2014
State of the County
Health Report
2014
OVERVIEW OF SELECTED HEALTH INDICATORS
FOR MECKLENBURG COUNTY
Mecklenburg
County
Table of Contents
Overview and Demographics ................................................................1
Chronic Disease Action Plan ..................................................................2
Mental Health Action Plan ....................................................................3
Access to Care Action Plan ....................................................................4
Violence Action Plan .............................................................................5
Leading Causes of Death .......................................................................6
Birth Outcomes & Highlights .................................................................7
Communicable Diseases & STIs .............................................................7
Health Behaviors...................................................................................8
New Initiatives & Emerging Issues ........................................................9
Appendix...............................................................................................10
Mecklenburg County, NC
Municipality Map
2014 Mecklenburg State of the County Health Report
In North Carolina, the state requires each local health department to conduct a
Community Health Assessment (CHA) every four years for accreditation and as part of
its consolidated contract. During the years between health assessments, health
directors submit an abbreviated State of the County Health report (SOTCH) report. In
Mecklenburg County, this report consists of an overview of selected health indicators
presented in tables and charts.
Sections include information on demographics, maternal, child and infant health and
leading causes of morbidity and mortality. Throughout this report, local programs and
initiatives will highlight progress in addressing the top four health issues as identified by
Mecklenburg residents. These snapshots of progress support the Healthy North
Carolina 2020 goal of making North Carolina a healthier state.
Mecklenburg County Demographics At a Glance (source: US Census)
Community Health Priorities
In Mecklenburg, the most
recent Community Health
Assessment (CHA) was
conducted in 2013. The CHA
process included a review of
community health indicators,
community opinion survey, a
community priority setting
activity and action planning on
leading priorities.
The top four health issues, as
decided by Mecklenburg
residents, were:
1. Chronic Disease
Prevention
2. Mental Health
3. Access to Care
4. Violence
Prevention
Learn more about the
2013 Mecklenburg Community
Health Assessment online at:
www.meckhealth.org
2013 Population
Median Age
Poverty
Total number of
people living in
Mecklenburg:
People in Mecklenburg are
younger than in the State.
The percent of people living
in poverty is lower than in NC.
990,977
Mecklenburg
34.5 years
NC
37.9 years
15%
18%
Mecklenburg
Median Household
Income:
Median Household income
is higher in Mecklenburg.
Unemployment Rates:
Percent Uninsured:
Unemployment rates are
similar to those in the State.
A slightly higher percent of
uninsured live in Mecklenburg.
9.3%
Mecklenburg NC
$54,278
NC
$45,906
Mecklenburg
9.7%
NC
2013 Mecklenburg County
Race/Ethnicity Distribution
Mecklenburg
NC
17.7%
15.6%
2013 Educational Attainment
White,
49%
45%
Hispanic,
13%
Two or
More
Races, 2%
Asian,
Other
5%
Races, 1%
Vulnerable populations,
includes groups that have not
been well integrated into
health care systems due to
cultural, economic, geographic
or health characteristics.
These populations may also be
at higher risk during disasters.
The following table includes
examples of vulnerable
populations in Mecklenburg.
2014 Mecklenburg County State of the County Health Report (SOTCH)
African
American,
31%
34%
Vulnerable Group
Characteristic
Estimated
Persons
% of
Population
Disabled
91,831
9.3%
Limited English Proficiency
85,224
8.6%
Homeless
2,014
0.2%
Children less than 5 years
70,376
7.1%
Persons 65 years and older
96,252
9.7%
Persons 85 years and older
11,065
1.1%
Source: 2013 American Community Survey Estimates
Page | 1
Priority #1: Chronic Disease Prevention
Local Community Objectives
Reduce the rate of overweight and obesity among Mecklenburg County adults by 5%
Current Rate: 61% overweight/obese
Target Rate: 58%
Current Rate: 17% current smokers
Target Rate: 15%
Reduce the rate of tobacco use among Mecklenburg County adults by 10%
Relevant Data
Healthy North Carolina 2020 Goals Aligned with our Priorities
Cross-Cutting Section: Increase the percentage of adults who are neither overweight nor obese to 38%.
Tobacco Section: Decrease the percentage of adults who are current smokers to 13%.
ACTION PLAN PROGRESS SNAPSHOTS
Village Heart BEAT participants engage in a
physical activity challenge
PHOTO: www.charlotteobserver.com
Tobacco Free Park sign
PHOTO: Mecklenburg County Health Department
Reducing Overweight and Obesity
• Village Heart BEAT (Building Education and Accountability Together) is
a program designed to promote heart health through improved diet,
increased physical activity and biometric screenings.
• New team competition orientation will begin in December 2014,
teams will participate in challenges throughout the next year.
• Expected enrollment is 15-20 teams with about 10 people per team
• Program is being evaluated by faculty at UNC Charlotte & UNC Chapel
Hill.
• The health equity council, Partners in Eliminating Health Disparities is
reconvening to strengthen its mission and impact in the community.
Reducing Tobacco Use
• In October 2014, county commissioners passed an ordinance that
prohibits smoking in all county-owned buildings, vehicles and grounds
including bus shelters.
• Commissioners also approved a tobacco free ordinance that applies
to nearly all county parks and buildings on park property.
• Both restrictions will be effective in March 2015.
2014 Mecklenburg County State of the County Health Report (SOTCH)
Page | 2
Priority #2: Mental Health
Local Community Objective
Reduce the suicide rate by 5%
Current Rate: 9.4 per 100,000
Target Rate: 8.9 per 100,000
Relevant Data
Healthy North Carolina 2020 Goals Aligned with our Priorities
Mental Health: Reduce the suicide rate (per 100,000 population to 8.3%)
ACTION PLAN PROGRESS SNAPSHOTS:
Reducing suicide rate
•
Four Mental Health First Aid trainings targeting staff
and volunteers working with the homeless populations
have been completed with a total of 47 participants.
•
Two more trainings are scheduled for the first 6
months of 2015 reaching an estimated 30-40
additional staff and volunteers, two more will likely be
scheduled for the second half of the year.
•
In addition to specifically targeting staff working with
the homeless population, the trainings are also being
delivered to 911 dispatchers, Mecklenburg County
Sheriffs/recruits/jail staff, Communities in Schools and
the community at large.
•
A youth suicide task force has formed under the
umbrella of the Child Fatality Prevention and
Protection team to review youth suicides and potential
risk factors for suicide.
World Mental Health Day, October 10th Charlotte, NC
PHOTO: Mecklenburg County
First responders attend a MHFA training in Greenville, NC
PHOTO: www.pittcc.edu
2014 Mecklenburg County State of the County Health Report (SOTCH)
Page | 3
Priority #3: Access to Care
Local Community Objective
Provide access to care to all individuals and families in Mecklenburg County, regardless of
ability to pay
Current rate: 18% uninsured individuals ages 0-64
Target rate: 8% uninsured individuals ages 0-64 (state target)
Relevant Data
Healthy North Carolina 2020 Goals Aligned with our Priorities
Cross Cutting: Reduce the percentage of non-elderly uninsured individuals (aged less than 65 years) to 8%
ACTION PLAN PROGRESS SNAPSHOTS:
Increase the number of insured individuals and families
•
Get Covered Mecklenburg hosted its first mass enrollment
event on November 15, 2014, the first day of open enrollment
via healthcare.gov; there are three more Saturday enrollment
events planned for the open enrollment period.
•
44,597 Mecklenburg residents obtained health coverage during
the first open enrollment period, an estimated 90% received
tax credits to help off-set the cost of monthly premiums.
•
Navigators are stationed throughout the county providing free
enrollment assistance, a statewide appointment line is set up
for consumers to schedule a convenient appointment time and
location.
•
Get Covered Mecklenburg has hosted forums and attended
festivals to encourage enrollment among our Hispanic and
Asian populations.
•
During the open enrollment period, Get Covered Mecklenburg
expects to reach about at least 1,500 individuals and families.
Navigator helps a family enroll in a qualified health plan
PHOTO: Get Covered Mecklenburg
A local low-cost clinic offer information at an enrollment
event
PHOTO: Get Covered Mecklenburg
2014 Mecklenburg County State of the County Health Report (SOTCH)
Page | 4
Priority #4: Violence
Local Community Objective
Reduce the homicide rate by 5%
Target Rate: 6.1 per 100,000
Current Rate: 6.4 per 100,000
Relevant Data
Healthy North Carolina 2020 Goals Aligned with our Priorities
Injury and Violence: Reduce the homicide rate (per 100,000 population)
ACTION PLAN PROGRESS SNAPSHOTS
Reducing the homicide rate
• A Charlotte-Mecklenburg Police officer visited a Project Safe
Neighborhood community to discuss the Crime Stoppers program,
an identity-protected means of reporting crime information that
rewards citizens whose tips result in an arrest. The person
reporting information is then eligible for a cash reward. Residents
were excited about the program and plan to engage their
neighbors to participate. Statistically, that community has seen a
19% reduction in violent crime for the year so far.
Students attend the Do The Write Thing leadership program
PHOTO: Mecklenburg County Community Support Services
• Community Support Services, Charlotte-Mecklenburg Schools,
Charlotte-Mecklenburg Police Department, Teen Health
Connection and several other community partners completed the
Seeking to Heal and Reclaim needs assessment as part of the
planning phase for the Consolidated Youth grant award from the
U.S. Department of Justice, Office on Violence Against Women.
This project will enhance services to victims of and/or those
exposed to domestic violence and teen dating violence.
• In October 2014, Community Support Services-Women’s
Commission Division hosted a leadership conference for middle
school students as part of the Do the Write Thing program. The
program is designed to help students become leaders and
ambassadors in their school; 17 students participated.
2014 Mecklenburg County State of the County Health Report (SOTCH)
Page | 5
All Others
N=2,302
(43%)
Cancer
N=1,207
(23%)
Heart Disease
N=1,042 Alzheimer’s
(19%)
Disease
N=301
(6%)
Stroke
N=263
(5%)
COPD*
N=245
(5%)
 Of the 5,360 deaths occurring in
Mecklenburg County in 2012,
nearly 50 percent were caused by
cancer, heart disease and stroke.
*COPD or Chronic Obstructive Pulmonary Disease
includes emphysema and chronic bronchitis.
Leading Causes of Death: MECK, NC (2012)
and the United States (2011)
2012 Leading Causes of Death by Age Group
Mecklenburg County
Infants (<1 yr.)
 Birth Defects
Ages 25—44 yrs
 Unintentional Injury
1
 Prematurity & Immaturity
 Cancer
6
6
 Neonatal Hemorrhage
 Homicide
4
4
4
COPD*
5
3
3
Ages 1—14 yrs
 Unintentional Injury
Ages 45—64 yrs
 Cancer
Unintentional Injury
6
5
5
 Heart Disease
 Heart Disease
Kidney Disease
7
9
9
 Birth Defects
 Unintentional Injury
Diabetes
8
7
7
Ages 15—24 yrs
 Unintentional Injury
Ages 65 yrs or more
 Heart Disease
Septicemia
9
10
**
 Homicide
 Cancer
Influenza and Pneumonia
10
8
8
 Suicide
 Alzheimer’s Disease
MECK
1
NC
1
US
2
Heart Disease
2
2
Alzheimer’s Disease
3
Stroke
Cancer
** Not included in top ten rankings.
Mecklenburg ranks comparably to NC and US with the following
exception: Mecklenburg ranks higher for Alzheimer’s disease.
2012 Leading Causes of Death by Gender
Mecklenburg County
2012 Leading Causes of Death by Race
Mecklenburg County
MALES
FEMALES
WHITE
MINORITIES
1. Cancer
1. Cancer
1. Cancer
1. Cancer
2. Heart Disease
2. Heart Disease
2. Heart Disease
2. Heart Disease
3. Unintentional Injury
3. Alzheimer’s Disease
3. Alzheimer’s Disease
3. Stroke
4. COPD
4. Stroke
4. COPD
4. Kidney Disease
5. Stroke
5. COPD
5. Unintentional Injury
5. Diabetes
6. Alzheimer’s Disease
6. Kidney Disease
6. Stroke
6. Unintentional Injury
7. Diabetes
7. Unintentional Injury
7. Influenza and Pneumonia
7. Alzheimer’s Disease
8. Septicemia
8. Influenza and Pneumonia
8. Suicide
8. COPD
Women tend to live longer than men. Women die from
Alzheimer’s disease at higher rates than men. Men die from
unintentional injuries at higher rates than women.
Source: NC DHHS, State Center for Health Statistics
While the two leading causes of death are similar among all
racial groups, people of other races often die at higher rates
and younger ages than whites.
Birth Outcomes and Highlights
2012 Mecklenburg Total Births: 13,848
Maternal Risk Factors
Live Birth Rate = 14.3 per 1,000 population
2012 Race/Ethnicity of Live Births
Other
Races, NonHispanic, 8%
Hispanic,
19%
White, NonHispanic,
41%
American
Indian, NonHispanic,
0.2%
40 plus
30 - 39 years
20 - 29 years
Teens < 20 years
• Teens 10-14
• Teens 15-17
• Teens 18-19
486
6,341
6,200
821
19
245
557
3.4%
49.2%
43.6%
Chronic Conditions during Pregnancy
• Gestational Diabetes
• Hypertension
815
693
5.9%
5.0%
9,750
70.4%
1,594
1,357
10,222
4,484
11.5%
9.8%
73.8%
32.4%
Birth Outcomes
•
•
•
•
2012 Live Births by Age of Mother
Births
% of Births
Maternal Pre-pregnancy BMI (kg/m²)
• Underweight (<18.5)
472
• Normal Weight (18.5 – 24.9)
6,814
• Overweight/Obese (>=25)
6,038
Prenatal Care (PNC)
• Received Adequate PNC
Black, NonHispanic,
32%
Age of Mother
Births
% of Births
3.5%
45.8%
44.8%
5.9%
2.3%
29.8%
67.8%
Premature (<37 weeks)
Low Birth Weight (<=2500g)
First Trimester Prenatal Care
Primary C-section
2012 Infant Deaths (deaths under 1 year of age)
Total Infant deaths
Infant Mortality Rate
(per 1,000 live births)
Source: NC DHHS/State Center for Health Statistics
Meck
74
5.3
NC
883
7.4
US (2011)
23,985
6.1
Communicable Diseases and Sexually Transmitted Infections
2011-2013 Communicable Disease and Sexually Transmitted Infection, Annual Case Rates: US, NC and Mecklenburg
(rates per 100,000 population)
2011
Column1
2012
2013
Meck
NC
USA
Meck
NC
USA
Meck
NC
USA
0.8
18.5
2.5
2.1
26.1
2.3
6.1
16.8
4.3
4.8
19.4
2.0
6.4
22.6
1.4
15.4
17.3
4.9
2.7
12.9
4.6
6.4
19.6
2.6
N/A
N/A
N/A
4.0
2.5
3.4
3.1
2.2
3.2
4.1
2.2
3.0
788.8
558.0
453.4
648.8
519.1
453.2
628.2
496.5
N/A
Gonorrhea
Primary/Secondary Syphilis
240.0
10.9
177.8
4.1
103.3
4.5
190.7
8.4
146.7
3.4
106.7
5.0
183.2
11.1
140.1
4.3
N/A
N/A
HIV Infection1
AIDS2
34.2
14.2
15.4
8.4
14.3
8.9
27.9
21.9
13.8
8.1
15.3
8.9
31.0
26.7
15.6
9.2
N/A
N/A
COMMUNICABLE DISEASES
Pertussis
Salmonella
Shigella
Tuberculosis
SEXUALLY TRANSMITTED
INFECTIONS
Chlamydia
Source: NC DHHS/State Center for Health Statistics, HIV/STD Prevention Care Unit: 2013 HIV/AIDS Surveillance Report
Centers for Disease Control and Prevention, 2013 Sexually Transmitted Disease Report and 2012 HIV/AIDS Surveillance Report
1. HIV infection includes all newly diagnosed HIV infected individuals by the date of first diagnosis regardless of status (HIV or AIDS)
2. The 2013 AIDS numbers are artificially inflated due to incomplete interstate de-duplication.
2014 Mecklenburg County State of the County Health Report (SOTCH)
Page |7
Health Behaviors
2011-2013 Behavior Risk Factor Surveillance System: US, NC and Mecklenburg County
Column1
BEHAVIORAL HEALTH RISKS
Smoking
Overweight/Obesity3
No Physical Activity
Fruit & Veg (≥5/day)4
CHRONIC CONDITIONS
Diabetes
Cardiovascular Dz.5
High Blood Pressure6
High Cholesterol6
Meck
2011
NC
USA
Meck
2012
NC
USA
Meck
2013
NC
USA
15%
56%
22%
19%
22%
65%
27%
14%
21%
64%
26%
N/A
20%
63%
20%
N/A
21%
66%
25%
N/A
20%
63%
23%
N/A
17%
61%
21%
11%
20%
66%
27%
12%
19%
65%
25%
N/A
10%
6%
28%
33%
11%
9%
32%
39%
N/A
N/A
31%
38%
10%
7%
N/A
N/A
10%
9%
N/A
N/A
N/A
N/A
N/A
N/A
8%
8%
33%
41%
11%
10%
36%
41%
N/A
N/A
31%
38%
2009-2013 Youth Risk Behavior Survey: US, NC and Charlotte-Mecklenburg High Schools (9 – 12 grade levels)
PSYCHOLOGICAL HEALTH
Ever attempted suicide or tried to kill themselves
SUBSTANCE ABUSE
Smoked cigarettes one or more days in past 30 days
Had at least one alcoholic drink one or more days in
the past 30 days
Used marijuana one or more times in the past 30 days
WEIGHT MANAGEMENT AND NUTRITION
Are obese (at or above the 95th percentile for body
mass index, by age and sex)
PHYSICAL ACTIVITY
Physically active for a total of 60 minutes or more per
day on 5 or more of the past 7 days
CMS
2009
NC
US
CMS
2011
NC
US
CMS
2013
NC
US
14%
10%
6%
15%
14%
8%
N/A
N/A
8%
13%
18%
20%
14%
18%
18%
10%
15%
16%
33%
35%
42%
34%
34%
39%
34%
32%
34%
21%
20%
21%
28%
24%
23%
29%
23%
23%
12%
13%
12%
13%
13%
13%
12%
13%
14%
43%
46%
37%
40%
48%
50%
45%
47%
47%
2009-2013 Youth Risk Behavior Survey: NC and Charlotte-Mecklenburg Middle Schools (6 – 8 grade levels)
PSYCHOLOGICAL HEALTH
Ever attempted suicide or tried to kill themselves
SUBSTANCE ABUSE
Smoked cigarettes on one or more days in the past 30 days
Ever had a drink of alcohol, other than a few sips
WEIGHT MANAGEMENT AND NUTRITION
Described themselves as slightly or very overweight
PHYSICAL ACTIVITY
Physically active for a total of 60 minutes or more per day
on five or more of the past seven days
2009
CMS
NC
2011
CMS
NC
CMS
NC
N/A
N/A
11%
10%
12%
11%
6%
33%
8%
30%
5%
31%
8%
29%
4%
28%
6%
26%
24%
26%
23%
25%
23%
26%
51%
60%
53%
59%
58%
57%
2013
Source: NC DHHS/State Center for Health Statistics
3. Overweight/Obesity-Body Mass Index (BMI)>25.0. BMI is computed as weight in kilograms divided by height in meters squared: (kg/m2); 4.Data for
Fruit and Vegetable was not collected for 2012; 5.History of any cardiovascular diseases includes heart attack, coronary heart disease or stroke; 6. Data
for High Blood Pressure and High Cholesterol was not collected for 2012
2014 Mecklenburg County State of the County Health Report (SOTCH)
Page |8
New Initiatives & Emerging Trends
New Initiative: Health Impact Assessment
of the Lynx Light Rail Extension
The Mecklenburg County Health Department was awarded
grant funding from the National Association of City and
County Health Officials that will enable staff and partners
to become trained in conducting Health Impact
Assessments (HIA). HIAs are conducted to improve
consideration of health in community design and built
environment projects. This study will focus on the
Charlotte Area Transit extension of the Lynx light rail Blue
Line and specifically connecting the two northern-most
stations in order to provide a safe, health-promoting route
for students, residents, and patrons of businesses in that
area. Current plans call for a pedestrian overpass;
however there have been no additional plans for
supporting infrastructure around the station to make it a
gateway into the campus and business centers. The
completed HIA will help inform future planning efforts
including vehicle traffic patterns, pedestrian crossings,
adequate sidewalk capacity and parking policies.
New Initiative: Charlotte Chamber’s Healthy
Charlotte Council
The Charlotte Chamber has developed a Healthy Charlotte
Council with a charge to make Charlotte nationally
recognized for its healthy initiatives and showcase our
health services industry. Using the American Fitness Index
(AFI) as a benchmark, the Council hopes to help Charlotte
achieve a top 10 ranking within the next five years
(Charlotte’s current ranking is 27th, up from 36th). The AFI
scores communities throughout the country with regard to
health issues such as health behaviors, health problems,
and its built environment. To achieve the goal of a top 10
ranking, the Council has developed three key action items:
(1) Identify key indicators of the index and track status; (2)
Establish connectivity with pertinent organizations to drive
community collaboration; (3) Increase national reputation
of Charlotte as a health care hub. The Data/Index and
Collaboration sub-committees of this council continue to
review current AFI criteria and reach out to community
partners and stakeholders to improve Charlotte’s ranking.
Emerging Trend: Mental Health & Violence
as Priority Health Issues
2013 marked the first year that the issues of mental health
and violence ranked among the top 4 issues facing the
county in the Community Health Assessment Priority
2014 Mecklenburg County State of the County Health Report (SOTCH)
Mental Health & Violence, cont.
Setting process. The issues were identified in both
components of the priority setting process; the community
survey and the community exercise. Accordingly, stakeholder groups were convened to develop goals and
recommendations for addressing each. The plans created
by each group each identified the on-going need for
collaboration and communication among community
stakeholders. For more information on these plans, see the
Action Plan section of this report.
Emerging Trend: Challenges to the
Affordable Care Act
In the fall of 2014, the US Supreme Court agreed to hear a
challenge to the Affordable Care Act. The issue in question
is whether the law was intended to give tax credits only to
those individuals who sign up for insurance plans in states
that have set up their own insurance exchange and not to
those signing up through the federal exchange,
healthcare.gov. Those enrolling in insurance plans during
the 2014-2015 enrollment period will still be able to take
advantage of tax credits, if qualified. The Supreme Court is
expected to announce their decision in June 2015.
Emerging Trend: Preparedness and Ebola
Response
Mecklenburg County was one of the first communities to
respond to the Ebola Virus Disease (EVD) threat in the US.
We experienced a suspected EVD case and had to
quarantine and monitor travelers from West Africa (Guinea,
Liberia, and Sierra Leone) before the Centers for Disease
Control and Prevention (CDC) developed protocols to do so.
Since then the Mecklenburg County Health Department
(MCHD) has been active in providing information to the
public and government leadership. In addition, MCHD has
provided Ebola-related training and planning advice to and
collaborated with our many community partners (airport,
school system, Sheriff’s Office, police department, local
colleges and universities, hospitals, Medic, and emergency
management). The Department has also reached out to
Mecklenburg residents from West African to educate them
about Ebola and how to prevent its spread. Various Health
Department protocols and procedures were also modified
to facilitate a more effective Ebola response, such as: after
hour contact; quarantine and isolation; and traveler
monitoring procedures. These measures should greatly
improve our response to the EVD threat.
Page | 9
Appendix
TECHNICAL NOTES FOR:
• HIV & STD Data
• Behavioral Data
• Birth & Mortality Data
Technical Notes: HIV & STD Data
HIV Disease Cases
HIV Disease covers the entire spectrum of disease, from initial infection of the virus to the deterioration of
the immune system and presentation of opportunistic infections (full-blown AIDS). The time that it takes for
each person to go through these stages varies. However, the process of HIV disease is fairly slow and
usually takes several years from infection to the development of AIDS. In surveillance and case reporting,
the term HIV disease includes:

persons with a diagnosis of HIV infection (not AIDS),

persons previously reported with an HIV infection who have progressed to AIDS,

persons with a concurrent diagnoses of HIV infection and AIDS.
HIV disease cases are counted by the date on which HIV infection was first diagnosed and reported. In
some cases the date of infection is based on the date of report for an AIDS diagnosis because the
infected individual was never reported with an HIV infection prior to the AIDS diagnosis.
HIV Disease Case Rates
Rates are expressed as cases per 100,000 population. Each rate is calculated by dividing the number of
cases reported in a geographic area during a specific time period by the area’s population during that time
period, multiplied by 100,000. Population denominators used to calculate rates for North Carolina and
Mecklenburg County were based on county and state population projections calculated by the NC State
Demographics Unit.
Chlamydia Gonorrhea Screening and Testing
It is important to note that the number of Chlamydia and Gonorrhea cases reported each year are
influenced by multiple factors in addition to the occurrence of the infection within the population. For
example changes in screening practices, use of diagnostic tests with differing test performance, and/or
changes in reporting practices may mask true increases or decreases in disease reporting. Caution should
be exercised in interpreting short-term trends in case reporting.
Women, especially young women, are hit hardest by Chlamydia. Studies have found that Chlamydia is
more common among adolescent females than adolescent males, and the long-term consequences of
untreated disease are much more severe for females. Up to 40 percent of females with untreated
Chlamydia infections develop PID, and 20 percent of those may become infertile. The Centers for
Disease Control and Prevention (CDC) recommends annual Chlamydia screening for all sexually active
women under age 26, as well as older women with risk factors such as new or multiple sex partners.
Chlamydia and Gonorrhea Annual Case Rates
Crude incidence rates (new cases/population) were calculated on an annual basis per 100,000. Rates
were calculated by dividing the number of cases reported by the most current county-specific population
estimates available at time of publication. Due to use of updated population data, rates presented in the
current report may be different from prior publications.
Sources:
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention:
2010 STD Surveillance Report.
Weinstock H, et al. Sexually transmitted diseases among American youth: incidence and prevalence estimates,
2000. Perspectives on Sexual and Reproductive Health 2004;36(1):6-10.
North Carolina DHHS, HIV/STD Prevention and Care Unit. 2013 STD Surveillance and Regional Reports.
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Technical Notes: Behavioral Data
Behavioral Risk Factor Data
Beginning in 2011, the Division of Behavioral Surveillance (DBS) of the Centers for Disease Control and
Prevention made two major changes to the BRFSS Survey methodology. These changes were designed
to improve the accuracy of BRFSS estimates; however the results using these new methods are not
comparable to BRFSS estimates from previous years1.
The first change is the adoption of an improved weighting method called iterative proportional fitting,
commonly referred to as “raking.” Raking is a technique for weighting the survey data, whereby the
weighted respondent data is made more comparable to the characteristics of the target population, such
as the proportion of Hispanic adults in the state. Raking improves the representativeness of state
estimates by including socio- economic factors, such as education and marital status, in the final survey
weights. The former post- stratification methodology was limited to adjusting the final weights by
categories of age, race and sex and is no longer utilized.
The second change is the addition of cell phone interviews to the BRFSS. Adoption of cell phones (with no
landline phone) has been particularly evident among younger adults and racial/ethnic minorities. Adding
cell phone interviews improves the BRFSS coverage of these groups. As a result of these changes, the
BRFSS will better represent lower-income and minority populations and provide more accurate prevalence
estimates. However, it will no longer be possible to compare results from 2011 or later BRFSS surveys to
results from earlier years of BRFSS data. It is also likely that prevalence estimates will be somewhat
higher as a result of the change in methods for behaviors that are more common among younger adults
and/or minorities.
For more information on changes to the methodology please visit the NC BRFSS at
www.schs.state.nc.us/units/stat/brfss/ or the CDC BRFSS www.cdc.gov/brfss/
Strengths and Limitations of the BRFSS Survey Data
One limitation of a telephone survey is the lack of coverage of persons who live in households without a
telephone. Households without a telephone are, on average, of lower income. Therefore, for many of the
health risks measured, the results are likely to understate the true level of risk in the total population of
adults. A second limitation is due to the fact that the data are self-reported by the respondents. We expect
that respondents tend to underreport health risk behaviors, especially those that are illegal or socially
unacceptable. A third limitation is that these data are “cross-sectional,” meaning that the data are collected
in a single point in time. Each month an entirely new sample of respondents are contacted. Therefore,
causality cannot be inferred from BRFSS survey results. All that can be determined is the likelihood of an
association between two or more variables, such as the association between smoking and cardiovascular
disease – these results do not permit one to say that smoking “causes” heart disease.
There are some significant advantages of the telephone survey methodology, including better quality
control over data collection made possible by a computer-assisted-telephone-interviewing system,
relatively low cost, and speed of data collection. The BRFSS methodology has been used and evaluated
by the CDC and participating states since 1984. The content of the survey questions, questionnaire
design, data collection procedures, interviewing techniques and editing procedures have been carefully
developed to improve data quality and lessen the potential for bias. The data collection is ongoing, and
each year new annual results become available.
Sources:
Pierannunzi, C., Town, M., Garvin, W., Shaw, F and Balluz, L. Methodologic Changes in the Behavioral risk Factor
Surveillance System in 2011 and Potential Effects on Prevalence Estimates. Morbidity and Mortality Weekly Report;
2012 June;61(22):410-413. Available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a3.htm?s_cid=mm6122a3_w. Accessed September 12, 2012.
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Technical Notes: Births & Mortality
Race and Ethnicity Considerations
The terms white, other races and minority designates racial status. The term Hispanic denotes ethnicity.
Hispanics can be of any race are therefore included in the denominator for both white and other races
categories. However, In Mecklenburg County, the majority of Hispanics fall into the white racial category,
therefore, if only two population categories, white and minority or other races, are available, it is erroneous
to assume the minority rates are heavily influenced by Hispanics.
In order to best compare one racial group to another, it is necessary to sort out non-Hispanic groups such
as non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, non-Hispanic American Indian (or Native
American) or non-Hispanic Other (often includes all races except White and Black due to small numbers)
when these data are available such a comparison can be made.
Pregnancies
Total Pregnancies represent the sum of all induced abortions, live births, and fetal deaths 20 or more weeks
of gestation reported in the state of North Carolina. Not included are spontaneous fetal deaths (still births)
occurring less than 20 weeks of gestation that are not reportable to the state.
•
•
•
Live Birth – the birth of a live born infant.
Abortion – The premature termination of a pregnancy, resulting in or caused by death of the fetus
or embryo. Two types are considered in the context of public health reporting:
o Induced Abortion: The purposeful interruption of pregnancy with the intention other than to
produce a live born infant or to remove a dead fetus and which does not result in a live birth.
In 1967, abortion became available on demand in NC with the condition it be performed by a
licensed physician in a hospital or licensed abortion clinic.
o Spontaneous Abortion: An interruption of pregnancy for some reason other than human
choice, i.e., a miscarriage or stillbirth. Spontaneous abortions less than 20 weeks gestation
are not reportable in NC.
Fetal Death – Stillbirths or an infant born 20 or more weeks gestation that is reported to the state of
North Carolina.
Infant Mortality
Infants are defined as all children within 365 days of date of birth or under 1 year of age. Infant mortality is
defined as the number of resident infant deaths per 1,000 resident live births for a particular year.
Small Number of Events and Caution When Interpreting Infant Mortality Rates
The term “rate” usually refers to the number of vital events (i.e. births, deaths, pregnancies etc.) in a given
period of time (i.e. 2003 or 2001-2003) divided by the average number of people at risk during that period
(i.e.average population estimate during that period). For example, the infant mortality rate represents the
number of infants less than 1 year of age at risk of dying before the age of 1 year (or years) of all the infants
born in a given time period or specific year. It is often the case when infant mortality rates are examined on
a local level (i.e. city or county) by race and ethnicity that the rate is based on a small number of deaths
(less than 20 events). Any death rate with less than 20 events in the numerator will have substantial random
variation over time (a large standard error) and are subject to serious random error. Therefore, extreme
caution should be taken when making comparisons or assessing trends with rates based on less than 20
events. When assessing trends in infant mortality rates that are race/ethnic specific rates and based on
small numbers, the emphasis should be placed on the number of deaths rather than the rates.
Annual infant mortality rates for Mecklenburg County as a whole would be a more stable rate because it is
based on number of events (>20) and the amount of random error associated with the rate is significantly
reduced. When examining infant mortality rates by race and ethnicity you are subject to smaller numbers of
events (i.e. number of deaths in the racial or ethnic category) and the amount of random error increases
making the rate unstable. Although the Hispanic population in Mecklenburg County has been growing an
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Technical Notes: Births & Mortality, cont.
average of 2 percentage points per year since 1998, the number of infant deaths is still less than 20 per
year making the infant mortality rate for this population unstable and subject to random error. As a
population grows it is normal to expect more deaths within that population as time goes on.
Source:
NC DHHS/State Center for Health Statistics
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