COMPREHENSIVE REPORT. Prepared by Florida Department of Health Collier County on behalf of Collier County Residents and Health Care Providers

Transcription

1 Collier County COMMUNITY STATUS 2013 COMPREHENSIVE REPORT Prepared by Florida Department of Health Collier County on behalf of Collier County Residents and Health Care Providers

2 Table of Contents ACKNOWLEDGMENTS... iii EXECUTIVE SUMMARY... iv LIST OF TABLES... xi LIST OF FIGURES... xv POPULATION... 1 Age Distribution, Gender and Population Growth... 1 Ethnicity... 7 Race... 9 Seasonal Population SOCIO-ECONOMIC CHARACTERISTICS Income Homelessness Education Unemployment Poverty and Food Assistance INFECTIOUS DISEASES Seasonal Variation of Reportable Cases and Conditions Cases Investigated but not Reportable Norovirus Mosquito-Borne Disease Tuberculosis Sexually Transmitted Diseases (STDs) HIV Infection HEALTH BEHAVIORS AND HEALTH STATUS Obesity and Overweight Tobacco Use Alcohol Use CHRONIC DISEASES Chronic Disease Mortality i

3 MORTALITY INDICATORS Life Expectancy Leading Causes of Death s of Potential Life Lost Actual Causes of Death, INJURIES Injury Mortality Motor Vehicle Crashes Unintentional Poisoning Drownings Falls Homicides Animal Bites MATERNAL AND INFANT HEALTH Infant Mortality Prenatal Health and Lifestyle Behaviors Birth Outcomes Low Birthweight Teenage Births Maternal Mortality Live Births HEALTH OF THE OLDER POPULATION Leading Causes of Death Clostridium Difficile (C.difficile) Alzheimer s Disease ORAL HEALTH Community Water Fluoridation Dental Care Resources ACCESS TO HEALTH CARE Health Insurance Coverage MENTAL HEALTH Suicide Mental Health Resources ii

4 COLLIER COUNTY COMMUNITY HEALTH STATUS ACKNOWLEDGEMENTS This document was conceived, designed, developed and written by a team consisting of Mark Crowley, MS; Muhammad Abbasi, MPH and Hugo Leon, RN within the Epidemiology and Health Assessment Program of the Florida Department of Health in Collier County. The assessment benefits significantly from the guidance and input of Joan Colfer, MD, MPH; Susan Crag, RN, MA; Stephanie Vick, RN, MS; Deb Millsap, M.Ed, RD, LD/N and Nancy Frees. We would like to thank Mike Riley, Chief Strategy Officer, NCH Healthcare System and Susan Manning, Director, Strategy, Quality and Performance Improvement, NCH Healthcare System for the provision of hospital data and their review and input into the analysis of the various health indicator chapters. Invaluable assistance was provided by Andrea McKinney, Shannon Kelley, MPH and Jeanna Money throughout the conception, design and finalization of the assessment document. iii

5 COLLIER COUNTY COMMUNITY HEALTH STATUS EXECUTIVE SUMMARY Demographics In the past two decades, Collier County has experienced tremendous growth and change in terms of population dynamics and demographics, socio-economic transitions and patterns of the health situation of the community. Between 1990 and 2010, the resident population of Collier County grew at a swift pace of 3.8 percent per year. The demographic dynamics of Collier County are being driven by the aging of the Baby Boomer cohort which began to turn 65 years of age during The older population is expected to increase to an estimated 144,000 by the year This tremendous rate of population increase generated unprecedented economic growth and development in the county through The post recession was accompanied by rising unemployment and limited investment which placed a significant burden on the social safety net of the county. The foreign born population in Collier County grew by 371 percent during this period. This ethnic demographic transition has created a shift in a number of public health indicators at the county level. In 2010, almost one third of Collier County residents spoke a language other than English at home, up from 17 percent in The correlation between educational attainment and income level and health status outcomes is well known. Many of the indicators of poverty are higher than expected in select areas of the county. Four of Collier County s communities have a per capita annual income ranging from $9,500 to just under $25,000; this is within one of the most affluent counties in Florida. These pockets of poverty greatly influence the overall quality of life and health status of the community, with children under 18 years of age being most affected. Over the past two decades the number of children living in poverty in Collier County increased by 138 percent. The good news is the educational attainment as measured by high school graduation rates and the percent of the population acquiring a bachelor s degree or higher has been steadily improving over the last 20 years. Life Expectancy and Mortality Collier County has the distinction of having the highest female life expectancy at birth among all of the counties in the United States at 85.8 years. Men in the county also benefit from a very high level of life expectancy at birth when compared to the rest of the country and is only surpassed by three other counties in the United States. iv

6 Hispanic residents of Collier County live almost three years longer than non-hispanics residents over the course of a lifetime. The significantly lower infant mortality among Hispanics in the county contributes heavily to these higher levels of life expectancy. This Hispanic survival advantage in longevity increases with age to the effect that by age 65, 91.2 percent of the Hispanic population in Collier County have survived competing causes of mortality compared with 86 percent of the non-hispanic population. In 2011, the ten leading causes of death in Collier County by rank order were: cancer, heart disease, chronic lower respiratory disease, stroke, unintentional injuries, Alzheimer s disease, diabetes mellitus, chronic liver disease and cirrhosis, kidney disease and Parkinson s disease. These ten leading causes accounted for 77 percent of all deaths occurring in the county. It should be emphasized that the ten leading causes of death do not all necessarily coincide with the causes of major public health importance. Premature and preventable causes of death within a community tend to become public health priorities since these causes or conditions affect the health status of the total population and a reduction in morbidity and mortality levels increases life expectancy and the quality of life at the county level. Chronic Disease Chronic diseases are the leading causes of death and disability in all counties in the United States. Seventy percent of all deaths among Collier County residents are due to chronic diseases, with heart diseases, cancers and stroke accounting for over 50 percent of all these deaths annually. Approximately 1 out of every 2 adults in Collier County has at least one chronic condition or disease. The burden of chronic disease is felt at all levels. For individuals it means limitations to function, health, activity and work which affect the quality of their lives, as well as the lives of families and friends. For the community it means increases in medical costs, uncompensated care and decreased worker productivity. Cancer became the leading cause of death in Collier in 2011 despite the fact the mortality rate for all cancers declined by 26 percent in the past two decades. Cancer has become the leading cause of death due to its high incidence and prevalence in the older population groups, in particular those 45 years of age and over, and the decrease in heart disease death rates. The leading cause of cancer deaths in Collier County is lung cancer, which accounted for 27 percent of all cancer mortality in Collier County has seen a substantial decline in this site-specific mortality rate since 1992, directly attributable to the decrease in the percentage of adults engaged in cigarette smoking. v

7 Between 1992 and 2011, the mortality rate from breast cancer declined by 24 percent in Collier County. Collier County Hispanic females experienced a very steep (74 percent) reduction in the breast cancer mortality rate between 2004 and Health education from health care providers and the public health sector has undoubtedly contributed to increased screening and earlier detection reducing the burden of mortality. Cerebrovascular disease is the 4 th leading cause of death in Collier County. In 2011, stroke accounted for almost 6 percent of all deaths within the county. Among females mortality from stroke accounted for 41 percent more deaths than in males in Diabetes is the 7 th leading cause of death in Collier County. The most significant risk factor for the development of diabetes is obesity and overweight. Diabetes is also a significant cause of heart disease and stroke and the leading cause of kidney failure. It is estimated that presently 27 percent of the total population, over 1 in 4, 65 years of age and older have diabetes. The risk of death among persons with diabetes is 2 times that of persons the same age without diabetes. Chronic liver disease and cirrhosis is the 8 th leading cause of death in the county. Excessive alcohol consumption is the major risk factor for liver disease followed by chronic hepatitis C and more recently obesity, which is now also a risk factor for the disease. Increasing obesity levels coupled with the high rate of consumption of alcohol in Collier County translates into projected increases in morbidity and mortality due to chronic liver disease and cirrhosis for future years. Health Behaviors and Actual Causes of Death The actual causes of death are major external and modifiable influences and factors that contribute to specific causes of death in our communities and its populations. These life style and behavioral factors are correlated and associated with a plurality, if not a majority, of all deaths. Almost one half of all deaths in Collier County are potentially preventable, based on the premise that major actual causes of mortality can be modified through education and access to care. Tobacco use is the leading cause of preventable mortality followed by overweight and obesity resulting from physical inactivity and poor diet habits. Together these two actual causes were responsible for 72 percent of all preventable causes of death in Collier County in Cigarette smoking has been scientifically associated as a cause in a myriad of diseases including numerous types of cancer, heart diseases and stroke, respiratory diseases and unfavorable maternal outcomes. In Collier County, 16.7 percent of the adult population identified themselves as current smokers; this is a decline of almost 3 percentage points vi

8 since Approximately 1 out of every 5 deaths in the county can be attributed to smoking. The lower the income and educational attainment the higher the smoking rates. Marriage appears to be a protective factor in Collier; the married population has significantly lower smoking rates than non-married couples. In 2010, 22.4 percent of Collier County adults indicated they were obese. An increase in the prevalence of obesity and overweight is related to a higher incidence of numerous chronic diseases including stroke, hypertension, cancer, diabetes and cardiovascular disease and premature mortality. Educational attainment is a protective factor against obesity in Collier County, with only 18.4 percent of adults with a four year college degree or beyond classified as obese compared with 34.8 percent with only a high school degree. The proportion of Collier County adult residents who engaged in heavy or binge drinking increased by over 2 percentage points between 2002 and 2010 to 19.2 percent. Males engaged in heavy or binge drinking at much greater rates than females in the county. Income level is a predictor of heavy or binge drinking; the higher the annual income ($50,000 or more), the more prevalent the overconsumption of alcohol. A significantly greater proportion of the population 65 years and older (12.6 percent) engaged in heavy or binge drinking. A strong statistical association exists between alcohol consumption and alcohol impaired driving. On average in Collier County 54 residents are killed annually in motor vehicle crashes with approximately 25 percent attributed to alcohol use. Oral Health Oral health is central to a person s overall health, well-being and quality of life. Between 2001 and 2011, the number of licensed dentists increased by 71 percent in Collier County. The majority of the dental care in the country is provided by dentists in private practice. Adults without private insurance have limited access to dental services at the county health department or federally qualified health centers. The only dental care option for many low income people who lack access to preventative dental services is the hospital emergency room. In Collier County, between 2000 and 2011, there was a 192 percent increase in hospitalizations from preventable dental conditions for people under 65 years of age. Collier Country residents with higher income and higher education are more likely to visit a dentist or dental clinic than persons with lower income and education. Health of the Older Population Since 1990, the number of residents in Collier County ages 65 and over has increased by 148 percent, from 35,182 to 87,144 in The median age of the population is getting older while the population cohort 65 years of age and over has been experiencing rapid growth. The older population of Collier County, persons 65 years and vii

9 above numbered 87,144 in This represents 27 percent of the total county population or over 1 in every 4 residents. As this older population increases to an estimated 144,000 by the year 2030, other concurrent factors will affect the health and well-being of this generation. Increased levels of life expectancy will translate into an increment in the necessity for increased geriatric health care service resources and availability. An increase in the demand for Assisted Living and Skilled Nursing beds is projected in the immediate future due to both increases in longevity and the projected number of Alzheimer s disease cases. In 2011, within Collier County over 11,000 residents 65 years of age and older had Alzheimer s disease; by 2030 using conservative population estimates, over 18,600 residents will be diagnosed with the disease. Incidence of falls beginning at ages 75 to 84 years rises exponentially to a rate of over 450 per 100,000 populations at ages 85 years and over. Falls in this age group are often associated with the need for hospitalization, rehabilitation services and decreased levels of independence. A significantly greater proportion of the population 65 years and older (12.6 percent) engaged in heavy or binge drinking. Mental Health Many studies have shown a link between depression and adverse health behaviors such as smoking, alcohol consumption, physical inactivity and sleep disturbance. Collier County residents experienced a remarkable increase in the percentage of individuals that reported poor mental health from 2007 to Over this four year period the percentage of residents reporting poor mental health status increased to 17.2 percent, or 1 in 6 persons. Males were much more likely to have experienced poor mental health than females and those in the age group years of age had the highest incidence while those 65 years and older had the lowest. Both income level and educational attainment were correlated with mental health status in Collier County, higher income and more education both translated into improved mental health status. Access to Care Private health insurance coverage is an integral mainstay for access to healthcare services for the core working population years of age and vital to the personal well-being and health of individuals. In Collier Country rates of health insurance coverage have been declining over the past two decades. This downward movement in health insurance coverage beginning in 2006 was exacerbated by the recession which pushed the uninsured population to historical heights as unemployment spiraled upwards. In 2011, almost 24 percent of the total resident population of Collier County was uninsured. Of the core working population years of age in Collier County, viii

10 38.5 percent were without health insurance. When controlling for race and ethnicity, whites, blacks and Hispanics in Collier Country are more likely to be uninsured than their counterparts in the state of Florida. Health insurance coverage rates in Collier County are highly correlated with educational attainment and income level. As education and income levels increase, the percentage of the uninsured population decreases a classic inverse correlation. The association being that within the core working population years of age, persons with higher education status are more likely to be employed at an income level that provides for or facilitates health insurance coverage as benefits to the employee. Maternal and Infant Health Maternal and infant health is the foundation for a vibrant and prosperous society. The infant mortality rate for Collier County declined to a new low of 5.0 infant deaths per 1,000 live births in The Hispanic infant mortality rate in the county was almost 60 percent lower (2.8 per 1,000 live births) than the non-hispanic rate( 6.9 per 1,000 live births). Pregnant women in Collier County continue to improve upon their health behaviors by decreasing their reliance on alcohol and tobacco use. Collier County lags behind the state of Florida for three indicators related to adequate prenatal care: births with first trimester prenatal care, births with late or no prenatal care and births with adequate prenatal care. Infectious Diseases While the great majority of diseases in Collier County and the United States causing morbidity and mortality in the 21 st century are non-communicable in nature, public health emerging infectious diseases continue to play a significant role in the health of communities. The risk of mosquito-borne encephalitis, dengue and malaria remain an ever present underlying risk in Collier County due to the unique climate and weather conditions particularly during the raining season. Dengue Fever has emerged in recent years in the Keys of Monroe County, only a few hours away via highway and is an emerging threat to Collier County. Between the years 2000 and 2011, the incidence of all communicable diseases increased by 20 percent in the county. Three of the 5 leading communicable diseases in Collier County are enteric or gastrointestinal related. During 2011, salmonella, campylobacter and giardiasis accounted for 50 percent of all reported infectious diseases in the county. The prevention of human rabies in Collier County is a public health priority due to the high risk wildlife species encountered naturally in the environment and the rapid land growth and development over the past two decades. In 2011, 13.3 percent of all reportable health conditions involved animal bites requiring post-exposure prophylaxis (PEP) to prevent the potential onset of rabies. Between 2001 and 2011, the number of animal bites to humans requiring PEP increased by over 90 percent. ix

11 The average rate of tuberculosis in Collier, once considered to have been virtually eliminated from the United States, has been trending upward since 2007, while the trend statewide and nationally has been declining. In Collier County medically underserved low income populations tend to have a high rate of tuberculosis exposure and infection. These vulnerable population groups disproportionately represent the majority of tuberculosis cases in the county. x

12 List of Tables POPULATION Table 1: Table 1: Collier County Population Rate of Growth, 1990, 2000 and Table 2: Collier County Population by Geographical Area, 1990, 2000 and Table 3: Collier County Households by Family Status, 1990, 2000 and Table 4: Collier County Population by Race, 1990, 2000, and Table 5: Collier County Population by Place of Birth, 1990, 2000 and Table 6: Collier County Foreign-born Population by Birth Place, 2000 and Table 7: Collier County Population by Language Spoken at Home, 1990, 2000 and Table 8: Collier County Peak Season Population, Estimates and Projections, 1990, 2000 and SOCIO ECONOMIC CHARACTERISTICS Table 1: Median Household Income, Collier County and Florida 1989, 1999 and Table 2: Real Median Household Income (Adjusted in 2009 Dollars), Collier County and Florida 1989, 1999 and Table 3: Distribution of Household Income, Collier County and Florida 1990, 2000 and Table 4: Median Household Income in Collier County, Florida and the United States, (Adjusted In 2011 Dollars) Table 5: Number of Participants in the Women, Infants and Children Program and Median Household Income (in 2011 dollars), Collier County, Table 6: Number of Children and Total Population Living in Poverty, Collier County and Florida, 1989,1999 and Table 7: Number of Homeless Shelter Admissions by Gender, Collier County, Table 8: Number of Homeless Shelter Admissions by Race, Collier County, Table 9: Number of Homeless Shelter Admissions by Average Length of Stay (in Days), Collier County, Table 10: Highest s of School Completed in the Population 25 s and Over, Collier County and Florida, 1990, 2000 and Table 11: Educational Attainment in Collier County and Florida, 1990, 2000 and Table 12: Unemployment Rates in Collier County and Florida, Table 13: Average Annual Employment in Collier County, by Sector Table 14: Distribution of the Collier County Labor Force, by Sector, 2001 and Table 15: Number of Children and Adults Participating in the Supplemental Nutrition Assistance Program, Collier County, Florida, INFECTIOUS DISEASE Table 1: Five Leading Communicable Diseases and Health Conditions Reported to the Epidemiology Program of the Collier County Health Department, Table 2: Animal Bites with PEP Recommended per 100,000 Population Table 3: Mosquito-Borne Diseases in Collier County, Table 4: PPD Positive Test Results from Refugees Resettlement Program Participants, Collier County, Table 5: Ratio of Female to Male Chlamydia Cases, Collier County, Table 6: Reported Chlamydia Cases by Select Age Group, Collier County, Table 7: Reported Chlamydia Cases by Select Age Group and Gender, Collier County, Table 8: Ratio of Female and Male Gonorrhea Cases, Collier County, Table 9: Reported Gonorrhea Cases by Select Age Group, Collier County, Table 10: Reported Gonorrhea Cases by Select Age Group and Gender, Collier County, Table 11: Reported Syphilis Cases by Type, Collier County, Table 12: Reported Syphilis Cases by Select Age Group and Gender, Collier County, Table 13: Reported Cases of HIV Infection, Collier County, Florida Table 14: Reported Cases of HIV Infection by Age, Collier County, Florida, Table 15: Cases of HIV Infection by Gender, Collier County, Florida, HEALTH BEHAVIORS AND HEALTH STATUS Table 1: Percent of Adults Who are Obese in Collier County and Florida, 2002, 2007 and Table 2: Percent of Adults Who are Obese, by Sex, in Collier County and Florida, 2002, 2007 and Table 3: Percent of Adults Who are Obese, by Ethnicity, in Collier County and Florida, 2002, 2007 and Table 4: Percent of Adults Who are Obese, by Educational Level, in Collier County and Florida, 2002, 2007 and Table 5: Percent of Adults Who are Obese, by Annual Income, in Collier County and Florida, 2002, 2007 and Table 6: Percent of Adults Who are Obese, by Age Group, in Collier County and Florida, 2002, 2007 and Table 7: Percent of Adults Who are Obese, by Marital Status, in Collier County and Florida, 2002, 2007 and Table 8: Percent of Adults Who are Overweight in Collier County and Florida, 2002, 2007 and Table 9: Percent of Adults Who are Overweight, by sex, in Collier County and Florida, 2002, 2007 and xi

13 Table 10: Percent of Adults Who are Overweight, by Ethnicity, in Collier County and Florida, 2002, 2007 and Table 11: Percent of Adults Who are Overweight, by Educational Level, in Collier County and Florida, 2002, 2007 and Table 12: Percent of Adults Who are Overweight, by Annual Income, in Collier County and Florida, 2002, 2007 and Table 13: Percent of Adults Who are Overweight, by Age Group, in Collier County and Florida, 2002, 2007 and Table 14: Percent of Adults Who are Overweight, by Marital Status, in Collier County and Florida, 2002, 2007 and Table 15: Percent of Adults Who are Currently Smokers in Collier County and Florida, 2002, 2007 and Table 16: Percent of Adults Who are Currently Smokers, by Sex, in Collier County and Florida, 2002, 2007 and Table 17: Percent of Adults Who are Currently Smokers, by Annual Income, in Collier County and Florida, 2002, 2007 and Table 18: Percent of Adults Who are Currently Smokers, by Educational Level, in Collier County and Florida, 2002, 2007 and Table 19: Percent of Adults Who are Currently Smokers, by Ethnicity, in Collier County and Florida, 2002, 2007 and Table 20: Percent of Adults Who are Currently Smokers, by Marital Status, in Collier County and Florida, 2002, 2007 and Table 21: Percent of Adults Who are Currently Smokers, by Age Group, in Collier County and Florida, 2002, 2007 and Table 22: Percent of Adults Who are Former Smokers in Collier County and Florida, 2002, 2007 and Table 23: Percent of Adults Who are Former Smokers, by Sex, in Collier County and Florida, 2002, 2007 and Table 24: Percent of Adults Who are Former Smokers, by Annual Income, in Collier County and Florida, 2002, 2007 and Table 25: Percent of Adults Who are Former Smokers, by Educational Level, in Collier County and Florida, 2002, 2007 and Table 26: Percent of Adults Who are Former Smokers, by Ethnicity, in Collier County and Florida, 2002, 2007 and Table 27: Percent of Adults Who are Former Smokers, by Marital Status, in Collier County and Florida, 2002, 2007 and Table 28: Percent of Adults Who are Former Smokers, by Age Group, in Collier County and Florida, 2002, 2007 and Table 29: Percent of Adults Who Have Never Smoked in Collier County and Florida, 2002, 2007 and Table 30: Percent of Adults Who Have Never Smoked, by Sex, in Collier County and Florida, 2002, 2007 and Table 31: Percent of Adults Who Have Never Smoked, by Ethnicity, in Collier County and Florida, 2002, 2007 and Table 32: Percent of Adults Who Have Never Smoked, by Education Level, in Collier County and Florida, 2002, 2007 and Table 33: Percent of Adults Who Have Never Smoked, by Annual Income, in Collier County and Florida, 2002, 2007 and Table 34: Percent of Adults Who Have Never Smoked, by Age Group, in Collier County and Florida, 2002, 2007 and Table 35: Percent of Adults Who Engage in Heavy or Binge Drinking, Collier County and Florida, 2002, 2007 and Table 36: Percent of Adults Who Engage in Heavy or Binge Drinking, by Sex, Collier County and Florida, 2002, 2007 and Table 37: Percent of Adults Who Engage in Heavy or Binge Drinking, by Ethnicity, Collier County and Florida, 2002, 2007 and 2010 Table 38: Percent of Adults Who Engage in Heavy or Binge Drinking, by Annual Income, Collier County and Florida, 2002, 2007 and Table 39: Percent of Adults Who Engage in Heavy or Binge Drinking, by Educational Level, Collier County and Florida, 2002, 2007 and Table 40: Percent of Adults Who Engage in Heavy or Binge Drinking, by Age Group, Collier County and Florida, 2002, 2007 and 2010 Table 41: Percent of Adults Who Engage in Heavy or Binge Drinking, by Marital Status, Collier County, and Florida, 2002, 2007and MORTALITY INDICATORS Table 1: Life Expectancy at Birth, Collier County, 1990, 2000 and Table 2: Life Expectancy at Birth, by Sex, Collier County, 1990, 2000 and Table 3: Life Expectancy in Collier County at Select Ages, by Ethnicity, Table 4: Leading Causes of Death, All Ages, both Sexes, Collier County, Table 5: Leading Causes of Death, All Ages, both Sexes, Collier County, Table 6: Leading Causes of Death, All Ages, both Sexes, Collier County, Table 7: Leading Causes of Death, All Ages, Males, Collier County, Table 8: Leading Causes of Death, All Ages, Females, Collier County, Table 9: Leading Causes of Death, All Ages, Males, Collier County, Table 10: Leading Causes of Death, All Ages, Females, Collier County, Table 11: Leading Causes of Death, All Ages, Males, Collier County, Table 12: Leading Causes of Death, All Ages, Females, Collier County, Table 13: Leading Causes of Death in Collier County in 2011 Contrasted with the Actual Preventable Causes of Death for Comparison Table 14: s of Potential Life Lost Under 75 s of Age per 100,000 Population, Females, Collier County, 1990, 2000, and Table 15: s of Potential Life Lost Under 75 s of Age per 100,000 Population, Males, Collier County, 1990, 2000 and Table 16: Ratio of Male to Female s of Potential Life Lost per 100,000 Population, by Leading Causes of Death, Collier County, Table 17: Leading Causes of Death in Collier County in 2011 Contrasted with the Actual Preventable Causes of Death for Comparison xii

14 MATERNAL AND INFANT HEALTH Table 1: Infant Deaths per 1,000 Live Births, Single Rates, Collier County and Florida, Table 2: Infant Deaths per 1,000 Live Births, Single by Race, Collier County and Florida, Table 3: Infant Deaths per 1,000 Live Births, Single Rates by Ethnicity, Collier County and Florida, and Table 4: Infant Deaths per 1,000 Live Births 3- Rolling Rates, Collier County and Florida, Table 5: Infant Deaths per 1,000 Live Births 3- Rolling Rates by Race, Collier County and Florida, Table 6: Infant Deaths per 1,000 Live Births 3- Rolling Rates by Ethnicity, Collier County and Florida, Table 7: Rates of Access to Prenatal care, Collier County and Florida, and Table 8: Reported Prenatal Health and Behaviors, Collier County and Florida, and Table 9: Percentage of Live Births Under 1,500 Grams (Very Low Birthweight), Collier County and Florida, Table 10: Percentage of Live Births Under 1,500 Grams (Very Low Birthweight) by Race, Collier County and Florida, Table 11: Percentage of Live Births Under 1,500 Grams (Very Low Birthweight) by Ethnicity, Collier County and Florida, Table 12: Percentage of Live Births Under 1,500 Grams (Very Low Birthweight) 3- Rolling Average, Collier County and Florida, Table 13: Percentage of Live Births Under 1,500 Grams (Very Low Birthweight) 3- Rolling Average by Race, Collier County and Florida, Table 14: Percentage of Live Births Under 1,500 Grams (Very Low Birthweight) 3- Rolling Average by Ethnicity, Collier County and Florida, Table 15: Percentage of Live Births Under 2,500 Grams (Low Birthweight), Collier County and Florida, Table 16: Percentage of Live Births Under 2,500 Grams (Low Birthweight) by Race, Collier County and Florida, Table 17: Percentage of Live Births Under 2,500 Grams (Low Birthweight) by Ethnicity, Collier County and Florida, Table 18: Percentage of Live Births Under 2,500 Grams (Low Birthweight) 3- Rolling Rates, Collier County and Florida, Table 19: Percentage of Live Births Under 2,500 Grams (Low Birthweight) 3- Rolling Average by Race, Collier County and Florida, Table 20: Percentage of Live Births Under 2,500 Grams (Low Birthweight) 3- Rolling Average by Ethnicity, Collier County and Florida, Table 21: Births to Teenage Mothers Ages 10-14, with Rates per 1,000 Female Population, Collier County and Florida, Table 22: Births to Teenage Mothers Ages by Race, with Rates per 1,000 Female Population, Collier County and Florida, Table 23: Births to Teenage Mothers Ages by Ethnicity, with Rates per 1,000 Female Population Collier County and Florida, Table 24: Births to Teenage Mothers Ages 15-19, Collier County and Florida, with Rates per 1,000 Female Population, Table 25: Births to Teenage Mothers Ages by Race, with Rates per 1,000 Female Population Collier County and Florida, Table 26: Births to Teenage Mothers Ages by Ethnicity, with Rates per 1,000 Female Population, Collier County and Florida, Table 27: Maternal Death Rate per 100,000 Live Births, Single Rates, Collier County and Florida, Table 28: Total Resident Live Birth Rates per 1,000 Population, with Rates per 1,000 Female Population, Collier County and Florida, Table 29: Total Resident Live Birth Rates per 1,000 Population by Race, Collier County and Florida, Table 30: Total Resident Live Birth Rates per 1,000 Population by Ethnicity, Collier County and Florida, THE HEALTH OF THE OLDER POPULATION Table 1: Population 45 to 64 years of Age by Gender, Collier County, 1990, 2000 and Table 2: Population under 65 years of Age by Gender, Collier County, 1990, 2000 and Table 3: Population 65 years of Age and over by Gender, Collier County, 1990, 2000 and Table 4: Total Population by Gender, Collier County, 1990, 2000 and Table 5: Population 65 to 74 years of Age by Gender, Collier County, 1990, 2000 and Table 6: Population 75 to 84 years of Age by Gender, Collier County, 1990, 2000 and Table 7: Population 85 years of Age by Gender, Collier County, 1990, 2000 and Table 8: Percentage Change in the Population 65 s of Age and Older and Select Ages, , and , Collier County Table 9: Population by Age Distribution (total population), Collier County, 2011, 2020, 2030 and Table 10: Collier County Resident Population Projections, 65 s of Age and Older, Table 11: The 10 Leading Causes of Death, 65 s and Over, Collier County, 1990 and Table 12: The 10 Leading Causes of Death, s, Collier County, 1990 and Table 13: The 10 Leading Causes of Death, s, Collier County, 1990 and Table 14: The 10 Leading Causes of Death, 85 s and Over, Collier County, 1990 and Table 15: The 10 Leading Causes of Death, 65 s and Over, Florida, 1990 and Table 16: The 10 Leading Causes of Death, 65 74, Florida, 1990 and Table 17: The 10 Leading Causes of Death, 75 84, Florida, 1990 and xiii

15 Table 18: The 10 Leading Causes of Death, 85 and Over, Florida, 1990 and Table 19: The 10 Leading Causes of Death, 65 s and Over Males, Collier County, 1990 and Table 20: The 10 Leading Causes of Death, 65 s and Over Females, Collier County, 1990 and Table 21: The 10 Leading Causes of Death, s Males, Collier County, 1990 and Table 22: The 10 Leading Causes of Death, s Females, Collier County, 1990 and Table 23: The 10 Leading Causes of Death, s Males, Collier County, 1990 and Table 24: The 10 Leading Causes of Death, s Females, Collier County, 1990 and Table 25: The 10 Leading Causes of Death, 85 and Over Males, Collier County, 1990 and Table 26: The 10 Leading Causes of Death, 85 and Over Females, Collier County, 1990 and Table 27: Estimated Number of Collier County Residents with Alzheimer s Disease by Age for 2010 and Projections Utilizing Current Prevalence Rates for Table 28: Alzheimer's Disease Age Adjusted Death Rates, 3- Rolling Rates, Collier County and Florida, Table 29: Alzheimer's Disease Age Adjusted Death Rates, 3 Rolling Rates by Gender, Collier County and Florida, Table 30: Number of Memory Care/Alzheimer s/dementia Type Beds Available within Collier Facilities in Collier County, Table 31: Number of Nursing Homes and Assisted Living Facilities in Collier County, ACCESS TO HEALTHCARE Table 1: Detrimental Effects of Lack of Health Insurance for Adults with Select Chronic Conditions and Disease Table 2: Percentage of the Population Uninsured by Age, Collier County and Florida, Table 3: Percentage of the Population Uninsured by Sex, Collier County and Florida, Table 4: Percentage of the Population Uninsured by Race and Ethnicity, Collier County and Florida, Table 5: Percentage of the Population Uninsured by Education, Collier County and Florida, Table 6: Percentage of the Population Uninsured by Income, Collier County and Florida, Table 7: Payor Source for ER Discharges (Non-Admissions), 0-24 s of Age, Collier County, 2003 and Table 8: Payor Source for ER Discharges (Non-Admissions), s of Age, Collier County, 2003 and Table 9: Payor Source for ER Discharges (Non-Admissions), s of Age, Collier County, 2003 and Table 10: Payor Source for Emergency Room Discharges (Non-Admissions), 65 s and Over, Collier County, 2003 and Table 11: Payor Source for Emergency Room Discharges (Non-Admissions), All Ages, Collier County, 2003 and Table 12: Total Hospital Beds with Rates per 100,000, Collier County and Florida, Table 13: Total Acute Care Beds with Rates per 100,000, Collier County and Florida, Table 14: Total Specialty Beds with Rates per 100,000, Collier County and Florida, Table 15: Total Licensed Physicians with Rates per 100,000, Collier County and Florida, MENTAL HEALTH Table 1: Number of Substance Abuse/Psychiatric Beds by Facility, Collier County, xiv

16 LIST OF FIGURES POPULATION Figure 1: Resident Population in Collier County, Figure 2: Total Population Projections, Collier County, Figure 3: Population by Age Distribution and Gender, Collier County, Figure 4: Population by Age Distribution and Gender, Collier County, Figure 5: Population by Age Distribution and Gender, Collier County, Figure 6: Collier County Median Age, 1990, 2000, and Figure 7: Collier County Population by Ethnicity, 1990, 2000, and Figure 8: Population Projection by Ethnicity in Collier County, Figure 9: U.S. and Foreign Born Population, Collier County, 1990, 2000 and Figure 10: Collier County Residents and Peak Season Population, Estimates and Projections to SOCIO ECONOMIC CHARACTERISTICS Figure 1: Real Median Household Income (Adjusted in 2009 Dollars), Collier County and Florida, 1990, 2000 and Figure 2: Median Household Income in Collier County, Florida and the United States, (Adjusted in 2011 Dollars) Figure 3: Collier County Women, Infants and Children Program Participation, Figure 4: Number of Participants in the Women, Infants and Children Program and Median Household Income(In 2011 dollars), Collier County, Figure 5: Number of Children and Adults Participating in the Supplemental Nutrition Assistance Program, Collier County, Florida, Figure 6: Number of Children Participants in the Supplemental Nutrition Program and Median Household Income (in 2011 dollars), Collier County, Figure 7: Percent of Children Under Age 18 Living in Poverty, Collier County and Florida, 1989, 1999, and Figure 8: Homeless Population Admissions by Gender, Collier County, Figure 9: Number of Homeless Children Admissions by Gender, Collier County, Figure 10: Educational Attainment in Population 25 s and Over, Collier County and Florida, 1990, 2000 and Figure 11: Educational Attainment in Collier County and Florida, 1990, 2000 and Figure 12: Unemployment Rates in Collier County and Florida, Figure 13: Number of Children and Adults Participating in the Supplemental Nutrition Program, Collier County, Florida Figure 14: Number of Children Participants in the Supplemental Nutrition Program and Median Household Income (in 2011 Dollars), Collier County, INFECTIOUS DISEASE Figure 1: Reported Cases of Salmonella in Collier County and Florida, Figure 2: Reported Cases of Campylobacteriosis in Collier County and Florida, Figure 3: Reported Cases of Giardiasis in Collier County and Florida, Figure 4: Reported Cases of Shigellosis in Collier County and Florida, Figure 5: Reported Cases of Hepatitis A in Collier County and Florida, Figure 6: Reported Cases of Varicella in Collier County and Florida, Figure 7: Reported Pertussis Cases in Collier County and Florida, per 100,000 Population, Figure 8: Frequency of Reported Cases of Pertussis in Collier County, Figure 9: Reported Animal Bites Requiring PEP in Collier County and Florida, Figure 10: Reported Animal Bites Requiring PEP in Collier County, Figure 11: Total Reportable Disease Cases in Collier County and Florida, (excluding HIV/Aids, STDs and Tuberculosis Figure 12: Total Reportable Disease Cases by Month in Collier County, 2001 and Figure 13: Reported Enteric Disease Cases in Outbreaks in Collier County and Florida, Figure 14: Animal Bites Reported by Month to the Epidemiology Program in Collier County, 2001 and Figure 15: Campylobacteriosis Cases Reported by Month to the Epidemiology Program in Collier County, 2001 and Figure 16: Giardiasis Cases Reported by Month to the Epidemiology Program in Collier County, 2001 and Figure 17: Salmonella Cases Reported by Month to the Epidemiology Program in Collier County, 2001 and Figure 18: Cases Investigated but not Reportable by the Epidemiology Program of the Collier County Health Department by Month, Figure 19: Number of Confirmed and Suspected Reported Norovirus Outbreaks, Collier County, Figure 20: Epidemic Curve of a Norovirus Outbreak in a Long Term Health Care Facility, Collier County, Figure 21: Mosquito-Borne Diseases in Collier County, Figure 22: Number of Tuberculosis Cases per 100,000 Population, Collier County, Figure 23: TB Cases by Ethnicity, Collier County, xv

17 Figure 24: Resistant and Non-Resistant TB Cases, Collier County, Figure 25: Frequency of TB Cases HIV Coinfected, Collier County, Figure 26: Number of Refugees Resettled in Collier County, Figure 27: TB Cases by Ethnicity, Collier County and Immokalee, Figure 28: Reported Chlamydia Cases and Rates by, Collier County, Figure 29: Reported Chlamydia Cases by Gender, Collier County, Figure 30: Reported Chlamydia Cases by Select Age Groups and Gender, Collier County, Figure 31: Reported Chlamydia Cases by Gender, s of Age, Collier County, Figure 32: Reported Chlamydia Cases by Gender and Race, Collier County, Figure 33: Reported Chlamydia Cases by Ethnicity, Collier County, Figure 34: Gonorrhea Reported cases by, Collier County, Figure 35: Reported Gonorrhea Cases by Gender, Collier County, Figure 36: Reported Gonorrhea Cases by Select Age Groups and Gender, Collier County, Figure 37: Reported Gonorrhea Cases by Gender, s, Collier County, Figure 38: Reported Gonorrhea Cases by Gender and Race, Collier County, Figure 39: Reported Gonorrhea Cases by Ethnicity, Collier County, Figure 40: Reported Syphilis Cases in Collier County, Figure 41: Reported Syphilis Cases by Gender, Collier County, Figure 42: Reported Syphilis Cases by Type, Collier County, Figure 43: Reported Syphilis Cases by Age Group and Gender, Collier County, HEALTH BEHAVIORS AND HEALTH STATUS Figure 1: Percent of Adults Who are Obese in Collier County and Florida, 2002, 2007, Figure 2: Percent of Adults Who are Obese in Collier County, 2002, 2007 and Figure 3: Percent of Adults Who are Obese, by Sex, in Florida, 2002, 2007 and Figure 4: Percent of Adults Who are Obese, by Ethnicity, in Collier County, 2002, Figure 5: Percent of Adults Who are Obese, by Ethnicity, in Florida, 2002, Figure 6: Percent of Adults Who are Obese, by Educational Level, in Collier County, 2002, 2007 and Figure 7: Percent of Adults Who are Obese, by Educational Level, in Florida, 2002, 2007 and Figure 8: Percent of Adults Who are Obese, by Annual Income, in Collier County, 2002, 2007 and Figure 9: Percent of Adults Who are Obese, by Annual Income, Florida, 2002, 2007 and Figure 10: Percent of Adults Who are Obese, by Age Group, in Collier County, 2002, 2007 and Figure 11: Percent of Adults Who are Obese, by Age Group, in Florida, 2002, 2007 and Figure 12: Percent of Adults Who are Obese, by Marital Status, in Collier County, 2002, 2007 and Figure 13: Percent of Adults Who are Obese, by Marital Status, in Florida, 2002, 2007 and Figure 14: Percent of Adults Who are Overweight in Collier County and Florida, 2002, 2007 and Figure 15: Percent of Adults Who are Overweight, by Sex, in Collier County, 2002, 2007 and Figure 16: Percent of Adults Who are Overweight, by Sex in Florida, 2002, 2007 and Figure 17: Percent of Adults Who are Overweight, by Ethnicity, in Collier County, 2002 and Figure 18: Percent of Adults Who are Overweight by Ethnicity, in Florida, 2002 and Figure 19: Percent of Adults Who are Overweight, by Educational Level, in Collier County, 2002, 2007 and Figure 20: Percent of Adults Who are Overweight, by Educational Level, in Florida, 2002, 2007 and Figure 21: Percent of Adults Who are Overweight, by Annual Income, in Collier County and Florida, 2002, 2007 and Figure 22: Percent of Adults Who are Overweight, by Annual Income, in Florida, 2002, 2007 and Figure 23: Percent of Adults Who are Overweight, by Age Group, in Collier County, 2002, 2007 and Figure 24: Percent of Adults Who are Overweight, by Age Group, in Florida, 2002, 2007 and Figure 25: Percent of Adults Who are Overweight, by Marital Status, in Collier County, 2002, 2007 and Figure 26: Percent of Adults Who are Overweight, by Marital Status, in Florida, 2002, 2007 and Figure 27: Percent of Adults Who are Currently Smokers in Collier County and Florida, 2002, 2007 and Figure 28: Percent of Adults Who are Currently Smokers, by Sex, in Collier County, 2002, 2007 and Figure 29: Percent of Adults Who are Currently Smokers, by Sex, in Florida, 2002, 2007 and Figure 30: Percent of Adults Who are Currently Smokers, by Annual Income, in Collier County, 2002, 2007 and Figure 31: Percent of Adults Who are Currently Smokers, by Annual Income, in Florida, 2002, 2007 and Figure 32: Percent of Adults Who are Currently Smokers, by Educational Level, in Collier County, 2002, 2007 and Figure 33: Percent of Adults Who are Currently Smokers, by Educational Level, in Florida, 2002, 2007 and Figure 34: Percent of Adults Who are Currently Smokers, by Ethnicity, in Collier County, 2002, 2007 and Figure 35: Percent of Adults Who are Currently Smokers, by Ethnicity, in Florida, 2002, 2007 and Figure 36: Percent of Adults Who are Currently Smokers, by Marital Status, in Collier County, 2002, 2007 and Figure 37: Percent of Adults Who are Currently Smokers, by Marital Status, in Florida, 2002, 2007 and Figure 38: Percent of Adults Who are Currently Smokers, by Age Group, in Collier County, 2002, 2007 and Figure 39: Percent of Adults Who are Currently Smokers, by Age Group, in Florida, 2002, 2007 and Figure 40: Percent of Adults Who are Former Smokers in Collier County and Florida, 2002, 2007 and xvi

18 Figure 41: Percent of Adults Who are Former Smokers, by Sex, in Collier County, 2002, 2007 and Figure 42: Percent of Adults Who are Former Smokers, by Sex, in Florida, 2002, 2007 and Figure 43: Percent of Adults Who are Former Smokers, by Annual Income, in Collier County, 2002, 2007 and Figure 44: Percent of Adults Who are Former Smokers, by Annual Income, in Florida, 2002, 2007 and Figure 45: Percent of Adults Who are Former Smokers, by Educational Level, in Collier County, 2002, 2007 and Figure 46: Percent of Adults Who are Former Smokers, by Educational Level, in Florida, 2002, 2007 and Figure 47: Percent of Adults Who are Former Smokers, by Ethnicity, in Collier County, 2002, 2007 and Figure 48: Percent of Adults Who are Former Smokers, by Ethnicity, in Florida, 2002, 2007 and Figure 49: Percent of Adults Who are Former Smokers, by Marital Status, in Collier County, 2002, 2007 and Figure 50: Percent of Adults Who are Former Smokers, by Marital Status, in Collier County, 2002, 2007 and Figure 51: Percent of Adults Who are Former Smokers, by Age Group, in Collier County, 2002, 2007 and Figure 52: Percent of Adults Who are Former Smokers, by Age Group, in Florida, 2002, 2007 and Figure 53: Percent of Adults Who Have Never Smoked in Collier County and Florida, 2002, 2007 and Figure 54: Percent of Adults Who Have Never Smoked, by Sex, in Collier County, 2002, 2007 and Figure 55: Percent of Adults Who Have Never Smoked, by Sex, in Florida, 2002, 2007 and Figure 56: Percent of Adults Who Have Never Smoked, by Ethnicity, in Collier County, 2002, 2007 and Figure 57: Percent of Adults Who Have Never Smoked, by Ethnicity, in Florida, 2002, 2007 and Figure 58: Percent of Adults Who Have Never Smoked, by Education Level, in Collier County, 2002, 2007 and Figure 59: Percent of Adults Who Have Never Smoked, by Education Level, in Florida, 2002, 2007 and Figure 60: Percent of Adults Who Have Never Smoked, by Annual Income, in Collier County, 2002, 2007 and Figure 61: Percent of Adults Who Have Never Smoked, by Annual Income, in Florida, 2002, 2007 and Figure 62: Percent of Adults Who Have Never Smoked, by Age Group, in Collier County, 2002, 2007 and Figure 63: Percent of Adults Who Have Never Smoked, by Age Group, in Florida, 2002, 2007 and Figure 64: Percent of Adults Who Engage in Heavy or Binge Drinking, Collier County and Florida, 2002, 2007 and Figure 65: Percent of Adults Who Engage in Heavy or Binge Drinking, by Sex, Collier County, 2002, 2007 and Figure 66: Percent of Adults Who Engage in Heavy or Binge Drinking, by Sex, Collier County, 2002, 2007 and Figure 67: Percent of Adults Who Engage in Heavy or Binge Drinking, by Ethnicity, Collier County, 2002, 2007 and Figure 68: Percent of Adults Who Engage in Heavy or Binge Drinking, by Ethnicity, Florida, 2002, 2007 and Figure 69: Percent of Adults Who Engage in Heavy or Binge Drinking, by Annual Income, Collier County, 2002, 2007 and Figure 70: Percent of Adults Who Engage in Heavy or Binge Drinking, by annual Income, Florida, 2002, 2007 and Figure 71: Percent of Adults Who Engage in Heavy or Binge Drinking, by Educational Level, Collier County, and Florida, 2002, 2007 and Figure 72: Percent of Adults Who Engage in Heavy or Binge Drinking, by Educational Level, Florida, 2002, 2007 and Figure 73: Percent of Adults Who Engage in Heavy or Binge Drinking, by Age Group, Collier County, 2002, 2007 and Figure 74: Percent of Adults Who Engage in Heavy or Binge Drinking, by Age Group, Florida, 2002, 2007 and Figure 75: Percent of Adults Who Engage in Heavy or Binge Drinking, by Marital Status, Collier County, 2002, 2007and Figure 76: Percent of Adults Who Engage in Heavy or Binge Drinking, by Marital Status, Florida, 2002, 2007and CHRONIC DISEASES Figure 1: Cancer Mortality Rate, Collier County and Florida, Figure 2: Cancer Mortality Rate by Sex, Collier County, Figure 3: Cancer Mortality Rate by Sex, Florida, Figure 4: Cancer Mortality Rate by Race, Collier County, Figure 5: Cancer Mortality Rate by Race, Florida, Figure 6: Cancer Mortality Rate by Ethnicity, Collier County, Figure 7: Cancer Mortality Rate by Ethnicity, Florida, Figure 8: Colorectal Cancer Mortality Rate, Collier County and Florida, Figure 9: Colorectal Cancer Mortality Rate by Sex, Collier County, Figure 10: Colorectal Cancer Mortality Rate by Sex, Florida, Figure 11: Colorectal Cancer Mortality Rate by Race, Collier County, Figure 12: Colorectal Cancer Mortality Rate by Race, Florida, Figure 13: Colorectal Cancer Mortality Rate by Ethnicity, Collier County, Figure 14: Colorectal Cancer Mortality Rate by Ethnicity, Florida, Figure 15: Lung Cancer Mortality Rate, Collier County and Florida, Figure 16: Lung Cancer Mortality Rate by Sex, Collier County, Figure 17: Lung Cancer Mortality Rate by Sex, Florida, Figure 18: Lung Cancer Mortality Rate by Race, Collier County, Figure 19: Lung Cancer Mortality Rate by Race, Florida, Figure 20: Lung Cancer Mortality Rate by Ethnicity, Collier County, Figure 21: Lung Cancer Mortality Rate by Ethnicity, Florida, Figure 22: Breast Cancer Mortality Rate, Collier County and Florida, Figure 23: Breast Cancer Mortality Rate by Race, Collier County, xvii

19 Figure 24: Breast Cancer Mortality Rate by Race, Florida, Figure 25: Breast Cancer Mortality Rate by Ethnicity, Collier County, Figure 26: Breast Cancer Mortality Rate by Ethnicity, Florida, Figure 27: Prostate Cancer Mortality Rate, Collier County and Florida, Figure 28: Prostate Cancer Mortality Rate by Race, Collier County, Figure 29: Prostate Cancer Mortality Rate by Race, Florida, Figure 30: Prostate Cancer Mortality Rate by Ethnicity, Collier County, Figure 31: Prostate Cancer Mortality Rate by Ethnicity, Florida, Figure 32: Cervical Cancer Mortality Rate, Collier County and Florida, Figure 33: Cervical Cancer Mortality Rate by Race, Collier County, Figure 34: Cervical Cancer Mortality Rate by Race, Florida, Figure 35: Cervical Cancer Mortality Rate by Ethnicity, Collier County, Figure 36: Cervical Cancer Mortality Rate by Ethnicity, Florida, Figure 37: Melanoma Mortality Rate, Collier County and Florida, Figure 38: Melanoma Mortality Rate by Sex, Collier County, Figure 39: Melanoma Mortality Rate by Sex, Florida, Figure 40: Melanoma Mortality Rate by Race, Collier County, Figure 41: Melanoma Mortality Rate by Race, Florida, Figure 42: Melanoma Mortality Rate by Ethnicity, Collier County, Figure 43: Melanoma Mortality Rate by Ethnicity, Florida, Figure 44: Leukemia Mortality Rate, Collier County and Florida, Figure 45: Leukemia Mortality Rate by Sex, Collier County, Figure 46: Leukemia Mortality Rate by Sex, Florida, Figure 47: Leukemia Mortality Rate by Race, Collier County, Figure 48: Leukemia Mortality Rate by Race, Florida, Figure 49: Leukemia Mortality Rate by Ethnicity, Collier County, Figure 50: Leukemia Mortality Rate by Ethnicity, Florida, Figure 51: Cerebrovascular Disease Mortality Rate, Collier County and Florida, Figure 52: Cerebrovascular Disease Mortality Rate by Sex, Collier County, Figure 53: Cerebrovascular Disease Mortality Rate by Sex, Florida, Figure 54: Cerebrovascular Disease Mortality Rate by Race, Collier County, Figure 55: Cerebrovascular Disease Mortality Rate by Race, Florida, Figure 56: Cerebrovascular Disease Mortality Rate by Ethnicity, Collier County, Figure 57: Cerebrovascular Disease Mortality Rate by Ethnicity, Florida, Figure 58: Heart Disease Mortality Rate, Collier County and Florida, Figure 59: Heart Disease Mortality Rate by Sex, Collier County, Figure 60: Heart Disease Mortality Rate by Sex, Florida, Figure 61: Heart Disease Mortality Rate by Race, Collier County, Figure 62: Heart Disease Mortality Rate by Race, Florida, Figure 63: Heart Disease Mortality Rate by Ethnicity, Collier County, Figure 64: Heart Disease Mortality Rate by Ethnicity, Florida, Figure 65: Diabetes Mellitus Mortality Rate, Collier County and Florida, Figure 66: Diabetes Mellitus Mortality Rate by Sex, Collier County, Figure 67: Diabetes Mellitus Mortality Rate by Sex, Florida, Figure 68: Diabetes Mellitus Mortality Rate by Race, Collier County, Figure 69: Diabetes Mellitus Mortality Rate by Race, Florida, Figure 70: Diabetes Mellitus Mortality Rate by Ethnicity, Collier County, Figure 71: Diabetes Mellitus Mortality Rate by Ethnicity, Florida, Figure 72: Chronic Liver Disease and Cirrhosis Mortality Rate, Collier County and Florida, Figure 73: Chronic Liver Disease and Cirrhosis Mortality Rate by Sex, Collier County, Figure 74: Chronic Liver Disease and Cirrhosis Mortality Rate by Sex, Florida, Figure 75: Chronic Liver Disease and Cirrhosis Mortality Rate by Race, Collier County, Figure 76: Chronic Liver Disease and Cirrhosis Mortality Rate by Race, Florida, Figure 77: Chronic Liver Disease and Cirrhosis Mortality Rate by Ethnicity, Collier County, Figure 78: Chronic Liver Disease and Cirrhosis Mortality Rate by Ethnicity, Florida, Figure 79: Chronic Lower Respiratory Disease Mortality Rate, Collier County and Florida, Figure 80: Chronic Lower Respiratory Disease Mortality Rate by Sex, Collier County, Figure 81: Chronic Lower Respiratory Disease Mortality Rate by Sex, Florida, Figure 82: Chronic Lower Respiratory Disease Mortality Rate by Race, Collier County, Figure 83: Chronic Lower Respiratory Disease Mortality Rate by Race, Florida, Figure 84: Chronic Lower Respiratory Disease Mortality Rate by Ethnicity, Collier County, Figure 85: Chronic Lower Respiratory Disease Mortality Rate by Ethnicity, Florida, xviii

20 MORTALITY INDICATORS Figure 1: Life Expectancy at Age 25, by Sex, Collier County, 1990, 2000 and Figure 2: Life Expectancy in Collier County at Select Ages, by Ethnicity, Figure 3: Life Expectancy at Birth by Sex, Collier County, 1990, 2000 and Figure 4: Five Leading Causes of death as a Percentage of All Deaths, Collier County and Florida, Figure 5: Five Leading Causes of death as a Percentage of All Deaths, Collier County, 1990, 2000 and Figure 6: Five Leading Causes of death as a Percentage of All Deaths, Florida, 1990, 2000, Figure 7: The Comparison of the Distribution of the Population by Select Age Groups in Collier County and Florida, Figure 8: Relationship Between s of Potential Life Lost Under 75 s of Age per 100,000 Population and Life Expectancy at Birth, Collier County, 1990, 2000 and INJURIES Figure 1: Death Rates for Leading Causes of Injuries per 100,000 Population, by Age, Collier County, Figure 2: Death Rates for Leading Causes of Injuries per 100,000 Population, 0-84 s of Age, Collier County, Figure 3: Deaths from all Injuries per 100,000 Population, Collier County and Florida, Figure 4: Deaths from all Injuries per 100,000 Population, by Age, Collier County, 1990, 2000 and Figure 5: Deaths from all Injuries per 100,000 Population, by Sex, Collier County, Figure 6: Deaths from all Injuries per 100,000 Population, by Sex, Florida, Figure 7: Deaths from all Injuries per 100,000 Population, by Race, Collier County, Figure 8: Deaths from all Injuries per 100,000 Population, by Race, Florida, Figure 9: Deaths from all Injuries per 100,000 Population, by Ethnicity, Collier County, Figure 10: Deaths from all Injuries per 100,000 Population, by Ethnicity, Florida, Figure 11: Deaths from Motor Vehicle Crashes per 100,000 Population, Collier County and Florida, Figure 12: Deaths from Motor Vehicle Crashes per 100,000 Population, by Sex, Collier County, Figure 13: Deaths from Motor Vehicle Crashes per 100,000 Population, by Sex, Florida, Figure 14: Deaths from Motor Vehicle Crashes per 100,000 Population, by Race, Collier County, Figure 15: Deaths from Motor Vehicle Crashes per 100,000 Population, by Race, Florida, Figure 16: Deaths from Motor Vehicle Crashes per 100,000 Population, by Ethnicity, Collier County, Figure 17: Deaths from Motor Vehicle Crashes per 100,000 Population, by Ethnicity, Florida, Figure 18: Deaths from Motor Vehicle Crashes per 100,000 Population, by Age, Collier County, 1990, 2000 and Figure 19: Deaths from Unintentional Poisoning per 100,000 Population, by Age, Collier County, 1990, 2000 and Figure 20: Deaths from Unintentional Poisoning per 100,000 Population, Collier County and Florida, Figure 21: Deaths from Unintentional Poisoning per 100,000 Population, by Sex, Collier County, Figure 22: Deaths from Unintentional Poisoning per 100,000 Population, by Sex, Florida, Figure 23: Deaths from Unintentional Poisoning per 100,000 Population, by Race, Collier County, Figure 24: Deaths from Unintentional Poisoning per 100,000 Population, by Race, Florida, Figure 25: Deaths from Unintentional Poisoning per 100,000 Population, by Ethnicity, Collier County, Figure 26: Deaths from Unintentional Poisoning per 100,000 Population, by Ethnicity, Florida, Figure 27: Deaths from Drownings per 100,000 Population, Collier County and Florida, Figure 28: Deaths from Drownings per 100,000 Population, by Age, Collier County, 1990, 2000 and Figure 29: Deaths from Drownings per 100,000 Population, by Sex, Collier County, Figure 30: Deaths from Drownings per 100,000 Population, by Sex, Florida, Figure 31: Deaths from Drownings per 100,000 Population, by Race, Collier County, Figure 32: Deaths from Drownings per 100,000 Population, by Race, Florida, Figure 33: Deaths from Drownings per 100,000 Population, by Ethnicity, Collier County, Figure 34: Deaths from Drownings per 100,000 Population, by Ethnicity, Florida, Figure 35: Deaths from Falls per 100,000 Population, by Age, Collier County, 1990, 2000 and Figure 36: Deaths from Falls per 100,000 Population, Collier County and Florida, Figure 37: Deaths from Falls per 100,000 Population, by Sex, Collier County, Figure 38: Deaths from Falls per 100,000 Population, by Sex, Florida, Figure 39: Deaths from Falls per 100,000 Population, by Race, Collier County, Figure 40: Deaths from Falls per 100,000 Population, by Race, Florida, Figure 41: Deaths from Falls per 100,000 Population, by Ethnicity, Collier County, Figure 42: Deaths from Falls s per 100,000 Population, by Ethnicity, Florida, Figure 43: Deaths from Homicide per 100,000 Population, Collier County and Florida, Figure 44: Deaths from Homicide per 100,000 Population, by Sex, Collier County, Figure 45: Deaths from Homicide per 100,000 Population, by Sex, Florida, Figure 46: Deaths from Homicide per 100,000 Population, by Race, Collier County, Figure 47: Deaths from Homicide per 100,000 Population, by Race, Florida, Figure 48: Deaths from Homicide per 100,000 Population, by Ethnicity, Collier County, xix