Respiratory diseases are top county health issue

Maui County’s community health needs are topped by respiratory diseases, followed by injury prevention and safety and mental health and mental disorders, according to the Hawaii Hospitals Health Needs Assessment released Wednesday.

The new study of Hawaii’s hospitals was mandated under President Barack Obama’s health care overhaul, the Affordable Care Act.

The health needs were identified to “offer meaningful understanding of the health needs of the islands” and to provide a foundation for hospitals’ planning efforts, according to an announcement of the assessment from the Healthcare Association of Hawaii, whose members include all of the acute-care hospitals in Hawaii and other providers.

The study ranked respiratory diseases as the top problem for Maui and Hawaii counties, using data analyzed using Hawaii Health Matters (hawaii healthmatters.org), a publicly available data platform with more than 100 health indicators from more than 20 sources.

According to Hawaii Health Matters’ indicators for respiratory disease, Maui County ranked second to Hawaii County in two measures – adults with asthma and children with asthma.

The 2010 data show 12 percent of adults on the Big Island have asthma, compared with 10.6 percent in Maui County, 8.9 percent in Honolulu and 5.6 percent on Kauai. The data also show 14.2 percent of Hawaii County children have asthma, compared with 12.7 percent in Maui County, 10.3 percent on Kauai and 10.2 percent in Honolulu.

The study did not look at potential causes, such as airborne volcanic ash, or vog, from the Big Island.

Statewide, more patients were hospitalized for mental health issues in 2011 than for any other preventable cause. The state’s health needs assessment shows mental health causes accounted for 5,180 hospital visits in Hawaii in 2011. That’s well above the next highest cause, heart failure, with 2,954 visits.

In Maui County, there were 618 hospitalizations for mental health problems, with an adjusted rate of 502.5 per 100,000 people. Honolulu’s adjusted rate was 440.8 per 100,000, and statewide the rate was 481.6.

Another indicator for mental health and mental disorders is the suicide rate. For the period of 2009 to 2011, the suicide rate in Maui County was 18.3 per 100,000 people. That rate was second to Hawaii County, with a rate of 19.4 per 100,000. Kauai County and the City and County of Honolulu were third and fourth, respectively, with rates of 15.3 and 10.9.

Numerous indicators were used to determine Maui County’s need for improved injury prevention and safety.

One of those indicators was hospitalizations due to assault. In 2009, Maui County reported the highest rate per 100,000 people with 39.8. Second highest was Honolulu with 24.4, followed by Hawaii County with 14.5 and Kauai County with 6.3.

Maui County’s rate of hospitalizations due to assault jumped 41.6 percent from 28.1 per 100,000 in 2008 to 39.8 per 100,000 in 2009.

Maui County also ranked highest in the state with its poisoning death rate.

From 2009 to 2011, Maui’s poisoning death rate per 100,000 people was 20.1, followed by Hawaii County with 15.8, Honolulu with 11.6 and Kauai with 9. For the period of 2006 to 2008, Maui’s poisoning death rate was 14.2 per 100,000, meaning that county’s rate went up 41.5 percent when comparing the 2006-to-2008 and 2009-to-2011 periods.

Maui County had the lowest rate for drowning deaths for the period of 2009 to 2011 with 2.1 deaths per 100,000 people. For the same period, Kauai County reported the highest rate with 5.3, followed by Hawaii County with 3.6 and Honolulu with 2.6.

From 2003 to 2005, Maui County tied with Honolulu for having the lowest homicide rate per 100,000 people with 1.5 deaths. The highest homicide rate was on Kauai with 2.8 deaths, followed by Hawaii County with 1.9.

Healthcare Association of Hawaii President George Greene said that the study sets benchmarks for hospitals to measure progress against every three years.

“We’re drawing a line in the sand here in 2013,” Greene said. “I’m very excited about looking forward six years from now, nine years from now, looking back on 2013 and saying that was the year that we figured out where we needed to focus our efforts and began to do that work.”

Each hospital is required to come up with its own plans for how to move forward by the end of its 2012 fiscal year, he said.

Maui Memorial Medical Center Chief Executive Officer Wesley Lo said that Maui County faces the same challenges as other counties, including health risk behaviors and chronic disease.

“This assessment will provide us with valuable insight into the key issues and how we might best address them,” he said. “We look forward to working in partnership with other organizations throughout Hawaii where possible to identify methods that might lessen some of these big issues, while helping to improve the overall health of Hawaii’s people.”

Low-income families, people in rural areas, veterans, Native Hawaiians and migrants under the Compact of Free Association have the most difficulty accessing mental health care, because of insurance coverage and other issues, the study said. The vast majority of hospital visits, more than 92 percent, came from people ages 18 to 64, a group that makes up 63 percent of the overall population.

The study identified heart disease and stroke as a top issue for Hawaii in terms of populations within the state and in comparison with the rest of the country.

“The lack of healthy eating and exercise behaviors in Hawaii largely contribute to poor cardiovascular health,” the assessment said. “Those living in low-income areas are disproportionately affected, and resources are not effectively reaching those most in need.”

Department of Health Director Loretta Fuddy said that the assessment helps state officials and health care providers look at social factors that affect health, such as access to fresh food and communities that encourage walking and other physical activity.

“We know that the social status, our economics, our environment are conditions that lead to our health conditions,” Fuddy said.

* The Associated Press contributed to this report.

Brian Perry can be reached at bperry@mauinews.com.