Finding Local Health Finding Local Health DataData

David BruckmanDavid BruckmanCleveland Dept. of Public HealthCleveland Dept. of Public Health

Dept. of Epidemiology and Dept. of Epidemiology and BiostatisticsBiostatistics

CWRU School of MedicineCWRU School of Medicine

2

CreditsCredits

►Presented to Case Masters of Public Presented to Case Masters of Public Health (Case MPH) Capstone Students Health (Case MPH) Capstone Students on October 15, 2007 at Case Western on October 15, 2007 at Case Western Reserve University School of Medicine Reserve University School of Medicine

►My thanks to Scott Frank, MD and Laura My thanks to Scott Frank, MD and Laura Santurri, MPH for the invitation, Santurri, MPH for the invitation, Johnbuck Creamer, MD and Alfred Johnbuck Creamer, MD and Alfred Rimm, PhDRimm, PhD

3

Finding local health data has not Finding local health data has not been an easy task…been an easy task…

► Idea for a local health data portal Idea for a local health data portal Johnbuck Creamer, MD, RN (MetroHealth)Johnbuck Creamer, MD, RN (MetroHealth) To aid in the search for dataTo aid in the search for data Act as a posting site for community health Act as a posting site for community health

datadata Content management systems readily Content management systems readily

available on the webavailable on the web

►www.ClevelandHealth.infowww.ClevelandHealth.info

4

5

6

SupportSupport

7

KeywordsKeywords

►Over 85 keywords listedOver 85 keywords listed►Data presented by Data presented by

General Health Information General Health Information ►Sources on topicSources on topic

StatisticsStatistics ServicesServices

►Providers in areaProviders in area

►Text SearchText Search

8

LocalHealth.infoLocalHealth.info

►GreaterCleveland.localhealth.infoGreaterCleveland.localhealth.info►Disseminate technology at a fraction Disseminate technology at a fraction

of the start-up costof the start-up cost Local Health DepartmentsLocal Health Departments Groups within area that are interested in Groups within area that are interested in

their own web pagetheir own web page

9

www.ClevelandHealth.iwww.ClevelandHealth.infonfo

All of the sites listed here can be All of the sites listed here can be found here.found here.

Let’s go behind the scenes and Let’s go behind the scenes and look at the source sites…look at the source sites…

10

Health and Disease DataHealth and Disease Data

►Governmental Health Data SourcesGovernmental Health Data Sources General health information, statisticsGeneral health information, statistics Cause specific: cancer, communicable Cause specific: cancer, communicable

disease, other clearinghousesdisease, other clearinghouses►StateState►LocalLocal

UniversitiesUniversities Research AgenciesResearch Agencies

►Non-governmental Non-governmental

11

Types of DataTypes of Data

► Vital StatisticsVital Statistics Injuries / deaths (CDC Injury Center)Injuries / deaths (CDC Injury Center) DisparitiesDisparities

►Mandated reporting / SurveillanceMandated reporting / Surveillance Communicable disease (CDC, ODH, LDH)Communicable disease (CDC, ODH, LDH) Cancer (SEER /NCI)Cancer (SEER /NCI)

► SurveysSurveys Probability-weighted Probability-weighted Inverse of (person-level) weight reflect Inverse of (person-level) weight reflect

representation within surveyed arearepresentation within surveyed area►Non-representative surveysNon-representative surveys

12

Types of DataTypes of Data

► Vital StatisticsVital Statistics Injuries / deaths (CDC Injury Center)Injuries / deaths (CDC Injury Center) DisparitiesDisparities

►Mandated reporting / SurveillanceMandated reporting / Surveillance Communicable disease (CDC, ODH, LDH)Communicable disease (CDC, ODH, LDH) Cancer (SEER /NCI)Cancer (SEER /NCI)

► SurveysSurveys Probability-weighted – Probability-weighted – BRFSS & YRBS onlyBRFSS & YRBS only Inverse of (person-level) weight reflect Inverse of (person-level) weight reflect

representation within surveyed arearepresentation within surveyed area►Non-representative surveysNon-representative surveys

13

Vital StatisticsVital Statistics

►Birth Certificates Birth Certificates Data collected at local/regional Data collected at local/regional Maintained at state level (ODH)Maintained at state level (ODH)

►Data cleaning, coding, reconciling,…Data cleaning, coding, reconciling,… Ohio: 3 year delay… improving Ohio: 3 year delay… improving

Child and maternal healthChild and maternal health►Infant mortalityInfant mortality►Prematurity Prematurity ►Maternal informationMaternal information►Poor source for birth defectsPoor source for birth defects

14

Vital StatisticsVital Statistics

►Death Certificates Death Certificates Data collected at local/regional Data collected at local/regional Maintained at state levelMaintained at state level

►Data cleaning, coding, (less) reconciling than Data cleaning, coding, (less) reconciling than BCBC

Manner of deathManner of death Primary underlying cause of deathPrimary underlying cause of death

►ICD-10 codes grouped into over 100 ICD-10 codes grouped into over 100 substantive categories (adult/infant)substantive categories (adult/infant)

►Not a good source for comorbiditiesNot a good source for comorbidities

15

Vital statisticsVital statistics

►National to census tract information National to census tract information availableavailable ODH – Ohio Department of Health ODH – Ohio Department of Health

►Interactive Data Warehouse (to county level)Interactive Data Warehouse (to county level)►As recent as 2005As recent as 2005

16

http://www.odh.state.oh.us/http://www.odh.state.oh.us/

17

Data WarehouseData Warehouse

Click “Health Statistics” and then

“Health Information Warehouse”

18

http://dwhouse.odh.ohio.gov/http://dwhouse.odh.ohio.gov/datawarehousev2.htmdatawarehousev2.htm

19

Vital Statistics also available Vital Statistics also available at at

►Case NEOCANDO Interactive Data Case NEOCANDO Interactive Data WarehouseWarehouse

►Various sites with “canned” profile and Various sites with “canned” profile and indicator reportsindicator reports Cuyahoga County Board of Health Cuyahoga County Board of Health

Indicator reportsIndicator reports►ClevelandHealth.infoClevelandHealth.info

Keyword: Child and Maternal HealthKeyword: Child and Maternal Health Use search fieldUse search field

20

Case MSASS: NEOCANDOCase MSASS: NEOCANDO

21

Municipal Early Childhood Municipal Early Childhood ProfilesProfiles

22

Municipal Early Childhood Municipal Early Childhood ProfilesProfiles

►Home demographicsHome demographics►Child and Family well being indicatorsChild and Family well being indicators

Births, births to teens, LBW, premature, Births, births to teens, LBW, premature, mothers with adequate prenatal caremothers with adequate prenatal care

Infant deaths’Infant deaths’ Lead poisoningLead poisoning Substantiated neglectSubstantiated neglect Receiving assistanceReceiving assistance Service levels (visits, care centers,…)Service levels (visits, care centers,…)

23

Interactive Data WarehouseInteractive Data Warehouse

24

Interactive Data WarehouseInteractive Data Warehouse

►Data from Data from CensusCensus Vital Statistics / ODHVital Statistics / ODH County auditor property and salesCounty auditor property and sales Mortgage lendingMortgage lending Crime (Cleveland Police)Crime (Cleveland Police) Juvenile delinquencyJuvenile delinquency Child maltreatmentChild maltreatment

► Level of detail depends on source, but Level of detail depends on source, but municipality and census tract data are municipality and census tract data are possiblepossible

25

http://www.odh.state.oh.us/http://www.odh.state.oh.us/

26

CSU- NODISCSU- NODIS

►Northeastern Ohio Data & Information Northeastern Ohio Data & Information ServiceService

►Designated as Regional Data Center Designated as Regional Data Center for NE Ohiofor NE Ohio Leading agency for analysis of census Leading agency for analysis of census

datadata Mark Salling, PhDMark Salling, PhD Data tables, reports, maps, ArcGIS Data tables, reports, maps, ArcGIS

projections and layersprojections and layers Internet Mapping CenterInternet Mapping Center

27

http://nodisnet1.urban.csuohio.edu/nodis/index.shtmlhttp://nodisnet1.urban.csuohio.edu/nodis/index.shtml

28

Health DisparitiesHealth DisparitiesSlide cursor over Health Statistics and then over Health Disparities

29

ODH – Health DisparitiesODH – Health Disparities

►Minority Health profile reportsMinority Health profile reports County DataCounty Data Health Risk Factors - overallHealth Risk Factors - overall Health InsuranceHealth Insurance

► CSHCN, Men’s Health, Native AmericansCSHCN, Men’s Health, Native Americans Health Disparities/General ReportsHealth Disparities/General Reports

►Women’s Health, Elderly, Children ins.Women’s Health, Elderly, Children ins. Health InsuranceHealth Insurance

►Morbidity, MortalityMorbidity, Mortality► Child and Maternal Indicator reportsChild and Maternal Indicator reports

30

ODH – Health DisparitiesODH – Health Disparities

►Ohio Family Health SurveyOhio Family Health Survey 1998 report at ODH website1998 report at ODH website

http://www.odh.ohio.gov/healthStats/survey/ofhs1http://www.odh.ohio.gov/healthStats/survey/ofhs1.aspx.aspx

2004 report at Ohio Dept Job and Family 2004 report at Ohio Dept Job and Family SvcsSvcshttp://jfs.ohio.gov/OHP/reports/FamHlthSurv.stmhttp://jfs.ohio.gov/OHP/reports/FamHlthSurv.stm

31

Injuries: WISQARS (CDC)Injuries: WISQARS (CDC)

32

Injuries: WISQARS (CDC)Injuries: WISQARS (CDC)

►http://www.cdc.gov/ncipc/wisqars/http://www.cdc.gov/ncipc/wisqars/►Acute InjuriesAcute Injuries►Violence PreventionViolence Prevention►Unintentional Injury PreventionUnintentional Injury Prevention►WISQARS: Interactive Data Warehouse WISQARS: Interactive Data Warehouse

(to state level)(to state level) Fatal and non-fatal injuriesFatal and non-fatal injuries Top 10 leading causes, by Age, Top 10 leading causes, by Age,

Race/ethnicity, and SexRace/ethnicity, and Sex Years of Potential Life LostYears of Potential Life Lost

33

Injuries: ODHInjuries: ODH

►Generated from death certificatesGenerated from death certificates►http://dwhouse.odh.ohio.gov/http://dwhouse.odh.ohio.gov/►Report: Selected Injuries, by countyReport: Selected Injuries, by county

Years are bundledYears are bundled Most recent: 2003-2005Most recent: 2003-2005 Printable reports (.pdf)Printable reports (.pdf)

34

Ohio Health SurveysOhio Health Surveys

35

Ohio SurveysOhio Surveys

1.1. Behavioral Risk Factors Surveillance System Behavioral Risk Factors Surveillance System 2.2. Ohio Family Health Survey Ohio Family Health Survey 3.3. Ohio Immunization Coverage Level Ohio Immunization Coverage Level 4.4. Pregnancy Risk Assessment Monitoring Pregnancy Risk Assessment Monitoring

System (PRAMS) System (PRAMS) 5.5. Youth Tobacco Survey (YTS) Youth Tobacco Survey (YTS) 6.6. Youth Risk Behavior Surveillance System Youth Risk Behavior Surveillance System

(YRBS) (YRBS)

36

BRFSS – Behavioral Risk BRFSS – Behavioral Risk SurveillanceSurveillance

► Go to BRFSS site at CDCGo to BRFSS site at CDC State level with age, race, gender, education, State level with age, race, gender, education,

income breakdownsincome breakdowns County/MMSA data (Cleveland-Elyria-Mentor)County/MMSA data (Cleveland-Elyria-Mentor) SMART site (metro/micro risk areas)SMART site (metro/micro risk areas)

http://apps.nccd.cdc.gov/brfss-smart/index.asphttp://apps.nccd.cdc.gov/brfss-smart/index.asp

► Data presented through ODH Data WarehouseData presented through ODH Data Warehouse County dataCounty data

http://dwhouse.odh.ohio.gov/http://dwhouse.odh.ohio.gov/datawarehousev2.htmdatawarehousev2.htm

37

BRFSS – local effortsBRFSS – local efforts

Center for Health Promotion Research Center for Health Promotion Research (Case), and the Ohio Tobacco (Case), and the Ohio Tobacco Research and Evaluation Center & Research and Evaluation Center & Steps to a Healthier Cleveland (CDPH)Steps to a Healthier Cleveland (CDPH)

►2006 Ohio Adult Tobacco Survey2006 Ohio Adult Tobacco Survey►Cuyahoga County Tobacco Data BriefsCuyahoga County Tobacco Data Briefs

http://www.case.edu/affil/healthpromotion/http://www.case.edu/affil/healthpromotion/

38

http://www.case.edu/affil/http://www.case.edu/affil/healthpromotion/healthpromotion/

39

BRFSS – local effortsBRFSS – local efforts

Center for Adolescent Health (Case)Center for Adolescent Health (Case)► Youth Risk Behavioral SurveyYouth Risk Behavioral Survey

injuries, violence, alcohol, tobacco, and drug use, injuries, violence, alcohol, tobacco, and drug use, sexual behaviors, nutrition, and physical activitysexual behaviors, nutrition, and physical activity

►Middle and high school studentsMiddle and high school students CMSDCMSD Inner ring schoolsInner ring schools County private and charter schoolsCounty private and charter schools

http://www.case.edu/med/adolescenthealth/yrbs.htmlhttp://www.case.edu/med/adolescenthealth/yrbs.html

40

http://www.case.edu/med/adolescenthealth/http://www.case.edu/med/adolescenthealth/yrbs.htmlyrbs.html

41

BRFSS – local effortsBRFSS – local efforts

►Coordination through Cuyahoga Coordination through Cuyahoga County Board of HealthCounty Board of Health Child and maternal health indicator Child and maternal health indicator

reportsreports►Municipalities, county, ringMunicipalities, county, ring

Pediatric Nutrition & ObesityPediatric Nutrition & Obesity MVA –pediatric injuriesMVA –pediatric injuries

42

http://www.ccbh.nethttp://www.ccbh.net

43

BRFSS – local effortsBRFSS – local efforts

►Child Fatality Death Review Report for Child Fatality Death Review Report for Cuyahoga CountyCuyahoga County

►““Protecting Our Future”Protecting Our Future” 2000 to 20052000 to 2005 Accidents, sleep related deaths, SIDS, Accidents, sleep related deaths, SIDS,

homicidehomicide Coroner’s office: Coroner’s office: http://protectingourfuture.cuyahogacounty.us/http://protectingourfuture.cuyahogacounty.us/

annualreports.htmannualreports.htm

44

http://protectingourfuture.cuyahogacounty.us/http://protectingourfuture.cuyahogacounty.us/annualreports.htmannualreports.htm

45

Ohio SurveysOhio Surveys

1.1. Behavioral Risk Factors Surveillance System Behavioral Risk Factors Surveillance System 2.2. Ohio Family Health Survey Ohio Family Health Survey 3.3. Ohio Immunization Coverage Level Ohio Immunization Coverage Level 4.4. Pregnancy Risk Assessment Monitoring Pregnancy Risk Assessment Monitoring

System (PRAMS) System (PRAMS) 5.5. Youth Tobacco Survey (YTS) Youth Tobacco Survey (YTS) 6.6. Youth Risk Behavior Surveillance System Youth Risk Behavior Surveillance System

(YRBS) (YRBS)

46

Private OrganizationsPrivate Organizations

March of DimesMarch of Dimes PeriStatsPeriStats State level graphs, charts, maps, and State level graphs, charts, maps, and

summaries of CMH datasummaries of CMH data Some infant data to city level (Cleveland)Some infant data to city level (Cleveland)

http://www.marchofdimes.com/peristats/http://www.marchofdimes.com/peristats/

47

PeristatsPeristats

► Perinatal Overview Perinatal Overview ► Births Births ► Preterm Birth Preterm Birth ► Birthweight Birthweight ► Prenatal Care Prenatal Care ► Infant Mortality Infant Mortality ► Singletons & Singletons &

Multiples Multiples ► Delivery Method Delivery Method

► Smoking/Alcohol/Drugs Smoking/Alcohol/Drugs

► Infections Infections ► Health Insurance Health Insurance ► Newborn Screening Newborn Screening ► Folic Acid Folic Acid ► Population Population ► MCH Programs MCH Programs ► Birth DefectsBirth Defects

48

http://www.marchofdimes.com/peristats/http://www.marchofdimes.com/peristats/

49

Private OrganizationsPrivate Organizations

Center for Community Solutions Center for Community Solutions (Cleveland)(Cleveland) Varied analytical reports on topic of local Varied analytical reports on topic of local

interestinterest From left edge menu: From left edge menu:

►Resources/Online Publications and ResourcesResources/Online Publications and Resources

►Highlights:Highlights: Community ProfilesCommunity Profiles Social and Economic Indicators ReportsSocial and Economic Indicators Reports UninsuredUninsured

50

http://http://www.communitysolutions.com/www.communitysolutions.com/

51

Private OrganizationsPrivate Organizations

Henry J. Kaiser Family Foundation: Henry J. Kaiser Family Foundation: www.kff.orgwww.kff.org

►National and State focusNational and State focus Medicaid/SCHIP Medicaid/SCHIP Medicare Medicare Costs/Insurance Costs/Insurance Uninsured/Coverage Uninsured/Coverage State Policy State Policy Prescription Drugs Prescription Drugs HIV/AIDS HIV/AIDS Minority Health Minority Health Women's Health Policy Women's Health Policy Entertainment Media Studies Entertainment Media Studies

52

Cancer Incidence and Cancer Incidence and MortalityMortality

►National Cancer Institute/SEER National Cancer Institute/SEER interactive site for causes, cases, age-interactive site for causes, cases, age-adjusted rates (State-level)adjusted rates (State-level)

►ODH Data Warehouse ODH Data Warehouse OCISS (Ohio Cancer Incidence OCISS (Ohio Cancer Incidence

Surveillance System)Surveillance System)

►ClevelandHealth.infoClevelandHealth.info Joint effort of CDPH and CCBHJoint effort of CDPH and CCBHhttp://www.clevelandhealth.info/keywords/Cancer/http://www.clevelandhealth.info/keywords/Cancer/

53

www.seer.cancer.govwww.seer.cancer.gov

54

http://www.odh.ohio.gov/odhprograms/svio/ci_surv/ci_surv1.aspxhttp://www.odh.ohio.gov/odhprograms/svio/ci_surv/ci_surv1.aspx(Easier to type OCISS in search field)(Easier to type OCISS in search field)

55

http://www.clevelandhealth.info/keywords/http://www.clevelandhealth.info/keywords/Cancer/Cancer/

56

http://www.odh.ohio.gov/pdf/idcm/intro9.pdf

Mandated disease reportingMandated disease reporting

57

http://www.odh.ohio.gov/pdf/idcm/intro9.pdf

Mandated disease reportingMandated disease reporting

58

HIV/AIDS reportingHIV/AIDS reporting

►HIV and incident AIDS diagnoses perinatal exposure to HIV, CD4 T-lymphocytes counts <200 or

14% must be reported on forms and in a manner prescribed by the Director.

Reporting formats vary Report to LHD as designated by ODH LHD-> ODH -> CDC (limited PHI)

59

Infectious DiseasesInfectious Diseases

►CDCCDC►ODHODH

ODRS (Ohio Disease Reporting System)ODRS (Ohio Disease Reporting System)http://www.odh.ohio.gov/healthStats/disease/http://www.odh.ohio.gov/healthStats/disease/

id1.aspxid1.aspx

►ClevelandHealth.infoClevelandHealth.info

60

http://www.odh.ohio.gov/healthStats/disease/id1.aspxhttp://www.odh.ohio.gov/healthStats/disease/id1.aspx

►Annual and Quarterly SummariesAnnual and Quarterly Summaries County level data includedCounty level data included

►HIV/AIDSHIV/AIDS► Immunization Coverage RatesImmunization Coverage Rates►STDsSTDs►TuberculosisTuberculosis►Zoonotic DiseaseZoonotic Disease

61

Questions using Questions using ClevelandHealth.info?ClevelandHealth.info?

►Contact me at Contact me at david.bruckman@case.edudavid.bruckman@case.edu

►Or click “contact” in the top right of Or click “contact” in the top right of the ClevelandHealth.info screenthe ClevelandHealth.info screen

Thank you !Thank you !