Half of Americans 30 and older, and almost half of Kentuckians that age, have advanced gum disease that can cause tooth loss

A person with periodontitis (Medical News Today image)

Half of Americans aged 30 and older have a disease of the gums called periodontitis, according to the Centers for Disease Control and Prevention. If left untreated, gum disease can not only lead to tooth loss, but can also lead to other health problems like heart disease and diabetes.

The CDC data found that 45 percent of Kentuckians aged 30 and older had periodontitis, with nearly 9 percent of those cases considered severe. The state ranks 23rd in percentage of population with the disease and 22nd in percentage with the severe version.

Periodontal disease is an inflammation of the gum tissues and the bone that supports the teeth. It is usually caused by bacteria that is found in a sticky substance called plaque that builds up on a person's teeth along the gum line. If plaque is allowed to harden, it becomes tartar, and can spread below the gum line, which can then only be removed by a dental health professional.

Symptoms of early gum disease, called gingivitis, include red, swollen or tender gums that may bleed when you brush. In this early stage, gum disease can usually be resolved by brushing your teeth more efficiently, using a fluoride toothpaste, using an antibacterial mouthwash and flossing daily.

But if left untreated, it can advance to a more serious condition called periodontitis, where the inner layer of the gum and bone pull away from the teeth and form pockets, which can collect debris and become infected, according to WebMD. At this advanced stage, gum tissue and the bones that support the teeth are destroyed, which can put a person at great risk of tooth loss.

Research has also found links between periodontal disease and heart disease, diabetes, dementia, rheumatoid arthritis and premature births. And though the researchers don't know exactly why this is, they think it is related to the bacteria and inflammation that is associated with advanced gum disease, says WebMD.

At the point gingivitis has progressed to periodontitis, it's time to see a dentist who may refer you to a specialist.

“Periodontists are trained to identify and address periodontal disease," Diksha Katwal, a diplomate at the American Board of Periodontology and pre-doctoral director at the University of Louisville School of Dentistry, said in a UofL news release. "These dental professionals exam each tooth above and below the gum line to determine if a person has the condition. ”

WebMD says anyone with the following symptoms should see their dentist:

• changes in the way your teeth fit together
• formation of deep pockets between teeth and gums
• gums that bleed during and after toothbrushing
• loose or shifting teeth
• persistent bad breath or bad taste in the mouth
• receding gums
• red, swollen, or tender gums

Katwal adds that it's important to visit a dentist at least once a year for a checkup, and more frequently if you have periodontitis.

Frankfort newspaper looks at county's syringe exchange

https://www.state-journal.com/2018/06/08/focus-syringe-exchange-program-reaching-hundreds/

Farmers' market in Columbia expects to serve 2,500 children at Hungry Kids Café on Saturdays this summer

Kasey Blue “KB” Kessler, Emma Burton, and sisters Kennedy and Cadence Booth, inspect tomatoes at the D&D Longview Angus booth at the farmers' market. (Kentucky Living photo by Joe Imel)

The farmers' market in Columbia has created a Hungry Kids' Cafe that expects to serve more than 2,500 meals on Saturdays this summer, Sharon Burton reports for Kentucky Living magazine, published by the Kentucky Association of Electric Cooperatives.

"The vision of serving free breakfast and lunch to children came about three years ago when market coordinators noticed two little boys who frequented the market and sampled all the free food vendors made available," Burton reports. "They wondered if the boys had food on other days when the market wasn’t open."

“We have so many kids who really rely on school meals during the year,” says café coordinator Lois Cunningham told Burton. “We would see these kids who would walk around and they couldn’t buy anything.”

Burton reports, "Volunteers started out working with federal programs, but quickly learned they had their own ideas and began asking the local community to help fund the café. Now, the program relies completely on local donations." This year the café got its new name and "went from a mobile trailer to a permanent building in the corner of a city parking lot where the market is held," at the corner of Campbellsville and Merchant streets from 8 to 1 on Saturdays and 1 to 5 on Wednesdays.

The market participates in the federal nutrition programs for seniors, mothers and children, and offers "Kids Bucks," giving children $4 in coupons to buy fruits or vegetables. Market coordinator Donna Jones says the market is offering several social functions this year, including two days of “Meet the Candidates” in local elections.

Burton, editor and publisher of the Adair County Community Voice and The Farmer's Pride, the statewide agricultural newspaper, reports that the market "is as much an entertainment destination as it is a place to find fresh food. It’s been compared by some with markets in large metropolitan areas because of its variety and atmosphere. . . . The market is the center of social gatherings during the summer, even for young marketgoers."

Information on farmers' markets in Kentucky is at www.kyagr.com/marketing/farmers-market.html. Fresh produce and other foods are also available at Kentucky Certified Roadside Farm Markets; information on them is at www.kyfb.com/federation/markets.

Celebrity suicides raise concern about 'contagion;' Ky. rate higher than most states; experts say we need to talk about it openly

Association For Suicide Prevention chart, based on data to 2016; click on it to view a larger version

"The suicides of fashion designer Kate Spade and celebrity chef Anthony Bourdain just days apart . . . have mental health professionals worried about the potential for what’s known as a 'contagion' effect, but at the same time they say media coverage may lead people to seek help," Marek Mazurek and Laney Ruckstuhl report for The Boston Globe.

“Anytime there’s a public figure, it affects a great many people,” Debbie Helms, co-chair of the Massachusetts Coalition for Suicide Prevention’s Northeast region, told the Globe. “Celebrities impact the whole country.” Calls to suicide-prevention centers rose after the two deaths.

Kentucky has a higher-than-average suicide rate, greater than five of the seven adjoining states (the exceptions being West Virginia and Missouri). The rate has increased in almost every state since 1999, to the point that suicide is the 10th leading cause of death in the U.S., with 123 per day, more than the number killed in automobile accidents, according to the federal Centers for Disease Control and Prevention. In Kentucky, suicide ranks 11th as a cause of death.

Kentucky's suicide hotspots are Marshall County, which had 49 from 2012 through 2016, and Grayson County, which had 35. Per 100,000 population, respectively, the counties' suicide rates were 29.2 and 26.2. The rate for the entire state was 16.79, 20th in the nation.

Suicides among teenagers are an increasing concern, especially in Kentucky. The number doubled between 2014 and 2016, from 19 to 44. The 2016 Kentucky Incentives for Prevention survey, given at participating Kentucky schools in even-numbered grades from 6 to 12, found that 15.4 percent of Kentucky high-school sophomores said they had "seriously considered" attempting suicide in the 12 months prior to the survey. The rates tended to be highest in Western Kentucky.

Young people have the greatest risk of being influenced by widely reported suicides, Boston psychiatrist Blaise Aguirre, who specializes in adolescents at risk of suicide, told the Globe. “When you have these young people already thinking about that and some of their idols are dying by suicide, it sort of — in their thinking — makes it more acceptable in a certain kind of way,” he said. “It seems like somewhere between 14 and 24, in that age range, they are particularly vulnerable.”

The "suicide contagion effect" seems to have been heightened by the rise of social media, Aguirre said: “For many years, if somebody famous died by suicide, you might read about it later in the newspaper, but young people weren’t necessarily in the habit of reading the papers. Now, there is the ability of this news to spread rapidly.”

Aguirre and other experts said that makes it all the more important to speak openly about suicide and reduce the stigma that often surrounds mental-health issues, "and making sure loved ones know they aren’t alone," the Globe reports. For warning signs of suicide, go to suicide.org.

Here's a sampling of views from health-care providers about health care and health in rural Kentucky

Louisville-based Medical News recently interviewed five health-care providers in Kentucky about the challenges that face rural health care: "Economic factors, cultural and social differences, educational shortcomings, sheer isolation with limited access to transportation and lack of recognition by legislators." Here are some excerpts:

Poverty and drugs compound each other, said Dr. Philip Hurley of Owensboro: "Whereas these addictions can affect all socioeconomic brackets, the effects on the poor tend to be more devastating as family and public support are often not as readily available. Obesity is another challenge. Sadly, our country has the dubious distinction of being the first country in history where the poor are obese."

Some noted the difficulty of attracting health-care providers to rural areas, but Dr. LaTonia Sweet of Molina Health in Louisville said, "Nowhere else can a physician use the same depth and breadth of skills needed as in rural healthcare. A physician can make a huge impact on the health of a community in rural areas."

"Rural areas work continuously to recruit talent for health-care delivery," said Dr. Brent Wright of the University of Louisville. "In addition to recruitment issues, there are continuous regulatory and technology demands that strain existing resources (electronic medical records, quality initiatives and value-based care). These initiatives drain resources from shrinking margins."

Hurley said electronic health records and telemedicine have helped rural Kentucky, "but most EHR records are close to garbage. It is often very difficult to glean useful, pertinent information. The electronic imaging and the ability to view it remotely is helpful."

Wright was more optimistic: "Telemedicine will see a resurgence as we all become more mobile through our smart devices. Brick and mortar healthcare will not be as necessary as bandwidth and connectivity increases. This is great for rural health because it means less travel and more access."

Asked what changes they would like to see to improve health care in rural Kentucky, Susan Starling of Marcum and Wallace Hospital in Irvine said "improved access to mental health, which has become very centralized in the urban areas; local access to alcohol and drug treatment centers; and support of critical access hospital programs and other federal programs that support rural health care."

Dr. Patrick Withrow of Paducah said he has been shocked by high suicide rates among farmers and other rural residents, which "need to be addressed. The wide geographic population and resultant limited mental and medical health resources in rural areas is a problem. Telemedicine may be a way to improve access to care. Also, the expansion of medical training to the more rural areas (Morehead, Bowling Green, Glasgow and northeast Kentucky) will improve access to care."

Elizabethtown expands smoking ban to e-cigarettes

The Elizabethtown City Council has expanded its 12-year-old ban ban on smoking in public places to include electronic cigarettes, at the request of the Lincoln Trail District Health Department.

“We approached the council about banning e-cigs because they still contain toxic gases and tiny particles that irritate the eyes and lungs,” health department spokesman Donny Gill said. “Also, the vapor does contain nicotine and is addictive and contributes to cardiovascular problems.”

"Gill said studies also have shown secondhand e-cigarette vapor is dangerous," Mary Alford reports for The News-Enterprise. "He said the vapor contains gases that contribute to heart and lung disease. Gill said children exposed to the vapor over time can develop asthma, colds and eczema."

Gill said, “The majority of the research has indicated that e-cigs are harmful to both the user and the bystander. So, when people use these devices to get around the existing smoking laws, they are still putting the health of others at risk. E-cigs and vape devices are not a safer alternative to traditional smoking. Also, they are not approved as a method to quit smoking. The vast majority of e-cig users also still use traditional cigarettes.”

Bowling Green hospital no longer releases information about births, in an effort to keep infants safe from possible abduction

The Medical Center at Bowling Green no longer releases information about births to the news media or through social media, following recommendations from the National Center for Missing and Exploited Children.

“This is a decision we recently made for safety reasons,” Jill Payne, executive vice president and chief nursing officer of the large hospital, told Don Sergent of the Bowling Green Daily News. “We’re always assessing and updating our practices.”

Parents who still want to announce the birth of their baby can still do so in the newspaper.

“We will still give people the opportunity to announce the births online and in print,” Joe Imel, director of media operations for the Daily News, told Sergent. “For more than 150 years we’ve listed births, deaths and anniversaries. We still want to offer the community the opportunity to announce these proud moments.”

The National Center for Missing and Exploited Children made this recommendation as an attempt to reduce the number of child abductions.

Graphic from National Center for Missing and Exploited Children; to view a larger version, click on it.

An analysis by the center, which it clearly states is not a scientific study, concluded that there have been 325 confirmed infant abductions in the U.S. since 1965, with 43 percent from health-care facilities, 42 percent from homes and 14 percent from other locations.

A map on the center's website says Kentucky has had four cases of infant abduction in that 53-year period.

The center recommends not posting a mother’s or infant’s full name where it is visible, and not using full names in announcements to the news media, Payne told Sergent. She added that the hospital is working to educate parents about this safety concern.

“We’re starting to inform folks now,” she said. “We’re making parents aware and educating them about using social media. It’s a great way to publicize these things, but sometimes it can be a dangerous place to put information.”

The Kentucky Hospital Association says it does not track such policies of the 47 Kentucky hospitals that offer maternity services. (The state has 92 acute-care hospitals.) Mike Rust, president and CEO, said KHA hasn't taken a position on the issue, and decisions are up to individual hospitals.

Cancer Society says screening for colon cancer should start at 45, not 50; Ky. leads the nation in colon cancer and deaths from it

By Melissa Patrick
Kentucky Health News

In response to rising rates of colorectal cancer among younger people, the American Cancer Society now recommends that adults with a normal risk for colon cancer get their first screening at age 45, instead of 50.

The change was prompted by an ACS study published last year in the Journal of the National Cancer Institute, which found that since the mid-1990s colon-cancer rates among Americans between the ages of 20 and 54 have been steadily increasing, between 0.5 percent and 2 percent per year. Rectal cancer has risen more rapidly, 2 to 3 percent a year.

"Millennials have double the risk of developing colon cancer and quadruple the risk of rectal cancer for reasons that are not yet 100 percent clear," Amanda Smart, executive director of the Colon Cancer Prevention Project, said in a news release about the new recommendations.

Graphic: Colon Cancer Prevention Project

Nationally, colon cancer is the second leading cause of death from cancers that affect both men and women with 43 percent of "young onset patients" diagnosed between the ages of 45 and 49, according to the release.

Kentucky leads the nation in colon cancer, but is nationally recognized for getting its citizens screened for it, moving from 49th to 19th in the past 15 years. However, only 65 percent of Kentuckians 50 and older have been screened. So, there's more work to do -- especially in a state that ranks fourth for colon cancer deaths.

Smart added, "No matter your age, if you are experiencing symptoms such as rectal bleeding, unexplained anemia, changes in bowel habits, unexplained weight loss or gain, or unexplained abdominal pain, please don’t wait to be screened!”

Dr. Whitney Jones, a Louisville gastroenterologist and founder of CCPP, emphasized that, while this policy change is a huge step forward, it only applies to individuals with average risk who do not have symptoms.

“Those with a family history of colon or rectal cancer, or advanced adenomatous colon polyps, should check with the doctor about on-time screening, which begins at 40 but could be necessary even earlier," he said in the release.

Options for screening include a colonoscopy, which is recommended every 10 years for people at average risk of the disease, a yearly stool test that looks for hidden blood, a DNA-based stool test done every three years, virtual colonoscopy and a flexible sigmoidoscopy, according to the National Cancer Institute.

Colon cancer usually starts from precancerous polyps in the colon or rectum, which can be removed before they turn into cancer. Screening also allows for early detection of the cancer, which is 90 percent curable when detected early.

In Kentucky, those with commercial insurance will be immediately eligible to receive "on-time" screening at 45, says the release.

Kentucky Medicaid has no age restrictions on colonoscopies for its fee-for-service members. The co-payment requirement is cancelled if it is billed as a preventive service for people 50 and older, but the state Department for Medicaid Servicessays it is working to have this changed to 45. The department said managed-care organizations will develop their own policies for their members.

Smart added that the new guideline may cause some confusion for doctors and patients, and stressed that it will be important for providers to enter the appropriate insurance code to make sure younger patients don't get charged for the exam.

The Patient Protection and Affordable Care Act requires colon cancer screenings be entirely covered by insurance. Kentucky has also passed a law to clarify that a fecal test to screen for colon cancer, and any follow-up colonoscopy, are also covered by insurance.

Smart said her Colon Cancer Prevention Project can help patients who have been wrongly charged.

The U.S. Preventive Services Task Force guidelines still recommend initial screening for colon cancer at age 50 for those with average risk.

Laurie McGinley of The Washington Post reports that the task force decided several years ago to not lower its recommended age because it concluded that the data was mixed and that a younger starting age would only proved a "modest" benefit. She adds that the cancer society, by extending the analysis used by the task force and incorporating recent data on the rising incidence of the disease among younger people, came to a different conclusion that shows the life-saving potential of earlier screening.

Despite some improvements, Kentucky continues to rank near the bottom of all states for senior health

By Melissa Patrick
Kentucky Health News

Kentucky ranks 48th for seniors' health in the most recent America's Health Rankings Report -- a potential source of great concern, since the senior population in Kentucky, and the rest of the nation, is only growing larger. Only Mississippi and Louisiana ranked worse than Kentucky.

The U.S. Census Bureau estimates that one in five Americans will be over the age of 65 by 2030, and by 2035, seniors will outnumber children younger than 18.

The report looked at 34 measures of senior health that included factors that influence health, which were broken into four categories: behaviors, community and environment, policy and clinical care, and health outcomes. Kentucky also ranked 48th in both of these broad categories.

It also highlighted two supplemental measures, senior suicide and risk for social isolation, which has been linked to increased mortality, poor health status and greater use of health-care resources.

The report found Kentucky seniors are at a high risk for social isolation, scoring in the bottom 10 states for four of the six indicators used to measure this risk, including seniors who are divorced, separated, or widowed; poverty; disability, and difficulty living independently. This indicator was also broken down by county. (See map.)

Since the 2014 report was published, the national suicide rate among seniors increased by 12 percent, to 16.6 deaths per 100,000 adults 65 and older, but it remained the same in Kentucky at 20 deaths per 100,000.

Kentucky senior health strengths and improvements

Despite their low health ranking, Kentucky's seniors have shown many improvements on the health front and have some solid strengths.

For example, the report found that only 4.5 percent of Kentucky seniors are heavy drinkers and only 6.9 percent who require a low amount of care are in nursing homes, ranking the state seventh and eighth, respectively.

Kentucky also ranked high for the percentage of seniors with prescription-drug coverage, 87 percent; those with a dedicated health-care provider, 95.2 percent; and diabetes management, 81.6 percent.

And while many Kentucky senior-health measures ranked near the bottom, they showed some improvement. For example, senior dental visits, which ranked 44th in the nation, rose to 58.6 percent from 57 percent in 2017; the number of home-health workers per 1,000 adults 75 and older (45th) increased to 62.6 per 1,000, from 56.5; the percentage of adults having teeth extracted (47th) decreased to 22 percent from 23.9 percent; and the number of nursing home beds with four- and five-star ratings (45th) increased to 35.6 percent from 29.5 percent in 2017.

Challenges persist

Smoking plagues every age group in Kentucky, with Kentucky seniors ranking 49th for for this measure, at 12.4 percent -- though the researchers say it's never too late to quit.

"Cessation, even in senior smokers, can have profound benefits on current health and long-term outcomes," the report says. "For example, the risk of dying of lung cancer drops by half 10 years after cessation."

Kentucky also ranks near the bottom for its low number of "able-bodied" seniors, 57.7 percent, compared to the national average of 64.8 percent; and its high number of preventable hospitalizations, 76.6 per 1,000 Medicare enrollees.

And though Kentucky's flu vaccination rate is higher than many states, the number of Kentuckians who got vaccinated this year dropped 12 percentage points, from 67.3 percent to 59.4 percent.

This is important because "around 71 to 85 percent of flu-related deaths occur in individuals aged 65 and older, and half of flu-related hospitalizations were among older adults in 2015-16," says the report.

Kentucky also ranks low, 44th, for the number of seniors who were enrolled in hospice during the last six months of life after a diagnosis that held a high probability of death: only 43.4 percent. In the state with the highest health ranking, Utah, nearly 66 percent who met this criteria enrolled in hospice.

Food insecurity is also an issue for Kentucky seniors, with 18 percent saying they had faced the threat of being hungry in the past 12 months.

Kentucky ranked 49th for home-delivered meals to seniors, delivering only 3.8 meals per 100, compared to the national average of 9.1 per 100. Utah, ranked first for senior health, delivered 19.1 meals per 100; New Hampshire, ranked second, delivered 33.7 meals per 100.

The report also shows Kentucky ranks 39th for the share of seniors (49.1 percent) who participate in the Supplemental Nutrition Assistance Program, formerly called food stamps; only 42 percent of eligible seniors participate in the program.

"The purpose of the report is to promote data-driven discussions among individuals, community leaders, the media, policy makers and public health officials that can drive positive change and improve the health of seniors," says the report.

UK and Norton hospitals rank high in resistant bloodstream infections; UK cites complex cases, recent improvements

Lexington Herald-Leader table by Chris Ware, adapted by Kentucky Health News, lists safety ratings and rankings of selected Kentucky hospitals by various rating groups, and number of methicillin-resistant staphlyococcus aureus bloodstream infections in fiscal 2017.

"Kentucky's two biggest hospital systems had some of the country's highest instances of an often deadly bacterial bloodstream infection known as MRSA" in the fiscal year that ended June 30, 2017, Linda Blackford reports for the Lexington Herald-Leader.

The Albert B. Chandler Hospital at the University of Kentucky and Louisville's Norton Healthcare each had 40 bloodstream infections of methicillin-resistant staphylococcus aureus, according to the Centers for Medicare and Medicaid Services. Of the 3,800 hospitals reporting, Norton and UK ranked sixth and seventh, respectively.

"UK's MRSA number was deemed 'no different from the national benchmark,' which considers a hospital's size and mission, according to a report by the CDC that compares hospitals," Blackford reports. "Still, UK's number was higher than many comparable teaching hospitals, such as the University of Cincinnati hospital, which had 27, or the University of North Carolina, with 33. . . . Norton and the bottom six hospitals were deemed 'worse than the national benchmark'."

Officials from both hospitals told Blackford that they follow precautions recommended by the federal Centers for Disease Control and Prevention, and that using the raw number of cases can be misleading because it doesn't take into account how many patients are admitted each year and how long they stay.

"At UK HealthCare, we take quality and safety very seriously and have implemented multiple processes to help reduce the number of infections to keep patients safe," spokeswoman Kristi Willett told Blackford. "Our large patient volumes and high level of patient complexity make us unique in the state of Kentucky as those things are known risk factors that can increase the risk of infection." MRSA is resistant to most antibiotics, and is most dangerous as a bloodstream infection.

UK handles many of the state's most complex medical cases, which require longer stays, making them more vulnerable to infection, said Derek Forster, UK's medical director for infection prevention and control. He said that since 2016, when it added precautions for patients in intensive care, the hospital's "standardized infection ratio" is down 55 percent, and MRSA infections in its ICUs have been reduced by half.

Norton's chief medical officer, Steven T. Hester, "said Norton noticed an increase in MRSA cases in 2016, and convened a system-level task force to deal with the issue," Blackford reports, quoting him: "Unfortunately, Kentucky is a state with a high incidence of opioid and intravenous drug abuse. We had concerns that our increase in MRSA could be related to the increased incidence and risk with substance dependent patients, specifically intravenous drug users."

Blackford reports, "Among other hospitals in Kentucky, the University of Louisville Hospital had 17 MRSA cases, Pikeville Medical Center had 12 and Hazard ARH had 10 cases. Hazard's number was deemed to be 'worse than the national benchmark.' Most of Kentucky's small, regional hospitals had fewer than five cases."

"Hospitals can and must do better," retired Somerset physician Kevin Kavanagh, board chair of Health Watch USA, writes in an op-ed for the Herald-Leader, in which he takes a close look at hospital ratings, especially on safety issues.

Pikeville Medical Center, citing bad decisions by prior management, continues to reduce staff, this time by laying off 100

Pikeville Medical Center, Eastern Kentucky's largest hospital, is cutting its workforce to correct what CEO Donovan Blackburn called "poor business decisions" by his predecessor, Walter May.

"The news comes a week after the credit rating agency Moody's lowered the hospital's credit rating two notches, citing increased labor costs and limited cash flow," notes Will Wright of the Lexington Herald-Leader.

May, who led the hospital's growth over the past 20 years, was fired in January. Since then, the hospital has cut 250 employees by attrition, but now is laying off 100, Blackburn said. Another 30 recently "left through a normal exit including quitting or being fired," WKYT-TV of Hazard reports.

Blackburn said the hospital hired 600 people for a clinic it built in 2015, pushing its workforce above 3,000, but didn't need 480 of them. "In 2016 we had the best year we ever had at the end of the 2016 year, but in 2017 we had the worst year we ever had," he told the station. The clinic was named for May's wife, hospital attorney Pamela May, who died in May 2017. That was the same month that the hospital hired Blackburn, who had been Pikeville's city manager.

Latest Commonwealth Fund health scorecard finds Kentucky in the bottom fifth of states again, but improving on 15 measures

By Melissa Patrick
Kentucky Health News

Kentucky's ranking among the states rose from 46th to 42nd in the latest Commonwealth Fund Scorecard on State Health System Performance, partly because it had fewer adults who lack health insurance or went without health care because of cost.

The scorecard evaluates states on more than 40 indicators in five areas: care access and affordability; prevention and treatment; avoidable hospital use and hospital cost; health outcomes; and health equity.

Since 2016, Kentucky improved on 15 indicators and worsened on five. Only eight states improved on more health indicators than Kentucky.

The report notes that states that expanded Medicaid to people who earn up to 138 of the federal poverty level, which Kentucky did in 2014, saw greater improvements, on average, than states that did not.

The Commonwealth Fund has issued a state scorecard since 2013, but it says this year's version uses different indicators and methods so it's not directly comparable to previous ones. That said, Kentucky has been in the bottom fifth of states in each of the reports.

Kentucky's top rankings were in access, affordability, prevention and treatment (30th). It remained near the bottom for avoidable hospital use and cost (47th), health outcomes (48th) and health equity (41st). The latter ranking largely reflects wide disparities between rich and poor Kentuckians.

Click here for an interactive map.

The report also estimated what would happen if the state improved to the level of the best-performing state, which this year was Hawaii.

It said, among a long list of other improvements, that if this were to happen: 77,109 more Kentucky adults would be insured, 167,087 fewer Kentucky adults would go without needed health care because of cost and the state would have nearly 535,000 fewer smokers, which causes many of the health problems that plague our state.

Among the state's top indicators, the report found Kentucky ranked fifth for its low percentage of home-health patients who did not get better at walking or moving around; fifth for the low percentage of children without health insurance; and sixth for the low number of diabetic adults with employer-sponsored insurance who did not get an annual blood test for hemoglobin A1C, an indicator of diabetes.

At the bottom of the rankings, Kentucky ranked 51st for its high percentage of hospital admissions for ambulatory care-sensitive conditions among very poor adults who are eligible for both Medicare and Medicaid; 48th for its large percentage of adults who smoke, 50th for the large share of adults who report fair or poor health, and 49th for the high percentage of adults who have lost six or more teeth.

The state's most improved indicators included the percentage of uninsured adults, which moved from 21 percent in the 2013 baseline performance to 7 percent; adults who went without care because of cost, improving from 19 percent to 12 percent; and home-health patients who did not get better at walking or moving around, which improved from 36 percent to 25 percent.

The indicators that worsened the most in Kentucky were hospital 30-day mortality, which increased from 13.3 percent in 2013 to 14.4 percent; adults with any mental illness reporting unmet needs, increasing from 19 percent to 23 percent; and deaths from suicide, alcohol and drug use per 100,000 people, up from 48.9 to 61.7, known as "deaths of despair." The national rate for such deaths was 43.2 per 100,000.