Florida State Highlights

In 2000, the Florida population was 15.9 million and had been estimated to increase by 6.5 percent to 17 million in 2003.^[6] With rates of 76.3 and 75.2 births per 1,000 women of childbearing ages, respectively, Blacks/African-Americans and Hispanics/Latinos(as), were the fastest growing major race/ethnic groups in Florida in 2002. American Indians/Alaskan Natives had a birth rate of 65.8 per 1,000, and Asians/Pacific Islanders had a rate of 65.2 per 1,000. In Florida, the lowest birth rate was for Non-Hispanic Whites with 53.7 births per 1,000 women of childbearing ages.

Population Dynamics

Geographic Distribution

Thirty-four of Florida's 67 counties were metropolitan. ^[7] There were four metropolitan counties in Florida in 2002 which were home to over one million residents each: Hillsborough (1.1 million), where Tampa is located, Palm Beach (1.2 million), Broward (1.7 million), which contains the city of Ft. Lauderdale, and Miami-Dade (2.3 million).

Race/Ethnicity

Table 2 shows that in 2003 an estimated 2.8 million Florida residents were Hispanic/Latino(a) (17 percent); this was a much lower proportion than in the U.S.-Mexico Border States (32 percent Hispanic/Latino(a)). Of the 6.9 million people who lived in Border Counties in the 4 Border States, 49 percent were Hispanic/Latino(a).^[8]

Education

Levels of education completed in Florida in 2000 were fairly consistent with the rates across the U.S. Florida residents were somewhat more likely to have completed high school or higher education than residents of the U.S.-Mexico Border States (80 percent vs. 77 percent) (Table 6).

Income^[9]

In Florida, the median family income in 2000 was $45,625. This was consistent with median family incomes for the U.S.-Mexico Border States of Arizona ($46,723), Texas ($45,861), and New Mexico ($39,425), but was below the median family incomes of California ($53,035) and the U.S. ($50,035). In 2000, the median family income for Hispanics/Latinos(as) in Florida was $36,794.

Poverty

Table 4 shows that 22 percent of Florida families lived below 150 percent of the Federal poverty guidelines in 2000; this was similar to the U.S. rate of 21 percent but lower than the 25 percent rate in the U.S.-Mexico Border States. The U.S. Federal Poverty Thresholds^[10] were established as a baseline to develop guidelines for determining eligibility for Federal and State programs such as Medicaid. In 2000, $17,761 for a family of four was established as the poverty threshold.

Health Access

In Florida, 18.0 percent of respondents to the Behavioral Risk Factor Surveillance System (BRFSS) indicated that at the current time they were not covered by health insurance.^[11], ^[12] In the U.S.-Mexico Border States, 19.4 percent of families indicated they had no health care coverage. The Florida rate was higher than the U.S. rate of 15.2 percent (Table 5).

Health Professions Shortage Areas (HPSAs) were the method that HRSA used to identify areas of a State that did not have a sufficient supply of health professionals to meet the health needs of the population. Statewide, 66 percent of the population lived in a primary care, 41 percent lived in a dental, and 16.6 percent lived in a mental HPSA (Tables 64, 65, and 66, respectively), either single or partial county.

Health Status

Health status indicators for this Report were based on the Healthy Border 2010 Goals and Objectives established by the U.S.-Mexico Border Health Commission in 2003. The Commission is a binational organization dedicated to addressing the pervasive health needs of the U.S.-Mexico Border.

The overarching goals of the Healthy Border Program are:

1. Improve the quality and increase the years of healthy life, and
2. Eliminate health disparities

The twenty Healthy Border (HB) 2010 objectives fall into eleven principal areas with their specific objectives as follows:

1. Improve access to primary health care
2. Reduce cancer mortality in women through improved screening for breast and cervical cancers
3. Reduce morbidity and mortality from diabetes mellitus
4. Improve water quality through improved sanitation and reduce amount of acute pesticide poisoning
5. Reduce transmission of HIV
6. Improve rates of immunization and reduce rates of infectious diseases
7. Reduce mortality from unintentional injuries
8. Reduce infant mortality and increase the number of women receiving prenatal care
9. Reduce the suicide mortality rate by improving mental health
10. Increase the usage of dental and oral health services
11. Reduce morbidity from asthma

The tables in this report provide detailed information about health status in Florida. Healthy Border objectives are reported along with rates for the State of Florida.

Breast and Cervical Cancer

• Screening for breast cancer is an important aspect of women's health. Evidence from the BRFSS in 2002 showed that 85 percent of women living in Florida had a mammogram within the past 2 years; this was consistent with the proportion of women living in the Border States (83 percent) who have had a mammogram within the past 2 years. ^[13]
• The breast cancer incidence rate in Florida was 97 per 100,000 population (Table 7).
• The 2002 age-adjusted ^[14] breast cancer mortality rate in Florida was 24 per 100,000 females; this was the same as the Border States. The loss due to premature breast cancer death cost 176 years of life per 100,000 females. This was higher than the years of life lost to breast cancer mortality in the Border States (145 years per 100,000 females).
• Regular screening with pap smears helps with early detection of cervical cancer. Eighty-four percent of women living in Florida had received a pap smear within the past 2 years; this rate was similar to women living in the Border States (82 percent) in general. ^[15]
• In Florida, the 2002 cervical cancer incidence rate was 11.5 per 100,000 females; this was higher than the Border States incidence rate of 4.5 per 100,000 females (Table 7).
• In Florida, the 2002 age-adjusted cervical cancer mortality rate at 2.9 per 100,000 females was similar to the rate of 2.6 per 100,000 females in the Border States and the U.S. (2.7 per 100,000 females).

Diabetes Mellitus

In 2002, diabetes was the sixth leading cause of death in the United States^[16] and Florida.^[17] Recent studies show that Type 2 diabetes is preventable.^[18] Overweight and obesity contribute to diabetes prevalence.^[19] Findings from the BRFSS indicate that Hispanics/Latinos(as) have a higher prevalence of diabetes than Non-Hispanic Whites at comparable Body Mass Index (BMI) ranking.^[20] Table 8 provides information about diabetes in Florida.

Sources: Agency for Health Care Administration, State Center for Health Statistics, Florida Department of Health (2002), and Office of Vital Statistics, Florida Department of Health (2002).

• Fifty-seven percent of Florida residents are overweight based on Body Mass Index: 38 percent are overweight but not obese, and 19 percent are obese (Table 9).
• The reported prevalence of diabetes in Florida was 7.7 percent of adults responding to the BRFSS; this is slightly higher than the Border States rate of 7.3 percent.
• Residents of Florida are somewhat more likely to be hospitalized for diabetes related issues (17.2 hospitalizations per 100,000 population) than those living in the Border States (14.5 per 100,000), but have a somewhat lower rate than the general U.S. population at 20 hospitalizations per 100,000 population (Table 8).
• The diabetes age-adjusted mortality rate in 2002 was 21 per 100,000 population in Florida; this is lower than the Border States and U.S. rates at 26 and 25 deaths per 100,000 population, respectively.
• Premature death due to diabetes results in 91 years of potential life lost per 100,000 population in Florida; this is 18 more years of life lost per 100,000 population than in the Border States. This suggests that many of the people in Florida who die as a result of diabetes or diabetes complications die at a younger age than those in the Border States who die of diabetes. Years of potential life lost rates in Florida are also much higher than the U.S. rates (79 years lost per 100,000 population).

Diabetes hospital discharge rates are much higher than the HB 2010 goals. Age-adjusted mortality rates for diabetes in Florida exceeded HB 2010 goals.

HIV/AIDS

HIV/AIDS, despite recent advances in treatment, is an increasing concern in Mexico and a major cause of illness and death in the United States.^[21] While the latest therapies have reduced death rates from AIDS in the Border region, their costs are prohibitive for some segments of the population.^[21] Estimates in the United States of the lifetime costs associated with health care for HIV/AIDS have increased from $55,000 to $155,000 or more, contributing to the burden of illness, disability, and death.^[17] In this context, HIV prevention becomes even more cost-effective.

• The incidence rate for HIV in Florida was 40 cases per 100,000 population in 2002 and was much higher than the Border States rate of 15.5 cases per 100,000 population (Table 10). The AIDS incidence rate was 29 cases per 100,000 which was 2.5 times the Border States rate of 11.5 cases per 100,000.
• The HIV incidence rate in Florida (at 40 cases per 100,000) was 9.5 times the established Healthy Border 2010 objective.

Hepatitis and Tuberculosis

The TB incidence rate of 6.2 cases per 100,000 population in Florida was slightly lower than the Border States rate of 7.8 cases per 100,000 population (Table 11).

Rates for hepatitis A and B in Florida are 2.1 and 3.7 per 100,000 population, respectively. Both rates for hepatitis are lower than the Border States rates of 4.3 for hepatitis A and 3.3 for hepatitis B.

Florida exceeded the HB 2010 objectives for hepatitis B and tuberculosis. The hepatitis A incidence rate was less than one-half the HB goal.

Sources: Bureau of Epidemiology, Florida Department of Health (2003), and Bureau of Tuberculosis and Refugee Health, Division of Disease Control, Florida Department of Health (2002).

Immunization Coverage

If children are properly immunized, most childhood diseases could be prevented. This could result in a significant reduction in the cost of health care. The only reliable data available about childhood immunization status come from the National Immunization Survey (NIS). These data were available only for the Nation and individual States.

• The NIS results estimated that 74 percent (plus or minus 5.5 percent)^[22] of Florida children 19 to 35 months of age had coverage for the prescribed vaccination series. Nationally, the NIS estimated that 73 percent of children in this age group (plus or minus 1.0 percent) had received this coverage.
• Non-Hispanic White children were somewhat more likely to have received immunizations (82 percent, plus or minus 5.9 percent) than Hispanics/Latinos(a) (77 percent, plus or minus 7.6 percent). Data for other race/ethnic groups was not available (Table 12).

Injury-Related Deaths

Injury is identified as the leading health threat in the first 4 decades of life.^[23] Unintentional injury was the fifth leading cause of death among all persons in Florida^[24], the Border States, and the United States^[25] in 2002. Most injuries are preventable. Intentional injury is also among the leading causes of death with suicide being eleventh, and homicide being the fourteenth in the United States.²⁵ Injuries sustained by violent-intentional or accidental-unintentional means are responsible for more than 146,000 deaths each year nationwide.^[26]

Source: Office of Vital Statistics, Florida Department of Health (2002).

• The motor vehicle crash age-adjusted mortality rate in Florida was 18.8 deaths per 100,000 population; this was higher than the Border States rate of 14.6 (Table 13).
• In 2002, lives claimed by premature deaths due to motor vehicle crashes resulted in the loss of 549 years of life per 100,000 Florida Residents; this was significantly higher than the years of potential life lost rate for the Border States (436 years lost per 100,000 population).
• In 2002, there were a total of 200 deaths among children ages 0 to 4 due to unintentional injuries^[27] in Florida. Non-Hispanic White children accounted for 52 percent of these deaths (103 of 200) and Hispanic/Latino(a) children accounted for 14.5 percent of these deaths (29 of 200) statewide.

The Florida mortality motor vehicle crash rate was 1.9 times the HB 2010 goal.

Prenatal Care

Early prenatal care is important to a healthy pregnancy and is critical in identifying potential problems that may put the pregnancy at risk. Risk factors and maternal health conditions including pregnancy-related hypertension, gestational diabetes, and cigarette smoking, among others, which can contribute to poor infant outcomes can be identified by screenings as a part of prenatal care.^[28]

Source: Office of Vital Statistics, Florida Department of Health (2002).

• In Florida, 84 percent of women received prenatal care in the first trimester (Table 15).
• In 2002, 89 percent of Florida's Non-Hispanic White mothers began prenatal care in the first trimester. Eighty-three percent of Hispanic/Latina mothers began prenatal care in the first trimester.
• Blacks/African-Americans (76 percent) and American Indians/Alaskan Natives (70 percent) in Florida fell below the desired goal set out in the Healthy Border 2010 Objective (85 percent) for the proportion of women who should start prenatal care in their first trimester of pregnancy.

Prenatal Care - Florida State Teenage Mothers

Table 17 shows that in Florida, 64 percent of mothers ages 15 to 17 received prenatal care in the first trimester. This was consistent with the proportion in the Border States (67 percent).

Prenatal Care of Border Teenage Mothers - Comparison of Race/Ethnicity to State

The proportions of teenage mothers of all race/ethnicities in Florida who began prenatal care in the first trimester of pregnancy were far below the HB 2010 goals.

Source: Office of Vital Statistics, Florida Department of Health (2002).

Teenage Pregnancy

Source: Office of Vital Statistics, Florida Department of Health (2002).

• In 2002, the Black/African-American teenage birth rate was 59 per 1,000 females ages 15 to 17 in Florida. There was considerable variation in the teenage birth rate by race/ethnicity. The rate among Hispanics/Latinas was 35 births per 1,000 teenage women and 12.8 per 1,000 among Non-Hispanic White teenage women. The higher teenage birth rate was reflected in all race-ethnic categories except Non-Hispanic Whites and Asians/Pacific Islanders.
• Overall, the teenage birth rate in Florida was lower than the rate for the U.S. (18 per 1,000 females ages 15 to 17). The Florida teenage birth rate was below the HB 2010 goal of 28 births per 1,000 women between 15 and 17.

Infant Mortality

Table 14 shows that, in Florida, the infant mortality rate in 2002 was 7.5 deaths per 1,000 live births.

Source: Office of Vital Statistics, Florida Department of Health (2002).

• For Non-Hispanic Whites and Hispanics/Latinos(as), the infant mortality rate was 6.6 and 4.5, respectively.
• The Black/African-American infant mortality rate was 13.7 deaths for each 1,000 live births. This reflects an infant mortality rate that was over two times greater than occurred in the Non-Hispanic White and Hispanic/Latino(a) populations.

Mental Health

Meeting mental health needs has been identified as a national priority in the United States. The National Action Agenda, established by the Surgeon General, notes specific action steps aimed to decrease the burden of mental illness include promoting public awareness, supporting mental health-related research, improving early assessment, recognition and access to care, and training appropriate personnel to recognize and manage mental disorders.^[29]

Hospitalizations for psychiatric-related conditions occurred at the rate of 50 per 10,000 population in Florida in 2002; this was higher than the rate of 38 per 10,000 population for the Border States (Table 18).

Suicide takes a disproportionate toll in the community as well as on the family and friends of the deceased. It also results in a significant loss of years of potential life of a productive community member. Suicide was the ninth leading cause of death in Florida^[30] and the eleventh in the U.S.^[31]

• Table 18 shows that in 2002, the Florida age-adjusted suicide mortality rate was 13.4 deaths per 100,000 population. This was somewhat higher than rates for the Border States and U.S. (10.9 per 100,000 each).
• In Florida, suicide resulted in the loss 292 years of life per 100,000 population.

Oral Health

"You are not healthy without good oral health," noted Dr. C. Everett Koop, former U.S. Surgeon General.^[32] The importance of meeting oral health care needs in communities Florida, the Border States and nationwide is increasing as research continues to link oral health with general well-being. Oral infection has been associated with the onset and severity of systemic diseases such as cardiovascular disease and diabetes, and negative birthing outcomes.^[33] Despite increased use of dental sealants and water fluoridation, preventable oral diseases still afflict many children and adults during their lifetimes, impacting their self-image and quality of life as well as compromising their health and well-being.³³ Disparities in access to preventative and therapeutic oral care are demonstrated by the unmet needs of those with lower income and education levels, underserved populations, and a notable proportion of untreated tooth decay (over 40 percent in persons between 2 and 19 years, and approximately 90 percent of adults) observed in individuals regardless of sociodemographic characteristics.^[34] While it is now possible to maintain healthy teeth throughout a lifetime, currently available preventive measures, knowledge, and technologies must be utilized universally by professionals and consumers alike.^[35]

The HB 2010 Objective for oral health includes these essential services:

• Treatment of dental cavities
• Preventive services such as dental sealants
• Dental restorative treatments such as replacement of permanent teeth
• Screening and diagnosis of oral and pharyngeal cancers
• Identification and referral for treatment of oral birth defects, such as cleft lip and cleft palate

Information collected in the Behavioral Risk Factor Surveillance System (BRFSS) results from answers to the question, "Have you visited the dentist or dental clinic within the past year for any reason?"

• In 2002, Florida residents fell below the HB 2010 goal of 75 percent visiting a dentist each year. Sixty-nine percent of adults had visited a dentist or dental clinic within the past year. This was similar to the Border States (66 percent) and the U.S. (70 percent).

Source: Behavioral Risk Factor Surveillance System (2002).

Asthma

Of Florida respondents to the BRFSS, 10.5 percent reported that they have been diagnosed as ever having asthma by a health professional.

• In 2002, the Florida asthma hospitalization rate of 15.1 per 10,000 was nearly three times the HB 2010 goal. The hospitalization rate reflects only cases that were severe enough to be admitted to the hospital, not cases that presented themselves in the emergency department, treated and released.
• Death due to asthma was a relatively rare cause of death; the age-adjusted mortality rate was 1.2 deaths per 100,000 population. This was similar to the Border States and the U.S. rates (1.5 and 1.4 deaths per 100,000 respectively).