Cardiovascular Disease (CVD) in Texas Philip Huang, MD, MPH Texas Department of State Health...

Cardiovascular Disease (CVD) in Texas

Philip Huang, MD, MPHTexas Department of State Health Services

Overview Burden of CVD

Mortality Morbidity Economic Cost

Risk Factors Quality/Performance

HEDIS EMS

Strategies to Address

Burden of CVD Leading cause of death in Texas

and in the United States 34% of all deaths in Texas 1,422,000 Texas adults reported

that they have had heart disease or stroke in 2005

MORTALITY DATA

Mortality Data Death certificate data were

compiled and tabulated by the Statistical Services Division of the Texas Vital Statistical Unit (VSU)

All death rates are age-adjusted using the 2000 US standard population

LEADING CAUSES OF DEATH, TEXAS, 2004

35,027

2,420

2,557

3,198

4,331

5,426

7,387

8,270

9,831

33,836

40,091

0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000

Other Causes

Septicemia

Nephritis, Nephrotic Syndrome, Nephrosis

Influenza and Pneumonia

Alzheimer's Disease

Diabetes Mellitus

Chronic Lower Respiratory Diseases

Accidents [Injuries]

Cerebrovascular Disease [Stroke]

Malignant Neoplasms [Cancer]

Diseases of the Heart

Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 2004

LEADING CAUSES OF DEATH, Whites, 2004

22,667

1,512

1,758

2,356

2,935

3,654

5,329

6,384

6,983

24,380

29,173

0 5,000 10,000 15,000 20,000 25,000 30,000 35,000

Other Causes


Intentional Self harm

Influenza and Pneumonia

Diabetes Mellitus

Alzheimer's Disease

Accidents [Injuries]






LEADING CAUSES OF DEATH, African American, 2004

4,493

411

432

462

476

488

862

902

1,336

4,200

4,985

0 1,000 2,000 3,000 4,000 5,000 6,000

Other Causes

Septicemia

Human Immunodeficiency Virus disease

Assault (Homicide)



Diabetes Mellitus

Accidents





LEADING CAUSES OF DEATH, Hispanics, 2004

6841

527

529

532

557

841

1,512

1,629

2,039

5,256

5,933

0 1000 2000 3000 4000 5000 6000 7000 8000

All Other Cause


Septicemia

Assault (Homicide)


Chronic Live diseases and cirrhosis


Diabetes Mellitus

Accidents




Trends of Heart Disease

DISEASES OF THE HEART (OVERALL)

0

100

200

300

400

500

600

1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

YEAR

Ag

e-a

dju

ste

d M

ort

ality

Rate

s p

er

100,0

00

U.S.

Texas

Data Source: Texas Vital Statistical Unit (VSU), Texas Department of State Health Services, 1969-2004

Trends of Stroke


STROKE (OVERALL)

0

20

40

60

80

100

120

140

160

180

1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

YEAR

Ag

e-a

dju

ste

d M

ort

ality

Rate

s

per

100,0

00

U.S.

Texas

Trends in Selected Causes of Death----1990-2004, Texas

0

50

100

150

200

250

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Age-

adju

sted

Rat

es P

er 1

00,0

00

ICD 10Ischemic Heart Disease

Stroke

ICD 9


ISCHEMIC HEART DISEASETexas, 1999-2004

0.0

50.0

100.0

150.0

200.0

250.0

300.0

Ag

e-ad

just

ed M

ort

ality

Rat

es P

er

100,

000

1999

2000

2001

2002

2003

2004


Mortality Data-Ischemic Heart Disease


Ischemic Heart Disease6 Year Average Age-Adjusted Mortality Rates, 1999-2004

STROKETexas, 1999-2004

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Ag

e-ad

just

ed M

ort

alit

y R

ates

Per

100

,000

1999

2000

2001

2002

2003

2004


Mortality Data-Stroke


Stroke 6-Year Average Age-Adjusted Mortality Rates,1999-2004

Hospital Discharge Data

2000 - 2004

Hospital Discharge Data

Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2005

Number of Selected First-List Hospital Discharges--2005

118,771

82,150

71,685

53,052

44,376

29,026

24,835

24,801

9,747

4,206

0 20,000 40,000 60,000 80,000 100,000 120,000 140,000

Ischemic Heart Disease

Cancer (Any Type)

Congestive Heart Failure

Stroke (Ischemic or Hemorragic)

Osteoarthritis

Type 2 Diabetes

Hypertension

Asthma

Type 1 Diabetes

Alzheimers Disease

Number of Selected First-Listed Diagnoses for Hospital Discharges Texas 2000-2004

59,995

55,345

7,376

127,954

58,603

8,136

136,863

67,121

59,142

8,251

134,304

71,432

58,589

8,220

129,578

72,424

45,110

8,681

126,597

64,387

- 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000

CHF

Isch Stroke

Hge Stroke

IHD

Number of Cases

2000 2001 2002 2003 2004

Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2000-2003

Estimated Hospital Charges

Estimated Average Hospital Charge Per Day Texas 2000-2004

$3,025

$2,742

$3,833

$6,240

$3,293

$3,014

$4,228

$6,803

$3,665

$3,288

$4,377

$7,469

$4,476

$3,835

$5,425

$8,995

$5,143

$4,199

$5,969

$10,223

$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000

CHF

Isch Stroke

Hge Stroke

IHD

Average Daily Charge in Dollars

2000 2001 2002 2003 2004

Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2000-2003

Total Hospital Charges Texas 2000-2004

$1,092,952,960

$906,349,120

$277,945,984

$3,761,979,904

$1,307,297,152

$1,061,718,272

$335,220,512

$4,405,183,488

$1,580,782,208

$1,215,433,600

$375,700,544

$5,031,501,824

$1,769,506,393

$1,300,267,809

$420,543,242

$5,215,958,793

$2,287,495,232

$1,217,124,457

$486,242,171

$5,845,981,928

$0 $1,000,000,000 $2,000,000,000 $3,000,000,000 $4,000,000,000 $5,000,000,000 $6,000,000,000 $7,000,000,000

CHF

Isch Stroke

Hge Stroke

IHD

Total Charges in Dollars

2000 2001 2002 2003 2004Data Source: Texas Health Care Information Collection (THCIC), Department of State Health Services, 2000-2003

Medicaid Claims Data for Cardiovascular Disease Texas, 2005

The data is based on paid Medicaid claims for Fee-For-Service (FFS) and Patient Care Case Management (PCCM) clients. It does not include information on individuals served by Medicaid HMOs or those served by STAR+PLUS.

This information is derived from paid or partially paid Medicaid claims and does not include data on denied or pending claims.

Primary CVD Diagnoses, Inpatient Cost, Texas, 2005

Source: Fee for Service (FFS) and Patient Care Case Management (PCCM) clients

Hypertension $2,132,630

Hypertensive heart disease $1,655,524

Ischemic Heart Disease $47,697,130

Stroke $20,071,425

Congestive Heart Failure $30,885,743

Primary CVD Diagnoses, Outpatient Cost, Texas, 2005


Hypertensive heart disease $1,061,310


Stroke $9,944,830



Primary CVD Diagnoses, Emergency Department Cost Texas, 2005




Stroke $3,248,339


Total Medicaid Paid Claims Due to CVD, Texas, 2005

Inpatient Emergency Department

Outpatient

Medicaid Paid Amount for CVD

$182,524,852.67 $42,641,919.19 $103,351,622.91


Risk Factor Surveillance

BRFSS Ongoing telephone survey

sponsored by DSHS in partnership with CDC

Conducted on a monthly basis of 500 randomly selected Texans 18 years or older are asked questions about their health habits

BRFSS Behavioral Risk Factors Medical Risk Factors Preventive Health Practices

Texas Adult Current Smoking Rates

15.0%

17.0%19.0%

21.0%23.0%

25.0%

1998 1999 2000 2001 2002 2003 2004 2005 2006

Adult Cigarette SmokingPrevalence – 2006

Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 2006

19.6%17.9%

20.5%

15.4%17.4%

25.0%

16.3%

21.3%

17.3%20.2%

9.8%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Wei

ghte

d pe

rcen

t %

Adult Cigarette SmokingHealth Service Region – 2006


Cigarette Smoking Among Youth – 2001 & 2005

Percent of Students Who Smoked One or More Cigarettes in the Past 30 Days

0

10

2030

40

50

60

7080

90

100

Male Female White Black Hispanic Texas

We

igh

ted

Pe

rce

nt

%

2001

2005

Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005(Excluding Houston ISD) High School Survey

Overweight/Obesity

Overweight or Obesity Texas and US Adults, 1995-2006

Data Source: Texas Behavioral Risk Factor Surveillance System, Texas Department of State Health Services, 1995-2006

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

We

igh

ted

pe

rce

nt

%

US Texas

Overweight or Obesity Texas, BRFSS,- 2006

61.5% 62.3%68.6%

55.8%60.3%

72.9%65.4%

49.9%

66.3% 67.8%62.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Wei

gh

ted

Per

cen

t %


Overweight or Obesity Health Service Region-2006


Overweight

0

10

20

30

40

50

60

70

80

90

100

Male Female White Black Hispanic Texas

We

igh

ted

Pe

rce

nt

%

2001

2005

Overweight among

Youth Prevalence – 2001 & 2005

Data Source: Texas Youth Risk Behavior Surveys (YRBS), Texas Department of State Health Services, 2001, 2005(Excluding Houston ISD) High School Survey

Lack of Physical Activity

Lack of Physical Activity* Texas & US Adults, 1995-2006

* During the past 30 days, did you participate in any physical activities or exercise? % of adults who did not participate in any physical activities during the past 30 days


0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

We

igh

ted

Pe

rce

nt

%

US Texas

Lack of Physical Activity* Adults, Prevalence – 2006



24.2%28.4%

25.8%

31.0%

23.7%

33.9%38.1%

27.4%25.3%

29.3%

34.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

Wei

ghte

d P

erce

nt %

Lack of Physical Activity* Adults, Prevalence – 2006



Poor Nutrition

Poor Nutrition* Adults, Prevalence – 2005

75.8% 77.4%81.8%

73.1% 76.1% 78.3% 79.5% 81.7% 79.2% 75.7%69.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

We

igh

ted

Pe

rce

nt

%

•*% of adults who reported eating fewer than 5 servings of fruits and vegetables per day


Poor Nutrition* Health Service Region – 2005

•*% of adults who reported eating fewer than 5 servings of fruits and vegetables per day


•*% of students who reported eating 5 or more servings of fruits and vegetables per day


Nutrition*

Public High School Students – 2001,2005

Ate 5 or More Servings of Fruits or Vegetables in Past 7 Days

0

10

20

30

40

50

60

70

80

90

100

Male Female White AfricanAmerican

Hispanic Texas

We

igh

ted

Pe

rce

nt

%

2001

2005

Medical Risk Factors

DiabetesHigh CholesterolHigh Blood Pressure

DiabetesTexas and U.S Adult - 1995-2006


0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

We

igh

ted

Pe

rce

nt

%

US Texas

DiabetesPrevalence - 2006

8.1% 8.0% 8.0% 7.9% 7.8%10.3%

8.0%

0.9%

3.5%

12.8%

19.4%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Wei

ghte

d Pe

rcen

t %


Diabetes Prevalence Health Service Region– 2006


High CholesterolTexas and U.S Adult-1995-2005

0

5

10

15

20

25

30

35

40

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Years

Wei

gh

ted

Per

cen

t %

US Texas


High CholesterolPrevalence - 2005

35.9% 34.0% 32.8%35.1% 36.7%

30.4% 28.2%

9.9%

24.2%

43.4%49.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Wei

ghte

d pe

rcen

t %


High Cholesterol Health Service Region– 2005


High Blood PressureTexas and U.S Adult -1995-2005

0

510

15

2025

30

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Years

Wei

ghte

d Pe

rcen

t %

US Texas


High Blood PressurePrevalence - 2005

26.2% 24.5% 24.2% 24.8%28.2%

33.9%

16.7%

5.0%

14.1%

36.3%

56.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Wei

ghte

d pe

rcen

t %


High Blood Pressure Health Service Region--- 2005


HEDIS

Health Plan Employer Data and Information Set

HEDIS Standardized performance

measures designed for comparing the quality of care of managed care organizations

Result from HEDIS. Texas, 2001-2006

Measures 2001 2002 2003 2004 2005 2006

Controlling High BP 1 47.8 50.9 57.9 59.2 64.5 64.5

Beta Blocker Treatment After a Heart Attack2 NA 90.3 86.9 85.2 83.3 84.3

LDL-C Screening after acute CV event3 72.4 76.2 77.1 77.9 79.4 75.6

LDL-C Level < 130 mg/dL4 42.6 57.7 56.3 55.8 46.8

Data Source: http://www.opic.state.tx.us/page.php?p_sub_page_id=582001-2006

STRATEGIES Surveillance, Data and Outcome

Management Health Education and Outreach Clinical Prevention and Treatment

Services Community Policy and

Environmental Changes

Date post:	27-Mar-2015
Category:	Documents
Upload:	emma-wagner
View:	213 times
Download:	1 times

Cardiovascular Disease (CVD) in Texas Philip Huang, MD, MPH Texas Department of State Health...

Documents