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Harford County Board of Health Update October 17, 2017
Russell Moy, MD, MPH Acting Health Officer
•
•
•
2
Harford County Health Department (HCHD) Today’s Update
Baltimore City
Anne Arundel
Howard
Baltimore
Caroline
Queen Anne’s
Prince George’s
St. Mary's
Charles
Allegany
Carroll Harford
Cecil
Kent
Wicomico
Dorchester
Worcester
Washington
Garrett
District of Columbia
Frederick
Montgomery
Talbot
Calvert
Somerset
Age 80 or over
Age 79
Age 78
Age 77
Age 76 or under
Legend
Life Expectancy
Harford County has
improved from 79.6 to
79.7 years from 2014
to 2015.
“Beyond Health Care,” RWJF Commission to Build a Healthier America, 2009
Source: Maryland Vital Statistics, 2015
How healthy are Harford County residents? What is our average life expectancy?
There’s a 10-year life
expectancy disparity
within Maryland.
4
A community’s health is more than mortality
and clinical care . . .
80% of what influences your health and life expectancy happens outside of the healthcare system
From Tony Iton, MD, “Is Your Zip Code More
Important Than Your Zip Code,” 2015 lecture
7
Mo
ntg
om
ery
Ho
war
d
Car
roll
Fred
eric
k
Talb
ot
Cal
vert
Qu
een
An
ne'
s
St. M
ary'
s
Har
ford
Wo
rces
ter
An
ne
Aru
nd
el
Ch
arle
s
Bal
tim
ore
Pri
nce
Geo
rge'
s
Ce
cil
Gar
rett
Was
hin
gto
n
Ken
t
Alle
gan
y
Wic
om
ico
Car
olin
e
Som
erse
t
Do
rch
este
r
Bal
tim
ore
Cit
y
9th Healthiest for Health Outcomes:
Birth outcomes Death rates
Quality of life
Source: County Health Rankings, RWJF, 2017
8
Ho
war
d
Mo
ntg
om
ery
Fred
eric
k
Car
roll
Talb
ot
Qu
een
…
Cal
vert
Har
ford
An
ne…
St. M
ary'
s
Bal
tim
ore
Ken
t
Ch
arle
s
Gar
rett
Wo
rces
ter
Pri
nce
…
Was
hin
gto
n
Cec
il
Alle
gan
y
Wic
om
ico
Car
olin
e
Do
rch
este
r
Som
erse
t
Bal
tim
ore
…
8th Healthiest for Health Factors:
Health behaviors Access to care
Socio-economics Environment
Source: County Health Rankings, RWJF, 2017
9
198
182
176 172
170
168
193
180
175 172
170
169
150
160
170
180
190
200
210
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15
Pe
r 1
00
,00
0 P
op
ula
tio
n
Harford
Maryland
* Age-Adjusted Rates
Source: Maryland Vital Statistics Reports
Harford County rates improving and comparable with the State.
10
43
40
38
34
37
35
40 39
37
37
36
37
30
40
50
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15
Pe
r 1
00
,00
0 P
op
ula
tio
n
Harford
Maryland
* Age-Adjusted Rates
Source: Maryland Vital Statistics Reports
Harford County rates improving and comparable with the State.
11
16.9
12.4 14.9
11.3 10.0 8.8
27.2
24.7
22.1
19.3 17.8 16.9
0
10
20
30
2010 2011 2012 2013 2014 2015
Pe
r 1
,00
0 F
em
ale
s, A
ges
15-
19
Harford
Maryland
* Age-Adjusted Rates
Source: Maryland Vital Statistics Reports
Harford County rates improving and better than the State.
12
5.5 3.7
5.3 5.2 4.8
3.3
6.7 6.7 6.3 6.6 6.5 6.7
0
2
4
6
8
10
2010 2011 2012 2013 2014 2015
Pe
r 1
,00
0 L
ive
Bir
ths
Harford
Maryland
* Age-Adjusted Rates
Source: Maryland Vital Statistics Reports
Harford County rates improving and better than the State.
13
6.7
11.3
5.5
4.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
All Black Hispanic White
Pe
r 1
,00
0 L
ive
Bir
ths
All
Black
Hispanic
White
Source: Maryland Vital Statistics, 2015
Infant mortality racial disparities exist in Maryland
14
179
171 172
168
171
166
177
171
167
164 162
159
150
160
170
180
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15
Pe
r 1
00
,00
0 P
op
ula
tio
n
Harford
Maryland
* Age-Adjusted Rates
Source: Maryland Vital Statistics Reports
Harford County rates improving but worse than the State.
15
47
41 38 37 37
39
36 35 34 33
31 31
20
30
40
50
60
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15
Pe
r 1
00
,00
0 P
op
ula
tio
n
Harford
Maryland
* Age-Adjusted Rates
Source: Maryland Vital Statistics Reports
Harford County rates worse than the State.
16
498 482
110 95
80 61 50 48 46 33 32
0
100
200
300
400
500
600
# o
f D
eat
hs
Age-Adjusted Rates
Source: Maryland Vital Statistics, 2015
The Leading Causes of Death
Harford County, 2015
Heart disease, cancer and COPD are the leading disease causes of death.
17
The Leading Actual Underlying Causes of
Death
Source: Mokdad et al, “Actual Causes of Death in the
U.S., 2000” JAMA, 3/19/2004
But smoking, obesity and alcohol are the leading actual causes of death.
18
18.6
21.7
16.9
18.9
20.7
10
12
14
16
18
20
22
24
2011 2012 2013 2014 2015
Pe
rce
nt
Harford
Maryland
Source: phpa.health.maryland.gov
MD BRFSS, 2011-15
Harford County adult use rates remain higher than the State average.
19
Note: Students Grades 9-12 who used any tobacco products in the past 30 days
Source: Maryland YRBSS, 2013 and 2014:
20.2 19.2
16.9 16.4
0
5
10
15
20
25
2013 2014
Pe
rce
nt
Harford Maryland
Harford County youth use rates are higher than the State average.
•
•
•
–
–
–
20
HCHD Tobacco Use Prevention Efforts
Impact of the opioid overdose crisis
22
1,164 1,108
1,179
1,245
1,382
1,462
1,674
800
1,000
1,200
1,400
1,600
1,800
2008 2009 2010 2011 2012 2013 2014
Pe
r 1
00
,00
0 P
op
ula
tio
n
Harford
Harford
Source: Maryland Vital Statistics Reports
23
35 33
43 38 39
36
43
50
84
2008 2009 2010 2011 2012 2013 2014 2015 2016
Per
100
,000
Po
pu
lati
on
All Drugs/Alcohol Heroin Fentanyl
Harford County had a 68% increase in overdose deaths from 2015-2016. Preliminary data for 2017 indicate a possible 100% increase from 2016-2017.
Source: Maryland Vital Statistics: Drug- and Alcohol-Related Intoxication Deaths in Maryland, 2016
24
498 482
110 95
80 61 50 48 46 33 32
0
100
200
300
400
500
600
# o
f D
eat
hs
Source: Maryland Vital Statistics, 2015
The Leading Causes of Death
Harford County, 2015
At the current rate, overdose deaths may become the 3rd leading cause of death in 2017.
25
1,566 1,401
1,275 1,119 1,113
949 913 913 900 883 866 817 785 742 740 712 690 640 546 550 519 495
356 353 283
Ken
t
Alle
gan
y
Was
hin
gto
n
Cal
vert
Cec
il
Talb
ot
Car
roll
Har
ford
Wic
om
ico
Bal
tim
ore
Co
Ch
arle
s
Gar
rett
St. M
ary'
s
Fred
eric
k
An
ne
Aru
nd
el
Wo
rces
ter
Qu
een
An
ne'
s
U.S
. Ave
rage
Do
rch
este
r
Som
erse
t
Bal
tim
ore
Cit
y
Car
olin
e
Mo
ntg
om
ery
Ho
war
d
Pri
nce
Geo
rge'
s
Mo
rph
ine
Mill
igra
m E
qu
ival
ents
(M
ME
)
2010 2015Harford County ranks 8th worst in the State.
Source: Dinsmore, “How Maryland measured up in opioid
prescribing,” Baltimore Sun, 7/8/17 – citing CDC data
26
4.5 5.6
8.8
5.1 5.9
12.6 12.1 9.5
12.3
19.9 16.9
29.6 26.4
36.7
29.1
29.4
38.2
11.8 11.3 12.4 11.9 10.2
12.6 13.1 13.3 14.5
14.7 16.0 17.6
18.6 21.0 20.4 20.1
33.3
0
10
20
30
40
Rat
e E
xpo
sed
Pe
r 1
,00
0 N
ew
bo
rns
Year
Harford County Maryland
>7-fold increase in newborn exposure to drugs/alcohol
over the past 16 years for Harford County residents
NOTE: ICD Codes used 760.70, 760.71. 760.72, 760.73, 760.75, 760.77, 779.5
Source: HSCRC Hospital Data, 2000-16,Maryland resident births only, does not include Maryland resident births born out of state.
Source: “Drug and Alcohol Related Intoxication
Deaths in Maryland, 2016,” Maryland Vital Statistics
Heroin increased by 62%
Fentanyl increased by 229%
From 2015 to 2016.
AGE (years)
Source: “Drug and Alcohol Related Intoxication
Deaths in Maryland, 2016,” Maryland Vital Statistics
45-54 yr olds impacted most.
25-34 yr olds impacted next most.
29
Stein et al, AJPH, October 2017
30
11.9
11.2 11.3
10.7
11.6 11.6
8.8 8.9 8.8 9.0
9.2 9.1
8
9
10
11
12
13
2008-10 2009-11 2010-12 2011-13 2012-14 2013-15
Pe
r 1
00
,00
0 P
op
ula
tio
n
Harford
Maryland
* Age-Adjusted Rates
Source: Maryland Vital Statistics Reports
Harford County rates worse than the State.
•
–
•
–
•
–
–
–
•
•
31
HCHD Opioid Use Prevention Efforts
33
Harford County OOCC OIT Project
Central Intake, Navigation & Recovery Team
Individual/Family
in Need of
Guidance
ACR Telephone Resource Line
443-417-7810
-CENTRAL INTAKE
-Screening
-Assessment
-NAVIGATION
of the treatment
system
-RECOVERY
-Housing
-Peer Support
RECOVERY
& SUPPORT
Individual/Family
in Need of
Treatment
Individual/Family
in Need of
Recovery Support
01,0002,0003,0004,0005,0006,0007,0008,0009,000
10,000
Q1 Q2 Q3 Q4 TotalFY 2015 2,217 2,228 1,967 2,881 9,293
FY 2016 2,147 1,796 3,056 2,521 9,520
FY 2017 2,338 1,978 2,601 2,873 9,790
# V
isit
s
FY 2015
FY 2016
FY 2017
5% Increase From FY15-17
34
Source: HCHD County Stat Data
Key Health Issues Ahead
Impact of Maryland’s hospital federal waiver
37
# High Utilizers with 3+ Inpatient HospitalizationsFor SHIP Disease Indicators, Maryland & Harford County ZIP, 2015
Source: “High Utilizer Use of Inpatient Hospitals,” CRISP Reporting
Service Dashboards Workbook at https://reports.crisphealth.org/
High readmission rates may
mean problems with follow up
appointments and medications.
Highest rates in Aberdeen,
Havre de Grace and Joppa.
38
# High Utilizers with 3+ Emergency Dept VisitsFor SHIP Disease Indicators, Maryland & Harford County ZIP, 2015
Source: “High Utilizer Use of Inpatient Hospitals,” CRISP Reporting
Service Dashboards Workbook at https://reports.crisphealth.org/
High repeat E.D. visit rates may
mean problems accessing
ambulatory care in the
community.
Highest rates in Aberdeen,
Edgewood and Havre de Grace.
0500
1,0001,5002,0002,5003,0003,5004,0004,5005,000
Q1 Q2 Q3 Q4 TotalFY 2014 1,162 949 1,008 1,097 4,216
FY 2015 1,148 983 1,032 1,124 4,287
FY 2016 1,213 1,133 1,167 1,156 4,669
FY 2017 1,144 954 1,063 1,126 4,287
# C
hild
ren
’s D
en
tal V
isit
s
FY 2014
FY 2015
FY 2016
FY 2017
39
Source: HCHD County Stat Data
40
52.1
55.4 56.5
59.7 59.9
58.3
60.2
52.8
57.1
60.2
62.2 63.3 63.2
64.3
50
55
60
65
70
2009 2010 2011 2012 2013 2014 2015
Pe
rce
nt
Harford
Maryland
Source: Maryland Medicaid Service Utilization
Harford County rates worse than the State.
0
1000
2000
3000
4000
Q1 Q2 Q3 Q4 TotalFY 2014 431 286 37 386 1,140
FY 2015 576 594 638 1,042 2,850
FY 2016 1,414 769 692 636 3,511
FY 2017 575 556 581 543 2,255
# M
CH
P A
pp
licat
ion
s
FY 2014
FY 2015
FY 2016
FY 2017
98% Increase From FY14-17
41
Source: HCHD County Stat Data
42
17.0
15.5
12.2
9.5 10.7 10.9
5.8
3.4
0
5
10
15
20
25
2008 2009 2010 2011 2012 2013 2014 2015
Pe
rce
nt Harford
Maryland
Source: phpa.health.maryland.gov
MD BRFSS, 2011-15
Harford County uninsured rates much better than the State average.
0500
10001500200025003000350040004500
Q1 Q2 Q3 Q4 TotalFY 2014 431 506 864 780 2,581
FY 2015 681 609 408 728 2,426
FY 2016 1,185 882 940 1,387 4,394
FY 2017 771 703 872 624 2,970
# A
CC
U C
on
tact
s
FY 2014
FY 2015
FY 2016
FY 2017
15% Increase From FY14-17
43
Source: HCHD County Stat Data
010,00020,00030,00040,00050,00060,00070,00080,00090,000
100,000
Q1 Q2 Q3 Q4 TotalFY 2014 11,404 11,843 13,822 16,597 53,666
FY 2015 18,323 19,705 18,889 16,813 73,730
FY 2016 18,437 16,735 31,664 31,272 98,108
FY 2017 26,448 18,666 20,666 20,628 86,408
# Tr
ansp
ort
s p
rovi
de
d
FY 2014
FY 2015
FY 2016
FY 2017
61% Increase From FY14-17
44
Source: HCHD County Stat Data
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Q1 Q2 Q3 Q4 TotalFY 2014 1,500 972 1,409 1,104 4,985
FY 2015 1,368 1,441 1,862 1,378 6,049
FY 2016 1,518 1,268 1,410 1,080 5,276
FY 2017 1,438 1,156 1,519 1,243 5,356
# C
ase
Man
age
me
nt
Enco
un
ters
FY 2014
FY 2015
FY 2016
FY 2017
7% Increase From FY14-17
45
Source: HCHD County Stat Data
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Q1 Q2 Q3 Q4 TotalFY 2014 18,191 17,414 16,868 16,903 69,376
FY 2015 17,617 17,272 16,622 16,791 68,302
FY 2016 17,004 16,150 15,710 15,803 64,667
FY 2017 16,080 15,916 16,036 15,025 63,057
# W
IC V
isit
s
FY 2014
FY 2015
FY 2016
FY 2017
46
Source: HCHD County Stat Data
Impact of potential changes to the Affordable Care Act
- Unsubsidized
health care
premiums under
the ACA are
expected to rise
nationally by about
25% in 2017.
- Uninsured rates
may rise.
- Need for safety
net services may
increase.
Source: ACASignups.net, USA Today, Oct 2017
Snapshot of FY 2017 HCHD Services
0
50
100
150
200
250
300
350
Q1 Q2 Q3 Q4 TotalFY 2015 88 44 40 101 273
FY 2016 80 60 26 132 298
FY 2017 109 62 34 122 327
# P
oo
l In
spe
ctio
ns
FY 2015
FY 2016
FY 2017
Level From FY14-17
49
Source: HCHD County Stat Data
0
200
400
600
800
Q1 Q2 Q3 Q4 TotalFY 2015 194 147 101 164 606
FY 2016 176 168 117 204 665
FY 2017 215 159 139 200 713
# O
utr
eac
h
FY 2015
FY 2016
FY 2017
11% Increase From FY14-17
50
Source: HCHD County Stat Data
0
500
1000
1500
2000
Q1 Q2 Q3 Q4 TotalFY 2015 468 406 397 517 1,788
FY 2016 365 396 379 467 1,607
FY 2017 312 311 290 311 1,224
# Fo
od
Insp
ect
ion
s
FY 2015
FY 2016
FY 2017
40% Decrease From FY14-17
Source: HCHD County Stat Data
51
• Healthier Than the State Average
– Harford County’s health status is better than the State average.
• Lifestyle Improvements Needed
– Improvements need to be focused on substance use, tobacco use, and other
behavioral lifestyle improvements.
• Safety Net Providers and Care Coordination Needed
– Safety net providers and care coordination efforts need to be supported in
order to meet the needs of vulnerable and underserved populations.
• Environmental Health a Priority
– Environmental health professionals need to be supported in order to protect
the health and safety of Harford County residents.
52
Harford County Health Department (HCHD) In Summary
Harford County Health Department (HCHD) Mission and Vision
Mission To protect and promote the health, safety, and
environment of the residents of Harford County
through public health assessment, education,
collaboration and assurance of services.
Vision To make Harford County the healthiest
community in Maryland.