1. Current Demographic Changes in Texas Relevant to Health Workforce Demand State Health Plan Population Working Group Presented by Karl Eschbach, Ph.D.

2. Current population trends with implications for health care demand Rapid growth rate Geographic shifts Shifts in ethnic composition Aging of the population Increases in morbidity 2

3. Fastest Growing States, 2000-2009 State 2000 Population 2009 Population Numerical Change 2000-2009 Percent Change 2000- 2009 Rank in Percent Change Texas20,851,82024,782,3023,930,48218.86 California33,871,64836,961,6643,090,0169.119 Florida15,982,37818,537,9692,555,59116.09 Georgia8,186,4539,829,2111,642,75820.14 Arizona5,130,6326,595,7781,465,14628.62 North Carolina8,049,3139,380,8841,331,57116.58 Virginia7,078,5157,882,590804,07511.415 Washington5,894,1216,664,195770,07413.111 Colorado4,301,2615,024,748723,48716.87 Nevada1,998,2572,643,085644,82832.31 Source: 2000 Census and 2009 Vintage Census Bureau Estimates

4. Sources of population growth 2008 to 2009 + Births: +410,000 -Deaths: -164,000 +Migration from other countries: +88,000 +Migration from other states: +143,000 Total: ~477,000 Source: U.S. Bureau of the Census, 2009 Vintage Estimates

5. Natural Increase in Texas (Births minus Deaths) Birth Rate: 16.8 per 1,000 vs. 14.0 for US (2 nd highest) Death Rate: 6.8 per 1,000 vs. 8.3 for US (5 th lowest) Natural Increase: 10.0 per 1,000 vs. 5.7 for US (3rd high) Texas is young: – Median Age: 33.2 vs. 36.8 for US (2 nd lowest) Texas has a high total fertility rate (Children per woman) – 2.34 vs. 2.05 for US (4 th highest) Source: NCHS Vital Statistics Data, 2005 http://wonder.cdc.gov/http://wonder.cdc.gov/

6. Natural Increase per 1,000 by state Source: NCHS Vital Statistics Data, 2005 http://wonder.cdc.gov/http://wonder.cdc.gov/

7. Total Fertility Rate by Ethnicity, Texas, 2000 Sources: Calculated from Census 2000 5% Public-Use Microdata File and National Center for Health Statistics Natality Detail File, 2000,

8. Annual Net Migration to Texas, 2000 to 2008 8 Source: U.S. Bureau of the Census 2008 Estimates

9. Projected Population of Texas to 2040 (Millions) Source: Texas State Data Center Population Projections 4

10. Population Change by Area, 2000-2008 County Population Percent Increase Births- Deaths Migration 20002008ChangeForeignDomestic Big 5 Cities5,524,3156,334,169809,85415na Big 5 Counties9,270,90710,768,7091,497,80216981,509580,088-129,327 Suburban to Big Five3,567,5104,943,4871,375,97739328,96693,530953,905 Border Metros1,777,4292,098,343320,91418288,30293,173-51,103 All Other Metros3,328,7023,533,922205,220 6196,14338,559-16,024 All Non-Metro2,907,2722,982,51375,241 390,02746,559-45,666 Total20,851,82024,326,9743,475,154171,884,947851,909711,785 Big 5 Cities: Houston, San Antonio, Dallas, Austin, Fort Worth Big 5 Counties: Harris, Dallas, Bexar, Tarrant, Travis Source: U.S. Bureau of the Census, 2000 Counts, 2008 Vintage Estimates

12. Growth of Texas Race/Ethnic Groups 2000-2008 Race/ Ethnic Group 20002008Growth Percent Increase Percent of Growth Black2,349,6412,748,323398,68217.0 11.5 Anglo10,927,53811,525,623598,0855.5 17.2 Latino6,670,1228,870,4752,200,35333.0 63.3 Asian549,054810,967261,91347.7 7.5 Other/Two +355,465371,58616,1214.5 0.5 Total20,853,82024,328,9823,475,15416.7 100.0 Sources: 2000 Census, Census 2008 Vintage Estimates 10

13. Projected Population (Millions) by Race/Ethnicity 2000-2010 Long-term Growth Migration Scenario YearTotalAngloBlackLatinoAsian and other 200020.911.12.4 6.70.7 201024.311.52.8 9.11.0 202028.011.83.111.91.3 203031.811.83.315.11.6 204035.811.53.418.82.0 Short-term Growth Migration Scenario YearTotalAngloBlackLatino Asian and Other 200020.911.12.4 6.70.7 201025.411.42.9 9.81.2 202030.911.63.413.91.9 203037.311.53.919.02.9 204044.911.24.325.14.2 Source: Texas State Data Center Projections Long-term: ½ of 1990 to 2000; Short-term: Estimated 2000 to 2007

14. When do Hispanics pass Anglos in Texas? When do Hispanics become a majority in Texas? Migration Scenario Pass Anglos ? Absolute Majority ? No Migration20342040+ 1/2 of 1990-200020202035 Observed 1990-200020142026 Estimated 2000-200720152028 Source: Texas State Data Center Projections

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16. Population Growth by Age, 2000 to 2008 Sources: 2000 Census, Census 2008 Vintage Estimates 8

17. Table 2. Projected Annual Growth Rate: Total and Ages 65 and older in Texas, 2000-2040 17

18. Observed and projected growth by age, 2000 to 2008, and 2008 to 2016 Sources: U.S. Census 2000, 2008 Vintage Estimates, State Data Center Projections

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21. Projected percent 65-years-old or older, 2000-2040 by area

22. Obese or Overweight 1995-2007 Source: Centers for Disease Control, BRFSS

23. Age and Obesity in Texas 1995, 2000, 2007 Source: Centers for Disease Control, BRFSS

24. Race/Ethnicity and Obesity in Texas, 1995 and 2007 Source: Centers for Disease Control, BRFSS

25. Projected Increase in Obesity in Texas by Ethnicity, 2006 to 2040 Source: Texas State Data Center Projections

26. Insurance coverage and no insurance by type for ethnic groups, 2008 26

27. Source: State Data Center tabulation of U.S. Bureau of the Census, American Community Survey, 2007 Percent of Texans Reporting a Self-Care Limitation or Any Limitation, by Age, 2007

28. Source: State Data Center tabulation of U.S. Bureau of the Census, American Community Survey, 2007 Percent Age of Texans Age 65 or Older Reporting An Activity Limitation, 2007, by Ethnicity

29. Projected Growth of the 65+ Population Reporting a Self-Care Limitation, 2000 to 2040, Assuming Constant Age/Sex/Race/Ethnic Rates of Disability Source: Office of the State Demographer, 2000-2004 Projection Scenario

30. Contact Information Karl Eschbach, Ph.D. Professor and Director of Population Research Department of Internal Medicine-Geriatrics 0460 University of Texas Medical Branch 301 University Blvd Galveston, TX 77555-0460 (409) 747-3516 Phone (409) 772-8931 Fax kaeschba@utmb.edu 30