The Proportion of Deaths in Virginia Associated With  Reduced Household Income: The Virginia Study 2011 Virginia TeleHealt...
<ul><li>Virginia Commonwealth University </li></ul><ul><li>Steven H. Woolf, MD MPH </li></ul><ul><li>Resa Jones, MPH, PhD ...
<ul><li>Acknowledgments </li></ul><ul><li>Vital statistics </li></ul><ul><li>Calvin Reynolds, Director, Virginia Departmen...
Background <ul><li>The notion that social conditions affect health is intuitive to policymakers and the public. </li></ul>...
Background <ul><li>Area-based measures of economic status can act as a proxy for this package of interrelated social (indi...
 
 
Setting <ul><li>Virginia’s counties and cities </li></ul><ul><ul><li>Areas of deep poverty </li></ul></ul>
Poverty in Virginia
Poverty in Virginia Source : U.S. Department of Agriculture, Economic Research Service   Rural Urban Total Poverty rate (%...
Setting <ul><li>Virginia’s counties and cities </li></ul><ul><ul><li>Areas of deep poverty </li></ul></ul><ul><ul><li>Sinc...
U.S. Census Bureau, American Community Survey Reports, ACS-09, Income, Earnings, and Poverty: Data From the 2007 American ...
Fairfax County, Virginia
Setting <ul><li>Virginia’s counties and cities </li></ul><ul><ul><li>Areas of deep poverty </li></ul></ul><ul><ul><li>Sinc...
Our Question <ul><li>How many deaths would be averted in  Virginia if every county and city experienced the mortality rate...
Methods: Data Sources <ul><li>Virginia Health Department: 1900-2006 vital statistics </li></ul><ul><li>U.S. Census Bureau:...
Methods: Reference Population <ul><li>Reference population  (RP): For each year we identified the 5 counties/cities with h...
Counties/Cities Comprising Reference Population (RP) <ul><li>Loudoun County </li></ul><ul><li>Fairfax County </li></ul><ul...
Methods: Avertable Deaths <ul><li>Avertable deaths for county/city : </li></ul><ul><ul><li>Adjusted mortality rates for co...
Methods: Avertable Deaths <ul><li>Proportion (%) of deaths averted  by county/city  determined by a moving aggregate, pool...
Results <ul><li>From 1990 to 2006,  24.3%  of deaths in Virginia would have been averted if the entire state experienced t...
Proportion of Deaths Averted, By Year
Absolute Number of Avertable Deaths in Virginia 220,211
Demographic Profile of Averted Deaths * 2005-2009 American Community Survey 5-year Estimates Demographic characteristics P...
Avertable Deaths Among Adults (Age  >  20)  by Educational Attainment * * Some college  = 1-3 years of post-secondary educ...
Avertable Deaths, by County, 2000-2004 Proportion of deaths averted
Averted Deaths, by County, 2000-2004 Proportion of deaths averted
Eastern Shore Richmond Williamsburg Charles City  County Petersburg Dinwiddie County Virginia Beach Chesapeake Norfolk Pri...
Charles City  County (40.4%) Prince George County (26.4%) Dinwiddie County (40.4%) Study results Source : U.S. Census Bure...
Averted Deaths by Rural-Urban Continuum 2003 Rural-Urban Continuum Codes Metro  counties:  1 Counties in metro areas of 1 ...
Urban-Rural Continuum 2000* * Source : U.S. Department of Agriculture, Economic Research Service, using data from the U.S....
Averted Deaths by Metro, Non-Metro
Non-Metro cities/counties, 2000* * Source : U.S. Department of Agriculture, Economic Research Service, using data from the...
Averted Deaths by Population Density
Population Density, 2009* * Source : U.S. Department of Agriculture, Economic Research Service, using data from the U.S. B...
Top 5 Counties in Percent Averted Deaths
Top 5 Cities in Percent Averted Deaths
Discussion <ul><li>Could policies enable every county and city to achieve the health advantages of northern VA? </li></ul>...
Discussion <ul><li>In this study we demonstrated the magnitude of association between low income and mortality. </li></ul>...
Limitations <ul><li>Cross-sectional study, not longitudinal </li></ul><ul><li>Limited to Virginia, not the nation </li></u...
Online Data: Avertable Deaths in Virginia <ul><ul><li>http://www.graham-center.org/online/graham/home/tools-resources/virg...
Other Links <ul><li>Economic Research Service </li></ul><ul><li>Rural Atlas  http://www.ers.usda.gov/Data/RuralAtlas/index...
Other Studies <ul><li>County Health Calculator  (VCU CHN) </li></ul><ul><ul><li>www.countyhealthcalculator.org   </li></ul...
 
 
 
MyPreventiveCare may be used to <ul><li>Provide your patients personalized health recommendations </li></ul><ul><li>Help t...
Thank you! <ul><li>Contact us at  www.humanneeds.vcu.edu </li></ul><ul><li>Bob Johnson [email_address]   </li></ul>
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Income and Health

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Income and Health

  1. 1. The Proportion of Deaths in Virginia Associated With Reduced Household Income: The Virginia Study 2011 Virginia TeleHealth Summit April 6, 2011 Wintergreen Resort, Virginia Robert E. Johnson, PhD Department of Biostatistics Department of Family Medicine VCU Center on Human Needs Virginia Commonwealth University Richmond, Virginia
  2. 2. <ul><li>Virginia Commonwealth University </li></ul><ul><li>Steven H. Woolf, MD MPH </li></ul><ul><li>Resa Jones, MPH, PhD </li></ul><ul><li>Robert E. Johnson, PhD </li></ul><ul><li>Virginia Department of Health </li></ul><ul><li>Anushree Vichare, MPH </li></ul><ul><li>Robert Graham Center </li></ul><ul><li>Robert L. Phillips, Jr., MD MSPH </li></ul><ul><li>Andrew Bazemore, MD, MPH </li></ul><ul><li>University of Virginia </li></ul><ul><li>M. Norman Oliver, MD </li></ul>Avertable Deaths Associated With Household Income in Virginia, Am J Public Health . 2010 Apr;100(4):750-5.
  3. 3. <ul><li>Acknowledgments </li></ul><ul><li>Vital statistics </li></ul><ul><li>Calvin Reynolds, Director, Virginia Department of Health, Division of Health Statistics </li></ul><ul><li>Mapping </li></ul><ul><li>Imam Xierali, PhD, </li></ul><ul><li>Research Scientist and Health Geographer, Robert Graham Center </li></ul><ul><li>Interpretation of county data </li></ul><ul><li>David W. Marsland, MD </li></ul><ul><li>Financial support </li></ul><ul><li>Robert Wood Johnson Foundation, Grant No. 63408 </li></ul>
  4. 4. Background <ul><li>The notion that social conditions affect health is intuitive to policymakers and the public. </li></ul><ul><li>The magnitude of this effect may not be fully appreciated. </li></ul><ul><li>Social determinants exert influences on health through individual and household circumstances as well as through concurrent environmental conditions that exist in areas where people reside. </li></ul>
  5. 5. Background <ul><li>Area-based measures of economic status can act as a proxy for this package of interrelated social (individual and community) conditions. </li></ul><ul><li>We chose income as our proxy. </li></ul><ul><ul><li>Known association between income and mortality </li></ul></ul><ul><ul><li>Issue is salient amid current economic stresses on nation </li></ul></ul>
  6. 8. Setting <ul><li>Virginia’s counties and cities </li></ul><ul><ul><li>Areas of deep poverty </li></ul></ul>
  7. 9. Poverty in Virginia
  8. 10. Poverty in Virginia Source : U.S. Department of Agriculture, Economic Research Service   Rural Urban Total Poverty rate (%) 2009 15.9 9.7 10.6 Per-capita income 2008 30,024 46,410 44,075 Earnings per job 2008 34,796 55,936 53,585
  9. 11. Setting <ul><li>Virginia’s counties and cities </li></ul><ul><ul><li>Areas of deep poverty </li></ul></ul><ul><ul><li>Since 2000, 1 or more counties among 10 highest median household income in the US. </li></ul></ul>
  10. 12. U.S. Census Bureau, American Community Survey Reports, ACS-09, Income, Earnings, and Poverty: Data From the 2007 American Community Survey, U.S. Government Printing Office, Washington, DC, 2008.
  11. 13. Fairfax County, Virginia
  12. 14. Setting <ul><li>Virginia’s counties and cities </li></ul><ul><ul><li>Areas of deep poverty </li></ul></ul><ul><ul><li>Since 2000, 1 or more counties among 10 highest median household income in the US. </li></ul></ul><ul><ul><li>The lead researchers live and work in Virginia. </li></ul></ul>
  13. 15. Our Question <ul><li>How many deaths would be averted in Virginia if every county and city experienced the mortality rates of the most affluent areas? </li></ul>
  14. 16. Methods: Data Sources <ul><li>Virginia Health Department: 1900-2006 vital statistics </li></ul><ul><li>U.S. Census Bureau: median household income data for 95 counties and 39 cities in Virginia, 1993, 1995, 1997-2006 </li></ul><ul><ul><ul><li>County/city income for selected years (1990-92, 1994, 1996) interpolated by regressing household income on year and taxable income </li></ul></ul></ul>
  15. 17. Methods: Reference Population <ul><li>Reference population (RP): For each year we identified the 5 counties/cities with highest median household income </li></ul><ul><ul><li>Mortality rate for RP determined for 12 age- and gender-specific subgroups </li></ul></ul>
  16. 18. Counties/Cities Comprising Reference Population (RP) <ul><li>Loudoun County </li></ul><ul><li>Fairfax County </li></ul><ul><li>Falls Church City </li></ul><ul><li>Prince William County </li></ul><ul><li>Fairfax City </li></ul><ul><li>Stafford County </li></ul>
  17. 19. Methods: Avertable Deaths <ul><li>Avertable deaths for county/city : </li></ul><ul><ul><li>Adjusted mortality rates for county/city determined by average of age-gender-specific RP mortality rates weighted by county/city age-gender-specific population counts. ( indirect standardization ) </li></ul></ul><ul><ul><li>Averted deaths calculated from the difference between the observed and adjusted county/city mortality rates. </li></ul></ul>
  18. 20. Methods: Avertable Deaths <ul><li>Proportion (%) of deaths averted by county/city determined by a moving aggregate, pooling data over 4 years </li></ul><ul><li>Avertable deaths for Virginia : sum of avertable deaths for all counties and cities </li></ul><ul><li>Results post-stratified by (but not adjusted for) race/ethnicity, educational attainment, and cause of death </li></ul>
  19. 21. Results <ul><li>From 1990 to 2006, 24.3% of deaths in Virginia would have been averted if the entire state experienced the mortality rate of the Reference Population (RP) </li></ul><ul><li>220,211 avertable deaths over 1990-2006 </li></ul><ul><li>Average of 12,954 (range =10,548-14,569) avertable deaths per year </li></ul>
  20. 22. Proportion of Deaths Averted, By Year
  21. 23. Absolute Number of Avertable Deaths in Virginia 220,211
  22. 24. Demographic Profile of Averted Deaths * 2005-2009 American Community Survey 5-year Estimates Demographic characteristics Proportion of averted deaths (%) 2005-2009 ACS* Population (%) Gender Male 49.2 49.1 Female 50.8 50.9 Age (years) 0-19 2.3 26.8 20-49 9.4 43.4 50-64 17.2 18.1 65 and above 71.1 11.8 Race/ethnicity Non-Hispanic whites 75.6 67.0 Non-Hispanic blacks 23.2 19.3 Hispanics 0.6 6.7
  23. 25. Avertable Deaths Among Adults (Age > 20) by Educational Attainment * * Some college = 1-3 years of post-secondary education, college = 4 or more years of post-secondary education * 2005-2009 American Community Survey 5-year Estimates
  24. 26. Avertable Deaths, by County, 2000-2004 Proportion of deaths averted
  25. 27. Averted Deaths, by County, 2000-2004 Proportion of deaths averted
  26. 28. Eastern Shore Richmond Williamsburg Charles City County Petersburg Dinwiddie County Virginia Beach Chesapeake Norfolk Prince George County Henrico County Chesterfield County Middle Peninsula Emporia Suffolk Sussex County Newport News Brunswick County
  27. 29. Charles City County (40.4%) Prince George County (26.4%) Dinwiddie County (40.4%) Study results Source : U.S. Census Bureau, Quick Facts, http://quickfacts.census.gov/qfd/states/51000.html VA=81.5% VA=$51,103 VA=$125,400
  28. 30. Averted Deaths by Rural-Urban Continuum 2003 Rural-Urban Continuum Codes Metro counties: 1 Counties in metro areas of 1 million population or more 2 Counties in metro areas of 250,000 to 1 million population 3 Counties in metro areas of fewer than 250,000 population Nonmetro counties : 4 Urban population of 20,000 or more, adjacent to a metro area 5 Urban population of 20,000 or more, not adjacent to a metro area 6 Urban population of 2,500 to 19,999, adjacent to a metro area 7 Urban population of 2,500 to 19,999, not adjacent to a metro area 8 Completely rural or less than 2,500 urban population, adjacent to a metro area 9 Completely rural or less than 2,500 urban population, not adjacent to a metro area
  29. 31. Urban-Rural Continuum 2000* * Source : U.S. Department of Agriculture, Economic Research Service, using data from the U.S. Bureau of the Census. Map from Atlas of Rural and Small Town America Avertable deaths, by city/county* * Source : study results
  30. 32. Averted Deaths by Metro, Non-Metro
  31. 33. Non-Metro cities/counties, 2000* * Source : U.S. Department of Agriculture, Economic Research Service, using data from the U.S. Bureau of the Census. Map from Atlas of Rural and Small Town America Avertable deaths, by city/county* * Source : study results
  32. 34. Averted Deaths by Population Density
  33. 35. Population Density, 2009* * Source : U.S. Department of Agriculture, Economic Research Service, using data from the U.S. Bureau of the Census. Map from Atlas of Rural and Small Town America Avertable deaths, by city/county* * Source : study results
  34. 36. Top 5 Counties in Percent Averted Deaths
  35. 37. Top 5 Cities in Percent Averted Deaths
  36. 38. Discussion <ul><li>Could policies enable every county and city to achieve the health advantages of northern VA? </li></ul><ul><li>Individual and community characteristics are intertwined, but how they contribute to improved health is of great interest. </li></ul>
  37. 39. Discussion <ul><li>In this study we demonstrated the magnitude of association between low income and mortality. </li></ul><ul><li>The ‘‘package’’ of individual and environmental conditions associated with high household income exerts influence on health outcomes, perhaps more than health care itself. </li></ul>
  38. 40. Limitations <ul><li>Cross-sectional study, not longitudinal </li></ul><ul><li>Limited to Virginia, not the nation </li></ul><ul><li>Reliance on small area statistics </li></ul><ul><li>Comparisons made at county, not census tract, level </li></ul><ul><li>Stopped at 2006, after which dramatic economic events occurred </li></ul>
  39. 41. Online Data: Avertable Deaths in Virginia <ul><ul><li>http://www.graham-center.org/online/graham/home/tools-resources/virginia-mapper.html </li></ul></ul>
  40. 42. Other Links <ul><li>Economic Research Service </li></ul><ul><li>Rural Atlas http://www.ers.usda.gov/Data/RuralAtlas/index.htm </li></ul><ul><li>Rural/Urban Continuum Codes: Virginia Counties http://www.ers.usda.gov/Data/RuralUrbanContinuumCodes/2003/LookUpRUCC.asp?C=R&ST=VA </li></ul><ul><li>Virginia Fact Sheet http://www.ers.usda.gov/StateFacts/VA.htm </li></ul><ul><li>2009 poverty level rates for Virginia counties </li></ul><ul><li>http://www.ers.usda.gov/Data/PovertyRates/PovListpct.asp?ST=VA&view=Percent </li></ul>
  41. 43. Other Studies <ul><li>County Health Calculator (VCU CHN) </li></ul><ul><ul><li>www.countyhealthcalculator.org </li></ul></ul><ul><li>Project on Societal Distress (VCU CHN) </li></ul><ul><ul><li>www.societaldistress.org </li></ul></ul><ul><li>My Preventive Care (VCU Family Medicine) </li></ul><ul><ul><li>www.mypreventivecare.org </li></ul></ul>
  42. 47. MyPreventiveCare may be used to <ul><li>Provide your patients personalized health recommendations </li></ul><ul><li>Help to explain lab results to your patients </li></ul><ul><li>Direct your patients to self management tools for obesity, hypertension, hyperlipidemia, diabetes, smoking cessation </li></ul><ul><li>Meet Medicare Annual Wellness Visit criteria </li></ul><ul><li>Support Meaningful Use </li></ul><ul><li>Report PQRS measures </li></ul>
  43. 48. Thank you! <ul><li>Contact us at www.humanneeds.vcu.edu </li></ul><ul><li>Bob Johnson [email_address] </li></ul>

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