Burke County Community Health Assessment

BURKE COUNTY 2011 COMMUNITY HEATLH ASSESSMENT

VOLUME I

- 1 - - 1 -Page 1 of 155 Burke County Community Health Assessment

Narrative

In Burke County a coalition of community partners, Healthy Burke, strives to promote better health for all residents throughout the community. This coalition plus an extended group of community partners and agencies provided assistance with collecting resources and data for the 2011 Community Health Assessment.

Together the coalition developed a multi-phase plan for conducting the assessment. The team gathered secondary data from online resources, state and federal level data systems, local county agencies and the Western Piedmont Council of Governments. Second phase gathered primary data from surveys developed and distributed in paper form and online survey managed by Survey Monkey. The team distributed paper surveys and the online link to numerous agencies throughout the county. Third phase included analyzing, detailing and documenting all the data into the final Community Health Assessment report. The next phases will be taking place over the next several months when the team will determine action plans and task forces and strategies to best address the priorities (red flags) found during the assessment period. The last and important phases will be to present this wealth of information back to the stakeholders; the community. A community forum will be held in the Spring of 2012 to present the information and secure manpower and resources to implement successful strategies to improve the health and well being of the entire community.

During the data analysis, several things became very clear that the shift in Burke County’s population will be driving a change in some priorities due to the increase of the older adults. The data also revealed that the top six leading causes of death in Burke County changed very little in the last four years. The change noted was an increase in Alzheimer’s Disease which rose to the sixth leading cause of death. Another overwhelming realization is the magnitude of unemployment/underemployment and how much it affects the health of this community. This information will be shared and discussed with the local administration to assess a plan for improvement over the next four years.

Burke County has already implemented some positive strategies to improve the priority areas and will be highlighted in the action plans and community forum to follow this assessment. This community will pull together and combine resources in this difficult economic time to reverse some of the problems found.

The Priority Areas (Red Flags) that will be worked on through current task forces or newly created ones include: * Heart Disease * Cancer * Chronic Lower Respiratory * Cerebrovascular Disease * Unintentional Non-Motor Vehicle Injuries * Alzheimer’s Disease * Diabetes * Aging population issues * Unemployment/Underemployment Several of these will be combined and go under the action plan for our Healthy Lifestyles Task Force to address.

- 2 - - 2 -Page 2 of 155 Burke County Community Health Assessment

Table of Contents Page

Introduction 2

Chapter One: Demographic and Socioeconomic Data ...... 7 Location and Geography ...... 8 History ...... 9 County Map ...... 10 Population Characteristics ...... 11 Older Adults ...... 16 Non-English Speaking Population ...... 19 Commuting Patterns ...... 20 Civic Participation ...... 22 Economic Climate ...... 23 Employment ...... 24 Unemployment ...... 27 Business Closings and Layoffs ...... 27 Poverty ...... 28 Poverty and Race ...... 28 Poverty and Age ...... 29 Food Stamps ...... 30 Housing ...... 31 Affordable Housing ...... 31 Children and Families ...... 32 Single Parent Families ...... 33 Child Care ...... 34 Education ...... 36

- 3 - - 3 -Page 3 of 155 Burke County Community Health Assessment

Page Crime and Safety ...... 38 Index Crime ...... 38 Crime Rates ...... 39 Numbers of Crimes ...... 40 Non-Index Criminal Activities ...... 40 Domestic Violence ...... 40 Child Abuse and Maltreatment ...... 41 Health Care Resources ...... 42 Practitioners ...... 42 Hospitals ...... 44 Local Health Department ...... 45 Community Health Centers and Clinics ...... 47 Long-Term Care Facilities ...... 48 Nursing Homes ...... 48 Medical Insurance ...... 49 Medically Indigent Population ...... 49 Medicaid ...... 50 North Carolina Health Choice ...... 51 Community Care of North Carolina: ACCESS ...... 52

Chapter Two: Health Statistics ...... 53 Methodology ...... 54 Understanding Health Statistics ...... 54 Behavioral Risk Factor Surveillance System ...... 54

- 4 - - 4 -Page 4 of 155 Burke County Community Health Assessment

Page Maternal and Child Health ...... 57 Overall Pregnancies and Births ...... 57 Teen Pregnancies and Births ...... 59 Abortion ...... 60 Pregnancy Risk Factors ...... 61 Pregnancy Outcomes ...... 64 Low Birth Weight ...... 64 Infant Mortality ...... 65 Leading Causes of Death ...... 66 State and National Mortality Rate Comparisons ...... 67 Gender Disparities in Mortality ...... 68 Racial Disparities in Mortality ...... 69 Heart Disease and Stroke ...... 71 Heart Disease Mortality ...... 72 Stroke Mortality ...... 73 Cancer ...... 75 Total Cancer ...... 75 Breast Cancer ...... 77 Lung Cancer ...... 79 Prostate Cancer ...... 81 Colon and Rectal Cancer ...... 83 Chronic Lower Respiratory Disease ...... 85 Unintentional Non-Motor Vehicle Injury ...... 86 Diabetes ...... 88 Pneumonia and Influenza ...... 90 Unintentional Motor Vehicle Injury ...... 91 Alzheimer’s Disease ...... 93 Suicide ...... 94 Nephritis, Nephrotic Syndrome and Nephrosis ...... 96 Septicemia ...... 97 Chronic Liver Disease and Cirrhosis ...... 98 Homicide ...... 99

- 5 - - 5 -Page 5 of 155 Burke County Community Health Assessment

Page Communicable Disease ...... 101 Reportable Communicable Disease ...... 101 Sexually Transmitted Disease ...... 102 Gonorrhea ...... 102 Syphilis ...... 102 HIV/AIDS ...... 103 Oral Health ...... 104 Child Oran Health ...... 104 Adult Oral Health ...... 105 Mental Health and Substance Abuse ...... 106 Obesity ...... 107 Childhood Obesity ...... 107 Asthma ...... 107

Chapter Three: Community Health Survey ...... 109 Methodology ...... 110 Survey Participants ...... 110 Survey Results ...... 111 Demographic Questions ...... 111 Quality of Life Statements ...... 117 Health Problems ...... 120 Unhealthy Behaviors ...... 121 Community Social Issues ...... 122 Personal Health and Self-Reported Behaviors ...... 124 Questions for Parents ...... 138 Acknowledgements ...... Copy of Community Survey ...... References ......

- 6 - - 6 -Page 6 of 155 Burke County Community Health Assessment

Chapter One

Demographic and Socioeconomic Data

- 7 - - 7 -Page 7 of 155 Burke County Community Health Assessment

Chapter One: Demographic and Socioeconomic Data

Location and Geography

Burke County is located in the western part of North Carolina in the foothills of the Blue Ridge Mountains. Burke County is bordered to the west by McDowell County and to the south by Rutherford and Cleveland counties. Its border to the north is shared by Caldwell and Avery counties while Catawba County lies due east.

Burke County covers a land mass approximately 513 square miles with an elevation that ranges from 900 to over 4,300 feet above sea level. Temperatures range from lows in the 40’s to summer highs in the 70’s, for an annual average temperature of almost 58 degrees; the typical annual precipitation of around 50 inches approximately eight to ten inches of snow. The Catawba River runs through the county and feeds Lake James, which has become one of the major attractions of Burke County and supports1.5 million recreational users a year. Burke County consists of 13 townships and seven municipalities. Morganton is the largest of these and the county seat.

The county’s highways include US Interstate 40 which stretches across the county, providing access to Hickory and destinations east and Asheville to the west. Highway 70 runs parallel and slightly north of I-40. US Highway 321 runs through the eastern portion of the county and is the most frequently used route to Charlotte. State routes 18 and Old 18 provide access to the southeastern portions of the county, while Highway 64 runs through the southwestern half of the county. State routes 126 and 181 head north and east into the Pisgah National Forest, which covers the northern most section of the county. Highway 18 heads north from Morganton towards Blowing Rock and Boone. The Blue Ridge Parkway cuts across a small portion of the northwestern corner of Burke County. Ninety-five percent of Burke County residents live within 10 miles of a four-lane highway.

In 2008, the Burke County Transit Administration/Greenway Transportation, Inc. merged with Alexander, Burke, Caldwell and Catawba County/Piedmont Wagon. On July 1, 2008, the new system started providing service as Western Piedmont Regional Transit Authority operating as Greenway Public Transportation. Greewway Public Transportation provides bus service to the following areas, Burke, Caldwell, Catawba counties along with Charlotte, Asheville, Winston Salem, Chapel Hill, Mooresville and Statesville. The public transportation system provided approximately 130,000 boardings from 2007-2010 with an average fare of $1.00 to $3.00 per ride (boarding). As of September, 2011, the Western Piedmont Regional Transit Authority purchased a 35 foot Hybrid electric bus. Grants from the Federal Transit Administration’s Congestion Mitigation and Air Quality Improvement Program paid the entire price of the vehicle. The hybrid bus is 30% more fuel efficient, and maintenance costs are expected to drop by 30% to 50% due to the construction of the bus. The hybrids also provide emission reductions up to 50%. This vehicle is part of a larger effort to transition to alternate fuel vehicles. Also in October, 2011, Greenway Transportation will add three new Flex Routes and add Saturday bus routes to serve Lenoir Rhyne University students. One of the new flex routes will provide service from Glen Alpine to Hickory traveling down the Hwy 70 corridor with stops along major townships toward Hickory. The fare will be $1.25 each way, children five and under ride free and persons who quality for reduced fare would pay $.60 each way.

The Morganton-Lenoir Airport is a full-service operation serving most types of aircraft, including civilian, corporate and chartered planes. The Hickory Regional Airport is conveniently located just off Hwy 321in Hickory, NC. The Hickory Municipal Airport was first opened to aircraft traffic in 1940. Charlotte/Douglas International Airport is approximately 75 miles from Burke County and services an average of 680 departing and arriving flights daily.

- 8 - - 8 -Page 8 of 155 Burke County Community Health Assessment

History

From the Burke County Government Website

In 1777 the NC General Assembly passed an act dividing Rowan County and creating a new county named in honor of Thomas Burke. Mr. Burke was a representative in the Continental Congress until he became the third governor of the state. The new county of Burke comprised such a large territory that it later became the largest part of the 16 counties including Buncombe, Catawba, Mitchell, Madison, Yancey, Caldwell, McDowell and Alexander. In 1834, Burke County was reduced to its present size of 514 square miles.

Burke County’s first courthouse was built in 1785 about eight years after the county was formed. A second courthouse was constructed in 1791 and served as the county Courthouse until 1833 when a two-story building was authorized by the General Assembly. Until vacated for the new courthouse in 1976, the Old Burke County Courthouse was the oldest public structure still being used for its originally designated purpose in western North Carolina.

To date the largest landowners in Burke County, are the US Government, Crescent Resources (Duke Energy Co.), and the State of North Carolina. Burke County also has the third largest concentration of state employees working for the North Carolina Department of Transportation, Department of Corrections, NC School for the Deaf, J. Iverson Riddle Developmental Center and Broughton Hospital. Burke County has been referred to as the “Western State Capital.”

One of the most pristine lakes remaining in the Southeast is located in the northwestern portion of Burke County. To preserve Burke County’s environmental integrity the Lake James and South Mountain State Parks were established. Other attractions include the wild, rugged and scenic wilderness of Linville Gorge, the age old mystery of the Brown Mountain Lights, panoramic vistas from the top of Table Rock, Shortoff Mountain, and the Blue Ridge Parkway. Efforts by the government of Burke County, as well as clubs, agencies, organizations and private individuals have focused on preserving the natural beauty of Burke County for posterity. The combined efforts have hinged on a philosophy that to allow the beauty and appeal of Burke County to slip through our fingers would result in the loss of a rare asset.

- 9 - - 9 -Page 9 of 155 Burke County Community Health Assessment

Figure 1. County Map

Source: Burke County GIS Mapping Department

- 10 - - 10 -Page 10 of 155 Burke County Community Health Assessment

Population Characteristics

According to the data in Table 1:

 The median age in Burke County for 2010 is 41.2 which is up 4 years from 36.9 in the year 2000.  In the year 2000 Census, the population was evenly split between males and females and continues to be evenly split in the 2010 Census. Again at the state level in 2010, females outnumber the males by 1.3%.  The number of children under 5 years of age has declined slightly from 6.2% (5509) in 2000 to5.6% (5068) in 2010.  Racial distribution within Burke County has changed very slightly from 2000 to 2010 with the percentage of white being 86% in 2000 and 84% in 2010 and other races comprised approximately 14% of the population in 2000 and approximately 15% in 2010.  When compared to average NC County , Burke County is higher in the population of 65 and older residents while the average NC County is has a higher population in the younger portion of the population.

Table 1. General Demographic Characteristics

Total % Pop Census 2010 Population Change 65 and 65 and % Census Census Median Under Older Older % Other % Hispanic County 2010 2000-2010 Males Females Age 5 Male Female White Races (Any Race) Burke County 90,912 2.0 45,468 45,444 41.2 5,068 6,233 8,440 84.4 15.6 5.1 NC Total 9,535,483 18.4 4,645,492 4,889,991 37.4 632,040 523,956 710,123 68.5 31.5 8.4 NC County Avg. 95,355 N/A 46,455 48,900 N/A 6,320 5,237 7,112 N/A N/A N/A

Source: US Census Bureau, 2010 Census, http://www.census.gov

Table 2. Population Growth Comparison (Years as noted) 1980 1990 % Change 2000 % Change 2010 % Change County Census Census 1980-1990 Census 1990-2000 Census 2000-2010 Burke County 72,504 75,740 4.5 89,148 17.7 90,912 2.0 NC Total 5,880,995 6,632,448 12.8 8,046,485 21.3 9,535,483 18.4 NC County Avg. 58,801 66,324 N/A 80,465 N/A 95,355 N/A

 From 2000 to 2010, the total population saw a small growth of 2% from 89,148 to 90,912.

- 11 - - 11 -Page 11 of 155 Burke County Community Health Assessment

Table 3. Burke County Population by Township (2010)

Table 3. Burke County Population by Township (2010)

Township Number Percent Median Age

Drexel 6,594 7.3 43.5 Icard 17,628 19.4 40.7 Jonas Ridge 678 0.7 48.8 Linville 1,761 1.9 50.1 Lovelady 8,546 9.4 44.3 Lower Creek 2,830 3.1 38.5 Lower Fork 3,667 4.0 39.5 Morganton 28,058 30.9 39.0 Quaker Meadows 7,339 8.1 44.3 Silver Creek 10,793 11.9 39.9 Smoky Creek 772 0.8 44.7 Upper Creek 1,180 1.3 43.7 Upper Fork 1,066 1.2 45.6 TOTAL 90,912

Source: US Census Bureau, American Fact Finder, Data Sets, Summary File 1, Quick Tables, County Subdivision, Chose NC and county, then add applicable townships. Highlight Table DP-1 - http://factfinder.census.gov.

Townships:

 In 2010, Morganton is the largest township with 30.9% of the total county’s population (Table 3).  Jonas Ridge is the smallest township in 2010 with .7% of the county’s population.  Morganton is the youngest township with a median age of 39 years of age which is only 2 years younger than the county’s median age of 41.  Linville is the oldest township of Burke County with a median age of 50.

- 12 - - 12 -Page 12 of 155 Burke County Community Health Assessment

Table 4. Burke County Township Population by Race (2010)

African- Native Asian-American/ Other/Mixed Hispanic Origin White American American Pacific Islander Race (Any Race) Township Number % Number % Number % Number % Number % Number % Drexel 5,736 87.0 266 4.0 22 0.3 335 5.1 235 3.6 223 3.4 Icard 16,179 91.8 162 0.9 42 0.2 758 4.3 687 2.7 461 2.6 Jonas Ridge 663 97.8 1 0.1 0 0.0 3 0.4 11 1.6 11 1.6 Linville 1,508 85.6 225 12.8 7 0.4 10 0.6 11 0.7 9 0.5 Lovelady 7,985 93.4 111 1.3 9 0.1 276 3.2 165 1.9 172 2.0 Lower Creek 2,155 76.1 373 13.2 16 0.6 81 2.9 201 7.1 202 7.1 Lower Fork 3,362 91.7 78 2.1 8 0.2 149 4.1 70 1.9 44 1.2 Morganton 21,209 75.6 3,196 11.4 163 0.6 909 3.3 2,581 9.2 3,084 11.0 Quaker Meadows 5,979 81.5 954 13.0 20 0.3 123 1.6 263 3.5 159 2.2 Silver Creek 9,097 84.3 593 5.5 28 0.3 791 7.3 284 2.7 242 2.2 Smokey Creek 722 93.5 10 1.3 4 0.5 31 4.0 5 0.7 4 0.5 Upper Creek 1,104 93.6 32 2.7 1 0.1 9 0.8 34 2.8 17 1.4 Upper Fork 1,017 95.4 11 1.0 5 0.5 9 0.8 24 2.3 6 0.6 Total Burke County 76,716 84.4 6,012 6.6 325 0.4 3,488 3.8 4,371 4.9 4,634 5.1 Source: 2010 Census, US Census Bureau. http://www.census.gov

 Lower Creek and Morganton Township had the highest percentage of American Indian residents, however in most townships American Indians represented less than 0.4% of the population (Table 4).  Drexel Township had the highest percentage of Asian residents with 4.9% though a number of townships have Asians that represent less than 1% of the population.  The highest percentage of Hispanic/Latinos lived in Morganton; Linville and Smokey Creek Townships had the lowest percentage of Hispanic/Latino residents.  Native Hawaiian or Other Pacific Islander residents represent less than 1% of the population in all 13 townships.

- 13 - - 13 -Page 13 of 155 Burke County Community Health Assessment

 As of the 2010 Census, young persons aged 5-19 represents a higher percentage of the population compared to other groups (Tables 5).  Children age 0-4 represents the smallest segment of the population in Burke County.  Compared to the average NC County, Burke County had a smaller number of residents in all categories except for the 45-54 and 55-64 age groups.  In 2010, Burke County had the highest percentages of the total population in the 5-19 and 65 (+) age groups encompassing both ends of the life span. North Carolina also has a high percentage of the population in the 5-19 age group (Table 6).

Table 5 . Population Distribution by Age, Number of Persons (2010)

Census 2010 20-24 25-34 35-44 45-54 55-64 County Population 0-4 Years 5-19 Years Years Years Years Years Years 65+ Years Burke County 90,912 5,068 18,119 5,247 9,727 12,160 13,800 12,118 14,673 NC Total 9,535,483 632,040 1,926,640 661,573 1,246,593 1,327,151 1,368,646 1,138,761 1,234,079 NC County Avg. 95,355 6,320 19,266 6,616 12,466 13,272 13,686 11,388 12,341 Source: 2010 Census, US Census Bureau. http://www.census.gov

Table 6. Population Distribution by Age, Percent of Total Population (2010)

Census 2010 County Population 0-4 Years 5-19 Years 20-24 Years 25-34 Years 35-44 Years 45-54 Years 55-64 Years 65+ Years Burke County 90,912 5.6 19.9 5.8 10.7 13.4 15.2 13.4 16.1 NC Total 9,535,483 6.6 20.2 6.9 13.1 13.9 14.3 11.9 12.9 Source: 2010 Census, US Census Bureau. http://www.census.gov

- 14 - - 14 -Page 14 of 155 Burke County Community Health Assessment

Table 7. Burke County Demographic Profile by Age and Sex (2010)

Burke County North Carolina Number Percent Percent Age Group Total Male Female Total Male Female Total Male Female All Ages 90,912 45,468 45,444 100.0 100.0 100.0 100.0 100.0 100.0 Under 5 5,068 2,665 2,403 5.6 5.9 5.3 6.6 7.0 6.3 5 to 9 5,316 2,720 2,596 5.8 6.0 5.7 6.7 7.0 6.4 10 to 14 5,841 3,030 2,811 6.4 6.7 6.2 6.6 6.9 6.3 15 to 19 6,962 4,079 2,883 7.7 9.0 6.3 6.9 7.3 6.6 20 to 24 5,247 2,897 2,350 5.8 6.4 5.2 6.9 7.2 6.6 25 to 29 4,804 2,500 2,304 5.3 5.5 5.1 6.6 6.7 6.5 30 to 34 4,923 2,450 2,473 5.4 5.4 5.4 6.5 6.6 6.4 35 to 39 5,706 2,882 2,824 6.3 6.3 6.2 6.9 7.0 6.9 40 to 44 6,454 3,327 3,127 7.1 7.3 6.9 7.0 7.1 6.9 45 to 49 7,010 3,545 3,465 7.7 7.8 7.6 7.3 7.3 7.3 50 to 54 6,790 3,242 3,548 7.5 7.1 7.8 7.0 7.0 7.1 55 to 59 6,151 3,001 3,150 6.8 6.6 6.9 6.3 6.1 6.5 60 to 64 5,967 2,879 3,070 6.6 6.3 6.8 5.6 5.5 5.8 65 to 69 4,720 2,196 2,524 5.2 4.8 5.6 4.2 4.0 4.4 70 to 74 3,552 1,637 1,915 3.9 3.6 4.2 3.1 2.9 3.3 75 to 79 2,765 1,135 1,630 3.0 2.5 3.6 2.3 2.0 2.6 80 to 84 1,960 765 1,195 2.2 1.7 2.6 1.7 1.4 2.1 85+ 1,676 500 1,176 1.8 1.1 2.6 1.5 1.0 2.1 Source: 2010 Census, US Census Bureau. http://www.census.gov  Table 7 represents a breakdown of the 2010 Census data on the number and percent of people in each age group, stratified by gender for both Burke County and North Carolina.  The state of North Carolina has a higher percentage of the population between the ages of 0-59 while Burke County has a higher percentage between the ages of 45 to over 85.  The chart below graphically depicts the increase in the older population from 2000-2010.

Under 5 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-59 60-64 65-74 75-84 85 & years years years years years years years years years years years years over Change 2000- -441 -734 -398 746 -70 -2,803 -1,718 -1,457 1,215 1,823 1,579 799 309 2010 % Change -8.0 -12.1 -6.4 12.0 -1.3 -22.4 -12.4 11.8 24.6 44.0 23.6 20.4 22.6 2000- 2010

- 15 - - 15 -Page 15 of 155 Burke County Community Health Assessment

Older Adults

Growth of the Elderly Population

 Table 8 presents data on the numerical growth of the population older than age 60 in both Burke County and North Carolina. The population in each of the four age groups cited has continued to increase in the last 10 years.  Persons aged 60-69 consistently represent the largest age group among older adults while adults over the age of 85 are the smallest sub-population among persons older than 60.  Since the elderly population trend is projected to continue to increase, aging factors such as access, mobility and disability will be some issues that Burke County will need to research and develop plans to address.  Table 8 shows that the state population numbers declined in all categories from the 2000 Census and 2010 Census but is projected to rise in 2020 and 2030.

Table 8. Growth of the Elderly Population (2000-2010)

2000 Census 2010 Census 2020 Projected 2030 Projected County 60-69 70-74 75-84 85+ 60-69 70-74 75-84 85+ 60-69 70-74 75-84 85+ 60-69 70-74 75-84 85+ Burke 7,799 3,038 3,926 1,367 10,687 3,552 4,725 1,676 9,982 4,058 4,565 1,805 10,066 4,282 5,655 2,282 State Total 606,385 250,959 329,830 105,464 497,904 161,522 230,497 103,205 1,180,635 434,478 474,107 178,397 1,340,853 557,116 716,616 249,869 NC County 6,064 2,510 3,298 1,055 4,979 1,615 2,305 1,032 11,806 4,345 4,741 1,784 13,409 5,572 7,166 2,499 Avg. Source: 2000-2010 Census, US Census Bureau and NC Office of Management and Budget, 2011.

- 16 - - 16 -Page 16 of 155 Burke County Community Health Assessment

Location of the Elderly Population

Table 9. Burke County Population Age 65 and Older by Township (2010)

Township 65 and Over % of Population Drexel 1,261 19.1 Icard 2,673 15.2 Jonas Ridge 159 23.5 Linville 330 18.7 Lovelady 1,631 19.1 Lower Creek 347 12.3 Lower Fork 407 11.1 Morganton 4,612 16.4 Quaker Meadows 1,224 16.7 Silver Creek 1,530 14.2 Smokey Creek 139 18.0 Upper Creek 183 15.5 Upper Fork 177 16.6 Total Burke County 14,673 16.1 Source: 2010 Census, US Census Bureau. http://www.census.gov

 Table 9 depicts the township with the highest percentage of 65 and over residents is Jonas Ridge which is located in the western most portion of the county.  The township with the lowest percentage of 65 and over residents is Lower Fork.

Characteristics of the Older Population

Some of the Division’s 2010 US Census-derived data on Burke County – and comparable data for the state of North Carolina as a whole – are summarized below.

Educational Attainment

 In Burke County 40.5% of persons age 65 and older lack a high school diploma, compared to a comparable figure of 25.2% for the state as a whole. In addition, 21.1% of persons aged 45-64 in Burke County lack a high school diploma, compared to 12.6% for the state as a whole.  Not unexpectedly, a smaller percentage Burke County residents age 65 and older than North Carolina residents in the same age category has had a Bachelor’s degree or higher education (15.0% vs. 19.9%). In the age group 45-64 the difference is even greater: 18.8% in Burke County compared to 26.9% statewide.

- 17 - - 17 -Page 17 of 155 Burke County Community Health Assessment

Income

 The populations in several older age categories in Burke County had lower median incomes than their counterparts statewide, according to data reported for 2010. For the group ages 45-64 the median income in the county was $47,317, 7% lower than the median income for the age group statewide, $50,983. For the population group 65 and older, the Burke County median income figure was $26,800 compared to a statewide figure of $31,694.

Living Conditions

 Approximately 826 persons in Burke County can be classified as grandparents who are raising grandchildren under the age of 18. This number computes to a proportion of the total population at the time equal to approximately 0.9%, a figure 80% higher than the comparable percentage for North Carolina as a whole (0.5%).  With regard to home ownership, slightly higher percentage of Burke County’s elderly are homeowners than in North Carolina as a whole: in Burke County approximately 78% of the persons between the ages of 45 and 64 and 82% of those aged 65 and older are homeowners compared to state figures of 76% and 80% respectively.  In 2010 28.4% of Burke County residents age 65 or older lived alone; the comparable state rate was 27.5%.  In 2010 3.6% of persons 65 or older were living in nursing homes and 12.2% of that age group were living in adult care homes. The comparable state figures were 4.2% and 3.7%, respectively. The lower local rates participation of long-term care may be related to the higher rate of home ownership among Burke County elderly OR a lack of available long-term care services.

Mobility

 The elderly population in Burke County has a slightly higher proportion of persons with disabilities than in the elderly population in North Carolina as a whole. According to 2010 US Census figures, 20.4% of persons age 65 or older in Burke County reported having one disability; 28.0% of the same population reported having two or more disabilities. These percentages compare to respective statewide figures of 16.3% and 22.1%. The US Census bureau of disability includes any long-lasting physical, mental or emotional condition that can make it difficult for persons to walk, climb stairs, dress, bathe, learn or remember.  Larger proportions of Burke County residents in some of the older age groups are without a car as compared to similar data for North Carolina as a whole. In Burke County, 3.4% of householders between the ages of 35 and 64 and 18.3% of those between the ages of 65 or older are without a car; these figures compare to rates of 5.2% and 10.5% of the respective groups statewide.

- 18 - - 18 -Page 18 of 155 Burke County Community Health Assessment

Non-English Speaking Population

North Carolina has seen continuous growth in the number of foreign-born residents, with this segment of the population increasing from 430,000 to 719,137, an almost 67% increase. According to demographers, this official count is likely an underestimate, since many in this population are missed by or do not participate in the Census. The foreign-born population in a community is one that potentially does not speak English, and so is of concern to service providers.

Statewide the greatest proportion of the increase in foreign-born persons is represented by immigrants of Hispanic origin; however, statewide there has also been an influx foreign-born immigrants from Southeast Asia, which is especially the case in Burke County.

 According to 2010 Census data, 4,702 foreign-born residents were living in Burke County (Table 10).  The largest number of foreign-born individuals entered the county after 2000.  In each ten year period since 1990, Burke County saw the arrival of less foreign-born persons that the average NC county.  Even though there is a constant fluctuation of the foreign born population the numbers stay relatively stable. The fluctuation of numbers is due in part to the economic climate within the county.

Table 10. Growth of the Potentially Non-English Speaking Population

Number of Persons by Year of Entry for Foreign-Born Population County Before 1980 1980-1989 1990-1999 After 2000 Total Burke 485 970 1,272 1,975 4,702 NC Total 77,831 89,145 223,399 328,762 719,137 NC County Average 778 891 2,234 3,288 7,191

- 19 - - 19 -Page 19 of 155 Burke County Community Health Assessment

Commuting Patterns

 The percentage of Burke County workers commuting out of the county for work remained nearly unchanged between 2000 and 2010; as did the comparable state percentage (Table 11)  A higher percentage of the Burke County workforce left the county for work than the average for NC as a whole, while a lower percentage of Burke County workers were working outside the state of North Carolina.

Table 11. Worker Commuting Patterns (2000 and 2010)

2000 2010 County Total % % % Total Total % % % Total Leaving All Working Working Working Working Leaving Leaving All Working Workin Working Workin Leaving County Workers Out of Out of Out of Out of County County Workers Out of g Out of Out of g Out of County for Over 16 County State County State for Work for Work Over 16 County County State State for Work Work Burke 42,214 12,826 30.4 265 0.6 13,091 31.0 37,101 11,322 30.5 110 0.3 11,432 30.8 NC 3,837,773 936,047 24.4 75,604 2.0 1,011,651 26.4 4,119,560 1,047,069 25.4 106,608 2.6 1,153,677 28.0 Total Source: US Census Bureau, 2000 Census and the 2010 American Community Survey. http://www.census.gov

Table 12. 2000 Census -Workers Travel Time – Burke County

< 5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-59 60-89 90+ minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes 1,252 4,349 8,183 8,811 7,207 2,534 4,805 757 725 1,231 900 733

 The mean travel time to work for workers age 16 (+) for years 2005 – 2009 in Burke County was 21.4 minutes compared to 23.2 minutes for NC workers in the same years.

- 20 - - 20 -Page 20 of 155 Burke County Community Health Assessment

Table 13. Modes of Transportation to Work (2000 and 2010)

Drove Alone Carpooled Used Public Transportation Walked, or Worked at Home County 2000 2010 2000 2010 2000 2010 2000 2010 Burke 34,548 31,396 5,792 2,931 94 59 1,224 2,715 NC Total 3,046,666 3,372,823 538,264 414,493 34,803 43,004 177,098 289,240 NC County 30,467 33,728 5,383 4,149 348 4,300 1,771 2,892 Avg. Source: US Census Bureau, 2000 Census and the 2010 American Community Survey. http://www.census.gov

 The majority of workers in Burke County and NC drive alone to work. Carpooling is the next most popular mode of transportation, although the number of people who carpooled to work decreased in Burke County between 2000 and 2010 (Table 13).  The number of Burke County residents who drove alone to work decreased from 2000to 2010, however the NC County average increased the number of residents who drove alone to work and both Burke County and the average NC County saw a reduction in the number of residents who carpooled to work.  Also, the average NC County saw a significant rise in the number of residents using pubic transportation.

- 21 - - 21 -Page 21 of 155 Burke County Community Health Assessment

Civic Participation

At the present time, Burke County governmental affairs are overseen by five county commissioners who are elected every two years. The County Manager is the chief administrator of the County.

The Burke County Board of Elections and the North Carolina Board of Elections report voter registration and election turnout information for the county. Information specific to Burke County voters is reported in Table 14.

 In Burke County the number of registered voters increased by 1,465 from 2008 to 2010.  Of the 55,921 registered voters in Burke County in 2008, approximately 41% (22,872) are registered as Democrat, 36% are registered as Republican.  Of the 57,386 registered voters in Burke County in 2010, approximately 40% (22,721) are registered as Democrat, 35% are registered as Republican.  In 2008, 54.19% of the voting age population voted in the general election along with 66.96% of registered voters casting their vote. Source: LINC – Topic Report- Voter Registration and Election Results/ http://data.osbm.state.nc.us

Table 14. Registered Voters (2008 and 2010)

Number and Percent of Population Registered to Vote % of Population that Voted in 2004 Election 1990 2000 County Total % Total White Non-White Total % Total White Non-White Total White Minority

Burke 65.5 37,904 35,521 2,383 72.5 49,134 45,974 3,150 59.4 55.0 4.2 State Total 66.7 3,347,635 2,677,162 670,473 84.2 5,122,123 4,028,032 1,091,890 65.0 49.3 13.0 Source a a a a a a a a b b b

a - Log Into North Carolina (LINC), http://linc.state.nc.us b - NC Board of Elections, Data and Statistics. Voter Turnout 2004 General Election. http://w w w .sboe.state.nc.us/index_data.html

- 22 - - 22 -Page 22 of 155 Burke County Community Health Assessment

Economic Climate

In 1996 the NC General Assembly created the William S. Lee Quality Jobs and Existing Business Expansion Act to expand an existing job creation tax credit to all 100 counties in the state and significantly expand the amount available in the most distressed counties. The amount of credit available was to be determined depending on the county’s assigned enterprise tier. Five enterprise tiers were established to assign levels of economic and community stress for all 100 NC counties. The original criteria for assigning tier status were per capita income, unemployment rate, and population growth. Under the original legislation the ten most economically distressed counties were in tier one, the next fifteen counties were in tier two, and the remaining 75 counties were divided evenly among tiers three, four and five. Since the original legislation was enacted several amendments have been attached to implement provisions to make tier assignment more equitable for smaller (population under 50,000) counties, and to better define the timing and circumstances around which a county is moved from one tier to another. The tier enterprise program has invoked much critical observation and debate regarding the parameters on which it is based, but remains a useful tool for community development.

 The NC Department of Commerce ranks the 100 counties annually based on their economic status and gives a Tier designation. The 40 counties with the most distressed economy are given the Tier 1 status, the next 40 is Tier 2, and the 20 least distressed counties receive Tier 3 status.  Burke County has been designated a Tier 1 county for 2011. Between 1996 and 2002, Burke County was consistently designated a Tier 4 county, but since 2007 then it has been designated a Tier 1 (24) indicating a worsening local economic climate. Source: NC Department of Commerce/ http://www.nccommerce.com

Income

 As of 2010, the per capita personal income in Burke County was almost $2,700 lower than in the NC Average (Table 15).  The median household income in Burke County of around $38,100 is lower than the NC county average of around $43,326.

Table 15. Income (Years as noted)

Median Household 2011 Tier Per Capita Personal Per Capita Income Median Household Income Difference from County Designation Income (2010) Difference from State Income (2010) State Burke 1 $20,679 $-2,753 $38,131 $-5,195 NC County N/A $23,432 N/A $43,326 N/A Avg. Source: 2010 American Community Survey and NC Department of Commerce. http://www.census.gov and http://nccommerce.com

- 23 - - 23 -Page 23 of 155 Burke County Community Health Assessment

Employment

The following definitions will be useful in understanding the data in this section.

The term labor force includes all persons over the age of 16 who, during the week, are employed, unemployed or in the armed services. The term civilian labor force excludes the Armed Forces from the equation. Civilians are considered unemployed if they are not currently employed but are available for work and have actively looked for a job within the four weeks prior to the data of analysis. Those who have been laid off and are waiting to be called back to their jobs as well as those who will be starting new jobs in the next 30 days are also considered unemployed. The unemployment rate is calculated by dividing the number of unemployed persons by the number of people in the civilian labor force. Employment growth is the rate at which net new nonagricultural jobs are being created.

 Between 2005 and 2010, Burke County experienced four years of large negative growth (or job losses) (Table 16).  Net employment growth in Burke County between 2007 and 2010 was actually negative 3.9, reflecting numerous job losses; at the state level employment growth over the same period was negative 1.3.

Table 16. Annual Employment Growth

Percent Change from Previous Year County 2007 2008 2009 2010 Burke -3.9 -2.0 -8.7 -0.8 State Total 1.4 -0.7 -5.3 -0.7 Source: NC Employment Security Division, NC Department of Commerce. http://www.ncesc.com and http://www.nccommerce.com

 Table 17 on following page, lists the major employers in Burke County, only two of which employed more than 1,000 people during the period cited.  The largest employers in Burke County are the State of NC Department of Health and Human Services and Burke County Public Schools.  In 2005, Burke County’s major employers included 5 manufacturing companies and 6 administration/Education service companies. Conversely in 2010, the major employers shifted with a continued decrease in manufacturing to 3 and an increase in administration/Education services to 8.

- 24 - - 24 -Page 24 of 155 Burke County Community Health Assessment

Table 17. Major Employers in Burke County, 4th Quarter 2010

Number Employer Industry Employed State of NC Dept of Health & Human Public Administration 1,000+ Burke County Public Schools Education and Health Services 1,000+ Turning Point Services, Inc Education and Health Services 500-999 State of NC Dept of Correction Public Administration 500-999 Grace Hospital Inc Education and Health Services 500-999 Valdese Weavers LLC Manufacturing 500-999 Case Farms Processing Natural Resources and Mining 500-999 Western Piedmont Community College Education and Health Services 500-999 Burke County Public Administration 500-999 Leviton Manufacturing Co Inc Manufacturing 500-999 Continental Automotive Systems, Inc Manufacturing 250-499 City of Morganton Public Administration 250-499

Source: Employment Security Commission of NC, Labor Market Information, Industry Information: North Carolina's Largest Employers. 25 Largest Employers by County. Scroll through the long document to find the appropriate county. http://jobs.esc.state.nc.us/lmi/largest/largest.pdf

 Table18 on following page, details the various categories of industry in Burke County. The largest industry in Burke County is manufacturing, which accounts for more than 28% of the workforce, which is roughly double the comparable fraction of the statewide workforce that is employed in the manufacturing sector (15%).  Health care/social assistance is the second largest industry, employing more than 19% of the county’s workforce.

- 25 - - 25 -Page 25 of 155 Burke County Community Health Assessment

Table 18. Burke County Employment by Industry (2010)

Industry % of Workforce Burke County North Carolina Accommodation/Food Services 7.7 7.9 Administrative/Waste Services 2.8 5.6 Arts/Entertainment/Recreation 0.5 0.7 Construction 2.2 5.9 Educational Services 8.2 9.3 Finance/Insurance 1.6 3.7 Health Care/Social Assistance 19.7 12.7 Information 0.4 2.0 Management of Companies 0.2 1.7 Manufacturing 28.7 15.1 Other Services (not Public Admin) 1.9 2.6 Professional and Technical Services 1.8 4.3 Public Administration 9.6 5.7 Real Estate/Rental Leasing 0.6 1.3 Retail Trade 9.5 11.6 Transportation and Warehousing 2.9 3.6 Unclassified 0.0 0.4 Utilities 0.2 0.4 Wholesale Trade 1.4 0.4

- 26 - - 26 -Page 26 of 155 Burke County Community Health Assessment

Unemployment

 In 2010, an average 13.4% of the Burke County civilian labor force was unemployed (Table 19).  The unemployment rate in Burke County and North Carolina increased overall between 2000 and 2010, and increased very significantly between 2007 and 2010.  The unemployment rate in Burke County has exceeded the comparable state rate every year since 2001.

Table 19 . Annual Unemployment Rate (2000-2010)

County 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Burke 3.6 6.6 7.8 7.8 6.7 6.3 5.7 5.9 8.2 14.4 13.4 State Total 3.7 5.6 6.6 6.5 5.5 5.3 4.8 4.7 6.2 10.8 10.6 Source: NC Employment Security Division, NC Department of Commerce. http://www.ncesc.com and http://www.nccommerce.com

Business Closings and Layoffs

According to data synthesized by the NC Employment Security Commission from newspaper reports and reports from employing units, the following closings and layoffs have occurred in Burke County in recent years (27):

 2007 – Five closings affecting 584 people and two layoffs affecting 143 people.  2008 – Six closings affecting 320 people and five layoffs affecting 251 people.  2009 – Seven closings affecting 179 people and nine layoffs affecting 350 people.  2010 – Eight closings affecting 43 people and four layoffs affecting 130 people.

Between 2002 – 2006, Burke County saw 2,161 people and their families be affected by business closings or layoffs. Recently from 2007-2010, Burke County has seen an additional 2,000 people and their families be affected by business closings or layoffs

It should be noted that due to the reporting methods used, these figures are almost certainly underestimates of the true number of people affected by closings and layoffs.

- 27 - - 27 -Page 27 of 155 Burke County Community Health Assessment

Poverty

The poverty rate is the percent of the population (both individuals and families) whose money income (which includes job earnings, unemployment compensation, social security income, public assistance, pension/retirement, royalties, child support, etc.) is below the threshold established by the Census Bureau.

 The poverty rate in Burke County has exceeded the state poverty rate in seven of the past eight years (Table 20).

Table 20. Annual Poverty Rate (2003-2010)

County 2003 2004 2005 2006 2007 2008 2009 2010 Burke 13.6 14.0 14.6 16.9 16.0 15.5 17.4 18.7 NC 13.4 13.8 14.9 14.6 14.3 14.6 16.2 17.4 Source: US Census Bureau Small Area Income Estimates Program. http://www.census.gov

Poverty and Race

 Between 2000 and 2010 the total percent of Burke County residents in poverty increased by 81.6% (Table 21).  During this same interval the percent of white county residents in poverty increased by 80% and the percent of black county residents in poverty increased by 125%. Statewide over this time frame the percent of both whites and blacks in poverty increased: 55% among whites and 21% among blacks.  The percentage of white persons in poverty in Burke County exceeded the state rate in both 2000 and 2010.  Poverty rates in Burke County and North Carolina as a whole have been highest among the black population. The 2010 poverty rate for blacks in the county was 2.8% higher than the comparable state percentage. But low numbers of populations will cause rates to look disproportionately high.

Table 21. Persons in Poverty by Race (2000 and 2010)

2000 2010 Total Total % % African- Total Total % % White % African- Persons in % in White in American Persons in in in American in County Poverty Poverty Poverty in Poverty Poverty Poverty Poverty Poverty Burke 9,132 10.7 9.8 13.0 16,588 18.7 17.6 30.5 NC 958,667 12.3 8.5 22.9 1,627,602 17.5 13.2 27.7

- 28 - - 28 -Page 28 of 155 Burke County Community Health Assessment

Poverty and Age

 When compared to the state in 2010, Burke County had a higher percentage of the population below the poverty level in all age groups except under 5 and 65 to 74. (Table 22).  The largest difference occurred among the populations aged 18-64: the Burke County rate was 3 percentage points higher than the state rate.  In Burke County in 2010 49% of all persons in poverty were under the age of 18; statewide 34.4% of all persons in poverty were in that age group.

Table 22. Persons in Poverty by Age (2010)

Total Persons Under 5 Years Ages 5-17 Ages 18-64 Ages 65-74 Age 75 and Older County in Poverty Number % Number % Number % Number % Number % Burke 16,588 1,408 28.5 3,464 23.6 10,493 19.2 546 5.8 677 12.1 NC 1,627,602 181,582 29.1 378,293 22.9 948,936 16.2 695,318 8.6 58,963 11.7 Source: 2010 American Community Survey. http://www.census.gov

 The percentage of young children (under age 6) living in poverty in Burke County over the past three Census cycles has been consistently below the rate in the average NC county. Poverty rates among Children under 5 has risen dramatically between 2000 and 2010 (Table 23).

Table 23. Children under Age 5 in Poverty (1990-2010)

1990 2000 2010 County Number % Number % Number % Burke 775 16.7 691 16.0 1,408 28.5 NC Total 86,628 19.2 71,615 16.5 181,582 29.1 NC County Average 862 N/A 716 N/A 1,816 N/A Source: 1990 and 2000 Census and the 2010 American Community Survey. http://www.census.gov

- 29 - - 29 -Page 29 of 155 Burke County Community Health Assessment

Food Stamps

 Between 2003 and 2010 about the same number of persons receive food stamps compared to the average NC County (Table 24).  Between 2002 and 2010 the number of people on food stamps has increased dramatically in Burke County.  According to 2010 data provided by the NC Department of Health and Human Services, 5,586 households and 13,098 individuals (65% of the eligible population) were certified to receive food stamps. The average food stamp monthly benefit per household was approximately $262.

Table 24. Food Stamp Recipients (2002-2010)

County 2002 2003 2004 2005 2006 2007 2008 2009 2010 Burke 5,273 6,123 7,267 7,904 8,594 8,835 9,034 10,774 13,098 NC Total 555,591 624,167 727,710 787,756 842,363 874,426 924,265 1,077,914 1,294,732 NC County Average 5,556 6,247 7,277 7,878 8,424 8,744 9,243 10,779 12,947 Source: NC Department of Health and Human Services. http://www.ncdhhs.gov

 The percentage of Burke County households with children under the age of 18 receiving food stamps increased between 2005 and 2010; a similar trend occurred statewide over the same time frame (Table 25). The net increase over the interval in the county was 76%, at the state level the increase was 47%.

Table 25. Percent of Households with Children Ages 0-17 Receiving Food Stamps (2005-2010)

County 2005 2006 2007 2008 2009 2010 Burke 15.5 18.6 18.9 26.2 16.7 27.2 NC County Average 15.5 15.2 15.3 19.8 19.6 22.8 Source: 2005-2010 American Community Survey. http://www.census.gov

- 30 - - 30 -Page 30 of 155 Burke County Community Health Assessment

Housing

 The size of the average household in both Burke County and the state as a whole decreased marginally between 2000 and 2010 (Table26).  In Burke County the number of owner occupied housing units increased between census cycles, but makes up a lower percentage of occupied units in 2010 than in 2000.  Both the number and percentage of owner occupied housing units in Burke County were higher than in the average NC County in the periods cited.  The number and percentage of renter occupied housing units in Burke County increased between 2000 and 2010.  The median rent in Burke County increased during the reporting period, although as of 2010 it was $90 lower than the average NC County.

Table 26. Housing (2000 and 2010)

2000 2010 Total Average Owner Renter Median Total Average Owner Renter Median Housing Persons/ Occupied Units Occupied Gross Housing Persons/ Occupied Units Occupied Units Gross Units Household Units Rent Units Household Rent County Number Number Number % Number % ($) Number Number Number % Number % ($) Burke 37,427 2.48 25,589 76.1 8,939 23.9 353 40,879 2.45 25,872 72.3 9,932 27.7 621 NC 3,523,944 2.49 2,172,355 72.8 959,658 27.2 431 4,327,528 2.48 2,497,900 66.7 1,247,255 33.3 731 NC 35,239 2.49 21,724 72.8 9,597 27.2 431 43,275 2.48 24,498 66.7 12,473 33.3 731 County Avg. Source: 1990 and 2000 Census and the 2010 American Community Survey. http://www.census.gov

According to local data provided by the Burke County Department of Social Services for 2006-2010:

 1,982 households were certified for Crisis Intervention Program assistance in paying energy bills, amounting to a total of $590,796.  3,066 households were eligible for Low Income Energy Assistance, a one-time payment that averaged around $243.00 in 2010.

Affordable Housing

According to data from the US Census Bureau:

 In 2010, 27.1% of the Burke County population was living in “unaffordable” housing; this compares to 35.6% statewide. (The Census Bureau defines unaffordable housing as housing that costs more than 30% of the total household income.)  Less than 0.1% of Burke County housing units, compared to the same percentage statewide, were considered “substandard”, meaning that they were overcrowded (more than one person living in a room) and lacking complete indoor plumbing facilities (hot and cold piped water, a flush toilet, and a bath or shower).  In Burke County in 2010, the home-ownership rate was 72.3%; this figure compares favorably to the statewide rate of 66.7%.

- 31 - - 31 -Page 31 of 155 Burke County Community Health Assessment

Children and Families

 As of the 2010 Census, 22% of Burke County residents were under the age of 18 (Table 27).  Just over 5% of the county’s population is under the age of 5 (Table 1).  The largest number of children lives in Morganton, while the township with the highest percentage of children is Lower Creek.  Jonas Ridge Township has both the smallest number and percentage of children.

Table 27. Burke County Population under Age 18, by Township (2010)

Township Under 18 % of Population Drexel 1,667 21.7 Icard 3,984 22.6 Jonas Ridge 114 16.8 Linville 297 16.9 Lovelady 1,804 21.1 Lower Creek 714 25.2 Lower Fork 921 25.1 Morganton 6,065 21.6 Quaker Meadows 1,612 22.0 Silver Creek 2,571 23.8 Smokey Creek 159 20.6 Upper Creek 250 21.2 Upper Fork 222 20.8 Total Burke County 20,188 22.2 Source: 2010 Census, US Census Bureau. http://www.census.gov

- 32 - - 32 -Page 32 of 155 Burke County Community Health Assessment

Single Parent Families

 The number and percent of homes with single parents increased between 2000 and 2010 in Burke County and the state (Table 28).  When compared to the state, Burke County has a significantly lower percentage of single parent homes in 2010.  The number of Burke County households headed by single fathers increased by 13% during this period, while the percentage increase statewide was 40%. In both 2000 and 2010 the percentage of households headed by a single male was higher in Burke County than the average NC County.  The percentage of households in Burke County headed by a single female increased by 8% between 2000 and 2010, the comparable increase at the state level was 2%.

Table 28 . Single Parent Families (2000 and 2010)

2000 2010 Family Single Parent Family Single Parent Single Parent Single-Parent Single Parent Single-Parent Household Female Household Male Female Households Male Households Households s Households s Households Households Numbe Numbe Numbe Numbe Numbe Numbe Number % % % Number % % % County r r r r r r Burke 24,331 2,936 12.1 875 3.6 2,061 8.5 24,445 3,233 13.2 998 4.1 2,235 9.6 NC 2,158,869 288,142 13.3 60,791 2.8 227,351 10.5 2,499,174 377,703 15.1 85,199 3.4 292,504 11.7 NC County 21,589 6,975 13.3 608 2.8 2,274 10.5 24,992 3,777 15.1 851 3.4 2,925 11.7 Avg. Source: 2010 Census, US Census Bureau. http://www.census.gov

- 33 - - 33 -Page 33 of 155 Burke County Community Health Assessment

Child Care

 Compared to the average county in NC, Burke County had a much higher number of children ages 0-12 enrolled in regulated child care in 2007 than in 2005 (Table 29).  The number of children in foster care in Burke County decreased by 29% between 2006 and 2010 while the comparable average for NC counties also decreased.

 The number of children in foster care in Burke County was 123.  Local DSS data indicates 55 children left foster care and 24 adoptions were completed in 2010. Burke County DSS served as the legal guardian for 123 individuals in 2010.

Table 29. Child Care Programs (years as noted)

# of Children # of Children (0-12) (0-12) Enrolled in Enrolled in Regulated Regulated # of Children # of Children Child Care Child Care in Foster in Foster County (2005) (2007) Care (2006) Care (2010) Burke 1,886 3,037 224 173 NC Total 260,252 276,099 17,389 13,951 NC County Avg. 2,603 2,761 174 140 Source: NC Child Advocacy Institute.

- 34 - - 34 -Page 34 of 155 Burke County Community Health Assessment

The NC Division of Child Development issues star rated licenses to all eligible Child Care Centers and Family Child Care Homes. North Carolina’s Star Rated License System gives stars to child care programs based on how well they are doing in providing quality child care. Child Care programs receive a rating of one to five stars. A rating of one star means that a child care program meets North Carolina’s minimum licensing standards for child care. Programs that choose to voluntarily meet higher standards can apply for a two to five star license. (Note: Religious-sponsored child care programs will continue to operate with a notice of compliance and will not receive a star rating.)

Three areas of child care provider performance are assessed in the star system: program standards, staff education, and compliance history. Each area has a range of one through five points. The star rating is based on the total points earned for all three areas. Listed below is the breakdown for the number of stars received based on the total points earned in each of the three areas. A five-star facility has earned a total of from 14-15 points, a four-star facility from 11-13 points, a three-star facility from 8-10 points, a two-star facility from 5-7 points, and a one-star facility from 3-4 points (38). (Note: The system will implement new compliance rules beginning January 1, 2008.)

According to the NC Division of Child Development Child Care Facility Search Site () as of October 31, 2011, there were 68 child care facilities in Burke County that were licensed to operate in the following categories:

 Five Star Center License - 24 facilities  Five Star Family Child Care Home License - 2 facilities  Four Star Center License – 9 facilities  Four Star Family Child Care Home License – 2 facilities  Three Star Center License –8 facilities  Three Star Family Child Care Home License – 3 facilities  Two Star Child Care Center License – 2 facility  Two Star Family Child Care Home License – 2 facilities  One Star Center License – 1 facility  One Star Family Child Car Home License – 12 facilities  Temporary License – 2 facilities  GS 110-106 (religious affiliation) – 1 facility

Table 30. Licensed Child Care Facilities (2006- Oct. 2011)

2006 2007 2008 2009 2010 2011 Number of Facilities 84 84 88 78 73 68 Licensed Slots Available 5,054 5,061 5,197 4,929 4,511 4,180 Number of Slots 4,984 4,948 4,994 4,690 4,375 4,114 Used Source: NC Division of Child Development: http://ncchildcare.dhhs.state.nc.us

 Over the last 5 years, the number of licensed child care facilities has decreased by 20 facilities.  The peak of availability and usage for licensed facilities was in 2008 with 88 facilities and 4,994 slots being filled.  With the decrease in licensed facilities, the number of licensed slots has decreased by 1,017 and the number of slots being filled has decreased by 880.

- 35 - - 35 -Page 35 of 155 Burke County Community Health Assessment

Education

There are 26 schools in the Burke County Public School (BCPS) system: 15 primary/elementary-level schools, five middle schools, five high schools, one alternative school, one special needs school, and one pre-school program. The New Dimensions School is the only charter school listed in the county, and there are three private schools.

With a SY 2004-05 enrollment of approximately 13,000 students, the BCPS system currently serves 2,400 students with special needs and 1,000 students (speaking 19 different languages) with limited English proficiency. More than 100 buses transport 7,000 students on a daily basis. The average attendance rate was 97% during the 10-11 school year; 12% of the students are academically gifted. The racial composition of the student body is as follows: 74% white, 7% Asian, 6% African American, 9% Hispanic/Latino, 4% Multi-racial and 0.2% American Indian.

During the 2010-11 school year two BCPS schools were rated “Honor Schools of Excellence”, sixteen were “Schools of Distinction”, and four were a “School of Progress”. Burke County schools have very high rates of students qualifying as “proficient” on End-of-Grade tests and most schools met “adequate yearly progress” expectations. No Burke County public schools were categorized as “low performing” during the 2010-11 school year. At the state level, 98% of public school teachers are considered “Highly Qualified”; in Burke County 98% of the teachers are considered highly qualified .

Burke County is home to Western Piedmont Community College, located in Morganton, a highly regarded educational institution which offers a wide variety of courses to, on average, students annually.

 During the 2010-11 school year, 13,006 students were enrolled in the Burke County school system. Enrollment in BCPS schools has been declining steadily since 2007, in large part to the reduction of employment in Burke County and a greater number of older adults (not within childbearing years) within the county (Table 31).

Table 31. Public School Enrollment

County 2007-08 2008-09 2009-10 2010-11 2011-12 Burke 14,139 13,941 13,616 13,378 13,006 NC Total 1,444,867 1,453,719 1,447,370 1,428,946 1,465,918 NC County Average 14,449 14,537 14,474 14,289 14,659 Source: North Carolina Department of Public Instruction. http://www.ncpublicschools.org

- 36 - - 36 -Page 36 of 155 Burke County Community Health Assessment

 As of the 2010 Census, Burke County had 13% fewer high school graduates and 9% fewer college graduates than the average NC County (Table 32).  The 2010-11 per-pupil expenditure (i.e. per-pupil expenditures from state, federal and local sources) in the Burke County School System of $7,749 was ranked 98 out of all 117 school systems in the state.  Higher percentages of Burke County third graders and eighth graders both scored “proficient” on the 2010 end-of-grade math and reading tests than the state average.  The average SAT score among Burke County students was 990 in 2010, which is 11 points lower than the state average.  The reported rate of acts of school violence in Burke County schools for the 2010-11 school year was 57% lower than the state average.

Table 32. Educational Attainment and Investment (years as noted)

Total Per % 3rd % 3rd % 8th % 8th Pupil Graders Graders Graders Graders School % Expenditure: Total Per Proficient Proficient Proficient Proficient Average Crime/ County % High Bachelor’s State, Pupil on EOG on EOG on EOG on EOG Total Violence School or Higher Federal and Expenditure Math Reading Math Reading SAT Acts/1,000 Graduates Graduates Local Ranking Test Test Test Test Scores Students (2010) (2011) (2010-11) (Out of 117) (2010-11) (2010-11) (2010-11) (2010-11) (2010-11) (2010-11) Burke County 74.4 17.9 $7,749 98 88.1 74.0 92.2 76.5 990 8.6 NC Average 84.7 26.5 $8,398 N/A 82.1 67.6 84.4 69.8 1,001 15.2 Source: North Carolina Department of Public Instruction. http://www.ncpublicschools.org

 The high school drop-out rate in Burke County decreased by 62% overall between the 2004-05 and 2009-10 school years, at the end of that it period the local rate was 31% lower than the NC drop-out rate (Table33).  According to local sources, the dropout rate fell to an all-time low of 1.4 in 2008-09.

Table 33. High School Drop-Out Rate (SY 2005-2010)

County 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 Burke 4.7 4.0 3.8 2.9 1.4 1.8 NC County Avg. 3.2 3.5 3.6 3.4 2.9 2.6 Source: North Carolina Department of Public Instruction. http://www.ncpublicschools.org

- 37 - - 37 -Page 37 of 155 Burke County Community Health Assessment

Crime and Safety

Index Crime

All crime statistics reported below were obtained from the North Carolina State Bureau of investigation unless otherwise noted. Table 34 shows the rates for Index Crimes, which consists of violent crime (murder, rape, robbery and aggravated assault) and property crime (burglary, larceny, arson and motor vehicle theft).

Numbers of Crimes

According to crime rate data presented in Table 34 :

 The index crime rate in Burke County increased between 2006 and 2007, but subsequently decreased.  In 2010 the county index crime rate, is 41% lower than the comparable state index crime rate.  The violent crime rate in Burke County has steadily decreased between 2006 and 2010. In 2010 the county violent crime rate was less than half the comparable state violent crime rate.  The property crime rate in Burke County decreased every year from 2007 through 2010.  The 2010 property crime rate in Burke County was 39% lower than the comparable state property crime rate.

Table 34. Crime Rates (2006-2010)

Crimes per 100,000 Population

2006 2007 2008 2009 2010 Violen Violen Violen Violen Violen Index t Propert Index t Propert Index t Propert Index t Propert Index t Propert County Crime Crime y Crime Crime Crime y Crime Crime Crime y Crime Crime Crime y Crime Crime Crime y Crime

Burke 2513.5 212.2 2301.3 2738.1 235.7 2502.4 2615.2 196.8 2418.5 2341.9 158.2 2183.7 2340.3 142.5 2197.8 State Total 4649.8 483.0 4166.8 4658.6 480.5 4178.1 4554.6 474.2 4080.4 4191.2 417.1 3774.1 3955.7 374.4 3581.4 Source North Carolina Department of Justice, Crime In North Carolina – 2006-2010 Annual Summary Report, http://crimereporting.ncdoj.gov/Reports.aspx (View Crime Statistics)

- 38 - - 38 -Page 38 of 155 Burke County Community Health Assessment

Number of Crimes

 As detailed in Table 35, the numbers of crimes in Burke County fluctuates on a yearly basis.  The highest total number of crimes in the past 10 years occurred in 2005.  The lowest total number of crimes in the past 10 years occurred in 2010.  The number of violent crimes peaked in 2007.  Aggravated assault accounts for the majority of the violent crimes.  The number of property crimes peaked in 2005.  Larceny (the theft of property without the use of force) is the most common property crime.

Table 35 . Number of Index Crimes Reported in Burke County (2000-2010)

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Total Crime 2,515 2,557 2,421 2,410 2,330 2,587 2,153 2,393 2,246 2,028 2,036

Violent Crime 179 195 138 166 157 182 182 206 169 137 124

Murder 1 7 2 4 6 2 5 4 4

Rape 14 12 10 19 16 11 16 14 11 13 10

Robbery 23 44 30 50 42 25 25 38 34 20 21

Aggravated Assault 141 132 96 93 99 140 139 149 120 104 89

Property Crime 2,356 2,472 2,283 2,244 2,170 2,405 1,971 2,187 2,077 1,891 1,912

Burglary 638 692 680 726 726 844 738 680 793 728 707

Larceny 1,598 1,646 1,489 1,387 1,316 1,391 1,117 1,360 1,149 1,077 1,116

Motor Vehicle Theft 120 134 114 131 131 170 116 147 135 86 89

Source North Carolina Department of Justice, Crime Statistics, Uniform Crime Reporting Program, Annual Summary Reports (Available 1993-2010). In an individual year's report, under "Crime Trends - Offenses and Rates per 100,000", Select "County Offenses, Ten Year Trend".

http://crimereporting.ncdoj.gov/Reports.aspx

- 39 - - 39 -Page 39 of 155 Burke County Community Health Assessment

Non-Index Crime Activities

Could not find updated data on non-index crime activities except for:

 As of 2010, there were 138 registered sex offenders living in Burke County, up from 14 in 2002.

Domestic Violence

According to Options, Inc., Burke County’s Women’s Domestic Violence Shelter, the following data was gathered from 2006-201l (fiscal years):

Agency & Shelter Program

Total clients served (seen in person, sheltered and crisis line calls) 12,100 Number of Victims Sheltered 646 Women 567 Children Nights of Shelter provided to victims 10,740 Number of Clients returning to abuser 72 Number of Clients not returning to abuser 225

Domestic Violence Court Program

Total clients served 4,754 Civil 50-B orders 948 Criminal Cases 1,264

Rape & Sexual Assault Program

Total clients served 207 Number of school programs provided 215

Therapy Program

Total clients served 815 Child therapy clients 109 Adult therapy clients 12 Battered Women’s Support Group 536

- 40 - - 40 -Page 40 of 155 Burke County Community Health Assessment

 There was 6 domestic violence-related homicides in Burke County from 2008-2010 compared to 4 homicides for the average NC County.

Table 36. Number of Domestic Violence-Related Homicides (2008-2010)

County 2008 2009 2010

Burke County 3 3 0 NC County Average 1 0 3

NC Coalition Against Domestic Violence. Homicides. Source: (Available for 2008-2010). http://www.nccadv.org/homicides.htm

Child Abuse and Maltreatment

Table 37. Reports of Abuse & Neglect in Burke County

Reports of Abuse & Neglect in Burke County 2008-2009 2009-2010

County Ages 0-5 Ages 6-12 Ages 13-17 Ages 0-5 Ages 6-12 Ages 13-17

Burke 422 219 125 370 187 104

Source NC Department of Health and Human Services, Division of Social Services, Statistics and Reviews, Child Welfare, Central Registry Statistics. http://www.dhhs.state.nc.us/dss/stats/cr.htm

 Burke County had 766 reports of abuse and neglect in 2008-2009 but dropped to 661 in 2009-2010 (Table 37).

- 41 - - 41 -Page 41 of 155 Burke County Community Health Assessment

Health Care Resources

Access and utilization of healthcare is affected by a range of variables including the availability of medical professionals in a region, insurance coverage, transportation, cultural expectations and other factors. Compilation of comprehensive health resources data was beyond the scope of this project; nevertheless, some overview-type data was collected and are presented here.

Practitioners

The person per provider ratio is commonly used to describe the availability of medical providers in a community. The person per provider ratio (PPR) is calculated by dividing the total population by the number of providers of a certain type practicing in the county. According to the Department of Health and Human Services, the recommended ratio of people per provider is 2,000:1. For an area to have what can be officially considered a shortage of physicians, that ratio needs to be at least 3,000:1.

 Table 38 on following page, shows the distribution of health care professionals in Burke County according to specialty area.  As of 2010, there was representation in Burke County for every major category of health care provider.

- 42 - - 42 -Page 42 of 155 Burke County Community Health Assessment

Table 38. Licensed Medical Practitioners in Burke County (2010)

Category of Practitioner Number Family practice 35 General practice 1 Internal medicine 20 Obstetrics/Gynecology 7 Pediatric 6 Other medical specialties 120 Registered nurses 971 Nurse practitioners 22 Licensed practical nurses 172 Chiropractors 10 Physician assistants 24 Podiatrists 1 Dentists 31 Dental hygienists 31 Optometrists 5 Pharmacists 75 Physical therapists 36 Physical therapy assistants 45 Practicing psychologists 25 Psychological associates 33 Respiratory therapists 30

Source: Cecil G. Sheps Center for Health Services Research, Data Available, NC Health Professions Data System, Download Data, State and County Profiles. Chose the year and then the county. Available for 2010. http://www.shepscenter.unc.edu/hp/stco.htm

- 43 - - 43 -Page 43 of 155 Burke County Community Health Assessment

Hospitals

Burke County is served by three hospitals: Broughton State Hospital in Morganton, Grace Hospital in Morganton, and Valdese Hospital in Valdese.

Broughton Hospital

Today, Broughton Hospital is the largest of the four psychiatric hospitals operated by the State of North Carolina within the Department of Health and Human Services under the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. The Hospital serves the 37 westernmost counties in the state, which have a population of over three million, or about 36.4% of the State’s total population. Services are rendered through direct admission to the hospital or through local management entities (LMEs) in the hospital’s catchment area that provide outpatient services. Patients are admitted to the hospital by judicial commitment or on a voluntary basis.

The hospital is currently organized by function and program service, and at the level of wards is comprised of four residential divisions with patients grouped by major treatment modalities, age, and patient need. The four divisions are Division A (Adult Admissions), Division M (Medical), Division P (Psychiatric Rehabilitation), and Division S (Specialty Services).

Broughton Hospital is certified for the receipt of Medicaid and Medicare funds. In addition to certified psychiatric beds, the hospital maintains an acute medical hospital. The hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), certified by the Centers for Medicaid and Medicare Services (CMS), and licensed through deemed status from the North Carolina Department of Health and Human Services, Division of Facility Services.

Grace Hospital

Blue Ridge HealthCare System includes Grace and Valdese hospitals. The creation of this healthcare partnership was said to offer residents of Burke County and the surrounding communities’ access to a broader network of physicians, services and the efficiencies of a single management and delivery system. This combination of management services, including those from Carolinas HealthCare System, creates the second largest healthcare system in the area and cements a leadership role for not-for-profit healthcare in the region. Although Blue Ridge HealthCare System will oversee operations of both hospitals, each retains its autonomy, local governance and community dedication.

Grace Hospital is a non-profit entity that offers the following services: cancer care, cardiac services, diagnostics, the Grace Center for Behavioral Health, home health care, rehabilitation services, occupational health, the family center, senior services, and physician recruitment and volunteer services. The hospital, in the name of Blue Ridge Health, operates the Phifer Wellness Center, a 26,000 square foot facility that offers workout equipment, classes, racquetball courts, a heated indoor swimming pool, whirlpool and sauna and therapeutic massage services. Along with their wellness center, Blue Ridge Health offers community outreach and screenings to local businesses, churches, schools, etc. From 2008-2010, the Community Outreach worker has completed over 34, 271 screenings from lipid panels, bone density, mammograms, PSA’s, etc within Burke County. Blue Ridge HealthCare generates a positive community benefit that includes financial assistance provided to uninsured and underinsured patients as well as vital healthcare and education programs offered to the community. The total reported value of Blue Ridge HealthCare’s community benefit in 2010 was $40,515,000.

- 44 - - 44 -Page 44 of 155 Burke County Community Health Assessment

Valdese Hospital

Valdese Hospital, located in Valdese, N.C., and is part of Blue Ridge Health Care and Carolinas Health Care System serving residents of Burke, Caldwell and western Catawba counties. It is a non-profit hospital with a staff providing a full range of medical and surgical services. It provides most medical and surgical specialties including: anesthesiology and pain management, cardiology, ear/nose throat, emergency medicine, family medicine, gastroenterology, general surgery, hematology, hyperbaric medicine, internal medicine, neurology, obstetrics and gynecology, medical and radiation oncology, orthopedics, pathology, pediatric and adolescent medicine, pulmonology, radiology, sleep medicine, and urology.

Table 39. Number of Admissions for Grace and Valdese Hospitals (2007-2010)

Table 39 : Number of Admissions for Grace and Valdese Hospitals (2007-2010) 2007 2008 2009 2010 Grace Hospital 6,198 6,524 6,639 6,223 Valdese Hospital 2,779 2,437 2,265 1,957 Source: BlueRidge Healthcare System

Local Health Department

The Burke County Health Department, located in Morganton, offers the following basic healthcare services:

 Adult Health - provides health exams for men and women over 21 years old (based on sliding scale fee) and Medicaid.  Child Health - provides well child check-ups and school physicals for young people up to age 21 (sliding scale fee, Medicaid)  Immunizations - provides shots for children and adults (most are free for children; TB skin test; Flu & Pneumonia vaccinations during flu season)  Sexually Transmitted Infections – provides diagnosis and treatment to anyone who may have or who suspects s/he has a sexually transmitted infection (no cost)  HIV Antibody Testing - provides pre and post test counseling and testing for anyone who suspects s/he has been put at risk for HIV (no cost)  Maternity - provides prenatal care for pregnant women (including PCM and WIC services for those who are eligible) (sliding scale fee, Medicaid, or insurance)  Family Planning - provides education, exam and birth control methods for women who desire to delay or space pregnancies (sliding scale fee, Medicaid, or insurance)  Special services provided to the community by request such as immunizations for businesses, nursing homes, etc.

Since the 2007 Community Health Assessment, the Burke County Health Department closed both the Adult and Children’s Dental clinics due to budget and reimbursement reductions and the poor economic climate had dentists increase the number of Medicaid and underinsured clients that were seen and reduced the number of clients for the health department clinic.

- 45 - - 45 -Page 45 of 155 Burke County Community Health Assessment

In addition, the health department provides other community-based health promotion and disease prevention services, including:

 Health Education - provides education and wellness programs (for church, work, and other groups who desire custom programs; small charge depending on type of program)  WIC - provides nutrition vouchers and services for women, infants, and children (to age 5) who qualify (no cost, but must qualify by income)  SIDS - provides counseling by specially trained nurses who help families deal with the loss of a child from Sudden Infant Death Syndrome (no cost)  Care Coordination for Children – serves children from birth to five years who have special needs or who are at risk for developmental delays  Health Check - makes well-child and sick visit appointments for participating Medicaid infants and children  OB Care Managers - serves Medicaid eligible pregnant women who need help in securing resources to improve likelihood of a healthy baby  Child Care Health Consultant (CCHC) – Smart Start funded position that provides consultation, training and educational resources for staff employed in licensed Child Care facilities

Environmental Health services offered by the Burke County Health Department include the following:

 Food, lodging, and institution inspections  Inspections of new and existing septic tank systems  Swimming pool sanitation  Childhood lead investigation  Private water supply sanitation  Tattoo parlor sanitation  Particulate air sampling (some fees apply for certain services)  Service plans and emergency action plans for school children who have special needs or who are at risk for health problems (no cost)

Table 40. Healthcare Personnel in the Health Department (FY 2009)

% Ratio Ratio Change Population FTEs Pop/Staff Population FTEs Pop/Staff Pop/Staff County 2005 2005 2005 2009 2009 2009 2005-2009 Burke 88,239 55 1,604 90,521 81 1,118 47.3 NC Total 8,685,611 8,705 977 9,435,936 9,567 986 9.9 NC County Average 86,856 87 977 94,359 96 986 10.3 Source: NC Center for Health Statistics and the NC Office of Management and Budget.

Between 2005 and 2009, the Burke County Health Department increased its staffing by 47%, accounting for a nearly 44% decrease in the population-per-staff member ratio (Table 40). The Burke County Health Department currently employs 51 after two reduction in force layoffs (2009 – 8 reductions and 2011 – 6).

- 46 - - 46 -Page 46 of 155 Burke County Community Health Assessment

Community Health Centers and Clinics

Good Samaritan Clinic

The Good Samaritan Clinic is a project of Burke United Christian Ministries. The facility, located in downtown Morganton, is Burke County’s community health center for low-income, non-veteran Burke County adult residents who are without insurance (including Medicaid and Medicare) and who meet financial requirements. The clinic offers general health care, basic laboratory services, non-narcotic prescriptions, mental health services, periodic orthopedic and gynecological care, and limited dental services. The clinic has a few paid staff members but is staffed primarily by volunteer physicians, interpreters, pharmacists, and others from the community. The Good Samaritan Clinic continues to grow and serve the uninsured/underinsured, non-Medicaid eligible Burke County resident. According to local data provided by the Good Samaritan Clinic:

Number of Clinic visits: 2009 – 9,220 2010 – 10,693

Number of prescriptions dispensed: 2009 – 24,927 2010 – 25,084

Of the 2009 clinic visits, 39% were male and 61% female while in 2010, 43% were male and 57% were female. The race/ethnicity breakdown for 2009 was 75% white, 9% African American, 13% Hispanic and 3% listed as other and in 2010 there was 68% white, 9% African American, 21% Hispanic and 1% Asian

 In 2009, 50% of Good Samaritan clinic clients were employed and 47% of the clinic population was unemployed and either seeking employment or disability.  In contrast, 2010 statistics saw a 16.6% increase in those clients that were unemployed; seeking employment or disability.  Good Samaritan clinic population serves more residents aged 30-64 than all other age categories. Clinic client ages 18-29 years old (13%); 30-45 years old (58%), 46-64 years old (27%) and 65 (+) years old (2%). 

PSALMS (Payment-now Stabilizes A Low-cost Medical Service) Urgent Care

PSALMS Urgent Care opened June 11, 2010 focused on delivering urgent care to the Burke County community. This center is filling a gap in the community for those residents who are uninsured or underinsured and accomplishes this without grants or governmental assistance. PSALMS Urgent Care delivers care on a fee for service basis with discounted rates. Since the 2010 opening, PSALMS has seen 7,006 clients.

- 47 - - 47 -Page 47 of 155 Burke County Community Health Assessment

Long Term Care Facilities

 Compared to the NC county average, Burke County has slightly more nursing homes beds, and the number had not changed between 2004 and 2010. Despite the growing elderly population in North Carolina, the number of nursing home beds in the state increased only slightly over the same period (Table 41).

Table 41. Number of Beds in Long Term Care Facilities

County 2004 2005 2006 2007 2008 2009 Burke 556 556 556 556 556 556 NC Total 43,776 43,987 44,248 44,210 44,234 44,315 NC County Average 438 440 442 442 442 443

Nursing Homes

Nursing homes are facilities that provide nursing or convalescent care for three or more persons unrelated to the licensee. A nursing home provides long term care for chronic conditions or short term convalescent or rehabilitative care for remedial ailments, for which medical and nursing care are indicated. All nursing homes must be licensed in accordance with NC law by the NC Division of Facility Services Licensure Section. Includes, for example in Burke County (59):

 College Pines Health and Rehab Center (Valdese) – 104 nursing care beds  Grace Heights Health and Rehabilitation Center (Morganton) – 120nursing care beds  Grace Ridge (Morganton) – 72 nursing care beds

Grace Heights Admissions from 2007-2010: 2007 – 189 2008 – 197 2009 – 226 2010 – 233

College Pines Admissions from 2007-2010: 2007 – 248 2008 – 172 2009 – 174 2010 – 230

Grace Ridge has the following types of beds: Memory care – 12 Skilled Nursing – 25 Assisted Living - 35

- 48 - - 48 -Page 48 of 155 Burke County Community Health Assessment

Medical Insurance

Medically Indigent Population

In most communities, citizens’ access to and utilization of health care services is related to their ability to pay for those services, either directly or through private or government health insurance plans/programs.

 In Burke County the percentage of the total population that in uninsured was lower than the state percentage in 2009 and 2010 (Table 42).  The percentage of the population without health insurance was highest in 2010 in both Burke County and NC.

Table 42. Percent of Population without Health Insurance (2009-2010)

County 2009 2010 Burke 18.3 21.6 NC Total 16.1 18.3 Source: 2009 and 2010 American Community Survey. http://www.census.gov

 The proportions of children under the age of 18 and adults between the ages of 18 and 64 in Burke County who were uninsured were higher than the comparable percentages in the state as a whole in 2002, the last year for which this data was available (Table 43).  The percentage of uninsured children under 18 in Burke County grew to 9.9% in 2010.  The percentage of uninsured adults between the ages of 18 and 64 in Burke County exceeded 25% in 2010.

Table 43. Percent of Population without Health Insurance, by Age (2009-2010)

2009 2010 County Total Under 18 18-64 Total Under 18 18-64 Burke 18.3 7.9 26.8 21.6 9.9 25.5 NC Total 16.1 8.2 22.3 18.3 8.7 21.9 Source: 2009 and 2010 American Community Survey. http://www.census.gov

- 49 - - 49 -Page 49 of 155 Burke County Community Health Assessment

Medicaid

 The number and percentage of Burke County residents who were eligible for Medicaid increased annually by 188 persons between 2007 and 2008 (Table 44).  When compared to the NC county average, a greater number and larger percentage of Burke County residents were eligible for Medicaid.  Burke County spent more per capita on Medicaid in each succeeding year during the period cited, and the amounts spent were consistently above the comparable NC county average expenditures.

Table 44. Medicaid Eligibility and Expenditures (2007-2008)

2007 2008 Estimated Per Capita Estimated Per Capita Total Number % Expenditur Total Number % Expenditur County Population Eligible Eligible e Population Eligible Eligible e Burke 88,980 18,100 20.3 $13,819 89,984 18,288 20.3 $14,364 NC Total 9,090,572 1,682,028 18.5 $13,395 9,279,794 1,726,412 18.6 $13,948 NC County Average 90,905 16,820 18.5 $13,395 92,798 17,264 18.6 $13,948 Source: Bureau of Economic Analysis.

- 50 - - 50 -Page 50 of 155 Burke County Community Health Assessment

North Carolina Health Choice

As has been established with previously cited data, children in Burke County are disproportionately burdened by poverty and its consequences. One of these consequences is limited access to health care due to inability to pay. Enrollment in Medicaid or NC Health Choice for Children can help them access needed services. Families not eligible for Medicaid but whose income is not sufficient to afford rising health insurance premiums may be able to receive free or reduced- price comprehensive health care for their children through the North Carolina Health Choice for Children (NCHC) program. This plan, which took effect in October 1998, includes the same benefits as the State Health Plan, plus vision, hearing and dental benefits (following the same guidelines as Medicaid). Children enrolled in NCHC are eligible for benefits including sick visits, check-ups, hospital care, counseling, prescriptions, dental care, eye exams and glasses, hearing exams and hearing aids and more.

 Both the number and percent of Burke County children enrolled in Medicaid grew between 2000 and 2004, as did the number and percent of county children enrolled in NC Health Choice between 2005 and 2009 (Table 45).  The percent of Burke County children enrolled in Medicaid increased 21% between 2000 and 2004; at the state level the rate of increase was 18%.  The percent of Burke County children enrolled in NC Health Choice increased by just 1% over the period cited; at the state level the number decreased by 1%.  As of October 1, 2011, Health Choice is now under Medicaid.

Table 45. Children Enrolled in Medicaid and Health Choice (2000 to 2009)

# Children % Children # Children % Children # Children % Children # Children % Children Enrolled in Enrolled in Enrolled in Enrolled in Enrolled in Enrolled in Enrolled in Enrolled in NC Health NC Health NC Health NC Health Medicaid Medicaid Medicaid Medicaid Choice Choice Choice Choice County (2000) (2000) (2004) (2004) (2005) (2005) (2009) (2009) Burke 5,919 28 6,961 34 1,499 7.1 1,516 7.4 NC Total 559,025 28 674,963 33 134,194 5.9 132,273 6.0 NC County Average 5,590 N/A 6,750 N/A 13,419 N/A 1,323 N/A Source: Annie E Casey Foundation-Kids Count NC

- 51 - - 51 -Page 51 of 155 Burke County Community Health Assessment

Community Care of North Carolina

Carolina ACCESS

Carolina ACCESS, implemented in 1991, is North Carolina’s Primary Care Case Management (PCCM) Program for Medicaid recipients. It serves as the foundation managed care program for Medicaid recipients and brings a system of coordinated care to the Medicaid program by linking each eligible recipient with a primary care provider (PCP) who has agreed to provide or arrange for healthcare services for each enrollee. Primary care providers bill fee-for-service and are reimbursed based on the Medicaid fee schedule; they also receive a small monetary incentive per member per month for coordinating the care of program participants enrolled with their practice. By improving access to primary care and encouraging a stable doctor-patient relationship, the program helps to promote continuity of care, while reducing inappropriate health service utilization and controlling costs (64).

Percent of Managed Managed Number of Medicaid MC Year Care Care CA/CCNC Eligibles Eligibles Eligibles Enrolled practices Enrolled

2007 Burke 13299 12005 9707 80.86% 27 State 1247126 1150429 935000 81.27% 2053

2008 Burke 14825 12384 9785 79.01% 27 State 1391130 1159565 944667 81.47% 2049

2009 Burke 15184 13786 11115 80.63% 27 State 1423962 1319982 1051410 79.65% 2073

2010 Burke 15377 13887 11957 86.10% 25 State 1471054 1362207 1130474 82.99% 2111

2011 Burke 15884 14416 12336 85.57% 26 (thru Nov) State 1529811 1417173 1213166 85.60% 2146

Explanation of column titles: Medicaid Eligibles--those who are receiving Medicaid Managed Care Eligibles--those who are able to be enrolled with a CCNC/CA provider Managed Care Enrolled--those who are actually enrolled with a CCNC/CA provider Percent--the percent of Managed Care eligibles who are enrolled with a CCNC/CA provider Number of CCNC/CA practices--Total number of practices (some practices may have more than one provider) Source: Community Care of NC. - 52 - - 52 -Page 52 of 155 Burke County Community Health Assessment

Chapter Two

Health Statistics

- 53 - - 53 -Page 53 of 155 Burke County Community Health Assessment

Chapter Two: Health Statistics

Methodology

Routinely collected mortality and morbidity surveillance data and behavior survey data can be used to describe the health status of Burke County residents. These data, which are readily available in the public domain, typically use standardized definitions, thus allowing comparisons among county, state and national figures. There is, however, some error associated with each of these data sources. Surveillance systems for communicable diseases and cancer diagnoses, for instance, rely on reports submitted by health care facilities across the state and are likely to miss a small number of cases.

Understanding Health Statistics

Age-adjustment

Mortality rates or death rates are often used as measures of the health status of a community. Many factors can affect the risk of death, including race, gender, occupation, education and income. The most significant factor is age, because the risk of death inevitably increases with age. Thus, as a population ages, its collective risk of death increases. Therefore, an older population will automatically have a higher overall death rate just because of its age distribution. At any one time some communities have higher proportions of “young” people, and other populations have a higher proportion of “old” people. In order to compare mortality data from one community with the same kind of data from another, it is necessary first to control for differences in the age composition of the communities being compared. This is accomplished by “age-adjusting” the data. Age-adjustment is a complicated statistical manipulation usually performed by the professionals responsible for collecting and cataloging health data, such as the staff of the NC State Center for Health Statistics (NC-SCHS). It is not necessary to understand the nuances of age-adjustment to use this report. Suffice it to know that age-adjusted data are preferred for comparing health data from one population to another and have been used in this report whenever available.

Aggregate Data

Another convention typically used in the presentation of health statistics is aggregate data combining data gathered over a five-year period. The practice of presenting data that are aggregated over a five-year period avoids the instability typically associated with using highly variable year-by-year data consisting of relatively few cases or deaths. It is particularly important to aggregate data for smaller counties. The calculation is performed by dividing the number of cases or deaths due to a particular disease over five years by the sum of the population size for each of the five years.

- 54 - - 54 -Page 54 of 155 Burke County Community Health Assessment

Incidence

Incidence is the population-based rate at which new cases of a disease occur and are diagnosed. It is calculated by dividing the number of newly diagnosed cases of a disease or condition during a given time period by the population size during that time period. Typically, the resultant value is multiplied by 100,000 and is expressed as cases per 100,000.

Incidence

Incidence is calculated according to the following formula:

Incidence = number of new cases of disease X 100,000 = cases per 100,000 people population size

The incidence rates for certain diseases, such as cancer, are simple to obtain, since data are routinely collected by the North Carolina Central Cancer Registry. However, other conditions, such as diabetes or heart disease, are not normally reported to central data-collecting agencies. It is therefore difficult to measure burden of disease within a community, and incidence is often estimated by consulting hospital records. Utilization records show the number of residents within a county who use hospital, in-patient services for given diseases during a specific time period. Typically, these data underestimate the true incidence of the given disease in the population, since individuals who are diagnosed outside of the hospital, in-patient setting are not captured by the measure.

Mortality

Mortality is calculated by dividing the number of deaths due to a specific disease in a given time period by the population size in the same time period. Like incidence, mortality is a rate, usually presented as number of deaths per 100,000 residents. Mortality rates are easier to obtain than incidence rates since the underlying (or primary) causes of death are routinely reported on death certificates. However, some error can be associated with cause-of-death classification, since it is sometimes difficult to choose an underlying cause of death from potentially many, co-occurring conditions.

Mortality

Mortality is calculated according to the following formula:

Mortality Rate = number of deaths from disease X 100,000 = deaths per 100,000 people population size

- 55 - - 55 -Page 55 of 155 Burke County Community Health Assessment

Prevalence

Prevalence, which describes the extent of a problem, refers to the number of existing cases of a disease or health condition in a population at a defined point in time or during a time period. Prevalence expresses a proportion, not a rate. It is not used extensively in this report.

Trends

Data for multiple years is included in this report wherever possible. Since comparing data on a year-by-year basis can yield very unstable trends due to the often small number of cases and deaths per year in Burke County, the preferred method for reporting incidence and mortality trend data is long-term trends using the age-adjusted aggregated format. Most data points used in the report are standardized to the projected 2000 US population.

Behavioral Risk Factor Surveillance System (BFRSS) Data

Every year North Carolina residents from across the state participate in a statewide CDC-sponsored Behavioral Risk Factor Surveillance System (BRFSS) survey. Results from the survey can be used to estimate the prevalence of certain conditions, behaviors and diseases. In 2005 Burke County residents participated in a BRFSS telephone survey in an aggregate group that also included Alexander, Caldwell, Cleveland and Lincoln counties. BRFSS data will be included in this report where appropriate; however, it is important to note that all “diagnostic” type responses are self-reports, and that geographically or demographically stratified results are based on sometimes small sample sizes; therefore all BRFSS data should be interpreted with caution.

- 56 - - 56 -Page 56 of 155 Burke County Community Health Assessment

Maternal and Child Health

The following definitions will be helpful in understanding some of the terms used in this section.

The total number of pregnancies that occur in any area in any given time frame is the sum of live births, induced abortions, and fetal deaths that occurred after 20 weeks gestation. The pregnancy rate is the number of pregnancies per 1,000 women of reproductive age (ages 15-44) in the population. The birth rate is the number of live births per 1,000 people (of both sexes) in the population, while the fertility rate, which sometimes is erroneously reported as a birth rate, is the number of live births per 1,000 women of reproductive age in the population. The abortion rate is the number of induced abortions per 1,000 women of reproductive age. Infant mortality is reported as the number of infant deaths per 1,000 live births; an infant death is the death of a live born child under the age of one.

Overall Pregnancies and Births

 As the data in Table 46 demonstrates, most Burke County pregnancy, fertility and abortion rates have fluctuated on a yearly basis from 2006-2009 and are lower than the comparable state rates.  Among white women aged 15-44 in Burke County, pregnancy, fertility, and abortion rates have been lower than the comparable state rates among white women since 2006.

Table 46. Pregnancy and Birth Rates, Women Aged 15-44 (2006-2009)

Table 46. Burke County Pregnancy and Birth Rates, Women Ages 15-44 (2006-2009)

2006 2007 2008 2009 Pregnancy Fertility Abortion Pregnancy Fertility Abortion Pregnancy Fertility Abortion Pregnancy Fertility Abortion County Rate Rate Rate Rate Rate Rate Rate Rate Rate Rate Rate Rate

Burke Total 67.3 59.9 7.2 67.8 60.3 7.2 71.9 65.5 6.3 64.9 58.7 5.9 Burke White 64.6 59.0 5.5 67.9 61.0 6.6 72.3 67.0 5.1 63.6 58.5 4.8 Burke Minority 81.7 66.2 14.6 64.9 56.0 8.9 67.8 56.9 11.0 69.5 60.7 8.9 NC Total 84.8 68.5 15.8 84.7 69.1 15.1 83.9 69.1 14.4 78.9 65.1 13.4 NC White 79.1 69.3 9.5 79.3 69.8 9.1 78.6 69.9 8.4 74.0 66.0 7.7 NC Minority 93.2 66.7 25.8 92.4 67.5 24.2 91.2 69.9 23.3 85.4 62.8 21.9 NC County Avg Total 70.2 61.4 8.5 70.1 61.4 8.3 72.5 63.4 8.9 67.8 60.3 7.2 NC County Avg White 69.4 62.5 6.6 68.1 61.8 6.0 71.1 64.5 6.5 65.4 60.8 4.4 NC County Avg.Minority 70.3 53.4 16.4 77.0 58.4 17.6 75.3 56.4 17.9 76.7 57.5 18.5 Source NC Center for Health Statistics, County-level Data. North Carolina Reported Pregnancies, 2006-2009. Pregnancy, Fertility, & Abortion Rates by Race for Women by age: North Carolina, Regions & Counties. Women 15-44. http://www.schs.state.nc.us/SCHS/data/county.cfm

- 57 - - 57 -Page 57 of 155 Burke County Community Health Assessment

 Figure 2 presents the number of births in Burke County 2006 and 2010. The number of births in Burke County has been steadily decreasing since 2005.

Figure 2

Resident Births (2006-2010)

1,100 1,050 1,000 950

900 Births 850

800 Number of Resident of Number 750 700 2006 2007 2008 2009 2010

Burke County

Source: NC State Center for Health Statistics, County-level Data, Baby Books for 2006-2010. http://www.schs.state.nc.us/SCHS/birth/babybook

 The overall pregnancy rate in Burke County for the period from 2007-2009 was 68.2, which was 17% lower than the state rate of 82.5 (Table48 , following page).  During that same period, 12.7% of the live births occurred among minority mothers, a percentage that is more than half the rate of the state.  In 2008, Burke County had a higher percentage of live births to Medicaid mothers, WIC and Health Department mothers when compared to the state.  In Burke County, females age 15-19 had a higher percentage of low weight, late/no care and mothers who smoked than the percentage of total pregnancies within the county during the same time period.

- 58 - - 58 -Page 58 of 155 Burke County Community Health Assessment

Table 47. Pregnancies and Births (2007-2009)

Table 47 . Burke County Pregnancies and Births (2007-2009)

2008 Percent of Live Births Pregnancy, Total (2007-2009) Pregnancy, Females 15 - 19 (2007-2009) To: Percent of Live Births Percent of Live Births

Health Preg Birth Low Late/No Mother Preg Birth Low Late/No Mother Medicaid Dept. WIC County Rate Rate Minority Weight Care Smoked Rate Rate Minority Weight Care Smoked Moms Moms Moms

Burke 68.2 61.5 12.7 7.8 28.3 21.2 67.7 59.3 15.6 8.8 34.5 24.6 68.8 41.7 48.5 NC 82.5 67.7 28.6 9.1 16.8 10.6 59.1 45.8 41.0 10.9 28.4 12.6 52.6 20.8 41.8 Source: NC Center for Health Statistics, NC Health Statistics Pocket Guide 2009. Pregnancy Statistics Total and Females 15-19. Birth and Medicaid Statistics. http://www.schs.state.nc.us/SCHS/data/pocketguide/2009

Teen Pregnancies and Births

Current data available from Adolescent Pregnancy Prevention Coalition of North Carolina (APPCNC) shows that for 2009, the teen pregnancy rate in Burke County among teens 15-19 years old is 64.4 per 100,000. This rate is over 8 teens higher (per 100,000) than the state rate of 56.0. The teen pregnancy rate has continued to rise from 59.0 per 100,000 in 2003 to 64.4 per 100,000 in 2009. The number of pregnancies for 10-14 years old in Burke County has also increased from 2 to 6 from 2008-2009 consecutively.

According to the APPCNC, the total percentage of teen repeat pregnancies in Burke County in 2009 was 31.1% compared to 28.6% for the state. The percentage of repeat pregnancies in Burke has remained over 25% of total pregnancies since 2005. More recently there was an increase in repeat pregnancies from 2008- 2009 by over 3% at a current rate of 31.1% of all pregnancies. Burke County continues the rise while the state is declining.

When ranked with other counties in North Carolina on a scale of 1 to 100, with 100 being the county with the lowest percentage of overall teen pregnancies, Burke County ranks 30th. In 2009, repeat pregnancies rates for Burke County were more than nine times higher than the 100th ranking county. With an average annual increase of four repeat pregnancies for teen’s age 15-19, per year (based on a four year period), if this trend continues the repeat pregnancy rate would become 39% of the total number of pregnancies in Burke County by 2015.

According to local birth certificate data gathered from January 2010 – September 2011, teens age 13-18 that gave birth for the first time, 16.87 was the average age of the teen mom and 22.35 for the father. For teens that had a second pregnancy during that time frame, the average age for the teen mom at delivery was 18.41; however, there was a sixteen year old that had one previous live birth. In addition, more than four teens that gave birth from 2010-2011 had two previous live births while under the age of 19 years. The majority of teens who gave birth were white at 81.25% followed by Hispanic at 9.8%, Asian at 3%, Bi-Racial and Black at 3% and the rest representing Hmong and American Indian.

- 59 - - 59 -Page 59 of 155 Burke County Community Health Assessment

Abortion

 Burke County abortion rates tend to be higher among minority women.  Abortion rates in Burke County have been lower than the comparable state rates among women aged 15-44 (Figure 3).  The state minority abortion rate was on average 55% higher than Burke County’s abortion rate for years 2005-2009

Figure 3

Abortion Rate (2005-2009)

12

10

8

6

Rate Abortion 4

2

0

2005 2006 2007 2008 2009

Women 15-19 Women 15-44

Source: NC State Center for Health Statistics. County-level Data. County Health Databooks (2005-2009). Pregnancy and Live Births. Pregnancy, Fertility and Abortion Rates per 1,000 Population, by Race for Females 15-19 and 15-44. http://www.schs.state.nc.us/SCHS/data/databook/

- 60 - - 60 -Page 60 of 155 Burke County Community Health Assessment

Pregnancy Risk Factors

 According to the NC-SCHS, a birth is high parity if the mother is younger than 18 when she has had one or more births, or aged 18 or 19 and has had two or more births, or is 20 to 24 and has had four or more births, etc.  The percentage of high parity births among women aged <30 in Burke County from 2005 through 2009 was higher than the comparable state rate (Table 48).  The percentage of high parity births among Burke County women age 30 and older was also higher than the state rate, by 2%.  The percentage of short interval births (less than six months between pregnancies) is 4% higher in Burke County than statewide.  Between 2005 and 2009, nearly 21% of babies in Burke County were born to mothers who smoked a rate 47% higher than the state rate.

Table 48. High Risk Births (2005-2009)

Table 48 . High Risk Births (2005-2009)

High Parity Births Births to Mothers Mothers Under 30 Mothers Over 30 Short Interval Births Who Smoke

Number Percent Number Percent Number Percent Number Percent

Burke County 771 20.4 276 20.4 451 13.4 1,044 20.6 State Total 74,727 17.9 43,711 20.0 54,565 12.9 70,529 11.0

Source a a a a b b c c

a - NC State Center for Health Statistics. County-level Data. County Health Databooks. 2009 County Health Data Book. 2005-2009 Number At Risk NC Live Births due to High Parity by County of Residence. http://www.schs.state.nc.us/SCHS/data/databook/

b - NC State Center for Health Statistics. County-level Data. County Health Databooks. 2009 County Health Databook. 2005-2009 NC Live Births by County of Residence; Number with Interval from Last Delivery to Conception of Six Months or Less. http://www.schs.state.nc.us/SCHS/data/databook/ c - NC State Center for Health Statistics. County-level Data. County Health Databooks. 2009 County Health Databook. 2005-2009: NUMBER AND PERCENT OF BIRTHS TO MOTHERS WHO SMOKED PRENATALLY. http://www.schs.state.nc.us/SCHS/data/databook/

- 61 - - 61 -Page 61 of 155 Burke County Community Health Assessment

Figure 4

Percent of Babies Born to Women who Smoked During

Pregnancy (1999-2009)

22

18

14

Percent of Live Births of Live Percent

10 1999-2003 2000-2004 2005-2009

Burke County North Carolina

NC State Center for Health Statistics. County-level data. County Health Data Books (2005-2009). Births to Mothers Who Smoke. http://www.schs.state.nc.us/SCHS/data/databook/

 While the percentage of babies born to Burke County mothers who smoked during pregnancy has decreased since 1996, the county figure continues to exceed the figure for the state as a whole (Figure 4).

- 62 - - 62 -Page 62 of 155 Burke County Community Health Assessment

 The overall percentage of pregnant women in Burke County who received prenatal care in their first trimester was below the state average for the entire period except for Native American women in 2004-2008 (Table 49).  Between 2000 and 2004, 80.8% of pregnant women in Burke County received prenatal care in their first trimester, a proportion 3% lower than the state rate of 83.7% and the percentage worsened in 2004-2008 to 10% lower than the state rate.

Table 49. Percentage of Women Receiving Care in the First Trimester (1999-2008)

Table 49 . Women Receiving Care in the First Trimester (1999- 2008)

1999-2003 2000-2004 2004-2008 Native Total Black Total Black Total Black American

Burke County 80.8 77.7 80.8 77.3 74.1 68.7 87.5 State Total 84.0 75.4 83.7 75.4 82.1 75.0 77.7

Source NC State Center for Health Statistics. County-level Data. County Health Data Books 2004-2008. Women Receiving Prenatal Care in the First Trimester. http://www.schs.state.nc.us/SCHS/data/databook/

- 63 - - 63 -Page 63 of 155 Burke County Community Health Assessment

Pregnancy Outcomes

Low Birth Weight and Very Low Birth Weight

* From 2004-2008, the total percentage of low birth weight births (below 2500 grams or 5.5 pounds) was slightly lower in Burke County than in North Carolina as a whole (8.5% vs. 9.1%). The percentage of white low birth weight babies was 7% higher than the comparable state rate, while the percentage of minority low birth weight babies was 11% lower than the comparable state rate (Table 50) .  The overall percentage of very low birth weight births (below 1500 grams or 3.3 pounds) was 11% lower in Burke County than statewide overall, but the percentage among Burke County minorities was only 8% higher than among minorities statewide.  During this period, minority mothers experienced a higher percentage of very low birth weight births than minority mothers statewide. In 2004-2008, Burke County minority mothers low birth weight rates were 34% higher than white mothers.

Table 50. Number and Percent of Low and Very Low Birth Weight Births by Race (2004-2008)

Table 50 . Number and Percent of Low and Very Low Birth Weight Births by Race (2004-2008)

Very Low Weight (<1500 grams) Low Birth Weight (<2500 grams) Births Births Total White Minority Total Black County Number Percent Number Percent Number Percent Number Percent Number Percent

Burke County 436 8.5 356 8 80 12.1 84 1.6 10 3.8 State Total 57,823 9.1 33,941 7.4 23,882 13.6 11,649 1.8 5,198 3.5 Source a a a a a a b b c c

a - NC State Center for Health Statistics. County-level Data. County Health Databooks. 2010 County Health Data Book. Low Birth Weight Births by Race, 2004-2008. http://www.schs.state.nc.us/SCHS/data/databook/

b - NC State Center for Health Statistics. County-level Data. County Health Databooks. 2010 County Health Data Book. Low (<2500 grams) and Very Low (<1500 grams) Weight Births, 2004-2008. http://www.schs.state.nc.us/SCHS/data/databook/ c - NC State Center for Health Statistics. County-level Data. County Health Databooks. 2010 County Health Data Book. Low (<2500 grams) and Very Low (<1500 grams) Weight Black Births, 2004-2008. http://www.schs.state.nc.us/SCHS/data/databook/

- 64 - - 64 -Page 64 of 155 Burke County Community Health Assessment

Infant Mortality

 During the years 2005-2009, Burke County rates for infant death and white infant deaths were higher than the state rate ranging from 1.4 to 3.3 but the minority rate was lower in Burke County than the state.  The infant mortality rate in 2009 was 13.4 which is 41% higher than the state rate.  Comparing the infant mortality rate for 2009 to 2010; the rate dropped significantly in Burke County from 13.4 to 6.9 while the state rate stayed relatively the same.

Table 51. Infant (<1 year) Death Rate per 1,000 Live Births

Table 51 . Infant (<1 year) Death Rate per 1,000 Live Births (Years as noted)

2009 2005-2009 Total White Minority Infant White Infant Minority Infant Death Infant Death Infant Death County Total White Minority Rate Deaths Rate Deaths Rate

Burke County 13.4 10.3 3.1 49 9.7 41.0 8.0 12.0 State Total 7.9 38.0 40.9 5289.0 8.3 2764.0 6 14.0 Source a a a b b b b b

a - NC State Center for Health Statistics, County-level Data, County Health Data Books 2005- 2009. Infant Death Rates per 1,000 Live Births. http://www.schs.state.nc.us/SCHS/healthstats/databook/

b- NC State Center for Health Statistics. County-level Data. Infant Mortality Statistics 2009. County-by-county listing of final infant death rates for 2009. http://www.schs.state.nc.us/SCHS/deaths/ims/2009

- 65 - - 65 -Page 65 of 155 Burke County Community Health Assessment

Leading Causes of Death

Table 52, shows the leading causes of death, listed in descending order, in Burke County based on combined mortality data for the years 2005 through 2009. Items in boldface type indicate where the Burke County rate exceeds the state rate.

Table 52. Age-Adjusted Mortality Rates for the Leading Causes of Death (2005-2009)

Table 52. Age-Adjusted Mortality Rates for the Leading Causes of Death in Burke County and North Carolina (2005-2009) North Burke County Cause of Death Carolina Number Rate Rate 1. HEART DISEASE 1,043 197.7 191.7 2. TOTAL CANCER 1,013 188.8 185.6 3. CHRONIC LOWER RESPIRATORY DISEASE 261 48.7 47.0 4. CEREBROVASCULAR DISEASE 250 47.4 50.5 5. UNINTENTIONAL NON-MOTOR VEHICLE INJURIES 203 43.8 28.6 6. ALZHEIMER'S DISEASE 151 28.7 28.3 7. DIABETES 115 21.7 23.6 8. PNEUMONIA AND INFLUENZA 108 20.6 19.4 9. NEPHRITIS, NEPHROTIC SYNDROME, NEPHROSIS 97 18.4 18.7 10. UNINTENTIONAL MOTOR VEHICLE INJURIES 83 18.1 17.6 11. SUICIDE 75 17.1 12.0 12. SEPTICEMIA 83 15.9 13.8 13. CHRONIC LIVER DISEASE AND CIRRHOSIS 45 8.5 9.1 14. HOMICIDE 24 5.5 7.0 15. HIV/AIDS 5 N/A 4.2

Source: a - NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

- 66 - - 66 -Page 66 of 155 Burke County Community Health Assessment

State and National Mortality Rate Comparisons

Compared to North Carolina, Burke County had higher age-adjusted mortality rates for:

 Suicide – by 30%  Unintentional motor vehicle injuries – by 3%  Unintentional non-motor vehicle injuries – by 34%  Chronic lower respiratory disease – by 3%  Pneumonia/influenza – by 6%  Heart disease – by 3%  Total Cancer – by 2%  Alzeheimer’s Disease – by 1%  Septicemia - by 13%

- 67 - - 67 -Page 67 of 155 Burke County Community Health Assessment

Gender Disparities in Mortality

Table 53, compares rates for males versus females in Burke County. The mortality data cited in this section were obtained from the North Carolina State Center for Health Statistics except for the period from 2005-2009. Boldface type indicates the higher rate in each gender pair.

Table 53. Age-Adjusted Mortality Rates by Gender, Burke County (2005-2009)

Table 53. Age-Adjusted Mortality Rates by Gender, Burke County (2005-2009)

MALES FEMALES Cause of Death Number Rate Number Rate

HEART DISEASE 532 252.3 511 153.4 CEREBROVASCULAR DISEASE 99 50.4 151 45.3 TOTAL CANCER 559 251.3 454 148.6 Colon, Rectum, and Anus 67 30.3 40 12.5 Trachea, Bronchus, and Lung 211 93.0 137 44.1 Female Breast 0 0.0 71 23.8

Prostate 34 16.7 0 0.0

DIABETES 66 29.2 49 16.1 PNEUMONIA AND INFLUENZA 49 26.7 59 17.3 CHRONIC LOWER RESPIRATORY DISEASE 125 59.1 136 43.4 CHRONIC LIVER DISEASE AND CIRRHOSIS 30 12.3 15 n/a SEPTICEMIA 45 22.2 38 11.7

NEPHRITIS, NEPHROTIC SYNDROME, NEPHROSIS 43 20.1 54 16.7

UNINTENTIONAL MOTOR VEHICLE INJURIES 55 24.8 28 11.4 UNINTENTIONAL NON-MOTOR VEHICLE INJURIES 125 57.0 78 31.3 SUICIDE 62 28.1 13 n/a HOMICIDE 19 n/a 5 n/a ALZHEIMER'S DISEASE 41 22.6 110 31.0 HIV/AIDS 4 n/a 1 n/a

Source: NC State Center for Health Statistics. County-level Data. County Health Data Book. 2009 County Health Data Book, 2005-2009 Race-Specific and Sex-Specific Age-Adjusted Rates By County. http://www.schs.state.nc.us/SCHS/data/databook/

**Rates based on fewer than 20 cases (indicated by “n/a”) are unstable and a rate is not shown. - 68 - - 68 -Page 68 of 155 Burke County Community Health Assessment

For all deaths combined, Burke County males have a 39% higher mortality rate than females.

In addition, compared to the mortality rates for Burke County females, the mortality rates among Burke County males are higher for all leading causes of death (except breast cancer and Alzheimer’s Disease):

 Unintentional non-motor vehicle injuries – by 10%  Lung cancer – by 53%  Colorectal cancer – by 59%  Unintentional motor vehicle injuries – by 54%  Heart disease – by 39%  Chronic lower respiratory disease – by 27%  Total cancer – by 41%  Nephritis/nephrotic syndrome/nephrosis – by 17%  Pneumonia/influenza – by 35%  Septicemia – by 47%  Diabetes – by 45%  Cerebrovascular disease – by 10%

Racial Disparities in Mortality

Racial disparities in mortality are discussed in detail in the descriptions of specific diseases and health conditions in the sections that follow. Note that because the numbers of deaths in the minority population due to certain causes are quite small disparities based on mortality rates calculated from the small numbers should be interpreted with caution. Mortality rates will not be analyzed for racial disparities for any cause of death for which there were twenty or fewer aggregate white or minority deaths during the period in question, and gender-stratified racial disparities will not be analyzed for any cause of death that resulted in twenty or fewer aggregate deaths among minority males or females during the period.

- 69 - - 69 -Page 69 of 155 Burke County Community Health Assessment

Boldface type indicates the higher rate in each racial pair.

Table 54. Age-Adjusted Mortality Rates by Race, Burke County (2005-2009)

Table 54. Age-Adjusted Mortality Rates by Race, Burke County (2005-2009)

WHITES MINORITIES Cause of Death Number Rate Number Rate

HEART DISEASE 966 195.9 77 n/a CEREBROVASCULAR DISEASE 233 47.2 17 n/a

TOTAL CANCER 945 188.8 70 n/a Colon, Rectum, and Anus 101 20.0 6 n/a Trachea, Bronchus, and Lung 327 64.7 21 n/a Female Breast 67 13.4 4 n/a

Prostate 28 5.5 6 n/a DIABETES 98 20.0 17 n/a PNEUMONIA AND INFLUENZA 102 20.8 6 n/a CHRONIC LOWER RESPIRATORY DISEASE 252 50.4 9 n/a

CHRONIC LIVER DISEASE AND CIRRHOSIS 42 8.6 3 n/a SEPTICEMIA 74 15.1 9 n/a NEPHRITIS, NEPHROTIC SYNDROME, NEPHROSIS 90 18.2 7 n/a 18.9 UNINTENTIONAL MOTOR VEHICLE INJURIES 77 6 n/a UNINTENTIONAL NON-MOTOR VEHICLE INJURIES 195 46.3 8 n/a SUICIDE 70 17.6 5 n/a HOMICIDE 20 5.1 4 n/a ALZHEIMER'S DISEASE 148 30.0 3 n/a HIV/AIDS 5 n/a 0 0.0

Source: NC State Center for Health Statistics. County-level Data. County Health Data Books. 2009 County Health Data Book. Mortality. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook.

**Rates based on fewer than 20 cases (indicated by “n/a”) are unstable and a rate is not shown or a minority rate was not given Comparisons for minorities and whites cannot be made due to small numbers.

- 70 - - 70 -Page 70 of 155 Burke County Community Health Assessment

Heart Disease and Stroke

Heart disease and cerebrovascular disease (stroke) are both diseases of the circulatory system. While heart disease is any disease that diminishes or interrupts blood supply to the heart, stroke is an interruption in blood supply to the brain. The most common cause of both of these diseases is a narrowing or blockage of arteries that supply the heart and brain, respectively.

Heart Disease and Stroke Incidence

Hospital utilization data provided by the NC-SCHS (Table 55) give some indication of the burden of heart disease in Burke County. Between 2005-2009, the hospital discharge rates for all circulatory diseases, as well as heart disease individually, increased between 2005 and 2006 then began to decline. Diseases of the circulatory system remain a problem in Burke County since it is still the leading cause of death in Burke County. Hospital discharge rates for cerebrovascular disease have fluctuated on a yearly basis, though the rate has not yet exceeded the 2000 high of 4.1. Together, heart and cerebrovascular diseases currently account for more hospitalizations than any other condition. Consequently, hospital costs attributable to these two conditions were greater than any other condition, together accounting for more than $66.2 million in hospital charges in Burke County in 2009 compared with $54 million in 2004. It should be noted that the usefulness of hospital discharge information is limited in that it does not include people who may have cardiovascular or cerebrovascular conditions but have not sought medical care or been hospitalized. The category represented in Table 68 includes not only diagnoses of heart disease and cerebrovascular disease, but other diseases of cardiovascular and circulatory systems as well. Therefore, the sum of the rates for heart disease and cerebrovascular disease will not add up to the total discharge rates for all cardiovascular and circulatory diseases.

Table 55. Burke County Hospital Discharges per 1,000 Persons (2005-2009)

Condition 2005 2006 2007 2008 2009 Cardiovascular and Circulatory Diseases 23.3 24.6 21.7 21.6 18.4 Heart Disease 17.2 18.2 15.4 14.0 12.4 Cerebrovascular Disease 3.2 3.4 3.3 4.0 3.0

NC State Center for Health Statistics. Health Data. County-level Data. County Health Data Books, 2005-2009. Morbidity. Inpatient Hospital Utilization and Charges by Principal Diagnosis, and County of Residence. Available at: http://www.schs.state.nc.us/SCHS/data/databook/.

- 71 - - 71 -Page 71 of 155 Burke County Community Health Assessment

Heart Disease Mortality

Heart disease is the leading cause of death among Burke County residents. During 2005-2009, 1,043 Burke County residents died of heart disease which has decreased from the 2004 number of 1,132. The county mortality rate due to heart disease (197.7) was higher than the state mortality rate (191.7). The mortality rate due to heart disease in Burke County has paralleled the same trend seen at the state level. Since 1999-2003, Burke County’s rate was slightly lower than the state (233.2 vs. 243.2) but increased above the state rate in 2000-2004 (236.9 vs. 233.9) but continued to parallel the state rate. In the 2005-2009 data, both Burke County and the state decreased in the number and rate of deaths due to heart disease but Burke County continues to be higher than the state rate (197.7 vs. 191.7).

Table 56. Heart Disease Mortality (2005-2009)

Table 56. Heart Disease Mortality (2005-2009)

White Overall Rate White Males Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 1,043 197.7 497 251.9 469 149.6 35 283.8 42 226.6 State Total 86,920 191.7 35,204 236.2 33,177 144.2 9,314 294.0 9,225 186.0

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex- Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Gender and Racial Disparities in Heart Disease Mortality

In Burke County, minority males have a 5% higher mortality rate (238.8) due to heart disease than white males (251.9). Minority females in Burke County have a 17% higher mortality rate (221.2) due to heart disease than white females (184.2).

Gender disparities exist among both whites and minorities in Burke County. The mortality rate due to heart disease among white males is 41% higher than that of white females. The mortality rate among minority males is 37% higher than the rate among minority females.

- 72 - - 72 -Page 72 of 155 Burke County Community Health Assessment

Stroke Mortality

Stroke was the fourth leading cause of death in Burke County in the years from 2005 through 2009, over which period the deaths of 250 Burke County residents were attributable to stroke. The county mortality rate for stroke for that period (47.4) was lower than the state rate of 50.5 (Table 57).

Table 57 Mortality: Cerebrovascular Disease (2005-2009)

Table 57. Cerebrovascular Disease Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 250 47.4 93 51.3 140 44.8 6 n/a 11 n/a State Total 22,600 50.5 6,658 47.1 10,431 45.1 2,362 77.1 3,149 63.8

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005- 2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Between 1999 and 2009, the mortality due to stroke in Burke County has remained close to the statewide rate. Between the 1999 and 2004 data, Burke County’s stroke mortality rate was slightly higher than the state but the 2005-2009 data shows a decrease in both the county and state rate. In 2005-2009, Burke County’s stroke mortality rate has decreased below the state rate (47.4 vs. 50.5).

Gender and Racial Disparities in Stroke Mortality

Racial disparities are more pronounced than gender disparities. The statewide cerebrovascular mortality rate among minority males (77.1) is 39% higher than the rate for white males (47.1). Minority comparisons cannot be made for Burke County since minority males (n=6) and minority females (n=11) since the numbers are small and the rates cannot be calculated. The Burke County stroke disease mortality rate among white males is 13% higher than the rate among white females.

- 73 - - 73 -Page 73 of 155 Burke County Community Health Assessment

Risk Factors for Heart Disease and Stroke

 Age (65 or older for heart disease, 55 or older for stroke)  Gender (male)  Heredity/family history  Race (especially African American)  Tobacco use  High cholesterol  High blood pressure  Physical inactivity  Obesity/overweight  Diabetes  Stress  Alcohol abuse

- 74 - - 74 -Page 74 of 155 Burke County Community Health Assessment

Cancer

Total Cancer

Cancer is the group of diseases characterized by the uncontrollable growth and spread of abnormal body cells. If the disease remains unchecked, it can result in death. Cancers of all kinds are sometimes grouped together in a parameter called “total cancer”. Total cancer was the second leading cause of death in Burke County for the period from 2005-2009. Inpatient hospital charges for cancer patients in Burke County amounted to over $14 million in 2009 compared to the $9 million in 2004.

Total Cancer Incidence

Table 59 shows age-adjusted total cancer incidence rates for the period of 2004-2008, as well as colorectal, lung, breast, and prostate cancers. In Burke County, the incidence rates of cancer overall, as well as colorectal and lung individually are above the North Carolina rates, with the county rate of female breast (149.4) and prostate cancer (137.5) lower than the state rate of 151.9 and 158.8 respectively.

For all cancers combined, there were 2,590 newly diagnosed cases in Burke County between 2004 and 2008. The incidence rate for total cancer in Burke County (496.3) is 1.1% lower than the North Carolina rate.

Table 58. Cancer Incidence (2004-2008)

Table 58. Cancer Incidence (2004-2008)

All Cancer Colorectal Cancer Lung Cancer Female Breast Cancer Prostate Cancer

Number of Incidence Number of Incidence Number of Incidence Number of Incidence Number of Incidence County Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate

Burke County 2,590 496.3 274 52.3 461 87.1 420 149.4 332 137.5 State Total 227,397 495.2 21,349 46.8 34,881 76.3 38,098 151.9 32,943 158.8

Source NC Central Cancer Registry. 2004-2008 Cancer Incidence Rates. http://www.cdc.gov/nchs

Since 1995, the age-adjusted total cancer incidence rate in Burke County has remained below the North Carolina rate. Between 1996 and 2002, the rate decreased, but since the aggregate period of 1998-2002, the incidence rate spiked. From 1999 through 2003 the cancer incidence rate was slightly lower in Burke County (436.6) than the state rate (446.5) by approximately 10%. But the data for 2004 through 2008 incidence rate shows an increase for both the county and state; however, Burke County (496.3) has increased above the state rate (495.2) for the first time since before 1995.

- 75 - - 75 -Page 75 of 155 Burke County Community Health Assessment

Total Cancer Mortality

Table 59 presents the number of deaths and mortality rates associated with total cancer and the four major site-specific cancers.

Table 59. Cancer Mortality, by Site of Cancer (2005-2009)

Table 59. Cancer Mortality, by Site of Cancer (2005- 2009)

Total Cancer Lung Cancer Breast Cancer Prostate Cancer Colorectal Cancer County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 1,013 188.8 348 64.1 71 13.3 34 6.3 107 19.8 State Total 86,246 185.6 26,681 57.0 6,257 13.4 4,306 9.6 7,621 16.5

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Total cancer is the second leading cause of death among Burke County residents, resulting in 1,013 deaths between 2005 and 2009. According to data presented in Table 59, the Burke County mortality rate for total cancer during the four-year aggregate period of 2005-2009 (188.8) is 2% higher than the North Carolina state rate (185.6).

Gender and Racial Disparities in Total Cancer Mortality

Table 60, depicts the total cancer mortality in regards to gender and race for 2005-2009.

Table 60. Total Cancer Mortality (2005-2009) For Gender and Race Table 60. Total Cancer Mortality (2005-2009) for Gender & Race Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 1,013 188.8 517 248.5 426 149.4 42 367.7 28 135.5 State Total 86,246 185.6 35,824 224.4 31,893 149.4 9,848 304.0 8,681 168.8 Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex- Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

- 76 - - 76 -Page 76 of 155 Burke County Community Health Assessment

In Burke County minority males have a 32% higher rate of death due to cancer than white males. White females have a 9% higher rate of death due to cancer than minority females.

While total cancer mortality appears to have a racial disparity component, the gender disparity is more pronounced. Among white men in Burke County, the mortality rate due to all types of cancer is 40% higher than the rate for white women, and the mortality rate for minority men is 63% higher than the rate for minority women.

Breast Cancer

Breast Cancer Incidence

Since 1995, the breast cancer incidence rate has been lower in Burke County than in North Carolina. Both rates appeared relatively stable until the 1999-2003 aggregate period, when the incidence rate in Burke County rose, nearing the North Carolina incidence rate within 10% (137.6 vs. 147.3). The 2004-2008 incidence data shows a continued rise and parallels the state with Burke County continuing to stay below the state rate (149.4 vs. 151.9 respectively). Hospital charges for Burke County breast cancer patients totaled $292,473 in 2009.

Breast Cancer Mortality and Racial Disparities in Breast Cancer Mortality

Between 2005 and 2009, 71 people died of breast cancer in Burke County, representing an age-adjusted mortality rate of 13.3 per 100,000, versus 13.4 per 100,000 for the state as a whole. The number of deaths in Burke County had only increased by one since the 2000-2004 data in the overall, white female and minority female categories.

Table 61. Mortality: Breast Cancer (2005-2009)

Table 61 . Breast Cancer Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 71 13.3 0 0.0 67 24.1 0 0.0 4 n/a State Total 6,257 13.4 39 0.3 4,571 21.8 16 n/a 1,631 31.3

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005- 2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

- 77 - - 77 -Page 77 of 155 Burke County Community Health Assessment

There appears to be a significant difference between breast cancer mortality rates for white and minority women in Burke County. Burke County comparisons cannot be made due to small numbers and rates cannot be calculated

While rare, it should be noted that breast cancer does occur in males. For the period 2000-2004, one Burke County male died of breast cancer but for 2005-2009 there were no male deaths due to breast cancer.

.Breast Cancer Risk Factors

Risk factors for breast cancer include:

 A personal or family history of breast cancer  A biopsy-confirmed hyperplasia  A long menstrual history (menstrual periods that started early and ended late in life)  Obesity after menopause  Recent use of oral contraceptives or postmenopausal estrogens and progestin  Not having children or having a first child after age 30  Consumption of alcoholic beverages

Suspected risk factors include:

 High breast density

- 78 - - 78 -Page 78 of 155 Burke County Community Health Assessment

Lung Cancer

Lung Cancer Incidence

Between 2005 and 2009, 461 new cases of trachea, bronchus, and lung cancer were diagnosed in Burke County which increased by 78 new cases from the 1999- 2003 number of 383. Lung cancer is the second highest age-adjusted incidence rate of any cancer in the county. The resulting aggregate incidence rate of 87.7 was slightly higher than the rate for the state as a whole at 76.3. In 2009, hospital charges for the treatment of lung cancer in Burke County residents totaled almost $1 million which is lower than the 2004 amount of $1.5 million.

Since 1995, Burke County lung cancer incidence rate has remained below the state, although it spiked between the 1998-2002 and 1999-2003 aggregate periods. Unfortunately, the aggregate period 2003-2007 shows an increase in the incidence rate in Burke County to push higher than the state (88.0 vs. 75.8).

Lung Cancer Mortality

The 2005-2009 lung cancer mortality rate was 11% higher in Burke County than in the state as a whole (64.1vs. 57.0) (Table 62). Between 2005 and 2009, a total of 348 people died of lung cancer in Burke County. This figure has increased by 24 people since the 2000-2004 data. Before 1999-2003, the lung cancer mortality rate in Burke County (67.5 vs. 69.3) remained almost parallel below the NC rate, but after 2003 passed the NC rate. The incidence rate for 2003-2007 reported a rate of 88.0 for Burke County and 75.8 as the state rate.

Table 62. Lung Cancer Mortality (2005-2009)

Table 62. Lung Cancer Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females

County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 348 64.1 199 93.9 128 44.3 12 n/a 2 n/a State Total 26,681 57.0 12,605 76.9 9,292 43.7 3,061 90.3 1,723 33.0

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Gender and Racial Disparities in Lung Cancer Mortality

It appears that gender disparities may be more pronounced than racial disparities. In Burke County, minority comparisons cannot be made due to small numbers and no rate calculated. However, statewide the lung cancer mortality rate for white men is approximately 43% higher than the rate for white women. The lung cancer mortality rate for minority men is more than 2 ½ times the rate for minority women.

- 79 - - 79 -Page 79 of 155 Burke County Community Health Assessment

Lung Cancer Risk Factors

Risk factors for lung cancer include:

 Cigarette smoking  Exposure to arsenic  Exposure to some organic chemicals, radon, and asbestos  Radiation exposure from occupational, medical, and environmental sources  Air pollution  Tuberculosis  Secondhand exposure to tobacco smoke

- 80 - - 80 -Page 80 of 155 Burke County Community Health Assessment

Prostate Cancer

Prostate Cancer Incidence

Between 2003 and 2007, prostate cancer had the third highest age-adjusted incidence rate of any cancer in Burke County, at 138.5 cases per 100,000, slightly lower than the rate for North Carolina (153.8). There were 322 new cases of prostate cancer diagnosed in the county during this period compared to 316 cases in 1999-2003.

Between 1995 and 2002, the Burke County prostate cancer incidence rate had remained relatively stable and below the comparable state rate to date. In the aggregate four year period of 1999-2003, both the state and Burke County rates dropped; however the 2003-2007 incidence rates have again taken a sharp increase at both the county and state level (136.5 and 153.8 respectively) as reported by the NC Central Cancer Registry in 2010.

Prostate Cancer Mortality

The 2005-2009 prostate cancer mortality rate was 34% lower in Burke County than in the state as a whole (6.3 vs. 9.6) (Table 63). During that period, 34 men in Burke County died from prostate cancer. The prostate cancer mortality rate in the county has fluctuated but has remained below the rate for the state as a whole. The overall mortality rate has decreased significantly at both the county and state level since the 2000-2004 aggregate period. In 2000-2004 the rate for Burke County was 19.5 and the state rate was 32.7 but in 2005-2009 the rate for Burke County was 6.3 and the state was 9.6.

Table 63. Mortality: Prostate Cancer (2005-2009)

Table 63 . Prostate Cancer Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females

County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 34 6.3 28 14.5 0 0.0 6 n/a 0 0.0 State Total 4,306 9.6 2,863 20.5 0 0.0 1,443 58.4 0 0.0

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005- 2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

- 81 - - 81 -Page 81 of 155 Burke County Community Health Assessment

Racial Disparities in Prostate Cancer Mortality

Because the number of minority males in the county that died from prostate cancer in that time (n=6) is so low, meaningful comparison of mortality rates is not possible. Statewide, however, the prostate cancer mortality rate among minority males is over 2 ½ times the rate among white males. In Burke County the prostate cancer mortality rate among white males is 29% lower than the comparable state rate. In Burke County, the number of white males dying from prostrate cancer is significantly higher than minority males.

Prostate Cancer Risk Factors

Risk factors for prostate cancer include:

 Increasing age  Familial predisposition (may be responsible for 5-10 percent of cases)

A suspected risk factor is:

 High fat consumption

- 82 - - 82 -Page 82 of 155 Burke County Community Health Assessment

Colon and Rectal Cancer

Colorectal Cancer Incidence

Cancers of the colon and rectum accounted for 246 new cancer diagnoses in Burke County between 2003 and 2007, making it the fourth most commonly diagnosed cancer in the county. The incidence rate (47.9) for colon and rectal cancer was 1% higher than the incidence rate for the state as a whole (47.4). In 2009, hospital charges attributable to colorectal cancers among Burke County residents totaled more than $2.4 million.

The Burke County colorectal cancer incidence rate has remained below the state rate until 1999-2003 data when Burke County became close to the state rate (44.6 vs. 48.2) and the most recent aggregate period shows Burke County has surpassed the state rate by .5 (47.9 vs. 47.4).

Colorectal Cancer Mortality

In Burke County during the period from 2005 through 2009, 107 people died from colorectal cancer, representing an age-adjusted mortality rate of 19.8 per 100,000, slightly higher than the statewide rate (Table 64). The mortality rates are higher in Burke County than at the state level.

Table 64. Colorectal Cancer Mortality (2005-2009)

Table 64. Colorectal Cancer Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females

County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 107 19.8 63 30.3 38 12.8 4 n/a 2 n/a State Total 7,621 16.5 2,939 18.4 2,789 12.8 944 29.5 949 18.8

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005- 2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Gender and Racial Disparities in Colorectal Cancer Mortality

Because the number of minority males in the county that died from prostate cancer in that time (n=4) and minority females (n=2) is so low, meaningful comparison of mortality rates is not possible. Since the 2006 Community Health Assessment, 2 minority female deaths occurred due to colorectal cancer. The colorectal cancer mortality rate for white men is 58% higher than the rate for white women. The mortality rate for white females is exactly the same for Burke County and the state. In Burke County, the number of deaths in white males is almost double the number of white females.

- 83 - - 83 -Page 83 of 155 Burke County Community Health Assessment

Colorectal Cancer Risk Factors

Risk factors for colorectal cancer include:

 Personal or family history of rectal polyps  Inflammatory bowel disease

Other suspected risk factors include:

 Smoking  Physical inactivity  High-fat diet  Low-fiber diet  Alcohol consumption

- 84 - - 84 -Page 84 of 155 Burke County Community Health Assessment

Chronic Lower Respiratory Disease

According to the National Institutes of Health (NIH), chronic obstructive pulmonary disease (COPD) is a group of lung diseases involving limited airflow, airway inflammation and the destruction of lung tissue. Hospital charges for treating Burke County residents with COPD totaled over $7.1 million in 2009, an increase from $5 million in 2004.

CLRD/COPD Mortality

COPD/CLRD was the third leading cause of death in Burke County for the period 2005-2009. Table 65, shows race-sex specific age-adjusted mortality rates for CLRD/COPD in Burke County and North Carolina. For the most current aggregate time period (2005-2009), the overall CLRD/COPD mortality rate in Burke County (48.7) was 3% higher than the state rate (47.0).

Table 65. Chronic Lower Respiratory Disease Mortality, including COPD (2005-2009)

Table 65. Chronic Lower Respiratory Disease Mortality, including COPD (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 261 48.7 119 60.5 133 45.4 6 n/a 3 n/a

State Total 21,228 47.0 8,817 59.1 9,995 45.5 1,362 47.4 1,054 21.0

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race- Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Both the Burke County and North Carolina CLRD/COPD mortality rates have climbed steadily since 1979, with the local rate consistently above the state rate but has closed the gap in this recent aggregate period. In 1999-2003, Burke County mortality rate was 48.2 compared to the state rate of 46.8. In 2000-2004, Burke County’s rate was 51.2 and the state rate was 46.0 while the 2005-2009 data shows Burke County decreased to 48.7 and the state rate increased to 47.0.

Gender and Racial Disparities in CLRD/COPD Mortality

Because the number of minority males in the county that died from prostate cancer in that time (n=6) and minority females (n=3) is so low, meaningful comparison of mortality rates is not possible. The mortality rate for white men in Burke County is 25% higher than the rate for white women. The number of CLRD deaths among minority women in the county during the period (n=3) was below the threshold for meaningful local mortality rate comparisons. Statewide, however, the CLRD/COPD mortality rate for minority males is over two times the rate for minority females.

- 85 - - 85 -Page 85 of 155 Burke County Community Health Assessment

CLRD/COPD Risk Factors

The leading cause of CLRD/COPD is smoking, which leads to emphysema and chronic bronchitis, the two most common forms of CLRD/COPD. Other risk factors include environmental pollutants and passive smoking (exposure to secondhand smoke).

Unintentional Non-Motor Vehicle Injury

The NC-SCHS distinguishes unintentional non-motor vehicle injuries from motor vehicle injuries when calculating mortality rates for unintentional injuries and ranking leading causes of death. Both non-motor vehicle and motor vehicle injuries are among the ten leading causes of death in Burke County. Unintentional injuries of all types are costly injuries and led to over $30 million in hospital charges for Burke County residents in 2009, an increase of $13 million from 2004.

Non-Motor Vehicle Injury Mortality

Between the years 2005 and 2009, there were 203 deaths in Burke County due to unintentional non-motor vehicle injuries (e.g., boating accidents, falls, burns, animal bites, drowning, choking), making this category of injury the fifth leading cause of death in the county. Unintentional non-motor vehicle injuries are also the leading cause of death for Burke County residents between the ages of 20 and 39. For 2005-2009, the Burke County mortality rate attributable to non-motor vehicle injuries was 43.8 per 100,000 (Table 66), 35% higher than that of the state as a whole (28.6 per 100,000).

Table 66. All Other Unintentional Injury Mortality Rates (2005-2009)

Table 66. Unintentional Non-Motor Vehicle Injury Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 203 43.8 120 61.0 75 33.1 5 n/a 3 n/a

State Total 12,896 28.6 6,364 40.5 4,435 21.9 1,350 32.6 747 13.9

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race- Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Since 1994, the Burke County rate has exceeded the NC rate and continued to rise to its current rate of 43.8. Burke County increased the unintentional injury rate by 30% between aggregate periods 2000-2004 and 2005-2009 while the state only increased by 13% for the same years.

- 86 - - 86 -Page 86 of 155 Burke County Community Health Assessment

Gender and Racial Disparities in Unintentional Non-Motor Vehicle Injury Mortality

Significant gender disparities are apparent. The data shows that in Burke County the mortality rate among white males is 46% higher than among white females. This trend is exactly the same at the state level. There were too few deaths by this cause among minority women (n=3) and minority men (n=5) in Burke County to calculate a local rate for comparison, but at the state level, the non-motor vehicle mortality rate among minority men is more than 2 times the rate minority women.

Because the number of minority males in the county (n=5) and minority females (n=3) is so low, meaningful comparison of mortality rates is not possible. Racial disparities in injury mortality also exist in the county and the state. At the state level, the mortality rate among white males is 20% higher than that of minority males (40.5 vs. 32.6). At the state level, the mortality rate due non-motor vehicle injuries is 37% higher among white women than among minority women.

- 87 - - 87 -Page 87 of 155 Burke County Community Health Assessment

Diabetes

Diabetes is a disorder of the metabolic system resulting from a shortage of insulin, a hormone that allows sugar to enter body cells and convert into energy. If diabetes is uncontrolled, sugar and fats remain in the blood, over time damaging vital organs. Diabetes was the sixth leading cause of death in Burke County in 2000-2004 and dropped to the seventh leading cause of death in 2005-2009. Diabetes caused almost $1.8 million in hospital charges in 2004 and increased to $3.3 million in 2009.

Diabetes Incidence

 Burke County hospital discharge rates for diabetes from 2005-2008 spiked above the state rate in 2006 but dropped below the state rate in 2007 and has stayed below the state through the 2008 data (Figure 5).  In 2008, the hospital discharge rate for Burke County was 1.7 with the state rate at 1.8

Figure 5

Hospital Discharge Rate Diabetes (2005-2008)

2.5

2

1.5

1,000 per Rate Discharge 1 2005 2006 2007 2008

Burke NC

NC State Center fo r Health Statistics. Health Data. County-level Data. County Health Data Books, 2002-2006. Morbidity. Inpatient Hospital Utilization and Charges by Principal Diagnosis, and County of Residence. Available at: http://www.schs.state.nc.us/SCHS/data/databook/.

- 88 - - 88 -Page 88 of 155 Burke County Community Health Assessment

Diabetes Mortality

Between 2005 and 2009, 115 deaths in Burke County were caused by diabetes. The Burke County mortality rate attributable to diabetes during this period was 21.7, 8% lower than the state rate of 23.6 (Table 67). In Burke County, the overall number of deaths attributable to diabetes has dropped from 129 in 2000-2004 to 115 in 2005-2009 with the greatest drop occurring in white females from 63 (2000-2004) to 38 (2005-2009).

Table 67. Diabetes Mortality (2005-2009) Table 67. Diabetes Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 115 21.7 60 28.0 38 13.8 6 n/a 11 52.4 State Total 10,906 23.6 3,595 22.6 3,310 15.1 1,729 53.3 2,272 45.5

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race- Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Since 2003, the mortality rate for diabetes started to decrease at both the county and state level. The 2000-2004 aggregate data showed Burke County dropping below the state rate and the 2005-2009 data depicted a continually drop by 19% (26.9 in 2000-2004 and 21.7 in 2005-2009) in Burke County and the state with a 14% reduction (27.5 in 2000-2004 and 23.6 in 2005-2009).

Gender and Racial Disparities in Diabetes Mortality

In terms of gender disparities, in Burke County the diabetes mortality rate was 51% higher among white males than among white females. At the state level, the diabetes mortality rate was 33% higher among white males than among white females. There were too few deaths by this cause among minority males (n=6) in Burke County to calculate a local rate for comparison. However, at the state level, the rate among minority males was 15% higher than the rate among minority females.

A much more pronounced difference is seen at the state level, where the rate among minority males is 58% higher than the rate among white males. The diabetes mortality rate among minority females in Burke County is also more than twice the rate among white females with minority females being 74% higher than while females. At the state level, the diabetes mortality rate among minority females is twice the rate among white females.

Diabetes Risk Factors

Risk factors for diabetes include: older age; obesity; family history of diabetes; prior history of gestational diabetes; impaired glucose tolerance; and physical inactivity.

- 89 - - 89 -Page 89 of 155 Burke County Community Health Assessment

Pneumonia and Influenza

Pneumonia and influenza are diseases of the lungs. Influenza (the “flu”) is a contagious infection of the throat, mouth and lungs caused by an airborne virus. Pneumonia is an inflammation of the lungs caused by either bacteria or viruses. Bacterial pneumonia is the most common and serious form of pneumonia, and among individuals with suppressed immune systems it may follow influenza or the common cold. Pneumonia/Influenza was the eighth leading cause of death in Burke County in the period 2005-2009, and hospital charges in 2009 totaled $12.2 million.

Mortality

From 2005 through 2009, 108 deaths in Burke County were attributable to pneumonia or influenza, a decrease from the 121 deaths in 2000-2004. The overall county mortality rate for pneumonia and influenza in Burke County (20.6) during this period was 6% higher than the rate for North Carolina (19.4) as a whole (Table 68). Table 68. Pneumonia/Influenza Mortality (2005-2009)

Table 68. Pneumonia/Influenza Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 108 20.6 48 28.0 54 17.1 1 n/a 5 n/a

State Total 8,632 19.4 3 22.2 4,107 17.7 683 25.0 795 16.1

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

From 2000-2004, the overall number of pneumonia and influenza deaths was 121 and has steadily decreased over the next five year trend to 108 in 2009. Also, in those same years, white males and minority female deaths have increased while white females and minority males have decreased.

Gender and Racial Disparities in Pneumonia/Influenza Mortality

The numbers of pneumonia/influenza deaths among minority men and minority women in Burke County (n=1 and n=5, respectively) were below the threshold for meaningful local mortality rate comparisons. However, at the state level for the aggregate period 2005-2009, the pneumonia/influenza mortality rate among minority men was 11% higher than the rate among white men (25.0 vs. 22.2). Statewide, the mortality rate among white women was 9% higher than the rate among minority women (17.7 vs. 16.1).

For the aggregate period 2005-2009, the county pneumonia/influenza mortality rate among white men was 39% higher than the rate among white women (22.2 vs. 17.7). Statewide, the mortality rate among minority men was 36% higher than the rate among minority women (25.0 vs. 16.1).

- 90 - - 90 -Page 90 of 155 Burke County Community Health Assessment

Unintentional Motor Vehicle Injury

The NC-SCHS distinguishes unintentional motor vehicle injuries from all other injuries when calculating mortality rates and ranking leading causes of death. Injury mortality attributable to motor vehicle accidents is the tenth leading cause of death in Burke County.

Unintentional Motor Vehicle Injury Mortality

Between 2005 and 2009, there were 83 deaths due to motor vehicle injuries in Burke County, computing to a county vehicular injury mortality rate of 18.1, which has the trend decreasing over time. The 2000-2004, overall number of deaths was 109 and a mortality rate of 24.4 which translates to a reduction of 26 deaths in ten years due to vehicular injury.

Table 69. Unintentional Motor Vehicle Injury Mortality (2005-2009)

Table 69. Unintentional Motor Vehicle Injury Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females

County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 83 18.1 50 25.9 27 12.2 5 n/a 1 n/a State Total 8,027 17.6 4,211 25.3 1,848 10.5 1,425 27.4 543 8.5

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Gender and Racial Disparities in Motor Vehicle Injury Mortality

In Burke County, the mortality rate due to motor vehicle injury for white men is 53% higher than the rate for white women. There were too few deaths by this cause among minority males (n=5) and minority females (n=1) in Burke County to calculate a local rate for comparison. Statewide, the mortality rate for minority men is three times that for minority women and the rate for white men more than double the rate for white women.

The overall statewide trend in mortality due to motor vehicle injuries has declined gradually since 1979. In Burke County, the overall trend has been increasing and the local rate has surpassed the state rate in each of the two most recent aggregate reporting periods but has dropped in line with the state rate in the recent aggregate reporting period of 2005-2009. In 2000-2004 the Burke County rate was 24.4 with the state rate at 19.6; however, in 2005-2009 Burke County dropped 26% to 18.1 and the state reported a rate of 17.6.

- 91 - - 91 -Page 91 of 155 Burke County Community Health Assessment

While motor vehicle injuries are the tenth leading cause of death for Burke County residents overall, considerably more significant are rates for specific age groups. During the five-year aggregate period between 2000 and 2004, motor vehicle injuries were the second leading cause of death for Burke County residents under the age of 20 and in the age range 20-39, at mortality rates of 13.5 and 31.5. During the next five year aggregate period between 2005-2009, motor vehicle injuries dropped to the third leading cause of death for Burke County residents under the age of 39 depicting a slight improvement over time.

According to the NC Highway Safety Research Center, in 2009 there were 1,745 motor vehicle accidents in Burke County, resulting in 1,004 nonfatal injuries and 14 fatalities; 1,064 of the total crashes involved property damage only.

Frequently, motor vehicle crashes are associated with alcohol consumption. In 2009, 6.3% of all Burke County motor vehicle accidents were associated with alcohol. Alcohol was involved in 8.7% of all nonfatal motor vehicle accidents in the county but in 23.1% of fatal accidents. At the state level, a higher proportion of both nonfatal and fatal crashes were alcohol related (8.3% and 29.4%, respectively) than in Burke County.

Table 70. Motor Vehicle Accidents and Injuries, 2009

Table 70. Motor Vehicle Accidents and Injuries, 2009

Crashes Number of Injuries Alcohol Related Crashes Percent Number Alcohol Alcohol Percent Percent Total of Non- Alcohol Non-Fatal Fatal Related Related of Total of Fatal Number Fatal Related Non-Fatal Fatal Crashes Crashes Crashes

Burke County 1,745 109 1,004 14 87 3 6.3 8.7 23.1

State Total 204,167 11,263 108,669 1,346 8,767 394 5.5 8.3 29.4

Highway Safety Research Center, NC Alcohol Facts, Source: http://www.hsrc.unc.edu/ncaf

- 92 - - 92 -Page 92 of 155 Burke County Community Health Assessment

Alzheimer’s Disease

Alzheimer’s disease is a progressive neurodegenerative disease affecting mental abilities including memory, cognition and language. Alzheimer’s disease is characterized by memory loss and dementia. The risk of developing Alzheimer’s disease increases with age (e.g., almost half of those 85 years and older suffer from Alzheimer’s disease). Early-onset Alzheimer’s has been shown to be genetic in origin, but a relationship between genetics and the late-onset form of the disease has not been demonstrated. No other definitive causes have been identified.

Alzheimer’s Disease Mortality

Alzheimer’s disease data has been recorded only in recent years, so trend data is not yet available. According to data aggregated between 2000-2004, the mortality rate attributable to Alzheimer’s disease was somewhat lower in Burke County than in North Carolina (22.4 vs. 24.2), however, in the 2005-2009 aggregated data Burke County is slightly higher than NC (28.7 vs. 28.3 respectively) (Table 71). During this period there were 105 deaths due to Alzheimer’s disease in the county, where it was the ninth leading cause of death and in 2005-2009, the number of deaths increased to 151 and now ranks as the sixth leading cause of death in both Burke County and North Carolina.

Table 71 Alzheimer's Disease Mortality (2005-2009)

Table 71. Alzheimer's Disease Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 151 28.7 40 23.5 108 32.5 1 n/a 2 n/a

State Total 12,386 28.3 2,897 22.7 7,745 32.3 434 20.1 1,310 27.0

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Gender and Racial Disparities in Alzheimer’s Disease Mortality

In Burke County the mortality rate due to Alzheimer’s disease for the period 2005 through 2009 was 28% higher among white females than among white males. There were too few deaths due to Alzheimer’s disease among Burke County minorities during the period (n=1 for minority males; n=2 for minority females) to compute rates reliable for comparison. Statewide, however, the rates for Alzheimer’s disease mortality were considerably lower among minorities than among whites of either gender.

- 93 - - 93 -Page 93 of 155 Burke County Community Health Assessment

Suicide

Between 2000 and 2004, there were 81 deaths due to suicide in Burke County, making it the tenth leading cause of death. Conversely 2005-2009, overall suicide deaths dropped to 75 in Burke County and dropping it to the eleventh leading cause of death. While the number of deaths has decreased in Burke County, the suicide mortality rate of 17.1 (2005-2009) is still 30% higher than the state rate of 12.0 which is up from the 2000-2004 rate. Over the last several years, Burke County has seen a decreasing trend in suicide deaths but continues to be higher than the state rate.

Table 72. Suicide (2005-2009)

Table 72. Suicide Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 75 17.1 58 29.1 12 n/a 4 n/a 1 n/a State Total 5,483 12.0 3,757 22.3 1,127 6.4 479 8.7 120 1.6

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Gender and Racial Disparities in Suicide

The numbers of suicide deaths among the Burke County minority population were too low (n=4 for minority males; n=1 for minority females) during the period to calculate mortality rates reliable for comparison. However, at the state level, the suicide mortality rate among minority men was more than 5 times the rate among minority women. In Burke County, the number of suicide deaths had decreased in white males and females and minority males but rose by 1 in minority females.

At the state level, the suicide mortality rate among white males was approximately 2.5 times the rate among minority males, and 3 times the rate among white women and approximately 93% higher than the rate among minority women.

- 94 - - 94 -Page 94 of 155 Burke County Community Health Assessment

Age Disparities in Suicide

Compared to the state, Burke County experiences a greater proportion of suicide deaths among residents who are between 20 and 39. In the 2005-2009 aggregated data, suicide deaths was not in the top ten leading causes of death in all ages for both Burke County and North Carolina. In the 2005-2009 data, the number of deaths in Burke County in the other age groups only rose slightly from the 2000-2004 aggregated data (2000-2004 – 1 age 0-19; 28 aged 20-39; and 33 aged 40-64) (2005-2009 – 2 aged 0-19; 29 aged 20-39 and 36 aged 40-64 respectively).

Table 73. Suicide Death Counts and Unadjusted Death Rates, by Age (2005-2009)

Table 73. Suicide Death Counts and Unadjusted Death Rates, by Age (2005-2009)

All Ages Ages 0-19 Ages 20-39 Ages 40-64 Number Death Rate Number Death Rate Number Death Rate Number Death Rate

Burke County 0 0 2 1.7 29 25.2 36 24

State Total 0 0 260 2.1 1,747 13.8 2,592 17.5

Source NC State Center for Health Statistics, County-level Data. County Health Databooks. 2009 County Health Databook. Death Counts and Crude Death Rates for Leading Causes of Death, by Age Groups NC 2005-2009. http://www.schs.state.nc.us/SCHS/data/databook/

Suicide was not listed as one of the top ten leading causes of death for all ages for either Burke County or North Carolina.

- 95 - - 95 -Page 95 of 155 Burke County Community Health Assessment

Nephritis, Nephrotic Syndrome and Nephrosis

Nephritis, nephrotic syndrome and nephrosis are renal (kidney) disorders. Nephritis is any inflammation of the kidneys, while nephrotic syndrome (also known as nephrosis) is a kidney disease resulting from damage to the blood vessels that filter waste from the blood. These conditions can result from infections, drug exposure, malignancy, hereditary disorders, immune disorders, or diseases that affect multiple body systems (e.g., diabetes and lupus) (67). This complex of kidney disorders represented the ninth leading cause of death in Burke County for the period from 2005 through 2009, and cost county residents $3.2 million in hospital charges in 2009 compared to $1.6 million in 2004.

Kidney Disease Mortality

Kidney disease was the eleventh leading cause of death in Burke County over the period from 2000 through 2004, but the trend has worsened with the 2005-2009 data showing that kidney disease is now the ninth leading cause of death in Burke County. A total of 68 deaths were reported in 2000-2004 and 97 deaths in 2005-2009. Currently, the mortality rate from all kidney disorders among Burke County residents is 18.4 per 100,000, a figure 2% lower than that of NC as a whole (Table 74).

Table 74. Nephritis, Nephrotic Syndrome, Nephrosis Mortality (2005-2009)

Table 74. Nephritis, Nephrotic Syndrome, Nephrosis Mortality (2005-2009)

Minority Overall Rate White Males White Females Minority Males Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 97 18.4 40 20.1 50 16.6 3 26.3 4 n/a State Total 8,449 18.7 2,725 19.0 2,830 12.5 1,236 41.6 1,658 34.0

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

Both Burke County and North Carolina as a whole has seen a significant increase in the number and rate of kidney disease mortality from 2000-2004 data and the recent 2005-2009 statistics. The state saw an increase of 1,526 deaths in the past ten years.

- 96 - - 96 -Page 96 of 155 Burke County Community Health Assessment

Gender and Racial Disparities in Kidney Disease Mortality

In Burke County, the kidney disease mortality rate among white males was 17% higher than among white females. The number of county deaths due to kidney disease among minority males (n=3) and minority females (n=4) was too small to generate a rate reliable for comparison. At the state level, the renal disease mortality rate among minority males was 18% higher than the rate among minority females. At the state level, minority males had a mortality rate a little over two times that of white males.

Septicemia

Septicemia is a rapidly progressing infection resulting from the presence of bacteria in the blood. The disease often arises from other infections throughout the body, such as meningitis, burns and wound infections. Septicemia can lead to septic shock wherein low blood pressure and low blood flow cause organ failure. Hospital charges associated with its treatment totaled over $4.7 million for county residents in 2004 and has risen more than $6.5 million to $11.2 million in 2005-2009 data.

Septicemia Mortality

Septicemia was the twelfth leading cause of death in Burke County for the period 2000 through 2004 but has risen to the tenth leading cause of death in 2005- 2009. The mortality rate in 2000-2004 was 13.1 per 100,000 and unfortunately has increased to 15.9 per 100,000 in 2005-2009. The 13.1 rate in Burke County in 2000-2004 was 8% lower than that of the state as a whole but now is 13% higher than the state rate in 2005-2009 (Table 75).

Table 75. Septicemia Mortality (2005-2009)

Table 75. Septicemia Mortality (2005-2009)

Minority Overall Rate White Males White Females Minority Males Females

County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 83 15.9 41 21.7 33 10.7 4 n/a 5 n/a State Total 6,241 13.8 2,007 13.4 2,524 11.4 749 24.4 961 19.5

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

- 97 - - 97 -Page 97 of 155 Burke County Community Health Assessment

Gender and Racial Disparities in Septicemia Mortality

The county mortality rate due to septicemia among white males was 15% higher than the comparable rate for white females. In the most recent five-year aggregate (2005-2009), the numbers of septicemia deaths among minority males (n=4) and minority females (n=5) were too small to compute a rate reliable for comparison. At the state level, however, the septicemia mortality rate among minority men was 20% higher than the rate among minority women.

In North Carolina, all genders and races increased in the number of deaths due to septicemia but in Burke County all increased except for white females with their numbers staying the same.

Chronic Liver Disease and Cirrhosis

Chronic liver disease is marked by the gradual destruction of liver tissue over time. Cirrhosis is a group of chronic liver diseases in which normal liver cells are damaged and replaced by scar tissue, progressively diminishing blood flow through the liver. Risk factors for chronic liver disease include: exposure to hepatitis and other viruses; use of certain drugs; alcohol abuse; chemical exposure; autoimmune diseases; diabetes; malnutrition; and hereditary diseases. In 2004, chronic liver disease and cirrhosis cost county residents $425,339 in hospital charges and in the 2005-2009 data this disease costs residents $694,367, accounting for an increase of $269,028.

Chronic Liver Disease and Cirrhosis Mortality

Between 2000 and 2004, liver disease/cirrhosis was the thirteenth leading cause of death in Burke County and has increased to the twelfth leading cause of death in 2005-2009. In 2000-2004, there were 42 deaths attributable to chronic liver disease/cirrhosis and in 2005-2009 there were 45 deaths (Table 77). The 2005- 2009 age-adjusted county mortality rate was 8.5 (Table 76), 7% lower than the comparable state rate of 9.1.

Table 76 Chronic Liver Disease and Cirrhosis Mortality (2005-2009)

Table 76. Chronic Liver Disease and Cirrhosis Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 45 8.5 27 12.1 15 n/a 3 n/a 0 0.0 State Total 4,356 9.1 2,326 13.1 1,204 5.9 541 12.2 285 4.9

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

From 2000 to 2009, Burke County and the state have seen their rates parallel and level off with the mortality rate due to liver disease/cirrhosis.

- 98 - - 98 -Page 98 of 155 Burke County Community Health Assessment

Gender and Racial Disparities in Chronic Liver Disease and Cirrhosis Mortality

There were only three minority male deaths and no minority female deaths due to liver disease and cirrhosis in Burke County in this time period (Table 76), so the resulting mortality rates are not reliable for comparison. At the state level, however, the liver disease mortality rate among minority males was 2.4 times the rate among minority females.

At the state level, the liver disease mortality for minority men was just 7% higher than the rate for white men, and the mortality rate among minority women was almost identical to the rate among white women.

Homicide

Homicide was the fourteenth leading cause of mortality in Burke County for the period 2000 through 2004 and was responsible for 23 deaths in that five-year aggregate but the 2005-2009 data depicts an increase to the thirteenth leading cause of death in Burke County with 24 deaths. The county homicide rate for 2000-2004 was 5.1 per 100,000 and 5.5 in 2005-2009 while continuing to stay 21% lower than the state rate.

Table 77. Homicide (2005-2009)

Table 77 . Homicide Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females

County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 24 5.5 15 n/a 5 n/a 4 n/a 0 0.0 State Total 3,160 7.0 976 5.8 414 2.4 1,451 27.0 319 5.4

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005-2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

- 99 - - 99 -Page 99 of 155 Burke County Community Health Assessment

Gender and Racial Disparities in Homicide

The aggregate number of homicide deaths for white females (n=5), minority males (n=4), and minority females (n=0) for the period from 2005 through 2009 were too low to calculate mortality rates for reliable comparison. However, for the 2005-2009 aggregate, the North Carolina mortality rate among white males was more than 2 times the rate among white females, and the rate among minority males almost 5 times the rate among minority females.

At the state level, the homicide rate among minority males was 4 times the rate among white males, and the rate among minority females was a little more than 2 times the rate among white females.

- 100 - - 100 -Page 100 of 155 Burke County Community Health Assessment

Communicable Disease

Reportable Communicable Diseases

Health professionals are required to report cases of certain communicable diseases to the North Carolina Department of Health and Human Services through their local health department. Tables 91 and 92 present Burke County and North Carolina average data for several important infectious diseases subject to this requirement. Food-, water- and vector-borne communicable diseases also are discussed in Volume II (Environmental Data) of this assessment.

There were no cases of measles or mumps in the county during 2000-2005, despite their presence in the state. The numbers of Burke County cases of Hepatitis A, B, and C and VRE were all lower than the average numbers of cases compared to other NC counties.

Table 78. Communicable Disease Incidence (2000-2005)

Number of Cases

Hepatitis A Hepatitis B Hepatitis C Measles Mumps Pertussis VRE*

Burke County 14 8 1 0 0 16 6 State Total 920 1,222 117 3 36 622 2,808

* VRE = Vancomycin resistant enterococci Source NC Division of Public Health, Epidemiology, Communicable Disease Control, County Tables, http://www.epi.state.nc.us/epi/gcdc.html

- 101 - - 101 -Page 101 of 155 Burke County Community Health Assessment

Sexually Transmitted Infections

Table 79 lists incidence rates for the most prevalent STIs and HIV/AIDS in Burke County. From these data it is apparent that during the years 2000 – 2009, the incidence rate trend for Chlamydia, Gonorrhea, Syphilis and HIV/AIDS have all been increasing, during the past ten years.

Table 79. Sexually Transmitted Infection Incidence Rates, Burke County

Table 79. Sexually Transmitted Infection

Incidence Rates

Burke County (2000-2009)

2000-2004 2005-2009

Chlamydia ¹ n/a 197.8 Gonorrhea 39.9 78.5 Minority 153.8 263 Syphilis 0.2 2.7 Minority 0.0 1.8 HIV/AIDS 2.2 2.9

Source for Chlaymdia data: NC State Center for Health Satatistics. NC Health Statistics Pocket Guide. Morbidity Statistics. Selected Health Indicators. http://www.schs.state.nc.us/SCHS/data/other.cfm

Source for all other data: NC State Center for Health Statistics, County-level Data. County Health Databooks. 2010 County Health Data Book. http://www.schs.state.nc.us/SCHS/healthstats/databook/

Gonorrhea

The minority population in Burke County, as in the state as a whole, is disproportionately burdened by gonorrhea. The 2000-2009 incidence rate for gonorrhea among minority residents of Burke County was over 3 times the rate for the county as a whole (Table 79). Gonorrhea has increased 42% in the minority population from 2000-2004 to 2005-2009 and rose 49% in the county as whole from one set of aggregated data to another.

Syphilis

Primary and secondary syphilis are the communicable stages of the disease and as such are the cases that are reported. The Burke County incidence rate for the period 2000-2004 is 0.2 cases per 100,000 versus 2.7 cases per 100,000 for in 2005-2009 an increase of 93% (Table 79).

- 102 - - 102 -Page 102 of 155 Burke County Community Health Assessment

HIV/AIDS

HIV/AIDS Incidence

The 2005-2009 HIV/AIDS incidence rate in Burke County was 2.9 cases per 100,000, a rate 57% lower than the statewide incidence rate of 6.8. Between 1997 and 2003, the number of cases of HIV/AIDS in Burke County has changed very little but never exceeded 2.2 cases per 100,000 until the 2005- 2009 data which shows a slight increase to 2.9 cases per 100,000.

HIV/AIDS Mortality

The number of deaths attributable to HIV/AIDS is presented in Table 80 . Please note that the numbers of AIDS deaths in Burke County are very low and the resulting rates should be interpreted with extreme caution. Burke County mortality rates are either below or very similar to the comparable state rates for all represented groups.

Table 80. HIV/AIDS Mortality (2005-2009)

Table 80. HIV/AIDS Mortality (2005-2009)

Overall Rate White Males White Females Minority Males Minority Females County Number Rate Number Rate Number Rate Number Rate Number Rate

Burke County 5 n/a 4 n/a 1 n/a 0 0.0 0 0.0 State Total 1,934 4.2 353 2.0 76 0.5 970 n/a 535 n/a

Source NC State Center for Health Statistics, County-level Data. County Health Databook. 2009 County Health Data Book. 2005- 2009 Race-Sex-Specific Age-Adjusted Rates by County. http://www.schs.state.nc.us/SCHS/data/databook/

**Rates that are based on fewer than 20 cases (indicated by n/a) are unstable and do not have calculated rates. The trend for HIV/AIDS mortality since 2000 has been declining in all genders and ethnicities.

Gender and Racial Disparities in HIV/AIDS Mortality

The numbers of HIV/AIDS deaths in Burke County for the aggregate period 2000-2004 were too small to compute stratified rates reliable for comparison. At the state level, however, the racial disparity in HIV/AIDS mortality becomes clear. Statewide comparisons could not be made since there were no mortality rates given. At the state level, just comparing number of deaths, it is easy to see that minorities continue to be disproportionately higher than whites and the minority females had 459 more deaths than white females.

- 103 - - 103 -Page 103 of 155 Burke County Community Health Assessment

Oral Health

Child Oral Health

In years past, the Oral Health Section of the North Carolina Division of Public Health periodically coordinates a dental assessment screening for kindergarten and fifth-grade school children. Dental hygienists use a standardized technique to measure the prevalence of decayed and filled teeth among these children. Since the 2006 Community Health Assessment the State Dental Hygienist for Burke County retired and the state eliminated the position. Local school nurses routinely screen 1st, 3rd and 5th grades and the information gathered is listed below. In June, 2010, the Burke County Health Department closed their Child Dental Clinic due to reduction of revenue and clients since dentists in Burke County began seeing Medicaid and Health Check/Health Choice clients due to the worsening economic trends within the county and state.

According to the Burke County Public School Nurse Program:

 1,815 – Pre-K to 12th grade students received dental screenings from a school nurse.  161 students were referred to see a dentist.  Of those 161 referrals, 91 students secured dental care.

- 104 - - 104 -Page 104 of 155 Burke County Community Health Assessment

Adult Oral Health

The data used for this section is derived from the 2010 BRFSS Survey for the Western NC Region and North Carolina. The majority of respondents for these two questions were female.

While the majority of adult respondents both in the Burke region and the state reported having visited a dentist within the last 12 months, a higher percentage of regional respondents said it had been more than five years since their last dental visit (Figure 6).

When compared to statewide results, a lower percentage of Burke region respondents reported having lost no teeth. Additionally, a higher percentage of county residents reported losing 1-5, 6 or more and all of their teeth to decay when compared to the state results (Figure 7, following page).

Figure 6

2010 BRFSS Results: Time Since Last Visit to Dentist

80 67.0 70 62.5 60

50

40 30 17.5 20 10.3 10.1 11.8 9.8 9.4 10 Percentage of Respondents Percentage 0.8 0.7 0

1-12 Months 1-2 Years 2-5 Years More than 5 Never Years

Burke County Region North Carolina

- 105 - - 105 -Page 105 of 155 Burke County Community Health Assessment

Figure 7

2010 BRFSS Results: Number of Teeth Missing Due to Tooth Decay

60 53.3

50 44.4 40 30.7 30 28.0

20 15.1 12.0 9.7 10 6.7 Percentage of Respondents Percentage 0 1-5 6 or More All None

Burke County Region North Carolina

Source for Figures 6 and 7: NC State Center for Health Statistics. BRFSS. 2010 Survey Results. Alexander, Burke, Caldwell, Cleveland and Lincoln Counties. Oral Health. http://www.schs.state.nc.us/SCHS/brfss/2010

Substance Abuse

According to the Burke Council on Alcoholism and Chemical Dependency:

 Their Student Assistance and Substance Use programs saw 712 to 748 students from 2007 – 2010. These programs provide individual and group education and counseling to students.  These programs had over 3,000 unduplicated contacts per year with students, parents, faculty and community members.  The council fielded over 1,300 calls each year for general information, referral or appointments.  Over 10,000 pieces of literature (educational material) was distributed in the community.

- 106 - - 106 -Page 106 of 155 Burke County Community Health Assessment

Obesity

Childhood Obesity

According to Eat Smart Move More North Carolina:

 North Carolina has the 11th highest childhood obesity rate in the nation.  Nearly 32% of children ages 10-17 in North Carolina are overweight or obese.  Nearly 31% of those children age 2-4 who participate in WIC in North Carolina are overweight or obese.

According to the NC-NPASS data, regarding children who are at risk of becoming overweight:

 In 2009, Burke County had 39.5% of children 2-18 years of age that were overweight and/or obese compared to the statewide percentage of 34.2.  Burke County was higher than the average NC County at 30.2% overweight/obese children age 2-18.

The Burke County’s Public School’s School Health Advisory Committee has been working on a School Based Wellness initiative in the 15 elementary schools for the past couple school years and will be highlighting their endeavors and successes in the accompanying action plan.

Asthma

 The hospitalization rate due to asthma (including children and adults) was 33% lower in Burke County (88.1) than the state as a whole (117.1) (Table 81, on following page).  For children aged 0-14, the Burke County asthma hospitalization rate of 69.2 is 40% lower than the state rate of 175.0.  Since 1997, the Burke County total hospitalization rate due to asthma has remained below the state rate.

- 107 - - 107 -Page 107 of 155 Burke County Community Health Assessment

Table 81. Asthma Hospitalization Rates

Table 81. Asthma Hospitalization Rates (2009)

Asthma Hospitalizations Per 100,000 (2009 Hospital Discharge Reports)

Total Ages 0-14 Years County Number Rate Number Rate

Burke County 79 88.1 11 69.2 State Total 10,986 117.1 3,228 175.0

Source NC State Center for Health Statistics, County-level Data. County Health Databooks. 2009 County Health Databook. Asthma Hospitalizations per 100,000, 2009 Hospital Discharge Reports. http://www.schs.state.nc.us/SCHS/healthstats/databook/

- 108 - - 108 -Page 108 of 155 Burke County Community Health Assessment

Chapter Three

Community Health Survey

- 109 - - 109 -Page 109 of 155 Burke County Community Health Assessment Chapter Three

Chapter Three: Community Health Survey

Methodology

Members of the Burke County Health Assessment Team, assisted by the Burke County Health Department and community volunteers conducted the community survey using paper surveys and a “convenience sample” technique and Survey Monkey online survey. Surveys and the link to the online survey were taken to places where people were gathered for other purposes, for example, meetings, workplaces, waiting rooms, community events, etc. The sample sites were deliberately chosen to assure that the participants would be representative of the demographic distribution of the Burke County community. Surveys, which were available in English and Spanish versions, were distributed and retrieved by the volunteers over several months. Surveys plainly stated, and participants were reminded, that their responses would be confidential and not linked to them personally in any way. Copies of the survey are appended to this report. A total of 1,933 completed paper surveys or took the survey online through Survey Monkey. The following sources are where surveys or link access was distributed:

 Burke County Department of Social Services – staff and clients  Burke County Public Schools – teachers and parents of enrolled children  Burke Senior Center - clients  Catawba Valley Medical Services – patients and staff  Burke County Health Department – clients and staff  Daycare centers – teachers, parents and staff  Good Samaritan Clinic - clients  Grace Hospital – staff  Hispanic population – members of the local community  Hmong population – members of the local community  Survey monkey link e-mailed to 60 churches for their bulletin  Newspaper article with link to online survey  Western Piedmont Community College – staff and students  6 local banks  J. Iverson Riddle Development Center staff  Broughton Hospital staff  4 large businesses - staff  Grace Heights, Grace Ridge and College Pines  Employment Security Commission – staff and residents  13- town/municipalities – office  Burke Council on Alcoholism and Chemical Dependency  Morganton Rotary Club  Council on Aging  Blue Ridge Community Action

- 110 - - 110 -Page 110 of 155 Burke County Community Health Assessment Chapter Three It should be noted that not every respondent answered every question. The number and corresponding percentage of individuals who chose each response category are presented in the analysis below. Responses to behavioral questions are stratified by gender, age, race, and income. Responses to access to care questions are stratified by age, race, and income.

Survey Participants

Survey participants were asked to provide demographic information about themselves by selecting appropriate responses from lists describing categories of age, gender, race and ethnicity, marital status, education level, employment status, household income, and who that income supports. This demographic information was collected in order to assess how well the survey participants represented the general population of Burke County. Table 104 presents the demographic profile of the survey respondents as compared to that of the general Burke County population.

Survey Results

Note: The order of some of the questions in the analysis may differ from their order in the actual survey, having been rearranged for clarity.

Demographic Questions

1. Do you live in Burke County? (n=1,798) Number Percent Yes 1,745 97 No 53 0.3  The vast majority of the survey participants live in Burke County.

2. Do you work or go to school outside Burke County? (n=1,776)

Number Percent Yes 363 20 No 1,413 80

 Approximately 20% of respondents work or attend school somewhere other than Burke County.

- 111 - - 111 -Page 111 of 155 Burke County Community Health Assessment Chapter Three

3. What is your zip code? (n=1,774)

Zip Code Number Percent 28655/28680 (Morganton) 1,165 66 28612 (Connelly’s Springs) 154 9 28601/28602 (Hickory) 60 3 28690 (Valdese) 198 11 28619 (Drexel) 49 3 28628 (Glen Alpine) 45 3 28666 (Icard) 23 1 28637 (Hildebran) 34 2 28671 (Rutherford College) 43 2

 Over 65% of respondents reside in Morganton.  Other zip codes include: Lenoir (3)

4. How old are you? (n=1,800)

Age Number Percent 18-24 99 6 25-29 125 7 30-34 187 10 35-39 226 13 40-44 219 12 45-49 199 11 50-54 246 14 55-59 204 11 60-64 158 8 65-69 69 4 70-74 29 2 75 and older 39 2

 35% of survey respondents were younger than 40.  7.6% of respondents were 65 or over.

5. What is your gender? (n=1,746) Number Percent Female 1,330 76.2 Male 416 23.8

 Approximately 73% of survey respondents were female. - 112 - - 112 -Page 112 of 155 Burke County Community Health Assessment Chapter Three

6. What is your race or ethnicity? (n=1,795)

Race/Ethnicity Number Percent White 1,555 86.6 Hispanic/Latino 125 6.9 African American/Black 65 3.6 Asian/Pacific Islander 30 1.7 Native American 10 0.6 Other 10 0.6 “Other write in’s” included: 2-White/Hispanic; 2-White/African American; 2-Hmong; 1-Native American/African American; 1-White/Pacific Islander

 Minorities comprised approximately 13% of the survey respondents.

7. What is your marital status? (n=1,798)

Status Number Percent Married 1,220 68 Never Married 229 13 Divorced 192 11 Widowed 59 3 Separated 59 3 Other 30 2 “Other write in’s included: 13-single; 3-in a relationship; 2- have partners; 1-separated but living with a woman for 3 yrs.; 1-married but not living with spouse and not legally separated 5-same sex relationships; 4 engaged.

 Approximately 68% of respondents were married.  Approximately 28% were unmarried (single, divorced, never married or widowed).

- 113 - - 113 -Page 113 of 155 Burke County Community Health Assessment Chapter Three

8. What is your highest education level? (n=1,791)

Educational Level Number Percent Less than high school 81 5 High School/GED 254 14 Associate’s Degree/Vocational Training 292 16 College degree 463 26 Graduate Degree or higher 415 23 Some college but no degree 286 16 Other “Other write in’s included: 9th-28 responses; 11th-25 responses; 10th-12 responses; 8th-6 responses; don’t know-4 responses; 5th-1 response; 7th-1 response; 6th-1 response and 1-current GED student.

 5% of respondents did not have a high school diploma.  Approximately 14% of respondents had a high school diploma or GED.  49% of respondents earned a college or graduate degree.

9. What is your employment status? (n=1,789)

Employment Number Percent ¹ Employed full-time 1,330 74 Employed part-time 149 8 Retired 161 5 Student 54 9 Unemployed 92 3 Homemaker 52 3 Disabled 53 3

1 Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with any other response. The total of the percent column is greater than 100.

 82% of respondents were employed full or part time.  5% of respondents were retired.  3% were unemployed and disabled or unable to work.

- 114 - - 114 -Page 114 of 155 Burke County Community Health Assessment Chapter Three 10. What was your total household income last year, before taxes? (n=1,714)

Income Number Percent Less than $20,000 223 13 $20,000- $29,999 192 11 $30,000- $49,999 401 23 $50,000- $74,999 441 26 $75,000 - $100,000 285 17 Over $100,000 172 10

 Approximately 13% of respondents have a household income of less than $20,000.  About 35% of respondents have a household income between $20,000 and $50,000.  Approximately 52.4% of respondents had a household income that was $50,000 or greater.  The majority of respondents had a household income of $50,000- $74,999.

11. How many children under 18 does this income support? (n=1,825)

Children <18 Number Percent 0 506 27.7 1-2 928 50.9 3-4 318 17.4 5-6 61 3.4 More than 6 12 0.7

 Approximately 2/3 of respondents are supporting two children or fewer with their household income.  About 17% are supporting three to four children.  Just over 4% support more than five children.

- 115 - - 115 -Page 115 of 155 Burke County Community Health Assessment Chapter Three 12. How many adults age 18 and older does this household income support? (n=1,691)

Adults Number Percent 0 85 5% 1-2 1,268 75% 3-4 236 14% 5-6 102 6% 1,691 responded to this question  The majority of those who did respond (80%) are supporting between one and two adults with their household income.

13. Are you the primary caregiver for any of the following (check all that apply): (n=195)

Caregiver Focus Number Percent Senior Adult (age 65 or older) 81 42 Disabled Child (under age 18) 29 15 Grandchild (under age 18) 46 24 Disabled Adult (age 18 or older) 47 24 Foster Child (under age 18) 10 5 Note: Since respondents could check all that apply, but all that replied was 195.

14. Please check the township in which you live: (n=1,740)

Age Number Percent Jonas Ridge 2 0.1 Lower Creek 40 2.3 Smokey Creek 2 0.1 Upper Fork 18 1.0 Icard 154 9 Upper Creek 40 2.3 Quaker 143 8.2 Meadows Morganton 821 47.2 Lovelady 188 10.8 Linville 39 2.2 Silver Creek 125 7.2 Drexel 124 7.1 Lower Fork 44 2.5

 Almost half of the respondents live in the Morganton area.  There were respondents from every township within the county.

- 116 - - 116 -Page 116 of 155 Burke County Community Health Assessment Chapter Three Quality of Life Statements

Community members were asked to respond to eight questions focused on local quality of life, choosing their response to each question as one of four Likert Scale choices: strongly disagree, disagree, agree and strongly agree. In the following section the analysis is based only on the population that actually answered each question (“respondents”).

1. There is a good health care system in Burke County. (Think about health care options, access, cost, availability, quality, etc.)

Health Care System Number Percent Strongly Disagree 106 6 Disagree 462 24 Agree 1,192 62 Strongly Agree 155 8 Total 1,915 100

 Nearly 70% of respondents either agreed or strongly agreed with the statement that there is a good health care system in Burke County.

2. Burke County is a good place to raise children. (Think about the availability and quality of schools, day care, after school programs, places to play, etc.)

Raise Children Number Percent Strongly Disagree 60 3.1 Disagree 296 15.5 Agree 1,191 62.3 Strongly Agree 365 19.1 Total 1,912 100

 The vast majority of respondents (81.3%) agreed or strongly agreed with the statement that Burke County is a good place to raise children.

3. Burke County is a good place to grow old. (Think about elder-friendly housing, access/ways to get to medical services, elder day care, and social support for the elderly living alone, meals on wheels, etc.)

Grow Old Number Percent Strongly Disagree 59 3.1 Disagree 250 13.1 Agree 1,265 66.2 Strongly Agree 336 17.6 Total 1,910 100

- 117 - - 117 -Page 117 of 155 Burke County Community Health Assessment Chapter Three

4. There are plenty of ways to earn a living in Burke County. (Think about job options and quality of jobs, job training/higher education opportunities, affordable housing, etc.)

Earn a Living Number Percent Strongly Disagree 614 32 Disagree 960 50 Agree 290 15 Strongly Agree 50 3 Total 1,914 100

 Nearly 82% of respondents disagreed or strongly disagreed with the statement that there are plenty of ways to make a living in Burke County.

5. Burke County is a safe place to live. (Think about safety at home, in the workplace, in schools, at playgrounds, parks, shopping centers, etc.)

Safe Place Number Percent Strongly Disagree 18 0.9 Disagree 101 5.3 Agree 1,476 77.1 Strongly Agree 319 16.7 Total 1,914 100

 Approximately 94% of respondents agreed or strongly agreed that Burke County is a safe place to live.

6. There is plenty of support for individuals and families during times of stress and need in Burke County. (Examples include neighbors, support groups, faith community outreach, agencies, organizations, etc.)

Plenty of Support Number Percent Strongly Disagree 69 3.6 Disagree 361 18.8 Agree 1,267 66.1 Strongly Agree 220 11.5 Total 1,917 100

 Approximately 18% of respondents disagreed with the statement that there is plenty of support for individuals and families during times of stress and need in Burke County.

- 118 - - 118 -Page 118 of 155 Burke County Community Health Assessment Chapter Three

7. Burke County has clean air.

Clean Air Number Percent Strongly Disagree 25 1.3 Disagree 164 8.6 Agree 1,470 76.8 Strongly Agree 254 13.3 Total 1,913 100

 The vast majority (77%) of respondents agreed that Burke County has clean air.

8. Burke County has clean water.

Clean Water Number Percent Strongly Disagree 27 1 Disagree 176 9 Agree 1,463 77 Strongly Agree 239 13 Total 1,905 100

 Nearly 77% of respondents agreed that Burke County has clean water.

- 119 - - 119 -Page 119 of 155 Burke County Community Health Assessment Chapter Three

Health Problems

Survey participants were presented an alphabetized list of twenty-one health problems and asked to select the five they thought had the greatest overall impact on health in Burke County. They also had the option of writing-in a topic of their choice as one of the five. The list of responses below in Table 82 is arranged in descending order of the frequency with which a named problem was chosen. Some respondents selected more than five, some fewer. A few skipped the section entirely.

Table 82. Ranking of Health Problems in Burke County

Health Problem Number Percent 1. Obesity/Overweight 1,451 76.7 2. Mental Health 1,173 62 3. Cancer 1,121 59.3 4. Diabetes 993 52.5 5. Heart Disease 943 49.9 6. Aging Problems 818 43.3 7. Teen Pregnancy 643 34.0 8. Poor Oral/Dental Health 505 26.7 9. Asthma 268 14.2 10. Lung Disease 266 14.1 11. Motor Vehicle Accidents 217 11.5 12. Infectious/Contagious Diseases 214 11.3 13. Stroke 173 9.1 14. Sexually Transmitted Infections 169 8.9 15. Kidney Disease 76 4.0 16. Gun Related Injuries 61 3.2 17. HIV/AIDS 46 2.4 18. Liver Disease 39 2.1 19. Infant Death 31 1.6 20. Other 76 4.0

“Other” write-ins included: topics that could be categorized under either unhealthy behaviors or community issues [i.e. substance abuse/drugs (34); smoking (4); chemicals being used (2), high blood pressure (2), head lice (1),thyroid problems (1); lack of education/low graduation rate (1); dangerous mold in schools (1); allergies (4); MRSA (1); children’s issues/safe homes (1); Parkinson’s (1); Fibromyalga (1); lack of interest in wellness (1); stress (2); lack of jobs & nothing being done about it (1); lack of care for uninsured (2)]

- 120 - - 120 -Page 120 of 155 Burke County Community Health Assessment Chapter Three

Unhealthy Behaviors

Survey participants were presented an alphabetized list of fifteen unhealthy behaviors and asked to select the five they thought had the greatest overall impact on health in Burke County. They also had the option of writing-in a topic of their choice as one of the five. The list of responses in Table 83 below is arranged in descending order of the frequency with which a named problem was chosen. Some respondents selected more than five, some fewer. A few skipped the section entirely.

Table 83. Ranking of Unhealthy Behaviors in Burke County

Unhealthy Behavior Number Percent 1. Drug Abuse 1,352 71.6 2. Alcohol Abuse 1,231 65.2 3. Poor Eating Habits 1,199 63.5 4. Lack of Exercise 1,133 60.0 5. Smoking/Tobacco Use 1,094 58.0 6. Not going for medical checkups 781 41.4 7. Having unsafe sex 506 26.8 8. Not going to the dentist for checkups 504 26.7 9. Reckless/drunk driving 443 23.5 10. Violent behavior 291 15.4 11. Breathing secondhand smoke 286 15.2 12. Not using child safety seats 144 7.6 13. Not Using Seatbelts 122 6.5 14. Not getting immunizations 115 6.1 15. Suicide 73 3.9 16. Other 26 1.4

“Other” write-ins included: “break up of family”; cell phone driving; substance abuse problems (3); “eating meat and dairy products”; elderly drivers; extramarital sex; unsafe public water; lottery; not having insurance; high schools; parents are not involved in children’s lives; “profiling from officers”; stress; and “the ER’s behavior toward Veterans”.

- 121 - - 121 -Page 121 of 155 Burke County Community Health Assessment Chapter Three

Community Social Issues

Survey participants were presented an alphabetized list of seventeen community social issues and asked to select the five they thought had the greatest overall impact on quality of life in Burke County. They also had the option of writing-in a topic of their choice as one of the five. The list of responses in Table 84 below is arranged in descending order of the frequency with which a named problem was chosen. Some respondents selected more than five, some fewer. A few skipped the section entirely.

Table 84. Ranking of Community Social Issues in Burke County

Community Social Issue Number Percent 1. Underemployment 1,650 87.8 2. Lack of Affordable Health Care/Insurance 1,216 64.7 3. Poverty 1,092 58.1 4. Neglect and Abuse 872 46.4

5. Lack of Education/Dropping out of school 789 42.0 6. Lack of transportation options 599 31.0 7. Homelessness 566 30.1 8. Availability of healthy food choices 564 30.0 9. Inadequate/unaffordable housing 525 27.9

10. Lack of cultural services 261 13.9 11. Racism 254 13.5 12. Lack of health care providers 164 8.7 13. Violent crime 159 8.5

14. Disaster preparedness/bioterrorism 149 7.9 15. Pollution 122 6.5

16. Other 104 5.5

- 122 - - 122 -Page 122 of 155 Burke County Community Health Assessment Chapter Three

“Other” community social issues that were written in included: Immigration (14); Drugs (8); Lack of services/problems with Department of Social Services (4); Lack of activities for youth (4); Domestic violence (4); Gas prices (3); School related issues (e.g., bullying, overcrowding) (3); Lack of child care (2); Poor emergency services (2); Lack of reading/studying programs (2); Lack of information (2); Lottery; Prescriptions being sold on the streets; Child molesters; Health insurance; High taxes; Lack of public “wellness” space; Lack of injustice in the court system; Lack of work ethic; Lack of morality; Lack of faith in God; Lack of crisis intervention; and “not allowing smokers their rights”.

Of the 195 people who indicated that the lack of health care providers was a top community issue, 86 of them wrote in a kind of provider that they felt was lacking. Some provided more than one suggestion: Specialists (15): including pediatric cardiologists, orthopedics, diabetes, and neurologists; gynecologists; Dentists (11): including child dentistry and those that take Medicaid and file insurance claims; For those who can’t afford to pay or are uninsured (15); Affordable (4); For the elderly (4); Cardiologists (3); Neurologists (3); Nurses (3); Child Psychiatrists (2); Counselors (2); Two in Spanish (2); Family Doctors (2); More doctors (2); More experienced doctors and nurses (2); Pediatricians (2); Bilingual services (2); Quality mental health care (1); CAPS Program (1); Oncologist (1); More accessible to Hispanics (1); Caregivers (1); Mental Health (1); Community mental health program (1); Endocrinologist (1); Weight loss (1); Hospital (1); In home care (1); ER (1); and Urgent Care (1). - 123 - - 123 -Page 123 of 155 Burke County Community Health Assessment Chapter Three Personal Health and Self-Reported Behaviors

A portion of the Burke County Community Survey collected information on respondents’ personal health behaviors. The results of this portion of the survey offer some insight into lifestyle factors that affect the health of individuals in Burke County.

1. How would you rate your own personal health?

Health Status Number Percent Very Healthy 240 13.0 Healthy 891 48.4 Somewhat Healthy 618 33.6 Unhealthy 73 4.0 Very Unhealthy 19 1.0 Total 1,841 100

 Approximately 61% of respondents rated themselves as healthy or very healthy.  Nearly 5% of respondents feel that they are unhealthy or very unhealthy.

2. Do you currently have any of the following kinds of health insurance or health care coverage (check all the answers that apply.)? (n=1,836)

Health Insurance Number Percent1 Health Insurance my employer provides 1,301 70.9 I currently do not have any insurance 161 8.8 Health insurance my spouse’s employer provides 207 11.3 Medicaid 83 4.5 Medicare 155 8.4 Health insurance I bought for myself 147 8.0 Health insurance my parent or my parent’s employer provides 22 1.2 Veteran’s Administration Benefits 34 1.9 Other 40 2.2 Health insurance my school provides 24 1.3

1 Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with any other response. The total of the percent column is greater than 100.

“Other” responses included: NC Health Choice (10); AARP (3); retirement plans (2); Good Samaritan Clinic (2); NC state insurance; tricare for life; “waiting on Medicaid to come through”; Burke County Hospice; hospital; long term care; “faith and wisdom”; aflac; and through their child’s policy.

- 124 - - 124 -Page 124 of 155 Burke County Community Health Assessment Chapter Three 8.8% of respondents did not have any health insurance at the time the survey was administered.  Almost 71% of respondents receive health insurance through their employers and an additional 11% indicated that they were covered through their spouse’s insurance.  Five percent of respondents are covered by Medicaid and 8% reported they were covered by Medicare.

3. During the past 12 months, was there any time that you did not have any health insurance or coverage?

Number Percent Yes 251 13.7 No 1,581 86.3 Total 1,832 100

 While the majority of respondents had health insurance, approximately 14% of respondents indicated that they have been without health insurance at some point in the past year.

4. Where do you usually go when you are sick or need advice about your health? (n=1,843)

Place for Health Advice Number Percent Doctor’s Office 1,606 87.1 Hospital Emergency Room 68 1.2 Health Department 23 1.2 Good Samaritan Clinic 22 1.2 Pharmacy 18 1.0 Company Nurse 8 0.4 Shaman 8 0.4 VA Provider 16 0.9 Urgent Care Center 34 1.8

37 “Other” write-in responses included: friend or family member (11); do not go for care (7); prayer (5); books or the internet (4); “Tienda Hispana” (3); self-treat (2); “natural remedy store”; free clinic; and three responses were unclear.

 The majority (87.1%) of respondents seek the care of a doctor when sick.

- 125 - - 125 -Page 125 of 155 Burke County Community Health Assessment Chapter Three 5. Where is the provider you usually go to for medical care or medical advice located? (n=2,165)

Provider Locale Number Percent Morganton 1,221 66.4 Valdese 228 12.4 Hickory 215 11.7 Lenoir 23 1.3 Asheville 60 3.3 Winston Salem 10 0.5 Charlotte 19 1.0 Chapel Hill 2 0.1 Durham 7 0.4 Total 1,839

 The majority of respondents seek care in Morganton, with an additional 12% seeking care in Valdese and nearly 12% in Hickory.

6. During the past 12 months, did you have a problem getting the medical care you needed?

Number Percent Yes 236 12.9 No 1,595 87.1 Total 1,831 100

 Approximately 13% of respondents had a problem getting needed health care in the past year.

7. If answering yes, [to the question about having a problem accessing needed health care] these problems included: (n=244)

Medical Access Problem Number Percent1 I didn’t have health insurance 104 42.6 My share of the cost was too high 108 44.3 I didn’t have transportation 10 4.1 I didn’t know where to go 10 4.1 My insurance didn’t cover what I needed 35 14.3 Other 45 18.4 Dr. wasn’t taking new patients 11 4.5 Doctor wouldn’t take my insurance/Medicaid 11 4.5 Hospital wouldn’t take my insurance 1 0.4 1 – Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with any other response. The total of the percent column is greater than 100.

“Other” problems that limited respondents access to medical care: language/cultural barrier (9); could not get an appointment (8); poor or insufficient medical care (8), for example: “couldn't find a mental health professional when having a breakdown”, “burke county does not have doctors that know how to take care of type I diabetes”,

- 126 - - 126 -Page 126 of 155 Burke County Community Health Assessment Chapter Three “hospital doesn't give good diagnosis”; long wait for a doctor (4); no insurance (4); and had to work; “VA cutting back on services”.

 The highest percentage of respondents who had a problem accessing medical care in the last 12 months reported that they had a problem because they didn’t have health insurance (42.6%), though the cost of care was also an important barrier (44.3%).

8. About how long has it been since you last visited a doctor for a routine checkup?

Time Since Last Medical Checkup Number Percent Within the past year 1,325 72 1-2 years ago 277 15 3-5 years ago 115 6 More than 5 years ago 83 5 I have never had a routine checkup 36 2 Total 1,836 100

 Nearly 87% of respondents have been to the doctor for a routine checkup within the past two years.  Almost 6% of respondents have either never had a routine checkup or have not had one within the past five years.

9. In the past 12 months I had a problem getting dental care I needed.

Number Percent Yes 384 21.0 No 1,447 79.0 Total 1,831 100

 Nearly 21% of respondents had a problem getting needed dental care within the past year.

10. If answering yes, [to the question about having a problem accessing needed dental care] these problems included: (n=689)

Dental Access Problem Number Percent1 I didn’t have dental insurance 235 57.9 I couldn’t afford the cost 213 52.5 My insurance didn’t cover what I needed 58 14.3 I didn’t know where to go 19 4.7 I didn’t have transportation 10 2.5 Dentist wouldn’t take my insurance/Medicaid 18 4.4 Dentist wasn’t taking new patients 16 3.9 Other 25 6.2

1 Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with any other response. The total of the percent column is greater than 100.

- 127 - - 127 -Page 127 of 155 Burke County Community Health Assessment Chapter Three “Other” reasons respondents couldn’t get dental care: language barrier (4); could not get an appointment (2); no services for young children (2); don’t know a good dentist (2); limited hours; didn’t like the dentist; waiting list was very long; needed emergency care after hours; and “cannot miss work even for sickness, or will be fired”.

 The highest percentage of respondents who had a problem accessing dental care in the last 12 months reported they had this problem because they did not have dental insurance.

11. What kind of dental care did you need in the past 12 months that you could not get? (n=638)

Unmet Dental Care Need Number Percent1 Routine check-up 450 70.5 Toothache 104 16.3 Tooth injury 81 12.7 Root canal 74 11.6 Other 101 15.8 Dentures 63 9.9

1 Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with any other response. The total of the percent column is greater than 100.

“Other” types of dental care that respondents could not get include: extractions (29); fillings (25); crowns (16); cavities (13); partials (5); braces (2); caps (2); gum care/infection (2); surgery (2); never been to the dentist (2); cleaning for a child; “dental problems due to radiation”; emergency care; skin graft; TMJ; and implants.

 Of those who reported not getting needed dental care in the past 12 months, approximately 71% indicated they could not get a routine check-up.

12. About how long has it been since you last visited a dentist for a routine checkup?

Time Since Last Dental Checkup Number Percent Within the past year 1,120 61.2 1-2 years ago 283 15.5 3-5 years ago 201 11.0 More than 5 years ago 192 10.5 I have never had a routine checkup 33 1.8 Total 1,829 100

 Nearly 77% of the respondents had been to the dentist for a routine checkup within the past two years.  Just over 12% of respondents either had never been to the dentist for a checkup or had not been within the last five years.

- 128 - - 128 -Page 128 of 155 Burke County Community Health Assessment Chapter Three 13. In the past 12 months, did you have a problem filling a medically necessary prescription?

Number Percent Yes 243 13.3 No 1,581 86.7 Total 1,824 100

 Thirteen percent of respondents had a problem filling a medically necessary prescription.

14. If answering yes, [to the question about having a problem filling a medically necessary prescription] these problems included: (n=466)

Prescription Access Problem Number Percent1 My share of the cost was too high 139 54.3 I didn’t have health insurance 69 27.0 My insurance didn’t cover what I needed 68 26.6 I didn’t have transportation 2 0.8 Other 30 11.7 Pharmacy would not take my insurance/Medicaid 3 1.2 I had a problem with Medicare Part D 2 0.8 I didn’t know where to go 7 2.7

1 Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with any other response. The total of the percent column is greater than 100.

“Other” reasons respondents couldn’t get prescriptions filled: Lack of the necessary medication (5); medication was denied (4); inconvenience of service (4) – e.g., “My doctor waited three weeks to call in the prescription”, “pharmacy closed early”; no help was available (2); medication was too expensive; language barrier; and a change in provider.

 Fifty-four percent of those who had a problem filling a prescription indicated it was because their share of the cost was too high.

- 129 - - 129 -Page 129 of 155 Burke County Community Health Assessment Chapter Three 15. If a friend or family member needed counseling for a mental health, substance abuse or developmental disability problem, whom would you suggest they go see? (n=1,818)

Mental Health Provider Referral Suggestion Number Percent I don’t know 364 20.0 Doctor 725 39.9 Mental Health Partners 479 26.3 Minister/Pastor 625 34.4 Private Counselor or Therapist 633 34.8 Burke Council on Alcoholism and Chemical Dependency 346 19.0 Other 79 4.3 Hospital Emergency Department 89 4.9 School Counselor 241 13.3 Children’s Developmental Services Agency 171 9.4 Narcotics Anonymous 131 7.2 Vocational Rehabilitation/Independent Living 96 5.3

 Nearly 20% of respondents indicated they did not know where they would suggest a friend or family member go for mental health counseling.  Other than “I don’t know”, the greatest number of respondents indicated that they would suggest a friend of family member go see a doctor (39.9%), Private Counselor or Therapist (34.8%), or a Minister or Pastor (34.4%).

16. During the past four weeks, other than your regular job, did you engage in any exercise activity that lasted at least a half an hour?

Number Percent Yes 1,462 80.1 No 363 19.9 Total 1,825 100

 More than a third of respondents did not engage in any such exercise activity during the preceding month.

17. If answering yes [to the question about getting exercise in the past four weeks] the frequency was:

Exercise Frequency Number Percent Less than once a week 156 11 Once a week 259 18 2-3 times a week 639 43 4-6 times a week 271 18 Daily 149 10 Total 1,474 100

 Approximately 18% of those who exercised in the past four weeks do so at least four times a week.

- 130 - - 130 -Page 130 of 155 Burke County Community Health Assessment Chapter Three

18. If answering no [to the question about getting exercise in the past four weeks] the reasons why not were: (n=420)

Reason for Not Exercising Number Percent1 I don’t have enough time to exercise 107 25.5 I’m too tired to exercise 87 20.7 My job is physical/hard labor 28 6.7 I have a health condition that limits my physical activity 94 22.4 Physical activity costs too much 22 5.2 I don’t have a place to exercise 13 3.1 Physical activity is not important to me 6 1.4 Other 38 9.0 Weather limits my physical activity 25 6.0

1 Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with any other response. The total of the percent column is greater than 100.

“Other” write-ins included: laziness (7); pregnant (4); retired (2); disabled; don’t like to exercise; no support to exercise; “have to stay home to take care of my husband”; have school; and no childcare. Two responses were not related to the question.

 The most common reason reported for not exercising is lack of time (25.5%), though 22% also reported that they have a health condition that limits physical activity.

19. Not counting juice, how many servings of fruit do you eat in an average day?

Fruit Consumption Number Percent I don’t eat fruit on every day 735 40.3 I never eat fruit 21 1.2 1-2 556 3-4 397 5-7 114 Total 1,823 100 1,067 Write in’s responded to this question  Approximately 40% of respondents indicated that they don’t eat fruit on each day.  Only 1.2% of respondents reported never eating fruit.

- 131 - - 131 -Page 131 of 155 Burke County Community Health Assessment Chapter Three 20. Not counting potatoes and salad, how many servings of vegetables do you eat in an average day?

Vegetable Consumption Number Percent I don’t eat vegetables on each day 392 98.5 I never eat vegetables 6 1.5 1-2 698 3-4 504 5-10 241 Total 398 100 1,448 wrote in number of vegetables eaten.  Approximately 99%of respondents indicated that they don’t eat vegetables on each day.

21. On how many of the past 30 days did you drink alcohol of any kind?

Alcohol Consumption Number Percent I never drink alcohol 705 38.8 I didn’t drink alcohol on any of the past 30 days 446 24.5 None 1-7 days 220 33% 8-14 days 190 29% 15-21 days 171 26% 22-30 days 85 13% Total 1,817 100 666 Write in’s responded to this question  Approximately 39% of respondents indicated that they never drink alcohol.  Approximately 1/4 of respondents said they did not drink alcohol on any of the past 30 days.

22. During that same period, how many times did you have 5 or more drinks in a day?

Number Percent I didn’t have 5 774 86.4 or more drinks 1-7 84 8-14 13 15-21 5 22-30 3 Total 896 100 105 Write in’s with this question  While the majority of respondents reported never binge drinking (consuming more than 5 drinks in one day), approximately 15% of respondents self-reported this behavior.

- 132 - - 132 -Page 132 of 155 Burke County Community Health Assessment Chapter Three 23. Do you smoke cigarettes?

Number Percent I have never smoked cigarettes 1,155 63.1 I used to smoke but have quit 443 24.2 Yes 232 12.7 Total 1,830 100

 Approximately 87% of respondents reported that they either never smoked or no longer smoke cigarettes.  Thirteen percent of respondents indicated that they do smoke cigarettes.

24. If your answer to Question 23 was yes, how many cigarettes do you smoke per day?

Number Percent Less than half a pack 107 44.2 Between half and one pack 118 48.8 More than one pack 17 7.0 Total 242 100

 Approximately 93% of those who smoke indicated that they smoke one pack or less a day.

If “More than one pack”, how many packs?

Number of Packs Number Percent 2 2 3 4 Total 2

25. Are you regularly exposed to second-hand smoke from others who smoke?

Number Percent Yes 380 20.9 No 1,437 79.1 Total 1,817 100

 Nearly 21% of respondents indicated they are regularly exposed to second-hand smoke.

- 133 - - 133 -Page 133 of 155 Burke County Community Health Assessment Chapter Three 26. If you answer to Question 25 was yes, where are you regularly exposed to second hand smoke? (n=957)

Second Hand Smoke Exposure Number Percent1 At work 96 25.2 At home 205 53.8 In the car 105 27.6 Other 97 25.5

1 Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with any other response. The total of the percent column is greater than 100.

“Other” write-ins included: Around friends and family (e.g., homes) (83); in public places (40); in schools (15); at the Laundromat (10); and other (3).

 Respondents are almost equally exposed to second hand smoke at restaurants and at work.

27. How often do you currently use smokeless tobacco (chewing tobacco, snuff, or dip)?

Number Percent Not at all 1,718 96.5 Some days 29 1.6 Every day 33 1.9 Total 1,780 100

 The overwhelming majority (96.5%) of respondents do not use chewing tobacco or snuff.

28. Have you ever been told by a doctor, nurse, or other health care worker that you have any of the following?

Diagnosis Yes/Number Percent No/Number Percent Asthma (n=1,636) 253 15.5 1,383 84.5 Depression (n=1,669) 439 26.3 1,230 73.7 Diabetes (n=1,634) 214 13.1 1,420 86.9 High Blood Pressure (n=1,715) 569 33.2 1,146 66.8 High Cholesterol (n=1,134) 557 32.9 1,134 67.1 Overweight (n=1,711) 705 41.2 1,006 58.8

 Overweight, high cholesterol and high blood pressure were the most frequently reported diagnoses among respondents.

- 134 - - 134 -Page 134 of 155 Burke County Community Health Assessment Chapter Three 29. Men: If you are over age 40, do you have an annual prostate exam?

Number Percent Yes 190 42.6 No 256 57.4 Total Number of men over 40 who gave their age on the survey = 446

 Approximately 57% of male respondents who answered this question reported that they do not have an annual prostate exam.

30. How long has it been since your last prostate exam?

Time Since Last Prostate Exam Number Percent Within the past 12 months 171 40.8 1-2 years ago 48 11.5 3-5 years ago 33 7.9 More than 5 years ago 16 3.8 I don’t know/don’t remember 17 4.1 I have never had a prostate exam 134 32.0 Total 419 100

 Approximately 32% of male respondents reported never having a prostate exam.  Nearly 52% of respondents reported having a prostate exam within the last two years.

31. Women: If you are over age 40, do you get a mammogram every 1-2 years?

Number Percent Yes 729 53.5 No 173 12.7 Total 1,363 100 Number of women over 40 who gave their age on the survey =1,363

 Slightly over 13% of women who responded to this question reported not having a mammogram every 1-2 years.

- 135 - - 135 -Page 135 of 155 Burke County Community Health Assessment Chapter Three 32. How long has it been since your last mammogram?

Time Since Last Mammogram Number Percent Within the past 12 months 579 53.7 1-2 years ago 202 18.7 3-5 years ago 62 5.8 More than 5 years ago 33 3.1 I don’t know/don’t remember 17 1.6 I have never had a mammogram 185 17.2 Total 1,078 100

 17.2% of respondents indicated that they had never had a mammogram.  Over 70% of female respondents reported having a mammogram within the last two years.

33. If you are age 21-30, do you get an Pap test every two years?

Number Percent Yes 453 52.1 No 126 14.5 N/A because I am under 21 or hysterectomy or over 65 291 33.4 Total 870 100

 Approximately 52% of respondents that were 21-30 years old have a Pap test every two years.

34. If you are age 30 or older and have had 3 negative Pap test, do you get a Pap test every 3 years?

Recent Pap Test Number Percent Yes 565 56 No 227 23 N/A I am over 65 or had a hysterectomy 211 21 Total 1,003 100

 Approximately 56% of respondents age 30 or older reported having a Pap test every 3 years.

- 136 - - 136 -Page 136 of 155 Burke County Community Health Assessment Chapter Three

35. How long has it been since your last Pap test?

Last Pap Test Number Percent Within the past 12 months 682 55 1-2 years ago 290 24 3-5 years ago 119 10 More than 5 years ago 73 6 I don’t know/don’t remember 35 3 I have never had a Pap test 22 2 Total 1,221 100

36. Have you ever had a test or exam for colon cancer?

Colon Cancer Number Percent Yes 540 38 No 446 31 I don’t know 24 2 N/A since I am under 50 412 29.0 Total 1,422 100

 540 respondents reported that they had a test or exam for colon cancer.  Approximately 31% of respondents indicated that they have never had a test or exam for colon cancer.

- 137 - - 137 -Page 137 of 155 Burke County Community Health Assessment Chapter Three

Questions for Parents

One section of the survey was directed only to parents of children between the ages of 9 and 17.

1. Do you think your child is engaging in any of the following high risk behaviors? (n=640)

Risk Behavior Number Percent2 My child is not engaging in any of these high risk behaviors 512 80 Sex 75 11.7 Alcohol 61 9.5 Drugs 32 5.0 Tobacco 48 7.5 Eating Disorder 20 3.1 Gang Member 2 0.3 Reckless driving/speeding 36 5.6

Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with any other response. The total of the percent column is greater than 100.

 Approximately 80% of respondents thought their child was not engaging in any of the listed high risk behaviors.  Among parents who thought their children were engaging in high risk behaviors, sex, alcohol, and tobacco were the most commonly named behaviors.

2. Are you comfortable talking to your child about the above behaviors?

Talking about Number Percent Behaviors Yes 654 94.9 No 35 5.1 Total 689 100

 Approximately 95% of respondents indicated they feel comfortable talking to their children about high-risk behaviors.

- 138 - - 138 -Page 138 of 155 Burke County Community Health Assessment Chapter Three

3. Do you think your child needs more information about any of the following issues? (n=639)

Risk Behavior Number Percent1 My child does not need information about any of these issues 344 53.8 Sex 153 23.9 Drugs 135 21.1 Fitness/Nutrition 165 25.8 Alcohol 130 20.3 STDs 125 19.6 HIV 96 15.0 Tobacco 92 14.4 Gangs 75 11.7 Reckless driving/speeding 118 18.5 Eating Disorders 68 10.6 Mental Health Issues 97 15.2 Other 25 3.9

1 Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with any other response. The total of the percent column is greater than 100.

“Other” write in responses included: anger management, teenage pregnancy, spirituality (2), over the counter drugs, internet usage, violence and guns, self esteem issues, stress, succeeding in school, prevention of “accidents” and eye health, and “all the help they can get”. One response was in Spanish, and a few respondents suggested ways the information should be provided to youths: through schools (2), and “pamphlets”.

 The respondents indicated they thought their children needed more information about sex, drugs, fitness/nutrition, alcohol, STIs, and reckless driving/speeding.

4. For all types of disasters, what do you feel you and your family are prepared to handle for up to 72 hrs without assistance?

Disaster Preparedness Number Percent Water (1 gallon per person/per day) 923 53.2 Prescription Medication 1,262 74.1 Flashlights & Batteries 1,512 83.0 Nonperishable food 1,373 80.7 Battery operated radio & batteries 956 56.2 Total 1,702 100 Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with other responses. The total of the percent column is greater than 100.

. Eighty three percent of the respondents felt they had flashlights and batteries for 72 hours without emergency assistance. . In summary, more than half of all respondents felt prepared with all listed indicators.

- 139 - - 139 -Page 139 of 155 Burke County Community Health Assessment Chapter Three

5. What are the methods of getting information from emergency personnel in any type of disaster?

Emergency Information Number Percent Television 1,570 88.0 Internet 1,296 72.6 Neighbors 931 52.2 Radio 1,392 78.0 Newspaper/print media 673 37.7

Other 134 7.5 Total 1,784

Because participants were allowed to select more than one response, the percent is a reflection of how often each option was chosen and does not indicate how often each response was chosen in combination with other responses. The total of the percent column is greater than 100.

. More than 50% of respondents reported that they will use all sources to gather emergency information except for print media. . “Other” write in responses included:

- 140 - - 140 -Page 140 of 155 Burke County Community Health Assessment Chapter Three

Thanks to the Healthy Burke Team and Community Partners:

Bill Allman Community member Distributed community surveys

Lisa Keller Burke County Public Schools Gathered data and distributed community surveys

Rebecca McLeod Burke County Health Department Analyzed data and distributed community surveys

Lisa Moore Burke County Health Department Analyzed data, distributed community surveys and compiled assessment

Heather Morgan-Gulnac Burke County Health Dept. Gathered data, distributed community surveys and compiled assessment

Cathy Pritchard Burke County Health Department Distributed community surveys

David Rust Burke County Health Department Distributed community surveys

Linda Satey Western Piedmont Community College Distributed community surveys

Kim Sorrell Western Piedmont Community College Distributed community surveys

Dianne Tate Caring Hearts Mission Outreach Distributed community surveys

Taylor Dellinger GISP/Western Piedmont Council Analyzed data and assisted with compiling assessment of Governments Tony Gallegos Western Piedmont Council of Analyzed data and assisted with compiling assessment Governments Sherry Long Western Piedmont Council of Analyzed data and assisted with compiling assessment Governments John Marshall Western Piedmont Council of Analyzed data and assisted with compiling assessment Governments Scott Miller Western Piedmont Council of Analyzed data and assisted with compiling assessment Governments John Tippett Jr. Western Piedmont Council of Analyzed data and assisted with compiling assessment Governments Erin Todd Western Piedmont Council of Analyzed data and assisted with compiling assessment Governments - 141 - - 141 -Page 141 of 155 Burke County Community Health Assessment Chapter Three John Wear Western Piedmont Council of Analyzed data and assisted with compiling assessment Camille Sterling Greenway Transportation Inc. Gathered and submitted data

Lou Hill Good Samaritan Clinic Gathered and submitted data

Debbie Kincaid Burke County Public Schools Gathered and submitted data

Margaret Shomate Burke County Dept. of Social Services Gathered and submitted data

PSALMS Urgent Care Gathered and submitted data

Brenda Kayga Community Outreach/BlueRidge Gathered and submitted data Healthcare Jim Van Hecke Burke Council on Alcoholism and Gathered and submitted data Chemical Dependency

- 142 - - 142 -Page 142 of 155 Burke County Community Health Assessment Chapter Three Burke County Community Health Survey

The purpose of this survey is to learn more about health and quality of life in Burke County. The Burke County Health Department, Blue Ridge Healthcare System, Burke County Public School System, Burke County Department of Social Services, The Riddle Institute, local government agencies and various community-based agencies will use the results of this survey and other information to identify the most pressing health problems in Burke County and to develop plans to address those identified problems. Thank you for taking the time to complete this Community Health Survey.

If you have already completed this survey, or if you don’t live in Burke County, please STOP here.

Your answers on this survey will not be linked to you in any way. Please do not write your name on this survey!

PART 1: The following questions ask you to share your views about life In Burke County.

Circle one number for each statement below. Quality of Life Statements Strongly Strongly Disagree Disagree Agree Agree 1. There is a good health care system in Burke County. (Think about health care options, access, cost, availability, 1 2 3 4 quality, etc.) 2. Burke County is a good place to raise children. (Think about the availability and quality of schools, day care, 1 2 3 4 after school programs, places to play, etc.) 3. Burke County is a good place to grow old. (Think about elder-friendly housing, access/ways to get to 1 2 3 4 medical services, elder day care, social support for the elderly living alone, meals on wheels, etc.) 4. There are plenty of ways to earn a living in Burke County. (Think about job options and quality of jobs, job 1 2 3 4 training/higher education opportunities, etc.) 5. Burke County is a safe place to live. (Think about safety at home, in the workplace, in schools, at 1 2 3 4 playgrounds, parks, shopping centers, etc.) 6. There is plenty of support for individuals and families during times of stress and need in Burke County. 1 2 3 4 (Examples include neighbors, support groups, faith community outreach, agencies, organizations, etc.) 7. Burke County has clean air. 1 2 3 4 8. Burke County has clean water. 1 2 3 4

- 143 - - 143 -Page 143 of 155 Burke County Community Health Assessment Chapter Three PART 2: The next three questions ask your opinion about the heath and wellbeing of the people who live in Burke County.

Community Health Problems

Using the following list, please put a check mark next to the five (5) most important “health problems” in Burke County. (Problems that you think have the greatest overall effect on health in the community.)

Remember to check only five (5):

___ Aging problems ___ Infant death ___ Motor vehicle accidents (Alzheimer’s, arthritis, ___ Infectious/contagious ___ Obesity/overweight hearing or vision loss, etc.) diseases (TB, pneumonia, ___ Poor oral/dental health ___ Asthma flu, etc.) ___ Sexually transmitted ___ Cancer ___ Kidney disease diseases (STDs) ___ Diabetes ___ Liver disease ___ Stroke ___ Gun-related injuries ___ Lung disease (e.g., ___ Teenage pregnancy ___ Heart disease emphysema) ___ Other: ______HIV/AIDS ___ Mental health (depression, anxiety, mood disorders, etc.)

Community Unhealthy Behaviors

Using the following list please put a check mark next to the five (5) most important “unhealthy behaviors” in Burke County. (Unhealthy behaviors that you think have the greatest overall effect on health and safety in the community.)

Remember to check only five (5):

___ Alcohol Abuse ___ Not using child safety seats ___ Poor eating habits ___ Drug Abuse ___ Not using seat belts ___ Reckless/drunk driving ___ Having unsafe sex ___ Not going to a dentist for ___ Smoking/tobacco use ___ Having to breathe second- preventive check ups ___ Suicide hand smoke (“well care”) ___ Violent behavior ___ Lack of exercise ___ Not going to the doctor for ____ Other: ______Not getting immunizations regular check ups (“well (“shots”) to prevent disease care”) and screenings

- 144 - - 144 -Page 144 of 155 Burke County Community Health Assessment Chapter Three Community Social Issues

Using the following list, please put a check mark next to the five (5) most important “community social issues” in Burke County. (Social issues that you think have the greatest overall effect on the quality of life in the community.)

Remember to check only five (5):

___ Availability of healthy food choices ___ Lack of transportation options ___ Disaster preparedness/bioterrorism ___ Neglect and abuse (of a child, a spouse, ___ Homelessness the elderly, etc.) ___ Inadequate/unaffordable housing ___ Pollution (air, water, land) ___ Lack of affordable health ___ Poverty insurance/health care ___ Racism ___ Lack of education/dropping out of ___ Underemployment/lack of well-paying school jobs ___ Lack of services for people with ___ Violent crime (rape, murder, assault, cultural or language differences. etc.) ___ Lack of health care providers ___ Other: ______What kind? ______

PART 3: The following questions ask about your own personal health. Remember, this survey will not be linked to you in any way.

1. How would you rate your own personal health? Please check only one (1) answer.

___ Very ___ Healthy ___ Somewhat ___ Unhealthy ___ Very healthy healthy Unhealthy

2. Do you currently have any of the following kinds of health insurance or health care coverage? Check all the answers that apply.

___ Health insurance my employer provides ___ Health insurance my spouse’s employer provides ___ Health insurance my school provides ___ Health insurance my parent or my parent’s employer provider ___ Health insurance I bought for myself ___ Medicaid ___ Medicare ___ Veteran’s Administration benefits ___ Other: ______I currently do not have any kind of health insurance or health care coverage

- 145 - - 145 -Page 145 of 155 Burke County Community Health Assessment Chapter Three

Remember, all these questions are about you!

3. During the past 12 months, was there any time that you did not have any health insurance or health care coverage?

___ Yes ___ No

4. Where do you usually go when you are sick or need advice about your health? Please check only one (1) answer.

____ Doctor's office ____ Shaman ____ Health department ____ Veteran’s Administration ____ Hospital emergency room ____ Pharmacy ____ Company nurse ____ Urgent Care Center ____ Good Samaritan Clinic ____ Other: ______

5. Where is this provider you usually go to for medical care or medical advice located?

____ Valdese ____ Charlotte ____ Lenoir ____ Morganton ____ Winston-Salem ____ Other: ______Hickory ____ Durham ____ Asheville ____ Chapel Hill

6. During the past 12 months, did you have a problem getting medical care you needed?

____ Yes (now go to Question #7) ____ No (now skip to Question #8)

7. If your answer to Question #6 was yes, why couldn’t you get the medical care you needed? Check all the answers that apply.

____ I didn’t have health insurance ____ My insurance didn’t cover what I needed ____ I couldn’t afford it/my share of the cost was too high ____ Doctor would not take my insurance or Medicaid ____ Hospital would not take my insurance ____ I didn’t have transportation ____ I didn’t know where to go ____ Doctor wasn’t taking new patients ____ Other: ______

8. About how long has it been since you last visited a doctor, physician assistant or nurse practitioner for a routine (“well”) medical checkup? Do not include times you visited the doctor because you were sick or pregnant.

____ Within the past 12 months ____ 1-2 years ago ____ 3-5 years ago ____ More than 5 years ago ____ I have never had a routine or “well” medical checkup.

- 146 - - 146 -Page 146 of 155 Burke County Community Health Assessment Chapter Three 9. During the past 12 months, did you have a problem getting dental care you needed?

____ Yes (now go to Question #10) ____ No (now skip to Question #12)

10. If your answer to Question #9 was yes, why couldn’t you get the dental care you needed? Check all the answers that apply.

____ I didn’t have dental insurance ____ My insurance didn’t cover what I needed ____ I couldn’t afford it/my share of the cost was too high ____ Dentist would not take my insurance or Medicaid ____ I didn’t have transportation ____ I didn’t know where to go ____ Dentist wasn’t taking new patients ____ Other: ______

11. What kind of dental care did you need in the past 12 months that you could not get? Check all the answers that apply.

____ Routine (“well’) check-up ____ Tooth injury (e.g. tooth knocked out or broken) ____ Toothache ____ Dentures ____ Root canal ____ Other: ______

12. About how long has it been since you last visited a dentist for a routine (“well”) dental checkup? Do not include times you visited the dentist because of a toothache or other emergency.

____ Within the past year ____ 1-2 years ago ____ 3-5 years ago ____ More than 5 years ago ____ I have never had a routine or “well” dental checkup

13. During the past 12 months, did you have a problem filling a medically necessary prescription?

____ Yes (now go to Question #14) ____ No (now skip to Question #15 on the next page)

14. If your answer to Question #13 was yes, why couldn’t you fill the prescription you needed? Check all the answers that apply.

____ I didn’t have health insurance ____ My insurance didn’t cover what I needed ____ I couldn’t afford it/my share of the cost was too high ____ Pharmacy would not take my insurance or Medicaid ____ I had a problem with Medicare Part D ____ I didn’t have transportation ____ I didn’t know where to go ____ Other: ______

- 147 - - 147 -Page 147 of 155 Burke County Community Health Assessment Chapter Three 15. If one of your friends or family members needed counseling for a mental health, substance abuse, or developmental disability problem, whom would you suggest they go see? (Check all that apply)

____ I don’t know ____ Mental Health Partners ____ Children’s Developmental Services Agency ____ Counselor or therapist in private practice ____ Doctor ____ Minister/pastor ____ School counselor ____ Vocational Rehabilitation/Independent Living ____ Hospital Emergency Department ____ Narcotics Anonymous ____ Burke Council on Alcoholism and Chemical Dependency ____ Other: ______

16. During the past 4 weeks, other than your regular job, did you engage in any physical activity that lasted at least half-an-hour?

____ Yes (now go to Question #17) ____ No (now skip to Question #18)

17. If your answer to Question #16 was yes, how frequently did you engage in physical activity for at least a half-an-hour during the past four weeks?

____ Less than once a week ____ Once a week ____ 2-3 times a week ____ 4-6 times a week ____ Daily (Now skip to Question #19)

18. If your answer to Question #16 was no, why didn’t you engage in physical activity?

____ My job is physical or hard labor ____ I don’t have enough time for physical activity ____ I’m too tired for physical activity ____ I have a health condition that limits my physical activity ____ I don’t have a place to exercise ____ Weather limits my physical activity ____ Physical activity costs too much (equipment, shoes, gym expense) ____ Physical activity is not important to me ____ Other: ______

19. Recommended servings are 5-9 per day. Not counting juice, how many servings (serving size = 1 cup) of fruit do you eat in an average day?

____ Servings of fruit per day (Please put a number in the blank) ____ I don’t eat fruit on every day ____ I never eat fruit.

- 148 - - 148 -Page 148 of 155 Burke County Community Health Assessment Chapter Three 20. Recommended servings are 5-9 per day. Not counting potatoes and salad, how many servings (serving size = 1 cup) of vegetables do you eat in an average day?

____ Servings of vegetables per day (Please put a number in the blank.) ____ I don’t eat vegetables on every day ____ I never eat vegetables

21. On how many of the past 30 days did you drink alcohol of any kind?

____ Number of days (now go to Question #22) ____ I didn’t drink alcohol on any of the past 30 days (now skip to Question #23) ____ I never drink alcohol (now skip to Question #23)

22. During that same 30-day period, how many times did you have five (5) or more alcoholic drinks in a single day?

____ Number of times ____ I didn’t have five or more drinks on any of the past 30 days

23. Do you smoke cigarettes?

____ Yes (now go to Question #24) ____ I have never smoked cigarettes (now skip to Question #25) ____ I used to smoke but have quit (now skip to Question #25)

24. If your answer to Question #23 was yes, how many cigarettes do you smoke per day? Please check only one (1) answer.

____ Less than half a pack per day ____ Between half a pack and one (1) pack per day ____ More than one (1) pack per day (Number of packs per day: ______)

25. Are you regularly exposed to second-hand smoke from others who smoke?

____Yes (now go to Question #26) ____ No (now skip to Question #27)

26. If your answer to Question #25 was yes, where are you regularly exposed to second-hand smoke? Check all answers that apply.

____ At work ____ At home ____ In the car ____ Other: ______

27. How often do you currently use smokeless tobacco (chewing tobacco, snuff, or “dip”)?

____ Not at all ____ On some days ____ Every day

- 149 - - 149 -Page 149 of 155 Burke County Community Health Assessment Chapter Three 28. Have you ever been told by a doctor, nurse, or other health professional that you have any of the following?

Asthma ____ Yes ____ No Depression ____ Yes ____ No Diabetes ____ Yes ____ No High blood pressure ____ Yes ____ No High cholesterol ____ Yes ____ No Overweight/obesity ____ Yes ____ No

MEN’S HEALTH QUESTIONS. Answer the following two (2) questions only if you are a man age 40 or older. If you are a man but younger than age 40, skip to Part 4 on page 9. If you are a woman, skip to Question #31

29. Do you get an annual prostate exam?

____ Yes ____ No

30. How long has it been since your last prostate exam?

____ Within the past 12 months ____ 1-2 years ago ____ 3-5 years ago ____ More than 5 years ago ____ I don’t know/don’t remember ____ I have never had a prostate exam (Now skip to Question #36)

WOMEN’S HEALTH QUESTIONS. Answer the following five (5) questions only if you are a woman. If you are a man, skip to Question #36. Pap tests recommendations: Women under age 21- not recommended for routine Pap screening. Women ages 21 – 30 can be screened every two years (not every year). Women age 30 and older, who have had three (3) negative Pap tests in a row, can be screened once every three (3) yrs.

31. If you are age 40 or older, do you get a mammogram every 1-2 years?

____ Yes ____ No ____ N/A because I’m under age 40 (now skip to Question #33)

32. How long has it been since your last mammogram?

____ Within the past 12 months ____ 1-2 years ago ____ 3-5 years ago ____ More than 5 years ago ____ I don’t know/don’t remember ____ I have never had a mammogram

- 150 - - 150 -Page 150 of 155 Burke County Community Health Assessment Chapter Three 33. If you are age 21 – 30, do you get a Pap test every two years?

____ Yes ____ No ____ N/A because I’m under age 21, had a hysterectomy or over age 65 (now skip to Question #36)

34. If you are age 30 or older and has had three (3) negative Pap tests in a row and continue to get a Pap test every three (3) years?

____ Yes ____ No ____ N/A because I’m over age 65 or had a hysterectomy (now skip to Question #36)

35. How long has it been since your last Pap test?

____ Within the past 12 months ____ 1-2 years ago ____ 3-5 years ago ____ More than 5 years ago ____ I don’t know/don’t remember ____ I have never had a Pap test

FOR MEN AND WOMEN: Answer the next question only if you are a man or woman age 50 or older

36. Have you ever had a test or exam for colon cancer?

____ Yes ____ No ____ I don’t know ____ N/A because I’m under age 50

PART 4. Questions about adolescent (age 9-17) behavior.

Answer the following three (3) questions only if you are the parent or guardian of a child aged 9-17. If you are not the parent or guardian of a child in this age range, skip to PART 5 on the next page.

37. Do you think your child is engaging in any of the following high-risk behaviors? Check all answers that apply.

____ Alcohol ____ Gang member ____ Drug Use (Illegal or Prescription Meds) ____ Reckless driving/speeding ____ Sex ____ Eating disorder (e.g. anorexia or bulimia) ____ Tobacco ____ My child is not engaging in any of these high risk behaviors

38. Are you comfortable talking to your child about the behaviors listed above in Question #37?

____ Yes ____ No

- 151 - - 151 -Page 151 of 155 Burke County Community Health Assessment Chapter Three 39. Do you think your child needs more information about any of the following issues? Check all answers that apply.

____ Alcohol ____ Reckless driving/speeding ____ Drugs ____ Eating disorder (e.g. anorexia or bulimia) ____ Sex ____ Mental health issues ____ Tobacco ____ Fitness/nutrition ____ STDs ____ Other: ______HIV ____ My child does not need information about any of these issues ____ Gangs

PART 5. Questions about Emergency Preparedness and Disasters

40. For all types of disasters (hurricanes, tornadoes, floods, ice storms, terrorist events or blackouts), what do you feel you and your family are prepared to handle for up to 72 hours (3 days) without emergency assistance? (Check all that apply)

_____ Water (1 gallon per person/per day) _____Nonperishable food _____ Prescription medication _____ Battery operated radio & batteries _____ Flashlights & batteries

41. What are your methods of getting information from emergency personnel in any type of disaster? (Check all that apply)

_____ Television _____ Radio _____ Internet _____ Newspaper/Print media _____ Neighbors _____ Other (Explain) ______

PART 6. Please answer this next set of questions so we can see how different types of people feel about local health issues.

42. Do you live in Burke County? ____ Yes ____ No

43. Do you work or go to school outside Burke County? ____ Yes ____ No

44. What is your zip code? ______

45. How old are you? ____ 18-24 ____ 40-44 ____ 60-64 ____ 25-29 ____ 45-49 ____ 65-69 ____ 30-34 ____ 50-54 ____ 70-74 ____ 35-39 ____ 55-59 ____ 75 or older

46. Are you: ____ Male ____ Female

47. What is your race or ethnicity? ____ White – Non-Hispanic ____ Asian/Pacific Islander ____ Black – Non-Hispanic ____ Native American ____ Hispanic/Latino ____ Other: ______

- 152 - - 152 -Page 152 of 155 Burke County Community Health Assessment Chapter Three

48. What is your marital status? ____ Married ____ Separated ____ Never married ____ Widowed ____ Divorced ____ Other:______

49. What is the highest education level you have completed? Check only one (1) answer.

____ Less than high school (Highest grade completed: ______) ____ High school diploma or GED ____ Associate’s Degree ____ Some college but no degree ____ College degree (Bachelor’s degree) ____ Graduate degree (Masters or Doctoral degree) ____ Other: ______

50. What is your employment status? Check all answers that apply.

____ Employed full-time ____ Employed part-time ____ Unemployed ____ Retired ____ Disabled; unable to work ____ Student ____ Homemaker

51. What was your total household income last year, before taxes? (This is the total income, before taxes, earned by all people over the age of 15 living in your house.)

____ Less than $20,000 ____ $20,000 to $29,999 ____ $30,000 to $49,999 ____ $50,000 to $74,999 ____ $75,000 to $100,000 ____ Over $100,000

52. How many children under the age of 18 does this household income support? _____

53. How many adults age 18 and older does this household income support? _____

54. Are you the primary caregiver for any of the following? Check all answers that apply.

____ Disabled child (under age 18) ____ Foster child (under age 18) ____ Disabled adult (age 18 or older) ____ Grandchild (under age 18) ____ Senior adult (age 65 or older)

- 153 - - 153 -Page 153 of 155 Burke County Community Health Assessment Chapter Three

References

1. Burke County, North Carolina. Government. About Burke County. History. Available at: http://www.co.burke.nc.us

2. US Census Bureau. American Fact Finder. Data Sets. 2010 Census. Available at www.census.gov

3. NC State Board of Elections. Data and Statistics. Voter Registration Data; Available at: http://www.sboe.state.nc.us/index.html.

4. NC Department of Commerce. Available at: http://www.nccommerce.com/publicaffairs/wsl_reexamination.pdf.

5. Employment Security Commission of North Carolina. Labor Market Information. Announces Business Closings and Layoffs. Available at: http://www.ncesc.state.nc.us

6. Burke County Department of Social Services, Annual Report 2010.

7. NC Division of Child development. Available at: http://ncchildcare.dhhs.state.nc.us

8. NC Department of Public Instruction. Statistics/Data. Available at: http://www.ncpublicschools.org/fbs/stats/.

9. NC Department of Justice. http://www.ncdoj.com

10. NC State Center for Health Statistics. Available at: http://www.schs.state.nc.us

11. NC Department of Health and Human Services, Division of Social Services, Statistics and Reviews, Available at: http://www.dhhs.state.nc.us

12. NC Division of Medical Assistance. Burke County. Available at: http://www.dhhs.state.nc.us

13. NC Highway Research Center. Alcohol Facts. Burke County Crash Data and Injury Data. Available at: http://www.hsrc.unc.edu

14. Eat Smart Move More. Data. NC NPASS. Available at: http://www.eatsmartmovemorenc.com/data.htm.

15. Log Into North Carolina. LINC. http:data.osbn.state.nc.us

16. NC Child Advocacy Institute. http://www.nccadv.org

17. Cecil G. Sheps Center. Health Services. State and County. Profiles. Available for 2010. http://www.shepscenter.unc.edu

18. Burke County Public Schools. Personal Communication.

19. Greenway Transportation, Inc. Personal Communication.

20. Good Samaritan Clinic. Personal Communication. - 154 - - 154 -Page 154 of 155 Burke County Community Health Assessment Chapter Three

21. PSALMS Urgent Care Clinic. Personal Communication.

22. Burke Council on Alcoholism and Chemical Dependency. Personal communication.

- 155 - - 155 -Page 155 of 155