Showing posts with label Cambria County. Show all posts
Showing posts with label Cambria County. Show all posts

Sunday, June 5, 2022

County Health Rankings Statistics and COVID Vaccination Rates


I have talked in the last few posts about COVID rates and County Health Rankings (CHR). I flagged significant correlations between the rates and the rankings (greater than 0.632 or less than -0.632 for 10 counties). While the rankings are easy to explain and are often quoted in the media, the individual statistics (more than 60 or them) used to create the rankings provides more specific information about the variables that predict local COVID rates.

This post focuses on COVID vaccination rates and individual CHR statistics.  The graph above shows the correlation between Vaccination rates (for those who have received the first 2 shots) and COVID case mortality rates. It shows a negative relationship between the two where every 1 % increase in the vaccination rate yields a predicted 0.046% decrease in the case mortality rate. This relationship accounts for 54% of the variability in the Case mortality rate. Next I will summarize the CHR statistics that are significant with the vaccination rates.
















There were 8 CHR variables that were significantly associated with the vaccination rate. The first that was significant was the average number of mentally unhealthy days (a quality of life statistic). This model states that for every one day increase in mentally unhealthy days, there is a predicted 19.3% decrease in the vaccination rate. This relationship accounts for 42.18% of the variability in the vaccination rate. 

To save space, I will summarize verbally the remaining significant correlations. The next significant correlation is the % of the county who are physically inactive which is also negative. This relationship accounts for 42.3% of the variability. Paradoxically, the % with access to exercise opportunities was positively correlated with the vaccination rate accounting for 49% of the variability.

The next significant correlation with the vaccination rate was with the primary care physician rate in the county. These rates were positively associated accounting for 42.3% of the variability. Likewise the flu vaccination rate was positively associated accounting for 49% of the variability. The high school completion rate and the % completing at least some college were both positively associated with the vaccination rate accounting for 44.9% and 39.7% of the variability respectively. Finally the income amount in the 80th percentile in the county was positively associated accounting for 39.7% of the variability. 

Next week I will summarize case mortality correlations.

**Related Posts**

2022 County Health Rankings are Out: Cambria Still Ranks Low



Saturday, May 14, 2022

A look at new Racial Disparity Numbers in Cambria County

Group

Cambria County

Pennsylvania

U.S.

Overall

75.8

78.1

77.3

White

76.1

78.4

77.6

African American

66.9

73.3

71.8

Hispanic

97.1

82.2

78.8


Two weeks ago I wrote about the new County Health Ranking (CHR) numbers for this year in Cambria County. As before, there was a big discrepancy in life expectancy between African Americans, Whites and Hispanics. The life expectancy estimate for Hispanics may be unreliable as they are a small percentage of the county population. The state life expectancy and racial U.S. life expectancy numbers are are from before the pandemic began.

As before I will go through the other CHR statistics to search for clues for this disparity:
  • The percentage of low birthweight babies was 9% for the county and 8% for the state. It was 17% for African Americans, 13% for Hispanics, and 8% for whites.
  • The overall child mortality rate was 50/100,000 which was the same as the state rate. It was 160/100,000 for African Americans and 40/100,000 for whites. The African Americans rate was down from 210/100,000 last year and 240/100,000 in 2020.
  • The overall infant mortality rate for the county was 7/1,000 live births which was 1% higher than the state rate. For African Americans it was 38/1,000 live births while for whites it was 5/1,000 live births.
  • The teen birth rate was 18/1,000 females age 15-19 for the county and 15/1,000 for the state. For African Americans it was 55/1,000, for Hispanics it was 17/1,000 and for whites it was 16/1,000.
  • The overall drug overdose mortality rate was 50/100,000 for the county while for the state it was 36/100,000. For African Americans the rate was 117/100,000 while for whites it was 47/100,000. According to overdose free PA, African Americans accounted for 9% of the deaths while they were only 3% of the county population. Whites still accounted for 89% of the overdose deaths.
  • The rate of preventable hospital stays was 5,518/100,000 for the county and for the state it was 3,966/100,000. For African Americans it was 7,326/100,000 while for whites it was 5,505/100,000.
  • The percentage of female Medicare enrollees receiving a mammogram was 45% for the county and 47% for the state. For Asian Americans it was 23%, it was 38% for African Americans, it was 57% for Hispanics, and it was 45% for whites.
  • Forty three percent of the county Medicare enrollees received a flu vaccination while for the state it was 54%. For Asian Americans it was 20%. For African Americans it was 36%. For Hispanics it was 46% and for whites it was 43%.
  • The overall child poverty rate for the county was 16% while for the state it was 14%. For Asians it was 15%, for African Americans it was 57%, for Hispanics it was 35% and for whites it was 19%.
  • The injury death rate was 133/100,000 for the county while it was 93/100,000 for the state. For African Americans it was 220/100,000 and for whites it was 131/100,000.
  • The average 3rd grade reading test level was 3.1 grade for the county which was the same as the state rate. For African Americans it was at the 2.2 grade level and at the 3.2 grade level.
  • The average math test level for 3rd graders was also at the 3.1 grade level which was also the same as the state rate. For African Americans it was at the 2.0 grade level while for whites it was at the 3.2 grade level.
  • Median household income for the county was $48,700 while for the state it was $64,900. For Asian Americans it was $100,100, for African Americans it was $28,500, for Hispanics it was $40,200, and for whites it was $48,900.
  • The homicide rate for the county was 5/100,000 while for the state it was 6/100,000. For African Americans it was 48/100,000 and for whites it was 3/100,000.
  • Eighty one percent of the county drives alone to work while for the state it was 74%. For African Americans it was 59%, for Hispanics it was 62% and for whites it was 83%.
Each year CHR provides more detailed information to explain the racial disparities in the health of the area. The next step is to take action to remedy these disparities. 

Coronavirus numbers for the cases and deaths county were not broken down by race at the county level. However, case rates are provided at the zip code level. The vast majority of African Americans in the county live in and around the city of Johnstown. Case rates are higher outside of Johnstown than in the city and its suburbs (zip codes 15901 to 15909) as can be seen in the graph below.

 

**Related Posts**



Saturday, April 30, 2022

2022 County Health Rankings are Out: Cambria Still Ranks Low


The 2022 County Health Rankings for every county in the U.S. were released this week. Cambria County's Health Outcomes rank is 62nd out of 67 counties in Pennsylvania. This ranking is a composite of length of life measures (63rd out of 67 counties) and quality of life measures (60th out of 67 counties). 

There is another ranking where the Cambria fares better. Health factors (Cambria Ranks 40 out of 67 counties) is a composite of four sub-measures: health behaviors (33rd), clinical care (57th), social and economic factors (37th), and the physical environment (38th). These sub-measures are themselves a composite of dozens of government statistics which are more informative than the overall ranking.


The length of life ranking is determined by one statistic: Years of potential life lost or YPLL. This statistic is the number of years lost before age 75. For example, if someone dies at age 25, they have 50 years of potential life lost. Cambria County had 9,600 YPLL compared to 7,600 for PA and 7,300 for the U.S in 2019. For African Americans in Cambria County, the YPLL rate was 20,900 compared to 9,200 for Caucasians. These numbers do not include the effect of the pandemic. Life expectancy is not included in the rankings but is easier to understand.

For the years 2018-2020, Cambria's overall life expectancy was 75.8 years. This is 2.2 years shorter than the state rate of 78.0 years and the U.S. rate of 79 years. For Caucasians, it was 76.1 years and for African Americans it was 66.9 years. One factor driving this racial disparity is child mortality.

For child mortality in Cambria County, the overall rate was 50 deaths per 100,000 and was the same as the overall state rate. However for African Americans, the rate was 160 deaths per 100,000 which was tied for the 2nd highest rate in the state. This rate was 4 times higher than the county Caucasian rate of 40 per 100,000.

Finally the COVID mortality rate for Cambria was 119 per 100,000. This was the 6th highest rate in the state. The overall rate was 88 per 100,000 in Pennsylvania. This death rate occurred on top of the other health issues enumerated in the County Health Rankings. It will take some time to sift out the relevant numbers for our county, I look forward to finding them.

**Relevant Posts**



Saturday, February 19, 2022

A Corona Virus Update: Cases and Hospitalizations Lower but Vaccinations also Lower

I stayed away from the Coronavirus as long as I could.  The news in Cambria County has recently been mostly good. The height of the omicron surge was January 16 when the 7 day average for new cases was 337.29 cases per day.  Today it is 43.14 per day, the lowest it has been since Sept 9 of last fall. 

The graph above shows that hospitalizations in Cambria (30) are now at the lowest level in the county since Sept 19.  Correspondingly, the current number of COVID patients on a ventilator (4) are at its lowest level since Sept 23.  Likewise, the number of patients in adult ICU (2) are at the lowest level since Sept 1.

There really was no corresponding surge in deaths in the county during the omicron surge in cases.  The 7 day average for the number of deaths per day has mostly ranged between 1 and 2 deaths per day since Sept 28.  

The trend in vaccinations also shows some declines with the number of partial vaccinations (dotted black line in the graph at the top) inching downward from a recent high of 9,063 on January 26 to 8,886 today.  This means that fewer individuals are getting the first shot.  The 7 day average for individuals getting the second shot or fully vaccinated (yellow line at the top) has also been declining from a recent high of 120.4 per day on Dec. 9 to 32.3 today.  Over the same period, the 7 day average for those getting the 3rd booster shot (pink line in the above graph) has also decreased from 369.7 per day to 40.3 per day today.  The decrease in the number getting the booster could be due to the vast majority who rushed to get the vaccine in the early days of the rollout received the booster.  

Dr. Anthony Fauci has said that it is time to start inching towards normality with the pandemic.  The omicron variant appears to be more contagious but less lethal than previous COVID variants.  There is always the nightmare scenario that a new variant could come along that is resistant to the virus and is more lethal.  I have updated the county numbers in the online with more recent data from the 2020 census.

**Related Posts**

PA County Factors that Predict Full COVID Vaccination Rates



Friday, January 14, 2022

PA County Factors that Predict Full COVID Vaccination Rates

Last month I posted on which county health ranking variables were most strongly correlated with COVID case mortality rates.  Granted these posts were made just as the omicron variant was arriving on the scene.  This month, I thought I would take a look at which variables were the best predictors of full vaccination rates.  Full vaccination means receiving the first two shots.  As of today, only 51.8% of the state population has received the first two shots.  This includes Philadelphia County and individuals who are ineligible to receive the shots.

Univariately, the average number of mentally unhealthy days had the strongest negative correlation with the full vaccination rate.  Not surprisingly, the flu vaccination rate at the county level had the highest positive correlation.  These and other variables were entered into a multiple regression model to find the most robust predictors.  The flu vaccination rate was not significant in the presence of other variables but others were and are presented below.  These variables accounted for 62% of the variability in the full vaccination rate.  Philadelphia county was a problematic outlier and was excluded from the data set.

Full vaccination rate = 0.585 - 0.006(social assoc rate) - 0.044(avg # mentally unhealthy days) + 0.003(% with access to exercise opportunities) + 0.001(Primary Care Physician Rate)


The rate of social associations in a county was negatively associated with the full vaccination rate.  In the model, for every unit increase in the association rate there is a 0.6% decrease in the full vaccination rate.  Univariately this relationship accounts for 22.8% of the variability in this relationship.  Montour county, with the highest vaccination rate in the state is an outlier for this relationship as well as other variables.

The average number of mentally unhealthy days in the last month is also negatively associated with the full vaccination rate.  For every increase of one day in this variable there is a predicted 4.4% decline in the full vaccination rate.  Univariately this relationship accounts for 34.9% of the variability in the rate.  


Access to exercise opportunities is positively associated with the full vaccination rate.  For every 1% increase in the rate, there is a predicted 0.3% increase in the full vaccination rate.  Univariately, this variable accounts for 33.9% of the variability in the full vaccination rate.
















The fourth variable is the primary care physician rate in the county which is positively associated with the full vaccination rate.  For every unit increase in the physician rate, there is a predicted 0.1% increase in the vaccination rate.  Univariately this variable accounts for 20.8% of the variability in the vaccination rate.  Montour County (where Geisinger Hospital is located), is influential in this relationship but not poorly fit.

When I looked at which County Healthy Ranking variables predicted COVID case mortality rate, the social association rate, the rate of mentally unhealthy days, and access to exercise opportunities were significantly associated with the outcome.  The PCP rate was not significant for case mortality and the % smoking did not hold up in variable selection for the vaccination rate.  

The correspondence is high for the models for these two dependent variables.  These predictors may provide clues as to crafting strategies for improving vaccination rates and thus decreasing COVID mortality.

**Related Posts**

Rates of Smoking and Social Associations Predict PA County COVID Case Mortality



Thursday, December 2, 2021

Rates of Smoking and Social Associations Predict PA County COVID Case Mortality

Two weeks ago I looked at the correlation between COVID case mortality and Trump's % of the vote in 2020 for Pennsylvania counties and six sub measures used to determine County Health Rankings.  The measure that was most strongly associated with COVID case mortality was the health behavior z-score (a higher z score is worse) accounting for 6.9% of the variability.  Health behaviors was even more strongly associated with Trump's % of the vote as shown in the above graph accounting for 34.4% of the variability.  This association would be even stronger if Philadelphia were excluded.  This post will focus on the individual statistics used to determine the sub measures and their association with COVID Case Mortality.  The mortality rates occur on top of the the other health issues confronting each county.


The above graph shows the strongest univariate association for the number of social membership associations per 100,000 and COVID Case mortality.  This relationship accounts for 20.4% of the variability.  This measure is not a component of the health behaviors sub measure.  It is a component of the social and economic measure.  The number of social associations is weakly correlated with health behaviors, accounting for 4.9% of the variability.


The next strongest variable associated with COVID Case Mortality is the average number of mentally unhealthy days (as reported to the Behavioral Risk Factor Surveillance System).  This measure accounted for 18.6% of the variability.  This measure is a component of the quality of life sub measure.


 
The percentage of smokers in the county is positively associated with the COVID case mortality rate accounting for 11.9% of the variability.  This measure is part of the health behaviors sub measure. 


Access to exercise opportunities is negatively correlated with COVID case mortality with counties having higher mortality rates generally having lower access to exercise opportunities.  This and the other graphs have outliers.  If a correlation were perfect positive or negative, all of the counties would form a perfect straight line sloping upward or downward.  

As always, one should be careful about inferring cause and effect relationships.  These statistics from County Health Rankings were compiled before the coronavirus pandemic began.  Next week I will look at the association of county health ranking measures with Trump's % of the vote.

**Related Posts**

The Seven Counties in PA that are Worse than Cambria in COVID Case Mortality



Wednesday, November 10, 2021

The Seven Counties in PA that are Worse than Cambria in COVID Case Mortality

County

Cases

Deaths

Case Mortality %

Cases per death

Deaths per 100,000

Rank of Deaths per 100.000 in PA

% Fully Vaccinated

JUNIATA

3,009

120

3.99%

25.1

484.6

1

36%

SULLIVAN

607

24

3.95%

25.3

395.7

6

48%

WARREN

4,436

141

3.18%

31.5

359.8

10

41%

NORTHUMBERLAND

13,371

409

3.06%

32.7

450.2

3

51%

TIOGA

4,814

137

2.85%

35.1

337.5

14

39%

MIFFLIN

7,494

212

2.83%

35.3

459.5

2

43%

MONTOUR

2,599

73

2.81%

35.6

400.4

5

68%

CAMBRIA

20,420

535

2.62%

38.2

410.9

4

48%

PENNSYLVANIA

1,608,022

32,188

2.01%

50.0

251.4

 

51%

Last week I posted on Cambria County's high case mortality rate from COVID.  It has the eighth highest rate in the state.  The case mortality is an estimate of the probability of a person dying when they are diagnosed with the disease.  This week I thought that I would take a look at the seven counties with higher case mortality rates than Cambria.  You can find these states in the map below.



The table above shows the top 8 counties in case mortality from COVID. Juniata County has the worst rate in the state with the probability of dying is one out of 25.1 cases when diagnosed with the disease.  Close behind is Sullivan County with a probability of one in every 25.3 cases.  Cambria's is one in every 38.2 cases.  Pennsylvania's rate is one in every 50 cases.  All of the counties with rates higher than Cambria have populations less than 100,000.

Not surprisingly, the population adjusted mortality rates for each county are higher than the state rate of 251.4 deaths/100,000.  Except for Warren and Tioga, all of them are in the top 8 counties for this metric.  Looking at vaccination rates, 6 of the 8 counties have full vaccination rates lower than the state rate of 51%.  Montour County actually has the highest full vaccination rate in Pennsylvania at 68%.  

 
The rates in the above table are cumulative from the beginning of the pandemic in PA.  Case mortality can vary with time as cases and deaths fluctuate.  The dotted green line shows the 7 day case mortality rate which is the 7 day average for deaths divided by the 7 day average for cases.  A rise in cases precedes a rise in deaths which makes the case mortality decrease.  

Since the vaccine has been rolled out, the cumulative rates decreased from a high of 3.41% on Jan 21 in Cambria to 2.62% today.  Over the same period for Pennsylvania, it decreased from 2.55% to 2.01%.  In the U.S., the rate decreased from 1.67% to 1.62% during this period.  The 7 day case mortality is not a continuous line because there were periods in Cambria where there were no deaths.  

I have written on Montour and Sullivan Counties on this blog before.  In January, Montour had a high rate of vaccinations, hospitalizations and patients on a ventilator.  It still has high rates in these areas.  Sullivan County had one of the highest uninsured rates and the lowest median income in PA before the Affordable Care Act was passed.  

**Related Posts**



Wednesday, November 3, 2021

Case Mortality in Cambria County Explained

I was thinking about writing about the Gabby Petito case but events here in Cambria County have trumped (no pun intended) that and put it on the back burner.  COVID deaths have been rising again in the county.  On Oct 23 the county reached 500 deaths.  Eleven days later we have reached 521 for an average of 1.91 deaths per day.

The graph above shows the case mortality rates for Cambria County, Pennsylvania, and the U.S.  The case mortality rate is simply the number of deaths divided by the number of cases.  The rates have remained fairly steady for all three entities as the rate of new cases have kept pace with the rate of new deaths.  

The current rate of 2.63% for Cambria may not seem that much larger than the corresponding PA rate of 2.01% and the U.S. rate of 1.62%.  It we take the reciprocal of these rates (cases divided by deaths) we see a different picture.  The reciprocal of Cambria's rate shows that 1 out of every 38 individuals who have COVID has died.  For PA it is 1 out of every 50 cases dying and for the U.S., it is one out of every 62 cases dying.  This means that someone is 31% more likely to die in Cambria than in PA as a whole and 62% nore likely to die than in the U.S. as a whole.

In my last post I talked about how more people are getting the 3rd booster show than are getting the first two.  To date only 48.06% of the county population has received the first two shots.  This number should rise with the approval of the vaccine for children aged 5-11 years old.  Let's hope the rate of vaccinations keeps pace with the rest of the U.S.  The lagging vaccination rate here suggests that most of the recent deaths were preventable.

**Related Posts**

COVID Deaths Rising in Cambria County and my 11th Anniversary Post