Advancing Wellbeing in Northern Arizona: a Regional Health Equity Assessment September 6, 2017

Advancing Wellbeing in Northern Arizona: A Regional Health Equity Assessment September 6, 2017 This report was prepared by the Northern Arizona University Center for Health Equity Research 1395 S. Knoles Dr. Flagstaff AZ, 96011 Phone: (928) 523-9188; Fax: (928) 523-4648 Email: [email protected] Report Contributors: Katharine Sanderson, MA, Heather J. Williamson, DrPH, Emery Eaves, PhD, Steven Barger, PhD, Crystal Hepp, PhD, Kristan Elwell, PhD, Ricky Camplain, PhD, Kyle Winfree, PhD, Robert T. Trotter, PhD, and Julie A. Baldwin, PhD This report was commissioned by The NARBHA Institute in partnership with the Northern Arizona Healthcare Foundation. TABLE OF CONTENTS List of Figures ...................................................................................................................................... iii List of Tables ........................................................................................................................................ vi Executive Summary ............................................................................................................................. vii Introduction ........................................................................................................................................ 1 Northern Arizona Regional Overview .................................................................................................. 1 Geographic Overview ................................................................................................................... 2 Demographic Overview ................................................................................................................ 3 Theoretical Framework and Research Design ..................................................................................... 9 Social Determinants of Health Model ........................................................................................... 9 Mixed-Methods Research Design ................................................................................................. 9 Qualitative Methods .............................................................................................................. 11 Quantitative Methods ............................................................................................................ 17 Negotiation of Data Use Agreements .................................................................................... 17 Results ................................................................................................................................................ 20 Regional Health Overview ............................................................................................................ 21 Leading Causes of Mortality ......................................................................................................... 22 Regional Trends ...................................................................................................................... 22 County Trends ........................................................................................................................ 24 Causes of Hospital Admission and Emergency Visits .................................................................... 25 Regional Trends ...................................................................................................................... 26 County Trends ........................................................................................................................ 27 Primary Care Area Trends ...................................................................................................... 28 Priority Health Outcomes of Community Members ..................................................................... 29 Substance Abuse and Behavioral Health Issues ..................................................................... 29 Population-Specific Information ............................................................................................ 35 Chronic Health Conditions of Concern ................................................................................... 35 Population-Specific Information ............................................................................................ 37 Patterns and Disparities in Populations ........................................................................................ 37 Health Patterns and Disparities in Rural vs. Urban Populations ............................................ 37 Health Patterns and Disparities by Race/Ethnicity ................................................................. 44 Leading Causes of Mortality: Stratification by Race and Ethnicity by County ........................ 47 Health Patterns in Children (Age 0–24) .................................................................................. 57 Social Determinants of Health ...................................................................................................... 65 SDOH Factor 1: Access to Health Care ................................................................................... 66 SDOH Factor 2: Economic Stability ......................................................................................... 79 SDOH Factor 3: Education ...................................................................................................... 89 SDOH Factor 4: Neighborhood and Physical Environment ..................................................... 96 SDOH Factor 5: Social and Cultural Context ........................................................................... 102 Organizational Barriers ................................................................................................................ 109 Lack of Funding Resources ..................................................................................................... 109 i Lack of Evaluation and Data Collection Capacity .................................................................... 110 Lack of Collaboration and Communication between Agencies .............................................. 110 Needed Services Identified by Participants ................................................................................. 111 Report Strengths and Limitations ........................................................................................................ 113 Preliminary Recommendation ............................................................................................................. 113 Social Determinants of Health ...................................................................................................... 113 Target Populations ........................................................................................................................ 113 Increase Quantity and Quality of Health Services and Resources ................................................ 114 Multi-Sector Collaboration ........................................................................................................... 115 Work Toward Integration of Health Services into One Medical System and Setting ................... 116 Increase Awareness of and Access to Existing Health Resources in the Community ................... 117 Next Steps ........................................................................................................................................... 117 Project Contributors ............................................................................................................................ 118 Works Cited ......................................................................................................................................... 119 Appendices .......................................................................................................................................... 123 A. Interview Guide for Community Member Interviews ............................................................ 124 B. Focus Group Question Guide for Community Member Focus Groups ................................... 125 C. CDC WONDER Leading Causes of Mortality by Nation, State, and County ............................ 126 D. Total Number of Hospital Admissions and Emergency Department Visits, 2010 and 2014, for each ICD-9 Code Category by County ..................................................... 135 E. Hospital Discharge Summary of Age Distributions at Time of Hospitalization Related to Suicide, Suicide Attempt, or Self-inflicted Injury by County (2014) ................................... 139 F. Top 15 Hospital Discharge Diagnoses for Inpatient Admission and ED Visits by Urban Area and Rural Areas, 2010 and 2014 ......................................................................... 145 G. Leading Causes of Mortality by Ethnicity and County ............................................................ 165 H. Top 15 Discharge Diagnoses for Selected Age Groups by County, 2010 and 2014 ................ 179 ii List of Figures 1. Map of the northern Arizona region ............................................................................................... 2 2. Regional land distribution by county ............................................................................................... 3 3. Regional land ownership by county ................................................................................................ 3 4. County population totals ................................................................................................................

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