Butte County Needs Assessment 2019-2022.pdf - TABLE OF CONTENTS LETTER FROM THE DIRECTOR 4 EXECUTIVE SUMMARY 5 BUTTE COUNTY\u2019S COMMUNITY PROFILE.14

Butte County Needs Assessment 2019-2022.pdf - TABLE OF...

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Unformatted text preview: TABLE OF CONTENTS LETTER FROM THE DIRECTOR ........................................................... 4 EXECUTIVE SUMMARY ....................................................................... 5 BUTTE COUNTY’S COMMUNITY PROFILE .....................................14 Butte County Overview ................................................................................ 14 Age and Gender.............................................................................................. 16 Race and Ethnicity.......................................................................................... 19 Population with Limited English Proficiency ....................................... 21 Disability Prevalence ..................................................................................... 23 Household Characteristics .......................................................................... 25 COMMUNITY HEALTH STATUS ASSESSMENT .............................27 Socioeconomic Characteristics ....................................................28 Household Income ........................................................................................ 28 Population in Poverty ................................................................................... 28 Unemployment ............................................................................................... 31 Educational Attainment ............................................................................... 33 High School Graduation .............................................................................. 33 High School Dropout Rates ....................................................................... 34 Quality of Life.................................................................................36 Air Quality and Pollution ............................................................................. 36 Access to Transportation ............................................................................ 37 Use of Public Transportation for Workplace Commuting.............. 38 Public Safety and Crime............................................................................... 38 Food Affordability .......................................................................................... 39 Supplemental Nutrition Assistance Program (SNAP) ...................... 40 Accessibility to Grocery Stores ................................................................. 41 Access to Nutritious Food .......................................................................... 42 Homelessness .................................................................................................. 43 Health Inequity for the Homeless Population .................................... 44 Veterans ............................................................................................................. 48 Chronic Diseases and Conditions ................................................50 Obesity ............................................................................................................... 52 Diabetes ........................................................................................................... 55 Cancer ................................................................................................................. 56 Asthma ............................................................................................................... 59 Chronic Obstructive Pulmonary Disease............................................... 60 Cardiovascular Disease ................................................................................ 61 Heart Disease and Health Insurance ...................................................... 61 Mental Health ................................................................................64 Suicide ................................................................................................................ 66 Veterans Mental Health ............................................................................... 68 BUTTE COUNTY COMMUNITY HEALTH ASSESSMENT 2019-2022 2|P ag e T A B L E O F C O N T E N T S Mental Health and Addiction Parity ....................................................... 71 Substance Misuse and Use Disorders .........................................74 Alcohol Misuse ................................................................................................ 74 Illicit Substance Use ...................................................................................... 76 E-Cigarette Use ............................................................................................... 79 Tobacco .............................................................................................................. 80 The Opioid Epidemic .................................................................................... 82 Sexually Transmitted Infections ..................................................85 Chlamydia ......................................................................................................... 85 Gonorrhea ......................................................................................................... 85 Syphilis & Congenital Syphilis .................................................................. 86 Maternal and Child Data ..............................................................88 Birthrates ........................................................................................................... 88 Teen Pregnancy .............................................................................................. 88 Breastfeeding ................................................................................................... 90 Adverse Birth Outcomes and Infant Mortality .................................... 92 Child Immunizations ..................................................................................... 96 Child Abuse and Neglect .......................................................................... 100 Adverse Childhood Experiences ............................................................. 103 Aging and Senior Related Health ............................................ 105 Falls in Older Adults .................................................................................... 105 Alzheimer’s Disease and Dementia ....................................................... 106 Causes of Death .......................................................................... 108 Access to Care Re-Assessment ................................................. 110 Methods ........................................................................................................... 110 Results .............................................................................................................. 111 Summary and Conclusions ....................................................................... 119 COMMUNITY ENGAGEMENT ....................................................... 120 Focus Groups Summary ............................................................................. 121 CONCLUSION .................................................................................. 130 Moving Forward: Community Health Improvement Plan ... 134 REFERENCES .................................................................................... 135 APPENDIX A .................................................................................... 144 BUTTE COUNTY COMMUNI TY HEALTH ASSESSMENT 2019-2022 3|P ag e LETTER FROM THE DIRECTOR Dear Community Members, As our community continues to recover and rebuild from the devastating effects of the Camp Fire, of utmost importance is the ongoing assessment of data and information related to our county’s health status. While a full understanding of the fire’s impacts on Butte County’s overall health and healthcare systems are still unknown, we hope that this Community Health Assessment (CHA) report can serve as a valuable resource for future recovery efforts and vital health improvement initiatives. The purpose of a CHA is to learn about our community, the overall health of the population, contributing factors to higher health risks or poorer health outcomes of identified populations, and community resources available to improve the public’s health. This report reflects a year-long process that included the selection and analysis of hundreds of health indicators, completion of multiple focus groups, and contribution of over 700 Butte County residents who took part in a nationally recognized community health survey process. The CHA will serve as the foundation for our upcoming Community Health Improvement Plan (CHIP). The CHIP will focus on a few selected health topics identified within the CHA and create a blueprint for our community to set priorities, direct the use of resources, and develop health related projects, programs, and polices. We would like to extend our sincere thanks to Enloe Medical Center, Adventist Health Feather River Hospital, and Orchard Hospital for their partnership and collaboration on this project. We are also extremely grateful to the many individuals and organizations who participated in the CHA focus groups and community health survey process. Each participant provided insightful feedback and suggestions for improving local health and access to care. Their input also highlighted some of the challenges we face in achieving optimal health in Butte County. We welcome your further input to this report and encourage you to utilize this information in your work with individuals, families, and communities in Butte County. Sincerely, Danette York Director, Butte County Public Health Department BUTTE COUNTY COMMUNITY HEALTH ASSESSMENT 2019-2022 4|P ag e EXECUTIVE SUMMARY The Butte County Community Health Assessment (CHA) partnership between Butte County Public Health, Enloe Medical Center, Adventist Health Feather River Hospital, and Orchard Hospital began convening to plan and implement the CHA presented here in the spring and summer of 2018. Of note, the most destructive wildfire in California’s history, the Camp Fire, interrupted these collaborative CHA efforts in the fall of 2018 through the spring of 2019; which dramatically affected Butte County across a myriad of health care delivery system factors and community health determinants. The full impact this natural disaster has had on the community’s health will not be evident for some time, and the results of the current assessment do not fully address them. Beginning in the fall of 2018, quantitative secondary data was collected from an array of wellestablished sources such as the Robert Wood Johnson Foundation (RWJF), California Health Interview Survey (CHIS), Office of Statewide Health Planning and Development (OSHPD), California Department of Public Health (CDPH), and many others. Primary health survey data was attained in the spring and summer of 2019, by conducting a sample of over 700 Butte County residents using the well-established Behavioral Risk Factor Surveillance System (BRFSS) survey protocol and methodology. Results of the oversample for Butte County are hereafter referred to as the Behavioral Risk Factor Survey (BRFS), and treated as equivalent to state and national BRFSS results for comparisons. Qualitative focus group data with underrepresented groups and other hard to reach subpopulations were also conducted in the spring and summer of 2019. The results of all three-assessment methods were reviewed for their degree of commonality. That is, an attempt was made to align secondary health metric data with health survey and qualitative focus group data, such that those health factors with the greatest alignment became evident. The health factors most substantially implicated that emerged through this process are: A. Access to Care I. Health Care Provider Shortages II. Preventative Practices B. Mental Health and Substance Use Disorders I. Suicide and Depressive Disorders II. Opioids Use Disorders and Excessive Drinking C. Chronic Conditions I. Cancer II. Alzheimer’s Disease III. Asthma IV. Chronic Lower Respiratory Disease V. Chronic Liver Disease D. Adverse Childhood Experiences and Childhood Maltreatment BUTTE COUNTY COMMUNITY HEALTH ASSESSMENT 2019-2022 5|P ag e E X E C U T I V E S U M M A R Y ACCESS TO CARE Access to health services is a leading health indicator (LHI) for the Healthy People 2020 (HP-2020) national health objectives. A person’s ability to access health services profoundly affects their health and well-being. Having a usual Primary Care Provider (PCP) is associated with: greater patient trust in the provider; better patient-provider communication; increased likelihood that patients will receive appropriate care; and lower mortality from all causes1. Access to mental health and oral health care are also both important, as both mental health conditions and oral health correlate strongly with physical health and well-being. The Health Resources & Services Administration (HRSA) has determined that there are Primary Care Shortage Areas, Dental Care Shortage Areas, and Mental Health Shortage Areas in Butte County. While only parts of the county meet Primary Care Shortage and Dental Care Shortage Area criteria, the entire county meets Mental Health Shortage Area criteria. Population to provider ratios also demonstrate that Butte County has fewer Primary Care Physicians, Dental Care Providers, and Mental Health Care Providers per capita than the state overall; however, Butte County does have more Non-Physician Primary Care Providers (e.g. Physician’s Assistants, Nurse Practitioners) per population than the state overall. Table Summary-1: Population to Provider Ratios: Butte County and California, 2012 & 2016 Butte County California 2012 2016 Percent Change 2012 2016 Percent Change 1497:1 1660:1 10.9% 1294:1 1270:1 -1.9% 1241:1 1042:1 -16.0% 2406:1 1770:1 -26.4% Dental Care 1461:1 1410:1 -3.5% 1291:1 1200:1 -7.0% Mental Health Care 238:1 170:1 -28.6% 388:1 310:1 -20.1% Primary Care Physician Other Primary Care (Non Physician) Source: 2012 and 2016 Area Health Resource Data File via County Health Rankings. Retrieved From: The BRFS demonstrated slightly more than one-third (34.1%) of Butte County adult respondents do not have a personal doctor or health care provider, which is substantially above state and nationwide rates (24.5% and 22.5%, respectively.) In addition, 14.5% of Butte County respondents reported not seeing a doctor because of the cost, while just 11.8% of California respondents cited costs as barrier to seeking medical care. Results of the focus groups demonstrated that access to care was ranked as the most important health topic across all groups, with 80.7% of the 88 total 1 BUTTE COUNTY COMMUNI TY HEALTH ASSESSMENT 2019-2022 6|P ag e E X E C U T I V E S U M M A R Y focus group participants ranking access to care as very important for community health in Butte County, and 40.9% ranking transportation as a substantial barrier to care for residents of the County. PREVENTATIVE PRACTICES Preventive health practices are those that prevent illnesses or diseases, such as screenings and immunizations, or patient counseling to prevent illness 2 . Examples include standard immunizations; and screenings for blood pressure, cancer, cholesterol, depression, obesity, and type 2 diabetes 3 . In recent years, several vaccine preventable diseases once on the verge of eradication, such as measles, have reemerged in the United States; with outbreaks occurring throughout California, including Butte County. Likewise, sexually transmitted infections (STIs) once thought to be declining or close to eradication, such as syphilis, have shown increasing rates nationally. Many STIs are treatable, but if undetected, may continue to be transmitted; and many more are preventable through education and patient counseling. The percentage of students having all required immunizations for enrollment into Butte County schools is slightly below the percentage of students statewide (93.0% compared to 95.6%), with more conditional entrants – students with some but not all required immunizations – attending Butte County schools than California schools overall (3.1% vs. 1.7%). According to the BRFS, 47.8% of Butte County respondents over the age of 65 have not had a flu shot in the past 12 months; and 29.0% had not received pneumococcal vaccine, which was also greater than the percentage statewide (23.2%). Likewise, 73.2% of Butte County respondents age 50 or older have not been vaccinated against shingles, which was slightly greater than the percentage of respondents statewide and nationwide (68.9% and 71.4%, respectively). Rates of STIs (chlamydia, gonorrhea, and syphilis) for both the county and the state have demonstrated a steadily increasing trend from 2013 to 2017. Especially concerning are the increasing rates of syphilis. In Butte County, rates increased from 0.9 cases per 100,000 residents in 2013 to 33.6 in 2017; and from 16.8 cases per 100,000 residents to 34.6 statewide during this time period. While rates of congenital syphilis showed an increasing but statistically unreliable trend in Butte County, the statewide rate increased from 11.7 to 58.2, indicating that the statistically underpowered trend observed in Butte County is likely accurate. Also concerning, is that a slightly lower percentage (37.9%) of Butte County BRFS respondents reported ever having an HIV test than respondents statewide (40.8%). Pertaining to preventative practices for excessive alcohol use, 17.0% of Butte County BRFS respondents reported being advised on harmful levels of drinking during a routine checkup with 2 3 BUTTE COUNTY COMMUNI TY HEALTH ASSESSMENT 2019-2022 7|P ag e E X E C U T I V E S U M M A R Y a healthcare provider, compared with 24.2% of respondents statewide; and 11.5% of Butte County respondents were advised to drink less compared with 12.5% of survey respondents statewide. MENTAL HEALTH & SUBSTANCE USE DIS ORDERS Like access to care, mental health is a LHI for the HP-2020 objectives. Mental health and physical health are inextricably linked. Evidence has shown that mental health disorders—most often depression—are strongly associated with the risk, occurrence, management, progression, and outcome of serious chronic diseases and health conditions; including diabetes, hypertension, stroke, heart disease, and cancer4. Suicide is the tenth leading cause of death in the nation, and the national suicide rate increased by 19.5% between 2007 and 2016. Suicide rates also tend to be higher in rural areas than in urban settings. Of significant concern, the suicide rate per capita in Butte County is elevated to nearly twice that of California overall (18.1 vs. 10.4 per 100,000 population); and likewise elevated above the HP-2020 objective (10.2). This is especially alarming when viewed in the context of Butte County’s co-occurring elevated metrics for drug induced deaths and excessive alcohol use; as nationally drug induced and alcohol related deaths in combination with suicide, collectively referred to as deaths of despair, have resulted in decreasing life expectancy in the United States since 2015. Rates of depressive disorders, a strong risk factor for suicide, also appear to be elevated in Butte County. Twenty-seven and five tenths percent of BRFS respondents in Butte County indicated having been diagnosed with a depressive disorder, compared to 17.3% statewide, and 20.0% nationwide. Focus groups also overwhelmingly felt mental health was a top community health priority in Butte County, with 69.3% of total focus group participants ranking mental health as a very important community health priority area. The finding that all of Butte County meets HRSA Mental Health Professional Shortage Area criteria highlights a disparity between the population’s need for mental health...
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