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									Citrus County Health Needs Assessment




   Prepared by the North Central Florida Health Planning Council, Inc.
                            December 2003




   Production of this document is supported with funds provided by the
                       Florida Department of Health
ACKNOWLEDGEMENTS

A special thank you to Virginia Crandall for her enthusiasm and dedication. Her participation
was invaluable to successfully completing the focus group process.



Council Staff

Edith M. Orsini, Executive Director
Alene Beck
Sandra Carroll
Caroel DeBose
Desiree Hayes
Marie Hill
Karen Klubertanz
Sarah McKune
Celia Paynter
Arun Skaria




Citrus County Health                          ii                              North Central Florida
Needs Assessment                                                       Health Planning Council, Inc.
TABLE OF CONTENTS

EXECUTIVE SUMMARY ...............................................................................................1
DEMOGRAPHIC AND SOCIO-ECONOMIC CHARACTERISTICS ......................7
  Introduction ..................................................................................................................7
  Population .....................................................................................................................8
     Population Growth and Distribution ........................................................................8
     Population by Age, Race and Gender ....................................................................14
  Socio-Economic Characteristics ...............................................................................19
     Personal Income .....................................................................................................19
     Cost of Living ........................................................................................................22
     Labor Force, Employment, and Types of Industries..............................................23
     Poverty ...................................................................................................................27
     Public Assistance ...................................................................................................32
     TANF and Food Stamp Programs..........................................................................33
     Florida KidCare Program .......................................................................................34
     Public School Free and Reduced Lunch Program .................................................35
     Managed Care ........................................................................................................35
     The Uninsured ........................................................................................................37
     Housing ..................................................................................................................39
     Education ...............................................................................................................40
  Summary of Key Findings ........................................................................................44

HEALTH STATUS ..........................................................................................................47
  Introduction ................................................................................................................47
  Leading Causes of Death ...........................................................................................48
     Average Annual Crude Mortality Rates ................................................................48
     Age-Adjusted Mortality Rates ...............................................................................53
     Age-Specific Mortality Rates ................................................................................57
         Heart Disease ...................................................................................................57
         Cancer ..............................................................................................................60
         Respiratory Disease .........................................................................................63
         Unintentional Injury .........................................................................................65
         Motor Vehicle Crashes ....................................................................................68
     Leading Causes of Death for Children...................................................................72
     Leading Causes of Death for Elders ......................................................................73
     Years of Potential Life Lost ...................................................................................74
  Human Immunodeficiency Virus .............................................................................75
  Hepatitis ......................................................................................................................76
  Morbidity ....................................................................................................................78
     Hospital Utilization Review ...................................................................................78
     Ambulatory Care Sensitive Conditions .................................................................92
  Behavioral Risk Factors ............................................................................................96
  Maternal Health .........................................................................................................97
     Introduction ............................................................................................................97
     Birth Indicators ......................................................................................................97
     Healthy Start Screening Data ...............................................................................103
  Summary of Key Findings ......................................................................................106


Citrus County Health                                                iii                                         North Central Florida
Needs Assessment                                                                                         Health Planning Council, Inc.
COMMUNITY COMMENTS ......................................................................................111
  Focus Groups ............................................................................................................111
  Interviews..................................................................................................................121
  Community Forums .................................................................................................124

STRATEGIES ................................................................................................................129

GLOSSARY AND ACCRONYMS ..............................................................................135

APPENDICES ................................................................................................................143
  Appendix A: Total Population by Race and Ethnicity, by Zip Code, county, and
  Florida, 2003 ..............................................................................................................145
  Appendix B: Ambulatory Care Sensitive Condition discharges and Rates .............147
  Appendix C: Births to All Races, Whites and Non-whites by Zip Code, county
  and Florida, 1997-2001 ..............................................................................................151
  Appendix D: Age Specific and Age Adjusted Mortality Rates, All Races, White
  and Non-white ............................................................................................................153
  Appendix E: Age Specific and Age Adjusted Mortality Rates by Zip Code ..........203
  Appendix F: Focus Group Instrument .....................................................................301




Citrus County Health                                               iv                                         North Central Florida
Needs Assessment                                                                                       Health Planning Council, Inc.
LIST OF TABLES


Table 1.    Population density, 2000 ....................................................................................8
Table 2.    Citrus County population by age group compared to Hernando County
            and the state, 2000-2020 ....................................................................................9
Table 3.    Citrus County population growth (percent change) by age group compared
            to Hernando County and the state, 2000-2020................................................10
Table 4.    Citrus County population growth and percent change by zip code,
            1980-2005 ........................................................................................................12
Table 5.    Population growth and percent change in municipalities and unincorporated
            areas, Citrus County, 1989-2000 .....................................................................13
Table 6.    Citrus County population growth due to natural increase and net migration,
            1999-2000 ........................................................................................................14
Table 7.    Population comparison by age group, 2003 .....................................................16
Table 8.    Citrus County Distribution of Zip Code area population by age, 2003 ...........17
Table 9.    Number and percent of population by gender, ethnicity and race, 2003 .........18
Table 10.   Number and percent of households by income category, by county and
            State, 2003........................................................................................................19
Table 11.   Household income distribution in Citrus County by Zip Code, 2003 .............20
Table 12.   Per capita income and median household income, by county and
            Florida, 2003 ....................................................................................................21
Table 13.   Citrus County per capita and median household income by zip code,
            county, and Florida 2003 .................................................................................21
Table 14.   Price level index, 2002 .....................................................................................22
Table 15.   Price level index ranking comparison 1997-2002 ...........................................22
Table 16.   Retail sales per capita, 1998, 2002...................................................................22
Table 17.   Labor force, 1996, 1998, 2000 .........................................................................23
Table18.    Net job growth in nonagricultural wage and salary employment by county
            and Florida, 1996-2000 ....................................................................................24
Table 19.   Small businesses by percent of total businesses by zip code, county,
            and Florida, 2001 .............................................................................................25
Table 20.   Industry by employment size, 2001 .................................................................26
Table 21.   Major private employers in Citrus County with 100 or more
            employees, 2003 ..............................................................................................26
Table 22.   Percent and estimated number of persons, families and households in
            poverty, 2003 ...................................................................................................27
Table 23.   Number and percent of female-headed families in poverty, by zip code,
            county and Florida, 2000 .................................................................................28
Table 24.   Estimated number and percent of persons in poverty in age groups by
            county and state, 2003......................................................................................29
Table 25.   Estimated number and percent of persons in poverty by level of poverty
            by zip code, county and Florida, 2003 .............................................................31
Table 26.   Medicaid eligibles by age, by county, and Florida, July 31, 2003 ..................33
Table 27.   Number and percent of families, households, and persons receiving TANF
            and food stamps, by county, Florida, August 2002 - July 2003 ......................33
Table 28.   KidCare enrollment type, by county and Florida, June 1, 2003 ......................35
Table 29.   Free and reduced-priced lunches, by county, and Florida, 1997-1998,
            2001-2002 ........................................................................................................35

Citrus County Health                                            v                                            North Central Florida
Needs Assessment                                                                                      Health Planning Council, Inc.
Table 30. Total and percent HMO enrollment, by county, and Florida as
          of March 31, 2003 ............................................................................................36
Table 31. Total and percent HMO enrollment, by type, by county, and Florida
          as of March 31, 2003 .......................................................................................36
Table 32. Number and percent of Medicare beneficiaries in managed care and the
          reimbursement rate in Citrus and Hernando counties, June 30, 1997, 1998
          1999, and 2000 .................................................................................................36
Table 33. Estimated Number and percent of non elder uninsured, by county, and
          Florida, 2000 ....................................................................................................37
Table 34. Percent of growth in the number of households (HH) and average
          household size by zip code, by county and Florida, 2000-2008 ......................39
Table 35. Percent of students tested and passing the FCAT, 2003 ..................................40
Table 36. Citrus County Public Schools FCAT scores, 1999-2003 ................................41
Table 37. High school graduation and dropout rates, by county and Florida,
          1994-1995 and 2000-01 school years ..............................................................42
Table 38. Estimated number and percent of persons 25 and over by highest level
          of education completed, by zip code, county and Florida, 2000 .....................43
Table 39. Average annual crude death rates per 100,000, population for all races
          by leading causes of deaths, by zip code, county and Florida, 1999-2001 ......49-50
Table 40. Average annual crude death rates per 100,000, population for all age
          groups in white races by leading causes of deaths, by zip code, county
          and Florida, 1999-2001 ....................................................................................51
Table 41. Average annual crude death rates per 100,000, population for nonwhite
          races by leading causes of deaths, by zip code, county and
          Florida, 1999-2001 ...........................................................................................52
Table 42. Age adjusted death rates per 100,000, population for all races by leading
          causes of deaths, by zip code, county and Florida, 1999-2001........................55
Table 43. Leading causes of death by average annual age-adjusted mortality rates
          per 100,000, population for WHITE residents, all ages groups in Citrus
          county compared with Hernando County and the state, 1999-2001 ................56
Table 44. Leading causes of death by average annual age-adjusted mortality rates
          per 100,000, population for NON WHITE residents, all age groups in
          Citrus County compared with Hernando County and the state, 1999-2001 ....56
Table 45. Comparison of leading causes of death in Citrus County by average
          annual age-adjusted mortality rates per 100,000, population, for all
          age groups, by race, 1999-2001 .......................................................................56
Table 46. Age-specific mortality rates for heart disease per 100,000, population
          1999-2001 ........................................................................................................58
Table 47. Age-specific mortality rates for heart disease per 100,000, population
          in selected age groups, by Citrus County Zip Code area, compared with
          the county and the state, 1999-2001 ................................................................60
Table 48. Age-specific mortality rates for cancer per 100,000, population,
          1999-2001 ........................................................................................................62
Table 49. Age-specific mortality rates for cancer per 100,000, population in
          selected age groups, by Citrus County zip code area, compared with
          the county and the state, 1999-2001 ................................................................63
Table 50. Age-specific mortality rates for respiratory disease per 100,000,
          population, 1999-2001 .....................................................................................64
Table 51. Age-specific mortality rates for respiratory disease per 100,000,

Citrus County Health                                           vi                                       North Central Florida
Needs Assessment                                                                                 Health Planning Council, Inc.
            population in selected age groups, by Citrus County zip code area,
            compared with the county and the state, 1999-2001........................................65
Table 52.   Age-specific mortality rates for unintentional injuries per 100,000,
            population, 1999-2001 .....................................................................................67
Table 53.   Age-specific mortality rates for unintentional injuries per 100,000,
            population in selected age groups, by Citrus County zip code area,
            compared with the county and state, 1999-2001 .............................................68
Table 54.   Age-specific mortality rates for motor vehicle crashes per 100,000,
            population , 1999-2001 ....................................................................................69
Table 55.   Age-specific mortality rates for motor vehicle crashes per 100,000,
            population in selected age groups, by Hernando County zip code areas
            compared with the county and state, 1999-2001 .............................................71
Table 56.   Leading causes of death for children 0-14 in Citrus County compared to
            Hernando County and Florida, average annual age-specific mortality rates
            per 100,000, population, 1999-2001 ................................................................72
Table 57.   Leading causes of death for adults 65 and over in Citrus County compared
            to Hernando County and Florida, average annual age-specific mortality
            rates per 100,000, population, 1999-2001 .......................................................73
Table 58.   Years of potential life lost (YPLL) by Citrus County residents due to the
            leading causes of death by age and percent of total years of potential life
            lost by cause, 1999-2001..................................................................................74
Table 59.   Number and rate of Hepatitis cases by type, by county and Florida,
            1996-2001 ........................................................................................................77
Table 60.   Citrus County residents by zip code and hospital utilized, calendar
            year 2002 ..........................................................................................................80-81
Table 61.   Citrus County, Hernando County, and Florida residents by type of hospital,
            admission, calendar year 2002 .........................................................................83
Table 62.   Percent of hospital admissions, by type, by zip code area, calendar
            year 2002 ..........................................................................................................83
Table 63.   Hospital discharges of Citrus County residents for the top 23 leading
            reasons for hospitalization by Diagnosis-Related Group (DRG),
            calendar Year 2002 ..........................................................................................85
Table 64.   Hospital discharges of Citrus County residents (0 – 17 years of age) for
            the top 16 leading reasons for hospitalization by Diagnosis-Related
            group (DRG), Calendar Year 2002 ..................................................................86
Table 65.   Hospital discharges of Citrus County residents (18 – 64 years of age) for
            the top 21 leading reasons for hospitalization by Diagnosis-Related
            group (DRG), Calendar Year 2002 ..................................................................87
Table 66.   Hospital discharges of Citrus County residents (65+ years of age) for
            the top 24 leading reasons for hospitalization by Diagnosis-Related
            Group (DRG), calendar Year 2002 ..................................................................88
Table 67.   Percent of Citrus County resident discharges per hospital by payor source,
            calendar year 2002 ...........................................................................................91
Table 68.   Average charges per patient day for Citrus County residents by hospital
            calendar year 2002 ...........................................................................................91
Table 69.   Major behavioral risk factors in Citrus County, Hernando County and
            the State, 2002 ..................................................................................................96
Table 70.   Total births and birth rates per 1,000 population by zip code, by race, by
            county and Florida, 1999-2001. .......................................................................98

Citrus County Health                                            vii                                         North Central Florida
Needs Assessment                                                                                     Health Planning Council, Inc.
Table 71. All races low birthweight babies by Zip Code, by county and Florida,
          1997-2001 ........................................................................................................99
Table 72. Low birthweight in Citrus County, Hernando County and Florida,
          1997-2001 ........................................................................................................99
Table 73. Very low birthweight, by county and state, for white, nonwhite and all
          births, 1997-2001 ...........................................................................................100
Table 74. All races very low birthweight babies by zip code, by county and
          Florida, 1997-2001 .........................................................................................100
Table 75. Infants mortality indicators, by county and state, for white, nonwhite
          and all births, 1997-2001 ...............................................................................101
Table 76. All races infant deaths by zip code, by county and Florida, 1997-2001 ........101
Table 77. Teen births (15-17) and rates per 1,000 female adolescents by race,
          by Zip Code, by county and Florida, 1999-2001 ...........................................102
Table 78. Healthy Start prenatal screening results, by county, Central Healthy Start,
          and Florida, June 2002-June 2003 .................................................................104
Table 79. Healthy Start infant screening results, by county, Central Healthy Start,
          and Florida, July 2002-June 2003 ..................................................................105




Citrus County Health                                             viii                                      North Central Florida
Needs Assessment                                                                                    Health Planning Council, Inc.
LIST OF FIGURES


Figure 1.     Citrus County ..................................................................................................7
Figure 2.     Comparison of population growth for Citrus and Hernando Counties,
              2000-2002 .......................................................................................................9
Figure3.      Comparison of population growth for Citrus and Hernando Counties,
              2000-2002 .....................................................................................................10
Figure 4.     Zip Code map of Citrus County, 2001 ..........................................................11
Figure 5.     Citrus County areas of highest and lowest population growth, 1990-2008 ..13
Figure 6.     Percent of population change due to natural increases and net migration,
              1990-2000 .....................................................................................................14
Figure 7.     2003 population pyramid for Citrus County .................................................15
Figure 8.     2003 population pyramid for Hernando County ...........................................15
Figure 9.     2003 population pyramid for Florida ............................................................15
Figure 10.    Unemployment rates, trend data 1996-2000 .................................................23
Figure 11.    Rate of new job growth by county, 1996-2000.............................................24
Figure 12.    Proportion of severities of poverty with Citrus and Hernando Counties
              and Florida, 2003 ..........................................................................................30
Figure 13.    Uninsured District 2 residents by specific age categories, 2000
              (compared to Florida) ...................................................................................38
Figure 14.    Zip Code Map of Citrus County, 2003 .........................................................59
Figure 15.    Percent of Citrus County residents by hospitals used, calendar
              year 2002 .......................................................................................................78
Figure 16.    Percent of Citrus County resident discharges by Zip Code area
              compared to percent of Citrus County population by Zip Code area,
              calendar year 2002 ........................................................................................79
Figure 17.    Percent of Citrus County residents by type of hospital admission,
              calendar year, 2002 .......................................................................................82
Figure 18.    Births to Citrus County Resident by Hospital...............................................86
Figure 19.    Citrus County, Hernando County and Florida Residents by hospital
              discharge status, calendar year, 2002 ............................................................89
Figure 20.    Percent of Residents by Payor for Hospital charges, Citrus County
              compared to Hernando County and Florida calendar year, 2002 .................90
Figure 21.    Rate of ACS discharges all ages by payor across county and state ..............93
Figure 22.    Citrus County ACS discharge rates by payor and patient age, 2003 ............94
Figure 23.    ACS discharge rates where Medicaid is payor by age group across
              counties and state ..........................................................................................94
Figure 24.    Total Birth Rate 1997-2001, Citrus County, Hernando County and state ....97
Figure 25.    Comparison of Birth rates between white and nonwhite adolescent
              Females, ages 15-17, in Citrus County, Hernando County and state,
              1999-2001 ...................................................................................................102




Citrus County Health                                            ix                                           North Central Florida
Needs Assessment                                                                                      Health Planning Council, Inc.
               Demographic and Socio-Economic
                       Characteristics
Introduction
The demographic and socio-economic characteristics of Citrus County residents are provided for
review. A comparison, when data are available, is provided for Citrus County, Hernando
County1, and Florida. The data indicators include, but are not limited to: population by age,
gender and race, population growth, population distribution, income levels, per capita and
median household income, retail sales activities, labor force, job growth, industry by
employment size, estimated number of persons and families in poverty, public assistance
enrollment, access to health insurance, and educational indicators. The information provided in
this section helps to establish a profile for the people of Citrus County and distinguish what
resources may be available to meet the health care needs of low-income, uninsured or
underinsured residents.

Figure 1. Citrus County




1
 Hernando County is designated a ―peer county‖ of Citrus County by the U.S. Health Resources and Services
Administration, due to similarities in population size, density, and poverty, and is the peer selected for comparison
because of its proximity to Citrus County.

Citrus County Health                                     7                                     North Central Florida
Needs Assessment                                                                        Health Planning Council, Inc.
Population
Citrus County, located on "Florida's Nature Coast", is located 70 miles north of Tampa and 60
miles northwest of Orlando, along Florida's west-central coast and the Gulf of Mexico (Figure
1). Citrus County is bordered by Levy and Marion Counties to the north, Sumter County to the
east and Hernando County to the south, and has a population just over 118,000. The city of
Inverness, the county seat, has a population of about 30,200 and is one of two municipalities in
the county, the second being Crystal River.

Despite Citrus County’s rapid growth over the past 20 years, the county continues to be rural
(less than 500 persons per square mile) in nature. Citrus County, comprised of 584 square miles,
has 202 persons per square mile, compared to peer county Hernando which has 274 persons per
square mile (Table 1). By comparison, the state of Florida as a whole averages 296 persons per
square mile.

Table 1. Population density, 2000

                                   Population                      Area                     Density
           Area                                                                      People per Square
                                       Total                 Square Miles
                                                                                            Mile
          Citrus                            118,085                          584                         202
        Hernando                            130,802                          478                         274
          Florida                       15,982,378                        53,937                         296
Note: Land area figures represent the total area in the counties in 2000 and are not adjusted for lands which cannot be developed
(government owned parks and reserves) or are uninhabitable (swamps or marshes).
Source: US Department of Commerce, Bureau of the Census, 2000 Summary File 1.
Prepared by NCFHPC


Population Growth and Distribution
Over the past two decades, growth along Florida’s Nature Coast has been among the fastest
growth in the state. The number of residents in Citrus County grew from an estimated 54,700 to
over 118,000 between 1980 and 2000, a growth rate of 116 percent. For this same period,
Hernando County grew by 194 percent and the state experienced a growth rate of 64 percent.

As illustrated in Figures 2 and 3, in addition to Tables 2 and 3, projections for population growth
in each area over the next 20 years indicate the growth rate is slowing, although the county will
continue to exceed the state’s growth rate through 2020 (Figure 3). Projected growth for the
county between 2000 and 2020 is estimated to be 38.8 percent, an increase of 45,783 persons,
which is a slightly lower rate than is projected for Hernando County and slightly higher than
projected for the state.




Citrus County Health                                          8                                        North Central Florida
Needs Assessment                                                                                Health Planning Council, Inc.
Figure 2. Comparison of population growth for Citrus and Hernando Counties, 2000-2020



                  Population Growth Comparison for Citrus and Hernando Counties,
                                           2000-2020
   200,000

   150,000

   100,000

    50,000

          0
                                                Citrus                                                                     Hernando
                                                                   2000      2005      2010      2015       2020
       Source: University of Florida, Bureau of Economic Business and Research, Florida Population Studies Bulletin #133 Population Projections by Age, Sex and Race.
       Prepared by NCFHPC, 2003.




Table 2. Citrus County population by age group compared to Hernando County and the state, 2000-2020

     Area                    Age                      2000                     2005                     2010                     2015                     2020

                                   Total               118,085                  129,245                  140,646                  152,124                  163,868
                                    0-14                 16,581                    16,142                  16,238                   16,189                   17,596
                                  15-24                    9,299                   11,380                  11,777                   11,544                   11,291
Citrus                            25-44                  22,616                    21,696                  21,433                   22,092                   23,313
                                  45-64                  31,725                    37,974                  43,914                   46,696                   47,224
                                     65+                 37,864                    42,053                  47,284                   54,973                   64,444
                                     18+                 97,632                 108,821                  120,157                  131,228                  142,222
                                   Total               130,802                  143,067                  156,641                  170,686                  185,030
                                    0-14                 20,369                    20,996                  21,296                   21,885                   23,077
                                  15-24                  11,687                    13,528                  14,685                   15,188                   15,005
Hernando                          25-44                  26,636                    25,605                  25,521                   26,441                   28,210
                                  45-64                  31,915                    40,467                  47,809                   50,998                   51,704
                                     65+                 40,195                    42,471                  47,330                   56,174                   67,034
                                     18+               105,922                  117,169                  130,018                  143,455                  156,700
                                   Total          15,982,378               17,436,441               18,866,703               20,314,499               21,792,601
                                    0-14            3,048,560                3,192,750                3,330,028                3,529,079                3,744,189
                                  15-24             1,953,977                2,257,078                2,425,608                2,488,072                2,532,037
Florida                           25-44             4,565,763                4,498,566                4,478,773                4,673,231                4,982,649
                                  45-64             3,619,911                4,442,670                5,217,234                5,596,120                5,713,686
                                     65+            2,794,167                3,045,377                3,415,060                4,027,997                4,820,040
                                     18+          12,318,892               13,554,310               14,812,370               16,061,167               17,293,988
Source: University of Florida, Bureau of Economic Business and Research, Florida Population Studies Bulletin #133 Population
Projections by Age, Sex and Race.
Prepared by NCFHPC, 2003.


Citrus County Health                                                           9                                                   North Central Florida
Needs Assessment                                                                                                            Health Planning Council, Inc.
Notably, the estimated growth rate for Citrus County’s population 65 and over is 24.9 percent
between the years 2000-2010. This growth rate is higher than the rates for both neighboring
Hernando County (17.8 percent) and the state of Florida (22.2 percent). Additionally notable,
the population growth rate of persons 25-44 in each of the three areas is expected to decline
through 2010, before beginning to increase between 2010 and 2015 (Table 3).
Figure 3. Comparison of population growth for Citrus and Hernando Counties, 2000 –2020

    10
      8
      6
      4

      2
      0
              2000-2005             2005-2010              2010-2015              2015-2020

                                   Citrus         Hernando              Florida

Source: University of Florida, Bureau of Economic Business and Research, Florida Population Studies Bulletin #133 Population Projections by
Age, Sex and Race.
Prepared by NCFHPC, 2003.

Table 3. Citrus County population growth (percent change) by age group compared to Hernando County
and the state, 2000-2020
                           2000-2005 2005-2010 2000-2010 2010-2015 2015-2020 2000-2020
   Area           Age       Percent       Percent      Percent       Percent     Percent     Percent
                            Change       Change        Change        Change      Change      Change
                     Total         9.5          8.8         19.1           8.2         7.7        38.8
                     0-14         -2.6          0.6          -2.1          3.6         4.6         6.1
                    15-24        22.4           3.5         26.6          -2.0        -2.2        21.4
  Citrus            25-44         -4.1         -1.2          -5.2          3.1         5.5         3.1
                    45-64        19.7         15.6          38.4           6.3         1.1        48.9
                      65+        11.1         12.4          24.9         16.3         17.2        70.2
                      18+        11.5         10.4          23.1           9.2         8.4        45.7
                     Total         9.4          9.5         19.8           9.0         8.4        41.5
                     0-14          3.1          1.4           4.6          2.8         5.4        13.3
                    15-24        15.8           8.6         25.7           3.4        -1.2        28.4
 Hernando           25-44         -3.9         -0.3          -4.2          3.6         6.7         5.9
                    45-64        26.8         18.1          49.8           6.7         1.4        62.0
                      65+          5.7        11.4          17.8         18.7         19.3        66.8
                      18+        10.6         11.0          22.7         10.3          9.2        47.9
                     Total         9.1          8.2         18.0           7.7         7.3        36.4
                     0-14          4.7          4.3           9.2          6.0         6.1        22.8
                    15-24        15.5           7.5         24.1           2.6         1.8        29.6
  Florida           25-44         -1.5         -0.4          -1.9          4.3         6.6         9.1
                    45-64        22.7         17.4          44.1           7.3         2.1        57.8
                      65+          9.0        12.1          22.2         17.9         19.7        72.5
                      18+        10.0           9.3         20.2           8.4         7.7        40.4
Source: University of Florida, Bureau of Economic Business and Research, Florida Population Studies Bulletin #133 Population Projections by
Age, Sex and Race.
Prepared by NCFHPC, 2003
Citrus County Health                                               10                                          North Central Florida
Needs Assessment                                                                                        Health Planning Council, Inc.
Population expansion is occurring in all Zip Code areas, with the greatest growth since 1990 in
the Beverly Hills (34465), Homosassa (34446) and Lecanto (34461) Zip Code areas of the
county (Table 4). The Inverness (34450) and Crystal River (34429) Zip Code areas are
experiencing the slowest growth rates (Figure 5). Expansion rates in each of the Zip Code areas
through 2008 are projected to decrease, though ranking of counties by growth rate is projected to
be similar to 2003’s. Homosassa (34446) is expected to maintain the highest growth rate in the
county of 12.4 percent, while Dunnellon’s growth rate grinds down to a mere one half percent.

Figure 4. Zip Code map of Citrus County, 2001.




Geographical reference by Zip Code:
34428 - North Crystal River                       34448 - West Homosassa
34429 - South Crystal River                       34450 - East Inverness
34433 - South West Dunnellon                      34452 - South West Inverness
34434 - South East Dunnellon                      34453 - North Inverness
34436 - Floral City                               34461 - Lecanto
34442 – Hernando                                  34465 - Beverly Hills
34446 - East Homosassa

Although growth rates are dropping as much as 41 percentage points in some areas, the overall
geographic composition of the county is not changing; county composition is projected to remain
quite stable over the next 20 years.

Citrus County Health                             11                            North Central Florida
Needs Assessment                                                        Health Planning Council, Inc.
Table 4. Citrus County population growth and percent change by Zip Code, 1990-2008
                                                                                                    Projected    Projected
                                                                               Percent   Percent
                                                                                                     Percent      Percent
 Zip Code       Population      Population     Population      Population      Change    Change
                                                                                                     Change       Change
   Area           1990            2000           2003            2008           1990-     2000-
                                                                                                      2003-        1990-
                                                                                2000      2003
                                                                                                      2008         2008
34428 –
Crystal
River                  7,378          8,920          9,474            10,396      20.9        6.2          9.7           40.9
34429 –
Crystal
River (1)              7,912          8,605          9,283            10,310       8.8        7.9         11.1           30.3
34433 –
Dunnellon              3,256          4,262          4,595             5,099      30.9        7.8         11.0           56.6
34434 –
Dunnellon              3,867          4,886          5,115             5,548      26.4        4.7          8.5           43.5
34436 –
Floral City            7,004          8,170          8,556             9,278      16.6        4.7          8.4           32.5
34442 –
Hernando
(2)                    8,764        11,176          11,799            12,880      27.5        5.6          9.2           47.0
34446 –
Homosassa              8,432        12,160          13,329            14,980      44.2        9.6         12.4           77.7
34448 –
Homosassa
(3)                    8,105        10,009          10,367            11,150      23.5        3.6          7.6           37.6
34450 –
Inverness
(4)                    8,679        10,069          10,369            11,105      16.0        3.0          7.1           28.0
34452 –
Inverness              8,725        10,627          11,220            12,231      21.8        5.6          9.0           40.2
34453 –
Inverness              6,491          7,903          8,616             9,649      21.8        9.0         12.0           48.7
34461 –
Lecanto (5)            6,768          8,987          9,801            10,970      32.8        9.1         11.9           62.1
34465 –
Beverly
Hills (6)              7,695        11,764          12,795            14,299      52.9        8.8         11.8           85.8
Citrus               93,515        118,085        125,887            138,508      26.3        6.6         10.0           48.1
Hernando           101,115         130,802        138,958            151,748      29.4        6.2          9.2           50.1
Florida         12,937,926     15,982,378      16,995,730     18,699,598          23.5        6.3         10.0           44.5
Note: Zip Code data include post office boxes.
(1) Includes 34423 Crystal River
(2) Includes 34445 Holder
(3) Includes 34447 Homosassa Springs and 34487 Homosassa
(4) Includes 34451 Inverness
(5) Includes 34460 Lecanto
(6) Includes 34464 Beverly Hills
Source: CACI Marketing Systems 2000, ESRI Business Solutions, 2003
Prepared by NCFHPC.


Citrus County Health                                     12                                     North Central Florida
Needs Assessment                                                                         Health Planning Council, Inc.
Figure 5. Citrus County areas of highest and lowest population growth, 1990 – 2008

                                  Citrus County Population Growth by Zip Code

   18,000
                                                                                                 34429 – Crystal River




                                                                                                 34446 – Homosassa
   12,000



                                                                                                 34450 – Inverness


    6,000

                                                                                                 34461 – Lecanto




         0                                                                                       34465 – Beverly Hills
                  1990               2000               2003               2008

Source: University of Florida, Bureau of Economic Business and Research, Florida Population Studies Bulletin #133 Population
Projections by Age, Sex and Race.
Prepared by NCFHPC, 2003

Growth in Citrus County is greater in the unincorporated areas than in its two municipalities, as
demonstrated in Table 5. From 1980-2000, growth in the unincorporated areas of the county
more than quadrupled the rate of growth in Crystal River and nearly doubled the rate of growth
in Inverness. Since 1990 Crystal River has experienced negative population growth, with a net
loss of 14 percent of their population from 1990-2000.
Table 5. Population growth and percent change in municipalities and unincorporated areas, Citrus County,
1980-2000
                                                    Population                                     Percent Change
         Municipalities
                                      1980             1990             2000         1980-1990        1990-2000        1980-2000
 Crystal River                              2,778         4,050            3,485             45.8            -14.0               25.4
 Inverness                                  4,095         5,797            6,789             41.6             17.1               65.8
 Unincorporated                         47,830           83,666         107,811              74.9             28.9             125.4
 Total                                  54,703           93,513         118,085              70.9             26.3             115.9
Source: University of Florida, Bureau of Economic Business and Research, Florida Estimates of Population, 1980, 1990 and 2000.
Prepared by NCFHPC.

Population fluctuation among Zip Code areas is an indication of the complexity of a growing
rural community. Since 1980, the population growth in the county has been primarily attributed
to in-migration, both from within the state and from out-of-state. As indicated in Table 6 and
Figure 6, this trend continued in the 1990s.



Citrus County Health                                           13                                    North Central Florida
Needs Assessment                                                                              Health Planning Council, Inc.
Table 6. Citrus County population growth due to natural increase and net migration, 1990-2000
                                                                                        Components of Change*
                             Total Population             Population
                                                           Change            Natural Increase                 Net Migration
     County
                                                           1990 to
                         1990               2000            2000            Number       Percent         Number           Percent

 Citrus                      93,513            118,085         24,572        -7,856            -32.0         32,428           132.0
 Hernando                 101,115              130,802         29,687        -6,960            -23.4         36,647           123.4
 Florida              12,938,071         15,982,378        3,044,307        448,216            14.7      2,596,091                 85.3
*Natural increase: births minus deaths; Net migration = the difference between the total population change and natural increase.
Source: University of Florida, Bureau of Economic Business and Research, Florida Statistical Abstract, 2001.
Prepared by NCFHPC.

Figure 6. Percent of population change due to natural increases and net migration, 1990-2000
                 Percent of Population Change 1990-2000 Due to Natural Increases and Net
                     Migration Citrus County Compared to Hernando County and Florida

      Florida


   Hernando


       Citrus


                -60    -40      -20        0        20       40        60       80       100       120      140       160
                                               Net Migration      Natural Increase

*Natural increase: births minus deaths; Net migration = the difference between the total population change and natural increase.
Source: University of Florida, Bureau of Economic Business and Research, Florida Statistical Abstract, 2001.
Prepared by NCFHPC.



Population by Age, Race and Gender
According to Florida Estimates of Population 2001, Citrus County has an older population than
most of the other counties in Florida. As of April 1, 2001, Citrus County ranked third out of the
67 counties in the state for the percent of population over 65 (32.07 percent). Hernando County
ranked fifth for this age group, with 30.7 percent of its residents age 65 and over. As a result of a
large elder population in the county, children in the age group 0-17 years old are significantly
under represented with only 17.2 percent of the county’s total population (ranked 63 out of the
67 counties). This unique age distribution, where the elder population far outweighs the younger
population, is effectively represented and observed in population pyramids (Figures 7-9). Note
that, while Citrus County’s population closely mirrors that of Hernando County rather than the
state of Florida, even in comparison to Hernando County, Citrus County has remarkably few
young people.




Citrus County Health                                           14                                       North Central Florida
Needs Assessment                                                                                 Health Planning Council, Inc.
                                       Figures 7-9. 2003 Population Pyramids for Citrus and Hernando Counties and Florida
Needs Assessment
Citrus County Health




                                                      Citrus County 2003 Popuation Pyramid                                         Hernando County Population Pyramid 2003
                                           85+                                                                       85+
                                         80-84                                                                     80-84
                                         75-79                                                                     75-79
                                         70-74                                                                     70-74
                                         65-69                                                                     65-69
                                         60-64                                                                     60-64
                                         55-59                                                                     55-59
                                         50-54                                                                     50-54
                                         45-50                                                                     45-50
                                         40-44                                                                     40-44
                                         35-40                                                                     35-40
                                         30-34                                                                     30-34
                                         25-30                                                                     25-30
                                         20-24                                                                     20-24
                                         15-19                                                                     15-19
                                         10-14                                                                     10-14
                                           5-9                                                                       5-9
                                           0-4                                                                       0-4
                                             6000 5000 4000 3000 2000 1000    0   1000 2000 3000 4000 5000 6000         6000 5000 4000 3000 2000 1000   0   1000 2000 3000 4000 5000 6000 7000

                                                       Males
                                                        Male                                  Females
                                                                                               Female                                    Male                    Female
15




                                                                                                    Florida Population Pyramid 2003
                                                              85+
                                                            80-84
                                                            75-79
                                                            70-74
                                                            65-69
                                                            60-64
                                                            55-59
                                                            50-54
                                                            45-50
       Health Planning Council, Inc.




                                                            40-44
                                                            35-40
                                                            30-34
                                                            25-30
              North Central Florida




                                                            20-24
                                                            15-19
                                                            10-14
                                                              5-9
                                                              0-4

                                                               800000        600000      400000       200000        0         200000       400000       600000      800000
                                                                                                     Male                         Female



                         Citrus County Health                                                  15                            North Central Florida Needs Assessment                        Health
                         Planning Council, Inc.
Current population estimates for the county depict a similar distribution for 2003, with 33.3
percent of the county’s residents age 65 and over and 17.3 percent less than 20 years old. In
comparison, 31.4 percent of the Hernando County population and 17.8 percent of all Floridians
are age 65 and over, while 19.5 percent of Hernando County residents and 24.7 percent of
Floridians are under age 20 (Table 7). The county has a slightly higher percentage of older elder
residents (age 85 and over) than Hernando County, and a substantially higher percentage than the
state.

The age distribution of Citrus County residents is similar to Hernando County. Though the
county’s median age is slightly higher than that of Hernando County, it is substantially higher
than the state as a whole. Notably, more than 61.7 percent of the county’s population is age 45
and older.

Table 7. Population comparison by age group, 2003

                             Citrus                      Hernando                    Florida
    Age           Number              Percent     Number        Percent     Number             Percent
 All Ages            125,887              100.0    138,958          100.0   16,995,730             100.0

 0–4                    4,532               3.6      6,114            4.4     985,752                5.8

 5–9                    5,035               4.0      6,531            4.7    1,019,744               6.0

 10 - 14                6,168               4.9      7,365            5.3    1,104,722               6.5

 15 - 19                6,043               4.8      7,087            5.1    1,087,727               6.4

 20 - 24                4,658               3.7      5,975            4.3    1,070,731               6.3

 25 - 44               21,653              17.2     25,846           18.6    4,588,847              27.0

 45 - 64               35,752              28.4     36,407           26.2    4,129,962              24.3

 65 - 84               37,388              29.7     39,186           28.2    2,634,338              15.5

 85 +                   4,532               3.6      4,447            3.2     390,902                2.3
 Median
 Age                                       54.2                      51.1                           39.8
Source: ESRI Business Solutions, 2003.
Prepared by NCFHPC.


Table 8 shows a detailed breakdown of residents by age group for each Zip Code area in Citrus
County. The summary results of the age distribution by county reflect the dominant elder
population, yet zip code data show subtle geographical separations of age groups within the
county.

The young adult population (25-44) and children make up the highest proportion of their
respective Zip Code Areas in the Crystal River (34428), Dunnellon (34433) and Inverness
(34452) areas of the county. The highest concentrations of the elder population are in the
Beverly Hills (34465) and Homosassa (34446) Zip Code Areas.
Citrus County Health                                16                             North Central Florida
Needs Assessment                                                            Health Planning Council, Inc.
                                Table 8. Citrus County Distribution of Zip Code area population by age, 2003
Needs Assessment
Citrus County Health




                                                                                                                                             Age
                                                           All
                                Zip Code Area                           0-4            5-9           10-14              15-19           20-24           25-44            45-64            65-84            85+
                                                          Ages
                                                                     No.      Pct.   No.     Pct.   No.      Pct.      No.      Pct.   No.      Pct.   No.      Pct.   No.       Pct.   No.       Pct.   No.     Pct.

                                34428 – Crystal River
                                                            9,474      417 4.4         474 5.0         578 6.1           540 5.7         417 4.4        1,952 20.6      2,890    30.5    1,999    21.1    208 2.2

                                34429 – Crystal River
                                                            9,283      316 3.4         353 3.8         455 4.9           464 5.0         362 3.9        1,606 17.3      2,989    32.2    2,423    26.1    316 3.4

                                34433 – Dunnellon
                                                            4,595      188 4.1         216 4.7         276 6.0           257 5.6         202 4.4         914 19.9       1,392    30.3    1,048    22.8    101 2.2

                                34434 – Dunnellon
                                                            5,115      210 4.1         225 4.4         271 5.3           256 5.0         184 3.6         895 17.5       1,366    26.7    1,519    29.7    184 3.6

                                34436 – Floral City
                                                            8,556      317 3.7         351 4.1         453 5.3           488 5.7         342 4.0        1,532 17.9      2,456    28.7    2,396    28.0    231 2.7

                                34442 – Hernando
                                                           11,799      389 3.3         425 3.6         519 4.4           531 4.5         389 3.3        1,841 15.6      3,469    29.4    3,787    32.1    460 3.9
  17




                                34446 – Homosassa
                                                           13,329      413 3.1         440 3.3         546 4.1           546 4.1         427 3.2        1,946 14.6      3,799    28.5    4,798    36.0    413 3.1

                                34448 – Homosassa
                                                           10,367      404 3.9         446 4.3         539 5.2           508 4.9         404 3.9        1,970 19.0      3,058    29.5    2,778    26.8    249 2.4

                                34450 – Inverness
                                                           10,369      353 3.4         384 3.7         456 4.4           467 4.5         363 3.5        1,586 15.3      3,163    30.5    3,194    30.8    415 4.0

                                34452 –Inverness
                                                           11,220      438 3.9         482 4.3         617 5.5           628 5.6         494 4.4        2,210 19.7      2,771    24.7    3,119    27.8    460 4.1

                                34453 – Inverness
                                                            8,616      370 4.3         388 4.5         431 5.0           422 4.9         345 4.0        1,577 18.3      2,361    27.4    2,361    27.4    353 4.1

                                34461 – Lecanto
                                                            9,801      353 3.6         412 4.2         549 5.6           568 5.8         382 3.9        1,764 18.0      2,930    29.9    2,578    26.3    274 2.8
                                34465 – Beverly Hills
                                                           12,795      397 3.1         422 3.3         448 3.5           397 3.1         320 2.5        1,702 13.3      2,930    22.9    5,323    41.6    857 6.7
Health Planning Council, Inc.




                                Citrus
                                                          125,887    4,532 3.6       5,035 4.0       6,168 4.9         6,043 4.8       4,658 3.7       21,653 17.2     35,752    28.4   37,388    29.7   4,532 3.6
       North Central Florida




                                Hernando
                                                          138,958    6,114 4.4       6,531 4.7       7,365 5.3         7,087 5.1       5,975 4.3       25,846 18.6     36,407    26.2   39,186    28.2   4,447 3.2

                                Florida
                                                        16,995,730 985,752 5.8 1,019,744 6.0 1,104,722 6.5 1,087,727 6.4 1,070,731 6.3 4,588,847 27.0 4,129,962                  24.3 2,634,338   15.5 390,902 2.3

                                Note: Zip Code data include post office boxes. See Table 4 for complete explanation.
                                Source: CACI Marketing Systems 2000, ESRI Business Solutions, 2003
                                Prepared by NCFHPC.


                                Citrus County Health                                           17                                    North Central Florida Needs Assessment
                                                                                                             Health Planning Council, Inc.
Table 9 provides information on the gender, ethnicity and race of the population in Citrus
County, compared to Hernando County and the state. The residents of Citrus County are similar
in gender composition to both of the comparative areas. However, the ethnic and racial
composition of Citrus County is considerably different than the state. The proportion of the
county’s Hispanic population is slightly lower than Hernando County’s and substantially lower
than the state’s. Although Citrus County is home to a slightly lower percentage of Black
residents than Hernando County, the percentage of Black residents within the county is six times
smaller than the state, and the percentage of the county’s white residents is nearly one third
larger than the state.

Table 9. Number and percent of population by gender, ethnicity and race, 2003


                Total               Females                       Males                 Hispanic               Non-Hispanic
  County
              Population
                               Number            Percent    Number        Percent    Number     Percent       Number     Percent


Citrus             125,887          65,461          52.0       60,426        48.0       3,651          2.9     122,236        97.1

Hernando           138,958          72,953          52.5       66,005        47.5       8,060          5.8     130,898        94.2

Florida         16,995,730       8,701,814          51.2    8,293,916        48.8 3,127,214        18.4 13,868,516            81.6


                                                                                       Asian/Pacific
                Total                    White                    Black                                           Other
  County                                                                                 Islander
              Population
                                Number           Percent    Number        Percent    Number     Percent       Number     Percent


Citrus             125,887         119,341           94.8         3,021        2.4      1,259           1.0      2,266         1.8

Hernando           138,958         128,536           92.5         5,836        4.2      1,112           0.8      3,474         2.5

Florida         16,995,730      13,069,716           76.9    2,532,364        14.9    322,919           1.9 1,070,731          6.3
Source: ESRI Business Solutions, 2003.
Prepared by NCFHPC.


Although Black residents represent only 2.4 percent of the county’s population, Black residents
live in greater concentration in the Dunnellon (34434) and Crystal River (34429) Zip Code areas.
(See Appendix A for full details of race and ethnicity by Zip Code Area.) It follows that there
are pockets of the county, such as Homosassa, with very few Black residents (as few as 0.6
percent). Similarly, although 2.9 percent of Citrus County is Hispanic, 5.2 percent of Inverness
(34452) and 4.9 percent of Dunnellon (34434) are Hispanic.




Citrus County Health                                         18                                      North Central Florida
Needs Assessment                                                                              Health Planning Council, Inc.
Socio-Economic Characteristics
The economic status of a county can be assessed by examining personal income, cost of living,
employment rates, labor force, employees by types of industry, and poverty. These standard
measures are used to compare Citrus County with Hernando County and the state.

Personal Income
Citrus County has a larger percentage of population with household income under $25,000 (35.7
percent) than either of the compared areas (Table 10). The county’s percentage of households
with incomes $25,000-$49,999 is higher than the state, but slightly lower than Hernando County.
The percentage of households in the county whose incomes exceed $50,000 is lower than both
Hernando County and the state.
Table 10. Number and percent of households by income category, by county and state, 2003
                                                      $25,000               $50,000             $100,000           $150,000
              Number           Less than
                                                         -                     -                   -                 and
 County      of House-          $25,000
                                                      $49,999               $99,999             $149,999             Over
               holds
                            Number        %       Number        %       Number        %      Number       %      Number      %

Citrus           56,351       20,117      35.7      19,779      35.1      12,510      22.2     2,592       4.6     1,352     2.4

Hernando         59,064       19,196      32.5      21,617      36.6      14,530      24.6     2,363       4.0     1,299     2.2

Florida      6,728,787 1,870,603          27.8 2,052,280        30.5 1,931,162        28.7 531,574         7.9 343,168       5.1
Family household income is the total money received in a calendar year by all family members 15 years and over in a household.
Source: ESRI Business Solutions, 2003.
Prepared by NCFHPC.


Table 11 depicts household income distribution in Citrus County by Zip Code. The percent of
households with less than $25,000 total income ranges from 28.7 percent in the Lecanto area
(34461) to 41.2 percent in the Beverly Hills area (34465). In nine of the 13 postal areas, more
than one third of the households earn less than $25,000.

The percent of Citrus County households in the $25,000-$49,999 income bracket ranges from
30.6 in the Crystal River area (34429) to 39.1 in the Dunnellon area (34434). Each of the 13 Zip
Code areas has a higher percentage of households in this income bracket than does the state as a
whole (30.5 percent). Notably, more than 60 percent of the households in all of the 13 county
Zip Code areas have incomes less than $50,000, with the Floral City area (34436) having the
largest percentage (75.9 percent) in this income bracket and the Crystal River (34429) having the
smallest percentage (61.8 percent).

The Crystal River area (34429) has the highest percentage (38.3) of households with incomes
over $50,000, and the Beverly Hills area (34465) has the lowest (22.6 percent).




Citrus County Health                                         19                                       North Central Florida
Needs Assessment                                                                               Health Planning Council, Inc.
Needs Assessment
Citrus County Health


                                 Table 11. Household income distribution in Citrus County by Zip Code, 2003
                                                                           Less Than                  $25,000-                 $50,000 -              $100,000 -          $150,000 and
                                     Zip Code          Total                $25,000                   $49,999                   $99,999                $149,999               Over
                                       Area          Households
                                                                      Number        Percent      Number        Percent     Number      Percent    Number      Percent    Number    Percent
                                 34428 – Crystal
                                 River                      3,959          1,346         34.0         1,314         33.2         903       22.8        273         6.9       123         3.1
                                 34429 – Crystal
                                 River                      4,232          1,320         31.2         1,295         30.6       1,088       25.7        326         7.7       207         4.9
                                 34433 –
                                 Dunnellon                  1,869            678         36.3           645         34.5         415       22.2          77        4.1        54         2.9
                                 34434 –
                                 Dunnellon                  2,266            811         35.8           886         39.1         460       20.3          66        2.9        43         1.9
                                 34436 – Floral
                                 City                       3,804          1,552         40.8         1,335         35.1         746       19.6        129         3.4        38         1.0
                                 34442 –
                                 Hernando                   5,432          1,771         32.6         1,977         36.4       1,304       24.0        212         3.9       168         3.1
                                 34446 –
                                 Homosassa                  6,128          1,783         29.1         2,200         35.9       1,740       28.4        294         4.8       110         1.8
 20




                                 34448 –
                                 Homosassa                  4,685          1,818         38.8         1,729         36.9         867       18.5        230         4.9        42         0.9
                                 34450 -
                                 Inverness                  5,007          1,918         38.3         1,737         34.7         981       19.6        225         4.5       145         2.9
                                 34452 –
                                 Inverness                  4,898          1,896         38.7         1,768         36.1         989       20.2        167         3.4        78         1.6
                                 34453 –
                                 Inverness                  3,776          1,480         39.2         1,306         34.6         770       20.4        151         4.0        72         1.9
                                 34461 – Lecanto            3,685          1,058         28.7         1,223         33.2       1,080       29.3        206         5.6       122         3.3
 Health Planning Council, Inc.




                                 34465 – Beverly
                                 Hills                      6,353         2,617          41.2        2,300          36.2       1,093       17.2        197         3.1       146         2.3
        North Central Florida




                                 Citrus                    56,351        20,117          35.7       19,779          35.1      12,510       22.2      2,592         4.6     1,352         2.4
                                 Hernando                  59,064        19,196          32.5       21,617          36.6      14,530       24.6      2,363         4.0     1,299         2.2
                                 Florida                6,728,787     1,870,603          27.8    2,052,280          30.5   1,931,162       28.7    531,574         7.9   343,168         5.1
                                 Note: Zip Code data include post office boxes. See Table 4 for complete explanation.
                                 Source: CACI Marketing Systems 2000, ESRI Business Solutions, 2003; Prepared by NCFHPC.


                                 Citrus County Health                                     15                                  North Central Florida Needs Assessment
                                                                                                      Health Planning Council, Inc.
Citrus County residents have a per capita income of $20,546, which is below the state per capita
income of $24,118, but similar to Hernando County ($21,151) (Table 12). Variations in per
capita income within the county are listed in Table 13. Per capita income ranges from $17,455
in the Floral City area (34436) to $26,052 in the Crystal River area (34429), which is the only
Zip Code area in the county with a higher per capita income than both the county and state.

As shown in Table 12, the county median household income ($33,434) is lower than both
Hernando County ($35,162) and the state ($42,332). Income variations within the county are
reported in Table 13; Floral City residents (34436) have the lowest median household income
level and Lecanto area residents (34461), the highest. While no Zip Code area exceeds the state’s
median household income, five Zip Code areas exceed the county’s median household income –
Crystal River (34428 and 34429), Hernando (34442), Homosassa (34446), and Lecanto (34461).

Table 12. Per capita income and median household income, by county and Florida, 2003
                                                          Per Capita Income                       Median Household Income
                  County                                                    Percent of                              Percent of
                                                      Dollars                                      Dollars
                                                                              State                                   State
 Citrus                                                     20,546                       85.2             33,434               79.0
 Hernando                                                   20,151                       83.6             35,162               83.1
 Florida                                                    24,118                      100.0             42,332            100.0
Source: ESRI Business Information Solutions, 2003. Prepared by NCFHPC.


Table 13. Citrus County per capita and median household income by zip code, county, and Florida 2003
                                                            Per Capita Income                   Median Household Income
                 Zip Code Area                                           Percent of                            Percent of
                                                       Dollars                                  Dollars
                                                                        County (State)                        County (State)
    34428 - Crystal River                                 20,896                       101.7      34,788                104.0
    34429 - Crystal River                                 26,052                       126.8      39,219                117.3
    34433 – Dunnellon                                     17,716                        86.2      31,890                  95.4
    34434 – Dunnellon                                     17,924                        87.2      31,624                  94.6
    34436 - Floral City                                   17,455                        85.0      29,619                  88.6
    34442 – Hernando                                      21,791                       106.1      36,398                108.9
    34446 – Homosassa                                     21,421                       104.3      38,895                116.3
    34448 - Homosassa                                     17,438                        84.9      30,331                  90.7
    34450 - Inverness                                     23,512                       114.4      31,727                  94.9
    34452 – Inverness                                     20,036                        97.5      29,861                  89.3
    34453 – Inverness                                     18,207                        88.6      31,705                  94.8
    34461 - Lecanto                                       19,610                        95.4      41,304                123.5
    34465 - Beverly Hills                                 21,246                       103.4      30,051                  89.9
    Citrus                                                20,546                       (85.2)     33,434                (79.0)
    Hernando                                              20,151                       (83.6)     35,162                (83.1)
    Florida                                               24,118                   (100.0)        42,332               (100.0)
Note: Zip Code data include post office boxes. See Table 4 for complete explanation.
Source: ESRI Business Solutions, 2003. Prepared by NCFHPC.
Citrus County Health                                                21                                      North Central Florida
Needs Assessment                                                                                     Health Planning Council, Inc.
Cost of Living
The cost of living in a county provides another measure of economic health. The Florida price
level index is used to compare the relative cost of living within the counties. The five elements
considered in this index are: food, health care, housing, transportation, and other goods and
services.

In 2002, the total price level index for all items in Citrus County was 90.9, ranking the county 56
among the state’s 67 counties (Tables 14 and 15). Housing (81.85) was the lowest and food
(102.44) was the highest of the five indices for Citrus county. The county’s overall price level
index was lower than that of Hernando County.

Table 14. Price level index, 2002
                               Rank Among                                                                      Other Goods
   Area           Index                           Food        Health Care     Housing Transportation
                                Counties                                                                       and Services

Citrus                 90.90               56       102.44           86.63         81.85              96.76              94.24
Hernando               91.74               46        97.55           94.35         84.37              97.02              94.96
Florida              100.00                         100.00          100.00        100.00             100.00            100.00
Source: Florida Department of Education, 2002 Florida Price Level Index. Prepared by NCFHPC.

Table 15. Price level index ranking comparison, 1997-2002

                                                     Rank Among Counties in the State
         Area
                        1997             1998               1999              2000               2001              2002

Citrus                         52                 49                 57                52                 61                 56
Hernando                       32                 40                 47                49                 55                 46
Source: Florida Department of Education, 2002 Florida Price Level Index. Prepared by NCFHPC.


During 2002, retail sales per capita in the county totaled less than half that of Hernando County,
and only 40 percent that of the state (Table 16). Total retail sales in the county from 1997 to
2001 increased by 35.9 percent, higher than the 24.5 percent increase in Hernando County and
29 percent increase in the state. The county’s percentage of increase in total retail sales for the
period was 24 percent higher than that of the state.
Table 16. Retail sales per capita, 1997, 2001
                                     Retail Sales
                                      (Dollars)                                                Per Capita Retail
      Area                                                             Percent Change
                                                                                                    Sales *
                            1997                       2001

Citrus                    1,351,931,000             1,837,215,000                     35.9                $15,240.53
Hernando                  3,333,377,000             4,149,098,000                     24.5                $31,146.81
Florida                480,334,505,000           619,832,393,000                      29.0                $37,912.05
* Calculated using the 2001 ESRI Business Solutions population estimates
Source: University of Florida, Bureau of Economic Business and Research, Florida Statistical Abstract, 1999 and 2002. ESRI
Business Solutions 2001.



Citrus County Health                                          22                                     North Central Florida
Needs Assessment                                                                              Health Planning Council, Inc.
Labor Force, Employment, and Types of Industries
As the unemployment trend data indicate in Table 17 and Figure 10, Citrus County has
traditionally had higher rates of unemployment than either Hernando County or the state. One
exception to this was in 1999 when the state unemployment rate jumped to 4.8, just above Citrus
County’s rate of 4.6. Unemployment rates for 2000 fell back into the 1996-1998 ranking, where
Citrus County’s rate is higher than the state, and state’s rate is higher than Hernando County’s
rate.

Table 17. Labor force, 1996, 1998, 2000

                                                                           1996
          Area                   Labor               Employed               Unemployed                Unemployment
                                 Force                Persons                Persons                      Rate
Citrus                               34,615                 32,481                   2,134                             6.2
Hernando                             43,421                 41,474                   1,947                             4.5
Florida                           6,956,333              6,603,417                352,917                              5.1
                                                                           1998
          Area                   Labor               Employed               Unemployed                Unemployment
                                 Force                Persons                Persons                      Rate
Citrus                               35,347                 33,279                   2,067                             5.9
Hernando                             46,430                 44,634                   1,797                             3.9
Florida                           7,228,000              6,917,833                310,250                              4.3
                                                                           2000
          Area                   Labor               Employed               Unemployed                Unemployment
                                 Force                Persons                Persons                      Rate
Citrus                               37,698                 35,935                   1,763                             4.7
Hernando                             49,074                 47,462                   1,612                             3.3
Florida                           7,490,333              7,221,417                268,750                              3.6
Source: University of Florida, Bureau of Economic Business and Research, Florida County Perspectives, 2001.
Prepared by NCFHPC

Figure 10. Unemployment rates, trend data 1996-2000

   8

   6

   4

   2

   0
            1996            1997             1998            1999            2000
                                Citrus        Hernando           Florida
Source: University of Florida, Bureau of Economic Business and Research, Florida County Perspectives, 2001.
Prepared by NCFHPC




Citrus County Health                                        23                                      North Central Florida
Needs Assessment                                                                             Health Planning Council, Inc.
Net job growth is an important indicator in the economic health of a community. The number of
nonagricultural wage and salaried jobs in Citrus County increased 13.7 percent from 1996
through 2000, though the pace has fluctuated up and down from year to year (Table 18). This
fluctuation in pace is also observed in Hernando County’s history, despite the state’s net job
growth remaining relatively stable (Figure 11). This increase at a county level may reflect some
combination of real economic growth and social choices by more people to enter the labor
market. By comparison, the number of comparable jobs in Hernando County increased 18.2
percent and in the state of Florida, 14.0 percent.

Table 18. Net job growth in nonagricultural wage and salary employment by county and Florida, 1996-2000

         Year                      Area                Number of Jobs             Increase over           Percent Increase
                                                                                  Previous Year
                          Citrus                                  26,802                    1,249                           4.9
1996                      Hernando                                28,126                    1,757                           6.7
                          Florida                              6,635,701                  192,152                           3.0
                          Citrus                                  27,091                      289                           1.1
1997                      Hernando                                28,642                      516                           1.8
                          Florida                              6,865,792                  230,091                           3.5
                          Citrus                                  28,012                      921                           3.4
1998                      Hernando                                29,588                      946                           3.3
                          Florida                              7,077,008                  211,216                           3.1
                          Citrus                                  29,511                    1,499                           5.4
1999                      Hernando                                31,456                    1,868                           6.3
                          Florida                              7,337,465                  260,457                           3.7
                          Citrus                                  30,466                      955                           3.2
2000                      Hernando                                33,256                    1,800                           5.7
                          Florida                              7,566,198                  228,733                           3.1

Figures do not include those jobs performed on an informal basis whose work is not reported to any government agency; figures do
not reveal how many jobs were actually lost and added to arrive at the net gain figure.
Source: University of Florida, Bureau of Economic Business and Research, Florida Statistical Abstract 1999-2002.
Prepared by NCFHPC.


Figure 11. Rate of new job growth by county, 1996-2000

   8


   6


   4


   2


   0
            1996              1997              1998              1999             2000

                                 Citrus         Hernando           Florida

Source: University of Florida, Bureau of Economic Business and Research, Florida Statistical Abstract 1999-2002.
Prepared by NCFHPC.

Citrus County Health                                         24                                       North Central Florida
Needs Assessment                                                                               Health Planning Council, Inc.
Small businesses comprise 96.8 percent of Citrus County’s total private industry, higher than,
though similar, to Hernando County and Florida as a whole (Table 19).



Table 19. Small businesses by percent of total businesses by zip code, county, and Florida, 2001

                                                                                                   Small Business as a
                                                  Total                  Number of
                 Area                                                                               Percent of Total
                                                Businesses             Small Businesses
                                                                                                      Businesses
34428 – Crystal River                                          197                           183                     92.9
34429 – Crystal River                                          489                           471                     96.3
34433 – Dunnellon                                                41                           40                     97.6
34434 – Dunnellon                                                44                           44                    100.0
34436 - Floral City                                              85                           84                     98.8
34442 – Hernando                                               177                           174                     98.3
34446 - Homosassa                                              154                           152                     98.7
34448 - Homosassa                                              233                           221                     94.8
34450 – Inverness                                              344                           339                     98.5
34452 – Inverness                                              141                           135                     95.7
34453 – Inverness                                              191                           187                     97.9
34461 – Lecanto                                                188                           178                     94.7
34465 – Beverly Hills                                          127                           126                     99.2
Citrus                                                       2,415                      2,338                        96.8
Hernando                                                     2,380                      2,296                        96.5
Florida                                                   434,583                    413,647                         95.2
Note: Zip Code data include post office boxes. See Table 4 for complete explanation.
Small business is defined as those businesses with 50 or fewer employees.
Source: U.S. Department of Commerce, Bureau of the Census, County Business Patterns, 2001.

The overwhelming majority of the retail trade and service establishments in the county each
employ fewer than 20 people, similar to Hernando County and the state (Table 20). Generally,
these businesses are characterized by low salaries and may lack health insurance benefits.




Citrus County Health                                      25                                        North Central Florida
Needs Assessment                                                                             Health Planning Council, Inc.
Table 20. Industry by employment size, 2001
                                           Percentage of Establishments by Employment Size
                                     Retail Trade*                                                  Services*
   County
                  Total         1-19       20-49      50-99        100+        Total         1-19      20-49        50-99   100+
                 Number                                                       Number
                                                Percent                                                     Percent
 Citrus                459        89.1         5.7         1.7         3.5       1,139         90.5         6.4       1.7     1.4
 Hernando              355        88.2         3.7         3.4         4.8       1,132         89.8         7.3       1.9     1.0
 Florida           69,077         88.1         6.5         2.6         2.8     206,270         87.2         7.9       2.8     2.1
*North American Industry Classification (NAIC) codes for retail trade: 44-45; services: 54-56, 61,62, 71, 72, 81.
Source: U.S. Census Bureau, County Business Patterns, 2001.
Prepared by NCFHPC.


Three private employers in Citrus County employ at least 1,000 people; Florida Power
Corporation, Citrus Memorial Hospital, and Citrus County School Board (Table 21).
Table 21. Major private employers in Citrus County with 100 or more employees, 2003

                                                                   Number of
   Rank                          Company                                                      Type of Industry
                                                                   Employees

     1       Florida Power Corporation                                       1,000 Utility
     2       Citrus Memorial Hospital                                        1,000 Health Care
     3       Citrus County School Board                                      1,000 Educational
     4       Seven Rivers Community Hospital                                   500 Health Care
     5       Pro-Line Boats                                                   250 Boat Manufacturer
     6       Citrus County Sheriff’s Department                               250 Law Enforcement
     7       Service Zone, Inc                                                100 Business Consult ting
     8       Springs Lodge 378                                                100 Business Services
     9       Citrus County Detention Facility                                 100 Correctional Institute
     10      Cypress Creek Correctional Facility                              100 Correctional Institute
Source: Citrus County Economic Development Council, 2003.




Citrus County Health                                             26                                        North Central Florida
Needs Assessment                                                                                    Health Planning Council, Inc.
Poverty
When measuring poverty it is important to understand how the indicator is measured. Poverty
status is determined for all individuals except institutionalized people (which includes prisons,
nursing homes, etc.), people in military group quarters, people in college dormitories, and
unrelated individuals under 15 years old. These groups are excluded from the numerator and
denominator when calculating poverty, thus are considered neither ―poor‖ nor ―nonpoor‖.

In 2003, an estimated 401,451 Florida families (9 percent) fell below nationally established
poverty levels. Poverty levels are established each year by comparing annual income to ―poverty
thresholds.‖ The thresholds vary by family size: a family of four is considered to be living in
poverty today if the household income is below $18,400. The poverty rate for a county is the
percentage of the county’s families that have an annual income below the poverty threshold. The
threshold also varies by age; in 2002 the poverty threshold was $731 lower for the population
over 65 than it was for those under 65.

Poverty is more prevalent in north central Florida than is typical statewide. Citrus County has
higher percentages of poverty for all persons and families than Hernando County, and lower
percentages of poverty for all persons and families than the state as a whole. An examination of
the poverty status by Zip Code reveals the highest concentration of persons and families in
poverty in the Inverness (34453) and Floral City (34436) Zip Code areas (Table 22). The
Beverly Hills (34465) and Inverness (34450) areas have the lowest percentages of persons and
families living in poverty.
Table 22. Percent and estimated number of persons, families and households in poverty, 2003

                                     All Persons           Total Families              Total Households
                                            Percent                      Percent                       Percent
        Area                     Estimated                    Estimated                     Estimated
                         Total                in       Total                in       Total               in
                                     In                           In                            In
                       Number               Poverty Number               Poverty Number                Poverty
                                  Poverty                      Poverty                       Poverty
                                            (1999)                        (1999)                       (1999)
34428 - Crystal River      9,474     1,274     13.5     2,719        296     10.9     3,959        514    13.0
34429 - Crystal River      9,283     1,093     11.8     2,866        225      7.8     4,232        489    11.6
34433 - Dunnellon          4,595        519    11.3     1,367        129      9.4     1,869        217    11.6
34434 - Dunnellon          5,115        549    10.7     1,612        122      7.6     2,266        182     8.0
34436 - Floral City        8,556     1,320     15.4     2,583        294     11.4     3,804        587    15.4
34442 - Hernando          11,799     1,493     12.7     3,829        347      9.1     5,432        577    10.6
34446 - Homosassa         13,329     1,232      9.2     4,496        313      7.0     6,128        560     9.1
34448 - Homosassa         10,367     1,313     12.7     3,105        340     11.0     4,685        555    11.8
34450 - Inverness         10,369     1,030      9.9     3,217        194      6.0     5,007        495     9.9
34452 – Inverness         11,220     1,248     11.1     3,250        273      8.4     4,898        529    10.8
34453 – Inverness          8,616     1,317     15.3     2,473        284     11.5     3,776        537    14.2
34461 – Lecanto            9,801     1,118     11.4     2,791        212      7.6     3,685        394    10.7
34465 – Beverly Hills     12,795     1,138      8.9     3,975        231      5.8     6,353        684    10.8
Citrus                   125,887    14,698     11.7    38,465     3,271       8.5    56,351     6,374     11.3
Hernando                 138,958    14,361     10.3    42,208     3,009       7.1    59,064     5,775      9.8
Florida               16,995,730 2,126,599     12.5 4,441,076 401,451         9.0 6,728,787 788,981       11.7
Note: Zip Code data include post office boxes. See Table 4 for complete explanation.
Source: U.S., Department of Commerce, Bureau of the Census, 2000 Summary File 3.
Citrus County Health                                         27                               North Central Florida
Needs Assessment                                                                       Health Planning Council, Inc.
As indicated in Table 23, female-headed families (FHF) with children in Citrus County are more
than four times as likely to live in poverty as other types of families (36.2 percent of FHF versus
8.5 percent of all families). The poverty rate for these female-headed families increases
dramatically when the children are less than five years old.

Table 23. Number and percent of Female Headed Families in poverty, by zip code, county and Florida, 2000

                                                              Female-Headed Families           Female-Headed Families
                           Female-Headed Families
                                                              with Related Children in          with Related Children
                          (FHF) with Related Children
                                                                      Poverty                    Under 5 in Poverty

          Area                             Percent                          Total Number Percent
                            Total             of           Number Percent Number of FHF of FHF
                                                     Total
                           Number Number Total             of FHF of FHF of FHF      with    with
                                                    Number
                             of     of FHF Families           in     in      with children children
                                                    of FHF
                           Families        that are        Poverty poverty children <5 in    <5 in
                                             FHF                              <5    poverty poverty
34428 - Crystal River          2,645         188        7.1         188        70      37.2          34         0       0.0
34429 - Crystal River          2,588         202        7.8         202        71      35.1          35       17      48.6
34433 – Dunnellon              1,189         120       10.1         120        48      40.0          27       17      63.0
34434 – Dunnellon              1,409          96        6.8          96        15      15.6          23       15      65.2
34436 - Floral City            2,547         204        8.0         204        83      40.7          23         0       0.0
34442 – Hernando               3,319         167        5.0         167        96      57.5          29       22      75.9
34446 – Homosassa              4,108         192        4.7         192        81      42.2          23       17      73.9
34448 - Homosassa              3,047         233        7.6         233        90      38.6          67       67     100.0
34450 - Inverness              3,191         208        6.5         208        60      28.8          26         7     26.9
34452 – Inverness              3,094         258        8.3         258        87      33.7          36         8     22.2
34453 – Inverness              2,450         185        7.6         185        54      29.2          24         0       0.0
34461 - Lecanto                2,256         129        5.7         129        39      30.2          12         0       0.0
34465 - Beverly Hills          4,381         259        5.9         259        84      32.4          53       21      39.6
Citrus                       36,415       2,449         6.7        2,449      886      36.2        412       191      46.4
Hernando                     40,214       3,050         7.6        3,050      987      32.4        607       226      37.2
Florida                   4,238,409 501,641            11.8 501,641 164,596            32.8     80,544    30,474      37.8
Note: Zip Code data include post office boxes. See Table 4 for complete explanation.
Source: U.S., Department of Commerce, Bureau of the Census, 2000 Summary File 3.


Children are living in poverty more frequently than any other age group and represent over one-
fifth of all persons in poverty in the county (Table 24). The county’s poverty rate for both
children and adults is higher than the rates for either Hernando County or the state. Notably,
percent of poverty among residents 65 and over is higher at a state level (9.1 percent) than in
Citrus County (7.0 percent).




Citrus County Health                                          28                                     North Central Florida
Needs Assessment                                                                              Health Planning Council, Inc.
                                  Table 24. Estimated number and percent of persons in poverty in age groups by county and state, 2003
           Needs Assessment
           Citrus County Health




                                                                              Children (0-17)                                 Adults (18-64)                             65 and Over

                                              Area                                               Percent in                                    Percent in                              Percent in
                                                                     Total        Estimated                        Total          Estimated                   Total       Estimated
                                                                                                  Poverty                                       Poverty                                 Poverty
                                                                    Number        In Poverty                      Number          In Poverty                 Number       In Poverty
                                                                                                  (1999)                                        (1999)                                  (1999)
                                  34428 – Crystal River                  1,800             355           19.7             5,466          735         13.4       2,207            155           7.0
                                  34429 – Crystal River                  1,411             282           20.0             5,133          595         11.6       2,738            190           6.9
                                  34433 – Dunnellon                        841             136           16.2             2,605          292         11.2       1,149             60           5.2
                                  34434 – Dunnellon                        870             152           17.5             2,542          301         11.8       1,703             94           5.5
                                  34436 – Floral City                    1,420             305           21.5             4,509          807         17.9       2,627            196           7.4
                                  34442 – Hernando                       1,652             446           27.0             5,900          677         11.5       4,248            286           6.7
                                  34446 – Homosassa                      1,733             271           15.6             6,385          734         11.5       5,212            192           3.7
                                  34448 – Homosassa                      1,721             316           18.4             5,619          799         14.2       3,027            199           6.6
                                  34450 – Inverness                      1,483             184           12.4             5,278          551         10.4       3,608            293           8.1
             29




                                  34452 – Inverness                      1,930             372           19.3             5,711          616         10.8       3,579            250           7.0
                                  34453 – Inverness                      1,447             355           24.5             4,454          645         14.5       2,714            286         10.5
                                  34461 – Lecanto                        1,666             247           14.8             5,283          579         11.0       2,852            295         10.3
                                  34465 – Beverly Hills                  1,510             197           13.0             5,105          501           9.8      6,180            440           7.1
                                  Citrus                               19,512           3,657            18.7            64,454        7,902         12.3      41,920          2,932           7.0
                                  Hernando                             24,318           3,988            16.4            71,008        7,542         10.6      43,633          2,696           6.2
                                  Florida                           3,739,061        658,361             17.6 10,231,429           1,183,585         11.6    3,025,240       274,307           9.1
Health Planning Council, Inc.




                                  Note: Zip Code data include post office boxes. See Table 4 for complete explanation.
                                  Numbers in BOLD indicate the zip code area with the highest percent
       North Central Florida




                                  Source: U.S., Department of Commerce, Bureau of the Census, 2000 Summary File 3.




                                  Citrus County Health                                         29                                   North Central Florida Needs Assessment
                                                                                                            Health Planning Council, Inc.
Within Citrus County the highest concentration of poverty by age and Zip Code area exists
among children in the Hernando (34442) and Inverness (34453) Zip Code areas. The adult
population in poverty exists in greatest concentration in the Floral City (34436) and Inverness
(34453) Zip Code areas. For both children and adults, the lowest concentrations of poverty are
located in the Inverness (34450) and Beverly Hills (34469) Zip Code areas. It is interesting to
note that, although the Inverness (34453) Zip Code area has a high percentage of poverty among
the population 65 and over, the elder population generally does not follow the same geographic
patterns of poverty that the children and adults of Citrus County follow: excluding Inverness
(34453) the highest percentage of poverty among those 65 and over is in the Lecanto (34461) Zip
Code area, and the lowest percent in the Homosassa (34446) and Dunnellon (34433) Zip Code
areas.

Table 25 provides the estimated number of persons in the county by poverty level. Abject
poverty (less than 50 percent of poverty or $4,490) for Citrus County is higher than Hernando
County, but less prevalent than in the state. As demonstrated in Figure 12, a slightly larger
proportion of the state of Florida lives above 200 percent of poverty; however a higher
percentage of Floridians live below 100 percent of poverty than either Citrus or Hernando
County.

Figure 12. Proportion of severities of poverty with Citrus and Hernando Counties and Florida, 2003

    100%


      90%


      80%


      70%


      60%


      50%


      40%


      30%


      20%


      10%


       0%
                          Citrus                            Hernando                             Florida

    Under 50% Poverty              50-99% Poverty               100-124% Poverty              125-149% Poverty
    150-174% Poverty               175-184% Poverty             185-199%                      Above 200% Poverty
Source: U.S., Department of Commerce, Bureau of the Census, 2000 Summary File 3. ESRI Business Solutions, 2003.


Citrus County Health                                      30                                    North Central Florida
Needs Assessment                                                                         Health Planning Council, Inc.
   Table 25. Estimated number and percent of persons in poverty by level of poverty, by zip code, county and
   Florida 2003
                                    Under 50% of          50%-99% of           100%-124% of          125%-149% of
                         Total         Poverty              Poverty                Poverty               Poverty
        Area
                       Population
                                  Number Percent Number Percent Number Percent Number Percent
34428 – Crystal River       9,474     576         6.1         698       7.4       501          5.3       683     7.2
34429 – Crystal River            9,283        367          4.0             726     7.8        328          3.5          392     4.2
34433 – Dunnellon                4,595        190          4.1             329     7.2        324          7.1          286     6.2
34434 – Dunnellon                5,115        249          4.9             299     5.9        317          6.2          620    12.1
34436 - Floral City              8,556        477          5.6             843     9.9        488          5.7          577     6.7
34442 – Hernando                11,799        607          5.1             886     7.5        357          3.0          552     4.7
34446 - Homosassa               13,329        489          3.7             742     5.6        397          3.0          690     5.2
34448 - Homosassa               10,367        608          5.9             704     6.8        639          6.2          706     6.8
34450 – Inverness               10,369        463          4.5             567     5.5        471          4.5          694     6.7
34452 – Inverness               11,220        515          4.6             733     6.5        586          5.2          533     4.7
34453 – Inverness                8,616        480          5.6             838     9.7        322          3.7          542     6.3
34461 – Lecanto                  9,801        346          3.5             772     7.9        331          3.4          497     5.1
34465 – Beverly Hills           12,795        525          4.1             613     4.8        518          4.0          500     3.9
Citrus                        125,887       5,947          4.7           8,751     7.0      5,632          4.5        7,346     5.8
Hernando                      138,958       5,234          3.8           9,127     6.6      5,614          4.0        7,964     5.7
Florida                     16,995,730 967,230             5.7        1,159,369    6.8    738,005          4.3       821,796    4.8

                                        150%-174% of   175%-184% of    185%-199% of
                             Total                                                     200% and Over
          Area                             Poverty        Poverty         Poverty
                           Population
                                       Number Percent Number Percent Number Percent Number Percent
34428 – Crystal River            9,474      475    5.0    298      3.1    294      3.1   5,949    62.8
34429 – Crystal River            9,283          301       3.2            201       2.2        416          4.5        6,552    70.6
34433 – Dunnellon                4,595          215       4.7             55       1.2        116          2.5        3,081    67.1
34434 – Dunnellon                5,115          168       3.3             71       1.4        218          4.3        3,173    62.0
34436 – Floral City              8,556          435       5.1            295       3.5        290          3.4        5,150    60.2
34442 – Hernando                11,799          682       5.8            249       2.1        603          5.1        7,864    66.6
34446 – Homosassa               13,329          496       3.7            380       2.8        475          3.6        9,660    72.5
34448 – Homosassa               10,367          563       5.4            309       3.0        406          3.9        6,431    62.0
34450 – Inverness               10,369          486       4.7            216       2.1        408          3.9        7,064    68.1
34452 – Inverness               11,220          799       7.1            297       2.6        453          4.0        7,304    65.1
34453 – Inverness                8,616          412       4.8            179       2.1        469          5.4        5,374    62.4
34461 – Lecanto                  9,801          582       5.9            240       2.4        149          1.5        6,884    70.2
34465 – Beverly Hills           12,795          854       6.7            229       1.8        367          2.9        9,189    71.8
Citrus                        125,887         6,488       5.2          3,041       2.4      4,683          3.7       83,998    66.7
Hernando                      138,958         7,993       5.8          3,640       2.6      4,660          3.4       94,726    68.2
Florida                     16,995,730      795,665        4.7        345,459      2.0    465,926          2.7 11,702,281      68.9

    Note: Zip Code data include post office boxes. See Table 4 for complete explanation.
    Source: U.S., Department of Commerce, Bureau of the Census, 2000 Summary File 3. ESRI Business Solutions, 2000
    Citrus County Health                                         31                                  North Central Florida
    Needs Assessment                                                                          Health Planning Council, Inc.
Public Assistance
Florida Medicaid Program
The Florida Medicaid program is administered by the Agency for Health care Administration
(AHCA). The program is funded through federal and state participation, with counties
contributing to inpatient hospital and nursing home services. The Medicaid budget for fiscal
year 2001-02 is approximately $9.9 billion. The current eligibility thresholds for children to
receive Medicaid, based on the federal poverty level (FPL) of $18,400 annual income for a
family of four, are as follows:

 Age of Child          Percent of FPL   Eligibility Threshold
        0-1                  185               $34,040
        1-5                  133               $24,472
       6-14                  100               $18,400
       15+                   100               $18,400

Also, pregnant women at 185 percent of FPL or less are Medicaid eligible. All Medicaid
recipients are required to enroll in one of the managed care systems implemented by Florida’s
Medicaid program. Participants who do not enroll are assigned to a managed care system by the
district Medicaid program administrator.

As of July 31, 2003, 13,648 Medicaid-eligible residents in the county were receiving public
assistance. Public assistance includes Supplemental Security Income (SSI) payments made by
the federal Social Security Administration to low-income persons who are aged, blind, or
disabled, as well as Temporary Assistance for Needy Families (TANF). Public assistance does
not include payments made by the government for hospital or other medical care.

Medicaid-eligible residents in the county represent 11.6 percent of the county’s population,
compared to 11.3 percent of Hernando County residents and slightly more than 13.5 percent of
all Floridians.

Across compared geographic areas, young children ages 0-5 are the primary recipients of
Medicaid (Table 26). 45.9 percent of all Medicaid eligible residents in the county are under age
19. The percentage of Medicaid eligibles in Citrus County for all age groups is similar to
Hernando County and the state, though, notably, Hernando elder residents have the lowest rates,
as do Citrus County’s children under five, in the comparison.




Citrus County Health                            32                             North Central Florida
Needs Assessment                                                        Health Planning Council, Inc.
Table 26. Medicaid eligibles by age, by county, and Florida, July 31, 2003
                        Citrus                            Hernando                                 Florida
   Area
                 Number        Percent               Number      Percent                     Number        Percent
0-5                  2,601           19.1                3,343         22.6                      548,192         25.5
6-10                 1,535           11.2                1,701         11.5                      278,184         12.9
11-18                2,125           15.6                2,318         15.7                      370,593         17.2
19-20                  322             2.4                 360           2.4                      49,910           2.3
21-35                2,275           16.7                2,570         17.4                      303,476         14.1
36-59                2,245           16.4                2,352         15.9                      263,380         12.2
60-64                  322             2.4                 289           2.0                      41,887           1.9
65-74                  844             6.2                 801           5.4                     134,324           6.2
75-84                  785             5.8                 659           4.5                     106,787           5.0
85+                    594             4.4                 369           2.5                      55,522           2.6
Total               13,648          100.0               14,762        100.0                    2,152,255        100.0
Source: Agency for Health Care Administration, Medicaid Program Analysis, July 31, 2003.
Prepared by NCFHPC

TANF and Food Stamp Programs
Aid to families with dependent children was a program designed to provide funds to meet the
needs of the parent(s) or the needy relative(s) with whom dependent children are living. During
health care reform, this assistance was renamed ―temporary assistance for needy families‖
(TANF). Under TANF, assistance and work opportunities are provided for participants, but
these services are limited to a two-year period. If after the first two-year period, a family
requires assistance again, they may become eligible; however, there is a five-year cumulative
cap.

During July 2003, 719 Citrus County residents and 337 families received TANF benefits. These
numbers represent similar percentages to those in Hernando County, both much below the state’s
percentage of persons and families receiving TANF.

During July 2003, 6,882 county residents received food stamp, representing 5.8 percent of the
county’s total population. A higher percentage of the state population receives food stamps,
though the Citrus County rate is higher than Hernando County.

Table 27. Number and percent of families, households, and persons receiving TANF and food stamps, by
county, Florida, August 2002 - July 2003
                                                                    TANF                                   Food Stamps
                          House-
            Families             Population             Families             Persons             Households               Persons
  Area                     holds
             (2003)               (2003)
                          (2003)
                                                     Ave                  Ave                  Ave                     Ave
                                                             Percent               Percent           Percent                       Percent
                                                      #                    #                  Number                    #
Citrus      38,465    56,351    118,085    337                     0.9     719             0.6   3,004         5.3     6,882           5.8
Hernando    42,208    59,064    130,802    362                     0.9     686             0.5   2,939         5.0     6,948           5.3
Florida  4,441,076 6,728,787 15,982,378 60,323                     1.4 129,402             0.8 490,229         7.3 1,024,692           6.4
Source: State of Florida, Department of Children and Families, Public Assistance Caseload Report, 2003; ESRI Business Solutions,
2003.
Prepared by NCFHPC


Citrus County Health                                         33                                       North Central Florida
Needs Assessment                                                                               Health Planning Council, Inc.
Florida KidCare Program
In 1998, the Florida Legislature passed the Florida KidCare Act, authorizing the development of
expanded health insurance options for uninsured children living in families under 200 percent of
the federal poverty level (FPL) -- or (today) $36,800 for a family of four. As of January 2003,
KidCare enrollment for the state was over 1.4 million, consisting of MediKids for young
children, Healthy Kids for school-age children, Children’s Medical Services Network for
children with special health care needs, and Children’s Medicaid. Table 28 shows enrollment in
each of the components for Citrus and Hernando counties and the state.
MediKids – MediKids is a Medicaid ―look-alike‖ program for children ages 1-4. As of June 1,
2003, 262 Citrus County children ages 1-4 were enrolled in MediKids. Comparatively, Hernando
County had 361 children enrolled in the program.

Florida Healthy Kids Program - In 1990, the Florida Legislature established the non-profit
Florida Healthy Kids Corporation (FHKC) to administer a comprehensive health insurance
program for families in which parents cannot afford private insurance. This program provides
coverage to uninsured children ages 5-19 and their younger siblings. Children who are age five
and whose family’s household income is between 133-200 percent of FPL and children ages 6-
19 whose family’s household income is between 101-200 percent of FPL are eligible for
subsidized premiums. The highest subsidized premium cost is $20 per family per month,
regardless of the number of children in the family. Medicaid-eligible children cannot enroll;
families above 200 percent of FPL may pay the full premium and enroll their children in Healthy
Kids. Enrollment in Citrus County totaled 1,817 as of 2003.

Children’s Medical Services - Children’s Medical Services (CMS) is a program for children
ages 0-19 that have special health care needs. Like Healthy Kids, CMS was in existence prior to
the implementation of KidCare. Children in CMS have access to specialty providers, care
coordination programs, early intervention services, and other programs that are essential for their
health care.

CMS is statutorily authorized to operate the CMS Network, which is a managed care option for
low-income children with special health care needs. Children ages 0-1 that are between 186-200
percent of FPL, ages 1-6 and between 134-200 percent of FPL, or 6-19 and between 101-200
percent of FPL and who meet the medical criteria may enroll in CMS. They receive the
Medicaid benefit package. Under CMS, there is a new Specialized Behavioral Health Program
option for children ages 15-19 who are between 101-200 percent of FPL and have severe
behavioral health needs.

As of June 1, 2003, 148 children throughout Citrus County were enrolled in CMS; Hernando
County had 87 enrollees.

Children’s Medicaid – Children’s Medicaid includes all children with health care benefits under
the Florida Medicaid Program. As of June 1, 2003, Citrus County had 6,059 enrollees in
Children’s Medicaid. By comparison, Hernando County had 6,888 and Florida had 1,146,522.




Citrus County Health                           34                               North Central Florida
Needs Assessment                                                         Health Planning Council, Inc.
Table 28. KidCare Enrollment Type, by county and Florida, June 1, 2003

                                                                                   Medicaid
                 Healthy                                                                                                 KidCare
   Area                        Medikids         CMS         TITLE XXI TITLE XXI            Title XIX      Medicaid
                 Kids (1)                                                                                                Total (6)
                                                               (2)       (3)                   (4)        Total (5)
Citrus               1,817             262            148               0              7        6,052          6,059          8,286
Hernando             2,674             361             87               0              1        6,887          6,888         10,010
Florida           296,290          36,368          9,270                0        1,428 1,145,094 1,146,522 1,488,450
(1) Healthy Kids total enrollment includes all funding options (Title XXI, state/local, and full pay).
Healthy Kids county level enrollment numbers separating children enrolled through Title XXI health options is not currently available.
(2) Medicaid Title XXI. Teens born before October 1, 1983 between 28 percent of poverty and 100 percent of poverty. Decreases
over time in Medicaid Title XXI enrollment are
expected. Children born on or after October 1, 1983 and meet the Medicaid eligibility requirements would be covered under Title XIX
Medicaid.
(3) Medicaid Title XXI. Babies between 185 percent of the poverty and 200 percent of the poverty.
(4) Medicaid Title XIX.
(5) Medicaid Total is the sum of Medicaid Title XXI, Medicaid Title XXI babies and Medicaid Title XIX.
(6) KidCare Total is the sum of Healthy Kids, MediKids, CMS, and Medicaid Total
Source: State of Florida, Kidcare, County Level Enrollment Trends, June 1, 2003

Public School Free and Reduced Lunch Program
Another example of public assistance for children is the free and reduced lunch program
provided by the public school system. The number of children participating in the program has
increased by 17 percent since the 1997-1998 school year, though total school enrollment has
increased only 4.3 percent. Since the 1999-2000 school year, annual enrollment in the free or
reduced school lunch program has exceeded 40 percent of all students (Table 29).

Routinely since 1997-1998 data indicate that a higher percentage of students in the state of
Florida are enrolled in the free and reduced lunch program than in Citrus County; Hernando
County, however, has had lower enrollment percentages than Citrus County since 1999-2000.

Table 29. Free and reduced-priced lunches, by county, and Florida, 1997-1998 - 2001-2002
                             Citrus County                           Hernando County                               Florida
                                                              Percent                   Percent
School Year               Number Percent of          Number                    Number
                                            Number             of Free Number            of Free
                Number of Free and Free and          Free and                  Free and
                                               of                and     of                and
                 Students Reduced Reduced            Reduced                   Reduced
                                            Students          Reduced Students          Reduced
                          Lunches Lunches            Lunches                   Lunches
                                                              Lunches                   Lunches
1997-1998            14,597         5,380            36.9      16,111        6,249          38.8 2,294,160         991,417           43.2
1998-1999            14,626         4,741            32.4      16,421        7,189          43.8 2,336,793 1,019,815                 43.6
1999-2000            14,899         6,167            41.4      16,824        6,867          40.8 2,379,348 1,046,520                 44.0
2000-2001            15,200         6,353            41.8      17,216        6,724          39.1 2,431,521 1,068,609                 43.9
2001-2002            15,230         6,294            41.3      17,940        7,173          40.0 2,499,781 1,092,525                 43.7
Source: State of Florida, Department of Education, Profiles of Florida School Districts, 1997- 1998 - 2001-2002.
Prepared by: North Central Florida Health Planning Council, Inc.


Managed Care
According to the Florida Department of Insurance (DOI), 24 health maintenance organizations
(HMOs) had more than 4,300,000 Floridians enrolled as of March 31, 2003. Statewide 12.6

Citrus County Health                                            35                                       North Central Florida
Needs Assessment                                                                                  Health Planning Council, Inc.
percent of the enrollees are in Medicare HMOs, 17.3 percent are in Medicaid HMOs, and a full
70.1 percent fall into ―other‖, which includes individuals, small groups, large groups, Healthy
Kids, and federal employees (Table 31). Six HMOs are licensed to operate in Citrus County,
with 5,819 residents, or 4.9 percent, enrolled as of March 31, 2003 (Table 30). Notably, 38.2
percent of these are in a Medicaid HMO, over twice that of Hernando County or the state.
Hernando County, where 8 HMOs are licensed to operate, has 25.3 percent of residents enrolled
in HMOs and the state has 27 percent.
Table 30. Total and percent HMO enrollment, by county, and Florida as of March 31, 2003
                                         Population                      Total HMO Enrollees
                            Total                                                          Rate Per
         Area                                     Percent                      Percent
                          HMO's       Number                   Number                        1,000
                                                  of State                     of State
                                                                                          Population
Citrus                            6     118,085         0.7          5,819            0.1          49.3
Hernando                                   8        130,802           0.8           33,128              0.8          253.3
Florida                                  24    15,982,378                      4,313,048                             269.9
Source: State of Florida, Department of Financial Services, HMO Report, March 2003; ESRI Business Solutions, 2003.
Prepared by: North Central Florida Health Planning Council, Inc.

Table 31. Total and percent HMO enrollment, by type, by county, and Florida as of March 31, 2003
                                                        HMO Enrollment Type
     Area       Total Number       Medicare                   Medicaid                 All Others *
                              Number       Percent       Number      Percent       Number      Percent
Citrus                  5,819         24          0.4        2,223         38.2        3,572        61.4
Hernando                   33,128           9,612             29.0          5,655            17.1       17,861        53.9
Florida                4,313,048         541,786              12.6      746,057              17.3     3,025,205       70.1
* All Others include: Individuals, Small Groups, Large Groups, Healthy Kids, and Federal Employees.
Source: State of Florida, Department of Financial Services, HMO Report, March 2003.
Prepared by: North Central Florida Health Planning Council, Inc.

Rural areas often lack Medicare managed health plans because payment rates set by Medicare
are much lower and less predictable in rural areas and because rural areas often lack the
necessary infrastructure, such as provider networks and specialists to make managed care
systems viable. According to the federal Health Care Financing Administration (HCFA), the
number of Medicare beneficiaries in Citrus County enrolled in managed care plans decreased
87.6 percent (from 1,782 to 221) between 1997 and 2000 (Table 32). This is due to a reduction
of the number of HMO’s available and willing to serve Citrus County residents.

Table 32. Number and percent of Medicare beneficiaries in managed care and the reimbursement rate in
Citrus and Hernando counties, June 30, 1997, 1998, 1999, 2000
                              Citrus County                                            Hernando County
 Year      Number of Managed Care Reimbursement Number of            Managed Care Reimbursement
          Beneficiaries Number Percent Rate (Dollars) Beneficiaries Number Percent Rate (Dollars)
1997            34,637 1,782       5.1          445.6       40,384     891    22.1         511.2
1998             35,278       1,688        4.8                454.6          41,326     10,851         26.3          521.4
1999             35,703         309        0.9                474.0          41,742     12,058         28.9          531.8
2000             36,147         221        0.6                488.6          41,970     10,175         24.2          542.7
Source: Health Care Finance Administration, Medicare Market Quarterly Data Files, June 30, 1997, 1998, 1999, 2000.
Prepared by NCFHPC.
Citrus County Health                                          36                                     North Central Florida
Needs Assessment                                                                              Health Planning Council, Inc.
The Uninsured
According to the Florida Health Insurance Study: Statewide Summary 2000 (FHIS), conducted
by the Agency for Health Care Administration (AHCA), 16.8 percent of Floridians under the age
of 65 in 1999 were uninsured. Based on the 1999 rate, an estimated 2,213,363 non-elder
Floridians are currently uninsured. There is clear evidence that persons without health insurance
are less likely to obtain medical care, and their health suffers for it. Floridians without health
insurance often do not have access to preventive care or early diagnosis of health problems,
which leads to more serious problems in the future.

The percent of uninsured non-elder residents in Citrus and Hernando counties is comparable to
the state, though Citrus County has a slightly lower percentage when compared to Hernando
County or the state (Table 33).

Table 33. Estimated number and percent of non elder uninsured, by county, and Florida, 2000

                                       (0 - 64)                                                                 Percent
         Area                                                        Estimated Number Uninsured
                                   2000 Population                                                             Uninsured

Citrus                                                  80,075                                    12,652                 15.8
Hernando                                                90,449                                    14,924                 16.5
Florida                                             13,174,781                                 2,213,363                 16.8
Sources: Agency for Health Care Administration, Florida Health Insurance Study, 1999. U.S., Department of Commerce, Bureau of
the Census 2000 Summary File 1.
Prepared by NCFHPC


Uninsurance rates in Florida decline continuously as incomes rise. Based on data from the 2000
Florida Insurance Study, 34.5 percent of Floridians living below 100 percent of Federal poverty
level (FPL) are uninsured while only 8.6 percent of Floridians living above 250 percent of the
FPL are uninsured. The same can be said for FHIS District 2, in which Citrus County is
included, where 29.2 percent of the residents living below 100 percent of the FPL are uninsured,
compared to 9.7 percent of those living above 250 percent of the FPL.

Throughout the district, there are sizeable differences in uninsurance rates by age (Figure 13).
Among children ages 0-4 in District 2, the uninsurance rate is 9.4 percent, which is below the
district rate of 18.9 percent for all non-elder residents. By contrast, the uninsurance rate among
adults ages 25-34 throughout the district is 25.3. The uninsurance rate of each age group 5-17
and 25-64 is higher for the district than the state and lower for the district than the state for the
remaining age groups. Among adults, increasing age is associated with consistently lower
uninsurance rates, both within the district and throughout the state.

Employment status is associated with varying levels of health insurance coverage. The FHIS
study reports that, within the district, the uninsurance rate for persons 18-64 who are employed
full-time is 16.1 percent, compared to 24.7 percent for those who work part-time and 40 percent
for those who are unemployed. For the state as a whole, the comparative rates are 14.1 percent,
23.8 percent, and 46.2 percent, respectively.




Citrus County Health                                        37                                      North Central Florida
Needs Assessment                                                                             Health Planning Council, Inc.
Figure 13. Uninsured District 2 residents by specific age categories, 2000 (compared to Florida)

   30%
                                                               25.3%
   25%
                                                                            20.7%
                                        19.8%         19.6%
   20%                                                                               17.9%       17.5%
                           14.4%
   15%

               9.4%
   10%

     5%

     0%
               0-4         5-9          10-17     18-24       25-34       35-44     45-54       55-64
                              Florida                                 District 2
The Florida Health Insurance Study, Volume I, 2000.
Data indicated numerically is for Citrus County.


Employment-based insurance is the primary source of health care insurance for non-elder, FHIS
District 2 residents (58.3 percent) and all Floridians (62.7 percent). The percentage with
individually purchased insurance is less than 10 percent for both District 2 (6.7) and the state
(9.0). Publicly funded insurance (Champus/VA, Medicaid and Title XXI programs, other
government programs) accounts for the rest.

Generally, the rates of uninsurance among residents who are employed full time decline as the
size of the employment establishment increases. In the district, 27.4 percent of full-time
employed individuals who are uninsured work for establishments with fewer than 10 employees.
By contrast, only 8.5 percent of full-time uninsured workers work for establishments with 100 or
more employees.

The rate of uninsurance also declines with increasing education. Adults 18-64 in the district with
less than a high school education have the highest rate of uninsurance, at 26.3 percent. This
uninsurance rate is lower than the state as a whole, which has 40.1 percent uninsurance. By
contrast, adults with a bachelor’s degree or higher have the lowest rate of uninsurance for the
district, at 9.5 percent, which is higher than the comparative rate for the state as a whole, which
is 8.5 percent.




Citrus County Health                                          38                                   North Central Florida
Needs Assessment                                                                            Health Planning Council, Inc.
Housing
Growth in the housing arena continues to increase. Between 1990 and 2003, the number of
households in Citrus County has increased by 38.9 percent, from 40,573 to 56,531. The number
of households is projected to increase 19 percent from 2000-2008, an 11.1 percent increase from
the 2003 numbers. This rate of increase (2000-2008) is slightly higher than the projected rate for
Hernando County or the state.

Table 34. Percent of growth in the number of households (HH) and average household size, by zip code, by
county and Florida, 2000-2008
                                         2000                     2003                         2008
                        1990                                                                 Projected Projected
                                        Percent                   Percent         Projected
        Area           House- Number Change Average Number Change Average Number Percent Percent
                                    of             HH       of              HH                Change Change
                        holds            (1990 -                  (2000 -             of
                                          HH                  Size       HH                   Size              (1990 -   (2000 -
                                                   2000)                           2003)               HH
                                                                                                                 2008)     2008)
34428 - Crystal River    3,457     3,713               7.4       2.5     3,959          6.6     2.4    4,384       26.8        18.1
34429 - Crystal River    3,911     3,885             (0.7)       2.3     4,232          8.9     2.1    4,772       22.0        22.8
34433 – Dunnellon        1,689     1,730               2.4       2.5     1,869          8.0     2.5    2,090       23.7        20.8
34434 – Dunnellon        2,123     2,167               2.1       2.2     2,266          4.6     2.2    2,471       16.4        14.0
34436 - Floral City      3,626     3,615             (0.3)       2.3     3,804          5.2     2.2    4,166       14.9        15.2
34442 – Hernando         5,314     5,108             (3.9)       2.2     5,432          6.3     2.1    6,004       13.0        17.5
34446 – Homosassa        4,972     5,541             11.4        2.3     6,128         10.6     2.2    6,975       40.3        25.9
34448 - Homosassa        4,308     4,507               4.6       2.3     4,685          3.9     2.2    5,085       18.0        12.8
34450 - Inverness        4,915     4,845             (1.4)       2.2     5,007          3.3     2.1    5,410       10.1        11.7
34452 – Inverness        4,643     4,617             (0.6)       2.3     4,898          6.1     2.2    5,403       16.4        17.0
34453 – Inverness        3,695     3,426             (7.3)       2.4     3,776         10.2     2.2    4,296       16.3        25.4
34461 – Lecanto          3,179     3,354               5.5       2.7     3,685          9.9     2.6    4,175       31.3        24.5
34465 – Beverly Hills    5,001     5,880             17.6        1.9     6,353          8.0     2.0    7,123       42.4        21.1
Citrus                  40,573 52,634                29.7        2.3    56,351          7.1     2.2   62,634       54.4        19.0
Hernando                42,300 55,425                31.0        2.4    59,064          6.6     2.3   64,968       53.6        17.2
Florida               5,134,869 6,337,929             23.4         2.5 6,728,787        6.2     2.5 7,451,804      45.1        17.6
Note: Zip Code data include post office boxes. See Table 4 for complete explanation.
Source: CACI Marketing Systems, 2000, ESRI Business Solutions 2003.




Citrus County Health                                          39                                      North Central Florida
Needs Assessment                                                                               Health Planning Council, Inc.
Education
Currently, the county has 17 public schools and 6 private schools (K-12). As of Fall 2002,
student enrollment in the public schools totaled 15,344, a 4.9 percent increase since 1998
(Florida Department of Education, January 2003). The majority of public school students, 89
percent, are white, 4.3 percent are African American, and 3.2 percent are Hispanic. Private
school enrollment was 1,097 in 2000.

The Florida Comprehensive Assessment Test (FCAT) was first administered in 1998 as part of
Florida's effort to improve the teaching and learning of higher educational standards. The
primary purpose of the FCAT is to assess student achievement of the high-order cognitive skills
represented in the Sunshine State Standards (SSS) in Reading, Writing, Mathematics, and
Science. The test is administered in grades 3-10 yearly. Though scoring lower than Hernando
County, Citrus County is similar to the state averages for both the communications and
mathematic sections (Table 35).

Table 35. Percent of students tested and passing the FCAT, 2003

                                       Reading                                                    Mathematics
   Area                       Average                                                        Average
               Number                    Average              Percent         Number                    Average              Percent
                              Develop                                                        Develop
               Tested                   Scale Score           Passed          Tested                   Scale Score           Passed
                              Score (1)                                                      Score (1)
Citrus                   70          1,762            270               31             58          1,793             277           40
Hernando                 49          1,848            286               55             50          1,837             287           52
Florida            15,065            1,729            263               31        12,072           1,820             283           42
(1) The FCAT Developmental Score is used to describe performance across all grade levels, 3-10. Its approximate range for both
subjects is 0-3000.
Sources: State of Florida, Department of Education, FCAT 2003 Grade 12 Passing Percent by District .


Schools, as well as students, are being graded by the Department of Education as an
accountability measure. The school-grading component is an important part of Florida’s
standard-based system of accountability. The 1999 legislation requires schools to be assigned a
performance grade of ―A‖ to ―F,‖ based primarily upon student achievement data from the
Florida Comprehensive Assessment Test (FCAT). Other data relevant to a school’s performance
grade include the percentage of students tested, attendance and discipline data, and dropout rates.
The performance grade represents the school’s progress as shown below:

   A=      schools making excellent progress
   B=      schools making above average progress
   C=      schools making satisfactory progress
   D=      schools making less than satisfactory progress
   F=      schools failing to make adequate progress

Citrus County schools exemplified tremendous achievement in the 2003 FCAT testing, with all
elementary and middle schools receiving A rankings, and all high schools receiving B rankings.
The history of performance is shown below (Table 36).


Citrus County Health                                         40                                      North Central Florida
Needs Assessment                                                                              Health Planning Council, Inc.
Table 36. Citrus County Public Schools FCAT Scores, 1999-2003
                                                  Elementary Schools
          Schools                      1999            2000          2001         2002             2003
Citrus Springs Elementary                       C             C             C             A                A
Crystal River Primary                           D             C             C             B                A
Floral City Elementary                          C             C             B             C                A
Forest Ridge Elementary                                                     N             A                A
Hernando Elementary                             D              C            C             C                A
Homosassa Elementary                            D              A            A             A                A
Inverness Primary                               C              A            C             A                A
Lecanto Primary                                 C              A            C             B                A
Pleasant Grove Element.                         C              A            C             B                A
Rock Crusher Elementary                         C              A            B             B                A
                                                     Middle Schools
Citrus Springs Middle                           C              C            B             B                A
Crystal River Middle                            B              C            B             A                A
Inverness Middle                                B              C            C             B                A
Lecanto Middle                                  B              C            B             A                A
                                                      High Schools
Citrus High                                     C              C            C             C                B
Crystal River High                              C              C            C             C                B
Lecanto High School                             C              C            C             B                B
Florida Department of Education, as of August 2003


Graduation and dropout rates must be interpreted as they are defined. In Florida’s system of
public education, a graduate is defined as a student who receives a standard diploma, special
diploma, or GED diploma. The graduation rate is the number of graduates (taken from the
cohort group of first-time ninth graders in fall four years prior to graduation plus subsequent
incoming transfers on the same schedule to graduate), divided by the number of first-time ninth
graders in membership during fall four years prior plus incoming transfer students on the same
schedule to graduate minus students from this combined population who transferred out, students
who left to enroll in a private school, or an adult education program, and deceased students.

A dropout is defined as a student who withdraws from school without transferring to another
school, home education program, or adult education program. Prior to 1998-99, state dropout
rates were reported only for students who were 16 years old or older—that is, students beyond
the age of compulsory school attendance. Now, the dropout rate is calculated and reported for all
children in grades 9-12 who drop out of school.

As indicated in Table 37, graduation rates in Citrus County have fluctuated; rates fell steadily
from 1994/95 – 1997/98, rising again in the three subsequent years, then falling again in the
2001/02 school year. The graduation rate is currently lower than it was in 1994/95, but remains
higher than the state rate. The county’s dropout rate has been consistently as high if not higher
than the statewide dropout rate.




Citrus County Health                                      41                           North Central Florida
Needs Assessment                                                                Health Planning Council, Inc.
Table 37. High school graduation and dropout rates, by county and Florida, 1994-1995 - 2000-01 school years

                      1994-1995                      1995-1996                       1996-1997                      1997-1998
   Area
              Graduation       Dropout        Graduation       Dropout        Graduation      Dropout        Graduation        Dropout
                 Rate           Rate             Rate           Rate             Rate          Rate             Rate            Rate
Citrus                 77.8             6.6           77.3              6.4           66.7             7.4           65.4            6.8
Hernando               66.1             5.7           73.1              5.0           84.6             4.5           66.2            4.7
Florida                72.9             5.2           73.2              5.0           73.2             5.4           71.9            4.8

                      1998-1999                      1999-2000                       2000-2001                      2001-2002
   Area
              Graduation       Dropout        Graduation       Dropout        Graduation      Dropout        Graduation        Dropout
                 Rate           Rate             Rate           Rate             Rate          Rate             Rate            Rate
Citrus                 70.8             7.9           72.3              4.6           73.6             3.2           71.2            4.3
Hernando               68.7             6.1           67.4              2.9           67.8             2.0           74.0            2.1
Florida                60.2             5.4           62.3              4.6           63.8             3.8           67.9            3.2
Sources: State of Florida, Department of Education, Graduation Rates by District, 2000-2001; Dropout Rates by District 2000-
2001.
Prepared by: North Central Florida Health Planning Council, Inc.


In many studies, overall educational attainment level has been found to affect the health status
and behavior of people. Nationally, people living in rural communities tend to have a lower
educational attainment level than those living in metropolitan areas. These factors apply to
North Central Florida.

As indicated in Table 38, Citrus County has a higher percent of residents whose highest level of
education completed is either less than or equal to a high school diploma than Hernando County
or the state as a whole. Citrus County’s proportion of residents with a college degree as their
highest level of education completed is lower than both Hernando County and the state’s
proportion.




Citrus County Health                                         42                                       North Central Florida
Needs Assessment                                                                               Health Planning Council, Inc.
Table 38. Estimated number and percent of persons 25 and over by highest level of education completed, by
zip code, county and Florida, 2000
                                           No High School
                                                                  High School Diploma          College Degree
                            Population         Diploma
            Area                25+      Estimated               Estimated                   Estimated
                               (2003)                 Percent                    Percent                  Percent
                                          Number                  Number                      Number
                                                       (1999)                     (1999)                  (1999)
                                          (2003)                   (2003)                     (2003)
34428 - Crystal River              7,049       1,536       21.8        4,120          58.5        1,392       19.8
34429 - Crystal River                  7,334           1,280         17.5          4,292          58.5            1,761    24.0
34433 - Dunnellon                      3,455             688         19.9          2,206          63.9             561     16.2
34434 - Dunnellon                      3,964             938         23.7          2,347          59.2             679     17.1
34436 - Floral City                    6,614           1,673         25.3          4,025          60.9             916     13.9
34442 - Hernando                       9,557           2,047         21.4          5,560          58.2            1,950    20.4
34446 - Homosassa                    10,956            1,766         16.1          6,916          63.1            2,274    20.8
34448 - Homosassa                      8,055           2,056         25.5          4,780          59.3            1,219    15.1
34450 - Inverness                      8,357           1,908         22.8          4,910          58.7            1,540    18.4
34452 - Inverness                      8,561           2,052         24.0          5,150          60.2            1,359    15.9
34453 - Inverness                      6,652           1,595         24.0          3,960          59.5            1,097    16.5
34461 - Lecanto                        7,547           1,629         21.6          4,221          55.9            1,696    22.5
34465 - Beverly Hills               10,812            2,255          20.9         6,347           58.7         2,211       20.4
Citrus                              99,325           21,538          21.7        59,076           59.5        18,711       18.8
Hernando                           105,886           22,800          21.5        63,365           59.8        19,721       18.6
Florida                         11,744,049        2,364,809          20.1     5,932,276           50.5     3,446,964       29.4
Note: Zip Code data include post office boxes. See Table 4 for complete explanation.
Source: U.S., Department of Commerce, Bureau of the Census, 2000 Summary File 3; ESRI Business Solutions, 2003.




Citrus County Health                                      43                                      North Central Florida
Needs Assessment                                                                           Health Planning Council, Inc.
Summary of Key Findings
The demographic and socio-economic profile of Citrus County reveals the following:
    Population density in Citrus County is 202 persons per square mile compared to 274
     persons per square mile in Hernando County and 296 persons per square mile statewide.
    Growth in Citrus County is occurring at a faster rate than the statewide rate, and this trend
     is projected to continue through 2020 with the greatest growth occurring in the Dunnellon
     (34433), Inverness (34453), Lecanto (34461) and Beverly Hills (34465) Zip Code areas.
    The majority of the county's residents live in unincorporated areas.
    Since 1980, the population growth in the county has been primarily attributed to in-
     migration.
    Citrus County has the third-highest proportion of people age 65 and over and the fifth-
     lowest proportion of children age 0-17 in the state. More than 61 percent of the county’s
     population is age 45 and older.
    The county’s young adult population (25-44) and their children reside primarily in the
     Crystal River (34428) and Dunnellon (34433) Zip Code areas of the county. The elder
     population is predominantly located in the Beverly Hills (34465) and Homosassa Zip Code
     areas of the county.
    The county has a lower percentage of nonwhite residents than the state as a whole.
    In each of the county’s 13 postal areas, at least 28 percent of the households earn less than
     $25,000.

    Per capita incomes for Citrus County residents is slightly higher than Hernando County
     and lower than the state. Per capita income in Citrus ranges from $17,438 in the
     Homosassa area (34448) to $26,052 in the Crystal River area (34429), which is the only
     Zip Code area in the county with a per capita income that is higher than both the county
     and the state.

    Median family income for county residents is lower than the state and Hernando County.
     No Zip Code area exceeds the state’s median household income, and only five areas’ rates,
     Crystal River (34428, 34429), Hernando (34442), Homosassa (34446) and Lecanto
     (34461), – exceed the median household income in the county.
    Of the five cost-of-living indicators, food is the highest in the county.
    Total retail sales in the county from 1998 to 2002 increased by 35.9 percent, compared to a
     24.5 percent increase in Hernando County.
    Citrus County’s unemployment rates for 1996-2000 were higher than the rates for
     Hernando County and the state. The number of nonagricultural wage and salaried jobs in
     Citrus County increased 13.7 percent from 1996 through 2000.
    Small business establishments, employing fewer than 50 people, comprise almost 97
     percent of Citrus County’s private industry.
     More than 89 percent of the retail trade and services business establishments with the
       county employ fewer than 20 people, which may indicate lower salaries and a lack of
       benefits, especially health insurance.
Citrus County Health                            44                             North Central Florida
Needs Assessment                                                          Health Planning Council, Inc.
    The highest percent of families living in poverty in Citrus County reside in the Floral City
     (34436), Homosassa (34448) and Inverness (34453) Zip Code areas. The Beverly Hills
     (34465) and Inverness (34450) areas have the lowest percentages of persons and families
     living in poverty.
    More than 36 percent of the county’s female-headed households with children live in
     poverty. The poverty rate for these families increases to 46.4 percent when the children are
     less than five years old.
    Of the 14,698 county residents living in poverty, 24.9 percent are children 0-17.
    Approximately 11 percent of the county’s total population is eligible for Medicaid.
    From August 2002 to July 2003, more than 700 Citrus County residents received
     temporary aid to needy families (TANF), and 6,882 received food stamps benefits.
    8,286 Citrus County children (ages 0-19) receive services through the Florida KidCare
     program.
    41 percent of the students enrolled in Citrus County public schools participate in the free
     and reduced lunch program.
    Six HMOs operate in Citrus County, with over 5,800 enrollees.
    Nearly 13,000 Citrus County residents under age 65 are estimated to be uninsured.
    Since 1990, the number of households in Citrus County has increased by 38.9 percent;
     another 11.1 percent increase is projected by 2008.
    The percentages of Citrus County public school students passing the FCAT paralleled the
     statewide averages for both the communications and mathematics sections.
    During the 2002-2003 school year, all public schools in Citrus County received recognition
     by their FCAT school scores for demonstrating sustained or significantly improved student
     performance.
    The percentage of Citrus County adult residents who have never obtained a high school
     diploma is higher than the statewide percentage as well as neighboring Hernando County
     for the same measure.




Citrus County Health                           45                               North Central Florida
Needs Assessment                                                         Health Planning Council, Inc.
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Citrus County Health                    46                              North Central Florida
Needs Assessment                                                 Health Planning Council, Inc.

								
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