Health Disparities in Nevada
Mary Tabor Griswold, PhD
Office of Statewide Initiatives
University of Nevada School of Medicine
Reno, Nevada
DATE
4/07/2015
Nevada Public Health Week
Nevada State Health Division
Nevada Rural and Frontier Health Data Book 2015 Edition
• Biennial production by the Nevada State Office of Rural Health
• Most comprehensive source of county‐level data on health and health care
Distribution of Population by Place
• Rural and Frontier
–
–
–
–
–
14 counties
86.9% of land mass
284,496 population
10.1% of state population
3.0 residents per sq mile
• Urban
–
–
–
–
–
3 counties
13.1% of land mass
2.5 million population
89.9% of state population
176.7 residents per sq mile Source: Nevada Office of Rural Health. (2015). See Nevada Rural and Frontier Health Data Book 2015, p. 4, Map 1.
Population City, County, and Region
• RUCA codes
– Rural‐urban commuting areas
– A more specific population classification tool
• Considerable variation
– Urban counties have substantial rural/frontier regions (i.e. Washoe, Clark)
– Rural/frontier counties have areas economically tied to urban areas (i.e. Lyon, Nye)
Source: Rural‐Urban Commuting Area Codes (Version 3.0). (2001). See Nevada Rural and Frontier Health Data Book 2015, p. 8, Map 4.
Population – 1990 to 2014
Region
1990
2014
Percent Change
Rural & Frontier
165,264
284,496
72.1 %
Urban
1,036,559
2,544,298
145.4 %
Nevada
1,201,756
2,828,794
135.4%
Source: Nevada State Demographer’s Office. (2014). U.S. Census Bureau. (1990). See Nevada Rural and Frontier Health Data Book 2015, p. 22, Table 1.2. and p. 24, Table 1.4.
Population – 1990 to 2014
Percent Change 200
150
Percent
Nevada Average
100
50
0
‐50
Rural & Frontier Urban
Source: Nevada State Demographer’s Office. (2014). U.S. Census Bureau. (1990). See Nevada Rural and Frontier Health Data Book 2015, p. 22, Table 1.2. and p. 24, Table 1.4.
Population Aged 65 and Over – 1990 to 2014
Percent
Percent Change
500
450
400
350
300
250
200
150
100
50
0
Nevada Average
Rural & Frontier Urban
Source: Nevada State Demographer’s Office. (2014). U.S. Census Bureau. (1990). See Nevada Rural and Frontier Health Data Book 2015, p. 36, Table 1.12. and p. 37, Table 1.13.
Hispanic Population – 1990 to 2014 Percent Change 700
600
Percent
500
Nevada Average
400
300
200
100
0
‐100
Rural & Frontier Urban
Source: Nevada State Demographer’s Office. (2014). U.S. Census Bureau. (1990). See Nevada Rural and Frontier Health Data Book 2015, p. 46, Table 1.22. and p. 47, Table 1.23.
Veterans Population – 2014
Percent of Total County Population
25
Percent
20
15
10
Nevada Average
5
0
Rural & Frontier Urban Source: U.S. Department of Veterans Affairs. (2014). See Nevada Rural and Frontier Health Data Book, p. 48, Table 1.24.
Nevada’s Population Health Profile
• Perennial rank among the bottom tier of US states on many population health measures
• High levels of mental illness and behavioral health problems – aggravated by the economic recession, and slow recovery.
• Further compounded by high levels of “at risk” behaviors including cigarette smoking and immoderate alcohol consumption, and prescription drug abuse
Nevada’s Population Health Profile
• High uninsured rates for the population under the age of 65 across all regions of the state • Translates to low rates of routine preventive health services use, such as recommended childhood immunizations and cancer screening
• While rural health is a reflection of the state’s overall health profile, important differences exist between rural and urban areas
Health Insurance Coverage – 2012
Population Aged 64 and Under ‐ Uninsured
35
Percent Uninsured
30
25
Nevada Average
20
15
10
5
0
Rural & Frontier Urban
Source: U.S. Census Bureau. (2014h). See Nevada Rural and Frontier Health Data Book 2015, p.101, Table 3.1.
Medicare Enrollment – 2012
Percent of Population
35
30
Percent
25
20
Nevada Average
15
10
5
0
Rural & Frontier Urban
Source: Centers for Medicare and Medicaid Services (2014a). See Nevada Rural and Frontier Health Data Book 2015, p. 117, Table 3.17.
Overweight and Obesity – 2013 Percent of Adults with BMI 25+, Self‐Reported
68.0
66.0
65.8
66.0
64.9
64.3
64.0
62.0
60.6
59.6
60.0
58.0
56.0
Rural and Clark County Carson City
Frontier
Washoe
County
Nevada
Source: Office of Health Statistics and Surveillance. (2014e). See Nevada Rural and Frontier Health Data Book 2015, p.125, Table 3.25
United States
Obesity Prevalence – 2011
Percent of Population
35
30
Percent
25
Nevada Average
20
15
10
5
0
Rural & Frontier Urban
Source: Centers for Disease Control (2014b). See Nevada Rural and Frontier Health Data Book 2015, p. 128, Table 3.28.
Current Smokers – 2013 Percent of Adults, Self‐Reported
25
22
21.5
19.8
20
19.4
19
Nevada
United States
15.4
15
10
5
0
Rural and
Frontier
Carson City Clark County
Washoe
County
Source: Office of Health Statistics and Surveillance. (2014e). See Nevada Rural and Frontier Health Data Book 2015, p.125, Table 3.25.
All Cause Mortality Rate – 2013 Age‐Adjusted Deaths per 100,000 Population
1,400.0
1,200.0
1,000.0
800.0
Nevada Average
600.0
400.0
200.0
0.0
Source: Office of Health Statistics and Surveillance. (2014e). See Nevada Rural and Frontier Health Data Book 2015, p.147, Table 3.47.
Diseases of the Heart – 2013 Age‐Adjusted Deaths per 100,000 Population
700.0
600.0
500.0
400.0
300.0
200.0
Nevada Average
100.0
0.0
N/A
Source: Office of Health Statistics and Surveillance. (2014e). See Nevada Rural and Frontier Health Data Book 2015, p.148, Table 3.48.
Malignant Neoplasm (Cancer) – 2013 Age‐Adjusted Deaths per 100,000 Population
300.0
250.0
200.0
150.0
Nevada Average
100.0
50.0
N/A N/A
0.0
Source: Office of Health Statistics and Surveillance. (2014e). See Nevada Rural and Frontier Health Data Book 2015, p.149, Table 3.49.
Chronic Lower Respiratory Disease – 2013 Age‐Adjusted Deaths per 100,000 Population
160.0
140.0
120.0
100.0
80.0
60.0
Nevada Average
40.0
20.0
N/A N/A
0.0
Source: Office of Health Statistics and Surveillance. (2014e). See Nevada Rural and Frontier Health Data Book 2015, p.150, Table 3.50.
N/A
Lung, Trachea, and Bronchus Cancer – 2013 Age‐Adjusted Deaths per 100,000 Population
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Nevada Average
N/A N/A
N/A N/A
N/A N/A
Source: Office of Health Statistics and Surveillance. (2014e). See Nevada Rural and Frontier Health Data Book 2015, p.151, Table 3.51.
Chronic Liver Disease and Cirrhosis – 2013 Age‐Adjusted Deaths per 100,000 Population
25.0
22.6
20.0
15.0
17.2
14.5
13.0
10.7
10.0
5.0
0.0
Rural and
Frontier
Carson City
Clark
Washoe County
Source: Office of Health Statistics and Surveillance. (2014e). See Nevada Rural and Frontier Health Data Book 2015, p.153, Table 3.53.
Nevada
Rural Health Care Resources
• 14 hospitals with 2,250 employees and a payroll of $141.2 million, including 11 Critical Access Hospitals (CAHs)
• 40 federally designated Rural Health Clinics (RHCs) & Community Health Centers (CHCs) • 13 tribal clinics and medical centers Source: National Association of Community Health Centers. (2015). Centers for Medicare & Medicaid Services (2015). See Nevada Rural and Frontier Health Data Book 2015, p. 4, Map 1.
Unique Geography of Rural and Frontier Nevada
Average Distance from a Rural Hospital to:
• Nearest incorporated town: 46 miles
• Nearest hospital: 54 miles
• Nearest tertiary hospital: 108 miles
• Office of Rural Health & NRHP: 261 miles Source: See Nevada Rural and Frontier Health Data Book 2015, p. 227 Map 5.1.
Primary Medical Care Health Professional Shortage Areas – 2015
• Most regions of rural and frontier Nevada are federally‐designated HPSAs
• 9 rural counties are single‐county HPSAs
• Most rural and frontier census tracts of Clark and Washoe Counties are Primary Care HPSAs
Source: Bureau of Health Professions, Health Resources & Services Administration. (2015). See Nevada Rural and Frontier Health Data Book 2015, p. 214, Map 4.1.
Physician and Primary Care Workforce – 2014
Number per 100,000 Population
Rural &
Frontier
Urban
Nevada
Allopathic Physicians (MD)
76.3
185.4
173.8
Adv Practitioners of Nursing (APN)
14.9
23.1
22.3
Osteopathic Physicians (DO)
14.6
19.3
18.8
Physician Assistants (PA)
14.2
17.8
17.5
Primary Care Physicians (MD & DO)
44.0
80.0
76.2
Profession
Source: See references for Tables 4.6 through 4.42 in Nevada Rural and Frontier Health Data Book 2015, p. 212, Table 4.48.
Mental Health Professional Shortage Areas – 2014
• All 14 rural and frontier counties are mental health HPSAs
• With the closure of numerous rural mental health clinics, access to mental health services in rural areas is major public health issue
Source: Bureau of Health Professions, Health Resources & Services Administration. (2015). See Nevada Rural and Frontier Health Data Book 2015, p. 220, Map 4.7.
Mental and Behavioral Health Workforce – 2014
Number per 100,000 Population
Profession
Rural &
Frontier
Urban
Nevada
Alcohol, Drug, & Gambling Counselors
55.5
42.0
43.4
Marriage & Family Therapists
17.3
25.1
24.3
Psychiatrists
0.7
7.0
6.4
Psychologists
6.0
14.0
13.2
27.1
40.9
39.5
Social Workers (LSWs)
Source: See references for Tables 4.6 through 4.42 in Nevada Rural and Frontier Health Data Book 2015, p. 212, Table 4.48.
Dental Health Professional Shortage Areas – 2015
• 8 of 14 rural and frontier counties are dental HPSAs
• Majority of census tracts in rural Clark County are also HPSAs
• Counties such as Churchill, Humboldt, and Lyon have historically been dental HPSAs
Source: Bureau of Health Professions, Health Resources & Services Administration. (2015). See Nevada Rural and Frontier Health Data Book 2015, p. 217, Map 4.4.
Oral Health Care Workforce – 2014
Number per 100,000 Population
Profession
Rural &
Frontier
Urban
Nevada
Dentists
38.0
56.8
54.9
Dental Hygienists
36.6
37.1
37.0
Source: See references for Tables 4.6 through 4.42 in Nevada Rural and Frontier Health Data Book 2015, p. 212, Table 4.48.
Major Rural Health Policy Issues
•
•
•
•
•
Financial and geographic access barriers
Economic viability of rural hospitals and clinics
Concerns about financing of long‐term care
High numbers of uninsured (and underinsured)
EMS resource and workforce deficits
Major Rural Health Policy Issues
•
•
•
•
•
Mental health and health care crisis
Chronic health workforce shortages
Underdeveloped public health services
Aging physical plant of many rural hospitals
State budget shortfall, esp. Medicaid, mental health
Additional Information
Mary Tabor Griswold, PhD
Health Services Research Analyst
Office of Statewide Initiatives
University of Nevada School of Medicine
(775) 682‐8475 / [email protected]
http://medicine.nevada.edu/statewide