PROVIDED TO YOU COURTESY OF:

COMMUNITY HEALTH STATUS REPORT

Bradley County Tennessee

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

2009

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

www.astho.org chsi@astho.org

Johns Hopkins University Bloomberg School of Public Health

www.communityPHIND.net chsi@jhu.edu

NACCHO National Association of County and City Health Officials

www.naccho.org chsi@naccho.org

NALBOH The National Association of Local Boards of Health

www.nalboh.org chsi@nalboh.org

PHF Public Health Foundation

www.phf.org chsi@phf.org

Our Mission: Provide Information for Improving Community Health

RWJF Robert Wood Johnson Foundation

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

communityhealth.hhs.gov

PUBLIC HEALTH IN AMERICA

CONFIDENCE INTERVALS
SUMMARYMEASURESOFHEALTHpage4 Value ConfidenceInterval ALLCAUSESOFDEATH 944.7 (915.5973.8) SELFRATEDHEALTHSTATUS 18.9% (14.123.7%) AVERAGENUMBEROFUNHEALTHYDAYSIN 5.9 (4.47.3) PASTMONTH ADULTPREVENTIVESERVICESUSE(%)page10 Value ConfidenceInterval PapSmears(18+) 83.6% (78.089.2%) Mammography(50+) 81.2% (73.688.7%) Sigmoidoscopy(50+) nrf (nrfnrf) Pneumoniavaccine(65+) nrf (nrfnrf) Fluvaccine(65+) nrf (nrfnrf) RISKFACTORSFORPREMATUREDEATHpage11 Value ConfidenceInterval Noexercise 31.6% (25.537.8%) FewFruits/Vegetables 77.2% (71.183.3%) Obesity 28.9% (22.835.1%) HighBloodPressure 30.9% (24.337.4%) Smoker 20.4% (15.225.7%) Diabetes 10.3% (6.414.2%)

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

PUBLIC HEALTH

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

ESSENTIAL PUBLIC HEALTH SERVICES

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

ATSDR Agency for Toxic Substances and Disease Registry

atsdr.cdc.gov

CDC Center for Disease Control and Prevention

www.cdc.gov

HRSA Health Resources and Services Administration

www.hrsa.gov

NLM National Library of Medicine

www.nlm.nih.gov

Source:

PublicHealthFunctionsSteeringCommittee,Fall1994.

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

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

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

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DEMOGRAPHIC INFORMATION

RISK FACTORS FOR PREMATURE DEATH1

Bradley County, TN
Populationsize1 Populationdensity(peoplepersquaremile)2 Individualslivingbelowpovertylevel3 Age distribution1 UnderAge19 Age1964 Age6584 Age85+ Race/Ethnicity1 White Black AmericanIndian Asian/PacificIslander Hispanicorigin(nonadd) 93.3% 4.4% 0.3% 0.8% 3.5% 24.4% 61.7% 12.3% 1.5% 96,472 293 13.2%

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

PEER COUNTIES Peer counties (counties and county-like geographic areas) in stratum number 19 were stratified on the basis of the following factors: frontier status, population size, poverty, age. Below are peer county ranges representing the 10th and 90th percentile of values. This trimmed range of peer county value is used consistently throughout the report.
nrf Noreport,surveysamplesizefewerthan50.

Populationsize1 Populationdensity(peoplepersquaremile)2 Individualslivingbelowpovertylevel3

55,316102,044 36293 10.717.8% Age distribution1 UnderAge19 Age1964 Age6584 Age85+ Race/Ethnicity
1

1 CDC.BehavioralRiskFactorSurveillanceSystem,20002006.

ACCESS TO CARE

Bradley County, TN
In addition to use of services, access to care may be characterized by medical care coverage and service availability. 13,360 Uninsuredindividuals(ageunder65)1 Medicarebeneficiaries2 Elderly(Age65+) Disabled Medicaidbeneficiaries2 Primarycarephysiciansper100,000pop2 Dentistsper100,000pop2 Community/MigrantHealthCenters3 HealthProfessionalShortageArea3
nda Nodataavailable.
1 TheCensusBureau.SmallAreaHealthInsuranceEstimatesProgram,2006. 2 HRSA.AreaResourceFile,2008. 3 HRSA.GeospatialDataWarehouse,2009.

22.326.0% 60.164.4% 8.614.2% 1.42.3%

12,476 3,575 22,858 66.3 35.2 Yes No

White Black AmericanIndian Asian/PacificIslander Hispanicorigin(nonadd)

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

77.596.9% 0.620.8% 0.22.1% 0.62.7% 0.95.6%

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PREVENTIVE SERVICES USE

PEER COUNTIES
A distinctive aspect of this report is the ability to compare a county with its peers, those counties similar in population composition and selected demographics. Strata, or peer group size averages 36 and ranges from 15 to 62 counties. There are a total of 88 strata. Listed below are the 36 peer counties in stratum number 19. Due to the population size of counties within this stratum, data on vital statistics (e.g. births and deaths) and nationally notifiable diseases were aggregated across the most recent 5 year time period (2001-2005) in order to ensure stable estimates.

Bradley County, TN
INFECTIOUS DISEASE CASES1 These diseases respond to public health control efforts. The expected number is based on the occurrence of cases among peer counties.

Reported Cases
AIDS Tuberculosis HaemophilusinfluenzaeB HepatitisA HepatitisB Measles Pertussis CongenitalRubellaSyndrome Syphilis rna rna 1 10 8 0 3 0 1

Expected Cases
rna rna 0 5 9 0 42 0 0

Indicatesastatusfavorabletopeers. Indicatesastatuslessthanfavorable. rna Thereleaseofdataforallcountieshasnotbeen authorized

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

Alabama Elmore County Limestone County Arkansas Faulkner County Georgia Walker County Idaho Kootenai County Illinois Coles County Indiana Grant County Kansas Douglas County Saline County Kentucky Campbell County Maryland Wicomico County Michigan Marquette County Minnesota Blue Earth County Clay County Missouri Cape Girardeau County Montana Cascade County Gallatin County

Montana Lewis and Clark County New York Tompkins County North Carolina Burke County Caldwell County Cleveland County Wilkes County North Dakota Grand Forks County Ohio Marion County Pickaway County Washington County Tennessee Hamblen County Maury County Putnam County Sevier County Vermont Rutland County Virginia Henry County West Virginia Berkeley County Putnam County Wisconsin Eau Claire County

nrf Noreport,surveysamplesizefewerthan50.
1 CDC.NationalNotifiableDiseasesSurveillanceSystem,20032007. 2 CDC.BehavioralRiskFactorSurveillanceSystem,20002006.

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SUMMARY MEASURES OF HEALTH

VULNERABLE POPULATIONS

Bradley County, TN
AVERAGE LIFE EXPECTANCY1

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

Vulnerable Populations Include People Who1

ALL CAUSES OF DEATH2

Havenohighschooldiploma(amongadultsage25 andolder) Areunemployed Areseverelyworkdisabled Havemajordepression Arerecentdrugusers(withinpastmonth)

17,431 2,946 3,041 7,287 7,228

nda Nodataavailable.

SELF-RATED HEALTH STATUS3

1 Themostcurrentestimatesofprevalence,obtainedfromvarious

sources(seetheDataSources,Definitions,andNotesfordetails), wereappliedto2008midyearcountypopulationfigures.

ENVIRONMENTAL HEALTH

Bradley County, TN
INFECTIOUS DISEASES1

Cases
E.coli

Reported Expected
4 56 167 5 65 18 313,040 pounds

AVERAGE NUMBER OF UNHEALTHY DAYS IN PAST MONTH3

Salmonella Shigella

TOXIC CHEMICALS RELEASED ANNUALLY2 :

Carbon Nitrogen Sulfur Monoxide Dioxide Dioxide Yes Yes Yes

NATIONAL AIR QUALITY STANDARDS MET BY COUNTY3

Ozone Yes Particulate Matter Yes Lead Yes

nrf Noreport,surveysamplesizefewerthan50. nda Nodataavailable.

1 Murrayetal.,PLoSMedicine2006Vol.3,No.9,e260doi:10.1371/journal.pmed.0030260. 2 NCHS.VitalStatisticsReportingSystem,20012005. 3 CDC.BehavioralRiskFactorSurveillanceSystem,20002006.

Indicatesastatusfavorabletopeers. Indicatesastatuslessthanfavorable.

nda Nodataavailable.
1 CDC.NationalNotifiableDiseasesSurveillanceSystem,20032007. 2 EPA.ToxicReleaseInventory(TRI)ExplorerReport,2008. 3 EPA.AIRSData,2008.

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RELATIVE HEALTH IMPORTANCE

NATIONAL LEADING CAUSES OF DEATH1

Bradley County, TN

Bradley County, TN
UnderAge1 White Black Other Hispanic

Complicationsof Pregnancy/Birth BirthDefects

Ages114

38% 19% nrf nrf nrf 38% nrf nrf nrf 23% 18% 12% nrf nrf nrf 31% 25% 33% 20%

nrf nrf nrf nrf nrf nrf nrf nrf nrf nrf 14% nrf nrf nrf 14% 18% 27% 30% 14%

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

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

PrematureBirths(<37weeks) BirthstoWomenunder18 InfantMortality WhitenonHispanicInfant Mortality NeonatalInfantMortality PostneonatalInfantMortality BreastCancer(Female) CoronaryHeartDisease

Injuries Cancer Homicide

Ages1524
LungCancer MotorVehicleInjuries Stroke

Injuries Homicide Suicide Cancer

Ages2544

Homicide

LowBirthWt.(<2500g) VeryLowBirthWt.(<1500g) BirthstoWomenage4054 BirthstoUnmarriedWomen ColonCancer Suicide UnintentionalInjury

Injuries Cancer HeartDisease Suicide HIV/AIDS Homicide

Ages4564

Cancer HeartDisease
Ages65+

HeartDisease Cancer

The Relative Health Importance table creates four categories of relative concern by simply comparing a county to its peers and to the U.S. A county's indicators in the upper left-hand box ( ) are higher than the U.S. and its peers and may warrant more attention. Conversely, indicators in the lower right-hand box ( ) of the table compare favorably to both peers and the U.S. The other boxes represent intermediate levels of health where a county's rate is higher than either its peers or the U.S., but not both.
nrf Noreport,fewerthan20deathsinrace/ethnicityandagegrouporlessthan10% ofthedeaths. nda Nodataavailable. LocaldataarepresentedfortheNation'stopleadingcausesofdeathineachage group.Columns,withinagecategories,donottotal100%becauseallcausesof deatharenotlisted. Themostcompleteethnicitydataavailablearereported.
1 NCHS.VitalStatisticsReportingSystem,20012005.

Source:MeasuresofBirthandDeathtables,pages67.
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MEASURES OF BIRTH AND DEATH1

Bradley County, TN
CountyPercent/C.I. 8.1 1.0 14.5 4.1 1.1 30.4 cdna (7.4,8.8) (0.7,1.2) (13.6,15.4) (3.6,4.6) (0.8,1.4) (29.2,31.5) (cdna,cdna) PeerCountyRange 6.09.7 0.91.8 9.515.3 1.55.3 1.22.7 25.743.0 cdna BirthMeasures LowBirthWt.(<2500g) VeryLowBirthWt.(<1500g) PrematureBirths(<37weeks) BirthstoWomenunder18 BirthstoWomenage4054 BirthstoUnmarriedWomen NoCareinFirstTrimester2 InfantMortality3 InfantMortality WhitenonHispanicInfantMortality BlacknonHispanicInfantMortality HispanicInfantMortality NeonatalInfantMortality PostneonatalInfantMortality DeathMeasures 4 BreastCancer(Female) ColonCancer CoronaryHeartDisease Homicide LungCancer MotorVehicleInjuries Stroke Suicide UnintentionalInjury U.S. Percent 2005 8.2 1.5 12.7 3.4 2.7 36.9 cdna HealthyPeople 2010Target 5.0 0.9 7.6 Noobjective Noobjective Noobjective 10.0

CountyRate/C.I. 8.8 9.0 nrf nrf 5.0 3.7 (6.5,11.5) (6.6,11.9) (nrf,nrf) (nrf,nrf) (3.4,7.2) (2.3,5.6)

PeerCountyRange 5.09.4 4.49.0 0.022.5 0.017.6 3.06.9 1.13.8

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

CountyRate/C.I. 30.6 16.9 213.3 5.1 61.6 18.2 52.3 9.2 23.4 (24.2,38.3) (13.2,21.3) (199.3,227.3) (3.2,7.7) (54.4,68.8) (14.5,22.6) (45.3,59.2) (6.7,12.4) (18.9,27.9)

PeerCountyRange 18.530.6 15.524.2 97.4215.9 1.07.6 46.175.8 11.324.5 43.972.2 9.420.0 18.532.0

Thetotalnumberofbirthsduringthistimeperiodwas5,941andthetotalnumberofdeathswas4,094. Indicatesastatusfavorabletopeers. Indicatesastatuslessthanfavorable. Noreport,fewerthan500birthsand5events(birthmeasuresandinfant mortality)orfewerthan10events(deathmeasures)occurredduringthe specifiedtimeperiod.

nrf

nda Nodataavailable. cdna Comparabledatanotavailable.

1 NCHS.VitalStatisticsReportingSystem,20012005. 2 Include37states,NewYorkCityandDC(seetheDataSources,Definitions,andNotesfordetails). 3 Infantmortality:deathsper1000livebirths(Neonatal:<28dayspostneonatal:day28tounderoneyear). 4 Ratesareageadjustedtotheyear2000standardper100,000population.

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