Oral Health Data Profile Thurston County Local Impact Network

Oral Health Data Profile Thurston County Local Impact Network
Mary Ann O’Garro, Epidemiologist Prepared for the Thurston County Local Impact Network Thurston County Public Health and Social Services Department September 2018

The whole community is accountable
Purpose Population Health Indicators Describe current conditions Identify oral health disparities Inform anchor strategy planning Support network collaboration Population-Level: The whole community is accountable Thurston County Public Health & Social Services Department

is ranked 6th healthiest in Washington State
Thurston County is ranked 6th healthiest in Washington State Source: County Health Rankings, University of Wisconsin and Robert Wood Johnson Foundation Overall, Thurston County is ranked 6th healthiest compared to all 39 counties for health outcomes The rank measures how long people live and how healthy people are while alive A lower rank is better (1 best, 39 worst) Thurston County Public Health & Social Services Department

Dental Insurance Data Thurston County Public Health & Social Services Department

Dental Insurance: Thurston County Adults
All Adults Detail Timeframe: 2016 Uninsured Estimate = 51,000 adults Parameters: Covered or partially covered by dental insurance Note: Any form of dental insurance Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “Do you have any kind of insurance coverage that pays for some or all of your routine dental care, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid?” Estimate based on Washington State Office of Financial Management Population Estimates for 2016 In 2016, 24% of Thurston County adults did not have dental insurance Comparison for Washington State All Adults: Insured = 67%, Uninsured = 33% Thurston Uninsured Rank (1 worst, 39 best) = 35th Thurston County Public Health & Social Services Department

Insured Adults Detail Timeframe: Insured Estimate 2012 = 131,500 adults 2016 = 161,700 adults Parameters: Covered or partially covered by dental insurance Note: Any form of dental insurance Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “Do you have any kind of insurance coverage that pays for some or all of your routine dental care, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid?” Estimate based on Washington State Office of Financial Management Population Estimates for 2012 and 2016 The percent of Thurston County adults covered by dental insurance increased between 2012 and 2016 Thurston County Public Health & Social Services Department

Detail Timeframe: 2016 Parameters: Covered or partially covered by dental insurance Low Income: Annual household income less than $35,000 Note: Any form of dental insurance Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “Do you have any kind of insurance coverage that pays for some or all of your routine dental care, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid?” In 2016, 34% of low income Thurston County adults had no dental insurance compared to 14% of county adults who were not low income Comparison for Washington State Low Income: Insured = 49%, Uninsured = 51% Not Low Income: Insured = 77%, Uninsured = 23% Thurston County Public Health & Social Services Department

Detail Timeframe: 2016 Uninsured Estimate Age 18 to 64 = 35,200 Age 65 and Up = 15,200 Parameters: Covered or partially covered by dental insurance Note: Any form of insurance Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “Do you have any kind of insurance coverage that pays for some or all of your routine dental care, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid?” Estimate based on Washington State Office of Financial Management Population Estimates for 2016 In 2016, 21% of Thurston County adults age had no dental insurance compared to 34% of county adults age 65 and up Comparison for Washington State Age 18 to 64: Insured = 73%, Uninsured = 27% Age 65 and Up: Insured = 46%, Uninsured = 54% Thurston County Public Health & Social Services Department

Medicare & Dental Insurance: Thurston County Adults
All Medicare Adults Detail Insurance: Medicare Timeframe: 2016 Parameters: Covered or partially covered by dental insurance Note: Any form of dental insurance Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “Do you have Medicare?” Question asked “Do you have any kind of insurance coverage that pays for some or all of your routine dental care, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid?” Of Thurston County adults covered by Medicare in 2016, 33% did not have dental insurance Thurston County Public Health & Social Services Department

Health & Dental Insurance: Thurston County Adults
Source of Health Insurance Detail Timeframe: 2016 Parameters: 18 and up with any form of dental insurance Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “What is the primary source of your health care coverage?” Question asked “Do you have any kind of insurance coverage that pays for some or all of your routine dental care, including dental insurance, prepaid plans such as HMOs, or government plans such as Medicaid?” Of Thurston County adults with dental insurance, 59% had a health insurance plan purchased through an employer or union in 2016 Thurston County Public Health & Social Services Department

Medicaid Dental Utilization Data
Thurston County Public Health & Social Services Department

All Ages WA State: 39% Thurston: 31%
Source: Health Care Authority Apple Health (Medicaid) Green is best, blue is better, yellow less than state, red worst Thurston County is yellow and our peer LIN Spokane is green Thurston County is worse than surrounding counties In fiscal year 2017, 31% of Thurston County residents covered by Medicaid used dental services. Thurston County Utilization Rank (1 best, 39 worst) = 30th Thurston County Public Health & Social Services Department

Age Birth to 20 WA State: 56% Thurston: 47%
Source: Health Care Authority Apple Health (Medicaid) Children coverage goes through age 20, adult benefits change at 21. Color patterns do improve for some places for children, but not for Thurston County. In fiscal year 2017, 47% of Thurston County residents age birth to 20 covered by Medicaid used dental services. Thurston County Utilization Rank (1 best, 39 worst) = 29th Thurston County Public Health & Social Services Department

Age 21 and Up WA State: 23% Thurston: 19%
Source: Health Care Authority Apple Health (Medicaid) In fiscal year 2017, 19% of Thurston County adults age 21 and up covered by Medicaid used dental services. Thurston County Utilization Rank (1 best, 39 worst) = 26th Thurston County Public Health & Social Services Department

Dental Care Utilization: Thurston County Residents
Detail Insurance: Medicaid Timeframe: Percent Change: Eligibles = 22% increase Users = 31% increase Note: FY = Fiscal Year Source: Health Care Authority Source: Health Care Authority Apple Health (Medicaid) Between fiscal year 2013 and 2017, the number of Thurston County residents age birth to 20 covered by Medicaid who used dental services increased from 13,052 to 17,043 (31% increase in use) Comparison for Washington State Percent Change Age Birth to 20 Eligibles = 16% increase, Users = 19% increase Thurston County Public Health & Social Services Department

Dental Care Utilization: Thurston County Residents
Detail Insurance: Medicaid Timeframe: Percent Change: Eligibles = 166% increase Users = 392% increase Note: FY = Fiscal Year Source: Health Care Authority Source: Health Care Authority Apple Health (Medicaid) Between fiscal year 2013 and 2017, the number of Thurston County residents age 20 and up covered by Medicaid who used dental services increased from 1,954 to 9,618 (392% increase in use) Comparison for Washington State Percent Change Eligibles = 129% increase, Users = 268% increase Thurston County Public Health & Social Services Department

Age Birth to 5 WA State: 53% Thurston: 45%
Source: Health Care Authority Apple Health (Medicaid) In fiscal year 2017, 45% of Thurston County residents age birth to 5 covered by Medicaid used dental services. Thurston County Public Health & Social Services Department

Dental Care Utilization: Thurston County Children
FY 2017 # Eligibles # Users % Users Age birth to 1 4,769 1,366 29% Age 2 to 5 7,517 4,152 55% Age 6 to 14 15,263 8,359 Age 15 to 17 4,692 2,152 46% Detail Insurance: Medicaid Timeframe: 2017 Note: FY = Fiscal Year Source: Health Care Authority Source: Health Care Authority Apple Health (Medicaid) Thurston County Public Health & Social Services Department

Licensed Provider Data

Ratio of Population to Dentists: Thurston County
Detail Timeframe: 2016 Total Dentists = 203 Ratio Thurston = 1,360 to 1 WA = 1,250 to 1 Source: HRSA Source: County Health Rankings, Health Resources and Services Administration (HRSA) Thurston County Rank (1 best, 30 worst) = 10th Best = King, Worst = Skamania Note: Thurston County based dentists serve individuals from outside of the county Thurston County Public Health & Social Services Department

Designations North County South County Nisqually Tribe
Source: Washington State Department of Health, Health Care Professional Shortage program Thurston County designations are geographic with date of designation and last update 10/2017 Nisqually Health Clinic has a facility/tribal designation with a last update of 10/2009 Only dentists are counted for shortage designation and are defined as a non-federal dentist with an active dentist credential who provides patient care addressing general dental care Thurston County Public Health & Social Services Department

Dental Visit Data Thurston County Public Health & Social Services Department

Last Dental Visit: Thurston County 8th Graders
All 8th Graders Detail Timeframe: 2016 Visit 1 or More Years Ago Estimate = th graders Parameters: Visit for any reason Note: Provider can be based in any county Source: HYS Source: Healthy Youth Survey (HYS), Washington State Department of Health Question asked “When was the last time you saw a dentist for a check-up, exam, teeth cleaning, or other dental work?” 8th Graders are usually age 13-14 In 2016, 77% of Thurston County 8th graders had visited a dentist in the past year (23% had not) Comparison for Washington State All 8th Graders: In Past Year 76%, 1 to 2 Years = 7%, 2 or More Years = 3%, Never or Not Sure = 14% Thurston County Public Health & Social Services Department

Last Dental Visit: Thurston County 10th Graders
All 10th Graders Detail Timeframe: 2016 Visit 1 or More Years Ago Estimate = th graders Parameters: Visit for any reason Note: Provider can be based in any county Source: HYS Source: Healthy Youth Survey (HYS), Washington State Department of Health Question asked “When was the last time you saw a dentist for a check-up, exam, teeth cleaning, or other dental work?” 10th Graders are usually age 15-16 In 2016, 80% of Thurston County 10th graders had visited a dentist in the past year (20% had not) Comparison for Washington State All 10th Graders: In Past Year = 80%, 1 to 2 Years = 8%, 2 or More Years = 4%, Never or Not Sure = 8% Thurston County Public Health & Social Services Department

Last Dental Visit, Thurston County Youth
Detail Timeframe: 2016 Parameters: Visit for any reason Low income: Eligible for free or reduced school meals Note: Provider can be based in any county Source: HYS Source: Healthy Youth Survey (HYS), Washington State Department of Health Question asked “When was the last time you saw a dentist for a check-up, exam, teeth cleaning, or other dental work?” 8th Graders are usually age 13-14 10th Graders are usually age 15-16 Low income Thurston County youth are less likely to visit a dentist compared to not low income youth. In 2016, 69% of low income Thurston County 8th graders visited a dentist in the past year compared to 84% of not low income 8th graders. In 2016, 70% of low income Thurston County 10th graders visited a dentist in the past year compared to 85% of not low income 10th graders. Thurston County Public Health & Social Services Department

Last Dental Visit: Thurston County Adults
All Adults Detail Timeframe: 2016 Last Visit 1 Year or More Ago Estimate = 63,800 adults 5 or More Years Ago Estimate = 17,000 adults Parameters: Visit for any reason, including specialists Note: Provider can be based in any county Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “How long has it been since you last visited a dentist or a dental clinic for any reason? Include visits to dental specialists, such as orthodontists” Estimate based on Washington State Office of Financial Management Population Estimates for 2016 In 2016, 70% of Thurston County adults had visited a dentist in the past year Comparison for Washington State All Adults: In Past Year = 69%, 1 to Under 2 Years = 12%, 2 to Under 5 Years = 9%, 5 or More Years = 9% Thurston County Public Health & Social Services Department

Detail Timeframe: 2016 Parameters: Visit for any reason, including specialists Note: Provider can be based in any county Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “Question asked “How long has it been since you last visited a dentist or a dental clinic for any reason? Include visits to dental specialists, such as orthodontists” Comparison for Washington State Age 18 to 64: Past Year = 68%, 1 Year or More = 32% Age 65 and Up: Past Year = 71%, 1 Year or More = 29% Thurston County Public Health & Social Services Department

Detail Timeframe: 2016 Parameters: Visit for any reason, including specialists Low Income: Annual household income less than $35,000 Note: Provider can be based in any county Source: BRFSS Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “Question asked “How long has it been since you last visited a dentist or a dental clinic for any reason? Include visits to dental specialists, such as orthodontists” In 2016, 57% of low income Thurston County adults visited a dentist in the past year (43% visited one or more years ago or never) Comparison for Washington State Low Income: In Past Year = 52%, Not in Past Year = 48% Not Low Income: In Past Year = 77%, Not in Past Year = 23% Thurston County Public Health & Social Services Department

Oral Health Data Thurston County Public Health & Social Services Department

Missed School Toothache: Thurston County 6th Graders
Detail Timeframe: 2016 Missed School Due to Toothache Estimate = 220 6th graders Parameters: Missing school in past year (answer of yes or 1 or more days) Note: Does not include braces or injury Source: HYS Source: Healthy Youth Survey (HYS), Washington State Department of Health Question “During the past year, did you miss any time from school because of toothache? (Do not include toothache due to braces or an injury.)” 6th Graders are usually age 11-12 Estimate based on Office of Superintendent of Public Instruction enrollment for the school year In 2016, 7% of Thurston County 6th graders missed school due to a toothache Comparison for Washington State All 8th Graders: No Days = 94%, 1 or More Days= 6% Thurston County Public Health & Social Services Department

Missed School Toothache: Thurston County 8th Graders
Detail Timeframe: 2016 Missed School Due to Toothache Estimate = 120 8th graders Parameters: Missing school in past year (answer of yes or 1 or more days) Note: Does not include braces or injury Source: HYS Source: Healthy Youth Survey (HYS), Washington State Department of Health Question asked “During the past 12 months, how many days did you miss some school because of toothache? (Do not include toothache due to braces or injury.)” 8th Graders are usually age 13-14 Estimate based on Office of Superintendent of Public Instruction enrollment for the school year In 2016, 4% of Thurston County 8th graders missed school due to a toothache Comparison for Washington State All 8th Graders: No Days = 96%, 1 or More Days= 4% Thurston County Public Health & Social Services Department

Missed School Toothache, Thurston County Youth
Detail Timeframe: 2016 Parameters: Missing school in past year (answer of yes or 1 or more days) Low income: Eligible for free or reduced school meals Note: Does not include braces or injury Source: HYS Source: Healthy Youth Survey (HYS), Washington State Department of Health Question asked “During the past 12 months, how many days did you miss some school because of toothache? (Do not include toothache due to braces or injury.)” 8th Graders are usually age 13-14 10th Graders are usually age 15-16 Low income Thurston County youth are more likely to miss school due to a toothache compared to not low income youth. In 2016, 6% of low income Thurston County 8th graders missed school due to a toothache compared to 3% of not low income 8th graders. In 2016, 6% of low income Thurston County 10th graders missed school due to a toothache compared to 3% of not low income 10th graders. Thurston County Public Health & Social Services Department

Mouth Pain in Past Year: Thurston County Adults
All Adults Detail Timeframe: 2016 Experienced Mouth Pain Estimate = 34,000 adults Parameters: Yes (very often, occasionally), No (hardly ever, never) Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “How often during the last year have you had painful aching anywhere in your mouth?” Estimate based on Washington State Office of Financial Management Population Estimates for 2016 In 2016, 16% of Thurston County adults experienced mouth pain in the past year Comparison for Washington State All Adults: Yes = 16%, No = 84% Thurston County Public Health & Social Services Department

Detail Timeframe: 2016 Parameters: Yes (very often, occasionally), No (hardly ever, never) Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “How often during the last year have you had painful aching anywhere in your mouth?” In 2016, 18% of Thurston County adults age had experienced mouth pain in the past year compared to 9% of county adults age 65 and up. Comparison for Washington State Age 18 to 64: Yes = 18%, No = 82% Age 65 and Up: Yes = 11%, No = 89% Thurston County Public Health & Social Services Department

Detail Timeframe: 2016 Parameters: Yes (very often, occasionally), No (hardly ever, never) Low Income: Annual household income less than $35,000 Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “How often during the last year have you had painful aching anywhere in your mouth?” In 2016, 30% of low income Thurston County adults had experienced mouth pain in the past year compared to 12% of county adults who were not low income. Comparison for Washington State Low Income: Yes = 24%, No= 76% Not Low Income: Yes = 13%, No = 87% Thurston County Public Health & Social Services Department

Permanent Teeth Removed: Thurston County Adults
All Adults Detail Timeframe: 2016 1 or More Teeth Removed Estimate = 78,700 adults Parameters: Due to tooth decay or gum disease Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “How many of your permanent teeth have been removed because of tooth decay or gum disease? Include teeth lost to infection, but do not include teeth lost for other reasons, such as injury or orthodontics.” Estimate based on Washington State Office of Financial Management Population Estimates for 2016 In 2016, 37% of Thurston County had 1 or more permanent teeth removed due to tooth decay (33% 1 tooth, but not all and 4% all) Comparison for Washington State All Adults: 1 or More, Not All = 33%, All = 4%, None = 63% Thurston County Public Health & Social Services Department

Detail Timeframe: 2016 Parameters: Due to tooth decay or gum disease Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “How many of your permanent teeth have been removed because of tooth decay or gum disease? Include teeth lost to infection, but do not include teeth lost for other reasons, such as injury or orthodontics.” Comparison for Washington State Age 18 to 64: 1 or More = 31%, None = 69% Age 65 and Up: 1 or More = 62%, None = 38% Thurston County Public Health & Social Services Department

Detail Timeframe: 2016 Parameters: Due to tooth decay or gum disease Low Income: Annual household income less than $35,000 Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “How many of your permanent teeth have been removed because of tooth decay or gum disease? Include teeth lost to infection, but do not include teeth lost for other reasons, such as injury or orthodontics.” Comparison for Washington State Low Income: 1 or More = 50%, None= 50% Not Low Income: 1 or More = 31%, None = 69% Thurston County Public Health & Social Services Department

Diabetes: Thurston County Adults
All Adults Detail Timeframe: 2016 Diabetes Estimate = 21,200 adults Parameters: Ever told by health professional Source: BRFSS Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Washington State Department of Health Question asked “Has a doctor, nurse, or other health professional ever told you that you had any of the following: Diabetes?” Estimate based on Washington State Office of Financial Management Population Estimates for 2016 In 2016, 10% of Thurston County adults had been diagnosed with diabetes Comparison for Washington State All Adults: Yes = 9%, Yes, Pregnancy = 1%, Pre-Diabetes = 1%, No = 89% Thurston County Public Health & Social Services Department

Smile Survey Data Thurston County Public Health & Social Services Department

Arcora Foundation Report for Thurston County

Emergency Department Data

Oral Health ED Visits: Thurston County Residents
Detail Timeframe: July 1, June 30, 2018 Total Visits = 72 Parameters: Visits for tooth, teeth, dental in chief complaint or discharge In-County: Providence St. Peter Hospital Note: ED = Emergency Department Source: ESSENCE Source: Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) Providence St. Peter Hospital is participating with data available Capital Medical Center is participating in the system, but does not yet have data available to users Includes county residents who went to in-county and out-of-county emergency department Thurston County Public Health & Social Services Department

Age Detail Timeframe: July 1, June 30, 2018 Total Visits = 72 Parameters: Visits for tooth, teeth, dental in chief complaint or discharge Note: ED = Emergency Department Source: ESSENCE Source: Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) Providence St. Peter Hospital is participating with data available Capital Medical Center is participating in the system, but does not yet have data available to users Includes county residents who went to in-county and out-of-county emergency department Thurston County Public Health & Social Services Department

Gender Detail Timeframe: July 1, June 30, 2018 Total Visits = 72 Parameters: Visits for tooth, teeth, dental in chief complaint or discharge Note: ED = Emergency Department Source: ESSENCE Source: Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) Providence St. Peter Hospital is participating with data available Capital Medical Center is participating in the system, but does not yet have data available to users Includes county residents who went to in-county and out-of-county emergency department Thurston County Public Health & Social Services Department

Overdose ED Visits, Thurston County Residents
Detail Timeframe: July 1, June 30, 2018 Total Visits = 103 Average: 2 opioid overdoses ED visits every week (1st half 2018) Parameters: Includes unintentional, intentional, assault and undetermined Note: ED = Emergency Department Source: ESSENCE Source: Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE) Providence St. Peter Hospital is participating with data available Capital Medical Center is participating in the system, but does not yet have data available to users Includes county residents who went to in-county and out-of-county emergency department Thurston County Public Health & Social Services Department

Overdose Deaths, Thurston County Residents
Detail Timeframe: Calendar Year Average: 1 opioid overdose death every 3 weeks (2017) Parameters: Includes unintentional, intentional, assault and undetermined Source: Opioid Quarterly Report Source: Opioid Quarterly Report from Death Certificates, Washington State Department of Health Thurston County Public Health & Social Services Department

Oral Health Disparities
Definition A difference in health outcomes due to systematic experiences or societal conditions that impact specific groups of people. Thurston County Age Income In Thurston County oral health disparities have been identified for age and income Thurston County Public Health & Social Services Department

Population Change: Thurston County Residents
Source: Washington State Office of Financial Management, Thurston Regional Planning Council Population Forecast Population change for the number of Thurston County residents age 65 and up for = 90% increase Population change for the number of Thurston County residents age 65 and up for = 50% increase Thurston County Public Health & Social Services Department

Income Change: Thurston County Residents
Detail Timeframe: Parameters: Low income (less than 200% of poverty), Poverty (less than 100% of poverty) Source: American Community Survey Source: US Census Bureau, American Community Survey, Ratio of Income to Poverty Level in Past 12 Months The number of Thurston County low income residents changed from 61,269 in 2010 to 71,393 in 2016 = 17% increase The number of Thurston County residents living in poverty changed from 25,417 in 2010 to 29,303 in 2016 = 15% increase Thurston County Public Health & Social Services Department

Contact Information Mary Ann O’Garro Presentation available online in PDF and Powerpoint Requests for additional data or further detail is welcome Thurston County Public Health & Social Services Department

Oral Health Data Profile Thurston County Local Impact Network

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