1F.C. Lemus

COMMUNITY CORRELATES OF BACTERIAL PNEUMONIA

HOSPITALIZATIONS, 65+, TEXAS BORDER COUNTIES

Frank C. Lemus, M.A., Predoctoral Student, Alai Tan, M.D., Ph.D., Carlos Reyes-Ortiz, M.D., Ph.D., Daniel

H. Freeman Jr., Ph.D., Jean L. Freeman, Ph.D.

APHA 134th Annual Meeting and ExpositionNovember 4-8, 2006

Boston, MA

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ABSTRACT

We estimated baseline hospitalization rates in the 32 Texas Border Counties toward achieving Healthy Border 2010 Focus Area 1: Improve access to primary care and Focus Area 6: Improve rates of immunization and reduce rates of infectious diseases by tracking Healthy People 2010 Objective 1.9c: Reduce hospitalization rates for the following ambulatory care sensitive condition (ACSC) & Agency on Healthcare Research & Quality (AHRQ) prevention quality indicator (PQI): immunization-preventable bacterial pneumonia-persons aged 65+. Hospitalization rates based on data from Texas Health Care Information Council (THCIC) hospital discharge data system for 3 years 1999, 2000, 2001, & population counts from 2000 U.S. Census.

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PURPOSE

Estimate baseline hospitalization rates for bacterial pneumonia, 65+, Texas Border Counties

Learn if contextual (county) characteristics associated with ACSC & PQI bacterial pneumonia

Methodology to assess progress of Texas Border Counties toward achieving Healthy Border 2010 Focus Areas 1: and 6: and Healthy People 2010 Objective 1.9c.

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AIMS Estimate hospitalization rates for ACSC & PQI

-Immunization preventable bacterial pneumonia (persons 65+)

Identify association of contextual (county) characteristics with bacterial pneumonia hospitalizations

-race/ethnic concentration, income

Study 3 major racial/ethnic groups (non-Hispanic White, Black, Latino)

Target 32 Texas Border Counties defined by La Paz Agreement (1983) and Public Law 103-400 (1994)

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Healthy Border & Healthy People 2010 Overarching Goals

Increase Quality & Years of Healthy Life

– Help individuals of all ages increase life

expectancy and improve their quality of life

Eliminate Health Disparities

– Eliminate health disparities among different

segments of the population

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United States–Mexico Border Region

Legally defined by La Paz Agreement (1983) and Public Law 103-400

2000 mile long (California/Baja California to Texas/Tamaulipas)

62 miles (100 kilometers) within either side of United States and Mexico

1,248 mile Texas/Mexico border

Rio Grande River one of most polluted rivers in North America, and primary source of drinking water for many border communities.

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Source: U.S.-Mexico Border Health Commission: 2004 Immunization Week Preparatory Workshop, Quito, Ecuador: http://www.paho.org/English/DD/PIN/285,3,Slide 3

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Texas Office Of Border Health

http://www.dshs.state.tx.us/borderhealth/border_health_map.shtm

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Border FactsLatinos 41% of border population, without San Diego County 71%, (historically permanent home or “in-transition” home)Over 90% border population concentrated in or near 14 sister or twin cities on both sides of borderDouble-digit population growth rate between 1970 and 2000, over 2.7 million to over 6 million36% of Latino border population <18 years compared to 19% of non-Latinos, yet 65+ in US = 12.4%; TX = 9.9%, 32 Border Counties = 13.3%Maquiladoras (assembly plants), NAFTA, Colonias are major influences on border health

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WHY ACSCs/PQIs?

Provide baseline information about a community

Mechanism to evaluate the progress of a community in achieving the goals of Healthy Border 2010 & Healthy People 2010

ACSCs/PQIs based on hospital inpatient data, but provide insight into the quality of the health

care system outside the hospital setting

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DATA & RESOURCESTexas Health Care Information Council (THCIC) hospital discharge database (32 Texas Border Counties) Years 1999, 2000, 2001

2000 U.S. Census Summary File 1 (SF 1) State population counts for targeted communities by age, sex, race, ethnicity

International Classification of Diseases, 9th Revision Clinical Modification (ICD-9-CM)

Healthy Border 2010 report & Healthy People 2010 report

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THCIC DISCHARGE DATA

Administrative data– demographics & clinical (ICD-9-CM)

2.57 million discharge records per year

Public use data for years 1999, 2000, and 2001

Helps Texas consumers and researchers make informed health care decisions

Data source for health services research on hospital care in Texas

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2000 U.S. CENSUS

Summary File 1 (SF 1): Presents data for the United States, the 50 states, and the District of Columbia. Contains 286 detailed tables including state population counts by targeted communities for:

Age Income Race Ethnicity

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Hospitalizations, Persons 65+, 32 Texas Border Counties (THCIC)

Year 1999: 255,414

Year 2000: 262,145

Year 2001: 270,516

Total Records: 788,075

Bacterial Pneumonia Discharges, 65+, 32 Texas Border County Records: 10,749

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METHODOLOGY FOR RATE CALCULATIONS

Followed HP 2010 protocol for rate calculation for each county

Numerator = discharge data x 10,000

Denominator = U.S. Census data x 3

= Rate

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Followed HP 2010 Protocol & Methodology for Rate Calculation

Bacterial pneumonia rate per 10,000 persons in Duval County = 386.29/10,000 persons

10,000 x persons 65+ years hospitalized in Duval Co (213), ICD-9-CM Codes Bacterial Pneumonia, (THCIC 1999-2001)

Population 65+ years in Duval Co, 2000 (1838) X 3 (2000 US Census (SF 1))

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Bacterial pneumonia hospitalization rates, 32 Texas Border counties, 65+

years, 1999-2001

0

50

100

150

200

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Texas Border Counties

Bac

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per

10,

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COUNTY POPULATION BY COUNTY BACTERIAL PNEUMONIA RATES

Counties by population 65+ with 4 lowest rates/10,000– Kenedy: 44 0– Kinney: 822 16.22 – Val Verde: 4913 23.75– Zavala: 1307 38.26

Counties by population 65+ with 4 mid range rates/10,000– La Salle: 682 151.52– Hidalgo: 55274 160.53– Cameron: 37375 161.60– Jeff Davis: 359 167.13

Counties by population 65+ with 4 highest rates/10,000– Brewster: 1297 246.72– Hudspeth: 331 302.11– Brooks: 1150 318.84– Duval: 1838 386.29

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Bacterial pneumonia hospitalization rates/ 10,000, 65+ yrs by Mdn Hshld Inc,1999-2001

0.0

100.0

200.0

300.0

400.0

15000.0 20000.0 25000.0 30000.0 35000.0

BP_rate vs Income

Income

BP

_ra

te

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Bacterial pneumonia hospitalization rates per 10,000 by % White, 65+ yrs,1999-2001

0.0

100.0

200.0

300.0

400.0

0.0 25.0 50.0 75.0 100.0

BP_rate vs X_white

X_white

BP

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Bacterial pneumonia hospitalization rates per 10,000 by % Hispanic, 65+ yrs,1999-2001

0.0

100.0

200.0

300.0

400.0

0.0 25.0 50.0 75.0 100.0

BP_rate vs X__hispanic

X__hispanic

BP

_ra

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GLOBAL FINDINGS

Disparity between Whites and Latinos

Income gradients correlated with rates of bacterial pneumonia

LIMITATIONS: Administrative data Reporting of race/ethnicity Variation in coding practices

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IMPLICATIONSProvides baseline estimate of bacterial pneumonia

hospitalization rates, persons 65+, in 32 Texas Border Counties (future comparability health studies of Texas counties, 4 U.S. & 6 Mexico Border States) (CA, AZ,NM, TX) (BC, Sonora, Chihuahua, Nuevo Leon, Coahuila, Tamaulipas)

32 Texas Border County stakeholders can assess health status of population & sets basis to target interventions using community based participatory research techniques

Demonstrates use of hospital discharge data for community based health services research

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DIRECTIONSExtend baseline estimates & analysis of AHRQquality of care indicators - QIs (population health)

bacterial pneumonia hospitalizations (PQI)

pneumonia inpatient mortality (IQI)

all Texas counties

65+, all Texas counties fclemus@utmb.edu 409-762- 5140

Primary Funding Source: University of Texas Medical Branch, Division of Epidemiology and Biostatistics Educational Enhancement Fund.