Rural Health Advisory Committee
Updated November 2011
HEALTH STATUS
OF RURAL MINNESOTANS
3
TABLE OF CONTENTS
Executive Summary…………………………………………………………………………………………………5
Introduction………………………………………………………………………………………………………….7
What is Rural?………………………………………………………………………..……………………..8
Regional Profiles…………………………………………………………………………………………………...10
Overall Health Status……………...........................................................................................................................17
Overall Mortality…………………………………………………………………………………………..18
Infant Mortality……………………………………………………………………………………………19
Perceived Health…………………………………………………………………………………………...20
Health Access………………………………………………………………………………………………………21
Primary and Dental Care…………………………………………………………………………………22
Health Insurance Coverage………………….……………………………………………………………24
Behavioral Health………………………………………………………………………………………………….25
Smoking…………………………………………………………………………………………………….26
Driving While Intoxicated…………………………………………………………………………………27
Seatbelt Use……………………………………………………………………….………………………..28
Obesity………………………………………………………….…………………………………………..29
Physical Activity………………………………………………………...…………………………………30
Disease……………………………………………………………………………………………………………...31
Sexually Transmitted Infections: Chlamydia……………………………………………………………32
Sexually Transmitted Infections: Gonorrhea……………………………………………………………33
Sexually Transmitted Infections: HIV/AIDS……………………………………………………………34
Tick-Borne Disease: Lyme Disease………………………………………………………………….……35
Tick-Borne Disease: Human Anaplasmosis……………………………………………………………..36
Food-Borne Illness: Salmonellosis………………………………………………………………….…….37
Food-Borne Illness: Giardiasis…………………………………………………………………….……..38
Food-Borne Illness: Campylobacteriosis………………………………………………………….……..39
Respiratory Illness: Pneumonia and Influenza Mortality Rate………………………………….…….40
Respiratory Illness: Asthma………………………………………………………………………..…….41
Cancer: Breast……………………………………………………………………..……………….……..43
Cancer: Prostate……………………………………………………………………………………..……45
Cancer: Lung………………………………………………………………………………….…….…….47
Cancer: Colon and Rectal………………………………………………………………………….……..49
4
All Cancers…………………………………………………………………………………………..….….51
Chronic Disease: Cirrhosis……………………………………………………………………………..…53
Chronic Disease: Diabetes……………………………………………………………………………...…54
Chronic Disease: Heart Disease…………………………………………………………………….….…55
Chronic Disease: Stroke…………………………………………………………………………….….…56
Injury……………………………………………………………………………………………………….……...57
Homicide…………………………………………………………………………………………….….….58
Suicide……………………………………………………………………………………………….….….59
Unintentional Injury………………………………………………………………..………………..……60
Deaths due to Falls……………………………………………….………………………………….….…61
Motor Vehicle Deaths……………………………………………………………………………….….…62
Traumatic Brain Injury (TBI) …………………………………………………………………….….….63
Aging Populations……………………………………………………………………………………………..…..64
Age 65 and Over Population……………………………………………………………………….….….65
Age 85 and Over Population……………………………………………….…………………………..…66
Aging Populations: Alzheimer’s Disease……………………………….……………………………..…67
Aging Populations: Cancer…………………………………………………………………………….…69
Aging Populations: Diabetes………………………………………………………………………..….…71
Aging Populations: Heart Disease…………………………………………………………………….….73
Aging Populations: Pneumonia and Influenza……………………………………………………….…75
Aging Populations: Stroke………………………………………………………………….………….…77
Aging Populations: Unintentional Injury……………………………………………….……………….79
Regional Summaries………………………………………………………………………………………………81
Key Findings………………………………………………………………………………………………………87
Conclusion…………………………………………………………………………………………………………88
Glossary……………………………………………………………………………………………………………89
Works Cited…………………………………………………………………………………………….…………90
5
Executive Summary
This chart book provides a snapshot of the health of rural Minnesotans by summarizing key health indicators, health behaviors, and
other social and environmental health determinants. It is a follow-up to “Health and Well-being of Rural Minnesotans: A Minnesota
Rural Health Status Report.” The 2005 Minnesota Department of Health publication highlighted key health indicators in both the
seven-county metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington counties) and Greater Minnesota
(all non-metropolitan counties)i.
In order to identify “rural” Minnesota, this 2011 report adopts a regional health approach, dividing the state into six pre-identified,
distinct regions, and determining the percent of residents of each region living in small rural or isolated rural areas as measured by
Rural Urban Commuting Areas (RUCAs). The six regions are Central, Metro, Northeast, Northwest, Southeast and Southwest.
Key Findings
Some clear differences exist in rural regions compared to urban regions:

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
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Fewer people with at least some college
More people reported “fair” or “poor” health
More people reported being current smokers
More people were identified as obese
Fewer people reported exercising in the previous month
More people were uninsured
Lower rates of chlamydia, gonorrhea and
HIV/AIDS infection
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Higher mortality rates due to pneumonia and
influenza, especially in the older population
Higher diabetes, stroke and heart disease
mortality rates
Lower homicide rates
Higher suicide rates
Lower unintentional injury mortality rates
Higher mortality due to motor vehicle injury.
This report is intended to generate awareness among policymakers, primary and rural health care providers, public health officials and
concerned community members about the importance of examining rural and regional disparities.
6
7
Introduction
This chart book provides a snapshot of the health of rural Minnesotans by summarizing key health indicators, health behaviors, and
other social and environmental health determinants. It is a follow-up to “Health and Well-being of Rural Minnesotans: A Minnesota
Rural Health Status Report.” The 2005 Minnesota Department of Health publication highlighted key health indicators in both the
seven-county metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington counties) and Greater Minnesota
(all non-metropolitan counties)ii.
Although the following information summarizes health indicators of all Minnesotans, it focuses on key health issues for rural
Minnesotans. This is not meant to be a comprehensive report on any one condition or illness, nor is it designed to identify the causes
or contributing factors of health conditions. Instead, this report identifies regional disparities and other health issues that require
further attention and research. The intended audience for this chart book includes policymakers, primary and rural health care
providers, public health officials and concerned community members.
8
WhatisRural?
The term “rural” has many definitions and can be interpreted in
many different ways depending on the context or discipline in
which it is being used.iii Historically, Greater Minnesota has been
used as a surrogate measure of rural Minnesota, and indeed much
of the land area outside the seven-county metro area is farmland,
prairie or woodland that is isolated from the resources available in
urban areas. Despite this wealth of open space, many of the
people in Greater Minnesota are concentrated in close proximity
to urban centers outside of the twin cities, including Duluth,
MN/Superior, WI; Moorhead, MN/Fargo, ND; Rochester, MN;
and St. Cloud, MN.
Another method of defining rural that is particularly useful in
public health research is to use Rural-Urban Commuting Areas
(RUCAs). RUCAs are used to categorize the rurality of an area
based on the measures of urbanization, population density and
daily commuting.iii In this report, RUCAs are divided into four
categories: Urban, Large Rural, Small Rural and Isolated Rural
According to RUCAs and data from the 2000 census, 62 percent
of the population of Greater Minnesota lived in Urban or Large
Rural areas (Figure 1). This means that despite being classified as
“rural” in many reports and publications, most Greater
Minnesotans actually live in or near cities or large towns.
9
Figure 1
120
Percentage of Population in Small or Isolated Rural Areas: Metro vs. Greater Minnesota
(2000)
100
100
Percent
80
62
60
38
40
20
0
0
Metro
Greater MN
Urban/Large Rural
Small/Isolated Rural
Source: US Department of Agriculture
Because RUCAs are defined according to census tract or zip code level data, they are not easily linked to most population health data.
This prohibits their consistent use in describing a wide variety of health data, and for this reason they are not the primary unit of
rurality in this report. Instead, this report adopts a regional health approach, dividing the state into six pre-identified, distinct regions
(Central, Metro, Northeast, Northwest, Southeast, Southwest), and determining the percent of residents of each region living in small
rural or isolated rural RUCAs. Data from the Behavioral Risk Factor Surveillance Survey (BRFSS) was not available at the regional
level, therefore traditional Metro/Greater Minnesota regions were used in this report for some behavioral health risk factors.
10
Regional Profiles
The Minnesota Department of Employment and Economic Development (DEED) Planning Areas are referred to as regions for the
purposes of this report. DEED and other state agencies use these planning areas in regional reporting of economic information. These
regions are made up of counties, and are defined as follows:
Central Region: Benton, Chisago, Isanti, Kanabec, Kandiyohi, McLeod,
Meeker, Mille Lacs, Pine, Renville, Sherburne, Stearns, Wright.
Seven-County Metropolitan Region (Metro): Anoka, Carver, Dakota,
Hennepin, Ramsey, Scott, Washington.
Northeast Region: Aitkin, Carlton, Cook, Itasca, Koochiching, Lake,
St. Louis.
Northwest Region: Becker, Beltrami, Cass, Clay, Clearwater, Crow
Wing, Douglas, Grant, Hubbard, Kittson, Lake of the Woods, Mahnomen,
Marshall, Morrison, Norman, Otter Tail, Pennington, Polk, Pope, Red
Lake, Roseau, Stevens, Todd, Traverse, Wadena, Wilkin.
Southeast Region: Dodge, Fillmore, Freeborn, Goodhue, Houston,
Mower, Olmsted, Rice, Steele, Wabasha, Winona.
Southwest Region: Big Stone, Blue Earth, Brown, Chippewa,
Cottonwood, Faribault, Jackson, Lac qui Parle, Le Sueur, Lincoln, Lyon,
Martin, Murray, Nicollet, Nobles, Pipestone, Redwood, Rock, Sibley,
Swift, Waseca, Watonwan, Yellow Medicine.
11
The western regions had the highest percentage of the population living in small or isolated rural areas.
Figure 2
Percentage of Population in Small or Isolated Rural Areas by Region (2000)
100
90
80
Percent
70
66
64
60
50
40
32
31
30
19
20
10
0
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
Source: US Department of Agriculture
Figure 2 illustrates the percent of the population in each region who resided in a Small or Isolated Rural RUCA. In 2000, all residents
of the Metro region were living in an urban RUCA.
In this chart book, the colors of the bars representing each region are shaded according to the relative rurality of that region, with the
most rural region shaded the lightest and the least rural region shaded the darkest.
12
Almost half of Minnesota’s population lived outside the seven-county metropolitan area.
Figure 3
Population by Region (2009)
3,500,000
2,846,576
3,000,000
Population
2,500,000
2,000,000
1,500,000
1,000,000
676,538
544,136
489,687
387,600
500,000
321,677
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
Source: Minnesota Center for Health Statistics-US Census 2009 estimates
Figure 3 illustrates the population of each of the six regions. In 2009, the Metro region had a population of approximately 2.8 million,
which represents 54 percent of the total population of Minnesota. The Central region was the next most populous, with 13 percent of
the population. The Northeast was the least populated region at only 6 percent of the state population. Although the Northeast region
had the smallest population, only 31 percent of the residents lived in small rural or isolated rural RUCAs (Figure 2).
13
Rural residents were predominately White.
Figure 4
White Population by Region (2009)
100
94
96
96
94
94
83
Northwest
Southwest
Central
Northeast
Southeast
Metro
90
80
Percent
70
60
50
40
30
20
10
0
Region
Source: Minnesota Center for Health Statistics-US Census 2009 estimates
In 2009, an estimated 88.6 percent of Minnesotans self-identified as White. In the non-metro regions, over 90 percent considered
themselves White, while 83.42 percent of Minnesotans in the Metro region self-identified as White (Figure 4).
14
Notable Hispanic populations were recorded throughout southern Minnesota.
Figure 5
Minority Population by Region (2009)
10
9
8
8
Percent
7
6
6
5
5
5
4
4
4
3
2
1
1
1
1
3
3
2
3
2
1
2
1
1
1
1 1
1
1
2
1
1
0
2
1
1
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Race/Ethnicity
Black/African American
Amer. Indian/Alaskan Native
Asian/Pacific Islander
Two or More Races
Hispanic/Latino
Source: Minnesota Center for Health Statistics-US Census 2009 estimates
Figure 5 illustrates the population of each race/ethnicity by region. These populations were self-identified and not mutually exclusive,
meaning that one person could self-identify as more than one race/ethnicity (e.g., White, Asian/Pacific Islander and Hispanic/Latino).
In the Metro region, 7.7 percent of people identified themselves as Black/African American, 6 percent of people identified as
Asian/Pacific Islander, and 5.4 percent as Hispanic/Latino. In all regions except for the Northeast, 2 percent or more of the population
self-identified as Hispanic/Latino. In the Northeast and Northwest regions, over 2 percent of the population identified as American
Indian/Alaskan Native. While minority populations in Minnesota, particularly in non-Metro regions, were relatively small, there were
differences in the makeup of those populations. Although these differences may not appear to have immediate health implications, it is
important to identify regional differences in racial/ethnic distributions since different cultural and ethnic groups may have different
health challenges.
15
The Northwest, Southwest and Northeast regions had highest percentages of older Minnesotans.
Figure 6
Age Distribution by Region (2009)
Percent of Total Population
35
30
30
28
27
29
27
26 26
24
25
21
27
21
20
20
16
15
10
12
14
12
9 8
7
7
16
14 15
8
9
15
13 13
13
11
9 8
7
6 6 6
7 7 7
7
6 5
5
0-4
05-14
15-24
25-44
45-64
65-74
75+
0-4
05-14
15-24
25-44
45-64
65-74
75+
0-4
05-14
15-24
25-44
45-64
65-74
75+
0-4
05-14
15-24
25-44
45-64
65-74
75+
0-4
05-14
15-24
25-44
45-64
65-74
75+
0-4
05-14
15-24
25-44
45-64
65-74
75+
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
Source: Minnesota Center for Health Statistics: Vital Statistics Interactive Query Tool
Population health challenges and needs also differ depending on the age makeup of the population. For example, populations with
younger adults may have lower incidence of diseases associated with aging such as heart disease and diabetes, but they may have
increased incidence of sexually transmitted infections such as HIV, chlamydia or gonorrhea. Figure 6 illustrates the age distribution of
each region in Minnesota. Combining the 65-74 and 75+ age groups, the Northeast, Northwest and Southwest have the largest
populations over 65, all at 17 percent, while the Metro and Central Regions have the lowest, at 11 percent and 12 percent respectively.
Consequently, we may expect to see more health problems related to aging in the Northwest, Southwest and Northeast regions. It is
also notable that these regions, particularly the Northwest and Southwest have more residents living in small rural and isolated rural
areas (Figure 2).
16
A lower percentage of Minnesotans in rural regions had at least some college.
Figure 7
Percentage of People With at Least Some College (2009)
100
90
80
73
Percent
70
60
68
64
55
58
52
50
40
30
20
10
0
Northwest*
Southwest*
Central*
Northeast
Southeast
Metro*
Region
Source: MDH Health Economics Program and University of Minnesota School of Public Health, 2009 Minnesota Health Access Surveys.
* Indicates a statistically significant difference from statewide rate within year at the 95 percent level.
Education is frequently used as a measure of socio-economic status (SES), which is associated with many different health outcomes,
health behaviors, and access to health care. The Northwest, Southwest and Central regions had a significantly lower percentage of
residents with some college education than the overall state level of 67 percent.
17
Overall Health Status
This section of the chart book presents three commonly used measures of population health: overall mortality, infant mortality and
self-reported health status. The overall mortality rate is the total number of deaths occurring over a specific time period, divided by the
population. It has been adjusted to account for regional differences in age. The infant mortality rate is the total number of infant deaths
divided by the number of live births.
Self-reported health status is an established predictor of mortality, with higher rates of mortality among persons reporting worse
healthiv. This report draws self-reported health status from the 2009 Minnesota Health Access Survey. Survey respondents were asked
to rate their health according to the following five categories: Excellent, Very Good, Good, Fair or Poor.
Taken together, these health indicators can help identify disparities in overall health between more and less rural regions of the state.
Additional information on health behaviors and specific diseases can help to provide a more detailed picture of the reasons for overall
differences in health between regions.
18
OverallMortality
The overall mortality rate was highest in the Northeast.
Figure 8
Source: Minnesota Center for Health Statistics, Vital Statistics, rates calculated by Minnesota Cancer Surveillance System staff


Between 2004 and 2008, there were 186,986 deaths in Minnesota, a rate of 678 per 100,000 person-years.
The Northwest, Central and Northeast regions had overall mortality rates higher than the Metro region.
19
InfantMortality
The infant mortality rate was highest in the Northwest
Figure 9
Infant Mortality Rate by Region (2006-2009)
10.0
Number per 1,000 live births
9.0
8.0
7.0
6.1
6.0
5.0
4.4
4.7
4.7
Central
Northeast
4.9
5.2
Southeast
Metro
4.0
3.0
2.0
1.0
0.0
Northwest
Southwest
Region
Source: Minnesota Center for Health Statistics, County Health Tables
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Minnesota consistently ranks among the states with the lowest infant mortality rates. An average infant mortality rate of 5.1
per 1,000 live births was recorded from 2006 to 2009.
All regions in Minnesota had infant mortality rates lower than the national average of 6.7 per 1,000 births.
The Northwest had the highest infant mortality rate in the state in 2009, at 6.1 deaths per 1,000 births, which is higher than the
four-year state average of 5.1 deaths per 1,000 births.
More information: http://www.health.state.mn.us/divs/chs/infantmortality/index.html.
20
PerceivedHealth
The percentage of Minnesotans in 2009 reporting “Fair” or “Poor” health was significantly lower in the
Metro region than the statewide percentage.
Figure 10
Percentage of People Reporting Fair or Poor Health (2009)
20
18
17
15
Percent
16
14
12
12
12
11
10
10
8
6
4
2
0
Northwest
Southwest
Central
Northeast
Southeast
Metro*
Region
Source: MDH Health Economics Program and University of Minnesota School of Public Health, 2009 Minnesota Health Access Surveys.
* Indicates a statistically significant difference from statewide rate within year at the 95 percent level.
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The Southwest and Northeast had a higher percentage of people reporting Fair or Poor health than other regions, although this
difference was not significantly different from the statewide percentage (11 percent).
More information: https://pqc.health.state.mn.us/mnha/Welcome.action.
21
Health Access
This section of the chart book highlights disparities in access to three fundamental types of health care: primary care, dental care and
health insurance. Taken together with an understanding of key health indicators, this information paints a more complete picture of
disparities in Minnesota.
Regular primary care and dental care are central to maintaining population health and preventing poor health outcomes. While lack of
access to health care does not cause disease directly, the availability of health care, and utilization of primary care services is related to
health outcomes. People with no health insurance have worse health outcomes than people who do,v in part because lack of health
insurance leads to poor utilization of primary care and dental care.
Adult behavioral health information comes from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based, nationwide
survey that collects information on health behaviors from a random sample of adult residents (18 years and older). The Minnesota
Department of Health has been collecting BRFSS data since 1984 and receives an average annual response rate of approximately 60
percent.
More information on any Behavioral Risk Factor Surveillance System (BRFSS) chart:
http://www.health.state.mn.us/divs/chs/brfss/index.html.
22
PrimaryandDentalCare
Throughout Minnesota, more women than men utilized primary and dental care.
Figure 11
Source: Minnesota Center for Health Statistics-Behavioral Health Risk Factor Surveillance System

In both years, a higher percentage of women than men in all regions reported having a personal doctor.
23
Figure 12
Source: Minnesota Center for Health Statistics-Behavioral Health Risk Factor Surveillance System


For both years, a slightly lower percentage of men and women in Greater Minnesota reported a dental visit in the previous year
than those in the Metro region.
The percentage of women in the Metro region who reported a dental visit in the previous year decreased approximately
5.5 percent from 2004 to 2008.
24
HealthInsuranceCoverage
The Northwest region had the highest percentage of people with no health insurance.
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
Source: MDH Health Economics Program and University of Minnesota School of Public Health, 2009 Minnesota Health Access Surveys.
*Indicates a statistically significant difference from statewide rate within year at the 95 percent level.



Nine percent of all Minnesotans surveyed did not have health insurance in 2009.
The Northwest had a significantly higher percentage of people with no health insurance than the statewide average of
9 percent, while the Metro had a significantly lower percentage.
More information: https://pqc.health.state.mn.us/mnha/Welcome.action.
25
Behavioral Health
The behavior of groups and individuals can have direct and indirect effects on population health. For example, when individuals
smoke it poses individual risks to their health, and if many people in their community smoke it may make it more difficult to quit.
Measuring health behaviors at a population level can help highlight urban and rural differences, as well as more specific regional
differences. Understanding these differences can help target resources and interventions and prevent more serious diseases such as
heart disease and cancer from developing. This type of disease prevention not only saves lives, but increases productivity, and
decreases health care costs, resulting in healthier, more vibrant communities.
Adult behavioral health information comes from the Behavioral Risk Factor Surveillance System (BRFSS). Additional data on
Driving While Intoxicated (DWI) violations comes from the Minnesota Department of Public Safety.
More information on any Behavioral Risk Factor Surveillance System (BRFSS) chart:
http://www.health.state.mn.us/divs/chs/brfss/index.html.
26
Smoking
A higher percentage of adults in Greater Minnesota reported current smoking than Metro residents.
Figure 13
Source: Minnesota Center for Health Statistics-Behavioral Health Risk Factor Surveillance System


In both survey years, more men smoked than women in both the Metro and Greater Minnesota.
While the overall percentage of people who reported smoking decreased from 2004 to 2009, more Greater Minnesotans than
Metro residents reported smoking in both years.
27
DrivingWhileIntoxicated
The rate of DWI violations was highest in Northwest and Northeast Minnesota.
Figure 15
DWI Rate by Region of Residence (2006-2009)
Cases per 100,000 person-years
900
800
779
755
683
700
693
674
647
600
500
400
300
200
100
0
Northwest
Southwest
Central
Northeast
Southeast
Region
Source: Minnesota Department of Public Safety. Obtained from Minnesota Center for Health Statistics, County Health Tables


The overall DWI rate for all Minnesota residents was 679 DWIs per 100,000 person-years.
Only the Southeast and Metro regions had DWI rates lower than the overall DWI rate for Minnesota.
Metro
28
SeatbeltUse
A lower percentage of men reported always wearing a seatbelt.
Figure 16
Percentage of People who Reported Always Wearing a Seatbelt
100
90
92
90
86
82
86
80
80
70
Percent
70
64
60
50
Men
40
Women
30
20
10
0
Metro
Greater MN
Metro
2006
Greater MN
2008
Location
Source: Minnesota Center for Health Statistics-Behavioral Health Risk Factor Surveillance System
29
Obesity
A higher percentage of Greater Minnesotans were identified as obese.
Figure 17
Percentage of People Identified as Obese
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
Source: Minnesota Center for Health Statistics-Behavioral Health Risk Factor Surveillance System


In 2004 and 2009, a higher percentage of the population in Greater Minnesota were identified as obese (Body Mass Index
≥ 30.0) than in the Metro region.
In 2004, a higher percentage of men than women in Greater Minnesota were identified as obese. This difference decreased in
2009. Approximately equal percentages of men and women in the Metro region were identified as obese in both years.
30
PhysicalActivity
In 2009, a higher percentage of Greater Minnesotans reported not exercising recently.
Figure 18
Source: Minnesota Center for Health Statistics-Behavioral Health Risk Factor Surveillance System


In 2004, the percentage of residents who reported not exercising in the previous month in the Metro region and in Greater
Minnesota was approximately equal.
In 2009, more women in Greater Minnesota reported not exercising in the previous month than men.
31
Disease
Understanding differences in the distribution of specific diseases between regions is another way to identify potential disparities, and
determine where unmet needs may exist. Disease surveillance is critical for improving prevention strategies, as well as planning,
implementing and making treatment available.
This section highlights regional disease disparities. Data comes from infectious and reportable disease surveillance, vital statistics
records, chronic disease surveillance systems and other sources the Minnesota Department of Health, Center for Health Statistics
maintains.
The chart book highlights regional disparities in specific diseases; however, it does not attempt to identify their causes. References to
more complete sources of information on specific diseases are provided where available. Where appropriate and possible, disease
incidence rates and mortality rates were age-adjusted.
32
SexuallyTransmittedInfections:Chlamydia
The Metro region had the highest chlamydia infection rate.
Figure 19
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
Source: Minnesota Department of Health, Minnesota STD & HIV Surveillance Systems. Obtained from Minnesota Center for Health Statistics, County Health Tables.
Data exclude cases diagnosed in federal or private correctional facilities.





The Metro region had the highest chlamydia infection rate at 328 per 100,000 person-years, followed by the Northeast at
211 infections per 100,000 person-years.
The Northwest had the lowest chlamydia infection rate at 127 cases per 100,000 person-years.
In 2009, Minnesota chlamydia rates were lower than the national rate of 409 cases per 100,000 womenvi.
The overall chlamydia rate in Minnesota for 2006-2009 was 263 per 100,000 person-years.
More information: http://www.health.state.mn.us/divs/idepc/dtopics/stds/stdstatistics.html.
33
SexuallyTransmittedInfections:Gonorrhea
The Metro region had the highest gonorrhea infection rates.
Figure 20
Source: Minnesota Department of Health, Minnesota STD & HIV Surveillance Systems. Obtained from Minnesota Center for Health Statistics, County Health Tables.
Data exclude cases diagnosed in federal or private correctional facilities.




The Metro region had the highest rate of gonorrhea at 85 new infections per 100,000 person-years, followed by the Northeast
at 34 new infections per 100,000 person-years.
All regions in Minnesota had gonorrhea rates lower than the national average of 99 per 100,000vi.
Only the Metro had a rate higher than the state average of 58 per 100,000.
More information: http://www.health.state.mn.us/divs/idepc/dtopics/stds/stdstatistics.html.
34
SexuallyTransmittedInfections:HIV/AIDS
The Metro region had the highest rate of new HIV/AIDS diagnoses.
Figure 21
HIV/AIDS Incidence Rate by Region (2004-2009)
20
Cases per 100,000 person-years
18
15
16
14
12
10
8
6
4
2
3
3
Southwest
Central
2
3
Northeast
Southeast
1
0
Northwest
Metro
Region
Source: Minnesota Department of Health, Minnesota STD & HIV Surveillance Systems. Obtained from Minnesota Center for Health Statistics, County Health Tables.
HIV infection includes all new cases of HIV infection (both HIV (non-AIDS) and AIDS at first diagnosis)



From 2004-2009, there were 1,941 new HIV/AIDS cases, 1,706 (88 percent) of which were in the Metro region.
The Metro region had the highest HIV/AIDS incidence rate at 15 new cases per 100,000 person-years.
More information: http://www.health.state.mn.us/divs/idepc/dtopics/stds/stdstatistics.html.
35
Tick‐BorneDisease:LymeDisease
The Northwest and Northeast had higher rates of Lyme disease.
Figure 22
Source: Minnesota Department of Health, Acute Disease Epidemiology. Obtained from Minnesota Center for Health Statistics, County Health Tables.
Lyme disease and human anaplasmosis (HA) are caused by bites from blacklegged ticks (deer ticks), which are found in wooded areas of northcentral, eastern and southeastern Minnesota
and western Wisconsin. Most Minnesotans with Lyme disease or HA lived in or traveled to these areas. County of residence does not always indicate county of tick exposure.



From 2006-2009, Minnesota had 4,267 confirmed cases of Lyme disease (21 cases per 100,000 person-years).
The Northwest and Northeast had the highest rates of Lyme disease at 42 and 37 cases per 100,000 person-years.
More information on tick-borne diseases: http://www.health.state.mn.us/divs/idepc/dtopics/vectorborne/index.html.
36
Tick‐BorneDisease:HumanAnaplasmosis
The Northwest and Northeast regions had the highest rate of human anaplasmosis infection.
Figure 23
Source: Minnesota Department of Health, Acute Disease Epidemiology. Obtained from Minnesota Center for Health Statistics, County Health Tables.
Lyme disease and human anaplasmosis (HA) are caused by bites from blacklegged ticks (deer ticks), which are found in wooded areas of northcentral, eastern and southeastern Minnesota
and western Wisconsin. Most Minnesotans with Lyme disease or HA lived in or traveled to these areas. County of residence does not always indicate county of tick exposure.



From 2006-2009, Minnesota had 1,093 confirmed cases of human anaplasmosis (five cases per 100,000 person-years).
The Northwest and Northeast had the highest rates of human anaplasmosis at 22 and 12 cases per 100,000 person-years.
More information on tick-borne diseases: http://www.health.state.mn.us/divs/idepc/dtopics/vectorborne/index.html.
37
Food‐BorneIllness:Salmonellosis
The Northeast had the lowest rate of salmonella infection.
Figure 24
Salmonellosis Rate by Region (2006-2009)
16
Cases per 100,000 person-years
14
14
14
Southeast
Metro
14
12
12
12
10
8
8
6
4
2
0
Northwest
Southwest
Central
Northeast
Region
Source: Minnesota Department of Health, Acute Disease Epidemiology. Obtained from Minnesota Center for Health Statistics, County Health Tables.



From 2006-2009, Minnesota had 2,770 reported cases of salmonella infection (13 per 100,000 person-years).
The Southwest, Southeast and Metro regions had the highest rate of infection, all at 14 per 100,000 person-years.
More information: http://www.health.state.mn.us/divs/idepc/diseases/salmonellosis/statistics.html.
38
Food‐BorneIllness:Giardiasis
The Metro region had the highest rate of giardia infection.
Figure 25
Giardiasis Rate by Region (2006-2009)
Cases per 100,000 person-years
20
18
18
16
16
14
14
13
12
12
10
9
8
6
4
2
0
Northwest
Southwest
Central
Northeast
Southeast
Region
Source: Minnesota Department of Health, Acute Disease Epidemiology. Obtained from Minnesota Center for Health Statistics, County Health Tables.




From 2006-2009, Minnesota had 3,281 reported cases of giardia infection (16 per 100,000 person-years)
The Metro region had the highest rate of infection at 18 per 100,000 person-years.
The Northwest had the lowest rate at nine per 100,000 person-years
More information: http://www.health.state.mn.us/divs/idepc/diseases/giardiasis/statistics.html.
Metro
39
Food‐BorneIllness:Campylobacteriosis
The Southwest and Southeast regions had the highest rates of campylobacter infection.
Figure 26
Source: Minnesota Department of Health, Acute Disease Epidemiology. Obtained from Minnesota Center for Health Statistics, County Health Tables.



From 2006-2009, Minnesota had 1,747 reported cases of campylobacter infection (17 cases per 100,000 population).
The Southwest had the highest infection rate at 28 per 100,000, followed by the Southeast at 26 per 100,000.
More information: http://www.health.state.mn.us/divs/idepc/diseases/campylobacteriosis/statistics.html.
40
RespiratoryIllness:PneumoniaandInfluenzaMortalityRate
Pneumonia and influenza mortality rates were higher in non-Metro regions.
Figure 27
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
Source: Minnesota Center for Health Statistics, Vital Statistics



From 2006-2009, there were 2,564 deaths due to pneumonia and influenza in Minnesota, an age-adjusted rate of 12 deaths per
100,000 person-years.
The Metro region had a lower pneumonia and influenza mortality rate than the rural regions of the state, at 10 deaths per
100,000 person-years.
More information: http://www.health.state.mn.us/divs/idepc/diseases/flu/stats/index.html and
http://www.health.state.mn.us/divs/idepc/diseases/pneumococcal/stats/index.html.
41
RespiratoryIllness:Asthma
The Northeast and Metro had the highest asthma emergency department visit and hospitalization rates.
Figure 28
Source: Minnesota Department of Health, Asthma Program




From 2007 to 2009, there were 50,643 asthma related emergency department (ED) visits in Minnesota, a rate of
32 per 10,000 person-years.
The Northeast and Metro regions had the highest asthma ED visit rates, at 39 and 38 per 10,000 person-years respectively.
Both regions had rates higher than the statewide rate of 32 per 10,000.
The Southwest had the lowest rate at 22 per 10,000 person-years.
More information: http://www.health.state.mn.us/divs/hpcd/cdee/asthma/Research.html.
42
Figure 29
Source: Minnesota Department of Health, Asthma Program




From 2007 to 2009, there were 12,838 asthma hospitalizations in Minnesota, or eight per 10,000 person-years.
The Central, Northeast, and Metro regions had the highest asthma hospitalization rates, at 9.6, 10.8, and 11.0 per 10,000
person-years respectively.
The Northwest, Southwest and Southeast all had relatively low hospitalization rates with approximately seven per 10,000
person-years.
More information: http://www.health.state.mn.us/divs/hpcd/cdee/asthma/Research.html.
43
Cancer:Breast
The incidence of breast cancer in women is higher in more urban regions, but mortality is approximately
equal in all regions of the state.
Figure 30
Diagnoses per 100,000 person-years
Age-Adjusted Breast Cancer Incidence Rate Among Women (2004-2008)
150
145
140
135
130
130
Southeast
Metro
130
123
125
124
121
120
115
115
110
105
100
Northwest
Southwest
Central
Northeast
Region
Source: Minnesota Cancer Surveillance System (MCSS)



Between 2004 and 2008, there were 17,913 new cases of breast cancer identified in Minnesota, a rate of 126 per 100,000
person-years (among women only).
The Metro and Southeast regions had the highest incidence rates, at approximately 130 cases per 100,000 person-years. This
may reflect an increased likelihood of cancer screening in residents of regions with abundant health care resources such as the
Metro and Southeast regions.
The Northwest had the lowest incidence rate at 115 per 100,000 person-years.
44
Figure 31
Source: Minnesota Center for Health Statistics, Vital Statistics, rates calculated by Minnesota Cancer Surveillance System staff


Between 2004 and 2008, there were 3,229 deaths resulting from breast cancer in Minnesota, a rate of 21.5 per
100,000 person-years (among women only).
All regions of the state had breast cancer mortality rates close to the state average.
45
Cancer:Prostate
The Central and Northwest regions had the highest incidence of prostate cancer among men.
Figure 32
Source: Minnesota Cancer Surveillance System (MCSS)



Between 2004 and 2008, there were 22,113 new cases of prostate cancer identified in Minnesota, a rate of 184 per 100,000
person-years (among men only).
The Central region had the highest prostate cancer incident rate, approximately 196 per 100,000 person-years, followed by the
Northwest at approximately 190 per 100,000 person-years (among men only).
The Southeast had the lowest incidence rate at approximately 172 per 100,000 person-years (among men only).
46
The Northeast had the highest prostate cancer mortality rate among men.
Figure 33
Source: Minnesota Center for Health Statistics, Vital Statistics, rates calculated by Minnesota Cancer Surveillance System staff


Between 2004 and 2008, there were 2,577 deaths resulting from prostate cancer in Minnesota, a rate of 25 per 100,000
person-years.
The Northeast had the highest mortality rate at 30 deaths per 100,000 person-years (among men only).
47
Cancer:Lung
The incidence and mortality of lung cancer was higher among men than women in all regions of the state.
Figure 34
Source: Minnesota Cancer Surveillance System (MCSS)




Between 2004 and 2008, there were 14,805 new cases of lung cancer (including bronchus cancer) identified in Minnesota.
More men were diagnosed with lung cancer than women in all regions of Minnesota. The statewide lung cancer incidence rate was
68 per 100,000 person-years for men, and 50 per 100,000 person-years for women.
The Central, Northeast and Northwest regions had the highest rates among men.
The Metro, Northeast and Central regions had the highest rates among women.
48
The Northeast had the highest lung cancer mortality rates among men and women.
Figure 35
Source: Minnesota Center for Health Statistics, Vital Statistics, rates calculated by Minnesota Cancer Surveillance System staff



From 2004 through 2008, there were 11,830 deaths resulting from lung cancer in Minnesota.
The statewide lung cancer mortality rate was 57 per 100,000 person-years for men, and 37 per 100,000 person-years for women.
The Southwest region had the lowest lung cancer mortality rate for men and women.
49
Cancer:ColonandRectal
The colon and rectal cancer incident rate was highest in the Southwest region.
Figure 36
Source: Minnesota Cancer Surveillance System (MCSS)



From 2004 through 2008, there were 12,403 new cases of colon and rectal cancer identified in Minnesota.
More men had colon and rectal cancer than women in all regions of Minnesota. The statewide colon and rectal cancer incidence
rate was 54 per 100,000 person-years for men, and 41 per 100,000 person-years for women.
The Southwest had the highest incidence rate among men and women, at 61 per 100,000 person-years among men, and 48 per
100,000 person-years among women.
50
Figure 37
Source: Minnesota Center for Health Statistics, Vital Statistics, rates calculated by Minnesota Cancer Surveillance System staff



From 2004 through 2008, there were 4,110 deaths resulting from colon and rectal cancer in Minnesota.
The statewide colon and rectal cancer mortality rate was 18 per 100,000 person-years for men, and 13 per 100,000
person-years for women.
The Northeast had the highest mortality rate among men, followed by the Northwest. Colon and rectal cancer mortality rates
were all approximately equal across regions for women.
51
AllCancers
Incidence rates of all cancers were approximately equal across regions
Figure 38
Source: Minnesota Cancer Surveillance System (MCSS)


Between 2004 and 2008 in Minnesota, 125,539 new cases of cancer were diagnosed, a rate of 476 per 100,000 person-years.
More men were diagnosed with cancer than women in Minnesota, with 561 new cancer cases per 100,000 person-years for
men, and 414 new cancer cases per 100,000 person-years for women.
52
The Northeast had the highest cancer mortality rate.
Figure 39
Source: Minnesota Center for Health Statistics, Vital Statistics, rates calculated by Minnesota Cancer Surveillance System staff





Cancer is the leading cause of death in Minnesota.
Between 2004 and 2008 in Minnesota, 45,584 deaths resulted from malignant cancer, a rate of 171 per 100,000 person-years.
More men died from cancer than women in all regions of Minnesota. The statewide all-cancer mortality rate was 208.7 per
100,000 person-years for men, and 147.5 per 100,000 person-years for women.
The Northeast had the highest cancer mortality rates, with 230.9 per 100,000 person-years for men and 161.2 per 100,000
person-years for women.
More information on cancer in Minnesota: http://www.health.state.mn.us/divs/hpcd/cdee/mcss/index.html.
53
ChronicDisease:Cirrhosis
The Northeast region had a cirrhosis mortality rate almost double the state average.
Figure 40
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
Source: Minnesota Center for Health Statistics, Vital Statistics


From 2006 to 2009, there were 1,483 deaths due to cirrhosis in Minnesota, a rate of 7 per 100,000 person-years.
The Northeast region had almost double the statewide rate, at 12 deaths per 100,000 person-years.
54
ChronicDisease:Diabetes
The more rural regions of the state had higher rates of mortality due to diabetes.
Figure 41
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
Source: Minnesota Center for Health Statistics, Vital Statistics



From 2006 to 2009, there were 4,344 deaths due to diabetes in Minnesota, a rate of 21 per 100,000 person-years.
The Southeast and Metro had lower diabetes mortality rates than the other regions.
More information: http://www.health.state.mn.us/diabetes/data/index.html.
55
ChronicDisease:HeartDisease
The Metro had a substantially lower heart disease mortality rate.
Figure 42
Source: Minnesota Center for Health Statistics, Vital Statistics





Heart disease was the second leading cause of death in Minnesota from 2006-2009.
From 2006 to 2009, there were 29,753 deaths due to heart disease in Minnesota, a rate of 139 per 100,000 person-years.
The Northeast had the highest rate of heart disease deaths at 181 per 100,000, followed by the Southwest and Northwest.
The Metro region had the lowest rate at 116 deaths per 100,000 person-years.
More information: http://www.health.state.mn.us/divs/hpcd/chp/cvh/Data.htm.
56
ChronicDisease:Stroke
The Southeast had the lowest mortality rate due to stroke.
Figure 43
Age-Adjusted Stroke Mortality Rate (2006-2009)
Deaths per 100,000 person-years
50
45
41
42
41
39
40
40
35
35
30
25
20
15
10
5
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
Source: Minnesota Center for Health Statistics, Vital Statistics





Stroke was the third leading cause of death in Minnesota from 2006 to 2009.
From 2006 to 2009 in Minnesota, 8,406 deaths were due to stroke, a rate of 40 per 100,000 person-years.
The Southeast had a lower stroke mortality rate than the rest of the state, at 35 deaths per 100,000 person-years.
The four most rural regions of the state had higher mortality rates than the more urban Southeast and Metro regions.
More information: http://www.health.state.mn.us/divs/hpcd/chp/cvh/Data.htm.
57
Injury
Injuries have a variety of causes, and can be classified in many different ways. Fatal injuries are often categorized into three major
groups according to intent:
1. Unintentional injury - unintentional fatal or non-fatal injury resulting from a variety of causes
2. Suicide - intentional fatal injury caused by the victim
3. Homicide - intentional fatal injury caused by another person.
In 2009, unintentional injuries, suicide and homicide were the fifth, 10th and 15th leading causes of death in the United States
respectivelyvii. In 2007, there were 182,497 deaths, 2,855,000 hospitalizations, and 29,757,000 people treated in emergency
departments for nonfatal injuriesviii,ix. In 2005, injuries cost approximately $406 billion in medical and work loss costsx. In Minnesota,
unintentional injuries are the leading cause of death among 1- to 34-year-olds. Suicide is the second leading cause of death among
15- to 34-year-olds, and homicide is the third leading cause of death among 15- to 24-year-oldsxi.
Significant progress has been made in the area of injury prevention, largely through policy measures aimed at the use of safety
equipment such as seatbelts, bicycle helmets, gun safety locks and child safety seats. Ongoing measures are in place to reduce the
number of motor vehicle injuries associated with drunk driving, and new attention is being placed on distracted driving in Minnesota,
including a new law prohibiting texting while driving that took effect in 2008. This section of the chart book presents data on
unintentional injuries, suicides and homicides in Minnesota, with specific attention paid to two types of unintentional injury: falls and
motor vehicle injuries. Rural Minnesota had a higher mortality rate resulting from motor vehicle injuries. The Southeast, Northeast,
and to some extent the Metro region had higher mortality rates resulting from falls.
More information: http://www.health.state.mn.us/injury/index.cfm
58
Homicide
The Metro had the highest homicide rate.
Figure 44
Age-Adjusted Homicide Mortality Rate (2006-2009)
Deaths per 100,000 person-years
10
9
8
7
6
5
4
3
3
2
2
2
1
1
1
1
0
Northwest
Southwest
Central
Northeast
Southeast
Region
Source: Minnesota Center for Health Statistics, Vital Statistics


From 2006 to 2009, there were 466 homicides in Minnesota, a rate of two per 100,000 person-years.
The Metro region had the most homicides with 325, a rate of three per 100,000 person-years.
Metro
59
Suicide
The Northeast and Northwest had the highest suicide rates.
Figure 45
Source: Minnesota Center for Health Statistics, Vital Statistics




From 2006 to 2009, suicide was the 10th leading cause of death in Minnesota.
From 2006 to 2009, there were 2,302 suicides in Minnesota, a rate of 11 per 100,000 person-years.
The Northeast region had the highest age-adjusted suicide rate, at 15 per 100,000 person-years, followed by the Northwest.
The Metro region had the lowest suicide rate, at 10 per 100,000 person-years.
60
UnintentionalInjury
The Northeast and Northwest had the highest mortality rate due to unintentional injury.
Figure 46
Source: Minnesota Center for Health Statistics, Vital Statistics





From 2006 to 2009, unintentional injury was the fourth leading cause of death in Minnesota.
From 2006 to 2009, there were 8,008 deaths due to unintentional injury in Minnesota, a rate of 38 per 100,000 person-years.
The Northeast had the highest rate, at 46 deaths per 100,000 person-years followed by the Northwest at 45 deaths per 100,000
person-years.
The Metro had the lowest rate at 36 per 100,000 person-years.
Together, falls and motor vehicle injuries made up 60 percent of deaths due to unintentional injury. Deaths resulting from falls
are concentrated in urban regions, while deaths due to motor vehicle injuries are concentrated in rural regions (see Figures 47
and 48).
61
DeathsduetoFalls
The more urban regions had higher mortality rates due to falls.
Figure 47
Fall Injury Deaths by Region (2006-2009)
20
Deaths per 100,000 person-years
18
16
15
14
13
14
12
12
11
12
10
8
6
4
2
0
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
Source: Minnesota Center for Health Statistics, County Health Tables. These rates could not be age-adjusted due to lack of age specific data.



From 2006 to 2009, there were 2,723 injury deaths resulting from falls in Minnesota, a rate of 13 per 100,000 people.
The Southeast had the highest rate of injury deaths due to falls, with 15 per 100,000 people.
The Southwest had the lowest rate of injury deaths due to falls, with 11 per 100,000 people.
62
MotorVehicleDeaths
The more rural regions had higher rates of motor vehicle injury deaths.
Figure 48
Motor Vehicle Injury Deaths 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
Source: Minnesota Center for Health Statistics, County Health Tables. These rates could not be age-adjusted due to lack of age specific data.



From 2006-2009 in Minnesota, 2,062 deaths were due to motor vehicle injuries, a rate of 10 per 100,000 person-years.
The Southwest had the highest rate at 18 per 100,000 person-years, followed by the Northwest at 16 per 100,000 person-years.
The Metro had the lowest rate at six per 100,000 person-years.
63
TraumaticBrainInjury(TBI)
The TBI rate was lower in the rural Northwest and Southwest.
Figure 49
Traumatic Brain Injury Rate by Region (2006-2009)
Cases per 100,000 person-years
140
120
119
120
97
100
94
83
80
63
60
40
20
0
Northwest
Southwest
Central
Northeast
Southeast
Region
Source: Minnesota Center for Health Statistics, County Health Tables. These rates could not be age-adjusted due to lack of age-specific data.




From 2006 to 2009, there were 19,651 TBIs in Minnesota, a rate of 94 per 100,000 person-years.
TBI injury rates were highest in the Northeast and Southeast.
The Northwest and Southwest had the lowest TBI rates.
More information: http://www.health.state.mn.us/injury/index.cfm.
Metro
64
Aging Populations
As Minnesota’s baby boom generation ages, health issues associated with aging will become increasingly prevalent. Identifying where
older Minnesotans live, and where health problems associated with aging occur may provide opportunities for planning and allocating
resources. Older populations have been defined in many different ways, but perhaps most frequently they include people 65 years of
age or older. This report uses two definitions: Minnesotans 65 and older and Minnesotans 85 and older. Charts in this section include
age-specific rates and denominators include only people in the age cohort represented in each individual chart.
More information: http://www.cdc.gov/aging/data/index.htm.
65
Age65andOverPopulation
In 2009, the largest populations of 65-year-olds and over were in the Northwest, Southwest and Northeast.
Figure 50
Percent of Population 65 and over (2009)
20.0
18.0
16.0
14.9
14.5
13.7
14.0
12.0
Percent
12.0
10.3
9.0
10.0
8.0
6.0
4.0
2.0
0.0
Northwest
Southwest
Central
Northeast
Region
Source: Minnesota Center for Health Statistics-US Census 2009 estimates

The Metro and Central regions had the lowest percent of the population 65 and over.
Southeast
Metro
66
Age85andOverPopulation
In 2009, the largest populations of 85-year-olds and over were in the Northwest, Southwest and Northeast.
Figure 51
Percent of Population 85 and over (2009)
4.0
3.5
3.0
3.2
2.8
2.7
2.5
Percent
2.5
2.0
1.6
1.7
1.5
1.0
0.5
0.0
Northwest
Southwest
Central
Northeast
Region

The Metro and Central regions had the lowest percent of the population 85 and over.
Southeast
Metro
67
AgingPopulations:Alzheimer’sDisease
Alzheimer’s mortality rates were highest in the Northeast and Northwest.
Figure 52
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 5,127 deaths were due to Alzheimer’s disease among people 65 and over, a rate of 198
per 100,000 person-years.
The Northeast region had the highest mortality rate due to Alzheimer’s among people 65 and over, at 287 per 100,000
person-years. This was almost two times greater than the statewide average.
The Northwest had the next highest rate, at 231 per 100,000 person-years.
68
Figure 53
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 3,516 deaths were due to Alzheimer’s disease among people 85 and over, a rate of 838
per 100,000 person-years.
The Northeast had the highest mortality rate due to Alzheimer’s among people 85 and over, at 1,178 per 100,000 person-years,
followed by the Northwest with a rate of 975 per 100,000 person-years.
Southeast and Southwest rates were much lower than the state average, at 630 and 678 per 100,000 person-years respectively.
69
AgingPopulations:Cancer
The Northeast had the highest all-cancer mortality rates in both the 65+ and 85+ age groups.
Figure 54
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 26,278 deaths were due to all types of cancer among people 65 and over, a rate of 1,033
per 100,000 person-years.
The Northeast region had the highest all-cancer mortality rate among people 65 and over, at 1,139 per 100,000 person-years.
The Southwest and Northeast regions had rates higher than the state average.
70
Figure 55
Source: Minnesota Center for Health Statistics, Vital Statistics


Between 2006 and 2009 in Minnesota, 7,078 deaths were due to all types of cancer among people 85 and over, a rate of
1,687 per 100,000 people.
The Northeast region had the highest all-cancer mortality rate among people 85 and over, at 1,863 per 100,000 person-years.
71
AgingPopulations:Diabetes
Older Minnesotans in the more rural regions had higher diabetes mortality rates.
Figure 56
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
Source: Minnesota Center for Health Statistics, Vital Statistics


Between 2006 and 2009 in Minnesota, 3,383 deaths were due to diabetes among people 65 and over, a rate of 130 per
100,000 person-years.
The Southwest had the highest diabetes mortality rate among people 65 and over, at 158 per 100,000 person-years, followed by
the Northeast at 155 per 100,000 person-years.
72
Figure 57
Diabetes Mortality Rate: Ages 85 and over (2006-2009)
Deaths per 100,000 person-years
450
430
410
396
390
362
370
352
350
339
330
310
290
281
283
270
250
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 1,346 deaths were due to diabetes among people 85 and over, a rate of 321 per
100,000 people.
The Central region had the highest diabetes mortality rate among people 85 and over, at 396 per 100,000 person-years.
The Southeast and Metro regions had diabetes rates substantially lower than the other regions.
73
AgingPopulations:HeartDisease
Older Minnesotans in the more rural regions had higher heart disease mortality rates.
Figure 58
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
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 24,853 deaths were due to heart disease among people 65 and over, a rate of 961 per
100,000 person-years.
The Northeast had the highest heart disease mortality rate among people 65 and over, at 1,257 per 100,000 person-years,
followed by the Southwest at 1,229 per 100,000 person-years.
The Metro region had a much lower rate than the other regions, at 775 per 100,000 person-years.
74
Figure 59
Heart Disease Mortality Rate: Ages 85 and over (2006-2009)
Deaths per 100,000 person-years
4500
4300
4100
3930
3900
3671
3700
3500
3615
3451
3410
3300
3100
2801
2900
2700
2500
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 13,711 deaths were due to heart disease among people 85 and over, a rate of 3,268 per
100,000 people.
The Northeast had the highest heart disease mortality rate among people 85 and over, at 3,930 per 100,000 person-years,
followed by the Southwest at 3,671 per 100,000 person-years.
The Metro region had a much lower rate than the non-Metro regions, at 2,801 per 100,000 person-years.
75
AgingPopulations:PneumoniaandInfluenza
Older Minnesotans in the more rural regions had higher mortality due to pneumonia and influenza.
Figure 60
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
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 2,290 deaths were due to pneumonia and influenza among people 65 and over, a rate of
89 per 100,000 person-years.
The Southwest had the highest rate, 107 per 100,000 person-years, followed by the Central region at 105 per 100,000
person-years.
The Metro region had a much lower rate than the non-Metro regions, at 71 per 100,000 person-years.
76
Figure 61
Pneumonia and Influenza Mortality Rate: Ages 85 and over (2006-2009)
Deaths per 100,000 person-years
500
455
450
408
400
386
381
392
350
297
300
250
200
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 1,516 deaths were due to pneumonia and influenza among people 85 and over, a rate of
361 per 100,000 person-years.
The Central region had the highest rate, 455 per 100,000 person-years.
The Metro region had a much lower rate than the non-Metro regions, at 297 per 100,000 person-years.
77
AgingPopulations:Stroke
The Southwest region had the highest rate of stroke mortality among the 65+ age group.
Figure 62
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
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 7,509 deaths were due to stoke among people 65 and over, a rate of 290 per 100,000
person-years.
The Southwest region had the highest rate, 348 per 100,000 person-years.
Stroke mortality rates among people 65 and over were higher in the more rural regions.
78
Figure 63
Stroke Mortality Rate: Ages 85 and over (2006-2009)
Deaths per 100,000 person-years
1200
1150
1127
1100
1050
1072
1048
979
1000
963
950
925
900
850
800
Northwest
Southwest
Central
Northeast
Southeast
Metro
Region
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 4,238 deaths were due to stroke among people 85 and over, a rate of 1,010 per 100,000
person-years.
The Central region had the highest rate, 1,127 per 100,000 person-years.
Stroke mortality rates among people 85 and over were higher in the more rural regions, except the Northeast, which had rates
somewhat lower than the Metro.
79
AgingPopulations:UnintentionalInjury
The Metro, Southeast and Central regions had higher unintentional injury mortality rates among the 65+
age group and the 85+ age group, with a larger difference in the 85+ age group.
Figure 64
Unintentional Injury Mortality Rate: Ages 65 and over (2006-2009)
200
Deaths per 100,000 person-years
180
160
140
153
149
128
131
Northwest
Southwest
155
137
120
100
80
60
40
20
0
Central
Northeast
Southeast
Metro
Region
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 3,773 deaths were due to unintentional injury among people 65 and over, a rate of 146
per 100,000 person-years.
The Metro had the highest rate, 155 per 100,000 person-years, followed by the Southeast at 153 per 100,000 person-years.
The Northwest had the lowest rate at 128 per 100,000 person-years.
80
Figure 65
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
Source: Minnesota Center for Health Statistics, Vital Statistics



Between 2006 and 2009 in Minnesota, 2,041 deaths were due to unintentional injury among people 85 and over, a rate of
486per 100,000 person-years.
The Metro had the highest rate, 564 per 100,000 person-years, followed by the Central region at 516 per 100,000 person-years.
The Southwest had the lowest rate at 349 per 100,000 person-years.
81
Regional Summaries
In order to generate this chart book, a large amount of data was compiled from many different sources. Each of the charts conveyed
specific information about demographics, health behaviors, and diseases. All these pieces of information converge to provide a general
picture of regional health status, but they are not necessarily causally related to each other. Summaries of the data for each of the six
regions follow.
Northwest











Mostly small rural or isolated rural population
Highest percentage American Indian/Alaskan Native population
Fewer people with at least some college than the state average
High percent of population over 65
Highest infant mortality rate in state (still lower than national average)
Highest percentage of people without health insurance
High unintentional injury mortality rate
High rate of mortality due to motor vehicle injuries
Lowest traumatic brain injury rate
Low unintentional injury mortality in 85+ populations
High Alzheimer’s disease mortality rate
82
Southwest














Mostly small rural or isolated rural population
Relatively large Hispanic/Latino community
Lowest percentage of people with at least some
college
High percent of population over 65
Highest percentage of people reporting “fair” or
“poor” health
Low percentage of people without health insurance
High rates of foodborne illness
Relatively high rates of diabetes mortality
Relatively high rates of heart disease mortality
Highest rate of motor vehicle injury deaths
Relatively low traumatic brain injury rates
Low Alzheimer’s Disease mortality rate
Low unintentional injury mortality rate in
85+ population
High diabetes, heart disease and stroke mortality rates in 65+ population
83
Central







Fewer people with at least some college than the state average
Highest asthma hospitalization and emergency department visit rate
Highest rate of pneumonia and influenza mortality
Highest prostate cancer incidence rate
Highest diabetes and stroke mortality rates in 85+ population
Highest pneumonia and influenza mortality rate in 85+ population
High unintentional injury rate in 85+ population
84
Northeast













High percent of population over 65
Relatively high percentage of people reporting “fair” or “poor” health
Highest overall mortality rate
Low rates of foodborne illness
High asthma hospitalization and emergency department visit rate
High rate of cancer mortality
Highest rate of cirrhosis mortality
Highest rates of diabetes and heart disease mortality
Highest suicide rate
Highest unintentional injury mortality rate
High mortality due to falls
High traumatic brain injury rates
High mortality rates from Alzheimer’s disease, cancer and heart disease among older population
85
Southeast








Mostly urban or large rural population
Low mortality rates due to cancer
High rate of campylobacter infection
Low incidence of prostate cancer
Low diabetes and stroke mortality rates
High mortality due to falls
High traumatic brain injury rate
Low mortality rates from Alzheimer’s disease, diabetes and stroke among older population
86
Metro
















All urban population
Larger minority population than other regions
More people with at least some college than the state average
Fewer people report “fair” or “poor” health than other regions
Fewer people uninsured than in other regions
High rate of chlamydia, gonorrhea and HIV/AIDS infection
Low pneumonia and influenza mortality rate
High asthma hospitalization and emergency department visit rate
Low rates of heart disease mortality
High homicide rate
Low suicide rate
High mortality due to falls
Low mortality due to motor vehicle injuries
Low heart disease and diabetes mortality rates in older population
High unintentional injury mortality rate in 85+ population
Lower percentage of residents obese than in other regions
87
Key Findings
Some clear differences exist in rural regions compared to urban regions:













Fewer people with at least some college
More people reported “fair” or “poor” health
More people reported being current smokers
More people were identified as obese
Fewer people reported exercising in the previous month
More people were uninsured
Lower rates of chlamydia, gonorrhea and HIV/AIDS infection
Higher mortality rates due to pneumonia and influenza, especially in the older population
Higher diabetes, stroke and heart disease mortality rates
Lower homicide rates
Higher suicide rates
Lower unintentional injury mortality rates
Higher mortality due to motor vehicle injury.
88
Conclusion
This report is intended to generate awareness among policymakers, primary and rural health care providers, public health officials and
concerned community members about the importance of examining rural and regional disparities. Many presentations of rural health
data focus on measuring the scarcity of health care services in rural areas. Data on health care resources has been very important in
developing policies that improve rural health care delivery; however, policies and practice around allocating health care resources can
be better understood in light of a complete picture of population health. This picture includes information about disparities in the
health status of specific populations within Minnesota. Identifying and documenting these disparities in health status provides
important information about how best to evaluate state and local health promotion and disease prevention activities.
Minnesota is frequently ranked as one of the healthiest states in the nation, despite considerable differences in the health of
Minnesotans in distinct regions of the state. These disparities may exist for a variety of reasons, including the rurality of the region.
Regardless of their causes, the first step in eliminating disparities and improving population health is identifying where they exist.
This chart book provides a snapshot of regional health in Minnesota. Caution should be used in interpreting the meaning of these data,
and no assumptions based on this report alone should be made as to the causes of potential health disparities. Rather, regional health
differences should raise questions and prompt further inquiry to determine the nature and scope of the problem, and then policies and
actions can be directed more effectively to provide a solution.
89
Glossary
Age-Adjusted Rate – A summary measure that helps to control for age differences among populations. A weighted average, called
the “direct method,” is used to adjust for age in this analysis. The U.S. 2000 standard population is used as the basis for weight
calculations. Age-adjusted rates are useful when comparing the rates of two population groups that have different age distributions.
Campylobacteriosis – An infection caused by bacteria of the genus Campylobacter. These bacteria live in the intestines of healthy
birds. Most raw poultry meat commonly has Campylobacter. Campylobacter is one of the most common bacterial causes of diarrheal
illness in the United States and is the most commonly reported bacterial enteric pathogen in Minnesota.
Chlamydia – The most commonly reported sexually transmitted bacterial infection in Minnesota and the United States. It is caused by
Chlamydia trachomatis, a bacterium that can infect the penis, vagina, cervix, anus and urethra. It can also infect the eyes or lungs of
children at the time of birth. Chlamydia is curable with antibiotics.
Giardiasis – A diarrheal illness caused by Giardia intestinalis (also known as Giardia lamblia), a one-celled, microscopic protozoan
parasite that lives in the intestines of people and animals. During the past two decades, Giardia has become recognized as one of the
most common causes of waterborne disease (drinking and recreational) in humans in the United States.
Gonorrhea – Caused by the bacteria Neisseria gonorrhea, which can infect the soft skin covering the urethra, vagina, cervix, anus
and the throat. Gonorrhea can be cured with antibiotics.
Human Anaplasmosis – A bacterial disease transmitted to humans by Ixodes scapularis (blacklegged tick or deer tick), the same tick
that transmits Lyme disease. The tick must be attached at least 12-24 hours to transmit the bacteria. Not all ticks carry these bacteria.
Person-Years – A unit of a denominator indicating one person at risk for a particular disease or outcome for one year. For rates
spanning multiple years, one person may contribute more than one person-year to the denominator. For example, the overall mortality
rate for Minnesota from 2004-2008 was 678 deaths per 100,000 person-years, or put another way, 678 deaths per 100,000 persons per
year. A person who lived in Minnesota from 2004 through 2008 would have contributed five person-years to the denominator. If a
person moved away from Minnesota at the end of 2005 and a new person moved into Minnesota at the beginning of 2006 through
2008, the former person would have contributed two person-years and the latter person would have contributed three person-years for
a total of five person years.
Salmonellosis – An infection with a bacteria called Salmonella. Salmonella live in the intestinal tracts of animals, including birds.
Salmonella are usually transmitted when humans eat foods contaminated with animal feces.
90
Works Cited
i
Minnesota Department of Health. (2005). Health and Well-being of Rural Minnesotans: A Minnesota Rural Health Status Report.
http://www.health.state.mn.us/divs/orhpc/pubs/hwb.pdf.
ii
Minnesota Department of Health. (2005). Health and Well-being of Rural Minnesotans: A Minnesota Rural Health Status Report.
http://www.health.state.mn.us/divs/orhpc/pubs/hwb.pdf.
iii
Hart GL, Larson EH, Lishner DM. (2005). Rural Definitions for Health Policy and Research. American Journal of Public Health. 2005;95(7):1149-1155.
iv
Kaplan GA, Camacho T. (1983). Perceived health and mortality: a nine year follow-up of the Human Population Laboratory cohort. Am J Epidemiol 1983;
117:292-304.
v
Franks P, Clancy CM, Gold MR. Health Insurance and Mortality: Evidence From a National Cohort. JAMA. 1993; 270(6):737-741.
vi
CDC (2009). Trends in Sexually Transmitted Diseases in the United States: 2009 National Data for Gonorrhea, Chlamydia and Syphilis.
http://www.cdc.gov/std/stats09/tables/trends-table.htm.
vii
Kochanek K, Xu J, Murphy SL, Minino AM, Kung HC. (2011) Deaths: Preliminary Data for 2009. National Vital Statistics Reports, Vol. 59, No.4.
http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_04.pdf.
viii
Centers for Disease Control and Prevention, National Center for Health Statistics (NCHS). National hospital discharge survey: 2007 summary. National health
statistics reports, no. 29. Atlanta, GA: NCHS; 2010.
ix
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System
(WISQARS) [online] (2007) [cited 2011 Mar 4]. Available from URL: http://www.cdc.gov/injury/wisqars.
x
Finkelstein EA, Corso PS, Miller TR, Associates. Incidence and economic burden of injuries in the United States. New York, NY: Oxford University Press;
2006.
xi
Minnesota Department of Health, Injury and Violence Prevention Unit (2011). http://www.health.state.mn.us/injury/pub/leading_causes_of_death19992008.pdf
Minnesota Department of Health-Office of Rural Health and Primary Care P O Box 64882 St. Paul, MN 55164-0882
http://www.health.state.mn.us/divs/orhpc/
Updated November 2011