1. Executive Summary
The Marion County Community Health Assessment describes the health status of the Marion County population, as compared to the populations of other major United States cities, Indiana, and the nation. It also examines trends and patterns in the health of the county over the past few years. The data come from various sources, including birth and death certificates, hospital discharge records, the United States Census, and local, state, or national surveys.
This executive summary reviews the most notable issues arising from the report. It includes the most promising findings and the most worrisome findings, and discusses issues that have large impacts on our current health, as well as issues that, unless modified, will have large detrimental impact on our community’s health in the coming years.
Organization of the Report
This report is organized in nine topical sections, each of which provide the detailed documentation, graphs, tables, and interpretation for the major highlights. These sections are:
· Population demographics
· Access to care
· Health risk factors and prevention
· Children’s health
· Communicable diseases
· Social and mental health
· Environmental health
· Morbidity and hospitalizations
· Causes of death
Each section begins with a table summarizing relevant indicators. For every indicator, the Marion County data was compared with the Indiana or U.S. populations.
Current Trends and Issues
Declining Mortality from Heart Disease and Stroke
Marion County’s mortality rates for heart disease and stroke, two top causes of death, decreased and were lower than national rates in 2005. That year, age adjusted mortality from heart disease in Marion County was 12 percent lower than that of the United States, while age-adjusted mortality from stroke was 10 percent lower. Whereas heart disease was the leading cause of death in most of the United States, it had fallen to second, behind cancer, as a cause of death in Marion County. Heart disease mortality in Marion County declined by 23 percent from 2000 to 2005, while stroke mortality declined by 26 percent in that period. Marion County’s 2005 mortality rate from stroke was already lower than the Healthy People 2010 Objective 12-1. These declines are especially significant because, locally and nationally, heart disease and stroke cause one of every four deaths (27 percent of deaths in Marion County in 2005). Mortality from heart disease and stroke has been declining nationwide as well as in Marion County for several years.
Low Breast Cancer Mortality
In 2004, Indianapolis had one of the lowest breast cancer mortality rates of any large city in the United States. Indianapolis’s 2004 age-adjusted breast cancer mortality rate was the third lowest among the 54 largest cities in the United States. Marion County’s breast cancer mortality rate had declined 13 percent from 2001 through 2005. In 2005, breast cancer was about 30 percent above the Healthy People 2010 Objective 3-3, similar to the state and national rates. Breast cancer accounts for fewer than two percent of deaths in Marion County, or about one out of every 64 deaths.
Decrease in Accidental Deaths
There was a 12 percent decline in accidental deaths in Marion County from 2001 to 2005. Marion County’s 2005 age-adjusted mortality rate from accidents was 40 percent lower than the national rate, and 29 percent higher than the Healthy People 2010 Objective 15-13, set by the Centers for Disease Control and Prevention (CDC). Accidents account for 2.5 percent of deaths in Marion County, or about one out of every 40 deaths.
Reversal of Syphilis Outbreak
In 1999, Indianapolis had the highest incidence of new syphilis cases among large U.S. cities. Through an intensive, coordinated community effort, the outbreak was contained, and Indianapolis achieved the lowest syphilis incidence among large U.S. cities in 2003, 2004 and 2005. As in other urban areas, the incidence of new cases of syphilis in Marion County continues to exceed national rates. The community effort that brought about Marion County’s improvement was directed by the Stamp Out Syphilis coalition and received significant federal support. Activities included media campaigns to encourage testing and treatment, aggressive case finding, contact tracing, and targeted education, outreach, screening, and treatment. The effort was studied and documented by the Centers for Disease Control and Prevention (CDC), and has been presented nationally by the CDC as a model of how to cultivate a community effort to combat and resolve a public health problem.
Cigarette Smoking
While the prevalence of cigarette smoking is slowly declining in Marion County and nationwide, the consequences of residents’ past smoking habits pervade Marion County’s health statistics and one-fourth of Marion County residents continue to smoke. One in four Marion County adults smoke, compared to one in five nationally. Smoking is especially common among males, especially White males (33 percent of whom smoke), and persons who have not completed high school. In the most recent year (2003) with data comparing 44 of the largest U.S. cities, Indianapolis had the third highest rate of smoking during pregnancy, with one out of six pregnant women (17.6 percent) smoking. The 2003 national prevalence was 10.7 percent. Marion County’s prevalence declined to 16.6 percent by 2005, following the national trend. Among women less than 20 years old, the prevalence of smoking during pregnancy is 40 percent for Whites, compared to seven percent for Blacks and two percent for Hispanics.
A consequence of Marion County’s history of high smoking rates is the high rate of deaths from lung cancer and chronic obstructive pulmonary disease (COPD). Marion County’s 2005 mortality rate from lung cancer was 28 percent above the national rate, and sixth highest among the 54 largest cities. Cancer was the leading cause of death in Marion County, and one third of the cancer deaths were from lung cancer. Over 90 percent of lung cancer deaths are attributable to smoking. COPD was Marion County’s third leading cause of mortality, with its COPD mortality rate being 41 percent above that of the nation. Marion County’s overall mortality rate is eight percent higher than that of the nation, with half of that excess attributable to our excess lung cancer and COPD deaths. Without the lung cancer and COPD deaths attributable to smoking, Marion County’s total mortality rate might have been 28 percent lower, giving Indianapolis one of the lowest mortality rates of any large city in the U.S. Smoking during pregnancy also can result in low birth weight, miscarriages, premature delivery, and sudden infant death syndrome. Environmental tobacco smoke, or second hand smoke, may also trigger myocardial infarctions (heart attacks) or asthma attacks and increase the risk of heart disease and significant lung conditions. Common impacts of secondhand smoke on children include bronchitis, asthma, other respiratory problems, and earaches.
Children whose parents smoke are more likely to become smokers. No comprehensive survey of childhood smoking in Marion County is available, but the especially high prevalence of smoking among young pregnant women indicates that the prevalence of smoking may be unusually high among our youth in general. Unless our youth are prevented from establishing a smoking habit, smoking will continue to be a pervasive cause of poor health status, high health care cost, and excess deaths in Marion County.
Infant Mortality
After reaching a low point in 2001, infant mortality increased steadily from 2001-2004, then decreased slightly in 2005. During that period, national infant mortality rates were stable and consistently lower than Marion County’s. Marion County’s increase was specific to White and Hispanic infants. No single factor appeared to be causing the increase, though most of the increase was in deaths in the month after birth, which are usually related to premature births or birth complications. Among the 53 largest U.S. cities, Indianapolis ranked 17th in infant mortality in 2003, with a rank of one corresponding to the highest rate. The Black infant mortality rate in Marion County was fairly stable and about ten percent higher than the national Black infant mortality rate. However, both the national and Marion County Black infant mortality rates continued to be about twice as high as White infant mortality rates.
Accidents, Suicide and Homicide
Deaths from accidents, suicides, and homicides accounted for 18 percent of the years of potential life lost (YPLL) in 2005. Combined, these three causes of death were second only to cancer in contributing to premature death in Marion County. Indianapolis’s homicide rate was in the middle rank of large U.S. cities, but this cause has a disproportionately large impact on the Black community. The greater homicide rate accounted for over one-third of the difference between Black and White YPLL per person. For Blacks, homicide was second only to cancer in total YPLL. Overall mortality for Blacks under age 25 is twice that of Whites.
Gonorrhea and Chlamydia
Marion County had a high prevalence of chlamydia and gonorrhea, having the tenth and seventh highest rates, respectively, among the 43 largest U.S. cities reporting rates in 2005. Marion County’s rank for gonorrhea had been declining since 2000, when Marion County was ranked 16th. Adolescents and young adults were at greatest risk for these sexually transmitted diseases. There was one new gonorrhea infection reported for every forty-seven 15 to 24 year olds in 2006. In that same age group, there was one new reported male chlamydia case for every 47 males and for every 16 females. Many cases of both diseases have no symptoms and go undetected, so the actual incidences were probably higher.
Leading Causes of Death
Chronic diseases are diseases of long duration and generally slow progression. Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases, and diabetes, are by far the leading cause of mortality in the world, representing 60 percent of all deaths.
The four most common causes of death among Marion County residents between 2002 and 2005 were cancer (214.0 deaths per 100,000 persons), heart disease (192.0), chronic obstructive pulmonary disease (COPD) (59.0), and stroke (45.0). Stroke, diabetes, and homicide consistently ranked higher as causes of death for Blacks than for Whites over the four-year period, while COPD and dementia ranked higher for Whites than for Blacks. The death rate for males (1040.7) in Marion County for 2005 exceeded that for females (736.0). Among races and ethnicities, Blacks had the highest death rate (1099.0) followed by Whites (813.6), other races (551.5), and Hispanics (279.9).
In the following causes of death summary table, thumbs up and thumbs down symbols denote positive or negative changes in the public health indicators. Descriptors without direct health implications use directional arrows to indicate Marion County’s rate is higher/lower than the comparison year at a statistically significant level (95%) or is a noteworthy difference according to the analysts’ professional opinion. A lack of a significant change is denoted by the thumbs down and thumbs up symbols together.
Table 1‑1: Causes of Death Summary
|
Cause of Death |
County Data* |
Recent Change |
U.S. Comparison |
IN Comparison |
HP 2010 |
|||||
|
yrs |
% Change |
DC |
U.S. Data* |
DC |
IN Data* |
DC |
||||
|
Positive Indicators for Marion County |
||||||||||
|
Strokes |
45 (2005) |
5 |
-26% (2000-2005) |
C |
50 (2004) |
C |
50 (2005) |
C |
12-7 50 |
|
|
Heart Disease |
192 (2005) |
5 |
-23% (2000-2005) |
C |
218 (2004) |
C |
222 (2005) |
C |
12-1 162 |
|
|
Breast Cancer |
14 (2005) |
5 |
-13% (2000-2005) |
C |
14 (2004) |
DC |
13 (2005) |
DC |
3-3 10.6a |
|
|
Accidents |
22 (2005) |
5 |
-12% (2000-2005) |
C |
37 (2004) |
C |
39 (2005) |
C |
15-13 17 |
|
|
Neutral Indicators for Marion County |
||||||||||
|
Suicide |
10 (2005) |
5 |
-9% (2000-2005) |
DC |
6 (2004) |
DC |
12 (2005) |
C |
18-1 5 |
|
|
All Cancer |
214 (2005) |
5 |
-1.4% (2000-2005) |
DC |
185 (2004) |
D |
199 (2005) |
DC |
3-1 159 |
|
|
Diabetes |
27 (2005) |
5 |
0% (2000-2005) |
DC |
24 (2004) |
D |
27 (2005) |
DC |
5-3 8 |
|
|
Motor Vehicle Accidents |
9 (2005) |
5 |
0% (2000-2005) |
DC |
15 (2004) |
C |
15 (2005) |
C |
15-15a 8 |
|
|
Negative Indicators for Marion County |
||||||||||
|
AIDS |
5 (2005) |
5 |
+67% (2000-2005) |
D |
4 (2004) |
D |
2 (2005) |
D |
13-14 1 |
|
|
Alzheimer’s |
21 (2005) |
5 |
+31% (2000-2005) |
D |
22 (2004) |
DC |
25 (2005) |
C |
NA |
|
|
Kidney Disease |
18 (2005) |
5 |
+20% (2000-2005) |
D |
14 (2004) |
D |
20 (2005) |
C |
NA |
|
|
Homicide |
13 (2005) |
5 |
+18% (2000-2005) |
D |
6 (2004) |
D |
6 (2005) |
D |
15-32 2.8 |
|
* All data are age-adjusted death rates per 100,000 persons to the year 2000 U.S. standard population. Deaths among Marion County Residents, per death certificate data 2005(DR0483-T37). Causes of death are classified using National Center for Health Statistics categories using the International Classification of Diseases, version 10 (ICD-10) coding.
a Healthy People 2010 objective 3-3 is 21.3 breast cancer deaths per 100,000 females. We approximate the overall (both gender) rate implied by this objective by dividing it in half.
Table notes: County data: Is for most recent year available. Recent Change: Percent change of most recent measurement from a measurement the noted number of years prior. Changes of more than 5 percent in either direction are denoted by thumbs up or thumbs down symbols thumbs up or thumbs down. Neutral thumbs indicate no change, even though no change may be a negative outcome; U.S. or IN population data: Is for most recent year available; U.S. (or IN) Comparison: Comparison of most recent data using thumbs up or thumbs down symbols to denote differences that are statistically significant or deemed to be noteworthy from the analysts’ professional perspective. Note: When there is no public health implication associated with a measure, directional arrows replace thumb icons to indicate the direction of change or the relationship of the Marion County measure (higher/lower/not different) to the U.S./IN measure.
Table 1‑2: Selected Age-Adjusted* Rates of Death per 100,000 Persons, Marion County, Indiana, and U.S.
|
Cause of Death |
Marion County |
Indiana 2005 |
Milwaukee County WI 2005 |
Davidson County TN 2004 |
U.S. 2004^
|
||
|
2000 |
2004 |
2005 |
|||||
|
Cancer |
217.4 |
205.2 |
214.4 |
199.1 |
200.0 |
197.4 |
184.6 |
|
Heart Disease |
247.8 |
206.9 |
191.5 |
222.0 |
209.1 |
233.5 |
217.5 |
|
COPD |
57.5 |
57.5 |
59.1 |
54.0 |
39.6 |
46.9 |
41.8 |
|
Strokes |
61.1 |
47.6 |
45.1 |
50.2 |
43.5 |
53.7 |
50.0 |
|
Unspecified Dementia |
19.8 |
28.0 |
29.3 |
NA |
NA |
NA |
NA |
|
Diabetes |
27.2 |
25.2 |
26.8 |
26.7 |
22.7 |
31.5 |
24.4 |
|
Accidents |
25.3 |
27.6 |
21.9 |
38.7 |
46.8 |
51.3 |
36.6 |
|
Motor Vehicle Accidents |
9.2 |
8.9 |
9.0 |
15.2 |
7.8 |
18.3 |
14.8 |
|
Alzheimer’s |
16.0 |
17.2 |
20.5 |
24.7 |
18.3 |
25.1 |
21.7 |
|
Influenza & Pneumonia |
17.2 |
15.9 |
19.2 |
20.1 |
20.6 |
20.6 |
20.4 |
|
Kidney Disease |
14.5 |
20.1 |
17.7 |
19.6 |
17.0 |
12.6 |
14.3 |
|
Homicide |
11.3 |
11.6 |
12.8 |
5.9 |
15.7 |
9.5 |
5.6 |
|
Suicide |
11.0 |
11.8 |
10.1 |
11.7 |
9.6 |
12.1 |
10.7 |
|
AIDS |
3.1 |
4.5 |
5.0 |
1.6 |
3.2 |
13.6 |
4.4 |
|
Tuberculosis |
0.6 |
0.1 |
0.5 |
0.2 |
NA |
0.7 |
0.2 |
|
Overall |
931.4 |
873.0 |
864.0 |
857.9 |
854.3 |
883.7 |
801.1 |
* Age-adjusted to match the age distribution of the 2000 U.S. population, so comparisons across regions will not be affected by differences between regions’ age distributions.
^ Provisional data. NA: Not available.
Source: Marion County Death Certificates (DR0483-T37); IN: Indiana Mortality Report 2005, ISDH;[1] U.S.: CDC, National Center for Health Statistics;[2] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[3] TN: HIT (Health Information Tennessee), Tennessee Dept. of Health.[4]
Table 1‑3: Rank of Ten Leading Causes of Death, Plus Homicide, Suicide, and AIDS Deaths by Race, Marion County, 2002-2005
|
Cause of Death |
2005 |
2004 |
2003 |
2002 |
||||
|
White |
Black |
White |
Black |
White |
Black |
White |
Black |
|
|
Heart Disease |
1 |
2 |
1 |
1 |
1 |
1 |
1 |
2 |
|
Cancer |
2 |
1 |
2 |
2 |
2 |
2 |
2 |
1 |
|
COPD |
3 |
5 |
3 |
6 |
3 |
5 |
3 |
8 |
|
Stroke |
4 |
3 |
4 |
3 |
4 |
3 |
4 |
3 |
|
Unspecified Dementia |
5 |
8 |
5 |
10 |
5 |
8 |
6 |
13 |
|
Accidents |
6 |
9 |
6 |
7 |
7 |
9 |
7 |
6 |
|
Alzheimer’s |
7 |
10 |
8 (Tie) |
13 |
10 |
11 |
10 |
>11 |
|
Diabetes |
8 |
4 |
7 |
4 (Tie) |
6 |
4 |
9 |
5 |
|
Pneumonia & Influenza |
9 |
>11 |
10 |
15 |
11 |
14 |
8 |
12 |
|
Kidney Disease |
10 |
7 |
8 (Tie) |
8 |
9 |
7 |
11 |
7 |
|
Homicide |
21 |
6 |
22 |
4 (Tie) |
20 |
6 |
21 |
4 |
|
Suicide |
14 |
16 |
11 |
21 |
13 |
18 |
12 |
18 |
|
AIDS |
24 |
15 |
24 |
14 |
26 |
15 |
23 |
16 |
Source: Marion County Death Certificates (DR0483-T36).
Table 1‑4: Marion County All Causes Death Rates by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
80.1 |
110.2 |
173.5 |
742.9 |
4865.7 |
864.2 |
|
Males |
84.7 |
185.0 |
223.7 |
919.5 |
5743.6 |
1040.7 |
|
Females |
75.2 |
35.0 |
123.5 |
583.0 |
4341.0 |
736.0 |
|
Whites |
58.5 |
72.7 |
152.2 |
682.3 |
4699.9 |
813.6 |
|
Blacks |
116.1 |
170.9 |
262.1 |
1039.2 |
5866.2 |
1099.0 |
|
Hispanics |
106.1 |
145.1 |
70.5 |
311.3 |
1162.0 |
279.9 |
|
Other Races |
52.4 |
132.3 |
102.2 |
233.3 |
3478.3 |
551.5 |
|
White Males |
62.0 |
111.6 |
191.5 |
821.3 |
5535.3 |
967.9 |
|
White Females |
54.8 |
34.0 |
113.0 |
551.9 |
4197.5 |
703.2 |
|
Black Males |
121.8 |
307.5 |
375.3 |
1393.7 |
7089.9 |
1386.3 |
|
Black Females |
110.2 |
39.2 |
167.2 |
755.3 |
5152.9 |
897.9 |
|
Hispanic Males |
114.7 |
251.3 |
83.7 |
515.4 |
1493.3 |
387.6 |
|
Hispanic Females |
97.1 |
0 |
47.4 |
60.5 |
887.7 |
160.6 |
|
Other Males |
53.3 |
142.8 |
131.3 |
325.3 |
3807.8 |
623.9 |
|
Other Females |
51.6 |
123.2 |
72.1 |
158.2 |
3610.3 |
541.1 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
Source: Marion County Death Data (DR0483-T39.3).
Heart Disease
Heart Disease is the leading cause of death in the United States, representing 22 percent of the country’s total mortality. Deaths due to heart disease have been decreasing in recent years, both nationally and in Marion County. The Marion County death rate for heart disease declined by 23 percent between 2000 and 2005. The Marion County heart disease death rates for 2004 through 2005 also compared favorably with those for Indiana, the U.S. and comparison counties in Wisconsin and Tennessee.
Marion County heart disease death rates in 2005 were generally higher for men than for women, and higher for Blacks than for Whites. Gender differences were especially pronounced in the 25 to 64 year old age groups, where male to female rate ratios were over 2 to 1. The Marion County heart disease mortality rate of 192 per 100,000 persons has significantly decreased since 2000 when the rate was 248 per 100,000. It is now approaching the revised Healthy People 2010 Objective 12-1 of no more than 162 heart disease deaths per 100,000.
Table 1‑5: Marion County Heart Disease Death Rates by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
1.8 |
3.7 |
21.1 |
148.6 |
1197.3 |
191.5 |
|
Males |
0.9 |
3.7 |
30.1 |
208.9 |
1393.6 |
232.2 |
|
Females |
2.7 |
3.7 |
12.1 |
93.7 |
1078.5 |
161.8 |
|
Whites^ |
1.5 |
4.6 |
20.9 |
141.7 |
1177.2 |
187.5 |
|
Blacks^ |
3.1 |
2.8 |
25.8 |
188.8 |
1312.7 |
216.6 |
|
White Males |
0 |
6.2 |
28.5 |
198.3 |
1412.6 |
231.9 |
|
White Females |
3.1 |
3.1 |
13.3 |
88.6 |
1031.4 |
155.1 |
|
Black Males |
3.1 |
0 |
41.9 |
270.8 |
1391.4 |
249.2 |
|
Black Females |
3.2 |
5.6 |
12.3 |
123.0 |
1265.2 |
192.3 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
^ Rates for Hispanics and Other races are omitted from the table, as the base populations are too small to provide stable statistics after being divided by age. There were 6 Hispanic, and 14 Other Race, Non-Hispanic Heart Disease deaths in 2005. Heart Disease deaths per 100,000 persons among the Marion County Hispanic population are 50.7 among men, 22.5 among women, and 39.1 overall.
Source: Marion County Death Data (DR0483-T39.1)
Cancer
Death rates for all cancers, breast cancer and prostate cancer fell in Marion County between 2000 and 2005, while rates of death from lung cancer and colorectal cancer increased. The Marion County death rates for all cancers (214.4 per 100,000), lung cancer (71.0) and breast cancer (13.7) in 2005 exceeded the death rates for those causes in Indiana, the U.S. and two comparison counties for the closest year available. However, for the most recent comparison year (2004), Indianapolis had the third lowest breast cancer mortality rate among 54 largest U.S. cities. In 2005, the Marion County death rate for prostate cancer was lower than the Healthy People 2010 objective. The breast and cervical rates were somewhat above the Healthy People 2010 objectives, while lung, colorectal, and overall cancer mortality rates were far above the objectives.
Deaths from lung cancer are especially common in Marion County. The age-adjusted rate of 71 deaths per 100,000 residents in 2005 was 34 percent higher than the 2004 national rate. Compared to the 54 largest U.S. cities, for the most recent comparison year (2004), Indianapolis had the sixth highest rate of lung cancer mortality.
Death rates for all cancers in Marion County for 2005 were higher for males than for females and higher among Blacks than Whites. After age 65, the cancer death rate for Whites was over two-thirds higher than that for White females. Among Blacks over 65, the cancer death rate was more than twice as high for males as for females.
Table 1‑6: Selected Age-Adjusted* Rates of Cancer Deaths per 100,000 Persons for Marion County, Indiana, Comparable Counties, and Healthy People 2010 Objectives
|
Cause |
Marion County 2000 |
Marion County 2005 |
Indiana 2005 |
U.S. 2004^ |
Milwaukee County WI 2005 |
Davidson County TN 2004 |
Healthy People 2010 Objective |
|
Lung |
67.7 |
71.0 |
63.0 |
52.9 |
54.4 |
66.0 |
43.3 |
|
Colorectal |
18.5 |
19.2 |
19.4 |
17.9 |
16.5 |
17.8 |
13.7 |
|
Breast |
16.2 |
13.7 |
12.9 |
13.6 |
13.1 |
12.9 |
10.6a |
|
Prostate |
12.1 |
10.1 |
8.7 |
9.7 |
9.8 |
9.2 |
14.1a |
|
Cervical |
1.1 |
1.1 |
1.4 |
1.3 |
1.4 |
1.5 |
1.0a |
|
All Cancer |
217.4 |
214.4 |
199.1 |
184.6 |
200.0 |
197.4 |
158.6 |
* Age-adjusted to match the age distribution of the 2000 U.S. population, so comparisons across regions will not be affected by differences between regions’ age distributions.
^ Provisional data.
a Healthy People 2010 objective 3-3 and 3-4 are 21.3 breast and 2.0 cervical cancer deaths per 100,000 females. Objective 3-7 is 28.2 prostate cancer deaths per 100,000 males. We approximate the overall (both gender) rates implied by these objectives by dividing them in half.
Source: Marion County Death Data (DR0483-T38); IN: Indiana Mortality Report 2005, ISDH;[5] U.S.: CDC, National Center for Health Statistics;[6] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[7] TN: HIT (Health Information Tennessee), Tennessee Dept. of Health;[8] Healthy People 2010 Objective: Healthy People 2010, U.S. Department of Health and Human Services. [9]
Table 1‑7: Marion County All Cancers Deaths per 100,000 Persons by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
2.5 |
5.5 |
28.0 |
245.8 |
1187.8 |
214.3 |
|
Males |
3.0 |
9.2 |
17.6 |
267.8 |
1628.1 |
272.4 |
|
Females |
2.0 |
1.8 |
38.3 |
226.8 |
925.2 |
179.4 |
|
Whites^ |
2.4 |
6.2 |
26.4 |
232.3 |
1140.4 |
205.0 |
|
Blacks^ |
1.7 |
5.7 |
40.0 |
328.0 |
1511.8 |
277.0 |
|
White Males |
1.5 |
9.3 |
15.4 |
250.5 |
1526.7 |
254.8 |
|
White Females |
3.4 |
3.1 |
37.5 |
216.3 |
912.6 |
175.7 |
|
Black Males |
3.3 |
11.6 |
28.4 |
379.5 |
2254.9 |
380.1 |
|
Black Females |
0 |
0 |
49.6 |
287.1 |
1074.9 |
214.4 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
^ Rates for Hispanics and Other races are omitted from the table, as the base populations are too small to provide stable statistics after being divided by age. There were 4 Hispanic, and 5 Other Race, Non-Hispanic deaths from All Cancers in 2005. Deaths from All Cancers per 100,000 persons among the Marion County Hispanic population are 18.7 among men, 13.4 among women, and 16.5 overall.
Source: Marion County Death Data (DR0483-T39.4)
Stroke
Like heart disease death rates, stroke death rates nationally have declined steadily over many years. The decline has occurred mainly due to improved detection and treatment of high blood pressure. Stroke deaths share several risk factors with heart disease, including uncontrolled high blood pressure, cigarette smoking, high cholesterol, and obesity. Prevention strategies include maintaining healthy weight and physical activity levels. Secondary prevention includes early detection and monitoring of persons with elevated blood pressure and adherence to anti- hypertension medications by treated individuals.
The overall Marion County stroke death rate decreased by 26 percent from 2000 to 2005. In 2005, the Marion County stroke death rate was lower than the stroke death rate for Indiana, the U.S. and that of Nashville, Tennessee (Davidson County), but was slightly higher than the stroke death rate for Milwaukee County in 2005. The 2004 and 2005 stroke death rates for Marion County (45 deaths per 100,000 persons) have met and surpassed the Healthy People 2010 Objective 12-7 of 50 deaths per 100,000 persons.
Marion County stroke death rates for all ages in 2005 were only slightly higher for females than for males, but were 44 percent higher for Blacks than for Whites. In the 25 to 64 year old age groups, the Black stroke death rate was over three times the rate for Whites. Stroke death rates increased significantly for all groups shown in the table after 65 years of age. Comparing race-sex combinations within that age group, Black males had the highest stroke death rate and White males had the lowest stroke death rate.
Figure 1‑1: Age-Adjusted* Rates of Stroke Deaths per 100,000 Persons for Marion County and Comparison Populations
* Age-adjusted to match the age distribution of the 2000 U.S. population, so comparisons across regions will not be affected by differences between regions’ age distributions.
^ Provisional data.
Source: Marion County Death Data (DR0483-T37); IN: Indiana Mortality Report 2005, ISDH;[10] U.S.: CDC, National Center for Health Statistics;[11] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[12] TN: HIT (Health Information Tennessee), Tennessee Dept. of Health.[13]
Table 1‑8: Marion County Stroke Deaths per 100,000 Persons by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
0.9 |
0.9 |
4.8 |
33.6 |
284.1 |
45.1 |
|
Males |
0.9 |
1.8 |
1.6 |
31.9 |
289.2 |
44.6 |
|
Females |
0.9 |
0 |
7.9 |
35.5 |
282.2 |
46.1 |
|
Whites^ |
0.8 |
0 |
3.0 |
21.1 |
283.8 |
41.6 |
|
Blacks^ |
1.6 |
2.8 |
9.7 |
77.9 |
308.9 |
60.0 |
|
White Males |
1.5 |
0 |
0 |
15.5 |
282.5 |
39.5 |
|
White Females |
0 |
0 |
6.0 |
26.7 |
287.8 |
44.1 |
|
Black Males |
0 |
5.8 |
3.6 |
89.6 |
329.0 |
63.4 |
|
Black Females |
3.2 |
0 |
14.8 |
68.8 |
292.5 |
57.4 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
^ Rates for Hispanics and Other races are omitted from the table, as the base populations are too small to provide stable statistics after being divided by age. There were 2 Hispanic, and 2 Other Race, Non-Hispanic Stroke deaths in 2005. Stroke deaths per 100,000 persons among the Marion County Hispanic population are 44.2 among men, 0 among women, and 20.7 overall.
Source: Marion County Death Data (DR0483-T39)
Homicide
In the Indianapolis metropolitan statistical area (MSA), the FBI’s Uniform Crime Reports (UCR) estimated 122 murders occurred in 2005, for an MSA rate of 7.5 homicides per 100,000 persons, the same as the St. Louis MSA and similar to Nashville (8.1 per 100,000) and Milwaukee (8.6). The majority of these cases (108) occurred within the Indianapolis city limits. For the most recent available comparison year (2004), Indianapolis’s homicide rate was in the middle rank of large U.S. cities.
Differences between the 2005 UCR murder rates and homicide rates from 2004 Marion County death certificates may reflect incomplete reporting for all police jurisdictions at the time of the 2005 crime statistics report. Death certificate data reflect deaths among Marion County residents, while UCR data reflect homicides of residents and non-residents occurring within the county.
Death certificate-based homicide mortality rates for the Marion County population increased slightly from 11 (2000) to 13 per 100,000 persons in 2005. In 2004 in Marion County, homicide was listed as a cause of death more than twice as often as for Indiana or the U.S. populations, and by 2005 it was four times higher than the revised Healthy People 2010 Objective 15-32 of 2.8 deaths per 100,000.
Figure 1‑2: Age-Adjusted Rates of Homicide Rate per 100,000 Persons for Marion County and Comparison Populations
* Age-adjusted to match the age distribution of the 2000 U.S. population, so comparisons across regions will not be affected by differences between regions’ age distributions.
^ Provisional data.
Source: Marion County Death Data; IN (DR0483-T39): Indiana Mortality Report 2004, ISDH[14]; U.S.: CDC, National Center for Health Statistics;[15] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[16] TN: HIT (Health Information Tennessee), Tennessee Dept. of Health.[17]
Assault (Homicide) Mortality: ICD10 codes U01-U02, X85-Y09, Y87.1
Other Selected Causes of Death
Other selected causes of death include chronic liver disease, and cirrhosis, diabetes, pneumonia/influenza, AIDS, and accidents (unintentional injury).
Table 1‑9: Marion County Chronic Liver Disease and Cirrhosis Deaths per 100,000 Persons by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
0 |
0 |
3.6 |
19.6 |
24.3 |
8.5 |
|
Males |
0 |
0 |
6.4 |
28.5 |
32.7 |
12.4 |
|
Females |
0 |
0 |
0.8 |
11.5 |
18.8 |
5.2 |
|
Whites^ |
0 |
0 |
4.2 |
22.4 |
26.8 |
9.6 |
|
Blacks^ |
0 |
0 |
3.1 |
11.2 |
16.8 |
5.5 |
|
White Males |
0 |
0 |
7.1 |
30.9 |
34.5 |
13.4 |
|
White Females |
0 |
0 |
1.2 |
14.5 |
21.9 |
6.3 |
|
Black Males |
0 |
0 |
6.7 |
20.4 |
28.4 |
10.1 |
|
Black Females |
0 |
0 |
0 |
3.8 |
9.2 |
2.0 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
^ Rates for Hispanics and Other races are omitted from the table, as the base populations are too small to provide stable statistics after being divided by age. There were 1 Hispanic, and 0 Other Race, Non-Hispanic Chronic Liver Disease and Cirrhosis deaths in 2005. Chronic Liver Disease and Cirrhosis deaths per 100,000 persons among the Marion County Hispanic population are 11.7 among men, 0 among women, and 6.3 overall.
Source: Marion County Death Data (DR0483-T39.5)
Table 1‑10: Marion County Diabetes Mellitus Deaths per 100,000 Persons by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
0 |
0 |
4.4 |
27.7 |
153.1 |
26.8 |
|
Males |
0 |
0 |
4.8 |
38.3 |
198.6 |
35.0 |
|
Females |
0 |
0 |
4.0 |
18.1 |
129.3 |
21.6 |
|
Whites^ |
0 |
0 |
1.8 |
22.9 |
113.6 |
20.0 |
|
Blacks^ |
0 |
0 |
11.4 |
49.6 |
307.2 |
53.2 |
|
White Males |
0 |
0 |
3.5 |
31.0 |
147.0 |
26.5 |
|
White Females |
0 |
0 |
0 |
15.3 |
96.8 |
15.6 |
|
Black Males |
0 |
0 |
10.9 |
74.7 |
419.4 |
72.8 |
|
Black Females |
0 |
0 |
11.8 |
29.5 |
247.9 |
41.4 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
^ Rates for Hispanics and Other races are omitted from the table, as the base populations are too small to provide stable statistics after being divided by age. There were 3 Hispanic, and 3 Other Race, Non-Hispanic Diabetes Mellitus deaths in 2005. Diabetes Mellitus deaths per 100,000 persons among the Marion County Hispanic population are 32.5 among men, 44.9 among women, and 39.5 overall.
Source: Marion County Death Data (DR0483-T39.6)
Table 1‑11: Marion County Pneumonia/Influenza Deaths per 100,000 Persons by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
0 |
0 |
2.8 |
7.0 |
133.2 |
19.2 |
|
Males |
0 |
0 |
4.8 |
10.6 |
146.0 |
22.2 |
|
Females |
0 |
0 |
0.8 |
3.9 |
125.6 |
17.0 |
|
Whites^ |
0 |
0 |
1.2 |
4.1 |
128.7 |
17.5 |
|
Blacks^ |
0 |
0 |
8.0 |
16.4 |
157.8 |
26.0 |
|
White Males |
0 |
0 |
1.2 |
4.2 |
144.3 |
19.5 |
|
White Females |
0 |
0 |
1.2 |
4.0 |
120.0 |
16.4 |
|
Black Males |
0 |
0 |
17.6 |
32.2 |
154.4 |
31.9 |
|
Black Females |
0 |
0 |
0 |
3.8 |
156.7 |
20.7 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
^ Rates for Hispanics and Other races are omitted from the table, as the base populations are too small to provide stable statistics after being divided by age. There were 1 Hispanic, and 3 Other Race, Non-Hispanic Pneumonia/Influenza deaths in 2005. Pneumonia/Influenza deaths per 100,000 persons among the Marion County Hispanic population are 36.1 among men, 0 among women, and 13.8 overall.
Source: Marion County Death Data (DR0483-T39.7)
Table 1‑12: Marion County AIDS Deaths per 100,000 Persons by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
0 |
0 |
10.3 |
8.5 |
0 |
5.0 |
|
Males |
0 |
0 |
16.7 |
14.5 |
0 |
8.2 |
|
Females |
0 |
0 |
4.0 |
2.9 |
0 |
1.8 |
|
Whites^ |
0 |
0 |
8.3 |
3.5 |
0 |
3.3 |
|
Blacks^ |
0 |
0 |
18.0 |
21.7 |
0 |
10.2 |
|
White Males |
0 |
0 |
15.4 |
5.6 |
0 |
5.8 |
|
White Females |
0 |
0 |
1.1 |
1.4 |
0 |
0.6 |
|
Black Males |
0 |
0 |
24.8 |
39.2 |
0 |
16.1 |
|
Black Females |
0 |
0 |
12.3 |
7.6 |
0 |
5.4 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
^ Rates for Hispanics and Other races are omitted from the table, as the base populations are too small to provide stable statistics after being divided by age. There were 3 Hispanic, and 0 Other Race, Non-Hispanic AIDS deaths in 2005. AIDS deaths per 100,000 persons among the Marion County Hispanic population are 19.8 among men, 0 among women, and 11.1 overall.
Source: Marion County Death Data (DR0483-T39.10)
Table 1‑13: Marion County Accident (Unintentional Injury) Deaths per 100,000 Persons by Age, Race, and Sex, 2005
|
Group |
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total* |
|
Total |
8.8 |
21.1 |
11.8 |
25.0 |
63.2 |
21.9 |
|
Males |
9.3 |
36.6 |
17.5 |
42.6 |
75.8 |
31.3 |
|
Females |
8.2 |
5.5 |
6.1 |
8.7 |
54.9 |
13.2 |
|
Whites^ |
4.7 |
21.7 |
13.5 |
25.4 |
65.6 |
22.0 |
|
Blacks^ |
19.7 |
14.2 |
6.1 |
28.4 |
51.0 |
20.8 |
|
White Males |
7.7 |
37.2 |
20.0 |
46.3 |
82.6 |
33.5 |
|
White Females |
1.5 |
6.2 |
7.1 |
5.4 |
53.6 |
11.3 |
|
Black Males |
15.9 |
23.2 |
10.3 |
40.0 |
33.6 |
22.9 |
|
Black Females |
23.5 |
5.6 |
2.5 |
19.1 |
60.9 |
18.5 |
* Age-adjusted to match the age distribution of the 2000 U.S. population
^ Rates for Hispanics and Other races are omitted from the table, as the base populations are too small to provide stable statistics after being divided by age. There were 8 Hispanic, and 1 Other Race, Non-Hispanic Unintentional Injury deaths in 2005. Unintentional Injury deaths per 100,000 persons among the Marion County Hispanic population are 17.3 among men, 5.7 among women, and 12.5 overall.
Source: Marion County Death Data (DR0483-T39.11)
Future Challenges
The prevalence of obesity and access to healthcare coverage are Marion County’s greatest challenges.
Poor Diet, Physical Inactivity and Obesity
We are only experiencing the beginnings of the health impacts of this high prevalence of obesity, and of the poor diet and physical inactivity that lead to obesity. As with the habit of smoking, the habits of poor diet and physical inactivity produce chronic disease, such as high blood pressure, diabetes, coronary heart disease, respiratory conditions, and some cancers. As these chronic diseases progress, they will eventually result in decreased quality of life, increased health care needs, hospitalizations, and, ultimately, increased mortality. Because obesity has increased only relatively recently, much of the consequent chronic disease is still in early stages. But if the trend in obesity is not reversed, severe chronic disease is likely to become increasingly common. The result may be a notable worsening of our general health status, as well as decreased productivity, increased demand on our health care system, and increased health care costs. As with smoking, much of the solution depends on individuals improving their own personal health behaviors – in this case, improving their diets and physical activity.
The prevalence of obesity in the United States doubled from 1990-2005. Obesity in Indiana has consistently been about three percentage points more prevalent than in the rest of the country. Reasonable reliable estimates of the prevalence of obesity in Marion County are only available since 2002, and have been similar to those for the state. In 2005, one out of four adults in Marion County was obese, and another 35 percent were overweight.
Overweight is also common among Marion County school-aged children. In 2005, 22 percent of Marion County schoolchildren were overweight and 18 percent were at risk of overweight. Even in the five to nine year old group, 37 percent are overweight or at risk of overweight. Overweight among Marion County children was similar to that of Arkansas in 2003, the one state with similarly collected data.
Healthcare Access and Safety-Net Services
While many programs are available in Marion, the health assessment revealed that over half of Marion County residents either depend on government subsidized healthcare coverage or have no healthcare coverage at all. One of every three Marion County residents depends on government subsidized healthcare coverage, with Medicaid covering 18 percent of the population, and the county-sponsored Health Advantage program covering another 15.5 percent. Medicaid covers 39 percent of Marion County children, 14 percentage points more than the national rate. In a 2005 survey, 17.5 percent of the Marion County population reported having no healthcare coverage at all. Public programs accounted for a majority (59 percent) of hospital costs in 2005 and the uninsured (self-pay) accounted for 6.4 percent. Lack of insurance varied by race or ethnicity. Despite being employed at rates similar to Whites, almost half of Hispanic residents in Marion County had no health care coverage, compared to a quarter of Blacks and one-eighth of Whites.
There are many financially vulnerable households in Marion County. More than one in ten of all Marion County families live in poverty. Fifteen percent of residents had incomes below the 2005 federal poverty guidelines, compared to 11 percent nationally.
The Hispanic population increased from four to six percent of the Marion County population between 2000 and 2005. Of the six percent of Marion County residents from households where Spanish is the usual language spoken, six out of ten have difficulty communicating in English. The growth in the Marion County residents who are not fluent in English is creating an increased need for translation services in hospitals and physicians’ offices. The impact may be greater than these numbers indicate; the most common reason for hospitalization is to give birth, and 16 percent of births in Marion County were to Hispanic mothers.
What Can Be Done
Chronic disease programs in state public health agencies across the United States are integrating activities across single-disease program lines. The perceived benefits of program integration include efficient use of staff, funds and surveillance and intervention efforts.
Preventable risk factors for heart disease and stroke have been established by several national and international cohort studies. The risk factors include high serum total and LDL cholesterol levels, hypertension, obesity, and diabetes. Non-modifiable risk factors include family history of stroke or heart disease, as well as gender, race, and age. Risk factors amenable to change include smoking and physical inactivity, high fat/low fiber intake, and weight gain in adulthood. Risk of heart disease and stroke may also be reduced through use of low-dose aspirin by adults and appropriate stress reduction to maintain cardiovascular health.
Secondary prevention methods for persons with clinical changes in blood pressure, cholesterol, and glucose or insulin function can decrease consequent health problems through regular monitoring of blood pressure, serum cholesterol components, and blood glucose levels, and adherence to medication regimens for these conditions. Significant end-organ changes, such as altered cardiac performance, can be tested by stress ECG monitoring. Atherosclerotic vessel changes can be detected in angiograms or carotid artery sonograms. These tests may prompt invasive procedures (bypass surgery, stent placement or angioplasty for example) that improve quality of life for heart disease patients, but are not major factors in reducing mortality risk.
The incidence of colon and breast cancer can be reduced through physical activity and healthy diet, including fiber, anti-oxidant rich fruits, vegetables, and low animal-fat intake. As cigarette smoking is a direct risk factor for over 80 percent of lung cancer, primary prevention requires reduced smoking initiation among youth, early and successful cessation by current smokers, and reduced exposure to any secondhand smoke (SHS) among non-smokers. Smoke-free workplace ordinances have been increasingly accepted as a major public health policy to reduce the public SHS exposure, while social marketing strategies and increased tobacco taxation have been successful in reducing uptake and promoting cessation in youth.
Appropriate cancer screening tests for breast (self and clinical examinations; mammography), colon (colonoscopy; FOBT), cervical (Pap tests), and prostate (PSA) cancer provide secondary prevention via early detection and intervention in the disease. Early detection and intervention for any of these cancers results in a greater survival rate and lower costs from morbidity and lost productivity.
Nearly half of American adults report that they do not exercise at all, and seven out of 10 do so infrequently. Too many of America’s youth do not exercise at all, are overweight, and have poor dietary habits. Five chronic diseases associated with obesity – heart disease, stroke, cancer, diabetes, and chronic obstructive pulmonary disease (e.g., bronchitis, emphysema, asthma) – account for more than two-thirds of all deaths in the United States. In addition to claiming more than 1.7 million American lives each year, these diseases hinder daily living for more than one of every 10 Americans, or 25 million people. More than 100 million Americans live with chronic disease, and millions of new cases are diagnosed each year.
Although these chronic diseases are among the most prevalent and deadly health problems facing our nation, some of them are very preventable. Effective measures exist today to prevent or delay much of the chronic disease burden and curtail its devastating consequences. Families can take simple, affordable steps to work physical activity, good nutrition, and behavior changes into their daily routine.
Key Recommendations
Many factors contribute to health, but behavior patterns have the greatest influence. An expert review of many studies estimated that behavioral patterns account for 40 percent all premature deaths, followed by genetic predispositions, which genetic predispositions accounted for 30 percent (see Figure 1‑3).[18] Below are steps we each can take to protect and improve our health.
· Be physically active
· Develop healthy dietary habits, including fiber and anti-oxidant rich fruits, vegetables and low animal-fat intake.
· Stop smoking.
· Obtain regular prenatal care.
· Get regular screening tests for breast, colon, cervical and prostate cancer.
· Obtain early detection and treatment.
· Manage diabetes by eating healthy, being more active, losing weight, and not smoking.
Figure 1‑3: Contribution of Various Factors to Preventable Deaths
McGinnis, J. M., P. Williams-Russo, et al. (2002). "The case for more active policy attention to health promotion." Health Aff (Millwood) 21(2): 78-93. http://content.healthaffairs.org/cgi/reprint/21/2/78