COMMUNITY CORRELATES OF BACTERIAL PNEUMONIA HOSPITALIZATIONS, 65 , TEXAS BORDER COUNTIES Frank C' Le

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COMMUNITY CORRELATES OF BACTERIAL PNEUMONIA
HOSPITALIZATIONS, 65, TEXAS BORDER
COUNTIESFrank C. Lemus, M.A., Predoctoral
Student, Alai Tan, M.D., Ph.D., Carlos
Reyes-Ortiz, M.D., Ph.D., Daniel H. Freeman Jr.,
Ph.D., Jean L. Freeman, Ph.D.APHA 134th Annual
Meeting and ExpositionNovember 4-8, 2006Boston,
MA
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ABSTRACT

• We estimated baseline hospitalization rates in
  the 32 Texas Border Counties toward achieving
  Healthy Border 2010 Focus Area 1 Improve access
  to primary care and Focus Area 6 Improve rates
  of immunization and reduce rates of infectious
  diseases by tracking Healthy People 2010
  Objective 1.9c Reduce hospitalization rates for
  the following ambulatory care sensitive condition
  (ACSC) Agency on Healthcare Research Quality
  (AHRQ) prevention quality indicator (PQI)
  immunization-preventable bacterial
  pneumonia-persons aged 65. Hospitalization
  rates based on data from Texas Health Care
  Information Council (THCIC) hospital discharge
  data system for 3 years 1999, 2000, 2001,
  population counts from 2000 U.S. Census.

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PURPOSE

• Estimate baseline hospitalization rates for
  bacterial pneumonia, 65, Texas Border Counties
• Learn if contextual (county) characteristics
  associated with ACSC PQI bacterial pneumonia
• Methodology to assess progress of Texas Border
  Counties toward achieving Healthy Border 2010
  Focus Areas 1 and 6 and Healthy People 2010
  Objective 1.9c.

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AIMS

• Estimate hospitalization rates for ACSC PQI
• -Immunization preventable bacterial pneumonia
  (persons 65)
• Identify association of contextual (county)
  characteristics with bacterial pneumonia
  hospitalizations
• -race/ethnic concentration, income
• Study 3 major racial/ethnic groups
  (non-Hispanic White, Black, Latino)
• Target 32 Texas Border Counties defined by La
  Paz Agreement (1983) and Public Law 103-400 (1994)

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Healthy Border Healthy People 2010 Overarching
Goals

• Increase Quality Years of Healthy Life
• Help individuals of all ages increase life
  expectancy and improve their quality of life
• Eliminate Health Disparities
• Eliminate health disparities among different
  segments of the population

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United StatesMexico Border Region

• Legally defined by La Paz Agreement (1983)
  and Public Law 103-400
• 2000 mile long (California/Baja California to
  Texas/Tamaulipas)
• 62 miles (100 kilometers) within either side of
  United States and Mexico
• 1,248 mile Texas/Mexico border
• Rio Grande River one of most polluted rivers in
  North America, and primary source of drinking
  water for many border communities.

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Source U.S.-Mexico Border Health Commission
2004 Immunization Week Preparatory Workshop,
Quito, Ecuador http//www.paho.org/English/DD/PI
N/285,3,Slide 3
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Texas Office Of Border Health
http//www.dshs.state.tx.us/borderhealth/border_he
alth_map.shtm
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Border Facts

• Latinos 41 of border population, without San
  Diego County 71, (historically permanent home or
  in-transition home)
• Over 90 border population concentrated in or
  near 14 sister or twin cities on both sides of
  border
• Double-digit population growth rate between 1970
  and 2000, over 2.7 million to over 6 million
• 36 of Latino border population lt18 years
  compared to 19 of non-Latinos, yet 65 in US
  12.4 TX 9.9, 32 Border Counties 13.3
• Maquiladoras (assembly plants), NAFTA, Colonias
  are major influences on border health

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WHY ACSCs/PQIs?

• Provide baseline information about a community
• Mechanism to evaluate the progress of a
  community in achieving the goals of Healthy
  Border 2010 Healthy People 2010
• ACSCs/PQIs based on hospital inpatient data,
  but provide insight into the quality of the
  health care system outside the hospital setting

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DATA RESOURCES

• Texas Health Care Information Council (THCIC)
  hospital discharge database (32 Texas Border
  Counties) Years 1999, 2000, 2001
• 2000 U.S. Census Summary File 1 (SF 1) State
  population counts for targeted communities by
  age, sex, race, ethnicity
• International Classification of Diseases, 9th
  Revision Clinical Modification (ICD-9-CM)
• Healthy Border 2010 report Healthy People 2010
  report

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THCIC DISCHARGE DATA

• Administrative data demographics clinical
  (ICD-9-CM)
• 2.57 million discharge records per year
• Public use data for years 1999, 2000, and 2001
• Helps Texas consumers and researchers make
  informed health care decisions
• Data source for health services research on
  hospital care in Texas

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2000 U.S. CENSUS

• Summary File 1 (SF 1) Presents data for the
  United States, the 50 states, and the District of
  Columbia. Contains 286 detailed tables including
  state population counts by targeted communities
  for
• Age
• Income
• Race
• Ethnicity

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Hospitalizations, Persons 65, 32 Texas Border
Counties (THCIC)

• Year 1999 255,414
• Year 2000 262,145
• Year 2001 270,516
• Total Records 788,075
• Bacterial Pneumonia Discharges, 65, 32 Texas
  Border County Records 10,749

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METHODOLOGY FOR RATE CALCULATIONS

• Followed HP 2010 protocol for rate calculation
  for each county
• Numerator discharge data x 10,000
• Denominator U.S. Census data x 3
• Rate

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Followed HP 2010 Protocol Methodology for Rate
Calculation

• Bacterial pneumonia rate per 10,000 persons in
  Duval County 386.29/10,000 persons
• 10,000 x persons 65 years hospitalized in Duval
  Co (213), ICD-9-CM Codes Bacterial Pneumonia,
  (THCIC 1999-2001)
• Population 65 years in Duval Co, 2000 (1838) X 3
  (2000 US Census (SF 1))

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COUNTY POPULATION BY COUNTY BACTERIAL PNEUMONIA
RATES

• Counties by population 65 with 4 lowest
  rates/10,000
• Kenedy 44 0
• Kinney 822 16.22
• Val Verde 4913 23.75
• Zavala 1307 38.26
• Counties by population 65 with 4 mid range
  rates/10,000
• La Salle 682 151.52
• Hidalgo 55274 160.53
• Cameron 37375 161.60
• Jeff Davis 359 167.13
• Counties by population 65 with 4 highest
  rates/10,000
• Brewster 1297 246.72
• Hudspeth 331 302.11
• Brooks 1150 318.84
• Duval 1838 386.29

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Bacterial pneumonia hospitalization rates/
10,000, 65 yrs by Mdn Hshld Inc,1999-2001
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Bacterial pneumonia hospitalization rates per
10,000 by White, 65 yrs,1999-2001
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Bacterial pneumonia hospitalization rates per
10,000 by Hispanic, 65 yrs,1999-2001
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GLOBAL FINDINGS

• Disparity between Whites and Latinos
• Income gradients correlated with rates of
  bacterial pneumonia
• LIMITATIONS
• Administrative data
• Reporting of race/ethnicity
• Variation in coding practices

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IMPLICATIONS

• Provides baseline estimate of bacterial pneumonia
  hospitalization rates, persons 65, in 32 Texas
  Border Counties (future comparability health
  studies of Texas counties, 4 U.S. 6 Mexico
  Border States) (CA, AZ,NM, TX) (BC, Sonora,
  Chihuahua, Nuevo Leon, Coahuila, Tamaulipas)
• 32 Texas Border County stakeholders can assess
  health status of population sets basis to
  target interventions using community based
  participatory research techniques
• Demonstrates use of hospital discharge data for
  community based health services research

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DIRECTIONS

• Extend baseline estimates analysis of AHRQ
• quality of care indicators - QIs (population
  health)
• bacterial pneumonia hospitalizations (PQI)
• pneumonia inpatient mortality (IQI)
• all Texas counties
• 65, all Texas counties fclemus_at_utmb.edu
  409-762- 5140
• Primary Funding Source University of Texas
  Medical Branch, Division of Epidemiology and
  Biostatistics Educational Enhancement Fund.