Survey: Opioids, mental health, obesity rank among top concerns
The Dispatch - 11/17/2018
Nov. 17--The growing opioid crisis, access to mental health resources and obesity rates are causing concern among the citizens of Davidson County, according to the results of a recent community survey. The survey, which was conducted by the Davidson County Health Department as part of this year's Community Health Assessment, and its results were discussed during a community forum held Friday.
Every three years, the Davidson County Health Department and the county's two hospitals get together to assess the health of the county and prioritize the issues that need the most attention from the community and providers in the years to come. Friday's gathering, held at Davidson County Community College, offered the health organizations the opportunity to present their findings and gather input from the community on prioritizing health needs.
"The purpose of today is to hear the data, see what's going on and then kind of take a look and say 'Here's what I think we need to focus on.' We will take the information you give and present that to our Healthy Communities Coalition who will narrow it down to three or four priorities," said Jen Hames.
The county's health priorities will be formally established in a meeting of the Healthy Communities Coalition on Nov. 26.
As part of the survey, the 1,109 respondents were asked to name the top community health problems they saw. Obesity ranked highest with 60.3 percent of respondents including it in their list, followed by the opioid crisis with 58.2 percent of respondents naming it, and mental health, which was named by 57 percent of survey respondents.
Concern over obesity remained similar to responses given in 2015, which indicated 60.4 percent of respondents concerned over the issue. Mental health concern increased from 44.7 percent of respondents in 2015, and the opioid crisis was not included in the 2015 surveys.
Outside consultants Sheila and Annika Pfaender delved into these results and others during their presentation Friday.
According to Annika Pfaender, who said she specializes in analyzing data on substance abuse in communities, the opioid crisis was also ranked as the top community social concern as well, with community survey respondents naming prescription medication, alcohol and methamphetamine as the most abused substances. Methamphetamine abuse also saw a significant jump up the list during the survey as 42.5 percent of respondents named it as compared to 28.7 percent in 2015.
According to the results of the assessment, an average of 59 percent of Medicare Part D prescribers were prescribing opioids between 2013 and 2016. The state average is 54 percent, and the national average is 46 percent. Prescribers in the 27292 Lexington zip code were ranked highest in the county with 64 percent of them prescribing opioids.
"Davidson County zip codes trend a little higher, certainly, than nationwide and also in many cases as compared to the state," Annika Pfaender said.
The number of unintentional opioid-related deaths increased to 43 in 2017 from 32 in 2016. The number of EMS visits receiving an opioid overdose diagnosis also increased to 119 in 2017 over 94 in 2016.
"This is a site to keep your eye on," Annika Pfaender said.
"Typically, in the past, opioid overdoses were based more on prescription drugs. Statewide, there has been an increase in overdoses related to fentanyl which has crept into the system. In 2017, 75 percent of those overdoses were related to fentanyl," she added.
Some more positive statistics on the opioid crisis in Davidson County, however, included decreases in the multiple provider episode rate, which tracks people who visit multiple doctors seeking opioid prescriptions; the overall number of opioid pills dispensed; the percentage of patients with an opioid prescription receiving more than the daily dose; and the percentage of days a patient with an opioid prescription also took a benzodiazepine on the same day, which is shown to increase the risk of overdose.
In terms of mental health, more than 3,000 Davidson County residents were served by the local area mental health program, Cardinal Innovations, in 2017. An additional 21 were served by state psychiatric hospitals.
"There's one statistic here that I want to bring to your attention," Shelia Pfaender said, speaking of the number of patients served by local resources.
"You'll see that the numbers seem relatively low for a county the size of Davidson, and that's because the idea with mental health reform is to treat all persons, even with severe disorders, in the local communities rather than in a state facility," she added about the 21 people treated on the state level.
According to data gathered by the hospitals, 2.9 percent of emergency room visitors were there due to a mental, behavioral or neurodevelopmental disorder in 2017. That equates to 1,633 patients. That number was slightly higher than in both 2015 (1,560) and 2016 (1,406).
Consultant analysis revealed that the average number of mental health emergency department visits per year between 2015 and 2017, which was 1,533, equaled about 48 percent of the number of served by local resources like Cardinal Innovations. According to Sheila Pfaender, this statistic is higher than seen in many other surrounding communities.
"That is extraordinarily high. Why is this happening? It's putting a heavy burden on your hospitals," she said. "There is a disconnect here that needs studying."
Comparing the obesity rate of Davidson County to our state-named peer county, Randolph County, we rank similarly. An average of 29.8 percent of adults per year in Davidson County were diagnosed as obese between 2006 and 2013. Randolph County saw a similar average of 29.2 percent.
The obesity rates in children, however, are more surprising. In a study of 94 Davidson County children ages 5 to 11, 50.3 percent of them were diagnosed as obese in 2015. For comparison, the state saw 15 percent of children in that age group diagnosed as obese. The consultants did note the smaller sample size that led to this measure was a concern, but said it was something to keep an eye on. The obesity rate among 2- to 4-year-olds was about average, coming in at 14.6 percent as compared to the state's 14 percent.
Overall, the leading causes of death named for Davidson County were cancer with 1,915 Davidson County deaths between 2012 and 2016; diseases of the heart (1,764); chronic lower respiratory diseases (645); cerebrovascular disease (499); and Alzheimer's Disease (370).
"In Davidson County, life expectancies are lower than they are statewide. County and statewide, life expectancy figures are decreasing," Sheila Pfaender added.
"For each of these causes of death, in each of the time periods shown, the mortality rates in Davidson County were higher than the state as a whole for every one," she said.
Also mentioned during Friday's forum was the growing population of older adults in Davidson County. According to the consultants' presentation, Davidson County's median age is 41.9 years old. The state's is 38.3. Additionally, the county has higher numbers of adults aged 39 and up than the state average.
With an older population, the consultants warned that fewer residents are of age to enter the workforce and more strain is put on health-care providers as adults over 65 "consume more health services" and frequent hospitals more often. This was a trend the consultants warned health-care providers to keep an eye on.
Also putting a strain on health services is the low numbers of health-care providers available in Davidson County. According to the assessment, Davidson County has 6.64 medical doctors per 10,000 people. For comparison, the state has 23.78 per 10,000 people. Rates for dentists are similarly low, with Davidson County having 1.56 per 10,000 as compared to the state's 4.98 per 10,000 people. Registered nurses and pharmacists were also noted as providers the county was lacking.
"In every case, the figures for the ratio in Davidson County are considerably lower than the ratio for North Carolina as a whole," Sheila Pfaender said.
The comprehensive report on the Community Health Assessment with more complete data sets and analysis of topics not discussed during Friday's forum will become available on the Health Department's website in March.
Elizabeth Pattman can be reached at (336) 249-3981, ext. 213, or at firstname.lastname@example.org. Follow Elizabeth on Twitter: @LexDispatchEP
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