Healthiest Wisconsin 2020 Baseline and Health Disparities Report Healthy Growth and Development

Wisconsin Department of Health Services

January 2014 P-00522H

Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Healthy Growth and Development

HEALTHY GROWTH AND DEVELOPMENT

Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities

Report • Healthiest Wisconsin 2020 objectives and indicators• Rationale• Key points

Data• Infant mortality and low birthweight• Risk factors• Health care access and utilization

References

Links to additional reports and resources

Contacts

Chapter Outline

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Chapter outline


Report Overview

• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf

• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.

• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.

• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

Report overview

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http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf

http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf



Report Format

Full Report• Format: PDF • Intended use: reference document

Chapters• Format: Annotated PowerPoint slide set• Intended uses: presentations to

– Decision-makers– Service providers– Community leaders– The public

Sample annotated slide

Report overview

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Report Outline

Executive Summary

Section 1: Introduction

Section 2: Demographic overview

Section 3: Health focus areas

Section 4: Infrastructure focus areas

Section 5: Data summaries by population

Section 6: Technical notes

Report overview

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Report Outline: Detail

Section 3: Health focus areas

• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure

Section 4: Infrastructure focus areas• Access to health care

Report overview

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Report Outline: Detail

Section 5: Data summaries by population

Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics

People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography

Report overview

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Data notes

• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

• The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution.

• Population estimates that are considered unreliable are excluded.

• Misclassification of racial/ethnic groups may affect the accuracy of rates.

• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.

Report overview

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Factors that influence health

Social determinants

of health

Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

Report overview

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Objective 1 By 2020, increase the proportion of children who receive periodic developmental screening and individualized intervention.

Objective 1 Indicators

• Proportion of parents reporting that a health provider assessed their child’s learning, development, communication, or social behavior.

• Number of children who received services from the Birth to Three program during the first year of life.

Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Healthy Growth and Development Profile.

Healthiest Wisconsin 2020 objectives and indicators

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HW2020 objectives


Objective 2

By 2020, provide pre-conception and inter-conception care to Wisconsin women in population groups disproportionately affected by poor birth outcomes.


• Rates of avoidable infant and fetal death.

• Percentage of births to women with avoidable risks for poor birth outcomes.

Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Healthy Growth and Development Profile.11


HW2020 objectives


Objective 3

By 2020, reduce the racial and ethnic disparities in poor birth outcomes, including infant mortality.


• Disparity ratios for infant mortality, low birthweight, prematurity, and timing of entry into the Women, Infants and Children (WIC) program.

Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Healthy Growth and Development Profile.


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HW2020 objectives


Rationale

• Healthy growth and development in early life have a profound effect on health across the life span.

• Research demonstrates a link between early life events and adult chronic diseases. Babies born at lower birthweights have an increased risk of developing heart disease, diabetes, and high blood pressure in later life.

• Infants with poor birth outcomes begin life with multiple risk factors that may prevent them from reaching their full health and development potential.

Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Healthy Growth and Development Profile.13

Rationale


Key points

• While Wisconsin’s infant mortality rate has declined over the past 10 years, notable racial disparities remain. In 2010, the Black infant mortality rate (13.9 deaths per 1,000 live births) was approximately three times greater than for Whites (4.9 per1,000).

• During 2009-2010, nearly two out of three births to Black mothers in Wisconsin were the result of unintended pregnancy.

• Smoking during pregnancy is much more common than drinking during pregnancy. An estimated one out of five Black women who recently gave birth smoked during pregnancy.

• In more than one-third of Laotian/Hmong births, the mother did not receive first-trimester care, nearly three times the rate among White births.

• Rates of drinking during pregnancy were similar by race/ethnicity. Among the racial and ethnic groups reported here, Hispanic women were the least likely to smoke or drink during a recent pregnancy.

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Key points


Infant mortality and low birthweight

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Infant mortality by race/ethnicity, rate per 1,000 births, Wisconsin, 2001-2010

Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.


2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

5

10

15

20

25 BlackAmerican IndianLaotian/HmongHispanicWhite

Rate

per

1,0

00 b

irths

16


Percentage of low birthweight (<5.5 pounds) births, by maternal race/ethnicity, Wisconsin, 2008-2010

Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates.


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Low birthweight0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

6.0% 13.7% 6.1% 7.1% 6.8%

WhiteBlackHispanicLaotian/HmongAmerican Indian


Percentage of low birthweight (<5.5 pounds) births, by maternal education level, Wisconsin, 2008-2010


Low birthweight0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

10.0% 8.1% 6.6% 5.5%

Some high schoolHigh school graduateSome collegeCollege graduate

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Risk factors

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Unintended pregnancy as a percent of births, by race/ethnicity, Wisconsin, 2009-2011

Risk factors

Source: Wisconsin Department of Health Services, Division of Public Health, PRAMS, 2009-2011. 20

Percent of births in which pregnancy was unintended0%

10%

20%

30%

40%

50%

60%

70%

32% 65% 43%

White Black

Hispanic


Percentage of new mothers who drank alcohol during the last three months of pregnancy, by race/ethnicity, Wisconsin, 2009-2011

Risk factors

Drank alcohol during last three months of pregnancy0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

8% 6% 6%

White Black

Hispanic

Source: Wisconsin PRAMS, 2009-2011. Division of Public Health, Department of Health Services.Note: “Other” includes Asians and American Indians.

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Percentage of new mothers who smoked during the last three months of pregnancy, by race/ethnicity, Wisconsin, 2009-2011

Risk factors


Smoked during last three months of pregnancy0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

13% 18% 7%

White Black

Hispanic

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Percentage of new mothers who smoked postpartum, by race/ethnicity, Wisconsin, 2009-2011

Risk factors


Smoked postpartum0%

5%

10%

15%

20%

25%

17% 23% 9%

White Black

Hispanic

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Health care access and utilization

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Percentage of births to mothers who received prenatal care during the first trimester, by race/ethnicity, Wisconsin, 2010


Prenatal care during first trimester0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

88% 74% 75% 66% 72%

WhiteBlackHispanicLaotian/HmongAmerican Indian


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Percentage of births to mothers who received prenatal care during the first trimester, by maternal education level, Wisconsin, 2010


Prenatal care during first trimester0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

70% 80% 88% 93%

Some high schoolHigh school graduateSome collegeCollege graduate


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HEALTHY GROWTH AND DEVELOPMENTPercentage of children ages 10 months to 5 years who did not receive screening for developmental, behavioral, and social delays, Wisconsin and United States, 2011-2012

Source: National Survey of Children’s Health, 2011-2012.

Did not receive developmental screening in past 12 months0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

66% 69%

WisconsinU.S.


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References

1. University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach

2. Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf

3. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

4. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/

5. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

6. National Survey for Health Statistics. National Vital Statistics Reports. Deaths: Preliminary Data for 2010. http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf

7. U.S. Department of Health and Human Services. Infant Mortality Fact Sheet. http://www.hhs.gov/news/factsheet/infant.html

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References

http://www.countyhealthrankings.org/our-approach

http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf

http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/

http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf

http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf

http://www.hhs.gov/news/factsheet/infant.html




8. Centers for Disease Control and Prevention (CDC). Is low birthweight a health problem? http://www.cdc.gov/pednss/how_to/interpret_data/case_studies/low_birthweight/what.htm

9. CDC. Unintended Pregnancies. http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/

10. CDC. PNSS Health Indicators. http://www.cdc.gov/pednss/what_is/pnss_health_indicators.htm#Smoking/Drinking Indicators

11. CDC. Health Effects of Secondhand Smoke. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/

12. CDC. During Prgnancy. http://www.cdc.gov/pregnancy/during.html 13. American Academy of Pediatrics. Developmental Surveillance and Screening of

Infants and Young Children. http://pediatrics.aappublications.org/content/108/1/192.full

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References

http://www.cdc.gov/pednss/how_to/interpret_data/case_studies/low_birthweight/what.htm

http://www.cdc.gov/pednss/how_to/interpret_data/case_studies/low_birthweight/what.htm

http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/

http://www.cdc.gov/pregnancy/during.html

http://www.cdc.gov/pregnancy/during.html

http://pediatrics.aappublications.org/content/108/1/192.full


Links to additional reports and resources

• Wisconsin Births and Infant Deaths, 2010: http://www.dhs.wisconsin.gov/publications/P4/P45364-10.pdf

• Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS):http://www.dhs.wisconsin.gov/births/prams/index.htm

• Children and Youth with Special Health Care Needs Program:http://www.dhs.wisconsin.gov/health/children/

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Links


Liz OftedahlEpidemiologistChildren and Youth with Special Health Care Needs (CYSHCN) Program / Maternal and Child Health ProgramBureau of Community Health PromotionDivision of Public Health Wisconsin Department of Health ServicesEmail: [email protected]

Contact

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Contacts

mailto:[email protected]

Documents

Healthiest Wisconsin 2020 Baseline and Health Disparities Report Healthy Growth and Development