Community Assessment Summary

• Changing demographics with growing senior population and the increasing Hispanic or Latino population in Miller County. Hispanics are more likely to be uninsured, have inadequate prenatal care and have an increased rate of diabetes. Increased rate of smoking in county among adults.

• Increasing rate of smoking during pregnancy.

• Higher rates of high blood pressure and heart disease.

• Higher rates of death due to unintentional injuri

• • Limited local access to medical, dental and mental health providers.

Older residents are not seeking preventive health screenings (mammograms, blood stool and colonoscopy) at rates significantly higher than the state rates.

agency are (public health priorities):

health education.
prevention and heart health.

Analysis of Health Status Indicators

Demographic/Education/Socioeconomic Indicators

Age Analysis:

How does age distribution in your county compare with state percentages?

Does your county have a higher than state average percentage of children, adolescents, middle age or citizens over 65? Have there been significant changes in the age distribution?
The age distribution in Miller County does not vary significantly from Missouri.

The most significant growth between 1990 and 2007 occurred in the following age groups: 45-64 year olds - increase of 2.5%; 65+ year olds - increase of 1.1%. In 2007 15.5% of the county's population was 65 or over compared to 13.4 statewide.

The 2007 gender distribution is: Female - 51.1%; Male - 48.9%. The gender distribution for Missouri is: Female - 51.2%; Male - 48.8%.

Race/Ethnicity Analysis:

Are there racial, ethnic, immigrant, or refugee population groups that potentially experience disparity in health status, or barriers to accessing health care or preventive services?

The 2007 estimates reflect a 243.5% increase (from 92 to 316) from 1990-2007 in the Hispanic or Latino population of Miller County. Missouri's increase in Hispanic and Latino population from 1990-2007 was 189.2%. These families may experience barriers in accessing care, due to a number of environmental factors, including language, transportation, lack of insurance coverage, lack of appropriate documentation, etc. Kids Count Data indicates there were 3 children in 2002 with limited English proficiency and that number had increased to 17 in 2006.
Miller County also experienced a significant increase in the African American population from 18 to 195 as well as an increase in Asian Pacific Islanders from 16 to 69.

Is the number or overall percentage of population that is represented by special population groups increasing or decreasing?

It is anticipated the county will continue to see growth in the Hispanic or Latino population as seen between 1990 and 2007.

Other Demographic Features:

Is it possible that factors such as low educational levels, family size and/or structure, or illiteracy contribute to increased health risks for some members of the community?

The 2000 census indicates there were 799 households reported as single parent representing 8.6% of total households in Miller County.

Compared to the Missouri rate of 9.1% percent of households, Miller County has a smaller percentage of single parent households.

Educational Attainment. 2000 Census reflects the following: 40.2% of the Miller County population over the age of 25 had at most a high school diploma or equivalency, and 11.4% have college or higher level degrees.

Miller County has a lower percentage of individuals with college or advanced degrees when compared to the Missouri rate of 26.7%.
High School Dropout Rate. The 2004-2008 dropout rates were lower than Missouri rates.

Economic Indicators:

Identify features related to household income, employment opportunity, leading industry, and economic stability of the community. Are there age groups or other specific populations more severely affected by poverty?

The 2006 per capita income in Miller County was $16,445 compared to Missouri's at $32,789. Miller County has remained below state per capita average since 1997.

Poverty. 2007 population estimates indicate that 15.7% of all persons in Miller County live in poverty as compared to the state rate of 13.3%. 2007 Senior Report reflects greater than 10.9% of Miller County seniors live in poverty.

Household Income. 2007 population estimate data indicates median household income for Miller County at $36,501 as compared to the Missouri median income of $45,012.

2005 average annual salary/wage for Miller County was $23,491-$26,956 as compared to the Missouri of $35,448.

Unemployment. The annualized unemployment rate for Miller County in 2008 was 7.7%. The Missouri rate for 2008 was 6.0%.

2000 Census data do not reflect any significant disparities among individuals in poverty.

Environmental Health Risk Indicators

Analysis of indicators related to housing:

What percent of housing in your county was built before 1950? What is the geographic location of older housing and what are the demographics of populations living in these areas? Describe any lead abatement/renovation projects that have been undertaken.

The percentage of housing in Miller County built before 1939 is 10.5%.
Older housing is dispersed throughout the county. In the 2000 census, 65.1% of all housing was built prior to 1970. No knowledge of any asbestos or lead abatement projects underway in the county.

What percentage of children in your county are tested for lead poisoning?

What percentage of those tested was found to have elevated blood levels?

Where do these children live, e.g., are they close to a lead smelter/lead mine/historic lead smelter?

Kids count data indicate that 1.5% of those children tested were found to have elevated blood lead levels. Child Health profile for 2006 shows a lead testing rate of 13.6 compared to a state rate of 18.5.

Analysis of indicators related to water supply:

What is proximity of hazardous waste sites and sewage disposal systems to public/private water supply?

There are no hazardous waste sites in Miller County.

Describe any hazardous substance events that have occurred recently.

Per DHSS, there were no hazardous substance release reports filed in 2004.

Do industrial or agricultural operations contribute to environmental health risks?

Miller County has several water bodies (creeks and rivers) throughout the county as well as the Lake of the Ozarks on its' southwestern boundary.

Are public water supplies fluoridated?

Eldon is a fluoridated water system.

Public Safety/Domestic Violence

Analysis of indicators of public safety:

Analyze crime rates including homicide, juvenile crime, and violent crimes.

Are special circumstances, specific age groups, or populations involved? Are rates increasing or decreasing?
In 2008 the Highway Patrol Uniform Crime Reporting System reflects a total of 2,986 crimes reported in Miller County. In 2007, 3,543 crimes were recorded. Miller County property and violent crime rate per 1000 was in the range of 30.1-45.0 statewide.

The juvenile law violation referral rate in Miller County in 2005 was 79.2 per 1,000 juveniles age 10-17. The Missouri rate for the same year was 59 reflecting Miller County has a higher rate.

Is there a problem with illegal drug use or alcohol abuse?

In 2006 there were 7 methamphetamine laboratory incidents. This number is higher than some of the surrounding counties and other counties in the area. The DHSS Cause of Death profile indicate a higher incidence of alcohol/drug attributable deaths with a rate of 19.8 for the years 1996-2006 compared to the state rate of 14.

Analysis of indicators related to abuse or neglect of vulnerable populations:

Identify and analyze indicators of maltreatment or neglect of vulnerable populations including the elderly and children. Is domestic violence a problem? Are trends worsening?

Child Abuse and Neglect. The 2006 Missouri Child Abuse/Neglect data reflect a 50.2 rate per 1,000 compared to the Missouri rate of 32.7.

Domestic Partner Violence. In 2008 there were 112 domestic violence reports filed for Miller County. In 2007 there were 110 domestic violence incident reports.

Unintended Injury
Analysis of indicators related to injury:

What are the major types of injuries in your county, the causes, and the ages or population groups primarily involved?

Is the rate of injury related hospitalization increasing or decreasing?

From 1996-2006, motor vehicle accidents as the major cause of unintentional injury deaths was higher than the state rate with a rate of 38.7 compared to a state rate of 19.8. Miller County had rates higher than Missouri for falls, firearms, burns and overall unintentional injury deaths.

Analysis of indicators related to traffic safety:

Analyze circumstances related to traffic safety including use of seat belts and child safety seats.

Seat Belt Usage. The Missouri Highway Patrol 2005 Missouri Traffic Crashes Report ranks Miller 74th among counties in seatbelt usage (rank of 1 being worst). Report indicates 91.36% as the usage percentage for Miller County.

To what extent is drug or alcohol use contributing to traffic accidents?

In 2006 there were 51 traffic crashes in which alcohol was involved, with 2 fatalities.

What age groups are more likely to be involved in traffic accidents?

Motor vehicle injuries are highest among the 15-34 year old age groups.

Analysis of injuries at work:

What types of work-related injuries, and what industry or specific populations are primarily affected? Is the incidence of injury at work increasing?

From 1996-2006, there were 2 incidents of work place death in Miller County. Data not available for workplace injury incidents.
Maternal and Child Health Indicators
Analysis of maternal and child health indicators:

Discuss how your county compares with the rest of the state on maternal and child health indicators such as adequate prenatal care, births to teens, birth spacing, smoking during pregnancy, births to women without high school education, and infant mortality.

Late Prenatal Care. The 2006 rate for 2nd/3rd trimester care is 25.9 compared to the state rate of 12.1. County rate is significantly higher than state rate.

Births to Teens. The 2002-2006 rate was 30.1 as compared to the state rate of 28.7. County rate is higher than state rate. Miller County rates are also higher than the state rates for 18-19 year olds and 20-24 year olds.

Smoking in Pregnancy. The 2006 rate for Miller County was 30.2 as compared to the Missouri rate of 18.4. Significantly higher rate for Miller County.

No High School Diploma. The 2002-2006 rate for Miller County was 23.6 as compared to the Missouri rate of 18.6. The county rate is higher than the state rate for births to women without a high school education.
Infant Mortality. There were less than 20 infant deaths between 1996 and 2006 in Miller County making the rate of 4.5 unstable.

Do trend lines show that problems are increasing or decreasing?

Miller County rates for smoking during pregnancy are significantly higher than the state rate.

Can poor birth outcomes be linked to poverty or to low educational levels?

Overall, Miller County has relatively good birth outcomes although a number of risk factors such as teen pregnancies, smoking, obesity, lack of prenatal care and no high school diploma are present.

Identify specific races or special populations that experience higher rates of infant mortality, low birth weight, or poor birth outcomes.

None noted.

Analyze indicators related to prenatal risks:

Are risks such as smoking, improper weight gain, teen pregnancy, birth spacing, late or no prenatal care more common within special populations?

The data are not readily broken down beyond race.

Analyze indicators of child well-being:

Are the majority of children properly immunized and are they receiving periodic screenings?

A review of each type of immunization indicates Miller County immunization rates are somewhat higher than the state rates.

How do unintentional injury and death rates among children in the community compare with state averages? What are the leading causes? Are they preventable? Are trends improving?

Childhood Emergency Room Visits. Between 2001 and 2006 the 3 leading causes of emergency room visits for children under age 15 were: Injury and Poisoning, Throat and Lung, and Brain - Spinal cord - Eyes - Ears. No significant findings noted.
Childhood Hospitalizations. Between 2001 and 2006 the 3 leading causes of inpatient hospitalization for children under age 15 were: Throat and Lung, injury and poisoning, and infections. No significant variance from Missouri data.

Prevalence of Infectious Disease

Analysis of communicable disease rates:

Discuss how your county compares with the rest of the state on infectious disease indicators. (Rates of Tuberculosis, sexually transmitted diseases, etc.)

In 2008 (through Sept.) there were 2 Gonorrhea cases, and 24 Chlamydia cases reported in Miller County. In 2007 those numbers were 3 Gonorrhea cases, 1 Syphilis case, and 24 Chlamydia cases. 2006 data reflects 4 Gonorrhea cases, 2 Syphilis cases, and 44 Chlamydia cases. No significant findings noted.
The 2007 Communicable Disease report indicates nothing significant.

Identify and include information unique to races or special populations.

None noted.

What circumstances surround any recent outbreaks or extraordinary incidence of enteric diseases? Was food, water or vector determined to be an origin?

None noted.

Analysis of vaccine preventable disease:

Discuss circumstances surrounding any vaccine preventable disease cases among children.

None noted.

Are morbidity/mortality rates for influenza and pneumonia higher than in other areas?

No.

Note county adult and childhood immunization rates for vaccine preventable disease.

Immunization rates for county are comparable to state for vaccine preventable diseases.
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Prevalence of Chronic Disease Risk Factors

Discuss behavioral risk factors such as tobacco use, physical inactivity, and obesity that contribute to chronic disease rates.

Tobacco Use. The 2007 Health and Preventive Practices County Level Study reflect 31.9% of Miller County residents smoke. In 2003, 33.3% of Miller County residents smoked compared to the Missouri rate of 26.5%.

Physical Activity. The 2003 Health and Preventive Practices Status Report indicate that 26.6% of Miller County residents are physically inactive. The 2007 Health and Preventive Practices County Level Study reflect 34.6% of county residents receive no leisure-time physical activity.
Obesity. The 2003 Health and Preventive Practices Status Report indicate 33.1% of Miller County adults are overweight, and 26.5% are obese. The 2007 Health and Preventive Practices County Level Study shows that 29.5% of the residents are obese.

Analyze indicators of obesity and inadequate diet by particular age groups, race, or special populations.

County level data not available.

Review causes of preventable hospitalization related to chronic disease and identify the most prevalent. Are causes of hospitalization consistent with risk behaviors?

Overall, rates of preventable hospitalization for Miller County were consistent with rates for Missouri. From 2002 to 2006, there were 100 hospitalizations due to diabetes, 84 hospitalizations due to heart failure, 96 hospitalizations due to asthma, and 167 hospitalizations for COPD. These are all related to chronic disease.

Discuss chronic disease behavioral risks of youth such as tobacco use, exposure to second hand smoke, obesity, and fruit and vegetable consumption.

Statewide data only.

Discuss how the county compares with the state on chronic disease indicators. Identify and include information unique to races or special populations.

Diabetes regional profile for Miller shows similar rates for risk factors of obese (22.4) and physical inactivity (22.8) as compared to the state rates of 24.5 and 21.9. The 2007 county level health profile show slightly higher diabetes rate than the state (9.8 compared to 7.2 for the state).

Are screenings for early detection and diagnosis of diseases utilized by a majority at age appropriate levels?

The 2007 Health & Preventive Practices County Level Study reflects a higher rate for Miller County on: women age 18 and older who have not had a pap test in the past three years 22.5 compared to the 2003 state rate of 13.2. Women age 40 and older who have not had a mammogram or clinical breast exam in the past year 44.2%. Could indicate women are not receiving screenings as often as recommended.

Leading Causes of Mortality
Analysis of leading causes of mortality:

Discuss causes of mortality where rates are higher than the state.

Miller has significantly higher death rates from the following diseases:
Heart disease at 309.3 compared to state rate of 271.9
Stroke at 64.6 compared to state rate of 60
Chronic Lower Respiratory Disease at 56.5 compared to state rate of 46.8
Alcohol/Drug Induced at 19.5.3 compared to state rate of 14

Are trends for leading causes of death improving or worsening?

There are no trends noted.

How do rates compare with other cities or counties of similar size and/or demographics?

No comparisons drawn.

To what extent do mortality rates reflect premature deaths?

None noted from data.

Are rates of mortality that are higher than the state rate consistent with behavioral risk factors for such diseases (Ex: obesity, smoking, physical inactivity)?

No linkages noted.

Are rates of mortality that are higher than the state rate consistent with rates of screening tests for early detection, or other risk factors like high blood pressure or high cholesterol?

No linkages noted.

B. Community Health Improvement Capacity Indicators

Section 13. Health Care System Indicators

Analysis of the Community's Health Care System:

Are there an adequate number of health care providers in your area?

Miller County does not have a hospital or Federally Qualified Health Center in the county.

What other barriers besides physician/patient ratios limit access to health care for certain populations?

None noted.

Is there adequate access to emergency services, inpatient acute care, and skilled long-term care?

Emergency services are available in the county. There are 7 long-term care facilities in the county.

What percentage of your population lacks health insurance coverage? Are there particular segments of the population without health insurance?

There are many working people without health insurance coverage and the 2007 Health and preventive Practices County Level Study indicate that 25.2% of Miller County adults have no coverage.

Is there an adequate supply of dental health and mental health services?

Services are limited. Residents must travel outside of county to receive services.

Is there a choice of primary care providers in your community?

There are a limited number of primary care providers in Miller County. Residents must travel to Cole, Camden or Pulaski counties for services.

Are there an adequate number of primary care providers that are Medicaid participants?

No shortage noted from Mo Health Net provider list.

Are Medicaid participating dentists available to your community?

Are there any populations not served by language-specific or culturally knowledgeable service providers?

Efforts must be made to assure Hispanic individuals with limited English proficiency are able to access services.

Are resources available to provide transportation for health care access?

OATS and non-emergency medical transportation (primarily for MC+). It is important to note that each of these services is available on a scheduled basis only.
Several local fire districts also do emergency response.

Do resources accommodate those needing sight and hearing impaired services or other assisting technology?

SB40 Board provides residential and other related services to individuals with mental retardation or developmental disabilities.
There are a number of service providers who cover reimbursable home health care.

What health care resource gaps exist in your community?

Lack of access in county to primary or specialty care physicians. Lack of access in county to Dental Services.

Section 14. Community Health Resource Indicators

Analysis of health resources that are available to address leading causes of mortality, especially premature deaths, and risk factors that contribute to leading health problems in the community:

Considering the leading health problems that were identified in previous sections, discuss the presence or absence of health resources that would support improvement in indicators.

Recreational Opportunities. Conservation walking and hiking trails are available throughout county. City parks, lakes, swimming pools and community center are also available. Miller County borders the Lake of the Ozark which offers numerous opportunities for outdoor recreation.
The Miller County Health Department provides health education to all clients. Additionally, blood pressure checks and other preventive services are offered. Central Missouri Food Bank distributes food in 5 locations throughout the county.
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Health Indicators Table - Miller County

Indicators Significant Results Primary or Secondary Reference Notes/ Implications Data Source

Demographics

1a Age N No S The most significant growth between 1990 and 2007 occurred in the following age groups: 45-64 year olds - increase of 2.5%; 65+ year olds - increase of 1.1%; Miller Co. overall growth rate from 2000-2007 was 5.7% compared to a state rate of 5.1%. In 2007, an estimated 15.5 percent of Miller County residents were 65 and older compared to 13.4 percent statewide. At the same time, estimates for under 18 were 24.3% of the county's population compared to 24.2 percent for the state. www.oseda.missouri.edu
1b Gender No S The 2007 gender distribution is: Female - 51.1%; Male - 48.9%. The gender distribution for Missouri is: Female - 51.2%; Male - 48.8%. www.oseda.missouri.edu

1c Marital Status No S In 2000, 55.7% of households were married couple families (5,174 of 9,288 households). In Missouri, 52% of households were married couple families. More recent data not available. www.oseda.missouri.edu

1d Race/Ethnicity Yes S Data from the 2000 US Census. The Hispanic or Latino population increased most significantly between 1990 and 2000 (from 92 to 234). 2007 estimates reflect a 243.5% increase (from 92 to 316) from 1990 in Hispanic or Latino population of Miller Co. compared to a 189.2% for Missouri. Miller county reflects an increase in African American from 18 in 1990 to 195 in 2007 as well as an increase in Asian Pacific Islanders from 16 to 69. Increases in both of these population groups exceed the Missouri increases of 27.9% for African American and 125.1% for Asian/Pacific Islander. www.oseda.missouri.edu
1e Non-English speaking students in school system Yes S Kids Count data indicates there were 3 children in 2002 and 17 in 2006 with limited English proficiency. http://oseda.missouri.edu/kidscount/