Wisconsin Department of Health Services
January 2014 P-00522G
Healthiest Wisconsin 2020 Baseline and Health Disparities Report
Environmental and Occupational Health
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities
Report • Healthiest Wisconsin 2020 objectives and indicators• Rationale• Key points
Data• Youth asthma• Adult asthma• Asthma hospitalizations• Occupational injury• Lead poisoning
ReferencesLinks to additional reports and resourcesContacts
Chapter Outline
Chapter outline
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Report Overview
• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf
• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.
• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.
• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf
Report overview
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Report Format
Full Report• Format: PDF • Intended use: reference document
Chapters• Format: Annotated PowerPoint slide
set• Intended uses: presentations to
– Decision-makers– Service providers– Community leaders– The public
Sample annotated slide
Report overview
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Report Outline
Executive Summary
Section 1: Introduction
Section 2: Demographic overview
Section 3: Health focus areas
Section 4: Infrastructure focus areas
Section 5: Data summaries by population
Section 6: Technical notes
Report overview
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Report Outline: Detail
Section 3: Health focus areas
• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure
Section 4: Infrastructure focus areas• Access to health care
Report overview
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Report Outline: Detail
Section 5: Data summaries by population
Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics
People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography
Report overview
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Data notes
• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf
• The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution.
• Population estimates that are considered unreliable are excluded.
• Misclassification of racial/ethnic groups may affect the accuracy of rates.
• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.
Report overview
8
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Factors that influence health
Social determinants
of health
Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach
Report overview
9
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Healthiest Wisconsin 2020 objectives and indicators
Objective 1
By 2020, improve the overall quality and safety of the food supply and the natural, built and work environments.
Objective 1 Indicator
• Proportion of local and tribal jurisdictions that have assessed, prioritized and improved performance on an environmental and occupational health index.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Environmental and Occupational Health Focus Area Profile.
HW2020 objectives
10
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Healthiest Wisconsin 2020 objectives and indicators
Objective 2
By 2020, increase the percentage of homes with healthy, safe environments in all communities.
Objective 2 Indicator
• Proportion of local and tribal jurisdictions that have assessed, prioritized and improved performance on a home health and safety index.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Environmental and Occupational Health Focus Area Profile.
HW2020 objectives
11
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Rationale
• Environmental and occupational health includes the prevention of illnesses and injuries resulting from hazards in the natural and built environments where people live, work and play.
• The air we breathe, water we drink, communities we live in, and food we eat are recognized as underlying determinants of health.
• Disparities in the quality of living spaces are often related to socioeconomic, racial/ethnic, and income- and education-level factors. These factors can affect whether or not environmental contaminants are detected and removed.
Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Environmental and Occupational Health Focus Area Profile.
Rationale
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Key points
• Black adults had significantly higher percentages of lifetime and current asthma compared to other racial/ethnic groups.
• Lifetime and current asthma rates are significantly higher among people with lower incomes and those with lower educational attainment.
• While the statewide rate of asthma hospitalization has declined slightly over the past 10 years, notable disparities exist by race. The hospitalization rate was five times greater for the Black population and two times greater for American Indians than for the White population.
• Milwaukee and Menominee counties had asthma hospitalization and emergency department visit rates that were roughly twice the statewide rates.
• The estimated rate of work-related injury and illness has declined over the past decade.
• Lead poisoning has steadily decreased among children under age six since 2001; however, racial and ethnic disparities remain. In 2010, Black children were six times as likely as White children to have experienced lead poisoning.
Key points
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Youth asthma
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Rates of lifetime and current asthma among Wisconsin children, by sex, 2011-2012
Youth asthma
Have ever been told you have asthma
Currently have asthma0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
11% 8%13% 9%9% 6%
TotalMaleFemale
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2011-2012 landline-cellphone combined dataset.
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Rates of lifetime asthma among public middle and high school students, by race/ethnicity, Wisconsin, 2008 and 2010
Source: Wisconsin Department of Health Services, Youth Tobacco Survey, 2008 and 2010.Note: “Other” includes Hispanic, American Indian/Alaskan Native, Asian, Native Hawaiian or other Pacific Islander.
White, non-Hispanic Black, non-Hispanic Other0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
12% 16% 12%12% 26% 11%
20082010
Youth asthma
16
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Adult asthma
17
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Rates of lifetime and current asthma among Wisconsin adults, by sex, 2009-2011
Adult asthma
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 landline-cellphone combined dataset.
Have ever been told you have asthma Currently have asthma0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
13% 9%11% 7%15% 11%
Total Male
Female
18
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Rates of lifetime and current asthma among Wisconsin adults, by age, 2009-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2009-2011 landline-cellphone combined dataset.
Have ever been told you have asthma Currently have asthma0%
5%
10%
15%
20%
25%
30%
18% 10%14% 9%11% 9%11% 9%
18 - 2425 - 4445 - 6465+
Adult asthma
19
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Age-adjusted rates of asthma among Wisconsin adults, by race/ethnicity, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.
Have ever been told you have asthma Currently have asthma0%
5%
10%
15%
20%
25%
30%
13% 9%23% 16%13% 9%10%
WhiteBlackHispanicAmerican Indian
Adult asthma
20
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Age-adjusted rates of asthma among Wisconsin adults, by income level, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.
Have ever been told you have asthma Currently have asthma0%
5%
10%
15%
20%
25%
30%
22% 18%13% 9%10% 7%
Low income (<$20,000)
Middle income ($20,000-$74,999)
High income ($75,000+)
Adult asthma
21
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Age-adjusted rates of asthma among Wisconsin adults, by level of urbanization, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.
Have ever been told you have asthma Currently have asthma0%
5%
10%
15%
20%
25%
30%
14% 11%15% 10%11% 8%
Milwaukee CountySmaller metropolitan countiesNon-metropolitan counties
Adult asthma
22
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Rates of lifetime and current asthma among Wisconsin adults, by sexual orientation, 2008-2011
Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.
Adult asthma
Have ever been told you have asthma Currently have asthma0%
5%
10%
15%
20%
25%
30%
13% 9%16% 10%
Sexual majoritySexual minority
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Asthma hospitalizations
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Asthma hospitalizations, age-adjusted rate per 10,000, Wisconsin, 2001-2010
Source: 2001-2010 hospital inpatient discharge file.
Asthma hospitalizations
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
2
4
6
8
10
12
Year
Age-
adju
sted
rate
per
10,
000
popu
-la
tion
25
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Asthma hospitalizations by race/ethnicity, age-adjusted rate per 10,000, Wisconsin, 2010
Source: Wisconsin Inpatient Hospitalization Discharge file, 2010.
Asthma hospitalizations
White Black Hispanic Asian American Indian
0.0
2.0
4.0
6.0
8.0
10.0
12.0
26
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Asthma hospitalizations by age and sex, rate per 10,000, Wisconsin, 2010
Source: 2010 Wisconsin inpatient hospitalization discharge file.
Asthma hospitalizations
0-4 5-14 15-34 35-64 65+ All ages0
5
10
15
20
25
30
35
30 10 2 5 10 716 7 4 12 17 10
MaleFemale
Age Group (years)
Age-
adju
sted
rate
per
10,
000
popu
-la
tion
27
ENVIRONMENTAL AND OCCUPATIONAL HEALTHCounties exceeding the statewide age-adjusted rates per 10,000 of asthma hospitalizations and emergency department visits, Wisconsin, 2008-2010
Source: 2008-2010 Wisconsin hospital inpatient discharge file; 2008-2010 Wisconsin emergency department visit file.
Asthma hospitalizations
Asthma health care utilization
Both hospitalization and emergencydepartment rates exceed state rate
Neither hospitalization or emergency department rate exceeds state rate
Hospitalization rate exceeds staterate (9 per 10,000)
Emergency department rate exceeds state rate (38 per 10,000)
28
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Distribution of asthma hospitalizations by primary payer, Wisconsin, 2010
Commercial, 27%
Self pay, 6%
Medicare, 33%
Medicaid, 33%
Other government programs, 1%
Source: 2010 Wisconsin hospital inpatient discharge file.
Asthma hospitalizations
Asthma hospitalizations in 2010:Number: 4,949Average hospitalization charge: $12,420
Governmental payers
Non-governmental payers
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Asthma hospitalizations among Medicaid recipients by race/ethnicity, rate per 10,000, Wisconsin, 2007-2009
Source: Wisconsin Division of Health Care Access and Accountability, 2007-2009 Medicaid Data.Note: White, Black, and American Indian are non-Hispanic; Hispanic may include people of any race.
White Black Hispanic Asian American Indian0
10
20
30
40
50
60
70
30 50 30 10 3020 50 30 10 3020 60 30 20 40
200720082009
Rat
e pe
r 10,
000
enro
llees
Asthma hospitalizations
30
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Occupational injury
31
ENVIRONMENTAL AND OCCUPATIONAL HEALTHEstimated work-related nonfatal injury/illness incidence rate and crude fatality rate per 100,000 full-time-equivalent workers (FTEs) age 16 years or older, Wisconsin, 2001-2010
Source: U.S. Bureau of Labor Statistics Survey of Occupational Illnesses and Injuries and U.S. Bureau of Labor Statistics Census of Fatal Occupational Injuries.
Occupational injury
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0Nonfatal injury/illness rate Fatality rate
Estim
ated
inju
ry a
nd il
lnes
s ra
te p
er
100,
000
FTEs
Ann
ual c
rude
fata
lity
rate
per
100
,000
FT
Es
32
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Lead poisoning
33
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Percent of children under age six who were lead tested and had a confirmed elevated blood lead level, by state, 2010
Source: Centers for Disease Control and Prevention (CDC) Lead Program, National Surveillance data. Data exclude children who have been previously tested and found to have elevated blood lead levels.
Lead poisoning
Series1
-0.5%
0.0%
0.5%
1.0%
1.5%
2.0%
United States = 0.61%
34
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Number of Wisconsin children under age six who were lead tested and lead poisoned (10 mcg/dL or higher), Wisconsin, 2001-2010
Source: Wisconsin Department of Health Services, Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP).
Lead poisoning
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
1,000
2,000
3,000
4,000
5,000
6,000
0
20,000
40,000
60,000
80,000
100,000
120,000Tested Poisoned
Num
ber o
f chi
ldre
n un
der a
ge s
ix
lead
-poi
sone
d
Num
ber o
f chi
ldre
n un
der a
ge s
ix t
este
d fo
r blo
od le
ad
35
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Annual prevalence of lead poisoning (10 mcg/dL or higher) among tested children under age six, by race/ethnicity, Wisconsin, 2000-2010
Source: Wisconsin Department of Health Services, Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP).
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100%
5%
10%
15%
20%
25% BlackHispanicAsianWhite
Year
Lead poisoning
36
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Annual mean blood lead level (mcg/dL) for tested children under age six, by race/ethnicity, Wisconsin, 2010
Source: Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP).Note: Racial groups are non-Hispanic; Hispanics may include any race.
White Black Hispanic Asian American Indian0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
2.7 4.1 3.2 2.9 2.3
Mea
n bl
ood
lead
leve
l (m
cg/d
L)Lead poisoning
37
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Percentage of lead poisoning (10 mcg/dL or greater) among tested children under age six, by Medicaid enrollment, Wisconsin, 2010
Source: Wisconsin Department of Health Services, Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP).
Percent with lead poisoning (≥10 µg/dL)
-0.5%
0.0%
0.5%
1.0%
1.5%
2.0%
0.7% 1.6%
Non-Medicaid enrolleesMedicaid enrollees
Lead poisoning
38
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Percentage of lead poisoning (10 mcg/dL or greater) among tested children under age six, by county, Wisconsin, 2010
Source: Wisconsin Department of Health Services, Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP).
Lead poisoning
Elevated blood lead level
0% - 0.3%
0.4% - 0.7%
0.8% - 1.3%
1.4% - 2.4%
Statewide = 1.3%
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ENVIRONMENTAL AND OCCUPATIONAL HEALTH
References
1. University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach
2. Center for Urban Population Health. Milwaukee Health Report, 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf
3. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf
4. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/
5. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf
6. Centers for Disease Control and Prevention (CDC). Asthma. http://www.cdc.gov/asthma/faqs.htm
7. CDC. Adolescent and School Health: Asthma and Schools. http://www.cdc.gov/healthyyouth/asthma/index.htm
8. American Lung Association. Asthma and Children. http://www.lung.org/lung-disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.html
References
40
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
9. Wisconsin Department of Health Services (DHS). Burden of Asthma in Wisconsin 2010: http://www.dhs.wisconsin.gov/eh/asthma/pdf/BurdenofAsthma2010Web.pdf
10. U.S. Department of Health and Human Services, Office of Minority Health. Asthma and African Americans. http://minorityhealth.hhs.gov/templates/content.aspx?ID=6170
11. Leigh, JP. Individual and job characteristics as predictors of industrial accidents. Accident Analysis and Prevention, 1986; 18(3).
12. National Institute for Occupational Safety and Health. Occupational Health Disparities. http://www.cdc.gov/niosh/programs/ohd/
13. DHS. The Legacy of Lead: Report on Childhood Lead Poisoning in Wisconsin 2008: http://www.dhs.wisconsin.gov/lead/doc/LegacyofLead2008webpage.pdf
14. DHS. Lead-Safe Wisconsin: Action level changed from blood lead level of 10 to 5. http://www.dhs.wisconsin.gov/lead/
References
41
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Links to additional reports and resources
• Burden of Asthma in Wisconsin 2010: http://www.dhs.wisconsin.gov/eh/asthma/pdf/BurdenofAsthma2010Web.pdf
• Wisconsin Asthma Plan 2009-2014: http://www.dhs.wisconsin.gov/eh/Asthma/pdf/WACPlan20092014.pdf
• Wisconsin Occupational Health Program Website: http://www.dhs.wisconsin.gov/dph_boh/occ/pages/index.htm
• The Legacy of Lead: Report on Childhood Lead Poisoning in Wisconsin 2008: http://www.dhs.wisconsin.gov/lead/doc/LegacyofLead2008webpage.pdf
• Centers for Disease Control and Prevention (CDC). Environmental Health: http://www.cdc.gov/Environmental/
• CDC. Environmental Health: Workplace Health and Safety: http://www.cdc.gov/Workplace/
Links
42
ENVIRONMENTAL AND OCCUPATIONAL HEALTH
Contacts
Carrie Tomasallo, PhD, MPHSenior EpidemiologistBureau of Environmental and Occupational HealthDivision of Public HealthWisconsin Department of Health ServicesEmail: [email protected]
Marjorie Coons, MSProgram ManagerWisconsin Healthy Homes and Childhood Lead Poisoning Prevention ProgramBureau of Environmental and Occupational HealthDivision of Public HealthWisconsin Department of Health ServicesEmail: [email protected]
Contacts
43