Making Data Driven Decisions: Where to Find Health Data

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Making Data Driven DecisionsWhere to Find
Health Data

• Indiana Lead-Safe and Healthy Homes Conference
• November 5, 2008

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Session Objectives

• In this session, the participant will
• Learn what information is available from the
  Indiana State Department of Health
• Learn possible uses and applications for the
  information
• Learn what resources are available for assistance
  with data collection and dissemination

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Vital StatisticsAnalyzed by the Data Analysis
Team

• Indiana Mortality Data www.in.gov/isdh/19096.htm
  
• Annual reports
• State, counties, cities with population gt
  25,000
• Deaths, infant deaths, fetal deaths
• By age, sex, race, and cause of death

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Vital Statistics, continued

• Indiana Natality Report www.in.gov/isdh/19095.ht
  m
• Annual reports
• State, counties, cities with population gt
  25,000
• Births, birth rates, low birth weight,
  gestational age
• By age, sex, race, and unmarried status of mother
• By select maternal behaviors
• Smoking
• Alcohol use
• Prenatal care

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Indiana Birth Defects and Problems Registry

• Multiple year report
• State and counties
• Targeted and reportable conditions
• Rates per live births
• IBDPR Rule (410 IAC 21-3)

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Table 8 Confirmed and Probable Counts and Rates
of Targeted Conditions for 2003-2004 Births to
Indiana Women by County (Rates per 1,000 live
births.)
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Indiana State Cancer Registry

• Annual reports
• State and counties
• Incidence (the number or rate of newly diagnosed
  cases in a specified population during a given
  year), mortality, stage (classification based on
  the extent of the cancer)
• By age, sex, race and ethnicity

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Behavioral Risk Factor Surveillance System
(BRFSS)

• Annual reports
• Adults gt 18 years
• State and national comparison
• Prevalence (the percent of the population with a
  condition or practicing a behavior during a given
  time period)
• By age, sex, race and ethnicity, education level,
  or income level

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Hospital Discharge Data

• Public Access Data Files Aggregate Data
• Annual
• State
• Principal diagnosis or procedure, ICD-9-CM codes
• Patient/event numbers, total charges, average
  charges, length of stay in days, by hospital and
  primary payor
• http//www.in.gov/isdh/reports/hosp_disch_data/200
  6/index.htm

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What is Asthma?

• A chronic disease affecting the airways of the
  lungs
• Common symptoms include wheezing, breathlessness,
  chest tightness, nighttime or early morning
  coughing
• Triggers are things that cause an asthma attack
• Pet dander, dust mites, mold, cockroaches,
  pollen, tobacco smoke, air pollution, strong
  odors, exercise, respiratory infections

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The Impact of Asthma on the U.S. Population

• In 2005, an estimated
• 32.6 million people had been diagnosed with
  asthma during their lifetime
• 22.2 million people currently were diagnosed with
  asthma
• 12.2 million people experienced an asthma attack
  in the previous year
• In 2004, asthma accounted for
• 13.6 million doctor visits
• 1.1 million hospital outpatient visits
• 1.8 million emergency department visits
• 497,000 hospitalizations
• 3816 death
• Source CDC National Center for Health
  Statistics, National Vital Statistic Report 2004
• http//www.cdc.gov/nchs/products/pubs/pubd/hestats
  /asthma/asthma.htm
• http//www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19
  .pdf

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Indiana State Department of Health - Asthma
Program

• Develops maintains a comprehensive asthma
  surveillance system
• Four primary sources of data
• The Behavioral Risk Factor Surveillance System
  (BRFSS)
• Hospital discharge data
• Death certificates
• Medicaid administrative data
• What is measured - child adult asthma
  prevalence, hospitalizations, emergency room
  visits, deaths, disease management
• What is identified disparities, progress
  towards Healthy People 2010, program goals
  objectives

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County Level Data

• BRFSS (asthma prevalence) - not reported due to
  the small sample size of most counties
• 2005 ageadjusted asthma hospitalization rates
  numbers available in 2008 Burden Report
• 2005 ageadjusted asthma emergency department
  visits rates numbers available in 2008 Burden
  Report

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Where to Find Asthma Data Specific to Indiana

• Publications online at http//www.in.gov/isdh/1727
  9.htm
• Burden Report (2004 2008)
• Breathe In, Breathe Out (newsletter)
• Fact Sheets
• Contact the Indiana State Department of Health
  Asthma Program

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The Impact of Asthma on Indiana

• In 2007, approximately
• 415,000 (8.8) adults currently have asthma
• 125,000 (8) children in Indiana reported that
  have current asthma.
• In 2005, asthma prevalence was significantly
  higher among
• Adult females
• Adults with less than a high school education
• Adults with an annual household income less than
  15,000
• Source Indiana BRFSS The Burden of Asthma in
  Indiana Second Edition March 2008

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The Impact of Asthma on Indiana

• In 2005
• 85 deaths due to asthma (60 females 25 males)
• Asthma hospitalization rate relatively steady
  from 2002 to 2005 (12.8 per 10,000 to 13.2 per
  10,000 Indiana residents)
• Number rate of asthma hospitalizations higher
  for females than males
• Asthma hospitalization rate for blacks was more
  than two and a half times higher than the rate
  for whites
• One third of adults with current asthma were
  current smokers
• Source The Burden of Asthma in Indiana Second
  Edition March 2008

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Healthy People 2010 Goals

• Two Healthy People 2010 objectives (Section 1.9
  and 24) addressing asthma
• Objectives for asthma focus on mortality rates,
  hospitalization rates, emergency department (ED)
  rates, disease management
• Indiana has met objectives for
• Asthma hospitalizations among children under 18
• Asthma mortality rate for individuals 65 years
  older
• Asthma ED rates for age groups 5-64 gt65

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How Can the Data be Used?

• Assess disease burden
• Grant applications
• Create new or change existing policies
• Set program goals objectives
• Measure progress towards goals objectives
• Inform partners stakeholders

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Indiana Lead and Healthy Homes Program Statewide
Surveillance Data Capacity

• Collection of statewide blood lead level (BLL)
  testing data from all labs.
• Childhood BLL surveillance
• Includes children 0 to lt16 years of age
• Reporting age 0 84 months, currently 72 of BLL
  surveillance data is electronically transferred.
• Data is submitted to CDC every 3 months
• Adult BLL surveillance data (Adults gt16 years of
  age)
• Data is submitted to CDC NIOSH (National
  Institute for Occupational Safety and Health) two
  times per year for the Adult Blood Lead
  Epidemiology and Surveillance program (ABLES)
• BLL testing data for pregnant women - information
  is available from the ISDH lab data.

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Indiana Lead and Healthy Homes Program Statewide
Surveillance Data Capacity

• Information generated from statewide BLL
  surveillance system
• Total number of blood lead levels (BLLs) tested
• Number of unique children tested
• Total number of children with initial elevated
  BLLs gt10µg/dL.
• Total number of children with confirmed elevated
  BLLs gt10µg/dL
• Case management and environmental investigations
  data
• All of the above information available statewide,
  by county, for specific period of time
• 
  

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Indiana Lead and Healthy Homes Program Statewide
Surveillance Data Capacity

• Blood lead testing and elevated BLL information
  in Medicaid eligible children 0 to 84 months of
  age.
• Number of Medicaid eligible children tested -
  Statewide, by county, for specific period of time
  
• Total number of Medicaid eligible children with
  confirmed elevated blood lead levels gt10µg/dL -
  Statewide, by county, for specific period of time

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Indiana Lead and Healthy Homes Program Statewide
Surveillance Data Capacity

• Section 8 and PHA address matching with elevated
  BLLs.
• Feed back information for state HUD Field Office,
  LOCAL Public Housing Authorities and Section 8
  Housing Organizations.
• Lead poisoning awareness information from Indiana
  Behavioral Risk Factor Surveillance System
  (BRFSS)
• Program has been working on identifying testing
  rates and elevated BLLs in WIC eligible children

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Monitoring Long Term Goals Elevated Blood Lead
LevelsFY 2005, FY 2006, FY 2007, FY 2008
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The Indiana Lead and Healthy Homes ProgramReport
to the Legislature forCalendar Year 2007
70,000
60,000
50,000
Children tested
40,000
30,000
20,000
10,000
0
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The Indiana Lead and Healthy Homes ProgramReport
to the Legislature forCalendar Year 2007
Confirmed elevated BLL
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The Indiana Lead and Healthy Homes ProgramReport
to the Legislature forCalendar Year 2007
Percent of existing confirmed elevated blood lead
levels
2000 to 2007
2
1.9
1.8
1.8
1.6
1.4
1.4
1.3
1.2
1.2
1.1
Percent with confirmed elevated BLL
1
0.98
0.8
0.6
0.4
0.2
0
2001
2002
2003
2004
2005
2006
2007
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Case Management and Environmental
InvestigationsJanuary 1, 2007 to December 31,
2007
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Case Management and Environmental
InvestigationsJanuary 1, 2007 to December 31,
2007
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State and CDC Sub Grantee Medicaid Screening
Rates, Children 0 to 7 Years of Age
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Medicaid Screening Rates in CDC
Sub Grantees Jurisdictions
Children 0 to 7 Years of Age
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Data Used for HUD Lead Hazard Control Grant
Applications
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Top Ten Counties BLL Testing and Elevated BLLs
Calendar Year 2006 Children 0 to 7 Years
Foot note Numbers based on 2000 Census
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Data Limitations

• BRFSS Data
• Self-reported data (self-reported diagnosis of
  asthma)
• Excludes children under the age of 18.
• Not enough sample on the county level. (less than
  50 is not reliable sample size)
• Medicaid Data
• Medicaid prevalence figures reported are based to
  a large extent on non-reimbursed encounter claims
  (shadow claims).
• People age 65 and older are not included.
• Those individuals enrolled in Medicaid for less
  than 11 months were not included.

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Confidentiality

• In order to respect the privacy and guard the
  confidentiality of all persons, we cannot release
  any individual level data. We also will not
  release information which could be linked with
  other sources of data to identify an individual.
  Thus, case numbers less than 5 are suppressed.
  Also, because rates based on small numbers of
  cases are unstable and misleading, rates based on
  less than 20 cases are flagged or suppressed.

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QUESTIONS

• For questions about the mortality, natality, or
  inpatient aggregated hospital discharge data
  reports please call 317.233.7349 or e-mail
  data-analysis_at_isdh.state.in.us
• For questions about the cancer incidence and
  mortality reports, please call [phone] or
  e-mail mlundy_at_isdh.in.gov

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Data Sources

• List of recommended data sources
• http//www.isdh.state.in.us/NewIntranet/pdfs/Recom
  mendedDataSources.pdf
• Indiana Birth Defects and Problems Registry
• http//www.in.gov/isdh/20218.htm
• Indiana State Cancer Registry
• http//www.in.gov/isdh/22689.htm

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Contact Information

• Lead information
• Syama Dasari
• 317.233.1250
• sdasari_at_isdh.in.gov
• Asthma information
• Hesam Lahsaee
• 317.234.2886
• hlahsaee_at_isdh.in.gov
• Other information
• Elizabeth Hamilton-Byrd
• 317.233.7542
• ebyrd_at_isdh.in.gov