Cimarron County A Look Back To Move Forward

Cimarron County The state of has been in a downward health trend since the 1990’s, until recently. Through the efforts of the state and county health departments, state and local governments and the individual communities the health of Oklahomans is looking up. However, we could do more to improve the health of the citizens of Oklahoma. This report focuses on the health factors for the citizens of Cimarron County. We will take a look back to discover what has been affecting the health of the citizens in order to move forward and make healthy, effective and safe changes for all.

Inside this issue:

County Demographics 2 Teen Pregnancy 5

Top 10 Leading Causes of Death 2 Poverty 5

Nutrition & Obesity 2 OK By One—State Immunization Data 6 Top 10 Leading Causes of Death Table 3 County Health Department Usage 7 Injury & Violence 4 Health Care Costs Summary 7 Tobacco use 4 Turning Point 8 Physical Activity, Wellness & Diabetes 4 State of the County’s Health Report OKLAHOMA STATE HEALTH OF DEPARTMENT Demographics * U.S. Census Bureau

• Population estimates o 5% decrease from 1990 to 2000 Cimarron County Population Growth with Projections (3,301 to 3,148) Percent of State o 8% decrease from 2000 to 2004 County Population Population th o Ranked 76 for growth in state 0. 12 2000 Census ,000 % 4 • Hispanic/Latino ethnicity = 15% 00 0. 5 10 • Race 3, % o Whites = 86% 0. o Native Americans =1% 3,000 08 % o Blacks =1% 2,500 0.06% o Other/Multiple = 13% 0 00 • Age 2, 0. o Under 5 = 7% 04 1,500 o Over 64 = 19% % Median age = 39.3 years 0. o 1,000 02 00 % • Housing units 5 o Occupied = 1,257 (79%) 0. 0 00 2 3 3 4 5 Vacant = 326 (21%) 91 02 % o 990 000 001 • Disability (ages 21 to 64) = 16.5% 1 19 199 199 1994 1995 1996 1997 1998 1999 2 2 20 200 200 200 2010 2015 2020 2025 2030 national = 19.2% state = 21.5% Year • Individuals below poverty = 17.6% Cimarron Percent of Population national = 12.4% state = 14.7% * Vital Statistics, Health Care Information Systems, OSDH & Top 10 Leading Causes of Death Centers for Disease Control

The top 10 leading causes of death is still the leading cause Cimarron County. table on the next page displays a of death among all age Heart disease Alzheimer’s disease and the broad picture of the causes of death groups. According to complications associated in Cimarron County. Since many the Centers for Disease accounts for almost with it have increased from health-related issues are unique to Control, almost $4 million a year in the 13th ranked cause of specific ages, this table provides $400,000 is spent on death (1983-1993) to the 8th causes of death by age group at a each heart disease- medical costs in ranked cause of death in glance. The causes of death that are related death. With an persons 65 and older ac- present across almost every age average of 10.4 deaths Cimarron County. counting for a 800% in- group have been highlighted. From a year, heart disease crease in deaths. 1983 to 1993 heart disease killed accounts for almost $4 159 people in Cimarron County and million a year in medical costs in * Behavioral Risk Factor Surveillance Sys- tem, Health Care Information System, OSDH Nutrition and Obesity & Health Affairs Journal, R. Strum, 2002

With the United States coming in as the costs are reflecting this downward spi- they do not take into account the per- most obese country in the world, health ral of health. For persons under the age centage of obese or overweight persons care costs related to obesity and poor of 65, on average, health care costs are who are over the age of 65. nutrition are on the rise. $395 more for obese individuals and

are even greater for persons over the Of the 292 million people in the UnitedNo Data Available At This Time age of 65. States, 129 million are overweight or obese according to their body mass in- In 2001-2005, 3% (103) of people in dex (BMI). The number of obese (BMI Cimarron County were consideredSensible Foods — Sensible Portions > 29) and overweight (BMI 25-29) Ok- obese which accounted for an addi- 5 to 9 Fruits & Vegetables lahomans has been increasing at the tional in medical costs for the county. a Day same rate as the nation, and health care These costs are underestimated because

Page 2 STATE OF THE COUNTY’S HEALTH REPORT 9 13 10 22 HEART HEART INJURY KIDNEY KIDNEY SUICIDE STROKE ASTHMA DISEASE DISEASE DISEASE MELLITUS DIABETES DIABETES

UNINTENT. UNINTENT. INFLUENZA/ PNEUMONIA BRONCHITIS/ ALZHEIMER'S ALZHEIMER'S EMPHYSEMA/ EMPHYSEMA/ 4 7 18 18 21 74 93 104 114 HEART HEART INJURY KIDNEY KIDNEY AORTIC AORTIC STROKE ASTHMA CANCER CANCER DISEASE DISEASE DISEASE MELLITUS DIABETES DIABETES UNINTENT. UNINTENT. ANEURYSM INFLUENZA/ PNEUMONIA BRONCHITIS/ ALZHEIMER'S ALZHEIMER'S EMPHYSEMA/ EMPHYSEMA/ 3 NON- HEART HEART INJURY TUMOR SUICIDE STROKE DISEASE MELLITUS DIABETES DIABETES UNINTENT. CANCEROUS LIVER DISEASE LIVER 119 53 111618 111018 2 21 111718 34 HEART HEART OTHER OTHER STROKE ASTHMA DISEASE MELLITUS DIABETES DIABETES INFLUENZA/ DEFICIENCY PNEUMONIA BRONCHITIS/ NUTRITIONAL EMPHYSEMA/ EMPHYSEMA/ 1 3 3411 1 LEGAL OTHER INJURY SUICIDE STROKE SUICIDE CANCER CANCER CANCER MELLITUS DIABETES DIABETES HOMICIDE/ HOMICIDE/ UNINTENT. UNINTENT. 2 12 1 21 23 LEGAL OTHER INJURY SUICIDE CANCER HOMICIDE/ HOMICIDE/ UNINTENT. Cimarron CountyCimarron 1993-2003 Top Age 10 Causes by Death Group of INJURY SUICIDE UNINTENT. UNINTENT. 25 , Health Care Information Division, Oklahoma State Department of Health of Department Oklahoma State Division, Care Information Health , INJURY UNINTENT. 2 11 Vital Statistics Vital PERIOD PERINATAL PERINATAL ANOMALIES CONGENITAL CONGENITAL 1 2 3 4 5 6 7 8 9 10 Rank 0-4 05-14 15-24 25-34 35-44 45-54 55-64 65+ Ages All Data source: Produced by: Community DevelopmentService, Community Health Services,Oklahoma State Department of Health

CIMARRON COUNTY Page 3 * Vital Statistics, Health Care Information Systems, OSDH & Injury and Violence National Safety Council

Across the nation and the state of that translates to almost $2 million and suicide) in Cimarron County are Oklahoma, unintentional and violence- a year. ranked in the top 10 in fiveof the eight age related injuries are on the rise. Unin- groups (see Top 10 list on page 3). Violence-related injuries (homicide tentional injuries account for the 4th leading cause of death in the United Injury and Violence-Related Deaths in States and the 5th leading cause of Cimarron County, 1999 - 2003 death in Oklahoma from 1999-2002. 2.5 For persons ages 1 to 44 in Oklahoma, unintentional injuries are the leading 2 cause of death. 1.5 This trend does not change much in Cimarron County. Unintentional inju- 1 ries are the leading cause of death from ages 5 to 24. Number of Deaths 0.5 It is estimated that for every motor ve- 0 hicle-related death $1.1 million in eco- 1999 2000 2001 2002 2003 nomic costs are incurred. For Cimar- Year of Death ron County which has an average of FALLS FIRES/BURNS MVC SUICIDE 1.6 motor vehicle-related deaths a year, *No homicides/legal intervention or poisoning deaths occurred during this time period

* Vital Statistics, Health Care Information Systems, OSDH & Tobacco Use Centers for Disease Control

According to the 2005 State of the the community as a whole. With health are #VALUE! $ million a year for Cim- State’s Health Report, tobacco use care costs on the rise, targeting areas arron County. among Oklahomans has remained such as tobacco use is an effective way fairly stable from 1990 to 2002. to control those costs. “Medical costs Oklahoma has been consistently No DataIn 2002, Availablethe CDC estimated At that This a per- Time higher in its tobacco use than the accumulated by those son that used tobacco accrued over nation and is 30% higher than the persons are #VALUE! $ $3,300 in health care costs per year. nation on the amount of tobacco According to the Behavioral Risk Fac-million a year for consumed per capita (103 packs vs. tor Surveillance System, it is estimatedCimarron County” 79 packs). that n/a% ( ) of people in Cimarron Tobacco use is no longer just the County use tobacco of some sort. Medi- problem of the individual but also cal costs accumulated by those persons

* Behavioral Risk Factor Surveil- lance System, Health Care Infor- Physical Activity, Wellness and Diabetes mation System, OSDH & Ameri-

The increasing inactivity of the U.S. County had no leisure activity in the health care costs of in one year for population is contributing to an increase past month at the time they were sur- Cimarron County. in numerous poor health-related out- veyed. comes. Physical inactivity robs the body The BRFSS also indicated that n/a% ( ) of precious energy needed to function No Dataof Cimarron Available County citizens At have This been Time properly, in turn health declines and rates diagnosed by a health professional as of various chronic diseases escalate. having diabetes. In 2002, the per capita According to the 2002-2004 Behavioral annual healthcare costs for peopleIncrease with activity gradually. Risk Factor Surveillance System diabetes was $13,243 comparedModerate to exercise for 30 (BRFSS), it is estimated that n/a% $2,560 for people without diabetes.minutes 5 days a week. (#VALUE!) of people in Cimarron Persons with diabetes accumulated

Page 4 STATE OF THE COUNTY’S HEALTH REPORT * Sawhill V., Policy Brief #8, The Brookings Institute; Vi- tal Statistics, Health Care Information Systems, OSDH & Teen Pregnancy National Vital Statistics, Centers for Disease Control

While births to teen mothers (age 15 to was 60.0 (per 1,000 15-19 year old 31% and 7%, respectively. 19) are on the decline in both the U.S. females) in the U.S. and 66.6 in Children of teen mothers are more likely and Oklahoma, Oklahoma has moved Oklahoma. In 2003, the rate de- to display poor health and social outcomes up in rank from 13th to 8th in the creased to 41.7 in the U.S. and than those of older mothers, such as pre- country. In 1993 the rate of teen births 55.8 in Oklahoma, a decrease of mature birth, low birth weight, higher rates of abuse and neglect, and more likely Rate of Live Births to Teen Mothers, Ages 15-19, to go to foster care or do poorly in school. Cimarron County, 1993 to 2003 Additionally, births to teen mothers accu- 80 mulate $3,200 a year for each teenage 70 birth, which is passed on to citizens. 60 According to Oklahoma Vital Statistics, 50 Cimarron County had a teen birth rate of . 40 in 2003 which was a #VALUE! increase females 30 from 2002 (53.1) and a #VALUE! in- 20 crease since 1993 (55). 10 Rate per 1,000 15-19 year old 15-19 year old per 1,000 Rate With an average of 6 births per year, teen 0 pregnancy costs the citizens of Cimarron 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 County $19,200.00 a year. Year

*2003 U.S. data is preliminary Cimarron Oklahoma U.S.* Note: births to a mother 10-14 years of age occurred during the 11 year period.

Poverty * U.S. Census Bureau As the nation advances in tech- quate prenatal care, higher rates of County for whom poverty status nology and the ability to detect low-birth-weight babies, infant was known had an income below and prevent disease at an ear- deaths and low immunization rates what was needed to live at the lier stage, persons that are im- are all associated with poverty federal poverty level. Cimarron poverished carry a large burden along with a myriad of other ad- County is 20% above the state of poor health outcomes. verse health outcomes. (14.7%) and 42% above the na- Higher incidences of un- According to the 2000 census, tion (12.4%) for persons with in- planned or unwanted pregnan- 17.6% of persons in Cimarron comes below the federal poverty cies, teen pregnancy, inade- level.

Income to Poverty Ratio, Cimarron County, 2000 Census

51% to 99% poverty level to 150% to 199% 200% and Poverty level Total 50% below below 149% above above above

Population 3,103 217 328 382 393 1,783

Cumulative Population 217 545 927 1,320 3,103

% of Total 100.0% 7.0% 10.6% 12.3% 12.7% 57.5%

Cumulative % 7.0% 17.6% 29.9% 42.5% 100.0%

CIMARRON COUNTY Page 5 * 2 Year-old Immunization Sur- OK By One - State Immunization Data vey, Immunization Service, OSDH

2003-04 Immunization Coverage Rates

Nowata Ottawa Kay Woods Grant Craig Cimarron Beaver Harper Alfalfa

Osage Washington

Woodward Garfield Noble Pawnee Rogers Mayes Major Delaware Ellis Tulsa Payne Dewey King fisher Wagoner Blaine Creek Log an 80% Adair Muskogee Roger Mills Custer Lincoln Okmulgee Canadian Oklahoma Okfuskee Sequoyah 70-79% MacIntosh ie m Washita o le Beckham Cleveland t o a n Haskell Caddo w i 66-69% ta m t e o S Hughes Grady P Pittsburg Greer Kiowa McClain Latimer 60-65% Le Flore Garvin Pontotoc Harmon Comanche Jackson Coal 50-59% Stephens Murray Pushmataha Tillman Atoka Cotton Johnston <50% Carter Jefferson McCurtain Marshall Choctaw Love Bryan

4:3:1:3:3 Coverage by Location of Shots, Oklahoma, 2004

80.0 69.7 70.0 64.0 66.5 64.1 60.0 Health Dept 50.0 Priv Dr. 40.0 IHS/Tribal

Percent 30.0 20.0 Other 10.0 0.0 Provider Type

Oklahoma Children On Schedule by Antigen, 2004 100

80

60 DTaP IPV 40 Percent MMR 20 Hib 0 HepB 2 Mth 4 Mth 6 Mth 12 Mth 15-18 24 Mth Mth **Note: County level Age data will be available soon.

Page 6 STATE OF THE COUNTY HEALTH REPORT * PHOCIS, Community County Health Department Usage Health Services, OSDH

Health Services Sought in Surrounding Counties by Cimarron County Residents

100% 90% 80% 70% 60% 50% 40%

Percent of Visits 30% 20% 10% 0% Adult Child Health Early Family Maternity STD Tuberculosis WIC Services Intervention Planning Health Service

BECKHAM CADDO CUSTER KIOWA WASHITA WOODWARD

Health Care Costs Summary

Cardiovascular Disease (Heart Disease) Motor Vehicle-Related Injury Death Diabetes • Average 10 deaths a year • Average 1.6 deaths per year • Data Not Available At This Time • $369,476.69 per death • $1,120,000.00 in economic costs Teen Pregnancy per death • Total— $3,694,766.90 a year • Average of 6 births to teen mothers • Total—$1,792,000.00 a year per year Obesity • $3,200.00 in costs for each birth a • Data Not Available At This Time Tobacco Use year

• Data Not Available At This Time • Total— $19,200.00 a year

Grand Total for Cimarron County:

$5,505,966.90

CIMARRON COUNTY Page 7 The Oklahoma Turning Point Initiative is public health improvement in action. The success of the Turning

OKLAHOMA STATE DEPARTMENT OF HEALTH Point process involves a partnership between the state Community Health Services and county departments of health, local communities, Community Development Service and policy-makers. The Oklahoma Turning point en- 1000 NE 10th St, Room 508 Oklahoma City, OK 73117 Phone: 405-271-6127 gine is fueled by a community-based decision making Fax: 405-271-1225 Email: [email protected] process whereby local communities tap into the ca-

pacities, strengths, and vision of their citizens to create Looking Back to Move Forward and promote positive, sustainable changes in the pub-

Report compiled by: Miriam McGaugh, M.S. lic health system, and the public’s health. Community Development Service, OSDH Kelly Baker, MPH Health Care Information Systems, OSDH

Oklahoma Community Partners in P ublic H ealth Innovation

Page 8 STATE OF THE COUNTY’S HEALTH REPORT