Dallas County Health Report
Dallas County Health Report
Dallas County Health Report
Dallas County General Health Profile 28 SDOHs by Healthy People 2020 Category ....................120
Leading Causes of Death .........................................30 Social Impact & Community Context ......................121
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INTRODUCTION
COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DALLAS COUNTY HEALTH AND HUMAN
The Patient Protection and Affordable Care Act (ACA) through the Internal SERVICES OVERVIEW
Revenue Code, requires a hospital organization treated as tax-exempt under Public health activities in Dallas date back to 1873 with the
501(c)(3) to conduct a Community Health Needs Assessment (CHNA) at appointment of the first City Health Officer and early efforts
least once every three years and to adopt an implementation strategy to to control the disposal of waste, sale and serving of food
meet the community health needs identified through the CHNA. Parkland items and the processing of milk products. The work of Dallas
Health & Hospital System completed two previous CHNAs in 2013 and in County Health and Human Services is wide-ranging and is
2016. Parkland’s next CHNA is to be delivered via online posting to the primarily focused on disease prevention. DCHHS is committed
residents of Dallas County on September 30, 2019. to improve the health and quality of life for all Dallas County
residents and to address inequities and disparities in health.
A CHNA is also required as part of the accreditation process for public
DCHHS targets services to reach vulnerable populations in
health departments. The Dallas County 2016-2019 CHNA allowed the
areas of the community with the highest need.
Dallas County Health and Human Services Department (DCHHS) to
successfully achieve National Public Health Accreditation in November DCHHS employs epidemiologists who serve as disease
2016. The county health department is expected to use this CHNA to detectives investigating outbreaks of clusters of illnesses and
inform the development of a broader Community Health Improvement Plan study the trends as well as causes and effects of health and
(CHIP) aimed at identifying priority issues, developing and implementing disease conditions in the community. DCHHS has been at the
strategies for action, and establishing measurable accountability to monitor forefront of local responses to Ebola, H1N1, West Nile and
improvement of the health status of targeted populations. Zika viruses, as well as preparedness efforts to respond in the
event of a bioterrorism attack or other disaster. DCHHS offers
In light of Parkland’s shared mission with DCHHS, a joint assessment of the
specialized Sexual Health and TB Clinics that provide services
current state of health in Dallas County has been conducted by the two
for the diagnosis, treatment and prevention and control of the
organizations through a collaborative process that included the exchange
spread of these infections. Other DCHHS activities include,
of data, information and insights. Beyond what is required under the ACA,
Parkland and the DCHHS will use this assessment to develop a collective Child and adult immunizations,
impact approach to improving the health of populations experiencing Refugee screening clinic,
health disparities within Dallas County over the next three years. This Restaurant inspections,
approach will include strengthening partnerships with other healthcare
Social service programs that assist low-income residents with
providers and community-based organizations who share a common housing and energy payments, weatherization services, and
mission with Parkland and DCHHS and establishing new relationships with repairs to home heating and cooling units, and
organizations we have yet to engage. Parkland will also incorporate the Development of new programs to support chronic disease
CHNA into the next iteration of its multi-year strategic plan that will be prevention and address other non-communicable disease
developed in 2020. issues.
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PARKLAND HEALTH & HOSPITAL
SYSTEM OVERVIEW
Established at the corner of Oak Lawn and FIGURE 1. Parkland’s Footprint in Dallas County
Maple in 1894, Parkland has been caring for
Dallas County’s most vulnerable patients for
125 years. Today, Parkland is an integrated
health system comprised of a state-of-the-
art acute care hospital, 30 community-based
outpatient clinics, a Medicaid managed care
plan as well as numerous educational and
outreach programs. As one of the leading
public academic medical centers in the nation,
Parkland has developed countless innovations
that save lives, improve access to services and
reduce healthcare costs.
9
PURPOSE OF THE CHNA
10
OVERVIEW OF DALLAS COUNTY
u Economy
Comprised of 31 cities and covering over 871.28 square miles,1 Dallas sciences, and over 430,000 professionals in education and health
County is Texas’ second most populous county and the eighth in services.2-3 Between 2016 and 2017, employment in Dallas County grew
the nation, and plays a pivotal role in its economic development and at a rate of 1.63%, from 1.28 million to 1.31 million employees.3
success.2 Dallas’ economy employs about 1.31 million individuals
- 33%of this workforce has at least a college degree. Retail trade, Historically, Dallas County’s strong economy has maintained an
healthcare and social assistance, and construction are the largest unemployment rate consistently below the state and national rates (see
industries. In 2017, Dallas County had over 860,000 professionals figure 3). The county’s median household income in 2017 was $53,626
in management, finance, computing, architecture, engineering and compared to the U.S. median $57,652.2
1
United States Census Bureau available at: https://www.census.gov/quickfacts/fact/table/dallascountytexas/PST045217\
2
Dallas County. Available at: https://www.dallascounty.org/Assets/uploads/docs/plandev/englishdcbook.pdf
3
Data USA. https://datausa.io/profile/geo/dallas-county-tx/#about
12
FIGURE 3. Unemployment Rate Dallas County, Texas and U.S., 2016 - 2018
4
onduent. Community Health, Health and Hospital Systems. Available at:
C
https://www.conduent.com/solution/community-population-health/community-health-assessment/
5
Health North Texas. SocioNeeds Index. Available at: http://www.healthyntexas.org/index.php?module=indicators&controller=index&action=socioneeds
14
OVERVIEW OF DALLAS COUNTY
# ZIP Code SocioNeeds Index Rank # ZIP Code SocioNeeds Index Rank
1 75210 99.7 5 32 75050 82.3 4
2 75212 98.8 5 33 75116 81.2 4
3 75216 98.6 5 34 75149 81.2 4
4 75217 98.2 5 35 75243 79.6 4
5 75203 97.6 5 36 75159 75.1 4
6 75211 97.3 5 37 75040 74.8 4
7 75227 96.6 5 38 75150 73.6 4
8 75233 96.3 5 39 75235 73 4
9 75223 96.2 5 40 75062 69.2 4
10 75224 96.1 5 41 75146 67.8 4
11 75042 95.9 5
12 75220 95.5 5
13 75180 95 5
FIGURE 5. Distribution of Zip Codes by SNI Rank
14 75215 94.8 5
15 75172 94.7 5
16 75237 94.7 5
17 75228 94.2 5
18 75253 93.7 5
19 75041 93.4 5
20 75061 92.4 5
21 75231 92.4 5
22 75247 92.3 5
23 75051 92.1 5
24 75240 91.9 5
25 75141 91.1 5
26 75241 90.7 5
27 75232 90.1 5
28 75060 89.9 5
29 75246 89.4 5
30 75236 88.9 5
31 75208 85.8 5
15
OVERVIEW OF DALLAS COUNTY
6
enter for Public Policy Priorities, Communities Foundation of Texas. Dallas Economic Opportunity Assessment.
C
Available at: https://www.cftexas.org/dallas-economic- opportunity-assessment
16
OVERVIEW OF DALLAS COUNTY
16k 280k
8k 240k
0 200k
17
OVERVIEW OF DALLAS COUNTY
A
u CCESS TO CARE IN
DALLAS COUNTY Figure 7. Insurance Coverage, Dallas County, 2013 – 2017
INSURANCE COVERAGE
In Dallas County, approximately 81% 40%
of the population has some form of
health insurance coverage: 35%
9% Medicare 30%
2% Medicare Dual Eligible 25%
15% Medicaid
20%
47% Private – Employer Sponsored
5% Private – Direct 15%
3% Private – Exchange 10%
19% Uninsured
5%
Source: IBM Watson/Truven Health
Analytics 2019 0%
2013 2014 2015 2016 2017
As depicted in Figure 7, employer Employer Medicaid Medicare Military or VA Non Group Uninsured
sponsored plans have been the main
source of health coverage since Adopted from: DATAUSA. Dallas County
2013 in Dallas County, followed by
Medicaid.
18
OVERVIEW OF DALLAS COUNTY
7
T exas Medical Association. Texas is the uninsured capital of the United States. More than 4.5 million Texans - including 623,000 children lack health insurance - 2018.
Available at: https://www.texmed.org/uninsured/
19
OVERVIEW OF DALLAS COUNTY
427,904
418,299
405,472
20
OVERVIEW OF DALLAS COUNTY
FIGURE 10. Dallas County Medicaid Enrollment by Managed Care Organization, 2018
21
OVERVIEW OF DALLAS COUNTY
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149
75050 75215
75208
75203
75211
75051 75181
75180
75224 75217
75216
75233
75236
75253
75052 75237 75241
75116 75232
75141
75249
75159
75137
75134
75115 75172
75104
75146
22
OVERVIEW OF DALLAS COUNTY
18
19
20
21
22
23
24
25
26
27
28
29
30
1,840 primary care physicians FTEs. The shortage
20
20
20
20
20
20
20
20
20
20
20
20
20
20
of primary care physicians is expected to grow by
Supply Demand
90% which indicates continued challenges for
Adopted From: Texas Health and Human Services. Department of State Health Services. Texas Projections of Supply and Demand for
Primary Care and Psychiatrists, 2017 – 2030. July 2018 Dallas County in terms of access to primary care
services. 8
8
T exas Health and Human Services. Department of State Health Services. Texas Projections of Supply and Demand for Primary Care
and Psychiatrists, 2017 – 2030. July 2018.
23
OVERVIEW OF DALLAS COUNTY
24
OVERVIEW OF DALLAS COUNTY
FIGURE 13. Dallas County Hospitals Geographic Distribution FIGURE 14. Dallas County Hospital Beds Availability by ZIP Codes
35
Methodist Richardson MC
Texas Health Hosp
121 75
114 Baylor Surgical Hosp at Las Colinas Baylor S&W MC Lake Pointe
Medical City Dallas
360
Dallas Med Ctr
ROCKWALL
Medical City Las Colinas Texas Health Presbyterian Hosp Dallas
North Central Surgical Ctr 30
Texas Institute for Surgery
635
Pine Creek MC
Baylor S&W MC Irving 482 City Hosp at White Rock
Parkland Hosp
Baylor S&W MC Uptown
161 Zale Lipshy University Hosp
Baylor S&W Heart and Vascular Hosp
Baylor University MC Baylor S&W MC - Sunnyvale
175
Dallas VA MC 20
KAUFMAN
45
Baylor S&W Emergency Hosp - Grand Prairie
Methodist Charlton MC
67
Crescent MC Lancaster
Data Source: American Hospital Association Guide 2017. Source: American Hospital Association Guide 2017.
9
Agency for Healthcare Research of U.S. Health Systems, 2016. Available at: https://www.ahrq.gov/chsp/data-resources/compendium.html
10
Robert Wood Johnson Foundation. Culture of Health Blog. Hospitals as Anchor Institutions for Community Investment. Available at https://www.rwjf.org/en/blog/2017/03/can-hospitals-defy-tradition.html
25
CHNA METHODOLOGY
The methodology applied for this CHNA and the subsequent implementation Patient Listening Sessions
strategy for addressing identified issues includes four components:
Parkland Patient and Family Advisory Good Street Baptist Church
LEADERSHIP AND OWNERSHIP Council Mary Kay local groups
This component is based on the principle that improving the community’s health Patient Listening Session at Chase (2 sessions in 75217)
is a shared responsibility, if not a moral obligation of hospitals, public health Building MLK Community Center (2 sessions)
agencies and the community at large. Putting this principle in practice, Parkland
Resident/Patient Listening Sessions: True Lee Missionary Baptist Church
in collaboration with the DCHHS, employed public health practices to identify
populations experiencing a higher burden of disease or health disparities, as well as New Comforter Church Food Bank, Inspired Vision
the underlying social determinants of health driving these inequalities. Pleasant Zion Missionary Church Compassion Center (4 sessions)
Springs Fellowship Church Cornerstone Baptist Church
STRATEGIC PLANNING
Parkland and DCHHS will use the results of this CHNA to develop programs and Parkland Frontline Staff
strategic initiatives aimed at improving health and reducing disparities.
Emergency Department Physicians COPC Physicians
COMMUNITY ENGAGEMENT and Nursing Staff COPC Community
Community Based Participatory Research (CBPR) was adopted to ensure the COPC Social Workers Advisory Board Members
community had meaningful participation during the CHNA development. The
Agency for Healthcare Research and Quality (AHRQ) defines CBPR as: COPC and Specialty Clinic Nurses Patient Financial Services Staff
8. Metro Dallas Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017,
Accessed at http://wonder.cdc.gov/ucd-icd10.html on Apr 25, 2019.
Homeless Alliance
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DALLAS COUNTY GENERAL HEALTH PROFILE
28
DALLAS COUNTY GENERAL HEALTH PROFILE
u MORTALITY
This section provides a snapshot of mortality rates in Dallas County by race, ethnicity, age and disease.
30
FIGURE 17. Top Five Leading Causes of Death Mortality Rate Trends, Dallas County, 1999 - 2017
11
National Vital Statistics Reports. Trends in Cancer and Heart Disease Among Adults Aged 45 - 64: United States, 1999 - 2017. Vol. 68, Number 5
31
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 18. Top Five Leading Causes of Death Mortality Rates Trends, United States, 1999 - 2017
32
Dallas County General Health Profile
FIGURE 19. All-Cause Mortality Rate Adjusted by Age per 100,000 Population, Dallas County, 2012 – 2016
33
DALLAS COUNTY GENERAL HEALTH PROFILE
Heart Disease Mortality FIGURE 21. Heart Disease Mortality Rate Adjusted by Age per
Heart disease refers to different types of heart 100,000 population, Dallas County, 2012 – 2016
conditions such as atherosclerotic cardiovascular
disease, hypertensive heart disease, acute
myocardial infarction and heart failure, among
others. Heart disease is the leading cause of death
in United States and claims more than 630,000
lives every year.12 Heart disease is the leading
cause of death for men of most racial and ethnic
groups. National health statistics show that 8.5%
of all white men, 7.9% of African American men
and 6.3% of Hispanic men have coronary heart
disease.13 Likewise, heart disease was the leading
cause of death in Dallas County in 2017 and was
attributed to 3,513 deaths.
12
U.S. Centers for Disease Control and Prevention. Heart Disease. Available at: https://www.cdc.gov/heartdisease/facts.htm
13
U.S. Centers for Disease Control and Prevention. Division of Heart Disease and Stroke Prevention. Men and Heart Disease Fact Sheet. Available at: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_men_heart.htm
34
Dallas County General Health Profile
FIGURE 22. Cerebrovascular (Stroke) Mortality Rate Adjusted by Age per 100,000 population, Dallas County, 2012 – 2016
35
DALLAS COUNTY GENERAL HEALTH PROFILE
CANCER MORTALITY FIGURE 23. Cancer Mortality Rate by Type of Cancer, Dallas County, 1999 - 2017
Despite the ongoing decline
in mortality rates attributed 70 Breast
to lung cancer since 1999, it Lung
remains the leading cause of 60
Colon
cancer deaths. Breast cancer
Year
FIGURE 24. Cancer Mortality Rate by Race and Ethnicity, Dallas County, 1999 - 2017
36
Dallas County General Health Profile
FIGURE 25. Cancer Mortality Rate Adjusted by Age per 100,000 population, Dallas County, 2012 – 2016
37
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 26. Other Leading Causes of Death Mortality Rate Trends, Dallas County, 1999 – 2017
As depicted in Figure
26, Alzheimer’s Disease
is among the leading
causes of death in Dallas
County and the sixth
leading cause of death
in U.S., between 2000
and 2017, the number
of deaths as recorded
on death certificates
has increased by 145%
and as the number
of elderly individuals
increases, the incidence
and prevalence is also
expected to double.16
While Alzheimer’s
related deaths has been
increasing at the national
level, the sharp increase
in Alzheimer’s related
deaths in Dallas County
beginning after 2012, is
most likely related to the Data Source; CDC Wonder
expansion of Alzheimer’s
related ICD-10 codes.
14
National Vital Statistic Report. Dementia Mortality in the United States, 2000 – 2017. Vol 68, Number 2. March 14, 2019
15
U.S. Centers for Disease Control and Prevention. U.S. burden of Alzheimer’s disease, related dementia to double by 2060
16
Alzheimer’s Association. Facts and Figures. Available at https://www.alz.org/alzheimers-dementia/facts-figures
38
Dallas County General Health Profile
FIGURE 27. Alzheimer’s Disease Mortality Rate Adjusted by Age per 100,000 Population, Dallas County, 2012 - 2016
39
Dallas County General Health Profile
FIGURE 28. Diabetes Mortality Rate Adjusted by Age per 100,000 Population, Dallas County, 2012 – 2016
40
Dallas County General Health Profile
FIGURE 29. Influenza and Pneumonia Mortality Rate Adjusted by Age per 100,000 Population, Dallas County, 2012-2016
41
DALLAS COUNTY GENERAL HEALTH PROFILE
42
DALLAS COUNTY GENERAL HEALTH PROFILE
43
Dallas County General Health Profile
Texas was in the forefront of the national media recently as the reported state maternal mortality rate
after 2010 doubled within a two-year period to levels not seen in other states. For example, the reported
rate of maternal mortality in Texas was as high as 35.8 per 100,000 live births in 2014.18 Although this
rate was later identified to be influenced by case ascertainment, statistical methods and data tracking, this
national emphasis has prompted further examination of maternal care at both the state and national level.
19
In an effort to address maternal morbidity and mortality at the state level, a multidisciplinary task force,
The Maternal Mortality and Morbidity Task Force, within the Texas Department of State Health Services
(DSHS) was formed in 2013. A joint report on the findings and recommendations of the task force
was released in September 2018. One of the 10 recommendations from this report was to, “Support
strategies to improve the maternal death review process (#10/10)”.20
Current definitions of maternal mortality require access to information from several sources for up to one
year after the end of a pregnancy. Included are women admitted to a hospital after discharge following
delivery, including those who may have delivered at another facility. Prevention efforts for maternal deaths
could be well-served if there was a system encouraging each hospital to identify maternal deaths in
three domains: (1) women admitted before delivery event (antepartum); (2) admitted during the delivery
event (delivery event); and (3) women admitted to the hospital after delivery discharge (postpartum).
Information ascertained from these domains could stimulate more emphasis on preventability. This could
also more easily tie-in with healthcare performance metrics.
17
. MacDorman M, Declercq E, Cabral H, Morton C. Recent Increases in the U.S. Maternal Mortality Rate.
1
18
Macdorman MF, Declercq E, Thoma ME. Trends in Texas maternal mortality by maternal age, race/ethnicity, and cause of death, 2006-2015. Birth. 2018;45(2):169-177. doi:10.1111/birt.12330.
19
Koch AR, Lightner S, Geller SE. Identifying Maternal Deaths in Texas Using an Enhanced Method, 2012. Obstetrics & Gynecology. 2018;132(2):520-521. doi:10.1097/aog.0000000000002771.
20
Maternal Mortality and Morbidity Task Force. Texas Health and Human Services. September 2018
44
DALLAS COUNTY GENERAL HEALTH PROFILE
21
March of Dines. 2018 Premature Birth Report Card United States. Available at: https://www.marchofdimes.org/materials/PrematureBirthReportCard-United%20States-2018.pdf
45
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 34. Percent of Births by Race, Dallas County, 2018 FIGURE 35. Percent of Births by Ethnicity, Dallas County, 2018
FIGURE 36. Percent of Births by Race, Parkland, 2018 FIGURE 37. Percent of Births by Ethnicity, Parkland, 2018
46
DALLAS COUNTY GENERAL HEALTH PROFILE
u LIFE EXPECTANCY
Life expectancy is defined as the expected average number of years of life remaining at a given age.22
Life expectancy in Dallas County differs by race, ethnicity, gender and ZIP code. Figure 38 below
illustrates the variances in life expectancy by ZIP code and Figure 39 shows the variance between the five
ZIP codes with the lowest life expectancy and the five ZIP codes highest for all populations.
FIGURE 38. Life Expectancy of DFW and Surrounding Areas, 2010 - 2014
22
U.S. Centers for Disease Control and Prevention. Mortality in the United States, 2017. Available at: https://www.cdc.gov/nchs/products/databriefs/db328.htm
47
Dallas County General Health Profile
FIGURE 39. Life Expectancy Variances Between ZIP Codes with Lowest and Highest Life Expectancy
95
90
85
80
YEARS
75
70
65
60
75215 75210 75216 75217 75232 75220 75229 75230 75205 75204
48
Dallas County General Health Profile
FIGURE 40. Life Expectancy for All Populations and African American Men in ZIP Codes with Low Life Expectancy.
49
Dallas County General Health Profile
u MORBIDITY
BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS)
DCHHS in collaboration with the Texas Department of State Health
Services used information gathered from the 2013-2017 Behavioral
Risk Factor Surveillance System (BRFSS) to provide insight into the
health behaviors of Dallas County residents.
23
ehavioral Risk Factor Surveillance System. “About BRFSS.” U.S. Centers for Disease Control and Prevention
B
(CDC), CDC, May 16, 2014, https://www.cdc.gov/brfss/about/index.htm
50
Dallas County General Health Profile
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51
Dallas County General Health Profile
FIGURE 42. Prevalence of Residents Diagnosed with a Depressive Disorder, Dallas County, 2013 - 2017
• 14% of adults in
Dallas County have 40
been diagnosed with a 35%
depressive disorder. 35
• The percent of adults age 30
18 and over with physical
limitation who has a 25 23% 23%
depressive order was 35%. 21%
19% 20%
• Among adults age 18 and 20 17%
over those are more like to 16% 16% 15%
14% 14% 15%15%
have a depressive disorder 15 12% 13%
are
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52
Dallas County General Health Profile
FIGURE 43. Percent of Residents Reporting Poor Mental Health for 14+ Days, Dallas County, 2013 - 2017
• The percent of adults age
25 18 and over with physical
22% limitation who have poor
mental health for 14+ days
20 was 22%.
• Adults age 18 and over, who
are more likely to have poor
15 mental health for 14+ days
13% fall into the following groups
12%
11% o People who are non-
9% 9% 10% 10% 9%
10 Hispanic black,
8% 8% 8% 8%
7% 7% 7% 7% 7% o People who have less than
6% 5% 6% 6%
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5 o People who are earning
less than $25,000.
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53
Dallas County General Health Profile
18% 17%
• In Dallas County,
asthma is more 16%
prevalent in women
(11%) than men (5%). 14% 13%
• Individuals between 12% 11% 11% 11% 11%
the ages of 18-29 years 10% 10%
(10%) and greater than 10% 9% 9%
65 years (11%) report 8% 8% 8%
a higher prevalence of 8% 7% 7% 7% 7% 7%
asthma. 6%
6% 5% 5% 5% 5%
• The percent of adults
age 18 and over with 4%
physical limitation who
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Data source: Center for Health Statistics BRFSS 2013-2017, Texas Department of State Health Services
Note: R = Relative Standard Error greater than 30.0%, estimate unreliable and not displayed
54
Dallas County General Health Profile
ale
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c
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W
Hi
years,
Data source: Center for Health Statistics BRFSS 2013-2017, Texas Department of State Health Services
Note: R = Relative Standard Error greater than 30.0%, estimate unreliable and not displayed o People with a physical
limitation.
55
Dallas County General Health Profile
FIGURE 46. Prevalence of Overweight/Obese Adults by Race and Ethnicity Dallas County, 2013 - 2017
Data source: Center for Health Statistics BRFSS 2013-2017, Texas Department of State Health Services
56
Dallas County General Health Profile
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ale
c
ic
l g ool
Co me ate
e
te
$4 0
$5 99
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the least likely to be current
So
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gh
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Data source: Center for Health Statistics BRFSS 2013-2017, Texas Department of State Health Services
Note: R = Relative Standard Error greater than 30.0%, estimate unreliable and not displayed
57
Dallas County General Health Profile
FIGURE 48. Adults Who Are Current Smokers, Dallas-Plano-Irving, Texas Metroplex, 2002-2017
25%
22% 22%
20% 19%
18%
17% 17%
16% 16%
15%
15%
Crude Prevalence(%)
5%
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Year
Data source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion,
Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. [accessed Sep 17, 2019].
URL: https://www.cdc.gov/brfss/brfssprevalence/.
58
Dallas County General Health Profile
FIGURE 49. Adults Who Are Current Smokers, Dallas-Plano-Irving, Texas Metroplex, 2011-2017
18%
16%
16% 15% 15%
12%
12%
10%
8%
6%
4%
2%
0
2011 2012 2013 2014 2015 2016 2017
Year
Data source: Centers for Disease Control and Prevention, National Center for Chronic
Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence
& Trends Data [online]. 2015. [accessed Sep 17, 2019]. URL: https://www.cdc.gov/brfss/
brfssprevalence/.
59
Dallas County General Health Profile
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Ot
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W
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greater than Data source: Center for Health Statistics BRFSS 2013-2017, Texas Department of State Health Services
$50,000.
60
Dallas County General Health Profile
FIGURE 51. P
ercent of Residents Who Did Not Receive a Flu Shot in the Past Year, Adults 65+ Years Dallas County, 2013 -2017 • 41% of Dallas County adults
60% over 65 years of age report
54% not receiving a flu shot in the
past year.
50%
45% 45% 45% 44% 45% • The percent of adults age
43%
41% 40% 41% 65 and over with health
38% 38%
40% 35% 36% 36% 36% insurance who did not receive
34% influenza vaccine in the past
32%
year was 41%.
30%
• More women (45%) than
men (34%) report not
20% receiving a flu shot.
• Among adults age 65 and
over, high school graduates
10% without any college education
N N N N have the highest percentage
0 (54%) of persons who are
al
ale
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te
$5 99
ed
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ce
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n
unvaccinated compared to
he
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Data source: Center for Health Statistics BRFSS 2013-2017, Texas Department of State Health Services
Note: N = Sample size less than 50, estimate not displayed
61
DALLAS COUNTY GENERAL HEALTH PROFILE
2% Other
FIGURE 52. Primary and Secondary Syphilis Diagnoses, Dallas County, 2007 - 2017
Hispanic
White
43%
5% 55+
45-54
13%
26% 35-44
15-24
38%
Data Source: 2009-2017 STD Incidence and Prevalence Data, Texas Department of
State Health Services
62
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 54. New Primary and Secondary Syphilis Diagnoses by ZIP Code, Dallas County, 2012 - 2016
75082
_
75080
75006 75044 75048
75248
75019
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201 Age-adjusted
75212 75226
75202
75210 75227 75149 New Primary and
Secondary Syphilis
75050
75208 75215 Diagnoses Incidence Rate
75203 per 100,000:
75211
75051 75181
0.00 - 2.00
75180
75224 75217
75216
75233 2.01 - 4.00
Insufficient Data
75146
63
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 55. Chlamydia Diagnoses Dallas County, 2007 -2017 FIGURE 56. ChlamydiaDiagnoses by Race and Age Group
Dallas County, 2017
2% Other
Hispanic
16%
Black
36%
White
46%
1%1% 55+
3%
7% 45-54
35-44
15-24
0-14
Data Source: 2009-2017 Dallas STD Incidence and Prevalence Data, Texas
Department of State Health Services
64
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 57. New Chlamydia Diagnoses by ZIP Code Dallas County, 2012 - 2016
75082
_
75080
75006 75044 75048
75248
75019
75001
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149 Age-adjusted
New Chlamydia Diagnoses
75050 75215 Incidence Rate per 100,000:
75208
75203
0.00 - 120.00
75211
75051 75181
75180 120.01 - 300.00
75224 75217
75216
75233 300.01 - 430.00
75236
75253
430.01 - 500.00
75237 75241
75052
75116 75232 500.01 - 580.00
75141 580.01 -700.00
75249
75159
75137
700.01 - 1,300.00
75134
>1300.00
75115 75172
75104 Insufficient Data
75146
65
DALLAS COUNTY GENERAL HEALTH PROFILE
2% Other
FIGURE 58. Gonorrhea Diagnoses Dallas County, 2007 - 2017
Hispanic
19%
23% Black
White
56%
5% 2% 1% 55+
45-54
11%
35-44
47% 25-34
34% 15-24
66
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 60. New Gonorrhea Diagnoses by ZIP Code Dallas County, 2012 - 2016
75082
_
75080
75006 75044 75048
75248
75019
75001
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149
75050 75215
75208
75203 Age-adjusted
New Gonorrhea Diagnoses
75051
75211
75181 Incidence Rate per 100,000:
75180
75224 75216
75217 0.00 - 40.00
75233
40.01 - 90.00
75236
75253
90.01 - 125.00
75052 75237 75241
75116 75232
125.01 - 170.00
75141
75249
75159 170.01 - 260.00
75137
75134
260.01 400.00
67
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 61. New HIV Diagnoses and Cumulative Number of Persons Living with
HIV Dallas County, 2008 - 2017
68
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 62. HIV Mortality Rate by Race, Dallas County, 1999 - 2017
69
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 63. New HIV Diagnoses by Gender and Exposure, Dallas County, 2017
Male
Female
17%
FIGURE 64. Persons Living with HIV by Race and Ethnicity Dallas County, 2008 - 2017
83%
Heterosexual
Pediatric
Data Source: 2009-2017 Dallas HIV Incidence and Prevalence Data, Data Source: 2009-2017 Dallas HIV Incidence and Prevalence Data,
Texas Department of State Health Services Texas Department of State Health Services
70
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 65. New HIV Diagnoses by ZIP Code Dallas County, 2012 - 2016
75082
_
75080
75006 75044 75048
75248
75019
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149 Age-adjusted
New HIV Diagnoses
75050
75208 75215 Incidence Rate per 100,000:
75203
0.00 - 5.00
75211
75051 75181
75180 5.01 - 13.00
75224 75217
75216
75233 13.01 - 18.00
75236 18.01 - 23.00
75253
75237 75241
75052
75232
23.01 - 30.00
75116
75249
75141 30.01 - 41.00
75159
75137 41.01 - 64.00
75134
>64.00
75115 75172
75104 Insufficient Data
75146
71
DALLAS COUNTY GENERAL HEALTH PROFILE
12%
45-64
19-44 34%
FIGURE 66. Annual Tuberculosis Cases and Incidence Rates Dallas County, 1993 - 2017 46%
37%
≥65
15%
5-18 0-4
3% 2%
21.7% Hispanic
31.2%
White
Black
41.4% 5.7%
Asian
72
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 68. Tuberculosis Incidence Rates by Race and Ethnicity Dallas County,
2006 - 2017
73
DALLAS COUNTY GENERAL HEALTH PROFILE
In 2016, of the
427,175 visits
(inpatient, outpatient
and emergency
department visits)
pertaining to
behavioral health,
37% were substance
misuse and 12%
were mental health
combined with
substance misuse
visits.27
Adopted: U.S. Centers from Disease Control and Prevention. 500 Cities Project: Local Data for Better Health.
25
Office of Disease Prevention and Health Proportion. HealthyPeople2020. Health-Related Quality of Life & Well Being. Available https://www.healthypeople.gov/2020/topics-objectives/topic/health-related-quality-of-life-well-being
26
National Institute of Mental Health. Chronic Illness & Mental Health. Available https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml
27
DFWHC Foundation. Behavioral Health Needs Assessment. Available http://www.healthyntexas.org/content/sites/dallasfortworth/BHCHNA__16_Counties_CHC.DFWHCFoundation2018.pdf
74
Dallas County General Health Profile
Utilization of mental
Both
health services by race
and ethnicity in 2016 is
12% Substance Misuse illustrated in Figure 71.
The left pie chart indicates
Mental Health that 53% of the visits
were made by whites
51% and 35% by African
37% Americans. The right pie
chart shows that 82.2%
of encounters were
non-Hispanic Latinos
individuals.
FIGURE 71. Mental Health Services Visits by Race and Ethnicity, 2016
Black
12% 17.75%
White/Non Hispanic
White Hispanic/Latino
53%
35%
82.2%
75
DALLAS COUNTY GENERAL HEALTH PROFILE
Uninsured
u HOSPITAL UTILIZATION
This section provides an overview of inpatient and emergency 15% Medicare
19%
INPATIENT DISCHARGES
Figure 72 shows that 40% of the overall discharges for inpatient
services in Dallas County were completed for individuals covered
Data Source: DFWHC Foundation Regional Data, 2018
by private insurance. Individuals covered by Medicaid represent
19% and those covered by Medicare represent 26%; while
Parkland inpatient services discharges by privately insured patients
represents only 6%, Medicaid covered individuals represent 36%
of inpatient services and Medicare 18% (see Figure 73).
The Inpatient Discharges Uninsured 2018 map (see Figure 74) FIGURE 73. Inpatient
Discharges by Payer Type (All Age Groups, Includes
illustrates the number of individuals discharged from inpatient Normal Newborns), Parkland, 2018
services in Dallas County in 2018 by ZIP code and shows the
highest volume of inpatient discharges of uninsured individuals
reside in ZIP codes 75217, 75216, 75243 and 75228 (for detailed
breakdown by ZIP code see Figure 76). Similarly, the ZIP codes with
the highest volume of Parkland’s uninsured patients also include
75217, 75216 and 75228 (see Figures 77 and 78).
ZIP codes 75217, 75216, 75211 and 75228 have the highest
volume of uninsured, Medicaid and Medicare inpatient discharges
both at the county level and at Parkland. ZIP codes 75052, 75115
and 75228 have the highest volume of privately insured discharges
(see Figure 79 – 80).
76
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 74. Inpatient Medicaid and Uninsured Discharges, Dallas County, 2018 (All Age Groups, Includes Normal Newborns)
75082
_
75080
75006 75044 75048
75248
75019
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149
75050 75215
75208
75203
75211
75051 75181
75180
Uninsured
75224 75217
75216
75233 109 and below
75249
75141 350 to 519
75159
75137 520 to 699
75134
700 to 899
75115 75172
75104 900 to 999
77
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 75. Inpatient Discharges Insured, Dallas County, 2018 (All Age Groups, Includes Normal Newborns)
75082
_
75080
75006 75044 75048
75248
75019
75081
75254
75240 75089
75244 75040
75234
75251
75063 75243 75042
75230
75039 75229 75088
75041
75038 75231 75238
75220 75225
75043
75209
75062 75218
75235 75275
75214
75061
75206
75228 75150
75247 75219
75182
75204
75060
75207 75246 75223
75201
75212 75226
75202
75210 75227 75149
75050 75215
75208
75203
75211
75051
75180
75181
Count
75224 75217
75216
75233 299 and below
78
Dallas County General Health Profile
Medicaid Uninsured
75211
1,147 519
75220
953 468
75243
1,004 310
75227
887 410
75060
576 258
75212
483 333
Medicaid Uninsured
79
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 78. Inpatient Discharges Uninsured, Parkland, Dallas County 2018 (All Ages, Includes Normal Newborns)
80
Dallas County General Health Profile
FIGURE 79. Inpatient Medicare and Insured Discharges by Top ZIP Codes, Dallas County, 2018 (All Age Groups, Includes Normal Newborns)
FIGURE 80. Inpatient Medicare and Insured Discharges by Top ZIP Codes, Parkland, 2018 (All Age Groups, Includes Normal Newborns)
75216 68 344
75217
79 266
75212 48 270
75211
70 211
75227
85 165
75235 69 172
75241 38 161
75224 65 130
75228
52 126
75232
37 111
Insured Medicare
81
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 81. Inpatient Discharges by Age Groups & Primary Payer Group,
Dallas County, 2018
FIGURE 82. Inpatient Discharges by Age Groups & Primary Payer Group,
Parkland, 2018
82
Dallas County General Health Profile
FIGURE 83 Inpatient Discharges by Race, Dallas County, 2018 (All Ages, Includes Normal Newborns)
160,000
64%
140,000
120,000
100,000
32%
80,000
60,000
40,000
When inpatient
20,000
5% discharges are broken
0% down by race and
ethnicity it shows that
0 American Indian / Asian or Black White
Eskimo / Aleut Pacific Islander
in Dallas County whites
comprised 64% of
Uninsured Medicaid Medicare Privately Insured the discharges and
Data Source: DFWHC Foundation Regional Data, 2018 African Americans 32%.
Parkland’s discharge
FIGURE 84. Inpatient Discharges by Race, Parkland, 2018 (All Ages, Includes Normal Newborns) demographics show that
whites (a race category
35,000
72%
that includes Hispanics)
represent 72% and
30,000 African Americans, 25%.
25,000
20,000
15,000
25%
10,000
5,000
0% 2% 1%
83
Dallas County General Health Profile
FIGURE 85. I npatient Discharges by Ethnicity, Dallas County, 2018 (All Ages,
Includes Normal Newborns)
Medicare 11%
Insured 5%
84
Dallas County General Health Profile
FIGURE 87. ED Discharges by Payer Type (All Ages) Dallas County, 2018
EMERGENCY Uninsured
DEPARTMENT (ED)
DISCHARGES PROFILE Medicare
For both Dallas County
and Parkland, uninsured 26% Medicaid
individuals comprise
the highest volume of 46% Privately Insured
ED discharges however,
in Dallas County the 13%
uninsured are 46% of all
ED discharges whereas at
Parkland they represent
15%
65%. The percentages for
Medicare and Medicaid ED
discharges within Dallas
County as a whole are
similar to those at Parkland FIGURE 88. ED Discharges by Payer Type (All Ages) Parkland, 2018
(Figures 87 and 88).
5% Uninsured
Medicare
17% Medicaid
Privately Insured
65% 13%
86
Dallas County General Health Profile
87
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 90. Medicaid and Uninsured ED Discharges by Top ZIP Codes, Dallas County, 2018
88
DALLAS COUNTY GENERAL HEALTH PROFILE
FIGURE 91. Medicaid and Uninsured ED Discharges by Top ZIP Codes, Parkland, 2018
89
Dallas County General Health Profile
32,509
108,251 69,561
91,329
152,712 9,183
23,614
11,911
49,805 23,569 24,848 65,294
34,724
Figures 92 and 93 29,799
64,927 68,799
show the distribution 37,443 48,388 44,046
25,246 17,148
7,562
of ED discharges by age
groups for Dallas County 0-17 YEARS 18-24 YEARS 25-34 YEARS 34-49 YEARS 50-64 YEARS 65-84 YEARS 85+ YEARS
displaying a near-normal
Privately Insured Medicaid Medicare Uninsured
bell shape distribution
with the exception of the Data Source: DFWHC Foundation Regional Data, 2018
0-17 age group for the
county as a whole.
FIGURE 93. ED Discharges by Age Groups, Parkland, 2018
49,032 38,009
29,502
15,368 6,792
963 2,702 5,876
9,028 11,365 8,524 11,019 10,137
1,943
2,608 1,920 3,113 3,533 3,195 300
0-17 YEARS 18-24 YEARS 25-34 YEARS 34-49 YEARS 50-64 YEARS 65-84 YEARS 85+ YEARS
90
Dallas County General Health Profile
600,000
500,000
400,000
300,000
200,000
100,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
91
Dallas County General Health Profile
Hispanic or Latino
Hispanic or Latino
92
Dallas County General Health Profile
FIGURE 98. Inpatient Hospital Discharges Diagnoses, Dallas County, 2018 (All Ages, Includes Normal Newborn) PROMINENT HOSPITAL
DIAGNOSES
Hospital discharge data
Cardiology/Circulatory System 8,722 9,753 19% offers insight regarding
Respiratory System 6,171 6,162 13% patterns of utilization,
Orthopedics/Musculoskeletal 7,777 6,426 13% Insured public health, injury,
morbidity and the burden
Digestive Diseases 6,595 4,590 12% Medicaid
of chronic disease.28 For
Neurology/Neurosurgery 5,100 4,704 10% Medicare this report, inpatient
Kidney & Urinary Tract 3,474 4,029 7% and ED discharge data
Uninsured was analyzed based
Psychiatry 4,004 1,836 7%
on diagnosis-related
Metabolic & Endocrine 3,040 2,469 7%
groups (DRG) to
Hepatobiliary & Pancreas 2,536 5% identify similarities and
Oncology 2,333 4% differences between
Dermatology 3% uninsured, Medicaid,
Medicare and privately
0 5,000 10,000 15,000 20,000 25,000
insured patients across a
Data Source: DFWHC Foundation Regional Data, 2018 variety of diagnoses.
FIGURE 99. Inpatient Hospital Discharges Diagnoses, Medicare and Insured, Dallas County, 2018 (All Ages, Includes Normal Newborns)
28
Arizona Department of Health Services. Hospital Discharge Data. Available at: https://www.azdhs.gov/preparedness/public-health-statistics/hospital-discharge-data/index.php .
93
Dallas County General Health Profile
FIGURE 100. Inpatient Hospital Discharges Diagnoses, Medicaid and Uninsured, Dallas County,
2018 (All Ages, Includes Normal Newborns)
FIGURE 101. Inpatient Discharge Diagnoses, Parkland, 2018 (All Ages, Includes Normal Newborns)
94
Dallas County General Health Profile
FIGURE 102. Inpatient Diagnoses, Medicare and Insured, Parkland, 2018 (All Ages, Includes Normal Newborns)
FIGURE 103. Inpatient Diagnosis, Medicaid and Uninsured, Parkland, 2018 (All Ages, Includes Normal Newborns)
95
Dallas County General Health Profile
96
Dallas County General Health Profile
97
DALLAS COUNTY GENERAL HEALTH PROFILE
Diabetes,
41,056
PARKLAND UTILIZATION BY
CHRONIC DIAGNOSES
Parkland monitors the number of
patients with chronic disease as a CKD, CHF,
means to identity at-risk populations Multiple Chronic 10,386 8,595
as well as geographic hot spots across Hypertension, Behavioral Health, Conditions, Asthma,
the county. Figure 106 on the right 79,801 65,923 60,662 13,878 Cancer, 5,310
shows the number of patients per Data Source: Parkland Decision Support, Strategy & Business Development
chronic disease as well as the number
of patients with multiple chronic FIGURE 107. Visits by Chronic Disease Patients, FY18
conditions. Figure 107 indicates the
number of visits incurred by patients
with chronic disease.
Multiple Chronic
Hypertension, Conditions, CKD, CHF, Asthma, Cancer,
681,108 601,554 135,973 109,322 98,359 95,393
98
u
P arkland maintains
several clinical registries
including those focused
on chronic disease
and uses this data to
identify trends within
the population and
develop new strategies
for managing those
patients suffering from
chronic conditions.
The following maps
display the county-
wide distribution of
Parkland patients
with hypertension,
behavioral health issues,
diabetes, asthma,
chronic kidney disease,
cancer and chronic
heart failure or multiple
chronic diagnoses.
Dallas County General Health Profile
100
Dallas County General Health Profile
FIGURE 109. Parkland, Behavioral Health (Inpatient and Outpatient) Registry by Zip Codes
101
Dallas County General Health Profile
102
Dallas County General Health Profile
103
Dallas County General Health Profile
104
Dallas County General Health Profile
105
Dallas County General Health Profile
106
Dallas County General Health Profile
107
Figure 116. Correctional Health Demographics by
Race, Dallas County, 2018
Dallas County General Health Profile
CORRECTIONAL HEALTH
In 2018, Parkland provided healthcare
15,000
services to 52,098 individuals in the
19,989
Dallas County Jail. Of those, 63% (n-
33,186) also have a medical record with 10,000
Parkland, which indicates a tendency 21%
for these patients to cycle between the 18%
health system and correctional health 5,000
facilities. Those ZIP codes with the highest 6,857 5,866
incarceration rates are the same ones
1%
identified in previous sections as having 0
Hispanic or Non Hispanic Unspecified Unknown
significant health disparities. Latino or Non Latino
Data Source: Clarity Data prepared by PCCI
29
U.S. Centers for Disease Control and Prevention. Correctional Health.
108
Dallas County General Health Profile
FIGURE 118. Correctional Health Cases per ZIP Code, Dallas County, 2018
75216 1,051
75217 973
75228 631
75211 630
75201 455
75227 615
75243 570
75241 542
75215 477
75149 422
0 200 400 600 800 Figure
1,000 119. Correctional Health Cases per Top
1,200
FIGURE 119. Correctional Health Cases per Top Chronic Conditions, Dallas County, 2018
Lung
Diabetes, Liver Disease, Heart Failure, Disease,
1,132 546 285 225
109
Dallas County General Health Profile
FIGURE 120. Correctional Health Cases per ZIP Code, Dallas County, 2018
110
Dallas County General Health Profile
HOMELESS HEALTH
Parkland’s Homeless Outreach Medical Services (HOMES) program serves homeless individuals of all ages in
Figure 121. HOMES Top 10 ZIP Codes 2018
Dallas County. It is the only program of its kind in Dallas County that seeks to improve access to healthcare
for individuals experiencing homelessness. The program provides services at over 25 locations through two
fixed sites, four mobile medical units, and one mobile dental unit. Locations include homeless shelters,
domestic violence shelters, housing programs, drug treatment programs, day programs and social service
centers. HOMES is a Health Care for the Homeless Federally Qualified Health Center under the Health
Resources and Services Administration (HRSA).
111
Dallas County General Health Profile
FIGURE 122. HOMES Population by Race, 2016 - 2018 FIGURE 124. HOMES Veterans Patients, 2016 - 2018
# of HOMES Veterans
% of Total HOMES Patients
40
30
20
5 6 7
10 6.25%
4.50%
2.83%
0
Black/African American White All Others
CY 2016 CY 2017 CY 2018
CY 2016 CY 2017 CY 2018 Data Source: HOMES Annual HRSA UDS Submissions
112
Dallas County General Health Profile
FIGURE 125. HOMES Patients by Age Group, 2016 - 2018 FIGURE 127. HOMES Other Selected Medical Condition Diagnoses, 2016 – 2018
90
60%
80
50
40% 40
32% 31% 32%
30 54 43 82
30% 20 37 45
10 24
20%
0
12%
11% 8% 8%
Abnormal Breast Abnormal Cervical
8% (Female)
10% 7%
1% 1% 1% CY 2016 CY 2017 CY 2018
0
Under 18 18-44 45-59 60-69 70 and Over Data Source: HOMES Annual HRSA UDS Submissions
FIGURE 126. HOMES Selected Medical Condition Diagnoses, 2016 – 2018 FIGURE 128. Selected Infection and Parasitic Disease Diagnoses, 2016 – 2018
2,500 350
2,215 2,192
2,134 298
300 279 276
2,000
# of HOMES Patients w/DX
250
Data Source: HOMES Annual HRSA UDS Submissions Data Source: HOMES Annual HRSA UDS Submissions
113
Dallas County General Health Profile
FIGURE 129. HOMES Mental Health Conditions and Substance Use Disorders, 2016 – 2018
1,600
1,522
1,400
1,279
1,192
1,200 1,160 1,205 1,184
1,000 986
784
# of HOMES Patients w/DX
800
629
584
600 526
400 384
218186 230
200
119 104
53
0
Depression/ Tobacco Use Other Mental/ Anxiety/PTSD Alcohol-Related Attention Deficit/
Other Mood Non Drug&Alcohol Disruptive Behavior
114
Dallas County General Health Profile
1,200
1,059
1,000
787
800
# of HOMES Patients
600 565
400
269
232 209 149
200
115 81 80 119
16 14 13 14 3
0
Restorative Oral Oral Rehabilitative Prophylaxis Fluoride
Services Exams Surgery Services (Adult/Child) Treatment
(Adult/Child)
CY 2016 CY 2017 CY 2018
115
Dallas County General Health Profile
30
afeez H, Zeshan M, Tahir MA, Jahan N, Naveed S. Health Care Disparities Among Lesbian, Gay, Bisexual, and
H
Transgender Youth: A Literature Review. Cureus. 2017;9(4):e1184. Published 2017 Apr 20. doi:10.7759/cureus.1184
31
Source: Morton, M. H., Dworsky, A., Matjasko, J. L., Curry, S. R., Schlueter, D., Chávez, R.& Farrell, A. F. (2018).
Prevalence and correlation of youth homelessness in the United States. Journal of Adolescent Health, 62(1), 14-21
116
Dallas County General Health Profile
COMMUNITY INPUT
Community and frontline health provider input is essential for FIGURE 131. Breakdown by HealthyPeople 2020 Domains
understanding the barriers to better health experienced by the
residents of Dallas County as well as the opportunities to address
them. As explained previously in this assessment, dozens of
focus groups were conducted with participants from 49 groups Health and Healthcare 61%
representing patients, community-based organizations and
healthcare professionals from various functions within the industry. Social Impact and
Participants offered insights on a range of issues such as barriers
Community Context 19%
to care, social determinants of health and which community
institutions are best positioned to guide health improvement efforts
in the county. Education 10%
u COMMUNITY HEALTH INTEGRATION Neighborhood and
A number of participants recognized the need for leadership and
Built Environment 5%
better coordination among organizations and services in order to
address the increasingly complex issues affecting the health and
well-being of Dallas County residents. While it was acknowledged
that improving the health of the county and eliminating disparities
Economic Stability 4%
will require a community-wide effort beyond what the health
provider entities can achieve on their own, several participants
expressed the opinion that the county health agencies (Parkland
and DCHHS) are best positioned to organize such efforts. 14% of
the respondents offered responses that identified Parkland as an
anchor organization in the community. A number of participants
urged Parkland, in particular, to help support and enable the efforts
of other allied organizations within the community who serve a
population common to the health system.
The graphic above shows that after categorizing all focus group
u BARRIERS TO BETTER CARE responses (N=820) by SDOH according the HealthyPeople 2020
Focus group participants identified several barriers that prevent framework, the top three SDOH that participants perceived as having
the patient population most commonly served by Parkland and the most influence over the health of the community are: Health and
DCHHS from improving their health status. The team developing Healthcare (61%), Social Impact and Community Context (19%) and
the CHNA collected this feedback and, as described in the Education (10%).
methodology section of this assessment, coded responses based
on the CDC’s HealthyPeople 2020 Social Determinants of Health
(SDOH) Framework. Once the data from the focus group responses
was analyzed and coded, the SDOH were ranked by number of
participant references to each topic (see Figure 131).
118
119
COMMUNITY INPUT
Of the responses that fall within the Health and Healthcare domain, Access to
Access to Care was the most prominent. Factors categorized under Bevavioral Health Services 29%
Access to Care create situations in which it is difficult physically, Other 16%
financially or in terms of navigating a complicated healthcare system,
for patients to access care through available resources. It also includes Insurance Coverage 14%
health literacy which, apart from being a factor that impacts an
individual’s ability to navigate the healthcare landscape, impacts one’s
Increase in Patient Volume 14%
ability to understand and manage chronic disease. Poor Health Literacy 13%
Responses within the Access to Care category include the following: Overall Access to Care 6%
Lack of insurance coverage Care Coordination 4%
Poor Health Literacy
Other
Access to Medication 3%
Increase in Patient Volumes 0 5 10 15 20 25 30
Access to Medication Source: HOMES Annual HRSA UDS Submissions
Access to behavioral Health Services
Care Coordination
120
COMMUNITY INPUT
Social cohesion
Discrimination
Cultural Competency
Other
121
COMMUNITY INPUT
EDUCATION
The category with the third largest number of responses was
Education. While health literacy was discussed often over
the course of our focus groups, a number of participants
raised the issue of reading literacy and the challenges
patients have when they are unable to read treatment plans
and prescriptions. These responses were closely correlated
with health literacy and discussion tended to drift between
reading literacy and health literacy.
Access to transportation
Reliance on family members or others for transportation
(scheduling rides)
Cost of transportation
Elderly people’s difficulty in dealing with the public
transportation system.
122
123
COMMUNITY INPUT
DALLAS COUNTY
COMMUNITY HEALTH NEEDS ASSESSMENT 2019
Parkland Health & Hospital System | Dallas County Health and Human Services