Update on health characteristics of adult residents of North Carolina's health service areas

"X^ North Carolina State LTbrary ^^^ ^ ^ ^^qq N. C

STUDIES

A SPECIAL REPORT SERIES BY THE N.C. DEPARTMENT OF HUMAN RESOURCES, DIVISION OF
HEALTH SERVICES, STATE CENTER FOR HEALTH STATISTICS, P.O. BOX 2091, RALEIGH. N.C. 27602

No. 19 November 1980

UPDATE ON HEALTH CHARACTERISTICS OF ADULT
RESIDENTS OF NORTH CAROLINA'S HEALTH SERVICE AREAS

The North Carolina Citizen Survey (NCCS) is a sample survey conducted by the North
Carolina Division of State Budget and Management in order to provide data regarding
demographic, health, economic, personal opinion and other characteristics of the state's
household population. The survey has been conducted during September and October of each
year since 1975. In addition, for the last two years, a spring survey has been con-
ducted.

The present report attempts to highlight results of health-related questions from
the Fall 1979 survey for adults and households in North Carolina and in the state's six
Health Service Areas (HSA's). In addition, where appropriate and where comparable
questions were asked, results from earlier surveys are examined.

Details concerning the 1976 and 1977 survey design and methodology have been
reported (1-4) . A stratified random sample with proportional allocation was selected
from the prior year's state income tax returns and listings of residents eligible for
Medicaid assistance. After elimination of duplicate household listings, a cross-section
of adults was then questioned by telephone, in person, or through a mail survey. Design
and methodology for the 1978 and 1979 surveys were essentially the same as in previous
years. The 1979 sampling frame included 93 percent of the estimated households in 1978,
while the 1978 frame consisted of 87 percent of the 1977 estimate. The final sample
for the 1979 and 1978 surveys contained 1,394 and 1,391 households, respectively, each
household having one respondent aged 18 or over (5). Sample sizes for HSA's for each
year 1976-79 are given in Table I.

The representativeness of the 1976 and 1977 samples has also been discussed (1-4) .
Generally, differences between estimates obtained in the surveys and those from
independent sources are not large, but small differences in variables such as rurality,
sex and age exist. Due to a change in definitions, urban-rural estimates from the 1976
survey are not comparable to those obtained in subsequent NCCS surveys. This factor is
probably responsible for the apparent overrepresentation of urban households in the
1976 survey, while the other surveys tend to be biased towards rurality. In all but
the 1979 sample, males appear underrepresented, while in all samples, adults aged 18-29
appear underrepresented and middle-aged adults appear overrepresented to varying degrees

Population Characteristics

Differences in demographic composition contribute to differences among health
characteristics of the six HSA's. The 1979 survey included proportionately more non-
whites in the Capital, Cardinal and Eastern HSA's, higher percentages of rural as well
as low-income households in the Western, Cardinal and Eastern HSA's and a greater per-
centage of females in the Piedmont.

Chronic Health Problems

For HSA's and each of four survey years. Table I shows the percentages of sampled
adults by type of diagnosed chronic disease. For nearly every disease category, the

Table I

Percentage of Adults Reporting a Doctor's
Diagnosis of Selected Chronic Diseases

North Carolina Citizen Survey, 1976-1979

Diagnosed
Disease

North Carolina 1

Western I

Piedmont

Southern Piedmont ]

1976

1977

1978

1979

1976

1977

1978

1979

1976

1977

1978

1979

1976

1977

1978

1979

Diabetes

4.2

6.4

4.8

5.4

4.3

7.3

4.1

4.3

2.9

4 0

3.8

2.6

5.7

4.9

5.5

3.1

Cancer

3.2

3.9

2.5

2.7

3.5

4.2

1.7

4.7

2.6

4.7

3.8

2.3

2.3

4.0

2.5

1.1

High Blood Pressure

19.9

23.7

21.7

19. B

15.7

21.8

22.7

13.3

12.1

21.9

17.2

14.7

27.6

21.9

22.3

18.3

Heart Disease

7.2

10.2

6.7

7.7

6.1

e.4

9.9

9.8

8.9

11.5

5.2

6.4

7.7

5.B

5.9

6.9

Stroke

1.7

1.9

1.5

1.4

1.3

3.1

3.3

1.2

1.8

2.5

0.7

0.4

1.1

0.0

0.8

2.3

Glaucoi&a

1.0

1.4

0.6

1.2

0.4

1.9

0.4

1.6

1.5

1.1

0.0

1.1

0.4

0.4

0.0

0.4

Kidney Disease

6.3

7.5

5.5

5.2

6.5

B.O

9.5

4.7

6.3

7.9

3.1

3.B

5.7

7.1

2.5

4.6

Lung Disease

3.1

3.0

3.0

2.7

3.5

4.6

5.4

3.9

4.8

4.0

2.8

2.6

2.7

2.2

2.1

1.9

Sample Size (N)

1,3B0

1,400

1,391

1,394

229

261

242

255

270

278

290

266

262

224

238

262

Diagnosed
Disease

Capital

Care

inal

Eastern

1976

1977

1978

1979

1976

1977

1978

1979

1976

1977

1978

1979

Diabetes
Cancer

5.6
3.4

7.6
2.5

5.0
2.0

4.0
3.3

3.2
3.7

7.1

4.0

S.8
3.2

10.6
2.4

3.6
4.0

8.3
3.3

5.3
1.9

8.3
2.8

Note; Percentages are
computed by including
unknowns in the denomi-

High Blood Pressure
Heart Disease

17.3
6.7

19.3

11.7

23.3
5.9

24.0
5.3

25.8
7.9

28.3
11.6

25.0
8.3

27.1
9.7

21.8
5.6

29.3
12.4

22.1
5.7

24.9
7.5

nator. Due to this treat-
ment of unknowns, percent-
ages may not agree with

Stroke
Glaucoma

1.1
1.1

1.5
2.5

1.0
1.5

0.7
2.0

3.7
2.6

2.0
2.5

1.9

0.6

2.4
1.4

1.6

0.4

2.1

0.0

1.5
1.5

1.6
1.2

those released by the
Office of State Budget and
Management.

Kidney Disease

7.3

9.6

4.5

6.0

5.3

7.6

7.7

7.2

6.7

5.8

6.5

5.5

Lung Disease

3.4

1.5

1.5

2.0

3.7

3.0

3.2

2.4

0.8

2.1

3.1

2.8

Saiif>le Size (Nl

179

197

202

150

190

198

156

207

251

242

262

253

1977 survey resulted in higher percentages than did the other surveys, among which
results were fairly consistent. The higher 1977 estimates may reflect greater rurality
of the 1977 scunple.

Findings from the 1979 survey indicate that 30.5 percent of the state sample had
been told by a doctor that they had one or more of eight chronic diseases. This percent-
age compares with 32 percent in 1976, about 37 percent in 1977 and 31 percent in 1978.
In every year, high blood pressure was reported most often with percentages ranging from
a low of 19.9 percent in 1979 to a high of 23.9 percent in 1977. Heart disease appeared
the second most prevalent diagnosed disease with a low of 6.7 percent in 1978 and a high
of 10.3 percent in 1977.

Women and nonwhites appear to have diagnosed chronic diseases more often than men
and whites. In the 1979 sample, 34 percent of women and 41 percent of nonwhites, compared
to 27 percent of men and 29 percent of whites, had been diagnosed. Diabetes, high blood
pressure and kidney disease were more often problems of females and nonwhites. Cancer and
lung disease were more prevalent among whites.

During 1979, the percentages of adults reporting a diagnosed chronic disease were
highest in the Capital, Cardinal and Eastern samples. These higher percentages appear
mainly attributable to the prevalence of diagnosed high blood pressure. In the Cardinal
HSA, percentages were also high for diabetes, heart disease, stroke and kidney disease,
while in the Western HSA, percentages were high for cancer, heart disease and lung
disease.

The 1979 NCCS also suggests that approximately 5.6 percent of North Carolina's
adult household population have a neurological disorder — mainly blackouts and fainting
as shown in Table II. This percentage compares to 6.5 percent in 1978. In the 1979
survey, the Cardinal HSA experienced the highest prevalence of neurological disorders.

Table II
Percentage of Adults Reporting Neurological Disorders
North Carolina Citizen Survey, 1978 and 1979

North

Southern

Neurological
Disorder

Carolina

Western

Piedmont

piedmont

Capital

Cardinal

Eastern

1978

1979

1978

1979

1978 1979

1978

1979

1978

1979

1978

1979

1978

1979

Fainting Spells

3.5

2.4

4.5

2.4

3.1 2.3

1.7

1.9

2.5

1.3

4.5

4.8

4.6

1.6

Blackouts

4.3

2.9

6.2

3.5

4.5

3.0

3.4

0.8

2.0

1.3

6.4

4.8

3.8

4.0

Seizure Disorders

0.9

0.9

1.7

2.0

1.4

0.0

0.0

1.1

0.5

0.7

0.6

0.5

1.1

0.8

Epilepsy

0.7

0.4

0.0

0.0

2.1

0.0

0.4

0.4

0.5

0.0

0.0

1.0

0.8

0.8

Other Similar Disorders

1.6

1.1

0.4

1.6

1.4

1.5

0.8

0.8

2.0

2.0

0.0

1.4

4.2

0.0

Percentages are computed by including unknovms in the denominator. Due to this treatment of unknowns, percentages
may not agree with those released by the Office of State Budget and Management.

About 12 percent of households in 1979 included one or more persons with a
physical handicap. This figure compares with previous results of 14 percent in 1978
and 15 percent in 1977. In 1979, the percentages ranged from about 9 percent in the
Capital and Eastern HSA's to 19 percent in the Cardinal. As in previous years, a
majority of households with handicapped members were of low income and the most pre-
valent handicapping conditions were visual impairments and deformities.

In 1979, about 15 percent of sampled adults had a physical, mental or other
health condition which had lasted six months or longer and which limited them in some
way. Table III shows the percentages of adults reporting varying degress of limitation.
Overall, the Cardinal HSA had the highest percentage of limiting health conditions with
14 percent of adults reportedly unable to work at a job because of their health. This
percentage compares with a low of 7.3 percent in the Capital HSA.

Table III
Percentage of Adults Reporting Limiting Conditions
North Carolina Citizen Survey, 1979

North

Southern

Nature of Limiting Health Condition

Carolina

Western

Piedmont

Piedmont

Capital

Cardinal

Eastern

Limits Kind or Anoxmt of Work Done at Job

13.9

12.1

13.2

14.1

12.7

15.9

15.4

Prevents Working at a Job

10.1

9.4

9.8

9.2

7.3

14.0

10.7

Prevents or Limits Use of Public Transporation

3.4

3.1

4.1

3.8

1.3

4.3

2.8

Limits Access to Public Buildings

2.7

2.0

2.6

3.4

2.0

4.3

2.0

Limits Access to Suitable Housing

1.8

1.2

1.9

2.7

2.0

1.9

1.2

Note: Percentages are computed by including unknowns in the denominator. Due to this treatment of unknowns, percentages may
not agree with those released by tha Office of State Budget and Management.

Health Care Resources

According to the last three surveys, the main place adults get medical care is a
doctor's office or clinic. In 1979, about 77 percent relied mainly on this medical
provider. A large proporti-on of adults — 16 percent in 1979 — use hospital emergency
rooms or outpatient clinics as their main source of health care. This source was most
utilized in the Capital HSA — by 25 percent of survey respondents.

For each of the three survey years, only 2 percent of adults relied on public
health departments as their main source of health care, and in 1979, almost 3 percent
of adults had no main medical provider. Females and nonwhites used health departments
more than males and whites.

Overall, about 15 percent of the state sample lived more than 15 miles from their
main source of health care during 1979. The percentage exceeded 20 in the Cardinal and
Eastern HSA's. Southern Piedmont respondents were least apt to live over 15 miles from
their main health provider.

Statewide, the average time spent traveling to the main health care provider was
19 minutes in 1979. Residents of the Cardinal and Eastern HSA's averaged over 22
minutes. Survey results also show that about 4 percent of adults lived over 15 miles
from the closest doctor and about 6 percent lived at least that distance from the
closest dentist. These percentages varied, ranging from under 1 percent for both in
the Southern Piedmont to 9 and 13 percent, respectively, in the Eastern HSA. Statewide,
the average times required to travel to the closest doctor and dentist were 12 and 13
minutes, respectively. Average time to the closest doctor ranged from 10 minutes in
the Capital HSA to 13 minutes in the Cardinal; mean time to the closest dentist ranged
from 10 in the Capital to 15 in the Eastern.

In the 1979 survey, 4 percent of adults had tried but were unable to get a health
care service within 15 miles of their home. This figure compares with 9 percent in 1978
and 5 percent in 1977. Among fourteen types of service listed, respondents had most
trouble getting eye and physical examinations, dental care, family planning/pap smears/
breast examinations and chest X-rays. Eastern and Capital residents were most apt and
Cardinal residents least apt to get a needed service close to home.

Health Insurance

In 1979, about 7 percent of respondents had no health insurance, 19 percent had
some type of government insurance, 45 percent had Blue Cross/Blue Shield and 51 percent
had another kind of insurance. These results are similar to those for prior years as
shown in Table IV. Adults with no insurance ranged from about 4 percent in the Piedmont
and Southern Piedmont to 10 percent in the Western and Cardinal HSA's. The percentages
with government insurance ranged from 13 in the Capital HSA to 24 in the Cardinal sample.

According to 1979 survey results, health insurance was a fringe benefit of their
job for over two-thirds of employed adults. Among those, over half of employers paid
all of the cost for the employee; 17% paid all, and 47% paid part, of the cost for the
employee's family.

Preventive Health

The 1979 NCCS included questions pertaining to exercise, cigarette smoking and
diet. Results indicate that almost 22 percent of adults did not exercise at all during
the past month while 44 percent claimed planned exercise at least several times a week.
Another 11 percent exercised about once a week. Compared to a year ago, 15 percent said
they exercised less and 21 percent exercised more. A majority of those who exercised
more did so for reasons of general health and weight control.

According to the 1977 NCCS, 37 percent of adult respondents were current cigarette
smokers. The 1978 survey omitted questions pertaining to smoking but, in 1979,
approximately 39 percent of adults currently smoked. An additional 17 percent had
stopped smoking, as shown in Table V. In the 1979 sample, current smokers included 48
percent of males, 32 percent of females, 40 percent of whites and 37 percent of non-
whites with smoking most prevalent below age 50. Males, whites and older persons were
most apt to have stopped smoking.

Table IV

Percentage of Adults According
to Reported Type of Health Insurance

North Carolina Citizen Survey, 1977-1979

Type of Insurance

— 1
North Carolina

We s te m

Piedmont

Southern

piedmont

1977

1978

1979

1977

1978

1979

1977

1978

1979

1977

1978

1979

No Insurcince
Government Insurance
Blue Cross/Blue Shield
Other Insurance

7.6
23.6
40.3
48.8

6.3

19.2
42.2
51.0

6.8

18.4
44.0
49.9

8.8
21.1

41.0
53.6

7.9
20.7
39.7
53.3

9.8
17.6
33.3
54.9

5.4
19.8
40.6
52.9

5.5
14.5
43.8
53.8

3.8
17.3
47.4
56.0

6.7
20.5
30.8
60.3

2.1

15.5
33.6
63.9

3.8
16.4
40.1
60.7

Type of Insurance

Capital

Cardinal

Eastern

1977

1978

1979

1977

1978

1979

1977

1978

1979

No Insurcince
Government Insurance
Blue Cross/Blue Shield
Other Insurance

7.6
22.8
46.2

44.7

5.4
18.3
51.5
47.5

5.3
13.3
57.3
37.3

9.1
26.3
35.4
44.4

9.6
26.9
37.2

42.3

9.7
23.7
41.1
40.1

8.7
31.8
47.1
35.1

8.0
22.5
46.6

41.6

8.7

21.3
49.8
42.3

Note: Percentages are computed by including unknovms in the denominator. Due to this treatment of

unknowns, percentages may not agree with those released by the Office of State Budget and
Management.

Table V

Percentage of Adults According
to Reported Smoking Status

North Carolina Citizen Survey, 1979

Smoking Status

North
Carolina

Western

Piedmont

Southern
Piedmont

-
Capital

Cardinal

Eastern

Ever Smoked
Smoke Now
Stopped Smoking

56.7
39.3
17.4

58.4
43.1
15.3

54.1
39.1
14.7

57.3
35.1
22.1

58.0
37.3
20.7

59.4
46.4

13.0

54.5
35.6

19.0

Note: Percentages are computed by including unknowns in the denominator. Due to this treatment of unknowns,
percentages may not agree with those released by the Office of State Budget and Management.

Among the HSA's, current smokers were most prevalent and former smokers least
prevalent in the Cardinal. Former smokers were most prevalent in the Southern Piedmont.

Although diets of a majority of the 1979 sample were about the same as a year ago,
between one-quarter and one-third of respondents did report reduced consumption of fried
foods, soft drinks, salt and beef /pork and increased consumption of vegetables, fruit
and fish/chicken/turkey. Roughly 20 percent reported reduced consumption of eggs and
butter and increased consumption of whole grain bread. In general, females and Capital
HSA residents were most apt to report these changes. To what extent these findings
reflect actual change as opposed to knowledge of desirable change is unknown.

Environmental Health

Concerning environmental issues in 1979, about 53 percent of the N.C. sample felt
the state should continue building nuclear plants, while 31 percent were against further
such construction and 16 percent were undecided. Western and Cardinal residents most
often supported nuclear power plants while Capital residents were most often against
them.

In 1979, almost half of adults felt that water and air pollution were problems in
North Carolina. About 36 percent felt that water quality programs were not strong
enough; 30 percent felt that state programs regulating air quality were not strong
enough and 58 percent felt that programs regulating the disposal of hazardous and
toxic wastes were not strong enough.

Perceptions of Health Care

A majority of the 1979 N.C. sample rated health services in their areas as excellent
(9%) or good (52%) . Nearly 17 percent felt health services were poor or not available
at all. As in 1976, residents of the Cardinal and Eastern HSA's appeared most dis-
satisfied.

Summary

According to the 1979 North Carolina Citizen Survey, three out of ten of the state's
adult household population have been diagnosed by a physician as having one or more of
eight chronic diseases. Diagnosed diseases were more frequent among women and nonwhites
than among men and whites, and high blood pressure was the most prevalent disease.
Approximately 5.6 percent of the North Carolina sample reported at least one neurological
disorder; blackouts and fainting were the most prevalent conditions. In addition,
results reveal that 12 percent of sample households in 1979 included one or more persons
with a physical handicap and approximately 15 percent of adults were limited in some way
by a health condition.

Approximately 77 percent of the 1979 sample reportedly received medical care mainly
at a doctor's office or clinic. Fifteen percent of adults lived more than 15 miles from
their main source of medical care; 4 percent lived at least that distance from the
closest doctor, and 6 percent lived that far from the closest dentist. Almost a fifth
of the state sample had some type of government health insurance while 7 percent had no
health insurance.

As indicated by past NCCS's, the Cardinal HSA had higher prevalences of diseases,
disorders and handicaps than other HSA's. At the same time, more residents of this HSA
had either government health insurance or no health insurance at all, were unable to get
medical care within 15 miles of their home, and traveled longer to get to their main
place of medical care.

Although approximately 22 percent of the North Carolina sample reported no exercise
at all, 44 percent claimed to have planned exercise at least several times a week.
Almost 57 percent said they smoked or had smoked regularly in the past; approximately 39
percent smoked at the time of the survey while an additional 17 percent had stopped
smoking .

Concerning changes in dietary habits, respondents indicated desirable changes more
frequently than undesirable changes although a majority indicate no change during the
past year. They also indicated concern about environmental factors with 58 percent
feeling that state programs regulating the disposal of hazardous and toxic wastes are
not strong enough.

REFERENCES

(1) North Carolina Department of Acaministration , Division of State Budget and

Management. "How the Survey Was Conducted and What It Cost," North
Carolina Citizen Survey, Vol. 2. Raleigh, May 1977.

(2) North Carolina Department of Administration, Division of State Budget and

Management. "Overview," North Carolina Citizen Survey. Vol. 1.
Raleigh, 1978.

(3> North Carolina Department of H\man Resources, Division of Health Services,

Public Health Statistics Branch. "Health Problems and Health Care Among
Adult Residents of North Carolina's Health Service Areas," PHSB Studies.
No. 7. Raleigh, July 1977.

(4) North Carolina Department of Human Resources, Division of Health Services,

Public Health Statistics Branch. "Health Characteristics of Adults in
North Carolina's Health Service Areas," PHSB Studies. No. 11.
Raleigh, July 1978.

(5) North Carolina Department of Administration, Division of State Budget and

Management. Unpublished documentation of sample design and analysis of
sample representativeness.

A major portion of the work for this report is attributable
to Rhonda K. Johnson, former employee of the SCHS and now
a graduate student in the English Department of Emory
University. As our data users already know, the SCHS sorely
misses Rhonda as we wish her well in all present and future
endeavors.

STATE LIBRARY OF NORTH CAROLINA

3 3091 00753 7434

Department of Human Resources

Division of Health Services

State Center for Health Statistics

P.O. Box 2091

Raleigh, North Carolina 27602