This project has the objective to develop preventive medicine teaching cases that will

Transcription

1 STUDENT VERSION This project has the objective to develop preventive medicine teaching cases that will motivate medical be en Community Health Assessment: Onondaga County, New York Donald A. Cibula, PhD Lloyd F. Novick, MD, MPH Kathy Kerkering, MD Modified from: Cases in Population-Oriented Prevention (C-POP) Prepared by: Donald A. Cibula, PhD Lloyd F. Novick, MD, MPH Cynthia B. Morrow, MD, MPH Sally M. Sutphen, MS, MPH

2 Abstract: Community health assessment is key to understanding the health problems and priorities of a population. This case outlines a process by which the participants can complete a health assessment of a community using indicator-based methods. Students construct a set of health indicators from a variety of domains, evaluate problems and report on the health priorities for a community. The students relate identified health issues to underlying behavioral risk factors. Recommended Reading: McGinnis AM, Foege WH. Actual Causes of Death. JAMA. 1993; 270 (18): Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289(2): Healthy People 2020 Foundation Health Measures: available online at (accessed ) Objectives: At the end of the case, the student will be able to: Perform a community health assessment Identify sources and limitations of population based data Select and appraise the utility of standards including Healthy People 2020 health indicators Identify specific health indicators to assess the health status of a community Describe the priority health issues of a community Relate priority health issues to behavioral, social, and environmental health determinants 2

3 Section A: Community Health Assessment The goal of public health is to improve the health of a population. Public health interventions such as safe water sources, immunization programs, and improved motor vehicle safety regulations account for the majority of years of life expectancy gained in the United States over the last 100 years. A community health assessment involves obtaining and interpreting information to determine the health status of a specific community. Once community health needs are identified, public health interventions can be developed and their effectiveness evaluated using a similar approach. Information necessary for performing a community health assessment, for example data on mortality rates or behavioral risk factors such as smoking, is available from various sources, most notably the internet. This case deals with assessing the health of a community. Please answer the following questions using the information that you have learned from the recommended reading. Questions: 1. How do you define community? 3

4 2. How would you assess the health of a community? 4

5 3. What stakeholders (groups/organizations) would you want to consult with? 4. What types and sources of data would you use? 5

6 Section B: Healthy People 2020 The Healthy People 2020 initiative is a national approach that identifies high priority health issues and establishes objectives to reduce the impact of these public health threats. (Please refer to the U.S. Department of Health and Human Services. Healthy People 2020 at accessed ) Questions: 1. How are Healthy People 2020 standards used? What are advantages and disadvantages to applying them at a local community level? 2. What other standards (national, state, or local) can be used? 6

7 Section C: Health Indicators For this exercise, you will use an indicator approach to develop a community health assessment. A community health assessment involves three-step feedback loop. The first step in such an assessment involves identifying important health indicators. Health indicators are measurable health outcomes, such as death rate, insurance coverage measures, immunization rates, or other data items that are relevant to the health of a community. Indicators are thoughtfully selected data points that provide useful information about the health of a community. To organize indicators, it is helpful to identify major areas of focus. For this case, we will refer to these broad categories of public health concerns as domains. Please refer to Table 1 below for examples of domains. For each domain, an example of an indicator is provided. Table 1: List of Domains to Assist Developing a Community Health Assessment Domain: Communicable Diseases (including Sexually Transmitted Diseases) Chronic Diseases (including Cancer) Injury and Violence Maternal and Child Health Environmental Health Access to Health Care Example of an Indicator: Incidence of Gonorrhea Incidence of Diabetes Homicide rate Childhood immunization rate Rates of Lead Poisoning Rates of Uninsured The second step in the assessment involves matching those indicators with available data. In the third step, standards such as those explored in Section B are applied to the data gathered in the first two steps to transform it into useful information about health needs of the population. Questions: 1. Are there any other domains of health or health-related conditions that you would include in your community assessment? 7

8 2. What criteria would you use to choose specific indicators within the listed domains? 3. How would you obtain data for your indicators? 8

9 Section D: Performing a Community Health Assessment As a consultant to the Onondaga County Health Department, you are asked to perform a community health assessment for the county. Below is information about the county, derived from the American Community Survey, , conducted by the US Census Bureau. Onondaga County is located in central New York and has an estimated population of 453,846 residents. Caucasians comprise about 84% of the County population. About 10% of residents are Black or African Americans, approximately 3% are Asians, and about 2% are multi-racial. Onondaga County contains the Onondaga Nation, and American Indians make up about 1% of the total population. The County has a growing Latino/Hispanic population, and they comprise about 3% of all residents of any race. The median family income in Onondaga County is estimated to be $65,458, higher than the national average ($62,363), but lower than the New York State average ($67,040). Nearly 13% of Onondaga County residents live in poverty, and the poverty rate for children under age five years is estimated to be about 20%. Over half (52%) of children under five years of age who live in female-headed households are in poverty. The unemployment rate for the period is estimated to be about 6%, but unemployment has spiked since 2008 and the estimates for 2009 and 2010 are about 8%. The Behavioral Risk Factor Survey System, maintained by the CDC, reports that in , between 7% and 12% of adult Onondaga County residents lacked health insurance and 10% to 19% of adults did not seek needed health care during that period because of cost. The city of Syracuse, NY, with an estimated population of 139,386 persons is the largest city in the central New York area. Syracuse residents, on average, have very different demographic, social and economic characteristics than the balance of the County s residents. In general, they are younger, poorer, more likely to be of minority racial and ethnic groups and have more health risk factors than their suburban and rural counterparts in Onondaga County. For example, about 25% of Syracuse families live in poverty, compared with 13% for the population as a whole, and 67.2% of female-headed households in Syracuse with children under age five live in poverty. Additional characteristics of Syracusans in relation to other communities within Onondaga County are provided in Table 5. Consider these factors when evaluating populations at risk and targeting resources for public health activities. You now embark on the steps needed to perform your assessment. STEP ONE: IDENTIFYING HEALTH INDICATORS As noted earlier, the first step in a community health assessment is identifying health indicators. Working with a team, develop a list of 20 indicators you would want to use in your assessment. 9

10 STEP TWO: MATCHING THE INDICATORS Now that you have chosen indicators to use for a community health assessment, use the information provided in Table 2 to match available data to your chosen indicators. In this example, residents of Onondaga County constitute the community. Question: 1. What is the comparative health status of residents of Onondaga County? STEP THREE: SETTING HEALTH PRIORITIES Using the information gathered in the first two steps, please answer the following questions.. 10

11 Questions: 1. What are the priority health issues for this population? What else would you want to know about this community? 2. How does your set of indicators compare with the Healthy People 2020 foundation measures? 3. How do your chosen priority health issues relate to behavioral, social, and environmental risk factors? For example, risk factors associated with gonorrhea include history of substance use and history of risky sexual behavior such as high number of partners or lack of condom use. 11

12 Section E: Putting It All Together You have now developed a community health assessment, compared it to a national standard list of indicators, and identified priority health issues for this community. Question: 1. Using the knowledge that you have gained during this exercise, how would you allocate resources to develop interventions to address these issues? What factors do you need to take into account when developing public health policy? Healthy People

13 Table 2: Community Health Assessment Indicators for Onondaga County (NY), Upstate New York (New York State Excluding NYC), and the United States Domain: Maternal and Child Health Indicator Onondaga Upstate New United States County York Low Birth Weight (<2,500 g) per 100 births 7.9 (a) 7.7 (a) 8.3 (d) Very Low Birth Weight (<1,500 g) per 100 births 1.8 (a) 1.4 (a) 1.5 (e) Gestational Age Less Than 37 Weeks per 100 births 12.7 (a) 11.9 (a) 12.7 (e) Infant Mortality Rate per 1,000 live births 6.6 (a) 5.6 (a) 6.9 (d) Black Infant Mortality Rate per 1,000 black live births 14.4 (b) n/a 13.3 (d) White Infant Mortality Rate per 1,000 white live births 5.0 (b) n/a 5.7 (d) Neonatal Infant Mortality Rate per 1,000 live births 5.1 (a) 4.0 (a) 4.5 (d) Postneonatal Infant Mortality Rate per 1,000 live births 1.8 (a) 1.7 (a) 2.3 (d) Maternal Mortality Rate per 100,000 live births 6.1 (a) 9.8 (a) n/a Percent of Births to Teens (10-17 years) 3.6% (a) 2.1% (a) 3.4% (d) Early (1st Trimester Prenatal Care) per 100 live births 76.7 (a) 76.4 (a) 68.3 (d) Late (3rd Trimester)/ No Prenatal Care per 100 live births 3.8 (a) 4.0 (a) 8.2 (d) Percent of Women Who Smoked During the Last Three 14.3 (c) n/a n/a Months of Pregnancy Percent of Women Who Used Illicit Drugs During 4.5% (c) n/a n/a Pregnancy Percent of Women Who Used ETOH Use During Pregnancy 1.6% (c) n/a n/a Percentage of Children Screened for Elevated Blood Lead 93.2% (a) 81.9% (a) n/a Levels by Age 2 Incidence Rate of Elevated Blood Level per 100 Children 2.0% (a) 1.3% (a) 1.2% (f) Less Than 6 Years of age (10 mcg/dl or greater) Footnotes (a) NYS County Health Assessment indicators ( ) (b) Onondaga County Health Department ( ) (c) Syracuse Regional Perinatal Data System (2008) (d) National Center for Health Statistics (2005, 2006) (e) National Vital Statistics System, (2005, 2007) (f) CDC, Childhood Lead Poisoning Prevention Program,( 2006) 13

14 Table 2 Continued: Domain: Sexually Transmitted Diseases Indicator Gonorrhea Rate per 100,000 population All ages years Chlamydia Rate per 100,000 population Males All Ages years years Females All Ages years years Onondaga County (a) (a) (a) (a) (a) (a) (a) (a) Upstate New York 65.7 (a) (a) (a) (a) (a) (a) (a) (a) United States (e) (e) (e) Early Syphilis Rate per 100,000 population 1.2 (a) 2.2 (a) 3.6 (e) Congenital Syphilis Rate per 100,000 births 0.0 (b) 9.2 (d) 10.1 (d) AIDS Rate per 100,000 population 8.4 (b) 2.3 (b) 11.9 (f) Teen Pregnancy Rate per 1,000 teens (Aged 15 to 19) 49.8 (a) 40.9 (a) n/a Percent of Teens Who Have Ever Had Sexual n/a 43.6% * (c) 47.8% (c) Intercourse Percent of Teens Who Are Currently Sexually Active (Had sexual intercourse with at least one person during the 3 months before the survey) n/a 31.1% * (c) 35.0% (c) Teen Condom Use: (Did not use a condom during n/a 33.3% * (c) 38.5% (c) last sexual intercourse, among those sexually active) Footnotes * New York State (a) NYS County Health Assessment indicators ( ) (b) Onondaga County Health Indicator Profiles ( ) (c) CDC Youth Risk Behavior Survey (2007) (d) CDC Sexually Transmitted Diseases Syphilis Profiles (2007) (e) CDC Sexually Transmitted Diseases Surveillance (2007) (f) CDC HIV/AIDS Statistics and Surveillance (2007) 14

15 Table 2 Continued: Domain: Cancer Indicator Onondaga County New York State United States Lung Cancer Male Incidence Rate per 100,000 males (a) 79.5 (a) 79.4 (f) Male Mortality Rate per 100,000 population 76.5 (a) 59.4 (a) 72.0 (f) Female Incidence Rate per 100,000 females 73.3 (a) 54.1 (a) 52.6 (f) Female Mortality Rate per 100,000 population 50.4 (a) 37.1 (a) 41.0 (f) Prevalence of Adult Current Smoking 16.3% (b) 18.2% (g) 20.1% (h) Prevalence of Teen Current Smoking Prevalence 13.0 (c) 13.8% (e) 20.0% (i) (smoked on at least 1 of past 30 days), Breast Cancer (Female) Mortality Rate per 100,000 females 24.7 (a) 24.5 (a) 25.0 (f) Female Incidence Rate per 100,000 females (a) (a) (f) Percent of Women Aged 50+ years who have had a 88.4% (d) 83.1% (d) n/a mammogram in the last 2 years Colorectal Cancer Male Incidence Rate per 100,000 males (a) 79.5 (a) 79.4 (f) Male Mortality Rate per 100,000 males 76.5 (a) 59.4 (a) 72.0 (f) Female Incidence Rate per 100,000 females 73.3 (a) 54.1 (a) 52.6 (f) Female Mortality Rate per 100,000 males 50.4 (a) 37.1 (a) 41.0 (f) Percent of Adults aged 50+ who used a home blood stool test within past 2 years 24.8% (d) 20.5% (d) n/a Percent of Adults aged 50+ who had a sigmoidoscopy or 69.9% (d) 64.6% (d) n/a colonoscopy within past 10 years* Cervical Cancer Incidence Rate per 100,000 females 6.1 (a) 8.7 (a) 8.4 (f) Mortality Rate per 100,000 females 1.9 (a) 2.6 (a) 2.5 (f) Percent early stage 56% (a) 50% (a) n/a Percent of Women 18+ years who have had a pap smear 89.4% (d) 82.7% (d) n/a in past 3 years Prostate Cancer Incidence Rate per 100,000 males (a) (a) (f) Mortality Rate per 100,000 males 23.2 (a) 24.4 (a) 26.7 (f) Percent early stage 88% (a) 87% (a) n/a Percent of men 40+ who have had a PSA test in past % (d) 59.8% (d) n/a years Footnotes (a) NYS Cancer Registry, ( ) (b) Onondaga County Community Tobacco Survey (2008) (c) Search Institute Data for grades 8, 10, 12 in Onondaga County (2005) (d) New York State Expanded Behavioral Risk Factor Surveillance System Final Report ( ) (e) New York State Youth Risk Behavior Data (2007) (f) National Cancer Institute: Surveillance, Epidemiology, and End Results (SEER) Program ( ) (g) CDC BRFSS (2006) (h) CDC NHIS (2006) (i) CDC YRBS (2007) 15

16 Table 2 Continued: Domain: Chronic Diseases Indicator Onondaga County Upstate New York United States Heart Disease Mortality Rate per 100,000 population (a) (a) (b) Hospitalization Rate per 10,000 population 96.8 (a) (a) (c) Stroke Mortality Rate per 100,000 population 40.9 (a) 35.1 (a) 43.6 (b) Hospitalization Rate per 10,000 population 25.0 (a) 26.7 (a) 29.8 (c) Cirrhosis Mortality Rate per 100,000 population 7.3 (a) 6.5 (a) 8.8 (b) Hospitalization Rate per 10,000 population 2.3 (a) 2.5 (a) n/a Diabetes Mortality Rate per 100,000 population 19.8 (a) 17.2 (a) 23.3 (b) Hospitalization Rate per 10,000 population 12.6 (a) 14.3 (a) 19.6 (c) (primary dx) COPD Mortality Rate per 100,000 population 43.7 (a) 39.5 (a) 40.5 (b) Hospitalization Rate per 10,000 population 21.1 (a) 29.5 (a) n/a High Blood Pressure: "Have you ever been told by a health professional that you have high blood pressure?" 26.1% yes (d) 25.7% yes (d)* 27.8% yes (e) Asthma Hospitalizations per 10,000 population 8.5 (a) 12.2 (a) 14.9 (c) Overweight or Obesity Among Adults 55.5% (d) 59.3% (d)* 63.2% (e) Physical Activity: "During the past month, did you participate in any physical activity?" 79.7% yes (d) 76.3% yes (d)* 75.4% yes (e) 16

17 Table 2 Continued: Domain: Chronic Diseases Indicator Heavy Drinking in the Past Month Among Adults (defined as more than 2 drinks per day for men, and more than one drink per day for women) Onondaga Upstate New United States County York 7.5% yes (d) 5.0% yes (d)* 5.1% yes (e) Footnotes * New York State (a) NYSDOH, County Health Indicator Profiles ( ), Age-adjusted (b) National Center for Health Statistics, 2006, Age-adjusted (c) National Health Statistics Report: 2006 National Hospital Discharge Survey (d) New York State Expanded Behavioral Risk Factor Surveillance System, June 2008-July 2009 (e) CDC, National Behavioral Risk Factor Surveillance System,

18 Table 2 Continued: Domain: Injury and Violence Indicator Onondaga County Upstate New York Fall Injuries Hospitalization Rate per 10,000 population 35.1 (a) 36.9 (a) n/a Motor Vehicle Mortality Rate per 100,000 population 8.7 (a) 9.5 (a) 15.0 (b) United States Alcohol Related Motor Vehicle Injuries and Deaths per 100,000 population 5.1 (a) 5.6 (a) n/a Unintentional Injuries Mortality Rate per 100,000 population 34.4 (a) 27.2 (a) 39.8 (b) Hospitalization Rate per 10,000 population 57.6 (a) 66.0 (a) n/a Occupational Injury Mortality Rate per 100,000 population 2.8 (a) 2.6 (a) 3.8 (c) Hospitalization Rate per 10,000 population 13.5 (a) 19.2 (a) n/a Poisoning Mortality Rate per 100,000 population 8.0 (d) 6.7 (d)* 9.1 (b) Hospitalization Rate per 10,000 population 10.2 (a) 9.0 (a) 9.1 (e) Table 2 Continued: Domain: Injury and Violence Indicator Onondaga County Upstate New York United States Violence Mortality Rate per 100,000 population 8.0 (d) 6.7 (d)* 9.1 (b) Hospitalization Rate per 10,000 population 10.2 (a) 9.0 (a) 9.1 (e) Assault Hospitalization Rate per 10,000 population 4.2 (a) 2.8 (a) n/a Footnotes *New York State (a) NYSDOH, County Health Indicator Profiles ( ), Age-adjusted (b) National Center for Health Statistics, 2006, Age-adjusted (c) National Center for Health Statistics, 2007, Age-adjusted (d) NYSDOH, Bureau of Vital Statistics, 2007 (e) National Health Statistics Report: 2006 National Hospital Discharge Survey 18

19 Table 2 Continued: Domain: Communicable Diseases Indicator Onondaga Upstate New United States County York TB rate per 100,000 population 3.4 (a) 2.7 (a) 4.4 (b) Giardiasis rate per 100,000 population (c) 11.6 (c) 7.7 (b) Campylobacter rate per 100,000 population 12.6 (c) 13.4 (c) n/a Salmonella rate per 100,000 population 13.6 (a) 13.0 (a) 16.0 (b) Group A Streptococcus rate per 100, (c) 3.1 (c) 1.9 (b) Hepatitis A rate per 100,000 population 1.0 (a) 0.9 (a) 1.0 (b) Hepatitis B rate per 100,000 population 1.0 (a) 0.8 (a) 1.5 (b) Hepatitis C rate per 100,000 population 1.0 (c) 0.4 (c) 0.3 (b) Legionella rate per 100,000 population 4.5 (c) 3.3 (c) 0.9 (b) Lyme Disease rate per 100,000 population 2.4 (a) 40.6 (a) 9.2 (b) Pertussis rate per 100,000 population 10.4 (a) 6.9 (a) 3.5 (b) Footnotes (a) NYSDOH, County Health Indicator Profiles ( ), Age-adjusted (b) CDC, Summary of Notifiable Disease United States, 2007 (c) NYSDOH, Bureau of Communicable Disease,

20 Healthy People 2020 What Is Healthy People? Healthy People 2020 is a set of health objectives for the Nation to achieve over the second decade of this century. It can be used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health. Healthy People 2020 builds on initiatives pursued over the past three decades. The 1979 Surgeon General's Report, Healthy People, and the Healthy People 2000 and 2010 National Health Promotion and Disease Prevention Objectives established national health objectives and served as the basis for the development of State and community plans. Like its predecessors, Healthy People 2020 was developed through a broad consultation process, built on the best scientific knowledge and designed to measure programs over time. What are the Foundation Health Measures? A set of four Foundation Health Measures will be used to assess progress in promoting health, reducing the burden of disease and disability through prevention, eliminating disparities and improving quality of life. The four Foundation Health Measures are: General Health Status; Health Related Quality of Life and Well-Being; Determinants of Health; and Disparities. Each of these broad measures will be monitored using selected indicators, as shown in the Table 3 below. 20

21 Table 3: Foundation Health Measures, Healthy People 2020 Foundation Measure Sub measure Topic Sub measures 1. General Health Status Life expectancy (with international comparison) Healthy life expectancy Years of potential life lost (YPLL) (with international comparison) Life expectancy at birth Life expectancy at age 65 Expected years of life in good or better health Expected years of life free of limitation of activity Expected years of life free of selected chronic diseases Death rate for population under age 75 years Death rate for population under age 75 years by cause of death Physically and mentally unhealthy days Number of days in the past 30 days that individuals rate their physical or mental health as not good Self assessed health status Limitation of activity Chronic disease prevalence Individuals' perception of health status as excellent, very good, good, fair, or poor Self reported limitations in the following areas: Activities of daily living (such as bathing/showering, dressing, eating, walking) Instrumental activities of daily living (such as doing housework, preparing meals, shopping, managing money) Play, school, or work Remembering Any other activity that they cannot do because of limitations caused by physical, mental, or emotional problems Self reported incidence or prevalence of: Cardiovascular disease Arthritis Diabetes Asthma Cancer Chronic obstructive pulmonary disease (COPD) Source: accessed

22 Table 3 Continued: Foundation Health Measures, Healthy People 2020 Foundation Measure Sub measure Topic Sub measures Physical, mental, and social healthrelated quality of life 2. Health Related Quality of Life and Well Being Well being/satisfaction 3. Health Determinants Policymaking Participation in common activities Social and physical environmental factors Health services Individual behavior Biology and genetics Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Measure. A standardized survey tool that measures health related quality of life in the physical, mental and social domains Self assessment of aspects of life that promote satisfaction and contentment with quality of life Self assessment of impact of health on social participation, including participation in education, employment, civic, social and leisure activities Tracking and monitoring federal and state policies that promote health Measures of a variety of social and physical environmental factors that have an influence on health. Examples of social factors include school quality, crime, violence and public safety, transportation options, availability of nutritious food and degree of residential segregation. Physical factors include exposure to toxic substances or other physical hazards, walkability of neighborhoods, and condition of housing stock Measures of access to services, including availability, affordability, insurance coverage and language access. Measures such as diet, physical activity, smoking, alcohol and drug use and handwashing habits Measures of biologic and genetic determinates of health, including age, sex, HIV status, inherited conditions, BRCA1 And BRCA2 gene status, family history of heart disease or colon cancer 4. Health Disparities Disparities in risk, outcomes and Measures of rates of illness, death, disability, chronic conditions access to health services and risk factors by race, geographic area, sexual orientation, disability status and other factors Source: accessed

23 Table 4: Topic Areas, Healthy People 2020 Access to Health Services Genomics Nutrition and Weight Status Adolescent Health Global Health Occupational Safety and Health Arthritis, Osteoporosis, and Chronic Back Conditions Health Communication and Health Information Technology Older Adults Blood Disorders and Blood Safety Healthcare Associated Infections Oral Health Cancer Health Related Quality of Life & Well Being Physical Activity Chronic Kidney Disease Hearing and Other Sensory or Communication Disorders Preparedness Dementias, Including Alzheimer's Disease Heart Disease and Stroke Public Health Infrastructure Diabetes HIV Respiratory Diseases Disability and Health Immunization and Infectious Diseases Sexually Transmitted Diseases Early and Middle Childhood Injury and Violence Prevention Sleep Health Educational and Community Based Lesbian, Gay, Bisexual, and Programs Transgender Health Social Determinants of Health Environmental Health Maternal, Infant, and Child Health Substance Abuse Family Planning Medical Product Safety Tobacco Use Food Safety Mental Health and Mental Disorders Vision Source: accessed

24 Table 5: Onondaga County Municipalities Data, Pop. < Age 5 Years Black or African American Am. Indian / Alaska Native Data Source: American Community Survey, , US Census Bureau Hispanic (Any Race) Town/City Total Population White Asian Other Race Multi Racial Camillus 23, % 95.1% 1.4% 0.2% 1.3% 0.7% 1.4% 1.4% Cicero 29, % 97.4% 1.2% 0.0% 0.2% 0.2% 1.0% 1.6% Clay 58, % 90.6% 4.3% 0.7% 2.3% 0.4% 1.6% 1.4% De Witt 24, % 87.2% 4.2% 0.7% 4.7% 1.2% 2.0% 2.2% Elbridge 6, % 97.7% 0.0% 0.9% 0.4% 0.0% 0.9% 1.0% Fabius 2, % 92.0% 0.5% 1.6% 1.3% 3.8% 0.8% 4.1% Geddes 17, % 97.7% 0.7% 0.4% 0.4% 0.2% 0.7% 1.3% LaFayette 4, % 92.8% 0.0% 0.5% 2.1% 0.4% 4.0% 0.9% Lysander 20, % 95.1% 2.0% 0.0% 1.4% 0.2% 1.2% 1.2% Manlius 32, % 93.7% 1.2% 0.6% 3.3% 0.4% 0.8% 1.3% Marcellus 6, % 98.4% 0.0% 0.4% 0.4% 0.0% 0.9% 0.3% Onondaga 21, % 93.9% 1.1% 1.6% 1.2% 1.3% 1.0% 2.1% Otisco 2, % 100.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Pompey 6, % 96.9% 0.2% 0.0% 2.2% 0.0% 0.8% 0.7% Salina 32, % 92.9% 2.4% 0.6% 2.9% 0.3% 0.9% 1.7% Skaneateles 7, % 95.1% 0.1% 0.1% 1.2% 2.0% 1.5% 3.2% Spafford 2, % 97.6% 0.6% 0.9% 0.3% 0.0% 0.6% 0.0% City of Syracuse 139, % 61.2% 27.8% 1.2% 4.1% 1.5% 4.2% 6.2% Tully 2, % 94.0% 1.4% 0.0% 3.5% 0.7% 0.4% 1.5% Van Buren 12, % 96.8% 0.6% 0.6% 0.7% 0.4% 0.9% 1.6% Onondaga County 453, % 83.8% 9.9% 0.7% 2.6% 0.9% 2.1% 3.0% New York State 19,423, % 67.1% 15.6% 0.3% 6.8% 8.3% 1.8% 16.3% United States 301,461, % 74.5% 12.4% 0.8% 4.4% 5.7% 2.2% 15.1% 24

25 Table 5 Continued: Onondaga County Municipalities Data, Median Persons 16+ Years Old, 25+ Years 15+ Years Old, Mean Travel Town/City Family Income Below Poverty Level In Labor Force, Unemployed, Old, < HS Education Married, Not Separated Time to Work (Min.) Camillus $ 70, % 4.9% 6.9% 56.6% 19.0 Cicero $ 74, % 4.4% 9.3% 58.3% 20.2 Clay $ 73, % 4.9% 7.3% 53.9% 19.7 De Witt $ 79, % 5.1% 7.3% 55.0% 15.3 Elbridge $ 72, % 9.3% 7.2% 57.7% 22.5 Fabius $ 73, % 2.8% 9.2% 66.6% 23.5 Geddes $ 63, % 6.4% 10.7% 48.6% 16.9 LaFayette $ 71, % 4.3% 7.7% 55.8% 21.1 Lysander $ 88, % 3.9% 7.5% 62.7% 23.6 Manlius $ 87, % 2.6% 4.7% 58.3% 18.9 Marcellus $ 67, % 5.2% 7.5% 54.8% 24.8 Onondaga $ 82, % 5.8% 7.4% 57.2% 19.8 Otisco $ 63, % 7.4% 9.5% 58.4% 28.8 Pompey $ 96, % 2.2% 5.4% 67.2% 27.4 Salina $ 58, % 6.5% 9.8% 47.1% 16.6 Skaneateles $ 90, % 4.1% 5.3% 61.0% 24.3 Spafford $ 75, % 5.9% 5.3% 66.7% 31.4 City of Syracuse $ 37, % 9.6% 20.4% 28.6% 16.8 Tully $ 83, % 3.0% 6.0% 54.4% 22.5 Van Buren $ 60, % 2.8% 10.6% 47.7% 21.3 Onondaga County $ 65, % 6.1% 11.2% 50.1% 19.0 New York State $ 67, % 7.0% 15.8% 49.1% 31.4 United States $ 62, % 7.2% 15.4% 52.3% 25.2 Data Source: American Community Survey, , US Census Bureau 25