public Health

http://www.idph.state.il.us/health/infant/infmort0608.htm

http://www.flpublichealth.com/VSBOOK/viewreport.aspx?CEID=71

54&Year=2009 Interactive Florida Vital Statistics Annual Report

This indicator shows the mortality rate in deaths

per 1,000 live births for infants within their first year

of life.



http://www.idph.state.il.us/health/infant/infmort0608.htm

http://www.flpublichealth.com/VSBOOK/viewreport.aspx?CEID=7154&Year=2009

http://www.flpublichealth.com/VSBOOK/viewreport.aspx?CEID=7154&Year=2009

http://www.flpublichealth.com/VSBOOK/VSBOOK.aspx

63

Low Birth Weight Births: Percent of Births

that are Very Low Birth Weight, <1,500

grams, 2001 to 2010 1

.4%

1.4

%

1.7

%

1.4

%

1.6

%

1.4

%

1.6

%

1.3

%

1.6

%

1.4

%

1.4

%

1.3

%

1.4%

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

1.8%

2.0%

2010 2001



Healthy People 2020




Dade, Cook


1.0% – 1.8%

Percent of Births

Percent of Births

Texas Dept of State Health Services, Query System 2001-2010 Very low birth weight births. Email

from Lyudmila Baskin, Ph.D., Research Scientist, TDSHS; CDC Wonder2010; Healthy People

2020 Objective MCH-8.2


http://www.mchb.hrsa.gov/chusa10/hstat/hsi/pages/203vlbw.html for U.S. data

1.4%

1.5%

1.5%

1.6%

1.6%

1.7%

1.7%

1.6%

1.7%

1.6%

1.7%

0.0% 0.5% 1.0% 1.5% 2.0%

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Healthy People 2020 goal is to reduce low

birth weight (LBW) and very low birth

weight (VLBW) (Target set 5% reduction)


National Center for Health Statistic, Beyond 20/20

WDS; http:///205.207.175.93/vitalstats/table

viewer/tablevies.aspx


http://www.mchb.hrsa.gov/chusa10/hstat/hsi/pages/203vlbw.html for U.S

http://205.207.175.93/vitalstats/table viewer/tablevies.aspx

http://205.207.175.93/vitalstats/table viewer/tablevies.aspx

64

Rate of Years of Potential Life Lost

6,9

84

6,9

98

6,8

51

7,3

07

6,6

34

7,4

05

6,6

72

6,9

63

6,9

06

7,4

96

6,8

02

7,3

27

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

2010 2002

U.S. Bexar Co. Harris Co. Tarrant Co. Dallas Co. Texas




Dade, Cook

Trend in Dallas County YPLL

Rate, 2002 to 2010

6,009 – 7,533


Baskin, Ph.D, Research Specialist, Texas Dept of State Health Services. Deaths 2002-2010

http://soupfin.tdh.state.tx.us/death10.htm DSHS's deaths website, American Community Survey 2002-2011,

http://www.cdc.gov/nchs/data/hus/hus06.pdf, Comparison counties http://www.countyhealthrankings.org/

7,496

7,591

7,253

7,420

7,038

6,735

6,906

6,851

0 2,000 4,000 6,000 8,000

2002

2004

2006

2007

2008

2009

2010

2011

Dallas Co.

This indicator shows the years of life lost

due to deaths under age 75, per 100,000

population.

Premature death is represented by the years of

potential life lost before age 75 (YPLL-75). Every

death occurring before the age of 75 contributes to

the total number of years of potential life lost. For

example, a person dying at age 25 contributes 50

years of life lost, whereas a person who dies at age

65 contributes 10 years of life lost to a county’s YPLL.

http://soupfin.tdh.state.tx.us/death10.htm

http://www.cdc.gov/nchs/data/hus/hus06.pdf

http://www.countyhealthrankings.org/

65

Notifiable Communicable Disease Incidence:

Campylobacteriosis Rate 2004-2010

13

.0

12

.9

10

.5

4.9

3.9

6.1

3.8

5.4

5.9

8.0

0

2

4

6

8

10

12

14

2010 2004


Source: 2004 and 2010 data from Texas Department of State Health Services, Infectious

Disease Control Unit personal communication; other years from Dallas County Health and

Human Services web site. http://www.dallascounty.org/department/hhs/epistats.html

US data 2009 CDC Foodnet http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5914a2.htm

Campylobacteriosis is an infectious disease

caused by bacteria of the genus Campylobacter.

Most people who become ill with

campylobacteriosis get diarrhea, cramping,

abdominal pain, and fever within two to five days

after exposure to the organism. The diarrhea

may be bloody and can be accompanied by

nausea and vomiting. The illness typically lasts

one week. Some infected persons do not have

any symptoms. In persons with compromised

immune systems, Campylobacter occasionally

spreads to the bloodstream and causes a

serious life-threatening infection.

Cases per 100,000



5.3

5.9

4.2

5.2

8.5

6.1

8.5

5.5

0 2 4 6 8 10

2003

2004

2005

2006

2007

2008

2009

2010

Dallas Co.

Cases per 100,000

http://www.dallascounty.org/department/hhs/epistats.html

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5914a2.htm

66


Aseptic Meningitis Rate 2004-2010

0.9

11

.4

4.8

12

.3

12

.1

20

.7

10

.4

11

.3

6.6

11

.5

0

5

10

15

20

25

2010 2004





Disease Control Unit personal communication; other years from Dallas County Health

and Human Services web site.

http://www.dallascounty.org/department/hhservices/services/communicable/documents/

ReportableConditions2003-07Annual.pdf

21.6

11.3

22.0

14.9

12.7

11.4

10.5

10.4

0 5 10 15 20 25

2003

2004

2005

2006

2007

2008

2009

2010

Dallas Co.

Aseptic meningitis is a common, rarely

fatal condition usually caused by certain

viruses. Meningitis means inflammation

of the membranes covering the brain and

spinal cord. Community rates of aseptic

meningitis may contain some mild cases

of West Nile Virus infection and other

mosquito-borne diseases that go

undetected by clinicians in the absence of

an outbreak.

Cases per 100,000

Cases per 100,000

67


Pertussis Rate 2004-2010

1.4

3.8

2.2

1.9

15

.6

3.9

5.9

11

.4

11

.3

5.4

0

2

4

6

8

10

12

14

16

18

2010 2004









21.6

11.4

22.0

14.9

12.7

8.0

6.9

5.9

0 5 10 15 20 25

2003

2004

2005

2006

2007

2008

2009

2010

Dallas Co.

Pertussis is a highly contagious bacterial

disease that causes uncontrollable, violent

coughing. This is a vaccine preventable

disease, and almost all cases are in

unvaccinated or incompletely vaccinated

patients. Pertussis can be deadly in

infants and unvaccinated children.

Cases per 100,000

Cases per 100,000

68


Salmonellosis Rate 2004-2010

15

.5

11

.7

14

.6

11

.3

20

.0

6.4

14

.9

8.1

19

.6

12

.2

0

5

10

15

20

25

2010 2004









7.3

8.1

8.6

7.7

10.1

13.9

11.3

14.9

0 5 10 15 20

2003

2004

2005

2006

2007

2008

2009

2010

Dallas Co.

Salmonellosis is a type of food poisoning

caused by the Salmonella bacterium.

Children are the most likely to get

salmonellosis, while young children, older

adults and people with impaired immune

systems are the most likely to have

severe infections.

Cases per 100,000

Cases per 100,000

69

Source: Texas Department of State Health Services, BRFSS program,

2009-2010, personal email from TX Dept of State Health Services 3.18.13

Outcomes: Percent of Adults Rating

Current Mental Health Not Good on

Five or More Days Out of Past 30 Days,

2003/2004 Combined to 2011

BRFSS Survey Question: Now thinking about your mental

health, which includes stress, depression, and problems

with emotions, for how many days during the past 30 days

was your mental health was not good?

Percent No Healthy People 2020 goal for this indicator

21

.8%

20

.8%

23

.1%

21

.5%

19

.5%

20

.2%

19

.2%

21

.1%

18

.5%

20

.8%

19

.8%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

2011 2003-2004


18.5%

18.0%

17.6%

20.4%

21.1%

0 0 0 0 0 0

2003/2004

2005/2006

2007/2008

2009/2010

2011

Dallas Co.




70

Demographics: The demographic composition of Dallas taken in the context of the state and the nation, profoundly influences the service size, scope and priorities for Parkland Health & Hospital System. This section examines the significant demographic drivers outlined below:

Market Demographic Characteristics

•Population size and growth trends

•Population age distribution and trends

•Population ethnic composition and trends

•Per capita income and trends

•Poverty and unemployment trends

•Population educational attainment and trends

71

General Dallas County Demographic

Trends

2011 Estimated Population by

Age and Sex Female %* Male %**

0-4 96,361 7.9% 101,681 8.5%

5-14 179,305 14.7% 185,419 15.5%

15-17 51,230 4.2% 53,831 4.5%

18-24 115,877 9.5% 122,018 10.2%

25-44 367,148 30.1% 369,642 30.9%

45-64 285,424 23.4% 272,745 22.8%

65 years and up 125,635 10.3% 89,719 7.5%

Total 1,220,982 100.0% 1,195,056 100.0%

*: % of female population in Dallas County

**: % of male population in Dallas County

Population Trend by Age 2000 2010 2011

% change

2000-2011

0-4 181,951 192,838 198,113 8.9%

5-14 340,788 356,914 364,818 7.1%

15-44 1,098,009 1,068,802 1,079,958 -1.6%

45-64 419,279 541,613 558,099 33.1%

65 and up 178,872 207,972 215,025 20.2%

Total 2,218,899 2,368,139 2,416,014 8.9%

Ethnicity 2011 Population

% of the

Total

Population

White 789,297 32.67%

African American 514,297 21.29%

Asian 123,214 5.10%

American Indians 4,653 0.19%

Two or More 40,018 1.66%

Other 4,476 0.18%

Hispanic 939,984 38.91%

Total 2,416,014 100.0%

Household Income 2011 County

less than $25,000 25.6%

$25,000 to $74,999 45.1%

$75,000 to $99,999 10.3%

$100,000 and over 18.9%

Totals 100.0%

The Texas population has grown at a rate substantially outpacing that of the United States. Also growing at a very fast pace,

Dallas County has expanded by over 32%, or more than 600,000 thousand people, from 1990 to 2012.

The Dallas-Fort Worth area is one of the largest in the nation. Dallas-Fort Worth, the fourth largest metro area in the country,

grew by 23.5% in the past decade. Dallas County is the 9th largest county in the country, growing by 10.6% from 2000 to 2012.

The city of Dallas is the 9th largest city in the country, but only grew by 4.4% from 2000 to 2012.

Sources: U.S. Census 2000, 2010 and 2011.

72

Per Capita Income Trends 2006 and 2011

$2

6,7

08

$2

5,2

67

$2

3,1

71

$2

0,8

18

$2

6,5

43

$2

4,3

03

$2

6,4

89

$2

5,3

98

$2

5,2

67

$2

4,2

71

$2

4,6

82

$2

2,5

01

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

2011 2006


Dallas County Trend in Per

Capita Income, 2006 - 2011

Source: U.S. Census Bureau, American Community Survey, 2006-2011

$24,271

$25,769

$26,147

$24,915

$24,722

$25,267

$0 $10,000 $20,000 $30,000

2006

2007

2008

2009

2010

2011

Dallas Co.

Per Capita Income

Per capita income

$21,966 – $28,043



Dade, Cook

Other Peer Counties

Range

73

Percent of the population living below 200%

of the federal poverty level 2006 and 2011

35

.2%

31

.2%

40

.9%

39

.3%

41

.3%

39

.5%

36

.3%

31

.1%

44

.5%

39

.9%

39

.7%

38

.3%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2011 2006


Dallas County Trend for those with

Living below 200% of the Federal

Poverty Level, 2006 - 2011


39.9%

40.0%

41.9%

42.9%

43.6%

44.5%

0% 10% 20% 30% 40% 50%

2006

2007

2008

2009

2010

2011

Dallas Co.

Percent

Percent

37.1%– 46.0%



Dade, Cook

Other Peer Counties

Range

74

Percent of the children under the age of 6

living below the poverty level 2006 and 2011

25

.6%

20

.7%

28

.1%

27

.9%

32

.5%

25

.0%

28

.0%

18

.9%

33

.5%

26

.8%

29

.6%

26

.8%

0%

5%

10%

15%

20%

25%

30%

35%

40%

2011 2006


Dallas County Trend for children

under the age of 6 living below

the Federal Poverty Level, 2005 -

2011


28.8%

26.8%

29.6%

30.7%

31.6%

31.4%

33.5%

0% 10% 20% 30% 40%

2005

2006

2007

2008

2009

2010

2011

Dallas Co.

Percent

Percent

26.6% – 29.2%



Dade, Cook

Other Peer Counties

Range

75

Sources: Bureau of Labor Statistics http://www.bls.gov/lau/#tables and http://www.bls.gov/cps/cpsaat1.pdf ;

U.S. Census Bureau, American Community Survey 2005-2011

Dallas County Trend 2005 to Sept 2012

Access: Percent of Unemployment in the

Civilian Labor Force

This indicator shows the percent of the

civilian population unemployed

Historical data represents annual averages

Percent of the civilian population

Percent

Other Peer Counties



7.9

5.1

6.4

5.1

6.7

5.7

6.6

5.1

6.7

5.6

6.6

5.4

-

2.0

4.0

6.0

8.0

10.0

2012 2005


5.6

5.2

4.6

5.5

8.2

8.8

9.3

6.7

- 2.0 4.0 6.0 8.0 10.0

2005

2006

2007

2008

2009

2010

2011

2012

Dallas Co.

Other Peer Counties

Range, Sept 2012

6.9% to 9.7%

http://www.bls.gov/lau/

http://www.bls.gov/cps/cpsaat1.pdf

76

Percent of the population over the age of 25

with no high school diploma 2006 and 2011

14

.1%

15

.9%

17

.8%

19

.6%

21

.4%

23

.5%

15

.7%

16

.9%

23

.2%

25

.5%

18

.9%

21

.2%

0%

5%

10%

15%

20%

25%

30%

2011 2006


Dallas County Trend for those with

no high school diploma, 2006 - 2011


25.5%

25.5%

25.9%

25.1%

22.7%

23.2%

0% 5% 10% 15% 20% 25% 30%

2006

2007

2008

2009

2010

2011

Dallas Co.

Percent

Percent

13.7 % – 23.7%



Dade, Cook

Other Peer Counties

Range

77

Assumptions

Green – Doing better than the benchmark

Yellow – Same as/not significantly different from the benchmark

Red – Worse than the benchmark

Healthy People 2010 benchmark – higher, lower or same

Peer County Comparison benchmark – if Dallas County is in first or second

quartile, green; third quartile, yellow; fourth quartile, red (method used for

county rankings by Health Matters).

Dallas County Trend benchmark – if only 1-3 years of previous Dallas County data

are available, calculate percent difference from earliest year’s data to most

recent, assign red/yellow/green for worse/same/better; if 4 or more years of

previous Dallas County data are available, calculate 95% Confidence Interval

(see next page for notes about this procedure) and assign green for statistically

significantly better, red for statistically significantly worse, or yellow for no

significant difference. For BRFSS questions, latest year’s data and 95%

Confidence Interval was compared with that of the most recent previous year,

and if the 95% Confidence Intervals overlapped, the Trend was considered not

significantly different. If the Confidence Intervals did not overlap, the trend was

significantly higher or lower.

78

Assumptions

Confidence Intervals

For common events (such as ED visits for Injuries, non-emergent ED visits, percent

of population under 200% FPL) 95% Confidence Intervals were calculated on

previous years’ data using a binomial approach.

For uncommon events (rates less than 5%), which includes many of the measures

in this Dashboard, 95% Confidence Intervals were calculated on previous years’

data using a Poisson formula. This approach does not use population size.

For survey data, such as BRFSS data, where possible the 95% Confidence Interval

of the most recent year’s survey was compared with the 95% Confidence

Interval of the previous year’s survey, to determine whether there was

significant change. Because BRFSS surveys include a fairly small percentage

of the Dallas County population, these 95% CI’s are fairly wide, and few show

statistically significant improvement from one year to the next for Dallas County

data.

79

Notes: Age Adjusted Death

Rates

• Age Adjusted Death Rates: Death rates that control for the effects in population age

distributions. The centers for Disease Control and Prevention established the

standard population weights for direct age adjustments. The need for age

adjustment becomes particularly important when cause-specific mortality is of

interest. Unadjusted rates for chronic diseases (cardiovascular diseases, cancers,

or chronic lower respiratory diseases) may appear to be higher for older

populations when compared to a younger population. With age-adjustment those

differences may be reduced or even reversed. A mechanism for adjusting the age

structure differences is needed to determine if there really are mortality differences

between two populations. By applying age-specific mortality rates to a standard

population, direct standardization controls for differences in population

composition. Mortality trends can be more accurately compared along geographic,

temporal, or race/ethnicity lines, etc. In short, standardization lets us look at what

the death rate would be in one population if that population had the same age

structure as the standard population. Beginning with 1999 events, the United States

year 2000 population is used as the standard for age-adjusting.

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