Community Health Needs Assessment Community Dialogue

Community Health Needs AssessmentCommunity Dialogue

“Realizing Maine’s Health”

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ANDROSCOGGIN, FRANKLIN AND OXFORD COUNTIES COMPARISON

Community Health Needs Assessment Report

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Access To CareMEASURE Andro. Frank. Oxford MAINE

% Without Usual Source of Primary Care (Male) 18% 18% 16% 18%

% Not Having Checkup Within the Past 2 years (Male) 12% 18% 17% 15%

% Without Usual Source of Primary Care (Female) 5.7% 9.2% 12% 8%

% Not Having Checkup Within the Past 2 years (Female) 5.5% 6.4% 6.6% 6.4%

% No Dental Visit in Past 2 Years (Male & Female) 27% 24% 34% 24%

ED Visits per 100,000 Population 57,097 41,596 52,871 47,665

ED Visits per 100,000 Population Ages 65+ 48,645 46,089 55,633 49,497

Hospitalizations per 100,000 Population 12,920 12,044 12,484 12,076

Hospitalizations per 100,000 Population Ages 65+ 28,349 33,240 31,433 31,396

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Cardiovascular Health

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Respiratory HealthMEASURE Andro. Frank. Oxford MAINE

% Current Smokers (MALE) 20% 20% 29% 23%

% Current Smokers (FEMALE) 20% 19% 20% 20%

% Former Smokers (MALE & FEMALE) 32% 36% 30% 31%

% Current Smokers Advised to Quit in the Past Year 71% 58% 72% 72%

% Current Smokers Tried to Quit in Past Year 52% 42% 61% 54%

% Current Smokers That Have Used Maine Tobacco Quit Line 21% 21% 22% 19%

MEASURE Andro. Frank. Oxford MAINE

% Current Asthma (Ages 18+) 12% 9.4% 11% 10%

% Ever Asthma (Ages 0-17) 10% 3.0% 6.9% 6.1%

Bronchitis and Asthma, Hospital Admission Rate 127 94 87 87

Age 65+ 84 47 100 114

Bronchitis and Asthma, ED Visit Rate 1,064 544 987 988

Age 65+ 435 221 559 6325

Respiratory HealthMEASURE Andro. Frank. Oxford MAINE

% COPD 4.3% 2.5% 6.7% 4.2%

COPD, Hospital Admission Rate 307 502 401 284

COPD, ED Visit Rate 1,264 754 1,306 998

Age 65+ 1,870 1,769 2,531 1,914


Pneumonia, Hospital Admission Rate 299 349 465 326

Age 65+ 1,255 1,653 2,105 1,402

Pneumonia, ED Visit Rate 506 232 531 505

Age 65+ 747 500 1,235 1,503

Emphysema, Hospital Admission Rate 12 24 26 23

Age 65+ 35 105 100 79

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Respiratory Health


Lung Cancer, Mortality Rate (MALES) 73 104 88 78

Lung Cancer, Mortality Rate (FEMALE) 59 69 73 61

COPD, Mortality Rate (MALE & FEMALE AGE 65+) 436 435 406 332

Pneumonia, Mortality Rate (MALE & FEMALE AGE 65+) 79 109 89 103

Smoking-Related Neoplasms, Mortality Rate (MALES) 191 243 254 205

Smoking-Related Neoplasms, Mortality Rate (FEMALES) 141 167 163 150

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Cancer HealthIncidence Rates

MEASUREMENT Andro. Frank. Oxford MAINE

All Cancers, Incidence Rate 585 251 684 629

Bladder, Incidence Rate 35 1.1 40 35

Female Breast Cancer, Incidence Rate 141 20 178 162

Female Cervix Uteri, Incidence Race 7.9 2.2 3.5 7.3

Colorectal, Incidence Rate 57 26 69 62

Lung and Bronchus Cancer, Incidence Rate 93 86 107 95

Melanoma, Incidence Rate 25 1.1 24 26

Male Prostate Cancer, Incidence Rate 169 25 184 187

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Cancer HealthMEASUREMENT Andro. Frank. Oxford MAINE

Female Breast Cancer, Incidence Rate 141 156 178 162

% Reported Mammogram Past Year (40+) 69% 74% 70% 69%

% Stage Female Breast, Local 68% 71% 67% 66%

% Stage Female Breast, Distant 4.3% 9.7% 3.2% 3.8%

Female Breast Cancer, Mortality Rate 24 20 38 28


Female Cervix Uteri, Incidence Race 7.9 8.7 3.5 7.3

% Reported PAP Smear past 2 Years 67% 72% 68% 70%

% Stage Cervix Uteri Female, Local 46% 25% 100% 52%

% Stage Cervix Uteri Female, Distant 18% 25% 0% 14%

Female Cervix Uteri, Mortality Rate 2.4 2.2 2.3 2.5

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Colorectal, Incidence Rate 57 72 69 62

% Reported Blood Stool Test Past Year (Age 50+) 23% 25% 27% 20%

% Reported Having Sigmoid/Colonoscopy Past 5 Years (Age 50+) 67% 59% 61% 63%

% Stage Colorectal, Local 47% 41% 28% 47%

% Stage Colorectal, Distant 18% 14% 36% 17%

Colorectal, Mortality Rate 17 26 24 21


Lung and Bronchus Cancer, Incidence Rate 93 83 107 95

% Stage Lung and Bronchus Male, Local 17% 15% 16% 16%

% Stage Lung and Bronchus Male, Distant 55% 51% 51% 50%

% Stage Lung and Bronchus Female, Local 20% 30% 18% 21%

% Stage Lung and Bronchus Female, Distant 50% 52% 58% 47%

Lung, Mortality Rate 66 86 80 6910


Male Prostate, Incidence Rate 169 176 184 187

% Reported Prostate Exam (PSA) Past 2 Years (MALES Age 50+) 32% 29% 35% 36%

% Reported Digital Rectal (PSA) Past 2 Years (MALES Age 50+) 71% 57% 66% 68%

% Stage Prostate, Local 84% 74% 28% 76%

% Stage Prostate, Distant 4.5% 1.3% 36% 3.8%

Male Prostate, Mortality Rate 20 25 17 23


All Cancers, Incidence Rate 585 609 684 629

All Cancers, Mortality Rate 216 251 277 234

Bladder, Incidence Rate 35 41 40 35

Bladder, Morality Rate 10 1.1 9.4 7.5

Melanoma, Incidence Rate 25 15 24 26

Melanoma, Mortality Rate 4.0 1.1 1.8 3.611

Diabetes Health

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Diabetes Health

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Diabetes Health

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Pediatric Health

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Pediatric Health

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Pediatric Health

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ANDROSCOGGIN COUNTYCommunity Health Needs Assessment Report

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County Risk Factors

Healthcare Challenges• Overweight/Obesity: Low

percentage of adults with regular physical activity. (22%)

• High percentage with no dental visit in past two years. (27%)

• Highest percentage reporting street drug use. (7.%)

• Highest teen birth rate of any county

Healthcare Assets• Lowest percentage of

unmet medical needs due to cost. (4.9%)

• Low percentage of uninsured adults. (10%)

• Highest percentage of daily aspirin use among adults Age 35+. (41%)

• Low percentage of male smokers. (20%)

• Low rate of chronic heavy drinking. (5.5%)

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County Disease Incidence & PrevalenceHealthcare Challenges

• High Prevalence of Heart Disese. (7.3%)• 2nd Highest Prevalence of Hypercholestemia. (34%)• High Prevalence of Adults and Youths with Asthma (12%)• High Diabetes prevalence among 45 – 64 year olds. (16%)• 2nd Lowest A1c measurement annually among diabetics. (77%)• Highest incidence of Hepatitis C and Chlamydia.

Healthcare Assets

• Low incidence of female breast cancer.

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County Risk Hospital Utilization & Mortality Rates

Healthcare Challenges• High rates of overall hospitalizations and ambulatory care

sensitive condition hospitalizations for Ages 0 – 64.• High rates of admissions for Congestive Heart Failure and

CABG.• Highest hospital admissions for most mental health

conditions and substance abuse conditions.• High rates of overall ED visits and ACSC ED visits for Ages 0 -

64.• High rates of ED Visits for respiratory disease including COPD,

Bronchitis/Asthma and Pneumonia.• Highest rates of ED use for bipolar disorder, anxiety, and

acute drug related mental disorders21


Healthcare Challenges• High COPD mortality rate.• High mortality rates for bladder cancer.• High mortality rates for females with smoking related

neoplasms.

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Healthcare Assets• Low hospital admissions and ED rates overall for 65+.• Low hospital admission rates for AMI and Emphysema.• Low hospital admission rates for schizophrenia and anxiety.• Low ED visits for alcohol and drug related psychoses.• Low mortality rates for female breast, colorectal, and male

prostate cancers.• Low motor vehicle accident mortality rate.

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ANDROSCOGGIN COUNTY2011 County Health Rankings

A Report Produced by the Robert Wood Johnson Foundation and the University of Wisconsin

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MEASURE Ranking Rate Maine Best Maine County

90th% of US

Health Outcomes 12

Mortality 14

Premature Death (Years of Potential Life Lost before Age 75) 7368 6575 5618 5564

Morbidity 13

Poor to Fair Health (% of adults) 14% 13% 10% 10%

Poor Physical Health Days (Mean) 3.8 3.6 3.1 2.6

Poor Mental Health Days (Mean) 3.7 3.6 3.0 2.3

Live Births with Low Birthweight (% < 2500 grams) 6.8% 6.5% 5.2% 6.0%

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90th% of US

Health Factors 12

Health Behaviors 13

Current Smokers (% of Adults) 22% 20% 16% 15%

Obesity (% of Adults with BMI >30) 31% 26% 21% 25%

ALCOHOL USE

Excessive Drinking in Past 30 days (% of Adults) 19% 17% 13% 8%

Motor Vehicle Crash Death Rate Per 1,000 Pop. 13 15 10 12

HIGH RISK SEXUAL BEHAVIORS

Chlamydia Rate Per 100,000 Pop. 307 198 89 83

Teen Birth Rate Per 1,000 Females Ages 15 - 19 40 26 17 22

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90th% of US

Health Factors 12

Clinical Care 4

ACCESS TO CARE

% of Uninsured Adults Ages 18 - 64 10% 12% 10% 13%

Population-to-PCP Ratio 709:1 694:1 474:1 631:1

QUALITY OF CARE

Preventable Hospital Stays Per 1,000 Medicare Enrollees 62 64 48 52

Diabetic Screening: % of Medicare Enrollees who had an A1c Test

Conducted90% 88% 91% 89%

% of Female Medicare Enrollees who received a mammogram 74% 72% 80% 74%

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90th% of US

Health Factors 12

Socio-Economic Factors 11

EDUCATION

High School Graduation (% in 2007) 75% 79% 90% 92%

% of 25 – 44 Years Old with Some level of post-secondary education 52% 59% 70% 68%

Unemployment Rate in 2009 8.4% 8.0% 6.4% 5.3%

Income: Children in Poverty in 2008 18% 17% 12% 11%

FAMILY & SOCIAL SUPPORT

Adults Reporting no Socio-Economic Support 19% 17% 15% 14%

Single-parent Households 35% 31% 25% 20%

Community Safety: Violent Crimes per 100,000 Population 143 118 48 10028


90th% of US

Health Factors 12

Physical Environment 14

Air Pollution – Ozone Days 1 0 0 0

Air Pollution – Particulate Matter Days 1 0 0 0

Percent Zip Codes with Access to Healthy Foods 40% 47% 75% 92%

Access to Recreational Facilities Per 100,000 Population 15 14 22 17

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FRANKLIN COUNTYCommunity Health Needs Assessment Report

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County Risk Factors

• High percentage of uninsured adults. (15%)• High percentage with no medical check-up in past 2 years. (12%)• High percentage reporting unmet medical needs due to cost.

(7.3%)• High percentage of former smokes. (36%)• Lowest percentage of current smokers reporting being advised

to quit within the last year. (58%)• Lowest percentage of current smokers who have attempted to

quit within the last year. (42%)

Healthcare Challenges

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County Risk Factors

• Low percentage reporting flu shot or mist in past year. (35%)• Low percentage reporting blood stool test, prostate exam (PSA),

or digital rectal screening.• High teen birth rate.• High percentage with report of past month alcohol use by

youths. (40%)• High percentage with report of past month marijuana use.

(28%)

Healthcare Challenges

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County Risk Factors

• 2nd highest county reporting regular physical activity. (30%)• Lowest rate of chronic heavy drinking. (4.0%)• Low percentage reporting current substance abuse problem.

(0.7%)• Low percentage reporting use of street drugs. (4.3%)• Low percentage reporting abuse of prescription medications.

(1.0%)• Lowest percentage of youth reporting suicide ideation. (11%)• Lowest percentage of youth current smokers. (17%)• Highest percentage of youth reporting regular physical activity.

(50%)

Healthcare Assets

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• High incidence of bladder, cervical and colorectal cancers.

• Low receipt of eye and foot examinations by diabetics.

• Low participation in diabetes self management courses by diabetics.

• High percentage at risk for clinical depression. (9.2%)

• Highest percentage reporting being diagnosed with psychiatric disorder other than depression. (15%)

Healthcare Assets• Low prevalence of heart

disease. (3.8%)• Low percentage of ever

being diagnosed with COPD. (2.5%)

• Low incidence of lung cancer, particularly among females.

• Low incidence of melanoma.

• Low report of unmet mental health needs. (3.9%)

• Low rates of STD/STIs.34


Healthcare Challenges• High rates of hospitalizations for ambulatory care sensitive

conditions.• High rates of hospital admissions for CHF, CABG, and COPD.• 2nd highest rate of hospital admissions for asthma/bronchitis

among Ages 0 – 17.• 2nd highest rate of hospital admissions for diabetes among

Ages 18 – 44.• High rate of hospital admissions for hip procedures and

head/brain injury in Ages 65+

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Healthcare Challenges• High mortality rates for cardiovascular disease including AMI.• High mortality rates for all respiratory disease including lung

cancer.• High mortality rates for colorectal cancer.• 2nd highest mortality rate for diabetes.• High suicide mortality rate.• High alcohol related mortality including liver disease.• High motor vehicle accident mortality.

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Healthcare Assets• Low rates of overall ED visits and ACSC ED visits.• Low ED visit rates for respiratory disease.• Low hospital admission and ED visits for all mental health

disorders among all age groups.• Low hospital admission and ED visits for substance abuse

diagnoses among all age groups.• Low mortality rates for:

– Bladder cancer– Breast cancer– Cervical cancer– Melanomas

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FRANKLIN COUNTY2011 County Health Rankings


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90th% of US

Health Outcomes 2

Mortality 1


Morbidity 3





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90th% of US

Health Factors 8

Health Behaviors 3



ALCOHOL USE






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90th% of US

Health Factors 8

Clinical Care 3

ACCESS TO CARE



QUALITY OF CARE



Conducted88% 88% 91% 89%


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90th% of US

Health Factors 8


EDUCATION










90th% of US

Health Factors 8






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OXFORD COUNTYCommunity Health Needs Assessment Report

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County Risk FactorsHealthcare Challenges

• Access to Care:– High percentage of nonelderly adults (Ages 18 – 64) who are

uninsured. (18%)– Highest percentage of females with no usual source of medical care.

(12%)– High percentage reporting unmet medical needs in past year due to

cost. (9%)– High percentage with no dental visit in the past 2 years. (34%)

• Health Status:– High percentage report health as “fair to poor”. (23%)– High percentage report 11 or more days lost in past month due to

poor health. (11%)– High percentage with 3+ chronic conditions. (17%)

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• Overweight/Obesity:– High percentage with sedentary lifestyle. (24%)– High percentage with obesity. (33%)

• Smoking:– High percentage of current smokers. (25%)

• Interpersonal Violence:– High percentage of respondents report experiencing interpersonal

violence during lifetime. (15%)

• Alcohol and Substance Abuse:– High percentage of chronic heavy drinking. (8%)– Higher percentage report use of street drugs in past 30 days. (7%)– High percentage report of a household overdose in past year. (1.5%)

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• Youth– High percentage of youth population used smokeless tobacco oevr the

past month. (11%)– Low percentage report regular physical activity. (34%)– High percentage of youth are overweight. (17%)– High percentage of youth are obese. (16%)

Healthcare Assets• High percentage of smokers report having tried to qui in past year.

(61%)• High percentage of elderly females report having received

pneumococcal vaccination. (87%)• Low percentage of reported prescription medication misuse. (0.9%)• Low teen birth rate. 47


• High prevalence of COPD and youth Asthma. (6.7%, 7%)• High percentage reporting having been diagnosed with cancer

in lifetime. (9.3%)• High incidence of lung cancer among males.• High incidence of bladder and colorectal cancers.• High prevalence of diabetes. (12%)• High incidence of Hepatitis C and Gonorrhea.• High percentage with unmet mental health needs. (6%)

Healthcare Assets• Low incidence of female cervical cancer.

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Healthcare Challenges• Hospital Admissions:

– High hospitalization rates for respiratory disease including COPD, pneumonia, emphysema and bronchitis/asthma.

– High hospitalization rates for drug related psychoses, high risk pregnancy complications, hip procedures and head/brain injuries.

• Emergency Department Utilization:– High overall ED utilization.– High ED rates for bronchitis/asthma among ages 0 – 17 and COPD.

• High Mortality Rates for:– Stroke, COPD, diabetes, cancer.– High mortality rates among females for suicide and motor vehicle

accidents.– High morality rates for smoking neoplasms among males.

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Healthcare Assets• Low hospital admission rates for ambulatory care sensitive

conditions for Ages 0 – 44.• Low hospitalization rates for cardiovascular disease including

CHF, AMI and stroke.• How hospitalization for bronchitis/asthma among pediatrics.• Low hospitalization rate for mental health diagnosis.• Low mortality rate for AMI.• Low mortality rates for melanoma and prostate cancers.• Low infant mortality rates.

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OXFORD COUNTY2011 County Health Rankings


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90th% of US

Health Outcomes 16

Mortality 15


Morbidity 15





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90th% of US

Health Factors 13

Health Behaviors 12



ALCOHOL USE






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90th% of US

Health Factors 13

Clinical Care 11

ACCESS TO CARE



QUALITY OF CARE



Conducted90% 88% 91% 89%


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90th% of US

Health Factors 13


EDUCATION










90th% of US

Health Factors 13






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Community Health Needs Assessment Community Dialogue

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