Green River Area Development District
HEALTH NEEDS ASSESSMENT

Contents

Acknowledgments

Executive Summary

Introduction

Demographics

Health Status

Disease Burden

Health Behaviors

Health Care Access

Health Insurance

References

 

Acknowledgments

The community health needs assessment for the Green River District was conducted by the staff of the Center for Health Services Management and Research of the University of Kentucky. Dr. Carol L. Ireson served as project director. Misook Chung, PhDC and James Schwar, MS were the research assistants.

The health needs assessment in this report is the first stage of a journey to improve the health status of the citizens of the Green River Area. The entire project was conducted under the auspices of the Public Life Foundation of Owensboro in partnership with the City of Owensboro, Daviess County, Hager Educational Foundation, Messenger-Inquirer, Owensboro Mercy Health Systems, Audubon Area community Services, Green river district Health Department, River Valley Behavioral Health, United Way of the Ohio Valley, Hancock, Henderson County, McLean County, Ohio County, Union County, Webster County, Ohio County Hospital, Yeager Foundation, Henderson Methodist Hospital, Methodist Hospital Union county, city of Henderson, The Gleaner, Preston Family Foundation, Henderson County School System. We wish to thank Mr. John Hager of the Public Life Foundation for providing his time, energy, and resources during the development and implementation of the project. We appreciate the time of the Health Council in providing overall direction for the project.

We also appreciate the input of the over 1800 citizens who answered the survey and thereby contributed to enhancing the quality of life for themselves and their neighbors.

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EXECUTIVE SUMMARY

The University of Kentucky Center for Health Services Management and Research conducted a comprehensive assessment of the health status, access to care, and health insurance coverage for the people in the Green River Area Development District (GRADD). We used qualitative and quantitative methods including telephone surveys, personal interviews, and mailed questionnaires to gather information from citizens, physician, and other health care professionals. The core components of the assessment were an analysis of secondary health data and a random digit dial telephone survey of households conducted by the University of Louisville Urban Studies Institute. Our 1720 household sample for the seven county area compares favorably to the 2,397 interviews conducted for the statewide Kentucky Health Interview Survey. The survey consisted of 91 questions concerning health status, health promotion behaviors, access to health care, and affordability of health care. A mailed survey to area physicians and interviews with other health professionals provided data to enrich the assessment. The findings from the telephone survey agree reasonably well with information gathered from other surveys of the region and with the physician survey increasing the confidence in the information. The survey also gives new information about the region and provides a baseline for measuring progress toward the Healthy Kentuckians 2010 objectives.

Health Insurance. The 10% of individuals in GRADD without insurance at some time during the last year, is lower than the 14% rate for Kentucky Thirty-five percent of the respondents had children under the age of 18 living in their household. Of the households with children, 234 or 39% were eligible for K-Chip coverage based on income and of those eligible, 63 (26%) were enrolled in K-Chip. Nearly 11% (65) of households with children had no insurance and the children were not enrolled in K-Chip, 21 were eligible for K-Chip, and 42 were not. One-fourth (24%) of persons in the telephone survey indicated they could not afford needed medical care, 20% could not afford medications, and 22% could not dental care. The 24% included people with health insurance. The physician respondents also reported that 24% of their patients go without needed care and cannot get needed medications because of cost.

Access to Care. The majority (80%) had access to a primary care provider, 93% have a place where they usually receive their medical care, and 75% had routine medical check-ups. The 20% without a primary care provider is lower than the state, despite the smaller ratio of PCPs to the population than statewide. Of the households with children, 80% had a primary care provider. The poor and uninsured did not have a usual source of care. A large percent (47%) visited the emergency room within the past year and 25% had 2 or more visits.

A large percent reported being satisfied with the total health services provided in their area with 92% rating it good, very good, or excellent. The uninsured and poor were less satisfied.

Health Status. The overall health status of the survey respondents was positive, reporting higher physical health, mental health, role functioning, and health related quality of life than the average Kentucky resident reported on the Kentucky Health Survey. Those with less education and lower incomes had significantly lower health status scores in all areas.

Disease Burden. The questions about health conditions were based on an analysis of the most common conditions in Kentucky and the most common diagnosis seen at the areas two largest health care facilities. Arthritis emerged as the most common chronic condition of the seven conditions we asked about. The same was true with the Kentucky Health Interview with 34% of all ages combined reporting having physician-diagnosed arthritis. Hypertension affects more GRADD residents (28%) than other Kentucky residents (24%) and the cardiovascular death rate is higher than the rest of the state and the leading cause of death in the GRADD. The number of respondents with diabetes (8%) was also higher than the state rate of 4.4%. Over 12% have asthma; the estimate for the state is 17%.

Cancer is the second leading cause of death. Eight percent reported having had cancer with breast and skin cancer representing 20% each of the total cancer diagnoses. Although the cancer incidence for the major cancers including breast, cervical, prostate, and lung are lower than the rest of the state, cancer deaths are higher and represent the second leading cause of death in the GRADD. This finding indicates either a lack of early diagnosis or available treatment.

An area of concern was the high percentage (17%) of female respondents or members of the household (22%) who had low birth weight babies. This was significantly related to the high percentage (27%) of women who smoked during pregnancy. Education and income were not significant factors.

Health Behaviors. A very high percentage of respondents smoked (54%) and the GRADD ranks third among the ADDs in the percentage of smokers. Smoking was related to being male but not education and income. Additionally, the number of pregnant women who smoked was very high. These finding suggest a need for intensive attention smoking cessation programs and prevention for all ages.

One of the most significant findings from the survey is the percentage of GRADD residents who are overweight and obese. Those considered normal weight comprised only 40% as compared to the 32% of the Kentucky population, while a total of 60% were overweight (33%), and obese (27%). Only 16%, significantly lower than the 2010 goal of 40%, consumed the "Five-a-Day"--the nationally recommended number of servings of fruits and vegetables, 30% the recommended grains, and 32% the recommended red meat intake. Being female and lack of exercise, but not dietary habits were the most significant predictors of being overweight and obese. The 60% reporting physical activity either work or exercise 3 times per week, much higher than the state and national number, raising questions about over reporting.

 

Potential GRADD Priorities for Health Kentucky 2010:

Disease Burden

Health Behavior

Health Care Access

Health Insurance

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Green River Area Development District

HEALTH NEEDS ASSESSMENT

 

The following report provides a picture of the health status, access to health care, and health insurance coverage for the people of the Green River Area Development District. The picture has different views. The data for the report came from several sources: community focus groups, telephone surveys, personal interviews, and data from state and national sources. The data were analyzed using quantitative and qualitative methods. The results were compared to the Healthy People 2010 goals.

Voices of the people

Focus groups.

Twenty-three people participated in five focus groups held in Owensboro/Daviess County, Henderson County and Ohio County. The focus groups were conducted in November, 1999 by Dr. Jim Applegate and Annie Forsythe, a doctoral student in health communications. Participants in four of the five focus groups were recruited by the Local Project Assistant, Bonnie Pfanensteil, a registered nurse with the Green River Health Department who works regularly with many underserved populations in the GRADD area. Ms. Pfanensteil selected sites for the focus groups that were the most accessible for the targeted participants and arranged transportation when needed. The participants gave written consent to participate and each participant was given a stipend of $15.

The majority of the participants were white-non Latino (96%) and female (83%). Over half had a college degree of some kind, although 17% had not completed high school. One-third had an annual income of less than $25,000; another third earned between $25,000 and $50,000; and the remainder earned over $50,000. Family size ranged from 1 to 6 with the majority (64%) having 3 or more people in their family. Over half had private insurance coverage, 26% had Medicaid, 13% Medicare, and 9% had no insurance coverage. Groups represented in the focus groups included the working poor, African-American women, retirees, the unemployed, the middle class, and community health leaders. All were very interested in the health care priorities of the community. The messages that came from their voices provided the direction for the remainder of the community needs assessment. Without these voices the community health needs assessment could have not been completed.

During the two hour sessions, the focus groups responded to questions about Health Insurance Coverage, Continuity of Care, Preventive and Medical Services, Accessibility to Health Care, and Health Care Priorities. The following themes were gleaned from the recordings of the sessions:

 

Providers Voices

Survey of physician providers.

A survey was sent to 281 physician providers in the seven county GRADD area. The names of the providers were obtained from the state medical licensing board. Four were returned due to bad addresses. A total of 75 physicians responded including four retired, and one unusable for a 26.6% response rate. The physicians were asked some of the same questions as the random digit dial Survey 2000 about the type of insurance coverage, access, ability to pay, and the health status for their patient population.

The physician respondents specialized predominantly in family practice and pediatrics (GRAPH A). The majority practiced in Daviess and Henderson Counties and had an average of 15 years practicing in the area. The type of health care coverage used by their payments was 39% private insurance, 34% Medicare, 17% Medicaid and 10 self-pay. Over one-fourth, 25.7%, of physicians were not taking new Medicaid patients. Physicians reported a wait to get an appointment from 13 to 15 days. This varied by type of insurance coverage the next available appointment time also varied slightly by type of insurance. Physicians reported that the average office wait prior to being seen was 25 minutes and the average time spent with each patient was 18 minutes. They reported that on the average they provided 12.4 hours of free care in a one-month period. Nearly one-fourth, 24.3%, of their patients do not get their medication due to costs and 24.3% delayed getting needed medical care or did not get it because of inability to pay. Overall physicians rated the health of their patients as good (45%), followed by very good (17.7%), fair (20.7%) excellent (1.4%), and poor (0.7%).

Interviews with non-physician providers.

Interviews were conducted with non-physician health care providers in Henderson, Fordsville, and Owensboro. These individuals represented the continuum of care including primary care, acute care, home care, adult day care, long term care and community based pharmacy. Providers were asked questions about the services they provided and the health status, health care access, and insurance status of the recipients of their services. The following themes came from the information they provided:

of care.

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  1. DEMOGRAPHICS
  2. The random digit dial telephone survey conducted over a two-month period resulted in 1720 completed surveys for a response rate of 50%. The 1720 people who responded to the survey were predominately female 68% (1170) and white 94% (1614); 4% (73) were African-American with multiracial (9), Hispanic (3), native Americans (4), and Asians (2) representing less than one-percent each. The 1997 population in the seven county GRADD was 61.5% female and the percent of African-Americans ranged from 0.46% in McLean to 7.3% in Henderson except for Union with 15.4%. The majority, (65%) were married, 12% widowed, 15% divorced or separated and 8% single (GRAPH 1).

    Over one-half of the respondents (52%) worked full-time outside of the home, 9% worked part-time, 24% were retired and 15% were not employed. Those not employed outside the home included those who were disabled (5.7%), in school (1.2%) or keeping house (25%). Of those not employed outside the home only 2% considered themselves unemployed and looking for work.

    Nineteen percent (19%) had a college education, 27% had some college, 40% completed high school, and the remaining 14% had less than a high school education. Nearly 11% of the respondents reported annual income of less than $10,000 with an additional 29% earning less than $30,000 (GRAPH 2). The median income was $34,5000 slightly higher than Kentucky at $34,076 (GRAPH 3). Home ownership was high with nearly 77% owning their home. Less than half of the respondents (41%) had access to the Internet from home, 38% of the women and 47% of the men.

     

    Table 1. Demographics of Survey

     

    Description

    Frequency

    Percent

    Race

    Black/African-American

    73

    4.26

     

    White

    1614

    94.22

     

    Hispanic

    3

    0.18

     

    Native American

    4

    0.23

     

    Asian/Pacific Islander

    2

    0.12

     

    Multiracial

    9

    0.53

     

    Other

    8

    0.47

           

    Education

    Never attended school

    2

    .12

     

    Elementary

    77

    4.50

     

    Some high school

    169

    9.87

     

    High school

    692

    40.42

     

    Some college

    459

    26.81

     

    College graduate

    313

    18.28

           

    Marriage

    Married and living with spouse include common law marriage

    1097

    64.08

     

    Married and spouse away in service

    7

    .41

     

    Widowed

    200

    11.68

     

    Divorce

    230

    13.43

     

    Separated

    35

    2.04

     

    Never married

    119

    6.95

     

    Partner, not married

    24

    1.40

     

    Table 2. County of residence

     

    Frequency

    Percent

    Daviess

    679

    39.48

    Henderson

    692

    40.23

    Hancock

    63

    3.08

    McLean

    55

    3.20

    Ohio

    119

    6.92

    Union

    60

    3.49

    Webster

    62

    3.60

     

    1720

    100

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  3. HEALTH STATUS

The questions concerning health status cover physical functioning, role functioning, pain experience, mental health, and current health perceptions and were worded the same as the questions asked on the Kentucky Health Survey. Questions were grouped and scored from 0 to 100, with 0 indicating worst health and 100 best health. Scores were analyzed for adult respondents, using groupings of young through middle adults (18 - 64) and older adults (65+); and for males and females. Comparisons also were made between income levels, education, access to health care, and insurance status.

Overall, Green River respondents reported higher health related quality of life

scores than those of the general Kentucky population from the Kentucky Health Survey

(GRAPH 4). Nearly 48% of the respondents rated their health as good, very good, or excellent; one-third (32%) rated it as fair; and 20% rated their health poor (GRAPH 5). There were no differences between men and women in health rating. Finally, the health perception score for all ages of 75.2 compared to the 67.5 reported for the average Kentucky resident (GRAPH 6).

In contrast to the findings from the Kentucky Health Survey for the whole state, there was no difference between GRADD men and women in the areas physical functioning, role functioning, or health perceptions. Education and income, on the contrary, made a significant difference in all indicators of health status; those with more education had better physical and mental health status, higher role functioning scores and viewed their health as better. The same was true for income; those with higher incomes had significantly higher scores in all indicators of health status.

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  1. DISEASE BURDEN
  2. The questions about health conditions were based on an analysis of the most common conditions in Kentucky, the most common diagnosis seen at the areas two largest health care facilities, and the leading cause of death in the GRADD (GRAPH 7). The respondents were asked if a doctor or other health care provider had told them they had the following conditions (the results are compared to the goals for the Healthy People 2010 for Kentucky and the nation):

    3.1 Heart Disease and Stroke

    Objective of Kentucky Health 2010 (20.3): To decrease to at least 20% the proportion of adult Kentuckians with high blood pressure.

    Over one fourth of the respondents, 28%, have been told that they have high blood pressure, higher than the 24.4% reported statewide (GRAPH 8). Hypertension is a risk factor for cardiovascular and cerebrovascular disease, the leading cause of death in the GRADD.

    Objective of Kentucky Health 2010 (20.1): To reduce heart disease deaths to no more than 200 deaths per 100,000 people (age adjusted to the year 2000 standard population).

    Nearly 15% of the survey respondents reported a diagnosis of heart disease. According to the Kentucky Annual Vital Statistics Report, the age adjusted rate death of health disease in the GRADD in 1997 of 223.1 was lower than the Kentucky rate of 230.1. However, among the GRADD counties, Hancock (239.9), Ohio (254.6) and Union (267) counties exceeded the rate of Kentucky.

    Table 3. Death by heart disease — Age adjusted rate

    KY

    GRADD

    Daviess

    Hancock

    Henderson

    McLean

    Ohio

    Union

    Webster

    1995

    226.2

    247.2

    219.0

    295.1

    253.2

    266.9

    294.2

    213.6

    258.6

    1996

    215.5

    212.7

    182.1

    240.4

    226.8

    263.4

    225.8

    213.2

    300.1

    1997

    230.1

    223.1

    210.1

    239.9

    227.3

    204.4

    254.6

    267

    198.4

    Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

    The 1997 Kentucky deaths from heart disease represented 32% of all deaths and cerebrovascular disease represented 7%. In GRADD, deaths from heart disease were 32.9% of total deaths; 7% were from cerebrovascular disease During 1997, the highest rate was among Henderson Countians, 35.2% died from heart disease and 11.8% from cerebrovascular disease (Graph 7a).

    Objective of Kentucky Health 2010 (20.2): To reduce cerebrovascular death to no more than 35 deaths per 100,000 people (age-adjusted to the year 2000 standard population).

    Three percent (3%) of the survey respondents reported having had a stroke. In 1997 cerebrovascular death rate in the GRADD was 60.5 per 100,000, higher than the Kentucky rate of 44.6. Among GRADD counties, Henderson (74.0) had the highest cerebrovascular death rates. Hancock (71.3) Ohio (66.3), Daviess (59.6) and Webster (59.2) also reported high death rates.

    Table 4. Death by cerebrovascular disease - Age adjusted rate per 100,000 populations

    KY

    GRADD

    Daviess

    Hancock

    Henderson

    McLean

    Ohio

    Union

    Webster

    1996

    45.1

    49.4

    50.0

    72.7

    47.8

    37.1

    42.8

    67.4

    48.1

    1995

    43.6

    43.6

    51.4

    98.5

    35.4

    22.6

    45.9

    10.8

    48.9

    1997

    44.6

    60.5

    59.6

    71.3

    74.0

    48.1

    66.3

    34.0

    56.2

    Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

     

    3.2 Respiratory Disease

    Objective of Kentucky Health 2010 (24.1): Reduce the asthma death rate to no more than 14 per million population.

    Over 12% of the respondents reported a diagnosis of asthma. Although there is no statewide collection of asthma prevalence, the statewide estimate is 220,000 cases for the total population for a 17.76% rate. Medicaid data showed a 7% rate for Region 2 that includes the GRADD (GRAPH 9). Nearly 9% of the respondents suffer from chronic lung disease and 15% have been diagnosed with pneumonia.

    Table 5. Death rate of chronic obstructive pulmonary disease per 100,000 population (case number)

    KY

    GRADD

    Daviess

    Hancock

    Henderson

    McLean

    Ohio

    Union

    Webster

    1996

    50.9

    (1978)

    63.2

    (130)

    54

    (49)

    57.1

    (5)

    63

    (28)

    no data

    82.5

    (18)

    109

    (18)

    88.7

    (12)

    1997

    50.7

    (1979)

    47.5

    (98)

    57.1

    (52)

    11.3

    (1)

    47.1

    (21)

    51.6

    (5)

    36.4

    (8)

    36.3

    (6)

    37

    (5)

    Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

    3.3 Arthritis

    In the health history, arthritis was the most common chronic condition with over one third (33.7%) of the respondents reported a diagnosis of arthritis. The Kentucky Health Interview survey also reported arthritis as the most common condition with a rate 16% for the state. Although there is not a Kentucky Health 2010 objective related to arthritis, the number reporting problems with arthritis suggest that the burden of the disease is significant and will likely increase as the population ages. The elderly did not report a higher rate than those between 18 and 65 years.

    3.4 Diabetes

    Objective of Kentucky Health 2010 (18.2): Slow the rise in the prevalence of diagnosed diabetes to no more than 7% of the population 18 years and older.

    Over 8% of the survey respondents reported a diagnosis of diabetes. The 1995-1997 BRFSS indicated that 5.1% of the adult population in GRADD had been diagnosed with diabetes, higher than Kentucky rate of 4.5% (GRAPH 10).

    Objective of Kentucky Health 2010 (18.3): Slow the rise in the diabetes death rate (diabetes as a primary/underlying cause) to no more than 28 per 100,000 persons.

    The diabetes mortality rate of 31.5 for the GRADD is lower than the state, but under the 2010 goal (GRAPH 11). The rates for the seven counties range from 0 for Hancock to 82.6 for McLean.

    Table 6. Diabetes mortality - Crude rate (case number)

    KY

    GRADD

    Daviess

    Hancock

    Henderson

    McLean

    Ohio

    Union

    Webster

    1995

    22.4(941)

    27.8(57)

    30.9(28)

    35.4(3)

    9.0(4)

    30.9(3)

    41.8(9)

    12.1(2)

    59.4(8)

    1996

    24.2(939)

    28.7(59)

    30.8(28)

    34.3(3)

    15.8(7)

    30.8(3)

    36.7(8)

    24.2(4)

    44.4(6)

    1997

    34.4(1346)

    31.5(65)

    27.5(25)

    0

    33.6(15)

    82.6(8)

    45.6(10)

    12.1(2)

    37.0(5)

    Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

    3.5 Cancer

    Objective of Kentucky Health 2010(17.1): To reduce cancer deaths to a rate of no more than 220.7 per 100,000 people in Kentucky.

    Cancer is the second leading cause of death in GRADD (GRAPH 12). Nearly 8% of respondents, 132 people reported having had cancer with 20% of those having breast cancer and another 20% skin cancer. In 1997 a total of 510 people, 24.4% of total deaths, were due to cancer. The age adjusted cancer mortality rate was 192.5 in GRADD higher than the state rate of 188.5. Henderson (215.9), McLean (227.3), Ohio (238.4) and Webster (229.2) reported higher cancer mortality rate than GRADD. The crude rate was high in GRADD (247.4) higher than the state rate of 230. The crude cancer death rates of McLean (309.9), Ohio (350.8), and Webster (340.3) counties were very high in 1997. However, the Kentucky Cancer Registry reports a lower age adjusted incidence of cancer cases in 1998 for the GRADD (394) than for the state (421). The difference in incidence and mortality rates may be linked to lack of early diagnosis and treatment.

    Table 7. Death from the cancer - Crude rate per 100,000 population (case number)

    KY

    GRADD

    Daviess

    Hancock

    Henderson

    McLean

    Ohio

    Union

    Webster

    1995

    229.4

    (8854)

    264.6 (542)

    270.2

    (245)

    306.5

    (26)

    256.6

    (114)

    329.7

    (32)

    264.4

    (57)

    200

    (33)

    259.9

    (35)

    1996

    233.3 (9060)

    231.5

    (476)

    221.3

    (201)

    148.6

    (13)

    236.3

    (105)

    297.3

    (29)

    297.3

    (65)

    236.2

    (39)

    177.5

    (24)

    1997

    230.0

    (8985)

    247.4

    (510)

    226.3

    (206)

    226.6

    (20)

    210.7

    (94)

    309.9

    (30)

    350.8

    (77)

    223.9

    (37)

    340.3

    (46)

    Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

    Table 8. Cancer incidence rate in 1998

    All sites

    Lung

    Breast

    Prostate

    Colorectal

    Kentucky

    421.84

    79.09

    121.66

    108.21

    55.53

    GRADD

    394.90

    71.21

    122.66

    89.92

    47.20

    Daviess

    399.62

    81.59

    120.88

    81.66

    43.08

    Henderson

    334.35

    58.97

    107.54

    99.72

    25.80

    Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

    3.5.1 Lung Cancer

    Objective of Kentucky Health 2010(17.2): To reduce lung cancer deaths to a rate of no more than 80.7 per 100,000 people in Kentucky.

    Lung cancer deaths are higher than those of the state. However, according to the Kentucky Cancer Registry; the 1998 incidence of lung cancer 71.2 in the GRADD is lower than the 79.1 reported for the state (GRAPH 13). According to Kentucky Cancer registry, male lung cancer incidence rate (100.51) in GRADD was twice as high as female lung cancer rate (50.11) in 1998. This finding is likely linked to the survey finding of significantly higher smoking behavior in males.

    Table 9. Death from lung cancer — Crude rate per 100,000 population (case number)

    KY

    GRADD

    Daviess

    Hancock

    Henderson

    McLean

    Ohio

    Union

    Webster

    1995

    79.2

    (3056)

    91.3

    (187)

    98.2

    (89)

    94.3

    (8)

    101.3

    (45)

    92.7

    (9)

    65

    (14)

    66.7

    (11)

    81.7

    (11)

    1996

    80.4

    (3123)

    93.4

    (192)

    89.2

    (81)

    34.2

    (3)

    103.5

    (46)

    102.5

    (10)

    123.7

    (27)

    96.9

    (16)

    66.5

    (9)

    Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

     

    3.5.2 Breast Cancer

    Objective of Kentucky Health 2010(17.3): Reduce breast cancer deaths to a rate of no more than 22.5 per 100,000 women in Kentucky.

    Of the 132 survey respondents with cancer, breast cancer accounted for 20% of the total. The breast cancer mortality rate in the GRADD (33.9) is higher than the State rate of 30.6 and significantly higher than the 2010 goal of 22.5.

    Table 10. Death from breast cancer - Crude rate (case)

    KY

    GRADD

    Daviess

    Hancock

    Henderson

    McLean

    Ohio

    Union

    Webster

    1995

    31.7 (631)

    28.3 (30)

    29.3

    (14)

    0

    (0)

    17.3

    (4)

    80.9

    (4)

    62.6

    (7)

    12.4

    (1)

    0

    1996

    30.6 (612)

    33.9 (36)

    33.8

    (16)

    0

    (0)

    43.2

    (10)

    100.6

    (5)

    35.3

    (4)

    0

    (0)

    14.3

    (1)

    Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

    3.6. Maternal, Child Health

    3.6.1 Infant Mortality

    Objective of Kentucky Health 2010 (12.1): To reduce the infant mortality rates to no more than 6 per 1,000 live births

    In 1997, the GRADD infant mortality rate (6.2 per 1,000 live births) was lower than the Kentucky (7.2). Among the GRADD counties, Hancock (16.3) and McLean (26.5) reported high infant mortality (GRAPH 14). The high rates in these counties are related to the low numbers of births.

    Table 11. Infant mortality rate - Crude rate per 1,000 live birth (case number)

    Kentucky

    GRADD

    Daviess

    Hancock

    Henderson

    McLean

    Ohio

    Union

    Webster

    1995

    7.5 (391)

    6.2 (16)

    5.5(7)

    0

    11.4 (6)

    10.2 (1)

    4 (1)

    4.9 (1)

    0

    1996

    7.3 (385)

    9.1 (23)

    13.3 (16)

    8.8(1)

    6.1 (3)

    0

    4 (1)

    10.5 (2)

    0

    1997

    7.2 (382)

    6.2 (16)

    4 (5)

    16.3 (2)

    4.3 (2)

    26.5 (3)

    7.2 (2)

    5.6 (1)

    6.1 (1)

    Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

    3.6.3 Low Birth Weight Babies

    Objective of Kentucky Health 2010 (12.12): To reduce the incidence of low birth weight to no more than 5% (baseline 6.4%), very low birth weight to no more than 1% (baseline: 1.3% white and 3.0% nonwhite), and reduce the incidence of premature birth to no more than 7.6% (baseline: 6.1% white and 9.1% nonwhite) of all live births.

    Low birth weight infants are infants weighing less than 2500 grams or about 5 1/2 pounds. Low birth weight infants are less likely to survive and at higher risk of disability if they live. Overall, 87% of female respondents had given birth and17% of those reported they had a baby weighing less than 5 1/2 pounds at birth. Of those having low-birth weight babies, 94% received prenatal care during their entire pregnancy. Over one-fourth, 27%, smoked while pregnant. Another 21% of respondents reported that a female member of their household had a baby weighing less than 5 12 pounds at birth and of those 96% had prenatal care and 22% smoked while pregnant. Smoking during pregnancy was the most significant risk factor for having a low birth weight infant. Nearly 42% of mothers of low birth weight babies had a high school education and 26%had some college. Although one third earned less than $20,000 annually, 30% were in households with incomes between $30,000 and $50,000. More of those having a low birth weight baby had insurance at the time of the survey, their insurance status at the time of the pregnancy is not known.

    The 1997 incidence rate of low birth weight babies in total births was 8.6% in the GRADD, higher than Kentucky (7.8%, 4,113. McLean (11.5%), Ohio (11.6%), Union (10%), Hancock (8.9%) counties’ incident rates were very high (GRAPH 15).

    The rate of low birth weight is very high for the teen mother. In 1997, the incident rate of low birth weight babies by teen mother of the total births in GRADD was 10.9 %, which is higher than Kentucky (9.3%). Hancock (19.5%), Henderson (11.46%), McLean (13.33%), Ohio (16.98%) counties reported very high incident rates.

    Table 12. Resident low weight (2,500 grams or less) live births - Crude rate per

    100 total live births

    Kentucky

    GRADD

    Daviess

    Hancock

    Henderson

    McLean

    Ohio

    Union

    Webster

    1994

    7.7

    9.3

    9.5

    10.9

    9.9

    5.1

    7.2

    9.6

    9.6

    1995

    7.6

    8.8

    8.7

    7.4

    9.9

    11.2

    8.4

    6.8

    9

    1996

    7.9

    8.8

    8.6

    6.1

    10.8

    12.5

    8.3

    8.9

    4.7

    1997

    7.8

    8.6

    7.7

    8.9

    8.6

    11.5

    11.6

    10

    7.3

    Source: Kentucky Vital Statistics Annual Reports for GRADD 1986-1997

    Objective of Kentucky Health 2010 (3.4): Reduce cigarette smoking among pregnant women to a prevalence of no more than 20 percent.

    Of the 1021 female respondents who had given birth, 26.5% smoked during their

    pregnancies, as did 21.6% of the additional 568 female household members (GRAPH 15a).

    3.7 Mental Health

    Nearly 10%, two-thirds women, reported that they needed to talk with a mental health professional within the last year. There is no state data related to need for mental health care. However, approximately 20 percent of the U.S. population are affected by mental illness during a given year and depression is the most common disorder.

    One percent reported that they or a member of their family had attempted suicide in the last year. The state age adjusted death rate of suicide is 11.7 per 100,000.

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  3. HEALTH BEHAVIORS
  4. In this section the health habits, behaviors, and risk factors of illness are analyzed.

    Heart disease and cancer are the leading causes of death in the GRADD and the following Kentucky Health 2010 objectives relate to health habits, behaviors, and risk factors that contribute to a reduction in the rate by 2010.

    4.1 Blood Pressure

    Ninety-four percent (94%) reported getting their blood pressure checked within the last year; this did not differ by sex. Twenty-eight percent (28%) of those who had their blood pressure taken were hypertensive. There is not a 2010 goal related to monitoring blood pressure or data from the Kentucky BRFSS survey.

    4.2 Cholesterol Screening

    Objective of Kentucky Health 2010 (20.4): To increase to at least 85% the proportion of adults who have had their blood cholesterol checked within the preceding five years.

    Eighty-one percent of respondents had their cholesterol checked within the last 2 years and over 85% within the last five years meeting the Healthy Kentucky 2010 goal.

    4.3 Smoking

    Objective of Kentucky Health 2010 (3.1): Reduce the proportion of adults (18 and older) who smoke cigarettes to 25% and smokeless tobacco to 2%.

    Fifty-four percent of survey respondents have smoked at least 100 cigarettes. Those who smoked were male and less educated. Less than 3% use smokeless tobacco. Having a usual source of care, routine medical check-ups, and a primary provider did not affect smoking behavior. The BRFSS data show that 34.5% adults age 18 and older in GRADD report have ever smoked 100 cigarettes and currently smoke, higher than the state rate of 30.1% and third among all Kentucky districts (GRAPH 16).

    4.4 Mammograms

    Objective of Kentucky Health 2010 (17.5): To increase to at least 85% the proportion of women ages 40 and older who have ever received a CBE and mammogram, and to at least 85% those ages 50 and older who have received a CBE and mammogram within the preceding one to two years.

    Overall 65% of all women reported getting a mammogram within the last two years. This was related to income and having insurance but not education. More women over age 65 (70%) reported getting a mammogram within the last two years than those under 65 years (GRAPH 17).

    1. Cervical Screening
    2. Objective of Kentucky Health 2010 (17.6): To increase to at least 95% the proportion of women ages 18 and older who have ever received a Pap test, and to at least 85% those who received a Pap test within the preceding one to three years.

      Eighty percent received a Pap test within the preceding one to three years exceeding the state rate in 1997 of 75.4%; two-thirds of women got a Pap smear in the last year. The uninsured and uneducated were less likely to get annual pap smears. Only one-half of elderly women had an annual Pap smear (GRAPH 18).

    3. Colorectal Screening
    4. Objective of Kentucky Health 2010 (17.7): To reduce colorectal cancer deaths to no more than 23.5 per 100,000 people in Kentucky.

      The respondents were not asked about sigmoidoscopic exams but were about rectal or prostate exams. Eighty-three percent of men received a rectal or prostate exam within the last three years.

    5. Immunizations and Infectious Diseases
    6. Objective of Kentucky Health 2010 (22.12): Increase the rate of influenza immunization coverage for non-institutionalized adults 65 years of age or older to 75%.

      Nearly two thirds, (65%) of adults over 65 received flu shots in the last 12 months. Over 40% of all respondents got a flu shot during the last fall or winter and 20% got the flu. The elderly were no more likely to the get the flu than younger respondents (GRAPH 19).

    7. Physical Activity and Fitness
    8. Objective of Kentucky Health 2010 (1.1): To reduce overweight to a prevalence of no more than 25% among Kentuckians ages 18 and over increase to at least 50% the prevalence of healthy weight (defined as a body mass index (BMI) greater than 19.0 and less than 25.0) among all people aged 20 and older.

      Body mass index (BMI) is a calculation of height in inches divided by weight squared. A BMI less than 25 is considered normal; between .25 and 30 is overweight; and greater than 30 is obese. If those considered 40% were normal weight, 33% were overweight, and 27% obese. Being overweight was related to being female and lack of exercise, but not to positive dietary habits. Positive dietary habits were defined as eating 5 or more fruits, vegetables, and grains; avoiding fast food; and a low fat and red meat intake. The 1997 BRFSS data show the prevalence of overweight population in GRADD to be lower than the state (GRAPH 20).

      Objective of Kentucky Health 2010 (1.2): To increase to at least 50% the proportion of Kentuckians ages 18 and over who engage regularly in physical activity for at least 20 minutes 3 or more times per week.

      The percentage of survey respondents engaging in physical activity was very positive with 60% reporting they exercised or worked for at least 3 times per week for 20 minutes without stopping and the activity was hard enough to cause them to breathe heavier or their heart to beat faster. There was no difference between men and women. This number is much higher than that reported in the 1997 BRFSS of 30% of the GRADD population meeting the physical activity goal. The rate for the US as a whole is 15% for the adult population. The difference may be related to the fact that the Survey 2000 question included exercise or work and the BRFSS survey asks only about exercise (GRAPH 21).

    9. Nutrition

Objective of Kentucky Health 2010 (2.5): Increase to at least 40% the proportion of age 2 and older that meet the dietary guidelines’ minimum average daily goal of at least five servings of vegetables and fruits.

A healthy diet includes 5 or more servings of fruits and vegetables, 3-4 servings of grains or pasta, low intakes of fat and red meat. Only 16% of the survey respondents consumed the recommended amount of fruits and vegetables, 30% the recommended grains, and 32% the recommended amount of red meat. Only one-fourth ate at fast food restaurants more than out 3-4 times per week. Women were more likely to eat the recommended amount of fruits and vegetables, red meat and fat, but not grains, breads, and cereals, and to avoid eating fast food. The BRFSS reported only 15.5% of people age 18 and older in GRADD ate fruits and vegetables more than 5 times per day (GRAPH 22).

4.10 Injury/Violence Prevention

Objective of Kentucky Health 2010 (7.13): Increase use of safety belts to 93% of motor vehicle occupants.

Three fourths of the survey respondents use seatbelts all of the time; women use them more than men. Those who drank were more likely not to use seatbelts. The 1997 BRFSS data show that only 61.1% of individuals in GRADD report using a seat belt at all time (GRAPH 23).

4.11 Substance Abuse

Objective of Kentucky Health 2010 (26.12): Reduce alcohol consumption in Kentucky to an annual average of no more than 2 gallons of ethanol per person.

.

Objective of Kentucky Health 2010 (26.19): Reduce by half the proportion of persons who report having driven a vehicle, or riding with a driver who had been drinking, during the past month (No percentage available from state at this time).

Forty-two percent of respondents reporting having at least one drink in the last month and 31% of those consumed more than two drinks when they drank. Only 2% admitted driving when they had drunk too much.

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5. HEALTH CARE ACCESS

Objective of Kentucky Health 2010 (10.6): Increase to at least 90 percent the proportion of people who have a specific source of ongoing primary care.

 

5.1 Usual Source of Care

Most of the respondents (93%) have a place where they usually receive their medical care and women were more likely to have a usual source of care than men (GRAPH 24). The site of care was most often a physician's office (78%) or clinic (14%) (GRAPH 25). The poor were more likely to use an emergency room or urgent treatment center as their only source of care. Those without a usual source of care were uninsured (30%), poor (25%), and did not have a convenient place to go. One-fourth without a usual source of care felt they did not need medical care, and 10% did not believe in doctors (GRAPH 25a).

The majority (75%) had routine medical check-ups and women were more likely to get them than men. They most often (84%) have their check-ups at a physician's office, or clinic/health center (13%). Only 2%, most often women, get their routine check-ups at an emergency room or urgent treatment center. Over 90% of all respondents and 94% of the elderly had a routine check-up within the last year. Those with a chronic illness were more likely to have a usual source of care, get routine medical check-ups, and have a primary care provider except for those with asthma. This finding suggests a need for increased community wide attention to asthma. Those who had pneumonia or a stroke were more likely to not have a primary care provider.

Those with a usual source of care and routine medical check-ups were more likely to have their blood pressure monitored, cholesterol checked, get mammograms, pap smears, flu shots, and prostate exams. The same was true for those having a primary care provider except for pap smears suggesting that those without a PCP get pap smears elsewhere. Having a usual source of care, routine medical check-ups, and a primary provider did not affect smoking behavior.

If the respondents needed to see a doctor during regular office hours the majority went to a physician's office (76%) or a clinic (14%). Nearly 4% however went to an emergency room (ER) for care during regular office hours. When the need arose to see a doctor after regular office hours, 77% go the emergency room and another 17% go to an urgent treatment center. Fifty-three percent did not visit the emergency room during the last year, but 25% of respondents had 2 or more ER visits.

5.2 Primary Care Provider

Eighty percent of the respondents, significantly more women than men, had access to a primary care provider. The 20% without a primary care provider is lower than the state rate of 28.9% but higher than the 17.1% for the US (GRAPH 25b). According to the Kentucky Board of Medical Licensure the GRADD has 64 PCPs per 100,000 compared to 78 for Kentucky. The Kentucky Cabinet for Health Services Primary Care Branch reports 41.6 PCPs for the GRADD compared to 56.3 for the state. Respondents reported that getting an appointment with their PCP required an average of 9 days but could wait as long as 90 days (GRAPH 26). Those with Medicaid, Medicare, and the uninsured waited longer for an appointment than those with private insurance. Once they had an appointment, the wait in the physician averaged 32 minutes and could be as long as 90 minutes (GRAPH 26a). Less than one-fourth (22%) of those who had to wait were dissatisfied with the wait, and this did not differ on the basis of insurance status.

The majority (91%) of respondents, insured and uninsured, felt that their primary care providers spent as much time with them as they needed. The majority 92% also felt their physician involved them in medical decisions with significantly. Women were more involved than men. Although 95% reported that their physician treated them with respect, the uninsured were less likely to report this (GRAPH 27).

Most respondents, 82% or family members of respondents, 88%, had not changed doctors in the last two years. The 18% who had changed did so mainly because they were dissatisfied, their provider retired, or they changed residence or moved.

 

    1. Medications
    2. During the last year 20% of the respondents could not afford to fill their prescriptions. Women, the uninsured, and those in poverty level were less likely to get the medications they needed.

       

      5.4 Oral Health Care

      Objective of Kentucky Health 2010 (9.9): Increase to at least 70% the proportion of adults aged 18 and older using the oral health care system each year.

      Sixty-six percent of respondents used the oral health care system in the last year and 79% had visited a dentist within the last two years. Over 14% had not visited a dentist for more than 5 years. Oral health care use was directly related to income, the lower the income the less dental care was obtained. One fifth, 21%, of the respondents had no dental care in the last two years. Women did not differ from men in access to dental care. Those who did not see a dentist when needed made up 22% of the respondents, higher than the 16% who did not get needed medical care. When asked the reason, they consistently cited lack of money as the primary reason. Income was related to oral health care, those with lower incomes did not get dental care when needed.

       

    3. Source of Health Care Information
    4. Overall 66% of respondents, women more likely than men, get their health care information from a health care professional. Friends and family members, television, and magazines followed. Men were more likely to use television as the second most common source.

    5. Alternative Therapies
    6. Only 16% of respondents use alternative therapies and those who do see a massage a chiropractor (41%), therapist (34%), or a herbalist, (17%).

    7. Satisfaction with Health Care

Overall satisfaction with all of the health care received was high with 92% rating it good, very good, or excellent. The uninsured and those below poverty level were less satisfied (GRAPH 28).

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6. HEALTH INSURANCE

Nearly 8% of survey respondents had no health insurance of any type and nearly 10% were without insurance sometime in the last 12 months. The residents of the GRADD were more likely to have health insurance than the 14% of Kentucky residents and 16.3% of US citizens as a whole who are uninsured. The majority of those who were insured (83%) felt that it was easy to the information that they needed from their health plan except for those with Medicaid. The uninsured were poor and lacked access to needed health care (GRAPH 29).

Those below the poverty level who did get care were unable to pay their medical bills and their credit was affected. Overall, 18% of the respondents reported credit problems related to medical costs and those affected had annual incomes up to $40,000. Nearly one-half of those living in poverty were uninsured (12%) or elderly (35%), a very significant for the elderly because they require more medications and lack prescription drug coverage. Of those without insurance at some time during the last year, 40% could not afford to pay for insurance and an additional 21% lacked coverage because they or their spouse or parent lost or changed jobs.

Objective of Kentucky Health 2010 (10.1): Reduce to zero the proportion of children and adults without health care coverage.

Thirty-five percent of the respondents or 601 households had children under the age of 18 living in their household. Of the households with children, 234 or 39% were eligible for K-Chip coverage based on income and of those eligible, 63 (26%) were enrolled in K-Chip. Nearly 11% (65) of those with children had no insurance and the children were not enrolled

in K-Chip.

Table 13. Type of health insurance coverage

 

Frequency

Percent

Your employer

708

41.45

Someone else’s employer

322

18.85

A plan that you or someone else buys on your own

61

3.57

Medicare

349

20.43

Medicaid or medical assistance

70

4.10

The military, CHAMPUS, TriCare or the VA

18

1.05

Some other source

44

2.58

No Coverage

136

7.96

 

1708

100

Objective of Kentucky Health 2010 (10.6a): Increase to least 95 percent the proportion of children 18 years and under and who have a specific source of primary care.

Of the 601 households with children, 80% had a primary care provider.

Objective of Kentucky Health 2010 (10.7): Reduce to no more than 7 %, the proportion of individual/families who report that they did not obtain all of the health care that they needed.

Nearly one-fourth, (24%), of the respondents reported that there was a time during the last year when they needed to see a physician but did not because of the costs (GRAPHS 30 and 31). Those who did not see a physician when they needed were more likely to be female, uninsured, and have incomes below the poverty level.

During the last year 20% of the respondents could not afford to fill their prescriptions. Women, the uninsured, and those in poverty level were less likely to get the medications they needed.

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7. PREDICTORS OF HEALTH

A model for positive health was tested. All of the factors influencing health, exercise, diet, screening for risks, income, and insurance, were analyzed statistically to determine which factors influenced positive health for women and men. For women the things that contributed significantly to positive health were diet, exercise, having mammograms, and pap smears; higher income contributed but not as significantly. For men, diet, exercise, and a higher income contributed significantly to positive health.

 

References

Beaulieu, J., Lancaster, M., Scutchfield, F.D., Ireson, C.L., Johnson, K. (1999). Health-related of life in the 1990s. Center for Health Services Management & Research Policy Brief (Vol. 1, No 2).

Finger, R., Mendiondo, M., Stapleton, M., Spears, E. (1995) Kentucky Health Interview and Examination Survey. Department for Public Health Cabinet for Health Services.

Healthy Kentuckians 2010 Prevention Initiative. (2000). Department for Public Health. Cabinet for Health Services.

Healthy People 2010 Objectives. January 24, 2000. http://www.health.gov/healthypeople/

Kentucky Cancer Registry. http://web.kcr.uky.edu

Kentucky lifestyles behavioral risk factors: District composites. (1999). Division of Epidemiology and Health Planning. Department for Public Health, Cabinet for Health Services.

Primary health care for the underserved people. (1999). US Department of Health and Human Services, Health Resources and Services Administration. http://stateprofiles.hrsa.gov/1999/KY199902.htm.

Kentucky State Center for Health Statistics Annual Vital Statistics Report. (1997). Cabinet for Health Services Department for Public Health Division of Epidemiology and Health Planning, Health Data Branch. Frankfort, Kentucky.

Tackett, E. K. (1999). Kentucky health profession: Workforce summary. Kentucky State Office of Rural Health. Center for Excellence in Rural Health, University of Kentucky.

Wright, D. L. Kentucky Vital Statistics Annual Reports for the Green River District 1986-1996. County Health Profiles for the Green River District Health Department 1994,1995,1996. Health Trends 1991-1995 for the Green River District.

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