Dallas County Health Report

DALLAS COUNTY
COMMUNITY HEALTH NEEDS ASSESSMENT 2019

Parkland Health & Hospital System | Dallas County Health and Human Services
3
4
Executive Summary 6 Dallas County General Health Profile (cont.)
Morbidity ......................................................................50
Introduction 8 Behavioral Risk Factor Surveillance System (BRFSS) ..50
Dallas County Health and Selected Reportable Infectious Diseases....................62
Human Services Overview................................................8
Other Reportable Infectious Diseases........................72
Parkland overview ...........................................................9
Behavioral Health in Dallas County ...........................74
Hospital Utilization ........................................................76
Purpose of the Dallas County CHNA 10
Inpatient Discharges.................................................76
Emergency Department (ED) Discharges Profile ........86
Overview of Dallas County 12
Prominent Hospital Diagnoses ..................................93
Economy .......................................................................12
Parkland Utilization by Chronic Diagnoses ................98
Housing ........................................................................16
Other At-Risk Populations............................................108
Access to Care in Dallas County ....................................18
Correctional Health ................................................108
Insurance Coverage .................................................18
Homeless Health ....................................................111
Dallas County Medicaid Enrollment ..........................20
Lesbian, Gay, Bisexual and Transgender Health .......116
Access to Primary Care Physicians ............................23
Hospitals and Health Systems ...................................24
Community Input 118
Community Health Integration ....................................118
CHNA Methodology 26
Barriers to Better Care .................................................118
Dallas County General Health Profile 28 SDOHs by Healthy People 2020 Category ....................120
Mortality .......................................................................30 Health and Healthcare ...........................................120
Leading Causes of Death .........................................30 Social Impact & Community Context ......................121
Heart Disease Mortality ............................................34 Education ..............................................................122
Cancer Mortality ......................................................36 Neighborhood and Built Environment ....................122
Other Leading Causes of Death................................38 Summary of Community Input ....................................122
Leading Causes of Death by Race and Ethnicity ........42

Maternal Mortality in Dallas County .........................44
Infant Mortality in Dallas County ..............................45
Life Expectancy..............................................................47
EXECUTIVE SUMMARY
Parkland Health & Hospital System (Parkland) and the Dallas County Health • Health Literacy: Provider and patient feedback from focus groups indicates
and Human Services (DCHHS) undertook a joint Community Health Needs there is a general lack of understanding of how to obtain/use health
Assessment (CHNA) in adherence to the Patient Protection and Affordable coverage, navigate the health system and adhere to treatment plans and
Care Act (ACA) and as part of the accreditation process for public health provider instructions, which are often not culturally or linguistically accessible
departments. In accordance with the ACA, the CHNA’s report was accepted by to the patient. There is an overall concern with the degree to which Dallas
Parkland’s Board of Managers on September 18, 2019. County residents, particularly racial and ethnic minorities and those living in
southeast area of the County, have the capacity to obtain, communicate,
The overarching goal of this CHNA was to identify the geographic areas and process and understand information pertaining to health and health services.
populations that experience the most significant health disparities including,
racial and ethnical minorities, low social economic populations, underserved • Cultural Competency: The ever-increasing diversity of Dallas County
population, those with chronic disease and those with infectious disease. requires greater resources devoted to cultural competency including the
establishment of best practices.
The methodology framework used for this CHNA includes: Public Health
Practice, Community Based Participatory Research, Strategic Planning as well Health Disparities:
as qualitative and quantitative data analysis. The data used for this report was • There are significant health disparities by race and ethnicity and by
gathered from an array of data sources and from a series of focus groups geographic location within the county. African American and people living
conducted throughout Dallas County. in ZIP Codes located in Southeast Dallas continue to experience the highest
burden of disease and mortality.
The following provides an overview of the key finding that emerged from this
CHNA. Special Populations:
• The demand for health services for homeless and elderly individuals
Findings: continues to grow as these populations increase in numbers.
Access to Care: • Assessing the health status for Lesbian, Gay, Bisexual and Transgender
• Health Insurance Coverage: There is high uninsured rate in Dallas County individuals remains a challenge due to limited data pertaining to sexual
and high a high volume uninsured hospital discharges, particularly in orientation and gender identity (SOGI) data.
Parkland. Of note, Dallas County has one of the highest uninsured rates
among all urban counties in the nation—higher than both Harris County, Chronic Conditions:
Texas and Bexar County, Texas • Hypertension, cancer, diabetes, asthma, chronic kidney disease and chronic
heart failure, which are related to tobacco use, poor nutrition and lack of
• Behavioral Health: Dallas County does not have enough behavioral health physical activity are the leading causes of death and contributors of a high
capacity to support the high demand for those services. Navigating the
volume of inpatient hospitalizations.
health system in Dallas County is difficult for those with behavioral health
needs and there is a lack of integration between behavioral health and Infectious Diseases:
physical health. According to input provided by focus group participants, the • The increasing number of Sexually Transmitted Diseases, cases in Dallas
demand for behavioral health services for school children, youth, and seniors County is a significant problem
is concerning.
6
7
INTRODUCTION
COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DALLAS COUNTY HEALTH AND HUMAN
The Patient Protection and Affordable Care Act (ACA) through the Internal SERVICES OVERVIEW
Revenue Code, requires a hospital organization treated as tax-exempt under Public health activities in Dallas date back to 1873 with the
501(c)(3) to conduct a Community Health Needs Assessment (CHNA) at appointment of the first City Health Officer and early efforts
least once every three years and to adopt an implementation strategy to to control the disposal of waste, sale and serving of food
meet the community health needs identified through the CHNA. Parkland items and the processing of milk products. The work of Dallas
Health & Hospital System completed two previous CHNAs in 2013 and in County Health and Human Services is wide-ranging and is
2016. Parkland’s next CHNA is to be delivered via online posting to the primarily focused on disease prevention. DCHHS is committed
residents of Dallas County on September 30, 2019. to improve the health and quality of life for all Dallas County
residents and to address inequities and disparities in health.
A CHNA is also required as part of the accreditation process for public
DCHHS targets services to reach vulnerable populations in
health departments. The Dallas County 2016-2019 CHNA allowed the
areas of the community with the highest need.
Dallas County Health and Human Services Department (DCHHS) to
successfully achieve National Public Health Accreditation in November DCHHS employs epidemiologists who serve as disease
2016. The county health department is expected to use this CHNA to detectives investigating outbreaks of clusters of illnesses and
inform the development of a broader Community Health Improvement Plan study the trends as well as causes and effects of health and
(CHIP) aimed at identifying priority issues, developing and implementing disease conditions in the community. DCHHS has been at the
strategies for action, and establishing measurable accountability to monitor forefront of local responses to Ebola, H1N1, West Nile and
improvement of the health status of targeted populations. Zika viruses, as well as preparedness efforts to respond in the
event of a bioterrorism attack or other disaster. DCHHS offers
In light of Parkland’s shared mission with DCHHS, a joint assessment of the
specialized Sexual Health and TB Clinics that provide services
current state of health in Dallas County has been conducted by the two
for the diagnosis, treatment and prevention and control of the
organizations through a collaborative process that included the exchange
spread of these infections. Other DCHHS activities include,
of data, information and insights. Beyond what is required under the ACA,
Parkland and the DCHHS will use this assessment to develop a collective Child and adult immunizations,
impact approach to improving the health of populations experiencing Refugee screening clinic,
health disparities within Dallas County over the next three years. This Restaurant inspections,
approach will include strengthening partnerships with other healthcare
Social service programs that assist low-income residents with
providers and community-based organizations who share a common housing and energy payments, weatherization services, and
mission with Parkland and DCHHS and establishing new relationships with repairs to home heating and cooling units, and
organizations we have yet to engage. Parkland will also incorporate the Development of new programs to support chronic disease
CHNA into the next iteration of its multi-year strategic plan that will be prevention and address other non-communicable disease
developed in 2020. issues.
8
PARKLAND HEALTH & HOSPITAL
SYSTEM OVERVIEW
Established at the corner of Oak Lawn and FIGURE 1. Parkland’s Footprint in Dallas County
Maple in 1894, Parkland has been caring for
Dallas County’s most vulnerable patients for
125 years. Today, Parkland is an integrated
health system comprised of a state-of-the-
art acute care hospital, 30 community-based
outpatient clinics, a Medicaid managed care
plan as well as numerous educational and
outreach programs. As one of the leading
public academic medical centers in the nation,
Parkland has developed countless innovations
that save lives, improve access to services and
reduce healthcare costs.
Parkland Memorial Hospital averages about

61,000 admissions and, through its various
clinics, the health system completes more than
1 million outpatient visits annually. Premier
services include The Rees-Jones Level I Trauma
Center, one of largest civilian burn centers in
the U.S. and a Level III Neonatal Intensive Care
Unit. Parkland also carries services to Dallas
County’s homeless population through its
Homeless Outreach Medical Services (HOMES)
program and is responsible for Dallas County
correctional health. Parkland is the primary
teaching hospital for The University of Texas
Southwestern Medical Center. For more
information about Parkland Health & Hospital
System, visit www.parklandhospital.com.
9
PURPOSE OF THE CHNA
The purpose of the Dallas County CHNA is to identify

populations at risk due to prevalent health disparities as well as
medically- underserved areas within the county.
Many residents within these populations or geographic areas do
not receive adequate medical care as a result of being uninsured,
under-insured or due to cultural or socioeconomic barriers to
maintaining their health. The results of the CHNA will be used to
produce a community health implementation plan that addresses
identified disparities and opportunities to improve the overall
health and wellness of Dallas County residents.
10
OVERVIEW OF DALLAS COUNTY
u Economy
Comprised of 31 cities and covering over 871.28 square miles,1 Dallas sciences, and over 430,000 professionals in education and health
County is Texas’ second most populous county and the eighth in services.2-3 Between 2016 and 2017, employment in Dallas County grew
the nation, and plays a pivotal role in its economic development and at a rate of 1.63%, from 1.28 million to 1.31 million employees.3
success.2 Dallas’ economy employs about 1.31 million individuals
- 33%of this workforce has at least a college degree. Retail trade, Historically, Dallas County’s strong economy has maintained an
healthcare and social assistance, and construction are the largest unemployment rate consistently below the state and national rates (see
industries. In 2017, Dallas County had over 860,000 professionals figure 3). The county’s median household income in 2017 was $53,626
in management, finance, computing, architecture, engineering and compared to the U.S. median $57,652.2
FIGURE 2. Dallas County Map
Dallas County Cities

1. Addison 17. Highland Park
2. Balch Springs 18. Hutchins
3. Carrollton 19. Irving
4. Cedar Hill 20. Lancaster
5. Cockrell Hill 21. Lewisville
6. Combine 22. Mesquite
7. Coppell 23. Ovilla
8. Dallas 24. Richardson
9. DeSoto 25. Rowlett
10. Duncanville 26. Sachse
11. Farmers Branch 27. Seagoville
12. Ferris 28. Sunnyvale
13. Garland 29. University Park
14. Glenn Heights 30. Wilmer
15. Grand Prairie 31. Wylie
16. Grapevine
1
United States Census Bureau available at: https://www.census.gov/quickfacts/fact/table/dallascountytexas/PST045217\
2
Dallas County. Available at: https://www.dallascounty.org/Assets/uploads/docs/plandev/englishdcbook.pdf
3
Data USA. https://datausa.io/profile/geo/dallas-county-tx/#about
12
FIGURE 3. Unemployment Rate Dallas County, Texas and U.S., 2016 - 2018
Source: Federal Reserve Bank of St. Louis. Economic Research.

FIGURE 4. SocioNeeds Index Map, Dallas County, 2019
While much of Dallas County benefits from a

strong economy, there are several geographic
areas that struggle with severe poverty or
pockets of economic instability and the
social ills that accompany a lack of resources
including significant health disparities. Many
of the ZIP codes within these underserved
areas have suffered from these disparities for
decades.
This CHNA uses a SocioNeeds Index (SNI)

score to identify zip codes that offer the
greatest challenges and opportunities for
addressing health disparities. SNI is a measure
of socio-economic need based on ZIP Code
data and is calculated from 6 indicators:
poverty, income, unemployment, occupation,
education and language. The indicators are
weighted to maximize the correlation of
the index with premature death rates and
preventable hospitalization rates. Zip codes are
given an index score ranging from 0 (lowest 1
need) to 100 (highest need) which is then
ranked from 1 (lowest need) to 5 (highest 2
need).4 The darkest area in the Dallas County
(SNI) map5 reveals an expansive geographic 3
area with high socio-economic need and
where health disparities are more likely to be 4
present.
5
Greater need
â
Adopted from DFWHC Foundation, Healthy North Texas SocioNeeds Index.
4
onduent. Community Health, Health and Hospital Systems. Available at:
C
https://www.conduent.com/solution/community-population-health/community-health-assessment/
5
Health North Texas. SocioNeeds Index. Available at: http://www.healthyntexas.org/index.php?module=indicators&controller=index&action=socioneeds
14
TABLE 1. Zip Codes with SNI Rankings of 4 or Higher
# ZIP Code SocioNeeds Index Rank # ZIP Code SocioNeeds Index Rank
1 75210 99.7 5 32 75050 82.3 4
2 75212 98.8 5 33 75116 81.2 4
3 75216 98.6 5 34 75149 81.2 4
4 75217 98.2 5 35 75243 79.6 4
5 75203 97.6 5 36 75159 75.1 4
6 75211 97.3 5 37 75040 74.8 4
7 75227 96.6 5 38 75150 73.6 4
8 75233 96.3 5 39 75235 73 4
9 75223 96.2 5 40 75062 69.2 4
10 75224 96.1 5 41 75146 67.8 4
11 75042 95.9 5
12 75220 95.5 5
13 75180 95 5
FIGURE 5. Distribution of Zip Codes by SNI Rank
14 75215 94.8 5
15 75172 94.7 5
16 75237 94.7 5
17 75228 94.2 5
18 75253 93.7 5
19 75041 93.4 5
20 75061 92.4 5
21 75231 92.4 5
22 75247 92.3 5
23 75051 92.1 5
24 75240 91.9 5
25 75141 91.1 5
26 75241 90.7 5
27 75232 90.1 5
28 75060 89.9 5
29 75246 89.4 5
30 75236 88.9 5
31 75208 85.8 5
15
TABLE 2. Dallas County Housing Data
Housing Dallas County U.S.
Housing units, July 1, 2018, (V2018) 1,027,837 138,537,078

u Housing
The median property value in Dallas County of
$148,300 is 23% below the national median Owner-occupied housing unit rate, 2013-2017 50.50% 63.80%
value of $193,500 and home ownership
(50.5%) is below the national average of Median value of owner-occupied housing units,
$148,300 $193,500
63.8%.1 According to an economic assessment 2013-2017
by the Communities Foundation of Texas, in
2018, 34% of Dallas County households spent Median selected monthly owner costs -with a
$1,483 $1,515
over 30% or more of their income on housing. mortgage, 2013-2017
Likewise, 50% of renters spent more than
30% of their income on rent. 6 Median selected monthly owner costs -without
$549 $474
a mortgage, 2013-2017
Median gross rent, 2013-2017 $984 $982
Building permits, 2018 18,123 1,328,827
6
enter for Public Policy Priorities, Communities Foundation of Texas. Dallas Economic Opportunity Assessment.
C
Available at: https://www.cftexas.org/dallas-economic- opportunity-assessment
16
FIGURE 6. Dallas County Homes Sales and Average Price
32k 360k Since 2011, the average

housing price has steadily
increased, whereas home
sales have remained
24k 320k
consistent for the past
three years.
16k 280k
8k 240k
0 200k
Dallas County Average price
Source: Adopted from Texas A&M University, Real Estate Center.
17
A
u CCESS TO CARE IN
DALLAS COUNTY Figure 7. Insurance Coverage, Dallas County, 2013 – 2017
INSURANCE COVERAGE
In Dallas County, approximately 81% 40%
of the population has some form of
health insurance coverage: 35%
9% Medicare 30%
2% Medicare Dual Eligible 25%
15% Medicaid
20%
47% Private – Employer Sponsored
5% Private – Direct 15%
3% Private – Exchange 10%
19% Uninsured
5%
Source: IBM Watson/Truven Health
Analytics 2019 0%
2013 2014 2015 2016 2017
As depicted in Figure 7, employer Employer Medicaid Medicare Military or VA Non Group Uninsured
sponsored plans have been the main
source of health coverage since Adopted from: DATAUSA. Dallas County
2013 in Dallas County, followed by
Medicaid.
18
The uninsured rate in Texas

is 1.75 times higher than the
national rate. On the left, Table 3
TABLE 3. Health Insurance Coverage of Population, U.S. and Dallas County, 2013 - 2017 shows the percentage of insured
noninstitutionalized residents in
Dallas Dallas Dallas Dallas County (77.9%) is below the
United States
Demographics Texas Covered % County Total County County Texas (81.8%) and national (89.5%)
Covered %
Population Covered (n) Covered % coverage rates. Analysis conducted
Civilian by the Congressional Budget Office
noninstitutionalized 89.50% 81.80% 2,532,552 1,971,698 77.90% (CBO), found that groups with a high
population likelihood of lacking health insurance
Under 19 years 94.30% 89.00% 716,483 619,773 86.50% include:
Race and Ethnicity People in families with income
below 200% of the Federal
White (all ethnicity) 90.60% 82.10% 1,554,075 1,193,926 76.80% Poverty Level,
Black or African Hispanics,
87.70% 84.10% 565,421 468,544 82.90%
American alone
Young adults, age 19 to 34 years,
American Indian and
Alaska Native alone
78.40% 77.60% 8,106 5,904 72.80% People in families in which the
adults worked either part-time or
Asian alone 90.80% 86.70% 153,022 130,318 85.20%
only part of the year, or
Hispanic or Latino
78.80% 71.40% 1,007,876 651,493 64.60% Individuals in fair or poor health
(of any race)
White, Non Hispanic
status who are significantly more
92.90% 89.80% 762,899 683,475 89.60% likely than others to be uninsured
or Non Latino
for longer periods.7
Data Source: American Community Survey 2013 - 2017
Hispanics in Dallas County have
the lowest rates of coverage with
just 64% of that population having
health insurance.
7
T exas Medical Association. Texas is the uninsured capital of the United States. More than 4.5 million Texans - including 623,000 children lack health insurance - 2018.
Available at: https://www.texmed.org/uninsured/
19
FIGURE 8. Dallas County Medicaid Enrollment, 2016 -2018
427,904
418,299
405,472
DALLAS COUNTY MEDICAID ENROLLMENT

As of September 2019, Texas is one of 14 states
that has not expanded Medicaid enrollment
under the ACA. Figures 8 and 9 below show
2016 2017 2018
the steady decline in the number of Medicaid Source: Texas Health and Human Services, Healthcare Statistics.
enrollees in Dallas County between 2016 and

2018. The Texas Medicaid system includes
STAR, STAR+PLUS, STAR Kids, STAR Health FIGURE 9. DALLAS COUNTY CHILDREN’S MEDICAID ENROLLMENT, 2016 - 2018
programs and the Texas Dual Eligible Integrated
Care Demonstration Project. In Dallas County,
328,585
Amerigroup, Molina Healthcare of Texas, Parkland
Community Health Plan, Superior HealthPlan
and Children’s Health are the managed care 320,100
organizations that manage these services on
behalf of the state.
309,093
2016 2017 2018
Source: Texas Health and Human Services, Healthcare Statistics.
20
FIGURE 10. Dallas County Medicaid Enrollment by Managed Care Organization, 2018
Figure 10, shows that

combined, Amerigroup
(45%) and Parkland
Community Health Plan
(35%), provide insurance
Molina Healthcare coverage to 80% of
of Texas, 12%
Medicaid enrollees in
Dallas County.
Amerigroup, Parkland Community Health Plan, Superior CMC,

45% 35% HealthPlan, 6% 2%
Amerigroup, 45% Molina Healthcare of Texas, 12% Children’s Medical Center, 2%
Parkland Community Health Plan, 35% Superior HealthPlan, 6%
Source: Texas Health and Human Services, Healthcare Statistics.
21
FIGURE 11. Uninsured Population, Dallas County, 2019

75082
_
75080
75006 75044 75048
75248
75019
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149
75050 75215
75208
75203
75211
75051 75181
75180
75224 75217
75216
75233
75236
75253
75052 75237 75241
75116 75232
75141
75249
75159
75137
75134
75115 75172
75104
75146
Data Source: IBM Watson/Truven Health Analytics 2019
22
FIGURE 12. Primary Care Supply Trends in Texas, 2017 -20308

ACCESS TO PRIMARY CARE PHYSICIANS
10,000
8,724 Texas Health and Human Services describes primary
9,000 care physicians as those who indicate they have
8,000 a primary specialty of general practice, family
6,884
7,000 8,037 practice/medicine, internal medicine, pediatrics,
obstetrics and/or gynecology, or geriatrics and
6,000
6,523 are a sub-set of direct patient care physicians.
5,000 Dallas County’s ratio of population to primary care
4,000 physicians’ ranks 18th among Texas counties. In
3,000 North Texas, where Dallas County sits, demand
is expected to continue outpacing supply for
2,000
primary care physicians between the years 2017
1,000 and 2030. The number of primary care physician
0 FTEs is expected to increase over that period by
1,514 while demand is expected to increase by
17
18
19
20
21
22
23
24
25
26
27
28
29
30
1,840 primary care physicians FTEs. The shortage
20
20
20
20
20
20
20
20
20
20
20
20
20
20
of primary care physicians is expected to grow by
Supply Demand
90% which indicates continued challenges for
Adopted From: Texas Health and Human Services. Department of State Health Services. Texas Projections of Supply and Demand for
Primary Care and Psychiatrists, 2017 – 2030. July 2018 Dallas County in terms of access to primary care
services. 8
8
T exas Health and Human Services. Department of State Health Services. Texas Projections of Supply and Demand for Primary Care
and Psychiatrists, 2017 – 2030. July 2018.
23
HOSPITALS AND HEALTH SYSTEMS

The Compendium of U.S. Health Systems 2016
defines a health system as an organization that TABLE 5. Dallas County Hospitals by city
includes at least one hospital and at least one
Hospital Name City Staffed Beds
group of physicians who provide comprehensive
care (including primary and specialty care) and are Baylor Scott & White Heart and Vascular Hospital Dallas 54
connected with each other and with the hospital
Baylor Scott & White Medical Center - Sunnyvale Sunnyvale 70
through common ownership or joint management.9
Table 4 is a list of health systems located in Dallas Baylor Scott & White Medical Center Irving Irving 222
County.
Baylor Scott & White Medical Center Uptown Dallas 24
Hospitals and health systems serve as anchor Baylor Surgical Hospital at Las Colinas Irving 20
institutions within local communities. In addition to
Baylor University Medical Center Dallas 893
their role safeguarding the health of local community
hospitals also play a role as an employer and City Hospital at White Rock Dallas 218
contribute significantly to the local economy.10 Table
Crescent Medical Center Lancaster Lancaster 84
5 provides a list of Dallas County hospitals by city
while Figure 13 shows the geographic distribution of Dallas Medical Center Dallas 83
hospitals within the county.
Dallas Regional Medical Center Mesquite 202
Dallas VA Medical Center Dallas 514
TABLE 4: Dallas County Health Systems Medical City Dallas Dallas 561
Not-for-Profit Medical City Las Colinas Irving 100
Baylor Scott and White Health Methodist Charlton Medical Center Dallas 290
Children’s Health Methodist Dallas Medical Center Dallas 432
Methodist Health System
North Central Surgical Center Dallas 24
Texas Health Resources
Parkland Memorial Hospital Dallas 764
UT Southwestern Medical Center
For-Profit Pine Creek Medical Center Dallas 15
HCA Healthcare Texas Health Hospital Carrollton 50

Tenet Healthcare Corporation Texas Health Presbyterian Hospital Dallas Dallas 651
Pipeline Health
Texas Institute for Surgery Dallas 9
Government
UT Southwestern William P. Clements Jr. University Hospital Dallas 460
Veterans Health Administration
Parkland Health & Hospital System Zale Lipshy University Hospital Dallas 148
Source: American Hospital Association Guide 2017.
24
FIGURE 13. Dallas County Hospitals Geographic Distribution FIGURE 14. Dallas County Hospital Beds Availability by ZIP Codes
35
DENTON Medical City Lewisville COLLIN
Baylor S&W MC Carrollton
Methodist Richardson MC
Texas Health Hosp
121 75
Baylor S&W MC Grapevine
114 Baylor Surgical Hosp at Las Colinas Baylor S&W MC Lake Pointe
Medical City Dallas
360
Dallas Med Ctr
ROCKWALL
Medical City Las Colinas Texas Health Presbyterian Hosp Dallas
North Central Surgical Ctr 30
Texas Institute for Surgery
635
Pine Creek MC
Baylor S&W MC Irving 482 City Hosp at White Rock
Parkland Hosp
Baylor S&W MC Uptown
161 Zale Lipshy University Hosp
Baylor S&W Heart and Vascular Hosp
Baylor University MC Baylor S&W MC - Sunnyvale
Methodist Dallas MC Dallas Regional MC

12
30
35E
80
DALLAS
408
175
Dallas VA MC 20
KAUFMAN
45
Baylor S&W Emergency Hosp - Grand Prairie
Methodist Charlton MC
67
Crescent MC Lancaster
Data Source: American Hospital Association Guide 2017. Source: American Hospital Association Guide 2017.
9
Agency for Healthcare Research of U.S. Health Systems, 2016. Available at: https://www.ahrq.gov/chsp/data-resources/compendium.html
10
Robert Wood Johnson Foundation. Culture of Health Blog. Hospitals as Anchor Institutions for Community Investment. Available at https://www.rwjf.org/en/blog/2017/03/can-hospitals-defy-tradition.html
25
CHNA METHODOLOGY
The methodology applied for this CHNA and the subsequent implementation Patient Listening Sessions
strategy for addressing identified issues includes four components:
Parkland Patient and Family Advisory Good Street Baptist Church
LEADERSHIP AND OWNERSHIP Council Mary Kay local groups
This component is based on the principle that improving the community’s health Patient Listening Session at Chase (2 sessions in 75217)
is a shared responsibility, if not a moral obligation of hospitals, public health Building MLK Community Center (2 sessions)
agencies and the community at large. Putting this principle in practice, Parkland
Resident/Patient Listening Sessions: True Lee Missionary Baptist Church
in collaboration with the DCHHS, employed public health practices to identify
populations experiencing a higher burden of disease or health disparities, as well as New Comforter Church Food Bank, Inspired Vision
the underlying social determinants of health driving these inequalities. Pleasant Zion Missionary Church Compassion Center (4 sessions)
Springs Fellowship Church Cornerstone Baptist Church
STRATEGIC PLANNING
Parkland and DCHHS will use the results of this CHNA to develop programs and Parkland Frontline Staff
strategic initiatives aimed at improving health and reducing disparities.
Emergency Department Physicians COPC Physicians
COMMUNITY ENGAGEMENT and Nursing Staff COPC Community
Community Based Participatory Research (CBPR) was adopted to ensure the COPC Social Workers Advisory Board Members
community had meaningful participation during the CHNA development. The
Agency for Healthcare Research and Quality (AHRQ) defines CBPR as: COPC and Specialty Clinic Nurses Patient Financial Services Staff
“A collaborative research approach that is designed to ensure and Community-Based Organizations

establish structures for participation by communities affected by
African American Pastor’s Coalition White Rock Center of Hope
the issue being studied, representatives of organizations, and
Agape Clinic North Dallas Shared Ministries
researchers in all aspects of the research process to improve health
Bridge Breast Network 211/Area Agency on Aging
and well-being through taking action, including social change.”
Catholic Charities of Dallas Community Council of Greater Dallas
Applying CBPR, Parkland used focus groups to gather an array of perspectives from CitySquare Los Barrios Unidos Community Clinic
community stakeholders. The focus groups were conducted in two phases. Dallas County Jail (medical staff) (FQHC)
Grow South (Ed Cor health) DFW Hindu Temple
Phase I: P arkland in collaboration with Baylor Scott & White Health, Texas Health
Harmony Counseling Center at Faith Promise of Irving
Resources and Methodist Health System engaged IBM Watson to conduct a
series of focus groups to assess the perception of the health needs in Dallas Concord Church Genesis Women’s Shelter & Support
County. Focus group participants were invited based on their involvement International Rescue Committee Dallas Area Interfaith
with public health or their work with medically-underserved, chronic Legal Aid of Northwest Texas Foremost Family Health Center
disease, low-income or minority populations. Participation was also sought North Texas Food Bank (FQHC)
from community leaders, other healthcare organizations and providers, Many Helping Hands
Refugee Services of Texas
including physicians.
Sharing Life Community Outreach Metro Dallas Homeless Alliance
Phase II: F ocused on gathering more in-depth input from the safety-net patient Urban Inter-Tribal Center of Texas Salvation Army
population and frontline providers who care for them. This phase included Veterans Center of North Texas Society St. Vincent de Paul
10 focus groups conducted by Parkland staff. Dallas independent School District
VNA (Meals on Wheels)
Nurses
26
A summary of the focus groups session results is
provided in the Community Input section of this report.
Data Collection: For this CHNA, quantitative and

qualitative data was collected and maintained in a
single repository to ensure consistency and accuracy.
Quantitative data was gathered from the primary
sources listed below. The qualitative data was gathered
through informational interviews and focus groups.
Primary Data Sources FIGURE 15. CHNA Framework
1. Behavioral Risk 9. Parkland Center for

Factors Surveillance Clinical Innovation
System (BRFSS) (PCCI)
§ Public Health § Systemic Analysis
2. Dallas County Health 10. Parkland Health &
and Human Services Hospital System
Practice Approach
3. Dallas-Fort Worth 11. Texas Demographic Leadership & Strategic

Hospital Council Center Ownership Planning
Foundation (DFWHC)
12. Texas Department of
4. DFWHC Healthy State Health Services
North Texas
13. The Federal Reserve
5. HOMES Uniform Data Bank of St. Louis Community
System (UDS) Annual
Data
14. U.S. Centers for Engagement Collection
Report, 2016 – 2018
Disease Control and
6. HRSA UDS Maps Prevention (CDC)
§ Community Based § Quantitative Data
7. IBM Watson/Truven 15. United States Census Participatory Research § Qualitative Data
Health Analytics Bureau
8. Metro Dallas Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017,
Accessed at http://wonder.cdc.gov/ucd-icd10.html on Apr 25, 2019.
Homeless Alliance
27
DALLAS COUNTY GENERAL HEALTH PROFILE
One does not have to look deep into the

health data of Dallas County to recognize
that significant disparities exist among the
population and the geography of these
disparities is readily apparent. There is a central
to north by northwest region within the county
that is home to a reasonably healthy population
whose profile does not generally stand out
among national and state benchmarks when
it comes to health disparities. That region is
contrasted by a crescent shaped collection of ZIP
codes stretching from Northeast Dallas County
through the southern portions of Dallas County
and turning north again into Grand Prairie and
parts of Irving that experience higher SNI scores
and poorer health profiles. Even within this
crescent-shaped region of ZIP codes experiencing
some level of health disparities, there are a
handful of ZIP codes that are present in our
analysis for virtually every negative indicator.
These ZIP codes are 75210, 75216, 75217 and
75241. The information that follows will offer
insight into the nature of the health disparities
that exist within the county.
28
u MORTALITY
This section provides a snapshot of mortality rates in Dallas County by race, ethnicity, age and disease.
LEADING CAUSES OF DEATH

Age adjusted mortality rates are used to compare mortality between populations and assess changes over
time. Between 2013 and 2017, heart disease and malignant neoplasms (cancer) have been the leading
causes of death in Dallas County -see Figure 16.
FIGURE 16. Leading Causes of Death, Dallas County, 2013 - 2017
Data Source: CDC Wonder
30
FIGURE 17. Top Five Leading Causes of Death Mortality Rate Trends, Dallas County, 1999 - 2017
Figure 17 shows that

in Dallas County the
mortality rates for heart
disease and cancer have
declined steadily between
2013 – 2017, similar
to the national trends.
Figure 18 illustrates that
in the United States
the mortality rates for
cancer and heart disease
have declined at varying
rates between 1999 and
2017.11
11
National Vital Statistics Reports. Trends in Cancer and Heart Disease Among Adults Aged 45 - 64: United States, 1999 - 2017. Vol. 68, Number 5
31
FIGURE 18. Top Five Leading Causes of Death Mortality Rates Trends, United States, 1999 - 2017
32
Dallas County General Health Profile
FIGURE 19. All-Cause Mortality Rate Adjusted by Age per 100,000 Population, Dallas County, 2012 – 2016
Age Adjustment uses 2000 Standard Population

Data Source: Texas Department of State Health Services
33
Heart Disease Mortality FIGURE 21. Heart Disease Mortality Rate Adjusted by Age per
Heart disease refers to different types of heart 100,000 population, Dallas County, 2012 – 2016
conditions such as atherosclerotic cardiovascular
disease, hypertensive heart disease, acute
myocardial infarction and heart failure, among
others. Heart disease is the leading cause of death
in United States and claims more than 630,000
lives every year.12 Heart disease is the leading
cause of death for men of most racial and ethnic
groups. National health statistics show that 8.5%
of all white men, 7.9% of African American men
and 6.3% of Hispanic men have coronary heart
disease.13 Likewise, heart disease was the leading
cause of death in Dallas County in 2017 and was
attributed to 3,513 deaths.
FIGURE 20. Mortality Data, Heart Disease Mortality Rate by

Type of Heart Disease, Dallas County, 1999 – 2017

12
U.S. Centers for Disease Control and Prevention. Heart Disease. Available at: https://www.cdc.gov/heartdisease/facts.htm
13
U.S. Centers for Disease Control and Prevention. Division of Heart Disease and Stroke Prevention. Men and Heart Disease Fact Sheet. Available at: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_men_heart.htm
34
FIGURE 22. Cerebrovascular (Stroke) Mortality Rate Adjusted by Age per 100,000 population, Dallas County, 2012 – 2016

35
CANCER MORTALITY FIGURE 23. Cancer Mortality Rate by Type of Cancer, Dallas County, 1999 - 2017
Despite the ongoing decline
in mortality rates attributed 70 Breast
to lung cancer since 1999, it Lung
remains the leading cause of 60
Colon
cancer deaths. Breast cancer
Age Adjusted Rate per 100,000

50 Liver
and colon cancer rank second
Ovary
and third among the leading 40
Prostate
causes of death per cancer
30
type (see Figure 23). In Dallas Pancreas
County, African Americans 20

have the highest age adjusted
mortality rate for cancer (see 10
Figure 24).
0
99 000 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017
19 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Year
FIGURE 24. Cancer Mortality Rate by Race and Ethnicity, Dallas County, 1999 - 2017
36
FIGURE 25. Cancer Mortality Rate Adjusted by Age per 100,000 population, Dallas County, 2012 – 2016

37
OTHER LEADING CAUSES OF DEATH

Among the top 10 leading causes of death in Dallas County, Alzheimer’s disease stands out, particularly
between 2013 and 2017. This is worth noting given this disease presents a major public health challenge in
the U.S. and that in 2017, Alzheimer’s disease ranked as the sixth leading cause of death among people of all
ages and fifth leading cause of death among people aged 65 and over.14 The CDC forecasts that the burden
of Alzheimer’s disease and related dementia will continue to increase and double by 2060.15
FIGURE 26. Other Leading Causes of Death Mortality Rate Trends, Dallas County, 1999 – 2017
As depicted in Figure
26, Alzheimer’s Disease
is among the leading
causes of death in Dallas
County and the sixth
leading cause of death
in U.S., between 2000
and 2017, the number
of deaths as recorded
on death certificates
has increased by 145%
and as the number
of elderly individuals
increases, the incidence
and prevalence is also
expected to double.16
While Alzheimer’s
related deaths has been
increasing at the national
level, the sharp increase
in Alzheimer’s related
deaths in Dallas County
beginning after 2012, is
most likely related to the Data Source; CDC Wonder
expansion of Alzheimer’s
related ICD-10 codes.
14
National Vital Statistic Report. Dementia Mortality in the United States, 2000 – 2017. Vol 68, Number 2. March 14, 2019
15
U.S. Centers for Disease Control and Prevention. U.S. burden of Alzheimer’s disease, related dementia to double by 2060
16
Alzheimer’s Association. Facts and Figures. Available at https://www.alz.org/alzheimers-dementia/facts-figures
38
FIGURE 27. Alzheimer’s Disease Mortality Rate Adjusted by Age per 100,000 Population, Dallas County, 2012 - 2016

39
FIGURE 28. Diabetes Mortality Rate Adjusted by Age per 100,000 Population, Dallas County, 2012 – 2016

40
FIGURE 29. Influenza and Pneumonia Mortality Rate Adjusted by Age per 100,000 Population, Dallas County, 2012-2016

41
LEADING CAUSES OF DEATH BY RACE AND ETHNICITY

Figure 30 below details all-cause mortality rate trends by race and ethnicity in Dallas County since
1999 and indicates that African Americans have a higher mortality rate when compared to other
racial and ethnic groups.
FIGURE 30. All-Cause

Mortality Rate by Race and Ethnicity, Dallas County, FIGURE 31. LeadingCauses of Death by Race and Ethnicity, Dallas County,
1999 - 2017 2013 - 2017
42
FIGURE 32. Leading Causes of Death by Race and Ethnicity
43
MATERNAL MORTALITY IN DALLAS COUNTY

Maternal health has become a major focus in American obstetrics due to the reported rising rate of
maternal mortality. Over the past two decades the maternal mortality rate in the United States (per
100,000 live births) steadily increased by 26.6%, from 18.8 in 2000 to 23.8 in 2014.17
Texas was in the forefront of the national media recently as the reported state maternal mortality rate
after 2010 doubled within a two-year period to levels not seen in other states. For example, the reported
rate of maternal mortality in Texas was as high as 35.8 per 100,000 live births in 2014.18 Although this
rate was later identified to be influenced by case ascertainment, statistical methods and data tracking, this
national emphasis has prompted further examination of maternal care at both the state and national level.
19
In an effort to address maternal morbidity and mortality at the state level, a multidisciplinary task force,
The Maternal Mortality and Morbidity Task Force, within the Texas Department of State Health Services
(DSHS) was formed in 2013. A joint report on the findings and recommendations of the task force
was released in September 2018. One of the 10 recommendations from this report was to, “Support
strategies to improve the maternal death review process (#10/10)”.20
Current definitions of maternal mortality require access to information from several sources for up to one
year after the end of a pregnancy. Included are women admitted to a hospital after discharge following
delivery, including those who may have delivered at another facility. Prevention efforts for maternal deaths
could be well-served if there was a system encouraging each hospital to identify maternal deaths in
three domains: (1) women admitted before delivery event (antepartum); (2) admitted during the delivery
event (delivery event); and (3) women admitted to the hospital after delivery discharge (postpartum).
Information ascertained from these domains could stimulate more emphasis on preventability. This could
also more easily tie-in with healthcare performance metrics.
17
. MacDorman M, Declercq E, Cabral H, Morton C. Recent Increases in the U.S. Maternal Mortality Rate.
1
18
Macdorman MF, Declercq E, Thoma ME. Trends in Texas maternal mortality by maternal age, race/ethnicity, and cause of death, 2006-2015. Birth. 2018;45(2):169-177. doi:10.1111/birt.12330.
19
Koch AR, Lightner S, Geller SE. Identifying Maternal Deaths in Texas Using an Enhanced Method, 2012. Obstetrics & Gynecology. 2018;132(2):520-521. doi:10.1097/aog.0000000000002771.
20
Maternal Mortality and Morbidity Task Force. Texas Health and Human Services. September 2018
44
INFANT MORTALITY IN DALLAS COUNTY

Premature birth and its complications are the largest contributors
to infant death in this country and globally. That is, women
delivering preterm infants have the highest rates of infant
mortality, and the risk of preterm birth is higher in African
American women compared to white women. The March of
FIGURE 33. Infant Mortality Rate by Race and Ethnicity, Dallas County, 1999 - 2017 Dimes recently released its 2018 national report card for preterm
births. The United States received a “C” (9.9% of preterm birth),
and Texas scored a “D” (10.6% preterm birth). Interestingly,
most major metropolitan areas in Texas had poor ratings for
preterm birth: Harris County scored a “D” (11.2%) and Bexar
County scored an “F” (11.7%), whereas Dallas County scored
a “B” (8.3%). Of the 100 cities in the United States with the
largest number of births, Dallas was listed in the top 10 for best
performing areas for preterm birth.21
As previously shown in a peer-reviewed publication by Parkland,

access to prenatal care is directly associated with risks of preterm
birth. Specifically, women with access to prenatal care have
significantly less preterm birth. Ninety-seven percent of the
12,000 women who delivered at Parkland received prenatal care
in the Parkland system. Parkland’s prenatal care program is, in
part, responsible for Dallas County’s performance when compared
to other regions with much less access to prenatal care. See link:
https://www.chron.com/news/houston-texas/houston/article/
Alarming-number-of-women-not-receiving-prenatal-13083657.
php
Data Source: Texas Death Certiﬁcate Data, Texas Department of State Health Services
To summarize, preterm births are the primary contributor to
infant deaths, and limited access to prenatal care is significantly
associated with higher rates of preterm birth. When compared to
other regions both nationally and within the state, Dallas County
has a substantially lower rate of preterm birth. As 31% of Dallas
County births take place at Parkland, the fact that 97% of those
women delivering at Parkland utilize the system’s prenatal care
services contributed to Dallas County’s performance.
21
March of Dines. 2018 Premature Birth Report Card United States. Available at: https://www.marchofdimes.org/materials/PrematureBirthReportCard-United%20States-2018.pdf
45
FIGURE 34. Percent of Births by Race, Dallas County, 2018 FIGURE 35. Percent of Births by Ethnicity, Dallas County, 2018
FIGURE 36. Percent of Births by Race, Parkland, 2018 FIGURE 37. Percent of Births by Ethnicity, Parkland, 2018
Data Source: DFWHC Foundation Regional Data, 2018
46
u LIFE EXPECTANCY
Life expectancy is defined as the expected average number of years of life remaining at a given age.22
Life expectancy in Dallas County differs by race, ethnicity, gender and ZIP code. Figure 38 below
illustrates the variances in life expectancy by ZIP code and Figure 39 shows the variance between the five
ZIP codes with the lowest life expectancy and the five ZIP codes highest for all populations.
FIGURE 38. Life Expectancy of DFW and Surrounding Areas, 2010 - 2014
Adopted from: University of Texas Southwestern Medical Center, UTHealth.

Life Expectancy by ZIP Code.
22
U.S. Centers for Disease Control and Prevention. Mortality in the United States, 2017. Available at: https://www.cdc.gov/nchs/products/databriefs/db328.htm
47
FIGURE 39. Life Expectancy Variances Between ZIP Codes with Lowest and Highest Life Expectancy
95
90
85
80
YEARS
75
70
65
60
75215 75210 75216 75217 75232 75220 75229 75230 75205 75204
Lowest Life Expectancy Highest Life Expectancy
Data Source: University of Texas Southwestern Medical Center, UTHealth.

48
FIGURE 40. Life Expectancy for All Populations and African American Men in ZIP Codes with Low Life Expectancy.
Data Source: University of Texas Southwestern Medical Center, UTHealth.

49
u MORBIDITY
BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS)
DCHHS in collaboration with the Texas Department of State Health
Services used information gathered from the 2013-2017 Behavioral
Risk Factor Surveillance System (BRFSS) to provide insight into the
health behaviors of Dallas County residents.
BRFSS is a system of health-related telephone surveys conducted at

the state and local level that began in 1984 and encompasses all
50 states, the District of Columbia and three U.S. territories. Each
year, BRFSS conducts over 400,000 phone interviews with adult U.S.
residents regarding their health behaviors, chronic conditions and
use of preventive services. It is the largest continuously conducted
health survey system in the world and is sponsored by a variety
of federal agencies including the CDC, the Health Resources and
Services Administration, Administration on Aging, Department of
Veteran’s Affairs, and Substance Abuse and Mental Health Services
Administration.23 Information gathered from the BRFSS is free to
access on the CDC website and is used by public health entities to
identify at-risk populations and develop health-related programs and
activities.
Understanding the prevalence of health behaviors such as seatbelt

use and smoking, as well as chronic conditions such as diabetes,
obesity, asthma and mental health within Dallas County allows
healthcare providers and public health officials to tailor programs and
outreach efforts that target at-risk demographics, resulting in more
efficient allocation of funds and resources.
23
ehavioral Risk Factor Surveillance System. “About BRFSS.” U.S. Centers for Disease Control and Prevention
B
(CDC), CDC, May 16, 2014, https://www.cdc.gov/brfss/about/index.htm
50
• 9% of adults in Dallas County

FIGURE 41. Percent of Residents Who Do Not Wear a Seatbelt, Dallas County, 2013 -2017 report not wearing a seatbelt
16 when in the car.
14% 14% • Among adults age 18 and
14 13% 13% over those who are less likely
12% 12% to wear a seatbelt are
12 11% 11% 11% o People who are
unmarried,
10 9% 9% 9% 9% 9% 9%
8% 8% 8% 8% o Non-Hispanic black people
8 7% 7% 7% o People who are aged
6% 6% 6% 18-29
6
• Among adults age 18 and
over those who are more
4
likely to wear a seatbelt
are college graduates and
2
those earning greater than
R $50,000.
0
l
Fe e
e
Hi ic
Hi nic
ic
So rad l
lle co e
gr ge
te
$4 0
0, 9
0+
t m ed
em yed
ed
su e
e
lim tion
n
ta
o
he
Co me uat
c
nc
al
al
-2
-4
-6
to ,00
$5 ,99
tio
rie
65
n- an
an
ho
ua
th ran
To
oy
ge lle
No arri
00
m
M
18
30
45
Ot
ra
o
ar
No ita
ita
No isp
sp
sp
9
ad
sc
pl
pl
00 $2
u
M
im
he ins
Em
H
gh
in
an
ac n-
sl
ol
Hi
No alth
t
Bl No
Ha
No
ho
al
<
ss
He
,
k,
sc
te
5,
Le
$2
hi
gh
W
Hi
Data source: Center for Health Statistics BRFSS 2013-2017, Texas Department of State Health Services
Note: R = Relative Standard Error greater than 30.0%, estimate unreliable and not displayed
51
FIGURE 42. Prevalence of Residents Diagnosed with a Depressive Disorder, Dallas County, 2013 - 2017
• 14% of adults in
Dallas County have 40
been diagnosed with a 35%
depressive disorder. 35
• The percent of adults age 30
18 and over with physical
limitation who has a 25 23% 23%
depressive order was 35%. 21%
19% 20%
• Among adults age 18 and 20 17%
over those are more like to 16% 16% 15%
14% 14% 15%15%
have a depressive disorder 15 12% 13%
are
9% 9% 10%11% 10% 11%
9%
11% 10%
o Female, 10
o Non-Hispanic black 5
people,
R
o People aged 45-64, 0
al
ale
ale
c
c
ic
4
+
ol
e
e
te
$4 0
$5 99
ed
ed
e
ce
lim ion
n
he
n- ani
h i anc
ge lleg
-2
-4
-6
tio
rie
rie
65
00
an
an
t
ho
ua
an
00 25,0
9,9
To
oy
oy
m
M
du
18
30
45
No itat
Ot
o People earning less
0,0
ar
ar
ita
No isp
sp
sp
ad
sc
r
ur
o
Fe
pl
pl
su
a
tm
M
ec
Hi
Hi
im
$
ns
Em
m
gr
gr
-H
gh
in
$2 han
to
te
m
sl
No
Bl Non
ol
than $25,000 and Hi
lth
So
Ha
No
ho
alt
lle
t
<
a
5,0
ss
He
he
,
k,
sc
Co
te
Le
unemployed
ac
hi
gh
No
W
Hi
52
FIGURE 43. Percent of Residents Reporting Poor Mental Health for 14+ Days, Dallas County, 2013 - 2017
• The percent of adults age
25 18 and over with physical
22% limitation who have poor
mental health for 14+ days
20 was 22%.
• Adults age 18 and over, who
are more likely to have poor
15 mental health for 14+ days
13% fall into the following groups
12%
11% o People who are non-
9% 9% 10% 10% 9%
10 Hispanic black,
8% 8% 8% 8%
7% 7% 7% 7% 7% o People who have less than
6% 5% 6% 6%
5% 5% 5% a high school diploma
5 o People who are earning
less than $25,000.
R • Hispanics, college graduates
and individuals over 65 years
al
Fe e
ale
ic
ic
0
ic
e
4
te
$4 0
64
$5 99
+
l
e c te
t m ied
ed
ed
ns ce
ce
lim ion
n
oo
he
al
ge lleg
-2
-4
00
tio
rie
65
00
an
an
an
t
ua
a
n
an
-
9,9
To
oy
oy
m
M
r
So adu
18
30
45
ch
No itat
Ot
alt ura
00 25,
0,0
ar
ar
ita
isp
isp
sp
ad
ur
o
pl
pl
of age are the least likely to
hs
M
Hi
im
$
he ins
Em
m
gr
gr
-H
-H
$2 han
to
g
te
m
sl
hi
No
on
on
ol
Hi
h
report having poor mental
Ha
No
ho
alt
,N
,N
lle
t
<
5,0
ss
He
sc
Co
te
Le
ac
hi
gh
health 14+ days.
No
Bl
W
Hi
53
FIGURE 44. Prevalence of Asthma Dallas County, 2013 - 2017
18% 17%
• In Dallas County,
asthma is more 16%
prevalent in women
(11%) than men (5%). 14% 13%
• Individuals between 12% 11% 11% 11% 11%
the ages of 18-29 years 10% 10%
(10%) and greater than 10% 9% 9%
65 years (11%) report 8% 8% 8%
a higher prevalence of 8% 7% 7% 7% 7% 7%
asthma. 6%
6% 5% 5% 5% 5%
• The percent of adults
age 18 and over with 4%
physical limitation who
have asthma was 17%. 2%
R R R
0
l
ale
ale
ic
ic
ic
4
+
ol
gr ge
te
to 000
0,0 9
+
No rried
ed
ed
ce
ce
lim ion
n
ta
he
t
-2
-4
-6
$5 9,99
tio
rie
65
00
on pan
an
an
oo cho
ua
alt uran
an
To
No ploy
oy
ge lle
m
M
du
18
30
45
No itat
Ot
5,
ar
ita
isp
sp
ad
ur
lle e co
Fe
pl
5,0 n $2
$4
is
s
ra
tm
M
Hi
im
ns
ns
Em
m
-H
-H
gh
lg
te
m
sl
No lth i
hi
on
a
Hi
th
So
00
Ha
,N
,N
<
a
ss
He
he
sc
Co
te
Le
ac
$2
hi
gh
Bl
W
Hi
54
• 10% of Dallas County

FIGURE 45. Prevalence of Diabetes Dallas County, 2013 - 2017 residents report having
diabetes.
35%
• Diabetes is prevalent across
30% all education levels with
30% the exception of college
graduates earning more than
25% $50,000 annually.
22%
• There is a greater prevalence
20% 18% of diabetes in the following
16% 16% groups
15% 13% 13% o Unemployed, non-
12% 12%12%
10% 10% 11% 11% 11% Hispanic black males,
10% 8% 8% o People over 65 years of
7% 7% 7% 7% 7%
6% age,
5% o People who have a
R R R physical limitation.
0 o People who are
al
ale
ale
c
sp ic
ic
d
4
+
ol
o e
e
te
$4 0
0,0 9
+
ed
ed
ed
ce
ce
lim ion
n
he
ni
e c at
ge lleg
-2
-4
-6
0
$5 9,99
tio
rie
65
00
Hi pan
an
t
ho
ua
alt uran
an
00 25,0
To
oy
oy
ri
m
M
No ispa
m du
18
30
45
No itat
unemployed black, non-
Ot
ar
ar
ita
ad
sc
ur
Fe
pl
pl
s
So gra
tm
M
Hi
im
$
ns
ns
Em
m
gr
-H
gh
$2 han
to
n-
te
sl
hi
hi
No
Hispanic,
Bl Non
ol
Hi
Ha
No
ho
alt
lle
t
<
5,0
ss
He
he
,
k,
sc
Co
te
Le
ac
hi
gh
No
o Men over the age of 65
W
Hi
years,
Note: R = Relative Standard Error greater than 30.0%, estimate unreliable and not displayed o People with a physical
limitation.
55
FIGURE 46. Prevalence of Overweight/Obese Adults by Race and Ethnicity Dallas County, 2013 - 2017
• The black, non-Hispanic 60%

demographic has the 53%
highest prevalence
for obesity (38%) 50%
and the lowest 40%
prevalence for being 38%
40% 36%
at a recommended 34%
weight (21%); this 31% 31% 29%
demographic also shows 30%
24% 24%
an increasing trend in 21%
normal-overweight- 17%
20%
obese weight patterns
(21%-31%-38%).
• Hispanics are the most 10%
likely to be overweight
(40%), followed by 0
white, non-Hispanics Normal Over Obese Normal Over Obese Normal Over Obese Normal Over Obese
(36%). White, Non-Hispanic Black, Non-Hispanic Hispanic Other/Multiracial,
Non-Hispanic
56
FIGURE 47. Prevalence of Current Smokers Dallas County, 2013 - 2017

• 15% of Dallas County
25% residents report being a
21% current smoker.
20% 19% 19% 20% 20% • The groups with the largest
20%
18% 18% percentage of smokers
17% 17% include:
16% 16% 16%
14% 15% 14% o Unmarried black, non-
15%
13% 13% 13% Hispanic men
12%
o People with no health
10% 9% 9% insurance
15% 8% 8%
o People who have a
physical limitation(s)
5% o People making $25,000-
$49,000
• Married college graduates
0 with an income of greater
l
Fe e
ale
c
ic
l g ool
Co me ate
e
te
$4 0
$5 99
tm d
m ed
ed
ns ce
ce
lim ion
n
ta
he
ni
i
al
ge lleg
-2
-4
-6
00
tio
No arrie
rie
65
00
an
an
ua
n
an
9,9
To
y
oy
m
M
No ispa
du
18
30
45
No itat
Ot
alt ura
No plo
00 25,
0,0
ar
ita
sp
sp
ad
sc
than $50,000 annual are
ur
co
pl
ra
M
Hi
Hi
im
$
he ins
Em
gr
-H
gh
$2 han
to
n-
te
sl
hi
Bl Non
Hi
No lth
the least likely to be current
So
Ha
ho
lle
t
<
a
5,0
ss
,
k,
He
sc
te
Le
ac
hi
smokers.
gh
W
Hi
57
FIGURE 48. Adults Who Are Current Smokers, Dallas-Plano-Irving, Texas Metroplex, 2002-2017
25%
22% 22%
20% 19%
18%
17% 17%
16% 16%
15%
15%
Crude Prevalence(%)
15% 15% 13% 13%

13%
12% 12%
10%
5%
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year
Data source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion,
Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. [accessed Sep 17, 2019].
URL: https://www.cdc.gov/brfss/brfssprevalence/.
58
FIGURE 49. Adults Who Are Current Smokers, Dallas-Plano-Irving, Texas Metroplex, 2011-2017
18%
16%
16% 15% 15%
14% 13% 13%

13%
Age-Adjusted Prevalence(%)
12%
12%
10%
8%
6%
4%
2%
0
2011 2012 2013 2014 2015 2016 2017
Year
Data source: Centers for Disease Control and Prevention, National Center for Chronic
Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence
& Trends Data [online]. 2015. [accessed Sep 17, 2019]. URL: https://www.cdc.gov/brfss/
brfssprevalence/.
59
• In Dallas County, 66%

of adults between the
ages of 18-64 years FIGURE 50. Percent of Residents Who Did Not Receive a Flu Shot in the Past Year, Adults 18 – 64 Years, Dallas County, 2013 - 2017
did not receive a flu
shot in the past year. 90%
• The percent of adults
82%
age 18-64 without 80% 75% 75%
73% 73%
health insurance 69% 70% 68% 71% 72% 71% 70% 68%
70% 66% 64% 66% 66%
who did not receive
influenza vaccine in 58% 59% 57%
60% 57% 54%
the past year was 53% 51%
82%. 50%
• Among adults age
18-64 years those 40% 34%
who are more likely 30%
to receive influenza
vaccine are 20%
o Non-Hispanic white
people, 10%
o People ages 45-64, 0
al
Fe e
ale
ic
ad l
e
te
$4 0
99
t m ried
m ed
ed
ns ce
ce
lim on
n
o
he
ni
t
al
ge lleg
-2
-4
-6
tio
rie
00
an
an
t
ol cho
ua
ua
h i an
an
00 25,0
9,9
To
t e oy
oy
No itati
m
M
No ispa
18
30
45
o College graduates,
Ot
0,0
ar
ar
ita
sp
sp
ad
alt ur
ur
o
No mpl
pl
s
M
ec
Hi
Hi
im
$
$5
he ins
gr
gr
-H
sc gh
$2 han
to
n-
E
m
sl
and
No
Bl Non
gh < Hi
No alth
So
Ha
ho
lle
t
5,0
ss
He
,
k,
Co
te
Le
ac
hi
o People earning
W
Hi
greater than Data source: Center for Health Statistics BRFSS 2013-2017, Texas Department of State Health Services
$50,000.
60
FIGURE 51. P
ercent of Residents Who Did Not Receive a Flu Shot in the Past Year, Adults 65+ Years Dallas County, 2013 -2017 • 41% of Dallas County adults
60% over 65 years of age report
54% not receiving a flu shot in the
past year.
50%
45% 45% 45% 44% 45% • The percent of adults age
43%
41% 40% 41% 65 and over with health
38% 38%
40% 35% 36% 36% 36% insurance who did not receive
34% influenza vaccine in the past
32%
year was 41%.
30%
• More women (45%) than
men (34%) report not
20% receiving a flu shot.
• Among adults age 65 and
over, high school graduates
10% without any college education
N N N N have the highest percentage
0 (54%) of persons who are
al
ale
ale
ol
te
$5 99
ed
ed
ce
te
tm d
ce
n
unvaccinated compared to
he
i
leg
,00
tio
tio
rie
rie
00
an
an
an
t
ho
ua
ua
an
an
9,9
To
No ploy
oy
m
M
Ot
0,0
ar
ar
ita
ita
isp
sp
sp
25
ol
ad
ad
sc
ur
ur
Fe
pl
$4
M
ec
adults age 65 and over with

Hi
Hi
im
lim
n$
ns
ns
Em
m
gr
gr
-H
gh
to
n-
te
m
sl
hi
hi
No
on
ol
ge
a
Hi
No
No
th
So
00
Ha
o
alt
alt
,N
lle
some college (32%) and

<
ch
5,0
ss
He
he
k,
Co
te
Le
ac
$2
hi
gh
No
Bl
college graduate (35%).

W
Hi
Note: N = Sample size less than 50, estimate not displayed
61
SELECTED REPORTABLE INFECTIOUS DISEASES

In Dallas County, sexually transmitted infections
have been trending upward. Prevention of STIs is an
essential primary care strategy for safeguarding and
improving reproductive health.24 FIGURE 53. Primary
and Secondary Syphilis Diagnoses by
Race and Age Group Dallas County, 2017
2% Other
FIGURE 52. Primary and Secondary Syphilis Diagnoses, Dallas County, 2007 - 2017
Hispanic
27% 28% Black
White
43%
5% 55+
45-54
13%
26% 35-44
Data Source: 2009-2017 Dallas STD incidence and

Prevalence Data, Texas Department of State Health Services 18% 25-34
15-24
38%
Data Source: 2009-2017 STD Incidence and Prevalence Data, Texas Department of
State Health Services
62
FIGURE 54. New Primary and Secondary Syphilis Diagnoses by ZIP Code, Dallas County, 2012 - 2016
75082
_
75080
75006 75044 75048
75248
75019
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201 Age-adjusted
75212 75226
75202
75210 75227 75149 New Primary and
Secondary Syphilis
75050
75208 75215 Diagnoses Incidence Rate
75203 per 100,000:
75211
75051 75181
0.00 - 2.00
75180
75224 75217
75216
75233 2.01 - 4.00
75236 4.01 - 5.50

75253
75052 75237 75241 5.51 - 8.00
75116 75232
75141 8.01 - 10.00

75249
75159
75137 10.01 - 13.00
75134 13.01 - 20.00
75115 75172
75104 >20.00
Insufficient Data
75146

*10 multi-county ZIP codes were excluded
63
FIGURE 55. Chlamydia Diagnoses Dallas County, 2007 -2017 FIGURE 56. ChlamydiaDiagnoses by Race and Age Group
Dallas County, 2017
2% Other
Hispanic
16%
Black
36%
White
46%
1%1% 55+
3%
7% 45-54
35-44
Data Source: 2009-2017 Dallas STD incidence and Prevalence Data,

Texas Department of State Health Services
28% 60% 25-34
15-24
0-14
Data Source: 2009-2017 Dallas STD Incidence and Prevalence Data, Texas
Department of State Health Services
64
FIGURE 57. New Chlamydia Diagnoses by ZIP Code Dallas County, 2012 - 2016
75082
_
75080
75006 75044 75048
75248
75019
75001
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149 Age-adjusted
New Chlamydia Diagnoses
75050 75215 Incidence Rate per 100,000:
75208
75203
0.00 - 120.00
75211
75051 75181
75180 120.01 - 300.00
75224 75217
75216
75233 300.01 - 430.00
75236
75253
430.01 - 500.00
75237 75241
75052
75116 75232 500.01 - 580.00
75141 580.01 -700.00
75249
75159
75137
700.01 - 1,300.00
75134
>1300.00
75115 75172
75104 Insufficient Data
75146

65
FIGURE 59. Gonorrhea

Diagnoses by Race and Age
Group Dallas County, 2017
2% Other
FIGURE 58. Gonorrhea Diagnoses Dallas County, 2007 - 2017
Hispanic
19%
23% Black
White
56%
5% 2% 1% 55+
45-54
11%
35-44
47% 25-34
34% 15-24
Data Source: 2009-2017 Dallas STD incidence and Prevalence Data,

Texas Department of State Health Services 0-14
Data Source: 2009-2017 Dallas STD Incidence and Prevalence Data,

66
FIGURE 60. New Gonorrhea Diagnoses by ZIP Code Dallas County, 2012 - 2016
75082
_
75080
75006 75044 75048
75248
75019
75001
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149
75050 75215
75208
75203 Age-adjusted
New Gonorrhea Diagnoses
75051
75211
75181 Incidence Rate per 100,000:
75180
75224 75216
75217 0.00 - 40.00
75233
40.01 - 90.00
75236
75253
90.01 - 125.00
75052 75237 75241
75116 75232
125.01 - 170.00
75141
75249
75159 170.01 - 260.00
75137
75134
260.01 400.00
75115 75172 400.01 - 600.00

75104
>600.00

67
FIGURE 61. New HIV Diagnoses and Cumulative Number of Persons Living with
HIV Dallas County, 2008 - 2017
Data Source: 2009-2017 Dallas HIV Incidence and Prevalence Data,

68
FIGURE 62. HIV Mortality Rate by Race, Dallas County, 1999 - 2017
69
FIGURE 63. New HIV Diagnoses by Gender and Exposure, Dallas County, 2017
Male
Female
17%
FIGURE 64. Persons Living with HIV by Race and Ethnicity Dallas County, 2008 - 2017
83%
Heterosexual
Injection Drug Use

(IDU)
18%
5% MSM/IDU
Men Who Have Sex

3% 74% With Men (MSM)
Pediatric
Data Source: 2009-2017 Dallas HIV Incidence and Prevalence Data, Data Source: 2009-2017 Dallas HIV Incidence and Prevalence Data,
Texas Department of State Health Services Texas Department of State Health Services
70
FIGURE 65. New HIV Diagnoses by ZIP Code Dallas County, 2012 - 2016
75082
_
75080
75006 75044 75048
75248
75019
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149 Age-adjusted
New HIV Diagnoses
75050
75208 75215 Incidence Rate per 100,000:
75203
0.00 - 5.00
75211
75051 75181
75180 5.01 - 13.00
75224 75217
75216
75233 13.01 - 18.00
75236 18.01 - 23.00
75253
75237 75241
75052
75232
23.01 - 30.00
75116
75249
75141 30.01 - 41.00
75159
75137 41.01 - 64.00
75134
>64.00
75115 75172
75146

71
OTHER REPORTABLE INFECTIOUS DISEASE FIGURE 67. Tuberculosis

Cases by Age Group Age,
Tuberculosis Race and Ethnicity
12%
45-64
19-44 34%
FIGURE 66. Annual Tuberculosis Cases and Incidence Rates Dallas County, 1993 - 2017 46%
37%
≥65
15%
5-18 0-4
3% 2%
21.7% Hispanic
31.2%
White
Black
41.4% 5.7%
Asian
72
FIGURE 68. Tuberculosis Incidence Rates by Race and Ethnicity Dallas County,
2006 - 2017
73
BEHAVIORAL HEALTH IN DALLAS COUNTY

Behavioral health has been shown to be a key indicator in quality of life and health-related quality of life.25
It has also been linked with increased risk factors associated with chronic diseases.26 The U.S. Centers for
Disease Control and Prevention 500 Cities Project identifies the geographic distribution of adults 18 years
of age or older within Dallas who have reported poor mental health for ≥ 14 days during the past 30 days.
FIGURE 69. Mental Health Risk Factors
In 2016, of the
427,175 visits
(inpatient, outpatient
and emergency
department visits)
pertaining to
behavioral health,
37% were substance
misuse and 12%
were mental health
combined with
substance misuse
visits.27
Adopted: U.S. Centers from Disease Control and Prevention. 500 Cities Project: Local Data for Better Health.
25
Office of Disease Prevention and Health Proportion. HealthyPeople2020. Health-Related Quality of Life & Well Being. Available https://www.healthypeople.gov/2020/topics-objectives/topic/health-related-quality-of-life-well-being
26
National Institute of Mental Health. Chronic Illness & Mental Health. Available https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml
27
DFWHC Foundation. Behavioral Health Needs Assessment. Available http://www.healthyntexas.org/content/sites/dallasfortworth/BHCHNA__16_Counties_CHC.DFWHCFoundation2018.pdf
74
FIGURE 70. Dallas County Behavioral Health Encounters, 2016
Utilization of mental
Both
health services by race
and ethnicity in 2016 is
12% Substance Misuse illustrated in Figure 71.
The left pie chart indicates
Mental Health that 53% of the visits
were made by whites
51% and 35% by African
37% Americans. The right pie
chart shows that 82.2%
of encounters were
non-Hispanic Latinos
individuals.
Source: DFWHC Behavioral Health Needs Assessment, 2016
FIGURE 71. Mental Health Services Visits by Race and Ethnicity, 2016
Other .02% Unknown
Black
12% 17.75%
White/Non Hispanic
White Hispanic/Latino
53%
35%
82.2%
Source: DFWHC Behavioral Health Needs Assessment, 2016
75
FIGURE 72. Inpatient

Discharges by Payer Type (All Age Groups,
Includes Normal Newborns), Dallas County, 2018
Uninsured
u HOSPITAL UTILIZATION
This section provides an overview of inpatient and emergency 15% Medicare
department (ED) discharges in Dallas County and at Parkland, Medicaid

including those resulting from encounters with Correctional
40%
Health and Homeless Medical Outreach Services (HOMES). Privately Insured
26%
19%
INPATIENT DISCHARGES
Figure 72 shows that 40% of the overall discharges for inpatient
services in Dallas County were completed for individuals covered
by private insurance. Individuals covered by Medicaid represent
19% and those covered by Medicare represent 26%; while
Parkland inpatient services discharges by privately insured patients
represents only 6%, Medicaid covered individuals represent 36%
of inpatient services and Medicare 18% (see Figure 73).
The Inpatient Discharges Uninsured 2018 map (see Figure 74) FIGURE 73. Inpatient
Discharges by Payer Type (All Age Groups, Includes
illustrates the number of individuals discharged from inpatient Normal Newborns), Parkland, 2018
services in Dallas County in 2018 by ZIP code and shows the
highest volume of inpatient discharges of uninsured individuals
reside in ZIP codes 75217, 75216, 75243 and 75228 (for detailed
breakdown by ZIP code see Figure 76). Similarly, the ZIP codes with
the highest volume of Parkland’s uninsured patients also include
75217, 75216 and 75228 (see Figures 77 and 78).
ZIP codes 75217, 75216, 75211 and 75228 have the highest
volume of uninsured, Medicaid and Medicare inpatient discharges
both at the county level and at Parkland. ZIP codes 75052, 75115
and 75228 have the highest volume of privately insured discharges
(see Figure 79 – 80).
Data Source: DFWHC Foundation Regional Data
76
FIGURE 74. Inpatient Medicaid and Uninsured Discharges, Dallas County, 2018 (All Age Groups, Includes Normal Newborns)
75082
_
75080
75006 75044 75048
75248
75019
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149
75050 75215
75208
75203
75211
75051 75181
75180
Uninsured
75224 75217
75216
75233 109 and below
75236 110 to 199

75253
75052 75237 75241 200 to 349
75116 75232
75249
75141 350 to 519
75159
75137 520 to 699
75134
700 to 899
75115 75172
75104 900 to 999
1000 and above

75146
Other
77
FIGURE 75. Inpatient Discharges Insured, Dallas County, 2018 (All Age Groups, Includes Normal Newborns)
75082
_
75080
75006 75044 75048
75248
75019
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149
75050 75215
75208
75203
75211
75051
75180
75181
Count
75224 75217
75216
75233 299 and below
75236 300 to 569

75253
75052 75237 75241 570 to 899
75116 75232
75141 900 to 1299

75249
75159
75137 1300 to 1599
75134 1600 to 1899
75115 75172
75104 1900 to 2999
300 and above

75146
Other
78
Inpatient Medicaid and Uninsured Discharges by Top ZIP Codes,

FIGURE 76.
Dallas County, 2018 (All Age Groups, Includes Normal Newborns)
75217 2,992 1,242

75216 2,357 995
75243 2,337 981
75228 2,317 969
75211 2,409 863
75227 1,948 794
75061 1,559 804
75052 1,408 652
75220 1,307 625
75231 1,326 579
0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500
Medicaid Uninsured
Inpatient Medicaid and Uninsured Discharges by Top ZIP Codes,

FIGURE 77.
Parkland, 2018 (All Age Groups, Includes Normal Newborns)
75217 1,579 702
75211
1,147 519
75216 1,079 505
75228 1,003 431
75220
953 468
75243
1,004 310
75227
887 410
75061 846 301
75060
576 258
75212
483 333
0 500 1,000 1,500 2,000 2,500
Medicaid Uninsured
79
FIGURE 78. Inpatient Discharges Uninsured, Parkland, Dallas County 2018 (All Ages, Includes Normal Newborns)
80
FIGURE 79. Inpatient Medicare and Insured Discharges by Top ZIP Codes, Dallas County, 2018 (All Age Groups, Includes Normal Newborns)
75052 3,751 1,339

75115 2,495 1,389
75228 2,192 1,416
75043
2,183 1,338
75216 1,767 1,669
75040 2,068 1,216
75150 2,032 1,141
75243 1,955 1,135
75217 1,755 1,295
75080 1,976 1,048
75104 2,061 881
75061 1,556 1,214
0 1000 2000 3000 4000 5000 6000
Privately Insured Medicare
FIGURE 80. Inpatient Medicare and Insured Discharges by Top ZIP Codes, Parkland, 2018 (All Age Groups, Includes Normal Newborns)
75216 68 344
75217
79 266
75212 48 270
75211
70 211
75227
85 165
75235 69 172
75241 38 161
75224 65 130
75228
52 126
75232
37 111
0 50 100 150 200 250 300 350 400 450
Insured Medicare
81
FIGURE 81. Inpatient Discharges by Age Groups & Primary Payer Group,
Dallas County, 2018
FIGURE 82. Inpatient Discharges by Age Groups & Primary Payer Group,
Parkland, 2018
82
FIGURE 83 Inpatient Discharges by Race, Dallas County, 2018 (All Ages, Includes Normal Newborns)
160,000
64%
140,000
120,000
100,000
32%
80,000
60,000
40,000
When inpatient
20,000
5% discharges are broken
0% down by race and
ethnicity it shows that
0 American Indian / Asian or Black White
Eskimo / Aleut Pacific Islander
in Dallas County whites
comprised 64% of
Uninsured Medicaid Medicare Privately Insured the discharges and
Data Source: DFWHC Foundation Regional Data, 2018 African Americans 32%.
Parkland’s discharge
FIGURE 84. Inpatient Discharges by Race, Parkland, 2018 (All Ages, Includes Normal Newborns) demographics show that
whites (a race category
35,000
72%
that includes Hispanics)
represent 72% and
30,000 African Americans, 25%.
25,000
20,000
15,000
25%
10,000
5,000
0% 2% 1%
0 American Indian / Asian or Black Other White

Uninsured Medicaid Medicare Privately Insured
83
FIGURE 85. I npatient Discharges by Ethnicity, Dallas County, 2018 (All Ages,
Includes Normal Newborns)
Insured 15,184 79,242 39%
Medicaid 29,106 31,321 25%
Medicare 47,689 22%
Uninsured 13,657 20,879 14%
0 20,000 40,000 60,000 80,000 100,000
Hispanic or Latino Non Hispanic or Non Latino
FIGURE 86. I npatient Discharges by Ethnicity, Parkland, 2018

(All Age Groups, Includes Normal Newborns)
Medicaid 17,415 7,206 54%
Uninsured 8,041 6,030 31%
Medicare 11%
Insured 5%
0 1,000 10,000 15,000 20,000 25,000 30,000
Hispanic or Latino Non Hispanic or Non Latino
84
FIGURE 87. ED Discharges by Payer Type (All Ages) Dallas County, 2018
EMERGENCY Uninsured
DEPARTMENT (ED)
DISCHARGES PROFILE Medicare
For both Dallas County
and Parkland, uninsured 26% Medicaid
individuals comprise
the highest volume of 46% Privately Insured
ED discharges however,
in Dallas County the 13%
uninsured are 46% of all
ED discharges whereas at
Parkland they represent
15%
65%. The percentages for
Medicare and Medicaid ED
discharges within Dallas
County as a whole are
similar to those at Parkland FIGURE 88. ED Discharges by Payer Type (All Ages) Parkland, 2018
(Figures 87 and 88).
5% Uninsured
Medicare
17% Medicaid
Privately Insured
65% 13%
DFWHC Foundation Regional Data, 2018
86
FIGURE 89. Uninsured ED Discharges by ZIP Code, Dallas County, 2018
87
FIGURE 90. Medicaid and Uninsured ED Discharges by Top ZIP Codes, Dallas County, 2018
The ZIP codes with the

highest volume of ED
discharges regardless of
payer type are 75217,
75216, 75235 and 75211
(see Figure 90 and Figure
91).
88
FIGURE 91. Medicaid and Uninsured ED Discharges by Top ZIP Codes, Parkland, 2018
89
FIGURE 92. ED Discharges by Age Groups, Dallas County, 2018
32,509
108,251 69,561
91,329
152,712 9,183
23,614
11,911
49,805 23,569 24,848 65,294
34,724
Figures 92 and 93 29,799
64,927 68,799
show the distribution 37,443 48,388 44,046
25,246 17,148
7,562
of ED discharges by age
groups for Dallas County 0-17 YEARS 18-24 YEARS 25-34 YEARS 34-49 YEARS 50-64 YEARS 65-84 YEARS 85+ YEARS
displaying a near-normal
Privately Insured Medicaid Medicare Uninsured
bell shape distribution
with the exception of the Data Source: DFWHC Foundation Regional Data, 2018
0-17 age group for the
county as a whole.
FIGURE 93. ED Discharges by Age Groups, Parkland, 2018
49,032 38,009
29,502
15,368 6,792
963 2,702 5,876
9,028 11,365 8,524 11,019 10,137
1,943
2,608 1,920 3,113 3,533 3,195 300
0-17 YEARS 18-24 YEARS 25-34 YEARS 34-49 YEARS 50-64 YEARS 65-84 YEARS 85+ YEARS
90
FIGURE 94. ED Discharges by Race, Dallas County, 2018
600,000
500,000
400,000
300,000
200,000
100,000
American Indian / Asian or Black Other White

Privately Insured Medicaid Medicare Figure

Uninsured 95. ED Discharges by Race, Parkland, 2018
FIGURE 95. ED Discharges by Race, Parkland, 2018

160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
American Indian / Asian or Black Other White

91
Figure 96. ED Discharges by Payer Group and

Ethnicity, Dallas County, 2018
FIGURE 96. ED Discharges by Payer Group and Ethnicity, Dallas County, 2018
Uninsured 142,834 218,810
Hispanic or Latino
Insured 59,789 236,545 Non Hispanic or

Non Latino
Medicaid 116,341 151,541
Medicare 17,010 105,389
0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000
FIGURE 97. ED Discharges by Payer Group and Ethnicity, Parkland, 2018
Uninsured 76,433 63,780
Hispanic or Latino
Medicare 5,879 15,491 Non Hispanic or

Non Latino
Medicaid 21,535 22,634
Insured 5,126 7,165
0 30,000 60,000 90,000 120,000 150,000
92
FIGURE 98. Inpatient Hospital Discharges Diagnoses, Dallas County, 2018 (All Ages, Includes Normal Newborn) PROMINENT HOSPITAL
DIAGNOSES
Hospital discharge data
Cardiology/Circulatory System 8,722 9,753 19% offers insight regarding
Respiratory System 6,171 6,162 13% patterns of utilization,
Orthopedics/Musculoskeletal 7,777 6,426 13% Insured public health, injury,
morbidity and the burden
Digestive Diseases 6,595 4,590 12% Medicaid
of chronic disease.28 For
Neurology/Neurosurgery 5,100 4,704 10% Medicare this report, inpatient
Kidney & Urinary Tract 3,474 4,029 7% and ED discharge data
Uninsured was analyzed based
Psychiatry 4,004 1,836 7%
on diagnosis-related
Metabolic & Endocrine 3,040 2,469 7%
groups (DRG) to
Hepatobiliary & Pancreas 2,536 5% identify similarities and
Oncology 2,333 4% differences between
Dermatology 3% uninsured, Medicaid,
Medicare and privately
0 5,000 10,000 15,000 20,000 25,000
insured patients across a
Data Source: DFWHC Foundation Regional Data, 2018 variety of diagnoses.
FIGURE 99. Inpatient Hospital Discharges Diagnoses, Medicare and Insured, Dallas County, 2018 (All Ages, Includes Normal Newborns)
Cardiology/Circulatory System 8,722 9,753
Other 7,813 7,201
Orthopedics/Musculoskeletal 7,777 6,426 Privately Insured
Respiratory System 6,171 6,162 Medicare
Digestive Diseases 6,595 4,590
Neurology/Neurosurgery 5,100 4,704
Kidney & Urinary Tract 3,474 4,029
Psychiatry 4,004 1,836
0 5,000 10,000 15,000 20,000

28
Arizona Department of Health Services. Hospital Discharge Data. Available at: https://www.azdhs.gov/preparedness/public-health-statistics/hospital-discharge-data/index.php .
93
FIGURE 100. Inpatient Hospital Discharges Diagnoses, Medicaid and Uninsured, Dallas County,
2018 (All Ages, Includes Normal Newborns)
Other 2,095 4,091

Cardiology/Circulatory System 1,929 3,943
Respiratory System 2,858 2,372
Digestive Diseases 1,419 2,721 Medicaid
Neurology/Neurosurgery 1,191 2,489 Uninsured
Psychiatry 1,865 1,815

Metabolic & Endocrine 1,068 2,034
Orthopedics/Musculoskeletal 855 2,009
Hepatobiliary & Pancreas 602 2,033
Kidney & Urinary Tract 790 1,429
0 2,000 4,000 6,000 8,000
FIGURE 101. Inpatient Discharge Diagnoses, Parkland, 2018 (All Ages, Includes Normal Newborns)
Cardiology/Circulatory System 633 1,023 1,623

Digestive Diseases 323 983
Orthopedics/Musculoskeletal 368 882
Metabolic & Endocrine 336 947 Insured
Respiratory System 433 760

Medicaid
Neurology/Neurosurgery 325 793
Hepatobiliary & Pancreas 799 Medicare
Kidney & Urinary Tract 327 597
Uninsured
Oncology 567
Psychiatry 408
Dermatology 378
0 500 1,000 1,500 2,000 2,500 3,000 3,500
94
FIGURE 102. Inpatient Diagnoses, Medicare and Insured, Parkland, 2018 (All Ages, Includes Normal Newborns)
Cardiology/Circulatory System 137 1,023

Other 206 690
Respiratory System 69 433 Insured
Neurology/Neurosurgery 102 325 Medicare

Metabolic & Endocrine 61 336
Hepatobiliary & Pancreas 63 174
Oncology 157
Psychiatry 150
0 200 400 600 800 1,000 1,200
FIGURE 103. Inpatient Diagnosis, Medicaid and Uninsured, Parkland, 2018 (All Ages, Includes Normal Newborns)
Cardiology/Circulatory System 633 1,623

Metabolic & Endocrine 264 947
Medicaid
Respiratory System 308 760 Uninsured
Neurology/Neurosurgery 229 793

Hepatobiliary & Pancreas 215 799
Oncology 264 567
Psychiatry 172 408
0 500 1,000 1,500 2,000 2,500
95
FIGURE 104. Dallas County ED Visits, Top Diagnosis by Payer, 2018
Acute Upper Respiratory Infection 4,941 14,167 7,092
Chest Pain, Unspecified 6,303 2,576 7,511
Other Chest Pain 7,214 1,918 6,317
Urinary Tract Infection 4,920 3,377 5,491
Headache 4,740 2,394 7,542
Fever, Unspecified 1,953 8,559 2,206
Unspecified Abdominal Pain 3,715 2,267 4,921
Sepsis, Unspecified Organism 3,702 2,495
Acute Pharyngitis, Unspecified 2,291 3,689 4,280
Essential (Primary) Hypertension 3,423 4,011
Nausea With Vomiting, Unspecified 2,962 2,400 3,255
Low Back Pain 2,652 4,298
Viral Infection, Unspecified 1,910 4,232 2,600
Cough 1,682 2,523 3,816
Insured Medicaid Medicare Uninsured

96
FIGURE 105. Parkland ED Visits, Top Diagnosis by Payer, 2018
364 814 665 3,823

Chest Pain, Unspecified
Headache 342 537 364 3,944
Cough 510 432 2,567
Fluid Overload, Unspecified 693 320 2,364
Other Chest Pain 358 344 2,124
Low Back Pain 363 281 2,169
Unspecified Abdominal Pain 352 253 2,138
Essential (Primary) Hypertension 263 321 1,919
Acute Upper Respiratory Infection, Unspecified 330 202 1,723
Epigastric Pain 234 1,851
Oth Diseases and Conditions COMPL PREG/CHLDBRTH 1,427 573
Sepsis, Unspecified Organism 385 380 1,089
Acute Pharyngitis, Unspecified 233 1,416
Dizziness and Giddiness 218 1,296
Urinary Tract Infection, Site Not Specified 192 196 1,277
Insured Medicaid Medicare Uninsured
97
FIGURE 106. Patient Count by Chronic Disease Type, Parkland FY18
Diabetes,
41,056
PARKLAND UTILIZATION BY
CHRONIC DIAGNOSES
Parkland monitors the number of
patients with chronic disease as a CKD, CHF,
means to identity at-risk populations Multiple Chronic 10,386 8,595
as well as geographic hot spots across Hypertension, Behavioral Health, Conditions, Asthma,
the county. Figure 106 on the right 79,801 65,923 60,662 13,878 Cancer, 5,310
shows the number of patients per Data Source: Parkland Decision Support, Strategy & Business Development
chronic disease as well as the number
of patients with multiple chronic FIGURE 107. Visits by Chronic Disease Patients, FY18
conditions. Figure 107 indicates the
number of visits incurred by patients
with chronic disease.
Behavioral Health, Diabetes,

471,147 384,498
Multiple Chronic
Hypertension, Conditions, CKD, CHF, Asthma, Cancer,
681,108 601,554 135,973 109,322 98,359 95,393
Data Source: Parkland Decision Support, Strategy & Business Development
98
u
P arkland maintains
several clinical registries
including those focused
on chronic disease
and uses this data to
identify trends within
the population and
develop new strategies
for managing those
patients suffering from
chronic conditions.
The following maps
display the county-
wide distribution of
Parkland patients
with hypertension,
behavioral health issues,
diabetes, asthma,
chronic kidney disease,
cancer and chronic
heart failure or multiple
chronic diagnoses.
FIGURE 108. Parkland, Hypertension Registry by ZIP Codes
Data Source: Parkland Hypertension Registry
100
FIGURE 109. Parkland, Behavioral Health (Inpatient and Outpatient) Registry by Zip Codes
Data Source: Parkland Behavioral Health (Inpatient and Outpatient) Registry
101
FIGURE 110. Parkland, Behavioral Health Psychiatric ED Registry by ZIP Code
Data Source: Parkland Behavioral Health Psychiatric ED Registry
102
FIGURE 111. Parkland Diabetes Registry by ZIP Code
Data Source: Parkland Diabetes Registry
103
FIGURE 112. Parkland Asthma Registry by ZIP Code
Data Source: Parkland Asthma Registry
104
FIGURE 113. Parkland, Chronic Kidney Disease Registry by ZIP Code
Data Source: Parkland Chronic Kidney Disease Registry
105
FIGURE 114. Parkland Cancer Registry by ZIP Code
Data Source: Parkland Cancer Registry
106
FIGURE 115. Parkland, Chronic Heart Failure Registry by ZIP Code
Data Source: Parkland Chronic Heart Failure Registry
107
Figure 116. Correctional Health Demographics by
Race, Dallas County, 2018
FIGURE 116. Correctional Health Demographics by Race, Dallas County, 2018

u OTHER AT-RISK POPULATIONS
Parkland and DCHHS are committed to Black 51%
improving the health of populations that have
traditionally been marginalized due to their
environment or their lack of representation in White 39%
health data collected and acted upon within
the county.29 Dallas County’s incarcerated Hispanic
7%
population and its homeless population face
social and environmental barriers to health.
Both Parkland and DCHHS are striving to see Other 2%
that these populations do not fall through the
cracks when it comes to improving the health
of the county. In addition, data sources that Unknown 1%
adequately track and aid in the development
of health strategies geared toward improving 0% 10% 20% 30% 40% 50% 60%
health within Dallas County’s Lesbian, Gay, Data Source: Clarity Data prepared by PCCI
Bisexual and Transgender (LGTBQ) community
do not currently exist.
FIGURE 117. Correctional Health Demographics by Ethnicity, Dallas County, 2018

60%
20,000
CORRECTIONAL HEALTH
In 2018, Parkland provided healthcare
15,000
services to 52,098 individuals in the
19,989
Dallas County Jail. Of those, 63% (n-
33,186) also have a medical record with 10,000
Parkland, which indicates a tendency 21%
for these patients to cycle between the 18%
health system and correctional health 5,000
facilities. Those ZIP codes with the highest 6,857 5,866
incarceration rates are the same ones
1%
identified in previous sections as having 0
Hispanic or Non Hispanic Unspecified Unknown
significant health disparities. Latino or Non Latino
Data Source: Clarity Data prepared by PCCI
29
U.S. Centers for Disease Control and Prevention. Correctional Health.
108
FIGURE 118. Correctional Health Cases per ZIP Code, Dallas County, 2018
75216 1,051
75217 973
75228 631
75211 630
75201 455
75227 615
75243 570
75241 542
75215 477
75149 422
0 200 400 600 800 Figure
1,000 119. Correctional Health Cases per Top
1,200
Number of Unique Patients Chronic Conditions, Dallas County, 2018

FIGURE 119. Correctional Health Cases per Top Chronic Conditions, Dallas County, 2018
Renal Failure, 418
Lung
Diabetes, Liver Disease, Heart Failure, Disease,
1,132 546 285 225
109
FIGURE 120. Correctional Health Cases per ZIP Code, Dallas County, 2018
110
HOMELESS HEALTH
Parkland’s Homeless Outreach Medical Services (HOMES) program serves homeless individuals of all ages in
Figure 121. HOMES Top 10 ZIP Codes 2018
Dallas County. It is the only program of its kind in Dallas County that seeks to improve access to healthcare
for individuals experiencing homelessness. The program provides services at over 25 locations through two
fixed sites, four mobile medical units, and one mobile dental unit. Locations include homeless shelters,
domestic violence shelters, housing programs, drug treatment programs, day programs and social service
centers. HOMES is a Health Care for the Homeless Federally Qualified Health Center under the Health
Resources and Services Administration (HRSA).
FIGURE 121. HOMES Top 10 ZIP Codes 2018

1,800
25% Population Demographics
1,600
Figure 118 below shows
1,400 that 10 ZIP codes make
up 71% of the overall
# of Patients
1,200 HOMES population

1,000 served; the remaining
14% 29% of the HOMES
12%
800 population is distributed
10% among 47 ZIP codes.
600 8% 8%
7% 7% 6%
400
3%
200 1,571 890 721 597 487 487 463 422 381 207
0
75201 75235 75226 75228 75241 75215 75247 75208 75146 75204
Data Source: 2018 HRSA HOMES UDS Reporting Submission
111
FIGURE 123. HOMES Patient Population by Ethnicity, 2016 - 2018

The demographics of HOMES patients has
remained consistent from 2016 to 2018. The 100%
HOMES patient is generally non-Hispanic, white or 80.4% 79.4%

83.8%
% of Total HOMES Patients

African American between the ages of 18 to 44 80%
years. They are 100% below the Federal Poverty

Level and are treated in a homeless shelter. HOMES 60%
has seen an increase in homeless veterans annually

since 2016. While the number of patients with 40%
hypertension and diabetes has remained constant,

17.4% 18.1% 15.2%
there has been an increase in patients who are 20%
overweight or obese, have abnormal cervical 2.1% 2.5% 1.0%

cancer screenings and suffer from depression. 0
Non Hispanic or Hispanic/Latino Unreported
Non Latino
CY 2016 CY 2017 CY 2018
Data Source: HOMES Annual HRSA UDS Submissions
FIGURE 122. HOMES Population by Race, 2016 - 2018 FIGURE 124. HOMES Veterans Patients, 2016 - 2018
48.47% 49.32% 49.73%

50 47.44%
45.28% 46.17%
# of HOMES Veterans
% of Total HOMES Patients
40
30
20
5 6 7
10 6.25%
4.50%
2.83%
0
Black/African American White All Others
CY 2016 CY 2017 CY 2018
CY 2016 CY 2017 CY 2018 Data Source: HOMES Annual HRSA UDS Submissions
112
FIGURE 125. HOMES Patients by Age Group, 2016 - 2018 FIGURE 127. HOMES Other Selected Medical Condition Diagnoses, 2016 – 2018
90
60%
80
# of HOMES Patients w/DX

49% 51% 70
50% 48%
60
# of Total HOMES Patients
50
40% 40
32% 31% 32%
30 54 43 82
30% 20 37 45
10 24
20%
0
12%
11% 8% 8%
Abnormal Breast Abnormal Cervical
8% (Female)
10% 7%
1% 1% 1% CY 2016 CY 2017 CY 2018
0
Under 18 18-44 45-59 60-69 70 and Over Data Source: HOMES Annual HRSA UDS Submissions
CY 2016 CY 2017 CY 2018

FIGURE 126. HOMES Selected Medical Condition Diagnoses, 2016 – 2018 FIGURE 128. Selected Infection and Parasitic Disease Diagnoses, 2016 – 2018
2,500 350
2,215 2,192
2,134 298
300 279 276
2,000
250

200
1,500
1,135 150
112 118
1,000 100 100114
93 92
608 581 602 657 654 50 33 32 20
500 2 8 3
216 230 260 209 224 0
58 Hepatitis C Symptomatic/ Sexually Hepatitis B Tuberculosis
0 Asymptomatic HIV transmitted
Hypertension Overweight/Obesity Diabetes Heart Disease Contact infections
Dermatitis/Eczema
CY 2016 CY 2017 CY 2018 CY 2016 CY 2017 CY 2018
Data Source: HOMES Annual HRSA UDS Submissions Data Source: HOMES Annual HRSA UDS Submissions
113
FIGURE 129. HOMES Mental Health Conditions and Substance Use Disorders, 2016 – 2018
1,600
1,522
1,400
1,279
1,192
1,200 1,160 1,205 1,184
1,000 986
784
800
629
584
600 526
400 384
218186 230
200
119 104
53
0
Depression/ Tobacco Use Other Mental/ Anxiety/PTSD Alcohol-Related Attention Deficit/
Other Mood Non Drug&Alcohol Disruptive Behavior
CY 2016 CY 2017 CY 2018
Source: HOMES Annual HRSA UDS Submissions
114
FIGURE 130. HOMES Dental Services, 2016 – 2018
1,200
1,059
1,000
787
800
# of HOMES Patients
600 565
400
269
232 209 149
200
115 81 80 119
16 14 13 14 3
0
Restorative Oral Oral Rehabilitative Prophylaxis Fluoride
Services Exams Surgery Services (Adult/Child) Treatment
(Adult/Child)
CY 2016 CY 2017 CY 2018
115
LESBIAN, GAY, BISEXUAL AND TRANSGENDER (LGTBQ) HEALTH

Studies indicate that members of the LGTBQ community experience
health disparities in terms of physical and mental health.30 The LGBTQ
population also bears a higher risk for homelessness. According to a
national survey, young adults, ages 18 to 25 who identified as LGBTQ
experienced homelessness within the last 12 months at over twice the
rate of their heterosexual peers who identified as their birth gender
(“cisgender”). Young people who identified as LGBTQ made up about
20% of those young adults who reported homelessness. In larger urban
communities, the proportions of youth experiencing homelessness who
identified as LGBTQ were higher than for smaller more rural communities
and reached up to 40% of homeless youth in one county’s youth count.
Given that many young people may be reluctant to disclose their sexual
orientation or gender identity in a survey, these statistics should be viewed
as conservative estimates, especially in households and communities
where there is less acceptance of LGBTQ individuals.31
HealthyPeople 2020 has highlighted the need to document, understand

and address the environmental factors that contribute to the health
disparities in the LGTBQ populations and recommends improving the
collection of health-related data pertaining to sexual orientation and
gender identity (SOGI).
30
afeez H, Zeshan M, Tahir MA, Jahan N, Naveed S. Health Care Disparities Among Lesbian, Gay, Bisexual, and
H
Transgender Youth: A Literature Review. Cureus. 2017;9(4):e1184. Published 2017 Apr 20. doi:10.7759/cureus.1184
31
Source: Morton, M. H., Dworsky, A., Matjasko, J. L., Curry, S. R., Schlueter, D., Chávez, R.& Farrell, A. F. (2018).
Prevalence and correlation of youth homelessness in the United States. Journal of Adolescent Health, 62(1), 14-21
116
COMMUNITY INPUT
Community and frontline health provider input is essential for FIGURE 131. Breakdown by HealthyPeople 2020 Domains
understanding the barriers to better health experienced by the
residents of Dallas County as well as the opportunities to address
them. As explained previously in this assessment, dozens of
focus groups were conducted with participants from 49 groups Health and Healthcare 61%
representing patients, community-based organizations and
healthcare professionals from various functions within the industry. Social Impact and
Participants offered insights on a range of issues such as barriers
Community Context 19%
to care, social determinants of health and which community
institutions are best positioned to guide health improvement efforts
in the county. Education 10%
u COMMUNITY HEALTH INTEGRATION Neighborhood and
A number of participants recognized the need for leadership and
Built Environment 5%
better coordination among organizations and services in order to
address the increasingly complex issues affecting the health and
well-being of Dallas County residents. While it was acknowledged
that improving the health of the county and eliminating disparities
Economic Stability 4%
will require a community-wide effort beyond what the health
provider entities can achieve on their own, several participants
expressed the opinion that the county health agencies (Parkland
and DCHHS) are best positioned to organize such efforts. 14% of
the respondents offered responses that identified Parkland as an
anchor organization in the community. A number of participants
urged Parkland, in particular, to help support and enable the efforts
of other allied organizations within the community who serve a
population common to the health system.
The graphic above shows that after categorizing all focus group
u BARRIERS TO BETTER CARE responses (N=820) by SDOH according the HealthyPeople 2020
Focus group participants identified several barriers that prevent framework, the top three SDOH that participants perceived as having
the patient population most commonly served by Parkland and the most influence over the health of the community are: Health and
DCHHS from improving their health status. The team developing Healthcare (61%), Social Impact and Community Context (19%) and
the CHNA collected this feedback and, as described in the Education (10%).
methodology section of this assessment, coded responses based
on the CDC’s HealthyPeople 2020 Social Determinants of Health
(SDOH) Framework. Once the data from the focus group responses
was analyzed and coded, the SDOH were ranked by number of
participant references to each topic (see Figure 131).
118
119
COMMUNITY INPUT
SDOHS BY HEALTHY PEOPLE 2020 CATEGORY

HEALTH AND HEALTHCARE
The HealthyPeople 2020 category which received the most focus FIGURE 132. Breakdown of Health and Healthcare Domain
group participant responses was Health and Healthcare.
Of the responses that fall within the Health and Healthcare domain, Access to
Access to Care was the most prominent. Factors categorized under Bevavioral Health Services 29%
Access to Care create situations in which it is difficult physically, Other 16%
financially or in terms of navigating a complicated healthcare system,
for patients to access care through available resources. It also includes Insurance Coverage 14%
health literacy which, apart from being a factor that impacts an
individual’s ability to navigate the healthcare landscape, impacts one’s
Increase in Patient Volume 14%
ability to understand and manage chronic disease. Poor Health Literacy 13%
Responses within the Access to Care category include the following: Overall Access to Care 6%
Lack of insurance coverage Care Coordination 4%
Poor Health Literacy
Other
Access to Medication 3%
Increase in Patient Volumes 0 5 10 15 20 25 30
Access to Medication Source: HOMES Annual HRSA UDS Submissions
Access to behavioral Health Services
Care Coordination
“Along with our mental health patients

“Health literacy is a major barrier.
we’re also seeing two distinct groups
A patient might bring in a bag with
– geriatric and adolescent. With both
meds and have no idea what they take
groups they may end up in the Psych ED
them for. Sometimes we find they have
for four days because there’s no place for
different meds for the same thing.”
them to go in the community.”
120
COMMUNITY INPUT
SOCIAL IMPACT & COMMUNITY CONTEXT

The category with the second highest number of responses
was Social Impact and Community Context. The factors
within the Social Impact & Community Context category FIGURE 133. Breakdown of Social Impact & Community Context Domain
include responses that deal with social cohesion (the
willingness of members of a society to cooperate with each
other in order to prosper), discrimination (real, perceived
Social Cohesion 44%
and/or anticipated) and cultural competency. Responses
within this category reflected a level of fear and /or anxiety Discrimination 26%
on the part of patients when dealing with the healthcare
industry and health providers (ranging from fear of being
unnecessarily charged to not being treated well by staff
Cultural Competency 16%
to “not wanting to know” if they have health issues).
In addition, a level of fear and/or anxiety was expressed Other 4%
by frontline healthcare providers who have experienced,
witnessed or been made aware of increased patient on staff
violence over the past two years.
Demographics Changes 6%
0 10 20 30 40 50
Responses within the Social Impact & Community Context
domain included the following:
Social cohesion
Discrimination
Cultural Competency
Other
“Patients have a fear of going to doctors

“Patients are afraid the employer
and a distrust of the system. They may
won’t fill out the paperwork
feel that ‘they don’t want to know’
(to access financial assistance).”
health issues.”
121
COMMUNITY INPUT
EDUCATION
The category with the third largest number of responses was
Education. While health literacy was discussed often over
the course of our focus groups, a number of participants
raised the issue of reading literacy and the challenges
patients have when they are unable to read treatment plans
and prescriptions. These responses were closely correlated
with health literacy and discussion tended to drift between
reading literacy and health literacy.
NEIGHBORHOOD AND BUILT ENVIRONMENT

Discussion topics within the Neighborhood and Built
Environment domain included SDOH such as access to
health facilities, access to fresh foods, and access to
adequate child care. Among patients, transportation issues
were important.
Access to transportation
Reliance on family members or others for transportation
(scheduling rides)
Cost of transportation
Elderly people’s difficulty in dealing with the public
transportation system.
u SUMMARY OF COMMUNITY INPUT

The community expressed several priorities over the course
of the CHNA focus groups. First and foremost, participants
want to see improved access to care including changes in
state and federal healthcare policies that facilitate access.
Participants also clearly identified a need for better and more
public education with regards to health and interacting
with healthcare service or insurance providers. There was
consensus among the focus groups that a collective,
community-wide approach is needed to address the barriers
to better health within Dallas County.
122
123
COMMUNITY INPUT
DALLAS COUNTY
COMMUNITY HEALTH NEEDS ASSESSMENT 2019
Parkland Health & Hospital System | Dallas County Health and Human Services

Dallas County Health Report

Uploaded by

Copyright:

Available Formats

You might also like

Dallas County Health Report

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Dallas County Health Report

Uploaded by

Copyright:

Available Formats

DALLAS COUNTY

COMMUNITY HEALTH NEEDS ASSESSMENT 2019

Mortality .......................................................................30 Health and Healthcare ...........................................120

Heart Disease Mortality ............................................34 Education ..............................................................122

Cancer Mortality ......................................................36 Neighborhood and Built Environment ....................122

Other Leading Causes of Death................................38 Summary of Community Input ....................................122

Leading Causes of Death by Race and Ethnicity ........42

Parkland Memorial Hospital averages about

The purpose of the Dallas County CHNA is to identify

FIGURE 2. Dallas County Map

Dallas County Cities

Source: Federal Reserve Bank of St. Louis. Economic Research.

FIGURE 4. SocioNeeds Index Map, Dallas County, 2019

While much of Dallas County benefits from a

This CHNA uses a SocioNeeds Index (SNI)

Adopted from DFWHC Foundation, Healthy North Texas SocioNeeds Index.

TABLE 1. Zip Codes with SNI Rankings of 4 or Higher

TABLE 2. Dallas County Housing Data

Housing Dallas County U.S.

Housing units, July 1, 2018, (V2018) 1,027,837 138,537,078

Median gross rent, 2013-2017 $984 $982

Building permits, 2018 18,123 1,328,827

FIGURE 6. Dallas County Homes Sales and Average Price

32k 360k Since 2011, the average

Dallas County Average price

Source: Adopted from Texas A&M University, Real Estate Center.

The uninsured rate in Texas

FIGURE 8. Dallas County Medicaid Enrollment, 2016 -2018

DALLAS COUNTY MEDICAID ENROLLMENT

enrollees in Dallas County between 2016 and

2016 2017 2018

Source: Texas Health and Human Services, Healthcare Statistics.

Figure 10, shows that

Amerigroup, Parkland Community Health Plan, Superior CMC,

Amerigroup, 45% Molina Healthcare of Texas, 12% Children’s Medical Center, 2%

Parkland Community Health Plan, 35% Superior HealthPlan, 6%

Source: Texas Health and Human Services, Healthcare Statistics.

FIGURE 11. Uninsured Population, Dallas County, 2019

Data Source: IBM Watson/Truven Health Analytics 2019

FIGURE 12. Primary Care Supply Trends in Texas, 2017 -20308

HOSPITALS AND HEALTH SYSTEMS

HCA Healthcare Texas Health Hospital Carrollton 50

Source: American Hospital Association Guide 2017.

DENTON Medical City Lewisville COLLIN

Baylor S&W MC Carrollton

Baylor S&W MC Grapevine

Methodist Dallas MC Dallas Regional MC

“A collaborative research approach that is designed to ensure and Community-Based Organizations

Data Collection: For this CHNA, quantitative and

Primary Data Sources FIGURE 15. CHNA Framework

1. Behavioral Risk 9. Parkland Center for

3. Dallas-Fort Worth 11. Texas Demographic Leadership & Strategic

One does not have to look deep into the

LEADING CAUSES OF DEATH

FIGURE 16. Leading Causes of Death, Dallas County, 2013 - 2017

Data Source: CDC Wonder

Figure 17 shows that

Data Source: CDC Wonder

1. Behavioral Risk 9. Parkland Center for

3. Dallas-Fort Worth 11. Texas Demographic Leadership & Strategic

• 9% of adults in Dallas County

o People earning less

• 10% of Dallas County

• The black, non-Hispanic 60%

• In Dallas County, 66%