How Healthy are Rural
Minnesotans?
A Regional Approach
Jim Root, Vice President of HR, Saint Elizabeth’s Medical
Center
Paul Jansen, M.P.H., Minnesota Department of Health
Nancy Stratman, R.N., Cokato Charitable Trust & Manor
1
Image courtesy of Derek Bakken
Purpose:
• Summarize statewide health statistics
• Identify regional health disparities
Audience:
• Rural health care providers
• Local public health officials
• Concerned community members
• Policymakers
Focus:
• Key health issues for rural Minnesotans
2
Contents
•
•
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•
•
•
•
•
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What is Rural?
Regional Profiles
Overall Health Status
Health Access
Behavioral Health
Disease
Injury
Aging Populations
Conclusion
3
What is rural???
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Image courtesy of John Brian McCarthy
That depends on context
In Minnesota it’s usually
7 County Metro
vs. Greater Minnesota
X
5
But 62% of the people in
Greater Minnesota live in
large rural or urban areas.
6
Duluth
7
Image courtesy of Indiefox
St. Cloud
8
Image courtesy of mity102181
38% of people live in small
or isolated rural areas
9
Flom
10
Image courtesy of Andrew Filer
Granite Falls
11
Image courtesy of jpellgen
Rural Urban
Commuting
Areas
(RUCAs)
12
Minnesota
DEED
Planning
Regions
13
Regional Profiles
14
• The Northwest and Southwest are the most rural regions
• The Central and Northeast also have substantial rural
populations
• The Southeast and Metro are the least rural
15
Regions as Measures of Rurality
• Not perfect, but better than Greater Minnesota vs.
Metro
• Each region is unique
• Northwest and Southwest are most rural
• Central and Northeast are mixed and unique
• Southeast is mostly large rural or urban
• Metro is 100% Urban
16
Northwest
•
•
•
•
•
•
66% small or isolated rural
4% American Indian/Alaskan Native
15% 65 and older
Highest infant mortality rate
High unintentional injury mortality rate
High rate of Alzheimer’s disease in 65+ population
17
Southwest
•
•
•
•
64% small or isolated rural
5% Hispanic
14% 65 and older
Highest percentage of people reporting “fair” or
“poor” health
• High rate of motor vehicle injury deaths
• High diabetes, pneumonia and influenza, heart
disease and stroke mortality rates in 65+
population
18
Central
•
•
•
•
•
32% small or isolated rural
High asthma hospitalization rate
Highest rate of pneumonia and influenza mortality
High rates of death due to diabetes
High unintentional injury mortality rate in 85+
population
19
Northeast
•
•
•
•
•
•
•
•
•
31% small or isolated rural
15% 65 and older
Highest overall mortality rate
High asthma hospitalization and ED visit rates
High rate of cirrhosis mortality
High rates of diabetes and heart disease mortality
High suicide rate
High unintentional injury mortality rate
High mortality rates from cancer, alzheimer’s
disease, diabetes and heart disease in 65+
population
20
Southeast
•
•
•
•
•
•
19% small or isolated rural
4% Hispanic
Low diabetes and stroke mortality rates
High mortality due to falls
High TBI rate
Highest rate of death due to falls
21
Metro
• 0% small or isolated rural
• Large minority populations
• High rate of chlamydia, gonorrhea, and HIV/AIDS
infection
• High asthma hospitalization and ED visit rate
• High mortality due to falls
• High unintentional injury mortality rate in 85+
population
22
Overall Health Status
23
Age-Adjusted All Cause Mortality Rate (2004-2008)
Deaths per 100,000 person-years
1000
900
800
700
767
697
687
670
661
642
600
500
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• The overall mortality rate is higher in the Northeast
24
• The Northwest had the highest infant mortality rate
• This was still lower than the national average, 6.7 infant
deaths per 1,000 births
25
Percentage of People Reporting Fair or Poor Health (2009)
20
18
17
15
16
14
12
Percent
12
12
11
10
10
8
6
4
2
0
Northwest
Southwest
Central
Northeast
Southeast
Metro*
Region
• The percentage of Minnesotans in 2009 reporting “Fair” or
“Poor” was significantly lower in the Metro region than
statewide
26
Percentage of People with No Health Insurance (2009)
20
18
16
14
Percent
14
11
12
9
10
9
8
8
8
6
4
2
0
Northwest*
Southwest
Central
Northeast
Southeast
Metro*
Region
• The Northwest region had a higher percentage of people with no
health insurance
• The Metro region had a lower percentage of people with no
health insurance
27
Behavioral Health
28
• A Higher Percentage of Adults in Greater Minnesota reported
current smoking than Metro residents
• More men smoke than women
• Less people smoked in 2009 than 2004
29
Percentage of People Identified as Obese by Location and Sex (BRFSS)
35
29
30
Percent
25
20
29
23
22
28
21
20
19
Men
Women
15
10
5
0
Metro
Greater MN
Metro
2004
Greater MN
2009
Location
• A higher percentage of Greater Minnesotan’s were identified
as obese
30
Disease
31
Gonorrhea Infection Rate by Region (2006-2009)
Cases per 100,000 person-years
100
90
85
80
70
60
50
40
34
29
30
17
20
20
12
10
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• The Metro had a much higher rate of gonorrhea infection than the other
regions of the state
• The rural Northwest and Southwest had the lowest gonorrhea infection rates
32
Chlamydia Infection Rate by Region (2006-2009)
Cases per 100,000 person-years
400
350
328
300
250
211
190
200
150
161
159
Southwest
Central
127
100
50
0
Northwest
Northeast
Southeast
Metro
Region
• The Metro had a much higher rate of gonorrhea infection than the other
regions of the state
• The rural Northwest, Southwest, Central had the lowest gonorrhea infection
rates
33
HIV/AIDS Incidence Rate by Region (2004-2009)
20
Cases per 100,000 person-years
18
16
15
14
12
10
8
6
4
2
3
3
Southwest
Central
2
3
1
0
Northwest
Northeast
Southeast
Metro
Region
• The Metro has approximately 5-15 times the incidence rate of HIV/AIDS than
any other region
34
Age-Adjusted Asthma Emergency Department Visit Rate (2007-2009)
Emergency Department Visits
per 10,000 person-years
50
45
39
40
35
30
31
29
25
38
31
22
20
15
10
5
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• The Metro and Northeast regions had the highest asthma
emergency department visit rate
35
Hospitalizations per 10,000 person-years
Age-Adjusted Asthma Hospitalization Rate (2007-2009)
20
18
16
14
12
10
10
8
11
11
7
7
7
6
4
2
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• The Northeast, Metro, and Central regions had the highest
asthma hospitalization rates
36
Age-Adjusted Pneumonia and Influenza Mortality Rate (2006-2009)
Deaths per 100,000 person-years
20
18
16
15
14
14
13
13
13
12
10
10
8
6
4
2
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• Pneumonia and influenza mortality rates were higher in nonMetro regions
37
Age-Adjusted Total Cancer Deaths (2004-2008)
Deaths per 100,000 person-years
240
220
231
209
206
203
208
203
200
180
Men
161
160
140
Women
151
139
144
143
140
120
100
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• Men had higher cancer mortality rates than women in all regions
• The Northeast had the highest cancer mortality rates for both
men and women
38
Age-Adjusted Cirrhosis Mortality Rate (2006-2009)
Deaths per 100,000 person-years
20
18
16
14
12
12
10
8
7
6
6
6
6
Southwest
Central
6
4
2
0
Northwest
Northeast
Southeast
Metro
Region
• The Northeast had the highest cirrhosis mortality rates for both
men and women
39
Age-Adjusted Diabetes Mortality Rate (2006-2009)
Deaths per 100,000 person-years
30
24
25
23
21
21
19
20
16
15
10
5
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• The more rural regions of the state had higher rates of mortality
due to diabetes than the more urban Metro and Southeastern
regions
40
Age-Adjusted Heart Disease Mortality Rate (2006-2009)
200
Deaths per 100,000 person-years
182
180
160
159
163
146
146
140
116
120
100
80
60
40
20
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• The more rural regions of the state had substantially higher
heart disease mortality rates than the Metro
41
Injury
42
Age-Adjusted Suicide Rate (2006-2009)
Deaths per 100,000 person-years
30
25
20
16
15
14
11
12
Southwest
Central
12
10
10
5
0
Northwest
Northeast
Southeast
Metro
Region
• The Northeast and Northwest had the highest suicide rates
43
Age-Adjusted Unintentional Injury Mortality Rate (2006-2009)
Deaths per 100,000 person-years
60
50
48
46
40
41
39
40
Southwest
Central
36
30
20
10
0
Northwest
Northeast
Southeast
Metro
Region
• The Northeast and Northwest had the highest mortality rate due
to unintentional injury
44
Fall Injury Mortality Rate by Region (2006-2009)
20
Deaths per 100,000 person-years
18
16
15
14
14
12
13
12
11
12
10
8
6
4
2
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• The more urban Southeast, Northeast and Metro regions had
higher mortality rates due to falls
45
Motor Vehicle Injury Mortality Rate by Region (2006-2009)
Deaths per 100,000 person-years
20
18
18
16
16
14
13
13
13
12
10
8
6
6
4
2
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• The more rural Northwest and Southwest regions had the highest
motor vehicle injury mortality rates
• The Metro region had the lowest motor vehicle injury mortality
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rate
Traumatic Brain Injury Rate by Region (2006-2009)
Cases per 100,000 person-years
140
120
120
119
97
100
94
83
80
63
60
40
20
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• The more rural Northwest and Southwest regions had the lowest
TBI rates
• The Northeast and Southeast regions had the highest TBI rates
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Aging Population
48
Alzheimer's Mortality Rate: Ages 65 and over (2006-2009)
Deaths per 100,000 person-years
300
287
280
260
240
231
220
193
200
186
182
180
161
160
140
120
100
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• Older Minnesotans living in the Northeast and Northwest regions
had higher Alzheimer’s mortality rates than those living in other
regions
49
All Cancer Mortality Rate: Ages 65 and over (2006-2009)
Deaths per 100,000 person years
1200
1139
1150
1100
1071
1050
1023
1011
1023
1006
1000
950
900
850
800
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• The Northeast had the highest cancer mortality rate
50
Diabetes Mortality Rate: Ages 65 and over (2006-2009)
180
Deaths per 100,000 person-years
170
158
160
155
150
140
138
140
130
119
120
112
110
100
90
80
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• Older Minnesotans in the more rural regions had higher diabetes
mortality rates than the more urban Southeast and Metro regions
51
Heart Disease Mortality Rate: Ages 65 and over (2006-2009)
Deaths per 100,000 person-years
1400
1300
1257
1229
1200
1100
1074
1050
1007
1000
900
775
800
700
600
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• Older Minnesotans in the more rural regions had higher heart
disease mortality rates than the Metro region
52
Pneumonia and Influenza Mortality Rate: Ages 65 and over (2006-2009)
Deaths per 100,000 person-years
120
107
110
103
105
99
100
100
90
80
71
70
60
50
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• Older Minnesotans in the more rural regions had higher mortality
due to pneumonia and influenza than those in the Metro region
53
Stroke Mortality Rate: Ages 65 and over (2006-2009)
Deaths per 100,000 person-years
400
380
360
348
340
320
306
297
300
292
275
280
270
260
240
220
200
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• Older Minnesotans in the rural Northwest and Southwest regions
had the highest stroke mortality rates
54
Unintentional Injury Mortality Rate: Ages 85 and over (2006-2009)
600
Deaths per 100,000 person-years
564
550
516
501
500
450
400
428
394
349
350
300
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
• Residents in the rural Northwest and Southwest regions had
lower unintentional injury mortality rates
55
Conclusions
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Non-Metro vs. Metro
• Higher percentage of people reporting “fair” or
“poor” health
• Higher percentage of smokers
• Higher percentage of people obese
• Higher percentage uninsured
• Higher suicide rates
• Higher pneumonia and influenza mortality
• Higher diabetes and heart disease mortality
• Higher mortality due to motor vehicle injury
57
Non-Metro vs. Metro
Aging Populations
•
•
•
•
•
•
Higher population over 65
Higher diabetes mortality rate
Higher heart disease mortality rate
Higher pneumonia and influenza mortality rate
Higher stroke mortality rate
Lower unintentional injury rates in Northwest and
Southwest, especially in 85+ population
58
Case Study in Chronic Disease
Prevention
59
The story of Doris:
Once upon a time…
“I was tired of being tired and
out-of-shape. I also wanted to combat
my family history, which is not very
good, I knew I had to
do something. What keeps me going
are my kids, and especially my
grandkids. I want to be around and
healthy enough to be involved in their
lives and see them grow up.”
Doris Schumacher
The story of Doris:
The Synopsis
LEARN
Wellness
Works
Well
Screen
Sustained
Behavior
Change
The story of Doris: Chapter 1&2

Well Screen

WellnessWorks
The story of Doris: Chapter 3&4

LEARN

Sustained Behavior
Change
The story of Doris:
The next chapter
Doris celebrates health:
•Lost 31.5 pounds
•Lost 23 inches
•BMI reduction of 6.2 points
•Blood pressure: 130/78 to 102/63
•Exercises 200 minutes per week
•Achieves monthly nutrition goals
•Earned $250 cash in 2010 by meeting
her WellnessWorks goals.
•And feels really good!!
SATISFACTION/PARTICIPATION
HEALTH IMPROVEMENT
Increase in participation
(80% of employees
engaged in wellness
initiatives)
Reduction in Risk Factors
(11% improvement in
lipids)
89%
89% of employees believe Saint Elizabeth’s
supports their efforts to live a healthy lifestyle.
56%
56% of employees are no longer identified
as being pre-diabetic.
$11,00
0
Over $11,000 in cash incentives were
distributed in 2010 for achieving wellness goals.
Next Steps




Ask more questions
Dig deeper
Prioritize resources
Spread the word
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Image courtesy of John Lillis