Harford County Board of Health Update...Oct 17, 2017 · Today’s Update. Baltimore City to 2015. Anne Arundel Howard Baltimore Caroline Queen Anne’s Prince George’s ... Maryland

Harford County Board of Health Update October 17, 2017

Russell Moy, MD, MPH Acting Health Officer

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Harford County Health Department (HCHD) Today’s Update

Baltimore City

Anne Arundel

Howard

Baltimore

Caroline

Queen Anne’s

Prince George’s

St. Mary's

Charles

Allegany

Carroll Harford

Cecil

Kent

Wicomico

Dorchester

Worcester

Washington

Garrett

District of Columbia

Frederick

Montgomery

Talbot

Calvert

Somerset

Age 80 or over

Age 79

Age 78

Age 77

Age 76 or under

Legend

Life Expectancy

Harford County has

improved from 79.6 to

79.7 years from 2014

to 2015.

“Beyond Health Care,” RWJF Commission to Build a Healthier America, 2009

Source: Maryland Vital Statistics, 2015

How healthy are Harford County residents? What is our average life expectancy?

There’s a 10-year life

expectancy disparity

within Maryland.

4

A community’s health is more than mortality

and clinical care . . .

80% of what influences your health and life expectancy happens outside of the healthcare system

From Tony Iton, MD, “Is Your Zip Code More

Important Than Your Zip Code,” 2015 lecture

7

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9th Healthiest for Health Outcomes:

Birth outcomes Death rates

Quality of life

Source: County Health Rankings, RWJF, 2017

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…

8th Healthiest for Health Factors:

Health behaviors Access to care

Socio-economics Environment

Source: County Health Rankings, RWJF, 2017

9

198

182

176 172

170

168

193

180

175 172

170

169

150

160

170

180

190

200

210

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Pe

r 1

00

,00

0 P

op

ula

tio

n

Harford

Maryland

* Age-Adjusted Rates

Source: Maryland Vital Statistics Reports

Harford County rates improving and comparable with the State.

10

43

40

38

34

37

35

40 39

37

37

36

37

30

40

50

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Pe

r 1

00

,00

0 P

op

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Harford

Maryland



Harford County rates improving and comparable with the State.

11

16.9

12.4 14.9

11.3 10.0 8.8

27.2

24.7

22.1

19.3 17.8 16.9

0

10

20

30

2010 2011 2012 2013 2014 2015

Pe

r 1

,00

0 F

em

ale

s, A

ges

15-

19

Harford

Maryland



Harford County rates improving and better than the State.

12

5.5 3.7

5.3 5.2 4.8

3.3

6.7 6.7 6.3 6.6 6.5 6.7

0

2

4

6

8

10

2010 2011 2012 2013 2014 2015

Pe

r 1

,00

0 L

ive

Bir

ths

Harford

Maryland



Harford County rates improving and better than the State.

13

6.7

11.3

5.5

4.0

0.0

2.0

4.0

6.0

8.0

10.0

12.0

All Black Hispanic White

Pe

r 1

,00

0 L

ive

Bir

ths

All

Black

Hispanic

White


Infant mortality racial disparities exist in Maryland

14

179

171 172

168

171

166

177

171

167

164 162

159

150

160

170

180

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Pe

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,00

0 P

op

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Harford

Maryland



Harford County rates improving but worse than the State.

15

47

41 38 37 37

39

36 35 34 33

31 31

20

30

40

50

60

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

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,00

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Harford

Maryland



Harford County rates worse than the State.

16

498 482

110 95

80 61 50 48 46 33 32

0

100

200

300

400

500

600

# o

f D

eat

hs

Age-Adjusted Rates


The Leading Causes of Death

Harford County, 2015

Heart disease, cancer and COPD are the leading disease causes of death.

17

The Leading Actual Underlying Causes of

Death

Source: Mokdad et al, “Actual Causes of Death in the

U.S., 2000” JAMA, 3/19/2004

But smoking, obesity and alcohol are the leading actual causes of death.

18

18.6

21.7

16.9

18.9

20.7

10

12

14

16

18

20

22

24

2011 2012 2013 2014 2015

Pe

rce

nt

Harford

Maryland

Source: phpa.health.maryland.gov

MD BRFSS, 2011-15

Harford County adult use rates remain higher than the State average.

19

Note: Students Grades 9-12 who used any tobacco products in the past 30 days

Source: Maryland YRBSS, 2013 and 2014:

20.2 19.2

16.9 16.4

0

5

10

15

20

25

2013 2014

Pe

rce

nt

Harford Maryland

Harford County youth use rates are higher than the State average.

•

•

•

–

–

–

20

HCHD Tobacco Use Prevention Efforts

Impact of the opioid overdose crisis

22

1,164 1,108

1,179

1,245

1,382

1,462

1,674

800

1,000

1,200

1,400

1,600

1,800

2008 2009 2010 2011 2012 2013 2014

Pe

r 1

00

,00

0 P

op

ula

tio

n

Harford

Harford


23

35 33

43 38 39

36

43

50

84

2008 2009 2010 2011 2012 2013 2014 2015 2016

Per

100

,000

Po

pu

lati

on

All Drugs/Alcohol Heroin Fentanyl

Harford County had a 68% increase in overdose deaths from 2015-2016. Preliminary data for 2017 indicate a possible 100% increase from 2016-2017.

Source: Maryland Vital Statistics: Drug- and Alcohol-Related Intoxication Deaths in Maryland, 2016

24

498 482

110 95

80 61 50 48 46 33 32

0

100

200

300

400

500

600

# o

f D

eat

hs


The Leading Causes of Death

Harford County, 2015

At the current rate, overdose deaths may become the 3rd leading cause of death in 2017.

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1,566 1,401

1,275 1,119 1,113

949 913 913 900 883 866 817 785 742 740 712 690 640 546 550 519 495

356 353 283

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(M

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2010 2015Harford County ranks 8th worst in the State.

Source: Dinsmore, “How Maryland measured up in opioid

prescribing,” Baltimore Sun, 7/8/17 – citing CDC data

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4.5 5.6

8.8

5.1 5.9

12.6 12.1 9.5

12.3

19.9 16.9

29.6 26.4

36.7

29.1

29.4

38.2

11.8 11.3 12.4 11.9 10.2

12.6 13.1 13.3 14.5

14.7 16.0 17.6

18.6 21.0 20.4 20.1

33.3

0

10

20

30

40

Rat

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xpo

sed

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0 N

ew

bo

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Year

Harford County Maryland

>7-fold increase in newborn exposure to drugs/alcohol

over the past 16 years for Harford County residents

NOTE: ICD Codes used 760.70, 760.71. 760.72, 760.73, 760.75, 760.77, 779.5

Source: HSCRC Hospital Data, 2000-16,Maryland resident births only, does not include Maryland resident births born out of state.

Source: “Drug and Alcohol Related Intoxication

Deaths in Maryland, 2016,” Maryland Vital Statistics

Heroin increased by 62%

Fentanyl increased by 229%

From 2015 to 2016.

AGE (years)

Source: “Drug and Alcohol Related Intoxication

Deaths in Maryland, 2016,” Maryland Vital Statistics

45-54 yr olds impacted most.

25-34 yr olds impacted next most.

29

Stein et al, AJPH, October 2017

30

11.9

11.2 11.3

10.7

11.6 11.6

8.8 8.9 8.8 9.0

9.2 9.1

8

9

10

11

12

13

2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Pe

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00

,00

0 P

op

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Harford

Maryland




•

–

•

–

•

–

–

–

•

•

31

HCHD Opioid Use Prevention Efforts

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Harford County OOCC OIT Project

Central Intake, Navigation & Recovery Team

Individual/Family

in Need of

Guidance

ACR Telephone Resource Line

443-417-7810

-CENTRAL INTAKE

-Screening

-Assessment

-NAVIGATION

of the treatment

system

-RECOVERY

-Housing

-Peer Support

RECOVERY

& SUPPORT

Individual/Family

in Need of

Treatment

Individual/Family

in Need of

Recovery Support

01,0002,0003,0004,0005,0006,0007,0008,0009,000

10,000

Q1 Q2 Q3 Q4 TotalFY 2015 2,217 2,228 1,967 2,881 9,293

FY 2016 2,147 1,796 3,056 2,521 9,520

FY 2017 2,338 1,978 2,601 2,873 9,790

# V

isit

s

FY 2015

FY 2016

FY 2017

5% Increase From FY15-17

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Source: HCHD County Stat Data

Key Health Issues Ahead

Impact of Maryland’s hospital federal waiver

37

# High Utilizers with 3+ Inpatient HospitalizationsFor SHIP Disease Indicators, Maryland & Harford County ZIP, 2015

Source: “High Utilizer Use of Inpatient Hospitals,” CRISP Reporting

Service Dashboards Workbook at https://reports.crisphealth.org/

High readmission rates may

mean problems with follow up

appointments and medications.

Highest rates in Aberdeen,

Havre de Grace and Joppa.

38

# High Utilizers with 3+ Emergency Dept VisitsFor SHIP Disease Indicators, Maryland & Harford County ZIP, 2015

Source: “High Utilizer Use of Inpatient Hospitals,” CRISP Reporting

Service Dashboards Workbook at https://reports.crisphealth.org/

High repeat E.D. visit rates may

mean problems accessing

ambulatory care in the

community.

Highest rates in Aberdeen,

Edgewood and Havre de Grace.

0500

1,0001,5002,0002,5003,0003,5004,0004,5005,000

Q1 Q2 Q3 Q4 TotalFY 2014 1,162 949 1,008 1,097 4,216

FY 2015 1,148 983 1,032 1,124 4,287

FY 2016 1,213 1,133 1,167 1,156 4,669

FY 2017 1,144 954 1,063 1,126 4,287

# C

hild

ren

’s D

en

tal V

isit

s

FY 2014

FY 2015

FY 2016

FY 2017

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40

52.1

55.4 56.5

59.7 59.9

58.3

60.2

52.8

57.1

60.2

62.2 63.3 63.2

64.3

50

55

60

65

70

2009 2010 2011 2012 2013 2014 2015

Pe

rce

nt

Harford

Maryland

Source: Maryland Medicaid Service Utilization


0

1000

2000

3000

4000

Q1 Q2 Q3 Q4 TotalFY 2014 431 286 37 386 1,140

FY 2015 576 594 638 1,042 2,850

FY 2016 1,414 769 692 636 3,511

FY 2017 575 556 581 543 2,255

# M

CH

P A

pp

licat

ion

s

FY 2014

FY 2015

FY 2016

FY 2017


41


42

17.0

15.5

12.2

9.5 10.7 10.9

5.8

3.4

0

5

10

15

20

25

2008 2009 2010 2011 2012 2013 2014 2015

Pe

rce

nt Harford

Maryland

Source: phpa.health.maryland.gov

MD BRFSS, 2011-15

Harford County uninsured rates much better than the State average.

0500

10001500200025003000350040004500

Q1 Q2 Q3 Q4 TotalFY 2014 431 506 864 780 2,581

FY 2015 681 609 408 728 2,426

FY 2016 1,185 882 940 1,387 4,394

FY 2017 771 703 872 624 2,970

# A

CC

U C

on

tact

s

FY 2014

FY 2015

FY 2016

FY 2017


43


010,00020,00030,00040,00050,00060,00070,00080,00090,000

100,000

Q1 Q2 Q3 Q4 TotalFY 2014 11,404 11,843 13,822 16,597 53,666

FY 2015 18,323 19,705 18,889 16,813 73,730

FY 2016 18,437 16,735 31,664 31,272 98,108

FY 2017 26,448 18,666 20,666 20,628 86,408

# Tr

ansp

ort

s p

rovi

de

d

FY 2014

FY 2015

FY 2016

FY 2017


44


0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Q1 Q2 Q3 Q4 TotalFY 2014 1,500 972 1,409 1,104 4,985

FY 2015 1,368 1,441 1,862 1,378 6,049

FY 2016 1,518 1,268 1,410 1,080 5,276

FY 2017 1,438 1,156 1,519 1,243 5,356

# C

ase

Man

age

me

nt

Enco

un

ters

FY 2014

FY 2015

FY 2016

FY 2017


45


0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Q1 Q2 Q3 Q4 TotalFY 2014 18,191 17,414 16,868 16,903 69,376

FY 2015 17,617 17,272 16,622 16,791 68,302

FY 2016 17,004 16,150 15,710 15,803 64,667

FY 2017 16,080 15,916 16,036 15,025 63,057

# W

IC V

isit

s

FY 2014

FY 2015

FY 2016

FY 2017

46


Impact of potential changes to the Affordable Care Act

- Unsubsidized

health care

premiums under

the ACA are

expected to rise

nationally by about

25% in 2017.

- Uninsured rates

may rise.

- Need for safety

net services may

increase.

Source: ACASignups.net, USA Today, Oct 2017

Snapshot of FY 2017 HCHD Services

0

50

100

150

200

250

300

350

Q1 Q2 Q3 Q4 TotalFY 2015 88 44 40 101 273

FY 2016 80 60 26 132 298

FY 2017 109 62 34 122 327

# P

oo

l In

spe

ctio

ns

FY 2015

FY 2016

FY 2017

Level From FY14-17

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0

200

400

600

800

Q1 Q2 Q3 Q4 TotalFY 2015 194 147 101 164 606

FY 2016 176 168 117 204 665

FY 2017 215 159 139 200 713

# O

utr

eac

h

FY 2015

FY 2016

FY 2017


50


0

500

1000

1500

2000

Q1 Q2 Q3 Q4 TotalFY 2015 468 406 397 517 1,788

FY 2016 365 396 379 467 1,607

FY 2017 312 311 290 311 1,224

# Fo

od

Insp

ect

ion

s

FY 2015

FY 2016

FY 2017

40% Decrease From FY14-17


51

• Healthier Than the State Average

– Harford County’s health status is better than the State average.

• Lifestyle Improvements Needed

– Improvements need to be focused on substance use, tobacco use, and other

behavioral lifestyle improvements.

• Safety Net Providers and Care Coordination Needed

– Safety net providers and care coordination efforts need to be supported in

order to meet the needs of vulnerable and underserved populations.

• Environmental Health a Priority

– Environmental health professionals need to be supported in order to protect

the health and safety of Harford County residents.

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Harford County Health Department (HCHD) In Summary

Harford County Health Department (HCHD) Mission and Vision

Mission To protect and promote the health, safety, and

environment of the residents of Harford County

through public health assessment, education,

collaboration and assurance of services.

Vision To make Harford County the healthiest

community in Maryland.

Documents

Harford County Board of Health Update...Oct 17, 2017 · Today’s Update. Baltimore City to 2015. Anne Arundel Howard Baltimore Caroline Queen Anne’s Prince George’s ... Maryland