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KEY TRENDSFROMAMERICA’SHEALTHRANKINGSNovember 27, 2018

2

Annual ReportSince 1990

Seniors Aged 65+Since 2013

Women and ChildrenSince 2016

Those Who Have ServedSince 2016

Overview of America’s Health Rankings

Visit AmericasHealthRankings.org

BehaviorsCommunity &

Environment

PolicyClinical

Care

Health

Outcomes

3

America’s Health Rankings Model

Challenges

Behaviors

• High Rate of Drug Deaths

• High Prevalence of Smoking - All Adults

• High Tobacco Use During Pregnancy

• High Prevalence of Obesity

• High Physical Inactivity – Adults and Among Seniors

Policy

• Low Maternity Practices in Infant Nutrition

and Care (mPINC) Value

Clinical Care

• High Rate of Preventable Hospitalizations

Outcomes

• High Rate of Cancer Deaths

• High Premature Death Rate

• High Rate of Drug Deaths Among Women

• High Prevalence of Diabetes – All Adults and Among

Women

Community & Environment

• High Rate of Household Smoke

• Low Nursing Home Quality Scores

Strengths

Behaviors

• Low Excessive Drinking Rates – Adults and Among

Seniors

• High School Graduation Rate

• Low Substance Dependence Among Adolescents

• Low Chlamydia Rate

Policy

• Low Uninsured Rate

• Low-Care Nursing Home Residents

Clinical Care

• High Women and Adolescent Well-Visits

• High Diabetes Management Participation Among Seniors

Outcomes

• Low Disparity in Health Status

• Low Number of Children Missing School


• Low Violent Crime

• Low Cost of Infant Child Care

4

Kentucky’s Strengths & Challenges

Positive and Negative Drivers Across Populations

-0.18 -0.16 -0.14 -0.12 -0.1 -0.08 -0.06 -0.04 -0.02 0

Smoking

Frequent Physical Distress

Cancer Deaths

Premature Death

Preventable Hospitalizations

Obesity

Frequent Mental Distress

Diabetes

Physical Inactivity

Cardiovascular Deaths

Drug Deaths

5

Behaviors

Policy

Clinical Care

Outcomes


Key Drivers in Kentucky’s 2017 Annual Rank

Negative Impacts on Kentucky’s 42nd Place Ranking

-0.1 -0.09 -0.08 -0.07 -0.06 -0.05 -0.04 -0.03 -0.02 -0.01 0

Tobacco Use During Pregnancy

Household Smoke

Intimate Partner Violence - Lifetime

Drug Deaths - Women

Food Insecurity - Household

Breastfed

Diabetes - Women

Tobacco Use - Youth

mPINC

Neighborhood Amenities

6

Behaviors

Policy

Clinical Care

Outcomes


Key Drivers in Kentucky’s 2018 Health of Women and Children Rank

Negative Impacts on Kentucky’s 42nd Place Ranking

7

KEY FINDINGS ON KENTUCKY’S HEALTH

Outcomes, Risk and Protective Factors,

Preventive Services and Access

8

Mortality: Key Findings

Bright Spots

• Compared with the U.S., the maternal mortality rate in Kentucky is

similar to the U.S. rate in most subpopulations and lower among

black women.

Challenges Related to Key Mortality Findings

• The premature death rate in Kentucky is 1.8 times higher than that

of the top-ranked state (10,042 years lost before age 75 per

100,000 population in Kentucky compared to 5,555 years lost

before age 75 per 100,000 population in the top-ranked state).

• From 2016 to 2018, drug deaths increased 27% from 23.0 to 29.1

deaths per 100,000 females aged 15-44.

• The infant mortality rate (6.9 deaths per 1,000 live births) is higher

than the national average (5.9 deaths per 1,000 live births).

• Early death among seniors is 35% higher (2,418 deaths per

100,000 adults aged 65 to 74) than the national average (1,789

deaths per 100,000 adults aged 65 to 74).

Key Measures

Outcomes

• Premature Death

• Drug Deaths

• Drug Deaths Among Women

• Early Death Among Seniors

• Infant Mortality

• Cardiovascular Deaths

• Cancer Deaths

• Suicide

• Teen Suicide

• Maternal Mortality

9

Women’s Reproductive Health: Key Findings

Bright Spots

• Compared with the U.S., there are 211.4 fewer cases per 100,000

of chlamydia among women aged 18-44.

• Rates of adolescent well-visits, baby-friendly facilities, and

dedicated health care providers among women are higher

in Kentucky than the U.S. average.

• Other than Tennessee (-2.9 births per 1000/year), Kentucky had a

faster rate of decline in teen birth rates (-2.6 births per 1,000/year)

compared to neighboring states and the U.S.(-2.5 births per

1,000/year) over the past 10 years.

• Low uninsured rate among women (6.6% of women aged 18-44).

Challenges Related to Key Findings of

Women’s Reproductive Health

• Compared with the U.S., low birthweight infants are 0.6 percentage

points higher overall, 0.6 percentage points higher among black

mothers and 1.3 percentage points higher among white mothers.

• Low-risk cesarean delivery is 1.6 percentage points higher overall

and is 2.2 percentage points higher among white women.

• Breastfed, Maternity Practices in Infant and Nutrition Care Survey

Score (mPINC), and tobacco use during pregnancy are all

challenges, ranking in the bottom 10 (unhealthiest) states.

Key Measures

Outcomes

• Chlamydia (Women)

• Low Birthweight

• Low-Risk Cesarean Delivery

• Maternal Mortality

• Preterm Birth

• Teen Births

Risk Factors and Protective Factors

• Baby-Friendly Facility

• Breastfed

• Maternity Practices in Infant

and Nutrition Care Survey Score

(mPINC)

• Tobacco Use During Pregnancy

• Adolescent Well-Visit

Preventive Services

• Prenatal Care Before 3rd Trimester

• Well-Woman Visit

• Dedicated Health Care Provider

(Women)

Bright Spots

• Kentucky ranks in the top 10 healthiest states for youth

substance use disorder and has a lower prevalence

than the U.S.

• Compared with neighboring states, Kentucky has more

mental health providers per 100,000 population.

Challenges Related to Key Mental Health Findings

• The prevalence of frequent mental distress is higher

than any of its neighboring states and the U.S.

• Teen suicide is also higher in Kentucky than

neighboring states and 22% higher than the U.S.

• Kentucky ranks in the bottom 10 for adverse childhood

experiences, concentrated disadvantage, food

insecurity, and risk of social isolation. Protective family

routines and habits is also an area of challenge.

10

Mental Health: Key Findings

Key Measures

Outcomes

• Frequent Mental Distress

• Teen Suicide

Risk Factors

• Adverse Childhood Experiences

• Concentrated Disadvantage

• Food Insecurity

• Substance Use Disorder (Youth)

• Risk of Social Isolation (Seniors)

Protective Factors

• Mental Health Providers

• Neighborhood Amenities

• Protective Family Routines

and Habits

11

Health Behaviors: Key Findings

Bright Spots

• Excessive drinking is lower in Kentucky at 15.8% of adults than the

U.S. (18.5% of adults) and all neighboring states except Tennessee

and West Virginia.

• Adolescents report low rates of dependence or abuse of illicit drugs

or alcohol in the past year (4.1% of children aged 12-17).

• Kentucky has the 7th best high school graduation rate in the nation.

Challenges Related to Health Behaviors

• Obesity prevalence is higher among females, whites, adults aged

65+, all urbanicities, and among those with less than high school

and college graduates than any of its neighboring states.

• Compared with the U.S., household smoke, smoking, and youth

tobacco use are all higher in Kentucky. HPV immunizations for

males and females are also lower than the US.

Key Measures

Risk Factors

• Excessive Drinking

• Obesity

• Physical Inactivity

• Smoking

• Household Smoke and Tobacco

Use (Youth)

• Substance Use Disorder – Youth

• HPV Immunizations

12

TAKING ACTIONHow United Health Foundation is Addressing Challenges

Improving Oral Health in Kentucky

United Health Foundation is supporting the University of Kentucky College of

Dentistry (UKCD) in its “Eradicate Oral Cancer in Eastern Kentucky” project

The three-year project will:

Raise public awareness of the symptoms of oral cancer and its links to heavy

alcohol and tobacco use

Provide approximately 1,000 oral cancer screenings at local health departments;

Help connect patients who need additional care to cancer specialists in Lexington; and

Enable UKCD to lead an integrated outreach and care program to local residents

Expanding Access to Mental Health Services in Kentucky

Pathways and the United Health Foundation have recently launched a new

partnership to improve mental health care in eastern Kentucky

The three-year project will expand mental health services for over 3,000 children in eastern

Kentucky using telehealth technology

• Telehealth technology will be installed at 16

locations across a 10-county service area

• The new technology will eliminate the need for

families to drive up to two hours to access a

children’s mental health specialist

THANK YOUExplore Data.

Gain Insights.

Learn more about your state.

VISIT: www.AmericasHealthRankings.org

16

APPENDIXSupporting Information

-0.12 -0.1 -0.08 -0.06 -0.04 -0.02 0

Smoking

Pain Management

Early Death

Able-bodied

Physical Inactivity

High Health Status

Dental Visit

Teeth Extractions

Hip Fractures

Nursing Home Quality

17

Behaviors

Policy

Clinical Care

Outcomes


Key Drivers in Kentucky’s 2018 Health of Seniors Rank

Negative Impacts on Kentucky’s 48th Place Ranking

18

MENTALHEALTHOutcomes, Risk Factors and Protective Factors

US IN OH TN VA KY

Overall 11.7 13.2 12.9 13.7 10.9 14.7

Female 13.6 14.8 15.8 16.8 13.2 17.5

Male 9.7 11.5 9.8 10.3 8.4 11.8

Amer. Indian / Alaskan Native 19.9 29.6 28.4

Black 12.4 13.9 14.3 15.4 11.0 16.1

White 11.8 13.3 12.5 13.0 11.2 14.3

Multiracial 20.0 10.2 21.8 31.6 16.5 26.6

Aged 18-44 12.9 15.2 15.3 14.0 13.3 17.0

Aged 45-64 12.5 14.2 14.0 16.6 10.4 15.5

Aged 65+ 7.3 6.8 6.2 8.3 6.0 8.4

Rural 11.2 9.2 11.2 15.3 10.9 15.3

Suburban 10.0 11.5 10.2 10.9 8.4 12.3

Urban 10.1 12.3 11.1 13.9 7.9 10.9

Less than High School* 17.1 19.6 25.1 26.5 13.7 25.2

High School Grad* 12.3 12.9 13.3 13.6 11.5 15.1

Some College* 12.0 13.2 13.0 12.7 10.9 14.0

College Grad* 6.8 6.7 6.7 7.0 6.4 6.3

Less Than $25,000* 19.7 21.3 25.7 25.2 19.4 26.4

$25-$49,999* 11.1 11.5 11.4 11.6 8.9 13.2

$50-$74,999* 8.4 8.9 7.7 8.4 7.8 8.9

$75,000 or More* 6.2 6.9 6.2 6.0 5.9 6.3

19

Mental Health Outcomes: Frequent Mental Distress

In Kentucky and Peer States

Source: CDC, Behavioral Risk Factor Surveillance System, 2016

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

FREQUENT MENTAL DISTRESSPercentage of adults who reported their mental health was not good 14 or more days in the past 30 days

*Aged 25+

At-Risk Populations

in Kentucky

• Female

• Aged 18-44

• Less than high school

• Income less than $25,000

Comparing Kentucky to the

U.S. and Neighboring States

• Overall frequent mental distress

prevalence is higher than any of its

neighboring states and the U.S.

• Compared with the U.S., frequent

mental distress is higher among all

subpopulations except college

graduates.

• Compared with neighboring states,

frequent mental distress prevalence

is lower among college graduates.

20

Mental Health Outcomes: Teen Suicide


At-Risk Populations

in Kentucky

• Males

• White teens



• Compared with neighboring states

and the U.S., teen suicide is higher

among males and whites (all

available subpopulations).

TEEN SUICIDENumber of deaths by suicide per 100,000 adolescents aged 15 to 19

Source: CDC, National Vital Statistics System, 2014-2016

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

US IN OH TN VA KY

Overall 8.9 9.9 9.1 11.2 9.8 11.9

Female 4.8 4.9 5.0 4.7 5.3

Male 14.0 14.7 13.1 17.5 14.2 19.8

Black 5.5 7.4 8.0 5.5

White 10.4 10.5 9.5 12.3 11.7 12.5

21

Mental Health Risk Factors


Sources: CAHMI, Data Resource Center for Child and Adolescent Health,

National Survey of Children’s Health, 2016; U.S. Census Bureau, American

Community Survey, 2012-2016; U.S. Department of Agriculture,

Current Population Survey Food Security Supplement, 2014-2016; Substance

Abuse and Mental Health Services Administration (SAMHSA), National

Survey on Drug Use and Health, 2015-2016



• Compared with the U.S., adverse

childhood experiences,

concentrated disadvantage, and

food insecurity are challenges.

• Kentucky ranks in the top 10

healthiest states for youth

substance use disorder and has a

lower prevalence the the U.S.

• Compared with all states, Kentucky

ranks in the bottom 10 for adverse

childhood experiences,

concentrated disadvantage, food

insecurity, and risk of social

isolation.

• For these four risk factors, Kentucky

is more challenged than its

neighboring states with the

exception of adverse childhood

experiences in Ohio.

US IN OH TN VA KY

Adverse Childhood Experiences

(% of children aged 0-17

with 2+ experiences)

21.7 24.2 27.1 24.6 19.3 26.9

Concentrated Disadvantage

(% of households)23.8 19.3 23.1 24.9 11.7 27.8

Food Insecurity

(% of households)13.0 15.2 14.8 13.4 9.9 17.3

Substance Use Disorder – Youth

(% of children aged 12-17)4.6 4.2 4.3 4.0 3.7 4.1

Risk of Social Isolation – Seniors

(Percentile of mean z scores

for six social isolation risk factors

in adults 65+)

51.0 63.0 79.0 28.0 93.0

Top 10 11 to 20 21 to 30 31 to 40 Bottom 10

RISK FACTORSShaded by quintile of measure rank

22

Mental Health Protective Factors




• Compared with the U.S., mental

health providers, neighborhood

amenities, and protective family

routines and habits are challenges.


Kentucky has more mental health

providers per 100,000 population.

• Kentucky has the lowest percentage

of neighborhood amenities compared

with neighboring states.


only Ohio has a lower percentage of

protective family routines and habits.

US IN OH TN VA KY

Mental Health Providers

(# per 100,000 population)218.0 144.2 182.5 138.2 145.2 194.6

Neighborhood Amenities

(% of children aged 0-17)38.6 26.4 35.5 23.7 34.3 19.0

Protective Family

Routines and Habits

(% of children aged 0-17)

12.2 13.0 10.6 12.1 13.2 11.3

PROTECTIVE FACTORSShaded by quintile of measure rank

Sources: U.S. HHS, Centers for Medicare & Medicaid Services, National Plan and Provider Enumeration System, 2016; U.S. Census Bureau, Annual Estimates of the

Resident Population: April 1, 2010 to July 1, 2016, 2016; CAHMI, Data Resource Center for Child and Adolescent Health, National Survey of Children’s Health, 2016;

CAHMI, Data Resource Center for Child and Adolescent Health, National Survey of Children’s Health, 2016


23

WOMEN’SREPRODUCTIVEHEALTHOutcomes, Risk and Protective Factors,

Preventive Services and Access

US IN OH TN VA KY

Overall 1,609.0 1,546.8 1,758.1 1,597.8 1,388.8 1,397.6

Black 3,198.2 4,763.7 4,153.2 4,061.3 2,733.8 3,508.9

Hispanic 1,140.9 1,157.4 908.4 1,215.4 636.8 895.1

White 712.7 982.1 746.8 973.8 582.0 696.3

24

Reproductive Health Outcomes: Chlamydia (Women)


Source: Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, NCHHSTP AtlasPlus, 2015

At-Risk Populations

in Kentucky

• Black women



• There are 211.4 fewer cases per

100,000 of chlamydia among women

overall, and incidence is lower

among all race groups except black

women.

• Chlamydia incidence among women

is lower overall and in each race

group than neighboring states

Indiana, Ohio, and Tennessee.

• Chlamydia incidence is higher

overall and in each race group than

in Virginia.

CHLAMYDIA (WOMEN)Number of new cases of chlamydia per 100,000 females aged 15 to 44

250+ LessThan KY

100-250 LessThan KY

Within 100of KY

100-250 MoreThan KY

250+ MoreThan KY

25

Reproductive Health Outcomes: Low Birthweight


Source: CDC, National Vital Statistics System, 2015

At-Risk Populations

in Kentucky

• Infants born to black mothers

• Infants born to mothers aged 40-44



• Compared with the U.S., the

percentage of low birthweight infants

is higher overall, and among black

and white mothers, but not Hispanic

mothers, and among mothers of all

age groups except those aged 15-19.


the percentage of low birthweight

infants among Hispanic mothers is

lower than all except Virginia.



infants is higher among white

mothers.



infants is lower among mothers

aged 15-19.

US IN OH TN VA KY

Overall 8.1 8.0 8.5 9.2 7.9 8.7

Black 13.3 12.4 13.9 14.7 12.2 13.9

Hispanic 7.2 7.1 7.7 6.8 6.4 6.5

White 6.9 7.4 7.3 7.8 6.6 8.2

Mother Aged 15-19 9.5 9.2 10.0 10.4 9.9 8.7

Mother Aged 20-24 8.4 8.4 9.3 9.6 8.7 9.4

Mother Aged 25-29 7.5 7.3 7.9 8.6 7.7 8.0

Mother Aged 30-34 7.5 7.8 7.4 8.3 6.8 8.3

Mother Aged 35-39 8.7 8.5 9.5 10.0 7.8 8.8

Mother Aged 40-44 10.8 10.3 10.6 11.5 10.2 11.8

LOW BIRTHWEIGHTPercentage of infants weighing less than 2,500 grams (5 pounds, 8 ounces) at birth

2%+ LessThan KY

1-2% LessThan KY

Within 1%of KY

1-2% MoreThan KY

2%+ MoreThan KY

26

Reproductive Health Outcomes: Low-Risk Cesarean Delivery


At-Risk Populations

in Kentucky

• Black women



• Compared with the U.S., low-risk

cesarean delivery is higher overall

and among Hispanic and white

women.

• Kentucky has a higher percentage of

births through low-risk cesarean

delivery overall and across all

subpopulations, compared with

Indiana, Ohio, and Virginia.

US IN OH TN VA KY

Overall 25.8 22.9 24.2 27.6 25.1 27.4

Black 29.7 26.0 27.3 30.4 28.6 29.9

Hispanic 25.2 19.0 20.7 24.2 22.8 27.2

White 24.8 22.6 23.7 27.1 23.4 27.0

LOW-RISK CESAREAN DELIVERYPercentage of singleton, term (37 or more weeks gestation), vertex (non-breech) cesarean deliveries to women

having their first birth per 100 women delivering singleton, term, vertex, first births


5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

27

Reproductive Health Outcomes: Maternal Mortality


Source: CDC, National Vital Statistics System, 2011-2015

At-Risk Populations

in Kentucky

• Black women

• Women aged 35-44




maternal mortality rate in Kentucky

is similar to the U.S. rate in most

subpopulations.

• Compared with the U.S., maternal

mortality is lower among black

women and higher among women

aged 35-44.

• The maternal mortality rate among

black women is lower than Indiana

and Ohio, but higher than Tennessee

and Virginia.

• Maternal mortality among women

aged 35-44 is higher than all

neighboring states, except Indiana.

US IN OH TN VA KY

Overall 20.7 41.4 20.3 23.3 15.6 19.4

Black 47.2 53.4 46.0 38.2 36.6 42.1

White 18.1 41.6 15.6 20.8 11.0 17.2

Aged 15-24 11.0 13.1 14.2 8.7 9.1

Aged 25-34 14.0 22.9 15.2 19.2 10.9 15.4

Aged 35-44 38.5 100.6 33.0 54.4 29.5 61.1

MATERNAL MORTALITYNumber of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during

pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 births

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

28

Reproductive Health Outcomes: Preterm Birth


CDC, National Vital Statistics System, 2015

At-Risk Populations

in Kentucky

• Infants born to black mothers

• Infants born to mothers aged 35-39

and aged 40-44



• Compared with the U.S., preterm

births are slightly higher overall and

among white mothers.

• Preterm births are higher for white

mothers and mothers aged 30-34,

aged 35-39, and aged 40-44,

compared with Virginia.

• Like the U.S. and neighboring states,

preterm birth in Kentucky is less

prevalent among women who have

graduated from college.

US IN OH TN VA KY

Overall 9.6 9.6 10.3 11.0 9.2 10.8

Black 13.4 12.8 14.1 14.8 12.6 13.3

Hispanic 9.1 9.3 10.5 9.2 8.4 8.9

White 8.9 9.2 9.4 10.2 8.3 10.7

Mother Aged 15-19 9.9 10.0 10.9 11.4 10.6 9.5

Mother Aged 20-24 9.3 9.2 10.3 10.7 9.2 10.9

Mother Aged 25-29 8.9 9.1 9.7 10.1 8.7 10.3

Mother Aged 30-34 9.3 9.8 9.5 10.7 8.6 10.6

Mother Aged 35-39 11.1 11.0 12.2 13.8 10.1 12.5

Mother Aged 40-44 13.7 12.0 14.2 14.8 12.8 15.4


High School Graduate* 10.3 10.1 11.2 12.0 10.5 11.6

Some College* 10.0 9.8 10.7 11.3 9.7 11.1

College Graduate* 8.6 8.4 8.9 9.2 8.1 9.6

PRETERM BIRTHPercentage of live births before 37 weeks gestation

2%+ LessThan KY

1-2% LessThan KY

Within 1%of KY

1-2% MoreThan KY

2%+ MoreThan KY

*Aged 25+

29

Reproductive Health Outcomes: Teen Births





• While Kentucky has a higher teen

birth rate at 30.9 per 1,000 live births

compared with the U.S at 20.3 per

1,000 live births, teen births have

declined at a faster rate in Kentucky

(-2.6 births per 1,000/year) compared

to the U.S.(-2.5 births per 1,000/year)

over the past 10 years.


Kentucky has a higher teen birth rate

(neighboring states range from 15.5

per 1,000 live births in Virginia to 28.0

per 1,000 live births in Tennessee).

• Compared to neighboring states, only

Tennessee had a larger decrease in

teen births over the past 10 years

(-2.9 births per 1,000/year).

• The other neighboring states all

declined at the same rate (-2.2 births

per 1,000/year).

TEEN BIRTHSTeen females aged 15-19 birth rate per 1,000 live births

U.S. Kentucky Indiana Ohio Tennessee Virginia

0

10

20

30

40

50

60

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Edition Year (two-year lag)

30

Reproductive Health: Risk and Protective Factors




• Compared with the U.S., adolescent

well-visit and baby-friendly facility are

higher than the national value.

• Breastfed, Maternity Practices in Infant

and Nutrition Care Survey Score

(mPINC), and tobacco use during

pregnancy are all challenges, ranking

in the bottom 10 (unhealthiest) states.


Kentucky has a higher prevalence of

tobacco use during pregnancy.

Sources: CAHMI, Data Resource Center for Child and Adolescent Health,

National Survey of Children’s Health, 2016; CDC, 2016 Breastfeeding Report

Card, 2016; CDC, National Center for Chronic Disease Prevention and Health

Promotion, Division of Nutrition, Physical Activity and Obesity, National

Immunization Survey, 2014; CDC, 2016 Breastfeeding Report Card, 2015;

CDC, National Vital Statistics System, 2015

US IN OH TN VA KY

Adolescent Well-Visit

(% of children aged 12-17)78.9 81.1 78.1 79.4 79.7 81.8

Baby-Friendly Facility

(% of live births)18.3 23.1 18.1 11.2 12.9 20.3

Breastfed

(% of infants)24.9 23.1 16.7 17.1 21.7 18.5

mPINC

(Maternity Practices in Infant and

Nutrition Care survey score)

79.0 80.0 80.0 72.0 80.0 73.0

Tobacco Use During Pregnancy

(% of live births)7.8 14.3 15.2 14.3 6.8 19.5


RISK AND PROTECTIVE FACTORSShaded by quintile of measure rank

31

Reproductive Health Preventive Services:

Prenatal Care Before 3rd Trimester



At-Risk Populations

in Kentucky

• Black and Hispanic mothers

• Mothers aged 40-44

• Less than high school education




percentage of mothers receiving

prenatal care before the 3rd trimester

is similar, except mothers aged 15-

19 have higher rates of prenatal care

before the 3rd trimester in Kentucky.

• Compared with Ohio, Kentucky has a

higher percentage for prenatal care

before 3rd trimester among black

and Asian/Pacific Islander mothers,

mothers aged 15-19, and those with

less than high school education.

US IN OH TN VA KY

Overall 94.0 94.3 93.4 94.1 95.8 94.8

Black 90.4 90.1 89.1 90.0 94.1 91.5

Hispanic 92.6 91.9 89.9 91.0 93.0 91.5

White 94.8 95.0 94.5 95.1 96.3 95.2

Asian/Pacific Islander 94.2 91.5 90.8 93.4 96.0 93.1

Mother Aged 15-19 89.6 91.5 90.3 91.3 91.5 93.2

Mother Aged 20-24 92.2 92.8 92.1 92.9 94.0 94.0

Mother Aged 25-29 94.3 94.9 93.8 94.7 95.8 95.4

Mother Aged 30-34 95.4 95.6 94.9 95.4 96.8 95.7

Mother Aged 35-39 95.3 94.9 94.1 95.1 96.7 94.9

Mother Aged 40-44 94.7 92.7 92.6 93.9 96.6 93.0


High School Graduate* 92.7 93.4 92.4 93.0 93.9

Some College* 94.6 95.1 93.9 95.0 96.0 95.2

College Graduate* 96.7 97.5 96.4 97.3 97.7 97.9

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

PRENATAL CARE BEFORE 3RD TRIMESTERPercentage of live births in which the mother began prenatal care between the 1st and 6th month of pregnancy

*Aged 25+

32

Reproductive Health Preventive Services: Well-Woman Visit


Source: CDC, Behavioral Risk Factor Surveillance System, 2015-2016

At-Risk Populations

in Kentucky

• Multiracial women

• Urban women

• Aged 25-34




and the U.S., the prevalence of well-

woman visits is higher overall and

among Hispanic and white women,

women aged 18-24 and 35-44,

women with less than or a high

school education, and women with

incomes less than $50,000.


and the U.S., the prevalence of well-

woman visits is lower among

multiracial women.

US IN OH TN VA KY

Overall 66.8 65.1 69.8 67.7 70.4 73.7

Black 77.8 78.2 80.4 77.4 78.9 77.6

Hispanic 62.8 58.8 73.0 69.2 65.8 80.9

White 65.3 64.2 67.5 65.4 69.4 73.1

Multiracial 64.5 65.6 59.3 49.2

Aged 18-24 65.6 64.8 70.6 66.7 67.9 72.6

Aged 25-34 65.1 64.0 64.4 66.4 71.4 69.6

Aged 35-44 69.4 66.3 74.9 69.8 71.2 78.4

Rural 65.8 59.0 71.7 69.0 79.5 72.1

Suburban 69.4 67.8 70.2 65.4 75.2 74.1

Urban 71.1 66.5 75.8 71.4 76.3 67.1


High School Grad* 65.7 65.0 69.9 63.6 67.3 74.2

Some College* 67.2 64.2 69.4 71.2 73.1 72.8

College Grad* 70.6 69.7 72.0 71.5 73.3 72.5

Less Than $25,000* 63.2 63.5 68.2 63.1 66.2 74.7

$25-$49,999* 65.6 61.6 68.7 67.0 71.7 74.4

$50-$74,999* 67.4 69.5 63.6 69.2 75.3 70.2

$75,000 or More* 71.9 67.9 75.3 75.6 73.1 72.1

WELL-WOMAN VISITPercentage of women aged 18 to 44 with a preventive medical visit in the past year

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

*Aged 25+

33

Reproductive Health Preventive Services:

Dedicated Health Care Provider (Women)

Women in Kentucky and Peer States

Source: CDC, Behavioral Risk Factor Surveillance System, 2015-2016

At-Risk Populations

in Kentucky

• Black, Hispanic and multiracial

women

• Aged 18-24




percentage of women with a

dedicated health care provider is

higher in Kentucky overall and

among Hispanic women, women

aged 25-44, and among all levels of

education and income.

• Dedicated healthcare provider is

lower among black women in

Kentucky and Ohio, compared with

the U.S., Indiana, Tennessee, and

Virginia.


dedicated health care provider is

lower among rural adults and higher

among less than high school and

income less than $25,000.

US IN OH TN VA KY

Overall 73.7 80.1 78.2 74.4 72.6 77.1

Black 75.7 77.8 70.5 75.3 77.5 71.6

Hispanic 60.3 69.6 61.7 56.3 56.7 68.9

White 78.7 82.6 81.2 77.0 75.0 78.6

Multiracial 75.2 70.9 68.4 69.3

Aged 18-24 67.3 77.0 70.0 68.7 62.3 65.2

Aged 25-34 71.5 74.7 76.1 71.3 70.3 76.0

Aged 35-44 80.9 88.3 86.7 81.8 82.6 86.8

Rural 80.8 86.9 88.7 88.3 83.9 81.8

Suburban 82.1 86.4 88.5 73.7 78.8 79.5

Urban 81.8 88.8 80.7 80.3 85.8 79.0


High School Grad* 73.0 79.9 78.7 70.9 69.8 78.9

Some College* 78.9 83.3 82.7 81.3 77.5 81.9

College Grad* 82.5 86.0 82.9 81.7 83.8 83.1

Less Than $25,000* 66.0 75.9 74.6 68.1 62.4 79.7

$25-$49,999* 75.1 81.1 80.3 77.9 72.4 78.0

$50-$74,999* 81.6 85.0 81.6 84.6 82.7 87.2

$75,000 or More* 86.3 88.8 89.5 83.4 84.9 84.6

Dedicated Health Care Provider (Women)Percentage of women aged 18 to 44 who reported having one or more people they think of as their personal doctor or health care provider

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

*Aged 25+

34

CANCERMortality, Risk Factors and Preventive Services

35

Cancer Mortality

Deaths in Kentucky and Peer States

At-Risk Populations

in Kentucky

• Males

• White



• Compared with the U.S., cancer

deaths are a challenge overall and

among all subpopulations expect

Hispanics and Asian/Pacific

Islanders.

• Compared neighboring states,

cancer deaths are higher overall and

in all subpopulations except black

and Hispanic.

US IN OH TN VA KY

Overall 189.8 210.5 210.3 217.7 190.7 234.9

Female 161.9 176.6 179.3 179.5 162.4 195.9

Male 227.8 257.0 253.2 269.2 229.9 288.0

Black 222.9 237.8 237.6 248.1 220.5 232.2

Hispanic 131.7 110.0 108.5 99.6 93.7 88.6

White 195.9 212.9 210.5 216.7 192.8 237.9

Asian/Pacific Islander 117.6 98.3 104.7 106.7 103.5 112.0

American Indian/Alaska Native 163.7 65.9 71.5 55.8 86.8

CANCER DEATHSAge-adjusted number of deaths due to all causes of cancer per 100,000 population

Source: CDC, National Vital Statistics System, 2014-2016 – This is newer than what appears on the website, will appear in 2018 Annual Report

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

36

Cancer Mortality: 2009-2018




• In the past 10 years, cancer deaths

have increased an average 1.0 deaths

per 100,000/ year, while cancer deaths

in the U.S. have declined (-0.17 deaths

per 100,000/year).


Kentucky has the highest cancer

mortality rate at 234.9 deaths per

100,000; neighboring states range from

190.7 deaths per 100,000 in Virginia to

217.7 deaths per 100,000 in Tennessee.

• Virginia was the only neighboring

state to have a decrease in cancer

deaths over the past 10 years,

decreasing at a rate of -0.78 deaths

per 100,000 per year).

• Cancer deaths in Kentucky are

increasing at a faster rate than

Indiana (0.30 deaths per 100,000/year),

Ohio (0.01 deaths per 100,000/year)

and Tennessee (0.33 deaths per

100,000 per year)

Source: CDC, National Vital Statistics System, 2014-2016 – This is newer than what appears on the website, will appear in 2018 Annual Report

U.S. Kentucky Indiana Ohio Tennessee Virginia

180

190

200

210

220

230

240

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Edition Year (two-year lag)

CANCER MORTALITYAge-adjusted number of deaths due to all causes of cancer per 100,000 population

37

At-Risk Populations

in Kentucky

• Males

• Hispanics and multiracial adults

• Aged 18-44

• College graduates

• Income greater than $50,000



• Excessive drinking overall is lower than

the U.S. and all neighboring states

except Tennessee.

• Excessive drinking is lower among

females, blacks, high school graduates

and the lowest income group than the

U.S. and any of its neighboring states.

• Compared with neighboring states and

the U.S., excessive drinking is higher

among Hispanics and college

graduates.

Cancer Risk Factors: Excessive Drinking



US IN OH TN VA KY

Overall 18.5 18.6 19.1 14.4 17.4 15.8

Female 13.9 13.3 14.1 11.4 13.6 10.6

Male 23.2 24.1 24.5 17.6 21.3 21.3

Black 15.0 18.5 14.7 14.0 13.8 12.8

Hispanic 18.6 19.7 21.2 18.4 15.6 21.5

White 19.7 18.9 19.6 14.7 18.9 15.9

Multiracial 19.8 17.7 21.4 21.7 20.8

Aged 18-44 25.2 26.2 28.0 21.9 24.2 23.4

Aged 45-64 15.9 16.0 15.7 11.0 14.3 12.8

Aged 65+ 7.1 5.5 6.0 4.4 5.9 4.5

Rural 11.4 12.1 10.7 7.2 10.2 7.3

Suburban 12.8 13.1 12.2 8.3 11.2 11.6

Urban 12.2 12.6 11.5 7.8 12.7 9.2


High School Grad* 17.2 15.9 16.9 12.6 14.9 12.2

Some College* 17.9 19.4 17.9 12.8 17.1 16.2

College Grad* 18.4 17.4 18.3 17.3 17.9 20.4

Less Than $25,000* 13.7 12.8 15.6 9.4 11.0 9.3

$25-$49,999* 16.9 17.6 15.8 12.6 16.2 13.9

$50-$74,999* 19.5 20.8 20.0 13.8 19.2 18.9

$75,000 or More* 22.2 21.6 22.3 20.5 19.9 21.1

EXCESSIVE DRINKINGPercentage of adults who reported either binge drinking (having four or more (women) or five or more (men) drinks

on one occasion in the past 30 days) or chronic drinking (having eight or more (women) or 15 or more (men) drinks per week)

*Aged 25+

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

38

At-Risk Populations

in Kentucky

• Females

• Blacks

• Aged 45-64

• Rural and urban

• Less than a college education




• Compared with the U.S., obesity is a

challenge among all subpopulations

except American Indian/Alaskan

Natives and Hispanics.

• Obesity prevalence is higher among

females, whites, adults aged 65+, all

urbanicities, and among those with less

than high school and college graduates

than any of its neighboring states.

Cancer Risk Factors: Obesity



US IN OH TN VA KY

Overall 29.9 32.5 31.5 34.8 29.0 34.2

Female 29.5 32.6 32.1 33.4 29.5 35.2

Male 29.6 32.3 30.9 36.2 28.5 33.1

American Indian/Alaskan Native 38.1 30.6 60.4 47.7 25.5

Black 38.3 42.1 35.8 46.6 40.0 40.1

Hispanic 33.1 26.8 37.9 39.1 28.0 30.2

White 28.6 32.1 30.8 32.5 27.5 34.2

Multiracial 31.0 48.3 42.8 42.6 36.2 31.9

Aged 18-44 26.5 28.8 27.8 33.9 25.0 32.4

Aged 45-64 34.6 38.4 37.3 40.0 35.1 38.4

Aged 65+ 28.0 30.6 29.7 28.6 27.8 31.0

Rural 34.2 36.4 37.2 35.3 35.5 37.7

Suburban 30.1 34.4 32.6 34.2 28.7 34.7

Urban 29.8 33.9 33.6 36.9 30.3 38.3


High School Grad* 35.0 36.8 36.4 38.3 35.0 38.2

Some College* 33.9 36.9 35.5 41.5 35.1 37.3

College Grad* 22.8 28.4 26.0 29.6 22.3 30.0

Less Than $25,000* 36.6 38.7 38.6 38.1 37.9 39.7

$25-$49,999* 33.6 36.1 34.2 40.7 34.0 40.8

$50-$74,999* 32.7 36.3 36.2 36.2 31.4 34.2

$75,000 or More* 26.7 30.8 28.3 33.6 25.5 31.5

OBESITYPercentage of adults with a body mass index of 30.0 or higher based on reported height and weight

*Aged 25+

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

39

At-Risk Populations

in Kentucky

• Females

• American Indian/Alaska Natives and

multiracial adults

• Aged 45+

• Rural and urban

• Less than a high school or high school

education




• Compared with the U.S., physical

inactivity is a challenge among all

subpopulations except blacks and

Hispanics.


the U.S., physical inactivity is lower

among black and Hispanics.

• Physical inactivity is lower among

suburban adults than in Indiana and

Tennessee.

Cancer Risk Factors: Physical Inactivity



US IN OH TN VA KY

Overall 23.1 26.8 25.9 28.4 23.3 29.8

Female 26.4 28.5 28.6 32.6 25.2 31.7

Male 21.9 25.0 23.1 23.9 21.4 27.8

American Indian/Alaskan Native 26.5 20.3 24.5 29.7 35.6

Black 29.5 27.5 33.0 32.0 27.8 25.3

Hispanic 30.1 32.9 25.9 33.4 41.6 24.0

White 22.1 26.3 25.1 27.2 20.7 30.3

Multiracial 21.6 24.3 20.6 31.0 20.1 35.8

Aged 18-44 19.1 20.2 18.8 19.8 19.1 21.0

Aged 45-64 26.6 30.2 27.9 33.7 25.3 34.9

Aged 65+ 32.2 36.3 37.3 38.5 30.4 40.5

Rural 31.4 33.5 34.8 36.2 32.0 38.4

Suburban 26.3 29.6 27.3 34.7 27.6 27.6

Urban 26.8 30.2 29.6 31.3 21.9 32.5


High School Grad* 32.4 36.9 34.9 35.2 30.8 37.3

Some College* 23.1 24.3 23.8 26.2 22.8 27.1

College Grad* 12.5 13.1 12.2 13.5 11.5 13.6

Less Than $25,000* 39.5 42.4 42.1 40.7 43.7 44.7

$25-$49,999* 28.4 31.3 29.7 35.6 26.9 32.3

$50-$74,999* 20.0 21.7 20.7 21.3 21.1 24.0

$75,000 or More* 12.9 14.2 13.1 13.0 12.0 16.4

PHYSICAL INACTIVITYPercentage of adults who reported doing no physical activity or exercise other than their regular job in the past 30 days

*Aged 25+

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

40

Cancer Risk Factors: Smoking



US IN OH TN VA KY

Overall 17.1 21.1 22.5 22.1 15.3 24.5

Female 14.3 18.8 20.5 20.4 13.7 24.0

Male 18.6 23.6 24.7 23.9 17.0 25.0

American Indian/Alaskan Native 26.5 36.1 26.8 34.3 23.3 48.7

Black 18.4 23.0 23.5 21.0 15.8 26.5

Hispanic 12.4 17.8 22.3 21.0 11.8

White 17.4 21.0 22.4 22.2 16.4 24.3

Multiracial 24.7 31.9 37.0 45.8 24.9 45.4

Aged 18-44 18.1 22.7 26.4 23.0 16.5 28.7

Aged 45-64 18.6 24.7 24.9 26.3 17.3 26.2

Aged 65+ 8.7 11.6 10.6 13.2 8.6 12.4

Rural 18.0 18.5 19.1 21.7 18.7 25.4

Suburban 13.1 15.9 16.7 20.8 10.8 18.5

Urban 12.7 18.7 19.0 15.6 10.7 23.2


High School Grad* 22.4 28.0 29.6 26.7 22.3 30.1

Some College* 17.6 19.2 22.1 20.6 18.1 23.7

College Grad* 6.6 7.3 7.3 7.6 6.5 9.2

Less Than $25,000* 26.5 35.0 39.3 34.7 27.7 40.8

$25-$49,999* 19.2 26.1 26.1 23.4 19.7 25.6

$50-$74,999* 15.1 16.6 19.0 19.4 16.8 18.7

$75,000 or More* 9.4 10.9 11.0 10.8 8.3 13.7

SMOKINGPercentage of adults who are smokers (reported smoking at least 100 cigarettes in their lifetime and currently smoke every or some days

At-Risk Populations

in Kentucky

• American Indian/Alaskan Natives

and multiracial adults

• Aged 18-44

• Less than a high school and high school

education




• Compared with the U.S., smoking is a

challenge among all subpopulations.


the U.S., smoking prevalence

is higher among females, males, blacks

whites, multiracial adults, those aged

18-44, rural, urban, all education groups

except less than high school, and the

lowest and highest income groups.

*Aged 25+

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

41

Cancer Risk Factors: Smoking and Tobacco




• Compared with the U.S., household

smoke, smoking, and youth tobacco use

are all higher in Kentucky.

• With the exception of Virginia, all

neighboring states rank in the bottom 10

(unhealthiest) states for household

smoke and smoking.

• All neighboring states have a healthier

rank for youth tobacco use.

• Virginia has healthier ranks in all 3

smoking measures.

Sources: CDC, Behavioral Risk Factor Surveillance System, 2016; Child and

Adolescent Health Measurement Initiative (CAHMI), Data Resource Center for

Child and Adolescent Health, National Survey of Children’s Health, 2016;

SAMHSA, National Survey on Drug Use and Health, 2015-2016

US IN OH TN VA KY

Household Smoke

(% of children aged 0-17)16.2 22.2 21.6 24.8 16 24.6

Smoking

(% of adults)17.1 21.1 22.5 22.1 15.3 24.5

Tobacco Use – Youth

(% of children aged 12-17)5.7 7.7 6.9 7.5 5.6 9.6

SMOKING AND TOBACCOShaded by quintile of measure rank


42

Cancer Preventive Services



US IN OH TN VA KY

Cervical Cancer Screening

(% of women aged 21-44)80.0 77.5 82.6 83.4 80.1 81.7

Health Screening – Colorectal

Cancer and Breast Cancer

(% of seniors with

recommended screenings)73.0 67.1 69.8 70.3 73.9 73.0

Immunizations HPV – Females

(% of females aged 13-17)49.5 43.5 42.5 36.9 41.1 39.7

Immunizations HPV – Males

(% of males aged 13-17)37.5 24.7 41.1 35.2 37.4 28.5


PREVENTIVE SERVICESShaded by quintile of measure rank



• Compared with the U.S., cervical

cancer screening is higher, however,

HPV immunization is a challenge.


cervical cancer screening is higher

than Indiana and Virginia.


health screenings are higher than in

Indiana, Ohio, and Tennessee.

• Tennessee and Virginia are also in

the bottom (unhealthiest) quartile of

states for HPV immunization among

females.

• Neighboring states Ohio, Tennessee,

and Virginia rank higher for HPV

immunization among males.

43

At-Risk Populations

in Kentucky

• Females

• Rural

• Less than high school




• Compared with the U.S., health

screenings are higher among seniors

with less than high school, some

college, and among seniors with

incomes of $25-$49,999 and $75,000 or

more.

• Health screenings among seniors with

less than a high school or high school

education are higher than in

neighboring states.

Cancer Preventive Services: Senior Health Screenings

(Colorectal Cancer and Breast Cancer)



US IN OH TN VA KY

Overall 73.0 67.1 69.8 70.3 73.9 73.0

Female 68.0 61.5 66.0 67.2 69.4 66.0

Male 78.4 73.3 74.0 73.7 78.8 80.7

Black 74.1 50.0 65.8 76.0 76.8 75.4

White 74.3 68.7 70.6 69.3 74.1 73.8

Rural 66.4 64.1 66.6 58.3 65.9 65.3

Suburban 74.3 66.0 70.4 68.4 75.5 74.5

Urban 75.3 71.1 72.1 79.7 80.0 79.8


High School Grad* 69.9 65.0 66.6 67.8 67.4 70.9

Some College* 74.6 68.0 70.6 73.7 79.3 77.5

College Grad* 80.7 76.6 81.7 78.8 80.5 80.8

Less Than $25,000* 61.1 57.2 62.3 62.1 64.1 62.8

$25-$49,999* 71.5 68.1 69.6 71.2 75.2 74.0

$50-$74,999* 79.9 76.4 81.1 78.0 78.8 81.4

$75,000 or More* 84.1 76.6 78.5 79.4 85.1 86.5

SENIOR HEALTH SCREENINGSPercentage of women aged 65 to 74 who reported receiving a mammogram in the past two years and the

percentage of adults aged 65 to 75 who reported receiving colorectal cancer screening within the recommended time period

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

*Aged 25+

44

At-Risk Populations

in Kentucky

• Females below poverty

• White males



• Compared with the U.S., HPV

immunization is lower among all

subpopulation groups.

• Compared with neighboring states, HPV

immunization is higher among females

than in Tennessee and higher than

males in Indiana.


HPV immunization among females is

lower overall than in Indiana and Ohio,

and lower among white females than in

Indiana and Virginia.

• Compared with neighboring states, HPV

immunization among males is higher

than in Ohio, Tennessee and Virginia.

Cancer Preventive Services: HPV Immunization (Females and Males)


Source: CDC, National Immunization Survey, 2016

US IN OH TN VA KY

Overall 49.5 43.5 42.5 36.9 41.1 39.7

White 45.7 42.1 37.5 30.4 45.1 38.0

Above Poverty 47.9 43.7 41.3 30.0 35.9 42.0

Below Poverty 58.1 53.6 33.9

IMMUNIZATION HPV (FEMALES)Percentage of women aged 13 to 17 who are up to date on all the recommended doses of human papillomavirus (HPV) vaccine

US IN OH TN VA KY

Overall 37.5 24.7 41.1 35.2 37.4 28.5

White 34.0 21.0 35.6 31.7 38.9 27.0

Above Poverty 35.8 25.5 38.1 32.0 38.0 29.0

Below Poverty 42.5 49.8

IMMUNIZATION HPV (MALES)Percentage of males aged 13 to 17 who are up to date on all the recommended doses of human papillomavirus (HPV) vaccine

5%+ LessThan KY

2-5% LessThan KY

Within 2%of KY

2-5% MoreThan KY

5%+ MoreThan KY

key trends from america’s health rankings · dedicated health care providers among women are...

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