Cerebrovascular Disease Mortality Rates Northwest Dallas Service Area

Home , Northwest Dallas, North Dallas, South Dallas

Community Health Assessment Northwest Dallas Service Area Organizational Model For the Community Health Dashboard

Mortality Years of Potential Life Lost Health Infant Mortality Outcomes Very Low Birth Weight Births Morbidity Injury Mortality Violence and Injury Prevention ED Visits for Injuries Health Risk HIV/STD Rates Behaviors High Risk Sexual Behavior Teen Birth Rate

Alcohol Use Liquor Store Density Health Factors Percent Uninsured Access to Clinical Care Physician-to-Population Ratio Emergency Department Use Quality of Clinical Care Prevention Quality Indicators Demographic Profile Northwest Dallas Service Area

100% • The population of the Northwest Dallas Service 17,669 227,874 Area is slightly younger than the county 90% Age population. 80% 60,485 590,701 70% • The service area is one of the three Dallas County 60% 65+ 50% 45-64 service areas that is majority white; its population 103,467 1,084,253 also has the highest proportion of other race non- 40% 15-44 30% Hispanics (16.1%). 0-14 20% • The Northwest Dallas Service Area has the 10% 48,168 602,576 highest percentage of people with more than a 0% Northwest Dallas SA Dallas County high school education (76%) of the 13 service areas. 100% 100% 165,086 Race/ Highest 90% 36,918 90% Ethnicity Educational 80% 80% Attainment 992,473 810,489 70% 54,968 Other Non- 70% Hispanic 60% 60% 122,107 20,247 More than HS 50% Hispanic 50% 498,777 HS Diploma 40% 40% 364,474 Black Non- 30% 30% Less than HS 117,656 Hispanic 20% 20% 849,068 White Non- 23,115 10% 10% 400,087 Hispanic 14,053 0% 0% Northwest Dallas SA Dallas County Northwest Dallas SA Dallas County 2 Source: Nielson/Claritas Pop-Facts mid-2010 version Demographic Profile Northwest Dallas Service Area

• The Northwest Dallas Service Area has the 100% 3,391 third lowest percentage of households in 90% 81,577 Poverty Status, 80% poverty (6.2%) of the 13 service areas. (Households) 70% • The Service Area’s per capita income was the 60% 50% 51,052 below poverty second highest of the 13 service areas. 504,943 40% above poverty • The average 2010 unemployment rate for this 30% 20% Service Area was the lowest of all 13 service 10% areas for 2010. 0% Northwest Dallas SA Dallas County

$45,000 $39,796 Percent Unemployed in the Civilian Labor Force $40,000 14.0% 13.1% $35,000 12.0% 9.1% $30,000 10.0% 6.2%6.1% 7.9% 8.0% $24,240 5.5% 6.0% 6.0%5.5% $25,000 6.0% 4.1% 4.4% 3.8% 3.2% $20,000 4.0% Per 2.0% $15,000 Capita 0.0% Income $10,000 $5,000 $0 Northwest Dallas SA Dallas County 3 Source: Nielson/Claritas, Inc. Pop-Facts mid-2010 version Access to care

Percent Uninsured

Access to Physician-to- Clinical Care Population Ratio

Emergency Department Use Access to Healthcare: Percent Without Healthcare Insurance Northwest Dallas Service Area

Percent Uninsured 100% Percent Without Health 90% Healthy People 2020 Goal – 0% uninsured Insurance, Northwest Dallas Service Area 80%

70% 2010 11.3%

60% 2009 11.1%

50% 47% 44% 2008 9.9%

40% 36% 32% 2007 9.7% 30% 31% 31% 28% 30% 24% 26% 25% 27% 21% 24% 2006 9.0% 21% 19% 21% 18% 19% 20% 20% 12% 18% 17% 17% 15% 11% 11% 2005 9.3% 9% 9% 10% 8% 2004 9.5% 0% 0.0% 5.0% 10.0% 15.0% Irving Irving Texas Texas 09 Texas Outer NE Outer NE SE Dallas Cedar Hill SE Dallas Cedar Hill NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Stemmons Corr Stemmons Corr Dallas County 09 Dallas County Wilmer/Hutch/Seag 2010 Wilmer/Hutch/Seag 2006

Source: 2006 Solucient, Inc.; 2010 Market Planner Plus; Denominator population data from Claritas, Inc.; except 2010 from Nielson/Claritas Pop-Facts mid 2010 version; Dallas County and Texas rates from US Census Bureau’s 5 American Community Survey 2009 Access to Healthcare: Primary Care Physician-to-Population Ratio Northwest Dallas Service Area

Primary Care Physicians per 100,000 160 Primary Care Physician-to- 134.4 140 130.9 Population Ratio, per 100,000, 120.9 Northwest Dallas Service Area 120 111.2 112.6

100 91.9 2010 76.2 82.3 76.2 79.2 80 71.3 69.1 66.1 68.1 53.7 57.1 54.4 59.8 2008 62.8 60 47.1 55.6 48.6 43.3 45.7 46.1 38.4 40.3 40 33 2006 61.3 23.1 20 13 10.6 9.3 2004 71.3 0 Irving Irving 0.0 25.0 50.0 75.0 100.0 Texas Texas Outer NE Outer NE Cedar Hill SE Dallas Cedar Hill SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2010 2004 Wilmer Hutch Seag Wilmer Hutch Seag

Source: Texas Medical Association Physician Practice Address files; denominator population data from Claritas, Inc., except 2010 from Nielson/Claritas Pop Facts mid 2010 version. County and State sources is Texas Bureau of Primary Care. http://www.dshs.state.tx.us/chs/hprc/tables/Primary- Care-Physicians-(PC)-by-County-of-Practice---September,-2010/ and http://www.dshs.state.tx.us/chs/hprc/tables/04PC.shtm 6 Access to Healthcare: Non- Emergent ED Utilization Northwest Dallas Service Area

Non-Emergent ED Visits, per 1,000 Population 60.0 Rate of Non-Emergent ED 53.7 51.3 Visits, per 1,000, Northwest Dallas Service Area 50.0

38.9 40.0 36.5 2009 15.1 34.7 32.1 33.5 31.5 31.1 28.8 29.5 27.4 29.1 30.0 26.2 26.1 24.4 2008 13.8 23.0 23.2 20.4 18.9 19.7 19.8 20.0 17.1 17.6 14.7 15.1 15.8 12.9 2007 15.0

10.0

2006 15.8 0.0

0.0 5.0 10.0 15.0 20.0 Irving Irving Outer NE Outer NE SE Dallas SE Dallas Cedar Hill Cedar Hill NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2009 2006 Wilmer Hutch Seag Wilmer Hutch Seag

Source: DFWHC, Outpatient Data System; NYU Algorithm for determining appropriate Emergency Dept. Use; denominator population data from Claritas, Inc. 7 Access to Care

– Doing better than the benchmark Northwest Northwest Northwest – Same as/not significantly different from the benchmark Dallas Dallas Dallas – Worse than the benchmark Compared Compared to Compared to Healthy Benchmark to Past People Counties* Years’ Data 2020 Goal (Quartiles) (CI)

Percent Uninsured

Access to Physician-to- N/A Clinical Population Ratio Care

Emergency N/A N/A Department Use *Benchmark Counties are: Maricopa, Los Angeles, Cook, Miami-Dade, Bexar, Harris and Tarrant Quality of care

Diabetes- Related

Cardiovascular Quality of Prevention Clinical Quality Indicators Care Acute/Infectious

Chronic Pulmonary Healthcare Quality: Rate of Preventable Hospitalizations, 2008 Diabetes-Related Hospitalizations Northwest Dallas Service Area

Diabetes Short Term Complications, 2008 Diabetes Long Term Complications, 2008 126.9 276.5 140.0 108.4 300.0 120.0 250.0 181.9 213.0 100.0 73.4 70.9 55.1 200.0 117.9 167.2 80.0 55.8 55.6 106.3 120.5 85.1 43.3 50.8 35.1 150.0 106.1 110.6 60.0 38.0 38.631.8 29.2 30.5 99.0 73.6 84.0 40.0 100.0 57.0 41.7 20.0 50.0 0.0 0.0

Uncontrolled Diabetes, 2008 Lower Extremity Amputation Among Diabetics, 50.0 2008 39.5 120.0 98.6 40.0 33.5 100.0 69.8 30.0 24.2 21.6 80.0 49.6 20.7 31.0 34.1 48.6 43.6 13.6 60.0 42.1 20.0 12.3 12.2 9.8 11.4 10.6 12.0 28.6 32.1 25.9 9.4 7.8 7.7 40.0 18.2 12.622.2 26.6 10.0 20.0 0.0 0.0

Source: Texas Department of State Health Services, Texas Health Care Information Council, unpublished data; denominator population data from Claritas, Inc.; County and State rates from Texas Department of State Health 10 Services, Texas Health Care Information Council, 2003, 2005 and 2008 Healthcare Quality: Rate of Preventable Hospitalizations, 2008 Cardiovascular Disease Hospitalizations Northwest Dallas Service Area

Congestive Heart Failure, 2008 Hypertension, 2008 700.0 625.3 618.7 200.0 173.3 600.0 379.1 432.9 150.0 500.0 329.9 364.6 266.3 389.4 91.5 88.2 84.0 400.0 310.8 257.6 302.9 255.3 88.5 80.4 217.6 259.1 100.0 57.3 62.9 63.2 300.0 201.2 46.2 41.2 43.3 200.0 50.0 30.2 29.1 40.7 100.0 0.0 0.0

Angina Without Cardiac Procedure, 2008 14.4 16.0 13.1 12.5 12.9 14.0 11.3 10.8 11.8 12.0 9.2 8.2 10.0 7.0 6.8 8.2 8.0 5.5 6.0 3.3 4.0 2.3 2.0 0.0

Source: Texas Department of State Health Services, Texas Health Care Information Council, unpublished data; denominator population data from Claritas, Inc.; County and State rates from Texas Department of State Health 11 Services, Texas Health Care Information Council, 2003, 2005 and 2008 Healthcare Quality: Rate of Preventable Hospitalizations, 2008 Acute/Infectious Disease Hospitalizations Northwest Dallas Service Area

Bacterial Pneumonia, 2008 Dehydration, 2008 331.3 270.8 275.2 140.0 100.9 116.8 350.0 233.8 238.3 284.4 87.3 108.3107.0 300.0 220.8 233.4 120.0 80.5 233.8 241.4 216.5 100.0 88.3 88.3 82.6 80.3 250.0 196.5 185.4 211.7 179.0 75.2 65.8 200.0 80.0 53.250.0 49.6 150.0 60.0 100.0 40.0 50.0 20.0 0.0 0.0

Urinary Tract Infection, 2008 200.6 250.0 217.2 196.0 184.2 180.8 198.2 167.0 174.8 201.3 168.5 200.0 164.3 140.9 150.0 129.5 127.4 129.5 100.0 50.0 0.0

Source: Texas Department of State Health Services, Texas Health Care Information Council, unpublished data; denominator population data from Claritas, Inc.; County and State rates from Texas Department of State Health 12 Services, Texas Health Care Information Council, 2003, 2005 and 2008 Healthcare Quality: Rate of Preventable Hospitalizations, 2008 Chronic Pulmonary Disease Hospitalizations Northwest Dallas Service Area

Chronic Obstructive Pulmonary Disease, 2008 Adult Asthma, 2008 400.0 351.6 300.0 242.1 350.0 185.9 250.0 174.7 210.4 177.0 165.8 184.0 300.0 159.9 160.2 200.0 250.0 128.0 164.4 162.0 124.1 148.2 89.6 113.6 91.1 200.0 112.2 150.0 83.7 85.2 83.9 150.0 100.4 101.2 102.1 112.7 100.0 59.9 59.3 71.4 72.4 100.0 50.0 50.0 0.0 0.0

Source: Texas Department of State Health Services, Texas Health Care Information Council, unpublished data; denominator population data from Claritas, Inc.; County and State rates from Texas Department of State Health 13 Services, Texas Health Care Information Council, 2003, 2005 and 2008 Healthcare Quality

Northwest Dallas – Doing better than the benchmark Compared to 12 Other – Same as/not significantly different from the benchmark Service Areas – Worse than the benchmark (Quartiles)

Diabetes ST Comp

Diabetes LT Comp

Uncontrolled Diabetes

Lower Extremity Amputations Among Diabetics Quality of Prevention Congestive Heart Failure Quality Clinical Indicators Hypertension Care Angina Without Cardiac Procedure

Bacterial Pneumonia

Dehydration

Urinary Tract Infection

Chronic Obstructive Pulmonary Disease

Adult Asthma Health Risk Behaviors

Mortality Injury Prevention ED Use

Health Risk HIV/STD’s Behaviors High Risk Sexual Behavior Teen Birth Rate

Liquor Store Alcohol Use Density Risk Factors: Auto Accident Mortality Rates Northwest Dallas Service Area

Age-Adjusted Deaths per 100,000 25.0 Auto Accident Mortality Rate, Healthy People 2020 Goal 12.4 Age-Adjusted Death Rate per 20.9 100,000, Northwest Dallas Service Area 20.0 18.7 16.2 17.1 16.2 15.5 2009 5.8 14.8 14.4 15.0 13.7 14.1 12.3 12.6 11.9 2008 6.3 11.4 11.4 10.8 11.1 10.0 8.7 9.0 8.2 7.9 8.0 2007 10.6 7.2 6.1 5.8 5.3 4.6 4.4 2006 4.8 5.0 3.5

2005 8.4 0.0 2004 9.0 Irving Irving Texas Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas 0.0 5.0 10.0 15.0 North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2004 Wilmer Hutch Seag 2009 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 16 Risk Factors: Accidental Poisoning Mortality Rates Northwest Dallas Service Area

Age-Adjusted Deaths per 100,000 14.0 Accidental Poisoning Mortality Healthy People 2020 Goal 11.1 13.2 Rate, Age-Adjusted Death Rate per 100,000, Northwest Dallas 12.0 Service Area

10.0 8.6 2009 1.3 7.8 8.0 7.5 6.4 6.6 2008 5.4 5.9 5.9 6.1 6.0 5.5 5.1 4.5 4.3 2007 7.5 3.2 3.9 4.0 2.8 2.8 3.1 2.3 2.2 2.4 2.1 2.3 2006 3.4 2.0 1.3 1.5 1.3 0.7 0.6 0.4 2005 5.3 0.0

2004 4.5 Irving Irving Texas Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas 0.0 2.5 5.0 7.5 10.0 North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2004 Wilmer Hutch Seag 2009 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 17 Risk Factors: Accidental Falls Mortality Rates Northwest Dallas Service Area

Age-Adjusted Deaths per 100,000 12.0 Accidental Falls Mortality Rate, 10.8 Healthy People 2020 Goal 7.0 Age-Adjusted Death Rate per 10.1 10.0 100,000, Northwest Dallas 9.9 10.0 9.3 9.8 Service Area 8.9 8.4 8.4 8.1 8.2 7.7 8.0 7.2 2009 10.1 6.6 6.8 6.6 6.3 6.2 6.5 5.8 6.0 4.9 4.9 2008 5.5 4.1 4.0 4.0 3.5 3.6 3.2 2007 5.1 2.5

2.0 2006 2.9 0.0 0.0 2005 2.5 Irving Irving Texas Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas 0.0 5.0 10.0 15.0 North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2005 Wilmer Hutch Seag 2009 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 18 Risk Factors: Falls Death Rates Among Seniors Northwest Dallas Service Area

Falls Deaths Age 65+

80.0 Falls fatality rates, ages 65+, 72.0 70.6 Healthy People 2020 Goal 45.3 per 100,000, Northwest 70.0 62.5 Dallas Service Area 62.1 55.7 61.5 60.0 53.5 55.8 55.0 55.6 50.3 49.8 49.6 2009 47.9 48.7 55.7 50.0 45.8 42.6 43.7 42.442.1 38.8 40.0 2008 32.5 33.9

30.0 24.8 22.6 2007 27.2 20.2 18.4 17.4 20.0 15.0 2006 14.4 10.0 0.0 0.0 2005 15.0 Irving Irving Texas 0.0 20.0 40.0 60.0 Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2009 2005 Wilmer Hutch Seag Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics, unpublished data; denominator population data from Claritas, Inc.; 2005 Dallas County data from Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death File 2005-2006. CDC WONDER On-line Database, compiled from Multiple Cause of Death File 2005-2006 Series 20 No. 2L, 2009. Accessed at 19 http://wonder.cdc.gov/mcd-icd10.html on Mar 25, 2010 2:52:15 PM; 2005 Texas data from http://soupfin.tdh.state.tx.us/ Risk Factors: Rate of Injury- Related ED Visits Northwest Dallas Service Area

Rate of Injury-Related ED Visits Healthy People 2020 Goal 73.3 80.0 76.0 Rate of Injury-Related ED 74.3 73.6 Visits, per 1,000, Northwest Dallas Service Area 70.0 65.3 63.2 63.6 64.4 57.1 60.8 60.0 56.8 51.8 53.5 53.0 53.6 49.7 50.3 50.7 50.3 2009 35.0 50.0 45.8 42.7 37.3 38.1 40.0 37.5 37.1 36.8 35.0 35.3 2008 33.2 28.8 30.0

20.0 2007 36.9

10.0

0.0 2006 37.1 Irving Irving 0.0 10.0 20.0 30.0 40.0 50.0 Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2009 2006 Wilmer Hutch Seag Wilmer Hutch Seag

Source: Dallas Fort Worth Hospital Council, COGNOS application, unpublished data; denominator population data from Claritas, Inc. 20 Risk Factors: Suicide Mortality Rates Northwest Dallas Service Area

Age-Adjusted Deaths per 100,000 Suicide Mortality Rate, Age- 16.0 15.1 Adjusted Death Rate per 14.1 Healthy People 2020 Goal 10.2 100,000, Northwest Dallas 14.0 12.4 Service Area

12.0 11.2 11.0 10.4 10.6 10.2 9.5 9.5 9.5 9.7 2009 12.4 10.0 9.1 8.7 8.4 8.3 8.6 7.7 7.7 2008 13.1 8.0 7.2 7.0 7.1 6.6 6.5 6.7 5.5 5.7 6.0 5.3 2007 10.5

4.0 3.4 2006 7.3

2.0 2005 10.6 0.0

2004 15.1 Irving Irving Texas Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas 0.0 5.0 10.0 15.0 20.0 North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2004 Wilmer Hutch Seag 2009 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 21 Risk Factors: Homicide Mortality Rates Northwest Dallas Service Area

Age-Adjusted Deaths per 100,000 45.0 Homicide Mortality Rate, Age- 40.4 Adjusted Death Rate per 40.0 Healthy People 2020 Goal 5.5 100,000, Northwest Dallas Service Area 35.0 31.9

30.0 2009 5.4

25.0 2008 3.5 20.0 20.0 13.7 14.7 2007 2.7 15.0 12.6 11.2 11.3 9.3 10.0 8.1 8.6 7.0 7.1 7.2 2006 4.9 6.4 6.3 6.2 6.1 5.4 4.9 4.0 4.7 4.5 5.0 3.3 2.9 3.5 2.8 1.1 1.2 2005 2.8 0.0 2004 2.8 Irving Irving Texas Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas 0.0 2.0 4.0 6.0 North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2004 Wilmer Hutch Seag 2009 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 22 Risk Factors: High Risk Sexual Behavior, Sexually Transmitted Disease Incidence Rates, 2009 Northwest Dallas Service Area

Chlamydia Incidence per 100,000 Gonorrhea Incidence per 100,000 559.6 1,400.0 1,281.9 600.0 1,200.0 783.2 500.0 1,000.0 762.0 751.0 759.0 400.0 800.0 451.9 243.8 240.8 252.2 577.4 422.7 580.7 300.0 600.0 405.9 417.4 221.2 149.4 183.2 391.6 349.3 291.2 67.4 193.3 400.0 224.7 200.0 89.1 111.1 121.8 115.7 200.0 100.0 77.7 64.9 - -

Primary & Secondary Syphilis Incidence per New HIV Incidence per 100,000 100,000 91.9 46.6 100.0 50.0 80.0 66.7 40.0 41.9 60.0 43.7 30.0 33.1 19.3 16.5 29.3 35.9 20.0 14.6 10.9 14.6 12.2 40.0 21.5 22.5 24.0 26.0 6.2 6.7 8.0 7.8 6.6 18.5 15.4 17.5 10.0 3.0 2.2 3.1 20.0 11.7 - -

23 Source: Texas Department of State Health Services, Bureau of STD/HIV, unpublished data; Denominator population data from Claritas, Inc.; Dallas County and Texas Rates are from http://www.dshs.state.tx.us/hivstd/reports/STD2009.pdf and http://www.dshs.state.tx.us/hivstd/reports/HIV2009.pdf Risk Factors: High Risk Sexual Behavior, Teen Birth Rates Northwest Dallas Service Area

Teen Birth Rate 80.0 Teen Births, Rate Per 1,000 Girls Ages 15-17, Northwest Dallas 67.8 70.0 Healthy People 2020 Goal 36.2 Service Area 62.7 60.3 59.1 57.5 60.0 55.8 55.4 55.1 2009 21.4 50.0 46.3 47.6 43.5 40.7 44.4 40.8 42.0 40.0 36.5 2008 21.5 32.3 35.7 29.1 31.4 30.0 23.7 21.4 24.3 2007 19.7 18.6 20.1 19.0 20.0 15.7 16.6 2006 20.8 10.0

- 2005 19.0 Irving Irving 0.0 5.0 10.0 15.0 20.0 25.0 Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2005 Wilmer Hutch Seag 2009 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 24 Risk Factors: Liquor Store Density, 2007 Northwest Dallas Service Area

Liquor Stores Per 100,000, 2007 Liquor Store Density, Stores per 60.0 100,000, State of Texas

48.6 50.0

2008 7.0 40.0

2007 7.1 30.0

20.0 2006 6.9 14.7 14.2 10.4 8.9 8.7 9.3 10.0 7.1 2005 7.4 4.0 2.8 2.0 1.9 0.0 0.0 0.0 0.0 2004 7.2 Irving Texas 0.0 2.5 5.0 7.5 10.0 Outer NE SE Dallas Cedar Hill NE Dallas SW Dallas NW Dallas North Dallas South Dallas DeSoto Lanc Grand Prairie Dallas County Stemmons Corr Wilmer Hutch Seag

Source: US Census Bureau, 2007 Economic Census; denominator population data from Claritas, Inc.; Dallas County and State of Texas data from US Census Bureau, NIACS annual business estimates, denominator is American 25 Community Survey 2007 population estimate Health Risk Behaviors

– Doing better than the benchmark – Same as/not significantly different from the benchmark Northwest Northwest Northwest – Worse than the benchmark Dallas Dallas Dallas Compared Compared to Compared to Healthy Benchmark to Past People Counties* Years’ 2020 Goal (Quartiles) Data (CI)

Motor Vehicle Crash Death Rate Accidental Poisoning Death Rate Accidental Falls Death Health Rate Injury Senior Falls Death Risk Prevention Behaviors Rate Suicide Death Rate

*Benchmark Counties are: Homicide Death Rate Maricopa, Los Angeles, Cook, Miami-Dade, Bexar, Harris and Tarrant Emergency Department Injury Visits Health Risk Behaviors

Chlamydia Incidence Rate N/A High Risk Gonorrhea Sexual Incidence Rate N/A Behavior Syphilis Health N/A Risk Incidence Rate HIV Incidence Behaviors Rate N/A

Alcohol Liquor Store N/A N/A Use Density Health Outcomes

Heart Disease

Cancer

Cerebrovascular Mortality Disease

Chronic Obstructive Infant Mortality Pulmonary Disease

Low Birth Diabetes Mellitus Health Weight Births Outcomes Years of Potential Life Aseptic Meningitis Lost

Communicable Cryptosporidiosis Disease Morbidity Pertussis

Salmonellosis Health Outcomes: Heart Disease Mortality Rates Northwest Dallas Service Area

Age-Adjusted Deaths per 100,000 350.0 Heart Disease Mortality Rate, Age- 323.2 Healthy People 2020 Goal 100.8 Adjusted Death Rate per 100,000, 300.0 285.9 Northwest Dallas Service Area 262.2 252.9 229.2 250.0 235.7 240.8 218.1 224.5 2009 147.3 198.6 197.0 200.0 175.0 189.9 191.8 188.3 174.4 166.6 170.0 168.6 167.9 164.6 2008 152.1 149.5 147.3 149.4 141.3 150.0 132.4 139.4 135.1 138.1 2007 167.1

100.0 2006 135.1

50.0 2005 159.9 0.0 2004 149.4 Irving Irving Texas Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas 0.0 50.0 100.0 150.0 200.0 SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2004 Wilmer Hutch Seag 2009 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 29 Health Outcomes: Cancer Mortality Rates Northwest Dallas Service Area

Age-Adjusted Deaths per 100,000 300.0 Cancer Mortality Rate, Age- Healthy People 2020 Goal 160.6 Adjusted Death Rate per 100,000, 253.1 Northwest Dallas Service Area 250.0 231.7 229.6 205.8 202.4 187.6 189.5 182.7 200.0 185.6 186.8 2009 148.1 176.7 181.4 168.7 148.6 161.3 173.0 160.7 165.9 147.9 148.1 161.0 148.6 151.6 2008 133.9 150.0 138.5 139.5 145.8 141.9

114.8 111.5 2007 130.5 100.0

2006 130.5 50.0

2005 161.2 0.0 2004 147.9 Irving Irving Texas Outer NE Outer NE Cedar Hill SE Dallas Cedar Hill SE Dallas NE Dallas NE Dallas 0.0 50.0 100.0 150.0 200.0 SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr Wilmer Hutch Seag 2009 2004 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 30 Health Outcomes: Cerebrovascular Disease Mortality Rates Northwest Dallas Service Area

Age-Adjusted Deaths per 100,000 100.0 Cerebrovascular Disease Healthy People 2020 Goal 33.8 Mortality Rate, Age-Adjusted 90.0 87.7 Death Rate per 100,000, 80.5 80.5 Northwest Dallas Service Area 80.0 66.1 70.0 65.5 65.0 64.1 62.8 63.0 2009 40.0 59.1 61.5 58.8 60.0 57.7 56.2 48.6 46.8 48.7 48.2 2008 38.7 50.0 45.2 46.0 42.6 44.6 43.5 43.8 40.0 40.0 33.6 33.2 33.3 33.7 2007 26.7 30.0 2006 43.8 20.0

10.0 2005 40.8 0.0 2004 46.0 Irving Irving Texas Outer NE Outer NE Cedar Hill SE Dallas Cedar Hill SE Dallas NE Dallas NE Dallas 0.0 20.0 40.0 60.0 SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr Wilmer Hutch Seag 2009 2004 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 31 Health Outcomes: Chronic Obstructive Pulmonary Disease Mortality Rates Northwest Dallas Service Area

Age-Adjusted Deaths per 100,000 Chronic Obstructive Pulmonary 80.0 74.7 Disease Mortality Rate, Age- 72.6 Adjusted Death Rate per 100,000, 70.0 Northwest Dallas Service Area

58.9 60.0 50.5 2009 32.3 50.0 46.8 47.2 43.2 44.6 42.7 41.6 41.7 37.9 38.9 2008 31.8 40.0 34.0 34.0 36.1 36.4 35.2 32.3 33.6 31.5 29.9 31.2 28.7 30.0 30.0 28.1 27.2 27.9 26.9 2007 31.2

20.0 2006 24.1

10.0 2005 37.1 0.0 2004 35.2 Irving Irving Texas Outer NE Outer NE Cedar Hill SE Dallas Cedar Hill SE Dallas NE Dallas NE Dallas 0.0 10.0 20.0 30.0 40.0 SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr NOTE: No Healthy People 2020 goal Wilmer Hutch Seag 2009 2004 Wilmer Hutch Seag matches this metric.

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 32 Health Outcomes: Diabetes Mortality Rates Northwest Dallas Service Area

Age-Adjusted Deaths per 100,000 70.0 Diabetes Mellitus Mortality Rate, Age-Adjusted Death Rate per 100,000, Northwest Dallas 60.0 Service Area

50.0 Healthy People 2020 Goal 65.8 2009 6.9

40.0 37.0 35.1 34.6 36.6 32.4 32.7 2008 13.0 29.3 30.7 29.6 30.0 26.6 26.2 22.9 23.5 22.9 2007 13.2 18.6 19.9 19.0 18.4 20.0 16.8 17.8 16.3 14.5 13.8 12.2 12.6 2006 13.9 10.9 8.6 10.0 7.2 6.9 2005 13.3 0.0 2004 17.8 Irving Irving Texas Outer NE Outer NE Cedar Hill SE Dallas Cedar Hill SE Dallas NE Dallas NE Dallas 0.0 5.0 10.0 15.0 20.0 SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr Wilmer Hutch Seag 2009 2004 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 33 Health Outcomes: Birth Outcomes, Rate of Very Low Birth Weight Births Northwest Dallas Service Area

Very Low Birth Weight Rate 3.0% Very Low Birth Weight Rate, % of 2.7% Healthy People 2020 Goal 1.4% Births Below 1500 Grams at Birth, Northwest Dallas Service Area 2.5% 2.4% 2.5% 2.4% 2.4% 2.2% 2.2%

1.9% 2009 1.2% 2.0% 1.8% 1.8% 1.8% 1.7% 1.7% 1.7% 1.7% 1.6% 1.6% 1.6% 1.5% 1.5% 1.5% 1.5% 1.5% 1.5% 2008 1.5% 1.3% 1.3% 1.3% 1.2% 1.2% 1.1% 2007 1.8% 1.0%

2006 1.5% 0.5%

2005 1.2% 0.0%

0.0% 0.5% 1.0% 1.5% 2.0% Irving Irving Texas Texas Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2005 Wilmer Hutch Seag 2009 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 34 Health Outcomes: Birth Outcomes, Infant Mortality Rate Northwest Dallas Service Area

Infant Mortality Rate Infant Mortality Rate, Deaths 14.0 13.2 12.8 per 1,000 Live Births, 12.4 Healthy People 2020 Goal 6.0 Northwest Dallas Service Area 12.0 11.2 11.3 11.2

10.0 2009 12.8 8.6 8.4 7.6 7.9 8.0 7.3 7.0 7.2 7.1 10.3 6.7 2008 6.4 6.4 6.4 6.4 6.5 5.2 6.0 5.6 5.0 5.0 4.6 2007 3.0 3.9 3.9 3.7 4.0 3.2 2006 4.6 2.0

2005 5.0 0.0

0.0 5.0 10.0 15.0 Irving Irving Texas Texas Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2005 Wilmer Hutch Seag 2009 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 35 Health Outcomes: Years of Potential Life Lost, All Causes Northwest Dallas Service Area

Years of Potential Life Lost Rate per 100,000* 16,000 Years of Potential Life Lost Rate*, per 100,000, Northwest 14,016 13,958 14,000 Dallas Service Area

12,000 2009 4,495 10,000 9,1498,806 8,690 8,271 7,443 7,816 7,339 2008 4,771 8,000 7,509 7,153 6,727 6,921 6,556 6,625 6,128 6,046 6,169 5,733 5,518 6,000 4,495 5,024 5,075 4,862 2007 3,991 4,324 4,568 4,451 3,960 4,000 2006 3,810 2,000

2005 - 3,960 Irving Irving 0 2,500 5,000 7,500 Outer NE Outer NE Cedar Hill Cedar Hill SE Dallas SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie *Years of Potential Life Lost Dallas County Dallas County Stemmons Corr Stemmons Corr Rate is defined as the rate of 2005 Wilmer Hutch Seag 2009 Wilmer Hutch Seag deaths under age 75 per 100,000 population under age 75.

Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 36 Health Outcomes: Reportable Communicable Disease Rates Northwest Dallas Service Area

Aseptic Meningitis Incidence, per 100,000 50.00 Aseptic Meningitis Incidence Rate, per 100,000, Northwest 45.00 43.35 Dallas Service Area

40.00 38.12

35.00 30.10 2009 11.12 29.45 30.00 2008 6.33 25.00 22.01 20.91 21.72 16.33 16.84 20.00 15.40 2007 5.93 15.76 15.51 14.74 15.31 12.36 15.00 11.30 13.24 11.85 10.59 11.12 10.49 8.97 2006 6.92 10.00 7.01 7.81 7.96 5.81 6.28 5.00 2.38 2005 15.51 0.00 0.0 5.0 10.0 15.0 20.0 Irving Irving Outer NE Outer NE SE Dallas SE Dallas Cedar Hill Cedar Hill NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2005 Wilmer Hutch Seag 2009 Wilmer Hutch Seag

Source: Texas Department of State Health Services, Infectious Disease Control Unit, unpublished data; denominator population data from Claritas, Inc.; 2005 Dallas County data from Dallas County Health and Human Services web site: 37 http://www.dallascounty.org/department/hhservices/services/communicable/documents/ReportableConditions2003-07Annual.pdf; 2005 Dallas County denominator population data from American Community Survey. Health Outcomes: Reportable Communicable Disease Rates Northwest Dallas Service Area

Cryptosporidiosis Incidence, per 100,000 3.00 Cryptosporidiosis Incidence Rate, per 100,000, Northwest 2.59 Dallas Service Area 2.50

2009 1.33 2.00 1.83 1.61 1.46 2008 22.61 1.50 1.32 1.33 1.19 1.17 1.13 1.14 1.09 1.06 2007 1.37 1.00 0.79 0.73 0.73 0.55 0.56 0.59 2006 0.92 0.47 0.50 0.50 0.39 0.39 0.42

2005 1.83 0.00 0.00 0.00 0.00 0.00 0.00 0.0 10.0 20.0 30.0 Irving Irving Outer NE Outer NE Cedar Hill SE Dallas Cedar Hill SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2009 2005 Wilmer Hutch Seag Wilmer Hutch Seag

Source: Texas Department of State Health Services, Infectious Disease Control Unit, unpublished data; denominator population data from Claritas, Inc.; 2005 Dallas County data from Dallas County Health and Human Services web site: http://www.dallascounty.org/department/hhservices/services/communicable/documents/ReportableConditions2003-07Annual.pdf; 38 2005 Dallas County denominator population data from American Community Survey. Health Outcomes: Reportable Communicable Disease Rates Northwest Dallas Service Area

Pertussis Incidence, per 100,000 14.00 Pertussis Incidence Rate, per 12.87 100,000, Northwest Dallas 12.15 11.85 Service Area 12.00 11.29 10.44 10.17 10.00 9.40 8.98 2009 5.78 7.50 7.29 8.00 7.19 7.24 7.26 6.63 6.48 6.94 2008 8.59 6.40 6.37 6.20 6.23 5.93 5.78 6.00 5.30 5.14 5.30 2007 2.73 4.54 4.30

4.00 3.12 2006 5.07 2.00 2005 5.93 0.00 0.0 3.0 6.0 9.0 12.0 Irving Irving Outer NE Outer NE Cedar Hill SE Dallas Cedar Hill SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2009 2005 Wilmer Hutch Seag Wilmer Hutch Seag

Source: Texas Department of State Health Services, Infectious Disease Control Unit, unpublished data; denominator population data from Claritas, Inc.; 2005 Dallas County data from Dallas County Health and Human Services web site: 39 http://www.dallascounty.org/department/hhservices/services/communicable/documents/ReportableConditions2003-07Annual.pdf; 2005 Dallas County denominator population data from American Community Survey. Health Outcomes: Reportable Communicable Disease Rates Northwest Dallas Service Area

Salmonellosis Incidence, per 100,000 18.00 Salmonellosis Incidence Rate, 15.98 Healthy People 2020 Goal 11.4 per 100,000, Northwest Dallas 16.00 Service Area

14.00 12.95 11.92 11.33 11.41 2009 9.34 11.34 11.68 11.52 12.00 10.14 10.87 11.27 9.48 9.65 8.89 10.00 9.34 9.48 9.22 8.83 2008 12.21 8.42 8.56 7.76 7.62 8.00 6.53 6.37 5.94 6.24 2007 10.94 6.00 5.13 4.30 4.00 2006 6.92

2.00 2005 7.76 0.00 0.0 5.0 10.0 15.0 Irving Irving Outer NE Outer NE Cedar Hill SE Dallas Cedar Hill SE Dallas NE Dallas NE Dallas SW Dallas SW Dallas NW Dallas NW Dallas North Dallas North Dallas South Dallas South Dallas DeSoto Lanc DeSoto Lanc Grand Prairie Grand Prairie Dallas County Dallas County Stemmons Corr Stemmons Corr 2009 2005 Wilmer Hutch Seag Wilmer Hutch Seag

Source: Texas Department of State Health Services, Infectious Disease Control Unit, unpublished data; denominator population data from Claritas, Inc.; 2005 Dallas County data from Dallas County Health and Human Services web site: 40 http://www.dallascounty.org/department/hhservices/services/communicable/documents/ReportableConditions2003-07Annual.pdf; 2005 Dallas County denominator population data from American Community Survey. Health Outcomes

– Doing better than the benchmark Northwest Northwest Northwest – Same as/not significantly different from the benchmark – Worse than the benchmark Dallas Dallas Dallas Compared Compared to Compared to Healthy Benchmark to Past People Counties* Years’ Data 2020 Goal (Quartiles) (CI)

Heart Disease Death Rate

Cancer Death Rate Health Mortality Outcomes Cerebrovascular Disease Death Rate

Chronic Obstructive Pulmonary Disease N/A Death Rate *Benchmark Counties are: Maricopa, Los Angeles, Cook, Miami-Dade, Bexar, Harris and Diabetes Death Rate Tarrant Health Outcomes

Northwest Northwest Northwest – Doing better than the benchmark Dallas Dallas Dallas – Same as/not significantly different from the benchmark Compared Compared Compared – Worse than the benchmark to Healthy to Bench- to Past People mark Years’ 2020 Goal Counties* Data (CI) *Benchmark Counties are: (Quartiles) Maricopa, Los Angeles, Cook, Miami-Dade, Bexar, Harris and Infant Mortality Rate Tarrant Very Low Birth Weight Birth Rate Years of Potential Life Lost Rate N/A Health Aseptic Meningitis N/A N/A Outcomes Incidence Rate Cryptosporidiosis N/A N/A Communicable Incidence Rate Disease Pertussis Incidence Morbidity Rate N/A N/A

Salmonellosis Incidence Rate N/A Summary – Model With Stoplight Pie Charts, Northwest Dallas Service Area

South Dallas Wilmer Hutchins Seagoville Southwest Dallas Southeast Dallas Stemmons Corridor DeSoto Lancaster Cedar Hill Northwest Dallas Irving Northeast Dallas Each vertical line Grand Prairie represents 100% North Dallas difference from the Dallas County average. Outer Northeast

More Unfavorable More Favorable NOTE: All data are from the years 2007-2010, years available varies Percent Difference from the Dallas County Average by topic.

Mortality Years of Potential Life Lost Infant Mortality Very Low Birth Weight Morbidity Violence and Injury High Risk Sexual Behavior Access to Clinical Care Preventable Hospitalizations Socioeconomic Methods of calculating deviations from the Dallas County mean for the preceding chart.

• Mortality. For each service area and for Dallas County, add the 2009 age-adjusted death rates per 100,000 for the five leading causes of death, to get a single number. Calculate for each service area the percent deviation from the Dallas County total, from -infinity to +infinity. That deviation is the mortality deviation for the chart. Because heart disease and cancer predominate, this tends to over-weight these two causes compared to the other three (stroke, COPD and diabetes). • Years of potential life lost. Using the Years of Potential Life Lost Rate per 100,000, calculate for each service area the percent deviation from the Dallas County YPLL rate, from -infinity to +infinity. That deviation is the YPLL deviation for the chart. • Infant Mortality. Using the Infant mortality rate per 1,000 live births, calculate for each service area the percent deviation from the Dallas County infant mortality rate, from -infinity to +infinity. That deviation is the infant mortality deviation for the chart. • Very Low Birth Weight. Using the Very Low Birth Weight rate per 1,000 live births, calculate for each service area the percent deviation from the Dallas County VLBW rate, from -infinity to +infinity. That deviation is the VLBW deviation for the chart. • Morbidity. For each service area and for Dallas County, add the 2009 incidence rates per 100,000 for the four reportable diseases (aseptic meningitis, cryptosporidiosis, pertussis, salmonellosis), to get a single number. Calculate for each service area the percent deviation from the Dallas County total, from -infinity to +infinity. That deviation is the morbidity deviation for the chart. Meningitis and salmonellosis are more common, so this tends to over-weight them, although all are fairly rare in a population sense. • Violence and Injury. Three steps: For each service area and for Dallas County, add the 2009 age-adjusted death rates for the injury-related causes of death (motor vehicle crashes, poisoning, falls, suicide and homicide) and the age-specific seniors falls death rate (all of which are in units of deaths per 100,000), to get a single number. Calculate for each service area the percent deviation from the Dallas County total, from -infinity to +infinity. Then using the rate per 100,000 of ED visits for injuries, calculate for each service area the percent deviation from the Dallas County rate, from -infinity to +infinity. Calculate the arithmetic mean of these two percent deviations. That is the Violence and Injury deviation for the chart. This might over-weight ED visits somewhat, but it is qualitatively different from mortality. Methods of calculating deviations from the Dallas County mean for the preceding chart.

• High Risk Sexual Behavior. Three steps: For each service area and for Dallas County, add the 2009 incidence rates for three non-HIV STDs (Chlamydia, gonorrhea and syphilis), to get a single number in units of cases per 100,000. Calculate for each service area the percent deviation from the Dallas County total, from -infinity to +infinity. Then using the rate of new HIV diagnoses per 100,000, calculate for each service area the percent deviation from the Dallas County rate, from -infinity to +infinity. The using the rate of births to girls 15-17, per population of girls 15-17, calculate for each service area the percent deviation from the Dallas County rate, from - infinity to +infinity. Calculate the arithmetic mean of these three percent deviations. That is the High Risk Sexual Behavior deviation for the chart. This might under-weight syphilis somewhat. By giving the three equal statistical weight (STDs, HIV and teen births) you could set off debates over which has the most impact over harm to the area’s health status, but since they are qualitatively quite different we probably can’t resolve that to everyone’s satisfaction. • Access to Clinical Care. For each service area and for Dallas County, add the 2010 percent of people without health insurance and rate of non-emergent ED user per 1000 population, then subtract the rate of primary care physicians per 100,000 population (since higher is better for this measure), to get a single number. Calculate for each service area the percent deviation of this totalfrom the Dallas County total, from -infinity to +infinity. That deviation is the access to care deviation for the chart. Although these three measures are in different units, the values were in the range of 5-130 (in different units), such that the contributions of each of the three measures to the total was approximately equal. • Quality of Clinical Care. There are 12 preventable hospitalization discharge rates for each service area, age-adjusted in unitsof discharges per 100,000. Some are more common, such as bacterial pneumonia (in the range of 100-400 discharges per 100,00), while some are more rare (around 5-10 per 100,000). So for each service area and for Dallas County, for each discharge category calculate the percent deviation from the Dallas County rate. Calculate the arithmetic average of these 12 deviations, that deviation is the quality of care deviation for the chart. • Socioeconomic indicators. There are four socioeconomic indicators—percent age 65 or older, percent age birth to 14, percent of adults age 25+ without a high school diploma, percent of the population below the federal poverty limit. For each service area and for Dallas County, for each of these four indicators calculate the percent deviation from the Dallas County rate. Calculate the arithmetic average of these four deviations, that deviation is the socioeconomic deviation for the chart.

46 Notes:

• Age Adjusted Death Rates: Death rates that control for the effects in population age distributions. The centers for Disease Control and Prevention established the standard population weights for direct age adjustments. The need for age adjustment becomes particularly important when cause-specific mortality is of interest. Unadjusted rates for chronic diseases (cardiovascular diseases, cancers, or chronic lower respiratory diseases) may appear to be higher for older populations when compared to a younger population. With age-adjustment those differences may be reduced or even reversed. A mechanism for adjusting the age structure differences is needed to determine if there really are mortality differences between two populations. By applying age-specific mortality rates to a standard population, direct standardization controls for differences in population composition. Mortality trends can be more accurately compared along geographic, temporal, or race/ethnicity lines, etc. In short, standardization lets us look at what the death rate would be in one population if that population had the same age structure as the standard population. Beginning with 1999 events, the United States year 2000 population is used as the standard for age-adjusting.