Health Disparities Report - PHDMC
Transcript of Health Disparities Report - PHDMC
Page 2 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.
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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.
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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
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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
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Average Age (years) at Death by Race and Sex, Montgomery County, 2014-2015
All Male Female
Total White Black Total White Male
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).
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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.
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Top 10 Leading Causes of Death for Males by Race, Montgomery County, 2014-2015
Rank Male White Male Black Male
1 Heart Disease (23.8%) Heart Disease (23.8%) Heart Disease (24.2%)
2 Cancer (21.2%) Cancer (21.7%) Cancer (19.7%)
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
1 Heart Disease (20.9%) Heart Disease (20.2%) Heart Disease (23.8%)
2 Cancer (19.9%) Cancer (19.8%) Cancer (20.2%)
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).
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*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
-ad
just
ed
de
ath
rat
e p
er
10
0,0
00
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
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Heart Disease Deaths
Age-adjusted Heart Disease 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
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 death rate per 100,000
Age-adjusted Heart Disease Death Rate by Race and Sex, Montgomery County 2014-2015
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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%).
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Cancer Deaths
Age-adjusted Cancer 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
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
Black vs. White 1.10 or 10%
Black Male vs. White Male 1.12 or 12%
Black Female vs. White Female 1.13 or 13%
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 death rate per 100,000
Age-adjusted Cancer Death Rate by Race and Sex, Montgomery County2014-2015
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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
-ad
just
ed
de
ath
rat
e p
er
10
0,0
00
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
-ad
just
ed
de
ath
rat
e p
er
10
0,0
00
Age-adjusted Female Breast Cancer Death Rate by Race, Montgomery County, 2014-2015
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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.
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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.
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Accidental Deaths
Age-adjusted Accidental 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
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%
Male vs. Female 1.90 or 90%
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 death rate per 100,000
Age-adjusted Accidental Death Rate by Race and Sex, Montgomery County 2014-2015
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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.
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Age-adjusted Unintentional Drug Overdose 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
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
Black vs. White 0.45 or -45%
Black Male vs. White Male 0.50 or -50%
Black Female vs. White Female 0.41 or -41%
Male vs. Female 2.09 or 109%
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 death rate per 100,000
Age-adjusted Unintentional Drug Overdose Death Rate by Race and Sex Montgomery County, 2014-2015
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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
Page 21 of 91 PHDMC Epidemiology 11/16/17
Homicide Deaths
Age-adjusted Homicide 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
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 vs. White 8.44 or 744%
Black Male vs. White Male 11.60 or 1,060%
Black Female vs. White Female 3.43 or 243%
Male vs. Female 4.30 or 330%
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 death rate per 100,000
Age-adjusted Homicide Death Rate by Race and Sex, Montgomery County2014-2015
Page 22 of 91 PHDMC Epidemiology 11/16/17
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.
Page 23 of 91 PHDMC Epidemiology 11/16/17
Suicides
Age-adjusted Suicide 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
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 death rate per 100,000
Age-adjusted Suicide Rate by Race and Sex, Montgomery County2014-2015
NA
Ratio of Suicide Rates, 2014-2015
Black vs. White 0.49 or -51%
Black Male vs. White Male 0.63 or -37%
Black Female vs. White Female NA
Male vs. Female 4.02 or 302% NA—not applicable
Page 24 of 91 PHDMC Epidemiology 11/16/17
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
Total White Black Total White Male
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
*Per 100,000 population
Ratio of CLRD Death Rates, 2014-2015
Black vs. White 0.90 or -10%
Black Male vs. White Male 1.04 or 4%
Black Female vs. White Female 0.82 or -18%
Male vs. Female 1.23 or 23%
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 death rate per 100,000
Age-adjusted CLRD Death Rate by Race and Sex, Montgomery County, 2014-2015
Page 25 of 91 PHDMC Epidemiology 11/16/17
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.
Page 26 of 91 PHDMC Epidemiology 11/16/17
Stroke Deaths
Age-adjusted Stroke 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
43.8 41.1 55.5 43.1 40.5 51.9 43.8 41.3 56.0
*Per 100,000 population
Ratio of Stroke Death Rates, 2014-2015
Black vs. White 1.35 or 35%
Black Male vs. White Male 1.28 or 28%
Black Female vs. White Female 1.36 or 36%
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 death rate per 100,000
Age-adjusted Stroke Death Rate by Race and Sex, Montgomery County2014-2015
Page 27 of 91 PHDMC Epidemiology 11/16/17
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%).
Page 28 of 91 PHDMC Epidemiology 11/16/17
Alzheimer’s Disease Deaths
Age-adjusted Alzheimer’s Disease 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
40.1 40.0 42.4 37.2 37.7 35.3 41.6 41.3 45.9
*Per 100,000 population
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%
Black Female vs. White Female 1.11 or 11%
Male vs. Female 0.89 or -11%
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 death rate per 100,000
Age-adjusted Alzheimer's Disease Death Rate by Race and Sex, Montgomery County 2014-2015
Page 29 of 91 PHDMC Epidemiology 11/16/17
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
Page 30 of 91 PHDMC Epidemiology 11/16/17
Diabetes Deaths
Age-adjusted Diabetes 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
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
Black vs. White 2.32 or 132%
Black Male vs. White Male 2.20 or 120%
Black Female vs. White Female 2.41 or 141%
Male vs. Female 1.54 or 54%
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 death rate per 100,000
Age-adjusted Diabetes Death Rate by Race and Sex, Montgomery County, 2014-2015
Page 31 of 91 PHDMC Epidemiology 11/16/17
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.
Page 32 of 91 PHDMC Epidemiology 11/16/17
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
Page 33 of 91 PHDMC Epidemiology 11/16/17
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
Page 34 of 91 PHDMC Epidemiology 11/16/17
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.
Page 35 of 91 PHDMC Epidemiology 11/16/17
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.
Page 36 of 91 PHDMC Epidemiology 11/16/17
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%
*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.
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%
*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.
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.
Page 37 of 91 PHDMC Epidemiology 11/16/17
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
Total Male Female Total Male Female Total Male Female
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
Total Male Female Total Male Female Total Male Female
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
Total Male Female Total Male Female Total Male Female
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
Page 38 of 91 PHDMC Epidemiology 11/16/17
Age-specific Cancer Incidence* (per 100,000) by Age†, Race, and Sex, Montgomery County, 2011-2013
Leukemia
All White Black
Total Male Female Total Male Female Total Male Female
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
Total Male Female Total Male Female Total Male Female
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
Total Male Female Total Male Female Total Male Female
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
Total Male Female Total Male Female Total Male Female
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
Total Male Female Total Male Female Total Male Female
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.
Page 39 of 91 PHDMC Epidemiology 11/16/17
Age-specific Cancer Incidence (per 100,000) by Age, Race, and Sex, Montgomery County, 2011-2013
Ovarian
All Female White Female Black Female
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
Total Male Female Total Male Female Total Male Female
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
Total Male Female Total Male Female Total Male Female
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 Female White Female Black Female
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
Page 40 of 91 PHDMC Epidemiology 11/16/17
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
Total White Black Total White Male
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
Page 41 of 91 PHDMC Epidemiology 11/16/17
Bladder Cancer
All Male Female
Total White Black Total White Male
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%
Male vs. Female 3.79 or 279%
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 incidence rate per 100,000
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
Health Disparities Report 2017
Page 42 of 91 PHDMC Epidemiology 11/16/17
Female Breast Cancer
All White Black 128.8 126.3 132.0
*Per 100,000 population
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 incidence rate per 100,000
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
Health Disparities Report 2017
Page 43 of 91 PHDMC Epidemiology 11/16/17
Colorectal Cancer
All Male Female
Total White Black Total White Male
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%
Male vs. Female 1.28 or 28%
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 incidence rate per 100,000
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
Health Disparities Report 2017
Page 44 of 91 PHDMC Epidemiology 11/16/17
Kidney and Renal Pelvis Cancer
All Male Female
Total White Black Total White Male
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%
Male vs. Female 1.58 or 58%
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
Health Disparities Report 2017
Page 45 of 91 PHDMC Epidemiology 11/16/17
Leukemia
All Male Female
Total White Black Total White Male
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
White vs. Black 1.36 or 36%
White Male vs. Black Male 2.02 or 102%
White Female vs. Black Female 1.07 or 7%
Male vs. Female 1.17 or 17%
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 incidence rate per 100,000
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
Health Disparities Report 2017
Page 46 of 91 PHDMC Epidemiology 11/16/17
Lung and Bronchus Cancer
All Male Female
Total White Black Total White Male
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 vs. Black 1.03 or 3%
White Male vs. Black Male 0.92 or -8%
White Female vs. Black Female 1.14 or 14%
Male vs. Female 1.25 or 25%
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 incidence rate per 100,000
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
Health Disparities Report 2017
Page 47 of 91 PHDMC Epidemiology 11/16/17
Melanoma of the Skin
All Male Female
Total White Black Total White Male
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
Male vs. Female 1.55 or 55%
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 incidence rate per 100,000
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
Health Disparities Report 2017
Page 48 of 91 PHDMC Epidemiology 11/16/17
Non-Hodgkin’s Lymphoma (NHL)
All Male Female
Total White Black Total White Male
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
White vs. Black 1.53 or 53%
White Male vs. Black Male 2.02 or 102%
White Female vs. Black Female 1.15 or 15%
Male vs. Female 1.55 or 55%
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 incidence rate per 100,000
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
Health Disparities Report 2017
Page 49 of 91 PHDMC Epidemiology 11/16/17
Oral Cavity and Pharynx Cancer
All Male Female
Total White Black Total White Male
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 vs. Black 1.92 or 92%
White Male vs. Black Male 1.65 or 65%
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 incidence rate per 100,000
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
Health Disparities Report 2017
Page 50 of 91 PHDMC Epidemiology 11/16/17
Ovarian Cancer (female)
All White Black 12.8 13.5 9.7
*Per 100,000 population
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 incidence rate per 100,000
Age-adjusted Ovarian Cancer Incidence Rate by RaceMontgomery County, 2011-2013
Age-adjusted Ovarian Cancer Incidence Rate* by Race, Montgomery County, 2011-2013
Health Disparities Report 2017
Page 51 of 91 PHDMC Epidemiology 11/16/17
Pancreatic Cancer
All Male Female
Total White Black Total White Male
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%
Male vs. Female 1.11 or 11%
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 incidence rate per 100,000
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
Health Disparities Report 2017
Page 52 of 91 PHDMC Epidemiology 11/16/17
Prostate Cancer (male)
All White Black 106.2 92.5 149.7
*Per 100,000 population
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
Health Disparities Report 2017
Page 53 of 91 PHDMC Epidemiology 11/16/17
Thyroid Cancer
All Male Female
Total White Black Total White Male
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
White vs. Black 1.49 or 49%
White Male vs. Black Male 1.94 or 94%
White Female vs. Black Female 1.48 or 48%
Male vs. Female 0.31 or -69%
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 incidence rate per 100,000
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
Health Disparities Report 2017
Page 54 of 91 PHDMC Epidemiology 11/16/17
Uterine Cancer (female)
All White Black 24.2 25.2 19.5
*Per 100,000 population
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 incidence rate per 100,000
Age-adjusted Uterine Cancer Incidence Rate by Race, Montgomery County2011-2013
Age-adjusted Uterine Cancer Incidence Rate* by Race, Montgomery County, 2011-2013
Health Disparities Report 2017
Page 55 of 91 PHDMC Epidemiology 11/16/17
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.
Health Disparities Report 2017
Page 56 of 91 PHDMC Epidemiology 11/16/17
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
Melanoma of the Skin
NHL*
Oral Cavity & Pharynx
Ovarian
Pancreatic
Prostate
Thyroid
Uterine *Non-Hodgkin’s Lymphoma
Indicates Highest Rate
Not Applicable
Health Disparities Report 2017
Page 57 of 91 PHDMC Epidemiology 11/16/17
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.
Health Disparities Report 2017
Page 58 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
Page 59 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
Page 60 of 91 PHDMC Epidemiology 11/16/17
*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
Health Disparities Report 2017
Page 61 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
Page 62 of 91 PHDMC Epidemiology 11/16/17
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)
Montgomery County, 2014-2015
Health Disparities Report 2017
Page 63 of 91 PHDMC Epidemiology 11/16/17
* 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
Health Disparities Report 2017
Page 64 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
Page 65 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
Page 66 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
Page 67 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
Page 68 of 91 PHDMC Epidemiology 11/16/17
*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
Health Disparities Report 2017
Page 69 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
Page 70 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
Page 71 of 91 PHDMC Epidemiology 11/16/17
* Special equipment such as a cane, wheelchair, special bed, or special telephone.
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
Health Disparities Report 2017
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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
Health Disparities Report 2017
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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
Health Disparities Report 2017
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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
Health Disparities Report 2017
Page 75 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
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*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
Health Disparities Report 2017
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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
Health Disparities Report 2017
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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
Health Disparities Report 2017
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* Special equipment such as a cane, wheelchair, special bed, or special telephone.
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
Health Disparities Report 2017
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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
Health Disparities Report 2017
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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
Health Disparities Report 2017
Page 82 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
Page 83 of 91 PHDMC Epidemiology 11/16/17
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
Health Disparities Report 2017
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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
Total < HS HS Grad Some College College Grad
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
Health Disparities Report 2017
Page 85 of 91 PHDMC Epidemiology 11/16/17
57.0%45.4%
55.8% 58.7%
84.9%
0
10
20
30
40
50
60
70
80
90
Total < HS HS Grad Some College College Grad
Pe
rce
nt
73.4%
48.3%64.3%
76.0%89.6%
0
10
20
30
40
50
60
70
80
90
100
Total < HS HS Grad Some College College Grad
Pe
rce
t
Current Smokers Who Tried to Quit Smoking by Educational Attainment
Montgomery County, 2014-2015
Adults who are Physically Active by Educational Attainment, Montgomery County
2014-2015
Health Disparities Report 2017
Page 86 of 91 PHDMC Epidemiology 11/16/17
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.
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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.
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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.
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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.
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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
Health Disparities Report 2017
Page 91 of 91 PHDMC Epidemiology 11/16/17
This report was produced by
Public Health – Dayton & Montgomery County Epidemiology
Reibold Building • 117 South Main Street
Dayton, OH 45422-1280.
For more information, call (937) 225-5700.
To download or view this report online,
Visit www.phdmc.org.
Search for: Health Disparities Report
Report completed by Kyle D. Wallace, Epidemiologist