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Health in the District of Columbia: Epidemiology and Trends John O. Davies-Cole, PhD, MPH, CPM State Epidemiologist DC Department of Health CHP HEALTH FORUM MAY 2008
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Health in the District of Columbia: Epidemiology and Trends
John O. Davies-Cole, PhD, MPH, CPMState Epidemiologist
DC Department of Health
CHP HEALTH FORUMMAY 2008
Health Status
• The health status of the District of Columbia is a description of the health of its population.
• The information used to report health status comes from a variety of sources:
- birth and death records - hospital discharge data - health information collected from health care
records - personal interviews
- telephone surveys.
African
American,
56.5%
White, 38.4%
Asian /
Pacific
Islander, 3.2%
Hispanics,
8.2%
Estimated Population by Race, District of Columbia,
2006 (581,530)
Life Expectancy
• Life expectancy at birth is strongly influenced by infant and child mortality
• District of Columbia was 72.6 in 2000 compared to 77.0 for the U.S.
• This was the lowest compared to all states
• Neighboring states: Maryland (76.3) and Virginia (76.9) were slightly below the national average.
Life Expectancy (2000)Years
Place White
Male Female
Black
Male Female
US 74.6 79.9 67.8 74.7
DC 71.4 81.1 57.5 71.6
6.0
6.2
7.4
9.3
10.8
11.6
14.4
21.4
22.0
25.3
37.3
43.3
53.5
190.1
232.3
0 50 100 150 200 250
Age-adjusted rates per 100,000 population standard population
Assault (homicide)
Parkinson's disease
Essential (primary) hypertension
Chronic liver disease and cirrhosis
Intentional self-harm (suicide)
Septicemia
Nephritis, nephrotic syndrome and nephrosis
Alzheimer's disease
Influenza and pneumonia
Diabetes mellitus
Accidents (unintentional injuries)
Chronic lower respiratory diseases
Cerebrovascular diseases
Malignant neoplasms
Diseases of heart
Age-Adjusted Death Rates for the 15 Leading Causes of Death in the United States, 2003
Source: National Vital Statistics Reports, Vol. 54. No.13, April 19,2006
DISTRICT OF COLUMBIA AND UNITED STATES
TOP TEN AGE-ADJUSTED DEATH RATES, 2004
Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics.
US: CDC, NHCS NVSS Vol. 55, No. 19, 8.21.2007.
Notes: Top 10 causes of death account for 75.4% of all D.C. resident deaths.
Ranking is based on DC deaths, US deaths are among top 15 deaths.
*HIV//AIDS, hypertension and homicide not among top 10 for US.
0.0
26.0
24.6
33.6
28.4
37.1
35.2
38.9
58.7
203.0
234.2
41.1
19.8
24.5
0.0
37.7
50.0
0.0
185.8
217.0
0 50 100 150 200 250
Chronic Lower Respiratory
Influenza/Pneumonia
Diabetes
Homicide*
Accidents
Cerebrovascular Diseases
HIV/AIDS*
Hypertension*
Cancer
Heart
Age-adjusted rates per 100,000 US standard population
US
DC
0.0
26.0
24.6
33.6
28.4
37.1
35.2
38.9
58.7
203.0
234.2
41.1
19.8
24.5
0.0
37.7
50.0
0.0
185.8
217.0
0 50 100 150 200 250
Chronic Lower Respiratory
Influenza/Pneumonia
Diabetes
Homicide*
Accidents
Cerebrovascular Diseases
HIV/AIDS*
Hypertension*
Cancer
Heart
Age-adjusted rates per 100,000 US standard population
US
DC
6.0
6.2
7.4
9.3
10.8
11.6
14.4
21.4
22.0
25.3
37.3
43.3
53.5
190.1
232.3
0 50 100 150 200 250
Age-adjusted rates per 100,000 population standard population
Assault (homicide)
Parkinson's disease
Essential (primary) hypertension
Chronic liver disease and cirrhosis
Intentional self-harm (suicide)
Septicemia
Nephritis, nephrotic syndrome and nephrosis
Alzheimer's disease
Influenza and pneumonia
Diabetes mellitus
Accidents (unintentional injuries)
Chronic low er respiratory diseases
Cerebrovascular diseases
Malignant neoplasms
Diseases of heart
DC
US
City Mortality Rate* Ranking
Baltimore, MD 1, 140 5
Detroit, MI 1, 103 8
Memphis, TN 1, 046 13
Atlanta, GA 974 21
Washington, DC 966 24
City Average 964
Overall Mortality Rates In 5 Selected Cities, 2004
Source: Big Cities Health Inventory 2003
Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population
Crude Death Rate from Heart Diseases by Ward, 2004
Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics.
131.2
172.6
223.7
305.4 303.5
210.8
299.8
186.9
227.6 222.2
0.0
50.0
100.0
150.0
200.0
250.0
300.0
350.0
cru
de d
eath
rate
per
100,0
00 p
opula
tion
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 DCTotal
USTotal
City Heart Disease Mortality Rate*
Ranking
Detroit, MI 370 4
Memphis 305 7
Baltimore, MD 287 10
Washington, DC 274 14
Atlanta, GA 230 33
City Average 253
Heart Disease Mortality Rates In 5 Selected Cities, 2004
Source: Big Cities Health Inventory 2003
* Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population
Crude Death Rate from Hypertension by Ward, 2004
Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics
42.5
54.3
40.2
64.4
84.1
51.9
66.5
60.157.2
7.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
cru
de r
ate
per
100,0
00 p
opula
tion
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 DC Total U.S
CityHypertension
Mortality Rate*
Washington, DC 60
Baltimore, MD 13
Memphis, TN 13
St. Louis, MO 9
Atlanta, GA 8
Hypertension Mortality Rates in 5 Selected Cities, 2004
* Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population
Sources: Big Cities Health Inventory 2007
DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics, “Major Causes of Death for the District of Columbia, U.S., and Selected Cities, 2002-2004”
Georgia Department of Human Resources, Division of Public Health, http://health.state.ga.us/pdfs/ohip/vsr/mortality.06.pdf
Department of Health and Senior Services: http://www.dhss.mo.gov/cgi-bin/death1
Crude Death Rate from Cancer by Ward, 2004
Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics
142.5
169.0 169.7
289.9
150.9
175.7
253.5
133.3
197.9188.6
0.0
50.0
100.0
150.0
200.0
250.0
300.0
cru
de r
ate
per
100,0
00 p
opula
tion
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 DC Total U.S
City All Cancer Mortality Rate*
Ranking
Baltimore, MD 231 15
Detroit, MI 230 16
Memphis, TN 226 19
Atlanta, GA 211 28
Washington, DC 206 33
City Average 217
All Cancer Mortality Rates In 5 Selected Cities, 2004
Source: Big Cities Health Inventory 2003
* Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population
Crude Death Rate for Diabetes by Ward, 2004
Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics
18.7
15.7 16.3
35.0
54.1
30.6
68.0
34.1 32.7
24.8
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
crud
e ra
te p
er 1
00,0
00 p
opul
atio
n
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 DC Total U.S
CityDiabetes
Mortality Rate* Ranking
Washington, DC 40 8
Baltimore, MD 39 11
Memphis, TN 35 15
Detroit, MI 32 18
Atlanta, GA 20 50
City Average 31
Diabetes Mortality Rates In 5 Selected Cities, 2004
Source: Big Cities Health Inventory 2003
* Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population
Crude Death Rate from Homicide by Ward, 2004
Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics
10.0
4.8
1.3
29.4
51.147.4
55.6
66.6
31.1
5.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
cru
de
ra
te p
er
10
0,0
00
po
pu
latio
n
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 DCTotal
US
City Homicide Rate* Ranking
Baltimore, MD 40 2
Detroit, MI 37 3
Washington, DC 28 4
Atlanta, GA 22 7
Memphis, TN 18 10
City Average 13.8
Homicide Rates In 5 Selected Cities, 2004
Source: Big Cities Health Inventory 2003
* Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population
Infant Mortality Rates by Ward, 2004
Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics
13.1
6.6
1.0
8.3
16.4
18.0
22.3
10.611.8
6.8
0.0
5.0
10.0
15.0
20.0
25.0
per
1,0
00 li
ve b
irths
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 DC Total U.S
City Infant Mortality Rate*OverallRank
Memphis, TN 17.3 1
Detroit, MI 16.4 2
Baltimore, MD 12.8 4
St. Louis, MO 12.7 5
Washington, DC 10.5 10
City Average 8.0
Ranking of Infant Mortality Rate in 5 Selected Cities, 2003
Source: Big Cities Health Inventory 2007
* * Infant death/ 1,000 live births
Crude Death Rates from HIV/AIDS by Ward, 2004
Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics
42.5
30.2
2.5
22.4
66.1
35.1
52.5
68.3
39.2
4.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
cru
de
ra
te p
er
10
0,0
00
po
pu
latio
n
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 DC Total U.S
Average Rate* of HIV Cases, by Ward –District of Columbia, 2001-2006, [N=3,052]
Ward 4
Ward 3Ward 1 Ward 5
Ward 2
Ward 6 Ward 7
Ward 8
60.1
8.696.8
91.5
88.0
115.1 79.4
105.1
† Numbers found below each ward refer to the rate of newly reported HIV cases per 100,000 population
* Numbers found below each ward refer to the rate of newly reported HIV cases per 100,000 population.** Rates were calculated using 2000 census data.
† For 16% of cases, ward information was not available and therefore not displayed on this map.
Average Rate* of AIDS Cases, by Ward –District of Columbia, 2001-2006 (N=4,062)
Ward 4
Ward 3Ward 1 Ward 5
Ward 2Ward 6 Ward 7
Ward 8
75.6
9.5118.1
105.3
129.4
131.3 127.8
134.0
* Numbers found below each ward refer to the rate of newly reported AIDS cases per 100,000 population.** Rates were calculated using 2000 census data.
† For 25% of cases, ward information was not available and therefore not displayed on this map.
Number of AIDS Deaths, by Ward –District of Columbia, 2001-2006 (N=1,525)
Ward 4
Ward 3Ward 1 Ward 5
Ward 2Ward 6 Ward 7
Ward 8
n=153
n=14n=206
n=149
n=264
n=244 n=198
n=247
Jail 22
Homeless 28
CityHIV-Related
Mortality Rate* Ranking
Baltimore, MD 51 2
Atlanta, GA 42 3
Washington, DC 41 4
Memphis 18 8
Detroit, MI 12 14
City Average 14
HIV-Related Mortality Rates In 5 Selected Cities, 2004
Source: Big Cities Health Inventory 2003
* Per 100,000 population using 2000 U.S. Census figures; age-adjusted to the year 2000 standard population
Figure 1. District of Columbia and National Infant Mortality Rates 1996-2005
0
2
4
6
8
10
12
14
16
DC Rate 14.4 13.1 12.5 15 11.9 10.6 11.5 10.2 11.8 13.6
US Rate 7.3 7.2 7.2 7.1 6.9 6.9 7 6.9 6.8 6.8
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
0
2
4
6
8
10
12
14
16
18
20
Rat
e pe
r 1,0
00 li
ve b
irths
Figure 2: Infant Mortality Rates for the District of Columbia and the United States, 2005
DC 3.8 18.4 10.6 *** 13.6 8.0
US 5.7 13.7 5.9** *** 6.8 4.5
White Black Hispanic*Asian/P acific
IslanderTotal
DC HP 2010 Target
Figure 8. Leading Causes of Non-Hispanic Black Infant Death, 2001-2005
Respiratory Distress, 2.5%
Labor/delivery complications, 2.8%
Circulatory system complications, 1.9%
Necrotizing enterocolitis, 3.1%
Bacterial sepsis, 2.5%
SIDS, 6.7%
Placenta complications, 6.9%
Short gestation/low birth w eight, 10.3%
Congenital malformations, 11.9%
Pregnancy complications, 18.3%All other causes,
33.2%
Crude Death Rates from Unintentional Injures by Ward, 2004
Source: DC Department of Health, Center for Policy, Planning and Epidemiology, State Center for Health Statistics
22.524.1
22.6
44.8
49.6
35.1
49.552.0
36.938.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
cru
de
ra
te p
er
10
0,0
00
po
pu
latio
n
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 DCTotal
U.S
Some Risk Behaviors
Current Smokers Prevalence by Ward, 2005
Source: DOH, CPPE, Behavioral Risk Factor Surveillance System
17.1 17.7
10.6
16.5
24.2
20
26.1
23.2
20 20.6
0
5
10
15
20
25
30
% R
es
po
nd
en
ts
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 DC Total U.S
Obesity
Prevalence of Obesity by Race (1996 – 2003)
BlackHispanic
OtherWhite
Obese
Overweight
Normal weight
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
%
Race
Obesity Prevalence by Ward, 2005
Source: DOH, CPPE, Behavioral Risk Factor Surveillance System
1516.1
7.9
22
27.5
18
42.1
39.6
21.7
24.4
0
5
10
15
20
25
30
35
40
45
% R
esp
on
de
nts
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 DC Total U.S
Health Disparities
Source: D.C. State Center for Health Statistics. National Center for Health Statistics.Hispanics include persons of all Hispanic origin of any race.**U.S. rates base on 2003 data***Rates not computed due to small number of infant deaths and, therefore are likely to be unstable.*Healthy People 2010 targets for US and DC: rates per 1,000 live births.
------ 2010 Target (US)------ 2010 Target (DC)
US: 4.5*
DC:8*
0
2
4
6
8
10
12
14
16
18R
ate
pe
r 1
,00
0 li
ve b
irth
s
Infant Mortality Rates by Race for the District of Columbia and the United States, 2004
DC 2.8 16.7 9.7 *** 11.8
US 5.7 13.7 5.9** *** 6.8
White Black Hispanic*Asian/Pacific
IslanderTotal
Breast and Cervical Cancer* Age-Adjusted Death Rates by Race: District of Columbia, 2004
18.5
15.6
0
2
4
6
8
10
12
14
16
18
20A
ge-A
djus
ted
Rat
e pe
r 10
0,00
0 st
anda
rd p
opul
atio
n
Black White
Source: DC Department of Health. *Rates are per 100,000 and age-adjusted to the 2000 U.S. standard.
Incidence of Breast Cancer* Age-Adjusted Rates by Race: District of Columbia, 2003
153.4175.4
81.5
0
20
40
60
80
100
120
140
160
180A
ge-A
djus
ted
Rat
e pe
r 10
0,00
0 st
anda
rd p
opul
atio
n
Black White Other
Source: DC Department of Health, Cancer Registry *Rates are per 100,000 and age-adjusted to the 2000 U.S. standard.
Hypertension* Age-Adjusted Death Rates by Race: District of Columbia, 2004
71.6
38.6
0
10
20
30
40
50
60
70
80
Black White
Ag
e-a
dju
sted
Rate
per
10
0,0
00
Sta
nd
ard
Pop
ula
tion
Rates are age-adjusted to the year 2000 standard population.Source: DC Department of Health, State Center for Health Statistics, 2004.
Diabetes* and Gestational Diabetes Prevalence by Race: District of Columbia, BRFSS 2004
12.3
1.0
2.3
1.2
1.8
3.2
0
2
4
6
8
10
12
14
Black White Hispanic
Diabetes Gestational Diabetes
Perc
ent
Source: 2004 DC BRFSS weighted data. DC Department of Health, Diabetes Control Program.*Healthy People 2010 targets for US and DC: rate per 100,000 deaths.
HIV/AIDS* Age-Adjusted Death Rates by Race: District of Columbia, 2004
61.6
7.1
0
10
20
30
40
50
60
70
Black White
Ag
e-a
dju
sted
Rate
per
10
0,0
00
Sta
nd
ard
Pop
ula
tion
Rates are age-adjusted to the year 2000 standard population.Source: DC Department of Health, State Center for Health Statistics, 2004.
Homicide* Age-Adjusted Rates by Race : District of Columbia, 2004
51.1
2.7
0
10
20
30
40
50
60
Black White
Ag
e-a
dju
sted
Rate
per
10
0,0
00
Sta
nd
ard
Pop
ula
tion
Rates are age-adjusted to the year 2000 standard population.Source: DC Department of Health, State Center for Health Statistics, 2006.
US: 3.0*
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