Nevada Rural and Frontier Health Data Book – Seventh Edition

January 2015

Tabor Griswold, PhD, John Packham, PhD, Laima Etchegoyhen, MPH, and Christopher Marchand, MPH

Version 7.1

Nevada State Office of Rural Health Office of Statewide Initiatives University of Nevada School of Medicine 411 West Second Street Reno, Nevada 89503 www.medicine.nevada.edu/statewide

Nevada Rural and Frontier Health Data Book Table of Contents

Contents Page

Table of Contents ...... i

Introduction: Health and Health Care in Rural and Frontier Nevada ...... 1

Map 1: Healthcare Resources in Nevada – 2015 ...... 4

Map 2: Census Bureau Designation of Urban and Rural Areas in Nevada ...... 6

Map 3: Office of Management and Budget Designation of Metropolitan, Micropolitan, and Non-metropolitan Areas in Nevada ...... 7

Map 4: Nevada Population and Geography by Rural-Urban Commuting Areas (RUCA) ...... 8

Map 5: Nevada Geography ...... 10

Map 6: Public and Private Land Ownership in Nevada ...... 11

Map 7: Selected Northeastern States Placed Within the State of Nevada ...... 12

Section One: Demographic Profile of Rural and Frontier Nevada ...... 17

Highlights and Key Findings ...... 17

Table 1.1: Population in Nevada by County – 2014 to 2018 ...... 21

Table 1.2: Population in Nevada by County – 2010 to 2014 ...... 22

Table 1.3: Population in Nevada by County – 2014 to 2024 ...... 23

Table 1.4: Population in Nevada by County – 1990 to 2010 ...... 24

Table 1.5: Population and Geography in Nevada by County – 2010 to 2014 ...... 25

Table 1.6: Population and Housing Density in Nevada by County – 2014 ...... 26

Table 1.7: Housing Units in Nevada by County – 2000 to 2013 ...... 27

Table 1.8: Population in Nevada by City, County, and Region – 2000 to 2013 ...... 28

Table 1.9: Population in Incorporated and Unincorporated Areas in Nevada by County – 2013 ...... 33

Table 1.10: Population by Age Category in Nevada by County – 2014 ...... 34

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Table 1.11: Population Aged 65 and Over in Nevada by County – 2000 to 2010 ...... 35

Table 1.12: Population Aged 65 and Over in Nevada by County – 2014 to 2019 ...... 36

Table 1.13: Population Aged 65 and Over in Nevada by County – 1990 to 2010 ...... 37

Table 1.14: Median Age of Nevadans by County – 1990 to 2012 ...... 38

Table 1.15: Population Aged 17 and Under in Nevada by County – 2000 to 2010 ...... 39

Table 1.16: Population Aged 17 and Under in Nevada by County – 2014 to 2019 ...... 40

Table 1.17: Population Aged 18 to 64 in Nevada by County – 2000 to 2010 ...... 41

Table 1.18: Population Aged 18 to 64 in Nevada by County – 2014 to 2019 ...... 42

Table 1.19: Population by Selected Racial and Ethnic Categories in Nevada by County – 2014 ...... 43

Table 1.20: Percent of Population by Selected Racial and Ethnic Categories in Nevada by County – 2014 ...... 44

Table 1.21: Non-Hispanic and Hispanic Populations in Nevada by County – 2014 ...... 45

Table 1.22: Hispanic Population in Nevada by County – 1990 to 2014 ...... 46

Table 1.23: Hispanic Population in Nevada by County – 2014 to 2019 ...... 47

Table 1.24: Veteran Population by Age in Nevada by County – 2014 ...... 48

Table 1.25: Veteran Population in Nevada by County – 2014 to 2024 ...... 49

Table 1.26: Population by Place of Birth in Nevada by County – 2012 ...... 50

Table 1.27: Population Incarcerated in State of Nevada Correctional Facilities by County – 2014 ...... 51

Table 1.28: Population Incarcerated in State of Nevada Correctional Facilities by County – 2006 to 2014 ...... 52

Section Two: Social and Economic Profile of Rural and Frontier Nevada ...... 53

Highlights and Key Findings ...... 53

Table 2.1: Personal Income in Nevada by County – 2002 to 2012 ...... 59

Table 2.2: Annual Percentage Change in Personal Income in Nevada by County – 2002 to 2012 ...... 60

Table 2.3: Per Capita Personal Income in Nevada by County – 2002 to 2012 ...... 61

Table 2.4: Change in Per Capita Personal Income in Nevada by County – 2002 to 2012 ...... 62

Table 2.5: Per Capita Personal Income as a Percent of Nevada and U.S. Per Capita Income in Nevada by County – 2012 ...... 63

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Table 2.6: Sources and Amounts of Personal Income in Nevada by County – 2012 ...... 64

Table 2.7: Sources and Percent of Personal Income in Nevada by County – 2012...... 65

Table 2.8: Income from Transfer Payments by Type of Transfer Payment in Nevada by County – 2012 ...... 66

Table 2.9: Median Family Income in Nevada by County – 2009 to 2013 American Community Survey (ACS) Estimates ...... 67

Table 2.10: Median Family Income in Nevada by County – 2013 American Community Survey (ACS) Estimates ...... 68

Table 2.11: Median Household Income in Nevada by County – 2009 to 2013 Small Area Income and Poverty Estimate (SAIPE) ...... 69

Table 2.12: Median Household Income in Nevada by County – 2013 Small Area Income and Poverty Estimate (SAIPE) ...... 70

Table 2.13: Personal Bankruptcy Filing Rates in Nevada by County – 2005 to 2013 ...... 71

Table 2.14: New Building Permits Issued in Nevada by County – 2003 to 2013 ...... 72

Table 2.15: Population in Poverty in Nevada by County – 2002 to 2012 ...... 73

Table 2.16: Change of Population in Poverty in Nevada by County – 2002 to 2012 ...... 74

Table 2.17: School-aged Children (5 to 17) and Children (18 and Under) in Poverty in Nevada by County – 2012 ...... 75

Table 2.18: Supplemental Nutrition Assistance Program (SNAP) Participation in Nevada by County – 2006 to 2014 ...... 76

Table 2.19: Students Qualifying for Free and Reduced School Lunch (FRL) in Nevada by County – 2013 ...... 77

Table 2.20: Public Expenditures on Education in Nevada by County – 2009 to 2013 ...... 78

Table 2.21: Enrollment in Public and Private Schools (K-12) in Nevada by County – 2012 ...... 79

Table 2.22: Students as a Percent of Total Population in Nevada by County – 2012 ...... 80

Table 2.23: Number of Schools in Nevada by County – 2012 ...... 81

Table 2.24: Enrollment in Public Primary and Secondary Schools in Nevada by County – 2012 ...... 82

Table 2.25: High School Graduation Rate by Gender in Nevada by County – 2013 ...... 83

Table 2.26: High School Graduation Rate by Race and Ethnicity in Nevada by County – 2013 ...... 84

Table 2.27: Students Eligible for Millennium Scholarships in Nevada by County – 2004 to 2012 ...... 85

Table 2.28: Public High School Graduates Enrolled in Nevada System of Higher Education (NSHE) Institutions in Nevada by County – 2006 to 2012 ...... 86

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Contents Page

Table 2.29: First-year Persistence in Nevada System of Higher Education (NSHE) Institutions in Nevada by County – 2009 to 2011 ...... 87

Table 2.30: Educational Attainment in Nevada by County – 2000 to 2012 ...... 88

Table 2.31: Registered Voters in Nevada by County – 2014 ...... 89

Table 2.32: Registered Voters by Party in Nevada by County – 2014 ...... 90

Table 2.33: Percent of Registered Voters by Party in Nevada by County – 2014 ...... 91

Table 2.34: Community Organizations in Nevada by County – 2012...... 92

Table 2.35: United States Decennial Census Participation Rates in Nevada by County – 2000 to 2010 ...... 93

Table 2.36: Reported Violent Crimes in Nevada by County – 2012 ...... 94

Table 2.37: Reported Property Crimes in Nevada by County – 2012 ...... 95

Table 2.38: Violent Crime Rates and Property Crime Rates in Nevada by County – 2012 ...... 96

Section Three: Population Health Profile in Rural and Frontier Nevada ...... 97

Highlights and Key Findings ...... 97

Table 3.1: Health Insurance Coverage for Population Under the Age of 65 in Nevada by County – 2012 ...... 101

Table 3.2: Health Insurance Coverage for Population Under the Age of 65 at or Below 138% Federal Poverty Level (FPL) in Nevada by County – 2012 ...... 102

Table 3.3: Health Insurance Coverage for Population Under the Age of 65 at or Below 250% Federal Poverty Level (FPL) in Nevada by County – 2012 ...... 103

Table 3.4: Health Insurance Coverage for Population Under the Age of 65 at or Below 400% of Federal Poverty Level (FPL) in Nevada by County – 2012 ...... 104

Table 3.5: Health Insurance Coverage for Population Under the Age of 65 by Gender in Nevada by County – 2012 ...... 105

Table 3.6: Health Insurance Coverage for Population Under the Age of 19 in Nevada by County – 2012 ...... 106

Table 3.7: Health Insurance Coverage for Population Under the Age of 19 at or Below 138% Federal Poverty Level (FPL) in Nevada by County – 2012 ...... 107

Table 3.8: Health Insurance Coverage for Population Aged 18 to 64 in Nevada by County – 2012 ...... 108

Table 3.9: Health Insurance Coverage for Population Aged 18 to 64 at or Below 138% Federal Poverty Level (FPL) in Nevada by County – 2012 ...... 109

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Table 3.10: Health Insurance Coverage for Population Aged 40 to 64 in Nevada by County – 2012 ...... 110

Table 3.11: Health Insurance Coverage for Population Aged 40 to 64 at or Below 138% Federal Poverty Level (FPL) in Nevada by County – 2012 ...... 111

Table 3.12: Medicaid Enrollment in Nevada by County – 2011 to 2014 ...... 112

Table 3.13: Medicaid Enrollment in Nevada by County – 2004 to 2014 ...... 113

Table 3.14: Nevada Check Up (Nevada’s Children’s Health Insurance Program) Enrollment in Nevada by County – 2004 to 2014 ...... 114

Table 3.15: Nevada Check Up (Nevada’s Children’s Health Insurance Program) Enrollment by Age in Nevada by County – 2014 ...... 115

Table 3.16: Population Eligible for Medicare Benefits – Aged and Disabled in Nevada by County – 2012 ...... 116

Table 3.17: Number Enrolled in Medicare by Program Part in Nevada by County – 2012 ...... 117

Table 3.18: Percent Enrolled in Medicare by Program Part in Nevada by County – 2012 ...... 118

Table 3.19: Medicare-eligible Population in Nevada by County – 2000 to 2012 ...... 119

Table 3.20: Enrollment in the Veterans Health Administration by Gender in Nevada by County – 2013 ...... 120

Table 3.21: Users of the Veterans Health Administration by Gender in Nevada by County – 2013 ...... 121

Table 3.22: Enrollment and Users of the Veterans Health Administration as a Percent of Veteran Population in Nevada by County – 2013 ...... 122

Table 3.23: Users of Tribal Health Services in Nevada by County – 2003 to 2013 ...... 123

Table 3.24: Self-reported Chronic Conditions in Nevada by Region – 2013 ...... 124

Table 3.25: Self-reported Lifestyle and Behavioral Risk Factors to Health in Nevada by Region – 2013 ...... 125

Table 3.26: Self-reported Health Status and Health Care Access in Nevada by Region – 2013 ...... 126

Table 3.27: Diabetes Incidence in Nevada by County – 2004 to 2011 ...... 127

Table 3.28: Obesity Prevalence in Nevada by County – 2004 to 2011 ...... 128

Table 3.29: Physical Inactivity Prevalence in Nevada by County – 2004 to 2011 ...... 129

Table 3.30: Self-reported Substance Abuse and Mental Illness Among Population Aged 12 and Over in Nevada by Region – 2012 ...... 130

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Contents Page

Table 3.31: Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Incidence and Prevalence in Nevada by Region – 2013 ...... 131

Table 3.32: Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Incidence and Prevalence in Nevada by Region – 2009 to 2013 ...... 132

Table 3.33: Sexually Transmitted Disease (STD) Incidence in Nevada by Region – 2013 ...... 133

Table 3.34: Sexually Transmitted Disease (STD) Incidence in Nevada by Region – 2009 to 2013 ...... 134

Table 3.35: Tuberculosis Incidence in Nevada by Region – 2013 ...... 135

Table 3.36: Tuberculosis Prevalence in Nevada by Region – 2009 to 2013 ...... 136

Table 3.37: Maternal Health Behaviors and Birth Outcomes in Nevada by Region of Residence – 2013 ...... 137

Table 3.38: Neonatal, Post-neonatal, and Infant Mortality in Nevada by Region of Residence – 2013 ...... 138

Table 3.39: Birth Rates for Female Population in Nevada by County of Residence – 2010 to 2013 ...... 139

Table 3.40: Teen Pregnancy Rates for Female Population Aged 15 to 17 in Nevada by County of Residence – 2010 to 2012 ...... 140

Table 3.41: Teen Pregnancy Rates for Female Population Aged 18 to 19 in Nevada by County of Residence – 2010 to 2012 ...... 141

Table 3.42: Teen Pregnancy Rates for Female Population Aged 15 to 19 in Nevada by County of Residence – 2010 to 2012 ...... 142

Table 3.43: Teen Birth Rates for Female Population Aged 15 to 17 in Nevada by County of Residence – 2010 to 2013 ...... 143

Table 3.44: Teen Birth Rates for Female Population Aged 18 to 19 in Nevada by County of Residence – 2010 to 2013 ...... 144

Table 3.45: Teen Birth Rates for Female Population Aged 15 to 19 in Nevada by County of Residence – 2010 to 2013 ...... 145

Table 3.46: Childhood Disability by Type of Disability in Nevada by County of Residence – 2013...... 146

Table 3.47: Mortality for All Causes in Nevada by County of Residence – 2009 to 2013 ...... 147

Table 3.48: Heart Disease Mortality in Nevada by County of Residence – 2009 to 2013 ...... 148

Table 3.49: Malignant Neoplasm (Cancer) Mortality in Nevada by County of Residence – 2009 to 2013 ...... 149

Table 3.50: Chronic Lower Respiratory Disease (CLRD) Mortality in Nevada by County of Residence – 2009 to 2013 ...... 150

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Table 3.51: Lung, Trachea, and Bronchus Cancer (LTBC) Mortality in Nevada by County of Residence – 2009 to 2013 ...... 151

Table 3.52: Cerebrovascular Disease (Stroke) Mortality in Nevada by County of Residence – 2009 to 2013 ...... 152

Table 3.53: Mortality Rates by Cause of Death in Nevada by Region of Residence – 2013 ...... 153

Table 3.54: Mortality Rates by Cause of Death in Rural and Frontier Nevada – 2009 to 2013 ...... 154

Table 3.55: Leading Causes of Death in Nevada by Region of Residence – 2013 ...... 155

Table 3.56: Mortality by Socio-demographic Status in Nevada by Region of Residence – 2013 ...... 156

Table 3.57: Population Health Institute’s County Health Rankings in Nevada – Health Outcomes – 2014 ...... 157

Table 3.58: Population Health Institute’s County Health Rankings in Nevada – Health Determinants – 2014 ...... 158

Section Four: Health Workforce in Rural and Frontier Nevada ...... 159

Highlights and Key Findings ...... 159

Table 4.1: Labor Force in Nevada by County – 2014 ...... 165

Table 4.2: Unemployment in Nevada by County – 2004 to 2014 ...... 166

Table 4.3: Health Sector Employment in Nevada by County – 2013 ...... 167

Table 4.4: Health Sector Payroll in Nevada by County – 2013 ...... 168

Table 4.5: Employment in the Health Care and Social Assistance Sector by Region in Nevada – 2014 ...... 169

Table 4.6: Projected Employment in the Health Care and Social Assistance Sector by Region in Nevada – 2024 ...... 170

Table 4.7: Licensed Allopathic Physicians (MDs) in Nevada by County – 2004 to 2014 ...... 171

Table 4.8: Licensed Allopathic Physicians (MDs) by Location of Medical Education in Nevada by County – 2014 ...... 172

Table 4.9: Licensed Osteopathic Physicians (DOs) in Nevada by County – 2006 to 2014 ...... 173

Table 4.10: Licensed Primary Care Physicians (MDs and DOs) in Nevada by County – 2014 ...... 174

Table 4.11: Licensed Advanced Practitioners of Nursing (APNs) in Nevada by County – 2004 to 2014 ...... 175

Table 4.12: Licensed Physician Assistants (PAs) in Nevada by County – 2004 to 2014 ...... 176

Table 4.13: Licensed Registered Nurses (RNs) in Nevada by County – 2004 to 2014 ...... 177

Table 4.14: Licensed Practical Nurses (LPNs) in Nevada by County – 2004 to 2014 ...... 178

Table 4.15: Certified Registered Nurse Anesthetists (CRNAs) in Nevada by County – 2004 to 2014 ...... 179

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Table 4.16: Licensed Registered Nurses (RNs) with Emergency Medical Services (EMS) Certification in Nevada by County – 2004 to 2014 ...... 180

Table 4.17: Certified Nursing Assistants (CNAs) in Nevada by County – 2004 to 2014 ...... 181

Table 4.18: Licensed Dentists in Nevada by County – 2004 to 2014 ...... 182

Table 4.19: Licensed Registered Dental Hygienists (RDHs) in Nevada by County – 2004 to 2014 ...... 183

Table 4.20: Licensed Alcohol, Drug and Gambling Counselors in Nevada by County – 2008 to 2014 ...... 184

Table 4.21: Licensed Marriage and Family Therapists (MFTs) in Nevada by County – 2010 to 2012 ...... 185

Table 4.22: Licensed Clinical Professional Counselors in Nevada by County – 2010 to 2012...... 186

Table 4.23: Licensed Psychiatrists in Nevada by County – 2008 to 2014 ...... 187

Table 4.24: Licensed Psychologists in Nevada by County – 2008 to 2014 ...... 188

Table 4.25: Licensed Social Workers in Nevada by County – 2014 ...... 189

Table 4.26: Licensed Social Workers per 100,000 Population in Nevada by County – 2014 ...... 190

Table 4.27: Licensed Pharmacists in Nevada by County – 2004 to 2014 ...... 191

Table 4.28: Licensed Pharmaceutical Technicians in Nevada by County – 2004 to 2014 ...... 192

Table 4.29: Licensed Chiropractors in Nevada by County – 2004 to 2014 ...... 193

Table 4.30: Registered Dietitians (RDs) in Nevada by County – 2014 ...... 194

Table 4.31: Licensed Dispensing Opticians in Nevada by County – 2004 to 2014 ...... 195

Table 4.32: Licensed Dispensing Optician Apprentices in Nevada by County – 2004 to 2014 ...... 196

Table 4.33: Licensed Emergency Medical Technicians (EMTs) in Nevada by County – 2012 ...... 197

Table 4.34: Licensed Emergency Medical Technicians (EMTs) per 100,000 Population in Nevada by County – 2012 ...... 198

Table 4.35: Licensed Emergency Medical Technicians (EMTs) in Nevada by County – 2006 to 2012 ...... 199

Table 4.36: Licensed Massage Therapists in Nevada by County – 2010 to 2014 ...... 200

Table 4.37: Licensed Medical Laboratory Personnel in Nevada by County – 2014 ...... 201

Table 4.38: Licensed Medical Laboratory Personnel per 100,000 Population in Nevada by County – 2014 ...... 202

Table 4.39: Licensed Medical Laboratory Personnel in Nevada by County – 2004 to 2014 ...... 203

Table 4.40: Licensed Occupational Therapists (OTs) in Nevada by County – 2004 to 2014 ...... 204

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Table 4.41: Licensed Occupational Therapy Assistants (OTAs) in Nevada by County – 2004 to 2014 ...... 205

Table 4.42: Licensed Optometrists in Nevada by County – 2004 to 2014 ...... 206

Table 4.43: Licensed Physical Therapists (PTs) in Nevada by County – 2004 to 2014 ...... 207

Table 4.44: Licensed Physical Therapy Assistants (PTAs) in Nevada by County – 2004 to 2014 ...... 208

Table 4.45: Licensed Podiatrists in Nevada by County – 2004 to 2014 ...... 209

Table 4.46: Licensed Respiratory Therapists (RTs) in Nevada by County – 2004 to 2014 ...... 210

Table 4.47: Licensed Speech-language Pathologists in Nevada by County – 2006 to 2014 ...... 211

Table 4.48: Licensed Health Workforce Supply in Rural and Urban Regions of Nevada – 2014 ...... 212

Table 4.49: Population Residing in Health Professional Shortage Areas (HPSAs) in Nevada – 2015 ...... 213

Map 4.1: Primary Medical Care Health Professional Shortage Areas (HPSAs) in Nevada – 2015 ...... 214

Map 4.2: Primary Medical Care Health Professional Shortage Areas (HPSAs) in Metropolitan Clark County – 2015 ...... 215

Map 4.3: Primary Medical Care Health Professional Shortage Areas (HPSAs) in Metropolitan Northwestern Nevada – 2015 ...... 216

Map 4.4: Dental Health Professional Shortage Areas (HPSAs) in Nevada – 2015 ...... 217

Map 4.5: Dental Health Professional Shortage Areas (HPSAs) in Metropolitan Clark County – 2015 ...... 218

Map 4.6: Dental Health Professional Shortage Areas (HPSAs) in Metropolitan Northwestern Nevada – 2015 ...... 219

Map 4.7: Mental Health Professional Shortage Areas (HPSAs) in Nevada – 2015 ...... 220

Map 4.8: Mental Health Professional Shortage Areas in Metropolitan Clark County (HPSAs) in Nevada – 2015 ...... 221

Map 4.9: Mental Health Professional Shortage Areas (HPSAs) in Metropolitan Northwestern Nevada – 2015 ...... 222

Section Five: Health Care Resources and Economics of Rural and Frontier Nevada ...... 223

Highlights and Key Findings ...... 223

Map 5.1: Nevada Mileage Diagram ...... 226

Table 5.1: The Unique Geography of Community Hospitals in Rural and Frontier Nevada – 2015 ...... 227

Table 5.2: Community Hospitals in Rural and Frontier Nevada – 2015 ...... 228

Table 5.3: Community Hospitals in Urban Nevada – 2015 ...... 229

Table 5.4: Employment Impact of Community Hospitals in Rural and Frontier Nevada – 2013 ...... 230

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Nevada Rural and Frontier Data Book – Seventh Edition

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Table 5.5: Payroll Impact of Community Hospitals in Rural and Frontier Nevada – 2013 ...... 231

Table 5.6: Health Sector Employment in Nevada by County – 2013 ...... 232

Table 5.7: Health Sector Payroll in Nevada by County – 2013 ...... 233

Table 5.8: Employment Impact of the Health Sector in Nevada by County – 2013...... 234

Table 5.9: Payroll Impact of the Health Sector in Nevada by County – 2013 ...... 235

Table 5.10: Number and Type of Licensed Beds in Community Hospitals in Rural and Frontier Nevada – 2015 ...... 236

Table 5.11: Number and Per Capita Distribution of Licensed Community Hospital Beds and Skilled Nursing Beds in Nevada by County – 2015 ...... 237

Table 5.12: Ownership, Tax Status, and Service Area of Community Hospitals in Rural and Frontier Nevada – 2015 ...... 238

Table 5.13: Hospital-based Rural Health Clinics (RHC) in Rural and Frontier Nevada – 2015 ...... 239

Table 5.14: Federally Qualified Health Centers (FQHC) in Rural and Frontier Nevada – 2015 ...... 240

Table 5.15: Tribal Medical Clinics and Health Centers in Rural and Frontier Nevada – 2015 ...... 241

Table 5.16: Utilization Trends in Rural and Frontier Hospitals in Nevada – 2013 ...... 242

Table 5.17: Admissions and Inpatient Days in Rural and Frontier Hospitals in Nevada – 2013 ...... 243

Table 5.18: Total Patient Revenue in Rural and Frontier Hospitals in Nevada – 2013 ...... 244

Table 5.19: Total Revenue in Rural and Frontier Hospitals in Nevada – 2013 ...... 245

Table 5.20: Net Income in Rural and Frontier Hospitals in Nevada – 2013 ...... 246

Table 5.21: Net Operating Income Benchmarks in Rural and Frontier Hospitals in Nevada – 2013 ...... 247

Table 5.22: Net Income Benchmarks in Rural and Frontier Hospitals in Nevada – 2013 ...... 248

Table 5.23: Inpatient Billed Charges and Case Mix in Rural and Frontier Hospitals in Nevada – 2013 ...... 249

Table 5.24: Inpatient Admissions by Payer Source in Rural and Frontier Hospitals in Nevada – 2013 ...... 250

Table 5.25: Inpatient Days by Payer Source in Rural and Frontier Hospitals in Nevada – 2013 ...... 252

Table 5.26: Inpatient Billed Charges by Payer Source in Rural and Frontier Hospitals in Nevada – 2013 ...... 254

Table 5.27: Inpatient Billed Charges by Payer Source in Rural and Frontier Hospitals in Nevada – 2013 ...... 256

Table 5.28: Top Twenty Types of Admissions in Community Hospitals in Rural and Frontier Nevada – 2013 ...... 258

Table 5.29: Top Twenty Types of Admissions in Community Hospitals in Urban Nevada – 2013 ...... 259

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Data Sources ...... 261

End_Notes ...... 269

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Nevada Rural and Frontier Health Data Book Introduction: Health and Health Care in Rural and Frontier Nevada

The Nevada Rural and Frontier Health Data Book – Seventh Edition contains a wide range of current county-level information on the resident population, economy, social environment, population health, health workforce, and the health care delivery system. It includes important data for public policy makers, health care professionals and administrators, rural health care advocates, and equally important, the residents of rural and frontier Nevada. The primary purpose of this data book is to provide the most current and accurate data for these audiences, as well as for those interested in learning more about health and health care in Nevada.

Utilizing over 50 sources of public and private data, most tables also provide data aggregated at the regional level highlighting important, general distinctions between rural and urban regions of the state. In some cases, the only available data is regional in nature (e.g., HIV/AIDS prevalence rates). In other instances, the data counts for individual rural and frontier counties are suppressed by the data-collecting agency for confidentiality or other reasons (e.g., teen pregnancy and birth rates). Regardless, the expressed intent of this publication is to highlight important differences among the urban, rural, and frontier areas of the state.

It should also be noted that, with the state’s ever-changing demography, economy, and health care delivery system, some of the data are in flux and, thus, must be approached with caution. In some cases, the information is not updated on a regular basis. Consequently, the “most current” available data likely understates county and regional trends (e.g., unemployment rates, uninsured estimates). Nonetheless, all of the information presented in this volume is, to our best knowledge, the most currently available.

The Nevada Rural and Frontier Health Data Book – Seventh Edition is divided into five major sections containing the most current data on:

 Demographic characteristics of rural and frontier Nevada, including recent population estimates and projections;

 The social and economic characteristics of rural and frontier Nevada, including data on income, economic indicators, poverty, and educational attainment;

 Health insurance coverage, population health status, and vital statistics in rural and frontier Nevada;

 The health care workforce in rural and frontier Nevada, including estimates and projections for many licensed health care occupations across the major regions of the state; and

 Health care resources and the economics of health care in rural and frontier Nevada.

The majority of tables contained in the data book are organized into two broad categories: (1) rural and frontier counties and (2) urban counties. Rural and frontier counties include Churchill, Douglas, Elko, Esmeralda, Eureka, Humboldt, Lander, Lincoln, Lyon, Mineral, Nye, Pershing, Storey, and White Pine Counties. Urban counties include Carson City, and Clark and Washoe Counties.

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Nevada Rural and Frontier Data Book – Seventh Edition

Provider-to-population ratios, insurance enrollment rates, and other population-based ratios and calculations utilize county- and state-level population estimates certified by the Nevada State Demographer’s Office for any given year. Some of the population estimates presented in this data book and utilized in the aforementioned denominators vary slightly from those published later in the same year. Numbers and percentages presented throughout the data book may not add up due to rounding. All dollar figures and estimates are in current U.S. dollars and have not been adjusted for inflation. A complete list of data sources is contained at the end of this report, as well as endnotes providing additional information on data and data sources.

Nevada Rural and Frontier Health Data Book – Seventh Edition details important differences among rural, frontier, and urban areas of Nevada. These differences impact population health, the availability of hospital and other health care resources, and access to health care services between rural and frontier and urban areas. For example, the age distribution of a county has a significant influence on the health status and health care needs of a population. The population age distribution within a county may affect available resources for local residents (e.g., number and percent of Medicare-eligible residents, proportion of county income from Social Security and other transfer payments).

All things being equal, rural counties tend to have an older population than urban counties. An older population, in turn, is typically at a greater risk of death and disability than a younger population, and uses a disproportionately larger share of health care resources. In general, urban, rural and frontier areas possess important differences in demographics, economics, and social characteristics, which produce differences in health priorities, population health, health-related behaviors, the delivery of health services, and access to health care. For example, research has consistently documented higher levels of obesity and smoking prevalence, lower levels of health insurance coverage, and greater barriers to accessing health care services in non-metropolitan versus metropolitan areas. Thus, it is not surprising that non-metropolitan areas have significantly higher age-adjusted all-cause mortality rates and cause-specific mortality rates than metropolitan areas.

Defining Rural and Frontier

The definition of what is and is not a “rural” area is no mere academic matter. Indeed, policy makers utilize different, and in some cases competing, classification schemes to target programs, services, and projects to populations in Nevada and the United States. The classification scheme adopted by the Nevada Office of Rural Health and utilized in this edition of the Nevada Rural and Frontier Health Data Book emphasizes the important distinctions between “rural” and “frontier” regions of the state. This classification scheme was developed by the National Center for Frontier Communities (NCFC) with input from state health planners and rural health professionals throughout the country.

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Nevada Rural and Frontier Data Book – Seventh Edition

The Center’s classification scheme distinguishes certain areas of the country as being more remote than rural areas. The Center’s classification scheme represents an improvement over previous schemes that defined “frontier” simply in terms of population density, where counties with a population density of six or less persons per square mile were defined as “frontier.” Frontier counties are different from rural counties by being more remote in terms of travel time and distance from the nearest population centers with more specialized medical care and facilities. Additional information on the Center’s classification scheme and methodology can be found at www.frontierus.org. Map 1 highlights the three urban counties (Carson City, and Clark and Washoe County), three rural counties (Douglas, Lyon, and Storey Counties), and the remaining eleven frontier counties. It also indicates the location of Nevada’s major towns, cities, and county seats. According to 2014 population estimates prepared by the Nevada State Demographer’s Office, 2.5 million Nevadans or 89.9% of the state’s population resides in the state’s three urban counties. Approximately 72.5% of the state’s population resides in Clark County (Las Vegas metropolitan area) alone and 15.5% in Washoe County (Reno-Sparks metropolitan area). In comparison, an estimated 284,496 Nevadans or 10.1% of Nevada’s population resides in the state’s rural and frontier counties. The rural and frontier population spreads over 95,431 square miles or 86.9% of the state’s land mass.

Map 1 also provides a current snapshot of the major health care services available to rural and frontier residents of Nevada. This map excludes the offices of physicians, emergency medical services agencies, or other individual health providers. While most of the state’s tertiary care centers are concentrated in the state’s three urban counties, a diverse range of acute care hospital services, outpatient clinics and medical services are scattered across twelve of the state’s fourteen rural and frontier counties (exceptions are Storey and Esmeralda counties where there are no health care facilities). These facilities and services – highlighted in greater detail throughout this data book – provide most of the basic health care received by our state’s rural and frontier populations.

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Nevada Rural and Frontier Data Book – Seventh Edition

Maps 2 through 4 illustrate different ways that rural and urban areas are defined by federal agencies and researchers. Map 2 provides a visual depiction of the Census Bureau’s classification of urban and rural counties in Nevada. In general, urban counties possess a population greater than 50,000. In Map 2, the state’s three urban counties are shaded white and the state’s fourteen rural counties are shaded in blue. In these terms, Nevada’s three urban counties currently have a combined population of 2,544,298 (89.1%) and its fourteen rural counties have a combined population of 284,496. Additional information on the Census Bureau’s classification scheme can be found at http://www.census.gov/geo/reference/urban-rural.html.

Map 3 illustrates the distribution of metropolitan, micropolitan, and non-metropolitan counties in Nevada utilizing a classification scheme developed by the White House’s Office of Management and Budget (OMB) and used by the Economic Research Service (ERS) of the U.S. Department of Agriculture. The original OMB system distinguished two broad types of areas: metropolitan (shaded white in Map 3) and non-metropolitan (shaded light and dark blue). Basically, metropolitan areas have at least one city of more than 50,000 residents and non- metropolitan areas typically have less than 50,000 residents.

The OMB classification scheme was recently updated to include “micropolitan” areas (shaded light blue in Map 3) that are distinguished by closer economic ties to metropolitan areas, yet possessing population less than 50,000. Utilizing the current OMB classifications scheme, Nevada possesses four metropolitan counties with a combined population of 2.5 million, seven micropolitan counties with a population of 250,215, and six non- metropolitan counties with a combined population of 34,281. Additional information on the OMB classification scheme can be found at http://www.ers.usda.gov/topics/rural-economy-population/rural-classifications/what- is-rural.aspx.

Map 4 illustrates the considerable heterogeneity of Nevada’s population and geography utilizing “Rural-Urban Commuting Areas” or “RUCA” codes ranging from 1 (the red shaded or core areas of urbanized areas) to 10 (the blue shaded, mostly frontier, isolated areas of the state). The RUCA methodology provides a more fine-grained classification of rural areas applicable at both the county and sub-county units of analysis. Map 4 underscores the concentration of most of the state’s population in zip code areas located in the northwestern and southern counties of the state (RUCAs 1-2), and the dispersion of the remaining 10 percent of the population is scattered across a vast geographic expanse of rural and frontier regions of the state (RUCAs 4-10).

Map 4 also highlights the considerable variation within counties. For example, the urban counties of Washoe County and Clark County contain substantial areas that are rural or frontier in nature; conversely rural and frontier counties such as Lyon and Nye Counties possess comparatively small urban areas or zip codes that are economically integrated with urban centers in the state. Additional information on the RUCA methodology can be found at http://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx.

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Nevada Rural and Frontier Data Book – Seventh Edition

Map 5 highlights the unique topography and vast distances separating the state’s rural communities from the urban centers. Most rural and frontier communities are located in sparsely populated counties that are considerable distances from the state’s urban and tertiary health care centers. The average distance between acute care hospitals in rural Nevada and the next level of care or tertiary care hospital is 114.7 miles and the average distance to the nearest incorporated town is 46.5 miles. Consequently, the primary health care delivery issue for rural and frontier residents and communities in Nevada is how best to overcome the spatial isolation and enormous geographic distances that characterize most of rural and frontier Nevada.

Nevada comprises the western half of our nation’s Great Basin. Ridge after ridge of rugged, brown mountains are broken up with flat sage covered valleys. The Great Basin is a high desert defined by 150 mountain ranges running north to south and earthquake activity second only to Hawai’i. Most mountain passes are subject to very difficult seasonal weather conditions. Most major roads follow the north to south pattern with two major exceptions. U.S. Highway 50 – “the loneliest highway in America” – across the middle of the state winds through numerous mountain summits. Interstate 80 curves northeastwards across the state largely following the railroad tracks built in the 1870’s. Travel time from most county hospitals to regional medical centers is thus measured in hours not minutes. Driving long distances is a very daunting task to obtain emergency health care in winter conditions. Helicopter pads are located at all rural hospitals for emergency transport to/from either Reno, Las Vegas, or other emergency care centers.

Map 6 details public and private land ownership in Nevada. Approximately 10 percent of land is privately owned (shaded black). The remaining 90 percent is publicly owned and administered by a wide range of federal, state, and tribal entities. The major administrators of public lands in Nevada are the Bureau of Land Management, Departments of Defense and Energy, and the U.S. Forest Service. The checkerboard pattern along Interstate 80 and the Humboldt River in Northern Nevada highlights a large swath of land owned between the Bureau of Land Management and the railroad company’s land grants. Geo

Map 7 highlights the enormous geographic expanse of the state – Nevada is the 7th largest state in the U.S. – by comparing it with selected northeastern states. Nevada’s land mass is approximately 110,000 square miles. By comparison, seven northeastern states with a combined land mass of 47,820 square miles would easily fit within Nevada’s borders.

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Nevada Rural and Frontier Data Book – Seventh Edition

Data Book Sections and Contents

Section One: Demographic Profile of Rural and Frontier Nevada

The first section of the Nevada Rural and Frontier Health Data Book – Seventh Edition contains the most current data on the social and demographic characteristics of rural and frontier Nevada, including information on:

 Population and population density  Population change and projections  Population aging and diversification  Population by place of birth  Veterans in Nevada

Section Two: Social and Economic Profile of Rural and Frontier Nevada

The second section contains the most current data from state and federal agencies on the social and economic characteristics of rural and frontier Nevada, including data on:

 Personal and family income  Poverty rates for children and adults  Educational enrollment and public school expenditures  Educational attainment and high school graduation rates  Voter registration and party affiliation  Crime statistics

Section Three: Population Health Profile of Rural and Frontier Nevada

The third section contains the most current data on population health and health insurance coverage in rural and frontier Nevada, including information on:

 Health insurance coverage and the uninsured  Population health status and risk factors to health  Teen pregnancy and birth rates  Morbidity and mortality rates  County health outcomes and health determinants rankings

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Nevada Rural and Frontier Data Book – Seventh Edition

Section Four: Health Care Workforce in Rural and Frontier Nevada

The fourth section contains the most current data on the health care workforce in rural and frontier Nevada, including data on:

 General labor market trends  Estimated hospital and health sector employment  Number and per capita geographic distribution of licensed health professionals  Health professional shortage areas and medically underserved areas

Section Five: Health Care Resources and Economics in Rural and Frontier Nevada

The fifth section contains the most current data on health care facilities, health care resources, and economic aspects of health care in rural and frontier Nevada, including information on:

 Hospital and other health care resources  Health care and hospital industry sector employment and payroll  Economic impact of the health care and hospital industry sector  Rural and frontier clinics, community health centers, tribal facilities, and Nevada’s telehealth network  Utilization trends and financial performance among the state’s rural and frontier hospitals and comparisons with urban facilities

The data sources, explanation of data tabulations, and notes on the strengths and weaknesses of the data presented for each table, figure, and map in the data book are contained in the appendices.

Acknowledgments

We would like to thank the numerous individuals, organizations, and agencies who assisted us in the preparation of the data book, and who provided data used in the seventh edition of the data book. In particular, we would like to acknowledge:

 Keith Clark from the Office of Statewide Initiatives provided the data book’s cover photo  Tara Barnett, Nicolette De Los Angeles, and Brian Lee, student workers from the University of Nevada, Reno  Julia Peek, Amy Lucas, Angel Stachnik, Jay Kvam, Theron Huntamer, Brad Towle, and Vickie Estes, Nevada Division of Public and Behavioral Health  Darlene Dougherty, Division of Welfare and Supportive Services  Jeff Hardcastle, Nevada State Demographer’s Office  Steve Boline, Nevada Rural Hospital Partners  Joseph Greenway, Center for Health Information Analysis at the University of Nevada, Las Vegas

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 Tom Harris and Jeffrey Stroup, University Center for Economic Development at the University of Nevada, Reno  John Torres, Nevada Department of Employment, Training, and Rehabilitation  Wanda Brown and Lisa Jones, Aging and Disability Services Division  Alejandra Livingston, Nevada Department of Corrections  Melissa Lewis, Nevada Division of Health Care Financing and Policy  Jody Sekerak, Phoenix Area Indian Health Services (IHS)  Paula Guzman, Nevada Health Centers  John Hammond, Southern Nevada Health District  Kelly Flannery, U.S. Department of Veterans Affairs  The nearly two dozen State of Nevada licensing boards

The responsibility for any errors of omission or commission are ours alone. The preparation and distribution of this volume was made possible through funding received by the Nevada Office of Rural Health from the Medicare Rural Hospital Flexibility Grant Program that is administered by the federal Office of Rural Health Policy (ORHP) within the Health Services Resource Administration (HRSA) and the Medical Education Council of Nevada (MECON).

In closing, since health and health care in rural and frontier Nevada are ever changing, our ambition is to continue to update and distribute this volume on a biennial basis. If your organization or agency utilizes the data book, we would appreciate learning more about how you have used it and how the eighth edition of the data book can be improved. As such, please send your comments and suggestions, as well as requests for additional copies to Tabor Griswold at [email protected].

Tabor Griswold, PhD Nevada State Office of Rural Health Office of Statewide Initiatives University of Nevada School of Medicine

Reno, Nevada January 2015

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Section One: Demographic Profile of Rural and Frontier Nevada Highlights and Key Findings

 The current population of Nevada is 2,855,061, including 286,251 residents in the state’s fourteen rural and frontier counties (Table 1.1).

 Over the past four years, the state’s population has grown by 128,243 or 4.5%. During the same period, the rural population has grown by 11,895 or 4.2% (Table 1.2).

 Population growth between 2010 and 2014 in rural and frontier counties ranged from a loss of 286 or -6.0% in Mineral County to a gain of 5,483 or 11.2% in Elko County (Table 1.2).

 The population in Nevada is projected to grow from 2,828,794 in 2014 to 3,096,503 in 2024 (9.5%) (Table 1.3).

 Over the next decade, the population of rural and frontier Nevada is projected to grow by 19,948 or 7.0% – 11 rural and frontier counties are projected to increase population, while only three counties are projected to lose population (Table 1.3).

 In both urban and rural Nevada, the population is projected to grow at a slower rate, as compared to the previous two decades. From 1990 to 2010, the state’s population increased by 1.5 million residents or 124.7%. During the same period, the rural and frontier population grew by 107,404 or 65.0% (Table 1.4).

 Currently, 10.1% of the state’s population resides in rural and frontier areas, as compared to 89.9% residing in the state’s three urban counties – 2.1 million residents or 72.5% of the state’s population resides in Clark County alone (Table 1.5).

 While rural and frontier counties represent only 10.1% of the state’s population, these counties cover 86.9% of the state’s land mass or 95,431 square miles (Table 1.5).

 Currently, there are 25.8 people per square mile in Nevada. Population density ranges from 0.3 persons per square mile in Esmeralda County to 383.0 persons per square mile in Carson City (Table 1.6).

 In 2014, there were 10.8 housing units per square mile in Nevada. Housing density ranges from 0.2 housing units per square mile in Esmeralda County and Eureka County to 163.6 housing units per square mile in Carson City (Table 1.6).

 Since 2000, the total number of housing units has increased in both rural and urban regions of the state; rural counties included an increase of 54.3% or 7,819 houses in Lyon County and 35.9% or 5,727 units in Nye County – in urban Clark County, the number of housing units increased by 288,002 or 50.9% (Table 1.7).

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Nevada Rural and Frontier Data Book – Seventh Edition

 Between 2000 and 2013, the population of rural and frontier Nevada has grown by 27,804 or 10.9% – seven rural and frontier counties increased population, while seven lost population (Table 1.8).

 Between 2000 and 2013, three of the five fastest growing counties in Nevada were rural and frontier: Clark County (42.5%) (urban), Lyon County (41.6%) (rural), Washoe County (29.6) (urban), Nye County (24.6%) (frontier), and Lincoln County (13.6%) (frontier) (Table 1.8).

 In 2013, 1,586,272 (56.6%) Nevadans were residents of an incorporated city, as compared to 1,214,694 (43.4%) who lived in an unincorporated town or rural area (Table 1.9).

 Only 26.8% of the rural and frontier population in Nevada reside in an incorporated area, as compared to 60.0% of urban residents (Table 1.9).

 Currently, 24.1% of the state’s population is 17 and under, 62.2% are between 18 and 64 years of age, and 13.7% are 65 and over (Table 1.10).

 In general, rural counties possess older populations versus urban counties – for example, five rural and frontier counties have more people aged 65 and over than people 17 years of age and under (Table 1.10).

 Between 2000 and 2010, the number of residents aged 65 and over increased in every county in Nevada (Table 1.11).

 Between 2000 and 2010, the number of Nevada residents aged 65 and over grew by 97,930 or 44.1%, including an increase of 15,328 residents aged 65 and over in rural and frontier counties (52.2%) (Table 1.11).

 The number of residents aged 65 and over in Nevada is projected to increase from 385,994 in 2014 to 449,428 in 2019 – an increase of 63,434 or 16.4% (Table 1.12).

 The population aged 65 and over is expected to increase in 12 of 14 rural and frontier counties over the next five years – overall, the number of residents aged 65 and over in rural and frontier Nevada is projected to increase by 7,272 or 13.7% through 2019 (Table 1.12).

 Between 1990 and 2010, the number of residents aged 65 and over in Nevada increased by 192,576 or 150.9%, including an increase of 26,925 in rural and frontier counties (151.5%) (Table 1.13).

 From 1990 to 2012, the median age has increased in every county of Nevada – the state average increased from 33.3 years in 1990 to 36.3 years in 2012 (Table 1.14).

 In 2012, among rural and frontier counties, the median age ranged from 33.4 years in Elko County to 52.8 years in Storey County; by comparison, among urban counties, the median age ranged from 35.5 years in Clark County to 41.6 in Carson City (Table 1.14).

 Between 2000 and 2010, the number of residents aged 17 and under decreased in 10 of 14 rural and frontier counties in Nevada (Table 1.15).

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 From 2000 to 2010, the population aged 17 and under in urban counties grew by 156,410 or 30.8% (Table 1.15).

 The number of residents aged 17 and under in Nevada is projected to increase from 676,377 in 2014 to 692,501 in 2019 – an increase of 16,124 or 2.4% (Table 1.16).

 For the next five years, the growth rate in the population aged 17 and under in rural and frontier counties (-1.2%) is projected to be lower than urban counties (2.4%) (Table 1.16).

 From 2000 to 2010, the population aged 18 to 64 in urban counties grew by 428,642 or 38.0%, as compared to rural and frontier counties that grew by 23,898 or 17.2% (Table 1.17).

 The number of residents between the ages of 18 and 64 in Nevada is projected to increase from 1,747,427 in 2014 to 1,804,466 in 2019 – an increase of 57,039 or 3.3% (Table 1.18).

 For the next five years, the growth rate in the population aged 18 to 64 in rural and frontier counties (2.4%) is projected to be similar to that of urban counties (3.4%) (Table 1.18).

 In general, urban areas of Nevada are more racially and ethnically diverse than rural and frontier regions – for example, 78.5% of rural and frontier residents are white, as compared to 51.3% in urban counties (Tables 1.19 and 1.20).

 Hispanic residents represent 15.2% of the population in rural and frontier counties and 29.2% in urban counties of Nevada (Tables 1.19 and 1.20).

 Hispanic residents are a growing segment of the population in every county of Nevada – the percent of the population claiming Hispanic ancestry ranges from 5.5% in Storey County to 21.5% in Humboldt County in rural and frontier areas, as compared to a range of 20.8% in Carson City to 30.6% in Clark County in urban areas (Table 1.21).

 The Hispanic population in Nevada has increased from 124,419 in 1990 to 781,886 in 2014 – an increase of 657,467 or 528.4% (Table 1.22).

 While the growth rate of the Hispanic population has been greater in urban areas (578.3%) of Nevada, the number of Hispanic residents in rural and frontier counties has increased by 27,244 or 176.4% in the past twenty-five years (Table 1.22).

 Between 2014 and 2019, the Hispanic population in Nevada is projected to increase by 81,991 or 10.5% – the growth rate in urban counties (10.6%) is projected to exceed that of rural counties (8.3%) (Table 1.23).

 Currently, there are 223,504 military veterans in Nevada, representing 7.9% of the state’s population (Table 1.24).

 There are 32,575 veterans residing in rural and frontier counties of Nevada – rural veterans represent 14.6% of all veterans in Nevada and 11.5% of the total population of rural and frontier Nevada (Table 1.24).

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Nevada Rural and Frontier Data Book – Seventh Edition

 The percent of the population who are military veterans ranges from 7.6% in Elko County to 21.7% in Esmeralda and Mineral Counties in rural and frontier areas, as compared to a range of 7.4% in Clark County to 10.4% in Carson City in urban areas (Table 1.24).

 According to the Veterans Health Administration, the veteran population is projected to decline in every county of Nevada between 2014 and 2024 – over the next ten years, the number of veterans in Nevada is expected to decline from 223,504 in 2014 to 197,850 in 2024 (Table 1.25).

 In 2012, an estimated 657,108 residents of Nevada were born in Nevada (24.7% of the population), 1.5 million residents were born in the U.S. outside of Nevada (55.8%), and 518,944 were born in another country (19.5%) (Table 1.26).

 In general, rural areas possess slightly greater percentages of native-born residents than urban regions of Nevada – 27.6% of rural and frontier residents are native-born, as compared to 24.4% in urban counties (Table 1.26).

 A much greater proportion of foreign-born residents are in the urban counties of Nevada than in rural and frontier counties; the foreign-born population ranges from 2.1% of the total population in Eureka and Lincoln Counties to 16.8% in Esmeralda County in rural and frontier areas; from 12.0% in Carson City to 22.3% in Clark County in urban areas of the state (Table 1.26).

 Currently, there are 12,743 prisoners in State of Nevada correctional facilities – 27.0% of the prison population or 3,441 prisoners are incarcerated in rural and frontier facilities (Table 1.27).

 Since 2006, the prison population in Nevada has increased by 706 inmates or 5.9% (Table 1.28).

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Table 1.1: Population in Nevada by County – 2014 to 2018

Population Region/County 2014 2015 2016 2017 2018 Rural and Frontier Churchill County 25,461 25,665 25,901 26,186 26,504 Douglas County 48,208 48,003 47,877 47,828 47,847 Elko County 54,301 54,993 55,527 56,038 56,562 Esmeralda County 912 959 997 1,029 1,053 Eureka County 2,056 2,069 2,073 2,085 2,107 Humboldt County 17,909 18,248 18,492 18,653 18,755 Lander County 6,569 6,708 6,775 6,787 6,757 Lincoln County 5,075 5,117 5,148 5,172 5,188 Lyon County 53,331 53,639 54,216 55,391 56,755 Mineral County 4,486 4,356 4,258 4,197 4,162 Nye County 44,919 45,081 45,258 45,461 45,680 Pershing County 6,977 7,031 7,047 7,034 7,019 Storey County 4,030 4,037 4,052 4,066 4,089 White Pine County 10,262 10,345 10,365 10,339 10,279 Region Subtotal 284,496 286,251 287,986 290,266 292,757 Urban Carson City 54,772 55,098 55,576 56,358 57,243 Clark County 2,051,946 2,069,967 2,085,920 2,103,756 2,120,173 Washoe County 437,580 443,745 450,687 458,808 467,565 Region Subtotal 2,544,298 2,568,810 2,592,183 2,618,922 2,644,981 Nevada – Total 2,828,794 2,855,061 2,880,169 2,909,188 2,937,738

Source: Nevada State Demographer’s Office (2014a).

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Table 1.2: Population in Nevada by County – 2010 to 2014

Population Change – 2010 to 2014 Region/County 2010 2014 Number Percent Rural and Frontier Churchill County 24,877 25,461 584 2.3 Douglas County 46,997 48,208 1,211 2.6 Elko County 48,818 54,301 5,483 11.2 Esmeralda County 783 912 129 16.5 Eureka County 1,987 2,056 69 3.5 Humboldt County 16,528 17,909 1,381 8.4 Lander County 5,775 6,569 794 13.7 Lincoln County 5,345 5,075 -270 -5.1 Lyon County 51,980 53,331 1,351 2.6 Mineral County 4,772 4,486 -286 -6.0 Nye County 43,946 44,919 973 2.2 Pershing County 6,753 6,977 224 3.3 Storey County 4,010 4,030 20 0.5 White Pine County 10,030 10,262 232 2.3 Region Subtotal 272,601 284,496 11,895 4.2 Urban Carson City 55,274 54,772 -502 -0.9 Clark County 1,951,269 2,051,946 100,677 5.2 Washoe County 421,407 437,580 16,173 3.8 Region Subtotal 2,427,950 2,544,298 116,348 4.6 Nevada – Total 2,700,551 2,828,794 128,243 4.5

Source: United States Census Bureau (2014a). Nevada State Demographer’s Office (2014a).

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Table 1.3: Population in Nevada by County – 2014 to 2024

Population Change – 2014 to 2024 Region/County 2014 2019 2024 Number Percent Rural and Frontier Churchill County 25,461 26,839 28,594 3,133 12.3 Douglas County 48,208 47,887 48,413 205 0.4 Elko County 54,301 57,016 58,157 3,856 7.1 Esmeralda County 912 1,069 1,059 147 16.1 Eureka County 2,056 2,134 2,337 281 13.7 Humboldt County 17,909 18,775 18,125 216 1.2 Lander County 6,569 6,681 6,095 -474 -7.2 Lincoln County 5,075 5,201 5,245 170 3.3 Lyon County 53,331 58,098 64,499 11,168 20.9 Mineral County 4,486 4,142 4,236 -250 -5.6 Nye County 44,919 45,888 46,937 2,018 4.5 Pershing County 6,977 7,012 7,035 58 0.8 Storey County 4,030 4,117 4,346 316 7.8 White Pine County 10,262 10,181 9,366 -896 -8.7 Region Subtotal 284,496 295,040 304,444 19,948 7.0 Urban Carson City 54,772 58,087 62,218 7,446 13.6 Clark County 2,051,946 2,136,172 2,213,760 161,814 7.9 Washoe County 437,580 475,996 516,081 78,501 17.9 Region Subtotal 2,544,298 2,670,255 2,792,059 247,761 9.7 Nevada – Total 2,828,794 2,965,295 3,096,503 267,709 9.5

Source: Nevada State Demographer’s Office (2014a).

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Table 1.4: Population in Nevada by County – 1990 to 2010

Population Change – 1990 to 2010 Region/County 1990 2000 2010 Number Percent Rural and Frontier Churchill County 17,938 23,982 24,877 6,939 38.7 Douglas County 27,637 41,259 46,997 19,360 70.1 Elko County 33,530 45,291 48,818 15,355 45.9 Esmeralda County 1,344 971 783 -561 -41.7 Eureka County 1,547 1,651 1,987 440 28.4 Humboldt County 12,844 16,106 16,528 3,684 28.7 Lander County 6,266 5,794 5,775 -491 -7.8 Lincoln County 3,775 4,165 5,345 1,570 41.6 Lyon County 20,001 34,501 51,980 31,979 159.9 Mineral County 6,475 5,071 4,772 -1,703 -26.3 Nye County 17,781 32,485 43,946 26,165 147.2 Pershing County 4,336 6,693 6,753 2,417 55.7 Storey County 2,526 3,399 4,010 1,484 58.7 White Pine County 9,264 9,181 10,030 766 8.3 Region Subtotal 165,197 230,549 272,601 107,404 65.0 Urban Carson City 40,433 52,457 55,274 14,841 36.7 Clark County 741,459 1,375,765 1,951,269 1,209,810 163.2 Washoe County 254,667 339,486 421,407 166,740 65.5 Region Subtotal 1,036,559 1,767,708 2,427,950 1,391,391 134.2 Nevada – Total 1,201,756 1,998,257 2,700,551 1,498,795 124.7

Source: United States Census Bureau (2014a). United States Census Bureau (2014b). United States Census Bureau (2014c).

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Table 1.5: Population and Geography in Nevada by County – 2010 to 2014

Population Geography

Region/County Percent of Percent of Area in Percent of 2010 State 2014 State Square State Land Population Population Miles Mass Rural and Frontier Churchill County 24,877 0.9 25,461 0.9 4,929 4.5 Douglas County 46,997 1.7 48,208 1.7 710 0.6 Elko County 48,818 1.8 54,301 1.9 17,179 15.6 Esmeralda County 783 0.0 912 0.0 3,588 3.3 Eureka County 1,987 0.1 2,056 0.1 4,176 3.8 Humboldt County 16,528 0.6 17,909 0.6 9,648 8.8 Lander County 5,775 0.2 6,569 0.2 5,494 5.0 Lincoln County 5,345 0.2 5,075 0.2 10,634 9.7 Lyon County 51,980 1.9 53,331 1.9 1,994 1.8 Mineral County 4,772 0.2 4,486 0.2 3,756 3.4 Nye County 43,946 1.6 44,919 1.6 18,147 16.5 Pershing County 6,753 0.3 6,977 0.2 6,037 5.5 Storey County 4,010 0.1 4,030 0.1 263 0.2 White Pine County 10,030 0.4 10,262 0.4 8,876 8.1 Region Subtotal 272,601 10.1 284,496 10.1 95,431 86.9 Urban Carson City 55,274 2.0 54,772 1.9 143 0.1 Clark County 1,951,269 72.3 2,051,946 72.5 7,910 7.2 Washoe County 421,407 15.6 437,580 15.5 6,342 5.8 Region Subtotal 2,427,950 89.9 2,544,298 89.9 14,395 13.1 Nevada – Total 2,700,551 100.0 2,828,794 100.0 109,826 100.0

Source: United States Census Bureau (2014a). Nevada State Demographer’s Office’s Office (2014a).

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Nevada Rural and Frontier Data Book – Seventh Edition

Table 1.6: Population and Housing Density in Nevada by County – 2014

Density Number of Area in Square Region/County Population Housing Units Housing Units Miles Population per per Square Square Mile Mile Rural and Frontier Churchill County 25,461 10,650 4,929 5.2 2.2 Douglas County 48,208 23,617 710 67.9 33.3 Elko County 54,301 20,060 17,179 3.2 1.2 Esmeralda County 912 823 3,588 0.3 0.2 Eureka County 2,056 1,037 4,176 0.5 0.2 Humboldt County 17,909 7,169 9,648 1.9 0.7 Lander County 6,569 2,537 5,494 1.2 0.5 Lincoln County 5,075 2,709 10,634 0.5 0.3 Lyon County 53,331 22,225 1,994 26.7 11.1 Mineral County 4,486 2,788 3,756 1.2 0.7 Nye County 44,919 21,681 18,147 2.5 1.2 Pershing County 6,977 2,400 6,037 1.2 0.4 Storey County 4,030 1,970 263 15.3 7.5 White Pine County 10,262 4,425 8,876 1.2 0.5 Region Subtotal 284,496 124,091 95,431 3.0 1.3 Urban Carson City 54,772 23,394 143 383.0 163.6 Clark County 2,051,946 854,089 7,910 259.4 108.0 Washoe County 437,580 185,305 6,342 69.0 29.2 Region Subtotal 2,544,298 1,062,788 14,395 176.7 73.8 Nevada – Total 2,828,794 1,186,879 109,826 25.8 10.8

Source: Nevada State Demographer’s Office (2014a). United States Census Bureau (2014d).

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Table 1.7: Housing Units in Nevada by County – 2000 to 2013

Housing Units Change – 2000 to 2013 Region/County 2000 2010 2013 Number Percent Rural and Frontier Churchill County 9,760 10,826 10,650 890 9.1 Douglas County 19,162 23,671 23,617 4,455 23.2 Elko County 18,492 19,566 20,060 1,568 8.5 Esmeralda County 834 850 823 -11 -1.3 Eureka County 1,026 1,076 1,037 11 1.1 Humboldt County 6,977 7,123 7,169 192 2.8 Lander County 2,782 2,575 2,537 -245 -8.8 Lincoln County 2,181 2,730 2,709 528 24.2 Lyon County 14,406 22,547 22,225 7,819 54.3 Mineral County 2,866 2,830 2,788 -78 -2.7 Nye County 15,954 22,350 21,681 5,727 35.9 Pershing County 2,390 2,464 2,400 10 0.4 Storey County 1,603 1,990 1,970 367 22.9 White Pine County 4,439 4,498 4,425 -14 -0.3 Region Subtotal 102,872 125,096 124,091 21,219 17.0 Urban Carson City 21,348 23,534 23,394 2,046 9.6 Clark County 566,087 840,343 854,089 288,002 50.9 Washoe County 144,986 184,842 185,305 40,319 27.8 Region Subtotal 732,421 1,048,719 1,062,788 330,367 31.5 Nevada – Total 835,293 1,173,815 1,186,879 351,586 30.0

Source: United States Census Bureau (2014d).

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Table 1.8: Population in Nevada by City, County, and Region – 2000 to 2013

Estimated Population Change – 2000 to 2013 Region/Place 2000 2013 Change Percent Rural and Frontier Churchill County 26,247 25,322 -925 -3.5 Incorporated Cities Fallon 8,386 8,706 320 3.8 No Unincorporated Towns Unincorporated Rural 17,861 16,615 -1,246 -7.0 Douglas County 43,101 48,478 5,377 12.5 No Incorporated Cities Unincorporated Towns Gardnerville 3,528 5,541 2,013 57.1 Genoa 245 220 -25 -10.2 Minden 2,818 2,993 175 6.2 Unincorporated Rural 36,510 39,724 3,214 8.8 Elko County 50,756 53,384 2,628 5.2 Incorporated Cities Carlin 2,395 2,851 456 19.0 Elko 18,642 20,958 2,316 12.4 Wells 1,563 1,307 -256 -16.4 West Wendover 3,867 4,453 586 15.2 Unincorporated Towns Jackpot 1,310 923 -387 -29.5 Montello 216 60 -156 -72.2 Mountain City 150 109 -41 -27.3 Unincorporated Rural 22,613 22,724 111 0.5 Esmeralda County 1,513 858 -655 -43.3 No Incorporated Cities Unincorporated Towns Goldfield 574 293 -281 -49.0 Silver Peak 230 132 -98 -42.6 Unincorporated Rural 709 433 -276 -38.9

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Table 1.8: Population in Nevada by City, County, and Region – 2000 to 2013 (continued)

Estimated Population Change – 2000 to 2013 Region/Place 2000 2013 Change Percent Rural and Frontier Eureka County 1,847 2,024 177 9.6 No Incorporated Cities Unincorporated Towns Crescent Valley 369 371 2 0.5 Eureka 558 720 162 29.0 Unincorporated Rural 920 933 13 1.4 Humboldt County 18,149 17,457 -692 -3.8 Incorporated Cities Winnemucca 8,884 8,185 -699 -7.9 No Unincorporated Towns Unincorporated Rural 9,265 9,272 7 0.1 Lander County 6,822 6,343 -479 -7.0 No Incorporated Cities Unincorporated Towns Austin 359 169 -190 -52.9 Battle Mountain 4,066 3,657 -409 -10.1 Kingston 258 124 -134 -51.9 Unincorporated Rural 2,139 2,394 255 11.9 Lincoln County 4,420 5,020 600 13.6 Incorporated Cities Caliente 1,132 1,068 -64 -5.7 Unincorporated Towns Alamo 507 583 76 15.0 Panaca 671 811 140 20.9 Pioche 892 790 -102 -11.4 Unincorporated Rural 1,218 1,768 550 45.2

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Table 1.8: Population in Nevada by City, County, and Region – 2000 to 2013 (continued)

Estimated Population Change – 2000 to 2013 Region/Place 2000 2013 Change Percent Rural and Frontier Lyon County 37,393 52,960 15,567 41.6 Incorporated Cities Fernley 9,570 18,987 9,417 98.4 Yerington 3,210 3,106 -104 -3.2 Unincorporated Rural 24,613 30,867 6,254 25.4 Mineral County 6,270 4,662 -1,608 -25.6 No Incorporated Cities Unincorporated Towns Hawthorne 3,875 3,076 -799 -20.6 Luning 106 100 -6 -5.7 Mina 380 163 -217 -57.1 Walker Lake 412 346 -66 -16.0 Unincorporated Rural 1,497 977 -520 -34.7 Nye County 35,924 44,749 8,825 24.6 No Incorporated Cities Unincorporated Towns Amargosa Valley 1,271 1,342 71 5.6 Beatty 1,255 966 -289 -23.0 Gabbs 459 259 -200 -43.6 Manhattan 135 124 -11 -8.1 Pahrump 26,399 37,030 10,631 40.3 Round Mountain 1,131 822 -309 -27.3 Tonopah 3,086 2,593 -493 -16.0 Unincorporated Rural 2,188 1,613 -575 -26.3 Pershing County 7,458 6,882 -576 -7.7 Incorporated Cities Lovelock 2,772 1,987 -785 -28.3 Unincorporated Towns Imlay 261 244 -17 -6.5 Unincorporated Rural 4,425 4,651 226 5.1

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Table 1.8: Population in Nevada by City, County, and Region – 2000 to 2013 (continued)

Estimated Population Change – 2000 to 2013 Region/Place 2000 2013 Change Percent Storey County 3,897 4,017 120 3.1 No Incorporated Cities Unincorporated Towns Gold Hill 194 200 6 3.1 Virginia City 1,023 841 -182 -17.8 Unincorporated Rural 2,680 2,976 296 11.0 White Pine County 10,650 10,095 -555 -5.2 Incorporated Cities Ely 5,118 4,100 -1,018 -19.9 Unincorporated Towns Lund 1,374 206 -197 -14.3 McGill 469 1,177 -45 -9.6 Ruth 3,391 424 797 23.5 Unincorporated Rural 3,599 4,188 589 16.4 Rural and Frontier Subtotal 254,447 282,251 27,804 10.9

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Table 1.8: Population in Nevada by City, County, and Region – 2000 to 2013 (continued)

Estimated Population Change – 2000 to 2013 Region/Place 2000 2013 Change Percent Urban Carson City 53,208 54,668 1,460 2.7 Clark County 1,425,723 2,031,723 606,000 42.5 Incorporated Cities Boulder City 15,519 15,635 116 0.7 Henderson 198,691 274,270 75,579 38.0 Las Vegas 483,448 598,520 115,072 23.8 Mesquite 15,605 17,477 1,872 12.0 North Las Vegas 124,936 226,199 101,263 81.1 Unincorporated Towns Bunkerville 909 1,067 158 17.4 Enterprise 21,905 170,699 148,794 679.3 Indian Springs 1,387 1,203 -184 -13.3 Laughlin 8,083 8,835 752 9.3 Moapa 736 1,094 358 48.6 Moapa Valley 9,088 6,871 -2,217 -24.4 Mt. Charleston 917 651 -266 -29.0 Paradise (Strip) 172,297 187,949 15,652 9.1 Searchlight 767 397 -370 -48.2 Spring Valley 130,168 188,818 58,650 45.1 Summerlin 4,845 26,855 22,010 454.3 Sunrise Manor 160,231 199,754 39,523 24.7 Whitney 14,946 39,857 24,911 166.7 Winchester 30,735 31,960 1,225 4.0 Unincorporated Rural 30,510 33,613 3,103 10.2 Washoe County 333,566 432,324 98,758 29.6 Incorporated Cities Reno 182,818 232,243 49,425 27.0 Sparks 66,420 91,551 25,131 37.8 Unincorporated Towns Unincorporated Rural 84,328 108,531 24,203 28.7 Urban Subtotal 1,812,497 2,518,715 733,972 40.5 Nevada – Total 2,066,944 2,800,966 734,022 35.5

Source: Nevada State Demographer’s Office (2014b).

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Table 1.9: Population in Incorporated and Unincorporated Areas in Nevada by County – 2013

Incorporated Unincorporated Region/County Total Number Percent Number Percent Rural and Frontier Churchill County 8,707 34.4 16,615 65.6 25,322 Douglas County 0 0.0 48,478 100.0 48,478 Elko County 29,569 55.4 23,815 44.6 53,384 Esmeralda County 0 0.0 858 100.0 858 Eureka County 0 0.0 2,024 100.0 2,024 Humboldt County 8,185 46.9 9,272 53.1 17,457 Lander County 0 0.0 6,343 100.0 6,343 Lincoln County 1,068 21.3 3,952 78.7 5,020 Lyon County 22,093 41.7 30,867 58.3 52,960 Mineral County 0 0.0 4,662 100.0 4,662 Nye County 0 0.0 44,749 100.0 44,749 Pershing County 1,987 28.9 4,895 71.1 6,882 Storey County 0 0.0 4,017 100.0 4,017 White Pine County 4,100 40.6 5,995 59.4 10,095 Region Subtotal 75,709 26.8 206,542 73.2 282,251 Urban Carson City 54,668 100.0 0 0.0 54,668 Clark County 1,132,101 55.7 899,622 44.3 2,031,723 Washoe County 323,794 74.9 108,531 25.1 432,324 Region Subtotal 1,510,563 60.0 1,008,152 40.0 2,518,715 Nevada – Total 1,586,272 56.6 1,214,694 43.4 2,800,966

Source: Nevada State Demographer’s Office (2014b).

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Table 1.10: Population by Age Category in Nevada by County – 2014

Population Percent of Total Population Region/County 17 and 65 and 17 and 65 and 18 to 64 18 to 64 Under Over Under Over Rural and Frontier Churchill County 6,197 15,289 3,976 24.3 60.0 15.6 Douglas County 8,730 27,639 11,839 18.1 57.3 24.6 Elko County 11,831 35,855 6,270 21.9 66.5 11.6 Esmeralda County 114 529 269 12.5 58.0 29.5 Eureka County 415 1,312 329 20.2 63.8 16.0 Humboldt County 4,349 11,491 1,953 24.4 64.6 11.0 Lander County 1,433 4,355 781 21.8 66.3 11.9 Lincoln County 1,015 2,679 1,085 21.2 56.1 22.7 Lyon County 12,107 31,119 10,105 22.7 58.4 18.9 Mineral County 920 2,616 949 20.5 58.3 21.2 Nye County 8,418 24,332 12,021 18.8 54.3 26.8 Pershing County 1,200 3,290 876 22.4 61.3 16.3 Storey County 544 2,431 1,056 13.5 60.3 26.2 White Pine County 2,095 5,095 1,689 23.6 57.4 19.0 Region Subtotal 59,368 168,032 53,198 21.2 59.9 19.0 Urban Carson City 12,639 29,898 9,918 24.1 57.0 18.9 Clark County 500,906 1,277,188 262,252 24.6 62.6 12.9 Washoe County 103,464 272,309 60,626 23.7 62.4 13.9 Region Subtotal 617,009 1,579,395 332,796 24.4 62.4 13.2 Nevada – Total 676,377 1,747,427 385,994 24.1 62.2 13.7

Source: Nevada State Demographer’s Office (2014d).

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Table 1.11: Population Aged 65 and Over in Nevada by County – 2000 to 2010

Population Aged 65 and Over Change – 2000 to 2010 Region/County 2000 2010 Number Percent Rural and Frontier Churchill County 2,834 3,742 908 32.0 Douglas County 6,431 9,323 2,892 45.0 Elko County 2,581 4,072 1,491 57.8 Esmeralda County 178 195 17 9.6 Eureka County 206 222 16 7.8 Humboldt County 1,325 2,079 754 56.9 Lander County 406 623 217 53.4 Lincoln County 684 1,367 683 99.9 Lyon County 5,220 8,081 2,861 54.8 Mineral County 994 1,008 14 1.4 Nye County 6,207 11,143 4,936 79.5 Pershing County 575 729 154 26.8 Storey County 489 671 182 37.2 White Pine County 1,239 1,442 203 16.4 Region Subtotal 29,369 44,697 15,328 52.2 Urban Carson City 7,779 9,415 1,636 21.0 Clark County 149,587 212,545 62,958 42.1 Washoe County 35,542 53,550 18,008 50.7 Region Subtotal 192,908 275,510 82,602 42.8 Nevada – Total 222,277 320,207 97,930 44.1

Source: United States Census Bureau (2014a). United States Census Bureau (2014c).

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Table 1.12: Population Aged 65 and Over in Nevada by County – 2014 to 2019

Population Aged 65 and Over Change – 2014 to 2019 Region/County 2014 2019 Number Percent Rural and Frontier Churchill County 3,976 4,249 273 6.9 Douglas County 11,839 13,237 1,398 11.8 Elko County 6,270 7,700 1,430 22.8 Esmeralda County 269 267 -2 -0.9 Eureka County 329 390 61 18.5 Humboldt County 1,953 2,442 489 25.0 Lander County 781 982 201 25.7 Lincoln County 1,085 1,104 19 1.8 Lyon County 10,105 11,724 1,619 16.0 Mineral County 949 903 -46 -4.8 Nye County 12,021 13,137 1,116 9.3 Pershing County 876 1,069 193 22.0 Storey County 1,056 1,283 227 21.5 White Pine County 1,689 1,983 294 17.4 Region Subtotal 53,198 60,470 7,272 13.7 Urban Carson City 9,918 12,804 2,886 29.1 Clark County 262,252 302,874 40,622 15.5 Washoe County 60,626 73,280 12,654 20.9 Region Subtotal 332,796 388,958 56,162 16.9 Nevada – Total 385,994 449,428 63,434 16.4

Source: Nevada State Demographer’s Office (2014d).

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Table 1.13: Population Aged 65 and Over in Nevada by County – 1990 to 2010

Population Aged 65 and Over Change – 1990 to 2010 Region/County 1990 2010 Number Percent Rural and Frontier Churchill County 2,297 3,742 1,445 62.9 Douglas County 3,352 9,323 5,971 178.1 Elko County 2,042 4,072 2,030 99.4 Esmeralda County 148 195 47 31.8 Eureka County 128 222 94 73.4 Humboldt County 934 2,079 1,145 122.6 Lander County 371 623 252 67.9 Lincoln County 599 1,367 768 128.2 Lyon County 3,019 8,081 5,062 167.7 Mineral County 846 1,008 162 19.1 Nye County 2,179 11,143 8,964 411.4 Pershing County 504 729 225 44.6 Storey County 263 671 408 155.1 White Pine County 1,090 1,442 352 32.3 Region Subtotal 17,772 44,697 26,925 151.5 Urban Carson City 6,041 9,415 3,374 55.9 Clark County 77,678 212,545 134,867 173.6 Washoe County 26,140 53,550 27,410 104.9 Region Subtotal 109,859 275,510 165,651 150.8 Nevada – Total 127,631 320,207 192,576 150.9

Source: United States Census Bureau (2014a). United States Census Bureau (2014b).

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Nevada Rural and Frontier Data Book – Seventh Edition

Table 1.14: Median Age of Nevadans by County – 1990 to 2012

Median Age (Years) Change – 1990 to 2012 Region/County 1990 2000 2010 2012 Number Percent Rural and Frontier Churchill County 32.9 35.0 39.0 39.2 6.3 19.1 Douglas County 36.1 41.7 47.4 47.3 11.2 31.0 Elko County 29.4 31.4 33.4 33.4 4.0 13.6 Esmeralda County 35.9 45.8 52.9 51.8 15.9 44.3 Eureka County 30.6 38.4 42.4 38.5 7.9 25.8 Humboldt County 30.6 33.3 36.2 36.6 6.0 19.6 Lander County 28.9 34.4 37.1 35.4 6.5 22.5 Lincoln County 33.4 37.8 39.9 35.9 2.5 7.5 Lyon County 36.4 38.7 40.9 40.6 4.2 11.5 Mineral County 33.9 42.7 49.2 50.4 16.5 48.7 Nye County 36.4 43.1 48.4 48.8 12.4 34.1 Pershing County 31.5 34.4 41.0 39.9 8.4 26.7 Storey County 37.6 45.1 50.5 52.8 15.2 40.4 White Pine County 33.7 37.5 40.8 42.0 8.3 24.6 Urban Carson City 36.5 39.0 41.7 41.6 5.1 14.0 Clark County 33.0 34.5 35.5 35.5 2.5 7.6 Washoe County 33.6 35.8 37.0 37.0 3.4 10.1 Nevada – Average 33.3 35.7 36.3 36.3 3.0 9.0

Source: United States Census Bureau (2014a). United States Census Bureau (2014b). United States Census Bureau (2014c).

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Table 1.15: Population Aged 17 and Under in Nevada by County – 2000 to 2010

Population Aged 17 and Under Change – 2000 to 2010 Region/County 2000 2010 Number Percent Rural and Frontier Churchill County 6,935 6,128 -807 -11.6 Douglas County 9,910 9,128 -782 -7.9 Elko County 14,699 14,306 -393 -2.7 Esmeralda County 199 144 -55 -27.6 Eureka County 459 475 16 3.5 Humboldt County 5,062 4,522 -540 -10.7 Lander County 1,863 1,573 -290 -15.6 Lincoln County 1,255 1,336 81 6.5 Lyon County 9,345 12,524 3,179 34.0 Mineral County 1,237 842 -395 -31.9 Nye County 7,706 8,622 916 11.9 Pershing County 1,719 1,247 -472 -27.5 Storey County 669 631 -38 -5.7 White Pine County 2,220 2,170 -50 -2.3 Region Subtotal 63,278 63,648 370 0.6 Urban Carson City 7,837 11,741 3,904 49.8 Clark County 351,770 489,207 137,437 39.1 Washoe County 84,480 99,179 14,699 17.4 Region Subtotal 444,087 600,127 156,040 35.1 Nevada – Total 507,365 663,775 156,410 30.8

Source: Nevada State Demographer’s Office (2014d).

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Nevada Rural and Frontier Data Book – Seventh Edition

Table 1.16: Population Aged 17 and Under in Nevada by County – 2014 to 2019

Population Aged 17 and Under Change – 2014 to 2019 Region/County 2014 2019 Number Percent Rural and Frontier Churchill County 6,197 6,819 622 9.1 Douglas County 8,730 8,170 -560 -6.9 Elko County 11,831 11,212 -619 -5.5 Esmeralda County 114 104 -10 -9.6 Eureka County 415 417 2 0.5 Humboldt County 4,349 4,403 54 1.2 Lander County 1,433 1,500 67 4.5 Lincoln County 1,015 967 -48 -5.0 Lyon County 12,107 12,597 490 3.9 Mineral County 920 853 -67 -7.9 Nye County 8,418 8,129 -289 -3.6 Pershing County 1,200 1,000 -200 -20.0 Storey County 544 490 -54 -11.0 White Pine County 2,095 1,968 -127 -6.5 Region Subtotal 59,368 58,629 -739 -1.2 Urban Carson City 12,639 12,021 -618 -5.1 Clark County 500,906 512,497 11,591 2.3 Washoe County 103,464 109,354 5,890 5.4 Region Subtotal 617,009 633,872 16,863 2.7 Nevada – Total 676,377 692,501 16,124 2.4

Source: Nevada State Demographer’s Office (2014d).

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Table 1.17: Population Aged 18 to 64 in Nevada by County – 2000 to 2010

Population Aged 18 to 64 Change – 2000 to 2010 Region/County 2000 2010 Number Percent Rural and Frontier Churchill County 14,182 14,652 470 3.3 Douglas County 25,092 27,877 2,785 11.1 Elko County 27,916 30,886 2,970 10.6 Esmeralda County 605 428 -177 -29.3 Eureka County 987 1,239 252 25.5 Humboldt County 9,831 10,489 658 6.7 Lander County 3,528 3,570 42 1.2 Lincoln County 2,237 2,982 745 33.3 Lyon County 20,413 30,477 10,064 49.3 Mineral County 2,829 2,708 -121 -4.3 Nye County 18,795 24,045 5,250 27.9 Pershing County 4,454 4,528 74 1.7 Storey County 2,284 2,494 210 9.2 White Pine County 5,722 6,398 676 11.8 Region Subtotal 138,875 162,773 23,898 17.2 Urban Carson City 32,349 34,261 1,912 5.9 Clark County 877,096 1,250,003 372,907 42.5 Washoe County 219,209 273,032 53,823 24.6 Region Subtotal 1,128,654 1,557,296 428,642 38.0 Nevada – Total 1,267,529 1,720,069 452,540 35.7

Source: Nevada State Demographer’s Office (2014d).

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Nevada Rural and Frontier Data Book – Seventh Edition

Table 1.18: Population Aged 18 to 64 in Nevada by County – 2014 to 2019

Population Aged 18 to 64 Change – 2014 to 2019 Region/County 2014 2019 Number Percent Rural and Frontier Churchill County 15,289 15,771 482 3.2 Douglas County 27,639 26,481 -1,158 -4.2 Elko County 35,855 37,759 1,904 5.3 Esmeralda County 529 698 169 31.9 Eureka County 1,312 1,327 15 1.1 Humboldt County 11,491 11,814 323 2.8 Lander County 4,355 4,199 -156 -3.6 Lincoln County 2,679 2,834 155 5.8 Lyon County 31,119 33,778 2,659 8.5 Mineral County 2,616 2,386 -230 -8.8 Nye County 24,332 24,474 142 0.6 Pershing County 3,290 3,331 41 1.2 Storey County 2,431 2,264 -167 -6.9 White Pine County 5,095 5,024 -71 -1.4 Region Subtotal 168,032 172,140 4,108 2.4 Urban Carson City 29,898 30,944 1,046 3.5 Clark County 1,277,188 1,309,201 32,013 2.5 Washoe County 272,309 292,181 19,872 7.3 Region Subtotal 1,579,395 1,632,326 52,931 3.4 Nevada – Total 1,747,427 1,804,466 57,039 3.3

Source: Nevada State Demographer’s Office (2014d).

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Table 1.19: Population by Selected Racial and Ethnic Categories in Nevada by County – 2014

Population Region/County Native Asian Pacific Hispanic White Black Total American Islander Origin Rural and Frontier Churchill County 19,899 481 1,302 915 2,864 25,461 Douglas County 39,784 260 1,111 1,260 5,793 48,208 Elko County 39,318 331 2,797 617 10,894 53,957 Esmeralda County 748 0 46 2 116 912 Eureka County 1,750 4 29 16 256 2,055 Humboldt County 13,057 48 754 112 3,821 17,792 Lander County 4,869 12 309 24 1,354 6,568 Lincoln County 4,320 28 89 17 325 4,779 Lyon County 42,431 495 1,550 856 7,999 53,331 Mineral County 3,035 216 695 45 496 4,487 Nye County 36,259 691 753 767 6,301 44,771 Pershing County 4,027 18 167 33 1,120 5,365 Storey County 3,686 12 54 56 222 4,030 White Pine County 7,252 52 503 119 1,129 9,055 Region Subtotal 220,435 2,648 10,159 4,839 42,690 280,771 Urban Carson City 38,618 322 1,392 1,188 10,936 52,456 Clark County 973,992 217,154 13,379 211,300 624,522 2,040,347 Washoe County 285,701 10,643 7,126 29,191 103,738 436,399 Region Subtotal 1,298,311 228,119 21,897 241,679 739,196 2,529,202 Nevada – Total 1,518,746 230,767 32,056 246,518 781,886 2,809,973

Source: Nevada State Demographer’s Office (2014c).

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Table 1.20: Percent of Population by Selected Racial and Ethnic Categories in Nevada by County – 2014

Percent of Population Region/County Native Asian Pacific Hispanic White Black American Islander Origin Rural and Frontier Churchill County 78.2 1.9 5.1 3.6 11.2 Douglas County 82.5 0.5 2.3 2.6 12.0 Elko County 72.9 0.6 5.2 1.1 20.2 Esmeralda County 82.0 0.0 5.0 0.2 12.7 Eureka County 85.2 0.2 1.4 0.8 12.5 Humboldt County 73.4 0.3 4.2 0.6 21.5 Lander County 74.1 0.2 4.7 0.4 20.6 Lincoln County 90.4 0.6 1.9 0.4 6.8 Lyon County 79.6 0.9 2.9 1.6 15.0 Mineral County 67.6 4.8 15.5 1.0 11.1 Nye County 81.0 1.5 1.7 1.7 14.1 Pershing County 75.1 0.3 3.1 0.6 20.9 Storey County 91.5 0.3 1.3 1.4 5.5 White Pine County 80.1 0.6 5.6 1.3 12.5 Region Subtotal 78.5 0.9 3.6 1.7 15.2 Urban Carson City 73.6 0.6 2.7 2.3 20.8 Clark County 47.7 10.6 0.7 10.4 30.6 Washoe County 65.5 2.4 1.6 6.7 23.8 Region Subtotal 51.3 9.0 0.9 9.6 29.2 Nevada – Total 54.0 8.2 1.1 8.8 27.8

Source: Nevada State Demographer’s Office (2014c).

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Table 1.21: Non-Hispanic and Hispanic Populations in Nevada by County – 2014

Population Region/County Non-Hispanic Hispanic Total Number Percent Number Percent Rural and Frontier Churchill County 22,597 88.8 2,864 11.2 25,461 Douglas County 42,415 88.0 5,793 12.0 48,208 Elko County 43,063 79.8 10,894 20.2 53,957 Esmeralda County 796 87.3 116 12.7 912 Eureka County 1,799 87.5 256 12.5 2,055 Humboldt County 13,971 78.5 3,821 21.5 17,792 Lander County 5,214 79.4 1,354 20.6 6,568 Lincoln County 4,454 93.2 325 6.8 4,779 Lyon County 45,332 85.0 7,999 15.0 53,331 Mineral County 3,991 88.9 496 11.1 4,487 Nye County 38,470 85.9 6,301 14.1 44,771 Pershing County 4,245 79.1 1,120 20.9 5,365 Storey County 3,808 94.5 222 5.5 4,030 White Pine County 7,926 87.5 1,129 12.5 9,055 Region Subtotal 238,081 84.8 42,690 15.2 280,771 Urban Carson City 41,520 79.2 10,936 20.8 52,456 Clark County 1,415,825 69.4 624,522 30.6 2,040,347 Washoe County 332,661 76.2 103,738 23.8 436,399 Region Subtotal 1,790,006 70.8 739,196 29.2 2,529,202 Nevada – Total 2,028,087 72.2 781,886 27.8 2,809,973

Source: Nevada State Demographer’s Office (2014c).

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Table 1.22: Hispanic Population in Nevada by County – 1990 to 2014

Hispanic Population Change – 1990 to 2014 Region/County 1990 2000 2010 2014 Number Percent Census Census Census Estimated Rural and Frontier Churchill County 1,008 2,076 3,009 2,864 1,856 184.1 Douglas County 1,652 3,057 5,103 5,793 4,141 250.7 Elko County 4,339 8,935 11,158 10,894 6,555 151.1 Esmeralda County 125 99 120 116 -9 -7.2 Eureka County 138 158 238 256 118 85.5 Humboldt County 2,335 3,040 4,038 3,821 1,486 63.6 Lander County 789 1,073 1,219 1,354 565 71.6 Lincoln County 156 221 332 325 169 108.3 Lyon County 1,511 3,784 7,674 7,999 6,488 429.4 Mineral County 546 428 436 496 -50 -9.2 Nye County 1,237 2,713 5,967 6,301 5,064 409.4 Pershing County 662 1,294 1,508 1,120 458 69.2 Storey County 96 174 228 222 126 131.3 White Pine County 852 1,008 1,326 1,129 277 32.5 Region Subtotal 15,446 28,060 42,356 42,690 27,244 176.4 Urban Carson City 3,110 7,466 11,777 10,936 7,826 251.6 Clark County 82,904 302,143 568,644 624,522 541,618 653.3 Washoe County 22,959 56,301 93,724 103,738 80,779 351.8 Region Subtotal 108,973 365,910 674,145 739,196 630,223 578.3 Nevada – Total 124,419 393,970 716,501 781,886 657,467 528.4

Source: United States Census Bureau (2014b). Nevada State Demographer’s Office (2014c).

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Table 1.23: Hispanic Population in Nevada by County – 2014 to 2019

Hispanic Population Change – 2014 to 2019 Region/County 2014 2019 Number Percent Rural and Frontier Churchill County 2,864 2,983 119 4.2 Douglas County 5,793 6,348 555 9.6 Elko County 10,894 11,222 328 3.0 Esmeralda County 116 124 8 6.9 Eureka County 256 279 23 9.0 Humboldt County 3,821 4,048 227 5.9 Lander County 1,354 1,452 98 7.2 Lincoln County 325 349 24 7.4 Lyon County 7,999 9,288 1,289 16.1 Mineral County 496 447 -49 -9.9 Nye County 6,301 7,105 804 12.8 Pershing County 1,120 1,175 55 4.9 Storey County 222 237 15 6.8 White Pine County 1,129 1,158 29 2.6 Region Subtotal 42,690 46,215 3,525 8.3 Urban Carson City 10,936 12,689 1,753 16.0 Clark County 624,522 681,525 57,003 9.1 Washoe County 103,738 123,448 19,710 19.0 Region Subtotal 739,196 817,662 78,466 10.6 Nevada – Total 781,886 863,877 81,991 10.5

Source: Nevada State Demographer’s Office (2014c).

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Nevada Rural and Frontier Data Book – Seventh Edition

Table 1.24: Veteran Population by Age in Nevada by County – 2014

Veteran Population

Region/County Percent of Percent of State Under 45 45 to 64 65 to 85 Over 85 Total Total Veteran Population Population Rural and Frontier Churchill County 767 1,575 1,442 167 3,951 1.8 15.5 Douglas County 768 1,580 2,039 253 4,639 2.1 9.6 Elko County 979 1,426 1,568 178 4,151 1.9 7.6 Esmeralda County 33 69 86 10 198 0.1 21.7 Eureka County 39 83 83 6 211 0.1 10.3 Humboldt County 287 569 585 58 1,499 0.7 8.4 Lander County 116 227 223 26 591 0.3 9.0 Lincoln County 105 236 282 28 651 0.3 12.8 Lyon County 1,171 2,507 2,853 304 6,834 3.1 12.8 Mineral County 178 356 389 48 971 0.4 21.7 Nye County 770 2,032 3,054 281 6,136 2.7 13.7 Pershing County 152 315 298 32 796 0.4 11.4 Storey County 140 270 258 24 691 0.3 17.1 White Pine County 261 416 505 73 1,255 0.6 12.2 Region Subtotal 5,764 11,661 13,664 1,487 32,575 14.6 11.5 Urban Carson City 949 2,045 2,395 329 5,719 2.6 10.4 Clark County 35,379 56,829 52,455 6,388 151,052 67.6 7.4 Washoe County 6,809 13,178 12,672 1,498 34,157 15.3 7.8 Region Subtotal 43,138 72,052 67,523 8,216 190,929 85.4 7.5 Nevada – Total 48,902 83,713 81,186 9,703 223,504 100.0 7.9

Source: United States Department of Veterans Health Administration (2014).

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Nevada Rural and Frontier Data Book – Seventh Edition

Table 1.25: Veteran Population in Nevada by County – 2014 to 2024

Veteran Population Region/County Change – 2014 to 2024 2014 2019 2024 Number Percent Rural and Frontier Churchill County 3,951 3,918 3,789 -162 -4.1 Douglas County 4,639 4,522 4,336 -303 -6.5 Elko County 4,151 4,155 4,135 -16 -0.4 Esmeralda County 198 188 174 -24 -12.0 Eureka County 211 197 181 -30 -14.3 Humboldt County 1,499 1,425 1,334 -165 -11.0 Lander County 591 559 520 -72 -12.1 Lincoln County 651 601 562 -89 -13.6 Lyon County 6,834 6,705 6,414 -420 -6.1 Mineral County 971 936 886 -86 -8.8 Nye County 6,136 6,116 5,926 -210 -3.4 Pershing County 796 750 704 -93 -11.6 Storey County 691 634 583 -108 -15.7 White Pine County 1,255 1,245 1,243 -12 -1.0 Region Subtotal 32,575 31,949 30,787 -1,789 -5.5 Urban Carson City 5,719 5,582 5,343 -376 -6.6 Clark County 151,052 141,979 133,102 -17,950 -11.9 Washoe County 34,157 31,348 28,619 -5,539 -16.2 Region Subtotal 190,929 178,910 167,064 -23,865 -12.5 Nevada – Total 223,504 210,859 197,850 -25,654 -11.5

Source: United States Department of Veterans Health Administration (2014).

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Nevada Rural and Frontier Data Book – Seventh Edition

Table 1.26: Population by Place of Birth in Nevada by County – 2012

Native-born Born in U.S. Foreign-born Population Outside of Nevada Population Total Region/County Percent of Percent of Percent of Population Number Total Number Total Number Total Population Population Population Rural and Frontier Churchill County 8,570 35.0 14,533 59.3 1,416 5.8 24,519 Douglas County 8,705 18.7 34,943 75.2 2,808 6.0 46,456 Elko County 16,078 32.9 27,915 57.2 4,819 9.9 48,812 Esmeralda County 108 11.8 654 71.4 154 16.8 916 Eureka County 677 38.3 1,053 59.6 37 2.1 1,767 Humboldt County 5,859 35.8 8,272 50.5 2,246 13.7 16,377 Lander County 2,089 36.9 3,022 53.4 552 9.7 5,663 Lincoln County 1,585 30.0 3,580 67.8 113 2.1 5,278 Lyon County 13,371 26.0 34,211 66.5 3,852 7.5 51,434 Mineral County 1,781 37.8 2,768 58.8 158 3.4 4,707 Nye County 8,733 20.1 30,988 71.5 3,649 8.4 43,370 Pershing County 2,117 31.8 3,683 55.4 848 12.8 6,648 Storey County 904 22.7 2,909 73.1 166 4.2 3,979 White Pine County 4,025 40.5 5,661 56.9 255 2.6 9,941 Region Subtotal 74,602 27.6 174,192 64.5 21,073 7.8 269,867 Urban Carson City 14,927 27.3 33,182 60.7 6,547 12.0 54,656 Clark County 440,714 23.0 1,050,061 54.7 427,735 22.3 1,918,510 Washoe County 126,865 30.5 225,787 54.2 63,589 15.3 416,241 Region Subtotal 582,506 24.4 1,309,030 54.8 497,871 20.8 2,389,407 Nevada – Total 657,108 24.7 1,483,222 55.8 518,944 19.5 2,659,274

Source: United States Census Bureau (2014a).

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Nevada Rural and Frontier Data Book – Seventh Edition

Table 1.27: Population Incarcerated in State of Nevada Correctional Facilities by County – 2014

Incarcerated Population

Region/County Percent of State Percent of County 2014 Incarcerated Population Population Rural and Frontier Churchill County 0 0.0 0.0 Douglas County 0 0.0 0.0 Elko County 307 2.4 0.6 Esmeralda County 0 0.0 0.0 Eureka County 0 0.0 0.0 Humboldt County 131 1.0 0.7 Lander County 0 0.0 0.0 Lincoln County 182 1.4 3.6 Lyon County 0 0.0 0.0 Mineral County 0 0.0 0.0 Nye County 127 1.0 3.6 Pershing County 1,613 12.7 23.1 Storey County 0 0.0 0.0 White Pine County 1,081 8.5 10.5 Region Subtotal 3,441 27.0 1.2 Urban Carson City 2,308 18.1 4.2 Clark County 6,908 54.2 0.3 Washoe County 86 0.7 0.0 Region Subtotal 9,302 73.0 0.4 Nevada – Total 12,743 100.0 0.5

Source: Nevada Department of Corrections (2014).

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Nevada Rural and Frontier Data Book – Seventh Edition

Table 1.28: Population Incarcerated in State of Nevada Correctional Facilities by County – 2006 to 2014

Incarcerated Population Region/County Number Change – 2006 to 2014 2006 2014 Number Percent Rural and Frontier Churchill County 0 0 0 0.0 Douglas County 0 0 0 0.0 Elko County 293 307 14 4.8 Esmeralda County 0 0 0 0.0 Eureka County 0 0 0 0.0 Humboldt County 140 131 -9 -6.4 Lander County 0 0 0 0.0 Lincoln County 193 182 -11 -5.7 Lyon County 156 0 -156 -100.0 Mineral County 0 0 0 0.0 Nye County 146 127 -19 -13.0 Pershing County 1,599 1,613 14 0.9 Storey County 0 0 0 0.0 White Pine County 1,220 1,081 -139 -11.4 Region Subtotal 3,747 3,441 -306 -8.2 Urban Carson City 2,934 2,308 -626 -21.3 Clark County 5,257 6,908 1,651 31.4 Washoe County 99 86 -13 -13.1 Region Subtotal 8,290 9,302 1,012 12.2 Nevada – Total 12,037 12,743 706 5.9

Source: Nevada Department of Corrections (2014).

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Nevada Rural and Frontier Health Data Book Section Two: Social and Economic Profile of Rural and Frontier Nevada

Highlights and Key Findings

 From 2002 to 2012, total personal income in Nevada has grown from $69.3 billion to $105.5 billion – during the same period; total personal income in rural and frontier counties grew from $6.7 billion to $11.1 billion (Table 2.1).

 Most counties in Nevada experienced a decline in total personal income at some point during the 2006 to 2012 period – the exceptions were rural and frontier counties with strong mining sectors (Elko, Eureka, Humboldt, Lander, and Pershing Counties) (Tables 2.1 and 2.2).

 From 2002 to 2012, per capita personal income in Nevada grew from $31,878 to $38,221 – during the same decade, per capita income in rural and frontier counties grew from $28,391 to $40,676 (Table 2.3).

 In 2012, county-level per capita income in rural and frontier Nevada ranged from $25,507 in Lincoln County to $54,199 in Douglas County – the average per capita income for all rural and frontier counties ($40,676) was above the urban average of $37,956, yet below the U.S. average of $43,735 (Table 2.3).

 During the period 2002 to 2007, all Nevada counties experienced a positive change in per capita personal income – 13 of 17 Nevada counties had a rate of growth that exceeded the national average of 25.2% (Table 2.4).

 During the period 2007 to 2012, all urban counties in Nevada experienced a negative change in per capita personal income – in contrast, 12 of 14 rural and frontier counties experienced a positive change in per capita personal income and nine of 14 rural and frontier counties possessed a growth rate exceeding the national average of 9.9% (Table 2.4).

 The average per capita personal income in Nevada of $38,221 is 87.4% of the U.S. average per capita personal income of $43,735 – the average per capita personal income in rural and frontier Nevada of $40,676 is 95.7% of the U.S. average (Table 2.5).

 In 2012, county-level per capita personal income in rural and frontier areas as a percent of the Nevada average per capita personal income ranged from 66.7% in Lincoln County to 141.8% in Douglas County (Table 2.5).

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Nevada Rural and Frontier Data Book – Seventh Edition

 Nevada’s 14 rural and frontier counties had a combined total of $11.1 billion in personal income in 2012 from three principal sources: net earnings of $6.9 billion (61.7%); $2.3 billion from dividends, interest, rent, and pensions (20.3%); and $2.0 billion from transfer payments (18.0%) (Tables 2.6 and 2.7).

 Rural and frontier counties vary considerably in terms of the percent of personal income by source. For example, net earnings as a percent of total personal income ranged from 42.1% in Mineral County to 77.5% in Lander County; dividends, interest, rent, and pensions as a percent of total personal income ranged from 11.6% in Lander County to 33.1% in Douglas County; and transfer payments as a percent of total personal income ranged from 10.1% in Eureka County to 40.8% in Mineral County (Table 2.7).

 Nevada rural and frontier counties had a combined total of $2.0 billion in transfer payments from the following sources: retirement and disability insurance payments of $831.7 million; medical benefits (Medicare, Medicaid, and VA health care) of $723.2 million; income maintenance benefits of $148.3 million; unemployment benefits of $97.9 million; and other sources of $118.1 million (Table 2.8).

 In 2013, median family income in Nevada was $61,359 or 94.8% of the U.S. average of $64,719 (Tables 2.9 and 2.10).

 Median family income in 2013 among rural and frontier counties of Nevada ranged from $45,798 in Nye County to $94,648 in Eureka County (Table 2.9).

 In 2013, 7 of 14 rural and frontier counties had a median family income above the state average of $61,359 and 5 of 14 rural and frontier counties were above the U.S. average of $64,719 (Table 2.10).

 In 2013, median household income in Nevada was $51,250 or 98.1% of the U.S. average of $52,250 (Table 2.11 and 2.12).

 Median household income among rural and frontier counties in Nevada ranged from $40,496 in Mineral County to $71,354 in Elko County in 2013 (Table 2.11).

 In 2013, 8 of 14 rural and frontier counties had a median household income above the state average of $51,250 and 7 of 14 were above the U.S. average of $52,250 (Table 2.11).

 In 2013, there were 4.8 personal bankruptcy filings per 1,000 population in Nevada – 45.5% higher than the U.S. rate of 3.3 filings per 1,000 population (Table 2.13).

 Over the past eight years, personal bankruptcy filing rates have declined in every county of Nevada – statewide, the number of filings per 1,000 population has dropped from 9.4 in 2005 to 4.8 in 2013 (Table 2.13).

 From 2003 to 2008, the number of new building permits issued annually in Nevada declined by 77.8% – during the same period, the number of new building permits issued in rural and frontier counties dropped by 74.6% (Table 2.14).

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Nevada Rural and Frontier Data Book – Seventh Edition

 During the period 2008 to 2013, the number of new building permits issued annually in Nevada increased by 21.5% – the number of new building permits issued in rural and frontier counties increased by 93.9%, as compared to 18.0% in urban counties of the state (Table 2.14).

 In 2012, there were 441,374 Nevadans or 16.2% of the state’s population in poverty, including 34,119 individuals or 12.8% of the population residing in rural and frontier counties (Table 2.15).

 Between 2002 and 2012, the percent of population in poverty increased in 14 of 17 Nevada counties – in rural and frontier Nevada the poverty rate increased from 9.7% in 2002 to 12.8% in 2012 (Table 2.15).

 From the onset of the 2007 to 2012 recession, the number of Nevadans in poverty increased by 173,542 or 64.8% – during the same period, the number of rural and frontier residents in poverty increased by 7,413 or 27.8% (Table 2.16).

 In 2012, 101,584 or 21.7% of the children aged 5 to 17 years were in poverty, including 8,052 or 17.9% of children 5 to 17 years old in rural and frontier areas (Table 2.17).

 In 2012, 152,663 or 23.4% of the children aged 18 and under were in poverty, including 11,596 or 18.9% of children 18 years old and under in rural and frontier areas (Table 2.17).

 In 2012, the rate of childhood poverty in rural and frontier Nevada ranged from 9.4% in Eureka County to 29.0% in Nye County (Table 2.17).

 In 2014, 410,529 Nevadans or 14.5% of the state’s population participated in the Supplemental Nutrition Assistance Program (SNAP), including 30,469 or 10.7% of rural and frontier residents (Table 2.18).

 Between 2006 and 2014, the percent of population participating in the SNAP program increased in 16 of 17 counties in Nevada – among rural and frontier counties, SNAP participation rates currently range from 1.8% in Esmeralda County to 19.7% in Nye County (Table 2.18).

 In 2013, 233,493 students qualified for the Free and Reduced Lunch Program in Nevada (54.7% of the total student population), including 17,367 or 42.1% of the rural and frontier student population (Table 2.19).

 Among rural and frontier counties of Nevada, student participation rates in the Free and Reduced Lunch Program ranged from 20.4% of the student population in Eureka County to 64.0% in Pershing County (Table 2.19).

 In 2013, the average public expenditure on education in Nevada was $8,274 per pupil – the average expenditure per pupil in rural and frontier counties was $10,368, as compared to $8,100 in urban counties (Table 2.20).

 Among Nevada counties in 2013, average public expenditures on education ranged from $8,006 per pupil in Clark County to $31,980 per pupil in Esmeralda County (Table 2.20).

 In 2012, there were 461,323 students enrolled in K-12 schools in Nevada (public and private), including 42,313 students enrolled in schools in rural and frontier areas of the state (Table 2.21).

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Nevada Rural and Frontier Data Book – Seventh Edition

 In 2012, 441,040 students or 95.6% of the total student population were enrolled in public K-12 schools as well as 20,283 or 4.4% were enrolled in private K-12 schools in Nevada – in rural and frontier counties, 98.6% were enrolled in public K-12 schools and 1.4% were enrolled in private K-12 schools (Table 2.21).

 In 2012, students enrolled in K-12 public and private schools represented 16.8% of the state’s population – students represented a slightly higher percentage of the total population in urban counties (16.4%), as compared to rural and frontier counties (14.9%) (Table 2.22).

 In 2012, there were 441,040 students enrolled in public primary and secondary schools in Nevada, including 41,706 in rural and frontier counties of which 22,111 were students enrolled in public primary schools and 19,541 were students enrolled in public secondary schools in rural and frontier counties (Table 2.24).

 In 2013, the average high school graduation rate in Nevada was 70.7% – among Nevada’s 17 counties, the graduation rate ranged from 51.5% in Mineral County to 95.0% in Eureka County (Table 2.25).

 On average, the high school graduation rate in Nevada for females is 74.0%, as compared to 67.3% for males (Table 2.25).

 In 2013, graduation rates in Nevada varied considerably by race and ethnicity – for example, the graduate rate for whites was 77.2%, Hispanics was 64.4%, American Indians was 58.7%, Asians was 82.0%, Pacific Islanders was 74.8%, and Blacks was 56.7% (Table 2.26).

 In 2012, there were 9,708 graduating high school students in Nevada who were eligible for Millennium Scholarships, including 939 students in rural and frontier counties (Table 2.27).

 In 2012, there were 21,648 public high school graduates that enrolled in a Nevada System of Higher Education (NSHE) institution, including 2,374 graduates from public high schools in rural and frontier counties (Table 2.28).

 Between 2006 and 2012, the number of public high school graduates in Nevada increased by 5,305 – however, the percent of graduates enrolled in NSHE institutions declined from 46.7% in 2006 to 41.4% in 2012 (Table 2.28).

 Between 2009 and 2011, the percent of Nevada high school graduates enrolled in NSHE institutions increased from 49.2% to 51.6% – however, during the same time period, the percent of students who finished one year of higher education courses decreased from 72.7% to 64.3% (Table 2.29).

 In 2012, 84.4% of Nevadans aged 25 and older graduated from high school, 22.2% had a bachelor’s degree or higher, and 7.1% had a master’s degree or higher – the percentages in all three categories have increased since 2000 (Table 2.30).

 Urban and rural areas of Nevada, in 2012, have similar high school graduation rates – however, the percent of population aged 25 and over with a bachelor’s degree is lower in rural and frontier areas of the state (16.5%) when compared to urban areas (22.9%), and the percent with a master’s degree or higher is lower in rural areas (5.6%) versus urban areas (7.7%) (Table 2.30).

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 In 2014, there were 1,475,969 registered voters out of an eligible voting population of 2,090,830 (70.6%), including 155,439 registered voters in rural and frontier counties out of an eligible population of 221,230 (70.3%) (Table 2.31).

 County-level voter registration rates in Nevada range from 52.8% in Lander County to 85.3% in Douglas County (Table 2.31).

 Currently, registered Republicans outnumber registered Democrats in 15 of 17 counties in Nevada – however, there are 490,496 registered Republicans (33.2%), as compared to 597,989 registered Democrats (40.5%) in Nevada, with an additional 387,484 Nevadans registered as Independents or another party affiliation (26.3%) (Tables 2.32 and 2.33).

 There are 1,271 community organizations in Nevada or 46.2 community organizations per 100,000 population – the number of community organizations per 100,000 population ranges from 36.2 in Clark County to 112.5 in Lander County (there are no reported community organizations in Esmeralda County) (Table 2.34).

 In 2010, the percent of population participating in the U.S. Decennial Census was 71%, in Nevada, which is lower than the U.S. average of 74% – county-level participation rates ranged from 32% in Esmeralda County to 85% in Storey County (Table 2.35).

 In 2012, there were 77,833 reported property crimes and 16,743 reported violent crimes in Nevada, including 5,774 property crimes and 1,039 violent crimes reported in rural and frontier counties (Tables 2.36 and 2.37).

 In 2012, the rate of reported violent crimes per 100,000 population in Nevada was 608.8 – county-level rates ranged from 39.2 in Lincoln County to 1,169.9 in Storey County (Table 2.38).

 In 2012, the rate of reported property crimes per 100,000 population in Nevada was 2,830.1 – county-level rates ranged from 930.2 in Esmeralda County to 2,999.6 in Clark County (Table 2.38).

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Table 2.1: Personal Income in Nevada by County – 2002 to 2012

Estimated Personal Income (Thousands of Dollars) Region/County 2002 2004 2006 2008 2010 2012 Rural and Frontier Churchill County 702,759 846,984 956,527 1,025,441 1,026,028 1,156,928 Douglas County 1,804,368 2,234,321 2,591,346 2,618,935 2,409,370 2,547,137 Elko County 1,128,564 1,332,047 1,524,001 1,749,143 1,879,851 2,161,367 Esmeralda County 25,915 32,535 32,556 34,798 29,811 34,256 Eureka County 40,788 44,630 50,053 65,408 66,379 80,648 Humboldt County 371,595 446,944 528,879 598,555 669,220 778,926 Lander County 135,173 154,247 182,864 208,335 241,716 285,162 Lincoln County 90,151 104,749 108,868 123,990 123,264 137,867 Lyon County 910,532 1,116,702 1,364,817 1,523,946 1,460,946 1,558,685 Mineral County 120,762 139,799 139,491 163,837 166,085 162,693 Nye County 901,666 1,137,979 1,378,163 1,495,953 1,406,744 1,451,002 Pershing County 107,145 128,685 140,815 160,614 162,544 186,966 Storey County 103,693 125,320 152,689 153,536 137,366 136,370 White Pine County 245,347 292,248 339,019 376,448 375,811 420,189 Region Subtotal 6,688,458 8,137,190 9,151,069 9,922,491 10,155,135 11,098,196 Urban Carson City 1,804,159 2,123,191 2,321,964 2,364,850 2,233,741 2,316,159 Clark County 47,186,254 57,281,141 70,236,952 74,088,664 69,407,336 73,379,049 Washoe County 13,616,710 16,206,088 18,514,793 19,222,621 17,409,987 18,656,484 Region Subtotal 62,607,123 75,610,420 91,073,709 95,676,135 89,051,064 94,351,692 Nevada – Total 69,295,581 83,747,610 100,563,797 105,975,074 99,206,199 105,449,888

Source: Bureau of Economic Analysis (2014a).

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Nevada Rural and Frontier Data Book – Seventh Edition

Table 2.2: Annual Percentage Change in Personal Income in Nevada by County – 2002 to 2012

Annual Percentage Change in Personal Income Region/County 2002 2004 2006 2008 2010 2012 Rural and Frontier Churchill County 6.0 9.7 4.5 4.6 4.6 7.4 Douglas County 1.4 14.4 6.3 -3.7 0.3 2.5 Elko County -0.7 11.1 8.8 3.4 7.7 5.0 Esmeralda County 0.2 13.6 -0.6 11.6 -5.8 2.3 Eureka County -8.2 7.4 8.4 17.4 6.8 1.0 Humboldt County -1.9 12.2 8.8 8.3 9.4 4.8 Lander County -4.4 8.6 5.6 11.5 9.8 8.1 Lincoln County 2.9 8.9 2.6 9.7 1.5 3.5 Lyon County 1.0 11.4 7.2 3.2 -1.3 2.2 Mineral County 1.5 7.7 -2.6 9.2 2.0 -2.8 Nye County 3.3 13.1 6.7 1.4 -0.8 2.2 Pershing County -2.0 11.3 3.3 4.6 4.9 3.8 Storey County 0.3 10.0 7.5 -0.8 -3.9 -0.2 White Pine County 1.0 14.0 5.8 4.2 3.6 5.3 Region Average 1.2 12.2 6.6 2.0 2.7 3.7 Urban Carson City 1.2 7.7 3.1 -2.4 0.2 2.9 Clark County 5.0 12.1 8.0 0.5 -0.1 3.9 Washoe County 2.2 10.8 4.6 -4.1 0.7 3.0 Region Average 4.2 11.7 7.2 -0.5 0.1 3.7 Nevada – Average 3.9 11.8 7.1 0.3 0.3 3.7 U.S. – Average 1.8 6.0 7.3 3.7 2.9 4.2

Source: Bureau of Economic Analysis (2014a).

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Table 2.3: Per Capita Personal Income in Nevada by County – 2002 to 2012

Per Capita Personal Income (Dollars) Region/County 2002 2004 2006 2008 2010 2012 Rural and Frontier Churchill County 29,094 34,962 38,504 40,937 41,382 47,464 Douglas County 41,541 48,166 55,306 55,404 51,228 54,199 Elko County 25,549 30,391 33,053 36,720 38,422 42,201 Esmeralda County 27,986 37,014 36,870 42,437 38,367 44,201 Eureka County 25,039 30,361 31,699 36,787 33,289 40,304 Humboldt County 25,149 29,972 34,298 37,508 40,305 45,690 Lander County 26,095 30,328 34,457 37,735 41,762 47,999 Lincoln County 20,995 23,801 23,021 24,283 22,929 25,507 Lyon County 24,234 26,254 27,391 29,219 28,039 30,368 Mineral County 25,607 28,577 28,678 34,268 34,819 34,965 Nye County 26,186 30,519 32,404 33,718 32,057 33,773 Pershing County 16,146 19,698 21,166 24,098 24,059 27,703 Storey County 31,120 35,491 39,021 37,457 34,376 34,656 White Pine County 28,224 33,561 35,645 38,681 37,465 41,843 Region Average 28,391 33,224 36,037 38,021 37,264 40,676 Urban Carson City 33,102 37,918 41,905 42,570 40,409 42,236 Clark County 30,983 34,449 38,939 38,742 35,531 36,676 Washoe County 37,576 42,338 46,235 46,343 41,234 43,396 Region Average 32,185 35,978 40,302 40,150 36,629 37,956 Nevada – Average 31,878 35,695 39,864 39,936 36,692 38,221 U.S. – Average 31,798 34,300 38,127 40,873 40,163 43,735

Source: Bureau of Economic Analysis (2014a).

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Table 2.4: Change in Per Capita Personal Income in Nevada by County – 2002 to 2012

Change in Per Capita Personal Income (Dollars)

Region/County Change – 2002 to 2007 Change – 2007 to 2012 Number Percent Number Percent Rural and Frontier Churchill County 10,193 35.0 8,177 20.8 Douglas County 16,116 38.8 -3,458 -6.0 Elko County 10,109 39.6 6,543 18.3 Esmeralda County 9,624 34.4 6,591 17.5 Eureka County 8,069 32.2 7,196 21.7 Humboldt County 10,153 40.4 10,388 29.4 Lander County 8,246 31.6 13,658 39.8 Lincoln County 2,274 10.8 2,238 9.6 Lyon County 4,303 17.8 1,831 6.4 Mineral County 5,153 20.1 4,205 13.7 Nye County 7,134 27.2 453 1.4 Pershing County 6,727 41.7 4,830 21.1 Storey County 7,564 24.3 -4,028 -10.4 White Pine County 9,292 32.9 4,327 11.5 Region Average 9,110 32.1 3,175 8.5 Urban Carson City 10,734 32.4 -1,600 -3.6 Clark County 8,481 27.4 -2,788 -7.1 Washoe County 11,455 30.5 -5,635 -11.5 Region Average 9,055 28.1 -3,284 -8.0 Nevada – Average 8,981 28.2 -2,638 -6.5 U.S. – Average 8,006 25.2 3,931 9.9

Source: Bureau of Economic Analysis (2014a).

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Table 2.5: Per Capita Personal Income as a Percent of Nevada and U.S. Per Capita Income in Nevada by County – 2012 Per Capita Personal Income as a Per Capita Percent of Region/County Personal Income Nevada U.S. Average Average Rural and Frontier Churchill County 47,464 124.2 108.5 Douglas County 54,199 141.8 123.9 Elko County 42,201 110.4 96.5 Esmeralda County 44,201 115.6 101.1 Eureka County 40,304 105.4 92.2 Humboldt County 45,690 119.5 104.5 Lander County 47,999 125.6 109.8 Lincoln County 25,507 66.7 58.3 Lyon County 30,368 79.5 69.4 Mineral County 34,965 91.5 80.0 Nye County 33,773 88.4 77.2 Pershing County 27,703 72.5 63.3 Storey County 34,656 90.7 79.2 White Pine County 41,843 113.5 99.2 Region Average 40,676 109.5 95.7 Urban Carson City 42,236 110.5 96.6 Clark County 36,676 96.0 83.9 Washoe County 43,396 113.5 99.2 Region Average 37,956 99.3 86.8 Nevada – Average 38,221 100.0 87.4 U.S. – Average 43,735 114.4 100.0

Source: Bureau of Economic Analysis (2014a).

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Table 2.6: Sources and Amounts of Personal Income in Nevada by County – 2012

Personal Income (Thousands of Dollars) Region/County Net Earnings Dividends, (Wages and Interest, Rent, Transfer Payments Total Benefits) Pensions Rural and Frontier Churchill County 762,368 194,539 200,021 1,156,928 Douglas County 1,345,002 841,840 360,295 2,547,137 Elko County 1,670,822 269,320 221,225 2,161,367 Esmeralda County 19,051 7,452 7,753 34,256 Eureka County 61,392 11,074 8,182 80,648 Humboldt County 580,279 110,076 88,571 778,926 Lander County 221,057 33,173 30,932 285,162 Lincoln County 69,404 33,556 34,907 137,867 Lyon County 874,158 303,540 380,987 1,558,685 Mineral County 81,108 33,056 78,529 162,693 Nye County 693,312 302,770 454,920 1,451,002 Pershing County 121,356 27,870 37,740 186,966 Storey County 80,698 28,020 27,652 136,370 White Pine County 281,712 64,963 73,514 420,189 Region Subtotal 6,861,719 2,261,249 2,005,228 11,098,196 Urban Carson City 1,324,494 553,284 438,381 2,316,159 Clark County 47,499,813 13,912,662 11,966,574 73,379,049 Washoe County 10,806,414 5,191,638 2,658,432 18,656,484 Region Subtotal 59,630,721 19,657,584 15,063,387 94,351,692 Nevada – Total 66,492,440 21,918,833 17,068,615 105,449,888

Source: Bureau of Economic Analysis (2014b).

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Table 2.7: Sources and Percent of Personal Income in Nevada by County – 2012

Percent of Personal Income by Source

Region/County Net Earnings Dividends, Transfer (Wages and Interest, Rent, Payments Benefits) Pensions Rural and Frontier Churchill County 65.9 16.8 17.3 Douglas County 52.8 33.1 14.1 Elko County 77.3 12.5 10.2 Esmeralda County 55.6 21.8 22.6 Eureka County 76.1 13.7 10.1 Humboldt County 74.5 14.1 11.4 Lander County 77.5 11.6 10.8 Lincoln County 50.3 24.3 25.3 Lyon County 56.1 19.5 24.4 Mineral County 42.1 17.2 40.8 Nye County 47.8 20.9 31.4 Pershing County 64.9 14.9 20.2 Storey County 59.2 20.5 20.3 White Pine County 67.0 15.5 17.5 Region Subtotal 61.7 20.3 18.0 Urban Carson City 57.2 23.9 18.9 Clark County 64.7 19.0 16.3 Washoe County 57.9 27.8 14.2 Region Subtotal 63.2 20.8 16.0 Nevada – Total 63.0 20.8 16.2

Source: Bureau of Economic Analysis (2014b).

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Table 2.8: Income from Transfer Payments by Type of Transfer Payment in Nevada by County – 2012

Income by Type of Transfer Payment (Thousands of Dollars) Region/County Retirement, Income Disability Medical Unemployment Maintenance Other Insurance Benefits Benefits Benefits Benefits Rural and Frontier Churchill County 66,918 83,295 17,348 9,083 18,363 Douglas County 180,546 117,936 17,767 18,383 15,896 Elko County 80,383 81,575 21,321 12,935 14,468 Esmeralda County 3,217 3,258 334 223 550 Eureka County 3,931 2,542 441 473 361 Humboldt County 33,535 33,987 8,720 4,380 4,425 Lander County 12,018 12,485 2,417 1,727 1,047 Lincoln County 13,447 14,938 2,107 1,682 1,609 Lyon County 169,942 123,350 30,414 23,372 23,264 Mineral County 15,783 22,840 3,752 1,941 3,251 Nye County 200,136 166,425 34,753 16,929 27,788 Pershing County 13,109 16,808 2,901 2,016 1,847 Storey County 14,189 7,622 1,405 1,694 1,884 White Pine County 24,526 36,112 4,609 3,046 3,386 Region Subtotal 831,680 723,173 148,289 97,884 118,139 Urban Carson City 156,267 184,191 37,213 22,244 27,616 Clark County 4,104,777 4,511,278 1,394,834 787,391 755,104 Washoe County 1,034,930 948,817 239,222 170,873 175,902 Region Subtotal 5,295,974 5,644,286 1,671,269 980,508 958,622 Nevada – Total 6,127,654 6,367,459 1,819,558 1,078,392 1,076,875

Source: Bureau of Economic Analysis (2014a).

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Table 2.9: Median Family Income in Nevada by County – 2009 to 2013 American Community Survey (ACS) Estimates

Median Family Income (Dollars) Region/County 2009 2010 2011 2012 2013 Rural and Frontier Churchill County 62,947 63,599 65,070 63,295 60,951 Douglas County 72,233 73,543 71,240 70,130 67,597 Elko County 72,981 75,171 75,617 75,349 75,231 Esmeralda County 54,063 57,292 58,281 54,688 51,500 Eureka County 68,500 75,179 68,542 66,597 94,648 Humboldt County 68,819 69,032 70,236 71,792 74,433 Lander County 58,971 67,157 70,772 69,634 75,857 Lincoln County 55,714 56,167 51,121 50,307 48,816 Lyon County 55,570 56,106 54,564 52,561 52,918 Mineral County 48,375 57,064 51,193 58,542 61,226 Nye County 50,646 50,218 44,997 44,544 45,798 Pershing County 56,387 61,410 63,622 57,668 56,250 Storey County 62,363 65,121 65,691 69,375 64,173 White Pine County 51,021 62,946 63,188 57,240 63,982 Urban Carson City 65,035 65,389 64,844 65,299 63,883 Clark County 63,510 63,888 64,074 62,370 60,666 Washoe County 67,177 67,428 66,509 65,047 64,556 Nevada – Average 63,912 64,418 64,353 62,789 61,359 U.S. – Average 62,363 62,982 64,293 64,585 64,719

Source: United States Census Bureau (2014a).

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Table 2.10: Median Family Income in Nevada by County – 2013 American Community Survey (ACS) Estimates

Median Family Income Median Family Income (Dollars) as a Percent of – Region/County 90% Confidence Nevada U.S. 2013 Interval Average Average Rural and Frontier Churchill County 60,951 54,411 – 67,411 99.3 94.2 Douglas County 67,597 63,849 – 71,345 110.2 104.4 Elko County 75,231 72,096 – 78,366 122.6 116.2 Esmeralda County 51,500 31,050 – 71,950 83.9 79.6 Eureka County 94,648 77,486 – 111,810 154.3 146.2 Humboldt County 74,433 67,706 – 81,160 121.3 115.0 Lander County 75,857 67,113 – 84,601 123.6 117.2 Lincoln County 48,816 42,563 – 55,069 79.6 75.4 Lyon County 52,918 49,872 – 55,964 86.2 81.8 Mineral County 61,226 52,736 – 69,716 99.8 94.6 Nye County 45,798 42,251 – 49,345 74.6 70.8 Pershing County 56,250 45,559 – 66,941 91.7 86.9 Storey County 64,173 56,408 – 71,938 104.6 99.2 White Pine County 63,982 53,545 – 74,419 104.3 98.9 Urban Carson City 63,883 60,722 – 67,044 104.1 98.7 Clark County 60,666 60,132 – 61,200 98.9 93.7 Washoe County 64,556 63,282 – 65,830 105.2 99.7 Nevada – Average 61,359 60,870 – 61,848 100.0 94.8 U.S. – Average 64,719 64,537 – 64,901 105.5 100.0

Source: United States Census Bureau (2014a).

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Table 2.11: Median Household Income in Nevada by County – 2009 to 2013 Small Area Income and Poverty Estimate (SAIPE)

Median Household Income (Dollars) Region/County 2009 2010 2011 2012 2013 Rural and Frontier Churchill County 52,055 48,235 50,620 49,463 50,158 Douglas County 60,578 57,176 54,640 60,869 56,613 Elko County 62,091 66,210 62,937 68,759 71,354 Esmeralda County 42,526 40,929 40,536 40,517 41,075 Eureka County 56,815 58,391 58,985 62,864 66,592 Humboldt County 57,309 59,960 61,680 63,772 66,290 Lander County 62,329 70,176 64,392 67,424 69,658 Lincoln County 44,387 42,637 42,724 43,617 44,366 Lyon County 51,151 47,108 44,877 48,035 46,526 Mineral County 36,017 39,940 39,705 40,308 40,496 Nye County 43,215 41,054 41,150 41,426 42,998 Pershing County 45,644 44,684 46,683 45,192 51,548 Storey County 54,246 57,763 54,582 53,471 59,785 White Pine County 48,063 49,376 52,014 50,417 52,588 Urban Carson City 52,548 49,386 50,689 48,227 47,476 Clark County 53,512 51,427 48,343 49,583 51,071 Washoe County 53,036 50,839 50,910 49,449 53,565 Nevada – Average 53,310 50,987 49,099 49,909 51,250 U.S. – Average 50,221 50,046 50,502 51,371 52,250

Source: United States Census Bureau (2014e).

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Table 2.12: Median Household Income in Nevada by County – 2013 Small Area Income and Poverty Estimate (SAIPE)

Median Household Income Median Household Income as a (Dollars) Percent of – Region/County 90% Confidence Nevada United States 2013 Interval Average Average Rural and Frontier Churchill County 50,158 45,415 – 54,901 97.9 96.0 Douglas County 56,613 52,968 – 60,258 110.5 108.4 Elko County 71,354 67,364 – 75,344 139.2 136.6 Esmeralda County 41,075 36,970 – 45,180 80.1 78.6 Eureka County 66,592 59,841 – 73,343 129.9 127.4 Humboldt County 66,290 60,060 – 72,520 129.3 126.9 Lander County 69,658 62,626 – 76,690 135.9 133.3 Lincoln County 44,366 39,914 – 48,690 86.6 84.9 Lyon County 46,526 43,605 – 49,447 90.8 89.0 Mineral County 40,496 36,446 – 44,546 79.0 77.5 Nye County 42,998 39,424 – 46,572 83.9 82.3 Pershing County 51,548 46,492 – 56,604 100.6 98.7 Storey County 59,785 55,255 – 64,615 116.7 114.4 White Pine County 52,588 47,610 – 57,566 102.6 100.6 Urban Carson City 47,476 44,214 – 50,738 92.6 90.9 Clark County 51,071 50,321 – 51,821 97.7 97.7 Washoe County 53,565 50,928 – 56,202 104.5 102.5 Nevada – Average 51,250 50,676 – 51,824 100.0 98.1 U.S. – Average 52,250 52,185 – 52,315 102.0 100.0

Source: United States Census Bureau (2014e).

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Table 2.13: Personal Bankruptcy Filing Rates in Nevada by County – 2005 to 2013

Personal Bankruptcy Filings per 1,000 Population Region/County Change in Bankruptcy Rate 2005 2009 2013 2005 to 2009 2009 to 2013 Rural and Frontier Churchill County 6.5 4.2 2.2 -2.3 -2.0 Douglas County 6.5 5.6 2.8 -0.9 -2.8 Elko County 6.2 2.5 1.8 -3.7 -0.7 Esmeralda County 8.0 3.7 N/A -4.3 N/A Eureka County 3.4 2.1 2.4 -1.3 0.3 Humboldt County 5.2 2.8 1.3 -2.4 -1.5 Lander County 5.8 2.5 1.3 -3.3 -1.2 Lincoln County 3.6 1.9 1.5 -1.7 -0.4 Lyon County 7.9 8.3 4.4 0.4 -3.9 Mineral County 6.5 2.7 2.4 -3.8 -0.3 Nye County 9.0 8.9 4.0 -0.1 -4.9 Pershing County 4.4 3.1 1.2 -1.3 -1.9 Storey County 6.5 5.9 2.5 -0.6 -3.4 White Pine County 3.9 3.7 2.0 -0.2 -1.7 Urban Carson City 8.6 6.8 4.0 -1.8 -2.8 Clark County 10.4 12.7 5.5 2.3 -7.2 Washoe County 7.7 7.9 3.9 0.2 -4.0 Nevada – Average 9.4 10.7 4.8 1.3 -5.9 U.S. – Average 6.8 4.6 3.3 -2.2 -1.3

Source: Federal Deposit Insurance Corporation (2014).

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Table 2.14: New Building Permits Issued in Nevada by County – 2003 to 2013

New Building Permits Issued Region/County Percent Change 2003 2008 2013 2003 to 2008 2008 to 2013 Rural and Frontier Churchill County 121 62 10 -48.8 -83.9 Douglas County 552 49 113 -91.1 130.6 Elko County 96 77 291 -19.8 277.9 Esmeralda County N/A N/A N/A N/A N/A Eureka County N/A N/A N/A N/A N/A Humboldt County 26 41 79 57.7 92.7 Lander County 4 4 34 0.0 750.0 Lincoln County 14 14 13 0.0 -7.1 Lyon County 476 80 105 -83.2 31.3 Mineral County 8 4 0 -50.0 -100.0 Nye County N/A N/A N/A N/A N/A Pershing County 1 2 5 100.0 150.0 Storey County 36 6 9 -83.3 50.0 White Pine County 12 3 4 -75.0 33.3 Region Subtotal 1,346 342 663 -74.6 93.9 Urban Carson City 199 16 38 -92.0 137.5 Clark County 28,277 6,202 7,232 -78.1 16.6 Washoe County 4,289 1,008 1,259 -76.5 24.9 Region Subtotal 32,765 7,226 8,529 -77.9 18.0 Nevada – Total 34,111 7,568 9,192 -77.8 21.5

Source: United States Census Bureau (2014f).

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Table 2.15: Population in Poverty in Nevada by County – 2002 to 2012

Population in Poverty in Nevada – 2002 to 2012

County 2002 2007 2012

Number Percent Number Percent Number Percent Rural and Frontier Churchill County 2,369 9.7 2,593 10.6 3,565 14.9 Douglas County 2,824 6.4 3,463 7.7 4,611 9.9 Elko County 3,705 8.6 4,040 8.7 4,494 8.9 Esmeralda County 115 13.6 103 15.0 109 14.1 Eureka County 141 9.4 141 9.1 171 8.6 Humboldt County 1,434 9.9 1,967 11.4 1,797 10.7 Lander County 438 8.8 533 10.5 587 9.9 Lincoln County 513 13.1 564 12.8 667 13.0 Lyon County 3,759 9.5 5,163 10.0 7,737 15.2 Mineral County 638 13.5 796 16.9 792 17.2 Nye County 4,569 12.9 5,450 12.5 7,048 16.6 Pershing County 860 17.2 774 15.6 1,036 20.5 Storey County 152 4.4 218 5.2 338 8.6 White Pine County 975 13.5 901 11.4 1,167 13.3 Region Subtotal 22,492 9.7 26,706 10.2 34,119 12.8 Urban Carson City 4,896 9.4 6,687 12.9 8,244 15.9 Clark County 164,499 10.6 193,665 10.7 324,535 16.4 Washoe County 31,951 8.7 40,774 10.2 74,476 17.6 Region Subtotal 201,346 10.2 241,126 10.6 407,255 16.6 Nevada – Total 223,838 10.1 267,832 10.6 441,374 16.2

Source: United States Census Bureau (2014e).

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Table 2.16: Change of Population in Poverty in Nevada by County – 2002 to 2012

Change of Population in Poverty in Nevada – 2002 to 2012

County Change – 2002 to 2007 Change – 2007 to 2012 Change – 2002 to 2012

Number Percent Number Percent Number Percent Rural and Frontier Churchill County 224 9.5 972 37.5 1,196 50.5 Douglas County 639 22.6 1,148 33.2 1,787 63.3 Elko County 335 9.0 454 11.2 789 21.3 Esmeralda County -12 -10.4 6 5.8 -6 -5.2 Eureka County 0 0.0 30 21.3 30 21.3 Humboldt County 533 37.2 -170 -8.6 363 25.3 Lander County 95 21.7 54 10.1 149 34.0 Lincoln County 51 9.9 103 18.3 154 30.0 Lyon County 1,404 37.4 2,574 49.9 3,978 105.8 Mineral County 158 24.8 -4 -0.5 154 24.1 Nye County 881 19.3 1,598 29.3 2,479 54.3 Pershing County -86 -10.0 262 33.9 176 20.5 Storey County 66 43.4 120 55.0 186 122.4 White Pine County -74 -7.6 266 29.5 192 19.7 Region Subtotal 4,214 18.7 7,413 27.8 11,627 51.7 Urban Carson City 1,791 36.6 1,557 23.3 3,348 68.4 Clark County 29,166 17.7 130,870 67.6 160,036 97.3 Washoe County 8,823 27.6 33,702 82.7 42,525 133.1 Region Subtotal 39,780 19.8 166,129 68.9 205,909 102.3 Nevada – Total 43,994 19.7 173,542 64.8 217,536 97.2

Source: United States Census Bureau (2014e).

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Table 2.17: School-aged Children (5 to 17) and Children (18 and Under) in Poverty in Nevada by County – 2012 Children Aged 18 and Under Children Aged 5 to 17 in Poverty in Poverty Percent of Region/County Percent of Children Number Children Aged Number Aged 18 and 5 to 17 Under Rural and Frontier Churchill County 841 20.5 1,280 22.3 Douglas County 978 14.8 1,396 16.0 Elko County 1,184 11.5 1,798 12.5 Esmeralda County 19 18.4 26 18.2 Eureka County 29 9.1 43 9.4 Humboldt County 497 15.2 729 16.0 Lander County 151 14.0 223 14.2 Lincoln County 161 17.1 236 18.5 Lyon County 1,899 21.5 2,601 22.0 Mineral County 139 23.8 212 25.7 Nye County 1,663 27.4 2,333 29.0 Pershing County 200 22.0 287 23.9 Storey County 56 12.3 79 13.7 White Pine County 235 16.5 353 17.1 Region Subtotal 8,052 17.9 11,596 18.9 Urban Carson City 1,767 21.5 2,660 23.4 Clark County 76,039 22.0 114,367 23.7 Washoe County 15,726 22.6 24,040 24.8 Region Subtotal 93,532 22.1 141,067 23.9 Nevada – Total 101,584 21.7 152,663 23.4

Source: United States Census Bureau (2014e).

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Table 2.18: Supplemental Nutrition Assistance Program (SNAP) Participation in Nevada by County – 2006 to 2014

Supplemental Nutrition Assistance Program (SNAP) Participation

Change – Percent of County 2006 2010 2014 Population in SNAP Percent of Percent of Percent of 2006 to 2010 to Number Number Number Population Population Population 2010 2014 Rural and Frontier Churchill County 1,542 5.6 3,318 13.3 3,891 15.3 7.7 1.9 Douglas County 931 1.8 2,589 5.5 2,658 5.5 3.7 0.0 Elko County 1,539 3.2 3,386 6.9 3,813 7.0 3.8 0.1 Esmeralda County 34 2.7 26 3.3 16 1.8 0.6 -1.6 Eureka County 11 0.8 44 2.2 60 2.9 1.5 0.7 Humboldt County 644 3.6 1,302 7.9 1,328 7.4 4.2 -0.5 Lander County 128 2.3 434 7.5 543 8.3 5.3 0.8 Lincoln County 148 3.7 356 6.7 410 8.1 2.9 1.4 Lyon County 1,808 3.3 5,144 9.9 6,615 12.4 6.5 2.5 Mineral County 524 11.9 708 14.8 830 18.5 2.9 3.7 Nye County 4,015 9.0 8,618 19.6 8,852 19.7 10.6 0.1 Pershing County 203 2.9 463 6.9 451 6.5 3.9 -0.4 Storey County 25 0.6 79 2.0 105 2.6 1.4 0.6 White Pine County 425 4.5 869 8.7 897 8.7 4.2 0.1 Rural Subtotal 11,977 4.3 27,336 10.0 30,469 10.7 5.7 0.7 Urban Carson City 2,600 4.5 7,562 13.7 7,854 14.3 9.2 0.7 Clark County 89,397 4.8 242,342 12.4 316,513 15.4 7.7 3.0 Washoe County 15,622 3.8 45,969 10.9 55,423 12.7 7.1 1.8 Urban Subtotal 107,619 4.6 295,873 12.2 379,790 14.9 7.6 2.7 Nevada – Total 119,596 4.6 323,209 12.0 410,529 14.5 7.4 2.5

Source: Economic Research Service (2014). Division of Welfare and Support Services (2014). Nevada State Demographer’s Office (2014a).

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Table 2.19: Students Qualifying for Free and Reduced School Lunch (FRL) in Nevada by County – 2013 Students Students Qualifying for – Qualifying for Total Student FRL as a Region/County Population Reduced Percent of Free Lunch Lunch Total Total Student Program Program Population Rural and Frontier Churchill County 3,673 1,415 321 1,736 47.3 Douglas County 6,083 1,722 314 2,036 33.5 Elko County 9,921 2,567 917 3,484 35.1 Esmeralda County 84 40 3 43 51.2 Eureka County 274 25 31 56 20.4 Humboldt County 3,477 936 358 1,294 37.2 Lander County 1,127 252 47 299 26.5 Lincoln County 831 202 113 315 37.9 Lyon County 8,200 3,047 719 3,766 45.9 Mineral County 489 178 49 227 46.4 Nye County 5,087 2,803 346 3,149 61.9 Pershing County 705 412 39 451 64.0 Storey County 62 21 9 30 48.4 White Pine County 1,214 424 57 481 39.6 Region Subtotal 41,227 14,044 3,323 17,367 42.1 Urban Carson City 7,542 2,851 570 3,920 52.0 Clark County 314,755 142,858 25,420 182,300 57.9 Washoe County 63,323 16,499 3,426 29,905 47.2 Region Subtotal 385,620 162,208 29,416 216,125 56.0

Charter Schools 19,876 1,145 1,649 5,763 29.0

Nevada – Total 426,874 176,252 32,739 233,493 54.7

Source: Nevada Department of Education (2014a).

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Table 2.20: Public Expenditures on Education in Nevada by County – 2009 to 2013

Public Expenditures on Education (Dollars per Pupil) Region/County 2009 2010 2011 2012 2013 Rural and Frontier Churchill County 9,153 8,634 8,451 10,171 10,236 Douglas County 9,506 8,795 8,990 9,369 9,689 Elko County 9,641 9,848 9,480 9,432 9,533 Esmeralda County 29,984 25,460 30,089 38,703 31,980 Eureka County 28,550 24,688 28,369 31,808 31,461 Humboldt County 9,998 8,822 9,005 9,580 9,568 Lander County 9,769 9,593 9,269 10,894 11,761 Lincoln County 13,820 11,128 12,112 11,280 14,076 Lyon County 9,092 8,813 8,097 9,312 9,914 Mineral County 13,551 12,233 15,399 13,877 14,013 Nye County 10,672 9,822 9,538 10,122 10,417 Pershing County 14,027 12,718 13,351 15,081 14,161 Storey County 14,639 13,061 13,124 16,252 15,768 White Pine County 11,420 9,887 10,081 10,903 10,745 Region Subtotal 10,110 9,523 9,401 10,102 10,368 Urban Carson City 8,812 8,927 8,989 9,780 10,587 Clark County 8,246 7,757 7,404 8,091 8,006 Washoe County 8,458 8,067 7,992 8,632 8,506 Region Subtotal 8,292 8,916 7,532 8,213 8,100 Nevada – Total 8,457 8,515 7,716 8,353 8,274

Source: Nevada Department of Education (2014b).

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Table 2.21: Enrollment in Public and Private Schools (K-12) in Nevada by County – 2012

Enrollment in Public Schools Enrollment in Private Schools County Total Number Percent Number Percent Rural and Frontier Churchill County 3,677 97.3 103 2.7 3,780 Douglas County 6,076 95.6 282 4.4 6,358 Elko County 9,811 99.7 27 0.3 9,838 Esmeralda County 67 100.0 0 0.0 67 Eureka County 251 100.0 0 0.0 251 Humboldt County 3,453 100.0 0 0.0 3,453 Lander County 1,086 100.0 0 0.0 1,086 Lincoln County 950 100.0 0 0.0 950 Lyon County 8,006 99.6 36 0.4 8,042 Mineral County 487 100.0 0 0.0 487 Nye County 5,324 97.1 159 2.9 5,483 Pershing County 697 100.0 0 0.0 697 Storey County 413 100.0 0 0.0 413 White Pine County 1,408 100.0 0 0.0 1,408 Region Subtotal 41,706 98.6 607 1.4 42,313 Urban Carson City 7,795 94.2 479 5.8 8,274 Clark County 313,406 95.3 15,604 4.7 329,010 Washoe County 64,280 94.7 3,593 5.3 67,873 Region Subtotal 385,481 95.1 19,676 4.9 405,157

Charter Schools 13,853 100.0 0 0.0 13,853

Nevada – Total 441,040 95.6 20,283 4.4 461,323

Source: Nevada Department of Education (2014c).

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Table 2.22: Students as a Percent of Total Population in Nevada by County – 2012

Enrollment in Enrollment in Total Enrollment Public Schools Private Schools Region/County Percent of Percent of Percent of Number Total Number Total Number Total Population Population Population Rural and Frontier Churchill County 3,677 14.6 103 0.4 3,780 15.0 Douglas County 6,076 12.7 282 0.6 6,358 13.2 Elko County 9,811 19.0 27 0.1 9,838 19.0 Esmeralda County 67 7.8 0 0.0 67 7.8 Eureka County 251 12.5 0 0.0 251 12.5 Humboldt County 3,453 19.9 0 0.0 3,453 19.9 Lander County 1,086 17.5 0 0.0 1,086 17.5 Lincoln County 950 18.6 0 0.0 950 18.6 Lyon County 8,006 15.3 36 0.1 8,042 15.4 Mineral County 487 10.4 0 0.0 487 10.4 Nye County 5,324 12.0 159 0.4 5,483 12.4 Pershing County 697 9.9 0 0.0 697 9.9 Storey County 413 10.1 0 0.0 413 10.1 White Pine County 1,408 14.2 0 0.0 1,408 14.2 Region Subtotal 41,706 14.7 607 0.2 42,313 14.9 Urban Carson City 7,795 14.1 479 0.9 8,274 14.9 Clark County 313,406 15.8 15,604 0.8 329,010 16.5 Washoe County 64,280 15.0 3,593 0.8 67,873 15.9 Region Subtotal 385,481 15.6 19,676 0.8 405,157 16.4

Charter Schools 13,853 0.5 N/A N/A 13,853 0.5

Nevada – Total 441,040 16.0 20,283 0.7 461,323 16.8

Source: Nevada Department of Education (2014c). United Stated Census Bureau (2014d).

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Table 2.23: Number of Schools in Nevada by County – 2012

Public Schools Private Schools Region/County Total Primary Secondary Other Subtotal Primary Secondary Other Subtotal

Rural and Frontier Churchill County 4 2 2 8 0 0 3 3 11 Douglas County 7 4 1 12 1 2 3 6 18 Elko County 15 14 10 39 0 0 1 1 40 Esmeralda County 4 0 0 4 0 0 0 0 4 Eureka County 2 1 1 4 0 0 0 0 4 Humboldt County 8 5 3 16 0 0 0 0 16 Lander County 2 2 3 7 0 0 0 0 7 Lincoln County 4 4 2 10 0 0 0 0 10 Lyon County 9 7 6 22 1 0 1 2 24 Mineral County 2 2 2 6 0 0 0 0 6 Nye County 10 12 7 29 0 1 1 2 31 Pershing County 2 2 1 5 0 0 0 0 5 Storey County 2 2 0 4 0 0 0 0 4 White Pine County 4 3 3 10 0 0 0 0 10 Region Subtotal 75 60 41 176 2 3 9 14 190 Urban Carson City 6 3 5 14 0 1 4 5 19 Clark County 218 105 53 376 52 0 38 90 466 Washoe County 62 26 21 109 22 1 16 39 148 Region Subtotal 286 134 79 499 74 2 58 134 633

Charter Schools 0 4 12 16 0 0 0 0 16

Nevada – Total 361 198 132 691 76 5 67 148 839

Source: Nevada Department of Education (2014c).

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Table 2.24: Enrollment in Public Primary and Secondary Schools in Nevada by County – 2012

Enrollment in Public Schools in Nevada County Primary Secondary Ungraded Total Schools Schools Rural and Frontier Churchill County 1,868 1,809 0 3,677 Douglas County 3,129 2,937 10 6,076 Elko County 5,317 4,478 16 9,811 Esmeralda County 55 12 0 67 Eureka County 132 119 0 251 Humboldt County 1,914 1,539 0 3,453 Lander County 570 513 3 1,086 Lincoln County 415 535 0 950 Lyon County 4,332 3,654 20 8,006 Mineral County 291 196 0 487 Nye County 2,746 2,578 0 5,324 Pershing County 370 327 0 697 Storey County 216 193 4 413 White Pine County 756 651 1 1,408 Region Subtotal 22,111 19,541 54 41,706 Urban Carson City 4,285 3,510 0 7,795 Clark County 171,147 141,704 555 313,406 Washoe County 35,031 29,184 65 64,280 Region Subtotal 210,463 174,398 620 385,481

Charter Schools 7,312 6,541 0 13,853

Nevada – Total 239,886 200,480 674 441,040

Source: Nevada Department of Education (2014c).

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Table 2.25: High School Graduation Rate by Gender in Nevada by County – 2013

High School Graduation Rate Number of Region/County Graduates Male Female Total Rural and Frontier Churchill County 433 65.6 78.2 72.0 Douglas County 621 82.3 87.8 85.0 Elko County 904 67.8 72.9 70.5 Esmeralda County N/A N/A N/A N/A Eureka County 27 100.0 – 95.0 Humboldt County 340 62.2 71.5 67.1 Lander County 134 70.8 73.0 71.6 Lincoln County 85 80.5 71.4 76.8 Lyon County 851 74.5 82.9 78.6 Mineral County 56 – 68.8 51.5 Nye County 638 64.7 77.1 70.2 Pershing County 68 72.0 88.5 80.4 Storey County 55 86.7 80.9 89.9 White Pine County 166 77.8 77.4 77.6 Urban Carson City 757 70.7 80.9 75.9 Clark County 28,059 68.0 75.0 71.5 Washoe County 5,520 70.0 75.2 72.6

Charter Schools 2,973 41.3 50.5 46.3

Nevada – Average 42,612 67.3 74.0 70.7

Source: Nevada Department of Education (2014d).

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Table 2.26: High School Graduation Rate by Race and Ethnicity in Nevada by County – 2013

High School Graduation Rate by Race and Ethnicity Region/County Black / Two or American Pacific White Hispanic Asian African More Total Indian Islander American Races Rural and Frontier Churchill County 74.5 67.4 – 63.2 – – – 72.0 Douglas County 89.0 73.1 – – – – – 85.0 Elko County 74.7 64.6 54.2 83.3 – – – 70.5 Esmeralda County N/A N/A N/A N/A N/A N/A N/A N/A Eureka County 92.3 – – – – – – 95.0 Humboldt County 71.8 61.5 – – – – – 67.1 Lander County 69.1 78.3 – – – – – 71.6 Lincoln County 75.8 – – – – – – 76.8 Lyon County 80.3 77.0 71.4 – – – 76.9 78.6 Mineral County 51.9 – – – – – – 51.5 Nye County 75.0 53.4 – – – 68.8 – 70.2 Pershing County 77.4 86.7 – – – – – 80.4 Storey County 88.5 – – – – – – 89.9 White Pine County 82.4 – – – – – – 77.6 Urban Carson City 81.6 64.9 – – – – – 75.9 Clark County 79.6 65.8 57.8 82.8 76.6 57.9 82.5 71.5 Washoe County 79.4 61.8 60.2 84.4 71.4 53.8 75.3 72.6

Charter Schools 50.2 40.1 – 52.0 – 32.6 80.1 46.3

Nevada – Average 77.2 64.4 58.7 82.0 74.8 56.7 89.7 70.7

Source: Nevada Department of Education (2014d).

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Table 2.27: Students Eligible for Millennium Scholarships in Nevada by County – 2004 to 2012

Students Eligible for Millennium Scholarships Region/County Change – 2004 to 2012 2004 2008 2012 Number Percent Rural and Frontier Churchill County 131 111 105 -26 -19.8 Douglas County 236 189 167 -69 -29.2 Elko County 259 191 185 -74 -28.6 Esmeralda County N/A N/A N/A N/A N/A Eureka County 10 5 12 2 20.0 Humboldt County 97 76 61 -36 -37.1 Lander County 48 31 27 -21 -43.8 Lincoln County 40 40 27 -13 -32.5 Lyon County 203 162 181 -22 -10.8 Mineral County 9 9 5 -4 -44.4 Nye County 111 81 111 0 0.0 Pershing County 29 28 22 -7 -24.1 Storey County 12 15 15 3 25.0 White Pine County 46 35 21 -25 -54.3 Region Subtotal 1,231 973 939 -292 -23.7 Urban Carson City 247 174 157 -90 -36.4 Clark County 5,777 6,002 6,897 1,120 19.4 Washoe County 1,766 1,578 1,715 -51 -2.9 Region Subtotal 7,790 7,754 8,769 979 12.6 Nevada – Total 9,021 8,727 9,708 687 7.6

Source: Legislative Counsel Bureau (2014).

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Table 2.28: Public High School Graduates Enrolled in Nevada System of Higher Education (NSHE) Institutions in Nevada by County – 2006 to 2012

Public High School Graduates

Region/County 2006 2009 2012 Percent Percent Percent Number of Number of Number of Enrolled in Enrolled in Enrolled in HS Grads HS Grads HS Grads NSHE NSHE NSHE Rural and Frontier Churchill County 259 38.6 252 37.3 233 30.0 Douglas County 414 56.8 436 53.7 364 48.4 Elko County 491 41.8 599 42.2 514 39.3 Esmeralda County N/A N/A N/A N/A N/A N/A Eureka County 16 81.3 16 62.5 11 72.7 Humboldt County 180 28.9 188 31.4 160 38.8 Lander County 71 39.4 103 26.1 76 26.3 Lincoln County 60 25.0 45 17.8 45 4.4 Lyon County 372 42.2 464 57.3 519 41.2 Mineral County 23 34.8 26 53.8 23 60.9 Nye County 244 29.9 315 27.0 278 44.2 Pershing County 46 32.6 48 47.9 44 31.8 Storey County 29 58.6 29 62.1 22 50.0 White Pine County 90 21.1 79 39.2 85 36.5 Region Subtotal 2,295 46.3 2,600 43.3 2,374 39.9 Urban Carson City 431 60.6 466 62.7 448 48.7 Clark County 10,915 44.1 13,624 40.6 15,524 38.7 Washoe County 2,702 60.2 2,985 59.0 3,146 52.2 Region Subtotal 14,048 47.7 17,075 44.5 19,118 41.2

Charter Schools 24 66.7 199 45.2 156 47.4

Nevada – Total 16,343 46.7 19,874 44.3 21,648 41.1

Source: Nevada System of Higher Education (2014).

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Table 2.29: First-year Persistence in Nevada System of Higher Education (NSHE) Institutions in Nevada by County – 2009 to 2011

2009 2011

Region/County Number Percent Number Percent Percent Percent of High Finished of High Finished Enrolled Enrolled School First Year School First Year in NSHE in NSHE Graduates Courses Graduates Courses Rural and Frontier Churchill County – – – 240 36.7 65.9 Douglas County 449 54.8 74.0 437 51.9 74.4 Elko County 359 44.8 64.0 519 45.3 46.4 Esmeralda County N/A N/A N/A N/A N/A N/A Eureka County 22 63.6 57.1 15 80.0 75.0 Humboldt County – – – 163 46.6 56.6 Lander County N/A N/A N/A 81 29.6 62.5 Lincoln County 42 14.3 33.3 49 22.4 9.1 Lyon County 805 30.9 59.4 473 39.1 64.9 Mineral County 28 35.7 70.0 32 37.5 50.0 Nye County 310 33.2 68.0 334 37.4 59.2 Pershing County 63 50.8 71.9 37 35.1 69.2 Storey County 135 18.5 48.8 150 23.3 40.0 White Pine County 18 22.2 75.4 91 40.7 45.9 Urban Carson City 462 59.3 71.9 424 59.7 71.1 Clark County 13,521 48.5 73.3 14,603 50.8 63.0 Washoe County 3,105 61.2 75.1 3,107 62.2 71.2

Charter Schools 199 45.2 37.7 612 24.7 34.2

Nevada – Total 19,605 49.2 72.7 21,015 51.6 64.3

Source: Nevada Department of Education (2014e). Nevada Department of Education (2014f).

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Table 2.30: Educational Attainment in Nevada by County – 2000 to 2012

Population Aged 25 Years and Older

2000 2012 Region/County Percent Percent Percent Percent Percent Percent with High with with with High with with Number School Bachelor’s Master’s Number School Bachelor’s Master’s Diploma Degree or Degree or Diploma Degree or Degree or or Higher Higher Higher or Higher Higher Higher Rural and Frontier Churchill County 15,167 85.1 16.7 5.2 16,399 89.3 16.7 6.5 Douglas County 29,279 91.6 23.2 7.3 34,587 92.6 25.5 9.0 Elko County 26,798 79.1 14.8 4.9 30,122 83.5 15.8 5.2 Esmeralda County 711 78.9 9.6 1.5 758 82.6 12.8 3.4 Eureka County 1,104 76.7 13.6 3.3 1,218 89.5 24.9 6.5 Humboldt County 9,846 78.3 14.2 3.8 10,603 81.3 14.7 3.3 Lander County 3,581 79.2 10.8 2.9 3,513 79.4 12.8 3.0 Lincoln County 2,654 83.0 15.1 5.0 3,320 86.1 16.8 5.6 Lyon County 22,863 81.5 11.3 2.7 35,157 84.3 14.7 5.3 Mineral County 3,527 77.1 10.1 3.0 3,579 86.8 7.0 1.5 Nye County 23,234 79.2 10.1 3.2 32,083 81.5 11.7 3.5 Pershing County 4,498 75.9 8.7 3.5 4,985 80.4 11.0 2.9 Storey County 2,540 86.7 18.0 5.7 3,195 90.3 18.8 8.2 White Pine County 6,184 82.0 11.8 4.8 6,918 83.3 13.1 3.3 Rural Subtotal 151,986 82.6 14.9 4.6 186,437 85.7 16.5 5.6 Urban Carson City 35,953 82.5 18.5 6.6 38,640 86.3 20.9 8.5 Clark County 900,400 79.5 17.3 5.9 1,287,447 83.7 22.1 7.2 Washoe County 221,837 83.9 23.7 7.9 278,505 86.5 26.8 9.7 Urban Subtotal 1,158,190 80.4 18.6 6.3 1,604,592 84.2 22.9 7.7 Nevada – Total 1,310,176 80.7 18.2 6.1 1,791,029 84.4 22.2 7.1

Source: United States Census Bureau (2014a).

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Table 2.31: Registered Voters in Nevada by County – 2014

Eligible Voting Registered Voters Population Region/County Aged 18 and Percent of Number Over Eligible Voters Rural and Frontier Churchill County 19,265 13,893 72.1 Douglas County 39,478 33,683 85.3 Elko County 42,125 22,397 53.2 Esmeralda County 798 556 69.7 Eureka County 1,641 940 57.3 Humboldt County 13,444 7,225 53.7 Lander County 5,136 2,713 52.8 Lincoln County 3,764 2,978 79.1 Lyon County 41,224 31,775 77.1 Mineral County 3,565 2,852 80.0 Nye County 36,353 26,707 73.5 Pershing County 4,166 2,456 59.0 Storey County 3,487 2,768 79.4 White Pine County 6,784 4,496 66.3 Region Subtotal 221,230 155,439 70.3 Urban Carson City 39,816 28,039 70.4 Clark County 1,539,440 1,027,102 66.7 Washoe County 332,935 265,389 79.7 Region Subtotal 1,912,191 1,320,530 69.1 Nevada – Total 2,090,830 1,475,969 70.6

Source: Nevada Secretary of State (2014). Nevada State Demographer’s Office (2014a).

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Table 2.32: Registered Voters by Party in Nevada by County – 2014

Registered Voters Region/County Independent Other Party Democratic Republican Non-partisan American Affiliation Rural and Frontier Churchill County 3,109 7,639 832 2,160 153 Douglas County 8,555 17,200 1,791 5,599 538 Elko County 4,543 12,336 1,206 4,024 288 Esmeralda County 122 315 48 61 10 Eureka County 115 649 53 113 10 Humboldt County 1,597 3,838 364 1,313 113 Lander County 557 1,549 133 454 20 Lincoln County 840 1,627 134 353 24 Lyon County 9,304 14,917 2,397 5,594 563 Mineral County 1,132 1,126 182 392 30 Nye County 8,277 11,672 1,845 4,565 348 Pershing County 675 1,148 122 485 26 Storey County 744 1,285 189 504 46 White Pine County 1,422 2,015 253 757 49 Region Subtotal 39,992 77,316 9,549 26,364 2,218 Urban Carson City 8,878 12,203 1,651 4,809 498 Clark County 453,497 302,647 46,520 207,826 16,612 Washoe County 95,622 98,330 13,484 51,238 6,715 Region Subtotal 557,997 413,180 61,655 263,873 23,825 Nevada – Total 597,989 490,496 71,204 290,237 26,043

Source: Nevada Secretary of State (2014).

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Table 2.33: Percent of Registered Voters by Party in Nevada by County – 2014

Percent of Registered Voters Region/County Independent Other Party Democratic Republican Non-partisan American Affiliation Rural and Frontier Churchill County 22.4 55.0 6.0 15.5 1.1 Douglas County 25.4 51.1 5.3 16.6 1.6 Elko County 20.3 55.1 5.4 18.0 1.3 Esmeralda County 21.9 56.7 8.6 11.0 1.8 Eureka County 12.2 69.0 5.6 12.0 1.1 Humboldt County 22.1 53.1 5.0 18.2 1.6 Lander County 20.5 57.1 4.9 16.7 0.7 Lincoln County 28.2 54.6 4.5 11.9 0.8 Lyon County 29.3 46.9 7.5 17.6 1.8 Mineral County 39.7 39.5 6.4 13.7 1.1 Nye County 31.0 43.7 6.9 17.1 1.3 Pershing County 27.5 46.7 5.0 19.7 1.1 Storey County 26.9 46.4 6.8 18.2 1.7 White Pine County 31.6 44.8 5.6 16.8 1.1 Region Average 25.7 49.7 6.1 17.0 1.4 Urban Carson City 31.7 43.5 5.9 17.2 1.8 Clark County 44.2 29.5 4.5 20.2 1.6 Washoe County 36.0 37.1 5.1 19.3 2.5 Region Average 42.3 31.3 4.7 20.0 1.8 Nevada – Average 40.5 33.2 4.8 19.7 1.8

Source: Nevada Secretary of State (2014).

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Table 2.34: Community Organizations in Nevada by County – 2012 Community Organizations – Religious, Civic, and Other Nonprofit Organizations Region/County Number per Number 100,000 Population Rural and Frontier Churchill County 19 75.3 Douglas County 48 100.0 Elko County 25 48.3 Esmeralda County 0 0.0 Eureka County 2 99.5 Humboldt County 10 57.5 Lander County 7 112.5 Lincoln County 3 58.8 Lyon County 21 40.2 Mineral County 2 42.7 Nye County 24 54.2 Pershing County 6 85.6 Storey County 3 73.1 White Pine County 4 40.2 Region Subtotal 174 61.4 Urban Carson City 49 88.4 Clark County 719 36.2 Washoe County 329 76.9 Region Subtotal 1,097 44.5 Nevada – Total 1,271 46.2

Source: United States Census Bureau (2014g).

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Table 2.35: United States Decennial Census Participation Rates in Nevada by County – 2000 to 2010

Census Participation Rates

Region/County Percent of Percent of Change in Population – Population – Percent 2000 2010 2000 to 2010 Rural and Frontier Churchill County 71 81 10 Douglas County 70 73 3 Elko County 69 63 -6 Esmeralda County 0 32 32 Eureka County 49 40 -9 Humboldt County 69 69 0 Lander County 56 58 2 Lincoln County 67 54 -13 Lyon County 69 80 11 Mineral County 58 55 -3 Nye County 13 57 44 Pershing County 57 59 2 Storey County 66 85 19 White Pine County 58 56 -2 Urban Carson City 81 80 -1 Clark County 71 70 -1 Washoe County 73 76 3 Nevada – Average 71 71 0 U.S. – Average 67 74 7

Source: United States Census Bureau (2014c). United States Census Bureau (2014d).

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Table 2.36: Reported Violent Crimes in Nevada by County – 2012

Number of Violent Crimes

Region/County Murder, Aggravated Non-negligent Forcible Rape Robbery Total Assault Manslaughter Rural and Frontier Churchill County 3 2 6 36 47 Douglas County 2 8 7 75 92 Elko County 7 39 10 132 188 Esmeralda County 0 1 0 1 2 Eureka County 0 2 0 4 6 Humboldt County 2 0 2 45 49 Lander County 0 9 0 31 40 Lincoln County 0 0 0 2 2 Lyon County 1 19 12 121 153 Mineral County 2 0 0 18 20 Nye County 0 11 26 229 266 Pershing County 0 3 1 75 79 Storey County 0 7 2 39 48 White Pine County 0 11 1 35 47 Region Subtotal 17 112 67 843 1,039 Urban Carson City 0 0 14 118 132 Clark County 94 739 4,424 8,647 13,904 Washoe County 12 80 402 1,174 1,668 Region Subtotal 106 819 4,840 9,939 15,704 Nevada – Total 123 931 4,907 10,782 16,743

Source: Federal Bureau of Investigation (2014).

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Table 2.37: Reported Property Crimes in Nevada by County – 2012

Number of Property Crimes Region/County Motor Vehicle Burglary Larceny/Theft Arson Total Theft Rural and Frontier Churchill County 155 410 40 1 606 Douglas County 162 670 36 36 904 Elko County 349 789 139 6 1,283 Esmeralda County 2 3 3 0 8 Eureka County 14 13 2 0 29 Humboldt County 62 111 24 2 199 Lander County 38 55 11 3 107 Lincoln County 17 49 5 0 71 Lyon County 294 662 72 9 1,037 Mineral County 35 35 6 1 77 Nye County 335 689 126 11 1,161 Pershing County 27 43 5 0 75 Storey County 23 55 8 2 88 White Pine County 65 58 4 2 129 Region Subtotal 1,578 3,642 481 73 5,774 Urban Carson City 298 731 78 4 1,111 Clark County 17,558 33,565 8,223 300 59,646 Washoe County 2,650 7,341 1,229 82 11,302 Region Subtotal 20,506 41,637 9,530 386 72,059 Nevada – Total 22,084 45,279 10,011 459 77,833

Source: Federal Bureau of Investigation (2014).

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Table 2.38: Violent Crime Rates and Property Crime Rates in Nevada by County – 2012

Violent Crimes Property Crimes

Region/County Number per Number per Number 100,000 Number 100,000 Population Population Rural and Frontier Churchill County 47 186.2 606 2,401.1 Douglas County 92 191.6 904 1,882.7 Elko County 188 363.1 1,283 2,478.2 Esmeralda County 2 232.6 8 930.2 Eureka County 6 298.4 29 1,442.1 Humboldt County 49 281.9 199 1,144.7 Lander County 40 643.0 107 1,720.0 Lincoln County 2 39.2 71 1,392.2 Lyon County 153 292.9 1,037 1,984.9 Mineral County 20 427.4 77 1,645.7 Nye County 266 600.6 1,161 2,621.2 Pershing County 79 1,126.5 75 1,069.4 Storey County 48 1,169.9 88 2,144.8 White Pine County 47 472.6 129 1,297.1 Region Subtotal 1,039 366.7 5,774 2,038.0 Urban Carson City 132 238.1 1,111 2,003.9 Clark County 13,904 699.2 59,646 2,999.6 Washoe County 1,668 390.0 11,302 2,642.5 Region Subtotal 15,704 636.6 72,059 2,921.0 Nevada – Total 16,743 608.8 77,833 2,830.1

Source: Federal Bureau of Investigation (2014).

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Highlights and Key Findings

 In 2012, there were 580,573 uninsured Nevadans under the age of 65 (24.5%), including 50,533 uninsured rural and frontier residents (22.9%) (Table 3.1).

 In 2012, 590,607 Nevadans under the age of 65 were below 138% of the federal poverty level – 237,690 or 40.2% of this group were uninsured, including 19,566 rural and frontier residents (40.9%) (Table 3.2).

 In 2012, 1.1 million Nevadans under the age of 65 were below 250% of the federal poverty level – 410,153 or 37.3% of this group were uninsured, including 34,551 rural and frontier residents (36.9%) (Table 3.3).

 In 2012, 1.6 million Nevadans under the age of 65 were below 400% of the federal poverty level – 520,190 or 31.6% of this group were uninsured, including 44,564 rural and frontier residents (30.2%) (Table 3.4).

 There were 114,866 uninsured Nevadans under the age of 19 (16.7%) in 2012, including 11,306 uninsured rural and frontier children (17.4%) (Table 3.6).

 In 2012, 229,037 Nevadans under the age of 19 were below 138% of the federal poverty level – 52,111 or 22.8% of this group were uninsured, including 4,421 rural and frontier children (24.5%) (Table 3.7).

 There were 475,714 uninsured Nevadans between the ages of 18 and 64 (27.8%) in 2012, including 40,277 uninsured rural and frontier residents (25.4%) (Table 3.8).

 In 2012, 372,112 Nevadans between the ages of 18 and 64 were below 138% of the federal poverty level – 189,937 or 51.0% of this group were uninsured, including 15,573 rural and frontier residents (50.5%) (Table 3.9).

 There were 204,428 uninsured Nevadans between the ages of 40 and 64 (22.8%) in 2012, including 19,690 uninsured rural and frontier residents (20.8%) (Table 3.10).

 In 2012, 159,924 Nevadans between the ages of 40 and 64 were below 138% of the federal poverty level – 77,585 or 48.5% of this group were uninsured, including 7,089 rural and frontier residents (48.1%) (Table 3.11).

 Currently, 573,874 Nevadans or 20.3% of the population are enrolled in Nevada Medicaid, including 47,638 rural and frontier residents (16.7%) (Table 3.12).

 Between 2004 and 2014, Nevada Medicaid enrollment has increased by 374,388 or 187.7%, including enrollment growth of 26,879 (129.5%) in rural and frontier counties (Table 3.13).

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 Between 2004 and 2014, Nevada Check Up (Nevada’s Children’s Health Insurance Program) enrollment has increased by 5,778 or 21.4% – Nevada Check Up enrollment declined in 12 of 14 rural and frontier counties over the past decade (Table 3.14).

 Currently, 215 Nevada Check Up enrollees are under the age of 1 (0.7%), 7,825 are between the ages of 1 and 6 (23.8%), 16,164 are between the ages of 7 and 13 (49.2%), and 8,185 are between the ages of 14 and 18 (24.9%) (Table 3.15).

 In 2012, there were 429,566 Nevadans eligible for Medicare benefits, including 358,347 residents aged 65 and over (83.4%) and 71,219 disabled Nevadans (16.6%) (Table 3.16).

 In 2012, there were 60,046 rural and frontier resident of Nevada eligible for Medicare benefits, including 50,463 residents aged 65 and over (84.0%) and 9,583 disabled residents (16.0%) (Table 3.16).

 In 2012, 435,196 Nevadans were enrolled in Medicare Part A (100.0% of the Medicare-eligible population), 386,998 were enrolled in Medicare Part B (88.9%), 141,389 were enrolled Medicare Part C (32.5%), and 145,496 were enrolled in Medicare Part D (33.4%) (Tables 3.17 and 3.18).

 In 2012, 58,512 Nevadans residing in rural and frontier counties were enrolled in Medicare Part A (100.0% of the Medicare-eligible population), 55,221 were enrolled in Medicare Part B (94.4%), 10,684 were enrolled Medicare Part C (18.3%), and 24,097 were enrolled in Medicare Part D (41.2%) (Tables 3.17 and 3.18).

 Between 2000 and 2012, the Medicare-eligible population in Nevada has grown by 195,625 or 81.6% – the rate of growth of this population was greater in rural and frontier areas (95.1%) than urban areas of the state (80.4%) (Table 3.19).

 In 2013, there were 102,495 Nevadans enrolled in the Veterans Health Administration – this figure represents 45.4% of all veterans in Nevada (Tables 3.20 and 3.22).

 During 2013, 65,854 veterans in Nevada used health care services delivered by the Veterans Health Administration – this figure represents 29.2% of all veterans in Nevada (Table 3.21 and 3.22).

 In 2013, there were 14,617 rural and frontier veterans enrolled in the Veterans Health Administration – this figure represents 44.8% of all veterans residing in rural and frontier counties in Nevada (Tables 3.20 and 3.22).

 During 2013, 10,100 rural and frontier veterans in Nevada who used health care services delivered by the Veterans Health Administration – this figure represents 30.9% of all veterans living in rural and frontier areas in Nevada (Tables 3.21 and 3.22).

 Over the past decade, the number of Native Americans using tribal health services in Nevada grew from 15,579 in 2003 to 19,152 – an increase of 3,573 or 22.9% (Table 3.23).

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 In 2013, 9,081 patients (47.4% of all users) received health care services from tribal facilities located in rural and frontier counties of Nevada (Table 3.23).

 In terms of self-reported health status, risk factors to health, and utilization of preventive health services, there are substantial differences between rural and urban areas of Nevada. For example, residents of rural and frontier areas of the state report higher rates of obesity and higher levels of hypertension than do residents of urban areas (Tables 3.24 to 3.26).

 New data from the Centers for Disease Control and Prevention (CDC) provide information on county-level trends in diabetes incidence, obesity prevalence, and leisure-time physical inactivity prevalence in Nevada. For example, while obesity rates are generally lower in most Nevada counties compared to the U.S. rate of 28.7% of adults who are obese, county-level obesity prevalence ranges from 21.6% in Douglas County to 31.6% in Churchill County in 2011 (Tables 3.27 to 3.29).

 The National Survey on Drug Use and Health administered by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) yields current data on a wide-range of self-reported mental health and substance abuse indicators by region in Nevada. For example, rural and frontier counties report higher levels of cigarette and tobacco product use than urban counties (Table 3.30).

 The Nevada Office of Public Health Informatics and Epidemiology collects current data on indicators of infectious disease incidence (new cases) and prevalence (total cases) by region in Nevada. For example, in 2013, the number of new cases of chlamydia per 100,000 population is considerably lower in rural and frontier counties (218.9), as compared to Washoe County (391.2) and Clark County (428.9) (Tables 3.31 to 3.36).

 The Nevada Office of Public Health Informatics and Epidemiology collects a wide-range of data on indicators of maternal and child health by county and region in Nevada. For example, over the past three years, all but one county in Nevada reported a decline in teen pregnancy rates and 12 of 16 counties reported a decline in teen birth rates (Tables 3.37 to 3.45).

 The Nevada Department of Education (NDOE) collects data on childhood disabilities by county of residence, including data on autism spectrum disorders, learning disabilities, and speech/language/hearing impairment. In 2013, there were 50,332 total cases of childhood disability in Nevada, including 5,541 cases in rural and frontier Nevada (Table 3.46).

 The Nevada Office of Public Health Informatics and Epidemiology collects a wide-range of data on mortality and leading causes of death by county and region in Nevada (Tables 3.47 to 3.56).

 In 2013, the age-adjusted mortality rate for all causes of death in Nevada was 777.4 deaths per 100,000 population – rates declined in 10 of 17 counties since 2009 and currently range from 561.4 in Storey County to 1,272.9 in Esmeralda County (Table 3.47).

 In 2013, the age-adjusted mortality rate for heart disease in Nevada was 199.2 deaths per 100,000 population – rates declined in 9 of 16 counties with available data since 2009 and currently range from 78.2 in Pershing County to 582.8 in Eureka County (Table 3.48).

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 In 2013, the age-adjusted mortality rate for malignant neoplasms (cancer) in Nevada was 166.9 deaths per 100,000 population – rates declined in 9 of 15 counties with available data since 2009 and currently range from 62.7 in Storey County to 262.8 in Mineral County (Table 3.49).

 In 2013, the ten leading causes of death in Nevada were: (1) heart disease; (2) cancer; (3) chronic lower respiratory disease; (4) lung, trachea, and bronchus cancer; (5) cerebrovascular disease (stroke); (6) non- transport (pedestrian) accidents; (7) prostate cancer; (8) breast cancer; (9) influenza and pneumonia; and (10) Alzheimer’s disease (Table 3.55).

 In 2013, the ten leading causes of death in rural and frontier Nevada were: (1) heart disease; (2) cancer; (3) chronic lower respiratory disease; (4) lung, trachea, and bronchus cancer; (5) cerebrovascular disease (stroke); (6) prostate cancer; (7) non-transport (pedestrian) accidents; (8) diabetes mellitus; (9) Alzheimer’s disease; and (10) breast cancer (Table 3.55).

 For the past five years, the University of Wisconsin and the Robert Wood Johnson Foundation have ranked all U.S. counties in terms of health determinants (health behaviors, clinical care, social and economic factors, and physical environment) and health outcomes (length of life and quality of life). Among Nevada counties, Lincoln County is currently the healthiest county in Nevada and Nye County is the least healthy (Tables 3.57 and 3.58).

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Table 3.1: Health Insurance Coverage for Population Under the Age of 65 in Nevada by County – 2012

Estimated Population Under the Aged of 65

Total Region/County Uninsured Population Insured Population Population Aged Number Percent Number Percent 65 and Under Rural and Frontier Churchill County 4,694 23.3 15,449 76.7 20,143 Douglas County 7,302 20.2 28,759 79.8 36,061 Elko County 9,672 21.1 36,119 78.9 45,791 Esmeralda County 182 31.4 399 68.6 582 Eureka County 356 20.9 1,345 79.1 1,701 Humboldt County 3,671 24.3 11,422 75.7 15,093 Lander County 1,042 20.3 4,091 79.7 5,133 Lincoln County 1,086 26.1 3,080 73.9 4,167 Lyon County 10,651 25.5 31,167 74.5 41,817 Mineral County 823 23.2 2,718 76.8 3,541 Nye County 7,854 24.7 23,910 75.3 31,764 Pershing County 1,055 25.1 3,151 74.9 4,206 Storey County 704 23.5 2,296 76.5 2,999 White Pine County 1,441 19.7 5,866 80.3 7,307 Region Subtotal 50,533 22.9 169,772 77.1 220,305 Urban Carson City 10,291 24.2 32,287 75.8 42,579 Clark County 433,402 25.0 1,301,388 75.0 1,734,790 Washoe County 86,347 23.5 281,827 76.5 368,174 Region Subtotal 530,040 24.7 1,615,502 75.3 2,145,543 Nevada – Total 580,573 24.5 1,785,274 75.5 2,365,848

Source: United States Census Bureau (2014h).

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Table 3.2: Health Insurance Coverage for Population Under the Age of 65 at or Below 138% Federal Poverty Level (FPL) in Nevada by County – 2012

Estimated Population Under the Age of 65

Region/County At or Below 138% FPL Above 138% FPL Total

Number Percent Population Number Percent Population Number Percent Population Uninsured Uninsured Subtotal Uninsured Uninsured Subtotal Uninsured Uninsured Total Rural and Frontier Churchill County 1,859 37.2 4,996 2,835 18.7 15,147 4,694 23.3 20,143 Douglas County 2,640 44.5 5,936 4,662 15.5 30,125 7,302 20.2 36,061 Elko County 3,102 42.9 7,238 6,570 17.0 38,553 9,672 21.1 45,791 Esmeralda County 77 52.4 147 105 24.1 435 182 31.4 582 Eureka County 136 43.5 313 220 15.9 1,388 356 20.9 1,701 Humboldt County 1,392 44.6 3,122 2,279 19.0 11,971 3,671 24.3 15,093 Lander County 347 41.5 837 695 16.2 4,296 1,042 20.3 5,133 Lincoln County 435 41.9 1,039 651 20.8 3,128 1,086 26.1 4,167 Lyon County 4,430 42.2 10,496 6,221 19.9 31,321 10,651 25.5 41,817 Mineral County 366 37.8 966 457 17.7 2,575 823 23.2 3,541 Nye County 3,567 36.6 9,744 4,287 19.5 22,020 7,854 24.7 31,764 Pershing County 456 43.2 1,055 599 19.0 3,151 1,055 25.1 4,206 Storey County 238 49.2 485 466 18.5 2,514 704 23.5 2,999 White Pine County 521 34.3 1,520 920 15.9 5,787 1,441 19.7 7,307 Region Subtotal 19,566 40.9 47,894 30,967 18.0 172,411 50,533 22.9 220,305 Urban Carson City 4,074 38.4 10,608 6,217 19.4 31,971 10,291 24.2 42,579 Clark County 178,152 40.3 442,455 255,250 19.8 1,292,335 433,402 25.0 1,734,790 Washoe County 35,898 40.0 89,650 50,449 18.1 278,524 86,347 23.5 368,174 Region Subtotal 218,124 40.2 542,713 311,916 19.5 1,602,830 530,040 24.7 2,145,543 Nevada – Total 237,690 40.2 590,607 342,883 19.3 1,775,241 580,573 24.5 2,365,848

Source: United States Census Bureau (2014h).

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Table 3.3: Health Insurance Coverage for Population Under the Age of 65 at or Below 250% Federal Poverty Level (FPL) in Nevada by County – 2012

Estimated Population Under the Age of 65

Region/County At or Below 250% FPL Above 250% FPL Total

Number Percent Population Number Percent Population Number Percent Population Uninsured Uninsured Subtotal Uninsured Uninsured Subtotal Uninsured Uninsured Total Rural and Frontier Churchill County 3,288 34.5 9,539 1,406 13.3 10,604 4,694 23.3 20,143 Douglas County 4,818 38.7 12,448 2,484 10.5 23,613 7,302 20.2 36,061 Elko County 5,904 38.6 15,302 3,768 12.4 30,489 9,672 21.1 45,791 Esmeralda County 134 45.7 293 48 16.6 289 182 31.4 582 Eureka County 241 36.9 652 115 11.0 1,049 356 20.9 1,701 Humboldt County 2,456 40.5 6,069 1,215 13.5 9,024 3,671 24.3 15,093 Lander County 632 35.8 1,765 410 12.2 3,368 1,042 20.3 5,133 Lincoln County 757 37.8 2,001 329 15.2 2,166 1,086 26.1 4,167 Lyon County 7,712 37.8 20,404 2,939 13.7 21,413 10,651 25.5 41,817 Mineral County 596 33.5 1,780 227 12.9 1,761 823 23.2 3,541 Nye County 5,864 34.1 17,217 1,990 13.7 14,547 7,854 24.7 31,764 Pershing County 774 38.2 2,025 281 12.9 2,181 1,055 25.1 4,206 Storey County 446 41.7 1,069 258 13.4 1,930 704 23.5 2,999 White Pine County 929 30.7 3,027 512 12.0 4,280 1,441 19.7 7,307 Region Subtotal 34,551 36.9 93,591 15,982 12.6 126,714 50,533 22.9 220,305 Urban Carson City 7,186 36.2 19,828 3,105 13.6 22,751 10,291 24.2 42,579 Clark County 307,134 37.4 821,496 126,268 13.8 913,294 433,402 25.0 1,734,790 Washoe County 61,282 37.2 164,593 25,065 12.3 203,581 86,347 23.5 368,174 Region Subtotal 375,602 37.3 1,005,917 154,438 13.6 1,139,626 530,040 24.7 2,145,543 Nevada – Total 410,153 37.3 1,099,508 170,420 13.5 1,266,340 580,573 24.5 2,365,848

Source: United States Census Bureau (2014h).

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Table 3.4: Health Insurance Coverage for Population Under the Age of 65 at or Below 400% of Federal Poverty Level (FPL) in Nevada by County – 2012

Estimated Population Under the Age of 65

Region/County At or Below 400% FPL Above 400% FPL Total

Number Percent Population Number Percent Population Number Percent Population Uninsured Uninsured Subtotal Uninsured Uninsured Subtotal Uninsured Uninsured Total Rural and Frontier Churchill County 4,139 29.1 14,220 555 9.4 5,923 4,694 23.3 20,143 Douglas County 6,288 29.8 21,099 1,014 6.8 14,962 7,302 20.2 36,061 Elko County 8,253 30.1 27,454 1,419 7.7 18,337 9,672 21.1 45,791 Esmeralda County 164 37.5 437 18 12.4 145 182 31.4 582 Eureka County 309 29.2 1,060 47 7.3 641 356 20.9 1,701 Humboldt County 3,192 33.4 9,567 479 8.7 5,526 3,671 24.3 15,093 Lander County 884 29.0 3,046 158 7.6 2,087 1,042 20.3 5,133 Lincoln County 967 31.2 3,104 119 11.2 1,063 1,086 26.1 4,167 Lyon County 9,710 31.0 31,286 941 8.9 10,531 10,651 25.5 41,817 Mineral County 736 28.2 2,614 87 9.4 927 823 23.2 3,541 Nye County 7,133 29.9 23,849 721 9.1 7,915 7,854 24.7 31,764 Pershing County 949 31.1 3,049 106 9.2 1,157 1,055 25.1 4,206 Storey County 592 32.1 1,843 112 9.7 1,156 704 23.5 2,999 White Pine County 1,248 25.6 4,871 193 7.9 2,436 1,441 19.7 7,307 Region Subtotal 44,564 30.2 147,499 5,969 8.2 72,806 50,533 22.9 220,305 Urban Carson City 9,127 30.9 29,490 1,164 8.9 13,089 10,291 24.2 42,579 Clark County 389,187 31.8 1,223,189 44,215 8.6 511,601 433,402 25.0 1,734,790 Washoe County 77,312 31.3 247,115 9,035 7.5 121,059 86,347 23.5 368,174 Region Subtotal 475,626 31.7 1,499,794 54,414 8.4 645,749 530,040 24.7 2,145,543 Nevada – Total 520,190 31.6 1,647,293 60,383 8.4 718,555 580,573 24.5 2,365,848

Source: United States Census Bureau (2014h).

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Table 3.5: Health Insurance Coverage for Population Under the Age of 65 by Gender in Nevada by County – 2012

Estimated Population Under the Age of 65

Region/County Male Female Total

Number Percent Population Number Percent Population Number Percent Population Uninsured Uninsured Subtotal Uninsured Uninsured Subtotal Uninsured Uninsured Total Rural and Frontier Churchill County 2,485 24.5 10,161 2,209 22.1 9,982 4,694 23.3 20,143 Douglas County 3,751 20.8 17,991 3,551 19.7 18,070 7,302 20.2 36,061 Elko County 5,267 22.2 23,715 4,406 20.0 22,076 9,672 21.1 45,791 Esmeralda County 104 32.3 321 79 30.2 260 182 31.4 582 Eureka County 197 21.8 905 159 20.0 796 356 20.9 1,701 Humboldt County 1,946 24.8 7,844 1,725 23.8 7,249 3,671 24.3 15,093 Lander County 553 21.1 2,619 489 19.5 2,514 1,042 20.3 5,133 Lincoln County 605 27.3 2,220 481 24.7 1,947 1,086 26.1 4,167 Lyon County 5,694 27.1 21,012 4,957 23.8 20,805 10,651 25.5 41,817 Mineral County 431 25.1 1,712 392 21.5 1,828 823 23.2 3,541 Nye County 4,158 26.2 15,901 3,696 23.3 15,864 7,854 24.7 31,764 Pershing County 572 26.1 2,189 483 24.0 2,017 1,055 25.1 4,206 Storey County 376 24.8 1,519 327 22.1 1,481 704 23.5 2,999 White Pine County 770 20.4 3,772 671 19.0 3,535 1,441 19.7 7,307 Region Subtotal 26,909 24.1 111,881 23,625 21.8 108,424 50,533 22.9 220,305 Urban Carson City 5,616 26.3 21,315 4,675 22.0 21,264 10,291 24.2 42,579 Clark County 230,121 26.3 874,700 203,281 23.6 860,089 433,402 25.0 1,734,790 Washoe County 47,695 25.5 186,847 38,652 21.3 181,327 86,347 23.5 368,174 Region Subtotal 283,432 26.2 1,082,862 246,608 23.2 1,062,680 530,040 24.7 2,145,543 Nevada – Total 310,341 26.0 1,194,743 270,233 23.1 1,171,104 580,573 24.5 2,365,848

Source: United States Census Bureau (2014h).

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Table 3.6: Health Insurance Coverage for Population Under the Age of 19 in Nevada by County – 2012

Estimated Population Under the Age of 19

Region/County Total Uninsured Insured Population Under the Number Percent Number Percent Age of 19 Rural and Frontier Churchill County 1,104 17.9 5,072 82.1 6,177 Douglas County 1,532 16.6 7,682 83.4 9,215 Elko County 2,411 15.9 12,728 84.1 15,139 Esmeralda County 40 27.5 107 72.5 147 Eureka County 89 18.4 395 81.6 484 Humboldt County 914 19.1 3,867 80.9 4,781 Lander County 266 16.1 1,385 83.9 1,651 Lincoln County 315 23.0 1,056 77.0 1,371 Lyon County 2,280 18.2 10,224 81.8 12,504 Mineral County 151 17.2 726 82.8 877 Nye County 1,479 17.2 7,146 82.8 8,625 Pershing County 268 20.9 1,013 79.1 1,281 Storey County 127 20.6 492 79.4 620 White Pine County 329 15.0 1,863 85.0 2,191 Region Subtotal 11,305 17.4 53,756 82.6 65,063 Urban Carson City 2,047 17.0 9,989 83.0 12,036 Clark County 84,122 16.5 424,582 83.5 508,704 Washoe County 17,392 17.0 85,040 83.0 102,432 Region Subtotal 103,561 16.6 519,611 83.4 623,172 Nevada – Total 114,866 16.7 573,367 83.3 688,235

Source: United States Census Bureau (2014h).

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Table 3.7: Health Insurance Coverage for Population Under the Age of 19 at or Below 138% Federal Poverty Level (FPL) in Nevada by County – 2012

Estimated Population Under the Age of 19

Region/County At or Below 138% FPL Above 138% FPL Total

Number Percent Population Number Percent Population Number Percent Population Uninsured Uninsured Subtotal Uninsured Uninsured Subtotal Uninsured Uninsured Total Rural and Frontier Churchill County 475 23.8 1,997 629 15.0 4,180 1,104 17.9 6,177 Douglas County 597 29.9 1,999 935 13.0 7,216 1,532 16.6 9,215 Elko County 721 25.1 2,873 1,690 13.8 12,266 2,411 15.9 15,139 Esmeralda County 19 36.9 51 21 21.9 96 40 27.5 147 Eureka County 33 30.5 107 56 14.9 377 89 18.4 484 Humboldt County 339 26.7 1,269 575 16.4 3,512 914 19.1 4,781 Lander County 77 22.8 338 189 14.4 1,313 266 16.1 1,651 Lincoln County 140 32.9 425 175 18.5 946 315 23.0 1,371 Lyon County 958 24.5 3,903 1,322 15.4 8,601 2,280 18.2 12,504 Mineral County 71 22.6 313 80 14.2 564 151 17.2 877 Nye County 705 19.7 3,572 774 15.3 5,053 1,479 17.2 8,625 Pershing County 122 30.0 409 146 16.7 872 268 20.9 1,281 Storey County 51 34.6 147 76 16.1 473 127 20.6 620 White Pine County 113 18.6 606 216 13.6 1,585 329 15.0 2,191 Region Subtotal 4,421 24.5 18,009 6,884 14.6 47,054 11,305 17.4 65,063 Urban Carson City 835 21.0 3,972 1,212 15.0 8,064 2,047 17.0 12,036 Clark County 38,968 22.3 174,716 45,154 13.5 333,988 84,122 16.5 508,704 Washoe County 7,887 24.4 32,340 9,505 13.6 70,092 17,392 17.0 102,432 Region Subtotal 47,690 22.6 211,028 55,871 13.6 412,144 103,561 16.6 623,172 Nevada – Total 52,111 22.8 229,037 62,755 13.6 459,198 114,866 16.7 688,235

Source: United States Census Bureau (2014h).

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Table 3.8: Health Insurance Coverage for Population Aged 18 to 64 in Nevada by County – 2012

Estimated Population Aged 18 to 64 Region/County Uninsured Insured Total Population Number Percent Number Percent Aged 18 to 64 Rural and Frontier Churchill County 3,705 25.9 10,610 74.1 14,315 Douglas County 5,913 21.6 21,419 78.4 27,332 Elko County 7,493 23.9 23,912 76.1 31,406 Esmeralda County 144 32.7 296 67.3 440 Eureka County 275 22.0 973 78.0 1,249 Humboldt County 2,822 26.8 7,703 73.2 10,526 Lander County 796 22.3 2,772 77.7 3,568 Lincoln County 801 27.7 2,090 72.3 2,891 Lyon County 8,569 28.6 21,387 71.4 29,956 Mineral County 687 25.3 2,029 74.7 2,716 Nye County 6,533 27.6 17,122 72.4 23,655 Pershing County 810 27.0 2,188 73.0 2,999 Storey County 590 24.3 1,836 75.7 2,426 White Pine County 1,139 21.8 4,091 78.2 5,230 Region Subtotal 40,277 25.4 118,428 74.6 158,709 Urban Carson City 8,428 27.1 22,726 72.9 31,155 Clark County 356,509 28.5 894,311 71.5 1,250,820 Washoe County 70,500 26.0 200,187 74.0 270,688 Region Subtotal 435,437 28.0 1,117,224 72.0 1,552,663 Nevada – Total 475,714 27.8 1,235,652 72.2 1,711,372

Source: United States Census Bureau (2014h).

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Table 3.9: Health Insurance Coverage for Population Aged 18 to 64 at or Below 138% Federal Poverty Level (FPL) in Nevada by County – 2012

Estimated Population Aged 18 to 64

Region/County At or Below 138% FPL Above 138% FPL Total

Number Percent Population Number Percent Population Number Percent Population Uninsured Uninsured Subtotal Uninsured Uninsured Subtotal Uninsured Uninsured Total Rural and Frontier Churchill County 1,438 46.1 3,123 2,267 20.3 11,192 3,705 25.9 14,315 Douglas County 2,099 51.9 4,046 3,814 16.4 23,286 5,913 21.6 27,332 Elko County 2,458 54.4 4,519 5,035 18.7 26,887 7,493 23.9 31,406 Esmeralda County 59 60.4 98 85 24.9 342 144 32.7 440 Eureka County 107 49.9 215 168 16.2 1,034 275 22.0 1,249 Humboldt County 1,075 56.5 1,902 1,747 20.3 8,624 2,822 26.8 10,526 Lander County 276 53.5 516 520 17.0 3,052 796 22.3 3,568 Lincoln County 309 47.9 645 492 21.9 2,246 801 27.7 2,891 Lyon County 3,562 52.3 6,805 5,007 21.6 23,151 8,569 28.6 29,956 Mineral County 302 45.0 671 385 18.8 2,045 687 25.3 2,716 Nye County 2,932 46.1 6,354 3,601 20.8 17,301 6,533 27.6 23,655 Pershing County 345 51.4 671 465 20.0 2,328 810 27.0 2,999 Storey County 193 55.4 349 397 19.1 2,077 590 24.3 2,426 White Pine County 418 44.2 944 721 16.8 4,286 1,139 21.8 5,230 Region Subtotal 15,573 50.5 30,858 24,704 19.3 127,851 40,277 25.4 158,709 Urban Carson City 3,318 48.5 6,835 5,110 21.0 24,320 8,428 27.1 31,155 Clark County 142,402 51.7 275,700 214,107 22.0 975,120 356,509 28.5 1,250,820 Washoe County 28,644 48.8 58,719 41,856 19.7 211,969 70,500 26.0 270,688 Region Subtotal 174,364 51.1 341,254 261,073 21.6 1,211,409 435,437 28.0 1,552,663 Nevada – Total 189,937 51.0 372,112 285,777 21.3 1,339,260 475,714 27.8 1,711,372

Source: United States Census Bureau (2014h).

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Table 3.10: Health Insurance Coverage for Population Aged 40 to 64 in Nevada by County – 2012

Estimated Population Aged 40 to 64

Total Region/County Uninsured Insured Population Aged Number Percent Number Percent 40 to 64 Rural and Frontier Churchill County 1,699 21.1 6,345 78.9 8,044 Douglas County 3,232 18.2 14,488 81.8 17,720 Elko County 3,086 18.8 13,330 81.2 16,416 Esmeralda County 79 27.3 209 72.7 288 Eureka County 134 16.8 664 83.2 797 Humboldt County 1,129 19.7 4,615 80.3 5,744 Lander County 308 15.4 1,694 84.6 2,002 Lincoln County 384 22.4 1,328 77.6 1,711 Lyon County 4,353 24.1 13,697 75.9 18,049 Mineral County 374 21.5 1,367 78.5 1,741 Nye County 3,660 23.4 11,958 76.6 15,618 Pershing County 375 20.8 1,428 79.2 1,803 Storey County 356 20.5 1,379 79.5 1,735 White Pine County 521 16.8 2,581 83.2 3,101 Region Subtotal 19,690 20.8 75,083 79.2 94,769 Urban Carson City 3,994 21.9 14,243 78.1 18,236 Clark County 150,714 23.6 488,500 76.4 639,214 Washoe County 30,030 20.9 113,980 79.1 144,010 Region Subtotal 184,738 23.1 616,723 76.9 801,460 Nevada – Total 204,428 22.8 691,806 77.2 896,229

Source: United States Census Bureau (2014h).

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Table 3.11: Health Insurance Coverage for Population Aged 40 to 64 at or Below 138% Federal Poverty Level (FPL) in Nevada by County – 2012

Estimated Population Aged 40 to 64

Region/County At or Below 138% FPL Above 138% FPL Total

Number Percent Population Number Percent Population Number Percent Population Uninsured Uninsured Subtotal Uninsured Uninsured Subtotal Uninsured Uninsured Total Rural and Frontier Churchill County 572 45.1 1,268 1,127 16.6 6,776 1,699 21.1 8,044 Douglas County 1,058 51.0 2,074 2,174 13.9 15,646 3,232 18.2 17,720 Elko County 944 52.0 1,817 2,142 14.7 14,599 3,086 18.8 16,416 Esmeralda County 30 57.5 53 49 20.9 235 79 27.3 288 Eureka County 45 45.7 98 89 12.7 699 134 16.8 797 Humboldt County 362 51.4 705 767 15.2 5,039 1,129 19.7 5,744 Lander County 92 48.6 189 216 11.9 1,813 308 15.4 2,002 Lincoln County 137 43.7 314 247 17.7 1,397 384 22.4 1,711 Lyon County 1,759 50.6 3,474 2,594 17.8 14,575 4,353 24.1 18,049 Mineral County 148 42.9 346 226 16.2 1,395 374 21.5 1,741 Nye County 1,517 43.8 3,467 2,143 17.6 12,151 3,660 23.4 15,618 Pershing County 141 46.3 304 234 15.6 1,499 375 20.8 1,803 Storey County 112 53.2 210 244 16.0 1,525 356 20.5 1,735 White Pine County 172 40.2 429 349 13.1 2,672 521 16.8 3,101 Region Subtotal 7,089 48.1 14,748 12,601 15.7 80,021 19,690 20.8 94,769 Urban Carson City 1,329 46.4 2,866 2,665 17.3 15,370 3,994 21.9 18,236 Clark County 58,330 49.1 118,831 92,384 17.8 520,383 150,714 23.6 639,214 Washoe County 10,837 46.2 23,479 19,193 15.9 120,531 30,030 20.9 144,010 Region Subtotal 70,496 48.6 145,176 114,242 17.4 656,284 184,738 23.1 801,460 Nevada – Total 77,585 48.5 159,924 126,843 17.2 736,305 204,428 22.8 896,229

Source: United States Census Bureau (2014h).

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Table 3.12: Medicaid Enrollment in Nevada by County – 2011 to 2014

Medicaid Enrollment

Region/County 2011 2012 2013 2014 Percent of Percent of Percent of Percent of Number Number Number Number Population Population Population Population Rural and Frontier Churchill County 3,627 14.4 3,617 14.3 3,680 14.5 5,319 20.9 Douglas County 3,218 6.8 3,211 6.7 3,093 6.4 4,939 10.2 Elko County 5,068 10.2 4,954 9.6 4,871 9.1 6,797 12.5 Esmeralda County 70 8.5 77 9.0 99 11.5 123 13.5 Eureka County 79 4.0 80 4.0 85 4.2 136 6.6 Humboldt County 1,965 11.5 1,914 11.0 1,672 9.6 2,644 14.8 Lander County 636 10.6 626 10.1 588 9.3 917 14.0 Lincoln County 481 9.1 474 9.3 484 9.6 688 13.6 Lyon County 7,374 14.1 7,365 14.1 7,533 14.2 11,110 20.8 Mineral County 880 19.1 908 19.4 843 18.1 1,088 24.3 Nye County 8,106 18.2 8,060 18.2 7,917 17.7 11,308 25.2 Pershing County 651 9.5 642 9.2 628 9.1 818 11.7 Storey County 65 1.6 68 1.7 73 1.8 140 3.5 White Pine County 1,272 12.7 1,269 12.8 1,201 11.9 1,611 15.7 Region Subtotal 33,492 12.1 33,265 11.9 32,767 11.6 47,638 16.7 Urban Carson City 9,272 16.5 9,534 17.2 9,616 17.2 13,133 24.0 Clark County 272,444 13.8 289,693 14.6 300,734 14.8 427,242 20.8 Washoe County 53,440 12.7 56,015 13.1 56,674 13.1 85,861 19.6 Region Subtotal 335,156 13.7 355,242 14.4 367,024 14.6 526,236 20.7 Nevada – Total 368,648 13.5 388,507 14.1 399,791 14.3 573,874 20.3

Source: Division of Health Care Financing and Policy (2014a).

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Table 3.13: Medicaid Enrollment in Nevada by County – 2004 to 2014

Medicaid Enrollment

Region/County 2004 2014 Change – 2004 to 2014 Percent of Percent of Number Number Number Percent Population Population Rural and Frontier Churchill County 2,521 9.9 5,319 20.9 2,798 111.0 Douglas County 1,684 3.5 4,939 10.2 3,255 193.3 Elko County 3,317 6.1 6,797 12.5 3,480 104.9 Esmeralda County 100 11.0 123 13.5 23 23.0 Eureka County 70 3.4 136 6.6 66 94.3 Humboldt County 1,358 7.6 2,644 14.8 1,286 94.7 Lander County 454 6.9 917 14.0 463 102.0 Lincoln County 453 8.9 688 13.6 235 51.9 Lyon County 3,662 6.9 11,110 20.8 7,448 203.4 Mineral County 783 17.5 1,088 24.3 305 39.0 Nye County 4,899 10.9 11,308 25.2 6,409 130.8 Pershing County 431 6.2 818 11.7 387 89.8 Storey County 46 1.1 140 3.5 94 204.3 White Pine County 981 9.6 1,611 15.7 630 64.2 Region Subtotal 20,759 8.1 47,638 16.7 26,879 129.5 Urban Carson City 6,370 11.6 13,133 24.0 6,763 106.2 Clark County 141,926 6.9 427,242 20.8 285,316 201.0 Washoe County 30,431 7.0 85,861 19.6 55,430 182.1 Region Subtotal 178,727 8.3 526,236 20.7 347,509 194.4 Nevada – Total 199,486 8.3 573,874 20.3 374,388 187.7

Source: Division of Health Care Financing and Policy (2014a).

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Table 3.14: Nevada Check Up (Nevada’s Children’s Health Insurance Program) Enrollment in Nevada by County – 2004 to 2014

Nevada Check Up Enrollment

Region/County 2004 2014 Change – 2004 to 2014 Percent of Percent of Number Number Number Percent Population Population Rural and Frontier Churchill County 282 1.1 289 4.0 7 2.5 Douglas County 453 0.9 377 0.8 -76 -16.8 Elko County 710 1.5 474 0.9 -236 -33.2 Esmeralda County 18 1.5 17 1.9 -1 -5.6 Eureka County 6 0.4 8 0.4 2 33.3 Humboldt County 324 1.9 215 1.2 -109 -33.6 Lander County 101 1.9 44 0.7 -57 -56.4 Lincoln County 54 1.4 42 0.8 -12 -22.2 Lyon County 884 2.0 768 1.4 -116 -13.1 Mineral County 56 1.2 22 0.5 -34 -60.7 Nye County 430 1.1 367 0.8 -63 -14.7 Pershing County 56 1.2 22 0.5 -34 -60.7 Storey County 14 0.4 3 0.1 -11 -78.6 White Pine County 93 1.0 31 0.3 -62 -66.7 Region Subtotal 3,481 1.4 2,697 0.9 -784 -22.5 Urban Carson City 1,044 1.9 1,117 2.0 73 7.0 Clark County 18,031 1.1 23,233 1.1 5,202 28.9 Washoe County 4,491 1.2 5,778 1.3 1,287 28.7 Region Subtotal 23,566 1.1 30,128 1.2 6,562 27.8 Nevada – Total 27,047 1.1 32,825 1.2 5,778 21.4

Source: Division of Health Care Financing and Policy (2014b).

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Table 3.15: Nevada Check Up (Nevada’s Children’s Health Insurance Program) Enrollment by Age in Nevada by County – 2014

Nevada Checkup Enrollment Region/County Under 1 Year Age 1 to 6 Age 7 to 13 Age 14 to 18 Total Number Percent Number Percent Number Percent Number Percent Rural and Frontier Churchill County 0 0.0 62 21.8 140 49.1 83 29.1 285 Douglas County 0 0.0 92 24.6 173 46.3 109 29.1 374 Elko County 6 1.3 119 25.4 215 45.9 128 27.4 468 Esmeralda County 0 0.0 3 18.8 8 50.0 5 31.3 16 Eureka County 0 0.0 3 37.5 2 25.0 3 37.5 8 Humboldt County 1 0.5 62 28.8 112 52.1 40 18.6 215 Lander County 0 0.0 8 18.2 21 47.7 15 34.1 44 Lincoln County 0 0.0 9 22.5 22 55.0 9 22.5 40 Lyon County 7 0.9 149 19.7 375 49.5 227 29.9 758 Mineral County 0 0.0 6 26.1 11 47.8 6 26.1 23 Nye County 1 0.3 72 19.4 160 43.1 138 37.2 371 Pershing County 0 0.0 16 35.6 18 40.0 11 24.4 45 Storey County 0 0.0 1 33.3 0 0.0 2 66.7 3 White Pine County 0 0.0 3 10.3 13 44.8 13 44.8 29 Region Subtotal 15 0.6 605 22.6 1,270 47.4 789 29.5 2,679 Urban Carson City 8 0.7 245 22.3 555 50.4 293 26.6 1,101 Clark County 152 0.7 5,645 24.7 11,493 50.2 5,610 24.5 22,900 Washoe County 40 0.7 1,330 23.3 2,846 49.9 1,493 26.2 5,709 Region Subtotal 200 0.7 7,220 24.3 14,894 50.1 7,396 24.9 29,710 Nevada – Total 215 0.7 7,825 24.2 16,164 49.9 8,185 25.3 32,389

Source: Division of Health Care Financing and Policy (2014b).

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Table 3.16: Population Eligible for Medicare Benefits – Aged and Disabled in Nevada by County – 2012

Aged Eligible Disabled Eligible Region/County Total Number Percent Number Percent Rural and Frontier Churchill County 4,341 83.3 869 16.7 5,210 Douglas County 11,257 89.8 1,282 10.2 12,539 Elko County 4,747 82.1 1,035 17.9 5,782 Esmeralda County 232 86.6 36 13.4 268 Eureka County 262 84.8 47 15.2 309 Humboldt County 1,996 81.5 453 18.5 2,449 Lander County 714 81.4 163 18.6 877 Lincoln County 924 86.2 148 13.8 1,072 Lyon County 9,811 80.9 2,310 19.1 12,121 Mineral County 1,127 80.5 273 19.5 1,400 Nye County 11,816 83.6 2,324 16.4 14,140 Pershing County 797 80.8 189 19.2 986 Storey County 874 85.9 143 14.1 1,017 White Pine County 1,565 83.4 311 16.6 1,876 Region Subtotal 50,463 84.0 9,583 16.0 60,046 Urban Carson City 10,493 85.2 1,821 14.8 12,314 Clark County 237,067 83.2 47,882 16.8 284,949 Washoe County 60,324 83.5 11,933 16.5 72,257 Region Subtotal 307,884 83.3 61,636 16.7 369,520 Nevada – Total 358,347 83.4 71,219 16.6 429,566

Source: Centers for Medicare and Medicaid Services (2014a).

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Table 3.17: Number Enrolled in Medicare by Program Part in Nevada by County – 2012

Medicare Enrollment – Number Region/County Total Part A Part B Part C Part D Rural and Frontier Churchill County 5,015 5,013 4,841 396 2,131 Douglas County 12,685 12,685 11,712 1,044 6,404 Elko County 5,520 5,520 5,108 84 2,856 Esmeralda County 244 244 241 24 107 Eureka County 299 299 258 – 146 Humboldt County 2,281 2,280 2,205 75 1,196 Lander County 813 811 780 12 401 Lincoln County 1,024 1,024 1,024 17 576 Lyon County 12,083 12,083 11,137 2,411 4,823 Mineral County 1,263 1,263 1,246 146 465 Nye County 13,631 13,630 13,194 6,274 3,145 Pershing County 914 913 899 20 513 Storey County 1,044 1,044 869 167 409 White Pine County 1,703 1,703 1,703 14 925 Region Subtotal 58,519 58,512 55,221 10,684 24,097 Urban Carson City 12,005 12,000 11,356 960 6,256 Clark County 291,050 291,022 255,809 108,464 88,899 Washoe County 73,660 73,660 64,612 21,281 26,244 Region Subtotal 376,715 376,684 331,777 130,705 121,399 Nevada – Total 435,234 435,196 386,998 141,389 145,496

Source: Centers for Medicare and Medicaid Services (2014a). Centers for Medicare and Medicaid Services (2014b). Centers for Medicare and Medicaid Services (2014c).

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Table 3.18: Percent Enrolled in Medicare by Program Part in Nevada by County – 2012

Medicare Enrollment – Percent Region/County Total Part A Part B Part C Part D Rural and Frontier Churchill County 5,015 100.0 96.5 7.9 42.5 Douglas County 12,685 100.0 92.3 8.2 50.5 Elko County 5,520 100.0 92.5 1.5 51.7 Esmeralda County 244 100.0 98.8 9.8 43.9 Eureka County 299 100.0 86.3 – 48.8 Humboldt County 2,281 99.9 96.7 3.3 52.4 Lander County 813 99.7 95.9 1.5 49.3 Lincoln County 1,024 100.0 100.0 1.7 56.3 Lyon County 12,083 100.0 92.2 20.0 39.9 Mineral County 1,263 100.0 98.7 11.6 36.8 Nye County 13,631 100.0 96.8 46.0 23.1 Pershing County 914 99.9 98.4 2.2 56.1 Storey County 1,044 100.0 83.2 16.0 39.2 White Pine County 1,703 100.0 100.0 0.8 54.3 Region Subtotal 58,519 100.0 94.4 18.3 41.2 Urban Carson City 12,005 100.0 94.6 8.0 52.1 Clark County 291,050 100.0 87.9 37.3 30.5 Washoe County 73,660 100.0 87.7 28.9 35.6 Region Subtotal 376,715 100.0 88.1 34.7 32.2 Nevada – Total 435,234 100.0 88.9 32.5 33.4

Source: Centers for Medicare and Medicaid Services (2014a). Centers for Medicare and Medicaid Services (2014b). Centers for Medicare and Medicaid Services (2014c).

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Table 3.19: Medicare-eligible Population in Nevada by County – 2000 to 2012

Medicare-eligible Population Change – 2000 to 2012 Region/County 2000 2012 Number Percent Rural and Frontier Churchill County 3,167 5,015 1,848 58.4 Douglas County 5,793 12,685 6,892 119.0 Elko County 2,999 5,520 2,521 84.1 Esmeralda County 145 244 99 68.3 Eureka County 232 299 67 28.9 Humboldt County 1,501 2,281 780 52.0 Lander County 466 813 347 74.5 Lincoln County 781 1,024 243 31.1 Lyon County 5,641 12,083 6,442 114.2 Mineral County 1,118 1,263 145 13.0 Nye County 6,862 13,631 6,769 98.6 Pershing County 519 914 395 76.1 Storey County 165 1,044 879 532.7 White Pine County 1,389 1,703 314 22.6 Region Subtotal 30,778 58,519 27,741 90.1 Urban Carson City 9,770 12,005 2,235 22.9 Clark County 159,007 291,050 132,043 83.0 Washoe County 40,054 73,660 33,306 83.9 Region Subtotal 208,831 376,715 167,884 80.4 Nevada – Total 239,609 435,234 195,625 81.6

Source: Centers for Medicare and Medicaid Services (2014a). Centers for Medicare and Medicaid Services (2014b). Centers for Medicare and Medicaid Services (2014c). Aging and Disability Services (2014).

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Table 3.20: Enrollment in the Veterans Health Administration by Gender in Nevada by County – 2013

Enrollment in Veterans Health Administration Region/County Total Male Female Number Percent Number Percent Rural and Frontier Churchill County 1,645 91.7 149 8.3 1,794 Douglas County 2,113 96.0 89 4.0 2,202 Elko County 1,262 94.4 75 5.6 1,337 Esmeralda County 61 96.8 2 3.2 63 Eureka County 52 91.2 5 8.8 57 Humboldt County 526 93.6 36 6.4 562 Lander County 136 94.4 8 5.6 144 Lincoln County 150 94.9 8 5.1 158 Lyon County 3,198 93.5 223 6.5 3,421 Mineral County 298 93.1 22 6.9 320 Nye County 3,579 94.4 213 5.6 3,792 Pershing County 203 97.6 5 2.4 208 Storey County 79 94.0 5 6.0 84 White Pine County 451 94.9 24 5.1 475 Region Subtotal 13,753 94.1 864 5.9 14,617 Urban Carson City 2,603 94.6 149 5.4 2,752 Clark County 61,120 92.0 5,348 8.0 66,468 Washoe County 17,450 93.5 1,208 6.5 18,658 Region Subtotal 81,173 92.4 6,705 7.6 87,878 Nevada – Total 94,926 92.6 7,569 7.4 102,495

Source: United States Department of Veterans Health Administration (2014).

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Table 3.21: Users of the Veterans Health Administration by Gender in Nevada by County – 2013

Users of Veterans Health Administration Region/County Total Male Female Number Percent Number Percent Rural and Frontier Churchill County 1,094 91.8 98 8.2 1,192 Douglas County 1,466 95.9 62 4.1 1,528 Elko County 803 94.5 47 5.5 850 Esmeralda County 39 100.0 0 0.0 39 Eureka County 32 91.4 3 8.6 35 Humboldt County 375 94.2 23 5.8 398 Lander County 83 96.5 3 3.5 86 Lincoln County 92 93.9 6 6.1 98 Lyon County 2,359 93.3 170 6.7 2,529 Mineral County 201 93.1 15 6.9 216 Nye County 2,454 94.1 155 5.9 2,609 Pershing County 143 97.3 4 2.7 147 Storey County 55 91.7 5 8.3 60 White Pine County 297 94.9 16 5.1 313 Region Subtotal 9,493 94.0 607 6.0 10,100 Urban Carson City 1,806 94.4 108 5.6 1,914 Clark County 37,066 91.5 3,424 8.5 40,490 Washoe County 12,464 93.4 886 6.6 13,350 Region Subtotal 51,336 92.1 4,418 7.9 55,754 Nevada – Total 60,829 92.4 5,025 7.6 65,854

Source: United States Department of Veterans Health Administration (2014).

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Table 3.22: Enrollment and Users of the Veterans Health Administration as a Percent of Veteran Population in Nevada by County – 2013

Enrollees Users Veteran Region/County Percent of Percent of Population Number Veteran Number Veteran Population Population Rural and Frontier Churchill County 1,794 45.4 1,192 30.1 3,959 Douglas County 2,202 47.4 1,528 32.9 4,644 Elko County 1,337 32.2 850 20.5 4,156 Esmeralda County 63 31.5 39 19.5 200 Eureka County 57 26.7 35 16.4 213 Humboldt County 562 37.3 398 26.4 1,508 Lander County 144 24.1 86 14.4 596 Lincoln County 158 23.8 98 14.7 665 Lyon County 3,421 50.0 2,529 37.0 6,840 Mineral County 320 32.7 216 22.1 978 Nye County 3,792 62.0 2,609 42.7 6,115 Pershing County 208 25.7 147 18.2 809 Storey County 84 12.0 60 8.6 701 White Pine County 475 37.8 313 24.9 1,257 Region Subtotal 14,617 44.8 10,100 30.9 32,643 Urban Carson City 2,752 48.0 1,914 33.4 5,732 Clark County 66,468 43.5 40,490 26.5 152,818 Washoe County 18,658 53.7 13,350 38.5 34,714 Region Subtotal 87,878 45.5 55,754 28.8 193,264 Nevada – Total 102,495 45.4 65,854 29.2 225,907

Source: United States Department of Veterans Health Administration (2014).

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Table 3.23: Users of Tribal Health Services in Nevada by County – 2003 to 2013

Users of Tribal Health Services Change – 2003 to 2013 Region/County 2003 2013 Number Percent Rural and Frontier Churchill County 1,295 1,355 60 4.6 Douglas County 403 880 477 118.4 Elko County 2,831 3,160 329 11.6 Esmeralda County 3 2 -1 -33.3 Eureka County 18 20 2 11.1 Humboldt County 658 646 -12 -1.8 Lander County 264 272 8 3.0 Lincoln County 2 3 1 50.0 Lyon County 975 1,166 191 19.6 Mineral County 842 755 -87 -10.3 Nye County 259 237 -22 -8.5 Pershing County 210 212 2 0.9 Storey County 10 5 -5 -50.0 White Pine County 287 368 81 28.2 Region Subtotal 8,057 9,081 1,024 12.7 Urban Carson City 1,047 1,174 127 12.1 Clark County 1,393 2,793 1,400 100.5 Washoe County 5,082 6,104 1,022 20.1 Region Subtotal 7,522 10,071 2,549 33.9 Nevada – Total 15,579 19,152 3,573 22.9

Source: Phoenix Area Indian Health Service (2014).

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Table 3.24: Self-reported Chronic Conditions in Nevada by Region – 2013

Percent of Population Aged 18 and Over Indicator Rural and Carson Clark Washoe United Frontier Nevada City County County States Counties Asthma, Still Have 8.5 6.3 7.5 7.7 7.6 9.0 Asthma, Ever Had 13.0 11.5 11.2 11.1 11.4 14.1 Blood Cholesterol, Told Was High 39.8 39.7 38.8 36.7 38.6 38.4 Coronary Heart Disease, Ever Diagnosed 4.4 5.6 3.1 3.7 3.4 4.1 Diabetes, Ever Told by Doctor 8.6 7.7 10.2 7.8 9.6 9.7 Diabetes, Now Taking Insulin 26.8 – 24.0 29.9 25.1 27.7 Heart Attack, Ever Diagnosed 5.6 3.6 4.2 5.0 4.4 4.3 Hypertension, Ever Been Told 35.5 35.1 30.4 28.0 30.6 31.4 Stroke, Ever Diagnosed 3.9 2.7 2.8 2.4 2.9 2.8

Source: Office of Health Statistics and Surveillance (2014a).

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Table 3.25: Self-reported Lifestyle and Behavioral Risk Factors to Health in Nevada by Region – 2013

Percent of Population Aged 18 and Over Indicator Rural and Carson Clark Washoe United Frontier Nevada City County County States Counties Alcohol, Binge Drinking, 5+, Single Occasion 19.1 15.9 13.6 19.4 15.2 16.8 Alcohol, Heavy Drinking, Daily, 3+ M, 2+ W 8.2 9.9 6.7 7.5 7.1 6.2 Fruits and Vegetables, Not Enough 83.6 77.4 82.4 77.5 81.7 87.3 Overweight or Obese, Body Mass Index (BMI) ≥ 25.0 65.8 60.6 66.0 59.6 64.9 64.3 Obesity, Body Mass Index (BMI) ≥ 30.0 30.5 22.7 26.2 23.9 26.2 29.4 Physical Activity or Exercise in Last 30 Days 71.2 83.9 75.9 81.2 76.3 74.7 Seatbelt Usage 92.1 93.2 94.3 95.5 94.2 94.1 Smoking, Current Smoker 22.0 21.5 19.8 15.4 19.4 19.0 Smoking, Former Smoker 27.5 32.2 20.6 27.0 22.5 25.2

Source: Office of Health Statistics and Surveillance (2014a).

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Table 3.26: Self-reported Health Status and Health Care Access in Nevada by Region – 2013

Percent of Population Aged 18 and Over Indicator Rural and Carson Clark Washoe United Frontier Nevada City County County States Counties Activity Limitation Due to Health 22.3 24.8 17.9 19.8 18.8 19.7 Disability, Use Aid Equipment 11.1 12.9 7.4 7.4 7.9 8.1 Flu Vaccine, Within Past 12 Months 33.3 36.0 29.2 35.2 30.6 32.4 Flu Vaccine, Past 12 Months, Aged 65+ 46.0 54.8 52.6 51.7 51.6 62.8 Health Status in General, Fair or Poor 17.8 15.0 17.0 18.0 17.3 16.7 Health Care Coverage, Percent Uninsured 18.5 19.0 24.1 19.3 22.5 16.8 HIV/AIDS Test, Ever Had 31.8 34.5 42.7 37.6 40.6 35.2 Mammogram, Past 2 Years 67.9 59.1 66.3 68.9 66.8 74.0 Mammogram, Ever Had, Aged 40+ 89.7 82.3 88.1 89.4 88.4 92.0 Oral Health, 6+ Permanent Teeth Removed, Aged 18+ 22.3 24.8 17.9 19.8 18.8 16.9 Oral Health, Visited Dentist in Past Year 58.8 59.1 60.2 64.6 60.8 67.2 Pap Smear, Had Within Past Year 40.4 37.2 48.6 48.6 47.5 44.5 Pneumonia Vaccine, Ever Had 32.7 47.1 28.4 34.0 30.0 32.4 Pneumonia Vaccine, Aged 65+, Ever Had 68.2 76.0 64.2 75.0 66.8 69.5 Sigmoidoscopy or Colonoscopy, Ever Had 61.8 62.2 59.3 65.2 60.6 67.3

Source: Office of Health Statistics and Surveillance (2014a).

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Table 3.27: Diabetes Incidence in Nevada by County – 2004 to 2011

Number of New Cases of Diabetes per 1,000 Population (Age-adjusted) Region/County 2004 2005 2006 2007 2008 2009 2010 2011 Rural and Frontier Churchill County 7.7 8.8 10.5 9.9 8.7 8.4 8.8 8.4 Douglas County 6.6 6.8 7.4 7.4 6.8 7.3 6.8 6.0 Elko County 7.0 7.6 9.2 8.9 9.0 8.5 8.7 8.1 Esmeralda County 7.6 8.0 9.1 9.1 8.6 8.4 8.2 6.9 Eureka County 7.6 8.1 8.9 8.3 8.1 8.2 8.3 6.9 Humboldt County 7.5 8.2 8.9 8.2 7.3 8.0 7.6 6.6 Lander County 7.8 8.5 9.1 8.6 8.2 8.8 8.6 6.9 Lincoln County 7.8 8.5 9.0 10.0 9.2 10.4 8.2 6.8 Lyon County 7.7 8.3 8.2 7.7 7.7 8.4 9.0 7.9 Mineral County 7.8 8.3 9.7 10.8 11.3 11.9 10.5 7.9 Nye County 8.1 9.3 9.7 10.1 9.9 9.5 9.3 7.4 Pershing County 8.2 8.5 10.6 8.7 8.3 9.0 9.0 8.0 Storey County 7.6 7.9 9.4 8.1 8.0 8.4 7.9 6.5 White Pine County 7.8 7.3 7.2 8.7 9.1 8.8 8.5 7.7 Urban Carson City 7.8 7.8 8.0 7.5 7.6 8.3 8.8 7.5 Clark County 8.4 9.3 10.5 10.6 9.9 10.0 9.3 8.3 Washoe County 7.6 7.2 8.2 7.0 7.2 7.2 7.3 6.0 Nevada – Total 6.5 7.1 7.6 8.0 8.6 7.9 8.4 10.0 U.S. – Total 7.0 7.3 7.5 7.7 8.0 8.4 8.6 8.5

Source: Centers for Disease Control and Prevention (2014a).

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Table 3.28: Obesity Prevalence in Nevada by County – 2004 to 2011

Percent of Population Aged 18 and Over Who are Obese (Age-adjusted) Region/County 2004 2005 2006 2007 2008 2009 2010 2011 Rural and Frontier Churchill County 20.7 23.7 27.4 26.9 26.0 28.9 31.6 31.6 Douglas County 16.8 17.2 19.6 21.2 21.4 21.7 22.1 21.6 Elko County 21.1 23.9 25.4 29.0 29.4 30.6 32.0 31.4 Esmeralda County 19.9 23.9 25.2 27.0 26.2 28.6 29.5 27.4 Eureka County 20.3 22.4 25.0 27.0 26.5 26.8 25.0 25.3 Humboldt County 21.2 26.0 26.9 31.0 29.3 29.4 26.6 25.3 Lander County 21.6 24.9 28.3 29.5 28.7 26.9 26.7 28.9 Lincoln County 21.5 25.5 29.6 30.5 27.5 26.3 27.1 24.6 Lyon County 22.7 24.4 26.2 27.7 28.7 30.0 30.8 28.0 Mineral County 24.4 29.3 30.7 30.7 30.2 32.0 29.9 26.8 Nye County 26.5 30.3 31.2 32.3 31.4 31.0 30.7 29.3 Pershing County 24.1 26.9 30.5 33.0 32.8 29.0 29.1 30.7 Storey County 22.0 24.0 27.2 27.3 25.5 22.7 22.9 24.3 White Pine County 22.0 23.0 30.0 33.2 34.9 30.0 26.0 24.6 Urban Carson City 19.3 20.2 22.2 23.9 24.0 23.1 22.8 22.8 Clark County 20.6 21.5 22.9 24.5 25.7 26.0 25.0 24.7 Washoe County 17.5 19.0 19.2 21.0 21.5 22.6 22.2 22.0 Nevada – Total 20.3 20.7 24.2 24.1 25.1 25.8 28.3 24.6 U.S. – Total 24.3 25.3 26.2 26.6 27.5 27.9 35.7 28.7

Source: Centers for Disease Control and Prevention (2014b).

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Table 3.29: Physical Inactivity Prevalence in Nevada by County – 2004 to 2011

Percent of Population Aged 18 and Over Reporting No Participation in Leisure-time Physical Activity (Age-adjusted) Region/County 2004 2005 2006 2007 2008 2009 2010 2011 Rural and Frontier Churchill County 19.0 19.7 21.2 23.8 24.3 26.0 25.0 23.4 Douglas County 15.0 15.6 15.0 15.3 15.8 16.4 15.3 14.3 Elko County 22.1 25.1 25.5 26.6 24.8 24.7 21.3 20.3 Esmeralda County 19.1 20.4 21.1 23.4 23.0 23.2 21.7 21.4 Eureka County 21.9 22.9 23.2 25.2 24.8 25.6 23.7 22.0 Humboldt County 21.1 22.3 22.5 26.1 25.7 24.4 21.2 19.9 Lander County 20.8 23.0 23.0 23.1 22.3 24.3 23.0 20.1 Lincoln County 18.5 18.8 19.7 21.5 22.3 22.9 21.1 20.5 Lyon County 22.3 21.8 20.7 23.0 23.4 25.3 24.4 23.2 Mineral County 21.9 22.9 25.8 25.0 25.4 28.2 28.1 25.8 Nye County 25.5 27.6 25.8 28.1 26.4 28.7 26.8 25.7 Pershing County 18.8 22.1 22.5 26.9 24.9 26.0 21.9 20.3 Storey County 19.2 20.0 19.5 20.1 20.6 22.4 22.4 21.3 White Pine County 19.2 22.0 23.0 23.1 21.9 24.0 25.2 23.0 Urban Carson City 18.7 19.2 20.2 21.6 20.4 19.8 17.7 16.8 Clark County 23.6 24.3 23.8 24.7 25.3 25.6 23.6 21.6 Washoe County 16.3 17.2 17.2 17.3 16.7 17.2 15.9 15.5 Nevada – Total 19.2 22.0 22.4 23.4 23.4 24.4 22.4 21.3 U.S. – Total 22.9 24.0 22.6 22.8 24.8 23.8 23.8 26.1

Source: Centers for Disease Control and Prevention (2014c).

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Table 3.30: Self-reported Substance Abuse and Mental Illness Among Population Aged 12 and Over in Nevada by Region – 2012

Percent of Population Aged 12 and Over

Indicator Rural and West Clark Washoe United Nevada Frontier Counties County County States Counties Alcohol Use in Past Month Among Persons Aged 12 to 20 14.9 17.4 14.3 21.8 25.3 25.0 Alcohol Use in Past Month 49.1 57.6 51.4 60.0 53.0 51.8 Alcohol Binge Use in Past Month Among Persons Aged 12 to 20 14.9 17.4 14.3 21.8 15.7 15.9 Alcohol, Binge Use in Past Month 21.9 24.6 24.6 28.7 25.1 22.8 Alcohol Dependence in Past Year 3.8 3.8 4.0 5.4 4.2 3.2 Alcohol Dependence or Abuse in Past Year 9.3 9.1 8.7 11.9 9.3 6.8 Cigarette Use in Past Month 27.7 24.7 23.5 23.7 23.9 22.3 Cocaine Use in Past Year 1.3 1.5 1.6 2.1 1.6 1.7 Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year 10.7 10.5 9.8 14.0 10.6 8.4 Illicit Drug Dependence in Past Year 1.6 1.6 2.0 2.5 2.0 1.9 Illicit Drug Dependence or Abuse in Past Year 2.5 2.3 2.6 3.3 2.7 2.7 Illicit Drugs Other than Marijuana, Used in Past Month 4.0 4.1 3.9 5.2 4.1 3.4 Illicit Drug Use in Past Month 9.3 9.2 10.8 12.4 10.9 8.9 Marijuana, Average Annual Rate of First Use 1.8 1.9 2.0 2.9 2.1 1.9 Marijuana, Used in Past Month 7.3 7.3 7.7 9.7 8.0 7.0 Marijuana, Use in Past Year 11.8 12.4 13.9 15.8 13.9 11.7 Mental Health, Serious – Adults 4.7 4.3 4.2 4.2 4.2 3.7 Mental Illness, Any – Adult 18+ 18.6 17.7 16.0 18.1 16.6 18.1 Mental Illness, One+ Major Depressive Episode in Past Year 6.3 6.5 6.5 6.1 6.4 6.7 Pain Relievers, Nonmedical Use of in Past Year 5.5 5.1 5.9 6.4 5.9 4.6 Perceptions of Great Risk of Having Five or More Drinks 39.6 40.3 43.2 40.0 42.3 42.5 Perceptions of Great Risk of Daily Smoking 63.5 70.8 70.3 70.8 70.0 71.5 Perceptions of Great Risk of Smoking Marijuana Once a Month 29.2 30.3 29.0 24.7 28.4 31.8 Suicide, Serious Thoughts in Past Year 4.0 3.7 3.5 3.9 3.6 3.8 Tobacco Product Use in Past Month 32.5 27.6 26.9 28.1 27.5 26.8 Treatment, Needing for Alcoholism in Past Year 9.4 9.5 8.4 11.6 9.1 6.4 Treatment, Needing for Illicit Drug Use in Past Year 2.0 1.9 2.3 2.8 2.3 2.4

Source: National Survey on Drug Use and Health (2014).

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Table 3.31: Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Incidence and Prevalence in Nevada by Region – 2013

AIDS and HIV Incidence and Prevalence

Indicator Rural and Clark Washoe Frontier Nevada County County Counties New AIDS Diagnosis (New Cases) Number 5 221 22 248 Percent of Total Cases 2.0 89.0 9.0 100.0 Number per 100,000 Population 1.5 11.0 5.1 8.9 New HIV Infections (New Cases) Number 11 388 38 437 Percent of Total Cases 3.0 89.0 9.0 100.0 Number per 100,000 Population 3.3 19.3 8.8 15.7 Persons Living with HIV/AIDS (Total Cases to Date) Number 412 7,808 935 9,155 Percent of Total Cases 5.0 85.0 10.0 100.0 Number per 100,000 Population 122.7 388.8 216.9 329.9

Source: Office of Health Statistics and Surveillance (2014b).

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Table 3.32: Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Incidence and Prevalence in Nevada by Region – 2009 to 2013 Change AIDS and HIV Prevalence (Total Cases to Date) 2009 to 2013 Indicator 2009 2010 2011 2012 2013 Number Percent

Persons Living with HIV/AIDS Rural and Frontier Counties 468 448 417 436 412 -56 -12.0 Clark County 6,867 7,105 7,284 7,515 7,808 941 13.7 Washoe County 837 837 862 841 935 98 11.7 Nevada 8,172 8,390 8,563 8,792 9,155 983 12.0 AIDS and HIV Prevalence per 100,000 Population Rural and Frontier Counties 134.8 129.0 125.4 120.8 122.7 -12.1 -9.0 Clark County 349.0 361.1 370.2 381.7 388.8 39.8 11.4 Washoe County 197.5 197.5 204.5 201.5 216.9 19.4 9.8 Nevada 298.4 306.3 314.6 320.1 329.9 31.5 10.6

Source: Office of Health Statistics and Surveillance (2014b).

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Table 3.33: Sexually Transmitted Disease (STD) Incidence in Nevada by Region – 2013

Sexually Transmitted Disease (STD) Incidence (New Cases)

Indicator Rural and Carson Clark Washoe Frontier City/Douglas/ Nevada County County Counties Lyon Counties Primary and Secondary Syphilis Number 4 2 170 31 207 Percent of Total Cases 1.9 1.0 82.1 15.0 100.0 Number per 100,000 Population 2.2 1.3 8.5 7.2 7.5 Gonorrhea Number 54 38 2,090 367 2,549 Percent of Total Cases 2.1 1.5 82.0 14.4 100.0 Number per 100,000 Population 30.0 24.4 104.1 85.1 91.8 Chlamydia Number 394 413 8,614 1,686 11,107 Percent of Total Cases 3.5 3.7 77.6 15.2 100.0 Number per 100,000 Population 218.9 264.9 428.9 391.2 400.2

Source: Office of Health Statistics and Surveillance (2014c).

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Table 3.34: Sexually Transmitted Disease (STD) Incidence in Nevada by Region – 2009 to 2013

Change Sexually Transmitted Disease (STD) Incidence (New Cases) 2009 to 2013 Indicator 2009 2010 2011 2012 2013 Number Percent

Primary and Secondary Syphilis All other Counties 2 5 2 1 4 2 100.0 Carson City/Douglas/Lyon Counties 0 1 0 0 2 2 200.0 Clark County 86 126 126 97 170 84 97.7 Washoe County 3 2 8 16 31 28 933.0 Nevada 91 134 136 114 207 116 127.5 Gonorrhea All Other Counties 14 23 27 29 54 40 285.7 Carson City/Douglas/Lyon Counties 26 11 30 33 38 12 46.2 Clark County 1,553 1,511 1,740 1,968 2,090 537 34.6 Washoe County 134 100 213 238 367 233 173.9 Nevada 1,727 1,645 2,010 2,268 2,549 822 47.6 Chlamydia All Other Counties 320 327 337 542 394 74 23.1 Carson City/Douglas/Lyon Counties 302 312 365 398 413 111 36.8 Clark County 8,183 7,362 8,336 8,589 8,614 431 5.3 Washoe County 1,254 1,429 1,490 1,629 1,686 432 34.4 Nevada 10,059 9,430 10,528 11,158 11,107 1,048 10.4

Source: Office of Health Statistics and Surveillance (2014c).

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Table 3.35: Tuberculosis Incidence in Nevada by Region – 2013

Tuberculosis Incidence (New Cases)

Indicator Rural and Clark Washoe Frontier Carson City Nevada County County Counties Number 6 1 76 9 92 Percent of Total Cases 6.5 1.1 82.6 9.8 100.0 Number per 100,000 Population 2.1 1.8 3.8 2.1 3.3

Source: Office of Health Statistics and Surveillance (2014d).

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Table 3.36: Tuberculosis Prevalence in Nevada by Region – 2009 to 2013

Tuberculosis Prevalence (Total Cases to Date) Total Indicator 2009 2010 2011 2012 2013 Change Percent Tuberculosis Prevalence Rural and Frontier Counties 2 3 1 5 6 4 200.0 Carson City 2 2 2 1 1 -1 -50.0 Clark County 87 97 85 70 76 -11 -12.6 Washoe County 15 12 8 8 9 -6 -40.0 Nevada 106 114 96 84 92 -14 -13.2 Tuberculosis Prevalence per 100,000 Population Rural and Frontier Counties 0.7 1.1 0.4 1.8 2.1 1.4 200.0 Carson City 3.6 3.6 3.6 1.8 1.8 -1.8 -50.0 Clark County 4.5 5.0 4.3 3.5 3.8 -0.7 -15.6 Washoe County 3.6 2.9 1.7 1.9 2.1 -1.5 -41.7 Nevada 4.0 4.2 3.5 3.1 3.3 -0.7 -17.5

Source: Office of Health Statistics and Surveillance (2014d).

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Table 3.37: Maternal Health Behaviors and Birth Outcomes in Nevada by Region of Residence – 2013 Maternal Health Behaviors and Birth Outcome Rates (Percent) Indicator Rural and Carson Clark Washoe Frontier Nevada City County County Counties Women Receiving Prenatal Care in First Trimester 62.4 64.2 64.0 77.2 65.9 Pregnant Women Abstaining from Alcohol Consumption 97.4 98.9 98.6 98.8 98.5 Pregnant Women Abstaining from Smoking 82.8 87.9 93.7 91.0 92.3 Live Births Below 2,500 Grams 7.7 7.2 8.1 7.4 7.9 Births Prior to 37 Weeks of Gestation 8.6 7.2 10.0 8.8 9.7 Infant Mortality Rate, per 1,000 Live Births 7.1 – 4.8 6.8 5.3

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.38: Neonatal, Post-neonatal, and Infant Mortality in Nevada by Region of Residence – 2013

Infant Mortality

Indicator Rural and Clark Washoe Frontier Nevada County County Counties Neonatal Mortality Number of Deaths (1-28 Days) 15 76 28 119 Percent of Total Cases 12.6 63.9 23.5 100.0 Number per 1,000 Live Births 5.4 2.9 5.3 3.5 Post-neonatal Mortality Number of Deaths (29-365 Days) 7 47 7 61 Percent of Total Cases 11.5 77.0 11.5 100.0 Number per 1,000 Live Births 2.5 1.8 1.3 1.8 Infant Mortality Number of Deaths (1-365 Days) 21 124 36 181 Percent of Total Cases 11.6 68.5 19.9 100.0 Number per 1,000 Live Births 7.5 4.8 6.8 5.3

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.39: Birth Rates for Female Population in Nevada by County of Residence – 2010 to 2013 Number of Live Births per 1,000 Change – Female Population 2010 to 2013 Region/County 2010 2011 2012 2013 Number Percent Rural and Frontier Churchill County 12.2 12.4 12.6 12.4 0.2 1.6 Douglas County 7.6 7.5 6.3 7.2 -0.4 -4.7 Elko County 13.9 13.6 13.3 12.1 -1.8 -12.7 Esmeralda County – – – – – – Eureka County 8.9 9.5 9.0 5.9 -3.0 -34.0 Humboldt County 15.8 15.3 15.3 14.4 -1.4 -8.6 Lander County 13.4 12.9 15.3 14.0 0.6 4.3 Lincoln County 4.1 4.2 7.8 3.9 -0.2 -5.3 Lyon County 10.9 10.8 9.9 10.8 -0.1 -0.5 Mineral County 14.1 14.6 11.3 12.0 -2.1 -14.8 Nye County 9.5 9.4 8.0 7.6 -1.9 -19.6 Pershing County 8.1 8.0 9.0 9.0 0.9 10.9 Storey County 6.5 6.3 4.1 4.9 -1.6 -24.9 White Pine County 12.7 12.8 11.0 8.3 -4.4 -34.6 Urban Carson City 9.6 9.5 10.1 9.8 0.2 2.1 Clark County 13.5 13.4 12.9 12.8 -0.7 -5.2 Washoe County 12.5 12.4 12.3 12.2 -0.3 -2.4 Nevada – Total 13.0 12.9 12.5 12.4 -0.6 -4.6

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.40: Teen Pregnancy Rates for Female Population Aged 15 to 17 in Nevada by County of Residence – 2010 to 2012 Number of Pregnancies per 1,000 Change – Females Aged 15 to 17 2010 to 2012 Region/County 2010 2011 2012 Number Percent Rural and Frontier Churchill County 33.4 20.5 10.6 -22.8 -68.3 Douglas County 19.8 7.4 11.0 -8.8 -44.5 Elko County 19.9 21.8 15.1 -4.8 -24.3 Esmeralda County – – – – – Eureka County – – – – – Humboldt County 42.9 30.9 22.9 -20.0 -46.6 Lander County 39.2 0.0 0.0 – – Lincoln County – – – – – Lyon County 18.9 19.3 21.9 3.0 15.6 Mineral County – 49.3 – – – Nye County 13.6 25.2 8.1 -5.5 -40.3 Pershing County 67.0 – – – – Storey County – – – – – White Pine County 29.2 32.6 – – – Urban Carson City 30.3 22.7 19.0 -11.3 -37.3 Clark County 25.4 24.1 21.0 -4.4 -17.3 Washoe County 24.4 22.5 18.2 -6.2 -25.4 Nevada – Total 25.0 23.5 19.9 -5.1 -20.4

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.41: Teen Pregnancy Rates for Female Population Aged 18 to 19 in Nevada by County of Residence – 2010 to 2012 Number of Pregnancies per 1,000 Change – Females Aged 18 to 19 2010 to 2012 Region/County 2010 2011 2012 Number Percent Rural and Frontier Churchill County 68.3 89.8 52.8 -15.5 -22.7 Douglas County 46.2 26.0 47.3 1.1 2.4 Elko County 102.1 85.2 72.0 -30.2 -29.5 Esmeralda County – – – – – Eureka County – – – – – Humboldt County 117.6 125.8 116.1 -1.5 -1.3 Lander County 79.1 88.5 45.6 -33.5 -42.4 Lincoln County – – – – – Lyon County 75.2 71.2 75.8 0.6 0.8 Mineral County – 106.5 80.0 – – Nye County 66.6 61.1 60.0 -6.6 -9.9 Pershing County 110.3 73.6 119.2 8.9 8.1 Storey County – – – – – White Pine County 92.3 95.6 73.1 -19.2 -20.8 Urban Carson City 101.9 68.2 81.8 -20.1 -19.7 Clark County 84.0 74.6 71.8 -12.2 -14.5 Washoe County 76.6 69.2 67.1 -9.5 -12.4 Nevada – Total 82.4 73.3 70.7 -11.7 -14.2

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.42: Teen Pregnancy Rates for Female Population Aged 15 to 19 in Nevada by County of Residence – 2010 to 2012 Number of Pregnancies per 1,000 Change – Females Aged 15 to 19 2010 to 2012 Region/County 2010 2011 2012 Number Percent Rural and Frontier Churchill County 46.9 49.1 28.5 -18.4 -39.2 Douglas County 30.6 15.7 27.5 -3.1 -10.2 Elko County 54.0 47.9 38.7 -15.3 -28.4 Esmeralda County – – – – – Eureka County – – – – – Humboldt County 73.2 65.2 55.3 -17.9 -24.5 Lander County 55.6 49.1 30.7 -24.9 -44.8 Lincoln County – – – – – Lyon County 40.7 38.8 43.0 2.3 5.7 Mineral County – 71.8 45.1 – – Nye County 36.0 39.7 29.0 -7.0 -19.4 Pershing County 86.3 51.0 67.2 -19.1 -22.1 Storey County – – – – – White Pine County 55.1 56.8 35.3 -19.8 -35.9 Urban Carson City 58.3 40.9 43.9 -14.4 -24.7 Clark County 49.1 44.2 41.3 -7.8 -15.9 Washoe County 46.0 41.5 38.0 -8.0 -17.4 Nevada – Total 48.3 43.4 40.3 -8.0 -16.6

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.43: Teen Birth Rates for Female Population Aged 15 to 17 in Nevada by County of Residence – 2010 to 2013 Number of Live Births per 1,000 Change – Females Aged 15 to 17 2010 to 2013 Region/County 2010 2011 2012 2013 Number Percent Rural and Frontier Churchill County 19.1 15.4 8.8 – – – Douglas County 9.3 – – – – – Elko County 14.2 17.0 12.3 10.4 -3.8 -26.8 Esmeralda County – – – – – – Eureka County – – – – – – Humboldt County 34.8 23.8 18.3 11.2 -23.6 -67.8 Lander County – – – 33.3 – – Lincoln County – – – – – – Lyon County 9.5 11.2 15.6 15.0 5.5 57.9 Mineral County – 19.7 – – – – Nye County 12.2 25.2 8.1 10.5 -1.7 -13.9 Pershing County 55.8 – – – – – Storey County – – – – – – White Pine County 29.2 – – – – – Urban Carson City 23.9 17.3 12.7 11.3 -12.6 -52.7 Clark County 19.5 19.1 16.0 12.7 -6.8 -34.9 Washoe County 17.8 16.8 13.8 11.4 -6.4 -36.0 Nevada – Total 18.8 18.3 15.1 12.3 -6.5 -34.6

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.44: Teen Birth Rates for Female Population Aged 18 to 19 in Nevada by County of Residence – 2010 to 2013 Number of Live Births per 1,000 Change – Females Aged 18 to 19 2010 to 2013 Region/County 2010 2011 2012 2013 Number Percent Rural and Frontier Churchill County 63.2 75.2 50.4 29.7 -33.5 -53.0 Douglas County 34.7 14.8 32.2 36.1 1.4 4.0 Elko County 95.4 74.4 66.6 65.5 -29.9 -31.3 Esmeralda County – – – – – – Eureka County – – – – – – Humboldt County 101.9 100.7 107.5 73.9 -28.0 -27.5 Lander County 79.1 62.0 45.6 88.8 9.7 12.3 Lincoln County – – – – – – Lyon County 66.8 59.4 62.9 62.4 -4.4 -6.6 Mineral County – 91.3 80.0 – – – Nye County 62.9 61.1 56.0 55.3 -7.6 -12.1 Pershing County 110.3 – – – – – Storey County – – – – – – White Pine County 92.3 69.5 73.1 – – – Urban Carson City 80.4 54.6 69.3 67.4 -13.0 -16.2 Clark County 65.3 59.2 56.8 52.7 -12.6 -19.3 Washoe County 57.9 52.2 51.1 49.0 -8.9 -15.4 Nevada – Total 64.9 58.1 56.2 52.4 -12.5 -19.3

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.45: Teen Birth Rates for Female Population Aged 15 to 19 in Nevada by County of Residence – 2010 to 2013 Number of Live Births per 1,000 Change – Females Aged 15 to 19 2010 to 2013 Region/County 2010 2011 2012 2013 Number Percent Rural and Frontier Churchill County 36.1 40.1 26.4 16.7 -19.4 -53.7 Douglas County 19.6 7.4 17.2 19.1 -0.5 -2.6 Elko County 47.8 40.6 34.8 33.6 -14.3 -29.9 Esmeralda County – – – – – – Eureka County – – – – – – Humboldt County 62.1 51.6 49.3 34.9 -27.2 -43.8 Lander County 41.7 28.6 30.7 50.2 8.5 20.5 Lincoln County – – – – – – Lyon County 31.6 29.3 34.2 33.8 2.2 6.9 Mineral County – 47.8 33.8 – – – Nye County 33.7 39.7 27.4 28.4 -5.2 -15.6 Pershing County 80.2 44.7 40.3 32.7 -47.4 -59.2 Storey County – – – – – – White Pine County 55.1 40.1 35.3 14.9 -40.2 -73.0 Urban Carson City 46.0 32.2 35.1 34.4 -11.6 -25.2 Clark County 38.0 35.1 32.2 28.6 -9.4 -24.7 Washoe County 34.4 31.2 28.9 26.8 -7.6 -22.1 Nevada – Total 37.5 34.2 31.6 28.4 -9.1 -24.3

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.46: Childhood Disability by Type of Disability in Nevada by County of Residence – 2013

Number of Disabled Children

Speech/ Region/County Autism Develop- Other Emotional Intellectual Learning Language/ Spectrum mentally Impairment Total Disturbance Disability Disability Hearing Disorder Delayed Disabilities Impairment Rural and Frontier Churchill County 31 95 – 28 297 81 27 564 Douglas County 52 59 21 25 326 181 128 792 Elko County 57 71 14 60 556 233 94 1,085 Esmeralda County 0 0 0 0 0 – – – Eureka County 0 – 0 0 11 – – 22 Humboldt County 32 57 19 22 266 71 28 495 Lander County – 14 0 – 68 – 12 114 Lincoln County – 13 – – 69 31 0 126 Lyon County 96 78 44 44 371 241 168 1,042 Mineral County – 12 – – 35 22 12 89 Nye County 49 75 48 37 495 91 69 864 Pershing County – 11 0 – 42 18 13 90 Storey County – – – – 1,326 13 – 51 White Pine County – 16 – – 78 68 32 207 Region Subtotal 333 501 149 216 2,640 1,050 583 5,541 Urban Carson City 48 54 33 19 411 275 159 999 Clark County 3,611 3,940 1,292 1,373 14,734 5,197 3,800 33,947 Washoe County 512 806 293 337 3,969 1,519 1,191 8,627 Region Subtotal 4,171 4,800 1,618 1,729 19,114 6,991 5,150 43,573 Charter Schools 157 25 105 – 517 216 189 1,215 Nevada – Total 4,676 5,333 1,884 1,967 22,271 8,270 5,931 50,332

Source: Nevada Department of Education (2014c).

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Table 3.47: Mortality for All Causes in Nevada by County of Residence – 2009 to 2013 Number of Deaths per 100,000 Change – Population (Age-adjusted) 2009 to 2013 Region/County 2009 2011 2013 Number Percent Rural and Frontier Churchill County 1,022.0 1,125.0 1,040.7 18.7 1.8 Douglas County 636.5 703.1 654.2 17.7 2.8 Elko County 850.7 842.2 717.4 -133.3 -15.7 Esmeralda County 823.0 1,182.6 1,272.9 449.9 54.7 Eureka County 744.7 339.3 1,026.3 281.5 37.8 Humboldt County 745.7 861.2 610.3 -135.3 -18.2 Lander County 731.7 564.3 697.0 -34.6 -4.7 Lincoln County 744.9 625.4 765.7 20.8 2.8 Lyon County 805.0 837.9 782.4 -22.6 -2.8 Mineral County 1,482.1 1,227.3 1,166.1 -316.0 -21.3 Nye County 928.1 972.9 918.8 -9.3 -1.0 Pershing County 757.3 775.0 618.1 -139.3 -18.4 Storey County 459.6 565.3 561.4 101.9 22.2 White Pine County 795.7 795.4 657.9 -137.8 -17.3 Urban Carson City 983.9 987.5 954.6 -29.3 -3.0 Clark County 748.1 754.1 739.9 -8.2 -1.1 Washoe County 854.5 880.5 898.0 43.5 5.1 Nevada – Total 782.3 791.0 777.4 8.6 1.1

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.48: Heart Disease Mortality in Nevada by County of Residence – 2009 to 2013 Number of Heart Disease Deaths Change – per 100,000 Population (Age-adjusted) 2009 to 2013 Region/County 2009 2011 2013 Number Percent Rural and Frontier Churchill County 224.5 196.8 216.2 -8.3 -3.7 Douglas County 167.5 138.1 138.5 -29.0 -17.3 Elko County 165.6 206.8 254.5 88.9 53.7 Esmeralda County – – – – – Eureka County – 222.3 582.8 – – Humboldt County 142.7 171.7 127.0 -15.7 -11.0 Lander County 123.8 175.6 116.3 -7.5 -6.1 Lincoln County 151.0 129.2 239.6 88.6 58.7 Lyon County 172.1 179.1 146.1 -26.0 -15.1 Mineral County 505.3 368.3 249.6 -255.7 -50.6 Nye County 228.6 293.6 258.1 29.5 12.9 Pershing County 142.6 242.7 78.2 -64.4 -45.2 Storey County 136.6 79.1 199.5 62.9 46.0 White Pine County 153.0 190.2 109.4 -43.6 -28.5 Urban Carson City 212.1 188.9 203.2 -8.9 -4.2 Clark County 185.9 185.0 194.0 8.1 4.4 Washoe County 212.7 248.2 234.8 22.1 10.4 Nevada – Total 191.5 196.9 199.2 7.7 4.0

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.49: Malignant Neoplasm (Cancer) Mortality in Nevada by County of Residence – 2009 to 2013 Number of Cancer Deaths Change – per 100,000 Population (Age-adjusted) 2009 to 2013 Region/County 2009 2011 2013 Number Percent Rural and Frontier Churchill County 262.7 273.0 216.8 -45.9 -17.5 Douglas County 142.2 164.7 144.4 2.2 1.5 Elko County 160.0 170.9 88.9 -71.1 -44.4 Esmeralda County – – – – – Eureka County 340.7 – – – – Humboldt County 177.5 174.1 135.0 -42.5 -23.9 Lander County 126.0 99.3 180.5 54.5 43.3 Lincoln County 121.6 70.5 125.0 3.4 2.8 Lyon County 214.8 189.7 175.2 -39.6 -18.4 Mineral County 326.4 256.0 262.8 -63.6 -19.5 Nye County 209.7 173.5 211.9 2.2 1.0 Pershing County 143.7 95.3 87.6 -56.1 -39.0 Storey County – 114.6 62.7 – – White Pine County 138.2 173.9 179.1 40.9 29.6 Urban Carson City 231.5 207.1 203.8 -27.7 -12.0 Clark County 166.2 166.7 163.0 -3.2 -1.9 Washoe County 184.9 179.5 182.4 -2.5 -1.4 Nevada – Total 173.4 170.8 166.9 -6.5 -3.7

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.50: Chronic Lower Respiratory Disease (CLRD) Mortality in Nevada by County of Residence – 2009 to 2013 Number of CLRD Deaths Change – per 100,000 Population (Age-adjusted) 2009 to 2013 Region/County 2009 2011 2013 Number Percent Rural and Frontier Churchill County 97.0 84.9 144.7 47.7 49.2 Douglas County 38.5 35.6 39.4 0.9 2.3 Elko County 69.7 72.6 65.0 -4.7 -6.7 Esmeralda County – – – – – Eureka County – – – – – Humboldt County 65.5 83.9 51.5 -14.0 -21.4 Lander County – – 80.9 – – Lincoln County – – 65.2 – – Lyon County 71.4 68.9 73.6 2.2 3.1 Mineral County 93.4 – 139.0 45.6 48.8 Nye County 60.0 74.2 70.7 10.7 17.8 Pershing County 131.2 – 88.5 -42.7 -32.5 Storey County – – – – – White Pine County 63.1 42.0 76.9 13.8 21.9 Urban Carson City 72.4 51.4 63.7 -8.7 -12.0 Clark County 48.3 46.7 51.3 3.0 6.2 Washoe County 57.7 56.4 60.4 2.7 4.7 Nevada – Total 52.1 49.8 55.3 3.2 6.1

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.51: Lung, Trachea, and Bronchus Cancer (LTBC) Mortality in Nevada by County of Residence – 2009 to 2013 Number of LTBC Deaths Change – per 100,000 Population (Age-adjusted) 2009 to 2013 Region/County 2009 2011 2013 Number Percent Rural and Frontier Churchill County 81.3 81.2 58.3 -23.0 -28.3 Douglas County 46.3 0.0 47.3 1.0 2.2 Elko County 47.2 47.7 23.1 -24.1 -51.1 Esmeralda County – – – – – Eureka County – – – – – Humboldt County 42.6 31.7 36.4 -6.2 -14.6 Lander County – – – – – Lincoln County – – – – – Lyon County 57.5 61.1 64.1 6.6 11.5 Mineral County 91.2 68.1 89.9 -1.3 -1.4 Nye County 72.6 49.6 78.4 5.8 8.0 Pershing County 82.0 – – – – Storey County – – – – – White Pine County 62.2 0.0 40.5 -21.7 -34.9 Urban Carson City 60.2 55.3 46.2 -14.0 -23.3 Clark County 49.5 49.2 44.9 -4.6 -9.3 Washoe County 51.1 45.1 44.5 -6.6 -12.9 Nevada – Total 51.4 48.8 46.2 -5.2 -10.1

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.52: Cerebrovascular Disease (Stroke) Mortality in Nevada by County of Residence – 2009 to 2013 Number of Stroke Deaths Change – per 100,000 Population (Age-adjusted) 2009 to 2013 Region/County 2009 2011 2013 Number Percent Rural and Frontier Churchill County 34.3 72.3 38.9 4.6 13.4 Douglas County 26.4 34.1 38.3 11.9 45.1 Elko County 57.3 32.5 14.7 -42.6 -74.3 Esmeralda County – – – – – Eureka County – – – – – Humboldt County – 35.0 – – – Lander County – – – – – Lincoln County – – – – – Lyon County 26.7 18.9 44.6 17.9 67.0 Mineral County – – – – – Nye County 41.9 47.6 40.1 -1.8 -4.3 Pershing County – 81.7 – – Storey County – – – – – White Pine County – 41.8 – – – Urban Carson City 43.6 54.6 41.8 -1.8 -4.1 Clark County 36.4 35.5 33.6 -2.8 -7.7 Washoe County 35.0 33.4 33.9 -1.1 -3.1 Nevada – Total 36.1 36.0 33.7 -2.4 -6.6

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.53: Mortality Rates by Cause of Death in Nevada by Region of Residence – 2013

Number of Deaths per 100,000 Population (Age-adjusted)

Cause of Death Rural and Clark Washoe Frontier Carson City Nevada County County Counties Alzheimer’s Disease 21.4 46.0 13.9 33.3 18.8 Atherosclerosis 4.5 – 0.4 13.6 3.0 Benign Neoplasms 3.3 – 3.4 5.0 3.6 Breast Cancer (Women) 21.3 23.1 22.8 21.6 22.6 Cerebrovascular Diseases (Stroke) 31.8 40.7 33.3 32.5 33.7 Chronic Liver Disease and Cirrhosis 14.5 22.6 10.7 17.2 13.0 Chronic Lower Respiratory Disease 66.6 59.8 50.7 58.3 55.3 Colorectal Cancer 14.3 22.1 16.3 18.6 17.0 Diabetes Mellitus 23.0 28.1 11.8 19.3 15.0 Diseases of the Heart, Total 177.5 197.3 190.6 224.4 199.2 Essential Hypertensive Renal 10.1 26.7 4.6 11.0 7.0 Homicide, Assault 3.4 8.4 5.0 4.3 5.4 Human Immunodeficiency Virus (HIV) – – 3.0 – 2.6 Influenza and Pneumonia 17.4 14.0 18.2 22.0 19.0 Lip, Oral Cavity, and Pharynx Cancer 3.6 – 2.6 3.4 3.0 Lung, Trachea, and Bronchus Cancer 53.5 46.2 44.7 43.5 46.2 Malignant Neoplasms, Total 158.1 191.6 162.1 179.0 170.8 Melanoma (Skin Cancer) 2.0 – 1.8 3.3 2.2 Nephritis, Nephrotic Syndrome, Nephrosis 9.8 10.0 14.7 9.1 13.4 Parkinson’s Disease 5.4 10.1 6.3 9.7 7.0 Pedestrian Deaths (Non-transport) 23.7 16.2 25.2 31.2 29.5 Pneumonitis Due to Solids and Liquids 4.7 – 4.8 12.9 6.4 Prostate Cancer (Men) 29.2 29.2 22.9 31.1 25.0 Septicemia 8.9 – 7.4 14.9 9.0 Suicide, Intentional Self Harm 20.4 34.1 16.4 20.3 18.6 Transport Accidents 12.1 17.3 8.4 6.7 11.7 Total Mortality – All Causes 756.3 954.6 739.9 898.0 777.4

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.54: Mortality Rates by Cause of Death in Rural and Frontier Nevada – 2009 to 2013

Number of Deaths per 100,000 Change – Population (Age-adjusted) 2009 to 2013 Region/County 2009 2011 2013 Number Percent

Alzheimer’s Disease 15.4 21.2 21.4 6.0 39.0 Atherosclerosis 4.4 4.4 4.5 0.1 2.3 Benign Neoplasms 5.5 3.4 3.3 -2.2 -40.0 Breast Cancer (Women) 16.7 21.0 21.3 4.6 27.5 Cerebrovascular Diseases (Stroke) 34.2 37.0 31.8 -2.4 -7.0 Chronic Liver Disease and Cirrhosis 14.3 18.5 14.5 0.2 1.4 Chronic Lower Respiratory Disease 61.8 58.5 66.6 4.8 7.8 Colorectal Cancer 16.4 16.8 14.3 -2.1 -12.8 Diabetes Mellitus 22.4 19.7 23.0 0.6 2.7 Diseases of the Heart, Total 187.2 199.5 177.5 -9.7 -5.2 Essential Hypertensive Renal 9.6 9.1 10.1 0.5 5.2 Homicide, Assault 2.0 7.0 3.4 1.4 70.0 Human Immunodeficiency Virus (HIV) 2.1 – – – – Influenza and Pneumonia 22.3 22.7 17.4 -4.9 -22.0 Lip, Oral Cavity, and Pharynx Cancer 3.2 3.4 3.6 0.4 12.5 Lung, Trachea, and Bronchus Cancer 59.4 49.3 53.5 -5.9 -9.9 Malignant Neoplasms, Total 186.4 174.9 158.1 -28.3 -15.2 Melanoma (Skin Cancer) 4.0 5.3 2.0 -2.0 -50.0 Nephritis, Nephrotic Syndrome, Nephrosis 14.5 13.4 9.8 -4.7 -32.4 Parkinson’s Disease 4.5 3.1 5.4 0.9 20.0 Pedestrian Deaths (Non-transport) 24.6 35.7 23.7 -0.9 -3.7 Pneumonitis Due to Solids and Liquids 6.1 6.1 4.7 -1.4 -23.0 Prostate Cancer (Men) 25.5 20.5 29.2 3.7 14.5 Septicemia 9.8 12.0 8.9 -0.9 -9.2 Suicide, Intentional Self Harm 23.7 26.3 20.4 -3.3 -13.9 Transport Accidents 12.2 24.5 12.1 -0.1 -0.8 Total Mortality – All Causes 809.1 839.8 756.3 -52.8 -6.5

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.55: Leading Causes of Death in Nevada by Region of Residence – 2013

Leading Causes of Death – Rank Within Region

Cause of Death Rural and Clark Washoe Frontier Carson City Nevada County County Counties Diseases of the Heart, Total 1 1 1 1 1 Malignant Neoplasms, Total 2 2 2 2 2 Chronic Lower Respiratory Disease 3 3 3 3 3 Lung, Trachea, and Bronchus Cancer 4 4 4 4 4 Cerebrovascular Disease (Stroke) 5 6 5 6 5 Prostate Cancer (Men) 6 8 7 8 7 Non-transport Accidents 7 15 6 7 6 Diabetes(Pedestrian) MellitusDeaths) 8 9 14 12 13 Alzheimer's Disease 9 5 13 5 10 Breast Cancer (Women) 10 11 8 10 8 Suicide, Intentional Self Harm 11 7 10 11 11 Influenza and Pneumonia 12 16 9 9 9 Chronic Liver Disease and Cirrhosis 13 12 15 14 15 Colorectal Cancer 14 13 11 13 12 Transport Accidents 15 14 16 21 16 Essential Hypertensive Renal 16 10 21 18 18 Nephritis, Nephrotic Syndrome, Nephrosis 17 18 12 20 14 Septicemia 18 21 17 15 17 Parkinson's Disease 19 17 18 19 19 Pneumonitis Due to Solids and Liquids 20 20 20 17 20 Atherosclerosis 21 22 26 16 23 Homicide, Assault 22 19 19 23 21 Lip, Oral Cavity, and Pharynx Cancer 23 25 24 24 24 Benign Neoplasms 24 23 22 22 22 Melanoma (Skin Cancer) 25 24 25 25 26 Human Immunodeficiency Virus (HIV) 26 26 23 26 25

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.56: Mortality by Socio-demographic Status in Nevada by Region of Residence – 2013

Number of Deaths per 100,000 Population (Age-adjusted)

Socio-demographic Status Rural and Carson Clark Washoe Frontier Nevada City County County Counties Gender Male 891.5 1,177.8 889.8 1,077.2 924.9 Female 654.1 797.8 617.3 757.4 647.2 Race and Ethnicity White 774.6 994.0 743.3 932.6 785.1 Black 579.5 788.9 981.6 1,086.2 975.3 Native American 558.6 954.6 353.3 619.9 503.8 Asian 433.1 – 639.7 640.5 629.7 Hispanic 515.9 517.0 658.5 602.2 638.4 Total Mortality 766.6 964.5 741.6 903.9 777.4

Source: Office of Health Statistics and Surveillance (2014e).

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Table 3.57: Population Health Institute’s County Health Rankings in Nevada – Health Outcomes – 2014

Health Outcomes County Rank Mortality – Morbidity – Overall Rank – Length of Life Quality of Life Health Outcomes 1 Storey Lincoln Lincoln 2 Lincoln Humboldt Storey 3 Douglas Churchill Douglas 4 Washoe Carson City Washoe 5 Lyon Washoe Carson City 6 Clark Elko Elko 7 Elko Eureka Lyon 8 Carson City Douglas Clark 9 Pershing White Pine Humboldt 10 Eureka Clark Eureka 11 Churchill Lyon Churchill 12 Humboldt Lander Pershing 13 Lander Mineral White Pine 14 White Pine Pershing Lander 15 Mineral Storey Mineral 16 Nye Nye Nye

Source: County Health Rankings (2014).

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Table 3.58: Population Health Institute’s County Health Rankings in Nevada – Health Determinants – 2014

Health Determinants County Social and Overall Rank – Rank Physical Health Behaviors Clinical Care Economic Health Environment Factors Determinants 1 Lander Douglas Eureka Eureka Douglas 2 Douglas White Pine Elko Lander Eureka 3 Lincoln Washoe Lander White Pine Lander 4 Washoe Carson City Douglas Elko White Pine 5 White Pine Eureka Storey Carson City Storey 6 Carson City Elko Humboldt Washoe Elko 7 Storey Clark White Pine Mineral Washoe 8 Clark Storey Churchill Pershing Lincoln 9 Eureka Churchill Lincoln Humboldt Humboldt 10 Humboldt Nye Washoe Lyon Carson City 11 Churchill Lyon Lyon Nye Churchill 12 Pershing Lincoln Clark Churchill Clark 13 Elko Humboldt Pershing Lincoln Lyon 14 Lyon Lander Carson City Douglas Pershing 15 Nye Mineral Mineral Clark Nye 16 Mineral Pershing Nye Storey Mineral

Source: County Health Rankings (2014).

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Highlights and Key Findings

 Currently, there are 1.37 million Nevadans in the state’s labor force, including 1.26 million who are employed and 112,617 who are unemployed – the annualized unemployment rate for 2014 is 8.2% (Table 4.1).

 In 2014, the average annual unemployment rate ranged from 3.1% in Esmeralda County to 11.5% in Lyon County – across most rural counties, unemployment rates increased between 2004 and 2010, and have declined between 2010 and 2014 (Table 4.2).

 In 2013, there were an estimated 96,484 Nevadans employed in the health sector, including 6,276 in rural and frontier counties – 7.0% of the state’s workforce is employed in hospitals, outpatient settings, nursing homes, pharmacies, and other industries in the health sector (Table 4.3).

 In 2013, Nevadans employed in the health sector earned $5.5 billion in payroll, including $287.8 million by rural Nevadans (Table 4.4).

 In 2014, there were an estimated 105,692 Nevadans employed in the health care and social services sector, including 44,259 employed in ambulatory health care services (41.9%), 32,148 employed in hospitals (30.4%), and 12,198 employed in nursing and residential care facilities (11.5%) (Table 4.5).

 In 2014, there were an estimated 6,064 individuals employed in the health care and social services sector in rural and frontier counties of Nevada, including 2,305 employed in ambulatory health care services (38.0%), 2,154 employed in hospitals (35.5%), and 1,006 employed in nursing and residential care facilities (16.6%) (Table 4.5).

 In 2024, there will be a projected 121,132 Nevadans employed in the health care and social services sector, including 50,441 employed in ambulatory health care services (41.6%), 35,243 employed in hospitals (29.1%), and 13,958 employed in nursing and residential care facilities (11.5%) (Table 4.6).

 In 2024, there were an estimated 7,487 individuals employed in the health care and social services sector in rural and frontier counties of Nevada, including 2,843 employed in ambulatory health care services (38.0%), 2,179 employed in hospitals (29.1%), and 1,223 employed in nursing and residential care facilities (16.3%) (Table 4.6).

 In 2014, there were 4,874 licensed allopathic physicians (MDs) in Nevada or 172.3 MDs per 100,000 population, including 207 licensed MDs in rural and frontier counties or 72.8 MDs per 100,000 population (Table 4.7).

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 Over the past decade, the number of licensed MDs in Nevada increased from 3,616 in 2004 to 4,874 in 2014 – an increase of 1,258 or 34.8% (Table 4.7).

 Since 2004, the number of licensed MDs per 100,000 population in Nevada increased from 150.0 in 2004 to 172.3 in 2014 – an increase of 14.9%; however, the number of MDs per capita in rural and frontier counties declined by 9.6% during the same period (Table 4.7).

 In 2014, 11.1% of licensed MDs in Nevada completed their undergraduate medical education (UME) at the University of Nevada School of Medicine (UNSOM) – 14.5% of rural and frontier MDs completed their UME at UNSOM (Table 4.8).

 In 2014, 10.9% of licensed MDs in Nevada completed their graduate medical education (GME) at the University of Nevada School of Medicine (UNSOM) – only 5.3% of rural and frontier MDs completed their GME at UNSOM (Table 4.8).

 In 2014, there were 595 licensed osteopathic physicians (DOs) in Nevada, including 45 DOs in rural and frontier counties – since 2006, the number of DOs in Nevada has increased by 147 or 32.8% and the per capita number of DOs has grown from 17.1 to 21.0 per 100,000 population (22.8%) (Table 4.9).

 In 2014, there were 2,442 licensed primary care physicians in Nevada (2,127 MDs and 315 DOs), including 141 primary care physicians (111 MDs and 30 DOs) in rural and frontier counties – the per capita number of primary care physicians in rural and frontier counties is 49.6 per 100,000 population, as compared to 90.4 per 100,000 population in urban areas (Table 4.10).

 In 2014, there were 901 advanced practitioners of nursing (APNs) in Nevada, including 56 APNs in rural and frontier counties – the per capita number of APNs in rural and frontier counties is 19.7 per 100,000 population, as compared to 33.2 per 100,000 population in urban areas (Table 4.11).

 Over the past decade, the number of APNs in Nevada has increased from 382 in 2004 to 901 in 2014 (135.9%) and the per capita number of APNs in Nevada has increased by 101.9% during the same period (Table 4.11).

 In 2014, there were 571 physician assistants (PAs) in Nevada, including 40 PAs in rural and frontier counties – the per capita number of PAs in rural and frontier counties is 14.1 per 100,000 population, as compared to 20.9 per 100,000 population in urban areas (Table 4.12).

 Over the past decade, the number of physician assistants (PAs) in Nevada has increased from 302 in 2004 to 571 in 2014 (89.1%) and the per capita number of PAs in Nevada has increased by 61.6% during the same period (Table 4.12).

 Currently, there are 21,563 licensed registered nurses (RNs) who reside in Nevada, including 1,475 RNs in rural and frontier counties (8,445 RNs licensed by the State of Nevada reside out of state) (Table 4.13).

 Over the past decade, the number of licensed registered nurses (RNs) has increased from 14,825 in 2004 to 21,563 in 2014 (45.5%) and the per capita number of RNs in Nevada has increased 24.0% during the same period (Table 4.13).

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 At the county level, the number of RNs per 100,000 population currently ranges from 48.6 in Eureka County to 967.4 in Washoe County – the average for rural and frontier counties is 518.5 RNs per 100,000 population, as compared to 789.5 in urban counties (Table 4.13).

 In 2014, there were 2,977 licensed practical nurses (LPNs) in Nevada, including 219 LPNs in rural and frontier counties – since 2004, the number of LPNs in Nevada has increased by 392 or 15.2%, yet the per capita number of LPNs has declined from 107.2 to 105.2 per 100,000 population during the same period (-1.9%) (Table 4.14).

 In 2014, there were 86 certified registered nurses anesthetists (CRNAs) in Nevada, including 15 CRNAs in rural and frontier counties – since 2004, the number of CRNAs in Nevada has increased by 27 or 45.8% and the per capita number of CRNAs has grown from 2.4 to 3.0 per 100,000 population (25.0%) (Table 4.15).

 In 2014, there were 124 registered nurses with emergency medical services certification (EMS/RNs) in Nevada, including 23 EMS/RNs in rural and frontier counties – since 2004, the number of EMS/RNs in Nevada has decreased by 9 or -6.8% and the per capita number of EMS/RNs has declined from 5.5 to 4.4 per 100,000 population (-20.0%) (Table 4.16).

 In 2014, there were 7,863 certified nursing assistants (CNAs) in Nevada, including 930 CNAs in rural and frontier counties – since 2004, the number of CNAs in Nevada has increased by 2,217 or 39.3% and the per capita number of CNAs has grown from 234.2 to 278.0 per 100,000 population (18.7%) (Table 4.17).

 Currently, there are 1,553 licensed dentists in Nevada, including 108 dentists in rural and frontier counties (Table 4.18).

 Over the past decade, the number of licensed dentists has increased from 1,091 in 2004 to 1,553 in 2014 (42.3%) and the per capita number of dentists in Nevada has increased 21.2% during the same period (Table 4.18).

 At the county level, the number of dentists per 100,000 population currently ranges from 15.2 in Lander County to 63.9 in Carson City (Esmeralda and Storey counties have no dentists) – the average for rural and frontier counties is 38.0 dentists per 100,000 population, as compared to 56.8 in urban counties (Table 4.18).

 In 2014, there were 1,047 licensed dental hygienists in Nevada, including 104 dental hygienists in rural and frontier counties – since 2004, the number of dental hygienists in Nevada has increased by 56 or 5.7%, yet the per capita number of dental hygienists has declined from 41.1 to 37.0 per 100,000 population (-10.0%) (Table 4.19).

 In 2014, there were 1,227 licensed alcohol, drug, and gambling counselors in Nevada, including 158 licensed alcohol, drug, and gambling counselors in rural and frontier counties – since 2004, the number of licensed alcohol, drug, and gambling counselors in Nevada has decreased by 6 or -0.5% and the per capita number of licensed alcohol, drug, and gambling counselors has declined from 45.0 to 43.4 per 100,000 population (-3.6%) (Table 4.20).

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 In 2012, there were 669 licensed marriage and family therapists (MFTs) in Nevada, including 49 MFTs in rural and frontier counties – since 2010, the number of MFTs in Nevada has increased by 34 or 5.4% and the per capita number of MFTs has increased from 23.5 to 24.3 MFTs per 100,000 population (3.4%) (Table 4.21).

 In 2012, there were 47 licensed clinical professional counselors (LCPCs) in Nevada, including 8 LCPCs in rural and frontier counties – since 2010, the number of LCPCs in Nevada has increased by 19 or 67.9% and the per capita number of LCPCs has increased from 12.7 to 20.4 LCPCs per 100,000 population (60.6%) (Table 4.22).

 In 2014, there were 602 licensed clinical social workers (LCSWs) in Nevada, including 42 LCSWs in rural and frontier counties – the average for rural and frontier counties is 14.8 LCSWs per 100,000 population, as compared to 22.0 in urban counties (Tables 4.25 and 4.26).

 Currently, there are 2,217 licensed pharmacists in Nevada, including 127 pharmacists in rural and frontier counties (Table 4.27).

 Over the past decade, the number of licensed pharmacists has increased from 1,530 in 2004 to 2,217 in 2014 (44.9%) and the per capita number of pharmacists in Nevada has increased 23.5% during the same period (Table 4.27).

 In 2014, there were 5,463 licensed pharmaceutical technicians in Nevada, including 420 pharmaceutical technicians in rural and frontier counties – since 2004, the number of pharmaceutical technicians in Nevada has increased by 2,768 or 102.7% and the per capita number of pharmaceutical technicians as grown from 111.8 to 193.1 per 100,000 population (72.7%) (Table 4.28).

 In 2014, there were 593 licensed chiropractors in Nevada, including 35 chiropractors in rural and frontier counties – since 2004, the number of chiropractors in Nevada has increased by 78 or 15.1%, however, the per capita number of chiropractors has decreased from 21.4 to 21.0 chiropractors per 100,000 population (-1.9%) (Table 4.29).

 In 2014, there were 400 registered dietitians (RDs) in Nevada, including 19 RDs in rural and frontier counties (Table 4.30).

 In 2014, there were 287 licensed dispensing opticians in Nevada, including 11 opticians in rural and frontier counties – since 2004, the number of licensed dispensing opticians in Nevada has increased by 92 or 47.2% and the per capita number of opticians has grown from 8.1 to 10.1 per 100,000 population (24.7%) (Table 4.31).

 In 2014, there were 150 licensed dispensing optician apprentices in Nevada, including eight optician apprentices in rural and frontier counties (Table 4.32).

 In 2012, there were 6,425 emergency medical technicians (EMTs) in Nevada, including 601 first responders, 1,865 basic EMTs, 2,431 intermediate EMTs, and 1,528 paramedics (Table 4.33).

 In 2012, there were 1,715 emergency medical technicians (EMTs) in rural and frontier Nevada, including 439 first responders, 643 basic EMTs, 474 intermediate EMTs, and 159 paramedics (Table 4.33).

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 In 2012, there were 233.6 emergency medical technicians (EMTs) per 100,000 population in Nevada – at the county level, the per capita number of EMTs ranged from 165 EMTs per 100,000 population in Clark County to 3,321 EMTs per 100,000 population in Esmeralda County (Table 4.34).

 Between 2006 and 2012, the number of emergency medical technicians (EMTs) in Nevada declined from 7,176 to 6,425 or -10.5% – during the same period, in rural and frontier areas, the number of EMTs declined by 458 or -21.1% (Table 4.35).

 In 2014, there were 3,696 licensed massage therapists in Nevada, including 184 licensed massage therapists in rural and frontier counties (Table 4.36).

 In 2014, there were 1,812 licensed medical laboratory technologists and technicians in Nevada, including 85 laboratory technologists and technicians in rural and frontier counties – currently, there are 64.1 licensed medical laboratory technologists and technicians per 100,000 population in Nevada, including 29.9 per 100,000 population in rural and frontier counties (Tables 4.37 and 4.38).

 Currently, there are 570 occupational therapists (OTs) in Nevada, including 34 OTs in rural and frontier counties – since 2004, the number of OTs in Nevada has increased by 205 or 56.2% and the per capita number of OTs has grown from 15.1 to 20.1 per 100,000 population (33.1%) (Table 4.40).

 In 2014, there were 171 occupational therapy assistants (OTAs) in Nevada, including 8 OTAs in rural and frontier counties – since 2004, the number of OTAs in Nevada has increased by 31 or 22.1% and the per capita number of OTAs has grown from 5.8 to 6.0 per 100,000 population (3.4%) (Table 4.41).

 In 2014, there were 386 licensed optometrists in Nevada, including 37 optometrists in rural and frontier counties – since 2004, the number of licensed optometrists in Nevada has increased by 145 or 60.2% and the per capita number of optometrists has grown from 10.0 to 13.6 per 100,000 population (36.0%) (Table 4.42).

 Currently, there are 1,074 physical therapists (PTs) in Nevada, including 82 PTs in rural and frontier counties – since 2004, the number of PTs in Nevada has increased by 360 or 50.4% and the per capita number of PTs has grown from 31.1 to 38.0 per 100,000 population (22.2%) (Table 4.43).

 In 2014, there were 302 physical therapy assistants (PTAs) in Nevada, including 17 PTAs in rural and frontier counties – since 2004, the number of PTAs in Nevada has increased by 148 or 96.1% and the per capita number of PTAs has grown from 6.7 to 10.7 per 100,000 population (59.7%) (Table 4.44).

 In 2014, there were 743 licensed podiatrists in Nevada or 26.3 licensed podiatrists per 100,000 population, including 43 licensed podiatrists in rural and frontier counties (Table 4.45).

 Currently, there are 1,314 licensed respiratory therapists (RTs) in Nevada, including 76 RTs in rural and frontier counties – since 2004, the number of RTs in Nevada has increased by 595 or 82.8% and the per capita number of RTs has grown from 29.8 to 46.5 per 100,000 population (56.0%) (Table 4.46).

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 In 2014, there were 744 licensed speech-language pathologists (SLPs) in Nevada, including 43 SLPs in rural and frontier counties – since 2004, the number of SLPs in Nevada has increased by 504 or 210.0% and the per capita number of SLPs has grown from 9.1 to 26.3 per 100,000 population (189.0%) (Table 4.47).

 In general, the number of licensed health professionals per 100,000 population is lower in rural and frontier counties of Nevada versus urban areas of the state – important exceptions include registered nurses with EMS certification, registered nurse anesthetists, and emergency medical technicians (Table 4.48).

 Currently, an estimated 911,684 Nevadans or 33.7% of the state’s population reside in a federally- designated primary medical care health professional shortage area (HPSA) – 9 of 17 counties in Nevada are single-county primary medical care HPSAs (Table 4.49 and Maps 4.1 through 4.3).

 In 2015, an estimated 142,476 residents of rural and frontier Nevada (50.6% of the population) live in a primary medical care health professional shortage area (HPSA) – 9 of 14 rural and frontier counties in Nevada are single-county primary medical care HPSAs (Table 4.49 and Maps 4.1 through 4.3).

 Currently, an estimated 903,241 Nevadans or 31.7% of the state’s population reside in a federally designated dental health professional shortage area (HPSA) – eight of 17 counties in Nevada are single- county dental HPSAs (Table 4.49 and Maps 4.4 through 4.6).

 In 2015, an estimated 145,426 residents of rural and frontier Nevada (51.4% of the population) live in a dental health professional shortage area (HPSA) – 8 of 14 rural and frontier counties in Nevada are single- county dental HPSAs (Table 4.49 and Maps 4.4 through 4.6).

 Currently, 1.5 million Nevadans or 53.3% of the state’s population reside in a federally designated mental health professional shortage area (HPSA) – 16 of 17 counties in Nevada are single-county mental HPSAs (Table 4.49 and Maps 4.7 through 4.9).

 In 2015, an estimated 286,251 residents of rural and frontier Nevada (100% of the population) live in a mental health professional shortage area (HPSA) – 14 of 14 rural and frontier counties in Nevada are single- county mental HPSAs (Table 4.49 and Maps 4.7 through 4.9).

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Table 4.1: Labor Force in Nevada by County – 2014

Labor Force

Region/County Unemployed Total Employed Labor Force Unemployment Number Rate Rural and Frontier Churchill County 12,615 11,734 881 7.0 Douglas County 21,097 19,209 1,889 9.0 Elko County 29,532 27,865 1,667 5.7 Esmeralda County 705 683 22 3.1 Eureka County 1,055 995 60 5.7 Humboldt County 9,679 9,073 606 6.3 Lander County 4,827 4,590 237 4.9 Lincoln County 1,654 1,476 178 10.8 Lyon County 21,649 19,162 2,488 11.5 Mineral County 1,802 1,605 197 10.9 Nye County 17,283 15,658 1,625 9.4 Pershing County 2,772 2,534 238 8.6 Storey County 2,107 1,941 167 7.9 White Pine County 5,288 4,951 337 6.4 Region Subtotal 132,065 121,476 10,592 8.0 Urban Carson City 26,675 24,314 2,361 8.8 Clark County 992,068 910,064 82,005 8.3 Washoe County 222,241 204,582 17,659 8.0 Region Subtotal 1,240,984 1,138,960 102,025 8.2 Nevada – Total 1,373,049 1,260,436 112,617 8.2

Source: Department of Employment, Training, and Rehabilitation (2014a).

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Table 4.2: Unemployment in Nevada by County – 2004 to 2014

Average Annual Unemployment Rate Region/County 2004 2006 2008 2010 2012 2014 Rural and Frontier Churchill County 4.2 5.0 6.3 10.6 9.9 7.0 Douglas County 4.3 5.4 7.7 14.5 13.1 9.0 Elko County 3.8 4.4 4.5 7.4 6.5 5.7 Esmeralda County 5.3 4.8 5.2 7.1 6.1 3.1 Eureka County 4.2 5.2 5.5 7.6 6.3 5.7 Humboldt County 3.9 4.3 5.2 8.1 6.6 6.3 Lander County 4.2 4.5 4.6 7.1 5.7 4.9 Lincoln County 5.3 5.6 5.8 12.6 13.5 10.8 Lyon County 5.5 7.4 10.2 17.8 15.8 11.5 Mineral County 5.4 8.2 7.8 13.9 13.1 10.9 Nye County 6.0 5.8 10.2 16.5 14.8 9.4 Pershing County 4.3 6.3 7.3 10.9 10.9 8.6 Storey County 3.3 5.4 7.2 14.4 12.0 7.9 White Pine County 3.7 4.8 4.9 8.8 7.4 6.4 Region Average 4.6 4.8 7.3 12.4 10.9 8.0 Urban Carson City 5.0 5.4 7.4 13.0 12.2 8.8 Clark County 4.5 4.3 7.0 14.1 12.3 8.3 Washoe County 4.1 4.7 7.1 13.1 11.9 8.0 Region Average 4.4 4.2 7.0 13.9 12.2 8.2 Nevada – Average 4.4 4.2 7.0 13.7 12.1 8.2 U.S. – Average 5.5 4.6 5.8 9.6 8.1 6.5

Source: Department of Employment, Training, and Rehabilitation (2014a).

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Table 4.3: Health Sector Employment in Nevada by County – 2013

Health Sector Employment (Number of Jobs)

Physicians, Region/County Other Medical Dentists, and Nursing and Hospital Pharmacies and Health Total Other Protective Care Services Professionals Rural and Frontier Churchill County 297 236 228 38 45 844 Douglas County 293 588 260 55 110 1,306 Elko County 321 550 275 24 126 1,296 Esmeralda County 0 0 0 0 0 0 Eureka County 0 13 0 0 0 13 Humboldt County 250 139 121 10 21 541 Lander County 116 14 0 10 0 140 Lincoln County 76 13 138 10 4 241 Lyon County 158 118 103 43 10 432 Mineral County 136 38 0 0 0 174 Nye County 249 245 79 48 108 729 Pershing County 97 10 10 4 0 121 Storey County 0 117 0 0 0 117 White Pine County 165 54 79 24 0 332 Region Subtotal 2,158 2,136 1,293 266 423 6,276 Urban Carson City 1,259 947 650 87 292 3,235 Clark County 22,348 23,442 8,555 3,709 9,788 67,842 Washoe County 6,706 7,099 3,029 556 1,741 19,131 Region Subtotal 30,313 31,488 12,234 4,352 11,821 90,208 Nevada – Total 32,471 33,624 13,527 4,618 12,244 96,484

Sources: Nevada Compare Care. (2014a). Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). University Center for Economic Development (2014).

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Table 4.4: Health Sector Payroll in Nevada by County – 2013

Health Sector Payroll (Thousands of Dollars)

Physicians, Region/County Other Medical Hospital Dentists, and Nursing and Pharmacies and Health Total Payroll Other Protective Care Services Professionals Rural and Frontier Churchill County 16,613 13,808 5,762 1,320 1,196 38,700 Douglas County 14,577 33,842 10,294 1,800 4,378 64,891 Elko County 17,406 30,461 9,023 940 1,749 59,579 Esmeralda County 0 0 0 0 0 0 Eureka County 0 592 0 0 0 592 Humboldt County 13,627 6,136 6,533 199 486 26,981 Lander County 6,780 371 0 223 0 7,373 Lincoln County 2,810 297 5,353 294 85 8,840 Lyon County 5,850 5,969 3,058 1,461 384 16,722 Mineral County 6,508 1,318 0 0 0 7,826 Nye County 9,942 12,303 2,374 1,527 3,909 30,055 Pershing County 3,709 455 379 51 0 4,594 Storey County 0 3,074 0 0 0 3,074 White Pine County 13,174 2,055 3,005 344 520 18,578 Region Subtotal 110,996 110,679 45,782 8,160 12,187 287,804 Urban Carson City 74,188 76,544 18,436 3,290 16,845 189,303 Clark County 1,542,325 1,422,414 290,434 150,470 508,285 3,913,928 Washoe County 393,173 521,990 98,567 19,484 87,504 1,120,717 Region Subtotal 2,009,686 2,020,948 407,436 173,244 612,634 5,223,948 Nevada – Total 2,120,681 2,131,627 453,218 181,405 624,821 5,511,752

Sources: Nevada Compare Care. (2014a). Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). University Center for Economic Development (2014).

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Table 4.5: Employment in the Health Care and Social Assistance Sector by Region in Nevada – 2014

Estimated Employment Industry Las Vegas Reno-Sparks Carson City Rural and Nevada MSA MSA MSA Frontier Ambulatory Health Care Services Offices of Physicians 12,043 3,582 602 832 17,058 Offices of Dentists 5,289 1,376 206 553 7,425 Offices of Other Health Practitioners 3,783 1,128 136 461 5,509 Outpatient Care Centers 2,771 766 0 38 3,574 Medical and Diagnostic Laboratories 2,562 345 66 0 2,974 Home Health Care Services 4,351 617 0 41 5,008 Other Ambulatory Health Care Services 1,411 642 278 380 2,711 Subtotal – Ambulatory Health Care Services 32,210 8,456 1,288 2,305 44,259

Hospitals General Medical and Surgical Hospitals 19,800 6,220 1,071 2,154 29,245 Psychiatric and Substance Abuse Hospitals 619 677 0 0 1,296 Other Hospitals 1,607 0 0 0 1,607 Subtotal – Hospitals 22,026 6,897 1,071 2,154 32,148

Nursing and Residential Care Facilities Nursing Care Facilities 4,067 1,118 435 651 6,271 Residential Mental Health Facilities 1,013 528 0 163 1,704 Community Care Facility for the Elderly 2,138 566 212 192 3,108 Other Nursing and Residential Care Facilities 386 720 9 0 1,115 Subtotal – Nursing and Residential Care Facilities 7,604 2,932 656 1,006 12,198 Total – Health Care Industries 61,840 18,285 3,015 5,465 88,605

Social Assistance Individual and Family Services 7,611 2,132 423 306 10,472 Emergency and Other Relief Services 561 211 0 0 772 Vocational Rehabilitation Services 1,465 582 0 0 2,047 Child Day Care Services 2,653 850 0 293 3,796 Subtotal – Social Assistance 12,290 3,775 423 599 17,087

Total – Health Care and Social Assistance Sector 74,130 22,060 3,438 6,064 105,692

Sources: Department of Employment, Training, and Rehabilitation (2014b). Nevada Compare Care (2014a).

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Table 4.6: Projected Employment in the Health Care and Social Assistance Sector by Region in Nevada – 2024

Projected Employment Industry Las Vegas Reno-Sparks Carson City Rural and Nevada MSA MSA MSA Frontier Ambulatory Health Care Services Offices of Physicians 12,579 4,288 662 971 18,500 Offices of Dentists 5,680 1,539 236 607 8,062 Offices of Other Health Practitioners 4,520 1,438 167 549 6,674 Outpatient Care Centers 3,470 1,025 0 64 4,559 Medical and Diagnostic Laboratories 3,186 300 87 0 3,573 Home Health Care Services 4,950 793 0 0 5,743 Other Ambulatory Health Care Services 1,415 842 428 645 3,330 Subtotal – Ambulatory Health Care Services 35,800 10,225 1,580 2,843 50,441

Hospitals General Medical and Surgical Hospitals 21,264 7,672 1,110 2,179 32,225 Psychiatric and Substance Abuse Hospitals 709 0 0 0 709 Other Hospitals 2,309 0 0 0 2,309 Subtotal – Hospitals 24,282 7,672 1,110 2,179 35,243

Nursing and Residential Care Facilities Nursing Care Facilities 4,752 1,306 514 777 7,349 Residential Mental Health Facilities 1,225 639 0 197 2,061 Community Care Facility for the Elderly 2,681 0 274 249 3,204 Other Residential Care Facilities 493 840 11 0 1,344 Subtotal – Nursing and Residential Care Facilities 9,151 2,785 799 1,223 13,958 Total – Health Care Industries 69,233 20,682 3,489 6,238 99,642

Social Assistance Individual and Family Services 9,631 2,820 534 400 13,385 Emergency, and Other Relief Services 654 246 0 521 1,421 Vocational Rehabilitation Services 1,613 604 0 0 2,217 Child Day Care Services 3,117 1,022 0 328 4,467 Subtotal – Social Assistance 15,015 4,692 534 1,249 21,490

Total – Health Care and Social Assistance Sector 84,248 25,374 4,023 7,487 121,132

Sources: Department of Employment, Training, and Rehabilitation (2014c). Nevada Compare Care (2014a).

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Table 4.7: Licensed Allopathic Physicians (MDs) in Nevada by County – 2004 to 2014

Licensed Allopathic Physicians (MDs)

Number per 100,000 Region/County Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 24 27 3 12.5 91.9 106.0 Douglas County 74 76 2 2.7 154.8 157.7 Elko County 41 40 -1 -2.4 88.2 73.7 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 1 0 -1 -100.0 67.4 0.0 Humboldt County 7 12 5 71.4 41.9 67.0 Lander County 3 1 -2 -66.7 56.0 15.2 Lincoln County 1 2 1 100.0 26.2 39.4 Lyon County 15 20 5 33.3 33.6 37.5 Mineral County 4 3 -1 -25.0 85.6 66.9 Nye County 22 17 -5 -22.7 57.6 37.8 Pershing County 2 0 -2 -100.0 30.2 0.0 Storey County 1 0 -1 -100.0 26.3 0.0 White Pine County 11 9 -2 -18.2 122.7 87.7 Region Subtotal 206 207 1 0.5 80.5 72.8 Urban Carson City 141 180 39 27.7 251.1 328.6 Clark County 2,366 3,355 989 41.8 137.9 163.5 Washoe County 903 1,132 229 25.4 235.5 258.7 Region Subtotal 3,410 4,667 1,257 36.9 158.2 183.4 Nevada – Total 3,616 4,874 1,258 34.8 150.0 172.3

Source: Nevada State Board of Medical Examiners (2004). Nevada State Board of Medical Examiners (2014).

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Table 4.8: Licensed Allopathic Physicians (MDs) by Location of Medical Education in Nevada by County – 2014

Licensed Allopathic Physicians (MDs)

University of Nevada School of Medicine Region/County Total Undergraduate Graduate Medical Education Medical Education Number Percent Number Percent Rural and Frontier Churchill County 27 6 22.2 5 18.5 Douglas County 76 11 14.5 1 1.3 Elko County 40 7 17.5 1 2.5 Esmeralda County 0 0 0 0 0 Eureka County 0 0 0 0 0 Humboldt County 12 0 0.0 0 0.0 Lander County 1 0 0.0 0 0.0 Lincoln County 2 0 0.0 0 0.0 Lyon County 20 4 20.0 3 15.0 Mineral County 3 0 0.0 0 0.0 Nye County 17 0 0.0 0 0.0 Pershing County 0 0 0 0 0 Storey County 0 0 0 0 0 White Pine County 9 2 22.2 1 11.1 Region Subtotal 207 30 14.5 11 5.3 Urban Carson City 180 27 15.0 11 6.1 Clark County 3,355 225 6.7 344 10.3 Washoe County 1,132 260 23.0 167 14.8 Region Subtotal 4,667 512 11.0 522 11.2 Nevada – Total 4,874 542 11.1 533 10.9

Source: Nevada State Board of Medical Examiners (2014).

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Table 4.9: Licensed Osteopathic Physicians (DOs) in Nevada by County – 2006 to 2014

Licensed Osteopathic Physicians (DOs)

Region/County Number per 100,000 Number Change – 2006 to 2014 Population 2006 2014 Number Percent 2006 2014 Rural and Frontier Churchill County 3 3 0 0.0 11.0 11.8 Douglas County 8 10 2 25.0 15.5 20.7 Elko County 9 11 2 22.2 18.6 20.3 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 1 1 100.0 0.0 48.6 Humboldt County 1 2 1 100.0 5.6 11.2 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 2 1 -1 -50.0 3.7 1.9 Mineral County 0 0 0 0.0 0.0 0.0 Nye County 5 9 4 80.0 11.2 20.0 Pershing County 1 3 2 200.0 14.4 43.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 1 5 4 400.0 10.5 48.7 Region Subtotal 30 45 15 50.0 10.7 15.8 Urban Carson City 20 20 0 0.0 34.7 36.5 Clark County 334 456 122 36.5 17.8 22.2 Washoe County 64 74 10 15.6 15.6 16.9 Region Subtotal 418 550 132 31.6 17.9 21.6 Nevada – Total 448 595 147 32.8 17.1 21.0

Source: Nevada State Board of Osteopathic Medicine (2006). Nevada State Board of Osteopathic Medicine (2014).

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Table 4.10: Licensed Primary Care Physicians (MDs and DOs) in Nevada by County – 2014

Licensed Primary Care Physicians (MDs and DOs)

Region/County Number Number per Total 100,000 MDs DOs Rural and Frontier Churchill County 19 2 21 82.5 Douglas County 26 6 32 66.4 Elko County 20 4 24 44.2 Esmeralda County 0 0 0 0.0 Eureka County 0 1 1 48.6 Humboldt County 10 2 12 67.0 Lander County 0 0 0 0.0 Lincoln County 1 0 1 19.7 Lyon County 15 1 16 30.0 Mineral County 5 0 5 111.5 Nye County 10 8 18 40.1 Pershing County 0 2 2 28.7 Storey County 0 0 0 0.0 White Pine County 5 4 9 87.7 Region Subtotal 111 30 141 49.6 Urban Carson City 66 9 75 136.9 Clark County 1,480 233 1,713 83.5 Washoe County 470 43 513 117.2 Region Subtotal 2,016 285 2,301 90.4 Nevada – Total 2,127 315 2,442 86.3

Source: Nevada State Board of Medical Examiners (2014). Nevada State Board of Osteopathic Medicine (2014).

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Table 4.11: Licensed Advanced Practitioners of Nursing (APNs) in Nevada by County – 2004 to 2014

Licensed Advanced Practitioners of Nursing (APNs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 4 3 -1 -25.0 15.3 11.8 Douglas County 12 19 7 58.3 25.1 39.4 Elko County 13 12 -1 -7.7 28.0 22.1 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 1 1 100.0 0.0 48.6 Humboldt County 2 6 4 200.0 12.0 33.5 Lander County 0 1 1 100.0 0.0 15.2 Lincoln County 1 1 0 0.0 26.2 19.7 Lyon County 7 7 0 0.0 15.7 13.1 Mineral County 0 0 0 0.0 0.0 0.0 Nye County 4 4 0 0.0 10.5 8.9 Pershing County 2 1 -1 -50.0 30.2 14.3 Storey County 1 0 -1 -100.0 26.3 0.0 White Pine County 2 1 -1 -50.0 22.3 9.7 Region Subtotal 48 56 8 16.7 18.8 19.7 Urban Carson City 15 21 6 40.0 26.7 38.3 Clark County 202 577 375 185.6 11.8 28.1 Washoe County 117 247 130 111.1 30.5 56.4 Region Subtotal 334 845 511 153.0 15.5 33.2 Nevada – Total 382 901 519 135.9 15.8 31.9

Source: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014).

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Table 4.12: Licensed Physician Assistants (PAs) in Nevada by County – 2004 to 2014

Licensed Physician Assistants (PAs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 6 10 4 66.7 23.0 39.3 Douglas County 4 5 1 25.0 8.4 10.4 Elko County 3 9 6 200.0 6.5 16.6 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 1 0 -1 -100.0 67.4 0.0 Humboldt County 1 0 -1 -100.0 6.0 0.0 Lander County 1 1 1 0.0 18.7 15.2 Lincoln County 1 2 1 100.0 26.2 39.4 Lyon County 4 5 1 25.0 9.0 9.4 Mineral County 1 3 2 200.0 21.4 66.9 Nye County 7 2 -5 -71.4 18.3 4.5 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 2 2 200.0 0.0 49.6 White Pine County 1 1 0 0.0 11.2 9.7 Region Subtotal 30 40 10 33.3 11.7 14.1 Urban Carson City 9 25 16 177.8 16.0 45.6 Clark County 215 399 184 85.6 12.5 19.4 Washoe County 48 107 59 122.9 12.5 24.5 Region Subtotal 272 531 259 95.2 12.6 20.9 Nevada – Total 302 571 269 89.1 12.5 20.2

Sources: Nevada State Board of Medical Examiners (2004). Nevada State Board of Medical Examiners (2014). Nevada State Board of Osteopathic Medicine (2014).

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Table 4.13: Licensed Registered Nurses (RNs) in Nevada by County – 2004 to 2014

Licensed Registered Nurses (RNs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 144 173 29 20.1 551.6 679.5 Douglas County 301 372 71 23.6 629.7 771.7 Elko County 237 270 33 13.9 509.7 497.2 Esmeralda County 5 2 -3 -60.0 425.2 219.3 Eureka County 4 1 -3 -75.0 269.5 48.6 Humboldt County 55 74 19 34.5 329.5 413.2 Lander County 19 28 9 47.4 354.7 426.2 Lincoln County 10 20 10 100.0 261.6 394.1 Lyon County 180 283 103 57.2 403.2 530.6 Mineral County 16 21 5 31.3 342.4 468.1 Nye County 112 144 32 28.6 293.3 320.6 Pershing County 22 19 -3 -13.6 331.8 272.3 Storey County 20 18 -2 -10.0 526.7 446.7 White Pine County 41 50 9 22.0 457.3 487.2 Region Subtotal 1,166 1,475 309 26.5 455.8 518.5 Urban Carson City 504 518 14 2.8 897.7 945.7 Clark County 10,165 15,337 5,172 50.9 592.6 747.4 Washoe County 2,990 4,233 1,243 41.6 779.8 967.4 Region Subtotal 13,659 20,088 6,429 47.1 633.8 789.5 Nevada – Total 14,825 21,563 6,738 45.5 614.9 762.3

Source: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014).

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Table 4.14: Licensed Practical Nurses (LPNs) in Nevada by County – 2004 to 2014

Licensed Practical Nurses (LPNs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 31 21 -10 -32.3 118.7 82.5 Douglas County 37 27 -10 -27.0 77.4 56.0 Elko County 32 22 -10 -31.3 68.8 40.5 Esmeralda County 1 0 -1 -100.0 85.0 0.0 Eureka County 0 1 1 100.0 0.0 48.6 Humboldt County 12 9 -3 -25.0 71.9 50.3 Lander County 2 2 0 0.0 37.3 30.4 Lincoln County 7 6 -1 -14.3 183.2 118.2 Lyon County 48 52 4 8.3 107.5 97.5 Mineral County 6 9 3 50.0 128.4 200.6 Nye County 47 46 -1 -2.1 123.1 102.4 Pershing County 9 4 -5 -55.6 135.7 57.3 Storey County 2 2 0 0.0 52.7 49.6 White Pine County 25 18 -7 -28.0 278.8 175.4 Region Subtotal 259 219 -40 -15.4 101.2 77.0 Urban Carson City 75 50 -25 -33.3 133.6 91.3 Clark County 1,850 2,354 504 27.2 107.9 114.7 Washoe County 401 354 -47 -11.7 104.6 80.9 Region Subtotal 2,326 2,758 432 18.6 107.9 108.4 Nevada – Total 2,585 2,977 392 15.2 107.2 105.2

Sources: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014).

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Table 4.15: Certified Registered Nurse Anesthetists (CRNAs) in Nevada by County – 2004 to 2014

Certified Registered Nurse Anesthetists (CRNAs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 1 3 2 200.0 3.8 11.8 Douglas County 1 1 0 0.0 2.1 2.1 Elko County 3 6 3 100.0 6.5 11.0 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 1 2 1 100.0 6.0 11.2 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 0 0 0 0.0 0.0 0.0 Mineral County 0 0 0 0.0 0.0 0.0 Nye County 2 1 -1 -50.0 5.2 2.2 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 2 2 0 0.0 22.3 19.5 Region Subtotal 10 15 5 50.0 3.9 5.3 Urban Carson City 2 1 -1 -50.0 3.6 1.8 Clark County 39 63 24 61.5 2.3 3.1 Washoe County 8 7 -1 -12.5 2.1 1.6 Region Subtotal 49 71 22 44.9 2.3 2.8 Nevada – Total 59 86 27 45.8 2.4 3.0

Sources: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014).

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Table 4.16: Licensed Registered Nurses (RNs) with Emergency Medical Services (EMS) Certification in Nevada by County – 2004 to 2014

Licensed Registered Nurses with EMS Certification

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 6 3 -3 -50.0 23.0 11.8 Douglas County 2 1 -1 -50.0 4.2 2.1 Elko County 8 5 -3 -37.5 17.2 9.2 Esmeralda County 1 0 -1 -100.0 85.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 1 2 1 100.0 6.0 11.2 Lander County 4 2 -2 -50.0 74.7 30.4 Lincoln County 1 0 -1 -100.0 26.2 0.0 Lyon County 0 4 4 400.0 0.0 7.5 Mineral County 3 0 -3 -100.0 64.2 0.0 Nye County 1 5 4 400.0 2.6 11.1 Pershing County 2 1 -1 -50.0 30.2 14.3 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 0 0 0 0.0 0.0 0.0 Region Subtotal 29 23 -6 -20.7 11.3 8.1 Urban Carson City 1 0 -1 -100.0 1.8 0.0 Clark County 69 64 -5 -7.2 4.0 3.1 Washoe County 34 37 3 8.8 8.9 8.5 Region Subtotal 104 101 -3 -2.9 4.8 4.0 Nevada – Total 133 124 -9 -6.8 5.5 4.4

Sources: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014).

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Table 4.17: Certified Nursing Assistants (CNAs) in Nevada by County – 2004 to 2014

Certified Nursing Assistants (CNAs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 66 82 16 24.2 252.8 322.1 Douglas County 60 87 27 45.0 125.5 180.5 Elko County 139 168 29 20.9 298.9 309.4 Esmeralda County 1 0 -1 -100.0 85.0 0.0 Eureka County 1 3 2 200.0 67.4 145.9 Humboldt County 44 55 11 25.0 263.6 307.1 Lander County 18 31 13 72.2 336.0 471.9 Lincoln County 24 12 -12 -50.0 627.9 236.5 Lyon County 151 236 85 56.3 338.2 442.5 Mineral County 40 36 -4 -10.0 856.0 802.5 Nye County 93 138 45 48.4 243.6 307.2 Pershing County 25 27 2 8.0 377.0 387.0 Storey County 7 7 0 0.0 184.4 173.7 White Pine County 61 48 -13 -21.3 680.3 467.7 Region Subtotal 730 930 200 27.4 285.3 326.9 Urban Carson City 234 280 46 19.7 416.8 511.2 Clark County 3,405 5,320 1,915 56.2 198.5 259.3 Washoe County 1,277 1,333 56 4.4 333.0 304.6 Region Subtotal 4,916 6,933 2,017 41.0 228.1 272.5 Nevada – Total 5,646 7,863 2,217 39.3 234.2 278.0

Sources: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014).

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Table 4.18: Licensed Dentists in Nevada by County – 2004 to 2014

Licensed Dentists

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 4 10 6 150.0 15.3 39.3 Douglas County 24 28 4 16.7 50.2 58.1 Elko County 17 31 14 82.4 36.6 57.1 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 1 1 100.0 0.0 48.6 Humboldt County 7 7 0 0.0 41.9 39.1 Lander County 1 1 0 0.0 18.7 15.2 Lincoln County 1 2 1 100.0 26.2 39.4 Lyon County 11 10 -1 -9.1 24.6 18.8 Mineral County 1 2 1 100.0 21.4 44.6 Nye County 6 9 3 50.0 15.7 20.0 Pershing County 2 3 1 50.0 30.2 43.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 5 4 -1 -20.0 55.8 39.0 Region Subtotal 79 108 29 36.7 30.9 38.0 Urban Carson City 25 35 10 40.0 44.5 63.9 Clark County 763 1,135 372 48.8 44.5 55.3 Washoe County 224 275 51 22.8 58.4 62.8 Region Subtotal 1,012 1,445 433 42.8 47.0 56.8 Nevada – Total 1,091 1,553 462 42.3 45.3 54.9

Source: Nevada State Board of Dental Examiners (2004). Nevada State Board of Dental Examiners (2014).

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Table 4.19: Licensed Registered Dental Hygienists (RDHs) in Nevada by County – 2004 to 2014

Licensed Registered Dental Hygienists

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 12 16 4 33.3 46.0 62.8 Douglas County 34 35 1 2.9 71.1 72.6 Elko County 8 19 11 137.5 17.2 35.0 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 2 9 7 350.0 12.0 50.3 Lander County 1 1 0 0.0 18.7 15.2 Lincoln County 0 1 1 100.0 0.0 19.7 Lyon County 10 11 1 10.0 22.4 20.6 Mineral County 2 2 0 0.0 42.8 44.6 Nye County 4 6 2 50.0 10.5 13.4 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 2 4 2 100.0 22.3 39.0 Region Subtotal 75 104 29 38.7 29.3 36.6 Urban Carson City 31 38 7 22.6 55.2 69.4 Clark County 644 647 3 0.5 37.5 31.5 Washoe County 241 258 17 7.1 62.8 59.0 Region Subtotal 916 943 27 2.9 42.5 37.1 Nevada – Total 991 1,047 56 5.7 41.1 37.0

Source: Nevada State Board of Dental Examiners (2004). Nevada State Board of Dental Examiners (2014).

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Table 4.20: Licensed Alcohol, Drug and Gambling Counselors in Nevada by County – 2008 to 2014

Licensed Alcohol, Drug and Gambling Counselors

Region/County Number per 100,000 Number Change – 2008 to 2014 Population 2008 2014 Number Percent 2008 2014 Rural and Frontier Churchill County 39 37 -2 -5.1 144.5 145.3 Douglas County 30 22 -8 -26.7 57.5 45.6 Elko County 88 23 -65 -73.9 174.0 42.4 Esmeralda County 1 0 -1 -100.0 80.6 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 9 11 2 22.2 50.0 61.4 Lander County 2 5 3 150.0 34.0 76.1 Lincoln County 1 2 1 100.0 23.0 39.4 Lyon County 31 32 1 3.2 55.5 60.0 Mineral County 1 0 -1 -100.0 22.7 0.0 Nye County 16 16 0 0.0 33.8 35.6 Pershing County 2 4 2 100.0 27.8 57.3 Storey County 2 3 1 50.0 45.6 74.4 White Pine County 4 3 -1 -25.0 41.3 29.2 Region Subtotal 226 158 -68 -30.1 78.0 55.5 Urban Carson City 62 50 -12 -19.4 107.6 91.3 Clark County 619 704 85 13.7 31.5 34.3 Washoe County 326 315 -11 -3.4 76.9 72.0 Region Subtotal 1,007 1,069 62 6.2 41.1 42.0 Nevada – Total 1,233 1,227 -6 -0.5 45.0 43.4

Source: Nevada State Board of Examiners for Alcohol, Drug and Gambling Counselors (2008). Nevada State Board of Examiners for Alcohol, Drug and Gambling Counselors (2014).

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Table 4.21: Licensed Marriage and Family Therapists (MFTs) in Nevada by County – 2010 to 2012

Marriage and Family Therapists

Region/County Number per 100,000 Number Change – 2010 to 2012 Population 2010 2012 Number Percent 2010 2012 Rural and Frontier Churchill County 6 6 0 0.0 24.1 23.5 Douglas County 22 23 1 4.5 46.8 48.7 Elko County 3 3 0 0.0 6.1 5.7 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 3 2 -1 -33.3 18.2 11.7 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 1 1 0 0.0 18.7 18.4 Lyon County 5 7 2 40.0 9.6 13.1 Mineral County 1 1 0 0.0 21.0 21.4 Nye County 3 3 0 0.0 6.8 6.6 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 1 2 1 100.0 24.9 46.6 White Pine County 1 1 0 0.0 10.0 9.5 Region Subtotal 46 49 3 6.5 16.9 17.3 Urban Carson City 20 22 2 10.0 36.2 39.7 Clark County 335 350 15 4.5 17.2 17.6 Washoe County 234 248 14 6.0 55.5 58.6 Region Subtotal 589 620 31 5.3 24.3 25.1 Nevada – Total 635 669 34 5.4 23.5 24.3

Source: Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors (2010). Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors (2012).

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Table 4.22: Licensed Clinical Professional Counselors in Nevada by County – 2010 to 2012

Licensed Clinical Professional Counselors

Region/County Number per 100,000 Number Change – 2010 to 2012 Population 2010 2012 Number Percent 2010 2012 Rural and Frontier Churchill County 0 0 0 0.0 0.0 0.0 Douglas County 1 2 1 100.0 2.1 4.2 Elko County 2 2 0 0.0 4.1 3.8 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 0 0 0 0.0 0.0 0.0 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 2 3 1 50.0 3.8 5.6 Mineral County 0 0 0 0.0 0.0 0.0 Nye County 0 1 1 100.0 0.0 2.2 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 0 0 0 0.0 0.0 0.0 Region Subtotal 5 8 3 60.0 1.8 2.8 Urban Carson City 0 0 0 0.0 0.0 0.0 Clark County 15 25 10 66.7 0.8 1.3 Washoe County 8 14 6 75.0 1.9 3.3 Region Subtotal 23 39 16 69.6 0.9 1.6 Nevada – Total 28 47 19 67.9 1.0 1.7

Source: Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors (2010). Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors (2012).

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Table 4.23: Licensed Psychiatrists in Nevada by County – 2008 to 2014

Licensed Psychiatrists

Region/County Number per 100,000 Number Change – 2008 to 2014 Population 2008 2014 Number Percent 2008 2014 Rural and Frontier Churchill County 0 0 0 0.0 0.0 0.0 Douglas County 3 1 -2 -66.7 5.8 2.1 Elko County 0 0 0 0.0 0.0 0.0 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 0 0 0 0.0 0.0 0.0 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 0 0 0 0.0 0.0 0.0 Mineral County 0 0 0 0.0 0.0 0.0 Nye County 0 1 1 100.0 0.0 2.2 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 0 0 0 0.0 0.0 0.0 Region Subtotal 3 2 -1 -33.3 1.1 0.7 Urban Carson City 5 3 -2 -40.0 8.7 5.5 Clark County 97 118 21 21.6 5.2 5.8 Washoe County 47 57 10 21.3 11.5 13.0 Region Subtotal 149 178 29 19.5 6.4 7.0 Nevada – Total 152 180 28 18.4 5.8 6.4

Source: Nevada State Board of Medical Examiners (2008). Nevada State Board of Medical Examiners (2014).

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Table 4.24: Licensed Psychologists in Nevada by County – 2008 to 2014

Licensed Psychologists

Region/County Number per 100,000 Number Change – 2008 to 2014 Population 2008 2014 Number Percent 2008 2014 Rural and Frontier Churchill County 3 2 -1 -33.3 11.1 7.9 Douglas County 5 5 0 0.0 9.6 10.4 Elko County 4 0 -4 -100.0 7.9 0.0 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 3 1 -2 -66.7 16.7 5.6 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 2 5 3 150.0 3.6 9.4 Mineral County 0 0 0 0.0 0.0 0.0 Nye County 2 3 1 50.0 4.2 6.7 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 2 0 -2 -100.0 45.6 0.0 White Pine County 0 1 1 100.0 0.0 9.7 Region Subtotal 21 17 -4 -19.0 7.3 6.0 Urban Carson City 24 18 -6 -25.0 41.7 32.9 Clark County 147 197 50 34.0 7.5 9.6 Washoe County 119 141 22 18.5 28.1 32.2 Region Subtotal 290 356 66 22.8 11.8 14.0 Nevada – Total 311 373 62 19.9 11.4 13.2

Source: Nevada State Board of Psychological Examiners (2008). Nevada State Board of Psychological Examiners (2014).

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Table 4.25: Licensed Social Workers in Nevada by County – 2014

Licensed Social Workers – All License Types

Licensed Licensed Region/County Licensed Clinical Licensed Social Associates in Independent Social Workers Total Workers (LSWs) Social Work Social Workers (LCSWs) (LASWs) (LISWs) Rural and Frontier Churchill County 16 0 7 0 23 Douglas County 1 1 8 0 10 Elko County 29 2 6 0 37 Esmeralda County 0 0 0 0 0 Eureka County 0 0 0 0 0 Humboldt County 4 0 3 0 7 Lander County 0 0 2 0 2 Lincoln County 1 0 4 0 5 Lyon County 9 1 3 0 13 Mineral County 0 0 0 0 0 Nye County 11 0 6 0 17 Pershing County 2 0 0 0 2 Storey County 0 0 0 0 0 White Pine County 4 1 3 0 8 Region Subtotal 77 5 42 0 124 Urban Carson City 70 6 0 2 78 Clark County 655 52 405 8 1,120 Washoe County 316 16 155 5 492 Region Subtotal 1,041 74 560 15 1,690 Nevada – Total 1,118 79 602 15 1,814

Source: State of Nevada Board of Examiners for Social Workers (2014).

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Table 4.26: Licensed Social Workers per 100,000 Population in Nevada by County – 2014

Social Workers per 100,000 Population – All License Types

Region/County Licensed Associates Licensed Clinical Licensed Licensed Social in Social Work Social Workers Independent Social Workers (LSWs) (LASWs) (LCSWs) Workers (LISWs) Rural and Frontier Churchill County 62.8 0.0 27.5 0.0 Douglas County 2.1 2.1 16.6 0.0 Elko County 53.4 3.7 11.0 0.0 Esmeralda County 0.0 0.0 0.0 0.0 Eureka County 0.0 0.0 0.0 0.0 Humboldt County 22.3 0.0 16.8 0.0 Lander County 0.0 0.0 30.4 0.0 Lincoln County 19.7 0.0 78.8 0.0 Lyon County 16.9 1.9 5.6 0.0 Mineral County 0.0 0.0 0.0 0.0 Nye County 24.5 0.0 13.4 0.0 Pershing County 28.7 0.0 0.0 0.0 Storey County 0.0 0.0 0.0 0.0 White Pine County 39.0 9.7 29.2 0.0 Region Subtotal 27.1 1.8 14.8 0.0 Urban Carson City 127.8 11.0 0.0 3.7 Clark County 31.9 2.5 19.7 0.4 Washoe County 72.2 3.7 35.4 1.1 Region Subtotal 40.9 2.9 22.0 0.6 Nevada – Total 39.5 2.8 21.3 0.5

Source: State of Nevada Board of Examiners for Social Workers (2014).

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Table 4.27: Licensed Pharmacists in Nevada by County – 2004 to 2014

Licensed Pharmacists

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 12 17 5 41.7 46.0 66.8 Douglas County 42 32 -10 -23.8 87.9 66.4 Elko County 19 18 -1 -5.3 40.9 33.1 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 6 5 -1 -16.7 35.9 27.9 Lander County 2 2 0 0.0 37.3 30.4 Lincoln County 0 4 4 400.0 0.0 78.8 Lyon County 7 23 16 228.6 15.7 43.1 Mineral County 1 1 0 0.0 21.4 22.3 Nye County 12 16 4 33.3 31.4 35.6 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 4 9 5 125.0 44.6 87.7 Region Subtotal 105 127 22 21.0 41.0 44.6 Urban Carson City 28 28 0 0.0 49.9 51.1 Clark County 1,063 1,640 577 54.3 62.0 79.9 Washoe County 334 422 88 26.3 87.1 96.4 Region Subtotal 1,425 2,090 665 46.7 66.1 82.1 Nevada – Total 1,530 2,217 687 44.9 63.5 78.4

Source: Nevada State Board of Pharmacy (2004). Nevada State Board of Pharmacy (2014).

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Table 4.28: Licensed Pharmaceutical Technicians in Nevada by County – 2004 to 2014

Licensed Pharmaceutical Technicians

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 30 48 18 60.0 114.9 188.5 Douglas County 26 52 26 100.0 54.4 107.9 Elko County 21 58 37 176.2 45.2 106.8 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 16 31 15 93.8 95.9 173.1 Lander County 2 5 3 150.0 37.3 76.1 Lincoln County 4 7 3 75.0 104.7 137.9 Lyon County 42 117 75 178.6 94.1 219.4 Mineral County 4 3 -1 -25.0 85.6 66.9 Nye County 28 70 42 150.0 73.3 155.8 Pershing County 1 7 6 600.0 15.1 100.3 Storey County 2 2 0 0.0 52.7 49.6 White Pine County 7 20 13 185.7 78.1 194.9 Region Subtotal 183 420 237 129.5 71.5 147.6 Urban Carson City 61 81 20 32.8 108.6 147.9 Clark County 1,925 4,028 2,103 109.2 112.2 196.3 Washoe County 526 934 408 77.6 137.2 213.4 Region Subtotal 2,512 5,043 2,531 100.8 116.6 198.2 Nevada – Total 2,695 5,463 2,768 102.7 111.8 193.1

Source: Nevada State Board of Pharmacy (2004). Nevada State Board of Pharmacy (2014).

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Table 4.29: Licensed Chiropractors in Nevada by County – 2004 to 2014

Licensed Chiropractors

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 3 4 1 33.3 11.5 15.7 Douglas County 15 9 -6 -40.0 31.4 18.7 Elko County 6 5 -1 -16.7 12.9 9.2 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 3 5 2 66.7 18.0 27.9 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 5 5 0 0.0 11.2 9.4 Mineral County 0 1 1 100.0 0.0 22.3 Nye County 8 5 -3 -37.5 21.0 11.1 Pershing County 2 0 -2 -100.0 30.2 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 1 1 0 0.0 11.2 9.7 Region Subtotal 43 35 -8 -18.6 16.8 12.3 Urban Carson City 17 21 4 23.5 30.3 38.3 Clark County 357 415 58 16.2 20.8 20.2 Washoe County 98 122 24 24.5 25.6 27.9 Region Subtotal 472 558 86 18.2 21.9 21.9 Nevada – Total 515 593 78 15.1 21.4 21.0

Source: Chiropractic Physicians’ Board of Nevada (2004). Chiropractic Physicians’ Board of Nevada (2014).

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Table 4.30: Registered Dietitians (RDs) in Nevada by County – 2014

Registered Dietitians Region/County Number per 100,000 Number Population Rural and Frontier Churchill County 3 11.8 Douglas County 5 10.4 Elko County 2 3.7 Esmeralda County 0 0.0 Eureka County 1 48.6 Humboldt County 4 22.3 Lander County 0 0.0 Lincoln County 0 0.0 Lyon County 0 0.0 Mineral County 0 0.0 Nye County 1 2.2 Pershing County 0 0.0 Storey County 2 49.6 White Pine County 1 9.7 Region Subtotal 19 6.7 Urban Carson City 9 16.4 Clark County 257 12.5 Washoe County 115 26.3 Region Subtotal 381 15.0 Nevada – Total 400 7.1

Source: Bureau of Health Care Quality Compliance (2014c).

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Table 4.31: Licensed Dispensing Opticians in Nevada by County – 2004 to 2014

Licensed Dispensing Opticians

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 0 2 2 200.0 0.0 7.9 Douglas County 0 0 0 0.0 0.0 0.0 Elko County 0 4 4 400.0 0.0 7.4 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 1 0 -1 -100.0 6.0 0.0 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 2 0 -2 -100.0 4.5 0.0 Mineral County 1 2 1 100.0 21.4 44.6 Nye County 1 3 2 200.0 2.6 6.7 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 0 0 0 0.0 0.0 0.0 Region Subtotal 5 11 6 120.0 2.0 3.9 Urban Carson City 6 10 4 66.7 10.7 18.3 Clark County 134 203 69 51.5 7.8 9.9 Washoe County 50 63 13 26.0 13.0 14.4 Region Subtotal 190 276 86 45.3 8.8 10.8 Nevada – Total 195 287 92 47.2 8.1 10.1

Source: State of Nevada Board of Dispensing Opticians (2004). State of Nevada Board of Dispensing Opticians (2014).

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Table 4.32: Licensed Dispensing Optician Apprentices in Nevada by County – 2004 to 2014

Licensed Dispensing Optician Apprentices Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Number Percent 2004 2014 Rural and Frontier Churchill County 0 1 1 100.0 0.0 3.9 Douglas County 0 0 0 0.0 0.0 0.0 Elko County 0 4 4 400.0 0.0 7.4 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 0 0 0 0.0 0.0 0.0 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 2 0 -2 -100.0 4.5 0.0 Mineral County 0 1 1 100.0 0.0 22.3 Nye County 2 2 0 0.0 5.2 4.5 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 0 0 0 0.0 0.0 0.0 Region Subtotal 4 8 4 100.0 1.6 2.8 Urban Carson City 4 5 1 25.0 7.1 9.1 Clark County 86 105 19 22.1 5.0 5.1 Washoe County 38 32 -6 -15.8 9.9 7.3 Region Subtotal 128 142 14 10.9 5.9 5.6 Nevada – Total 132 150 18 13.6 5.5 5.3

Source: State of Nevada Board of Dispensing Opticians (2004). State of Nevada Board of Dispensing Opticians (2014).

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Table 4.33: Licensed Emergency Medical Technicians (EMTs) in Nevada by County – 2012

Licensed Emergency Medical Technicians (EMTs) Region/County First Advanced Basic Intermediate Total Responder (Paramedics) Rural and Frontier Churchill County 4 33 21 13 71 Douglas County 6 43 34 57 140 Elko County 91 183 125 13 412 Esmeralda County 9 7 11 0 27 Eureka County 26 9 11 0 46 Humboldt County 120 64 20 12 216 Lander County 40 24 9 0 73 Lincoln County 37 26 15 0 78 Lyon County 14 85 83 30 212 Mineral County 5 42 17 2 66 Nye County 51 65 84 30 230 Pershing County 9 27 10 0 46 Storey County 0 1 6 2 9 White Pine County 27 34 28 0 89 Region Subtotal 439 643 474 159 1,715 Urban Carson City 11 51 47 49 158 Clark County 14 731 1,456 1,070 3,271 Washoe County 137 440 454 250 1,281 Region Subtotal 162 1,222 1,957 1,369 4,710 Nevada – Total 601 1,865 2,431 1,528 6,425

Source: Emergency Medical Systems and Trauma Systems (2012).

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Table 4.34: Licensed Emergency Medical Technicians (EMTs) per 100,000 Population in Nevada by County – 2012

Licensed Emergency Medical Technicians (EMTs) per 100,000 Population Region/County First Advanced Basic Intermediate Total Responder (Paramedics) Rural and Frontier Churchill County 15.7 129.4 82.3 51.0 278.3 Douglas County 12.7 91.1 72.0 120.7 296.5 Elko County 172.4 346.7 236.8 24.6 780.5 Esmeralda County 1,107.0 861.0 1,353.5 0.0 3,321.0 Eureka County 1,288.4 446.0 545.1 0.0 2,279.5 Humboldt County 679.8 362.6 113.3 68.0 1,223.7 Lander County 636.2 381.7 143.2 0.0 1,161.1 Lincoln County 679.3 477.3 275.4 0.0 1,432.0 Lyon County 26.3 159.4 155.6 56.3 397.5 Mineral County 106.9 898.0 363.5 42.8 1,411.2 Nye County 111.4 142.0 183.5 65.6 502.6 Pershing County 129.0 386.9 143.3 0.0 659.2 Storey County 129.0 386.9 143.3 0.0 659.2 White Pine County 256.3 322.7 265.8 0.0 844.8 Region 155.0 227.0 167.3 56.1 605.3 Urban Carson City 19.8 91.9 84.7 88.3 284.8 Clark County 0.7 36.8 73.2 53.8 164.5 Washoe County 32.4 104.0 107.3 59.1 302.8 Region 6.6 49.5 79.3 55.5 190.9 Nevada 21.9 67.8 88.4 55.6 233.6

Source: Emergency Medical Systems and Trauma Systems (2012).

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Table 4.35: Licensed Emergency Medical Technicians (EMTs) in Nevada by County – 2006 to 2012

Licensed Emergency Medical Technicians (EMTs) – All Types Region/County Number Change – 2006 to 2012 2006 2012 2006 2012 Rural and Frontier Churchill County 101 71 -30 -29.7 Douglas County 136 140 4 2.9 Elko County 483 412 -71 -14.7 Esmeralda County 34 27 -7 -14.7 Eureka County 42 46 4 9.5 Humboldt County 313 216 -97 -31.0 Lander County 114 73 -41 -36.0 Lincoln County 75 78 3 4.0 Lyon County 267 212 -55 -20.6 Mineral County 66 66 0 0.0 Nye County 265 230 -35 -13.2 Pershing County 47 46 1 -2.1 Storey County 87 9 -78 -89.7 White Pine County 143 89 -54 -37.8 Region Subtotal 2,173 1,715 -458 -21.1 Urban Carson City 211 158 -53 -25.1 Clark County 3,545 3,271 -274 -7.7 Washoe County 1,247 1,281 34 2.7 Region Subtotal 5,003 4,710 -293 -5.9 Nevada – Total 7,176 6,425 -751 -10.5

Source: Emergency Medical Systems and Trauma Systems (2012).

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Table 4.36: Licensed Massage Therapists in Nevada by County – 2010 to 2014

Licensed Massage Therapists

Region/County Number per 100,000 Number Change – 2010 to 2014 Population 2010 2014 Number Percent 2010 2014 Rural and Frontier Churchill County 11 14 3 27.3 41.7 55.0 Douglas County 54 64 10 18.5 109.7 132.8 Elko County 25 26 1 4.0 48.0 47.9 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 7 9 2 28.6 38.1 50.3 Lander County 1 2 1 100.0 16.7 30.4 Lincoln County 0 1 1 100.0 0.0 19.7 Lyon County 39 29 -10 -25.6 74.5 54.4 Mineral County 2 1 -1 -50.0 44.7 22.3 Nye County 34 28 -6 -17.6 74.8 62.3 Pershing County 2 2 0 0.0 28.0 28.7 Storey County 1 1 0 0.0 23.6 24.8 White Pine County 7 7 0 0.0 73.7 68.2 Region Subtotal 183 184 1 0.5 64.8 64.7 Urban Carson City 52 72 20 38.5 93.1 131.5 Clark County 2,578 2,868 290 11.2 130.9 139.8 Washoe County 525 572 47 9.0 125.8 130.7 Region Subtotal 3,155 3,512 357 11.3 129.2 138.0 Nevada – Total 3,338 3,696 358 10.7 122.5 130.7

Source: Nevada State Board of Massage Therapists (2010). Nevada State Board of Massage Therapists (2014).

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Table 4.37: Licensed Medical Laboratory Personnel in Nevada by County – 2014

Licensed Medical Laboratory Personnel Region/County Directors Supervisors Technologists Technicians Assistants Total Rural and Frontier Churchill County 0 20 8 3 61 92 Douglas County 3 13 4 1 134 155 Elko County 6 13 5 2 133 159 Esmeralda County 0 0 0 0 1 1 Eureka County 0 2 0 0 7 9 Humboldt County 1 8 6 0 30 45 Lander County 0 1 5 2 11 19 Lincoln County 0 4 0 0 16 20 Lyon County 1 9 18 8 149 185 Mineral County 0 1 4 2 10 17 Nye County 1 17 10 3 73 104 Pershing County 0 0 0 0 2 2 Storey County 0 2 0 2 3 7 White Pine County 0 9 2 0 21 32 Region Subtotal 12 99 62 23 651 847 Urban Carson City 8 32 7 7 188 242 Clark County 182 836 1,039 480 4,404 6,941 Washoe County 44 255 63 131 1,082 1,667 Region Subtotal 234 1,123 1,109 618 5,674 8,850 Nevada – Total 246 1,222 1,171 641 6,325 9,697

Source: Bureau of Health Care Quality and Compliance (2014d).

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Table 4.38: Licensed Medical Laboratory Personnel per 100,000 Population in Nevada by County – 2014

Licensed Medical Laboratory Personnel per 100,000 Population Region/County Directors Supervisors Technicians Technologists Assistants Total Rural and Frontier Churchill County 0.0 78.6 31.4 11.8 239.6 361.3 Douglas County 6.2 27.0 8.3 2.1 278.0 321.5 Elko County 11.0 23.9 9.2 3.7 244.9 292.8 Esmeralda County 0.0 0.0 0.0 0.0 109.6 109.6 Eureka County 0.0 97.3 0.0 0.0 340.5 437.7 Humboldt County 5.6 44.7 33.5 0.0 167.5 251.3 Lander County 0.0 15.2 76.1 30.4 167.5 289.2 Lincoln County 0.0 78.8 0.0 0.0 315.3 394.1 Lyon County 1.9 16.9 33.8 15.0 279.4 346.9 Mineral County 0.0 22.3 89.2 44.6 222.9 379.0 Nye County 2.2 37.8 22.3 6.7 162.5 231.5 Pershing County 0.0 0.0 0.0 0.0 28.7 28.7 Storey County 0.0 49.6 0.0 49.6 74.4 173.7 White Pine County 0.0 87.7 19.5 0.0 204.6 311.8 Region Subtotal 4.2 34.8 21.8 8.1 228.8 297.7 Urban Carson City 14.6 58.4 12.8 12.8 343.2 441.8 Clark County 8.9 40.7 50.6 23.4 214.6 338.3 Washoe County 10.1 58.3 14.4 29.9 247.3 359.9 Region Subtotal 9.2 44.1 43.6 24.3 223.0 344.2 Nevada – Total 8.7 43.2 41.4 22.7 223.6 339.5

Source: Bureau of Health Care Quality and Compliance (2014d).

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Table 4.39: Licensed Medical Laboratory Personnel in Nevada by County – 2004 to 2014

Licensed Medical Laboratory Personnel – All Types

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Change Percent 2004 2014 Rural and Frontier Churchill County 93 92 -1 -1.1 339.8 361.3 Douglas County 115 155 40 34.8 222.1 321.5 Elko County 117 159 42 35.9 242.0 292.8 Esmeralda County 0 1 1 100.0 0.0 109.6 Eureka County 3 9 6 200.0 205.5 437.7 Humboldt County 40 45 5 12.5 225.3 251.3 Lander County 19 19 0 0.0 336.0 289.2 Lincoln County 23 20 -3 -13.0 576.9 394.1 Lyon County 137 185 48 35.0 253.6 346.9 Mineral County 25 17 -8 -32.0 568.3 379.0 Nye County 89 104 15 16.9 198.7 231.5 Pershing County 3 2 -1 -33.3 43.1 28.7 Storey County 3 7 4 133.3 73.0 173.7 White Pine County 35 32 -3 -8.6 366.8 311.8 Region Subtotal 702 847 145 20.7 249.4 297.7 Urban Carson City 203 242 39 19.2 351.8 441.8 Clark County 5,645 6,941 1,596 23.0 301.1 338.3 Washoe County 1,385 1,575 190 13.7 338.6 359.9 Region Subtotal 7,233 8,758 1,525 21.1 308.9 344.2 Nevada – Total 7,935 9,605 1,670 21.0 302.5 339.5

Sources: Bureau of Health Care Quality and Compliance (2004). Bureau of Health Care Quality and Compliance (2014d).

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Table 4.40: Licensed Occupational Therapists (OTs) in Nevada by County – 2004 to 2014

Licensed Occupational Therapy (OTs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Change Percent 2004 2014 Rural and Frontier Churchill County 6 5 -1 -16.7 23.0 19.6 Douglas County 9 13 4 44.4 18.8 27.0 Elko County 3 5 2 66.7 6.5 9.2 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 1 1 0 0.0 6.0 5.6 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 1 1 100.0 0.0 19.7 Lyon County 7 7 0 0.0 15.7 13.1 Mineral County 0 0 0 0.0 0.0 0.0 Nye County 1 2 1 100.0 2.6 4.5 Pershing County 1 0 -1 -100.0 15.1 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 0 0 0 0.0 0.0 0.0 Region Subtotal 28 34 6 21.4 10.9 12.0 Urban Carson City 11 14 3 27.3 19.6 25.6 Clark County 233 412 179 76.8 13.6 20.1 Washoe County 93 110 17 18.3 24.3 25.1 Region Subtotal 337 536 199 59.1 15.6 21.1 Nevada – Total 365 570 205 56.2 15.1 20.1

Source: State of Nevada Board of Occupational Therapy (2004). State of Nevada Board of Occupational Therapy (2014).

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Table 4.41: Licensed Occupational Therapy Assistants (OTAs) in Nevada by County – 2004 to 2014

Licensed Occupational Therapy Assistants (OTAs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Change Percent 2004 2014 Rural and Frontier Churchill County 0 3 3 300.0 0.0 11.8 Douglas County 0 3 3 300.0 0.0 6.2 Elko County 0 2 2 200.0 0.0 3.7 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 1 0 -1 -100.0 6.0 0.0 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 1 0 -1 -100.0 2.2 0.0 Mineral County 0 0 0 0.0 0.0 0.0 Nye County 1 0 -1 -100.0 2.6 0.0 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 0 0 0 0.0 0.0 0.0 Region Subtotal 3 8 5 166.7 1.2 2.8 Urban Carson City 2 4 2 100.0 3.6 7.3 Clark County 119 139 20 16.8 6.9 6.8 Washoe County 16 20 4 25.0 4.2 4.6 Region Subtotal 137 163 26 19.0 6.4 6.4 Nevada – Total 140 171 31 22.1 5.8 6.0

Source: State of Nevada Board of Occupational Therapy (2004). State of Nevada Board of Occupational Therapy (2014).

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Table 4.42: Licensed Optometrists in Nevada by County – 2004 to 2014

Licensed Optometrists

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Change Percent 2004 2014 Rural and Frontier Churchill County 4 6 2 50.0 15.3 23.6 Douglas County 3 9 6 200.0 6.3 18.7 Elko County 5 10 5 100.0 10.8 18.4 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 1 3 2 200.0 6.0 16.8 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 1 1 100.0 0.0 19.7 Lyon County 1 1 0 0.0 2.2 1.9 Mineral County 0 0 0 0.0 0.0 0.0 Nye County 2 5 3 150.0 5.2 11.1 Pershing County 0 1 1 100.0 0.0 14.3 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 1 1 0 0.0 11.2 9.7 Region Subtotal 17 37 20 117.6 6.6 13.0 Urban Carson City 12 17 5 41.7 21.4 31.0 Clark County 153 253 100 65.4 8.9 12.3 Washoe County 59 79 20 33.9 15.4 18.1 Region Subtotal 224 349 125 55.8 10.4 13.7 Nevada – Total 241 386 145 60.2 10.0 13.6

Source: Nevada State Board of Optometry (2004). Nevada State Board of Optometry (2014).

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Table 4.43: Licensed Physical Therapists (PTs) in Nevada by County – 2004 to 2014

Licensed Physical Therapists (PTs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Change Percent 2004 2014 Rural and Frontier Churchill County 5 3 -2 40.0 19.4 11.8 Douglas County 13 24 11 84.6 28.5 49.8 Elko County 12 19 7 58.3 26.2 35.0 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 5 8 3 60.0 30.4 44.7 Lander County 3 2 -1 -33.3 56.9 30.4 Lincoln County 1 0 -1 -100.0 26.7 0.0 Lyon County 7 15 8 114.3 17.0 28.1 Mineral County 2 0 -2 -100.0 42.7 0.0 Nye County 2 6 4 200.0 5.5 13.4 Pershing County 1 0 -1 -100.0 14.4 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 2 5 3 150.0 22.6 48.7 Region Subtotal 53 82 29 54.7 21.4 28.8 Urban Carson City 36 66 30 83.3 65.2 120.5 Clark County 422 653 231 54.7 26.0 31.8 Washoe County 203 273 70 34.5 54.4 62.4 Region Subtotal 661 992 331 50.1 32.3 39.0 Nevada – Total 714 1,074 360 50.4 31.1 38.0

Source: State of Nevada Physical Therapy Examiners’ Board (2004). State of Nevada Physical Therapy Examiners’ Board (2014).

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Table 4.44: Licensed Physical Therapy Assistants (PTAs) in Nevada by County – 2004 to 2014

Licensed Physical Therapy Assistants (PTAs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Change Percent 2004 2014 Rural and Frontier Churchill County 1 1 0 0.0 3.9 3.9 Douglas County 0 3 3 300.0 0.0 6.2 Elko County 1 1 0 0.0 2.2 1.8 Esmeralda County 0 2 2 200.0 0.0 219.3 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 1 0 -1 -100.0 6.1 0.0 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 0 0 0 0.0 0.0 0.0 Mineral County 0 0 0 0.0 0.0 0.0 Nye County 1 10 9 900.0 2.7 22.3 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 0 0 0 0.0 0.0 0.0 Region Subtotal 4 17 13 325.0 1.6 6.0 Urban Carson City 8 4 -4 -50.0 14.2 7.3 Clark County 125 251 126 100.8 7.7 12.2 Washoe County 17 30 13 76.5 4.6 6.9 Region Subtotal 150 285 135 90.0 7.3 11.2 Nevada – Total 154 302 148 96.1 6.7 10.7

Source: State of Nevada Physical Therapy Examiners’ Board (2004). State of Nevada Physical Therapy Examiners’ Board (2014).

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Table 4.45: Licensed Podiatrists in Nevada by County – 2004 to 2014

Licensed Podiatrists

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Change Percent 2004 2014 Rural and Frontier Churchill County 0 5 5 500.0 0.0 19.6 Douglas County 2 18 16 800.0 4.2 37.3 Elko County 2 11 9 450.0 4.3 20.3 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 0 2 2 200.0 0.0 11.2 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 0 3 3 300.0 0.0 5.6 Mineral County 0 1 1 100.0 0.0 22.3 Nye County 0 0 0 0.0 0.0 0.0 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 0 0 0 0.0 0.0 0.0 White Pine County 0 3 3 300.0 0.0 29.2 Region Subtotal 4 43 39 975.0 1.6 15.1 Urban Carson City 5 18 13 260.0 8.9 32.9 Clark County 60 420 360 600.0 3.5 20.5 Washoe County 19 262 243 1,278.9 5.0 59.9 Region Subtotal 84 700 616 733.3 3.9 27.5 Nevada – Total 88 743 655 744.3 3.7 26.3

Source: Nevada State Board of Podiatry (2004). Nevada State Board of Podiatry (2014).

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Table 4.46: Licensed Respiratory Therapists (RTs) in Nevada by County – 2004 to 2014

Licensed Respiratory Therapists (RTs)

Region/County Number per 100,000 Number Change – 2004 to 2014 Population 2004 2014 Change Percent 2004 2014 Rural and Frontier Churchill County 8 4 -4 -50.0 30.6 15.7 Douglas County 13 24 11 84.6 27.2 49.8 Elko County 5 8 3 60.0 10.8 14.7 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 5 4 -1 -20.0 30.0 22.3 Lander County 2 2 0 0.0 37.3 30.4 Lincoln County 2 0 -2 -100.0 52.3 0.0 Lyon County 18 16 -2 -11.1 40.3 30.0 Mineral County 2 0 -2 -100.0 42.8 0.0 Nye County 7 15 8 114.3 18.3 33.4 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 1 0 -1 -100.0 26.3 0.0 White Pine County 3 3 0 0.0 33.5 29.2 Region Subtotal 66 76 10 15.2 25.8 26.7 Urban Carson City 10 13 3 30.0 17.8 23.7 Clark County 491 1,027 536 109.2 28.6 50.1 Washoe County 152 198 46 30.3 39.6 45.2 Region Subtotal 653 1,238 585 89.6 30.3 48.7 Nevada – Total 719 1,314 595 82.8 29.8 46.5

Source: Nevada State Board of Medical Examiners (2004). Nevada State Board of Medical Examiners (2014).

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Table 4.47: Licensed Speech-language Pathologists in Nevada by County – 2006 to 2014

Licensed Speech-language Pathologists

Region/County Number per 100,000 Number Change – 2006 to 2014 Population 2006 2014 Change Percent 2006 2014 Rural and Frontier Churchill County 5 5 0 0.0 18.3 19.6 Douglas County 3 18 15 500.0 5.8 37.3 Elko County 1 11 10 1,000.0 2.1 20.3 Esmeralda County 0 0 0 0.0 0.0 0.0 Eureka County 0 0 0 0.0 0.0 0.0 Humboldt County 0 2 2 200.0 0.0 11.2 Lander County 0 0 0 0.0 0.0 0.0 Lincoln County 0 0 0 0.0 0.0 0.0 Lyon County 6 3 -3 -50.0 11.1 5.6 Mineral County 0 1 1 100.0 0.0 22.3 Nye County 1 0 -1 -100.0 2.2 0.0 Pershing County 0 0 0 0.0 0.0 0.0 Storey County 2 0 -2 -100.0 48.7 0.0 White Pine County 2 3 1 50.0 21.0 29.2 Region Subtotal 20 43 23 115.0 7.1 15.1 Urban Carson City 7 19 12 171.4 12.1 34.7 Clark County 146 420 274 187.7 7.8 20.5 Washoe County 67 262 195 291.0 16.4 59.9 Region Subtotal 220 701 481 218.6 9.4 27.6 Nevada – Total 240 744 504 210.0 9.1 26.3

Source: Nevada Board of Examiners for Audiology and Speech Pathology (2006). Nevada Board of Examiners for Audiology and Speech Pathology (2014).

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Table 4.48: Licensed Health Workforce Supply in Rural and Urban Regions of Nevada – 2014 Number per 100,000 Population Licensed Health Professionals Rural Counties Urban Counties Nevada Medicine and Primary Care Allopathic Physicians (MDs) 72.8 183.4 172.3 Osteopathic Physicians (DOs) 15.8 21.6 21.0 Advanced Practitioners of Nursing (APNs) 19.7 33.2 31.9 Primary Care Physicians (MDs and DOs) 49.6 90.4 86.3 Physician Assistants (PAs) 14.1 20.9 20.2 Registered Nurses (RNs) 518.5 789.5 762.3 Licensed Practical Nurses (LPNs) 77.0 108.4 105.2 Registered Nurse Anesthetists (CRNAs) 5.3 2.8 3.0 RNs with EMS Certification 8.1 4.0 4.4 Certified Nursing Assistants (CNAs) 326.9 272.5 278.0 Dentists 38.0 56.8 54.9 Registered Dental Hygienists (RDHs) 36.6 37.1 37.0 Alcohol, Drug, and Gambling Counselors 55.5 42.0 43.4 Clinical Professional Counselors 2.8 1.6 1.7 Licensed Clinical Social Workers (LCSWs) 14.8 22.0 21.3 Marriage and Family Therapists 17.3 25.1 24.3 Psychiatrists 0.7 7.0 6.4 Psychologists 6.0 14.0 13.2 Pharmacists 44.6 82.1 78.4 Pharmacy Technicians 147.6 198.2 193.1 Audiologists 0.7 3.2 2.9 Chiropractors 12.3 21.9 21.0 Registered Dietitians(RD) 6.7 15.0 7.1 Dispensing Opticians (OD) 3.9 10.8 10.1 Dispensing Optician Apprentices 2.8 5.6 5.3 EMS – First Responders 155.0 6.6 21.9 EMS – Basic Emergency Medical Technicians 227.0 49.5 67.8 EMS – Intermediate EMTs 167.3 79.3 88.4 EMS – Advanced EMTs (Paramedics) 56.1 55.5 55.6 Massage Therapists 64.7 138.0 130.7 Medical Laboratory Technologists 8.1 24.3 22.7 Medical Laboratory Technicians 21.8 43.6 41.4 Medical Laboratory Assistants 228.8 223.0 223.6 Medical Laboratory Supervisors 34.8 44.1 43.2 Medical Laboratory Directors 4.2 9.2 8.7 Occupational Therapists (OTs) 12.0 21.1 20.1 Occupational Therapy (OTAs) 2.8 6.4 6.0 Optometrists 13.0 13.7 13.6 Physical Therapists (PTs) 28.8 39.0 38.0 Physical Therapy Assistants (PTAs) 6.0 11.2 10.7 Podiatrists 15.1 27.5 26.3 Respiratory Therapists (RTs) 26.7 48.7 46.5 Speech Language Pathologists (SLP) 15.1 27.6 26.3

Source: Department Of Employment, Training, and Rehabilitation (2014d). Notes: See Tables 4.7 through 4.47 for a complete list of citations for the professions and data contained in this table. Shaded cells highlight the region in Nevada with the lower per capita number of health professions in a given field.

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Table 4.49: Population Residing in Health Professional Shortage Areas (HPSAs) in Nevada – 2015

Population Residing in Health Professional Shortage Areas (HPSAs)

Region/County Primary Medical Care HPSAs Dental HPSAs Mental HPSAs Population

Percent of Percent of Percent of Number Number Number Population Population Population Rural and Frontier Churchill County 1,412 5.5 1,412 5.5 25,665 100.0 25,665 Douglas County 7,536 15.7 0 0.0 48,003 100.0 48,003 Elko County 3,520 6.4 10,779 19.6 54,993 100.0 54,993 Esmeralda County 959 100.0 959 100.0 959 100.0 959 Eureka County 2,069 100.0 0 0.0 2,069 100.0 2,069 Humboldt County 712 3.9 0 0.0 18,248 100.0 18,248 Lander County 6,708 100.0 6,708 100.0 6,708 100.0 6,708 Lincoln County 5,117 100.0 5,117 100.0 5,117 100.0 5,117 Lyon County 53,639 100.0 53,639 100.0 53,639 100.0 53,639 Mineral County 4,356 100.0 4,356 100.0 4,356 100.0 4,356 Nye County 45,081 100.0 45,071 100.0 45,081 100.0 45,081 Pershing County 7,031 100.0 7,031 100.0 7,031 100.0 7,031 Storey County 4,037 100.0 0 0.0 4,037 100.0 4,037 White Pine County 30 2.9 10,345 100.0 10,345 100.0 10,345 Region Subtotal 142,476 50.6 145,426 51.4 286,251 100.0 286,251 Urban Carson City 51,186 92.9 0 0.0 55,098 100.0 55,098 Clark County 612,710 29.6 612,710 29.6 736,908 35.6 2,069,967 Washoe County 151,761 34.2 145,105 32.7 443,745 100.0 443,745 Region Subtotal 815,657 31.8 757,815 29.5 1,235,751 31.1 2,568,810 Nevada – Total 962,156 33.7 903,241 31.7 1,522,002 38.1 2,855,061

Sources: Health Resources and Services Administration (2015). Nevada State Demographer’s Office (2014a).

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Nevada Rural and Frontier Health Data Book Section Five: Health Care Resources and Economics in Rural and Frontier Nevada Highlights and Key Findings

 Currently, there are 15 rural and frontier hospitals in Nevada serving an estimated population of 286,251 residents scattered over 95,431 square miles – 11 of these facilities are federally designated Critical Access Hospitals (CAHs) (Tables 1.5 and 5.1).

 On average, Nevada’s 15 rural and frontier hospitals are 59.1 miles from the nearest hospital and 118.1 miles from the nearest tertiary care hospital (Table 5.1 and Map 5.1).

 In 2013, Nevada’s 15 rural and frontier hospitals had a combined 2,250 employees (FTE) and payroll of $141.2 million – these hospitals had an average annual salary of $62,772 (Table 5.2).

 Nevada’s 11 Critical Access Hospitals (CAHs) had a combined 1,502 employees (FTE) and payroll of $94.4 million in 2013 – these CAHs had an average annual salary of $62,825 (Table 5.2).

 In 2013, Nevada’s 19 urban acute care hospitals had a combined 21,825 employees (FTE) and payroll of $1.6 billion – urban hospitals had an average annual salary of $71,809 (Table 5.3).

 Nevada’s 15 rural and frontier hospitals employed 2,250 individuals in 2013 – when the jobs created in other businesses, as a result of hospital operating activity, are included in the analysis, rural and frontier hospitals were responsible for an additional 807 jobs for a total employment impact of 3,057 jobs (Table 5.4).

 In 2013, Nevada’s 19 urban hospitals employed 21,825 individuals – when the jobs created in other businesses, as a result of hospital operating activity, are included in the analysis, urban hospitals were responsible for an additional 15,532 jobs for a total employment impact of 37,470 jobs (Tables 5.3 and 5.4).

 Nevada’s 15 rural and frontier hospitals had a combined payroll of $94.4 million in 2013 – when the income created in other businesses, as a result of hospital operating activity, is included in the analysis, rural and frontier hospitals were responsible for an additional $18.7 million in personal income for a total payroll impact of $113.1 million (Table 5.5).

 In 2013, Nevada’s 19 urban hospitals had a combined payroll of $1.6 billion – when the income created in other businesses, as a result of hospital operating activity, is included in the analysis, urban hospitals were responsible for an additional $674 million in personal income for a total payroll impact of $2.0 billion (Table 5.5).

 In 2013, there were 96,484 Nevadans employed in the health sector with a combined payroll of $5.5 billion, including 6,S276 rural and frontier residents with a combined payroll of $287.8 million (Tables 5.6 and 5.7).

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 Businesses in Nevada’s health sector employed 96,370 in 2013 – when the jobs created in other non-health sector businesses, as a result of health sector operating activity, are included in the analysis, Nevada’s health sector was responsible for an additional 50,099 jobs for a total employment impact of 146,469 jobs (Table 5.8).

 In 2013, businesses in the health sector in rural and frontier counties of Nevada employed 6,162 individuals – when the jobs created in other non-health sector businesses, as a result of health sector operating activity, are included in the analysis, the rural health sector was responsible for an additional 1,488 jobs for a total employment impact of 7,650 jobs (Table 5.8).

 Businesses in Nevada’s health sector had a combined payroll of $5.5 billion in 2013 – when the income created in other non-health sector businesses, as a result of health sector operating activity, is included in the analysis, Nevada’s health sector was responsible for an additional $2.0 billion in personal income for a total payroll impact of $7.5 billion (Table 5.9).

 In 2013, businesses in the health sector in rural and frontier counties of Nevada had a combined payroll of $284.8 million – when the income created in other non-health sector businesses, as a result of health sector operating activity, is included in the analysis, the rural health sector was responsible for an additional $43.7 million in personal income for a total payroll impact of $328.6 million (Table 5.9).

 Currently, there are 7,140 licensed community hospital beds in Nevada, including 272 licensed community hospital beds in rural and frontier counties (Table 5.11).

 There are 5,174 licensed skilled nursing beds in Nevada, including 567 licensed skilled nursing beds in rural and frontier counties (Table 5.11).

 Currently, there are 2.5 licensed community hospital beds per 1,000 population in Nevada – there are 1.0 licensed community hospital beds per 1,000 population in rural and frontier counties, as compared to a rate of 2.7 in urban counties (Table 5.11).

 Currently, there are 1.8 licensed skilled nursing beds per 1,000 population in Nevada – there are 2.0 licensed skilled nursing beds per 1,000 population in rural and frontier counties, as compared to a rate of 1.8 in urban counties (Table 5.11).

 Currently, of the 15 rural and frontier hospitals in Nevada, six are not-for-profit (publicly owned) hospitals, 5 not-for-profit (privately owned) hospitals, and three for-profit (privately owned) hospitals, and one not-for- profit (non-governmental) hospital (Table 5.12).

 In 2015, there are eight rural and frontier community hospitals with provider-based rural health clinics (RHCs). There are also 9 non-hospital based Federally Qualified Health Clinics (FQHCs), and 13 tribal and Indian Health Service (IHS) clinics and health centers (Tables 5.13, 5.14, and 5.15).

 In 2013, Nevada’s 15 rural and frontier hospitals had a combined 9,770 admissions, 31,665 inpatient days, an average stay of 3.2 days, an average daily census of 86.8, and an occupancy rate of 16.2% (Table 5.16).

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 In 2013, rural and frontier hospitals had inpatient operating revenue of $240.1 million or 27.5% of the total patient revenue; the outpatient revenue was $631.6 million or 72.4% of the total patient revenue (Table 5.18).

 For 2013, rural and frontier hospitals had $871.7 million in total revenue, $506.8 million in contractual deductions and adjustments, resulting in net patient revenue of $364.9 million; when adding other operating revenue ($8.2 million), the total revenue was $373.1 million (Table 5.19).

 For 2013, rural and frontier hospitals had $373.1 million in total revenue, $317.8 million in operating expenses, resulting in net operating income of $55.3 million; when adding other non-operating revenue ($30.1 million), the net income was $85.4 million (Table 5.20).

 In 2013, net operating income was $40.2 million for all 34 community hospitals in Nevada; the net operating income per adjusted admission was $105 and a net operating income per adjusted inpatient day was $22 (Table 5.21).

 In 2013, net income was $108.5 million for all 34 community hospitals in Nevada; the net operating income per adjusted admission was $284 and a net operating income per adjusted inpatient day was $58 (Table 5.22).

 In 2013, rural and frontier hospitals had an average daily charge of $6,468 and an average charges per admission of $18,816 (Table 5.23).

 In 2013, 41.0% of inpatient admissions, 51.6% inpatient days, and 52.1% of inpatient billed charges were Medicare patients in rural and frontier hospitals (Tables 5.24, 5.25, and 5.26).

 In 2013, the top 20 admissions in rural and frontier hospitals mirror the urban top 20 admissions, however, some of the top admissions in rural and frontier Nevada reflect an older population, e.g., digestive disorders, chest pain, and simple pneumonia (Tables 5.28 and 5.29).

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Table 5.1: The Unique Geography of Community Hospitals in Rural and Frontier Nevada – 2015

Mileage to –

Office of Hospital – Town/County Nearest Nearest Rural Health Nearest Incorporated Tertiary Program Hospital Town Hospital Office in Reno Critical Access Hospitals (CAHs) Battle Mountain General Hospital – Battle Mountain/Lander 49 54 218 219 Boulder City Hospital – Boulder City/Clark 11 11 11 474 Carson Valley Medical Center – Gardnerville/Douglas 18 24 52 53 Desert View Hospital – Pahrump/Nye 62 62 62 406 Grover C. Dils Medical Center – Caliente/Lincoln 25 96 149 454 Humboldt General Hospital – Winnemucca/Humboldt 54 54 166 167 Incline Village Community Hospital – Incline Village/Washoe 20 27 34 35 Mesa View Hospital – Mesquite/Clark 39 39 39 517 Mt. Grant General Hospital – Hawthorne/Mineral 57 57 123 133 Pershing General Hospital – Lovelock/Pershing 56 56 93 94 William Bee Ririe Hospital – Ely/White Pine 118 118 242 320 Critical Access Hospitals – Average 46.3 54.4 108.1 261.1 CAH-eligible Hospitals Banner Churchill Community Hospital – Fallon/Churchill 27 56 63 64 Northeastern Nevada Regional Hospital – Elko/Elko 20 70 230 295 Nye Regional Medical Center – Tonopah/Nye 93 104 209 238 South Lyon Medical Center – Yerington/Lyon 46 59 80 81 CAH-eligible Hospitals – Average 46.5 72.3 145.5 169.5 Rural and Frontier Average 46.3 59.1 118.1 236.7

Source: Nevada Department of Transportation (2014).

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Table 5.2: Community Hospitals in Rural and Frontier Nevada – 2015

Employees – Annual Payroll – Average Salary Hospital Licensed Beds FY 2013 (FTE) FY 2013 (Dollars) (Dollars)

Critical Access Hospitals (CAHs) Battle Mountain General Hospital 25 108 6,451,656 59,738 Boulder City Hospital 91 161 8,513,325 52,878 Carson Valley Medical Center 23 260 15,592,625 59,972 Desert View Hospital 25 155 8,025,538 51,778 Grover C. Dils Medical Center 20 60 2,819,167 46,986 Humboldt General Hospital 53 213 16,088,050 75,531 Incline Village Community Hospital 4 36 2,837,406 78,817 Mesa View Regional Hospital 25 149 11,476,721 77,025 Mt. Grant General Hospital 35 114 5,612,734 49,235 Pershing General Hospital 38 71 3,714,507 52,317 William Bee Ririe Hospital 25 175 13,231,227 75,607 CAH Subtotal 364 1,502 94,362,956 62,825 CAH-eligible Hospitals Banner Churchill Community Hospital 40 270 18,710,591 69,298 Northeastern Nevada Regional Hospital 75 273 19,125,092 70,055 Nye Regional Medical Center 12 49 1,916,036 39,103 South Lyon Medical Center 63 156 7,122,688 45,658 CAH-eligible Subtotal 190 748 46,874,407 62,666 Rural and Frontier Subtotal 554 2,250 141,237,363 62,772 Urban Subtotal (See Table 5.3) 5,411 21,825 1,567,216,463 71,809 Nevada – Total 5,965 24,075 1,708,453,826 70,965

Sources: Bureau of Health Care Quality and Compliance (2014e). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014).

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Table 5.3: Community Hospitals in Urban Nevada – 2015

Employees – Annual Payroll – Average Salary Hospital Licensed Beds FY 2013 (FTE) FY 2013 (Dollars) (Dollars)

Carson City Carson Tahoe Regional Medical Center 190 956 67,419,946 70,491 Sierra Surgery Hospital 15 105 7,882,794 74,867 Clark County Centennial Hills Hospital Medical Center 171 645 45,757,712 70,979 Desert Springs Hospital Medical Center 293 1,001 67,439,744 67,376 MountainView Hospital 340 1,145 110,363,359 96,426 North Vista Hospital 177 521 40,601,148 77,946 St. Rose Dominican Hospital, Rose de Lima Campus 119 696 49,593,786 71,255 St. Rose Dominican Hospital, San Martin Campus 147 648 49,832,955 76,903 St. Rose Dominican Hospital, Siena Campus 230 1,479 108,938,962 73,657 Southern Hills Hospital and Medical Center 134 488 39,780,925 81,515 Spring Valley Hospital Medical Center 237 973 69,106,435 70,988 Summerlin Hospital Medical Center 454 1,338 97,258,840 72,692 Sunrise Hospital and Medical Center 690 2,434 201,349,278 82,724 University Medical Center of Southern Nevada 541 3,578 232,902,407 65,090 Valley Hospital Medical Center 301 1,268 90,380,891 71,270 Washoe County Northern Nevada Medical Center 108 364 23,188,234 63,746 Renown Regional Medical Center 808 2,560 157,739,648 61,611 Renown South Meadows Medical Center 76 351 22,451,929 64,044 Saint Mary’s Regional Medical Center 380 1,275 85,227,470 66,850 Urban Subtotal 5,411 21,825 1,567,216,463 71,809 Rural and Frontier Subtotal (See Table 5.2) 554 2,250 141,237,363 62,772 Nevada – Total 5,965 24,075 1,708,453,826 70,965

Sources: Bureau of Health Care Quality and Compliance (2014a). Nevada Compare Care (2014a).

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Table 5.4: Employment Impact of Community Hospitals in Rural and Frontier Nevada – 2013

Employment Impact of Community Hospitals (Number of Jobs) Hospital Type II Secondary Hospital Total Employment Employment Employment Employment Impact Multiplier Impact Critical Access Hospitals (CAHs) Battle Mountain General Hospital 108 1.20 22 130 Boulder City Hospital 161 1.76 122 283 Carson Valley Medical Center 260 1.44 114 373 Desert View Hospital 155 1.26 40 195 Grover C. Dils Medical Center 60 1.18 11 71 Humboldt General Hospital 213 1.28 60 273 Incline Village Community Hospital 36 1.64 23 59 Mesa View Regional Hospital 149 1.76 113 262 Mt. Grant General Hospital 114 1.23 26 140 Pershing General Hospital 71 1.06 4 76 William Bee Ririe Hospital 175 1.28 49 224 CAH Subtotal 1,502 – 584 2,086 CAH-eligible Hospitals Banner Churchill Community Hospital 270 1.27 73 343 Northeastern Nevada Regional Hospital 273 1.37 101 374 Nye Regional Medical Center 49 1.26 13 62 South Lyon Medical Center 156 1.23 36 192 CAH-eligible Subtotal 748 – 222 971 Rural and Frontier Subtotal 2,250 – 807 3,057 Urban Hospitals Carson City 1,061 1.45 281 1,338 Clark County 16,214 1.76 12,248 28,462 Washoe County 4,550 1.64 3,003 7,670 Urban Subtotal 21,825 – 15,532 37,470 Nevada – Total 24,075 – 16,339 40,527

Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014).

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Table 5.5: Payroll Impact of Community Hospitals in Rural and Frontier Nevada – 2013

Payroll Impact of Community Hospitals (Dollars) Hospital Hospital Type II Payroll Secondary Payroll Total Payroll Payroll Multiplier Impact Impact Critical Access Hospitals (CAHs) Battle Mountain General Hospital 6,451,656 1.06 387,099 6,838,755 Boulder City Hospital 8,513,325 1.40 3,405,330 11,918,655 Carson Valley Medical Center 15,592,625 1.20 3,118,525 18,711,150 Desert View Hospital 8,025,538 1.16 1,284,086 9,309,624 Grover C. Dils Medical Center 2,819,167 1.11 310,108 3,129,275 Humboldt General Hospital 16,088,050 1.15 2,413,208 18,501,258 Incline Village Community Hospital 2,837,406 1.43 1,220,085 4,057,491 Mesa View Regional Hospital 11,476,721 1.40 4,590,688 16,067,409 Mt. Grant General Hospital 5,612,734 1.11 617,401 6,230,135 Pershing General Hospital 3,714,507 1.04 148,580 3,863,087 William Bee Ririe Hospital 13,231,227 1.09 1,190,810 14,422,037 CAH Subtotal 94,362,956 – 18,685,920 113,048,876 CAH-eligible Hospitals Banner Churchill Community Hospital 18,710,591 1.11 2,058,165 20,768,756 Northeastern Nevada Regional Hospital 19,125,092 1.25 4,781,273 23,906,365 Nye Regional Medical Center 1,916,036 1.16 306,566 2,222,602 South Lyon Medical Center 7,122,688 1.14 997,176 8,119,864 CAH-eligible Subtotal 46,874,407 – 8,143,180 55,017,587 Rural and Frontier Subtotal 141,237,363 – 26,829,100 168,066,463 Urban Hospitals Carson City 75,302,740 1.20 12,048,438 87,351,178 Clark County 1,203,306,442 1.40 343,744,787 1,547,051,229 Washoe County 288,607,281 1.43 124,101,131 412,708,412 Urban Subtotal 1,567,216,463 – 673,903,079 2,047,110,819 Nevada – Total 1,708,453,826 – 341,307,558 2,215,177,828

Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014).

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Table 5.6: Health Sector Employment in Nevada by County – 2013

Health Sector Employment (Number of Jobs)

Physicians, Region/County Nursing and Other Medical Dentists, and Hospital Protective Pharmacies and Health Total Other Care Services Professionals Rural and Frontier Churchill County 297 236 228 38 45 844 Douglas County 293 588 260 55 110 1,306 Elko County 321 550 275 24 126 1,296 Esmeralda County 0 0 0 0 0 0 Eureka County 0 13 0 0 0 13 Humboldt County 250 139 121 10 21 541 Lander County 116 14 0 10 0 140 Lincoln County 76 13 138 10 4 241 Lyon County 158 118 103 43 10 432 Mineral County 136 38 0 0 0 174 Nye County 249 245 79 48 108 729 Pershing County 97 10 10 4 0 121 Storey County 0 117 0 0 0 117 White Pine County 165 54 79 24 0 332 Region Subtotal 2,158 2,136 1,293 266 423 6,276 Urban Carson City 1,259 947 650 87 292 3,235 Clark County 22,348 23,442 8,555 3,709 9,788 67,842 Washoe County 6,706 7,099 3,029 556 1,741 19,131 Region Subtotal 30,313 31,488 12,234 4,352 11,821 90,208 Nevada – Total 32,471 33,624 13,527 4,618 12,244 96,484

Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014).

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Table 5.7: Health Sector Payroll in Nevada by County – 2013

Health Sector Payroll (Thousands of Dollars)

Physicians, Region/County Nursing and Other Medical Dentists, and Hospital Protective Pharmacies and Health Total Other Care Services Professionals Rural and Frontier Churchill County 16,613 13,808 5,762 1,320 1,196 38,700 Douglas County 14,577 33,842 10,294 1,800 4,378 64,891 Elko County 17,406 30,461 9,023 940 1,749 59,579 Esmeralda County 0 0 0 0 0 0 Eureka County 0 592 0 0 0 592 Humboldt County 13,627 6,136 6,533 199 486 26,981 Lander County 6,780 371 0 223 0 7,373 Lincoln County 2,810 297 5,353 294 85 8,840 Lyon County 5,850 5,969 3,058 1,461 384 16,722 Mineral County 6,508 1,318 0 0 0 7,826 Nye County 9,942 12,303 2,374 1,527 3,909 30,055 Pershing County 3,709 455 379 51 0 4,594 Storey County 0 3,074 0 0 120 3,074 White Pine County 13,174 2,055 3,005 344 520 18,578 Region Subtotal 110,996 110,679 45,782 8,160 12,187 287,804 Urban Carson City 74,188 76,544 18,436 3,290 16,845 189,303 Clark County 1,542,325 1,422,414 290,434 150,470 508,285 3,913,928 Washoe County 393,173 521,990 98,567 19,484 87,504 1,120,717 Region Subtotal 2,009,686 2,020,948 407,436 173,244 612,634 5,223,948 Nevada – Total 2,120,681 2,131,627 453,218 181,405 624,821 5,511,752

Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014).

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Table 5.8: Employment Impact of the Health Sector in Nevada by County – 2013

Employment Impact of the Health Sector (Number of Jobs)

Region/County Type II Secondary Total Health Sector Employment Employment Employment Employment Multiplier Impact Impact Rural and Frontier Churchill County 844 1.24 206 1,050 Douglas County 1,306 1.37 489 1,795 Elko County 1,296 1.24 307 1,603 Esmeralda County 0 0.00 0 0 Eureka County 13 1.07 1 14 Humboldt County 541 1.21 112 653 Lander County 140 1.15 21 161 Lincoln County 241 1.12 30 271 Lyon County 432 1.19 83 515 Mineral County 174 1.22 38 212 Nye County 729 1.19 135 864 Pershing County 121 1.08 10 131 Storey County 3 1.12 0 3 White Pine County 322 1.18 57 379 Region Subtotal 6,162 – 1,488 7,650 Urban Carson City 3,235 1.38 1,233 4,468 Clark County 67,842 1.55 37,007 104,849 Washoe County 19,131 1.54 10,370 29,501 Region Subtotal 90,208 – 48,610 138,818 Nevada – Total 96,370 – 50,099 146,469

Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014).

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Table 5.9: Payroll Impact of the Health Sector in Nevada by County – 2013

Payroll Impact of the Health Sector (Thousands of Dollars)

Region/County Type II Secondary Health Sector Total Payroll Income Payroll Payroll Impact Multiplier Impact Rural and Frontier Churchill County 38,700 1.11 4,236 42,936 Douglas County 64,891 1.20 13,030 77,921 Elko County 59,579 1.20 12,167 71,746 Esmeralda County 0 0 0 0 Eureka County 592 1.03 19 611 Humboldt County 26,981 1.13 3,631 30,612 Lander County 7,373 1.07 524 7,897 Lincoln County 8,840 1.09 831 9,670 Lyon County 16,722 1.12 2,022 18,744 Mineral County 7,826 1.14 1,100 8,926 Nye County 30,055 1.14 4,282 34,337 Pershing County 4,594 1.05 236 4,830 Storey County 120 1.07 9 129 White Pine County 18,577 1.09 1,625 20,203 Region Subtotal 284,849 – 43,712 328,562 Urban Counties Carson City 189,303 1.20 37,933 227,236 Clark County 3,913,928 1.38 1,475,155 5,389,083 Washoe County 1,120,717 1.37 417,336 1,538,053 Region Subtotal 5,223,948 – 1,930,424 7,154,372 Nevada – Total 5,508,797 – 1,974,137 7,482,934

Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014).

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Table 5.10: Number and Type of Licensed Beds in Community Hospitals in Rural and Frontier Nevada – 2015

Licensed Beds

Rehabilitation Total Beds Hospital Skilled Acute Care Swing and (Acute and Nursing Beds Beds Psychiatric Skilled Beds Beds Nursing Care) Critical Access Hospitals (CAHs) Battle Mountain General Hospital 7 18 7 0 25 Boulder City Hospital 24 47 0 20 91 Carson Valley Medical Center 23 0 5 0 23 Desert View Hospital 25 0 0 0 25 Grover C. Dils Medical Center 4 16 4 0 20 Humboldt General Hospital 23 30 2 0 53 Incline Village Community Hospital 4 0 0 0 4 Mesa View Regional Hospital 25 0 14 0 25 Mt. Grant General Hospital 11 24 11 0 35 Pershing General Hospital 13 25 13 0 38 William Bee Ririe Hospital 25 0 0 0 25 CAH Subtotal 184 160 56 20 364 CAH-eligible Hospitals Banner Churchill Community Hospital 40 0 0 0 40 Northeastern Nevada Regional Hospital 75 0 0 16 75 Nye Regional Medical Center 12 0 0 0 12 South Lyon Medical Center 14 49 14 0 63 CAH-eligible Subtotal 141 49 14 16 190 Rural and Frontier Nevada – Total 325 209 70 36 554

Sources: Bureau of Health Care Quality and Compliance (2014a). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014).

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Table 5.11: Number and Per Capita Distribution of Licensed Community Hospital Beds and Skilled Nursing Beds in Nevada by County – 2015

Licensed Community Hospital Beds Licensed Skilled Nursing Beds

Number per Region/County Number per Number per Percent of Percent of 1,000 Number 1,000 Number 1,000 Nevada Total Nevada Total Population Population Population Aged 65+ Rural and Frontier Churchill County 40 0.6 1.6 102 2.0 4.0 25.7 Douglas County 23 0.3 0.5 60 1.2 1.2 5.1 Elko County 75 1.1 1.4 146 2.8 2.7 23.3 Esmeralda County 0 0.0 0.0 0 0.0 0.0 0.0 Eureka County 0 0.0 0.0 0 0.0 0.0 0.0 Humboldt County 23 0.3 1.3 30 0.6 1.7 15.4 Lander County 7 0.1 1.1 18 0.3 2.7 23.0 Lincoln County 4 0.1 0.8 16 0.3 2.8 14.7 Lyon County 14 0.2 0.3 49 0.6 0.9 4.8 Mineral County 11 0.2 2.5 24 0.5 5.3 25.3 Nye County 37 0.5 0.8 0 0.0 0.0 0.0 Pershing County 13 0.2 1.9 25 0.5 3.6 28.5 Storey County 0 0.0 0.0 0 0.0 0.0 0.0 White Pine County 25 0.4 2.4 97 1.9 9.5 57.4 Region Subtotal 272 3.8 1.0 567 11.0 2.0 10.7 Urban Counties Carson City 234 3.3 4.3 339 6.6 6.2 34.2 Clark County 4,909 68.9 2.4 3,392 65.6 1.7 12.9 Washoe County 1,725 24.2 3.9 876 16.9 2.0 14.4 Region Subtotal 6,868 96.2 2.7 4,607 89.0 1.8 13.8 Nevada – Total 7,140 100.0 2.5 5,174 100.0 1.8 13.4

Sources: Bureau of Health Care Quality and Compliance (2014a). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014).

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Table 5.12: Ownership, Tax Status, and Service Area of Community Hospitals in Rural and Frontier Nevada – 2015

Estimated Service Area Hospital Ownership – Tax Status Population – Service Area

Critical Access Hospitals (CAH) Not-for-profit / Public – Lander County 6,000 / Battle Mountain, Lander Battle Mountain General Hospital Hospital District County, Northern Eureka County Not-for-profit / Private – Boulder City 25,000 / Boulder City, Henderson, Boulder City Hospital Hospital, Inc. Searchlight, Clark County Not-for-profit / Private – Barton 50,000 / Minden, Gardnerville, Douglas Carson Valley Medical Center Healthcare and Renown Health County, Bordering California Counties For-profit / Private – Rural Health 40,000 / Pahrump, Southern Nye Desert View Hospital Management Corp. County Not-for-profit / Public – Lincoln County 5,000 / Caliente, Panaca, Pioche, Grover C. Dils Medical Center Hospital District Alamo, Lincoln County Not-for-profit / Public – Humboldt 18,000 / Winnemucca, Humboldt Humboldt General Hospital County Hospital District County Not-for-profit / Private – Tahoe Forest 10,000 / Incline Village, Washoe Incline Village Community Hospital Hospital District County, North Lake Tahoe Area For-profit / Private – Community 20,000 / Mesquite, Moapa, Western Mesa View Regional Hospital Health Systems Clark County Not-for-profit / Public – Mineral 5,000 / Hawthorne, Schurz, Mineral Mt. Grant General Hospital County Hospital District County Not-for-profit / Public – Pershing Pershing General Hospital 7,000 / Lovelock, Pershing County County Hospital District Not-for-profit / Public – White Pine 10,000 / Ely, Ruth, White Pine County, William Bee Ririe Hospital County Hospital District Western Eureka County CAH-Eligible Hospitals Not-for-profit / Private – Banner 55,000 / Fallon, Fernley, Churchill Banner Churchill Community Hospital Health System County, Northern Lyon County For-profit / Private – Province Health 52,000 / Elko, Carlin, Wells, Elko Northeastern Nevada Regional Hospital Care Corporation County Not-for-profit / Private – Primecare 5,000 / Tonopah, Northern Nye Nye Regional Medical Center Nevada County, Esmeralda County Not- for- profit / Non- governmental – 5,000 / Yerington, Wellington, Smith South Lyon Medical Center Receives Lyon County Tax Support Valley, Southern Lyon County Rural and Frontier – Total 12 Not-for-profit / 3 For-profit 313,000 in rural and frontier counties

Source: Nevada Rural Hospital Partners (2014). Nevada State Demographer’s Office (2014b).

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Table 5.13: Hospital-based Rural Health Clinics (RHC) in Rural and Frontier Nevada – 2015 Rural Health Estimated Service Area Hospital Clinic Population – Service Area

Critical Access Hospitals (CAH) 6,000 / Battle Mountain, Lander County, Northern Eureka Battle Mountain General Hospital Yes County Boulder City Hospital No 25,000 / Boulder City, Henderson, Searchlight, Clark County 50,000 / Minden, Gardnerville, Douglas County, Bordering California Carson Valley Medical Center Yes Counties Desert View Hospital No 40,000 / Pahrump, Southern Nye County

Grover C. Dils Medical Center Yes 5,000 / Caliente, Panaca, Pioche, Alamo, Lincoln County

Humboldt General Hospital Yes 18,000 / Winnemucca, Humboldt County

Incline Village Community Hospital No 10,000 / Incline Village, Washoe County, North Lake Tahoe Area

Mesa View Regional Hospital No 20,000 / Mesquite, Moapa, Western Clark County

Mt. Grant General Hospital Yes 5,000 / Hawthorne, Schurz, Mineral County

Pershing General Hospital Yes 7,000 / Lovelock, Pershing County

William Bee Ririe Hospital Yes 10,000 / Ely, Ruth, White Pine County, Western Eureka County

CAH-Eligible Hospitals 55,000 / Fallon, Fernley, Churchill County, Northern Lyon Banner Churchill Community Hospital No County Northeastern Nevada Regional Hospital No 52,000 / Elko, Carlin, Wells, Elko County

Nye Regional Medical Center No 5,000 /Tonopah, Northern Nye County, Esmeralda County 5,000 / Yerington, Wellington, Smith Valley, Southern Lyon South Lyon Medical Center Yes County Rural and Frontier – Total 8 313,000 in rural and frontier counties

Source: Nevada Rural Hospital Partners (2014). Nevada State Demographer’s Office (2014b).

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Table 5.14: Federally Qualified Health Centers (FQHC) in Rural and Frontier Nevada – 2015

Patient Visits Estimated Service Area Community Health Center / County Percent Population – Service Area 2013 of Total 1,500 / Amargosa Valley, Southern Nye Amargosa Valley Medical Clinic – Nye County 690 6.1 County, Bordering California Counties Austin Medical Clinic – Lander County 143 1.3 500 / Austin, Southern Lander County

Beatty Medical Clinic – Nye County 719 6.3 1,500 / Beatty, Southern Nye County

Carlin Community Health Center – Elko County 931 8.2 2,500 / Carlin, Western Elko County 500 / Crescent Valley, Northern Eureka Crescent Valley Medical Center – Eureka County 250 1.8 County Elko Medical and Dental Clinic – Elko County 4,623 40.7 45,000 / Elko, Central Elko County

Eureka Medical Clinic – Eureka County 844 7.4 500 / Eureka, Eureka County 5,000 / Jackpot, Northern Elko County, Jackpot Community Health Center – Elko County 423 3.7 Southern Idaho Counties 5,000 / West Wendover, Eastern Elko County, Wendover Community Health Center – Elko County 2,788 24.5 Wendover, Utah Rural and Frontier – Total 11,366 100.0 59,000 / 30,000 Square Miles

Source: Nevada Health Centers (2014). Nevada State Demographer’s Office (2014b).

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Table 5.15: Tribal Medical Clinics and Health Centers in Rural and Frontier Nevada – 2015

Estimated Tribal Population – Tribal Clinic or Health Center Service Unit / Tribe or Colony Clinic or Health Center Service Area

Elko / Shoshone / Battle Mountain Battle Mountain Health Center 500 / Lander County Band

3,000 / Northern Elko County, Owyhee Duck Valley Health Center Elko/ Duck Valley Shoshone-Paiute County (ID)

Duckwater Health Department Elko / Duckwater Shoshone 300 / Nye County

Ely Shoshone Tribal Clinic – Newe Elko / Ely Shoshone 600 / Eureka and White Pine Counties Medical Clinic Schurz / Fallon Paiute-Shoshone, 3,000 / Churchill, Humboldt, Lander, Fallon Tribal Health Clinic Lovelock Paiute, Summit Lake Lyon, Nye, and Pershing Counties Paiute Schurz / Fort McDermitt Paiute- 1,000 / Northern Humboldt County, Fort McDermitt IHS Health Station Shoshone Malheur County (OR)

Elko / Confederated Tribes of the 500 / Eastern Elko County, Juab Goshute Indian Health Clinic Goshute Reservation County (UT)

Moapa Tribal Clinic Schurz / Moapa Band of Paiute 500 / Lincoln, Nye and Clark Counties

Pyramid Lake Tribal Health Clinic Schurz / Pyramid Lake Paiute 4,000 / Lyon County, Washoe County

Elko/ Te-Moak Western Shoshone, 3,000 / Elko, Eureka and Lander Southern Bands Health Center and Elko, South Fork, Wells and Counties, Tooele County (UT) Battle Mountain Bands Schurz / Timbisha Shoshone, 2,000 / Esmeralda, Mineral and Nye Walker River Tribal Health Center Walker River Paiute and Yomba Counties Shoshone Schurz / Washoe Tribe of Nevada 3,000 / Carson City, Douglas, Lyon and Washoe Tribal Health Center and California / Carson, Dresslerville, Storey Counties, Alpine County (CA) Stewart and Woodfords Colonies 1,500 / Lyon County Yerington Paiute Tribal Health Clinic Schurz / Yerington Paiute

22,900 in Nevada and Bordering Rural and Frontier Nevada – Total Counties of Idaho, Utah, California, and Oregon

Source: Phoenix Area Indian Health Systems (2014). Nevada State Demographer’s Office (2014b).

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Table 5.16: Utilization Trends in Rural and Frontier Hospitals in Nevada – 2013

Utilization

Hospital Average Inpatient Average Occupancy Admissions Length of Days Daily Census Rate Stay (Days) Critical Access Hospitals (CAHs) Battle Mountain General Hospital 32 76 2.4 0.2 0.8 Boulder City Hospital 381 2,374 6.2 6.5 9.2 Carson Valley Medical Center 795 2,580 3.2 7.1 30.7 Desert View Hospital 1,048 3,934 3.8 10.8 43.1 Grover C. Dils Medical Center 147 626 4.3 1.7 8.6 Humboldt General Hospital 873 2,293 2.6 6.3 11.9 Incline Village Community Hospital 6 7 1.2 0.0 0.5 Mesa View Hospital 720 1,879 2.6 5.1 20.6 Mt. Grant General Hospital 458 1,831 4.0 5.0 14.3 Pershing General Hospital 64 368 5.8 1.0 2.7 William Bee Ririe Hospital 404 1,009 2.5 2.8 11.1 CAH Subtotal 4,928 16,977 3.4 46.5 13.5 CAH-eligible Hospitals Banner Churchill Community Hospital 1,849 6,064 3.3 16.6 41.5 Northeastern Nevada Regional Hospital 2,797 8,013 2.9 22.0 29.3 Nye Regional Medical Center 70 157 2.2 0.4 3.6 South Lyon Medical Center 126 454 3.6 1.2 2.0 CAH-eligible Subtotal 4,842 14,688 3.0 40.2 21.2 Rural and Frontier Subtotal 9,770 31,665 3.2 86.8 16.2 Urban Subtotal 239,816 1,185,886 4.9 3,249.0 62.3 Nevada – Total 249,586 1,217,551 4.9 3,335.8 58.1

Sources: Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014).

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Table 5.17: Admissions and Inpatient Days in Rural and Frontier Hospitals in Nevada – 2013

Admissions Inpatient Days

Hospital Adjusted Percent Adjusted Percent of Number of Number Of Nevada Number of Number Nevada Inpatient Total Admissions Total Days Critical Access Hospitals (CAHs) Battle Mountain General Hospital 32 0.0 179 76 0.0 425 Boulder City Hospital 381 0.2 1,481 2,374 0.2 9,227 Carson Valley Medical Center 795 0.3 4,179 2,580 0.2 13,561 Desert View Hospital 1,048 0.4 3,561 3,934 0.3 13,368 Grover C. Dils Medical Center 147 0.1 315 626 0.1 1,342 Humboldt General Hospital 873 0.3 3,239 2,293 0.2 8,509 Incline Village Community Hospital 6 0.0 835 7.0 0.0 974 Mesa View Hospital 720 0.3 4,020 1,879 0.2 10,491 Mt. Grant General Hospital 458 0.2 977 1,831 0.2 3,905 Pershing General Hospital 64 0.0 296 368 0.0 1,701 William Bee Ririe Hospital 404 0.2 2,272 1,009 0.1 5,673 CAH-Subtotal 4,928 2.0 21,149 16,977 1.4 72,858 CAH-eligible Hospitals Banner Churchill Community Hospital 1,849 0.7 5,733 6,064 0.5 18,802 Northeastern Nevada Regional Hospital 2,797 1.1 7,414 8,013 0.7 21,240 Nye Regional Medical Center 70 0.0 893 157.0 0.0 2,004 South Lyon Medical Center 126 0.1 393 454 0.0 1,416 CAH-eligible Subtotal 4,842 1.9 14,187 14,688 1.2 43,035 Rural and Frontier Subtotal 9,770 3.9 35,470 31,665 2.6 114,960 Urban Subtotal 239,816 96.1 359,221 1,185,886 97.4 1,776,341 Nevada – Total 249,586 100.0 381,616 1,217,551 100.0 1,861,629

Sources: Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014).

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Table 5.18: Total Patient Revenue in Rural and Frontier Hospitals in Nevada – 2013

Total Patient Revenue (Thousands of Dollars) Hospital Percent of Total Percent of Total Total Patient Inpatient Outpatient Patient Revenue Patient Revenue Revenue Critical Access Hospitals (CAHs) Battle Mountain General Hospital 2,133 17.9 9,792 82.1 11,925 Boulder City Hospital 11,981 25.7 34,584 74.3 46,565 Carson Valley Medical Center 24,442 19.0 104,035 81.0 128,477 Desert View Hospital 28,956 29.4 69,440 70.6 98,396 Grover C. Dils Medical Center 2,940 46.7 3,361 53.3 6,301 Humboldt General Hospital 19,148 26.9 51,905 73.1 71,053 Incline Village Community Hospital 102 0.7 14,052 99.3 14,153 Mesa View Hospital 13,936 17.9 63,871 82.1 77,807 Mt. Grant General Hospital 9,763 46.9 11,059 53.1 20,822 Pershing General Hospital 2,328 21.6 8,433 78.4 10,761 William Bee Ririe Hospital 7,809 17.8 36,100 82.2 43,909 CAH Subtotal 123,537 23.3 406,633 76.7 530,170 CAH-eligible Hospitals Banner Churchill Community Hospital 37,953 32.3 79,725 67.7 117,679 Northeastern Nevada Regional Hospital 72,488 37.7 119,658 62.3 192,146 Nye Regional Medical Center 1,308 7.8 15,380 92.2 16,688 South Lyon Medical Center 4,820 32.1 10,208 67.9 15,028 CAH-eligible Subtotal 116,569 34.1 224,972 65.9 341,541 Rural and Frontier Subtotal 240,106 27.5 631,605 72.4 871,711 Urban Subtotal 16,228,682 66.8 8,080,299 33.2 24,308,981 Nevada – Total 16,468,789 65.4 8,711,905 34.6 25,180,694

Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014).

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Table 5.19: Total Revenue in Rural and Frontier Hospitals in Nevada – 2013

Total Revenue (Thousands of Dollars) Hospital Contractual Total Patient Net Patient Other Operating Total Deductions and Revenue Revenue Revenue Revenue Adjustments Critical Access Hospitals (CAHs) Battle Mountain General Hospital 11,925 5,201 6,724 1,267 7,991 Boulder City Hospital 46,565 29,297 17,268 249 17,517 Carson Valley Medical Center 128,477 85,820 42,657 560 43,217 Desert View Hospital 98,396 74,279 24,117 447 24,564 Grover C. Dils Medical Center 6,301 1,919 4,382 57 4,439 Humboldt General Hospital 71,053 33,903 37,150 0 37,150 Incline Village Community Hospital 14,153 5,620 8,533 673 9,206 Mesa View Hospital 77,807 50,733 27,074 236 27,310 Mt. Grant General Hospital 20,822 9,992 10,830 98 10,928 Pershing General Hospital 10,761 3,418 7,343 1,912 9,255 William Bee Ririe Hospital 43,909 19,063 24,846 359 25,205 CAH Subtotal 530,170 319,245 210,925 5,858 216,783 CAH-eligible Hospitals Banner Churchill Community Hospital 117,679 74,391 43,288 588 43,876 Northeastern Nevada Regional Hospital 192,146 100,121 92,025 0 92,025 Nye Regional Medical Center 16,688 6,323 10,365 0 10,365 South Lyon Medical Center 15,028 6,752 8,276 1,782 10,058 CAH-eligible Subtotal 341,541 187,587 153,954 2,369 156,323 Rural and Frontier Subtotal 871,711 506,832 364,879 8,227 373,106 Urban Subtotal 24,308,981 20,105,550 4,203,431 87,389 4,290,820 Nevada – Total 25,180,694 20,612,382 4,568,311 95,616 4,663,928

Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014).

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Table 5.20: Net Income in Rural and Frontier Hospitals in Nevada – 2013

Net Income (Thousands of Dollars) Hospital Total Operating Net Operating Non-operating Net Income Revenue Expense Income Revenue Critical Access Hospitals (CAHs) Battle Mountain General Hospital 7,991 12,699 -4,708 11,441 6,733 Boulder City Hospital 17,517 16,277 1,240 538 1,778 Carson Valley Medical Center 43,217 40,399 2,818 63 2,881 Desert View Hospital 24,564 22,474 2,090 0 2,090 Grover C. Dils Medical Center 4,439 5,041 -602 693 91 Humboldt General Hospital 37,151 37,608 -457 11,501 11,044 Incline Village Community Hospital 9,206 9,032 174 137 311 Mesa View Hospital 27,310 29,663 -2,353 214 -2,140 Mt. Grant General Hospital 10,928 11,314 -386 468 82 Pershing General Hospital 9,255 6,239 3,016 1,307 4,323 William Bee Ririe Hospital 25,205 26,517 -1,312 2,210 898 CAH Subtotal 216,783 217,263 -480 28,572 28,092 CAH-eligible Hospitals Banner Churchill Community Hospital 43,876 42,577 1,299 4 1,303 Northeastern Nevada Regional Hospital 92,025 46,496 45,529 821 46,350 Nye Regional Medical Center 10,365 0 10,365 0 10,365 South Lyon Medical Center 10,058 11,487 -1,429 672 -757 CAH-eligible Subtotal 156,323 100,560 55,763 1,497 57,260 Rural and Frontier Subtotal 373,107 317,823 55,284 30,069 85,353 Urban Subtotal 4,290,820 4,305,918 -15,098 38,257 23,159 Nevada – Total 4,663,925 4,625,850 40,186 68,326 108,512

Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014).

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Table 5.21: Net Operating Income Benchmarks in Rural and Frontier Hospitals in Nevada – 2013

Net Operating Income Benchmarks (Dollars)

Hospital Net Operating Net Operating Net Operating Income Income per Income per (Thousands of Adjusted Adjusted Dollars) Admissions Inpatient Day Critical Access Hospitals (CAHs) Battle Mountain General Hospital -4,708 -26,317 -11,081 Boulder City Hospital 1,240 837 134 Carson Valley Medical Center 2,818 674 208 Desert View Hospital 2,090 587 156 Grover C. Dils Medical Center -602 -1,911 -449 Humboldt General Hospital -457 -141 -54 Incline Village Community Hospital 174 208 179 Mesa View Hospital -2,353 -585 -224 Mt. Grant General Hospital -386 -395 -99 Pershing General Hospital 3,016 10,194 1,773 William Bee Ririe Hospital -1,312 -577 -231 CAH Subtotal -479 -23 -7 CAH-eligible Hospitals Banner Churchill Community Hospital 1,299 227 69 Northeastern Nevada Regional Hospital 45,529 6,141 2,144 Nye Regional Medical Center 10,365 11,603 5,173 South Lyon Medical Center -1,429 -3,639 -1,010 CAH-eligible Subtotal 55,763 3,931 1,296 Rural and Frontier Subtotal 55,284 1,559 481 Urban Subtotal -15,098 -42 -8 Nevada – Total 40,186 105 22

Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014).

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Table 5.22: Net Income Benchmarks in Rural and Frontier Hospitals in Nevada – 2013

Net Income Benchmarks (Dollars)

Hospital Net Income Net Income per Net Income per (Thousands of Adjusted Adjusted Inpatient Dollars) Admission Day Critical Access Hospitals (CAHs) Battle Mountain General Hospital 6,733 37,637 15,847 Boulder City Hospital 1,778 1,201 193 Carson Valley Medical Center 2,881 689 213 Desert View Hospital 2,090 587 156 Grover C. Dils Medical Center 91 289 68 Humboldt General Hospital 11,044 3,409 1,310 Incline Village Community Hospital 311 372 320 Mesa View Hospital -2,140 -532 -204 Mt. Grant General Hospital 82 84 21 Pershing General Hospital 4,323 14,612 1,709 William Bee Ririe Hospital 898 395 158 CAH Subtotal 28,092 1,328 368 CAH-eligible Hospitals Banner Churchill Community Hospital 1,303 227 69 Northeastern Nevada Regional Hospital 46,350 6,252 2,182 Nye Regional Medical Center 10,365 11,603 5,173 South Lyon Medical Center -757 -1,927 -535 CAH-eligible Hospitals Subtotal 57,260 4,036 1,331 Rural and Frontier Subtotal 85,353 2,406 742 Urban Subtotal 23,159 64 13 Nevada – Total 108,512 284 58

Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014).

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Table 5.23: Inpatient Billed Charges and Case Mix in Rural and Frontier Hospitals in Nevada – 2013

Inpatient Billed Charges and Case Mix

Hospital Percent Total Charges Average of All Charges Average Daily Average Case (Thousands of Charges per Authorized in Charges Mix Dollars) Admission Nevada Critical Access Hospitals (CAHs) Battle Mountain General Hospital 135 0.0 1,804 4,510 0.92 Boulder City Hospital 5,911 0.0 3,609 15,805 0.94 Carson Valley Medical Center 23,736 0.1 9,579 30,238 1.28 Desert View Hospital 23,640 0.1 6,815 18,556 0.85 Grover C. Dils Medical Center 1,108 0.0 1,714 10,560 0.95 Humboldt General Hospital 14,542 0.1 5,432 13,305 0.76 Incline Village Community Hospital N/A N/A N/A N/A N/A Mesa View Hospital 14,013 0.1 6,843 17,322 1.04 Mt. Grant General Hospital 4,649 0.0 3,613 13,171 0.88 Pershing General Hospital 375 0.0 2,954 8,156 0.86 William Bee Ririe Hospital 7,288 0.0 6,837 16,306 0.94 CAH Subtotal 95,397 0.6 6,360 19,080 0.93 CAH-eligible Hospitals Banner Churchill Community Hospital 37,669 0.2 5,718 17,185 0.99 Northeastern Nevada Regional Hospital 72,850 0.4 8,102 21,370 0.86 Nye Regional Medical Center N/A N/A N/A N/A N/A South Lyon Medical Center 1,056 0.0 2,412 8,189 0.88 CAH-eligible Subtotal 111,575 0.6 6,974 18,596 – Rural and Frontier Subtotal 206,972 1.2 6,468 18,816 – Urban Subtotal 17,018,726 98.8 10,980 59,059 – Nevada – Total 17,225,698 100.0 10,895 57,577 1.38

Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014).

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Table 5.24: Inpatient Admissions by Payer Source in Rural and Frontier Hospitals in Nevada – 2013

Inpatient Admissions (Percent) Hospital Medicare CHAMPUS Commercial Medicare Medicaid Self Pay HMO CHAMPVA Insurer Critical Access Hospitals (CAHs) Battle Mountain General Hospital 66.7 0.0 0.0 0.0 0.0 0.0 Boulder City Hospital 61.5 7.2 6.4 0.0 2.7 0.0 Carson Valley Medical Center 66.6 2.9 4.5 1.9 6.1 6.2 Desert View Hospital 35.6 31.7 8.0 3.7 5.8 11.3 Grover C. Dils Medical Center 75.2 0.0 0.0 0.0 0.0 0.0 Humboldt General Hospital 22.1 0.0 14.6 0.0 11.7 19.2 Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital 47.1 7.8 16.3 0.0 0.0 6.3 Mt. Grant General Hospital 61.8 0.0 6.0 0.0 15.3 9.1 Pershing General Hospital 63.0 0.0 0.0 0.0 0.0 26.1 William Bee Ririe Hospital 28.4 0.0 11.4 0.0 34.9 18.3 CAH – Average 43.3 9.7 9.9 1.2 8.8 10.9 CAH-eligible Hospitals Banner Churchill Community Hospital 33.8 1.8 18.9 3.7 0.0 7.1 Northeastern Nevada Regional Hospital 23.8 0.4 12.1 0.5 31.1 9.0 Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center 58.1 24.0 0.0 0.0 0.0 0.0 CAH-eligible – Average 28.4 1.5 14.4 1.7 18.5 8.1 Rural and Frontier – Average 35.6 5.4 12.2 1.5 13.8 9.5 Urban – Average 27.0 9.1 16.3 2.1 4.0 8.7 Nevada – Average 27.4 9.0 16.1 2.1 4.4 8.7

Sources: Nevada Compare Care (2014c).

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Table 5.24: Inpatient Admissions by Payer Source in Rural and Frontier Hospitals in Nevada – 2013 (continued)

Inpatient Admissions (Percent) Hospital Negotiated Workers County Discounts HMO Charity Other Comp Indigent (PPO) Critical Access Hospitals (CAHs) Battle Mountain General Hospital 0.0 0.0 0.0 0.0 0.0 33.3 Boulder City Hospital 8.0 0.0 0.0 2.7 0.0 11.5 Carson Valley Medical Center 8.9 0.0 0.0 0.0 0.0 2.8 Desert View Hospital 0.0 2.6 0.0 0.0 0.0 1.3 Grover C. Dils Medical Center 0.0 0.0 0.0 0.0 0.0 24.8 Humboldt General Hospital 17.8 8.6 0.0 0.0 0.0 6.0 Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital 21.4 0.0 0.0 0.0 0.0 1.1 Mt. Grant General Hospital 0.0 4.8 0.0 0.0 0.0 3.1 Pershing General Hospital 0.0 0.0 0.0 0.0 0.0 10.9 William Bee Ririe Hospital 0.0 0.0 0.0 0.0 0.0 6.9 CAH – Average 8.8 2.7 0.0 0.2 0.0 4.5 CAH-eligible Hospitals Banner Churchill Community Hospital 14.6 6.7 0.0 0.0 12.5 0.9 Northeastern Nevada Regional Hospital 19.3 0.0 0.0 0.0 0.0 3.8 Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center 0.0 0.0 0.0 0.0 0.0 17.8 CAH-eligible – Average 17.0 2.6 0.0 0.0 4.8 3.0 Rural and Frontier – Average 13.1 2.6 0.0 0.1 2.5 3.7 Urban – Average 9.7 18.6 0.5 1.9 0.5 1.9 Nevada – Average 9.8 18.0 0.5 1.9 0.6 2.0

Sources: Nevada Compare Care (2014c).

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Table 5.25: Inpatient Days by Payer Source in Rural and Frontier Hospitals in Nevada – 2013

Inpatient Days (Percent) Hospital Medicare CHAMPUS Commercial Medicare Medicaid Self Pay HMO CHAMPVA Insurer Critical Access Hospitals (CAHs) Battle Mountain General Hospital 62.7 0.0 0.0 0.0 0.0 0.0 Boulder City Hospital 64.7 4.3 12.8 0.0 1.5 0.0 Carson Valley Medical Center 69.7 2.7 3.8 1.9 4.6 6.3 Desert View Hospital 38.3 32.3 7.6 3.1 4.7 10.9 Grover C. Dils Medical Center 84.9 0.0 0.0 0.0 0.0 0.0 Humboldt General Hospital 35.0 0.0 12.0 0.0 8.6 16.6 Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital 52.3 9.0 14.5 0.0 0.0 4.9 Mt. Grant General Hospital 66.9 0.0 5.4 0.0 12.2 7.5 Pershing General Hospital 70.9 0.0 0.0 0.0 0.0 21.3 William Bee Ririe Hospital 35.6 0.0 10.6 0.0 31.7 14.1 CAH – Average 51.9 9.3 8.8 1.0 6.6 8.7 CAH-eligible Hospitals Banner Churchill Community Hospital 50.0 3.2 13.1 2.5 0.0 4.6 Northeastern Nevada Regional Hospital 31.7 0.5 9.0 0.4 25.8 10.7 Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center 57.3 31.1 0.0 0.0 0.0 0.0 CAH-eligible – Average 40.0 2.4 10.4 1.3 14.5 7.9 Rural and Frontier – Average 45.8 5.8 9.6 1.1 10.6 8.3 Urban – Average 34.4 8.9 16.9 2.9 4.2 6.4 Nevada – Average 34.6 8.8 16.8 2.8 4.3 6.5

Sources: Nevada Compare Care (2014c).

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Table 5.25: Inpatient Days by Payer Source in Rural and Frontier Hospitals in Nevada – 2013 (continued)

Inpatient Days (Percent)

Hospital Negotiated Workers County Discounts HMO Charity Other Comp Indigent (PPO) Critical Access Hospitals (CAHs) Battle Mountain General Hospital 0.0 0.0 0.0 0.0 0.0 37.3 Boulder City Hospital 4.2 0.0 0.0 1.5 0.0 11.1 Carson Valley Medical Center 7.7 0.0 0.0 0.0 0.0 3.3 Desert View Hospital 0.0 1.8 0.0 0.0 0.0 1.3 Grover C. Dils Medical Center 0.0 0.0 0.0 0.0 0.0 15.1 Humboldt General Hospital 15.8 7.0 0.0 0.0 0.0 5.1 Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital 18.3 0.0 0.0 0.0 0.0 1.0 Mt. Grant General Hospital 0.0 4.1 0.0 0.0 0.0 3.9 Pershing General Hospital 0.0 0.0 0.0 0.0 0.0 7.9 William Bee Ririe Hospital 0.0 0.0 0.0 0.0 0.0 8.1 CAH – Average 6.8 2.0 0.0 0.2 0.0 4.7 CAH-eligible Hospitals Banner Churchill Community Hospital 11.6 4.0 0.0 0.0 10.2 0.9 Northeastern Nevada Regional Hospital 15.3 0.0 0.0 0.0 0.0 6.7 Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center 0.0 0.0 0.0 0.0 0.0 11.6 CAH-eligible – Average 13.4 1.6 0.0 0.0 4.2 4.4 Rural and Frontier – Average 10.1 1.8 0.0 0.1 2.1 4.6 Urban – Average 7.6 14.1 0.5 2.3 0.4 2.2 Nevada – Average 7.6 13.8 0.5 2.2 0.4 2.2

Sources: Nevada Compare Care (2014c).

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Table 5.26: Inpatient Billed Charges by Payer Source in Rural and Frontier Hospitals in Nevada – 2013

Inpatient Billed Charges (Percent) Hospital Medicare CHAMPUS Commercial Medicare Medicaid Self-Pay HMO CHAMPVA Insurer Critical Access Hospitals (CAHs) Battle Mountain General Hospital 60.6 0.0 0.0 0.0 0.0 0.0 Boulder City Hospital 58.6 6.7 9.6 0.0 0.0 0.0 Carson Valley Medical Center 68.0 2.0 4.1 1.8 5.1 6.4 Desert View Hospital 38.9 33.0 7.1 3.1 5.2 10.1 Grover C. Dils Medical Center 84.8 0.0 0.0 0.0 0.0 0.0 Humboldt General Hospital 35.8 0.0 12.1 0.0 8.3 14.9 Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital 52.1 9.1 10.4 0.0 0.0 4.7 Mt. Grant General Hospital 66.5 0.0 5.2 0.0 12.1 7.8 Pershing General Hospital 71.2 0.0 0.0 0.0 0.0 22.1 William Bee Ririe Hospital 29.5 0.0 9.9 0.0 40.1 12.8 CAH – Average 50.1 10.4 7.8 1.2 7.5 8.5 CAH-eligible Hospitals Banner Churchill Community Hospital 51.3 3.0 11.4 2.5 0.0 3.7 Northeastern Nevada Regional 38.8 0.5 6.8 0.4 24.9 9.2 Hospital Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center 60.3 27.2 0.0 0.0 0.0 0.0 CAH-eligible – Average 43.2 1.6 8.3 1.1 16.3 7.3 Rural and Frontier – Average 46.4 5.7 8.0 1.1 12.2 7.8 Urban – Average 34.3 12.5 12.9 1.8 3.8 6.0 Nevada – Average 34.5 12.4 12.9 1.8 3.9 6.0

Sources: Nevada Compare Care (2014c).

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Table 5.26: Inpatient Billed Charges by Payer Source in Rural and Frontier Hospitals in Nevada – 2013 (continued)

Inpatient Billed Charges (Percent)

Hospital Negotiated Workers County Discounts HMO Charity Other Comp Indigent (PPO) Critical Access Hospitals (CAHs) Battle Mountain General Hospital 0.0 0.0 0.0 0.0 0.0 39.4 Boulder City Hospital 5.3 0.0 0.0 2.8 0.0 17.0 Carson Valley Medical Center 9.5 0.0 0.0 0.0 0.0 3.2 Desert View Hospital 0.0 1.7 0.0 0.0 0.0 0.97 Grover C. Dils Medical Center 0.0 0.0 0.0 0.0 0.0 15.2 Humboldt General Hospital 16.6 7.0 0.0 0.0 0.0 5.3 Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital 22.4 0.0 0.0 0.0 0.0 1.4 Mt. Grant General Hospital 0.0 4.6 0.0 0.0 0.0 3.8 Pershing General Hospital 0.0 0.0 0.0 0.0 0.0 6.7 William Bee Ririe Hospital 0.0 0.0 0.0 0.0 0.0 7.7 CAH – Average 8.5 1.7 0.0 0.2 0.0 4.6 CAH-eligible Hospitals Banner Churchill Community Hospital 12.2 4.2 0.0 0.0 10.8 1.0 Northeastern Nevada Regional Hospital 14.0 0.0 0.0 0.0 0.0 5.3 Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center 0.0 0.0 0.0 0.0 0.0 12.5 CAH-eligible – Average 13.3 1.4 0.0 0.0 3.6 3.9 Rural and Frontier – Average 11.1 1.5 0.0 0.1 2.0 4.2 Urban – Average 7.6 16.1 0.8 2.2 0.4 2.0 Nevada – Average 7.7 16.0 0.8 2.2 0.2 2.0

Sources: Nevada Compare Care (2014c).

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Table 5.27: Inpatient Billed Charges by Payer Source in Rural and Frontier Hospitals in Nevada – 2013

Inpatient Billed Charges (Thousands of Dollars) Hospital Medicare CHAMPUS Commercial Medicare Medicaid Self-Pay HMO CHAMPVA Insurer Critical Access Hospitals (CAHs) Battle Mountain General Hospital 82 0 0 0 0 0 Boulder City Hospital 3,463 396 566 0 1 0 Carson Valley Medical Center 16,132 471 983 419 1,201 1,512 Desert View Hospital 9,205 7,792 1,670 723 1,232 2,391 Grover C. Dils Medical Center 940 0 0 0 0 0 Humboldt General Hospital 5,204 0 1,766 0 1,204 2,168 Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital 7,300 1,271 1,450 0 0 658 Mt. Grant General Hospital 3,091 0 240 0 562 364 Pershing General Hospital 267 0 0 0 0 83 William Bee Ririe Hospital 2,147 0 723 0 2,925 932 CAH – Average 47,831 9,930 7,398 1,142 7,125 8,108 CAH-eligible Hospitals Banner Churchill Community Hospital 19,319 1,137 4,282 933 0 1,388 Northeastern Nevada Regional Hospital 28,271 368 4,965 287 18,156 6,721 Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center 636 288 0 0 0 0 CAH-eligible – Average 48,226 1,793 9,247 1,220 18,156 8,109 Rural and Frontier – Average 96,057 11,723 16,645 2,362 25,281 16,217 Urban – Average 5,855,143 2,120,634 2,222,294 297,807 644,197 1,019,875 Nevada – Average 5,951,200 2,132,357 2,238,939 300,169 669,478 1,036,092

Sources: Nevada Compare Care (2014c).

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Table 5.27: Inpatient Billed Charges by Payer Source (Dollars) in Rural and Frontier Hospitals in Nevada – 2013 (continued)

Inpatient Billed Charges (Thousands of Dollars)

Hospital Negotiated Workers County Discounts HMO Charity Other Comp Indigent (PPO) Critical Access Hospitals (CAHs) Battle Mountain General Hospital 0 0 0 0 0 53 Boulder City Hospital 315 0 0 165 0 1,006 Carson Valley Medical Center 2,260 0 0 0 0 759 Desert View Hospital 0 397 0 0 0 230 Grover C. Dils Medical Center 0 0 0 0 0 169 Humboldt General Hospital 2,407 1,017 0 0 0 776 Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital 3,139 0 0 0 0 195 Mt. Grant General Hospital 0 214 0 0 0 178 Pershing General Hospital 0 0 0 0 0 25 William Bee Ririe Hospital 0 0 0 0 0 561 CAH – Average 8,121 1,628 0 165 0 3,952 CAH-eligible Hospitals Banner Churchill Community Hospital 4,594 1,579 0 0 4,053 384 Northeastern Nevada Regional Hospital 10,193 0 0 0 0 3,889 Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center 0 0 0 0 0 132 CAH-eligible – Average 14,787 1,579 0 0 4,053 4,405 Rural and Frontier – Average 22,908 3,207 0 165 4,053 8,357 Urban – Average 1,290,480 2,746,418 132,584 332,578 76,578 280,136 Nevada – Average 1,313,388 2,749,625 132,584 332,743 80,631 288,493

Sources: Nevada Compare Care (2014c).

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Table 5.28: Top Twenty Types of Admissions in Community Hospitals in Rural and Frontier Nevada – 2013

Utilization and Charges Type of Admission DRG Average (Diagnostically Related Group) Number of Total Patient Charge per Admissions Days Admission (Dollars) 795 Normal Newborn 1,191 1,758 2,602 775 Vaginal Delivery W/O Complicating Diagnoses 910 1,313 10,257 392 Esophagitis, Gastroenteritis and Misc Digest Disorders W/O MCC 660 1,813 26,172 313 Chest Pain 431 778 28,069 194 Simple Pneumonia and Pleurisy W CC 413 1,680 24,720 766 Cesarean Section W/O CC/MCC 304 687 17,205 690 Kidney and Urinary Tract Infections W/O MCC 303 1,153 18,802 641 Nutrition and Miscellaneous Metabolic Disorders W/O MCC 302 912 22,235 603 Cellulitis W/O MCC 237 1,118 24,359 470 Major Joint Replacemt or Reattachment of Lower Extremity W/O MCC 206 679 60,491 192 Chronic Obstructive Pulmonary Disease W/O CC/MCC 203 564 17,389 794 Neonate W/ Other Significant Problems 198 342 3,096 195 Simple Pneumonia and Pleurisy W/O CC/MCC 180 516 17,517 190 Chronic Obstructive Pulmonary Disease W MCC 163 800 28,576 292 Heart Failure and Shock W CC 162 652 24,410 948 Signs and Symptoms W/O MCC 160 562 16,767 871 Septicemia or Severe Sepsis W/O MV 96+ Hours W MCC 159 1,092 45,058 191 Chronic Obstructive Pulmonary Disease W CC 146 755 29,384 872 Septicemia or Severe Sepsis W/O MV 96+ Hours W/O MCC 134 743 32,197 310 Cardiac Arrhythmia and Conduction Disorders W/O CC/MCC 129 250 13,493

Sources: Nevada Compare Care (2014d).

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Table 5.29: Top Twenty Types of Admissions in Community Hospitals in Urban Nevada – 2013

Utilization and Charges

Type of Admission Average DRG Total (Diagnostically Related Group) Number of Charge per Patient Admissions Admission Days (Dollars) 795 Normal Newborn 22,572 44,888 3,021 775 Vaginal Delivery W/O Complicating Diagnoses 17,583 31,830 14,807 945 Rehabilitation W CC/MCC 8,758 124,492 62,920 766 Cesarean Section W/O CC/MCC 7,497 20,127 24,822 470 Major Joint Replacemt or Reattachment of Lower Extremity W/O MCC 6,364 20,507 89,152 794 Neonate W/ Other Significant Problems 5,210 14,533 8,332 392 Esophagitis, Gastroenteritis and Misc Digest Disorders W/O MCC 5,022 13,071 29,592 871 Septicemia or Severe Sepsis W/O MV 96+ Hours W MCC 4,690 35,788 87,110 765 Cesarean Section W CC/MCC 3,753 15,137 33,275 603 Cellulitis W/O MCC 3,405 11,881 31,224 690 Kidney and Urinary Tract Infections W/O MCC 2,804 9,250 30,637 313 Chest Pain 2,589 4,410 28,843 194 Simple Pneumonia and Pleurisy W CC 2,580 9,966 40,055 460 Spinal Fusion Except Cervical W/O MCC 2,378 7,371 137,212 683 Renal Failure W CC 2,369 10,458 44,534 774 Vaginal Delivery W Complicating Diagnoses 2,323 5,411 16,998 292 Heart Failure and Shock W CC 2,254 8136 41,446 247 Perc Cardiovasc Proc W Drug-Eluting Stent W/O MCC 2,201 5,560 104,928 287 Circulatory Disorders Except AMI, W Card Cath W/O MCC 2,068 5,881 61,601 378 G.I. Hemorrhage W CC 1,958 6,774 43,538

Sources: Nevada Compare Care (2014c).

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Emergency Medical Systems and Trauma Systems. (2014). Unpublished data. Las Vegas, NV: Southern Nevada Health District. Available from: http://www.southernnevadahealthdistrict.org/ems

ESRI. (2014). ArcGIS 10.3 Software. Redlands, CA: ESRI, Inc. Available from: www.esri.com

Federal Bureau of Investigation. (2014). Uniform Crime Reports. Stats and Services. Reports and Publications. Uniform Crime Reports: Crime in the United States 2013. Offenses Known to Law Enforcement. Go to Offense tables (Tables 8, 9, 10, 11). Available from: http://www.fbi.gov

Federal Deposit Insurance Corporation. (2014). Nevada. . County overview. Employment and Income. Personal Bankruptcy Filings (all counties). Available from: http://www2.fdic.gov/recon

Health Resources and Services Administration. (2015). Find shortage Areas: HPSA by State and County. Available from http://hpsafind.hrsa.gov/

Legislative Counsel Bureau. (2014). Research/Library. Research Division. Publication of the Research Division. Research Division Studies and Legislative Reports. 2013 Nevada Education Data Book. Carson City, NV: Nevada Legislature. Available from: www.leg.state.nv.us/

Minnesota IMPLAN Group. (2014). State of Nevada Input-Output Data for 2009. Unpublished data.

National Survey on Drug Use and Health. (2012). Data. Reports by Topic. NSDUH/NSHDA. 2008-2010 NSDUH sub-state estimates of substance use and mental disorders. Rockville, MD: Substance Abuse and Mental Health Services Administration. Available from: http://www.samhsa.gov

Nevada Board of Examiners for Audiology and Speech Pathology. (2006). Unpublished data. Las Vegas, NV: State of Nevada.

Nevada Board of Examiners for Audiology and Speech Pathology. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: http://www.nvaud-sp.org/

Nevada Board of Optometry. (2004). Unpublished data. Las Vegas, NV: State of Nevada.

Nevada Board of Optometry. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: http://optometry.nv.gov/

Nevada Compare Care. (2014a). CHIA Static Reports. NHQR Quarterly Reports. Acute Hospitals Utilization. Las Vegas: University of Nevada, Las Vegas. Available from: http://nevadacomparecare.net

Nevada Compare Care. (2014b). CHIA Static Reports. NHQR Quarterly Reports. Acute Hospitals Financial. Las Vegas: University of Nevada, Las Vegas. Available from: http://nevadacomparecare.net

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Nevada Compare Care. (2014c). CHIA Static Reports. Standard Reports. Hospital by Payer. Las Vegas: University of Nevada, Las Vegas. Available from: http://nevadacomparecare.net

Nevada Compare Care. (2014d). CHIA Static Reports. Standard Reports. Hospital by DRG. Las Vegas: University of Nevada, Las Vegas. Available from: http://nevadacomparecare.net

Nevada Department of Corrections. (2014). Unpublished data. Carson City, NV: State of Nevada. Available from: http://www.doc.nv.gov

Nevada Department of Education. (2014a). Data/Reports. Free and Reduced Lunch Data (Child Nutrition Program external link. Free and Reduced Lunch. 2013-2014 Carson City, NV: State of Nevada. Available from http://www.doe.nv.gov

Nevada Department of Education (2014b). Nevada Report Card. Fiscal and Technology. Fiscal and Information. 2007-2013. Carson City, NV: State of Nevada. Available from: http://www.nevadareportcard.com

Nevada Department of Education. (2014c). Resources. Research Bulletin. 2013 FY. Carson City, NV: State of Nevada. Available from http://www.doe.nv.gov

Nevada Department of Education (2014d). Assessment and Accountability. Graduation Rates. Cohort Graduation Rates (Class of 2013-2014). Carson City, NV: State of Nevada. Available from: http://www.nevadareportcard.com

Nevada Department of Education (2014e). Data Center. Annual Reports College-going and College Credit Accumulation Rates. C12. 2009. Carson City, NV: State of Nevada. Available from: http://www.doe.nv.gov

Nevada Department of Education (2014f). Data Center. Annual Reports College-going and College Credit Accumulation Rates. C11. 2011. Carson City, NV: State of Nevada. Available from: http://www.doe.nv.gov

Nevada Department of Transportation. (2014). 2013-2014 Official Highway Map. Carson City, NV: NDOT. Available from: http://www.nevadadot.com/Traveler_Info/Maps/Map_Info.aspx

Nevada Health Centers. (2014). Unpublished data. Carson City, NV. Available from: http://www.nvrhc.org/

Nevada Office of Rural Health. (2014). Unpublished data. Reno, NV: University of Nevada School of Medicine.

Nevada Rural Hospital Partners. (2014). Membership Directory. Unpublished data. Reno, NV. Available from: http://nrhp.org/

Nevada Secretary of State. (2014). Election Center. Voters. Voter Registration Statistics. Voter Registration by County and Party. October 2014 Total Voters. Carson City, NV: State of Nevada. Available from http://www.nvsos.gov

Nevada State Board of Dental Examiners. (2004). Unpublished data. Las Vegas, NV: State of Nevada.

Nevada State Board of Dental Examiners. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: http://www.nvdentalboard.nv.gov/

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Nevada State Board of Examiners for Alcohol, Drug and Gambling Counselors. (2008). Unpublished data. Las Vegas, NV: State of Nevada.

Nevada State Board of Examiners for Alcohol, Drug and Gambling Counselors. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: http://www.alcohol.state.nv.us/

Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors. (2010). Unpublished data. Las Vegas, NV: State of Nevada.

Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors. (2012). Unpublished data. Las Vegas, NV: State of Nevada. Available from: http://marriage.state.nv.us/

Nevada State Board of Massage Therapists. (2010). Unpublished data. Reno, NV: State of Nevada. Available from: http://nvmas.glsuite.us/GLSuiteWeb/Clients/NVMAS/Public/Home.aspx

Nevada State Board of Massage Therapists. (2014). Unpublished data. Reno, NV: State of Nevada. Available from: http://nvmas.glsuite.us/GLSuiteWeb/Clients/NVMAS/Public/Home.aspx

Nevada State Board of Medical Examiners. (2004). Unpublished data. Reno, NV: State of Nevada.

Nevada State Board of Medical Examiners. (2008). Unpublished data. Reno, NV: State of Nevada.

Nevada State Board of Medical Examiners. (2014). Unpublished data. Reno, NV: State of Nevada. Available from: http://www.medboard.nv.gov/

Nevada State Board of Nursing. (2004). Nevada State Board of Nursing Annual Report. Reno, NV: State of Nevada.

Nevada State Board of Nursing. (2014). Nevada State Board of Nursing Annual Report. Reno, NV: State of Nevada. Available from: http://nevadanursingboard.org/consumers/annual-reports/

Nevada State Board of Optometry. (2004). Unpublished data. Carson City, NV: State of Nevada.

Nevada State Board of Optometry. (2014). Unpublished data. Carson City, NV: State of Nevada. Available at http://optometry.nv.gov/

Nevada State Board of Osteopathic Medicine. (2006). Unpublished data. Henderson, NV: State of Nevada.

Nevada State Board of Osteopathic Medicine. (2014). Unpublished data. Henderson, NV: State of Nevada Available from: http://license.k3systems.com/LicensingPublic/board.jsp

Nevada State Board of Pharmacy. (2004). Unpublished data. Las Vegas, NV: State of Nevada.

Nevada State Board of Pharmacy. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: http://bop.nv.gov/

Nevada State Board of Podiatry. (2004). Unpublished data. Las Vegas, NV: State of Nevada.

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Nevada State Board of Podiatry. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: http://podiatry.state.nv.us/

Nevada State Board of Psychological Examiners. (2008). Unpublished data. Las Vegas, NV: State of Nevada.

Nevada State Board of Psychological Examiners. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: http://psyexam.nv.gov/

Nevada State Demographer’s Office. (2014a). Data and Publications. Population Projections for Nevada and Nevada’s Counties. 2014 to 2033. Reno, NV: The Nevada State Demographer’s Office, University of Nevada, Reno. Available from: http://nvdemography.org/data-and-publications/

Nevada State Demographer’s Office. (2014b). Data and Publications. Population estimates of Nevada’s Counties, Cities and Unincorporated Towns from July 2000 to July 2013. Governor Certified Population Estimates of Nevada’s Counties, Cities and Towns 2000 to 2013. Reno, NV: University of Nevada, Reno. Available from: http://nvdemography.org/data-and-publications/

Nevada State Demographer’s Office. (2014c). Data and Publications. Age, Sex, Race and Hispanic Origin (ASRHO) Estimates and Projections October 2013. Reno, NV: The Business Services Group, University of Nevada, Reno. Available from: http://nvdemography.org/data-and-publications/

Nevada State Demographer’s Office. (2014d). Unpublished data. Age, Sex, Race and Hispanic Origin (ASRHO) Estimates and Projections for the state of Nevada 2000 to 2033. Reno, NV: University of Nevada, Reno.

Nevada System of Higher Education. (2014). Data and Reports. Institution Research. Capture Rates by County. NSHE Capture Rates of Recent Nevada High School Graduates. Las Vegas, NV: State of Nevada. Available from: http://www.nevada.edu/

Office of Health Statistics and Surveillance. (2014a). Unpublished data. 2013 Behavioral Risk Factor Surveillance Survey. Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics.

Office of Health Statistics and Surveillance. (2014b). HIV/AIDS Surveillance Reports. State Fast Facts 2013. Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics. Available from: http://health.nv.gov

Office of Health Statistics and Surveillance. (2014c). STD Statistics. 2013. Fast Facts 2013. Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics. Available from: http://health.nv.gov

Office of Health Statistics and Surveillance. (2014d). Tuberculosis Program. Trends and Statistics. 2009-2013 Fast Facts. Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics. Available from: http://health.nv.gov

Office of Health Statistics and Surveillance. (2014e). Unpublished data. Vital Statistics. Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics.

Phoenix Area Indian Health Service. (2013). Unpublished data. Phoenix Area Fiscal Year 2013 Active Users and Census Projections Report. Phoenix, AZ: Indian Health Services.

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State of Nevada Board of Examiners for Social Workers. (2014). Unpublished data. Reno, NV: State of Nevada. Available from: http://socwork.nv.gov/

State of Nevada Board of Dispensing Opticians. (2004). Unpublished data. Las Vegas: State of Nevada.

State of Nevada Board of Dispensing Opticians. (2014). Unpublished data. Las Vegas: State of Nevada. Available from: http://nvbdo.state.nv.us/

State of Nevada Board of Occupational Therapy. (2004). Unpublished data. Las Vegas: State of Nevada.

State of Nevada Board of Occupational Therapy. (2014). Unpublished data. Las Vegas: State of Nevada. Available from: http://www.nvot.org/

State of Nevada Physical Therapy Examiners’ Board. (2004). Unpublished data. Las Vegas: State of Nevada.

State of Nevada Physical Therapy Examiners’ Board. (2014). Unpublished data. Las Vegas: State of Nevada. Available from: http://ptboard.nv.gov/

United States Census Bureau. (2014a). 2010 Census. Factfinder2. Washington DC: U.S. Department of Commerce. Available from: http://factfinder2.census.gov/

United States Census Bureau. (2014b). 1990 Census. Washington DC: U.S. Department of Commerce. Available from: http://www.census.gov/main/www/cen1990.html

United States Census Bureau. (2014c). 2000 Census. Washington DC: U.S. Department of Commerce. Available from: http://www.census.gov/main/www/cen2000.html

United States Census Bureau. (2014d). Topics. Population. Population estimates. Current Estimates Data. Housing Units: (V 2013). Annual estimates of county housing units for states: 2010 to 2013. Nevada. Washington DC: U.S. Department of Commerce. Available from http://www.census.gov/

United States Census Bureau. (2014e). Topics. Income and Poverty. Small Area Income and Poverty. SAIPE. Interactive Data Tool. Washington DC: U.S. Department of Commerce. http://www.census.gov/

United States Census Bureau. (2014f). Topics. Business and Industry. Data by geography. Counties. Building Permits 2014. Permits by County or Place. Building Permits (2003, 2008, and 2013). Washington DC: U.S. Department of Commerce. Available from: http://www.census.gov

United States Census Bureau. (2014g). Topics. Economy. Other Economic Programs. County Business Patterns. Nevada. NAICS code 81: Other Services (except Public Administration). NAICS code 813: Religious, Grant making, Civic, Professional, and Similar Organizations. Available from: http://www.census.gov

United States Census Bureau. (2014h). Topics. Health. Small Area Health Insurance Estimates (SAHIE). Interactive Data Visualization and Mapping Tool. Washington DC: U.S. Department of Commerce. Available from http://www.census.gov

United States Department of Agriculture. (2014). Rural-urban Commuting Area Codes. Data. Available from http://www.ers.usda.gov/.

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United States Department of Veterans Health Administration. (2014). Enrollment, User, and Projections. Unpublished data. Reno, NV.

University Center for Economic Development. (2013). Health Sector Payroll and Employment Data for Nevada Counties. Unpublished data. Reno, NV: University of Nevada, Reno.

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Section One: Demographic Profile of Rural and Frontier Nevada

Table 1.1 to Table 1.5: Population in Nevada by County

Note: The figures in these tables are from the most recently released Nevada State Demographer’s Office projected population numbers based on the certified estimates of the year 2013. Population estimates are released twice a year, the certified general population estimates of the previous year are released in July with the next twenty years of population projections.

In October, the age, sex, race, and Hispanic origin reports are released. Some ASRHO numbers may be from unpublished data. In 2014, estimates were released twice. The second release included the impact of the Tesla project in Nevada.

Table 1.6: Population and Housing Density in Nevada by County – 2014

Note: Population per square mile uses the 2014 data and housing units per square mile uses 2013 data.

Table 1.7: Housing Units in Nevada by County – 2000 to 2013

Note: The change in housing units shows the increase or decrease of all housing units in an area over a period of time and can be used to measure the growth (or decline) experienced in that area. Nevada has many mobile homes in mining areas. Population estimate is from 2014 and the housing estimates is from 2013.

Table 1.8: Population in Nevada by City, County, and Region – 2010 to 2013

Note: These are the certified population estimates by the Nevada State Demographer’s Office released in July 2014. The 2010 population numbers are from the Nevada State Demographer’s Office (July 2010) not the decennial 2010 Census (April 2010). The Office of Statewide Initiatives calculated numbers not supplied by the Nevada State Demographer.

Table 1.9: Population in Incorporated and Unincorporated Areas in Nevada by County – 2013

Note: There are unincorporated cities in seven of 14 rural and frontier counties in Nevada. Incorporated cities may be small or large and unincorporated populations may be large in rural and frontier counties. Carson City is considered a metropolitan city/county and has no rural population.

Table 1.10 and Table 1.16: Population under 17 – 2014

Note: Totals for ages 17 and under were calculated from unpublished Age, Sex, Race, and Hispanic Origin population data from the Office of the Nevada State Demographer.

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Table 1.19 to Table 1.22: Age, Sex, Race, and Hispanic Origin Population in Nevada by County

Note: In October, the age, sex, race, and Hispanic origin population reports are released. Some ASRHO numbers may be from unpublished data. Two population estimates are released: one include group quarters, e.g. prison population, dormitories, institutionalized people and nursing homes; the second does not include in the data used for Tables 1.19 to 1.22. The prison numbers are in Tables 1.27 and 1.28.

Table 1.24: Veterans Population by Age in Nevada by County

Note: Percent of total population is for each county.

Table 1.26: Population by Place of Birth in Nevada by County

Note: These numbers are averaged from 2008 – 2012 calculated by the American Community Survey for all counties. American factfinder query was used to find median age from population characteristics.

Section 2: Social and Economic Profile of Rural and Frontier Nevada

Table 2.1 to Table 2.8: Sources and Amounts of Personal Income in Nevada by County

Note: All dollar estimates are in current dollars (not adjusted for inflation).

Table 2.8: Income from Transfer Payments by Type of Transfer Payment in Nevada by County – 2012

Note: Income by type of transfer payment excluded payments less than $50,000 from the column “Other,” but the estimates for this item are included in the total of the column.

Table 2.9: Median Family Income in Nevada by County – 2009 to 2013 American Community Survey (ACS) Estimates

Note: Within each year, the American Community Survey estimate is based on five years of data for the average.

Table 2.10: Median Family Income in Nevada by County – 2013 American Community Survey (ACS) Estimates

Note: American Community Survey estimate is based on five years of data for the average. To build county- level data, estimates may vary broadly and the confidence interval should help interpret the variation.

Table 2.11: Median Household Income in Nevada by County – 2009 to 2013 Small Area Income and Poverty Estimates (SAIPE)

Note: These numbers are from the Small Area Income and Poverty Estimates reflecting the most current household incomes by county in 2012 in contrast to five-year averages.

Table 2.12: Median Household Income in Nevada by County – 2013 Small Area Income and Poverty Estimates (SAIPE)

Note: American Community Survey estimate is based on five years of data for the average. To build county- level data, estimates may vary broadly and the confidence interval should help interpret the variation

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Table 2.13: Personal Bankruptcy in Nevada by County – 2005 to 2013

Note: “N/A” means no information provided.

Table 2.14: New Building Permits Issued in Nevada by County – 2003 to 2013

Note: Counties must participate in the Census Building Permits Survey to be counted. This data can be considered an indicator for the economic vitality of a county. N/A means no data available.

Table 2.19: Students Qualifying for Free and Reduced School Lunch (FRL) in Nevada by County – 2013

Note: Provision II lunches are included only in the totals not in FRL subtotals.

Table 2.21 and Table 2.22: Enrollment in Public and Private Schools in Nevada by County – 2012

Note: Public Charter Schools enrollment data may be statewide or in a county, however it is combined into a statewide total. N/A means data not available.

Table 2.21, Table 2.22 and Table 2.24: Enrollment in Public and Private Schools in Nevada by County

Note: School enrollment include grades Kindergartener through 12 grades.

Table 2.23: Number of Schools in Nevada by County – 2012

Note: “Other” for public schools include Charter K-12 Schools, Public K-12 Schools, and Public Special Schools (Detention Facilities, Special Education Schools, Alternative Education Schools, and Adult Schools). “Other” for private schools include Private K-12 Schools.

Table 2.24: Enrollment in Public Primary and Secondary Schools in Nevada by County – 2012

Note: “Ungraded” refers to a student who is enrolled in a non-graded class in a school for special education or a student who cannot be assigned to a grade because of the nature of his or her condition (NAC 387.111). Although the State Board of Education is not considered a "District", it is the State Sponsor of eleven Charter Schools and one University School, which are listed separately.

Table 2.25 to Table 2.28: High School Graduation Rates and post-secondary education in the Nevada System of Higher Education.

Note: Esmeralda County has no high school, “N/A” means not available and “– “ means numbers are less than 10 or suppressed. Department of Education uses “0” to indicate no population.

Table 2.29: First-year Persistence in Nevada System of Higher Education (NSHE) Institutions in Nevada by County – 2009 to 2011

Note: “—“ means numbers are suppressed. N/A means data is not available. “Percent Finished First Year of Courses” refers to completion of one year’s worth of progress within 2 years of initial in-state public enrolment.

Table 2.31: Voter Registration in Nevada by County – 2014

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Note: Eligible voting population aged 18 and over do not include people living in group quarters, e.g. prisons.

Table 2.33: Percent of Registered Voters by Party in Nevada by County – 2014

Note: Column “Other Party Affiliation” includes Libertarian party, which is larger than all other unlisted affiliations.

Table 2.36 to Table 2.38: Reported Violent and Property Crimes – 2012

Note: Data was aggregated from the sheriff’s office, county police department, tribal agencies, University of Nevada (Las Vegas and Reno), and Truckee Meadows College campuses.

Section Three: Population Health Profile of Rural and Frontier Nevada

Tables 3.1 to 3.11: Health Insurance Coverage for Population Under the Age of 65, by Federal Poverty Level, Age and Gender.

Note: The Small Area Health Insurance Estimates are single-year estimates produced annually using a model based upon and consistent with the American Community Survey areas of interest. These survey estimates are “enhanced” with administrative data, within a Hierarchical Bayesian framework. Data is consistent over time from 2008 to 2012.

Table 3.12: Medicaid Enrollment in Nevada by County –2011 – 2012

Note: Enrollment increased between 2013 and 2014 due to the implementation of the Affordable Care Act.

Table 3.13 and 3.14: Nevada Check Up (Nevada’s Children Health Insurance Program) Enrollment by County and Age 2004 – 2014

Note: Totals may not balance due to data being gathered at different points of time.

Table 3.16: Population Eligible for Medicare Benefits – Aged and Disabled in Nevada by County - 2012

Note: Report was published mid-year and totals may different from year-end reports.

Table 3.17 and 3.18: Number and Percent Enrolled in Medicare by Program Part in Nevada by County - 2012

Note: Hospital Insurance is Part A, Supplemental Medical Insurance is Part B, Medicare Advantage is Part C and Prescription Drug Plan is Part D. The total eligible reflects numbers from the Medicare Advantage Report Part C filed for December 2014 and may vary from the aged and disability report. Part B totals do not reflect any changes. Data is suppressed for Eureka County due to a count less than 10. County totals may not appear to add to overall totals due to rounding errors. ‘—‘ means data was suppressed.

Table 3.19: Medicare Eligible Population in Nevada by County – 2000 to 2012

Note: The 2012 number reflects changes from the Medicare Advantage Report Part C filed for December 2014 and may vary from the aged and disability report.

Table 3.24 – Table 3.26 Behavioral Risk Factor Surveillance System (BRFSS) Tables

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Note: Refinements to the system include data received from cell phone users facilitates the inclusion of a broader demographic and ultimately provides a better reflection of the nation's health status.

Table 3.27 – Table 3.29 2004 to 2011 Diabetes, Obesity, and Physical Inactivity Tables

Note: The prevalence of diagnosed diabetes and selected risk factors by county was estimated using data from CDC's Behavioral Risk Factor Surveillance System (BRFSS) and data from the US Census Bureau’s Population Estimates Program. The BRFSS is an ongoing, monthly, state - based telephone survey of the adult population. The survey provides state - specific information on behavioral risk factors and preventive health practices. Respondents were considered. You can view trends in county - level data beginning in 2004. Three years of data were used to improve the precision of the year - specific county - level estimates of diagnosed diabetes and selected risk factors. For example, 2003, 2004, and 2005 were used for the 2004 estimate and 2004, 2005, and 2006 were used for the 2005 estimate. Estimates were restricted to adults 20 years of age or older to be consistent with population estimates from the US Census Bureau. The US Census Bureau provides year - specific county population estimates by demographic characteristics — age, sex, race, and Hispanic origin. The county level estimates for the over 3,200 counties or county equivalents (e.g., parish, borough, and municipality) in the 50 US states, Puerto Rico and the District of Columbia were based on indirect model – dependent estimates. The model - dependent approach employs a statistical model that “borrows strength” in making an estimate for one county from BRFSS data collected in other counties. Bayesian multilevel modeling techniques were used to obtain these estimates. Multilevel Poisson regression models with random effects of demographic variables (age 20 – 44, 45 – 64, ≥65; race; sex) at the county - level were developed. State was included as a county - level covariate. The model specification is essentially the same as Malec, et al. For selected years, rates were age adjusted by calculating age specific rates for the following three age groups, 20 – 44, 45 – 64, and ≥65. A weighted sum based on the distribution of these three age groups from the 2000 census was then used to adjust the rates by age using the weights 0.52, 0.31, 0.17, respectively.

Table 3.30 – Self-reported Substance Abuse and Mental Illness Among Population Aged 12 and Over in Nevada by Region – 2012.

Note: West Counties includes Carson City, Douglas County, and Lyon County.

Table 3.31 and 3.32: Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Incidence and Prevalence in Nevada by Region – 2013 and 2009 -- 2013

Note: Carson City data is suppress due to confidentiality issues of the count being less than 10 for a single county.

Table 3.37 to 3.54: Various Vital Statistics Tables by County/Region in Nevada – 2013

Note: ‘–‘ denotes counts that do not meet the criteria, reliability, data quality or confidentiality and regional subtotals may not sum to a statewide total. Las Vegas Metropolitan Statistical Area (MSA) is Clark County, Reno-Sparks MSA includes Washoe and Storey Counties, and Rural and Frontier includes the remaining 13 non-urban counties. Counts are preliminary and are subject to changes on all vital statistics tables.

Table 3.46: Childhood Disability by Type of Disability in Nevada by County of Residence - 2013

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Note: County detail may not cross-foot to county totals due to suppressing of counts less than 10.

Table 3.57: Population Health Institute’s County Health Rankings in Nevada Health Outcomes – 2012

Note: Urban counties are white. Esmeralda County is not ranked due to small populations and missing data.

Table 3.58: Population Health Institute’s County Health Rankings in Nevada Health Determinants – 2012

Note: Urban counties are white. Esmeralda County is not ranked due to small populations and missing data.

Section Four: Health Care Workforce in Rural and Frontier Nevada

Table 4.3: Health Sector Employment in Nevada by County – 2013

Note: Las Vegas Metropolitan Statistical Area (MSA) is Clark County, Reno-Sparks MSA includes Washoe and Storey Counties, and Rural and Frontier includes the remaining 13 non-urban counties. Some data were generated by the authors using hospital employment data supplementing DETR employment growth rate for the sector.

Table 4.4: Health Sector Payroll in Nevada by County – 2013

Note: Some DETR data may be suppressed and changes may occur from other sources of data.

Note: Las Vegas Metropolitan Statistical Area (MSA) is Clark County, Reno-Sparks MSA includes Washoe and Storey Counties, and Rural and Frontier includes the remaining 13 non-urban counties. Some data were generated by the authors using hospital payroll data supplementing DETR data for the sector.

Table 4.5: Employment in the Health Care and Social Assistance Sector by Region in Nevada by County – 2014

Note: Las Vegas Metropolitan Statistical Area (MSA) is Clark County, Reno-Sparks MSA includes Washoe and Storey Counties, and Rural and Frontier includes the remaining 13 non-urban counties. Some data were generated by the authors using hospital employment data supplementing DETR employment data for the sector.

Table 4.6: Projected Employment in the Health Care and Social Assistance Sector by Region in Nevada – 2014

Note: Las Vegas Metropolitan Statistical Area (MSA) is Clark County, Reno-Sparks MSA includes Washoe and Storey Counties, and Rural and Frontier includes the remaining 13 non-urban counties. The authors used hospital generated employment data supplementing DETR employment growth rate for the sector.

Table 4.7 to 4.47: Licensed Professionals by County/Region in Nevada – 2012

Note: The calculation of the number of licensed health care professionals per 100,000 population in Tables 4.7 through 4.47 utilize county- and state- population estimates developed by the Nevada State Demographer’s Office for 2014. Some of the population estimates presented in this data book may utilize denominators varying slightly from these numbers as the tables and per population denominators were built using the most recent numbers at the time. All health professional licensure data presented in Tables 4.7 through 4.47 refer to individuals possessing an active license with a State of Nevada licensing board. Thus, these tables exclude inactive and/or retired licensees. Specific licensure data may not be updated for year 2014 if it were not made available to the authors.

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Table 4.8: Licensed Primary Care Physicians (MDs and DOs) by in Nevada by County – 2014

Note: Family Medicine, General Practice, Internal Medicine, Obstetrics and Gynecology, and Pediatric physicians are considered primary care physicians.

Table 4.12: Licensed Physician Assistants (PAs) by in Nevada by County – 2014

Note: Allopathic and Osteopathic PAs have been combined; in the year 2004, only Allopathic PAs were counted.

Table 4.49: Population Residing in a Health Professional Shortage Area in Nevada by County – 2015

Note: HPSA Areas are current designations and population counts are from the 2014 census bureau.

Maps 4.1 to Maps 4.9:

Note: Maps which shows HPSAs and those areas and facilities with a greater chance of National or Nevada Health Service Corps funding based on a HPSA score of 16 and above, the state primary care office can better direct providers to the correct loan repayment program depending on their work location.

Section Five: Health Care Resources and Economics of Rural and Frontier Nevada

Table 5.2: Community Hospitals in Rural and Frontier Nevada – 2013

Note: The term “Critical Access Hospital” of CAH refers to a Medicare hospital facility designation from the Centers for Medicare and Medicaid Services. This designation allows small rural and frontier hospitals to receive cost-based reimbursement for inpatient and outpatient services provided to Medicare beneficiaries. As of February 2013, there were eleven certified CAHs and four CAH-eligible hospitals in Nevada. CAH and CAH-eligible receive financial and technical assistance from the Nevada Rural Hospital Flexibility Program. The Nevada Flex Program is a federally supported program administered by the Nevada State Office of Rural Health based with the Office of Statewide Initiatives at the University of Nevada School of Medicine.

Tables 5.18: Total Patient Revenue in Rural and Frontier Hospitals in Nevada – 2013.

Note: Inpatient revenue includes inpatient and long-term care numbers. Outpatient revenue includes outpatient and clinic care numbers.

Tables 5.20: Net Income in Rural and Frontier Hospitals in Nevada – 2013.

Note: Operating expense includes Medicaid and Medicare fees for service and management; PPOs, insurance and non-Medicaid/Medicare HMOs; uninsured discounts; charity care; bad debt; government and other contractual deductions.

Tables 5.23 to 5.27: Income Tables in Rural and Frontier Hospitals in Nevada – 2013.

Note: N/A means data was not supplied by the source. Uninsured may be counted in self-pay or charity care.

Nevada State Office of Rural Health 275