Allen County Community Health Assessment This report was supported by the Cooperative Agreement Number 5U58CD001-308-02 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of The Centers for Disease Control and Prevention.
Purdue Healthcare Advisors 1435 Win Hentschel Blvd West Lafayette, IN 47906 (765) 496-1911
1 9/27/2012
Contents EXECUTIVE SUMMARY ............................................................................................................................. 4 INTRODUCTION ....................................................................................................................................... 6 Report Organization ............................................................................................................................ 6 SOCIODEMOGRAPHIC PROFILE ................................................................................................................ 8 Population Demographics .................................................................................................................... 8 Population Characteristics ................................................................................................................... 9 Population Growth .......................................................................................................................... 9 Age Distribution............................................................................................................................. 10 Age Trends..................................................................................................................................... 10 Race and Ethnicity ......................................................................................................................... 11 Grandparents ................................................................................................................................ 14 Household Composition................................................................................................................. 15 Housing Characteristics .................................................................................................................. 16 Housing Costs ................................................................................................................................ 17 Residence Patterns ........................................................................................................................ 18 Income .......................................................................................................................................... 19 Household Income Levels .............................................................................................................. 20 Employment .................................................................................................................................. 21 Poverty .......................................................................................................................................... 22 Education ...................................................................................................................................... 23 COUNTY HEALTH RANKINGS .................................................................................................................. 24 COUNTY HEALTH PROFILE...................................................................................................................... 28 Leading Causes of Death .................................................................................................................... 28 Heart Disease .................................................................................................................................... 29 Cancer ........................................................................................................................................... 30 Chronic Lower Respiratory Diseases............................................................................................... 32 Stroke ............................................................................................................................................ 33 12
Schwamm, L., Fayad, P., Acker, J. E. et al. (2010). Translating evidence into practice: A decade of efforts by the American Heart Association/American Stroke Association to reduce death and disability due to stroke. Stroke, 41, 1051-1065 ............................................................................... 33 Kidney Disease............................................................................................................................... 34 Alzheimer ’s Disease ...................................................................................................................... 35 2
Diabetes ........................................................................................................................................ 36 Influenza and Pneumonia .............................................................................................................. 37 Risk Factors ....................................................................................................................................... 38 Diabetes ........................................................................................................................................ 39 Obesity .......................................................................................................................................... 44 Physical Activity and Nutrition ....................................................................................................... 49 Hypertension ................................................................................................................................. 55 Smoking......................................................................................................................................... 56 Substance Abuse............................................................................................................................ 59 Personal Safety .............................................................................................................................. 62 Maternal and Child Health ............................................................................................................. 63 Births ............................................................................................................................................. 64 Source: Indiana State Department of Health .................................................................................. 64 Teen Births .................................................................................................................................... 65 Low Birth Weight ........................................................................................................................... 66 HEALTHCARE ACCESS AND UTILIZATION ................................................................................................ 67 Health Insurance Coverage ................................................................................................................ 67 Professional Shortage and Medically Underserved Areas ................................................................... 68 Medicaid ........................................................................................................................................... 73 Hospital/Community Healthcare Facilities and Resources .................................................................. 74 Parkview Regional Medical Center ................................................................................................. 74 Lutheran Hospital .......................................................................................................................... 74 Ft. Wayne-Allen County Department of Health ............................................................................... 74 Neighborhood Health Clinics, Inc. ................................................................................................... 74 Utilization of Hospital Emergency Services .......................................... Error! Bookmark not defined.
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EXECUTIVE SUMMARY Overall, Allen County has a lower incidence of disease and chronic health conditions in several categories compared to the rest of Indiana. However, in some instances, the mortality rate and incidence for health conditions are higher in Allen County compared to the state. There are also some health disparities identified for Allen County. This Community Health Assessment is organized into two sections: (1) Sociodemographic Profile, and (2) County Health Profile. Current Health Trends and Issues
Population Growth. Allen County has had consistent population growth since 1960. In the last decade, the population increased by 7.1%, while the population in Indiana increased by 6.6%. The fastest growing age group in Allen County in the last decade was residents 45 – 64 years of age (27.6%). Growth in Minority Populations. The Hispanic/Latino population in Allen County grew from 4.2% of the total population in 2000 to 6.5% of the population in 2010. The proportions of Blacks, American Indians, and Asians also increased during this time period. Housing. Of the 5,047 grandparents living with their own grandchildren less than 18 years of age in Allen County, 47.3% were responsible for their caretaking. In 2010, of the 135,807 households, 33.8% were non-family households, and 29% of residents rented their residence. Income. From 2000 to 2010, the per capita income for residents of Allen County decreased from $36,938 to $34,088. Unemployment Rate. The Allen County 2011 annual average unemployment rate (9.1%) was higher than Indiana’s rate (9.0%), and ranks 45th out of the 92 counties. Poverty. Over the past decade, the percentage of the population living in poverty increased from 9.1% to 12.3% in Allen County, and increased from 9.5% to 13.5% in Indiana. Educational Attainment. Of the adult population in Allen County, 32% earned a high school degree (or the equivalent), and 57% have at least some college education. Cause of Death. According to the Indiana State Department of Health, the major causes of death in Allen County in 2010 were: 1) cardiovascular diseases (863 deaths), 2) cancer (636 deaths), 3) all other diseases (422 deaths), 4) chronic lower respiratory diseases (198 deaths), and 5) stroke (139 deaths). Cardiovascular Disease. Age-adjusted rates of death due to other diseases of the heart, hypertensive heart disease, and essential hypertension are higher in Allen County than the Indiana rates. In Allen County, the numbers of deaths from diseases of the heart, other diseases of the heart, stroke, hypertensive heart disease, and atherosclerosis are notably higher for females than males.
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Cancer. With an age-adjusted rate of 178.16, Allen County has a lower cancer mortality rate than Indiana (190.16). Allen County rates are higher than the state rates for breast cancer, urinary tract cancer, prostate cancer, cervical/ovarian cancer, and leukemia. Allen County rates are lower than the state rates for lung cancer, other malignant neoplasms, colon cancer, pancreatic cancer, Non-Hodgkin’s Lymphoma, and stomach cancer. Diabetes. County-level CDC estimates of diagnosed diabetes among adults 20 years of age or older in Allen County, using an age-adjusted percentage, show an increasing trend of diagnosed diabetes from 7.1% in 2004 to 9.9% in 2009. This rate is higher than the state rate of 9.1%. In addition, Allen County currently has a higher mortality rate for diabetes than Indiana. Obesity. Overweight is defined as having a BMI ranging from 25.0 to 29.9, and obese is defined as having a BMI greater than or equal to 30.0. A trend of increasing overweight from 24.7% in 2004 to 32.8% in 2009 is noted in Allen County among adults > 20 years of age. Sedentary Lifestyle. According to the CDC, National Diabetes Surveillance System, in 2009, one quarter of Allen County residents (25.3%) did not engage in any leisurely physical activity and were considered to have a sedentary lifestyle. In 2004, the rate was 23.0%. Smoking. According to 2010 data from the Behavioral Risk Factor Surveillance System, the adult smoking rate (21.2%) is the lowest it has ever been in Indiana. Even with this improvement, Indiana continues to be a state with one of the highest rates of smoking in the nation, with the current U.S. prevalence rate for smoking being 17.3%. More than a million Hoosiers still smoke and the rate for men (23.3%) remains higher than for women (19.3%). In Allen County, the prevalence of smoking in 2008-2010 was 19.4%, which was lower than the state (23.4%) but higher than the national (17.9%) rates during that time period. Clandestine Meth Labs. During the last decade, the number of meth lab seizures peaked at 22 in 2010 in Allen County. Maternal and Child Health. In 2009, 14.7% of mothers smoked during pregnancy in Allen County, compared to 18.2% in Indiana. Also, 43.6% of mothers were unmarried in Allen County, compared to 43.9% in Indiana. Healthcare Access and Utilization. In 2012, Allen County was ranked by the University of Wisconsin and Robert Wood Johnson Foundation as the 35th healthiest county of all 92 counties in Indiana. The county has several health-related facilities, including Parkview Regional Medical Center, Lutheran Hospital, the Ft. Wayne-Allen County Department of Health, and Neighborhood Health Clinics.
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INTRODUCTION Report Organization This report is organized into two sections: •
•
The Sociodemographic Profile provides information on a number of social and economic demographic indicators for Allen County using data gleaned from existing public databases. The County Health Profile provides information on the overall health of Allen County using data gleaned from existing public databases. Much of information presented in this section compares county-level data to state-level data. First, some of the leading causes of death are evaluated. Second, some key health indicators for Allen County residents are explored. Third, the current status of maternal and child health is evaluated. Finally, the status of Allen County residents’ access to healthcare is examined.
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SOCIODEMOGRAPHIC PROFILE
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SOCIODEMOGRAPHIC PROFILE Population Demographics Allen County was created on December 17, 1823, out of Delaware and Randolph counties, and formed on April 1, 1824. The county is named for Colonel John Allen, an attorney and Kentucky state senator who was killed in the War of 1812. As of the 2010 census, the Allen County population was 355,329. The county is approximately 660 square miles in size, with 541 persons per square mile, compared to the Indiana average of 182 persons per square mile. It is bordered by DeKalb, Noble, Whitley, Huntington, Allen, and Adams Counties. The county seat is Fort Wayne. In 2012, Allen County was ranked by the University of Wisconsin and the Robert Wood Johnson Foundation as the 35th healthiest county of all 92 counties in Indiana.
1
University of Wisconsin Population Health Institute. (2012). County Health Rankings 2012. Retrieved from www.countyhealthrankings.org
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Population Characteristics Population Growth Table 1 below displays population changes in Allen County over the past 50 years. The county population has steadily increased during this time. During the past decade, the population of Allen County increased by 7.1%, compared to a 6.6% increase for Indiana. In 2010, the population change was attributed to domestic migration (-320), international migration (+121), and natural increase (+655). The 2011 population estimate of Allen County was 358,327. Table 1. Allen County Population Changes, 1960–2010 Year 1960 1970 1980 1990 2000 2010
Allen 232,196 280,455 294,335 300,836 331,849 355,329
Change NA +20.8% +4.9% +2.2% +10.3% +7.1%
Indiana 4,662,498 5,193,669 5,490,224 5,544,159 6,080,485 6,483,802
Change NA +11.4% +5.7% +1.0% +9.7% +6.6%
Source: U.S. Census Bureau
Table 2. Population Changes by City/Town over 1,000 residents, 1990 – 2010
City/Town Fort Wayne New Haven Huntertown Leo-Cedarville Woodburn Monroeville Grabill
1990 173,072 9,320 1,330 NA 1,321 1,232 751
2000 205,727 12,406 1,771 2,782 1,579 1,236 1,113
2010 253,691 14,794 4,810 3,603 1,520 1,235 1,053
Change Change 1990-2010 2000-2010 # % # % +80,619 +46.6% +47,964 +23.3% +5,474 +58.7% +2,388 +19.2% +3,480 +261.7% +3,039 +171.6% NA NA +821 +29.5% +199 +15.1% -59 -0.0% +3 +0.2% -1 -0.0% +302 +40.2% -60 -0.1%
Source: STATS Indiana
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Age Distribution In 2010, 37.5% of Allen County’s population was 45 years old and older, as compared to 39.5% in Indiana. Approximately 27.0% of Allen County’s 2010 population was younger than 18 years of age, as compared to 24.8% in Indiana. According to the US Census Bureau, the median age in Allen County increased from 34.1 years of age in 2000 to 35.3 years in 2010. Figure 1. Population by Age Group, 2010 35.0% 30.0% 25.0% 20.0% Allen 15.0%
Indiana
10.0% 5.0% 0.0% 0 - 4 yrs
5 - 17 yrs
18 - 24 yrs
25 - 44 yrs
45-64 yrs
65+ yrs
Source: U.S. Census Bureau
Age Trends From 2000 to 2010, the population under 45 years of age slightly decreased by 0.3%, while the population 45 years of age and older increased by 22.0%. Table 3. Allen County Residents’ Age Distribution, 2000 and 2010 Age 0-4 years 5-17 years 18-24 years 25-44 years 45-64 years 65+ years
2000 25,440 66,511 31,193 99,507 71,438 37,760
2010 26,524 69,434 33,491 92,609 91,134 42,137
Change +4.3% +4.4% +7.4% -6.9% +27.6% +11.6%
Source: U.S. Census Bureau
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Race and Ethnicity A detailed description of Allen County’s population by race/ethnicity can be seen in Tables 4-7. According to the U.S. Census Bureau, in 2010 Whites accounted for 79.3% of Allen County’s population followed by Blacks (11.7%), Asians (2.7%), and American Indians (0.4%). Of note, is that 10,455 individuals or 2.9% of the population of Allen County is some other race, undefined by the U.S. Census Bureau. Additionally, the Hispanic or Latino population comprises 6.5% of the total population in Allen County, with Mexican accounting for 5.0% of that 6.5%. Table 4. Population Totals for Allen County by Race, 2000 and 2010 Race One Race White Black or African American American Indian and Alaskan Native Asian Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Native Hawaiian and Other Pacific Islander Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander Some Other Race Two or More Races White and American Indian or Alaskan Native White and Asian White and Black or African American White and Some Other Race
2000 325,903 275,697 37,527 1,187 4,652 1,054 541 389 189 306 871 1,302 124 36 35 27 26 6,716 5,946 NA NA NA NA
Percent (%) 98.2 83.1 11.3 0.4 1.4 0.3 0.2 0.1 0.1 0.1 0.3 0.4 0.0 0.0 0.0 0.0 0.0 2.0 1.8 NA NA NA NA
2010 344,882 281,653 41,618 1,246 9,721 1,560 730 679 183 397 1,014 5,158 189 61 71 15 42 10,455 10,447 1,283 1,185 4,771 1,415
Percent (%) 97.1 79.3 11.7 0.4 2.7 0.4 0.2 0.2 0.1 0.1 0.3 1.5 0.1 0.0 0.0 0.0 0.0 2.9 2.9 0.4 0.3 1.3 0.4
Change +5.8% +2.2% +10.9% +5.0% +109.0% +48.0% +34.9% +74.6% -3.2% +29.7% +16.4% +296.2% +52.4% +69.4% +102.9% -44.4% +61.5% +55.7% +75.7% NA NA NA NA
Source: U.S. Census Bureau
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Table 5. Race alone or in combination with one or more other races, 2000 and 2010 Race
2000
White Black or African American American Indian and Alaskan Native Asian Native Hawaiian and Other Pacific Islander Some Other Race
280,920 40,193 2,636 5,681 267 8,472
Percent (%) 84.7 12.1 0.8 1.7 0.1 2.6
2010 291,063 47,666 3,335 11,438 454 12,575
Percent (%) 81.9 13.4 0.9 3.2 0.1 3.5
Change +3.6% +18.6% +26.5% +101.3% +70.0% +48.4%
Source: U.S. Census Bureau
Figure 2. Race alone or in combination with one or more other races, 2010 Asian, 3.2%
Pacific Islander, 0.1% Other Race , 3.5%
American Indian, 0.9% Black, 13.4%
White, 81.9%
Source: U.S. Census Bureau
The U.S. Census data indicates that Allen County’s Hispanic/Latino population grew from 4.2% of the total population in 2000 to 6.5% in 2010. There was a slight decrease in the proportion of Whites (from 84.7% to 81.9%), and increases in the proportions of Blacks (from 12.1% to 13.4%), American Indians (from 0.8% to 0.9%), and Asians (from 1.7% to 3.2%). The proportion of Native Hawaiians in Allen County remained the same from 2000 to 2010.
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Table 6. Allen County Hispanic or Latino, 2000 and 2010 Hispanic or Latino Hispanic or Latino (of any race) Mexican Puerto Rican Cuban Other Hispanic or Latino Not Hispanic or Latino
2000 13,877 9,874 665 182 3,156 317,972
Percent (%) 4.2 3.0 0.2 0.1 1.0 95.8
2010 23,093 17,596 1,119 226 4,152 332,236
Percent Change (%) 6.5 +66.4% 5.0 +78.2% 0.3 +68.3% 0.1 +24.2% 1.2 +31.6% 93.5 +4.5%
Source: U.S. Census Bureau
Table 7. Allen County Hispanic or Latino and Race, 2000 and 2010 Hispanic or Latino and Race Hispanic or Latino White alone Black or African American alone American Indian and Alaskan Native alone Asian alone Native Hawaiian and Other Pacific Islander alone Some Other Race alone Two or More Races Not Hispanic or Latino White alone Black or African American alone American Indian and Alaska Native alone Asian alone Native Hawaiian and Other Pacific Islander alone Some Other Race alone Two or More Races
2000 13,877 NA NA NA NA NA
Percent (%) 4.2 NA NA NA NA NA
2010
Percent Change (%) 6.5 +66.4% 2.8 NA 0.2 NA 0.1 NA 0.0 NA 0.0 NA
23,093 9,864 620 259 110 70
NA NA 317,972 269,732 NA NA NA NA
NA NA 95.8 81.3 NA NA NA NA
9,798 2,372 332,236 271,789 40,998 987 9,611 119
2.8 0.7 93.5 76.5 11.5 0.3 2.7 0.0
NA NA +4.5% +0.8% NA NA NA NA
NA NA
NA NA
657 8,075
0.2 2.3
NA NA
Source: U.S. Census Bureau
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Grandparents Based on the U.S. Census Bureau’s American Community Survey, in 2010, 5,047 grandparents in Allen County were living with their own grandchildren under the age of 18. A total of 2,387 (47.3%) of the 5,047 who were living with their grandchildren were responsible for their caretaking. Of these grandparents, 1,544 (64.7%) were female and 1,552 (65.0%) were married.
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Household Composition The U.S. Census Bureau’s American Community Survey indicated that the average household size for Allen County residents was 2.55 persons in 2010. Allen County had a total of 135,807 households. Family households accounted for 66.2% of all households in Allen County. Married-couple families comprised 49.5% of all households. Nonfamily households made up 33.8% of all households in Allen County. A householder living alone comprised 28.1% of all households. Figure 3. Types of Households in Allen County, 2006-2010 Married-Couple Families
Male Householder, no wife present, family
Female Householder, no husband present, family
Nonfamily Households 0%
20%
40%
60%
80%
100%
Source: American Community Survey
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Housing Characteristics During the period of 2006-2010, Allen County had a total of 151,557 housing units, 10.4% of which were vacant. Of the total housing units, 74.8% were single-unit structures, 21.4% were multi-unit structures, and 3.8% were mobile homes. Of the total housing units, 24.8% have been built in the county since 1990. Figure 4. Types of Housing Units in Allen County, 2006-2010 Single-Unit Structure
Multi-Unit Structure
Mobile Home 0%
20%
40%
60%
80%
100%
Source: American Community Survey
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Housing Costs For the period of 2006 to 2010, the median monthly housing cost was $1,080 for mortgaged owners, $344 for nonmortgage owners, and $629 for renters in Allen County. Twenty-three percent of owners with mortgages, 8.0% of owners without mortgages, and 41.9% of renters in Allen County spent 30% or more of household income on housing. Fifty-one percent of residents have a home mortgage, 20% own their home without a mortgage burden, and 29% rent their residence. Figure 5. Occupants with a Housing Cost Burden in Allen County, 2006-2010 Owners With Mortgage
Owners Without Mortgage
Renters 0%
20%
40%
60%
80%
100%
Source: American Community Survey
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Residence Patterns Between 2006 and 2010, 13.7% of the population moved within/to Allen County. Specifically, 10.0% moved between residences in Allen County, 1.4% moved from another county in Indiana, 1.9% moved from another state, and 0.4% (1,227 individuals) moved from abroad. Figure 6. Residence patterns in Allen County, 2006-2010 Same House Different House, Same County Different House, Different IN County Different House, Different US State Abroad 0%
20%
40%
60%
80%
100%
Source: American Community Survey
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Income According to 2010 figures from the US Census Bureau, Allen County’s median income was $47,014, compared to the state’s median income of $44,616. This represents a 6.0% increase in median income in Allen County from 2000 to 2010. As displayed in Figure 7, per capita income increased from 1980 to 2000, but decreased between 2000 and 2010 (from $36,938 to $34,088). As shown in Table 8, for all levels of education, increasing income is noted with increasing levels of education, and differences in median income are noted between males and females in Allen County. Figure 7. Allen County, Per Capita Personal Income, 1980-2010 (Adjusted for Inflation) $40,000 $35,000 $30,000 $25,000 $20,000 $15,000
$10,000 $5,000 $0 1980
1990
2000
2010
Source: STATS Indiana
Table 8. Median Earnings by Educational Attainment for 25 Years of Age and Over (In 2010 Inflation-Adjusted Dollars) Education Attainment Less than High School Graduate High School Graduate (or equivalent) Some College or Associate’s Degree Bachelor’s Degree Graduate or Professional Degree OVERALL MEDIAN
Total $20,929 $28,638 $32,411 $45,627 $57,889 $34,587
Male $22,051 $34,817 $40,357 $52,498 $71,355 $40,545
Female $19,287 $22,685 $27,433 $36,274 $51,995 $28,805
Source: American Community Survey
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Household Income Levels The 2010 American Community Survey data indicated that the largest percentage of household incomes (21.0%) for Allen County fell between $50,000 and $74,999. Eighty-two percent of Allen County households received earnings and wages, 25% received Social Security income, and 17% received retirement income. Figure 8. Household Income Levels, 2010 25% 20% 15% 10% 5%
0%
Source: American Community Survey
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Employment Research demonstrates that socioeconomic status in general, and income in particular, are predictors of health status.3 Such research also demonstrates that while loss of income has an impact on health status, persistent poverty is an even stronger predictor of health status in lowincome individuals.4 In 2011, the Allen County total labor force was estimated at 179,007, of which 16,254 were unemployed. The Allen County 2011 annual average unemployment rate (9.1%) was higher than Indiana’s rate (9.0%), and ranks 45th out of the 92 counties.
Figure 9. Allen County, Indiana, and U.S. Unemployment Rates, 2006-2011 (Not Seasonally Adjusted, Annual Average) 20.0% 15.0% Allen 10.0%
Indiana U.S.
5.0%
0.0% 2006
2007
2008
2009
2010
2011
Source: STATS Indiana
3
Lantz, P. M., House, J. S., Lepowski, J. M., Williams, D. R., Mero, R.P., & Chen J. (1998). Socioeconomic factors, health behaviors, and mortality. Journal of the American Medical Association, 279, 1703–1708. 4 McDonough, P., Duncan, G. J., Williams, D. R., & House, J. S. (1997). Income dynamics and adult mortality in the US, 1972– 1999. American Journal of Public Health, 87, 1476–1483.
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Poverty The 2010 U.S. Census Bureau’s American Community Survey data indicate that 12.3% of Allen County’s total population was living below the federal poverty guidelines, compared to 13.5% for Indiana. Included in the Allen County population living below the poverty level is 17.0% of individuals under 18 years of age, 5.8% of individuals 65 years of age and over, and 9.1% of all families. Of all households in Allen County, 9.5% had received Food Stamp/SNAP Benefits in the past 12 months. Table 9. Estimates of Persons and Youth in Poverty for Allen County and Indiana, 2000 & 2010 Population Individuals living in Poverty (all ages) Youth under 18 years living in Poverty Individuals ≥ 65 years living in Poverty Families living in Poverty
Allen County 2000 2010 9.1% 12.3% 12.4% 17.0% 6.4% 5.8% 6.7% 9.1%
Indiana 2000 2010 9.5% 13.5% 11.7% 18.5% 7.7% 7.7% 6.7% 9.6%
Source: American Community Survey
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Education The 2010 U.S. Census data indicate that in Allen County, 11% of adults have less than a high school diploma, 32% earned a high school degree (or the equivalent), 22% have some college education, 9% have an Associate’s degree, 18% earned a Bachelor’s degree, and 8% have a graduate or professional degree. Taken together, 57% of the adult population in Allen County has at least some college education. Figure 10. Allen County Educational Attainment Estimates by Percentage, 2010
Some School High School Graduate (or Equivalent) Some College Associate's Degree Bachelor's Degree Graduate or Professional Degree 0%
5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Source: American Community Survey
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COUNTY HEALTH RANKINGS In 2003, the Robert Wood Johnson Foundation and the University of Wisconsin Population Institute began a collaborative venture called the Mobilizing Action Toward Community Health (MATCH) project. One element of this project is the County Health Rankings.5 Using data from a myriad of governmental agencies (e.g., Centers for Disease Control and Prevention, Federal Bureau of Investigation, National Center for Education Statistics); the County Health Rankings provide standings for counties in each of the 50 states. Each year, every county is given a global health rank within their respective state that is comprised of rankings for mortality, morbidity, and four health domains: health behaviors, clinical care, social and economic factors, and physical environment (see figure below). Figure 11. County Health Rankings Model
Source: County Health Rankings model ©2010 UWPHI 5
University of Wisconsin Population Health Institute. (2010). County Health Rankings 2010. Retrieved from www.countyhealthrankings.com
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The goal of the County Health Rankings is to provide data that compels and mobilizes local and state officials to address any barriers to quality healthcare access and care for all residents. Overall, Allen County was ranked 35th in Indiana. Table 10 shows the 2012 rankings (out of Indiana’s 92 counties) for each of the health domains for Allen County. Table 10. Allen County Health Rankings, 2012 Health Outcomes Ranked 35th Mortality Morbidity
Premature Death
Ranked 28th
Poor or Fair Health
Health Behaviors Adult Smoking
Health Factors Ranked 29th Clinical Care Social and Economic Factors Uninsured High School Graduation
Physical Environment
Air Pollution – Particulate Matter Days Poor Physical Adult Primary Care Some College Air Pollution – Health Days Obesity Physicians Ozone Days Poor Mental Physical Preventable Unemployment Access to Health Days Inactivity Hospital Stays Recreational Facilities Low Birth Excessive Diabetic Children in Limited Weight Drinking Screening Poverty Access to Healthy Foods Motor Mammography Inadequate Fast Food Vehicle Crash Screening Social Support Restaurants Death Rate Sexually Children in Transmitted Single-Parent Infections Households Teen Birth Violent Crime Rate Rate Ranked 50th Ranked 48th Ranked 20th Ranked 35th Ranked 41st
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Table 11. Allen County Health Rankings by Year
HEALTH OUTCOMES Mortality Morbidity HEALTH FACTORS Health Behaviors Clinical Care Social and Economic Factors Physical Environment
2010 33 29 45 39 53 10 52 88
2011 35 29 42 36 65 22 49 24
2012 35 28 50 29 48 20 35 41
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COUNTY HEALTH PROFILE
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COUNTY HEALTH PROFILE Leading Causes of Death This section details the leading causes of death for Allen County. The top five leading causes for Allen County are as follows: (1) Major Cardiovascular Diseases, (2) Cancer, (3) All Other Diseases, (4) Chronic Lower Respiratory Diseases, and (5) Stroke. This order is comparable to that for Indiana. Much of the data in this section compares Allen County’s mortality rates to those for the state of Indiana. All data presented in this section, unless otherwise noted, were captured from the Indiana State Department of Health. Unless otherwise noted, all of the mortality rates in this section are age-adjusted deaths per 100,000 people. Age-adjusted mortality rates provide rates of death while controlling for changes in the age distribution over time. Age-adjustment also affords comparison of death rates among communities with different age distributions. Table 12. Top Ten Leading Causes of Death Based on Total Number of Deaths in Allen County Rank
Cause of Death
1
Major Cardiovascular Diseases Cancer All Other Diseases Chronic Lower Respiratory Diseases Stroke Alzheimer’s Disease Kidney Disease All Other and Unspecified Accidents and Adverse Effects Diabetes Influenza and Pneumonia
2 3 4 5 6 7 8
9 10
Indiana Age-Adjusted Rates 255.11
Allen AgeAdjusted Rates 237.74
Allen No. of Deaths 863
190.16 134.10 55.19
178.16 115.24 56.14
636 422 198
43.32 26.75 20.93 29.19
38.24 30.32 31.38 28.55
139 113 112 104
23.98 17.03
28.47 11.85
99 44
Source: 2009 Indiana Mortality Report, Indiana State Department of Health, Epidemiology Resource Center
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Heart Disease Heart disease is the number one cause of death for Americans and has been for the last 80 years.6 Heart disease includes congenital heart defects, coronary artery disease, high blood pressure, heart failure, and stroke.7 In 2006, heart disease accounted for approximately one out of every 2.9 deaths nationwide. Data on the mortality rate for heart disease in 2005 showed that about 2,400 Americans died daily–an estimated one death for every 37 seconds.8 Age-adjusted rates of death due to other diseases of the heart, hypertensive heart disease, and essential hypertension are higher in Allen County than the Indiana rates as demonstrated in Table 17 below. In Allen County, the numbers of deaths from diseases of the heart, other diseases of the heart, stroke, hypertensive heart disease, and atherosclerosis are notably higher for females than males. Table 13. Age-adjusted Mortality Rates for Heart Disease by Race Diagnosis
Diseases of the heart Ischemic heart diseases Other diseases of the heart Stroke Hypertensive heart disease with or without renal disease Other diseases of the circulatory system Essential hypertension and hypertensive renal disease Atherosclerosis
Indiana AgeAdjusted Rates 194.06 117.75
Allen Allen AgeNo. of Adjusted Deaths Rates 184.36 669 91.89 331
All
White Male Female All
Black Male Female
614 307
298 172
316 135
49 20
30 12
19 8
68.94
73.17
268
245
98
147
21
13
8
43.32 7.37
38.24 19.30
139 70
115 62
50 28
65 34
20 8
6 5
14 3
7.40
7.13
26
23
15
8
2
1
1
6.57
6.72
24
22
11
11
2
2
0
3.76
1.29
5
5
1
4
0
0
0
Source: 2009 Indiana Mortality Report, Indiana State Department of Health, Epidemiology Resource Center
6
Greenlund, K. J., Giles, W. H., Keenan, N. L., et al. (2006). Heart disease and stroke mortality in the 20th century. In: J. Ward & C. Warren (Eds). Silent victories: the history and practice of public health in twentieth century America. Oxford, England: Oxford University Press. 7 Llyod-Jones, D., Adams, R. J., Brown, T. M. et al. (2010). Heart disease and stroke statistics—2010 update. A report from the American Heart Association. Circulation, 121, 1-70. 8 Cardiovascular disease statistics. (n.d.). Retrieved from http://www.americanheart.org/presenter.jhtml?identifier=4478
29
Cancer Cancer is the second leading cause of death in the United States, accounting for approximately one out of four deaths each year.9 While the 5-year relative survival rate for cancer has improved over the years, the mortality rate associated with cancer remains fairly high. With an age-adjusted rate of 178.16, Allen County has a lower cancer mortality rate than Indiana (190.16). The table below displays the most recent data available for Allen County on some of the various forms of cancer, and provides comparison to Indiana rates. Allen County rates are higher than the state rates for breast cancer, urinary tract cancer, prostate cancer, cervical/ovarian cancer, and leukemia. Allen County rates are lower than the state rates for lung cancer, other malignant neoplasms, colon cancer, pancreatic cancer, Non-Hodgkin’s Lymphoma, and stomach cancer. Table 14. Age-Adjusted Cancer Mortality Rates for Different Forms of Cancer
Type of Cancer Malignant neoplasm of the trachea, bronchus, and lung Other malignant neoplasms Malignant neoplasm of the colon, rectum and anus Malignant neoplasm of the breast Malignant neoplasm of the urinary tract Malignant neoplasm of the pancreas Malignant neoplasm of the prostate Malignant neoplasm of the cervix uteri, corpus uteri, and ovary Leukemia Non-Hodgkin’s Lymphoma Malignant neoplasm of the stomach
Indiana AgeAdjusted Rates 59.49
Allen AgeAdjusted Rates 49.57
Allen No. of Deaths
% County Cancer Deaths
176
27.7%
46.93 17.17
43.23 16.73
153 61
24.1% 9.6%
13.05 9.55 11.34 8.05 8.04
14.07 10.87 10.46 9.27 8.27
52 38 38 33 29
8.2% 6.0% 6.0% 5.2% 4.6%
6.93 6.97 2.63
6.95 6.57 2.16
25 23 8
3.9% 3.6% 1.3%
Source: 2009 Indiana Mortality Report, Indiana State Department of Health, Epidemiology Resource Center
9
American Cancer Society. (2009). Cancer Facts & Figures 2009. Atlanta: American Cancer Society.
30
Figure 12. Allen County Cancer Mortality Rates for Different Forms of Cancer 2009 Leukemia 4% Cervical/Ovarian 5%
Lymphoma 4%
Stomach 1% Lung 28%
Prostate 5%
Pancreatic 6%
Urinary Tract 6%
Breast 8% Other 24% Colon 9%
Source: 2009 Indiana Mortality Report, Indiana State Department of Health, Epidemiology Resource Center
31
Chronic Lower Respiratory Diseases Chronic lower respiratory diseases includes chronic bronchitis, asthma, emphysema, and other chronic lower respiratory diseases.10 Overall, Allen County has a slightly higher mortality rate for chronic lower respiratory diseases than Indiana as displayed in Figure 13. Figure 13. Age-adjusted Mortality Rates for Chronic Lower Respiratory Diseases, 2009 100 90 80 70 60 50 40
Allen Indiana
30 20 10 0 Source: 2009 Indiana Mortality Report, Indiana State Department of Health, Epidemiology Resource Center
10
National Center for Health Statistics. (2010). Health, United States, 2009: With Special Feature on Medical Technology. Retrieved from http://www.cdc.gov/nchs/data/hus/hus09.pdf
32
Stroke Stroke is a disease marked by blockage or bursts in arteries that are either located in or lead to the brain. Nationally, stroke is ranked third for leading cause of death and ranked first as cause of long-term disability.11 The mortality rate for stroke in the U.S. has declined due largely in part to the founding of the American Stroke Association in 1997 which has firmly advocated for and obtained increased funding for clinical research and hospitals specializing in treatment of stroke.12 In Allen County, the mortality rate for stroke is lower than Indiana’s rate. Figure 14. Age-adjusted Mortality Rates for Stroke, 2009 100 90 80 70 60 50 40
Allen Indiana
30 20 10 0 Source: 2009 Indiana Mortality Report, Indiana State Department of Health, Epidemiology Resource Center
11
American Heart Association. (2010). Stroke News Release. Retrieved from http://www.newsroom.heart.org/index.php?s=43&item=1023 Schwamm, L., Fayad, P., Acker, J. E. et al. (2010). Translating evidence into practice: A decade of efforts by the American Heart Association/American Stroke Association to reduce death and disability due to stroke. Stroke, 41, 1051-1065 12
33
Kidney Disease Allen County has a higher age-adjusted mortality rate for kidney disease than Indiana. Figure 15. Age-adjusted Mortality Rates for Kidney Disease, 2009 100
90 80 70 60 50 40
Allen Indiana
30 20 10 0 Source: 2009 Indiana Mortality Report, Indiana State Department of Health, Epidemiology Resource Center
34
Alzheimer ’s Disease Alzheimer’s disease is a progressive incurable disease characterized by memory loss and impaired intellectual functioning. Slowly, the symptoms of Alzheimer’s disease manifest, resulting in an adult’s inability to complete basic tasks and activities. 16 In 2007, Alzheimer’s disease was the sixth leading cause of death in the U.S., accounting for almost 75,000 deaths. 17 Currently, the National Institute on Aging estimates that approximately 5.1 million Americans have Alzheimer’s. Allen County has a higher age-adjusted mortality rate than Indiana. Figure 16. Age-adjusted Mortality Rates for Alzheimer’s, 2009 100 90 80 70 60 50 40
Allen Indiana
30 20 10 0 Source: 2009 Indiana Mortality Report, Indiana State Department of Health, Epidemiology Resource Center
16
Alzheimer’s Disease Education & Referral [ADER]. U.S. Department of Health and Human Services, National Institute on Aging National Institutes of Health. (2010). Alzheimer’s Disease Fact Sheet. (NIH Publication 08-6423). Washington, DC: US Government Printing Office. 17 Xu, J. Q., Kochanek, K. D., Murphy, S. L., & Tejada-Vera, B. (2010). Final data for 2007. National Vital Statistics Reports, 58(19), 1-136.
35
Diabetes Diabetes is a chronic illness marked by resistance to insulin, insulin deficits, or both and causes high blood sugar levels. The number of people diagnosed with diabetes has increased steadily over the years in the U.S.19 Nationally, the mortality rate for diabetes is 22.5. Indiana is ranked 27th in the United States for number of deaths due to diabetes. 20 Allen County has a higher age-adjusted mortality rate for diabetes than Indiana. Figure 17. Age-adjusted Mortality Rates for Diabetes, 2009 100 90 80 70 60 50 40
Allen Indiana
30 20
10 0 Source: 2009 Indiana Mortality Report, Indiana State Department of Health, Epidemiology Resource Center
19
Centers for Disease Control and Prevention. (2010). National Diabetes Surveillance System. Retrieved from http://www.cdc.gov/diabetes/statistics/index.htm 20 Kaiser Foundation. (2010). State Health Facts. Retrieved from http://www.statehealthfacts.org/comparemaptable.jsp?ind=74&cat=2
36
Influenza and Pneumonia Influenza (commonly referred to as the ―flu‖) is a respiratory illness caused by a virus. In severe cases, influenza can lead to pneumonia, an inflammatory lung disease. The mortality rate in the U.S. for influenza and pneumonia has decreased from 22.8 in 1999 to 17.5 in 2007.21 Allen County has a lower mortality rate for influenza and pneumonia than Indiana. Figure 18. Age-adjusted Mortality Rates for Influenza/Pneumonia, 2009 100 90 80 70 60 50 40
Allen Indiana
30 20 10 0 Source: 2009 Indiana Mortality Report, Indiana State Department of Health, Epidemiology Resource Center
21
Xu, J. Q., Kochanek, K. D., Murphy, S. L., & Tejada-Vera, B. (2010). Final data for 2007. National Vital Statistics Reports, 58(19), 1-136.
37
Risk Factors This section outlines the status of various factors that have been found to be predictive of or present risk for a multitude of health problems, including chronic diseases. The presence of any of these factors or a combination of these factors may negatively impact an individual’s health status. Substantial health research has suggested that decreasing or eliminating risk factors exponentially improves overall health and in many cases extends life expectancy. 22 Many of the risk factors covered in this section are health indicators being tracked as part of the national Healthy People 2020 initiative (see http://www.healthypeople.gov for more information) to improve quality of life and eliminate health disparities for Americans.
22
Danaei, G., Rimm E. B., Oza S., et al. (2010). The promise of prevention: The effects of four preventable risk factors on national life expectancy and life expectancy disparities by race and county in the United States. PLoS Medicine, 7(3). doi:10.1371/journal.pmed.1000248
38
Diabetes While diabetes is the 7th leading causes of death for Whites and the 4th leading cause of death for Blacks in Indiana, it is also a risk factor for many other physical complications and illnesses. It is estimated that 9.3% of adults, or about 450,000, in Indiana have diabetes. Additionally, an estimated 250,000 adults have undiagnosed diabetes in the state. County-level CDC estimates of diagnosed diabetes among adults 20 years of age or older in Allen County, using an age-adjusted percentage, is 9.9% (Figure 20). This rate is higher than the state rate of 9.1%. However, an increasing trend of diagnosed diabetes is noted in Allen County from 2004 to 2009 as shown in Figure 20 below. In addition, Allen County currently has a higher mortality rate for diabetes than Indiana. Figure 19. County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 Years. United States, 2009
Age-adjusted percent 0 - 6.3 6.4 - 7.5 7.6 - 8.8 8.9 - 10.5 > 10.6 Source: Centers for Disease Control and Prevention
39
Figure 20. Estimates of Diagnosed Diabetes among Adults aged ≥ 20 in Allen County, 20042009* 12
10
8
6
4
2
0 2004
2005
2006
2007
2008
2009
Source: Centers for Disease Control and Prevention *Graph displays midpoint of range reported for CDC estimates
Figure 21. 2004 Age-Adjusted Estimates of the Percentage of Adults with Diagnosed Diabetes in Indiana
Source: Centers for Disease Control and Prevention
40
Figure 22. 2005 Age-Adjusted Estimates of the Percentage of Adults with Diagnosed Diabetes in Indiana
Source: Centers for Disease Control and Prevention
Figure 23. 2006 Age-Adjusted Estimates of the Percentage of Adults with Diagnosed Diabetes in Indiana
Source: Centers for Disease Control and Prevention
41
Figure 24. 2007 Age-Adjusted Estimates of the Percentage of Adults with Diagnosed Diabetes in Indiana
Source: Centers for Disease Control and Prevention
Figure 25. 2008 Age-Adjusted Estimates of the Percentage of Adults with Diagnosed Diabetes in Indiana
Source: Centers for Disease Control and Prevention
42
Figure 26. 2009 Age-Adjusted Estimates of the Percentage of Adults with Diagnosed Diabetes in Indiana
Source: Centers for Disease Control and Prevention
43
Obesity Obesity is a risk factor that has gained a great deal of public attention in the last decade, and is one of the key initiatives for 2020 set forth by the U.S. Surgeon General. 23 It has been estimated that the percentage of obese adults in the United States has more than doubled in the last twenty years from 13.4% in 1980 to 34.3% in 2008. 24 The percentage of obese children has followed a similar trend; it rose from 5% in 1980 to 17% in 2008. 25 Figure 27 shows the county level estimates of obese adults aged 20 and older in 2008. Normal weight is defined as having a body mass index (BMI) ranging from 18.5 to 24.9. Overweight is defined as having BMI ranging from 25.0 to 29.9 and obese is defined as having BMI greater than or equal to 30.0. A gradual trend of increasing overweight from 24.7% in 2004 to 32.8% in 2009 is noted in Allen County as demonstrated in Figure 28. Figure 27. County-level Estimates of Obesity among Adults aged ≥ 20, United States, 2009.
Age-adjusted percent 0 - 27.2 27.3 - 29.1 29.2 - 31.1 > 31.2 Source: Centers for Disease Control and Prevention 23
U.S. Department of Health and Human Services. (2010). The Surgeon General’s Vision for a Healthy and Fit Nation. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General. 24 Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among US adults, 1999-2008. Journal of the American Medical Association, 303, 235-241. 25 Ogden, C. L., Carroll, M. D., Curtin, L. R., Lamb, M. M., & Flegal, K. M. (2010). Prevalence of high body mass index in US children and adolescents, 2007-2008. Journal of the American Medical Association, 303, 242-249.
44
Figure 28. Estimates of Obesity among Adults aged ≥ 20 in Allen County, 2004-2009* 40 35 30 25
Normal Range
20 15 10 5 0 2004
2005
2006
2007
2008
2009
Source: Centers for Disease Control and Prevention *Graph displays midpoint of range reported for CDC estimates
Figure 29. 2004 Age-Adjusted Estimates of the Percentage of Adults Who Are Obese in Indiana
Source: Centers for Disease Control and Prevention
45
Figure 30. 2005 Age-Adjusted Estimates of the Percentage of Adults Who Are Obese in Indiana
Source: Centers for Disease Control and Prevention
Figure 31. 2006 Age-Adjusted Estimates of the Percentage of Adults Who Are Obese in Indiana
Source: Centers for Disease Control and Prevention
46
Figure 32. 2007 Age-Adjusted Estimates of the Percentage of Adults Who Are Obese in Indiana
Source: Centers for Disease Control and Prevention
Figure 33. 2008 Age-Adjusted Estimates of the Percentage of Adults Who Are Obese in Indiana
Source: Centers for Disease Control and Prevention
47
Figure 34. 2009 Age-Adjusted Estimates of the Percentage of Adults Who Are Obese in Indiana
Source: Centers for Disease Control and Prevention
48
Physical Activity and Nutrition Physical activity and proper nutrition are essential to maintaining healthy weight and preventing disease. Physical inactivity and poor nutrition present significant risk for development of many chronic diseases such as heart disease, obesity, diabetes and cancer. Adults who are active are healthier, and are significantly less likely to develop these chronic diseases, and will have better aerobic fitness than adults who are inactive. Adults need to do two types of physical activity (aerobic and muscle-strengthening activities) each week to improve their individual health. According to the CDC, National Diabetes Surveillance System, in 2009, one quarter of Allen County residents (25.3%) did not engage in any leisurely physical activity and were considered to have a sedentary lifestyle. Figures 35 and 36 below display the number of adults with a sedentary lifestyle in the U.S., Indiana and Allen County. The trend for 2004 – 2009 is also presented below. Figure 35. Percentage of Adults with Sedentary Lifestyle, United States, 2009
Age-adjusted percent 0 - 19.9 20.0 - 24.1 24.2 - 27.9 28.0 - 32.5 > 32.6 Source: Centers for Disease Control and Prevention
49
Figure 36. Percentage of Adults with Sedentary Lifestyle in Allen County, 2004- 2009* 40 35 30 25
20 15 10 5 0 2004
2005
2006
2007
2008
2009
Source: Centers for Disease Control and Prevention *Graph displays midpoint of range reported for CDC estimates
Figure 37. 2004 Age-Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive in Indiana
Source: Centers for Disease Control and Prevention
50
Figure 38. 2005 Age-Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive in Indiana
Source: Centers for Disease Control and Prevention
Figure 39. 2006 Age-Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive in Indiana
Source: Centers for Disease Control and Prevention
51
Figure 40. 2007 Age-Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive in Indiana
Source: Centers for Disease Control and Prevention
Figure 41. 2008 Age-Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive in Indiana
Source: Centers for Disease Control and Prevention
52
Figure 42. 2009 Age-Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive in Indiana
Source: Centers for Disease Control and Prevention
53
In 2010, the CDC released a state level report entitled, “State Indicator Report on Physical Activity, 2010 Policy and Environmental Indicators.” Results for Indiana and the U.S. are provided below. At this time county-level data is not available. Table 15. Policy and Environmental Indicators for Physical Activity, Indiana and U.S., 2010 Create or Enhance Access to Places For Physical Activity % youth w/parks, community centers, sidewalks in neighborhood
Indiana U.S.
43.7% 50.0%
% census blocks w/fitness center within ½ mile of boundary
% census blocks w/park within ½ mile of boundary
15.2% 20.3%
13.3% 16.6%
Enhance PE and Physical Activity in Schools and Physical Activity in Child Care Settings Require or recommend elementary schools provide scheduled recess
Require elem., middle, high schools to teach PE
% middle and high schools that support walking or biking to and from school
Child care centers specific Physical Activity
No 20 states
Yes 37 states
N/A 46 states
No 8 states
Support Urban Design, Land Use and Transportation Policies
Indiana U.S.
Develop Physical Activity Public Health Workforce
Communityscale urban design/land use policy
Street-scale urban design/land use policy
Transportation and travel policy
Number of states physical activity full-time equivalent personnel
No 27 states
No 23 states
No 36 states
No 1 state
Source: CDC Physical Activity State Indicator Report
54
Hypertension Hypertension or high blood pressure is a well-documented risk factor for heart disease, stroke, and many chronic illnesses. Furthermore, there are a host of risk factors for hypertension (e.g., smoking, obesity, poor nutrition). Figure 43 shows comparable percentages of adults with hypertension in Allen County, Indiana, and the U.S. The percentage in Allen County (29.4%) is higher than the state (28.5%) and the national (27.3%) percentages. Figure 43. Percentage of Adults with Hypertension, Allen County, Indiana, U.S. 2005-2009 100 90 80 70 60
Allen
50
Indiana
40
U.S.
30 20 10 0 Source: Centers for Disease Control and Prevention (BRFSS) & Health Indicators Warehouse
55
Smoking Tobacco use is the single most preventable cause of death and disease in the United States. Annually, tobacco use causes more deaths than alcohol, AIDS, car accidents, illegal drugs, murders and suicides, combined. The American Cancer Society has estimated that approximately 170,000 cancer-related deaths are attributable to tobacco use. 26 Not only is smoking a risk factor for cancer, but it is also linked to many other chronic and potentially fatal illnesses. In Indiana, the impact of tobacco on Indiana is the loss of 9,700 lives each year. According to 2010 data from the Behavioral Risk Factor Surveillance System, the adult smoking rate (21.2%) is the lowest it has ever been in Indiana. Even with this improvement, Indiana continues to be a state with one of the highest rates of smoking in the nation, with the current U.S. prevalence rate for smoking being 17.3%. More than a million Hoosiers still smoke and the rate for men (23.3%) remains higher than for women (19.3%). In Allen County, the prevalence of smoking in 2008-2010 was 19.4%, which was lower than the state (23.4%) but higher than the national (17.9%) rates during that time period. Figure 44. Percentage of Adult Smokers in Allen County, Indiana, and U.S., 2008-2010 30% 25% 20% 15%
10%
Allen
Indiana U.S.
5% 0% Source: Centers for Disease Control and Prevention (BRFSS) & Health Indicators Warehouse
26
American Cancer Society. (2009). Cancer Facts & Figures 2009. Atlanta: American Cancer Society. http://www.in.gov/isdh/tpc/files/AdultSmoking_June2010.pdf
56
ALLEN COUNTY TOBACCO FREE POLICIES Fort Wayne Smoking banned in all enclosed workplaces, including all restaurants, bars, and private clubs but exempt retail tobacco stores and designated hotel smoking rooms. New Haven Rejected county-wide ban, but requires businesses that allow smoking to post their smoking policy on exterior signage. Other Towns in Allen County Follows county-wide ban on smoking in all enclosed workplaces, including most restaurants but exempting bars/ businesses requiring patrons and employees to be age 21 or older.
57
Poor Mental Health Unlike the other risk factors discussed in this section, mental health is a mental state, not a physical indicator. Nonetheless, poor mental health can have severe physical consequences. Adults who reported that their mental health was not good (i.e., issues with stress, depression, or problems with emotions) on 14 or more days in the previous 30 days were considered to be experiencing poor mental health. The County Health Rankings provide a county level measure of ‘poor mental health days’. The estimates provided are based on responses to the question: “Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” For each county what is presented is the average number of days a county’s adult respondents report that their mental health was not good. The measure is then age-adjusted to the 2000 U.S. population. For 2012, in Allen County the reported number of unhealthy days was 3.2 days per month. The range in Indiana was 1.5 to 7.1 days per month, with an overall measure for Indiana of 3.6 days per month.
Source: University of Wisconsin, County Health Rankings
58
Substance Abuse For children, ‘family’ is the most important influence in shaping their lives. For children growing up in homes where there is substance abuse, attending schools without effective non-drug use policies and growing up in communities where drug use is not well controlled, there is a tremendous impact on their health, safety and well-being. Variables associated with elevated risk for substance abuse are presented below, including tobacco, alcohol, and clandestine meth labs. Of note is that data on prescription drug abuse is not included in this report and may be further considered when evaluating the issue of substance abuse. Table 16. Tobacco Outlet Density and Annual Spending on Tobacco, 2009-2010
Allen County Indiana U.S.
Outlets Per 1,000 People
Outlets Per 1,000 Youth 10-17 Years
0.67 0.77 ---
5.95 7.06 ---
Annual Spending Per Household on Tobacco $313 $324 $343
Source: Indiana Prevention Resource Center
Figure 45. Map of Vulnerable* Youth, Ages 10-17, 2010
*The youth most vulnerable to sales of tobacco underage are considered to be 10-17.
59
This next indicator is defined as the number of alcohol sales outlets in relation to the total population. The following table shows the number of alcohol licenses; the number of licenses per 1000 18-20 year olds; and the rank of Allen County among Indiana's 92 counties for these two variables; plus comparisons to the state. Table 17. Alcohol Sales Outlets Per Capita in Allen County and Indiana, 2009-2010
Allen County Indiana U.S.
Number of Licenses
Licenses Per 1000 18-20 Year Olds
Rank Licenses Per 1000 18-20 Year Olds
Annual Alcohol Spending Per Household
696 13,812 ---
48.79 51.68 ---
67 ----
$572 $578 $642
Source: Indiana Prevention Resource Center
Methamphetamine is a drug that is highly addictive and physically damaging to the human body. However it is very simple to make and can be made in very clandestine settings in any community. Therefore, the prevalence of clandestine meth labs in Allen County is one indicator of substance abuse as an issue in the county. Figure 46 displays the number of clandestine lab seizures in Allen County and Indiana over the past decade. Figures 47 and 48 below compare the prevalence of clandestine meth labs in Allen County to other Indiana counties. Figure 46. Clandestine Meth Lab Seizures in Allen County and Indiana 1600 1400 1200 1000
Indiana
800
Allen 600 400 200 0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Source: Indiana Prevention Resource Center
60
Figure 47. Total Lab busts in 2009
Figure 48. Total Lab Busts in 2009
61
Personal Safety People prefer to live and work in geographic locations where they feel safe. The degree of criminal activity in every county has a significant influence on many aspects of life. Therefore, crime statistics are a useful insight into the character of a county and are important to consider in planning for healthy environments where people can live, work and play. Data about crimes, arrests and convictions are not collected in any one central location in the state of Indiana currently. The AGS Crime Risk Index displayed below describes the risk of various types of crime in Allen County and compares the rate of crime in the county to that in the state and the U.S. A crime rate of 100 is established for all crimes for U.S. statistics. Therefore, a rate of 200 means that the risk of crime in that location is two times higher than it is for the nation as a whole. In Allen County, the Personal Crime Index and the Property Crimes rate are higher than the state rates. Murder, rape, and robbery rates are higher than the state rates, but the assault rate is lower than the state rate. Burglary, larceny, and motor vehicle theft rates are considerably higher than the state rates. Table 18. Crimes Indices for Allen County, Indiana and U.S., 2009-2010 Crime Indices Total Crime Index Personal Crime Index Property Crimes Personal Crime Index Murder Rape Robbery Assault Property Crimes Burglary Larceny Motor Vehicle Theft
Allen County 117 73 139
Indiana 93 68 97
U.S. 100 100 100
105 109 111 31
96 88 72 63
100 100 100 100
123 156 116
93 102 80
100 100 100
Source: Indiana Prevention Resource Center
62
Maternal and Child Health Maternal and child health includes prenatal, perinatal, and postnatal health characteristics and behaviors. In 2009, 33.8% of mothers residing in Allen County began prenatal care after the first trimester, which was an increase from 27.1% in 2008. About 66.2% of all mothers in Allen County, compared to 66.1% in Indiana, received prenatal care within their first trimester of pregnancy in 2009. Of the resident births in Allen County in 2009, 9.1% were low birth weight as compared to 8.3% in Indiana. Also, 10.1% of the resident births in the county in 2009 were preterm, compared to 10.1% for Indiana. Table 19. Allen County Maternal and Child Health Statistics, 2005-2009 2005
2006
2007
2008
2009
Mortality # Fetal Deaths # Infant Deaths (< 1 year) # Neonatal Deaths (< 28 days) # Post-Neonatal Deaths (28-364 days)
26 43 28 15
41 52 32 20
34 42 29 13
41 54 37 17
31 50 32 18
5,881 5,295 540 8.7% 11.4% 82.8% 15.6% 38.9%
6,100 5,492 596 9.5% 10.6% 80.5% 15.3% 40.5%
6,025 5,448 539 8.6% 11.4% 71.8% 15.0% 41.5%
6,083 5,506 583 9.4% 12.5% 72.9% 16.5% 43.0%
5,996 5,463 529 9.1% 10.1% 66.2% 14.7% 43.6%
Natality # Pregnancies # Live Births # Teen Births (ages 15-19) % Low Birth Weight (less than 2500 grams) % Preterm Births % PNC in 1st Trimester % Smoked During Pregnancy % Unmarried Mothers Source: Indiana State Department of Health
63
Births The number of resident births fluctuated from 2005 to 2009 in Allen County. In Indiana, the number of births increased between 2005 and 2007, but decreased between 2007 and 2009 (Figure 48 and Figure 49). In Allen County, 43.6% of live births in 2009 were to unmarried mothers, as compared to 38.9% five years ago. The percent of pregnant women who smoked during pregnancy in Allen County decreased from 15.6% in 2005 to 14.7% in 2009.
Figure 49. Allen Resident Births, 2005-2009
Allen 10000 8000 6000 Allen
4000 2000 0 2005
2006
2007
2008
2009
Source: Indiana State Department of Health
Figure 50. Indiana Resident Births, 2005-2009
Indiana 100000 80000 60000 Indiana
40000 20000 0 2005
2006
2007
2008
2009
Source: Indiana State Department of Health
64
Teen Births Teen births are reported as births to mothers 15 to 19 years old in Indiana. Overall, the number of teen births for Allen County has declined over the past five years. In Indiana, the number of teen births increased between 2005 and 2007, but declined between 2007 and 2009. Table 20. Teen Births for Allen County and Indiana, 2005-2009
Allen County Indiana
2005 540 9,497
2006 596 9,611
2007 539 9,931
2008 583 9,602
2009 529 9,484
Source: Indiana State Department of Health
65
Low Birth Weight Infants born less than five and a half pounds, or 2500 grams, in weight are identified as being low birth weight. The Allen County low birth weight rate fluctuated from 2005 to 2009. The Indiana rate remained nearly unchanged.
Figure 51. Percent Low Birth Weight Births for Allen County and Indiana, 2005–2009 20% 18% 16% 14% 12% Allen
10%
Indiana
8% 6% 4% 2% 0% 2005
2006
2007
2008
2009
Source: Indiana State Department of Health
66
HEALTHCARE ACCESS AND UTILIZATION Health Insurance Coverage A variety of health insurance coverage options exist, including employer-provided plans, independently-purchased plans, health savings accounts, and government-funded plans. Lack of health insurance coverage presents significant risk to those needing health care services. According to a Harvard Medical School study, approximately 45,000 adults die each year as a result of not having health insurance coverage.27 This means that an American dies every 12 minutes of every year because they have no health care insurance coverage. Based on the U.S. Census Bureau Small Area Health Insurance Estimates, in 2010, approximately 17.1% of those less than 65 years of age were uninsured in Allen County. For those under the age of 19 years, the percent uninsured was 9.6%, and for all Allen County residents 18-64 years of age, the uninsured rate was 20.5%.
27
Wilper, A. P., Woolhandler, S., Lasser, K. E., McCormick, D., Bor, D. H., & Himmelstein, D. U. (2009). Health insurance and mortality in US adults. American Journal of Public Health, 99, 1-7.
67
Professional Shortage and Medically Underserved Areas The U.S. Department of Health and Human Services (DHHS) has designated a particular branch of its organization to track health professional shortages and medically underserved areas. This branch is the Health Resources and Services Administration (HRSA). 28 HRSA determines which geographic areas, populations, and/or institutions have shortages of primary care, dental or mental healthcare providers. Using strict criteria utilizing the ratios between population and number of clinicians, HRSA determines (a) if an entity has a shortage of health professionals (Health Professional Shortage Areas; HPSA) or (b) if specific areas (Medically Underserved Areas; MUA) or populations (Medically Underserved Populations; MUP) have too few primary care providers, high poverty, high infant mortality rates, or high elderly population.29 Based on the explanation above, geographic areas are assigned a score. For MUAs, scores range from 1 to 62, where the lower the score, the higher the need. If a score is not assigned, a ‘Governor’s Exception’ may also designate a MUP. Designations that are not MUAs or MUPs, are HPSAs, where the higher the score, the higher the need. The figures below show the Medically Underserved Areas and the Primary Care, Dental, and Mental Health Professional Shortage Areas for Indiana and Allen County.
28
Wilper, A. P., Woolhandler, S., Lasser, K. E., McCormick, D., Bor, D. H., & Himmelstein, D. U. (2009). Health insurance and mortality in US adults. American Journal of Public Health, 99, 1-7. 29 Department of Health and Human Services. Health Resources and Services Administration. HPSA by State and County. Retrieved from http://bhpr.hrsa.gov/shortage/
68
Figure 52. Indiana Medically Underserved Areas and Populations, 2012
Source: ISDH and Shortage Designation Branch, HRSA, U.S. Department of Health and Human Services
69
Figure 53. Indiana Primary Care Health Professional Shortage Areas and Populations, 2012
Source: ISDH and Shortage Designation Branch, HRSA, U.S. Department of Health and Human Services
70
Figure 54. Indiana Dental Health Professional Shortage Areas and Populations, 2012
Source: ISDH and Shortage Designation Branch, HRSA, U.S. Department of Health and Human Services
71
Figure 55. Indiana Mental Health Professional Shortage Areas, 2012
Source: ISDH and Shortage Designation Branch, HRSA, U.S. Department of Health and Human Services
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Medicaid Medicaid is a federal and state-funded program enacted by Congress in 1965 that provides healthcare resources to low income families. Indiana is ranked 33rd of all states of Medicaid population in the U.S.30 It is well known that Medicaid enrollment increased greatly from December 2007 to December 2009, as a result of the national economic recession. To be completed…total Medicaid enrollment
30
Kaiser Commission on Medicaid and the Uninsured. (2010). Health Management Associates from State Medicaid Enrollment Reports. Retrieved from http://www.kff.org/medicaid/upload/8050-02.pdf
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Hospital/Community Healthcare Facilities and Resources Parkview Regional Medical Center Through physician partnerships, Parkview offers patients diagnostic imaging, laboratory tests, physician’s office visits, treatments and pharmacy services all on the same campus. With multiple points of entry, the nine-story facility features specialty centers geared toward specific healthcare needs, including heart, cancer, women’s and children’s health and orthopedics. Parkview Comprehensive Cancer Center, radiation oncology and other outpatient cancer services Parkview Outpatient Center, radiology, lab, pre-admission testing, EKG, Premier Surgery Center, physician offices Parkview Women’s & Children’s Hospital, two c-section operating rooms; ten labor/delivery/recovery rooms; two labor/delivery/recovery/postpartum rooms; four antepartum rooms; 24 post-partum rooms; 31 all-private newborn ICU rooms Parkview Ortho Hospital, a joint venture between Parkview Health and Ortho NorthEast; eight surgical suites; two surgery suites operational for telemedicine; Inpatient Rehabilitation Therapy including Occupational Therapy (OT), Physical Therapy (OT); Activities for Daily Living (ADL) training facility; Training Car; Gym for OT and PT; and Rapid Recovery Club Ortho Program, structured care pathways for joint replacement and back surgery patients. Parkview Heart Institute, cardiovascular diagnosis, care, treatment and disease prevention education; heart catheterization, diagnostic radiology, non-invasive diagnostic procedures, rehabilitation facility.
Lutheran Hospital To be completed
Ft. Wayne-Allen County Department of Health To be completed Neighborhood Health Clinics, Inc. Services Provided Clinical Services Provided Onsite: Primary Health Care Services - acute and chronic disease; Preventive Health Services; Preventive Dental Services; Restorative Dental Services; Prenatal Services; Pediatrics; Family Planning Services; Diagnostic Laboratory Services; On-site WIC; Health Education and Counseling; Nutritional Counseling; HIV Counseling; Sickle Cell Services 74
Pharmacy Services: Samples; Prescriptions, Contracted Sliding Fee Pharmacy Enrollment Services: Medicaid, HIP, Care Select
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Utilization of Hospital Emergency Services
