Selected data concerning public health programs in Connecticut
and the health of Connecticut's residents
Published by:
State of Connecticut
Department of Public Health and Addiction Services
April, 1995
First Printing
This publication is not copyrighted. Readers may duplicate and use freely all or part of the material it contains; however, the Department of Public Health and Addiction Services requests acknowledgment of any information reprinted, quoted, or used in any way.
Suggested Citation:
Bower, C.E., D. Iodice, C. Rankl, and D.M. Winiarski. 1995. Connecticut health 1994: Selected data concerning public health programs in Connecticut and the health of Connecticut's residents. Hartford, CT: Connecticut Department of Public Health and Addiction Services, 128 pp.
Single copies of this book may be obtained without charge from the CT Department of Public Health. Please call 860-509-7218.
ACKNOWLEDGMENTS
We gratefully acknowledge the contributions of the following people, who provided data, critically reviewed the text, and provided support and assistance throughout the development and production of this publication:
Mary Adams, Eileen Alvarado, Federico Amadeo, Norman Armondino, Laura Victoria Barrera, Kay Berris, Al Bidorini, Vicki Carlson, Marcie Cavacas, Pat Checko, Carol Christoffers, Kathy Cobb, Susan Coes, George Cooper, Shirley Cotton, Bill Dahn, Paula Delage, Lois Desmarais, Dennis Dix, Carolyn Jean Dupuy, Linda Durante, Carol Fineout, Tom Furgalack, Mary Kapp, Elise Gaulin-Kremer, Joe Gillen, Ruth Gitchell, Jim Hadler, Sanders Hawkins, Sharon Hunter, Jerry Iwan, Ray Jarema, Heidi Jenkins, Liz Johnston, Jennifer Klein, Deanie LaPlante, Valerie Leal, Linda Lynch, John Maltese, Joe Marino, Jann Moody, Michelle Morris, Lloyd Mueller, Chris Murphy, Barbara Nevins, Sandra Newman, Karen Nolen, Lynn Noyes, Noreen Passardi, Pat Piepul, Tony Polednak, Bea Powell, Walter Rebenske, Bill Sawicki, Frank Schaub, Bob Schreiber, Paul Schur, Sandra Selenskas, Joan Shaia, Gordon Shand, Alan Siniscalchi, Ron Skomro, Paul Smith, Anita Steeves, Carolyn Sucheki, Dottie Trebisacci, Bill Ulrich, Beth Weinstein.
PREFACE
Connecticut Health 1994 is the first in a series of annual publications providing an overview of public health programs in Connecticut and the health of Connecticut residents. It replaces and expands the series of booklets entitled Connecticut Health Data, which was published each year from 1982 through 1991.
The information presented here generally pertains to the most recent 12-month period for which complete data were available at the time of compilation. Depending on the specific program or activity, the period may be a calendar year, CY (January 1 through December 31 of the named year), a state fiscal year, SFY (July 1 through June 30 of the named year), or a federal fiscal year, FFY (October 1 through September 30 of the named year). Data from one or more prior years and for the United States sometimes are included for comparison. For cumulative statistics (numbers of licensed professionals, etc.) numbers typically are presented "as of" the date of submission for publication; in future editions, they will be standardized to the last day of a given calendar year, state fiscal year, or federal fiscal year.
This book is not intended to be a complete and fully comprehensive aggregation of health statistics; rather, it is a compendium of useful information for enabling informed policy decisions, for public education, and for basic reference. It contains an array of key data from the many divisions within the Department of Public Health and Addiction Services (DPHAS) and from other sources, including other state agencies and prior, more comprehensive publications. For ease of reference, the material is divided into 12 chapters, which are arranged by subject area rather than by the organizational structure of DPHAS; hence, data gathered by any given DPHAS subdivision may be found in one or more chapters. The sources of all data are documented to enable readers to pursue topics of interest in greater depth.
For further information, readers are encouraged to contact staff in the DPHAS division referenced at the end of the entry of interest. An abridged department telephone directory, arranged according to the major organizational divisions within DPHAS, is included as an appendix.
CONTENTS
ACKNOWLEDGMENTS
PREFACE
Population Estimates
Unemployment
Births, Deaths, Marriages, and Divorces
Leading Causes of Death
Fetal and Infant Deaths
Legal Induced Abortions
Infant and Maternal Health Indicators
Behavioral Risk Factor Surveillance System
Connecticut Health Check: Health Risk Appraisal for Youth
Reportable Diseases
Rabies and Other Zoonoses
Acquired Immunodeficiency Syndrome (AIDS)
Sexually Transmitted Diseases
Tuberculosis Prevention and Control
Incidence of Cancer
Clinical Stage of Disease at Diagnosis
Prevalence of Substance Abuse
Community-based Treatment Programs
Prevention Programs
Pre-trial Alcohol Education System (PAES)
Adolescent Pregnancy Prevention & Young Parent Program
Healthy Start
Special Supplemental Food Program for Women, Infants, and Children (WIC)
Genetics
Sudden Infant Death Syndrome
Immunizations
Healthy Steps
Children with Special Health Care Needs
Nutrition
Asbestos
Food Protection
Childhood Lead Poisoning Prevention
Occupational Health Surveillance
Radon
Recreational Health and Safety
On-site Sewage Disposal and Groundwater Control
Water Supplies
State Laboratory Services
Biological Sciences
Laboratory Standards and Clinical Chemistry
Environmental Chemistry
Toxicology and Criminology
Medical and Other Health Service Professions
Emergency Medical Service Professions
Environmental Health Professions
Long-term Care Facilities, Acute Care and Chronic Disease Hospitals, Outpatient Clinics, Home Health Care Agencies, and Specialty Facilities
Mental Health and Substance Abuse Facilities
Well-child Clinics, Day Care Centers, and Day Care Homes
Day and Residential Youth Camps
Funeral Homes and Optical Establishments
Laboratories
Local Health Departments
School-based Health Centers
Community Health Centers
Sexual Assault Crisis Services
Acute Care
Home Health Care
Long-term Care
Most Popular Names for Babies
Federal Poverty Guidelines
1 DEMOGRAPHICS
1.1 Population Estimates
Mid-year town population estimates for 1993 were issued in October, 1994 by the DPHAS Health Research and Data Analysis Unit (1). These estimates are the basis of birth, death, and other population-based rates for 1993. The estimates indicate that since the 1990 US Census, Connecticut's population decreased by 9,806 residents.
TABLE 1-1. Connecticut population estimates, 1993, by county,a congressional district,b uniform regional service delivery area (URSDA),c and towna,d (1).
State, State, County,
County, Congressional
Congressional Estimated District, Estimated
District, population URSDA, or Town population
URSDA, or
Town
Connecticut 3,277,310 Town
Ashford 3,920
County Avon 14,290
Fairfield 828,250 Barkhamsted 3,410
Hartford 846,560 Beacon Falls 5,260
Litchfield 176,390 Berlin 16,890
Middlesex 144,420 Bethany 4,720
New Haven 800,660 Bethel 17,780
New London 248,110 Bethlehem 3,210
Tolland 129,860 Bloomfield 19,080
Windham 103,060 Bolton 4,710
Bozrah 2,260
Congr. Branford 28,150
District
District 1 544,250 Bridgeport 138,730
District 2 542,360 Bridgewater 1,690
District 3 541,435 Bristol 60,570
District 4 546,986 Brookfield 14,480
District 5 552,352 Brooklyn 6,710
District 6 549,927 Burlington 7,430
Canaan 1,180
URSDA Canterbury 4,560
Northwestern 555,940 Canton 8,380
North Central 945,000 Chaplin 2,060
Eastern 383,920 Cheshire 26,160
South Central 764,590 Chester 3,450
Southwestern 627,860 Clinton 12,800
Colchester 11,290
Town Colebrook 1,340
Andover 2,710 Columbia 4,680
Ansonia 18,130 Cornwall 1,430
Table 1-1 continues.
TABLE 1-1. (Continued.)
State, State, County, County, Congressional Congressional Estimated District, Estimated District, population URSDA, or Town population URSDA, or Town Town Town Coventry 10,630 Killingworth 5,010 Cromwell 12,480 Lebanon 6,220 Danbury 66,420 Ledyard 14,660 Darien 18,720 Lisbon 3,790 Deep River 4,350 Litchfield 8,450 Derby 12,080 Lyme 1,950 Durham 5,950 Madison 15,980 Eastford 1,350 Manchester 50,760 Easton 6,370 Mansfield 19,020 East Granby 4,330 Marlborough 5,670 East Haddam 6,970 Meriden 58,970 East Hampton 10,690 Middlebury 6,180 East Hartford 48,970 Middlefield 3,960 East Haven 26,530 Middletown 42,940 East Lyme 15,270 Milford 49,360 East Windsor 9,810 Monroe 17,380 Ellington 11,600 Montville 16,540 Enfield 46,010 Morris 2,150 Essex 5,760 Naugatuck 31,200 Fairfield 52,960 Newington 28,490 Farmington 21,030 Newtown 20,810 Franklin 1,750 New Britain 73,100 Glastonbury 28,000 New Canaan 18,420 Goshen 2,410 New Fairfield 12,900 Granby 9,390 New Hartford 5,970 Greenwich 57,550 New Haven 125,630 Griswold 10,030 New London 26,820 Groton 43,550 New Milford 24,400 Guilford 20,180 Norfolk 2,080 Haddam 6,980 North Branford 13,080 Hamden 51,960 North Canaan 3,110 Hampton 1,630 North Haven 21,580 Hartford 139,980 No. Stonington 4,760 Hartland 1,900 Norwalk 79,450 Harwinton 5,300 Norwich 35,470 Hebron 7,390 Old Lyme 6,480 Kent 3,040 Old Saybrook 9,350 Killingly 16,070 Orange 12,490
Table 1-1 continues.
TABLE 1-1. (Continued.)
State, State, County, County, Congressional Congressional Estimated District, Estimated District, population URSDA, or Town population URSDA, or Town Town Town Oxford 9,070 Suffield 11,350 Plainfield 14,280 Thomaston 7,130 Plainville 17,300 Thompson 8,580 Plymouth 11,660 Tolland 11,360 Pomfret 3,250 Torrington 33,720 Portland 8,410 Trumbull 31,660 Preston 4,980 Union 630 Prospect 8,010 Vernon 29,950 Putnam 8,720 Voluntown 2,220 Redding 7,990 Wallingford 41,090 Ridgefield 21,300 Warren 1,230 Rocky Hill 17,060 Washington 3,980 Roxbury 1,860 Waterbury 108,950 Salem 3,450 Waterford 17,460 Salisbury 4,040 Watertown 20,930 Scotland 1,230 Westbrook 5,320 Seymour 14,480 Weston 8,960 Sharon 2,950 Westport 24,610 Shelton 35,760 West Hartford 58,370 Sherman 2,950 West Haven 53,500 Simsbury 22,110 Wethersfield 24,770 Somers 9,310 Willington 6,220 Southbury 15,740 Wilton 16,170 Southington 38,760 Winchester 11,300 South Windsor 22,350 Windham 21,890 Sprague 2,960 Windsor 27,990 Stafford 11,650 Windsor Locks 12,420 Stamford 109,070 Wolcott 14,110 Sterling 2,580 Woodbridge 8,070 Stonington 16,200 Woodbury 8,420 Stratford 47,810 Woodstock 6,230
a From 1993 Connecticut population estimates (1).
b The estimated population of each congressional district is equal to the sum of the populations of its constituent towns (2). The populations of four towns are divided between two districts (Bolton, Dist. 1,2; Monroe, Dist. 4,5; Southbury, Dist. 5,6; and Woodbridge, Dist. 3,5). The proportions of the populations of these towns assigned to the respective districts are the same as those used for congressional districts in the 1994 State Register & Manual (2), which employed 1990 US Census data.
Footnotes to Table 1-1 continue.
Footnotes to Table 1-1 (continued):
c The Uniform Regional Service Delivery Areas were established by Connecticut Special Act 92-20, as amended by Public Acts 93-262 and 93-381 (3). Estimates for each URSDA consist of the sum of the 1993 estimated populations of its constituent towns.
d Town-level estimates are based on three components: 1) a July 1, 1990 base population, which is the April 1, 1990 US Census count plus the natural increase in population (births minus deaths) during the 3-month period of April to June, 1990; 2) changes in group quarters (e.g., populations of colleges, nursing homes, correctional institutions, psychiatric hospitals, institutions for the mentally retarded, etc.) and natural increase in population (births minus deaths, using preliminary 1993 data and 1992 final data for births and deaths); and 3) changes in four statistical indicators (motor vehicle registrations, voter registrations, elementary school enrollment, and housing units). Town-level component data and a more detailed discussion of methodology are available from the Health Research and Data Analysis Unit.
OF NOTE
Ten Connecticut towns (New Haven, Bridgeport, New Britain, Mansfield, Norwich, West Hartford, New London, Groton, Stratford, East Hartford) had population decreases of more than 1,000 between 1990 and 1993, while Stamford and Norwalk each gained more than 1,000 in population. New Haven lost the most people (4,844) and Norwalk gained the most (1,119) (4).
The resident population of the United States plus Armed Forces overseas was estimated to be 259,681,000 on January 1, 1994 (5) The estimated world population was 5,643,290,000 (6).
About 5.5% of the 105 billion people born since the dawn of the human race are alive today, according to demographer Carl Haub of the Population Reference Bureau(7).
REFERENCES
(1) Estimated populations in Connecticut as of July 1, 1993. 1994. State of Connecticut, Department of Public Health and Addiction Services, Office of Strategic Planning and Information Services, Health Research and Data Analysis Unit, Hartford, CT.
(2) Connecticut congressional districts. 1994. In: Register & Manual, 1994. State of Connecticut, Secretary of the State. Hartford, CT, p. 663-668.
(3) Final uniform regions for state health and human services agencies, January, 1994. Page 56 in: Health and human services reorganization. Progress report to the Connecticut General Assembly, January 1, 1994. Office of Policy and Management, Department of Public Health and Addiction Services, and Department of Social Services. Hartford, CT.
(4) Estimated populations in Connecticut as of July 1, 1993. Unpublished worksheet sorted by change in population size from 1990 to 1993. State of Connecticut, Department of Public Health and Addiction Services, Office of Strategic Planning and Information Services, Health Research and Data Analysis Unit, Hartford, CT.
(5) Estimates of the population of the United States to January 1, 1994. Current population reports: Population estimates and projections. US Department of Commerce, Economics and Statistics Administration, Bureau of the Census. Publ. No. P25-1114, March 1994.
(6) US Bureau of the Census. 1994. Statistical abstract of the United States: 1994 (114th edition). Washington, DC.
(7) Otten, A.L. 1995. People patterns: Odds and ends. Wall Street Journal, February 24, 1995, page B1.
1.2 Unemployment
Labor force data by place of residence are compiled annually by the Connecticut Labor Department.
TABLE 1-2. Annual averagea labor force, employed, and unemployed in CY 1993 for the State of Connecticut and cities with labor forces of 20,000 or more people (1).
Labor No. No. Percent State or city force employed unemployed unemployed Connecticut 1,788,000 1,678,000 111,000 6.2% Bridgeport 64,764 58,604 6,160 9.5% Bristol 34,666 32,118 2,548 7.4% Danbury 38,709 36,318 2,391 6.2% East Hartford 28,568 26,077 2,491 8.7% Enfield 25,459 23,767 1,692 6.6% Fairfield 27,909 26,642 1,267 4.5% Greenwich 31,091 30,086 1,005 3.2% Hamden 29,252 27,696 1,556 5.3% Hartford 57,662 51,674 5,988 10.4% Manchester 29,713 27,674 2,039 6.9% Meriden 32,067 29,507 2,560 8.0% Middletown 24,644 22,927 1,717 7.0% Milford 28,058 26,141 1,917 6.8% New Britain 37,355 34,083 3,272 8.8% New Haven 58,495 54,566 3,929 6.7% Norwalk 48,774 46,465 2,309 4.7% Shelton 20,387 19,088 1,299 6.4% Southington 22,181 20,850 1,331 6.0% Stamford 64,334 61,053 3,281 5.1% Stratford 26,608 24,757 1,851 7.0% Torrington 20,543 19,015 1,528 7.4% Wallingford 23,448 22,029 1,419 6.1% Waterbury 55,798 51,013 4,785 8.6% West Hartford 29,981 28,596 1,385 4.6% West Haven 30,302 28,237 2,065 6.8%
a "Annual average" refers to the average of 12 calendar months.
OF NOTE
The 1993 annual average unemployment for the United States was 6.8% or 8,734,000 individuals (1).
REFERENCE
(1) Connecticut labor force data for labor market areas and towns (by place of residence). Annual average 1993. 1994. State of Connecticut, Department of Labor, Office of Research, Wethersfield, CT. 2 pp.
2 VITAL STATISTICS
Births, Deaths, Marriages, and Divorces
2.1 Births, Deaths, Marriages, and Divorces
The Department of Public Health and Addiction Services maintains a registry of vital events--births, deaths, marriages, and divorces--for the State of Connecticut, and publishes an annual statistical summary in its Registration Report (1). The Registration Report, which contains detailed analyses of birth and death data, is available from the DPHAS Health Research and Data Analysis Unit. The most popular names given to babies born in 1993 are listed in Appendix 1.
TABLE 2-1. Live births, deaths, marriages, and divorces of
Connecticut residents in CY 1990 (1).
Event Number Rate Live births 50,098 15.2b Deaths 27,545 8.4b Marriages 26,046a 15.8c Divorces 11,617 7.1c
a Marriage data are based on the number of events occurring in Connecticut
and do not necessarily reflect the residence of either party.
b Based on number of events per 1,000 population.
c Based on number of individuals married or divorced per 1,000 population,
not on number of events.
TABLE 2-2. Connecticut population, resident live births, and deaths by race and Hispanic ethnicity for CY 1990 (1,2).
Live Deaths Population births Race or No. % Rateb Rateb, ethnicitya No. No. c Race White 2,859,353 87.0 41,501 14.5 25,441 8.9 Black 274,269 8.3 6,196 22.6 1,827 6.7 Other 153,494 4.7 1,093 7.1 99 0.6 Unknown - - 1,308 - 178 - TOTAL 3,287,116 100 50,098 15.2 27,545 8.4 Ethnicity Hispanic 213,116 6.5 5,299 24.9 487 2.3d ethnicity Non-Hispanic 3,074,000 93.5 40,100 13.0 27,057 8.8 Unknown - - 4,699 - 1 - TOTAL 3,287,116 100 50,098 15.2 27,545 8.4
a Race and ethnicity are separate categories. Hence, individuals of Hispanic ethnicity may be of
any race and are also included in the race category statistics as white, black, other, or unknown.
b These are crude birth and death rates (no. events per 1,000 population, not adjusted for age).
c Crude death rates among races are not directly comparable, because of the different age compo-
sitions of the racial subgroups. Consequently, for this period, the Connecticut age-adjusted
mortality rate for blacks was about 1.4 greater than for whites, even though the crude death rate
was lower. (See introduction to Section 2.2 for explanation of age-adjusted mortality rates.)
d The low death rate for Hispanics is due in part to under-utilization of the "Hispanic origin"
item on Connecticut death certificates. This item was added to the death certificates in 1989.
OF NOTE
In CY 1990, residents of Canaan had the highest birth rate (24.6 per 1,000 population), and residents of Union had the lowest rate (4.9 per 1,000).
Canaan had the highest resident crude death rate* (14.2 per 1,000) and Hartland had the lowest (1.6 per 1,000). Hartford had the highest resident infant death rate (15.1 per 1,000 live births), and South Windsor had the highest resident fetal death rate (15.7 per 1,000 live births).
No Thomaston or Middlefield residents and only one Canaan resident married in 1990.
Of the total marriages in 1990, 60% were first marriages, 11% were second marriages, and 1% were third marriages for both parties; 127 men and 153 women married for the fourth time or more.
Of the total divorces in 1990, 66% were granted to the wife and 32% were granted the husband; only one divorce was granted jointly.** Half of all the divorces involved children under age 18.
The most divorces (8.6%) occurred during the fourth year of marriage, and about four out of ten divorces occurred after 2 to 6 years of marriage.
__________
* Crude death rate is defined simply as the number of deaths per 1,000 population. Unlike the
age-adjusted death rate (see introduction to Section 2.2), it does not eliminate the effects of
differences in age composition by adjusting the rate to a standard population.
** Party to whom divorce was granted was not stated for 170 marriage dissolutions.
REFERENCES
(1) One hundred and forty-third registration report of births, marriages, divorces and deaths for the year ending December 31, 1990. 1994. State of Connecticut, Department of Public Health and Addiction Services, Office of Health Policy Development, Health Status Section, Hartford, CT. 92 pp. plus appendices.
(2) Connecticut population and household characteristics. 1990 census complete count data - Part A. Section 1, Connecticut state data. State of Connecticut, Office of Policy and Management, Connecticut State Data Center, Hartford, CT.
Addendum
The following data became available from DPHAS Vital Records after Section 2.1 had been completed. The CY 1991-1993 birth figures and CY 1991-1992 death figures are based on final data. The CY 1993 death figures reflect provisional data and are subject to change.
Numbers and rates (per 1,000 population) of live births to and deaths of Connecticut residents in CY 1991-1993. The denominators used in the rate calculations (DPHAS Connecticut population estimates for each respective year) are shown in parenthesis below each year.
1991 1992 1993 (Pop. (Pop. (Pop. 3,277,310) 3,286,100) 3,279,340) Event No. Rate No. Rate No. Rate Births 48,542 14.8 47,574 14.5 46,658 14.2 Deaths 27,962 8.5 28,224 8.6 28,905 8.9
2.2 Leading Causes of Death
The leading causes of death of Connecticut residents in CY 1990, expressed as numbers of deaths and age-adjusted mortality rates, are shown in the following tables for both sexes and individually for males and females.
An age-adjusted mortality rate (AAMR) is the number of deaths per 100,000 population, taking into account the age composition of the population. Age-specific mortality rates for a selected population are applied to the age distribution of a standard population to calculate the AAMR for the selected population. The 1940 US population was used as the standard to allow comparison with national rates published by the National Center for Health Statistics. Age-adjusted rates are artificial measurements, and should never be compared with any other type of rate or used to calculate the actual number of events.
Note that mortality rates were age adjusted to the 1970 US population standard in Connecticut's 1990 Registration Report and in all previous editions of Connecticut Health Data; hence AAMRs in those publications are not comparable with those given here.
TABLE 2-3. Leading causes of death of Connecticut residents (male and female combined) in CY 1990, and age-adjusted mortality rates (AAMRs) for Connecticut (1) and the United States (2,3). All figures are based on primary cause of death.
AAMRb
Ranka Cause of Death No. CT US
1 Diseases of the heart 9,493 132.4 152.0
2 All cancers 6,812 122.9 135.0
Lung & other respiratory 1,802 34.8 41.4
cancer
Lung cancer 1,739 33.7 39.9
Colon cancer 697 11.1 N/A
Pancreatic cancer 359 6.2 N/A
Leukemia 240 4.6 5.0
Bladder cancer 162 2.2 N/A
Brain & other CNS cancer 145 3.2 N/A
Rectal cancer 134 2.2 N/A
Malignant melanoma of skin 88 1.9 N/A
3 Cerebrovascular disease 1,719 21.0 27.7
4 Pneumonia & influenza 1,150 12.7 14.0
5 Chronic obstructive pulmonary 1,015 15.2 19.7
disease
6 Unintentional injuries 924 22.5 32.5
Motor vehicle accidents 412 12.2 18.5
Falls 183 2.4 N/A
Drowning 47 1.4 N/A
Residential fire 29 0.8 N/A
7 Diabetes mellitus 493 7.9 11.7
8 Septicemia 434 6.2 4.1
9 Chronic liver disease & 306 6.9 8.6
cirrhosis
Table 2-3 continues.
TABLE 2-3. (Continued.)
AAMRb
Ranka Cause of Death No. CT US
10 Nephritis, nephrotic syndrome, 298 4.3 4.3
& nephrosis
11 Suicide 287 7.9 11.5
12 HIV Infection 280 7.9 9.8
13 Atherosclerosis 181 1.8 2.7
14 Homicide & legal intervention 174 5.5 10.2
ALL CAUSESc 27,542 445.0 520.2
a Based on number of deaths.
b AAMR = Age-adjusted mortality rate (direct method). See introduction to Section 2.2, Leading Causes of Death, for explanation.
c The number of deaths for all causes includes one case of unknown sex.
TABLE 2-4. Leading causes of death of male Connecticut residents in CY 1990, and age-adjusted mortality rates (AAMRs) for Connecticut (1) and the United States (2,3). All figures are based on primary cause of death.
AAMRb
Ranka Cause of Death No. CT US
1 Diseases of the heart 4,626 182.9 206.7
2 All cancers 3,503 149.0 166.3
Lung & other respiratory cancer 1,098 48.3 61.0
Lung cancer 1,055 46.6 N/A
Prostate cancer 430 15.5 16.7
Colon cancer 339 13.6 N/A
Pancreatic cancer 190 8.2 N/A
Leukemia 126 5.7 6.4
Bladder cancer 102 3.7 N/A
Brain & other CNS cancer 79 3.9 N/A
Rectal cancer 63 2.8 N/A
Malignant melanoma of skin 48 2.3 N/A
3 Cerebrovascular disease 630 22.6 30.2
4 Unintentional injuries 596 33.7 47.7
Motor vehicle accidents 292 18.1 26.3
Falls 73 3.0 N/A
Drowning 42 2.6 N/A
Residential fire 19 1.1 N/A
5 Chronic obstructive pulmonary 537 20.2 27.2
disease
6 Pneumonia & influenza 473 16.0 18.5
7 HIV Infection 227 13.0 17.7
Table 2-4 continues.
TABLE 2-4. (Continued.)
AAMRb
Ranka Cause of Death No. CT US
7 Suicide 227 12.9 19.0
9 Diabetes mellitus 195 8.2 12.3
10 Chronic liver disease & 192 9.8 12.2
cirrhosis
11 Septicemia 187 7.3 4.9
12 Nephritis, nephrotic syndrome, 148 5.6 5.4
& nephrosis
13 Homicide & legal intervention 134 8.8 16.3
14 Atherosclerosis 67 2.2 3.2
ALL CAUSES 13,619 576.6 680.2
a Based on number of deaths.
b AAMR = Age-adjusted mortality rate (direct method). See introduction to Section 2.2, Leading Causes of Death, for explanation.
TABLE 2-5. Leading causes of death of female Connecticut residents in CY 1990, and age-adjusted mortality rates (AAMRs) for Connecticut (1) and the United States (2,3). All figures are based on primary cause of death.
AAMRb
Ranka Cause of Death No. CT US
1 Diseases of the heart 4,867 93.7 108.9
2 All cancers 3,309 105.7 112.7
Lung & other respiratory cancer 704 25.0 26.2
Lung cancer 684 24.3 N/A
Breast cancer 604 21.3 23.1
Colon cancer 358 9.4 N/A
Ovarian cancer 170 5.9 N/A
Pancreatic cancer 169 4.5 N/A
Leukemia 114 3.8 3.9
Rectal cancer 71 1.7 N/A
Brain & other CNS cancer 66 2.5 N/A
Bladder cancer 60 1.4 N/A
Endometrial cancer 42 1.3 N/A
Malignant melanoma of skin 40 1.6 N/A
3 Cerebrovascular disease 1,089 19.8 25.7
4 Pneumonia & influenza 677 10.7 11.0
5 Chronic obstructive pulmonary 478 12.2 14.7
disease
6 Unintentional injuries 328 11.6 17.9
Motor vehicle accidents` 120 6.3 10.7
Falls 110 1.8 N/A
Residential fire 10 0.5 N/A
Drowning 5 0.3 N/A
Table 2-5 continues.
TABLE 2-5. (Continued.)
AAMRb
Ranka Cause of Death No. CT US
7 Diabetes mellitus 298 7.5 11.1
8 Septicemia 247 5.4 3.5
9 Nephritis, nephrotic syndrome, 150 3.6 3.6
& nephrosis
10 Chronic liver disease & 114 4.4 5.3
cirrhosis
10 Atherosclerosis 114 1.5 2.4
12 Suicide 60 3.2 4.5
13 HIV Infection 53 3.0 2.1
14 Homicide & legal intervention 40 2.2 4.2
ALL CAUSES 13,922 342.5 390.6
a Based on number of deaths.
b AAMR = Age-adjusted mortality rate (direct method). See introduction to Section 2.2, Leading Causes of Death, for explanation.
OF NOTE
For decedents of both sexes in age group 1-4 years and in the five, 5-year age cohorts from 10-14 years to 30-34 years, the leading cause of death was "unintentional injuries."
For those in age group 5 to 9 years and in the four consecutive 10-year intervals from age 35 to 74 years, the leading cause of death was "malignant neoplasms."
The leading cause of death for both sexes aged 75 years and older was "diseases of the heart," specifically "ischemic heart disease."
Infection with human immunodeficiency virus (HIV) was the fourth leading cause of death of males aged 20-24 years and the second leading cause for males aged 25-44 years and females aged 25-34 years.
REFERENCES
(1) Selenskas, S.L. In preparation. Connecticut age-adjusted mortality rates and age-adjusted years of potential life lost for selected causes of death in 1989, 1990, and 1991. State of Connecticut, Department of Public Health and Addiction Services, Health Research and Data Analysis, Hartford, CT.
(2) National Center for Health Statistics. 1993. Advance report of final mortality statistics, 1990. Monthly Vital Statistics Report 41(7 S). US Public Health Service, Hyattsville, MD.
(3) Health United States 1992, and healthy people 2000 review. 1993. National Center for Health Statistics, Centers for Disease Control and Prevention, US Public Health Service, Hyattsville, MD. DHHS Publ. No. (PHS) 93-1232, 390 pp.
2.3 Fetal and Infant Deaths
Fetal death, commonly called "stillbirth," is defined as the death in utero (in the womb) of a fetus after 20 or more weeks of gestation. An infant death is that of an individual less than 1 year (365 days) of age. The total number of infant deaths equals the sum of neonatal and post-neonatal deaths. Neonatal deaths are those of infants less than 28 days old, and post-neonatal deaths are those of infants 28 to 364 days old.
TABLE 2-6. Numbers and rates of resident fetal, infant, neonatal, and post-neonatal deaths, broken out by race for Connecticut in CY 1990 (1). Figures for the United States (2,3,4) are included for comparison.
CT US
Type of Racea, No. Rateb,c No. Rateb,c
death
Fetal All races 343 6.8 31,386 7.5
White 263 6.3 21,081 6.4
Black 70 11.3 9,201 13.3
Other 5 4.6 1,104 6.0
Unknown 5 - 0 -
Infant All races 398 7.9 38,351 9.2
White 266 6.4 24,883 7.6
Black 110 17.8 12,290 18.0
Other 11 10.1 1,178 6.4
Unknown 11 - - -
Neonatal All races 278 5.5 24,309 5.8
White 187 4.5 15,751 4.8
Black 74 11.9 7,905 11.6
Other 7 6.4 653 3.6
Unknown 10 - - -
Post-neonata All races 120 2.4 14,042 3.4
l
White 79 1.9 9,132 2.8
Black 36 5.8 4,385 6.4
Other 4 3.7 525 2.9
Unknown 1 - - -
a Fetal deaths are based on the mother's reported race. Infant, neonatal, and post-neonatal
deaths are based on the reported race of the infant.
b Rate is expressed as number per 1,000 live births. Live births are shown by race in
Table 2-2.
c In calculating the infant mortality rate, the numerator is the number of deaths based on the
infant's race, and the denominator is number of live births based on the mother's race. This
method has been used for national rates since 1989.
OF NOTE
The overall infant mortality rate for 1990, 7.9 deaths per 1,000 live births, was the lowest ever recorded and represented a decrease from the 1989 rate of 8.9 per 1,000.
The neonatal death rate (5.5/1,000) was also lower than the 1989 rate (6.5/1,000); however, the post-neonatal death rate was unchanged.
The infant mortality rate for blacks was 2.3 times the overall rate for all races and 2.8 times the rate for whites.
Seven towns (Bridgeport, Hartford, Meriden, New Britain, New Haven, Stamford, and Waterbury) had 10 or more resident infant deaths, representing 46% of the state total. Four towns (Bridgeport, Hartford, New Haven, and Stamford) together accounted for 27% of the fetal deaths in Connecticut.
Fourteen infants died of sudden infant death syndrome (SIDS), three of unintentional injuries, and three of homicide and purposely inflicted injury.
Eighty-two percent of total fetal deaths were associated with low birth weight (<2,500 grams or <5 lbs. 8 oz).
REFERENCES
(1) One hundred and forty-third registration report of births, marriages, divorces and deaths for the year ending December 31, 1990. 1994. State of Connecticut, Department of Public Health and Addiction Services, Office of Health Policy Development, Health Status Section, Hartford, CT. 92 pp. plus appendices.
(2) National Center for Health Statistics. 1993. Advance report of final mortality statistics, 1990. Monthly Vital Statistics Report 41(7 S). US Public Health Service, Hyattsville, MD.
(3) Health United States 1992, and healthy people 2000 review. 1993. National Center for Health Statistics, Centers for Disease Control and Prevention, US Public Health Service, Hyattsville, MD. DHHS Publ. No. (PHS) 93-1232. 390 pp.
(4) National Center for Health Statistics. 1994. Vital statistics of the United States, 1990, vol. II, Mortality, Part A. US Public Health Service, Washington DC, DHHS Publ. No. (PHS) 95-1101.
2.4 Legal Induced Abortions
According to the Connecticut Public Health Code every induced abortion performed within the state must be reported within 7 days to the Commissioner of Health Services by the physician who performed the procedure. The reports include the date and place where the procedure took place, the method, the physician's estimate of gestational age at the time of abortion, and the patient's age and state of residence. No other patient identifiers are reported.
TABLE 2-7. Types of facilities at which legal induced abortions
were performed in Connecticut during CY 1991 (1). All procedures
were performed by curettage.a
Abortions Facility type Number Percent Physician's office 4,088 22.1% Non-hospital clinic 12,632 68.2% Hospital (inpatient or 1,814 9.8% outpatient) Total 18,534 100%
a The method of abortion was not reported for one case.
TABLE 2-8 States of residencea of women who received legal
induced legal abortions in Connecticut during CY 1991(1).
Abortions State Number Percent Connecticut 17,689 95.4% Massachusetts 506 2.7% New York 151 0.8% Rhode Island 131 0.7% Other state or nation 57 0.3% Total 18,534 100%
a Induced abortion statistics are not available by patient's town of residence.
TABLE 2-9. Ages of women who received legal
induced abortions in Connecticut during CY 1991 (1).
Abortions Age (years) Number Percent 19 or less 3,972 21.7% 20-34 12,990 70.8% 35 or greater 1,379 7.5% TOTALa 18,341 100%
a Total excludes 193 cases where patient's age was not reported.
TABLE 2-10. Numbers of women under
the age of 20 years who received legal induced
abortions in Connecticut during CY 1991 (1).
Abortions Age Number Percent (years) 12 or 0 0% less 13 12 0.3% 14 90 2.3% 15 233 5.9% 16 545 13.7% 17 853 21.5% 18 991 24.9% 19 1,248 31.4% TOTAL 3,972 100%
TABLE 2-11. Physician's estimate of gestational
age (GA) at time of abortion for legal induced abortions
performed in Connecticut during CY 1991 (1).
Abortions GA (weeks) Number Percent <13 17,010 92.4% 13-15 1,167 6.3% 16-20 221 1.2% 21+ 15 0.1% TOTALa 18,413 100%
a Total excludes 121 cases where gestational age was not reported.
All 121 procedures were done by curettage, however, indicating that the
abortions occurred early in the pregnancies.
REFERENCE
(1) Statistical summary of legal induced abortions occurring in Connecticut during calendar year 1991. 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Community Health and State-operated Treatment Facilities, Division of Planning, Development, and Information, Hartford, CT,
2 pp.
3 RISK FACTORS
Infant and Maternal Health Indicators
Behavioral Risk Factor Surveillance System
Connecticut Health Check: Health Risk Appraisal for Youth
3.1 Infant and Maternal Health Indicators
Birth weight, adequacy of prenatal care, and births to teenage mothers are considered important measures of increased risk of infant death. Low birth weight is related to several preventable risk factors, including lack of prenatal care, maternal smoking, maternal use of alcohol and other drugs, and maternal age (especially when less than
18 years).
TABLE 3-1. Infant and maternal health indicators by mother's race and
Hispanic ethnicity for Connecticut resident births in CY 1990 (1).
CT
Mother's race
Indicator and ethnicitya No. %d
Low birth weight All races 3,294 6.6
(<2,500 g or <5 White 2,319 5.6
lbs 8 oz)
Black 812 13.1
Other 64 5.9
Unknown 99 7.6
Hispanic 474 8.9
ethnicity
Very low All races 671 1.3
birth weight White 442 1.1
(<1,500 g or <3 Black 194 3.1
lbs 5 oz)
Other 10 0.9
Unknown 25 1.9
Hispanic 98 1.9
ethnicity
Late or no All races 6,590 15.1
prenatal careb
White 4,478 12.1
Black 1,759 35.0
Other 156 16.9
Unknown 197 26.4
Hispanic 1,242 29.4
ethnicity
Non-adequate All races 8,549 20.7
prenatal carec White 5,988 17.1
Black 2,113 45.2
Other 211 23.8
Unknown 237 36.1
Hispanic 1,637 42.6
ethnicity
Table 3-1 continues.
TABLE 3-1. (Continued.)
CT
Mother's race
Indicator and ethnicitya No. %d
Teen births All races 93 0.2
(mother's age)
< 15 years White 42 0.1
Black 46 0.7
Other - -
Unknown 5 0.4
Hispanic ethnicity 35 0.7
< 18 yrs All races 1,607 3.2
White 950 2.3
Black 550 8.9
Other 21 1.9
Unknown 86 6.6
Hispanic ethnicity 542 10.2
< 20 yrs All races 4,121 8.2
White 2,601 6.3
Black 1,246 20.1
Other 69 6.3
Unknown 205 15.7
Hispanic ethnicity 1,198 22.6
a Race consists of four mutually exclusive groups (white, black, other, unknown).
b Late prenatal care is defined as prenatal care beginning in the second or third trimester of
pregnancy. This category includes 203 births to women who received no prenatal care (4).
c Adequacy of prenatal care is defined by the timing of the first prenatal visit and subsequent
number of visits, using a modified Kessner Index (2,3). This indicator is associated with risk
of low birth weight.
d Percentages are based on number of births for each racial or ethnic group.
OF NOTE
The largest infant born to a Connecticut resident in 1990 weighed 6,835 grams or just over 15 pounds. The youngest mother was 12 years old, and the oldest was 58 (4).
In 1990 17 births occurred after more than 50 weeks of gestation (4).
REFERENCES
(1) One hundred and forty-third registration report of births, marriages, divorces and deaths for the year ending December 31, 1990. 1994. State of Connecticut, Department of Public Health and Addiction Services, Office of Health Policy Development, Health Status Section, Hartford, CT. 92 pp. plus appendices.
(2) Kessner, D.M., J. Singer, C.E. Kalk, and E.R. Schlesinger. 1973. Infant death: an analysis by maternal risk and health care. Contrasts in health status, vol. 1. Institute of Medicine, National Academy of Sciences, Washington, DC.
(3) Modified Kessner index. 1991. State of Connecticut, Department of Public Health and Addiction Services, Health Surveillance and Planning Division, Hartford, CT.
(4) Unpublished birth records, 1990. State of Connecticut, Office of Strategic Planning and Information Services, Vital Records, Hartford, CT.
3.2 Behavioral Risk Factor Surveillance System
The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based telephone survey of randomly selected adults age 18 and older. The survey is conducted in cooperation with the Centers for Disease Control and Prevention (CDC) in Atlanta. The BRFSS was first conducted in CT by the DPHAS Division of Chronic Disease and Injury Prevention in 1985 and then continuously since 1988.
In 1993, 49 states (all except Wyoming) plus the District of Columbia participated in the system; 1,810 Connecticut adults were interviewed by a survey firm under contract with DPHAS and funded by the CDC. The data presented below are the results for 1993, adjusted to be representative of Connecticut's adult population.
TABLE 3-2. Percent of adults who self-reported the following health-related characteristics. Data from 1993 BRFSS report (1).
Connecticut United States All All HP2000 Characteristic Male Female adults adultsk targetl Current smokinga 21.9 19.5 20.6 22.5 15 Overweightb 25.3 18.6 21.8 25.5 20 Safety belt 35.8 24.5 29.9 36.3 15 non-usec Chronic drinkingd 5.9 1.0 3.3 3.0 - Acute drinkinge 21.3 7.8 14.2 14.2 - Drink and drivef 5.7 0.5 3.0 2.4 - Diabetesg 5.6 4.9 5.2 4.5 - No health insurance 12.2 6.8 9.4 12.9 - Cholesterol 68.2 72.3 70.3 65.0 75 screenedh Mammogram/breast N/A 77.2 N/A 73.4 80 exam i Pap testj N/A 88.9 N/A 93.7 95
a Current smoking = respondents who report ever smoking 100 cigarettes and who smoke now (regularly or irregularly).
b Overweight = females with body mass index (weight in kilograms divided by height in meters squared) equal to or more than 27.3, and males with body mass index equal to or greater than 27.8.
c Does not always wear a safety belt.
d Average of 60 or more alcoholic drinks per month.
e "Binge" drinking, or five or more drinks on an occasion, one or more times in the past month.
f Have driven after having too much to drink, one or more times in the past month.
g Told by a doctor they have diabetes.
h Had blood cholesterol checked within the past 5 years.
i Women age 40 and older who report they have ever had a mammogram and clinical breast exam.
j Women with intact uterine cervix who report they have ever had a pap smear test. Students, women who had never married, and 18-24 year olds were among the least likely to have been tested (63.1%, 67.6%, and 61.0%, respectively).
k The figures in this column represent the median values for the 50 participants (49 states plus District of Columbia) in the survey.
l Healthy People 2000 (2) is a national initiative to improve the health of all Americans through prevention. It is driven by 384 specific objectives for promoting health and preventing disease, with the year 2000 as the target for achievement.
Estimated Smoking-attributable Mortality
Computer software distributed by the Centers for Disease Control and Prevention was used to estimate Connecticut mortality attributable to smoking. Calculations were based on deaths and BRFSS smoking data for the same year and relative risks for smoking-related diseases from major prospective studies.
TABLE 3-3. Estimated smoking-attributable mortality for males and females in Connecticut, and years of potential life losta (3).
Smoking-attributable deaths Sex Number % of total Average YPLLa deaths Male 3,420 24.2% 11.6 Female 2,028 14.5% 12.8 Both sexes 5,448 19.4% 12.0
a Average years of potential life lost (YPLL), for people who die prematurely of smoking-related
causes, is the estimated average number of years of life that they lose, measured to life expectancy.
OF NOTE
Hysterectomy. About one in three women age 45 and older, and 16.5% of women age 18 and older, reported they had a hysterectomy.
Health Care Access and Coverage. 12.2% of men and 6.8% of women reported they did not have any kind of health care coverage, and 12.1% said they could not see a doctor on at least one occasion in the last year, due to financial constraints.
AIDS. 85.3% of respondents 18-64 years old felt their chances of getting the AIDS virus were low to none; however, 21.5% reported they had their blood tested for the AIDS virus.
Safe Sex. 91.4% of respondents 18 to 64 years old said that if they had a sexually active teenager, they would encourage him or her to use a condom.
Smoking. 72% of current smokers reported they would like to stop smoking.
Child Safety Belt Use. 91% of respondents with children between the ages of 5 and 14 reported that the oldest child under 15 always or nearly always used a safety belt.
Pet Ownership. Three in 10 adults said they owned at least one dog, and another 3 in 10 reported owning one or more cats; 12% of respondents owned both cats and dogs.
REFERENCES
(1) Behavioral risk factor surveillance system: Connecticut statewide survey data, 1993. State of Connecticut, Department of Public Health and Addiction Services, Division of Chronic Disease and Injury Prevention, Surveillance and Evaluation Unit, Hartford, CT.
(2) Healthy people 2000: National health promotion and disease prevention objectives. 1991. US Department of Health and Human Services, Public Health Service. DHHS Publ. No. (PHS) 91-50213. 154 pp.
(3) Adams, M.L. 1994. The public health impact and economic cost of smoking in Connecticut - 1989. Connecticut Medicine 58: 194-198.
3.3 CT Health Check: Health Risk Appraisal for Youth
Connecticut Health Check is a computerized health risk appraisal developed by the DPHAS Division of Chronic Disease and Injury Prevention; it has been promoted as a motivational and educational tool for youth since 1985. The Health Check questionnaire covers a broad range of health issues including exercise, alcohol consumption, nutrition, tobacco and illegal drug use, AIDS, stress, and seatbelt use. Separate versions of the questionnaire are available for grades 4-5, 6-8, and 9-12. As of June, 1994, approximately 53,000 students had participated in the Health Check, including 5,100 youths in 27 schools, who took part during the 1993-1994 school year (September, 1993-June, 1994).
The Health Check questionnaires are offered to schools on a first come, first served basis, and often are used in conjunction with health education classes. Students record their answers on computer cards, the cards are optically scanned, and a report highlighting risk areas and offering suggestions for improvement is generated immediately for each individual, thus giving the students useful and timely feedback. Both the cards and the print-outs are anonymous and confidential.
Because schools are self-selected for participation in Health Check, results are not necessarily representative of all students in Connecticut. They do, however, provide some measure of behavioral risk factors in youth, in the absence of more representative surveys. Some results of the 1993-1994 Health Check are shown below. Tabular data for 4th and 5th graders are not included because of the small number of participants.
TABLE 3-4. Percent of male students in grades 9-12 who self-reported certain behaviors in the Connecticut Health Check during the 1993-1994 school year (1).
Grade level (Males) 9 10 11 12 Health risk appraisal item (n=724) (n=605) (n=226) (n=175) Eat breakfast <3 times a 24 23 34 27 week Eat junk food daily 40 35 37 44 Exercise <3 times a week 20 21 16 27 Smoke cigarettes 19 22 24 26 Drink alcohol 51 56 65 73 Drink alcohol weekly 10 9 16 24 Use marijuana currently 10 15 17 25 Have tried/currently use 5 3 4 9 cocaine Were in physical fight 49 45 42 45 within last year Have access to a gun at 35 32 40 35 home Are currently depressed 8 7 9 7 Attempted suicide within 1 1 1 2 past year Feel it is OK to have sex 60 63 75 76 at their age
TABLE 3-5. Percent of female students in grades 9-12 who self-reported certain behaviors in the Connecticut Health Check during the 1993-1994 school year (1).
Grade level (Females) 9 10 11 12 Health risk appraisal item (n=664) (n=482) (n=196) (n=177) Eat breakfast <3 times a 42 33 40 46 week Eat junk food daily 35 27 24 24 Exercise <3 times a week 41 33 43 56 Smoke cigarettes 21 24 28 32 Drink alcohol 51 59 62 76 Drink alcohol weekly 5 5 6 7 Use marijuana currently 7 11 12 15 Have tried/currently use 3 2 1 5 cocaine Were in physical fight 33 23 20 28 within last year Have access to a gun at 23 21 24 21 home Are currently depressed 14 16 17 14 Attempted suicide within 3 2 4 2 past year Feel it is OK to have sex 42 48 53 67 at their age
TABLE 3-6. Percent of male students in grades 6, 7, and 8 who self-reported certain behaviors in the Connecticut Health Check during the 1993-1994 school year (1).
Grade level (Males) 6 7 8 Health risk appraisal (n=335) (n=285) (n=148) item Eat breakfast <3 times a 16 19 21 week Eat junk food daily 27 35 34 Smoke cigarettes 1 5 5 Drink alcohol 31 56 51 Drink alcohol weekly 1 9 7 Use marijuana currently 1 3 3 Have tried/currently use 1 2 5 cocaine Were in physical fight 69 72 72 w/in last year Have access to a gun at 22 37 50 home Are currently depressed 9 10 11 Attempted suicide within 1 2 4 past year
TABLE 3-7. Percent of female students in grades 6, ,7 and 8 who self-reported certain behaviors in the Connecticut Health Check during the 1993-1994 school year (1).
Grade level (Females) 6 7 8 Health risk appraisal (n=322) (n=282) (n=161) item Eat breakfast <3 times a 25 26 26 week Eat junk food daily 28 28 32 Smoke cigarettes 1 2 9 Drink alcohol 25 46 47 Drink alcohol weekly 2 2 3 Use marijuana currently 1 1 4 Have tried/currently use 1 1 2 cocaine Were in physical fight 45 48 42 w/in last year Have access to a gun at 15 21 26 home Are currently depressed 11 14 12 Attempted suicide within 1 0 4 past year
OF NOTE
Thirty-seven percent of the students in grades 6-12 reported they do not live with both of their natural parents; 18-19% live with a single parent.
Fourteen percent of the teen participants had not visited a dentist or dental clinic in the past year.
Nearly half (48%) of the 190 elementary school participants (mostly 5th graders) reported getting most of their information about health at school, compared to 38% from their parents.
Of the elementary school students who ride bicycles, 40% reported they do not wear bicycle helmets.
Thirty-five percent of the elementary school students said they watch 3 or more hours of television daily.
Twenty-five percent of the elementary school students think they might smoke when they're older.
REFERENCE
(1) Connecticut health check results: School year 1993-1994. 1994. State of Connecticut, Department of Public Health and Addiction Services, Division of Chronic Disease and Injury Prevention, Surveillance and Evaluation Unit, Hartford, CT, 30 pp.
4 INFECTIOUS DISEASES
Acquired Immunodeficiency Syndrome (AIDS)
Tuberculosis Prevention and Control
4.1 Reportable Diseases
The Commissioner of the DPHAS is required to declare an annual list of reportable diseases. Each report filed with DPHAS and with local health departments contains the identities of the reporting and attending health care providers, the disease being reported, and the name, race, ethnicity, sex, address, and occupation of the person affected. The directors of all clinical laboratories in Connecticut also must report laboratory findings suggestive of specified diseases relating to public health; these reports supplement those of the health care providers.
TABLE 4-1. Cases of selected diseases (excluding zoonoses) reportable to the DPHAS Epidemiology Section during CY 1993, and average annual numbers and ranges of cases for the prior 5 yearsa (1).
CY 1993 1988-1992 Total Avg. no. Range of Disease cases Rateb cases/yr cases/yr AIDSc 1,731 52.8 467 323-690 Brucellosis 0 <1 0-1 Gonorrheac 4,658 142.1 8,368 5,669-11,014 Haemophilis influenzae, 9 0.3 34 12-58 type B Hansen's disease 0 <1 0-1 (Leprosy) Hepatitis A 117 3.6 181 81-243 Hepatitis B 75 2.3 212 158-251 Leptospirosis 0 <1 0-1 Malaria 30 0.9 21 13-29 Measles 9 0.3 95 6-229 Meningococcal disease 33 1.0 45 29-65 Mumps 8 0.2 12 8-17 Pertussis (Whooping 102 3.1 31 22-50 cough) Rheumatic fever 1 0.03 2 0-4 Rubella (German 0 1 1-3 measles) Salmonellosis 811 24.7 995 726-1,213 Shigellosis 245 7.5 206 133-336 Syphilis (primary and 158 4.8 690 257-1,139 secondary)c Tetanus 0 <1 1-1 Tuberculosisc 155 4.7 154 141-164 Typhoid fever 6 0.2 6 2-9 Yersiniosis 14 0.4 18 2-26
a Reportable diseases for which there were no reported cases in Connecticut in 1993 or the prior
5 years are not included. Diseases transmitted by animals are discussed below in Section 4.2,
Rabies and Other Zoonoses. Occupational diseases are discussed in Section 8.4, Occupational
Health Surveillance.
b Crude incidence rate, or reported cases per 100,000 population (not adjusted), based on 1993 CT population estimate of 3,277,310 (2).
c For further information, see Sections 4.3 (AIDS), 4.4 (Sexually Transmitted Diseases), and 4.5
(Tuberculosis Prevention and Control).
4.2 Rabies and Other Zoonoses
A zoonosis is an infection or infectious disease transmissible under natural conditions from vertebrate animals to man. The following zoonoses were reportable in Connecticut in 1993: babesiosis, cat-scratch disease, eastern equine encephalitis, Lyme disease, plague, psittacosis, rabies, and Rocky Mountain spotted fever.
Rabies and Lyme disease are the two most important zoonoses in Connecticut. Rabies is caused by a virus and is spread when the virus-laden saliva of an infected, warm-blooded animal is introduced by a bite or scratch. Lyme disease, caused by a spirochete bacterium, is transmitted by ticks.
TABLE 4-2. Cases of selected reportable zoonoses (diseases transmissible under natural conditions from vertebrate animals to humans) reported in Connecticut during CY 1993, and average numbers and ranges of cases for the prior 5 yearsa (1). All cases except those for rabies were reported in humans.
1988-1992 Total Avg. no. Range of Disease cases Rateb cases cases/yr Babesiosis 8 0.2 14 3-25 Cat-scratch diseasec 131 4.0 N/A N/A Lyme disease 1,350 41.2 1,032 704-1,760 Psittacosis 0 N/A 2 0-6 Rabies (animal) 780 N/A 211 3-838 Rocky Mountain spotted 0 N/A 2 1-4 fever
a Reportable diseases for which there were no reported cases in Connecticut in 1993 or the prior
5 years are not included.
b Crude incidence rate, or reported cases per 100,000 population (not adjusted), based on 1993 CT population estimate of 3,277,310 (2).
c Cat-scratch disease, associated with cat scratches or bites, has been reportable in CT since 1992,
during which year 111 cases were reported. The most common symptoms of the disease are
swollen glands, skin lesions, malaise, and fever.
TABLE 4-3. Spread of the raccoon strain of rabies, by
county and calendar year, across Connecticut since
its introduction in March, 1991a (1).
Cases by calendar year County 1991 1992 1993 Fairfield 194 384 40 Hartford 2 109 236 Litchfield 1 174 119 Middlesex 0 9 105 New Haven 0 157 229 New London 1 1 0 Tolland 1 3 50 Windham 1 1 1 TOTAL 200 838 780
a All cases occurred in animals. There were no cases of human rabies in
Connecticut, and only three cases in the US, during 1993.
TABLE 4-4. Reported numbers of animals with rabies
in Connecticut in CY 1993, showing the extent to which the
rabies epizootic has affected other animal species. With the
exception of bats, all cases are due to the raccoon straina (1).
Cases Animal Number Percent Raccoon 662 84.9% Skunk 75 9.6% Bat 16 2.0% Cat 11 1.4% Woodchuck 6 0.8% Fox 4 0.5% Horse 2 0.3% Dog 2 0.3% Cow 1 0.1% Sheep 1 0.1% TOTAL 780 100%
a An epizootic of raccoon rabies reached Connecticut in March, 1991 (4).
There were 9,377 cases of animal rabies nationwide in 1993 (3).
TABLE 4-5. Geographic distribution of Lyme
disease in Connecticut during CY 1993 (1).
Cases County Number Ratea Fairfield 258 31 Hartford 73 9 Litchfield 38 22 Middlesex 265 183 New Haven 148 18 New London 291 117 Tolland 112 86 Windham 100 97 Unknown 65 - TOTAL 1,350 41
a Crude incidence rate, or reported cases per 100,000 population (not adjusted), based on 1993 county and state population
estimates for Connecticut (2).
OF NOTE
In 1993, the total numbers of reported measles and mumps cases were the lowest ever recorded in the US, whereas pertussis reached the highest annual level since 1967 (4).
The last case of smallpox in the US occurred in 1949 (4).
Although Lyme disease is spread by tick bites, transmission does not occur until after the tick has fed for several hours (5).
REFERENCES
(1) Summary data for CY 1993. Department record. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Epidemiology Section, Epidemiology Program, Hartford, CT.
(2) Estimated populations in Connecticut as of July 1, 1993. 1994. State of Connecticut, Department of Public Health and Addiction Services, Office of Strategic Planning and Information Services, Health Research and Data Analysis Unit, Hartford, CT.
(3) Summary data for CY 1993. Department record. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Environmental Epidemiology and Occupational Health Division, Occupational Health Program, Hartford, CT.
(4) Centers for Disease Control and Prevention. 1994. Summary of notifiable diseases, United States, 1993. Morbidity and Mortality Weekly Report
42(53): 1-73.
(5) Benenson, A.S., Editor. 1990. Control of communicable diseases in man. American Public Health Association, Washington, DC. 532 pp.
4.3 Acquired Immunodeficiency Syndrome (AIDS)
Acquired Immunodeficiency Syndrome (AIDS), first described in 1981, is the end stage of long-term infection with Human Immunodeficiency Virus (HIV). AIDS, as defined by the Centers for Disease Control and Prevention, is a reportable condition in all 50 states and US territories, and HIV infection is reportable in 35 states. In Connecticut, both HIV infection and AIDS are reportable for children less than 13 years of age, whereas only AIDS is reportable for those over 12 years of age.
The AIDS Division of DPHAS has several functions, most of which are carried out through contracts with local agencies. 1) It conducts AIDS surveillance and seroprevalence studies to determine the number of AIDS cases, the incidence of HIV infection in certain populations, and the distribution of the disease in CT. 2) It sponsors individual-, group-, and community-level activities to reduce risky sex and drug behaviors and to create community support for safer behaviors. 3) It funds HIV counseling and testing for more than 20,000 people at risk annually, with referral of those who test positive for treatment and counseling. 4) It funds and supports needle-exchange programs in six cities, where injection drug users trade their used needles for clean ones. 5) It provides financial and technical support for health care and social services for people with HIV and their families. 6) It provides training for outreach workers, educators, counselors, case managers, and supervisors of AIDS staff.
TABLE 4-6. Cumulative total cases of acquired immunodeficiency syndrome in males and females in Connecticut (1) and the United States (2) reported from January 1, 1980 (the first case of AIDS in CT was diagnosed in 1980) through December 31, 1993, by age, race/ethnicity, and transmission category.
Connecticut United States Group Male Female Male Female characteris No. % No. % No. % No. % tic Age (years) <13 60 2 51 5 2,747 1 2,481 5 13-19 6 - 10 1 1,070 - 484 1 20-29 558 15 267 25 57,477 18 11,006 23 30-39 1,765 47 502 46 143,788 46 20,698 44 40-49 984 26 182 17 77,121 25 8,029 17 50+ 410 11 71 7 32,121 10 4,139 9 Race/Ethnic itya White 1,596 42 303 28 169,080 54 11,050 25 Black 1,419 37 536 49 88,192 28 23,810 54 Hispanic 745 20 238 22 50,942 16 9,066 20 Other/Unkno 23 1 6 1 3,364 1 431 1 wn
Table 4-6 continues.
TABLE 4-6. (Continued.)
Connecticut United States Group Male Female Male Female characteris No. % No. % % % tic No. No. Transmissio n categoryb Ho/Bi male 1,407 37 N/A N/A 193,652 62 IDU 1,715 45 595 55 65,512 21 21,746 46 Ho/Bi & 195 5 N/A N/A 23,360 7 IDU Hemophiliac 34 1 1 - 3,058 1 75 - Heterosexua 144 4 323 31 7,679 2 15,487 33 l Transfusion 28 1 27 2 3,660 1 2,521 5 Pediatric 200 5 77 7 2,747 - 2,481 5 Unknown 60 2 51 5 14,657 5 4,528 9 TOTALd 3,783 100 1,083 100 314,325c 100 46,838c 100
a US data on pediatric cases not available by race/ethnicity.
b Ho/Bi = homosexual or bisexual male; IDU = injection drug user; Ho/Bi & IDU = males who are both injection drug users and homo- or bisexual; Hemophiliac = adult hemophiliac; Pediatric =<13 years.
c US totals include one male and one female whose ages were unknown.
d Percents may not add up to 100%, because of rounding.
TABLE 4-7. Cumulative cases of AIDS in Connecticut from January 1, 1980a through December 31, 1993, by county and town of residenceb (1).
County/Town No. cases Percent New Haven County 1,610 33.1 New Haven 951 19.5 Waterbury 200 4.1 West Haven 93 1.9 Meriden 68 1.4 Fairfield County 1,248 25.6 Bridgeport 459 9.4 Stamford 275 5.7 Norwalk 150 3.0 Danbury 95 2.0 Greenwich 54 1.1 Hartford County 1,444 29.7 Hartford 965 19.7 New Britain 115 2.3 East Hartford 51 1.0 New London County 255 5.2 New London 98 2.0 Norwich 58 1.2 Middlesex County 86 1.8 Litchfield County 64 1.3 Tolland County 61 1.3 Windham County 51 1.0 County Unknown 47 1.0
a The first case of AIDS in Connecticut was diagnosed in 1980.
b Only towns with more than 50 reported cases are listed.
TABLE 4-8. Estimated numbers of HIV-infected adolescents and adults in Connecticut as of December 31, 1993, by sex, race/ethnicity, and transmission categorya,b. Numbers are rounded to the nearest 10 (1).
Sex
Group Male Female Total
characteristic
Race/Ethnicity
White 3,740-4,990 840 4,580-5,830
Black 2,220-4,290 1,420 3,640-5,710
Hispanic 1,740-2,320 640 2,380-2,960
Transmission
categoryc
Ho/Bi male 3,300-4,400 N/A 3,300-4,400
IDU 4,000-5,440 1,680 5,680-7,120
Heterosexual 350-460 930 1,280-1,390
Other 1,040-1,390 290 1,330-1,680
TOTAL 8,700-11,60 2,900 11,600-14,500
0
a Additionally, an estimated 217 to 313 Connecticut children under age 13 (born through
March 31, 1993) are infected with HIV.
b Estimates for females are based on a sero-survey of childbearing women; data for males
are extrapolated from the values for females, assuming that the number of HIV-infected
males is three to four times that of infected women (1).
the female estimates.
c Ho/Bi male = homosexual or bisexual male; IDU = injection drug user.
OF NOTE
Worldwide in 1993, more than 15 million people, including one million children, were estimated to be infected with AIDS.
In 1993, AIDS became the leading killer of 25- to 44-year-old Americans, surpassing heart disease, cancer, homicide, and suicide.
As of December 31, 1993, almost half of all people reported with AIDS in Connecticut--2,327 adults and 47 children--had already died.
Between 1990 and 1993, the rate of AIDS in CT nearly doubled, from 16.3 to 29.5 per 100,000 population.
Three out of every 1,000 childbearing women in Connecticut were infected with HIV in 1993, and about one-third of CT women with AIDS became infected through heterosexual contact with a person with HIV infection or AIDS.
Although AIDS cases have been reported from 149 of CT's 169 towns, half of all reported cases were among residents of Hartford, New Haven, and Bridgeport.
In a recent survey, 72 % of CT respondents aged 18-64 years indicated they would be willing to work with a person infected with the AIDS virus, and 66% said they would allow their child to be in the same class with a child infected with the AIDS virus (3).
REFERENCES
(1) AIDS in Connecticut. Annual surveillance report, December 31, 1993. 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion, AIDS Division. Hartford, CT. 84 pp.
(2) Centers for Disease Control and Prevention. 1993. HIV/AIDS surveillance report 5(4).
(3) Behavioral Risk Factor Surveillance System, Connecticut Statewide Survey Data, 1993. 1994. State of Connecticut, Department of Public Health and Addiction Services, Division of Chronic Disease and Injury Prevention, Hartford, CT.
4.4 Sexually Transmitted Diseases (STDs)
The goal of the STD Control Program at DPHAS is to reduce and prevent sexually transmitted diseases through appropriate treatment, education, and epidemiologic follow-up of the population at risk, thereby reducing the costly, debilitating, and life threatening consequences of the diseases. Five diseases (gonorrhea, syphilis, chlamydia, neonatal herpes, and chancroid) currently are reportable.
The incidence rates of gonorrhea and early syphilis are declining and are similar to rates seen more than 20 years ago. Chlamydia, which became reportable in 1990, is also beginning to decline. The reasons for these decreases are not clear. While some population groups may have adopted safer sex behaviors, other groups (e.g. teens, urban minority groups) continue to have disproportionately high rates of STDs.
TABLE 4-9. Gonorrhea cases, rates, and changes in rates by
age in Connecticut for CY 1993 (1).
Age No. % of Change (years) cases total Ratea in rateb 0-9 19 0.4 4 - 33% 10-14 102 2.2 53 + 47% 15-19 1,201 25.8 569 - 9% 20-24 1,243 26.7 495 - 21% 25-29 801 17.2 279 - 25% 30-34 537 11.5 182 - 12% 35+ 645 13.8 48 - 19% TOTALc 4,658 100 142 - 18%
a Cases per 100,000 population.
b Change in rate from CY 1992 to CY 1993.
c Total includes 110 cases where age was not reported.
TABLE 4-10. Chlamydia cases, rates, and changes in rates by
age in Connecticut for CY 1993 (1).
Age % of Change (years) No. total Ratea in rateb cases 0-9 52 0.7 12 - 25% 10-14 241 3.2 124 + 7% 15-19 2,771 36.4 1,314 - 1% 20-24 2,353 30.9 938 - 16% 25-29 1,008 13.2 351 - 23% 30-34 500 6.6 169 - 14% 35+ 371 4.9 28 - 32% TOTALc 7,610 100 232 - 13%
a Cases per 100,000 population.
b Change in rate from CY 1992 to CY 1993.
c Total includes 314 cases where age was not reported.
TABLE 4-11. Primary and secondary syphilisa cases by race/ethnicityb
in Connecticut and selected cities during CY 1993 (1).
Race/Ethnicity Black White Hispanic Totalc,d State/City No. % No. % No. % No. % Connecticut 128 81 13 8 15 9 158 100 Bridgeport 29 81 0 0 7 19 36 100 Hartford 27 75 3 8 5 14 36 100 New Haven 52 98 0 0 1 2 53 100
a Type of syphilis depends on stage of disease at diagnosis. Primary syphilis is
characterized by a painless lesion or chancre; secondary syphilis is characterized
by an eruption involving skin or mucous membranes.
b The race/ethnicity categories black, white, and Hispanic are mutually exclusive.
c Totals include two cases (one in Hartford) where race/ethnicity was not reported as
black, white, or Hispanic.
d Percents may not total 100, because of rounding.
OF NOTE
Syphilis. CY 1993 was the fourth consecutive year that primary and secondary
(P & S) syphilis incidence decreased, dropping 86% since 1989. Congenital syphilis declined from 27 cases in CY 1990 to 10 cases in CY 1993. P & S cases declined 75% and 71% in whites and Hispanics, respectively, but only by 17% in blacks. Blacks accounted for 81% of the reported cases, and had a case rate nine times the state's overall rate.
Gonorrhea. The lowest annual total of gonorrhea cases in 25 years was reported in CY 1993. Residents of Bridgeport, New Haven, and Hartford accounted for 58% of the cases, and Hartford alone for 27%. Although rates among adolescents aged 15-19 continued to decline, this age group accounted for 26% of the cases. The rate for adolescents was higher than for all other age groups, and was four times the overall state rate. Blacks accounted for 75% of reported cases, and rates for black adolescents were 25 times higher than for white adolescents.
Chlamydia. Reported cases of chlamydia, the most frequently reported STD, dropped 13% during CY 1993; 46% of all cases were in residents of Hartford, Bridgeport, and New Haven. Eighty-nine percent of all cases were in women, probably because health providers screen women for chlamydia routinely, whereas relatively few men are tested. The rates in black and Hispanic females in the 15-19 year age group were 14 and 7 times greater, respectively, than for white females.
REFERENCE
(1) Sexually transmitted diseases: 1993 surveillance summary. 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Division of Infectious Disease Surveillance and Control, Sexually Transmitted Disease Control Program, Hartford, CT.
4.5 Tuberculosis Prevention and Control
Tuberculosis (TB) is a disease caused by the bacterium Mycobacterium tuberculosis; it is transmitted when a person with the active disease coughs or expels small, bacteria-laden droplets into the air. Of those who become infected with M. tuberculosis, only about 5% actually develop the active disease; however, all infected persons have a
life-long risk of becoming diseased. One hundred fifty-five cases of TB were reported in Connecticut during CY 1993.
The Tuberculosis Prevention and Control Program conducts state-wide surveillance and prevention activities as part of a national effort to eliminate tuberculosis. The program provides technical and financial assistance and staffing to local health departments, community agencies, and health care providers. Active cases of TB are identified and brought to treatment, and persons likely to be exposed to TB or who are in high-risk settings are screened and treated preventively.
TABLE 4-12. Disease treatment and preventive treatment indicators for CY 1993 for persons with active tuberculosis and those infected with M. tuberculosis (1).
Indicator Number Percentb Completed disease therapy in 140 90% <12 months Infected contacts identified 2,354 99% and examined Completed preventive treatment Infected contacts 58 94% Tuberculin convertersa 855 72% Others with M. tuberculosis 724 75% infection
a Tuberculin converters are people who initially tested negative for TB, but who later became
infected, as indicated by a positive skin test within the past 2 years.
b Percent of reported cases.
OF NOTE
Co-infection with human immunodeficiency virus (HIV) increases the likelihood that people infected with M. tuberculosis will develop active tuberculosis. Connecticut was the first state to specifically require reporting of persons co-infected with TB and HIV. Through prevention efforts in CY 1993, an estimated 25 co-infected Connecticut residents were prevented from developing active tuberculosis.
Among the northeast states in 1992, Connecticut had the highest proportion (92%) of TB patients who completed treatment (2).
REFERENCE
(1) Annual tuberculosis report, 1993. 1994. State of Connecticut, Department of Public Health and Addiction Services, Infectious Disease Surveillance and Control Division, Tuberculosis Control Program, Hartford, CT. 25 pp.
(2) Reported tuberculosis in the United States, 1993. 1994. US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Prevention Services, Division of Tuberculosis Elimination.
5 CANCER
Clinical Stage of Disease at Diagnosis
5.1 Incidence of Cancer
The Connecticut Tumor Registry, located within DPHAS, is a population-based resource for examining rates and patterns of cancer in Connecticut residents. Established in 1941, the Registry compiles data on reported cancers diagnosed since 1935. Information is maintained on incident cancers (those that are newly diagnosed in an individual patient) and on clinical stage (extent of disease) at diagnosis, survival rates, and treatment. All hospitals and private pathology laboratories in the State are required by public health legislation to report incident cases. The identity of all patients who are reported to the Registry is protected by State Statute.
The Tumor Registry is used for cancer surveillance efforts on the state and local levels, and has been a part of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program since 1973. SEER data are used to set priorities for research on the prevention and treatment of cancer in the US population. A list of publications containing data from the Connecticut Tumor Registry is available from the Registry.
TABLE 5-1. Numbers of cancers diagnosed in male and female Connecticut residents during CY 1991 (1).
Males Females
Rank Site or type of No.a Site or type of No.a
cancer cancer
1 Prostate 2,246 Breast 2,461
2 Lung 1,460 Lung 943
3 Colon 734 Colon 763
4 Bladder 600 Corpus uteri 482
5 Rectum 329 Ovary 333
6 Non-Hodgkin's 298 Rectum 277
lymphoma
7 Melanoma of skin 277 Non-Hodgkin's 270
lymphoma
8 Unknown 254 Unknown 254
9 Oral cavity, 250 Melanoma of skin 250
pharynx
10 Kidney 238 Bladder 238
11 Stomach 223 Pancreas 203
12 Leukemia 164 Kidney 173
13 Pancreas 147 Oral cavity, 154
pharynx
14 Larynx 135 Uterine cervix 148
15 Brain, CNSb 134 Stomach 148
16 Esophagus 129 Leukemia 142
17 Testis 100 Thyroid 118
18 Liver, ducts 84 Brain, CNS 88
19 Myeloma 77 Myeloma 79
20 Hodgkin's disease 57 Hodgkin's disease 55
ALL SITESc 8,306 ALL SITESc 8,056
a Numbers of cancers (not persons with cancer).
b Central nervous system.
c Includes all invasive cancers (plus in situ bladder tumors) including sites not shown in table. In situ bladder tumors are included because they are difficult to distinguish histologically from invasive
tumors. Invasive tumors are those with a potential to spread to other tissues.
5.2. Clinical Stage of Disease at Diagnosis
Survival rates decline as the extent of disease at diagnosis increases. Screening of the general population for breast and cervical cancers is widely accepted as effective in reducing mortality. Screening for prostate and colorectal cancers is recommended by some organizations. The need for an effective screening test for ovarian cancer is evident from the large proportion of cases diagnosed at advanced stages (see below).
TABLE 5-2. Stage distribution (extent of disease at time of diagnosis) of invasive cancers diagnosed in CY 1991 in residents of Connecticut (1).
Stage of disease
Site Locala Regionalb Distantc Unstagedd Totale
Female No. 1,568 670 114 109 2,461
breast
% 63.7 27.2 4.6 4.4 100
Uterine No. 72 27 30 19 148
cervix
% 48.6 18.2 20.3 12.8 100
Ovary No. 82 33 191 27 333
% 24.6 9.9 57.4 8.1 100
Prostate No. 1,376 195 294 381 2,246
% 61.3 8.7 13.1 17.0 100
Colon, No. 280 292 126 36 734
males
% 38.1 39.8 17.2 4.9 100
Colon, No. 255 320 130 58 763
females
% 33.4 41.9 17.0 7.6 100
Rectum, No. 151 96 52 30 329
males
% 45.9 29.2 15.8 9.1 100
Rectum, No. 103 95 38 41 277
females
% 37.2 34.3 13.7 14.8 100
a Localized cancers are confined entirely to the organ of origin.
b Regional stage involves extension beyond the organ and directly into surrounding organs or tissues and/or into regional lymph nodes.
c Distant stage refers to spread to parts of the body remote from the primary tumor, either by direct extension or discontinuous metastasis (that is, spread of cancer cells by blood or lymph).
d Unstaged cancers are those for which information is not sufficient to assign a stage at diagnosis.
e Percentages do not always sum to 100, because of rounding.
OF NOTE
From 1983 and 1990, the use of partial mastectomy increased, and the use of modified radical mastectomy declined, for the treatment of local-stage breast cancers among Connecticut women (2). Partial mastectomy (with radiotherapy) has been shown in clinical trials to be as effective as modified radical mastectomy.
Residents of certain ocean-shoreline towns in Connecticut have higher incidence rates of skin melanomas; this may reflect greater exposure to intense sunlight at beaches (3).
REFERENCES
(1) Summary data for 1991. Department record. State of Connecticut, Department of Public Health and Addiction Services, Connecticut Tumor Registry. Hartford, CT.
(2) Polednak, A.P., and J.T. Flannery. 1993. Time trends in breast cancer treatment in Connecticut Connecticut Medicine 57: 59-64.
(3) Polednak, A.P. 1994. Cutaneous malignant melanoma in Connecticut towns, 1989-1991. Connecticut Medicine 58: 523-526.
6 ALCOHOL AND DRUG ADDICTION
Community-based Treatment Programs
Pre-trial Alcohol Education System (PAES)
6.1 Prevalence of Substance Abuse
The DPHAS Office of Addiction Services and Bureau of Community Health and State-operated Treatment Facilities were created when the Connecticut Alcohol and Drug Abuse Commission (CADAC) merged with the Department of Health Services in 1993. The two entities now plan, administer, and monitor the funding of programs for the prevention and treatment of abuse of alcohol and other drugs. They also fund and support the information and training needs of volunteers and professionals working in the field of addictions. Diverse substance abuse prevention and rehabilitation services discourage and prevent initial involvement with alcohol and other drugs, or lead to the recovery and rehabilitation of those who already have substance abuse problems.
DPHAS collects data on all licensed substance abuse services in Connecticut. In CY 1993, DPHAS operated 4 facilities (11 clinics), funded and monitored grants to 142 community programs, and collected treatment data from an additional 61 programs that did not receive funding from DPHAS.
TABLE 6-1. Estimated prevalencea of substance abuse in individuals
aged 18 and older in Connecticut (1).
Populationb Estimated No. Alcohol abusers 251,000 Drug abusers 65,000 Injecting drug users 35,000
a Based on extrapolations from national and other states' studies. Prevalence is the proportion of individuals in a given population who have a particular attribute at a specified time or period of time.
b The populations of alcohol abusers and drug abusers are not mutually exclusive.
TABLE 6-2. Primary problem substances used by clients who received services at facilities operated, funded, and not funded by DPHAS during CY 1993 (1). Numbers are percentagesa of clients served or treatment episodes.
Primary problem substance Facility type Alcohol Heroin Cocaine Marijuana Other Operated by DPHAS 53% 31% 14% 1% 1% Funded by DPHAS 50% 24% 18% 7% 2% Not funded by 72% 12% 12% 2% 2% DPHAS TOTAL 55% 22% 16% 5% 2%
a Percentage totals may not equal 100% because of rounding.
6.2 Community-based Treatment Programs
Treatment programs provide residential and outpatient services, targeting special populations such as youth, pregnant women and their children, minorities, the elderly, people with HIV/AIDS, and the dually diagnosed. Residential services are provided at 24-hour, live-in facilities, and include long-term care, medical detoxification, and intensive, intermediate, and long-term treatment and rehabilitation. Outpatient services include the medical management of withdrawal from alcohol and drugs, the provision of medication and counseling for individuals addicted to heroin and other opiates (methadone maintenance program), and counseling services for addicted individuals, their families, and significant others.
TABLE 6-3. Race and ethnicity, by sex and treatment modality, of recipientsa of residential and outpatient alcohol and drug rehabilitative services in clinics that were operated, funded, or not funded by DPHAS during CY 1993b (2).
Treatment modalityd Residential Outpatient Clinic type/ No. No. No. No. Total Race & Ethnicityc Male Female Male Female No. Operated by DPHAS White 3,547 1,039 N/A N/A 4,586 Black 1,197 435 N/A N/A 1,632 Hispanic 1,087 258 N/A N/A 1,345 Other 34 10 N/A N/A 44 Missing/Unknown 11 5 N/A N/A 16 TOTAL, operated 5,876 1,747 N/A N/A 7,623 Funded by DPHAS White 5,909 1,586 6,812 3,368 17,675 Black 3,445 1,041 3,967 1,449 9,902 Hispanic 1,709 373 2,734 901 5,717 Other 40 14 97 37 188 Missing/Unknown 8 1 11 3 23 TOTAL, funded 11,111 3,015 13,621 5,758 33,505 Not funded by DPHAS White 3,439 1,347 3,964 1,127 9,877 Black 1,023 425 748 339 2,535 Hispanic 430 168 290 108 996 Other 25 4 33 13 75 Missing/Unknown 5 1 12 9 27 TOTAL, not funded 4,922 1,945 5,047 1,596 13,510 TOTAL, all 21,909 6,707 18,668 7,354 54,638 facilities
a Numbers are for treatment episodes, and do not represent individual clients served. Figures include
those persons in treatment on January 1, 1993, plus all admissions and treatment episodes from
January 1 through December 31, 1993.
b Figures include counts for prison behavioral studies, DWI (driving while intoxicated), residential clients, employer assistance programs, and research projects.
c All categories of race and ethnicity are mutually exclusive.
d Residential services include long-term care, medical detoxification, and intensive, intermediate, and long-term treatment and rehabilitation. Outpatient services include the medical management of withdrawal from alcohol and drugs, the provision of medication and counseling for individuals addicted to heroin and other opiates (methadone maintenance program), and counseling services for addicted individuals, their families, and significant others. Outpatient services are not offered at facilities operated by DPHAS.
TABLE 6-4. Age, by sex and treatment modality, of recipientsa of residential and outpatient alcohol and drug rehabilitative services in clinics that were operated, funded, or not funded by DPHAS during CY 1993b (2).
Treatment modalityd Residential Outpatient Clinic type/ No. No. No. No. Total Age groupc Male Female Male Female No. Operated by DPHAS <20 44 13 N/A N/A 57 20-34 2,641 982 N/A N/A 3,623 35-49 2,454 628 N/A N/A 3,082 50-64 616 104 N/A N/A 720 65+ 121 20 N/A N/A 141 TOTAL, operated 5,876 1,747 N/A N/A 7,623 Funded by DPHAS <20 270 68 790 244 1,372 20-34 5,020 1,898 7,286 3,169 17,373 35-49 4,449 928 4,777 2,002 12,156 50-64 1,170 97 580 248 2,095 65+ 202 24 188 95 509 TOTAL, funded 11,111 3,015 13,621 5,758 33,505 Not funded by DPHAS <20 289 109 231 120 749 20-34 1,968 998 2,539 839 6,344 35-49 2,087 637 1,890 549 5,163 50-64 508 153 334 69 1,064 65+ 70 48 53 19 190 TOTAL, not funded 4,922 1,945 5,047 1,596 13,510 TOTAL, all 21,909 6,707 18,668 7,354 54,638 facilities
a Numbers are for treatment episodes, and do not represent individual clients served. Figures include
those persons in treatment on January 1, 1993, plus all admissions and treatment episodes from
January 1 through December 31, 1993.
b Figures include counts for prison behavioral studies, DWI (driving while intoxicated), residential
clients, employer assistance programs, and research projects.
c For residential clients, based on age at time of admission.
d Residential services include long-term care, medical detoxification, and intensive, intermediate, and long-term treatment and rehabilitation. Outpatient services include the medical management of withdrawal from alcohol and drugs, the provision of medication and counseling for individuals
addicted to heroin and other opiates (methadone maintenance program), and counseling services for addicted individuals, their families, and significant others. Outpatient services are not offered at
facilities operated by DPHAS.
TABLE 6-5. Insurance status, by sex and treatment modality, of recipientsa of residential and outpatient alcohol and drug rehabilitative services in clinics that were operated, funded, or not funded by DPHAS during CY 1993b (2).
Treatment modalityd Clinic type/ Residential Outpatient Insurance No.Male No.Female No. No.Female Total statusc Male No. Operated by DPHAS No insurance 4,370 1,052 N/A N/A 5,422 Blue Cross/Blue 38 7 N/A N/A 45 Shield Other private 90 36 N/A N/A 126 insurance Medicare 213 65 N/A N/A 278 CHAMPUS 14 2 N/A N/A 16 City or local 721 323 N/A N/A 1,044 welfare Medicaid 412 260 N/A N/A 672 HMO 17 2 N/A N/A 19 CADAC contract 1 0 N/A N/A 1 TOTAL, operated 5,876 1,747 N/A N/A 7,623 Funded by DPHAS No insurance 2,460 752 7,968 1,875 13,055 Blue Cross/Blue 119 26 402 184 731 Shield Other private 350 91 1,173 559 2,173 insurance Medicare 648 56 275 159 1,138 CHAMPUS 33 4 12 6 55 City or local 4,656 1,108 2,580 1,220 9,564 welfare Medicaid 1,064 577 735 1,529 3,905 HMO 209 68 181 89 547 CADAC contract 1,572 333 295 134 2,334 Unspecified 0 0 0 3 3 third party TOTAL, funded 11,111 3,015 13,621 5,758 33,505 Not funded by DPHAS No insurance 460 275 1,719 312 2,766 Blue Cross/Blue 755 217 483 109 1,564 Shield Other private 2,154 531 1,377 302 4,364 insurance Medicare 43 18 93 38 192 CHAMPUS 11 12 19 14 56 City or local 818 290 466 187 1,761 welfare Medicaid 364 472 241 392 1,469 HMO 312 129 629 230 1,300 CADAC contract 5 1 20 12 38 TOTAL, not 4,922 1,945 5,047 1,596 13,510 funded TOTAL, all 21,909 6,707 18,668 7,354 54,638 facilities
a Numbers are for treatment episodes, and do not represent individual clients served. Figures include
those persons in treatment on January 1, 1993, plus all admissions and treatment episodes from
January 1 through December 31, 1993.
b Figures include counts for prison behavioral studies, DWI (driving while intoxicated), residential
clients, employer assistance programs, and research projects.
c For residential clients, based on insurance status at time of admission.
d Outpatient services are not offered at facilities operated by DPHAS. See introductory material in
Section 6.2, Community-based Treatment Programs, for descriptions of inpatient and outpatient
clients and services.
6.3 Prevention Programs
The DPHAS-funded prevention system uses a systems approach, incorporating a statewide prevention infrastructure and a wide range of community-based programs for preventing alcohol, tobacco, and other drug (ATOD) abuse. It employs six key strategies for changing the attitudes and behaviors that contribute to alcohol and drug abuse: 1) heightening information and public awareness; 2) educating and developing new skills; 3) participating in activities that exclude ATODs; 4) involving communities and social institutions in prevention; 5) promoting appropriate changes in social policy; and 6) early identification and intervention.
The system targets special populations, including children of alcoholics, high-risk youth, lesbians and gay men, the elderly, people with disabilities, pregnant women and women of childbearing age, minorities, school dropouts, and the unemployed.
TABLE 6-6. Summary of prevention and intervention program measures for alcohol and drug addiction, SFY 1994 (3).
Program Measure Number Prevention infrastructure programs 17 Training events held 373 Individuals served 4,142 Technical assistance 22,925 Local prevention councils/towns 120/169 served Research & demonstration programs 7 Educational sessions and activities 306 Individuals serveda 1,878 Primary prevention & early 21 intervention programs Educational sessions and activities 5,497 Individuals served 25,915 Referrals made 94 Local prevention council programs 155
a Individuals served include those primarily targeted in grants, not total number reached.
6.4 Pre-trial Alcohol Education System (PAES)
PAES provides counseling and education for state residents charged for the first time with operating a motor vehicle under the influence of alcohol or drugs. Offenders may be brought face-to-face with survivors of drunk driving accidents and families of victims.
TABLE 6-7. Numbers of participants in the Pre-trial Alcohol Education System
(PAES) during CY 1993 (3).
Program measure Number or % Participants in education track 1,280 Education track successfully completed 97% Participants in therapeutic track (group 4,634 intervention) Therapeutic track successfully completed 94% Participants recommended for further 645 treatment Participants convicted of subsequent DWIa after 710 completing PAES
a Driving while intoxicated.
OF NOTE
In Connecticut during CY 1993:
Four out of every 100 treatment episodes involved youths under the age of 20 (2).
The youngest client was 10 years old, and the oldest was 94 (2).
Almost half of all substance abusers in treatment first used drugs or alcohol before the age of 17, and 4% were under age 11 (2).
One in five clients injected drugs (2).
About one-third of the clients had dependent children under age 18, and 5% of the female clients were pregnant (2).
According to the 1993 National Household Drug Abuse Survey (4):
About 11.7 million Americans currently use illicit drugs.
Marijuana is used most commonly (about 5.1 million weekly users).
Of all current illicit drug users, 74% are white, 13% black, and 10% Hispanic.
Since 1979, the percentage of drug users over 35 years old nearly tripled, while users in all other age groups declined.
Only about half of youths aged 12-17 feel there is great risk in using marijuana occasionally or in trying cocaine, PCP, or heroin. In contrast, 77% of the general population aged 12 and older associated great risk with marijuana use, and 67% perceived great risk in trying cocaine, 71% in trying PCP, and 75% in trying heroin.
REFERENCES
(1) Statewide services delivery plan for substance abuse treatment services. Connecticut Alcohol and Drug Abuse Commission, Hartford, CT, March, 1990.
(2) Client information and collection system (CICS) data for CY 1993. 1994. State of Connecticut, Department of Public Health and Addiction Services, Office of Addiction Services, Hartford, CT.
(3) Unpublished department records. 1994. State of Connecticut, Department of Public Health and Addiction Services, Office of Addiction Services, Hartford, CT.
(4) National household survey on drug abuse: Population estimates 1993. 1994. US Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Washington, DC.
7 FAMILY HEALTH
Adolescent Pregnancy Prevention & Young Parent Program
Special Supplemental Food Program for Women, Infants, and Children (WIC)
Children with Special Health Care Needs
7.1 Adolescent Pregnancy Prevention and Young Parent
Program
The objectives of the Adolescent Pregnancy Prevention and Young Parent Program (APP/YPP) are to prevent initial and repeat pregnancies, assure healthy birth outcomes, and promote self-sufficiency among the teen population, through community outreach and planning activities between private and public sectors, along with family counseling on reproductive and primary health care for teens and low-income families.
Thirteen APP/YPP programs serve at-risk pregnant and parenting adolescents and their partners, whether they are in or out of school. The programs are based in four hospitals (in Bridgeport, Meriden, Middletown, and Milford), two schools (in New Haven and New London) and seven community agencies (in Bristol, Danielson, New Britain, Norwich, Stamford, Waterbury, and Willimantic).
TABLE 7-1. Activities and adolescents served by the Adolescent Pregnancy
Prevention and Young Parent Program during FFY 1993 (1).
Type of service Number
Long-term intensive case management
and care
Clients served 2,386
Prevention (public information and
education)
Community public education 1,862
meetings held
Clients served 13,162
OF NOTE
Of the 220,000 female adolescents in Connecticut it is estimated that half are at risk for pregnancy, and 9,400 are already pregnant or parents (2).
Only 6% of APP/YPP clients experience repeat pregnancies while enrolled in the programs, compared to 23% nationally (3).
The incidence of low birthweight babies born to teens in Connecticut APP/YPP programs is 3%, well below the national average of 10% (3).
REFERENCES
(1) APP/YPP FFY 1992-1993 service utilization summary. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Community Health and State-operated Treatment Facilities, Adolescent Pregnancy Prevention/Young Parent Program. Hartford, CT.
(2) LaPlante, O.R. 1991. APP/YPP services to female adolescents. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Community Health and State-operated Treatment Facilities, Adolescent Pregnancy Prevention/Young Parent Program, Hartford, CT. (Chart.)
(3) Gioco, D., and C.B. Stern. 1990. Survey shows YPPs/APPs prevent second pregnancies, low birth weights. Misconceptions, January, 1990: 1-3.
7.2 Healthy Start Program
Healthy Start is a statewide collaborative initiative between the Department of Public Health and Addiction Services and the Department of Social Services to improve access to medical and support services for pregnant and postpartum women, infants, and children through age six (age 11 effective July 1, 1994) who live in households with a total income at or below 185% of the federal poverty level (see Appendix A-2).
Funds from a federal Title V Maternal and Child Health Block Grant to DPHAS are used: 1) to provide program enhancements not funded by Medicaid, such as outreach/case-finding, liaison, and case management, to ensure a healthy pregnancy outcome; and 2) to provide ambulatory medical care to pregnant clients not eligible for Title XIX Medicaid (undocumented residents, non-resident aliens, and unemancipated teens) through Extended Eligibility Coverage. Twenty-three grantees and their numerous subcontractors are funded by Healthy Start in Connecticut.
TABLE 7-2. Numbers of women, infants, and children who received liaison and/or
case management services through Healthy Start in SFY 1994a (1).
Services provided Case Client type Liaison management Total Women 6,062 7,999 14,061 Infantsb 3,630 3,964 7,594 Childrenc 2,212 1,258 3,470 TOTAL 11,904 13,221 25,125
a An unduplicated total of 15,938 clients (8,271 women and 7,667 infants and children) received
services through Healthy Start during SFY 1994. Some received only liaison services, some only
case management, and others received both. Hence, column totals (numbers of women, infants,
and children who received either type of service) are unduplicated, whereas row totals (sums of
women, infants, or children who received liaison and/or case management services) are duplicated.
b Infants are from birth through 12 months.
c Children are from age 1 through 6 years.
REFERENCE
(1) Summary data for SFY 1994. Department records. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Community Health and State-operated Treatment Services, Maternal and Child Health Division, Healthy Start Program, Hartford, CT.
7.3 Special Supplemental Food Program for Women, Infants, and Children (WIC Program)
The US Department of Agriculture sponsors the WIC Program, which provides specific nutritious foods and nutrition education to eligible pregnant and breast-feeding women up to 1 year after delivery, non-breast-feeding mothers up to 6 months after delivery, and infants and children up to their fifth birthday. Eligibility is based on the applicant's income (up to 185% of federal poverty level, see Appendix A-2) and nutritional need. Once certified, eligible participants receive the selected foods and nutrition education for 6 months. Participation after 6 months may be continued if necessary. The WIC food list consists of formulas, cereals, and juices for infants, and milk, cheeses, eggs, fruit juices, legumes, peanut butter, iron-fortified cereals, canned tuna, and carrots for women and children. Children with special dietary needs may receive formulas if prescribed by a physician.
WIC is a 100% federally-funded program administered in Connecticut through the DPHAS Bureau of Community Health and State-operated Treatment Facilities, Maternal and Child Health Section. Twenty-one local agencies (hospitals, community health centers, community action agencies, and municipalities) are awarded contracts to provide services to people in Connecticut's 169 towns.
TABLE 7-3. Numbers of women, infants, and
children who participated in the Connecticut
WIC Program during FFY 1993 (1).
Client type Number Women 10,468 Infants 13,535 Children 41,731 TOTAL 65,734
OF NOTE
Nationally, about 6 million of an estimated 9 million eligible persons are served by the WIC Program.
In 1993 Connecticut ranked first in the nation in serving the eligible population; every eligible person in the state (based on estimates of population eligibility) received WIC Program services.
Every dollar invested in WIC for pregnant women produces $1.92-4.21 in Medicaid savings for newborns and their mothers in the first days after birth, and Medicaid costs are reduced an average of $376-753 for each participant who receives WIC benefits at some time during pregnancy (2).
REFERENCES
(1) Summary data for FFY 1993 (provisional). State of Connecticut, Department of Public Health and Addiction Services, Bureau of Community Health and State-operated Treatment Facilities, Maternal and Child Health Section, WIC Program, Hartford, CT.
(2) US Department of Agriculture. Addendum to the 1990 Mathematica Policy Research Inc. Study, October, 1991.
7.4 Genetics
Five programs are operated under the aegis of the DPHAS Genetics Unit.
Newborn Screening Program
All newborns delivered in CT hospitals are required by law to be screened for certain genetic disorders which, undiagnosed and untreated, cause irreversible mental retardation and/or death. The Newborn Screening Program follows up and tracks all infants with positive screening tests.
TABLE 7-4. Clients served and results of tests conducted through the Newborn Screening Program during CY 1993 (1).
Screening or service type No. clients Total newborns tested 47,496 Initial positive (non-sickle cell)a 889 Identified diseases (non-sickle cell): Benign hyperphenylalanine 1 Biotinidase deficiency 0 Congenital hypothyroidism 10 Homocystinuria 0 Maple syrup urine disease (MSUD) 0 Phenylketonuria (PKU) 1 Sickle cell diseases and traits: Hemoglobinopathies (sickle cell 25 diseases) Sickle cell traits 566
a All babies that test positive initially are followed up and tracked for identification of disease.
Clinical Genetics Program
This program provides comprehensive genetic diagnostic, counseling, and testing services based in two university hospitals (John Dempsey Hospital and Yale-New Haven Hospital), with field clinics in Norwich, Norwalk, Danbury, and Bridgeport.
Clinical Sickle Cell Program
This program provides comprehensive testing, counseling, and treatment services based at Yale University's Comprehensive Sickle Cell Service or St. Francis Hospital's Sickle Cell Service. Field clinics are located at Bridgeport Hospital, Norwalk Hospital, and St. Mary's Hospital.
Maternal PKU Program
In collaboration with the University of Connecticut and Yale University medical schools, the Maternal PKU Program tracks and provides genetic and nutritional counseling and high-risk pregnancy care to all adolescent and adult females in CT with phenylketonuria (PKU). Women with PKU are at high risk for delivering abnormal babies, but the abnormalities can be prevented by effective dietary intervention before conception and throughout pregnancy.
Pregnancy Exposure Information Service (PEIS)
Based at the University of Connecticut Health Center's Department of Pediatric Health, Division of Human Genetics, the PEIS provides information and referral services to pregnant women and health care providers concerning the potential teratogenic effects of drugs, maternal illness, and occupational exposure via a statewide toll-free telephone number.
TABLE 7-5. Clients served by the Clinical Genetics Program, Clinical
Sickle Cell Program, Maternal PKU Program, and Pregnancy Exposure
Information Service (PEIS) during CY 1993 (1).
Program or service No. clients Clinical Genetics Program Outreach clinics 191 Clinics at Yale University & UConn Health Center Prenatal services 5,000a General genetics services 2,500a Clinical Sickle Cell Program 180 Maternal PKU Program 44 Pregnancy Exposure Information 2,641 Service
a Estimates based on extrapolation from first-quarter actuals. Annual counts not available.
OF NOTE
More than 5,000 genetic disorders, which affect an estimated 32,000 Connecticut residents, have been identified (2).
Congenital anomalies are the leading cause of infant death. Five percent of all infants, or 1,300 to 2,100 of the babies born in CT each year, have a congenital anomaly (2).
Approximately 35% of hospital admissions to children's services are for conditions of genetic origin (2).
One in 400 babies is born with a serious congenital malformation or mental retardation, as a result of in utero exposure to a drug, chemical, illicit substance, infectious agent, or radiation.
REFERENCES
(1) Summary data for CY 1993 (provisional). Department record. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Community Health and State-operated Treatment Facilities, Genetics Unit, Hartford, CT.
(2) Annual report for CY 1992: Genetics Unit. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Community Health and State-operated Treatment Facilities, Genetics Unit, Hartford, CT.
7.5 Sudden Infant Death Syndrome (SIDS) Program
Sudden infant death syndrome (SIDS) refers to the unexplained, sudden and unexpected death of an apparently healthy baby under 1 year old. The exact cause of death remains unknown even after autopsy. SIDS is not caused, however, by vaccination, suffocation, or bottle feeding, nor is it contagious or heritable.
The DPHAS SIDS Program Coordinator provides immediate crisis intervention, (telephone counseling, information, and referral to a SIDS support group) and follow-up to the families of every SIDS victim in Connecticut, upon notification of a SIDS death by the State Medical Examiner's Office. The Program Coordinator also offers SIDS training to first responders, such as State Police, state and local auxiliary police, and emergency personnel, and provides consultation and technical assistance to community-based groups.
TABLE 7-6. Numbers and percents of victims of sudden infant death syndrome,
by sex and race/ ethnicity, in Connecticut during SFYs 1992, 1993, and 1994 (1).
State fiscal year 1992 1993 1994a Sex or No. % No. % No. % race/ethnicity Sex Male 25 59.5 16 61.5 17 54.8 Female 17 40.5 10 38.5 14 45.2 Race/Ethnicityb White 30 71.4 18 69.2 19 61.3 Black 11 26.2 7 26.9 12 38.7 Hispanic 0 0 1 3.9 0 0 Asian 1 2.4 0 0 0 0 TOTAL 42 100 26 100 31 100
a At the close of SFY 1994 31 cases were confirmed and 3 additional cases were pending.
b All racial and ethnic categories are mutually exclusive.
OF NOTE
SIDS is the number one cause of death among infants between the ages of one month and one year.
Approximately 6,000 babies die of SIDS every year in the US.
Blacks are disproportionately represented.
REFERENCE
(1) Summary data for SFY 1992, SFY 1993, and SFY 1994. Department records. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Addiction and Community Health Services, Maternal and Child Health Division, Sudden Infant Death Syndrome Program, Hartford, CT.
7.6 Immunization Program
The primary purpose of the Connecticut Immunization Program is to prevent the occurrence and transmission of vaccine preventable diseases--diphtheria, pertussis, tetanus, poliomyelitis, measles, rubella, mumps, invasive Hemophilus influenzae type b (Hib) disease, hepatitis B, influenza, and pneumococcal disease. This is accomplished through early childhood immunization and immunization of adults.
TABLE 7-7. Percent of Connecticut children immunized at age
24 months, based on results of CY 1993 and CY 1994 retrospective
surveysa(1).
Survey year Immunization series 1993 1994 completedb 4 DTP, 3 OPV, 1 MMR 63.6% 70.3%c 3 DTP, 3 OPV 1 MMR 73.1% 78.9% MMR complete 88.2% 90.5%c
a The retrospective surveys randomly assessed the immunization records of children currently in kindergartens throughout CT, most of whom were born in 1988 and were expected to complete their basic immunization series within two years of birth.
b DTP = diphtheria, tetanus, and pertussis vaccines. OPV = oral polio vaccine. MMR = measles, mumps, and rubella vaccines.
c These levels were record highs for the State for immunizations completed by age 24 months.
OF NOTE
On September 29, 1994, the World Health Organization declared that polio has been eradicated from the Western Hemisphere (2). The last documented case of human-to-human transmission of the wild polio virus in the US was in 1979, and the last Connecticut cases occurred in 1972 (3).
There were less than 10 reported cases of measles, mumps, and rubella in CT in 1993, whereas tens of thousands of cases were reported annually before 1965 (3).
A total of 794,238 doses of DTP, polio, measles, rubella, mumps, and Hib vaccines were administered through the Connecticut Immunization Program in 1992 (3).
REFERENCES
(1) Retrospective surveys of immunization status, 1993 and 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion, Immunization Program, Hartford, CT.
(2) WHO declares polio a disease of the past. Hartford Courant, September 30, 1994, p. A8.
(3) Report prepared for DPHAS Health Research and Data Analysis Unit, March 16, 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Immunization Program, Hartford, CT.
7.7 Healthy Steps
Healthy Steps is a pilot insurance program that targets children under age 14 who live in and attend school in the city of New Haven, whose family incomes are below 200% of the federal poverty level (see Appendix A-2), who are not enrolled in Medicaid, and do not have another source of health care coverage. The program is state-subsidized and administered by DPHAS. Its aims are to improve access to primary care, improve health status, reduce the level of hospital uncompensated care, and reduce inappropriate use of hospital emergency rooms for primary care services.
Healthy Steps provides comprehensive health care coverage, including primary and preventive care, inpatient and outpatient hospital care, prescription drugs, and dental services. The program uses a managed-care system administered by Blue Cross and Blue Shield of Connecticut.
TABLE 7-8. Age, sex, and income level of Healthy Steps
enrollees during CY 1993 (1).
Characteristic Number Percent Total 504 100% Agea <1 15 3.0% 1-5 124 24.6% 6-13 365 72.4% Sex Male 268 53.2% Female 236 46.8% Income (% FPL)b <61% 36 7.2% 61-100% 115 22.8% 101-133% 133 26.4% 134-185% 177 35.1% >185% 43 8.5%
a Age at the time of enrollment.
b Income as percent of Federal Poverty Level (FPL) at the time
of enrollment (see Appendix A-2).
TABLE 7-9. Total claims and expenditures for health services provided through Healthy Steps, and mean claims and expenditures per full-year-equivalent (FYE) enrolleea during CY 1993(1).
Claims Expenditures ($) Service type Total Mean per Total Mean per FYE FYE Ambulatory medical care Primary care 1,585 4.3 51,456 140 Specialty care 165 0.4 15,885 43
Table 7-9 continues.
TABLE 7-9. (Continued.)
Claims
Expenditures ($)
Service type Total Mean per Total Mean per
FYE FYE
Ambulatory medical
care (cont'd)
Outpatient hospital
servicesb
Hospital charges 127 0.3 45,352 123
Physician 55 0.1 8,366 23
services
Inpatient hospital
servicesb
Hospital charges 15 <0.1 44,260 120
Physician services 43 0.1 5,573 15
Dental care 1,551 4.2 67,185 182
Prescription drugsc 637 1.7 7,741 21
Laboratory 520 1.4 6,376 17
Transportation 0 0 0 0
Appliances/Equipment 6 <0.1 527 2
Total 4,704 12.8 $252,721 $686
a Of the 504 children who enrolled in the program, 378 remained enrolled continuously throughout 1993. Because of the variation in duration of enrollment, enrollees were weighted before analysis of service utilization and expenditures to produce 368.3 full-year equivalent (FYE) enrollees. A child enrolled for 6 months thus has half the weight of a child enrolled for the full 12 months.
b Claims for inpatient and outpatient physician services were submitted as part of hospital services claims. There were 127 outpatient visits with 55 associated physician claims, and 15 inpatient hospitalizations with 43 associated physician claims.
c Prescription drugs were the only services for which a copayment was charged. The copayments ($2/prescription) amounted to an average of $3 per FYE enrollee.
OF NOTE
Nationwide in 1993, the number of people without health insurance was 39.7 million, including 9.5 million under the age of 18 years. Based on 1991-1992 percentages, Connecticut ranked third lowest among the states in uninsureds, with 9.1%. Louisiana was highest with 23.1% (2).
According to a 1992 estimate, 250,000 Connecticut residents had no health insurance. This figure did not include the recently unemployed who may have lost their coverage (3).
In 1992 an estimated one-quarter of the uninsured in Connecticut, or about 66,500 people, were children under the age of 18 (3).
REFERENCES
(1) Schwalberg, R. and L. Bartlett. 1994. An evaluation of the State of Connecticut's Healthy Steps pilot insurance program. Prepared for Connecticut Department of Public Health and Addiction Services by Health Systems Research, Inc., Washington, DC.
(2) US Bureau of the Census. 1994. Cited in: State Health Notes (George Washington University) 15(191): 8.
(3) Arnold, J. 1992. Pursuing health care reform in Connecticut. Prepared for the State of Connecticut, Health Care Access Commission. Lewin ICF, June, 1992.
7.8 Children with Special Health Care Needs (CSHCN)
An estimated 46,315 Connecticut children under the age of 20 years have special health care needs (1). The objective of the CSHCN program is to assure that children with special health care needs receive early identification and access to complex, highly specialized, interdisciplinary diagnostic and treatment services, through community-based care. The services covered under the CSHCN program include medical specialty care, hospital outpatient care, laboratory and radiology services, rehabilitation services, equipment, and medications and prescriptions.
Table 7-10. Services provided and types of clients served by the Connecticut Children with Special Health Care Needs program in FFY 1993(2).
Service type Client type No.
clients
Community-baseda Orthopedic/pediatric 360
Other multiple diagnoses 640
Tertiary-basedb Cardiac 4,700
Juvenile diabetes and cystic 860
fibrosis
Pediatric, orthopedic, and 190
neurological
Child developmentc All types (for diagnosis 319
only)
TOTAL 7,069
a Provided through contractual arrangements with community-based care providers
(orthopedic/pediatric clinics) for specialty care.
b Provided through contractual arrangements with tertiary care centers (Yale University School of
Medicine, University of Connecticut School of Medicine, and Hartford Hospital).
c Provided mainly through contractual arrangements with clinics in Hartford, New Haven, Bridgeport, Norwich, and Torrington. CSHCN staff also conduct child development assessments in northwest Connecticut.
OF NOTE
CSHCN is the oldest maternal and child health program at DPHAS. It began in 1937 as part of the Social Security Act of 1935.
Nationally, 15% of all children (nearly 10 million) have some chronic health problem; 6% (nearly 4 million) have a limit on usual childhood activities (school, play, etc.); 1% (about 700,000) have both a disability and low income that qualifies them for Supplemental Security Income; 0.2% (about 150,000) have limitations in their activities of daily living (eating, walking, etc.); and 0.1% (about 40,000) reside in long-term care institutions (3).
REFERENCES
(1) Maternal child health block grant application. 1994. State of Connecticut, Department of Public Health and Addiction Services, Community Health Services Division, Children with Special Health Care Needs Program, Hartford, CT.
(2) CSHCN summary data for FFY 1992-93 (provisional). State of Connecticut, Department of Public Health and Addiction Services, Bureau of Community Health and State-operated Treatment Facilities, Children with Special Health Care Needs Program, Hartford, CT.
(3) Buchanan, G. 1994. How many children have special health care needs? Presented at Pediatric Institute, Columbus, OH, June, 1994.
7.9 Nutrition Program
The DPHAS Nutrition Program provides nutrition consultation, training, and technical assistance to health care providers, community leaders, educators, school food service personnel, the food industry, the public, and the media throughout Connecticut, in order to promote health, prevent disease, and reduce health care costs. Major, ongoing initiatives include: "5 a Day for Better Health," which aims to increase to five the portions of fruits and vegetables consumed daily; promoting optimal nutrition for children with special health care needs; and "Munch a Healthy Lunch," a week-long celebration during National Nutrition Month (March), highlighting nutrition education and healthy menus in schools across Connecticut.
TABLE 7-11. Education, materials, and services provided through the initiatives
and activities of the DPHAS Nutrition Program during SFY 1994 (1).
Type of activity or service/recipient Number "Munch a Healthy Lunch" celebration participants: Adults 3,375 Students 174,010 Recipients of nutrition education and materials at the 1994 10,000a Food and Nutrition Show (Hartford Civic Center) "5-a-Day" program participants (adults >4,000 and children) School breakfast videos and kits 2,000 distributed Adult attendees at nutrition conferences 527 and presentations
a Estimate based on volume of literature distributed.
OF NOTE
Broccoli was voted the favorite vegetable, and strawberries the favorite fruit, by more than 3,000 Connecticut residents of all ages at the 1994 Food and Nutrition Show.
Only 37% of Connecticut women breast feed their babies upon hospital discharge, and the rate declines to 11% by 5-6 months (2).
Obesity in American youth is on the rise. According to the CDC's third National Health and Nutrition Examination Survey (3), 20% of males and 22% of females age 12-19 are overweight. This represents an increase of 6% since the last survey. (See also Sections 3.2 and 3.3.)
REFERENCES
(1) Annual report for SFY 1994. 1994. State of Connecticut, Department of Public Health and Addiction Services, Community Health Services Division, Nutrition Program, Hartford, CT.
(2) Mothers' survey. 1991. Ross Products Division, Abbott Laboratories, Columbus, OH.
(3) Division of Health Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention. 1994. Prevalence of overweight among adolescents--United States, 1988-1991. Morbidity and Mortality Weekly Report 43:818-821.
8 ENVIRONMENTAL HEALTH
Childhood Lead Poisoning Prevention
Occupational Health Surveillance
Recreational Health and Safety
On-site Sewage Disposal and Groundwater Control
8.1 Asbestos
Asbestos is a generic term for various forms of hydrated magnesium silicate. Because it is incombustible and chemically resistant, it was commonly used for fireproofing, electrical insulation, building materials, brake linings, and chemical filters.
The DPHAS Asbestos Program aims to reduce cancer and other diseases caused by asbestos exposure. The program staff perform compliance inspections for asbestos abatement, evaluate the implementation of school asbestos management plans, and provide technical assistance to the public and the asbestos industry concerning proper conduct of abatement activities. All training courses for asbestos abatement workers, site supervisors, and consultants must be approved by the DPHAS Asbestos Program. Licensing of asbestos abatement contractors and consultants became mandatory as of November, 1994 (see Section 10.3, Environmental Health Professions).
TABLE 8-1. Summary of activities of the Asbestos Program during FFY 1994 (1).
Activity Number
Abatement notifications received 3,117
AWP applicationsa reviewed 210
Compliance inspections performed 110
Conditions of non-compliance requiring 32
enforcement action
School inspections performed 122
Non-compliance letters issued 34
a Applications for review of alternate work practice (AWP) for regulatory compliance.
OF NOTE
Prolonged inhalation of fibrous asbestos particles, which are released when it is handled (e.g. during mining, milling, or remodeling), causes asbestosis, a type of chronic lung inflammation. Asbestos also is a known carcinogen, causing lung cancers and mesotheliomas.
Asbestos is currently disposed in authorized waste disposal facilities. Disposal in Connecticut requires authorization from the Department of Environmental Protection.
REFERENCE
(1) Summary data for FFY 1994 (provisional). State of Connecticut, Department of Public Health and Addiction Services, Environmental Health Services Division, Asbestos Program, Hartford, CT.
8.2 Food Protection
The Food Protection Program seeks to reduce the public risk of food-borne illness by ensuring reasonable protection from contaminated food and by improving the sanitary condition of food establishments. This mission is carried out by promulgating safety regulations in retail food establishments, training, certifying, and re-certifying local food inspectors, providing regulatory interpretations and opinions, and acting as consultants to local health officials regarding food-borne disease outbreaks.
The key risk factors for outbreaks of food-borne diseases are the holding and cooking temperatures of the food, personal hygiene of food handlers, cross-contamination of foods via equipment, and the approval status of the food source. (See also Section 10.3, Environmental Health Professions.)
TABLE 8-2. Confirmed and suspected outbreaks of food-borne disease , number
of cases, and populations at risk during CY 1993 (1).
No. No. Etiologic agent outbreaks No. at riska cases Bacterial, confirmed Escherichia coli 0157:H7 1 23 166 Salmonella enteritidis 4 70 163 Viral, suspected Norwalk virus 2 101 726 Unknown 3 90 164 Unknown etiology 5 67 1,503 TOTAL 15 351 2,722
a Individuals at risk are those who attended the event or ate in the establishment associated with the outbreak or who consumed the suspect food at the event or establishment.
OF NOTE
An estimated 24-80 million cases of food-borne diarrheal disease and person-to-person transfer occur each year in the United States, resulting in about 10,000
deaths (2).
In 1993, an outbreak of Escherichia coli O157:H7, due to insufficiently cooked hamburgers at a fast-food restaurant chain, affected more than 500 people in four western states and caused four deaths (3).
Most food service inspections are performed by local health departments.
REFERENCES
(1) Summary data for CY 1993. Department record. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Environmental Health Division, Food Protection Program, Hartford, CT.
(2) Archer, D.L., and J.E. Kvenberg. 1985. Incidence and cost of food-borne diarrheal disease in the United States. Journal of Food Protection 45: 887-894.
(3) Centers for Disease Control and Prevention. 1994. Summary of notifiable diseases, United States 1993. Morbidity and Mortality Weekly Report 42(53): 1-73.
8.3 Childhood Lead Poisoning Prevention
Lead poisoning occurs after lead paint chips or fine lead dust are swallowed or inhaled. A threshold blood lead concentration of 10 micrograms per deciliter (10 mg/dl) is considered unsafe and indicative of lead poisoning, and requires some type of intervention. The detrimental effects of lead poisoning include impaired growth, developmental delays, learning disabilities, hearing deficits, and behavioral problems.
The Childhood Lead Poisoning Prevention Program provides technical and financial assistance to local health departments and community agencies, and tracks cases of childhood lead poisoning from the initial screening through medical management and environmental intervention. Effective July 1, 1995, the Program will oversee the mandatory licensing of lead abatement contractors and the mandatory certification of lead inspectors and lead abatement professionals (see Section 10.3, Environmental Health Professions).
TABLE 8-3. Numbers and results of screening and confirmatory tests for lead poisoning completed during CY 1993 (1).
Type of testa No. tests No. positive performed testsb Screening (finger stick) 90,213 13,773 Confirmatory (venous) 20,077 6,664
a The Centers for Disease Control and Prevention recommend that confirmatory (venous) blood
tests be performed when screening levels are 15 mg/dl, and that environmental inspection
of the child's home be performed when confirmatory levels 20 mg/dl are found.
b Blood lead concentration equal to or greater than 10 mg/dl.
OF NOTE
Lead-based paint was banned from residential buildings in 1978. An estimated 64% of Connecticut housing built before 1980 contains lead-based paint (1).
Children's bodies absorb lead in amounts 4 to 5 times greater than those absorbed by adults; they also retain higher levels. High lead levels in adults are not as serious as in children, because the development process has been completed before lead can affect it (2).
Blood lead levels in Americans declined 78% between 1976 and 1991, mainly because of the removal of 99.8% of the lead from gasoline and the removal of lead from soldered food cans and household paints (3).
REFERENCES
(1) Summary data for CY 1993. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Environmental Health Division, Childhood Lead Poisoning Prevention Program, Hartford, CT.
(2) Gerchufsky, M. 1994. Lead poisoning. Advance for Nurse Practitioners 2(11):15-16, 19, 37.
(3) Brody, D.J., J.L. Pirkle, R.A. Kramer, K.M. Flegal, P.D. Matte, E.W. Gunter, and D.C. Paschal. 1994. Blood lead levels in the United States population. Journal of the American Medical Association 272(4): 277-283.
8.4 Occupational Health Surveillance
Acute and chronic workplace exposures take the lives of an estimated 750-1,700 Connecticut residents annually (1). The DPHAS Occupational Health Surveillance Program (OHSP), in conjunction with the Department of Labor and the Workers Compensation Commission, is responsible for the active surveillance of occupational diseases for which Connecticut workers are at risk. The OHSP seeks to increase awareness and reporting of occupational diseases among the state's health care providers, to identify disease clusters in Connecticut workplaces, to disseminate results, and to seek collaborative, industry-specific interventions that will reduce the incidence of occupational diseases.
TABLE 8-4. Reported numbers of occupational diseases identified in Connecticut during CY 1992 and 1993 (2). Injuries and miscellaneous diseases not included.
Disease CY 1992 CY 1993 % Change Allergy/dermatitis 70 83 18.6% Chemical exposure 21 111 429% Lead toxicity (adults)a,b 393 2,010 411% Occupational cancerc 0 3 - Repetitive trauma Carpal tunnel syndrome 71 121 70.4% Hand/arm vibration 55 8 -85.5% Musculoskeletal 34 32 -5.9% Nervous system 26 15 -42.3% Tendonitis 96 60 -37.5% Vibration white finger 34 6 -82.4% Other repetitive trauma 79 64 -19.0% Respiratory Asbestosis 38 11 -71.1% Asthmaa 20 11 -45.0% Bronchitis 7 5 -28.6% Pleural plaque 34 5 -85.3% Reactive airway 2 3 50.0% Silicosisa 1 1 0% Other respiratory 7 2 -71.4% TOTAL 988 2,551 158%
a Lead poisoning, occupational asthma, and silicosis are reportable diseases.
b On October 1, 1992 the minimum reportable level for blood lead was lowered from 25 mg/dl to
10 mg/dl. (See Section 8.3, Childhood Lead Poisoning Prevention for statistics on lead levels
in children.)
c Other cancers are undoubtedly related at least in part to occupation. An estimated 4% of all cancers are related to occupational exposures.
REFERENCES
(1) Connecticut conducts occupational disease surveillance. 1994. Connecticut Epidemiologist 14(4): 13-14.
(2) Occupational disease surveillance system summary data, CYs 1992-1993. Department record. State of Connecticut, Department of Public Health and Addiction Services, Environmental Epidemiology and Occupational Health Division, Occupational Health Surveillance Program, Hartford, CT. [Data represent reports from sentinel providers.]
8.5 Radon
Radon is an odorless, colorless gas that arises naturally within the ground from the decay of radioactive elements. The "action level" for home exposure is 4 picocuries of radon per liter of air (4 pCi/L). At least 140 people may die from radon-induced lung cancer each year in Connecticut (1,2). The primary goal of the DPHAS Radon Program is to reduce the estimated annual mortality by increasing levels of radon awareness through extensive outreach and education, and by promoting radon testing, mitigation, and use of radon-resistant techniques in new construction. (See also Section 10.3, Environmental Health Professions.)
TABLE 8-5. Percent of Connecticut population that was aware of radon, tested for radon, and mitigated radon problems during SFY 1993 and SFY 1994 (1,3), and cumulative numbers of schools tested for radon as of December 31, 1993 and
December 31, 1994 (1,4).
Year Factor 1993 1994 CT population aware of radon 80.2% 84.2% CT population tested for radon 18.0% 23.4% CT population that mitigated 2.7% 4.1% radon problems Schools tested 139 205
OF NOTE
The average radon level in American homes is 1.25 pCi/L, and 6 million homes have levels of 4 pCi/L and above (5).
In Connecticut, the average living area level is 1.3 pCi/L, and an estimated 125,000 homes have levels at or above 4 pCi/L (2).
REFERENCES
(1) 1993 and 1994 Department Records. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Environmental Epidemiology and Occupational Health Division, Radon Program, Hartford, CT.
(2) Siniscalchi, A.J., S.J. Tibbetts, A. Mahmood, X. Soto, Z.F. Dembek, R.C. Beakes, M.A. Thomas, and N.F. McHone. In press. Multicomponent health risk assessment of Connecticut homes with multiple pathway radon exposure. In: Proceedings of Indoor Air: An Integrated Approach, An International Workshop. Elsevier Science, Ltd., Oxford, U.K.
(3) Siniscalchi, A.J., A. Mahmood, R.C. Beakes, X. Soto, Z.F. Dembek, and G.D. Ferree, Jr. 1994. Radon awareness in Connecticut: comparison of two statewide residential surveys and their use in setting numerical target goals for increasing awareness, testing and mitigation for the years 1995 and 2000. In: Proceedings of the 1994 International Radon Symposium. Omnipress Inc., Madison, WI, pp. II 5.1-5.10.
(4) Siniscalchi, A.J., Z.F. Dembek, S.J. Tibbetts, X. Soto, R.C. Beakes, A. Mahmood, and A.W. Hantman. 1994. Radon in school well water: case studies and mitigation implications. In: Proceedings of the 1994 International Radon Symposium. Omnipress Inc., Madison, WI, pp. VII 2.1-2.9.
(5) US Environmental Protection Agency. 1992. Technical support document for the 1992 citizens guide to radon. EPA 400-R-92-011. US Government Printing Office, Washington, DC.
8.6 Recreational Health and Safety
The mission of the Recreational Health and Safety Program is to protect the health, safety, and well-being of persons participating in recreational activities in Connecticut. The program performs three primary functions to carry out its mission: it licenses and inspects day and residential youth camps annually (see also Section 11.4, Day and Residential Youth Camps); it provides assistance to the Department of Environmental Protection to ensure safe bathing water at state parks; and it approves plans for the construction and repair of public swimming pools.
TABLE 8-6. Summary statistics for Recreational Health and Safety
Program, including injuries to persons attending licensed youth
camps in Connecticut during CY 1993 (1).
Number Activity or health indicator or percent Youth camps Total licensed and opened 308 Total attendees 96,349 Inspections performed Preliminary 39 Regulatory 303 Re-inspections 1 Violations observed at regular inspectionsa Non-major 122 Major 134 Percent of camps with major 43% violations Attendee injuries Broken bones 56 Lacerations 24 Other (concussion, allergic 49 reaction, etc.) Fatalities 0 Public swimming pools Plans reviewed 36 Site inspections performed 2 Other Outbreaks of foodborne disease 0
a No violations were found during re-inspections.
OF NOTE
Connecticut has been licensing youth camps since 1969.
REFERENCE
(1) Summary data for SFY 1993. Department records. State of Connecticut, Department of Public Health and Addiction Services, Environmental Health Division, Recreational Health and Safety Program, Hartford, CT
8.7 On-site Sewage Disposal and Groundwater Control
The primary function of the On-site Sewage Disposal Section is to protect surface and underground water supplies by ensuring proper treatment and disposal of domestic sewage that is generated by approximately one third of Connecticut's residents.
Section staff train and certify town sanitarians, certify sewage disposal inspectors, license septic system cleaners and installers (see Section 10.3, Environmental Health Professions), and review plans for sewage disposal systems. The section also reviews and approves plans for all public crematories, mausoleums, and private burial grounds.
TABLE 8-7. Activities of the On-site Sewage Disposal Section
during SFY 1994 (1).
Activity Number Plans for sewage disposal systems reviewed Large systems (2,000 gallons) 28 Small systems (<2,000 gallons) 147 Exceptionsa 265 Mausoleums approved 2 Crypts approved 648 Crematories approved 1 Private burial grounds approved 0
a Exceptions include wells, easements, and central systems.
OF NOTE
Double-depth burials are not prohibited by statute or regulation in Connecticut, but are generally limited to cemeteries with no shallow ground water or ledge rock.
Public Act 93-279, Sec. 19 allows multiple interment of fetal remains within a common hospital container, provided that consent forms for disposition of remains have been obtained.
Approximately 35% of Connecticut households are served by on-site sewage disposal systems; most permits for residential systems are processed by local health departments.
REFERENCE
(1) Summary data for SFY 1994 (provisional). Department record. State of Connecticut, Department of Public Health and Addiction Services, Environmental Health Services Division, On-site Sewage Disposal Section, Hartford, CT.
8.8 Water Supplies
The primary goal of the Water Supplies Section of the Environmental Health Services Division is to ensure a safe, adequate supply of drinking water, by reducing or eliminating the threat of bacteriological and chemical contamination and by developing and coordinating water supply planning activities. (See also Section 10.3, Environmental Health Professions.)
TABLE 8-8. Surveys and reviews performed, permits granted and denied,
and enforcement actions initiated and resolved during SFY 1994 by the Water
Supplies Section (1).
Activity Number Sanitary surveys performed Community 238 Non-community 114 Reviews performed Community water quality reports 3,736 Plans and specifications 297 Community systems annual watershed 38 reports Community systems annual cross-connection 84 reports Individual water supply plans 24/12 reviewed/approved Well exception permits granted/denied 27/20 Formal enforcement actions 99/93 initiated/resolved
OF NOTE
About 85% of Connecticut residents obtain their drinking water from community public water systems, and 82% of the state's population drinks fluoridated water.
Connecticut was the second state in the nation to achieve primacy, that is, primary responsibility for drinking water regulations in the State. DPHAS is the State's primacy agency for the US Environmental Protection Agency.
Connecticut and Rhode Island are the only states in the United States that prohibit the discharge of waste materials into sources of drinking water.
REFERENCE
(1) Provisional summary data for SFY 1994. Department records. State of Connecticut, Department of Public Health and Addiction Services, Environmental Health Services Division, Water Supplies Section, Hartford, CT.
9 LABORATORY SERVICES
Laboratory Standards and Clinical Chemistry
9.1 State Laboratory Services
The DPHAS Bureau of Laboratory Services, also known as the State Health Laboratory, is a centralized resource for state and local health and law enforcement agencies, hospitals, physicians, and licensed and registered laboratories. The Health Laboratory provides data and other surveillance information used for the assessment of human and environmental health issues, and also provides the judicial system with data from the analysis of evidence in criminal cases.
The Laboratory does not duplicate work that can be performed less expensively and more readily in the private sector. Rather, it focuses on procedures needed for compliance with federal and state laws, for surveillance of infectious and genetic diseases, and for emergency response. It also provides laboratory services unavailable elsewhere, including investigations that assure the quality of clinical, environmental, and public health laboratory tests performed by licensed and registered laboratories throughout Connecticut.
The Bureau of Laboratory Services has four divisions: Biological Sciences; Laboratory Standards and Clinical Chemistry; Environmental Chemistry; and Toxicology and Criminology.
9.2 Biological Sciences Division
The Biological Sciences Division tests human specimens, milk, and water for the presence of bacterial, viral, fungal, and parasitic agents of public health significance.
TABLE 9-1. Tests performed by the Biological Sciences Division
during SFY 1993 (1). Specimens for rabies tests were of animal
origin; all others were from human sources.
Type of specimen or test No. specimens Bacteriology 40,256 Nasopharyngeal specimens 492 Streptococcus, Group A 20 Pertussis 254 Legionellosis 218 Mycobacteria specimens 4,991 Enteric specimens 1,668 Gonococcus specimens 23,908 Anaerobic specimens 38 Other bacteriology 9,159 specimensa Mycology 1,888 Parasitology 1,090 Intestinal specimens 1,043 Malaria specimens 47
Table 9-1 continues.
TABLE 9-1. (Continued.)
Type of specimen or test No. specimens Virology 10,058 Rabies specimens 3,707 Viral isolation specimens 2,162 Herpes simplex specimens 3,803 Clostridium difficile toxin 386 Immunology and Serology 101,259 Syphilis serology specimens 15,938 Bacterial serology specimens 2,994 Legionellosis 1,555 Lyme disease 1,439 Parasitic serology 1,459 specimensb Viral & rickettsial serology 13,247 specimensc HIV serology specimens 67,385 Parvovirus B19 specimens 236
a Includes 8,831 specimens analyzed for Chlamydia, 15 other genital specimens, and 313
aerobic reference cultures.
b All specimens for toxoplasmosis identification.
c Includes specimens for the identification of mycoplasma, Epstein Barr virus (associated
with the disease infectious mononucleosis), hepatitis A, hepatitis B, and rubella; excludes
human immunodeficiency virus (HIV).
TABLE 9-2. Microbiological tests performed on water, wastewater
and sewage by Environmental Microbiology, and on dairy, food, and
beverage samples by the Biological Sciences Division during SFY 1993 (1).
Type of specimen or test No. samples Water samples 14,098 Potable water 4,823 Non-potable water 9,218 Shellfish seawater 6,486 Other non-potable water 2,732 Sewage and waste 57 Dairy products samplesa 1,908 Food and beverage samplesb 698
a Includes milk, cream, ice cream, cheese, frozen desserts, other dairy products, plant equipment,
and empty containers.
b Includes seafood and food samples from suspected food-associated disease outbreaks and samples
for determination of food quality.
9.3 Laboratory Standards and Clinical Chemistry
The Division of Laboratory Standards and Clinical Chemistry has three sections. The Newborn Screening Section performs seven tests for inborn metabolic abnormalities on every infant born in Connecticut. The Biochemistry Section screens blood samples for evidence of lead poisoning and Tay-Sachs disease. The Laboratory Standards Section inspects clinical facilities and certifies environmental laboratories to test the environment for contaminants. The Section's Safety, Security, and Training Office plans, organizes, and coordinates programs for DPHAS lab personnel, inspects the laboratories, and educates staff on selected topics.
TABLE 9-3. Tests performed by the Laboratory Standards
and Clinical Chemistry Division during SFY 1993 (1,2).
Type of test No. tests
Newborn screeninga 233,608
Tay-Sachs disease 337
Blood lead 104,985
Screening 87,894
Confirmation 17,091
Phenylalanine 418
a Includes tests for phenylketonuria, tyrosinemia, galactosemia, hypothyroidism,
and hemoglobinopathy.
9.4 Environmental Chemistry
The Environmental Chemistry Division supports state and local agencies for testing environmental contaminants, and is a regional technical support laboratory for the US Environmental Protection Agency. Chemical analyses for organics, inorganics or radioactivity are performed on samples such as river and lake waters, air, drinking waters, wastewaters, landfills, industrial wastes, spills, fish and shellfish, consumer products, and soils.
TABLE 9-4. Laboratory analyses performed by the Environmental
Chemistry Division during SFY 1993 (1)
Type of sample or test No. samples Potable water 13,270 Synthetic organic chemicals 5,502 Pesticides and herbicides 1,052 Inorganic chemicals 5,650 Radionuclides 1,066
Table 9-4 continues.
TABLE 9-4. (Continued.)
Type of sample or test No. samples Ambient water 3,659 Synthetic organic chemicals 50 Pesticides and herbicides 22 Inorganic chemicals 2,801 Radionuclides 786 Solid and hazardous waste 1,901 Synthetic organic chemicals 1,901 Food 442 Synthetic organic chemicals 3 Pesticides and herbicides 140 Inorganic chemicals 170 Radionuclides 129 Air pollution 6,145 Radiological analysis 2,225 Air, water, milk, food, soil, 2,096 wipes Fish, shellfish, vegetation, 129 charcoal filter Occupational safety and 112 health Samples for asbestos 42 Environmental samples 70 Othera 11,037
a Includes lead in wipes and soil, and asbestos in soil.
9.5 Toxicology and Criminology
The Division of Toxicology and Criminology analyzes evidence submitted by local and state police. The material may be evidence from cases of arson, rape, drug abuse, or driving while under the influence of alcohol or drugs, or from consumer protection cases (such as suspected poisoning of foods or pharmaceuticals).
TABLE 9-5. Forensic laboratory analyses performed by the Toxicology
and Criminology Division during SFY 1993 (1).
Type of sample or test No. samples TOTAL SAMPLES 37,676 Biological samples 12,272 Ethyl alcohol 5,636 In blood 2,159 In urine 3,477 Drugs and narcotics in urine 5,167 Blood typing 1,469 Physical samples 25,404 Liquids for alcohol 349 Plant and plant material 8,435 (including marijuana) Drugs and narcotics 11,601 Articles for blood stains 2,004 Fibers and hairs 1,169 Clothing for seminal stains 1,846
REFERENCES
(1) Consolidated annual report to the Association of State and Territorial Public Health Laboratory Directors for SFY 1993. 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Laboratory Services, Hartford, CT.
(2) Annual report for SFY 1992-1993. State of Connecticut, Department of Public Health and Addiction Services, Hartford, CT, p. 23-26.
10 HEALTH PROFESSIONALS
Medical and Other Health Service Professions
Emergency Medical Service Professions
Environmental Health Professions
10.1 Medical and Other Health Service Professions
The Bureau of Health Systems Regulation, Division of Medical Quality Assurance (MQA), licenses 31 medical and health-related professions and is responsible for certifying three professions and registering one profession. The Applications and Examinations Section of MQA receives, reviews, and approves all applications, in collaboration with 16 licensing boards or commissions. MQA's Public Health Hearing Office receives, investigates, and resolves complaints against regulated health professionals.
TABLE 10-1. Numbers of licensed, registered, and certifieda medical professionals
in Connecticut as of December 31, 1993 (1).
New in Percent Profession 1993 Total of Ratiob total Chiropractors 83 812 0.7% 24.8 Dental hygienists 138 2,807 2.6% 85.6 Dentistsc 121 2,819 2.6% 86.0 Homeopaths 1 30 0.0% 0.9 Licensed practical 616 10,851 10.0% 331 nurses Marriage & family 27 481 0.4% 14.7 therapistsa Naturopaths 12 79 0.1% 2.4 Nurse aidesa 5,709 27,874 25.6% 851 Nurse-midwives 8 84 0.1% 2.6 Occupational therapists 90 784 0.7% 23.9 Occupational therapy 43 181 0.2% 5.5 assistants Optometrists 32 598 0.5% 18.2 Osteopaths 28 129 0.1% 3.9 Physical therapists 202 2,708 2.5% 82.6 Physician assistants 409 409 0.4% 12.5 Physicians/surgeons 772 11,041 10.1% 337 Podiatrists 22 342 0.3% 10.4 Psychologists 85 1,185 1.1% 36.2 Registered nurses 2,198 45,024 41.3% 1,374 Registered nurses, 154 694 0.6% 21.2 advanced practice Respiratory care 5 41 0.0% 1.3 practitionersa Total medical 10,755 108,973 100% - professionals
a Marriage and family therapists and respiratory care practitioners are certified but not licensed.
Nurse aides are registered but not licensed. All other professionals are licensed. Licenses are
renewed annually or biennially. As certification and registration programs have no renewal
process, the data represent cumulative total numbers of these "credentialed" individuals.
b Ratio = number of professionals per 100,000 population, based on 1993 Connecticut population
estimate of 3,277,310 (2).
c As of August 16, 1994, 5 dentists were licensed separately for conscious sedation and 134 dentists
were licensed for general anesthesia and conscious sedation.
TABLE 10-2. Numbers of licensed or certifieda health professionals (other than medical professionals) in Connecticut as of December 31, 1993 (1).
New in Percent Profession 1993 Total of Ratiob total Audiologists 7 164 0.5% 5.0 Barbers 54 2,189 6.8% 66.8 Embalmers 15 806 2.5% 24.6 Funeral directors 0 128 0.4% 3.9 Hairdressers/Cosmeticians 1,146 21,754 67.9% 664 Hearing aid dealers 12 190 0.6% 5.8 Hypertrichologists 15 235 0.7% 7.2 Nursing home 42 827 2.6% 25.2 administrators Opticians 49 525 1.6% 16.0 Social workersa 209 3,016 9.4% 92.0 Speech pathologists 118 1,415 4.4% 43.2 Veterinarians 53 769 2.4% 23.5 TOTAL 1,720 32,018 100% -
a Social workers are certified but not licensed. All other professionals are licensed. Licenses are
renewed annually or biennially. As certification and registration programs have no renewal
process, the data represent cumulative total numbers of credentialed individuals.
b Ratio = number of professionals per 100,000 population, based on 1993 Connecticut population
estimate of 3,277,310. (2)
TABLE 10-3. Numbers of complaints received by Public Health Hearings Office in
CY 1993, frequency of complaints, and disciplinary actions taken (1). Professions
are listed in order of frequency of complaints.
Complaints Disciplin ary No. Percent actions Profession receive received Frequency takenb d a Veterinarians 32 3.5% 4.16 4 Dentists 113 12.4% 4.01 7 Naturopaths 3 0.3% 3.80 1 Podiatrists 12 1.3% 3.51 3(1) Chiropractors 26 2.9% 3.20 3(1) Hearing aid dealers 6 0.7% 3.16 0 Funeral directors 4 0.4% 3.13 1 Physicians/surgeons 288 31.6% 2.61 36(5) Embalmers 14 1.5% 1.74 4 Optometrists 10 1.1% 1.67 0 Osteopaths 2 0.2% 1.55 0 Nursing home 11 1.2% 1.33 1 administrators Psychologists 9 1.0% 0.76 1 Nurse aides 156 17.1% 0.56 13(4) Licensed practical 50 5.5% 0.46 15 nurses
Table 10-3 continues
TABLE 10-3. (Continued.)
Complaints Disciplin ary Number Percent actions Profession receive Frequency takenb d receive a d Opticians 2 0.2% 0.38 1 Subsurface sewage 8 0.9% 0.32 5 installers Social workers 7 0.8% 0.23 2 Marriage & family 1 0.1% 0.21 2 therapists Registered nurses 81 8.9% 0.18 48(1) Registered nurses, 1 0.1% 0.14 0 advanced practice Physical therapists 3 0.3% 0.11 0 Hairdressers/Cosmeticians 21 2.3% 0.10 8 Barbers 2 0.2% 0.09 2 Dental hygienists 1 0.1% 0.04 1 Audiologists 0 0% 0 0 Homeopaths 0 0% 0 0 Hypertrichologists 0 0% 0 0 Nurse-midwives 0 0% 0 0 Occupational therapists 0 0% 0 0 Occupational therapy 0 0% 0 0 assistants Physician assistants 0 0% 0 0 Respiratory care 0 0% 0 0 practitioners Sanitarians 0 0% 0 0 Speech pathologists 0 0% 0 1 Other Unlicensed persons 44 4.8% N/A 6 Resident physicians 5 0.5% N/A 0 Total 912 100% - 165
a Frequency = Number of complaints per 100 licensees.
b The number of actions taken includes cases dismissed by a Board or Hearing officer after hearing.
Cases dismissed are shown in parenthesis.
OF NOTE
Since the Hearing Office was established in 1978, complaints have increased more than ten-fold, and disciplinary actions have increased by a factor of 8. Six out of every ten complaints are filed against physicians/surgeons, nurse aides, or dentists.
Consumer satisfaction, measured by relative frequency of complaints, is greatest for speech pathologists and occupational therapists and lowest for veterinarians and dentists.
MQA collected more than $13 million in individual licensing fees in SFY 1993, all of which went into the State's general fund.
Five professions (registered nurses, hairdressers, nurse aids, physicians, and licensed practical nurses) accounted for 83% of all licenses held.
New programs for licensing physician assistants and massage therapists were implemented in 1993-1994.
[See end of Section 10.3 for References.]
10.2 Emergency Medical Service Professions
The Office of Emergency Medical Services (OEMS) is the lead agency for the statewide development of emergency medical services. OEMS is responsible for developing the State EMS Plan, enforcing EMS regulations, and providing technical assistance on all aspects of emergency medical services. The OEMS, in conjunction with the State EMS Advisory Board and Regional EMS Councils, is developing a statewide trauma system, data system, and replacement for the statewide EMS communication system. OEMS also administers the DPHAS emergency response duties and maintains a 24-hour point-of-contact for public health emergencies.
OEMS certifies four categories of emergency medical personnel, with re-certification required every 24 to 36 months, and also licenses ambulance providers. OEMS has a process for complaint reporting, investigation, and resolution.
TABLE 10-4. Emergency medical personnel certified by OEMS as of
December 2, 1993. During SFY 1993, the Office approved 566 emergency medical care training programs (3).
Profession Number Ratioa Medical Response Technician (MRT)b 5,197 159 Emergency Medical Technician 11,690 357 (EMT)c Intermediate Emergency Medical 1,214 37 Techniciand Paramedic Emergency Medical 861 26 Techniciane TOTAL 18,962 579
a Ratio = number of professionals per 100,000 population, based on 1993 Connecticut population estimate of 3,277,310 (2).
b The MRT is the "first responder," who provides the emergency medical care needed until emergency medical technicians arrive.
c The basic level EMT generally staffs ambulances and provides basic life support skills. The training program is 120 hours.
d The Intermediate EMT, working under the direction of a physician through radio communication, provides advanced medical skills (e.g. advanced airway care, administration of intravenous fluids). Additional training of 65-80 hours above the basic EMT program is required.
e The Paramedic EMT works under a physician's direction through radio communication and provides a higher level of medical care, including administration of drugs, defibrillation of cardiac arrhythmia,, and intubation. The course involves about 600 to 1,000 hours of instruction, clinical and field internships.
TABLE 10-5. Types of ambulance providers licensed by
OEMS as of December 31, 1993 (3).
Type of provider Number Volunteer associations 76 Volunteer fire departments 56 Other volunteer (school, 3 racetrack) Municipal fire departments 14 Industrial/other fire 9 departments Commercial services 29 Other private (EMS 4 foundations) Hospital-based 10 Police-based 1 TOTAL 202
TABLE 10-6. Complaints received and disciplinary actions taken against emergency medical personnel and ambulance companies during CY 1993 (3).
No. No. disciplina Profession/Provider Complaints ry actions Medical Response Technician (MRT) 1 1 Emergency Medical Technician (EMT) 5 5 Intermediate Emergency Medical 1 1 Technician (EMT-I) Paramedic Emergency Medical Technician 2 1 (EMT-P) Ambulance Companies 13 4 Othera 1 1 TOTAL 23 13
a One complaint, made against an uncertified EMT, was turned over to the local police department
(i.e., criminal impersonation).
OF NOTE
Connecticut was the third state in the nation to implement a statewide enhanced
911 emergency telephone system, which automatically provides caller information (telephone number and street address) at the answering station.
Every municipality in Connecticut is covered by a designated basic life support ambulance, and pre-hospital advanced life support care is available to more than 80% of Connecticut residents.
The statewide EMS communication network links more than 500 field units with 37 emergency medical facilities.
Connecticut has two "Lifestar" aeromedical helicopters that provide both advance scene care and rapid inter-facility transfer of critically ill or injured patients.
[See end of Section 10.3 for References.]
10.3 Environmental Health Professions
Various divisions and programs under the aegis of the DPHAS Bureau of Health Promotion and Disease Prevention are responsible for the licensing and credentialing of professionals who work in several areas of environmental health.
TABLE 10-7. Environmental professionals currently licensed or credentialed by divisions and programs within the DPHAS Bureau of Health Promotion (4). Dates are specified in footnotes.
No. No. No. Profession licensed certifie other d Asbestos abatement contractorsa 30 - - Asbestos consultantsa 0 - - Food inspectorsb - 347 - Lead abatement contractorsc 28 - - Lead inspectors and - 164 - professionalsc Radon diagnostic and mitigation 16 contractorsd Radon air and water testerse 44 Sewage disposal, Phase I 347 inspectorsf Sewage disposal, Phase II 273 inspectorsf Subsurface sewage cleanersf 166 Subsurface sewage installersf 2,386 Registered sanitariansf 363 Water treatment plant 378 operatorsg Water distribution system 430 operatorsg Cross-connection control 323 officersg
a Licenses issued by the Environmental Health Division, Asbestos Program as of
September 21, 1994 (4). Licensing of asbestos contractors and consultants became mandatory in
June, 1994.
b Certifications issued by Food Protection Program as of December 19, 1994 (5).
c Licensed or certified with non-mandatory license or certification program as of September 29, 1994. Mandatory licensing by Childhood Lead Poisoning Prevention Program begins July 1, 1995 (6).
d Number of individuals listed with the US Environmental Protection Agency (EPA) Radon
Contractor Proficiency Program as of October 24, 1994. Nine companies also are EPA-listed.
e Number of individuals listed with the US EPA Radon Proficiency Program as of November 1, 1994. Thirty-nine companies also are EPA-listed (7).
f Licenses issued through the Environmental Health Division, On-site Sewage Disposal Section as of August 14, 1994 (8).
g Certified by the Environmental Health Division, Water Supplies Section as of July 1, 1994 (9).
REFERENCES (for Sections 10.1-10.3)
(1) Annual report of activities, 1993. 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Systems Regulation, Division of Medical Quality Assurance, Hartford, CT.
(2) Estimated populations in Connecticut as of July 1, 1993. 1994. State of Connecticut, Department of Public Health and Addiction Services, Office of Strategic Planning and Information Services, Health Research and Data Analysis Unit, Hartford, CT.
(3) Provisional summary data for CY 1993 and SFY 1993. Department record. State of Connecticut, Department of Public Health and Addiction Services, Office of Emergency Medical Services. Hartford, CT.
(4) Provisional summary data for FFY 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Environmental Health Division, Asbestos Program, Hartford, CT.
(5) Provisional summary data for CY 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Environmental Health Division, Food Protection Program, Hartford, CT.
(6) Provisional summary data for FFY 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Environmental Health Division, Childhood Lead Poisoning Prevention Program, Hartford, CT.
(7) Department records. 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Environmental Epidemiology and Occupational Health Division, Radon Program, Hartford, CT.
(8) Department records. 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Environmental Health Division, On-site Sewage Disposal Section, Hartford, CT.
(9) Department records. 1994. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Promotion and Disease Prevention, Environmental Health Division, Water Supplies Section, Hartford, CT.
11 FACILITIES
Mental Health and Substance Abuse Facilities
Well-child Clinics, Day Care Centers, and Day Care Homes
Day and Residential Youth Camps
Funeral Homes and Optical Establishments
11.1 Long-term Care Facilities, Acute Care and Chronic
Disease Hospitals, Outpatient Clinics, Home Health
Care Agencies, and Specialty Facilities
TABLE 11-1. Numbers and sizes of licensed long-term care facilities, hospitals, outpatient clinics, home health care agencies, and other facilities in Connecticut, as
of September 30, 1994 (1,2).
Licensed Licensed
Type of facility Number bassinets
beds
Chronic & convalescent nursing
homes (CCNH)a
Freestanding CCNH 168 18,827
CCNH with attached RHNSb 85 9,081
Total CCNHs 253 27,908
Rest homes with nursing
supervision (RHNS)
Freestanding RHNS 18 1,165
RHNS attached to CCNH 85 3,100
Total RHNSs 103 4,265
Homes for the aged 119 3,085
Outpatient
Outpatient clinics 120 N/A
Outpatient HMOs 14 N/A
Total outpatient clinics 134 N/A
Home health care agencies 114c N/A
Specialty facilities
Acute care (general) hospitals 34 10,348 883
Ambulatory surgical units 10 N/A
Children's hospitals 1 98
Chronic disease hospitals 6 811
Hemodialysis units (outpatient) 9 N/A
Hospices 1 52
Maternity homes 1 16 16
a Also known as skilled nursing facilities (SNFs).
b Rest Homes with Nursing Supervision.
c Licensed as of June 30, 1993.
REFERENCES
(1) Monthly data report for September, 1994. State of Connecticut, Department of Public Health and Addiction Services, Hospital and Medical Care Division, Hartford, CT.
(2) Home health care agency annual licensure renewal applications for SFY 1993. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health System Regulation, Hospital and Medical Care Division, Hartford, CT.
11.2 Mental Health and Substance Abuse Facilities
TABLE 11-2. Numbers and sizes of licensed mental health and substance
abuse facilities in Connecticut as of September 30, 1994 (1).
Licensed Type of facility Number beds Psychiatric hospitals 6 432 Psychiatric outpatient 99 N/A clinics Mental health day treatments 8 N/A Mental health intermediate 1 8 treatments Mental health residential 17 166 living centers Mental health community 8 64 residences Substance abuse and 98 1,428 dependence facilities
REFERENCE
(1) Monthly data report for September, 1994. State of Connecticut, Department of Public Health and Addiction Services, Division of Hospital and Medical Care, Hartford, CT.
11.3 Well-child Clinics, Day Care Centers, and Day Care Homes
TABLE 11-3. Numbers of licensed well child clinics, day
care centers and group day care homes, and family day care
homes in Connecticut as of September 30, 1994 (1).
Type of facility Number Well-child clinics 93 Day care center & group day 1,562 care homes Family day care homes 5,494
REFERENCE
(1) Summary data for SFY 1994 (provisional). State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health System Regulation, Community Nursing/Day Care Licensing Division. Hartford, CT.
11.4 Day and Residential Youth Camps
TABLE 11-4. Numbers of licensed for-profit
and not-for-profit day and residential youth
camps in Connecticut as of December 31, 1993 (1).
Type of camp Number Day camps For profit 30 Not for profit 171 Residential camps For profit 50 Not for profit 57 TOTAL 308
REFERENCE
(1) Summary data for CY 1993 (provisional). State of Connecticut, Department of Public Health and Addiction Services, Environmental Health Division, Recreational Health and Safety Program, Hartford, CT.
11.5 Funeral Homes and Optical Establishments
TABLE 11-5. Numbers of licensed funeral homes and optical establishments in Connecticut, and complaints received and acted upon by the Public Health Hearing Office as of December 31, 1993 (1).
No. No. No. Type of facility licensed (frequency) disciplinary of actions complaintsa taken Funeral homes 314 5 (1.59) 1 Optical 203 2 (0.99) 0 establishments
a Frequency - Number of complaints per 100 licenses.
REFERENCE
(1) Annual report of activities, 1993. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health Systems Regulation, Division of Medical Quality Assurance, Hartford, CT.
11.6 Laboratories
TABLE 11-6. Numbers of laboratories licensed, registered, approved, or certified by the DPHAS Bureau of Laboratory Services as of June 30, 1993a (1).
No. licensed No. No.
Type of laboratory or permits registered certifie
approved db
Clinical 254 176
Public health 6 45 6
Physician's office 1,800
Dairy 5
Food 12
Water 237
Drinking water 197c
Other water 40c
Microbiology 14
Chemistry 153
Microbiology and 70
chemistry
a Laboratories located both in Connecticut and other states are included.
b Laboratories certified in accordance with the Clinical Laboratory Improvement Amendments
of 1988 (CLIA).
c Includes total number of licensed, registered, approved, or certified laboratories.
REFERENCE
(1) Consolidated annual report to the Association of State and Territorial Public Health Laboratory Directors for SFY 1993. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Laboratory Services, Hartford, CT.
12 HEALTH CARE DELIVERY
Sexual Assault Crisis Services
12.1 Local Health Departments
The mission of the Office of Local Health Administration at DPHAS is to assure universal access to quality local public health services in each community in the state.
Health districts and municipalities that provide full-time public health services currently receive between $ 0.52 and $1.78 per capita (depending on population) in state subsidies, to encourage local capacity building and augment local services.
TABLE 12-1. Full-time and part-time services provided by local health departments and local health districts, and percentages of Connecticut's population served by them. Data are for SFY 1994 (1).
No. of Population serveda Services provided municipaliti Number Percent es Full-time services Individual 30 1,605,050 48.9 Districts 75b 976,850 29.8 Total 105 2,581,900 78.7 Part-time 73c 697,440 21.3 services
a Based on 1992 individual town population estimates, and a State population estimate of
3,279,340 (2).
b Includes the City of Groton and Boroughs of Bantam, Litchfield, Newtown, and Danielson.
c Includes the Boroughs of Fenwick, Jewett City, Stonington, and Woodmont.
As of July 1, 1994, the following individual cities and towns had their own local health departments: Bethel; Berlin; Bloomfield; Bridgeport; Danbury; East Hartford; Fairfield; Glastonbury; Greenwich; Hartford; Manchester; Meriden; Middletown; Milford; New Britain; New Fairfield; New Haven; New London; New Milford; Norwalk; Old Lyme; Stamford; Stratford; Waterbury; West Hartford; West Haven; Wethersfield; Wilton; Windham; and Windsor. The constituent towns in Connecticut's health districts are listed in Table 12-2.
TABLE 12-2. Connecticut's local health districts as of July 1, 1994 (1).
Health district Constituent towns
(HD)
Bristol-Burlington Bristol, Burlington
HD
Chesprocott HD Cheshire, Prospect, Watertown,
Wolcott
East Shore HD Branford, East Haven, North
Branford
Farmington Valley Avon, Barkhamsted, Canton,
HD Colebrook, East Granby,
Farmington, Granby, Hartland,
New Hartford, Simsbury
Ledge Light HD City of Groton, Town of Groton
Naugatuck Valley HD Ansonia, Beacon Falls, Derby,
Naugatuck, Seymour, Shelton
Newtown HD Borough of Newtown, Town of
Newtown
North Central HD East Windsor, Ellington,
Enfield, Suffield, Vernon,
Windsor Locks
Northeast HD Ashford, Brooklyn, Canterbury,
Eastford, Hampton, Killingly,
Plainfield, Pomfret, Putnam,
Sterling, Thompson, Woodstock
Pomperaug HD Oxford, Southbury, Woodbury
Quinnipiack Valley Hamden, North Haven,
HD Woodbridge
Stafford HD Stafford, Union
Torrington Area HD Bethlehem, Cornwall, Goshen,
Harwinton, Kent, Litchfield,
Morris, Norfolk, Salisbury,
Thomaston, Torrington, Warren,
Winchester
Uncas Regional HD Montville, Norwich
Weston-Westport HD Weston, Westport
OF NOTE
As of July 1, 1994, eight out of ten Connecticut residents, the largest proportion ever, had access to a full-time local health department.
REFERENCES
(1) Summary data for SFY 1994. Department records. State of Connecticut, Department of Public Health and Addiction Services, Office of Local Health Administration, Hartford, CT.
(2) Estimated populations in Connecticut as of July 1, 1992. 1993. State of Connecticut, Department of Public Health and Addiction Services, Health Surveillance and Planning Division, Health Status Data and Analysis Unit, Hartford, CT.
12.2 School-based Health Centers
School-based health centers (SBHCs) are licensed outpatient clinics that deliver primary health care and mental health services within a school building. In SFY 1994, DPHAS funded 29 centers in 11 cities and towns.
Each center is staffed by an advanced practice registered nurse and a social worker, both with clinical supervision and back-up, and a coordinator. Additional health or allied health professionals may also be employed, depending on school and community need. SBHCs provide services via collaboration between a local health and/or mental health agency and the school system. Students must have a parental permission slip on file before receiving services. Services are provided to all children regardless of ability to pay.
TABLE 12-3. Locations and settings of school-based health centers funded
by the Department of Public Health and Addiction Services in SFY 1994a (1).
Type of schoolb City ECC PK-8 Elem. Middle High Branford 1 Bridgeport 1 1 3 Danbury 1 East 1 Hartford Groton 1 Hartford 1 2 Middletown 1 New Haven 3 2 New London 1 5 1 1 Norwalk 1 Stamford 2 TOTAL 1 1 7 7 13
a Three additional SBHCs, which do not receive state funding, are located at elementary schools in Bridgeport, Hartford, and New Haven.
b ECC = early childhood center; PK-8 = pre-kindergarten through grade 8; Elem. = elementary
school; Middle = middle school; High = high school.
TABLE 12-4. The ten medical services provided most frequently by
DPHAS-funded school-based health centers in SFY 1994a (1).
No.
Rank Service type service
encounters
1 History taken 14,094
2 Reproductive health 13,092
education
3 General health education 11,816
4 Physical examination 11,062
Table 12-4 continues.
TABLE 12-4. (Continued.)
No.
Rank Service type service
encounters
5 Medicine administered or 5,513
dispensed
6 Health screenings 4,774
7 Dental services 3,725
8 Reproductive health 2,342
servicesb
9 Prescription given 1,554
10 Tuberculosis testing 1,047
a Data from Weaver High School (Hartford) not included.
b Includes pelvic exams, STD screens, Pap smears, and methods check.
TABLE 12-5. The ten psycho-social services provided most frequently
by DPHAS-funded school-based health centers in SFY 1994a (1).
No.
Rank Service type service
encounters
1 Psychological 10,159
support/counseling
2 Family problem counseling 6,730
3 Referral/advocacy 6,079
4 Peer problem counseling 5,910
5 School problem counseling 4,814
6 Stress management 2,762
counseling
7 Substance abuse counseling 2,141
8 Depression counseling 1,427
9 Psycho-social evaluation 1,420
10 Violence counseling 1,353
a Data from Weaver High School (Hartford) not included.
OF NOTE
During SFY 1994, a total of 8,935 students made 41,856 visits to school-based health centers, during which 140,414 services were provided. The services ranged from diagnosis and treatment of acute health problems to sports physicals and nutrition education.
Nearly 40% of the children and adolescents who registered for care had no regular source of medical care..
REFERENCE
(1) Provisional data for SFY 1994. Department records. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Community Health and State-operated Treatment Facilities, School and Adolescent Health, Hartford, CT.
12.3 Community Health Centers
Community health centers (CHCs) are non-profit organizations whose main purpose is to provide comprehensive primary care services to low-income, uninsured, and underinsured people of all ages. The primary care services include medical, mental health, dental, substance abuse, and social services, as well as community-based programs, outreach, and enabling services. Obstetrics and gynecology, family planning, diagnostic laboratory, health education, HIV, and homeless services also are offered at most sites.
CHCs promote access to health care through their strategic neighborhood location, multilingual staff, sliding fee scale, and continuity of care. They provide health care to all, regardless of insurance status.
CHCs are staffed by board-certified family practitioners, internists, pediatricians, and obstetricians/gynecologists, along with nurse practitioners, nurse midwives, physician assistants, nutritionists, social workers, and dentists.
TABLE 12-6. Numbers and locations of community health centers, including
satellite and categorical service sites, in Connecticut as of November 30, 1994a (1).
Main Additional City/town Main satellite service siteb sitesc Bridgeport 2 2 13 Danielson 1 Hartford 2 18 Meriden 2 Middletown 1 New Haven 2 1 11 New London 1 Norwich 1 Old Saybrook 1 Stamford 1 Stratford 1 Waterbury 1 Windham 1 TOTAL 12 8 42
a As part of the State-funded Community Center Expansion, two new satellites (West Haven
and Groton) and two new CHC corporations are being developed.
b There are presently 12 CHC corporations. One main site is listed for each CHC corporation.
c Additional categorical services are provided at eight senior health centers, seven substance
abuse sites, one substance abuse/homeless health services site, six school-based health centers,
one child guidance clinic, and one perinatal site.
TABLE 12-7. Numbers and percentages of persons served at community health centers during SFY 1994, by gender, race/ethnicity, and age (1).
Characteristic Number Percenta Gender Male 51,203 43 Female 68,151 57 Race/Ethnicityb White (non-Hispanic) 20,434 17 Black (non-Hispanic) 37,575 31 Hispanic 57,911 49 Other 1,631 1 Unknown 1,803 2 Age group (years) <1 5,409 5 1-4 13,928 12 5-14 24,091 20 15-19 12,136 10 20-34 29,485 25 35-44 15,321 13 45-64 12,586 11 65+ 6,264 5 Unknown 134 TOTAL 119,354 100
a Subgroup percentage totals may not equal 100, due to rounding.
b All race/ethnicity categories are mutually exclusive.
TABLE 12-8. Numbers and types of visits to community health centers, for all clients and for self-paya clients during SFY 1994 (1).
Total visits Self-pay visitsa % of total Visit type Number Percent Number visitsd Medical 256,656 64.8 62,849 65.3 Dental 49,567 12.5 18,000 18.7 Mental health 29,761 7.5 3,472 3.6 Substance abuse 23,571 6.0 3,542 3.7 Otherb 36,475 9.2 8,449 8.8 TOTALc 396,030 100 96,312 100.1
a Self-pay clients = uninsured clients.
b Other visits include social services, WIC, podiatry, hospital visits, and nutrition services.
c The total number of visits comprises 512,416 face-to-face encounters with billable providers.
d Percentage total does not equal 100, due to rounding.
TABLE 12-9. Payer mix for clients who visited community
health centers during SFY 1994 (1).
Payer No. visits Percent Medicaid 184,969 46.7 Medicare 17,283 4.4 City welfare 61,055 15.4 Private insurance 23,276 5.9 Self pay 96,312 24.3 (uninsured) Othera 13,135 3.3 TOTAL 396,030 100
a Includes WIC (see Section 7.3) and family planning.
OF NOTE
Connecticut's community health centers are part of a network of more than 700 CHCs nationwide (2).
Compared to the general population, people with incomes below 200% of the federal poverty level are "at risk" for elevated rates of mortality and morbidity, and face substantial barriers to health care access. An estimated 519,088 persons--about 16% of Connecticut's population--fall into this "at risk" group (3).
REFERENCES
(1) Connecticut Primary Care Association. 1994. Community health center medically uninsured contract, SFY 1994. Prepared for: State of Connecticut, Department of Public Health and Addiction Services, Bureau of Community Health and State-operated Treatment Facilities, Division of Program Management, Primary Care Cooperative Agreement, Hartford, CT.
(2) Community health center directory. 1994. US Public Health Service, Health Resources and Service Administration, Bureau of Primary Health Care, Bethesda, MD.
(3) Connecticut socio-economic characteristics.: 1990 census sample data. 1993. Prepared by NY, CT, and MA State Data Centers, using 1990 Census of Population and Housing Summary Tape File 3A. Distributed by State of Connecticut, Office of Policy and Management, Hartford, CT.
12.4 Sexual Assault Crisis Services
Connecticut Sexual Assault Crisis Services, Inc. (CONNSACS) is a statewide association of 12 community-based sexual assault crisis programs working together to end sexual violence through victim assistance, community education, and legislative action.
All CONNSACS member agencies provide free, confidential, direct services to past and present victims of sexual assault and sexual abuse and to their families. The services include a 24-hour hotline, crisis intervention and short-term counseling, accompaniment and advocacy through the medical, police, and court systems, information and referral for other needs, and support groups for rape and incest victims and survivors. Member agencies also provide professional in-service trainings, child sexual abuse prevention programs, and community education. Male counselors and bilingual staff are available.
TABLE 12-10. Characteristics of the primary victimsa of sexual assault served by CONNSACS during SFY 1994. Total primary victims = 4,569; total secondary victimsb = 2,259 (1).
Characteristics of primary victims No. victims Percent Gender Female 4,113 90% Male 456 10% Age (years) 0-12 578 13% 13-17 782 17% 18-29 1,558 34% 30-44 1,375 30% 45-64 263 6% 65+ 13 <1% Race and Ethnicityc White 3,540 77% Black 556 12% Hispanic 354 8% American Indian 4 <1% Other 39 <1% Unknown 76 2% Disability Disabled 213 5% Unknown 4,356 95%
a Primary victims are those who have been sexually abused, assaulted, or harassed.
This abuse may have taken place recently or in the past, and the victim may be
male or female or any age.
b Secondary victims are those who know and/or interact with a primary victim
(i.e., partners, parents, employers, teachers, etc.)
c All racial and ethnic categories are mutually exclusive.
TABLE 12-11. Numbers and percentages of primary victims of
various crimes for persons served by CONNSACS and its members
during SFY 1994 (1).
Type of crime or No. victims Percent assailant Crime Rapea 1,452 32% Gang rape 134 3% Date rapeb N/A N/A Spousal rape 163 4% Cohabitation rape 95 2% Attempted rape 118 3% Sexual contact 113 2% Incest 1,419 31% Child sexual abuse 890 19% Sexual harassment 185 4% Assailant Known to victim 4,055 89% Unknown to victim 514 11%
a Includes all rapes, except by a spouse or cohabitor.
b Numbers of date rape victims were not distinguished from other rape victims for
SFY 1994; however, during SFY 1993, 11% (500) of CONNSACS clients were
victims of date rape.
OF NOTE
A rape crisis hotline is available 24 hours a day, 7 days a week, 365 days a year in every town in Connecticut. Phone CONNSACS at (203) 282-9881 for local hotline numbers.
Since SFY 1989, the number of victims served by the 12 sexual assault crisis centers in Connecticut has increased by 84%.
Gang rapes reported to rape crisis centers in CT increased 41% between SFY 1993 and SFY 1994.
It is estimated that 85% of all rapes go unreported to the police (2).
In the US, forcible rape of adult women occurs at a rate of about 1 every 46 seconds, for a projected total of 683,000 per year (2).
REFERENCES
(1) Victim statistics for SFY 1994 (unpublished). Connecticut Sexual Assault Crisis Services, Inc., East Hartford, CT.
(2) Rape in America: A report to the nation. 1992. National Victim Center, Arlington, VA, and Crime Victim Research and Treatment Center, Charleston, SC. 16 pp.
12.5 Acute Care
The Connecticut General Statutes require Connecticut's acute care hospitals to report facility-specific financial data and information on patient volumes to the Commission on Hospitals and Health Care each year. The Commission uses the information to identify trends in hospital utilization, to assess the financial viability of the facilities, and to determine relative cost of the hospitals.
The Connecticut Health Information Management and Exchange (CHIME), a program of the Connecticut Hospital Research and Education Foundation, Inc., is a statewide data bank of discharge data from Connecticut acute care facilities. CHIME data are contributed by the member hospitals of the Connecticut Hospital Association.
TABLE 12-12. Selected data on patient volumes (1) and emergency department (ED) visits (2) for Connecticut's acute care hospitals during FFY 1993.
No. No. Avg. length No. Hospital patient discharge of stay ED days s (days) visits Wm. W. Backus 57,011 10,105 5.6 38,476 Bradley Memorial 16,729 2,369 7.1 16,306 Bridgeporta 148,837 19,917 7.5 60,476 Bristol 47,990 8,544 5.6 24,546 Danbury 112,120 19,049 5.9 57,830 Day Kimball 26,131 5,216 5.0 18,465 John Dempsey 58,275 6,670 8.7 15,887 Greenwich 53,417 8,758 6.1 22,406 Griffin 42,830 6,506 6.6 35,945 Hartford 249,116 39,749 6.3 96,921 Charlotte 43,649 6,705 6.5 23,692 Hungerfordb Johnson Memorial 22,025 3,305 6.7 12,636 Lawrence & 78,334 13,323 5.9 73,801 Memorial Manchester 58,015 10,013 5.8 47,143 Memorial Middlesex 59,383 11,043 5.4 72,029 Milford 28,719 5,029 5.7 23,405 Mount Sinai 51,065 8,298 6.2 22,060 New Britain 89,170 15,718 5.7 41,077 General Newington 13,031 876 14.9 0 Children's New Milford 18,612 3,574 5.2 16,444 Norwalk 100,174 14,555 6.9 23,779 Park Citya 10,878 1,883 5.8 10,627 Rockville 22,806 4,811 4.7 15,494 General Saint Francis 147,057 23,338 6.3 46,779 Saint Joseph 40,696 5,885 6.9 16,541 Saint Mary's 86,364 14,342 6.0 56,198 Saint Raphael 161,043 20,809 7.7 47,863
Table 12-12 continues.
TABLE 12-12. (Continued.)
No. No. Avg. Hospital Patient Discharges length of ED days stay visits (days) Saint Vincent's 120,986 17,342 7.0 43,556 Sharon 20,521 3,453 5.9 13,824 Stamford 71,714 12,454 5.8 26,170 Veterans 54,711 10,093 5.4 53,351 Memorial Waterbury 87,849 14,058 6.2 43,882 Windhamc 24,790 4,634 5.3 N/A Winsted Memorial 7,173 1,210 5.9 13,567 Yale-New Haven 236,031 35,579 6.6 69,081 TOTAL 2,467,252 389,213 6.3 1,200,257
a Park City Hospital merged with Bridgeport Hospital effective April 1, 1993. Emergency depart-
ment statistics are all inclusive in Bridgeport Hospital, and other statistics for Park City Hospital
are for the first 6 months of FFY 1993.
b Charlotte Hungerford Hospital did not report emergency department visits for September, 1993.
c Windham Hospital did not report emergency department visits.
TABLE 12-13. Selected financial data for Connecticut's acute care hospitals for
FFY 1993 (1). Hospitals are ranked by cost indexa (3).
Gross revenues Operating
($ x 1,000) Cost
expenses
Rank Hospital Total ($ x indexa
I/Pb O/Pb 1,000)
1 Newington 30,652 17,453 13,199 33,376 2.74
Children's
2 Saint Joseph 89,800 73,541 16,259 49,974 1.22
3 Milford 66,197 47,386 18,811 36,707 1.18
4 New Milford 55,614 36,936 18,678 31,490 1.16
5 Griffin 98,387 65,085 33,302 56,377 1.15
6 Winsted 21,433 13,106 8,327 13,444 1.14
7 Sharon 41,923 29,508 12,415 25,976 1.13
8 Johnson 49,090 34,050 15,040 29,419 1.12
Memorial
9 John Dempsey 138,161 93,875 44,286 103,961 1.12
10 Veteran's 148,528 90,113 58,415 93,380 1.10
Memorial
11 Greenwich 129,820 81,867 47,953 85,703 1.07
12 Windham 68,792 41,994 26,798 39,158 1.06
13 Waterbury 199,108 150,538 48,570 122,807 1.04
14 Bridgeport 248,014 205,910 42,105 167,159 1.03
15 Rockville 60,089 31,457 28,632 42,121 1.03
General
16 Saint Vincent's 216,641 183,095 33,546 122,403 1.03
17 Saint Raphael 337,109 277,854 59,255 222,045 1.02
Table 12-13 continues.
TABLE 12-13. (Continued.)
Gross revenues Operatin
($ x 1,000) g Cost
expenses
Rank Hospital Total ($ x indexa
I/Pb O/Pb 1,000))
18 Day Kimball 62,150 37,210 24,940 42,302 1.01
19 Manchester 126,308 76,580 49,728 81,972 1.01
Memorial
20 Norwalk 219,953 157,523 62,430 143,941 1.01
21 Yale-New Haven 585,774 487,651 98,123 375,890 1.01
22 Stamford 140,823 108,715 32,108 93,495 1.00
23 Lawrence & 160,444 108,471 51,973 104,130 1.00
Memorial
24 Bristol 91,385 57,711 33,674 64,325 1.00
25 Hartford 494,787 409,704 85,083 343,094 1.00
26 Mount Sinai 131,550 85,217 46,333 79,143 0.96
27 Charlotte 78,622 53,291 25,332 55,240 0.95
Hungerford
28 Danbury 240,055 166,819 73,236 161,679 0.95
29 Bradley 36,029 22,500 13,529 24,269 0.94
Memorial
30 Middlesex 140,557 84,547 56,010 99,020 0.90
31 Wm. W. Backus 106,725 68,098 38,626 73,293 0.89
32 Saint Mary's 205,832 140,785 65,047 119,772 0.88
33 Saint Francis 303,127 225,467 77,660 206,439 0.86
34 New Britain 168,054 108,710 59,344 122,357 0.84
General
N/A Park Cityc 28,798 18,610 10,187 18,322 N/A
TOTAL 5,320,3 3,891,377 1,428,95 3,484,18
31 4 3
a Cost index is a measure of the relative cost of inpatient hospital services to payers. It compares an estimate of a hospital's inpatient net revenue per discharge or "cost," adjusted for case mix and other factors that are not comparable among hospitals (medical education expenses, proportion of indigent patients, etc.), with an estimate of a statewide average or "standard" inpatient net revenue per discharge. An index greater than 1.0 means that the hospital's comparable cost for inpatient services is higher than the statewide weighted average, and an index less than 1.0 means the hospital's comparable cost to payers is lower than average.
b I/P = inpatient; O/P = outpatient.
c Park City Hospital merged with Bridgeport Hospital effective April 1, 1993, so cost index for
FFY 1995 budget was not calculated.
TABLE 12-14. The top 25 diagnosis related groupsa assigned to patients discharged from 31 Connecticut acute care hospitalsb during FFY 1994c (4).
No.
Rank Diagnosis related group (DRG)a discharges
1 391 Normal newborn 33,936
2 373 Vaginal delivery w/o complicating 30,580
diagnoses
3 430 Psychoses 9,129
4 127 Heart failure or shock 8,508
5 371 Cesarean section w/o cc 6,774
Table 12-14 continues.
TABLE 12-14. (Continued.)
No.
Rank Diagnosis related group (DRG)a discharge
s
6 089 Simple pneumonia & pleurisy age >17 w/ 6,670
cc
7 209 Major joint & limb reattachment 5,325
procedures (lower extremities)
8 112 Percutaneous cardiovascular procedures 5,265
9 143 Chest pain 5,255
10 140 Angina pectoris 5,007
11 014 Specific cerebrovascular disorders 4,902
except TIAd
12 215 Back and neck procedures w/o cce 4,548
13 359 Uterine & adnexa procedures for 4,481
non-malignancy w/o cce
14 390 Neonate w/ other significant problems 4,382
15 088 Chronic obstructive pulmonary disease 4,269
16 174 Gastrointentestinal hemorrhage w/ cce 3,659
17 182 Esophagitis, gastroent. & misc. 3,558
digestive disorders age >17 w/ cce
18 410 Chemotherapy w/o acute leukemia as 3,539
secondary diagnosis
19 124 Circulatory disorders ex. AMIf w/ 3,476
cardiac catheter & complex diag.
20 494 Laparoscopic cholecystectomy w/o CDEg 3,302
w/o cce
21 372 Vaginal delivery w/ complicating 3,064
diagnosis
22 148 Major small & large bowel procedures w/ 3,063
cce
23 138 Cardiac arrhythmia & conduction 3,054
disorders w/ cce
24 389 Full-term neonate w/ major problems 2,945
25 121 Circulatory disorders w/ AMIf & CVCh 2,917
discharged alive
Total discharges assigned to top 25 DRGs 171,608
Total discharges during FFY 1994b 369,803
a Cases are classified into DRGs based on the principal diagnosis, up to eight additional diagnoses, up to six procedures performed during the stay, and the age, sex, and discharge status of the patient. The DRG is therefore not necessarily synonymous with "cause of hospitalization."
b Does not include data for Charlotte Hungerford, Griffin, or Windham hospitals.
c The Connecticut Hospital Research and Education Foundation, Inc. disclaims any responsibility for conclusions drawn from analysis of the data.
d TIA = transient ischemic attach (stroke).
e cc = complications and comorbidities.
f AMI = acute myocardial infarction.
g CDE = common duct exploration.
h CVC = cardiovascular complications.
REFERENCES
(1) Summary hospital data from Schedule S10 for October 1, 1992 through
September 30, 1993. State of Connecticut, Commission on Hospitals and Health Care, Hartford, CT.
(2) Emergency department visits, 36 short-term Connecticut hospitals, 1993 vs. 1992. Patient Census Report 93(12): 21. Connecticut Hospital Association, Wallingford, CT.
(3) Hospital cost index for FY 1995 budget. 1994. State of Connecticut, Commission on Hospitals and Health Care, Hartford, CT.
(4) CHIME database. 1994. Connecticut Hospital Research and Education Foundation, Inc., Connecticut Health Information Management and Exchange (CHIME), Wallingford, CT.
12.6 Home Health Care
Home health care agencies are licensed and are required to submit annual service reports to the Hospital and Medical Care Division of DPHAS, which compiles and summarizes the data for presentation at 5-year intervals. The agencies provide a variety of services, including skilled nursing, physical therapy, occupational therapy, speech therapy, social work services, and homemaker-home health aide services. (See Section 11.1 for numbers of licensed home health care agencies.)
TABLE 12-15. Characteristics of home health care agencies and
types of services they delivered during SFY 1993 (1).
Agency or service Number characteristic Staff serving clients 16,803 Clients served 75,342 Service visits: Homemaker-home health aide 2,433,665 Nursing 1,257,238 Physical therapy 255,194 Occupational therapy 31,807 Social work 40,351 Speech therapy 16,917 Total visits, all services 4,035,172
TABLE 12-16. Sex, age, primary diagnosis, functional status, living
arrangement, referral source, and primary payer of recipients of home
health care services in Connecticut during SFY 1993 (1).
Client characteristic Numbera Percent Sex Male 27,413 36% Female 47,929 64% Age <65 22,343 30% 65-74 16,687 22% 75-84 23,243 31% 85+ 13,069 17% Primary diagnosis Heart disease 10,040 13% Cancer 9,262 12% Other 56,064 75% Functional status Ambulatory, needs no 27,353 37% assistance Ambulatory, needs 39,366 53% assistanceb Non-ambulatoryc 7,891 10%
Table 12-16 continues.
TABLE 12-16. (Continued.)
Client characteristic Numbera Percent Living arrangement Living alone 24,016 32% Living with persons who assist 45,090 59% with care Living with persons who do not 7,078 9% assist with care Referral source General hospital 39,426 53% Private physician 11,264 15% Self or family 6,659 9% Other 17,385 23% Primary payerd Medicare 2,457,528 59% Medicaid 843,738 20% BC/BS & commercial insurance 349,891 8% State or local government 234,957 7% Self pay (uninsured) 184,824 4% Other 100,894 2%
a Totals for each client characteristic do not always equal total clients from preceding table, because of unknown or missing data.
b Requires assistance with personal care, use of walkers, etc.
c Requires assistance with personal care, use of equipment, and confined to bed for most of the day.
d Data refer to number and percent of visits paid for by the various sources, not number and percent of clients.
OF NOTE
Connecticut was one of the first states to establish a uniform system for collecting and reporting home health care service data (established in 1986).
The home health care industry has experienced major growth in delivery of all services. Between 1991 and 1993 the following increases were reported:
17% more clients;
43% more home visits;
39% more children served in the 0-5 year age group;
18% more clients served in the 85+ year age group.
The proportion of for-profit home health care agencies in Connecticut has been increasing steadily and in SFY 1993 represented 36% of the market.
REFERENCE
(1) Home health care agency annual licensure renewal applications for SFY 1993. State of Connecticut, Department of Public Health and Addiction Services, Bureau of Health System Regulation, Hospital and Medical Care Division, Hartford, CT.
12.7 Long-term Care
The Connecticut Public Health Code requires nursing home administrators to submit an annual patient roster and census report to DPHAS. The roster, a chronological list of patients who resided in a facility between October 1 and September 30 of a given reporting year, contains demographic and health status information about each patient. In the DPHAS Health Research and Data Analysis Unit, records for individual patients are merged into a longitudinal database, which contains all nursing home patient records filed since 1977. The staff also provide technical and analytic support to the Connecticut Partnership for Long-Term Care, an arrangement between the State and private insurers for long-term-care insurance.
TABLE 12-17. Age and primary payer, by sex, of patients who resided in Connecticut nursing homes on September 30, 1993a,b (1).
Male Female Total Characteristic No. % No. % No. % Age group (years) <55 511 2 449 1 960 3 55-64 516 2 579 2 1,095 4 65-74 1,344 4 2,215 8 3,559 12 75-84 2,666 9 6,963 24 9,629 33 85+ 2,334 8 11,504 40 13,838 48 Totalc 7,371 25 21,714 75 29,085 100 Payer Medicaid 4,687 16 14,694 51 19,381 67 Private 1,497 5 4,961 17 6,458 22 Medicare 748 2 1,620 6 2,368 8 Out-of-state 258 1 309 1 567 2 Medicaid Other 179 0.5 124 0.5 303 1 Totald 7,369 25 21,708 75 29,077 100
a The data in this table represent a census of nursing home residents on September 30, 1993, regardless of admission dates. The census did not include patients who were discharged and not
re-admitted by September 30.
b As of September 30, 1993, the licensed bed capacity was 30,901, which included 1,072 new beds added during FFY 1993, and the occupancy rate was 94.1%.
c Totals include four females for whom age was not recorded.
d Totals do not include eight patients for whom payer was not recorded.
OF NOTE
Long-term nursing home residents are more likely to be unmarried, low-income, female, and on Medicaid. More than 2.24 million Americans used a nursing home or licensed personal care home in 1987, the most recent year for which national data are available (2).
REFERENCES
(1) Annual patient roster, October 1, 1992-September 30, 1993. State of Connecticut, Department of Public Health and Addiction Services, Office of Strategic Planning and Information Services, Health Research and Data Analysis Unit. Hartford, CT.
(2) Feinleib, S.E., P.J. Cunningham, and P.F. Short. 1994. Use of nursing and personal care homes by the civilian population, 1987. 1994. National Medical Expenditure Survey Research Findings 23. Bethesda, MD, US Public Health Service, Agency for Health Care Policy and Research, Publ. No. 94-0096.
APPENDICES
A-1 Most Popular Names for Babies
The following lists of most frequently used names for babies born to Connecticut residents were tabulated using the exact spelling of the name on the birth certificate. Variations in the spelling of the same name (Ashley, Ashlie, etc.) were not grouped together for ranking.
TABLE A-1. The most popular names for female babies born to Connecticut
residents in CY 1993 and ten years earlier (1). Number of infants given each
name is also shown.
1993 1983
Rank Name No. Name No.
1 Emily 431 Jennifer 695
2 Sarah 403 Jessica 615
3 Ashley 388 Sarah 413
4 Jessica 375 Nicole 365
5 Nicole 371 Melissa 360
6 Samantha 343 Elizabeth 302
6 Amanda 323 Stephanie 299
8 Stephanie 283 Ashley 293
9 Lauren 262 Katherine 190
10 Elizabeth 254 Megan 175
TABLE A-2. The most popular names for male babies born to Connecticut
residents in CY 1993 and ten years earlier (1). Number of infants given each
name is also shown.
1993 1983
Rank Name No. Name No.
1 Michael 918 Michael 1,107
2 Matthew 675 Christopher 876
3 Christopher 623 Matthew 739
4 Nicholas 553 David 599
5 Ryan 490 Daniel 563
6 John 433 John 485
6 Joseph 433 Jason 451
8 Daniel 424 Joseph 444
9 Andrew 421 Brian 433
10 Joshua 390 James 420
TABLE A-3. The most popular names for female white, black, and Hispanic
babies born to Connecticut residents during CY 1993 (1).
Race or ethnicity
Rank White Black Hispanic
1 Emily Jasmine Stephanie
2 Sarah Ashley Ashley
3 Nicole Amber Kassandra
4 Jessica Taylor Jessica
5 Samantha Brianna Jennifer
6 Ashley Brittany Amanda
7 Amanda Briana Jasmine
8 Stephanie Alexis Vanessa
9 Lauren Bria Maria
10 Elizabeth Chelsea Melissa
TABLE A-4. The most popular names for male white, black, and Hispanic
babies born to Connecticut residents during CY 1993 (1).
Race or ethnicity
Rank White Black Hispanic
1 Michael Christopher Jonathan
2 Matthew Brandon Joshua
3 Nicholas Michael Jose
4 Christopher Anthony Luis
5 Ryan Jordan Angel
6 Joseph James Christopher
7 John Joshua Michael
8 Daniel Robert Juan
9 Andrew Aaron Anthony
10 Joshua Eric Carlos
OF NOTE
Some of the more unusual names used in 1993 were Courage, Cupid, Jazz, Lefty, Miracle, Storm, Victorious, and Zen (boys), and Blue, Care, Caress, Chastity, Cherish, Genesis, Justice, Medlyne, Miracle, Odyssey, Patience, Precious, Pretty, Rhapsody, September, Symphoni, Sahara, Summer, and Trinity (girls).
REFERENCE
(1) Analysis of 1983 and 1993 master files of birth records (unpublished). 1994. State of Connecticut, Department of Public Health and Addiction Services, Office of Strategic Planning and Information Services, Health Research and Data Analysis, Hartford, CT.
A-2 Federal Poverty Guidelines
Each year the US Department of Health and Human Services (HHS) publishes poverty guidelines, with each annual adjustment effective July 1. These guidelines are a simplified version of the federal government's statistical poverty thresholds used by the Bureau of the Census to prepare its estimates of the number of persons and families living in poverty. The HHS poverty guidelines are used for administrative purposes, such as for determining whether a person or family is financially eligible for assistance or services under a particular state or federal program. In certain cases, the program uses the poverty guidelines as one of several eligibility criteria, or uses a percentage multiple of the guidelines.
TABLE A-5. 1994 HHS poverty guidelines, expressed as annual or annualized income, for all states (except Alaska and Hawaii) and the District of Columbiaa (1). Amounts for percentage multiples of the guidelines are rounded upward to the nearest dollar.b
Family Guidelin Percentage multiples of federal e poverty guidelines size amount 110% 133% 175% 185% 200% 1 $7,360 $8,096 $9,789 $12,880 $13,616 $14,720 2 9,840 10,824 13,087 17,220 18,204 19,680 3 12,320 13,552 16,386 21,560 22,792 24,640 4 14,800 16,280 19,684 25,900 27,380 29,600 5 17,280 19,008 22,982 30,240 31,968 34,560 6 19,760 21,736 26,281 34,580 36,556 39,520 7 22,240 24,464 29,579 38,920 41,144 44,480 8 24,720 27,192 32,878 43,260 45,732 49,440 Each add'l 2,480 2,728 3,298 4,340 4,588 4,960 person
a The 1993 guideline amount for a family of one was $6,970, with $2,460 for each additional
person. The 1994 amounts reflect the 1993 change in the Consumer Price Index.
b The amounts of the percentage multiples were calculated by DPHAS staff and were not provided
by the US Department of Health and Human Services.
REFERENCE
(1) Annual update of the HHS poverty guidelines. 1994. Federal Register 59(28): 6277-6278.