1 / 44

Community Health Needs Assessment 2010

Community Health Needs Assessment 2010. A comprehensive look at Seton’s 11 County Coverage Area. Seton Planning Department, 2010. Purpose.

hila
Télécharger la présentation

Community Health Needs Assessment 2010

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Community Health Needs Assessment 2010 A comprehensive look at Seton’s 11 County Coverage Area Seton Planning Department, 2010

  2. Purpose • This assessment is provided to the Board help it gauge how Seton Family of Hospitals current and planned services meet community needs – particularly unmet needs. • This report supplements other information on the community and its needs and characteristics that have been on the board strategic thinking agenda at previous meetings. The Board Dinner discussion will include a recap of those other community needs as well as highlights of the new information in this report. Links to the Board Share Point site where those materials are available are also provided below. • Demographics • http://sharepoint.seton.org/sites/board/meetings_and_agendas/Lists/Agenda/DispForm.aspx?ID=1602&Source=http%3A%2F%2Fsharepoint%2Eseton%2Eorg%2Fsites%2Fboard%2Fmeetings%5Fand%5Fagendas%2Fdefault%2Easpx%3FInstanceID%3D29%26Paged%3DNext%26p%5FStartTimeUTC%3D20090610T170000Z%26View%3D%257b83326A00%252d6108%252d46DF%252dA52A%252d70F8359EDCD7%257d • Behavioral health • http://sharepoint.seton.org/sites/board/Strategic%20Direction/Forms/AllItems.aspx?RootFolder=%2fsites%2fboard%2fStrategic%20Direction%2fBehavioral%20Health&View=%7b49C9D19F%2d2B4E%2d44B9%2d87EB%2d62E90CE59B63%7d • Physician supply/shortage • http://sharepoint.seton.org/sites/board/meetings_and_agendas/Lists/Agenda/DispForm.aspx?ID=1493&Source=http%3A%2F%2Fsharepoint%2Eseton%2Eorg%2Fsites%2Fboard%2Fmeetings%5Fand%5Fagendas%2Fdefault%2Easpx%3FInstanceID%3D27%26Paged%3DNext%26p%5FStartTimeUTC%3D20090610T170000Z%26View%3D%257b83326A00%252d6108%252d46DF%252dA52A%252d70F8359EDCD7%257d • Poor and vulnerable • http://sharepoint.seton.org/sites/board/Strategic%20Direction/Forms/AllItems.aspx?RootFolder=%2fsites%2fboard%2fStrategic%20Direction%2fPoor%20and%20Vulnerable&View=%7b49C9D19F%2d2B4E%2d44B9%2d87EB%2d62E90CE59B63%7d Note: Data in this report are for residents of the 11-county Central Texas area that is the Seton Family of Hospital’s primary service area for adults. Geographic details on that area can be found on page 39.

  3. Executive Summary Community needs an on-going strategic discussion by Board Needs of the Central Texas community have been at the heart of many of board’s strategic discussions over the last several years. Discussions of demographics have highlighted a rapidly growing and increasingly diverse population to serve. Residents’ difficulty in accessing care, whether due to financial barriers or caused by an insufficient number of clinicians to meet this area’s needs, has been at the core of discussions of plans for graduate medical education and of needs of vulnerable populations. And finally, on-going chronic conditions and the fragmented system response to those, have highlighted needs of the medically and socially vulnerable. These chronic conditions were discussed in thinking about a behavioral health strategy and in understanding the heavy resource use of some of the vulnerable segments where underlying conditions such as diabetes and hypertension are often present.

  4. Executive Summary Causes of mortality and premature mortality highlight additional needs While mortality rates for the community as a whole continue to decline (mortality rate for population as a whole), prevention opportunities are still present for deaths from accidents, suicide, cancer and cardio and cerebrovascular diseases. Premature mortality rates are higher in the more rural east and western regions of Central Texas. And an aging population presents additional service needs highlighted by increasing mortality from Alzheimer’s. Community indicators suggest other opportunities or possible warning flags Self-reported health status studies highlight an increasing challenge in obesity, and residents are increasingly less likely to say that their health status is “excellent.” Syphilis rates are increasing and the number of children not immunized due to conscience is increasing.

  5. Executive Summary Community environment affect on health The economic, education, and natural and built environment in Central Texas also has impact on health. The relationships among these factors are key findings in the Children’s Optimal Health project as they affect children. For the community as a whole, findings from the most recent Central Texas Sustainability Indicators Project suggest additional efforts are needed to address issues of safe families, quality of and access to child care, equity among schools, water consumption and quality, air quality, mental health, vehicle miles traveled, rural land, cost of living, home loans and race relations.

  6. Overview Purpose Page 2 Summary Page 3 Causes of mortality Page 7 Cancer incidence Premature mortality Page 17 Health Status Page 22 Communicable disease Page 23 Teen pregnancy Page 29 Lifestyle health indicators Page 30 Immunizations Page 34 Community Environment Page 35 Child Safety Page 37 Appendix Page 38

  7. Mortality Rates As an Indicator One way to look at what a community’s health needs is to identify the leading causes of death and investigate changes in the mortality rate trends over time.

  8. Causes of Mortality • Cancer and cardiac disease account for nearly three out of every five deaths in Central Texas. • Accidents, stroke and chronic lower respiratory diseases together cause another quarter of the deaths. • The table on the following page presents more detail on these causes of mortality. Texas Health Data, 2006

  9. Mortality Cause of death overview Texas Health Data, 2006 *Lymphoma, endocrine system, skin, karposi sarcoma, leukemia, oral cavity and pharynx, myeloma, brain, soft tissue including heart

  10. Mortality Rates: The Big Picture • Downward trends mortality rates in Cancer, Diseases of the Heart, Stroke, and Influenza and Pneumonia • Upward trend in Alzheimer’s and Nephritis • Relatively steady in Diabetes, Accidents, Septicemia, and Suicide Texas Health Data , 2006 ** * Mortality data collected before 1999 uses ICD-9, after 1999 uses ICD-10. All mortality data collected from the Texas Health Data, TDHHS. All age, race, and gender populations collected from the Texas Health Data, TDHHS. * Chronic Lower Respiratory Disease

  11. Mortality Findings and Trends • Cancer and cardiovascular disease are virtually tied for the top cause of death in Central Texas. In recent years, cancer has surpassed cardiac as the top cause. Crude mortality rates for both show a decline since 1990. Texas Health Data, 2006 Mortality data collected before 1999 uses ICD-9, after 1999 uses ICD-10. All mortality data collected from the Texas Health Data, TDHHS. All age, race, and gender populations collected from the Texas Health Data, TDHHS.

  12. Mortality Findings and Trends • Cerebrovascular diseases (Stroke) • Downward trend in Central Texas • Ages 45-64, however, show opposite, slight upward trend in last nine years of data Texas Health Data, 2006 Mortality data collected before 1999 uses ICD-9, after 1999 uses ICD-10. All mortality data collected from the Texas Health Data, TDHHS. All age, race, and gender populations collected from the Texas Health Data, TDHHS.

  13. Mortality Findings and Trends • Alzheimer’s • Increasing trend overall, but persons of “white” racial/ethnic background show the largest increase Note: The rate of increase in Alzheimer’s as a cause of death may be attributed to improved diagnosis or to other factors. We cannot draw conclusions from these data. Texas Health Data, 2006 Mortality data collected before 1999 uses ICD-9, after 1999 uses ICD-10. All mortality data collected from the Texas Health Data, TDHHS. All age, race, and gender populations collected from the Texas Health Data, TDHHS.

  14. Mortality Findings and Trends • Accidents • While accidents are steady over all, there is downward trend in motor vehicle accidents (MVAs) and an upward trend in falls, accidental poisonings and exposure to noxious substances, and other causes. Texas Health Data, 2006 Mortality data collected before 1999 uses ICD-9, after 1999 uses ICD-10. All mortality data collected from the Texas Health Data, TDHHS. All age, race, and gender populations collected from the Texas Health Data, TDHHS.

  15. Incidence increasing Causes of Cancer Mortality Central Texas cancer mortality by tumor site is shown in the graph at right. Investigation of cancer incidence in Central Texas for these tumor sites shows some increase in the “other” category and an increase between 2002 and 2004 for prostate cancer. A more detailed graph on incidence trends can be found on the following page. Incidence increasing *”Other” cancers include: Lymphoma, endocrine system, skin, karposi sarcoma, leukemia, oral cavity and pharynx, myeloma, brain, soft tissue including heart Cancer mortality data have been provided by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th Street, Austin, Texas, 78756 , http://www.dshs.state.tx.us/tcr/default.shtm , or (512) 458-7523. Accessed 12/1/09

  16. Cancer Incidence Rates Note: Some increase in reported cancer incidence may be due to improved imaging and other technology allowing earlier diagnosis. *”Other” cancers include: Lymphoma, endocrine system, skin, karposi sarcoma, leukemia, oral cavity and pharynx, myeloma, brain, soft tissue including heart * Cancer incidence data have been provided by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th Street, Austin, Texas, 78756 , http://www.dshs.state.tx.us/tcr/default.shtm , or (512) 458-7523.

  17. Years of “potential” life lost Public health professionals sometimes use an indicator that tracks causes of years of life lost before age 65* as one way to focus prevention/intervention initiatives. This indicator helps focus on causes of premature mortality. *Many, including the author, question whether age 65 is the right cutoff for “potential” life, but the focus this indicator puts on early causes of death remains useful. Literature suggests a potential move to age 75 as a better benchmark.

  18. Years of Potential Life Lost (YPLL) • There are four major causes of years of life lost before age 65: accidents, cancer, cardiovascular disease and suicide. • Many of these years of life lost are preventable; accidents and suicide clearly are largely preventable. Lifestyle changes can also prevent some cancer and cardiac disease. • The following pages present data on the trended rates of these years of productive life lost expressed against the population under 65. State of New Jersey Department of Health and Senior Services: Center for Health Statistics Information for Local Health Officers. “How to calculate years of potential life lost before age 65. http://www.state.nj.us/health/chs/localhealth/YPLL65.xls . Accessed 11/23/09.

  19. Years of Potential Life Lost (YPLL) • Accidents • From 2002 forward, the rate for the region as a whole dropped some, but rebounded again in 2006 • This rate of years lost to accidents is higher in the more rural west and east regions. The south region has a declining rate. Source: Texas Health Data Years of Productive Life Lost (YPLL) rate: years of life lost before age 65 per 100,000 population under age 65. State of New Jersey Department of Health and Senior Services: Center for Health Statistics Information for Local Health Officers. “How to calculate years of potential life lost before age 65. http://www.state.nj.us/health/chs/localhealth/YPLL65.xls . Accessed 11/23/09.

  20. Years of Potential Life Lost (YPLL) Malignant neoplasms (Cancer) YPLL rates for cancer have gradually declined since 1966 Rates in the more rural west and east regions are higher than the region as a whole. Source: Texas Health Data Years of Productive Life Lost (YPLL) rate: years of life lost before age 65 per 100,000 population under age 65. State of New Jersey Department of Health and Senior Services: Center for Health Statistics Information for Local Health Officers. “How to calculate years of potential life lost before age 65. http://www.state.nj.us/health/chs/localhealth/YPLL65.xls . Accessed 11/23/09.

  21. Years of Potential Life Lost (YPLL) Intentional Self-harm (Suicide) Years lost to suicide have dropped a little, but like in many of the other indicators, years lost in the more rural west and east regions are higher than the region as a whole. Source: Texas Health Data Years of Productive Life Lost (YPLL) rate: years of life lost before age 65 per 100,000 population under age 65. State of New Jersey Department of Health and Senior Services: Center for Health Statistics Information for Local Health Officers. “How to calculate years of potential life lost before age 65. http://www.state.nj.us/health/chs/localhealth/YPLL65.xls . Accessed 11/23/09.

  22. Health Status Self-reported health status (Would you say your healthis…) for residents of the five core counties in Central Texas suggests that most believe their health is very good or excellent. The percent reporting excellent, however, has dropped in recent years. Central Texas Sustainability Indicators Project. Phone survey, May-June 2008, 2,395 sample, using SF-36 health status questions.

  23. Communicable Disease Another assessment of the community’s health is the prevalence and incidence of communicable diseases. Increasing trends in incidence should be addressed by community and public health efforts. Travis County public health officials suggest examination of data for HIV/AIDS, Syphilis, Tuberculosis, Pertussis (whooping cough) and Meningococcal virus. Data for all but meningococcal virus are presented in the following pages. The data set for meningococcal virus was too small for meaningful conclusions.

  24. HIV/AIDS • People are living longer with HIV… • HIV/AIDS: • What is the difference? • HIV is the immunodeficiency virus that causes AIDS • AIDS diagnosis is made when T cell count drops below 200 …while the number of new infections drop Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008. http://www.dshs.state.tx.us/hivstd/stats/default.shtm.

  25. HIV/AIDS • Dropping AIDS incidence rates tied with increasing HIV prevalence suggests that medication and education are making HIV/AIDS more of a chronic disease affecting fewer new people each year. Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008. http://www.dshs.state.tx.us/hivstd/stats/default.shtm.

  26. Syphilis • Syphilis incidence rates are increasing Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008. http://www.dshs.state.tx.us/hivstd/stats/default.shtm.

  27. TB • TB incidence rates are dropping Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008. http://www.dshs.state.tx.us/hivstd/stats/default.shtm.

  28. Pertussis • Pertussis incidence rates (Whooping cough) • The trend here is up. Public health officials credit both an increase in incidence and an aggressive outreach and education program for the increased reports of incidence. Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008. http://www.dshs.state.tx.us/hivstd/stats/default.shtm.

  29. Teen Pregnancy Rates • Teen pregnancy rates are relatively stable. Texas Department of State Health Services: Vital Statistics Annual Reports 2001-2006, Births. Tables 14B. http://www.dshs.state.tx.us/CHS/VSTAT/annrpts.shtm. Accessed 11/11/09.

  30. Lifestyle Health Indicators Self-reported health risk factors for a community can also be useful in assessing health and targeting prevention and education efforts. While most factors have not changed during the period analyzed there’s good news and bad news: There are more people reporting weight that puts them into the overweight or obese categories. In 2008, that was more than 60% of the survey respondents. Fewer people are smoking. Details for the key areas with changes follow.

  31. Lifestyle Health Indicators • Taken from Behavioral Risk Factor Surveillance System (BRFFS)* • Includes Bastrop, Caldwell, Hays, Travis, and Williamson counties – Adults only • Youth Risk Behavior Survey results not offered for our coverage area • Obesity • Overweight and obese show an increase • Smoking • Decreased number of residents smoking • Asthma • Small, steady decline • Alcohol consumption • Binge drinking is on the rise slightly • Heavy drinking is relatively steady • Light drinking is relatively steady • Diabetes • Remains steady, but at low rates *Source: Texas Department of Health. Telephone survey of residents of Bastrop, Caldwell, Hays, Travis & Williamson counties. Sample size: 2004, 560; 2005, 527; 2006, 524; 2007, 1,373; 2008, 933. http://www.dshs.state.tx.us/chs/brfss/

  32. Lifestyle Health Indicators: Overweight/Obesity • The percent of residents reporting overweight or obese status is increasing. *Source: Texas Department of Health. Telephone survey of residents of Bastrop, Caldwell, Hays, Travis & Williamson counties. Sample size: 2004, 560; 2005, 527; 2006, 524; 2007, 1,373; 2008, 933. http://www.dshs.state.tx.us/chs/brfss/

  33. Lifestyle Health Indicators: Smoking • Slightly fewer Central Texans are smokers *Source: Texas Department of Health. Telephone survey of residents of Bastrop, Caldwell, Hays, Travis & Williamson counties. Sample size: 2004, 560; 2005, 527; 2006, 524; 2007, 1,373; 2008, 933. http://www.dshs.state.tx.us/chs/brfss/

  34. Immunizations • The level of immunization of a population is also an indicator of potential health issues. • Most counties in the region have good coverage, 96%-100%, of all immunizations except for Hep A • Hep A immunizations were only required for “students attending a school located in a high incidence geographic area as designated by the department” before the 09-10 school year; Seton service area does not fall into this geographic area • Must have by 2nd birthday, therefore not tracked in 7th grade vaccination reports • Increases in Hep A immunizations in most counties; Llano sees a decrease, Bastrop stays relatively stable • Reason of Conscience under-reports immunizations • The data don’t include those who cite reason of conscience to refuse immunizations. • Students must present a medical exemption or “Reason of Conscience” if not immunized • For “Reason of Conscience”, parents must request this document from the state, complete the document and have it notarized, exemption is valid for two years • Number of students presenting a “Reason of Conscience” exemption continues to increase every year • These students are listed in a separate category, not under delinquent immunizations Note: Immunizations tracked in kindergarteners and 7th graders, but only consistently for Kindergarteners. Diseases tracked: DTP, Hep A, Hep B, Measles 1, Measles 2, Mumps, Polio, Rubella, Varicella

  35. Community Environment Impact on Health • The community environment in Central Texas also has an impact on health. • Air and water quality are often public health concerns and have been shown to impact health care costs1. • Availability of recreational spaces and community walkability design can encourage more active healthy lifestyles. • Economic health2 and educational attainment have been shown to have strong correlation to individual health status. • A safe environment contributes not only to reduced accidents but to a mental well-being of the community. • The 2009 report from the Central Texas Sustainability Indicators Project provides a useful summary of these community indicators. • 1http://www.rand.org/health/projects/air-pollution-in-california/ • 2 http://www.centex-indicators.org/annual_rept.html, pg 112

  36. Community Environment Impact on Health The 2009 report from the Central Texas Sustainability Indicators Project1 provides a useful summary of these community indicators. Most indicators show either a “red” or “yellow” flag status, suggesting that continual monitoring or action is needed. Areas that are listed as doing well include higher education, philanthropy/volunteerism and neighborliness. Areas that are shown to require action include safe families, quality of and access to child care, equity among schools, water consumption and quality, air quality, mental health, vehicle miles traveled, rural land, cost of living, home loans and race relations. 1http://www.centex-indicators.org/annual_rept.html

  37. Child Safety • Falls (47%), motor vehicle collisions (MVC) (15%) and sports (6%) are the top three drivers of accidental injury of children at Dell Children’s Medical Center. • Accidental injury data are for patients held longer than 48 hrs Source: Dell Children’s Medical Center Injury Prevention Program; Data for for 2008

  38. Appendix Geography of area assessed Assessment limitations and notes Explanation of prevalence and incidence Acknowledgements

  39. Broken down into 5 Regions West – Burnet, Llano, Blanco North – Williamson Central – Travis South – Hays, Caldwell East – Lee, Bastrop, Fayette, Gonzales 11 County Service Area

  40. Assessment Limitations and Notes • International Classification of Diseases (ICD) change • In 1999 the classification system changed from ICD-9 to ICD-10, they cannot be compared over time (we look at 1990-2006) • Sample sizes below 20 cannot be reliable for rate calculations • Behavioral Risk Factors Surveillance System is self-reported and only for adults • Only available for certain counties in Seton’s coverage area • Youth version, YRBS, is not available for any counties in Seton’s coverage area • Basic data analysis will indicate where to focus on more in-depth statistical analysis • Control charts showed no statistically significant trends • Even though we have up and down trends, statistically we are steady

  41. Communicable Diseases A crash course in incidence vs. prevalence Incidence rate number of new cases in population/population Prevalence rate total number of cases in population/population Higginson, I, Constantini, M. Interactive Textbook on Clinical Symptom Research. Chapter 19: Epidemiological Methods in Studies of Symptoms in Advanced Disease, Pg. 6. http://symptomresearch.nih.gov/chapter_19/sec4/cihs4pg1.htm. Accessed 3/3/2010.

  42. Resources • Air Quality. News 8 Austin. http://www.news8austin.com/Content/Weather/Air_Quality/AQIndex/. Accessed 2/9/10. • Cancer incidence data have been provided by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th Street, Austin, Texas, 78756 , http://www.dshs.state.tx.us/tcr/default.shtm , or (512) 458-7523. Accessed 12/1/09. • Cause of death data by age 90-98 from Janice Jackson. 11/5/09. • CensusScope: Language. http://www.censusscope.org/us/s48/chart_language.html. Accessed 12/7/09. • Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2009. • Deaths, percent of total deaths, and death rates for the 15 leading causes of death: United States and each State. Accessed 11/9/09. • Goodhealth.com. Keep Kids Safe on Bike This Summer. http://www.goodhealth.com/articles/2007/06/29/keep_kids_safe_on_bikes_this_summer. Posted 6/29/2007. Accessed 11/30/09. • Hays County’s 2006 Parks and Open Space Master Plan. http://parks.co.hays.tx.us/LinkClick.aspx?fileticket=HRCdjYKL2MM%3d&tabid=58. Accessed 3/10/2010. • Health Insurance Coverage Status and Type of Coverage by State--Persons Under 65: 1999 to 2008 [XLS]. Source: U.S. Census Bureau, Housing and Household Economic Statistics Division. http://www.census.gov/hhes/www/hlthins/historic/hihistt6.xls. Accessed 11/25/09. • Health Insurance Coverage in Texas: 1988 to 2001. U.S. Census Bureau. March Current Population Survey (CPS). http://www.hhsc.state.tx.us/research/dssi/HIS/TXINSHIST.html. Accessed 11/25/09. • State of New Jersey Department of Health and Senior Services: Center for Health Statistics Information for Local Health Officers. “How to calculate years of potential life lost before age 65. http://www.state.nj.us/health/chs/localhealth/YPLL65.xls. Accessed 11/23/09. • Higginson, I, Constantini, M. Interactive Textbook on Clinical Symptom Research. Chapter 19: Epidemiological Methods in Studies of Symptoms in Advanced Disease, Pg. 6. http://symptomresearch.nih.gov/chapter_19/sec4/cihs4pg1.htm. Accessed 3/3/2010. • Strassman, Mark. CBS Evening News. Early Onset Alzheimer’s On The Rise. http://www.cbsnews.com/stories/2008/03/08/eveningnews/main3919747.shtml. Accessed 2/9/10. • Texas Administrative Code. Title 25, Part 1, Chapter 97, Subchapter B, Rule 97.63 Immunization Requirements in Texas Elementary and Secondary Schools. Texas Department of State Health Services. http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=97&rl=63. Accessed 2/5/10. • Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. HARS HIV/AIDS Cases Annual Data 2001-2005. http://www.dshs.state.tx.us/hivstd/stats/default.shtm. Accessed 1/5/2010.

  43. Resources Continued • Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. Meningococcal Invasive. http://www.dshs.state.tx.us/idcu/disease/meningococcal_invasive/l. Accessed 1/5/10. • Texas Department of State Health Services: HIV/STD Program, Statistics and Trends. Texas HIV/STD Surveillance Report 2008 Annual Report 2000-2008. http://www.dshs.state.tx.us/hivstd/stats/default.shtm. Accessed 1/5/10. • Texas Department of State Health Services: Infectious Disease Control Unit. Tuberculosis Statistics, Cases and Rates by County. http://www.dshs.state.tx.us/idcu/disease/tb/statistics/default.asp. Accessed 12/21/09. • Texas Department of State Health Services: Substance-Related Statistics by County. http://www.tcada.state.tx.us/research/statistics/region7.shtml. Accessed 12/10/09. • Texas Department of State Health Services: Texas Health Data, Death Data. Age groups. http://soupfin.tdh.state.tx.us/deathdoc.htm. Accessed 11/26-28. • Texas Department of State Health Services: Texas health data, Population data. http://soupfin.tdh.state.tx.us/people.htm. Accessed 11/10/09, 12/21/09. • Texas Department of State Health Services: Vital Statistics Annual Reports 2001-2006, Births. Tables 14B. http://www.dshs.state.tx.us/CHS/VSTAT/annrpts.shtm. Accessed 11/11/09. • Texas Department of State Health Services: Vital Statistics Annual Reports 2001-2006, Death Tables 27. http://www.dshs.state.tx.us/CHS/VSTAT/annrpts.shtm. Accessed 11/18/09. • Texas Department of State Health Services: Vital Statistics Annual Reports 2001-2006, Deaths. Tables 16. http://www.dshs.state.tx.us/CHS/VSTAT/annrpts.shtm. Accessed 11/5/09. • Texas Department of State Health Services: Vital Statistics Annual Reports 2001-2006, Deaths. Tables 27-28B. http://www.dshs.state.tx.us/CHS/VSTAT/annrpts.shtm. Accessed 12/9/09. • Texas Dept. of State Health Services. Cause of death rates by age and race 90-2006 from Janice Jackson. 11/18/09. • Texas Department of State health Services: Texas health data, Population data. http://soupfin.tdh.state.tx.us/people.htm. Accessed 11/10/09, 12/21/09, 1/8/10. • U.S. Census Bureau: Small Area Health Insurance Estimates. State and County by Demographic and Income Characteristics 2006, 2005, 2001. http://www.census.gov/did/www/sahie/data/index.html. Accessed 11/27/09. • U.S. Census Bureau: State & County Quick Facts. http://quickfacts.census.gov/qfd/states/. Accessed 12/1/09. • US Census Bureau. http://www.census.gov/population/www/cen2000/briefs/phc-t20/tables/tab05.xls. Accessed 12/7/09. • US and Texas Cause of death. CDC/NCHS, National Vital Statistics System http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=25&pt=1&ch=97&rl=63. Accessed 2/5/10.

  44. Special Thanks To…. • Ashton Cumberbatch • Braxton Beyer and Becky Botkin • Dave Cripe • Geronimo Rodriguez • John Hugg, Janice Jackson, David Risser, Lucille Palenapa, David Walsh, Rachel Wiseman and Kenzi Guerrero at TDHHS • Kit Abney • Dr. Phillip Huang at ATCHHSD • Ryan Leslie and Mike Chapman • Tareka Wheeler and Paula Yuma • Dr. Tate Erlinger

More Related