PROVIDED TO YOU COURTESY OF:

COMMUNITY HEALTH STATUS REPORT

Grundy County Tennessee

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

2009

communityhealth.hhs.gov ASTHO Association of State and Territorial Health Officials

www.astho.org chsi@astho.org

Johns Hopkins University Bloomberg School of Public Health

www.communityPHIND.net chsi@jhu.edu

NACCHO National Association of County and City Health Officials

www.naccho.org chsi@naccho.org

NALBOH The National Association of Local Boards of Health

www.nalboh.org chsi@nalboh.org

PHF Public Health Foundation

www.phf.org chsi@phf.org

Our Mission: Provide Information for Improving Community Health

RWJF Robert Wood Johnson Foundation

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

communityhealth.hhs.gov

PUBLIC HEALTH IN AMERICA

CONFIDENCE INTERVALS
SUMMARYMEASURESOFHEALTHpage4 Value ConfidenceInterval ALLCAUSESOFDEATH 1848.1 (1760.61935.6) SELFRATEDHEALTHSTATUS nrf (nrfnrf) AVERAGENUMBEROFUNHEALTHYDAYSIN nrf (nrfnrf) PASTMONTH ADULTPREVENTIVESERVICESUSE(%)page10 Value ConfidenceInterval PapSmears(18+) nrf (nrfnrf) Mammography(50+) nrf (nrfnrf) Sigmoidoscopy(50+) nrf (nrfnrf) Pneumoniavaccine(65+) nrf (nrfnrf) Fluvaccine(65+) nrf (nrfnrf) RISKFACTORSFORPREMATUREDEATHpage11 Value ConfidenceInterval Noexercise nrf (nrfnrf) FewFruits/Vegetables nrf (nrfnrf) Obesity nrf (nrfnrf) HighBloodPressure nrf (nrfnrf) Smoker nrf (nrfnrf) Diabetes 9.5% (2.616.3%)

VISION Healthy People in Healthy Communities MISSION Promote Physical and Mental Health and Prevent Disease, Injury, and Disability

PUBLIC HEALTH

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

ESSENTIAL PUBLIC HEALTH SERVICES

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

ATSDR Agency for Toxic Substances and Disease Registry

atsdr.cdc.gov

CDC Center for Disease Control and Prevention

www.cdc.gov

HRSA Health Resources and Services Administration

www.hrsa.gov

NLM National Library of Medicine

www.nlm.nih.gov

Source:

PublicHealthFunctionsSteeringCommittee,Fall1994.

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

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

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

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DEMOGRAPHIC INFORMATION

RISK FACTORS FOR PREMATURE DEATH1

Grundy County, TN
Populationsize1 Populationdensity(peoplepersquaremile)2 Individualslivingbelowpovertylevel3 Age distribution1 UnderAge19 Age1964 Age6584 Age85+ Race/Ethnicity1 White Black AmericanIndian Asian/PacificIslander Hispanicorigin(nonadd) 98.1% 0.6% 0.3% 0.2% 1.1% 24.6% 59.2% 14.0% 2.2% 14,220 39 29.5%

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

PEER COUNTIES Peer counties (counties and county-like geographic areas) in stratum number 69 were stratified on the basis of the following factors: frontier status, population size, poverty, age, population density. Below are peer county ranges representing the 10th and 90th percentile of values. This trimmed range of peer county value is used consistently throughout the report.
nrf Noreport,surveysamplesizefewerthan50.

Populationsize1 Populationdensity(peoplepersquaremile)2 Individualslivingbelowpovertylevel3 Age distribution1 UnderAge19 Age1964 Age6584 Age85+ Race/Ethnicity
1

12,94625,115 3877 19.030.2%

1 CDC.BehavioralRiskFactorSurveillanceSystem,20002006.

ACCESS TO CARE

Grundy County, TN
In addition to use of services, access to care may be characterized by medical care coverage and service availability. 2,110 Uninsuredindividuals(ageunder65)1 Medicarebeneficiaries2 Elderly(Age65+) Disabled Medicaidbeneficiaries2 Primarycarephysiciansper100,000pop2 Dentistsper100,000pop2 Community/MigrantHealthCenters3 HealthProfessionalShortageArea3
nda Nodataavailable.
1 TheCensusBureau.SmallAreaHealthInsuranceEstimatesProgram,2006. 2 HRSA.AreaResourceFile,2008. 3 HRSA.GeospatialDataWarehouse,2009.

23.028.6% 57.963.8% 10.514.0% 1.32.2%

2,031 788 7,207 21.1 0.0 Yes Yes

White Black AmericanIndian Asian/PacificIslander Hispanicorigin(nonadd)

nda Nodataavailable.
1 TheCensusBureau.CurrentPopulationEstimates,2008. 2 HRSA.AreaResourceFile,2008. 3 TheCensusBureau.SmallAreaIncomePovertyEstimates,2008.

49.198.4% 0.349.6% 0.10.7% 0.10.7% 0.78.0%

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PREVENTIVE SERVICES USE

PEER COUNTIES

Grundy County, TN
INFECTIOUS DISEASE CASES1 These diseases respond to public health control efforts. The expected number is based on the occurrence of cases among peer counties. A distinctive aspect of this report is the ability to compare a county with its peers, those counties similar in population composition and selected demographics. Strata, or peer group size averages 36 and ranges from 15 to 62 counties. There are a total of 88 strata. Listed below are the 44 peer counties in stratum number 69. Due to the population size of counties within this stratum, data on vital statistics (e.g. births and deaths) and nationally notifiable diseases were aggregated across the most recent 10 year time period (1996-2005) in order to ensure stable estimates.

Reported Cases
AIDS Tuberculosis HaemophilusinfluenzaeB HepatitisA HepatitisB Measles Pertussis CongenitalRubellaSyndrome Syphilis rna rna 1 0 4 0 1 0 1

Expected Cases
rna rna 0 3 4 0 1 0 3

Indicatesastatusfavorabletopeers. Indicatesastatuslessthanfavorable. rna Thereleaseofdataforallcountieshasnotbeen authorized

nda Nodataavailable. CHILD PREVENTIVE SERVICES USE Indicators such as immunizations, dental caries, and the prevalence of lead screening are not collected at the national level and must be obtained locally. ADULT PREVENTIVE SERVICES USE (%)2

Florida Hardee County Union County Georgia Bacon County Ben Hill County Berrien County Cook County Crisp County Evans County Grady County Greene County Jeff Davis County Lanier County McDuffie County Meriwether County Mitchell County Peach County Pierce County Worth County Kentucky Clay County Jackson County Knott County Lawrence County Magoffin County Martin County McCreary County

Kentucky Powell County Louisiana Assumption Parish East Feliciana Parish Pointe Coupee Parish St. James Parish Mississippi Clay County Covington County Grenada County Walthall County Missouri McDonald County North Carolina Washington County Oklahoma Adair County South Carolina Bamberg County Barnwell County Lee County Tennessee Hardeman County Lauderdale County Scott County Virginia Dickenson County

nrf Noreport,surveysamplesizefewerthan50.
1 CDC.NationalNotifiableDiseasesSurveillanceSystem,19982007. 2 CDC.BehavioralRiskFactorSurveillanceSystem,20002006.

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SUMMARY MEASURES OF HEALTH

VULNERABLE POPULATIONS

Grundy County, TN
AVERAGE LIFE EXPECTANCY1

Grundy County, TN
Vulnerable populations may face unique health risks and barriers to care, requiring enhanced services and targeted strategies for outreach and case management.

Vulnerable Populations Include People Who1 ALL CAUSES OF DEATH2 Havenohighschooldiploma(amongadultsage25 andolder) Areunemployed Areseverelyworkdisabled Havemajordepression Arerecentdrugusers(withinpastmonth)

4,440 486 788 1,070 1,013

SELF-RATED HEALTH STATUS3

nda Nodataavailable.
1 Themostcurrentestimatesofprevalence,obtainedfromvarious

sources(seetheDataSources,Definitions,andNotesfordetails), wereappliedto2008midyearcountypopulationfigures.

ENVIRONMENTAL HEALTH

Grundy County, TN
INFECTIOUS DISEASES1

Cases
E.coli

Reported Expected
0 12 1 0 33 11

AVERAGE NUMBER OF UNHEALTHY DAYS IN PAST MONTH3

Salmonella Shigella

TOXIC CHEMICALS RELEASED ANNUALLY2 : nda NATIONAL AIR QUALITY STANDARDS MET BY COUNTY3
Carbon Nitrogen Sulfur Monoxide Dioxide Dioxide Yes Yes Yes Ozone Yes Particulate Matter Yes Lead Yes

nrf Noreport,surveysamplesizefewerthan50. nda Nodataavailable.

1 Murrayetal.,PLoSMedicine2006Vol.3,No.9,e260doi:10.1371/journal.pmed.0030260. 2 NCHS.VitalStatisticsReportingSystem,19962005. 3 CDC.BehavioralRiskFactorSurveillanceSystem,20002006.

Indicatesastatusfavorabletopeers. Indicatesastatuslessthanfavorable.

nda Nodataavailable.
1 CDC.NationalNotifiableDiseasesSurveillanceSystem,19982007. 2 EPA.ToxicReleaseInventory(TRI)ExplorerReport,2008. 3 EPA.AIRSData,2008.

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RELATIVE HEALTH IMPORTANCE

NATIONAL LEADING CAUSES OF DEATH1

Grundy County, TN

Grundy County, TN
UnderAge1 White Black Other Hispanic

Complicationsof Pregnancy/Birth BirthDefects

Ages114

nrf nrf nrf nrf nrf 68% nrf nrf nrf 22% 12% 18% nrf nrf nrf 26% 29% 29% 21%

nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf

nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf

nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf

PrematureBirths(<37weeks) BreastCancer(Female) ColonCancer CoronaryHeartDisease Homicide LungCancer MotorVehicleInjuries Stroke Suicide UnintentionalInjury

Injuries Cancer Homicide

Ages1524
LowBirthWt.(<2500g) BirthstoWomenunder18

Injuries Homicide Suicide Cancer

Ages2544

BirthstoWomenage4054

VeryLowBirthWt.(<1500g) BirthstoUnmarriedWomen InfantMortality WhitenonHispanicInfantMortality NeonatalInfantMortality PostneonatalInfantMortality

Injuries Cancer HeartDisease Suicide HIV/AIDS Homicide

Ages4564

Cancer HeartDisease
Ages65+

HeartDisease Cancer

The Relative Health Importance table creates four categories of relative concern by simply comparing a county to its peers and to the U.S. A county's indicators in the upper left-hand box ( ) are higher than the U.S. and its peers and may warrant more attention. Conversely, indicators in the lower right-hand box ( ) of the table compare favorably to both peers and the U.S. The other boxes represent intermediate levels of health where a county's rate is higher than either its peers or the U.S., but not both.
nrf Noreport,fewerthan20deathsinrace/ethnicityandagegrouporlessthan10% ofthedeaths. nda Nodataavailable. LocaldataarepresentedfortheNation'stopleadingcausesofdeathineachage group.Columns,withinagecategories,donottotal100%becauseallcausesof deatharenotlisted. Themostcompleteethnicitydataavailablearereported.
1 NCHS.VitalStatisticsReportingSystem,19962005.

Source:MeasuresofBirthandDeathtables,pages67.
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MEASURES OF BIRTH AND DEATH1

Grundy County, TN
CountyPercent/C.I. 9.1 1.1 14.6 5.2 1.1 30.6 cdna (7.8,10.4) (0.7,1.6) (13.1,16.2) (4.2,6.2) (0.6,1.5) (28.6,32.7) (cdna,cdna) PeerCountyRange 7.511.9 1.12.5 12.017.8 5.48.6 0.71.4 26.957.0 cdna BirthMeasures LowBirthWt.(<2500g) VeryLowBirthWt.(<1500g) PrematureBirths(<37weeks) BirthstoWomenunder18 BirthstoWomenage4054 BirthstoUnmarriedWomen NoCareinFirstTrimester2 InfantMortality3 InfantMortality WhitenonHispanicInfantMortality BlacknonHispanicInfantMortality HispanicInfantMortality NeonatalInfantMortality PostneonatalInfantMortality DeathMeasures 4 BreastCancer(Female) ColonCancer CoronaryHeartDisease Homicide LungCancer MotorVehicleInjuries Stroke Suicide UnintentionalInjury U.S. Percent 2005 8.2 1.5 12.7 3.4 2.7 36.9 cdna HealthyPeople 2010Target 5.0 0.9 7.6 Noobjective Noobjective Noobjective 10.0

CountyRate/C.I. 5.1 5.2 nrf nrf 3.1 2.0 (2.5,9.4) (2.5,9.5) (nrf,nrf) (nrf,nrf) (1.1,6.7) (0.6,5.2)

PeerCountyRange 5.213.3 4.612.8 0.020.4 0.013.5 3.59.1 2.25.4

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

CountyRate/C.I. 48.7 41.4 396.1 27.1 122.0 92.6 111.2 40.2 64.3 (31.0,73.0) (29.5,56.5) (355.9,436.3) (17.1,40.8) (99.9,144.1) (73.0,115.9) (89.9,132.6) (27.7,56.4) (48.6,83.5)

PeerCountyRange 32.058.3 27.043.7 278.2459.0 7.822.1 91.9153.5 37.773.7 85.4148.2 13.828.5 32.565.2

Thetotalnumberofbirthsduringthistimeperiodwas1,953andthetotalnumberofdeathswas1,734. Indicatesastatusfavorabletopeers. Indicatesastatuslessthanfavorable. Noreport,fewerthan500birthsand5events(birthmeasuresandinfant mortality)orfewerthan10events(deathmeasures)occurredduringthe specifiedtimeperiod.

nrf

nda Nodataavailable. cdna Comparabledatanotavailable.

1 NCHS.VitalStatisticsReportingSystem,19962005. 2 Include37states,NewYorkCityandDC(seetheDataSources,Definitions,andNotesfordetails). 3 Infantmortality:deathsper1000livebirths(Neonatal:<28dayspostneonatal:day28tounderoneyear). 4 Ratesareageadjustedtotheyear2000standardper100,000population.

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