Pima County Community Health Needs Assessment March 2012 Prepared on behalf of Carondelet Health Network, Tucson Medical Center and The University of Arizona Medical Center Data Analyst: Emily A. Coyle, MPH Student The University of Arizona Mel and Enid Zuckerman College of Public Health ACKNOWLEDGMENT The University of Arizona Medical Center, Carondelet Health Network and Tucson Medical Center wish to thank the following individuals who contributed time, expertise and valuable input to the Pima County Community Health Needs Assessment: Alexandra Adams, Marketing Specialist, UAMC Michele Barnard, Vice President, Marketing & Communications, The University of Arizona Health Network Odette Bolano, CEO, Carondelet Health Network Jessamyn Bowling, MPH Candidate, University of Arizona College of Public Health Juliet Charron, MPH Candidate, University of Arizona College of Public Health Andrea Chiasson, Government Relations, United Way of Southern Arizona Patricia Coyle, President, Coyle Creative Solutions Kayla DeRosa, Intern, UAMC Dr. Howard Eng, Assistant Professor, University of Arizona College of Public Health Mindy Fain, MD, Co‐Director, University of Arizona Center on Aging Andrew J Gall, MPH Candidate, University of Arizona College of Public Health Christina Geare, Manager of Community Relations, UAMC Michal Goforth, Executive Director, Pima County Access Program Scott Going, Interim Department Head, University of Arizona Nutritional Sciences Steve Goldschmid, MD, Dean, University of Arizona College of Medicine, Co‐CEO, The University of Arizona Health Network Taz Greiner, Manager of Community Benefit and Access to Care, Carondelet Health Network Chuck Huckleberry, County Administrator, Pima County Maia Ingram, Program Director, University of Arizona College of Public Health Cheryl Kohout, Communications Coordinator, Tucson Medical Center Jan Lesher, Deputy County Administrator, Pima County Brad McKinney, Division Manager, Records and Administrative Services, Pima County Health Department Karen Mlawsky, Co‐CEO, The University of Arizona Health Network Jim Murphy, President & CEO, Pima Council on Aging Christopher O’Connor, MS Candidate, University of Arizona School of Natural Resources Honey Pivirotto, Assistant County Administrator, Pima County Judy Rich, CEO, Tucson Medical Center Dorothy Sawyer, Senior Vice President & CEO, St. Mary’s Hospital Joe Snell, President & CEO, TREO Julia Strange, Vice President for Community Benefit, Tucson Medical Center Andy Theodorou, MD, Co‐CEO, UAMC Donna Zazworsky, Vice President, Carondelet Health Network 2 TABLE OF CONTENTS EXECUTIVE SUMMARY ......................................................................................................................... 5 INTRODUCTION ................................................................................................................................... 10 KEY INFORMANTS ............................................................................................................................... 11 I. PIMA COUNTY GEOGRAPHY, DEMOGRAPHICS AND SOCIAL STATISTICS ..................... 15 Population Unemployment Poverty level Education Race/Ethnicity Economics II. ACCESS TO HEALTH CARE ........................................................................................................... 23 Provider Shortages and Medically‐Underserved Areas Hospitals and Travel and Transportation Population Healthcare Coverage Percent Medicaid (AHCCCS) and Medicare III. HEALTH STATUS OF OVERALL POPULATION AND PRIORITY POPULATIONS ......... 35 Leading (Top 10) Causes of Death Top 10 Causes of Inpatient Hospital Discharge Rates of “preventable” hospitalizations IV. RISK FACTOR BEHAVIORS AND CONDITIONS RELATED TO TOP 10 CAUSES OF DEATH ..................................................................................................................................................... 44 Tobacco use, obesity rates and related behaviors Screenings utilization rates V. MATERNAL AND CHILD HEALTH ............................................................................................... 52 Infant mortality rate Low birth weight rates Proportion of women who receive late or no prenatal care Teen pregnancy rate 3 VI. INFECTIOUS DISEASES ................................................................................................................. 68 Sexually transmitted infection incidence rates (chlamydia, gonorrhea and syphilis) HIV incidence rate Tuberculosis incidence rate VII. NATURAL AND BUILT ENVIRONMENT ................................................................................. 78 Air quality annual rating Access to healthy foods and recreational activities VIII. SOCIAL ENVIRONMENT ............................................................................................................ 80 Violent crime rate Housing affordability rate IX. RESOURCES/ASSETS ..................................................................................................................... 81 X. COMMUNITY LEADER FOCUS GROUP ....................................................................................... 86 XI. KEY INFORMANT ANALYSIS ....................................................................................................... 92 XI. APPENDICES .................................................................................................................................... 97 Focus Group Content Analysis Outline Key Informant Questions and Complete Answers Methodology 4 TABLE OF FIGURES Figure 1: Map of Arizona and Pima County, AZ ........................................................................................ 15 Figure 2: Unemployment rate in Pima County by Primary Care Area ........................................... 18 Figure 3: Unemployment rate in Pima County by Primary Care Area – greater Tucson ....... 18 Figure 4: Percent of Pima County population below 200% of Federal Poverty Level ............ 20 Figure 5: Percent of Pima County population under 200% of Federal Poverty Level ‐ Greater Tucson ............................................................................................................................................. 20 Figure 6: Tucson Pima Enterprise Zone ...................................................................................................... 22 Figure 7: Ratio of Pima County Population to Primary Care Providers ......................................... 25 Figure 8: Ratio of Pima County Population to Primary Care Providers ‐ Greater Tucson ..... 25 Figure 9: Federal Medically Underserved Areas ‐ Pima County ....................................................... 27 Figure 10: Federal Medically Underserved Areas ‐ Greater Tucson ............................................... 27 Figure 11: Primary Care Score ‐ Pima County .......................................................................................... 29 Figure 12: Primary Care Score ‐ Greater Tucson ..................................................................................... 29 Figure 13: Primary Care Area Transportation Score ‐ Pima County ............................................... 31 Figure 14: Primary Care Area Transportation Score ‐ Greater Tucson ......................................... 31 Figure 15: Percent of Population Enrolled in AHCCCS ‐ Pima County ........................................... 34 Figure 16: Percent of Population Enrolled in AHCCCS ‐ Greater Tucson ...................................... 34 Figure 17: Top 10 Causes of Death, Pima County, 2010 ....................................................................... 37 Figure 19: Youth Cigarette Smoking, Pima County, Arizona and U.S. ............................................. 45 Figure 20: Arizona Statewide Substance Abuse Epidemiological Profile, December 2009 .. 46 5 Figure 21: Youth Drug and Alcohol Consumption, Pima County, Arizona, U.S. .......................... 48 Figure 22: 2008 Age‐Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive in Arizona ...................................................................................................................................... 50 Figure 23: Infant Mortality per 1000 Live Births by Primary Care Area ‐ Pima County ........ 55 Figure 25: Low‐Weight Births per 1000 Live Births by Primary Care Area ‐ Pima County .. 58 Figure 26: Low‐Weight Births per 1000 Live Births by Primary Care Area ‐ Greater Tucson ............................................................................................................................................................................. 58 Figure 27: Prenatal Care Beginning in the First Trimester by Primary Care Area ‐ Pima County ............................................................................................................................................................... 62 Figure 28: Prenatal Care Beginning in the First Trimester by Primary Care Area ‐ Greater Tucson .............................................................................................................................................................. 62 Figure 29: Teen Births per 1000 Females Age 14‐19 by Primary Care Area ‐ Pima County 65 Figure 30: Teen Births per 1000 Females Age 14‐19 by Primary Care Area ‐ Greater Tucson ............................................................................................................................................................................