Obici Healthcare Foundation Community Health Assessment

1
Obici Healthcare Foundation Community Health
Assessment

• Community Health Solutions, Inc.
• May 23, 2007

2
Table of Contents

• Executive Summary (Slide 3)
• Health Demographic Indicators (Slide 13)
• Community Survey Indicators (Slide 19)
• Mortality Indicators (Slide 26)
• Birth Indicators (Slide 31)
• Adult Health Status Indicators (Slide 37)
• Health Care Access Indicators (Slide 42)
• Appendix A Gates County, NC Indicators (Slide
  53)
• Appendix B Table of Charts (Slide 68)

3
Executive Summary

• Executive Summary Outline
• Study Purpose, Scope, and Limitations
• Study Methods
• The Study Region
• The Mission Statement as Organizing Principle
• Demographics of the Study Region
• Mission Focus 1 Addressing Unmet Needs of the
  Medically Indigent Uninsured
• Mission Focus 2 Preventing or Reducing Illness
  or Disease
• Additional Issues
• Organization of the Report

4
Study Purpose, Scope, and Limitations

• Purpose
• The purpose of the study is to provide
  information on community health status to the
  Obici Healthcare Foundation
• Scope
• The study includes
• Seven cities and counties in Virginia and North
  Carolina
• Six categories of health indicators from existing
  data
• Original survey data from Survey of Local Health
  Professionals and Community Leaders
• Limitations
• The study was
• Not designed or budgeted to identify or detail
  every conceivable health issue
• Designed to be a starting point to support
  Foundation planning rather than a comprehensive
  assessment of every issue

5
Study Methods

• The study was conducted by Community Health
  Resource Center of Richmond, VA during
  December-May 2007
• Demographic data were obtained from SRC, Inc., a
  commercial data vendor
• Death and Birth data were obtained from Virginia
  Department of Health and the North Carolina
  Department of Health
• Hospital Discharge data were obtained from
  Virginia Health Information, Inc.
• Adult health status data were obtained from the
  National Behavioral Risk Factor Surveillance
  Survey
• Community Survey data were obtained from a sample
  of local health professionals and community
  leaders. The survey was limited to Virginia.
• Gates County, NC data are presented separately
  (in Appendix A) because data were not available
  for some indicators, and other data were in
  different formats than Virginia data.

6
The Study Region
The Obici Healthcare Foundation Service Region
includes most of seven cities and counties,
including Gates County, NC.
Surry
Sussex
Isle of Wight
Suffolk
Southampton
Gates
Franklin
7
The Mission Statement as Organizing Principle

• The mission of the Obici Healthcare Foundation is
  to improve the health status of people living in
  the service area by
• 1) addressing the unmet needs of the medically
  indigent and uninsured and
• 2) supporting programs which have the primary
  purpose of preventing or reducing illness and
  disease.
• Study results are summarized in terms of the two
  mission focus areas.

8
Demographics of the Service Area

• Major Findings from Virginia Service Region
• More than 156,000 people in the Virginia service
  region
• Expected to reach 178,000 by 2011
• Growing twice as fast as Virginia
• Growth driven by Suffolk and Isle of Wight
• 42 percent African American compared to 19
  percent for Virginia
• 22 of adults age 25 without high school diploma
  compared to 14 for state
• Poorer than state as a whole on most economic
  measures, including low-income children

In addition, Gates County, NC has a population of
11,500.and a roughly similar profile in terms of
age, race, and income. See Appendix A for detail.
9
Mission Focus 1 Addressing the Needs of the
Medically Indigent Uninsured

• Major Findings in the Virginia Service Region
• Access to quality health services identified as
  immediate significant health concern by 39 of
  63 respondents to Survey of Local Health
  Professionals and Community Leaders
• In the Virginia Study Region for 2005
• An estimated 22,500 uninsured in the region,
  including 3,000-4000 children
• An estimated 12,700 uninsured with income below
  200 percent of poverty
• An estimated 17,000 adults could not see a
  doctor due to cost
• An estimated 22,300 adults had no dental visit
  in previous 2 years
• 3,584 hospital discharges for potentially
  preventable conditions
• Rates for all of the above were near or above the
  Virginia statewide rate

In addition, Gates County, NC had an estimated
1,600 uninsured in 2005. See Appendix A for
detail.
10
Mission Focus 2 Preventing or Reducing Illness
and Disease

• Major Findings in the Virginia Service Region
• Survey of Local Health Professionals and
  Community Leaders identified the following as
  leading community health concerns
• Overweight, Obesity, Nutrition
• Heart Disease Stroke
• Diabetes
• Physical Activity Fitness
• Cancer
• Substance abuse
• Oral health
• Mental health mental disorders
• Sexually transmitted diseases
• Injury violence
• Tobacco
• Additional issues are noted in the report

11
Mission Focus 2 Preventing or Reducing Illness
and Disease

• Major Findings in the Virginia Service Region
• By the numbers
• Leading causes of death heart disease, cancer,
  stroke, chronic lower respiratory disease,
  injury, and diabetes
• Among adults, an estimated
• 73,000 overweight or obese
• 30,000 no exercise in past 30 days
• 91,000 not consuming 5 or more fruits
  vegetables per day
• 26,000 smoke
• 15,900 at risk for binge drinking
• 37,000 with high blood pressure
• 35,700 with high cholesterol
• 15,700 with asthma
• 11,000 with diabetes
• National rates of childhood overweight range from
  10-16 percent, suggesting 3,700-6,000 children in
  the Virginia service region may be overweight.
• Rates in the Virginia Study Region were near or
  above Virginia statewide rates on most
  indicators.

Rates in Gates County, NC are similar to the
Virginia Service Region rates. See Appendix A
for detail.
12
Additional Issues

• Community Survey Responses
• Community Survey Respondents were asked to
  identify local health concerns expected to emerge
  in the Virginia Service Region over next 1-3
  years
• Most frequently mentioned emerging local health
  issues
• Medical Product Safety
• Public Health Infrastructure
• Occupational Safety Health
• Vision Hearing
• Food Safety

13
Part 1. Health Demographic Indicators

• Purpose
• Health status is highly influenced by a persons
  age, sex, race, ethnicity, education, and income.
• Content
• Chart 1.1-1.5 provide a demographic profile of
  the Virginia Service Region.
• Source
• CHRC analysis of data from SRC Corporation, a
  commercial vendor of demographic data.

14
Chart 1.1 Population Change 2000-2011
The Virginia Service Region population is
expected to grow by 29 percent from 2000 to 2011,
with Suffolk and Isle of Wight driving the
increase.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Population 2000 - 8,346 29,728 17,482 63,677 6,829 12,504 138,566 7,078,515
Population 2005 - 8,339 33,171 17,233 79,287 7,057 11,639 156,726 7,538,791
Population 2011 - 8,645 37,059 17,078 97,063 7,170 11,499 178,514 8,078,397
Population Growth 2000-2011 - 299 7,331 -404 33,386 341 -1,005 39,948 999,882
Percent Growth 2000-2011 - 4 25 -2 52 5 -8 29 14
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
15
Chart 1.2 Population by Age 2005
The Virginia Service Region includes more than
37,000 children and more than 19,800 seniors.
The region is slightly older than Virginia as a
whole.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Age 0-17 2005 - 2,040 7,575 3,535 20,668 1,597 2,175 37,590 1,811,335
Percent Age 0-17 2005 - 24 23 21 26 23 19 24 24
Age 18-64 2005 - 4,802 21,240 11,119 49,947 4,429 7,797 99,334 4,845,084
Percent Age 18-64 2005 - 58 64 65 63 63 67 63 64
Age 65 Plus 2005 - 1,497 4,356 2,579 8,672 1,031 1,667 19,802 882,375
Pct Age 65 Plus 2005 - 18 13 15 11 15 14 13 12
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
16
Chart 1.3 Population by Race Ethnicity 2005
The Virginia Service Region includes a
significantly higher proportion of Black or
African American residents than the state as a
whole.
Indicator Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
American Indian or Alaska Native 2005 9 65 26 182 13 12 307 16,819
Percent AIAN 2005 0 0 0 0 0 0 0 0
Asian Population 2005 65 118 35 624 10 15 867 345,897
Percent Asian 2005 1 0 0 1 0 0 1 5
Black or African American Pop. 2005 4,355 8,999 7,377 34,450 3,634 7,216 66,031 1,462,507
Percent Black or African Am. 2005 52 27 43 43 51 62 42 19
Hawaiian or Pacific Islander Pop. 2005 1 10 1 21 2 2 37 3,776
Percent Hawaiian or Pacific Is. 2005 0 0 0 0 0 0 0 0
Multirace Population 2005 77 314 101 1,035 67 87 1,681 148,715
Percent Multirace 2005 1 1 1 1 1 1 1 2
Other Race Population 2005 18 104 47 317 20 69 575 136,887
Percent Other Race 2005 0 0 0 0 0 1 0 2
Percent White 2005 46 71 56 54 47 36 56 72
White Population 2005 3,812 23,546 9,640 42,621 3,307 4,236 87,162 5,418,426
Hispanic Population 2005 76 418 169 1,313 73 156 2,205 435,843
Percent Hispanic 2005 1 3 1 1 2 1 1 3
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
17
Chart 1.4 Adult Population by Education Status
2005
The Virginia Service Region has lower educational
attainment (among adults) than Virginia as a
whole.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Population Age 25 Plus in 2005 - 5,484 22,451 11,913 50,756 4,762 8,374 103,740 4,994,743
Age 25 Plus and Less than High School Education 2005 Lower 1,273 4,242 3,517 9,375 1,130 2,853 22,390 694,230
Percent Age 25 Plus and Less than High School Education 2005 Lower 23 19 30 18 24 34 22 14
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
18
Chart 1.5 Population by Income Status 2005
The Virginia Service Region includes higher rates
of poverty and near-poverty than Virginia as a
whole. Rates are high for both children and
adults.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Per Capita Income 2006 Higher 21,363 23,170 18,958 21,141 18,408 16,351 20,704 27,345
Average Household Income 2006 Higher 49,295 59,560 47,254 56,088 47,442 42,826 53,812 69,571
Median Household Income 2006 Higher 35,968 51,445 38,349 46,456 41,051 34,821 44,359 54,073
Child Poverty Rate 2004 Lower 24 12 18 15 15 21 16 15
Est. Children in Poverty Lower 490 909 636 3,100 240 457 5,831 271,700
Students Approved for Free/Reduced School Lunch 2005 Lower 80 34 40 39 52 74 na 33
Est. Population Below 200 Percent Poverty 2005 Lower 3,169 7,961 5,515 24,579 2,329 3,492 47,044 1,809,310
Percent Population Below 200 Percent Poverty 2000 Lower 38 24 32 31 33 30 30 24
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
19
Part 2. Community Survey Indicators

• Purpose
• Community officials and professionals have
  valuable insight into community health concerns
• Content
• Charts 2.1-2.6 summarize responses to the survey
• Results are for Virginia Service Region only
• Source
• The survey was sent to 180 community officials
  and health professionals from a list provided by
  Obici Healthcare Foundation
• 63 valid responses were received
• Analysis is by CHRC

20
Chart 2.1 Top Local Health Concerns from
Community Survey
Overweight, Obesity, Nutrition was the most
frequently named top local health concern in the
Virginia Service Region
Number of survey respondents (out of 63)
identifying issue as among the top five local
health concerns.
21
Chart 2.2 Top Local Health Concerns from
Community Survey
(continued)
Number of survey respondents (out of 63)
identifying issue as among the top five local
health concerns.
22
Chart 2.3 Immediate Significant Local Health
Concerns from Community Survey
Overweight, Obesity, Nutrition was the most
frequently named immediate significant local
health concern in the Virginia Service Region.
Number of survey respondents (out of 63)
identifying issue as an immediate significant
local health concern.
23
Chart 2.4 Immediate Significant Local Health
Concerns from Community Survey
(continued)
Number of survey respondents (out of 63)
identifying issue as an immediate significant
local health concern.
24
Chart 2.5 Emerging Local Health Concerns from
Community Survey
Medical Product Safety, Public Health
Infrastructure, Occupational Safety Health,
Vision Hearing, and Food Safety were the most
frequently identified emerging local health
issues in the Virginia Service Region.
Number of survey respondents (out of 63)
identifying issue as not a significant concern
now, but may be in 1-3 years.
25
Chart 2.6 Emerging Local Health Concerns from
Community Survey
(continued)
Number of survey respondents (out of 63)
identifying issue as not a significant concern
now, but may be in 1-3 years.
26
Part 3. Mortality Indicators

• Purpose
• Leading causes of death provide important
  insights into the health and concerns of a
  population
• Content
• Charts 3.1-3.4 show the leading causes of death
  in terms of counts, deaths per 100,000
  population, and age-adjusted deaths per 100,000
  population.
• Source
• CHRC analysis of 2004 data from the Virginia
  Department of Health

27
Chart 3.1 Leading Causes of Death
In 2004, multiple localities had age-adjusted
death rates above the statewide rate for overall
deaths, heart disease deaths, and cancer deaths.
Suffolk had a higher rate for cerebrovascular
disease deaths.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Total Deaths 2004 Lower 113 323 184 670 47 125 1,462 56,312
Deaths per 100,000 Population Lower 1,334 985 1,046 875 674 1,049 947 755
Age-adjusted Deaths per 100,000 Population Lower 939.2 1002.4 961.7 1000.6 606.9 948.1 na 806.0
Diseases of the Heart                  
Total Deaths 2004 Lower 38 88 49 165 14 28 382 13,850
Deaths per 100,000 Population Lower 448.5 268.4 278.6 215.4 200.9 235 247.5 185.7
Age-adjusted Deaths per 100,000 Population Lower 294.6 278.5 246.9 252.0 180.3 211.3 na 200.5
Malignant Neoplasms                  
Total Deaths 2004 Lower 23 79 44 149 15 25 335 13,005
Deaths per 100,000 Population Lower 271.5 241 250.2 194.5 215.2 209.8 217.1 174.3
Age-adjusted Deaths per 100,000 Population Lower 192.9 229.5 218.2 219.8 198.6 186.0 na 182.4
Cerebrovascular Disease                  
Total Deaths 2004 Lower 2 13 10 48 2 5 80 3,681
Deaths per 100,000 Population Lower 23.6 39.7 56.9 62.7 28.7 42 51.8 49.3
Age-adjusted Deaths per 100,000 Population Lower 14.4 41.8 49.3 73.1 27.1 37.1 na 54.0
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
28
Chart 3.2 Leading Causes of Death
In 2004, multiple localities had age-adjusted
death rates above the statewide rate for chronic
lower respiratory disease, unintentional injury,
diabetes, and Alzheimers.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Chronic Lower Respiratory Disease                  
Total Deaths 2004 Lower 6 16 4 24 1 6 57 2,652
Deaths per 100,000 Population Lower 70.8 48.8 22.7 31.3 14.3 50.4 36.9 35.5
Age-adjusted Deaths per 100,000 Population Lower 48.9 48.6 20.2 36.7 10.0 44.7 na 38.8
Unintentional Injury                  
Total Deaths 2004 Lower 3 11 18 33 2 7 74 2,458
Deaths per 100,000 Population Lower 35.4 33.6 102.4 43.1 28.7 58.8 48.0 32.9
Age-adjusted Deaths per 100,000 Population Lower 23.5 33.3 99.8 45.4 23.6 58.3 na 33.7
Diabetes Mellitus                  
Total Deaths 2004 Lower 4 11 5 30 0 6 56 1,555
Deaths per 100,000 Population Lower 47.2 33.6 28.4 39.2 0 50.4 36.3 20.8
Age-adjusted Deaths per 100,000 Population Lower 34.8 31.0 25.6 45.1 0.0 44.4 na 22.0
Alzheimer's Disease                  
Total Deaths 2004 Lower 4 13 4 22 0 1 44 1,452
Deaths per 100,000 Population Lower 47.2 39.7 22.7 28.7 0 8.4 28.5 19.5
Age-adjusted Deaths per 100,000 Population Lower 28.8 46.6 20.3 35.7 0.0 7.6 na 22.0
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
29
Chart 3.3 Leading Causes of Death
In 2004, multiple localities had age-adjusted
death rates above the statewide rate for
Pneumonia Influenza, Nephritis Nephrosis,
Septicemia, and Suicide.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Pneumonia and Influenza                  
Total Deaths 2004 Lower 7 6 5 12 2 6 38 1,401
Deaths per 100,000 Population Lower 82.6 18.3 28.4 15.7 28.7 50.4 24.6 18.8
Age-adjusted Deaths per 100,000 Population Lower 58.6 17.5 25.9 18.4 23.6 45.9 na 20.8
Nephritis and Nephrosis                  
Total Deaths 2004 Lower 5 1 6 14 0 4 30 1,232
Deaths per 100,000 Population Lower 59 3.1 34.1 18.3 0 33.6 19.4 16.5
Age-adjusted Deaths per 100,000 Population Lower 46.9 2.7 30.4 20.9 0.0 29.7 na 17.9
Septicemia                  
Total Deaths 2004 Lower 1 7 4 14 0 2 28 1,160
Deaths per 100,000 Population Lower 11.8 21.4 22.7 18.3 0 16.8 18.1 15.5
Age-adjusted Deaths per 100,000 Population Lower 9.1 22.1 18.7 21.2 0.0 15.2 na 16.8
Suicide                  
Total Deaths 2004 Lower 0 6 1 7 0 2 16 805
Deaths per 100,000 Population Lower 0 18.3 5.7 9.1 0 16.8 10.4 10.8
Age-adjusted Deaths per 100,000 Population Lower 0.0 18.6 6.8 9.6 0.0 16.7 na 10.6
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
30
Chart 3.4 Leading Causes of Death
In 2004, multiple localities had age-adjusted
death rates above the statewide rate for
pneumonitis, chronic liver disease, and
homicide/legal intervention.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Pneumonitis due to Solids and Lquids                  
Total Deaths 2004 Lower 0.0 2.0 0.0 4.0 1.0 4.0 11.0 525.0
Deaths per 100,000 Population Lower 0.0 6.1 0.0 5.2 14.3 33.6 7.1 7.0
Age-adjusted Deaths per 100,000 Population Lower 0.0 5.8 0.0 6.0 12.9 29.7 na 7.8
Chronic Liver Disease                  
Total Deaths 2004 Lower 2 1 0 4 1 1 9 508
Deaths per 100,000 Population Lower 23.6 3.1 0 5.2 14.3 8.4 5.8 6.8
Age-adjusted Deaths per 100,000 Population Lower 20.5 3.5 0.0 5.8 10.0 7.5 na 6.7
Homicide and Legal Intervention                  
Total Deaths 2004 Lower 1 2 3 3 0 3 12 412
Deaths per 100,000 Population Lower 11.8 6.1 17.1 3.9 0 25.2 7.8 5.5
Age-adjusted Deaths per 100,000 Population Lower 11.4 6.0 18.3 3.8 0.0 26.1 na 5.5
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
31
Part 4. Birth Indicators

• Purpose
• Birth indicators provide insight into maternal
  and child health and health care access
• Content
• Charts 4.1-4.5 show counts and rates for several
  common birth indicators.
• Source
• CHRC analysis of 2004 data from the Virginia
  Department of Health

32
Chart 4.1 Total Pregnancies
In 2004, the region had 2,760 pregnancies
resulting in 2,054 live births. Franklin,
Suffolk, and the region as a whole had birth
rates above the statewide rate.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Total Pregnancies - 210 455 209 1,636 91 159 2,760 137,157
Induced Terminations of Pregnancy Lower 47 67 22 355 20 27 538 25,918
Natural Fetal Deaths Lower 9 33 15 95 7 9 168 7,409
Total Live Births Higher 154 355 172 1,186 64 123 2,054 103,830
Birth Rate/1,000 Estimated Population - 18.2 10.8 9.8 15.5 9.2 10.3 14.07 13.9
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
33
Chart 4.2 Low Birth Weight and Late Prenatal Care
Births
In 2004 there were 195 low weight births and 226
late or no prenatal care births. The low birth
weight rate was higher than the statewide rate in
three localities and the region as a whole. The
late/no prenatal care rate was above the state
rate in Franklin.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Low Weight Births                  
Low Weight Birth (lt2,500 grams) Lower 17 26 17 121 4 10 195 8,674
Low Weight Birth Percent of Total Births Lower 11 7.3 9.9 10.2 6.3 8.1 9.5 8.4
Late/No Prenatal Care Births                  
Began Care in First 13 Weeks Higher 126 332 150 1,061 54 105 1828 88,054
Began Care After 13 Weeks Lower 28 23 22 125 10 18 226 15,776
Percent Began Care After 13 Weeks Lower 18.2 6.5 12.8 10.5 15.6 14.6 11.0 15.2
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
34
Chart 4.3 Non-marital Births
In 2004 there were 773 non-marital births. The
non-marital birth rate exceeded the statewide
rate throughout the region.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Non-Marital Births Lower 88 113 71 408 28 65 773 32,190
Percent Non-Marital Births Lower 57.1 31.8 41.3 34.4 43.8 52.8 37.63 31
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
35
Chart 4.4 Teen Pregnancies
In 2004 there were 336 teenage pregnancies,
including 128 to teens under 18. Teen pregnancy
rates were above the statewide rate in multiple
localities.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Total Teenage Pregnancies Lower 38 47 23 192 7 29 336 13,343
Preg Rate/1,000 Pop Ages 10-19 Lower 60.1 21.6 21.1 34.3 13.5 45.7 na 26.5
Pregnancies Ageslt15 yrs Lower 0 0 1 6 0 1 8 293
Preg Rate/1,000 Pop Ageslt15 Lower 0 0 1.8 2.1 0 3.1 na 1.2
Pregnancies Ages 15-17 Lower 14 22 5 71 1 7 120 3,906
Preg Rate/1,000 Ages 15-17 Lower 65.4 33.4 14.3 38.9 5.3 34 na 26
Pregnancies Ages 18-19 Lower 24 25 17 115 6 21 208 9,144
Preg Rate/1,000 Ages 18-19 Lower 237.6 71 100 134.3 62.5 198.1 na 92
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
36
Chart 4.5 Infant Deaths
In 2004 there were 24 infant deaths. Over the
period 200-2004, the infant death rate was higher
than the statewide rate in every locality except
Isle of Wight.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Total Infant Deaths 2004 Lower 3 4 4 12 0 1 24 768
Five-Year Infant Death Rate/1,000 Live Births 2000-2004 Lower 11.8 5.8 8.3 9.6 8.5 13.3 na 7.4
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
37
Part 5. Adult Health Status Estimates

• Purpose
• Adult health status estimates paint a picture of
  community health beyond death rates, birth rates,
  and hospitalization rates.
• Content
• Charts 5.1-5.4 contain local estimates of adult
  health status.
• The figures are synthetic estimates based on
  application of statewide and national survey data
  to local demographics. They are for planning
  purposes only, and are not guaranteed for
  accuracy.
• Source
• CHRC analysis of data from the National
  Behavioral Risk Factor Surveillance Survey and
  demographic data from SRC, Inc.

38
Chart 5.1 Adult Health Limitation Estimates
In 2005 there were an estimated 20,000 adults in
fair or poor health status. Estimated rates were
above the statewide average.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Fair or Poor Health Status 2005 Lower 1,228 4,147 2,397 9,965 1,021 1,685 20,443 851,950
Percent Fair or Poor Health Status 2005 Lower 20 16 18 17 19 18 17 15
Limitations Due to Health 2005 Lower 1,222 4,838 2,534 10,610 1,021 1,647 21,872 1,018,935
Percent Limitations Due to Health 2005 Lower 19 19 19 18 19 17 18 18
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
39
Chart 5.2 Adult Overweight, Obesity, Exercise,
and Nutrition Estimates
In 2005 there were an estimated 73,000 adults
who could be classified as overweight or obese.
Overweight/obesity rates were estimated to be
above the statewide average throughout the region.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Overweight or Obese 2005 Lower 3,874 15,383 8,452 35,992 3,374 6,019 73,094 3,300,258
Percent Overweight or Obese 2005 Lower 62 60 62 61 62 64 61 58
No Exercise in Past 30 Days 2005 Lower 1,757 6,169 3,520 15,124 1,474 2,527 30,571 1,315,080
Percent No Exercise in Past 30 Days 2005 Lower 28 24 26 26 27 27 26 23
Less Than Five Servings Per Day of Fruits and Vegetables 2005 Lower 4,768 19,658 10,561 45,195 4,150 7,316 91,648 4,369,963
Percent Less than Five Servings per Day of Fruits Vegetables 2005 76 77 77 77 76 77 77 77
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
40
Chart 5.3 Adult Smoking and Alcohol Consumption
Estimates
In 2005 there were an estimated 26,000 adult
smokers and an estimated 15,900 adults at risk
for binge drinking.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Smoke 2005 Lower 1,291 5,682 3,027 12,955 1,174 2,148 26,278 1,285,441
Percent Smoke 2005 Lower 21 22 22 22 22 23 22 23
Risk for Binge Drinking 2005 Lower 699 3,558 1,877 7,796 655 1,325 15,910 877,214
Percent Risk for Binge Drinking 2005 Lower 11 14 14 13 12 14 13 15
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
41
Chart 5.4 Adult Chronic Disease Estimates
In 2005 there were an estimated 11,500 adults
with diabetes, 37,000 adults with high blood
pressure, 35,700 with high cholesterol, 15,200
with asthma, and 34,600 with arthritis. These
estimates assume a diagnosis of the specified
disease, and do not include those not yet
diagnosed.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Diabetes (Told by Doctor) 2005 Lower 712 2,329 1,370 5,627 595 956 11,589 445,774
Percent Diabetes (Told by Doctor) 2005 Lower 11 9 10 10 11 10 10 8
High Blood Pressure (Told by Doctor) 2005 Lower 2,242 7,730 4,397 18,055 1,862 3,047 37,333 1,525,070
Percent High Blood Pressure (Told by Doctor) 2005 Lower 36 30 32 31 34 32 31 27
High Cholesterol (Told by Doctor) 2005 Lower 1,990 7,884 4,150 17,293 1,682 2,726 35,724 1,646,714
Percent High Cholesterol (Told by Doctor) 2005 Lower 32 31 30 30 31 29 30 29
Asthma (Told by Doctor) 2005 Lower 806 3,251 1,753 7,562 693 1,221 15,286 731,758
Percent Asthma (Told by Doctor) 2005 Lower 13 13 13 13 13 13 13 13
Arthritis (Told by Doctor) 2005 Lower 2,047 7,602 4,041 16,706 1,676 2,584 34,656 1,538,622
Percent Arthritis (Told by Doctor) 2005 Lower 33 30 30 29 31 27 29 27
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
42
Part 6. Health Care Access Indicators

• Purpose
• Access to health care is a fundamental
  prerequisite for community health.
• Content
• Charts 6.1-6.9 provide various measures of health
  care access in the Virginia Service Region.
• Source
• Uninsured estimates and adult health care access
  estimates were produced by CHRC using synthetic
  estimation techniques in which national and
  state-level survey data are applied to local
  demographic profiles.
• Underserved area designations were obtained from
  the U.S. Health Resources and Services
  Administration.
• Ambulatory Care Sensitive Condition indicators
  were produced by CHRC using discharge data from
  Virginia Health Information, Inc. and population
  data from SRC, Inc.

43
Chart 6.1 Uninsured Estimates
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Est. Population Below 200 Percent Poverty 2005 Lower 3,169 7,961 5,515 24,579 2,329 3,492 47,044 1,809,310
Est. Uninsured Below 200 Percent Poverty 2005 Lower 856 2,149 1,489 6,636 629 943 12,702 488,514
Est. Uninsured Above 200 Percent Poverty 2005 Lower 465 2,269 1,055 4,924 426 733 9,871 515,653
Est. Uninsured Rate 2005 Lower 16 13 15 15 15 14 14 13
Est. Uninsured Total 2005 Lower 1,321 4,418 2,544 11,560 1,054 1,676 22,573 1,004,167
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
Among the uninsured are an estimated 3,000-5,000
children under 18, and17,500-19,500 adults.
44
Chart 6.2 Adult Health Care Access Estimates
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Est. Could Not See Doctor Due to Cost 2005 Lower 901 3,404 1,918 8,558 797 1,439 17,017 765,200
Est. Percent Could Not See Doctor Due to Cost 2005 Lower 14 13 14 15 15 15 14 13
Est. No Dental Visit Past 2 Years 2005 Lower 1,247 4,532 2,676 10,918 1,033 1,901 22,307 997,589
Percent No dental visit 2 years 2005 Lower 20 18 20 19 19 20 19 18
Yellow shading local rate above Virginia state
rate. See Appendix A for Gates County, NC data
45
Chart 6.3 Underserved Area Designations
Access to health care is closely tied to
availability of health care providers. Every
locality in the region except for Southampton and
Franklin have been designated as health
professional shortage areas (HPSAs), meaning they
may have a shortage of health professionals to
meet population need. In addition, Surry County,
Sussex County, Gates County are designated as
medically underserved areas (MUA), indicating
they have additional risk factors related to
poverty, infant mortality, or both. Designations
are made by the Federal Bureau of Primary Health
Care in coordination with the Virginia Department
of Health.
MUA/ HPSA
HPSA
MUA/ HPSA
HPSA
MUA/ HPSA
46
Charts 6.4-6.9Ambulatory Care Sensitive
Condition Discharges

• Ambulatory Care Sensitive Conditions are health
  conditions for which inpatient hospitalization
  may be avoided with proper ambulatory care.
• A region with high rates of ACSC discharges may
  have barriers to ambulatory care utilization.
• Technical Note
• Virginia Health Information, Inc. requires the
  following notice to accompany any use of its
  data
• VHI has provided non-confidential patient level
  information used in this report which it has
  compiled in accordance with Virginia law, but
  which it has no authority to independently
  verify. By using this report, the user agrees to
  assume all risks that may be associated with or
  arise from the use of inaccurate data. VHI
  cannot and does not represent that the use of
  VHIs data was appropriate for this report, or
  endorse or support any conclusions of inferences
  that may be drawn from the use of VHIs data.

47
Chart 6.4 Ambulatory Care Sensitive Condition
Discharges
In 2005, residents of the Virginia Service Region
had 3,548 ACSC discharges from Virginia
hospitals. The rate of hospitalization was above
the statewide rate in Franklin, Southampton,
Sussex, and the region as a whole.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Total Ambulatory Care Sensitive Condition Discharges w/o Psychosis 2005 Lower 551 589 436 1,547 125 336 3,584 150,932
Ambulatory Care Sensitive Condition Discharges (w/o Psychosis) per 100,000 Population 2005 Lower 6,608 1,776 2,530 1,951 1,771 2,887 2,287 2,002
Charts 6.5-6.8 show detailed breakouts of ACSC
discharges by condition. Chart 6.9 shows separate
data on discharges for psychosis, which some
researchers also identify as an ambulatory care
sensitive condition.
48
Chart 6.5 Ambulatory Care Sensitive Condition
Discharges
Yellow shadingrates above statewide rate. Use
caution in interpreting rates for conditions with
less than 30 discharges.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Dehydration Discharges 2005 Lower 151 127 99 292 28 89 786 34,555
Dehydration Discharges per 100,000 Pop. Lower 1,811 383 574 368 397 765 502 458
Congestive Heart Failure Discharges 2005 Lower 113 133 101 356 20 61 784 24,513
CHF Discharges per 100,000 Pop. Lower 1,355 401 586 449 283 524 500 325
Bacterial Pneumonia Discharges 2005 Lower 67 80 62 208 19 50 486 23,440
Bact Pneum Discharges per 100,000 Pop. Lower 803 241 360 262 269 430 310 311
Chronic Obstructive Pulmonary Disease Discharges 2005 Lower 35 46 29 114 9 31 264 14,097
COPD Discharges per 100,000 Pop. Lower 420 139 168 144 128 266 168 187
Asthma Discharges 2005 Lower 32 38 32 107 8 17 234 10,233
Asthma Discharges per 100,000 Pop. Lower 384 115 186 135 113 146 149 136
49
Chart 6.6 Ambulatory Care Sensitive Condition
Discharges
Yellow shadingrates above statewide rate. Use
caution in interpreting rates for conditions with
less than 30 discharges.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Kidney Discharges 2005 Lower 55 31 41 90 4 18 239 10,194
Kidney Discharges per 100,000 Pop. Lower 660 93 238 114 57 155 152 135
Cellulitis Discharges 2005 Lower 21 31 30 103 9 23 217 9,646
Cellulitis Discharges per 100,000 Pop. Lower 252 93 174 130 128 198 138 128
Diabetes Discharges 2005 Lower 34 48 15 133 10 14 254 8,498
Diabetes Discharges per 100,000 Pop. Lower 408 145 87 168 142 120 162 113
Convulsions Discharges 2005 Lower 12 14 10 48 4 11 99 4,122
Convulsions Discharges per 100,000 Pop. Lower 144 42 58 61 57 95 63 55
Gastroenteritis Discharges 2005 Lower 6 12 2 20 2 6 48 2,861
Gastro Discharges per 100,000 Pop. Lower 72 36 12 25 28 52 31 38
50
Chart 6.7 Ambulatory Care Sensitive Condition
Discharges
Yellow shadingrates above statewide rate. Use
caution in interpreting rates for conditions with
less than 30 discharges.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Hypertension Discharges 2005 Lower 4 3 1 23 4 4 39 2,133
Hypertension Discharges per 100,000 Pop. Lower 48 9 6 29 57 34 25 28
Angina Discharges 2005 Lower 4 7 6 10 0 3 30 2,105
Angina Discharges per 100,0000 Pop. Lower 48 21 35 13 0 26 19 28
Epilepsy Discharges 2005 Lower 6 1 2 10 1 0 20 1,204
Epilepsy Discharges per 100,000 Pop. Lower 72 3 12 13 14 0 13 16
Iron Deficiency Anemia Discharges 2005 Lower 3 1 0 7 2 2 15 753
Iron Deficiency Anemia Discharges per 100,000 Pop. Lower 36 3 0 9 28 17 10 10
Severe ENT Infection Discharges 2005 Lower 2 6 2 8 2 3 23 959
Severe ENT Discharges per 100,000 Pop. Lower 24 18 12 10 28 26 15 13
51
Chart 6.8 Ambulatory Care Sensitive Condition
Discharges
Yellow shadingrates above statewide rate. Use
caution in interpreting rates for conditions with
less than 30 discharges.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Pelvic Inflammatory Disease Discharges 2005 Lower 4 6 1 13 2 4 30 941
PID Discharges per 100,000 Pop. Lower 48 18 6 16 28 34 19 12
Dental Condition Discharges 2005 Lower 1 2 2 3 0 0 8 374
Dental Discharges per 100,000 Pop. Lower 12 6 12 4 0 0 5 5
Tuberculosis Discharges 2005 Lower 1 3 1 1 1 0 7 179
Tuberculosis Discharges per 100,000 Pop. Lower 12 9 6 1 14 0 4 2
Hypoglycemia Discharges 2005 Lower 0 0 0 1 0 0 1 125
Hypoglycemia Discharges per 100,000 Pop. Lower 0 0 0 1 0 0 1 2
52
Chart 6.9 Ambulatory Care Sensitive Condition
Discharges Psychosis
Yellow shadingrates above statewide rate. Use
caution in interpreting rates for conditions with
less than 30 discharges.
Indicator Desired Direction Franklin Isle of Wight Southampton Suffolk Surry Sussex Virginia Study Region Virginia
Psychosis Discharges 2005 Lower 64 109 52 320 59 122 726 40,694
Psychosis Discharges per 100,000 Population 2005 Lower 767 329 302 404 836 1,048 463 540
Note Psychosis is treated separately in this
study because some but not all researchers
identify psychosis as an ambulatory care
sensitive condition.
53
Appendix A. Gates County, NC Indicators

• Gates County, NC is treated separately in this
  report for two reasons
• 1) Data for some indicators were not available in
  the same format or for the same year as the
  Virginia Study Region
• 2) the Survey of Local Health Professionals and
  Community Leaders was limited to the Virginia
  Study Region.

54
Chart A.1 Gates County Population Profile
Indicator Value
Population 2000 10,516
Population 2005 11,060
Population 2011 11,519
Population Growth 2000-2011 1,003
Percent Growth 2000-2011 10
Source CHRC analysis of data from SRC Corp.
55
Chart A.2 Gates County Race Ethnicity Profile
Indicator Value
American Indian or Alaska Native 38
Percent AIAN 0
Asian Population 2005 36
Percent Asian 2005 0
Black or African American Population 2005 4249
Percent Black or African American 2005 38
Hawaiian or Pacific Islander Population 2005 3
Percent Hawaiian or Pacific Islander 2005 0
Multirace Population 2005 97
Percent Multirace 2005 1
Other Race Population 2005 11
Percent Other Race 2005 0
White Population 2005 6626
Percent White 2005 60
Hispanic Population 2005 92
Percent Hispanic 2005 0
Source CHRC analysis of data from SRC Corp.
56
Chart A.3 Gates County Age Profile
Indicator Value
Age 0-17 2005 2583
Percent Age 0-17 2005 23
Age 18-64 2005 6832
Percent Age 18-64 2005 62
Age 65 Plus 2005 1645
Pct Age 65 Plus 2005 15
Source CHRC analysis of data from SRC Corp.
57
Chart A.4 Gates County Educational Attainment
Economic Profile
Indicator Value
Education  
Population Age 25 Plus in 2005 7,370
Age 25 Plus and Less than High School Education 2005 1810
Percent Age 25 Plus and Less than High School Education 2005 25
Economic Status  
Per Capita Income 2006 18,290
Average Household Income 2006 47,623
Median Household Income 2006 39,802
Child Poverty Rate 2004 18
Est. Children in Poverty 462
Est. Population Below 200 Percent Poverty 2005 3,871
Percent Population Below 200 Percent Poverty 2000 35
Source CHRC analysis of data from SRC Corp.
58
Chart A.5 Gates County Health Care Access Profile
Indicator Value
Medically underserved as of 2006 Yes
Uninsured Estimates  
Est. Population Below 200 Percent Poverty 2005 3,871
Est. Uninsured Below 200 Percent Poverty 2005 1,045
Est. Uninsured Above 200 Percent Poverty 2005 647
Est. Uninsured Rate 2005 15
Est. Uninsured Total 2005 1,692
Adult Access Estimates  
Est. Could Not See Doctor Due to Cost 2005 1,102
Est. Percent Could Not See Doctor Due to Cost 2005 13
Est. No Dental Visit Past 2 Years 2005 1,865
Percent No dental visit 2 years 2005 22
Source CHRC synthetic estimates using National
Behavioral Risk Factor Surveillance Survey data
applied to local demographic data from SRC Corp.
59
Chart A.6 Gates County Mortality Profile
Indicator Value
Deaths from All Causes  
Total Deaths 2005 118
Deaths per 100,000 Population 204
Age-adjusted Deaths per 100,000 Population 226.8
Diseases of the Heart  
Total Deaths 2005 23
Deaths per 100,000 Population 205
Age-adjusted Deaths per 100,000 Population 233.9
Malignant Neoplasms  
Total Deaths 2005 31
Deaths per 100,000 Population 276.3
Age-adjusted Deaths per 100,000 Population 209.1
Cerebrovascular Disease  
Total Deaths 2005 11
Deaths per 100,000 Population 98
Age-adjusted Deaths per 100,000 Population 62.9
Chronic Lower Respiratory Disease  
Total Deaths 2005 5
Deaths per 100,000 Population 44.6
Age-adjusted Deaths per 100,000 Population 46
Source CHRC analysis of data from NC Department
of Health
60
Chart A.7 Gates County Mortality Profile
(continued)
Indicator Value
Unintentional Injury  
Total Deaths 2005 2
Deaths per 100,000 Population 17.8
Age-adjusted Deaths per 100,000 Population  NA
Diabetes Mellitus  
Total Deaths 2005 7
Deaths per 100,000 Population 62.4
Age-adjusted Deaths per 100,000 Population 53.7
Alzheimer's Disease  
Total Deaths 2005 1
Deaths per 100,000 Population 8.9
Age-adjusted Deaths per 100,000 Population 17.5
Pneumonia and Influenza  
Total Deaths 2005 2
Deaths per 100,000 Population 17.8
Age-adjusted Deaths per 100,000 Population 9.8
Nephritis and Nephrosis  
Total Deaths 2005 2
Deaths per 100,000 Population 17.8
Age-adjusted Deaths per 100,000 Population 11
Source CHRC analysis of data from NC Department
of Health
61
Chart A.8 Gates County Mortality Profile
(continued)
Indicator Value
Septicemia  
Total Deaths 2005 3
Deaths per 100,000 Population 26.7
Age-adjusted Deaths per 100,000 Population 24.6
Suicide  
Total Deaths 2005 2
Deaths per 100,000 Population 17.8
Age-adjusted Deaths per 100,000 Population 5.4
Chronic Liver Disease  
Total Deaths 2005 0
Deaths per 100,000 Population 0
Age-adjusted Deaths per 100,000 Population 6.7
Homicide and Legal Intervention  
Total Deaths 2005 2
Deaths per 100,000 Population 17.8
Age-adjusted Deaths per 100,000 Population 15.2
Source CHRC analysis of data from NC Department
of Health
62
Chart A.9 Gates County Birth Profile
Indicator Value
Pregnancies  
Total Pregnancies 172
Induced Terminations of Pregnancy 44
Natural Fetal Deaths 1
Total Live Births 127
Birth Rate/1,000 Estimated Population 11.5
Source CHRC analysis of data from NC Department
of Health
63
Chart A.10 Gates County Birth Profile (continued)
Indicator Value
Non-Marital Births  
Non-Marital Births 64
Percent Non-Marital Births 50
Low Weight Births  
Low Weight Birth (lt2,500 grams) 19
Low Weight Birth Percent of Total Births 15
Late/No Prenatal Care Births  
Began Care in First 13 Weeks 111
Began Care After 13 Weeks 16
Percent Began Care After 13 Weeks 13
Source CHRC analysis of data from NC Department
of Health
64
Chart A.11 Gates County Birth Profile (continued)
Indicator Value
Teen Pregnancy  
Total Teenage Pregnancies 30
Preg Rate/1,000 Pop Ages 10-19 52.3
Pregnancies Ageslt15 yrs 0
Preg Rate/1,000 Pop Ageslt15 na
Pregnancies Ages 15-17 12
Preg Rate/1,000 Ages 15-17 na
Pregnancies Ages 18-19 18
Preg Rate/1,000 Ages 18-19 na
Source CHRC analysis of data from NC Department
of Health
65
Chart A.12 Gates County Adult Health Status
Indicators
Indicator Value
Adult Population 2005 8,477
Fair or Poor Health Status 2005 1,335
Percent Fair or Poor Health Status 2005 16
Limitations Due to Health 2005 1,526
Percent Limitations Due to Health 2005 18
Source CHRC synthetic estimates using National
Behavioral Risk Factor Surveillance Survey data
applied to local demographic data from SRC Corp.
66
Chart A.13 Gates County Adult Health Status
Indicators (continued)
Indicator Value
Overweight or Obese 2005 5,256
Percent Overweight or Obese 2005 62
No Exercise in Past 30 Days 2005 2,204
Percent No Exercise in Past 30 Days 2005 26
Less Than Five Servings Per Day of Fruits and Vegetables 2005 6,358
Percent Less Than Five Servings Per Day of Fruits and Vegetables 2005 75
Smoke 2005 1,950
Percent Smoke 2005 23
Risk for Binge Drinking 2005 1,102
Percent Risk for Binge Drinking 2005 13
Source CHRC synthetic estimates using National
Behavioral Risk Factor Surveillance Survey data
applied to local demographic data from SRC Corp.
67
Chart A.14 Gates County Adult Health Status
Indicators (continued)
Indicator Value
Diabetes (Told by Doctor) 2005 839
Percent Diabetes (Told by Doctor) 2005 10
High Blood Pressure (Told by Doctor) 2005 2,560
Percent High Blood Pressure (Told by Doctor) 2005 30
High Cholesterol (Told by Doctor) 2005 2,357
Percent High Cholesterol (Told by Doctor) 2005 28
Asthma (Told by Doctor) 2005 1,119
Percent Asthma (Told by Doctor) 2005 13
Arthritis (Told by Doctor) 2005 2,543
Percent Arthritis (Told by Doctor) 2005 30
Source CHRC synthetic estimates using National
Behavioral Risk Factor Surveillance Survey data
applied to local demographic data from SRC Corp.
68
Appendix B. Table of Charts

• Part 1 Health Demographic Indictors
• Chart 1.1 Population Change 2000-2011 (Slide 14)
• Chart 1.2 Population by Age 2005 (Slide 15)
• Chart 1.3 Population by Race Ethnicity 2005
  (Slide 16)
• Chart 1.4 Adult Population by Education Status
  2005 (Slide 17)
• Chart 1.5 Population by Income Status 2005 (Slide
  18)
• Part 2 Community Survey
• Chart 2.1 Top Local Health Concerns from
  Community Survey (Slide 20)
• Chart 2.2 Top Local Health Concerns from
  Community Survey Cont. (Slide 21)
• Cart 2.3 Immediate Significant Local Health
  Concerns from Community Survey (Slide 22)
• Chart 2.4 Immediate Significant Local Health
  Concerns from Community Survey Cont. (Slide 23)
• Chart 2.5 Emerging Local Concerns from Community
  Survey (Slide 24)
• Chart 2.6 Emerging Local Concerns from Community
  Survey Cont. (Slide 25)
• Part 3 Mortality Indicators
• Chart 3.1 Leading Causes of Death (Slide 27)
• Chart 3.2 Leading Causes of Death Cont. (Slide
  28)
• Chart 3.3 Leading Causes of Death Cont. (Slide
  29)

• Part 5 Adult Health Status Estimates
• Chart 5.1 Adult Health Limitation Estimates
  (Slide 38)
• Chart 5.2 Adult Overweight, Obesity, and
  Nutrition Estimates (Slide 39)
• Chart 5.3 Adult Smoking and Alcohol Consumption
  Estimates (Slide 40)
• Chart 5.4 Adult Chronic Disease Estimates (Slide
  41)
• Part 6 Health Care Access Indicators
• Chart 6.1 Uninsured Estimates (Slide 43)
• Chart 6.2 Adult Health Care Access Estimates
  (Slide 44)
• Chart 6.3 Uninsured Area Designations (Slide 45)
• Chart 6.4 Ambulatory Care Sensitive Condition
  Discharges (Slide 46)
• Chart 6.5 through Chart 6.8 Ambulatory Care
  Sensitive Condition Discharges (Slides 47-51)
• Chart 6.9 Ambulatory Care Sensitive Condition
  Discharges Psychosis (Slide 52)
• Appendix A Gates County, NC Indicators
• Chart A.1 Gates County Population Profile (Slide
  54)
• Chart A.2 Gates County Race Ethnicity Profile
  (Slide 55)
• Chart A.3 Gates County Age Profile (Slide 56)
• Chart A.4 Gates County Educational Attainment
  Economic Profile (Slide 57)