State Highlights

In 2000, the Arizona population was 5.13 million and had been estimated to increase by 9 percent to 5.58 million in 2003.^[2]  The Arizona population was 64 percent Non-Hispanic White, 25 percent Hispanic/Latino(a), 4 percent American Indian/Alaskan Native, 3 percent Black/African-American, and 4 percent Other Races.  With a rate of 109 births per 1,000 women of childbearing ages, Hispanics/Latinos(as) were the fastest growing major race/ethnic group in Arizona.  American Indians had a birth rate of 97 per 1,000, and Asians/Pacific Islanders had a rate of 75 per 1,000, but both of these populations were relatively small.  The population of Arizona made up 9 percent of the 65 million people who lived in the four States (California, Arizona, New Mexico, and Texas) that share a Border with Mexico.  California contributed 55 percent of the population of the four States and Texas and New Mexico contributed 34 percent and 2.9 percent, respectively.

This report provides information about two regions of Arizona based on distance from the U.S.-Mexico Border.  Arizona has 15 counties.  The 4 counties within 62 miles (100 kilometers) of the U.S.-Mexico Border are identified as Border Counties, excluding La Paz, Maricopa, and Pinal Counties.  In 2003, an estimated 1.2 million Arizona residents lived in the Border Counties.

Population Dynamics

Geographic Distribution
In 2000, Arizona’s Border Counties contained 23 percent of the State’s population (Table 1).  Sixty percent of the population of Arizona lived in Maricopa County.  The major cities in Arizona were Phoenix, Tucson, Mesa, Glendale, Scottsdale, and Tempe, all of which are located in Maricopa County.  Counties more than 62 miles from the U.S.-Mexico Border were home to 77 percent of the State population.

Race/Ethnicity
Table 2 shows that Non-Hispanic Whites account for the majority of the population across Arizona, regardless of geographic area:  64 percent statewide and 57 percent of the Border Counties.  A larger proportion of the Arizona Border county population was Hispanic/Latino(a) (34 percent) than the State population (25 percent).  Of the 6.9 million people who lived in Border Counties in the 4 Border States, 49 percent were Hispanic/Latino(a).

Pima County, designated as a metropolitan county, covers 9,184 square miles and had an estimated population of 843,746 in 2000.  While 58 percent of the population lived in Tucson, 42 percent lived in the rest of the county.^[3]   This area may face access to care problems similar to those of a non-metropolitan area even though it is part of a metropolitan county.

Education
In Arizona’s Border Counties, 80 percent of residents had completed high school or more.  This was consistent with the Arizona (81 percent) and U.S. (80 percent) populations which had completed high school or a higher education (Table 6).

Income^[4]
The median family income in the year 2000 in the Metropolitan Statistical Areas (MSA) of Arizona were:  Phoenix-Mesa:  $51,126; Tucson:  $44,446.  In the California MSA in San Diego, the median family income was $53,438.  These incomes are much higher than the median family incomes in 2000 for Las Cruces, New Mexico, at $33,576; El Paso, Texas, at $33,410; Laredo, Texas, at $29,394, and Brownsville–Harlingen, Texas, at $27,853.  The Texas MSAs included as Border Counties according to the definition used by the Texas Comptroller of Public Accounts, but not directly on the U.S.-Mexico Border (San Antonio and Corpus Christi), had median family incomes similar to those of Arizona and California.  Hispanic/Latino(a) median family incomes ranged from $31,000 to $34,000 in Arizona and California Border MSAs, respectively, compared to $24,500 to $28,500 in New Mexico and Texas Border MSAs.

Poverty
Table 4 shows that the proportion of families living below 150 percent of the Federal poverty guidelines in counties within 62 miles of the U.S.-Mexico Border (27 percent) was similar to that of the overall Arizona population (24 percent).  In the counties more than 62 miles from the U.S.-Mexico Border 23 percent of the population lived on incomes of less than 150 percent of poverty.  The U.S. Federal Poverty Thresholds^[5] were established as a baseline to develop guidelines for Federal and State programs such as Medicaid.  In 2000, $17,761 for a family of four was established as the poverty threshold.

Source: U.S. Census Bureau (2000).

Health Access
According to the Behavioral Risk Factor Surveillance System (BRFSS) 16.1 percent of the Arizona population was uninsured; this was below the rate for Border States (19.4 percent), but higher than the U.S. rate (15.2 percent).^[6], ^[7]  In opposition to the findings for families living below 150 percent of the poverty guidelines, a slightly larger proportion of uninsured residents lived in the Arizona counties more than 62 miles from the U.S.-Mexico Border where the rate was 16.7 percent (Table 5).

Health Professional Shortage Areas (HPSAs) were the method that HRSA used to identify areas of a State that do not have a sufficient supply of health professionals to meet the health needs of the population.  Thirty-six percent of the population in the Arizona Border Counties resided in a primary care HPSA, either single or partial county (Table 44).  While 31 percent (Table 45) of the Border Counties population in Arizona lived in a dental HPSA, 13.7 percent (Table 46) of residents lived in a mental HPSA.  Statewide, 34 percent of the population lived in a primary care HPSA, 22 percent lived in a dental HPSA, and 20 percent lived in a mental HPSA.

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 Arizona. Comparisons to the Healthy Border objectives are used to highlight disparities in health with a focus on the Border Counties (those within 62 miles of the U.S.-Mexico Border).

Breast and Cervical Cancer

• Screening for breast cancer is an important aspect of women’s health. Evidence from the BRFSS in 2002 show that 81 percent of women living in the Arizona Border Counties had a mammogram within the past 2 years; this was similar to the proportion of women living in Arizona (84 percent) and the Border States (83 percent) who have had a mammogram within the past 2 years. ^[8]

• The breast cancer incidence rate in counties within 62 miles of the U.S.-Mexico Border was 67 per 100,000, this was higher than the Arizona incidence rate of 62 (Table 7).

• The age-adjusted^[9] breast cancer mortality rate in the Arizona Border Counties was 10.8 per 100,000 population; this was similar to the Arizona rate of 12.3 per 100,000 population and the Border States rate of 13.3 (Table 7). When the rate is calculated only for women, the rate was 19.6 deaths in the Arizona Border Counties. The loss due to premature breast cancer death cost 70 years of life per 100,000 population in Arizona in 2002. The years of potential life lost rate was consistent across Arizona and notably lower than the U.S. rate of 86 years per 100,000 population. The number of years of life lost to breast cancer is brought more into focus when the rate was calculated for those most effected by breast cancer: 140 years of life were lost per 100,000 women per year in Arizona, in 2002.

• Regular screening with pap smears helps with early detection of cervical cancer. Seventy-eight percent of women living in the Arizona Border Counties had received a pap smear within the past 2 years; this rate was similar to Arizona (81 percent) women and women living in the Border States (82 percent) in general.^[10]

• In counties within 62 miles of the U.S.-Mexico Border, the cervical cancer incidence rate was 8.2 per 100,000 females; this was similar to the Arizona incidence rate of 7.4 per 100,000 females and slightly lower than the Border States incidence rate of 4.5 per 100,000 females (Table 7).

• In the Arizona Border Counties, the age-adjusted cervical cancer mortality rate at 1.8 per 100,000 females was lower than the State (2.3) and Border States (2.6) rates.

Diabetes Mellitus

In 2002, diabetes was the sixth leading cause of death in the United States^[11] and the ninth in Arizona.^[12]   Recent studies show that Type 2 diabetes is preventable.^[13]  Overweight and obesity contribute to diabetes prevalence.^[14]   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. ^[15]   Table 8 provides information about diabetes in Arizona.

Sources: Section of Cost Reporting and Discharge Data Review, Bureau of Public Health Statistics, Arizona Department of Health Services (2002), and Office of Vital Records, Bureau of Public Health Statistics, Arizona Department of Health Services (2002).

• Fifty-six percent of Arizona residents were overweight based on Body Mass Index; 37 percent were overweight but not obese, and 20 percent were obese. There was little variation across geographic areas of the State (Table 9) with respect to this measure.

• The reported prevalence of diabetes in the Arizona Border Counties was 7.3 percent of adults responding to the BRFSS. This figure was higher than the State rate of 6.5 percent and the same as the Border States rate.

• Residents of the Arizona Border Counties were hospitalized for diabetes related issues (15.8 hospital discharges per 100,000 population) at similar rates of Arizona residents in general (14.8 per 100,000 population). This Border Counties rate was similar to the Border States rate of 14.5 per 100,000 and notably lower than the U.S. rate of 20.1 hospital discharges per 100,000 population (Table 8).

• The diabetes age-adjusted mortality rate was 21 per 100,000 population in counties within 62 miles of the U.S.-Mexico Border. This was similar to the Arizona rate of 23 deaths per 100,000 population which was lower than the Border States and U.S. rates at 26 and 25 deaths per 100,000 population, respectively.

• Premature death due to diabetes resulted in 74 years of potential life lost per 100,000 population in the Arizona Border Counties. Years of potential life lost due to diabetes in Arizona (78 years lost per 100,000 population) was somewhat higher than the Border States (73 years lost per 100,000 population) and similar to the U.S. rates (79 years lost per 100,000 population).
  Hospital discharge rates for diabetes in the Arizona Border Counties were approaching the HB 2010 goals, while mortality rates were lower.

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.^[16] While the latest therapies have reduced death rates from AIDS in the Border region, their costs are prohibitive for some segments of the population.^[16] 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.^[16] In this context, HIV prevention becomes even more cost-effective.

• The incidence rate for HIV in the Arizona Border Counties was 6.8 cases per 100,000 and the AIDS incidence rate was 5.2 cases per 100,000 population, in 2002. Both rates were lower than the Arizona rates (8.0 and 5.3 cases per 100,000 respectively), and less than half the rates for the Border States (15.5 and 11.5 cases per 100,000 respectively, Table 11).
• The HIV incidence rate in the Arizona Border Counties (at 6.8 per 100,000) was 1.6 times the goal established by HB 2010 objectives.

Hepatitis and Tuberculosis

The TB incidence rate of 3.5 cases per 100,000 population in the Arizona Border Counties was lower than both the State rate (4.8 cases per 100,000) and the Border States rate of 7.8 cases per 100,000 population (Table 12). Counties within 62 miles of the U.S.-Mexico Border exceeded the HB 2010 objective for tuberculosis in 2002. The hepatitis A and B incidence rates, however, were higher than the HB 2010 objectives for the Arizona Border Counties.

Sources: Infectious Disease Epidemiology Section, Office of Infectious Disease Services, Public Health Services, Arizona Department of Health Services (2002), and Tuberculosis Control Program, Office of Infectious Disease Services, Public Health Services, Arizona Department of Health Services (2002).

Immunization Coverage

If children were properly immunized, most childhood diseases can be prevented. This could result in a significant reduction in the cost of health care. The only reliable data available about childhood immunization status comes from the National Immunization Survey (NIS). These data were available only for the Nation and individual States. The sample size was too small to allow estimates of immunization rates for counties or smaller areas.

• The NIS results estimated that 68 percent (plus or minus 4.4 percent)^[17] of Arizona 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) had received this coverage.

• Non-Hispanic White children and Hispanics/Latinos(as) had similar rates of immunization: 68 percent (plus or minus 6.9) and 68 percent (plus or minus 6.4), respectively. Data for other race/ethnic groups were not available (Table 13).

Injury-Related Deaths

Injury is identified as the leading health threat in the first 4 decades of life. ^[18]Unintentional injury was the third leading cause of death among all persons in Arizona^[19], and the fifth leading cause in the Border States and the United States in 2002. ^[20] Most injuries are preventable.  Intentional injury was also among the leading causes of death in the United States with suicide being eleventh, and homicide being the fourteenth.^[20]  Injuries sustained by violent-intentional or accidental-unintentional means are responsible for more than 146,000 deaths each year nationwide.^[21]

Source: Office of Vital Records, Bureau of Public Health Statistics, Arizona Department of Health Services (2002).

• The motor vehicle crash age-adjusted mortality rate in the Arizona Border Counties was 17.0 deaths per 100,000 population; this was similar to the Arizona and U.S. rates of 18.4 and 15.7 per 100,000 population, respectively (Table 14).

• In 2002, lives claimed by premature deaths due to motor vehicle crashes resulted in the loss of 526 years of life per 100,000 population in Arizona; this was 90 more years of life lost than the rate for the Border States (436 years lost per 100,000 population). Similar to the Border States rate, the counties within 62 miles of the U.S.-Mexico Border had a rate of 454 years lost per 100,000 population.

• In 2002, there were a total of 66 deaths among children ages 0 to 4 due to unintentional injuries in Arizona.^[22] Approximately 23 percent of these deaths (15 of 66) occurred in the Border Counties of Arizona. Hispanic/Latino(a) children accounted for 42 percent of these deaths (28 of 66) statewide.
  The Arizona Border Counties will need to improve mortality rates due to motor vehicle crashes in order to meet the HB objective by 2010.

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. ^[23]

Source: Office of Vital Records, Bureau of Public Health Statistics, Arizona Department of Health Services (2002).

• In 2002, 72 percent of women in the Arizona Border Counties received prenatal care in the first trimester of pregnancy (Table 16). In Arizona, 78 percent of women received prenatal care in the first trimester.

• In 2002, 87 percent of Arizona’s Non-Hispanic White and 86 percent of Asian/Pacific Islander mothers began prenatal care in the first trimester. Only 70 percent of Hispanic/Latina and 67 percent of American Indian/Alaskan Native mothers began prenatal care in the first trimester.

• Blacks/African-Americans, Hispanics/Latinas, and American Indians/Alaskan Natives in Arizona fell well below the desired goal set out in the HB 2010 objective for the proportion of women who should begin prenatal care in their first trimester of pregnancy. These rates were: 77 percent of Black/African-American, 70 percent of Hispanic/Latina, and 67 percent of American Indian/Alaskan Native mothers.

• Additional efforts may be needed to help achieve the HB 2010 goal of 85 percent of mothers beginning prenatal care in the first trimester of pregnancy among Black/African-American, Hispanic/Latina, and American Indian/Alaskan Native mothers in Arizona.

Prenatal Care – Border Teenage Mothers by Race/Ethnicity

Teenage mothers living in counties within 62 miles of the U.S.-Mexico Border received prenatal care in the first trimester of pregnancy at rates well below the desired goal established in the Healthy Border 2010 Objectives of 85 percent (Table 18). In 2002, the proportions of teenage mothers in the Border Counties that received prenatal care in the first trimester were:

• 63 percent of Non-Hispanic White mothers
• 67 percent of Black/African-American mothers
• 59 percent of Hispanic/Latina mothers
• 65 percent of Native American/Alaskan Native mothers

Prenatal Care – Arizona State Teenage Mothers by Geographic Distribution

In Arizona, the proportion of mothers ages 15 to 17 who received prenatal care in the first trimester were similar across geographic regions. The rates were 61 percent of teenage mothers in the Arizona Border Counties and 62 percent of mothers in counties more than 62 miles from the Border (Table 18).

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

In the Arizona Border Counties, while all teenage mothers, regardless of race/ethnic groups, fell well below the HB 2010 goals for early prenatal care, a smaller proportion of Hispanic/Latina mothers (59 percent) received prenatal care during the first trimester.

Source: Office of Vital Records, Bureau of Public Health Statistics, Arizona Department of Health Services (2002).

Teenage Pregnancy

• The birth rate for teenage women in Arizona was 34 births per 1,000 females ages 15 to 17. There was little variation across the State in birth rates among teenage women in 2002 (Table 17). The teenage birth rate in Arizona was considerably higher than the Border States teenage birth rate of 29 and the U.S. rate (18.2 per 1,000).
  
  
  
  

Source: Office of Vital Records, Bureau of Public Health Statistics, Arizona Department of Health Services (2002).

• There was considerable variation in the teenage birth rate by race/ethnicity. The Hispanic/Latina teenage birth rate was 89 per 1,000 in Arizona, 62 per 1,000 for American Indians/Alaskan Natives, 42 per 1,000 for Blacks/African-Americans, and 12 per 1,000 among Non-Hispanic White teenage women (Table 17). The highest teenage birth rate in the State was for Hispanics/Latinas in the counties more than 62 miles from the Border (97 per 1,000).
• The higher teenage birth rate was reflected in all race/ethnic categories except Non-Hispanic Whites and Asian/Pacific Islanders.

Infant Mortality

Table 15 shows that in Arizona, the infant mortality rate in 2002 was 6.4 deaths per 1,000 live births.

Source: Office of Vital Records, Bureau of Public Health Statistics, Arizona Department of Health Services (2002).

• For Non-Hispanic Whites and Hispanics/Latinos(as), the infant mortality rate was 6.0 and 6.5 per 1,000 live births, espectively.

• The Black/African-American infant mortality rate was 11.8 deaths for each 1,000 live births. This reflects an infant mortality rate that was almost twice that in the Non-Hispanic White and Hispanic/Latino(a) populations.

• There was little variation in infant mortality rates across geographic areas in Arizona.
  In 2002, the infant mortality rates in Arizona were higher for all major racial/ethnic groups, except Asian/Pacific Islander, than the target established by the HB 2010 Objective of 4.6 deaths per 1,000 live births.

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 including 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.^[24]

Hospitalizations for psychiatric-related conditions occurred at the rate of 19 per 10,000 population in Arizona in 2002; this was one-half of the Border States rate of 38 per 10,000 (Table 19).

• At 15 psychiatric related conditions per 10,000 population in the counties more than 62 miles from the U.S.-Mexico Border, the rate was much lower than in the Arizona Border Counties.

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 Arizona^[25] and the eleventh in the United States.^[26]

• Table 19 shows that the Arizona 2002 age-adjusted suicide mortality rate was 16.3 deaths per 100,000 population. This was much higher than the Border States and the U.S. rates (10.9 per 100,000, respectively).

• The loss of life due to suicide in Arizona Border Counties was slightly lower than in the State. The age-adjusted suicide rate was 15.5 per 100,000 in the Border Counties; this reflects a years of potential life lost rate of 337 years per 100,000 population.

• In the counties more than 62 miles from the U.S.-Mexico Border, the loss due to suicide was similar to the State rate with an age-adjusted rate of 16.5 per 100,000 population. There were 392 years of potential life lost per 100,000 population in 2002 in the counties more than 62 miles from the U.S.-Mexico Border.

Oral Health

“You are not healthy without good oral health,” noted Dr. C. Everett Koop, former U.S. Surgeon General.^[27] The importance of meeting oral health care needs in communities in the Border Counties, 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.^[28] 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.^[28] 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.^[29] 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.^[30]

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?”

Source: Behavioral Risk Factor Surveillance System (2002).

Results indicate that, in 2002, 68 percent of Arizona residents had visited a dentist within the past year. Sixty-nine percent of adults living in the Border Counties had visited a dentist or dental clinic in the past year. This was similar to Border States (66 percent) and the U.S. (70 percent, Table 20).

Asthma

f Arizona respondents to the BRFSS in 2002, 13.9 percent reported that they had been diagnosed as ever having asthma by a health professional.

• The asthma rate was 15.0 percent among residents in the Arizona Border Counties.

• In 2002, the asthma hospitalization rate (8.9 per 10,000) in counties within 62 miles of the U.S.-Mexico Border was 1.7 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 for Arizona was 1.5 deaths per 100,000 population. This rate was consistent across Arizona and similar to the Border States and U.S. rates.