Ky. vaccination rate is more than 7 times the new-case rate, which keeps dropping, along with positive-test rate and hospitalizations

Chart by The Washington Post, adapted by Kentucky Health News

By Al Cross
Kentucky Health News

Vaccinations are up, and new cases and hospitalizations are down, but Kentucky hospitals remain stressed by the pandemic -- and the state's new-case rate remains seventh in the nation, mainly due to several hot spots.

In the last seven days, coronavirus vaccinations in Kentucky have averaged more than 15,000 a day, a 19 percent increase from the previous seven-day period, according to Centers for Disease Control and Prevention data analyzed by The Washington Post.

The Post says 53.2% of Kentuckians are fully vaccinated, which ranks 25th among the states, just behind Illinois at 54.1%. The only other adjoining state with a better rate is Virginia, at 61.3.%.

The University of Kentucky, which is requiring students to get tested weekly if they are not vaccinated, reported that 85% of students are fully or partially vaccinated. Counting UK employees, the campus-wide rate is 87%.

The state reported 2,145 new cases of the virus Friday, lowering the seven-day rolling average by 282, to 2,143 per day. That's the lowest in two months. The vaccination rate is now more than seven times the new-case rate.

The state's daily report said its seven-day rate of daily new cases fell to 40.71 per 100,000 residents, the lowest in two months and two days. Of the 120 counties, 104 remain in red on the state map, with rates above 25.

County rates above the state rate are: Perry, 94.8; Harlan, 94.5; Pendleton, 93; Whitley, 89.4; Rockcastle, 86.4; Owsley, 84.1; Robertson, 81.3; Mercer, 78.2; Green, 77; Taylor, 74.8; Wolfe, 73.9; Muhlenberg, 73.2; Lawrence, 70.9; Adair 67; Bell, 65.3; Grayson, 64.9; Knox, 62.8; Estill, 61.8; Pike, 61.5; Garrard, 61.5; Powell, 61.3; Floyd, 60.2; Leslie, 59.3; Meade, 59; Monroe, 57.7; Allen, 57.6; Madison, 57.5; Russell, 56.6; Jackson, 55.7; Metcalfe, 55.3; Henry, 54.9; Rowan, 53.1; Greenup, 52.9; Boyd, 51.1; Trimble, 50.6; Nelson, 50.1; Harrison, 49.9; Breathitt, 49.8; Hart, 49.5; Ohio, 48.8; Simpson, 48.5; Carroll, 48.4; Lincoln, 47.7; Carter, 47.4; Logan, 46.9; Grant, 46.2; Marion, 46; Gallatin, 45.1; Bracken, 44.7; Henderson, 44.2; Nicholas, 43.2; McCreary, 43.1; Martin, 42.1; and Bourbon, 41.9.

Despite McCreary County's nearly average rating on the state report, its new-case rate still ranks first in the nation on The New York Times' list of hot-spot counties, and stands out on a National Geographic map, both of which are based on CDC data. The state has attributed the disparities to differences in methodology, including removal of duplicate test results, but has not fulfilled a request for further clarification. McCreary County, on the Tennessee border south of Somerset, is the site of a large federal prison, which could account for some of the difference.

The Times' hot-spot list incudes several other Kentucky counties, topped by Green, which ranks fourth; Whitley, sixth; Perry, 13th; Harlan, 22nd; Casey, 28th; Pendleton, 33rd; and Grayson, 34th.

Kentucky hospitals reported 1,514 Covid-19 patients, 64 fewer than Thursday, with 466 in intensive care and 310 on mechanical ventilation, down six and three, respectively.

The Northern Kentucky hospital region continues to report its intensive-care units fully occupied. Four other regions reported using more than 90% of their ICU capacity, and four others were above 80%.

The state reported 31 more Covid-19 deaths, raising Kentucky's pandemic toll to 9,053. Deaths are the lagging indicator of the pandemic; the leading indicator, the share of Kentuckians testing positive for the virus in the last seven days, fell again, to 8.5%, the lowest since July 28.

Beshear says testing gives "accurate picture" of virus in Kentucky; economists backed by universities, Chamber, foundation disagree

This story has been updated.

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear disagreed Monday with two prominent Kentucky economists who want the state to do random testing for the novel coronavirus to get a more reliable estimate of its spread than they say is available from voluntary testing.

"My belief is that we have so much testing statewide right now that we are getting an accurate picture," Beshear said at his daily briefing. "I mean, we've got over 2 million, I believe now, total tests that we've done since the beginning of this virus." 

He added, "I know some economists, just from a value system, are more worried about, you know, economic impact than lives. But it's not an either-or here. It's not. I mean, all the national economists . . . say that protecting our economy is about lessening the virus, because if people think restrictions are a problem, if the virus continues at this level, anywhere we go in public, anywhere inside, the virus will be spreading and it'll impose capacity restrictions on its own."

Economists Paul Coomes and Kenneth Troske

The economists are Kenneth Troske, who holds an endowed chair at the University of Kentucky, and Paul Coomes, emeritus professor of economics at University of Louisville. They made their case for increased random testing, combined model-based estimates, in a paper commissioned by UK's Institute for the Study of Free Enterprise and first reported by Kentucky Health News.

They write that "convenience samples," as opposed to representative random samples, offer an inaccurate measure of the spread of the disease, and that national studies indicate that as of September, the state was still only identifying one of every two people infected.

A similar result has been found through random testing in Louisville, by the Co-Immunity Project at UofL. Its last round of testing found the number of people who had been infected by the virus was much higher than the number that had been reported. 

"We estimate that nearly 34,000 individuals (between 21,470 and 52,900) may have been exposed to the virus – a number much higher than the 17,516 cases reported in the city by the end of September,” Aruni Bhatnagar, director of the U of L Christina Lee Brown Envirome Institute, said in an October news release.

Asked about the economists' argument that many more people have been infected than the daily case count reveals, which means that the death rate would be much lower than is being reported, and the suspicion of some that the current method of testing and reporting is making people more afraid of the virus than they really need to be, Beshear did not answer directly.

"We're not forcing anybody to get tested, so there's no way to manipulate the numbers to make people more scared," he said. "We've always talked about the death rate probably being lower than what it is right now, but . . . 1,576 people have died, at least in part, due to covid. Again, we can rationalize or create arguments or try to poke holes in the numbers, but is 1,500 people not enough to say it's real. . . . If that economist wants to say, 'See, it's not a big deal,' he can go talk to every single one of those 1,500 families."

Coomes and Troske replied in an email, "The governor has a tough job this year, and he is no doubt doing what he thinks is best for the state. However, our analysis suggests that the state needs more reliable indicators of the spread and lethality of the virus. The state, using results from nonrandom testing, has been grossly underestimating the prevalence of the virus in the population, and thus overestimating the true fatality rate. We believe that more accurate measures would lead to more targeted public-health policies, with no more and perhaps fewer deaths than the state has suffered so far.

"The experiences of the folks running the Co-Immunity project in Jefferson County and the folks from Indiana State Department of Health and the School of Public Health at IUPUI have demonstrated it is possible to successfully conduct testing of randomized populations that produces more accurate data on how covid-19 is spreading throughout a region, which can then lead to a more effective allocation of resources to fight the disease. And while we can’t speak directly for the people involved in the Co-immunity project, we are confident that we all remain willing to devote our expertise in data collection and analysis to help the state implement testing procedures that will produce the data needed to develop these more effective policies."

Business, health and university leaders also seek random testing

The Kentucky Chamber of Commerce, the Foundation for a Healthy Kentucky and the presidents of the two universities endorsed the economists' approach in a letter to the governor's office June 17. They called for the expansion of the Co-Immunity Project across the state, using federal Coronavirus Aid, Relief and Economic Security Act funds.

"This research will provide, for the first time, the real percentage of the population that has been infected, have symptoms and were treated as well as the array of outcomes," the letter said. "The information will be presented by age, gender, race, and location in the community. This data would allow health and policy leaders to determine if the rate of infection is increasing or decreasing, and which parts of the state are most affected.

"Because the same number of tests will be performed each time, the increase in the number of positive tests would not be due to an increase in testing. Such information would help the state catch any resurgence in the rates of infection early before spreading widely and determine whether it would overwhelm the current health care capacity."

The letter notes that the Co-Immunity Project brings together economists from UK and U of L to consider the social and economic impacts of the medical data: "Combining health information with such data as the economic impact of businesses and the characteristics of people who work at or frequent different types of businesses would enable the development of data-driven measures on what types of businesses could safely remain open and what types of workers could continue to work. 

"This evidence will support more targeted public health and economic policies as alternatives to broader closing, such as reopening and closing in cycles that may occur until a vaccine or a highly effective treatment is developed. Of greatest importance is the fact that this information would allow Kentucky to effectively protect its most vulnerable citizens in a less costly manner." 

Ashli Watts, president of the Chamber, said it still supports this approach.  "We still believe that this type of testing could give a more accurate representation of cases across Kentucky," she said in an e-mail. "The experts feel that knowing this data would help as we work to reopen business, schools, etc." 

Bonnie Hackbarth, the foundation's vice-president for external affairs, said the foundation continues to support statewide random testing, especially sewage wastewater testing that is also being done by the Co-Immunity Project, because it provides early warning signs of coronavirus hotspots and can guide targeted interventions.

"Regular, random, voluntary testing would give Kentucky the most detailed information about the state of covid at any given time, because it's scientific," she said. 

Hackbarth added that the foundation, which focuses on health equity, has invested $50,000 in the project, to not only support its work in Louisville, but to help it expand to Northern Kentucky and Graves County. 

"If we can identify hotspots in communities where statistically we've seen that covid rates are higher, so communities of color, lower income," she said, "we can target interventions to reduce the spread in those communities, and start to address the disparities that we're seeing in covid."

Health chief goes another round with legislators, pushing back on data questions and answering queries on schools, other topics

By Al Cross
Kentucky Health News

FRANKFORT, Ky. – Republican legislators kept up their questioning of the state's coronavirus data Thursday, and the state health commissioner and Democratic lawmakers pushed back.

Sen. Danny Carroll

Sen. Danny Carroll of Paducah, co-chair of the Program Review and Investigations Committee, was the leading questioner and most outspoken legislator, just as he was at the panel's Aug. 13 meeting, when the committee heard from Dr. Steven Stack, commissioner of the Department for Public Health, and Doug Thoroughman, the state's acting chief epidemiologist.

Carroll kept relying Thursday on Thoroughman's tacit acknowledgement, in response to a Carroll question last month, that the positive-test rate that the state reports daily is not accurate, because of imperfect state and federal reporting systems. Thoroughman also said that the rate is useful for comparison over time because its method of calculation remains the same.

Thursday, Carroll noted that some test results have been delayed for weeks, and asked, "How can we have faith in daily numbers?" He said Democratic Gov. Andy Beshear never includes a disclaimer when giving the figure.

Dr. Steven Stack

Stack replied that while the data is "imperfect," it is "incredibly valuable. He noted that the state's daily report has an asterisk leading to a long footnote explaining how the rate is calculated.

He noted that the rate is an average over the previous seven days, and “I believe it becomes a very useful and accurate measure” for seeing trends. He said his department has undertaken "an unprecedented process" to get enough data for rates for about 80 counties.

Carroll replied, "The public sees the governor on TV talking about cases and positive rate" that changes from day to day . . . There is a stress that is put on our people as a result of these numbers." He quoted Thoroughman as saying that the numbers are not accurate, and said. "From an ethical standpoint, I struggle with the comfort level of putting this information out on a daily basis."

Stack replied, "I’m sorry you have such low confidence . . . " and Carroll interjected, "It’s not me. I hear it from my constituents daily. They’re mad about this."

Stack said he hears from others who are grateful for the information, and "It's possible for people to reach different conclusions from same information."

He added, "I don’t feel my ethics are compromised or challenged. . . . The metrics we use and the way we create them are consistent with the state of the art as best as public-health professionals can do it." He said President Trump uses weekly data on positive tests, and told Carroll, "Your concern might be that the president of the United States is misleading the public."

At another point, Carroll noted that the committee had also asked to hear again from Thoroughman, and asked why he wasn't present. Stack replied, "I’ve got him doing a lot of other work and I’m the commissioner," the person ultimately responsible for answering questions about the department.

Carroll said that was "disappointing . . . were it not for Dr. Thoroughman, I’m not sure we would know now that our positivity rates were off."

Toward the end of the meeting, after he and Stack went back and forth about a medical waiver to exempt a special-needs student from the mask mandate, Carroll boiled over.

He said of the state's reporting, "It’s being used to manipulate our people, to make our people scared, to control our people. It’s not accurate and its portrayed as being accurate."

Essentially repeating what he said at the last meeting, Carroll said, "Half of this state does not believe a word that you all say when it comes to the data." He said "All of this could have been avoided had the administration reached out" to leaders of the legislature's Republican majority about pandemic matters.

Sen. Karen Berg, M.D.

Earlier, Democratic Sen. Karen Berg of Louisville, a physician, complimented state health officials' work and said, “They need us to understand it and trust it” so legislators can tell constituents “We have got our best minds working on it . . . It will never be perfect. . . . My constituents have different reactions from Senator Carroll’s. . . . Our responsibility is to get on board and let’s do the best we can.”

Apparently addressing her colleagues, Berg said health-care providers are scared of the virus, and “You all need to understand . . . this is not the flu, this is not a hoax, this has nothing to do with politics or how you want it to be.”

Rep. Adam Koenig

A moderate voice: Rep. Adam Koenig, R-Erlanger, said health-care providers “deserve more thanks than they’re getting,” but “There’s nothing wrong with asking difficult questions.” He told Stack, “It’s been a wonderful opportunity for you to dispel misinformation. . . . No one up here thinks this is a hoax; this is not a political witch hunt; these are questions we get; there’s a lot of frustration.”

Earlier, Carroll had asked Stack, "Why do we not react the same way to these other diseases that we do to covid-19?"

Stack replied, "It's much more dangerous, everybody’s susceptible, and the sheer numbers . . . It's killing a lot more people," and there is no treatment that works on most patients. "There’s over 190,000 Americans who have died in six months. That way outstrips influenza." 

He said that the ultimate mortality rate for covid-19 will probably be about 1 percent, and if only one-third of Kentuckians got infected in a year's time, and 1% died, "That’s 15,000 Kentuckians. . . . That’s why it’s getting so much attention."

Death data: Rep. Lynn Bechler, R-Marion, the other co-chair, asked Stack about the recent notice from the Centers for Disease Control and Prevention that only 6 percent of covid-19 fatalities had no other health conditions that could have contributed to their deaths.

"I didn’t think it was newsworthy, quite frankly," Stack said, "because what we have said all along is that the most vulnerable population is people over 60 or 65 and with chronic medical conditions."

Bechler asked if it was "reasonable to suspect that 94 percent of deaths in Kentucky have underlying conditions." Stack said, "It could be even higher," since Kentucky ranks very high in chronic medical conditions.

Sen. Steve West, R-Paris, told Stack that "a lot of Kentuckians are wondering" about the death rate.

Stack replied, "The question is, how do we assign the immediate cause of death?" He said it's possible that people who have died of covid-19 "would have died in six months anyway" from another condition, but the state "follows the long-established norms we use for any other disease case."

In one of his written responses to questions asked at the last meeting, Stack said, "For death certificates for which the cause of death is not clear as to the contribution of covid-19, or appears to incorrectly include or exclude covid-19 as contributory to the cause of death, the committee reviews patient medical records, discusses the information available, and reaches consensus opinion on whether covid-19 is appropriate for inclusion or exclusion." 

He said the committee had reviewed 41 deaths through Sept. 8 and found that 17 had been removed from the covid-19 list. Through that date, the state had reported just under 1,000 covid-19 deaths.

Sen. Whitney Westerfield

In another written response, to a question posed by Sen. Whitney Westerfield, R-Hopkinsville, Stack said the positive-test rate "is more challenging to make precise due to variable timing of sample collection vs. test-result reporting and due to longstanding limitations in test-reporting policies, processes, and technologies. However, when these limiting variables stay constant, and data are averaged over a period of time, this metric is very helpful for trending purposes."

Asked how long health officials keep contact-tracing data, and whether it is being used for any purpose other than to trace contacts, Stack said, "Basic information is gathered; name, address, phone number, e-mail, etc. Local health departments and Department for Public Health epidemiologists, disease investigators and limited supervisory personnel have access to this. This data is not used for any other purpose other than to trace contacts. Privacy and data security standards are well established and maintained."

Schools: Westerfield asked Stack if he had "any information indicating a return to in-person schooling" before Sept. 28, the date Beshear has recommended.

Stack said they are sticking to that date, and wanted the extra time to learn from the experience of other states. He said he and Beshear are "working on number of things to announce Monday." They have indicated that will include county-level data to guide local decisions.

He said fans are being allowed in stadiums, with strict limits, because "the public demands to be in those stadiums. . ..  Going into a stadium in the middle of an epidemic is not a good idea." He said one stadium wanted 18,000 fans, "which means 600 infected people, shouting and screaming," and people in VIP suites. He estimated that could result in nine to 20 hospitalizations per game, and two deaths.

“We certainly can’t live in fear and not get back to some activities, but we can’t be reckless and careless about it, Stack said. “You could just turbocharge an epidemic,” especially in a major city like Louisville.

In a written question from the last meeting, Westerfield asked if "school data related to abuse/dependency/neglect referrals, substance use [and] behavioral health referrals [is] weighed against covid data when making the recommendations and orders related to schools."

Stack replied in writing, "These are all public-health issues. Social-emotional status of students, food insecurity, drug overdoses, child abuse, etc. all weigh on the minds of public health. Balancing these issues with the effects of a deadly virus that spreads so rapidly presents challenges. However, death or long-term health impacts on individuals from this virus cannot be reversed. Currently, these unintended consequences of managing covid-19 are not contemporaneously measureable as [are] individuals diagnosed with covid and any associated deaths. Data is being collected on abuse/neglect as well as for overdose deaths and other behavioral health impacts. The use of medication-assisted therapy, telehealth and other tele-visitation put in place since the very early stages of covid-19’s entrance into Kentucky has been very helpful. The assessment of the full consequences of covid-19 and impact of the measures taken to minimize the impact on individuals and the economy will be measured and studied for years to come."

A video of the committee meeting is on the KET website.

Tackling obesity in Kentucky can be a touchy subject

KentuckyHealthFacts.org map; click on it for larger version

SLADE, Ky. -- Among the topics covered in "Covering Health: A News Workshop" Nov. 11 at Natural Bridge State Resort Park was one of Kentucky's biggest pairs of health problems: obesity and diabetes.

Reporting on obesity can be intimidating for journalists, said Danielle Ray, graduate intern at the Institute for Rural Journalism and Community Issues, who presented on the topic. "It’s a really awkward topic to approach," she said. "You feel like you’re embarrassing people." Reporting the facts about obesity is not intended to shame people, she said, noting that readers, viewers and listeners are at risk for life-threatening, yet preventable obesity-related illnesses, especially those in rural Kentucky counties.

Kentucky's obesity rate is the nation's fifth highest, with nearly 35 percent of adults categorized as obese on the basis of their height and weight. That number has been rapidly climbing for more than 25 years, according to the State of Obesity report. In 2000, about 22 percent of Kentuckians were obese; in 1990 the figure was less than 13 percent.

County-level map from KentuckyHealthFacts.org

Obesity is associated with diabetes and hypertension, or high blood pressure. Kentucky ranks fourth in the nation for diabetes, with more than 13 percent of the adult population diagnosed with type 2 diabetes.

The state ranks sixth highest in the nation for hypertension, with 39 percent or 1.8 million Kentuckians diagnosed with high blood pressure.

Hypertension, like diabetes, puts people at risk for other serious medical problems, including stroke, heart attack, renal disease and dementia.

Obesity also increases a person's likelihood of developing other conditions like heart disease, arthritis and cancer.

Childhood obesity may be an even greater problem in the state. Kentucky has the third highest rate of obese high-school-aged children, nearly 20 percent. Childhood obesity becomes intertwined with other factors that make the cycle hard to break. Most notably, children from low-income families are at a greater risk of obesity and its subsequent health problems, the report notes.

The workshop was presented with support from the Foundation for a Healthy Kentucky, which funds the rural-journalism institute to produce Kentucky Health News. The institute is part of the School of Journalism and Media in the College of Communication and Information at the University of Kentucky.

To find local information on obesity, visit Kentucky Health Facts or County Health Rankings.

Poll in fall found more Kentuckians reporting health coverage through employers, fewer saying they're on public insurance

By Al Cross
Kentucky Health News

More Kentuckians had health insurance through their employer last year than the year before, and fewer were on public insurance, according to a statewide poll taken last fall.

Both results reversed trends the poll had found in the previous four years, away from employer-provided insurance and toward public insurance such as Medicare and Medicaid.

The share of Kentuckians who said they had employer coverage rose to 44 percent in 2013 from 37 percent in 2012. The share who said they were on on public insurance dropped to 20 percent in 2013 from 27 percent in 2012.

The margin of error in the Kentucky Health Issues Poll was plus or minus 2.49 percentage points, applied to each number in the results, so the differences in the 2012 and 2013 numbers were beyond the error margin. The poll surveyed 1,551 Kentucky adults aged 18 through 64 by telephone, with 951 land-line interviews and 600 cell-phone interviews Oct. 26 through Nov. 25. Seniors were not surveyed because 99 percent of them have some form of health coverage, the Foundation for a Healthy Kentucky said in releasing the poll results.

"Further research will be required to determine whether this is a temporary upswing or signals a shift in the source of health insurance for Kentucky adults," said the foundation, which funds Kentucky Health News and sponsors the poll with Interact for Health, formerly the Health Foundation of Greater Cincinnati. The polling is done by the Institute for Policy Research at the University of Cincinnati.

Janie Miller, CEO of the new Kentucky Health Cooperative, a not-for-profit insurer, said through spokeswoman Susan Dunlap that employer coverage could have increased through "early adopters" in the business community who saw Obamacare as a chance to cover their employees for the first time, and people between 21 and 26 who were added to their parents' policies under a part of the law that took effect in 2012.

Could an improving economy also have contributed? Ron Crouch, director of research and statistics for the state Workforce Development Cabinet, was skeptical. He said the number of Kentuckians on food stamps went up from 2012 to 2013, and many people who went back to work did so at part-time jobs with lower pay and little or no benefits.

"I would not have expected that trend in that one year," Crouch said of the shifts. "It sort of seems like an outlier result." In statistical sampling, an outlier is a rare case that is not covered by a standard margin of error. The poll's error margin was calculated to provide accurate results in 95 out of 100 cases, the most commonly used standard. The pollster, Eric Rademacher, did not respond to a request for comment.

Through Nov. 10, the midpoint of the poll, more than 40,000 Kentuckians had signed up for coverage on the state health-insurance exchange -- about 7,000 for private insurance and the rest for Medicaid. That could skew the numbers toward public insurance, but Crouch and foundation CEO Susan Zepeda noted that those plans didn't take effect until Jan. 1. Thus, there would have been no impact if people who got coverage from the exchange answered precisely the question "Which type of health insurance do you now have?"

Twenty-five percent said they were uninsured, down from 28 percent a year earlier. Another 8 percent said they lacked coverage at some time in the previous 12 months. The total of 33 percent was a clear decline from 40 percent in the fall 2011 poll. (The 2012 figure was 37 percent, not enough year-to-year difference to exceed the error margins.)

Among people earning up to 138 percent of the federal poverty threshold, who are now eligible for Medicaid under health reform, just over a third (34 percent) said they were without insurance in the previous 12 months. The percentage was the same for people earning up to 200 percent of the poverty line. People earning up to 400 percent of the poverty line are eligible for subsidies for private insurance through the exchange.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

UK creates nation's first cancer-reporting system that uses electronic health records

Kentucky has the highest incidence of cancer in the United States, but it is about to be a national leader in delivering information about cancer cases to researchers.

With the help of an almost $1 million Centers for Disease Control grant, the University of Kentucky has created the nation's first working model for electronic reporting of cases to the state cancer registry. Kentucky's cancer doctors will be able to feed clinical data to the state's epidemiologists immediately so that they can see and analyze cancer statistics more quickly that ever before.

“This project is laying the groundwork for electronic reporting not only in Kentucky but across the United States,” said Eric Durbin, director of Cancer Informatics at the Kentucky Cancer Registry and one of the investigators who created the model. (Read more)

County data paint specific pictures of health; Ashland paper is one of first to pick up on it and do a story

More progress is needed to make sure children from low-income families are going to the dentist is just one of the findings of the 2011 Kentucky Kids Count County Data, released by Kentucky Youth Advocates.

The data paint a detailed portrait of each county's health for Kentucky's children, showing results of prenatal care, the percentage of mothers smoking during pregnancy, rates of preterm birth and low birthweight, breastfeeding, the number of children enrolled in Kentucky Children's Health Insurance Program and Medicaid, early-childhood obesity rates, asthma hospitalizations, and access to recreational facilities.

Statewide, the numbers show nearly one of every four children lived in poverty between 2005 and 2009, a 10 percent increase from 2000. The rates of preterm births and low-birthweight babies also increased. Overall, however, the numbers show improvement, particularly when it comes to children being covered by state or federal insurance. The number of children enrolled in KCHIP increased by 45 percent and in Medicaid more than 50 percent.

That data is supported by a reported released Tuesday by Georgetown University, which found the number of children without health insurance has dropped by 1 million nationwide in the past three years, Kelli Kennedy of The Associated Press reports. (Read more)

For an example of how to localize the data, click here. Mike James of The Independent in Ashland used it to assess the health status of children in Greenup, Carter and Boyd counties. He also spoke to a local school district and found officials will use the findings to bolster "requests for competitive grants that fund ... programs and ... identify gaps in services," he reports.

Kentucky's rates of leisure-time physical activity are among the lowest in the nation; Carter and Pike counties may be the worst

In three-fourths of Kentucky's counties, more than 30 percent of adults say they get no physical activity in their leisure time, according to new survey data from the Centers for Disease Control and Prevention. The statewide average is 30.1 percent. The problem is largely an Appalachian one; four Eastern Kentucky counties may have the highest percentage of physically inactive adults in the country.

CDC's telephone surveys indicate that 42.8 percent of adults in Pike and Carter counties were physically inactive in 2006-08. The only county with a higher figure, 43 percent, was McDowell County, West Virginia, which nearly borders Pike County. Magoffin and McCreary counties, also in Appalachia, rank fourth and fifth. The statewide rate for Kentucky is 30 percent; Kentucky Health Facts has this listing of county rates.


County figures are subject to error margins depending on the size of a county and its sample in the survey. Error margins are usually expressed in terms of a 95 percent confidence level, meaning that in 19 of 20 cases if the entire population were surveyed, the result would be within the error margin. For example, in Carter County, there's a 19 in 20 chance that the figure is between 36.3 and 50.4 percent. A less strict test is standard deviation, which gives the likely result if the data are distributed like the famous "bell curve." In Carter County, the standard deviation is 3.6 percentage points for each figure, meaning there's about a two-out-of-three chance that between 39.2 and 46.4 percent of adults in Carter County are physically inactive -- in any case, very high.

Because Pike County is larger and produces a larger sample for the survey, the error margin there is smaller, with a standard deviation of 2.6 percentage points. At the 95 percent confidence level, Pike County's physical-inactivity figure is between 37.9 and 48.2 percent. At the standard deviation it is between 40.2 and 45.4 percent -- again, very high in any case.

Magoffin County, with a likely rate of 42.2 percent, has a standard deviation of plus or minus 4.9 percentage points and a range of 33.4 to 52.7. McCreary County, at 41.6 percent, has a standard deviation of plus or minus 4.6 percentage points and a range of 33.4 to 51.2 percent.

Colors indicate level of inactivity for each county; legend below (click map for larger image)

FOR NATIONAL MAP

Fayette County was the only Kentucky county below the 2006-08 national rate of 25.4 percent, with a rate of 25.3 percent, plus or minus a standard deviation of 1.8 percentage points. It was followed by Calloway (25.5, plus or minus 2.7 points), Oldham (27.2, plus or minus 3.3), Henderson (27.5 percent, plus or minus 2.5) and Jefferson (27.6 percent, plus or minus 1.1).

Light blue/green: 21.1 to 26 percent
Medium blue: 26.1 to 31.1 percent
Dark blue 31.2 percent and above

Activity rates were higher in the northwestern quadrant of the state, in the Louisville and Evansville metropolitan areas. More than 30 percent of adults in Eastern and Southern Kentucky were physically inactive, making Kentucky adults as a whole some of the least physically active in the country. Physical inactivity rates were 29.2 percent or higher for more than 70 percent of the counties in Alabama, Kentucky, Louisiana, Mississippi, Oklahoma and Tennessee. Mississippi had the highest percentage of counties whose adults fell in the lowest of four levels measured, followed by Tennessee.

The results are based on data collected by the CDC's Behavioral Risk Factor Surveillance System, which is an ongoing telephone survey. People were listed as physically inactive if they answered "no" to this question: "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening or walking for exercise?" Three years of data are used to compute each year's results. (Read more)

Lack of physical activity is a risk factor for developing obesity and Type 2 diabetes. CDC numbers show the proportion of U.S. adults who are obese was 33.9 percent in 2007-2008. Obesity-related medical costs were as high as $147 billion in 2008. The average annual medical costs for an obese person are $1,429 more than for someone who weighs a normal amount. In 2010, 25.6 million people had diabetes. Kentucky's obesity and diabetes rates are among the highest in the nation.


OBESITY RATES
Orange: 26.3 to 29.7 percent
Red: Above 29.8 percent

DIAGNOSED DIABETES
Orange: 8.5 to 10.1 percent
Red: Above 10.1 percent