Health Inequities and the Aging Population in Oklahoma Community Service Council of Greater Tulsa...

Health Inequities and the Aging Population in Oklahoma

Community Service Council of Greater TulsaMay, 2008

Demographics… a global first in the number of people over age 65 years

Cost of living longer… People are living longer and healthier nationally, not in Oklahoma

Technology… Health is now 16% of the Gross Domestic Product and rising

Globalization… Medical costs to survive

New ways of thinking about health….

What are the dimensions……?

Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

File: Health Inequities OK Aging Conf May08rev052908.ppt

Global Aging - 2000, 2020 and 2050

Source: Central Intelligence Agency, Long Term Global Demographic Trends: Reshaping the Geopolitical Landscape, (July 2001).


Population Trends, United States1970 to 2000 and Projections for 2010 to 2050

Prepared by the Community Service Council of Greater Tulsa

Source: US Census Bureau, 1970 Census, 1980 Census, 1990 Census, 2000 Census, Population Projections 2010-2050.

1970 1980 1990 2000 2010 2020 2030 2040 2050

0

100,000,000

200,000,000

300,000,000

400,000,000

500,000,000Total Population

US 203,302,031 226,542,250 248,709,873 281,421,906 308,935,581 335,804,546 363,584,435 391,946,000 419,854,000

Projections

Life Expectancy at Birth 1840-2000

Source: “A Global Perspective Why Population Aging Matters,” National Institute on Aging, National Institutes of Health, U.S. Department of Health And Human Services, U.S. Department of State, March, 2007, Publication No. 07-6134, page 9http://www.state.gov/g/oes/rls/or/81537.htm

2005 Births

Projected to Live to 100 Years of Age



Source: US Census Bureau, 1970, 1980, 1990, & 2000 Censuses; US Census Bureau, Population Estimates Division, Population Projections, 2000 - 2030.

6.3

6.6

6.8

7.4

7.7

7.7

8.5

16.6

17.1

18.2

18.9

18.4

19.8

25.9

9.2

9.7

10.1

10

10.1

13.5

10.7

47.8

50.5

52.5

51.9

52.2

49.1

46.2

17.5

14.1

10.6

10.4

10.4

9

8.1

2030

2020

2010

2000

1990

1980

1970

0% 20% 40% 60% 80% 100%

Percent of population

0-4 5-17 18-24 25-64 65-84 85+

1.9

1.4

1.2

.9

.6

Pro

ject

ions 2.5

2.1

6.3

6.6

6.8

6.8

7.2

7.7

7.7

16.8

17.3

17.6

19.1

19.4

20.5

25

9.6

9.6

10.4

10.3

10.2

13.3

11.8

47.7

49.9

51.3

50.6

49.6

46

43.9

16.9

14.4

11.9

11.6

12

11.3

10.8

2030

2020

2010

2000

1990

1980

1970

0% 20% 40% 60% 80% 100%

Percent of population

0-4 5-17 18-24 25-64 65-84 85+

Age Distribution and Projections in Oklahoma 1970 to 2030

Percent of County Residents Aged 65+ US 2000

http://www.censusscope.org/us/map_65plus.gif Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Percent of County Residents Aged 65+ US 2000

http://www.censusscope.org/us/map_65plus.gif

Percent Population Age 65 and Over: % Population Age 65 and Over 450,100

13.2% % Population Age 85 and Over 65,500

1.8%

% Households with 1 or more 334,000 24.1% age 65 Years and Over


Percent of People Aged 65+ by County Oklahoma 2000


Oklahoma People Aged 65+ Percent Growth Compared to United States

2007-2030 OK US

Working age population change - 0.2% + 9.2%

Specifically those between ages 34 and 47 will decrease

Children 0-17 will grow by + 9.5% +15.8%

Persons 65 and over will grow +59.9% +88.8%

Persons 85 and over will grow +50.4% +72.8%

Dependent population will grow +26.9% +40.5%


Profile of the Aged in Oklahoma with National RankingsAmerican Community Survey 2006

US RANKUS RANK2006 Number2006 Number

13% people are over age 64 19 451,139

24% households 1 or more people over 64 16 334,153

18% households had retirement income 23 245,198

10% people 65+ below poverty level 19 45,673

1.8% the population over age 85 years 25t 65,571

Prepared by the Community Service Council of Greater Tulsa for the Metropolitan Human Services Commission, October, 2007

Profile of the Aged in Oklahoma with National RankingsAmerican Community Survey 2006

Prepared by the Community Service Council of Greater Tulsa for the Metropolitan Human Services Commission, October, 2007

US RANKUS RANK 2006 2006 NumberNumber

57% of grandparents responsible 6 43,029for their grandchildren

47% of people over 64 had a disability 8 211,077Of those over age 80 years

74% have a disability and 58% severe

62:100 workers age dependency ratio now 11

80:100 workers age dependency ratio by 2030

* Relationship of persons in family households is determined by relationship to the householder.

Population Age 65 and overNumber

455,700Percent

100.0%

In Households 427,226 93.7%

Family Households 284,102 62.3%

Householder 158,579 34.8%

Spouse 106,334 23.3%

Parent 10,126 2.2%

Other relative 8,162 1.8%

Non-relative 901 0.2%

Non-family Household 143,124 31.41%

Householder, Non-family Household, Living Alone 136,601 30.0%

Householder, Non-family Household, Two or More Persons 3,643 0.8%

Non-relative in Non-family Household 2,880 0.6%

In Group Quarters 28,474 6.3%

Institutionalized 26,134 5.7%

Non-institutionalized 2,340 0.5%

Household Types of the Aged in OklahomaUS Census 2000


Percent of People Aged 65+ Living in Group Quarters

Source: Census 2000 analyzed by the Social Science Data Analysis Network (SSDAN).


Percent of Persons Aged 65+ Living Alone

Source: Census 2000 analyzed by the Social Science Data Analysis Network (SSDAN).


Percent of Grandparents as Caregivers


Oklahoma – Percent of Grandparents as Caregivers

96.37%153,109,366Not Living With and Not Responsible for Grandchildren

0.59%933,408Responsible for 5 or More Years

0.24%374,251Responsible for 3 to 4 Years


0.17%262,623Responsible for 6 to 11 Months

0.18%293,045Responsible for Less Than 6 Months

1.53%2,426,730Responsible for Grandchildren

2.11%3,344,941Living With but Not Responsible for Grandchildren

3.63%5,771,671Living With Grandchildren

100.00%158,881,037Total People Age 30 years and older*

PercentNumber

96.37%153,109,366Not Living With and Not Responsible for Grandchildren

0.59%933,408Responsible for 5 or More Years



0.17%262,623Responsible for 6 to 11 Months

0.18%293,045Responsible for Less Than 6 Months

1.53%2,426,730Responsible for Grandchildren

2.11%3,344,941Living With but Not Responsible for Grandchildren

3.63%5,771,671Living With Grandchildren

100.00%158,881,037Total People Age 30 years and older*

PercentNumber


http://www.censusscope.org/us/map_aged_englishlessverywell.gif

English Language Ability of the Aged


National Health Care Expenditures and their Percentage of the GDP 1960 to 2005

5Source:CentersforMedicareandMedicaidServices,OfficeoftheActuary,NationalHealthStatisticsGroup,athttp://www.cms.hhs.gov/NationalHealthExpendData/(seeHistorical;NHEsummaryincludingshareofGDP, CY1960-2005;filenhegdp05.zip).

Adults aged 65 years and older have the highest health care spending, averaging $8,647 per person.


Infectious Diseases Replaced by Chronic Disease and Disability as Leading Causes of Death Globally and in the US

TuberculosisMalaria

HepatitisHIV/AIDS

CholeraDiptheria

Dysentery

Heart Disease

Cancer

Diabetes

Tuberculosis

HIV/AIDS

Hepatitis B and C

Source: Central Intelligence Agency, Long Term Global Demographic Trends: Reshaping the Geopolitical Landscape, (July 2001).

Community Service Council of Greater Tulsa

* Disability: A long-lasting physical, mental, or emotional condition. This condition can make it difficult for a person to do activities such as walking, climbing stairs, dressing, bathing, learning, or remembering. This condition can also impede a person from being able to go outside the home alone or to work at a job or business.** Physical Disability: A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying.*** Mobility Disability: The 2000 Census asks people if they have a "Go Outside The Home" disability. In previous years, the question has been labeled a "Mobility Disability." Both terms have the same meaning and include people who are limited from leaving their homes without assistance. The Census specifically asks if a person is unable to go outside the home for activities such as shopping and visiting the doctor.Source: Census 2000 analyzed by the Social Science Data Analysis Network (SSDAN).

Disability Status of the Aged in OklahomaUS Census 2000

Number Percent

Population Age 65 and over 429,566 100.0%

No disability 228,954 53.3%

One disability* 92,159 21.5%

Sensory disability only 17,794 4.1%

Physical disability only** 49,789 11.6%

Mental disability only 4,872 1.1%

Selfcare disability only 658 0.1%

Mobility disability only*** 19,046 4.4%

Two or more disabilities 108,453 25.3%


US Health Care Expenditures Exceed Global Expenditures But Outcomes Do Not Match

Source: Organisation for Economic Co-operation and Development. OECD Health Data 2007, from the OECD Internet subscription database updated July 2007. Copyright OECD 2007 ,www.oecd.org/health/healthdata.

US Health Care Expenditures 2004

Greatest in the World with Rank of 32nd in Health Outcomes

Health Care Spending is Greatest in the Top 5% of the Population

Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2004.


Health Care Spending is Greatest in Hospitals and Physicians

Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2004.


0

25,000

50,000

75,000

100,000

125,000

150,000

175,000

200,000

225,000C

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Hospitals Discharges by Payor Oklahoma, 2006For All Persons

Source: Oklahoma State Department of Health OK2SHARE

Total Discharges 518,602


29% commercial insurance payor62% public funds payor

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

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Hospitals Discharges by Payor Oklahoma, 2006 For Persons Age 65 and Over


Total Discharges 192,353 or37% of all Discharges



$0

$500,000,000

$1,000,000,000

$1,500,000,000

$2,000,000,000

$2,500,000,000

$3,000,000,000

$3,500,000,000

$4,000,000,000

$4,500,000,000

$5,000,000,000

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Total Charges from Hospitals by Payor Oklahoma, 2006For All Persons


Total Charges $9,457,070,618



$0

$500,000,000

$1,000,000,000

$1,500,000,000

$2,000,000,000

$2,500,000,000

$3,000,000,000

$3,500,000,000

$4,000,000,000

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Total Charges from Hospitals by Payor Oklahoma, 2006For Persons Age 65 and Over


Total Charges $4,179,600,508 or44% of all charges



$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

$300,000,000

$350,000,000

$400,000,000

$450,000,000

$500,000,000

Oklahoma Medicaid Expenditures by Service for All Persons (top 12)FY 2007

These 12 Medical services represent over 83% of Oklahoma’s total expenditures

Nursing Home Services use 17% & Inpatient Services use 15% of all Medicaid dollars spent on all persons

Source: Oklahoma Health Care Authority, CMS Annual Reporting, FFY 2007Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

$300,000,000

$350,000,000

$400,000,000

Oklahoma Medicaid Expenditures by Service for Persons Age 65 and Over(top 12)FY 2007

Source: Oklahoma Health Care Authority, CMS Annual Reporting, FFY 2007

These 12 Medical services represent over 96% of Oklahoma’s total expenditures for Personsage 65 and over

Nursing Home Services use 78% of all Medicaid dollars spent on person age 65 & over and21% of expenditures


Relative Expenditures by Source of Care are Increasing for Private Health Insurances

Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData


Minorities are More At-risk for Health Insecurities

A higher percentage having no health insurance Minorities make half as many physician visits for

preventive health Minority men are employed in the most dangerous

occupations (mining, construction, etc.) Men and boys are encouraged to more risky behaviors Research on health responses to specific diseases and

interventions by race are underfunded

Health Care Rx: Access For All The President’s Initiative on Race 1998


Gender Differences in Life Expectancy Favor Women

Life expectancy for men and women in 1920 was 1 year difference

Life expectancy for men and women in 2008 is 6 years difference

Men are more likely to die than women in all the top ten causes of death

At birth, there are more males than females. By age 36, the trend turns to more females than males. At age 100, women outnumber men by 8 to 1

www.menshealthnetwork.org


Premature Death Greater is Racial and Ethnic Minorities

The racial and ethnic minorities in Oklahoma are expected to reach 50% of the Oklahoma population by 2010-2015

Infant mortality is higher in minority populations

Oklahoma exceeds the national average in age adjusted death rate for heart disease, cancer and stroke with minority populations disproportionately represented

Source: Center for Vital Statistics, Oklahoma State Department of Health


Diminishing Population Increase Health Insecurities in Rural Areas



Source: Kaiser Family Foundation.

1,673,131 (48.2%)

141,341 (4.1%)459,315 (13.2%)

553,526 (15.9%)

644,292 (18.6%)

435,497 (50.5%)

312,416 (36.3%)

113,735 (13.2%)

1,240,462 (59.9%)

95,634 (4.6%)117,044 (5.6%)

93,994 (4.5%)

524,480 (25.3%)

3,337 (0.7%)29,855 (5.8%)

473,042 (92.3%) 6,077 (1.2%)

Employer Individual Medicaid Medicare/Other Public Uninsured

Total Population Under Age 19

Age 19-64 Age 65 & over

Health Insurance Status, by AgeOklahoma 2005-2006


Source: United Health Foundation.

#31

#27

#31

#24

#27

#47

#47

#48

#40

#50

#43

#43

Overall ranking

Poor mental health days

Poor physical health days

Infant mortality

Cardiovascular deaths

Cancer deaths

Premature death

1990 2007

Ranking: 1=best, 50=worst

Oklahoma's Rankings in OutcomesAssociated with Poor Health 1990 and 2007


Source: United Health Foundation.

#44

#23#31

#24#8

#32#21

#46

#41

#47#12

#44#24

#34#38

#24#42

#42#30

#25

#40#50

#45

Personal BehaviorsPrevalence of smoking

Prevalence of Binge Drinking

Prevalence of obesity

High school graduation

Community EnvironmentViolent crime

Occupational fatalities

Infectious disease

Children in poverty

Public & Health PoliciesLack of health insurance

Per capita public health spending

Immunization coverage

Clinical Care

Adequacy of prenatal care

Primary Care Physicians

Preventable Hospitalizations

1990 2007

Ranking: 1=best, 50=worst

Oklahoma's Rankings in Risk Factors Associated with Poor Health 1990 and 2007


Source: National Center for Health Statistics, Health E-Stats; Oklahoma State Department of Health, Vital Statistics.

Heart disease

Cancer

Stroke

Chronic lowerrespiratory diseases

Accidents

Diabetes mettitus

Alzheimer's disease

Influenza & pneumonia

0 50 100 150 200 250 300

Rate per 100,000 Persons

U.S.

Oklahoma

Tulsa County

Oklahoma County

Age-Adjusted Death Rates for the Leading Causes of DeathUS 2005, Oklahoma 2004

Oklahoma – Aging Planning Considerations

Shrinking working age population vs. growth of those age 64 and older

Consider the urban rural differences

Chronic and acute health care vs. prevention

The changing family and household structure

The need for 1 in 75 seniors to speak another language


Health Inequities and the Aging Population in Oklahoma

The Community Service Council of Greater Tulsa thanks the Human Service Committee - Social Services Subcommittee for the opportunity to share some of the information it has available concerning the aging of Oklahoma.We are available to provide a great amount of data and information on this topic and many others.

The Community Service Council's Census Information Center (CIC) is provided in cooperation with the U.S. Census Bureau to make census data more accessible for use in planning to meet the needs of people in Oklahoma.

Please visit our website for a variety of presentations and sets of data for your use in planning and development of the State of Oklahoma.

www.csctulsa.org, click on data

A Tulsa Area United Way agency

Community Service Council of Greater Tulsa

16 East 16th Street, Suite 202

Tulsa, OK 74119-4402

918-585-5551

Contact: [email protected] or [email protected]

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