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http://www.sanantonio.gov/health/
Fernando A. Guerra, M.D., M.P.H. Public Health Consultant
San Antonio Metropolitan Health District
Social Determinants Of Health and Health Disparities
Bexar County
0200,000400,000600,000800,000
1,000,0001,200,0001,400,0001,600,000
2000 2005 2010 2015 2020 2025 2030 2035 2040
White NH African Am Hispanic Other
Projected Population of Bexar Co. by Race/Ethnicity & Migration
Source: Texas State Data Center, 2010 2
2010 Age Distribution Bexar County Hispanic White NH
Population Source: U.S. Census Bureau, 2010
MaleFemaleAfrican Am. NH
MaleFemale MaleFemale
35000 15000 5000 25000Age 0 to 4 yrs
Age 10 to 14 yrs
Age 20 to 24 yrs
Age 30 to 34 yrs
Age 40 to 44 yrs
Age 50 to 54 yrs
Age 60 to 64 yrs
Age 70 to 74 yrs
Age 80 to 84 yrs
50000 30000 10000 10000 30000 50000Age 0 to 4 yrs
Age 10 to 14 yrs
Age 20 to 24 yrs
Age 30 to 34 yrs
Age 40 to 44 yrs
Age 50 to 54 yrs
Age 60 to 64 yrs
Age 70 to 74 yrs
Age 80 to 84 yrs
10000 5000 0 5000 10000Age 0 to 4 yrs
Age 10 to 14 yrs
Age 20 to 24 yrs
Age 30 to 34 yrs
Age 40 to 44 yrs
Age 50 to 54 yrs
Age 60 to 64 yrs
Age 70 to 74 yrs
Age 80 to 84 yrs
3
2010 Median Household Income Bexar County
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
Median household income
African American Hispanic NH White Total
4Population Source: U.S. Census Bureau, 2010 4
0%5%
10%15%20%25%30%35%40%
Non Hisp White Hispanic African Am. Total
2013 Lack of Health InsuranceAges 18 to 64 years and Race/Ethnicity
Bexar County
52013 American Community Survey 1-Year Estimates
6
Education Is One Of The Strongest Predictors Of Health*
• Health problems associated with dropping out of school are pregnancy, substance abuse, mental illness and behavioral problems.*
• The more schooling people have the more money they can earn, enabling them to purchase better housing in safer neighborhoods, healthier food, better medical care and health insurance, each of these is associated with improved health.*
• Math is the "gatekeeper" course for students seeking higher education and/or for those seeking employment. San Antonio Collage.
* Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Dis 2007;4(4). www.cdc.gov/pcd/issues/2007/oct/07_0063.htm 6
SAT Mean Total Score by School District 2013
800 1,000 1,200 1,400 1,600 1,800
Edgewood
Somerset
South San Antonio
San Antonio
Southside
Harlandale
Southwest
East Central
Judson
Northside
Ft Sam Houston
Lackland
North East
Randolph Field
Alamo Heights
% Economically Disadvantaged Children by School District 2013
020406080100Source: Texas Education Agency
2010 Educational Attainment: Bachelor's degree or higher Bexar County
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Bachelor's degree or higher
White NH Hispanic African Am. Total
8(Population 25 Years and Over)
Bexar County Scorecard – Maternal Health 2013Maternal Indicators
* Rate per 1000, Preliminary data subject to change.
Bexar County
9
Total Births 26,590Mother's Age 15 to 19 2,558 39.7*
Low Birth Weight <2500g 2,399 9.0%Late or No Prenatal Care 10,049 40.7%
Single Mother births 12,315 46.3%Premature (<37 Weeks) births 3,033 11.4%
Medicaid Funded Births 13,164 49.5%
Mothers BMI 30 + before pregnancy 7,664 28.8%
Births within < 24 mos previous birth 4,383 16.5%Mothers with < HS / GED edu 7,513 19.5%
Subsequent Births to Mothers Age 15-19 527 20.6%26.6*
United States
Infant Mortality 160 6.02*
11.4%
8.0%
40.6%
Births to Mothers <20 Yrs. by Birth Order and Age, Bexar County 2013
10
Birth Order Age of Mother 1 2 3 4 5 6 Total
12 - - - - - - - 13 4 - - - - - 4 14 26 2 - - - - 28 15 104 5 - - - - 109 16 224 17 1 1 - - 243 17 365 48 9 - - - 422 18 542 131 16 - - - 689 19 796 252 42 4 1 - 1,095
Total 2,061 455 68 5 1 - 2,590
% Late or No Prenatal Care Births By Zip Code Bexar
County 2013
Zip codes with Less than 20 Births not includeddue to small numbers
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I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N
Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604
I.H. 10 I.H. 10 I.H. 10 I.H. 10 I.H. 10 I.H. 10 I.H. 10 I.H. 10 I.H. 10
Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410
I.H. 35 N
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I.H. 37 S.
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U.S.
281
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281
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81 N
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281
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FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604
Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410
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I.H. 10I.H. 10I.H. 10
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I.H. 35 S.I.H. 35 S.
I.H. 35 S.I.H. 35 S.
I.H. 35 S.
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48% to 55%43% to 47%34% to 42%25% to 33%10% to 24%
% Medicaid Funded Births By Zip Code Bexar
County 2013I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N
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I.H. 35 N
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I.H. 37 S.
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281
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FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604
Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410
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I.H. 10I.H. 10I.H. 10
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I.H. 35 S.I.H. 35 S.
I.H. 35 S.
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Zip codes with Less than 20 Births not includeddue to small numbers
71.0% to 83 .2%60 .8% to 70.9%38 .6% to 60 .7%21 .7% to 38 .5%
1.4% to 21 .6%
% Births to mothers BMI ≥ 30 Before
Pregnancy By Zip Code Bexar County
2013
Zip codes with Less than 20 Births not includeddue to small numbers
I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N
I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N
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I.H. 35 N
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N
FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604
Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410
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36.8% to 43.4%31.1% to 36.7%25.1% to 31.0%17.2% to 25.0%
7.5% to 17.1%
% Teen Births ages 15 to 19 By Zip Code Bexar
County 2013
Zip codes with Less than 20 Births not includeddue to small numbers
I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N
I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N
Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604
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I.H. 35 N
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FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604
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I.H. 10I.H. 10I.H. 10
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14.3% to 22.3%
11.0% to 14.2%
7.5% to 10.9%
3.6% to 7.4%
0 to 3.5%
Birth rates for Females aged 15-19 years, by race and Hispanic origin of mother: United States and
Bexar County 2012
Rates per 1,000 women in specified age and race and Hispanic origin 15http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_09.pdf
Concentration of Health DisparitiesBirth Indicators Ten Zip Codes 2013
25% of 2010 Total Population 87% Hispanic 9% African American 3% White Non Hispanic
In 2002, Metro Health identified 10 Zip Codes of 72 (area in Red), as high-risk areas due to concentrations of Medicaid births, single mothers and teen mothers in proportion of population. 78221, 78201, 78242, 78211, 78210, 78223, 78237, 78227, 78228, and 78207.
Zip Codes selected for high numbers of single and teen mothers
Ten zip codes
Bexar County
% of total
Total Births 7,356 26,590 28%Mothes <age 18 400 804 50%Births to mothers 15 to 19 1,112 2,558 43%Births to Single Mothers 4,754 12,315 39%Late or no Prenatal Care 3,433 10,049 34%Low Birth Weight Births <2500 Grams 702 2,399 29%Estimated Premature <37 Weeks 878 3,033 29%Medicaid Payment 5,182 13,164 39%Births within 24 months of Previous Birth 1,371 4,383 31%Births to moms less than HS / GED 2,460 5,173 48%Births to moms BMI 30 + before pregnancy 2,627 7,664 34%Infant Deaths 47 160 29%
16
Confirmed 2012 Child Abuse/Neglect Cases In Texas
* Counties with a Population of 200,000 or more 17
Child Confirmed Cases rate per 1,000
Population
Bexar 477,922 6,205 13.0
Travis 259,016 3,045 11.8
Tarrant 517,952 5,598 10.8
Hidalgo 276,110 2,685 9.7
Texas 7,054,634 64,366 9.1
EL Paso 244,164 2,081 8.5
Dallas 667,394 5,107 7.7
Harris 1,171,213 5,383 4.6
Collin 237,706 1,082 4.6
Unduplicated Confirmed VictimsBexar County
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
18Source: Texas Department of Family And Protective Services, Management Reporting and Statistics by Fiscal Year
Neonatal Abstinence Syndrome (NAS) Neonatal Withdrawal of Opiates by
Year, Texas and Bexar County
Source: Source: Texas Hospital Inpatient Discharge Public Use Data File, Texas and San Antonio Hospitals, Diagnosis code 779.5, drug withdrawal syndrome in newborn, primary or contributing cause-Hospital Discharge Data
Year TexasSan
Antonio% of total Texas charges
San Antonio charges
San Antonio Length of Stay (days)
San Antonio Average LOS (days)
2013 913 291 32% $ 157,968,047 $ 38,706,912 8,044 27.62012 855 300 35% 138,713,777$ 55,955,510$ 9,498 31.72011 804 298 37% $ 129,372,333 $ 41,798,540 8,571 28.82010 704 252 36% $ 103,751,015 $ 31,300,507 6,913 27.42009 656 260 40% $ 74,563,545 $ 29,595,216 6,928 26.6Total 3,932 889 23% $ 604,368,717 $ 197,356,685 39,954 44.9
Rate of Juveniles on Probation Bexar
County 2013
20
Rate per 1000 by zip code
zip codes with <20 cases were not included
2009-2013 American Community Survey 5-Year Estimates population ages <18
I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N
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I.H. 35 N
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I.H. 37 S.
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24.0 to 47 .416 .3 to 23.912 .6 to 16 .2
8 .5 to 12 .52 .7 to 8.4
Rate of Domestic Violence callsSan Antonio
2013Rate per 1000 by
zip code
zip codes with <20 cases were not included
212009-2013 American Community Survey 5-Year Estimates population all ages
I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N
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I.H. 10I.H. 10I.H. 10
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11 .2 to 71 .28 .5 to 11 .16 .2 to 8.43 .3 to 6.11 to 3.2
Diabetic Amputations
Prepared by Metro Health EPI§Texas Hospital Inpatient Discharge Public Use Data File. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas. 2011*2009 is the most recent year available for national data.http://www.cdc.gov/diabetes/statistics/lea/fig1.htm
Rat
e pe
r 100
0 w
ith D
X o
f Dia
bete
s
§§*
22
Rate of Diabetic Amputations in Select Texas Counties 2009 & 2011
rate
per
10,
000
Prepared by Metro Health EPITexas Hospital Inpatient Discharge Public Use Data File, [quarter and year of data]. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas. 2006, 2009 & 2011 23
Hospital Inpatients Diagnosed with Diabetes or Diabetic Amputation, Bexar County, 2011
24
PopulationDx of
DiabeticsRate per 1,000
Diabetics Amputations
Rate per 1,000
Hispanic 1,033,722 27,651 26.7 1,316 47.6
White non Hispanic 548,965 11,932 21.7 389 32.6
African Am 132,487 3,690 27.9 137 37.1
Other 40,979 2,734 66.7 102 37.3
Total 1,756,153 46,007 26.2 1,944 42.3
Bexar County Resident, Hospital Discharge principal or other Diagnosis of diabetes or surgical or other procedure, Texas Hospital Inpatient Discharge Public Use Data File. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas
Rate of Diabetic Amputations by Zip Code, Bexar County, 2011
Rate per 1,000 Diabetic Inpatients
Note: The CDC, National Center for Health Statistics does not publish or release rates based on fewer than 20 observations, because they feel these
data do not meet their requirement for a minimum degree of accuracy.
I.H. 35 NI.H. 35 NI.H. 35 NI.H. 35 N
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Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604Loop 1604
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I.H. 35 N
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I.H. 37 S.
I.H. 37 S.
I.H. 37 S.I.H
. 37 S.I.H. 37 S.
I.H. 37 S.
I.H. 37 S.
I.H. 37 S.I.H
. 37 S.
Loop
410
Loop
410
Loop
410
Loop
410
Loop
410
Loop
410
Loop
410
Loop
410
Loop
410
U.S.
281
NU.
S. 2
81 N
U.S.
281
NU.
S. 2
81 N
U.S.
281
NU.
S. 2
81 N
U.S.
281
NU.
S. 2
81 N
U.S.
281
N
FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604FM Loop 1604
Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410Loop 410
I.H. 10I.H. 10I.H. 10
I.H. 10I.H. 10
I.H. 10I.H. 10I.H. 10I.H. 10
Loop 410Loop 410Loop 410
Loop 410Loop 410
Loop 410Loop 410Loop 410Loop 410
Loop
160
4
Loop
160
4
Loop
160
4Lo
op 1
604
Loop
160
4Lo
op 1
604
Loop
160
4
Loop
160
4
Loop
160
4
I.H. 10I.H. 10I.H. 10
I.H. 10I.H. 10
I.H. 10I.H. 10I.H. 10I.H. 10
I.H. 35 S.
I.H. 35 S.
I.H. 35 S.I.H. 35 S.
I.H. 35 S.I.H. 35 S.
I.H. 35 S.
I.H. 35 S.I.H. 35 S.
50.1 to 68.846.1 to 50.040.7 to 46.036.6 to 40.630 to 36.5
Bexar County Resident, Hospital Discharge principal or other Diagnosis of diabetes or surgical or other procedure, Texas Hospital Inpatient Discharge Public Use Data File. Texas Department of State Health Services, Center for Health Statistics, Austin, Texas 25
Infant Mortality Rateby Race & Ethnicity
Live Births to Bexar County Residents
0
24
68
10
1214
16
1999to
2001
2000to
2002
2001to
2003
2002to
2004
2003to
2005
2004to
2006
2005to
2007
2006to
2008
2007to
2009
2008to
2010
2009to
2011
2010to
2012
2011to
2013
Hispanic White NH Black NH Other NH
Rate per 1,000 births/Three-Year Moving Average 26
Rat
e pe
r 1,0
00 b
irths
Rate of Death by Gender ages 45 to 64 by Race and Ethnicity, Bexar County 2013
0
50
100
150
200
250
300
HispanicMales
White NHMales
Black Males HispanicFemales
White NHFemales
BlackFemales
Cancer Heart Disease Diabetes27
rate
per
100
k
Note: The CDC, National Center for Health
Statistics does not publish or release rates based on
fewer than 20 observations, because
they feel these data do not meet their requirement for
a minimum degree of accuracy.
% Death Before Age 65
Not included
Premature Deaths (<65 yrs) by Race & Ethnicity Bexar County 2012
39%
26%24%19%
42% 44%
32%
24%
0%5%
10%15%20%25%
30%35%40%45%50%
All Deaths Heart Disease
Hispanic White NH African Am All
5
Pre
mat
ure
Dea
ths
(<65
yrs
)
78211
78214
78221
78219
78217
78247
78258
78230
78201
78227
78109
78148
78202
7820478207
78209
78210
78212
7821378216
78218
78220
78222
7822378224
78225
78228
78229
78232
78233
78237
78238
7823978240
78242
78244
78245
78249
78250
7825178253
78254
78259
30% to 42%25% to 29%19% to 24% 0% to 18%
Premature Heart Disease Deaths (<age 65) by Zip Codes
Bexar County 2012
28
What Is The Consequence of not Addressing Health Disparities?
• Health disparities among minorities have long accounted for higher infant mortality, premature death and disease burden, and lower quality of health care when compared with the national average.
• Health disparities impacts us all by escalating health care spending and adversely affecting the health care system for everyone.
29The Public Health Approach to the Elimination of Disparities in Health. - David Satcher, M.D., Ph.D.