Health Profiles 2006 - The City of San Antonio

114 Pages·2011·6.79 MB·English

by  John Berlanga

Health Profiles 2006
EEvveerryybbooddyy ccaann bbee aa ppaarrtt
of a healthier San Antonio
Fernando A. Guerra, M.D., M.P.H.
Director of Health
San Antonio Metropolitan Health District
Healthy People
Make Healthy Communities
www.sanantonio.gov/health/
Acknowledgments
We would like to extend our gratitude to everyone who contributed data in the development of this year's
San Antonio Health Profiles. The U.S. Census Department, the Texas Education Agency, the Department
of State Health Services, the Texas Department of Protective and Regulatory Services, Bexar County
Juvenile Probation, and SAPD provided invaluable assistance through the data they made available.
I would like to thank John Berlanga for analyzing demographics, births and deaths, along with youth and
social environmental indicators. I would like to thank Roger Sanchez, Cara Hausler and Walter Widish for
analyzing data on Reportable Communicable Diseases, Sexually Transmitted Diseases and Immunizations
Rates.
I would like to thank Pamela R. Wood, MD for providing data on pediatric asthma inpatient admission and
Bryan Alsip, MD for reviewing the Health Profiles documents. We are also grateful for the support and
endorsement extended by the Bexar County Medical Society to this year's report.
We appreciate the input and suggestions provided by residents in the Occupational and Preventive Medicine
residency, United States Air Force School of Aerospace Medicine (USAFSAM), Brooks City-Base, TX. The
input and review of the material by Ronald Poole, MD and Stephen Hingson, MD significantly contributed to
the quality of the final product.
 THRIVE BY FIVE Washington Early Learning Fund
 Melinda Gates - United Way of King County Breakfast June 7, 2006
 Business, Babies and the Bottom Line: Corporate Innovations and Best Practices in Maternal and
Child Health
 What does a health crisis look like? See Houston-By Richard Wolf, USA TODAY-June 21, 2007
 Commonwealth Fund
Finally, special appreciation is extended to Sheryl L. Sculley, City Manager, Frances A. Gonzalez, Assistant
City Manager, and my staff at Metro Health for their guidance and support throughout this process, last-but-
not-least of whom is John Berlanga for analyzing the data in such a way that it highlights the needs of our
community.

Sincerely,

Fernando A. Guerra, M.D., M.P.H.
Director of Health

1) Internet access to the complete report is available at:
http://www.sanantonio.gov/health/Healthprofiles-2006.html

2) A CD-ROM of the complete report is available for $5.00 and a hard copy printout for $15.00. Orders may
be placed by mail, e-mail, fax, or telephone. Questions or comments regarding this report should be directed
to:

John A. Berlanga MPA
Management Analyst
Telephone: [phone]
Facsimile: [phone]
Email: [email protected]

The data and documents, which accompany the data in this report, are based upon information gathered by the census
and have been assembled by The City of San Antonio for its internal purposes only. All data and documents are released
without any express or implied warranty by The City of San Antonio as to accuracy, reliability, or fitness for any particular
application. Other persons are cautioned to independently verify any data or other information if it is used for any other
purpose.
SAN ANTONIO METROPOLITAN HEALTH DISTRICT

332 WEST COMMERCE
SAN ANTONIO, TEXAS 78205-2489
PHONE [phone] FAX [phone]

September 2007

Dear Shareholders of Public Health:

In large corporations, “shareholders” are defined as those with a vested interest in
the annual profits or outcomes of the business, because of time and money spent.
In that regard, Public Health is no different. We all have a vested interest in the
health of those around us. As you read this year’s Health Profiles 2006 report,
consider the returns achieved as a result of public health investments so far.
Conversely, there is clear evidence where more investment is needed and where
outcomes must be improved.

As Director of Health, I often encounter people who believe the San Antonio
Metropolitan Health District (Metro Health) only provides immunizations for
children, or takes care of the poor and uninsured. While that is part of the mission,
the department’s key responsibilities have changed dramatically over the past
decade. Metro Health now plays a greater role in disease prevention, vaccine
research, and tracking of disease outbreaks, such as this year’s rare cases of
measles, along with daily enforcement of City health codes for food, water and air
quality. During natural or man-made disasters, Metro Health is the legal authority
for issuing quarantines or other public health orders to protect the health and
safety of the entire community.

In the area of research and surveillance, Metro Health has become a subject
matter expert for statistical analysis of health outcomes in Bexar County. Insured
and uninsured alike are included in the statistical counts that determine Bexar
County’s overall health picture. Health Profiles 2006 presents a clear picture of
where San Antonio stands in relation to the Healthy People 2010 program; a set of
health objectives for the nation to achieve over the first decade of the century.

Is San Antonio on target for 2010? Each page of this report shows what areas are
nearing the goal, and where others, the “10 zip codes”, are lagging behind. There
have been gains in childhood immunization rates, improved prenatal services at
public health clinics, reduced teen pregnancies and a greater public understanding
of the risks of obesity and diabetes.

As a result of two legislative initiatives this year, Metro Health will lead two state
pilot research programs in 2008. The first is a Diabetes Registry which will gather
clinical test results from laboratories across Bexar County to determine the
prevalence of diabetes in the community and its overall impact on the community’s
economy and health care costs. A second study will gather laboratory tests to
determine the number of community-acquired staph cases; a drug-resistant skin
infection known as MRSA (methicillin resistant Staphylococcus aureus).
SAN ANTONIO METROPOLITAN HEALTH DISTRICT

332 WEST COMMERCE
SAN ANTONIO, TEXAS 78205-2489
PHONE [phone] FAX [phone]

This year, Metro Health will also test the concept of flu prevention via a school-
based flu immunizations program. The concept is that children who are immunized
at school are less likely to bring the flu virus home to their parents and siblings,
thereby reducing the impact for other school-age or workforce absences.

San Antonio can look with pride at the public health successes achieved. Yet, the
dynamics of public health can easily change. Anything from nursing shortages to
regional outbreaks of disease can upset the delicate balance of health for
vulnerable segments of the population, such as the elderly or disabled, the
homeless and the poor. The lessons of Hurricane Katrina have not been
forgotten!

Please use the data from the Health Profiles 2006 report to help advocate for
better health systems, both public and private. Whenever and wherever people
seek to improve their personal health, we all benefit. Consider it a mutual fund
where the return on investment benefits everyone involved.

Fernando A. Guerra, M.D., M.P.H.
Director of Health
Table of Contents
Leter from Fernando A. Guerra, MD, MPH, Director of Health
Acknowledgments
I Executive Summary
II Demographics and Education
Selected Demographics and Health Indicators
Life Expectancy at Birth
2000 Census Population Pyramid by Race and Ethnicity
Projected Population, and Births
Bexar County Education Statistics by School District
Texas Education Agency-2006-2007 Fall Students Receiving Special Education Services
Behavioral Risk Factor Surveillance System
Health Benchmarks
San Antonio Ten zip codes and Concentration of Poverty
Births and deaths 2000 to 2006 by zip code
III Maternal and Child Health Indicators
Birth Facts
Births by Ethnicity and Race
Maternal Health Indicators by Year and by Hospital
Multiple Births
Births by Age of Mother & birth Order
Births by Age for Hispanic Mothers
Births by Age for Non-Hispanic White Mothers
Births by Age for African-American Mothers
Births to Single Mothers by Age of Mother & Birth Order
Births to Mothers Age <20 by Age of Father
Low Birth Weight Births and Premature Births
City Council District Birth Summary
charts by City Council District
Births by Age of Mother and Council District
San Antonio Births to Single Mothers by Age & Council District
Births by Bexar County Precinct
Leading Maternal Indicators by Age Group
Medicaid Births and Spacing of Pregnancies
Births to Mothers Receiving Late or no Prenatal Care
Very Low Birth Weight Births
Maternal Indicators Occurring within School District
BMI before pregnancy
Births that Occurred within Bexar County to out of county residents
Prenatal Care Clustering for Singleton Live Births
Zip code Maps Births to Mothers age <18 & High Risk Births to mothers <22
Zip code Maps Infant Mortality, Late Prenatal Care Births
Zip code Maps Medicaid Funded Births, Low Birth Weight
Maternal Indicators by Zip Code
Maternal Indicators by Census tract
IV Youth Indicators
Bexar County Confirmed Victims of Child Abuse/Neglect in Bexar County
Bexar County Confirmed Victims of Child Abuse/Neglect by Zip Code
Bexar County, Juvenile Probation
Sample of Immunization Rates all Zip codes
Domestic Violence
Bexar County 2006 at-risk Indicators by Zip Code
Bexar County Head Start Provider Dental Screenings
Environmental Health Indicators
Pediatric Asthma Inpatient Admissions Patient age < 18 years by zip code
Bexar County 2006 Overweight/Underweight WIC Children by Zip Code
V Other Public Health Information
Preventable/ Selected Reportable Diseases
Selected Reportable Communicable Diseases
Selected Reportable Communicable Diseases by Age
Selected Reportable Communicable Diseases by zip code

Bexar County Tuberculosis Cases
Sexually Transmitted Diseases
Gonorrhea & Chlamydia Cases, Bexar County
Syphilis Cases, Bexar County
HIV & AIDS Cases, Bexar County
VIDeaths
Denominators used in Analyses
Infant Mortality
Major causes of Infant Mortality Summary
All Causes of Infant Mortality
All Causes of Death by Year for All Ages
All Causes of Death by Race & Ethnicity
All Causes of Death by Age
Major causes of Hispanic/African Americans early death age 45 to 64
Leading Causes Death by Age Group
All Causes of Death by Race & Ethnicity for Females
All Causes of Death by Age for Females
All Causes of Death by Race & Ethnicity for Males
All Causes of Death by Age for Males
Leading causes of deaths by Council District
Charts by Council District
Leading Causes of death by Bexar County Precinct
Leading Causes of Death by Zip Code
Deaths by age group/population by Zip Code
Leading Causes of Death by Census Tract
Health Profiles 2006 Narrative Profile
San Antonio Metropolitan Health District
Fernando A. Guerra, MD, MPH, Director of Health
John Berlanga, MPA

San Antonio Metropolitan Health District’s (Metro Health) annual public health
assessment is a snapshot of our community’s current health status. It also compares
the City of San Antonio with the state and the rest of the nation while offering some
indication of the progress we are making and the tasks that remain. It has been
developed through a statistical analysis of birth records, communicable disease reports,
school records and other sources. The goal of Health Profiles 2006 is to encourage
public and professional discussion regarding medical and daily living conditions that
affect the overall health of Bexar County’s entire metropolitan population.

Ten Zip Codes:
Metro Health has identified ten
zip codes as high-risk areas for
public health concerns 555111111111 777777777888888888222222222222222222888888888 777777777888888888222222222000000000111111111
connected with young families
(zip codes 78201, 78207,
78210, 78211, 78221, 78223,
78227, 78228, 78237, and 777777777888888888222222222222222222777777777 777777777888888888222222222333333333777777777 777777777888888888222222222000000000777777777
78242). Metro Health selected
these zip codes based on high 777777777888888888222222222111111111000000000
numbers of births to single
mothers or births to school-age
mothers.( Map1) 777777777888888888222222222222222222333333333
777777777888888888222222222444444444222222222
777777777888888888222222222111111111111111111 777777777888888888222222222333333333555555555
Children born to these mothers 777777777888888888222222222222222222111111111
often carry the extra burden of
a poverty-impacted
environment. Single mothers and their children are among the poorest and most
severely distressed in San Antonio, with 48% in poverty (American Community Survey,
2006). Many of these families are in their second or third generation of poverty. Teen
mothers, single mothers, low-income mothers, along with undocumented and uninsured
are concentrated in the ten zip codes listed above. Researchers have identified the
effects of poverty connected with domestic violence, juvenile crime, alcohol abuse, drug
addiction, and school failure.

Community Priority Issues:
Figure 1 displays the age distribution of Bexar County’s population, demonstrating that
the majority of the population is under age 40 years old. A significant portion of the
public health picture in San Antonio revolves around the needs of children, adolescents,
and young families.
Community Priority Issues of this
population include:
 Educational disparities
 Teen pregnancy
 Substance abuse
 Juvenile crime
 Unplanned births
 Low birth weight (LBW)
births
 Child abuse
 Neglect-domestic violence
 Medically uninsured-lack of
routine health care
 Diabetes, hypertension, and
obesity

Education, Teen Pregnancy, Substance Abuse and Juvenile Crime: Most
educational and neurological experts agree that the first five years of a child’s life lay the
groundwork for a child's emotional, social, linguistic, and cognitive development. Brain
development is most intense from 0-3 years of age. How many children in San Antonio
begin their first day of
Table 1
kindergarten unprepared
2005-2006 Education Statistics
for school? Sadly, we
know from decades of TAKS
experience that many of Grade 9
Total % Math, %
those who start behind, Studen % African % Economically Met
stay behind. Math is the ts American Hispanic Disadvantaged Standard
Somerset ISD 3,481 1% 83% 79% 26%
"gatekeeper" course for
Harlandale ISD 14,390 1% 95% 91% 34%
students seeking higher
S San Antonio ISD 9,667 2% 96% 90% 35%
education of any type, or
Edgewood ISD 12,075 1% 97% 92% 37%
even for those seeking
San Antonio ISD 56,422 9% 88% 92% 39%
meaningful work. By way
East Central ISD 8,143 11% 55% 56% 39%
of example, a student
Southside ISD 4,853 2% 83% 81% 42%
who finishes high school
Southwest ISD 9,950 3% 88% 81% 47%
must then take a
Judson ISD 19,250 28% 45% 54% 49%
placement exam at any
North East ISD 59,817 10% 44% 38% 64%
one of the colleges and
Northside ISD 78,711 8% 61% 49% 70%
universities in
Alamo Heights ISD 4,531 2% 30% 18% 83%
mathematics. Toyota
screens for math skills for their line positions and CPS Energy has a math qualifying
exam for their workers. (Table 1)

ii
Academic failure may lead to teenage pregnancy, higher dropout rates and possibly
higher incidence of crime. For the school year 2005 –2006, the Texas Education
Agency reports 152,892 (52%) Bexar County students to be at risk for academic failure.
Rates are highest among African
Americans, Hispanics, and low- Table 2
income students. These children Bexar County 2006 Births by Age of Mother and
tend to live in economically Birth Order
disadvantaged districts, defined
Age of Mother 1 2 3 4 5 6 Total
as eligible for free or reduced-
12 1 - - - - - 1
price meals under the National
13 9 - - - - - 9
School Lunch and Child Nutrition
14 37 2 - - - - 39
Program. San Antonio benefits 15 180 16 - - - - 196
from early learning and Head 16 352 36 5 - - - 393
Start programs. The healthy 17 582 113 15 - - - 710
18 740 231 40 4 - - 1,015
development of young children
19 877 362 87 15 2 - 1,343
should continue to be a priority
20 843 454 169 35 3 - 1,504
for San Antonio and the nation.
21 689 484 230 66 12 5 1,486
(Table 2) Total 4,310 1,698 546 120 17 5 6,696

Maternal-Child Health Care:
Currently, 50% of all births in Bexar County require Medicaid assistance to cover the
mother’s medical care during pregnancy. (Table 3)
 Medicaid funds 85% of births spaced too close together.
 Medicaid funds 80% of births to teen mothers.

Table 3
Birth outcomes can be improved
Bexar County Births
for uninsured women by
2004 % / rate 2005 % / rate 2006 % / rate
providing pre-conception care.
Total Births 25,136 100% 25,582 100% 26,194 100%
Women who are young, single,
Medicaid Births 12,268 49% 12,857 50% 13,152 50%
working part-time, or Mothers < 18
yrs old 1,437 6% 1,369 5% 1,350 5%
unemployed are at highest risk
Single Mothers 9,826 39% 10,623 42% 10,977 42%
for being uninsured. Based on
Late or No
pilot tests conducted in San Prenatal Care 3,421 14% 6,754 26% 7,365 28%
Low Weight
Antonio in 2007, among 40
Birth <2500 g. 2,233 9% 2,291 9% 2,543 10%
survey participants, 72% of Premature <37
Weeks 3,193 13% 3,100 12% 3,622 14%
mothers claimed they did not
Infant Deaths* 156 6.21 170 6.65 177 6.76
plan on getting pregnant. Note about
2000 births to undocumented mothers occurred in Bexar County each year. Emergency Medicaid funds these births which are not
included in the above statistics. Emergency Medicaid covers the infant and pays for the delivery

Maternal Indicators:
Among Bexar County residents, 26,194 births were recorded in 2006. This data
maintains a trend that concerns the health district:
 50% of deliveries funded by Medicaid
 Increasing numbers of single mother births.
 Increasing rate of late prenatal care births.
 Increasing rate of low birth weights/premature births.
*Note 2006 infant mortality rate data is not yet available from the State; we used locally collected deaths. All death data
for the State will be released at a later date.

iii
Unplanned Births and Low Birth Weight Births:
In 2006, Bexar County had 411 very low birth weight (VLBW) births in addition to 127
births from other counties.( Map 2)

Childbirth-related costs are the
single largest component of health
care costs for many employers.
The average cost of a normal,
healthy infant delivery in the U.S. is
about $6,400. One unhealthy birth
can cost anywhere from $20,000 to
more than $1 million per infant.
Those highest costs can be
attributed to VLBW infants (those <
1.5 kg).

In addition to the direct health care
costs, the related indirect costs of
increased absenteeism, higher
disability costs and lowered
productivity magnify the problem. Studies indicate that being at risk for having a low
birth weight baby is not a genetic predisposition, but is due to variable factors, including
stress (Maternal and Child Health Journal, Vol. 5, No. 2, 2001). Young mothers with
existing children have a much more difficult time with balancing employment, childcare,
and advancing their educations.

In 2006, Bexar County had 2,543 low birth weight (LBW) births. These newborns are at
greater risk for health problems throughout life, but especially in the first year of life.
These problems include asthma, cerebral palsy, learning disabilities, insulin resistance
syndrome, hypertension, and cardiovascular disease.

In 2006, 3,590 children and young adults (under 20 years old) were newly diagnosed
with a sexually transmitted disease (chlamydia, gonorrhea, syphilis, AIDS/HIV). That
includes 12 new cases of
AIDS/HIV. In the age group 20-29
years were found 5,531 newly
diagnosed STDs, including 59 new
cases of AIDS/HIV.
San Antonio continues to enjoy
high rates of childhood vaccination
against preventable diseases.
(Map 3)

The National Healthy People 2010
program has a goal of reaching
95% of all children (ages 19-35
months) with proper vaccinations.
Some areas of Bexar County are
close to this goal already; however,
iv