Acknowledgements This report was compiled by: Eileen Nehme, PhD MPH Additional contributors include (in alphabetical order): Nagla Elerian, MS David Lakey, MD Kathryn McCaslin, MPH Dorothy Mandell, PhD Jay Morrow, DVM MPH Divya Patel, PhD MPH Anthony Pederson Ella Puga, MPH Additional thanks and acknowledgements to the Texas Department of State Health Services and the Michael & Susan Dell Center for Healthy Living for providing data used in this report, and Dr. Paul McGaha and his staff at UT Health Northeast for their input and guidance. Table of Contents Table of Figures ........................................................................................................................................................ i Table of Tables ....................................................................................................................................................... v Executive Summary .............................................................................................................................................. 1 Introduction ....................................................................................................................................................................... 1 Population Description ................................................................................................................................................. 2 Geographic Health Disparities.................................................................................................................................... 3 Health Disparities within Northeast Texas ........................................................................................................... 4 Determinants of Geographic Health Disparities facing Northeast Texas ................................................. 4 Conclusion .......................................................................................................................................................................... 5 Overview ................................................................................................................................................................... 7 Geographic, Demographic, and Socioeconomic Characteristics .................................................................. 7 All-Cause Mortality Rates and Leading Causes of Death ............................................................................... 10 Composite County Health Rankings ....................................................................................................................... 13 Self-Rated Health ........................................................................................................................................................... 14 Access to Health Services ........................................................................................................................................... 14 Leading Causes of Death in Northeast Texas ............................................................................................ 16 1. Heart Disease .............................................................................................................................................................. 16 Coronary Heart Disease ...................................................................................................................................... 16 2. Cancer ............................................................................................................................................................................ 18 Site-Specific Cancers ............................................................................................................................................. 20 3. Chronic Lower Respiratory Disease .................................................................................................................. 26 Chronic Obstructive Pulmonary Disease ..................................................................................................... 26 Asthma ....................................................................................................................................................................... 27 4. Stroke ............................................................................................................................................................................. 29 5. Unintentional Injury ................................................................................................................................................ 31 Other Chronic Diseases and Conditions ..................................................................................................... 34 Diabetes ............................................................................................................................................................................. 34 Kidney Disease ................................................................................................................................................................ 36 Alzheimer’s Disease ...................................................................................................................................................... 37 Infectious Disease ............................................................................................................................................... 38 HIV and AIDS ................................................................................................................................................................... 38 Tuberculosis .................................................................................................................................................................... 40 Vaccine-Preventable Infectious Diseases ............................................................................................................ 41 Mental/Behavioral Health ............................................................................................................................... 43 Suicide ................................................................................................................................................................................ 43 Alcohol and Drug Abuse .............................................................................................................................................. 44 Maternal and Infant Health ............................................................................................................................. 45 Infant Mortality .............................................................................................................................................................. 45 Preterm Birth .................................................................................................................................................................. 47 Prenatal Risk Factors ................................................................................................................................................... 48 Smoking during Pregnancy ................................................................................................................................ 48 Maternal Obesity .................................................................................................................................................... 49 Prenatal Care Access ............................................................................................................................................ 50 Leading Modifiable Health Risk Factors for Northeast Texas ............................................................ 51 Cigarette Smoking ......................................................................................................................................................... 51 Smoking Ordinances ............................................................................................................................................. 51 Physical Inactivity ......................................................................................................................................................... 53 Overweight and Obesity.............................................................................................................................................. 54 Appendix Data Tables ...................................................................................................................................................................... A1 Healthy People 2020 Objectives ........................................................................................................................... A24 Definitions ..................................................................................................................................................................... A27 Abbreviations ............................................................................................................................................................... A31 Data Sources ................................................................................................................................................................. A32 Bibliography ................................................................................................................................................................. A34 The Health Status of