Health Inequities and the Aging Population in Oklahoma Community Service Council of Greater Tulsa May, 2008

Demographics … a global first in the number of people over age 65 years Cost of living longer … People are living longer and healthier nationally, not in Oklahoma Technology … Health is now 16% of the Gross Domestic Product and rising Globalization … Medical costs to survive New ways of thinking about health…. What are the dimensions……? Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission File: Health Inequities OK Aging Conf May08rev ppt

Global Aging , 2020 and 2050 Source: Central Intelligence Agency, Long Term Global Demographic Trends: Reshaping the Geopolitical Landscape, (July 2001). Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Population Trends, United States 1970 to 2000 and Projections for 2010 to 2050

Life Expectancy at Birth Source: “A Global Perspective Why Population Aging Matters,” National Institute on Aging, National Institutes of Health, U.S. Department of Health And Human Services, U.S. Department of State, March, 2007, Publication No , page Births Projected to Live to 100 Years of Age Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Total Fertility Rates for White and Black Women, 1800 to 2000 in the US Have Dropped Dramatically

Age Distribution and Projections in Oklahoma 1970 to 2030

Percent of County Residents Aged 65+ US Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Percent of County Residents Aged 65+ US Percent Population Age 65 and Over: % Population Age 65 and Over 450, % % Population Age 85 and Over 65, % % Households with 1 or more 334, % age 65 Years and Over Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Percent of People Aged 65+ by County Oklahoma 2000 Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Oklahoma People Aged 65+ Percent Growth Compared to United States OK US Working age population change - 0.2% + 9.2% Specifically those between ages 34 and 47 will decrease Children 0-17 will grow by + 9.5% +15.8% Persons 65 and over will grow +59.9% +88.8% Persons 85 and over will grow +50.4% +72.8% Dependent population will grow +26.9% +40.5% Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Population by Age, Race & Hispanic Origin US Census Population Estimates 2006

Profile of the Aged in Oklahoma with National Rankings American Community Survey 2006 US RANK2006 Number  13% people are over age ,139  24% households 1 or more people over ,153  18% households had retirement income23245,198  10% people 65+ below poverty level19 45,673  1.8% the population over age 85 years25t 65,571 Prepared by the Community Service Council of Greater Tulsa for the Metropolitan Human Services Commission, October, 2007

Profile of the Aged in Oklahoma with National Rankings American Community Survey 2006 Prepared by the Community Service Council of Greater Tulsa for the Metropolitan Human Services Commission, October, 2007 US RANK2006 Number  57% of grandparents responsible 6 43,029 for their grandchildren  47% of people over 64 had a disability 8211,077 Of those over age 80 years 74% have a disability and 58% severe  62:100 workers age dependency ratio now 11 80:100 workers age dependency ratio by 2030

* Relationship of persons in family households is determined by relationship to the householder. Population Age 65 and over Number 455,700 Percent 100.0% In Households427, % Family Households284, % Householder158, % Spouse106, % Parent10,1262.2% Other relative8,1621.8% Non-relative9010.2% Non-family Household143, % Householder, Non-family Household, Living Alone136, % Householder, Non-family Household, Two or More Persons3,6430.8% Non-relative in Non-family Household2,8800.6% In Group Quarters28,4746.3% Institutionalized26,1345.7% Non-institutionalized2,3400.5% Household Types of the Aged in Oklahoma US Census 2000 Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Percent of People Aged 65+ Living in Group Quarters Source: Census 2000 analyzed by the Social Science Data Analysis Network (SSDAN).Census 2000Social Science Data Analysis Network (SSDAN) Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Percent of Persons Aged 65+ Living Alone Source: Census 2000 analyzed by the Social Science Data Analysis Network (SSDAN).Census 2000Social Science Data Analysis Network (SSDAN) Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Percent of Grandparents as Caregivers Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Oklahoma – Percent of Grandparents as Caregivers Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

English Language Ability of the Aged Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

National Health Care Expenditures and their Percentage of the GDP 1960 to Source:CentersforMedicareandMedicaidServices,OfficeoftheActuary,NationalHealthStatisticsGroup,athttp:// v/NationalHealthExpendData/(seeHistorical;NHEsummaryincludingshareofGDP, CY ;filenhegdp05.zip). Adults aged 65 years and older have the highest health care spending, averaging $8,647 per person. Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Infectious Diseases Replaced by Chronic Disease and Disability as Leading Causes of Death Globally and in the US Tuberculosis Malaria Hepatitis HIV/AIDS Cholera Diptheria Dysentery Heart Disease Cancer Diabetes Tuberculosis HIV/AIDS Hepatitis B and C Source: Central Intelligence Agency, Long Term Global Demographic Trends: Reshaping the Geopolitical Landscape, (July 2001). Community Service Council of Greater Tulsa

* Disability: A long-lasting physical, mental, or emotional condition. This condition can make it difficult for a person to do activities such as walking, climbing stairs, dressing, bathing, learning, or remembering. This condition can also impede a person from being able to go outside the home alone or to work at a job or business. ** Physical Disability: A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying. *** Mobility Disability: The 2000 Census asks people if they have a "Go Outside The Home" disability. In previous years, the question has been labeled a "Mobility Disability." Both terms have the same meaning and include people who are limited from leaving their homes without assistance. The Census specifically asks if a person is unable to go outside the home for activities such as shopping and visiting the doctor. Source: Census 2000 analyzed by the Social Science Data Analysis Network (SSDAN).Census 2000Social Science Data Analysis Network (SSDAN) Disability Status of the Aged in Oklahoma US Census 2000 NumberPercent Population Age 65 and over429, % No disability228, % One disability*92, % Sensory disability only 17,7944.1% Physical disability only** 49, % Mental disability only 4,8721.1% Selfcare disability only % Mobility disability only*** 19,0464.4% Two or more disabilities108, % Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

US Health Care Expenditures Exceed Global Expenditures But Outcomes Do Not Match Source: Organisation for Economic Co-operation and Development. OECD Health Data 2007, from the OECD Internet subscription database updated July Copyright OECD 2007, US Health Care Expenditures 2004 Greatest in the World with Rank of 32nd in Health Outcomes

Health Care Spending is Greatest in the Top 5% of the Population Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Health Care Spending is Greatest in the Aged Over 65 Years and in Women Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Health Care Spending is Greatest in Hospitals and Physicians Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Hospitals Discharges by Payor Oklahoma, 2006 For All Persons Source: Oklahoma State Department of Health OK2SHARE Total Discharges 518,602 Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission 29% commercial insurance payor 62% public funds payor

Hospitals Discharges by Payor Oklahoma, 2006 For Persons Age 65 and Over Source: Oklahoma State Department of Health OK2SHARE Total Discharges 192,353 or 37% of all Discharges Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission 7% commercial insurance payor 91% public funds payor

Total Charges from Hospitals by Payor Oklahoma, 2006 For All Persons Source: Oklahoma State Department of Health OK2SHARE Total Charges $9,457,070,618 Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission 27% commercial insurance payor 64% public funds payor

Total Charges from Hospitals by Payor Oklahoma, 2006 For Persons Age 65 and Over Source: Oklahoma State Department of Health OK2SHARE Total Charges $4,179,600,508 or 44% of all charges Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission 7% commercial insurance payor 91% public funds payor

Oklahoma Medicaid Expenditures by Service for All Persons (top 12) FY 2007 These 12 Medical services represent over 83% of Oklahoma’s total expenditures Nursing Home Services use 17% & Inpatient Services use 15% of all Medicaid dollars spent on all persons Source: Oklahoma Health Care Authority, CMS Annual Reporting, FFY 2007 Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Oklahoma Medicaid Expenditures by Service for Persons Age 65 and Over (top 12) FY 2007 Source: Oklahoma Health Care Authority, CMS Annual Reporting, FFY 2007 These 12 Medical services represent over 96% of Oklahoma’s total expenditures for Persons age 65 and over Nursing Home Services use 78% of all Medicaid dollars spent on person age 65 & over and 21% of expenditures Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Relative Expenditures by Source of Care are Increasing for Private Health Insurances Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Minorities are More At-risk for Health Insecurities A higher percentage having no health insurance Minorities make half as many physician visits for preventive health Minority men are employed in the most dangerous occupations (mining, construction, etc.) Men and boys are encouraged to more risky behaviors Research on health responses to specific diseases and interventions by race are underfunded Health Care Rx: Access For All The President’s Initiative on Race 1998 Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Gender Differences in Life Expectancy Favor Women Life expectancy for men and women in 1920 was 1 year difference Life expectancy for men and women in 2008 is 6 years difference Men are more likely to die than women in all the top ten causes of death At birth, there are more males than females. By age 36, the trend turns to more females than males. At age 100, women outnumber men by 8 to 1 Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Premature Death Greater is Racial and Ethnic Minorities The racial and ethnic minorities in Oklahoma are expected to reach 50% of the Oklahoma population by Infant mortality is higher in minority populations Oklahoma exceeds the national average in age adjusted death rate for heart disease, cancer and stroke with minority populations disproportionately represented Source: Center for Vital Statistics, Oklahoma State Department of Health Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Diminishing Population Increase Health Insecurities in Rural Areas Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Health Insurance Status, by Age Oklahoma

Oklahoma's Rankings in Outcomes Associated with Poor Health 1990 and 2007

Oklahoma's Rankings in Risk Factors Associated with Poor Health 1990 and 2007

Mortality Rates for the Four Leading Causes of Death Oklahoma

Age-Adjusted Death Rates for the Leading Causes of Death US 2005, Oklahoma 2004

Heart Disease Deaths by Race and Sex, Oklahoma, Age Adjusted Death Rates per 100,000 Population

Cancer Deaths by Race and Sex, Oklahoma, Age Adjusted Death Rates per 100,000 Population

Stroke Deaths by Race and Sex, Oklahoma, Age Adjusted Death Rates per 100,000 Population Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Unintentional Injuries Deaths by Race and Sex, Oklahoma, Age Adjusted Death Rates per 100,000

Oklahoma – Aging Planning Considerations Shrinking working age population vs. growth of those age 64 and older Consider the urban rural differences Chronic and acute health care vs. prevention The changing family and household structure The need for 1 in 75 seniors to speak another language Slide prepared by the Community Service Council of Greater Tulsa, supported by the Metro Human Services Commission

Health Inequities and the Aging Population in Oklahoma The Community Service Council of Greater Tulsa thanks the Human Service Committee - Social Services Subcommittee for the opportunity to share some of the information it has available concerning the aging of Oklahoma. We are available to provide a great amount of data and information on this topic and many others. The Community Service Council's Census Information Center (CIC) is provided in cooperation with the U.S. Census Bureau to make census data more accessible for use in planning to meet the needs of people in Oklahoma. Census Information Center (CIC) Please visit our website for a variety of presentations and sets of data for your use in planning and development of the State of Oklahoma. click on data A Tulsa Area United Way agency Community Service Council of Greater Tulsa 16 East 16 th Street, Suite 202 Tulsa, OK Contact: or