HENDERSON COUNTY HEALTH 2000 REPORT

 

Contents

Acknowledgments

Executive Summary

Introduction

Demographics

Health Status

Disease Burden

Health Behaviors

Health Care Access

Health Insurance

Predictors of Health

 

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 Henderson County. 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. Nearly 40% of the respondents were from Henderson County. 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 Kentucky 2010 objectives.

Health Insurance. The 9% of individuals in Henderson County that were without insurance at some time during the last year is higher than GRADD (8%) and lower than the 14% rate for Kentucky. Thirty-three percent of the respondents had children under the age of 18 living in their household. Of the households with children, 93 or 41% were eligible for K-Chip coverage based on income and of those eligible, 24(26%) were enrolled in K-Chip. Nearly 12% or 11 households with children had no insurance and the children were not enrolled in K-Chip. One-fourth (24%) of persons in the telephone survey indicated they could not afford needed medical care. The 24% included people with health insurance. 19% could not afford medications, and 20% did not get dental care when the needed it. The physician respondents also reported that 24% of their patients delayed medical care and did not acquire medications because of cost.

Access to Care. The majority, (84%), had access to a primary care provider, 94% have a place where they usually receive their medical care, and 75% had routine medical check-ups. The 16% 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, 85% had a primary care provider. The poor and uninsured did not have a usual source of care. 48% of the respondents visited the emergency room within the past year but 26% of respondents had 2 or more emergency room visits.

A large percent reported being satisfied with the total health services provided in their area with 94% 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 with 36% of all ages combined reporting having physician-diagnosed arthritis. The Kentucky Health Interview survey also found arthritis to be the most common chronic condition with 16% reporting physician diagnosed arthritis. Hypertension affects more Henderson County residents (28%) than other Kentucky residents (24%) and the cardiovascular death rate is the leading cause of death. But the Henderson County cardiovascular death rate is lower than the state the GRADD rates. The number of respondents with diabetes (8%) was consistent with the GRADD rate but was higher than the state rate of 4.4%. Over 13% have asthma; the estimate for the state is 18%.

Cancer is the second leading cause of death. Eight per cent or 55 people reported having had cancer. The incidence rate for the major cancers, including lung, breast, cervical, prostate, and colorectal is lower than the rest of the state as are cancer deaths. Mortality from lung cancer and breast cancer exceeds the both the GRADD and the state rate. This finding for lung cancer and breast cancer likely indicates a lack of early diagnosis or available treatment.

An area of concern was the high percentage (18%) female respondents or members of the household (34%) who had of low birth weight babies. This was significantly related to the high percentage (28%) of women who smoked during pregnancy. Education and income were not significant factors.

Health Behaviors. A very high percentage of respondents had smoked, (54%) higher than the GRADD. 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 findings suggest a need for intensive attention smoking cessation programs and prevention for all ages.

One of the most significant findings from the survey was the percentage of Henderson County residents who are overweight and obese. Those considered normal weight comprised only 42% as compared to the 32% of the Kentucky population, while a total of 32% were overweight and 28% were obese. Only 14% of the respondents consumed the "Five-a-Day"--the nationally recommended number of servings of fruits and vegetables, 45% the recommended grains, and 38% the recommended red meat intake. Being male and lack of exercise, but not dietary habits were the most significant predictors of being overweight and obese. The 61% reporting physical activity either work or exercise 3 times per week, much higher than the state and national number, may be related to over reporting.

Potential Henderson County Priorities for Health Kentucky 2010:

Disease Burden

Health Behavior

Health Care Access

Health Insurance

The following report provides a picture of the health status, access to health care, and health care coverage for the people of Henderson County. The picture has different views. The information from the report came from several sources, community focus groups, telephone surveys, personal interviews, and data from state and national sources. The information was analyzed and summarized 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 focus groups held in Owensboro/Daviess County, Henderson County and Ohio County. The majority of the participants were White-non Latino (96%) and female (83%). Over half had a college degree of some kind, but 17% had not completed high school. One-third of them had an annual income of less than $25,000 and another third earned between $25,000 and $50,000, with the remainder earning over $50,000. Over half had private insurance coverage, 26% had Medicaid, 13% Medicare, and 9% had no insurance coverage. These are the messages that were heard from people in the West GRADD area:

Providers Voices

Mailed survey to physician providers. A survey was sent to 281 physician providers in the seven GRADD area. The names of the providers were obtained the state medical licensing board. A total of 70 physicians responded for a response rate of 25%, including those returned with bad addresses or who were no longer in the area. 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 and this varied by type of insurance coverage the next available appointment time also varied slightly by type of insurance.

The physician reported average office wait prior to being was 25 minutes and they spent an average of 18 minutes with each patient. Physicians 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:

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Survey 2000

A random digit dial telephone survey was conducted in the months of March, April, May and June of 2000 by the University of Louisville Urban Studies Institute. The random process was chosen to insure that the survey was representative of the population. The percent of people with a telephone in Henderson County (8.9) is greater than the state percent (10.2) as a whole. Studies from the Center for Disease Control in Atlanta found that random digit dial produces a higher response rate than other survey methods. They also found that those who are without a telephone this month had one last month or will have one next month indicating that this type survey indeed samples those without telephones.

The following describes the results of the survey questions, the relationships among the various issues related to health status, health care access, affordability, accessibility, and health insurance coverage:

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1. DEMOGRAPHICS

The 692 people who responded to the survey were predominately female 67% and white 93%; 6% were African-American, and 1% Hispanic, Asian, multiracial or other. The 1997 population in the Henderson County was 52% female and 7.3% Black/African-American (GRAPH 1). The majority (64%) were married, 11% widowed, 18% divorced or separated and 8% single. One-third had children under 18 years living at home.

The majority of the respondents, 52%, worked full-time outside of the home, 8% worked part-time, 16% were retired and 23% were not employed. Those not employed outside the home included those who were disabled (7%), in school (1%), or keeping house (14%). Of those not employed outside the home only 0.6% considered themselves unemployed and looking for work.

Nineteen percent had a college education, 27% had some college, 41% completed high school, and the remaining 14% had less than a high school education. The level of education did not differ on the basis of sex.

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 household income was $34,499, higher than the state (GRAPH 3). The elderly reported less with 56% under $10,000 per year.

Home ownership was high with nearly 76% owning their home. Less than half of the respondents, (39%) had access to the Internet from home, 37% of the women and 44% of the men.

Table 1. Demographics of Survey

 

Description

Frequency

Percent

Race

Black/African-American

38

5.51

 

White

641

92.90

 

Hispanic

3

0.43

 

Native American

2

0.29

 

Asian/Pacific Islander

2

0.29

 

Multiracial

2

0.29

 

Other

2

0.29

       

Education

Never attended school

0

0

 

Elementary

33

4.79

 

Some high school

61

8.85

 

High school

282

40.93

 

Some college

184

26.71

 

College graduate

129

18.72

       

Marriage

Married and living with spouse include common law marriage

439

63.72

 

Married and spouse away in service

1

0.15

 

Widowed

73

10.60

 

Divorce

109

15.82

 

Separated

14

2.03

 

Never married

43

6.24

 

Partner, not married

10

1.45

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2. 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, Henderson respondents reported higher health related quality of life scores than those of the general Kentucky population from the Kentucky Health Survey (GRAPH 4). Over 78% of the respondents rated their health as good, very good, or excellent; 13% rated it as fair; and 9% reported poor health (GRAPH 5). There were no differences between men and women in health rating. Finally, the health perception score for all ages of 79.9 exceeded the 67.5 reported for the average Kentucky resident (GRAPH 6).

Physical health. The average physical functioning score for all respondents was 87.4, higher than the 83.1 reported by Kentuckians as a whole. Men had higher physical functioning scores than women.

Role functioning. The role functioning score 86.2 compared favorably to the 81.0 for the rest of the state and men and women did not differ.

Mental health. The average mental health score of 79.2 was higher than the 74.9 for other Kentucky residents. In contrast to other Kentucky residents, there were no gender differences in mental health. Those over 65 years had significantly lower mental health scores than those younger than 65.

In contrast to the findings from the Kentucky Health Survey for the whole state, there was no difference between Henderson men and women in physical functioning, role functioning, mental health or health perceptions. Education and income, on the contrary, were highly correlated with better 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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3. 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, and the leading causes 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

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).

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).

Seventeen percent (17%) of respondents reported a diagnosis of heart disease According to the Kentucky Annual Vital Statistics Report, the age adjusted rate death of health disease in Henderson County in 1997 of 227.3 was lower than the Kentucky rate of 230.1 (GRAPH 7a).

Table 2. 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

In 1997, approximately 40 % of all deaths were from heart disease (32%) and cerebrovascular disease (7%) in Kentucky. In GRADD, over 42 % (881) of the total deaths (2,093) were from heart disease (32.9%) and cerebrovascular disease (9.3%). During 1997, 199 Henderson Countians (47% of total death) died from the heart disease (35.2%) and cerebrovascular disease (11.8%).

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 the 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 3. 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 Diseases

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

Over 13% of the respondents reported a diagnosis of asthma. Although there is no statewide collection of asthma prevalence, the statewide estimate is 220,000 diagnosed cases or 17.76%. Medicaid data showed a 7% rate for Region 2 that includes Henderson County (GRAPH 9). Over 9% of the respondents suffer from chronic lung disease and 15% have been diagnosed with pneumonia.

 

 

Table 4. 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

Arthritis is the most common chronic illness reported with 36% reported this diagnosis. Based on findings from the Kentucky Health Interview survey for the arthritis is the most common chronic illness with 165% reporting the diagnosis. Although there is not a Healthy Kentuckians 2010 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.

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.

Eight percent (8%) of the survey respondents reported a diagnosis of diabetes consistent with that of the total GRADD Survey 2000. The 1995-1997 BRFSS indicated that 5.1% of the adult population in GRADD had been diagnosed with diabetes, higher than Kentucky rate of 4.4% (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 33.6 death rate In Henderson from diabetes exceeds the GRADD rate but is lower than the state rate of 34.4 per 100,000 people (GRAPH 11).

Table 5. 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, 55 people reported having had cancer. In 1997 a total of 510 people, or 24.4% of total deaths, were due to cancer. The age adjusted cancer mortality rate was 215.9 higher

than the 192.5 in GRADD and the state rate of 188.5. McLean (227.3), Ohio (238.4) and Webster (229.2) also reported higher cancer mortality rate than GRADD’s. However, the Kentucky Cancer Registry reports a lower age adjusted incidence of cancer cases in 1998 for the Henderson (334.35) than for the state (421). The difference in incidence and mortality rates may be linked to lack of early diagnosis and treatment.

Table 6. 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 7. Cancer incidence rate in 1998

All site

Lung

Breast

Prostate

Colorectal

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

Kentucky

421.84

79.09

121.66

108.21

55.53

Kentucky Cancer Registry

 

3.5.1 Lung Cancer

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

The crude death rate for lung cancer for Henderson County of 103.5 exceeds the GRADD rate of 93.4 and the state rate of 80.4. and is significantly higher than the 2010 goal (GRAPH 13).

 

Table 8. 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.

The breast cancer mortality rate of 43.2 is higher than the GRADD rate of 33.9 and the state rate of 30.6 and significantly higher than the 2010 goal.

 

Table 9. 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 Henderson county infant mortality rate (4.3 per 1,000 live births) was lower than the GRADD (6.2) and Kentucky (7.2) (GRAPH 14).

Table 10. 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 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, 18% of the respondents who had given birth reported they had a baby weighing less than 5 1/2 pounds at birth. Of those 94% received prenatal care while pregnant. Another 34% reported that a female member of their household had a baby weighing less than 5 1/2 pounds at birth and of those 93% had prenatal care. Over 43% of mothers of low-birth weight babies had a high school education and 25% had some college. Having a low-birth weight baby was not related to income. Nearly one-third earned less than $20,000 annually, but more, 42% were in households with incomes between $40,000 and $80,000. More of those having a low birth weight baby had insurance at the time of the survey, however their insurance status at the time of the pregnancy is not known.

The incidence rate of low birth weight in total birth was 8.6% the same as the GRADD and higher than Kentucky (7.8%, 4,113) during 1997. The rate of low birth weight is very high for the teen mother. In 1997, the incident rate of low birth weight by teen mother

of the total births in Henderson was (11.46%), higher than GRADD at 10.9%, and higher than Kentucky (9.3%). Hancock (19.5%), McLean (13.33%), Ohio (16.98%) counties also reported very high incident rates (GRAPH 15).

Table 11. 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.

Twenty eight per cent of female respondents 28% smoked while pregnant and 21% smoked of household members while pregnant. Smoking during pregnancy was the most significant risk factor for having low birth weight infants (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. One percent reported that they or a member of their family had attempted suicide in the last year.

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4.0 HEALTH BEHAVIORS

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. 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):

4.1 Blood Pressure

Eighty-six percent (80%) reported getting their blood pressure checked within the last year; this did not differ by sex.

4.2 Cholesterol Screening

Objective of Kentucky Health 2010 92010 (20.4): To increase to at least 85% the proportion of adults who have had their blood cholesterol checked within the preceding five years.

Sixty-six percent had their cholesterol checked within the last two years and over 88% 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 use tobacco products.

Fifty-four percent have smoked at least 100 cigarettes in their life and currently smoke. Those who smoked were predominantly male and 69% had a high school or college education. Less than 2% use smokeless tobacco. Having a usual source of care, routine medical check-ups, and a primary provider did not affect smoking behavior (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 lease 85% those ages 50 and older who have received a CBE mammogram within the preceding on to two years.

Overall 69% of all women reported having a mammogram within the last two years. This was related having insurance and insurance type, but not education or income. The uninsured and those with Medicaid were less likely to have regular mammograms. Slightly more women over age 65 (72%) reported getting a mammogram within the last two years (GRAPH 17).

4.5 Cervical Screening

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 one percent (81%) of women got a Pap test within the last 2 years exceeding the state rate of 75.4% in 1997. The uninsured and those under poverty level were less likely to get annual pap smears. Only 50% of elderly women had an annual Pap smear (GRAPH 18).

4.6 Colorectal Screening

Objective of Kentucky Health 2010 (17.7): To reduce colorectal cancer deaths to no more than 2.5 per 100,000 people in Kentucky.

Less than 40% men had a prostate exam in the last year, with 67% of those over 65 getting an exam.

4.7 Immunizations and Infectious Diseases

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 755%.

Sixty percent (60%) of adults over age 65 received flu shots in the last 12 months, less than the 65% for GRADD as a whole. Twenty-one percent (21%) had the flu this past year, and the elderly were no more likely to have the flu than the young (GRAPH 19).

4.8 Physical Activity and Fitness

Objective of Kentucky Health 2010(1.1): To reduce overweight to a prevalence of no more than 24% 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. Those considered normal weight comprised 40%, while 32% were overweight, and 28% obese. Being overweight was related to being male 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. Obesity significantly affected physical functioning ability. 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 engaging in physical activity was very positive with 61% 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 question included exercise or work (GRAPH 21).

4.9 Nutrition

Objective of Kentucky Health 2010 (2.5): Increase to at least 40% the proportion of age 2 and older who 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 14% consumed the recommended amount of fruits and vegetables, 30% the recommended grains, and 38% the recommended amount of red meat. Only 28% ate at fast food restaurants more than out 1-2 times per week. There was no difference in the number of men and women who met the healthy diet recommendations (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.

Over three fourths used seatbelts all of the time, women more than men. Those who drank were more likely to not 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.

Forty percent (40%) reporting having at least one drink in the last month and 30% of those consumed more than two drinks when they drank. Only 3% admitted driving when they had drunk too much.

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5. HEALTH CARE ACCESS

Having access to health care was related to income, insurance status, and gender but not race. The following depicts the status access to health care of the residents of Henderson County.

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 (94%) have a place where they usually receive their medical care and women and Caucasians were more likely to have a usual source of care than men and non-whites (GRAPH 24). The site of care was most often a physician's office (81%) or clinic (16%) (GRAPH 25). Two percent, predominantly the poor, used an emergency room or urgent treatment center as their only source of care. Of those without a usual source of care, 21% felt they did not need medical care, 14% were uninsured, 14% could not afford care and 12% did not believe in doctors. Those without a usual source of care considered themselves to be as healthy than those with a source of care (GRAPH 25a).

Overall, of those with a chronic illness, only those with heart disease have a primary care provider, and get routine medical check-ups. This finding indicates a need for increased community attention to primary care for those asthma, cancer, arthritis, and chronic respiratory disease. Those who had acute phenomena, pneumonia or a stroke, also lacked a primary care provider.

The majority (75%) had routine medical check-ups and women were more likely to get them than men. Most (85%) have their check-ups at a physician's office, or clinic/health center (12%). Over 91% of all respondents and 92% of the elderly had a routine check-up within the last year.

Those with a usual source of care and a PCP were more likely to have their blood pressure monitored, cholesterol checked, and get flu shots. Those with asthma were less likely to have a usual source of care, routine checkups, and a primary care provider than those with any of the other chronic diseases. Those having a PCP were no more likely to get mammograms, pap smears, or prostate exams.

If the respondents needed to see a doctor during regular office hours the majority went to a physician's office (78%) or a clinic (15%). Nearly 3% however went to an emergency room for care during regular office hours. When the need arose to see a doctor after regular office hours, 68% go the emergency room and another 22% go to an UTC. Fifty two percent (52%) of respondents or family members did not the emergency room in the last year, but 26% of respondents had 2 or more emergency room visits.

5.2 Primary Care Provider

Over three-fourths (84%) of the respondents, significantly more women than men, had a primary care provider. Having a PCP did not differ on the basis of race. The 16% without a PCP is lower than the state figure of 28.9% and the 17.1% for the US as a whole (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. Henderson County has 24 PCPS for the 1998 estimated 44,457 citizens for a rate of 10.7 per 100,000.

Only 17% had changed doctors in the last 2 years, 18% because the provider moved and 21% because they were dissatisfied. Getting an appointment with their PCP required an average of 9 days but could wait as long as 90 days. Those with Medicaid, Medicare, and the uninsured waited longer for an appointment than those with private insurance (GRAPH 26). Once they had an appointment, the wait in the physician averaged 36 minutes and could be as long as 90 minutes (GRAPH 26a). Over 37% of those who had to wait were dissatisfied with the wait, and this did not differ on the basis of insurance status.

The majority (78%), insured and uninsured, felt that their primary care providers spent as much time with them as they needed. The majority 82% also felt their physician involved them in medical decisions. Most (87%) reported that their physician treated them with respect regardless of insurance status (GRAPH 27).

One-fourth of the respondents reported that during the last year they or a family member needed to see a physician but did not because of the costs. Those who did not see a physician when they needed were more likely to be female, uninsured, and have incomes below the poverty level.

5.3 Medications

During the last year 19% 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-eight percent (68%) of respondents visited the dentist in the last year. Having dental care visits was directly related to income, with 20% of the respondents having no dental care in the last two years and 20% not getting dental care when they needed it. Women did not differ from men in access to dental care.

5.5 Source of Health Care Information

Overall 62% of respondents, predominately women, get their health care information from a health care professional, followed by friends and family members, television, and magazines. There were no gender differences.

5.6 Alternative Therapies

Only 20% of respondents use alternative therapies and those who do see a massage a chiropractor, 41%, therapist, 34%, or a herbalist, 13%.

5.7 Satisfaction with Health Care

Overall satisfaction with all of the health care received was high with 91% 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

Seven per cent (7%) reporting having no insurance coverage of any type and 9% were without insurance at sometime during the last year. Fewer residents of Henderson County were uninsured than the GRADD (8%) or the state rate of 14.1%. The uninsured were predominantly women. Women were more likely to be employed in part-time jobs that usually do not offer employer sponsored insurance coverage. Of those without insurance at some time during the last year, 40% could not afford to pay for insurance and an additional 19% lacked coverage because they lost or changed jobs. Significantly more of those living in poverty lack insurance and fail to get needed care. When those below the poverty level do get care they are unable to pay their medical bills and their credit is affected. Credit problems related to medical costs affected 17%, primarily those with annual incomes under $40,000. Nearly one-half of those living in poverty were elderly (36%) or uninsured (10%). This is very significant for the elderly because they require more medications and lack prescription drug coverage (GRAPH 29).

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

Thirty-three percent (32.7%) of the 692 respondents or 226 households had children under the age of 18 living in their household. Nearly 12% or 27 households with children had no insurance. Of the households with children 92 or 41%% were eligible for K-Chip coverage based on income and of those eligible, 24 (26%) had K-Chip. Of the eligible who did not have K-Chip, 57 households (83%) had another source of insurance, but 11 or 12% of the eligible households with children had no insurance coverage.

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

Of the 226 households with children, 85% 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.

One-fourth, (25%), 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 19% 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, and a higher income. For men, diet and exercise were the two contributors to overall positive health.

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