PROVIDED TO YOU COURTESY OF

:

COMMUNITY HEALTH STATUS REPORT

Hamilton County Tennessee
2009

For more information, please contact your State of local health department or the project partners, or visit the Community Health Status Indicators Project web site at:

communityhealth.hhs.gov ASTHO Association of State and Territorial Health Officials
www.astho.org chsi@astho.org

Johns Hopkins University Bloomberg School of Public Health
www.communityPHIND.net chsi@jhu.edu

NACCHO National Association of County and City Health Officials
www.naccho.org chsi@naccho.org

NALBOH The National Association of Local Boards of Health
www.nalboh.org chsi@nalboh.org www.phf.org chsi@phf.org

PHF Public Health Foundation RWJF Robert Wood Johnson Foundation
www.rwjf.org

Our Mission: Provide Information for Improving Community Health

Brought to you by a partnership of Federal agencies and not-for-profit organizations that are identified at the end of the pamphlet. Comments and questions can be sent to comments@hrsa.gov. Please refer to the CHSI Data Sources, Definitions, and Notes for all sources, methods, and calculations (available on website).

communityhealth.hhs.gov

PUBLIC HEALTH IN AMERICA
VISION Healthy People in Healthy Communities

MISSION Promote Physical and Mental Health and Prevent Disease, Injury, and Disability

PUBLIC HEALTH • • • • • • Prevents epidemics and spread of disease Protects against environmental hazards Prevents injuries Promotes and encourages healthy behaviors Responds to disasters and assists communities in recovery Assures the quality and accessibility of health services

ESSENTIAL PUBLIC HEALTH SERVICES • • • • • • • • • •
Source:

Monitor health status to identify community health problems Diagnose and investigate health problems and health hazards in the community Inform, educate, and empower people about health issues Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health efforts Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services and assure the provision of health care when otherwise unavailable Assure a competent public health and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and populationbased health services Research for new insights and innovative solutions to health problems
Public Health Functions Steering Committee, Fall 1994.

* Other lifestyle and personal behavior (nongenetic) risk factors include microbes, toxins, firearms, sexual behavior, motor vehicles, and drug use. Source: McGinnis, J.M., & Foege, W.H. (1993). Actual causes of death in the United States. JAMA., 270(18), 2207-2212.

While we may measure deaths due to heart disease, cancers, or infant deaths, we should always keep in mind that factors such as tobacco, diet, activity, and alcohol use substantially contribute to these deaths. For example, as shown in the above graphic, tobacco use accounts for 19 percent of all U.S. deaths.

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COMMUNITY HEALTH STATUS REPORT

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Hamilton County, TN

DEMOGRAPHIC INFORMATION

Population size1 Population density (people per square mile)2 Individuals living below poverty level3 Age distribution1 Under Age 19 Age 19-64 Age 65-84 Age 85+

332,848 614 14.1% 23.7% 61.7% 12.5% 2.1% 76.8% 0.1% 0.3% 1.6% 3.1%

A distinctive aspect of this report is the ability to compare a county with its peers, those counties similar in population composition and selected demographics. Strata, or peer group size averages 36 and ranges from 15 to 62 counties. There are a total of 88 strata. Listed below are the 24 peer counties in stratum number 4. Due to the population size of counties within this stratum, data on vital statistics (e.g. births and deaths) and nationally notifiable diseases were aggregated across the most recent 3 year time period (2003-2005) in order to ensure stable estimates.
Alabama Madison County California Santa Barbara County Colorado Adams County Florida Brevard County Lee County Illinois Madison County Indiana Lake County Kansas Sedgwick County Michigan Ingham County Minnesota Ramsey County New Jersey Passaic County New York Onondaga County North Carolina Forsyth County Guilford County Ohio Stark County Oregon Marion County Pennsylvania Erie County Luzerne County Westmoreland County South Carolina Greenville County Tennessee Knox County Texas Montgomery County Utah Utah County Washington Spokane County

PEER COUNTIES

Race/Ethnicity1

PEER COUNTIES Peer counties (counties and county-like geographic areas) in stratum number 4 were stratified on the basis of the following factors: frontier status, population size, poverty. Below are peer county ranges representing the 10th and 90th percentile of values. This trimmed range of peer county value is used consistently throughout the report. Population size1 Population density (people per square mile)2 Individuals living below poverty level3 Age distribution1 Under Age 19 Age 19-64 Age 65-84 Age 85+

White Black2 American Indian Asian/Pacific Islander Hispanic origin (non add)

279,175 - 530,837 266 - 994 10.6 - 15.8% 21.5 - 28.7% 58.6 - 62.5% 8.6 - 15.6% 0.9 - 3.1% 71.1 - 94.9% .9 - 26.0% 0.2 - 1.6% 0.7 - 4.8% 2.2 - 34.9%

Race/Ethnicity1

White Black1 American Indian Asian/Pacific Islander Hispanic origin (non add)

nda No data available.
1 2

The Census Bureau. Current Population Estimates, 2008. HRSA. Area Resource File, 2008. 3 The Census Bureau. Small Area Income Poverty Estimates, 2008.

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Hamilton County, TN
Image description. Chart titled, Average Life Expectancy End of image description.

SUMMARY MEASURES OF HEALTH

NATIONAL LEADING CAUSES OF DEATH1

AVERAGE LIFE EXPECTANCY1
Hamilton (75.4) Median for all U.S. counties (76.5)
68 71.6 75.2 78.8 82.48 6

Hamilton County, TN
WhiteB Under Age 1 lack Other Hispanic

Years

Range among peer counties (75.7 - 78.9)

Complications of Pregnancy/Birth Birth Defects
Ages 1-14

48% 22% rf nrfn rf 31% rf 16% nrfn 18% 14% 16% rf nrf rf 31% 24% 27% 22%

66% nrfn 48% rf 13% 15% 42% nrfn rf nrfn 11% 15% nrfn 13% 11% 31% 26% 30% 22%

nrfn rf nrfn nrfn nrfn nrfn nrfn rf nrfn rf nrfn nrfn rf nrfn nrfn nrfn nrfn 16% 20%

rf nrf rf rf rf rf rf nrf rf nrf rf rf nrf rf rf rf rf nrf nrf

ALL CAUSES OF DEATH2
Image description. Chart titled, All Causes of Death End of image description.

Injuriesn Cancer Homiciden
Ages 15-24

Hamilton (890.4) Median for all U.S. counties (1136.9)
638 760.4 882.81 ,005.21 ,127.61 ,250

Deaths per 100,000 population

Range among peer counties (709.7 - 902.8)

Injuries Homiciden Suicide Cancer
Ages 25-44

SELF-RATED HEALTH STATUS3
Image description. Chart titled, Self-Rated Health Status End of image description.

Hamilton (17.3%) Median for all U.S. counties (17.1%)
11 12.8 14.6 16.4 18.22 0

Injuries Cancer Heart Disease Suiciden HIV/AIDS Homiciden
Ages 45-64

Percent of adults who report fair or poor health
Image description. Chart titled, Average Number of Unhealthy Days in Past Month End of image description.

Range among peer counties (12.3 - 18.3%)

AVERAGE NUMBER OF UNHEALTHY DAYS IN PAST MONTH3
Hamilton (5.6) Median for all U.S. counties (6.0)
55 .4 5.86 .2 6.67

Cancer Heart Disease
Ages 65+

Heart Disease Cancer

Average Number of Unhealthy Days in Past Month
nrf No report, survey sample size fewer than 50. nda No data available.
1

Range among peer counties (5.5 - 6.5)

nrfN o report, fewer than 20 deaths in race/ethnicity and age group or less than 10% of the deaths. ndaN o data available. Local data are presented for the Nation's top leading causes of death in each age group. Columns, within age categories, do not total 100% because all causes of death are not listed. The most complete ethnicity data available are reported.
1

Murray et al., PLoS Medicine 2006 Vol. 3, No. 9, e260 doi:10.1371/journal.pmed.0030260. 2 NCHS. Vital Statistics Reporting System, 2003-2005. 3 CDC. Behavioral Risk Factor Surveillance System, 2000-2006.
4

NCHS. Vital Statistics Reporting System, 2003-2005.

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MEASURES OF BIRTH AND DEATH1

Hamilton County, TN
County Percent / C.I. 11.2 1.8 18.0 4.9 1.7 40.3 cdna (10.6 (1.6 (17.3 (4.5 (1.5 (39.4 (cdna , , , , , , , 11.8) 2.0) 18.6) 5.3) 2.0) 41.2) cdna) Peer County Range 6.3 - 9.9 1.0 - 1.9 10.6 - 15.5 2.5 - 4.5 1.7 - 3.2 27.6 - 42.2 cdna Birth Measures Low Birth Wt. (<2500 g) Very Low Birth Wt. (<1500 g) Premature Births (<37 weeks) Births to Women under 18 Births to Women age 40-54 Births to Unmarried Women No Care in First Trimester2 U.S. Percent 2005 8.2 1.5 12.7 3.4 2.7 36.9 cdna Healthy People 2010 Target 5.0 0.9 7.6 No objective No objective No objective 10.0

County Rate / C.I. 9.8 6.7 17.7 11.1 6.5 3.3 (8.0 , 11.5) (5.0 , 8.8) (13.1 , 23.2) (5.3 , 20.5) (5.1 , 8.1) (2.3 , 4.5)

Peer County Range 5.3 - 8.8 4.2 - 7.1 6.6 - 16.9 2.1 - 11.1 3.4 - 6.1 1.8 - 3.1

Infant Mortality3 Infant Mortality White non Hispanic Infant Mortality Black non Hispanic Infant Mortality Hispanic Infant Mortality Neonatal Infant Mortality Post-neonatal Infant Mortality

U.S. Rate Healthy People 2005 2010 Target 6.9 4.5 5.8 4.5 13.6 4.5 5.6 4.5 4.5 2.9 2.3 1.2 U.S. Rate Healthy People 2005 2010 Target 24.1 21.3 17.5 13.7 154.0 162.0 6.1 2.8 52.6 43.3 14.6 8.0 47.0 50.0 10.9 4.8 39.1 17.1

County Rate / C.I. 28.6 17.3 174.9 7.5 63.6 14.0 55.5 11.0 23.5 (24.4 , 32.9) (14.8 , 19.8) (167.1 , 182.8) (5.8 , 9.5) (58.9 , 68.4) (11.7 , 16.3) (51.1 , 60.0) (9.0 , 13.1) (20.5 , 26.5)

Peer County Range 18.7 - 29.1 12.3 - 20.9 96.2 - 174.9 1.8 - 7.5 46.1 - 64.1 8.3 - 20.6 41.0 - 60.5 7.7 - 16.1 19.0 - 34.2

Death Measures4 Breast Cancer (Female) Colon Cancer Coronary Heart Disease Homicide Lung Cancer Motor Vehicle Injuries Stroke Suicide Unintentional Injury

The total number of births during this time period was 11,889 and the total number of deaths was 9,644.
Image descripti on. Favorabl e End of image descripti on. Image descripti on. Unfavor able End of image descripti on.

nrf nda cdna
1

Indicates a status favorable to peers. Indicates a status less than favorable. No report, fewer than 500 births and 5 events (birth measures and infant mortality) or fewer than 10 events (death measures) occurred during the specified time period. No data available. Comparable data not available.

NCHS. Vital Statistics Reporting System, 2003-2005. 2 Include 37 states, New York City and DC (see the Data Sources, Definitions, and Notes for details). 3 Infant mortality: deaths per 1000 live births (Neonatal: <28 days; post-neonatal: day 28 to under one year). 4 Rates are age-adjusted to the year 2000 standard; per 100,000 population.
6

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Hamilton County, TN

RELATIVE HEALTH IMPORTANCE

Hamilton County, TN

VULNERABLE POPULATIONS

Vulnerable populations may face unique health risks and barriers to care, requiring enhanced services and targeted strategies for outreach and case management. Vulnerable Populations Include People Who1 Have no high school diploma (among adults age 25 and older) 43,812 9,254 Are unemployed 7,512 Are severely work disabled 25,376 Have major depression 25,004 Are recent drug users (within past month)
nda No data available.
1

• • • • • • • • • • • • • • • •

Low Birth Wt. (<2500 g) Very Low Birth Wt. (<1500 g) Premature Births (<37 weeks) Births to Women under 18 Births to Unmarried Women Infant Mortality White non Hispanic Infant Mortality Black non Hispanic Infant Mortality Hispanic Infant Mortality Neonatal Infant Mortality Post-neonatal Infant Mortality Breast Cancer (Female) Coronary Heart Disease Homicide Lung Cancer Stroke

Suicide

The most current estimates of prevalence, obtained from various sources (see the Data Sources, Definitions, and Notes for details), were applied to 2008 mid-year county population figures.

Hamilton County, TN
INFECTIOUS DISEASES1

ENVIRONMENTAL HEALTH

Cases

Reported
148 22

Expected
0 157 39

• • • •

Births to Women age 40-54 Colon Cancer Motor Vehicle Injuries Unintentional Injury

E.coli0 Salmonella Shigella

TOXIC CHEMICALS RELEASED ANNUALLY2: 1,544,189 pounds NATIONAL AIR QUALITY STANDARDS MET BY COUNTY3
Carbon Nitrogen Sulfur Ozone Particulate Lead Monoxide Dioxide Dioxide Matter Yes Yes Yes Yes Yes Yes

The Relative Health Importance table creates four categories of relative concern by simply comparing a county to its peers and to the U.S. A county's indicators in the upper left-hand box ( ) are higher than the U.S. and its peers and may warrant more attention. Conversely, indicators in the lower right-hand box ( ) of the table compare favorably to both peers and the U.S. The other boxes represent intermediate levels of health where a county's rate is higher than either its peers or the U.S., but not both.
Source: Measures of Birth and Death tables, pages 6 - 7.

Indicates a status favorable to peers. Indicates a status less than favorable. nda No data available.
1 2

CDC. National Notifiable Diseases Surveillance System, 2005-2007. EPA. Toxic Release Inventory (TRI) Explorer Report, 2008. 3 EPA. AIRSData, 2008.

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Hamilton County, TN

PREVENTIVE SERVICES USE

Hamilton County, TN
Image description. Chart with no title End of image description.

RISK FACTORS FOR PREMATURE DEATH1

INFECTIOUS DISEASE CASES1

These diseases respond to public health control efforts. The expected number is based on the occurrence of cases among peer counties.

Communities may wish to obtain information about these measures, collected and monitored at local level.

Reported Cases
AIDS Tuberculosis Haemophilus influenzae B9 Hepatitis A Hepatitis B Measles0 Pertussis Congenital Rubella Syndrome Syphilis
Indicates a status favorable to peers. Indicates a status less than favorable.

Expected Cases
na na 0 10 20 0 59 0
1

No exercise Few Fruits/Vegetables Obesity High Blood Pressure Smoker Diabetes
02

27.3% 67.4% 25.2% 27% 22% 8.6%
04
Percentage of Adults

rnar rnar 11 28 22 00 21

06

08

0

nrf No report, survey sample size fewer than 50. CDC. Behavioral Risk Factor Surveillance System, 2000-2006.

rna The release of data for all counties has not been authorized nda No data available. CHILD PREVENTIVE SERVICES USE Indicators such as immunizations, dental caries, and the prevalence of lead screening are not collected at the national level and must be obtained locally. ADULT PREVENTIVE SERVICES USE (%)2
Image description. Chart with no title End of image description.

Hamilton County, TN

ACCESS TO CARE

In addition to use of services, access to care may be characterized by medical care coverage and service availability. Uninsured individuals (age under 65)1 Medicare beneficiaries2 Elderly (Age 65+) Disabled Medicaid beneficiaries2 Primary care physicians per 100,000 pop2 Dentists per 100,000 pop2 Community/Migrant Health Centers3 Health Professional Shortage Area3
nda No data available.
1 2

44,487 44,168 9,576 74,124 130.4 63.4 Yes No

100 80 60 40 20 0

85.8%

85.5% 47.6%

67.1%

66.8%

Pa

rs ea ) Sm (18+ p

Ma

m

y ph ) gra (50+ mo

Sig

mo

py co ) os (50+ id

ia on ) um (65+ e Pn ine cc va

F

ine ) cc va (65+ lu

nrf No report, survey sample size fewer than 50.
1 2

The Census Bureau. Small Area Health Insurance Estimates Program, 2006. HRSA. Area Resource File, 2008. 3 HRSA. Geospatial Data Warehouse, 2009.

CDC. National Notifiable Diseases Surveillance System, 2005-2007. CDC. Behavioral Risk Factor Surveillance System, 2000-2006.

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SELECTED TERMS
Age-Adjusted death rates allow comparison of rates between communities with different age structures. Rates have been adjusted to the year 2000 standard, the standard recommended for years 1999 and later. Expected number of infectious disease cases has been calculated by applying the rate observed for all the peer counties to the county population. Death rates and birth measures are consistent with U.S. Healthy People 2010 objectives. EPA air quality standards measured and exceeded are reported. Monitoring is conducted in areas believed to be at risk and is not done in every jurisdiction. Leading causes of death are provided for underlying cause of death categories constituting 10% or more of deaths in that race/ethnicity and age group. Prevalence rates indicate the number in a population who have a certain characteristic at any time during the period. The BRFSS survey has been weighted to represent the State's adults. Persons enrolled in Medicaid or Medicare are program beneficiaries. The number of persons under age 65 receiving Medicare may represent a measure of disability in children and adults. Persons over age 65 with Medicaid coverage may also represent a population having grater medical needs. Relative health importance determination of unfavorable were rates above the peer or the U.S. rate. Vulnerable populations of the work disabled, those depressed, and recent drug users were estimated. Work disabled used a regression-based county-specific estimate. National age- or race-specific rates of major depression and recent drug use were applied to the county population to obtain the county estimate.

CONFIDENCE INTERVALS
SUMMARY MEASURES OF HEALTH page 4 V alue Confidence Interval ALL CAUSES OF DEATH 890.4( 872.6 - 908.3) SELF-RATED HEALTH STATUS 17.3% (14.8 - 19.8%) AVERAGE NUMBER OF UNHEALTHY DAYS IN PAST 5.6( 4.8 - 6.4) MONTH ADULT PREVENTIVE SERVICES USE (%) page 10 V alue Confidence Interval Pap Smears (18+) 85.8% (82.9 - 88.7%) Mammography (50+) 85.5% (81.3 - 89.7%) Sigmoidoscopy (50+) 47.6% (41.4 - 53.9%) Pneumonia vaccine (65+) 67.1% (60.8 - 73.5%) Flu vaccine (65+) 66.8% (60.6 - 72.9%) RISK FACTORS FOR PREMATURE DEATH page 11 V alue Confidence Interval No exercise 27.3% (24.3 - 30.3%) Few Fruits/Vegetables 67.4% (63.5 - 71.3%) Obesity 25.2% (22.2 - 28.3%) High Blood Pressure 27.0% (23.8 - 30.1%) Smoker 22.0% (18.9 - 25.0%) Diabetes 8.6% (6.7 - 10.5%)

FEDERAL PARTNERS ATSDR Agency for Toxic Substances and Disease Registry
atsdr.cdc.gov

CDC Center for Disease Control and Prevention
www.cdc.gov

HRSA Health Resources and Services Administration
www.hrsa.gov

NLM National Library of Medicine
www.nlm.nih.gov

For complete information regarding data definitions and sources, please refer to the Data Sources, Definitions, and Notes available on HRSA's web site at:

communityhealth.hhs.gov
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