Health & Nutrition:
Human Health

Appendix C-Part I
An Application Of The Geographic Information System To Data Regarding Health Infrastructure & Health Status In Mississippi (Based On Data Available As Of June 1995)

Health Infrastructure Maps

1. Location of Acute Care Health Facilities in Mississippi
2. Location of Community Health Centers in Mississippi
3. Number of Licensed Hospital Beds per 1,000 Persons in Mississippi
4. Distribution of Practicing Physicians in Mississippi
5. Distribution of Practicing Primary Care Physicians in Mississippi

Health Status Maps

1. Distribution of Premature Births in Mississippi
2. Distribution of Children Born to Unmarried Mothers Aged 19 and Under (1993)
3. Distribution of Children Born under 2,500 grams in Mississippi
4. Distribution of Fetal and Infant Deaths in Mississippi
5. Distribution of Deaths Caused by Malignant Neoplasms
6. Distribution of Deaths Caused by Heart Disease
7. Distribution of Deaths Caused by Cerebrovascular Diseases
8. Distribution of Deaths Caused by Emphysema and Other Chronic Obstructive Pulmonary Diseases
9. Distribution of Deaths Caused by Motor Vehicle Accidents
10. Ranking of Mississippi Counties Based on Mortality and Fertility Indicators

Health Infrastructure Data by Mississippi Counties

1. Health Facilities in Mississippi

   Referring to Map No. EN-HE 001, Location of Acute Care Health Facilities in Mississippi, the following types of hospitals are indicated by county and within each of their respective General Health Service Areas (GHSA's): State or Local Government Owned Hospital; Privately Owned Hospital (For Profit); Not-For-Profit Hospital; Church Affiliated Hospital; and Government Owned Hospital Leased to Another Entity for Operation. At a glance, one can see the type and location of each of these health facilities. For example, in the northeast (Health Service Area 1), Itawamba County has no acute care facilities while its neighbor, Monroe County has a not-for-profit hospital and a state or local government owned hospital.

   In Map No. EN-HE 002, Location of Community Health Centers in Mississippi, the seven health service areas are once again outlined with color coding with the location of each Community Health Center indicated with a black triangle. Using the same two counties as in the previous map as an example, one could note that Monroe County has one community health center located in the northern section of the county. Once again, Itawamba County has none; however, since the community health center in Monroe is located at its southern border, this center is as conveniently placed for residents in southern Itawamba as those in northern Monroe.

   The number of licensed hospital beds can also be considered as a part of the health infrastructure. Map No. EN-HE 005, Number of Licensed Hospital Beds per 1000 Persons in Mississippi, has the population of county residents as the top number in each county and the actual number of hospital beds listed underneath. These numbers have been used to generate the rate per 1000 persons in each county. Eight counties are ranked at none; only two (Hinds and Lauderdale) counties have a rate greater than 8 per 1000 in population.

2. Practicing Physicians in Mississippi

   In the next map, Map No. EN-HE 003, Distribution of Practicing Physicians in Mississippi, the upper number within each county indicates that county's 1994 population, and the lower number represents the number of practicing physicians within that same county. These two numbers have been used to determine the number of practicing medical doctors per 1,000 county residents. These rates are easily compared with the aid of color coding on the map. Comparing the extremes, Isaquena County, the county with the lowest population, has none; while the most populated, Hinds County (home of the state capital Jackson and the medical school for the state), has the highest number and rate of practicing physicians.

   While the previous map was for all practicing physicians in Mississippi, Map No. EN-HE 004, Distribution of Practicing Primary Care Physicians in Mississippi, considers only those designated as "Primary Care" Physicians. Primary Care Physicians are defined as those in Family or General Practice, Internal Medicine, Pediatrics, Allergy Pediatrics, and Cardiology Pediatrics, and Obstetrics and/or Gynecology. As before, the upper number represents the population for each county, and the lower number is the number of primary care physicians in that same county. The rate per 1000 county residents has been determined for all 82 counties and the rates between 0 and 2 have been color coded to enhance readability of the map. Hinds County once again has the highest rate, with Isaquena claiming the lowest. It is also easy to see that most counties fall between the rates above 0 to 1 per 1000 county residents.

   These are certainly not the only data which can be obtained on Mississippi's health infrastructure. The five maps described are intended only as a sample of the types of information which can be gathered and mapped in this area.

Health Status Data by Mississippi Counties

1. Natality Factors in Mississippi

   In Map No. EN-HE 006, Distribution of Children Born to Unmarried Mothers Aged 19 and Under, the top number listed in each county represents total number of children born in that county in 1993, and the lower number represents the number of children born to unmarried mothers who were 19 or younger in that same county. Color coding indicates that seven counties had less than 10 percent, while two counties had a percentage between 30 and 40 percent. Most Mississippi counties have a percentage located somewhere between 10 and 30% of all women giving birth as being unmarried teenagers or younger.

   Throughout Mississippi, what's the percentage of premature births on the county level? Map No. EN-HE 007, Distribution of Premature Births in Mississippi, attempts to answer this question? Premature is defined as a gestation period of less than 37 weeks. In each county the top number represents the number of children born in that county for the year 1993, while the number below it, reflects the number of premature children born in that same county and year. These numbers are used to determine the percentage of premature births in each county. By viewing the map, it is easy to see that only four counties have less than 10 percent of all births in their counties as premature births for the year given. Nine counties have between one-fifth and one-quarter of all births for the year as premature births. Most counties fall between the levels of 10 to 20 percent.

   Another way to define prematurity would be to consider the weight of the newborn. Children born under 2,500 grams (or 5.5 pounds) are considered low-birth-weight babies. In Map No. EN-HE 008, Distribution of Children Born under 2,500 grams in Mississippi, the same top number used in the previous map (EN-HE 007) occurs in each county, while the number listed below refers to the number of children born in that county who weighed less than 2,500 grams or 5.5 pounds. Only two counties have less than 5 percent of their births for 1993 as low-birth-weight babies. Four counties register between 15 and 20 percent of all births in their counties as low-birth-weight. The remainder of the counties's low-birth-weight numbers fall between 5 and 15 percent of the total births in each of these counties.

2. Mortality Factors in Mississippi

   Fetal and infant deaths for 1993 within each county were considered in this first map, Map No. EN-HE 009, Distribution of Fetal and Infant Deaths in Mississippi. Infant death is defined as any death of a child under one year of age. Fetal deaths are those deaths which occur in utero, before delivery is completed, or where the newborn show no signs of life immediately after birth. Within each county there are three numbers. The top refers to the number of infant deaths for that county. The middle number gives the number of fetal deaths, and the bottom number is the total number of deaths in each county. The sum of the fetal and infant deaths is used as a percentage of the total number of deaths in each county for 1993. Only Isaquena and Stone Counties had no fetal or infant deaths in 1993. Franklin and Humphreys Counties have the highest percentages with between 7.5 to 10 percent of all deaths in 1993 being due to fetal and infant deaths. Further investigation would be needed to determine why this particular death rate is unusually high in these two counties.

   In Map No. EN-HE 010, Distribution of Deaths Caused by Malignant Neoplasms, the rate of death per 100,000 population was determined for all malignant neoplasms (cancers) in each county in 1993. Color codings indicate the lowest rates at less than 150 deaths per 100,000 population with the highest at more than 300 deaths per 100,000 population. Scanning the map, one can see five counties in the lowest rate category, while two (Attala and Issaquena Counties) fall in the highest category of deaths due to cancers. More research at the county level could shed light on possible factors involved in counties with the highest death rates for this disease classification.

   Another cause of deaths in 1993 investigated for Mississippians was heart disease. Distribution of Deaths Caused by Heart Disease, Map No. EN-HE 011, shows the death rates per 100,000 people for the 82 counties from a low of 250 deaths to a rate greater than 550 deaths per 100,000. Only three counties qualify for the lowest quintile. Clarke County has the highest rate of deaths due to heart disease with a rate of 566 per 100,000 population. Most counties fall between 250 and 550 deaths per 100,000 population for 1993.

   The Distribution of Deaths Caused by Cerebrovascular Diseases in 1993 (Map No. EN-HE 013) gives the death rate per 100,000 population for cerebrovascular diseases (CVD) or strokes. Holmes County, located in the center of the state, claims the highest rate at 222 deaths, while there are 16 counties located in the lowest quintile at rates less than 50 deaths per 100,000 population. From the preponderance of yellow, the viewer immediately picks up the information that an overwhelming number of counties fall between the rates of 50 and 100 in deaths per 100,000 due to CVD.

   The number of deaths due to chronic and obstructive pulmonary diseases, such as emphysema, asthma, or other pulmonary allergies, are considered for Mississippi residents in 1993. These numbers do not include any deaths due specifically to either pneumonia or influenza. Map No. EN-HE 015, Distribution of Deaths Caused by Emphysema and other Chronic Obstructive Pulmonary Diseases, has six groupings color coded for rates of death per 100,000 population from no deaths in the lowest group to more than 80 deaths per 100,000 in each county. Two counties reported no deaths in 1993 due to chronic and obstructive pulmonary diseases. Likewise, two counties have a death rate of over 80 (Choctaw County at 88 and Covington County at 85 deaths per 100,000 people in each county). Many counties fall in the middle area between the death rates of 20 to 60, as shown by the yellow and green coloring on the map.

   Motor vehicle accidents are out of the disease category; however, they are a leading cause of accidental death for Mississippians as well as the rest of the United States. Distribution of Deaths Caused by Motor Vehicle Accidents, Map No. EN-HE 016, displays the rate of deaths per 100,000 population for each county in 1993. One county (Issaquena County) reported no deaths due to motor vehicle accidents in 1993. On the other end of the spectrum, two counties (Benton and Calhoun Counties) have a death rate greater than 100 deaths per 100,000 residents. Many counties in Mississippi have a death rate between 25 to 50 per 100,000 population as evidenced by the yellow coloring.

3. Composite Map Based on Natality and Mortality Factors

   Based upon the data generated on health status in the nine maps described above for both natality and mortality factors, a final map was prepared in an attempt to describe the composite natality and mortality situation in each county. The natality maps used were: Distribution of Children Born to Unmarried Mothers Age 19 and Under for 1993 (Map No. EN-HE 006); Distribution of Premature Births in Mississippi for 1993 (Map No. EN-HE 007; and Distribution of Children Born Under 2,500 Grams in Mississippi (Map No. EN-HE 008). Mortality maps also included in the composite map were: Distribution of Fetal and Infant Deaths in Mississippi for 1993 (Map No. EN-HE 009); Distribution of Deaths Caused by Malignant Neoplasms for 1993 (Map No. EN-HE 010); Distribution of Deaths Caused by Heart Disease for 1993 (Map No. EN-HE 011); Distribution of Deaths Caused by Cerebrovascular Diseases for 1993 (Map No. EN-HE 013); Distribution of Death Caused by Emphysema and Other Chronic Obstructive Pulmonary Diseases for 1993 (Map No. EN-HE 015); and Distribution of Deaths Caused by Motor Vehicle Accidents for 1993 (Map No. EN-HE 016). The resulting composite map, Map No. EN-HE 017, Ranking of Missisippi Counties Based on Mortality and Fertility Indicators for 1993, has two numbers indicated per county. The upper is an index number based upon these natality (fertility) and mortality indicators using the formula for the United Nations Human Development Index. As this number approaches one, natality and mortality indicators reflect worsening conditions in that county. On the other hand, as this number approaches zero, improved natality and mortality conditions are noted. Using a percentile ranking system, counties at the highest percentiles (80 to 100 percent) have improved mortality and natality conditions, while those at the lowest percentiles (0 to 20 percent) indicate a worsening of natality and mortality conditions. The lower number in each county is simply the county ranking for each of the 82 counties. Therefore, best conditions based on these indicators would be in Lamar County ranked number 1. The worse conditions in regards to these specific indicators would be in Holmes County ranked number 82. All counties on or close to the delta region in Mississippi are in the two lowest percentile rankings (note blue and green), with the exception of DeSoto County (just south of Memphis) and Wilkinson County (on the coast). As with any composite, these results must be interpreted with care.