ContinueCARE Hospital at Baptist Health Paducah. Community Health Needs Assessment and Implementation Plan June 2017

Transcription

1 ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment and Implementation Plan

2 Table of Contents Section 1: Community Health Needs Assessment... 3 Executive Summary... 4 Process and Methodology... 8 Hospital Biography Study Area Demographic Overview Health Data Overview Phone Interview Findings Community Health Reports Preliminary Health Needs Prioritization Priorities That Will Not Be Addressed Resources in the Community Information Gaps About Appendix Summary of Data Sources Demographic Data Findings Health Data Findings HPSA and MUA/P Information Interviewee Biographies Priority Ballot Section 2: Implementation Plan Section 3: Feedback, Comments and Paper Copies Input Regarding the Hospital s Current CHNA Page 2

3 Section 1: Community Health Needs Assessment Page 3

4 Executive Summary A review of the CHNA process and rationales for the identified health needs Page 4

5 Executive Summary A comprehensive, six step community health needs assessment ( CHNA ) was conducted for ContinueCARE Hospital at Baptist Health Paducah (CCHBHP) by. This CHNA utilizes relevant health data and stakeholder input to identify the significant community health needs in McCracken County, Kentucky. The CHNA Team, consisting of leadership from CCHBHP, participated in a WebEx presentation with on March 7, 2017 to review the research findings and prioritize the community health needs. Four significant community health needs were identified by assessing the prevalence of the issues identified from the health data findings combined with the frequency and severity of mentions in community input. The final list of prioritized needs is listed below: 1. Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles 2. Access to Mental and Behavioral Health Care Services and Providers 3. Access to Specialty Care Services and Providers 4. Access to Affordable Care and Reducing Health Disparities Among Specific Populations The CHNA Team participated in a prioritization process using a structured matrix to rank the community health needs based on three characteristics: size and prevalence of the issue, effectiveness of interventions and the hospital s capacity to address the need. Once this prioritization process was complete, the hospital leadership discussed the results and decided to address two of the prioritized needs in various capacities through a hospital specific implementation plan. CCHBHP is a long term acute care facility within Baptist Health Paducah. Based on CCHBHP s status as a long term acute care facility, the hospital has focused its capabilities on addressing the needs of this particular market. Therefore, Access to Mental and Behavioral Health Care Services and Access to Specialty Care Services and Providers are not directly addressed in the hospital s implementation plan. The priorities listed above that will not be addressed are not core business functions of the hospital and the leadership team felt that resources and efforts would be better spent addressing the remaining two prioritized needs. This implementation plan addresses two of the identified needs. Hospital leadership has developed the following implementation plan to identify specific activities and services which directly address the identified priorities. The objectives were identified by studying the prioritized health needs, within the context of the hospital s overall strategic plan and the availability of finite resources. The plan includes a rationale for each priority, followed by objectives, specific implementation activities, responsible leaders, annual updates and progress, and key results (as appropriate). The CCHBHP Board reviewed and adopted the 2017 Community Health Needs Assessment and Implementation Plan on June 9, Page 5

6 Priority #1: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Data suggests that higher rates of specific mortality causes and unhealthy behaviors warrants a need for increased preventive education and services to increase the health of the community. Heart disease and cancer are the two leading causes of death in both the county and the state. McCracken County has higher mortality rates than the state for the following causes of death: diseases of heart; chronic lower respiratory diseases; cerebrovascular diseases; atherosclerosis; nephritis, nephrotic syndrome and nephrosis; intentional self harm (suicide); and pancreatic cancer ( ). Prevalence rates of sexually transmitted infections such as chlamydia and gonorrhea are higher in McCracken County as compared to the state, and the rate of residents with HIV/AIDS in the county is also higher than in the state. Rates of chronic conditions such as obesity are higher McCracken County than in the state, and percentages of residents participating in unhealthy lifestyle behaviors such as excessive drinking are also higher in the county as compared to Kentucky. With regards to maternal and child health, specifically, McCracken County has higher rates of infant mortality, and higher rates of teen births than the state. With regards to access to health care services and providers, McCracken County faces lower rates of mental health care providers per 100,000 persons, and has a higher rate of preventable hospitalizations among the Medicare Beneficiary population than Kentucky. McCracken County is also a designated Health Professional Shortage Area and Medically Underserved Area, as defined by the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA). Many interviewees mentioned the lack of health care literacy in the area and the strain this places on both patients as well as health care providers. The increase in chronic conditions has also stressed the health care system; high instances of smoking, heart issues as well as diabetes and obesity were mentioned. One interviewee specifically stated: We have a high rate of smoking and chronic illnesses like cardiac disease along with diabetes and obesity issues as well. The availability of programs was noted as adequate in the county; however, the disconnect seems to be with awareness of these programs and adequate marketing and transportation for those most in need of health related programming. One interviewee stated: In McCracken County, there are a lot of programs, but they are not publicized especially to the lower income. We struggle reaching out to the lower income and getting them involved. Priority #2: Access to Affordable Care and Reducing Health Disparities Among Specific Populations Data suggests that some residents in the study area face significant cost barriers when accessing the healthcare system. Out of the adult population (age 18 64), McCracken County has a higher percentage of uninsured residents than the state. Interviewees most often mentioned affordability as a reason for lack of access to health care. Lack of affordable health care was discussed as a potential reason for inappropriate usage of the ER. Those with government payors were mentioned as having the most difficulty in finding providers to accept them, and the additional steps to participate in these programs were seen as barriers for physician involvement. One interviewee specifically stated: I think the low income [population] has difficulty finding providers. A lot of our providers are opting out of various programs due to the red tape and paperwork. Affordability of medications was also a concern to interviewees as even those with comprehensive health coverage may struggle to afford necessary medications, and one interviewee specifically stated: Many people can t afford their medications and will forego buying food or utilities in order to get their medications. Page 6

7 Priority #2: Access to Affordable Care and Reducing Health Disparities Among Specific Populations (continued) When asked about which specific groups are at risk for inadequate care, interviewees spoke about elderly, youth, and un/underinsured residents. With regards to the elderly population, interviewees noted transportation, difficulty navigating and understanding the health care system, lack of appropriate housing accommodations, and lack of adult day care options for family caregivers as specific challenges for this particular subgroup of the population. For the youth population, interviewees brought up a lack of understanding of the importance of good health, as well as a significant need for substance abuse programs and suicide prevention efforts that were specific challenges for youth residents. Lastly, for the un/underinsured population in the community, interviewees discussed higher instances of overuse of emergency services, a lack of ability to access education and resources to maintain a healthy lifestyle (specifically fresh foods), lack of ability to afford prescriptions, and a lack of affordable dental services for those with Medicare or Medicaid as challenges that disproportionately affect un/underinsured residents. Page 7

8 Process and Methodology A detailed description of the process used to conduct this CHNA, the collaboration between hospital staff and, and the methods of data collection and analysis Page 8

9 Background and Objectives This CHNA is designed in accordance with CHNA requirements identified in the Patient Protection and Affordable Care Act and further addressed in the Internal Revenue Service final regulations released December 29, The objectives of the CHNA are to: Meet federal government and regulatory requirements Research and report on the demographics and health status of the study area, including a review of state and local data Gather input, data and opinions from persons who represent the broad interest of the community Analyze the quantitative and qualitative data gathered and communicate results via a final comprehensive report on the needs of the communities served by ContinueCARE Hospital at Baptist Health Paducah Prioritize the needs of the community served by the hospital Create an implementation plan that addresses the prioritized needs for the hospital Page 9

10 Scope of Report The CHNA components include: A description of the process and methods used to conduct this CHNA, including a summary of data sources used in this report A biography of CCHBHP A description of the hospital s defined study area Definition and analysis of the communities served, including both a demographic and a health data analysis Findings from phone interviews that collected input from people who represent a broad interest in the community, including: State, local, tribal or regional governmental public health department (or equivalent department or agency) with knowledge, information or expertise relevant to the health needs of the community; Members of a medically underserved, low income or minority populations in the community, or individuals or organizations serving or representing the interests of such populations Community leaders (EX: Superior Care Home, Caring People Services, Paducah Bank and Trust, Mayor of City of Paducah) The prioritized community needs and separate implementation plan, which intend to address the community needs identified Documentation and rationalization of priorities not addressed by the implementation plan A description of additional health services and resources available in the community A list of information gaps that impact the hospital s ability to assess the health needs of the community served Page 10

11 Methodology CCHBHP worked with in the development of its CHNA. CCHBHP provided essential data and resources necessary to initiate and complete the process, including the definition of the hospital s study area and the identification of key community stakeholders to be interviewed. conducted the following research: A demographic analysis of the study area, utilizing demographic data from Truven Health s Market Expert A study of the most recent health data available Conducted one on one interviews with individuals who have special knowledge of the communities, and analyzed results Facilitated the prioritization process during the CHNA Team meeting on March 7, CHNA Team included: Len McDade, President, CEO Mary Lou Young, CNO April Jones, HIM Coordinator/Medical Staff Coordinator Crystal Buck, Respiratory Therapy Manager Jennifer Duncan, Admissions Coordinator The methodology for each component of this study is summarized below. In certain cases methodology is elaborated in the body of the report. CCHBHP Biography Background information about CCHBHP, including the mission, vision, values, and hospital services was provided by the hospital or taken from its website Study Area Definition The study area for CCHBHP is based on hospital inpatient discharge data from FY 2016 and discussions with hospital staff Demographics of the Study Area Population demographics include population change by race, ethnicity, age, median household income, unemployment and economic statistics in the study area Demographic data sources include, but are not limited to, Truven Health s Market Expert, Community Commons, the Centers for Disease Control and Prevention (CDC) Community Health Status Indicators (CHSI), the Annie E. Casey Foundation Kids Count Data Center, the U.S. Census Bureau and the United States Bureau of Labor Statistics Page 11

12 Methodology Continued Health Data Collection Process A variety of sources, which are all listed in the references section of this report, were utilized in the health data collection process Health data sources include, but are not limited to, the Centers for Disease Control and Prevention (CDC) WONDER Tool, the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, Community Commons, the Centers for Disease Control and Prevention (CDC) Community Health Status Indicators (CHSI), the Kentucky Behavioral Risk Factor Surveillance System, the Kentucky Cancer Registry, Enroll America, and the U.S. Census Bureau Interview Methodology CCHBHP provided with a list of persons with special knowledge of public health in McCracken County, including public health representatives, not for profit organization professionals, charities and other individuals who focus specifically on underrepresented groups From that list, twelve in depth interviews were conducted using a structured interview guide Extensive notes were taken during each interview and then quantified based on responses, communities and populations (minority, elderly, un/underinsured, etc.) served, and priorities identified by respondents. Qualitative data from the interviews was also analyzed and reported. Prioritization Strategy Four significant needs were determined by assessing the prevalence of the issues identified in the health data findings, combined with the frequency and severity of mentions in the interviews Three factors were used to rank those needs during the CHNA Team meeting on March 7, 2017 See the prioritization section for a more detailed description of the prioritization methodology Page 12

13 Hospital Biography A brief description of the hospital and its services Page 13

14 About ContinueCARE Hospital at Baptist Health Paducah ContinueCARE Hospital at Baptist Health Paducah opened in the summer of 2015 as a 37 bed Long Term Acute Care Hospital (LTACH) located on the fifth floor of our host hospital, Baptist Health Paducah. As the only LTACH in the area, we enjoy the best of both worlds by being in partnership with a 373 bed acute and skilled care facility yet maintaining our small hospital atmosphere. Our employees are a dedicated team who work together delivering the best possible care for our patients. Since we have a longer length of stay, our staff has the opportunity to know patients and families. We believe spending quality time makes a difference. And we want to make a difference. As a hospital within a hospital, we are a separate yet fully licensed acute care hospital with the ability to provide intensive and complex medical treatment. Our specialty programs are specifically designed to meet the needs of longterm, acute care patients. Please tour our Website to learn more about our hospital, the specialty care we provide, career opportunities, and the benefits of being a part of our great team of professionals. Please feel free to call Administration for any additional information about ContinueCARE Hospital at Baptist Health Paducah or for career opportunities. We appreciate your interest and look forward to talking with you! Hospital Main Number: (270) Human Resources: (270) Page 14

15 Mission, Vision and Values Our Mission To provide quality long term, acute care and a healing environment for our patients, using Christian values as our guide. Our Vision To be the premier Long Term Acute Care hospital in Kentucky, committed to restoring the individual patient s highest quality of life and the healing of their body, mind, and spirit. Values Integrity Respect Stewardship Excellence Collaboration Page 15

16 Services A Long Term Acute Care Hospital (LTACH) serves the needs of patients with medically complex conditions, especially those suffering from multisystem complications and needing extended recovery times a hospital stay that is often 25 days or more. A patient is usually admitted after a short term, acute care hospital stay. After care in an LTACH, many patients are then able to transition from the LTACH to acute rehab, skilled nursing or go home. Hospice care is also a post acute treatment option for patients with a terminal disease who have a life expectancy of six months or less. As an LTACH, ContinueCARE Hospital at Baptist Health Paducah develops a continuum of care between the acute and long term phases of a patient s illness. Our innovative and distinctive physician driven approach allows us to bring new meaning to the hospitalwithin a hospital model. As a separate, fully licensed and staffed hospital, we are able to provide intensive and complex medical treatment to patients requiring longer lengths of stay for acute care. We have specialty programs designed to meet the needs of long term, acutely ill patients with conditions including ventilator dependence, respiratory failure, chronic pulmonary problems, complex and severe wounds, and infections requiring long term antibiotic therapy. LTACH facilities also provide physical, occupational, and nutritional therapies, as well as pain management. Page 16

17 Study Area The hospital s defined service area Page 17

18 Patient Origin Map McCracken County comprises 30.8% of inpatient discharges indicates the hospital ContinueCARE Hospital at Baptist Health Paducah Patient Origin by County FY 2016 County State FY 2016 Discharges % of Total Cumulative % of Total McCracken County KY % 30.8% All Others % 100.0% Total % Source: Hospital Inpatient Discharge Data by DRG; July 1, 2015 June 30, Page 18

19 Demographic Overview A demographic analysis of the community served by ContinueCARE Hospital at Baptist Health Paducah Page 19

20 Overall Population Change Projected Population Growth ( ) McCracken County Kentucky 0.2% 2.0% McCracken County Overall Population Growth Kentucky Geographic Location Change % Change McCracken County 65,565 65,148 65, % Kentucky 4,339,367 4,436,515 4,524,773 88, % Source: Truven Health Analytics, Market Expert; data accessed January 27, Page 20

21 Hispanic 2.5% Asian 0.9% Black 10.7% Population by Race/Ethnicity (2016) McCracken County 0.5% American Indian 0.3% All Others 2.1% White Non Hispanic 83.5% 6.1% 14.6% 14.8% 19.2% 11.3% Asian 1.4% Hispanic 3.6% Black 8.1% Kentucky American Indian 0.2% All Others 1.8% Race/Ethnicity Projected Growth ( ) McCracken County Kentucky 24.0% White Non Hispanic 84.8% 3.5% 3.7% 14.3% McCracken County Race/Ethnicity Change % Change White Non Hispanic 54,389 54, % Black 6,968 6, % Hispanic 1,648 1, % Asian % American Indian % All Others 1,368 1, % Total 65,148 65, % Kentucky Race/Ethnicity Change % Change White Non Hispanic 3,763,984 3,782,498 18, % Black 358, ,105 21, % Hispanic 159, ,011 23, % Asian 64,043 76,365 12, % American Indian 9,035 9, % All Others 81,753 93,439 11, % Total 4,436,515 4,524,773 88, % 0.3% White Non 1.9% Black Hispanic Asian American Indian All Others Hispanic Source: Truven Health Analytics, Market Expert; data accessed January 27, Page 21

22 McCracken County % % < % % Population by Age (2016) % Kentucky % Age Projected Growth ( ) < % % McCracken County Age Cohort Change % Change <18 14,038 13, % ,574 20, % ,164 17, % ,372 13,890 1, % Total 65,148 65, % Kentucky Age Cohort Change % Change <18 1,010,072 1,006,280 3, % ,549,893 1,550, % ,187,704 1,163,939 23, % , , , % Total 4,436,515 4,524,773 88, % McCracken County Kentucky 12.3% 16.8% 0.0% 0.2% 2.0% 1.9% 0.4% 0.9% 2.0% 5.2% < Total Source: Truven Health Analytics, Market Expert; data accessed January 27, Page 22

23 Median Age The median age in McCracken County, Kentucky, and the United States is expected to increase over the next five years ( ). McCracken County (42.4 years) has an older median age than Kentucky (40.8 years) and the nation (41.2 years) (2016). Median Age McCracken County Kentucky United States Source: Truven Health Analytics, Market Expert; data accessed January 27, Page 23

24 Median Household Income The median household income in McCracken County is expected to remain relatively steady over the next five years, while the median household income in Kentucky and the United States and the state is expected to increase ( ). McCracken County ($42,828) has a slightly higher median household income than Kentucky ($40,597), but a lower median household income than the nation ($48,280) (2016). Median Household Income $42,828 $43,398 $40,597 $43,315 $48,280 $51,808 McCracken County Kentucky United States Source: Truven Health Analytics, Market Expert; data accessed January 27, Page 24

25 Educational Attainment McCracken County (22.2%) has a consistent percentage of residents with a bachelor or advanced degree with the state (22.2%) and a lower rate than the nation (29.4%) (2016). Education Bachelor / Advanced Degree (2016) McCracken County Kentucky United States 22.2% 22.2% 29.4% McCracken County Kentucky United States Source: Truven Health Analytics, Market Expert; data accessed January 27, Page 25

26 Unemployment Unemployment rates in McCracken County and Kentucky decreased between 2013 and In 2015, McCracken County (5.9%) had a slightly higher unemployment rate than the state (5.4%). Unemployment Rates % 8.1% 7.0% 6.5% 5.9% 5.4% McCracken County Kentucky Source: Bureau of Labor Statistics, Local Area Unemployment Statistics, rates shown are a percentage of the labor force; data accessed January 27, Page 26

27 Unemployment Peer County Ranking In comparison to its peer counties, McCracken County (8.0%) ranked within the two middle quartiles for the percent of the Civilian Labor Force (age 16+) that was unemployed but seeking work in 2013 and also ranked above the U.S. median (7.1%). Unemployment, McCracken County Percent of the Civilian Labor Force (age 16+) that is unemployed but seeking work, % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 10, Page 27

28 Poverty McCracken County (13.8%) has a slightly lower percentage of families living below poverty than the state (14.5%), and a higher percentage than the nation (11.7%) (2016). Between 2012 and 2014, the percent of children (<18 years) living below poverty in McCracken County and in the state remained relatively steady. McCracken County (26.0%) has a consistent percentage of children (<18 years) living below poverty with Kentucky (25.9%) (2014). Families Below Poverty (2016) McCracken County Kentucky United States Children Below Poverty Percent, Children (<18 years), % 14.5% 11.7% 26.6% 28.7% 26.0% 26.5% 25.5% 25.9% McCracken County Kentucky United States McCracken County Kentucky Source: Truven Health Analytics, Market Expert; data accessed January 27, Source: The Annie E. Casey Foundation, Kids Count Data Center, data accessed January 27, Children Living Below Poverty Definition: Estimated percentage of related children under age 18 living in families with incomes less than the federal poverty threshold. Note: the 2016 Federal Poverty Guidelines define a household size of 4 as living below 100% of the federal poverty level if the household income is less than $24,300, and less than 200% of the federal poverty level if the household income is less than $48,600. Please see the appendix for the full 2016 Federal Poverty Guidelines. Page 28

29 Poverty Peer County Ranking In comparison to its peer counties, McCracken County (18.0%) ranked within the two middle quartiles for the percent of individuals living in poverty in 2012 and also ranked above the U.S. median (16.3%). Poverty, McCracken County Residents living in households with income below the Federal Poverty Level (FPL), % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 10, Note: the 2016 Federal Poverty Guidelines define a household size of 4 as living below 100% of the federal poverty level if the household income is less than $24,300, and less than 200% of the federal poverty level if the household income is less than $48,600. Please see the appendix for the full 2016 Federal Poverty Guidelines. Page 29

30 Children in the Study Area The percent of public school students that are eligible for free/reduced price lunch between 2013 and 2014 in McCracken County (52.4%) is lower than the state (54.8%) and consistent with the national (52.4%) rate. In , the percent of students receiving their high school diploma within four years in McCracken County (89.8%) was higher than the state (88.9%) and national (84.3%) rates. Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 10, Definition: receiving a high school diploma within four years. Page 30

31 Health Status Overview An analysis of available health data pertaining to the community served by ContinueCARE Hospital at Baptist Health Paducah Page 31

32 Data Methodology The following information outlines specific health data: Mortality, chronic diseases and conditions, health behaviors, natality, mental health and healthcare access Data Sources include, but are not limited to: Kentucky Department for Public Health Centers for Disease Control and Prevention Community Health Status Indicators Community Commons The Behavioral Risk Factor Surveillance System (BRFSS) The Behavioral Risk Factor Surveillance System (BRFSS) is the world s largest, on going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since Currently, data are collected monthly in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. It is a state based system of health surveys that collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. For many states, the BRFSS is the only available source of timely, accurate data on health related behaviors. States use BRFSS data to identify emerging health problems, establish and track health objectives, and develop and evaluate public health policies and programs. Many states also use BRFSS data to support health related legislative efforts. The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute Kentucky Cancer Registry Enroll America United States Census Bureau Data Levels: Nationwide, state, area development district and county level data Page 32

33 Kentucky County and Area Development District Map Purchase Area Development District (ADD) Ballard County Calloway County Carlisle County Fulton County Graves County Hickman County McCracken County Marshall County Source: Kentucky Department for Public Health, Behavioral Risk Factor Surveillance System (BRFSS), data accessed April 10, Page 33

34 County Health Rankings The County Health Rankings rank all 120 counties in Kentucky (1 being the best, 120 being the worst). Various factors go into these rankings. For example: Physical Environment: Drinking water violations Severe housing problems Driving alone to work Social & Economic Factors: High school graduation rate Unemployment Children in poverty Injury deaths Source: County Health Rankings & Roadmaps; data accessed January 27, Note: Please see the appendix for full methodology County Health Rankings McCracken County Health Outcomes 42 LENGTH OF LIFE 61 QUALITY OF LIFE 29 Health Factors 24 HEALTH BEHAVIORS 18 CLINICAL CARE 5 SOCIAL & ECONOMIC FACTORS 64 PHYSICAL ENVIRONMENT 114 Note: Green represents the best ranking for the county, and red represents the worst ranking. Page 34

35 Leading Causes of Death ( ) Rank McCracken County Kentucky 1 Diseases of heart (I00 I09,I11,I13,I20 I51) Diseases of heart (I00 I09,I11,I13,I20 I51) 2 Malignant neoplasms (C00 C97) Malignant neoplasms (C00 C97) 3 Chronic lower respiratory diseases (J40 J47) Chronic lower respiratory diseases (J40 J47) 4 Accidents (unintentional injuries) (V01 X59,Y85 Y86) Accidents (unintentional injuries) (V01 X59,Y85 Y86) 5 Cerebrovascular diseases (I60 I69) Cerebrovascular diseases (I60 I69) 6 Atherosclerosis (I70) Alzheimer's disease (G30) 7 Alzheimer's disease (G30) Diabetes mellitus (E10 E14) 8 Diabetes mellitus (E10 E14) 9 Nephritis, nephrotic syndrome and nephrosis (N00 N07,N17 N19,N25 N27) Nephritis, nephrotic syndrome and nephrosis (N00 N07,N17 N19,N25 N27) Influenza and pneumonia (J09 J18) 10 Intentional self harm (suicide) (*U03,X60 X84,Y87.0) Intentional self harm (suicide) (*U03,X60 X84,Y87.0) Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously. Page 35

36 Mortality Rate Comparison ( ) Disease McCracken County Green indicates that the county s rate is lower than the state s rate for that disease category. Red indicates that the county s rate is higher than the state s rate for that disease category. Kentucky Diseases of heart (I00 I09,I11,I13,I20 I51) Malignant neoplasms (C00 C97) Chronic lower respiratory diseases (J40 J47) Accidents (unintentional injuries) (V01 X59,Y85 Y86) Cerebrovascular diseases (I60 I69) Atherosclerosis (I70) Alzheimer's disease (G30) Diabetes mellitus (E10 E14) Nephritis, nephrotic syndrome and nephrosis (N00 N07,N17 N19,N25 N27) Intentional self harm (suicide) (*U03,X60 X84,Y87.0) Influenza and pneumonia (J09 J18) Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously. Page 36

37 Overall Mortality Overall mortality rates in McCracken County slightly decreased between 2011 and 2015, while rates in Kentucky remained relatively steady. In , McCracken County (911.4 per 100,000) had a consistent overall mortality rate with the state (910.3 per 100,000). 1, Overall Mortality Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County 2, , , , Kentucky 130, , , , Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously. Page 37

38 Heart disease is the leading cause of death in McCracken County and the state ( ). Heart disease death rates in McCracken County and the state slightly decreased between 2011 and In , McCracken County (217.9 per 100,000) had a slightly higher heart disease mortality rate than the state (200.5 per 100,000). Diseases of Heart Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, 2017 Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously Diseases of Heart Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County , Kentucky 29, , , , Page 38

39 Coronary Heart Disease Deaths Peer County Ranking In comparison to its peer counties, McCracken County (163.0 per 100,000) ranked within the least favorable quartile for coronary heart disease deaths between 2005 and 2011, and also ranked above the U.S. median (126.7 per 100,000) and the Healthy People 2020 Target (103.4 per 100,000). Coronary Heart Disease Deaths, McCracken County Age adjusted death rates per 100,000, Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 10, Page 39

40 Cancer (Malignant Neoplasms) Cancer is the second leading cause of death in McCracken County and the state ( ). Cancer death rates in McCracken County increased between 2011 and 2015, while rates in Kentucky remained relatively steady. In , McCracken County (176.3 per 100,000) had a lower cancer mortality rate than the state (198.0 per 100,000) Cancer (Malignant Neoplasms) Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky 29, , , , Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously. Page 40

41 Cancer Mortality Peer County Ranking In comparison to its peer counties, McCracken County (185.3 per 100,000) ranked within the two middle quartiles for cancer death rates between 2005 and 2011, and also ranked consistently with the U.S. median (185.0 per 100,000) and above the Healthy People 2020 Target (161.4 per 100,000). Cancer Deaths, McCracken County Age adjusted death rates per 100,000, Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 10, Page 41

42 Cancer Incidence Peer County Ranking In comparison to its peer counties, McCracken County (476.0 per 100,000) ranked within the two middle quartiles for cancer incidence rates per 100,000 between 2006 and 2010, and also ranked above the U.S. median (457.6 per 100,000). Cancer Incidence, McCracken County Age adjusted incidence rates per 100,000, Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 10, Page 42

43 Cancer Incidence and Mortality by Type Lung & Bronchus Age adjusted Incidence and Mortality Rate, Colon & Rectum Age adjusted Incidence and Mortality Rate, Incidence Mortality Incidence Mortality McCracken County Kentucky Pancreas Age adjusted Incidence and Mortality Rate, McCracken County Kentucky Breast (Either Sex) Age adjusted Incidence and Mortality Rate, Incidence Mortality Incidence Mortality McCracken County Kentucky McCracken County Kentucky Source: Kentucky Cancer Registry, Cancer Incidence and Mortality Rates in Kentucky, data accessed February 27, Note: Age Adjustment Uses 2000 Standard Million Population. All rates per 100,000. A minimum of 15 cases are required to calculate a stable age adjusted rates. Rates calculated with small numbers are unreliable and should be used cautiously. Page 43

44 Cancer Incidence by Type Peer County Ranking In comparison to its peer counties, McCracken County ranked within the most favorable quartile for colon and rectum (41.3 per 100,000) cancer incidence rates, the two middle quartiles for female breast (114.2 per 100,000) and male prostate (134.3 per 100,000) cancer incidence rates, and the least favorable quartile for lung and bronchus cancer incidence rates (93.7 per 100,000) per 100,000 persons between 2006 and Cancer Incidence by Type Age adjusted Incidence Rates per 100,000, McCracken County Colon & Rectum Female Breast Lung & Bronchus Male Prostate Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 13, Page 44

45 Chronic Lower Respiratory Disease Chronic Lower Respiratory Disease (CLRD) is the third leading cause of death in McCracken County and the state ( ). Between 2011 and 2015, CLRD mortality rates in McCracken County increased, while rates in the state remained steady. In , McCracken County (73.7 per 100,000) had a higher CLRD mortality rate than the state (64.2 per 100,000) Chronic Lower Respiratory Disease Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky 9, , , , Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously. Page 45

46 Chronic Lower Respiratory Disease Mortality Peer County Ranking In comparison to its peer counties, McCracken County (49.2 per 100,000) ranked within the two middle quartiles for chronic lower respiratory disease deaths between 2005 and 2011, and also ranked consistently with the U.S. median (49.6 per 100,000). Chronic Lower Respiratory Disease (CLRD) Deaths, McCracken County Age Adjusted Death Rates per 100,000, Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Page 46

47 Accidents Fatal accidents are the fourth leading cause of death in McCracken County and the state ( ). Between 2011 and 2015, fatal accidents in McCracken County decreased, while rates in the state remained steady. In , McCracken County (58.3 per 100,000) had a consistent accident mortality rate with the state (60.0 per 100,000). In , the leading cause of fatal accidents in McCracken County was due to accidental poisonings and exposure to noxious substances Accidents Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky 7, , , , Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously. Note: Accidents include motor vehicle accidents; other land transport accidents; water, air and space and other and unspecified transport accidents; falls; accidental discharge of firearms; accidental drowning and submersion; accidental exposure to smoke, fire and flames; accidental poisoning and exposure to noxious substances; other and unspecified nontransport accidents and their sequelae. Page 47

48 Unintentional Injury Mortality Peer County Ranking In comparison to its peer counties, McCracken County (48.3 per 100,000) ranked within the two middle quartiles for unintentional injury (including motor vehicle) deaths between 2005 and 2011 and also ranked slightly below the U.S. median (50.8 per 100,000) but above the Healthy People 2020 Target (36.0 per 100,000). Unintentional Injury (including motor vehicle) Deaths, McCracken County Age Adjusted Death Rates per 100,000, Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 10, Page 48

49 Cerebrovascular Diseases Cerebrovascular disease is the fifth leading cause of death in McCracken County and the state ( ). Between 2011 and 2015, cerebrovascular disease mortality rates in McCracken County and the state decreased. In , McCracken County (37.9 per 100,000) had a slightly lower cerebrovascular disease mortality rate than the state (41.4 per 100,000) Cerebrovascular Diseases Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky 6, , , , Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously. Page 49

50 Stroke Mortality Peer County Ranking In comparison to its peer counties, McCracken County (43.5 per 100,000) ranked within the most favorable quartile for stroke deaths between 2005 and 2011 and also ranked slightly below the US median (46.0 per 100,000) and above the Healthy People 2020 Target (34.8 per 100,000). Stroke Deaths, McCracken County Age Adjusted Death Rates per 100,000, Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Page 50

51 Atherosclerosis is the sixth leading cause of death in McCracken County, and is not within the top ten leading causes of death for Kentucky ( ). Between 2011 and 2015, atherosclerosis mortality rates in McCracken County and the state decreased. In , McCracken County (37.8 per 100,000) had a significantly higher atherosclerosis mortality rate than the state (2.1 per 100,000). Atherosclerosis Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously Atherosclerosis Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky Page 51

52 Alzheimer s Disease Alzheimer s Disease is the seventh leading cause of death in McCracken County, and the sixth leading cause of death in Kentucky ( ). Alzheimer s Disease mortality rates in McCracken County and the state remained relatively steady between 2011 and In , McCracken County (26.4 per 100,000) had a lower Alzheimer s Disease mortality rate than the state (32.8 per 100,000) Alzheimer's Disease Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky 4, , , , Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously. Page 52

53 Alzheimer s Disease Mortality Peer County Ranking In comparison to its peer counties, McCracken County (25.5 per 100,000) ranked within the two middle quartiles for Alzheimer s Disease deaths between 2005 and 2011 and also ranked below the U.S. median (27.3 per 100,000). Alzheimer s Disease Deaths, McCracken County Age Adjusted Death Rates per 100,000, Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Page 53

54 Diabetes is the eighth leading cause of death in McCracken County and the seventh leading cause of death in Kentucky ( ). Between 2011 and 2015, diabetes mellitus mortality rates in McCracken County decreased, while rates in the state remained relatively steady. In , McCracken County (22.1 per 100,000) had a lower diabetes mellitus mortality rate than the state (25.2 per 100,000). Diabetes Mellitus Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously Diabetes Mellitus Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky 3, , , , Page 54

55 Diabetes Mortality Peer County Ranking In comparison to its peer counties, McCracken County (18.2 per 100,000) ranked within the two middle quartiles for diabetes deaths between 2005 and 2011, and also ranked below the U.S. median (24.7 per 100,000). Diabetes Deaths, McCracken County Age Adjusted Death Rates per 100,000, Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, 2017 Page 55

56 Nephritis, Nephrotic Syndrome & Nephrosis Nephritis, nephrotic syndrome and nephrosis is the ninth leading cause of death in McCracken County, and the eighth leading cause of death in Kentucky ( ). Between 2011 and 2015, nephritis, nephrotic syndrome and nephrosis mortality rates in McCracken County increased, while rates in the stated remained steady. In , McCracken County (26.1 per 100,000) had a higher nephritis, nephrotic syndrome and nephrosis mortality rate than the state (19.9 per 100,000). Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously Nephritis, Nephrotic Syndrome & Nephrosis Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky 2, , , , Page 56

57 Chronic Kidney Disease Mortality Peer County Ranking In comparison to its peer counties, McCracken County (17.2 per 100,000) ranked within the two middle quartiles for chronic kidney disease deaths between 2005 and 2011 and also ranked below the U.S. median (17.5 per 100,000). Chronic Kidney Disease Deaths, McCracken County Age Adjusted Death Rates per 100,000, Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Page 57

58 Intentional Self Harm (Suicide) Intentional self harm (suicide) is the tenth leading cause of death in McCracken County and the state ( ). Between 2011 and 2015, suicide mortality rates in McCracken County remained relatively steady, while rates in the state slightly increased. In , McCracken County (21.5 per 100,000) had a higher suicide mortality rate than the state (16.2 per 100,000) Intentional Self Harm (Suicide) Moving Averages, Age adjusted Death Rates per 100,000, McCracken County Kentucky AGE AGE AGE AGE LOCATION ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky 2, , , , Source: Centers for Disease Control and Prevention, National Center for Health Statistics, icd10.html; data accessed February 10, Note: Age Adjustment Uses 2000 Standard Population. Rates calculated with small numbers are unreliable and should be used cautiously. Page 58

59 Communicable Diseases Chlamydia, Gonorrhea, and HIV In 2014, McCracken County (477.3 per 100,000) had a higher chlamydia infection rate than the state (400.4 per 100,000) and the nation (456.1 per 100,000). In 2014, McCracken County (139.2 per 100,000) had a higher gonorrhea infection rate than the state (99.0 per 100,000) and the nation (110.7 per 100,000). In 2013, McCracken County (172.2 per 100,000) had a higher HIV prevalence rate than the state (159.4 per 100,000) and a lower rate than the nation (353.2 per 100,000). Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 14, Page 59

60 Chronic Conditions Diabetes In 2014, the percentage of the Medicare fee forservice population in McCracken County (26.8%) that had ever been diagnosed with diabetes was slightly lower than the state rate (28.6%) and consistent with the national rate (26.7%). Between 2012 and 2014, the percent of adults that had ever been diagnosed with diabetes in the Purchase Area Development District (ADD) and in the state fluctuated. In 2014, Purchase ADD (10.0%) had a lower percent of adults that had ever been diagnosed with diabetes than the state (12.5%). Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 14, Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Definition: Has a doctor, nurse, or other health professional ever told you that you have diabetes? Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. 10.4% 8.3% 10.0% 10.7% Purchase ADD Diabetes Percent, Adults, % Kentucky 12.5% Page 60

61 Adult Diabetes Peer County Ranking In comparison to its peer counties, McCracken County (8.2%) ranked within the two middle quartiles for the percent of adults (age 20+) living with diagnosed diabetes between 2005 and 2011, and also ranked consistently with the U.S. median (8.1%). Adult Diabetes, McCracken County Percent, Adults (age 20+), % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Page 61

62 Chronic Conditions Obesity In 2013, the percentage of adults (age 20+) who self reported that they have a Body Mass Index (BMI) greater than 30.0 (obese) in McCracken County (33.7%) was slightly higher than the state (32.7%) and higher than the national rate (27.5%). Between 2012 and 2014, the percent of adults with a BMI greater than 30.0 (obese) in Purchase ADD and in the state remained steady. In 2014, Purchase ADD (33.0%) had a slightly higher percent of obese adults than the state (31.6%). Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. 33.8% Obesity Percent, Adults, % 33.0% 31.3% 33.2% 31.6% Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 14, 2017 Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Definition: BMI is weight in lbs. divided by (height in inches squared) times 703. Recommended BMI is 18.5 to 24.9 Overweight is 25.0 to 29.9 Obese is => Purchase ADD Kentucky Page 62

63 Obesity Peer County Ranking In comparison to its peer counties, McCracken County (29.6%) ranked within the two middle quartiles for the percent of obese adults (age 20+) between 2006 and 2012, and also ranked consistently with the U.S. median (30.4%). Adult Obesity, McCracken County Percent, Adults (age 20+), % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Page 63

64 Chronic Conditions Disability The percentage of the total civilian non institutionalized population with a disability in McCracken County (16.4%) is slightly lower than the state rate (17.0%) and higher than the national rate (12.4%) ( ). Between 2012 and 2014, the percent of adults that needed to use special equipment in Purchase ADD and the state fluctuated. In 2014, Purchase ADD (8.4%) had a lower percent of adults that needed to use special equipment than the state (11.8%). Between 2012 and 2014, the percent of adults with a physical, mental, or emotional disability in Purchase ADD decreased, while rates in Kentucky remained relatively steady. In 2014, Purchase ADD (20.7%) had a lower percent of adults with a physical, mental, or emotional disability than the state (27.6%). Adults Using Special Equipment Percent, Adults, Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Physical, Mental, or Emotional Disability Percent, Adults, % % 11.2% 10.0% 8.4% 11.8% % 26.2% 26.5% 25.8% 20.7% 27.6% Purchase ADD Kentucky Purchase ADD Kentucky Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 14, Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Disability Definition: Are you limited in any way in any activities because of physical, mental, or emotional problems? Use of Special Equipment Definition: Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone? Page 64

65 Chronic Conditions Asthma The percentage of adults (age 18+) who selfreported that they have ever been told by a doctor, nurse, or other health professional that they had asthma in McCracken County (11.8%) is lower than the state (15.5%) and national rates (13.4%) ( ). Between 2012 and 2014, the percent of adults ever diagnosed with asthma in Purchase ADD fluctuated while rates in Kentucky remained relatively steady. In 2014, the percent of adults with asthma in Purchase ADD (8.9%) was lower than the state rate (11.9%). Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 14, Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Definition: Has a doctor, nurse, or other health professional ever told you that you had asthma? 4.6% Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. 11.1% 10.4% 9.5% 8.9% Purchase ADD Asthma Percent, Adults, Kentucky 11.9% Page 65

66 Older Adult Asthma Peer County Ranking In comparison to its peer counties, McCracken County (4.0%) ranked within the upper end of the two middle quartiles for the percent of older adults (age 65+) living with asthma in 2012, and also ranked slightly above the U.S. median (3.6%). Older Adult Asthma, McCracken County Percent, Adults (age 65+), % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Page 66

67 Health Behaviors Physical Inactivity The percentage of adults (age 20+) who selfreported no leisure time for physical activity outside of work in McCracken County (26.3%) is consistent with the state rate (26.8%) and higher than the national rate (21.8%) (2013). Between 2012 and 2014, the percent of adults that reported participating in physical activity in both Purchase ADD and the state remained relatively steady. In 2014, the percent of adults in Purchase ADD (74.2%) that reported participating in physical activity was slightly higher than the state rate (71.8%). Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 14, Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Definition: During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise? Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Adults Participating in Physical Activity Percent, Adults, % 69.8% 74.2% 70.3% 69.8% 71.8% Purchase ADD Kentucky Page 67

68 Adult Physical Inactivity Peer County Ranking In comparison to its peer counties, McCracken County (28.7%) ranked within the upper end of the two middle quartiles for the percent of adults (age 18+) who reported no leisure time physical activity between 2006 and 2012, and also ranked above the U.S. median (25.9%) and below the Healthy People 2020 Target (32.6%). Adult Physical Inactivity, McCracken County Percent of adults (age 18+) reporting no leisure time exercise in past month, % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Definition: During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise? Page 68

69 Health Behaviors Binge Drinking The percentage of adults (age 18+) who selfreported heavy alcohol consumption (2+ drinks per day on average for men, 1+ drink per day on average for women) in McCracken County (13.0%) is slightly higher than the state rate (12.2%) and lower than the national rate (16.9%) ( ). Between 2012 and 2014, the percent of adults that participated in binge drinking during the past 30 days in Purchase ADD fluctuated, while rates in the state decreased. In 2014, the percent of adults that participated in binge drinking during the past 30 days in Purchase ADD (12.9%) was consistent with the state rate (12.7%). Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 14, 2017 Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Definition: During the past 30 days, what is the largest number of drinks you had on any occasion? Binge drinking is defined as adults consuming 4 or more drinks at one time (females) or 5 or more drinks at one time (males). Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. 15.5% 12.9% 14.9% 13.4% 12.7% 7.8% Purchase ADD Binge Drinking Percent, Adults, Kentucky Page 69

70 Binge Drinking Peer County Ranking In comparison to its peer counties, McCracken County (11.9%) ranked within the most favorable quartile for the percent of adults who reported binge drinking between 2006 and 2012 and also ranked below the U.S. median (16.3%). Adult Binge Drinking, McCracken County Percent, Adults (age 18+), % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Definition: having 5 or more drinks (men) or 4 or more drinks (women) on one or more occasions during the previous 30 days. Page 70

71 Health Behaviors Smoking The percentage of adults (age 18+) who selfreported currently smoking cigarettes some days or every day in McCracken County (25.4%) is slightly lower than the state rate (26.1%) and higher than the national rate (18.1%) ( ). Between 2012 and 2014, the percent of adults that reported currently smoking cigarettes every day or some days in Purchase ADD and the state steadily decreased. In 2014, the percent of adults that reported currently smoking cigarettes every day or some days in Purchase ADD (22.3%) was lower than the state (26.2%). Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 14, Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Frequency of Smoking Definition: Do you now smoke cigarettes every day, some days, or not at all? (Respondents that reported smoking Every Day are included in this chart) Note: smoking refers to cigarettes, and does not include electronic cigarettes (e cigarettes, NJOY, Bluetip), herbal cigarettes, cigars, cigarillos, little cigars, pipes, bidis, kreteks, water pipes (hookahs), marijuana, chewing tobacco, snuff, or snus. Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. 30.8% 28.3% 27.4% 26.5% 22.3% Purchase ADD Current Smokers Percent, Adults, Kentucky 26.2% Page 71

72 Smoking Peer County Ranking In comparison to its peer counties, McCracken County (25.4%) ranked within the upper end of the two middle quartiles for the percent of adults (age 18+) who reported smoking cigarettes between 2006 and 2012, and also ranked above the U.S. median (21.7%) and the Healthy People 2020 Target (12.0%). Adult Smoking, McCracken County Percent, Adults (age 18+), % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Definition: smoking cigarettes all or some days. Page 72

73 Natality and Maternal Health The rate of deaths to infants less than one year of age per 1,000 births in McCracken County (7.3 per 1,000 births) is consistent with the state rate (7.0 per 1,000 births) and higher than the national rate (6.5 per 1,000 births) ( ). The percentage of total births that are low birth weight (<2,500g) in McCracken County (9.1%) is consistent with the state rate (9.1%) and slightly higher than the national rate (8.2%) ( ). The rate of total births to women (age 15 19) per 1,000 female population age in McCracken County (52.9 per 1,000) is slightly higher than the state (48.4 per 1,000) and national rates (36.6 per 1,000) ( ). Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 14, Page 73

74 Teen Births Peer County Ranking In comparison to its peer counties, McCracken County (52.9 per 1,000) ranked within the least favorable quartile for the rate of teen births between 2005 and 2011 and also ranked above the U.S. median (42.1 per 1,000) and the Healthy People 2020 Target (36.2 per 1,000). Teen Births, McCracken County Rates per 1,000, Females (age 15 19), Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 14, Page 74

75 Mental Health Depression The percentage of the Medicare fee forservice population with depression in McCracken County (19.6%) is consistent with the state rate (19.8%) and higher than the national rate (16.2%) (2014). Between 2012 and 2014, the percent of adults ever diagnosed with a depressive disorder in Purchase ADD increased while rates in the state remained steady. In 2014, the percent of adults ever diagnosed with a depressive disorder in Purchase ADD (22.0%) was slightly lower than the state rate (23.9%). Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 16, Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Definition: (Ever told) you have a depressive disorder, including depression, major depression, dysthymia, or minor depression? Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. 18.7% 22.0% 23.5% 23.9% 18.7% 20.2% Purchase ADD Depressive Disorder Percent, Adults, Kentucky Page 75

76 Older Adult Depression Peer County Ranking In comparison to its peer counties, McCracken County (15.0%) ranked within the least favorable quartile for the percent of older adults (age 65+) living with depression during 2012, and also ranked above the U.S. median (12.4%). Older Adult Depression, McCracken County Percent, Adults (age 65+), % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 16, Page 76

77 Preventive Care Screenings Mammography The percentage of female Medicare enrollees (age 67 69) who have received one or more mammograms in the past two years in McCracken County (68.3%) is higher than the state rate (63.8%) and the national rate (63.1%) (2014). In 2014, the percent of women (age 40+) who had a mammogram within the past 2 years in Purchase ADD (79.2%) was higher than the state rate (74.5%). Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 16, Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Mammography Percent, Women (age 40+) who had a mammogram within the past 2 years, % Purchase ADD Purchase ADD Kentucky 74.5% Kentucky Page 77

78 Preventive Care Screenings Sigmoidoscopy and Colonoscopy The percentage of adults (age 50+) who self reported that they have ever had a sigmoidoscopy or colonoscopy in McCracken County (73.0%) is higher than the state (61.4%) and national rates (61.3%) ( ). In 2014, the percent of adults (age 50+) who ever had a sigmoidoscopy or colonoscopy in Purchase ADD (75.6%) was higher than the state rate (69.6%). Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 16, Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Sigmoidoscopy or Colonoscopy Percent, Adults (ages 50+) who ever had a sigmoidoscopy or colonoscopy, % Purchase ADD Purchase ADD Kentucky 69.6% Kentucky Page 78

79 Preventive Care Immunizations (Influenza Vaccine) Between 2012 and 2014, the percent of adults (age 65+) that received a flu shot in the past year in Purchase ADD fluctuated, while rates in the state increased. In 2014, the percent of adults (age 65+) that received a flu shot in the past year in Purchase ADD (68.2%) was consistent with the state rate (68.9%). Influenza Vaccination Percent, Adults (ages 65+) who had a flu shot in the past year, % 68.2% 68.9% 65.6% 61.5% 61.8% Purchase ADD Kentucky Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Definition: During the past 12 months, have you had either a flu shot or a flu vaccine that was sprayed in your nose? Page 79

80 Preventive Care Immunizations (Pneumococcal Vaccine) The percentage of older adults (age 65+) who self reported having ever received a pneumonia vaccine in McCracken County (67.1%) is higher than the state rate (66.9%) and consistent with the national rate (67.5%) ( ). In 2014, the percent of adults (age 65+) who ever had a pneumococcal vaccination in Purchase ADD (68.1%) was slightly lower than the state rate (69.4%). Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 16, Source: Kentucky Department for Public Health, Cabinet for Health and Family Services: Kentucky Behavioral Risk Factor Surveillance System Survey Data, data accessed February 8, Definition: Have you ever had a pneumonia shot? Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Pneumonia Vaccination Percent, Adults (ages 65+) who ever had a pneumococcal vaccination, % 69.4% Purchase ADD Kentucky Page 80

81 Health Care Access Uninsured The percentage of the total civilian noninstitutionalized population without health insurance coverage in McCracken County (10.4%) is slightly lower than the state rate (11.4%) and the national rate (13.0%) ( ). As of 2016, McCracken County (7.0%) has a higher percentage of adults (age 18 64) that are uninsured than the state (6.1%). Between 2013 and 2016, McCracken County experienced a 12.0% decline in the percent of adults (age 18 64) that were uninsured as compared to a 13.1% decline in Kentucky. Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Uninsured Percent, Adults (age 18 64), 2013 & % Change 19.0% 19.2% 12.0% 13.1% 7.0% 6.1% Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 16, Source: Enroll America, County Level Snap Shots, data accessed February 13, McCracken County Kentucky Page 81

82 Uninsured Peer County Ranking In comparison to its peer counties, McCracken County (15.5%) ranked within the two middle quartiles for the percent of the population without health insurance in 2011, and also ranked below the U.S. median (17.7%). Uninsured, McCracken County Percent, Adults (age <65), % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 16, Page 82

83 Cost Barrier to Care Peer County Ranking In comparison to its peer counties, McCracken County (18.1%) ranked within the upper end of the two middle quartiles for the percent of adults who did not see a doctor due to cost between 2006 and 2012, and also ranked above the U.S. median (15.6%) and the Healthy People 2020 Target (9.0%). Cost Barrier to Care, McCracken County Percent, Adults (age 18+), % Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 16, Definition: Was there a time in the past 12 months when you needed to see a doctor but could not because of cost? Page 83

84 Health Care Access Provider Access The number of primary care providers per 100,000 population in McCracken County (90.3 per 100,000) is higher than the state rate (74.0 per 100,000) and the national rate (87.8 per 100,000) (2014). The number of dentists per 100,000 population in McCracken County (89.2 per 100,000) is higher than the state (61.8 per 100,000) and national (65.6 per 100,000) rates (2015). The rate of the population to the number of mental health providers in McCracken County (127.0 per 100,000) is lower than both the state (179.8 per 100,000) and national rates (202.8 per 100,000) (2016). Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 16, Definition: Doctors classified as "primary care physicians" by the AMA include: General Family Medicine MDs and DOs, General Practice MDs and DOs, General Internal Medicine MDs and General Pediatrics MDs. Physicians age 75 and over and physicians practicing sub specialties within the listed specialties are excluded. Definition: All dentists qualified as having a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), who are licensed by the state to practice dentistry and who are practicing within the scope of that license. Definition: Psychiatrists, psychologists, clinical social workers, and counselors that specialize in mental health care. Page 84

85 Health Care Access Peer County Ranking In comparison to its peer counties, McCracken County (97.2 per 100,000) ranked within the most favorable quartile for the rate of primary care providers per 100,000 persons in 2011 and also ranked above the U.S. median (48.0 per 100,000). Primary Care Provider Access, McCracken County Rate of Primary Care Providers per 100,000, Source: Centers for Disease Control and Prevention, Community Health Status Indicators, filtered for McCracken County, KY; data accessed February 16, Definition: primary care providers include those in general practice, internal medicine, obstetrics and gynecology, or pediatrics. Page 85

86 Health Care Access Barriers to Accessing Care Cost of health care may delay or inhibit patients from seeking preventive care. Between 2011 and 2015, the percentage of the population with insurance enrolled in Medicaid (or other means tested public health insurance) in McCracken County (21.8%) was lower than the state rate (23.7%) and consistent with the national rate (21.2%). Lack of accessible and available primary care resources for patients to access may lead to increased preventable hospitalizations. In 2014, the rate of preventable hospital events in McCracken County (68.6 per 1,000 Medicare Enrollees) was higher than that of the state (46.1 per 1,000 Medicare Enrollees) and higher than the nation (49.9 per 1,000 Medicare Enrollees). Source: Community Commons, Health Indicator Report: logged in and filtered for McCracken County, KY, data accessed February 16, Note: A green dial indicates that the county has a better rate than the state, and a red dial indicates that the county has a worse rate than the state. Definition: Ambulatory Care Sensitive (ACS) conditions include pneumonia, dehydration, asthma, diabetes, and other conditions which could have been prevented if adequate primary care resources were available and accessed by those patients. Page 86

87 Phone Interview Findings A review of the community input collected from persons with expert knowledge of public health in the community served by ContinueCARE Hospital at Baptist Health Paducah Page 87

88 Overview Conducted 12 interviews with the two groups outlined in Internal Revenue Service Final Regulations issued December 29, 2014 Discussed the health needs of the community, access issues, barriers and issues related to specific populations Gathered background information on each interviewee Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, Page 88

89 Interviewee Information Carla Berry: Senior Vice President Wealth Management, Paducah Bank and Trust Karen Burton: Emergency Services Coordinator and Volunteer Coordinator, Paducah Cooperative Ministry Kaylene Cornell: Health Education Coordinator, Purchase District Health Department Brandi Harless: Mayor, City of Paducah Sharon Jones: Vice President Community Support, Four Rivers Behavioral Health Wanda Jordan: Assistant Property Manager, Paducah Housing Authority Bob Leeper: County Judge, McCracken County Candace Melloy: Aging Program Director, Family Service Society Carolyn Roberts: Co Owner and President, Caring People Services Helen Sims: Owner and CEO, Superior Care Home Bobbie Winters: Administrative Manager, KentuckyCare Clinics Monique Zuber: Executive Director, United Way (Paducah and McCracken County) Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, Page 89

90 Areas Served by Organizations Organization Caring People Services City of Paducah Family Service Society Four Rivers Behavioral Health KentuckyCare Clinics McCracken County Paducah Bank and Trust Paducah Cooperative Ministry Paducah Housing Authority Purchase District Health Department Superior Care Home United Way (Paducah and McCracken County) Counties Served 7 County Region (including McCracken County) McCracken County McCracken County 9 County Region (including McCracken County) McCracken County McCracken County McCracken County McCracken County McCracken County Ballard/Carlisle/Fulton/Hickman/ McCracken Counties 8 County Region (including McCracken County) Whitley County The counties primarily served by the interviewees organizations are broken out in the chart to the left. Some of the organizations serve community members/patients in multiple counties. Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, Page 90

91 Interviewee Characteristics Work for a state, local, tribal or regional governmental public health department (or equivalent department or agency) with knowledge, information or expertise relevant to the health needs of the community 8.3% Member of a medically underserved, low income or minority populations in the community, or individuals or organizations serving or representing the interests of such populations 50.0% Community leaders (EX: Superior Care Home, Caring People Services, Paducah Bank and Trust, Mayor of City of Paducah) 41.7% Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, Page 91

92 Community Need Summary Interviewees discussed the following as the most significant health issues: Overall Access Issues Affordability of Care Access to Physicians Access to Substance Abuse and Mental Health Services Lack of Community Education and Preventive Care Lack of Community Health Care Literacy Increased Prevalence of Chronic Conditions Need for Healthy Lifestyle Changes Access to Dental Care Providers Transportation Barriers Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, Page 92

93 Overall Access Issues Affordability of Care Interviewees most often mentioned affordability as a reason for lack of access to health care. Lack of affordable health care was discussed as a potential reason for inappropriate usage of the ER. Those with government payors were mentioned as having the most difficulty in finding providers to accept them. The additional steps to participate in these programs were seen as barriers for physician involvement. Affordability of medications was also a concern to interviewees as even those with comprehensive health coverage may struggle to afford necessary medications. Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, Access to affordable health care in general. A lot of the uninsured or low income go to the emergency room. A lot of times doctors aren t taking new patients or aren t taking people with certain coverage. There are not enough primary care physicians willing to see those on Medicaid. I think the low income [population] has difficulty finding providers. A lot of our providers are opting out of various programs due to the red tape and paperwork. Many people can t afford their medications and will forego buying food or utilities in order to get their medications. Page 93

94 Overall Access Issues Access to Physicians Increased access to primary care providers and services was noted as a need in the community by the interviewees. Interviewees noted the quality of primary care physicians but the shortage of them in the community. Many practices are closed to new patients and are the gateway for patients to be referred to a specialist, further limiting specialist accessibility. The lack of local specialists was often mentioned when referring to physician access issues, specifically the following specialty services: Orthopedics Nephrology Cardiology Dermatology Endocrinology ENT Neurosurgery Oncology Pain Management Plastic Surgery Podiatry Pulmonology Urology Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, I do think we have good primary care doctors, we just don t have enough especially pediatricians. You have to get a referral from primary care and sometimes you can t get into a primary care physician. Endocrinologists and urologists. We don t have as many as we need in our community to help with diabetes. Also, pulmonologists are needed with the high incidences of COPD and asthma. We don t have any dermatologists and nephrology is really hard to get someone into especially for the Medicaid population. Pain management, orthopedics, podiatry, ENT are all hard to get someone into. Page 94

95 Access to Substance Abuse and Many interviewees mentioned the increasing need for mental health services, especially for those with substance abuse issues, despite having some resources in the community. Cost for treatment, especially for those who are unable to pay out of pocket, was mentioned as a barrier to treatment. The lack of dementia care for elderly patients was also mentioned as a need in the community. Mental Health Services Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, We definitely don t have enough mental health beds or counselors. We definitely have a huge problem with substance abuse, with alcohol being number one. Our communities need more help in that area as well as marijuana and opiates. There are hospital resources, but there isn t a wide variety of options. I don t think people can afford services if they don t have insurance. Mental health is an area where we are lacking. We have a great facility and new players on board in the region, but to date, we are lacking specifically with a youth inpatient treatment facility. This is an issue. There is a big lack for dementia care. This is a specialty that we need. Geriatric physicians especially for dementia care. Page 95

96 Lack of Community Education and Preventive Many interviewees mentioned the lack of health care literacy in the area and the strain this places on both patients as well as health care providers. The increase in chronic conditions has also stressed the health care system. High instances of smoking, heart issues as well as diabetes and obesity were mentioned. The availability of programs was noted as adequate in the county. The disconnect seems to be with awareness of these programs and adequate marketing and transportation for those most in need of health related programming. Care If you have diabetes with insurance, you can t get into specialists without a referral. Those without knowledge of the system will have a hard time navigating. Education about how to advocate for yourself in general with a medical professional is important. People don t know what to ask, and they may not understand. We have a high rate of smoking and chronic illnesses like cardiac disease along with diabetes and obesity issues as well. I think things like diabetes and other diseases like that will become even more common. People don t understand how our bodies work. In McCracken County, there are a lot of programs, but they are not publicized especially to the lower income. We struggle reaching out to the lower income and getting them involved. Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, Page 96

97 Access to Dental Care Providers Interviewees discussed the prevalence of dental care providers overall, but there is a lack of dental care providers who accept patients with no insurance or government payors. The lack of coverage of Medicaid and Medicare for dental services was also mentioned as a barrier to care. Though some basic services are covered, other urgent services are not. Interviewees mentioned that though many residents now have health coverage, the increase in dental coverage was not as prevalent. Dental services in Paducah were seen as an important resource for those who live in the surrounding counties that are lacking dental health services. We have quite a few dentists that take private insurance but very few with uninsured or underinsured. If you have Medicare or Medicaid, they don t cover a lot of things. So many of our elderly folks who have Medicare and Medicaid need dentures. They can get their teeth pulled but they can t pay for the plates. I think there are plenty of dentists in Paducah, but the disconnect seems to be with those who have health insurance but no dental health. There are some counties that don t even have a dentist in the county. That s a huge lack. Those that we do have can t take the Medicaid population that we have. Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, Page 97

98 Transportation Barriers The low income and elderly populations were mentioned most often as those who struggle with transportation needs and can be a strain on their providers. Interviewees discussed new health care resources in the area, but a lack of transportation resources for them to be fully utilized. The affordability and time constraints of the current public transportation system were seen as hindrances to its effectiveness for those who lack other transportation means. Transportation issues for the low income and elderly it s a huge challenge. They will schedule appointments but don t always have reliable transportation, and then try to reschedule their appointments, which can strain their relationship with their provider. Our public transportation system is doing the best they can, but it s not a sophisticated transportation system. It only runs certain times. We recruited a federally qualified clinic to town and that has really helped spread access to care. Now we need awareness and transportation to it. I think the transportation is the biggest hindrance for those who can t afford [it] especially for those who are wheelchair bound. Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, Page 98

99 Populations Most at Risk When asked about which specific groups are at risk for inadequate care, interviewees spoke about: Elderly Transportation is an issue for this population Difficulty navigating and understanding the health care system Lack of appropriate housing accommodations for this population Nonexistent adult day care options for family caregivers that are still working Teens/Adolescents Lack of understanding of the importance of good health High need for substance abuse programs and suicide prevention Un/Underinsured Higher instances of over utilization of emergency services Ability to access education and means to maintain a healthy lifestyle particularly fresh foods Capability of affording prescriptions when they are able to access health care services Lack of affordable dental services even for those with Medicare or Medicaid Source: ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Assessment Interviews Conducted by, January 24, 2017 February 3, Page 99

100 Community Health Reports A description of the community health assessments completed by the local health departments within CCH at Baptist Health Paducah s defined study area Page 100

101 Baptist Health Paducah 2015 Community Health Needs Assessment Priority #1: Obesity prevention and illnesses related to obesity To increase the awareness of obesity as a health threat to service area residents and to encourage healthier living through diet, exercise and other means. Goal 1: Increase the awareness of obesity as a health threat to service area residents Goal 2: Encourage healthier living through diet, exercise and other means Priority #2: Access to health care To ensure service area residents have appropriate access to health care services through primary care and specialist physician planning and office locations; ambulatory care facilities; new services; the hospital s call center; and education and healthcare screenings. Goal 1: Ensure service area residents have appropriate access to health care services through primary care and specialist physician planning and office locations Goal 2: Evaluate ambulatory care facilities and new service mixes to build as appropriate Goal 3: Utilize the hospital s call center to promote education and healthcare screenings Priority #3: Smoking To reduce the number of smokers in the service area. This will ultimately reduce the incidence of heart disease, cancer, respiratory illnesses and stroke. Baptist Health Paducah supports a state wide smoking ban in public places. Goal 1: Reduce the number of smokers in the service area Goal 2: Reduce the incidence of heart disease, cancer, respiratory illnesses, and stroke Goal 3: Support a state wide smoking ban in public spaces Source: Baptist Health Kentucky, Baptist Health Paducah 2015 Community Health Needs Assessment, information accessed March 28, Page 101

102 Baptist Health Paducah 2015 Community Health Needs Assessment Priority #4: Long term acute care To provide an appropriate level of care to patients in the service area needing acute inpatient medical treatment for an extended period. LTACHs provide services at a lower cost and higher quality for patients with high acuity illnesses. Goal 1: Provide an appropriate level of care to patients in the service are needing acute inpatient medical treatment for an extended period Goal 2: Educate healthcare providers and the public about how LTACHs provide services at a lower cost and higher quality for patients with high acuity illnesses Source: Baptist Health Kentucky, Baptist Health Paducah 2015 Community Health Needs Assessment, information accessed March 28, Page 102

103 2017 Preliminary Health Needs A list of common health needs that were identified by evaluating demographic data, health data, and responses from interviewees Page 103

104 2017 Preliminary Health Needs Access to Affordable Care and Reducing Health Disparities Among Specific Populations Access to Mental and Behavioral Health Care Services and Providers Access to Specialty Care Services and Providers Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Page 104

105 Prioritization A description of the process the hospital used to prioritize the identified health needs, as well as a final list of needs that the hospital will seek to address Page 105

106 The Prioritization Process On March 7, 2017 leadership from CCHBHP met with CHC ContinueCARE to review findings and prioritize the community s health needs. Attendees from the hospital included: Len McDade, President, CEO Mary Lou Young, CNO April Jones, HIM Coordinator/Medical Staff Coordinator Crystal Buck, Respiratory Therapy Manager Jennifer Duncan, Admissions Coordinator Leadership ranked the health needs based on three factors: Size and Prevalence of Issue Effectiveness of Interventions Hospital s Capacity See the following page for a more detailed description of the prioritization process. Page 106

107 The Prioritization Process The CHNA Team utilized the following factors to evaluate and prioritize the significant health needs. Page 107

108 Health Needs Ranking Hospital leadership participated in a ballot process to rank the health needs in order of importance, resulting in the following order: Final Score Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles 4.67 Access to Mental and Behavioral Health Care Services and Providers 4.67 Access to Specialty Care Services and Providers 4.00 Access to Affordable Care and Reducing Health Disparities Among Specific Populations Page 108

109 Final Priorities Hospital leadership decided to address two of the four ranked health needs. The final health priorities that the hospital will address through its Implementation Plan are: 1. Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles 2. Access to Affordable Care and Reducing Health Disparities Among Specific Populations Page 109

110 Priorities That Will Not Be Addressed A description of the rationale behind why the hospital chose not to address any particular priority Page 110

111 Priorities that will not be Addressed CCHBHP decided not to specifically address Access to Mental and Behavioral Health Care Services and Providers and Access to Specialty Care Services and Providers. CCHBHP is a long term acute care facility within Baptist Health Paducah. Based on CCHBHP s status as a long term acute care facility, the hospital has focused its capabilities on addressing the needs of this particular market. Therefore, Access to Mental and Behavioral Health Care Services and Providers and Access to Specialty Care Services and Providers are not directly addressed in the hospital s implementation plan. While CCHBHP acknowledges that these are significant needs in the community and will work with the host hospital to see how the facility can assist in these needs, the priorities listed above that will not be addressed by the hospital are not core business functions of the hospital and the leadership team felt that resources and efforts would be better spent addressing the remaining two prioritized needs. Page 111

112 Resources in the Community An extensive list of resources that are available in the community to address the identified health needs Page 112

113 Resources in the Community In addition to the services provided by CCHBHP, other charity care services and health resources available in McCracken County are included in this section. As part of a subsequent CHNA, additional questions may be added to the interview guide as potential measures to determine positive changes in the identified significant community health needs. Page 113

114 Organization Name Area Primarily Served List of Community Resources and Services in McCracken County, KY Address City State Zip Code Phone Website Services Provided McCracken County Health Department McCracken County 916 Kentucky Ave. Paducah KY cabinet forhealth and family servicespurchase district health Provides essential needs for people of the community dept paducah mccracken county health center at 916 kentucky ave paducahky 42001/ Homeless Shelter Paducah Cooperative Ministry McCracken County Adult Education Community Action Agency American Red Cross KY Adult Protective Services McCracken County McCracken County McCracken County McCracken, Murray, Marshal, Benton McCracken County 402 Legion Drive Paducah KY Alben Barkley Dr ministry.org/ Provide temporary shelter for homeless Paducah KY N/A Provides education for adults to obtain GED 709 S. 22nd St. #9 Paducah KY N/A Thrift store for less money 232 N. 8th St Paducah KY National Service for people who are in need 275 E. Main St., 1E Frankfort KY B p/adult+safety+branch.ht m State provided service through the Cabinet of Health and Family Services Heartland MCcCracken 619 N 30th Street Paducah KY Provides assistant for HIV/AIDS; Community Clinics Made to Stay Four Rivers Behavioral Health Alcoholics Anonymous PATS Transportation Guardian Family Services Merryman House United Way of Paducah McCracken County McCracken McCracken County McCracken County McCracken, Metropolis McCracken County McCracken County 126 Cambridge Dr Paduicah KY Broadway Street 1397 Irvin Cobb Drive 850 Harrison Strett 117 W 10th St. Provide transportation to appointments, grocery store etc Paducah KY rbh.org Provides Mental Health; Crisis Line Paducah KY Provides meetings for Alcoholics and rehab treatment Paducah KY Transportation for appointments Metropoli s IL IL N/A Domestic violence/homeless shelter 400 Berger Rd Paducah KY Homeless shelter for domestic violence victims US Bank Bldg, 333 Broadway St. # 502 Paducah KY rg Various Charity Sponsorship Lourdes Hospital McCracken 1530 Lone Oak Rd Paducah KY Short Term Hospital and Rehab Unit Page 114

115 Organization Name Reidland United Methodist Church Meals on Wheels Lourdes Home Health Baptist Home Health Paducah McCracken Community Health Center Purchase Health Department Area Primarily Served List of Community Resources and Services in McCracken County, KY Address City State Zip Code Phone Website Services Provided McCracken 5515 Reidland Rd Paducah KY Builds Ramps for people McCracken McCracken, Graves, Murray, Mayfield McCracken, Graves, Murray, Mayfield McCracken County McCracken County 1400 H.C. Mathis Drive Paducah KY Joe Clifton Dr. Paducah KY Lone Oak Rd. Paducah KY Kentucky Ave. Paducah KY seniors aducah/specialties/homecare org/li/paducah_mccracken _county_community_heat h_center_ky Delivers 1 Meal to citizens daily Provides home health services Provides home health services Provides WIC 916 Kentucky Ave. Paducah KY Provides Assistance for WIC Page 115

116 Information Gaps A description of any information gaps in the demographic or health data collected for this study Page 116

117 Information Gaps While the following information gaps exist in the health data section of this report, please note that every effort was made to compensate for these gaps in the interviews conducted by CHC ContinueCARE. This assessment seeks to address the community s health needs by evaluating the most current data available. However, published data inevitably lags behind due to publication and analysis logistics. Due to lower population numbers, various data elements specifically within the mortality data section required the combining of individual years to calculate statistical rates for reporting purposes. The most significant information gap exists within this assessment s ability to capture various county level health data indicators, such as influenza immunization rates. Data for this indicator is reported at the Area Development District level. Page 117

118 About A description of, which is the organization that collaborated with the hospital to conduct this assessment Page 118

119 About CCHBHP is part of, which owns and manages long term acute care hospitals. Based in Plano, Texas, CHC provides the resources and experience community hospitals need to improve quality outcomes, patient satisfaction and financial performance. For more information about CHC, please visit the website at Page 119

120 Appendix Summary of Data Sources Demographic Data Findings Health Data Findings HPSA and MUA/P Information Interview Biographies Priority Ballot Page 120

121 Summary of Data Sources Page 121

122 Summary of Data Sources Demographics This study utilized demographic data from Truven Health Analytics Market Expert Tool. This study also used health data collected by Community Commons, a site which is managed by the Institute for People Place and Possibility, the Center for Applied Research and Environmental Systems, and Community Initiatives. Data can be accessed at The Annie E. Casey Foundation is a private charitable organization, dedicated to helping build better futures for disadvantaged children in the United States. One of their initiatives is the Kids Count Data Center, which provides access to hundreds of measures of child well being by county and state; The United States Bureau of Labor Statistics, Local Area Unemployment Statistics provides unemployment statistics by county and state; The Community Health Status Indicators (CHSI) 2015 is an online web application that produces health status profiles for each of the 3,143 counties in the United States and the District of Columbia. Each county profile contains indicators of health outcomes (mortality and morbidity); indicators on factors selected based on evidence that they potentially have an important influence on population health status (e.g., health care access and quality, health behaviors, social factors, physical environment); health outcome indicators stratified by subpopulations (e.g., race and ethnicity); important demographic characteristics; and HP 2020 targets. A key feature of CHSI 2015 is the ability for users to compare the value of each indicator with those of demographically similar peer counties, as well as to the U.S. as a whole, and to HP 2020 targets. Selection of the method and variables for the new peer county groupings was based on an iterative process that was guided by the advice of subject matter experts (internal and external to CDC) including representatives from academia and architects of the original CHSI. The analysis yielded 89 peer groupings based on the following 19 county level equivalent variables for all 3,143 U.S. counties, including (but not limited to): population size, growth, density, and mobility; percent children and elderly; sex ratio; overall and elderly poverty levels; and unemployment. Please see the appendix for a full description of the CHSI methodology. More information can be accessed at Page 122

123 Summary of Data Sources Health Data The County Health Rankings are made available by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The Rankings measure the health of nearly all counties in the nation and rank them within states. The Rankings are compiled using county level measures from a variety of national and state data sources. These measures are standardized and combined using scientifically informed weights. The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play. Building on the work of America's Health Rankings, the University of Wisconsin Population Health Institute has used this model to rank the health of Wisconsin s counties every year since 2003; The Centers for Disease Control and Prevention National Center for Health Statistics WONDER Tool provides access to public health statistics and community health data including, but not limited to, mortality, chronic conditions, and communicable diseases; icd10.html. The Community Health Status Indicators (CHSI) 2015 is an online web application that produces health status profiles for each of the 3,143 counties in the United States and the District of Columbia. Please see more information regarding the CHSI Peer County tool within the Demographic Data on the previous page. More information can be accessed at This study utilizes Area Development District level data from the Behavioral Risk Factor Surveillance System (BRFSS), provided by the Kentucky Department for Public Health Cabinet for Health and Family Services; This study also used health data collected by Community Commons, a site which is managed by the Institute for People Place and Possibility, the Center for Applied Research and Environmental Systems, and Community Initiatives. Data can be accessed at Enroll America is a health care enrollment coalition that provides information regarding uninsured rates at the county level. Data can be accessed at The U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) provides Medically Underserved Area / Population and Health Professional Shortage Area scores, and can be accessed at: Phone Interviews conducted interviews on behalf CCHBHP from January 24, 2017 February 3, Interviews were conducted and summarized by Claire Acree, Planning Analyst. Page 123

124 Demographic Data Findings Page 124

125 Overall Population Growth Overall Population Growth Geographic Location % Change Change McCracken County 65,565 65,148 65, % Kentucky 4,339,367 4,436,515 4,524,773 88, % Source: Truven Health's Market Expert, data accessed January 27, Page 125

126 Population by Race/Ethnicity McCracken County Race/Ethnicity Change % Change White Non Hispanic 55,025 54,389 54, % Black 7,179 6,968 6, % Hispanic 1,383 1,648 1, % Asian % American Indian % All Others 1,321 1,368 1, % Total 65,565 65,148 65, % Kentucky Race/Ethnicity Change % Change White Non Hispanic 3,745,655 3,763,984 3,782,498 18, % Black 333, , ,105 21, % Hispanic 132, , ,011 23, % Asian 50,412 64,043 76,365 12, % American Indian 8,642 9,035 9, % All Others 68,747 81,753 93,439 11, % Total 4,339,367 4,436,515 4,524,773 88, % Source: Truven Health's Market Expert, data accessed January 27, Page 126

127 Population by Age <18 14, % 13, % % , % 20, % % , % 17, % % , % 13, % 1, % Total 65, % 65, % % Kentucky <18 1,010, % 1,006, % 3, % ,549, % 1,550, % % ,187, % 1,163, % 23, % , % 804, % 115, % Total 4,436, % 4,524, % 88, % Median Age Age Cohort 2016 % of Total 2021 % of Total Geographic Location Median Age McCracken County Kentucky United States Median Household Income McCracken County Age Cohort 2016 % of Total 2021 % of Total Source: Truven Health's Market Expert, data accessed January 27, Source: Truven Health's Market Expert, data accessed January 27, Geographic Location Median Income Change Count % McCracken County $42,828 $43,398 $ % Kentucky $40,597 $43,315 $2, % United States $48,280 $51,808 $3, % Source: Truven Health's Market Expert, data accessed January 27, Change Change % Change % Change Page 127

128 Economic Analysis Geographic Location Average Income Median Income Families Below Poverty Household Income $100K+ Education Bachelor / Advanced McCracken County $56,686 $42, % 14.5% 22.2% Kentucky $53,871 $40, % 17.0% 22.2% United States $63,215 $48, % 24.3% 29.4% Unemployment 2016 Economic Analysis Source: Truven Health's Market Expert, data accessed January 27, Annual Average Unemployment Rates (%) McCracken County 7.9% 7.0% 5.9% Kentucky 8.1% 6.5% 5.4% Source: Bureau of Labor Statistics, Local Area Unemployment Statistics, (rates shown are a percentage of the labor force), data accessed January 27, Page 128

129 Children (<18 years) Living Below Poverty, Overall Population Growth % Geographic Location Change Change Overall Population Growth 65,565 65,148 65, % Geographic Location 4,339,367 4,436,515 4,524,773 88, % Source: The Annie E. Casey Foundation, Kids Count Data Center, data accessed January 27, Page 129

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133 Health Data Findings Page 133

134 Kentucky McCracken (MK), KY Health Outcomes 42 Length of Life 61 Premature death 8,800 9,600 Quality of Life 29 Poor or fair health 24% 19% Poor physical health days Poor mental health days Low birthweight 9% 9% Health Factors 24 Health Behaviors 18 Adult smoking 26% 20% Adult obesity** 32% 32% Food environment index** Physical inactivity** 29% 28% Access to exercise opportunities 70% 73% Excessive drinking 14% 11% Alcohol impaired driving deaths 29% 34% Sexually transmitted infections** Teen births Clinical Care 5 Uninsured 17% 15% Primary care physicians 1,500:1 1,130:1 Dentists 1,610:1 1,110:1 Mental health providers 560:1 790:1 Preventable hospital stays Diabetic monitoring 86% 88% Mammography screening 58% 67% Social & Economic Factors 64 High school graduation** 88% 87% Some college 59% 61% Unemployment 6.5% 7.1% Children in poverty 26% 26% Income inequality Children in single parent households 34% 40% Social associations Page 134

135 Kentucky McCracken (MK), KY Violent crime** Injury deaths Physical Environment 114 Air pollution particulate matter Drinking water violations Yes Severe housing problems 14% 13% Driving alone to work 82% 87% Long commute driving alone 28% 15% ** Compare across states with caution Note: Blank values reflect unreliable or missing data 2016 Page 135

136 All Causes, Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATH DEATH DEATH RATE RATE RATE AGE ADJUSTED DEATHS DEATH RATE McCracken County 2, , , , Kentucky 130, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Accidents, Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATH DEATH DEATH RATE RATE RATE AGE ADJUSTED DEATHS DEATH RATE McCracken County Kentucky 7, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Alzheimer's Disease, Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATH DEATH DEATH RATE RATE RATE AGE ADJUSTED DEATHS DEATH RATE McCracken County Kentucky 4, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Atherosclerosis, Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Page 136

137 Cancer (Malignant neoplasms), Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATH DEATH DEATH RATE RATE RATE AGE ADJUSTED DEATHS DEATH RATE McCracken County Kentucky 29, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Cerebrovascular disease, Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATH DEATH DEATH RATE RATE RATE AGE ADJUSTED DEATHS DEATH RATE McCracken County Kentucky 6, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Chronic lower respiratory disease, Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATHS DEATH DEATH DEATH DEATH RATE RATE RATE RATE McCracken County Kentucky 9, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Diabetes mellitus, Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATH DEATH DEATH RATE RATE RATE AGE ADJUSTED DEATHS DEATH RATE McCracken County Kentucky 3, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Page 137

138 Diseases of heart, Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATH DEATH DEATH RATE RATE RATE AGE ADJUSTED DEATHS DEATH RATE McCracken County , Kentucky 29, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Influenza and Pneumonia, Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATH DEATH DEATH RATE RATE RATE AGE ADJUSTED DEATHS DEATH RATE McCracken County Kentucky 2, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Nephritis, nephrotic syndrome and nephrosis, Deaths per 100,000 Population, Age Adjusted, LOCATION AGE ADJUSTED DEATHS DEATH RATE AGE AGE DEATHS ADJUSTED ADJUSTED DEATHS DEATH DEATH RATE RATE AGE ADJUSTED DEATHS DEATH RATE McCracken County Kentucky 2, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Suicide (Intentional self harm), Deaths per 100,000 Population, Age Adjusted, LOCATION AGE AGE AGE DEATHS ADJUSTED ADJUSTED ADJUSTED DEATHS DEATHS DEATH DEATH DEATH RATE RATE RATE AGE ADJUSTED DEATHS DEATH RATE McCracken County Kentucky 2, , , , Source: Centers for Disease Control and Preven on, Na onal Center for Health Sta s cs, h p://wonder.cdc.gov/ucd-icd10.html; data accessed February 10, Page 138

139 2012 Kentucky Area Development District (ADD) Profiles Behavioral Risk Factor Surveillance System (BRFSS) Published: June 2012 Published: October 2012 Page 139

140 Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Table of Contents Executive Summary...3 Introduction...4 Statewide and Nationwide Prevalence Estimates...5 Area Development Districts Barren River...6 Big Sandy...7 Bluegrass...8 Buffalo Trace Cumberland Valley...10 FIVCO...11 Gateway...12 Green River...13 Kentucky River...14 KIPDA...15 Lake Cumberland...16 Lincoln Trail...17 Northern Kentucky...18 Pennyrile.19 Purchase Page 140

141 Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Executive Summary The following report consists of data collected by the Kentucky Behavioral Risk Factor Surveillance System (KY BRFSS) program for the calendar year The BRFSS is a collaborative project of the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health (KDPH). Currently, all 50 states and the District of Columbia participate in this surveillance system. The BRFSS objective is to collect uniform, state specific data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases that affect the adult population. CDC publishes the data collected by each state on their website. This website has data at state level but not at sub-state level. In most cases, each state constitutes a single stratum. However, to provide adequate sample sizes for smaller geographically defined populations of interest, some states sample disproportionately from strata defined to correspond to sub-state regions. In Kentucky we sample all fifteen Area Development Districts (ADD), each of which has 500 completes, so we currently have fifteen strata. The ADD level data is not available on the CDC website. The main purpose of this document is to provide data in a timely manner to the Area Development Districts so the local health departments can use this data for strategic planning and prioritize program management. BRFSS data can be used to identify emerging health problems, establish and track health objectives, and develop and evaluate public health policies and programs. It can also be used to support health-related legislative efforts. The program hopes that this report will be useful in assisting the districts in identifying the health needs within their region. The 2011 BRFSS data reflects the addition of cell-phone only respondents and a change in weighting methodology (raking replaces post-stratification). Due to these significant changes, the 2011 BRFSS data should be considered a baseline year for data analysis; It is not directly comparable to previous years of BRFSS data. Comparing 2011 BRFSS data with BRFSS data from previous years may cause misinterpretation of trend line shifts in prevalence estimates. The changes in BRFSS protocol are discussed in detail in the June 8, 2012, MMWR Policy Note "Methodologic Changes in the Behavioral Risk Factor Surveillance System in 2011 and Potential Effects on Prevalence Estimates." This note is available online at the CDC Surveillance resource Center Additionally, the Kentucky BRFSS program released a report tailored to the changes seen in Kentucky data. It is entitled Effect of Changes in BRFSS Protocols on 2011 Behavioral Risk Factor Surveillance Data in Kentucky and can be obtained from the Kentucky BRFSS website 3 Page 141

142 Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Introduction The Behavioral Risk Factor Surveillance System (BRFSS) is a cross-sectional telephone health survey jointly sponsored by the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health (KDPH). The survey is randomly administered to non-institutionalized civilian adults aged 18 or older living in a household. Participation in the survey is strictly voluntary. Personal identifying information, such as a person s name or address, is not collected. The BRFSS is a nationwide surveillance tool. In Kentucky, the BRFSS has been conducted continuously since This document presents a data profile of each Area Development District (ADD) based on prevalence data collected from the 2011 Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Survey. Kentucky has 120 Counties that are divided into 15 ADDs for the planning of a variety of programs. Data for this report are analyzed by ADDs, rather than by county, because sample sizes for most counties are too small to provide statistically reliable estimates. Statewide and nationwide prevalence estimates have been included for comparison. Barren River: Big Sandy: Bluegrass: Buffalo Trace: Cumberland Valley: FIVCO : Gateway: Green River: Kentucky River: KIPDA: Lake Cumberland: Lincoln Trail: Northern Kentucky: Pennyrile: Purchase: Counties in each ADD Allen, Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Monroe, Simpson, Warren Floyd, Johnson, Magoffin, Martin, Pike Anderson, Bourbon, Boyle, Clark, Estill, Fayette, Franklin, Garrard, Harrison, Jessamine, Lincoln, Madison, Mercer, Nicholas, Powell, Scott, Woodford Bracken, Fleming, Lewis, Mason, Robertson Bell, Clay, Harlan, Jackson, Knox, Laurel, Rockcastle, Whitley Boyd, Carter, Elliott, Greenup, Lawrence Bath, Menifee, Montgomery, Morgan, Rowan Daviess, Hancock, Henderson, McLean, Ohio, Union, Webster Breathitt, Knott, Lee, Leslie, Letcher, Owsley, Perry, Wolfe Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, Trimble Adair, Casey, Clinton, Cumberland, Green, McCreary, Pulaski, Russell, Taylor, Wayne Breckinridge, Grayson, Hardin, Larue, Marion, Meade, Nelson, Washington Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Owen, Pendleton Caldwell, Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd, Trigg Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, McCracken, Marshall This report was prepared by Seth Siameh, BRFSS Epidemiologist, and Sarojini Kanotra, BRFSS Director and Coordinator. Questions concerning this report should be directed to Seth.Siameh@ky.gov or Sarojini.Kanotra@ky.gov. Suggested citation: Kentucky Behavioral Risk Factor Surveillance System Survey Data. Department for Public Health, Cabinet for Health and Family Services, Frankfort, Kentucky, [2011] 4 Page 142

143 Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) List of Variables Nationwide * (States and DC) Kentucky Median % % 95% CI Alcohol Consumption Adults who reported heavy drinking Adults who reported binge drinking Arthritis Adults who have arthritis Asthma Adults who currently have asthma Lifetime asthma prevalence among adults Cardiovascular Disease Adults who have ever had a heart attack Adults who have coronary heart disease Adults who have ever had a stroke Cholesterol Awareness Adults who had their blood cholesterol checked in past 5 years Adults with high blood cholesterol Diabetes Adults who have Diabetes Disability Adults with limited activity due to physical, mental, or emotional problems Adults with health problem(s) that requires the use of special equipment General Health Status Adults who reported good or better health Health Care Access/Coverage Adults who have health care coverage Adults aged who have health care coverage HIV Screening Test (Age 18-64) Adults who have ever been tested for HIV Not Available Hypertension Awareness Adults who have high blood pressure Immunization Adults aged 65+ who had a flu shot in past year Adults aged 65+ who have ever had a pneumococcal vaccination Overweight and Obesity (BMI) Adults who are overweight (BMI = ) Adults who are obese (BMI 30.0) Physical Activity Adults who participate in any physical activity Tobacco Use Adults who are current smokers *Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2011] 5 Page 143

144 Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Purchase Kentucky Purchase ADD % 95% CI % 95% CI Alcohol Consumption Adults who reported heavy drinking Adults who reported binge drinking Arthritis Adults who have arthritis Asthma Adults who currently have asthma Lifetime asthma prevalence among adults Cardiovascular Disease Adults who have ever had a heart attack Adults who have coronary heart disease Adults who have ever had a stroke Cholesterol Awareness Adults who had their blood cholesterol checked in past 5 years Adults with high blood cholesterol Diabetes Adults who have Diabetes Disability Adults with limited activity due to physical, mental, or emotional problems Adults with health problem(s) that requires the use of special equipment General Health Status Adults who reported good or better health Health Care Access/Coverage Adults who have health care coverage Adults aged who have health care coverage HIV Screening Test (Age 18-64) Adults who have ever been tested for HIV Hypertension Awareness Adults who have high blood pressure Immunization Adults aged 65+ who had a flu shot in past year Adults aged 65+ who have ever had a pneumococcal vaccination Overweight and Obesity (BMI) Adults who are overweight (BMI = ) Adults who are obese(bmi 30.0) Physical Activity Adults who participate in any physical activity Tobacco Use Adults who are current smokers % = Percentage, CI = Confidence Interval. All Percentages are weighted to population characteristics. N/A = Not available if the unweighted sample size for the denominator was < 50 or the CI half width was > 10 for any cell. Data Source: Kentucky BRFSS Survey Page 144

145 Kentucky Area Development District (ADD) Profiles Behavioral Risk Factor Surveillance System (BRFSS) 2013 BooneKentonCampbell Gallatin PendletonBracken Trimble Carroll Grant Mason Owen Robertson «4 Greenup Oldham Henry Harrison Lewis «10 Fleming Boyd Nicholas Carter Shelby Scott Franklin Jefferson Bourbon Rowan ««6 Bath Woodford «7 Elliott Spencer Fayette Bullitt Anderson Montgomery Lawrence Meade 3 Clark Menifee Morgan Nelson Johnson Henderson Hancock Jessamine Powell Breckinridge Mercer «8 Daviess Hardin Madison Wolfe Martin Washington Union Estill Magoffin ««12 Boyle Garrard Lee Floyd 2 Webster McLean Marion Larue Breathitt Ohio Grayson Lincoln Pike Jackson Owsley Crittenden Taylor Casey Rockcastle Hopkins Knott Hart Perry Green Livingston Muhlenberg ««14 Butler Edmonson «11 Clay Caldwell Laurel ««9 «1 Adair Pulaski 5 Leslie Letcher BallardMcCracken Lyon Warren Metcalfe Russell 15 Marshall Christian Logan Barren Knox Carlisle Trigg Todd Harlan Cumberland Wayne Graves Simpson Allen Whitley Monroe Clinton McCreary Bell Hickman Calloway Fulton «13 Page 145

146 Table of Contents Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Executive Summary...3 Introduction...4 Statewide and Nationwide Prevalence Estimates. 5 Area Development Districts Barren River Big Sandy...7 Bluegrass Buffalo Trace Cumberland Valley...10 FIVCO...11 Gateway...12 Green River...13 Kentucky River...14 KIPDA...15 Lake Cumberland...16 Lincoln Trail...17 Northern Kentucky...18 Pennyrile.19 Purchase...20 Legend for Kentucky ADD Map on Cover Page 1. Barren River ADD 5. Cumberland Valley ADD 2. Big Sandy ADD 6. FIVCO ADD 3. Bluegrass ADD 7. Gateway ADD 4. Buffalo Trace ADD 8. Green River ADD 9. Kentucky River ADD 10. KIPDA ADD 11. Lake Cumberland ADD 12. Lincoln Trail ADD 13. Northern Kentucky ADD 14. Pennyrile ADD 15. Purchase ADD Report Published: September 2013 Page 2 Page 146

147 Executive Summary Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) The following report consists of data collected by the Kentucky Behavioral Risk Factor Surveillance System (KY BRFSS) program for the calendar year The BRFSS is a collaborative project of the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health (KDPH). Currently, all 50 states and the District of Columbia participate in this surveillance system. The BRFSS objective is to collect uniform, state specific data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases that affect the adult population. CDC publishes the data collected by each state on their website. This website has data at state level but not at sub-state level. In most cases, each state constitutes a single stratum. However, to provide adequate sample sizes for smaller geographically defined populations of interest, some states sample disproportionately from strata defined to correspond to sub-state regions. In Kentucky we sample all fifteen Area Development Districts (ADD), each of which has 500 completes, so we currently have fifteen strata. The ADD level data is not available on the CDC website. The main purpose of this document is to provide data in a timely manner to the Area Development Districts so the local health departments can use this data for strategic planning and prioritize program management. BRFSS data can be used to identify emerging health problems, establish and track health objectives, and develop and evaluate public health policies and programs. It can also be used to support health-related legislative efforts. The program hopes that this report will be useful in assisting the districts in identifying the health needs within their region. The 2012 BRFSS data reflects the addition of cell-phone only respondents and a change in weighting methodology (raking replaces post-stratification). Due to these significant changes, the 2012 BRFSS data should be compared only to 2011 BRFSS which serves as the baseline for data analysis; It is not directly comparable to BRFSS data collected before Comparing 2012 BRFSS data with BRFSS data from years prior to 2011 may cause misinterpretation of trend line shifts in prevalence estimates. The changes in BRFSS protocol occurred in 2011 and are discussed in detail in the June 8, 2012, MMWR Policy Note "Methodologic Changes in the Behavioral Risk Factor Surveillance System in 2011 and Potential Effects on Prevalence Estimates." This note is available online at the CDC Surveillance resource Center Additionally, the Kentucky BRFSS program released a report tailored to the changes seen in Kentucky data. It is entitled Effect of Changes in BRFSS Protocols on 2011 Behavioral Risk Factor Surveillance Data in Kentucky and can be obtained from the Kentucky BRFSS website Page 3 Page 147

148 Introduction Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) The Behavioral Risk Factor Surveillance System (BRFSS) is a cross-sectional telephone health survey jointly sponsored by the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health (KDPH). The survey is randomly administered to non-institutionalized civilian adults aged 18 or older living in a household. Participation in the survey is strictly voluntary. Personal identifying information, such as a person s name or address, is not collected. The BRFSS is a nationwide surveillance tool. In Kentucky, the BRFSS has been conducted continuously since This document presents a data profile of each Area Development District (ADD) based on prevalence data collected from the 2012 Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Survey. Kentucky has 120 Counties that are divided into 15 ADDs for the planning of a variety of programs. Data for this report are analyzed by ADDs, rather than by county, because sample sizes for most counties are too small to provide statistically reliable estimates. Statewide and nationwide prevalence estimates have been included for comparison. Barren River: Big Sandy: Bluegrass: Buffalo Trace: Cumberland Valley: FIVCO : Gateway: Green River: Kentucky River: KIPDA: Lake Cumberland: Lincoln Trail: Northern Kentucky: Pennyrile: Purchase: Counties in each ADD Allen, Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Monroe, Simpson, Warren Floyd, Johnson, Magoffin, Martin, Pike Anderson, Bourbon, Boyle, Clark, Estill, Fayette, Franklin, Garrard, Harrison, Jessamine, Lincoln, Madison, Mercer, Nicholas, Powell, Scott, Woodford Bracken, Fleming, Lewis, Mason, Robertson Bell, Clay, Harlan, Jackson, Knox, Laurel, Rockcastle, Whitley Boyd, Carter, Elliott, Greenup, Lawrence Bath, Menifee, Montgomery, Morgan, Rowan Daviess, Hancock, Henderson, McLean, Ohio, Union, Webster Breathitt, Knott, Lee, Leslie, Letcher, Owsley, Perry, Wolfe Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, Trimble Adair, Casey, Clinton, Cumberland, Green, McCreary, Pulaski, Russell, Taylor, Wayne Breckinridge, Grayson, Hardin, Larue, Marion, Meade, Nelson, Washington Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Owen, Pendleton Caldwell, Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd, Trigg Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, McCracken, Marshall This report was prepared by Seth Siameh, BRFSS Epidemiologist, and Sarojini Kanotra, BRFSS Director and Coordinator. Questions concerning this report should be directed to Seth.Siameh@ky.gov or Sarojini.Kanotra@ky.gov. Suggested citation: Kentucky Behavioral Risk Factor Surveillance System Survey Data. Department for Public Health, Cabinet for Health and Family Services, Frankfort, Kentucky, [2012] Page 4 Page 148

149 Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) List of Variables Nationwide * (States and DC) Kentucky Median % % 95% CI Alcohol Consumption Adults who reported heavy drinking Adults who reported binge drinking Arthritis Adults who have doctor-diagnosed arthritis Cardiovascular Disease Adults who have ever had a heart attack Adults who have coronary heart disease Adults who have ever had a stroke Colorectal Cancer Screening Adults aged 50+ who had a blood stool test within past two years Adults aged 50+ who have ever had a sigmoidoscopy or colonoscopy Depression Adults who have ever been diagnosed with a depressive disorder Diabetes Adults who have Diabetes Disability Adults who are limited in any activities because of health problems Adults with health problem(s) that require use of special equipment Exercise Adults who participate in any leisure-time physical activity General Health Status Adults who reported good or better health Health Care Access/Coverage Adults who have health care coverage Adults aged who have health care coverage HIV Screening Test (Age 18-64) Adults aged who have ever been tested for HIV Not Available Immunization Adults aged 65+ who had a flu shot in past year Adults aged 65+ who have ever had a pneumococcal vaccination Oral Health Adults aged 65+ who had all their natural teeth extracted Adults who visited dentist or dental clinic in past year Overweight and Obesity (BMI) Adults who are overweight (BMI = ) Adults who are obese (BMI 30.0) Prostate Cancer Men aged 40+ who had a PSA test within the past two years Respiratory Disease Adults who currently have asthma Adults who have COPD, emphysema, or chronic bronchitis Tobacco Use Adults who are current smokers Women s Health Women aged 18+ who had a Pap test within the past three years Women aged 40+ who had a mammogram within the past two years *Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2012] Page 5 Page 149

150 Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Purchase Kentucky Purchase ADD % 95% CI % 95% CI Alcohol Consumption Adults who reported heavy drinking Adults who reported binge drinking Arthritis Adults who have doctor-diagnosed arthritis Cardiovascular Disease Adults who have ever had a heart attack Adults who have coronary heart disease Adults who have ever had a stroke Colorectal Cancer Screening Adults aged 50+ who had a blood stool test within past two years Adults aged 50+ who ever had a sigmoidoscopy or colonoscopy Depression Adults who have ever been diagnosed with a depressive disorder Diabetes Adults who have Diabetes Disability Adults who are limited in any activities because of health problems Adults with health problem(s) that require use of special equipment Exercise Adults who participate in any leisure-time physical activity General Health Status Adults who reported good or better health Health Care Access/Coverage Adults who have health care coverage Adults aged who have health care coverage HIV Screening Test (Age 18-64) Adults aged who have ever been tested for HIV Immunization Adults aged 65+ who had a flu shot in past year Adults aged 65+ who have ever had a pneumococcal vaccination Oral Health Adults aged 65+ who had all their natural teeth extracted Adults who visited the dentist or dental clinic within the past year Overweight and Obesity (BMI) Adults who are overweight (BMI = ) Adults who are obese (BMI 30.0) Prostate Cancer Men aged 40+ who had a PSA test within the past two years N/A Respiratory Disease Adults who currently have asthma Adults who have COPD, emphysema, or chronic bronchitis Tobacco Use Adults who are current smokers Women s Health Women aged 18+ who had a Pap test within the past three years Women aged 40+ who had a mammogram within the past two years % = Percentage, CI = Confidence Interval. All Percentages are weighted to population characteristics. N/A = Not available if the unweighted sample size for the denominator was < 50 or the CI half width was > 10 for any cell. Data Source: Kentucky BRFSS Survey 2012 Page 20 Page 150

151 Kentucky Area Development District (ADD) Profiles Behavioral Risk Factor Surveillance System (BRFSS) 2014 Page 151

152 Table of Contents Executive Summary... 3 Introduction... 4 Statewide and Nationwide Prevalence Estimates Area Development Districts Barren River Big Sandy... 7 Bluegrass Buffalo Trace Cumberland Valley FIVCO Gateway Green River Kentucky River KIPDA...15 Lake Cumberland Lincoln Trail Northern Kentucky Pennyrile.19 Purchase...20 Legend for Kentucky ADD Map on Cover Page 1. Barren River ADD 5. Cumberland Valley ADD 2. Big Sandy ADD 6. FIVCO ADD 3. Bluegrass ADD 7. Gateway ADD 4. Buffalo Trace ADD 8. Green River ADD 9. Kentucky River ADD 10. KIPDA ADD 11. Lake Cumberland ADD 12. Lincoln Trail ADD 13. Northern Kentucky ADD 14. Pennyrile ADD 15. Purchase ADD ContinueCARE Hospital at Baptist Health Paducah Community Health Needs Page Assessment 2 and Implementation Plan Page 152

153 Executive Summary The following report consists of data collected by the Kentucky Behavioral Risk Factor Surveillance System (KY BRFSS) program in calendar year The KY BRFSS is a collaborative project of the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health (KDPH). Currently, all 50 states and the District of Columbia participate in this surveillance system. The BRFSS objective is to collect uniform, state specific data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases that affect the adult population. CDC publishes the data collected by each state on their website. This website has data at state level but not at sub-state level. In most cases, each state constitutes a single stratum. However, to provide adequate sample sizes for smaller geographically defined populations of interest, some states sample disproportionately from strata defined to correspond to sub-state regions. In Kentucky we sample all fifteen Area Development Districts (ADD), each of which has 500 completes, so we currently have fifteen strata. The ADD level data is not available on the CDC website. The main purpose of this document is to provide data in a timely manner to the Area Development Districts so the local health departments can use this data for strategic planning and prioritize program management. BRFSS data can be used to identify emerging health problems, establish and track health objectives, and develop and evaluate public health policies and programs. It can also be used to support health-related legislative efforts. The program hopes that this report will be useful in assisting the districts in identifying the health needs within their region. The 2013 BRFSS data reflects the addition of cell-phone only respondents and a change in weighting methodology (raking replaces post-stratification). Due to these significant changes, the 2013 BRFSS data should only be compared to 2011 BRFSS (which serves as the new baseline for data analysis) or to 2012 BRFSS data; It is not directly comparable to BRFSS data collected before Comparing 2013 BRFSS data with BRFSS data from years prior to 2011 may cause misinterpretation of trend line shifts in prevalence estimates. The changes in BRFSS protocol occurred in 2011 and are discussed in detail in the June 8, 2012, MMWR Policy Note "Methodologic Changes in the Behavioral Risk Factor Surveillance System in 2011 and Potential Effects on Prevalence Estimates." This note is available online at the CDC Surveillance resource Center Additionally, the Kentucky BRFSS program released a report tailored to the changes seen in Kentucky data. It is entitled Effect of Changes in BRFSS Protocols on 2011 Behavioral Risk Factor Surveillance Data in Kentucky and can be obtained from the Kentucky BRFSS website Page 153

154 Introduction The Behavioral Risk Factor Surveillance System (BRFSS) is a cross-sectional telephone health survey jointly sponsored by the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health (KDPH). The survey is randomly administered to non-institutionalized civilian adults aged 18 or older living in a household. Participation in the survey is strictly voluntary. Personal identifying information, such as a person s name or address, is not collected. The BRFSS is a nationwide surveillance tool. In Kentucky, the BRFSS has been conducted continuously since This document presents a data profile of each Area Development District (ADD) based on prevalence data collected from the 2013 Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Survey. Kentucky has 120 Counties that are divided into 15 ADDs for the planning of a variety of programs. Data for this report are analyzed by ADDs, rather than by county, because sample sizes for most counties are too small to provide statistically reliable estimates. Statewide and nationwide prevalence estimates have been included for comparison. Barren River: Big Sandy: Bluegrass: Buffalo Trace: Cumberland Valley: FIVCO: Gateway: Green River: Kentucky River: KIPDA: Lake Cumberland: Lincoln Trail: Northern Kentucky: Pennyrile: Purchase: Counties in each ADD Allen, Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Monroe, Simpson, Warren Floyd, Johnson, Magoffin, Martin, Pike Anderson, Bourbon, Boyle, Clark, Estill, Fayette, Franklin, Garrard, Harrison, Jessamine, Lincoln, Madison, Mercer, Nicholas, Powell, Scott, Woodford Bracken, Fleming, Lewis, Mason, Robertson Bell, Clay, Harlan, Jackson, Knox, Laurel, Rockcastle, Whitley Boyd, Carter, Elliott, Greenup, Lawrence Bath, Menifee, Montgomery, Morgan, Rowan Daviess, Hancock, Henderson, McLean, Ohio, Union, Webster Breathitt, Knott, Lee, Leslie, Letcher, Owsley, Perry, Wolfe Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, Trimble Adair, Casey, Clinton, Cumberland, Green, McCreary, Pulaski, Russell, Taylor, Wayne Breckinridge, Grayson, Hardin, Larue, Marion, Meade, Nelson, Washington Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Owen, Pendleton Caldwell, Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd, Trigg Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, McCracken, Marshall This report was prepared by Seth Siameh, BS, MPHc, BRFSS Epidemiologist, and Sarojini Kanotra, MS, PhD, MPH, BRFSS Director and Coordinator. Questions concerning this report should be directed to Seth.Siameh@ky.gov or Sarojini.Kanotra@ky.gov. Suggested citation: Kentucky Behavioral Risk Factor Surveillance System Survey Data. Department for Public Health, Cabinet for Health and Family Services, Frankfort, Kentucky, [2013] Page 154

155 List of Variables Nationwide * (States and DC) Kentucky Median % % 95% CI Alcohol Consumption Adults who reported heavy drinking Adults who reported binge drinking Arthritis Adults who have arthritis Cardiovascular Disease Adults who have ever had a heart attack Adults who have coronary heart disease Adults who have ever had a stroke Cholesterol Awareness Adults who had their blood cholesterol checked in past 5 years Adults with high blood cholesterol Depression Adults who have ever been diagnosed with a depressive disorder Diabetes Adults who have diabetes Disability Adults with limited activity due to physical, mental, or emotional problems Adults with health problem(s) that requires the use of special equipment General Health Status Adults who reported good or better health Health Care Access/Coverage Adults who have health care coverage Adults aged who have health care coverage HIV Screening Test Adults who have ever been tested for HIV Hypertension Awareness Adults who have high blood pressure Immunization Adults aged 65+ who had a flu shot in past year Adults aged 65+ who have ever had a pneumococcal vaccination Overweight and Obesity (BMI) Adults who are overweight (BMI = ) Adults who are obese (BMI 30.0) Physical Activity Adults who participate in any physical activity Respiratory Disease Adults who currently have asthma Adults who have COPD, emphysema, or chronic bronchitis Tobacco Use Adults who are current smokers *Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2013] Data collected in calendar year 2013 Page 155

156 Purchase Kentucky Purchase ADD % 95% CI % 95% CI Alcohol Consumption Adults who reported heavy drinking N/A Adults who reported binge drinking Arthritis Adults who have arthritis Cardiovascular Disease Adults who have ever had a heart attack Adults who have coronary heart disease Adults who have ever had a stroke Cholesterol Awareness Adults who had their blood cholesterol checked in past 5 years Adults with high blood cholesterol Depression Adults who have ever been diagnosed with a depressive disorder Diabetes Adults who have diabetes Disability Adults with limited activity due to physical, mental, or emotional problems Adults with health problem(s) that requires the use of special equipment General Health Status Adults who reported good or better health Health Care Access/Coverage Adults who have health care coverage Adults aged who have health care coverage HIV Screening Test Adults who have ever been tested for HIV Hypertension Awareness Adults who have high blood pressure Immunization Adults aged 65+ who had a flu shot in past year Adults aged 65+ who have ever had a pneumococcal vaccination Overweight and Obesity (BMI) Adults who are overweight (BMI = ) Adults who are obese (BMI 30.0) Physical Activity Adults who participate in any physical activity Respiratory Disease Adults who currently have asthma Adults who have COPD, emphysema, or chronic bronchitis Tobacco Use Adults who are current smokers % = Percentage, CI = Confidence Interval. All Percentages are weighted to population characteristics. N/A = Not available if the unweighted sample size for the denominator was < 50 or the Relative Standard Error (RSE) is > 0.3 for any cell. Data collected in calendar year 2013 Page 156

157 Kentucky Area Development District (ADD) Profiles Behavioral Risk Factor Surveillance System (BRFSS) 2015 BooneKentonCampbell Gallatin PendletonBracken Trimble Carroll Grant Mason Owen Robertson «4 Greenup Oldham Henry Harrison Lewis «10 Fleming Boyd Nicholas Carter Shelby Scott Franklin Jefferson Bourbon Rowan ««6 Bath Woodford «7 Elliott Spencer Fayette Bullitt Anderson Montgomery Lawrence Meade 3 Clark Menifee Morgan Nelson Johnson Henderson Hancock Jessamine Powell Breckinridge Mercer «8 Daviess Hardin Madison Wolfe Martin Washington Union Estill Magoffin ««12 Boyle Garrard Lee Floyd 2 Webster McLean Marion Larue Breathitt Ohio Grayson Lincoln Pike Jackson Owsley Crittenden Taylor Casey Rockcastle Hopkins Knott Hart Perry Green Livingston Muhlenberg ««14 Butler Edmonson «11 Clay Caldwell Laurel ««9 «1 Adair Pulaski 5 Leslie Letcher BallardMcCracken Lyon Warren Metcalfe Russell 15 Marshall Christian Logan Barren Knox Carlisle Trigg Todd Harlan Cumberland Wayne Graves Simpson Allen Whitley Monroe Clinton McCreary Bell Hickman Calloway Fulton «13 Page 157

158 Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Table of Contents Executive Summary...3 Introduction...4 Statewide and Nationwide Prevalence Estimates. 5 Area Development Districts Barren River Big Sandy...7 Bluegrass Buffalo Trace Cumberland Valley...10 FIVCO...11 Gateway...12 Green River...13 Kentucky River...14 KIPDA...15 Lake Cumberland...16 Lincoln Trail...17 Northern Kentucky...18 Pennyrile.19 Purchase...20 Legend for Kentucky ADD Map on Cover Page 1. Barren River ADD 5. Cumberland Valley ADD 2. Big Sandy ADD 6. FIVCO ADD 3. Bluegrass ADD 7. Gateway ADD 4. Buffalo Trace ADD 8. Green River ADD 9. Kentucky River ADD 10. KIPDA ADD 11. Lake Cumberland ADD 12. Lincoln Trail ADD 13. Northern Kentucky ADD 14. Pennyrile ADD 15. Purchase ADD Report Published: July 2015 Page 2 Page 158

159 Executive Summary Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) The following report consists of data collected by the Kentucky Behavioral Risk Factor Surveillance System (KY BRFSS) program for the calendar year The BRFSS is a collaborative project of the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health (KDPH). Currently, all 50 states and the District of Columbia participate in this surveillance system. The BRFSS objective is to collect uniform, state specific data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases that affect the adult population. CDC publishes the data collected by each state on their website. This website has data at state level but not at sub-state level. In most cases, each state constitutes a single stratum. However, to provide adequate sample sizes for smaller geographically defined populations of interest, some states sample disproportionately from strata defined to correspond to sub-state regions. In Kentucky we sample all fifteen Area Development Districts (ADD), each of which has 500 completes, so we currently have fifteen strata. The ADD level data is not available on the CDC website. The main purpose of this document is to provide data in a timely manner to the Area Development Districts so the local health departments can use this data for strategic planning and prioritize program management. BRFSS data can be used to identify emerging health problems, establish and track health objectives, and develop and evaluate public health policies and programs. It can also be used to support health-related legislative efforts. The program hopes that this report will be useful in assisting the districts in identifying the health needs within their region. The 2014 BRFSS data reflects the addition of cell-phone only respondents and a change in weighting methodology (raking replaces post-stratification). Due to these significant changes, the 2014 BRFSS data should only be compared to BRFSS data. It is not directly comparable to BRFSS data collected before Comparing 2014 BRFSS data with BRFSS data from years prior to 2011 may cause misinterpretation of trend line shifts in prevalence estimates. The changes in BRFSS protocol occurred in 2011 and are discussed in detail in the June 8, 2012, MMWR Policy Note "Methodologic Changes in the Behavioral Risk Factor Surveillance System in 2011 and Potential Effects on Prevalence Estimates." This note is available online at the CDC Surveillance resource Center Additionally, the Kentucky BRFSS program released a report tailored to the changes seen in Kentucky data. It is entitled Effect of Changes in BRFSS Protocols on 2011 Behavioral Risk Factor Surveillance Data in Kentucky and can be obtained from the Kentucky BRFSS website Page 3 Page 159

160 Introduction Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) The Behavioral Risk Factor Surveillance System (BRFSS) is a cross-sectional telephone health survey jointly sponsored by the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health (KDPH). The survey is randomly administered to non-institutionalized civilian adults aged 18 or older living in a household. Participation in the survey is strictly voluntary. Personal identifying information, such as a person s name or address, is not collected. The BRFSS is a nationwide surveillance tool. In Kentucky, the BRFSS has been conducted continuously since This document presents a data profile of each Area Development District (ADD) based on prevalence data collected from the 2014 Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Survey. Kentucky has 120 Counties that are divided into 15 ADDs for the planning of a variety of programs. Data for this report are analyzed by ADDs, rather than by county, because sample sizes for most counties are too small to provide statistically reliable estimates. Statewide and nationwide prevalence estimates have been included for comparison. Barren River: Big Sandy: Bluegrass: Buffalo Trace: Cumberland Valley: FIVCO : Gateway: Green River: Kentucky River: KIPDA: Lake Cumberland: Lincoln Trail: Northern Kentucky: Pennyrile: Purchase: Counties in each ADD Allen, Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Monroe, Simpson, Warren Floyd, Johnson, Magoffin, Martin, Pike Anderson, Bourbon, Boyle, Clark, Estill, Fayette, Franklin, Garrard, Harrison, Jessamine, Lincoln, Madison, Mercer, Nicholas, Powell, Scott, Woodford Bracken, Fleming, Lewis, Mason, Robertson Bell, Clay, Harlan, Jackson, Knox, Laurel, Rockcastle, Whitley Boyd, Carter, Elliott, Greenup, Lawrence Bath, Menifee, Montgomery, Morgan, Rowan Daviess, Hancock, Henderson, McLean, Ohio, Union, Webster Breathitt, Knott, Lee, Leslie, Letcher, Owsley, Perry, Wolfe Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, Trimble Adair, Casey, Clinton, Cumberland, Green, McCreary, Pulaski, Russell, Taylor, Wayne Breckinridge, Grayson, Hardin, Larue, Marion, Meade, Nelson, Washington Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Owen, Pendleton Caldwell, Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd, Trigg Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, McCracken, Marshall This report was prepared by Sarojini Kanotra, BRFSS Director/Epidemiologist and Coordinator. Questions concerning this report should be directed to Sarojini.Kanotra@ky.gov. Suggested citation: Kentucky Behavioral Risk Factor Surveillance System Survey Data. Department for Public Health, Cabinet for Health and Family Services, Frankfort, Kentucky, [2014] Page 4 Page 160

161 Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) List of Variables Nationwide * (States and DC) Kentucky Median % % 95% CI Alcohol Consumption Adults who reported heavy drinking Adults who reported binge drinking Arthritis Adults who have doctor-diagnosed arthritis Cardiovascular Disease Adults who have ever had a heart attack Adults who have coronary heart disease Adults who have ever had a stroke Colorectal Cancer Screening Adults aged 50+ who had a blood stool test within past two years Adults aged 50+ who have ever had a sigmoidoscopy or colonoscopy Depression Adults who have ever been diagnosed with a depressive disorder Diabetes Adults who have Diabetes Disability Adults who are limited in any activities because of health problems Adults with health problem(s) that require use of special equipment Exercise Adults who participate in any leisure-time physical activity General Health Status Adults who reported good or better health Health Care Access/Coverage Adults who have health care coverage Adults aged who have health care coverage HIV Screening Test Adults who have ever been tested for HIV Immunization Adults aged 65+ who had a flu shot in past year Adults aged 65+ who have ever had a pneumococcal vaccination Oral Health Adults aged 65+ who had all their natural teeth extracted Adults who visited dentist or dental clinic in past year Overweight and Obesity (BMI) Adults who are overweight (BMI = ) Adults who are obese (BMI 30.0) Prostate Cancer Men aged 40+ who had a PSA test within the past two years Respiratory Disease Adults who currently have asthma Adults who have COPD, emphysema, or chronic bronchitis Tobacco Use Adults who are current smokers Women s Health Women aged 18+ who had a Pap test within the past three years Women aged 40+ who had a mammogram within the past two years *Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2014] Page 5 Page 161

162 Area Development District (ADD) Profiles Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Purchase Kentucky Purchase ADD % 95% CI % 95% CI Alcohol Consumption Adults who reported heavy drinking Adults who reported binge drinking Arthritis Adults who have doctor-diagnosed arthritis Cardiovascular Disease Adults who have ever had a heart attack Adults who have coronary heart disease Adults who have ever had a stroke Colorectal Cancer Screening Adults aged 50+ who had a blood stool test within past two years Adults aged 50+ who ever had a sigmoidoscopy or colonoscopy Depression Adults who have ever been diagnosed with a depressive disorder Diabetes Adults who have Diabetes Disability Adults who are limited in any activities because of health problems Adults with health problem(s) that require use of special equipment Exercise Adults who participate in any leisure-time physical activity General Health Status Adults who reported good or better health Health Care Access/Coverage Adults who have health care coverage Adults aged who have health care coverage HIV Screening Test (Age 18-64) Adults aged who have ever been tested for HIV Immunization Adults aged 65+ who had a flu shot in past year Adults aged 65+ who have ever had a pneumococcal vaccination Oral Health Adults aged 65+ who had all their natural teeth extracted Adults who visited the dentist or dental clinic within the past year Overweight and Obesity (BMI) Adults who are overweight (BMI = ) Adults who are obese (BMI 30.0) Prostate Cancer Men aged 40+ who had a PSA test within the past two years Respiratory Disease Adults who currently have asthma Adults who have COPD, emphysema, or chronic bronchitis Tobacco Use Adults who are current smokers Women s Health Women aged 18+ who had a Pap test within the past three years Women aged 40+ who had a mammogram within the past two years % = Percentage, CI = Confidence Interval. All Percentages are weighted to population characteristics. N/A = Not available if the unweighted sample size for the denominator was < 50 or the CI half width was > 10 for any cell. Data Source: Kentucky BRFSS Survey 2014 Page 20 Page 162

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186 KENTUCKY 2016 Enroll America and Civis Analytics first created a data model that predicts who likely has, and does not have, health coverage in anticipation of the opening of the health insurance marketplaces in This model has been updated each year and is used to estimate the insurance status of non-elderly Americans from 2013 to Grouping individual-level estimates by geography, sex, age, and race/ethnicity enables us to understand the uninsured landscape across the country. Here we provide a detailed look at the 2016 uninsured population in Kentucky, along with plan selection data from HHS and nationwide uninsured rates for context. All uninsured rates listed in this document are based on the Enroll America/Civis Analytics uninsured model. Enroll America Uninsured Estimates FOR KENTUCKY Public Enrollment Data FOR KENTUCKY plan_selecti2016 Marketplace Plan Selections: [1] 93, Estimated Uninsured Rate for 18 to 64 year olds: 6.1% Effectuated Effectuated Marketplace Enrollment, Mar. 2016: [2] 74, Estimated Uninsured Rate for 18 to 64 year olds: 19.2% financial_asmarketplace Enrollees With Financial Help: 67% Decrease from 2013 to 2016: 13.1% medicaid_chmedicaid and CHIP Enrollment, Aug. 2016: [3] 1,220,788 change_me Increase in Medicaid/CHIP Enrollment Since OE1: 101% Chart 1: Kentucky Uninsured Rates for 2013 and 2016 of Key Demographics Uninsured Rate Overall Race Gender Age National Kentucky Black White Latino Asian Male Female National Map: 2016 Uninsured Rates by County Chart 2: Distribution of Uninsured Population by Demographic Groups Distribution of Uninsured by Race in Kentucky Black 7% 7% White 89% 90% Latino 3% 2% Asian 1% 1% 0% 20% 40% 60% 80% 100% Distribution of Uninsured by Age in Kentucky 0% Map Scale: Uninsured Rates per County 5% 10% 15% 20% % 19% 25% 23% 19% 23% 35% 34% % 5% 10% 15% 20% 25% 30% 35% 40% Table 1: 2016 Uninsured Rates in Most Populous Counties Overall Race Gender Age Percent Top 5 Most Populous Counties, Ordered by Population Size Uninsured Rate Black White Latino Asian Male Female ### Jefferson County 5% 10% 5% 11% 6% 6% 5% 6% 5% 6% 5% 16% 2 ### Fayette County 6% 10% 6% 15% 7% 7% 6% 7% 5% 6% 6% 7% 3 ### Kenton County 4% 10% 4% 9% 5% 5% 4% 5% 4% 4% 4% 3% 4 ### Boone County 3% 6% 3% 7% 5% 4% 3% 4% 3% 3% 3% 2% 5 ### Hardin County 6% 6% 5% 8% 7% 6% 5% 6% 5% 5% 5% 2% % of KY Uninsured Population Footnotes [1] Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report, March Available online at: [2] Centers for Medicare & Medicaid Services, March 31, 2016 Effectuated Enrollment Snapshot, June Available online at: [3] Centers for Medicare & Medicaid Services, Medicaid & CHIP: August 2016 Monthly Applications, Eligibility Determinations and Enrollment Report, November Available online at: Additional Enroll America Research, Blogs and Maps can be found at : Kentucky State Snapshot - Enroll America - November Page 186