Healthy People Data: Transitioning from 2010 to 2020

Healthy People Data: Transitioning from 2010 to 2020

Healthy People Data: Transitioning from 2010 to 2020 LCDR David T. Huang, PhD, MPH, CPH Health Promotion Statistics Branch Office of Analysis and Epidemiology National Center for Health Statistics August 7, 2012 Role of the National Center for Health Statistics Serves as statistical advisor to HHS, 42 Healthy People Topic Area Workgroups, and Federal Interagency Workgroup Healthy People, National Prevention Strategy, etc. Maintains comprehensive database of all Healthy People objective data Coordinates monitoring of Healthy People goals/objectives Develops research on measuring the overarching goals of Healthy People Develops analytic and graphical presentations to track HP goals and objectives, including Progress Reviews 2 Healthy People 2010 Final Review OVERVIEW HP2010 Focus Areas

1. Access to Quality Health Services 2. Arthritis, Osteoporosis, and Chronic Back Conditions 3. Cancer 4. Chronic Kidney Disease 5. Diabetes 6. Disability and Secondary Conditions 7. Educational and CommunityBased Programs 8. Environmental Health 9. Family Planning 10. Food Safety 11. Health Communication 12. Heart Disease and Stroke 13. HIV 14. Immunization and Infectious Diseases SOURCE: Healthy People 2010 Final Review. 15. Injury and Violence Prevention 16. Maternal, Infant, and Child Health 17. Medical Product Safety 18. Mental Health and Mental Disorders 19. Nutrition and Overweight

20. Occupational Safety and Health 21. Oral Health 22. Physical Activity and Fitness 23. Public Health Infrastructure 24. Respiratory Disease 25. Sexually Transmitted Diseases 26. Substance Abuse 27. Tobacco Use 28. Vision and Hearing 4 Leading Health Indicators (LHIs) Physical Activity Moderate/vigorous physical activity among adults Vigorous physical activity among adolescents Suicides Treatment of adults with depression Injury and Violence Deaths from motor vehicle crashes Homicides Overweight and Obesity Obesity in adults Obesity in children and adolescents

Tobacco Use Cigarette smoking among adults Cigarette smoking among adolescents Environmental Quality Exposure to ozone Childrens exposure to tobacco smoke at home Nonsmoker exposure to tobacco smoke Immunization Substance Abuse Adolescents notPeople using 2010 alcohol orReview. illicit drugs SOURCE: Healthy Final Adults using illicit drugs Fully immunized young children Influenza & pneumonia vaccination of older adults 5 Objective status at Final Review

Total objectives: N = 969 Objectives with tracking 170 data: N = 733 17.5% 349 36.0% Tracking data available 66 6.8% 39 4.0% 173 17.9% Could not be assessed 172 Demonstrated no17.8% change Met or exceeded target SOURCE: Healthy People 2010 Final Review. Deleted at Midcourse Review Moved away from target Moved toward target

Progress at Final Review by Focus Area Total objectives: N = 696 Could not be assessed Demonstrated no change Met or exceeded target Immunization and Infectious Diseases 100 90 Number of objectives Deleted at Midcourse Review Moved away from target Moved toward target 80 70 60 50 40 d an th y al d

t n t a htafe He c u ty on ig S d o fe iti we al r P Sa tr er ion l u v t a N Opa c i d e cu c M O 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

HP2010 Focus Area SOURCE: Healthy People 2010 Final Review. Progress Chart excerpt for LHIs SOURCE: Healthy People 2010 Final Review. Progress Chart excerpt for LHIs (cont.) SOURCE: Healthy People 2010 Final Review. Two overarching goals: Goal 1 Goal 1: Increase the quality and years of healthy life Goal 2: Eliminate health disparities across Race and ethnicity Sex Educational attainment Income Geographic location Disability status Sexual orientation SOURCE: Healthy People 2010 Final Review. 1 Healthy life expectancy at birth

200001 80 200607 Years 78 76 74 72 70 68 0 Total Black White NOTES: Measures of healthy life expectancy combine life expectancy with a measure of health status. Life expectancy is decremented by some aspect of health on a factor between 0 and 1. For the data shown here, health status is assessed by the respondent. SOURCES: National Health Interview Survey (NHIS), CDC, NCHS; National Vital Statistics System (NVSS), CDC, NCHS. Goal 1

Healthy life expectancy at age 65 20 200001 200607 Years 18 16 14 12 10 8 6 4 2 0 NOTES: Measures of healthy life expectancy combine life expectancy with a measure of health status. Life expectancy is decremented by some aspect of health on a factor between 0 and 1. For the data shown here, health status is assessed by the respondent. SOURCES: National Health Interview Survey (NHIS), CDC, NCHS; National Vital Statistics System (NVSS), CDC, NCHS. Goal 1 Two overarching goals: Goal 2 Goal 1: Increase the quality and years

of healthy life Goal 2: Eliminate health disparities across Race and ethnicity Sex Educational attainment Income Geographic location Disability status Sexual orientation SOURCE: Healthy People 2010 Final Review. 1 Disparities by race and ethnicity Percent of objectives in which population group had the best rate: Percent 100% Non-Hispanic white: 51% Non-Hispanic black:

20% Hispanic or Latino: 17% American Indian or Alaska Native: 6% 80% 60% 40% 20% 0% SOURCE: Healthy People 2010 Final Review. Goal 2 Changes in disparities over the decade No significant change in health disparities by race and ethnicity for 117 (69%) of 169 objectives Of the 52 objectives with significant changes in disparities: 27 showed a decrease of 10 percentage

points or more 25 showed an increase of 10 percentage points or more SOURCE: Healthy People 2010 Final Review. Goal 2 1 Key Final Review takeaway messages 1. Significant progress toward achieving Healthy People 2010 objectives has been made over the decade. 2. Health disparities persist across the U.S. population. 3. Obesity remains an important challenge to monitor closely. 4. Data must be a priority. 1 Healthy People 2010 and 2020 DATA ISSUES HP2010 Leading Health Indicators (LHIs) Physical Activity

Moderate/vigorous physical activity among adults Vigorous physical activity among adolescents Suicides Treatment of adults with depression Injury and Violence Deaths from motor vehicle crashes Homicides Overweight and Obesity Obesity in adults Obesity in children and adolescents Tobacco Use Cigarette smoking among adults Cigarette smoking among adolescents Environmental Quality Exposure to ozone Childrens exposure to tobacco smoke at home Nonsmoker exposure to tobacco smoke Immunization Substance Abuse Adolescents not using alcohol or illicit drugs

Adults using illicit drugs Fully immunized young children Influenza & pneumonia vaccination of older adults 1 HP2020 Leading Health Indicators (LHIs) Access to Health Services Persons with health insurance Persons with a usual primary care provider Nutrition, Physical Activity, and Obesity Clinical Preventive Services Colorectal cancer screening Hypertension under control Poor glycemic control Fully immunized young children Physical activity / muscle strengthening among adults Obesity in adults Obesity in children and adolescents Total vegetable intake Environmental Quality

Oral Health Air quality index Childrens exposure to tobacco smoke at home Oral health system use Reproductive and Sexual Health Injury and Violence Female reproductive health service use HIV serostatus knowledge Fatal injuries Homicides Social Determinants Maternal, Infant, and Child Health Graduation with a regular diploma 4 years after 9th grade Infant deaths Preterm births Substance Abuse

Mental Health Suicides Adolescents who experience Major Depressive Episode (MDE) Adolescents using alcohol or illicit drugs Adult binge drinking Tobacco Cigarette smoking among adults Cigarette smoking among adolescents 1 HP2010 Population Template Race and ethnicity Optional Age Sex Education level Less than high school High school graduate At least some college OR Family income

level Poor Near poor Geographic location Urban/metropolitan Rural/non-metropolitan Disability status Persons with disabilities Persons without disabilities 2 HP2020 Population Template Race and ethnicity Age Sex Education level Less than high school High school graduate At least some college Associates degree 4 year college degree Advanced degree Family income level (% Federal Poverty Limit) <100 100-199 200-399

400-599 600+ Geographic location Metropolitan Non-metropolitan Family type Single Married couple or partners Select Populations Two parent family with children Sexual orientation Single parent with children People Health with insurance status chronic Other Insured conditions Any private People in nursing Country of birth Public only homes US Uninsured People in active

Outside US military service People in prisons Disability status Marital status Persons with disabilities Persons without disabilities Veteran status Obesity status 2 Progress HP2010 Targets Assessment Measureme nt All objectives have targets. HP2020 Informational objectives and Foundation Health Measures do not have targets. 1 round of progress 2 rounds of progress reviews

reviews (web-based) (in-person) Midcourse Review Midcourse Review (book) (book? + web) Final Review (book + web) Final Review (book? + web) Percent of targeted change achieved Percent of targeted change achieved, complemented by supplemental measures for selected objectives (e.g., Leading Health Indicators) 2 Disparities HP2010 Overarching Eliminate health disparities Goal HP2020 Achieve health equity, eliminate disparities, and

improve the health of all groups Disparity Targets No separate disparities targets No separate disparities targets Disparity Definition Any difference in health a quantity that separates a group from a reference point for a health indicator. A particular type of health difference that is closely linked with social or economic disadvantage. Relative disparity: percent difference from the best group rate Change in disparity over time: difference between relative disparities

Comparable methods to the ones used in HP2010, complemented by supplemental measures for selected objectives (e.g., Leading Health Indicators) Measureme nt 2 Healthy People Data Sources About 45% of objectives were measured by four NCHS data sources: National Health Interview Survey (NHIS) National Health and Nutrition Examination Survey (NHANES) National Vital Statistics SystemMortality (NVSS-M) National Survey of Family Growth (NSFG) Remaining 55% were measured by more than 150 other data sources Many objectives lack critical demographic specificity 2 Healthy People 2010 and 2020

TARGET SETTING HP2010 Target-Setting Methods Method No. (%) measures Better than the best racial/ethnic group 325 (44.3) Percent improvement 210 (28.6) Total coverage or elimination 64 (8.7) Consistent with another program 39 (5.3) Projection of trend 25 (3.4) Percentage point improvement 22 (3.0) Expert opinion 30 (4.1) Retain year 2000 target 13 (1.8) No increase from baseline 5 (0.7) Total (100)

733 NOTE: Includes measurable objectives (n=733) that had at least 2 data points for the HP2010 Final Review. 2 Better than the Best Objective 27-1a: Cigarette smoking among adults 35% Race/ethnicity Baselin e (1998) Total 24% American Indian or Alaska Native 35% Asian 13%

Hispanic or Latino 29% Non-Hispanic Black 25% Non-Hispanic White 25% 30% 25% 20% 15% 10% 5% 0% -5% SOURCE: National Health Interview Survey (NHIS), CDC, NCHS 2 Better than the Best Objective 27-1a: Cigarette smoking among adults 35%

Race/ethnicity Baselin e (1998) Total 24% American Indian or Alaska Native 35% Asian 13% Hispanic or Latino 29% Non-Hispanic Black 25% Non-Hispanic White

25% 30% 25% 20% 15% 10% 5% 0% -5% SOURCE: National Health Interview Survey (NHIS), CDC, NCHS 2 Better than the Best Objective 27-1a: Cigarette smoking among adults 35% Race/ethnicity Baselin e (1998) Total 24%

American Indian or Alaska Native 35% Asian 13% Hispanic or Latino 29% Non-Hispanic Black 25% Non-Hispanic White 25% 30% HP2010 Target = 12% 25% 20% 15% 10%

5% 0% -5% SOURCE: National Health Interview Survey (NHIS), CDC, NCHS 2 Better than the Best Objective 27-1a: Cigarette smoking among adults Baseline Final Race/ethnicity 35% Baselin e (1998) Final (2008) Total 24% 21% American Indian or Alaska

Native 35% 24% Asian 13% 10% 10% Hispanic or Latino 29% 15% 5% Non-Hispanic Black 25% 21% 0%

Non-Hispanic White 25% 23% 30% HP2010 Target = 12% 25% SOURCE: National Health Interview Survey (NHIS), CDC, NCHS 20% 15% -5% 3 Objective status at Final Review Total objectives: N = 969 Objectives with tracking 170 data: N = 733 17.5%

349 36.0% Tracking data available 66 6.8% 39 4.0% 173 17.9% Could not be assessed 172 Demonstrated no17.8% change Met or exceeded target SOURCE: Healthy People 2010 Final Review. Deleted at Midcourse Review Moved away from target Moved toward target HP2010 Objectives Meeting Hypothetical Targets Objectives Meeting Targets 50%

45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 49.3% 40.8% 34.9% 29.5% 25.1% 10% 15% 20% 25% 30% Target Setting Methodology (% improvement) NOTE: Includes measurable objectives and subobjectives (n=635) that have at least 2 data points

during the decade as of August 2009. 3 HP2020 Target-Setting Methods Method No. (%) measures 1. Desired/Recommended Approach Modeling/Projection/Trend Analysis Evidence-based 10 (1.1) 65 (7.3) 2. Standard default : 10% improvement 578 (64.6) 3. Alternative/Other Total coverage or elimination 66 (7.4) Consistent with national programs, policies, etc. 58 (6.5) Other specific percent change 43 (4.8) Minimal statistically significant change 21 (2.3) Retention of HP2010 target 16 (1.8) Maintain current level / no change 13 (1.5) Tracked for informational purposes only

17 (1.9) Other 8 (0.9) Total 895 (100) NOTE: Includes non-developmental objectives (n=895) that had a target setting method listed as of December 2011. 3 10 Percent Improvement Objective C-1: Overall cancer death rate (per 100,000) 250 Race/ethnicity Total Baseline (2006) 200 180.7 150

American Indian or Alaska Native 119.4 Asian or Pacific Islander 106.5 Hispanic or Latino 118.0 Non-Hispanic Black 221.7 Non-Hispanic White 184.6 Decrease desired HP2020 Target: 162.6 100 50

0 Am ta To l er d n o k it e in ac t h l B W La la N c r i Is

ic a o n k n c a ic ifi pa as n c s i sp Al a i a H P p H or is nor on H

n o N a n N di ia s n I A . iv at e SOURCE: National Vital Statistics System Mortality (NVSS-M), CDC, NCHS 3 HEALTHY PEOPLE 2020 DATA DISPLAY DATA2010 (HP2010 Data) http://wonder.cdc.gov/data2010

3 HP2020 Data Flow HP2020 Data healthypeople.g ov healthindicators.gov 3 Healthy People http://www.healthypeople.gov 3 Health Indicators Warehouse (HIW) http://www.healthindicators.gov 3 DATA2020 (Display Tool) DRAF T 4

National Snapshot DRAFT 4 Challenges and Future Opportunities Many objectives lack demographic specificity Difficult to measure and assess disparities between population groups Catalyst for more robust data collection Objectives are measured and tracked using over 150 diverse data sources Home agencies include federal and nongovernmental, health and non-health Significant data coordination and integration challenges and opportunities 4 Acknowledgements Rebecca Hines, Chief, Health Promotion Statistics Branch Lesley Dobrzynski Bob Francis Leda Gurley Kimberly Hurvitz Elizabeth Jackson Bruce Jonas

Deepthi Kandi Insun Kim Jeff Pearcy Cheryl Rose Asel Ryskulova Makram Talih Ritu Tuteja Jean Williams Sirin Yaemsiri Special Thanks to Richard Klein, NCHS, Chief, Health Promotion Statistics Branch (retired) 4 Key Websites Main Healthy People: www.healthypeople.gov Staying connected (listservs, Leading Health Indicators, webinars): www.healthypeople.gov/2020/connect/default.aspx NCHS/Healthy People: www.cdc.gov/nchs/healthy_people.htm Healthy People 2010 Final Review: www.cdc.gov/nchs/healthy_people/hp2010/hp2010_final_review.htm DATA2010: wonder.cdc.gov/data2010

Health Indicators Warehouse: www.healthindicators.gov Stay Connected JOIN THE HEALTHY PEOPLE LISTSERV & CONSORTIUM WEB healthypeople.gov EMAIL [email protected] TWITTER @gohealthypeople LINKEDIN Healthy People 2020 YOUTUBE USGOVHHS [search healthy people]

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