Gloucester-Mathews Health Report Analysis

Citizen Health in
Gloucester-Mathews
Derek Gower, 2017 MPP
Candidate at The College of
William & Mary
September 2016 1

Gloucester-Mathews Health Report
• This report presents key findings from the most recent
publicly-available data sources.
• The objective of the data collection is to transform hard
numbers into actionable knowledge.
• The report is intended to facilitate targeted community
dialogues, inform service providers and decision
makers, and serve as a catalyst for collaborative
approaches to health and human service needs.
• The over-arching goal is to reduce disparities and
improve the health of Gloucester-Mathews’ vulnerable
citizens.
2

Demographic Profile: Population
Gloucester-Mathews Population Decreased by 27
from 2010 to 2015
• Gloucester County with an additional 214 accounting for all of the
population growth
• Mathews County with a population decrease of 241 people
accounting for the overall negative population growth 3
Region
Population
in 2010
Population
in 2015
Percent
Change
Avg. Yearly
Growth
Numerical
Change
United States 308,745,538 321,418,820 3.62% 0.72% 12,673,282
Virginia 8,001,024 8,382,993 4.80% 0.96% 381,969
Gloucester-
Mathews
45,836 45,809 -0.06% -0.01% -27
Gloucester
County
36,858 37,072 0.58% 0.12% 214
Mathews County 8,978 8,737 -2.68% -0.54% -241
Source: U.S. Census Bureau, 2010-2014 American Community Survey 5-year Estimates

Demographic Profile: Age
• 18.5% of Gloucester-Mathews’ population is under age 18 (9,094 children)
• 58.5% of Gloucester-Mathews’ population is between the ages of 18 and 64
(27,887 individuals)
• 23.0% of Gloucester-Mathews’ population is over age 65 (8,996 older adults)
4
United States Virginia
Gloucester-
Mathews
Under 18 years 23.3% 22.6% 18.5%
18 to 64 years 62.6% 64.1% 58.5%
65 years and over 14.1% 13.4% 23.0%
23.3% 22.6%
18.5%
62.6% 64.1%
58.5%
14.1% 13.4%
23.0%
0%
10%
20%
30%
40%
50%
60%
70%
PercentofthePopulation
Age Group

Demographic Profile: Population Projections
• Gloucester County’s population is projected to increase by 12.9% by 2040
(6323 individuals)
• Mathews County’s population is projected to increase by 8.43% by 2040 (783
individuals) 5
Source: U.S. Census Bureau Projections; Weldon Cooper Center for Public Service, 2016.
2020 2030 2040
Gloucester-Mathews 48,966 52,201 55,289
Gloucester County 39,681 42,520 45,222
Mathews County 9,284 9,680 10,067
48,966
55,289
39,681
45,222
9,284 10,067
0
10,000
20,000
30,000
40,000
50,000
60,000
PopulationCount
Population Projections for Gloucester-Mathews
2020, 2030, and 2040

Demographic Profile: Race and Ethnicity
• Gloucester-Mathews has a much larger percentage of the population identify8ing as
white at 87.8%.
• The next largest racial group in Gloucester-Mathews are Blacks at 9.0% of the
population, and then the ethnicity Latino (all races) at 2.0%. 6
United States Virginia
Gloucester-
Mathews
White 78.4% 71.6% 87.8%
Black 13.0% 19.7% 9.0%
Asian 4.9% 5.6% 0.4%
Two or More Races 2.3% 2.5% 0.4%
Latino (All Races) 16.4% 7.9% 2.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PERCENTOFTHEPOPULATION
Race and Ethnicity of Gloucester-Mathews

Health Profile
• Years of Potential Life Lost (YPLL)
• Mortality Profile for Cancer
• Racial Disparities in Health Outcomes
• Prevention Quality Indicators (PQI)
7

Length of Life: Years of Potential Life Lost (YPLL)
8
Source: County Health Rankings & Roadmaps (2011-2013), 2016
Age-Adjusted Mortality
Virginia 315
Gloucester-Mathews 309.2
Gloucester County 343
Mathews County 275
0
50
100
150
200
250
300
350
400
TotalYearsofPotentialLifeLost
(Age-adjustedper100,000ofthepop.)
Total Years of Potential Life Lost (2013)

Cancer Mortality Profile
9
Source: Virginia Atlas of Community Health (2008-2012), 2013
171.2
22.7
14.9
48.2
2.9 7.9
22.4
177.3
14.4 17.1
55.7
2.3
12
30
0
20
40
60
80
100
120
140
160
180
200
All Cancers Breast
Cancer
(Female
Only)
Colorectal
Cancer
Lung and
Bronchus
Cancer
Melanoma Ovarian
Cancer
Prostate
Cancer
Age-adjustedCancerDeathRatesper100,000
ofthepopulation Cancer Death Rates (2008-2012)
Virginia
Gloucester-Mathews

Disparities in Health Outcomes
10
Source: Virginia Department of Health: All Cancer Deaths (2008-
2012), 2013
VIRGINIA Gloucester-Mathews
All Races* 171.2 177.3
White 168.2 172.4
Black 203.7 202.7
0
50
100
150
200
250
CancerDeathRatePer100,00People Cancer Death Rate (2008-2012) by Race

Quality of Care: Prevention Quality Indicators (PQI)
• Top 3 PQI Discharges in Gloucester-Mathews are Congestive Heart
Failure, Bacterial Pneumonia, and Urinary Tract Infection
11
PQI Discharges
(per 100,000)
Virginia Gloucester-
Mathews
Gloucester
County
Mathews
County
Total 88,401
(1040.9)
1,276 893
(1067.8)
352
(988.3)
Asthma in Younger Adults 1,121 6 4 2
Angina 661 12 7 5
Bacterial Pneumonia 15,720 145 112 33
COPD or Asthma in Older
Adults
15,997 108 89 19
Congestive Heart Failure 20,006 146 105 41
Dehydration 7,422 38 25 13
Diabetes 12,210 54 49 5
Hypertension 3,299 16 14 2
Perforated Appendix 1,139 11 9 2
Urinary Tract Infection 10,826 67 53 14
Source: Virginia Atlas of Community Health 2013 Report

Health Risk Profile
• Chronic Disease Population
• Unhealthy Behaviors
• Physical Health
• Behavioral Health
• Access to Care
• Preventive Screening
• Racial Disparities in Preventive Screening
12

Chronic Disease Population
13
Diagnosis # Adults
(18+)
% Virginia
Population
% Gloucester-
Mathews
Population
Gloucester-
Mathews Adult
Health Risk (# out of
10 residents)
Arthritis 9,012 24% 25%
Asthma/COPD 2,907 8% 8%
Diabetes 3,488 9% 9%
High Blood
Pressure
11,192 30% 31%
High
Cholesterol
13,082 35% 36%
Obesity 13,793 27% 30%
Source: Virginia Atlas of Community Health 2013 Report; County Health Rankings 2016

Health Risk Profile: Unhealthy Behaviors
14
Health Risk # Adults (18+) % Virginia
Population
% Gloucester-
Mathews
Population
Gloucester-
Mathews Adult
Health Risk (#
out of 10
residents)
Smoking 7,631 19.5% 19.5%
Excessive
Drinking
6,977 17.0% 18.0%
Overweight or
Obese
23,183 62.0% 65.0%
Source: Virginia Atlas of Community Health 2013 Report

Health Risk Profile: Physical Health Status
15
Health Risk # Gloucester-
Mathews
Adults (18+)
% Virginia
Population
% Gloucester-
Mathews
Population
Gloucester-
Mathews Adult
Health Risk (#
out of 10
residents)
Reported
Being in Poor
or Fair Health
5,741 17.0% 16.0%
Not meeting
recommended
physical
activity
18,604 47.0% 51.5%
Did not eat
recommended
servings of
fruits or
vegetables
29,360 80.0% 79.0%
Sources: County Health Rankings 2016 Report; Virginia Atlas of
Community Health 2013 Report

Health Risk Profile: Behavioral Health
16
Health Risk # Adults
(18+)
% Virginia
Population
%
Gloucester-
Mathews
Population
Gloucester-
Mathews Adult
Health Risk (# out
of 10 residents)
Frequent
Behavioral
Distress
4,230 11.0% 9.0%
Limited in their
activities
because of
health problems
7,776 19.0% 22.0%
Insufficient
Sleep
14,624 36.0% 31.8%
Source: County Health Rankings 2016 Report; Virginia Atlas of Community Health
2013 Report

Adult Health Risk Profile: Access to Healthcare
17
Health Risk # Adults (18+) % Virginia
Population
% Gloucester-
Mathews
Population
Gloucester-
Mathews Adult
Health Risk (#
out of 10
residents)
Adults with
no dental
visit in the
last year
7,922 22.0% 21.5%
Frequent
Physical
Distress
4,138 11.0% 9.0%
Cannot
afford to visit
doctor when
needed
4,579 10.0% 13.5%
Source: County Health Rankings 2016 Report; Virginia Atlas of Community Health
2013 Report

Preventive Screening
18
Health Issue # of Adults (18+) % Virginia
Population
% Gloucester-
Mathews
Population
Gloucester-
Mathews Adult
Health Risk (#
out of 10
residents)
Females (40+)
Did not have a
mammogram*
2,514 28.0% 29.0%
Men (40+) No
PSA test*
5,931 44.0% 44.5%
Adults (50+)
No blood
stool test*
14,508 82.0% 81.0%
* = In the last two years
Source: Dartmouth Atlas of Health Care 2013

Disparities in Preventive Screening
19
Source: Dartmouth Atlas of Health Care 2012 Estimates
90.6 90.8 90.4
82.0
85.5
78.6
91.8 91.4
92.1
70
75
80
85
90
95
Gloucester-Mathews Gloucester County Mathews County
PERCENTOFTHEDIABETICMEDICARE
POPULATION Average Annual Percentage of Diabetic Medicare Enrollees
(age 65-75) having hbA1c Tests by Race
Overall Black White

20
76.5
75.9
77.2
69.5
71.1
67.9
77.5
76.5
78.5
62
64
66
68
70
72
74
76
78
80
PercentofDiabeticMedicarePopulation
Average Annual Percentage of Diabetic Medicare
Enrollees (age 65-75) having Eye Examinations by Race
Overall Black White

21
84.9 84.4 85.4
71.2 71.1 71.4
86.7 86.0 87.4
0
10
20
30
40
50
60
70
80
90
100
PercentoftheDiabeticMedicarePopulation
Average Annual Percentage of Diabetic Medicare Enrollees
(age 65-75) having LDL-C Tests by Race
Overall Black White

Disparities in Ambulatory Visits to Primary Care
22
88.2
87.2
89.2
87.1
83.2
91.0
88.3
87.5
89.1
78
80
82
84
86
88
90
92
PercentoftheDiabeticMedicarePopulation
Medicare Enrollees having at least one Ambulatory Visit to
Primary Care within first year by Race
Overall Black White

Socio-Economic Determinants
of Health
23
• Unemployment and Poverty
• Medicaid Enrollment
• SNAP
• TANF
• Potential Medicaid Enrollees

Unemployment
• In 2015, the percent Gloucester-Mathews working population that was
unemployed stood at 4.1% (957 people)
24
Source: Virginia Department of Social Services Profile Report, SFY 2015
0%
1%
2%
3%
4%
5%
6%
7%
8%
PercentUnemployed Unemployment Rate 2000 to 2015
Virginia Gloucester-Mathews
Gloucester County Mathews County

Poverty
• In 2014, 4,466 (7.6%) people in Gloucester-Mathews lived in poverty
25
0%
2%
4%
6%
8%
10%
12%
14%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Percent of People Living in Poverty 2004-2014
Virginia Gloucester-Mathews Gloucester County Mathews County

Child Poverty
• In 2014, 16.6% of children (1,404) in Gloucester-Mathews were living in
poverty
• Mathews County had the largest percentage of children living in poverty at
18.0% (265 children), then Gloucester County at 15.2% (1,139 children) 26
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
PercentofChildrenLivinginPoverty Children Living in Poverty from 2004 to 2014
Virginia Gloucester-Mathews
Gloucester County Mathews County

Medicaid Enrollment
• In 2015, 10.5% (4,821 residents) of Gloucester-Mathews were enrolled in
Medicaid
• The Mathews County had the largest percent of Medicaid recipients at 15.3%
(1,352) and Gloucester County at 9.3% (4,821) compared to Virginia at 12.2%.
27
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
2010 2011 2012 2013 2014 2015
PercentofthePopulatoin
Medicaid Enrollment Rate from 2010 to 2015

SNAP Enrollment
• In 2015, 8.9% (4,079 residents) of Gloucester-Mathews were enrolled in SNAP
compared to Virginia at 10.4%
• Mathews County had the highest percent of SNAP recipients at 15.4% (1,360),
then Gloucester County at 7.3% (2,719)
28
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
2010 2011 2012 2013 2014 2015
SNAP Recipients as a Percent of the Population

TANF Enrollment
• In 2015, .6% (275 residents) of the Gloucester-Mathews population were
enrolled in TANF compared to Virginia at .63%
• Mathews County has the largest percentage of TANF recipients at 0.9% (81),
then Gloucester County at .5% (194)
29
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
1.6%
2005 2006 2007 2008 2009 2010
TANF as a Percent of the Population

Number of Uninsured by Age Group and Income (2014)
30
Indicator
Gloucester-
Mathews
Gloucester
County
Mathews
County
Uninsured Children under age 19 <
200% of the FPL
306
(11.1%)
260
(9.4%)
46
(12.8%)
Uninsured Adults between ages 18
and 64 < 138% of the FPL
1,548
(39.3%)
1,235
(38.1%)
313
(40.4%)
Uninsured People under 65 and
between 138%-400% of the FPL
2,685
(16.9%)
2,201
(16.1%)
484
(17.6%)
Total Uninsured under 65
Population
5,296
(14.9%)
4,286
(14.1%)
1,010
(15.7%)
Source: U.S. Census Bureau Small Area Health Insurance Estimates (SAHIE), 2015

Uninsured Children Eligible for CHIP/FAMIS
• In 2014, 11.1% of uninsured children (306) were eligible for CHIP/FAMIS
31
306 (11.1%)
260 (9.4%)
46 (12.8%)
0
50
100
150
200
250
300
350
NumberofUninsuredChildren
Uninsured Children from Household Below 200%
of the Federal Poverty Level (FPL)
Gloucester-Mathews Gloucester Mathews

Uninsured Adults Eligible under Medicaid Expansion
• If Medicaid were expanded, 39.3% (1,548) of uninsured adults would be
eligible for enrollment
32
1548 (39.3%)
1235 (38.1%)
313 (40.4%)
0
200
400
600
800
1000
1200
1400
1600
1800
NumberofUninsuredAdults
Uninsured Adults (18 to 64) with Incomes Below
138% of the FPL

Uninsured Eligible for Subsides on the Exchange
• In 2014, 51.6% (2,685 residents) were eligible for Subsidies on the Exchange
33
2685 (16.9%)
2201 (16.1%)
484 (17.6%)
0
500
1000
1500
2000
2500
3000
NumberofUninsuredPeople
Uninsured People (under age 65) with Incomes
between 138% and 400% of the FPL

Healthcare Reform and The Uninsured
34
If Medicaid is expanded and every eligible person enrolled,
and those eligible for subsidies purchased on the Exchange,
the number of uninsured could be reduced by as much as
4,539—or 85.7% of the uninsured population.
• 5,296 non-elderly adults are uninsured— 14.9% of that
population
• 1,548 uninsured adults would become eligible if Virginia
expanded Medicaid— 39.3% of non-elderly uninsured
• 306 children are eligible for CHIP/FAMIS, but not enrolled
— 11.1% of the non-elderly uninsured.
• 2,685 non-elderly uninsured are eligible for subsidized
coverage on the Exchange – 51.6% of that population

 "American Community Survey." 2014 Data Profiles. U.S. Census Bureau, 2014. Web. 06 Aug.
2016. https://www.census.gov/acs/www/data/data-tables-and-tools/data-profiles/2014/.
 Buettgens, Matthew, and Genevieve Kenney. “Changes in Eligibility" Urban Institute 0th ser.
16.5 (2016): 426-27. Urban Institute. Robert Wood Johnson Foundation, 01 July 2016. Web. 8 Aug.
2016. http://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000866-What-if-More-
States-Expanded-Medicaid-in-2017-Changes-in-Eligibility-Enrollment-and-the-Uninsured.pdf.
 "Community Health Status Indicators (CHSI 2015)." Community Health Status Indicators.
Robert Wood Johnson Foundation, 01 Jan. 2016. Web. 08 Aug. 2016.
http://wwwn.cdc.gov/CommunityHealth/.
 “Williamsburg Health Foundation.” Citizen Health in Greater Williamsburg. Aug. 2016
www.williamsburghealthfoundation.org/
 Dall, Timothy M. "Health Affairs." The Economic Burden Of Diabetes. Health Affairs, 10 Jan.
2010. Web. 06 Aug. 2016. http://content.healthaffairs.org/content/29/2/297.short
 Doykos, Patrick Mae. "Striving For Equity In Access To And Use Of Specialty Care." Health
Affairs. The People to People Health Foundation, Inc., 1 Aug. 2016. Web. 06 Aug. 2016.
http://healthaffairs.org/blog/2016/08/01/striving-for-equity-in-access-and-use-of-specialty-care/
 Knickman, James, and Kelly Hunt. "Good And Bad News For Diabetes Prevention In The
Community." Health Affairs. Health Affairs, 25 Mar. 2015. Web. 06 Aug. 2016.
36
Sources

 Mahon, Mary. "New Commonwealth Fund Report: Low-Income ACA Marketplace Enrollees
See Higher Out-Of-Pocket Costs and Fewer Benefits in States Without Medicaid Expansion." -
The Commonwealth Fund. The Commonwealth Fund, 15 June 2016. Web. 06 Aug. 2016.
http://www.commonwealthfund.org/publications/press-releases/2016/jun/low-income-aca-
marketplace-enrollees-see-higher-out-of-pocket-costs
 "Small Area Health Insurance Estimates (SAHIE)." Model-based Small Area Health Insurance
Estimates (SAHIE) for Counties and States. U.S. Department of Commerce, 01 Aug. 2015. Web. 08
Aug. 2016. https://www.census.gov/did/www/sahie/
 "Understanding of the Efficiency and Effectiveness of the Health Care System." Dartmouth
Atlas of Health Care. Dartmouth College, 01 Jan. 2012. Web. 08 Aug. 2016.
http://www.dartmouthatlas.org/
 "VA Health Insurance." The Virginia Atlas of Community Health. Virginia Health Care
Foundation, 1 Jan. 2016. Web. 8 Aug. 2016. http://www.vhcf.org/data/
 “Virginia Department of Social Services." Home. VDSS, 01 Aug. 2015. Web. 08 Aug. 2016.
http://www.dss.virginia.gov/
 "Virginia's Home For Cost, Quality, and Efficiency Healthcare Information." Virginia Health
Information: Health Insurance, Hospitals, Nursing, and Physicians. VHI, 08 Aug. 2016. Web. 08 Aug.
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estimates
37
Sources

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Editor's Notes