Nevada Rural and Frontier Health Data Book Seventh Edition

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3 Nevada Health Data Book Seventh Edition January 2015 Tabor Griswold, PhD, John Packham, PhD, Laima Etchegoyhen, MPH, and Christopher Marchand, MPH Version 7.1 Nevada State Office of Rural Health Office of Statewide Initiatives University of Nevada School of Medicine 411 West Second Street Reno, Nevada

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5 Nevada Health Data Book Table of Contents Contents Page Table of Contents... i Introduction: Health and Health Care in Nevada... 1 Map 1: Healthcare Resources in Nevada Map 2: Census Bureau Designation of and Rural Areas in Nevada... 6 Map 3: Office of Management and Budget Designation of Metropolitan, Micropolitan, and Non-metropolitan Areas in Nevada... 7 Map 4: Nevada Population and Geography by Rural- Commuting Areas (RUCA)... 8 Map 5: Nevada Geography Map 6: Public and Private Land Ownership in Nevada Map 7: Selected Northeastern States Placed Within the State of Nevada Section One: Demographic Profile of Nevada Highlights and Key Findings Table 1.1: Population in Nevada by County 2014 to Table 1.2: Population in Nevada by County 2010 to Table 1.3: Population in Nevada by County 2014 to Table 1.4: Population in Nevada by County 1990 to Table 1.5: Population and Geography in Nevada by County 2010 to Table 1.6: Population and Housing Density in Nevada by County Table 1.7: Housing Units in Nevada by County 2000 to Table 1.8: Population in Nevada by City, County, and Region 2000 to Table 1.9: Population in Incorporated and Unincorporated Areas in Nevada by County Table 1.10: Population by Age Category in Nevada by County Nevada State Office of Rural Health i

6 Contents Page Table 1.11: Population Aged 65 and Over in Nevada by County 2000 to Table 1.12: Population Aged 65 and Over in Nevada by County 2014 to Table 1.13: Population Aged 65 and Over in Nevada by County 1990 to Table 1.14: Median Age of Nevadans by County 1990 to Table 1.15: Population Aged 17 and Under in Nevada by County 2000 to Table 1.16: Population Aged 17 and Under in Nevada by County 2014 to Table 1.17: Population Aged 18 to 64 in Nevada by County 2000 to Table 1.18: Population Aged 18 to 64 in Nevada by County 2014 to Table 1.19: Population by Selected Racial and Ethnic Categories in Nevada by County Table 1.20: Percent of Population by Selected Racial and Ethnic Categories in Nevada by County Table 1.21: Non-Hispanic and Hispanic Populations in Nevada by County Table 1.22: Hispanic Population in Nevada by County 1990 to Table 1.23: Hispanic Population in Nevada by County 2014 to Table 1.24: Veteran Population by Age in Nevada by County Table 1.25: Veteran Population in Nevada by County 2014 to Table 1.26: Population by Place of Birth in Nevada by County Table 1.27: Population Incarcerated in State of Nevada Correctional Facilities by County Table 1.28: Population Incarcerated in State of Nevada Correctional Facilities by County 2006 to Section Two: Social and Economic Profile of Nevada Highlights and Key Findings Table 2.1: Personal Income in Nevada by County 2002 to Table 2.2: Annual Percentage Change in Personal Income in Nevada by County 2002 to Table 2.3: Per Capita Personal Income in Nevada by County 2002 to Table 2.4: Change in Per Capita Personal Income in Nevada by County 2002 to Table 2.5: Per Capita Personal Income as a Percent of Nevada and U.S. Per Capita Income in Nevada by County ii Nevada State Office of Rural Health

7 Contents Page Table 2.6: Sources and Amounts of Personal Income in Nevada by County Table 2.7: Sources and Percent of Personal Income in Nevada by County Table 2.8: Income from Transfer Payments by Type of Transfer Payment in Nevada by County Table 2.9: Median Family Income in Nevada by County 2009 to 2013 American Community Survey (ACS) Estimates Table 2.10: Median Family Income in Nevada by County 2013 American Community Survey (ACS) Estimates Table 2.11: Median Household Income in Nevada by County 2009 to 2013 Small Area Income and Poverty Estimate (SAIPE) Table 2.12: Median Household Income in Nevada by County 2013 Small Area Income and Poverty Estimate (SAIPE) Table 2.13: Personal Bankruptcy Filing Rates in Nevada by County 2005 to Table 2.14: New Building Permits Issued in Nevada by County 2003 to Table 2.15: Population in Poverty in Nevada by County 2002 to Table 2.16: Change of Population in Poverty in Nevada by County 2002 to Table 2.17: School-aged Children (5 to 17) and Children (18 and Under) in Poverty in Nevada by County Table 2.18: Supplemental Nutrition Assistance Program (SNAP) Participation in Nevada by County 2006 to Table 2.19: Students Qualifying for Free and Reduced School Lunch (FRL) in Nevada by County Table 2.20: Public Expenditures on Education in Nevada by County 2009 to Table 2.21: Enrollment in Public and Private Schools (K-12) in Nevada by County Table 2.22: Students as a Percent of Total Population in Nevada by County Table 2.23: Number of Schools in Nevada by County Table 2.24: Enrollment in Public Primary and Secondary Schools in Nevada by County Table 2.25: High School Graduation Rate by Gender in Nevada by County Table 2.26: High School Graduation Rate by Race and Ethnicity in Nevada by County Table 2.27: Students Eligible for Millennium Scholarships in Nevada by County 2004 to Table 2.28: Public High School Graduates Enrolled in Nevada System of Higher Education (NSHE) Institutions in Nevada by County 2006 to Nevada State Office of Rural Health iii

8 Contents Page Table 2.29: First-year Persistence in Nevada System of Higher Education (NSHE) Institutions in Nevada by County 2009 to Table 2.30: Educational Attainment in Nevada by County 2000 to Table 2.31: Registered Voters in Nevada by County Table 2.32: Registered Voters by Party in Nevada by County Table 2.33: Percent of Registered Voters by Party in Nevada by County Table 2.34: Community Organizations in Nevada by County Table 2.35: United States Decennial Census Participation Rates in Nevada by County 2000 to Table 2.36: Reported Violent Crimes in Nevada by County Table 2.37: Reported Property Crimes in Nevada by County Table 2.38: Violent Crime Rates and Property Crime Rates in Nevada by County Section Three: Population Health Profile in Nevada Highlights and Key Findings Table 3.1: Health Insurance Coverage for Population Under the Age of 65 in Nevada by County Table 3.2: Health Insurance Coverage for Population Under the Age of 65 at or Below 138% Federal Poverty Level (FPL) in Nevada by County Table 3.3: Health Insurance Coverage for Population Under the Age of 65 at or Below 250% Federal Poverty Level (FPL) in Nevada by County Table 3.4: Health Insurance Coverage for Population Under the Age of 65 at or Below 400% of Federal Poverty Level (FPL) in Nevada by County Table 3.5: Health Insurance Coverage for Population Under the Age of 65 by Gender in Nevada by County Table 3.6: Health Insurance Coverage for Population Under the Age of 19 in Nevada by County Table 3.7: Health Insurance Coverage for Population Under the Age of 19 at or Below 138% Federal Poverty Level (FPL) in Nevada by County Table 3.8: Health Insurance Coverage for Population Aged 18 to 64 in Nevada by County Table 3.9: Health Insurance Coverage for Population Aged 18 to 64 at or Below 138% Federal Poverty Level (FPL) in Nevada by County iv Nevada State Office of Rural Health

9 Contents Page Table 3.10: Health Insurance Coverage for Population Aged 40 to 64 in Nevada by County Table 3.11: Health Insurance Coverage for Population Aged 40 to 64 at or Below 138% Federal Poverty Level (FPL) in Nevada by County Table 3.12: Medicaid Enrollment in Nevada by County 2011 to Table 3.13: Medicaid Enrollment in Nevada by County 2004 to Table 3.14: Nevada Check Up (Nevada s Children s Health Insurance Program) Enrollment in Nevada by County 2004 to Table 3.15: Nevada Check Up (Nevada s Children s Health Insurance Program) Enrollment by Age in Nevada by County Table 3.16: Population Eligible for Medicare Benefits Aged and Disabled in Nevada by County Table 3.17: Number Enrolled in Medicare by Program Part in Nevada by County Table 3.18: Percent Enrolled in Medicare by Program Part in Nevada by County Table 3.19: Medicare-eligible Population in Nevada by County 2000 to Table 3.20: Enrollment in the Veterans Health Administration by Gender in Nevada by County Table 3.21: Users of the Veterans Health Administration by Gender in Nevada by County Table 3.22: Enrollment and Users of the Veterans Health Administration as a Percent of Veteran Population in Nevada by County Table 3.23: Users of Tribal Health Services in Nevada by County 2003 to Table 3.24: Self-reported Chronic Conditions in Nevada by Region Table 3.25: Self-reported Lifestyle and Behavioral Risk Factors to Health in Nevada by Region Table 3.26: Self-reported Health Status and Health Care Access in Nevada by Region Table 3.27: Diabetes Incidence in Nevada by County 2004 to Table 3.28: Obesity Prevalence in Nevada by County 2004 to Table 3.29: Physical Inactivity Prevalence in Nevada by County 2004 to Table 3.30: Self-reported Substance Abuse and Mental Illness Among Population Aged 12 and Over in Nevada by Region Nevada State Office of Rural Health v

10 Contents Page Table 3.31: Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Incidence and Prevalence in Nevada by Region Table 3.32: Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Incidence and Prevalence in Nevada by Region 2009 to Table 3.33: Sexually Transmitted Disease (STD) Incidence in Nevada by Region Table 3.34: Sexually Transmitted Disease (STD) Incidence in Nevada by Region 2009 to Table 3.35: Tuberculosis Incidence in Nevada by Region Table 3.36: Tuberculosis Prevalence in Nevada by Region 2009 to Table 3.37: Maternal Health Behaviors and Birth Outcomes in Nevada by Region of Residence Table 3.38: Neonatal, Post-neonatal, and Infant Mortality in Nevada by Region of Residence Table 3.39: Birth Rates for Female Population in Nevada by County of Residence 2010 to Table 3.40: Teen Pregnancy Rates for Female Population Aged 15 to 17 in Nevada by County of Residence 2010 to Table 3.41: Teen Pregnancy Rates for Female Population Aged 18 to 19 in Nevada by County of Residence 2010 to Table 3.42: Teen Pregnancy Rates for Female Population Aged 15 to 19 in Nevada by County of Residence 2010 to Table 3.43: Teen Birth Rates for Female Population Aged 15 to 17 in Nevada by County of Residence 2010 to Table 3.44: Teen Birth Rates for Female Population Aged 18 to 19 in Nevada by County of Residence 2010 to Table 3.45: Teen Birth Rates for Female Population Aged 15 to 19 in Nevada by County of Residence 2010 to Table 3.46: Childhood Disability by Type of Disability in Nevada by County of Residence Table 3.47: Mortality for All Causes in Nevada by County of Residence 2009 to Table 3.48: Heart Disease Mortality in Nevada by County of Residence 2009 to Table 3.49: Malignant Neoplasm (Cancer) Mortality in Nevada by County of Residence 2009 to Table 3.50: Chronic Lower Respiratory Disease (CLRD) Mortality in Nevada by County of Residence 2009 to vi Nevada State Office of Rural Health

11 Contents Page Table 3.51: Lung, Trachea, and Bronchus Cancer (LTBC) Mortality in Nevada by County of Residence 2009 to Table 3.52: Cerebrovascular Disease (Stroke) Mortality in Nevada by County of Residence 2009 to Table 3.53: Mortality Rates by Cause of Death in Nevada by Region of Residence Table 3.54: Mortality Rates by Cause of Death in Nevada 2009 to Table 3.55: Leading Causes of Death in Nevada by Region of Residence Table 3.56: Mortality by Socio-demographic Status in Nevada by Region of Residence Table 3.57: Population Health Institute s County Health Rankings in Nevada Health Outcomes Table 3.58: Population Health Institute s County Health Rankings in Nevada Health Determinants Section Four: Health Workforce in Nevada Highlights and Key Findings Table 4.1: Labor Force in Nevada by County Table 4.2: Unemployment in Nevada by County 2004 to Table 4.3: Health Sector Employment in Nevada by County Table 4.4: Health Sector Payroll in Nevada by County Table 4.5: Employment in the Health Care and Social Assistance Sector by Region in Nevada Table 4.6: Projected Employment in the Health Care and Social Assistance Sector by Region in Nevada Table 4.7: Licensed Allopathic Physicians (MDs) in Nevada by County 2004 to Table 4.8: Licensed Allopathic Physicians (MDs) by Location of Medical Education in Nevada by County Table 4.9: Licensed Osteopathic Physicians (DOs) in Nevada by County 2006 to Table 4.10: Licensed Primary Care Physicians (MDs and DOs) in Nevada by County Table 4.11: Licensed Advanced Practitioners of Nursing (APNs) in Nevada by County 2004 to Table 4.12: Licensed Physician Assistants (PAs) in Nevada by County 2004 to Table 4.13: Licensed Registered Nurses (RNs) in Nevada by County 2004 to Table 4.14: Licensed Practical Nurses (LPNs) in Nevada by County 2004 to Table 4.15: Certified Registered Nurse Anesthetists (CRNAs) in Nevada by County 2004 to Nevada State Office of Rural Health vii

12 Contents Page Table 4.16: Licensed Registered Nurses (RNs) with Emergency Medical Services (EMS) Certification in Nevada by County 2004 to Table 4.17: Certified Nursing Assistants (CNAs) in Nevada by County 2004 to Table 4.18: Licensed Dentists in Nevada by County 2004 to Table 4.19: Licensed Registered Dental Hygienists (RDHs) in Nevada by County 2004 to Table 4.20: Licensed Alcohol, Drug and Gambling Counselors in Nevada by County 2008 to Table 4.21: Licensed Marriage and Family Therapists (MFTs) in Nevada by County 2010 to Table 4.22: Licensed Clinical Professional Counselors in Nevada by County 2010 to Table 4.23: Licensed Psychiatrists in Nevada by County 2008 to Table 4.24: Licensed Psychologists in Nevada by County 2008 to Table 4.25: Licensed Social Workers in Nevada by County Table 4.26: Licensed Social Workers per 100,000 Population in Nevada by County Table 4.27: Licensed Pharmacists in Nevada by County 2004 to Table 4.28: Licensed Pharmaceutical Technicians in Nevada by County 2004 to Table 4.29: Licensed Chiropractors in Nevada by County 2004 to Table 4.30: Registered Dietitians (RDs) in Nevada by County Table 4.31: Licensed Dispensing Opticians in Nevada by County 2004 to Table 4.32: Licensed Dispensing Optician Apprentices in Nevada by County 2004 to Table 4.33: Licensed Emergency Medical Technicians (EMTs) in Nevada by County Table 4.34: Licensed Emergency Medical Technicians (EMTs) per 100,000 Population in Nevada by County Table 4.35: Licensed Emergency Medical Technicians (EMTs) in Nevada by County 2006 to Table 4.36: Licensed Massage Therapists in Nevada by County 2010 to Table 4.37: Licensed Medical Laboratory Personnel in Nevada by County Table 4.38: Licensed Medical Laboratory Personnel per 100,000 Population in Nevada by County Table 4.39: Licensed Medical Laboratory Personnel in Nevada by County 2004 to Table 4.40: Licensed Occupational Therapists (OTs) in Nevada by County 2004 to viii Nevada State Office of Rural Health

13 Contents Page Table 4.41: Licensed Occupational Therapy Assistants (OTAs) in Nevada by County 2004 to Table 4.42: Licensed Optometrists in Nevada by County 2004 to Table 4.43: Licensed Physical Therapists (PTs) in Nevada by County 2004 to Table 4.44: Licensed Physical Therapy Assistants (PTAs) in Nevada by County 2004 to Table 4.45: Licensed Podiatrists in Nevada by County 2004 to Table 4.46: Licensed Respiratory Therapists (RTs) in Nevada by County 2004 to Table 4.47: Licensed Speech-language Pathologists in Nevada by County 2006 to Table 4.48: Licensed Health Workforce Supply in Rural and Regions of Nevada Table 4.49: Population Residing in Health Professional Shortage Areas (HPSAs) in Nevada Map 4.1: Primary Medical Care Health Professional Shortage Areas (HPSAs) in Nevada Map 4.2: Primary Medical Care Health Professional Shortage Areas (HPSAs) in Metropolitan Clark County Map 4.3: Primary Medical Care Health Professional Shortage Areas (HPSAs) in Metropolitan Northwestern Nevada Map 4.4: Dental Health Professional Shortage Areas (HPSAs) in Nevada Map 4.5: Dental Health Professional Shortage Areas (HPSAs) in Metropolitan Clark County Map 4.6: Dental Health Professional Shortage Areas (HPSAs) in Metropolitan Northwestern Nevada Map 4.7: Mental Health Professional Shortage Areas (HPSAs) in Nevada Map 4.8: Mental Health Professional Shortage Areas in Metropolitan Clark County (HPSAs) in Nevada Map 4.9: Mental Health Professional Shortage Areas (HPSAs) in Metropolitan Northwestern Nevada Section Five: Health Care Resources and Economics of Nevada Highlights and Key Findings Map 5.1: Nevada Mileage Diagram Table 5.1: The Unique Geography of Community Hospitals in Nevada Table 5.2: Community Hospitals in Nevada Table 5.3: Community Hospitals in Nevada Table 5.4: Employment Impact of Community Hospitals in Nevada Nevada State Office of Rural Health ix

14 Contents Page Table 5.5: Payroll Impact of Community Hospitals in Nevada Table 5.6: Health Sector Employment in Nevada by County Table 5.7: Health Sector Payroll in Nevada by County Table 5.8: Employment Impact of the Health Sector in Nevada by County Table 5.9: Payroll Impact of the Health Sector in Nevada by County Table 5.10: Number and Type of Licensed Beds in Community Hospitals in Nevada Table 5.11: Number and Per Capita Distribution of Licensed Community Hospital Beds and Skilled Nursing Beds in Nevada by County Table 5.12: Ownership, Tax Status, and Service Area of Community Hospitals in Nevada Table 5.13: Hospital-based Rural Health Clinics (RHC) in Nevada Table 5.14: Federally Qualified Health Centers (FQHC) in Nevada Table 5.15: Tribal Medical Clinics and Health Centers in Nevada Table 5.16: Utilization Trends in Hospitals in Nevada Table 5.17: Admissions and Inpatient Days in Hospitals in Nevada Table 5.18: Total Patient Revenue in Hospitals in Nevada Table 5.19: Total Revenue in Hospitals in Nevada Table 5.20: Net Income in Hospitals in Nevada Table 5.21: Net Operating Income Benchmarks in Hospitals in Nevada Table 5.22: Net Income Benchmarks in Hospitals in Nevada Table 5.23: Inpatient Billed Charges and Case Mix in Hospitals in Nevada Table 5.24: Inpatient Admissions by Payer Source in Hospitals in Nevada Table 5.25: Inpatient Days by Payer Source in Hospitals in Nevada Table 5.26: Inpatient Billed Charges by Payer Source in Hospitals in Nevada Table 5.27: Inpatient Billed Charges by Payer Source in Hospitals in Nevada Table 5.28: Top Twenty Types of Admissions in Community Hospitals in Nevada Table 5.29: Top Twenty Types of Admissions in Community Hospitals in Nevada x Nevada State Office of Rural Health

15 Contents Page Data Sources End_Notes Nevada State Office of Rural Health xi

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17 Nevada Health Data Book Introduction: Health and Health Care in Nevada The Nevada Health Data Book Seventh Edition contains a wide range of current county-level information on the resident population, economy, social environment, population health, health workforce, and the health care delivery system. It includes important data for public policy makers, health care professionals and administrators, rural health care advocates, and equally important, the residents of rural and frontier Nevada. The primary purpose of this data book is to provide the most current and accurate data for these audiences, as well as for those interested in learning more about health and health care in Nevada. Utilizing over 50 sources of public and private data, most tables also provide data aggregated at the regional level highlighting important, general distinctions between rural and urban regions of the state. In some cases, the only available data is regional in nature (e.g., HIV/AIDS prevalence rates). In other instances, the data counts for individual rural and frontier counties are suppressed by the data-collecting agency for confidentiality or other reasons (e.g., teen pregnancy and birth rates). Regardless, the expressed intent of this publication is to highlight important differences among the urban, rural, and frontier areas of the state. It should also be noted that, with the state s ever-changing demography, economy, and health care delivery system, some of the data are in flux and, thus, must be approached with caution. In some cases, the information is not updated on a regular basis. Consequently, the most current available data likely understates county and regional trends (e.g., unemployment rates, uninsured estimates). Nonetheless, all of the information presented in this volume is, to our best knowledge, the most currently available. The Nevada Health Data Book Seventh Edition is divided into five major sections containing the most current data on: Demographic characteristics of rural and frontier Nevada, including recent population estimates and projections; The social and economic characteristics of rural and frontier Nevada, including data on income, economic indicators, poverty, and educational attainment; Health insurance coverage, population health status, and vital statistics in rural and frontier Nevada; The health care workforce in rural and frontier Nevada, including estimates and projections for many licensed health care occupations across the major regions of the state; and Health care resources and the economics of health care in rural and frontier Nevada. The majority of tables contained in the data book are organized into two broad categories: (1) rural and frontier counties and (2) urban counties. Rural and frontier counties include Churchill, Douglas, Elko, Esmeralda, Eureka, Humboldt, Lander, Lincoln, Lyon, Mineral, Nye, Pershing, Storey, and White Pine Counties. counties include Carson City, and Clark and Washoe Counties. Nevada State Office of Rural Health 1

18 Provider-to-population ratios, insurance enrollment rates, and other population-based ratios and calculations utilize county- and state-level population estimates certified by the Nevada State Demographer s Office for any given year. Some of the population estimates presented in this data book and utilized in the aforementioned denominators vary slightly from those published later in the same year. Numbers and percentages presented throughout the data book may not add up due to rounding. All dollar figures and estimates are in current U.S. dollars and have not been adjusted for inflation. A complete list of data sources is contained at the end of this report, as well as endnotes providing additional information on data and data sources. Nevada Health Data Book Seventh Edition details important differences among rural, frontier, and urban areas of Nevada. These differences impact population health, the availability of hospital and other health care resources, and access to health care services between rural and frontier and urban areas. For example, the age distribution of a county has a significant influence on the health status and health care needs of a population. The population age distribution within a county may affect available resources for local residents (e.g., number and percent of Medicare-eligible residents, proportion of county income from Social Security and other transfer payments). All things being equal, rural counties tend to have an older population than urban counties. An older population, in turn, is typically at a greater risk of death and disability than a younger population, and uses a disproportionately larger share of health care resources. In general, urban, rural and frontier areas possess important differences in demographics, economics, and social characteristics, which produce differences in health priorities, population health, health-related behaviors, the delivery of health services, and access to health care. For example, research has consistently documented higher levels of obesity and smoking prevalence, lower levels of health insurance coverage, and greater barriers to accessing health care services in non-metropolitan versus metropolitan areas. Thus, it is not surprising that non-metropolitan areas have significantly higher age-adjusted all-cause mortality rates and cause-specific mortality rates than metropolitan areas. Defining The definition of what is and is not a rural area is no mere academic matter. Indeed, policy makers utilize different, and in some cases competing, classification schemes to target programs, services, and projects to populations in Nevada and the United States. The classification scheme adopted by the Nevada Office of Rural Health and utilized in this edition of the Nevada Health Data Book emphasizes the important distinctions between rural and frontier regions of the state. This classification scheme was developed by the National Center for Frontier Communities (NCFC) with input from state health planners and rural health professionals throughout the country. 2 Nevada State Office of Rural Health

19 The Center s classification scheme distinguishes certain areas of the country as being more remote than rural areas. The Center s classification scheme represents an improvement over previous schemes that defined frontier simply in terms of population density, where counties with a population density of six or less persons per square mile were defined as frontier. Frontier counties are different from rural counties by being more remote in terms of travel time and distance from the nearest population centers with more specialized medical care and facilities. Additional information on the Center s classification scheme and methodology can be found at Map 1 highlights the three urban counties (Carson City, and Clark and Washoe County), three rural counties (Douglas, Lyon, and Storey Counties), and the remaining eleven frontier counties. It also indicates the location of Nevada s major towns, cities, and county seats. According to 2014 population estimates prepared by the Nevada State Demographer s Office, 2.5 million Nevadans or 89.9% of the state s population resides in the state s three urban counties. Approximately 72.5% of the state s population resides in Clark County (Las Vegas metropolitan area) alone and 15.5% in Washoe County (Reno-Sparks metropolitan area). In comparison, an estimated 284,496 Nevadans or 10.1% of Nevada s population resides in the state s rural and frontier counties. The rural and frontier population spreads over 95,431 square miles or 86.9% of the state s land mass. Map 1 also provides a current snapshot of the major health care services available to rural and frontier residents of Nevada. This map excludes the offices of physicians, emergency medical services agencies, or other individual health providers. While most of the state s tertiary care centers are concentrated in the state s three urban counties, a diverse range of acute care hospital services, outpatient clinics and medical services are scattered across twelve of the state s fourteen rural and frontier counties (exceptions are Storey and Esmeralda counties where there are no health care facilities). These facilities and services highlighted in greater detail throughout this data book provide most of the basic health care received by our state s rural and frontier populations. Nevada State Office of Rural Health 3

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21 Maps 2 through 4 illustrate different ways that rural and urban areas are defined by federal agencies and researchers. Map 2 provides a visual depiction of the Census Bureau s classification of urban and rural counties in Nevada. In general, urban counties possess a population greater than 50,000. In Map 2, the state s three urban counties are shaded white and the state s fourteen rural counties are shaded in blue. In these terms, Nevada s three urban counties currently have a combined population of 2,544,298 (89.1%) and its fourteen rural counties have a combined population of 284,496. Additional information on the Census Bureau s classification scheme can be found at Map 3 illustrates the distribution of metropolitan, micropolitan, and non-metropolitan counties in Nevada utilizing a classification scheme developed by the White House s Office of Management and Budget (OMB) and used by the Economic Research Service (ERS) of the U.S. Department of Agriculture. The original OMB system distinguished two broad types of areas: metropolitan (shaded white in Map 3) and non-metropolitan (shaded light and dark blue). Basically, metropolitan areas have at least one city of more than 50,000 residents and nonmetropolitan areas typically have less than 50,000 residents. The OMB classification scheme was recently updated to include micropolitan areas (shaded light blue in Map 3) that are distinguished by closer economic ties to metropolitan areas, yet possessing population less than 50,000. Utilizing the current OMB classifications scheme, Nevada possesses four metropolitan counties with a combined population of 2.5 million, seven micropolitan counties with a population of 250,215, and six nonmetropolitan counties with a combined population of 34,281. Additional information on the OMB classification scheme can be found at Map 4 illustrates the considerable heterogeneity of Nevada s population and geography utilizing Rural- Commuting Areas or RUCA codes ranging from 1 (the red shaded or core areas of urbanized areas) to 10 (the blue shaded, mostly frontier, isolated areas of the state). The RUCA methodology provides a more fine-grained classification of rural areas applicable at both the county and sub-county units of analysis. Map 4 underscores the concentration of most of the state s population in zip code areas located in the northwestern and southern counties of the state (RUCAs 1-2), and the dispersion of the remaining 10 percent of the population is scattered across a vast geographic expanse of rural and frontier regions of the state (RUCAs 4-10). Map 4 also highlights the considerable variation within counties. For example, the urban counties of Washoe County and Clark County contain substantial areas that are rural or frontier in nature; conversely rural and frontier counties such as Lyon and Nye Counties possess comparatively small urban areas or zip codes that are economically integrated with urban centers in the state. Additional information on the RUCA methodology can be found at Nevada State Office of Rural Health 5

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25 Map 5 highlights the unique topography and vast distances separating the state s rural communities from the urban centers. Most rural and frontier communities are located in sparsely populated counties that are considerable distances from the state s urban and tertiary health care centers. The average distance between acute care hospitals in rural Nevada and the next level of care or tertiary care hospital is miles and the average distance to the nearest incorporated town is 46.5 miles. Consequently, the primary health care delivery issue for rural and frontier residents and communities in Nevada is how best to overcome the spatial isolation and enormous geographic distances that characterize most of rural and frontier Nevada. Nevada comprises the western half of our nation s Great Basin. Ridge after ridge of rugged, brown mountains are broken up with flat sage covered valleys. The Great Basin is a high desert defined by 150 mountain ranges running north to south and earthquake activity second only to Hawai i. Most mountain passes are subject to very difficult seasonal weather conditions. Most major roads follow the north to south pattern with two major exceptions. U.S. Highway 50 the loneliest highway in America across the middle of the state winds through numerous mountain summits. Interstate 80 curves northeastwards across the state largely following the railroad tracks built in the 1870 s. Travel time from most county hospitals to regional medical centers is thus measured in hours not minutes. Driving long distances is a very daunting task to obtain emergency health care in winter conditions. Helicopter pads are located at all rural hospitals for emergency transport to/from either Reno, Las Vegas, or other emergency care centers. Map 6 details public and private land ownership in Nevada. Approximately 10 percent of land is privately owned (shaded black). The remaining 90 percent is publicly owned and administered by a wide range of federal, state, and tribal entities. The major administrators of public lands in Nevada are the Bureau of Land Management, Departments of Defense and Energy, and the U.S. Forest Service. The checkerboard pattern along Interstate 80 and the Humboldt River in Northern Nevada highlights a large swath of land owned between the Bureau of Land Management and the railroad company s land grants. Geo Map 7 highlights the enormous geographic expanse of the state Nevada is the 7 th largest state in the U.S. by comparing it with selected northeastern states. Nevada s land mass is approximately 110,000 square miles. By comparison, seven northeastern states with a combined land mass of 47,820 square miles would easily fit within Nevada s borders. Nevada State Office of Rural Health 9

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29 Data Book Sections and Contents Section One: Demographic Profile of Nevada The first section of the Nevada Health Data Book Seventh Edition contains the most current data on the social and demographic characteristics of rural and frontier Nevada, including information on: Population and population density Population change and projections Population aging and diversification Population by place of birth Veterans in Nevada Section Two: Social and Economic Profile of Nevada The second section contains the most current data from state and federal agencies on the social and economic characteristics of rural and frontier Nevada, including data on: Personal and family income Poverty rates for children and adults Educational enrollment and public school expenditures Educational attainment and high school graduation rates Voter registration and party affiliation Crime statistics Section Three: Population Health Profile of Nevada The third section contains the most current data on population health and health insurance coverage in rural and frontier Nevada, including information on: Health insurance coverage and the uninsured Population health status and risk factors to health Teen pregnancy and birth rates Morbidity and mortality rates County health outcomes and health determinants rankings Nevada State Office of Rural Health 13

30 Section Four: Health Care Workforce in Nevada The fourth section contains the most current data on the health care workforce in rural and frontier Nevada, including data on: General labor market trends Estimated hospital and health sector employment Number and per capita geographic distribution of licensed health professionals Health professional shortage areas and medically underserved areas Section Five: Health Care Resources and Economics in Nevada The fifth section contains the most current data on health care facilities, health care resources, and economic aspects of health care in rural and frontier Nevada, including information on: Hospital and other health care resources Health care and hospital industry sector employment and payroll Economic impact of the health care and hospital industry sector Rural and frontier clinics, community health centers, tribal facilities, and Nevada s telehealth network Utilization trends and financial performance among the state s rural and frontier hospitals and comparisons with urban facilities The data sources, explanation of data tabulations, and notes on the strengths and weaknesses of the data presented for each table, figure, and map in the data book are contained in the appendices. Acknowledgments We would like to thank the numerous individuals, organizations, and agencies who assisted us in the preparation of the data book, and who provided data used in the seventh edition of the data book. In particular, we would like to acknowledge: Keith Clark from the Office of Statewide Initiatives provided the data book s cover photo Tara Barnett, Nicolette De Los Angeles, and Brian Lee, student workers from the University of Nevada, Reno Julia Peek, Amy Lucas, Angel Stachnik, Jay Kvam, Theron Huntamer, Brad Towle, and Vickie Estes, Nevada Division of Public and Behavioral Health Darlene Dougherty, Division of Welfare and Supportive Services Jeff Hardcastle, Nevada State Demographer s Office Steve Boline, Nevada Rural Hospital Partners Joseph Greenway, Center for Health Information Analysis at the University of Nevada, Las Vegas 14 Nevada State Office of Rural Health

31 Tom Harris and Jeffrey Stroup, University Center for Economic Development at the University of Nevada, Reno John Torres, Nevada Department of Employment, Training, and Rehabilitation Wanda Brown and Lisa Jones, Aging and Disability Services Division Alejandra Livingston, Nevada Department of Corrections Melissa Lewis, Nevada Division of Health Care Financing and Policy Jody Sekerak, Phoenix Area Indian Health Services (IHS) Paula Guzman, Nevada Health Centers John Hammond, Southern Nevada Health District Kelly Flannery, U.S. Department of Veterans Affairs The nearly two dozen State of Nevada licensing boards The responsibility for any errors of omission or commission are ours alone. The preparation and distribution of this volume was made possible through funding received by the Nevada Office of Rural Health from the Medicare Rural Hospital Flexibility Grant Program that is administered by the federal Office of Rural Health Policy (ORHP) within the Health Services Resource Administration (HRSA) and the Medical Education Council of Nevada (MECON). In closing, since health and health care in rural and frontier Nevada are ever changing, our ambition is to continue to update and distribute this volume on a biennial basis. If your organization or agency utilizes the data book, we would appreciate learning more about how you have used it and how the eighth edition of the data book can be improved. As such, please send your comments and suggestions, as well as requests for additional copies to Tabor Griswold at [email protected]. Tabor Griswold, PhD Nevada State Office of Rural Health Office of Statewide Initiatives University of Nevada School of Medicine Reno, Nevada January 2015 Nevada State Office of Rural Health 15

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33 Nevada Health Data Book Section One: Demographic Profile of Nevada Highlights and Key Findings The current population of Nevada is 2,855,061, including 286,251 residents in the state s fourteen rural and frontier counties (Table 1.1). Over the past four years, the state s population has grown by 128,243 or 4.5%. During the same period, the rural population has grown by 11,895 or 4.2% (Table 1.2). Population growth between 2010 and 2014 in rural and frontier counties ranged from a loss of 286 or -6.0% in Mineral County to a gain of 5,483 or 11.2% in Elko County (Table 1.2). The population in Nevada is projected to grow from 2,828,794 in 2014 to 3,096,503 in 2024 (9.5%) (Table 1.3). Over the next decade, the population of rural and frontier Nevada is projected to grow by 19,948 or 7.0% 11 rural and frontier counties are projected to increase population, while only three counties are projected to lose population (Table 1.3). In both urban and rural Nevada, the population is projected to grow at a slower rate, as compared to the previous two decades. From 1990 to 2010, the state s population increased by 1.5 million residents or 124.7%. During the same period, the rural and frontier population grew by 107,404 or 65.0% (Table 1.4). Currently, 10.1% of the state s population resides in rural and frontier areas, as compared to 89.9% residing in the state s three urban counties 2.1 million residents or 72.5% of the state s population resides in Clark County alone (Table 1.5). While rural and frontier counties represent only 10.1% of the state s population, these counties cover 86.9% of the state s land mass or 95,431 square miles (Table 1.5). Currently, there are 25.8 people per square mile in Nevada. Population density ranges from 0.3 persons per square mile in Esmeralda County to persons per square mile in Carson City (Table 1.6). In 2014, there were 10.8 housing units per square mile in Nevada. Housing density ranges from 0.2 housing units per square mile in Esmeralda County and Eureka County to housing units per square mile in Carson City (Table 1.6). Since 2000, the total number of housing units has increased in both rural and urban regions of the state; rural counties included an increase of 54.3% or 7,819 houses in Lyon County and 35.9% or 5,727 units in Nye County in urban Clark County, the number of housing units increased by 288,002 or 50.9% (Table 1.7). Nevada State Office of Rural Health 17

34 Between 2000 and 2013, the population of rural and frontier Nevada has grown by 27,804 or 10.9% seven rural and frontier counties increased population, while seven lost population (Table 1.8). Between 2000 and 2013, three of the five fastest growing counties in Nevada were rural and frontier: Clark County (42.5%) (urban), Lyon County (41.6%) (rural), Washoe County (29.6) (urban), Nye County (24.6%) (frontier), and Lincoln County (13.6%) (frontier) (Table 1.8). In 2013, 1,586,272 (56.6%) Nevadans were residents of an incorporated city, as compared to 1,214,694 (43.4%) who lived in an unincorporated town or rural area (Table 1.9). Only 26.8% of the rural and frontier population in Nevada reside in an incorporated area, as compared to 60.0% of urban residents (Table 1.9). Currently, 24.1% of the state s population is 17 and under, 62.2% are between 18 and 64 years of age, and 13.7% are 65 and over (Table 1.10). In general, rural counties possess older populations versus urban counties for example, five rural and frontier counties have more people aged 65 and over than people 17 years of age and under (Table 1.10). Between 2000 and 2010, the number of residents aged 65 and over increased in every county in Nevada (Table 1.11). Between 2000 and 2010, the number of Nevada residents aged 65 and over grew by 97,930 or 44.1%, including an increase of 15,328 residents aged 65 and over in rural and frontier counties (52.2%) (Table 1.11). The number of residents aged 65 and over in Nevada is projected to increase from 385,994 in 2014 to 449,428 in 2019 an increase of 63,434 or 16.4% (Table 1.12). The population aged 65 and over is expected to increase in 12 of 14 rural and frontier counties over the next five years overall, the number of residents aged 65 and over in rural and frontier Nevada is projected to increase by 7,272 or 13.7% through 2019 (Table 1.12). Between 1990 and 2010, the number of residents aged 65 and over in Nevada increased by 192,576 or 150.9%, including an increase of 26,925 in rural and frontier counties (151.5%) (Table 1.13). From 1990 to 2012, the median age has increased in every county of Nevada the state average increased from 33.3 years in 1990 to 36.3 years in 2012 (Table 1.14). In 2012, among rural and frontier counties, the median age ranged from 33.4 years in Elko County to 52.8 years in Storey County; by comparison, among urban counties, the median age ranged from 35.5 years in Clark County to 41.6 in Carson City (Table 1.14). Between 2000 and 2010, the number of residents aged 17 and under decreased in 10 of 14 rural and frontier counties in Nevada (Table 1.15). 18 Nevada State Office of Rural Health

35 From 2000 to 2010, the population aged 17 and under in urban counties grew by 156,410 or 30.8% (Table 1.15). The number of residents aged 17 and under in Nevada is projected to increase from 676,377 in 2014 to 692,501 in 2019 an increase of 16,124 or 2.4% (Table 1.16). For the next five years, the growth rate in the population aged 17 and under in rural and frontier counties (-1.2%) is projected to be lower than urban counties (2.4%) (Table 1.16). From 2000 to 2010, the population aged 18 to 64 in urban counties grew by 428,642 or 38.0%, as compared to rural and frontier counties that grew by 23,898 or 17.2% (Table 1.17). The number of residents between the ages of 18 and 64 in Nevada is projected to increase from 1,747,427 in 2014 to 1,804,466 in 2019 an increase of 57,039 or 3.3% (Table 1.18). For the next five years, the growth rate in the population aged 18 to 64 in rural and frontier counties (2.4%) is projected to be similar to that of urban counties (3.4%) (Table 1.18). In general, urban areas of Nevada are more racially and ethnically diverse than rural and frontier regions for example, 78.5% of rural and frontier residents are white, as compared to 51.3% in urban counties (Tables 1.19 and 1.20). Hispanic residents represent 15.2% of the population in rural and frontier counties and 29.2% in urban counties of Nevada (Tables 1.19 and 1.20). Hispanic residents are a growing segment of the population in every county of Nevada the percent of the population claiming Hispanic ancestry ranges from 5.5% in Storey County to 21.5% in Humboldt County in rural and frontier areas, as compared to a range of 20.8% in Carson City to 30.6% in Clark County in urban areas (Table 1.21). The Hispanic population in Nevada has increased from 124,419 in 1990 to 781,886 in 2014 an increase of 657,467 or 528.4% (Table 1.22). While the growth rate of the Hispanic population has been greater in urban areas (578.3%) of Nevada, the number of Hispanic residents in rural and frontier counties has increased by 27,244 or 176.4% in the past twenty-five years (Table 1.22). Between 2014 and 2019, the Hispanic population in Nevada is projected to increase by 81,991 or 10.5% the growth rate in urban counties (10.6%) is projected to exceed that of rural counties (8.3%) (Table 1.23). Currently, there are 223,504 military veterans in Nevada, representing 7.9% of the state s population (Table 1.24). There are 32,575 veterans residing in rural and frontier counties of Nevada rural veterans represent 14.6% of all veterans in Nevada and 11.5% of the total population of rural and frontier Nevada (Table 1.24). Nevada State Office of Rural Health 19

36 The percent of the population who are military veterans ranges from 7.6% in Elko County to 21.7% in Esmeralda and Mineral Counties in rural and frontier areas, as compared to a range of 7.4% in Clark County to 10.4% in Carson City in urban areas (Table 1.24). According to the Veterans Health Administration, the veteran population is projected to decline in every county of Nevada between 2014 and 2024 over the next ten years, the number of veterans in Nevada is expected to decline from 223,504 in 2014 to 197,850 in 2024 (Table 1.25). In 2012, an estimated 657,108 residents of Nevada were born in Nevada (24.7% of the population), 1.5 million residents were born in the U.S. outside of Nevada (55.8%), and 518,944 were born in another country (19.5%) (Table 1.26). In general, rural areas possess slightly greater percentages of native-born residents than urban regions of Nevada 27.6% of rural and frontier residents are native-born, as compared to 24.4% in urban counties (Table 1.26). A much greater proportion of foreign-born residents are in the urban counties of Nevada than in rural and frontier counties; the foreign-born population ranges from 2.1% of the total population in Eureka and Lincoln Counties to 16.8% in Esmeralda County in rural and frontier areas; from 12.0% in Carson City to 22.3% in Clark County in urban areas of the state (Table 1.26). Currently, there are 12,743 prisoners in State of Nevada correctional facilities 27.0% of the prison population or 3,441 prisoners are incarcerated in rural and frontier facilities (Table 1.27). Since 2006, the prison population in Nevada has increased by 706 inmates or 5.9% (Table 1.28). 20 Nevada State Office of Rural Health

37 Table 1.1: Population in Nevada by County 2014 to 2018 Population Churchill County 25,461 25,665 25,901 26,186 26,504 Douglas County 48,208 48,003 47,877 47,828 47,847 Elko County 54,301 54,993 55,527 56,038 56,562 Esmeralda County ,029 1,053 Eureka County 2,056 2,069 2,073 2,085 2,107 Humboldt County 17,909 18,248 18,492 18,653 18,755 Lander County 6,569 6,708 6,775 6,787 6,757 Lincoln County 5,075 5,117 5,148 5,172 5,188 Lyon County 53,331 53,639 54,216 55,391 56,755 Mineral County 4,486 4,356 4,258 4,197 4,162 Nye County 44,919 45,081 45,258 45,461 45,680 Pershing County 6,977 7,031 7,047 7,034 7,019 Storey County 4,030 4,037 4,052 4,066 4,089 White Pine County 10,262 10,345 10,365 10,339 10,279 Region Subtotal 284, , , , ,757 Carson City 54,772 55,098 55,576 56,358 57,243 Clark County 2,051,946 2,069,967 2,085,920 2,103,756 2,120,173 Washoe County 437, , , , ,565 Region Subtotal 2,544,298 2,568,810 2,592,183 2,618,922 2,644,981 Nevada Total 2,828,794 2,855,061 2,880,169 2,909,188 2,937,738 Source: Nevada State Demographer s Office (2014a). Nevada State Office of Rural Health 21

38 Table 1.2: Population in Nevada by County 2010 to 2014 Population Change 2010 to Number Percent Churchill County 24,877 25, Douglas County 46,997 48,208 1, Elko County 48,818 54,301 5, Esmeralda County Eureka County 1,987 2, Humboldt County 16,528 17,909 1, Lander County 5,775 6, Lincoln County 5,345 5, Lyon County 51,980 53,331 1, Mineral County 4,772 4, Nye County 43,946 44, Pershing County 6,753 6, Storey County 4,010 4, White Pine County 10,030 10, Region Subtotal 272, ,496 11, Carson City 55,274 54, Clark County 1,951,269 2,051, , Washoe County 421, ,580 16, Region Subtotal 2,427,950 2,544, , Nevada Total 2,700,551 2,828, , Source: United States Census Bureau (2014a). Nevada State Demographer s Office (2014a). 22 Nevada State Office of Rural Health

39 Table 1.3: Population in Nevada by County 2014 to 2024 Population Change 2014 to Number Percent Churchill County 25,461 26,839 28,594 3, Douglas County 48,208 47,887 48, Elko County 54,301 57,016 58,157 3, Esmeralda County 912 1,069 1, Eureka County 2,056 2,134 2, Humboldt County 17,909 18,775 18, Lander County 6,569 6,681 6, Lincoln County 5,075 5,201 5, Lyon County 53,331 58,098 64,499 11, Mineral County 4,486 4,142 4, Nye County 44,919 45,888 46,937 2, Pershing County 6,977 7,012 7, Storey County 4,030 4,117 4, White Pine County 10,262 10,181 9, Region Subtotal 284, , ,444 19, Carson City 54,772 58,087 62,218 7, Clark County 2,051,946 2,136,172 2,213, , Washoe County 437, , ,081 78, Region Subtotal 2,544,298 2,670,255 2,792, , Nevada Total 2,828,794 2,965,295 3,096, , Source: Nevada State Demographer s Office (2014a). Nevada State Office of Rural Health 23

40 Table 1.4: Population in Nevada by County 1990 to 2010 Population Change 1990 to Number Percent Churchill County 17,938 23,982 24,877 6, Douglas County 27,637 41,259 46,997 19, Elko County 33,530 45,291 48,818 15, Esmeralda County 1, Eureka County 1,547 1,651 1, Humboldt County 12,844 16,106 16,528 3, Lander County 6,266 5,794 5, Lincoln County 3,775 4,165 5,345 1, Lyon County 20,001 34,501 51,980 31, Mineral County 6,475 5,071 4,772-1, Nye County 17,781 32,485 43,946 26, Pershing County 4,336 6,693 6,753 2, Storey County 2,526 3,399 4,010 1, White Pine County 9,264 9,181 10, Region Subtotal 165, , , , Carson City 40,433 52,457 55,274 14, Clark County 741,459 1,375,765 1,951,269 1,209, Washoe County 254, , , , Region Subtotal 1,036,559 1,767,708 2,427,950 1,391, Nevada Total 1,201,756 1,998,257 2,700,551 1,498, Source: United States Census Bureau (2014a). United States Census Bureau (2014b). United States Census Bureau (2014c). 24 Nevada State Office of Rural Health

41 Table 1.5: Population and Geography in Nevada by County 2010 to Percent of State Population Population 2014 Percent of State Population Area in Square Miles Geography Percent of State Land Mass Churchill County 24, , , Douglas County 46, , Elko County 48, , , Esmeralda County , Eureka County 1, , , Humboldt County 16, , , Lander County 5, , , Lincoln County 5, , , Lyon County 51, , , Mineral County 4, , , Nye County 43, , , Pershing County 6, , , Storey County 4, , White Pine County 10, , , Region Subtotal 272, , , Carson City 55, , Clark County 1,951, ,051, , Washoe County 421, , , Region Subtotal 2,427, ,544, , Nevada Total 2,700, ,828, , Source: United States Census Bureau (2014a). Nevada State Demographer s Office s Office (2014a). Nevada State Office of Rural Health 25

42 Table 1.6: Population and Housing Density in Nevada by County 2014 Population Number of Housing Units Area in Square Miles Population per Square Mile Density Housing Units per Square Mile Churchill County 25,461 10,650 4, Douglas County 48,208 23, Elko County 54,301 20,060 17, Esmeralda County , Eureka County 2,056 1,037 4, Humboldt County 17,909 7,169 9, Lander County 6,569 2,537 5, Lincoln County 5,075 2,709 10, Lyon County 53,331 22,225 1, Mineral County 4,486 2,788 3, Nye County 44,919 21,681 18, Pershing County 6,977 2,400 6, Storey County 4,030 1, White Pine County 10,262 4,425 8, Region Subtotal 284, ,091 95, Carson City 54,772 23, Clark County 2,051, ,089 7, Washoe County 437, ,305 6, Region Subtotal 2,544,298 1,062,788 14, Nevada Total 2,828,794 1,186, , Source: Nevada State Demographer s Office (2014a). United States Census Bureau (2014d). 26 Nevada State Office of Rural Health

43 Table 1.7: Housing Units in Nevada by County 2000 to 2013 Housing Units Change 2000 to Number Percent Churchill County 9,760 10,826 10, Douglas County 19,162 23,671 23,617 4, Elko County 18,492 19,566 20,060 1, Esmeralda County Eureka County 1,026 1,076 1, Humboldt County 6,977 7,123 7, Lander County 2,782 2,575 2, Lincoln County 2,181 2,730 2, Lyon County 14,406 22,547 22,225 7, Mineral County 2,866 2,830 2, Nye County 15,954 22,350 21,681 5, Pershing County 2,390 2,464 2, Storey County 1,603 1,990 1, White Pine County 4,439 4,498 4, Region Subtotal 102, , ,091 21, Carson City 21,348 23,534 23,394 2, Clark County 566, , , , Washoe County 144, , ,305 40, Region Subtotal 732,421 1,048,719 1,062, , Nevada Total 835,293 1,173,815 1,186, , Source: United States Census Bureau (2014d). Nevada State Office of Rural Health 27

44 Table 1.8: Population in Nevada by City, County, and Region 2000 to 2013 Estimated Population Change 2000 to 2013 Region/Place Change Percent Churchill County 26,247 25, Incorporated Cities Fallon 8,386 8, No Unincorporated Towns Unincorporated Rural 17,861 16,615-1, Douglas County 43,101 48,478 5, No Incorporated Cities Unincorporated Towns Gardnerville 3,528 5,541 2, Genoa Minden 2,818 2, Unincorporated Rural 36,510 39,724 3, Elko County 50,756 53,384 2, Incorporated Cities Carlin 2,395 2, Elko 18,642 20,958 2, Wells 1,563 1, West Wendover 3,867 4, Unincorporated Towns Jackpot 1, Montello Mountain City Unincorporated Rural 22,613 22, Esmeralda County 1, No Incorporated Cities Unincorporated Towns Goldfield Silver Peak Unincorporated Rural Nevada State Office of Rural Health

45 Table 1.8: Population in Nevada by City, County, and Region 2000 to 2013 (continued) Region/Place Estimated Population Change 2000 to Change Percent Eureka County 1,847 2, No Incorporated Cities Unincorporated Towns Crescent Valley Eureka Unincorporated Rural Humboldt County 18,149 17, Incorporated Cities Winnemucca 8,884 8, No Unincorporated Towns Unincorporated Rural 9,265 9, Lander County 6,822 6, No Incorporated Cities Unincorporated Towns Austin Battle Mountain 4,066 3, Kingston Unincorporated Rural 2,139 2, Lincoln County 4,420 5, Incorporated Cities Caliente 1,132 1, Unincorporated Towns Alamo Panaca Pioche Unincorporated Rural 1,218 1, Nevada State Office of Rural Health 29

46 Table 1.8: Population in Nevada by City, County, and Region 2000 to 2013 (continued) Region/Place Estimated Population Change 2000 to Change Percent Lyon County 37,393 52,960 15, Incorporated Cities Fernley 9,570 18,987 9, Yerington 3,210 3, Unincorporated Rural 24,613 30,867 6, Mineral County 6,270 4,662-1, No Incorporated Cities Unincorporated Towns Hawthorne 3,875 3, Luning Mina Walker Lake Unincorporated Rural 1, Nye County 35,924 44,749 8, No Incorporated Cities Unincorporated Towns Amargosa Valley 1,271 1, Beatty 1, Gabbs Manhattan Pahrump 26,399 37,030 10, Round Mountain 1, Tonopah 3,086 2, Unincorporated Rural 2,188 1, Pershing County 7,458 6, Incorporated Cities Lovelock 2,772 1, Unincorporated Towns Imlay Unincorporated Rural 4,425 4, Nevada State Office of Rural Health

47 Table 1.8: Population in Nevada by City, County, and Region 2000 to 2013 (continued) Region/Place Estimated Population Change 2000 to Change Percent Storey County 3,897 4, No Incorporated Cities Unincorporated Towns Gold Hill Virginia City 1, Unincorporated Rural 2,680 2, White Pine County 10,650 10, Incorporated Cities Ely 5,118 4,100-1, Unincorporated Towns Lund 1, McGill 469 1, Ruth 3, Unincorporated Rural 3,599 4, Subtotal 254, ,251 27, Nevada State Office of Rural Health 31

48 Table 1.8: Population in Nevada by City, County, and Region 2000 to 2013 (continued) Region/Place Estimated Population Change 2000 to Change Percent Carson City 53,208 54,668 1, Clark County 1,425,723 2,031, , Incorporated Cities Boulder City 15,519 15, Henderson 198, ,270 75, Las Vegas 483, , , Mesquite 15,605 17,477 1, North Las Vegas 124, , , Unincorporated Towns Bunkerville 909 1, Enterprise 21, , , Indian Springs 1,387 1, Laughlin 8,083 8, Moapa 736 1, Moapa Valley 9,088 6,871-2, Mt. Charleston Paradise (Strip) 172, ,949 15, Searchlight Spring Valley 130, ,818 58, Summerlin 4,845 26,855 22, Sunrise Manor 160, ,754 39, Whitney 14,946 39,857 24, Winchester 30,735 31,960 1, Unincorporated Rural 30,510 33,613 3, Washoe County 333, ,324 98, Incorporated Cities Reno 182, ,243 49, Sparks 66,420 91,551 25, Unincorporated Towns Unincorporated Rural 84, ,531 24, Subtotal 1,812,497 2,518, , Nevada Total 2,066,944 2,800, , Source: Nevada State Demographer s Office (2014b). 32 Nevada State Office of Rural Health

49 Table 1.9: Population in Incorporated and Unincorporated Areas in Nevada by County 2013 Incorporated Unincorporated Number Percent Number Percent Total Churchill County 8, , ,322 Douglas County , ,478 Elko County 29, , ,384 Esmeralda County Eureka County , ,024 Humboldt County 8, , ,457 Lander County , ,343 Lincoln County 1, , ,020 Lyon County 22, , ,960 Mineral County , ,662 Nye County , ,749 Pershing County 1, , ,882 Storey County , ,017 White Pine County 4, , ,095 Region Subtotal 75, , ,251 Carson City 54, ,668 Clark County 1,132, , ,031,723 Washoe County 323, , ,324 Region Subtotal 1,510, ,008, ,518,715 Nevada Total 1,586, ,214, ,800,966 Source: Nevada State Demographer s Office (2014b). Nevada State Office of Rural Health 33

50 Table 1.10: Population by Age Category in Nevada by County and Under Population 18 to and Over Percent of Total Population 17 and Under 18 to and Over Churchill County 6,197 15,289 3, Douglas County 8,730 27,639 11, Elko County 11,831 35,855 6, Esmeralda County Eureka County 415 1, Humboldt County 4,349 11,491 1, Lander County 1,433 4, Lincoln County 1,015 2,679 1, Lyon County 12,107 31,119 10, Mineral County 920 2, Nye County 8,418 24,332 12, Pershing County 1,200 3, Storey County 544 2,431 1, White Pine County 2,095 5,095 1, Region Subtotal 59, ,032 53, Carson City 12,639 29,898 9, Clark County 500,906 1,277, , Washoe County 103, ,309 60, Region Subtotal 617,009 1,579, , Nevada Total 676,377 1,747, , Source: Nevada State Demographer s Office (2014d). 34 Nevada State Office of Rural Health

51 Table 1.11: Population Aged 65 and Over in Nevada by County 2000 to 2010 Population Aged 65 and Over Change 2000 to Number Percent Churchill County 2,834 3, Douglas County 6,431 9,323 2, Elko County 2,581 4,072 1, Esmeralda County Eureka County Humboldt County 1,325 2, Lander County Lincoln County 684 1, Lyon County 5,220 8,081 2, Mineral County 994 1, Nye County 6,207 11,143 4, Pershing County Storey County White Pine County 1,239 1, Region Subtotal 29,369 44,697 15, Carson City 7,779 9,415 1, Clark County 149, ,545 62, Washoe County 35,542 53,550 18, Region Subtotal 192, ,510 82, Nevada Total 222, ,207 97, Source: United States Census Bureau (2014a). United States Census Bureau (2014c). Nevada State Office of Rural Health 35

52 Table 1.12: Population Aged 65 and Over in Nevada by County 2014 to 2019 Population Aged 65 and Over Change 2014 to Number Percent Churchill County 3,976 4, Douglas County 11,839 13,237 1, Elko County 6,270 7,700 1, Esmeralda County Eureka County Humboldt County 1,953 2, Lander County Lincoln County 1,085 1, Lyon County 10,105 11,724 1, Mineral County Nye County 12,021 13,137 1, Pershing County 876 1, Storey County 1,056 1, White Pine County 1,689 1, Region Subtotal 53,198 60,470 7, Carson City 9,918 12,804 2, Clark County 262, ,874 40, Washoe County 60,626 73,280 12, Region Subtotal 332, ,958 56, Nevada Total 385, ,428 63, Source: Nevada State Demographer s Office (2014d). 36 Nevada State Office of Rural Health

53 Table 1.13: Population Aged 65 and Over in Nevada by County 1990 to 2010 Population Aged 65 and Over Change 1990 to Number Percent Churchill County 2,297 3,742 1, Douglas County 3,352 9,323 5, Elko County 2,042 4,072 2, Esmeralda County Eureka County Humboldt County 934 2,079 1, Lander County Lincoln County 599 1, Lyon County 3,019 8,081 5, Mineral County 846 1, Nye County 2,179 11,143 8, Pershing County Storey County White Pine County 1,090 1, Region Subtotal 17,772 44,697 26, Carson City 6,041 9,415 3, Clark County 77, , , Washoe County 26,140 53,550 27, Region Subtotal 109, , , Nevada Total 127, , , Source: United States Census Bureau (2014a). United States Census Bureau (2014b). Nevada State Office of Rural Health 37

54 Table 1.14: Median Age of Nevadans by County 1990 to 2012 Median Age (Years) Change 1990 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Average Source: United States Census Bureau (2014a). United States Census Bureau (2014b). United States Census Bureau (2014c). 38 Nevada State Office of Rural Health

55 Table 1.15: Population Aged 17 and Under in Nevada by County 2000 to 2010 Population Aged 17 and Under Change 2000 to Number Percent Churchill County 6,935 6, Douglas County 9,910 9, Elko County 14,699 14, Esmeralda County Eureka County Humboldt County 5,062 4, Lander County 1,863 1, Lincoln County 1,255 1, Lyon County 9,345 12,524 3, Mineral County 1, Nye County 7,706 8, Pershing County 1,719 1, Storey County White Pine County 2,220 2, Region Subtotal 63,278 63, Carson City 7,837 11,741 3, Clark County 351, , , Washoe County 84,480 99,179 14, Region Subtotal 444, , , Nevada Total 507, , , Source: Nevada State Demographer s Office (2014d). Nevada State Office of Rural Health 39

56 Table 1.16: Population Aged 17 and Under in Nevada by County 2014 to 2019 Population Aged 17 and Under Change 2014 to Number Percent Churchill County 6,197 6, Douglas County 8,730 8, Elko County 11,831 11, Esmeralda County Eureka County Humboldt County 4,349 4, Lander County 1,433 1, Lincoln County 1, Lyon County 12,107 12, Mineral County Nye County 8,418 8, Pershing County 1,200 1, Storey County White Pine County 2,095 1, Region Subtotal 59,368 58, Carson City 12,639 12, Clark County 500, ,497 11, Washoe County 103, ,354 5, Region Subtotal 617, ,872 16, Nevada Total 676, ,501 16, Source: Nevada State Demographer s Office (2014d). 40 Nevada State Office of Rural Health

57 Table 1.17: Population Aged 18 to 64 in Nevada by County 2000 to 2010 Population Aged 18 to 64 Change 2000 to Number Percent Churchill County 14,182 14, Douglas County 25,092 27,877 2, Elko County 27,916 30,886 2, Esmeralda County Eureka County 987 1, Humboldt County 9,831 10, Lander County 3,528 3, Lincoln County 2,237 2, Lyon County 20,413 30,477 10, Mineral County 2,829 2, Nye County 18,795 24,045 5, Pershing County 4,454 4, Storey County 2,284 2, White Pine County 5,722 6, Region Subtotal 138, ,773 23, Carson City 32,349 34,261 1, Clark County 877,096 1,250, , Washoe County 219, ,032 53, Region Subtotal 1,128,654 1,557, , Nevada Total 1,267,529 1,720, , Source: Nevada State Demographer s Office (2014d). Nevada State Office of Rural Health 41

58 Table 1.18: Population Aged 18 to 64 in Nevada by County 2014 to 2019 Population Aged 18 to 64 Change 2014 to Number Percent Churchill County 15,289 15, Douglas County 27,639 26,481-1, Elko County 35,855 37,759 1, Esmeralda County Eureka County 1,312 1, Humboldt County 11,491 11, Lander County 4,355 4, Lincoln County 2,679 2, Lyon County 31,119 33,778 2, Mineral County 2,616 2, Nye County 24,332 24, Pershing County 3,290 3, Storey County 2,431 2, White Pine County 5,095 5, Region Subtotal 168, ,140 4, Carson City 29,898 30,944 1, Clark County 1,277,188 1,309,201 32, Washoe County 272, ,181 19, Region Subtotal 1,579,395 1,632,326 52, Nevada Total 1,747,427 1,804,466 57, Source: Nevada State Demographer s Office (2014d). 42 Nevada State Office of Rural Health

59 Table 1.19: Population by Selected Racial and Ethnic Categories in Nevada by County 2014 White Black Native American Population Asian Pacific Islander Hispanic Origin Churchill County 19, , ,864 25,461 Douglas County 39, ,111 1,260 5,793 48,208 Elko County 39, , ,894 53,957 Esmeralda County Eureka County 1, ,055 Humboldt County 13, ,821 17,792 Lander County 4, ,354 6,568 Lincoln County 4, ,779 Lyon County 42, , ,999 53,331 Mineral County 3, ,487 Nye County 36, ,301 44,771 Pershing County 4, ,120 5,365 Storey County 3, ,030 White Pine County 7, ,129 9,055 Region Subtotal 220,435 2,648 10,159 4,839 42, ,771 Carson City 38, ,392 1,188 10,936 52,456 Clark County 973, ,154 13, , ,522 2,040,347 Washoe County 285,701 10,643 7,126 29, , ,399 Region Subtotal 1,298, ,119 21, , ,196 2,529,202 Nevada Total 1,518, ,767 32, , ,886 2,809,973 Source: Nevada State Demographer s Office (2014c). Total Nevada State Office of Rural Health 43

60 Table 1.20: Percent of Population by Selected Racial and Ethnic Categories in Nevada by County 2014 White Black Percent of Population Native American Asian Pacific Islander Hispanic Origin Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Nevada State Demographer s Office (2014c). 44 Nevada State Office of Rural Health

61 Table 1.21: Non-Hispanic and Hispanic Populations in Nevada by County 2014 Population Non-Hispanic Hispanic Total Number Percent Number Percent Churchill County 22, , ,461 Douglas County 42, , ,208 Elko County 43, , ,957 Esmeralda County Eureka County 1, ,055 Humboldt County 13, , ,792 Lander County 5, , ,568 Lincoln County 4, ,779 Lyon County 45, , ,331 Mineral County 3, ,487 Nye County 38, , ,771 Pershing County 4, , ,365 Storey County 3, ,030 White Pine County 7, , ,055 Region Subtotal 238, , ,771 Carson City 41, , ,456 Clark County 1,415, , ,040,347 Washoe County 332, , ,399 Region Subtotal 1,790, , ,529,202 Nevada Total 2,028, , ,809,973 Source: Nevada State Demographer s Office (2014c). Nevada State Office of Rural Health 45

62 Table 1.22: Hispanic Population in Nevada by County 1990 to Census Hispanic Population Change 1990 to Census 2010 Census 2014 Estimated Number Percent Churchill County 1,008 2,076 3,009 2,864 1, Douglas County 1,652 3,057 5,103 5,793 4, Elko County 4,339 8,935 11,158 10,894 6, Esmeralda County Eureka County Humboldt County 2,335 3,040 4,038 3,821 1, Lander County 789 1,073 1,219 1, Lincoln County Lyon County 1,511 3,784 7,674 7,999 6, Mineral County Nye County 1,237 2,713 5,967 6,301 5, Pershing County 662 1,294 1,508 1, Storey County White Pine County 852 1,008 1,326 1, Region Subtotal 15,446 28,060 42,356 42,690 27, Carson City 3,110 7,466 11,777 10,936 7, Clark County 82, , , , , Washoe County 22,959 56,301 93, ,738 80, Region Subtotal 108, , , , , Nevada Total 124, , , , , Source: United States Census Bureau (2014b). Nevada State Demographer s Office (2014c). 46 Nevada State Office of Rural Health

63 Table 1.23: Hispanic Population in Nevada by County 2014 to 2019 Hispanic Population Change 2014 to Number Percent Churchill County 2,864 2, Douglas County 5,793 6, Elko County 10,894 11, Esmeralda County Eureka County Humboldt County 3,821 4, Lander County 1,354 1, Lincoln County Lyon County 7,999 9,288 1, Mineral County Nye County 6,301 7, Pershing County 1,120 1, Storey County White Pine County 1,129 1, Region Subtotal 42,690 46,215 3, Carson City 10,936 12,689 1, Clark County 624, ,525 57, Washoe County 103, ,448 19, Region Subtotal 739, ,662 78, Nevada Total 781, ,877 81, Source: Nevada State Demographer s Office (2014c). Nevada State Office of Rural Health 47

64 Table 1.24: Veteran Population by Age in Nevada by County 2014 Veteran Population Under to to 85 Over 85 Total Percent of State Veteran Population Percent of Total Population Churchill County 767 1,575 1, , Douglas County 768 1,580 2, , Elko County 979 1,426 1, , Esmeralda County Eureka County Humboldt County , Lander County Lincoln County Lyon County 1,171 2,507 2, , Mineral County Nye County 770 2,032 3, , Pershing County Storey County White Pine County , Region Subtotal 5,764 11,661 13,664 1,487 32, Carson City 949 2,045 2, , Clark County 35,379 56,829 52,455 6, , Washoe County 6,809 13,178 12,672 1,498 34, Region Subtotal 43,138 72,052 67,523 8, , Nevada Total 48,902 83,713 81,186 9, , Source: United States Department of Veterans Health Administration (2014). 48 Nevada State Office of Rural Health

65 Table 1.25: Veteran Population in Nevada by County 2014 to 2024 Veteran Population Change 2014 to Number Percent Churchill County 3,951 3,918 3, Douglas County 4,639 4,522 4, Elko County 4,151 4,155 4, Esmeralda County Eureka County Humboldt County 1,499 1,425 1, Lander County Lincoln County Lyon County 6,834 6,705 6, Mineral County Nye County 6,136 6,116 5, Pershing County Storey County White Pine County 1,255 1,245 1, Region Subtotal 32,575 31,949 30,787-1, Carson City 5,719 5,582 5, Clark County 151, , ,102-17, Washoe County 34,157 31,348 28,619-5, Region Subtotal 190, , ,064-23, Nevada Total 223, , ,850-25, Source: United States Department of Veterans Health Administration (2014). Nevada State Office of Rural Health 49

66 Table 1.26: Population by Place of Birth in Nevada by County 2012 Number Native-born Population Percent of Total Population Born in U.S. Outside of Nevada Number Percent of Total Population Foreign-born Population Number Percent of Total Population Total Population Churchill County 8, , , ,519 Douglas County 8, , , ,456 Elko County 16, , , ,812 Esmeralda County Eureka County , ,767 Humboldt County 5, , , ,377 Lander County 2, , ,663 Lincoln County 1, , ,278 Lyon County 13, , , ,434 Mineral County 1, , ,707 Nye County 8, , , ,370 Pershing County 2, , ,648 Storey County , ,979 White Pine County 4, , ,941 Region Subtotal 74, , , ,867 Carson City 14, , , ,656 Clark County 440, ,050, , ,918,510 Washoe County 126, , , ,241 Region Subtotal 582, ,309, , ,389,407 Nevada Total 657, ,483, , ,659,274 Source: United States Census Bureau (2014a). 50 Nevada State Office of Rural Health

67 Table 1.27: Population Incarcerated in State of Nevada Correctional Facilities by County Incarcerated Population Percent of State Incarcerated Population Percent of County Population Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County 1, Storey County White Pine County 1, Region Subtotal 3, Carson City 2, Clark County 6, Washoe County Region Subtotal 9, Nevada Total 12, Source: Nevada Department of Corrections (2014). Nevada State Office of Rural Health 51

68 Table 1.28: Population Incarcerated in State of Nevada Correctional Facilities by County 2006 to 2014 Incarcerated Population Number Change 2006 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County 1,599 1, Storey County White Pine County 1,220 1, Region Subtotal 3,747 3, Carson City 2,934 2, Clark County 5,257 6,908 1, Washoe County Region Subtotal 8,290 9,302 1, Nevada Total 12,037 12, Source: Nevada Department of Corrections (2014). 52 Nevada State Office of Rural Health

69 Nevada Health Data Book Section Two: Social and Economic Profile of Nevada Highlights and Key Findings From 2002 to 2012, total personal income in Nevada has grown from $69.3 billion to $105.5 billion during the same period; total personal income in rural and frontier counties grew from $6.7 billion to $11.1 billion (Table 2.1). Most counties in Nevada experienced a decline in total personal income at some point during the 2006 to 2012 period the exceptions were rural and frontier counties with strong mining sectors (Elko, Eureka, Humboldt, Lander, and Pershing Counties) (Tables 2.1 and 2.2). From 2002 to 2012, per capita personal income in Nevada grew from $31,878 to $38,221 during the same decade, per capita income in rural and frontier counties grew from $28,391 to $40,676 (Table 2.3). In 2012, county-level per capita income in rural and frontier Nevada ranged from $25,507 in Lincoln County to $54,199 in Douglas County the average per capita income for all rural and frontier counties ($40,676) was above the urban average of $37,956, yet below the U.S. average of $43,735 (Table 2.3). During the period 2002 to 2007, all Nevada counties experienced a positive change in per capita personal income 13 of 17 Nevada counties had a rate of growth that exceeded the national average of 25.2% (Table 2.4). During the period 2007 to 2012, all urban counties in Nevada experienced a negative change in per capita personal income in contrast, 12 of 14 rural and frontier counties experienced a positive change in per capita personal income and nine of 14 rural and frontier counties possessed a growth rate exceeding the national average of 9.9% (Table 2.4). The average per capita personal income in Nevada of $38,221 is 87.4% of the U.S. average per capita personal income of $43,735 the average per capita personal income in rural and frontier Nevada of $40,676 is 95.7% of the U.S. average (Table 2.5). In 2012, county-level per capita personal income in rural and frontier areas as a percent of the Nevada average per capita personal income ranged from 66.7% in Lincoln County to 141.8% in Douglas County (Table 2.5). Nevada State Office of Rural Health 53

70 Nevada s 14 rural and frontier counties had a combined total of $11.1 billion in personal income in 2012 from three principal sources: net earnings of $6.9 billion (61.7%); $2.3 billion from dividends, interest, rent, and pensions (20.3%); and $2.0 billion from transfer payments (18.0%) (Tables 2.6 and 2.7). Rural and frontier counties vary considerably in terms of the percent of personal income by source. For example, net earnings as a percent of total personal income ranged from 42.1% in Mineral County to 77.5% in Lander County; dividends, interest, rent, and pensions as a percent of total personal income ranged from 11.6% in Lander County to 33.1% in Douglas County; and transfer payments as a percent of total personal income ranged from 10.1% in Eureka County to 40.8% in Mineral County (Table 2.7). Nevada rural and frontier counties had a combined total of $2.0 billion in transfer payments from the following sources: retirement and disability insurance payments of $831.7 million; medical benefits (Medicare, Medicaid, and VA health care) of $723.2 million; income maintenance benefits of $148.3 million; unemployment benefits of $97.9 million; and other sources of $118.1 million (Table 2.8). In 2013, median family income in Nevada was $61,359 or 94.8% of the U.S. average of $64,719 (Tables 2.9 and 2.10). Median family income in 2013 among rural and frontier counties of Nevada ranged from $45,798 in Nye County to $94,648 in Eureka County (Table 2.9). In 2013, 7 of 14 rural and frontier counties had a median family income above the state average of $61,359 and 5 of 14 rural and frontier counties were above the U.S. average of $64,719 (Table 2.10). In 2013, median household income in Nevada was $51,250 or 98.1% of the U.S. average of $52,250 (Table 2.11 and 2.12). Median household income among rural and frontier counties in Nevada ranged from $40,496 in Mineral County to $71,354 in Elko County in 2013 (Table 2.11). In 2013, 8 of 14 rural and frontier counties had a median household income above the state average of $51,250 and 7 of 14 were above the U.S. average of $52,250 (Table 2.11). In 2013, there were 4.8 personal bankruptcy filings per 1,000 population in Nevada 45.5% higher than the U.S. rate of 3.3 filings per 1,000 population (Table 2.13). Over the past eight years, personal bankruptcy filing rates have declined in every county of Nevada statewide, the number of filings per 1,000 population has dropped from 9.4 in 2005 to 4.8 in 2013 (Table 2.13). From 2003 to 2008, the number of new building permits issued annually in Nevada declined by 77.8% during the same period, the number of new building permits issued in rural and frontier counties dropped by 74.6% (Table 2.14). 54 Nevada State Office of Rural Health

71 During the period 2008 to 2013, the number of new building permits issued annually in Nevada increased by 21.5% the number of new building permits issued in rural and frontier counties increased by 93.9%, as compared to 18.0% in urban counties of the state (Table 2.14). In 2012, there were 441,374 Nevadans or 16.2% of the state s population in poverty, including 34,119 individuals or 12.8% of the population residing in rural and frontier counties (Table 2.15). Between 2002 and 2012, the percent of population in poverty increased in 14 of 17 Nevada counties in rural and frontier Nevada the poverty rate increased from 9.7% in 2002 to 12.8% in 2012 (Table 2.15). From the onset of the 2007 to 2012 recession, the number of Nevadans in poverty increased by 173,542 or 64.8% during the same period, the number of rural and frontier residents in poverty increased by 7,413 or 27.8% (Table 2.16). In 2012, 101,584 or 21.7% of the children aged 5 to 17 years were in poverty, including 8,052 or 17.9% of children 5 to 17 years old in rural and frontier areas (Table 2.17). In 2012, 152,663 or 23.4% of the children aged 18 and under were in poverty, including 11,596 or 18.9% of children 18 years old and under in rural and frontier areas (Table 2.17). In 2012, the rate of childhood poverty in rural and frontier Nevada ranged from 9.4% in Eureka County to 29.0% in Nye County (Table 2.17). In 2014, 410,529 Nevadans or 14.5% of the state s population participated in the Supplemental Nutrition Assistance Program (SNAP), including 30,469 or 10.7% of rural and frontier residents (Table 2.18). Between 2006 and 2014, the percent of population participating in the SNAP program increased in 16 of 17 counties in Nevada among rural and frontier counties, SNAP participation rates currently range from 1.8% in Esmeralda County to 19.7% in Nye County (Table 2.18). In 2013, 233,493 students qualified for the Free and Reduced Lunch Program in Nevada (54.7% of the total student population), including 17,367 or 42.1% of the rural and frontier student population (Table 2.19). Among rural and frontier counties of Nevada, student participation rates in the Free and Reduced Lunch Program ranged from 20.4% of the student population in Eureka County to 64.0% in Pershing County (Table 2.19). In 2013, the average public expenditure on education in Nevada was $8,274 per pupil the average expenditure per pupil in rural and frontier counties was $10,368, as compared to $8,100 in urban counties (Table 2.20). Among Nevada counties in 2013, average public expenditures on education ranged from $8,006 per pupil in Clark County to $31,980 per pupil in Esmeralda County (Table 2.20). In 2012, there were 461,323 students enrolled in K-12 schools in Nevada (public and private), including 42,313 students enrolled in schools in rural and frontier areas of the state (Table 2.21). Nevada State Office of Rural Health 55

72 In 2012, 441,040 students or 95.6% of the total student population were enrolled in public K-12 schools as well as 20,283 or 4.4% were enrolled in private K-12 schools in Nevada in rural and frontier counties, 98.6% were enrolled in public K-12 schools and 1.4% were enrolled in private K-12 schools (Table 2.21). In 2012, students enrolled in K-12 public and private schools represented 16.8% of the state s population students represented a slightly higher percentage of the total population in urban counties (16.4%), as compared to rural and frontier counties (14.9%) (Table 2.22). In 2012, there were 441,040 students enrolled in public primary and secondary schools in Nevada, including 41,706 in rural and frontier counties of which 22,111 were students enrolled in public primary schools and 19,541 were students enrolled in public secondary schools in rural and frontier counties (Table 2.24). In 2013, the average high school graduation rate in Nevada was 70.7% among Nevada s 17 counties, the graduation rate ranged from 51.5% in Mineral County to 95.0% in Eureka County (Table 2.25). On average, the high school graduation rate in Nevada for females is 74.0%, as compared to 67.3% for males (Table 2.25). In 2013, graduation rates in Nevada varied considerably by race and ethnicity for example, the graduate rate for whites was 77.2%, Hispanics was 64.4%, American Indians was 58.7%, Asians was 82.0%, Pacific Islanders was 74.8%, and Blacks was 56.7% (Table 2.26). In 2012, there were 9,708 graduating high school students in Nevada who were eligible for Millennium Scholarships, including 939 students in rural and frontier counties (Table 2.27). In 2012, there were 21,648 public high school graduates that enrolled in a Nevada System of Higher Education (NSHE) institution, including 2,374 graduates from public high schools in rural and frontier counties (Table 2.28). Between 2006 and 2012, the number of public high school graduates in Nevada increased by 5,305 however, the percent of graduates enrolled in NSHE institutions declined from 46.7% in 2006 to 41.4% in 2012 (Table 2.28). Between 2009 and 2011, the percent of Nevada high school graduates enrolled in NSHE institutions increased from 49.2% to 51.6% however, during the same time period, the percent of students who finished one year of higher education courses decreased from 72.7% to 64.3% (Table 2.29). In 2012, 84.4% of Nevadans aged 25 and older graduated from high school, 22.2% had a bachelor s degree or higher, and 7.1% had a master s degree or higher the percentages in all three categories have increased since 2000 (Table 2.30). and rural areas of Nevada, in 2012, have similar high school graduation rates however, the percent of population aged 25 and over with a bachelor s degree is lower in rural and frontier areas of the state (16.5%) when compared to urban areas (22.9%), and the percent with a master s degree or higher is lower in rural areas (5.6%) versus urban areas (7.7%) (Table 2.30). 56 Nevada State Office of Rural Health

73 In 2014, there were 1,475,969 registered voters out of an eligible voting population of 2,090,830 (70.6%), including 155,439 registered voters in rural and frontier counties out of an eligible population of 221,230 (70.3%) (Table 2.31). County-level voter registration rates in Nevada range from 52.8% in Lander County to 85.3% in Douglas County (Table 2.31). Currently, registered Republicans outnumber registered Democrats in 15 of 17 counties in Nevada however, there are 490,496 registered Republicans (33.2%), as compared to 597,989 registered Democrats (40.5%) in Nevada, with an additional 387,484 Nevadans registered as Independents or another party affiliation (26.3%) (Tables 2.32 and 2.33). There are 1,271 community organizations in Nevada or 46.2 community organizations per 100,000 population the number of community organizations per 100,000 population ranges from 36.2 in Clark County to in Lander County (there are no reported community organizations in Esmeralda County) (Table 2.34). In 2010, the percent of population participating in the U.S. Decennial Census was 71%, in Nevada, which is lower than the U.S. average of 74% county-level participation rates ranged from 32% in Esmeralda County to 85% in Storey County (Table 2.35). In 2012, there were 77,833 reported property crimes and 16,743 reported violent crimes in Nevada, including 5,774 property crimes and 1,039 violent crimes reported in rural and frontier counties (Tables 2.36 and 2.37). In 2012, the rate of reported violent crimes per 100,000 population in Nevada was county-level rates ranged from 39.2 in Lincoln County to 1,169.9 in Storey County (Table 2.38). In 2012, the rate of reported property crimes per 100,000 population in Nevada was 2,830.1 county-level rates ranged from in Esmeralda County to 2,999.6 in Clark County (Table 2.38). Nevada State Office of Rural Health 57

74

75 Table 2.1: Personal Income in Nevada by County 2002 to 2012 Estimated Personal Income (Thousands of Dollars) Churchill County 702, , ,527 1,025,441 1,026,028 1,156,928 Douglas County 1,804,368 2,234,321 2,591,346 2,618,935 2,409,370 2,547,137 Elko County 1,128,564 1,332,047 1,524,001 1,749,143 1,879,851 2,161,367 Esmeralda County 25,915 32,535 32,556 34,798 29,811 34,256 Eureka County 40,788 44,630 50,053 65,408 66,379 80,648 Humboldt County 371, , , , , ,926 Lander County 135, , , , , ,162 Lincoln County 90, , , , , ,867 Lyon County 910,532 1,116,702 1,364,817 1,523,946 1,460,946 1,558,685 Mineral County 120, , , , , ,693 Nye County 901,666 1,137,979 1,378,163 1,495,953 1,406,744 1,451,002 Pershing County 107, , , , , ,966 Storey County 103, , , , , ,370 White Pine County 245, , , , , ,189 Region Subtotal 6,688,458 8,137,190 9,151,069 9,922,491 10,155,135 11,098,196 Carson City 1,804,159 2,123,191 2,321,964 2,364,850 2,233,741 2,316,159 Clark County 47,186,254 57,281,141 70,236,952 74,088,664 69,407,336 73,379,049 Washoe County 13,616,710 16,206,088 18,514,793 19,222,621 17,409,987 18,656,484 Region Subtotal 62,607,123 75,610,420 91,073,709 95,676,135 89,051,064 94,351,692 Nevada Total 69,295,581 83,747, ,563, ,975,074 99,206, ,449,888 Source: Bureau of Economic Analysis (2014a). Nevada State Office of Rural Health 59

76 Table 2.2: Annual Percentage Change in Personal Income in Nevada by County 2002 to 2012 Annual Percentage Change in Personal Income Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Average Carson City Clark County Washoe County Region Average Nevada Average U.S. Average Source: Bureau of Economic Analysis (2014a). 60 Nevada State Office of Rural Health

77 Table 2.3: Per Capita Personal Income in Nevada by County 2002 to 2012 Per Capita Personal Income (Dollars) Churchill County 29,094 34,962 38,504 40,937 41,382 47,464 Douglas County 41,541 48,166 55,306 55,404 51,228 54,199 Elko County 25,549 30,391 33,053 36,720 38,422 42,201 Esmeralda County 27,986 37,014 36,870 42,437 38,367 44,201 Eureka County 25,039 30,361 31,699 36,787 33,289 40,304 Humboldt County 25,149 29,972 34,298 37,508 40,305 45,690 Lander County 26,095 30,328 34,457 37,735 41,762 47,999 Lincoln County 20,995 23,801 23,021 24,283 22,929 25,507 Lyon County 24,234 26,254 27,391 29,219 28,039 30,368 Mineral County 25,607 28,577 28,678 34,268 34,819 34,965 Nye County 26,186 30,519 32,404 33,718 32,057 33,773 Pershing County 16,146 19,698 21,166 24,098 24,059 27,703 Storey County 31,120 35,491 39,021 37,457 34,376 34,656 White Pine County 28,224 33,561 35,645 38,681 37,465 41,843 Region Average 28,391 33,224 36,037 38,021 37,264 40,676 Carson City 33,102 37,918 41,905 42,570 40,409 42,236 Clark County 30,983 34,449 38,939 38,742 35,531 36,676 Washoe County 37,576 42,338 46,235 46,343 41,234 43,396 Region Average 32,185 35,978 40,302 40,150 36,629 37,956 Nevada Average 31,878 35,695 39,864 39,936 36,692 38,221 U.S. Average 31,798 34,300 38,127 40,873 40,163 43,735 Source: Bureau of Economic Analysis (2014a). Nevada State Office of Rural Health 61

78 Table 2.4: Change in Per Capita Personal Income in Nevada by County 2002 to 2012 Change in Per Capita Personal Income (Dollars) Change 2002 to 2007 Change 2007 to 2012 Number Percent Number Percent Churchill County 10, , Douglas County 16, , Elko County 10, , Esmeralda County 9, , Eureka County 8, , Humboldt County 10, , Lander County 8, , Lincoln County 2, , Lyon County 4, , Mineral County 5, , Nye County 7, Pershing County 6, , Storey County 7, , White Pine County 9, , Region Average 9, , Carson City 10, , Clark County 8, , Washoe County 11, , Region Average 9, , Nevada Average 8, , U.S. Average 8, , Source: Bureau of Economic Analysis (2014a). 62 Nevada State Office of Rural Health

79 Table 2.5: Per Capita Personal Income as a Percent of Nevada and U.S. Per Capita Income in Nevada by County 2012 Per Capita Personal Income Per Capita Personal Income as a Percent of Nevada Average U.S. Average Churchill County 47, Douglas County 54, Elko County 42, Esmeralda County 44, Eureka County 40, Humboldt County 45, Lander County 47, Lincoln County 25, Lyon County 30, Mineral County 34, Nye County 33, Pershing County 27, Storey County 34, White Pine County 41, Region Average 40, Carson City 42, Clark County 36, Washoe County 43, Region Average 37, Nevada Average 38, U.S. Average 43, Source: Bureau of Economic Analysis (2014a). Nevada State Office of Rural Health 63

80 Table 2.6: Sources and Amounts of Personal Income in Nevada by County 2012 Net Earnings (Wages and Benefits) Personal Income (Thousands of Dollars) Dividends, Interest, Rent, Pensions Transfer Payments Churchill County 762, , ,021 1,156,928 Douglas County 1,345, , ,295 2,547,137 Elko County 1,670, , ,225 2,161,367 Esmeralda County 19,051 7,452 7,753 34,256 Eureka County 61,392 11,074 8,182 80,648 Humboldt County 580, ,076 88, ,926 Lander County 221,057 33,173 30, ,162 Lincoln County 69,404 33,556 34, ,867 Lyon County 874, , ,987 1,558,685 Mineral County 81,108 33,056 78, ,693 Nye County 693, , ,920 1,451,002 Pershing County 121,356 27,870 37, ,966 Storey County 80,698 28,020 27, ,370 White Pine County 281,712 64,963 73, ,189 Region Subtotal 6,861,719 2,261,249 2,005,228 11,098,196 Carson City 1,324, , ,381 2,316,159 Clark County 47,499,813 13,912,662 11,966,574 73,379,049 Washoe County 10,806,414 5,191,638 2,658,432 18,656,484 Region Subtotal 59,630,721 19,657,584 15,063,387 94,351,692 Nevada Total 66,492,440 21,918,833 17,068, ,449,888 Source: Bureau of Economic Analysis (2014b). Total 64 Nevada State Office of Rural Health

81 Table 2.7: Sources and Percent of Personal Income in Nevada by County 2012 Percent of Personal Income by Source Net Earnings (Wages and Benefits) Dividends, Interest, Rent, Pensions Transfer Payments Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Bureau of Economic Analysis (2014b). Nevada State Office of Rural Health 65

82 Table 2.8: Income from Transfer Payments by Type of Transfer Payment in Nevada by County 2012 Retirement, Disability Insurance Benefits Medical Benefits Income by Type of Transfer Payment (Thousands of Dollars) Income Maintenance Benefits Unemployment Benefits Other Churchill County 66,918 83,295 17,348 9,083 18,363 Douglas County 180, ,936 17,767 18,383 15,896 Elko County 80,383 81,575 21,321 12,935 14,468 Esmeralda County 3,217 3, Eureka County 3,931 2, Humboldt County 33,535 33,987 8,720 4,380 4,425 Lander County 12,018 12,485 2,417 1,727 1,047 Lincoln County 13,447 14,938 2,107 1,682 1,609 Lyon County 169, ,350 30,414 23,372 23,264 Mineral County 15,783 22,840 3,752 1,941 3,251 Nye County 200, ,425 34,753 16,929 27,788 Pershing County 13,109 16,808 2,901 2,016 1,847 Storey County 14,189 7,622 1,405 1,694 1,884 White Pine County 24,526 36,112 4,609 3,046 3,386 Region Subtotal 831, , ,289 97, ,139 Carson City 156, ,191 37,213 22,244 27,616 Clark County 4,104,777 4,511,278 1,394, , ,104 Washoe County 1,034, , , , ,902 Region Subtotal 5,295,974 5,644,286 1,671, , ,622 Nevada Total 6,127,654 6,367,459 1,819,558 1,078,392 1,076,875 Source: Bureau of Economic Analysis (2014a). 66 Nevada State Office of Rural Health

83 Table 2.9: Median Family Income in Nevada by County 2009 to 2013 American Community Survey (ACS) Estimates Median Family Income (Dollars) Churchill County 62,947 63,599 65,070 63,295 60,951 Douglas County 72,233 73,543 71,240 70,130 67,597 Elko County 72,981 75,171 75,617 75,349 75,231 Esmeralda County 54,063 57,292 58,281 54,688 51,500 Eureka County 68,500 75,179 68,542 66,597 94,648 Humboldt County 68,819 69,032 70,236 71,792 74,433 Lander County 58,971 67,157 70,772 69,634 75,857 Lincoln County 55,714 56,167 51,121 50,307 48,816 Lyon County 55,570 56,106 54,564 52,561 52,918 Mineral County 48,375 57,064 51,193 58,542 61,226 Nye County 50,646 50,218 44,997 44,544 45,798 Pershing County 56,387 61,410 63,622 57,668 56,250 Storey County 62,363 65,121 65,691 69,375 64,173 White Pine County 51,021 62,946 63,188 57,240 63,982 Carson City 65,035 65,389 64,844 65,299 63,883 Clark County 63,510 63,888 64,074 62,370 60,666 Washoe County 67,177 67,428 66,509 65,047 64,556 Nevada Average 63,912 64,418 64,353 62,789 61,359 U.S. Average 62,363 62,982 64,293 64,585 64,719 Source: United States Census Bureau (2014a). Nevada State Office of Rural Health 67

84 Table 2.10: Median Family Income in Nevada by County 2013 American Community Survey (ACS) Estimates Median Family Income (Dollars) % Confidence Interval Median Family Income as a Percent of Nevada Average U.S. Average Churchill County 60,951 54,411 67, Douglas County 67,597 63,849 71, Elko County 75,231 72,096 78, Esmeralda County 51,500 31,050 71, Eureka County 94,648 77, , Humboldt County 74,433 67,706 81, Lander County 75,857 67,113 84, Lincoln County 48,816 42,563 55, Lyon County 52,918 49,872 55, Mineral County 61,226 52,736 69, Nye County 45,798 42,251 49, Pershing County 56,250 45,559 66, Storey County 64,173 56,408 71, White Pine County 63,982 53,545 74, Carson City 63,883 60,722 67, Clark County 60,666 60,132 61, Washoe County 64,556 63,282 65, Nevada Average 61,359 60,870 61, U.S. Average 64,719 64,537 64, Source: United States Census Bureau (2014a). 68 Nevada State Office of Rural Health

85 Table 2.11: Median Household Income in Nevada by County 2009 to 2013 Small Area Income and Poverty Estimate (SAIPE) Median Household Income (Dollars) Churchill County 52,055 48,235 50,620 49,463 50,158 Douglas County 60,578 57,176 54,640 60,869 56,613 Elko County 62,091 66,210 62,937 68,759 71,354 Esmeralda County 42,526 40,929 40,536 40,517 41,075 Eureka County 56,815 58,391 58,985 62,864 66,592 Humboldt County 57,309 59,960 61,680 63,772 66,290 Lander County 62,329 70,176 64,392 67,424 69,658 Lincoln County 44,387 42,637 42,724 43,617 44,366 Lyon County 51,151 47,108 44,877 48,035 46,526 Mineral County 36,017 39,940 39,705 40,308 40,496 Nye County 43,215 41,054 41,150 41,426 42,998 Pershing County 45,644 44,684 46,683 45,192 51,548 Storey County 54,246 57,763 54,582 53,471 59,785 White Pine County 48,063 49,376 52,014 50,417 52,588 Carson City 52,548 49,386 50,689 48,227 47,476 Clark County 53,512 51,427 48,343 49,583 51,071 Washoe County 53,036 50,839 50,910 49,449 53,565 Nevada Average 53,310 50,987 49,099 49,909 51,250 U.S. Average 50,221 50,046 50,502 51,371 52,250 Source: United States Census Bureau (2014e). Nevada State Office of Rural Health 69

86 Table 2.12: Median Household Income in Nevada by County 2013 Small Area Income and Poverty Estimate (SAIPE) Median Household Income (Dollars) % Confidence Interval Median Household Income as a Percent of Nevada Average United States Average Churchill County 50,158 45,415 54, Douglas County 56,613 52,968 60, Elko County 71,354 67,364 75, Esmeralda County 41,075 36,970 45, Eureka County 66,592 59,841 73, Humboldt County 66,290 60,060 72, Lander County 69,658 62,626 76, Lincoln County 44,366 39,914 48, Lyon County 46,526 43,605 49, Mineral County 40,496 36,446 44, Nye County 42,998 39,424 46, Pershing County 51,548 46,492 56, Storey County 59,785 55,255 64, White Pine County 52,588 47,610 57, Carson City 47,476 44,214 50, Clark County 51,071 50,321 51, Washoe County 53,565 50,928 56, Nevada Average 51,250 50,676 51, U.S. Average 52,250 52,185 52, Source: United States Census Bureau (2014e). 70 Nevada State Office of Rural Health

87 Table 2.13: Personal Bankruptcy Filing Rates in Nevada by County 2005 to 2013 Personal Bankruptcy Filings per 1,000 Population Change in Bankruptcy Rate 2005 to to 2013 Churchill County Douglas County Elko County Esmeralda County N/A -4.3 N/A Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Average U.S. Average Source: Federal Deposit Insurance Corporation (2014). Nevada State Office of Rural Health 71

88 Table 2.14: New Building Permits Issued in Nevada by County 2003 to 2013 New Building Permits Issued Percent Change 2003 to to 2013 Churchill County Douglas County Elko County Esmeralda County N/A N/A N/A N/A N/A Eureka County N/A N/A N/A N/A N/A Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County N/A N/A N/A N/A N/A Pershing County Storey County White Pine County Region Subtotal 1, Carson City Clark County 28,277 6,202 7, Washoe County 4,289 1,008 1, Region Subtotal 32,765 7,226 8, Nevada Total 34,111 7,568 9, Source: United States Census Bureau (2014f). 72 Nevada State Office of Rural Health

89 Table 2.15: Population in Poverty in Nevada by County 2002 to 2012 Population in Poverty in Nevada 2002 to 2012 County Number Percent Number Percent Number Percent Churchill County 2, , , Douglas County 2, , , Elko County 3, , , Esmeralda County Eureka County Humboldt County 1, , , Lander County Lincoln County Lyon County 3, , , Mineral County Nye County 4, , , Pershing County , Storey County White Pine County , Region Subtotal 22, , , Carson City 4, , , Clark County 164, , , Washoe County 31, , , Region Subtotal 201, , , Nevada Total 223, , , Source: United States Census Bureau (2014e). Nevada State Office of Rural Health 73

90 Table 2.16: Change of Population in Poverty in Nevada by County 2002 to 2012 Change of Population in Poverty in Nevada 2002 to 2012 County Change 2002 to 2007 Change 2007 to 2012 Change 2002 to 2012 Number Percent Number Percent Number Percent Churchill County , Douglas County , , Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County 1, , , Mineral County Nye County , , Pershing County Storey County White Pine County Region Subtotal 4, , , Carson City 1, , , Clark County 29, , , Washoe County 8, , , Region Subtotal 39, , , Nevada Total 43, , , Source: United States Census Bureau (2014e). 74 Nevada State Office of Rural Health

91 Table 2.17: School-aged Children (5 to 17) and Children (18 and Under) in Poverty in Nevada by County 2012 Children Aged 5 to 17 in Poverty Number Percent of Children Aged 5 to 17 Children Aged 18 and Under in Poverty Number Percent of Children Aged 18 and Under Churchill County , Douglas County , Elko County 1, , Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County 1, , Mineral County Nye County 1, , Pershing County Storey County White Pine County Region Subtotal 8, , Carson City 1, , Clark County 76, , Washoe County 15, , Region Subtotal 93, , Nevada Total 101, , Source: United States Census Bureau (2014e). Nevada State Office of Rural Health 75

92 Table 2.18: Supplemental Nutrition Assistance Program (SNAP) Participation in Nevada by County 2006 to 2014 County Number Supplemental Nutrition Assistance Program (SNAP) Participation Percent of Population Number Percent of Population Number Percent of Population Change Percent of Population in SNAP 2006 to 2010 Churchill County 1, , , Douglas County , , Elko County 1, , , Esmeralda County Eureka County Humboldt County , , Lander County Lincoln County Lyon County 1, , , Mineral County Nye County 4, , , Pershing County Storey County White Pine County Rural Subtotal 11, , , Carson City 2, , , Clark County 89, , , Washoe County 15, , , Subtotal 107, , , Nevada Total 119, , , to 2014 Source: Economic Research Service (2014). Division of Welfare and Support Services (2014). Nevada State Demographer s Office (2014a). 76 Nevada State Office of Rural Health

93 Table 2.19: Students Qualifying for Free and Reduced School Lunch (FRL) in Nevada by County 2013 Total Student Population Free Lunch Program Students Qualifying for Reduced Lunch Program Total Students Qualifying for FRL as a Percent of Total Student Population Churchill County 3,673 1, , Douglas County 6,083 1, , Elko County 9,921 2, , Esmeralda County Eureka County Humboldt County 3, , Lander County 1, Lincoln County Lyon County 8,200 3, , Mineral County Nye County 5,087 2, , Pershing County Storey County White Pine County 1, Region Subtotal 41,227 14,044 3,323 17, Carson City 7,542 2, , Clark County 314, ,858 25, , Washoe County 63,323 16,499 3,426 29, Region Subtotal 385, ,208 29, , Charter Schools 19,876 1,145 1,649 5, Nevada Total 426, ,252 32, , Source: Nevada Department of Education (2014a). Nevada State Office of Rural Health 77

94 Table 2.20: Public Expenditures on Education in Nevada by County 2009 to 2013 Public Expenditures on Education (Dollars per Pupil) Churchill County 9,153 8,634 8,451 10,171 10,236 Douglas County 9,506 8,795 8,990 9,369 9,689 Elko County 9,641 9,848 9,480 9,432 9,533 Esmeralda County 29,984 25,460 30,089 38,703 31,980 Eureka County 28,550 24,688 28,369 31,808 31,461 Humboldt County 9,998 8,822 9,005 9,580 9,568 Lander County 9,769 9,593 9,269 10,894 11,761 Lincoln County 13,820 11,128 12,112 11,280 14,076 Lyon County 9,092 8,813 8,097 9,312 9,914 Mineral County 13,551 12,233 15,399 13,877 14,013 Nye County 10,672 9,822 9,538 10,122 10,417 Pershing County 14,027 12,718 13,351 15,081 14,161 Storey County 14,639 13,061 13,124 16,252 15,768 White Pine County 11,420 9,887 10,081 10,903 10,745 Region Subtotal 10,110 9,523 9,401 10,102 10,368 Carson City 8,812 8,927 8,989 9,780 10,587 Clark County 8,246 7,757 7,404 8,091 8,006 Washoe County 8,458 8,067 7,992 8,632 8,506 Region Subtotal 8,292 8,916 7,532 8,213 8,100 Nevada Total 8,457 8,515 7,716 8,353 8,274 Source: Nevada Department of Education (2014b). 78 Nevada State Office of Rural Health

95 Table 2.21: Enrollment in Public and Private Schools (K-12) in Nevada by County 2012 Enrollment in Public Schools Enrollment in Private Schools County Total Number Percent Number Percent Churchill County 3, ,780 Douglas County 6, ,358 Elko County 9, ,838 Esmeralda County Eureka County Humboldt County 3, ,453 Lander County 1, ,086 Lincoln County Lyon County 8, ,042 Mineral County Nye County 5, ,483 Pershing County Storey County White Pine County 1, ,408 Region Subtotal 41, ,313 Carson City 7, ,274 Clark County 313, , ,010 Washoe County 64, , ,873 Region Subtotal 385, , ,157 Charter Schools 13, ,853 Nevada Total 441, , ,323 Source: Nevada Department of Education (2014c). Nevada State Office of Rural Health 79

96 Table 2.22: Students as a Percent of Total Population in Nevada by County 2012 Enrollment in Public Schools Number Percent of Total Population Enrollment in Private Schools Number Percent of Total Population Total Enrollment Number Percent of Total Population Churchill County 3, , Douglas County 6, , Elko County 9, , Esmeralda County Eureka County Humboldt County 3, , Lander County 1, , Lincoln County Lyon County 8, , Mineral County Nye County 5, , Pershing County Storey County White Pine County 1, , Region Subtotal 41, , Carson City 7, , Clark County 313, , , Washoe County 64, , , Region Subtotal 385, , , Charter Schools 13, N/A N/A 13, Nevada Total 441, , , Source: Nevada Department of Education (2014c). United Stated Census Bureau (2014d). 80 Nevada State Office of Rural Health

97 Table 2.23: Number of Schools in Nevada by County 2012 Public Schools Private Schools Primary Secondary Other Subtotal Primary Secondary Other Subtotal Total Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Charter Schools Nevada Total Source: Nevada Department of Education (2014c). Nevada State Office of Rural Health 81

98 Table 2.24: Enrollment in Public Primary and Secondary Schools in Nevada by County 2012 County Primary Schools Enrollment in Public Schools in Nevada Secondary Schools Ungraded Total Churchill County 1,868 1, ,677 Douglas County 3,129 2, ,076 Elko County 5,317 4, ,811 Esmeralda County Eureka County Humboldt County 1,914 1, ,453 Lander County ,086 Lincoln County Lyon County 4,332 3, ,006 Mineral County Nye County 2,746 2, ,324 Pershing County Storey County White Pine County ,408 Region Subtotal 22,111 19, ,706 Carson City 4,285 3, ,795 Clark County 171, , ,406 Washoe County 35,031 29, ,280 Region Subtotal 210, , ,481 Charter Schools 7,312 6, ,853 Nevada Total 239, , ,040 Source: Nevada Department of Education (2014c). 82 Nevada State Office of Rural Health

99 Table 2.25: High School Graduation Rate by Gender in Nevada by County 2013 Number of Graduates High School Graduation Rate Male Female Total Churchill County Douglas County Elko County Esmeralda County N/A N/A N/A N/A Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County 28, Washoe County 5, Charter Schools 2, Nevada Average 42, Source: Nevada Department of Education (2014d). Nevada State Office of Rural Health 83

100 Table 2.26: High School Graduation Rate by Race and Ethnicity in Nevada by County 2013 White Hispanic High School Graduation Rate by Race and Ethnicity American Indian Asian Pacific Islander Black / African American Two or More Races Churchill County Douglas County Elko County Esmeralda County N/A N/A N/A N/A N/A N/A N/A N/A Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Total Charter Schools Nevada Average Source: Nevada Department of Education (2014d). 84 Nevada State Office of Rural Health

101 Table 2.27: Students Eligible for Millennium Scholarships in Nevada by County 2004 to 2012 Students Eligible for Millennium Scholarships Change 2004 to 2012 Number Percent Churchill County Douglas County Elko County Esmeralda County N/A N/A N/A N/A N/A Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal 1, Carson City Clark County 5,777 6,002 6,897 1, Washoe County 1,766 1,578 1, Region Subtotal 7,790 7,754 8, Nevada Total 9,021 8,727 9, Source: Legislative Counsel Bureau (2014). Nevada State Office of Rural Health 85

102 Table 2.28: Public High School Graduates Enrolled in Nevada System of Higher Education (NSHE) Institutions in Nevada by County 2006 to 2012 Number of HS Grads Public High School Graduates Percent Enrolled in NSHE Number of HS Grads Percent Enrolled in NSHE Number of HS Grads Percent Enrolled in NSHE Churchill County Douglas County Elko County Esmeralda County N/A N/A N/A N/A N/A N/A Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal 2, , , Carson City Clark County 10, , , Washoe County 2, , , Region Subtotal 14, , , Charter Schools Nevada Total 16, , , Source: Nevada System of Higher Education (2014). 86 Nevada State Office of Rural Health

103 Table 2.29: First-year Persistence in Nevada System of Higher Education (NSHE) Institutions in Nevada by County 2009 to 2011 Number of High School Graduates Percent Enrolled in NSHE Percent Finished First Year Courses Number of High School Graduates Percent Enrolled in NSHE Percent Finished First Year Courses Churchill County Douglas County Elko County Esmeralda County N/A N/A N/A N/A N/A N/A Eureka County Humboldt County Lander County N/A N/A N/A Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County 13, , Washoe County 3, , Charter Schools Nevada Total 19, , Source: Nevada Department of Education (2014e). Nevada Department of Education (2014f). Nevada State Office of Rural Health 87

104 Table 2.30: Educational Attainment in Nevada by County 2000 to 2012 Population Aged 25 Years and Older Number Percent with High School Diploma or Higher Percent with Bachelor s Degree or Higher Percent with Master s Degree or Higher Number Percent with High School Diploma or Higher Percent with Bachelor s Degree or Higher Percent with Master s Degree or Higher Churchill County 15, , Douglas County 29, , Elko County 26, , Esmeralda County Eureka County 1, , Humboldt County 9, , Lander County 3, , Lincoln County 2, , Lyon County 22, , Mineral County 3, , Nye County 23, , Pershing County 4, , Storey County 2, , White Pine County 6, , Rural Subtotal 151, , Carson City 35, , Clark County 900, ,287, Washoe County 221, , Subtotal 1,158, ,604, Nevada Total 1,310, ,791, Source: United States Census Bureau (2014a). 88 Nevada State Office of Rural Health

105 Table 2.31: Registered Voters in Nevada by County 2014 Eligible Voting Population Aged 18 and Over Registered Voters Number Percent of Eligible Voters Churchill County 19,265 13, Douglas County 39,478 33, Elko County 42,125 22, Esmeralda County Eureka County 1, Humboldt County 13,444 7, Lander County 5,136 2, Lincoln County 3,764 2, Lyon County 41,224 31, Mineral County 3,565 2, Nye County 36,353 26, Pershing County 4,166 2, Storey County 3,487 2, White Pine County 6,784 4, Region Subtotal 221, , Carson City 39,816 28, Clark County 1,539,440 1,027, Washoe County 332, , Region Subtotal 1,912,191 1,320, Nevada Total 2,090,830 1,475, Source: Nevada Secretary of State (2014). Nevada State Demographer s Office (2014a). Nevada State Office of Rural Health 89

106 Table 2.32: Registered Voters by Party in Nevada by County 2014 Democratic Republican Registered Voters Independent American Non-partisan Other Party Affiliation Churchill County 3,109 7, , Douglas County 8,555 17,200 1,791 5, Elko County 4,543 12,336 1,206 4, Esmeralda County Eureka County Humboldt County 1,597 3, , Lander County 557 1, Lincoln County 840 1, Lyon County 9,304 14,917 2,397 5, Mineral County 1,132 1, Nye County 8,277 11,672 1,845 4, Pershing County 675 1, Storey County 744 1, White Pine County 1,422 2, Region Subtotal 39,992 77,316 9,549 26,364 2,218 Carson City 8,878 12,203 1,651 4, Clark County 453, ,647 46, ,826 16,612 Washoe County 95,622 98,330 13,484 51,238 6,715 Region Subtotal 557, ,180 61, ,873 23,825 Nevada Total 597, ,496 71, ,237 26,043 Source: Nevada Secretary of State (2014). 90 Nevada State Office of Rural Health

107 Table 2.33: Percent of Registered Voters by Party in Nevada by County 2014 Democratic Republican Percent of Registered Voters Independent American Non-partisan Other Party Affiliation Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Average Carson City Clark County Washoe County Region Average Nevada Average Source: Nevada Secretary of State (2014). Nevada State Office of Rural Health 91

108 Table 2.34: Community Organizations in Nevada by County 2012 Community Organizations Religious, Civic, and Other Nonprofit Organizations Number Number per 100,000 Population Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal 1, Nevada Total 1, Source: United States Census Bureau (2014g). 92 Nevada State Office of Rural Health

109 Table 2.35: United States Decennial Census Participation Rates in Nevada by County 2000 to 2010 Percent of Population 2000 Census Participation Rates Percent of Population 2010 Change in Percent 2000 to 2010 Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Average U.S. Average Source: United States Census Bureau (2014c). United States Census Bureau (2014d). Nevada State Office of Rural Health 93

110 Table 2.36: Reported Violent Crimes in Nevada by County 2012 Murder, Non-negligent Manslaughter Forcible Rape Number of Violent Crimes Robbery Aggravated Assault Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal ,039 Carson City Clark County ,424 8,647 13,904 Washoe County ,174 1,668 Region Subtotal ,840 9,939 15,704 Nevada Total ,907 10,782 16,743 Source: Federal Bureau of Investigation (2014). Total 94 Nevada State Office of Rural Health

111 Table 2.37: Reported Property Crimes in Nevada by County 2012 Burglary Larceny/Theft Number of Property Crimes Motor Vehicle Theft Arson Churchill County Douglas County Elko County ,283 Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County ,037 Mineral County Nye County ,161 Pershing County Storey County White Pine County Region Subtotal 1,578 3, ,774 Carson City ,111 Clark County 17,558 33,565 8, ,646 Washoe County 2,650 7,341 1, ,302 Region Subtotal 20,506 41,637 9, ,059 Nevada Total 22,084 45,279 10, ,833 Source: Federal Bureau of Investigation (2014). Total Nevada State Office of Rural Health 95

112 Table 2.38: Violent Crime Rates and Property Crime Rates in Nevada by County 2012 Number Violent Crimes Number per 100,000 Population Number Property Crimes Number per 100,000 Population Churchill County ,401.1 Douglas County ,882.7 Elko County ,283 2,478.2 Esmeralda County Eureka County ,442.1 Humboldt County ,144.7 Lander County ,720.0 Lincoln County ,392.2 Lyon County ,037 1,984.9 Mineral County ,645.7 Nye County ,161 2,621.2 Pershing County 79 1, ,069.4 Storey County 48 1, ,144.8 White Pine County ,297.1 Region Subtotal 1, ,774 2,038.0 Carson City ,111 2,003.9 Clark County 13, ,646 2,999.6 Washoe County 1, ,302 2,642.5 Region Subtotal 15, ,059 2,921.0 Nevada Total 16, ,833 2,830.1 Source: Federal Bureau of Investigation (2014). 96 Nevada State Office of Rural Health

113 Nevada Health Data Book Section Three: Population Health Profile of Nevada Highlights and Key Findings In 2012, there were 580,573 uninsured Nevadans under the age of 65 (24.5%), including 50,533 uninsured rural and frontier residents (22.9%) (Table 3.1). In 2012, 590,607 Nevadans under the age of 65 were below 138% of the federal poverty level 237,690 or 40.2% of this group were uninsured, including 19,566 rural and frontier residents (40.9%) (Table 3.2). In 2012, 1.1 million Nevadans under the age of 65 were below 250% of the federal poverty level 410,153 or 37.3% of this group were uninsured, including 34,551 rural and frontier residents (36.9%) (Table 3.3). In 2012, 1.6 million Nevadans under the age of 65 were below 400% of the federal poverty level 520,190 or 31.6% of this group were uninsured, including 44,564 rural and frontier residents (30.2%) (Table 3.4). There were 114,866 uninsured Nevadans under the age of 19 (16.7%) in 2012, including 11,306 uninsured rural and frontier children (17.4%) (Table 3.6). In 2012, 229,037 Nevadans under the age of 19 were below 138% of the federal poverty level 52,111 or 22.8% of this group were uninsured, including 4,421 rural and frontier children (24.5%) (Table 3.7). There were 475,714 uninsured Nevadans between the ages of 18 and 64 (27.8%) in 2012, including 40,277 uninsured rural and frontier residents (25.4%) (Table 3.8). In 2012, 372,112 Nevadans between the ages of 18 and 64 were below 138% of the federal poverty level 189,937 or 51.0% of this group were uninsured, including 15,573 rural and frontier residents (50.5%) (Table 3.9). There were 204,428 uninsured Nevadans between the ages of 40 and 64 (22.8%) in 2012, including 19,690 uninsured rural and frontier residents (20.8%) (Table 3.10). In 2012, 159,924 Nevadans between the ages of 40 and 64 were below 138% of the federal poverty level 77,585 or 48.5% of this group were uninsured, including 7,089 rural and frontier residents (48.1%) (Table 3.11). Currently, 573,874 Nevadans or 20.3% of the population are enrolled in Nevada Medicaid, including 47,638 rural and frontier residents (16.7%) (Table 3.12). Between 2004 and 2014, Nevada Medicaid enrollment has increased by 374,388 or 187.7%, including enrollment growth of 26,879 (129.5%) in rural and frontier counties (Table 3.13). Nevada State Office of Rural Health 97

114 Between 2004 and 2014, Nevada Check Up (Nevada s Children s Health Insurance Program) enrollment has increased by 5,778 or 21.4% Nevada Check Up enrollment declined in 12 of 14 rural and frontier counties over the past decade (Table 3.14). Currently, 215 Nevada Check Up enrollees are under the age of 1 (0.7%), 7,825 are between the ages of 1 and 6 (23.8%), 16,164 are between the ages of 7 and 13 (49.2%), and 8,185 are between the ages of 14 and 18 (24.9%) (Table 3.15). In 2012, there were 429,566 Nevadans eligible for Medicare benefits, including 358,347 residents aged 65 and over (83.4%) and 71,219 disabled Nevadans (16.6%) (Table 3.16). In 2012, there were 60,046 rural and frontier resident of Nevada eligible for Medicare benefits, including 50,463 residents aged 65 and over (84.0%) and 9,583 disabled residents (16.0%) (Table 3.16). In 2012, 435,196 Nevadans were enrolled in Medicare Part A (100.0% of the Medicare-eligible population), 386,998 were enrolled in Medicare Part B (88.9%), 141,389 were enrolled Medicare Part C (32.5%), and 145,496 were enrolled in Medicare Part D (33.4%) (Tables 3.17 and 3.18). In 2012, 58,512 Nevadans residing in rural and frontier counties were enrolled in Medicare Part A (100.0% of the Medicare-eligible population), 55,221 were enrolled in Medicare Part B (94.4%), 10,684 were enrolled Medicare Part C (18.3%), and 24,097 were enrolled in Medicare Part D (41.2%) (Tables 3.17 and 3.18). Between 2000 and 2012, the Medicare-eligible population in Nevada has grown by 195,625 or 81.6% the rate of growth of this population was greater in rural and frontier areas (95.1%) than urban areas of the state (80.4%) (Table 3.19). In 2013, there were 102,495 Nevadans enrolled in the Veterans Health Administration this figure represents 45.4% of all veterans in Nevada (Tables 3.20 and 3.22). During 2013, 65,854 veterans in Nevada used health care services delivered by the Veterans Health Administration this figure represents 29.2% of all veterans in Nevada (Table 3.21 and 3.22). In 2013, there were 14,617 rural and frontier veterans enrolled in the Veterans Health Administration this figure represents 44.8% of all veterans residing in rural and frontier counties in Nevada (Tables 3.20 and 3.22). During 2013, 10,100 rural and frontier veterans in Nevada who used health care services delivered by the Veterans Health Administration this figure represents 30.9% of all veterans living in rural and frontier areas in Nevada (Tables 3.21 and 3.22). Over the past decade, the number of Native Americans using tribal health services in Nevada grew from 15,579 in 2003 to 19,152 an increase of 3,573 or 22.9% (Table 3.23). 98 Nevada State Office of Rural Health

115 In 2013, 9,081 patients (47.4% of all users) received health care services from tribal facilities located in rural and frontier counties of Nevada (Table 3.23). In terms of self-reported health status, risk factors to health, and utilization of preventive health services, there are substantial differences between rural and urban areas of Nevada. For example, residents of rural and frontier areas of the state report higher rates of obesity and higher levels of hypertension than do residents of urban areas (Tables 3.24 to 3.26). New data from the Centers for Disease Control and Prevention (CDC) provide information on county-level trends in diabetes incidence, obesity prevalence, and leisure-time physical inactivity prevalence in Nevada. For example, while obesity rates are generally lower in most Nevada counties compared to the U.S. rate of 28.7% of adults who are obese, county-level obesity prevalence ranges from 21.6% in Douglas County to 31.6% in Churchill County in 2011 (Tables 3.27 to 3.29). The National Survey on Drug Use and Health administered by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) yields current data on a wide-range of self-reported mental health and substance abuse indicators by region in Nevada. For example, rural and frontier counties report higher levels of cigarette and tobacco product use than urban counties (Table 3.30). The Nevada Office of Public Health Informatics and Epidemiology collects current data on indicators of infectious disease incidence (new cases) and prevalence (total cases) by region in Nevada. For example, in 2013, the number of new cases of chlamydia per 100,000 population is considerably lower in rural and frontier counties (218.9), as compared to Washoe County (391.2) and Clark County (428.9) (Tables 3.31 to 3.36). The Nevada Office of Public Health Informatics and Epidemiology collects a wide-range of data on indicators of maternal and child health by county and region in Nevada. For example, over the past three years, all but one county in Nevada reported a decline in teen pregnancy rates and 12 of 16 counties reported a decline in teen birth rates (Tables 3.37 to 3.45). The Nevada Department of Education (NDOE) collects data on childhood disabilities by county of residence, including data on autism spectrum disorders, learning disabilities, and speech/language/hearing impairment. In 2013, there were 50,332 total cases of childhood disability in Nevada, including 5,541 cases in rural and frontier Nevada (Table 3.46). The Nevada Office of Public Health Informatics and Epidemiology collects a wide-range of data on mortality and leading causes of death by county and region in Nevada (Tables 3.47 to 3.56). In 2013, the age-adjusted mortality rate for all causes of death in Nevada was deaths per 100,000 population rates declined in 10 of 17 counties since 2009 and currently range from in Storey County to 1,272.9 in Esmeralda County (Table 3.47). In 2013, the age-adjusted mortality rate for heart disease in Nevada was deaths per 100,000 population rates declined in 9 of 16 counties with available data since 2009 and currently range from 78.2 in Pershing County to in Eureka County (Table 3.48). Nevada State Office of Rural Health 99

116 In 2013, the age-adjusted mortality rate for malignant neoplasms (cancer) in Nevada was deaths per 100,000 population rates declined in 9 of 15 counties with available data since 2009 and currently range from 62.7 in Storey County to in Mineral County (Table 3.49). In 2013, the ten leading causes of death in Nevada were: (1) heart disease; (2) cancer; (3) chronic lower respiratory disease; (4) lung, trachea, and bronchus cancer; (5) cerebrovascular disease (stroke); (6) nontransport (pedestrian) accidents; (7) prostate cancer; (8) breast cancer; (9) influenza and pneumonia; and (10) Alzheimer s disease (Table 3.55). In 2013, the ten leading causes of death in rural and frontier Nevada were: (1) heart disease; (2) cancer; (3) chronic lower respiratory disease; (4) lung, trachea, and bronchus cancer; (5) cerebrovascular disease (stroke); (6) prostate cancer; (7) non-transport (pedestrian) accidents; (8) diabetes mellitus; (9) Alzheimer s disease; and (10) breast cancer (Table 3.55). For the past five years, the University of Wisconsin and the Robert Wood Johnson Foundation have ranked all U.S. counties in terms of health determinants (health behaviors, clinical care, social and economic factors, and physical environment) and health outcomes (length of life and quality of life). Among Nevada counties, Lincoln County is currently the healthiest county in Nevada and Nye County is the least healthy (Tables 3.57 and 3.58). 100 Nevada State Office of Rural Health

117 Table 3.1: Health Insurance Coverage for Population Under the Age of 65 in Nevada by County 2012 Uninsured Population Estimated Population Under the Aged of 65 Insured Population Number Percent Number Percent Total Population Aged 65 and Under Churchill County 4, , ,143 Douglas County 7, , ,061 Elko County 9, , ,791 Esmeralda County Eureka County , ,701 Humboldt County 3, , ,093 Lander County 1, , ,133 Lincoln County 1, , ,167 Lyon County 10, , ,817 Mineral County , ,541 Nye County 7, , ,764 Pershing County 1, , ,206 Storey County , ,999 White Pine County 1, , ,307 Region Subtotal 50, , ,305 Carson City 10, , ,579 Clark County 433, ,301, ,734,790 Washoe County 86, , ,174 Region Subtotal 530, ,615, ,145,543 Nevada Total 580, ,785, ,365,848 Source: United States Census Bureau (2014h). Nevada State Office of Rural Health 101

118 Table 3.2: Health Insurance Coverage for Population Under the Age of 65 at or Below 138% Federal Poverty Level (FPL) in Nevada by County 2012 Estimated Population Under the Age of 65 At or Below 138% FPL Above 138% FPL Total Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Total Churchill County 1, ,996 2, ,147 4, ,143 Douglas County 2, ,936 4, ,125 7, ,061 Elko County 3, ,238 6, ,553 9, ,791 Esmeralda County Eureka County , ,701 Humboldt County 1, ,122 2, ,971 3, ,093 Lander County ,296 1, ,133 Lincoln County , ,128 1, ,167 Lyon County 4, ,496 6, ,321 10, ,817 Mineral County , ,541 Nye County 3, ,744 4, ,020 7, ,764 Pershing County , ,151 1, ,206 Storey County , ,999 White Pine County , ,787 1, ,307 Region Subtotal 19, ,894 30, ,411 50, ,305 Carson City 4, ,608 6, ,971 10, ,579 Clark County 178, , , ,292, , ,734,790 Washoe County 35, ,650 50, ,524 86, ,174 Region Subtotal 218, , , ,602, , ,145,543 Nevada Total 237, , , ,775, , ,365,848 Source: United States Census Bureau (2014h). 102 Nevada State Office of Rural Health

119 Table 3.3: Health Insurance Coverage for Population Under the Age of 65 at or Below 250% Federal Poverty Level (FPL) in Nevada by County 2012 Estimated Population Under the Age of 65 At or Below 250% FPL Above 250% FPL Total Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Total Churchill County 3, ,539 1, ,604 4, ,143 Douglas County 4, ,448 2, ,613 7, ,061 Elko County 5, ,302 3, ,489 9, ,791 Esmeralda County Eureka County , ,701 Humboldt County 2, ,069 1, ,024 3, ,093 Lander County , ,368 1, ,133 Lincoln County , ,166 1, ,167 Lyon County 7, ,404 2, ,413 10, ,817 Mineral County , , ,541 Nye County 5, ,217 1, ,547 7, ,764 Pershing County , ,181 1, ,206 Storey County , , ,999 White Pine County , ,280 1, ,307 Region Subtotal 34, ,591 15, ,714 50, ,305 Carson City 7, ,828 3, ,751 10, ,579 Clark County 307, , , , , ,734,790 Washoe County 61, ,593 25, ,581 86, ,174 Region Subtotal 375, ,005, , ,139, , ,145,543 Nevada Total 410, ,099, , ,266, , ,365,848 Source: United States Census Bureau (2014h). Nevada State Office of Rural Health 103

120 Table 3.4: Health Insurance Coverage for Population Under the Age of 65 at or Below 400% of Federal Poverty Level (FPL) in Nevada by County 2012 Estimated Population Under the Age of 65 At or Below 400% FPL Above 400% FPL Total Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Total Churchill County 4, , ,923 4, ,143 Douglas County 6, ,099 1, ,962 7, ,061 Elko County 8, ,454 1, ,337 9, ,791 Esmeralda County Eureka County , ,701 Humboldt County 3, , ,526 3, ,093 Lander County , ,087 1, ,133 Lincoln County , ,063 1, ,167 Lyon County 9, , ,531 10, ,817 Mineral County , ,541 Nye County 7, , ,915 7, ,764 Pershing County , ,157 1, ,206 Storey County , , ,999 White Pine County 1, , ,436 1, ,307 Region Subtotal 44, ,499 5, ,806 50, ,305 Carson City 9, ,490 1, ,089 10, ,579 Clark County 389, ,223,189 44, , , ,734,790 Washoe County 77, ,115 9, ,059 86, ,174 Region Subtotal 475, ,499,794 54, , , ,145,543 Nevada Total 520, ,647,293 60, , , ,365,848 Source: United States Census Bureau (2014h). 104 Nevada State Office of Rural Health

121 Table 3.5: Health Insurance Coverage for Population Under the Age of 65 by Gender in Nevada by County 2012 Estimated Population Under the Age of 65 Male Female Total Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Total Churchill County 2, ,161 2, ,982 4, ,143 Douglas County 3, ,991 3, ,070 7, ,061 Elko County 5, ,715 4, ,076 9, ,791 Esmeralda County Eureka County ,701 Humboldt County 1, ,844 1, ,249 3, ,093 Lander County , ,514 1, ,133 Lincoln County , ,947 1, ,167 Lyon County 5, ,012 4, ,805 10, ,817 Mineral County , , ,541 Nye County 4, ,901 3, ,864 7, ,764 Pershing County , ,017 1, ,206 Storey County , , ,999 White Pine County , ,535 1, ,307 Region Subtotal 26, ,881 23, ,424 50, ,305 Carson City 5, ,315 4, ,264 10, ,579 Clark County 230, , , , , ,734,790 Washoe County 47, ,847 38, ,327 86, ,174 Region Subtotal 283, ,082, , ,062, , ,145,543 Nevada Total 310, ,194, , ,171, , ,365,848 Source: United States Census Bureau (2014h). Nevada State Office of Rural Health 105

122 Table 3.6: Health Insurance Coverage for Population Under the Age of 19 in Nevada by County 2012 Uninsured Estimated Population Under the Age of 19 Insured Number Percent Number Percent Total Population Under the Age of 19 Churchill County 1, , ,177 Douglas County 1, , ,215 Elko County 2, , ,139 Esmeralda County Eureka County Humboldt County , ,781 Lander County , ,651 Lincoln County , ,371 Lyon County 2, , ,504 Mineral County Nye County 1, , ,625 Pershing County , ,281 Storey County White Pine County , ,191 Region Subtotal 11, , ,063 Carson City 2, , ,036 Clark County 84, , ,704 Washoe County 17, , ,432 Region Subtotal 103, , ,172 Nevada Total 114, , ,235 Source: United States Census Bureau (2014h). 106 Nevada State Office of Rural Health

123 Table 3.7: Health Insurance Coverage for Population Under the Age of 19 at or Below 138% Federal Poverty Level (FPL) in Nevada by County 2012 Estimated Population Under the Age of 19 At or Below 138% FPL Above 138% FPL Total Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Total Churchill County , ,180 1, ,177 Douglas County , ,216 1, ,215 Elko County ,873 1, ,266 2, ,139 Esmeralda County Eureka County Humboldt County , , ,781 Lander County , ,651 Lincoln County ,371 Lyon County ,903 1, ,601 2, ,504 Mineral County Nye County , ,053 1, ,625 Pershing County ,281 Storey County White Pine County , ,191 Region Subtotal 4, ,009 6, ,054 11, ,063 Carson City ,972 1, ,064 2, ,036 Clark County 38, ,716 45, ,988 84, ,704 Washoe County 7, ,340 9, ,092 17, ,432 Region Subtotal 47, ,028 55, , , ,172 Nevada Total 52, ,037 62, , , ,235 Source: United States Census Bureau (2014h). Nevada State Office of Rural Health 107

124 Table 3.8: Health Insurance Coverage for Population Aged 18 to 64 in Nevada by County 2012 Estimated Population Aged 18 to 64 Uninsured Insured Total Population Number Percent Number Percent Aged 18 to 64 Churchill County 3, , ,315 Douglas County 5, , ,332 Elko County 7, , ,406 Esmeralda County Eureka County ,249 Humboldt County 2, , ,526 Lander County , ,568 Lincoln County , ,891 Lyon County 8, , ,956 Mineral County , ,716 Nye County 6, , ,655 Pershing County , ,999 Storey County , ,426 White Pine County 1, , ,230 Region Subtotal 40, , ,709 Carson City 8, , ,155 Clark County 356, , ,250,820 Washoe County 70, , ,688 Region Subtotal 435, ,117, ,552,663 Nevada Total 475, ,235, ,711,372 Source: United States Census Bureau (2014h). 108 Nevada State Office of Rural Health

125 Table 3.9: Health Insurance Coverage for Population Aged 18 to 64 at or Below 138% Federal Poverty Level (FPL) in Nevada by County 2012 Estimated Population Aged 18 to 64 At or Below 138% FPL Above 138% FPL Total Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Total Churchill County 1, ,123 2, ,192 3, ,315 Douglas County 2, ,046 3, ,286 5, ,332 Elko County 2, ,519 5, ,887 7, ,406 Esmeralda County Eureka County , ,249 Humboldt County 1, ,902 1, ,624 2, ,526 Lander County , ,568 Lincoln County , ,891 Lyon County 3, ,805 5, ,151 8, ,956 Mineral County , ,716 Nye County 2, ,354 3, ,301 6, ,655 Pershing County , ,999 Storey County , ,426 White Pine County ,286 1, ,230 Region Subtotal 15, ,858 24, ,851 40, ,709 Carson City 3, ,835 5, ,320 8, ,155 Clark County 142, , , , , ,250,820 Washoe County 28, ,719 41, ,969 70, ,688 Region Subtotal 174, , , ,211, , ,552,663 Nevada Total 189, , , ,339, , ,711,372 Source: United States Census Bureau (2014h). Nevada State Office of Rural Health 109

126 Table 3.10: Health Insurance Coverage for Population Aged 40 to 64 in Nevada by County 2012 Uninsured Estimated Population Aged 40 to 64 Insured Number Percent Number Percent Total Population Aged 40 to 64 Churchill County 1, , ,044 Douglas County 3, , ,720 Elko County 3, , ,416 Esmeralda County Eureka County Humboldt County 1, , ,744 Lander County , ,002 Lincoln County , ,711 Lyon County 4, , ,049 Mineral County , ,741 Nye County 3, , ,618 Pershing County , ,803 Storey County , ,735 White Pine County , ,101 Region Subtotal 19, , ,769 Carson City 3, , ,236 Clark County 150, , ,214 Washoe County 30, , ,010 Region Subtotal 184, , ,460 Nevada Total 204, , ,229 Source: United States Census Bureau (2014h). 110 Nevada State Office of Rural Health

127 Table 3.11: Health Insurance Coverage for Population Aged 40 to 64 at or Below 138% Federal Poverty Level (FPL) in Nevada by County 2012 Estimated Population Aged 40 to 64 At or Below 138% FPL Above 138% FPL Total Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Subtotal Number Uninsured Percent Uninsured Population Total Churchill County ,268 1, ,776 1, ,044 Douglas County 1, ,074 2, ,646 3, ,720 Elko County ,817 2, ,599 3, ,416 Esmeralda County Eureka County Humboldt County ,039 1, ,744 Lander County , ,002 Lincoln County , ,711 Lyon County 1, ,474 2, ,575 4, ,049 Mineral County , ,741 Nye County 1, ,467 2, ,151 3, ,618 Pershing County , ,803 Storey County , ,735 White Pine County , ,101 Region Subtotal 7, ,748 12, ,021 19, ,769 Carson City 1, ,866 2, ,370 3, ,236 Clark County 58, ,831 92, , , ,214 Washoe County 10, ,479 19, ,531 30, ,010 Region Subtotal 70, , , , , ,460 Nevada Total 77, , , , , ,229 Source: United States Census Bureau (2014h). Nevada State Office of Rural Health 111

128 Table 3.12: Medicaid Enrollment in Nevada by County 2011 to 2014 Number Medicaid Enrollment Percent of Population Number Percent of Population Number Percent of Population Number Percent of Population Churchill County 3, , , , Douglas County 3, , , , Elko County 5, , , , Esmeralda County Eureka County Humboldt County 1, , , , Lander County Lincoln County Lyon County 7, , , , Mineral County , Nye County 8, , , , Pershing County Storey County White Pine County 1, , , , Region Subtotal 33, , , , Carson City 9, , , , Clark County 272, , , , Washoe County 53, , , , Region Subtotal 335, , , , Nevada Total 368, , , , Source: Division of Health Care Financing and Policy (2014a). 112 Nevada State Office of Rural Health

129 Table 3.13: Medicaid Enrollment in Nevada by County 2004 to 2014 Number Medicaid Enrollment Change 2004 to 2014 Percent of Population Number Percent of Population Number Percent Churchill County 2, , , Douglas County 1, , , Elko County 3, , , Esmeralda County Eureka County Humboldt County 1, , , Lander County Lincoln County Lyon County 3, , , Mineral County , Nye County 4, , , Pershing County Storey County White Pine County , Region Subtotal 20, , , Carson City 6, , , Clark County 141, , , Washoe County 30, , , Region Subtotal 178, , , Nevada Total 199, , , Source: Division of Health Care Financing and Policy (2014a). Nevada State Office of Rural Health 113

130 Table 3.14: Nevada Check Up (Nevada s Children s Health Insurance Program) Enrollment in Nevada by County 2004 to 2014 Number Nevada Check Up Enrollment Change 2004 to 2014 Percent of Population Number Percent of Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal 3, , Carson City 1, , Clark County 18, , , Washoe County 4, , , Region Subtotal 23, , , Nevada Total 27, , , Source: Division of Health Care Financing and Policy (2014b). 114 Nevada State Office of Rural Health

131 Table 3.15: Nevada Check Up (Nevada s Children s Health Insurance Program) Enrollment by Age in Nevada by County 2014 Nevada Checkup Enrollment Under 1 Year Age 1 to 6 Age 7 to 13 Age 14 to 18 Number Percent Number Percent Number Percent Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal , ,679 Carson City ,101 Clark County , , , ,900 Washoe County , , , ,709 Region Subtotal , , , ,710 Nevada Total , , , ,389 Source: Division of Health Care Financing and Policy (2014b). Total Nevada State Office of Rural Health 115

132 Table 3.16: Population Eligible for Medicare Benefits Aged and Disabled in Nevada by County 2012 Aged Eligible Disabled Eligible Number Percent Number Percent Total Churchill County 4, ,210 Douglas County 11, , ,539 Elko County 4, , ,782 Esmeralda County Eureka County Humboldt County 1, ,449 Lander County Lincoln County ,072 Lyon County 9, , ,121 Mineral County 1, ,400 Nye County 11, , ,140 Pershing County Storey County ,017 White Pine County 1, ,876 Region Subtotal 50, , ,046 Carson City 10, , ,314 Clark County 237, , ,949 Washoe County 60, , ,257 Region Subtotal 307, , ,520 Nevada Total 358, , ,566 Source: Centers for Medicare and Medicaid Services (2014a). 116 Nevada State Office of Rural Health

133 Table 3.17: Number Enrolled in Medicare by Program Part in Nevada by County 2012 Total Medicare Enrollment Number Part A Part B Part C Part D Churchill County 5,015 5,013 4, ,131 Douglas County 12,685 12,685 11,712 1,044 6,404 Elko County 5,520 5,520 5, ,856 Esmeralda County Eureka County Humboldt County 2,281 2,280 2, ,196 Lander County Lincoln County 1,024 1,024 1, Lyon County 12,083 12,083 11,137 2,411 4,823 Mineral County 1,263 1,263 1, Nye County 13,631 13,630 13,194 6,274 3,145 Pershing County Storey County 1,044 1, White Pine County 1,703 1,703 1, Region Subtotal 58,519 58,512 55,221 10,684 24,097 Carson City 12,005 12,000 11, ,256 Clark County 291, , , ,464 88,899 Washoe County 73,660 73,660 64,612 21,281 26,244 Region Subtotal 376, , , , ,399 Nevada Total 435, , , , ,496 Source: Centers for Medicare and Medicaid Services (2014a). Centers for Medicare and Medicaid Services (2014b). Centers for Medicare and Medicaid Services (2014c). Nevada State Office of Rural Health 117

134 Table 3.18: Percent Enrolled in Medicare by Program Part in Nevada by County 2012 Total Medicare Enrollment Percent Part A Part B Part C Part D Churchill County 5, Douglas County 12, Elko County 5, Esmeralda County Eureka County Humboldt County 2, Lander County Lincoln County 1, Lyon County 12, Mineral County 1, Nye County 13, Pershing County Storey County 1, White Pine County 1, Region Subtotal 58, Carson City 12, Clark County 291, Washoe County 73, Region Subtotal 376, Nevada Total 435, Source: Centers for Medicare and Medicaid Services (2014a). Centers for Medicare and Medicaid Services (2014b). Centers for Medicare and Medicaid Services (2014c). 118 Nevada State Office of Rural Health

135 Table 3.19: Medicare-eligible Population in Nevada by County 2000 to 2012 Medicare-eligible Population Change 2000 to Number Percent Churchill County 3,167 5,015 1, Douglas County 5,793 12,685 6, Elko County 2,999 5,520 2, Esmeralda County Eureka County Humboldt County 1,501 2, Lander County Lincoln County 781 1, Lyon County 5,641 12,083 6, Mineral County 1,118 1, Nye County 6,862 13,631 6, Pershing County Storey County 165 1, White Pine County 1,389 1, Region Subtotal 30,778 58,519 27, Carson City 9,770 12,005 2, Clark County 159, , , Washoe County 40,054 73,660 33, Region Subtotal 208, , , Nevada Total 239, , , Source: Centers for Medicare and Medicaid Services (2014a). Centers for Medicare and Medicaid Services (2014b). Centers for Medicare and Medicaid Services (2014c). Aging and Disability Services (2014). Nevada State Office of Rural Health 119

136 Table 3.20: Enrollment in the Veterans Health Administration by Gender in Nevada by County 2013 Enrollment in Veterans Health Administration Male Female Total Number Percent Number Percent Churchill County 1, ,794 Douglas County 2, ,202 Elko County 1, ,337 Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County 3, ,421 Mineral County Nye County 3, ,792 Pershing County Storey County White Pine County Region Subtotal 13, ,617 Carson City 2, ,752 Clark County 61, , ,468 Washoe County 17, , ,658 Region Subtotal 81, , ,878 Nevada Total 94, , ,495 Source: United States Department of Veterans Health Administration (2014). 120 Nevada State Office of Rural Health

137 Table 3.21: Users of the Veterans Health Administration by Gender in Nevada by County 2013 Users of Veterans Health Administration Male Female Total Number Percent Number Percent Churchill County 1, ,192 Douglas County 1, ,528 Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County 2, ,529 Mineral County Nye County 2, ,609 Pershing County Storey County White Pine County Region Subtotal 9, ,100 Carson City 1, ,914 Clark County 37, , ,490 Washoe County 12, ,350 Region Subtotal 51, , ,754 Nevada Total 60, , ,854 Source: United States Department of Veterans Health Administration (2014). Nevada State Office of Rural Health 121

138 Table 3.22: Enrollment and Users of the Veterans Health Administration as a Percent of Veteran Population in Nevada by County 2013 Number Enrollees Percent of Veteran Population Number Users Percent of Veteran Population Veteran Population Churchill County 1, , ,959 Douglas County 2, , ,644 Elko County 1, ,156 Esmeralda County Eureka County Humboldt County ,508 Lander County Lincoln County Lyon County 3, , ,840 Mineral County Nye County 3, , ,115 Pershing County Storey County White Pine County ,257 Region Subtotal 14, , ,643 Carson City 2, , ,732 Clark County 66, , ,818 Washoe County 18, , ,714 Region Subtotal 87, , ,264 Nevada Total 102, , ,907 Source: United States Department of Veterans Health Administration (2014). 122 Nevada State Office of Rural Health

139 Table 3.23: Users of Tribal Health Services in Nevada by County 2003 to 2013 Users of Tribal Health Services Change 2003 to Number Percent Churchill County 1,295 1, Douglas County Elko County 2,831 3, Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County 975 1, Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal 8,057 9,081 1, Carson City 1,047 1, Clark County 1,393 2,793 1, Washoe County 5,082 6,104 1, Region Subtotal 7,522 10,071 2, Nevada Total 15,579 19,152 3, Source: Phoenix Area Indian Health Service (2014). Nevada State Office of Rural Health 123

140 Table 3.24: Self-reported Chronic Conditions in Nevada by Region 2013 Indicator Rural and Frontier Counties Percent of Population Aged 18 and Over Carson City Clark County Washoe County Nevada Asthma, Still Have Asthma, Ever Had Blood Cholesterol, Told Was High Coronary Heart Disease, Ever Diagnosed Diabetes, Ever Told by Doctor Diabetes, Now Taking Insulin Heart Attack, Ever Diagnosed Hypertension, Ever Been Told Stroke, Ever Diagnosed Source: Office of Health Statistics and Surveillance (2014a). United States 124 Nevada State Office of Rural Health

141 Table 3.25: Self-reported Lifestyle and Behavioral Risk Factors to Health in Nevada by Region 2013 Indicator Rural and Frontier Counties Percent of Population Aged 18 and Over Carson City Clark County Washoe County Nevada Alcohol, Binge Drinking, 5+, Single Occasion Alcohol, Heavy Drinking, Daily, 3+ M, 2+ W Fruits and Vegetables, Not Enough Overweight or Obese, Body Mass Index (BMI) Obesity, Body Mass Index (BMI) Physical Activity or Exercise in Last 30 Days Seatbelt Usage Smoking, Current Smoker Smoking, Former Smoker Source: Office of Health Statistics and Surveillance (2014a). United States Nevada State Office of Rural Health 125

142 Table 3.26: Self-reported Health Status and Health Care Access in Nevada by Region 2013 Indicator Rural and Frontier Counties Percent of Population Aged 18 and Over Carson City Clark County Washoe County Nevada Activity Limitation Due to Health Disability, Use Aid Equipment Flu Vaccine, Within Past 12 Months Flu Vaccine, Past 12 Months, Aged Health Status in General, Fair or Poor Health Care Coverage, Percent Uninsured HIV/AIDS Test, Ever Had Mammogram, Past 2 Years Mammogram, Ever Had, Aged Oral Health, 6+ Permanent Teeth Removed, Aged Oral Health, Visited Dentist in Past Year Pap Smear, Had Within Past Year Pneumonia Vaccine, Ever Had Pneumonia Vaccine, Aged 65+, Ever Had Sigmoidoscopy or Colonoscopy, Ever Had Source: Office of Health Statistics and Surveillance (2014a). United States 126 Nevada State Office of Rural Health

143 Table 3.27: Diabetes Incidence in Nevada by County 2004 to 2011 Number of New Cases of Diabetes per 1,000 Population (Age-adjusted) Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total U.S. Total Source: Centers for Disease Control and Prevention (2014a). Nevada State Office of Rural Health 127

144 Table 3.28: Obesity Prevalence in Nevada by County 2004 to 2011 Percent of Population Aged 18 and Over Who are Obese (Age-adjusted) Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total U.S. Total Source: Centers for Disease Control and Prevention (2014b). 128 Nevada State Office of Rural Health

145 Table 3.29: Physical Inactivity Prevalence in Nevada by County 2004 to 2011 Percent of Population Aged 18 and Over Reporting No Participation in Leisure-time Physical Activity (Age-adjusted) Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total U.S. Total Source: Centers for Disease Control and Prevention (2014c). Nevada State Office of Rural Health 129

146 Table 3.30: Self-reported Substance Abuse and Mental Illness Among Population Aged 12 and Over in Nevada by Region 2012 Indicator Rural and Frontier Counties Percent of Population Aged 12 and Over West Counties Clark County Washoe County Nevada Alcohol Use in Past Month Among Persons Aged 12 to Alcohol Use in Past Month Alcohol Binge Use in Past Month Among Persons Aged 12 to Alcohol, Binge Use in Past Month Alcohol Dependence in Past Year Alcohol Dependence or Abuse in Past Year Cigarette Use in Past Month Cocaine Use in Past Year Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year Illicit Drug Dependence in Past Year Illicit Drug Dependence or Abuse in Past Year Illicit Drugs Other than Marijuana, Used in Past Month Illicit Drug Use in Past Month Marijuana, Average Annual Rate of First Use Marijuana, Used in Past Month Marijuana, Use in Past Year Mental Health, Serious Adults Mental Illness, Any Adult Mental Illness, One+ Major Depressive Episode in Past Year Pain Relievers, Nonmedical Use of in Past Year Perceptions of Great Risk of Having Five or More Drinks Perceptions of Great Risk of Daily Smoking Perceptions of Great Risk of Smoking Marijuana Once a Month Suicide, Serious Thoughts in Past Year Tobacco Product Use in Past Month Treatment, Needing for Alcoholism in Past Year Treatment, Needing for Illicit Drug Use in Past Year Source: National Survey on Drug Use and Health (2014). United States 130 Nevada State Office of Rural Health

147 Table 3.31: Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Incidence and Prevalence in Nevada by Region 2013 Indicator New AIDS Diagnosis (New Cases) Rural and Frontier Counties AIDS and HIV Incidence and Prevalence Clark County Washoe County Nevada Number Percent of Total Cases Number per 100,000 Population New HIV Infections (New Cases) Number Percent of Total Cases Number per 100,000 Population Persons Living with HIV/AIDS (Total Cases to Date) Number 412 7, ,155 Percent of Total Cases Number per 100,000 Population Source: Office of Health Statistics and Surveillance (2014b). Nevada State Office of Rural Health 131

148 Table 3.32: Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Incidence and Prevalence in Nevada by Region 2009 to 2013 Indicator AIDS and HIV Prevalence (Total Cases to Date) Change 2009 to Number Percent Persons Living with HIV/AIDS Counties Clark County 6,867 7,105 7,284 7,515 7, Washoe County Nevada 8,172 8,390 8,563 8,792 9, AIDS and HIV Prevalence per 100,000 Population Counties Clark County Washoe County Nevada Source: Office of Health Statistics and Surveillance (2014b). 132 Nevada State Office of Rural Health

149 Table 3.33: Sexually Transmitted Disease (STD) Incidence in Nevada by Region 2013 Indicator Primary and Secondary Syphilis Rural and Frontier Counties Sexually Transmitted Disease (STD) Incidence (New Cases) Carson City/Douglas/ Lyon Counties Clark County Washoe County Nevada Number Percent of Total Cases Number per 100,000 Population Gonorrhea Number , ,549 Percent of Total Cases Number per 100,000 Population Chlamydia Number ,614 1,686 11,107 Percent of Total Cases Number per 100,000 Population Source: Office of Health Statistics and Surveillance (2014c). Nevada State Office of Rural Health 133

150 Table 3.34: Sexually Transmitted Disease (STD) Incidence in Nevada by Region 2009 to 2013 Indicator Sexually Transmitted Disease (STD) Incidence (New Cases) Change 2009 to Number Percent Primary and Secondary Syphilis All other Counties Carson City/Douglas/Lyon Counties Clark County Washoe County Nevada Gonorrhea All Other Counties Carson City/Douglas/Lyon Counties Clark County 1,553 1,511 1,740 1,968 2, Washoe County Nevada 1,727 1,645 2,010 2,268 2, Chlamydia All Other Counties Carson City/Douglas/Lyon Counties Clark County 8,183 7,362 8,336 8,589 8, Washoe County 1,254 1,429 1,490 1,629 1, Nevada 10,059 9,430 10,528 11,158 11,107 1, Source: Office of Health Statistics and Surveillance (2014c). 134 Nevada State Office of Rural Health

151 Table 3.35: Tuberculosis Incidence in Nevada by Region 2013 Indicator Rural and Frontier Counties Tuberculosis Incidence (New Cases) Carson City Clark County Washoe County Nevada Number Percent of Total Cases Number per 100,000 Population Source: Office of Health Statistics and Surveillance (2014d). Nevada State Office of Rural Health 135

152 Table 3.36: Tuberculosis Prevalence in Nevada by Region 2009 to 2013 Tuberculosis Prevalence (Total Cases to Date) Total Indicator Change Percent Tuberculosis Prevalence Counties Carson City Clark County Washoe County Nevada Tuberculosis Prevalence per 100,000 Population Counties Carson City Clark County Washoe County Nevada Source: Office of Health Statistics and Surveillance (2014d). 136 Nevada State Office of Rural Health

153 Table 3.37: Maternal Health Behaviors and Birth Outcomes in Nevada by Region of Residence 2013 Indicator Rural and Frontier Counties Maternal Health Behaviors and Birth Outcome Rates (Percent) Carson City Clark County Washoe County Nevada Women Receiving Prenatal Care in First Trimester Pregnant Women Abstaining from Alcohol Consumption Pregnant Women Abstaining from Smoking Live Births Below 2,500 Grams Births Prior to 37 Weeks of Gestation Infant Mortality Rate, per 1,000 Live Births Source: Office of Health Statistics and Surveillance (2014e). Nevada State Office of Rural Health 137

154 Neonatal Mortality Table 3.38: Neonatal, Post-neonatal, and Infant Mortality in Nevada by Region of Residence 2013 Indicator Rural and Frontier Counties Clark County Infant Mortality Washoe County Nevada Number of Deaths (1-28 Days) Percent of Total Cases Number per 1,000 Live Births Post-neonatal Mortality Number of Deaths ( Days) Percent of Total Cases Number per 1,000 Live Births Infant Mortality Number of Deaths (1-365 Days) Percent of Total Cases Number per 1,000 Live Births Source: Office of Health Statistics and Surveillance (2014e). 138 Nevada State Office of Rural Health

155 Table 3.39: Birth Rates for Female Population in Nevada by County of Residence 2010 to 2013 Number of Live Births per 1,000 Female Population Change 2010 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). Nevada State Office of Rural Health 139

156 Table 3.40: Teen Pregnancy Rates for Female Population Aged 15 to 17 in Nevada by County of Residence 2010 to 2012 Number of Pregnancies per 1,000 Females Aged 15 to 17 Change 2010 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County 49.3 Nye County Pershing County 67.0 Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). 140 Nevada State Office of Rural Health

157 Table 3.41: Teen Pregnancy Rates for Female Population Aged 18 to 19 in Nevada by County of Residence 2010 to 2012 Number of Pregnancies per 1,000 Females Aged 18 to 19 Change 2010 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). Nevada State Office of Rural Health 141

158 Table 3.42: Teen Pregnancy Rates for Female Population Aged 15 to 19 in Nevada by County of Residence 2010 to 2012 Number of Pregnancies per 1,000 Females Aged 15 to 19 Change 2010 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). 142 Nevada State Office of Rural Health

159 Table 3.43: Teen Birth Rates for Female Population Aged 15 to 17 in Nevada by County of Residence 2010 to 2013 Number of Live Births per 1,000 Females Aged 15 to 17 Change 2010 to Number Percent Churchill County Douglas County 9.3 Elko County Esmeralda County Eureka County Humboldt County Lander County 33.3 Lincoln County Lyon County Mineral County 19.7 Nye County Pershing County 55.8 Storey County White Pine County 29.2 Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). Nevada State Office of Rural Health 143

160 Table 3.44: Teen Birth Rates for Female Population Aged 18 to 19 in Nevada by County of Residence 2010 to 2013 Number of Live Births per 1,000 Females Aged 18 to 19 Change 2010 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). 144 Nevada State Office of Rural Health

161 Table 3.45: Teen Birth Rates for Female Population Aged 15 to 19 in Nevada by County of Residence 2010 to 2013 Number of Live Births per 1,000 Females Aged 15 to 19 Change 2010 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). Nevada State Office of Rural Health 145

162 Table 3.46: Childhood Disability by Type of Disability in Nevada by County of Residence 2013 Autism Spectrum Disorder Developmentally Delayed Emotional Disturbance Number of Disabled Children Intellectual Disability Learning Disability Speech/ Language/ Hearing Impairment Other Impairment Disabilities Churchill County Douglas County Elko County ,085 Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County ,042 Mineral County Nye County Pershing County Storey County 1, White Pine County Region Subtotal ,640 1, ,541 Carson City Clark County 3,611 3,940 1,292 1,373 14,734 5,197 3,800 33,947 Washoe County ,969 1,519 1,191 8,627 Region Subtotal 4,171 4,800 1,618 1,729 19,114 6,991 5,150 43,573 Charter Schools ,215 Nevada Total 4,676 5,333 1,884 1,967 22,271 8,270 5,931 50,332 Source: Nevada Department of Education (2014c). Total 146 Nevada State Office of Rural Health

163 Table 3.47: Mortality for All Causes in Nevada by County of Residence 2009 to 2013 Number of Deaths per 100,000 Population (Age-adjusted) Change 2009 to Number Percent Churchill County 1, , , Douglas County Elko County Esmeralda County , , Eureka County , Humboldt County Lander County Lincoln County Lyon County Mineral County 1, , , Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). Nevada State Office of Rural Health 147

164 Table 3.48: Heart Disease Mortality in Nevada by County of Residence 2009 to 2013 Number of Heart Disease Deaths per 100,000 Population (Age-adjusted) Change 2009 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). 148 Nevada State Office of Rural Health

165 Table 3.49: Malignant Neoplasm (Cancer) Mortality in Nevada by County of Residence 2009 to 2013 Number of Cancer Deaths per 100,000 Population (Age-adjusted) Change 2009 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). Nevada State Office of Rural Health 149

166 Table 3.50: Chronic Lower Respiratory Disease (CLRD) Mortality in Nevada by County of Residence 2009 to 2013 Number of CLRD Deaths per 100,000 Population (Age-adjusted) Change 2009 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County 80.9 Lincoln County 65.2 Lyon County Mineral County Nye County Pershing County Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). 150 Nevada State Office of Rural Health

167 Table 3.51: Lung, Trachea, and Bronchus Cancer (LTBC) Mortality in Nevada by County of Residence 2009 to 2013 Number of LTBC Deaths per 100,000 Population (Age-adjusted) Change 2009 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County 82.0 Storey County White Pine County Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). Nevada State Office of Rural Health 151

168 Table 3.52: Cerebrovascular Disease (Stroke) Mortality in Nevada by County of Residence 2009 to 2013 Number of Stroke Deaths per 100,000 Population (Age-adjusted) Change 2009 to Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County 35.0 Lander County Lincoln County Lyon County Mineral County Nye County Pershing County 81.7 Storey County White Pine County 41.8 Carson City Clark County Washoe County Nevada Total Source: Office of Health Statistics and Surveillance (2014e). 152 Nevada State Office of Rural Health

169 Table 3.53: Mortality Rates by Cause of Death in Nevada by Region of Residence 2013 Cause of Death Number of Deaths per 100,000 Population (Age-adjusted) Rural and Frontier Counties Carson City Clark County Washoe County Nevada Alzheimer s Disease Atherosclerosis Benign Neoplasms Breast Cancer (Women) Cerebrovascular Diseases (Stroke) Chronic Liver Disease and Cirrhosis Chronic Lower Respiratory Disease Colorectal Cancer Diabetes Mellitus Diseases of the Heart, Total Essential Hypertensive Renal Homicide, Assault Human Immunodeficiency Virus (HIV) Influenza and Pneumonia Lip, Oral Cavity, and Pharynx Cancer Lung, Trachea, and Bronchus Cancer Malignant Neoplasms, Total Melanoma (Skin Cancer) Nephritis, Nephrotic Syndrome, Nephrosis Parkinson s Disease Pedestrian Deaths (Non-transport) Pneumonitis Due to Solids and Liquids Prostate Cancer (Men) Septicemia Suicide, Intentional Self Harm Transport Accidents Total Mortality All Causes Source: Office of Health Statistics and Surveillance (2014e). Nevada State Office of Rural Health 153

170 Table 3.54: Mortality Rates by Cause of Death in Nevada 2009 to 2013 Number of Deaths per 100,000 Population (Age-adjusted) Change 2009 to Number Percent Alzheimer s Disease Atherosclerosis Benign Neoplasms Breast Cancer (Women) Cerebrovascular Diseases (Stroke) Chronic Liver Disease and Cirrhosis Chronic Lower Respiratory Disease Colorectal Cancer Diabetes Mellitus Diseases of the Heart, Total Essential Hypertensive Renal Homicide, Assault Human Immunodeficiency Virus (HIV) 2.1 Influenza and Pneumonia Lip, Oral Cavity, and Pharynx Cancer Lung, Trachea, and Bronchus Cancer Malignant Neoplasms, Total Melanoma (Skin Cancer) Nephritis, Nephrotic Syndrome, Nephrosis Parkinson s Disease Pedestrian Deaths (Non-transport) Pneumonitis Due to Solids and Liquids Prostate Cancer (Men) Septicemia Suicide, Intentional Self Harm Transport Accidents Total Mortality All Causes Source: Office of Health Statistics and Surveillance (2014e). 154 Nevada State Office of Rural Health

171 Table 3.55: Leading Causes of Death in Nevada by Region of Residence 2013 Cause of Death Rural and Frontier Counties Leading Causes of Death Rank Within Region Carson City Clark County Washoe County Diseases of the Heart, Total Malignant Neoplasms, Total Chronic Lower Respiratory Disease Lung, Trachea, and Bronchus Cancer Cerebrovascular Disease (Stroke) Nevada Prostate Cancer (Men) Non-transport Accidents (Pedestrian)Deaths) Diabetes Mellitus Alzheimer's Disease Breast Cancer (Women) Suicide, Intentional Self Harm Influenza and Pneumonia Chronic Liver Disease and Cirrhosis Colorectal Cancer Transport Accidents Essential Hypertensive Renal Nephritis, Nephrotic Syndrome, Nephrosis Septicemia Parkinson's Disease Pneumonitis Due to Solids and Liquids Atherosclerosis Homicide, Assault Lip, Oral Cavity, and Pharynx Cancer Benign Neoplasms Melanoma (Skin Cancer) Human Immunodeficiency Virus (HIV) Source: Office of Health Statistics and Surveillance (2014e). Nevada State Office of Rural Health 155

172 Socio-demographic Status Gender Table 3.56: Mortality by Socio-demographic Status in Nevada by Region of Residence 2013 Rural and Frontier Counties Number of Deaths per 100,000 Population (Age-adjusted) Carson City Clark County Washoe County Nevada Male , , Female Race and Ethnicity White Black , Native American Asian Hispanic Total Mortality Source: Office of Health Statistics and Surveillance (2014e). 156 Nevada State Office of Rural Health

173 Table 3.57: Population Health Institute s County Health Rankings in Nevada Health Outcomes 2014 County Rank Mortality Length of Life Health Outcomes Morbidity Quality of Life Overall Rank Health Outcomes 1 Storey Lincoln Lincoln 2 Lincoln Humboldt Storey 3 Douglas Churchill Douglas 4 Washoe Carson City Washoe 5 Lyon Washoe Carson City 6 Clark Elko Elko 7 Elko Eureka Lyon 8 Carson City Douglas Clark 9 Pershing White Pine Humboldt 10 Eureka Clark Eureka 11 Churchill Lyon Churchill 12 Humboldt Lander Pershing 13 Lander Mineral White Pine 14 White Pine Pershing Lander 15 Mineral Storey Mineral 16 Nye Nye Nye Source: County Health Rankings (2014). Nevada State Office of Rural Health 157

174 County Rank Table 3.58: Population Health Institute s County Health Rankings in Nevada Health Determinants 2014 Health Behaviors Clinical Care Health Determinants Social and Economic Factors Physical Environment Overall Rank Health Determinants 1 Lander Douglas Eureka Eureka Douglas 2 Douglas White Pine Elko Lander Eureka 3 Lincoln Washoe Lander White Pine Lander 4 Washoe Carson City Douglas Elko White Pine 5 White Pine Eureka Storey Carson City Storey 6 Carson City Elko Humboldt Washoe Elko 7 Storey Clark White Pine Mineral Washoe 8 Clark Storey Churchill Pershing Lincoln 9 Eureka Churchill Lincoln Humboldt Humboldt 10 Humboldt Nye Washoe Lyon Carson City 11 Churchill Lyon Lyon Nye Churchill 12 Pershing Lincoln Clark Churchill Clark 13 Elko Humboldt Pershing Lincoln Lyon 14 Lyon Lander Carson City Douglas Pershing 15 Nye Mineral Mineral Clark Nye 16 Mineral Pershing Nye Storey Mineral Source: County Health Rankings (2014). 158 Nevada State Office of Rural Health

175 Nevada Health Data Book Section Four: Health Care Workforce in Nevada Highlights and Key Findings Currently, there are 1.37 million Nevadans in the state s labor force, including 1.26 million who are employed and 112,617 who are unemployed the annualized unemployment rate for 2014 is 8.2% (Table 4.1). In 2014, the average annual unemployment rate ranged from 3.1% in Esmeralda County to 11.5% in Lyon County across most rural counties, unemployment rates increased between 2004 and 2010, and have declined between 2010 and 2014 (Table 4.2). In 2013, there were an estimated 96,484 Nevadans employed in the health sector, including 6,276 in rural and frontier counties 7.0% of the state s workforce is employed in hospitals, outpatient settings, nursing homes, pharmacies, and other industries in the health sector (Table 4.3). In 2013, Nevadans employed in the health sector earned $5.5 billion in payroll, including $287.8 million by rural Nevadans (Table 4.4). In 2014, there were an estimated 105,692 Nevadans employed in the health care and social services sector, including 44,259 employed in ambulatory health care services (41.9%), 32,148 employed in hospitals (30.4%), and 12,198 employed in nursing and residential care facilities (11.5%) (Table 4.5). In 2014, there were an estimated 6,064 individuals employed in the health care and social services sector in rural and frontier counties of Nevada, including 2,305 employed in ambulatory health care services (38.0%), 2,154 employed in hospitals (35.5%), and 1,006 employed in nursing and residential care facilities (16.6%) (Table 4.5). In 2024, there will be a projected 121,132 Nevadans employed in the health care and social services sector, including 50,441 employed in ambulatory health care services (41.6%), 35,243 employed in hospitals (29.1%), and 13,958 employed in nursing and residential care facilities (11.5%) (Table 4.6). In 2024, there were an estimated 7,487 individuals employed in the health care and social services sector in rural and frontier counties of Nevada, including 2,843 employed in ambulatory health care services (38.0%), 2,179 employed in hospitals (29.1%), and 1,223 employed in nursing and residential care facilities (16.3%) (Table 4.6). In 2014, there were 4,874 licensed allopathic physicians (MDs) in Nevada or MDs per 100,000 population, including 207 licensed MDs in rural and frontier counties or 72.8 MDs per 100,000 population (Table 4.7). Nevada State Office of Rural Health 159

176 Over the past decade, the number of licensed MDs in Nevada increased from 3,616 in 2004 to 4,874 in 2014 an increase of 1,258 or 34.8% (Table 4.7). Since 2004, the number of licensed MDs per 100,000 population in Nevada increased from in 2004 to in 2014 an increase of 14.9%; however, the number of MDs per capita in rural and frontier counties declined by 9.6% during the same period (Table 4.7). In 2014, 11.1% of licensed MDs in Nevada completed their undergraduate medical education (UME) at the University of Nevada School of Medicine (UNSOM) 14.5% of rural and frontier MDs completed their UME at UNSOM (Table 4.8). In 2014, 10.9% of licensed MDs in Nevada completed their graduate medical education (GME) at the University of Nevada School of Medicine (UNSOM) only 5.3% of rural and frontier MDs completed their GME at UNSOM (Table 4.8). In 2014, there were 595 licensed osteopathic physicians (DOs) in Nevada, including 45 DOs in rural and frontier counties since 2006, the number of DOs in Nevada has increased by 147 or 32.8% and the per capita number of DOs has grown from 17.1 to 21.0 per 100,000 population (22.8%) (Table 4.9). In 2014, there were 2,442 licensed primary care physicians in Nevada (2,127 MDs and 315 DOs), including 141 primary care physicians (111 MDs and 30 DOs) in rural and frontier counties the per capita number of primary care physicians in rural and frontier counties is 49.6 per 100,000 population, as compared to 90.4 per 100,000 population in urban areas (Table 4.10). In 2014, there were 901 advanced practitioners of nursing (APNs) in Nevada, including 56 APNs in rural and frontier counties the per capita number of APNs in rural and frontier counties is 19.7 per 100,000 population, as compared to 33.2 per 100,000 population in urban areas (Table 4.11). Over the past decade, the number of APNs in Nevada has increased from 382 in 2004 to 901 in 2014 (135.9%) and the per capita number of APNs in Nevada has increased by 101.9% during the same period (Table 4.11). In 2014, there were 571 physician assistants (PAs) in Nevada, including 40 PAs in rural and frontier counties the per capita number of PAs in rural and frontier counties is 14.1 per 100,000 population, as compared to 20.9 per 100,000 population in urban areas (Table 4.12). Over the past decade, the number of physician assistants (PAs) in Nevada has increased from 302 in 2004 to 571 in 2014 (89.1%) and the per capita number of PAs in Nevada has increased by 61.6% during the same period (Table 4.12). Currently, there are 21,563 licensed registered nurses (RNs) who reside in Nevada, including 1,475 RNs in rural and frontier counties (8,445 RNs licensed by the State of Nevada reside out of state) (Table 4.13). Over the past decade, the number of licensed registered nurses (RNs) has increased from 14,825 in 2004 to 21,563 in 2014 (45.5%) and the per capita number of RNs in Nevada has increased 24.0% during the same period (Table 4.13). 160 Nevada State Office of Rural Health

177 At the county level, the number of RNs per 100,000 population currently ranges from 48.6 in Eureka County to in Washoe County the average for rural and frontier counties is RNs per 100,000 population, as compared to in urban counties (Table 4.13). In 2014, there were 2,977 licensed practical nurses (LPNs) in Nevada, including 219 LPNs in rural and frontier counties since 2004, the number of LPNs in Nevada has increased by 392 or 15.2%, yet the per capita number of LPNs has declined from to per 100,000 population during the same period (-1.9%) (Table 4.14). In 2014, there were 86 certified registered nurses anesthetists (CRNAs) in Nevada, including 15 CRNAs in rural and frontier counties since 2004, the number of CRNAs in Nevada has increased by 27 or 45.8% and the per capita number of CRNAs has grown from 2.4 to 3.0 per 100,000 population (25.0%) (Table 4.15). In 2014, there were 124 registered nurses with emergency medical services certification (EMS/RNs) in Nevada, including 23 EMS/RNs in rural and frontier counties since 2004, the number of EMS/RNs in Nevada has decreased by 9 or -6.8% and the per capita number of EMS/RNs has declined from 5.5 to 4.4 per 100,000 population (-20.0%) (Table 4.16). In 2014, there were 7,863 certified nursing assistants (CNAs) in Nevada, including 930 CNAs in rural and frontier counties since 2004, the number of CNAs in Nevada has increased by 2,217 or 39.3% and the per capita number of CNAs has grown from to per 100,000 population (18.7%) (Table 4.17). Currently, there are 1,553 licensed dentists in Nevada, including 108 dentists in rural and frontier counties (Table 4.18). Over the past decade, the number of licensed dentists has increased from 1,091 in 2004 to 1,553 in 2014 (42.3%) and the per capita number of dentists in Nevada has increased 21.2% during the same period (Table 4.18). At the county level, the number of dentists per 100,000 population currently ranges from 15.2 in Lander County to 63.9 in Carson City (Esmeralda and Storey counties have no dentists) the average for rural and frontier counties is 38.0 dentists per 100,000 population, as compared to 56.8 in urban counties (Table 4.18). In 2014, there were 1,047 licensed dental hygienists in Nevada, including 104 dental hygienists in rural and frontier counties since 2004, the number of dental hygienists in Nevada has increased by 56 or 5.7%, yet the per capita number of dental hygienists has declined from 41.1 to 37.0 per 100,000 population (-10.0%) (Table 4.19). In 2014, there were 1,227 licensed alcohol, drug, and gambling counselors in Nevada, including 158 licensed alcohol, drug, and gambling counselors in rural and frontier counties since 2004, the number of licensed alcohol, drug, and gambling counselors in Nevada has decreased by 6 or -0.5% and the per capita number of licensed alcohol, drug, and gambling counselors has declined from 45.0 to 43.4 per 100,000 population (-3.6%) (Table 4.20). Nevada State Office of Rural Health 161

178 In 2012, there were 669 licensed marriage and family therapists (MFTs) in Nevada, including 49 MFTs in rural and frontier counties since 2010, the number of MFTs in Nevada has increased by 34 or 5.4% and the per capita number of MFTs has increased from 23.5 to 24.3 MFTs per 100,000 population (3.4%) (Table 4.21). In 2012, there were 47 licensed clinical professional counselors (LCPCs) in Nevada, including 8 LCPCs in rural and frontier counties since 2010, the number of LCPCs in Nevada has increased by 19 or 67.9% and the per capita number of LCPCs has increased from 12.7 to 20.4 LCPCs per 100,000 population (60.6%) (Table 4.22). In 2014, there were 602 licensed clinical social workers (LCSWs) in Nevada, including 42 LCSWs in rural and frontier counties the average for rural and frontier counties is 14.8 LCSWs per 100,000 population, as compared to 22.0 in urban counties (Tables 4.25 and 4.26). Currently, there are 2,217 licensed pharmacists in Nevada, including 127 pharmacists in rural and frontier counties (Table 4.27). Over the past decade, the number of licensed pharmacists has increased from 1,530 in 2004 to 2,217 in 2014 (44.9%) and the per capita number of pharmacists in Nevada has increased 23.5% during the same period (Table 4.27). In 2014, there were 5,463 licensed pharmaceutical technicians in Nevada, including 420 pharmaceutical technicians in rural and frontier counties since 2004, the number of pharmaceutical technicians in Nevada has increased by 2,768 or 102.7% and the per capita number of pharmaceutical technicians as grown from to per 100,000 population (72.7%) (Table 4.28). In 2014, there were 593 licensed chiropractors in Nevada, including 35 chiropractors in rural and frontier counties since 2004, the number of chiropractors in Nevada has increased by 78 or 15.1%, however, the per capita number of chiropractors has decreased from 21.4 to 21.0 chiropractors per 100,000 population (-1.9%) (Table 4.29). In 2014, there were 400 registered dietitians (RDs) in Nevada, including 19 RDs in rural and frontier counties (Table 4.30). In 2014, there were 287 licensed dispensing opticians in Nevada, including 11 opticians in rural and frontier counties since 2004, the number of licensed dispensing opticians in Nevada has increased by 92 or 47.2% and the per capita number of opticians has grown from 8.1 to 10.1 per 100,000 population (24.7%) (Table 4.31). In 2014, there were 150 licensed dispensing optician apprentices in Nevada, including eight optician apprentices in rural and frontier counties (Table 4.32). In 2012, there were 6,425 emergency medical technicians (EMTs) in Nevada, including 601 first responders, 1,865 basic EMTs, 2,431 intermediate EMTs, and 1,528 paramedics (Table 4.33). In 2012, there were 1,715 emergency medical technicians (EMTs) in rural and frontier Nevada, including 439 first responders, 643 basic EMTs, 474 intermediate EMTs, and 159 paramedics (Table 4.33). 162 Nevada State Office of Rural Health

179 In 2012, there were emergency medical technicians (EMTs) per 100,000 population in Nevada at the county level, the per capita number of EMTs ranged from 165 EMTs per 100,000 population in Clark County to 3,321 EMTs per 100,000 population in Esmeralda County (Table 4.34). Between 2006 and 2012, the number of emergency medical technicians (EMTs) in Nevada declined from 7,176 to 6,425 or -10.5% during the same period, in rural and frontier areas, the number of EMTs declined by 458 or -21.1% (Table 4.35). In 2014, there were 3,696 licensed massage therapists in Nevada, including 184 licensed massage therapists in rural and frontier counties (Table 4.36). In 2014, there were 1,812 licensed medical laboratory technologists and technicians in Nevada, including 85 laboratory technologists and technicians in rural and frontier counties currently, there are 64.1 licensed medical laboratory technologists and technicians per 100,000 population in Nevada, including 29.9 per 100,000 population in rural and frontier counties (Tables 4.37 and 4.38). Currently, there are 570 occupational therapists (OTs) in Nevada, including 34 OTs in rural and frontier counties since 2004, the number of OTs in Nevada has increased by 205 or 56.2% and the per capita number of OTs has grown from 15.1 to 20.1 per 100,000 population (33.1%) (Table 4.40). In 2014, there were 171 occupational therapy assistants (OTAs) in Nevada, including 8 OTAs in rural and frontier counties since 2004, the number of OTAs in Nevada has increased by 31 or 22.1% and the per capita number of OTAs has grown from 5.8 to 6.0 per 100,000 population (3.4%) (Table 4.41). In 2014, there were 386 licensed optometrists in Nevada, including 37 optometrists in rural and frontier counties since 2004, the number of licensed optometrists in Nevada has increased by 145 or 60.2% and the per capita number of optometrists has grown from 10.0 to 13.6 per 100,000 population (36.0%) (Table 4.42). Currently, there are 1,074 physical therapists (PTs) in Nevada, including 82 PTs in rural and frontier counties since 2004, the number of PTs in Nevada has increased by 360 or 50.4% and the per capita number of PTs has grown from 31.1 to 38.0 per 100,000 population (22.2%) (Table 4.43). In 2014, there were 302 physical therapy assistants (PTAs) in Nevada, including 17 PTAs in rural and frontier counties since 2004, the number of PTAs in Nevada has increased by 148 or 96.1% and the per capita number of PTAs has grown from 6.7 to 10.7 per 100,000 population (59.7%) (Table 4.44). In 2014, there were 743 licensed podiatrists in Nevada or 26.3 licensed podiatrists per 100,000 population, including 43 licensed podiatrists in rural and frontier counties (Table 4.45). Currently, there are 1,314 licensed respiratory therapists (RTs) in Nevada, including 76 RTs in rural and frontier counties since 2004, the number of RTs in Nevada has increased by 595 or 82.8% and the per capita number of RTs has grown from 29.8 to 46.5 per 100,000 population (56.0%) (Table 4.46). Nevada State Office of Rural Health 163

180 In 2014, there were 744 licensed speech-language pathologists (SLPs) in Nevada, including 43 SLPs in rural and frontier counties since 2004, the number of SLPs in Nevada has increased by 504 or 210.0% and the per capita number of SLPs has grown from 9.1 to 26.3 per 100,000 population (189.0%) (Table 4.47). In general, the number of licensed health professionals per 100,000 population is lower in rural and frontier counties of Nevada versus urban areas of the state important exceptions include registered nurses with EMS certification, registered nurse anesthetists, and emergency medical technicians (Table 4.48). Currently, an estimated 911,684 Nevadans or 33.7% of the state s population reside in a federallydesignated primary medical care health professional shortage area (HPSA) 9 of 17 counties in Nevada are single-county primary medical care HPSAs (Table 4.49 and Maps 4.1 through 4.3). In 2015, an estimated 142,476 residents of rural and frontier Nevada (50.6% of the population) live in a primary medical care health professional shortage area (HPSA) 9 of 14 rural and frontier counties in Nevada are single-county primary medical care HPSAs (Table 4.49 and Maps 4.1 through 4.3). Currently, an estimated 903,241 Nevadans or 31.7% of the state s population reside in a federally designated dental health professional shortage area (HPSA) eight of 17 counties in Nevada are singlecounty dental HPSAs (Table 4.49 and Maps 4.4 through 4.6). In 2015, an estimated 145,426 residents of rural and frontier Nevada (51.4% of the population) live in a dental health professional shortage area (HPSA) 8 of 14 rural and frontier counties in Nevada are singlecounty dental HPSAs (Table 4.49 and Maps 4.4 through 4.6). Currently, 1.5 million Nevadans or 53.3% of the state s population reside in a federally designated mental health professional shortage area (HPSA) 16 of 17 counties in Nevada are single-county mental HPSAs (Table 4.49 and Maps 4.7 through 4.9). In 2015, an estimated 286,251 residents of rural and frontier Nevada (100% of the population) live in a mental health professional shortage area (HPSA) 14 of 14 rural and frontier counties in Nevada are singlecounty mental HPSAs (Table 4.49 and Maps 4.7 through 4.9). 164 Nevada State Office of Rural Health

181 Table 4.1: Labor Force in Nevada by County 2014 Total Labor Force Employed Labor Force Number Unemployed Unemployment Rate Churchill County 12,615 11, Douglas County 21,097 19,209 1, Elko County 29,532 27,865 1, Esmeralda County Eureka County 1, Humboldt County 9,679 9, Lander County 4,827 4, Lincoln County 1,654 1, Lyon County 21,649 19,162 2, Mineral County 1,802 1, Nye County 17,283 15,658 1, Pershing County 2,772 2, Storey County 2,107 1, White Pine County 5,288 4, Region Subtotal 132, ,476 10, Carson City 26,675 24,314 2, Clark County 992, ,064 82, Washoe County 222, ,582 17, Region Subtotal 1,240,984 1,138, , Nevada Total 1,373,049 1,260, , Source: Department of Employment, Training, and Rehabilitation (2014a). Nevada State Office of Rural Health 165

182 Table 4.2: Unemployment in Nevada by County 2004 to 2014 Average Annual Unemployment Rate Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Average Carson City Clark County Washoe County Region Average Nevada Average U.S. Average Source: Department of Employment, Training, and Rehabilitation (2014a). 166 Nevada State Office of Rural Health

183 Table 4.3: Health Sector Employment in Nevada by County 2013 Hospital Physicians, Dentists, and Other Professionals Health Sector Employment (Number of Jobs) Nursing and Protective Care Pharmacies Other Medical and Health Services Churchill County Douglas County ,306 Elko County ,296 Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal 2,158 2,136 1, ,276 Carson City 1, ,235 Clark County 22,348 23,442 8,555 3,709 9,788 67,842 Washoe County 6,706 7,099 3, ,741 19,131 Region Subtotal 30,313 31,488 12,234 4,352 11,821 90,208 Nevada Total 32,471 33,624 13,527 4,618 12,244 96,484 Sources: Nevada Compare Care. (2014a). Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). University Center for Economic Development (2014). Total Nevada State Office of Rural Health 167

184 Table 4.4: Health Sector Payroll in Nevada by County 2013 Hospital Payroll Physicians, Dentists, and Other Professionals Health Sector Payroll (Thousands of Dollars) Nursing and Protective Care Pharmacies Other Medical and Health Services Churchill County 16,613 13,808 5,762 1,320 1,196 38,700 Douglas County 14,577 33,842 10,294 1,800 4,378 64,891 Elko County 17,406 30,461 9, ,749 59,579 Esmeralda County Eureka County Humboldt County 13,627 6,136 6, ,981 Lander County 6, ,373 Lincoln County 2, , ,840 Lyon County 5,850 5,969 3,058 1, ,722 Mineral County 6,508 1, ,826 Nye County 9,942 12,303 2,374 1,527 3,909 30,055 Pershing County 3, ,594 Storey County 0 3, ,074 White Pine County 13,174 2,055 3, ,578 Region Subtotal 110, ,679 45,782 8,160 12, ,804 Carson City 74,188 76,544 18,436 3,290 16, ,303 Clark County 1,542,325 1,422, , , ,285 3,913,928 Washoe County 393, ,990 98,567 19,484 87,504 1,120,717 Region Subtotal 2,009,686 2,020, , , ,634 5,223,948 Nevada Total 2,120,681 2,131, , , ,821 5,511,752 Sources: Nevada Compare Care. (2014a). Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). University Center for Economic Development (2014). Total 168 Nevada State Office of Rural Health

185 Table 4.5: Employment in the Health Care and Social Assistance Sector by Region in Nevada 2014 Industry Ambulatory Health Care Services Las Vegas MSA Reno-Sparks MSA Estimated Employment Carson City MSA Rural and Frontier Nevada Offices of Physicians 12,043 3, ,058 Offices of Dentists 5,289 1, ,425 Offices of Other Health Practitioners 3,783 1, ,509 Outpatient Care Centers 2, ,574 Medical and Diagnostic Laboratories 2, ,974 Home Health Care Services 4, ,008 Other Ambulatory Health Care Services 1, ,711 Subtotal Ambulatory Health Care Services 32,210 8,456 1,288 2,305 44,259 Hospitals General Medical and Surgical Hospitals 19,800 6,220 1,071 2,154 29,245 Psychiatric and Substance Abuse Hospitals ,296 Other Hospitals 1, ,607 Subtotal Hospitals 22,026 6,897 1,071 2,154 32,148 Nursing and Residential Care Facilities Nursing Care Facilities 4,067 1, ,271 Residential Mental Health Facilities 1, ,704 Community Care Facility for the Elderly 2, ,108 Other Nursing and Residential Care Facilities ,115 Subtotal Nursing and Residential Care Facilities 7,604 2, ,006 12,198 Total Health Care Industries 61,840 18,285 3,015 5,465 88,605 Social Assistance Individual and Family Services 7,611 2, ,472 Emergency and Other Relief Services Vocational Rehabilitation Services 1, ,047 Child Day Care Services 2, ,796 Subtotal Social Assistance 12,290 3, ,087 Total Health Care and Social Assistance Sector 74,130 22,060 3,438 6, ,692 Sources: Department of Employment, Training, and Rehabilitation (2014b). Nevada Compare Care (2014a). Nevada State Office of Rural Health 169

186 Table 4.6: Projected Employment in the Health Care and Social Assistance Sector by Region in Nevada 2024 Industry Ambulatory Health Care Services Las Vegas MSA Reno-Sparks MSA Projected Employment Carson City MSA Rural and Frontier Nevada Offices of Physicians 12,579 4, ,500 Offices of Dentists 5,680 1, ,062 Offices of Other Health Practitioners 4,520 1, ,674 Outpatient Care Centers 3,470 1, ,559 Medical and Diagnostic Laboratories 3, ,573 Home Health Care Services 4, ,743 Other Ambulatory Health Care Services 1, ,330 Subtotal Ambulatory Health Care Services 35,800 10,225 1,580 2,843 50,441 Hospitals General Medical and Surgical Hospitals 21,264 7,672 1,110 2,179 32,225 Psychiatric and Substance Abuse Hospitals Other Hospitals 2, ,309 Subtotal Hospitals 24,282 7,672 1,110 2,179 35,243 Nursing and Residential Care Facilities Nursing Care Facilities 4,752 1, ,349 Residential Mental Health Facilities 1, ,061 Community Care Facility for the Elderly 2, ,204 Other Residential Care Facilities ,344 Subtotal Nursing and Residential Care Facilities 9,151 2, ,223 13,958 Total Health Care Industries 69,233 20,682 3,489 6,238 99,642 Social Assistance Individual and Family Services 9,631 2, ,385 Emergency, and Other Relief Services ,421 Vocational Rehabilitation Services 1, ,217 Child Day Care Services 3,117 1, ,467 Subtotal Social Assistance 15,015 4, ,249 21,490 Total Health Care and Social Assistance Sector 84,248 25,374 4,023 7, ,132 Sources: Department of Employment, Training, and Rehabilitation (2014c). Nevada Compare Care (2014a). 170 Nevada State Office of Rural Health

187 Table 4.7: Licensed Allopathic Physicians (MDs) in Nevada by County 2004 to 2014 Licensed Allopathic Physicians (MDs) Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 2,366 3, Washoe County 903 1, Region Subtotal 3,410 4,667 1, Nevada Total 3,616 4,874 1, Source: Nevada State Board of Medical Examiners (2004). Nevada State Board of Medical Examiners (2014). Nevada State Office of Rural Health 171

188 Table 4.8: Licensed Allopathic Physicians (MDs) by Location of Medical Education in Nevada by County 2014 Licensed Allopathic Physicians (MDs) Total University of Nevada School of Medicine Undergraduate Medical Education Graduate Medical Education Number Percent Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 3, Washoe County 1, Region Subtotal 4, Nevada Total 4, Source: Nevada State Board of Medical Examiners (2014). 172 Nevada State Office of Rural Health

189 Table 4.9: Licensed Osteopathic Physicians (DOs) in Nevada by County 2006 to 2014 Licensed Osteopathic Physicians (DOs) Number Change 2006 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Nevada State Board of Osteopathic Medicine (2006). Nevada State Board of Osteopathic Medicine (2014). Nevada State Office of Rural Health 173

190 Table 4.10: Licensed Primary Care Physicians (MDs and DOs) in Nevada by County 2014 Licensed Primary Care Physicians (MDs and DOs) MDs Number DOs Total Number per 100,000 Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 1, , Washoe County Region Subtotal 2, , Nevada Total 2, , Source: Nevada State Board of Medical Examiners (2014). Nevada State Board of Osteopathic Medicine (2014). 174 Nevada State Office of Rural Health

191 Table 4.11: Licensed Advanced Practitioners of Nursing (APNs) in Nevada by County 2004 to 2014 Licensed Advanced Practitioners of Nursing (APNs) Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014). Nevada State Office of Rural Health 175

192 Table 4.12: Licensed Physician Assistants (PAs) in Nevada by County 2004 to 2014 Licensed Physician Assistants (PAs) Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Sources: Nevada State Board of Medical Examiners (2004). Nevada State Board of Medical Examiners (2014). Nevada State Board of Osteopathic Medicine (2014). 176 Nevada State Office of Rural Health

193 Table 4.13: Licensed Registered Nurses (RNs) in Nevada by County 2004 to 2014 Licensed Registered Nurses (RNs) Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal 1,166 1, Carson City Clark County 10,165 15,337 5, Washoe County 2,990 4,233 1, Region Subtotal 13,659 20,088 6, Nevada Total 14,825 21,563 6, Source: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014). Nevada State Office of Rural Health 177

194 Table 4.14: Licensed Practical Nurses (LPNs) in Nevada by County 2004 to 2014 Licensed Practical Nurses (LPNs) Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 1,850 2, Washoe County Region Subtotal 2,326 2, Nevada Total 2,585 2, Sources: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014). 178 Nevada State Office of Rural Health

195 Table 4.15: Certified Registered Nurse Anesthetists (CRNAs) in Nevada by County 2004 to 2014 Certified Registered Nurse Anesthetists (CRNAs) Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Sources: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014). Nevada State Office of Rural Health 179

196 Table 4.16: Licensed Registered Nurses (RNs) with Emergency Medical Services (EMS) Certification in Nevada by County 2004 to 2014 Licensed Registered Nurses with EMS Certification Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Sources: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014). 180 Nevada State Office of Rural Health

197 Table 4.17: Certified Nursing Assistants (CNAs) in Nevada by County 2004 to 2014 Certified Nursing Assistants (CNAs) Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 3,405 5,320 1, Washoe County 1,277 1, Region Subtotal 4,916 6,933 2, Nevada Total 5,646 7,863 2, Sources: Nevada State Board of Nursing (2004). Nevada State Board of Nursing (2014). Nevada State Office of Rural Health 181

198 Table 4.18: Licensed Dentists in Nevada by County 2004 to 2014 Licensed Dentists Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 763 1, Washoe County Region Subtotal 1,012 1, Nevada Total 1,091 1, Source: Nevada State Board of Dental Examiners (2004). Nevada State Board of Dental Examiners (2014). 182 Nevada State Office of Rural Health

199 Table 4.19: Licensed Registered Dental Hygienists (RDHs) in Nevada by County 2004 to 2014 Licensed Registered Dental Hygienists Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total 991 1, Source: Nevada State Board of Dental Examiners (2004). Nevada State Board of Dental Examiners (2014). Nevada State Office of Rural Health 183

200 Table 4.20: Licensed Alcohol, Drug and Gambling Counselors in Nevada by County 2008 to 2014 Licensed Alcohol, Drug and Gambling Counselors Number Change 2008 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal 1,007 1, Nevada Total 1,233 1, Source: Nevada State Board of Examiners for Alcohol, Drug and Gambling Counselors (2008). Nevada State Board of Examiners for Alcohol, Drug and Gambling Counselors (2014). 184 Nevada State Office of Rural Health

201 Table 4.21: Licensed Marriage and Family Therapists (MFTs) in Nevada by County 2010 to 2012 Marriage and Family Therapists Number Change 2010 to 2012 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors (2010). Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors (2012). Nevada State Office of Rural Health 185

202 Table 4.22: Licensed Clinical Professional Counselors in Nevada by County 2010 to 2012 Licensed Clinical Professional Counselors Number Change 2010 to 2012 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors (2010). Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors (2012). 186 Nevada State Office of Rural Health

203 Table 4.23: Licensed Psychiatrists in Nevada by County 2008 to 2014 Licensed Psychiatrists Number Change 2008 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Nevada State Board of Medical Examiners (2008). Nevada State Board of Medical Examiners (2014). Nevada State Office of Rural Health 187

204 Table 4.24: Licensed Psychologists in Nevada by County 2008 to 2014 Licensed Psychologists Number Change 2008 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Nevada State Board of Psychological Examiners (2008). Nevada State Board of Psychological Examiners (2014). 188 Nevada State Office of Rural Health

205 Table 4.25: Licensed Social Workers in Nevada by County 2014 Licensed Social Workers (LSWs) Licensed Social Workers All License Types Licensed Associates in Social Work (LASWs) Licensed Clinical Social Workers (LCSWs) Licensed Independent Social Workers (LISWs) Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County ,120 Washoe County Region Subtotal 1, ,690 Nevada Total 1, ,814 Source: State of Nevada Board of Examiners for Social Workers (2014). Total Nevada State Office of Rural Health 189

206 Table 4.26: Licensed Social Workers per 100,000 Population in Nevada by County 2014 Social Workers per 100,000 Population All License Types Licensed Social Workers (LSWs) Licensed Associates in Social Work (LASWs) Licensed Clinical Social Workers (LCSWs) Licensed Independent Social Workers (LISWs) Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: State of Nevada Board of Examiners for Social Workers (2014). 190 Nevada State Office of Rural Health

207 Table 4.27: Licensed Pharmacists in Nevada by County 2004 to 2014 Licensed Pharmacists Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 1,063 1, Washoe County Region Subtotal 1,425 2, Nevada Total 1,530 2, Source: Nevada State Board of Pharmacy (2004). Nevada State Board of Pharmacy (2014). Nevada State Office of Rural Health 191

208 Table 4.28: Licensed Pharmaceutical Technicians in Nevada by County 2004 to 2014 Licensed Pharmaceutical Technicians Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 1,925 4,028 2, Washoe County Region Subtotal 2,512 5,043 2, Nevada Total 2,695 5,463 2, Source: Nevada State Board of Pharmacy (2004). Nevada State Board of Pharmacy (2014). 192 Nevada State Office of Rural Health

209 Table 4.29: Licensed Chiropractors in Nevada by County 2004 to 2014 Licensed Chiropractors Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Chiropractic Physicians Board of Nevada (2004). Chiropractic Physicians Board of Nevada (2014). Nevada State Office of Rural Health 193

210 Table 4.30: Registered Dietitians (RDs) in Nevada by County 2014 Number Registered Dietitians Number per 100,000 Population Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Bureau of Health Care Quality Compliance (2014c). 194 Nevada State Office of Rural Health

211 Table 4.31: Licensed Dispensing Opticians in Nevada by County 2004 to 2014 Licensed Dispensing Opticians Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: State of Nevada Board of Dispensing Opticians (2004). State of Nevada Board of Dispensing Opticians (2014). Nevada State Office of Rural Health 195

212 Table 4.32: Licensed Dispensing Optician Apprentices in Nevada by County 2004 to 2014 Licensed Dispensing Optician Apprentices Number Change 2004 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: State of Nevada Board of Dispensing Opticians (2004). State of Nevada Board of Dispensing Opticians (2014). 196 Nevada State Office of Rural Health

213 Table 4.33: Licensed Emergency Medical Technicians (EMTs) in Nevada by County 2012 First Responder Licensed Emergency Medical Technicians (EMTs) Basic Intermediate Advanced (Paramedics) Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal ,715 Carson City Clark County ,456 1,070 3,271 Washoe County ,281 Region Subtotal 162 1,222 1,957 1,369 4,710 Nevada Total 601 1,865 2,431 1,528 6,425 Source: Emergency Medical Systems and Trauma Systems (2012). Total Nevada State Office of Rural Health 197

214 Table 4.34: Licensed Emergency Medical Technicians (EMTs) per 100,000 Population in Nevada by County 2012 Licensed Emergency Medical Technicians (EMTs) per 100,000 Population First Responder Basic Intermediate Advanced (Paramedics) Total Churchill County Douglas County Elko County Esmeralda County 1, , ,321.0 Eureka County 1, ,279.5 Humboldt County ,223.7 Lander County ,161.1 Lincoln County ,432.0 Lyon County Mineral County ,411.2 Nye County Pershing County Storey County White Pine County Region Carson City Clark County Washoe County Region Nevada Source: Emergency Medical Systems and Trauma Systems (2012). 198 Nevada State Office of Rural Health

215 Table 4.35: Licensed Emergency Medical Technicians (EMTs) in Nevada by County 2006 to 2012 Licensed Emergency Medical Technicians (EMTs) All Types Number Change 2006 to Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal 2,173 1, Carson City Clark County 3,545 3, Washoe County 1,247 1, Region Subtotal 5,003 4, Nevada Total 7,176 6, Source: Emergency Medical Systems and Trauma Systems (2012). Nevada State Office of Rural Health 199

216 Table 4.36: Licensed Massage Therapists in Nevada by County 2010 to 2014 Licensed Massage Therapists Number Change 2010 to 2014 Number per 100,000 Population Number Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 2,578 2, Washoe County Region Subtotal 3,155 3, Nevada Total 3,338 3, Source: Nevada State Board of Massage Therapists (2010). Nevada State Board of Massage Therapists (2014). 200 Nevada State Office of Rural Health

217 Table 4.37: Licensed Medical Laboratory Personnel in Nevada by County 2014 Licensed Medical Laboratory Personnel Directors Supervisors Technologists Technicians Assistants Total Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County , ,404 6,941 Washoe County ,082 1,667 Region Subtotal 234 1,123 1, ,674 8,850 Nevada Total 246 1,222 1, ,325 9,697 Source: Bureau of Health Care Quality and Compliance (2014d). Nevada State Office of Rural Health 201

218 Table 4.38: Licensed Medical Laboratory Personnel per 100,000 Population in Nevada by County 2014 Licensed Medical Laboratory Personnel per 100,000 Population Directors Supervisors Technicians Technologists Assistants Total Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Bureau of Health Care Quality and Compliance (2014d). 202 Nevada State Office of Rural Health

219 Table 4.39: Licensed Medical Laboratory Personnel in Nevada by County 2004 to 2014 Licensed Medical Laboratory Personnel All Types Number Change 2004 to 2014 Number per 100,000 Population Change Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 5,645 6,941 1, Washoe County 1,385 1, Region Subtotal 7,233 8,758 1, Nevada Total 7,935 9,605 1, Sources: Bureau of Health Care Quality and Compliance (2004). Bureau of Health Care Quality and Compliance (2014d). Nevada State Office of Rural Health 203

220 Table 4.40: Licensed Occupational Therapists (OTs) in Nevada by County 2004 to 2014 Licensed Occupational Therapy (OTs) Number Change 2004 to 2014 Number per 100,000 Population Change Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: State of Nevada Board of Occupational Therapy (2004). State of Nevada Board of Occupational Therapy (2014). 204 Nevada State Office of Rural Health

221 Table 4.41: Licensed Occupational Therapy Assistants (OTAs) in Nevada by County 2004 to 2014 Licensed Occupational Therapy Assistants (OTAs) Number Change 2004 to 2014 Number per 100,000 Population Change Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: State of Nevada Board of Occupational Therapy (2004). State of Nevada Board of Occupational Therapy (2014). Nevada State Office of Rural Health 205

222 Table 4.42: Licensed Optometrists in Nevada by County 2004 to 2014 Licensed Optometrists Number Change 2004 to 2014 Number per 100,000 Population Change Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Nevada State Board of Optometry (2004). Nevada State Board of Optometry (2014). 206 Nevada State Office of Rural Health

223 Table 4.43: Licensed Physical Therapists (PTs) in Nevada by County 2004 to 2014 Licensed Physical Therapists (PTs) Number Change 2004 to 2014 Number per 100,000 Population Change Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total 714 1, Source: State of Nevada Physical Therapy Examiners Board (2004). State of Nevada Physical Therapy Examiners Board (2014). Nevada State Office of Rural Health 207

224 Table 4.44: Licensed Physical Therapy Assistants (PTAs) in Nevada by County 2004 to 2014 Licensed Physical Therapy Assistants (PTAs) Number Change 2004 to 2014 Number per 100,000 Population Change Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: State of Nevada Physical Therapy Examiners Board (2004). State of Nevada Physical Therapy Examiners Board (2014). 208 Nevada State Office of Rural Health

225 Table 4.45: Licensed Podiatrists in Nevada by County 2004 to 2014 Licensed Podiatrists Number Change 2004 to 2014 Number per 100,000 Population Change Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County , Region Subtotal Nevada Total Source: Nevada State Board of Podiatry (2004). Nevada State Board of Podiatry (2014). Nevada State Office of Rural Health 209

226 Table 4.46: Licensed Respiratory Therapists (RTs) in Nevada by County 2004 to 2014 Licensed Respiratory Therapists (RTs) Number Change 2004 to 2014 Number per 100,000 Population Change Percent Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County 491 1, Washoe County Region Subtotal 653 1, Nevada Total 719 1, Source: Nevada State Board of Medical Examiners (2004). Nevada State Board of Medical Examiners (2014). 210 Nevada State Office of Rural Health

227 Table 4.47: Licensed Speech-language Pathologists in Nevada by County 2006 to 2014 Licensed Speech-language Pathologists Number Change 2006 to 2014 Number per 100,000 Population Change Percent Churchill County Douglas County Elko County , Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Carson City Clark County Washoe County Region Subtotal Nevada Total Source: Nevada Board of Examiners for Audiology and Speech Pathology (2006). Nevada Board of Examiners for Audiology and Speech Pathology (2014). Nevada State Office of Rural Health 211

228 Table 4.48: Licensed Health Workforce Supply in Rural and Regions of Nevada 2014 Licensed Health Professionals Medicine and Primary Care Number per 100,000 Population Rural Counties Counties Nevada Allopathic Physicians (MDs) Osteopathic Physicians (DOs) Advanced Practitioners of Nursing (APNs) Primary Care Physicians (MDs and DOs) Physician Assistants (PAs) Registered Nurses (RNs) Licensed Practical Nurses (LPNs) Registered Nurse Anesthetists (CRNAs) RNs with EMS Certification Certified Nursing Assistants (CNAs) Dentists Registered Dental Hygienists (RDHs) Alcohol, Drug, and Gambling Counselors Clinical Professional Counselors Licensed Clinical Social Workers (LCSWs) Marriage and Family Therapists Psychiatrists Psychologists Pharmacists Pharmacy Technicians Audiologists Chiropractors Registered Dietitians(RD) Dispensing Opticians (OD) Dispensing Optician Apprentices EMS First Responders EMS Basic Emergency Medical Technicians EMS Intermediate EMTs EMS Advanced EMTs (Paramedics) Massage Therapists Medical Laboratory Technologists Medical Laboratory Technicians Medical Laboratory Assistants Medical Laboratory Supervisors Medical Laboratory Directors Occupational Therapists (OTs) Occupational Therapy (OTAs) Optometrists Physical Therapists (PTs) Physical Therapy Assistants (PTAs) Podiatrists Respiratory Therapists (RTs) Speech Language Pathologists (SLP) Source: Department Of Employment, Training, and Rehabilitation (2014d). Notes: See Tables 4.7 through 4.47 for a complete list of citations for the professions and data contained in this table. Shaded cells highlight the region in Nevada with the lower per capita number of health professions in a given field. 212 Nevada State Office of Rural Health

229 Table 4.49: Population Residing in Health Professional Shortage Areas (HPSAs) in Nevada 2015 Population Residing in Health Professional Shortage Areas (HPSAs) Primary Medical Care HPSAs Dental HPSAs Mental HPSAs Population Number Percent of Population Number Percent of Population Number Percent of Population Churchill County 1, , , ,665 Douglas County 7, , ,003 Elko County 3, , , ,993 Esmeralda County Eureka County 2, , ,069 Humboldt County , ,248 Lander County 6, , , ,708 Lincoln County 5, , , ,117 Lyon County 53, , , ,639 Mineral County 4, , , ,356 Nye County 45, , , ,081 Pershing County 7, , , ,031 Storey County 4, , ,037 White Pine County , , ,345 Region Subtotal 142, , , ,251 Carson City 51, , ,098 Clark County 612, , , ,069,967 Washoe County 151, , , ,745 Region Subtotal 815, , ,235, ,568,810 Nevada Total 962, , ,522, ,855,061 Sources: Health Resources and Services Administration (2015). Nevada State Demographer s Office (2014a). Nevada Office of Rural Health 213

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239 Nevada Health Data Book Section Five: Health Care Resources and Economics in Nevada Highlights and Key Findings Currently, there are 15 rural and frontier hospitals in Nevada serving an estimated population of 286,251 residents scattered over 95,431 square miles 11 of these facilities are federally designated Critical Access Hospitals (CAHs) (Tables 1.5 and 5.1). On average, Nevada s 15 rural and frontier hospitals are 59.1 miles from the nearest hospital and miles from the nearest tertiary care hospital (Table 5.1 and Map 5.1). In 2013, Nevada s 15 rural and frontier hospitals had a combined 2,250 employees (FTE) and payroll of $141.2 million these hospitals had an average annual salary of $62,772 (Table 5.2). Nevada s 11 Critical Access Hospitals (CAHs) had a combined 1,502 employees (FTE) and payroll of $94.4 million in 2013 these CAHs had an average annual salary of $62,825 (Table 5.2). In 2013, Nevada s 19 urban acute care hospitals had a combined 21,825 employees (FTE) and payroll of $1.6 billion urban hospitals had an average annual salary of $71,809 (Table 5.3). Nevada s 15 rural and frontier hospitals employed 2,250 individuals in 2013 when the jobs created in other businesses, as a result of hospital operating activity, are included in the analysis, rural and frontier hospitals were responsible for an additional 807 jobs for a total employment impact of 3,057 jobs (Table 5.4). In 2013, Nevada s 19 urban hospitals employed 21,825 individuals when the jobs created in other businesses, as a result of hospital operating activity, are included in the analysis, urban hospitals were responsible for an additional 15,532 jobs for a total employment impact of 37,470 jobs (Tables 5.3 and 5.4). Nevada s 15 rural and frontier hospitals had a combined payroll of $94.4 million in 2013 when the income created in other businesses, as a result of hospital operating activity, is included in the analysis, rural and frontier hospitals were responsible for an additional $18.7 million in personal income for a total payroll impact of $113.1 million (Table 5.5). In 2013, Nevada s 19 urban hospitals had a combined payroll of $1.6 billion when the income created in other businesses, as a result of hospital operating activity, is included in the analysis, urban hospitals were responsible for an additional $674 million in personal income for a total payroll impact of $2.0 billion (Table 5.5). In 2013, there were 96,484 Nevadans employed in the health sector with a combined payroll of $5.5 billion, including 6,S276 rural and frontier residents with a combined payroll of $287.8 million (Tables 5.6 and 5.7). Nevada State Office of Rural Health 223

240 Businesses in Nevada s health sector employed 96,370 in 2013 when the jobs created in other non-health sector businesses, as a result of health sector operating activity, are included in the analysis, Nevada s health sector was responsible for an additional 50,099 jobs for a total employment impact of 146,469 jobs (Table 5.8). In 2013, businesses in the health sector in rural and frontier counties of Nevada employed 6,162 individuals when the jobs created in other non-health sector businesses, as a result of health sector operating activity, are included in the analysis, the rural health sector was responsible for an additional 1,488 jobs for a total employment impact of 7,650 jobs (Table 5.8). Businesses in Nevada s health sector had a combined payroll of $5.5 billion in 2013 when the income created in other non-health sector businesses, as a result of health sector operating activity, is included in the analysis, Nevada s health sector was responsible for an additional $2.0 billion in personal income for a total payroll impact of $7.5 billion (Table 5.9). In 2013, businesses in the health sector in rural and frontier counties of Nevada had a combined payroll of $284.8 million when the income created in other non-health sector businesses, as a result of health sector operating activity, is included in the analysis, the rural health sector was responsible for an additional $43.7 million in personal income for a total payroll impact of $328.6 million (Table 5.9). Currently, there are 7,140 licensed community hospital beds in Nevada, including 272 licensed community hospital beds in rural and frontier counties (Table 5.11). There are 5,174 licensed skilled nursing beds in Nevada, including 567 licensed skilled nursing beds in rural and frontier counties (Table 5.11). Currently, there are 2.5 licensed community hospital beds per 1,000 population in Nevada there are 1.0 licensed community hospital beds per 1,000 population in rural and frontier counties, as compared to a rate of 2.7 in urban counties (Table 5.11). Currently, there are 1.8 licensed skilled nursing beds per 1,000 population in Nevada there are 2.0 licensed skilled nursing beds per 1,000 population in rural and frontier counties, as compared to a rate of 1.8 in urban counties (Table 5.11). Currently, of the 15 rural and frontier hospitals in Nevada, six are not-for-profit (publicly owned) hospitals, 5 not-for-profit (privately owned) hospitals, and three for-profit (privately owned) hospitals, and one not-forprofit (non-governmental) hospital (Table 5.12). In 2015, there are eight rural and frontier community hospitals with provider-based rural health clinics (RHCs). There are also 9 non-hospital based Federally Qualified Health Clinics (FQHCs), and 13 tribal and Indian Health Service (IHS) clinics and health centers (Tables 5.13, 5.14, and 5.15). In 2013, Nevada s 15 rural and frontier hospitals had a combined 9,770 admissions, 31,665 inpatient days, an average stay of 3.2 days, an average daily census of 86.8, and an occupancy rate of 16.2% (Table 5.16). 224 Nevada State Office of Rural Health

241 In 2013, rural and frontier hospitals had inpatient operating revenue of $240.1 million or 27.5% of the total patient revenue; the outpatient revenue was $631.6 million or 72.4% of the total patient revenue (Table 5.18). For 2013, rural and frontier hospitals had $871.7 million in total revenue, $506.8 million in contractual deductions and adjustments, resulting in net patient revenue of $364.9 million; when adding other operating revenue ($8.2 million), the total revenue was $373.1 million (Table 5.19). For 2013, rural and frontier hospitals had $373.1 million in total revenue, $317.8 million in operating expenses, resulting in net operating income of $55.3 million; when adding other non-operating revenue ($30.1 million), the net income was $85.4 million (Table 5.20). In 2013, net operating income was $40.2 million for all 34 community hospitals in Nevada; the net operating income per adjusted admission was $105 and a net operating income per adjusted inpatient day was $22 (Table 5.21). In 2013, net income was $108.5 million for all 34 community hospitals in Nevada; the net operating income per adjusted admission was $284 and a net operating income per adjusted inpatient day was $58 (Table 5.22). In 2013, rural and frontier hospitals had an average daily charge of $6,468 and an average charges per admission of $18,816 (Table 5.23). In 2013, 41.0% of inpatient admissions, 51.6% inpatient days, and 52.1% of inpatient billed charges were Medicare patients in rural and frontier hospitals (Tables 5.24, 5.25, and 5.26). In 2013, the top 20 admissions in rural and frontier hospitals mirror the urban top 20 admissions, however, some of the top admissions in rural and frontier Nevada reflect an older population, e.g., digestive disorders, chest pain, and simple pneumonia (Tables 5.28 and 5.29). Nevada State Office of Rural Health 225

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243 Critical Access Hospitals (CAHs) Table 5.1: The Unique Geography of Community Hospitals in Nevada 2015 Hospital Town/County Nearest Incorporated Town Nearest Hospital Mileage to Nearest Tertiary Hospital Office of Rural Health Program Office in Reno Battle Mountain General Hospital Battle Mountain/Lander Boulder City Hospital Boulder City/Clark Carson Valley Medical Center Gardnerville/Douglas Desert View Hospital Pahrump/Nye Grover C. Dils Medical Center Caliente/Lincoln Humboldt General Hospital Winnemucca/Humboldt Incline Village Community Hospital Incline Village/Washoe Mesa View Hospital Mesquite/Clark Mt. Grant General Hospital Hawthorne/Mineral Pershing General Hospital Lovelock/Pershing William Bee Ririe Hospital Ely/White Pine Critical Access Hospitals Average CAH-eligible Hospitals Banner Churchill Community Hospital Fallon/Churchill Northeastern Nevada Regional Hospital Elko/Elko Nye Regional Medical Center Tonopah/Nye South Lyon Medical Center Yerington/Lyon CAH-eligible Hospitals Average Average Source: Nevada Department of Transportation (2014). Nevada State Office of Rural Health 227

244 Table 5.2: Community Hospitals in Nevada 2015 Hospital Licensed Beds Employees FY 2013 (FTE) Annual Payroll FY 2013 (Dollars) Average Salary (Dollars) Critical Access Hospitals (CAHs) Battle Mountain General Hospital ,451,656 59,738 Boulder City Hospital ,513,325 52,878 Carson Valley Medical Center ,592,625 59,972 Desert View Hospital ,025,538 51,778 Grover C. Dils Medical Center ,819,167 46,986 Humboldt General Hospital ,088,050 75,531 Incline Village Community Hospital ,837,406 78,817 Mesa View Regional Hospital ,476,721 77,025 Mt. Grant General Hospital ,612,734 49,235 Pershing General Hospital ,714,507 52,317 William Bee Ririe Hospital ,231,227 75,607 CAH Subtotal 364 1,502 94,362,956 62,825 CAH-eligible Hospitals Banner Churchill Community Hospital ,710,591 69,298 Northeastern Nevada Regional Hospital ,125,092 70,055 Nye Regional Medical Center ,916,036 39,103 South Lyon Medical Center ,122,688 45,658 CAH-eligible Subtotal ,874,407 62,666 Subtotal 554 2, ,237,363 62,772 Subtotal (See Table 5.3) 5,411 21,825 1,567,216,463 71,809 Nevada Total 5,965 24,075 1,708,453,826 70,965 Sources: Bureau of Health Care Quality and Compliance (2014e). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). 228 Nevada State Office of Rural Health

245 Table 5.3: Community Hospitals in Nevada 2015 Hospital Licensed Beds Employees FY 2013 (FTE) Annual Payroll FY 2013 (Dollars) Average Salary (Dollars) Carson City Carson Tahoe Regional Medical Center ,419,946 70,491 Sierra Surgery Hospital ,882,794 74,867 Clark County Centennial Hills Hospital Medical Center ,757,712 70,979 Desert Springs Hospital Medical Center 293 1,001 67,439,744 67,376 MountainView Hospital 340 1, ,363,359 96,426 North Vista Hospital ,601,148 77,946 St. Rose Dominican Hospital, Rose de Lima Campus ,593,786 71,255 St. Rose Dominican Hospital, San Martin Campus ,832,955 76,903 St. Rose Dominican Hospital, Siena Campus 230 1, ,938,962 73,657 Southern Hills Hospital and Medical Center ,780,925 81,515 Spring Valley Hospital Medical Center ,106,435 70,988 Summerlin Hospital Medical Center 454 1,338 97,258,840 72,692 Sunrise Hospital and Medical Center 690 2, ,349,278 82,724 University Medical Center of Southern Nevada 541 3, ,902,407 65,090 Valley Hospital Medical Center 301 1,268 90,380,891 71,270 Washoe County Northern Nevada Medical Center ,188,234 63,746 Renown Regional Medical Center 808 2, ,739,648 61,611 Renown South Meadows Medical Center ,451,929 64,044 Saint Mary s Regional Medical Center 380 1,275 85,227,470 66,850 Subtotal 5,411 21,825 1,567,216,463 71,809 Subtotal (See Table 5.2) 554 2, ,237,363 62,772 Nevada Total 5,965 24,075 1,708,453,826 70,965 Sources: Bureau of Health Care Quality and Compliance (2014a). Nevada Compare Care (2014a). Nevada State Office of Rural Health 229

246 Table 5.4: Employment Impact of Community Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Hospital Employment Employment Impact of Community Hospitals (Number of Jobs) Type II Employment Multiplier Secondary Employment Impact Total Employment Impact Battle Mountain General Hospital Boulder City Hospital Carson Valley Medical Center Desert View Hospital Grover C. Dils Medical Center Humboldt General Hospital Incline Village Community Hospital Mesa View Regional Hospital Mt. Grant General Hospital Pershing General Hospital William Bee Ririe Hospital CAH Subtotal 1, ,086 CAH-eligible Hospitals Banner Churchill Community Hospital Northeastern Nevada Regional Hospital Nye Regional Medical Center South Lyon Medical Center CAH-eligible Subtotal Subtotal 2, ,057 Hospitals Carson City 1, ,338 Clark County 16, ,248 28,462 Washoe County 4, ,003 7,670 Subtotal 21,825 15,532 37,470 Nevada Total 24,075 16,339 40,527 Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014). 230 Nevada State Office of Rural Health

247 Table 5.5: Payroll Impact of Community Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Hospital Payroll Payroll Impact of Community Hospitals (Dollars) Type II Payroll Multiplier Secondary Payroll Impact Total Payroll Impact Battle Mountain General Hospital 6,451, ,099 6,838,755 Boulder City Hospital 8,513, ,405,330 11,918,655 Carson Valley Medical Center 15,592, ,118,525 18,711,150 Desert View Hospital 8,025, ,284,086 9,309,624 Grover C. Dils Medical Center 2,819, ,108 3,129,275 Humboldt General Hospital 16,088, ,413,208 18,501,258 Incline Village Community Hospital 2,837, ,220,085 4,057,491 Mesa View Regional Hospital 11,476, ,590,688 16,067,409 Mt. Grant General Hospital 5,612, ,401 6,230,135 Pershing General Hospital 3,714, ,580 3,863,087 William Bee Ririe Hospital 13,231, ,190,810 14,422,037 CAH Subtotal 94,362,956 18,685, ,048,876 CAH-eligible Hospitals Banner Churchill Community Hospital 18,710, ,058,165 20,768,756 Northeastern Nevada Regional Hospital 19,125, ,781,273 23,906,365 Nye Regional Medical Center 1,916, ,566 2,222,602 South Lyon Medical Center 7,122, ,176 8,119,864 CAH-eligible Subtotal 46,874,407 8,143,180 55,017,587 Subtotal 141,237,363 26,829, ,066,463 Hospitals Carson City 75,302, ,048,438 87,351,178 Clark County 1,203,306, ,744,787 1,547,051,229 Washoe County 288,607, ,101, ,708,412 Subtotal 1,567,216, ,903,079 2,047,110,819 Nevada Total 1,708,453, ,307,558 2,215,177,828 Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014). Nevada State Office of Rural Health 231

248 Table 5.6: Health Sector Employment in Nevada by County 2013 Hospital Physicians, Dentists, and Other Professionals Health Sector Employment (Number of Jobs) Nursing and Protective Care Pharmacies Other Medical and Health Services Churchill County Douglas County ,306 Elko County ,296 Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal 2,158 2,136 1, ,276 Carson City 1, ,235 Clark County 22,348 23,442 8,555 3,709 9,788 67,842 Washoe County 6,706 7,099 3, ,741 19,131 Region Subtotal 30,313 31,488 12,234 4,352 11,821 90,208 Nevada Total 32,471 33,624 13,527 4,618 12,244 96,484 Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014). Total 232 Nevada State Office of Rural Health

249 Table 5.7: Health Sector Payroll in Nevada by County 2013 Hospital Physicians, Dentists, and Other Professionals Health Sector Payroll (Thousands of Dollars) Nursing and Protective Care Pharmacies Other Medical and Health Services Churchill County 16,613 13,808 5,762 1,320 1,196 38,700 Douglas County 14,577 33,842 10,294 1,800 4,378 64,891 Elko County 17,406 30,461 9, ,749 59,579 Esmeralda County Eureka County Humboldt County 13,627 6,136 6, ,981 Lander County 6, ,373 Lincoln County 2, , ,840 Lyon County 5,850 5,969 3,058 1, ,722 Mineral County 6,508 1, ,826 Nye County 9,942 12,303 2,374 1,527 3,909 30,055 Pershing County 3, ,594 Storey County 0 3, ,074 White Pine County 13,174 2,055 3, ,578 Region Subtotal 110, ,679 45,782 8,160 12, ,804 Carson City 74,188 76,544 18,436 3,290 16, ,303 Clark County 1,542,325 1,422, , , ,285 3,913,928 Washoe County 393, ,990 98,567 19,484 87,504 1,120,717 Region Subtotal 2,009,686 2,020, , , ,634 5,223,948 Nevada Total 2,120,681 2,131, , , ,821 5,511,752 Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014). Total Nevada State Office of Rural Health 233

250 Table 5.8: Employment Impact of the Health Sector in Nevada by County 2013 Employment Impact of the Health Sector (Number of Jobs) Health Sector Employment Type II Employment Multiplier Secondary Employment Impact Total Employment Impact Churchill County ,050 Douglas County 1, ,795 Elko County 1, ,603 Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal 6,162 1,488 7,650 Carson City 3, ,233 4,468 Clark County 67, , ,849 Washoe County 19, ,370 29,501 Region Subtotal 90,208 48, ,818 Nevada Total 96,370 50, ,469 Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014). 234 Nevada State Office of Rural Health

251 Table 5.9: Payroll Impact of the Health Sector in Nevada by County 2013 Payroll Impact of the Health Sector (Thousands of Dollars) Health Sector Payroll Type II Income Multiplier Secondary Payroll Impact Total Payroll Impact Churchill County 38, ,236 42,936 Douglas County 64, ,030 77,921 Elko County 59, ,167 71,746 Esmeralda County Eureka County Humboldt County 26, ,631 30,612 Lander County 7, ,897 Lincoln County 8, ,670 Lyon County 16, ,022 18,744 Mineral County 7, ,100 8,926 Nye County 30, ,282 34,337 Pershing County 4, ,830 Storey County White Pine County 18, ,625 20,203 Region Subtotal 284,849 43, ,562 Counties Carson City 189, , ,236 Clark County 3,913, ,475,155 5,389,083 Washoe County 1,120, ,336 1,538,053 Region Subtotal 5,223,948 1,930,424 7,154,372 Nevada Total 5,508,797 1,974,137 7,482,934 Sources: Department of Employment, Training, and Rehabilitation (2014b). Minnesota IMPLAN Group (2014). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). University Center for Economic Development (2014). Nevada State Office of Rural Health 235

252 Table 5.10: Number and Type of Licensed Beds in Community Hospitals in Nevada 2015 Hospital Critical Access Hospitals (CAHs) Acute Care Beds Skilled Nursing Beds Licensed Beds Swing Beds Rehabilitation and Psychiatric Beds Total Beds (Acute and Skilled Nursing Care) Battle Mountain General Hospital Boulder City Hospital Carson Valley Medical Center Desert View Hospital Grover C. Dils Medical Center Humboldt General Hospital Incline Village Community Hospital Mesa View Regional Hospital Mt. Grant General Hospital Pershing General Hospital William Bee Ririe Hospital CAH Subtotal CAH-eligible Hospitals Banner Churchill Community Hospital Northeastern Nevada Regional Hospital Nye Regional Medical Center South Lyon Medical Center CAH-eligible Subtotal Nevada Total Sources: Bureau of Health Care Quality and Compliance (2014a). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). 236 Nevada State Office of Rural Health

253 Table 5.11: Number and Per Capita Distribution of Licensed Community Hospital Beds and Skilled Nursing Beds in Nevada by County 2015 Licensed Community Hospital Beds Licensed Skilled Nursing Beds Number Percent of Nevada Total Number per 1,000 Population Number Percent of Nevada Total Number per 1,000 Population Number per 1,000 Population Aged 65+ Churchill County Douglas County Elko County Esmeralda County Eureka County Humboldt County Lander County Lincoln County Lyon County Mineral County Nye County Pershing County Storey County White Pine County Region Subtotal Counties Carson City Clark County 4, , Washoe County 1, Region Subtotal 6, , Nevada Total 7, , Sources: Bureau of Health Care Quality and Compliance (2014a). Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). Nevada State Office of Rural Health 237

254 Table 5.12: Ownership, Tax Status, and Service Area of Community Hospitals in Nevada 2015 Hospital Ownership Tax Status Estimated Service Area Population Service Area Critical Access Hospitals (CAH) Battle Mountain General Hospital Boulder City Hospital Carson Valley Medical Center Desert View Hospital Grover C. Dils Medical Center Humboldt General Hospital Incline Village Community Hospital Mesa View Regional Hospital Mt. Grant General Hospital Pershing General Hospital William Bee Ririe Hospital CAH-Eligible Hospitals Banner Churchill Community Hospital Northeastern Nevada Regional Hospital Nye Regional Medical Center South Lyon Medical Center Not-for-profit / Public Lander County Hospital District Not-for-profit / Private Boulder City Hospital, Inc. Not-for-profit / Private Barton Healthcare and Renown Health For-profit / Private Rural Health Management Corp. Not-for-profit / Public Lincoln County Hospital District Not-for-profit / Public Humboldt County Hospital District Not-for-profit / Private Tahoe Forest Hospital District For-profit / Private Community Health Systems Not-for-profit / Public Mineral County Hospital District Not-for-profit / Public Pershing County Hospital District Not-for-profit / Public White Pine County Hospital District Not-for-profit / Private Banner Health System For-profit / Private Province Health Care Corporation Not-for-profit / Private Primecare Nevada Not- for- profit / Non- governmental Receives Lyon County Tax Support 6,000 / Battle Mountain, Lander County, Northern Eureka County 25,000 / Boulder City, Henderson, Searchlight, Clark County 50,000 / Minden, Gardnerville, Douglas County, Bordering California Counties 40,000 / Pahrump, Southern Nye County 5,000 / Caliente, Panaca, Pioche, Alamo, Lincoln County 18,000 / Winnemucca, Humboldt County 10,000 / Incline Village, Washoe County, North Lake Tahoe Area 20,000 / Mesquite, Moapa, Western Clark County 5,000 / Hawthorne, Schurz, Mineral County 7,000 / Lovelock, Pershing County 10,000 / Ely, Ruth, White Pine County, Western Eureka County 55,000 / Fallon, Fernley, Churchill County, Northern Lyon County 52,000 / Elko, Carlin, Wells, Elko County 5,000 / Tonopah, Northern Nye County, Esmeralda County 5,000 / Yerington, Wellington, Smith Valley, Southern Lyon County Total 12 Not-for-profit / 3 For-profit 313,000 in rural and frontier counties Source: Nevada Rural Hospital Partners (2014). Nevada State Demographer s Office (2014b). 238 Nevada State Office of Rural Health

255 Table 5.13: Hospital-based Rural Health Clinics (RHC) in Nevada 2015 Hospital Rural Health Clinic Estimated Service Area Population Service Area Critical Access Hospitals (CAH) Battle Mountain General Hospital Yes 6,000 / Battle Mountain, Lander County, Northern Eureka County Boulder City Hospital No 25,000 / Boulder City, Henderson, Searchlight, Clark County Carson Valley Medical Center Yes 50,000 / Minden, Gardnerville, Douglas County, Bordering California Counties Desert View Hospital No 40,000 / Pahrump, Southern Nye County Grover C. Dils Medical Center Yes 5,000 / Caliente, Panaca, Pioche, Alamo, Lincoln County Humboldt General Hospital Yes 18,000 / Winnemucca, Humboldt County Incline Village Community Hospital No 10,000 / Incline Village, Washoe County, North Lake Tahoe Area Mesa View Regional Hospital No 20,000 / Mesquite, Moapa, Western Clark County Mt. Grant General Hospital Yes 5,000 / Hawthorne, Schurz, Mineral County Pershing General Hospital Yes 7,000 / Lovelock, Pershing County William Bee Ririe Hospital Yes 10,000 / Ely, Ruth, White Pine County, Western Eureka County CAH-Eligible Hospitals Banner Churchill Community Hospital No 55,000 / Fallon, Fernley, Churchill County, Northern Lyon County Northeastern Nevada Regional Hospital No 52,000 / Elko, Carlin, Wells, Elko County Nye Regional Medical Center No 5,000 /Tonopah, Northern Nye County, Esmeralda County South Lyon Medical Center Yes 5,000 / Yerington, Wellington, Smith Valley, Southern Lyon County Total 8 313,000 in rural and frontier counties Source: Nevada Rural Hospital Partners (2014). Nevada State Demographer s Office (2014b). Nevada State Office of Rural Health 239

256 Table 5.14: Federally Qualified Health Centers (FQHC) in Nevada 2015 Community Health Center / County Patient Visits 2013 Percent of Total Amargosa Valley Medical Clinic Nye County Estimated Service Area Population Service Area 1,500 / Amargosa Valley, Southern Nye County, Bordering California Counties Austin Medical Clinic Lander County / Austin, Southern Lander County Beatty Medical Clinic Nye County ,500 / Beatty, Southern Nye County Carlin Community Health Center Elko County ,500 / Carlin, Western Elko County Crescent Valley Medical Center Eureka County / Crescent Valley, Northern Eureka County Elko Medical and Dental Clinic Elko County 4, ,000 / Elko, Central Elko County Eureka Medical Clinic Eureka County / Eureka, Eureka County Jackpot Community Health Center Elko County Wendover Community Health Center Elko County 2, ,000 / Jackpot, Northern Elko County, Southern Idaho Counties 5,000 / West Wendover, Eastern Elko County, Wendover, Utah Total 11, ,000 / 30,000 Square Miles Source: Nevada Health Centers (2014). Nevada State Demographer s Office (2014b). 240 Nevada State Office of Rural Health

257 Table 5.15: Tribal Medical Clinics and Health Centers in Nevada 2015 Tribal Clinic or Health Center Service Unit / Tribe or Colony Estimated Tribal Population Clinic or Health Center Service Area Battle Mountain Health Center Duck Valley Health Center Elko / Shoshone / Battle Mountain Band Elko/ Duck Valley Shoshone-Paiute 500 / Lander County 3,000 / Northern Elko County, Owyhee County (ID) Duckwater Health Department Elko / Duckwater Shoshone 300 / Nye County Ely Shoshone Tribal Clinic Newe Medical Clinic Fallon Tribal Health Clinic Fort McDermitt IHS Health Station Goshute Indian Health Clinic Elko / Ely Shoshone Schurz / Fallon Paiute-Shoshone, Lovelock Paiute, Summit Lake Paiute Schurz / Fort McDermitt Paiute- Shoshone Elko / Confederated Tribes of the Goshute Reservation 600 / Eureka and White Pine Counties 3,000 / Churchill, Humboldt, Lander, Lyon, Nye, and Pershing Counties 1,000 / Northern Humboldt County, Malheur County (OR) 500 / Eastern Elko County, Juab County (UT) Moapa Tribal Clinic Schurz / Moapa Band of Paiute 500 / Lincoln, Nye and Clark Counties Pyramid Lake Tribal Health Clinic Schurz / Pyramid Lake Paiute 4,000 / Lyon County, Washoe County Southern Bands Health Center Walker River Tribal Health Center Washoe Tribal Health Center Yerington Paiute Tribal Health Clinic Nevada Total Elko/ Te-Moak Western Shoshone, and Elko, South Fork, Wells and Battle Mountain Bands Schurz / Timbisha Shoshone, Walker River Paiute and Yomba Shoshone Schurz / Washoe Tribe of Nevada and California / Carson, Dresslerville, Stewart and Woodfords Colonies Schurz / Yerington Paiute 3,000 / Elko, Eureka and Lander Counties, Tooele County (UT) 2,000 / Esmeralda, Mineral and Nye Counties 3,000 / Carson City, Douglas, Lyon and Storey Counties, Alpine County (CA) 1,500 / Lyon County 22,900 in Nevada and Bordering Counties of Idaho, Utah, California, and Oregon Source: Phoenix Area Indian Health Systems (2014). Nevada State Demographer s Office (2014b). Nevada State Office of Rural Health 241

258 Table 5.16: Utilization Trends in Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Admissions Inpatient Days Utilization Average Length of Stay (Days) Average Daily Census Occupancy Rate Battle Mountain General Hospital Boulder City Hospital 381 2, Carson Valley Medical Center 795 2, Desert View Hospital 1,048 3, Grover C. Dils Medical Center Humboldt General Hospital 873 2, Incline Village Community Hospital Mesa View Hospital 720 1, Mt. Grant General Hospital 458 1, Pershing General Hospital William Bee Ririe Hospital 404 1, CAH Subtotal 4,928 16, CAH-eligible Hospitals Banner Churchill Community Hospital 1,849 6, Northeastern Nevada Regional Hospital 2,797 8, Nye Regional Medical Center South Lyon Medical Center CAH-eligible Subtotal 4,842 14, Subtotal 9,770 31, Subtotal 239,816 1,185, , Nevada Total 249,586 1,217, , Sources: Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). 242 Nevada State Office of Rural Health

259 Table 5.17: Admissions and Inpatient Days in Hospitals in Nevada 2013 Admissions Inpatient Days Hospital Critical Access Hospitals (CAHs) Number Percent Of Nevada Total Adjusted Number of Admissions Number Percent of Nevada Total Adjusted Number of Inpatient Days Battle Mountain General Hospital Boulder City Hospital ,481 2, ,227 Carson Valley Medical Center ,179 2, ,561 Desert View Hospital 1, ,561 3, ,368 Grover C. Dils Medical Center ,342 Humboldt General Hospital ,239 2, ,509 Incline Village Community Hospital Mesa View Hospital ,020 1, ,491 Mt. Grant General Hospital , ,905 Pershing General Hospital ,701 William Bee Ririe Hospital ,272 1, ,673 CAH-Subtotal 4, ,149 16, ,858 CAH-eligible Hospitals Banner Churchill Community Hospital 1, ,733 6, ,802 Northeastern Nevada Regional Hospital 2, ,414 8, ,240 Nye Regional Medical Center ,004 South Lyon Medical Center ,416 CAH-eligible Subtotal 4, ,187 14, ,035 Subtotal 9, ,470 31, ,960 Subtotal 239, ,221 1,185, ,776,341 Nevada Total 249, ,616 1,217, ,861,629 Sources: Nevada Compare Care (2014a). Nevada Rural Hospital Partners (2014). Nevada State Office of Rural Health 243

260 Table 5.18: Total Patient Revenue in Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Inpatient Total Patient Revenue (Thousands of Dollars) Percent of Total Patient Revenue Outpatient Percent of Total Patient Revenue Total Patient Revenue Battle Mountain General Hospital 2, , ,925 Boulder City Hospital 11, , ,565 Carson Valley Medical Center 24, , ,477 Desert View Hospital 28, , ,396 Grover C. Dils Medical Center 2, , ,301 Humboldt General Hospital 19, , ,053 Incline Village Community Hospital , ,153 Mesa View Hospital 13, , ,807 Mt. Grant General Hospital 9, , ,822 Pershing General Hospital 2, , ,761 William Bee Ririe Hospital 7, , ,909 CAH Subtotal 123, , ,170 CAH-eligible Hospitals Banner Churchill Community Hospital 37, , ,679 Northeastern Nevada Regional Hospital 72, , ,146 Nye Regional Medical Center 1, , ,688 South Lyon Medical Center 4, , ,028 CAH-eligible Subtotal 116, , ,541 Subtotal 240, , ,711 Subtotal 16,228, ,080, ,308,981 Nevada Total 16,468, ,711, ,180,694 Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014). 244 Nevada State Office of Rural Health

261 Table 5.19: Total Revenue in Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Total Patient Revenue Total Revenue (Thousands of Dollars) Contractual Deductions and Adjustments Net Patient Revenue Other Operating Revenue Total Revenue Battle Mountain General Hospital 11,925 5,201 6,724 1,267 7,991 Boulder City Hospital 46,565 29,297 17, ,517 Carson Valley Medical Center 128,477 85,820 42, ,217 Desert View Hospital 98,396 74,279 24, ,564 Grover C. Dils Medical Center 6,301 1,919 4, ,439 Humboldt General Hospital 71,053 33,903 37, ,150 Incline Village Community Hospital 14,153 5,620 8, ,206 Mesa View Hospital 77,807 50,733 27, ,310 Mt. Grant General Hospital 20,822 9,992 10, ,928 Pershing General Hospital 10,761 3,418 7,343 1,912 9,255 William Bee Ririe Hospital 43,909 19,063 24, ,205 CAH Subtotal 530, , ,925 5, ,783 CAH-eligible Hospitals Banner Churchill Community Hospital 117,679 74,391 43, ,876 Northeastern Nevada Regional Hospital 192, ,121 92, ,025 Nye Regional Medical Center 16,688 6,323 10, ,365 South Lyon Medical Center 15,028 6,752 8,276 1,782 10,058 CAH-eligible Subtotal 341, , ,954 2, ,323 Subtotal 871, , ,879 8, ,106 Subtotal 24,308,981 20,105,550 4,203,431 87,389 4,290,820 Nevada Total 25,180,694 20,612,382 4,568,311 95,616 4,663,928 Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014). Nevada State Office of Rural Health 245

262 Table 5.20: Net Income in Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Total Revenue Net Income (Thousands of Dollars) Operating Expense Net Operating Income Non-operating Revenue Net Income Battle Mountain General Hospital 7,991 12,699-4,708 11,441 6,733 Boulder City Hospital 17,517 16,277 1, ,778 Carson Valley Medical Center 43,217 40,399 2, ,881 Desert View Hospital 24,564 22,474 2, ,090 Grover C. Dils Medical Center 4,439 5, Humboldt General Hospital 37,151 37, ,501 11,044 Incline Village Community Hospital 9,206 9, Mesa View Hospital 27,310 29,663-2, ,140 Mt. Grant General Hospital 10,928 11, Pershing General Hospital 9,255 6,239 3,016 1,307 4,323 William Bee Ririe Hospital 25,205 26,517-1,312 2, CAH Subtotal 216, , ,572 28,092 CAH-eligible Hospitals Banner Churchill Community Hospital 43,876 42,577 1, ,303 Northeastern Nevada Regional Hospital 92,025 46,496 45, ,350 Nye Regional Medical Center 10, , ,365 South Lyon Medical Center 10,058 11,487-1, CAH-eligible Subtotal 156, ,560 55,763 1,497 57,260 Subtotal 373, ,823 55,284 30,069 85,353 Subtotal 4,290,820 4,305,918-15,098 38,257 23,159 Nevada Total 4,663,925 4,625,850 40,186 68, ,512 Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014). 246 Nevada State Office of Rural Health

263 Table 5.21: Net Operating Income Benchmarks in Rural and Frontier Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Net Operating Income Benchmarks (Dollars) Net Operating Income (Thousands of Dollars) Net Operating Income per Adjusted Admissions Net Operating Income per Adjusted Inpatient Day Battle Mountain General Hospital -4,708-26,317-11,081 Boulder City Hospital 1, Carson Valley Medical Center 2, Desert View Hospital 2, Grover C. Dils Medical Center , Humboldt General Hospital Incline Village Community Hospital Mesa View Hospital -2, Mt. Grant General Hospital Pershing General Hospital 3,016 10,194 1,773 William Bee Ririe Hospital -1, CAH Subtotal CAH-eligible Hospitals Banner Churchill Community Hospital 1, Northeastern Nevada Regional Hospital 45,529 6,141 2,144 Nye Regional Medical Center 10,365 11,603 5,173 South Lyon Medical Center -1,429-3,639-1,010 CAH-eligible Subtotal 55,763 3,931 1,296 Subtotal 55,284 1, Subtotal -15, Nevada Total 40, Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014). Nevada State Office of Rural Health 247

264 Table 5.22: Net Income Benchmarks in Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Net Income (Thousands of Dollars) Net Income Benchmarks (Dollars) Net Income per Adjusted Admission Net Income per Adjusted Inpatient Day Battle Mountain General Hospital 6,733 37,637 15,847 Boulder City Hospital 1,778 1, Carson Valley Medical Center 2, Desert View Hospital 2, Grover C. Dils Medical Center Humboldt General Hospital 11,044 3,409 1,310 Incline Village Community Hospital Mesa View Hospital -2, Mt. Grant General Hospital Pershing General Hospital 4,323 14,612 1,709 William Bee Ririe Hospital CAH Subtotal 28,092 1, CAH-eligible Hospitals Banner Churchill Community Hospital 1, Northeastern Nevada Regional Hospital 46,350 6,252 2,182 Nye Regional Medical Center 10,365 11,603 5,173 South Lyon Medical Center , CAH-eligible Hospitals Subtotal 57,260 4,036 1,331 Subtotal 85,353 2, Subtotal 23, Nevada Total 108, Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014). 248 Nevada State Office of Rural Health

265 Table 5.23: Inpatient Billed Charges and Case Mix in Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Total Charges (Thousands of Dollars) Inpatient Billed Charges and Case Mix Percent of All Charges Authorized in Nevada Average Daily Charges Average Charges per Admission Average Case Mix Battle Mountain General Hospital ,804 4, Boulder City Hospital 5, ,609 15, Carson Valley Medical Center 23, ,579 30, Desert View Hospital 23, ,815 18, Grover C. Dils Medical Center 1, ,714 10, Humboldt General Hospital 14, ,432 13, Incline Village Community Hospital N/A N/A N/A N/A N/A Mesa View Hospital 14, ,843 17, Mt. Grant General Hospital 4, ,613 13, Pershing General Hospital ,954 8, William Bee Ririe Hospital 7, ,837 16, CAH Subtotal 95, ,360 19, CAH-eligible Hospitals Banner Churchill Community Hospital 37, ,718 17, Northeastern Nevada Regional Hospital 72, ,102 21, Nye Regional Medical Center N/A N/A N/A N/A N/A South Lyon Medical Center 1, ,412 8, CAH-eligible Subtotal 111, ,974 18,596 Subtotal 206, ,468 18,816 Subtotal 17,018, ,980 59,059 Nevada Total 17,225, ,895 57, Sources: Nevada Compare Care (2014b). Nevada Rural Hospital Partners (2014). Nevada State Office of Rural Health 249

266 Table 5.24: Inpatient Admissions by Payer Source in Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Medicare Medicare HMO Inpatient Admissions (Percent) Medicaid CHAMPUS CHAMPVA Commercial Insurer Self Pay Battle Mountain General Hospital Boulder City Hospital Carson Valley Medical Center Desert View Hospital Grover C. Dils Medical Center Humboldt General Hospital Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital Mt. Grant General Hospital Pershing General Hospital William Bee Ririe Hospital CAH Average CAH-eligible Hospitals Banner Churchill Community Hospital Northeastern Nevada Regional Hospital Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center CAH-eligible Average Average Average Nevada Average Sources: Nevada Compare Care (2014c). 250 Nevada State Office of Rural Health

267 Table 5.24: Inpatient Admissions by Payer Source in Hospitals in Nevada 2013 (continued) Hospital Critical Access Hospitals (CAHs) Negotiated Discounts (PPO) HMO Inpatient Admissions (Percent) Workers Comp County Indigent Charity Battle Mountain General Hospital Boulder City Hospital Carson Valley Medical Center Desert View Hospital Grover C. Dils Medical Center Humboldt General Hospital Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital Mt. Grant General Hospital Pershing General Hospital William Bee Ririe Hospital CAH Average CAH-eligible Hospitals Banner Churchill Community Hospital Northeastern Nevada Regional Hospital Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center CAH-eligible Average Average Average Nevada Average Sources: Nevada Compare Care (2014c). Other Nevada State Office of Rural Health 251

268 Table 5.25: Inpatient Days by Payer Source in Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Medicare Medicare HMO Inpatient Days (Percent) Medicaid CHAMPUS CHAMPVA Commercial Insurer Battle Mountain General Hospital Boulder City Hospital Carson Valley Medical Center Desert View Hospital Grover C. Dils Medical Center Humboldt General Hospital Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital Mt. Grant General Hospital Pershing General Hospital William Bee Ririe Hospital CAH Average CAH-eligible Hospitals Banner Churchill Community Hospital Northeastern Nevada Regional Hospital Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center CAH-eligible Average Average Average Nevada Average Sources: Nevada Compare Care (2014c). Self Pay 252 Nevada State Office of Rural Health

269 Table 5.25: Inpatient Days by Payer Source in Hospitals in Nevada 2013 (continued) Hospital Critical Access Hospitals (CAHs) Negotiated Discounts (PPO) HMO Inpatient Days (Percent) Workers Comp County Indigent Charity Battle Mountain General Hospital Boulder City Hospital Carson Valley Medical Center Desert View Hospital Grover C. Dils Medical Center Humboldt General Hospital Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital Mt. Grant General Hospital Pershing General Hospital William Bee Ririe Hospital CAH Average CAH-eligible Hospitals Banner Churchill Community Hospital Northeastern Nevada Regional Hospital Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center CAH-eligible Average Average Average Nevada Average Sources: Nevada Compare Care (2014c). Other Nevada State Office of Rural Health 253

270 Table 5.26: Inpatient Billed Charges by Payer Source in Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Medicare Medicare HMO Inpatient Billed Charges (Percent) Medicaid CHAMPUS CHAMPVA Commercial Insurer Battle Mountain General Hospital Boulder City Hospital Carson Valley Medical Center Self-Pay Desert View Hospital Grover C. Dils Medical Center Humboldt General Hospital Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital Mt. Grant General Hospital Pershing General Hospital William Bee Ririe Hospital CAH Average CAH-eligible Hospitals Banner Churchill Community Hospital Northeastern Nevada Regional Hospital Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center CAH-eligible Average Average Average Nevada Average Sources: Nevada Compare Care (2014c). 254 Nevada State Office of Rural Health

271 Table 5.26: Inpatient Billed Charges by Payer Source in Hospitals in Nevada 2013 (continued) Hospital Critical Access Hospitals (CAHs) Negotiated Discounts (PPO) HMO Inpatient Billed Charges (Percent) Workers Comp County Indigent Charity Battle Mountain General Hospital Boulder City Hospital Carson Valley Medical Center Desert View Hospital Grover C. Dils Medical Center Humboldt General Hospital Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital Mt. Grant General Hospital Pershing General Hospital William Bee Ririe Hospital CAH Average CAH-eligible Hospitals Banner Churchill Community Hospital Northeastern Nevada Regional Hospital Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center CAH-eligible Average Average Average Nevada Average Sources: Nevada Compare Care (2014c). Other Nevada State Office of Rural Health 255

272 Table 5.27: Inpatient Billed Charges by Payer Source in Hospitals in Nevada 2013 Hospital Critical Access Hospitals (CAHs) Medicare Inpatient Billed Charges (Thousands of Dollars) Medicare HMO Medicaid CHAMPUS CHAMPVA Commercial Insurer Self-Pay Battle Mountain General Hospital Boulder City Hospital 3, Carson Valley Medical Center 16, ,201 1,512 Desert View Hospital 9,205 7,792 1, ,232 2,391 Grover C. Dils Medical Center Humboldt General Hospital 5, , ,204 2,168 Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital 7,300 1,271 1, Mt. Grant General Hospital 3, Pershing General Hospital William Bee Ririe Hospital 2, , CAH Average 47,831 9,930 7,398 1,142 7,125 8,108 CAH-eligible Hospitals Banner Churchill Community Hospital 19,319 1,137 4, ,388 Northeastern Nevada Regional Hospital 28, , ,156 6,721 Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center CAH-eligible Average 48,226 1,793 9,247 1,220 18,156 8,109 Average 96,057 11,723 16,645 2,362 25,281 16,217 Average 5,855,143 2,120,634 2,222, , ,197 1,019,875 Nevada Average 5,951,200 2,132,357 2,238, , ,478 1,036,092 Sources: Nevada Compare Care (2014c). 256 Nevada State Office of Rural Health

273 Table 5.27: Inpatient Billed Charges by Payer Source (Dollars) in Hospitals in Nevada 2013 (continued) Hospital Critical Access Hospitals (CAHs) Negotiated Discounts (PPO) Inpatient Billed Charges (Thousands of Dollars) HMO Workers Comp County Indigent Charity Battle Mountain General Hospital Boulder City Hospital ,006 Carson Valley Medical Center 2, Desert View Hospital Grover C. Dils Medical Center Humboldt General Hospital 2,407 1, Incline Village Community Hospital N/A N/A N/A N/A N/A N/A Mesa View Hospital 3, Mt. Grant General Hospital Pershing General Hospital William Bee Ririe Hospital CAH Average 8,121 1, ,952 CAH-eligible Hospitals Banner Churchill Community Hospital 4,594 1, , Northeastern Nevada Regional Hospital 10, ,889 Nye Regional Medical Center N/A N/A N/A N/A N/A N/A South Lyon Medical Center CAH-eligible Average 14,787 1, ,053 4,405 Average 22,908 3, ,053 8,357 Average 1,290,480 2,746, , ,578 76, ,136 Nevada Average 1,313,388 2,749, , ,743 80, ,493 Sources: Nevada Compare Care (2014c). Other Nevada State Office of Rural Health 257

274 DRG Table 5.28: Top Twenty Types of Admissions in Community Hospitals in Nevada 2013 Type of Admission (Diagnostically Related Group) Number of Admissions Utilization and Charges Total Patient Days Average Charge per Admission (Dollars) 795 Normal Newborn 1,191 1,758 2, Vaginal Delivery W/O Complicating Diagnoses 910 1,313 10, Esophagitis, Gastroenteritis and Misc Digest Disorders W/O MCC 660 1,813 26, Chest Pain , Simple Pneumonia and Pleurisy W CC 413 1,680 24, Cesarean Section W/O CC/MCC , Kidney and Urinary Tract Infections W/O MCC 303 1,153 18, Nutrition and Miscellaneous Metabolic Disorders W/O MCC , Cellulitis W/O MCC 237 1,118 24, Major Joint Replacemt or Reattachment of Lower Extremity W/O MCC , Chronic Obstructive Pulmonary Disease W/O CC/MCC , Neonate W/ Other Significant Problems , Simple Pneumonia and Pleurisy W/O CC/MCC , Chronic Obstructive Pulmonary Disease W MCC , Heart Failure and Shock W CC , Signs and Symptoms W/O MCC , Septicemia or Severe Sepsis W/O MV 96+ Hours W MCC 159 1,092 45, Chronic Obstructive Pulmonary Disease W CC , Septicemia or Severe Sepsis W/O MV 96+ Hours W/O MCC , Cardiac Arrhythmia and Conduction Disorders W/O CC/MCC ,493 Sources: Nevada Compare Care (2014d). 258 Nevada State Office of Rural Health

275 Table 5.29: Top Twenty Types of Admissions in Community Hospitals in Nevada 2013 DRG Type of Admission (Diagnostically Related Group) Number of Admissions Utilization and Charges Total Patient Days Average Charge per Admission (Dollars) 795 Normal Newborn 22,572 44,888 3, Vaginal Delivery W/O Complicating Diagnoses 17,583 31,830 14, Rehabilitation W CC/MCC 8, ,492 62, Cesarean Section W/O CC/MCC 7,497 20,127 24, Major Joint Replacemt or Reattachment of Lower Extremity W/O MCC 6,364 20,507 89, Neonate W/ Other Significant Problems 5,210 14,533 8, Esophagitis, Gastroenteritis and Misc Digest Disorders W/O MCC 5,022 13,071 29, Septicemia or Severe Sepsis W/O MV 96+ Hours W MCC 4,690 35,788 87, Cesarean Section W CC/MCC 3,753 15,137 33, Cellulitis W/O MCC 3,405 11,881 31, Kidney and Urinary Tract Infections W/O MCC 2,804 9,250 30, Chest Pain 2,589 4,410 28, Simple Pneumonia and Pleurisy W CC 2,580 9,966 40, Spinal Fusion Except Cervical W/O MCC 2,378 7, , Renal Failure W CC 2,369 10,458 44, Vaginal Delivery W Complicating Diagnoses 2,323 5,411 16, Heart Failure and Shock W CC 2, , Perc Cardiovasc Proc W Drug-Eluting Stent W/O MCC 2,201 5, , Circulatory Disorders Except AMI, W Card Cath W/O MCC 2,068 5,881 61, G.I. Hemorrhage W CC 1,958 6,774 43,538 Sources: Nevada Compare Care (2014c). Nevada State Office of Rural Health 259

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277 Nevada Health Data Book Data Sources Aging and Disability Services Division. (2014a). Medicare Recipients by County. Unpublished data. Carson City: NV: State of Nevada. Available from Bureau of Economic Analysis. (2014a). Interactive Data. Regional Data. GDP and Personal Income. Begin using data. Local areas personal income and employment. Personal income, per capita personal income, and population (CA 1-3). Washington DC: U.S. Department of Commerce. Available from: Bureau of Economic Analysis. (2014b). Interactive Data. Regional Data. GDP and Personal Income. Begin using data. Local areas personal income and employment. Economic profiles (CA 30). Washington DC: U.S. Department of Commerce. Available from: Bureau of Economic Analysis. (2014c). Interactive Data. Regional Data. GDP and Personal Income. Begin using data. Local areas personal income and employment. Personal current transfer receipts (CA 35). Washington DC: U.S. Department of Commerce. Available from: Bureau of Health Care Quality and Compliance. (2004). Unpublished data. Medical Licensed Personnel. Carson City: Nevada State Health Division. Bureau of Health Care Quality and Compliance. (2014a). Unpublished data. Medicaid Enrollment. Carson City: Nevada State Health Division. Bureau of Health Care Quality and Compliance. (2014b). Unpublished data. Nevada Checkup Enrollment. Carson City: Nevada State Health Division. Bureau of Health Care Quality and Compliance. (2014c). Unpublished data. Registered Dietitians. Carson City: Nevada State Health Division. Bureau of Health Care Quality and Compliance. (2014d). Unpublished data. Medical Licensed Personnel. Carson City: Nevada State Health Division. Bureau of Health Care Quality and Compliance. (2014e). Health Facility Locator. Carson City, NV: Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Available from: Bureau of Health Professions, Health Resources and Services Administration. (2010). Shortage Designation: HPSAs, MUAs, and MUPs. Washington DC: US Department of Health and Human Services. Available from: Centers for Disease Control and Prevention. (2014). Diabetes Public Health Resource. Diabetes Interactive Atlas. Available from: Nevada State Office of Rural Health 261

278 Centers for Disease Control and Prevention. (2014b). Obesity Public Health Resource. Obesity Interactive Atlas. Available from: Centers for Disease Control and Prevention. (2014b). Physical Activity Public Health Resource. Diabetes Interactive Atlas. Available from: Centers for Medicare and Medicaid Services. (2014a). Research, Statistics, Data and Systems. Statistics, Trends and Reports. Medicare Enrollment Reports. Available from Centers for Medicare and Medicaid Services. (2014b). Research, Statistics, Data and Systems. Statistics, Trends and Reports. Medicare Advantage/Part D Contract and Enrollment Data. MA State/County Penetration. Available from Centers for Medicare and Medicaid Services. (2014c). Research, Statistics, Data and Systems. Statistics, Trends and Reports. Medicare Advantage/Part D Contract and Enrollment Data. DPD State/County Penetration. Available from Chiropractic Physicians Board of Nevada. (2004). Unpublished data. Las Vegas, NV: State of Nevada. Chiropractic Physicians Board of Nevada. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: County Health Rankings. (2014). County Health Rankings and Reports. Madison, WI: University of Wisconsin, School of Medicine and Public Health. Available from: Department of Employment, Training, and Rehabilitation. (2014a). Nevada Workforce Informer. Data Analysis. Labor force. [Data file]. Carson City, NV: Nevada Department of Employment, Training, and Rehabilitation. Available from: Department of Employment, Training, and Rehabilitation. (2014b). Nevada Workforce Informer. Data Analysis. Quarterly Census of Employment and wages. [Data file]. Carson City, NV: Nevada Department of Employment, Training, and Rehabilitation. Available from: Department of Employment, Training, and Rehabilitation. (2014c). Nevada Workforce Informer. Data Analysis. 10 Year Industry Projections. [Data file]. Carson City, NV: Nevada Department of Employment, Training, and Rehabilitation. Available from: Department of Employment, Training, and Rehabilitation. (2014d). Nevada Workforce Informer. Data Analysis. Occupation and other wages. [Data file]. Carson City, NV: Nevada Department of Employment, Training, and Rehabilitation. Available from: Division of Health Care Financing and Policy. (2014a). Unpublished data. NV Check Up Member Enrollment. Carson City, NV: Nevada State Health Division. Division of Health Care Financing and Policy. (2014b). Nevada Check Up. Enrollment Statistics Enroll by age. Number of children enrolled by county and age for enrollment beginning: January Carson City, NV: Nevada State Health Division. Available from: Division of Welfare and Support Services. (2014). Unpublished Data. Nevada Department of Health and Human Services. Carson City, NV: State of Nevada. 262 Nevada State Office of Rural Health

279 Economic Research Service. (2014). Topic. Food and Nutrition Assistance. Supplemental Nutrition Assistance Program (SNAP). Supplemental Nutrition Assistance Program (SNAP) Data System. Enter the map. Time Series Data. Download the Excel file. Washington DC: U.S. Department of Agriculture. Available from: Emergency Medical Systems. (2012). Unpublished data. Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics. Emergency Medical Systems and Trauma Systems. (2014). Unpublished data. Las Vegas, NV: Southern Nevada Health District. Available from: ESRI. (2014). ArcGIS 10.3 Software. Redlands, CA: ESRI, Inc. Available from: Federal Bureau of Investigation. (2014). Uniform Crime Reports. Stats and Services. Reports and Publications. Uniform Crime Reports: Crime in the United States Offenses Known to Law Enforcement. Go to Offense tables (Tables 8, 9, 10, 11). Available from: Federal Deposit Insurance Corporation. (2014). Nevada. <select county>. County overview. Employment and Income. Personal Bankruptcy Filings (all counties). Available from: Health Resources and Services Administration. (2015). Find shortage Areas: HPSA by State and County. Available from Legislative Counsel Bureau. (2014). Research/Library. Research Division. Publication of the Research Division. Research Division Studies and Legislative Reports Nevada Education Data Book. Carson City, NV: Nevada Legislature. Available from: Minnesota IMPLAN Group. (2014). State of Nevada Input-Output Data for Unpublished data. National Survey on Drug Use and Health. (2012). Data. Reports by Topic. NSDUH/NSHDA NSDUH sub-state estimates of substance use and mental disorders. Rockville, MD: Substance Abuse and Mental Health Services Administration. Available from: Nevada Board of Examiners for Audiology and Speech Pathology. (2006). Unpublished data. Las Vegas, NV: State of Nevada. Nevada Board of Examiners for Audiology and Speech Pathology. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: Nevada Board of Optometry. (2004). Unpublished data. Las Vegas, NV: State of Nevada. Nevada Board of Optometry. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: Nevada Compare Care. (2014a). CHIA Static Reports. NHQR Quarterly Reports. Acute Hospitals Utilization. Las Vegas: University of Nevada, Las Vegas. Available from: Nevada Compare Care. (2014b). CHIA Static Reports. NHQR Quarterly Reports. Acute Hospitals Financial. Las Vegas: University of Nevada, Las Vegas. Available from: Nevada State Office of Rural Health 263

280 Nevada Compare Care. (2014c). CHIA Static Reports. Standard Reports. Hospital by Payer. Las Vegas: University of Nevada, Las Vegas. Available from: Nevada Compare Care. (2014d). CHIA Static Reports. Standard Reports. Hospital by DRG. Las Vegas: University of Nevada, Las Vegas. Available from: Nevada Department of Corrections. (2014). Unpublished data. Carson City, NV: State of Nevada. Available from: Nevada Department of Education. (2014a). Data/Reports. Free and Reduced Lunch Data (Child Nutrition Program external link. Free and Reduced Lunch Carson City, NV: State of Nevada. Available from Nevada Department of Education (2014b). Nevada Report Card. Fiscal and Technology. Fiscal and Information Carson City, NV: State of Nevada. Available from: Nevada Department of Education. (2014c). Resources. Research Bulletin FY. Carson City, NV: State of Nevada. Available from Nevada Department of Education (2014d). Assessment and Accountability. Graduation Rates. Cohort Graduation Rates (Class of ). Carson City, NV: State of Nevada. Available from: Nevada Department of Education (2014e). Data Center. Annual Reports College-going and College Credit Accumulation Rates. C Carson City, NV: State of Nevada. Available from: Nevada Department of Education (2014f). Data Center. Annual Reports College-going and College Credit Accumulation Rates. C Carson City, NV: State of Nevada. Available from: Nevada Department of Transportation. (2014) Official Highway Map. Carson City, NV: NDOT. Available from: Nevada Health Centers. (2014). Unpublished data. Carson City, NV. Available from: Nevada Office of Rural Health. (2014). Unpublished data. Reno, NV: University of Nevada School of Medicine. Nevada Rural Hospital Partners. (2014). Membership Directory. Unpublished data. Reno, NV. Available from: Nevada Secretary of State. (2014). Election Center. Voters. Voter Registration Statistics. Voter Registration by County and Party. October 2014 Total Voters. Carson City, NV: State of Nevada. Available from Nevada State Board of Dental Examiners. (2004). Unpublished data. Las Vegas, NV: State of Nevada. Nevada State Board of Dental Examiners. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: Nevada State Office of Rural Health

281 Nevada State Board of Examiners for Alcohol, Drug and Gambling Counselors. (2008). Unpublished data. Las Vegas, NV: State of Nevada. Nevada State Board of Examiners for Alcohol, Drug and Gambling Counselors. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors. (2010). Unpublished data. Las Vegas, NV: State of Nevada. Nevada State Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors. (2012). Unpublished data. Las Vegas, NV: State of Nevada. Available from: Nevada State Board of Massage Therapists. (2010). Unpublished data. Reno, NV: State of Nevada. Available from: Nevada State Board of Massage Therapists. (2014). Unpublished data. Reno, NV: State of Nevada. Available from: Nevada State Board of Medical Examiners. (2004). Unpublished data. Reno, NV: State of Nevada. Nevada State Board of Medical Examiners. (2008). Unpublished data. Reno, NV: State of Nevada. Nevada State Board of Medical Examiners. (2014). Unpublished data. Reno, NV: State of Nevada. Available from: Nevada State Board of Nursing. (2004). Nevada State Board of Nursing Annual Report. Reno, NV: State of Nevada. Nevada State Board of Nursing. (2014). Nevada State Board of Nursing Annual Report. Reno, NV: State of Nevada. Available from: Nevada State Board of Optometry. (2004). Unpublished data. Carson City, NV: State of Nevada. Nevada State Board of Optometry. (2014). Unpublished data. Carson City, NV: State of Nevada. Available at Nevada State Board of Osteopathic Medicine. (2006). Unpublished data. Henderson, NV: State of Nevada. Nevada State Board of Osteopathic Medicine. (2014). Unpublished data. Henderson, NV: State of Nevada Available from: Nevada State Board of Pharmacy. (2004). Unpublished data. Las Vegas, NV: State of Nevada. Nevada State Board of Pharmacy. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: Nevada State Board of Podiatry. (2004). Unpublished data. Las Vegas, NV: State of Nevada. Nevada State Office of Rural Health 265

282 Nevada State Board of Podiatry. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: Nevada State Board of Psychological Examiners. (2008). Unpublished data. Las Vegas, NV: State of Nevada. Nevada State Board of Psychological Examiners. (2014). Unpublished data. Las Vegas, NV: State of Nevada. Available from: Nevada State Demographer s Office. (2014a). Data and Publications. Population Projections for Nevada and Nevada s Counties to Reno, NV: The Nevada State Demographer s Office, University of Nevada, Reno. Available from: Nevada State Demographer s Office. (2014b). Data and Publications. Population estimates of Nevada s Counties, Cities and Unincorporated Towns from July 2000 to July Governor Certified Population Estimates of Nevada s Counties, Cities and Towns 2000 to Reno, NV: University of Nevada, Reno. Available from: Nevada State Demographer s Office. (2014c). Data and Publications. Age, Sex, Race and Hispanic Origin (ASRHO) Estimates and Projections October Reno, NV: The Business Services Group, University of Nevada, Reno. Available from: Nevada State Demographer s Office. (2014d). Unpublished data. Age, Sex, Race and Hispanic Origin (ASRHO) Estimates and Projections for the state of Nevada 2000 to Reno, NV: University of Nevada, Reno. Nevada System of Higher Education. (2014). Data and Reports. Institution Research. Capture Rates by County. NSHE Capture Rates of Recent Nevada High School Graduates. Las Vegas, NV: State of Nevada. Available from: Office of Health Statistics and Surveillance. (2014a). Unpublished data Behavioral Risk Factor Surveillance Survey. Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics. Office of Health Statistics and Surveillance. (2014b). HIV/AIDS Surveillance Reports. State Fast Facts Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics. Available from: Office of Health Statistics and Surveillance. (2014c). STD Statistics Fast Facts Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics. Available from: Office of Health Statistics and Surveillance. (2014d). Tuberculosis Program. Trends and Statistics Fast Facts. Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics. Available from: Office of Health Statistics and Surveillance. (2014e). Unpublished data. Vital Statistics. Nevada Department of Health and Human. Nevada Division of Public and Behavioral Health. Preparedness, Assurance, Inspection, and Statistics. Phoenix Area Indian Health Service. (2013). Unpublished data. Phoenix Area Fiscal Year 2013 Active Users and Census Projections Report. Phoenix, AZ: Indian Health Services. 266 Nevada State Office of Rural Health

283 State of Nevada Board of Examiners for Social Workers. (2014). Unpublished data. Reno, NV: State of Nevada. Available from: State of Nevada Board of Dispensing Opticians. (2004). Unpublished data. Las Vegas: State of Nevada. State of Nevada Board of Dispensing Opticians. (2014). Unpublished data. Las Vegas: State of Nevada. Available from: State of Nevada Board of Occupational Therapy. (2004). Unpublished data. Las Vegas: State of Nevada. State of Nevada Board of Occupational Therapy. (2014). Unpublished data. Las Vegas: State of Nevada. Available from: State of Nevada Physical Therapy Examiners Board. (2004). Unpublished data. Las Vegas: State of Nevada. State of Nevada Physical Therapy Examiners Board. (2014). Unpublished data. Las Vegas: State of Nevada. Available from: United States Census Bureau. (2014a) Census. Factfinder2. Washington DC: U.S. Department of Commerce. Available from: United States Census Bureau. (2014b) Census. Washington DC: U.S. Department of Commerce. Available from: United States Census Bureau. (2014c) Census. Washington DC: U.S. Department of Commerce. Available from: United States Census Bureau. (2014d). Topics. Population. Population estimates. Current Estimates Data. Housing Units: (V 2013). Annual estimates of county housing units for states: 2010 to Nevada. Washington DC: U.S. Department of Commerce. Available from United States Census Bureau. (2014e). Topics. Income and Poverty. Small Area Income and Poverty. SAIPE. Interactive Data Tool. Washington DC: U.S. Department of Commerce. United States Census Bureau. (2014f). Topics. Business and Industry. Data by geography. Counties. Building Permits Permits by County or Place. Building Permits (2003, 2008, and 2013). Washington DC: U.S. Department of Commerce. Available from: United States Census Bureau. (2014g). Topics. Economy. Other Economic Programs. County Business Patterns. Nevada. NAICS code 81: Other Services (except Public Administration). NAICS code 813: Religious, Grant making, Civic, Professional, and Similar Organizations. Available from: United States Census Bureau. (2014h). Topics. Health. Small Area Health Insurance Estimates (SAHIE). Interactive Data Visualization and Mapping Tool. Washington DC: U.S. Department of Commerce. Available from United States Department of Agriculture. (2014). Rural-urban Commuting Area Codes. Data. Available from Nevada State Office of Rural Health 267

284 United States Department of Veterans Health Administration. (2014). Enrollment, User, and Projections. Unpublished data. Reno, NV. University Center for Economic Development. (2013). Health Sector Payroll and Employment Data for Nevada Counties. Unpublished data. Reno, NV: University of Nevada, Reno. 268 Nevada State Office of Rural Health

285 Nevada Health Data Book End Notes Section One: Demographic Profile of Nevada Table 1.1 to Table 1.5: Population in Nevada by County Note: The figures in these tables are from the most recently released Nevada State Demographer s Office projected population numbers based on the certified estimates of the year Population estimates are released twice a year, the certified general population estimates of the previous year are released in July with the next twenty years of population projections. In October, the age, sex, race, and Hispanic origin reports are released. Some ASRHO numbers may be from unpublished data. In 2014, estimates were released twice. The second release included the impact of the Tesla project in Nevada. Table 1.6: Population and Housing Density in Nevada by County 2014 Note: Population per square mile uses the 2014 data and housing units per square mile uses 2013 data. Table 1.7: Housing Units in Nevada by County 2000 to 2013 Note: The change in housing units shows the increase or decrease of all housing units in an area over a period of time and can be used to measure the growth (or decline) experienced in that area. Nevada has many mobile homes in mining areas. Population estimate is from 2014 and the housing estimates is from Table 1.8: Population in Nevada by City, County, and Region 2010 to 2013 Note: These are the certified population estimates by the Nevada State Demographer s Office released in July The 2010 population numbers are from the Nevada State Demographer s Office (July 2010) not the decennial 2010 Census (April 2010). The Office of Statewide Initiatives calculated numbers not supplied by the Nevada State Demographer. Table 1.9: Population in Incorporated and Unincorporated Areas in Nevada by County 2013 Note: There are unincorporated cities in seven of 14 rural and frontier counties in Nevada. Incorporated cities may be small or large and unincorporated populations may be large in rural and frontier counties. Carson City is considered a metropolitan city/county and has no rural population. Table 1.10 and Table 1.16: Population under Note: Totals for ages 17 and under were calculated from unpublished Age, Sex, Race, and Hispanic Origin population data from the Office of the Nevada State Demographer. Nevada State Office of Rural Health 269

286 Table 1.19 to Table 1.22: Age, Sex, Race, and Hispanic Origin Population in Nevada by County Note: In October, the age, sex, race, and Hispanic origin population reports are released. Some ASRHO numbers may be from unpublished data. Two population estimates are released: one include group quarters, e.g. prison population, dormitories, institutionalized people and nursing homes; the second does not include in the data used for Tables 1.19 to The prison numbers are in Tables 1.27 and Table 1.24: Veterans Population by Age in Nevada by County Note: Percent of total population is for each county. Table 1.26: Population by Place of Birth in Nevada by County Note: These numbers are averaged from calculated by the American Community Survey for all counties. American factfinder query was used to find median age from population characteristics. Section 2: Social and Economic Profile of Nevada Table 2.1 to Table 2.8: Sources and Amounts of Personal Income in Nevada by County Note: All dollar estimates are in current dollars (not adjusted for inflation). Table 2.8: Income from Transfer Payments by Type of Transfer Payment in Nevada by County 2012 Note: Income by type of transfer payment excluded payments less than $50,000 from the column Other, but the estimates for this item are included in the total of the column. Table 2.9: Median Family Income in Nevada by County 2009 to 2013 American Community Survey (ACS) Estimates Note: Within each year, the American Community Survey estimate is based on five years of data for the average. Table 2.10: Median Family Income in Nevada by County 2013 American Community Survey (ACS) Estimates Note: American Community Survey estimate is based on five years of data for the average. To build countylevel data, estimates may vary broadly and the confidence interval should help interpret the variation. Table 2.11: Median Household Income in Nevada by County 2009 to 2013 Small Area Income and Poverty Estimates (SAIPE) Note: These numbers are from the Small Area Income and Poverty Estimates reflecting the most current household incomes by county in 2012 in contrast to five-year averages. Table 2.12: Median Household Income in Nevada by County 2013 Small Area Income and Poverty Estimates (SAIPE) Note: American Community Survey estimate is based on five years of data for the average. To build countylevel data, estimates may vary broadly and the confidence interval should help interpret the variation 270 Nevada State Office of Rural Health

287 Table 2.13: Personal Bankruptcy in Nevada by County 2005 to 2013 Note: N/A means no information provided. Table 2.14: New Building Permits Issued in Nevada by County 2003 to 2013 Note: Counties must participate in the Census Building Permits Survey to be counted. This data can be considered an indicator for the economic vitality of a county. N/A means no data available. Table 2.19: Students Qualifying for Free and Reduced School Lunch (FRL) in Nevada by County 2013 Note: Provision II lunches are included only in the totals not in FRL subtotals. Table 2.21 and Table 2.22: Enrollment in Public and Private Schools in Nevada by County 2012 Note: Public Charter Schools enrollment data may be statewide or in a county, however it is combined into a statewide total. N/A means data not available. Table 2.21, Table 2.22 and Table 2.24: Enrollment in Public and Private Schools in Nevada by County Note: School enrollment include grades Kindergartener through 12 grades. Table 2.23: Number of Schools in Nevada by County 2012 Note: Other for public schools include Charter K-12 Schools, Public K-12 Schools, and Public Special Schools (Detention Facilities, Special Education Schools, Alternative Education Schools, and Adult Schools). Other for private schools include Private K-12 Schools. Table 2.24: Enrollment in Public Primary and Secondary Schools in Nevada by County 2012 Note: Ungraded refers to a student who is enrolled in a non-graded class in a school for special education or a student who cannot be assigned to a grade because of the nature of his or her condition (NAC ). Although the State Board of Education is not considered a "District", it is the State Sponsor of eleven Charter Schools and one University School, which are listed separately. Table 2.25 to Table 2.28: High School Graduation Rates and post-secondary education in the Nevada System of Higher Education. Note: Esmeralda County has no high school, N/A means not available and means numbers are less than 10 or suppressed. Department of Education uses 0 to indicate no population. Table 2.29: First-year Persistence in Nevada System of Higher Education (NSHE) Institutions in Nevada by County 2009 to 2011 Note: means numbers are suppressed. N/A means data is not available. Percent Finished First Year of Courses refers to completion of one year s worth of progress within 2 years of initial in-state public enrolment. Table 2.31: Voter Registration in Nevada by County 2014 Nevada State Office of Rural Health 271

288 Note: Eligible voting population aged 18 and over do not include people living in group quarters, e.g. prisons. Table 2.33: Percent of Registered Voters by Party in Nevada by County 2014 Note: Column Other Party Affiliation includes Libertarian party, which is larger than all other unlisted affiliations. Table 2.36 to Table 2.38: Reported Violent and Property Crimes 2012 Note: Data was aggregated from the sheriff s office, county police department, tribal agencies, University of Nevada (Las Vegas and Reno), and Truckee Meadows College campuses. Section Three: Population Health Profile of Nevada Tables 3.1 to 3.11: Health Insurance Coverage for Population Under the Age of 65, by Federal Poverty Level, Age and Gender. Note: The Small Area Health Insurance Estimates are single-year estimates produced annually using a model based upon and consistent with the American Community Survey areas of interest. These survey estimates are enhanced with administrative data, within a Hierarchical Bayesian framework. Data is consistent over time from 2008 to Table 3.12: Medicaid Enrollment in Nevada by County Note: Enrollment increased between 2013 and 2014 due to the implementation of the Affordable Care Act. Table 3.13 and 3.14: Nevada Check Up (Nevada s Children Health Insurance Program) Enrollment by County and Age Note: Totals may not balance due to data being gathered at different points of time. Table 3.16: Population Eligible for Medicare Benefits Aged and Disabled in Nevada by County Note: Report was published mid-year and totals may different from year-end reports. Table 3.17 and 3.18: Number and Percent Enrolled in Medicare by Program Part in Nevada by County Note: Hospital Insurance is Part A, Supplemental Medical Insurance is Part B, Medicare Advantage is Part C and Prescription Drug Plan is Part D. The total eligible reflects numbers from the Medicare Advantage Report Part C filed for December 2014 and may vary from the aged and disability report. Part B totals do not reflect any changes. Data is suppressed for Eureka County due to a count less than 10. County totals may not appear to add to overall totals due to rounding errors. means data was suppressed. Table 3.19: Medicare Eligible Population in Nevada by County 2000 to 2012 Note: The 2012 number reflects changes from the Medicare Advantage Report Part C filed for December 2014 and may vary from the aged and disability report. Table 3.24 Table 3.26 Behavioral Risk Factor Surveillance System (BRFSS) Tables 272 Nevada State Office of Rural Health

289 Note: Refinements to the system include data received from cell phone users facilitates the inclusion of a broader demographic and ultimately provides a better reflection of the nation's health status. Table 3.27 Table to 2011 Diabetes, Obesity, and Physical Inactivity Tables Note: The prevalence of diagnosed diabetes and selected risk factors by county was estimated using data from CDC's Behavioral Risk Factor Surveillance System (BRFSS) and data from the US Census Bureau s Population Estimates Program. The BRFSS is an ongoing, monthly, state - based telephone survey of the adult population. The survey provides state - specific information on behavioral risk factors and preventive health practices. Respondents were considered. You can view trends in county - level data beginning in Three years of data were used to improve the precision of the year - specific county - level estimates of diagnosed diabetes and selected risk factors. For example, 2003, 2004, and 2005 were used for the 2004 estimate and 2004, 2005, and 2006 were used for the 2005 estimate. Estimates were restricted to adults 20 years of age or older to be consistent with population estimates from the US Census Bureau. The US Census Bureau provides year - specific county population estimates by demographic characteristics age, sex, race, and Hispanic origin. The county level estimates for the over 3,200 counties or county equivalents (e.g., parish, borough, and municipality) in the 50 US states, Puerto Rico and the District of Columbia were based on indirect model dependent estimates. The model - dependent approach employs a statistical model that borrows strength in making an estimate for one county from BRFSS data collected in other counties. Bayesian multilevel modeling techniques were used to obtain these estimates. Multilevel Poisson regression models with random effects of demographic variables (age 20 44, 45 64, 65; race; sex) at the county - level were developed. State was included as a county - level covariate. The model specification is essentially the same as Malec, et al. For selected years, rates were age adjusted by calculating age specific rates for the following three age groups, 20 44, 45 64, and 65. A weighted sum based on the distribution of these three age groups from the 2000 census was then used to adjust the rates by age using the weights 0.52, 0.31, 0.17, respectively. Table 3.30 Self-reported Substance Abuse and Mental Illness Among Population Aged 12 and Over in Nevada by Region Note: West Counties includes Carson City, Douglas County, and Lyon County. Table 3.31 and 3.32: Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Incidence and Prevalence in Nevada by Region 2013 and Note: Carson City data is suppress due to confidentiality issues of the count being less than 10 for a single county. Table 3.37 to 3.54: Various Vital Statistics Tables by County/Region in Nevada 2013 Note: denotes counts that do not meet the criteria, reliability, data quality or confidentiality and regional subtotals may not sum to a statewide total. Las Vegas Metropolitan Statistical Area (MSA) is Clark County, Reno-Sparks MSA includes Washoe and Storey Counties, and includes the remaining 13 non-urban counties. Counts are preliminary and are subject to changes on all vital statistics tables. Table 3.46: Childhood Disability by Type of Disability in Nevada by County of Residence Nevada State Office of Rural Health 273

290 Note: County detail may not cross-foot to county totals due to suppressing of counts less than 10. Table 3.57: Population Health Institute s County Health Rankings in Nevada Health Outcomes 2012 Note: counties are white. Esmeralda County is not ranked due to small populations and missing data. Table 3.58: Population Health Institute s County Health Rankings in Nevada Health Determinants 2012 Note: counties are white. Esmeralda County is not ranked due to small populations and missing data. Section Four: Health Care Workforce in Nevada Table 4.3: Health Sector Employment in Nevada by County 2013 Note: Las Vegas Metropolitan Statistical Area (MSA) is Clark County, Reno-Sparks MSA includes Washoe and Storey Counties, and includes the remaining 13 non-urban counties. Some data were generated by the authors using hospital employment data supplementing DETR employment growth rate for the sector. Table 4.4: Health Sector Payroll in Nevada by County 2013 Note: Note: Some DETR data may be suppressed and changes may occur from other sources of data. Las Vegas Metropolitan Statistical Area (MSA) is Clark County, Reno-Sparks MSA includes Washoe and Storey Counties, and includes the remaining 13 non-urban counties. Some data were generated by the authors using hospital payroll data supplementing DETR data for the sector. Table 4.5: Employment in the Health Care and Social Assistance Sector by Region in Nevada by County 2014 Note: Las Vegas Metropolitan Statistical Area (MSA) is Clark County, Reno-Sparks MSA includes Washoe and Storey Counties, and includes the remaining 13 non-urban counties. Some data were generated by the authors using hospital employment data supplementing DETR employment data for the sector. Table 4.6: Projected Employment in the Health Care and Social Assistance Sector by Region in Nevada 2014 Note: Las Vegas Metropolitan Statistical Area (MSA) is Clark County, Reno-Sparks MSA includes Washoe and Storey Counties, and includes the remaining 13 non-urban counties. The authors used hospital generated employment data supplementing DETR employment growth rate for the sector. Table 4.7 to 4.47: Licensed Professionals by County/Region in Nevada 2012 Note: The calculation of the number of licensed health care professionals per 100,000 population in Tables 4.7 through 4.47 utilize county- and state- population estimates developed by the Nevada State Demographer s Office for Some of the population estimates presented in this data book may utilize denominators varying slightly from these numbers as the tables and per population denominators were built using the most recent numbers at the time. All health professional licensure data presented in Tables 4.7 through 4.47 refer to individuals possessing an active license with a State of Nevada licensing board. Thus, these tables exclude inactive and/or retired licensees. Specific licensure data may not be updated for year 2014 if it were not made available to the authors. 274 Nevada State Office of Rural Health

291 Table 4.8: Licensed Primary Care Physicians (MDs and DOs) by in Nevada by County 2014 Note: Family Medicine, General Practice, Internal Medicine, Obstetrics and Gynecology, and Pediatric physicians are considered primary care physicians. Table 4.12: Licensed Physician Assistants (PAs) by in Nevada by County 2014 Note: Allopathic and Osteopathic PAs have been combined; in the year 2004, only Allopathic PAs were counted. Table 4.49: Population Residing in a Health Professional Shortage Area in Nevada by County 2015 Note: HPSA Areas are current designations and population counts are from the 2014 census bureau. Maps 4.1 to Maps 4.9: Note: Maps which shows HPSAs and those areas and facilities with a greater chance of National or Nevada Health Service Corps funding based on a HPSA score of 16 and above, the state primary care office can better direct providers to the correct loan repayment program depending on their work location. Section Five: Health Care Resources and Economics of Nevada Table 5.2: Community Hospitals in Nevada 2013 Note: The term Critical Access Hospital of CAH refers to a Medicare hospital facility designation from the Centers for Medicare and Medicaid Services. This designation allows small rural and frontier hospitals to receive cost-based reimbursement for inpatient and outpatient services provided to Medicare beneficiaries. As of February 2013, there were eleven certified CAHs and four CAH-eligible hospitals in Nevada. CAH and CAH-eligible receive financial and technical assistance from the Nevada Rural Hospital Flexibility Program. The Nevada Flex Program is a federally supported program administered by the Nevada State Office of Rural Health based with the Office of Statewide Initiatives at the University of Nevada School of Medicine. Tables 5.18: Total Patient Revenue in Hospitals in Nevada Note: Inpatient revenue includes inpatient and long-term care numbers. Outpatient revenue includes outpatient and clinic care numbers. Tables 5.20: Net Income in Hospitals in Nevada Note: Operating expense includes Medicaid and Medicare fees for service and management; PPOs, insurance and non-medicaid/medicare HMOs; uninsured discounts; charity care; bad debt; government and other contractual deductions. Tables 5.23 to 5.27: Income Tables in Hospitals in Nevada Note: N/A means data was not supplied by the source. Uninsured may be counted in self-pay or charity care. Nevada State Office of Rural Health 275

292