LIVINGSTON COUNTY COMMUNITY HEALTH ASSESSMENT

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LIVINGSTON COUNTY COMMUNITY HEALTH ASSESSMENT Powered By Docstoc
					  Final Report
October 25, 2002
             Health Indicators
Process
  – Community Health Assessment Committee
     • Held 6 meetings
     • Reviewed data from
       –   NYS Department of Health
       –   NYS Office of Alcohol and Substance Abuse
       –   Census 2002
       –   Finger Lakes Regional Perinatal Database
       –   Local government and agencies
             Health Indicators
Eight Indicators Identified
    1.   Socioeconomic/Demographic
    2.   Maternal Child Health
    3.   Adolescent Health
    4.   Infectious Diseases
    5.   Social/Mental Health
    6.   Physical/Environmental Health
    7.   Health Status/Mortality/Morbidity
    8.   Health and Social Resources
  Indicator #1
Socioeconomic/
 Demographic
                 Indicator #1
       Socioeconomic/Demographic

• Data sources
  – Census 2000
  – Office Alcohol and Substance Abuse Services
                  Indicator #1
       Socioeconomic/Demographic

• Data elements
  – Population
  – Education
  – Income/unemployment/poverty
  – Housing
               #1: Socioeconomic/Demographic


                SCOTTSVILLE

   LE ROY                          HONEOYE FALLS
              CALEDONIA
                                                                    0301
                          AVON       LIMA                                     0303
PAVILION                                                                                  0306
           PIFFARD
                                                                   0302
                                 LIVONIA
                     GENESEO                                                          0307
      LEICESTER                                                        0304
                                    HEMLOCK

                               CONESUS                          0309
         MOUNT MORRIS                      SPRINGWATER
                          GROVELAND                                 0310
                                                                 0308                     0311

            NUNDA
                       DANSVILLE     WAYLAND
                                                         0312                 0313 0314
           DALTON
  HUNT


             CANASERAGA
                #1: Socioeconomic/Demographic


• POP 2000 / Area

•   Yellow = Low
•   Lt Orange = Med
•   Orange = High
•   Brown = Very High



• Census 2000
    – 64,328
    – Includes college
      students and inmates
    – 6,749 in group quarters



     Source: US Census Bureau, Census 2000
        #1: Socioeconomic/Demographic


Race                                                  0301


                                                                           0306

•   Green = White                                 0302


•   Rose= Black/AA                                                  0307


•   Blue = Asian
•   Yellow = Hispanic
•   Purple = Other                                                         0311


                                               0308
                                        0312                 0313




Source: US Census Bureau, Census 2000
        #1: Socioeconomic/Demographic
                         Population


          Population Distribution by Age (Census 2000)
                       Median Age: 35.3

                    Age 65+
                      11%           Age less
                                     than 20
                                       29%
                                                      Increase of 3.1%
           Age 44 - 64                                from 1990, all in
              22%                                     the over 65 group

                                        Age 20 - 44   For non-
                                           38%        institutionalized
                                                      residents the
                                                      increase was 5%
Source: US Census Bureau, Census 2000
            #1: Socioeconomic/Demographic
                         Population


                Racial Distribution (2000 census)


                           Other
                                           Asian
                            6%
                                            1%
                                                       Other Races
                                                           2%
    White
    94%


                                                    Black/AA
                                                      3%

                        •While still primarily white (down from 96%),
                        increases over 1990 among Blacks (22%),
                        Asians (37%)
                        •Hispanics represent 2.3% of population (all
                        races) – 34% increase since 1990

Source: US Census Bureau, Census 2000
         #1: Socioeconomic/Demographic
                              Population

             Livingston County Residents Racial
             Distribution (households only) 2000
                            Census
                                                       White
                                                       Black
             97.1               0.9
                                              1.1      Hispanic
                                                       Other
                                             1.0
                                                     •Only 3% of the non-
                                                     institutionalized population
Households excludes census tracts with college and
                                                     identifies itself as other than
inmate populations                                   White
Source: US Census Bureau, Census 2000
          #1: Socioeconomic/Demographic
                         Population

                          Living Situation (2000 Census)

                                                       Institutionalize
                                                        d population
                                                              5%



         In households
              89%


                                                           Noninstitutional
                                                           ized population
                                                                 6%
         Most residents live
         in households

  Genesee County: 97% live in households
Source: US Census Bureau, Census 2000
        #1: Socioeconomic/Demographic
                       Population

              Nonrelative
                   s           Members of Households
                  7%               Census 2000
          Other
                                         Householde
        relatives
                                             r
           3%
                                            38%

                                          Average
           Child                          household size =
           31%                            2.6




                                        Spouse
                                         21%


Source: US Census Bureau, Census 2000
          #1: Socioeconomic/Demographic
                         Population

              Types of Family Households (Census 2000)
                 Other                      69% of all households
                  6%                        defined as Family
                                            Households
                                            Avg size 3.05
        Female
   householder, no
      husband
       present
         14%



                                                    Married-
                                                 couple family
                                                     80%




Source: US Census Bureau, Census 2000
           #1: Socioeconomic/Demographic
                                    Population

         Family Households with Own Childr en
                    Census 2000             Up from 60% - 1990
              ( A v e r a g e F a m i l y Ho u s e h o l d s i z e : 3 .0 5 )    GenCo 61% - 2000

70%                                                                              64%
60%          49%
50%                                            45%
40%
30%
20%
10%
 0%
      Fam ily hous ehold s            Married -coup le                      Fem ale
          (fam ilies )                   fam ily                      hous ehold er, no
          n=15,346                        n=12,149                    hus b and p res ent
                                                                                n=2222


 Source: US Census Bureau, Census 2000
          #1: Socioeconomic/Demographic
                       Marital Status
• Marital Status
          (based on 52,180 population of at least age 15)
  – Never Married                         31.6%
  – Married                               51.1%
  – Separated                              2.8%
  – Widowed                                5.9%
      • Female                             4.7%
  – Divorced                              8.5%
      • Female                            4.5%

  Source: US Census Bureau, Census 2000
 #1: Socioeconomic/Demographic Population

• Grandparents living in households with
  grandchildren:          627
• Grandparents responsible for
  grandchildren           245 (39.1%)

Genesee County:               38.2%


  Source: US Census Bureau, Census 2000
         #1: Socioeconomic/Demographic
                  School Enrollment

• School Enrollment (19,552)
  – Nursery/preschool                     3.8% (742)
  – Kindergarten                          3.0% (589)
  – Grades 1 – 8                         38.4% (7,512)
  – Grades 9 – 12                        19.7% (3,843
  – College/grad school                  35.1% (6,866)



 Source: US Census Bureau, Census 2000
          #1: Socioeconomic/Demographic
                           Education
• Educational Level
              (based on 40,081 population age 25 or older)
  –   Less than grade 9:                   4.4% (1,775)
  –   9 to 12 (no diploma)                13.2% (5,303)
  –   HS Grad/GED                         33.8% (13,557)
  –   Some College                        19.0% (7,609)
  –   Associates Degree                   10.3% (4,122)
  –   Bachelor’s Degree                   11.4% (4,555)
  –   Graduate or Prof degree             7.9 % (3,160)

  Source: US Census Bureau, Census 2000
          #1: Socioeconomic/Demographic
                          Education

• Educational Level
           (based on 40,081 population age 25 or older)
  – High school or greater                           82.3%
  – Bachelor’s degree of higher                      19.2%




  Source: US Census Bureau, Census 2000
                                   #1: Socioeconomic/Demographic Education


                                             Youth Risk Indicators - School Separation
   population under 21 years old




                                                        % H.S. Dropout
      Rates per 10,000 of the




                                   60                   % H.S. Grads Not Attending College
                                                        % Non-Regents Diplomas
                                   50
                                   40
                                   30
                                   20
                                   10
                                   0
                                        Livingston   Genesse 1998 New York 1998      Livingston
                                           1998                                         1994

Source: 1998 Community Risk Indicators
(NYS Office of Alcoholism and Substance Abuse Services)
          #1: Socioeconomic/Demographic
                  Disability Rates

• Disability
  – Under age 18:                         10% (1,635)
  – Ages 12 – 64                          17% (5,877)
      • Employed: 55.8%
  – Ages 65+                              34.5% (2,438)




  Source: US Census Bureau, Census 2000
         #1: Socioeconomic/Demographic
                         Language

• Language Spoken at Home
  – English Only                         95%
  – Language other than English           5%
  – Spanish                               2%




 Source: US Census Bureau, Census 2000
         #1: Socioeconomic/Demographic
                           Mobility

• Residence in 1995
            (based on population of 60,796 age 5 or older)
  – Same house               59%
  – Same county              19%
  – Same state               19%
  – Elsewhere                 1%




 Source: US Census Bureau, Census 2000
          #1: Socioeconomic/Demographic
                           Housing
• Total Units     24,023
     Homeownership rate 74.5%
  – Single unit                         70.5%
  – Multi-units                         17.9%
  – Mobile homes                        11.5%
• Vehicles available
  –   None                               6%
  –   One                               31%
  –   Two                               44%
  –   Three or more                     19%


Source: US Census Bureau, Census 2000
          #1: Socioeconomic/Demographic
                          Housing
Total Units                  24,023
  – Heating
     •   Utility gas                     47%
     •   Bottle/tank gas                 13%
     •   Electricity                     13%
     •   Fuel oil, kerosene              21%
     •   Wood                             5%



 Source: US Census Bureau, Census 2000
          #1: Socioeconomic/Demographic
                           Housing
• Total Units                 24,023
  – Lacking complete plumbing             0.3%
        (n = 76)
  – Lacking complete kitchen facilities
      (n = 80)                            0.4%
  – No telephone services                 1.1%
      (n = 234)



  Source: US Census Bureau, Census 2000
          #1: Socioeconomic/Demographic Economic
                                        Data

                   Community Risk Indicators - Median Family
                                   Income

          45,000      43,900                             43,646
          44,000
                                               42,700
          43,000
Dollars




          42,000                   40,900
          41,000
          40,000
          39,000
                    Livingston   Livingston   Genesee   New York
                        1998        1990        1998    State 1998
          Source: US Census Bureau
 #1: Socioeconomic/Demographic Economic
                             Data
• Employment
        (Based on population age 16 or greater of 51,247)
  – In labor force                           63.5%
     • Employed                              59.6%
     • Unemployed                             3.9%
  – Not in labor force                       36.5%
  – Females in labor force                   62.1%
               (based on 25,622 age 16 or greater)



 Source: US Census Bureau, Census 2000
  #1: Socioeconomic/Demographic Economic
                             Data
• Occupation
               (based on 30,550 age 16 or greater)
  – Management/professional                          32%
  – Service                                          16%
  – Sales/Office                                     24%
  – Farming, fishing, forestry                        1%
  – Construction, maintenance                        10%
  – Production, transportation                       17%

 Source: US Census Bureau, Census 2000
  #1: Socioeconomic/Demographic Economic
                              Data
• Class of worker
                (based on 30,550 age 16 or greater)
  – Private                               73%
  – Government                            20%
  – Self-employed                          7%
  – Unpaid family                         <1%




  Source: US Census Bureau, Census 2000
  #1: Socioeconomic/Demographic Economic
                             Data
• Household Income                       Median: $42,066
                   (based on 22,149 households)
  –   < $10,000                               7%
  –   $10,000 to 14,999                       7%
  –   $15,000 – 24,999                        14%
  –   $25,000 – 34,999                        13%
  –   $35,000 – 49,999                        19%
  –   $50,000 – 74,999                        23%
  –   $75,000 - $99,999                       11%
  –   >100,000                                 8%

 Source: US Census Bureau, Census 2000
  #1: Socioeconomic/Demographic Economic
                              Data
• Family Income               Median: $50,513
                    (based on 15,434 households)
  –   < $10,000                                4%
  –   $10,000 to 14,999                        4%
  –   $15,000 – 24,999                         10%
  –   $25,000 – 34,999                         12%
  –   $35,000 – 49,999                         19%
  –   $50,000 – 74,999                         28%
  –   $75,000 - $99,999                        14%
  –   >100,000                                  9%

  Source: US Census Bureau, Census 2000
 #1: Socioeconomic/Demographic Economic
                             Data
• Median Earnings
  – Male full-time year round   $ 36,599
  – Female full time year round $ 25,228




 Source: US Census Bureau, Census 2000
         #1: Socioeconomic/Demographic Economic
                                         Data
                                Unemployment
       5.5
       5.4
       5.3
       5.2
       5.1
Rate




         5
       4.9
       4.8
       4.7
       4.6
                  1995        1996          1997            1998           1999

             Unemployment declined in latter half of 1990s
 Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and Substance Abuse Services)
#1: Socioeconomic/Demographic Economic
                           Data

     •Poverty level data
     (1997 est.)
             –Population in poverty – 11.1%
                 (Genesee: 9.8%)

             –Children in poverty - 16.1%
                 (Genesee: 15.3%)
     •Poverty level data (1999)
     (2000 Census)
           - Population in poverty – 10.4%
              (Genesee: 7.6%)
Source: US Census Bureau
#1: Socioeconomic/Demographic Economic
                                Data


  •Poverty level data (1999)

      •Families in poverty
              (n = 902)                                 5.8%
        - with related children
                  under 18 (n = 719)                   9.0%*
           -with related children
                  -under 5 (n = 414)                   15.9%**
Total Families: 15,434
         *as % of families with related children <18
         **as % of families with related children <5
Source: US Census Bureau, Census 2000
 #1: Socioeconomic/Demographic Economic
                                 Data

  •Poverty level data (1999)

       •Female householder
               (n = 502)                             23.2%
         - with related children
                  under 18 (n = 479)                 30.4%
           -with related children
                  -under 5 (n = 281)                 60.8%

Total Families: 15,434; female headed ~ 2164
        *as % of female headed households with related children <18
        **as % of female headed households with related children <5
Source: US Census Bureau, Census 2000
#1: Socioeconomic/Demographic Economic
                                                Data

                                          Families in Poverty
                            Livingston 1990
                  2500      Livingston 1998
Rate per 10,000




                  2000      Genesee 1998
                  1500      New York State 1998

                  1000                                c
                   500

                    0
                         Couple-Headed     Male-Headed     Fem ale-Headed   Children Under
                           Fam ilies in     Fam ilies in     Fam ilies in    18 Living in
                            Poverty          Poverty          Poverty          Poverty


   No change in poverty level; 2000 data pending; rates at/lower than
   GenCo/NYS except male headed families
   Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and
   Substance Abuse Services)
       #1: Socioeconomic/Demographic Economic
                                    Data

                     Medicaid/Self Pay Deliveries
       30

       25

       20
Rate




       15

       10

       5

       0
            1995    1996     1997     1998     1999       2000   2001


        Medicaid supported deliveries rising since 1999
        Finger Lakes Perinatal Data System
#1: Socioeconomic/Demographic Economic
                                                  Data

                                          Program Participation
                         Livingston 1990
                         Livingston 1998
                  350    Genesee 1998
                  300    New York State 1998
Rate per 10,000




                  250
                  200
                  150
                  100
                   50
                    0
                         Aid to fam ilies w ith    Food Stam p    Medicaid Applications
                         dependent children        Applications
                        (AFDC) Applications


         Increase in AFDC/TANF and striking increase Medicaid applications with
         decline in food stamp applications. AFDC/TANF higher than GenCo/NYS.
         Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and
         Substance Abuse Services)
#1: Socioeconomic/Demographic Economic
                                                     Data
                   Free Lunch Participation by Livingston County School District

       50
                                            96-97
       45
                                            97-98
       40
                                            99-00
       35
       30
       25
       20
       15
       10
        5
        0
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 Overall decline in participation in free lunch across all LivCo school districts
 Source: NYS School Report Card 1999 - 2000
#1: Socioeconomic/Demographic Economic
                                                         Data

                    Reduced Lunch Participation by Livingston County School
                                            District
       14
                                             96-97
       12                                    97-98
                                             99-00
       10

        8

        6

        4

        2

        0




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 Variable trends across LivCo school districts with five districts at rates
 higher or equal to 96-97 levels
 Source: NYS School Report Card 1999 - 2000
       #1: Socioeconomic/Demographic


• Strengths
  – Relatively high levels
    • Education
    • Home Ownership
    • Employment
       – Broad distribution of employment
    • Median family income
    • Breadth of occupations
    • Adequate housing
       #1: Socioeconomic/Demographic


• Opportunities
  – Relatively high rates of
    • Population living in poverty
    • Children living in poverty
      #1: Socioeconomic/Demographic


• Trends to Watch
    • Decline in free lunch participation
    • Decline in food stamp applications
    • Number of grandparents involved as children’s
      care givers
    Indicator #2
Maternal Child Health
           #2 Maternal Child Health

• Data sources
  – Finger Lakes Perinatal Data System
  – NYS Department of Health
  – Livingston County Health Department
            #2 Maternal Child Health

• Data Elements
  – Mortality (Childhood, Infant/Neonatal)
  – Early Prenatal Care
  – Late/No prenatal Care
  – Satisfaction with care
  – Gestational Age <37 weeks
  – Low birthweight
                        #2 Maternal Child Health
                                         Infant Mortality
                                Number of Infant and Fetal Deaths
                                 Livingston County (1995 - 1999)

10                                                       Infant Deaths
                                          9
9                                                        Neonatal Deaths
                                                         Postneonatal Deaths
8
                                                         Spontaneous Fetal Deaths (20+ wks)
7
                                              6                 6
6
                    5                                                        5
5
                                                                    4                           4
4
         3 3                3                     3 3
3
                                 2                                       2         2
2
                                     1                   1                             1 1
1
                0
0
             1995                1996             1997              1998               1999


     Source: New York State Department of Health County Health Indicator Profiles, Livingston
     County (1995 – 1999)
                                      #2 Maternal Child Health
                                              Infant Mortality

                                     Livingston County Perinatal Health 1995-1999
spontaneous fetal deaths (rate per

                                                            Infant Deaths
                                     14                     Neonatal Deaths
      Rate per 1,000 except




                                     12                     Postneonatal Deaths
                                                            Spontaneous Fetal Deaths (20+ w ks)
                                     10
            100,000)




                                      8
                                      6
                                      4
                                      2
                                      0
                                           1995    1996    1997       1998          1999
       Due to low numbers, caution must be exercised in interpreting
       changes; rates variable; no improving or declining trend identified
       Source: New York State Department of Health County Health Indicator Profiles, Livingston
       County (1995 – 1999)
                                      #2 Maternal Child Health
                                             Infant Mortality

                                 Perinatal Health - Livingston County, Genesee
                                            County, New York State
                                              Infant Deaths
spontaneous fetal deaths (rate




                                              Neonatal Deaths
                                 10           Postneonatal Deaths
    Rate per1,000 except




                                              Spontaneous Fetal Deaths (20+ w ks)
                                  8
        per 100,000)




                                  6

                                  4

                                  2

                                  0
                                         1999
                                                       1999 Genesee 1999 New York
                                      Livingston
  Due to low numbers, caution must be exercised in interpreting changes; rates
  lower than NYS
  Source: New York State Department of Health County Health Indicator Profiles, Livingston County (1995 –
  1999)
                 #2 Maternal Child Health
                           Pregnancies
                           Number of Pregnancies and Births
                            Livingston County (1995 - 1999)
                                                                     Pregnancies (Total)
                                                                     Births
 1000
                          896
  900                                     871                             859
           846                                           830
  800
                 706            712             706                             698
  700                                                          665

  600

  500

  400

  300

  200

  100

    0
             1995           1996           1997            1998               1999




Source: New York State Department of Health County Health Indicator Profiles, Livingston
County (1995 – 1999)
                #2 Maternal Child Health
                           Pregnancies




No rate change in either pregnancies or births since 1995
Source: New York State Department of Health County Health Indicator Profiles, Livingston
County (1995 – 1999)
                              #2 Maternal Child Health
                                        Prenatal Care

                      First Trimester Entry into Prenatal Care
                               adjusted for births w ith m issing data*

              100%
               95%
               90%
               85%
               80%
               75%
               70%
                              1998            1999         2000           2001

                             n=510*          n=550*       n=519*          n=503*


Total Birth: 1998: 562: 1999: 597; 2000: 568; 2001: 563
Source: Finger Lakes Perinatal Data System
                              #2 Maternal Child Health
                                        Prenatal Care

                      Late or No Entry into Prenatal Care
                           adjusted for births with missing data
         5.0%
         4.0%
         3.0%
         2.0%
         1.0%
         0.0%
                         1998                1999         2000     2001
                      n=510*                 n=550*   n=519*       n=503*


Total Birth: 1998: 562: 1999: 597; 2000: 568; 2001: 563
Source: Finger Lakes Perinatal Data System
                    #2 Maternal Child Health
    Satisfaction with Prenatal Care
                    Satisfaction with Time to Get First
                          Prenatal Appointment       1999
               80            71
                     65 64                          2000
               60                                   2001
     Percent




               40                   26 29 24
               20                                   9    7      5
               0
                        VS             Sat              Other

GenCo: Very Satisfied 47%
       Satisfied 47%

Compared with GenCo, women from LivCo are more satisfied with the
time to get prenatal appointment

Source: Finger Lakes Perinatal Data System
                      #2 Maternal Child Health
    Satisfaction with Prenatal Care

                      Satisfaction with Wait Time After Arrival
                               57 55
                 60       50                                    1999
                 50
                                          37 35 39              2000
                 40
       Percent




                                                                2001
                 30
                 20                                      12
                                                               8      6
                 10
                 0
                               VS            Sat              Other
GenCo: Very Satisfied               37%
       Satisfied                    54%

Compared with GenCo, women from LivCo are more satisfied with the
wait time after arrival

Source: Finger Lakes Perinatal Data System
                  #2 Maternal Child Health
      Satisfaction with Prenatal Care
                   Satisfaction with Hours Open

             80                                           1999
                       63 62
                  57
             60                                           2000
   Percent




                                 35 32 33                 2001
             40
             20                                     8    5      5
             0
                       VS            Sat                Other


Compared with other prenatal care satisfaction measures, Liv Co
women are less satisfied with the hours available at prenatal care
sites
Source: Finger Lakes Perinatal Data System
                    #2 Maternal Child Health
   Satisfaction with Prenatal Care

                    Satisfaction with Time Spent by MD

               80          67 63                         1999
                      58
               60                                        2000
     Percent




                                    34                   2001
               40                        28 32
               20                                  8     5     5
               0
                           VS            Sat           Other

Compared with other prenatal care satisfaction measures, Liv Co
women are less satisfied with the time spent by MD
Source: Finger Lakes Perinatal Data System
                    #2 Maternal Child Health
                              Medical Risk
                Percent of Births with at Least One Medical Risk Factor

           37

           36

           35

           34

           33
 Percent




           32

           31

           30

           29

           28

           27
                     1999                    2000                     2001

Medical Risk Factors include: drug/alcohol use, STDs, hypertension;
smoking, prior preterm birth, diabetes, prior low birth weight birth
Source: New York State Department of Health County Health Indicator Profiles, Livingston County
(1995 – 1999)
                                #2 Maternal Child Health
                                             Birthweight


                  NYS DOH Rates of Low Birthweight <2500 grams

            8
                                                                          7.2
Pe rce nt




            6           5.5                      5.3
            4
                                                                                                   4.9
            2
            0
                  1995                     1996                     1997                     1999



                Decline in LBW since 1995
                Source: New York State Department of Health County Health Indicator Profiles, Livingston
                County (1995 – 1999)
                     #2 Maternal Child Health
                                  Birthweight

      Finger Lakes PDS Low Birthweight Rates

6%                                                   5.6%
5%
                         4.6%                                  4.3%
4%
3%
2%
1%
0%
                  1999                            2000      2001


     LBW rates unchanged in recent years.
     Total Births: 1999: 597; 2000: 568; 2001: 563
     Source: Finger Lakes Perinatal Data System
                           #2 Maternal Child Health
                                 Preterm Delivery
                                    Preterm Delivery

    10%
                                8.8%
     8%                                                      7.4%
                                                   6.7%
      6%
      4%
      2%
      0%
                         1999                   2000      2001


Decline in preterm delivery since 1999
Total Births: 1999: 597; 2000: 568; 2001: 563
Source: Finger Lakes Perinatal Data System
                             #2 Maternal Child Health
                                       Breastfeeding
              Breastfeeding Intention at time of Delivery

                                                1999   2000   2001
Breastmilk Only                                 54%    57%    55%
Formula Only                                    28%    31%    32%
Both                                            13%     8%    10%
Unknown*                                         5%     3%     3%

Some/All Breastfeeding                          67%     66%   65%
Breastfeeding rates stable
*Includes Don’t know, refused and missing responses
Total Births: 1999: 597; 2000: 567; 2001: 554
Source: Finger Lakes Perinatal Data System
                    #2 Maternal Child Health
                Children with Special Needs

              Children with Special Health Care Needs
                             1998 - 2001
                                                New Referrals
                                                Medical care
         60                                     Orthodontic treatm ent
         50
Number




         40
         30
         20
         10
          0
                  1998         1999            2000            2001

Medical care and orthodontic treatments are counts of PHCU Authorizations
Source: Livingston County Health Department
                                     #2 Maternal Child Health
                                 Pediatric Hospitalizations
                       Livingston County Pediatric Asthma Hospitalization
                                      Rates (0-4 years)
                  25                                               22.6
                                                                                       21
Rate per 10,000




                  20                           17.7
                            15.2
                  15
                                                                               9.2
                  10

                  5

                  0
                              1995




                                                 1996




                                                                        1997




                                                                               1998




                                                                                           1999
                       Interpret with caution due to small numbers; Since 1995 increases
                       in asthma hospitalizations (under age 5)
                   Source: New York State Department of Health SPARCS
                                 #2 Maternal Child Health
                             Pediatric Hospitalizations

                         Pediatric (0-4 years) Hospitalization Rates -
                    Livingston County, Genesee County, New York State
                                             1999
                  100
                                                                            81.6
Rate per 10,000




                   80

                   60

                   40                                         32.9
                                   21
                   20

                    0
                           1999 Livingston             1999 Genesee     1999 New York

                   1999 rates lower than GenCo and NYS
                   Source: New York State Department of Health SPARCS
                                #2 Maternal Child Health
                            Pediatric Hospitalizations

                       Livingston County Hospitalization Rates Pediatric (0-4
                                             years)           Gastroenteritis
                                                                             Otitis Media
                                                                         Drug Related
                  14
                                                                         Head Injury (Non-Fatal)
                  12
Rate per 10,000




                  10
                   8
                   6
                   4
                   2
                   0
                            1995       1996       1997       1998       1999
                         Livingston Livingston Livingston Livingston Livingston

                  Since 1995 slight increase in otitis media; decline in drug related
                  and head injury              Source: New York State Department of Health SPARCS
                                 #2 Maternal Child Health
                             Pediatric Hospitalizations

                       Pediatric (0-4years) Hospitalization Rates - Livingston
                          County, Genesee County, New York State 1999

                  30               Gastroenteritis
                  25               Otitis Media
Rate per 10,000




                                Drug Related
                  20            Head Injury (Non-Fatal)
                  15
                  10
                   5
                   0
                           1999 Livingston          1999 Genesee   1999 New York

                   1999 rates lower than GenCo and NYS
          Source: New York State Department of Health SPARCS
                                   #2 Maternal Child Health
                              Pediatric Hospitalizations

                              Asthma Hospitalizations Ages <18
                                       (1997 - 1999)

                         25                            GENESEE
       Rate per 10,000




                         20                            LIVINGSTON
                                      20
                         15                       13             12
                         10                                           9
                              11
                          5                 7
                          0
                                   1997         1998             1999

      Rate for LivCo in 1995 - 12             LivCo rates consistently lower than
                                              GenCo. No identifiable trend in
                                              LivCo. Declining trendline noted in
                                              GenCo.
Source: New York State Department of Health SPARCS
                     #2 Maternal Child Health
                      Pediatric Diagnoses
                     ADD/ADHD Diagnoses
10%
8%                                      8.5%
                 7.0%                                        7.1%
6%
4%                                         <6       6 - 10

2%
0%               0.3%                   0.4%                 0.2%
              1998                  1999                2000

        Rates of ADD/ADHD Diagnosis stable
      Source: Preferred Care and BC/BS - Excellus
               #2 Maternal Child Health
                 Pediatric Diagnoses
            ADD/ADHD Diagnoses Comparing
             Livingston and Genesee County
                         Children

  10%                                    8.5%
                  7.0%                                    7.7%
   8%                                                         7.1%
   6%                                         6.0%
   4%            6.0%
                                              Liv Co - 6 to 10
   2%
   0%                                         Gen Co - 6 to 10
                1998                 1999                2000

  Rates of ADD/ADHD Diagnosis among LivCo 6 to 10 year olds is
  stable and by 2000 lower than the GenCo 6 to 10 year old rate

Source: Preferred Care and BC/BS - Excellus
                #2 Maternal Child Health

• Strengths
  –   High rates of early entry into prenatal care
  –   Rate of low birthweight births remains low
  –   Preterm delivery rates declining
  –   Satisfaction with care high and improving
  –   Breastfeeding rates comparatively high
  –   Low rates of pediatric hospitalizations
            #2 Maternal Child Health

• Opportunities
  – Rates of late entry or no prenatal care
    variable and/or unchanged
  – Increasing numbers of children identified with
    special health care needs
  – Number of births with at least one medical risk
    increasing
            #2 Maternal Child Health

• Trends to Watch
  – Rates of ADHD diagnosis variable
  – Hospitalizations for pediatric asthma (among
    those under age 5)
  Indicator # 3
Adolescent Health
             #3 Adolescent Health

• Data sources
  – Finger Lakes Perinatal Data System
  – NYS Department of Health
  – Livingston County Health Department
  – Office of Alcohol and Substance Abuse
    Services
                   #3 Adolescent Health

• Data Elements
  – Alcohol Use
  – Drug Use
  – Tobacco Use
  – Youth Behavior
  – Teen Pregnancy




 * Not available
                                          #3 Adolescent Health
                                                 Alcohol Use


               Livingston County 9th Grade Survey Alcohol Use

          60
                                                                       1996-1997%                      54
                     50
          50                                    48                     2000-2001%

          40                 41                                                                                 46
Percent




                                                        42
                                                                                    39
          30
                                                                            23
          20

          10

           0
               Drank alcoholic beverage   Got drunk on alcohol ever   Got drunk on alcohol past    Intend to get drunk on
                     past 30 days                                             30 days             alcohol in the next year



          Declines in alcohol use and getting drunk and intention to get drunk with
          worrisome increase in ‘getting drunk in past 30 days’
                                          #3 Adolescent Health
                                                 Alcohol Use

               Livingston County 9th Grade Survey Alcohol Use -
                                    Males      1996-1997%
                                                                           2000-2001%
          90             78                                                                             78
          80                    70                         72
          70                                                        62                 59                    59
                                                                                  55
Percent




          60   46                                                        45 41
          50        40               39          44                                               41
          40                                35        28
          30                                                                                 23
          20
          10
           0
                         Beer        Wine         Wine      Hard          Yes       No        Yes         No
                                                 Cooler    Liquor

                Used          Types of beverages consum ed               Ever been drunk    Been drunk in past 30
               alcohol                                                                              days



                                                      with worrisome increase with
           Declines in alcohol use and getting drunk and intention to get drunkin ‘getting
           worrisome increase in
           drunk in past 30 days’ ‘getting drunk in past 30 days’
                                #3 Adolescent Health
                                        Alcohol Use
                          Livingston County 9th Grade Survey
                                                                                             1996-1997%
                                 Alcohol Use - Females                                       2000-2001%
          100
                                                                                                     77
           80                                                                                               65
                           63                   65        63
                                                                                    57
Percent




           60   54                    55                            51
                                50                   51                       49
                     42                    41                  42        43
                                                                                            35
           40
                                                                                          24
           20
            0
                            Beer       Wine      Wine      Hard     Yes        No           Yes        No
                                                Cooler    Liquor

                 Used           Types of beverages consum ed        Ever been drunk      Been drunk in past 30
                alcohol                                                                          days
                past 30

 Declines in alcohol use and getting drunk and intention to get drunk with
 worrisome increase in ‘getting drunk in past 30 days’
                         #3 Adolescent Health
                                Alcohol Use




Large increase in court mandated probation, decline in alcohol treatment. No changes in
arrests; slight increase in intoxicated youth in auto accidents and use at offense
probation cases.
Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and Substance Abuse Services)
                                        #3 Adolescent Health
                                             Drug Use

                           Livingston County 9th Grade Survey
                                  Drug Use (not alcohol)
          40   37
          35
                     30                                                                             1996-1997%
          30
                                        24 25                                                       2000-2001%
Percent




          25
                           20
          20                 17
                                                                                                    12                       11
          15
                                                      10
          10                                               7                      7
                                                                     5 3              4                         5
           5
           0
               Ever used     used       intend to     ever used     used       intend to  ever used     used other        intend to
               marijuana   marijuana       use         cocaine    cocaine in use cocaine other illegal illegal drugs use other
                            past 30    marijuana in                past 30    in the next   drugs        in past 30 illegal drugs
                             days        the next                   days          year                      days         in the next
                                           year                                                                              year
                                                                                                           *Other illegal drugs include
                                                                                                           LSD, PCP, Ecstasy, Mushrooms,
          Declines in drug use however intent to               use remains concerning                      Speed, Ice, or Heroin
                                    Ev
                             in          er                                  us                Percent
                               te            us                                 ed
                               m nd             ed
                                                    m




                                                                                     10
                                                                                     15
                                                                                     20
                                                                                     25
                                                                                     30
                                                                                     35
                                                                                     40




                                                                                      0
                                                                                      5
                  to              ar
                                      iju
                      us                                ar
                         e                an
                                              a
                                                           iju
                            m                                  an
                               ar               pa                 a
                                  iju               st

                                                                                        34
                                      an               30
                                           a                 da
                                             in                  ys
                                                th                                         33
                                                   e
                                                      ne
                       us               ev               xt
                          ed                er                ye


                                                                                           19 18
           in
              te              st               us                ar
                nd               er                ed
                     to              oi                st
                        us               ds               er
                            e                in               oi
                                                                 ds
                              st                pa
                                                                                                28 27




                                                                                                    3
                                 er                 st
                                     oi                30
                                         ds
                                             in              da
                                                th               ys
                                                   e
                                                                                       2
                      us                             ne
                                         ev              xt
          in             ed                 er                ye
             te              in                 us               ar
                                                   e
                                                                                       2
               nd              ha
                    to              la                in
                                       nt               ha
                       us                 s                  la
                           e
                                                                                                        2000-2001%
                                                                                                        1996-1997%




                                             in                nt
                             in                 pa                 s
                                                                                      0

                                ha                  st
                                    la                 30
                                       nt
                                                                                               11




                                          s                  da
                                             in                  ys
                                                th
                                                   e
                                                                                      0




                                                      ne
                                                                                          4




                       us               ev               xt
            in            ed                er                ye
              te                               us                ar
                                                                                                                                                          Drug Use




                               co
                                                                                      0




                 nd                ca              ed
                                                                                           6




                     to                 in             co
                        us                e                 ca
                            e                in                 in
                               co               pa                e
                                   ca               st
                                        in             30
                                                                                              99




        us              ev                e                  da
                                             in
                                                                                                                                                                     #3 Adolescent Health




in           ed             er                  th               ys
  te
    nd           ot            us                  e
                   he               ed                ne
       to                                                xt
                                                                                                                     Other Drugs Use - Males




                       ri                 ot
           us            lle                he                ye
              e              ga
                                ld
                                                ri
                                                  lle
                                                                 ar
                 ot
                   he               ru               ga
                                                                                       53 64




                       ri                gs              ld
                         lle                 in               ru
                             ga                 pa               gs
                                ld                  st
                                    ru                 30
                                         gs
                                             in              da
                                                                                              13 13




                                                th               ys
                                                   e
                                                                                                   9
                                                                                                                     Livingston County 9th Grade Survey




                                                     ne
                         Mushrooms,
                                                                                          5




                                                         xt
                                                              ye
                                                                 ar
                         LSD, PCP, Ecstasy,
                                                                                                   14




 Speed, Ice, or Heroin
                                                                                               11




                                              *Other illegal drugs include
                                    Ev
                              in         er                                                   us
                                                                                                                    Percent
                                te           us                                                  ed
                               m  nd            ed
                  to              ar                m




                                                                                                       0
                                                                                                       5
                                                                                                      10
                                                                                                      15
                                                                                                      20
                                                                                                      25
                                                                                                      35
                                                                                                      40
                                                                                                      45
                      us              iju               ar
                         e                an               iju
                            m                 a                an
                               ar
                                  iju
                                                pa
                                                    st             a

                                                                                                         38
                                      an               30
                                           a



                                                                                                      30 26
                                             in              da
                                                th               ys
                                                   e



                                                                                                            22
                       us               ev            ne
                                                         xt
           in             ed                er



                                                                                                              15
              te                                              ye
                nd            st               us                ar
                                 er                ed
                                                                                                                40


                     to              oi                st
                        us               ds               er
                            e                in               oi
                                                                                                                   23
                              st                pa               ds



                                                                                                                     3
                                 er                 st
                                     oi                30
                                         ds
                                             in              da
                                                th               ys
                                                   e
          in
                      us
                         ed              ev
                                            er
                                                     ne
                                                         xt                                             2
             te              in                               ye
               nd              ha               us               ar
                                                   e
                                                                                                        3
                    to              la                in
                       us              nt
                           e              s             ha
                                                             la
                             in              in                nt
                               ha               pa                 s
                                    la              st
                                                                                                                    12




                                       nt              30
                                          s
                                             in              da
                                                th               ys
                                                                                                                         14




                                                   e
                       us               ev            ne
                                                         xt
            in            ed                er                ye
              te                               us                ar
                                                                                                                                                                                   Drug Use




                 nd            co
                                   ca              ed
                     to                 in             co
                        us                e                 ca
                            e                in                 in
                               co
                                   ca
                                                pa                e
                                                    st
                                                                                                              12




                                        in              30
        us              ev                e
                                                                                                                                                                                              #3 Adolescent Health




in           ed             er               in              da
  te                           us               th               ys
    nd           ot
                   he               ed             e
       to              ri                             ne
           us            lle              ot             xt
                                            he                ye
              e              ga                 ri               ar
                 ot             ld                lle
                                                                                                                                 2000-2001%
                                                                                                                                 1996-1997%




                   he               ru               ga
                       ri                gs
                                                                                                        54 7 5 6 5 3 75




                         lle                             ld
                             ga              in               ru
                                ld              pa               gs
                                    ru              st
                                                                                                                        18




                                         gs            30
                                             in              da
                                                                                                                                              Other Drugs Use - Females




                                                th               ys
                                                   e
                                                                                                                         11 13




                                                     ne
                                                         xt
                                                                                                                               5




                                                              ye
      Speed, Ice, or Heroin




                                                                 ar
                                                                                                                                 16




                                                               *Other illegal drugs include
                                                                                                                                  11
                                                                                                                                              Livingston County 9th Grade Survey




                               LSD, PCP, Ecstasy, Mushrooms,
                       #3 Adolescent Health
                       Alcohol and Drugs

                    Relative Rankings of ASA Risk
                                     (NYS OASAS)
                                                            Livingston 1990
                                                            Livingston 1998
           60                                               Genesee 1998
    Rank




           40
           20
            0
                        Total youth                Total youth illicit
                        alcohol risk                  drug risk
Risk (composite score) increased for alcohol but not for drug use
Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and Substance
Abuse Services)
                                   #3 Adolescent Health
                                               Smoking
                          Livingston County 9th Grade Survey
                                   Tobacco Use (%)
          80
          70      67                                                                          1996-1997 %
                                                                                              2000-2001%
          60
          50
Percent




          40            53            36                   37

          30
          20                                                                                             15
                                                                  23                                             10
                                            20                                      5     5
          10
           0
               Smoked cigarettes   Smoked cigarettes      Intend to smoke        Used smokeless      Smoked cigars in past
                    ever             past 30 days      cigarettes in the next tobacco in the past 30      30 days
                                                                year                  days
                                     #3 Adolescent Health
                                                     Smoking

                            Livingston County 9th grade Survey
                                  Tobacco Use - Females

          80   76
          70                                                     1996-1997%
          60          51                                         2000-2001%
                               44                                                                                44
Percent




          50
          40
          30                          20                                                                              21
                                                  15
          20                                                                                            6
                                              9                 3        9 6              4
          10
                                                            0                         0             0
           0
                Smoked         Smoked          Smoke        Used       Smoked       Smoked          Smokes      Any tobacco
               cigarettes     cigarettes     cigarettes  smokeless     cigars in   bidis in the    kreteks in   use in past
                  ever       past 30 days     regularly   tobacco in past 30 days past 30 days    the past 30     30 days
                                            (20+ days of the past 30                                  days
                                               past 30       days
                                                days)
                                      #3 Adolescent Health
                                                   Smoking

                            Livingston County 9th Grade Survey
                                  Tobacco Use - Males (%)

70                                                                  1996-1997%
      58
60                                                                  2000-2001%
50                54
40                                                                                                       31
                       28
30                           20                                21                                              22
20                                  13     12                         13                        11
                                                   9     7                        5
10
                                                                             0              0
 0
      Sm oked       Sm oked          Sm oke         Used       Sm oked      Sm oked         Sm okes        Any
     cigarettes    cigarettes      cigarettes    sm okeless    cigars in   bidis in the    kreteks in    tobacco
        ever         past 30        regularly     tobacco in    past 30      past 30      the past 30   use in past
                      days        (20+ days of   the past 30     days         days           days        30 days
                                     past 30         days
                                      days)
                       #3 Adolescent Health
                        Youth Behavior
           ADD/ADHD Diagnoses by Age Group
10%                                    8.5%
                7.0%                                         8.0%
8%
                                                                 7.1%
6%                                 7.5%

4%             5.8%                           6 - 10   11 - 18          19 +

2%
              0.2%             0.4%
                                                             0.2%
0%
               1998                   1999                2000


      Rates of ADD/ADHD Diagnosis increasing among 11 – 18 year olds
Source: Preferred Care and BC/BS - Excellus
                       #3 Adolescent Health
                         Youth Behavior
      ADD/ADHD Diagnoses Comparing Livingston and
               Genesee County Children

10%
                                        7.5%
 8%                                                                 8.0%
               5.8%                       5.4%
 6%
                                                                    5.0%
 4%                                              Liv Co - 11 - 18
                4.1%
 2%                                              Gen Co - 11 - 18
 0%
                1999                  2000                    2001

Rates of ADD/ADHD Diagnosis higher among 11 – 18 year olds
from LivCo compared with GenCo
   Source: Preferred Care and BC/BS - Excellus
                                       #3 Adolescent Health
                                             Youth Behavior

                               Injury Hospitalizations Age <18 (1997 - 1999)

                        360
                                       345                  GE NE S E E
                        340
     Ratge per 10,000




                        320                                 LIVINGS TON
                        300
                              299
                        280
                        260                           261                  LivCo rates
                                                                     243   consistently
                        240
                                             239
                        220                                                lower than
                                                                  236
                        200                                                GenCo. Decline in
                                    1997           1998          1999      1998 maintained
                                                                           in 1999.. Rates by
      Rate for LivCo in 1995 - 584
                                                                           1999 nearly
Source: New York State Department of Health SPARCS                         equivalent with
                                                                           Gen Co.
                       #3 Adolescent Health
                           Youth Behavior




Declines in youth violent/property arrests; large declines in PINS (Persons in need of
assistance)
Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and Substance
Abuse Services)
                    #3 Adolescent Health
                           Pregnancies




No change in under age 20 pregnancies
Source: New York State Department of Health County Health Indicator Profiles, Livingston
County (1995 – 1999)
                                     #3 Adolescent Health
                                            Pregnancies
                        Perinatal Health Indicators - Livingston County, Genesee
                                      County, New York State 1999
                                Pregnancies (Total) Age 10-14
                 120                Age 15-19                       Births
                 100
Rate per 1,000




                  80
                  60
                  40
                  20
                    0        1999
                          Livingston           1999 Genesee         1999 New York


                 1999 LivCo rates lower than GenCo and NYS
                 Source: New York State Department of Health County Health Indicator Profiles, Livingston
                 County (1995 – 1999)
                               #3 Adolescent Health
                                               Births
                        Births to Teens - Livingston County
                                    (1999 - 2001)
         70
                                                               <16
         60                                                    16 - 17
         50                                                    18 - 19
Number




         40
         30
         20
         10
           0
                          1999                        2000         2001
         Source: Finger Lakes Regional Perinatal Data System
              #3 Adolescent Health

• Strengths
  – Teen pregnancy continues at one of the
    lowest rates in the state
  – Female teens reported lower rates of smoking
    than in prior survey period
              #3 Adolescent Health

• Opportunities
  – Alcohol risk behavior increasing
  – Reports of drug use unchanged
  – ADHD diagnoses increasing
             #3 Adolescent Health

• Trends to Watch
  – Selected aspects of smoking and alcohol use
    trending lower
    Indicator # 4
Infectious Diseases
          #4 Infectious Diseases
              Data sources
– NYS Department of Health
– Livingston County Health Department
               #4 Infectious Diseases

• Data Elements
  – Immunization rates
  – Communicable Diseases
  – AIDS incidence and mortality




 * Not available
       #4 Infectious Diseases
           Immunization
•Immunization Rates
  –Based on preliminary 2001 PBII data,
  Livingston County 2 year old immunization
  rate is 79.6%
  –Preliminary 2001-2002 school children
  survey indicates a 95% completion rate
  (lower than (1995-96)
     •Grades 1 – 3:            95%
     •Grades 4 – 11:    98%
                     #4 Infectious Diseases
                Communicable Diseases


               Communicable Disease Cases (STDs) 1997 - 2001

20
15                                                              Giardia
10                                                              Gonorrhea
 5                                                              Group B Strep
 0                                                              Syphilis
        1997         1998          1999         2000     2001

     Giardia increase in 1999, maintained through 2001; Gonorrhea
     decline in 2001 after increases since 1998
     Interpretation limited due to small numbers
     Livingston County Communicable Diseases 1997-2001
                       #4 Infectious Diseases
                   Communicable Diseases
                  Communicable Diseases (STD) Cases


   20                Giardia                         Gonorrhea
                     Group B Strep                   Syphilis
   10

    0
            1997           1998           1999      2000    2001

Giardia increase in 1999, maintained through 2001; Gonorrhea
decline in 2001 after increases since 1998
Interpretation limited due to small numbers
Livingston County Communicable Diseases 1997-2001
                           #4 Infectious Diseases
                      Communicable Diseases
                     Communicable Diseases (STDs)
                 Three Year Rolling Frequencies (# Cases)


        40
        30                                                  Giardia
Cases




                                                            Gonorrhea
        20
                                                            Group B Strep
        10
                                                            Syphilis
         0
                 1999        2000         2001

             Using three year counts, all demonstrate increases with
             Gonorrhea increasing the most dramatically
             Small numbers limit interpretation of Syphilis counts
             Livingston County Communicable Diseases 1997-2001
                          #4 Infectious Diseases
                    Communicable Diseases

              Livingston County Morbidity Trends TB, Lyme Disease 1995-
                                 1999 (per 100,000)

        3.5

          3                     TB Incidence
                                Lyme Disease Cases
        2.5

          2

        1.5

          1

        0.5

          0
                  Rate           Rate           Rate   Rate       Rate

                  1995           1996          1997    1998       1999
      Interpretation of rates limited due to small numbers. No TB cases were
      reported except: 1995: 2; 1996: 1; 1998: 2.
      No measles cases; Lyme disease cases: 1 each in 1996 and 1997
Source: New York State Department of Health SPARCS
                            #4 Infectious Diseases
                       Communicable Diseases
        Number of Enteric Communicable Diseases among
                     Children Under Age 10
         Camplyobacterosis Cryptosporidiosis Giardiasis Salmonellosis E.Coli     Shigellosis
 1999                    4                  1         4             3          0          0
 2000                    3                  0         5             0          1          0
 2001                    0                  0         4             3          1          2
Total                    7                  1        13             6          2          2


    Interpretation limited due to small numbers. No obvious trends;




  Source: Livingston County Health Department
                   #4 Infectious Diseases
                         Pneumonia

              ED Admissions for Acute Respiratory
                      Disease (Age >64)

         82                          81
         80
Number




         78        76
         76                                                     75
         74
         72
                  1998              1999                       2000

   Indirect indicator or possible proxy for flu/pneumonia
   vaccine access
                            Source: New York State Department of Health SPARCS
                               #4 Infectious Diseases
                                        HIV/AIDS
                               Livingston County Morbidity Trends
                                   AIDS and Newborn HIV Cases
                 40
                                                  AIDS Cases (4)

                 35                               Newborn HIV Seropositive


                 30
                                                        AIDS case data for 1998 and 1999 not
                 25                                     presented due to reporting lags

                 20                                     Case numbers:
                                                                                1995: 21
Rate / 100,000




                 15                                                             1996: 23
                                                                                1997: 22
                 10
                                                        Only 1 sero-positive newborn 1995 - 1999
                 5

                 0
                      Rate     Rate     Rate          Rate         Rate

                      1995     1996     1997          1998         1999


                  Cases presented by year of diagnosis; interpretation of
                  rates limited due to small numbers.
                                               Source: New York State Department of Health SPARCS
              #4 Infectious Diseases

• Strengths
  – High rates of immunization among school age
    children
  – Number of HIV sero-positive newborns nearly
    zero
            #4 Infectious Diseases

• Opportunities
  – Immunization rates among toddlers lower
    than rates among school age children
            #4 Infectious Diseases

• Trends to Watch
  – STD rates trending higher
  – AIDs/HIV cases
      Indicator # 5
Social and Mental Health
       #5 Social and Mental Health
           Data sources
– NYS Department of Health
– NYS Office of Alcohol and Substance Abuse
  Services
– Livingston County Health Department
             #5 Social and Mental Health

• Data Elements
  – Violence Data
    •   School
    •   Domestic violence
    •   Unintentional Injury
    •   Homicide/Suicide
  – Adult Alcohol Use
  – Adult Substance Use
  – Mental Health diagnoses
            #5: Social and Mental Health
              School- based Violence
• School incidents
  – Example from one school (elementary)
     • Number of incidents (% Physical Fighting)
        –   96/97                 310 (66%)
        –   97/98                 445 (41%)
        –   98/99                 457 (42%)
        –   99/00                 461 (40%)
        –   Period Mean           418 (47%)


  – Reports of interpersonal violence increasing with
    proportion designated as physical fighting stable
    since 97/98 year
             #5: Social and Mental Health
               School-based Violence
• School incidents (Interpersonal Violence)
   – “Higher Incident” schools (1998 – 1999)
     School Total            % Physical Fighting
      A               457                  42
     B                1372                 43
     C                690                  49

   Physical violence represents less than half of interpersonal
     violence incidents.
   Elementary School
                                  #5: Social and Mental Health
                                          Pediatric Incidents
                            Livingston County Hospitalization Rates
                                     Pediatric (0-4 years)
                                                                                 Drug Related

                  10                                                             Head Injury (non
                   8                                                             fatal)
                   6
Rate per 10,000




                   4
                   2
                   0
                           Rate              Rate             Rate      Rate      Rate

                           1995              1996             1997      1998      1999



                       Overall decline in drug related and head injury hospitalizations
                   Source: New York State Department of Health SPARCS
                                 #5: Social and Mental Health
                                                  Injury/Mortality

                        Injury Hospitalizations Ages 18 - 64 (1997 - 1999)

                                                                       GENESEE
                  600               571                                LIVINGSTON
                  550
Rate per 10,000




                  500                                453         492
                  450
                                                                 464
                  400   410                                            LivCo rates
                  350                                                  conistently lower
                                                    377
                  300                                                  than GenCo. No
                  250                                                  trend in LivCo,
                  200                                                  however uptick in
                               1997
                   Rate for LivCo in 1995 - 584     1998      1999     1999 warrants
                                                                       watching; parallel
Source: New York State Department of Health SPARCS                     trendl line noted
                                                                       in GenCo. Rates
                              #5: Social and Mental Health
                                      Injury/Mortality
                         Mortality Trends Livingston County, Genesee County,
                          New York State - Homicide, Suicide, Unintentional
                                                 Injury          Hom icides
                                                                                  Suicides
                                                                                  Unintentional Injury
                    30                                                               Motor Vehicle
 Rate per 100,000




                    25                                                               Non-Motor Vehicle

                    20
                    15
                    10
                    5
                    0
                                 1999         1999 Genesee                  1999 New York
                              Livingston
Source: New York State Department of Health County Health Indicator Profiles, Livingston County (1995 – 1999
                                    #5: Social and Mental Health
                                          Injury/Mortality
                                                                                                           Homicides
                    Livingston County Mortality Trends Homicide, Suicide,                                  Suicides
                                Unintentional Injury 1995-1999                                             Unintentional Injury
                    35                                                                                     M otor Vehicle
                    30                                                                                     Non-M otor Vehicle

                    25
                    20
Rate pe r 100,000




                    15
                    10
                     5
                     0
                           R at e        R at e            R at e             R at e              R at e

                           1995          1996              1997               1998                1999
     Unintentional injury (UI) on the rise since 1997, primarily due to Motor Vehicle
     1999 UI rates sim to GenCo; much higher than NYS; MV rates of UI lower than GenCo,
     higher than NYS
     Suicides increasing overtime; sim to GenCo; higher than NYS
     Source: New York State Department of Health County Health Indicator Profiles, Livingston County (1995 – 1999)
                            Mental Health - Injury/Mortality
                    Livingston County Mortality Trends Homicide, Suicide,
                                         1995-1999
                    14
                    12
                    10
                     8
Rate pe r 100,000




                                                                                                  Homicides
                    6                                                                             Suicides
                    4
                    2
                    0
                           R at e       R at e             R at e             R at e              R at e

                           1995         1996               1997               1998                1999
     Unintentional injury (UI) on the rise since 1997, primarily due to Motor Vehicle
     1999 UI rates sim to GenCo; much higher than NYS; MV rates of UI lower than GenCo,
     higher than NYS
     Suicides increasing overtime; sim to GenCo; higher than NYS
     Source: New York State Department of Health County Health Indicator Profiles, Livingston County (1995 – 1999)
                            #5: Social and Mental Health
                                   Alcohol and Injury
                           Alcohol Involved Motor Vehicle Accidents and
                                       Deaths/Injuries (1999)
                                             Livingston Co.
                     140                     Genesee Co.             125
                     120                     NY State
  Rate Per 100,000




                     100                                      89
                                     79
                     80                          N
                              51                                            49
                     60
                                            31
                     40
                     20
                      0
                             MV Alconol Involved              MV Deaths/Injuries




Alcohol related MV accidents and deaths/injuries are lower than comparison
GenCo, but higher than overall NYS rates
Source: NYS Health Department
              #5: Social and Mental Health
                       Adult Smoking
• Smoking Prevalence among Adults
   – Livingston County:                       31.5
   – Genesee County:                          28.3




Based on New York State Department of Health Behavioral Risk Factor
   Surveillance Survey (1995 – 98)
                #5: Social and Mental Health
                     Adults and Alcohol
• Based on CDC Behavioral Risk Factor
  Surveillance data from 1995 – 1997:
    – Prevalence of Binge Drinking among Adults:
        • Livingston County:     14.5
        • Genesee County: 13.6

Indirect estimates
                          #5: Social and Mental Health
                                Adults and Alcohol
                                AOD Exposure/Alcohol Accessibility

                    120                                 Livingston 1990
                                                        Livingston 1998
  Rate per 10,000




                    100                                 Genesee 1998
                     80                                 New York State 1998

                     60
                     40
                     20
                      0
                              Intoxicated
                          Adult DWI         On-Prem ise Off-Prem ise Off-Prem ise
                                Adults In
                          Arrests              Licensed        Licensed        Licensed
                                  Auto       Outlets, All        Liquor      Beer Outlets
                              Accidents                         Outlets
Decline in DWI arrests with small concomitant increase in intoxicated adults
in auto accidents. Rates lower than GenCo
Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and
Substance Abuse Services)
               #5: Social and Mental Health
                      Adults and Alcohol




Slight increase in deaths with decline in hospital diagnoses and alcohol
treatment. Latter is lower than both GenCo and NYS
Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and
Substance Abuse Services)
                              #5: Social and Mental Health
                                     Adults and Alcohol
                                           Adult Probation-Alcohol           Livingston 1990
                                                                             Livingston 1998
                                                                             Genesee 1998
                   80                                                        New York State 1998
Rate pe r 10,000




                   60
                   40
                   20
                   0
                        Probation Cases: Use at Offense Probation Cases: Court Mandates


     Increase in both use at offense and court mandate
     Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and
     Substance Abuse Services)
                     #5: Social and Mental Health
                              Adults and Drugs




Declines in adult drug arrests, hospital dx, treatment; rates lower than GenCo except for drug
tx and court mandates
Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and Substance Abuse
Services)
            #5: Social and Mental Health
                  Adults and Drugs

         Comparison of Males and Females Diagnosed
              with CD/SA (Livingston County)
                Male 19 - 39          Fem ale 19 - 39
                Male 40 - 59          Fem ale 40 - 59
    6%
    4%
    2%
    0%
              1998             1999              2000
Rates for male and female adults unchanged.
Rates similar to those among GenCo residents
Source: Preferred Care and BC/BS - Excellus
             #5: Social and Mental Health
             Mental Health Diagnoses
• Based on data from 1998 – 2000, covered
  lives among two area insurers represented
  37,000 to 41,000 Livingston County residents
  – between 10 – 11% have a mental health diagnosis
  – These diagnoses include the following
    problems/disorders:
      • Psychoses, schizophrenia, neuroses, sexual,
        depressive, emotional, mental retardation,
        affective, paranoia




   Source: Preferred Care and BC/BS - Excellus
          #5: Social and Mental Health
                  Mental Health
      Comparisons between Adults with Mental
       Health Diagnoses (Livingston County)
               Male 19 - 39          Female 19 - 39
25%            Male 40 - 59          Female 40 - 59
20%
15%
10%
 5%
 0%
           1998               1999            2000

Mental Health diagnoses increasing among younger females

Source: Preferred Care and BC/BS - Excellus
               #5: Social and Mental Health
                        Mental Health
          Comparison of Genesee and Livingston County
            Females Rates of Mental Health Diagnoses
                LivCo Fem ale < 19             LivCo Fem ale 19 - 39
 25%            LivCo Fem ale 40 - 59
                GenCo Fem ale 19 - 39
                                               GenCo Fem ale < 19
                                               GenCo Fem ale 40 - 59

 20%
 15%
 10%
  5%
  0%
              1998                      1999                 2000
Mental Health diagnoses among LivCo females slightly higher
than among GenCO females
Source: Preferred Care and BC/BS - Excellus
              #5: Social and Mental Health
                      Mental Health

              M ental Health Diagnoses Among Older
            Adults Comparing Livingston and Genesee
                             Counties
                   LivCo Male 60 +        LivCo Fem ale 60 +
                   GenCo Male 60 +        GenCo Fem ale 60 +
      12%
      10%
       8%
       6%
       4%
       2%
       0%
                 1998             1999           2000
Mental Health diagnoses slightly higher among LivCo seniors
than among GenCO seniors
Source: Preferred Care and BC/BS - Excellus
          #5: Social and Mental Health
              Domestic Violence

        Livingston County Sheriff Office DV Reports

               Incidents           Sex Offenses
     1999         453                   37
     2000         507                   24
     2001         561                   27
     2002         596                   28

2002 data is annualized from data through 9/17/02
                #5: Social and Mental Health
                      Domestic Violence
           Utilization of Domestic Violence Shelter


                    Clients            Bednights      Avg Occup.
    1998              226                2138            59%
    1999              177                1688            46%
    2000              156                2273            56%
    2001              155                1880            41%
    2002              151                1953            53%

2002 data is annualized from data through July 2002

Occupancy based on 9 bed through 3/00; subsequently, 12 beds’
significant decline after 9/11/01 through 4/02; occupancy 75% or more
since
Source: Chances and Changes, Geneseo
             #5: Social and Mental Health
                   Domestic Violence
 Calls Received by DV              • Increasing trend noted in
    Shelter Hotline                  calls to hotline, with
                                     dramatic spike in 2000.
               Hotline Calls
   1998             886
   1999             981
   2000            1456
   2001            1071
   2002            1085


2002 data is annualized from data through July 2002
Source: Chances and Changes, Geneseo
             #5: Social and Mental Health
                   Domestic Violence
                                   • Services to Non-residents
   Services provided to              variable with peak n 2001
      Non-Residents                  related to post 9/11.
   1998              278
   1999              174
   2000              269
   2001              291
   2002              147



2002 data is annualized from data through July 2002
Source: Chances and Changes, Geneseo
                                   #5: Social and Mental Health
                                          Family Functioning

                                        Family Dysfunction Indicators
                                   Livingston 1994          Livingston 1998
Rate per 10,000 youth




                    500            Genesse 1998             New York 1998

                    400
       < age 21




                    300
                    200
                    100
                        0
                             CPS Indicated       CPS Reports -        CPS Reports -            Divorces
                                Cases             Mandated           Total Received

                        Cases/reports increased; rates lower than GenCo and higher than NYS
                        Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and
                        Substance Abuse Services)
                                           #5: Social and Mental Health
                                                  Family Functioning

                                               Family Dysfunction Indicators
                                      Livingston 1994           Livingston 1998
Rate per 10,000 <age 21




                                      Genesse 1998              New York 1998
                          100
                          80
                          60
                          40
                          20
                           0
                                      Foster Care              Children in Foster         Preventive Services
                                      Admissions                     Care                      Openings
                                Preventing services openings declined as did foster care admissions/children
                                in foster care; rates lower than GenCo/NYS
                                Source: 1998 Community Risk Indicators (NYS Office of Alcoholism and
                                Substance Abuse Services)
          #5 Social and Mental Health

• Strengths
  – Utilization of domestic violence services
  – Schools developing violence plans
         #5 Social and Mental Health

• Opportunities
  – Adult alcohol use increasing
  – Domestic violence incidents increasing
  – Relatively high percent of adult smokers
  – Mental health diagnoses increasing among
    adult females
  – Suicides trending upward
           #5 Social and Mental Health

• Trends to Watch
  – Changes in patterns of foster care use
  – Openings in preventive services
  – Variable trends in number of sex offenses
  – School-based violence data insufficient/inadequate
    for trend analysis
  – Rates of drug/chemical dependency diagnoses
    unchanged
  – Declining rates of alcohol related diagnosis and
    treatment
         Indicator #6
Physical/Environmental Health
       #6 Physical/Environmental Health

• Data sources
  – Livingston County
        #6 Physical/Environmental Health

• Data Elements
  – Lead Testing
  – Water Supply Test Results
  – Food Service Inspections
  – Town and Village Fluoridation
  – Rabies reports
  – West Nile Surveillance



 * Not available
                                  #6 Physical/Environmental Health
                                             Lead Exposure

                                  Livingston County Total Lead Tests Done (Capillary
                                               and Venous) 1999-2001

                                720        713
              Number of tests




                                700

                                680                                            665
                                660                          652

                                640

                                620
                                          1999              2000               2001




Source: Livingston County Health Department
                               #6 Physical/Environmental Health
                                               Lead Exposure

                                     Livingston County Number of Confirmd Elevated Lead
                                                      Cases (1999-2001)

                                     12                         11-14 mcg/dl
               Number of confirmed




                                                                15-19
                 elevated cases




                                     10
                                     8                          20-44
                                     6
                                     4
                                     2
                                     0
                                            1999         2000           2001




Source: Livingston County Health Department
        #6: Physical/Environmental Health
         Water Supply Contamination
• Since 2000
  – 31 Municipal supplies
     • 11 had at least one incident since 2000
     • Total reports: 17
        – 14: T. Coliform
        – 1 each: line break > 4 hours, E. Coli, Midge Fly
  – 8 non-municipal supplies (wells)
     • 3 had at least on incident
     • Total reports: 7
        – All T. Coliform



 * Not available
       #6: Physical/Environmental Health
      Food Service Inspection Results


                    Stipulations Hearings
    1999                 34        10
    2000                 14         2
    2001                 20         1


During past three years, hearings declined dramatically;
stipulations also trended downward
       #6: Physical/Environmental Health
                  Indoor Air
Complaints

2001      10
2002       8 as of end September
        #6: Physical/Environmental Health
                  Water Fluoridation
Towns with fluoridation: 6 of 9
Villages with fluoridation: 8 of 18




Data as of 2/02
         #6: Physical/Environmental Health
                                 Rabies

                      # individuals                # positive
                         treated                    animals
      1997                  48                        23
      1998                  35                        12
      1999                  47                        16
      2000                  32                        10
      2001                  29                         9
Number of positive animals declined since 1997 with concomitant
decline in number of individuals treated
Raccoons accounted for 54 animal reports; others included: bats (7), cow (1),
skunks (2), woodchuck (1), cat (3), fox (2)
       #6: Physical/Environmental Health
                  West Nile Virus
• During Summer 2002
  – 11 positive bird reports (all but 2 crows)
  – Mosquito trappings
     • Six sites
     • 106 trap nights
            #6: Physical/Environmental Health
                              West Nile Virus



                  Avon        Dansville Geneseo      Groveland        Mt. Morris
                                                Bean Hill Maple Beach
Trap Nights              15        29        30         6           3           23
Species Trapped          14        15        11         9           6           13
      #6: Physical/Environmental Health
               Toxic Waste Sites
• Three Livingston County sites
  – NYSEG                     Dansville
    • former Dansville Coal Gas
  – Atrochem NA               Piffard (York)
    • former Lucidol
  – William Benson Landfill
                              Livonia
       #6 Physical/Environmental Health

• Strengths
  – Decline in food service related citations
  – Confirmed cases of lead exposure declining
  – Cases of animal rabies and exposed
    individuals declining
       #6 Physical/Environmental Health

• Opportunities
  – Absence of fluoridation in over half of villages
    and some towns
  – Presence of three toxic waste sites
       #6 Physical/Environmental Health

• Trends to Watch
  – West Nile Virus continues to be a concern
 Indicator #7
Health Status
             #7 Health Status
              Data sources
– NYS Department of Health
– Livingston County Health Department
                    #7 Health Status
                    Data Elements
• Morbidity and Mortality
  – Cardiovascular
  – Cancer
  – Cerebrovascular
  – Diabetes
  – Asthma
  – COPD
• Nutrition and Overweight


  * Not available
                                            #7: Health Status
                                    Mortality – All Causes
                             Livingston County Mortality 1999

                    200     178                    Diseases of the Heart             Lung Cancer (Male)
                                                   Lung Cancer (Total)               Lung Cancer (Fem ale)
                    180
                                                   Cerebrovascular Disease           Breast Cancer
                    160
Rates per 100,000




                                                   Unintentional Injury                 Motor Vehicle
                    140                            Suicides                             Non-Motor Vehicle
                                                   Cirrhosis (Liver)                 Cervical Cancer
                    120
                                                   AIDS                              Hom icides
                    100           83
                     80                69
                                              54     48
                     60                                   40
                     40                                        28
                                                                    16 12       12
                     20                                                              4   3     2    0
                      0
                          Heart        Lung        CV                        Motor Vehicle
                                               Breast Ca         Unintentional Injury

            Source: New York State Department of Health
                                              #7: Health Status
                                      Cardiovascular Disease

                                     Livingston County Mortality Trends -
                                            Diseases of the Heart


                                                    234
            Rate per 100,000




                               250
                                                                    194      178
                               200
                               150        194                206
                               100
                                50
                                 0
                                       1995      1996     1997     1998   1999
           Decline in mortality after uptick in 1996
Source: New York State Department of Health
                                              #7: Health Status
                                       Cardiovascular Disease

                                   Mortality Trends - Diseases of the Heart
                                    Livingston, Genesee, New York State
                                                     1999

                                 350                         323            316
              Rate per 100,000




                                 300
                                 250
                                 200        178
                                 150
                                 100
                                  50
                                   0
                                       1999 Livingston   1999 Genesee   1999 New York


           1999 rates lower than GenCo and NYS
Source: New York State Department of Health
                                                 #7: Health Status
              Cardiovascular Disease – Hospitalization
                               Data

                        Cardiovascular Hospitalizations Ages 18-64                       LivCo rates
                  GENESEE
                                      (1997 - 1999)                                      consistently
                  LIVINGSTON                                                             lower than
                  175                                                                    GenCo. No trend
                                      165                 144                            identified for
                  150
Rate per 10,000




                                                                                123      LivCo while
                  125        94                     88                                   consistent
                  100
                                                                                  88     decline among
                   75
                   50                                                                    residents of
                   25                                                                    GenCo.
                    0
                                  1997               1998                    1999

                  Rate for LivCo in 1995 - 112           Source: New York State Department of Health SPARCS
                                            #7: Health Status
   Cardiovascular Disease – Hospitalization
                    Data

                                     Cardiovascular Hospitalizations Ages >65
                                                  (1997 - 1999)

                              1600                                        GENESEE
                                            1494                          LIVINGSTON
           Rate per 100,000




                              1400
                                                      1324
                              1200                                 1198
                                      852
                              1000
                                                          825
                                                                          LivCo rates
                               800                                 833
                                                                          consistently
                               600                                        lower than
                                       1997        1998         1999      GenCo. No trend
                                                                          identified for
  Rate for LivCo in 1995 - 969                                            LivCo while
                                                                          consistent
Source: New York State Department of Health SPARCS
                                     #7: Health Status
                        Cancer - Incidence Trends

              Incidence -- All Cancers - Livingston Co
                         Genesee Co, NYS
                                               No change among males; increase among
                                               women; rates higher than GenCo and NYS
      600        505                   498
      500                                               450               455
                            353                375               363               350
      400
      300
      200
      100
        0
                92-96      92-96      94-98    94-98    94-98    94-98    94-98   Rate per
                male        rate       rate     rate     rate     rate     rate   females
                 rate     females     males   females   males   females   males

                                                        Genesee           New York
                        Livingston County               County              State
Source: New York State Department of Health
                              #7: Health Status
                  Cancer - Mortality Trends

           Mortality -- All Cancers - Livingston Co
                       Genesee Co, NYS
250       210                                     223
                              207                                     201
200
                    148                 153                 139                 142
150
100
 50
  0
         92-96     92-96     94-98     94-98     94-98     94-98     94-98     94-98
         male       rate      rate      rate      rate      rate      rate    Rate per
          rate    females    males    females    males    females    males    females
              Livingston County                   Genesee                   NYS
      No change; 94-98 rates slightly higher than GenCo and NYS except for males
      (GenCo)                                  Source: New York State Department of Health
                                               #7: Health Status
                                  Cancer - Hospitalization Data

                                  Neoplasm Hospitalizations Ages <18 (1997 - 1999)
                                               GENESEE
                            180                LIVINGSTON
                                                            151                169
                            160      138
          Rate per 10,000




                            140
                                                             142              133
                            120
                                            105
                            100
                             80
                             60
                                        1997                1998           1999
Source: New York State Department of Health SPARCS

        Rate for LivCo in 1995 - 123           LivCo rate flat until 1999, with no identifiable
                                               trend among GenCo rates. Uptick in 1999 may
                                            #7: Health Status
                            Cancer - Hospitalization Data

                                 Neoplasm Hospitalizations Ages 18 - 64
                                            (1997 - 1999)
                          950                                             GENESEE
                                                            890
                          900                   818                       LIVINGSTON
                          850                               869
        Rate per 10,000




                                      850
                          800
                          750
                                                                  LivCo rates
                                654                               conistently lower
                          700
                          650                  756
                                                                  than GenCo,
                          600
                                                                  however LivCo
                          550
                          500                                     rates increasing,
                                 1997          1998      1999     with similar
                                                                  increase in
       Rate for LivCo in 1995 - 565
                                                                  GenCo. Counties
Source: New York State Department of Health SPARCS
                                                                  nearly equivalent
                                                                  in 1999.
                                          #7: Health Status
                             Cancer - Hospitalization Data

                                   Neoplasm Hospitalizations Ages > 64
                                             (1997 - 1999)
                           5500
                                  5005                     GENESEE
         Rate per 10,000




                           5000                4747        LIVINGSTON

                                                              4374       LivCo rates
                           4500
                                                                         consistently
                                            3724              4166
                           4000   3734                                   lower than
                                                                         GenCo. However
                           3500                                          concerning
                                   1997       1998        1999           uptick in 1999 in
                                                                         LivCo rate given
       Rate for LivCo in 1995 - 3695                                     consistent
                                                                         declining trend
Source: New York State Department of Health SPARCS                       line for GenCo.
                        #7: Health Status
       Lung Cancer - Mortality Trends

         Mortality -- Lung/Bronchus Cancer -
          Livingston Co Genesee Co, NYS
100
       75                                   79
 80                       67
                                                              60
 60
                39                 39                36
 40                                                                      32

 20
  0
      92-96    92-96    94-98     94-98    94-98    94-98    94-98    94-98
      male      rate     rate      rate     rate     rate     rate   Rate per
       rate   females   males    females   males   females   males   females

          Livingston County                Genesee                 NYS
  Decline among men; 94-98 rates slightly higher than GenCo and NYS except for
  males (94-98)                       Source: New York State Department of Health
                           #7: Health Status
         Lung Cancer - Incidence Trends

             Incidence -- Lung/Bronchus Cancers -
                Livingston Co Genesee Co, NYS
  100                                              93
            86
                               79
    80                                                                73

    60                46                 49
                                                            43                     43
    40
    20
     0
           92-96     92-96    94-98     94-98     94-98    94-98     94-98   Rate per
           male       rate     rate      rate      rate     rate      rate   females
            rate    females   males    females    males   females    males
             Livingston County                Genesee               NYS

Decline among men; 94-98 rates slightly higher than GenCo and NYS except for
males (GenCo 94-98)                  Source: New York State Department of Health
                                           #7: Health Status
                            Lung Cancer - Mortality Trends
                    Livingston County Mortality Trends Cancer
                                                            Lung Cancer Total
                                   (1995-1999)              Lung Cancer Male
                                                                               Lung Cancer Female
Rate per 100,000




                   140
                   120
                   100
                    80
                    60
                    40
                    20
                     0
                             Rate            Rate            Rate             Rate             Rate

                             1995            1996            1997             1998             1999


                     Decline among men until uptick in 1999; Declines among women since 1998

      Source: New York State Department of Health
                                     #7: Health Status
               Breast Cancer - Incidence Trends

                            Incidence -- Breast Cancer
                        Livingston Co, Genesee Co, NYS
      120                                     118
                      115
      115
      110                                               106
                                                                       104
      105
      100
        95
                  92-96 rate            94-98 rate    94-98 rate   94-98 Rate per
                   females               females       females        females
                         Livingston County           Genesee            NYS
      No change; rates higher than GenCo and NYS

Source: New York State Department of Health
                                    #7: Health Status
                       Breast Cancer - Screening

                                    Breast Cancer Screening
                                       (un/under insured)

          100
                              79
                                              62    56
                                                               42
           50
                                                                             39

             0
                       1997               1998     1999      2000         2001

                         Livingston County         Genesee          NYS


Source: Livingston County Health Department
                                                #7: Health Status
                              Breast Cancer - Mortality Trends
                    Livingston County Mortality Trends Cancer
                                   (1995-1999)
                                                                                 B r east Cancer
Rate per 100,000




                   50                                                            Cer vi cal Cancer
                                                     41
                   40                                                                                        40
                   30
                   20                                              29
                                    18                                                               20
                   10
                    0
                               Rate              Rate               Rate                   Rate           Rate

                               1995              1996               1997                   1998           1999


                        Breast cancer mortality variable but increasing since 1995
      Source: New York State Department of Health
                                            #7: Health Status
                                    Cerebrovascular Disease

                                    Livingston County Mortality Trends -
                                          Cerebrovascular Disease
                               70                61     56      56
            Rate per 100,000




                               60        65
                               50
                                                                       48
                               40
                               30
                               20
                               10
                                0
                                     1995     1996    1997   1998    1999
           Decline in mortality since 1995
Source: New York State Department of Health
                                              #7: Health Status
                                      Cerebrovascular Disease

                                      Mortality Trends - Cerebrovascular
                                      Disease - Livingston, Genesee, New
                                                York State 1999

                                 50
                                           48.2
              Rate per 100,000




                                 48                          46.5
                                 46
                                                                            43.6
                                 44
                                 42
                                 40
                                       1999 Livingston   1999 Genesee   1999 New York

           Rates higher than GenCo and NYS in 1999
Source: New York State Department of Health
                                             #7: Health Status
                                   Diabetes Hospitalizations


                               Diabetes Hospitalizations (All Ages 1997 - 1999)

                          16
                                        15                                GENESEE
                          14
       Rates per 10,000




                          12                                      11.88   LIVINGSTON
                                                    11.25
                          10
                                  7.7
                          8                                               LivCo rates
                          6                        8.68
                                                               7.74       conistently lower
                          4
                                                                          than GenCo
                          2
                          0            0            0            0
                                    1997         1998         1999

Source: New York State Department of Health SPARCS
                                             #7: Health Status
                            Asthma - Hospitalization Data

                                Asthma Hospitalizations Ages 18 - 64 (1997 - 1999)

                                                                8
                        9   8
                        8                7                                   GENESEE
                                                     7
                                                                             LIVINGSTON
      Rate per 10,000




                        7
                        6                                           6
                        5
                        4
                        3                      4
                        2                                                 LivCo rates lower
                        1
                        0
                                                                          than GenCo in
                                  1997             1998        1999
                                                                          recent years.
                                                                          Uptic in 1999
          Rate for LivCo in 1995 – 7
                                                                          noted in both
                                                                          counties.
Source: New York State Department of Health SPARCS
                                             #7: Health Status
                             Asthma - Hospitalization Data
                              Asthma Hospitalizations Age >65 (1997 - 1999)
                                                                      GENESEE
                        30
                                                                      LIVINGSTON
                        25
      Rate per 10,000




                                                            18
                        20                   19
                             14
                        15
                        10                                 15       No trends noted
                             14                   14
                         5
                                                                    for either county.
                         0
                                  1997             1998   1999

               Rate for LivCo in 1995 – 13



Source: New York State Department of Health SPARCS
                                     #7: Health Status
                 COPD - Hospitalization Data



                                                         LivCo rates
                                                         consistently
                                                         lower than
                                                         GenCo. No trend
                                                         identified for
                                                         LicCo while
                                                         GenCo show
                                                         downward
       Rate for LivCo in 1995 - 12
                                                         trendline.
Source: New York State Department of Health SPARCS
                                         #7: Health Status
                              COPD - Hospitalization Data
                              COPD Hospitalizations Age 18 - 64 (1997 - 1999)

                         20                                            GENESEE
                                    17          16         17          LIVINGSTON
                               15
       Rate per 10,000




                         15                                     15

                         10
                                                12
                          5
                                                                       LivCo rates
                          0
                                                                       parallel those of
                                1997          1998         1999
                                                                       GenCo. No trend
                                                                       identified for
       Rate for LivCo in 1995 - 13
                                                                       either county.
Source: New York State Department of Health SPARCS
                                        #7: Health Status
                              COPD - Hospitalization Data


                              COPD Hospitalizations Age >65 (1997 - 1999)

                        200                                      GENESEE
                                              170                LIVINGSTON
                        180
      Rate per 10,000




                        160                               148
                        140
                                                                       LivCo rates
                        120   103
                                                                106    consistently
                        100
                         80
                              80               107                     lower than
                         60                                            GenCo; dipped in
                                1997         1998         1999         1997; No trend
                                                                       identified for
                                                                       either county.
     Rate for LivCo in 1995 - 104

Source: New York State Department of Health SPARCS
                    #7: Health Status
             Nutrition and Overweight
• Prevalence of overweight adults
  – Livingston County:             31.2
  – Genesee County:                28.5
• Prevalence of Sedentary Lifestyle
  – Livingston County:             80.5
  – Genesee County:                78.6
• Prevalence of consumption of 5 fruits/vegs
  – Livingston County:             21.6
  – Genesee County:                22.2


   Indirect estimates – NYS DOH BRFSS 1994 – 1998 –
   published December 2000
                              #7: Health Status
                       Nutrition and Overweight
                      Anemia among Pregnant Women

          12.0

          10.0

           8.0
Percent




           6.0
           4.0

           2.0

           0.0
                   1998          1999          2000         2001

           Increase since 1999 – proxy for adequate nutrition
           Based on data from Finger Lakes Regional Perinatal Data System
                                        #7: Health Status
                                 Nutrition and Overweight
                                          Pre Pregnancy BMI      Under 25 (normal)
                                                                 Overw eight

                            60                                   Obese
   Percent Pregnant Women




                            50
                            40

                            30

                            20
                            10

                            0
                                 1998      1999      2000     2001

Slight decline in women with normal BMI with increases in those
identified as obese
Based on data from Finger Lakes Regional Perinatal Data System
                   #7: Health Status
            Nutrition and Overweight
• Based on data from 1998 – 2000,
  covered lives among two area insurers
  represented 37,000 to 41,000
  Livingston County residents
  – between 1 to 2% have an obesity diagnosis




  Source: Preferred Care and BC/BS - Excellus
                  #7: Health Status
          Nutrition and Overweight

          Obesity Diagnoses among Males
                (Livingston County)
              Male < 19             Male 19 - 39
              Male 40 - 59          Male 60 +
 3%

 2%

 1%

 0%
           1998              1999            2000

Obesity diagnoses increasing slightly among LivCo males
GenCo rates were similar
Source: Preferred Care and BC/BS - Excellus
                     #7: Health Status
             Nutrition and Overweight

            Obesity Diagnoses among Females
                    (Livingston County
               Female < 19           Female 19 - 39
   4%          Female 40 - 59        Female 60 +
   3%
   2%
   1%
   0%
              1998            1999            2000
Obesity diagnoses increasing slightly among LivCo adult females
GenCo rates were similar
Source: Preferred Care and BC/BS - Excellus
                       #7: Health Status
               Nutrition and Overweight
• NYSDOH Heart Check Survey (2000)
• 46 Heart Check Surveys conducted at various
  worksites in Livingston County
    – Measures the physical activity and nutrition
      opportunities at worksites
• The mean score for nutrition was 13%
• The mean score for physical activity was 15%
(no prior year comparison data available)
              #7 Health Status

• Strengths
  – Mortality trends improving
  – Cardiovascular mortality declining
  – Cerebrovascular mortality declining
  – Improved breast cancer screening (more
    women diagnosed)
  – Lung cancer deaths among women declining
              #7 Health Status

• Opportunities
  – Breast cancer deaths among women
    increasing
  – Lung cancer deaths among men increasing
  – Adult asthma diagnoses increasing
  – Obesity rates increasing
               #7 Health Status

• Trends to Watch
  – Inadequate data to assess dental health
  – Diabetes hospitalizations unchanged
        Indicator #8
Health and Social Resources
#8 Health and Social Resources
• Data elements
  –   Emergency Services
  –   Hospital Beds
  –   Nursing Home Beds
  –   Health Plan Satisfaction
  –   Health Plan Performance
  –   Early Intervention Enrollment
#8 Health and Social Resources
• Data sources
  –   New York State Health Accountability Foundation
  –   Finger Lakes Regional Trauma Center
  –   Emergency Medical Service providers
  –   Finger Lakes Health Systems Agency
  –   Livingston County Health Department
  –   New York State Health Department
  –   Office of Alcohol and Substance Abuse Services
            #8: Health and Social Resources
             Emergency Medical Services
• Motor Vehicle Fatalities*
    – 17.1 per 100,000
       • National Average: 14.9
       • Second highest in Finger Lakes (Highest: Yates)
• Average time to Regional Trauma Center
    – 5.1 HOURS from time of injury to arrival at center (Higher than
      Ontario, Yates, Wayne, Monroe)
    – Time to RTC:     74 minutes driving
                       23 minutes flying


Data from Strong Memorial Hospital, Regional Trauma Center
*NHTSA, 2000
              #8: Health and Social Resources
              Emergency Medical Services
• Trauma Cases from Livingston
   – To Regional Trauma Center: 23
   – To Area Trauma Center:        1
• Emergency Medical Services
   – Calls in 2002 (Jan – September)*
        • Total:                                   1889
           – No crew available:                    11% (215 calls)




11 of 12 agencies reporting data of all calls; through September 16, 2002
                  #8: Health and Social Resources
                  Emergency Medical Services
                      EMS Village Response Times (1 - 9/02)

             25
                                       90th Perc.
             20                        Average
   Minutes




             15

             10

              5

              0
                  1      2        3        4             5   6        7     8
                                               Village
Average response is below target in all villages; 90th percentile exceeds
cutoff in five villages.
Target for village responses is <15minues
11 of 12 agencies reporting data of all calls; through September 16, 2002
                           #8: Health and Social Resources
                           Emergency Medical Services
                                       EMS Town Response Times (1 - 9/02)

                      30
                                            90th Perc.
                      25
                                            Average


                      20
            Minutes




                      15


                      10


                      5


                      0
                           1   2   3    4   5   6     7    8    9    10 11 12 13 14 15 16 17 18 19
                                                                    Towns
Average response is below target in all towns; 90 th percentile exceeds cutoff
in nine villages.
Target for town responses is <20minues
11 of 12 agencies reporting data of all calls; through September 16, 2002
        #8: Health and Social Resources
                 Hospital Bed Use


Shift in
utilization to
out of county
hospitals
          #8: Health and Social Resources
                  Hospital Bed Use


Census
declines in
local hospitals
          #8: Health and Social Resources
                   Nursing Home Use
            Rate of Nursing Home Utilization
           per 1000 population by Age Group

 Age Group                             Dec-94             Dec-98
 21 - 64                                 0.44               0.42
 65 -74                                  10.6                7.8
 75-84                                     56               46.7
 85+                                    236.5              174.3

 21+                                          8.8              7.6
   Utilization declining across all age groups
Source: Finger Lakes Health Systems Agency Report, July 2000
            #8: Health and Social Resources
                   Nursing Home Use
Case Mix Changes at Livingston County Nursing Homes
                         1986               1999
Low Intensity    42.9%                22.1%

High Intensity                57.1                   77.9

Intensity increased reflecting the type of individual residing in
   nursing home; lower intensity clients have shifted to other less
   intense facilities or to homes.
*Based on data compiled by Finger Lakes Health Systems Agency;
   using Mt. Morris and Geneseo Nursing Home Facilities
        #8: Health and Social Resources
               Nursing Home Use


Increases in
Adult Day
programs
mirrors
decline in
nursing
home bed
occupancy
             #8: Health and Social Resources
                 Children with Special Needs

             Children with Special Health Care Needs
                            1998 - 2001
                                                          Current Enrollm ent
                                                          Referrals
                                                          Transfers to EIP
           150                                            Discharges
           125
  Number




           100
            75
            50
            25
             0
                     1998             1999              2000              2001
Child Find statistics (at risk for developmental delay, birth to age 3;
Source: Livingston County Health Department
                 #8: Health and Social Resources
                 Children with Special Needs

                  Active Early Intervention Cases
                           (1995 - 2002)

           250
                                                    174      198   194
           200                      134       154
 Num ber




           150               113
                   85
           100
            50
             0
                 1995   1996   1997       1998   1999     2000   2001
Increasing number of cases
Source: Livingston County Health Department
                  #8: Health and Social Resources
                  Children with Special Needs

             Net Cost per Active Early Intervention
                       Case(1995 - 2002)

           1750                                      1250   1461 1346
           1500                      1091
           1250      920                      1000
 Num ber




           1000
            750              357
            500
            250
              0
                   1995    1996 1997     1998   1999 2000     2001
Increasing cost of cases
Source: Livingston County Health Department
          Health and Social Resources
                Dental Services

• Population below Federal Poverty Level
  – Population : Provider Ratio: 290,705:1
    • Unusually high need is defined as 4000:1
  – Livingston county qualified for designation as
    a Low Income/Medicaid HPSA.
                   #8: Health and Social Resources
                             Dental Services
                Dental Services Provided to Children
                1998 - 2001 (Eastman Dental Center Satellite)
          600

          500

          400
Num ber




          300
                                            Dental exam s
          200
                                            Sealants & Prophylaxis
                                            Restorative dental tx
          100

            0
                    1998         1999          2000         2001
          Enrollment: 1998: 822; 1999: 994; 2000: 1,145; 2001: 1, 320
          Source: Livingston County Health Department
                #8: Health and Social Resources
                          Dental Services
                 Dental Services Provided to Adults
                1998 - 2001 (Eastm an Dental Center Satellite)
          300
                                         Cleaning and fluoride
          250                            Restorative dental tx
                                         Em ergency tx
          200
Num ber




          150

          100

          50

           0
                  1998          1999          2000          2001

Enrollment: 1998: 238; 1999: 260; 2000: 278; 2001: 310
Source: Livingston County Health Department
                                    #8: Health and Social Resources
                                  Access to Quality Health Care
                                      Livingston County Primary Care
                                      Physician Provider Survey (2000)
                            50
Number Full Time Employed




                                                                                    45
                            45
                                       Primary Care Physician
                            40          35
                            35
                            30
                            25                                 Mid-Level
                                                           (Physicians Assistant
                            20                             Nurse Practitioners))
                            15                                  10                                     Primary Care
                            10                                                                         Physician to
                                                                                                       Population
                                                                                                       Ratio
                             5                                                                         1:1469

                             0                                                     Total Practioners


                            Note: Includes only providers within Livingston County
                             #8: Health and Social Resources
                            Access to Quality Health Care

                                   Prenatal Care (1st Trimester)

                     83
                                                                            82.2             82.5
                     82
 Percent of Births




                     81           81.3
                                                            80.8
                     80
                     79
                                             78.5
                     78
                     77
                     76
                            1995         1996         1997           1998              1999
                          n=706      n=712          n=706       n=655             n=698


Source: New York State Department of Health County Health Indicator Profiles, Livingston County (1995 – 1999)
                  #8: Health and Social Resources
                Access to Quality Health Care

                               Prenatal Care (1st Trimester)

      85              82.5
      80

      75                                                                            71.7
                                                     70.1
      70

      65

      60
               1999 - Livingston               1999 Genesee                  1999 New York



Source: New York State Department of Health County Health Indicator Profiles, Livingston County (1995 – 1999)
           #8 Health and Social Resources
          Access to Quality Health Care
     Uncontrolled Diabetes Hospitalizations (Age 18 – 64)

         Total Admissions from ED for Metabolic
                 Disorders (ages 18 - 64)

40
30                                                                        33
20
               37
10
                                        22
0
             1998                    1999                           2000
       Metabolic disorders may be a proxy for uncontrolled diabetes
       These admissions may reflect quality of care issues

                                Source: New York State Department of Health SPARCS
        #8 Health and Social Resources
        Satisfaction with Health Plan
• Two HMOs represent the majority of
  individuals living in this area of New York
  State (37,000 to 41,000 covered lives in
  Livingston County from 1998 – 2000)
• Both plans’ ratings are generally at the high
  end for all of New York State and with
  National ranges
• County specific ratings are not available
          #8 Health and Social Resources
          Satisfaction with Health Plan

Ratings
  – Respondents reporting
  Any difficulty getting care      12 – 13%
  Ability to get needed services   86 – 88%




 NYS HMO Report Card 2002
          #8 Health and Social Resources
          Satisfaction with Health Plan

Ratings
  – % of members rating plan as 8, 9 or 10
                       (out of a 10 point scale)
  Health Plan                                  72 – 75%
  Primary Care Provider                        67 – 78%
  – Respondents reporting
  Any difficulty getting care                  12 – 13%
  Ability to get needed services               86 - 88%


 NYS HMO Report Card 2002
          #8 Health and Social Resources
             Health Plan Performance
Preventive Services
Early prenatal care  89 – 90%
Screenings
 Cervical cancer     85 – 89%
 Breast cancer       82 – 83%
Childhood Immunizations
 (age 2)             80 – 87%

 NYS HMO Report Card 2002
          #8 Health and Social Resources
             Health Plan Performance
Other services
Follow-up after hospitalization for mental illness
                              75 – 91%
Beta Blocker after heart attack
                              96 – 99%
Follow-up of individuals treated for depression (3
  visits in 12 weeks after diagnosis)
                              22 – 28%
Appropriate asthma meds       76 – 71%


 NYS HMO Report Card 2002
           #8 Health and Social Resources
              Health Plan Performance
Other services
Cholesterol management               62 – 65%
  (% with heart disease with low cholesterol)
Eye exams for diabetics              67%
Blood sugar control for diabetics    20 – 29%*
  (% with blood sugar too high)
Control of hypertension              48 – 68%
  (% with Normal blood pressure)


 * Lower numbers are better

NYS HMO Report Card 2002
        #8 Health and Social Resources

• Strengths
  – Declining nursing home utilization with
    increasing intensity of case mix
  – High primary care provider ratio
  – Relatively high ratings of HMO provided
    health plans
        #8 Health and Social Resources

• Opportunities
  – Response time of emergency medical
    services inconsistent across county
  – Inadequate number of dental providers
    accepting Medicaid
  – Decreases in individuals receiving treatment
    at OASAS sites
  – Early Intervention cases increasing in number
    and cost
        #8 Health and Social Resources

• Trends to Watch
  – Increasing numbers of individuals receiving
    Medicaid
  – Hospital bed utilization

				
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