the health of the bronx and new york city thomas r. frieden, m.d., m.p.h. commissioner, new york...
TRANSCRIPT
The Health of The Bronx and New York City
Thomas R. Frieden, M.D., M.P.H.Commissioner, New York City
Department of Health and Mental HygieneApril 24, 2003
Community Health Survey
• First ever NYC health survey– 10,000 New Yorkers interviewed on health status
and lifestyle– Largest survey of its kind ever in NYC
• Data reported and broken down into many different categories– More than just traditional demographic information
(sex, age, ethnicity)
• Detail will allow us to target services at the community level on a neighborhood-by-neighborhood basis, as needed
Neighborhoods Most in Need:Harlem, So. Bronx, Central Brooklyn
Smoking Prevalence in The Bronx(by UHF Neighborhood)
16.519.1
24.926.9
30.4
25.3
21.7
0
5
10
15
20
25
30
35
NortheastBronx
Kingsbr-Riverdale
Pelham-ThrogsNeck
Fordham-Bronx Pk
SouthBronx
Bronx(Boroavg.)
NYC
Healthy People 2010 Goal: 12%
Annual Deaths from Smoking Compared with Other Causes
NYC, 2001
0
2000
4000
6000
8000
10000
* Total includes smoking-related deaths# Total includes 265 AA587 deaths+ Total does not include 2,743 WTC deaths
Cancer Screening inThe Bronx vs. NYC
8478
49
8077
49
0
20
40
60
80
100
Colon Screening Mammogram PAP Smear
Bronx NYC
HP 2010: 90%
Colon CancerDetection & Cure Rates
0
20
40
60
80
Colorectal Cancer Breast Cancer Prostate Cancer
Early-Stage Detection Rates Colorectal Cancer Cure Rates
0
20
40
60
80
100
Early stage Late-stage
HIV & AIDS Cases in The BronxCalendar Year 2001
1696
14694
0
2000
4000
6000
8000
10000
12000
14000
16000
# Living w/HIV & AIDS # New HIV Diagnoses
Figures as of 12/31/01
Rates of People Living w/HIV & AIDS in The Bronx vs. NYC vs. US
Calendar Year 2001 – Rates per 1,000 Pop.
5.1
7.9
10.7
15.617.0 17.0
11.1
9.2
3.23.9
0
2
4
6
8
10
12
14
16
18
Kin
gsb
ridg
e
NE
Bro
nx
Pe
lha
m
Fo
rdh
am
-B
ron
x P
k
Cro
ton
a-
Tre
mo
nt
Hu
nts
Po
int
Hig
hb
ridg
e
Bro
nx
NY
C
US
Figures as of 12/31/01
Rates of New HIV Diagnoses in The Bronx vs. NYC vs. US
Calendar Year 2001 – Rates per 1,000 Pop.
0.6
0.8
1.2
1.92.1
2.3
1.3
0.8
0.10.3
0.0
0.5
1.0
1.5
2.0
2.5
Kin
gsb
ridg
e
NE
Bro
nx
Pe
lha
m
Fo
rdh
am
-B
ron
x P
k
Cro
ton
a-
Tre
mo
nt
Hig
hb
ridg
e
Hu
nts
Po
int
Bro
nx
NY
C
US
Figures as of 12/31/01
There Has Been a Resurgence of Risky Sexual Behavior
• Syphilis cases more than doubled between 2000 and 2001, increased another 50% in 2002
• Syphilis increase almost entirely among men, especially MSM
• Foreshadowing future rise in HIV rates?
0.51 0.51 0.66
10.75
7.50
3.07
02
468
1012
2000 2001 2002
Rat
e per
100,0
00
Females Males
Reported Primary and Secondary Syphilis Case Rates, NYC, 2000-2002
Diabetes Prevalence Has More than Doubled in NYC in the Past 8 Years Adults with Self-Reported Diabetes, NYC, 1994-2002
7.9
6.3
6.7
4.73.7
0
1
2
3
4
5
6
7
8
9
1994-95 1996-97 1998-99 2000-01 2002
% R
epo
rtin
g D
iab
etes
Percent of Overweight NYC Residents (BMI > 25), by Borough
43
52 5357
62
53
0
10
20
30
40
50
60
70
Manhattan Queens Brooklyn StatenIsland
Bronx NYC
% O
ve
rwe
igh
t (B
MI
> 2
5)
A woman 5’4” tall is considered overweight at 146 lbs.A man 5’10” tall is considered overweight at 174 lbs.
Percent of Overweight Bronx Residents (BMI > 25), by UHF District
45
60 6065 66 66 66
62
53
0
10
20
30
40
50
60
70
% O
verw
eig
ht
(BM
I >
25)
A woman 5’4” tall is considered overweight at 146 lbs.
A man 5’10” tall is considered overweight at 174 lbs.
Percent of Obese NYC Residents (BMI > 30), by Borough
11.9
15.416.8
18.8
21.8
16.6
0
5
10
15
20
25
% O
bese (
BM
I >
30)
A woman 5’4” tall is considered obese at 175 lbs.A man 5’10” tall is considered obese at 209 lbs.
Percent of Obese Bronx Residents (BMI > 30), by UHF District
12.7
21.323.0 23.3
27.0 27.4 27.4
21.8
16.6
0
5
10
15
20
25
30
% O
bese (
BM
I >
30)
A woman 5’4” tall is considered obese at 175 lbs.A man 5’10” tall is considered obese at 209 lbs.
Diabetes Prevalence in NYCBy Borough, 2002
4.6
6.07.0
9.0
11.5
7.9
0
2
4
6
8
10
12
14
Staten Isl Manhattan Queens Brooklyn Bronx NYC
Healthy People 2010 Goal: 2.5%
Diabetes Prevalence in NYCBy Ethnicity, 2002
5.0
6.8
10.8
12.2
7.9
0
2
4
6
8
10
12
14
White Asian Black Hispanic NYC
Healthy People 2010 Goal: 2.5%
Percent of Bronx Residents w/ Diagnosed Diabetes, by UHF District
7.8
9.911.1
12.6 12.6 13.0 13.211.8
7.9
0
2
4
6
8
10
12
14
% w
/Dia
gn
ose
d D
iab
etes
Good Diabetes Management
• Patient education and participation– “Know your ABCs”
• A1c level below 7%• Blood pressure less than 130/80• Cholesterol (“bad” LDL cholesterol) less than 100
• Clinical best practices• Systematic monitoring of and accountability
for HbA1C, retinal, foot care• Cardiovascular disease prevention:
– Smoking, blood pressure, lipid control
On ABCs, USA Gets an “F”
• People with diabetes who have adequately controlled blood sugar – 11%
• People with hypertension who have adequately controlled blood pressure – 27%
• People with high cholesterol who have adequately controlled hyperlipidemia – 27%
Despite spending 1 out of every 7 dollars on health care!
Percent of NYC Adults Who Report One or More Binge Drinking Episodes
>5 drinks at one time within past month (by Borough)
12.8 13.0
14.916.2
18.6
15.2
0
2
4
6
8
10
12
14
16
18
20
Brooklyn Bronx Staten Isl Queens Manhattan NYC
Healthy People 2010 Goal: 6%
Percent of All Bronx Adults Who Report One or More Binge Drinking Episodes
>5 Drinks per Month (by UHF District)
8.0
13.2 13.4 13.514.4
13.0
15.2
0
2
4
6
8
10
12
14
16
NE Bro
nx
Fordh
am-B
ronx
Pk
Pelham
-Thr
ogs N
eck
Kingsb
ridge
South
Bro
nx
Bronx
NYC
Hospital AdmissionsRelated to Mental Disorders
Age adjusted rates per 10,000 population, excluding alcohol-related, by Bronx UHF Neighborhood, NYC 2000
52.9 55.862.5
87.5 90.599.3 99.5
69.4 66.5
0
20
40
60
80
100
120
Pe
lha
m-T
hro
gs
Ne
ck
Kin
gsb
rid
ge
NE
Bro
nx
Cro
ton
a-
Tre
mo
nt
Fo
rdh
am
-Bro
nx
Pk
Hig
h B
rid
ge
-M
orr
isa
nia
Hu
nts
Po
int-
Mo
tt H
ave
n
Bro
nx
NY
C
Ho
sp
ita
liza
tio
n R
ate
pe
r 1
0,0
00
Po
pu
lati
on
Trends in Infant MortalityNYC, 1991-2001
11.4
6.1
10.2 10.2
9.08.8
7.87.1 6.8 6.9 6.7
0.0
2.0
4.0
6.0
8.0
10.0
12.0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Per
1,0
00 L
ive
Bir
ths
HP 2010 Goal: 4.5
HP 2000 Goal: 7.0
Infant Mortality Rate and 95% Conf. Interval, by Bronx Health Center District, New York City, 2001
5.1 5.2 5.3
7.27.0
4.4
0.0
2.0
4.0
6.0
8.0
10.0
12.0
PELHAM BAY MOTT HAVEN FORDHAM-RIVERDALE
MORRISANIA TREMONT WESTCHESTER
IMR NYC Avg.: 6.1
HP2010 Goal: 4.5
HP2000 Goal: 7.0
Teen Pregnancy in NYC, 2000(by UHF Neighborhood)
NYC Teen Pregnancy Rates1996-2000, by Year & Borough of Residence
50
100
150
200
1996 1997 1998 1999 2000
per
1,0
00 f
emal
es a
ge
15-1
9
Manhattan Bronx Brooklyn Queens Staten Isl.
Trends in NYC Asthma HospitalizationRates per 1,000 persons, 1990-2000, All Ages
3.44.03.7
4.3
4.64.64.65.1
4.74.34.0
0
1
2
3
4
5
6
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Rat
e pe
r 1,0
00 P
erso
ns
Asthma HospitalizationsAre Decreasing
But Still More Prevalent Among Low-Income NeighborhoodsTrends in Asthma Hospitalization Rates, High- and Low-
Income ZIP Codes, Children Aged 0-4, NYC 1988-2000
0
5
10
15
20
25
30
Ra
te p
er
1,0
00
Po
pu
lati
on
Low-IncomeHigh-Income
Asthma Hospitalizations in The BronxHospitalization rate of children under age 15,
per 1,000 population, by UHF neighborhood, 2000
4.8
7.8
8.89.5
10.0
11.0
9.2
6.1
9.0
0
2
4
6
8
10
12
Kin
gsb
rid
ge
-
Riv
erd
ale
NE
Bro
nx
Pe
lha
m-T
hro
gs
Ne
ck
Fo
rdh
am
-Bro
nx
Pk
Cro
ton
a-T
rem
on
t
Hu
nts
Pt-
Mo
tt
Ha
ven
Hig
h B
rid
ge
-
Mo
rris
an
ia
Bro
nx
NY
C
Too Few People areGetting Flu Shots
NYC, 2001 Influenza Immunization Data
31
63
0
20
40
60
80
100
Ages 50-64 Ages 65+
% I
mm
un
ize
d
Healthy People 2010 Goal: 90%
Gender and Racial Disparities in Vaccinations
NYC, 2001 Influenza Immunization Data
59
6763
53 52
69
0
20
40
60
80
100
Male Female White Hispanic Black Asian
% Im
mu
niz
ed (
ove
r ag
e 65
)
Healthy People 2010 Goal: 90%
Gender and Racial Disparitiesin Vaccinations
NYC, 2001 Pneumococcus Immunization Data
49
56
4642
31
53
0
20
40
60
80
100
Male Female White Hispanic Black Asian
% Im
mu
niz
ed (
ove
r ag
e 65
)
Healthy People 2010 Goal: 90%
Flu Vaccinationsby Bronx Neighborhood
NYC, 2001 Influenza Immunization Data
49
57
67
80
64 6366
0
20
40
60
80
100
Fordham-Bronx Pk
NE Bronx SouthBronx
Pelham-ThrogsNeck
Kingsbr-Riverdale
Bronx NYC
% I
mm
uniz
ed (
over
age
65)
10 Things Everyone Should Do to Stay Healthy
1. Have a regular doctor or nurse practitioner
2. Don’t smoke and don’t accept smoking around you or your children
3. Know your vital signs and keep them healthy (blood pressure, cholesterol, weight)
4. Know your HIV status and use condoms to protect against HIV and other STDs
5. Don’t live with depression – seek help
10 Things Everyone Should Do to Stay Healthy
6. Know the warning signs of drug/alcohol abuse – ask your doctor to help
7. Get screened for cancer, especially colon, cervical and breast
8. Get your shots – everyone needs immunizations9. Live in a home free of violence10. Be healthy before getting pregnant, plan your
pregnancy, and get early and regular prenatal care