Massachusetts Department of Public Health June 26, 2007
description
Transcript of Massachusetts Department of Public Health June 26, 2007
2
Goals for holding regional dialogues
• Introduce new DPH leadership
• Present latest health data on your particular region
• Talk with residents and providers about data and identify areas of need
• Gather feedback to inform process of setting DPH priorities
3
Goals of New DPH leadership
• Use data and community input to set new priorities & reshape the Department
• Rely on science and evidence-based process to guide the work
• Strengthen ties with and support for local health and local agencies
• Increase resources to and visibility of public health in Massachusetts
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Timetable
• Hold 8 regional dialogues with comprehensive data review and identification of key health concerns (by July)
• Identify short list of top priorities by end of August
• Hold second round of community dialogues to discuss action plans/results by end of calendar year
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WesternRegion Central
Region
SoutheastRegion
Metro WestRegion
NortheastRegion
BostonRegion
Executive Office of Healthand Human Services Regions
Western Region
Central Region
North East Region
Metro West Region
South East Region
Boston Region
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A few comments about the limitations of this presentation
• A regional analysis has its drawbacks• Variability within a region – urban vs.
rural/suburban (i.e. Boston vs. the rest of the region)
• Variability by sub-population – race matters, poverty matters
• Our data don’t reflect all the important health indicators
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Largest:BOSTON558,435
REVERE45,551
BROOKLINE56,422
CHELSEA34,128
Smallest:WINTHROP
17,067
Population in Cities ofBoston Region: 2005
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
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Race and Ethnic Breakdown of PopulationCities in Boston Region and Massachusetts: 2005
Racial Hispanic
Group
City of Boston
Brookline Chelsea Revere Winthrop Boston Region
MA Total
White* 49.9% 73% 35.9% 81.6% 93.9% 54.1% 81%
Black* 25% 4.2% 5.6% 2.5% 1.5% 20.4% 6%
Hispanic 16.4% 4.8% 53.3% 10.5% 3.1% 16.6% 7.9%
Asian* 8.4% 17.9% 5% 5.2% 1.3% 8.6% 4.9%
American Indian*
0.3% 0.1% 0.3% 0.2% 0.2% 0.3% 0.2%
Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program
* Non-Hispanics
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Population by Age Group Cities in Boston Region and Massachusetts: 2005
Ages City of Boston
Brookline Chelsea Revere Winthrop Boston Region
MA Total
0-19 years
24% 19% 30% 23% 21% 23% 26%
20-24 years
11% 10% 7% 5% 5% 10% 7%
25-44 years
35% 34% 35% 33% 34% 35% 29%
45-64 years
20% 25% 18% 23% 25% 20% 25%
65+ years
11% 12% 11% 16% 16% 11% 13%
Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program
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Language Spoken at Home,Cities in Boston Region and Massachusetts: 2000
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
As % of all persons ages>5
City of Boston
Brookline Chelsea Revere Winthrop Boston Region
MA Total
Only English 66.6% 71% 41.6% 71% 87.1% 66.6% 81.3%
Spanish or Spanish Creole
13.6% 3.6% 43.8% 9% 3.6% 13.7% 6.2%
Chinese 3.2% 5.7% 0.6% 0.6% 0.1% 3% 1.2%
French Creole 3.5% 0.4% 0.8% 0.3% 0.1% 2.8% 0.7%
Portuguese or Port. Creole
2.3% 0.7% 2.1% 2.4% 1.4% 2.1% 2.7%
Vietnamese 1.8% 0.1% 1.9% 1% 0% 1.6% 0.5%
Italian 1.2% 0.4% 1% 6.8% 3% 1.5% 1%
French (Incl. Patois, Cajun)
1.4% 1.4% 0.9% 0.6% 1% 1.3% 1.4%
Russian 1.1% 4.4% 0.1% 0.5% 0% 1.2% 0.6%
Mon Khmer, Cambodian
0.1% 0.3% 0.9% 2.5% 0.1% 0.3% 0.4%
Hebrew 0.1% 2.1% 0.1% 0% 0.2% 0.3% 0.1%
Serbo Croatian 0.1% 0.1% 2% 0.9% 0% 0.2% 0.1%
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Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
City of Boston
Brookline Chelsea Revere Winthrop Boston Region
MA Total
Per Capita Income
$23,353 $44,327 $14,628 $19,698 $27,374 $24,413 $25,952
Those living below 100% poverty
19.5% 9.3% 23.3% 14.6% 5.5% 18.2% 9.3%
Less than a High School Education
21.1% 3.7% 40.5% 23.3% 10% 20.3% 15.2%
Speak language other than English at home
33.4% 29.0% 58.4% 29.1% 12.9% 21.9% 18.7%
Foreign born 25.8% 26.6% 36.1% 21% 8.7% 25.6% 12.2%
Unemployed 5.5% 3% 7.5% 6.3% 5.1% 5.4% 5.1%
Socio-Demographic IndicatorsCities in Boston Region and Massachusetts: 2000
14
5.1
7.0
9.4
5.8
10.2
4
5
6
7
8
9
10
11
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Infa
nt
De
ath
s p
er
10
00
Liv
e B
irth
s
MA Boston Region City of Boston
Infant Mortality Rate (IMR) Boston Region and Massachusetts: 1990-2005
MA
BostonRegion
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Infant Mortality Rate: deaths of infants less than one year of age per 1000 live births
*
*
City of Boston
Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better
15
Infant Mortality Rates by EOHHS Region Massachusetts: 2003-2005
4.8 4.9
4.0**4.7
5.6 5.45.7
0
1
2
3
4
5
6
7
8
9
10
Western Central Northeast Metrowest Southeast BostonRegion
MA
Infa
nt
De
ath
s p
er
10
00
Liv
e B
irth
s
Source: MDPH, Health Information, Statistics, Research & Evaluation Bureau, Research & Epidemiology Program
Infant Mortality Rate: deaths of infants less than one year of age per 1000 live births
Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better
16Infant Mortality Rates by Race/Ethnicity
Boston Region and Massachusetts: 2003-2005
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
11.2
3.24.1
11.6
7.06.2
2.13.0
0
2
4
6
8
10
12
14
Boston Region Massachusetts
Infa
nt
Dea
ths
per
100
0 L
ive
Bir
ths
White non-Hispanic Black non-HispanicHispanic Asian non-Hispanic
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
17
Teen Birth Rates by Cities in Boston Region & Massachusetts: 2003-2005
2230
44
29
73
0
25
50
75
100
City of Boston Chelsea Revere BostonRegion
MA
Bir
ths
pe
r 1
,00
0 w
om
en
ag
es
15
-19
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
*
Teen birth rates are number of births to women ages 15-19 per 1000 females ages 15-19.
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
*
*
*
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Public Source of Prenatal Care Payment byCities in Boston Region & Massachusetts: 2003-2005
30.7
44.8
23.9
5.8
66.1
46.2
52.1
0
10
20
30
40
50
60
70
City ofBoston
Brookline Chelsea Revere Winthrop BostonRegion
MA
Pe
rce
nt
(%)
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Statistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than state
**
*
*
Public: Government programs including Commonhealth, Healthy Start, Medicaid/MassHealth, or free care
*
*
**
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Leading Causes of DeathBoston Region and Massachusetts:2005
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Massachusetts N=53,776
Heart Disease
13,248 24.6%
Cancer
13,159 24.5%
Stroke 2,979 5.5%
All Injuries 2,657 4.9%
Chronic Lower Respiratory Disease
2,643 4.9%
Influenza and Pneumonia 1,932 3.6%
Alzheimer's 1,635 3.0%
Nephritis 1,403 2.6%
Diabetes 1,271 2.4%
Septicemia
982 1.8%
Boston RegionN=5,394
Cancer 1,293 24.0%
Heart Disease 1,180
21.9%**
All Injuries 315 5.8%*
Stroke 292 5.4%
Chronic Lower Respiratory Disease 230 4.3%
Influenza and Pneumonia 212 3.9%
Nephritis 165 3.1%
Septicemia 140 2.6%*
Diabetes 139 2.6%
Alzheimer’s 107 2.0%
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Adults who are Overweight1 by EOHHS Region, Massachusetts:
1995 & 2005
57.8
49.5 45.7
43.5 44.6
50.2
35.7
45.1
52.0
57.560.8
55.952.6
56.1
0
10
20
30
40
50
60
70
Western Central Northeast MetroWest
Southeast BostonRegion
MA
Per
cen
t
1995 2005
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), Health Survey Program
1 Obesity: BMI greater than or equal to 25
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
23
Hospital Discharge Rates for Hypertension byCities in Boston Region & Massachusetts: 2003-2005
39
85
3438
77
96
45
0
50
100
150
City ofBoston
Brookline Chelsea Revere Winthrop BostonRegion
MA
Ho
sp
ita
liza
tio
ns
pe
r 1
00
,00
0
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
*
*
Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database
*
24Hospital Discharge Rate for Hypertension
by Race/EthnicityBoston Region & Massachusetts: 2003-2005
176
2838
207
11489
3345
0
50
100
150
200
250
Boston Region Massachusetts
Ho
sp
ita
liza
tio
ns
pe
r 1
00
,00
0
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database
*
*
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
25
Prevalence of Diabetes Massachusetts: 1994-2005
3.8
5.6
6.46.25.8
5.6
5.8
4.9
4.3
4.7
3.8
0
1
2
3
4
5
6
7
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Per
cen
t
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), Health Survey Program
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Diabetes Hospital Discharges byCities in Boston Region & Massachusetts: 2003-2005
132.5
208.1
118.4
77.4
194.6
230.2
188.6
0
100
200
300
City ofBoston
Brookline Chelsea Revere Winthrop BostonRegion
MA
Ho
sp
ita
liza
tio
ns
pe
r 1
00
,00
0
Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database
*
*
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
*
**
*
27
Diabetes Hospital Discharge Rate by Race/Ethnicity
Boston Region and Massachusetts: 2003-2005
368
114136
416
239 242
4554
0
50
100
150
200
250
300
350
400
450
Boston Region Massachusetts
Ho
spit
aliz
atio
ns
per
100
,000
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Inpatient Hospital Discharge Database
*
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
*
29
Prostate Cancer Incidence Rates byCities in Boston Region & Massachusetts: 1999-2003
181.9191.3
213.6200.0
129.3
198.9
143.0
0
50
100
150
200
250
City ofBoston
Brookline Chelsea Revere Winthrop BostonRegion
MA
Ne
w c
as
es
pe
r 1
00
,00
0
Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
*
****
30
Lung Cancer Mortality Rate byCities in Boston Region & Massachusetts: 2003-2005
52.956.0
85.4
32.1
65.9
55.6
66.6
0
10
20
30
40
50
60
70
80
90
City ofBoston
Brookline Chelsea Revere Winthrop BostonRegion
MA
De
ath
s p
er
10
0,0
00
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
**
Age-adjusted to the 2000 US standard population
*
*
31
Adults who Currently Smoke by EOHHS Region, Massachusetts: 2005
20.418.1
12.4
18.318.821.2
19.5
0
5
10
15
20
25
30
Western Central Northeast Metro West Southeast BostonRegion
MA
Per
cen
t
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Health Survey Program
**
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
33
Substance Abuse Treatmentsby EOHHS Region, Massachusetts: 2005
1,7241,601
871
1,379
2,044
1,393
3,035
0
500
1000
1500
2000
2500
3000
3500
Western Central Northeast MetroWest
Southeast BostonRegion
MA
Tre
atm
en
ts p
er
10
0,0
00
*
** **
**
*
*
Source: Massachusetts Department of Public Health. BSAS Substance Abuse Treatment Programs 2005.
Statistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than stateCrude rates
34Substance Abuse Treatments Alcohol Primary Substance by
Cities in Boston Region & Massachusetts: 2005
661
437
1216
486
220
451
1034
0
200
400
600
800
1000
1200
1400
City ofBoston
Brookline Chelsea Revere Winthrop BostonRegion
MA
Tre
atm
ents
per
100
,000
Source: Massachusetts Department of Public Health. BSAS Substance Abuse Treatment Programs 2005.
*
**
*
****
**
Crude ratesStatistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than state
35
609
1484
897
73
633
1713
1284
0
200
400
600
800
1000
1200
1400
1600
1800
City ofBoston
Brookline Chelsea Revere Winthrop BostonRegion
MA
Tre
atm
ents
per
100
,000
Source: Massachusetts Department of Public Health. BSAS Substance Abuse Treatment Programs 2005.
**
*
*
Substance Abuse Treatments Heroin Primary Substance by
Cities in Boston Region & Massachusetts: 2005
*
*
Crude ratesStatistically different from state (p ≤.05)– Red (*) Statistically higher than state- Green (**) statistically lower than state
36Opioid-related Emergency Visit Rates by Race/Ethnicity
Boston Region and Massachusetts: 2003-2005
188
348
187
275300
237
20 100
50
100
150
200
250
300
350
400
Boston Region Massachusetts
Vis
its
per
100
,000
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
*
*
*
*
Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Department Visits
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
37
Opioid-Related Fatal Overdoses byCities in Boston Region & Massachusetts: 2003-2005
8.1
20.4
22.6
10.5 10.8
0
5
10
15
20
25
City of Boston Chelsea Revere Boston Region MA
De
ath
s p
er
10
0,0
00
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
*
Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
* *
*
39
2.6
8.6
7.3
1.9
0
2
4
6
8
10
City of Boston Region exc. City ofBoston
Boston Region MA
De
ath
s p
er
10
0,0
00
Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
Age-adjusted to the 2000 US standard population
*
*
Homicides in Boston Regionand Massachusetts: 2003-2005
40
Homicide Rates by Race/EthnicityBoston Region and Massachusetts: 2003-2005
1
15
86
4
22
23
0
5
10
15
20
25
30
Boston Region Massachusetts
De
ath
s p
er
10
0,0
00
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
*
*
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
41Emergency Department Visit Rates for Firearm Injuries by Race/Ethnicity
Boston Region and Massachusetts: 2003-2005
38
1 2
46
1419
3
0
5
10
15
20
25
30
35
40
45
50
Boston Region Massachusetts
Vis
its
per
100
,000
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
**
Age-adjusted to the 2000 US standard population. Source: Division of Health Care Finance and Policy. Calendar Year 2003-2005. Emergency Department Visits
NA
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
42
Firearm Death Rates by Race/EthnicityBoston Region and Massachusetts: 2003-2005
2 2
13
54
1
21
0
5
10
15
20
25
Boston Region Massachusetts
De
ath
s p
er
10
0,0
00
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
NA
*
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
44
HIV Incidence byCities in Boston Region & Massachusetts : 2005
13
23 22
45
39
0
5
10
15
20
25
30
35
40
45
50
City of Boston Chelsea Revere Boston Region MA
Ne
w c
as
es
pe
r 1
00
,00
0
*
*
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
Source: MDPH, BCDC HIV/AIDS Files as of 09/01/06Crude rates
45
HIV/AIDS Death Rate by Race/EthnicityBoston Region and Massachusetts: 2003-2005
2
20
16
13
1
5
9
0
5
10
15
20
25
Boston Region Massachusetts
De
ath
s p
er
10
0,0
00
White non-Hispanic Black non-HispanicHispanic Asian non-Hispanic
NA
*
Age-adjusted to the 2000 US standard population. Source: MDPH, Health Information, Statistics, Research and Evaluation Bureau, Research & Epidemiology Program
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
46
Tuberculosis Incidence by EOHHS Region Massachusetts: 2006
4.1
2.7
4.3
3.02.6
4.2
27.7
0
2
4
6
8
10
12
Western Central Northeast Metro West Southeast BostonRegion
MA
New
cas
es p
er 1
00,0
00 p
op
ula
tio
n
*
Statistically different from State (p ≤.05) Red (*) = Statistically worse; Green (**) = Statistically better
Source: MDPH Bureau of Communicable Disease Control, ISIS
48
Pediatric Asthma Prevalence Among School Children, Grades K-8
by EOHHS Region Massachusetts: 2005-2006
10.5 10.69.4
10.1
12.7
9.8
13.0
0
5
10
15
20
Western Central Northeast Metro West Southeast BostonRegion
MA
Pe
rce
nt
Source: MDPH, Center for Environmental Health, Pediatric Asthma Surveillance (2005-2006)
**
** ****
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
49Asthma Emergency Visit Rates,Children Ages 0-14
by EOHHS Region, Massachusetts: 2005
808697
584594
995
811
1,771
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
Western Central Northeast Metro West Southeast BostonRegion
MA
Vis
its
pe
r10
0,0
00
Source: Division of Health Care Finance and Policy. Calendar Year 2005. Emergency Visits
** **
*
*
**
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
50
516
2,096
356
726454
1,557
3,130
1,573
1,799
659623310
0
500
1,000
1,500
2,000
2,500
3,000
3,500
City of Boston Boston Region, exc Cityof Boston
MA
Vis
its
per
100
,000
White non-Hispanic Black non-Hispanic
Hispanic Asian non-Hispanic
*
Source: Division of Health Care Finance and Policy. Calendar Year 2005. Emergency Department Visits
*
*
Asthma Emergency Visit Rates by Race/Ethnicity Children Ages 0-14
Boston Region and Massachusetts: 2003-2005
*
**
****
Statistically different from state (p ≤.05)– Red (*) Statistically worse than state- Green (**) statistically better than state
51
Source: Division of Health Care Finance and Policy. Calendar Year 2005. Hospital Discharges
BOSTON646.8
REVERE403.5
BROOKLINE359.8
WINTHROP593
CHELSEA208.8
Hospitalization Rates by Townsper 100,000
Significantly higher than state rate
Not different from state rate
Significantly lower than state rate
Massachusetts State Total: 337.5
Pediatric Asthma Hospitalization Rates by TownsAmong Children Ages <5
Boston Region - Massachusetts 2004-2005
52
Summary
Residents of large cities are disproportionately affected by, including the following:
Boston: Teen pregnancies, diagnosis of prostate cancer & HIV, hospitalizations for hypertension & diabetes, admissions for substance abuse treatment, emergency visits of children with asthma, deaths to diabetes, opioid- related fatal overdoses, firearm injuries, and homicides
Chelsea: Teen pregnancies, hospitalizations for hypertension and diabetes, deaths to diabetes and to opioid-related fatal overdoses
Revere: Teen pregnancies, hospitalizations for diabetes, admissions for substance abuse treatment, deaths to lung cancer and to opioid-related fatal overdoses
Winthrop: Deaths to lung cancer, admissions for heroin abuse treatment
53
Health Disparities
The following groups of the Boston region, when compared with those at the state level, have higher rates of:
Blacks: hospitalizations for hypertension & diabetes, homicides, deaths to firearm injuries and HIV
Whites: hospitalizations for hypertension & diabetes, homicides
Refugees: high TB rates; increased lead poisoning among children
54
How Can You Access these Data?
• Hard Copies: (617) 624-5674
• TDD/TTY: (617) 624-6001
• DPH Website:
mass.gov/dph/bhsre/resep/resep.htm
• For other questions or suggestions:
[email protected], 617-624-6021
• For more detailed community data:
http://masschip.state.ma.us/