2012 Community Health Status Assessment Sullivan County, Tennessee
2012 Community Health Status Assessment
Acknowledgements:
Sullivan County Regional Health Department
Gary Mayes Barry Honeycutt Andrew Stephen May, MD, FAAFP Director Director of Operations Regional Medical Director
Special Thanks To:
Heather Mullins, MPH Regional Epidemiologist, Sullivan County Regional Health Department
Christian L. Williams, MPH DrPH Candidate, ETSU College of Public Health Academic Health Department Coordinator, Sullivan County Regional Health Department
East Tennessee State University, College of Public Health Students David Blackley, DrPH Billy Brooks, MPH Amber Hall, MPH
Knox County Health Department
Sullivan County Regional Health Department|ETSU College of Public Health 2 2012 Community Health Status Assessment
Sullivan County Community Members,
Improving the health of people in Sullivan County begins with a thorough understanding of the population’s health status as well as the underlying causes of those conditions that adversely affect our health. As such, the Sullivan County Regional Health Department in coordination with ETSU College of Public Health is pleased to present the 2012 Community Health Status Assessment (CHSA) for Sullivan County, Tennessee. The CHSA is one of four assessments that will be conducted over the next year as part of the Mobilizing for Action through Planning and Partnerships (MAPP) process to improve community health.
This document serves as a snapshot of our community’s health and provides data for over 150 health indicators covered in ten sections. Those sections are:
• Community description (including • Social and mental health demographics) • Maternal and child health • Access to health care and coverage • Death, illness and injury • Quality of life • Communicable disease • Behavioral risk factors • County health rankings • Environmental health indicators
Each section provides a brief overview of the topic area, relevant morbidity and mortality data, and when applicable comparisons between county, state, and national data. This document addresses four main questions: 1) How healthy are our residents? 2) What does the health status of our community look like? 3) What health resources are available to Sullivan County Residents? and 4) In what areas do we excel and in what areas do we need to improve?
This document should be used to identify priority health issues in Sullivan County, guide program planning, provide baseline data for programs/services, inform decision makers about Sullivan County residents’ health status, and help the community gain a better understanding of health disparities as they relate to health status.
It is our sincerest hope that you will find this document useful and refer to it often when planning your own programs to help improve our county’s health.
Sincerely,
Andrew Stephen May, M.D., FAAFP Regional Medical Director
Sullivan County Regional Health Department|ETSU College of Public Health 3 2012 Community Health Status Assessment
Executive Summary
The purpose of the Community Health Status Assessment (CHSA) is to develop a comprehensive health profile of Sullivan County in an effort to determine the health of its residents and their respective overall health status. The following table highlights the core health indicators included in the CHSA, providing a brief overview of Sullivan County’s strengths as well as challenging areas in need of improvement.
Core Health Indicator Strengths Areas for Improvement/Challenges Employment: The unemployment Population: Since 2000, estimates rate in Sullivan County was 8.4% in indicate that the population of 60-69 2010, below the national and state year olds has increased by 24.89% unemployment rates 9.7% and while the population of 30-39 year olds 9.6% respectively. has decreased by 18.50%. Community
Description Poverty: In 2010, approximately 18.4% of all people in Sullivan County were living below the poverty level (compared to 15.8% in 2005).
Healthcare: Sullivan County’s Insurance: Only 74.8% of adults aged ration of physicians and dentists 18-44 reported having some kind of per 100,000 population exceeds health insurance in 2010. This is slightly those for the state. Sullivan County lower than the state at 78.4% for this has 289.5 physicians per 100,000 age group. population and 61.2 dentists per 100,000 population compared to Sullivan County has one of the highest Access to the state’s ratios of 246.1 and 52.2 rates of dental related emergency respectively. room visits. This reveals that while Health Care individuals may have access to health and Coverage insurance they may not have adequate coverage.
*It should be noted that effects from Accountable Care Organization’s and the Affordable Care Act are not known at this time.
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Recreation: Sullivan County Recreation: Although Sullivan County residents have access to 17 boasts multiple options/venues for greenways and trails, 5 golf recreational activities, there is a need courses, and approximately 30 for additional marketing of these parks including sports complexes, activities within the community. soccer parks, skate parks, dog Furthermore, many residents feel they parks, and other facilities. cannot afford to take part in some of Sullivan County also boasts 4 these activities due to costs. community centers that offer Additionally, Sullivan County does not Quality of Life indoor games such as billiards, have many pedestrian friendly areas ping pong, and foosball. that allow residents to walk to their destinations safely. Health Perception: 78.6% of Sullivan County adults compared to 80.5% of Tennessee adults considered in general, that their health was excellent, very good, or good.
Alcohol Use: In 2010, 22.7% of Cigarette Use: In 2010, 22.0% of adults Sullivan County adults reported in Sullivan County reported being current alcohol use compared to current smokers compared to 20.0% in 28.2% in TN and 54.6% in the US. TN and 17.01% in the US.
Overweight/Obese: In 2010, 36.4% of adults in Sullivan County reported being obese and 36.5% reported being overweight based on their reported Behavioral height and weight. This is higher than Risk Factors the overall percentage for both Tennessee (31.7% and 36.1%) and the U.S (27.6% and 36.2%).
In addition, approximately 41% of elementary students, 46% of middle school students, and 41% of high school students in Sullivan County are considered overweight or obese.
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Sullivan County meets current None at this time. standards for regulation of Ozone and Particulate Matter. Environmental Furthermore, Sullivan County has a Health communication and action plan in Indicators place that enables officials to respond to ozone action days in an appropriate manner.
Homicide: The homicide rates in Social Support: In 2010, 11% of males Sullivan County have remained and 6% of females in Sullivan County consistently lower than those for reported that they rarely or never get Social and the state at 4.2 per 100,000 and all the social and/or emotional support Mental Health 7.89 per 100,000 respectively in that they need compared to 8% of 2007-2009. males and 5.8% of females in Tennessee.
Child Mortality: Child mortality Infant Mortality: In 2009, the infant rates have consistently remained mortality rate for Sullivan County was below the state level and saw a 5% 9.38 per 1,000 live births. This rate was decrease in 2009. higher than the national and state rates at 6.39 and 7.98 respectively. The Adolescent Pregnancy Rates: The majority of infant deaths in Sullivan adolescent pregnancy rates for 15- County are due to sleep related causes 17 year olds for 2006-2010 and prematurity. In response, the consistently remained below the health department has increased Maternal and state level. education efforts through initiatives Child Health such as Project ABC.
Tobacco Use during Pregnancy: In 2009, 29.0% of mothers reported smoking during pregnancy in Sullivan County. This is much higher than the national and state percentages of 18.4% and 10.4% respectively.
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Motor Vehicle Accidents: From Diabetes: In 2010, 8.7% of U.S. adults, 2007-2009, Sullivan County had 11.3% of adults in Tennessee, and 13.31 deaths per 100,000 due to 12.1% of adults in Sullivan County motor vehicle accidents. This was reported being told they had below the state rate of 19.23. Diabetes.
Diseases of the Heart: In 2010, in Sullivan County 8.9% of adults reported suffering from a heart attack, 5.7% reported having angina or coronary heart disease, and 39.8% reported having high blood pressure. That same year, in Tennessee 5.2% of Death, Illness, adults reported suffering from a heart attack, 4.8% reported having angina or and Injury coronary heart disease, and 35.4% reported having high blood pressure.
Malignant Neoplasms (Cancer): In Sullivan County the second leading cause of death is malignant neoplasm. Many lifestyle behaviors such as excessive drinking, tobacco use, and obesity can cause cancer.
Unintentional Injury: In Sullivan County, the number one cause of death due to unintentional injury is poisoning followed by falls. Influenza Vaccine: In 2010, 46.2% Influenza Vaccine: In 2012, 9.26% of of Sullivan County adults reported reproductive women (between the receiving the flu vaccine compared ages of 10 and 50) received a flu shot to only 40.6% in Tennessee. from Sullivan County Regional Health Department. Furthermore, only 1.6% Pneumonia Vaccine: of pregnant women received their Approximately, 29.8% of Sullivan influenza vaccine. County adults reported receiving Communicable the pneumonia vaccine compared STDs: In Sullivan County, incidence Disease to only 25.8% in Tennessee. rates for Chlamydia and Gonorrhea continue to rise in the 15-24 age Childhood Immunizations: In 2012, group. 80.9% of 24 month old children were on time with their immunizations. Approximately, 94.5% of 24 month old children in Sullivan County had received their influenza vaccine.
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Table of Contents
Acknowledgements: ...... 2
Executive Summary...... 4
List of Figures ...... 9
List of Tables ...... 15
Introduction: ...... 16
Methods: ...... 17
Section 1: Community Description ...... 18
Section 2: Access to Health Care and Coverage ...... 25
Section 3: Quality of Life ...... 31
Section 4: Behavioral Risk Factors ...... 32
Section 5: Environmental Health Indicators ...... 40
Section 6: Social and Mental Health ...... 53
Section 7: Maternal and Child Health ...... 60
Section 8: Death, Illness and Injury ...... 78
Section 9: Communicable Disease ...... 103
Section 10: County Health Rankings ...... 116
Conclusion ...... 116
References ...... 117
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List of Figures
Figure 1.1: Estimated Population by Age ...... 18
Figure 1.2: Percent Population Change by Age ...... 19
Figure 1.3: Estimated Number of Males and Females by Age ...... 19
Figure 1.4: Estimated Race Distribution ...... 20
Figure 1.5: Latino Community Growth ...... 20
Figure 1.6: Business Establishments by Employment Size ...... 21
Figure 1.7: Top Ten Business Types ...... 21
Figure 1.8: Percentage of Unemployed Residents ...... 22
Figure 1.9: Annual Median Income for Males and Females by Educational Attainment ...... 23
Figure 1.10: Per Capita Income ...... 23
Figure 1.11: Educational Attainment for Individuals 25 and Older ...... 24
Figure 1.12: Percentage of Residents who lived Below Poverty Level ...... 25
Figure 2.1: Percentage of Adults who reported they had Some Kind of Health Insurance ...... 26
Figure 2.2: Percentage of Adults who reported they had Some Kind of Health Insurance, by Gender .... 26
Figure 2.3: Physicians and Dentists per 100,000 Population, 2011 ...... 27
Figure 2.4: Percentage of Adults who reported visiting a Dentist in the Past 12 Months by Age...... 27
Figure 2.5: Percentage of Adults who reported visiting a Dentist in the Past 12 Months by Gender...... 28
Figure 2.6: Percentage of elderly adults (65 and older) who Reported Having Had All of Their Natural Teeth Extracted ...... 28
Figure 2.7: Number of TennCare Enrollees by Age ...... 29
Figure 2.8: Annual Expenditure of TennCare Members ...... 30
Figure 3.1: Religious Membership, Sullivan County ...... 31
Figure 4.1: Reported Cigarette Use for Adults ...... 33
Figure 4.2: Reported Alcohol Use for Adults ...... 34
Figure 4.3: Reported Fruit and Vegetable Consumption among Adults ...... 35
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Figure 4.4: Percentage of Adults who engaged in 30 Minutes of Moderate Physical Activity ...... 36
Figure 4.5: Percentage of Adults who engaged in 20 Minutes of Vigorous Physical Activity ...... 36
Figure 4.6: Percent of Adults Reporting No Physical Activity in the Last 30 Days ...... 37
Figure 4.7: Percentage of Adults who are Overweight and Obese ...... 38
Figure 4.8: Percentage of Elementary School Students who are Overweight and Obese ...... 38
Figure 4.9: Percentage of Middle School Students who are Overweight and Obese ...... 39
Figure 4.10: Percentage of High School Students who are Overweight and Obese ...... 39
Figure 5.1: Sullivan County Ozone Trend ...... 41
Figure 5.2: Ozone Episodes, 6/27/2012-6/30/2012 ...... 42
Figure 5.3: Annual Kingsport PM2.5 ...... 42
Figure 5.4: Kingsport PM2.5 (24 Hour Standard) ...... 43
Figure 5.5: Radon Levels across Tennessee, 2010 ...... 43
Figure 5.6: Incidence of Campylobacteriosis ...... 46
Figure 5.7: Incidence of Shiga Toxin-Producing E. Coli (STEC) ...... 46
Figure 5.8: Incidence of Acute Viral Hepatitis A ...... 47
Figure 5.9: Incidence of Salmonellosis ...... 47
Figure 5.10: Incidence of Shigellosis ...... 48
Figure 5.11: Percentage of Elevated BLLs of Total Children Tested for Blood Lead Poisoning ...... 49
Figure 5.12: Incidence of Cryptosporidiosis ...... 50
Figure 5.13: Incidence of Giardiasis ...... 50
Figure 5.14: Animals that Tested Positive for Rabies ...... 51
Figure 5.15: Incidence of Rocky Mountain Spotted Fever ...... 52
Figure 5.16: Incidence of Lyme Disease ...... 52
Figure 5.17: Mortality Rate Due to Accidental Poisoning ...... 53
Figure 6.1: Adults who reported Rarely or Never Getting the Social/Emotional Support they Need, by Gender ...... 54
Figure 6.2: Adults who reported Rarely or Never Getting the Social/Emotional Support they Need, by Age ...... 54
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Figure 6.3: Reported Child Abuse and Neglect Cases ...... 55
Figure 6.4: Substantiated Cases of Child Abuse and Neglect per 1,000 Children ...... 55
Figure 6.5: Age-Adjusted Homicide Rates ...... 56
Figure 6.6: Age-Adjusted Suicide Rates, Tennessee and Sullivan County ...... 57
Figure 6.7: Suicide Rates, Ages 65 and Older ...... 57
Figure 6.8: Suicide Rates, Ages 15-44 ...... 58
Figure 6.9: Hospital Discharge Rate for Mental Disorders ...... 59
Figure 6.10: Percent of Discharges for Mental Disorders by Age Group, Sullivan County ...... 59
Figure 7.1: Infant Mortality Rates, Sullivan County, Tennessee, United States ...... 61
Figure 7.2: Neonatal Mortality Rates ...... 61
Figure 7.3: Post-Neonatal Mortality Rates ...... 62
Figure 7.4: Infant Mortality Rates for Congenital Malformations, Deformations, and Chromosomal Abnormalities ...... 62
Figure 7.5: Infant Mortality Rates for Perinatal Conditions, Sullivan County and Tennessee ...... 63
Figure 7.6: Infant Mortality by Cause of Death, Sullivan County, 2011 ...... 63
Figure 7.7: Infant Mortality by Cause of Death, Sullivan County, 2012 ...... 64
Figure 7.8: Child Mortality Rates Ages (0-17) ...... 65
Figure 7.9: Child Fatalities by Age Group, Sullivan County...... 65
Figure 7.10: Child Mortality by Cause of Death, Sullivan County, 2011 ...... 66
Figure 7.11: Child Mortality by Cause of Death, Sullivan County, 2012 ...... 66
Figure 7.12: Fertility Rates for Women 15-44 Years of Age ...... 67
Figure 7.13: Number of Pregnancy Tests Conducted by Health Department Site ...... 67
Figure 7.14: Adolescent Pregnancy Rates, Ages 10-17 ...... 68
Figure 7.15: Adolescent Pregnancy Rates, Ages 15-17 ...... 68
Figure 7.16: Number of Family Planning Visits by Health Department Site ...... 69
Figure 7.17: Percent of Births to Unmarried Mothers ...... 70
Figure 7.18: Percent of Births to Mothers with Adequate Prenatal Care ...... 71
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Figure 7.19: Percent of Births Delivered by Cesarean Section in Sullivan County and Tennessee ...... 71
Figure 7.20: Percent of Mothers that Smoked during Pregnancy ...... 72
Figure 7.21: Neonatal Abstinence Syndrome Surveillance ...... 73
Figure 7.22: Percent of Low Birth Weight Babies Born ...... 74
Figure 7.23: Percentage of EPSDT Eligible Screened (ages 21 and under) ...... 74
Figure 7.24: Number of WIC Participants by Health department Site ...... 75
Figure 7.25: Percent Children under 6 Enrolled in WIC Program, Sullivan County and Tennessee ...... 76
Figure 7.26: Percentage of the WIC Population Served ...... 76
Figure 7.27: Intent to Breastfeed, Sullivan County, 2011-2012 ...... 77
Figure 7.28: Percent of WIC Infants who were Breastfed ...... 78
Figure 8.1: Top 10 Age-Adjusted Mortality Rates, Sullivan County, 2009 ...... 79
Figure 8.2: Age-Adjusted Leading Causes of Death in Sullivan County, 2009 ...... 80
Figure 8.3: Percentage of Adults Who Reported Ever Being Diagnosed with Asthma ...... 81
Figure 8.4: Age-adjusted asthma mortality rates ...... 82
Figure 8.5: Age-Adjusted Cerebrovascular Disease Mortality Rate ...... 83
Figure 8.6: Age-Adjusted Cerebrovascular Disease Mortality by Sex, Sullivan County ...... 83
Figure 8.7: Percentage of Adults Who Reported a Diabetes Diagnosis ...... 84
Figure 8.8: Age-Adjusted Diabetes Mortality Rates ...... 85
Figure 8.9: Age-Adjusted Diabetes Mortality Rates by Sex, Sullivan County ...... 85
Figure 8.10: Percentage of Adults Who Reported Risk Factors and Diseases of the Heart ...... 86
Figure 8.11: Age-Adjusted Mortality Rates Due to Diseases of the Heart Among Adults ...... 87
Figure 8.12: Age-Adjusted Mortality Rates Due to Diseases of the Heart, by Sex ...... 87
Figure 8.13: Age-Adjusted All Cancer Incidence Rates, by Sex ...... 88
Figure 8.14: Age-Adjusted Cancer Mortality Rates (by type of cancer), Sullivan County ...... 89
Figure 8.15: Age-Adjusted All-Cancer Mortality Rates, 1999-2008 ...... 89
Figure 8.16: Average Lung Cancer Incidence Rates by Sex ...... 90
Figure 8.17: Age-Adjusted Lung Cancer Mortality Rates ...... 91
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Figure 8.18: Age-Adjusted Lung Cancer Mortality Rates by Sex ...... 91
Figure 8.19: Percentage of Adults (age 50+) who Reported being Screened for Colorectal Cancer ...... 92
Figure 8.20: Age-Adjusted Colorectal Cancer Mortality Rates ...... 92
Figure 8.21: Age-Adjusted Colorectal Cancer Mortality Rates ...... 93
Figure 8.22: Age-Adjusted Colorectal Cancer Mortality Rates, by Sex, Sullivan County, 1992-2009 ...... 93
Figure 8.23: Women (Age 40+) Who Reported Having a Mammogram in the Last 2 Years ...... 94
Figure 8.24: Average Breast Cancer Incidence Rates ...... 94
Figure 8.25: Age-Adjusted Breast Cancer Mortality Rates for Females by Race ...... 95
Figure 8.26: Prostate Cancer Incidence Rates ...... 96
Figure 8.27: Age-Adjusted Prostate Cancer Mortality Rates ...... 96
Figure 8.28: Percent of Women (age 18+) Reporting Having a Pap Test Within the Past 3 Years ...... 97
Figure 8.29: Age-Adjusted Average Cervical Cancer Incidence Rates ...... 98
Figure 8.30: Age-Adjusted Cervical Cancer Mortality Rates ...... 98
Figure 8.31: Age-Adjusted Mortality Rates Due to Accidents ...... 99
Figure 8.32: Age-Adjusted Mortality Rates Due to Accidents by Sex ...... 99
Figure 8.33: Age-Adjusted Mortality Rates Due to Motor Vehicle Accidents ...... 100
Figure 8.34: Age-Adjusted Mortality Rates Due to Motor Vehicle Accidents by Sex ...... 100
Figure 8.35: Overall Crash Rates (Crashes per 1,000 Licensed Drivers) ...... 101
Figure 8.36: Crash Rate Where Crash Resulted in Injury and Fatality ...... 101
Figure 8.37: Age-Adjusted Mortality Rates Due to Non-Motorized Accidents ...... 102
Figure 9.1: Chlamydia Incidence Rates, 2011...... 103
Figure 9.2: Chlamydia Incidence, 2008-2012 ...... 104
Figure 9.3: Chlamydia Incidence by Age, 2007-2010 ...... 104
Figure 9.4: Chlamydia Incidence by Sex and Age, 2010 ...... 105
Figure 9.5: Gonorrhea Incidence Rates, 2011 ...... 105
Figure 9.6: Gonorrhea Incidence, 2008-2012 ...... 106
Figure 9.7: Gonorrhea Incidence by Age, 2007-2010 ...... 106
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Figure 9.8: Gonorrhea Incidence by Sex and Age, 2010 ...... 107
Figure 9.9: Syphilis Incidence by Stage of Syphilis, Four-Year Average 2006-2009...... 108
Figure 9.10: Number of Respondents Who Said They Had Participated in High-Risk Behavior in the Past Year, 2008-2010 ...... 109
Figure 9.11: Percentage of Adults Who Reported They Have Been Tested for HIV within Their Lifetime, 2008 - 2010 ...... 109
Figure 9.12: Incidence of Hepatitis A, 2000-2011 ...... 110
Figure 9.13: Incidence of Hepatitis B, 2000-2011 ...... 111
Figure 9.14: Incidence of Acute Hepatitis C, 2000-2011 ...... 112
Figure 9.15: Percentage of Adults (Age 65 and Older) Who Reported They Received a ‘Flu’ or ‘Pneumonia’ Shot in the Past 12 months, 2010 ...... 113
Figure 9.16: Percentage of Reproductive Women (Aged 10 to 50) who Received an Influenza Vaccine, 2012 ...... 113
Figure 9.17: Percentage of Pregnant Women who Received an Influenza Vaccine, 2012 ...... 114
Figure 9.18: Age-Adjusted Mortality Rates Due to Pneumonia and Influenza, 2000-2009 ...... 114
Figure 9.19: Age-Adjusted Mortality Rates Due to Pneumonia and Influenza by Gender ...... 115
Figure 9.20: Tuberculosis Incidence Rates, 2009-2011 ...... 115
Figure 10.1: County Health Rankings, 2010-2013 ...... 116
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List of Tables
Table 2.1: Hospital Services, Sullivan County, 2010 ...... 29
Table 2.2: Nursing Home Facilities, Sullivan County 2008...... 30
Table 2.3: Home Health Agencies, Sullivan County, 2011 ...... 31
Table 5.1: Criteria Pollutant Emission Levels in Sullivan County, 2008 ...... 40
Table 5.2: Impaired Waterways in Sullivan County ...... 44
Table 5.3: Violations of Health-Based Drinking Water Standards, Sullivan County, 2008-2012 ...... 45
Table 5.4: Total Number of Fatal Occupational Injuries, 2010-2011 ...... 45
Table 6.1: Domestic Violence Victims by Reporting Agency, Sullivan County, 2011 ...... 58
Table 6.2: Driving Under the Influence Arrests by Agency and Adult verses Juvenile, 2011 ...... 60
Table 7.1: Child Fatalities by Year, Sullivan County, 2000-2011 ...... 64
Table 8.1: Sullivan County Ranking (of 95 Counties in Tennessee) by Type of Crash, 2011 ...... 102
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Introduction:
Improving health is a shared responsibility of health care providers and public health officials, as well as a variety of organizations and individuals who contribute to the well-being of our community. No single entity can make a community healthy. So much more can be accomplished by working together with a common vision to improve health. To that end this document has been prepared to provide a foundation on which to implement change to work towards a healthier community and Sullivan County.
This assessment serves as the first step of the MAPP process, a detailed model of MAPP is depicted below:
This report begins with a community description with detailed demographic information and is followed with descriptions and detailed data for important health indicators including: Access to Health Care, Quality of Life, Behavioral Risk Factors, Environmental Health, Social and Mental Health, Maternal and Child Health, Death, Illness and Injury and Communicable Disease.
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Methods:
For this assessment pre-existing databases were used to draw comparisons between local, state, and national health and behavior data. Databases utilized for this report, include the Behavioral Risk Factor Surveillance System (BRFSS), death certificate data, birth certificate data, and hospital discharge data, among others.
Data was analyzed using demographic, socioeconomic and mortality measures. When possible, data was analyzed according to age, gender and race to offer insight into health disparities that may affect specific subgroups in the community. Some data cannot be compared by age, gender, and race categories due to insufficient sample sizes. It should be noted that some estimates do not add up to 100% due to a margin of error included in the data source.
Sullivan County data was compared to state and national data in order to provide insight into particular health concerns in our community. When applicable, Healthy People 2020 (HP 2020) targets were included to provide a benchmark for community health standards.
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Section 1: Community Description
Population and Population Growth An estimated 156,786 individuals reside in Sullivan County. In 2012, the total population for the state of Tennessee was estimated to be around 6.4 million. Estimates suggest the population will rise to approximately 6.8 million by 2020. Sullivan County is expected to see a population decline by about 0.2% by 2020.
Age Distribution and Trends The largest proportion of the population in Sullivan County is between the ages of 50-59 with 23,543 individuals. Closely behind are the 40-49 year olds with 22,795 individuals (Figure 1.1). Since 2000, estimates indicate the population of 60-69 year olds has increased 24.89%. The largest decrease occurred in the 30-39 age group, which declined by 18.50% since 2000 (Figure 1.2).
Figure 1.1: Estimated Population by Age
Source: US Census Bureau, American Community Survey
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Figure 1.2: Percent Population Change by Age
Source: US Census Bureau, American Community Survey
Gender Estimates for 2010 indicate that there are 5,491 more females than males residing in Sullivan County. Figure 1.3 depicts the estimated number of males and females in Sullivan County by age for 2010.
Figure 1.3: Estimated Number of Males and Females by Age
Source: US Census Bureau, American Community Survey
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Race In 2010, the majority (95%) of the population was Caucasian. Figure 1.4 shows the U.S. Census estimates for race distribution in Sullivan County for 2010.
Figure 1.4: Estimated Race Distribution
Source: US Census Bureau, American Community Survey
Ethnicity In the 2000 U.S. Census there were approximately 1,090 Latino residents in Sullivan County. The Latino population more than doubled to 2,321 individuals by 2010. Sullivan County has already surpassed the estimated population projection for 2020 (Figure 1.5).
Figure 1.5: Latino Community Growth
Source: US Census Bureau, American Community Survey
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Socioeconomic Characteristics
Description of Local Economy In 2010, there were 13,042 business establishments in Sullivan County. Of these, the majority (59.78%) employed 1-4 individuals and 1.6% employed more than 100 individuals (Figure 1.6).
Figure 1.6: Business Establishments by Employment Size
Source: TN Dept. of Labor and Workforce Development; Labor Market Statistics, Quarterly Census of Employment and Wages Program
The most common type of business in Sullivan County was Health Care and Social Assistance which accounted for 22% of business establishments. Manufacturing accounted for 20% (Figure 1.7).
Figure 1.7: Top Ten Business Types
Source: TN Dept. of Labor and Workforce Development; Labor Market Statistics, Quarterly Census of Employment and Wages Program
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Employment In 2010, the unemployment rate in Sullivan County was 8.4%. The unemployment rate has decreased since 2009 and is under the national and state unemployment rates (Figure 1.8).
Figure 1.8: Percentage of Unemployed Residents
Source: Tennessee Department of Labor and Workforce Development
Income Annual median income for males and females by educational attainment in Sullivan County is shown in Figure 1.9. Overall, income increased as education increased for both males and females, with the greatest difference in income between high school graduates and college graduates. The greatest disparity was between males and females with graduate or professional degrees. On average, a male with a graduate or professional degree had an annual median income of over $37,000 more than a female with the same education.
The median annual per capita income between 2005 and 2010 is shown in Figure 1.10. Per capita income has steadily decreased since 2007-2008, which coincides with trends in per capita income depicted for Tennessee and the U.S.
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Figure 1.9: Annual Median Income for Males and Females by Educational Attainment
Source: Tennessee Department of Labor & Workforce Development, Employment Security Division, Research and Statistics
Figure 1.10: Per Capita Income
Source: US Census Bureau, American Community Survey
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Education In Sullivan County, 82% of residents have at least a high school education, this percentage is slightly lower than state and national averages of 83.7% and 85.6% respectively. Approximately, 13% held a bachelor’s degree and 7% attained a graduate of professional degree (Figure 1.11).
Figure 1.11: Educational Attainment for Individuals 25 and Older
Source: U.S. Census Bureau, American Community Survey
Country of Origin and Language In 2011, an estimated 1.6% of individuals living in Sullivan County (2,352 people) were foreign- born. About 0.8% (1,800 people), were non-English speaking persons (defined as those who speak English less than very well).
Poverty In 2010, approximately 18.4% of all people in Sullivan County were living below the poverty level (compared to 15.8% in 2005). Of these, about 30% were children under the age of 18, compared to 23.6% in 2005. About 15.7% of males and 20.8% of females were living below the poverty level in 2010 (Figure 1.12).
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Figure 1.12: Percentage of Residents who lived Below Poverty Level
Source: US Census Bureau, American Community Survey
Section 2: Access to Health Care and Coverage
Health Care According to the 2010 Behavioral Risk Factor Surveillance System (BRFSS) the majority of Sullivan County adults reported having some kind of health insurance. However, only 74.8% of adults between the ages of 18 and 44 reported having some kind of health insurance, this is lower than any other age group (Figure 2.1). Approximately 84.6% of males and 87.5% of females reported having some kind of health insurance in 2010. This is higher than the averages for Tennessee and the U.S. (Figure 2.2).
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Figure 2.1: Percentage of Adults who reported they had Some Kind of Health Insurance
Source: CDC BRFSS
Figure 2.2: Percentage of Adults who reported they had Some Kind of Health Insurance, by Gender
Source: CDC BRFSS
Figure 2.3 shows the rate of physicians and dentists per 100,000 population in Sullivan County compared to Tennessee. In 2011, the number of physicians in Sullivan County was 289.5 per 100,000 population and the number of dentists in Sullivan County was 61.2 per 100,000 population. Sullivan County’s ratio of physicians and dentists per population exceeds those for the state.
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Figure 2.3: Physicians and Dentists per 100,000 Population, 2011
Source: Kids Count Data Center, Annie E. Casey Foundation
Dental Health According to the 2010 Sullivan County BRFSS, approximately 67% of adults between the ages of 18 and 44 reported visiting a dentist in the past twelve months (Figure 2.4). Approximately, 67% of males and 64% of females reported visiting a dentist in the past twelve months (Figure 2.5).
Figure 2.4: Percentage of Adults who reported visiting a Dentist in the Past 12 Months by Age.
Source: CDC BRFSS
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Figure 2.5: Percentage of Adults who reported visiting a Dentist in the Past 12 Months by Gender.
Source: CDC BRFSS
Figure 2.6 illustrates the percentage of older adults (65 and older) in Sullivan County who have had all of their teeth extracted due to decay, gum disease, or infection. Sullivan County does not meet the Healthy People 2020 goal of reducing the proportion of older adults (65 and older) who have had all of their natural teeth extracted to 21.6%.
Figure 2.6: Percentage of elderly adults (65 and older) who Reported Having Had All of Their Natural Teeth Extracted
Source: CDC BRFSS
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Hospital Services There are five hospitals located in Sullivan County. The majority of Sullivan County residents (84.3%) seek medical care at facilities located within the county. Approximately 12% of residents seek medical care at facilities located within Washington County. Table 2.1 breaks down hospital services and usage in Sullivan County.
Table 2.1: Hospital Services, Sullivan County, 2010 Service Measure Licensed Beds 1056 Staffed Beds 791 Average Daily Census 480 Licensed Beds Percent Occupancy 45.50% Staffed Beds Percent Occupancy 60.70% Average Length of Stay 4.5 Days Total Expenses $565,998,112 Total Net Revenue $600,724,472 Charity Care $42,276,020 Source: Tennessee Department of Health, Division of Health Statistics
TennCare TennCare is Tennessee’s government-operated medical assistance program for people who are eligible for Medicaid, as well as for some children who do not have insurance. In 2011, 27,308 individuals were enrolled to receive TennCare benefits in Sullivan County, approximately 17.5% of the total population. Most of the enrollees were under the age of 18 or were women ages 21-64 (Figure 2.7). Figure 2.8 illustrates the expenditure per TennCare member in Sullivan County.
Figure 2.7: Number of TennCare Enrollees by Age
Source: TennCare,TennCare Enrollment Data
Sullivan County Regional Health Department|ETSU College of Public Health 29 2012 Community Health Status Assessment
Figure 2.8: Annual Expenditure of TennCare Members
Source: Bureau of TennCare, TennCare Annual Fiscal Reports
Care for the Aging The 2010 U.S. Census Bureau estimated that 17.9% of the population in Sullivan County was aged 65 and older. In 2010, older Americans spent 13.2% of their total expenditures on health, more than twice the proportion spent by all consumers (6.6%). Health costs incurred on average by older consumers in 2010 consisted of $3,085 (65%) for insurance, $795 (18%) for medical services, $805 (17%) for drugs, and $158 (3.0%) for medical supplies.
As of 2008, there were 7 nursing home facilities in Sullivan County. A breakdown of nursing home facility occupancy is listed in Table 2.2. In Sullivan County there were approximately 34 beds per 1,000 population 65 years and older compared to 45 beds per 1,000 population 65 and older for the state.
Table 2.2: Nursing Home Facilities, Sullivan County 2008 Criterion Measure Number of Facilities 7 Total Number of Patients 883 Licensed Number of Beds 1,000 Admissions 2,528 Discharges 2,503 Average Length of Stay 182 Days Source: Tennessee Department of Health, Division of Health Statistics
There are 2 home health agencies in Sullivan County. The following table depicts home health services and usage for 2011.
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Table 2.3: Home Health Agencies, Sullivan County, 2011 Criterion Measure Total Number of Patients Served 4484 Number of TennCare Patients 340 Number of Medicare Patients 2436 Total Revenue 18779751 Percent Revenue Medicare 27.60% Percent Revenue TennCare/Medicaid 42.90% Charity Care as Percent Revenue 0.54% Source: Tennessee Department of Health, Division of Health Statistics
Section 3: Quality of Life
Quality of life (QOL) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life. Although health is one of the important domains of overall quality of life, there are other domains such as, jobs, housing, schools, and the neighborhood. Culture, values, and spirituality are also key aspects of overall quality of life that add to the complexity of its measurement.
Faith-based Organizations A report published in Nashville in 2010 by the Glenmary Research Center indicated that of religious adherents in the county, about 23% belong to the Southern Baptist Convention, 10% belong to the United Methodist Church, and the majority (63%) belongs to other (Figure 3.1). The ‘other’ category consists of 232 other faith groups that do not fall into the categories listed.
Figure 3.1: Religious Membership, Sullivan County
Source: U.S. Religion Census, Glenmary Research Center
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Community Facilities In addition to the many faith options in the community, Sullivan County has other facilities to promote community recreation with 8 public library facilities and 3 senior centers dispersed throughout the county.
Recreational Facilities Sullivan County offers residents 17 greenways and trails, 5 golf courses, and approximately 30 parks including sports complexes, soccer parks, skate parks, dog parks, and other facilities. Sullivan County also boasts 4 community centers that offer indoor games such as billiards, ping pong, and foosball. They also offer several outdoor games such as basketball, tennis, playgrounds, and picnic/shelter areas. There are also several youth and adult athletic leagues in both Kingsport and Bristol.
Community Perceptions The 2010 Sullivan County BRFSS provides insight into the perceptions of the quality of life for residents in the County.
• Overall, 78.6% of Sullivan County adults compared to 80.5% of Tennessee adults considered in general, that their health was excellent, very good, or good.
• Approximately, 21.4% of Sullivan County adults compared to 19.5% of Tennessee adults considered in general, that their health was fair or poor.
• About, 28.9% of adults in Sullivan County compared to 23.9% in Tennessee reported being limited in participating in activities because of physical, mental, or emotional problems.
Other aspects of quality of life for residents can be found in the Social and Mental Health section of this report.
Section 4: Behavioral Risk Factors
The CDC’s Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States yearly since 1984.
Behavioral risk factors are reported in this section. Where appropriate, Sullivan County data is compared to state and national data.
Tobacco Use According to the Centers for Disease Control and Prevention (CDC) the adverse health effects from cigarette smoking account for an estimated 443,000 deaths, or nearly one of every five deaths, each year in the United States. More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.
Sullivan County Regional Health Department|ETSU College of Public Health 32 2012 Community Health Status Assessment
Smoking causes an estimated 90% of all lung cancer deaths in men and 80% of all lung cancer deaths in women. Overall, an estimated 90% of all deaths from chronic obstructive lung disease are caused by smoking.
According to the 2010 BRFSS, 22% of Sullivan County residents reported being current smokers and approximately 24% reported being former smokers (Figure 4.1).
Figure 4.1: Reported Cigarette Use for Adults
Source: CDC BRFSS
Binge Drinking Binge drinking is defined as having five or more alcoholic drinks in a row within a couple of hours. Approximately, 7.4% of adults in Sullivan County reported engaging in binge drinking in the last 30 days in 2010 compared to 6.6% for the state. Heavy drinking is defined as consuming, on average, greater than two drinks per day for men and one drink per day for women. Compared to Tennessee, a slightly higher percentage of Sullivan County adults reported drinking heavily. A lower percentage of Sullivan County adults reported current alcohol use compared to Tennessee and the U.S. (Figure 4.2).
Sullivan County Regional Health Department|ETSU College of Public Health 33 2012 Community Health Status Assessment
Figure 4.2: Reported Alcohol Use for Adults
Source: CDC BRFSS
Lifestyle Lifestyle is the manner of living that reflects a person’s attitudes and values. Lifestyle as it pertains to the health of the community includes nutrition, obesity, physical activity, and sedentary lifestyle for the purpose of this report.
Nutrition Nutrition is an important component of a healthy lifestyle. Good dietary habits can promote health and reduce the risk for major chronic diseases. Learning how to eat healthy at a young age can help foster good nutritional habits into adulthood.
Approximately, 28.3% of Sullivan County adults reported consuming 5 or more servings of fruits and vegetables per day in 2009. This percentage was higher than what adults reported overall for Tennessee and the U.S. (Figure 4.3).
Sullivan County Regional Health Department|ETSU College of Public Health 34 2012 Community Health Status Assessment
Figure 4.3: Reported Fruit and Vegetable Consumption among Adults
Source: CDC BRFSS
Physical Activity Regular physical activity helps improve overall health and fitness, and reduces the risk for many chronic diseases. The CDC recommends that adults engage in at least 150 minutes of moderate to vigorous physical activity each week.
In 2009, 36.3% of adults in Sullivan County reported engaging in thirty minutes of moderate physical activity five or more days per week, while 14.2% reported engaging in twenty minutes of vigorous physical activity three or more days per week (Figures 4.4 and 4.5)
Sedentary Behavior Sedentary behavior describes a lack of physical activity and is commonly characterized as only participating in activities such as sitting, reading, watching television and computer use for much of the day with little or no physical activity. Lack of physical activity is one of the leading causes of preventable death worldwide.
In 2010, 27.7% of males and 38.2% of females in Sullivan County reported that they did not engage in any physical activity in the last 30 days (Figure 4.6).
Sullivan County Regional Health Department|ETSU College of Public Health 35 2012 Community Health Status Assessment
Figure 4.4: Percentage of Adults who engaged in 30 Minutes of Moderate Physical Activity
Source: CDC BRFSS
Figure 4.5: Percentage of Adults who engaged in 20 Minutes of Vigorous Physical Activity
Source: CDC BRFSS
Sullivan County Regional Health Department|ETSU College of Public Health 36 2012 Community Health Status Assessment
Figure 4.6: Percent of Adults Reporting No Physical Activity in the Last 30 Days
Source: CDC BRFSS
Obesity Obesity is defined as having a body mass index (BMI) of 30 or above; overweight is defined as having a BMI greater than or equal to 25 but less than 30. BMI is measured by taking both height and weight for adult men and women. BMI provides a reliable indicator of body fat for most people and is used to screen for weight categories that may lead to health problems.
According to the CDC, being overweight or obese increases an individual’s risk for major health conditions including, but not limited to, coronary heart disease, type 2 diabetes, hypertension (high blood pressure), high cholesterol, sleep apnea, stroke, osteoarthritis, and some types of cancer.
In 2010, 36.4% of adults in Sullivan County reported being obese and 36.5% reported being overweight based on their reported height and weight. This is slightly higher than the overall percentage for both Tennessee and the U.S. (Figure 4.7).
Sullivan County Regional Health Department|ETSU College of Public Health 37 2012 Community Health Status Assessment
Figure 4.7: Percentage of Adults who are Overweight and Obese
Source: CDC BRFSS
Figures 4.8-4.10 depict the percentage of Sullivan County students who are overweight or obese based on their BMI. All data was collected by Coordinated School Health during the 2012-2013 school year and represents all students enrolled in Sullivan County schools. The data does not represent those students enrolled in Kingsport City or Bristol City schools.
Figure 4.8: Percentage of Elementary School Students who are Overweight and Obese
Source: CSH Data **Does not represent Kingsport City or Bristol City Schools Data**
Sullivan County Regional Health Department|ETSU College of Public Health 38 2012 Community Health Status Assessment
Figure 4.9: Percentage of Middle School Students who are Overweight and Obese
Source: CSH Data **Does not represent Kingsport City or Bristol City Schools Data**
Figure 4.10: Percentage of High School Students who are Overweight and Obese
Source: CSH Data **Does not represent Kingsport City or Bristol City Schools Data**
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Section 5: Environmental Health Indicators
Air Quality Under the Clean Air Act, EPA established National Ambient Air Quality Standards (NAAQS) to protect public health, including the health of "sensitive" populations such as people with asthma, children, and older adults. EPA also sets limits to protect public welfare. This includes protecting ecosystems, including plants and animals, from harm, as well as protecting against decreased visibility and damage to crops, vegetation, and buildings.
EPA has set National Ambient Air Quality Standards for six common air pollutants (also called criteria pollutants):
• Carbon Monoxide (CO) • Lead (Pb) • Nitrogen Oxides (NOx) • Volatile Organic Compounds (VOCs) • Particulate Matter (PM) • Sulfur Dioxide (SO2)
Four of these pollutants (CO, Pb, NO2, and SO2) are emitted directly from a variety of sources. Ozone is not directly emitted, but is formed when oxides of nitrogen (NOx) and volatile organic compounds (VOCs) react in the presence of sunlight. PM can be directly emitted, or it can be formed when emissions of NOx, sulfur oxides (SOx), ammonia, organic compounds, and other gases react in the atmosphere. There are eight major categories of criteria pollutant sources: Agriculture, Dust, Fires, Fuel Combustion, Industrial Processes, Miscellaneous (Gas Stations, Waste Disposal, etc), Mobile, and Solvents. Table 5.1 below depicts the level of emissions from the criteria pollutants in Sullivan County for 2008.
Table 5.1: Criteria Pollutant Emission Levels in Sullivan County, 2008 Emissions (Tons Pollutant per Square Mile) Carbon Monoxide (CO) 51,969 Lead (Pb) 0 Nitrogen Oxides (NOx) 15,032 Volatile Organic Compounds (VOCs) 10,610 Particulate Matter (PM) 10,809 Sulfur Dioxide (SO2) 26,159 Source: Environmental Protection Agency Air Emissions
Sullivan County Regional Health Department|ETSU College of Public Health 40 2012 Community Health Status Assessment
Ozone Ozone is found in two regions of the Earth's atmosphere – at ground level and in the upper regions of the atmosphere. Ground level ozone- what we breathe- can harm our health. Even relatively low levels of ozone can cause health effects. People with lung disease, children, older adults, and people who are active outdoors may be particularly sensitive to ozone. Ozone is regulated by NAAQS and is measured by ppb (parts per billion). Figure 5.1 depicts the ozone trend for Sullivan County for 1999-2012. The current ozone standard is 75 ppb, but the standard may change in 2014.
Figure 5.1: Sullivan County Ozone Trend
Source: Northeast Tennessee Ozone Action Partnership
Figure 5.2 depicts ozone episodes in 2012 for the areas of Memphis, Nashville, Knoxville and Tri- Cities. The following key should be used for Figure 5.2 to determine what each color and associated Air Quality Index (AQI) value means.
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Figure 5.2: Ozone Episodes, 6/27/2012-6/30/2012
Source: Northeast Tennessee Ozone Action Partnership
Particulate Matter Particulate matter is particles in the air that can cause irritation to the eyes, nose, and throat, chest tightness, and increased sickness/premature death from lung diseases and heart disease. Fine particulate matter (PM 2.5) is about 1/30th the diameter of a human hair. Figures 5.3 and 5.4 depict PM 2.5 trends in Kingsport from 1999-2011.
Figure 5.3: Annual Kingsport PM2.5
Source: Northeast Tennessee Ozone Action Partnership
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Figure 5.4: Kingsport PM2.5 (24 Hour Standard)
Source: Northeast Tennessee Ozone Action Partnership
Radon Radon is a natural cancer-causing radioactive gas that you cannot see, smell, or taste. Radon is formed by the decay of radioactive uranium in the earth’s crust and then escapes to the atmosphere after working its way up through the soil. If a building or home is located where the gas is present, radon will infiltrate inside and potentially pose a danger to the occupants’ health. Radon is the leading cause of lung cancer among non-smokers and is the second leading cause of lung cancer in America claiming more than 20,000 lives annually. Fortunately, radon testing is available through the Tennessee Department of Health. Figure 5.5 depicts radon levels across the state of Tennessee for 2010.
Figure 5.5: Radon Levels across Tennessee, 2010
Sullivan County Regional Health Department|ETSU College of Public Health 43 2012 Community Health Status Assessment
Zone 1 counties have a predicted average indoor radon Highest Potential screening level greater than 4 pCi/L (picocuries per liter) Zone 2 counties have a predicted average indoor radon Moderate Potential screening level between 2 and 4 pCi/L Zone 3 counties have a predicted average indoor radon Low Potential screening level less than 2 pCi/L Source: Environmental Protection Agency
Water Quality Table 5.2 shows impaired waterways in Sullivan County. An impaired waterway is a river, lake, pond, bay or estuary that does not meet the water quality standards of the Clean Water Act. Sources of water impairment include pesticides, fertilizers, mercury, metals, sediment, and other pollutants that are carried through a watershed by rain water.
Table 5.2: Impaired Waterways in Sullivan County Impaired Waterways in Sullivan County, 2010 Name Type of Impairment Back Creek Nutrients Bear Creek Habitat Alteration Beaver Creek Nutrients Booher Creek Pathogens Cedar Creek Nutrients Clark Branch Sediment Fall Creek Habitat Alteration/Sediment Gammon Creek Nutrients/Pathogens/Oxygen Depletion Gravelly Creek Habitat Alteration Horse Creek Habitat Alteration/Pathogens Indian Creek Habitat Alteration Little Creek Habitat Alteration/Nutrients/Sediment Lynch Branch Pathogens Mill Creek Sediment Miller Branch Pathogens/Sediment Muddy Creek Pathogens North Fork Holston River Mercury Reedy Creek Sediment Sinking Creek Sediment South Fork Holston Flow Alteration/Mercury/Oxygen River Depletion/Temperature Timbertree Branch Habitat Alteration/Sediment Woods Branch Habitat Alteration/Sediment Source: Environmental Protection Agency
Drinking Water Table 5.3 shows all incidents where health based criteria (maximum contaminant levels) were not met in drinking water distribution systems in Sullivan County from 2008-2012.
Sullivan County Regional Health Department|ETSU College of Public Health 44 2012 Community Health Status Assessment
Table 5.3: Violations of Health-Based Drinking Water Standards, Sullivan County, 2008-2012 Date Nature of Violation 2008 Total Haloacetic Acids (Exceeded Maximum Contaminant Level)/Coliform (Water Not Treated Properly) 2009 Total Haloacetic Acids (Exceeded Maximum Contaminant Level)/Coliform (Water Not Treated Properly) 2010 Coliform (Water Not Treated Properly) 2011 Coliform (Water Not Treated Properly) 2012 Coliform (Water Not Treated Properly) Source: Environmental Protection Agency
Workplace Hazards Mortality due to occupational injury is quite low in both Sullivan County and Tennessee (Table 5.4). In 2010, there were 138 reported fatal occupational injuries in Tennessee. Of these, only 5 fatalities occurred in Sullivan County. In 2011, there were 120 reported fatal occupational injuries in Tennessee and 3 in Sullivan County.
Table 5.4: Total Number of Fatal Occupational Injuries, 2010-2011 Sullivan United Year County Tennessee States
2010 5 138 4,690
2011 3 120 4,609 Source: U.S. Department of Labor
Food Safety The following tables summarize data for reported cases of foodborne illnesses in Sullivan County. It is important to keep in mind that foodborne illnesses are vastly underreported because most infected individuals do not seek medical care.
Campylobacter Incidence of Campylobacter in Sullivan County from 2000-2010 is depicted in Figure 5.6. The incidence of Campylobacter in Tennessee has been increasing since 2000, but remains lower than the incidence in Sullivan County except for in 2010 where there were few cases reported.
Sullivan County Regional Health Department|ETSU College of Public Health 45 2012 Community Health Status Assessment
Figure 5.6: Incidence of Campylobacteriosis
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports
E. Coli 0157 Figure 5.7 shows the incidence of E. Coli 0157 in Sullivan County and Tennessee. An increase in incidence in 2007 and 2008 may be due in part to a national outbreak of E. Coli 0157 from contaminated beef products.
Figure 5.7: Incidence of Shiga Toxin-Producing E. Coli (STEC)
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports **Note: Due to Sullivan County’s population size, an increase of 1-2 cases of illness per year may skew graphic representations of data.**
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Hepatitis A Figure 5.8 shows the incidence of Acute Viral Hepatitis A in Sullivan County and Tennessee. Hepatitis A can be spread through fecal-oral transmission. If someone who is infected with the virus does not wash their hands thoroughly with soap and water, the virus can be spread to others through food or other objects. Cases increased in 2008 due to an outbreak of Hepatitis A in Northeast Tennessee, specifically Hawkins County.
Figure 5.8: Incidence of Acute Viral Hepatitis A
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports
Salmonella Figure 5.9 shows the incidence of Salmonella in Sullivan County and Tennessee. Between 2007 and 2009 there were five reported outbreaks of Salmonella in the United States.
Figure 5.9: Incidence of Salmonellosis
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports
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Shigella Incidence of Shigellosis for both Sullivan County and Tennessee increased dramatically in 2002- 2003, 2006, and 2009 (Figure 5.10).
Figure 5.10: Incidence of Shigellosis
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports
Lead Exposure The most common form of lead exposure in young children comes from paint. Other sources include older plumbing pipes, antique dishes, and some toys. Lead poisoning can affect nearly every system in the body, but because there are rarely any obvious symptoms, it often goes unrecognized. Extremely high Blood Lead Levels (BLLs) can cause severe neurologic problems in young children.
Figure 5.11 shows the percentage of elevated BLLs of children under the age of six tested in Sullivan County and in Tennessee 2007-2011. The average number of children tested annually during this time was 2,500.
Sullivan County Regional Health Department|ETSU College of Public Health 48 2012 Community Health Status Assessment
Figure 5.11: Percentage of Elevated BLLs of Total Children Tested for Blood Lead Poisoning
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports
Waterborne Disease Waterborne diseases are caused by pathogenic microorganisms that are most commonly transmitted in contaminated fresh water. Infection can result from drinking, bathing, and preparing and consuming food in infected water.
Cryptosporidiosis and Giardiasis Figure 5.12 shows the incidence of Cryptosporidiosis in Sullivan County and Tennessee and figure 5.13 depicts the incidence of Giardiasis. The incidence of Giardiasis has decreased in both Sullivan County and in Tennessee since 2000, but this may be due to underreporting of the disease.
Sullivan County Regional Health Department|ETSU College of Public Health 49 2012 Community Health Status Assessment
Figure 5.12: Incidence of Cryptosporidiosis
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports **Note: Due to Sullivan County’s population size, an increase of 1-2 cases of illness per year may skew graphic representations of data.**
Figure 5.13: Incidence of Giardiasis
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports
Rabies Figure 5.14 shows the number of animals that have tested positive for rabies in Sullivan County and Tennessee. There has been a decrease in the number of animals that tested positive for rabies in both Sullivan and Tennessee since 2008.
Sullivan County Regional Health Department|ETSU College of Public Health 50 2012 Community Health Status Assessment
Figure 5.14: Animals that Tested Positive for Rabies
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports
Vector-borne Diseases Vector-borne diseases are spread from an infected individual to another individual by an insect or other similar organism. Commonly known vector-borne diseases include Malaria, West Nile Virus, Lyme Disease and Rocky Mountain Spotted Fever.
West Nile Virus West Nile virus (WNV) is one of several mosquito-borne viruses in the United States that can infect people. The virus exists in nature primarily through a transmission cycle involving certain species of mosquitoes and birds. Most people (about 80 percent) that are infected with WNV by the bite of an infected mosquito will have no symptoms and will not know they have been infected. Approximately 20 percent of the people that are infected may experience a range of flu-like symptoms such as fever, headache, weakness, stiff neck, nausea, vomiting, muscle aches, rash and in some cases diarrhea and sore throat. Less than 1 percent of people that are infected with WNV will develop severe illness. Persons over 50 years of age are at the highest risk of developing the most severe form of the disease and persons over the age of 70 with other health problems are at greatest risk of death. Sullivan County did not have any reported cases of WNV during the 2012 WNV outbreak.
Rocky Mountain Spotted Fever Rocky Mountain Spotted Fever is a bacterial pathogen transmitted to humans through contact with ticks. The illness may be fatal in as many as 20% of untreated cases. The incidence of Rocky Mountain Spotted Fever has dramatically declined since 2006 (Figure 5.15).
Sullivan County Regional Health Department|ETSU College of Public Health 51 2012 Community Health Status Assessment
Figure 5.15: Incidence of Rocky Mountain Spotted Fever
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports
Lyme Disease Lyme disease is caused by a bacteria commonly transferred to humans through a tick bite. There are typically very few cases of Lyme disease in Northeast Tennessee. There were only 5 confirmed cases of Lyme disease in the state in 2011. The disease mainly occurs in the Northeastern United States.
Figure 5.16: Incidence of Lyme Disease
Source: TDH, Communicable and Environmental Disease Services Surveillance Reports **Note: Due to Sullivan County’s population size, an increase of 1-2 cases of illness per year may skew graphic representations of data.**
Sullivan County Regional Health Department|ETSU College of Public Health 52 2012 Community Health Status Assessment
Poisoning A poison is any substance, including medications, that is harmful to your body if too much is eaten, inhaled, injected, or absorbed through the skin. Any substance can be poisonous if too much is taken. Most unintentional poisonings are due to drug overdose. Figure 5.17 shows the mortality rates due to accidental poisoning from 2000-2009.
Figure 5.17: Mortality Rate Due to Accidental Poisoning
Source: TDH, Division of Health Statistics, Health Information Tennessee
Section 6: Social and Mental Health
The World Health Organization defines health as “not only the absence of infirmity and disease but also a state of physical, mental and social well-being.” The social and mental health of Sullivan County residents is an important piece of the overall health of the community. However, these aspects of health are often overshadowed by morbidity and mortality statistics.
Mental Health Status In the 2010 Sullivan County BRFSS, 11% of males and 6% of females in Sullivan County reported that they rarely or never get all the social and/or emotional support that they need (Figure 6.1). Furthermore, adults over the age of 75 were more likely to report that they did not get social/emotional support they need (Figure 6.2).
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Figure 6.1: Adults who reported Rarely or Never Getting the Social/Emotional Support they Need, by Gender
Source: CDC BRFSS
Figure 6.2: Adults who reported Rarely or Never Getting the Social/Emotional Support they Need, by Age
Source: CDC BRFSS
Child Abuse and Neglect Child abuse and neglect is one of the nation’s most serious concerns. Collecting data on cases of child abuse in children under the age of 18 will help support programs that address this important issue in the nation as well as Sullivan County.
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Figure 6.3 depicts the reported number of child abuse and neglect cases in Sullivan County from 2003 to 2010. There has been a decline in the number of cases since 2005. However, the percentage of Sullivan County reported abuse and neglect cases has been consistently higher than Tennessee since 2005.
Numbers of substantiated cases of child abuse and neglect for Sullivan County have been higher than the state average since 2005 (Figure 6.4). There has been an overall decrease in the number of substantiated child abuse and neglect cases since 2006.
Figure 6.3: Reported Child Abuse and Neglect Cases
Source: The Annie E. Casey Foundation, Kids Count Data Center
Figure 6.4: Substantiated Cases of Child Abuse and Neglect per 1,000 Children
Source: The Annie E. Casey Foundation, Kids Count Data Center, Tennessee and Sullivan County Profiles.
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Homicide Rate The homicide rates in Sullivan County have remained consistently lower than the homicide rate for the state of Tennessee (Figure 6.5). Sullivan County has reached the HP 2020 goal of 5.5 homicide deaths per 100,000 population.
Figure 6.5: Age-Adjusted Homicide Rates
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Suicide Figure 6.6 depicts the Suicide rates for Sullivan County and Tennessee from 1992 to 2009. From 2007-2009, deaths from suicide were 15.2 per 100,000 people in Sullivan County and 14.4 per 100,000 people in Tennessee.
Both in the state of Tennessee and in Sullivan County, rates of suicide in those over the age of 65 are a concern. Rates of suicide in Sullivan County in this age group are fairly consistent with Tennessee (Figure 6.7). It should be noted that Sullivan County rates should be interpreted with caution due to the small number of suicides per year (< 20).
In general, the rate of suicide for late adolescents and early adults ages 15-44 was less than those for seniors ages 65 and older (Figure 6.8). In Sullivan County, the suicide rates for those ages 15-44 was fairly consistent with the rates for Tennessee and remained steady.
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Figure 6.6: Age-Adjusted Suicide Rates, Tennessee and Sullivan County
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Figure 6.7: Suicide Rates, Ages 65 and Older
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Sullivan County Regional Health Department|ETSU College of Public Health 57 2012 Community Health Status Assessment
Figure 6.8: Suicide Rates, Ages 15-44
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Domestic Violence In 2010, domestic violence offenses in Tennessee made up 52.1% of all person crimes, resulting in 84,517 domestic violence reports according to the Tennessee Bureau of Investigations. Of these reports 47,279 (55.9%) were cleared. The majority of these offenses were simple assault, aggravated assault, and intimidation (96.1%). According to the Tennessee Bureau of Statistics, there were 1,061 reports of domestic violence in Sullivan County in 2011 (Table 6.1).
Table 6.1: Domestic Violence Victims by Reporting Agency, Sullivan County, 2011
Sullivan East County Kingsport Tennessee Tri Sheriff's Police State Cities Office Department University Airport Totals Reported 86 959 15 1 1,061 Cleared 76 431 13 0 520 Source: Tennessee Bureau of Investigations, Crime Statistics Unit
Psychiatric Admissions and Mental Health Treatment According to the CDC, mental illnesses account for a larger fraction of disability in the United States than any other form of illness. Mental illness is a cooperative term used to define various mental disabilities. These include unspecified psychosis, anxiety states, panic disorder, rhythmic disorder, psychogenic pain, acute reaction to stress, and depressive disorder. Mental health care is a concern for communities as it affects not only those afflicted, but also their loved ones and the entire community. Having proper resources available to meet mental health needs in the community is crucial.
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In 2010, the overall discharge rate for mental disorders in Sullivan County was significantly lower than for the state of Tennessee due to data not being properly reported for that year (Figure 6.9). The largest demographic for mental disorders by age group was those ages 15-64 comprising 82% (Figure 6.10).
Figure 6.9: Hospital Discharge Rate for Mental Disorders
Source: Tennessee Department of Health, Division of Health Statistics
Figure 6.10: Percent of Discharges for Mental Disorders by Age Group, Sullivan County
Source: Tennessee Department of Health, Division of Health Statistics.
Alcohol-Related Motor Vehicle Injury/Mortality Of the 95 counties in Tennessee, Sullivan County ranked 77 in alcohol-related traffic fatalities in 2009. According to the Tennessee Department of Safety, the alcohol-related crash rate for Sullivan County was 1.179 crashes per 1,000 licensed drivers with 145 total crashes.
Sullivan County Regional Health Department|ETSU College of Public Health 59 2012 Community Health Status Assessment
In addition to alcohol-related mortality, driving under the influence (DUI) arrests are also tracked by the Tennessee Bureau of Investigation. Table 6.2 shows that in 2011, there were 380 DUI arrests in Sullivan County, two of which were juvenile arrests.
Table 6.2: Driving Under the Influence Arrests by Agency and Adult verses Juvenile, 2011 Sullivan East County Kingsport Tennessee Tri Sheriff’s Police State Cities Office Department University Airport Totals Adult Arrests 121 235 22 0 378 Juvenile Arrests 1 1 0 0 2 Source: Tennessee Bureau of Investigation, Crime Statistics Unit
Depression According to the Centers for Disease Control, 1 in 10 Adults in the United States report that they are depressed. Depression affects everyone; however, women, people with less than a high school education, those previously married, people between the ages of 45-65, racial minorities, those unemployed, and people without insurance are more likely to be depressed. In the 2008 Department of Health and Human Services Community Health Status Report, 12,045 individuals (7.83% of Sullivan County’s population) reported having had major depression, compared to 10% of the US population.
Section 7: Maternal and Child Health
The health of mothers, infants and children is important to a community’s well-being. Not only do these individuals comprise a large segment of the population, but they also represent a prediction of the next generation’s health. Maternal and child health addresses many issues; those affecting pregnant women and postpartum women (including indicators of maternal illness and death) and those that affect infants’ health and survival (including infant mortality rates; birth outcomes; prevention and birth defects; access to preventative care; and fetal, perinatal and other infant deaths).
Infant Mortality Infant mortality is defined as the death of any child less than one year of age. Infant mortality rates are commonly used as a measure of a community’s health. The U.S. ranks 34th in the world for its infant mortality rates, and within the U.S., Tennessee ranks 49th.
In 2009, infant mortality rates for Sullivan County were above those for both Tennessee and the U.S. at 9.38 deaths per 1,000 live births (Figure 7.1). The U.S. Infant mortality rate has greatly decreased since 1940 from 47.0 deaths per 1,000 live births. Infant mortality rates at the county, state and national level are above the HP 2020 target of 5.6 deaths per 1,000 live births.
Sullivan County Regional Health Department|ETSU College of Public Health 60 2012 Community Health Status Assessment
Figure 7.1: Infant Mortality Rates, Sullivan County, Tennessee, United States
Source: National Center for Health Statistics. Deaths: Final Data for 2009 and Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Neonatal and Post-Neonatal Mortality Infant mortality is often divided into two categories-neonatal (less than 28 days old) and post neonatal (28 days to 1 year of age) mortality. Typically, neonatal rates of mortality are higher than post-neonatal rates due to congenital anomalies, prematurity and other medical conditions in newborns that cause death quickly after birth. In the U.S., infant mortality rates are higher than in similar nations. Figures 7.2 and 7.3 depict the neonatal and post-neonatal mortality rates for 2009.
Figure 7.2: Neonatal Mortality Rates
Sources: National Center for Health Statistics. Deaths: Final Data for 2009 and Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Sullivan County Regional Health Department|ETSU College of Public Health 61 2012 Community Health Status Assessment
Figure 7.3: Post-Neonatal Mortality Rates
Sources: National Center for Health Statistics. Deaths: Final Data for 2009 and Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Mortality Due to Birth Defects Figures 7.4 and 7.5 depict infant mortality rates due to congenital malformations, deformations, chromosomal abnormalities, and perinatal conditions. Though these infant mortality rates are low, some of these deaths are preventable with quality prenatal care and better maternal health. Due to the small number of deaths from these causes, rates for Sullivan County should be interpreted with caution.
Figure 7.4: Infant Mortality Rates for Congenital Malformations, Deformations, and Chromosomal Abnormalities
Sources: National Center for Health Statistics. Deaths: Final Data for 2009 and Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee **Note: Due to Sullivan County’s population size, an decrease of 1-2 cases per year may skew results.**
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Figure 7.5: Infant Mortality Rates for Perinatal Conditions, Sullivan County and Tennessee
Sources: National Center for Health Statistics. Deaths: Final Data for 2009 and Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Infant Mortality by Manner and Cause Manner of death is a classification of deaths based on the circumstances surrounding a cause of death and how the death occurred. The official manner includes two broad categories: medical causes and external causes. Medical causes include: prematurity, congenital anomalies, injuries, perinatal conditions, SIDS, unknown causes, and other medical conditions. Figure 7.6 depicts infant mortality by cause of death for 2011 while figure 7.7 depicts the data for 2012.
Figure 7.6: Infant Mortality by Cause of Death, Sullivan County, 2011
Source: Sullivan County Child Fatality Review Team records
Sullivan County Regional Health Department|ETSU College of Public Health 63 2012 Community Health Status Assessment
Figure 7.7: Infant Mortality by Cause of Death, Sullivan County, 2012
Source: Sullivan County Child Fatality Review Team records
Child Mortality In the state of Tennessee, the death of anyone below age 18 is considered a child death and is reviewed by the local Child Fatality Review Team. There were 144 total child deaths in Sullivan County between 2000 and 2009 (Table 7.1). There was a decrease in deaths during the time period with the total number of child deaths dropping nearly 5% by 2009. With the small number of events overall, fluctuation from year to year is expected and should be interpreted with caution. The number and the rate of child deaths in Sullivan County have shown a fairly consistent trend (Figure 7.8). Sullivan County child death rates have, consistently, remained below the state level. The highest rate of child deaths occurred in the less than 1 age group, where 73% of fatalities were children under the age of 1 year. Children ages 1-4, and ages 5-9 had the lowest child fatality rates at 5% each (Figure 7.9).
Table 7.1: Child Fatalities by Year, Sullivan County, 2000-2011 Year Deaths Population 2000 29 33,411 2001 28 33,027 2002 17 32,859 2003 24 32,617 2004 27 32,311 2005 29 32,049 2006 16 31,876 2007 23 31,857 2008 21 31,845 2009 19 31,832 2010 17 31,811 2011 22 31,767 Source: Sullivan County Child Fatality Review Team Records
Sullivan County Regional Health Department|ETSU College of Public Health 64 2012 Community Health Status Assessment
Figure 7.8: Child Mortality Rates Ages (0-17)
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Figure 7.9: Child Fatalities by Age Group, Sullivan County Child Fatalities by Age Group, Sullivan County, 2007-2009
Age<1 Age 1-4 Age 5-9 Age 10-14 Age 15-17
11%
6%
5%
5%
73%
Source: Sullivan County Child Fatality Review Team Records.
Child Mortality by Manner and Cause The child fatality review (CFR) team classifies causes of death as either medical causes or external causes. External causes include: motor vehicle accidents, weapons, fire or burns, poisoning or overdose, asphyxia, drowning, falls, and other injuries. Figure 7.10 depicts child mortality by cause of death for 2011 while figure 7.11 depicts the data for 2012.
Sullivan County Regional Health Department|ETSU College of Public Health 65 2012 Community Health Status Assessment
Figure 7.10: Child Mortality by Cause of Death, Sullivan County, 2011
Source: Sullivan County Child Fatality Review Team Records.
Figure 7.11: Child Mortality by Cause of Death, Sullivan County, 2012
Source: Sullivan County Child Fatality Review Team Records.
Live Births and Fertility Rates
Fertility rates in Sullivan County have exhibited a slight upward trend over the past 14 years ranging from 54.1 in 1995-1997 to 58.6 in 2007-2009 (Figure 7.12). Fertility rates for 15-44 year old females in Sullivan County are lower than the overall fertility rate for Tennessee.
In 2012, Sullivan County Regional Health Department conducted approximately 1,800 pregnancy tests (Figure 7.13).
Sullivan County Regional Health Department|ETSU College of Public Health 66 2012 Community Health Status Assessment
Figure 7.12: Fertility Rates for Women 15-44 Years of Age
Source: Tennessee Department of Health, Division of Health Statistics, Sullivan County Birth Certificate Data
Figure 7.13: Number of Pregnancy Tests Conducted by Health Department Site
Source: Tennessee Department of Health, Division of Policy, Planning, and Assessment
Adolescent pregnancy rates Adolescent pregnancy and parenting have a significant impact on an adolescent’s achievement. Children of teen mothers are at a greater risk for abuse and neglect and may be more likely to drop out of school or become adolescent parents themselves. Adolescent pregnancy rates in Sullivan County are lower than the adolescent pregnancy rates for Tennessee (Figure 7.14).
Sullivan County Regional Health Department|ETSU College of Public Health 67 2012 Community Health Status Assessment
Although great strides have been made since the early 1990s in decreasing the adolescent pregnancy rate in Sullivan County and Tennessee, the decline has been slowing in recent years. The HP 2020 goal is to reduce pregnancy among 15-17 year olds to 36.2 pregnancies per 1,000 females. From 2006-2010, both Sullivan County and Tennessee met this goal (Figure 7.15).
Figure 7.14: Adolescent Pregnancy Rates, Ages 10-17
*Note: Pregnancies include reported fetal deaths, abortions, and live births. Source: Tennessee Department of Health. Health Statistics, Vital Statistics. Pregnancies with Rates per 1,000 Females Aged 10-17
Figure 7.15: Adolescent Pregnancy Rates, Ages 15-17
*Note: Pregnancies include reported fetal deaths, abortions, and live births. Source: Tennessee Department of Health. Health Statistics, Vital Statistics. Live Births with Age- Specific Fertility Rates per 1,000 Females Aged 10-17
Sullivan County Regional Health Department|ETSU College of Public Health 68 2012 Community Health Status Assessment
Family Planning Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy.
In 2012, Sullivan County health educators provided community education and outreach to 3,660 pre-teens (adolescents < 13 years old) and 2,822 teens (ages 13-17). The education program focused on a wide range of topics including pregnancy prevention, abstinence education, information on puberty, and STI/HIV education. Figure 7.16 depicts the number of family planning visits by health department site in 2012.
Figure 7.16: Number of Family Planning Visits by Health Department Site
Source: Tennessee Department of Health, Division of Policy, Planning, and Assessment
The percentage of births to single mothers is increasing worldwide. Though not all births to single mothers are unintended, all births to single mothers are considered in birth outcome and risk assessment data because research has indicated that a single mother without a partner may have a higher risk of negative birth outcomes. According to the National Center for Health Statistics (NCHS), unmarried mothers gave birth to 4 out of every 10 babies born in the United States in 2007.
Between 2004 and 2009 in both Sullivan County and Tennessee, the percent of births to single mothers rose (Figure 7.17). These mothers may lack a support system and may be at higher risk of negative health outcomes.
Sullivan County Regional Health Department|ETSU College of Public Health 69 2012 Community Health Status Assessment
Figure 7.17: Percent of Births to Unmarried Mothers
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Prenatal Care Prenatal care is a strong indicator of birth outcomes. Adequate prenatal care helps to keep infant and mother healthy during pregnancy. Adequate care can provide early detection of problems with a pregnancy and opportunity for interventions to prevent negative health outcomes for infant and mother.
The Kessner Index is used as a classification system of prenatal care. This system was developed by the Institute of Medicine in 1973 and factors timing and quantity of prenatal care to determine the following categories: adequate, inadequate and intermediate. Though there are other systems of classification, the Kessner Index is most commonly used.
Adequate Prenatal Care Figure 7.18 shows the percent of births to mothers with adequate prenatal care as indicated by the Kessner Index. It should be noted that comparison between data before and after 2004 cannot be made because of a change in birth certificate data collected. Although Tennessee has a higher percentage of women receiving adequate prenatal care, both Sullivan County and Tennessee are well below the HP 2020 target of 77.6% of pregnant women receiving adequate and early prenatal care.
Sullivan County Regional Health Department|ETSU College of Public Health 70 2012 Community Health Status Assessment
Figure 7.18: Percent of Births to Mothers with Adequate Prenatal Care
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
C-Sections The percentage of births delivered by cesarean section (C-section) is rising and has increased 2.65% in Sullivan County, since 2004 (Figure 7.19). In 2009, C-section rates were slightly higher in Sullivan County than Tennessee at 35.65% compared to 33.74%.
Figure 7.19: Percent of Births Delivered by Cesarean Section in Sullivan County and Tennessee
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Sullivan County Regional Health Department|ETSU College of Public Health 71 2012 Community Health Status Assessment
Tobacco Use during Pregnancy Smoking during pregnancy is one of the most common preventable causes of infant morbidity and mortality. It is associated with 30% of small-for-gestational age infants, 10% of pre-term infants, and 5% of infant deaths. Smoking during pregnancy also increases the risk for complications during pregnancy and poor pregnancy outcomes. Additionally, infants born to mothers who smoke during pregnancy are 1.4 to 3.0 times more likely to die of Sudden Infant Death Syndrome (SIDS).
There are two HP 2020 national health objectives related to smoking during pregnancy: reducing the prevalence of cigarette smoking among pregnant women to 1.4% and increasing the percentage of pregnant smokers who stop smoking during pregnancy to 30%. Much work needs to be done to meet these national goals.
Figure 7.20: Percent of Mothers that Smoked during Pregnancy
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Neonatal Abstinence Syndrome Neonatal Abstinence Syndrome is a condition in which a baby is born dependent on legally prescribed or illegally obtained drugs used by the mother during pregnancy. The kinds of medications that may cause withdrawal include those known as opioids (painkillers) or benzodiazepines (which help with anxiety or sleep). Illicit drugs such as cocaine may also cause withdrawal. NAS can have a number of negative effects on the baby, including premature birth creating additional short- and long-term health challenges. NAS babies often require longer hospitalizations.
Over the past decade, we have seen a nearly ten-fold rise in the incidence of babies born with NAS in Tennessee. As of January 1, 2013 all cases of NAS should be reported to the Tennessee Department of Health. Figure 7.21 depicts the surveillance summary for NAS for the week of August 18-24, 2013. Weekly summaries can be found at: http://health.state.tn.us/MCH/NAS/NAS_Summary_Archive.shtml
Sullivan County Regional Health Department|ETSU College of Public Health 72 2012 Community Health Status Assessment
Figure 7.21: Neonatal Abstinence Syndrome Surveillance
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Low Birth Weight Low birth weight is defined as an infant born weighing less than 2,500 grams or 5 pounds, 8 ounces. CDC data for the U.S. indicates that approximately 8.3% of babies are born with low birth weight. Low birth weight babies are at a higher risk for health problems during the newborn period. This includes respiratory distress syndrome, bleeding of the brain, and other newborn medical risks. Some studies suggest that individuals who are born with low birth weight may be at increased risk for certain adult chronic conditions including type 2 diabetes, high blood pressure and heart disease.
Figure 7.22 depicts the percentage of low birth weight babies born between 2004 and 2009. Neither Sullivan County nor Tennessee has met the HP 2020 goal to reduce the percentage of low birth weight babies born to 7.8%.
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Figure 7.22: Percent of Low Birth Weight Babies Born
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
EPSDT The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mandate requires states to conduct regularly scheduled examinations (screens) of all Medicaid-eligible recipients under the age of 22 to identify physical and mental health problems.
As of 2011, 94% of EPSDT patients that were eligible in Sullivan County were screened (Figure 7.23). Sullivan County is currently behind Tennessee in the percentage of EPSDT eligible children who were screened.
Figure 7.23: Percentage of EPSDT Eligible Screened (ages 21 and under)
Source: TENNderCare Program, Sullivan County Regional Health Department
Sullivan County Regional Health Department|ETSU College of Public Health 74 2012 Community Health Status Assessment
WIC The Special Supplemental Nutritional Program for Women, Infants, and Children (WIC) serves to safeguard the health of low-income women, infants and children up to age five who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating and referrals to healthcare. Established in 1972, this federal program was made permanent in 1974. According to the Tennessee Department of Health, current numbers indicate that, on average, 4,159 women were participating in WIC in Sullivan County.
In 2012, nearly 15% (23,313) of Sullivan County mothers indicated they received WIC (Figure 7.24). Of these, 46% were in Blountville and 54% were in Kingsport. Blountville has consistently remained behind Kingsport in WIC participants.
The percent of children under 6 who participate in WIC is greater in Sullivan County than in Tennessee and has gradually increased since 2005 (Figure 7.25). Although the WIC population has shown an increase in the percent of children under age 6 enrolled in the program, there has been a decrease in the percentage of the WIC population served (Figure 7.26).
In 2009, 95% of the WIC population in Sullivan County was served by the health department. However, in 2012 only 84% to 85% of the WIC population was served by the health department. The percentage of the WIC population served remains higher in Sullivan County than Tennessee and has consistently reached the 87% benchmark.
Figure 7.24: Number of WIC Participants by Health department Site
Source: WIC Program, Sullivan County Regional Health Department
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Figure 7.25: Percent Children under 6 Enrolled in WIC Program, Sullivan County and Tennessee
Percent of Children Under Age 6 Enrolled in WIC Program, 2004-2009 35
30
25
20
15
Percent (%) Percent 10
5
0 2004 2005 2006 2007 2008 2009 Sullivan County 28 27.5 27.5 29.6 31.5 32.3 Tennessee 23.5 24.4 24.1 23 22.4 25.4
Source: WIC Data, Tennessee Department of Health, Annie E. Casey Foundation
Figure 7.26: Percentage of the WIC Population Served
Percentage of WIC Population Served, 2004-2012 110% 105% 100% 95% 90% 85% 80% 75% 70% 65% Percent (%) Percent 60% 55% 50% Q1 Q2 2004 2005 2006 2007 2008 2009 2010 2011 2012 2012 Sullivan County 89% 86% 86% 91% 94% 95% 91% 85% 84% 85% Best in State 91% 92% 92% 92% 102% 106% 101% 98% 99% 97% State Average 79% 79% 80% 80% 86% 89% 86% 82% 82% 82% Benchmark 87% 87% 87% 87% 87% 87% 87% 87% 87% 87%
Source: WIC Program, Sullivan County Regional Health Department
Breastfeeding Intent Public health is committed to increasing breastfeeding rates in the United States as an important part of maternal and infant health. Breast milk is likely to lower the risk of type 2 diabetes, breast cancer, ovarian cancer, and postpartum depression in a woman.
Breast milk may also reduce the following health problems in infants: ear infections, stomach viruses, diarrhea, respiratory infections, atopic dermatitis, asthma, obesity, type 1 and 2
Sullivan County Regional Health Department|ETSU College of Public Health 76 2012 Community Health Status Assessment
diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitits. There are multiple HP 2020 goals to increase breastfeeding rates. These goals include the following: • Increase the proportion of infants who are ever breastfed to 81.9% • Increase the proportion of infants who are exclusively breastfed at three months of age to 46.2% • Increase the proportion of infants who are exclusively breastfed at six months of age to 25.5% • Increase the proportion of infants who are breastfed at six months of age to 60.6% • Increase the proportion of infants who are breastfed at one year of age to 34.1%
Unfortunately, there is no surveillance system in place to follow mothers at specific intervals for breastfeeding. Therefore, the assessment for Sullivan County against these goals is difficult. Figure 7.27 shows that the intent to breastfeed decreased in each quarter, except in the fourth quarter, reported between 2011 and 2012.
Figure 7.28 depicts the percent of WIC children born in 2012 who were breastfed. The intent to breastfed is generally consistent with the goal for the state health department. The intent to breastfed is self-reported and cannot be used to estimate breastfeeding rates.
Figure 7.27: Intent to Breastfeed, Sullivan County, 2011-2012
Source: WIC Data, Sullivan County Regional Health Department
Sullivan County Regional Health Department|ETSU College of Public Health 77 2012 Community Health Status Assessment
Figure 7.28: Percent of WIC Infants who were Breastfed
Source: Tennessee Department of Health, Division of Policy, Planning, and Assessment
Section 8: Death, Illness and Injury
Heart disease is the leading cause of death in both men and women in the United States. The term heart disease refers to several types of heart conditions, many of which can lead to death and/or disability. In the U.S., the most common type of heart disease is coronary artery disease. Coronary artery disease can often be fatal and can cause heart attacks, angina, heart failure, and arrhythmias. The CDC has estimated that 1 in 4 deaths that occur in the U. S. are due to heart disease. In 2010, heart disease was responsible for 597,689 deaths.
The second leading cause of death in the United States is malignant neoplasm (cancer). According to the CDC, cancer is a term used for diseases where abnormal cells divide uncontrollably and are capable of invading other tissues. Therefore, cancer is composed of many diseases or different types of cancers such as colon cancer, breast cancer, cervical cancer, prostate cancer, thyroid cancer, and many others. In 2010, cancer was responsible for a total of 138,080 deaths in the United States.
Other leading causes of death in the United States include chronic lower respiratory disease (138,080 deaths in 2010), stroke (129,476 deaths in 2010), accidents or unintentional injuries (120,859 deaths in 2010), Alzheimer’s disease (83,494 deaths in 2010), diabetes (69,071 deaths in 2010), nephritis, nephritic syndrome, and nephrosis (50,476 deaths in 2010), influenza and pneumonia (50,097 deaths in 2010), and intentional self harm or suicide (38,364 deaths in 2010). More information on the leading causes of death in the U.S. can be found on the CDC’s website.
Sullivan County Regional Health Department|ETSU College of Public Health 78 2012 Community Health Status Assessment
Leading Causes of Death The leading causes of death in Sullivan County are generally consistent with the leading causes of death for the U.S. Diseases of the heart were the leading cause of death among Sullivan County residents in 2009. The age adjusted mortality rate for diseases of the heart was 204.44 per 100,000. The second leading cause of death was cancer (malignant neoplasm) at 187.46 per 100,000 followed by accidents at 44.54 per 100,000 (Figure 8.1).
Figure 8.1: Top 10 Age-Adjusted Mortality Rates, Sullivan County, 2009
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Mortality rates for the leading causes of death were higher among men than women (Figure 8.2): • Deaths due to diseases of the heart deaths were 35.4% higher among men • Deaths due to malignant neoplasm (cancer) were 31.7% higher among men • Accidental deaths were 50.3% higher among men • Chronic lower respiratory disease was nearly 15.3% higher among men
Male mortality rates were also higher for Alzheimer’s disease, diabetes mellitus, influenza and pneumonia, nephritis, nephritic syndrome and nephrosis, and suicide. However, cerebrovascular diseases were 0.09% higher in women (Figure 85).
Sullivan County Regional Health Department|ETSU College of Public Health 79 2012 Community Health Status Assessment
Figure 8.2: Age-Adjusted Leading Causes of Death in Sullivan County, 2009
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Chronic Illness
Asthma Asthma is a disease that affects the lungs and can cause complications, often in episodes, such as wheezing, chest tightness, breathlessness, nighttime or early morning coughing, and even death. Asthma can be alleviated by controlling possible “triggers” (entities that can cause an asthma attack or make a person’s asthma worse) in the environment and through the use of medications such as corticosteroids.
Asthma affects more than 20 million Americans and leads to more than 2 million emergency room visits and 5,000 deaths per year in the U.S. In Sullivan County, 8.2% of adults have reported ever being diagnosed with asthma. This is lower than the Tennessee (9.4%) and U.S. (13.8%) percentages (Figure 8.3).
Sullivan County Regional Health Department|ETSU College of Public Health 80 2012 Community Health Status Assessment
Figure 8.3: Percentage of Adults Who Reported Ever Being Diagnosed with Asthma
Sources: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee
Asthma Mortality Since 2004, asthma mortality rates in Sullivan County have remained below the state rate (Figure 8.4). Asthma mortality is very low compared to other chronic diseases. If diagnosed properly, asthma can be treated and controlled, therefore, reducing the number of deaths due to asthma.
HP 2020 set 2 targets for asthma mortality based on age. The targets are: • Reduce asthma deaths in adults age 35 to 64 years to 6.0 deaths per million • Reduce asthma deaths in adults aged 65 years and older to 22.9 deaths per million
However, Sullivan County does not have the data available at this time to assess if these goals are being met.
Sullivan County Regional Health Department|ETSU College of Public Health 81 2012 Community Health Status Assessment
Figure 8.4: Age-adjusted asthma mortality rates
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Cerebrovascular Disease Cerebrovascular disease is defined by the World Health Organization (WHO) as, “rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms with no apparent cause other than of vascular origin.” Cerebrovascular disease is divided into 2 categories: stroke (symptoms last more than 24 hours or lead to death) and transient ischemic attack (symptoms last less than 24 hours).
Cerebrovascular diseases mostly occur in individuals over the age of 65, but they can occur at any age. Data on the incidence of cerebrovascular disease in Sullivan County is not available. However, data is available on the mortality of cerebrovascular disease in Sullivan County.
Cerebrovascular Disease Mortality Cerebrovascular diseases are one of the leading causes of death in the United States killing approximately 129,000 people annually. Cerebrovascular disease is the 4th leading cause of death in the United States. In Sullivan County, cerebrovascular diseases were the fifth leading cause of death in 2009. Since 1992, cerebrovascular disease mortality has declined from 67.85 deaths per 100,000 to 41.13 deaths per 100,000 in Sullivan County and from 81.46 deaths per 100,000 to 51.28 deaths per 100,000 in Tennessee (Figure 8.5).
The current HP 2020 goal is to reduce cerebrovascular (stroke) mortality to 33.8 deaths per 100,000. Neither Sullivan County nor Tennessee has met this goal; however, both Tennessee and Sullivan County have made progress in reaching the HP 2020 goal.
From 2007-2009, women had a higher cerebrovascular disease mortality rate (41.84 deaths per 100,000) than men (38.69 deaths per 100,000). Neither group met the HP 2020 target of 33.8 deaths per 100,000 (Figure 8.6).
Sullivan County Regional Health Department|ETSU College of Public Health 82 2012 Community Health Status Assessment
Figure 8.5: Age-Adjusted Cerebrovascular Disease Mortality Rate
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Figure 8.6: Age-Adjusted Cerebrovascular Disease Mortality by Sex, Sullivan County
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Diabetes Diabetes is defined by the CDC as a disease where blood glucose levels are above normal because either the body does not make enough insulin or it cannot use its own insulin as well as it should causing sugar to build up in the blood. Symptoms of diabetes include frequent urination, excessive thirst, weight loss, extreme hunger, sudden vision changes, tingling or numbness in extremities, tiredness, dry skin, slow healing sores, and an increase in infections.
Sullivan County Regional Health Department|ETSU College of Public Health 83 2012 Community Health Status Assessment
Diabetes can present itself as three different types. Type 1 diabetes is often genetic and accounts for about 5% of diabetic cases. Type 2 diabetes is the most common type of diabetes, accounting for almost all cases, and is often related to an unhealthy lifestyle including being overweight or obese. The third type of diabetes is gestational diabetes that occurs only during pregnancy. There are many complications that can occur as a result of diabetes such as heart disease, blindness, kidney failure, and lower-extremity amputation.
Diabetes affects 25.8 million people in the United States. In 2010, 8.7% of U.S. adults, 11.3% of adults in Tennessee, and 12.1% of adults in Sullivan County reported being told they had diabetes (Figure 8.7). The current HP 2020 goal is to reduce the incidence of diabetes to 7.2 new cases of diabetes per 1,000. Sullivan County and Tennessee are both considerably above this goal.
Figure 8.7: Percentage of Adults Who Reported a Diabetes Diagnosis
Source: Sullivan County and CDC BRFSS
Diabetes Mortality Diabetes is the seventh leading cause of death in the United States and Sullivan County. Between 1992 and 2003, diabetes mortality showed a continual increase in both Tennessee and Sullivan County (Figure 8.8). However, in 2004, mortality rates for diabetes began to decrease again. This shows a trend of decline in diabetes related deaths in Sullivan County and in Tennessee. Diabetes mortality in Sullivan County has been generally higher among males than females (Figure 8.9). From 2007-2009, the mortality rate of diabetes was 31 per 100,000 for men and 23.73 per 100,000 for women.
Sullivan County Regional Health Department|ETSU College of Public Health 84 2012 Community Health Status Assessment
Figure 8.8: Age-Adjusted Diabetes Mortality Rates
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Figure 8.9: Age-Adjusted Diabetes Mortality Rates by Sex, Sullivan County
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Diseases of the Heart Figure 8.10 illustrates various percentages of risk factors for heart disease in Sullivan County and Tennessee. High blood pressure was the most frequently reported risk factor for both Sullivan County and Tennessee residents followed by high cholesterol, heart attack, and angina or coronary heart disease respectively in 2010. The HP 2020 goals related to heart related risk factors include:
Sullivan County Regional Health Department|ETSU College of Public Health 85 2012 Community Health Status Assessment
• Reduce the proportion of adults with total high cholesterol levels to 13.5% • Reduce the proportion of adults with high blood pressure (hypertension) to 29.9%
Figure 8.10: Percentage of Adults Who Reported Risk Factors and Diseases of the Heart
Source: CDC BRFSS
Mortality due to Diseases of the Heart Cardiovascular disease is the leading cause of death in the U.S. and is a major cause of disability for many individuals. Each year in the U.S. 600,000 people die of heart disease. Figure 8.11 depicts mortality rates for diseases of the heart from 1992-2009 in Sullivan County and Tennessee.
Figure 8.12 illustrates that mortality rates due to diseases of the heart is higher in males than in females. Since 1992, both genders have seen a decrease in mortality; however, mortality in males remains much higher (262.32 deaths per 100,000) than in females (151.46 deaths per 100,000).
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Figure 8.11: Age-Adjusted Mortality Rates Due to Diseases of the Heart Among Adults
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Figure 8.12: Age-Adjusted Mortality Rates Due to Diseases of the Heart, by Sex
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Cancer In Sullivan County, Tennessee and the U.S. cancer incidence is disproportionately higher among males than among females (Figure 8.13).
Sullivan County Regional Health Department|ETSU College of Public Health 87 2012 Community Health Status Assessment
Figure 8.13: Age-Adjusted All Cancer Incidence Rates, by Sex
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Cancer Mortality According to the CDC, the most common type of cancer in the U.S. is prostate cancer. However, the most common type of cancer in Sullivan County is lung/bronchus cancer with a mortality of 65.31 per 100,000 (Figure 8.14). This is followed by breast cancer (23.87 deaths per 100,000 women), colon/rectum cancer (17.54 deaths per 100,000) and prostate cancer (16.31 deaths per 100,000). Lung/bronchus cancer mortality rates are nearly double the rate of the second highest cancer type in Sullivan County, breast cancer. Possible explanations for such high rates of lung/bronchus cancer in Sullivan County are high rates of tobacco use and radon.
Sullivan County and Tennessee cancer mortality rates are higher than U.S. rates. While cancer mortality rates have decreased, the rate for Sullivan County in 2008 (195.33 deaths per 100,000) remains higher than the HP 2020 target of 160.6 deaths per 100,000 (Figure 8.15).
Sullivan County Regional Health Department|ETSU College of Public Health 88 2012 Community Health Status Assessment
Figure 8.14: Age-Adjusted Cancer Mortality Rates (by type of cancer), Sullivan County
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Figure 8.15: Age-Adjusted All-Cancer Mortality Rates, 1999-2008
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Lung Cancer In Sullivan County, more people died of lung cancer than any other type of cancer with a mortality rate of 65.31 per 100,000. It should be noted that 25% of individuals with advanced lung cancer do not report having any symptoms. The leading cause for lung cancer in the U.S. is smoking followed by radon exposure.
Sullivan County Regional Health Department|ETSU College of Public Health 89 2012 Community Health Status Assessment
Lung Cancer Incidence Figure 8.16 shows the age-adjusted lung cancer incidence for males and females in Sullivan County, Tennessee, and the United States from 2003 through 2007. The incidence of lung cancer in males and females is higher for Sullivan County than for the state and the U.S.
Figure 8.16: Average Lung Cancer Incidence Rates by Sex
Source: Li Q., Whiteside MA. Tennessee Department of Health, Office of Cancer Surveillance. Cancer in Tennessee 2003-2007 and National Cancer Institute. Surveillance Epidemiology and End Results.
Lung Cancer Mortality Lung cancer mortality has decreased in Sullivan County from 73.95 per 100,000 in 2001 to 65.31 per 100,000 in 2009 (Figure 8.17). The HP 2020 goal is to reduce lung cancer deaths to 45.5 deaths per 100,000. Currently, the rates in Sullivan County and Tennessee are above this target.
Lung cancer mortality is much higher in Sullivan County in males than in females (Figure 8.18). From 2007 through 2009, the average age-adjusted lung cancer mortality rate was 87.65 per 100,000 for men and 49.67 per 100,000 for women.
Sullivan County Regional Health Department|ETSU College of Public Health 90 2012 Community Health Status Assessment
Figure 8.17: Age-Adjusted Lung Cancer Mortality Rates
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Figure 8.18: Age-Adjusted Lung Cancer Mortality Rates by Sex
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Colorectal Cancer In 2010, approximately 52.8% of U.S. adults aged 50 years or older reported having a sigmoidoscopy or colonoscopy within the previous 5 years. In Sullivan County, 63.5% of adults aged 50 and older reported receiving a sigmoidoscopy or colonoscopy in the last two years (Figure 8.19). The HP 2020 goal for colorectal cancer screening is 70.5% of adults receiving a blood stool test or a sigmoidoscopy.
Sullivan County Regional Health Department|ETSU College of Public Health 91 2012 Community Health Status Assessment
Figure 8.19: Percentage of Adults (age 50+) who Reported being Screened for Colorectal Cancer
Source: CDC BRFSS
Colorectal Cancer Incidence Colorectal cancer is one of the most commonly diagnosed cancers in the U.S. In 2012, it was estimated there were 143,460 new cases of colorectal cancer in the U.S. Figure 8.20 depicts the colorectal cancer incidence rates for males and females in Sullivan County, Tennessee and the U.S. for 2003-2007. The incidence rates for Sullivan County are lower than those for the state and the U.S.
Figure 8.20: Age-Adjusted Colorectal Cancer Mortality Rates
Source: Li Q., Whiteside MA. Tennessee Department of Health, Office of Cancer Surveillance. Cancer in Tennessee 2003-2007 and National Cancer Institute. Surveillance Epidemiology and End Results.
Sullivan County Regional Health Department|ETSU College of Public Health 92 2012 Community Health Status Assessment
Colorectal Cancer Mortality In 2012, an estimated 51,690 men and women in the U.S. died of colorectal cancer. The mortality rate for colorectal cancer has decreased significantly in Sullivan County since 2001, although it still remains higher than the HP 2020 target of 14.5 deaths per 100,000 (Figure 8.21). Figure 8.22 shows that men have a higher colorectal cancer mortality rate than women in Sullivan County. From 2004-2009, the mortality rate for females met the HP 2020 target.
Figure 8.21: Age-Adjusted Colorectal Cancer Mortality Rates
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Figure 8.22: Age-Adjusted Colorectal Cancer Mortality Rates, by Sex, Sullivan County, 1992-2009
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
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Breast Cancer In 2010, the percent of women age 40 and older who reported having a mammogram in the past 2 years in Sullivan County was 78.6% (Figure 8.23). The HP 2020 target for breast cancer screening is for 81.1 percent of eligible women to have received a mammogram in the past two years. Sullivan County, Tennessee and U.S. were slightly below this target.
Figure 8.23: Women (Age 40+) Who Reported Having a Mammogram in the Last 2 Years
Source: CDC BRFSS
Breast Cancer Incidence Figure 8.24 illustrates age-adjusted breast cancer incidence rates in Sullivan County, Tennessee and the U.S.
Figure 8.24: Average Breast Cancer Incidence Rates
Source: Li Q., Whiteside MA. Tennessee Department of Health, Office of Cancer Surveillance. Cancer in Tennessee 2003-2007 and National Cancer Institute. Surveillance Epidemiology and End Results.
Sullivan County Regional Health Department|ETSU College of Public Health 94 2012 Community Health Status Assessment
Breast Cancer Mortality Breast Cancer mortality in Sullivan County has gradually declined from 1992 through 2009 from 31.3 per 100,000 persons to 23.87 per 100,000 (Figure 8.25). The HP 2020 goal is to reduce breast cancer mortality to 20.6 per 100,000 persons. Neither Sullivan County nor Tennessee has met this target.
Figure 8.25: Age-Adjusted Breast Cancer Mortality Rates for Females by Race
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Prostate Cancer Prostate cancer is a cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men. The National Cancer Institute estimates there will be 238,590 new cases of prostate cancer in the U.S. in 2013 and 29,720 deaths.
Prostate Cancer Incidence Figure 8.26 shows the age-adjusted incidence rates for prostate cancer from 2003 through 2007 in Sullivan County, Tennessee, and the U.S. Prostate cancer incidence in Sullivan County was approximately 141.8 cases per 100,000; higher in comparison to the incidence rate of 138.1 per 100,000 in Tennessee. From 2003 through 2007, the incidence rate for prostate cancer in the U.S. was 155.9 per 100,000 men.
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Figure 8.26: Prostate Cancer Incidence Rates
Source: Li Q., Whiteside MA. Tennessee Department of Health, Office of Cancer Surveillance. Cancer in Tennessee 2003-2007 and National Cancer Institute. Surveillance Epidemiology and End Results.
Prostate Cancer Mortality Prostate cancer is one of the most commonly diagnosed cancers in the U.S but is largely curable if diagnosed early. From 2003 through 2007, age-adjusted mortality from prostate cancer in Sullivan County decreased from 34.5 per 100,000 to 16.31 per 100,000 (Figure 8.27). The HP 2020 goal is 21.2 deaths per 100,000 persons.
Figure 8.27: Age-Adjusted Prostate Cancer Mortality Rates
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
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Cervical Cancer In 2010, about 81% of women 18 years of age and older reported having a pap test within the past 3 years in Sullivan County and the U.S. (Figure 8.28). The percent of women having a pap test within the past 3 years in Tennessee was slightly higher at 83.4%. The HP 2020 goal is to increase the percent of adult women (age 18 and older) who had a Pap test in the last three years to 93.0%.
Figure 8.28: Percent of Women (age 18+) Reporting Having a Pap Test Within the Past 3 Years
Source: CDC BRFSS
Cervical Cancer Incidence Cervical cancer is less common than breast cancer. The American Cancer Society estimates that in 2013, 12,340 women will be diagnosed with and 4,030 women will die of cervical cancer in the U.S.
The age-adjusted average cervical cancer rate in Sullivan County between 2004 through 2008 was 5.7 people with cervical cancer per 100,000 (Figure 8.29). Sullivan County has lower incidence rates than both Tennessee and the U.S.
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Figure 8.29: Age-Adjusted Average Cervical Cancer Incidence Rates
Source: Tennessee Department of Health. Tennessee Cancer Registry. National Cancer Institute. Surveillance Epidemiology and End Results.
Cervical Cancer Mortality Figure 8.30 shows cervical cancer mortality rates for females in Sullivan County and Tennessee from 1992 through 2009. Although cervical cancer mortality is typically between 1.9 deaths per 100,000 and 2.9 deaths per 100,000 in Sullivan County, rates were significantly lower from 1998 through 2000. The HP 2020 goal for cervical cancer mortality is 2.1 deaths per 100,000 females.
Figure 8.30: Age-Adjusted Cervical Cancer Mortality Rates
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Sullivan County Regional Health Department|ETSU College of Public Health 98 2012 Community Health Status Assessment
Injury Accidents are the third leading cause of death in Sullivan County and the U.S. Accidents are the fifth leading cause of death in Tennessee. Since 1995, the age-adjusted accident mortality rate among individuals in Sullivan County and Tennessee has been similar (Figure 8.31).
Figure 8.31: Age-Adjusted Mortality Rates Due to Accidents
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Males in Sullivan County are more likely to die from an accident than females (Figure 8.32). Mortality due to accidents in 2009 was more than double for men (65.66 per 100,000) than for women (27.54 per 100,000).
Figure 8.32: Age-Adjusted Mortality Rates Due to Accidents by Sex
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
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Motor Vehicle Accidents From 2007 through 2009, Sullivan County had 19.23 deaths per 100,000 due to motor vehicle accidents (Figure 8.33). Mortality from motor-vehicle accidents varies from year-to-year in Sullivan County, whereas it has remained somewhat stable in Tennessee.
The motor vehicle accident mortality rate is typically more than double among males compared to females (Figure 8.34).
Figure 8.33: Age-Adjusted Mortality Rates Due to Motor Vehicle Accidents
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Figure 8.34: Age-Adjusted Mortality Rates Due to Motor Vehicle Accidents by Sex
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Sullivan County Regional Health Department|ETSU College of Public Health 100 2012 Community Health Status Assessment
In 2011, the overall crash rate for Sullivan County was 32.27 crashes per 1,000 licensed drivers (Figure 8.35). The overall crash rate has gradually increased since 2009. The lowest rate was in 2009 (30.5 crashes per 1,000 licensed drivers). Figure 8.36 illustrates the crash rates that involved a fatality or an injury. Fatality crash rates have not changed notably since 2007 and remain low. The percentage of crashes that resulted in an injury was much higher, but appears to have declined since 2010 in Sullivan County.
Figure 8.35: Overall Crash Rates (Crashes per 1,000 Licensed Drivers)
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Figure 8.36: Crash Rate Where Crash Resulted in Injury and Fatality
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
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The following table depicts Sullivan County’s ranking among the other 95 counties by type of crash. In this instance, lower values indicate problem areas. Hence, a ranking of 1 is the worst and a ranking of 95 is the best. According to the Tennessee Department of Safety, Sullivan County’s “problem” areas are crashes that result in injury and crashes that involve young drivers.
Table 8.1: Sullivan County Ranking (of 95 Counties in Tennessee) by Type of Crash, 2011 Counties Ranked Worst to Best on a Scale of 1 to 95 Based on Crash Rate* (lower values indicate problem area) Worst Ranking (1st) Best Ranking (95th) Sullivan County Ranking Overall Davidson County Bledsoe County 28 Fatal Grundy County Pickett County 87 Injury Davidson County Bledsoe County 17 Senior Driver Putnam County Jackson County 19 Young Driver Putnam County Lake County 20 Speed-Related Hancock County Bledsoe County 42 Alcohol- Perry County Pickett County 41 Related *Crash rate is determined by number of crashes per 1,000 licensed drivers. Source: Tennessee Department of Safety. Tennessee Traffic Crash Data.
Unintentional Injury Mortality Mortality due to unintentional injury includes falls, death due to firearm discharge, drowning, smoke/fire, and poisoning (unspecified source). Death due to poisoning is the leading cause of unintentional injury in Sullivan County. After poisoning, falls are the second leading cause of death due to unintentional injury, followed by drowning, smoke/fire and death due to firearm discharge (Figure 8.37).
Figure 8.37: Age-Adjusted Mortality Rates Due to Non-Motorized Accidents
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
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Section 9: Communicable Disease
Sexually Transmitted Diseases Sexually Transmitted Infections (STIs) are a considerable problem in the United States. There are currently an estimated 110 million people in the U.S. living with an STI and an estimated 20 million who become newly infected annually. These infections cost the American healthcare system nearly $16 billion in direct medical costs alone.
Chlamydia In 2011, 1,412,791 cases of Chlamydia were reported to the CDC. Chlamydia is the most commonly reported bacterial STI in the U.S. Figure 9.1 depicts the Chlamydia incidence rates for the U.S., Tennessee, and Sullivan County for 2011. Chlamydia rates have been consistently higher in Sullivan County than the Northeast Region (Figure 9.2). Sullivan County had 257.9 cases of Chlamydia per 100,000 individuals in 2011. The incidence is highest among those ages 15-24 (Figure 9.3).
Nationally, Chlamydia rates are three times higher among females than males with an estimated 1 in 15 sexually active females between the ages of 15 and 19 years infected with Chlamydia. Figure 9.4 illustrates Chlamydia incidence among age categories by sex. The greatest number of Chlamydia infections occurs in the 15-24 age categories for both men and women. Similar to national rates, Chlamydia incidence in Sullivan County is higher among females.
Figure 9.1: Chlamydia Incidence Rates, 2011
Source: CDC Sexually Transmitted Disease Surveillance and TDH Communicable and Environmental Disease Reports
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Figure 9.2: Chlamydia Incidence, 2008-2012
Source: TDH Communicable and Environmental Diseases Surveillance Reports
Figure 9.3: Chlamydia Incidence by Age, 2007-2010
Source: CDC Sexually Transmitted Disease Surveillance and TDH Communicable and Environmental Disease Reports
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Figure 9.4: Chlamydia Incidence by Sex and Age, 2010
Source: CDC Sexually Transmitted Disease Surveillance and TDH Communicable and Environmental Disease Reports
Gonorrhea In 2011, 321,849 cases of gonorrhea were reported in the United States. CDC estimates that 820,000 people in the United States are infected with gonorrhea annually and only half of these cases are reported. In 2011, Sullivan County had an incidence rate of 24.8 cases per 100,000 (Figure 9.5). Gonorrhea incidence rates for Sullivan County have been similar to those for the Northeast Region (Figure 9.6).The greatest number of gonorrhea infections occurs in individuals aged 15 to 24 (Figure 9.7), with females having a higher incidence than males (Figure 9.8).
Figure 9.5: Gonorrhea Incidence Rates, 2011
Source: CDC Sexually Transmitted Disease Surveillance and TDH Communicable and Environmental Disease Reports
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Figure 9.6: Gonorrhea Incidence, 2008-2012
Source: CDC Sexually Transmitted Disease Surveillance and TDH Communicable and Environmental Disease Reports
Figure 9.7: Gonorrhea Incidence by Age, 2007-2010
Source: CDC Sexually Transmitted Disease Surveillance and TDH Communicable and Environmental Disease Reports
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Figure 9.8: Gonorrhea Incidence by Sex and Age, 2010
Source: CDC Sexually Transmitted Disease Surveillance and TDH Communicable and Environmental Disease Reports
Syphilis Syphilis is a genital bacterial STI that can cause significant complications if left untreated. Syphilis presents itself in 4 different stages: primary syphilis, secondary syphilis, early latent syphilis, and late latent syphilis. In the United States, the rate of syphilis has steadily increased since 2000. This trend is due to an increase of cases among men, particularly those who are homosexual or bisexual.
In Tennessee, the incidence of syphilis in all stages was above that of the U.S. (Figure 9.9). However, syphilis incidence in Sullivan County was less than one fifth of the incidence in the U.S. and less than one eight the incidence in Tennessee in each category with no cases of early latent syphilis reported. The HP 2020 goal is to reduce the incidence of primary and secondary syphilis to 1.3 per 100,000 females and 6.7 per 100,000 males. Sullivan County has met both of these goals.
Sullivan County Regional Health Department|ETSU College of Public Health 107 2012 Community Health Status Assessment
Figure 9.9: Syphilis Incidence by Stage of Syphilis, Four-Year Average 2006-2009.
Source: CDC Sexually Transmitted Disease Surveillance and TDH Communicable and Environmental Disease Reports
HIV/AIDS In 2011, an estimated 49,273 individuals were diagnosed with Human Immunodeficiency Virus (HIV). Additionally, CDC estimates that about 1.1 million people in the U.S. are living with HIV or AIDS (Acquired Immunodeficiency Syndrome) and almost 1 in 5 of these are unaware of their infection status.
Figure 9.10 shows the number of individuals who reported participating in high-risk behavior that places them at a greater risk for HIV/AIDS in the past year. In Tennessee, this number has increased from 2.7 per 100,000 in 2008 to 4.0 per 100,000 in 2010. The rate of high-risk behavior for HIV/AIDS in Sullivan County has remained fairly consistent from 2008 to 2010 with a decrease from 1.4 per 100,000 in 2008 to 1.2 per 100,000 in 2010.
In 2010, 38.1% of people reported they had been tested for HIV within their lifetime in Tennessee (Figure 9.11). Similarly, 37.3% of people reported they had been tested for HIV within their lifetime in Sullivan County.
The average number of new cases of HIV per year from 2006-2010 for Sullivan County was 2.2, and it is estimated that there are currently 111 individuals living with HIV/AIDS in Sullivan County. The number of men who are currently infected with HIV/AIDS is five times higher than the number of women. In Tennessee, the average number of new cases of HIV per year is approximately 946.2 and it is estimated that there are currently 14,887 individual living with HIV/AIDS across the state. The number of men who are currently infected with HIV/AIDS is three times higher than the number of women.
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Figure 9.10: Number of Respondents Who Said They Had Participated in High-Risk Behavior in the Past Year, 2008-2010
Source: CDC BRFSS
Figure 9.11: Percentage of Adults Who Reported They Have Been Tested for HIV within Their Lifetime, 2008 - 2010
Source: CDC BRFSS
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Other Communicable Diseases
Hepatitis A Hepatitis A is a liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a person ingests fecal matter from contact with objects, food, or drinks contaminated by the feces or stool of an infected person.
Since 2000, the incidence of hepatitis A in Tennessee has decreased dramatically from 2.7 per 100,000 in 2000 to 0.4 per 100,000 in 2011 (Figure 9.12). Cases increased in 2008 due to an outbreak of Hepatitis A in Northeast Tennessee, specifically Hawkins County. The incidence of Hepatitis A in Sullivan County has been 0 per 100,000 since 2009. This indicates very few cases being reported, most likely due to individuals not seeking healthcare during their infection because of very mild symptoms.
Figure 9.12: Incidence of Hepatitis A, 2000-2011
Source: TDH Communicable and Environmental Disease Reports
Hepatitis B Hepatitis B is usually spread through blood, semen, and other bodily fluids. It can be transmitted through sexual contact with an infected person or from sharing needles, syringes, or other drug- injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth. Hepatitis B can be either acute or chronic. Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection in some cases, can lead to chronic infection. Chronic Hepatitis B is a serious disease that can result in long-term health problems, and even death.
The incidence of acute Hepatitis B in Tennessee was higher in 2011 (3.4 per 100,000) than it had been since 2004 (Figure 9.13). The Incidence of acute Hepatitis B in Sullivan County was 2.5 per 100,000 in 2011.
Sullivan County Regional Health Department|ETSU College of Public Health 110 2012 Community Health Status Assessment
Figure 9.13: Incidence of Hepatitis B, 2000-2011
Source: TDH Communicable and Environmental Disease Reports
Hepatitis C CDC estimates that about 3.2 million people in the United States have chronic Hepatitis C. Most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. Acute Hepatitis C is defined as an acute illness with a discrete onset of any sign or symptom consistent with acute viral hepatitis (e.g., fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, and abdominal pain), and either a) jaundice, or b) elevated serum alanine aminotransferase (ALT) levels >400IU/L. It should be noted that the figure below does not include chronic Hepatitis C cases, only acute cases.
Figure 9.14 illustrates that the incidence of Acute Hepatitis C in Sullivan County has remained low since 2007. The incidence for the state has remained fairly consistent since 2002 with an increase in 2011 to 1.5 per 100,000.
Sullivan County Regional Health Department|ETSU College of Public Health 111 2012 Community Health Status Assessment
Figure 9.14: Incidence of Acute Hepatitis C, 2000-2011
Source: TDH Communicable and Environmental Disease Reports
Pneumonia and Influenza It is estimated that 5-20% of the U.S. population becomes infected with the influenza virus (flu) each year. Of these, approximately 200,000 are hospitalized due to complications while 36,000 die from flu-related causes. Complications of influenza can include bacterial pneumonia, ear infections, sinus infections, dehydration, and the worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes. Typically the elderly, young children and people with certain medical conditions are at greatest risk of complications from influenza. This highlights the need for individuals to receive an influenza vaccination.
In 2009, 1.1 million people in the United States were hospitalized with pneumonia and more than 50,000 people died from the disease. Certain individuals are more likely to become ill with pneumonia, including adults 65 years of age or older and children younger than 5 years of age. People up through 64 years of age who have underlying medical conditions (like diabetes or HIV/AIDS) and people 19 through 64 who smoke cigarettes or have asthma are also at an increased risk for contracting pneumonia. A vaccine is available for pneumonia and is recommended for adults 65 years old and older, and for individuals that suffer from a long-term medical condition. The vaccine is also recommended for some at-risk children.
In 2010, 46.2% of Sullivan County residents reported having received an influenza or pneumonia vaccine compared to 40.6% of Tennessee adults (Figure 9.15).
Sullivan County Regional Health Department|ETSU College of Public Health 112 2012 Community Health Status Assessment
Figure 9.15: Percentage of Adults (Age 65 and Older) Who Reported They Received a ‘Flu’ or ‘Pneumonia’ Shot in the Past 12 months, 2010
Source: CDC BRFSS
In 2012, only 9.3% of women of reproductive age in Sullivan County received an influenza vaccine at the health department. Similarly, only 11% of women of reproductive age in the state received an influenza vaccine (Figure 9.16). Figure 9.17 depicts the percentage of pregnant women who received an influenza vaccine in Sullivan County and Tennessee in 2012.
Figure 9.16: Percentage of Reproductive Women (Aged 10 to 50) who Received an Influenza Vaccine, 2012
Source: Tennessee Department of Health, Division of Policy, Planning, and Assessment
Sullivan County Regional Health Department|ETSU College of Public Health 113 2012 Community Health Status Assessment
Figure 9.17: Percentage of Pregnant Women who Received an Influenza Vaccine, 2012
Source: Tennessee Department of Health, Division of Policy, Planning, and Assessment
Figure 9.18 depicts mortality rates due to pneumonia and influenza in Sullivan County and Tennessee. In 2009, approximately 20.92 per 100,000 individuals died due to complications from influenza and/or pneumonia. Figure 9.19 depicts the mortality rate due to pneumonia and influenza by gender. In both Sullivan County and the state, men are about 1.5 times more likely than women to die due from influenza and/or pneumonia.
Figure 9.18: Age-Adjusted Mortality Rates Due to Pneumonia and Influenza, 2000-2009
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
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Figure 9.19: Age-Adjusted Mortality Rates Due to Pneumonia and Influenza by Gender
Source: Tennessee Department of Health, Division of Health Statistics. Health Information Tennessee.
Tuberculosis Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidneys, spine, and brain. If not treated properly, TB can be fatal. Individuals with other chronic health problems such as, diabetes and HIV are at a greater risk of developing TB. Since 2009, Sullivan County has had lower rates of tuberculosis than both Tennessee and United States. In 2011, the incidence rate of TB in Sullivan County was 1.9 per 100,000 individuals (Figure 9.20).
Figure 9.20: Tuberculosis Incidence Rates, 2009-2011
Source: TDH Communicable and Environmental Disease Reports
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Section 10: County Health Rankings
The following figure highlights the health rankings for Sullivan County for 2010-2013. A detailed description of the health rankings is included in the attached document.
Figure 10.1: County Health Rankings, 2010-2013
2010** 2011** 2012** 2013** HEALTH OUTCOMES 37 38 33 43 Mortality 41 42 42 33 LBW "Morbidity" 40 45 37 61 General Health Status HEALTH DETERMINANTS (Factors ) 14 5 16 13 HEALTH/CLINICAL CARE 3 2 5 4 HEALTH BEHAVIORS 31 32 49 54 SOCIOECONOMIC FACTORS 19 13 24 14 PHYSICAL ENVIRONMENT 78 36 69 33 **Note: 2013 data should not be compared to prior years due to changes in definition
Conclusion
While this report offers useful information on specific health indicators, it provides only one perspective of health in our community. The 2012 Community Health Status Assessment: Sullivan County Tennessee is one of four planned assessments which, when considered as a whole, will provide a more comprehensive picture of health and quality of life in Sullivan County. The ultimate decision about priority health issues, strategies and actions to improve health belongs to the community.
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2013 Rankings Tennessee
County Health Rankings 2013: Tennessee
Introduction Where we live matters to our health. The health Population Health Institute to bring this of a community depends on many different groundbreaking program to counties and states factors, including the environment, education across the nation. and jobs, access to and quality of healthcare, and individual behaviors. We can improve a The County Health Rankings & Roadmaps community’s health by implementing effective program includes the County Health Rankings policies and programs. For example, people project, launched in 2010, and the newer who live in communities with smoke‐free laws Roadmaps project that mobilizes local are less likely to smoke or to be exposed to communities, national partners and leaders second‐hand smoke, which reduces lung cancer across all sectors to improve health. The risk. In addition, people who live in program is based on this model of population communities with safe and accessible park and health improvement: recreation space are more likely to exercise, which reduces heart disease risk.
However, health varies greatly across communities, with some places being much healthier than others. And, until now, there has been no standard method to illustrate what we know about what makes people sick or healthy or a central resource to identify what we can do to create healthier places to live, learn, work and play.
We know that much of what influences our health happens outside of the doctor’s office – in our schools, workplaces and neighborhoods. The County Health Rankings & Roadmaps In this model, health outcomes are measures program provides information on the overall that describe the current health status of a health of your community and provides the county. These health outcomes are influenced tools necessary to create community‐based, by a set of health factors. Counties can improve evidence‐informed solutions. Ranking the health outcomes by addressing all health health of nearly every county across the nation, factors with effective, evidence‐informed the County Health Rankings illustrate what we policies and programs. know when it comes to what is making communities sick or healthy. The County Health Everyone has a stake in community health. We Roadmaps show what we can do to create all need to work together to find solutions. The healthier places to live, learn, work and play. County Health Rankings & Roadmaps serve as The Robert Wood Johnson Foundation both a call to action and a needed tool in this collaborates with the University of Wisconsin effort.
Guide to Our Web Site snapshots; or Share information with others via To compile the Rankings, we selected measures Facebook, Twitter, or Google+. To understand that reflect important aspects of population our methods, click on Learn about the Data and health that can be improved and are available Methods. You can also take advantage of the at the county level across the nation. Visit Using the Rankings Data guide to help you www.countyhealthrankings.org to learn more. explore the data and figure out more about what is driving your community’s health. To To get started and see data, enter your county learn about what you can do to improve health or state name in the search box. Click on the in your community, visit the Roadmaps to name of a county or measure to see more Health Action Center. Finally, you can learn details. You can: Compare Counties; Download what others are doing by reading Communities data for your state; Print one or more county Stories and visiting the Project Showcase.
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County Health Roadmaps RWJF Roadmaps to Health Prize The Rankings illustrate what we know when it In February 2013, RWJF awarded the first RWJF comes to making people sick or healthy. The Roadmaps to Health Prizes of $25,000 to six County Health Rankings confirm the critical role communities that are working to become that factors such as education, jobs, income and healthier places to live, learn, work and play. the environment play in how healthy people are The RWJF Roadmaps to Health Prize is intended and how long we live. not only to honor successful efforts, but also to inspire and stimulate similar activities in other The County Health Roadmaps mobilizes local U.S. communities. communities, national partners and leaders across all sectors to improve health. The County Health Roadmaps show what we can do to create healthier places to live, learn, work and play. The Robert Wood Johnson Foundation (RWJF) collaborates with the University of Wisconsin Population Health Institute (UWPHI) to bring this groundbreaking project to cities, counties and states across the nation.
The Roadmaps project includes grants to local coalitions and partnerships among policymakers, business, education, public health, health care, and community organizations; grants to national organizations working to improve health; recognition of communities whose promising efforts have led to better health; and customized guidance on strategies to improve health.
Roadmaps to Health Community Grants The Roadmaps to Health Community Grants provide funding for 2 years to thirty state and local efforts among policymakers, business, Roadmaps to Health Action Center education, healthcare, public health and The Roadmaps to Health Action Center, based community organizations working to create at UWPHI, provides tools and guidance to help positive policy or systems changes that address groups working to make their communities the social and economic factors that influence healthier places. The Action Center website the health of people in their community. provides guidance on developing strategies and advocacy efforts to advance pro‐health policies, Roadmaps to Health Partner Grants opportunities for ongoing learning, and a RWJF is awarding Roadmaps to Health Partner searchable database of evidence‐informed Grants to national organizations that are policies and programs focused on health experienced at engaging local partners and improvement: What Works for Health. Action leaders and are able to deliver high‐quality Center staff provide customized consultation training and technical assistance, and via email and telephone to those seeking more committed to making communities healthier information about how to improve health. places to live, learn, work and play. Partner Coaching, including possible on‐site visits, is grantees increase awareness about the County also available for communities who have Health Rankings & Roadmaps to their members, demonstrated the willingness and capacity to affiliates and allies. As of February 2013, RWJF address factors that we know influence how has awarded partner grants to United Way healthy a person is, such as education, income Worldwide, National Business Coalition on and family connectedness. Health, and National Association of Counties.
www.countyhealthrankings.org/tennessee 2 County Health Rankings 2013: Tennessee
County Health Rankings The 2013 County Health Rankings report ranks Our summary health outcomes rankings are Tennessee counties according to their summary based on an equal weighting of mortality and measures of health outcomes and health morbidity measures. The summary health factors. Counties also receive a rank for factors rankings are based on weighted scores mortality, morbidity, health behaviors, clinical of four types of factors: behavioral, clinical, care, social and economic factors, and the social and economic, and environmental. The physical environment. The figure below depicts weights for the factors (shown in parentheses in the structure of the Rankings model; those the figure) are based upon a review of the having high ranks (e.g., 1 or 2) are estimated to literature and expert input, but represent just be the “healthiest.” one way of combining these factors.
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The maps on this page and the next display summary rankings. The green map shows the Tennessee’s counties divided into groups by health distribution of summary health outcomes. The blue rank. Maps help locate the healthiest and least displays the distribution of the summary rank for healthy counties in the state. The lighter colors health factors. indicate better performance in the respective
HEALTH OUTCOMES
County Rank County Rank County Rank County Rank Anderson 34 Fentress 92 Lauderdale 84 Roane 55 Bedford 24 Franklin 33 Lawrence 51 Robertson 10 Benton 88 Gibson 74 Lewis 47 Rutherford 2 Bledsoe 20 Giles 26 Lincoln 63 Scott 57 Blount 4 Grainger 54 Loudon 7 Sequatchie 91 Bradley 17 Greene 65 Macon 89 Sevier 25 Campbell 94 Grundy 95 Madison 22 Shelby 53 Cannon 36 Hamblen 58 Marion 90 Smith 8 Carroll 66 Hamilton 28 Marshall 31 Stewart 81 Carter 61 Hancock 93 Maury 32 Sullivan 43 Cheatham 30 Hardeman 73 McMinn 69 Sumner 3 Chester 12 Hardin 79 McNairy 77 Tipton 39 Claiborne 86 Hawkins 56 Meigs 87 Trousdale 71 Clay 62 Haywood 75 Monroe 23 Unicoi 44 Cocke 85 Henderson 29 Montgomery 11 Union 59 Coffee 38 Henry 82 Moore 6 Van Buren 27 Crockett 52 Hickman 64 Morgan 60 Warren 68 Cumberland 45 Houston 16 Obion 49 Washington 21 Davidson 13 Humphreys 37 Overton 76 Wayne 40 Decatur 80 Jackson 50 Perry 48 Weakley 15 DeKalb 83 Jefferson 41 Pickett 19 White 46 Dickson 42 Johnson 70 Polk 78 Williamson 1 Dyer 35 Knox 14 Putnam 9 Wilson 5 Fayette 18 Lake 72 Rhea 67
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HEALTH FACTORS
County Rank County Rank County Rank County Rank Anderson 11 Fentress 79 Lauderdale 95 Roane 16 Bedford 78 Franklin 27 Lawrence 39 Robertson 24 Benton 76 Gibson 77 Lewis 82 Rutherford 3 Bledsoe 73 Giles 56 Lincoln 18 Scott 92 Blount 6 Grainger 59 Loudon 10 Sequatchie 49 Bradley 21 Greene 66 Macon 91 Sevier 40 Campbell 83 Grundy 89 Madison 22 Shelby 67 Cannon 46 Hamblen 43 Marion 55 Smith 17 Carroll 58 Hamilton 8 Marshall 44 Stewart 33 Carter 41 Hancock 94 Maury 34 Sullivan 13 Cheatham 14 Hardeman 90 McMinn 37 Sumner 5 Chester 23 Hardin 68 McNairy 63 Tipton 30 Claiborne 80 Hawkins 31 Meigs 61 Trousdale 57 Clay 54 Haywood 88 Monroe 84 Unicoi 20 Cocke 86 Henderson 65 Montgomery 32 Union 69 Coffee 29 Henry 71 Moore 9 Van Buren 81 Crockett 62 Hickman 70 Morgan 36 Warren 74 Cumberland 15 Houston 52 Obion 53 Washington 4 Davidson 28 Humphreys 26 Overton 47 Wayne 51 Decatur 45 Jackson 64 Perry 85 Weakley 35 DeKalb 48 Jefferson 38 Pickett 75 White 72 Dickson 19 Johnson 60 Polk 42 Williamson 1 Dyer 87 Knox 2 Putnam 12 Wilson 7 Fayette 25 Lake 93 Rhea 50
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Summary Health Outcomes & Health Factors Rankings Counties receive two summary ranks: Health outcomes represent how healthy a county is Health Outcomes while health factors represent what influences the Health Factors health of the county. Each of these ranks represents a weighted summary of a number of measures.
Rank Health Outcomes Rank Health Factors 1 Williamson 1 Williamson 2 Rutherford 2 Knox 3 Sumner 3 Rutherford 4 Blount 4 Washington 5 Wilson 5 Sumner 6 Moore 6 Blount 7 Loudon 7 Wilson 8 Smith 8 Hamilton 9 Putnam 9 Moore 10 Robertson 10 Loudon 11 Montgomery 11 Anderson 12 Chester 12 Putnam 13 Davidson 13 Sullivan 14 Knox 14 Cheatham 15 Weakley 15 Cumberland 16 Houston 16 Roane 17 Bradley 17 Smith 18 Fayette 18 Lincoln 19 Pickett 19 Dickson 20 Bledsoe 20 Unicoi 21 Washington 21 Bradley 22 Madison 22 Madison 23 Monroe 23 Chester 24 Bedford 24 Robertson 25 Sevier 25 Fayette 26 Giles 26 Humphreys 27 Van Buren 27 Franklin 28 Hamilton 28 Davidson 29 Henderson 29 Coffee 30 Cheatham 30 Tipton 31 Marshall 31 Hawkins 32 Maury 32 Montgomery 33 Franklin 33 Stewart 34 Anderson 34 Maury 35 Dyer 35 Weakley 36 Cannon 36 Morgan 37 Humphreys 37 McMinn 38 Coffee 38 Jefferson 39 Tipton 39 Lawrence 40 Wayne 40 Sevier 41 Jefferson 41 Carter 42 Dickson 42 Polk
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Rank Health Outcomes Rank Health Factors 43 Sullivan 43 Hamblen 44 Unicoi 44 Marshall 45 Cumberland 45 Decatur 46 White 46 Cannon 47 Lewis 47 Overton 48 Perry 48 DeKalb 49 Obion 49 Sequatchie 50 Jackson 50 Rhea 51 Lawrence 51 Wayne 52 Crockett 52 Houston 53 Shelby 53 Obion 54 Grainger 54 Clay 55 Roane 55 Marion 56 Hawkins 56 Giles 57 Scott 57 Trousdale 58 Hamblen 58 Carroll 59 Union 59 Grainger 60 Morgan 60 Johnson 61 Carter 61 Meigs 62 Clay 62 Crockett 63 Lincoln 63 McNairy 64 Hickman 64 Jackson 65 Greene 65 Henderson 66 Carroll 66 Greene 67 Rhea 67 Shelby 68 Warren 68 Hardin 69 McMinn 69 Union 70 Johnson 70 Hickman 71 Trousdale 71 Henry 72 Lake 72 White 73 Hardeman 73 Bledsoe 74 Gibson 74 Warren 75 Haywood 75 Pickett 76 Overton 76 Benton 77 McNairy 77 Gibson 78 Polk 78 Bedford 79 Hardin 79 Fentress 80 Decatur 80 Claiborne 81 Stewart 81 Van Buren 82 Henry 82 Lewis 83 DeKalb 83 Campbell 84 Lauderdale 84 Monroe 85 Cocke 85 Perry 86 Claiborne 86 Cocke 87 Meigs 87 Dyer 88 Benton 88 Haywood 89 Macon 89 Grundy 90 Marion 90 Hardeman
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Rank Health Outcomes Rank Health Factors 91 Sequatchie 91 Macon 92 Fentress 92 Scott 93 Hancock 93 Lake 94 Campbell 94 Hancock 95 Grundy 95 Lauderdale
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2013 County Health Rankings: Measures, Data Sources, and Years of Data Measure Data Source Years of Data HEALTH OUTCOMES Mortality Premature death National Center for Health Statistics 2008‐2010 Morbidity Poor or fair health Behavioral Risk Factor Surveillance System 2005‐2011 Poor physical health days Behavioral Risk Factor Surveillance System 2005‐2011 Poor mental health days Behavioral Risk Factor Surveillance System 2005‐2011 Low birthweight National Center for Health Statistics 2004‐2010 HEALTH FACTORS HEALTH BEHAVIORS Tobacco Use Adult smoking Behavioral Risk Factor Surveillance System 2005‐2011 Diet and Exercise Adult obesity National Center for Chronic Disease Prevention 2009 and Health Promotion Physical inactivity National Center for Chronic Disease Prevention 2009 and Health Promotion Alcohol Use Excessive drinking Behavioral Risk Factor Surveillance System 2005‐2011 Motor vehicle crash death rate National Center for Health Statistics 2004‐2010 Sexual Activity Sexually transmitted infections National Center for HIV/AIDS, Viral Hepatitis, 2010 STD, and TB prevention Teen birth rate National Center for Health Statistics 2004‐2010 CLINICAL CARE Access to Care Uninsured Small Area Health Insurance Estimates 2010 Primary care physicians HRSA Area Resource File 2011‐2012 Dentists HRSA Area Resource File 2011‐2012 Quality of Care Preventable hospital stays Medicare/Dartmouth Institute 2010 Diabetic screening Medicare/Dartmouth Institute 2010 Mammography screening Medicare/Dartmouth Institute 2010 SOCIAL AND ECONOMIC FACTORS Education High school graduation Primarily state‐specific sources, supplemented State‐specific with National Center for Education Statistics Some college American Community Survey 2007‐2011 Employment Unemployment Bureau of Labor Statistics 2011 Income Children in poverty Small Area Income and Poverty Estimates 2011 Family and Social Inadequate social support Behavioral Risk Factor Surveillance System 2005‐2010 Support Children in single‐parent households American Community Survey 2007‐2011 Community Safety Violent crime rate Federal Bureau of Investigation 2008‐2010 PHYSICAL ENVIRONMENT Environmental Quality Daily fine particulate matter 1 CDC WONDER Environmental data 2008 Drinking water safety Safe Drinking Water Information System FY 2012 Built Environment Access to recreational facilities Census County Business Patterns 2010 Limited access to healthy foods USDA Food Environment Atlas 2012 Fast food restaurants Census County Business Patterns 2010
1 Not available for AK and HI.
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CREDITS
Report Authors University of Wisconsin‐Madison School of Medicine and Public Health Department of Population Health Sciences Population Health Institute
Bridget Booske Catlin, PhD, MHSA Amanda Jovaag, MS Patrick Remington, MD, MPH
This publication would not have been possible without the following contributions:
Data Centers for Disease Control and Prevention: National Center for Health Statistics and Division of Behavioral Surveillance Dartmouth Institute for Health Policy & Clinical Practice
Research Assistance Jennifer Buechner Hyojun Park, MA Elizabeth Pollock Jennifer Robinson Matthew Rodock, MPH Anne Roubal, MS
Communications and Outreach Burness Communications Anna Graupner, MPH Kate Konkle, MPH Karen Odegaard, MPH Jan O’Neill, MPA Angela Russell, MS Julie Willems Van Dijk, PhD, RN
Design Forum One, Alexandria, VA
Robert Wood Johnson Foundation Abbey Cofsky, MPH –Senior Program Officer Michelle Larkin, JD, MS, RN – Assistant Vice‐President and Deputy Director, Health Group James S. Marks, MD, MPH – Senior Vice‐President and Group Director, Health Group Joe Marx – Senior Communications Officer
Suggested citation: University of Wisconsin Population Health Institute. County Health Rankings 2013.
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University of Wisconsin Population Health Institute 610 Walnut St, #524, Madison, WI 53726 (608) 265‐6370 / [email protected]