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Use of GIS Technology to Inform Planning Efforts Through Visualization of Community Level Data in Hawaii

HIGICC Conference 2015 October 14-16, 2015 Donald Hayes Hawaii Department of Health

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Use of GIS
technology to
inform planning
efforts through
visualization of
community level
data in Hawaii
Presented by
Donald Hayes, MD MPH
CDC Assigned Epidemiologist
Hawaii Department of Health
Family Health Services Division
Oct 16, 2015
Acknowledgments
 Pat Heu and Linda Chock, FHSD Chief -- acting
 Annette Mente, FHSD Planner
 Catherine Sorensen, FHSD Office of Primary Care
and Rural Health
 Division of Reproductive Health, CDC
 Maternal and Child Health Bureau, HRSA
Use of Data
 Increase awareness about particular issue
 Grant applications
 Identify new research questions
 Identify Gaps in the data
 Prepare for legislation and policy work
 Program Evaluation
 Where should limited funds get distributed
Some datasets in Hawaii
Birth Certificate
Death Certificate
Behavioral Risk Factor Surveillance System
Pregnancy Risk Assessment Monitoring Survey
Youth Risk Behavior Surveillance
Youth Tobacco Survey
Birth Defects
Women, Infant, and Children
Newborn Metabolic Screening
Newborn Hearing Screening
Early Intervention Services
Hawaii Household Survey
JABSOM National children study
School Data
Emergency room data
EMS Transport Data
Injury Data
Cancer Registry
Fetal Deaths
Family Planning
Medicaid
Children with Special Health Needs
Breastfeeding survey
Perinatal Support Services
Child Death Review
Immunization
Emergency Preparedness
Primary Care Contracts
Health Insurance Claims Data
Medical Outpatient Records
Electronic Health Records
Some FHSD Data Products
 Primary Care Data Book
 PRAMS Trend and County Reports
 FHSD Profiles
 Health Status of Children in Hawaii
 Perinatal and Title V Fact Sheets
 Birth Defects Surveillance Reports
 Journal Articles– Child Obesity, Adverse Birth Outcomes, Postpartum Depression, Intimate
Partner Violence, Breastfeeding, Physician Screening, Chronic Disease and Birth Outcomes,
Adverse Childhood Events, Oral Health Services Utilization…..
Most reports are online at hawaii.gov website
All DOH and older FHSD: http://health.hawaii.gov/about/publications/
Starting 2015, but still on all DOH:
http://health.hawaii.gov/FHSD/publications/
Evaluation and Feedback
http://health.hawaii.gov/fhsd/evaluation-forms-2
Primary Care Needs Assessment
(PCNA) Data Book
 Health and socio-economic indicators by Community in
Hawaii
 Multiple Data Sources
 Census, ACS
 Vital Statistics
 BRFSS
 Hospital Discharge
 Tables/Maps highlight differences
 Need Community Involvement

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Use of GIS Technology to Inform Planning Efforts Through Visualization of Community Level Data in Hawaii

  • 1. Use of GIS technology to inform planning efforts through visualization of community level data in Hawaii Presented by Donald Hayes, MD MPH CDC Assigned Epidemiologist Hawaii Department of Health Family Health Services Division Oct 16, 2015
  • 2. Acknowledgments  Pat Heu and Linda Chock, FHSD Chief -- acting  Annette Mente, FHSD Planner  Catherine Sorensen, FHSD Office of Primary Care and Rural Health  Division of Reproductive Health, CDC  Maternal and Child Health Bureau, HRSA
  • 3. Use of Data  Increase awareness about particular issue  Grant applications  Identify new research questions  Identify Gaps in the data  Prepare for legislation and policy work  Program Evaluation  Where should limited funds get distributed
  • 4. Some datasets in Hawaii Birth Certificate Death Certificate Behavioral Risk Factor Surveillance System Pregnancy Risk Assessment Monitoring Survey Youth Risk Behavior Surveillance Youth Tobacco Survey Birth Defects Women, Infant, and Children Newborn Metabolic Screening Newborn Hearing Screening Early Intervention Services Hawaii Household Survey JABSOM National children study School Data Emergency room data EMS Transport Data Injury Data Cancer Registry Fetal Deaths Family Planning Medicaid Children with Special Health Needs Breastfeeding survey Perinatal Support Services Child Death Review Immunization Emergency Preparedness Primary Care Contracts Health Insurance Claims Data Medical Outpatient Records Electronic Health Records
  • 5. Some FHSD Data Products  Primary Care Data Book  PRAMS Trend and County Reports  FHSD Profiles  Health Status of Children in Hawaii  Perinatal and Title V Fact Sheets  Birth Defects Surveillance Reports  Journal Articles– Child Obesity, Adverse Birth Outcomes, Postpartum Depression, Intimate Partner Violence, Breastfeeding, Physician Screening, Chronic Disease and Birth Outcomes, Adverse Childhood Events, Oral Health Services Utilization….. Most reports are online at hawaii.gov website All DOH and older FHSD: http://health.hawaii.gov/about/publications/ Starting 2015, but still on all DOH: http://health.hawaii.gov/FHSD/publications/ Evaluation and Feedback http://health.hawaii.gov/fhsd/evaluation-forms-2
  • 6. Primary Care Needs Assessment (PCNA) Data Book  Health and socio-economic indicators by Community in Hawaii  Multiple Data Sources  Census, ACS  Vital Statistics  BRFSS  Hospital Discharge  Tables/Maps highlight differences  Need Community Involvement
  • 7. Background  1990-1994 Primary Care Access Plan  Present Population Based Surveillance Data by Community  Improve awareness and discussion  Facilitate data to action  Initial MCH focus, starting in 2005 expansion to reflect primary care  Diverse Audience including  Health Policy Makers  Legislators  Planners  Public  Distribution  Hard Copy  Online PDF
  • 8. Summary  Overview  Summary Tables (all indicators) Chapter 1  Introduction Chapter 2  Primary Care Office  Designations Chapters 3-8  Indicators
  • 9. Primary Care Areas Defined • More detail on 3 largest areas (Ewa, E. Honolulu, W. Honolulu) - 11 new areas • 2010 Census Tract Changes
  • 13. Methodology  Census tract data aggregated into 35 communities in the State of Hawaii, County and State level.  For BRFSS data, Zip Codes converted to areas based on Missouri Data Center Zip code to census tract estimates  Hospital discharge data, priority was census tract information, but conversion used based on zip code for those without  SAS, SUDAAN software was used to create an Excel document for use in ArcGIS
  • 17. Proportion of Population 65 years and over  State: 14.0%  [13.3% in 2000]  7.7% in Mililani  8.1% in Kapolei-Makakilo  19.7% in Waikïkï-Pälolo  20.1% in Hawai‘i Kai- Kaimuki Socio-economic Indicators (Chapter 3)
  • 18. Proportion of Population Native Hawaiian  State: 21.3%  [19.8% in 2000]  11.3% in Waikïkï-Pälolo  11.3% in Airport-Moanalua  57.4% Häna  58.5% in Wai‘anae  61.8% in Moloka‘i
  • 19. Proportion of Adult Population Uninsured  State: 7.1%  3.5% in Hawai‘i Kai-Kaimuki  3.8% in McCully-Makiki  14.8% in Ka‘ū  15.7% in South Kona  19.4% in Häna
  • 20. Proportion of Children in Households Receiving Assistance  State: 17.2%  4.2% in Hawai‘i Kai-Kaimuki  4.7% in Lähainä  43.0% in Puna  49.2% in Wai‘anae
  • 21. Infant Mortality Rate (per 1,000 live births)  State: 6.0  3.9 in Makawao  4.2 in Wailuku  4.2 in Köloa  10.1 in Wai‘anae  12.4 in North Kohala Maternal and Infant Health (Chapter 4)
  • 22. Proportion of Adults Who Are Obese  State: 21.9%  13.2% in Hawai‘i Kai-Kaimuki  13.8% in Waialua  37.6% in Moloka‘i  43.5% in Wai‘anae Morbidity-Risk Factors (Chapter 5)
  • 23. Disease of the Heart Mortality Rate (per 100,000)  State: 135.2  72.3 in Mililani  97.4 in Hawai‘i Kai-Kaimuki  109.1 in Hänalei  231.3 in Häna  260.4 in Wai‘anae Mortality (Chapter 6)
  • 24. Proportion of Adults with No Teeth Cleaning Within Past Year  State: 28.7%  18.4% in Hawai‘i Kai- Kaimuki  22.4% in Wahiawä  22.5% in McCully-Makiki  43.8% in Puna  47.6% in Wai‘anae  49.3% in Ka‘ū Adult Oral Health (Chapter 7)
  • 25. Proportion of Admissions with a Substance Related Disorder  State: 8.9%  4.3% in Waipahu  4.5% in Mililani  5.0% in Hickam-Pearl City  13.7% in South Kona  13.8% in North Kona  14.2% in Häna  17.0% in Lähainä Mental Health and Substance Related Admissions (Chapter 8)
  • 26. Example 1: Grant Application  ACA Grant For Home Visiting Announced  Portion related to Needs Assessment (NA)  NA a requirement for Title V agencies  Portion of NA completed by use of data from PCNA Data Book for identification of high risk communities (poverty, low birth weight, infant mortality, no high school diploma, unemployment, etc….)  Data contributed to multi-million dollar grant award
  • 27. Example 2: Data and Budget Cuts Reduction in Primary Care Contracts in response to executive memo  FHSD Recommendation made to not eliminate or drastically reduce the funding and develop contingency plans before any drastic change in funding.  Data used to justify higher risk in the areas served by the contracts (poverty, per-capita income, unemployed, no high school diploma,...) No reduction
  • 28. Example 3: Community Health Needs Assessment Individual Hospital CHNA  Data used throughout several of the hospitals CHNA to comply with federal requirements for nonprofit hospital organizations related to ACA (to satisfy a requirement of a community health needs assessment) . Various indicators used (in addition to other data sources and outreach) including substance use and mental health hospitalizations, behavioral risk factors, socio- economic, and mortality data.
  • 29. Example 4: Overlays Department of Native Hawaiian Health, JABSOM. Assessment and Priorities for Health & Well-Being in Native Hawaiians & Other Pacific Peoples. Accessed online at http://www2.jabsom.hawaii.edu/native/comm_ulu-reports.htm
  • 30. Example 5: Other known uses Journal Article references Book Article references Medical Practice Business Plan Rural Health Nursing Resources
  • 32. Evaluation Results  Information from:  Community non-profits  Government agencies  Education Institutions  Use it for:  Needs Assessment  Planning  Grant  Resource/Facilities Planning
  • 33. How use?  Community Health Centers (CHC) need to update their needs assessments (part of their federal grant application process) every 3 years. The PCNA data book provides valuable health information stratified by geographic regions that match up with CHC service areas. As such, the PCNA data book makes finding relevant health data so much easier and convenient.  Used specific topic information and shared as fact sheets related to division and maternal and child health priorities. This assisted in discussion with other partners and supported further partnerships and use of this book by others in the State.  Indicators selected demonstrate significant community level differences and highlight the importance of data visualization by geography. Consolidates multiple data sources into one document
  • 34. How use?  Use it to share information with stakeholders about community level differences. Raises awareness and discussion of complex issues  A lot of information that highlights the geographic disparities are very useful. This resources provides comparative data across a range of topics from birth to death. It includes risk factor and socio- economic characteristics which are very useful in characterizing communities for potential grant opportunities.  Have used this in the request for information and request for proposal process in serving specific geographical areas and as reference materials for providers to use. Have incorporated in presentations for grantors on areas being served through women's, infant and maternal and child health contracts. Have referenced in discussions with public health stakeholders and collaborative planning activities. Have recommended to community stakeholders for use in their planning and other activities to serve those in need.  Ability to demonstrate service providers are located in appropriate high risk communities
  • 35. Other information?  Early Childhood indicators. The ability to look at an online version that allows you to get estimates from multiple indicators for a community. What about being able to look at overlays and see if there are statistical differences/relationships between communities.  Hospitalization data, trends...Wouldn't it be great to see this on an interactive map or if it could be dumped or used with UDS mapper?  Homelessness  Would like to see associations between the various indicators. For example, how much of the heart disease deaths are due to poverty characteristics. Can these maps be interactive so I can just select a community and get a download of all the data for that particular community. I know the length of the book is a concern, but think you should consider showing these same indicators by other groups when possible (Race, education, language, insurance, employment, etc...). Thanks for the great resource and look forward to its continued evolution and usefulness. When is the next version coming out?  Although aggregating the data based on population of each district, sometimes for some of the work that we do and information that we need, stratifying it further by ethnic background in each district will be very useful for us. Also, having a group on Micronesian (or maybe just Pacific Islander without Native Hawaiian) will also be useful as these groups are one of the special populations that FQHCs serve and data on this group would be useful (although I am not sure if their sample size would be sufficient to add them as another category). It would also be useful to add new indicators that the federal government is looking more into such as prediabetes.
  • 36. Closing Comments  Reports have helped raise awareness of data and issues  Building capacity in health department  Gradually increasing comfort and skills in GIS  Opportunity to look at community level indicators based on several data sources  Geographic Disparities shown - Some may be explained by race distribution - Others may be explained by age distribution - Others may be explained by poverty - What about other factors?  Additional analyses needed  Superimposing two-three maps?  Controlling for age, race/ethnicity and other factors  Partners want more so it is not just a static PDF/document  Next revision to PCNA currently in process
  • 39. Socio-economic Indicators (Chapter 3) • Race (2010 Census) - Alone - Alone or in combination In addition to Native Hawaiian and Filipino in 2009 data book, added White, Japanese, and Chinese in 2012 data book. Primarily Multiple Race population in Hawaii • Chinese (73% are in combination) • Native Hawaiian (72%) • Filipino (42%) • Japanese (41%) • White (40%)
  • 40. Proportion of Population Filipino  State: 25.1%  [22.8% in 2000]  7.0% in Hawai‘i Kai-Kaimuki  45.6% Lïhu‘e  54.4% Waipahu  63.9% Läna‘i Socio-economic Indicators (Chapter 3)
  • 43. Proportion of Adults with High Blood Pressure  State: 28.4%  11.7% in Häna  22.3% in South Kohala  22.5% in Köloa  22.6% in Lähainä  32.5% in Hilo  32.6% in Wai‘anae  35.4% in Waialua  36.7% in Lïhu‘e Morbidity-Risk Factors (Chapter 5)
  • 44. Stroke Mortality Rate (per 100,000)  State: 38.2  22.1 in ‘Ewa-Kalaeloa  22.8 in Mililani  49.5 in Hilo  56.4 in Waimea  67.8 in Läna‘i Mortality (Chapter 6)
  • 45. Unintentional Injury Mortality Rate (per 100,000)  State: 28.7  10.0 in Mililani  18.4 in Hickam-Pearl City  19.3 in ‘Ewa-Kalaeloa  48.7 in South Kona  52.1 in Waialua  58.6 in Wai‘anae Mortality (Chapter 6)
  • 46. Proportion Admissions w/ Delirium/Dementia Disorder  State: 8.4%  4.3% in Moloka‘i  4.5% in Ka‘ū  11.8% in Waikïkï-Pälolo  11.9% in McCully-Makiki  14.8% in Hawai‘i Kai-Kaimuki Mental Health and Substance Related Admissions (Chapter 8)
  • 47. Proportion of Households with Linguistic Isolation  State: 6.2%  0.3% in Häna  0.9% in Makawao  14.4% in Ala Moana- Nu‘uanu  21.1% in Downtown-Kalihi
  • 48. Proportion of Adults Who Smoke  State: 16.1%  9.9% in Hawai‘i Kai-Kaimuki  11.0% in Hänalei  25.3% in N Kohala  25.9% in Ka‘ū  26.0% in Wai‘anae
  • 49. Cancer Mortality Rate (per 100,000)  State: 134.7  90.2 in Häna  91.9 in Mililani  95.2 in ‘Ewa-Kalaeloa  173.1 in Waimea  177.0 in Moloka‘i  197.0 in Wai‘anae
  • 50. Proportion of Admissions with a Mood Disorder  State: 6.1%  3.1% in Moloka‘i  3.2% in Läna‘i  3.4% in Häna  8.0% in Hänalei  9.1% in Hilo  10.9% in Puna
  • 51. Proportion of Civilian Labor Force Unemployed  State: 4.6%  2.3% in Hawai‘i Kai-Kaimuki  2.3% in ‘Ewa-Kalaeloa  9.7% in Ka‘ū  13.5% in Moloka‘i
  • 52. Example 2: Data and Budget Cuts June 28-30, 2011: Reduction in Primary Care Contracts in response to executive memo  FHSD Recommendation made to not eliminate or drastically reduce the funding and develop contingency plans before any drastic change in funding. Data used to justify higher risk in the areas served by the contracts. (Gordon Takaki and Pat Heu, 2011 FHSD Meeting) July 7, 2011: No reduction
  • 53. Example 2: PCNA  June 2010: ACA Grant For Home Visiting Announced  Portion related to Needs Assessment (NA)  NA a requirement for Title V agencies  Sept 2010: Deadline for Needs Assessment  Portion of NA completed by use of data from PCNA Data Book for identification of high risk communities(Cindy Hirai led effort).  Data contributed to multi-million dollar grant

Editor's Notes

  1. 2005 BRFSS data added (smoking, obesity, diabetetes, oral health) 2005 Vital Stats data on stroke and heart disease mortality 2009 BRFSS data added (heavy drinking, physical inactivity, high blood pressure) 2009 Vital Stats data on Cancer mortality 2009 Census data on Filipino (alone or combination) 2011 HHIC data (mental health and substance related disorders) 2011 American Community Survey
  2. Ewa 325K [272k in 2000] people, E. Honolulu 255K [238k in 2000], W Honolulu 135K [133k in 2000] Range in Areas from 2,291 in Hāna to 115k in Ko’olaupoku and 95k in Hickam-Pearl City 2010 Census tract changes BRFSS/Vitals/HHIC based on 2000 tracts ACS/Census uses 2010 tracts
  3. Lose the relative ranking based on estimates across all areas. Also lost confidence intervals, the county, the statewide, and the healthy people 2010 objective…..but in reality almost all indicators are similar at the county level so not much gained by including CI on chart….(and detailed information available on facing page). Gain visually can see neighboring areas, spatial patterns, easier to visualize disparate areas based on color across state, but also within a particular county easier.
  4. NOTE: For 2012 PCNA data book, data source changed from Decennial Census to American Community Survey 5-year aggregate (2006 – 2010). Also Note: No change in data series but Table heading changed from ‘Percentage of Population Age 65 years and Over’ in 2005 PCNA data book to ‘Percent of Population 65 Years of Age and Over’ in 2009 PCNA data book to ‘Population 65 Years of Age and Older’ in 2012 PCNA data book. Over 65 in 2000 Census (2005 & 2009 PCNA data book): State 13.3%, Ko‘olauloa 8.0% & Wai‘anae 8.1%, East Honolulu 19.1%. (Note: 2005 PCNA data book has Ni‘ihau listed at 4.4%) Ratio: 20.1 / 7.7 = 2.61 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  5. Also Note: No change in data series but Table heading changed from ‘Percentage of Native Hawaiians by Service Area’ in 2005 PCNA data book to ‘Percent of Population that are Native Hawaiian (alone or in any combination)’ in 2009 PCNA data book to ‘Population Of Native Hawaiian (alone or in any combination)’ in 2012 PCNA data book. Native Hawaiian in 2000 Census (2005 & 2009 PCNA data book): State 19.8%, East & West Honolulu 11.7%, Hāna 62.7% & Moloka‘i 61.2% & Wai‘anae 55.7%. (Note: 2005 PCNA data book has Ni‘ihau listed at 81.3%) Ratio: 61.8 / 11.3 = 5.47 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  6. Also Note: No change in data series but Table heading changed from ‘Adults Without Health Insurance’ in 2009 PCNA data book to ‘Uninsured Adults’ in 2012 PCNA data book. Uninsured in (2009 PCNA data book): State 7.6%, Ko‘olaupoko 4.6% & Waialua 5.8%, Hāna 20.6% & Puna 15.9%. (Note: 2005 PCNA data book did not track uninsured population.) Ratio: 19.4 / 3.5 = 5.54 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  7. This indicator if new to the 2012 PCNA data book. Ratio: 49.2 / 4.2 = 11.71 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  8. NOTE: Infant Mortality Rate (IMR) calculation was based on 5 years of aggregated data in the 2005 & 2009 PCNA data book, but 10 years of aggregated data with the 2012 PCNA data book. Also Note: No change in data series but Table heading changed from ‘Infant Mortality’ in 2005 & 2009 PCNA data book to ‘Infant Mortality Rate’ in 2012 PCNA data book. Infant Mortality Rate in (2009 PCNA data book): State 6.3, Makawao 3.6 & Wailuku 3.8, Ka‘ū 17.2 & North Kohala 14.2. (Note that the IMR listed above also happens to be for locations which had more than 5 infant deaths events.) Infant Mortality Rate in (2005 PCNA data book): State 6.9, Lāhainā 3.6 & Līhu‘e 4.5, Ka‘ū 16.1 & Wai‘anae 12.9. (Note that the IMR listed above are only for locations which had 5 or more infant deaths events.) If you were to include IMR locations which had less than 5 infant death events as shown in the 2005 PCNA data book. The following locations would then have the lowest IMR, Hanalei 2.1 & Lāhainā 3.6 & Kōloa 4.2 Ratio: 12.4 / 3.9 = 3.18 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  9. NOTE: Body Mass Index (BMI) calculation to track Obesity, changed from >35.0 in the 2005 PCNA data book to >30.0 in the 2009 & 2012 PCNA data book. Also Note: No change in data series but Table heading changed from ‘Adult Obesity’ in 2005 PCNA data book to ‘Adults who are Obese’ in 2009 & 2012 PCNA data book. Obese Adults in (2009 PCNA data book): State 20.5%, Hanalei 15.1% & East Honolulu 15.5%, Wai‘anae 39.6% & Ko‘olauloa 31.7%. Obese Adults in (2005 PCNA data book): State 16.8%, Hāna 9.3% & Līhu‘e 11.7%, Wai‘anae 31.5% & Moloka‘i 29.0%. Ratio: 43.5 / 13.2 = 3.30 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  10. NOTE: For 2009 & 2012 PCNA data book, data source changed from Behavioral Risk Factor Surveillance System (BRFSS) to Office of Health Status Monitoring (OHSM). Also Note: No change in data series but Table heading changed from ??? ‘Chronic Heart Disease CHD) Mortality Rate (age adjusted)’ in 2005 PCNA data book to ‘Diseases of the Heart Mortality Rate’ in 2009 & 2012 PCNA data book Disease of the Heart in (2009 PCNA data book): State 197.9, Waimea 136.1 & North Kohala 145.7, Wai‘anae 370.7 & Puna 285.3 & Hāna 281.1. ??? Chronic Heart Disease in (2005 PCNA databook): State 66.5, Hāna 81.1 & Lāna‘i 87.1 & North Kohala 88.3 & Waimea 88.5, Wai‘anae 161.7 & Līhu‘e 161.5. Ratio: 260.4 / 72.3 = 3.60 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  11. Also Note: Change in data series and Table heading changed from ‘Teeth Cleaned within Past Year’ in 2005 PCNA data book to ‘Adults who did not have their Teeth Cleaned within the Past Year’ in 2009 PCNA data book to ‘Adults with No Teeth Cleaning within Past Year’ in 2012 PCNA data book. Did not Clean Teeth in (2009 PCNA data book): State 27.3%, East Honolulu 22.9% & ‘Ewa 23.6% & North Kohala 24.7%, Wahiawā 41.6% & South Kona 40.4% & South Kohala 40.4%. (Note: 2005 PCNA data book tracked Number who had Teeth Cleaned versus No Teeth Cleaning in 2009 & 2012.) Number below for related 2005 PCNA data are derived by minusing from 100%. Derived No Teeth Cleaning in (2005 PCNA data book): State 33.5% = 100% - 66.5% (teeth cleaned), Ko‘olauloa 19.4% = 100% - 80.6% & Wahiawā 25.8% = 100% - 74.2% & ‘Ewa 26.5% = 100% - 73.5%, Lāna‘i 66.3% = 100% - 33.7% & Hāna 60.6% = 100% - 39.4%. Ratio: 49.3 / 18.4 = 2.68 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  12. This indicator if new to the 2012 PCNA data book. Ratio: 17.0 / 4.3 = 3.95 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  13. Filipino in 2000 Census (2009 PCNA data book): State 22.8%, East Honolulu 7.0%, Lāna‘i 63.0%. (Note: 2005 PCNA data book did not track Filipino population.) Ratio: 63.9 / 7.0 = 9.13 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  14. NOTE: Infant Mortality Rate (IMR) calculation was based on 5 years of aggregated data in the 2005 & 2009 PCNA data book, but 10 years of aggregated data with the 2012 PCNA data book. Also Note: No change in data series but Table heading changed from ‘Infant Mortality’ in 2005 & 2009 PCNA data book to ‘Infant Mortality Rate’ in 2012 PCNA data book. Infant Mortality Rate in (2009 PCNA data book): State 6.3, Makawao 3.6 & Wailuku 3.8, Ka‘ū 17.2 & North Kohala 14.2. (Note that the IMR listed above also happens to be for locations which had more than 5 infant deaths events.) Infant Mortality Rate in (2005 PCNA data book): State 6.9, Lāhainā 3.6 & Līhu‘e 4.5, Ka‘ū 16.1 & Wai‘anae 12.9. (Note that the IMR listed above are only for locations which had 5 or more infant deaths events.) If you were to include IMR locations which had less than 5 infant death events as shown in the 2005 PCNA data book. The following locations would then have the lowest IMR, Hanalei 2.1 & Lāhainā 3.6 & Kōloa 4.2 Ratio: 12.4 / 3.9 = 3.18 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  15. High Blood Pressure in (2009 PCNA data book): State 26.1%, Hāna 8.8%, Waimea 32.6% & Līhu‘e 32.0%. (Note: 2005 PCNA data book did not track High Blood Pressure.) Ratio: 36.7 / 11.7 = 3.14 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  16. NOTE: For 2009 & 2012 PCNA data book, data source changed from Behavioral Risk Factor Surveillance System (BRFSS) to Office of Health Status Monitoring (OHSM). Also Note: No change in data series but Table heading changed from ‘Stroke Mortality Rate (age adjusted)’ in 2005 PCNA data book to ‘Stroke (Cerebrovascular Disease) Mortality Rate’ in 2009 & 2012 PCNA data book Stroke in (2009 PCNA data book): State 57.1%, Moloka‘i 36.9 & Hāna 40.6 & Līhu‘e 42.8, South Kona 78.1 & Puna 76.8. (Source OHSM) (note that Hāna had less than 5 stroke events reported) Stroke in (2005 PCNA data book): State 61.6%, (Source BRFSS) On the low end the following locations: Hanalei 11.4 & Molokai 13.9 & Lāna‘i 16.6 however, all had less than 5 events reported. Versus these locations with 5 or more events: Kōloa 40.0 & Waialua 49.3. And on the high end South Kona 99.7 & Hāmākua 87.2. Ratio: 67.8 / 22.1 = 3.07 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  17. This indicator if new to the 2012 PCNA data book. Ratio: 58.6 / 10.0 = 5.86 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  18. This indicator if new to the 2012 PCNA data book. Ratio: 14.8 / 4.3 = 3.44 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  19. This indicator if new to the 2012 PCNA data book. Ratio: 21.1 / 0.3 = 70.33 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  20. Also Note: No change in data series but Table heading changed from ‘Adult Smoker’ in 2005 PCNA data book to ‘Adults who Smoke’ in 2009 & 2012 PCNA data book. Adults who Smoke in (2009 PCNA data book): State 16.9%, Hanalei 12.7% & Ko‘olaupoko 13.3% , Wai‘anae 27.0% & Wahiawā 23.5% & Waimea 23.3%. Adults who Smoke in (2005 PCNA data book): State 19.6%, Waialua 14.1% & South Kohala 15.3%, Wai‘anae 34.4% & Kapa‘a 27.2%. Ratio: 26.0 / 9.9 = 2.63 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  21. Cancer in (2009 PCNA data book): State 174.8, Hāna 104.8, Wai‘anae 272.1 & North Kohala 146.8. (Note: 2005 PCNA data book did not track Cancer.) Ratio: 197.0 / 90.2 = 2.18 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  22. This indicator if new to the 2012 PCNA data book. Ratio: 10.9 / 3.1 = 3.52 (The ratio compares the highest to lowest from the 2012 PCNA data book.)
  23. NOTE: For 2012 PCNA data book, data source changed from State Department of Labor and Industrial Relations to American Community Survey 5-year aggregate (2006 – 2010). Also Note: No change in data series but Table heading changed from ‘Unemployment Rate’ in 2005 PCNA data book to ‘Percent of Civilian Labor Force Unemployed’ in 2009 PCNA data book to ‘Civilian Labor Force Unemployed’ in 2012 PCNA data book. Unemployed in (2009 PCNA data book): State 3.9%, South Kohala 2.3%, Ka‘ū 11.5% & Moloka‘i 9.6% & Wai‘anae 8.8%. Unemployed in (2005 PCNA data book): State 2.8%, South Kohala 1.3%, Moloka‘i 8.3% & Ka‘ū 7.0% & Wai‘anae 6.9%. Ratio: 13.5 / 2.3 = 5.87 (The ratio compares the highest to lowest from the 2012 PCNA data book.)