WEST VIRGINIA 1997 COUNTY HEALTH PROFILES INTRODUCTION
This 1997 edition of the West Virginia County Health Profiles updates the previous edition, which was published in 1992. While in the present document a few changes have been made to the tables and some additional material included, the majority of the presentation has been kept consistent to allow comparisons between data in the earlier and later editions. We have attempted to incorporate suggestions from County Health Profile users around the state to make the updated version even more useful to researchers, health planners, health educators, grant writers, policy makers, and other health data consumers.
OVERVIEW: HEALTH AND SOCIOECONOMIC STATUS
The attached health profiles compose an overview of the health and socioeconomic status of West Virginia residents on the state and county levels. The first page of each county's profile provides a snapshot of that county's health status through a comparison of the county to the United States on the basis of 31 selected health indicators, including mortality rates, behavioral prevalences, birth statistics, and prenatal care measures. Each indicator has been tested for statistical significance in the relation to the U.S. (see Appendix A for testing methodology) and classified as falling within a range of values (percentages or rates) that is lower than, the same as, or higher than that found for the nation as a whole. Based on these standards, county indicators were then categorized as better than, similar to, or worse than the U.S. For example, in Barbour County, the prevalence of binge drinking was found to be significantly lower than the national prevalence, the rate of breast cancer mortality was found to be neither significantly lower nor significantly higher than the U.S. rate, and the teen fertility rate was significantly higher than the national average. While the homicide rate in Barbour County was similar to the U.S. rate, the actual number of deaths over the study period was too small for valid significance testing (indicated by a double asterisk [**]).
This information is provided to allow counties to more accurately identify specific problems among their residents. This method of presentation is not meant to infer that indicators falling in ranges similar to or even lower than those for the nation do not pose serious problems to county residents or should not be addressed in health planning. However, a knowledge of a county's worst health problems is necessary in determining the priority of community interventions.
SELECTED CAUSES OF DEATH : 1986-95
County and state data on selected causes of death from 1986 through 1995 are presented on the second page of each profile. The total number of deaths from 1986-95 are given, followed by the county's crude mortality rate (deaths among county residents per 100,000 population) and adjusted mortality rate (adjusted by age and sex to the 1990 U.S. population distribution) for each cause. The 1990 U.S. crude rate is provided for comparison purposes, together with the percentage difference between the county adjusted rate and the U.S. crude rate. (The percentage differences presented in the profile tables cannot be reproduced in all cases from the rates given due to rounding.) Finally, to provide comparability among counties, each county is ranked according to its adjusted rates, from highest rate (1) to lowest rate (55). As an example, in Barbour County, the 1986-95 adjusted rate for deaths due to diseases of the heart was 9.8% higher than the 1990 U.S. crude rate (317.8 deaths per 100,000 population vs. 289.5 deaths per 100,000 population). Statistically significant differences are noted with an asterisk (*) in the significance indicator (SI) column. (Barbour County's heart disease rate was significantly higher than the national rate.) Barbour County ranked 42nd among the 55 counties in heart disease mortality.
PREMATURE DEATHS -- YEARS OF POTENTIAL LIFE LOST
The second page of each profile also presents data for each county on premature mortality, or years of potential life lost before the age of 65 (YPLL), calculated as the difference between the age of 65 and the age at death. For example, a person dying of lung cancer at the age of 45 contributes 20 years to the total YPLL for lung cancer (65-45=20 YPLL). The sum of YPLL for a specific cause of death is the total YPLL from all persons dying from that cause before the age of 65. YPLL is an important tool for emphasizing and evaluating causes of premature death.
The total YPLL for selected causes of death from 1986-95 are presented in column 1 of the YPLL table, followed by the crude YPLL rate (number of years of potential life lost by county residents per 100,000 population) and the adjusted YPLL rate (adjusted by age, sex, and race to the 1990 U.S. population distribution). The 1990 crude YPLL rate for the United States is provided, as well as the percentage difference between the county adjusted YPLL rate and the U.S. crude rate. Significance is indicated in the next column by an asterisk (*). The county's rank for each cause from highest (1) to lowest (55) is found in the last column. In Barbour County, our example, there were a total of 1,260 YPLL due to cancer from 1986-95, yielding a crude rate of 955.7 YPLL per 100,000 population in the county. Barbour County's adjusted rate for YPLL due to cancer was 958.7, which was 13.0% higher than the 1990 U.S. rate of 848.6, a statistically significant difference. Based on its adjusted rate, Barbour County ranked 21st in premature deaths due to cancer.
PERCENT CHANGE IN MORTALITY RATES: 1981-90 AND 1986-95
The graph and table on the third page of each profile present and illustrate changes in the numbers and rates for selected causes of death between 1981-90 (the study period used in the previous edition of the county health profiles, published in 1992) and 1986-95 (the current study period). The graph illustrates the percentage change in the adjusted rates for each of the selected causes between the two time periods. (Percentages are calculated using rates carried to 15 places past the decimal point and thus cannot be reproduced from rounded rates given in the table.) Both the number of deaths and the adjusted rates for each cause are provided in the table, followed by the percent difference depicted in the graph and an indication that the difference is statistically significant, if applicable. Using Barbour County once again as an example, the adjusted rate for heart disease mortality declined from 355.6 deaths per 100,000 population in 1981-90 to 317.8 deaths per 100,000 population in 1986-95, a 10.6% decrease. This decline was not statistically significant, however, when tested. (Due to space limitations, 1981-90 and 1986-95 are referred to by their midpoints, 1985 and 1990, respectively, in the titles to the graph and table.)
BEHAVIORAL RISK FACTOR PREVALENCE
Behavioral risk factor prevalences are found on the fourth page of each profile. Prevalences are given for nine behavioral risk factors that have been determined to affect health adversely: sedentary lifestyle, obesity, hypertension, seatbelt nonuse, cigarette smoking, smokeless tobacco use, binge drinking, being uninsured, and not seeing a doctor because of the cost. County prevalences from 1991 through 1995 have been aggregated and compared to (1) the estimated 1993 U.S. prevalence for each of the nine risk factors and (2) aggregated county prevalences from 1986 through 1991 (six years of data were necessary due to smaller sample sizes in the survey years prior to 1990).
For the 1991-95 prevalences, 24 counties had aggregated sample sizes large enough to yield individual prevalence calculations. Samples from the 31 counties that had sample sizes too small to stand alone were combined with samples from other less-populated, contiguous counties into 12 groupings, or multicounty regions. (A map depicting the final 36 groupings is found in Appendix B, as well as state trends for selected risk factors from 1984-95.) A single behavioral prevalence was then calculated for each grouping. This prevalence was provided as the prevalence for each county included in the grouping. Counties are ranked from highest to lowest prevalence on the basis of the final 36 areas, with counties within each grouping sharing a rank. (For the 1986-91 prevalences, 32 groupings were used, with 15 counties standing alone; therefore, comparisons between counties included in multicounty groupings in 1986-91 and/or 1991-95 must be made with caution.)
The graph compares 1991-95 risk factor prevalences to those from 1986-91. A statistically significant difference between the two time periods is indicated where appropriate. The table presents prevalences from 1986-91 and 1991-95, as well as estimated 1993 U.S. prevalences for additional comparisons. Statistical significance between county and national rates is indicated. The last column contains the county's rank for each risk factor. A rank of 1 denotes the highest prevalence of a risk factor, while 36 denotes the lowest prevalence. (Due to limited space, 1988 is used to refer to aggregated data from 1986-91; 1993 is used to refer to aggregated data from 1991-95.)
Continuing our example, the prevalence of obesity in Barbour County was 28.2% in 1986-91, increasing to 35.1% in 1991-95 (not a statistically significant difference). Although Barbour County's 1991-95 rate of 35.1% was 15.8% higher than the estimated 1993 U.S. prevalence of 30.3%, this was not found to be a statistically significant difference. Barbour County's grouping ranked 18th among the 36 groupings in obesity prevalence.
BIRTHS, INFANT DEATHS, AND FETAL DEATHS
Aggregated birth data from 1991 through 1995, found on the fifth page of each profile, are included to provide health educators, researchers, and planners with numbers of births, age-specific proportions of births, and age-specific fertility rates (the number of births to women in a specific age category per 1,000 women in that age category) by county. Comparable U.S. fertility rates are provided for 1993, followed by the percentage difference between the county and national rates, as well as significance indicators where applicable. Finally, for each age group, counties are ranked from highest fertility rate (1) to lowest fertility rate (55). In Barbour County, there were a total of 921 births from 1991-95 among women aged 15-44, yielding a fertility rate of 52.1 (births per 1,000 women aged 15-44). This was significantly lower than the comparable 1993 U.S. rate of 68.0. Barbour County ranked 43rd among the 55 counties in fertility rates among women of childbearing age (15-44).
Age-specific fertility rates provide a more accurate measure of the problem of births to teen mothers than does the more traditional method of comparing the proportion of all births that occur among teenagers. Statewide, and in most counties in the state, the proportion of total births that are to teenagers is higher than that in the nation as a whole. This does not take into account, however, the drastic decline in both teen (15-19) and, in particular, older (20+) births occurring in West Virginia since 1980. Because women in the state over the age of 19 are having fewer babies, the proportion of teen births has remained high, while statewide, and in many counties, the teen fertility rate is actually significantly lower than the national average.
Selected birth certificate data collected over the five-year period from 1991 through 1995 have also been included for each county. Information is provided on the number and percentage of low-birthweight births, births to unwed mothers, early (1st trimester) vs. late (3rd trimester)/no prenatal care, mother's use of tobacco during pregnancy, and mother's educational level (i.e., percent of mothers having less than a high school education). Comparable U.S. data from 1993 are presented, as well as the percentage difference between county and national statistics and significance indicators where applicable. The counties are ranked for each category from the highest percentage (1) to the lowest percentage (55). In the example of Barbour County, there were 72 low-birthweight births from 1991-95, representing 7.8% of all births. This percentage was 5.3% higher than the 1993 U.S. rate of 7.4% (not a significant difference). Barbour County ranked 18th in percent of low-birthweight births.
Total infant and fetal deaths from 1991 through 1995 are provided with accompanying rates. Infant mortality is broken down into neonatal deaths (infants less than 28 days old) and postneonatal deaths (infants 28 days to one year of age). Fetal deaths are those deaths that occur before birth at or after 20 weeks of gestation. Both infant mortality rates and fetal death ratios are calculated as the number of occurrences per 1,000 births to county residents. The 1993 U.S. rates for infant and fetal mortality are provided, followed by the percentage difference between the county and the nation and statistical significance indicators where applicable. Counties are ranked from highest (1) to lowest (55) rate. There were 12 infant deaths in Barbour County from 1991 through 1995, yielding an infant mortality rate of 13.0 deaths per 1,000 live births to county residents. This rate was higher than the 1993 U.S. rate of 8.4; however, the number of deaths is too small for significance testing. Barbour County's infant death rate was 6th highest among the 55 counties.
PERCENT CHANGE IN BIRTH STATISTICE: 1986-90 AND 1991-95
The graph and table on the sixth page of each profile present changes in the numbers and rates of selected natality characteristics between 1986-90 (the study period used in the previous edition of the county health profiles) and 1991-95 (the current study period). The graph illustrates the percentage change that occurred in the rates between two time periods, with statistical significance indicated where applicable. (Percentages are calculated using rates that are carried out to 15 places beyond the decimal point and thus cannot be reproduced from rounded rates given in the table.) For example, in Barbour County, the percentage of total births that occurred to unwed mothers was 51.7% higher in 1991-95 than in 1986-90 (20.6% in 1986-90 vs. 31.2% in 1991-95), a statistically significant increase. Both the number of births and the rates are provided in the table, together with the percentage difference between the time periods and significance indicators. (Because of limited space, 1986-90 and 1991-95 are referred to by their midpoints, 1988 and 1993, respectively, in the titles to the graph and table.)
1990 POPULATION DISTRIBUTION
The seventh page of each profile contains county population distributions by age, sex, and race based on the 1990 census. Each county's total population is broken down by five-year age groups and sex, with comparable breakdowns by race (white population, black population, and other races population). These data can be utilized in the calculation of age-, sex-, and race-specific mortality and birth statistics, information that is useful in determining the most effective intervention strategies on the individual county level.
The last page of each profile provides data on educational levels, poverty and income levels, and unemployment for each county. These factors all influence the overall health status of a county; a direct association exists between educational and income levels and many of the individual lifestyle behaviors that have been linked to poor health outcomes.
Educational statistics from the 1990 census include the number and percentage of county residents over the age of 25 who (1) have not graduated from high school, (2) are high school graduates, and (3) have attained some education past high school. The West Virginia average is given for comparison purposes, as well as a county rank (from worst percentage  to best percentage  for persons not graduating from high school and persons who have attained some education past high school).
The 1990 census is also the source for data on poverty and income levels. The number and percentage of county residents living below 100% of the poverty level are presented by age group, as well as the number and percentage of county residents living at from <50% to <200% of poverty level. The West Virginia average for each category provides a basis for comparison, as does the county rank (highest percentage of residents  to lowest percentage ). Data on both per capita and median household income are included (ranked from lowest income  to highest ).
Unemployment figures from the Bureau of Employment Programs have been aggregated for each county from 1991 through 1995. The average number of residents in the labor force over those years is provided, along with the average number of unemployed persons and the average unemployment rate. The state employment rate for 1991-95 is also given, and the counties are ranked from highest rate (1) to lowest rate (55).
Health Statistics Center
Office of Epidemiology and Health Promotion
West Virginia Bureau for Public Health Comments
Last updated 08/06/97.