2014 Community Health Assessment Appendix B: Charlotte County Data Prepared by: The Health Planning Council of Southwest Florida, Inc. www.hpcswf.com
Table of Contents Charlotte County Demographic and Socioeconomic Characteristics... 4 Population Demographics... 4 Population Growth... 5 Age... 6 Gender... 6 Race and Ethnicity... 7 Socioeconomic Indicators... 8 Charlotte County Health Status... 10 Health Ranking... 10 Healthy People 2020 Objectives... 14 Death Rate... 16 Death Rates by Race... 16 Leading Causes of Death... 18 Chronic Diseases... 21 Heart Disease... 21 Cancer... 23 Diabetes... 27 Communicable Diseases... 30 Sexually Transmitted Diseases... 31 Vaccine Preventable Diseases... 32 AIDS and Other Diseases... 34 Maternal and Child Health... 35 Teen Births... 36 Infant Deaths... 37 Mothers Who Smoked During Pregnancy... 38 Oral Health... 39 Accessibility for Low-Income Residents... 42 Dental Emergencies... 43 Social and Mental Health... 44 Crime and Domestic Violence... 44 Alcohol-related Motor Vehicle Crashes... 46 Florida Youth Substance Abuse Survey... 48 Suicides... 52 Baker Act... 53 2
Hospitalizations... 54 Prevention Quality Indicators... 54 Chronic Conditions... 55 Emergency Room Visits... 56 Charlotte County Health Resources... 57 Medicaid... 61 Florida KidCare... 62 Uninsured... 63 Physicians and Facilities... 66 Charlotte County Behavioral Risk Factor Surveillance Survey... 67 3
Demographic and Socioeconomic Characteristics This section provides a brief overview of some of the characteristics and trends that make Charlotte County unique in comparison to the state of Florida. Population Demographics Charlotte County, which has a population of approximately 161,100, is located in southwest Florida (Figure C-1). The county also shares borders with the following counties: Sarasota to the northwest; DeSoto to the north; Highlands to the northeast; Glades to the east; Hendry to the southeast; and Lee to the south. As seen in Figure C-2, Charlotte is one of seven counties in southwest Florida that comprise the Local Health Planning District 8 as designated by the Florida Agency for Health Care Administration (AHCA). Punta Gorda is the county seat and the only incorporated city. Charlotte County is 859.12 square miles in area; 19 percent of that area is covered by water. The county has a population density of about 235 persons per square mile compared to a state average of 357 persons per square mile. Figure C-1: Figure C-2: 4
Population Growth The illustration below represents the total population of Charlotte County from 1998-2012. The estimate for 2012 places the population of Charlotte County at 161,110. This represents a 19 percent increase since 1998. 186,000 166,000 146,000 126,000 106,000 86,000 66,000 46,000 26,000 Chart C-1: Total Population Charlotte County 1998-2012 135,610 139,032 142,357 145,749 148,999 152,337 154,553 153,569 157,610 160,434 160,269 159,821 160,012 160,632 161,110 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Source: The Florida Legislature, Office of Economic and Demographic Research Population growth in a community is the result of natural increase (more births than deaths) and also the migration of people moving into the area at a higher rate than those who are leaving. According to the Office of Economic and Demographic Research, the population of Charlotte County is expected to continue to grow in the coming years. In 2016, it is estimated that the population of Charlotte County will be 167,125; that is an increase of four percent from the same number for 2012. 168,000 167,000 166,000 165,000 164,000 163,000 162,000 161,000 160,000 159,000 158,000 Chart C-2: Estimated Population Charlotte County 2012-2016 161,110 162,044 163,475 165,248 167,125 2012 2013 2014 2015 2016 Source: The Florida Legislature, Office of Economic and Demographic Research 5
Age The largest proportion of the population of the county is between the ages of 45 and 64 which is the same for the state. However, Charlotte County has a larger elder population, aged 65 and older, than the state as a whole (34.5% Charlotte vs. 18.0% State). The median age in Charlotte County is much higher than the state (55.9 Charlotte vs. 40.7 State). Chart C-3: Population Percentage by Age Group Charlotte and State, 2012 Source: The Florida Legislature, Office of Economic and Demographic Research Gender There are more women than men in Charlotte County. This is not surprising since women make up a larger proportion of the United States population as a whole and tend to live longer than men. 51.5 percent of the residents of Charlotte County are female while 48.5 percent are male; statewide the percentages are 51.1 percent female and 48.9 percent male. 53.0 51.0 49.0 47.0 45.0 43.0 41.0 39.0 37.0 35.0 Chart C-4: Charlotte Population by Sex Percent of Total Population, 2012 51.5 51.1 48.5 48.9 Charlotte State Male Female Source: The Florida Legislature, Office of Economic and Demographic Research 6
Race and Ethnicity 9.2 percent of the population of Charlotte County is non-white; compared to a statewide population comprised of 21.6 percent non-whites. Approximately 3.1 percent of the population is listed as Other non-white. This category includes American Indian, Alaskan Native, Asian, Native Hawaiian, and other Pacific Islanders, and those of mixed race who chose not to select white or black. Chart C-5: Charlotte Population by Race Percent of Total Population, 2012 Other, 3.1% Black, 6.1% White, 90.8% Source: The Florida Legislature, Office of Economic and Demographic Research Only six percent of the residents of Charlotte County identify as Hispanic; this is much lower than the state average. The vast majority of the people in Charlotte County who identify as Hispanic identify as white. Table C- 1: Race and Ethnicity, 2012 Charlotte State Hispanic Non-Hispanic Hispanic Non-Hispanic White 5.4% 85.4% White 21.2% 57.1% Black 0.4% 5.7% Black 1.2% 15.4% Other 0.3% 2.8% Other 0.8% 4.3% Total 6.1% 93.9% Total 23.2% 76.8% Source: The Florida Legislature, Office of Economic and Demographic Research 7
Socioeconomic Indicators Like the rest of Florida, Charlotte County was affected by the economic downturn. The unemployment rate jumped from 3.7 percent in 2000 to 11.9 percent in 2012; it is higher than the state rate of 8.6 percent. The percent of people living under the poverty level in Charlotte County is lower than the state as a whole. Unfortunately, the percent of children 0-17 years of age who are under the poverty level is nearly as high in Charlotte County as for the state; that rate is 24.2 percent for Charlotte County compared to 25.1 percent for the Florida average. Table C- 2: Socioeconomic Indicators Charlotte County and State County County 2000 2012 State 2012 Labor Force as a % of Pop. Aged 18+ 46.2% 50.9% 62.5% Personal Bankruptcy Filing Rate per 1,000 3.73 4.06 Unemployment Rate 3.7% 11.9% 8.6% Average Annual Wage $31,488 $42,446 Per Capita Personal Income $26,122 $35,161* $39,636* % Living Below Poverty Level 13.2%* 17.0%* % ages 0-17 living below Poverty 24.2%* 25.1%* Source: The Florida Legislature, Office of Economic and Demographic Research *2011 data More residents of Charlotte County who are aged 25 and older have received a high school diploma than the state average. A smaller percentage of people in Charlotte County have received a Bachelor s degree than the percentage of residents of Florida who have done the same. Table C- 3: Educational Attainment Persons aged 25 and older, Charlotte and State County State % High School graduate or higher 88.4% 85.5% % Bachelor's degree or higher 20.9% 26.0% Source: The Florida Legislature, Office of Economic and Demographic Research 8
As seen in Chart C-6, among working adults in Charlotte County the most common sectors of employment are: education and health services, retail trade, professional and business services, and leisure and hospitality. Chart C-6: Average Employment by Category Charlotte and State, 2012 Education & health services Retail trade Professional and business services Leisure & hospitality Financial activities Construction Other services Public administration Manufacturing Transportation, warehousing, & utilities Wholesale trade Information Agriculture, forestry, fishing & mining 7.5% 7.7% 6.1% 6.2% 6.0% 5.3% 4.9% 4.9% 4.1% 5.3% 4.0% 4.9% 2.1% 2.9% 1.4% 1.9% 0.5% 1.1% 13.8% 13.8% 12.6% 11.1% 12.0% 20.3% 21.5% 18.2% Charlotte State Source: Florida Legislature, Office of Economic and Demographic Research 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 9
Health Status Health Ranking County Health Rankings & Roadmaps, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, has Charlotte County currently ranked the 28 th healthiest out of 67 counties in Florida for Health Outcomes, and 18 th healthiest for Health Factors. Charlotte County was ranked 28 th healthiest of all of the Florida counties for mortality, which is based on the years of potential life lost before the age of 75. Morbidity includes overall quality of health (poor or fair health, poor physical health days, and poor mental health days) as well as the percent of live births with low birth weight. In this category, Charlotte County ranked 29 th healthiest of all of the Florida counties. Charlotte County had a high average number of mentally unhealthy days reported in past 30 days (age-adjusted) (4.8) compared to the state average (3.7) and the national benchmark (2.3). Charlotte County was ranked as the 20 th healthiest county in Florida for health behaviors, which includes rates of adult smoking, adult obesity, physical inactivity, excessive drinking, motor vehicle crash deaths, sexually transmitted infections, and teen births. Charlotte County ranked higher than the state average for adult smoking (percent of adults that report smoking at least 100 cigarettes and currently smoking) (24% Charlotte vs. 19% State), but lower rates of teen births (35 births to teen mothers, per 1,000 female population) compared to the state average (40 births). For clinical care, Charlotte County was ranked as the 7 th healthiest county. Clinical care includes data on the number of uninsured, primary care physicians, dentists, preventable hospital stays, diabetic screening, and mammography screening. Charlotte County ranked high in clinical care partly due to higher than average rates of diabetic and mammography screenings. For example, the percent of female Medicare enrollees that receive mammography screening in Charlotte County (76%) was higher than that of the state average (70%) and the national benchmark (73%). Social & economic factors, where Charlotte County ranked 22 nd healthiest out of 67 counties in Florida, includes rates of high school graduation, some college, unemployment, children in poverty, inadequate social support, children in single-parent households, and violent crime. In Charlotte County, the percent of adults without social/emotional support was 24 percent. This rate is slightly higher than that of the state (22%), and considerably higher than the national benchmark (14%). The violent crime rate per 100,000 population in Charlotte County was 299, which is lower than the state rate (614 per 100,000) but higher than the national benchmark (66 per 100,000). Physical environment includes rates of daily fine particulate matter, drinking water safety, access to recreational facilities, limited access to healthy foods, and fast food restaurants. In this category, Charlotte County ranked 26 th healthiest. Charlotte County had lower than average rates of daily fine particulate matter (7.0 micrograms per cubic meter) than the state average (8.4) and the national benchmark (8.8). The percent of the Charlotte County population who are low-income and do not live close to a grocery store (limited access to healthy foods) (12%) was higher than the state average (7%) and significantly higher than the national benchmark (1%). 10
County Health Rankings Definitions for each measure are listed on the next pages. Charlotte County Error Margin Florida National Benchmark* Health Outcomes 28 Mortality 28 Premature death 7,877 7,263-8,492 7,310 5,317 Morbidity 29 Poor or fair health 20% 14-27% 16% 10% Poor physical health days 3.7 2.9-4.6 3.6 2.6 Poor mental health days 4.8 3.7-5.9 3.7 2.3 Low birth weight 7.3% 6.8-7.9% 8.7% 6.0% Health Factors 18 Health Behaviors 20 Adult smoking 24% 20-28% 19% 13% Adult obesity 26% 23-29% 26% 25% Physical inactivity 22% 19-24% 24% 21% Excessive drinking 15% 12-18% 16% 7% Motor vehicle crash death rate 15 14-19 16 10 Sexually transmitted infections 190 398 92 Teen birth rate 35 32-37 40 21 Clinical Care 7 Uninsured 23% 21-25% 25% 11% Primary care physicians** 1,525:1 1,439:1 1,067:1 Dentists** 2,298:1 2,095:1 1,516:1 Preventable hospital stays 65 62-68 65 47 Diabetic screening 90% 86-93% 84% 90% Mammography screening 76% 73-80% 70% 73% Social & Economic Factors 22 High school graduation** 73% 71% Some college 55% 51-59% 59% 70% Unemployment 10.8% 10.5% 5.0% Children in poverty 24% 18-31% 25% 14% Inadequate social support 24% 19-28% 22% 14% Children in single-parent households 36% 31-41% 37% 20% Violent crime rate 299 614 66 Rank (of 67) 11
Physical Environment 26 Daily fine particulate matter 7.0 6.9-7.0 8.4 8.8 Drinking water safety 1% 3% 0% Access to recreational facilities 8 9 16 Limited access to healthy foods** 12% 7% 1% Fast food restaurants 44% 44% 27% Source: County Health Rankings & Roadmaps. Available at http://www.countyhealthrankings.org. Accessed October 2, 2013. *90th percentile, i.e., only 10% are better **Data should not be compared with prior years due to changes in definition. Note: Blank values reflect unreliable or missing data. Definitions of Health Measures Premature death - Years of potential life lost before age 75 per 100,000 population (age-adjusted) Poor or fair health - Percent of adults reporting fair or poor health (age-adjusted) Poor physical health days Average number of physically unhealthy days reported in past 30 days (age-adjusted) Poor mental health days - Average number of mentally unhealthy days reported in past 30 days (age-adjusted) Low birth weight - Percent of live births with low birth weight (<2500 grams) Adult smoking - Percent of adults that report smoking >=100 cigarettes and currently smoking Adult obesity - Percent of adults that report a BMI >=30 Physical inactivity - Percent of adults aged 20 and over reporting no leisure time physical activity Excessive drinking - Binge plus heavy drinking Motor vehicle crash death rate - Motor vehicle crash deaths per 100,000 population Sexually transmitted infections - Chlamydia rate per 100,000 population Teen birth rate - Teen birth rate per 1,000 female population, ages 15-19 Uninsured - Percent of population under age 65 without health insurance Primary care physicians - Ratio of population to primary care physicians Dentists - Ratio of population to dentists Preventable hospital stays - Hospitalization rate for ambulatory-care sensitive conditions per 1,000 Medicare enrollees Diabetic screening - Percent of diabetic Medicare enrollees that receive HbA1c screening Mammography screening - Percent of female Medicare enrollees that receive mammography screening High school graduation - Percent of ninth grade cohort that graduates in 4 years 12
Some college - Percent of adults aged 25-44 years with some post-secondary education Unemployment - Percent of population age 16+ unemployed but seeking work Children in poverty - Percent of children under age 18 in poverty Inadequate social support - Percent of adults without social/emotional support Children in single-parent households - Percent of children that live in household headed by single parent Violent crime rate - Violent crime rate per 100,000 population Daily fine particulate matter - The average daily measure of fine particulate matter in micrograms per cubic meter (PM2.5) in a county Drinking water safety - Percentage of population exposed to water exceeding a violation limit during the past year Access to recreational facilities - Rate of recreational facilities per 100,000 population Limited access to healthy foods - Percent of population who are low-income and do not live close to a grocery store Fast food restaurants - Percent of all restaurants that are fast-food establishments 13
Healthy People 2020 Objectives Below is Charlotte County s Healthy People 2020 data with relation to selected objectives (comparing 2007 Behavioral Risk Factor Surveillance Survey data with 2010 data, available on page 219). Table C- 4: Healthy People 2020 Objectives Charlotte County 2010 Objective Measure 2007 2010 Progress AOCBC-2. Reduce the proportion of adults with doctor-diagnosed arthritis who experience a limitation in activity due to arthritis or joint symptoms. C-15. Increases the proportion of women who receive a cervical cancer screening based on the most recent guidelines. C-16. Increase the proportion of adults who receive a colorectal cancer screening based on the most recent guidelines. C-17. Increase the proportion of women who receive a breast cancer screening based on the most recent guidelines. D-9. Increase the proportion of adults with diabetes who have at least an annual foot examination. D-10. Increase the proportion of adults with diabetes who have an annual dilated eye examination. D-11. Increase the proportion of adults with diabetes who have a glycosylated hemoglobin (A1C) measurement at least twice a year. D-13. Increase the proportion of adults with diabetes who perform self-blood glucose-monitoring at least once daily. D-14. Increase the proportion of persons with diagnosed diabetes who receive formal diabetes education. HDS-5. Reduce the proportion of persons in the population with hypertension. IID-12.7. Increase the percentage of noninstitutionalized adults aged 65 years and older who are vaccinated against seasonal influenza. Percentage of adults who are limited in any way in any usual activities because of arthritis or chronic joint symptoms. Percentage of women 18 years of age and older who received a Pap test in the past year. Percentage of adults 50 years of age and older who received a sigmoidoscopy or colonoscopy in the past five years. Percentage of women 40 years of age and older who received a mammogram in the past year. Percentage of women 18 years of age and older who had a clinical breast exam in the past year. Percentage of adults with diabetes who had an annual foot exam. Percentage of adults with diabetes who had an annual eye exam. Percentage of adults with diabetes who had two A1C tests in the past year. Percentage of adults with diabetes who self-monitor blood glucose at least once a day on average. Percentage of adults with diabetes who ever had diabetes self-management education. Percentage of adults with diagnosed hypertension. Percentage of adults age 65 and over who received a flu shot in the past year. 13.3% 18.5% 62.90% 54.10% 61.00% 56.30% 64.70% 69.30% 64.40% 64.80% 63.10% 57.50% 77.60% 62.40% 54.40% 71.00% 73.70% 60.90% 75.00% 58.20% 29.80% 30.90% 74.80% 74.80% Needs Improvement Needs Improvement Needs Improvement Progress Shown Needs Improvement Needs Improvement Needs Improvement Progress Shown Needs Improvement Needs Improvement Needs Improvement Needs Improvement 14
IID-13.1. Increase the percentage of noninstitutionalized adults aged 65 years and older who are vaccinated against pneumococcal disease. NWS-8. Increase the proportion of adults who are at a healthy weight. NWS-9. Reduce the proportion of adults who are obese. SA-14. Reduce the proportion of persons engaging in binge drinking of alcoholic beverages. TU-4. Increase smoking cessation attempts by adult smokers. Percentage of adults age 65 and over who have ever received a pneumonia vaccination. Percentage of adults who have a healthy weight (BMI from 18.5 to 24.9). 71.90% 80.70% 38.30% 39.30% Percentage of adults who are obese. 22.00% 22.40% Percentage of adults who engage in heavy or binge drinking. Percentage of adult current smokers who tried to quit smoking at least once in the past year. 16.10% 19.20% 43.00% 49.80% Source: U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/pdfs/hp2020objectives.pdf. Accessed September 27, 2013. Data source: 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, [2010]. Progress Shown Progress Shown Needs Improvement Needs Improvement Progress Shown 15
Death Rate The death rate for Charlotte County residents has been consistently lower than the state average. For the three-year period from 2010-2012, Charlotte County s death rate was five percent lower than the state s rate (647.3 per 100,000 Charlotte County vs. 682.0 State). The death rate for Charlotte County has been on the decline for the past twenty years, but has seen an increase since 2007. 900 Chart C-7: Charlotte Death Rate over 20 Years Compared to State Age-Adjusted All Causes 3-Year Death Rate 800 700 600 500 400 300 State Charlotte 200 100 0 1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Source: Florida Department of Health, Office of Vital Statistics Age-adjusted death rates are computed using the year 2000 standard population. Death Rates by Race The overall death rate for blacks in Charlotte County is lower than that of whites (656.3 white population vs. 541.5 black population); this is the opposite of the death rates for blacks and whites across the state of Florida as a whole. From 2010-2012, the black population in Charlotte County had slightly higher rates of death due to stroke and diabetes than the white population. The white population had considerably higher rates of death due to chronic lower respiratory disease, suicide, and cirrhosis than the black population. The white population had death rates for chronic lower respiratory disease six times higher than the black population (42.0 white population vs. 6.7 black population) and death rates for cirrhosis nine times higher (18.4 white population vs. 2.0 black population). There have been no deaths due to suicide in the black population of Charlotte County over the last three years, while the white population had a rate of 21.5 per 100,000 during this time. 16
Cancer and heart disease were the leading causes of death for both whites and blacks. Table C- 5: Major Causes of Death and Race, Charlotte County and State 3-Year Age-Adjusted Death Rates by Cause, 2010-2012 County State White Black All Races White Black All Races Total Deaths 656.3 541.5 647.3 674.5 765.8 682.0 Cancer 153.1 132.9 151.3 161.1 166.5 160.4 Heart Disease 142.6 102.4 140.0 153.5 176.9 155.5 CLRD* 42.0 6.7 40.2 40.9 23.2 39.0 Stroke 27.1 28.1 27.0 29.6 48.0 31.5 Diabetes 21.1 25.4 20.9 17.6 39.4 19.6 Suicide 21.5 0.0 19.9 15.8 4.7 13.7 Cirrhosis 18.4 2.0 17.4 11.7 5.6 10.6 Motor Vehicle Crashes 14.7 14.5 14.1 12.8 16.9 12.3 Kidney Disease 11.9 8.7 11.7 10.5 22.3 11.7 Source: Florida Department of Health, Office of Vital Statistics *Chronic Lower Respiratory Disease Please note that due to the small size of the black population, a small number of deaths in one category can cause a large variance in the death rate for that category. 180 160 140 120 100 80 60 40 20 0 Chart C-8: Major Causes of Death and Race, Charlotte County 3-Year Age-Adjusted Death Rates by Cause 2010-2012 White Black All Races Source: Florida Department of Health, Office of Vital Statistics 17
Leading Causes of Death Mortality rates can be key indicators of the state of health of a community. A significant number of Charlotte County s deaths are premature and preventable. Behavior modification and risk reduction can reduce the mortality rates of many of the leading causes of death, especially those attributed to heart disease, stroke, diabetes, lung cancer and motor vehicle accidents. Individuals may improve both the length and the quality of their lives by simply following a healthy lifestyle and receiving regular medical care. Table C- 6 gives detailed information on the leading causes of death for residents of Charlotte County in 2012. The Deaths column is a simple count of the number of people who died by the listed cause during 2012. Percent of Total deaths lets you know what percent of the people who died in 2012 died from that cause. Crude Rate per 100,000 gives a sense of how likely a person is to die of that cause in any given year. For example, out of every 100,000 people in Charlotte County, 324 of them died of cancer in 2012. Using the rate per 100,000 allows comparison between areas with different populations such as comparing a small county to a large county or a county to the state. The next column lists the Age-Adjusted Death Rate per 100,000. Age-adjusting a rate is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population merely because the elderly are more likely to die or be hospitalized. The same distortion can happen when we compare races, genders, or time periods. Age adjustment can make the different groups more comparable. The 3-Year Age-Adjusted Death Rate per 100,000 gives an average of the three years ending in 2012 (2010, 2011, and 2012). A small increase or decrease in the number of deaths in a given year can make a big difference in the rate so averages are used to flatten out large fluctuations. The last column is Years of Potential Life Lost. This is an estimate of the number of years a person would have lived had they not died prematurely. In this case that number is given for all people who died under the age of 75 assuming that they would have lived to the age of 75. When the numbers are particularly low, such as they are for Alzheimer s disease, it is generally because that cause of death largely impacts the elderly. Conversely, a particularly high number such as for unintentional injuries suggests that the average age of the victims was fairly young. 18
Table C- 6: Major Causes of Death For 2012 Charlotte County Age- Adjusted Death Rate Per 100,000 3-Year Age- Adjusted Death Rate Per 100,000 Cause of Death Deaths Percent of Total Deaths Crude Rate Per 100,000 YPLL < 75 Per 100,000 Under 75 ALL CAUSES 2,239 100% 1389.7 621.8 647.3 10,665 HEART DISEASE 553 24.7% 343.2 144.2 140.0 1,915 CANCER 522 23.3% 324.0 142.3 151.3 2,749 CHRONIC LOWER RESPIRATORY DISEASE 172 7.7% 106.8 42.2 40.2 522 STROKE 94 4.2% 58.3 21.9 27.0 207 DIABETES 67 3.0% 41.6 19.0 20.9 372 UNINTENTIONAL INJURY 58 2.6% 36.0 23.6 35.0 699 INFLUENZA & PNEUMONIA 47 2.1% 29.2 12.2 11.0 136 ALZHEIMER'S DISEASE 44 2.0% 27.3 9.8 10.7 3 KIDNEY DISEASE 43 1.9% 26.7 10.6 11.7 197 CIRRHOSIS 38 1.7% 23.6 16.4 17.4 554 Source: Florida Department of Health, Office of Health Statistics and Assessment Age-adjusted death rates are computed using the year 2000 standard population. YPLL = Years of Potential Life Lost 19
The most frequent causes of death for people in Charlotte County are heart disease and cancer. Together they accounted for 48 percent of the deaths in 2012. Table C- 7, which compares the threeyear age-adjusted rates for Charlotte County with those for all of Florida, shows that the death rates in Charlotte County for stroke, unintentional injury and Alzheimer s disease are significantly lower than the state average. The death rate for Charlotte County is higher than the state average for chronic lower respiratory disease and influenza & pneumonia. Table C- 7: Major Causes of Death Charlotte and State County 2010-2012 Florida 2010-2012 Age-Adjusted Rate/100,000 Age-Adjusted Rate/100,000 Cause of Death All Causes 647.3 682.0 Heart Disease 144.2 155.5 Cancer 142.3 160.4 Chronic Lower Respiratory Disease 42.2 39.0 Stroke 21.9 31.5 Diabetes 19.0 19.6 Unintentional Injury 23.6 40.5 Influenza & Pneumonia 12.2 8.6 Alzheimer s Disease 9.8 16.4 Kidney Disease 10.6 10.9 Source: Florida Department of Health, Office of Health Statistics and Assessment Age-adjusted death rates are computed using the year 2000 standard population. 20
Chronic Diseases Heart Disease Heart disease is the leading cause of death in Charlotte County. As seen in Chart C-9, age-adjusted death rates from heart disease have primarily been on the decline for both Charlotte County and the state of Florida as a whole during this time period. Rates for Charlotte County are slightly lower than the state average. 300 Chart C-9: Deaths from Heart Disease Age-adjusted rate per 100,000, 3-Year Rates 1993-2012 250 200 150 100 State Charlotte 50 0 1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Source: Florida Department of Health, Bureau of Vital Statistics 21
According to the Centers for Disease Control and Prevention, coronary heart disease is the most common form of heart disease and can lead to a heart attack and/or angina (chest pain or discomfort). In Charlotte County, the percentage of adults who reported that they had ever had a heart attack, angina, or coronary heart disease was higher than for the state as a whole in 2010 (12.2% Charlotte vs. 10.2% State). Residents with lower annual incomes reported the highest rates. 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Chart C-10: Adults Who Ever Had a Heart Attack, Angina, or Coronary Heart Disease Percentage by Income, Charlotte County 2010 18.5% 10.6% 9.9% <$25,000 $25,000-$49,999 $50,000 or More Source: 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, [2010]. 22
Cancer Cancer is the second most common cause of death in Charlotte County. Chart C-11 gives a detailed look at the decline in deaths from all cancers across the last twenty years. The decline in Charlotte County is not as smooth as the decline at the state level, although it has been consistently lower in Charlotte than for the state as a whole. Despite a few higher years, the overall trend is mostly positive. In fact, Charlotte County had the twelfth lowest three-year rate of deaths from all cancers of all 67 counties in Florida for 2010-2012. 250 Chart C-11: Deaths from All Cancers Age-adjusted rate per 100,000, 3-Year Rates 1993-2012 200 150 100 State Charlotte 50 0 1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Source: Florida Department of Health, Bureau of Vital Statistics 23
Cancer incidence in Charlotte County has remained fairly consisted over the last twenty years, with a low of 392.1 per 100,000 in 2003-2005 and a high of 469.1 in 1996-1998. The most recent four years of data show a slight upward trend. 600 Chart C-12: Cancer Incidence Age-adjusted rate per 100,000, 3-Year Rates 1990-2009 500 400 300 200 State Charlotte 100 0 1988-90 1989-91 1990-92 1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 Source: Florida Department of Health, Bureau of Vital Statistics Among the types of cancer, lung cancer causes the highest number of deaths in Charlotte County. The incidence of prostate cancer is nearly as high as the incidence of lung cancer in Charlotte County, but it is not nearly as deadly. Table C- 8: Common Types of Cancer Death Rate and Incidence, Charlotte County 3 yr. Age-Adjusted Death Rate, 2010-2012 Avg. Annual Number of Events (Incidence), 2007-2009* Lung Cancer 45.9 240 Breast Cancer 17.3 153 Prostate Cancer 15.1 235 Colorectal Cancer 13.2 113 Cervical Cancer 5.0 6 Skin Cancer 4.1 67 Source: Deaths - Florida Department of Health, Office of Vital Statistics; Incidence - University of Miami (FL) Medical School, Florida Cancer Data System *2007-2009 is the most recent data available for annual number of cancer incidence. 24
An annual pap test is used to detect changes in the cells of the cervix, which can lead to cervical cancer. Detecting these abnormal cells early increases the chances of curing cervical cancer. According to the Behavioral Risk Factor Surveillance System 2010 Data Report (available in Appendix C), women over 18 years of age in Charlotte County were slightly less likely than women across the state as a whole to report that they had received a Pap test in the last year (52.6% Charlotte vs. 57.1% State). The rate is lowest for those women who make under $25,000 annually. Chart C-13: Women 18 Years of Age or Older Who Received a Pap Test in the Past Year Percentage By Income, Charlotte County 2010 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 41.8% 51.1% 72.0% Source: 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, [2010]. Women ages 40 years and older are recommended to receive a mammogram, an x-ray of the breast, annually to detect and/or diagnose breast cancer. A lower percentage of women 40 years or older in Charlotte County reported that they had received a mammogram than the state average (53.6% Charlotte vs. 61.9% State). Income played a significant factor; women with incomes below $25,000 annually had the lowest rates. Chart C-14: Women 40 Years of Age and Older Who Received a Mammogram in the Past Year Percentage By Income, Charlotte County 2010 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% <$25,000 $25,000-$49,999 $50,000 or More 45.4% 52.0% 61.8% 0.0% <$25,000 $25,000-$49,999 $50,000 or More Source: 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, [2010]. 25
Residents of Charlotte County over the age of 50 indicated that they are more likely as of 2010 to have received a sigmoidoscopy or colonoscopy, screening exams for colorectal cancer, in the past five years than they did in 2007 (59.5% 2010 vs. 55.6% 2007), and more likely than adults in the rest of the state to have been screened (59.5% Charlotte vs. 56.4% State). Chart C-15: Percentage of Adults 50 Years of Age and Older Who Received a Sigmoidoscopy or Colonoscopy in the Past Five Years Percentage By Income, Charlotte County 2010 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 48.4% 61.3% 63.3% Source: 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, [2010]. There has been a decrease in the number of adults 50 years or older who indicated that they have received a blood stool test (12.2% 2010 vs. 18.1% 2007); this rate is lower than the average across the state (12.2% Charlotte vs. 14.7% State). A blood stool test is another means of detecting colorectal cancer. Adults with annual incomes between $25,000 and $49,999 had the lowest rates across Charlotte County (8.1%). Chart C-16: Percentage of Adults 50 Years of Age and Older Who Received a Blood Stool Test in the Past Year Percentage By Income, Charlotte County 2010 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% <$25,000 $25,000-$49,999 $50,000 or More 13.6% Source: 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, [2010]. 8.1% 15.3% <$25,000 $25,000-$49,999 $50,000 or More 26
Diabetes Deaths rates for diabetes in Charlotte County are much lower than those for cancer and heart disease, but are still a health concern. The age-adjusted three-year rates have fluctuated over the last twenty years, from a low of 14.5 per 100,000 (1996-1998) to a high of 21.3 per 100,000 (1993-1995), and have remained lower than the state average for the most part until recently. 25 Chart C-17: Deaths from Diabetes Age-adjusted rate per 100,000, 3-Year Rates 1993-2012 20 15 10 State Charlotte 5 0 1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Source: Florida Department of Health, Bureau of Vital Statistics 27
Charlotte County has a slightly higher rate of adults diagnosed with diabetes than the state (11.2% Charlotte vs. 10.4% State). The number of men reporting a diabetes diagnosis has increased from 2007 (14.0% 2010 vs. 11.4% 2007), but the number of women reporting this chronic condition has decreased (8.7% 2010 vs. 13.3% 2007). 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% Chart C-18: Adults with Diagnosed Diabetes Percentage by Sex, 2007 and 2010 14.0% 13.3% 12.4% 11.4% 11.7% 11.2% 10.4% 8.7% 9.2% 2007 Charlotte 2010 Charlotte 2010 Florida 4.0% 2.0% 0.0% Men Women Overall Source: 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, [2010]. 28
Residents with lower annual incomes reported much higher rates of diabetes than those with higher incomes. Residents with incomes lower than $25,000 annually reported a 13.6% rate in 2010, while those with incomes $50,000 or more only reported a 8.8% rate of diagnosed diabetes. 18.0% Chart C-19: Percentage of Adults with Diagnosed Diabetes Percentage By Income, Charlotte County 2010 16.0% 14.0% 13.6% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 9.4% 8.8% 0.0% <$25,000 $25,000-$49,999 $50,000 or More Source: 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, [2010]. Of those adults who have been diagnosed with diabetes, more Charlotte County residents reported ever having participated in diabetes self-management education than the state as a whole (58.9% Charlotte vs. 55.1% State). 29
Communicable Diseases Charlotte County currently ranks below the state average rate for all sexually transmitted diseases and many vaccine preventable diseases. Note: It is possible that a larger number of individuals are positive for these diseases, but have not been tested. Table C- 10: Communicable Diseases Charlotte County and State 2010-2012 County County State Disease # of Cases 3 yr. Rate 3 yr. Rate Annual Avg. per 100,000 per 100,000 Sexually Transmitted Diseases Infectious Syphilis 0.3 0.2 6.7 Gonorrhea 46.7 29.1 104.6 Chlamydia 304.0 189.3 402.4 Vaccine Preventable Diseases Hepatitis B 2.7 1.7 1.5 Measles 0.0 0.0 0.0 Mumps 0.0 0.0 0.1 Rubella 0.0 0.0 0.0 Pertussis 0.7 0.4 2.0 Tetanus 0.0 0.0 0.0 AIDS and Other Diseases AIDS 5.7 3.5 16.3 Meningococcal Meningitis 0.0 0.0 0.0 Hepatitis A 0.7 0.4 0.9 Tuberculosis 2.7 1.7 2.9 Source: Division of Disease Control, Florida Department of Health 30
Sexually Transmitted Diseases Chlamydia is the most prevalent sexually transmitted disease in Charlotte County with an average of 304.0 cases per year between 2010 and 2012. That works out to a rate per 100,000 of 189.3; much lower than the state average of 402.4. The infection rate for chlamydia across the state of Florida has been on the rise for the last fifteen years, and has increased especially quickly in the last five years. The rates in Charlotte County have also seen a slight increase, but have remained well below the state rate over the past twenty years. For the three year period from 2010-2012 Charlotte County ranked 2 nd lowest out of 67 counties in Florida for the rate of chlamydia cases per 100,000 population. 500 450 400 350 300 250 200 150 100 50 0 Chart C-20: Chlamydia Cases 3-Year Rate per 100,000 1995-2012 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 State Charlotte Source: Florida Department of Health, Bureau of STD Prevention & Control 31
Vaccine Preventable Diseases The overall rate of infection from vaccine preventable diseases is very low in Charlotte County. For most of these diseases there is an average of less than one case every three years. Hepatitis B, a contagious liver disease that results from infection with the Hepatitis B virus, is the most common vaccine preventable disease in Charlotte County with an average of 2.7 cases per year between 2010 and 2012. At a 3-year rate of 1.7 per 100,000, Charlotte County is seeing its highest rates in fifteen years, and rates higher than the state average for the first time since 1993. 16 Chart C-21: Acute Hepatitis B Cases 3-Year Rate per 100,000 1992-2012 14 12 10 8 6 4 Florida Charlotte 2 0 1990-92 1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Source: Florida Department of Health, Bureau of Epidemiology 32
Pertussis, a highly contagious respiratory disease that is commonly known as whooping cough, is another vaccine preventable disease being seen more frequently in recent years in Charlotte County with an average of 0.7 cases per year between 2010 and 2012. At a 3-year rate of 1.0 per 100,000, Charlotte County has recently seen its highest rates in twenty years, fortunately there has not been a death attributed to pertussis in Charlotte County in at least forty years. 2.5 Chart C-22: Pertussis Cases 3-Year Rate per 100,000 1993-2012 2 1.5 1 State Charlotte 0.5 0 1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Source: Florida Department of Health, Bureau of Epidemiology 33
AIDS and Other Diseases An average of 5.7 people per year was diagnosed with AIDS in Charlotte County between 2010 and 2012. The rate per 100,000 in Charlotte County is 3.5 compared to a rate of 16.3 for the state as a whole. The largest number of those cases come from urban areas. These numbers have been declining over recent years. The 3-year rate per 100,000 Charlotte County residents has decreased 45 percent over the past decade (6.4 per 100,000 in 2000-2002 vs. 3.5 per 100,000 in 2010-2012), and is ranked the 4 th lowest county of all 67 counties for AIDS cases. 60 Chart C-23: AIDS Cases 3-Year Rate per 100,000 1996-2012 50 40 30 20 10 State Charlotte 0 Source: Florida Department of Health, Bureau of HIV/AIDS The rate of tuberculosis, an infectious bacterial disease, in Charlotte County is lower than the state as a whole at 1.7 per 100,000 compared to 2.9 per 100,000. Charlotte County had a 3-year high of 3.1 per 100,000 in 2007-2009, and has seen a fairly steady decline in the years since. 12 Chart C-24: Tuberculosis Cases 3-Year Rate per 100,000 1996-2012 10 8 6 4 2 State Charlotte 0 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Source: Florida Department of Health, Bureau of TB and Refugee Health 34
Maternal and Child Health On average, 1,011.7 babies were born per year in Charlotte County between 2010 and 2012. Babies born to young mothers under the age of 19 are more likely to experience poor birth outcomes than those born to adult mothers and are more at risk for developmental complications later in life. The rates in Charlotte County for births to teenage mothers are very similar to the state, and have been declining in recent years. Infant mortality rates are considered a primary indicator of the health of a community. Infant mortality rates for this time period in Charlotte County are lower than the average for the state of Florida, and continue to decline. Table C- 11: Maternal & Child Health Indicators, Charlotte County & State 3-Year Figures, 2010-2012 Births County State Trend Quartile* Total Births (3-yr annual avg.) 1,011.7 Births to Mothers ages 15-44, per 1,000 54.3 60 Births to Mothers ages 10-14, per 1,000 0.2 0.4 Positive 2 Births to Mothers ages 15-19, per 1,000 30.5 29.6 Positive 2 Percent of Births to Unwed Mothers 52.2 47.7 Negative 3 Infant Deaths Infant Deaths (0-364 days) per 1,000 Births 4.3 6.3 Positive 1 Neonatal Deaths (0-27 days) per 1,000 Births 2.3 4.2 Positive 1 Postneonatal Deaths (28-364 days) per 1,000 Births 2.0 2.2 Positive 2 Low Birth Weight Percent of Births < 1500 Grams 1.4 1.6 Negative 2 Percent of Births < 2500 Grams 8.4 8.7 Negative 3 Prenatal Care Percent of Births with 1st Trimester Prenatal Care 74.6 79.9 Steady 2 Percent of Births with Late or No Prenatal Care 6.5 4.6 Positive 4 Source: Florida Department of Health *County compared to other Florida counties. The lowest Quartile equals the lowest number. That is not always the most desirable rate. For instance, it would be desirable to have a quartile of 4 for percent of births with 1 st trimester care; however it would be desirable to have a quartile of 1 for infant deaths. 35
Teen Births In the 3-year period from 2010 through 2012, Charlotte County saw its lowest rates of live births to teenage and pre-teen mothers (15.8 births per 1,000). Charlotte County had rates of teen births consistently lower than the rates for the state of Florida until 2010. Rates for both the state and Charlotte County have been declining. 35 Chart C-25: Births to Mothers ages 10-19 3-Year Rate per 1,000 1993-2012 30 25 20 15 10 State Charlotte 5 0 1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Source: Florida Department of Health, Bureau of Vital Statistics 36
Infant Deaths Infant deaths in Charlotte County have declined consistently since the most recent peak in 2001-2003 (7.8 per 1,000 births). There were thirteen infant deaths in 2012 (4.3 per 1,000 births). 10 9 8 7 6 5 4 3 2 1 0 Chart C-26: Infant Deaths (0-364 days) 3-Year Rate per 1,000 1993-2012 1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 State Charlotte Source: Florida Department of Health, Bureau of Vital Statistics 37
Mothers Who Smoked During Pregnancy Charlotte County s rates have been consistently higher than that of the state. For the 3-year period from 2010 through 2012, Charlotte County had a rate of 14.7 births per 1,000 to mothers who smoked during pregnancy, as compared to the state average of 6.8 births per 1,000. This rate has seen a 47 percent decrease over the past twenty years, from a high of 27.9 births per 1,000 to mothers who smoked during pregnancy for 1991-1993 to its current rate of 14.7 births per 1,000 for 2010-2012. 30 Chart C-27: Births to Mothers who Smoked During Pregnancy 3-Year Rate per 1,000 1993-2012 25 20 15 10 State Charlotte 5 0 1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Source: Florida Department of Health, Bureau of Vital Statistics 38
Oral Health According to the Behavioral Risk Factor Surveillance System 2010 Data Report (available on page 219), a larger percentage of adults in Charlotte County reported that they had visited a dentist or dental clinic in the past year than the same for the state (71.3% Charlotte vs. 64.7% State). Women were more likely than men to have reported a visit to a dentist of dental clinic (68.3% men vs. 74.0% women). Persons in Charlotte County with higher annual incomes reported significantly higher rates of dental visits. 81.3 percent of persons with annual incomes of $50,000 or more reported visiting a dentist or dental clinic while only 55.5 percent of those with incomes under $25,000 annually only reported the same. Chart C-28: Adults Who Visited a Dentist or Dental Clinic in the Past Year Percentage By Income, Charlotte County 2010 90.0% 80.9% 81.3% 80.0% 70.0% 60.0% 55.5% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% <$25,000 $25,000-$49,999 $50,000 or More Source: 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, [2010]. 39
Charlotte County residents reported higher rates of having a permanent tooth removed because of tooth decay or gum disease than adults across the state (61.2% Charlotte vs. 53.0% State). Income levels, again, played a role in the percentage of these procedures amongst Charlotte County residents. Chart C-29: Adults Who Had a Permanent Tooth Removed Because of Tooth Decay or Gum Disease Percentage By Income, Charlotte County 2010 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 71.1% 60.3% 55.6% 0.0% <$25,000 $25,000-$49,999 $50,000 or More Source: 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, [2010]. 40
Overall 63.0 percent of Charlotte County adult residents had their teeth cleaned compared to 60.9 percent of adults across the state of Florida. Those with higher income levels were significantly more likely to have had a cleaning. 90.0% 80.0% 70.0% Chart C-30: Adults Who Had Their Teeth Cleaned in the Past Year Percentage By Income, Charlotte County 2010 78.0% 66.8% 60.0% 50.0% 44.7% 40.0% 30.0% 20.0% 10.0% 0.0% <$25,000 $25,000-$49,999 $50,000 or More Source: 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, [2010]. 41