Nash Health Care
2013 CHNA Community Health Needs Assessment
A comprehensive assessment of the health needs of residents of the Nash Health Care community
Contents
acknowledgements 5 executive summary 6 methodology 9 existing healthcare facilities & resources 11 demographics 21 socioeconomic factors 31 access to care 36 health data / indicators 41 health utilization 60 interviews / community feedback 66 health needs, prioritization process & results 70 attachments 76
Acknowledgements
This Community Health Needs Assessment represents the culmination of work completed by multiple individuals and groups during the past year. Nash Health Care would specifically like to thank the individuals named below for their contributions to this process.
The 2013 Community Health Needs Assessment Project Team:
Nash Health Care Board of Commissioners Vincent C. Andracchio, ii chairman Judge Robert Evans vice Chairman Rosa A. Brodie secretary Carl Daughtry Treasurer Michael T. Bryant Martha Chesnutt, MD Jerry W. Daniel Wayne Deal Leorita Hankerson James Lilley Kay Mitchell Betty Anne Whisnant Nash Health Care Executive Team Larry Chewning president and Chief Executive Officer Brad Weisner executive Vice President, Chief Operating Officer Cam Blalock senior Vice President, Corporate Services Leslie Hall senior Vice President, Chief Nursing Officer Al Hooks senior Vice President, Chief Financial Officer David Hinkle senior Vice President, Chief Information Officer Meera Kelley, md chief Medical Officer David Gorby, md vice President, Quality Bob Skelton vice President, Chief Development Officer Michelle Cosimeno vice President, Associate Chief Nursing Officer Nash Health Care Community Advisory Committee Max Avent word Tabernacle Church Amy Belflower-Thomas nash County Health Department Meredith Capps edgecombe County Health Department Magdalena Cruz nash-Rocky Mount Public Schools John Derybshire, md boice-Willis Clinic Jeff Hedgepeth nash Health Care Bill Hill nash County Health Department Reverend Richard Joyner nash Health Care Gina Lane eastpointe LME Karen Lachapelle edgecombe County Health Department Shakeerah McCoy nash Health Care Ginny Mohrbutter rocky Mount Area UnitedWay Sharon Romney, md wee Care Pediatrics Stacie Shatzer nash County Aging Department Ascendient Healthcare Advisors Brian Ackerman, mha principal Daniel Carter, mba principal Joe Gyamfi, PE, mba consultant Nathan Marvelle, mba senior Consultant DeeDee Murphy, JD, mph senior Consultant
5 Executive Summary
The 2013 Community Health Needs Assessment (CHNA) examines the overall health needs of the residents of the Nash Health Care community. While Nash Health Care (NHC) has historically assessed the health needs of the community and responded accordingly, this CHNA is another step in NHC’s efforts to identify and respond to the needs of its community. As outlined throughout this document, a significant amount of data and information have been reviewed and incorporated in this planning process, and NHC has been careful to ensure that a variety of sources were leveraged to develop a truly comprehensive report. It is also important to note that, although unique to NHC’s identified community, the sources and methodologies used to develop this report comply with CHNA guidelines provided in the Patient Protection and Affordable Care Act (PPACA).
Study Objectives Community
The overall intent of this study is to better NHC’s community or primary service area (PSA) understand, quantify, and articulate the health for the CHNA includes the following ZIP codes Patient needs of NHC’s identified community residents. located in Nash, Edgecombe, and Halifax counties: Discharges Key objectives of this CHNA include: 27801, 27803, 27804, 27809, 27816, 27823, 27844, (FY 2012) 27856, 27882, and 27891. NHC’s PSA occupies a • Identify the unmet health needs of under- land area of approximately 888 square miles 9,175 served residents in the identified community and encompasses significant portions of Nash, Edgecombe, and Halifax counties. Please see the • Understand the challenges these popula- accompanying map for illustration. Historically, tions face when trying to maintain and/or residents of these ZIP codes have accounted improve their health for approximately 79 percent of NHC’s patients. Given that NHC’s identified community for this • Understand where underserved populations CHNA is its PSA, those terms (community and turn for services needed to maintain and/or PSA) are used interchangeably throughout this 6,115 improve their health assessment.
• Understand what is needed to help these Data Collection & Analysis populations maintain and/or improve their health To achieve the study objectives both primary and secondary data were collected and • Prioritize the needs of the community and reviewed. Primary data included qualitative clarify/focus on the highest priorities information from interviews conducted with the target population, including community • Provide the framework and grounding for members, health service providers and those the future development of programs and ini- with knowledge of the health needs of the tiatives to meet those priority needs community. Secondary data included public data on demographics, health and healthcare resources, behavioral health surveys, county rankings, and disease trends as well as proprietary All Others NHC data on county resident utilization of inpatient, Though NHC is the largest pro- outpatient, and emergency department services. vider of inpatient services in its three-county PSA, approximately 40% of residents go outside the community for hospital care.
6 Nash Health Care is a nonprofit hospital authority comprised of four hospitals: Nash General Hospital, Nash Day Hospital, the Bryant T. Aldridge Rehabilitation Center, and Coastal Plain Hospital
NHC’s Primary Service Area (Shown in Purple)
Nash General Hospital
Halifax Regional Medical Center
Vidant Edgecombe
Vidant Medical Center
WakeMed Raleigh
7 Key Findings
This report includes detailed information in a variety of 8. Interviews/Community Feedback – Conclusions areas and on a number of topics. The report sections from interviews and meetings with community outlined below segment the results of this process into leaders and stakeholders are presented in this sec- nine distinct, but interrelated, segments: tion.
1. Methodology – The methodology section pro- 9. Health Needs, Prioritization Process and Re- vides a brief summary of how information was sults – This section provides an overall summary collected and assimilated into the development of of the health needs as identified in the prioritiza- this CHNA, as well as study limitations. tion process. Based on the analyses and findings from all of the previous sections, NHC condensed 2. Existing Healthcare Facilities and Resources a list of dozens of potential health needs down to a – This section provides a description of existing few select health needs it believes to represent the healthcare facilities, services, and provider re- current priorities for its PSA. Each potential need sources available in NHC’s PSA. In addition, this was analyzed against the others and prioritized section includes a summary of needs identified for based on a variety of different considerations, the PSA in the 2013 State Medical Facilities Plan. which are discussed throughout this assessment. Through the prioritization process, NHC identified 3. Demographics – This section provides informa- two categories of priority health need areas, which tion regarding the population characteristics (such include: as age, gender, and race) and trends of NHC’s PSA.
• Primary Care Access – Driven primarily by low 4. Socioeconomic Factors – Data findings regarding physician supply, higher than average level of income, poverty, unemployment, and education uninsured, community input, and historical level for NHC’s PSA are presented here. composition and growth of emergency depart- ment volumes in the community. 5. Access to Care – An assessment of factors impact- ing access to healthcare services in NHC’s PSA is • Chronic Conditions – Including, in particular, discussed here. diabetes, obesity, heart disease, and asthma, and driven primarily by high obesity rates, 6. Health Data/Indicators – Data findings for NHC’s smoking/tobacco use, low exercise rates, low PSA regarding health status and behavior, vital rankings for built environment, high mortality statistics, mental health and substance abuse, rates, inpatient utilization and community in- chronic disease prevalence, cancer incidence and put. mortality, communicable diseases, and women and children’s health are presented here. NHC believes that these two categories incorpo- rate many of the health needs identified in the 7. Health Utilization – This section presents findings CHNA, while enabling it to focus on two key areas from utilization data provided by NHC, including that could have a significant positive impact on inpatient discharges, outpatient and emergency the health of the community. department visits.
8 Methodology
Study Design. A multi-faceted approach was utilized to assess the community health needs and con- cerns of the NHC’s community. Multiple sources of public and private data along with diverse com- munity viewpoints were incorporated in the study to paint a complete picture of the identified com- munity’s health and healthcare landscape. Multiple methodologies, including ongoing community and stakeholder engagement, analysis of data, and content analysis of community feedback were utilized to identify key areas of priority and need. Specifically the following data types were employed:
Primary Data
Community engagement and feedback was obtained through individual and group interviews with key community and healthcare leaders, as well as significant input and direction from theC ommunity Advisory Committee.
Secondary Data
Key sources for quantitative health related data on the PSA included:
1. Multiple public data sources on demographics, health and healthcare resources, county rankings, so- cial/behavioral health trends, and disease trends.
2. Proprietary data on county resident utilization of hospital inpatient, outpatient, and emergency de- partment services
Study Limitations. The primary study limitation was the availability of high quality data in sufficient quantity to make reasonable conclusions regarding certain types of healthcare needs. This study utilized a broad range of data to assess the needs in the service area; however, there was a lack of more recent data for certain characteristics examined in the study. Specifically, much of the publicly available infor- mation is provided at the county level, with more limited data available at the ZIP code level; as a result, county-level data was assumed to be accurately applied to the entire county, since more precise data were not always available. As such, this study may not capture particular differences that exist at more granular levels of the community. In addition, gaps in information for particular sub-segments of the population exist. Many of the available data sets do not necessarily isolate the uninsured, low-income persons, or certain minority groups. NHC attempted to compensate for the lack of this data through qualitative research, particularly interviews with key members of the community. Finally, this study has relied on community members, through the Community Advisory Committee members and interview- ees, to provide their unique and representative knowledge of the healthcare needs of the community which has both validated and augmented the data collected. Given the infeasibility of gathering input from every single member of the community, the community members that participated have offered their best expertise and understanding on behalf of the entire community. As such, NHC has assumed that the community members that were surveyed accurately and completely represented their con- stituents; however, data to confirm this assumption are not available.
9
Existing Healthcare Facilities & Resources
The following section provides a description of the healthcare landscape in the PSA of NHC, including a description of the available healthcare facilities and services, and the need for additional healthcare facilities and services in NHC’s PSA as identified by the state. As noted previously, NHC’s community for this CHNA is its PSA, and therefore those terms (community and PSA) are used interchangeably throughout this assessment.
Acute Care Hospitals
1. Hospitals Located in NHC’s Community 2. Hospitals Serving the Residents of NHC’s Community
Nash General Hospital is a 270-bed* acute care facil- In fiscal year 2012, a total of 15,290 residents from NHC’s ity that has served the residents of the community for community were discharged from acute care hospitals more than 40 years. It was the first hospital in the state in North Carolina. Approximately 60 percent of these of North Carolina to offer all private rooms and one of resident discharges were from Nash General Hospital. the first hospitals nationwide with bedside computer Put another way, approximately 40 percent of NHC’s documentation capabilities. Nash General Hospital pro- PSA resident discharges in fiscal year 2012 were from vides a wide-range of inpatient and outpatient services, facilities located outside of the community. As dem- supported by more than 320 physicians. As a healthcare onstrated in the table below, patients are leaving the facility that has provided care since 1971, Nash General PSA and seeking care at facilities such as Vidant Medical Hospital has an extensive history delivering acute care Center, Vidant Edgecombe Hospital, WakeMed Raleigh, services and community residents rely heavily on the Wilson Memorial Hospital, Halifax Regional Medical hospital for their healthcare needs. As the only acute Center, and academic medical centers located in the Tri- care hospital in the PSA, Nash General Hospital serves angle. The facility with the second highest percentage an important function as the safety net provider for of the community’s resident discharges, which totaled healthcare services in the community. Specifically, its nearly 13 percent, Vidant Medical Center, is located in emergency department (ED) is not only utilized for Greenville, Pitt County. emergency services, but also provides primary health- care for many uninsured and underinsured residents of NHC’s community, including behavioral health patients.
Patient Hospital Facility County Discharges Percent of Total (FY 2012)
Nash General Hospital (NHC) Nash 9,175 60.0%
Vidant Medical Center Pitt 1,953 12.8%
Vidant Edgecombe Hospital Edgecombe 949 6.2%
WakeMed Wake 802 5.2%
Source: Truven Health Analyt- University of North Carolina Hospitals Orange 444 2.9% ics (Truven); excludes normal newborns, substance abuse, Wilson Memorial Hospital Wilson 433 2.8% psychiatric, and rehabilitation Halifax Regional Medical Center Halifax 420 2.7% discharges. Duke University Medical Center Durham 385 2.5% **Other includes all other acute care hospital facilities with less Rex Healthcare Wake 183 1.2% than one percent of the total LifeCare Hospital Nash 161 1.1% discharges. For a complete list of discharges by acute care hos- Other** 385 2.5% pital facility for fiscal year 2012, please see Attachment 1. Total 15.290 100%
*NHC includes 270 general acute care beds located at Nash General Hospital; 23 inpatient rehabilitation beds located at Bryant T. Aldridge Rehabilitation Center; as well as 16 substance abuse/chemical dependency treatment beds, and 44 psychiatry beds located at Coastal Plain Hospital. All of these facilities are operated under the same provider number and federal tax ID number; therefore, they are all the subject of this CHNA. 11 Behavioral/Mental Health/Substance Abuse
1. Providers Located in NHC’s Community 2. Providers Serving the Residents of NHC’s Community
In 1993, NHC acquired Coastal Plain Hospital, a psychi- In fiscal year 2012, NHC’s community residents had a atric and substance abuse facility that offers compre- total of 1,113 psychiatric/substance abuse discharges. hensive adult inpatient treatment services to residents More than 60 percent of psychiatric/substance abuse of eastern North Carolina. Coastal Plain Hospital oper- discharges were from Coastal Plain Hospital. The facil- ates 44 adult psychiatric and 16 adult substance abuse/ ity with the second highest percentage of the commu- chemical dependency treatment beds. Services at nity’s resident discharges, which totaled more than 15 Coastal Plain Hospital include substance abuse rehabili- percent, Halifax Regional Medical Center, is located in tation, and acute psychiatric stabilization for both vol- Halifax County. untary and involuntary patients.
Patient Hospital Facility County Discharges Percent of Total (FY 2102)
Coastal Plain Hospital (NHC) Nash 676 60.7%
Halifax Regional Medical Center Halifax 171 15.4%
Vidant Medical Center Pitt 62 5.6%
Psychiatric Solutions of NC Wake 50 4.5% (Holly Hill Hospital)
Brynn Marr Hospital Onslow 33 3.0% Source: Truven; only includes substance abuse and psychiatric Vidant Roanoke-Chowan Hospital Hertford 24 2.2% discharges.
University of North Carolina Hospitals Orange 16 1.4% *Other includes all other hospi- tal facilities with less than1% of Durham Regional Hospital Durham 14 1.3% total discharges. For a complete Other* 67 6.0% list of discharges by hospital facility for fiscal year 2012, Total 1,131 100% please see Attachment 2.
12 Inpatient Rehabilitation Services
1. Providers Located in NHC’s Community 2. Providers Serving the Residents of NHC’s Community
Currently, NHC is the only provider of inpatient rehabili- In fiscal year 2012, NHC’s community residents had a tation services located in the community. NHC’s Bryant total of 446 inpatient rehabilitation discharges with T. Aldridge Rehabilitation Center, a 23-bed rehabilita- nearly 72 percent of the discharges coming from Bryant tion facility was opened in 1999. The Center provides T. Aldridge Rehabilitation Center. The facility with the comprehensive inpatient rehabilitation services for second highest percentage of the community’s resident patients with brain trauma, stroke, degenerative dis- discharges, which totaled nearly 10 percent, is Vidant ease, spinal injury, and for patients who have had joint Medical Center. replacements. Therapies provided in the Center’s acute inpatient, outpatient, sports medicine, and inpatient rehabilitation units include physical, occupational, rec- reational, and speech. Cardiopulmonary rehabilitation is a multidisciplinary approach that includes registered nurses, exercise specialists, registered dietitians, and counselors under the direction of the physician medi- cal director.
Patient Hospital Facility County Discharges Percent of Total (FY 2102)
Bryant T. Aldridge Rehabilitation Center (NHC) Nash 334 71.7%
Source: Truven; includes only Vidant Medical Center Pitt 46 9.9% rehabilitation discharges. WakeMed Rehabilitation Hospital Wake 41 8.8%
*Other includes all other hospi- Vidant Edgecombe Hospital Edgecombe 34 7.3% tal facilities with less than one percent of the total discharges University of North Carolina Hospitals Orange 6 1.3% in fiscal year 2012. For a Other* 5 1.1% complete list of discharges by hospital facility for fiscal year Total 466 100% 2011, please see Attachment 3.
Top 4 Acute Care Hospitals in the NHC Community (Percent of Total 2012 Discharges)
60.0%
Four additional hospitals – UNC, Wilson Memorial, 12.8% Halifax Regional, and 5.2% 6.2% Duke – each claim 2% to 3% of discharges from the NHC community. WakeMed Vidant Vidant Nash General Raleigh Edgecombe Medical Hospital Center
13 Outpatient Services
Outpatient services in Nash County, which constitutes Outpatient services are a crucial part of the healthcare the greater part of NHC’s community, are primarily lo- continuum and are offered by NHC as well as other pro- cated in Rocky Mount, as shown in the table below. viders throughout the community.
Facility Name City
Outpatient Rehabilitation
Nash Day Hospital‡ Rocky Mount
HealthFirst Wellness Center‡ Rocky Mount
Bryant T. Aldridge Rehabilitation Center‡ Rocky Mount
Diagnostic Imaging Centers*
Nash General Hospital/Nash Day Hospital‡ Rocky Mount
Carolina Regional Orthopedics (Alliance Healthcare Services) Rocky Mount
Carolina Regional Orthopedics (Alliance Healthcare Services) Tarboro
Ambulatory Surgery Centers/Endoscopy
Nash General Hospital/Nash Day Hospital‡ Rocky Mount ‡These facilities are part of Boice-Willis Clinic Endoscopy Center Rocky Mount Nash Health Care.
Urgent Care Centers *Please note that this includes major diagnostic imaging Bailey Family Practice Center, PA Bailey centers, specifically those with either mobile or fixed MRI of- Boice-Willis Clinic Family Practice and Immediate Care Rocky Mount fices. This list is not exhaustive and does not include services Family Medical Center of Rocky Mount Rocky Mount provided at physician offices.
14 Provider Supply
The table below provides the number of health profes- psychologists, psychological associates, physical thera- sionals per 10,000 persons in Nash, Edgecombe, and pists, physical therapist assistants, and respiratory ther- Halifax counties as well as North Carolina for 2011. As apists as compared to North Carolina. illustrated in the table below, in 2011, Nash County had fewer physicians, primary care physicians, dentists, phar- In 2011, Halifax County had 13.2 physicians per 10,000, macists, nurse practitioners, certified nurse midwives, a rate nearly one-half that of North Carolina (22.1 per physician assistants, dental hygienists, chiropractors, 10,000). In addition, as illustrated in the table below, occupational therapists, optometrists, psychologists, Halifax County had fewer primary care physicians, den- and physical therapists as compared to North Carolina. tists, pharmacists, registered nurses, nurse practitioners, certified nurse midwives, physician assistants, dental In 2011, Edgecombe County had 6.6 physicians per hygienists, chiropractors, occupational therapists, oc- 10,000, a rate more than three times less than that of cupational therapy assistants, optometrists, podiatrists, North Carolina (22.1 per 10,000). Also in 2011, Edge- psychologists, and physical therapists as compared to combe County also had 2.9 primary care physicians North Carolina. per 10,000, a rate more than two times less than that of North Carolina (7.8 per 10,000). In addition, as illustrated In addition, please note that NHC regularly conducts its in the table below, Edgecombe County had fewer den- own medical staff planning analysis. In its most recent tists, pharmacists, registered nurses, nurse practitioners, analysis, conducted in 2012, NHC identified a need for certified nurse midwives, physician assistants, dental additional surgery, medicine, and primary care physi- hygienists, chiropractors, occupational therapists, oc- cian manpower. cupational therapy assistants, optometrists, podiatrists,
2011 Health Professionals Per 10,000 Population*
Edgecombe Halifax North Source: North Carolina Health Health Professionals Nash County Professions Data System, Cecil County County Carolina G. Sheps Center for Health Services Research, University Physicians** 18.9 6.6 13.2 22.1 of North Carolina at Chapel Hill, with data derived from Primary Care Physicians**^ 7.1 2.9 5.9 7.8 the North Carolina Medical Dentists 4.1 1.4 2.2 4.3 Board, 2011.
Note: the data provided in the Pharmacists 8.9 4.3 7.5 9.5 table include those who are Registered Nurses 111.0 60.3 79.6 98.6 licensed and active within the profession as well as those with Nurse Practitioners 2.2 1.2 2.6 4.1 unknown activity status; inac- tives are excluded. Certified Nurse Midwives^^ 1.1 0.7 0.4 1.6
*Log Into North Carolina Physician Assistants 4.2 2.1 2.2 4.0 (LINC) Database, Office of Dental Hygienists 4.2 2.5 5.1 5.6 State Planning, NC Office of the Governor. Licensed Practical Nurses 25.9 19.8 21.7 18.5 **Physicians include doctors Chiropractors 0.9 0.4 0.7 1.6 of medicine and doctors of os- teopathy who are non-federal, Occupational Therapists 1.9 1.6 0.7 2.8 non-resident-in-training. Occupational Therapy Assistants 1.6 1.1 1.1 1.3 ^Primary care physicians include those physicians who Optometrists 0.9 0.4 0.7 1.1 report a primary specialty of family practice, general Podiatrists 0.3 0.0 0.2 0.3 practice, internal medicine, Psychologists 0.6 0.2 0.7 2.1 obstetrics/gynecology, or pediatrics. Psychological Associates 1.1 0.5 0.9 0.9
^^Certified nurse midwives are Physical Therapists 4.9 1.8 2.2 5.4 calculated per 10,000 females aged 15-44 (child-bearing Physical Therapist Assistants 5.6 2.3 4.2 2.5 population); population source: Respiratory Therapists 5.5 3.4 4.6 4.3 LINC. 15 Needs Identified in the 2013 State Medical Facilities Plan (SMFP)
Each calendar year, the Governor of North Carolina, under advisement from the State Health Coordinat- ing Council, publishes the State Medical Facilities Plan (SMFP), which identifies the need for certain types of beds, equipment and other services in the state. In this section, we review the state’s needs assess- ment for 13 different types of facilities and services in Nash County and surrounding areas.
1. Acute Care Hospital Beds Bone marrow transplantation services: Currently, there are no providers of bone marrow transplanta- According to the 2013 SMFP, there is no need for addi- tion services in Nash, Edgecombe, or Halifax counties. tional acute care beds in Nash, Edgecombe, or Halifax According to the 2013 SMFP, there is no need for addi- counties. In fact, the 2013 SMFP identified a surplus of tional bone marrow transplantation services anywhere beds in each of these counties. Nash County was iden- in the state. tified as having a 78-bed surplus, Edgecombe County was identified as having a 38-bed surplus, and the mul- Solid organ transplantation services: Currently, there ticounty service area encompassing Halifax and North- are no providers of solid organ transplantation services ampton counties was identified as having a surplus of in Nash, Edgecombe, or Halifax counties. According to 92 beds. the 2013 SMFP, there is no need for additional solid or- gan transplantation services anywhere in the state. 2. Operating Rooms
According to the 2013 SMFP, there is no need for addi- tional operating rooms in Nash, Edgecombe, or Halifax counties. In fact, the 2013 SMFP identified a surplus of operating rooms in each of these counties. Nash County 208 was identified as having a 3.97 operating room surplus, The total number of surplus acute care hospital Edgecombe County was identified as having a 2.82 op- beds identified by the SMFP in Nash County, erating room surplus, and the multicounty service area Edgecombe County, and the multicounty service area encompassing Halifax and Northampton encompassing Halifax and Northampton counties was identified as having a 1.66 operating room surplus.
3. Other Acute Care Services 4. Inpatient Rehabilitation Services
Open heart surgery: Currently, there are no providers NHC’s Bryant T. Aldridge Rehabilitation Center (23 beds) of open heart surgery services in Nash, Edgecombe, or is the only provider of inpatient rehabilitation services Halifax counties. According to the 2013 SMFP, there is in NHC’s PSA. Vidant Edgecombe Hospital operates 16 no need for additional open heart surgery services any- inpatient rehabilitation beds. There are no providers of where in the state. inpatient rehabilitation services in Halifax County. Ac- cording to the 2013 SMFP, there is no need for addition- Burn intensive care services: Currently, there are no al inpatient rehabilitation beds anywhere in the state. providers of burn intensive care services in Nash, Edge- combe, or Halifax counties. According to the 2013 SMFP, there is no need for additional burn intensive care ser- vices anywhere in the state.
16 5. Technology and Equipment
Lithotripter: Currently, NHC and Halifax Regional Medi- MRI: Currently, there are two providers of MRI services in cal Center are served by mobile lithotripsy vendors. Nash County: NHC and Carolina Regional Orthopaedics According to the 2013 SMFP, there is no need for addi- (Alliance HealthCare Services). In Edgecombe County, tional lithotripters anywhere in the state. there are two providers of MRI services: Vidant Edge- combe Hospital and Alliance HealthCare Services. In Gamma Knife: Currently, there are no providers of gam- Halifax County, there are two providers of MRI services: ma knife services in Nash, Edgecombe, or Halifax coun- Halifax Regional Medical Center and Atlantic Radiology ties. According to the 2013 SMFP, there is no need for Associates (Alliance HealthCare Services). According to additional gamma knives anywhere in the state. the 2013 SMFP, there is no need for additional fixedMRI scanners anywhere in the state. Linear Accelerator: Nash County, along with Edge- combe, Halifax, Northampton and Wilson counties Cardiac Catheterization: Currently, Nash operates two comprise linear accelerator service area 25. There are units of fixed cardiac catheterization equipment and currently four linear accelerators in service area 25, two is the only provider in Nash County. In Halifax County, of which are operated in Nash County by NHC. The oth- Halifax Regional Medical Center operates one unit of er two linear accelerators in service area 25, neither of fixed cardiac catheterization equipment and is the only which is located in NHC’s PSA, are: Roanoke Valley Can- provider in the multicounty service area encompassing cer Center in Roanoke Rapids near Halifax Regional, and Halifax and Northampton counties. There is no provider Wilson Medical Center in Wilson. According to the 2013 of cardiac catheterization services in Edgecombe Coun- SMFP, there is no need for additional linear accelerators ty. According to the 2013 SMFP, there is no need for ad- anywhere in the state. ditional fixed cardiac catheterization equipment in the areas encompassed by NHC’s PSA. PET: Currently, there are three providers of fixed PET According to the 2013 SMFP, there is no need for ad- services in Health Service Area (HSA) VI, which includes ditional shared fixed or mobile cardiac catheterization Nash, Edgecombe, and Halifax counties. While there are equipment in any of areas encompassed by NHC’s PSA. three providers in HSA VI, only one is located in NHC’s PSA: NHC, which currently operates one fixed dedicated According to the 2013 SMFP, there is no need for addi- PET scanner. According to the 2013 SMFP, there is no tional mobile cardiac catheterization equipment any- need for additional fixed dedicated PET scanners in HSA where in the state. VI. Nash General Hospital also provides mobile PET ser- vices through a mobile vendor. According to the 2013 SMFP, there is no need for additional mobile PET scan- ners anywhere in the state.
Open heart surgery | Burn intensive care | Bone marrow transplantation | Solid organ transplantation | No need Inpatient rehabilitation | Lithotripter | Gamma knife | Mobile PET | Fixed MRI | Mobile cardiac catheterization statewide
No need
Fixed cardiac catheterization | Fixed dedicated PET Nash PSA
Excess in
Acute care hospital beds | Operating rooms Nash PSA
17 Findings of the 2013 State Medical Facilities Plan (continued)
6. Nursing Care Facilities 8. Home Health Services
Currently, there are five providers of nursing facility ser- Currently, there are two providers of home health ser- vices in Nash County: Autumn Care of Nash, Hunter Hills vices in Nash County: Nash County Home Health Agen- Nursing & Rehabilitation Center, Kindred Transitional cy and Gentiva Health Services. In Edgecombe County, Care & Rehab – Rocky Mount, South Village, and Univer- there is currently one provider of home health services: sal Health Care/Nashville. In Edgecombe County, there Edgecombe HomeCare & Hospice. In Halifax County, are currently three providers of nursing facility services: there is currently one provider of home health services: Golden Living Center – Tarboro, Tarboro Nursing Center, Home Health and Hospice of Halifax. According to the and The Fountains at Albemarle. In Halifax County, there 2013 SMFP, there is no need for additional Medicare- are currently five providers of nursing facility services: certified home health agencies or offices in Region L, EnfieldO aks Nursing & Rehabilitation Center, Kindred which includes Nash, Edgecombe, and Halifax counties. Nursing & Rehabilitation – Scotland Neck, Kindred Tran- sitional Care & Rehab – Roanoke Rapids, Liberty Com- mons Nursing & Rehab Center of Halifax County, and Our Community Hospital. According to the 2013 SMFP, there is no need for additional nursing care beds in 210 Nash, Edgecombe, or Halifax counties. In fact, the 2013 The total number of excess nursing facility beds SMFP identified a surplus of nursing facility beds in each identified by the SMFP in Nash County, Edgecombe of these counties. Nash County was identified as having County and Halifax County a 62 bed surplus, Edgecombe County was identified as having a 69 bed surplus, and Halifax County was identi- fied as having a 79 bed surplus. 9. Hospice Services
7. Adult Care Homes Currently, there are three hospice offices in Nash Coun- ty: Community Home Care & Hospice, Hospice and Currently, there are eleven providers of adult care home Palliative Care of Nash General Hospital, and United (assisted living) services in Nash County: Autumn Care Hospice of Eastern Carolina. In Edgecombe County, of Nash, Breckenridge Retirement Center, Hunter Hill there are two hospice offices: Community Home Care Assisted Living, Hunter Hills Nursing & Rehabilitation and Hospice and Edgecombe HomeCare & Hospice. In Center, Somerset Court of Rocky Mount, South Village, Halifax County, there are three hospice offices:C om- Spring Arbor of Rocky Mount, Sterling House of Rocky munity Home Care & Hospice, Home Health and Hos- Mount, Trinity Retirement Villas #1, Trinity Retirement pice of Halifax, and Continuum Home Care & Hospice of Villas #2, and Universal Health Care/Nashville. In Edge- Halifax County. According to the 2013 SMFP, there is no combe County, there are currently three providers need for additional hospice home offices in Nash, Edge- of adult care home services: Heritage Care of Rocky combe, or Halifax counties. Mount, Open Fields Assisted Living, and The Fountains at Albemarle. In Halifax County, there are currently five Currently, there are no hospice inpatient or residential providers of adult care home services: Carolina Rest beds in Nash, Edgecombe, or Halifax counties. Accord- Home, Liberty Commons Nursing & Rehab Center, Our ing to the 2013 SMFP, there is no need for additional Community Hospital, Woodhaven Rest Home #1, and hospice inpatient beds in Edgecombe or Halifax coun- Woodhaven Rest Home #2. According to the 2013 SMFP, ties; however, there is a need for seven hospice inpatient there is no need for additional adult care home beds in beds in Nash County. Nash, Edgecombe, or Halifax counties.
18 10. End Stage Renal Disease Dialysis Facilities 12. Substance Abuse Inpatient/Residential Services
Currently, there are two providers of end stage renal Nash County along with Edgecombe, Bladen, Colum- disease dialysis services in Nash County: Rocky Mount bus, Duplin, Greene, Lenoir, Robeson, Sampson, Scot- Kidney Center (BMA) and FMC of Spring Hope. In Edge- land, Wayne, and Wilson counties comprise the East- combe County, there are currently two providers of end pointe Mental Health service area. There is currently one stage renal disease dialysis services: Dialysis Care Edge- provider of substance abuse inpatient and residential combe County and BMA of East Rocky Mount. In Halifax services in the Eastpointe Mental Health service area: County, there are currently three providers of end stage Coastal Plain Hospital, part of Nash Health Care, located renal disease dialysis services: BMA of Roanoke Rapids, in Nash County. Halifax County along with Alamance, FMC of Halifax County, and FMC of Weldon. The North Caswell, Chatham, Franklin, Granville, Orange, Person, Carolina Medical Facilities Planning Section determines Vance, and Warren counties comprise the Cardinal Inno- the need for new outpatient dialysis stations twice each vations 2 Mental Health service area. There is currently calendar year. The report containing these determina- one provider of substance abuse inpatient and residen- tions is called the North Carolina Semiannual Dialysis tial services in the Cardinal Innovations 2 Mental Health Report (SDR). The relevant SDRs are available in Janu- service area: Alamance Regional Medical Center, located ary 2013 and July 2013. According to the July 2013 SDR, in Alamance County. According to the 2013 SMFP, there application of the county need methodology results in is no need for additional adult chemical dependency a need for 19 dialysis stations in Nash County; however, treatment beds (inpatient or residential) anywhere in the Certificate of Need Section is currently reviewing the state. While according to the 2013 SMFP, there is no applications for 23 additional stations in the county. need for additional child/adolescent chemical depend- ency treatment beds (inpatient or residential) in the 11. Psychiatric Inpatient Services Central Region, which encompasses the Cardinal Inno- vations 2 Mental Health service area and Halifax Coun- Nash County along with Edgecombe, Bladen, Colum- ty, there is a need for four additional child/adolescent bus, Duplin, Greene, Lenoir, Robeson, Sampson, Scot- chemical dependency treatment beds (inpatient or resi- land, Wayne, and Wilson counties comprise the East- dential) in the Eastern Region (HSAs IV, V, and VI), which pointe Local Management Entity service area. There are encompasses the Eastpointe Mental Health service area currently five providers of psychiatric inpatient services and Nash and Edgecombe counties.. in the Eastpointe Local Management Entity service area. One of the providers, Coastal Plain Hospital, part of 13. Intermediate Care Facilities for Individuals with Nash Health Care, is located in NHC’s PSA. Halifax Coun- Intellectual Disabilities (ICF/IID) [Formerly Interme- ty along with Alamance, Caswell, Chatham, Franklin, diate Care Facilities for the Mentally Retarded (ICF/ Granville, Orange, Person, Vance, and Warren counties MR)] comprise the Cardinal Innovations 2 Local Management Entity service area. There are currently four providers Currently, there are three providers of ICF/IID services in of psychiatric inpatient services in the Cardinal Innova- Nash County: LIFE, Inc. /Green Tea Lane, SCI Nash House tions 2 Local Management Entity service area, includ- I, and SCI Nash House II. In Edgecombe County, there is ing Halifax Regional Medical Center, in Halifax County. currently one provider of ICF/IID services: Skill Creations According to the 2013 SMFP, there is no need for addi- of Tarboro. In Halifax County, there are currently five tional adult psychiatric inpatient beds in the Eastpointe providers of ICF/IID services: Idlewood Group Home, Local Management Entity service area, which includes Life, Inc./King Street Group Home, LIFE, Inc./Lakeview, Nash and Edgecombe counties. However, according to McFarland Road, and SCI-Roanoke House. According to the 2013 SMFP, there is a need for 13 additional child/ the 2013 SMFP, there is no need for additional adult or adolescent psychiatric inpatient beds in the Eastpointe child ICF/IID beds anywhere in the state, including the Local Management Entity service area, which includes Eastpointe service area, which includes Nash and Edge- Nash and Edgecombe counties. According to the 2013 combe counties and the Cardinal Innovations 2 service SMFP, there is no need for additional adult or child/ado- area, which includes Halifax County. lescent psychiatric inpatient beds in the Cardinal Inno- vations 2 Local Management Entity service area, which includes Halifax County.
19
Demographics
NHC’s PSA occupies a land area of approximately 888 square miles and includes significant portions of Edgecombe, Halifax and Nash counties, as shown in the map in Attachment 4. The section below pro- vides detailed information regarding the population characteristics of NHC’s community with detailed information by ZIP code included in Attachment 5. NHC has utilized data from Nielsen, a global infor- mation and measurement company and a leading resource for demographic data.
Total Population
According to Nielsen, the community’s population has community has slower growth than the statewide pop- grown from 117,329 in 2000 to 121,272 in 2013, repre- ulation. Moreover, the table also indicates that, in the senting total growth of 3.4 percent and a compound next five years, the statewide population is projected to annual growth rate (CAGR) of 0.3 percent, as shown in grow faster than NHC’s community, even as both geo- the table below. In comparison, the population of North graphic areas will grow at slower rates than the 2000 to Carolina experienced total growth of 21.7 percent and a 2013 period. CAGR of 1.5 percent within the same period. Thus, the
Total Growth CAGR*
2000 2013 2018 2000 - 2013 - 2000 - 2013 - 2013 2018 2013 2018
NHC’s Community (PSA) 117,329 121,272 121,825 3.4% 0.5% 0.3% 0.1% Source: Nielsen, Attachment 5. *Compound annual growth North Carolina 8,049,331 9,796,936 10,251,127 21.7% 4.6% 1.5% 0.9% rate.
Age
The following three tables show the population by age whole. While the statewide population is expected to and gender for 2000, 2013, and 2018 in the primary ser- grow in every age cohort, the NHC community will see vice area of NHC in comparison to North Carolina as a growth only among its oldest residents.
2000 Population by Age
<18 18-44 45-64 65+ Total
NHC’s Community (PSA)
Male 15,945 21,184 12,770 5,586 55,485
Female 15,243 23,288 14,367 8,946 61,844
Total 31,188 44,472 27,137 14,532 117,329
North Carolina
Male 1,005,995 1,675,092 872,459 389,110 3,942,656
Female 957,917 1,632,268 936,399 580,091 4,106,675
Total 1,963,912 3,307,360 1,808,858 969,201 8,049,331 Source: Nielsen, Attachment 5.
21 Age (continued)
2013 Population by Age
<18 18-44 45-64 65+ Total
NHC’s Community (PSA)
Male 14,534 19,163 16,266 7,790 57,753
Female 13,819 20,315 18,366 11,019 63,519
Total 28,353 39,478 34,632 18,809 121,272
North Carolina
Male 1,190,713 1,761,155 1,240,888 582,696 4,775,452
Female 1,138,051 1,763,310 1,339,000 781,123 5,021,484
Total 2,328,764 3,524,465 2,579,888 1,363,819 9,796,936 Source: Nielsen, Attachment 5.
2018 Population by Age
<18 18-44 45-64 65+ Total
NHC’s Community (PSA)
Male 14,213 19,432 15,408 9,129 58,182
Female 13,543 19,958 17,500 12,642 63,643
Total 27,756 39,390 32,908 21,771 121,825
North Carolina
Male 1,234,936 1,784,433 1,288,439 693,251 5,001,059
Female 1,181,092 1,761,592 1,387,083 920,301 5,250,068
Total 2,416,028 3,546,025 2,675,522 1,613,552 10,251,127 Source: Nielsen, Attachment 5.
22 Age (continued)
As illustrated in the tables below, the population for above 44 years have increased. The population of the 65 each age group in NHC’s community, except age 65 and over age group is projected to grow at a faster rate and over, is projected to decrease in the next five years from 2013 to 2018 than the other groups in the com- (2013 to 2018). Population totals for age groups below munity, and at a similar rate to the projected growth 44 years have declined from 2000 to 2013, while those statewide for the 65 and over population.
2000 2013 2018 CAGR
<18 <18 <18 2000-2013 2013-2018
NHC’s Community (PSA)
Male 15,945 14,534 14,213 -0.7% -0.4%
Female 15,243 13,819 13,543 -0.8% -0.4%
Total 31,188 28,353 27,756 -0.7% -0.4%
North Carolina
Male 1,005,995 1,190,713 1,234,936 1.3% 0.7%
Female 957,917 1,138,051 1,181,092 1.3% 0.7%
Source: Nielsen, Attachment 5. Total 1,963,912 2,328,764 2,416,028 1.3% 0.7%
2000 2013 2018 CAGR
18-44 18-44 18-44 2000-2013 2013-2018
NHC’s Community (PSA)
Male 21,184 19,163 19,432 -0.8% 0.3%
Female 23,288 20,315 19,958 -1.0% -0.4%
Total 44,472 39,478 39,390 -0.9% 0.0%
North Carolina
Male 1,675,092 1,761,155 1,784,433 0.4% 0.3%
Female 1,632,268 1,763,310 1,761,592 0.6% 0.0%
Total 3,307,360 3,524,465 3,546,025 0.5% 0.1% Source: Nielsen, Attachment 5.
23 Age (continued)
2000 2013 2018 CAGR
45-64 45-64 45-64 2000-2013 2013-2018
NHC’s Community (PSA)
Male 12,770 16,266 15,408 1.9% -1.1%
Female 14,367 18,366 17,500 1.9% -1.0%
Total 27,137 34,632 32,908 1.9% -1.0%
North Carolina
Male 872,459 1,240,888 1,288,439 2.7% 0.8%
Female 936,399 1,339,000 1,387,083 2.8% 0.7%
Total 1,808,858 2,579,888 2,675,522 2.8% 0.7% Source: Nielsen, Attachment 5.
2000 2013 2018 CAGR
65+ 65+ 65+ 2000-2013 2013-2018
NHC’s Community (PSA)
Male 5,586 7,790 9,129 2.6% 3.2%
Female 8,946 11,019 12,771 1.6% 2.8%
Total 14,532 18,809 21,771 2.0% 3.0%
North Carolina
Male 389,110 582,696 693,251 3.2% 3.5%
Female 580,091 781,123 920,301 2.3% 3.3%
Total 969,201 1,363,819 1,613,552 2.7% 3.4% Source: Nielsen, Attachment 5.
24 Gender – Male
According to the Nielsen, the distribution of males in the community is lower than the statewide distribution of males for the same time periods as demonstrated in the table below.
% of 2000 % of 2000 % of 2013 % of 2013 % of 2018 % of 2018 Population Population Population Population Population Population NHC’s PSA NC NHC’s PSA NC NHC’s PSA NC
Source: Nielsen, Attachment 5. Males 47.3% 49.0% 47.6% 48.7% 47.8% 48.8%
Moreover, the compound annual growth rate of the male population in the community indicates that it is growing at a slower rate than the statewide male population for the same time period, as demonstrated in the table below.
Male Population CAGR
2000 2013 2018 2000-2013 2013-2018
NHC’s Community 55,485 57,753 58,182 0.3% 0.1% (PSA)
North 3,942,656 4,775,452 5,001,059 1.5% 0.9% Source: Nielsen, Attachment 5. Carolina
Gender – Female
According to the Nielsen, the distribution of females in the community is higher than the statewide distribution of females for the same time periods as demonstrated in the table below.
% of 2000 % of 2000 % of 2013 % of 2013 % of 2018 % of 2018 Population Population Population Population Population Population NHC’s PSA NC NHC’s PSA NC NHC’s PSA NC
Source: Nielsen, Attachment 5. Females 52.7% 51.0% 52.4% 51.3% 52.2% 51.2%
Moreover, the compound annual growth rate of the female population in NHC’s community is grow- ing at a slower rate than the statewide female population for the same time period as demonstrated in the table below.
Female Population CAGR
2000 2013 2018 2000-2013 2013-2018
NHC’s Community 61,844 63,519 63,643 0.2% 0.0% (PSA)
North 4,106,675 5,021,484 5,250,068 1.6% 0.9% Source: Nielsen, Attachment 5. Carolina
25 Race and Ethnicity
1. Race: According to Nielsen (see the tables below), increased by 1.0 percent annually. The Black/African the majority of NHC’s community residents originate American population in NHC’s community, on the other from one/single race as compared to those from two or hand, experienced 0.5 percent annual growth in the more races. As shown previously, the overall population same period as compared to 1.5 percent statewide. It of North Carolina has experienced a higher growth (1.5 is worth noting that the population of the Asian, Other percent) than NHC’s community (0.3 percent) in the past and Two or More Races have experienced the strong- 13 years. The White and Black/African American popu- est growth in the past 13 years and have some of the lation continue to be the dominant groups in both the highest future growth projections both within NHC’s state and NHC’s community. However, the White popu- community and North Carolina as a whole. The growth lation in NHC’s community has declined 0.4 percent an- trends for these groups are expected to continue in the nually in the past 13 years, while that of the state has next five years, except at slower rates.
Population – NHC’s Community CAGR
2000 2013 2013 2000-2013 2013-2018
Single Race
White 55,635 52,741 51,470 -0.4% -0.5%
Black or African 56,702 60,312 61,150 0.5% 0.3% American
American Indian 2,104 2,607 2,781 1.7% 1.3% or Alaska Native
Asian 532 807 885 3.3% 1.9%
Native Hawaiian or Other Pacific 26 34 33 2.1% -0.6% Islander
Other Race 1,204 2,814 3,286 6.7% 3.1%
Two or More 1,126 1,957 2,220 4.3% 2.6% Races
Total 117,329 121,272 121,825 0.3% 0.1% Source: Nielsen.
Population – North Carolina CAGR
2000 2013 2013 2000-2013 2013-2018
Single Race
White 5,804,695 6,619,386 6,796,989 1.0% 0.5%
Black or African 1,737,533 2,101,616 2,185,679 1.5% 0.8% American
American Indian 99,527 127,143 135,806 1.9% 1.3% or Alaska Native
Asian 113,652 234,610 275,612 5.7% 3.3%
Native Hawaiian or Other Pacific 3,991 7,382 8,610 4.8% 3.1% Islander
Other Race 186,622 472,395 567,081 7.4% 3.7%
Two or More 103,311 234,404 281,350 6.5% 3.7% Races
Total 8,049,331 9,796,936 10,251,127 1.5% 0.9% Source: Nielsen.
26 Photo Here
Further analysis of the Nielsen data indicates that the projected to further decline in the next five years.T he race distribution of NHC’s community is more diverse reverse is true for the other groups; that is, their propor- than that of the state, as demonstrated in the table tions of the total population have increased slightly or below. In fact, for both NHC’s community and North stayed essentially the same and are projected to exhibit Carolina as a whole, the White population as percent of similar trends through 2018. total population has declined in the past 13 years and is
NHC’s Community North Carolina
% of 2000 % of 2013 % of 2018 % of 2000 % of 2013 % of 2018 Population Population Population Population Population Population
Single Race
White 47.4% 43.5% 42.2% 72.1% 67.6% 66.3%
Black or African 48.3% 49.7% 50.2% 21.6% 21.5% 21.3% American
American Indian or 1.8% 2.1% 2.3% 1.3% 1.3% 1.3% Alaska Native
Asian 0.5% 0.7% 0.7% 1.4% 2.4% 2.7%
Native Hawaiian or Other Pacific 0.0% 0.0% 0.0% 0.0% 0.1% 0.1% Islander
Other Race 1.0% 2.3% 2.7% 2.3% 4.8% 5.5%
Two or More Races 1.0% 1.6% 1.8% 1.3% 2.4% 2.7%
Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Source: Nielsen.
27 Race and Ethnicity (continued)
2. Haliwa-Saponi Indian Tribe: NHC’s community in- Further analysis of the Nielsen data shows that in 2000, cludes two ZIP codes in an area that is home to a large approximately 78.1 percent of the population of the population of the Haliwa-Saponi Indian Tribe. The Hali- American Indian tribe in NHC’s community resided in wa-Saponi Tribe consists of 4,300 enrolled tribal mem- Enfield and Hollister, Halifax County. This proportion has bers, of whom approximately 2,700 (62 percent) live in decreased to 70.9 percent in 2013 and is projected to a tight-knit tribal community on the Warren and Halifax decrease further to 68.9 percent in 2018 as the popula- County border. Over 1,898 Tribal members reside in Hal- tion in Rocky Mount and Nashville continues to grow. ifax County, while over 887 live in Warren County.
American Indian Tribe Population by ZIP Code
CAGR CAGR ZIP Code City 2000 2013 2018 2000-2013 2013-2018
27801 Rocky Mount 52 70 78 2.3% 2.2%
27803 Rocky Mount 65 96 112 3.0% 3.1%
27804 Rocky Mount 110 267 317 7.1% 3.5%
27809 Battleboro 16 37 44 6.7% 3.5%
27816 Castalia 35 38 39 0.6% 0.5%
27823 Enfield 275 343 367 1.7% 1.4%
27844 Hollister 1,368 1,505 1,549 0.7% 0.6%
27856 Nashville 76 129 148 4.2% 2.8%
27882 Spring Hope 36 43 45 1.4% 0.9%
27891 Whitakers 71 79 82 0.8% 0.7%
NHC’s Community Total 2,104 2,607 2,781 1.7% 1.3%
North Carolina Total 99,527 127,143 135,806 1.9% 1.3% Source: Nielsen.
American Indian Tribe Population in NHC’s Community
% of 2000 % of 2013 % of 2018 ZIP Code County Population Population Population
27801 Edgecombe 2.5% 2.7% 2.8%
27823 & 27844 Halifax 78.1% 70.9% 68.9%
Other PSA Zips Nash 19.4% 26.4% 28.3%
Total 100.0% 100.0% 100.0% Source: Nielsen.
28 3. Hispanic population: The Hispanic population, both years. As a percentage of population, Hispanics repre- in NHC’s community and the state as a whole, has expe- sent a smaller group in NHC’s community than in the rienced significant growth compared to other groups in state as a whole. This situation is projected to continue the past 13 years. The first chart shows that this trend is in the future, as illustrated in the second chart below. projected to continue at lower rates over the next five
Population CAGR
2000 2013 2013 2000-2013 2013-2018
NHC’s Community (PSA)
Hispanic or 2,347 4,846 5,630 5.7% 3.0% Latino
Not Hispanic or 114,982 116,426 116,195 0.1% 0.0% Latino
Total 117,329 121,272 121,825 0.3% 0.1%
North Carolina
Hispanic or 378,979 914,490 1,099,507 7.0% 3.8% Latino
Not Hispanic or 7,670,352 8,882,446 9,151,620 1.1% 0.6% Latino
Total 8,049,331 9,796,936 10,251,127 1.5% 0.9% Source: Nielsen.
% of 2000 % of 2013 % of 2018 Population Population Population
NHC’s Community (PSA)
Hispanic or 2.0% 4.0% 4.6% Latino
Not Hispanic or 98.0% 96.0% 95.6% Latino
Total 100.0% 100.0% 100.0%
North Carolina
Hispanic or 4.7% 9.3% 10.7% Latino
Not Hispanic or 95.3% 90.7% 89.3% Latino
Total 100.0% 100.0% 100.0% Source: Nielsen.
Summary
As outlined above, NHC’s community has experienced a modest increase in overall popula- tion in the past 13 years and that growth is projected to increase at a reduced rate in the future. As discussed throughout this assessment, health is dependent on multiple factors, including, but not limited to, individual characteristics and the environment and community in which one lives. Such information can guide efforts to identify gaps in the existing system and to improve the health and healthcare available to communities. By examining the popu- lation of NHC’s community, NHC can identify local needs that may be obscured when data is aggregated on a state or national level.
29
Socioeconomic Factors
In addition to demographics, this assessment reviews socioeconomic factors that play a sig- nificant role in identifying healthcare needs.T he following section examines the details of some of the key factors including income, poverty, unemployment, and education.
Income Level
The median household income in 2013 for NHC’s com- compound annual growth rate in median household in- munity is approximately 11.9 percent below the North come for the community has been higher than for North Carolina average and 24.1 percent below the United Carolina as a whole, but lower than for the entire United States average. Similarly, the median household income States. Over the next five years, the NHC community for NHC’s community is projected to be 8.9 percent and median household income is expected to grow faster 23.6 percent below the North Carolina and United States than both North Carolina and the United States. averages respectively in 2018. From 2000 to 2013, the
NHC’s Community Median Household Income By ZIP Code
CAGR CAGR ZIP Code City 2000 2013 2018 2000-2013 2013-2018
27801 Rocky Mount $27,540 $28,807 $30,188 0.3% 0.9%
27803 Rocky Mount $33,573 $36,422 $36,567 0.6% 0.1%
27804 Rocky Mount $41,132 $44,089 $44,318 0.5% 0.1%
27809 Battleboro $37,360 $46,205 $47,030 1.6% 0.4%
27816 Castalia $31,142 $35,771 $35,339 1.1% -0.2%
27823 Enfield $24,336 $25,483 $26,529 0.4% 0.8%
27844 Hollister $19,870 $27,629 $28,559 2.6% 0.7%
27856 Nashville $38,451 $45,933 $46,114 1.4% 0.1%
27882 Spring Hope $35,066 $39,796 $39,583 1.0% -0.1%
27891 Whitakers $34,785 $32,055 $32,327 -0.6% 0.2%
NHC’s Community Total $33,711 $37,394 $38,068 0.8% 0.4%
North Carolina Total $39,585 $42,443 $41,797 0.5% -0.3%
U.S. Total $42,728 $49,297 $49,815 1.1% 0.2% Source: Nielsen
31 Poverty
In 2011, Nash County had 16 percent of its resident nity have poverty levels below the state average, while population living below the Federal Poverty Level of the other five (one in Edgecombe, two in Halifax and $22,350. The statewide poverty level was about the two in Nash) have much higher poverty levels. The same as Nash County. Edgecombe and Halifax counties, data also shows that all but one ZIP code (27809, Bat- on the other hand, had much higher percentages, 22.6 tleboro) has a lower percentage of households receiv- percent and 24.1 percent respectively, below the Federal ing food stamps than the state. In particular, three ZIP Poverty Level. However, all three counties (Edgecombe, codes (27801, 27823 and 27844) in Edgecombe and Halifax and Nash) had significantly higher percentages Halifax counties are among the poorest neighborhoods of their households receiving government assistance in within NHC’s community given that they have the low- the form of food stamps than the state overall. est median household incomes and among the highest percentages of households below poverty level and re- At the ZIP code level, five ZIP codes in NHC’s commu- ceiving food stamps
Percent of Population Below Federal Poverty Level North Carolina 2011
Less than 16% (33)
16% to 21% (40)
More than 21% (27)
Sources: U.S. Census Bureau 5-Year (2007-2011) American Community Survey Estimates.
2011 NHC Community Poverty Profile by ZIP Code
% of Households % Below Poverty ZIP Code City Receiving Food Level Stamps
27801 Rocky Mount 27.1% 31.9%
27803 Rocky Mount 19.4% 22.3%
27804 Rocky Mount 12.8% 11.4%
27809 Battleboro 11.8% 9.3%
27816 Castalia 26.1% 20.6%
27823 Enfield 31.1% 35.6%
27844 Hollister 25.1% 34.4%
27856 Nashville 13.6% 13.6%
27882 Spring Hope 15.6% 16.3%
27891 Whitakers 15.4% 16.8%
Edgecombe 22.6% 24.1%
Halifax 24.1% 26.4%
Nash 16.0% 15.7% Sources: US Census Bureau N.C. 16.1% 11.4% 5-Year (2007-2011) American Community U.S. 14.3% 10.2% Survey Estimates 32 Unemployment
Local unemployment rates in the three counties – Edge- since. In the 12-month period between December 2011 combe, Halifax and Nash – have been historically higher and December 2012, unemployment rates in Edge- than both statewide and national rates. Among the combe and Nash Counties declined at a faster rate than three counties, Nash County has the lowest unemploy- Halifax County, North Carolina and United States; Hali- ment rate and Edgecombe has the highest. As expect- fax County experienced a drop in civilian labor force for ed, the unemployment rates peaked in 2009 due to the the same period. economic recession and have been declining gradually
Civilian Labor Force and Unemployment
Civilian Labor Force (000’s) Unemployment Rate
Dec. 2011 Dec. 2012 Change Dec. 2011 Dec. 2012 Change
Edgecombe 25.9 26.4 0.5 16.1% 15.0% -1.1%
Halifax 23.2 22.6 (0.6) 14.0% 13.6% -0.4%
Nash 46.5 47.5 1.0 12.3% 11.2% -1.1%
N.C. 4,677.2 4,753.3 76.1 10.2% 9.5% -0.7%
Source: Bureau of Labor U.S. 153,945.0 155,511.0 1,566.0 8.5% 7.8% -0.7% Statistics
Unemployment Rates in NHC’s PSA Counties Compared with NC and US Data
Source: Data from the Bureau of Labor Statistics
33 Education Level
In addition to four traditional high schools, Nash-Rocky in 2008-2009 to 90.0 percent in 2011-2012, and attend- Mount Public Schools (NRMPS) have a non-traditional ance has consistently been in the mid-90 percent range. high school, the NRMPS Early College High School, es- tablished in September 2002 and located on the Nash The above notwithstanding, the high school dropout Community College campus. It is a fully accredited pub- rate in Nash County is among the highest in the east- lic school of choice representing a unique partnership ern North Carolina, second only to Edgecombe County between Nash-Rocky Mount Public Schools and Nash in 2007-2008. The four year cohort high school gradua- Community College. Students complete a rigorous tion rates for NRMPS and surrounding counties’ school program of study that blends both high school and col- systems have been significantly lower than the state- lege course work with a goal of earning a high school wide graduation rate in each year for the last six years diploma and an associate degree in just five years. Grad- as shown in the table below (with the sole exception of uation in post-secondary education at NRMPS Early Edgecombe County in 2010). College High School has increased from 64.0 percent
Four-Year Cohort Graduation Rate
2007 2008 2009 2010 2011 2012
Edgecombe 65.1% 59.2% 58.2% 76.7% 75.0% 79.8% County Schools
Halifax County 66.6% 65.0% 54.8% 70.1% 71.9% 75.5% Schools
Nash-Rocky Mount 68.4% 62.1% 67.2% 70.8% 74.7% 76.7% Public Schools Source: NC State Board of Education, Department of Public Instruction N.C. 69.5% 70.3% 71.8% 74.2% 77.9% 80.4%
According to the 2013 County Health Rankings, the Professional School Degree, 0.3 percent has earned a percentage of residents with some college education Doctorate Degree, and 11.4 percent has earned a Bach- in Nash County is 54 percent, significantly lower than elor’s Degree. In comparison, for the United States, it the state average of 62 percent and less than the na- is estimated that for the population age 25 and over, tional benchmark of 70 percent. Additionally, accord- 7.3 percent has earned a Master’s Degree, 1.9 percent ing to Nielsen, it is estimated that 2.4 percent of the has earned a Professional School Degree, 1.2 percent population age 25 and over in NHC’s community (PSA) has earned a Doctorate Degree, and 17.7 percent has has earned a Master’s Degree, 0.7 percent has earned a earned a Bachelor’s Degree.
70 Educational Achievement Nash County 54 U.S. (All figures in % of residents)
17.7 11.4 7.3 2.4 0.7 1.2
Some Bachelor’s Master’s Doctorate college degree degree
34 Community Need Index
Developed by Dignity Health and Truven, the Commu- and living in poverty, what percentage is uninsured, nity Need Index (CNI) identifies the severity of health what percentage is unemployed, etc. Using these data disparity for every ZIP code in the United States and a score is assigned to each barrier condition (with one demonstrates the link between community need, ac- representing less community need and five represent- cess to care, and preventable hospitalizations. ing more community need). The scores are then aggre- gated and averaged for a final CNI score (each barrier Rather than relying solely on public health data, the CNI receives equal weight in the average). A score of 1.0 in- accounts for the underlying economic and structural dicates a ZIP code with the lowest socio-economic bar- barriers that affect overall health. Using a combination riers, while a score of 5.0 represents a ZIP code with the of research, literature and experiential evidence, Dignity most socio-economic barriers. Health identified five prominent barriers that make it possible to quantify healthcare access in communities As reflected in the table below, the Rocky Mount ZIP across the nation. These barriers include those related code 27801 and the Enfield ZIP code 27823 have the to income, culture/language, education, insurance, and most socio-economic barriers to healthcare access in housing. NHC’s primary service area. Moreover, please note that all but two of the ZIP codes in the table below have CNI To determine the severity of barriers to healthcare ac- scores that fall in the high range. Only the Rocky Mount cess in a given community, the CNI gathers data about ZIP code 27804 and Nashville ZIP code 27856 have low- that community’s socio-economy. For example, that CNI er but above average (mid-high) socio-economic barri- considers what percentage of the population is elderly ers to healthcare access in the community.
NHC’s Primary Service Area Community Need Index (CNI) By ZIP Code
Community Community ZIP Code City Population Need Index Need Level
27801 Rocky Mount 21,734 5.0 High
27803 Rocky Mount 22,906 4.6 High
27804 Rocky Mount 30,223 4.0 Mid-high
27809 Battleboro 5,077 4.4 High
27816 Castalia 2,838 4.6 High
27823 Enfield 7,912 5.0 High
27844 Hollister 2,720 4.8 High
Source: Dignity Health 27856 Nashville 15,543 4.0 Mid-high (www.dignityhealth.org/cni)
27882 Spring Hope 7,421 4.4 High See Attachment 6 for a map illustrating CNI scores by ZIP code in the NHC 27891 Whitakers 4,809 4.4 High community
Summary
Overall, NHC’s community has higher unemployment rates than the state average. There is also a higher percentage of the population living below the Federal Poverty Level in the com- munity compared to the state and national data. The 2013 median income in the commu- nity is 11.9 percent below the state average. Enfield in Halifax County has the lowest median income and one of the highest Community Need Index (CNI) scores, indicating a possible underserved population with higher socio-economic barriers to health and healthcare for the population in that area.
35 Healing is a matter of time, but it is also sometimes a matter of “ opportunity. – Hippocrates ”
Access to Care This section examines data and issues related to individuals’ ability to obtain access to need- ed healthcare services in NHC’s identified community. Insurance, primary care, ED utilization, and outmigration are covered in this section.
Uninsured
According to a study published by the North Carolina County was ranked “Mid-High” and the percentage in Institute of Medicine (NCIOM) in January of this year, the Nash County “Mid-Low.” percentage of uninsured non-elderly adults (ages 0-64) in 2010-2011 in Nash, Edgecombe, and Halifax coun- On March 6, 2013, North Carolina Governor Pat McCrory ties was 17.2, 18.2, and 18.9 percent, respectively. The signed into law a bill to prevent North Carolina from ranks provided in the table below represent the quartile participating in the optional Medicaid expansion of the county – where “Low” denotes those 25 counties under the Patient Protection and Affordable Care Act with the lowest rate, “Mid-Low” the next 25 lowest rates, (PPACA). As a result, the PPACA is not likely to result in and so-on. As indicated, the percentage of uninsured as substantial a reduction of the uninsured in NHC’s non-elderly adults in Halifax County was ranked “High” community as the PPACA intended. at 18.9 percent, while the percentage in Edgecombe
North Carolina County-Level Estimates of Uninsured 2010-2011
Children (0-18) Adults (19-64) Total (0-64)
Number* % Rank Number* % Rank Number* % Rank
Nash County 2,000 8.6% Mid-High 13,000 20.7% Mid-Low 15,000 17.2% Mid-Low Source: North Carolina Institute of Medicine (NCIOM), North Carolina Edgecombe 1,000 8.8% High 8,000 22.2% Mid-High 9,000 18.2% Mid-High County-Level Estimates of County Non-Elderly Uninsured, 2010-2011 (published Halifax 1,000 8.6% High 8,000 23.0% High 9,000 18.9% High January 2013), available at County http://nciom.org/wp- content/uploads/2010/08/ North 214,000 1,341,000 1,562,000 County-Level_ Carolina Estimates_10-11.pdf
*Note: Because these are estimates, numbers of uninsured have been rounded to the nearest thousand.
36 Usual Source of Care
As noted previously and as illustrated in the table on registered nurses, nurse practitioners, certified nurse the following page, in 2011, Nash County had fewer midwives, physician assistants, dental hygienists, chiro- physicians, primary care physicians, dentists, phar- practors, occupational therapists, occupational therapy macists, nurse practitioners, certified nurse midwives, assistants, optometrists, podiatrists, psychologists, and physician assistants, dental hygienists, chiropractors, physical therapists as compared to North Carolina. occupational therapists, optometrists, psychologists, and physical therapists as compared to North Carolina. In addition, please note that NHC regularly conducts its In 2011, Edgecombe County had fewer physicians, pri- own medical staff planning analysis. In its most recent mary care physicians, dentists, pharmacists, registered analysis, conducted in 2012, NHC identified a need for nurses, nurse practitioners, certified nurse midwives, additional surgery, medicine, and primary care physi- physician assistants, dental hygienists, chiropractors, cian manpower. occupational therapists, occupational therapy assis- tants, optometrists, podiatrists, psychologists, psycho- The need for physicians, as well as the overall health of logical associates, physical therapists, physical therapist the population (see Section VI), is reflected in the overall assistants, and respiratory therapists as compared to high ED utilization in the community. As the map below North Carolina. In 2011, Halifax County had fewer phy- indicates, the ED visit rates per 1,000 in the PSA counties sicians, primary care physicians, dentists, pharmacists, are in the top two categories in the state.
Emergency Department Visit Rates per 1,000 Residents Resident Visits to North Carolina Emergency Departments Resident Visits to North Carolina Emergency Departments OctoberOctober 1, 2010 1, 2010 to September to September 30, 30, 2011 2011
Source: Truven. Produced by Cecil G. Sheps Center for Health Services Research, Visits per 1,000 Residents University of North Age-Adjusted to U.S. 2000 Standard Million Carolina at Chapel Hill. 129 to 316 (20) 317 to 373 (21) Note: Includes patients 374 to 454 (18) 455 to 540 (22) admitted to hospital. 541 to 717 (19)
Note: Includes patients admitted to hospital. Source: Truven Health Analytics (formerly Thomson Healthcare), Fiscal Year 2011. Produced By: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. 37 2011 Health Professionals Per 10,000 Population*
Health Professionals Nash County Edgecombe County Halifax County North Carolina
Physicians** 18.9 6.6 13.2 22.1
Primary Care 7.1 2.9 5.9 7.8 Physicians**^
Dentists 4.1 1.4 2.2 4.3
Pharmacists 8.9 4.3 7.5 9.5 Source: North Carolina Health Professions Data System, Cecil Registered Nurses 111.0 60.3 79.6 98.6 G. Sheps Center for Health Services Research, University Nurse Practitioners 2.2 1.2 2.6 4.1 of North Carolina at Chapel Hill, with data derived from Certified Nurse 1.1 0.7 0.4 1.6 Midwives^^ the North Carolina Medical Board, 2011.
Physician Assistants 4.2 2.1 2.2 4.0 Note: the data provided in the table include those who are Dental Hygienists 4.2 2.5 5.1 5.6 licensed and active within the profession as well as those with Licensed Practical 25.9 19.8 21.7 18.5 unknown activity status; inac- Nurses tives are excluded.
Chiropractors 0.9 0.4 0.7 1.6 *Log Into North Carolina (LINC) Database, Office of Occupational 1.9 1.6 0.7 2.8 State Planning, NC Office of Therapists the Governor. Occupational Therapy 1.6 1.1 1.1 1.3 **Physicians include doctors Assistants of medicine and doctors of os- Optometrists 0.9 0.4 0.7 1.1 teopathy who are non-federal, non-resident-in-training.
Podiatrists 0.3 0.0 0.2 0.3 ^Primary care physicians include those physicians who Psychologists 0.6 0.2 0.7 2.1 report a primary specialty of family practice, general Psychological 1.1 0.5 0.9 0.9 practice, internal medicine, Associates obstetrics/gynecology, or pediatrics. Physical Therapists 4.9 1.8 2.2 5.4 ^^Certified nurse midwives are Physical Therapist 5.6 2.3 4.2 2.5 calculated per 10,000 females Assistants aged 15-44 (child-bearing population); population source: Respiratory Therapists 5.5 3.4 4.6 4.3 LINC.
38 Outmigration
Outmigration to other provider facilities reveals a NHC but show a significant number and percentage of potential need for certain services – in particular, patients leaving the community for care. general surgery and orthopedics – which are offered at
NHC’s Community Residents 2012 Inpatient Outmigration
# Inpatients % Service cared for outside Outmigration PSA
General Medicine 1,177 34%
Cardiovascular 778 34% Diseases
Orthopedics 680 52%
General Surgery 666 55%
Cardio, Vascular, 596 81% Thoracic
Obstetrics 496 33%
Pulmonary 491 29%
Psychiatry 415 40%
Neurosciences 395 41%
Nephrology/Urology 276 29%
Neonatology 253 46%
Oncology 169 49%
Rehabilitation 132 28%
Gynecology 75 38%
ENT 51 57%
Substance Abuse 22 32%
Ophthalmology 12 60% Source: Truven
Summary
Estimates of the insurance coverage indicate that children, in particular, have high uninsured rates within Nash, Halifax, and Edgecombe counties. Access to both primary care and spe- cialty care is of particular importance and concern. As a result of the lack of availability of primary care and the poor health of the population, ED utilization is high. Outmigration to other locales for specific services is high, particularly for general surgery and orthopedics, which are available locally.
39
Health Data/Indicators
This section acknowledges that the health of a community depends on a number of factors, including, but not limited to, the physical environment, social and economic factors, access to healthcare, quality of healthcare, and individual behaviors. As discussed in detail below, such factors provide significant insight into the health status of residents of the community.
About County Health Rankings
The County Health Rankings report, launched in morbidity. Measures of health factors include health 2010, ranks the health of nearly every county in behaviors, clinical care, social and economic factors, the nation. Counties are ranked according to their and the physical environment. Counties with high measures of health outcomes and health factors. ranks, such as first or second, are estimated to be the Measures of health outcomes include mortality and healthiest.
HEALTH OUTCOMES
According to the 2013 County Health Rankings, Nash health outcomes include mortality and morbidity, each County ranked around the middle on overall health of which will be examined in detail in the following outcomes, 60th out of 100, when compared to other section. Although the data demonstrate that for some counties in the state. Nash County’s overall health measures, the counties have improved over the past few outcomes ranking is high in comparison to the overall years, Edgecombe and Halifax as a whole remain near health outcomes rankings for Edgecombe and Halifax the bottom of the state in terms of health outcomes. counties, 88th and 99th, respectively. Measures of
Health Outcomes Overall Rankings
County 2010 2011 2012 2013
Nash 61 61 65 60
Edgecombe 94 95 96 88 Source: County Health Rankings Report, Halifax 96 99 98 99 2010-2013
Mortality
In 2013, Nash County ranked 75th in mortality in North 86th and 93rd, respectively. Mortality is measured by Carolina, while Edgecombe and Halifax counties ranked premature death (deaths before age 75).
Health Outcomes Sub-Rankings: Mortality
County 2010 2011 2012 2013
Nash 79 79 79 75
Edgecombe 94 97 95 86 Source: County Health Rankings Report, Halifax 95 93 91 93 2010-2013
41 Morbidity
Morbidity refers to how healthy people feel while ranking for morbidity. In 2013, Nash County ranked they are alive. Morbidity is measured by four distinct 33rd in morbidity out of North Carolina’s 100 counties, metrics: poor or fair health, poor physical health days, while Edgecombe and Halifax counties ranked 85th and poor mental health days, and low birth weight. All of 100th, respectively. these factors are combined to arrive at a composite
Health Outcomes Sub-Rankings: Morbidity
County 2010 2011 2012 2013
Nash 33 26 33 33
Edgecombe 86 92 93 85 Source: County Health Rankings Report, Halifax 97 98 100 100 2010-2013
Morbidity Metric: Poor or Fair Health
The County Health Rankings uses county-level measures higher than that of North Carolina as a whole (18 from the Behavioral Risk Factor Surveillance System percent), while the rate for Halifax County (29 percent) (BRFSS) provided by the CDC to obtain the percent of was 11 percentage points higher than North Carolina as adults reporting fair or poor health. According to the a whole. Of particular note is the positive trend in Nash 2013 rankings, the percentage of adults reporting fair and Edgecombe counties, which has been improving or poor health in Nash and Edgecombe counties (19 over the four year period; Halifax County, conversely, percent, in each county) was one percentage point has declined and remains below the state average.
Health Outcomes Sub-Rankings Morbidity: Percent of Adults Reporting Poor or Fair Health
County 2010 2011 2012 2013
Nash 20% 18% 19% 19%
Edgecombe 27% 24% 23% 19%
Halifax 27% 29% 29% 29% Source: County Health Rankings Report, North Carolina 19% 18% 18% 18% 2010-2013
Morbidity Metric: Poor Physical Health Days
The County Health Rankings uses data from the BRFSS in each county) was higher than that of North Carolina to obtain the average number of poor physical health as a whole (3.6 days), while the rate for Nash County (2.8 days reported in the past 30 days through self-reported days) was lower than North Carolina as a whole. Nash survey responses. According to the 2013 rankings, the and Halifax counties have also trended positively over average number of poor physical health days in the past the past four years, although both Edgecombe and 30 days for Edgecombe and Halifax counties (4.6 days, Halifax counties remain well below the state average.
Health Outcomes Sub-Rankings Morbidity: Average Days of Poor Physical Health in the Past 30 Days
County 2010 2011 2012 2013
Nash 3.4 3.0 2.9 2.8
Edgecombe 4.4 5.3 5.3 4.6
Halifax 5.4 4.9 4.8 4.6 Source: County Health Rankings Report, North Carolina 3.6 3.6 3.6 3.6 2010-2013
42 Morbidity Metric: Poor Mental Health Days
The County Health Rankings uses data from BRFSS to days, respectively) was lower than North Carolina as a obtain the number of poor mental health data reported whole (3.4 days), while the rate for Halifax County (4.3 in the past 30 days through self-reported survey days) was higher than North Carolina as a whole. Both responses. According to the 2013 rankings, the average Nash and Halifax counties have trended lower for this number of poor mental health days in the past 30 days statistic, while Edgecombe County has shown modest for Nash and Edgecombe counties (3.1 days and 2.5 improvement.
Health Outcomes Sub-Rankings Morbidity: Average Days of Poor Mental Health in the Past 30 Days
County 2010 2011 2012 2013
Nash 2.9 2.9 3.0 3.1
Edgecombe 2.6 2.8 2.9 2.5
Halifax 3.4 3.8 4.0 4.3 Source: County Health Rankings Report, 2010-2013 North Carolina 3.2 3.3 3.4 3.4
Morbidity Metric: Low Birthweight
The County Health Rankings uses data from the National points higher than North Carolina as a whole (9.1 Center of Health Statistics to obtain the percentage of percent), while the rate for Nash County (9.9 percent) live births with weight less than 2,500 grams. According was less than a percentage point higher than North to the 2013 rankings, the percentage of live births less Carolina as a whole. In addition, all three counties have than 2,500 grams for Edgecombe and Halifax counties trended lower over the timeframe. (13.0 percent for both) was nearly four percentage
Health Outcomes Sub-Rankings Morbidity: Percent of Live Births Less than 2,500 Grams
County 2010 2011 2012 2013
Nash 9.4% 9.6% 9.8% 9.9%
Edgecombe 12.6% 12.7% 12.9% 13.0%
Halifax 12.4% 13.1% 13.5% 13.0% Source: County Health Rankings Report, 2010-2013 North Carolina 9.0% 9.1% 9.1% 9.1%
43 HEALTH FACTORS
The health factors category encompasses a number of Each of these indicators will be discussed below. When distinct indicators, including: all indicators are taken together, Nash County ranked • Health behaviors 72nd on health factors out of 100 counties in the state. • Clinical care Meanwhile, Edgecombe and Halifax counties ranked • Social and economic factors 98th and 95th, respectively. • Physical environment
Health Factors Overall Rankings
County 2010 2011 2012 2013
Nash 61 67 72 72
Edgecombe 99 99 99 98 Source: County Health Rankings Report, Halifax 93 91 97 95 2010-2013
Health Behaviors: Overview
In 2013, Nash County ranked 83rd in health behaviors of health behaviors include tobacco use, diet and in North Carolina, while Edgecombe and Halifax exercise, alcohol use, and sexual activity. Each of these counties ranked 99th and 94th, respectively. Measures is examined separately in the charts below.
Health Factors Sub-Rankings Health Behaviors
County 2010 2011 2012 2013
Nash 68 67 72 83
Edgecombe 100 99 99 97 Source: County Health Rankings Report, Halifax 75 95 89 94 2010-2013
Health Behavior: Tobacco Use
The County Health Rankings uses county-level measures According to the 2013 County Health Rankings, adult from the Behavioral Risk Factor Surveillance System smoking rates in Nash and Halifax counties (24 and 23 (BRFSS) provided by the CDC to obtain the number of percent, respectively) were higher than that of North current adult smokers who have smoked at least 100 Carolina as a whole (21 percent), while the rate for cigarettes in their lifetime. Edgecombe County (21 percent) was equal to that of North Carolina as a whole.
Health Factors Sub-Rankings Health Behaviors: Tobacco Use
County 2010 2011 2012 2013
Nash 28 35 35 58
Edgecombe 87 86 92 30 Source: County Health Rankings Report, Halifax 10 24 34 52 2010-2013
44 Health Behavior: Diet and Exercise
The County Health Rankings uses two measures to exercise, while Nash County ranks 72nd out of 100, as assess diet and exercise: obesity (the percent of the adult illustrated in the chart below. For 2013, adult obesity population that has a body mass index greater than or rates in Nash, Edgecombe, and Halifax counties (33, equal to 30) and physical inactivity (the percent of the 39, and 40 percent, respectively) were higher than the adult population that did not participate in any physical statewide average of 29 percent. Similarly, the percent activity or exercise during the past month, other than a of physically inactive persons in Nash, Edgecombe, and regular job). Due to relatively high rates of obesity and Halifax counties (29, 34, and 31 percent, respectively) physical inactivity, Edgecombe and Halifax counties was higher than the statewide average of 25 percent. fall near the bottom of the state rankings for diet and
Health Factors Sub-Rankings Health Behaviors: Diet & Exercise
County 2010 2011 2012 2013
Nash 81 74 72 72
Edgecombe 100 99 99 99 Source: County Health Rankings Report, 2010-2013 Halifax 91 98 98 98
Health Behavior: Alcohol Use
The County Health Rankings uses two measures to a whole (13 percent), while Edgecombe and Halifax assess alcohol use in a county: excessive drinking counties (10 and 8 percent, respectively), were lower in the adult population (which is provided through than the statewide average. Motor vehicle crash death self-reported surveys) and the crude motor vehicle rates in Nash, Edgecombe, and Halifax counties (22, 20, death rate per 100,000 people. For 2013, the percent and 24, respectively) were higher than the statewide of residents who drank excessively in Nash County average of 17. Taking both measures into account, the (15 percent) was higher than that of North Carolina as following chart ranks all three counties on alcohol use.
Health Factors Sub-Rankings Health Behaviors: Alcohol Use
County 2010 2011 2012 2013
Nash 75 84 83 86
Edgecombe 37 24 20 30 Source: County Health Rankings Report, Halifax 52 65 51 38 2010-2013
Health Behavior: Sexual Activity
The County Health Rankings uses two measures to and 1,144, respectively) were higher than North assess sexual activity: teen birth rates (birth rate per Carolina as a whole (441). Similarly, teen birth rates in 1,000 female population ages 15-19) and chlamydia Nash, Edgecombe, and Halifax counties (51, 65, and 67, incidence rates (per 100,000 population). According respectively) were higher than North Carolina as a whole to the 2013 County Health Rankings, chlamydia rates (46). Taking both measures into account, the following in Nash, Edgecombe, and Halifax counties (678, 636, chart ranks all three counties on sexual activity.
Health Factors Sub-Rankings Health Behaviors: Alcohol Use
County 2010 2011 2012 2013
Nash 69 77 72 83
Edgecombe 99 100 100 99 Source: County Health Rankings Report, 2010-2013 Halifax 98 97 93 92
45 Clinical Care: Overview
The County Health Rankings Report considers both County ranked 15th in clinical care statewide, indicating access to care and quality of care in determining a good healthcare infrastructure, while Edgecombe and statewide rankings for clinical care. For 2013, Nash Halifax counties ranked 53rd and 64th, respectively.
Health Factors Sub-Rankings Clinical Care
County 2010 2011 2012 2013
Nash 26 17 27 15
Edgecombe 35 16 57 53 Source: County Health Rankings Report, Halifax 47 21 64 64 2010-2013
Clinical Care Measure: Access to Care
The County Health Rankings uses two measures to Meanwhile, the ratio of population to primary care quantify access to care: the percentage of persons physicians in Nash (1,775:1), Edgecombe (3,326:1), and without health insurance and the ratio of population to Halifax (1,880:1) counties all fell below the statewide primary care physicians and dentists. According to the ratio of 1,479:1. A similar pattern was found in the ratio 2013 report, uninsured rates in Nash, Edgecombe, and of population to dentists (2,334:1 for Nash, 5,798:1 for Halifax counties (18, 19, and 19 percent, respectively) Edgecombe, and 4,304:1 for Halifax, compared to a were similar to the statewide average of 19 percent. statewide ratio of 2,171:1.
Health Factors Sub-Rankings Clinical Care: Access to Care
County 2010 2011 2012 2013
Nash 17 28 26 16
Edgecombe 22 19 59 59 Source: County Health Rankings Report, Halifax 7 7 40 34 2010-2013
Clinical Care Measure: Quality of Care
In assessing healthcare quality, the County Health enrollees that receive HbA1c screening), and Rankings uses three distinct measures: preventable mammography screening (percent of female Medicare hospital stays (hospital rate for ambulatory-care enrollees age 67-69 having at least one mammogram sensitive conditions per 1,000 Medicare enrollees), over a two-year period). Composite rankings are shown diabetic screening (percent of diabetic Medicare in the chart below.
Health Factors Sub-Rankings Clinical Care: Quality of Care
County 2010 2011 2012 2013
Nash 51 25 29 23
Edgecombe 58 34 57 51 Source: County Health Rankings Report, Halifax 86 70 80 75 2010-2013
For 2013, preventable hospital stays in Nash, and Halifax counties (72.9 and 66.8 percent) were higher Edgecombe, and Halifax counties (64, 83, and 85, than North Carolina as a whole (69.1 percent), while the respectively) were higher than the statewide rate of 63. rate for Edgecombe County (66.8 percent) was lower. Rates of diabetic screening in Nash, Edgecombe, and than that of North Carolina as a whole. Overall, the Halifax counties (91, 89, and 92 percent, respectively) results show that residents of Nash, Edgecombe, and were higher than rates for North Carolina as a whole (88 Halifax counties have access to and take advantage of percent). The rate of mammography screening in Nash routine health screenings.
46 Social and Economic Factors: Overview
Many social and economic factors contribute to As seen in the table below, when all social and economic healthcare rankings at the county level. Education, factors are taken together, Nash County ranked 80th in employment, income, family and social support, and North Carolina, while Edgecombe and Halifax counties community safety will all be considered separately in ranked 97th and 96th, respectively. the following sections.
Health Factors Sub-Rankings Social & Economic Factors
County 2010 2011 2012 2013
Nash 73 70 73 80
Edgecombe 99 99 99 97 Source: County Health Rankings Report, 2010-2013 Halifax 98 94 97 96
Socioeconomic Factor: Community Safety
The County Health Rankings uses the FBI’s Uniform According to the 2013 County Health Rankings, the Crime Reports data for violent crime rates (murder and violent crime rates in Nash, Edgecombe, and Halifax non-negligent manslaughter, forcible rape, robbery, counties (619, 674, and 609, respectively) were higher and aggravated assault) to assess community safety. than those of North Carolina as a whole (411).
Health Factors Sub-Rankings Social & Economic Factors: Community Safety
County 2010 2011 2012 2013
Nash 80 79 93 90
Edgecombe 91 89 95 96 Source: County Health Rankings Report, Halifax 84 81 90 88 2010-2013
47 Socioeconomic Factor: Education
The County Health Rankings uses two measures rates in Nash and Halifax counties (77 and 78 percent, to estimate educational attainment: high school respectively) were lower than North Carolina as a whole graduation (percent of ninth grade cohort that (80 percent), while the rate for Edgecombe County (80 graduates high school in four years) and some college percent) was equal to that of North Carolina as a whole. (an estimate of the percentage of the population age In addition, the rate of population achieving some 25-44 with some post-secondary education). Overall college in Nash, Edgecombe, and Halifax counties (54.3, education rankings are shown in the chart below. 48.2, and 46.3 percent, respectively) were lower than According to the 2013 report, high school graduation that of North Carolina as a whole (62.2 percent).
Health Factors Sub-Rankings Social & Economic Factors: Education
County 2010 2011 2012 2013
Nash 72 68 67 72
Edgecombe 94 73 84 76 Source: County Health Rankings Report, Halifax 87 77 93 83 2010-2013
Socioeconomic Factor: Employment
The County Health Rankings uses the annual average and Halifax counties (13.0, 15.9, and 14.1 percent, unemployment rate (which includes those age 16 and respectively) were higher than North Carolina as a older). According to the 2013 County Health Rankings, whole (10.5 percent). the unemployment rates in Nash, Edgecombe,
Health Factors Sub-Rankings Social & Economic Factors: Employment
County 2010 2011 2012 2013
Nash 51 25 29 23
Edgecombe 58 34 57 51 Source: County Health Rankings Report, Halifax 86 70 80 75 2010-2013
Socioeconomic Factor: Family and Social Support
The County Health Rankings uses two measures to social support in Nash, Edgecombe, and Halifax counties estimate family and social support: inadequate social (23, 32, and 37 percent, respectively) were higher than support (the percentage of adults without social/ that of North Carolina as a whole (21 percent). Similarly, emotional support, which is calculated using BRFSS the rates of children in single-parent households in data) and children in single-parent households (the Nash, Edgecombe, and Halifax counties (42, 52, and 48 percent of children living in family households that are percent, respectively) were higher than that of North raised by a single parent). For 2013, rates of inadequate Carolina as a whole (35 percent).
Health Factors Sub-Rankings Social & Economic Factors: Family/Social Support
County 2010 2011 2012 2013
Nash 76 78 78 76
Edgecombe 99 98 96 97 Source: County Health Rankings Report, Halifax 98 100 99 100 2010-2013
48 Socioeconomic Factor: Income
The County Health Rankings uses reports on children the rates of children in poverty in Nash, Edgecombe, and in poverty (the percent of children living in poverty Halifax counties (29, 40, and 39 percent, respectively) as defined by the federal poverty threshold) to assess were higher than that of North Carolina as a whole (25 income. According to the 2013 County Health Rankings, percent).
Health Factors Sub-Rankings Social & Economic Factors: Income
County 2010 2011 2012 2013
Nash 53 33 30 48
Edgecombe 94 94 96 97 Source: County Health Rankings Report, Halifax 99 92 91 96 2010-2013
Physical Environment: Overview
In 2013, Nash County ranked 40th in physical respectively. Measures of physical environment include environment in North Carolina, while Edgecombe environmental quality and built environment, which are and Halifax counties ranked 100th and 85th, discussed separately in the following section.
Health Factors Sub-Rankings Social & Economic Factors
County 2010 2011 2012 2013
Nash 15 86 94 40
Edgecombe 65 98 100 100 Source: County Health Rankings Report, 2010-2013 Halifax 6 28 48 85
49 Physical Environment: Built Environment
The County Health Rankings uses several measures number of restaurants in a county, and access to the to assess the built environment: the percent of the recreational facilities (the number of recreational population with limited access to healthy foods, the facilities per 100,000 persons). The composite rankings, number of fast-food establishments over the total based on all three factors, are shown in the chart below.
Health Factors Sub-Rankings Physical Environment: Built Environment
County 2010 2011 2012 2013
Nash 31 19 76 58
Edgecombe 74 49 96 98 Source: County Health Rankings Report, Halifax 21 50 71 93 2010-2013
According to the 2013 County Health Rankings, the were higher than that of North Carolina as a whole percent of the population with limited access to healthy (49 percent). Finally, the rates of access to recreational foods in Edgecombe and Halifax counties (nine and facilities in Nash, Edgecombe, and Halifax counties 10 percent, respectively) were higher than that of (8.3, 3.5, and 5.5, respectively) were lower than that North Carolina as a whole (seven percent), while the of North Carolina as a whole (10.5). Edgecombe and percentage for Nash County (four percent) was lower Halifax counties in particular ranked poorly for physical than that of North Carolina as a whole. Moreover, the environment—due primarily to lack of access to rates of fast food restaurants in Nash, Edgecombe, and recreational facilities and the percentage of restaurants Halifax counties (56, 64, and 59 percent, respectively) in the counties that are fast food related.
Physical Environment: Environmental Quality
The County Health Rankings uses two measures drinking water safety (the percentage of the population to assess environmental quality: average daily fine getting drinking water from public water systems particulate matter (the average daily measure of fine with at least one health-based violation). Composite particulate matter in micrograms per cubic meter) and rankings based on both factors are shown below.
Health Factors Sub-Rankings Physical Environment: Environmental Quality
County 2010 2011 2012 2013
Nash 51 25 29 23
Edgecombe 58 34 57 51 Source: County Health Rankings Report, Halifax 86 70 80 75 2010-2013
According to the 2013 County Health Rankings, one health-based violation in Edgecombe and Halifax the average daily fine particulate matter in Nash, counties (74 and 12 percent, respectively), were higher Edgecombe, and Halifax counties (12.5, 12.4, and 12.4, than that of North Carolina as a whole (3 percent), while respectively) were lower than that of North Carolina as a the percentage for Nash County (3 percent) was equal whole (12.9). The percentage of the population getting to that of North Carolina as a whole. drinking water from public water systems with at least
50 VITAL STATISTICS
Births
The total birth rate per 1,000 population in Nash and County was slightly higher (13.8). Hispanics had the Halifax counties (12.8 and 11.9, respectively) was lower highest birth rate in each of the PSA counties as well as than North Carolina’s average of 13.5, while Edgecombe in North Carolina as a whole.
North Carolina Resident Live Birth Rates per 1,000 Population, 2007-2011
Total White Black Other Hispanic
# of Rate # of Rate # of Rate # of Rate # of Rate births 07-11 births 07-11 births 07-11 births 07-11 births 07-11
Nash County 6,073 12.8 2,603 9.8 2,626 14.9 98 15.2 746 29.1
Edgecombe 3,722 13.8 1,001 9.7 2,464 16.1 16 11.1 241 21.8 County
Halifax 3,257 11.9 977 8.8 1,990 13.6 179 15.2 111 24.0 County
North 631,134 13.5 350,686 11.2 149,337 14.7 30,284 18.8 100,827 27.5 Carolina
Source: North Carolina Center for Health Statistics, 2013 County Health Data Book, available at http://www.schs.state. nc.us/schs/data/databook/CD1%20Live%20birth%20rates. html (Live Birth Rates per 1,000 Population, 2007-2011)
51 Deaths – Infant Mortality
The total fetal death rate per 1,000 deliveries in Nash, of 6.5. For Nash County, the fetal death rate in blacks Edgecombe, and Halifax counties (10.9, 16.4, and 10.3, was more than two times higher than that of whites. respectively) was higher than North Carolina’s average
North Carolina Resident Fetal Death Rates per 1,000 Deliveries, 2007-2011
Total White Black Other Hispanic
# of Rate # of Rate # of Rate # of Rate # of Rate births 07-11 births 07-11 births 07-11 births 07-11 births 07-11
Nash County 67 10.9 19 7.2 40 15.0 0 0 8 10.6
Edgecombe 62 16.4 5 5.0 55 21.8 0 0 2 8.2 County
Halifax 34 10.3 1 1.0 30 14.9 1 5.6 2 17.7 County
North 4,119 6.5 1,733 4.9 1,768 11.7 142 4.7 476 4.7 Carolina
Source: North Carolina Center for Health Statistics, 2013 County Health Data Book, available at http://www.schs.state. nc.us/schs/data/databook/CD1%20Live%20birth%20rates. html (Fetal Death Rates per 1,000 Deliveries, 2007-2011)
The total infant death rate per 1,000 live births in Nash, and more than six times that of Hispanics while the Edgecombe, and Halifax counties (10.2, 11.0, and 12.6, rate for other non-Hispanics was more than two times respectively) was higher than North Carolina’s average higher than that of whites and nearly four times that of of 7.8. For Nash County, the infant death rate in blacks other non-Hispanics. was more than three times higher than that of whites
North Carolina Resident Infant (<1 Year) Death Rates per 1,000 Live Births, 2007-2011
Total White Black Other Hispanic
# of Rate # of Rate # of Rate # of Rate # of Rate births 07-11 births 07-11 births 07-11 births 07-11 births 07-11
Nash County 62 10.2 13 5.0 46 17.5 1 10.2 2 2.7
Edgecombe 41 11.0 10 10.0 30 12.2 1 62.5 0 0 County
Halifax 41 12.6 6 6.1 32 16.1 2 11.2 1 9.0 County
North 4,899 7.8 2,001 5.7 2,129 14.3 188 6.2 581 5.8 Carolina
Source: North Carolina Center for Health Statistics, 2013 County Health Data Book, available at http://www.schs.state. nc.us/schs/data/databook/CD1%20Live%20birth%20rates. html (Infant Death Rates per 1,000 Live Births, 2007-2011)
52 Deaths – Mortality
As illustrated in the following table, cancer and heart In Edgecombe County, cancer and heart disease are disease are the two leading causes of death in Nash, not only the two leading causes of death for the total Edgecombe, and Halifax counties as well as North population, but also for those ages 20-39, 40-64, and Carolina as a whole. Moreover, chronic lower respiratory 65-84. The two leading causes of death for those ages diseases and cerebrovascular disease rank in the top 0-19 are conditions originating in the perinatal period five leading causes of death for Nash, Edgecombe, and and congenital anomalies while the two leading causes Halifax counties as well as North Carolina as a whole. of death for those ages 85+ are heart disease and cerebrovascular disease. In Nash County, cancer and heart disease are not only the two leading causes of death for the total In Halifax County, cancer and heart disease are not only population, but also for those ages 40-64, 65-84, and the two leading causes of death for the total population, 85+. The two leading causes of death for those ages but also for those ages 40-64, 65-84, and 85+. The 0-19 are conditions originating in the perinatal period two leading causes of death for those ages 0-19 are and congenital anomalies while the two leading causes conditions originating in the perinatal period and other of death for those ages 20-39 are motor vehicle injuries unintentional injuries while the two leading causes of and homicide. death for those ages 20-39 are homicide and motor vehicle injuries.
Ten Leading Causes of Death by County of Residence, 2007-2011
Rank Nash County Edgecombe County Halifax County North Carolina
1 Cancer - All Sites Cancer - All Sites Diseases of the heart Cancer - All Sites
2 Diseases of the heart Diseases of the heart Cancer - All Sites Diseases of the heart
Cerebrovascular Cerebrovascular Cerebrovascular Chronic lower 3 disease disease disease respiratory diseases
Chronic lower Chronic lower Cerebrovascular 4 Diabetes mellitus respiratory diseases respiratory diseases disease
Chronic lower Other Unintentional 5 Pneumonia & influenza Diabetes mellitus respiratory diseases injuries
Nephritis, nephrotic Nephritis, nephrotic Other Unintentional 6 Alzheimer's disease syndrome, & nephrosis syndrome, & nephrosis injuries
Other Unintentional Nephritis, nephrotic 7 Diabetes mellitus Diabetes mellitus injuries syndrome, & nephrosis
Other Unintentional Nephritis, nephrotic 8 Alzheimer's disease Pneumonia & influenza injuries syndrome, & nephrosis
9 Alzheimer's disease Pneumonia & influenza Alzheimer's disease Pneumonia & influenza
10 Motor vehicle injuries Septicemia Hypertension Motor vehicle injuries
Source: North Carolina Center for Health Statistics, 2013 County Health Data Book, available at http://www.schs.state. nc.us/schs/data/databook/ (Death Counts and Crude Death Rates per 100,000 Population for Leading Causes of Death, by Age Groups NC 2007-2011)
53 CHRONIC DISEASES
Cancer
Cancer risk increases with age and varies by gender and rates in Edgecombe and Halifax counties are higher race. As the average age of the population increases, than the state average. Moreover, the incidence rate of the incidence of cancer will also increase. Development colon/rectum and female breast cancer in Nash County of cancer can be related to personal lifestyle or is higher than the state average for those cancer sites. environmental factors (such as smoking, diet, and As illustrated in the second table below, the number of exercise) as well as age, gender, and family history. As cancer cases is expected to increase as the population illustrated in the first table below, total cancer incidence ages.
North Carolina Resident Age-Adjusted Incidence Rates per 100,000 Population, 2006-2010
Nash Edgecombe Halifax North Carolina Cancer by Selected Site # of Rate # of Rate # of Rate # of Rate Cases 06-10 Cases 06-10 Cases 06-10 Cases 06-10
Colon/Rectum 274 50.0 160 56.5 156 46.1 20,968 43.4
Lung/Bronchus 386 68.9 239 84.8 262 75.1 36,287 74.8
Female Breast 466 157.2 264 162.6 319 175.2 41,169 155.9
Prostate 355 138.5 233 181.3 258 171.0 34,733 153.7
Total Cancer 2,593 473.9 1,547 542.9 1,730 514.1 242,433 498.1
Source: North Carolina Center for Health Statistics, available at http://www.schs.state.nc.us/schs/CCR/ incidence/2010/5yearRates.pdfincidence/2010/5yearRates.pdf
Projected New Cancer Cases and Deaths for Selected Sites by County, 2013
Nash Edgecombe Halifax North Carolina Cancer by Selected Site Cases Deaths Cases Deaths Cases Deaths Cases Deaths
Colon/Rectum 51 18 30 11 31 11 4,852 1,694
Lung/Bronchus 91 66 53 39 56 40 8,559 6,186
Female Breast 99 15 60 9 60 9 9,339 1,410
Prostate 89 10 50 6 52 7 8,316 1,022
Total Cancer 593 212 347 125 356 131 56,164 20,067
Source: North Carolina Center for Health Statistics, available at http://www.schs.state.nc.us/schs/CCR/proj13co.pdf
54 As reported in the previous section on mortality, other cancers in Nash, Edgecombe, and Halifax cancer is one of the two leading causes of death in counties. Such is the case regardless of race; however, Nash, Edgecombe, and Halifax counties. As illustrated of note, the rate is higher for males than females in in the table below, total cancer death rates in Nash, Nash, Edgecombe, and Halifax counties as well as Edgecombe, and Halifax counties are higher than the North Carolina as a whole. Moreover, in Nash and state average. Halifax counties, African American males had a higher rate of mortality associated with cancer of the trachea, Among specific types of cancer, cancer of the trachea, bronchus, and lung than white males. Please see bronchus, and lung ranked higher in mortality than Attachments 7 and 8 for the detailed tables.
North Carolina Resident Age-Adjusted Death Rates per 100,000 Population, 2007-2011
Nash Edgecombe Halifax North Carolina Cancer by Selected Site # of Rate # of Rate # of Rate # of Rate Deaths 07-11 Deaths 07-11 Deaths 07-11 Deaths 07-11
Colon, Rectum, 120 21.3 58 20.7 81 23.2 7,614 15.5 and Anus
Pancreas 60 10.8 47 15.5 57 16.0 5,184 10.5
Trachea, Bronchus, 309 53.3 192 64.1 203 57.5 27,092 54.5 and Lung
Breast 78 25.5 58 34.5 64 34.0 6,414 23.0
Prostate 39 19.6 33 36.8 50 42.2 4,385 24.3
Total Cancer 1,053 186.9 659 227.0 735 210.2 88,518 179.7
Source: North Carolina Center for Health Statistics, 2013 County Health Data Book, available at http://www.schs.state. nc.us/schs/data/databook/ (2007-2011 Race-Sex-Specific Age-Adjusted Death Rates by County)
55 Heart Disease
As noted previously, heart disease is one of the two counties are higher than the state average. Of note, the leading causes of death in Nash, Edgecombe, and Halifax acute myocardial infarction death rate in Edgecombe counties. As illustrated in the table below, total heart County is nearly double that of North Carolina. disease death rates in Nash, Edgecombe, and Halifax
North Carolina Resident Age-Adjusted Death Rates per 100,000 Population, 2007-2011
Nash Edgecombe Halifax North Carolina Diseases of the Heart # of Rate # of Rate # of Rate # of Rate Deaths 07-11 Deaths 07-11 Deaths 07-11 Deaths 07-11
Acute Myocardial 212 38.4 202 70.4 212 60.1 18,189 37.7 Infarction
Other Ischemic 437 80 237 83.9 286 80.8 35,782 74.2 Heart Disease
Total Heart 1,020 187.5 655 233.2 794 226.5 86,099 179.3 Disease
Source: North Carolina Center for Health Statistics, 2013 County Health Data Book, available at http://www.schs.state.nc.us/schs/data/databook/ (2007-2011 Race-Sex-Specific Age-Adjusted Death Rates by County)
Among specific types of heart disease, other ischemic were higher than other ischemic heart disease. Please heart disease ranked higher in mortality than other see Attachments 7 and 8 for the detailed tables. diseases of the heart in Nash, Edgecombe, and Halifax counties. Such is the case regardless of race; however, African Americans in Nash County are disproportionately of note, the rate is higher for males than females in affected by heart disease. For heart disease, African Nash, Edgecombe, and Halifax counties as well as American males have higher rates than white males. North Carolina as a whole. Moreover, of note, rates of Also, African American females have higher rates than morbidity associated with acute myocardial infarction white females. Please see Attachments 7 and 8 for the among African American males in Edgecombe County detailed tables.
Diabetes
Diabetes is one of the ten leading causes of death in prevalence of obesity. Please see the following section Nash, Edgecombe, and Halifax counties as well as North for additional discussion relative to obesity. Carolina as a whole. It is the fourth leading cause of death in Edgecombe County, the fifth leading cause of African Americans in Nash, Edgecombe, and Halifax death in Halifax County, and the seventh leading cause counties are disproportionately affected by diabetes. of death in both Nash County and North Carolina as a In Nash and Halifax counties, the rates associated with whole. As illustrated in the following table, total diabetes African Americans are more than double those of whites death rates in Nash, Edgecombe, and Halifax counties and in Edgecombe County the rates are nearly double. are higher than the state average. Of note, the diabetes Moreover, African American males have higher rates death rate in Halifax County is more than double that of than white males. Also, African American females have North Carolina. Diabetes rates continue to rise in part higher rates than white females. Please see Attachments due to an increasing elderly population and greater 7 and 8 for the detailed tables.
North Carolina Resident Age-Adjusted Death Rates per 100,000 Population, 2007-2011
Nash Edgecombe Halifax North Carolina
# of Rate # of Rate # of Rate # of Rate Deaths 07-11 Deaths 07-11 Deaths 07-11 Deaths 07-11
Diabetes Mellitus 135 24.2 107 36.8 156 46.5 10,733 22.0
Source: North Carolina Center for Health Statistics, 2013 County Health Data Book, available at http://www.schs.state.nc.us/schs/data/databook/ (2007-2011 Race-Sex-Specific Age-Adjusted Death Rates by County)
56 Obesity
Obesity among adults continues to be a significant risk and respiratory problems. As shown in the table below, factor for chronic health conditions. Overweight and while the rankings of Nash and Edgecombe counties obese individuals are at an increased risk for a number have improved, the percentage of obese adults in each of physical ailments, which include, but are not limited of the three counties has increased, indicating possible to Type II diabetes, heart disease, stroke, hypertension, increased chronic diseases.
Adult Obesity Rates in North Carolina Counties
2010 2013
% Obese Rank % Obese Rank
Nash 32 81 33 73
Edgecombe 38 100 40 99
Halifax 34 91 39 98
North Carolina 29 N/A 29 N/A
Source: County Health Rankings
As illustrated in the table below, obesity rates among Edgecombe and Halifax counties rank in the top half children ages two to four are higher in Nash County of North Carolina counties for obese children. This data (16.1 percent) than the state as a whole (15.7 percent). suggests that obesity comes early in these counties, Moreover, while Nash County ranks in the top half affecting children before they even reach kindergarten. of North Carolina counties for overweight children,
Prevalence of Obesity, Overweight, Healthy Weight, and Underweight in Children Two Through Four Years of Age, By County, 2011
% % Healthy % Overweight Obese Rank % Obese Underweight Weight Overweight Rank Order Order
Nash 4.6% 63.7% 15.6% 41 16.1% 56
Edgecombe 4.7% 69.0% 14.1% 19 12.2% 12
Halifax 3.9% 63.5% 17.2% 65 15.4% 43
North 4.2% 63.9% 16.2% N/A 15.7% N/A Carolina
Source: North Carolina-Nutrition and Physical Activity Surveillance System (NC-NPASS), available at http://www.eatsmartmovemorenc.com/Data/Texts/NC%20NPASS%20 2011TABLE_County%20obesity%20rates.pdf (All children ages two to four included in the 2011 NC-NPASS data are from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Program. Since children are not eligible to participate in WIC once they become 5 years old and lacking other health department data sources for children 5-years of age and older, 2011 NC-NPASS data does not include county-specific rates for children ages 5 and older)
57 Asthma
According to the North Carolina Asthma Program, North Carolina have been diagnosed with asthma and more than 12.6 percent of adults in North Carolina had almost 10.3 percent still have it. Between 1999 and been diagnosed with asthma at some point in their 2009, asthma caused more than 1,000 deaths in North lives and more than 7.5 percent still have this chronic Carolina. There were twice as many deaths among adult condition. Approximately 16.8 percent of children in women as adult men.
2011 North Carolina Hospital Discharges with a Primary Diagnosis of Asthma
Total # Total Rate # Age 0-14 Rate Age 0-14
Nash 158 164.4 53 286.3 Source: North Carolina Center for Health Statistics, 2013 County Health Data Book, available at http://www.schs. state.nc.us/schs/data/databook/CD18%20Asthma%20 Edgecombe 163 290.9 47 426.2 hospitalizations%20by%20county.html (Asthma Hospital Discharges (Total and Ages 0-14) per 100,000 Population, 2011) Halifax 99 182.7 36 356.8 Notes: Provisional North Carolina hospital discharge data; data includes only North Carolina residents served in North North 9,880 102.3 3,004 157.3 Carolina hospitals; numbers and rates per 100,000 by county Carolina of residence
Summary
All of the Health Data/Indicators discussed throughout this section are summarized on the following page. Statistics printed in red are above the North Carolina average, while those in blue are below the North Carolina average.
58 Indicator Nash Edgecombe Halifax
Morbidity 33nd 85th 100th
Poor or Fair Health 19% 19% 29%
Poor Physical Health 2.8 days 4.6 days 4.6 days Days
Poor Mental Health 3.1 days 2.5 days 4.3 days Days
Low Birth Weight 9.9% 13.0% 13.0%
Tobacco Use 58th 30th 52nd
Diet and Exercise 72nd 99th 98th
Alcohol Use 86th 30th 38th
Sexual Activity 83rd 99th 92nd
Access to Care 16th 59th 34th
Quality of Care 23th 51st 75th
Community Safety 90th 96th 88th
Education 72nd 76th 83rd
Employment 83rd 98th 94th
Family and Social 76th 97th 100th Support
Income 48th 97th 96th
Built Environment 58th 98th 93rd
Environmental Quality 25th 97th 34th
Birth Rates 12.8 13.8 11.9
Fetal Mortality 10.9 16.4 10.3
Infant Mortality 10.2 11.0 12.6
Cancer Incidence 473.9 542.9 514.1
Cancer Death Rates 186.9 227.0 210.2
Heart Disease Death 187.5 233.2 226.5 Rates
Diabetes Death Rates 24.2 36.8 46.5
Adult Obesity 73rd 99th 98th
Obesity in Children 56th 12th 43th
Total Asthma Rate 164.4 290.9 182.7
Asthma Rate (0-14) 286.3 426.2 356.8
59 A healthy attitude is contagious, but don’t wait to catch it from “ others. Be a carrier. – Tom Stoppard ”
Health Utilization
This section examines historical patient data specific to NHC to determine trends and possible needs in the community. Detailed utilization data from the most recent three fiscal years for inpatient discharges, emergency visits, and outpatient visits was studied using Truven as the main source.
Ambulatory Care Sensitive Conditions
Ambulatory Care Sensitive Conditions, as identified Nash County’s ranking for ambulatory care sensitive by the Agency for Healthcare Research and Quality conditions (preventable hospitalization rate), which is (AHRQ), are conditions for which proper outpatient care based on the more applicable Medicare population, can potentially prevent the need for hospitalization or is 47 out of 100 counties with a rate of 64 preventable for which early intervention can prevent complications hospital stays per 1,000 Medicare enrollees, compared or more severe disease. The following table shows to the state average rate of 63 and a national benchmark the prevention quality indicators (PQIs) consisting of 47, which indicates there is room for improvement. In of 16 ambulatory care sensitive conditions, which comparison, Edgecombe County has a rate of 83 and are measured as rates of admission to a hospital. The Halifax County’s rate is 85, and they are ranked 77th relationship between each indicator and the quality of and 84th respectively, out of the 100 North Carolina healthcare services, as documented by the AHRQ, is also Counties. included.
Preventable Hospital Stays North Carolina 2010
Hospitalization rate for ambulatory- care sensitive conditions per 1,000 Medicare enrollees
39 to 58 (34)
59 to 76 (32) 77 to 113 (34)
Source: Dartmouth Atlas Project, CMS.
60 Category Conditions Relationship to Quality
Proper outpatient treatment may reduce admissions for bacterial pneumonia Bacterial pneumonia in non-susceptible individuals, and lower rates represent better quality care.
Proper outpatient treatment may reduce admissions for dehydration, and Dehydration lower rates represent better quality care.
Proper outpatient treatment may reduce admissions for urinary infection, and Acute Conditions Urinary tract infection lower rates represent better quality care.
Timely diagnosis and treatment may reduce the incidence of perforated Perforated appendix appendix, and lower rates represent better quality care.
Proper outpatient treatment may reduce admissions for gastroenteritis in the Pediatric gastroenteritis pediatric population, and lower rates represent better quality care.
Proper preventive care may reduce incidence of low birth weight, and lower Birth Outcomes Low-weight rates represent better quality care.
Proper outpatient treatment may reduce admissions for CHF, and lower rates Congestive heart failure represent better quality care.
Proper outpatient treatment may reduce admissions for hypertension, and Circulatory Diseases Hypertension lower rates represent better quality care.
Proper outpatient treatment may reduce admissions for angina (without Angina without procedure procedures), and lower rates represent better quality care.
Uncontrolled diabetes without Proper outpatient treatment and adherence to care may reduce the incidence complications of uncontrolled diabetes, and lower rates represent better quality care.
Proper outpatient treatment and adherence to care may reduce the incidence Short-term diabetes complications of diabetic short-term complications, and lower rates represent better quality care. Diabetes Proper outpatient treatment and adherence to care may reduce the incidence Long-term diabetes complications of diabetic long-term complications, and lower rates represent better quality care.
Proper and continued treatment and glucose control may reduce the Lower-extremity amputation incidence of lower-extremity amputation, and lower rates represent better among patients with disability quality care.
Proper outpatient treatment may reduce the incidence or exacerbation of Adult Asthma asthma requiring hospitalization, and lower rates represent better quality care.
Proper outpatient treatment may reduce admissions for asthma in the Respiratory Diseases Pediatric Asthma pediatric population, and lower rates represent better quality care.
Chronic obstructive pulmonary Proper outpatient treatment may reduce admissions for COPD, and lower rates disease represent better quality care.
61 Inpatient Utilization
Of the Top 20 inpatient discharges originating from Medical Cardiology, Rehabilitation, Orthopedics and NHC’s community in FY 2012 (excluding Women’s and General Medicine. Newborns), the top five service lines were Psychiatry,
Nash Health Care Top 20 Inpatient DRGs Excluding Women’s & Newborns (PSA Only)
MSDRG Description Service Line 2010 2011 2012
885 Psychoses Psychiatry 341 371 490
Circulatory disorders except AMI, w card 287 Medical Cardiology 158 278 302 cath w/o MCC
945 Rehabilitation w CC/MCC Rehabilitation 173 193 244
Major joint replacement or reattachment of 470 Orthopedics 251 213 220 lower extremity w/o MCC
Septicemia or severe sepsis w/o MV 96+ 871 General Medicine 258 207 205 hours w MCC
Esophagitis, gastroent & misc digest 392 General Medicine 215 172 198 disorders w/o MCC
292 Heart failure & shock w CC Medical Cardiology 111 127 182
291 Heart failure & shock w MCC Medical Cardiology 223 167 174
194 Simple pneumonia & pleurisy w CC Pulmonary Medical 99 155 160
683 Renal failure w CC Nephrology Urology 74 145 152
690 Kidney & urinary tract infections w/o MCC Nephrology Urology 161 135 148
378 G.I. hemorrhage w CC General Medicine 94 117 136
638 Diabetes w CC General Medicine 77 90 135
603 Cellulitis w/o MCC General Medicine 141 138 132
Chronic obstructive pulmonary disease 191 Pulmonary Medical 67 93 129 w CC
Intracranial hemorrhage or cerebral 065 Neuro Science 104 124 123 infarction w CC
Misc disorders of nutrition, metabolism, 641 General Medicine 111 99 110 fluids/electrolytes w/o MCC
881 Depressive neuroses Psychiatry 27 75 107
193 Simple pneumonia & pleurisy w MCC Pulmonary Medical 151 137 106
Total 2,836 3,036 3,453
Source: Truven. Services provided by NHC for PSA residents only, excluding Women’s and Normal Newborns
62 ED Utilization
According to data from Truven, as shown in the table the most populous ZIP codes in the community, 27801, below, NHC’s ED visits from its community increased by 27803 and 27804 in Rocky Mount, accounted for ap- 0.7 percent annually since 2010. The ED visits grew in proximately 67.2 percent of NHC’s total ED volume in all ZIP codes except 27891 (Whitakers). ED visits from 2012.
Nash Health Care ED Visits by ZIP Code (PSA Only)
2012 Percent 2010-2012 Zip Code City 2010 2011 2012 of Total CAGR
27801 Rocky Mount 13,102 13,161 13,110 23.8% 0.0%
27803 Rocky Mount 11,294 11,404 11,570 21.0% 1.2%
27804 Rocky Mount 12,310 12,400 12,324 22.4% 0.1%
27809 Battleboro 1,690 1,670 1,705 3.1% 0.4%
27816 Castalia 738 750 783 1.4% 3.0%
27823 Enfield 3,094 3,249 3,345 6.1% 4.0%
27844 Hollister 1,037 956 1,041 1.9% 0.2%
27856 Nashville 6,560 6,634 6,663 12.1% 0.8%
27882 Spring Hope 2,196 2,244 2,252 4.1% 1.3%
27891 Whitakers 2,307 2,223 2,285 4.1% -0.5%
NHC’s Community Total 54,328 54,691 55,078 100.0% 0.7%
Source: Truven. State ED Area Based Analysis. Services provided by NHC for PSA residents only.
63 The table below shows the payor mix for NHC’s ED comprised a significant portion of visits, nearly one-fifth visits in 2012. The majority of the visits were paid by of the total, indicating that lack of insurance may be Medicaid and Medicare, combining for approximately creating barriers to primary care. 58.4 percent of the total volume. Self-pay patients also
Nash Health Care ED Visits by Payor (PSA Only)
% of 2012 Payor 2012 Total
Medicaid 17,987 32.7%
Medicare 14,142 25.7%
Self Pay 10,085 18.3%
Blue Cross/ 6,390 11.6% Blue Shield
Managed Care/ 3,668 6.7% Commercial
Other 2,806 5.1%
Total 55,078 100.0%
Source: Truven. State ED Area Based Analysis. Services provided by NHC for PSA residents only.
Further analysis shows that most of the Top Ten Top Ten ED visits accounting for approximately 19 diagnoses for ED visits relate to Respiratory/Chest percent of the PSA’s total ED volume in 2012, an increase Conditions and Other Symptoms and Signs, with the of nearly four percentage points from 2010.
Nash Health Care Top 10 ED Visits By Service Line (PSA Only)
DXCode Description 2010 2011 2012
Symptoms Involving Respiratory System 78659 1,035 1,101 1,459 & Chest
Other Symptoms Involving Abdomen & 78900 605 648 1,437 Pelvis
4659 Acute Uri Multiple Or NOS Site 1,052 1,243 1,355
5990 Other Disorders Urethra & Urinary Tract 1,561 1,581 1,344
7840 Symptoms Involving Head & Neck 1,023 1,054 1,038
78060 General Symptoms 505 500 905
Symptoms Involving Respiratory System 78650 790 694 898 & Chest
Other Symptoms Involving Abdomen & 78909 340 577 869 Pelvis
486 Pneumonia Organism NOS 859 843 700
462 Acute Pharyngitis 631 664 654
Top Ten Total ED Visits 8,401 8,905 10,659
Total PSA ED Visits 54,328 54,691 55,078
Top Ten Total ED Visits 15.5% 16.3% 19.4% As Percent of Total PSA volume
Source: Truven. ED Area Based Pivot with Bill Type. Services 64 provided by NHC for PSA residents only. 65 Interviews/Community Feedback
Community Interviews: Sumary As discussed above, many members of the NHC community were interviewed to provide input for this Community Health Needs Assessment, including persons representing the community’s interests and those with knowledge of public health and healthcare issues. These individuals are listed below.
• Mr. James Baluss, Network Director, Access East/Community Care Plan of Eastern North Carolina • Mr. Michael Baker, Executive Director, Opportunities Industrialization Center (OIC) Family Medical Center • Reverend Peter Bynum, First Presbyterian Church, Rocky Mount • Ms. Elizabeth Cockrell, RN, School Nurse, Nash-Rocky Mount Public Schools • Bishop Shelton Daniel, Greater Joy Baptist Church • Reverend Dennis Darville, First Baptist Church of Rocky Mount • Ms. Carol Eatman, RN, Student Health Coordinator, Nash-Rocky Mount Public Schools • Ms. Patricia Earp, RN, Harvest Clinic Coordinator, Carolina Family Health Centers • Reverend James Galliard, Word Tabernacle Church • Ms. Evangeline Grant, First Baptist Church of Enfield • Mr. Brian Harris, CEO, North Carolina Rural Health Group • Ms. Melissa Lowry, Healthy Kids Coordinator, The Down East Partnership for Children • Pastor Keith Moore, Abundant Life Ministries • Dr. Claudia Richardson, Medical Director, OIC Family Medical Center • Elder Reginald Silver, SOZO Ministries, Inc. • Reverend Linda Taybron, Pleasant Grove Baptist Church • Mr. Gene Wilson, Executive Director of Tar River Mission Clinic
In addition, the Community Advisory Committee, which is composed of residents of the NHC Community, provided regular feedback at their meetings during the CHNA process. The members of this group are listed on p. 5 of this report.
The feedback from the interviews was diverse, but several key themes emerged, including:
Greater communication must be established among providers in order to develop a coordinated system of care. • The frequency of emergency department visits and readmissions to the hospital can be reduced if the myriad healthcare groups could communicate in a timely and effective manner. • Establish avenues of communication between parent/guardians, primary care physicians, school nurses, and emergency departments. • There is an opportunity to develop a visible, branded community health pillar that focuses on population health rather than episodic care.
66 Community outreach and education efforts should be better coordinated in order to leverage available resources. • Current efforts are fragmented and only reach certain segments of those in need. T here is a need for greater leadership to strengthen and focus these efforts. • Desperate need for support groups for chronic disease sufferers, which could be supported/coordinated through NHC and/or leverage expertise at academic medical centers. • Dental buses, health fairs, screening drives, etc. are reaching only some segments of their potential patients/ audience.
There is a large need for specialty physician services for the under- and uninsured. • Primary care clinics are frustrated by their inability to procure specialty services for their patients, many of which have been directed to them post-discharge. • The only option for many patients is to leave the community for specialty care and burden of such travel often results in foregoing care.
There is disparate access to pharmacy, imaging, cancer screening, and dental services across the Community. Some clinics are able to offer these to patients while others do not or cannot. • Agreements for radiology services with NHC and other acute care providers are in place for some but not all clinics. Other clinics send patients out of the market for more affordable services or to an emergency room. • Clinics vary in their co-payments, ability to offer in-house dental or pharmacy services, transportation, etc.
Public health issues such as chronic disease, lack of education, availability of fresh food, absence of mental health resources, and the prevalence of obesity must continue to be addressed by NHC, public resources, and other providers. • Asthma is the number one presenting complaint in schools. Education and outreach through traveling asthma clinics or support groups should be considered. • Efforts to encourage healthy eating and exercise developed by smaller community groups have seen success, but encounter barriers such as access to financial resources, lack of safe places to exercise, and transportation.
Primary care access for the uninsured and underinsured is spread broadly across NHC’s Community but there is still more need. • Access could be improved in central Rocky Mount and within the Latino community. • Lack of transportation is a barrier to access for many. • Additional after hours and urgent care resources are needed. • Emergency department is used for primary care because primary care relationships that could foster preventative care are weak or non-existent for many. • There is a greater need for pediatrics providers in particular, for all payor classes. Access to school nurses is improving, but is constrained by public funding. • A larger faith-based clinic presence could draw strong support from a coalition of faith leaders whose current efforts are fragmented and establish trust with segments of the community historically averse to existing providers.
Most interviewees believe that NHC is aware of many of these issues, and in many cases, has taken action. The over-arching theme from the interviewees was the need for strong leadership to coordinate, enhance, and/or fund the broad community-based efforts that are seen as the solution for the significant healthcare needs of NHC’s Community.
67 Community Representative Survey Results
As noted previously, NHC received regular input from the Community Advisory Committee during the development of the CHNA. During its August 2013 meeting, members were presented with a list of health issues that had been developed through quantitative analysis, community interviews, or through the input of the Committee members. The following table shows the recommended health issue prioritization made by members of the Committee.
Results of Community Representative Survey
Percent of Health Need Ordered by Rank Total
Healthcare provider shortage 15%
Primary care access for targeted 10% groups
Education/Outreach Coordination 9%
Improved Communication Among 9% Providers
Mental Health^ 8%
Diabetes 7%
Obesity 7%
Health Education 6%
Coordinated Access to Care 6%
Availability of Fresh Food/Nutrition 6%
Heart Disease 5%
Diet and Exercise 3%
Asthma^ 3%
Access to Safe Recreation 3%
Access to Specialty Physicians 2%
Cancer 2%
Alcohol Use/Abuse 1%
General Surgeon shortage 1%
Total 100%
^For both mental health and asthma, the special needs of children were noted as a particular concern.
68 As illustrated in the previous chart, the shortage of healthcare providers, access to primary care services for targeted groups, coordination of education and outreach, improved communication among providers and mental health concerns were the top five concerns, comprising 51 percent of the total weighted survey results. It should also be noted that communication among providers, mental health and diabetes were tied as the three most mentioned concerns in the survey, although diabetes was not weighted as heavily as the others. While the input of the Committee was not the sole factor in NHC’s prioritization of health needs, significant weight was given to this feedback, as discussed in the section to follow.
69 Health Needs, Priortization Process And Results
This final portion of the assessment includes a summary of the priority health needs identified throughout this document. Although a large number of potential needs have been discussed, it is simply not feasible or appropriate for NHC to apply significant resources to each and every area of need at this time. To determine which needs should be priorities, NHC reviewed outcomes and findings from this assessment and utilized an objective approach to estimate which areas of need are of greatest concern. This process and associated results are discussed below.
Prioritization Process
Each section of this assessment has been incorporated to not only measure and estimate the level of current health needs for residents of the Community, but also to highlight key factors and conditions that are expected to have the greatest impact on those needs going forward. As review, these sections included the following:
• Existing Healthcare Facilities and Resources • Demographics • Socioeconomic Factors • Access to Care • Health Data/Indicators • Health Utilization • Interviews/Community Feedback
Leveraging the analyses and findings from those sections, NHC has condensed a list of dozens of potential health needs down to the few select areas it believes to be the current priorities for the Community. Each potential need was analyzed against the others and prioritized based on a variety of different considerations, such as:
• Input received from, and multiple discussions with the Community Advisory Committee for the CHNA process; • Input received from interviews with community health leaders, community members, and members of NHC administrative team; • Variance of need metric(s) from state/other benchmarks; • Variance of need metric(s) from other NHC internal indicators; • Impact of demographics and socioeconomic characteristics on need levels; • Availability of other health resources to meet the need; and, • Ability of NHC to positively impact need.
70 Results
According to a Robert Wood Johnson study, about 55 percent of preventable illness and deaths in the U.S. result from socioeconomic or behavioral factors – determinants that can be changed with preventive measures. An additional 10 percent of preventable deaths are the result of medical access issues, as shown below.
Access to Care, 10%
Genetics, 30%
Socioeconomics, 15%
Environmental Exposure, 5%
Behavior, 40%
Source: “The Case for More Active Policy Attention to Health Promotion,” Health Affairs, March 2002.
Similarly, as demonstrated by the data in preceding sections of this CHNA, the NHC community has significant health needs relating to behavior, socioeconomics and access. If the data from the chart above are true for the NHC community, then nearly two-thirds of preventable illnesses and deaths can be addressed by expanding access, encouraging behavioral changes and a focus on socioeconomically disadvantaged residents.
Based on the factors discussed above, NHC has identified two categories of health needs as the key areas for action going forward. NHC believes that these categories incorporate many of the health needs identified in the CHNA, while enabling it to focus on two key areas that could have a significant positive impact on the health of the community. Each need area is detailed in the following pages, including a brief summary of facts and findings that led to each being considered a priority.
71 Priority Health Need: Primary Care Access
The rationale for identifying Primary Care Access as a priority health need in NHC’s community includes the following:
• Physician Need* - Significant deficit (greater than 3.0 FTEs) for adult primary care (family practice and internal medicine) and Ob/Gyn. Deficit of nearly 3.0 FTEs for pediatrics. While Nash County has only a slight deficit of primary care physicians compared to the state, Halifax County is much lower than the state, and Edgecombe County has a critical shortage of primary care physicians.
• ED Utilization – High ED utilization rates in the community and the payor mix for ED services at NHC (over 50 percent from Medicaid and self-pay patients) suggests barriers to primary care access for these residents.
• Ambulatory-Care Sensitive Conditions (ACSC’s) – High prevalence of ACSC’s in the community indicates need for greater interaction with primary care providers to reduce preventable hospitalizations.
• Community Need Index – High or mid-high ranking for each ZIP code in the community, indicating the need for greater access to care, particularly primary care.
• Uninsured – Nearly 20 percent of all residents 0 to 64 are uninsured, with the rates in Edgecombe and Halifax counties exceeding that of the state as a whole. All counties in the PSA exceed state rates of uninsured children ages 0 to 18.
• Health reform – Primary care providers are expected to have an increasingly important role in the care continuum in the future.
• Health Factors – Rates of obesity, low birth weight, diet and exercise, death from cancer, heart disease and diabetes are worse than the North Carolina average, indicating the need for better health management, supported by improved access to primary care.
• Socioeconomic factors – Low rankings for education, employment, income, family and social support and built environment all indicate the need for prevention and early intervention, coordinated through primary care providers.
• Community Input – Provider shortage and primary care access identified as top two priority health issues by the NHC Community Advisory Committee and by other interviewees.
*As noted in Section V, NHC regularly conducts its own medical staff planning analysis, the most recent of which was conducted in 2012.
72 Priority Health Need: Chronic Conditions
The rationale for identifying Chronic Conditions as a priority health need in NHC’s community are described below for each identified condition: diabetes, obesity, heart disease, and asthma.
The rationale for diabetes includes the following:
• Physician Need – Slight need for endocrinologists (less than 1.0 FTE) for assistance with diagnosis, consultation and disease management planning; significant shortage of primary care physicians for disease management.
• Obesity – Rates in the NHC community are higher than those of the state, particularly in Edgecombe and Halifax counties.
• Diet and Exercise – Low rates of exercise in the community compared to the statewide rates, along with low rankings for built environment contribute to the high rate of diabetes, particularly Type 2.
• Mortality – Diabetes ranks as the fourth and fifth leading cause of death in Edgecombe and Halifax counties, respectively, compared to seventh in Nash County and the state as a whole. A disproportionally higher rate occurs in the African-American population in the community.
• Inpatient Utilization – Diagnoses of diabetes with complications and comorbidities and miscellaneous disorders of nutrition, metabolism, and fluid/electrolytes account for two of the top 20 inpatient discharges at NHC.
• Community Input – Diabetes was identified as a priority health issue by the NHC Community Advisory Committee and other interviewees.
The rationale for obesity includes the following:
• Physician Need - Significant deficit (greater than 3.0 FTEs) for adult primary care (family practice and internal medicine) physicians, which are needed to assist with disease management and weight control.
• Morbidity – Obesity rates in the NHC community are higher than those in the state, particularly in Edgecombe and Halifax counties.
• Comorbid Conditions – Obesity is a known contributor to diabetes and heart disease, both of which also have high rates in the community.
• Diet and Exercise – Low rates of exercise in the community compared to the statewide rates, along with low rankings for built environment contribute to the high rate of obesity.
• Community Input – Obesity was cited as a priority health issue by the NHC Community Advisory Committee and other interviewees.
73 Chronic Conditions (continued)
The rationale for heart disease includes the following:
• Physician Need – Significant deficit (greater than 3.0 FTEs) for cardiologists.
• Smoking/Tobacco Use – Smoking/tobacco use rates are higher in Nash and Halifax counties than those in the state as a whole.
• Diet and Exercise – Low rates of exercise in the community compared to the statewide rates, along with low rankings for built environment contribute to higher rates of heart disease.
• Obesity – Rates in the NHC community are higher than those in the state, particularly in Edgecombe and Halifax counties.
• Mortality - Heart disease is the leading cause of death in Halifax County and the second leading cause of death in Nash and Edgecombe counties.
• Heart Attack Rates – Acute Myocardial Infarction death rates for the community exceed the state; Edgecombe County rates are nearly twice that of North Carolina.
• Community Input – Heart disease issues cited as concerns by the NHC Community Advisory Committee and other interviewees.
The rationale for asthma includes the following:
• Physician Need - Significant deficit (greater than 3.0 FTEs) for adult primary care (family practice and internal medicine) and pediatrics. Shortage of physicians for disease management.
• Smoking/Tobacco Use – Smoking/tobacco use rates are higher in Nash and Halifax counties than those in the state as a whole.
• ED Utilization – Diagnoses involving the respiratory system include the most frequent condition for NHC ED patient and three of the top ten diagnoses overall.
• Diet and Exercise – Low rates of exercise in the community compared to the statewide rates, along with low rankings for built environment contribute to higher rates of heart disease.
• Socioeconomic Factors – Low rankings for education, employment, income, family and social support and built environment all indicate the need for prevention, education, and ongoing coordination through pri- mary care providers. Difficulties in asthma management can lead to school absenteeism, which in turn, can further conditions of lack of education and poverty.
• Community Input – Asthma was cited as a priority health issue, particularly for children, by the NHC Community Advisory Committee and other interviewees. School nurses stated that asthma was the most frequent presenting complaint for their students.
74 Summary
In addition to these specific priorities, NHC also believes that other issues raised as health needs are best suited for consideration in the Implementation Strategy. Specifically, quantitative and qualitative data show a need for health education and coordination of outreach efforts, improved communication among providers and coordinated access to healthcare.
As noted above, it is simply impossible for NHC to apply significant resources to each and every area of need at this time; however, this CHNA will guide NHC’s actions over the next three years. Thus, a prioritized approach is important and subsequent CHNAs can address other priorities as they persist or develop. It should be noted that one health need that was identified as significant by both qualitative and quantitative data and that was discussed considerably by the Community Advisory Committee is mental health. Specifically, mental health was identified as an area of need based on community input, physician need, and prevalence in the community.
For this CHNA, however, NHC, after much consideration and on the advice of the Community Advisory Committee, has determined that mental health is not a priority health need for the hospital at this time. Although mental health issues are a statewide concern in North Carolina, the mental healthcare system in the state has significant challenges that must be addressed on a statewide level, and the key issues go beyond NHC’s ability to make a significant and sustainable impact. Given these factors, NHC has prioritized other health needs where resources can be used more effectively to improve the health of its community.
75 Attachment 1: Acute Care Discharges by Facility in NHC’s PSA
Patient Patient Percent of Percent of Facility Discharges Facility Discharges Total Total (FY 2012) (FY 2012)
Nash General (NHC) 9,175 60.0% Iredell Health System 4 0.0%
Vidant Medical Center 1,953 12.8% Wayne Memorial Hospital 3 0.0%
Vidant Edgecombe Hospital 949 6.2% Cape Fear Valley Health System 3 0.0%
WakeMed Raleigh 802 5.2% Martin General Hospital 3 0.0%
University of North Carolina Hospitals 444 2.9% Forsyth Memorial Hospital 2 0.0%
Wilson Memorial Hospital 433 2.8% MedWest Harris 2 0.0%
Halifax Regional Medical Center 420 2.7% Albemarle Health 2 0.0%
Duke University Medical Center 385 2.5% Outer Banks Hospital 2 0.0%
Rex Healthcare 183 1.2% Mercy Hospital 2 0.0%
LifeCare Hospitals 161 1.1% Cleveland Regional Medical Center 2 0.0%
Duke Raleigh 130 0.9% Catawba Valley Medical Center 2 0.0%
Franklin Regional Medical Center 61 0.4% Presbyterian Orthopaedic Hospital 1 0.0%
Durham Regional Hospital 29 0.2% Morehead Memorial Hospital 1 0.0%
Maria Parham Hospital 17 0.1% Mission Hospital 1 0.0%
Kindred Hospital of Greensboro 12 0.1% J. Arthur Dosher Memorial Hospital 1 0.0%
Cone Health 11 0.1% Presbyterian Hospital Huntersville 1 0.0%
CarolinaEast Medical Center 11 0.1% Carolinas Medical Center Northeast 1 0.0%
Carteret County General Hospital 9 0.1% Central Carolina Hospital 1 0.0%
The North Carolina Baptist Hospital 9 0.1% Presbyterian Hospital 1 0.0%
New Hanover Regional Medical 8 0.1% Watauga Medical Center 1 0.0% Center
Vidant Roanoke-Chowan Hospital 8 0.1% Vidant Beaufort Hospital 1 0.0%
Johnston Medical Center-Smithfield 8 0.1% Kernersville Medical Center 1 0.0%
Select Specialty Hospital - Durham 8 0.1% CaroMont Health Inc. 1 0.0%
Carolinas Medical Center Northeast 7 0.0% Thomasville Medical Center 1 0.0%
WakeMed Cary 7 0.0% Grand Total 15,290 100.0%
North Carolina Specialty Hospital 6 0.0%
First Health Moore Regional Hospital 4 0.0% Source: Truven Health Analytics (Truven) (formerly Thomson Reuters); excludes substance abuse, psychiatric, and rehabilitation discharges
76 Attachment 2: Behavioral Health Discharges by Facility in NHC’s PSA
Patient Percent of Facility Discharges Total (FY 2012)
Nash Health Care System 676 60.7%
Halifax Regional Medical Center 171 15.4%
Vidant Medical Center 62 5.6%
Psychiatric Solutions of NC (Holly Hill 50 4.5% Hospital)
Brynn Marr Hospital 33 3.0%
Vidant Roanoke-Chowan Hospital 24 2.2%
University of North Carolina Hospitals 16 1.4%
Durham Regional Hospital 14 1.3%
Cone Health 10 0.9%
CarolinaEast Medical Center 9 0.8%
Vidant Edgecombe Hospital 7 0.6%
Duke University Medical Center 7 0.6%
Wayne Memorial Hospital 7 0.6%
Thomasville Medical Center 6 0.5%
Vidant Beaufort Hospital 4 0.4%
Vidant Duplin Hospital 3 0.3%
Frye Regional Medical Center 2 0.2%
Johnston Medical Center-Smithfield 2 0.2%
Wilson Memorial Hospital 2 0.2%
High Point Regional Hospital 1 0.1%
WakeMed Raleigh 1 0.1%
Davis Medical Center 1 0.1%
Rex Healthcare 1 0.1%
Forsyth Memorial Hospital 1 0.1%
The North Carolina Baptist Hospital 1 0.1%
New Hanover Regional Medical 1 0.1% Center
Presbyterian Hospital 1 0.1%
Source: Truven; only includes substance abuse and psychiatric Grand Total 1,113 100.0% discharges. 77 Attachment 3: Rehabilitation Discharges by Facility in NHC’s PSA
Patient Percent of Facility Discharges Total (FY 2012)
Nash Health Care System 334 71.7%
Vidant Medical Center 46 9.9%
WakeMed Rehabilitation Hospital 41 8.8%
Vidant Edgecombe Hospital 34 7.3%
University of North Carolina Hospitals 6 1.3%
Durham Regional Hospital 3 0.6%
Forsyth Memorial Hospital 1 0.2%
LifeCare Hospitals 1 0.2%
Grand Total 466 100.0% Source: Truven; only includes substance abuse and psychiatric discharges.
Attachment 4: NHC’s Community or Primary Service Area (PSA)
NHC’s Primary Service Area
Nash General Hospital
Halifax Regional Medical Center
Vidant Edgecombe
Vidant Medical Center
WakeMed Raleigh
78 Total 4,667 2,691 7,626 2,898 7,239 4,999 20,969 22,735 30,056 17,945 121,825 ZIP Code ZIP Code 10,251,127 Source: Nielsen. Source: 779 490 497 899 65+ 3,540 4,078 5,443 1,480 3,196 1,369 21,771 1,613,552 754 723 2018 5,304 6,216 7,948 1,422 2,010 5,060 1,984 1,487 45-64 32,908 2,675,522 870 940 6,882 7,008 1,497 2,469 5,801 2,279 1,594 18-44 10,050 39,390 3,546,025 969 577 738 <18 5,243 5,433 6,615 1,667 3,888 1,607 1,019 27,756 2,416,028 Total 4,657 2,685 7,876 2,896 7,062 5,078 21,535 22,648 29,416 17,419 121,272 ZIP Code ZIP Code 9,796,936 641 415 439 774 65+ 3,154 3,558 4,628 1,329 2,696 1,175 18,809 1,363,819 2013 786 788 5,902 6,592 1,451 8,093 2,274 5,104 2,032 1,610 45-64 34,632 2,579,888 879 939 7,029 6,967 1,520 2,485 5,733 2,234 1,592 18-44 10,100 39,478 3,524,465 605 730 <18 5,450 5,531 1,045 6,595 1,788 3,886 1,621 1,102 28,353 2,328,764 Total 4,494 2,538 8,763 2,851 6,335 5,251 23,349 22,709 26,704 14,335 117,329 ZIP Code ZIP Code 8,049,331 Attachment 5: Nielsen Demographic Data Attachment 5: Nielsen Demographic and North Carolina Population NHC PSA Overall 422 307 313 823 633 65+ 2,627 2,860 3,620 1,215 1,712 14,532 Halifax Regional Medical Center 969,201 604 638 2000 5,214 5,209 1,106 6,165 1,913 3,478 1,550 1,260 45-64 27,137 1,808,858 999 8,593 8,357 1,774 3,093 1,081 5,753 2,387 1,981 18-44 10,454 44,472 3,307,360 628 819 <18 6,915 6,283 6,465 1,192 2,542 3,392 1,575 1,377 31,188 1,963,912 Age 27801 27803 27804 27809 27816 27823 27844 27856 27882 27891 North Total by by Total Carolina ZIP Code 79 Total 2,413 3,519 9,160 1,434 3,589 1,324 2,150 9,694 58,182 14,241 10,658 ZIP Code ZIP Code 5,001,059 Source: Nielsen. Source: 401 599 213 591 226 339 65+ 1,395 2,217 1,702 1,446 9,129 693,251 2018 698 966 346 910 361 657 2,588 3,684 2,833 2,365 45-64 15,408 1,288,439 804 491 441 656 1,151 3,177 1,228 4,955 3,351 3,178 18-44 19,432 1,784,433 510 803 384 860 296 498 <18 2,000 3,385 2,772 2,705 14,213 1,234,936 Total 2,441 3,432 8,908 1,431 3,703 1,329 2,143 9,891 57,753 13,908 10,569 ZIP Code ZIP Code 4,775,452 334 511 183 529 194 269 65+ 1,169 1,872 1,472 1,257 7,790 582,696 2013 763 974 387 382 675 2,635 1,044 3,729 3,028 2,649 45-64 16,266 1,240,888 795 471 441 657 1,139 3,100 1,202 4,914 3,263 3,181 18-44 19,163 1,761,155 549 808 390 928 312 542 <18 2,002 3,393 2,806 2,804 14,534 1,190,713 Total 2,563 3,052 7,295 1,382 4,099 1,265 2,044 55,485 12,653 10,567 10,565 ZIP Code ZIP Code 3,942,656 Attachment 5 (continued): and North Carolina Male Population NHC PSA 240 318 684 137 485 130 149 968 65+ 1,384 1,091 5,586 389,110 633 751 302 881 301 535 1,752 2,913 2,403 2,299 45-64 2000 12,770 872,459 967 509 494 756 1,181 3,097 1,429 5,082 3,876 3,793 18-44 21,184 1,675,092 723 802 434 340 604 <18 1,762 1,304 3,274 3,197 3,505 15,945 1,005,995 27891 27882 27856 27844 27823 27816 27809 27804 27803 27801 ZIP Code Total by Age by Total North Carolina 80 Total 2,586 3,720 8,785 1,464 4,037 1,367 2,517 63,643 15,815 12,077 11,275 ZIP Code ZIP Code 5,250,068 Source: Nielsen. Source: 498 770 284 889 264 440 65+ 1,801 3,226 2,376 2,094 12,642 920,301 2018 789 377 393 765 1,018 2,472 1,100 4,264 3,383 2,939 45-64 17,500 1,387,083 790 449 429 841 1,128 2,624 1,241 5,095 3,657 3,704 18-44 19,958 1,761,592 509 804 354 807 281 471 <18 1,888 3,230 2,661 2,538 13,543 1,181,092 Total 2,637 3,630 8,513 1,465 4,173 1,356 2,514 63,519 15,508 12,079 11,644 ZIP Code ZIP Code 5,021,484 440 664 256 800 221 372 65+ 1,527 2,756 2,086 1,897 11,019 781,123 2013 847 401 404 776 1,058 2,469 1,230 4,364 3,564 3,253 45-64 18,366 1,339,000 797 468 438 863 1,095 2,633 1,283 5,186 3,704 3,848 18-44 20,315 1,763,310 553 813 340 860 293 503 <18 1,884 3,202 2,725 2,646 13,819 1,138,051 Total 2,688 3,283 7,040 1,469 4,664 1,273 2,450 61,844 14,051 12,142 12,784 ZIP Code ZIP Code 4,106,675 Attachment 5 (continued): Population and North Carolina Female NHC PSA 393 505 176 730 177 273 65+ 1,028 2,236 1,769 1,659 8,946 580,091 627 799 336 303 571 1,726 1,032 3,252 2,806 2,915 45-64 2000 14,367 936,399 572 505 1,014 1,206 2,656 1,664 1,018 5,372 4,481 4,800 18-44 23,288 1,632,268 654 773 385 288 588 <18 1,630 1,238 3,191 3,086 3,410 15,243 957,917 27891 27882 27856 27844 27823 27816 27809 27804 27803 27801 ZIP Code Total by Age by Total North Carolina 81 Attachment 6: Community Need Index Scores by ZIP Code in NHC’s PSA
ZIP Code CNI Need Level
27801 Rocky Mount 5.0 High
27823 Enfield 5.0 High
27844 Hollister 4.8 High
27803 Rocky Mount 4.6 High
27816 Castalia 4.6 High
27809 Battleboro 4.4 High
27882 Spring Hope 4.4 High
27891 Whitakers 4.4 High
27804 Rocky Mount 4.0 Mid-high
27856 Nashville 4.0 Mid-high
82 Attachment 7: 2007-2011 NC Resident Race/Ethnicity-Specific and Sex- Specific Age-Adjusted Death Rates
Residence = North Carolina Total
White, non- Black, non- Other Races, Hispanic Male Female Overall Hispanic Hispanic non-Hispanic
Cause of Death Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate
All Causes 299,176 791.4 79,246 956.1 5,428 553.6 4,242 273.3 192,457 969.2 195,635 684.0 388,092 808.4
Diseases of Heart 67,605 176.2 16,965 209.3 1,070 118.6 459 46.1 44,630 229.4 41,469 141.6 86,099 179.3
Acute Myocardial Infarc- 14,536 37.7 3,312 41.6 259 27.9 82 8.7 9,908 50.0 8,281 28.4 18,189 37.7 tion
Other Ischemic Heart 28,558 74.1 6,570 81.1 467 52.3 187 21.4 20,412 104.0 15,370 52.3 35,782 74.2 Disease
Cerebrovascular Disease 16,418 43.0 4,933 62.4 280 32.6 143 15.1 8,730 46.8 13,044 44.5 21,774 46.0
Cancer 68,577 176.8 17,982 211.4 1,240 120.7 719 65.1 47,193 227.4 41,325 147.5 88,518 179.7
Colon, Rectum, and Anus 5,604 14.5 1,851 22.1 96 9.6 63 6.3 3,964 19.0 3,650 12.9 7,614 15.5
Pancreas 3,925 10.0 1,152 13.9 66 6.8 41 4.0 2,519 11.8 2,665 9.4 5,184 10.5
Trachea, Bronchus, and 21,946 55.9 4,667 54.1 369 35.4 110 11.9 15,876 74.4 11,216 40.0 27,092 54.5 Lung
Breast 4,679 21.8 1,596 30.3 79 12.0 60 8.5 56 N/A 6,358 22.8 6,414 23.0
Prostate 2,882 19.6 1,416 55.6 51 17.3 36 12.0 4,385 24.3 0 N/A 4,385 24.3
Diabetes Mellitus 6,745 17.5 3,681 44.8 217 23.6 90 8.8 5,399 26.0 5,334 18.8 10,733 22.0
Pneumonia and Influenza 6,930 18.2 1,377 17.8 83 10.2 65 6.2 3,711 20.9 4,744 16.1 8,455 17.9
Chronic Lower Respiratory 19,755 51.3 2,287 28.9 176 20.3 56 7.8 10,447 54.9 11,827 41.7 22,274 46.6 Diseases
Chronic Liver Disease and 3,829 9.9 737 7.5 82 6.6 75 5.0 3,122 13.2 1,601 5.9 4,723 9.3 Cirrhosis
Septicemia 4,700 12.3 1,662 20.5 82 9.3 71 5.9 2,943 15.0 3,572 12.6 6,515 13.6
Nephritis, Nephrotic Syn- 5,739 15.0 2,921 36.8 143 17.3 57 6.1 4,269 22.7 4,591 16.0 8,860 18.6 drome, and Nephrosis
Unintentional Motor Vehi- 5,011 15.5 1,547 15.3 236 14.9 542 14.3 5,222 22.9 2,114 8.6 7,336 15.5 cle Injuries
All Other Unintentional 11,385 33.1 1,854 20.3 246 19.6 296 11.3 8,140 38.8 5,641 20.9 13,781 29.2 Injuries
Suicide 4,986 15.0 489 4.8 123 7.7 153 4.7 4,446 19.6 1,305 5.3 5,751 12.1
Homicide 1,064 3.4 1,458 13.8 135 8.0 292 7.3 2,253 9.8 696 2.9 2,949 6.3
Alzheimer's disease 11,369 29.9 1,789 26.1 136 21.3 53 8.9 3,627 22.7 9,720 32.2 13,347 29.0
Acquired Immune Defi- 333 1.0 1,286 12.9 15 N/A 53 2.2 1,141 4.8 546 2.3 1,687 3.5 ciency Syndrome
All tables for Attachment 7: Standard = Year 2000 U.S. Population; *Rates Per 100,000 Population Technical Note: Rates based on fewer than 20 cases (indicated by “N/A”) are unstable and have been suppressed Rates for Breast and Prostate Cancers have sex-specific denominators (female and male, respectively) Source: 2013 County Health Data Book, N.C. Department of Health and Human Services, Division of Public Health, State Center for Health Statistics 83 Attachment 7 (continued): 2007-2011 Edgecombe Resident Race/Ethnici- ty-Specific and Sex-Specific Age-Adjusted Death Rates
Residence = Edgecombe
White, non- Black, non- Other Races, Hispanic Male Female Overall Hispanic Hispanic non-Hispanic
Cause of Death Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate
All Causes 1,404 1017.1 1,528 1102.8 5 N/A 13 N/A 1,462 1335.5 1,488 862.7 2,950 1054.5
Diseases of Heart 330 232.7 324 237.6 0 N/A 1 N/A 337 308.8 318 181.7 655 233.2
Acute Myocardial Infarc- 103 71.4 99 71.1 0 N/A 0 N/A 120 105.7 82 46.7 202 70.4 tion
Other Ischemic Heart 129 90.7 108 78.9 0 N/A 0 N/A 120 110.3 117 66.3 237 83.9 Disease
Cerebrovascular Disease 124 89.7 134 102.1 0 N/A 0 N/A 111 112.7 147 83.2 258 95.2
Cancer 300 211.0 353 244.9 1 N/A 5 N/A 335 289.6 324 189.8 659 227.0
Colon, Rectum, and Anus 16 N/A 41 30.0 0 N/A 1 N/A 22 19.7 36 21.4 58 20.7
Pancreas 22 15.3 25 15.6 0 N/A 0 N/A 25 20.7 22 12.4 47 15.5
Trachea, Bronchus, and 108 73.3 82 53.2 1 N/A 1 N/A 122 101.7 70 40.1 192 64.1 Lung
Breast 25 29.9 31 35.2 0 N/A 2 N/A 0 N/A 58 34.5 58 34.5
Prostate 3 N/A 30 77.5 0 N/A 0 N/A 33 36.8 0 N/A 33 36.8
Diabetes Mellitus 39 28.0 68 47.1 0 N/A 0 N/A 56 47.6 51 29.9 107 36.8
Pneumonia and Influenza 32 23.9 31 25.3 0 N/A 0 N/A 28 29.7 35 19.9 63 23.8
Chronic Lower Respiratory 63 44.7 34 25.6 0 N/A 0 N/A 57 54.7 40 23.3 97 35.3 Diseases
Chronic Liver Disease and 26 18.8 16 N/A 0 N/A 0 N/A 26 20.3 16 N/A 42 14.0 Cirrhosis
Septicemia 24 16.7 27 19.7 0 N/A 0 N/A 25 22.2 26 15.2 51 18.1
Nephritis, Nephrotic Syn- 17 N/A 62 43.7 0 N/A 0 N/A 34 30.1 45 26.0 79 27.7 drome, and Nephrosis
Unintentional Motor 14 N/A 25 17.3 1 N/A 2 N/A 31 26.4 11 N/A 42 15.7 Vehicle Injuries
All Other Unintentional 42 33.1 27 18.5 0 N/A 2 N/A 48 41.4 23 14.0 71 25.5 Injuries
Suicide 19 N/A 7 N/A 1 N/A 0 N/A 24 20.5 3 N/A 27 9.8
Homicide 5 N/A 25 18.0 0 N/A 0 N/A 25 22.2 5 N/A 30 12.3
Alzheimer's disease 44 31.3 21 18.1 0 N/A 0 N/A 16 N/A 49 26.5 65 24.7
Acquired Immune Defi- 2 N/A 35 22.2 0 N/A 1 N/A 18 N/A 20 13.4 38 13.8 ciency Syndrome
84 Attachment 7 (continued): 2007-2011 Halifax Resident Race/Ethnicity- Specific and Sex-Specific Age-Adjusted Death Rates
Residence = Halifax
White, non- Black, non- Other Races, Hispanic Male Female Overall Hispanic Hispanic non-Hispanic
Cause of Death Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate
All Causes 1,549 862.1 1,568 1032.0 103 950.0 12 N/A 1,623 1231.6 1,609 763.1 3,232 951.5
Diseases of Heart 392 202.4 378 246.8 20 184.5 4 N/A 405 307.8 389 172.5 794 226.5
Acute Myocardial 99 52.3 108 69.4 5 N/A 0 N/A 127 91.1 85 37.6 212 60.1 Infarction
Other Ischemic Heart 150 77.6 125 82.1 8 N/A 3 N/A 147 114.9 139 59.9 286 80.8 Disease
Cerebrovascular Disease 89 46.0 92 60.1 3 N/A 1 N/A 80 60.4 105 46.9 185 52.9
Cancer 343 192.0 366 232.0 25 236.4 1 N/A 389 280.2 346 170.0 735 210.2
Colon, Rectum, and 37 20.4 42 27.1 2 N/A 0 N/A 39 29.0 42 19.7 81 23.2 Anus
Pancreas 26 13.9 29 18.1 2 N/A 0 N/A 30 19.9 27 12.6 57 16.0
Trachea, Bronchus, and 113 63.6 84 51.3 6 N/A 0 N/A 121 83.6 82 39.5 203 57.5 Lung
Breast 31 34.5 32 34.9 0 N/A 1 N/A 0 N/A 64 34.0 64 34.0
Prostate 9 N/A 38 81.4 3 N/A 0 N/A 50 42.2 0 N/A 50 42.2
Diabetes Mellitus 56 32.3 98 65.4 2 N/A 0 N/A 73 53.5 83 40.7 156 46.5
Pneumonia and Influenza 35 18.3 30 20.6 4 N/A 0 N/A 31 26.0 38 17.0 69 19.8
Chronic Lower Respira- 100 52.5 58 37.2 5 N/A 0 N/A 80 60.6 83 37.3 163 46.0 tory Diseases
Chronic Liver Disease and 25 15.2 19 N/A 2 N/A 0 N/A 32 21.2 14 N/A 46 13.6 Cirrhosis
Septicemia 24 13.4 29 19.0 1 N/A 1 N/A 25 20.6 30 14.1 55 15.7
Nephritis, Nephrotic Syn- 28 15.4 40 26.3 3 N/A 0 N/A 41 31.7 30 13.6 71 20.4 drome, and Nephrosis
Unintentional Motor 15 N/A 37 25.6 5 N/A 0 N/A 37 28.6 20 15.0 57 21.4 Vehicle Injuries
All Other Unintentional 43 32.4 24 15.9 6 N/A 1 N/A 46 35.4 28 16.1 74 24.8 Injuries
Suicide 20 19.3 8 N/A 2 N/A 2 N/A 23 17.6 9 N/A 32 12.0
Homicide 8 N/A 26 19.5 1 N/A 0 N/A 25 21.8 10 N/A 35 14.8
Alzheimer's disease 34 16.6 30 21.1 1 N/A 0 N/A 23 20.3 42 17.2 65 18.2
Acquired Immune Defi- 2 N/A 23 15.4 0 N/A 0 N/A 14 N/A 11 N/A 25 8.9 ciency Syndrome
85 Attachment 7 (continued): 2007-2011 Nash Resident Race/Ethnicity- Specific and Sex-Specific Age-Adjusted Death Rates
Residence = Nash
White, non- Black, non- Other Races, Hispanic Male Female Overall Hispanic Hispanic non-Hispanic
Cause of Death Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate
All Causes 3,028 803.9 1,572 1008.1 28 588.0 33 241.1 2,344 1062.6 2,317 706.6 4,661 861.4
Diseases of Heart 675 174.8 333 219.1 9 N/A 3 N/A 537 249.1 483 143.9 1,020 187.5
Acute Myocardial 144 36.0 66 43.8 1 N/A 1 N/A 114 52.0 98 28.7 212 38.4 Infarction
Other Ischemic Heart 295 75.7 138 91.6 3 N/A 1 N/A 246 116.0 191 56.0 437 80.0 Disease
Cerebrovascular Disease 169 43.0 91 59.2 4 N/A 1 N/A 104 46.7 161 47.4 265 48.4
Cancer 708 182.8 338 205.5 2 N/A 5 N/A 578 246.1 475 148.6 1,053 186.9
Colon, Rectum, and 86 22.1 34 21.9 0 N/A 0 N/A 77 33.5 43 13.5 120 21.3 Anus
Pancreas 36 9.4 22 14.5 1 N/A 1 N/A 35 15.0 25 7.9 60 10.8
Trachea, Bronchus, and 213 53.0 95 56.2 1 N/A 0 N/A 200 80.6 109 33.6 309 53.3 Lung
Breast 44 22.7 33 31.8 0 N/A 1 N/A 0 N/A 78 25.5 78 25.5
Prostate 27 18.4 12 N/A 0 N/A 0 N/A 39 19.6 0 N/A 39 19.6
Diabetes Mellitus 68 17.6 66 42.3 0 N/A 1 N/A 81 34.0 54 16.3 135 24.2
Pneumonia and Influenza 98 25.3 44 30.2 2 N/A 0 N/A 58 28.8 86 25.5 144 26.6
Chronic Lower Respira- 199 50.0 43 28.7 1 N/A 0 N/A 125 58.0 118 35.2 243 44.0 tory Diseases
Chronic Liver Disease and 40 10.7 20 11.3 1 N/A 0 N/A 40 15.4 21 6.9 61 10.8 Cirrhosis
Septicemia 49 12.4 32 20.6 0 N/A 1 N/A 39 16.3 43 13.4 82 14.8
Nephritis, Nephrotic Syn- 60 15.4 80 52.2 0 N/A 0 N/A 68 31.4 72 21.7 140 25.5 drome, and Nephrosis
Unintentional Motor 56 21.3 27 15.0 1 N/A 7 N/A 63 28.4 28 11.1 91 19.2 Vehicle Injuries
All Other Unintentional 77 25.6 35 22.1 0 N/A 3 N/A 70 31.8 45 15.5 115 23.4 Injuries
Suicide 44 15.2 10 N/A 0 N/A 2 N/A 48 21.4 8 N/A 56 11.7
Homicide 18 N/A 31 17.3 2 N/A 4 N/A 43 19.6 12 N/A 55 12.2
Alzheimer's disease 76 19.2 21 16.2 1 N/A 0 N/A 28 16.0 70 19.6 98 18.4
Acquired Immune Defi- 3 N/A 24 13.6 0 N/A 1 N/A 16 N/A 12 N/A 28 5.8 ciency Syndrome
All tables for Attachment 8: Standard = Year 2000 U.S. Population; *Rates Per 100,000 Population Technical Note: Rates based on fewer than 20 cases (indicated by “N/A”) are unstable and have been suppressed Rates for Breast and Prostate Cancers have sex-specific denominators (female and male, respectively) Source: 2013 County Health Data Book, N.C. Department of Health and Human Services, Division of Public Health, State Center for Health Statistics 86 Attachment 8: 2007-2011 NC Resident Race/Ethnicity and Sex-Specific Age-Adjusted Death Rates 9.3 3.5 6.3 18.6 15.5 29.2 13.6 17.9 46.6 24.3 22.0 23.0 15.5 10.5 54.5 46.0 74.2 37.7 29.0 12.1 Rate 179.7 179.3 808.4 Overall 8,860 7,336 6,515 4,723 8,455 4,385 6,414 7,614 5,184 1,687 5,751 2,949 13,781 22,274 10,733 27,092 88,518 21,774 35,782 18,189 86,099 13,347 Deaths 388,092 5.9 4.8 6.5 6.5 8.6 7.0 6.2 8.5 5.2 9.6 4.8 6.8 1.7 2.0 N / A N / A N / A 59.4 15.5 15.0 37.4 10.3 Rate 229.0 Female 0 8 54 26 98 35 35 17 39 30 60 24 45 24 74 31 60 35 24 40 327 170 1,515 Deaths Hispanic 7.7 4.9 7.0 6.3 6.2 7.5 3.4 7.0 N / A N / A N / A 15.7 20.1 11.4 12.0 14.3 72.2 14.0 10.5 28.4 54.8 11.6 Rate 313.0 Male 0 31 36 51 21 58 35 36 65 39 17 69 51 18 45 242 444 392 127 289 129 252 2,727 Deaths 8.5 8.2 5.6 9.9 9.0 7.0 4.7 3.4 N / A N / A 13.1 17.5 15.6 22.2 11.9 26.7 28.5 21.5 39.6 24.9 Rate 103.1 100.8 483.4 Female 0 6 88 72 83 41 37 76 46 78 50 35 38 30 116 155 596 141 107 190 493 100 2,578 Deaths 7.8 6.1 N / A N / A 28.2 21.9 16.7 10.7 27.2 25.7 10.5 17.3 10.3 46.8 37.4 36.2 68.9 11.0 15.2 13.0 Rate 145.7 140.0 640.5 Other Races, non-Hispanic Other Races, Male 1 9 60 41 45 37 51 46 31 85 36 158 164 100 101 214 644 139 152 277 577 105 2,850 Deaths 7.3 4.8 8.7 4.7 1.4 N / A 13.3 33.7 18.4 15.1 21.1 40.4 17.8 12.5 32.9 30.1 57.7 33.8 59.8 28.1 Rate 164.0 167.5 788.7 Female 0 75 682 402 912 263 750 908 621 469 260 1,662 1,041 2,005 1,674 1,586 8,374 2,842 1,663 2,969 8,329 1,348 39,559 Deaths 8.9 N / A 30.1 24.9 41.6 24.0 43.9 11.0 50.9 22.9 28.6 15.6 87.5 55.6 67.9 53.4 21.2 18.2 23.9 Rate 293.2 113.6 271.6 1207.4 Black, non-Hispanic Male 10 414 750 474 627 943 531 441 817 1,172 1,145 1,259 1,246 1,676 2,993 1,416 9,608 2,091 1,649 3,601 8,636 1,198 39,687 Deaths 9.2 6.8 6.2 8.9 0.4 2.3 N / A 24.1 12.2 11.4 47.3 14.2 16.6 12.1 42.7 21.5 42.0 27.7 51.4 33.4 Rate 146.6 137.5 671.0 Female 0 63 366 1,542 4,817 1,168 2,820 2,584 1,284 3,174 3,918 1,985 2,668 4,634 9,342 9,987 6,480 8,237 10,675 32,028 12,151 32,477 Deaths 151,983 1.6 4.5 N / A 22.3 43.3 23.9 19.6 13.5 58.2 14.1 21.7 20.9 19.6 11.4 17.7 73.9 43.3 50.7 23.4 Rate 220.7 104.5 226.4 944.0 White, non-Hispanic White, Male 45 270 698 3,469 6,568 3,818 2,919 2,116 9,080 2,545 3,571 3,012 2,882 1,940 2,936 6,431 8,056 3,132 12,604 36,549 16,407 35,128 Deaths 147,193 njuries ung irrhosis njuries nus ehicle I yndrome, and yndrome, V eficiency nfarction nfluenza otor otor espiratory D iseases ellitus Cause of Death Cause mmune D yocardial I yocardial ectum, and A ower R ower nintentional I ther U nintentional auses rostate ancreas ther I schemic H eart D isease ronchus, and L B ronchus, rachea, cute M cute olon, R T
C O A ll O ll C lzheimer's disease cquired I cquired ancer erebrovascular D isease erebrovascular neumonia and I
epticemia 87 yndrome nintentional M U nintentional A S uicide N ephrosis S N ephrotic N ephritis, S hronic L C hronic D isease and C L iver C hronic iabetes M D iabetes P P P B reast C C A D iseases of H eart A S H omicide A Residence = North Carolina Total Residence = Edgecombe Race/Ethnicity andSex-SpecificAge-Adjusted DeathRates Attachment 8(continued):2007-2011EdgecombeResident
White, non-Hispanic Black, non-Hispanic Other Races, non-Hispanic Hispanic
Male Female Male Female Male Female Male Female Overall
Cause of Death Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate Deaths Rate
All Causes 708 1293.4 696 813.5 745 1404.1 783 911.1 2 N/A 3 N/A 7 N/A 6 N/A 2,950 1054.5
Diseases of Heart 169 299.0 161 181.6 167 328.5 157 182.8 0 N/A 0 N/A 1 N/A 0 N/A 655 233.2
Acute Myocardial Infarction 59 99.7 44 50.1 61 116.1 38 44.2 0 N/A 0 N/A 0 N/A 0 N/A 202 70.4
Other Ischemic Heart Disease 68 122.6 61 67.2 52 100.9 56 65.1 0 N/A 0 N/A 0 N/A 0 N/A 237 83.9
Cerebrovascular Disease 55 112.7 69 73.6 56 113.8 78 93.0 0 N/A 0 N/A 0 N/A 0 N/A 258 95.2
Cancer 160 265.9 140 173.3 175 325.9 178 202.2 0 N/A 1 N/A 0 N/A 5 N/A 659 227.0
Colon, Rectum, and Anus 7 N/A 9 N/A 15 N/A 26 31.2 0 N/A 0 N/A 0 N/A 1 N/A 58 20.7
Pancreas 10 N/A 12 N/A 15 N/A 10 N/A 0 N/A 0 N/A 0 N/A 0 N/A 47 15.5
Trachea, Bronchus, and Lung 69 112.5 39 46.4 53 90.1 29 31.0 0 N/A 1 N/A 0 N/A 1 N/A 192 64.1
Breast 0 N/A 25 29.9 0 N/A 31 35.2 0 N/A 0 N/A 0 N/A 2 N/A 58 34.5
Prostate 3 N/A 0 N/A 30 77.5 0 N/A 0 N/A 0 N/A 0 N/A 0 N/A 33 36.8
Diabetes Mellitus 24 42.3 15 N/A 32 55.0 36 41.6 0 N/A 0 N/A 0 N/A 0 N/A 107 36.8
Pneumonia and Influenza 15 N/A 17 N/A 13 N/A 18 N/A 0 N/A 0 N/A 0 N/A 0 N/A 63 23.8
Chronic Lower Respiratory Diseases 37 68.1 26 29.6 20 39.7 14 N/A 0 N/A 0 N/A 0 N/A 0 N/A 97 35.3
Chronic Liver Disease and Cirrhosis 19 N/A 7 N/A 7 N/A 9 N/A 0 N/A 0 N/A 0 N/A 0 N/A 42 14.0
Septicemia 12 N/A 12 N/A 13 N/A 14 N/A 0 N/A 0 N/A 0 N/A 0 N/A 51 18.1
Nephritis, Nephrotic Syndrome, and 6 N/A 11 N/A 28 49.9 34 38.6 0 N/A 0 N/A 0 N/A 0 N/A 79 27.7 Nephrosis
Unintentional Motor Vehicle Injuries 10 N/A 4 N/A 18 N/A 7 N/A 1 N/A 0 N/A 2 N/A 0 N/A 42 15.7
All Other Unintentional Injuries 27 51.0 15 N/A 19 N/A 8 N/A 0 N/A 0 N/A 2 N/A 0 N/A 71 25.5
Suicide 16 N/A 3 N/A 7 N/A 0 N/A 1 N/A 0 N/A 0 N/A 0 N/A 27 9.8
Homicide 5 N/A 0 N/A 20 32.2 5 N/A 0 N/A 0 N/A 0 N/A 0 N/A 30 12.3
Alzheimer's disease 14 N/A 30 31.5 2 N/A 19 N/A 0 N/A 0 N/A 0 N/A 0 N/A 65 24.7
Acquired Immune Deficiency 0 N/A 2 N/A 17 N/A 18 N/A 0 N/A 0 N/A 1 N/A 0 N/A 38 13.8 Syndrome Attachment 8 (continued): 2007-2011 Halifax Resident Race/Ethnicity and Sex-Specific Age-Adjusted Death Rates 8.9 13.6 15.7 20.4 24.8 46.0 21.4 57.5 46.5 19.8 34.0 52.9 23.2 16.0 42.2 80.8 60.1 12.0 18.2 14.8 Rate 210.2 951.5 226.5 Overall 46 55 71 74 57 69 64 81 57 50 32 65 35 25 163 203 156 735 185 286 212 794 3,232 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A Rate Female 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 0 0 4 1 0 0 Deaths Hispanic N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A Rate Male 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 8 3 0 0 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A Rate 546.5 Female 0 1 1 1 1 2 0 2 0 2 7 1 0 0 3 1 0 0 0 5 0 0 32 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A Rate 1446.2 Other Races, non-Hispanic Other Races, Male 2 0 2 5 4 3 4 4 0 0 1 2 3 0 7 5 2 1 1 0 18 71 15 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A 22.9 26.8 25.1 34.9 54.3 50.7 69.7 46.6 20.3 Rate 156.0 803.8 194.6 Female 6 9 0 1 5 18 22 13 17 26 14 13 24 32 51 48 68 45 20 11 146 750 186 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A 34.9 55.0 50.3 92.5 81.4 78.1 73.8 95.8 32.5 Rate 374.6 104.1 316.1 1368.0 Black, non-Hispanic Male 7 0 11 13 18 24 15 13 32 28 16 60 38 47 44 57 63 21 10 12 220 818 192 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A 18.0 44.9 34.5 24.1 53.4 31.2 41.1 50.3 33.0 15.5 Rate 185.1 737.6 151.7 Female 8 8 7 6 0 5 0 11 18 21 55 31 27 14 56 30 53 69 40 22 192 823 197 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A 31.4 42.9 64.1 77.9 35.3 52.1 83.6 Rate 206.2 116.9 284.6 1069.1 White, non-Hispanic White, Male 9 0 9 3 2 13 21 12 17 25 14 45 10 12 57 26 36 81 59 12 151 726 195 Deaths njuries ung irrhosis njuries nus ehicle I yndrome, and yndrome, V eficiency nfarction nfluenza otor otor espiratory D iseases ellitus Cause of Death Cause mmune D yocardial I yocardial ectum, and A ower R ower nintentional I ther U nintentional auses rostate ancreas ther I schemic H eart D isease ronchus, and L B ronchus, rachea, cute M cute olon, R T C
O A ll O ll C lzheimer's disease cquired I cquired ancer erebrovascular D isease erebrovascular neumonia and I epticemia yndrome 89 S N ephrosis S N ephrotic N ephritis, nintentional M U nintentional S uicide iver D isease and C L iver C hronic A B reast P hronic L C hronic P C P iabetes M D iabetes C H omicide A S A D iseases of H eart A Residence = Halifax Attachment 8 (continued): 2007-2011 Nash Resident Race/Ethnicity and Sex-Specific Age-Adjusted Death Rates 5.8 23.4 19.2 25.5 10.8 14.8 44.0 26.6 24.2 53.3 19.6 25.5 10.8 21.3 48.4 80.0 38.4 11.7 12.2 18.4 Rate 186.9 861.4 187.5 Overall 91 61 82 39 78 60 56 55 98 28 115 140 243 144 135 309 120 265 437 212 1,053 4,661 1,020 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A Rate Female 1 1 0 0 0 0 0 1 0 0 1 0 1 0 1 0 1 0 1 1 0 0 10 Deaths Hispanic N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A Rate 297.5 Male 6 2 0 0 1 0 0 0 0 0 0 1 4 0 0 1 0 2 3 2 0 1 23 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A Rate Female 1 0 0 0 0 0 2 0 0 1 0 1 2 0 3 2 1 0 0 6 1 0 17 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A Rate Other Races, non-Hispanic Other Races, Male 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 2 3 0 0 11 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A N / A 45.0 30.3 29.0 27.7 31.8 59.8 71.5 32.9 Rate 149.9 175.0 822.2 Female 7 7 0 9 6 0 6 12 16 43 18 29 28 27 33 57 68 31 16 10 147 166 787 Deaths N / A N / A N / A N / A N / A N / A N / A N / A N / A 25.2 36.5 66.6 46.4 61.7 97.8 50.2 54.2 29.3 60.6 Rate 295.3 129.4 290.9 1292.0 Black, non-Hispanic Male 0 5 10 20 23 16 37 13 25 15 38 12 68 13 28 34 70 25 35 14 191 167 785 Deaths N / A N / A N / A N / A N / A N / A N / A 16.4 12.0 11.7 42.3 23.0 11.1 22.7 36.8 17.2 40.1 49.6 20.5 26.3 Rate 151.9 130.6 655.8 Female 8 0 5 2 32 19 27 29 14 55 25 44 81 15 37 53 65 100 325 100 121 310 1,503 Deaths N / A N / A N / A 26.0 33.9 28.7 12.5 20.6 15.4 62.2 28.9 25.4 18.4 75.3 13.0 29.5 43.9 16.7 49.2 Rate 231.8 112.6 235.3 989.5 White, non-Hispanic White, Male 0 1 36 45 37 22 31 26 99 43 43 27 21 49 69 13 23 79 132 383 174 365 1,525 Deaths njuries ung irrhosis njuries nus ehicle I yndrome, and yndrome, V eficiency nfarction nfluenza otor otor espiratory D iseases ellitus Cause of Death Cause mmune D yocardial I yocardial ectum, and A ower R ower nintentional I ther U nintentional auses rostate ancreas ther I schemic H eart D isease ronchus, and L B ronchus, rachea, cute M cute olon, R T
C O A ll O lzheimer's disease ll C cquired I cquired ancer erebrovascular D isease erebrovascular neumonia and I epticemia yndrome S uicide A nintentional M U nintentional S N ephrosis S N ephrotic N ephritis, iver D isease and C L iver C hronic hronic L C hronic P B reast iabetes M D iabetes P P C C H omicide A D iseases of H eart A A S Residence = Nash 91 92
2013 Community Health Needs Assessment
Nash Health Care
2460 Curtis Ellis Drive Rocky Mount, NC 27804 (252) 962-8000