health disparities report - phdmc

of 91 PHDMC Epidemiology 11/16/17

Health Disparities Report Purpose Statement:

The purpose of this report is to identify disparities in health outcomes among Montgomery County

residents by looking primarily at differences in race, sex, and age.

Introduction:

The Centers for Disease Control and Prevention (CDC) defines health disparities as: “preventable

differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are

experienced by socially disadvantaged populations.” As a leader in the community for obtaining better

health outcomes, Public Health – Dayton & Montgomery County (PHDMC or Public Health), understands

the importance of identifying disparities among its citizens. By pinpointing these differences, Public

Health can allocate limited resources to select populations in the community that are disproportionately

affected by a disease. This is the first step toward achieving health equity and creating a community that

thrives.

Executive Summary:

In 2014, PHDMC published the second edition of the Montgomery County Community Health

Assessment (CHA), an update from the 2010 baseline study. The CHA provides the citizens of

Montgomery County with an in-depth analysis of the community’s health status and underscores health

outcomes of concern. The purpose of this Health Disparities Report is to update and augment the

chronic disease data found in the 2014 CHA in preparation for the third edition. This report assesses

existing population datasets that are related to chronic disease, unnecessary and early death, and

behavioral risk factors by examining differences in rates based on age, sex, race, income, education, and

disability. Data sources include the Ohio Department of Health (ODH) Vital Statistics, the Ohio Cancer

Incidence Surveillance System (OCISS), and the CDC’s Behavioral Risk Factor Surveillance System (BRFSS).

The following sections highlight key findings from the analysis and outlines take-home messages for

overall better health.


Key Findings:

Overall:

Disparities are inherent in all health outcomes; diseases are not experienced equally across any racial

or sex group. Improving the health of Montgomery County residents by eliminating disparities and

achieving health equity is a cross-cutting goal of all Public Health programs.

In general, Whites tend to have higher rates of newly-diagnosed cancer; however, Blacks tend to have

higher rates of cancer death. Differences in access to screening and treatment may play a role in this

racial disparity. Blacks (46.8%) tend to have a higher percentage of cases diagnosed with late-stage

disease compared to Whites (42.8%).

Death:

The top 10 leading causes of death varied by sex and race. The rankings for women show they are more

affected by Alzheimer’s disease and stroke deaths versus accidental and chronic lower respiratory

disease (CLRD) deaths for men. Among Whites, CLRD and Alzheimer’s disease deaths are of higher

concern compared to stroke and diabetes deaths for Blacks.

Of particular concern among the Black population is death due to homicide, Blacks (27.0 per 100,000)

experience a homicide death rate that is 8.4 times higher than the rate for Whites (3.2 per 100,000).

Cancer Staging and Incidence:

In Montgomery County, 42.8% of all cancers received a late-stage diagnosis type.

For those with Medicaid and those without insurance, the percentage of late-stage diagnosis increased

to 56.1% and 53.9%, respectively. The Medicaid insurance group had the highest percentage of cases

with a late-stage diagnosis.

Behavioral Health Risk Factors:

A negative correlation between fair or poor health status and income level was identified; as income

level increased, the prevalence of fair or poor health decreased.

A higher percentage of females (29.2%) compared to males (19.0%) reported being limited in activities

due to physical, mental, or emotional problems.

Adults with the lowest level of educational attainment (less than a high school diploma) reported the

worst health outcomes compared to other educational groups.


Table of Contents

Deaths

All Causes of Death ....................................................................................................................... 6

Leading Causes of Death by Race and by Sex ............................................................................... 8

Age-adjusted Death Rate for Top 7 Leading Causes of Death by Race ........................................ 9

Heart Disease Deaths .................................................................................................................... 11

Cancer Deaths ............................................................................................................................... 13

Tables of Cancer Death and Incidence Rates................................................................................ 15

Accidental Deaths ......................................................................................................................... 17

Unintentional Drug Overdose Deaths ................................................................................... 18

Homicide Deaths ........................................................................................................................... 21

Suicides ......................................................................................................................................... 23

Chronic Lower Respiratory Disease Deaths .................................................................................. 25

Stroke Deaths................................................................................................................................ 26

Alzheimer’s Disease Deaths .......................................................................................................... 28

Diabetes Deaths ............................................................................................................................ 30

Summary of Death Statistics

Tobacco Contribution to Chronic Disease Deaths ........................................................................ 32

Average Age at Death ................................................................................................................... 33

Highest Age-adjusted Death Rates ............................................................................................... 33

Cancer Staging and Incidence

Staging .......................................................................................................................................... 34

Cancer Incidence (Age-specific) by Age, Race and Sex ................................................................. 37

Cancer Incidence (Age-adjusted) by Age, Race and Sex ............................................................... 40

Summary of Cancer Incidence Statistics

Most Common Cancers by Race and by Sex ................................................................................. 55

Behavioral Health Risk Factors

Behavioral Health Risks by Age ..................................................................................................... 58

Behavioral Health Risks by Sex ..................................................................................................... 65

Behavioral Health Risks by Race ................................................................................................... 73

Behavioral Health Risks by Income Level ..................................................................................... 81

Behavioral Health Risks by Educational Attainment .................................................................... 84

Summary of Behavioral Health Risks

By Age, Sex, Race, Income Level, Educational Attainment ........................................................... 86

Appendix I

Definitions ..................................................................................................................................... 87

Appendix II

Education Categories .................................................................................................................... 89

Appendix III

References .................................................................................................................................... 90


Deaths

The Vital Statistics section of the Ohio Department of Health (ODH) receives death certificates for all

deaths that occur in the state of Ohio, along with Ohio resident deaths that occurred outside of Ohio.

The death certificates are compiled into an annual statistical data file made available to local health

departments. The following death data were derived from a combined 2014-2015 statistical data file

and are specific to Montgomery County residents. See Appendix I for definitions of chronic disease, rate,

ratio, death rate, and age-adjusted rate.

Data Source: Ohio Department of Health Vital Statistics, death files, 2014-2015 Disparities Analyzed: Age, Sex, Race, and Education

All Causes of Death

Age-adjusted Death Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female

Total White Black Total White Male

Black Male

Total White

Female Black

Female

872.2 850.4 983.5 1,028.8 1,000.3 1,170.9 745.9 726.6 844.7 *Per 100,000 population

844.7

726.6

745.9

1,170.9

1,000.3

1,028.8

983.5

850.4

872.2

0 200 400 600 800 1000 1200 1400

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty

Age-adjusted death rate per 100,000

Age-adjusted Death Rate by Race and Sex, Montgomery County, 2014-2015


Average Age (years) at Death by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

72.6 74.0 67.2 69.1 70.6 63.6 75.9 77.3 70.5

Summary:

• The age-adjusted death rate is 1.4 times higher for men (1,028.8) than for women (745.9).

• Blacks (983.5) have a higher death rate than Whites (850.4).

• By race and sex, Black men (1,170.9) have the highest age-adjusted death rate.

• The average age at death is 6.8 years older for Whites (74.0 years) compared to Blacks (67.2

years) and women (75.9 years) compared to men (69.1 years).


Leading Causes of Death: Ranking based on number of deaths per cause of death category (ordered high to low).

Percentages represent the total number of deaths in each group due to the cause indicated. Red text denotes a chronic disease.

Top 10 Leading Causes of Death by Sex, Montgomery County, 2014-2015

Rank Male Female

1 Heart Disease (23.8%) Heart Disease (20.9%)

2 Cancer (21.2%) Cancer (19.9%)

3 Accidents (9.5%) Alzheimer’s (6.7%)

4 CLRD* (5.4%) Stroke (6.4%)

5 Stroke (4.2%) CLRD* (6.1%)

6 Alzheimer's (3.5%) Accidents (5.9%)

7 Diabetes (3.3%) Diabetes (2.8%)

8 Suicide (2.2%) Septicemia (2.5%)

9 Septicemia (1.9%) Influenza/Pneumonia (1.6%)

10 Nephritis (1.5%) Nephritis (1.4%)

% LC† 76.5% 74.2%

*Chronic Lower Respiratory Disease †Percentage of all deaths due to the top ten leading causes.

Summary:

• Accidental deaths affect men and women disproportionately; men account for 61% of accidental

deaths (third leading cause of death among men and the sixth among women).

• Men and women are also disproportionately affected by Alzheimer’s disease; 67% of

Alzheimer’s deaths are women.

Top 10 Leading Causes of Death by Race, Montgomery County, 2014-2015

Rank All White Black

1 Heart Disease (22.3%) Heart Disease (21.9%) Heart Disease (24.0%)

2 Cancer (20.5%) Cancer (20.7%) Cancer (19.9%)

3 Accidents (7.6%) Accidents (8.0%) Accidents (5.8%)

4 CLRD* (5.7%) CLRD* (6.1%) Stroke (5.6%)

5 Stroke (5.3%) Alzheimer’s Disease (5.5%) Diabetes (4.9%)

6 Alzheimer’s Disease (5.2%) Stroke (5.3%) CLRD* (4.5%)

7 Diabetes (3.0%) Diabetes (2.5%) Alzheimer’s Disease (4.2%)

8 Septicemia (2.2%) Septicemia (2.1%) Homicide (2.7%)

9 Nephritis (1.5%) Influenza/Pneumonia (1.4%) Septicemia (2.2%)

10 Influenza/Pneumonia (1.4%) Suicide (1.4%) Nephritis (2.0%)

% LC† 74.7% 74.9% 75.8% *Chronic Lower Respiratory Disease

†Percentage of all deaths due to the top ten leading causes.

Summary:

• Heart disease, cancer and accidents are the top three causes of death regardless of race (50.4%

of all deaths, 50.6% of White deaths and 49.7% of Black deaths).

• Seven of the top 10 causes of death in Montgomery County are due to a chronic disease.


Top 10 Leading Causes of Death for Males by Race, Montgomery County, 2014-2015

Rank Male White Male Black Male



3 Accidents (9.5%) Accidents (9.8%) Accidents (7.6%)

4 CLRD* (5.4%) CLRD* (5.7%) Diabetes (5.1%)

5 Stroke (4.2%) Stroke (4.2%) Homicide (4.7%)

6 Alzheimer's Disease (3.5%) Alzheimer’s Disease (3.8%) CLRD* (4.4%)

7 Diabetes (3.3%) Diabetes (2.8%) Stroke (4.4%)

8 Suicide (2.2%) Suicide (2.3%) Alzheimer’s Disease (2.4%)

9 Septicemia (1.9%) Septicemia (1.8%) Nephritis (2.1%)

10 Nephritis (1.5%) Chronic Liver Disease (1.5%) Septicemia (2.0%)

% LC† 76.5% 77.4% 76.6% *Chronic Lower Respiratory Disease

†Percentage of all deaths due to the top ten leading causes.

Summary:

• Homicide is the fifth leading cause of death among Black men but does not make the list of top

ten causes of death for White men, while suicide is a leading cause of death among White men

(8th) but not Black men.

Top 10 Leading Causes of Death for Females by Race, Montgomery County, 2014-2015

Rank Female White Female Black Female



3 Alzheimer’s Disease (6.7%) Alzheimer’s Disease (7.0%) Stroke (6.7%)

4 Stroke (6.4%) CLRD* (6.4%) Alzheimer’s Disease (5.8%)

5 CLRD* (6.1%) Accidents (6.3%) Diabetes (4.7%)

6 Accidents (5.9%) Stroke (6.3%) CLRD* (4.6%)

7 Diabetes (2.8%) Septicemia (2.5%) Accidents (4.1%)

8 Septicemia (2.5%) Diabetes (2.3%) Septicemia (2.4%)

9 Influenza/Pneumonia (1.6%) Influenza/Pneumonia (1.6%) Hypertensive Renal Disease (2.1%)

10 Nephritis (1.4%) Nephritis (1.3%) Nephritis (1.9%)

% LC† 74.2% 73.7% 76.3% *Chronic Lower Respiratory Disease †Percentage of all deaths due to the top ten leading causes.

Summary:

• More women died due to Alzheimer’s disease than accidents.

• Deaths due to stroke and diabetes rank higher among the leading causes for Black women (3rd

and 5th, respectively) than for White women (6th and 8th, respectively).


*Chronic Lower Respiratory Disease

Summary:

• The age-adjusted death rates for heart disease (235.8), cancer (192.4), stroke (55.5), Alzheimer’s disease (42.4) and diabetes (49.1) are

highest among Blacks.

• Whites have the highest age-adjusted death rates for accidents (90.4) and CLRD (49.5).

188.1178.7

235.8

176.4 174.2

192.4

82.790.4

58.1

48.249.5

44.743.8 41.1

55.5

40.1 40.042.4

26.2 21.2

49.1

0

50

100

150

200

250

MontgomeryCounty

White Black

Age

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10

0,0

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Age-adjusted Death Rate for Top 7 Leading Causes of Death by Race, Montgomery County, 2014-2015

Heart Disease

Cancer

Accidents

CLRD*

Stroke

Alzheimer's Disease

Diabetes


Heart Disease Deaths

Age-adjusted Heart Disease Death Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

188.1 178.7 235.8 239.8 230.8 285.2 149.2 138.9 199.0 *Per 100,000 population

Ratio of HD* Death Rates, 2014-2015

Black vs. White 1.32 or 32%

Black Male vs. White Male 1.24 or 24%

Black Female vs. White Female 1.43 or 43%

Male vs. Female 1.61 or 61% *Heart disease

Summary:

• The age-adjusted heart disease death rate is 24% higher for Black men (285.2) than for White

men (230.8) and 43% higher for Black women (199.0) compared to White women (138.9).

• By race and sex, Black men have the highest heart disease death rate.

199.0

138.9

149.2

285.2

230.8

239.8

235.8

178.7

188.1

0 50 100 150 200 250 300

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Heart Disease Death Rate by Race and Sex, Montgomery County 2014-2015


Average Age (years) at Heart Disease Death Montgomery County, 2014-2015

Race & Sex

All Male Female

75.6

72.8

78.6

White Male Female

76.9

74.0

80.1

Black Male Female

70.7

67.8

73.3

Summary:

• The average age of death for an individual with heart disease is 75.6 years.

• Women (78.6 years) have an average age of heart disease death that is 5.8 years older than the

average age for men (72.8 years).

• On average, Blacks (70.7 years) die from heart disease 6.2 years sooner than Whites (76.9

years).

Percentage of Tobacco Use Contributing to Heart Disease Deaths Montgomery County, 2014-2015

Race & Sex

All Male Female

13.0%

16.2%

9.5%

White Male Female

14.2%

17.5%

10.4%

Black Male Female

8.9%

11.4%

6.6%

Age Group

35-44 years 14.3%

45-54 years 15.9%

55-64 years 21.6%

65-74 years 17.1%

75-84 years 14.6%

85+ years 5.7%

Summary:

• Tobacco use contributed to 13% of all heart disease deaths in Montgomery County.

• Tobacco contribution to heart disease death was highest among those aged 55-64 years (21.6%).


Cancer Deaths

Age-adjusted Cancer Death Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

176.4 174.2 192.4 208.4 205.6 230.4 153.6 150.7 170.2

*Per 100,000 population

Ratio of Cancer Death Rates, 2014-2015




Male vs. Female 1.36 or 36%

Summary:

• The Black (192.4) age-adjusted cancer death rate is 10% higher than the White (174.2) rate.

• The rate of cancer death among men (208.4) is 36% higher than it is for women (153.6).

• Black men (230.4) have the highest rate of cancer death by race and sex.

170.2

150.7

153.6

230.4

205.6

208.4

192.4

174.2

176.4

0 50 100 150 200 250

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Cancer Death Rate by Race and Sex, Montgomery County2014-2015


Age-adjusted Prostate Cancer Death Rate* by Race, Montgomery County, 2014-2015

All White Black Ratio†

18.7 13.9 41.9 3.01 or 201% *Per 100,000 population †Black to White ratio of age-adjusted prostate cancer death rates.

Summary:

• The rate of prostate cancer death is 3 times higher for Black men (41.9) than it is for White men

(13.9).

Age-adjusted Female Breast Cancer Death Rate* by Race, Montgomery County, 2014-2015

All White Black Ratio†

23.1 21.7 29.9 1.38 or 38% *Per 100,000 population †Black to White ratio of age-adjusted female breast cancer death rates.

Summary:

• Black women (29.9) have a 38% higher age-adjusted breast cancer death rate than White

women (21.7).

18.713.9

41.9

0

10

20

30

40

50

All White Black

Age

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Age-adjusted Prostate Cancer Death Rate by Race Montgomery County, 2014-2015

23.1 21.7

29.9

0

5

10

15

20

25

30

35

All White Black

Age

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10

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Age-adjusted Female Breast Cancer Death Rate by Race, Montgomery County, 2014-2015


Cancer Deaths, Montgomery County 2014-2015

Type of Cancer # of

cases Rate*

All Sites/Types 2,468 176.4

Lung and Bronchus 698 50.0

Female Breast 180 23.1

Prostate 106 18.7

Colorectal 190 13.4

Pancreas 156 10.9

Ovary 75 9.9

Liver and IBD† 121 8.6

Leukemia 113 8.0

Non-Hodgkin’s Lymphoma 87 6.3

Esophagus 62 4.4

Uterus 34 4.3

Brain and Other CNS‡ 53 4.3

Bladder 60 4.2

Kidney and Renal Pelvis 51 3.5

Stomach 44 3.1

Multiple Myeloma 40 2.8

Melanoma of the Skin 35 2.5

Cervix 18 2.4

Oral Cavity and Pharynx 24 1.8

Larynx 21 1.5

Thyroid 7 0.5

Hodgkin's Lymphoma 4 §

Testis 1 §

All Other Sites/Types 285 NA *Age-adjusted death rate per 100,000 population †Intrahepatic Bile Duct ‡Central Nervous System §Rates are not reported when case counts are < 5.

NA—not applicable

Cancer Incidence, Montgomery County 2011-2013

Type of Cancer # of

cases Rate*

All Sites/Types 8,923 451.0

Female Breast 1,369 128.8

Prostate 994 106.2

Lung and Bronchus 1,530 76.1

Colorectal 768 38.0

Uterus 266 24.2

Bladder 432 21.2

Melanoma of the Skin 353 18.5

Non-Hodgkin’s Lymphoma 345 17.4

Kidney and Renal Pelvis 331 16.9

Thyroid 236 14.2

Ovary 139 12.8

Oral Cavity and Pharynx 221 11.1

Pancreas 219 10.8

Leukemia 200 10.5

Cervix 65 7.8

Liver and IBD† 145 7.0

Stomach 135 6.8

Brain and Other CNS‡ 113 6.3

Multiple Myeloma 118 5.8

Testis 40 5.4

Esophagus 92 4.4

Larynx 87 4.2

Hodgkin’s Lymphoma 35 2.0

All Other Sites/Types 677 NA

*Age-adjusted incidence rate per 100,000 population †Intrahepatic Bile Duct ‡Central Nervous System

NA—not applicable

Mortality rates are highest for lung and

bronchus, female breast, prostate, and

colorectal cancers.

Incidence (new cases) rates are highest for

female breast, prostate, lung and bronchus,

and colorectal cancers.


Average Age (years) at Cancer Death Montgomery County, 2014-2015

Race & Sex

All Male Female

71.6

71.0

72.3

White Male Female

72.3

71.3

73.3

Black Male Female

68.8

69.1

68.6

Summary:

• The average age of cancer deaths is 71.6 years. Blacks (68.8 years) tend to die of cancer, on

average, 3.5 years earlier than Whites (72.3 years).

Percentage of Tobacco Use Contributing to Cancer Deaths Montgomery County, 2014-2015

Race & Sex

All Male Female

23.4%

29.0%

17.7%

White Male Female

23.8%

29.6%

17.8%

Black Male Female

22.3%

27.5%

17.6%

Age Group

35-44 years 20.0%

45-54 years 24.6%

55-64 years 27.8%

65-74 years 29.6%

75-84 years 20.6%

85+ years 14.2%

Summary:

• The use of tobacco contributed to nearly a quarter (23.4%) of all cancer deaths and 62% of lung

cancer deaths (data not shown).

• Tobacco use contributed to 29% of male cancer deaths but only 18% of female cancer deaths, a

difference of 64% between men and women.


Accidental Deaths

Age-adjusted Accidental Death Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

82.7 90.4 58.1 110.1 117.8 85.2 58.0 64.3 38.3 *Per 100,000 population

Ratio of Accidental Death Rates, 2014-2015

Black vs. White 0.64 or -36%

Black Male vs. White Male 0.72 or -28%

Black Female vs. White Female 0.60 or -40%


Summary:

• The accidental death rate is 36% lower for Blacks (58.1) than for Whites (90.4).

• The highest rate of accidental deaths is that of White men (117.8).

• Over half (53.6%) of accidental deaths are due to unintentional drug overdoses, while only 12%

are caused by motor vehicle accidents (data not shown).

38.3

64.3

58.0

85.2

117.8

110.1

58.1

90.4

82.7

0 20 40 60 80 100 120 140

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Accidental Death Rate by Race and Sex, Montgomery County 2014-2015


Average Age (years) of Accidental Death Montgomery County, 2014-2015

Race & Sex

All Male Female

53.2

49.7

58.5

White Male Female

54.2

50.0

60.5

Black Male Female

47.6

48.1

46.8

Education* < High School Graduate 47.6

High School/Some College 53.3

College Graduate 62.4

*See appendix I

Summary:

• The average age of accidental deaths is 53.2 years.

• Black women (46.8 years) have the lowest average age of accidental death.

• As level of education increases, the average age of accidental death increases. For those with

less than a high school education, the average age of accidental deaths is 47.6 years, while the

average is 53.3 years for high school graduates and 62.4 years for college graduates.

• Death due to accidents is the leading cause of death for teens (ages 13 to 19 years; data not

shown).

Accidental Deaths—Unintentional Drug Overdose Deaths:

Average Age (years) of Unintentional Drug Overdose Death Montgomery County, 2014-2015

Race & Sex

All Male Female

41.2

40.5

42.5

White Male Female

40.5

39.9

41.7

Black Male Female

45.7

44.5

48.3

Summary:

• The average age of unintentional drug overdose deaths is 41.2 years.

• By race and sex, White men (39.9 years) have the youngest average age of unintentional drug

overdose deaths.


Age-adjusted Unintentional Drug Overdose Death Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

50.1 58.5 26.4 68.5 78.2 38.9 32.7 39.0 15.9 *Per 100,000 population

Ratio of Unintentional Drug Overdose Death Rates, 2014-2015





Summary:

• The age-adjusted unintentional drug overdose death rate is 2.1 times higher for men (68.5) than

women (32.7) and 2.2 times higher for Whites (58.5) compared to Blacks (26.4).

• White men (78.2) have the highest rate of unintentional drug overdose deaths.

• Over 90% of unintentional drug overdose death victims do not have a college degree (data not

shown).

15.9

39.0

32.7

38.9

78.2

68.5

26.4

58.5

50.1

0 10 20 30 40 50 60 70 80 90

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Unintentional Drug Overdose Death Rate by Race and Sex Montgomery County, 2014-2015


Number and Percent* of Unintentional Drug Overdose Deaths by Race and Sex, Montgomery County, 2014-2015

Race and Sex # of OD Deaths % of OD Deaths*

All White Black Other

491 100%

424 86.4%

61 12.4%

6 1.2%

Male White Black Other

327 66.6%

282 57.4%

41 8.4%

4 0.8%

Female White Black Other

164 33.4%

142 28.9%

20 4.1%

2 0.4% *Percentage of the total number of OD deaths for each race and/or sex group.

OD—overdose

Summary:

• In 2014-2015, 491 Montgomery County residents died of an unintentional drug overdose.

• Whites accounted for 86% of all unintentional drug overdose deaths in Montgomery County.

• Nearly 60% of all unintentional drug overdose death victims were White men.

67%

33% Male

Female

% of Drug Overdose Deaths by Sex

86%13%

1%White

Black

Other

% of Drug Overdose Deaths by Race


Homicide Deaths

Age-adjusted Homicide Death Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

8.7 3.2 27.0 14.2 4.3 49.9 3.3 2.1 7.2 *Per 100,000 population

Ratio of Homicide Death Rates, 2014-2015


Black Male vs. White Male 11.60 or 1,060%



Summary:

• The homicide death rate for Blacks (27.0) is 8.4 times higher than the rate for Whites.

• The ratio of homicide death rates for Black men (49.9) versus White men (4.3) is 11.6, which

means the homicide rate for Black men is 1,060% higher than it is for White men.

7.2

2.1

3.3

49.9

4.3

14.2

27.0

3.2

8.7

0 10 20 30 40 50 60

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Homicide Death Rate by Race and Sex, Montgomery County2014-2015


Average Age (years) of Homicide Deaths Montgomery County, 2014-2015

Race & Sex

All Male Female

33.2

31.9

38.8

White Male Female

41.3

38.1

47.5

Black Male Female

30.2

30.0

31.1

Range Youngest 0

Oldest 72

Highest frequency 20-29 (33.7%)

Summary:

• Over a third of all homicides occur in the age range 20 to 29 years.

• On average, Black (30.2 years) homicide victims are 11.1 years younger than White (41.3 years)

homicide victims.


Suicides

Age-adjusted Suicide Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

15.0 16.8 8.2 24.5 26.7 16.7 6.1 7.4 †

*Per 100,000 population †Rates are not reported when case counts are < 5.

NA—not applicable

Summary:

• The age-adjusted rate of suicide is 51% lower for Blacks (8.2) compared to Whites (16.8).

• White men have the highest suicide rate at 26.7 per 100,000 with an average age at

death of 45.3 years.

• After accidental deaths, suicide is the second leading cause of death for teens (ages 13

to 19 years; data not shown).

7.4

6.1

16.7

26.7

24.5

8.2

16.8

15.0

0 5 10 15 20 25 30

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Suicide Rate by Race and Sex, Montgomery County2014-2015

NA

Ratio of Suicide Rates, 2014-2015



Black Female vs. White Female NA

Male vs. Female 4.02 or 302% NA—not applicable


Chronic Lower Respiratory Disease (CLRD) Deaths CLRD includes chronic bronchitis, emphysema, asthma, and other chronic lower respiratory diseases.

Age-adjusted CLRD Death Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

48.2 49.5 44.7 54.2 54.6 56.8 44.2 46.0 37.9


Ratio of CLRD Death Rates, 2014-2015





Summary:

• Although the overall Black (44.7) age-adjusted CLRD death rate is 10% lower than the White

death rate (49.5), Black men (56.8) have a 4% higher CLRD death rate than White men (54.2).

• Black men (56.8) have the highest rate of CLRD death, and Black women have the lowest rate

(37.9).

37.9

46.0

44.2

56.8

54.6

54.2

44.7

49.5

48.2

0 10 20 30 40 50 60

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted CLRD Death Rate by Race and Sex, Montgomery County, 2014-2015


Average Age (years) at CLRD Death Montgomery County, 2014-2015

Race & Sex

All Male Female

76.3

75.3

77.2

White Male Female

76.5

75.5

77.3

Black Male Female

75.8

74.3

77.3

Summary:

• The average age for all CLRD deaths is 76.3 years.

Percentage of Tobacco Use Contributing to CLRD Death Montgomery County, 2014-2015

Race & Sex

All Male Female

49.9%

51.1%

48.8%

White Male Female

50.4%

51.1%

49.8%

Black Male Female

46.7%

52.0%

41.8%

Age Group

35-44 years 28.6%

45-54 years 75.0%

55-64 years 64.6%

65-74 years 57.4%

75-84 years 53.4%

85+ years 32.8%

Summary:

• Tobacco use contributed to half (49.9%) of all CLRD deaths.


Stroke Deaths

Age-adjusted Stroke Death Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

43.8 41.1 55.5 43.1 40.5 51.9 43.8 41.3 56.0


Ratio of Stroke Death Rates, 2014-2015




Male vs. Female 0.98 or -2%

Summary:

• The age-adjusted stroke death rate is 35% higher for Blacks (55.5) compared to Whites (41.1).

• There is no distinct difference in stroke death rates between men (43.1) and women (43.8).

• Black women (56.0) have the highest age-adjusted stroke death rate by race and sex.

• The rate for Black women is 36% higher than the rate for White women (41.3).

56.0

41.3

43.8

51.9

40.5

43.1

55.5

41.1

43.8

0 10 20 30 40 50 60

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Stroke Death Rate by Race and Sex, Montgomery County2014-2015


Average Age (years) at Stroke Death Montgomery County, 2014-2015

Race & Sex

All Male Female

79.7

76.7

81.6

White Male Female

81.4

78.9

82.9

Black Male Female

73.5

68.4

76.7

Summary:

• The average age of stroke deaths is 79.7 years. Black men (68.4 years) have the youngest

average age of stroke death.

Percentage of Tobacco Use Contributing to Stroke Deaths Montgomery County, 2014-2015

Race & Sex

All Male Female

5.8%

9.7%

3.3%

White Male Female

6.0%

10.8%

2.9%

Black Male Female

5.3%

6.0%

4.9%

Age Group

35-44 years 0.0%

45-54 years 18.2%

55-64 years 18.6%

65-74 years 10.8%

75-84 years 4.9%

85+ years 1.4%

Summary:

• The highest percentage of tobacco contribution to stroke deaths is observed in White men

(10.8%).


Alzheimer’s Disease Deaths

Age-adjusted Alzheimer’s Disease Death Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

40.1 40.0 42.4 37.2 37.7 35.3 41.6 41.3 45.9


Ratio of Alzheimer’s Disease Death Rates, 2014-2015

Black vs. White 1.06 or 6% Black Male vs. White Male 0.94 or -6%



Summary:

• The Black (42.4) age-adjusted Alzheimer’s disease death rate is slightly higher (6% higher) than

the White rate (40.0).

• Women have a 12% higher rate of Alzheimer’s disease death than men.

• Black women (45.9) have the highest age-adjusted Alzheimer’s disease death rate by race and

sex.

45.9

41.3

41.6

35.3

37.7

37.2

42.4

40.0

40.1

0 5 10 15 20 25 30 35 40 45 50

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Alzheimer's Disease Death Rate by Race and Sex, Montgomery County 2014-2015


Average Age (years) at Alzheimer’s Disease Death Montgomery County, 2014-2015

Race & Sex

All Male Female

87.0

85.4

87.8

White Male Female

87.0

85.4

87.8

Black Male Female

87.0

85.3

87.6

Summary:

• Two-thirds (67%) of Alzheimer’s disease deaths are women—of the women who die from

Alzheimer’s disease, 83% of them are White.

• The average age of Alzheimer’s disease deaths is 87.0 years.

33.4%

66.6%

Male

Female

% of Alzheimer's Disease Deaths by Sex


Diabetes Deaths

Age-adjusted Diabetes Death Rate* by Race and Sex, Montgomery County, 2014-2015

All Male Female


Black Male

Total White

Female Black

Female

26.2 21.2 49.1 32.6 26.9 59.2 21.2 16.9 40.7 *Per 100,000 population

Ratio of Diabetes Death Rates, 2014-2015





Summary:

• The age-adjusted rate of diabetes death is 2.3 times higher for Blacks (49.1) than for Whites

(21.2).

• Black women (40.7) have a 2.4 times higher rate compared to White women (16.9).

• The diabetes death rate for Black men (59.2) is more than double the rate for all of Montgomery

County (26.2).

40.7

16.9

21.2

59.2

26.9

32.6

49.1

21.2

26.2

0 10 20 30 40 50 60 70

BlackFemale

White Female

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Diabetes Death Rate by Race and Sex, Montgomery County, 2014-2015


Average Age (years) at Diabetes Death Montgomery County, 2014-2015

Race & Sex

All Male Female

71.2

69.4

73.4

White Male Female

72.3

71.2

73.6

Black Male Female

68.8

65.0

72.6

Summary:

• The average age of diabetes deaths is 71.2 years.

• On average, Black men (65 years) die from diabetes 7.6 years earlier than Black women (72.6

years).

Percentage of Tobacco Use Contributing to Diabetes Deaths Montgomery County, 2014-2015

Race & Sex

All Male Female

15.2%

17.0%

13.0%

White Male Female

17.7%

21.8%

12.7%

Black Male Female

9.6%

5.2%

14.0%

Age Group

35-44 years 0.0%

45-54 years 16.0%

55-64 years 28.8%

65-74 years 18.3%

75-84 years 8.8%

85+ years 5.0%

Summary:

• Tobacco use contributed to nearly 22% of diabetes deaths in White men and about 5% of

diabetes deaths in Black men.


Summary of Death Statistics

13.1 13.0

23.4

61.9

49.9

5.8

15.213.6 14.2

23.8

62.0

50.4

6.0

17.7

11.38.9

22.3

62.6

46.7

5.39.6

0

10

20

30

40

50

60

70

80

All Deaths Heart Disease Cancer Lung Cancer CLRD Stroke Diabetes

Pe

rce

nt

Tobacco Contribution to Chronic Disease Death by Race, Montgomery County, 2014-2015

Total White Black


Race and Sex Groups with the Highest Age-adjusted Death Rates, Montgomery County, 2014-2015

Cause of Death White Men White Women Black Men Black Women

All Causes

Heart Disease

Cancer

Female Breast Cancer

Prostate Cancer

Accidents

Unintentional Drug OD

Homicide

Suicide

CLRD

Stroke

Alzheimer’s Disease

Diabetes OD—overdose

Indicates Highest Rate

Not Applicable

72.6 75.671.6

53.2

76.3 79.787.0

71.2

0

10

20

30

40

50

60

70

80

90

100

All Deaths HeartDisease

Cancer Accidents CLRD Stroke Alzheimer'sDisease

Diabetes

Ye

ars

Average Age at Death, Montgomery County, 2014-2015


Cancer Staging and Incidence

Information on all newly-diagnosed cases of cancer (cancer incidence) in Ohio is collected and analyzed

by the Ohio Cancer Incidence Surveillance System (OCISS). Required by Ohio law, Ohio healthcare

providers, report to OCISS all cancers diagnosed and/or treated within the state (within six months of

initial diagnosis and/or first contact with the facility). Cancer incidence data are made available to local

health departments to help determine the burden of cancer in the community and to inform treatment

and prevention efforts specific to the needs of the community. The following section highlights cancer

incidence in Montgomery County residents from 2011-2013 (the standard lag time between cancer

diagnosis and the first data report of cancer incidence to the public is about 2 years).

Data Source: Ohio Department of Health, Ohio Cancer Incidence Surveillance System, 2011-2013

Disparities Analyzed: Age, Sex, Race, and Insurance Type

Cancer Staging

When a person is diagnosed with cancer, the cancer is staged to determine its severity. The stage of

cancer is based on the extent to which cancer has spread throughout the body. Staging at diagnosis is a

crucial component in determining the prognosis of disease, the course of treatment, and the likelihood

of survival. Early detection of cancer is optimal for long-term survival; late-stage cancer diagnosis

indicates a lower probability of survival. Cancer is diagnosed as one of five stages: in situ, localized,

regional, distant, or unstaged/unknown (see definitions in Appendix I). For this report, the stages of

cancer were combined into three categories: early-stage (including in situ and localized cancer), late-

stage (including regional and distant cancer), and unstaged/unknown.

Cancer Incidence

Cancer incidence is new or newly-diagnosed cases of cancer. In situ cancers are confined to the site of

origin and are considered noninvasive. With the exception of bladder cancer, in situ cancers are not

included in the calculation of cancer incidence rates. See Appendix I for definitions of incidence rate,

age-specific rate, and age-adjusted rate.


Cancer Type by Stage at Diagnosis, Montgomery County, 2011-2013

Cancer Type Early-stage* Late-stage† Unstaged/Unknown

All Cancer 48.9% 42.8% 8.3%

Bladder 85.0% 11.8% 3.2%

Brain and Other CNS‡ 62.8% 17.7% 19.5%

Female Breast 70.3% 28.0% 1.6%

Cervix 44.6% 53.9% 1.5%

Colorectal 39.8% 48.2% 12.0%

Esophagus 17.2% 69.9% 12.9%

Hodgkin’s Lymphoma 22.9% 77.1% 0.0%

Kidney & Renal Pelvis 68.4% 27.2% 4.4%

Larynx 41.8% 56.0% 2.2%

Leukemia§ 0.5% 96.5% 3.0%

Liver and IBD** 41.4% 41.4% 17.2%

Lung & Bronchus 18.9% 74.4% 6.7%

Melanoma of the Skin 84.3% 8.9% 6.8%

Multiple Myeloma§ 4.3% 91.5% 4.2%

Non-Hodgkin’s Lymphoma 22.0% 69.3% 8.7%

Oral Cavity & Pharynx 29.7% 64.3% 6.0%

Ovary 15.0% 75.7% 9.3%

Pancreas 14.4% 73.4% 12.2%

Prostate 75.4% 19.3% 5.3%

Stomach 23.7% 54.8% 21.5%

Testis 75.0% 25.0% 0.0%

Thyroid 75.4% 23.7% 0.9%

Uterus 68.5% 27.3% 4.2%

Other Sites and Types 26.0% 39.4% 34.6%

*Early-stage is defined as cancer that is confined entirely to the organ of origin.

†Advanced/Late-stage is defined as cancer that has extended beyond the organ of origin.

‡Central Nervous System

§Staging for leukemia is based on white blood cell count; staging for multiple myeloma is based on serum blood levels.

**Intrahepatic Bile Duct

Summary:

• Leukemia (96.5%), multiple myeloma (91.5%), Hodgkin’s lymphoma (77.1%), ovarian (75.7%),

and lung and bronchus (74.4%) cancers have the highest percentages of cases receiving a late-

stage diagnosis.


Insurance Type by Stage at Diagnosis (All Cancer), Montgomery County 2011-2013

Insurance Type Early-stage* Late-stage† Unstaged/Unknown

No Insurance 41.4% 53.9% 4.7%

Medicaid 39.5% 56.1% 4.4%

Medicare 48.2% 46.2% 5.6%

Military/VA 58.1% 38.1% 3.8%

Private Insurance 55.9% 39.7% 4.5%



Summary:

• The Medicaid insurance group had the highest percentage of late-stage diagnosis (56.1%).

• Fifty-eight (58.1%) percent of cancer patients who had military health insurance were diagnosed

with early-stage disease, the highest percentage of early-stage diagnosis.

Race and Sex by Stage at Diagnosis (All Cancer), Montgomery County 2011-2013

Race Early-stage* Late-stage† Unstaged/Unknown

Total 48.9% 42.8% 8.3%

White 49.6% 42.8% 7.7%

Black 44.3% 46.8% 8.9%

Total Male 47.1% 43.4% 9.5%

White Male 47.2% 44.2% 8.6%

Black Male 45.6% 43.9% 10.5%

Total Female 50.5% 42.3% 7.2%

White Female 51.6% 41.5% 6.9%

Black Female 43.3% 49.2% 7.5%



Summary:

• Forty-seven (46.8%) percent of Black cancer patients were diagnosed with late-stage cancer,

compared to only 43% of White cancer patients.

• Almost half (49.2%) of the Black women diagnosed with cancer were diagnosed with late-stage

disease; this is higher than any other race and sex group.


Age-specific Cancer Incidence by Race and Sex Age-specific Cancer Incidence Rate (per 100,000) by Age, Race, and Sex, Montgomery County, 2011-2013

All Cancer

All White Black

Total Male Female Total Male Female Total Male Female

All Ages 556.3 555.7 556.6 586.9 582.7 590.5 439.8 444.8 435.5

< 18 years 18.5 20.0 16.9 20.4 22.6 18.1 15.6 15.4 15.7

18-64 years 382.9 377.3 388.2 383.1 372.1 393.8 366.9 378.6 356.9

65+ years 1,999.5 2,299.3 1,783.3 1,993.8 2,275.3 1,785.6 1,873.6 2,243.8 1,638.1

Bladder


All Ages 26.9 41.0 13.9 31.6 48.9 15.3 11.6 15.1 8.4

18-64 years 11.3 17.3 5.7 12.8 19.2 6.6 6.7 10.3 3.5

65+ years 126.1 219.8 58.8 136.7 243.9 58.0 65.6 93.8 47.7

Female Breast

All Female White Female Black Female

All Ages 164.4 171.8 139.9

18-64 years 131.3 128.4 141.9

65+ years 475.4 481.4 413.5

Colorectal


All Ages 47.9 49.1 46.7 48.8 50.2 47.4 39.2 41.8 37.0

18-64 years 30.4 34.4 26.6 27.6 31.3 24.0 32.3 37.1 28.2

65+ years 184.4 201.9 171.8 183.0 202.1 169.0 172.5 206.3 151.1

Kidney & Renal Pelvis


All Ages 20.6 24.0 17.5 20.3 23.5 17.2 22.0 25.5 19.0

18-64 years 15.0 19.4 10.8 13.2 15.9 10.5 19.5 29.9 10.6

65+ years 70.5 84.9 60.2 68.8 89.2 53.9 85.1 68.8 95.4


Age-specific Cancer Incidence* (per 100,000) by Age†, Race, and Sex, Montgomery County, 2011-2013

Leukemia

All White Black


All Ages 12.5 12.4 12.5 13.9 14.5 13.3 8.2 5.5 10.6

18-64 years 7.6 7.1 8.1 8.3 7.8 8.7 5.7 5.2 6.2

65+ years 42.9 50.9 37.2 43.5 54.2 35.6 38.9 25.0 47.7

Lung & Bronchus


All Ages 95.4 98.2 92.7 103.2 104.2 102.1 74.8 82.4 68.1

18-64 years 48.1 53.8 42.8 48.8 53.7 44.0 49.9 57.8 43.2

65+ years 415.6 470.8 375.3 421.5 466.4 387.8 388.8 500.0 318.1

Melanoma of the Skin


All Ages 22.0 26.3 18.0 26.3 31.7 21.2 0.6 - 1.1

18-64 years 18.8 20.8 17.0 22.3 24.6 20.0 - - -

65+ years 65.8 97.2 43.3 72.2 107.3 46.4 4.9 - 8.0

Non-Hodgkin’s Lymphoma


All Ages 21.5 24.6 18.6 24.2 28.3 20.4 12.1 10.9 13.2

18-64 years 14.0 16.0 12.0 14.3 16.5 12.1 11.4 10.3 12.3

65+ years 80.4 104.7 62.9 87.9 117.4 66.3 43.7 43.8 43.7

Oral Cavity & Pharynx


All Ages 13.8 21.1 7.0 16.0 24.0 8.4 6.2 10.9 2.1

18-64 years 13.5 21.7 5.7 14.9 23.5 6.6 7.6 14.4 1.8

65+ years 34.7 55.7 19.6 38.7 61.0 22.4 14.6 25.0 8.0

*In situ cancers are not included in incidence rates, except for in situ bladder cancer.

†Childhood cancer incidence is low; the development of specific cancer types common to adults is rare for children. In the U.S., leukemia (blood cell cancers) and cancer of the

brain and central nervous system account for more than half of childhood cancer incidence. In Montgomery County, 2011-2013, leukemia and cancers of the brain and central

nervous systems account for nearly half (49%) of all childhood cancer (age < 18).

(-) Indicates < 5 cases reported.


Age-specific Cancer Incidence (per 100,000) by Age, Race, and Sex, Montgomery County, 2011-2013

Ovarian


All Ages 16.7 18.3 10.6

18-64 years 13.2 14.5 7.9

65+ years 48.0 48.1 43.7

Pancreatic

All White Black


All Ages 13.7 12.8 14.4 14.1 13.5 14.6 13.3 12.1 14.3

18-64 years 6.5 7.9 5.1 6.3 8.4 4.2 7.6 7.2 7.9

65+ years 61.1 57.6 63.6 58.8 54.2 62.1 75.3 81.3 71.6

Prostate

All Male White Male Black Male

All Ages 128.9 120.4 144.8

18-64 years 91.1 80.2 130.0

65+ years 525.5 463.0 706.3

Thyroid


All Ages 14.7 7.0 21.9 15.5 7.3 23.2 9.6 3.0 15.3

18-64 years 18.4 7.5 28.8 19.5 7.8 30.8 10.9 2.1 18.5

65+ years 20.5 17.0 23.0 19.1 15.8 21.5 24.3 18.8 27.8

Uterine


All Ages 31.9 35.1 21.6

18-64 years 31.0 34.0 19.4

65+ years 73.7 73.7 75.5


Summary of Age-specific Cancer:

• Age-specific cancer incidence rates are highest for those ages 65 years and older, except for

rates of thyroid cancer. Females, Whites, and White females ages 18-64 years have higher rates

of thyroid cancer than their older counterparts (65+ years).

• In general, the rate of new cancer is higher for Whites compared to Blacks.

Age-adjusted Cancer Incidence Age-adjusted rates (per 100,000 population, see Appendix I) were calculated using the National Cancer

Institute’s proportions and age groupings of the 2000 U.S. standard population. Rates were not reported

if there were < 5 total cases.

Age-adjusted Cancer Incidence Rate* by Race and Sex, Montgomery County, 2011-2013

All Male Female


Black Male

Total White

Female Black

Female

451.0 446.6 439.0 484.2 475.5 485.6 429.3 428.8 406.7 *Per 100,000 population

Summary:

• Whites (446.6) have an overall higher age-adjusted cancer incidence rate than Blacks (439.0).

• The age-adjusted cancer incidence rate is highest for Black men (485.6) and lowest for Black

women (406.7). Black men have a 19% higher rate compared to Black women.

406.7

428.8

429.3

485.6

475.5

484.2

439.0

446.6

451.0

0 100 200 300 400 500 600

BlackFemale

WhiteFemale

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty

Age-adjusted incidence rate per 100,000

Age-adjusted Cancer Incidence Rate by Race and Sex, Montgomery County 2011-2013

Health Disparities Report 2017


Bladder Cancer

All Male Female


Black Male

Total White

Female Black

Female

21.2 23.0 11.8 36.8 40.3 18.3 9.7 10.0 7.2 *Per 100,000 population

Ratio of Bladder Cancer Incidence Rates, 2011-2013

White vs. Black 1.95 or 95%

White Male vs. Black Male 2.20 or 120%

White Female vs. Black Female 1.39 or 39%


Summary:

• The age-adjusted bladder cancer incidence rate is higher (by 95%) for Whites (23.0) compared to

Blacks (11.8). This is true for both sexes (120% higher for White men and 39% higher for White

women).

• White men (40.3) have the highest age-adjusted bladder cancer incidence rate.

7.2

10.0

9.7

18.3

40.3

36.8

11.8

23.0

21.2

0 5 10 15 20 25 30 35 40 45

BlackFemale

WhiteFemale

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Bladder Cancer Incidence Rate by Race and SexMontgomery County, 2011-2013

Age-adjusted Bladder Cancer Incidence Rate* by Race and Sex, Montgomery County, 2011-2013



Female Breast Cancer

All White Black 128.8 126.3 132.0


White to Black Ratio of Female Breast Cancer Incidence Rates, 2011-2013

0.96 or -4%

Summary:

• Black women (132.0) have a slightly higher age-adjusted breast cancer incidence rate compared

to White (126.3) women.

132.0

126.3

128.8

0 20 40 60 80 100 120 140

Black

White

All


Age-adjusted Female Breast Cancer Incidence Rate by Race Montgomery County, 2011-2013

Age-adjusted Female Breast Cancer Incidence Rate* by Race, Montgomery County, 2011-2013



Colorectal Cancer

All Male Female


Black Male

Total White

Female Black

Female

38.0 35.8 40.1 43.4 41.5 47.7 33.9 31.4 35.3 *Per 100,000 population

Ratio of Colorectal Cancer Incidence Rates, 2011-2013

White vs. Black 0.89 or -11%

White Male vs. Black Male 0.87 or -13%

White Female vs. Black Female 0.89 or -11%


Summary:

• The Black (40.1) age-adjusted colorectal cancer incidence rate is higher than the White rate

(35.8).

• Black men (47.7) have the highest rate of age-adjusted colorectal cancer incidence.

• Compared to women (33.9), men have a 28% higher rate of new colorectal cancer.

35.3

31.4

33.9

47.7

41.5

43.4

40.1

35.8

38.0

0 10 20 30 40 50 60

BlackFemale

WhiteFemale

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Colorectal Cancer Incidence Rate by Race and Sex Montgomery County, 2011-2013

Age-adjusted Colorectal Cancer Incidence Rate* by Race and Sex, Montgomery County, 2011-2013



Kidney and Renal Pelvis Cancer

All Male Female


Black Male

Total White

Female Black

Female

16.9 15.5 22.0 21.2 19.4 26.5 13.4 12.6 17.8 *Kidney and renal pelvis †Per 100,000 population

Ratio of Kidney Cancer Incidence Rates, 2011-2013

White vs. Black 0.70 or -30%

White Male vs. Black Male 0.73 or -27% White Female vs. Black Female 0.71 or -29%


Summary:

• The age-adjusted kidney and renal pelvis cancer incidence rate is 30% lower for Whites (15.5)

compared to Blacks (22.0).

• Black men (26.5) have the highest age-adjusted rate of kidney and renal pelvis cancer incidence.

• Men (21.2) have a rate that is 58% higher than the rate for women (13.4).

17.8

12.6

13.4

26.5

19.4

21.2

22.0

15.5

16.9

0 5 10 15 20 25 30

BlackFemale

WhiteFemale

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty

Age-adjusted incidence per 100,000

Age-adjusted Kidney Cancer Incidence Rate by Race and SexMontgomery County, 2011-2013

Age-adjusted Kidney Cancer* Incidence Rate† by Race and Sex, Montgomery County, 2011-2013



Leukemia

All Male Female


Black Male

Total White

Female Black

Female

10.5 11.3 8.3 11.5 12.7 6.3 9.8 10.2 9.5 *Per 100,000 population

Ratio of Leukemia Incidence Rates, 2011-2013





Summary:

• The age-adjusted leukemia incidence rate is higher for Whites (11.3) compared to Blacks (8.3).

• The leukemia incidence rate for White men (12.7) is twice the rate for Black men (6.3). White

men have the highest rate overall.

9.5

10.2

9.8

6.3

12.7

11.5

8.3

11.3

10.5

0 2 4 6 8 10 12 14

BlackFemale

WhiteFemale

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Leukemia Incidence Rate by Race and SexMontgomery County, 2011-2013

Age-adjusted Leukemia Incidence Rate* by Race and Sex, Montgomery County, 2011-2013



Lung and Bronchus Cancer

All Male Female


Black Male

Total White

Female Black

Female

76.1 76.7 74.7 85.8 84.5 92.1 68.5 70.6 61.9 *Lung and bronchus †Per 100,000 population

Ratio of Lung Cancer Incidence Rates, 2011-2013


White Male vs. Black Male 0.92 or -8%



Summary:

• Age-adjusted lung cancer incidence is very similar between Whites (76.7) and Blacks (74.7).

• The rate for men (85.8) is 25% higher than the rate for women (68.5).

• Black men (92.1) have the highest rate of new lung cancer, while Black women (61.9) have the

lowest rate.

61.9

70.6

68.5

92.1

84.5

85.8

74.7

76.7

76.1

0 10 20 30 40 50 60 70 80 90 100

BlackFemale

WhiteFemale

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Lung Cancer Incidence Rate by Race and SexMontgomery County, 2011-2013

Age-adjusted Lung Cancer* Incidence Rate† by Race and Sex, Montgomery County, 2011-2013




All Male Female


Black Male

Total White

Female Black

Female

18.5 21.0 † 23.3 26.3 † 15.0 16.9 † *Per 100,000 population †Rates are not reported when case totals are < 5.

Ratio of Melanoma Incidence Rates, 2011-2013


White Male vs. White Female 1.56 or 56%

Summary:

• White men (26.3) have 1.6 times higher melanoma incidence compared to White women (16.9).

16.9

15.0

26.3

23.3

21.0

18.5

0 5 10 15 20 25 30

WhiteFemale

Female

WhiteMale

Male

White

MontgomeryCounty


Age-adjusted Melanoma Incidence Rate by Race and SexMontgomery County, 2011-2013

Age-adjusted Melanoma Incidence Rate* by Race and Sex, Montgomery County, 2011-2013



Non-Hodgkin’s Lymphoma (NHL)

All Male Female


Black Male

Total White

Female Black

Female

17.4 18.3 12.0 21.9 23.4 11.6 14.1 14.4 12.5 *Per 100,000 population

Ratio of NHL Incidence Rates, 2011-2013





Summary:

• The White (18.3) age-adjusted NHL incidence rate is higher (by 53%) than the Black rate (12.0).

• This is true for both sexes (15% higher for White women and 102% higher for White men).

• By race and sex, White men (23.4) have the highest rate of new NHL diagnosis.

12.5

14.4

14.1

11.6

23.4

21.9

12.0

18.3

17.4

0 5 10 15 20 25

BlackFemale

WhiteFemale

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted NHL Incidence Rate by Race and SexMontgomery County, 2011-2013

Age-adjusted NHL Incidence Rate* by Race and Sex, Montgomery County, 2011-2013



Oral Cavity and Pharynx Cancer

All Male Female


Black Male

Total White

Female Black

Female

11.1 12.1 6.3 17.9 19.0 11.5 5.4 6.1 † *Per 100,000 population †Rates are not reported when case totals are < 5

NA—not applicable

Ratio of Oral Cancer Incidence Rates, 2011-2013



White Female vs. Black Female NA

Male vs. Female 3.31 or 231% NA—not applicable

Summary:

• Men (17.9) have an oral cavity and pharynx cancer incidence rate that is more than 3 times

higher than the incidence rate for women (5.4)

• The rate of new oral cancer is 92% higher for Whites (12.1) compared to Blacks (6.3).

• White men (19.0) have the highest rate of new oral cancer.

6.1

5.4

11.5

19.0

17.9

6.3

12.1

11.1

0 2 4 6 8 10 12 14 16 18 20

BlackFemale

WhiteFemale

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Oral Cancer Incidence Rate by Race and SexMontgomery County, 2011-2013

Age-adjusted Oral Cavity & Pharynx Cancer Incidence Rate* by Race and Sex, Montgomery County, 2011-2013

NA



Ovarian Cancer (female)

All White Black 12.8 13.5 9.7


White to Black Ratio of Ovarian Cancer Incidence Rates, 2011-2013

1.39 or 39%

Summary:

• The ovarian cancer incidence rate is 39% higher for White women (13.5) compared to Black

women (9.7).

9.7

13.5

12.8

0 2 4 6 8 10 12 14 16

Black

White

All


Age-adjusted Ovarian Cancer Incidence Rate by RaceMontgomery County, 2011-2013

Age-adjusted Ovarian Cancer Incidence Rate* by Race, Montgomery County, 2011-2013



Pancreatic Cancer

All Male Female


Black Male

Total White

Female Black

Female

10.8 10.4 13.5 11.3 10.9 14.4 10.2 9.6 12.8 *Per 100,000 population

Ratio of Pancreatic Cancer Incidence Rates, 2011-2013

White vs. Black 0.77 or -23% White Male vs. Black Male 0.76 or -24%

White Female vs. Black Female 0.75 or -25%


Summary:

• The age-adjusted pancreatic cancer incidence rate for Whites (10.4) is 23% lower than the rate

for Blacks (13.5).

• Black men (14.4) have the highest rate by race and sex.

12.8

9.6

10.2

14.4

10.9

11.3

13.5

10.4

10.8

0 2 4 6 8 10 12 14 16

BlackFemale

WhiteFemale

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Pancreatic Cancer Incidence Rate by Race and Sex Montgomery County, 2011-2013

Age-adjusted Pancreatic Cancer Incidence Rate* by Race and Sex, Montgomery County, 2011-2013



Prostate Cancer (male)



White to Black Ratio of Prostate Cancer Incidence Rates, 2011-2013

0.62 or -38%

Summary:

• Compared to Black men (149.7), White men have a 38% lower rate of newly diagnosed prostate

cancer.

149.7

92.5

106.2

0 20 40 60 80 100 120 140 160

Black

White

All

Age-adjusted Prostate Cancer Incidence Rate by RaceMontgomery County, 2011-2013

Age-adjusted Prostate Cancer Incidence Rate* by Race, Montgomery County, 2011-2013



Thyroid Cancer

All Male Female


Black Male

Total White

Female Black

Female

14.2 14.6 9.8 6.6 6.6 3.4 21.3 22.4 15.1 *Per 100,000 population

Ratio of Thyroid Cancer Incidence Rates, 2011-2013





Summary:

• Women have much higher rates than men regardless of race. Overall, the thyroid cancer

incidence rate is 69% lower for men (6.6) compared to women (21.3).

• The White (14.6) thyroid cancer incidence rate is 1.5 times the rate for Blacks (9.8).

15.1

22.4

21.3

3.4

6.6

6.6

9.8

14.6

14.2

0 5 10 15 20 25

BlackFemale

WhiteFemale

Female

BlackMale

WhiteMale

Male

Black

White

MontgomeryCounty


Age-adjusted Thyroid Cancer Incidence Rate by Race and SexMontgomery County, 2011-2013

Age-adjusted Thyroid Cancer Incidence Rate* by Race and Sex, Montgomery County, 2011-2013



Uterine Cancer (female)



White to Black Ratio of Uterine Cancer Incidence Rates, 2011-2013

1.29 or 29%

Summary:

• White women (25.2) have a 29% higher rate of age-adjusted uterine cancer incidence than Black

women (19.5).

19.5

25.2

24.2

0 5 10 15 20 25 30

Black

White

All


Age-adjusted Uterine Cancer Incidence Rate by Race, Montgomery County2011-2013

Age-adjusted Uterine Cancer Incidence Rate* by Race, Montgomery County, 2011-2013



Summary of Cancer Incidence Statistics

Highest Rates of New Cancers by Race Note. Ranking based on incidence rates for each cancer type (ordered high to low).

Top 5 Highest Rates of Cancer Incidence* by Race, Montgomery County, 2011-2013

Rank Montgomery County White Black

1 Female Breast Female Breast Prostate

2 Prostate Prostate Female Breast

3 Lung and Bronchus Lung and Bronchus Lung and Bronchus

4 Colorectal Colorectal Colorectal

5 Uterine Uterine Kidney and Renal Pelvis

*Age-adjusted incidence rates

Summary:

• Among Blacks, prostate cancer incidence ranks the highest.

• Female breast cancer is the most common new cancer among Whites.

• Regardless of race, lung and colorectal cancers have the third and fourth highest rate,

respectively.

Highest Rates of New Cancers by Sex Note. Ranking based on incidence rates for each cancer type (ordered high to low).

Top 5 Highest Rates of Cancer Incidence* by Sex, Montgomery County, 2011-2013

Rank Male Female

1 Prostate Breast

2 Lung and Bronchus Lung and Bronchus

3 Colorectal Colorectal

4 Bladder Uterine

5 Melanoma Thyroid

*Age-adjusted incidence rates

Summary:

• Lung (2nd) and colorectal (3rd) cancers are ranked the same for both men and women.



Race and Sex Groups with the Highest Age-adjusted Cancer Incidence Rates, Montgomery County 2011-2013

Cancer Type White Men White Women Black Men Black Women

All Cancer

Bladder

Female Breast

Colorectal

Kidney & Renal Pelvis

Leukemia

Lung & Bronchus


NHL*

Oral Cavity & Pharynx

Ovarian

Pancreatic

Prostate

Thyroid

Uterine *Non-Hodgkin’s Lymphoma

Indicates Highest Rate

Not Applicable



Behavioral Health Risk Factors

The Behavioral Risk Factor Surveillance System (BRFSS), a health-related telephone survey, is the largest,

ongoing, health survey in the world. The BRFSS collects state-based data on adults 18 years and older

regarding their health practices, chronic health conditions, and health-related risk behaviors. The

information collected in the survey is used to monitor behaviors that are associated with preventable

causes of morbidity and mortality such as cardiovascular disease, diabetes, cancer, and arthritis. Data

from the BRFSS can be analyzed at the county-level and used by local health departments to inform

decision-making and evaluate public health initiatives and policies. The following section highlights key

findings from the 2013-2015 BRFSS in respect to Montgomery County. See Appendix I for variable

definitions.

Data Source: Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance

System (BRFSS), 2013-2015

Disparities Analyzed: Age, Sex, Race, Income Level, Educational Attainment, and Disability

Data from the BRFSS include adults 18 years and older and are weighted by age, race, and sex. The data

used in this summary are self-reported and mostly from years 2014 and 2015. One statistic (percent of

adults with high blood pressure) used data from 2013 and 2015 because the question was not asked

during the 2014 BRFSS cycle.



Behavioral Health Risks by Age

10.7%

4.4%

20.1%24.6%

4.9%

12.4%

2.3%0

5

10

15

20

25

30

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

67.1%54.3%

65.7%56.6%

75.0% 74.3%68.3%

0

10

20

30

40

50

60

70

80

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

Overweight or Obese Adults by Age Group (years), Montgomery County, 2014-2015

Adults WITHOUT Health Care Coverage by Age Group (years), Montgomery County

2014-2015



20.6%15.0% 17.3%

33.1%30.1%

19.9%

11.3%

0

5

10

15

20

25

30

35

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

73.4%88.7%

75.3%63.0%

77.5% 74.6%67.3%

0

10

20

30

40

50

60

70

80

90

100

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

Adults who are Current Smokers by Age Group (years), Montgomery County

2014-2015

Adults who are Physically Active by Age Group (years), Montgomery County

2014-2015



*Coronary Heart Disease

5.7%0% 0% 0% 1.4%

5.5%

19.7%

0

5

10

15

20

25

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

5.1%0% 0% 1.7% 2.2%

5.1%

15.4%

0

2

4

6

8

10

12

14

16

18

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

Adults Diagnosed with CHD* by Age Group (years), Montgomery County, 2014-2015

Adults Diagnosed with a Heart Attack by Age Group (years)

Montgomery County, 2014-2015



39.2%

22.2%

8.4%

34.4% 35.3%

51.2%

64.9%

0

10

20

30

40

50

60

70

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

14.4%

8.5%

2.2%1.3%

13.5%

23.5%26.6%

0

5

10

15

20

25

30

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

Adults Diagnosed with High Blood Pressure by Age Group (years)

Montgomery County, 2013 & 2015

Adults Diagnosed with Diabetes by Age Group (years), Montgomery County

2014-2015



6.1%

0% 1.2%

5.3%

2.7%

13.0% 12.1%

0

2

4

6

8

10

12

14

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

39.8%

64.1%58.3%

46.4%

29.5%23.3% 27.0%

0

10

20

30

40

50

60

70

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

Adults Diagnosed with Prediabetes by Age Group (Years), Montgomery County, 2014-2015

Adults who have NOT had a Diabetes Screening by Age Group (years)




* Special equipment such as a cane, wheelchair, special bed, or special telephone.

31.8%

4.2% 10.9%18.4%

30.6%

45.2%

57.6%

0

10

20

30

40

50

60

70

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

9.7%

4.6% 0.8% 0%

7.6%

15.4%

21.3%

0

5

10

15

20

25

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

Adults Diagnosed with Arthritis by Age Group (years), Montgomery County, 2014-2015

Adults who Require Special Equipment* by Age Group (years), Montgomery County

2014-2015



24.7%

1.9%

20.5%26.1%

29.9% 30.3% 29.3%

0

5

10

15

20

25

30

35

Total 18-24 25-34 35-44 45-54 55-64 65+

Pe

rce

nt

Adults who are Limited in Activities by Age Group (years), Montgomery County

2014-2015



Behavioral Health Risks by Sex

19.3%16.5%

21.5%

0

5

10

15

20

25

Total Male Female

Pe

rce

nt

10.7%

14.6%

7.7%

0

2

4

6

8

10

12

14

16

Total Male Female

Pe

rce

nt

Adults Reporting Fair or Poor Health by Sex, Montgomery County, 2014-2015

Adults WITHOUT Health Care Coverage by Sex, Montgomery County, 2014-2015



67.1% 66.6% 67.5%

0

10

20

30

40

50

60

70

80

Total Male Female

Pe

rce

nt

20.6%24.1%

17.9%

0

5

10

15

20

25

30

Total Male Female

Pe

rce

nt

Overweight or Obese Adults by Sex, Montgomery County, 2014-2015

Adults who are Current Smokers by Sex, Montgomery County, 2014-2015



57.0% 54.8%59.5%

0

10

20

30

40

50

60

70

Total Male Female

Pe

rce

nt

73.4% 74.2% 72.7%

0

10

20

30

40

50

60

70

80

Total Male Female

Pe

rce

nt

Current Smokers Who Tried to Quit Smoking by Sex, Montgomery County

2014-2015

Adults who are Physically Active by Sex, Montgomery County, 2014-2015



*Coronary Heart Disease

5.7%7.0%

4.7%

0

1

2

3

4

5

6

7

8

Total Male Female

Pe

rce

nt

5.1%

6.6%

3.9%

0

1

2

3

4

5

6

7

Total Male Female

Pe

rce

nt

Adults Diagnosed with CHD* by Sex, Montgomery County, 2014-2015

Adults Diagnosed with a Heart Attack by Sex, Montgomery County

2014-2015



39.2%46.9%

32.6%

0

5

10

15

20

25

30

35

40

45

50

Total Male Female

Pe

rce

nt

14.4% 13.5%15.1%

0

2

4

6

8

10

12

14

16

Total Male Female

Pe

rce

nt

Adults Diagnosed with High Blood Pressure by Sex, Montgomery County, 2013 & 2015

Adults Diagnosed with Diabetes by Sex, Montgomery County, 2014-2015



6.1%

4.6%

7.2%

0

1

2

3

4

5

6

7

8

Total Male Female

Pe

rce

nt

39.8%45.6%

35.1%

0

5

10

15

20

25

30

35

40

45

50

Total Male Female

Pe

rce

nt

Adults who have NOT had a Diabetes Screening by Sex, Montgomery County

2014-2015

Adults Diagnosed with Prediabetes by Sex, Montgomery County, 2014-2015




31.8%

21.4%

40.0%

0

5

10

15

20

25

30

35

40

45

Total Male Female

Pe

rce

nt

9.7%

6.4%

12.3%

0

2

4

6

8

10

12

14

Total Male Female

Pe

rce

nt

Adults who Require Special Equipment* by Sex, Montgomery County, 2014-2015

Adults Diagnosed with Arthritis by Sex, Montgomery County, 2014-2015



24.7%19.0%

29.2%

0

5

10

15

20

25

30

35

Total Male Female

Pe

rce

nt

Adults who are Limited in Activities by Sex, Montgomery County, 2014-2015



Behavioral Health Risks by Race

19.3% 19.4%22.6%

0

5

10

15

20

25

Total White Black

Pe

rce

nt

10.7% 10.1%11.3%

0

2

4

6

8

10

12

Total White Black

Pe

rce

nt

Adults Reporting Fair or Poor Health by Race, Montgomery County, 2014-2015

Adults WITHOUT Health Care Coverage by Race, Montgomery County, 2014-2015



67.1% 67.8% 71.7%

0

10

20

30

40

50

60

70

80

Total White Black

Pe

rce

nt

20.6% 21.1%23.0%

0

5

10

15

20

25

Total White Black

Pe

rce

nt

Overweight or Obese Adults by Race, Montgomery County, 2014-2015

Adults who are Current Smokers by Race, Montgomery County, 2014-2015



57.0%50.8%

75.5%

0

10

20

30

40

50

60

70

80

Total White Black

Pe

rce

nt

73.4% 75.0%62.1%

0

10

20

30

40

50

60

70

80

Total White Black

Pe

rce

nt

Current Smokers Who Tried to Quit Smoking by Race, Montgomery County, 2014-2015

Adults who are Physically Active by Race, Montgomery County, 2014-2015



*Coronary Heart disease

5.7%6.7%

2.7%

0

1

2

3

4

5

6

7

8

Total White Black

Pe

rce

nt

5.1% 5.3%

3.1%

0

1

2

3

4

5

6

Total White Black

Pe

rce

nt

Adults Diagnosed with a Heart Attack by Race, Montgomery County, 2014-2015

Adults Diagnosed with CHD* by Race, Montgomery County, 2014-2015



39.2% 38.9%45.9%

0

5

10

15

20

25

30

35

40

45

50

Total White Black

Pe

rce

nt

14.4% 14.5%16.0%

0

2

4

6

8

10

12

14

16

18

Total White Black

Pe

rce

nt

Adults Diagnosed with High Blood Pressure by Race, Montgomery County, 2013 & 2015

Adults Diagnosed with Diabetes by Race, Montgomery County, 2014-2015



6.1% 6.5%

2.9%

0

1

2

3

4

5

6

7

Total White Black

Pe

rce

nt

39.8%43.9%

22.6%

0

5

10

15

20

25

30

35

40

45

50

Total White Black

Pe

rce

nt

Adults Diagnosed with Prediabetes by Race, Montgomery County, 2014-2015

Adults who have NOT had a Diabetes Screening by Race, Montgomery County, 2014-2015




31.8% 32.9%30.0%

0

5

10

15

20

25

30

35

Total White Black

Pe

rce

nt

9.7% 9.9%10.7%

0

2

4

6

8

10

12

Total White Black

Pe

rce

nt

Adults who Require Special Equipment* by Race, Montgomery County, 2014-2015

Adults Diagnosed with Arthritis by Race, Montgomery County, 2014-2015



24.7% 26.2%22.4%

0

5

10

15

20

25

30

Total White Black

Pe

rce

nt

Adults who are Limited in Activities by Race, Montgomery County, 2014-2015



Behavioral Health Risks by Income Level

19.3%

38.4%

24.4%

15.4%12.0% 9.7%

0

5

10

15

20

25

30

35

40

45

Total < $15,000 $15,000 -$24,999

$25,000 -$34,999

$35,0000 -$49,999

$50,000 +

Pe

rce

nt

10.7%

21.7%17.4%

9.4%

16.4%

2.6%0

5

10

15

20

25

Total < $15,000 $15,000 -$24,999

$25,000 -$34,999

$35,0000 -$49,999

$50,000 +

Pe

rce

nt

Adults Reporting Fair or Poor Health by Income Level, Montgomery County, 2014-2015

Adults WITHOUT Health Care Coverage by Income Level, Montgomery County

2014-2015



20.6%

34.2%

50.7%

23.8% 20.0%

7.7%0

10

20

30

40

50

60

Total < $15,000 $15,000 -$24,999

$25,000 -$34,999

$35,0000 -$49,999

$50,000 +

Pe

rce

nt

73.4% 66.5% 60.9% 64.1%75.2%

87.2%

0

10

20

30

40

50

60

70

80

90

100

Total < $15,000 $15,000 -$24,999

$25,000 -$34,999

$35,0000 -$49,999

$50,000 +

Pe

rce

nt

Adults who are Current Smokers by Income Level, Montgomery County, 2014-2015

Adults who are Physically Active by Income Level, Montgomery County, 2014-2015



39.8%48.7%

56.1%46.2% 44.9%

29.4%

0

10

20

30

40

50

60

Total < $15,000 $15,000 -$24,999

$25,000 -$34,999

$35,0000 -$49,999

$50,000 +

Pe

rce

nt

24.7%

45.1%

30.5%

40.2%

18.9%13.7%

0

5

10

15

20

25

30

35

40

45

50

Total < $15,000 $15,000 -$24,999

$25,000 -$34,999

$35,0000 -$49,999

$50,000 +

Pe

rce

nt

Adults who have NOT had a Diabetes Screening by Income Level, Montgomery County

2014-2015

Adults who are Limited in Activities by Income Level, Montgomery County, 2014-2015



Behavioral Health Risks by Educational Attainment

19.3%

35.9%

27.3%

16.4%

7.5%

0

5

10

15

20

25

30

35

40

Total < HS HS Grad Some College College Grad

Pe

rce

nt

20.6%

46.0%

26.2%

16.5%9.5%

0

5

10

15

20

25

30

35

40

45

50


Pe

rce

nt

Adults who are Current Smokers by Educational Attainment, Montgomery County

2014-2015

Adults Reporting Fair or Poor Health by Educational Attainment, Montgomery County

2014-2015



57.0%45.4%

55.8% 58.7%

84.9%

0

10

20

30

40

50

60

70

80

90


Pe

rce

nt

73.4%

48.3%64.3%

76.0%89.6%

0

10

20

30

40

50

60

70

80

90

100


Pe

rce

t

Current Smokers Who Tried to Quit Smoking by Educational Attainment


Adults who are Physically Active by Educational Attainment, Montgomery County

2014-2015



Summary of Behavioral Health Risks

By Age Group:

• Adults ages 35-44 years have the highest percentage of current smokers (33.1%).

• Older adults (age 65+ years) have a higher percentage of individuals diagnosed with chronic

conditions (CHD, heart attack, high blood pressure, diabetes, arthritis) compared to other age

groups.

By Sex:

• Women (21.5%) reported more fair or poor health compared to men (16.5%).

• A higher percentage of men reported diagnoses of CHD, heart attack, and high blood pressure,

but a higher percentage of women were diagnosed with diabetes, prediabetes, arthritis, and

were limited more in activities due to physical, mental, or emotional problems.

By Race:

• Whites (75%) compared to Blacks (62.1%), reported a higher a percentage of adults who are

physically active.

• Blacks had a higher percentage of adults with high blood pressure and diabetes, while Whites

had higher percentages of CHD, heart attack, prediabetes, and arthritis.

By Income Level:

• The lowest income group (< $15,000) had the highest reports of fair or poor health.

• The highest income group ($50,000 +) reported better health outcomes (lowest percent without

health insurance, lowest percent of fair or poor health, lowest percent of current smokers,

lowest percent being limited in activities, and the highest percent of individuals who are

physically active) than any other income group.

By Educational Attainment:

• Adults with the highest level of educational attainment (having a college degree) reported the

best health outcomes.



Appendix I

Definitions:

1. Rate—the occurrence of events over a specific interval in time; measure of frequency of some

phenomenon of interest [1].

2. Death rate (crude)—the number of deaths occurring among the population of a given

geographical area during a specified interval in time (year[s]), per 100,000 population [1].

Calculation: (# of deaths/population total)*100,000

3. Incidence rate (crude)—the number of new cases of a particular disease among the population

at risk occurring during a particular time interval [2]. Calculation: (# of new cases/population at

risk)*100,000

4. Age-specific rate—the rate of mortality or incidence of a specific age group, calculated per

100,000 population [3].

5. Age-adjusted rate—a statistical method allowing for comparison of rates between different

populations. This method considers differences in the age structure of populations by applying

weights to each age group. Typically, weights are derived from the 2000 US standard population

[3].

6. Ratio—a number that expresses the relative size of two other numbers [1].

Ex: a person has 15 apples and 5 oranges, the ratio of apples to oranges is 3; (15/5 = 3). This

ratio of 3 means the person has 200% more apples than oranges.

7. Chronic Disease—a disease that persists over an extended period of time; a disease of long

duration and generally slow progression [4].

8. Cancer Staging—is based on the extent to which cancer has spread throughout the body [5].

in situ – A tumor that has not invaded or penetrated surrounding tissue.

Localized – An invasive malignant tumor that is confined to the organ of origin.

Regional – An invasive malignant tumor that has spread by direct extension to adjacent

organs or tissues and/or has spread to regional lymph nodes.

Distant – An invasive malignant tumor that has spread by direct extension beyond the

adjacent organs or tissues and/or metastasized to distant lymph nodes or tissues.

Unstaged/Unknown – Insufficient information is available to determine the stage of

cancer at the time of diagnosis, or the case was reported with missing stage data.



BRFSS Variable Definitions:

1. General Health – General health status is self-reported as (descending order): excellent, very

good, good, fair, or poor.

2. Health Care Coverage – Health care coverage includes any type of health insurance, prepaid

plans such as HMOs, or government plans such as Medicare, or Indian Health Service.

3. Overweight or Obese – Overweight is considered a body mass index (BMI) of 25.0 to 29.9 kg/m2

and obese is considered a BMI > 30.0 kg/m2.

4. Smoking – A current smoker is an adult who has smoked at least 100 cigarettes in his or her life

and currently smokes some days or every day.

5. Quit Smoking – A current smoker tried to quit smoking if he or she stopped smoking for one or

more days because he or she was trying to quit (in the past 12 months).

6. Physical Activity – An adult is considered physically active if he or she participated in any

physical activities or exercise during the past month, other than at his or her regular job.

7. Angina & Coronary Heart Disease – Adults who reported ever being diagnosed with angina or

coronary heart disease (CHD).

8. Heart Attack – Adults who reported ever having a heart attack or myocardial infarction (MI).

9. High Blood Pressure – Adults who reported ever being diagnosed with high blood pressure (data

only includes years 2013 and 2015).

10. Diabetes – Adults who reported ever being diagnosed with diabetes (excludes women

diagnosed with gestational diabetes).

11. Prediabetes – Adults who reported ever being diagnosed with prediabetes or borderline

diabetes (excludes women diagnosed with gestational prediabetes).

12. Diabetes Screening – Adults who have had a diabetes screening within the past 3 years.

13. Arthritis – Adults who have ever been diagnosed with some form of arthritis (e.g. osteoarthritis,

rheumatoid arthritis, gout, lupus, fibromyalgia).

14. Disability (Use of Special Equipment) – Adults who reported a health problem that requires the

use of special equipment such as a cane, wheelchair, special bed, or special telephone.

15. Disability (Activity Limitations) – Adults who reported being limited in activities due to physical,

mental or emotional problems.



Appendix II

Education Categories:

1. < High School Graduate—no high school diploma or GED.

2. High School/Some College—high school graduate or GED completed/some college credit, but

no degree awarded.

3. College Graduate—completion of any postsecondary degree.



Appendix III

References:

1. Glossary of Statistical Terms. Organisation for Economic Co-Operation and Development (OECD)

2017. Available at: https://stats.oecd.org/glossary/.

2. Principles of Epidemiology in Public Health Practice, Third Edition: An Introduction to Applied

Epidemiology and Biostatistics. Centers for Disease Control and Prevention (CDC) 2012.

Available at: https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson3/section2.html.

3. Glossary of Statistical Terms. National Cancer Institute Surveillance, Epidemiology, and End

Results Program 2017. Available at: https://seer.cancer.gov/cgi-bin/glossary/glossary.pl.

4. Noncommunicable Diseases. World Health Organization (WHO) 2017. Available at:

http://www.who.int/topics/noncommunicable_diseases/en/.

5. Stage at Diagnosis for Selected Cancer Sites in Ohio. Ohio Cancer Incidence Surveillance System,

Ohio Department of Health and The Ohio State University, Columbus, Ohio, March 2012.

Available at: http://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/opi/cancer-incidence-

surveillance-system-

ociss/stageatdiagnosisforselectedcancersitestypesinohioMarch2012.pdf?la=en

https://stats.oecd.org/glossary/

https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson3/section2.html

https://seer.cancer.gov/cgi-bin/glossary/glossary.pl

http://www.who.int/topics/noncommunicable_diseases/en/

http://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/opi/cancer-incidence-surveillance-system-ociss/stageatdiagnosisforselectedcancersitestypesinohioMarch2012.pdf?la=en





This report was produced by

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Search for: Health Disparities Report

Report completed by Kyle D. Wallace, Epidemiologist

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