Introduction to Disability and Health Data System Webinar
March 16, 2012
11:00 am ET

Transcript:
Adriane Griffen, MPH, MCHES from AUCD:  Thank you for joining this webinar, Introduction to the Disability and Health Data System.  My name is Adriane Griffen and I work for the Association of University Centers on Disabilities (AUCD) as Project Director for the AUCD-NCBDDD Cooperative Agreement.  I will be providing you with a few administrative items before I pass it over to Dr. Shelley Reyes. She will further introduce the webinar and our speakers for today.

Just so you know, we will be recording today’s webinar and archiving it on AUCD’s webinar library.  The text transcript of this webinar will also be made available with the recording. If you have any questions during the presentations, please submit them by typing them into the chat box feature on the webinar tool panel. Lastly, at the end of the presentation you will receive a link to complete a short evaluation of the webinar.  We hope that you will take a few minutes to provide us with your feedback, thoughts and reactions.

We also wanted to mention that you should have received a reminder email this morning with links to related materials for this webinar. Specifically, there is a button you can use available at http://www.cdc.gov/ncbddd/disabilityandhealth/tools.html to share DHDS and promote good disability and health data with your constituents and staff in a visual way using your web site, intranet, blog or other social media platforms. The web button is a more recognizable way to bookmark the DHDS location, rather than a traditional text link
We are very excited to have with us today, Dr. Shelley Reyes and Dr. Brian Armour.  Shelley Reyes, PhD, MPH, joined DHDD as the Chief, Disability and Health Branch in November 2011 and has been with CDC for 20 years, so she brings a wealth of experience to the team. Dr. Brian Armour is the Lead for the Disability Research and Epidemiology team in the Division.   He has been with the CDC team eight years and has over 15 years of experience. 
Shelley Reyes, PhD, MPH from NCBDDD: Thank you. I would like to thank you, especially those on the West Coast and beyond for arranging your schedules to be on the call. I have been with the CDC for many years but with the Division a only a few short months area during this time on have come to really appreciate the staff passion and partners, just to improve things for people with disabilities. There is a product that has arrived from that passion. This system is a disability and health surveillance tool that has been developed by Brian Armour and his dedicated team.

Many of you on this call today have helped shape what you now see and I believe this tool is a sweet spot of what you as a collective group want to see in a surveillance tool. I applaud your work and disabilities and health and I look forward to meeting with many of you in the near future. I would like to turn this over to Brian Armour who will demonstrate the tool great 

Brian Armour, PhD from NCBDDD: Thank you Shelley and it is a pleasure to be with you today. I want to give you some background on the DHDS, mention key points and talk about the need for this system and it will start out a little slow. I will demonstrate what exactly you can do with this system. In terms of the need for this system, in 1991 the Institute of Medicine report a disability in America made a recommendation calling for national recognition of a disability surveillance system and they said the system should be developed to monitor the problem disability, provide state specific data for program planning and evaluation of interventions. Some 16 years later in 2007 the Institute of Medicine report, Future of Disability in America noted the lack of disability surveillance system highlighted in the report from 1991 remained a serious shortcoming in this country's system.

We at the CDC, specifically the National Center on Birth Defects and Developmental Disabilities (NCBDDD) working with our state partners have made good progress on these recommendations and have developed a state-level disability surveillance system that we think rules the serious shortcomings noted in the two IOM reports. This is a surveillance tool that turns data into information and I will demonstrate that shortly. And this information can be used by state health agencies and others to monitor the health, and hopefully direct resources to improve the health of people with disabilities. 

Without further ado, I want to talk a little bit your view. You are on the homepage of DHDS and if you want to learn about it you may click here. I will not read this to you, you can read it to yourself, but the surveillance tool, with state partners and others, it is to promote and invent opportunities to improve the health and wellness of people with disabilities. There is disability data and psychological distress data and healthcare expenditure data and I will talk about disability and expenditure data shortly. 

The tool contains brief information on methods and they talk about the data use it again if you tune in to the call next week, we'll go into more detail. It uses a state-level data collected by CDC and we have information on approximately 80 health indicators so it is very copperheads of. This is information that is very important to CDC. I will pull up under health copy guide some of the indicators that we cover. You will see an addition to our core indicators disability and psychological distress data and some of the health data that we have covered are all under the state categories, health risks and behaviors, healthcare services, prevention and screening, barriers and costs of healthcare, general conditions, chronic conditions, injuries, mental and emotional health you we have stratified all of this information by disability status. Again, disability is defined with our state partners, CDC and state partners and we use what is called the healthy people definition of disability so it is a very general definition. When we talk about disability and no definition this is the disability definition we are using. 

I want to talk about several of these indicators, I cannot cover them all because as I said there are almost 80, but I will touch on some that you will find very interesting. We have some on our go hall, HIV, physical activity, pollution, that all falls under health risks and behaviors are it then we have Healthcare Services information, prevention and screening, including your cancer screenings, doctor visits, teeth cleaning, vaccine information, and we have some information errors on cost of healthcare am a specifically insurance status and whether you can afford to see a doctor because of cost. 

There is also general health condition information, art health, high blood pressure, chronic condition information, injuries, and some information on mental and emotional health. You'll see there is a lot in there and that is on the health information site. In terms of demographics, we have information also stratified by several demographics. Not for everyone of the 79 or so indicators but for 50 of them. Most of these indicators you can find information stratified by age, gender, race, ethnicity, income, education, marital status and employment status and also veteran status. 

How we grouped it, that is available.  Disability information in 2001 and 2003 it was first loaded in what was called the core in 2004. If it is available for each year, we have data in there and so forth very this just tells you, and I have covered it a little bit, but I wanted to point out these are the three folks responsible for putting this together. Melissa ran the data, the future can be attributed to Michelle and others but she definitely took a lead role of those efforts, and overall what was going on. 

In terms of use, you'll find used stuff here but right now have some issues with two states with 2010 data. With suppressed data for those two states and we hope to shortly load the data and for those two states are in terms of its accessibility, I'll talk about that and the presentation, but with this slide it is 508 compliant you try to go about and beyond that and make it accessible for people with disabilities. This site is indeed about a disability. There is a tremendous health section. There are FAQs, glossaries, references, and you're thinking if you're just launching this how could you have FAQs? 

We do not think that what we knew best worked when we developed this, we worked closely with folks in our state to develop this system is so we user tested it and when we saw that they had difficulty navigating the system, we developed FAQs around the difficulty issues. You may find that information very useful. There is a glossary and also when we built this system it includes information that is important to those entries offices across CDC. When we defined obesity we do not develop it and the way we thought should be defined but we reached out to those dealing with it and the consistent health measure was consistent with how they defined it and you can find reference to all the papers we used to make sure that we did this right in this section. 

In terms of the health tides, Alyssa and Michelle did a great job did a great job putting together this health guide and anything missing today, you could probably find it in this health guide. Michelle might cover this in more detail during the next call, I will leave it at that and jump right into the system. If I go back to DHDS home, are three ways you can access data. Through the navigation tab, or you can access it through the middle of the page here by clicking on this button, or, there are some key topics here or you can access information. 

For now, I will to jump in and look at one of those key topics which is BMI to click on the center of the map here -- so if I were to click on the center of the map, it will take a minute to load, but hopefully right now you can see this map that shows obesity information for people with disabilities for 2010. When you choose a particular indicator, if you go over here, right here on this button choose data health topics, health risks and behaviors, BMI and obesity, you can have a choice of choosing disability or no disability. It always defaults to disability and to the latest year of information available. 

If I were to click on Virginia, what you're seeing is the obesity percentage for Virginia for people with disabilities and 2010. What that says is that approximately 37% of people with disabilities in Virginia are obese and 2010. What you can see, when I click on a state like Virginia, it will show you a tear on the map -- a tier on the map and it will show Virginia on this bar chart which links all of the states -- which ranks all of the states. Alaska, approximately 32% of people with disabilities are obese. Whereas in Mississippi it is approximately 45% of people with disabilities are obese you can see the Virginia falls somewhere in the middle. While I highlight Virginia, it shows up on the map, the chart and also the table. It will give you a value as well as some other descriptive statistics. 

Another thing you can do here, you can click on this, and it will switch to align so what you're now seeing for Virginia our rates and so forth of obesity. You can see it is 29.7% in 2004 and increased to 34.7% in 2005, and just moving along to 2010 up to 37.2%. Between 2010 and 2004, you can see it has increased by eight percentage points, obesity among people with disabilities for those and Virginia. You can save these images or you can print them. I can also blow this up if I click on these areas, I can see this map, scrolling across the map will give me the rates of the different states. 

I can also minimize it and go back. I can also select by limiting my map to just a certain region. I can flip back and will list the stay within that region and again, you can see Virginia, actually in the region, is doing pretty well when you compare it to the other states in the region. I can also limit it to a division if I knew what my division was. Those are the types of views you have the data. 

Again, you can print this, you can save it as an image, all of this information, you can download it, the data in a table in Excel, or, if you have trouble seeing these maps, we also show the high contrast views. Again, and high contrast views just to try to assist folks with individual impairments, and there is the information for Virginia and the high contrast view. 

So this gives you an idea of what you can do with this information. Again, I am focusing in on obesity. But I could also look at overweight, I could look at disability, no disability him a disparity, or total. I will limit it to disability in 2010 and I will look at people with disabilities in various states that are overweight and you can see in Virginia 35% of people with disabilities are overweight. As defined by CDC. That gives you some idea of information available. 

What I want to keep doing is give you a sense of types of different information we have in the system. What I will do now is talk to different indicator. We just looked at obesity. I will shoot up the homepage and look at smoking and look at the interactive maps. 

And then you will see choose data, help topics, health risks and figures, smoking, so I can look at current smokers, former smokers, or never smokers, encourage disability and this is what it defaults to. We now have smoking rates among people with disabilities and the various states. You can see the Virginia, the smoking percentage is 28.3%, and again, I can see it here on the map. I could perhaps compare Virginia to North Carolina if I wanted. I have done that by just holding down the control button and clicking on the state and now I can see how Virginia compares with North Carolina. 

I could flip that over and look at the trends between those two states, Virginia and North Carolina, and those two states will be highlighted also in the table down here. So you can do some really neat things and again, I could select specific to region or division, or I may want to also include South Carolina if I was interested in those three states, or perhaps West Virginia. You can do different things. The functionality on the system is really ornate, so again, I could look at smoking as a behavioral risk factor and you can see that smoking rates seem pretty high. 

Especially the states among folks who have disabilities so perhaps there is an ability to intervene to improve health and wellness for people with disabilities. I want to again, pressing on, show you some of the other information available, in terms of health care expenditures, I want to take a look at what we have which is healthcare expenditure information. I can choose total expenditures, Medicare, Medicaid, or nonpublic services. It defaults to total. What will show up here in the chart is the percentage and that is the percentage of expenditures. Right now I can show it for Virginia to keep it consistent with the Virginia team. 

22% of health care expenditures in Virginia are disability associated. I can see that down here in the table, and this is the dollar number. This is $7.9 billion approximately. Disability associated health care expenditures in Virginia were $7.9 billion. I can look at the Medicare expenditures and the disability associated, I can flip to that and again it represents approximately 40% of total expenditures, Medicare expenditures and Virginia are $2.5 billion. That is the expenditure information you have. 

What I would like to do now is show you how you can use the system to identify opportunities to improve health and want is for people with disabilities. What we have done with the system is try to look at differences by disability status to what I will do is go to DHDS home and I will show you a few things. I could pick mammography here off the homepage but I will show you how to access the information through the maps and data tables. Here are some of help topics I was looking at earlier. I want to look at mammograms so looking at these health topics, what our users did was they decided that mammograms fit on the prevention and screening. If you look under prevention and screens you will find mammography. 

And then you click. You have options, a single option, standard contrast, high contrast, double map high contrast. I want to click on the double map and show you what you can do in order to identify opportunities to improve health and wellness for people with disabilities. What you're seeing now hopefully on your screen are two maps and you're seeing a 45degree line. These maps show exactly the same things I want to change one of them. Up here with the map is showing our help topics, prevention and screening, cancer screenings, mammography and it is showing it for people with disabilities in 2010. Now what I can do in the second map I can look at cancer screenings, mammography, for people with disabilities in 2010. What these two maps are doing, and in Virginia for example, the screening rates for people with disabilities, 68.4, and in this case it is women 40 or older employment with like disabilities, in this case 81. Women with disabilities are more likely to get a mammography screening the Virginia, compared to women with high disabilities and that is what this is showing you. 

Approximately 68% of women with disabilities get a mammography screening in Virginia, compared to 81% of women without disabilities. Not just for Virginia, but it is showing you that for all these other states. What is kind of I think really neat about looking at this view, again, on the X axis we have rates for women with disabilities, data one, women would get -- women with disabilities, and data to women without disabilities, and you see tremendous variation in the state level difference in mammography screening for women with compared to women without this abilities. You see that two states, Massachusetts and Delaware, which in my opinion are doing a tremendous job of screening both women with and women without disabilities. There is very little difference, there is still a difference and there is still an opportunity in all these states to improve mammography screenings for women with disabilities, but these two states are doing I think a great job. 

You will see state like Idaho, Wyoming, Montana, Mississippi, Nevada, states you have tremendous opportunities to improve mammography screenings for women with disabilities. For example, if you look at Mississippi, you see approximately an eight percentage point difference. And again, for Arkansas three, but opportunities to improve both. At the US Virgin Islands and Idaho, Wyoming, you see these differences. 

What you can do, this tells you how women compare with disabilities compare to those without. You could identify which states have the most opportunity to improve in terms of disparities or you could change this down here, instead of looking at no disability you could look at disparity. What I am doing as I am plotting the disparities on this Y axis so here again I am looking at women with disabilities, and over here I am looking at disparities. You can see that in every state, with the exception of Puerto Rico, there is an opportunity to close the difference. 

What that means is that women with disabilities in every state, with the exception of Puerto Rico, are less likely to be screened for mammograms compared to women without disabilities. Again, some of these states like Massachusetts and Delaware, the differences are small. But in some of these other states, like Missouri for example, there is large differences. The difference is almost 15 percentage points. Basically women with disabilities in Missouri are really underserved in terms of mammography screenings are you there is a terminus opportunity to close that gap and improve on them. In all these states the differences are felt. 

What I am showing you here is a way to identify, at a state level, opportunities to improve health and wellness for in this case, women with disabilities. What I want to do now is show you a couple of other indicators where I think there are really stark differences and opportunities to improve health and wellness for people with disabilities. I want to show you now blood pressure screenings. 

So I go into my maps and data tables. I go into health topics, close it up, and I'm trying to remember where our folks in the states grouped blood-pressure screenings. I think it is under Gen. Gen. Yes, heart health and high blood pressure. So again, I could look at a single map or a high contrast map but I want the double map because it will tell me where the differences lie. Again, up here, if this data is only asked every other year, 2005, 2007, 2009 and in 2009, I have high blood pressure, yes, and people with disabilities, so I'll choose data and look at disability in 2009. It defaults to that. It defaults to that down here as well. 

I want to compare people with disabilities and without. Yes, no disability in 2009 and again I am starting to see differences here. People with disabilities, blood pressure, whether or not you have high blood pressure, compared to people without disabilities, dated number two on the Y axis end of Mississippi you can see the difference among people with disabilities and Mississippi, approximately half have high blood pressure, compared to approximately 1/3, or 31% for people without disabilities. You can see tremendous differences here. 

Again, Puerto Rico, Alabama, Tennessee, let's look at Virginia. For Virginia, there is a difference of about 14 percentage points to 38% of people with disabilities in Virginia have high blood pressure compared to approximately 25% of people without disabilities great. Again, a great opportunity to improve health and wellness when you see the differences and disparity. If I think of it in terms of disparity I can do that. 

And an individual state you can look at what is going on in each of these maps to find out information, but what you can do, you cannot look at two maps and notice these differences. Because your eyes are not quick enough so that is why we have developed this plot over here that allows you to plot two points for each state. It is just that your eyes are not quick enough as you scroll across the states. Just to be able to tell on huge and large differences so that is why we have this plot and I just wanted to mention that. 

Again, if I go down here and I wanted to think of this in terms of a disparity, to identify opportunities of the state level to improve health and wellness for people with disabilities. Here it is in terms of disparity and again you see a tremendous variation among states are if we look at Colorado, we see that 30% of people with disabilities have high blood pressure. Whereas, the findings is approximately 10 percentage points lower for people without disability in Colorado so it is right around 1%. Whereas, if you look at West Virginia that is a 30 percentage point difference and that is that 50% of people with disabilities in West Virginia have high blood pressure compared to approximately 30% of people without disabilities. 

The difference is 21% or 21 percentage points. This compares people with to people without disabilities. With the exception of New Hampshire and Colorado, all of the differences exceed 10 percentage points. They are huge and there is tremendous variation across the state. This is really telling you that there is a tremendous opportunity here to think about people with disabilities when you think about high blood pressure. There is a command is opportunity to improve blood pressure screening and get low-pressure under control for people with disabilities through 

Again, let me show you one more just to hit home how big the differences are at a state level, comparing people with disabilities to people without. So DHDS I'll -- home. So maps and data tables. Injuries, falls in the last three months. And again I want to look at a comparison map. 

And by now, you probably know it defaults to people with disabilities sit down here I want to change it to people without. And again, what you're seeing here, people without disabilities on this axis and people with on this one and you can see the differing ranges and there is a tremendous opportunity to improve health and wellness for people with disabilities, in this case falls. Alaska is a bit of an outlier and that makes sense because of the thick of Alaska I think of snow and ice. You see a lot of people who report falling have done so in the last three months. People with disabilities, approximately one in three are falling, reported falling in the last three months, compared to one in five without. These other state you are seeing tremendous differences comparing people with and without disabilities. Montana, one in three people with disabilities have fallen in the last three months on the compared to one in six without. The rate for falling has doubled for people with disabilities in Montana. 

Again, it is almost triple in Kentucky. 33% compared to 13%. You are seeing huge, state-level differences here and health want is for people with disabilities, and this case injuries, compared to people without. Again, in Oklahoma almost a threefold difference. Tremendous variation across the states, that is opportunities to improve health and wellness at a state level for people with disabilities. If I change this to the disparity, what I see is, on my Y axis is my disparity and some of the disparities are 20 percentage points. 

Arkansas, Oklahoma, Kentucky, but even the lowest ones are above 10 percentage points. The people with disabilities are so much more likely to fall, and again, any preventative programs or injury centers either a federal or state level that they have, they might start to give people with disabilities in these programs because they are more likely to fall fair to people without. Just a tremendous opportunity. 

If I wanted, I could select a region here and I could open that on the side. Even within the site, you are seeing tremendous variation in false -- and falls it opportunities to improve for people with disabilities compared to those without. In Arkansas, across while one in three people with disabilities fell in the last three months when these were taken. Compared to you know basically, 12% of people without disabilities. A difference of 22 percentage points. Down here in Maryland, it is still double. The fall rate for people with disabilities is double that. 

Even at a regional level, we are seeing tremendous variation and opportunities to improve health want us for people with disabilities. At the next session you will see a lot more tips and tricks that you can use and things that you can do with this system, but I want to stop here. It is about 11:45 AM and I want to take some questions if you have some. Thank you very much for your time and I hope that you have found this very interesting and I hope you have identified some opportunities, at least at the state level, to improve health and wellness for people with disabilities. So thank you. 

Adriane Griffen, MPH, MCHES from AUCD: We appreciate that. While you are on this screen we had a quick question on the legend. There is an icon at the bottom for ‘DS’. Could you go over with the category represents please?

Brian Armour, PhD from NCBDDD: Yes, the ‘DS’ is ‘data suppressed’ and that is just for 2010 for those two states, Arizona and DC. In the next few months we hope to update and load for those two states. What happened was there was a problem. The data was released and then CDC discovered a problem in these two states, and they had to take the data down and reissue it with the corrected information and we just not have -- we have just not loaded the corrected information there yet. 

Sharon Romelczyk, MPA from AUCD: Thank you so much. This is Sharon Romelczyk and I'm also working on the CDC Cooperative Agreement here at AUCD.  I will be helping to share some of the questions we have received today and I want to encourage attendees if you have questions, to continue to send them in via the chat box feature. The first question, where will the new Disability and Health Data System link people over the HealthyPeople2020 data or the warehouse to create a single point of entry for disability data? Are you still there? 

Brian Armour, PhD from NCBDDD: Yes. I would have to think a little about that question and get back to the folks on it I'm not sure that I can comment but what I can say about HealthyPeople 2020, certainly if we look at mammography, let me answer it this way. I don't know if this is a satisfactory answer. Certainly for a few states, Massachusetts, Delaware, they have already hit the 2020 goal on mammography. I think it is about 80%. Specific to mammography, some states have already met these goals. And others clearly have opportunity for improvement.

How to link this all together, we've actually consider trying, we have considered including 2020 goals and putting them in here is kind of reference points. We determined it was too much of a challenge at this time. All -- will probably think about it again in the future and I hope that is a satisfactory answer. If not, I would be happy to answer it off-line. 

Sharon Romelczyk, MPA from AUCD: Great. The next question is would you have a site that does not require/, I believe that is -- does not require Flash? 

Brian Armour, PhD from NCBDDD: I know we are working on it and I believe it is HTML 5. If we do upgrade, and I believe we will, HTML 5 is a consideration. I'm only pretending I know what I'm talking about I know that Flash for people on Apple products is problematic and is we a great HTML 5 is the google produces issues. We will upgrade to HTML 5 the next go around. 

Sharon Romelczyk, MPA from AUCD: Great. When will the 20 11 data be uploaded? 

Brian Armour, PhD from NCBDDD: The 2011 data has not been released. So what happens is, it is usually released sometime around June and then revisions are usually made in October. What we would like to do is get the information up there as quickly as we can after its release. As you saw with Arizona and DC it creates problems. If they release it in a couple months later they decided is problem, that is removed and that has created some problems with this. We would like to get it up there isn't as we possibly can. But we think it is important that what is up there is kind of correct. 

So we are still trying to work out some of those kinks. What we would like to certainly have it up there within a months after its release. Remember, it takes several months to run this so we are getting this data in and we are running all this information, working with programs across the CDC to make sure what we are measuring and how they are measuring it. And then loading that data into the system. 

It's not like we're just dumping raw data into the system and it is coming up by itself. We have to run programs and to conjunction with various CDC programs. We will have to work closely with the program over the next couple of months to take changes into consideration great to answer your question, would like to get it up there is as we possibly can, but there are a few wrinkles and that those records are if there are any revisions to the data, that causes problems for its board of CDC programs change of a measure something we have to take those measurements into consideration. 

Sharon Romelczyk, MPA from AUCD: Thank you. The next question is can you tell me the data source for the medical expenditures data and the participants, either CMS, who suggested as possible sources? 

Brian Armour, PhD from NCBDDD: Yes. There are references. What is the best way? I am thinking out loud here.

References. Help. So here is the data source for the expenditure estimates, one of the sources. There are two papers, the national paper in the state level paper. And that will give you the sources of this information, and also the details on how we calculated the expenditures. 

Sharon Romelczyk, MPA from AUCD: Great. The next question is, is it possible to get data from multiple states, or a whole region? Do you get the obesity rate for the South region or just obesity regions by states with in the southern region question the 

Brian Armour, PhD from NCBDDD: Could you repeat that question? It broke up a little bit.

Sharon Romelczyk, MPA from AUCD: Is it possible to get data from multiple states or for a whole region, and they specifically asked about obesity rates for the southern region. 

Brian Armour, PhD from NCBDDD: Yes. There are rates of obesity for state within that region. So they want a regional obesity rate? Is that the question? They want a rate for that region? Or do they want race for state within that region? This would be the obesity rates for states within that region for people with disabilities and 2010. 

Sharon Romelczyk, MPA from AUCD:  I think that does answer the question, so it is on a state and regional level. 

Brian Armour, PhD from NCBDDD: These are the rates for states within the region. I would look at the median I guess would be one way to do it, if they wanted an average rate for the region. 

Sharon Romelczyk, MPA from AUCD:  Okay. One of the next questions is can we identify prevalence and breakdown risk factors by different types of disabilities, such as intellectual disability only? 

Brian Armour, PhD from NCBDDD: Good question. Remember, for 20 years, IOM has been calling for state level information and the definition of disability we used is that healthy people 2010 definition so it is to a general definition. A flu within the next 20 years, I hope to have state specific data by types of disability, but no, that currently doesn't exist. And that is what everyone I think is striving towards. Unfortunately at this time we cannot look at various types of disabilities. 

Whether that is paralysis, or condition-specific like spina bifida. But maybe perhaps in the future. 

Sharon Romelczyk, MPA from AUCD:   Great. A number of the participants were wondering about the definition of disabilities for this resource. I don't know if you wanted to mention quickly the definition. 

Brian Armour, PhD from NCBDDD: Again. On the help topic and disability status, here's the definition. It is all up there in the system. It is basically two questions are added. Based on the BRFSS definition of people with which is are you limited in any way because of physical, mental, or emotional programs, or do you use special equipment such as a cane, wheelchair, or special bed? If you answer yes to any of those questions, you are identified as having a disability. It is a very general definition, Healthy People 2010 definition and it is designed to be inclusive. Very much a public health macro definition. 

Sharon Romelczyk, MPA from AUCD:  Thank you. A participant was wondering if you could show data on people with disabilities who also have low socioeconomic status and the various health-related data. 

Brian Armour, PhD from NCBDDD:  Good question. Let me see. Maps and data tables. Let me see if there is a risk factor, BMI. I am just picking one indicator. And I'm trying to think through it. There are 8 million pieces of information in this system and that will grow every year. That is a really good question but I just need to think about for a second. Income level. Low income. There you go, there it is for the lowest level of income, less than $50,000, disability, obesity, so yes you can do it. For about 49 of the indicators. I just selected one. Again, I would encourage folks, depending upon what they are interested in, I'm sure they could stratify this, in this case BMI by disability and income level. Again, I looked at the lowest level but there are other levels you could also look at. Answer to that question is yes. 

Sharon Romelczyk, MPA from AUCD: Thank you. Have you considered using the ICF is your uniform framework for disability data collection? 

Brian Armour, PhD from NCBDDD: We could discuss that for days probably. The challenge with the ICF is how we measure environment and how you collect the information. If someone could figure that out, which we would certainly want to include it, but right now the environment is not included or not measured. Access barriers and things like that. It would be a real challenge. 

Sharon Romelczyk, MPA from AUCD: Next question is, is there any way to look at each health area related to age group? 

Brian Armour, PhD from NCBDDD: Each health area related to age group. Yes. I just looked at income and it defaults to age. We're calling his prime, middle, and old. I hope I'm not offending anyone you can look at those three age groups. If I look at prime, 18 to 34, there is the obesity rate. Gender, race, income, education, marital status, employment am a about 50 indicators I could stratify on those. Again, I could look at the trend status -- that the trend -- veteran status and obesity. 

I encourage folks to go in and play with this system and get to know it's a little bit. We would be happy to help with that. 

Sharon Romelczyk, MPA from AUCD: Thank you. Next question is does the system allow a state to do I report or graphical health areas or can you look at only one health area at a time? 

Brian Armour, PhD from NCBDDD: At the next call Michelle I will show you how to download the information, but right now, the question refers to what we call their profiles. We're thinking about that for the next go around and it is really compensated. Think about this third. Right now they're 8 million pieces of information I have help topics. On there, something like heart health, just so everyone understands this question, or vaccines maybe. Maybe you want information not just on current flu vaccines, but maybe pneumonia. Right now you have to download the data in an Excel off to the side.

We're thinking about profiles were information will be grouped for you and you would be able to look at heart health, or arthritis or whatever it is, several cancer screenings, mammograms, colorectal perhaps, and a tap -- and a pap but there are so many permutations, we're just thinking about it. We're not sure what to do with it. We also have to reach out to various CDC programs are responsible for those different indicators and make sure that what we're doing is what they want us to do. 

We're thinking about it for the next go around but I cannot give you a timeline on it is there is just so much to consider given that we have a the indicators right now and the different combinations -- given that we have 80 indicators right now and some a different combinations. We want to do this for you and create a profile, or would it be easier for folks to download information and try to do it? Those are questions we have to wrestle with your first and talk to the partners about and then think what is best for everyone. Right now, it is a great question but we are still thinking about it. 

Sharon Romelczyk, MPA from AUCD: Thank you. Are the data within the tables downloadable into an Excel spread file?

Brian Armour, PhD from NCBDDD: Perhaps I covered that too quickly but they are. Michelle, and hopefully I'm not promising something you will not be covered, but I think what she gives the next talk, she is going to show you how can customize tables and download them. Right now, do you see the download data table? You could download these data tells -- tables with the click of a button. Michelle will show you how to customize it so you can really get what you want. And that will be for next week’s call. 

Sharon Romelczyk, MPA from AUCD: Thank you. Is there any chance the CDC will or can release a mobile app with new features and options. 

Brian Armour, PhD from NCBDDD: A mobile app? I think that is a wonderful suggestion and we would have to give it consideration.

Sharon Romelczyk, MPA from AUCD: Is federal data available so we compare state level data to the federal data?

Brian Armour, PhD from NCBDDD: This is federal data and is data collected by CDC and the state. Is national data available? Yes. It is available by NHIS end of their service and you can make comparisons. We have done that with some of the work we have done. You will see that whether looking at national or state level data, you see differences in what the state level system allows you to do at the IOM level you can drill down to the state level whereas the national level there is the state -- excuse me national levels area. 

Why show the double maps or mammography, or high blood pressure, he's determined is variation. If you look at this at the national level you will see differences, but you do not know what these differences look like, you just have this national picture and this gives you the state level picture and it says these states have the most opportunity to improve. 

Adriane Griffen, MPH, MCHES from AUCD: Thank you. That takes us to the close of our presentation for today. We'll be archiving today's webinar in the library. There are several tools at your fingertips to share the disability information with your colleagues and he has shared with us that this is a tremendous tool to integrate disability into your public-health surveillance and research activities, as well as your programs and policy initiatives. We hope that you take advantage of some of the tools for you, specifically the webinar button available within CDC.gov and a on the Disability and Health page. This is a tremendous way to share the information. We would also like to have you join us for the data users session next week where we will get more specific with some of the functionalities of the tool. That will take place on March 21 at 11 AM Eastern time.  You can find the registration information on AUCD’s homepage at aucd.org.  Thanks again and have a great day!
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