June 14, 2012

Mixed results define 2012 Tennessee Men’s Health Report Card

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Vanderbilt head football coach James Franklin speaks at Tuesday's event at LP Field marking the release of the 2012 Tennessee Men's Health Report Card. (photo by Joe Howell)

Mixed results define 2012 Tennessee Men’s Health Report Card

Heart disease is still the leading cause of death for men in Tennessee and cancer deaths continue to move further away from the Centers for Disease Control and Prevention’s (CDC) Healthy People 2020 (HP2020) goal, according to the 2012 Tennessee Men’s Health Report Card released this week at LP Field in Nashville.

Representatives from Vanderbilt University Medical Center, Meharry Medical College and the Tennessee Department of Health (TDH) unveiled the findings of the report, the most recent study of the overall state of men's health in Tennessee.

This year's report highlights some health victories but also shows areas where there is a need to improve, said Vanderbilt’s David Penson, M.D., MPH, who chaired the Tennessee Men’s Health Report Card.

“Although heart disease is still the leading cause of death among men over age 65 in our state, we are getting straight A's when it comes to meeting our goals for reducing deaths from heart disease. In addition, while there is still room for improvement, we're getting A's and B's when it comes to preventive medical services, like influenza vaccination and colorectal cancer screening,” said Penson, a professor of Urologic Surgery.

“Unfortunately, not all of the news is good. We still are using too many tobacco products, which in turn has led to unacceptable rates of lung and head and neck cancer deaths. Almost a third of Tennessee men are obese, which greatly contributes to diabetes, hypertension and heart disease in our state,” he said.

Heart disease is responsible for 26.9 percent of deaths for men age 65 and older, 26.2 percent for ages 40-64, and 9.7 percent for ages 18-39. It is also the most favorable category for Tennessee men, with whites and African-Americans receiving an “A” rating on this year’s report card. African-Americans reduced deaths in this category from 102.5 per 100,000 in 2005 to just 63.5 per 100,000 in 2010. The HP2020 goal is 100.8.

Risk factors such as obesity, lack of exercise, cigarette smoking, high blood pressure, high cholesterol, diabetes and poor nutritional choices all contribute to heart disease and stroke. Screening, early treatment and behavioral changes can help reduce heart disease risk.

“More than anything, this report highlights the continued need for targeted education and prevention programs throughout the state of Tennessee,” said Charles Mouton, M.D., M.S., dean of the School of Medicine and senior vice president for Health Affairs at Meharry Medical College.

“Tennessee has made a little progress, but we have to keep our vigilance in order to continue to move the state’s overall health forward. Many disparities still exist for African-American men in Tennessee when compared to white men, particularly in the areas of cancer and HIV/AIDS. Prevention and early screening programs save lives and are key to long-standing improvement in the state’s health outcomes," Mouton said.

The report provides data on the health status of more than 3 million adult men, comparing Tennessee to national benchmarks for health improvement established by the CDC. The report offers the opportunity to prospectively focus on improving health and health care in specific areas.

“Slightly more than 30 percent of Tennessee’s men age 18 and older are obese while more than 40 percent are considered overweight. According to 2011 data, Tennessee ranks fourth highest in the nation for obesity. The problem is epidemic,” said Jeff Balser, M.D., Ph.D., vice chancellor for Health Affairs for Vanderbilt University and dean of Vanderbilt University School of Medicine.

“Due to the profound complications associated with obesity, such as diabetes, kidney disease, cancer and heart disease, not to mention associated quality of life issues, it is imperative that we quickly begin to address this issue in ways that will bring impact.”

Data was collected from birth and death certificates, the statewide hospital discharge data reporting system, infectious diseases data reported to the State Department of Health, the Behavioral Risk Factor Surveillance System, and the U.S. Census Current Population Survey for Tennessee.

Grades were assigned by comparing Tennessee data from calendar year 2010, the most recent set of complete data available, to national health objectives set by the CDC in its HP2020 framework (healthypeople.gov/2020).

The CDC made considerable changes to the HP2020 goals, compared to the Healthy People 2010 goals that were used in the 2010 Tennessee Men’s Health Report Card, so making comparison of grades between the present and previous report card is problematic in some cases.

The report's findings do suggest some simple ways for Tennessee's men to take a more active role in improving their health by wearing seatbelts, exercising regularly, reducing alcohol intake, quitting tobacco and wearing condoms.

In Tennessee, 56.6 percent of occupants killed in motor vehicle crashes were not wearing restraints, compared to 49.2 percent nationally. Tobacco use is not only associated with lung cancer but also chronic lung disease such as emphysema and bronchitis, stroke, head and neck cancer, bladder cancer, heart disease and blood vessel disease.

Excessive alcohol use is a risk factor for liver disease, sexually transmitted infections, suicide, homicide, motor vehicle deaths and other unintentional injuries. It is also associated among men with cancers of the oral cavity, pharynx, esophagus, larynx, stomach, colon, rectum and liver.

“Gathering and examining statistical data is a critical function of the Tennessee Department of Health’s mission to promote, protect and improve the health of Tennesseans,” said Lori Ferranti, Ph.D., who directs the TDH Division of Policy, Planning and Assessment. “This report card marks the second year of work in generating this review. In addition to having a member on the Scientific Advisory Board, TDH provided statewide men’s demographic and health data, using information from our database of health surveys, hospitalizations and vital statistics.

“We believe the report card can be another valuable tool to inform the public of trends affecting the status of men’s health in Tennessee, and to help identify measures to address issues needing attention,” Ferranti said.

Although there were several categories with significant reductions in deaths since 2005, the state received overall failing grades in deaths from cancer, lung cancer, stroke, head and neck cancer, liver disease, motor vehicle accidents, HIV, syphilis, homicide, unintentional injury and suicide. Stroke deaths are down overall since 2005 but still received a “D,” Motor vehicle deaths are also down but still received an “F” overall.

More Tennessee men are living in poverty than five years ago and a large proportion (overall 17.5 percent) are over age 25 with no high school diploma. The HP2020 goal is to reduce the high school non-completion rate to 2.1 percent, but currently one in five blacks in Tennessee are over age 25 with no diploma and 44 percent of Hispanics in the state have less than a high school education.

In the category of Reported Health Conditions, the percentage of men told by a doctor they have hypertension, or high blood pressure, is now up to 35.1 percent, which is higher than the proportion of the general population with hypertension at 26.9 percent. Hypertension is a modifiable risk factor for heart and stroke and can improve with exercise, weight management and reducing alcohol and sodium and fat intake.

Racial disparities exist in areas such as prostate cancer deaths, where whites average 25.1 deaths per 100,000 for a “B” grade yet blacks received a “D” for 37.4 deaths per 100,000. Whites did very poorly in the area of cancer death, receiving an “F” for 342.5 per 100,000 and also showing a statistically significant worsening of the indicator since 2005.

AIDS deaths still represent one of the largest disparities, with whites receiving an “A” rating at 3.2 deaths per 100,000 and African-Americans receiving an “F” rating for 25.2 deaths, despite a dramatic reduction from 42 deaths per 100,000 in 2005. The HP2020 goal is 3.3 deaths.

“There are a lot of ways the average citizen can improve his health that don’t require a doctor's visit,” Penson said. “Increased physical activity, healthier dietary habits and quitting smoking are all things men can do on their own to improve their health.”

To review the complete 2012 Tennessee Men's Health Report Card please go to www.TNMensHealthReportCard.vanderbilt.edu.