obici healthcare foundation community health assessment community health solutions, inc. may 23,...

Obici Healthcare Foundation Community Health Assessment

Community Health Solutions, Inc.

May 23, 2007

Unofficial Discussion Draft Subject to Change 2

Table of Contents

Executive Summary (Slide 3)1. Health Demographic Indicators (Slide 13)2. Community Survey Indicators (Slide 19)3. Mortality Indicators (Slide 26)4. Birth Indicators (Slide 31)5. Adult Health Status Indicators (Slide 37)6. Health Care Access Indicators (Slide 42)Appendix A: Gates County, NC Indicators (Slide 53)Appendix B: Table of Charts (Slide 68)


Executive Summary

• Executive Summary Outline– Study Purpose, Scope, and Limitations

– Study Methods

– The Study Region

– The Mission Statement as Organizing Principle

– Demographics of the Study Region

– Mission Focus 1: Addressing Unmet Needs of the Medically Indigent & Uninsured

– Mission Focus 2: Preventing or Reducing Illness or Disease

• Additional Issues

• Organization of the Report


Study Purpose, Scope, and Limitations

• Purpose– The purpose of the study is to provide information on community

health status to the Obici Healthcare Foundation• Scope

– The study includes:• Seven cities and counties in Virginia and North Carolina• Six categories of health indicators from existing data• Original survey data from Survey of Local Health Professionals and

Community Leaders

• Limitations– The study was:

• Not designed or budgeted to identify or detail every conceivable health issue

• Designed to be a starting point to support Foundation planning rather than a comprehensive assessment of every issue


Study Methods

• The study was conducted by Community Health Resource Center of Richmond, VA during December-May 2007– Demographic data were obtained from SRC, Inc., a commercial

data vendor– Death and Birth data were obtained from Virginia Department of

Health and the North Carolina Department of Health– Hospital Discharge data were obtained from Virginia Health

Information, Inc.– Adult health status data were obtained from the National

Behavioral Risk Factor Surveillance Survey– Community Survey data were obtained from a sample of local

health professionals and community leaders. The survey was limited to Virginia.

– Gates County, NC data are presented separately (in Appendix A) because data were not available for some indicators, and other data were in different formats than Virginia data.


The Study Region

Franklin

Suffolk

Sussex

Surry

Southampton

Isle of Wight

Gates

The Obici Healthcare Foundation Service Region includes most of seven cities and counties, including Gates County, NC.

Gates

Suffolk

Isle of Wight

SurrySussex

Southampton

Franklin


The Mission Statement as Organizing Principle

• The mission of the Obici Healthcare Foundation is to improve the health status of people living in the service area by:– 1) addressing the unmet needs of the medically

indigent and uninsured; and– 2) supporting programs which have the primary

purpose of preventing or reducing illness and disease.• Study results are summarized in terms of the two

mission focus areas.


Demographics of the Service Area

• Major Findings from Virginia Service Region:– More than 156,000 people in the Virginia service

region– Expected to reach 178,000+ by 2011– Growing twice as fast as Virginia– Growth driven by Suffolk and Isle of Wight– 42 percent African American compared to 19 percent

for Virginia– 22% of adults age 25+ without high school diploma

compared to 14% for state– Poorer than state as a whole on most economic

measures, including low-income children

In addition, Gates County, NC has a population of 11,500+.and a roughly similar profile in terms of age, race, and income. See Appendix A for detail.


Mission Focus 1: Addressing the Needs of the Medically Indigent & Uninsured

• Major Findings in the Virginia Service Region:– ‘Access to quality health services’ identified as immediate &

significant health concern by 39 of 63 respondents to Survey of Local Health Professionals and Community Leaders

– In the Virginia Study Region for 2005:• An estimated 22,500+ uninsured in the region, including 3,000-4000

children• An estimated 12,700+ uninsured with income below 200 percent of

poverty• An estimated 17,000+ adults could not see a doctor due to cost• An estimated 22,300+ adults had no dental visit in previous 2 years• 3,584 hospital discharges for potentially preventable conditions• Rates for all of the above were near or above the Virginia statewide

rate

In addition, Gates County, NC had an estimated 1,600+ uninsured in 2005. See Appendix A for detail.


Mission Focus 2: Preventing or Reducing Illness and Disease

• Major Findings in the Virginia Service Region– Survey of Local Health Professionals and Community Leaders

identified the following as leading community health concerns:• Overweight, Obesity, & Nutrition• Heart Disease & Stroke• Diabetes• Physical Activity & Fitness• Cancer• Substance abuse• Oral health• Mental health & mental disorders• Sexually transmitted diseases• Injury & violence• Tobacco

– Additional issues are noted in the report


Mission Focus 2: Preventing or Reducing Illness and Disease

• Major Findings in the Virginia Service Region– By the numbers:

• Leading causes of death = heart disease, cancer, stroke, chronic lower respiratory disease, injury, and diabetes

• Among adults, an estimated:– 73,000+ overweight or obese– 30,000+ no exercise in past 30 days– 91,000+ not consuming 5 or more fruits & vegetables per day– 26,000+ smoke– 15,900+ at risk for binge drinking– 37,000+ with high blood pressure– 35,700+ with high cholesterol– 15,700+ with asthma– 11,000+ with diabetes

• National rates of childhood overweight range from 10-16 percent, suggesting 3,700-6,000 children in the Virginia service region may be overweight.

• Rates in the Virginia Study Region were near or above Virginia statewide rates on most indicators.

Rates in Gates County, NC are similar to the Virginia Service Region rates. See Appendix A for detail.


Additional Issues

• Community Survey Responses

– Community Survey Respondents were asked to identify local health concerns expected to emerge in the Virginia Service Region over next 1-3 years

– Most frequently mentioned emerging local health issues:

• Medical Product Safety

• Public Health Infrastructure

• Occupational Safety & Health

• Vision & Hearing

• Food Safety


Part 1. Health Demographic Indicators

• Purpose– Health status is highly influenced by a person’s age, sex, race,

ethnicity, education, and income.

• Content– Chart 1.1-1.5 provide a demographic profile of the Virginia

Service Region.

• Source– CHRC analysis of data from SRC Corporation, a commercial

vendor of demographic data.


Chart 1.1 Population Change 2000-2011

Indicator

Desired Direction Franklin

Isle of Wight

Southampton Suffolk Surry Sussex

VirginiaStudyRegion Virginia

Population 2000 - 8,346

29,728

17,482

63,677

6,829

12,504

138,566

7,078,515

Population 2005 - 8,339 33,171 17,233 79,287 7,057 11,639 156,726 7,538,791

Population 2011 - 8,645 37,059 17,078 97,063 7,170 11,499 178,514 8,078,397

Population Growth 2000-2011 - 299 7,331 -404 33,386 341 -1,005 39,948 999,882

Percent Growth 2000-2011 - 4% 25% -2% 52% 5% -8% 29% 14%

The Virginia Service Region population is expected to grow by 29 percent from 2000 to 2011, with Suffolk and Isle of Wight driving the increase.

Yellow shading = local rate above Virginia state rate. See Appendix A for Gates County, NC data


Chart 1.2 Population by Age 2005

IndicatorDesired Direction Franklin

Isle of Wight



Age 0-17 2005 - 2,040 7,575 3,535 20,668 1,597 2,175 37,590 1,811,335

Percent Age 0-17 2005 - 24% 23% 21% 26% 23% 19% 24% 24%

Age 18-64 2005 - 4,802 21,240 11,119 49,947 4,429 7,797 99,334 4,845,084

Percent Age 18-64 2005 - 58% 64% 65% 63% 63% 67% 63% 64%

Age 65 Plus 2005 - 1,497 4,356 2,579 8,672 1,031 1,667 19,802 882,375

Pct Age 65 Plus 2005 - 18% 13% 15% 11% 15% 14% 13% 12%

The Virginia Service Region includes more than 37,000 children and more than 19,800 seniors. The region is slightly older than Virginia as a whole.



Chart 1.3 Population by Race & Ethnicity 2005

Indicator FranklinIsle of Wight



American Indian or Alaska Native 2005 9 65 26 182 13 12 307 16,819

Percent AIAN 2005 0% 0% 0% 0% 0% 0% 0% 0%

Asian Population 2005 65 118 35 624 10 15 867 345,897

Percent Asian 2005 1% 0% 0% 1% 0% 0% 1% 5%

Black or African American Pop. 2005 4,355 8,999 7,377 34,450 3,634 7,216 66,031 1,462,507

Percent Black or African Am. 2005 52% 27% 43% 43% 51% 62% 42% 19%

Hawaiian or Pacific Islander Pop. 2005 1 10 1 21 2 2 37 3,776

Percent Hawaiian or Pacific Is. 2005 0% 0% 0% 0% 0% 0% 0% 0%

Multirace Population 2005 77 314 101 1,035 67 87 1,681 148,715

Percent Multirace 2005 1% 1% 1% 1% 1% 1% 1% 2%

Other Race Population 2005 18 104 47 317 20 69 575 136,887

Percent Other Race 2005 0% 0% 0% 0% 0% 1% 0% 2%

Percent White 2005 46% 71% 56% 54% 47% 36% 56% 72%

White Population 2005 3,812 23,546 9,640 42,621 3,307 4,236 87,162 5,418,426

Hispanic Population 2005 76 418 169 1,313 73 156 2,205 435,843

Percent Hispanic 2005 1% 3% 1% 1% 2% 1% 1% 3%

The Virginia Service Region includes a significantly higher proportion of Black or African American residents than the state as a whole.



Chart 1.4 Adult Population by Education Status 2005


Isle of Wight



Population Age 25 Plus in 2005 - 5,484 22,451 11,913 50,756 4,762 8,374 103,740 4,994,743

Age 25 Plus and Less than High School Education 2005 Lower 1,273 4,242 3,517 9,375 1,130 2,853 22,390 694,230

Percent Age 25 Plus and Less than High School Education 2005 Lower 23% 19% 30% 18% 24% 34% 22% 14%

The Virginia Service Region has lower educational attainment (among adults) than Virginia as a whole.



Chart 1.5 Population by Income Status 2005


Isle of Wight



Per Capita Income 2006 Higher $21,363 $23,170 $18,958 $21,141 $18,408 $16,351 $20,704 $27,345

Average Household Income 2006 Higher $49,295 $59,560 $47,254 $56,088 $47,442 $42,826 $53,812 $69,571

Median Household Income 2006 Higher $35,968 $51,445 $38,349 $46,456 $41,051 $34,821 $44,359 $54,073

Child Poverty Rate 2004 Lower 24% 12% 18% 15% 15% 21% 16% 15%

Est. Children in Poverty Lower 490 909 636 3,100 240 457 5,831 271,700

Students Approved for Free/Reduced School Lunch 2005 Lower 80% 34% 40% 39% 52% 74% na 33%

Est. Population Below 200 Percent Poverty 2005

Lower 3,169 7,961 5,515

24,579 2,329 3,492 47,044 1,809,310

Percent Population Below 200 Percent Poverty 2000

Lower38% 24% 32% 31% 33% 30% 30% 24%

The Virginia Service Region includes higher rates of poverty and near-poverty than Virginia as a whole. Rates are high for both children and adults.



Part 2. Community Survey Indicators

• Purpose– Community officials and professionals have valuable

insight into community health concerns• Content

– Charts 2.1-2.6 summarize responses to the survey– Results are for Virginia Service Region only

• Source– The survey was sent to 180+ community officials and

health professionals from a list provided by Obici Healthcare Foundation

– 63 valid responses were received– Analysis is by CHRC


Chart 2.1 Top Local Health Concerns from Community Survey

10

11

14

17

17

18

20

21

22

25

30

46

0 5 10 15 20 25 30 35 40 45 50

Health Education & Health Promotion

Adequate Health Provider Workforce

Sexually Transmitted Diseases

Mental Health and Mental Disorders

Access to Quality Health Services

Oral Health

Substance Abuse

Cancer

Physical Activity and Fitness

Diabetes

Heart Disease and Stroke

Overweight, Obesity, Nutrition

Overweight, Obesity, & Nutrition was the most frequently named top local health concern in the Virginia Service Region

Number of survey respondents (out of 63) identifying issue as among the ‘top five local health concerns.’


Chart 2.2 Top Local Health Concerns from Community Survey

1

1

2

2

3

4

4

4

4

5

5

5

7

8

9

0 1 2 3 4 5 6 7 8 9 10

Environmental Health Health

Disability & Secondary Conditions

Chronic Kidney Diseases

Medical Product Safety

Immunization & Infectious Diseases

Vision & Hearing

HIV

Family Planning

Arthritis, Osteoporosis, and Chronic Back Conditions

Respiratory Diseases

Maternal Health/Pregnancy

Public Health Infrastructure

Tobacco Use

Infant/Child Health & Development

Injury & Violence Prevention

Number of survey respondents (out of 63) identifying issue as among the ‘top five local health concerns.’

(continued)


Chart 2.3 Immediate & Significant Local Health Concerns from Community Survey

29

33

35

37

38

38

38

39

41

45

46

46

47

50

61

0 10 20 30 40 50 60 70

Family Planning




Tobacco Use


Oral Health



Cancer

Substance Abuse

Diabetes




Number of survey respondents (out of 63) identifying issue as an ‘immediate significant local health concern.’

Overweight, Obesity, & Nutrition was the most frequently named ‘immediate significant local health concern’ in the Virginia Service Region.


Chart 2.4 Immediate & Significant Local Health Concerns from Community Survey

4

7

9

15

15

16

17

18

19

21

23

27

27

28

0 5 10 15 20 25 30

Occupational Safety & Health


Food Safety


Vision & Hearing





HIV





Number of survey respondents (out of 63) identifying issue as an ‘immediate significant local health concern.’

(continued)


Chart 2.5 Emerging Local Health Concerns from Community Survey

14

14

15

17

17

18

18

20

20

20

22

23

23

24

24

0 5 10 15 20 25 30

Oral Health






HIV




Food Safety

Vision & Hearing

Occupational Safety & Health



Medical Product Safety, Public Health Infrastructure, Occupational Safety & Health, Vision & Hearing, and Food Safety were the most frequently identified emerging local health issues in the Virginia Service Region.

Number of survey respondents (out of 63) identifying issue as ‘not a significant concern now, but may be in 1-3 years.’


Chart 2.6 Emerging Local Health Concerns from Community Survey

2

5

5

6

7

7

8

8

9

9

10

10

11

13

0 2 4 6 8 10 12 14


Tobacco Use

Cancer

Substance Abuse


Diabetes








Family Planning

(continued)

Number of survey respondents (out of 63) identifying issue as ‘not a significant concern now, but may be in 1-3 years.’


Part 3. Mortality Indicators

• Purpose– Leading causes of death provide important insights

into the health and concerns of a population

• Content– Charts 3.1-3.4 show the leading causes of death in

terms of counts, deaths per 100,000 population, and age-adjusted deaths per 100,000 population.

• Source– CHRC analysis of 2004 data from the Virginia

Department of Health


Chart 3.1 Leading Causes of Death


Isle of Wight


Virginia StudyRegion Virginia

Total Deaths 2004 Lower 113 323 184 670 47 125 1,462 56,312

Deaths per 100,000 Population Lower 1,334 985 1,046 875 674 1,049 947 755

Age-adjusted Deaths per 100,000 Population Lower 939.2 1002.4 961.7 1000.6 606.9 948.1 na 806.0

Diseases of the Heart

Total Deaths 2004 Lower 38 88 49 165 14 28 382 13,850

Deaths per 100,000 Population Lower 448.5 268.4 278.6 215.4 200.9 235 247.5 185.7


Malignant Neoplasms


Deaths per 100,000 Population Lower 271.5 241 250.2 194.5 215.2 209.8 217.1 174.3


Cerebrovascular Disease


Deaths per 100,000 Population Lower 23.6 39.7 56.9 62.7 28.7 42 51.8 49.3


In 2004, multiple localities had age-adjusted death rates above the statewide rate for overall deaths, heart disease deaths, and cancer deaths. Suffolk had a higher rate for cerebrovascular disease deaths.





Isle of Wight



Chronic Lower Respiratory Disease


Deaths per 100,000 Population Lower 70.8 48.8 22.7 31.3 14.3 50.4 36.9 35.5


Unintentional Injury




Diabetes Mellitus


Deaths per 100,000 Population Lower 47.2 33.6 28.4 39.2 0 50.4 36.3 20.8


Alzheimer's Disease




In 2004, multiple localities had age-adjusted death rates above the statewide rate for chronic lower respiratory disease, unintentional injury, diabetes, and Alzheimer’s.




Isle of Wight



Pneumonia and Influenza




Nephritis and Nephrosis


Deaths per 100,000 Population Lower 59 3.1 34.1 18.3 0 33.6 19.4 16.5


Septicemia




Suicide

Total Deaths 2004 Lower 0 6 1 7 0 2 16 805

Deaths per 100,000 Population Lower 0 18.3 5.7 9.1 0 16.8 10.4 10.8


Chart 3.3 Leading Causes of DeathIn 2004, multiple localities had age-adjusted death rates above the statewide rate for Pneumonia & Influenza, Nephritis & Nephrosis, Septicemia, and Suicide.





Isle of Wight



Pneumonitis due to Solids and Lquids

Total Deaths 2004 Lower 0.0 2.0 0.0 4.0 1.0 4.0 11.0 525.0



Chronic Liver Disease


Deaths per 100,000 Population Lower 23.6 3.1 0 5.2 14.3 8.4 5.8 6.8


Homicide and Legal Intervention




In 2004, multiple localities had age-adjusted death rates above the statewide rate for pneumonitis, chronic liver disease, and homicide/legal intervention.



Part 4. Birth Indicators

• Purpose– Birth indicators provide insight into maternal

and child health and health care access

• Content– Charts 4.1-4.5 show counts and rates for

several common birth indicators.

• Source– CHRC analysis of 2004 data from the Virginia

Department of Health


Chart 4.1 Total Pregnancies


Isle of Wight



Total Pregnancies - 210

455

209

1,636

91

159

2,760 137,157

Induced Terminations of Pregnancy Lower 47 67 22 355 20 27 538 25,918

Natural Fetal Deaths Lower 9 33 15 95 7 9 168 7,409

Total Live Births Higher 154

355

172

1,186

64

123

2,054

103,830

Birth Rate/1,000 Estimated Population - 18.2 10.8 9.8 15.5 9.2 10.3

14.07 13.9

In 2004, the region had 2,760 pregnancies resulting in 2,054 live births. Franklin, Suffolk, and the region as a whole had birth rates above the statewide rate.



Chart 4.2 Low Birth Weight and Late Prenatal Care Births


Isle of Wight


VirginiaStudy Region Virginia

Low Weight Births

Low Weight Birth (<2,500 grams) Lower 17 26 17 121 4 10 195 8,674

Low Weight Birth Percent of Total Births Lower 11 7.3 9.9 10.2 6.3 8.1

9.5 8.4

Late/No Prenatal Care Births

Began Care in First 13 Weeks Higher 126 332 150 1,061 54 105 1828 88,054

Began Care After 13 Weeks Lower

28

23

22

125

10

18

226

15,776

Percent Began Care After 13 Weeks Lower

18.2

6.5

12.8

10.5

15.6

14.6

11.0

15.2

In 2004 there were 195 low weight births and 226 late or no prenatal care births. The low birth weight rate was higher than the statewide rate in three localities and the region as a whole. The late/no prenatal care rate was above the state rate in Franklin.



Chart 4.3 Non-marital Births

IndicatorDesired Direction

Franklin

Isle of Wight



Non-Marital Births Lower 88 113 71 408 28 65 773 32,190

Percent Non-Marital Births Lower 57.1 31.8 41.3 34.4 43.8 52.8 37.63 31

In 2004 there were 773 non-marital births. The non-marital birth rate exceeded the statewide rate throughout the region.



Chart 4.4 Teen Pregnancies

IndicatorDesired Direction

Franklin

Isle of Wight



Total Teenage Pregnancies Lower 38 47 23 192 7 29 336 13,343

Preg Rate/1,000 Pop Ages 10-19 Lower 60.1 21.6 21.1 34.3 13.5 45.7 na 26.5

Pregnancies Ages<15 yrs Lower 0 0 1 6 0 1 8 293

Preg Rate/1,000 Pop Ages<15 Lower 0 0 1.8 2.1 0 3.1 na 1.2

Pregnancies Ages 15-17 Lower 14 22 5 71 1 7 120 3,906

Preg Rate/1,000 Ages 15-17 Lower 65.4 33.4 14.3 38.9 5.3 34 na 26

Pregnancies Ages 18-19 Lower 24 25 17 115 6 21 208 9,144

Preg Rate/1,000 Ages 18-19 Lower 237.6 71 100 134.3 62.5 198.1 na 92

In 2004 there were 336 teenage pregnancies, including 128 to teens under 18. Teen pregnancy rates were above the statewide rate in multiple localities.



Chart 4.5 Infant Deaths


Isle of Wight


Virginia Study Region Virginia

Total Infant Deaths 2004 Lower 3 4 4 12 0 1 24 768

Five-Year Infant Death Rate/1,000 Live Births 2000-2004 Lower 11.8 5.8 8.3 9.6 8.5 13.3 na 7.4

In 2004 there were 24 infant deaths. Over the period 200-2004, the infant death rate was higher than the statewide rate in every locality except Isle of Wight.



Part 5. Adult Health Status Estimates

• Purpose– Adult health status estimates paint a picture of community health

beyond death rates, birth rates, and hospitalization rates.

• Content– Charts 5.1-5.4 contain local estimates of adult health status.– The figures are ‘synthetic estimates’ based on application of

statewide and national survey data to local demographics. They are for planning purposes only, and are not guaranteed for accuracy.

• Source– CHRC analysis of data from the National Behavioral Risk Factor

Surveillance Survey and demographic data from SRC, Inc.


Chart 5.1 Adult Health Limitation Estimates


Isle of Wight



Fair or Poor Health Status 2005 Lower 1,228 4,147 2,397 9,965 1,021 1,685 20,443 851,950

Percent Fair or Poor Health Status 2005 Lower 20% 16% 18% 17% 19% 18% 17% 15%

Limitations Due to Health 2005 Lower 1,222 4,838 2,534 10,610 1,021 1,647 21,872 1,018,935

Percent Limitations Due to Health 2005 Lower 19% 19% 19% 18% 19% 17% 18% 18%

In 2005 there were an estimated 20,000+ adults in fair or poor health status. Estimated rates were above the statewide average.



Chart 5.2 Adult Overweight, Obesity, Exercise, and Nutrition Estimates


Isle of Wight



Overweight or Obese 2005 Lower 3,874 15,383 8,452 35,992 3,374 6,019 73,094 3,300,258

Percent Overweight or Obese 2005 Lower 62% 60% 62% 61% 62% 64% 61% 58%

No Exercise in Past 30 Days 2005 Lower 1,757 6,169 3,520 15,124 1,474 2,527 30,571 1,315,080

Percent No Exercise in Past 30 Days 2005

Lower28% 24% 26% 26% 27% 27% 26% 23%

Less Than Five Servings Per Day of Fruits and Vegetables 2005 Lower 4,768 19,658 10,561 45,195 4,150 7,316 91,648 4,369,963

Percent Less than Five Servings per Day of Fruits & Vegetables 2005 76% 77% 77% 77% 76% 77% 77% 77%

In 2005 there were an estimated 73,000+ adults who could be classified as overweight or obese. Overweight/obesity rates were estimated to be above the statewide average throughout the region.



Chart 5.3 Adult Smoking and Alcohol Consumption Estimates


Isle of Wight



Smoke 2005 Lower 1,291 5,682 3,027 12,955 1,174 2,148 26,278 1,285,441

Percent Smoke 2005 Lower 21% 22% 22% 22% 22% 23% 22% 23%

Risk for Binge Drinking 2005 Lower 699 3,558 1,877 7,796 655 1,325 15,910 877,214

Percent Risk for Binge Drinking 2005

Lower11% 14% 14% 13% 12% 14% 13% 15%

In 2005 there were an estimated 26,000+ adult smokers and an estimated 15,900+ adults at risk for binge drinking.



Chart 5.4 Adult Chronic Disease Estimates


Isle of Wight



Diabetes (Told by Doctor) 2005 Lower 712 2,329 1,370 5,627 595 956 11,589 445,774

Percent Diabetes (Told by Doctor) 2005

Lower11% 9% 10% 10% 11% 10% 10% 8%

High Blood Pressure (Told by Doctor) 2005 Lower 2,242 7,730 4,397 18,055 1,862 3,047 37,333 1,525,070

Percent High Blood Pressure (Told by Doctor) 2005

Lower

36% 30% 32% 31% 34% 32% 31% 27%

High Cholesterol (Told by Doctor) 2005 Lower 1,990 7,884 4,150 17,293 1,682 2,726 35,724 1,646,714

Percent High Cholesterol (Told by Doctor) 2005

Lower

32% 31% 30% 30% 31% 29% 30% 29%

Asthma (Told by Doctor) 2005 Lower 806 3,251 1,753 7,562 693 1,221 15,286 731,758

Percent Asthma (Told by Doctor) 2005

Lower13% 13% 13% 13% 13% 13% 13% 13%

Arthritis (Told by Doctor) 2005 Lower 2,047 7,602 4,041 16,706 1,676 2,584 34,656 1,538,622

Percent Arthritis (Told by Doctor) 2005

Lower33% 30% 30% 29% 31% 27% 29% 27%

In 2005 there were an estimated 11,500+ adults with diabetes, 37,000+ adults with high blood pressure, 35,700+ with high cholesterol, 15,200+ with asthma, and 34,600+ with arthritis. These estimates assume a diagnosis of the specified disease, and do not include those not yet diagnosed.



Part 6. Health Care Access Indicators

• Purpose– Access to health care is a fundamental prerequisite for community

health.• Content

– Charts 6.1-6.9 provide various measures of health care access in the Virginia Service Region.

• Source– Uninsured estimates and adult health care access estimates were

produced by CHRC using ‘synthetic estimation techniques’ in which national and state-level survey data are applied to local demographic profiles.

– Underserved area designations were obtained from the U.S. Health Resources and Services Administration.

– Ambulatory Care Sensitive Condition indicators were produced by CHRC using discharge data from Virginia Health Information, Inc. and population data from SRC, Inc.


Chart 6.1 Uninsured Estimates


Isle of Wight



Est. Population Below 200 Percent Poverty 2005 Lower 3,169

7,961

5,515

24,579

2,329

3,492

47,044

1,809,310

Est. Uninsured Below 200 Percent Poverty 2005 Lower 856

2,149

1,489

6,636

629

943

12,702

488,514

Est. Uninsured Above 200 Percent Poverty 2005 Lower 465

2,269

1,055

4,924

426

733

9,871

515,653

Est. Uninsured Rate 2005 Lower 16% 13% 15% 15% 15% 14% 14% 13%

Est. Uninsured Total 2005 Lower 1,321

4,418

2,544

11,560

1,054

1,676

22,573

1,004,167


Among the uninsured are an estimated 3,000-5,000 children under 18, and17,500-19,500 adults.


Chart 6.2 Adult Health Care Access Estimates


Isle of Wight



Est. Could Not See Doctor Due to Cost 2005 Lower 901 3,404 1,918 8,558 797 1,439 17,017 765,200

Est. Percent Could Not See Doctor Due to Cost 2005

Lower

14% 13% 14% 15% 15% 15% 14% 13%

Est. No Dental Visit Past 2 Years 2005 Lower 1,247 4,532 2,676 10,918 1,033 1,901 22,307 997,589

Percent No dental visit 2 years 2005 Lower 20% 18% 20% 19% 19% 20% 19% 18%



Chart 6.3 Underserved Area Designations

Franklin

Suffolk

Sussex

Surry

Southampton

Isle of Wight

Gates

Access to health care is closely tied to availability of health care providers. Every locality in the region except for Southampton and Franklin have been designated as health professional shortage areas (HPSAs), meaning they may have a shortage of health professionals to meet population need. In addition, Surry County, Sussex County, Gates County are designated as ‘medically underserved areas’ (MUA), indicating they have additional risk factors related to poverty, infant mortality, or both. Designations are made by the Federal Bureau of Primary Health Care in coordination with the Virginia Department of Health.

MUA/ HPSA

MUA/ HPSA

HPSA

HPSA

MUA/ HPSA


Charts 6.4-6.9Ambulatory Care Sensitive Condition Discharges

• Ambulatory Care Sensitive Conditions are health conditions for which inpatient hospitalization may be avoided with proper ambulatory care.

• A region with high rates of ACSC discharges may have barriers to ambulatory care utilization.

• Technical Note:– Virginia Health Information, Inc. requires the following notice to accompany any

use of its data:– “VHI has provided non-confidential patient level information used in this report

which it has compiled in accordance with Virginia law, but which it has no authority to independently verify. By using this report, the user agrees to assume all risks that may be associated with or arise from the use of inaccurate data. VHI cannot and does not represent that the use of VHI’s data was appropriate for this report, or endorse or support any conclusions of inferences that may be drawn from the use of VHI’s data.”


Chart 6.4 Ambulatory Care Sensitive Condition Discharges


Isle of Wight



Total Ambulatory Care Sensitive Condition Discharges w/o Psychosis 2005 Lower 551 589 436 1,547 125 336 3,584 150,932

Ambulatory Care Sensitive Condition Discharges (w/o Psychosis) per 100,000 Population 2005 Lower 6,608 1,776 2,530 1,951 1,771 2,887 2,287 2,002

In 2005, residents of the Virginia Service Region had 3,548 ACSC discharges from Virginia hospitals. The rate of hospitalization was above the statewide rate in Franklin, Southampton, Sussex, and the region as a whole.

Charts 6.5-6.8 show detailed breakouts of ACSC discharges by condition.

Chart 6.9 shows separate data on discharges for psychosis, which some researchers also identify

as an ambulatory care sensitive condition.




Isle of Wight



Dehydration Discharges 2005 Lower 151 127 99 292 28 89 786 34,555

Dehydration Discharges per 100,000 Pop. Lower 1,811 383 574 368 397 765 502 458

Congestive Heart Failure Discharges 2005 Lower 113 133 101 356 20 61 784 24,513

CHF Discharges per 100,000 Pop. Lower 1,355 401 586 449 283 524 500 325

Bacterial Pneumonia Discharges 2005 Lower 67 80 62 208 19 50 486 23,440

Bact Pneum Discharges per 100,000 Pop. Lower 803 241 360 262 269 430 310 311

Chronic Obstructive Pulmonary Disease Discharges 2005 Lower 35 46 29 114 9 31 264 14,097

COPD Discharges per 100,000 Pop. Lower 420 139 168 144 128 266 168 187

Asthma Discharges 2005 Lower 32 38 32 107 8 17 234 10,233

Asthma Discharges per 100,000 Pop. Lower 384 115 186 135 113 146 149 136

Yellow shading=rates above statewide rate. Use caution in interpreting rates for conditions with less than 30 discharges.




Isle of Wight



Kidney Discharges 2005 Lower 55 31 41 90 4 18 239 10,194

Kidney Discharges per 100,000 Pop. Lower 660 93 238 114 57 155 152 135

Cellulitis Discharges 2005 Lower 21 31 30 103 9 23 217 9,646

Cellulitis Discharges per 100,000 Pop. Lower 252 93 174 130 128 198 138 128

Diabetes Discharges 2005 Lower 34 48 15 133 10 14 254 8,498

Diabetes Discharges per 100,000 Pop. Lower 408 145 87 168 142 120 162 113

Convulsions Discharges 2005 Lower 12 14 10 48 4 11 99 4,122

Convulsions Discharges per 100,000 Pop. Lower 144 42 58 61 57 95 63 55

Gastroenteritis Discharges 2005 Lower 6 12 2 20 2 6 48 2,861

Gastro Discharges per 100,000 Pop. Lower 72 36 12 25 28 52 31 38





Isle of Wight



Hypertension Discharges 2005 Lower 4 3 1 23 4 4 39 2,133

Hypertension Discharges per 100,000 Pop. Lower 48 9 6 29 57 34 25 28

Angina Discharges 2005 Lower 4 7 6 10 0 3 30 2,105

Angina Discharges per 100,0000 Pop. Lower 48 21 35 13 0 26 19 28

Epilepsy Discharges 2005 Lower 6 1 2 10 1 0 20 1,204

Epilepsy Discharges per 100,000 Pop. Lower 72 3 12 13 14 0 13 16

Iron Deficiency Anemia Discharges 2005 Lower 3 1 0 7 2 2 15 753

Iron Deficiency Anemia Discharges per 100,000 Pop. Lower 36 3 0 9 28 17 10 10

Severe ENT Infection Discharges 2005 Lower 2 6 2 8 2 3 23 959

Severe ENT Discharges per 100,000 Pop. Lower 24 18 12 10 28 26 15 13





Isle of Wight



Pelvic Inflammatory Disease Discharges 2005 Lower 4 6 1 13 2 4 30 941

PID Discharges per 100,000 Pop. Lower 48 18 6 16 28 34 19 12

Dental Condition Discharges 2005 Lower 1 2 2 3 0 0 8 374

Dental Discharges per 100,000 Pop. Lower 12 6 12 4 0 0 5 5

Tuberculosis Discharges 2005 Lower 1 3 1 1 1 0 7 179

Tuberculosis Discharges per 100,000 Pop. Lower 12 9 6 1 14 0 4 2

Hypoglycemia Discharges 2005 Lower 0 0 0 1 0 0 1 125

Hypoglycemia Discharges per 100,000 Pop. Lower 0 0 0 1 0 0 1 2



Chart 6.9 Ambulatory Care Sensitive Condition Discharges: Psychosis


Isle of Wight



Psychosis Discharges 2005 Lower 64 109 52 320 59 122 726 40,694

Psychosis Discharges per 100,000 Population 2005 Lower 767 329 302 404 836 1,048 463 540


Note: Psychosis is treated separately in this study because some but not all researchers identify psychosis as an ambulatory care sensitive condition.


Appendix A. Gates County, NC Indicators

• Gates County, NC is treated separately in this report for two reasons:– 1) Data for some indicators were not available

in the same format or for the same year as the Virginia Study Region

– 2) the Survey of Local Health Professionals and Community Leaders was limited to the Virginia Study Region.


Chart A.1 Gates County Population Profile

Indicator Value

Population 2000 10,516



Population Growth 2000-2011 1,003

Percent Growth 2000-2011 10%

Source: CHRC analysis of data from SRC Corp.


Chart A.2 Gates County Race & Ethnicity Profile

Indicator Value

American Indian or Alaska Native 38

Percent AIAN 0%

Asian Population 2005 36

Percent Asian 2005 0%

Black or African American Population 2005 4249

Percent Black or African American 2005 38%

Hawaiian or Pacific Islander Population 2005 3

Percent Hawaiian or Pacific Islander 2005 0%

Multirace Population 2005 97

Percent Multirace 2005 1%

Other Race Population 2005 11

Percent Other Race 2005 0%

White Population 2005 6626

Percent White 2005 60%

Hispanic Population 2005 92

Percent Hispanic 2005 0%



Chart A.3 Gates County Age Profile

Indicator Value

Age 0-17 2005 2583

Percent Age 0-17 2005 23%

Age 18-64 2005 6832

Percent Age 18-64 2005 62%

Age 65 Plus 2005 1645

Pct Age 65 Plus 2005 15%



Chart A.4 Gates County Educational Attainment & Economic Profile

Indicator Value

Education

Population Age 25 Plus in 2005 7,370

Age 25 Plus and Less than High School Education 2005 1810

Percent Age 25 Plus and Less than High School Education 2005 25%

Economic Status

Per Capita Income 2006 $ 18,290

Average Household Income 2006 $ 47,623

Median Household Income 2006 $39,802

Child Poverty Rate 2004 18%

Est. Children in Poverty 462

Est. Population Below 200 Percent Poverty 2005 3,871

Percent Population Below 200 Percent Poverty 200035%



Chart A.5 Gates County Health Care Access Profile

Indicator Value

Medically underserved as of 2006 Yes

Uninsured Estimates

Est. Population Below 200 Percent Poverty 2005 3,871

Est. Uninsured Below 200 Percent Poverty 2005 1,045

Est. Uninsured Above 200 Percent Poverty 2005 647

Est. Uninsured Rate 2005 15%

Est. Uninsured Total 2005 1,692

Adult Access Estimates

Est. Could Not See Doctor Due to Cost 2005 1,102

Est. Percent Could Not See Doctor Due to Cost 200513%

Est. No Dental Visit Past 2 Years 2005 1,865

Percent No dental visit 2 years 2005 22%

Source: CHRC synthetic estimates using National Behavioral Risk Factor Surveillance Survey data applied to local demographic data from

SRC Corp.


Chart A.6 Gates County Mortality ProfileIndicator Value

Deaths from All Causes

Total Deaths 2005 118

Deaths per 100,000 Population 204

Age-adjusted Deaths per 100,000 Population 226.8

Diseases of the Heart




Malignant Neoplasms


Deaths per 100,000 Population 276.3


Cerebrovascular Disease




Chronic Lower Respiratory Disease

Total Deaths 2005 5


Age-adjusted Deaths per 100,000 Population 46

Source: CHRC analysis of data from NC Department of Health


Chart A.7 Gates County Mortality Profile (continued)Indicator Value

Unintentional Injury

Total Deaths 2005 2


Age-adjusted Deaths per 100,000 Population NA

Diabetes Mellitus

Total Deaths 2005 7



Alzheimer's Disease

Total Deaths 2005 1



Pneumonia and Influenza

Total Deaths 2005 2



Nephritis and Nephrosis

Total Deaths 2005 2


Age-adjusted Deaths per 100,000 Population 11



Chart A.8 Gates County Mortality Profile (continued)

Indicator Value

Septicemia

Total Deaths 2005 3



Suicide

Total Deaths 2005 2



Chronic Liver Disease

Total Deaths 2005 0



Homicide and Legal Intervention

Total Deaths 2005 2





Chart A.9 Gates County Birth Profile

Indicator Value

Pregnancies

Total Pregnancies 172

Induced Terminations of Pregnancy 44

Natural Fetal Deaths 1

Total Live Births 127

Birth Rate/1,000 Estimated Population 11.5



Chart A.10 Gates County Birth Profile (continued)

Indicator Value

Non-Marital Births

Non-Marital Births 64

Percent Non-Marital Births 50%

Low Weight Births

Low Weight Birth (<2,500 grams) 19

Low Weight Birth Percent of Total Births 15%

Late/No Prenatal Care Births

Began Care in First 13 Weeks 111

Began Care After 13 Weeks 16

Percent Began Care After 13 Weeks 13%



Chart A.11 Gates County Birth Profile (continued)

Indicator Value

Teen Pregnancy

Total Teenage Pregnancies 30

Preg Rate/1,000 Pop Ages 10-19 52.3

Pregnancies Ages<15 yrs 0

Preg Rate/1,000 Pop Ages<15 na

Pregnancies Ages 15-17 12

Preg Rate/1,000 Ages 15-17 na

Pregnancies Ages 18-19 18

Preg Rate/1,000 Ages 18-19 na



Chart A.12 Gates County Adult Health Status Indicators

Indicator Value

Adult Population 2005 8,477

Fair or Poor Health Status 2005 1,335

Percent Fair or Poor Health Status 200516%

Limitations Due to Health 2005 1,526

Percent Limitations Due to Health 2005 18%


SRC Corp.


Chart A.13 Gates County Adult Health Status Indicators (continued)

Indicator Value

Overweight or Obese 2005 5,256

Percent Overweight or Obese 2005 62%

No Exercise in Past 30 Days 2005 2,204

Percent No Exercise in Past 30 Days 2005 26%

Less Than Five Servings Per Day of Fruits and Vegetables 2005 6,358

Percent Less Than Five Servings Per Day of Fruits and Vegetables 2005 75%

Smoke 2005 1,950

Percent Smoke 200523%

Risk for Binge Drinking 2005 1,102

Percent Risk for Binge Drinking 200513%


SRC Corp.


Chart A.14 Gates County Adult Health Status Indicators (continued)

Indicator Value

Diabetes (Told by Doctor) 2005 839

Percent Diabetes (Told by Doctor) 200510%

High Blood Pressure (Told by Doctor) 2005 2,560

Percent High Blood Pressure (Told by Doctor) 200530%

High Cholesterol (Told by Doctor) 2005 2,357

Percent High Cholesterol (Told by Doctor) 200528%

Asthma (Told by Doctor) 2005 1,119

Percent Asthma (Told by Doctor) 200513%

Arthritis (Told by Doctor) 2005 2,543

Percent Arthritis (Told by Doctor) 200530%


SRC Corp.


Appendix B. Table of ChartsPart 1 Health Demographic Indictors• Chart 1.1 Population Change 2000-2011 (Slide 14)• Chart 1.2 Population by Age 2005 (Slide 15)• Chart 1.3 Population by Race & Ethnicity 2005 (Slide 16)• Chart 1.4 Adult Population by Education Status 2005 (Slide 17)• Chart 1.5 Population by Income Status 2005 (Slide 18)

Part 2 Community Survey• Chart 2.1 Top Local Health Concerns from Community Survey

(Slide 20)• Chart 2.2 Top Local Health Concerns from Community Survey

Cont. (Slide 21)• Cart 2.3 Immediate & Significant Local Health Concerns from

Community Survey (Slide 22)• Chart 2.4 Immediate & Significant Local Health Concerns from

Community Survey Cont. (Slide 23)• Chart 2.5 Emerging Local Concerns from Community Survey

(Slide 24)• Chart 2.6 Emerging Local Concerns from Community Survey

Cont. (Slide 25)

Part 3 Mortality Indicators• Chart 3.1 Leading Causes of Death (Slide 27)• Chart 3.2 Leading Causes of Death Cont. (Slide 28)• Chart 3.3 Leading Causes of Death Cont. (Slide 29)• Chart 3.4 Leading Causes of Death Cont. (Slide 30)

Part 4 Birth Indicators• Chart 4.1 Total Pregnancies (Slide 32)• Chart 4.2 Low Birth Weight and Late Prenatal Care Births (Slide

33)• Chart 4.3 Non-marital Births (Slide 34)• Chart 4.4 Teen Pregnancies (Slide 35)

Part 5 Adult Health Status Estimates• Chart 5.1 Adult Health Limitation Estimates (Slide 38)• Chart 5.2 Adult Overweight, Obesity, and Nutrition Estimates

(Slide 39)• Chart 5.3 Adult Smoking and Alcohol Consumption Estimates

(Slide 40)• Chart 5.4 Adult Chronic Disease Estimates (Slide 41)

Part 6 Health Care Access Indicators• Chart 6.1 Uninsured Estimates (Slide 43)• Chart 6.2 Adult Health Care Access Estimates (Slide 44)• Chart 6.3 Uninsured Area Designations (Slide 45)• Chart 6.4 Ambulatory Care Sensitive Condition Discharges (Slide

46)• Chart 6.5 through Chart 6.8 Ambulatory Care Sensitive Condition

Discharges (Slides 47-51)• Chart 6.9 Ambulatory Care Sensitive Condition Discharges:

Psychosis (Slide 52)

Appendix A: Gates County, NC Indicators• Chart A.1 Gates County Population Profile (Slide 54)• Chart A.2 Gates County Race & Ethnicity Profile (Slide 55)• Chart A.3 Gates County Age Profile (Slide 56)• Chart A.4 Gates County Educational Attainment & Economic

Profile (Slide 57)• Chart A.5 Gates County Health Care Access Profile (Slide 58)• Chart A.6 Gates County Mortality Profile (Slide 59)• Chart A.7 – Chart A.8 Gates County Mortality Profile (Slides 60-

61)• Charts A.9-Chart A.11 Gates County Birth Profile (Slides 62-64)• Chart A.12 –Chart A.14Gates County Adult Health Status

Indicators (Slides 65-67)

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