2002: Most 2002 County Health Profile information is based on events occurring in calendar year 2000 or an average of years 1996-2000. The most current data year for information based on U.S. Bureau of the Census (Census) enumerations is 2000. Census population estimates (April 2002 revision) were used for 1996-99 in determining five-year rates.
2004: Most 2004 County Health Profile information is based on events occurring in calendar year 2002 or an average of years 1998-2002. Census population estimates were used for 1998-2002 in determining five-year rates (U.S. Bureau of the Census: 1998-99 estimates released March 2000; 2000-02 estimates released September 2004). Certain data items report enumerations from the 2000 Census (U.S. Bureau of the Census). Medicaid data reports enumerations from the 2003 state fiscal year (July 1, 2002 to June 30, 2003).
The specific sources of data are indicated within the data definitions. In general, vital data on reported pregnancy outcomes, births, and deaths were provided in electronic files by the Office of Vital Statistics, Montana Department of Public Health and Human Services (DPHHS). The Office of Vital Statistics receives reports on live births and fetal deaths for all Montana residents and induced abortions occurring within the state. There is no provision for reporting spontaneous abortions (miscarriages), regardless of where they occur, or induced abortions that occur outside Montana. Fetal deaths are reportable only after the fetus has reached 350 grams or, if the weight is unknown, 20 weeks of gestation.
Population data came from the Census and Economic Information Center (CEIC), Montana Department of Commerce, and the U.S. Census Bureau, in the format of downloadable files.
Many Montana counties have small populations and, therefore, the number of events in a given year, or even when summed over several years, are small. Because of the small number of events, rates based on these numbers are likely to be unstable, varying substantially between years or over longer periods of time. To assist in interpreting these rates, we have generally provided rates that are averaged over a five-year period and provided the absolute number of events in parentheses next to the rate. Users of County Health Profiles are cautioned that these data are not intended for forecasting.
This document reports crude death rates throughout (except heart disease, where both a crude and age-adjusted rate are reported). Comparison of crude rates over time or between populations may be misleading if significant differences exist in the demographics (e.g. age, race) of the populations being compared; observed differences in rate may result solely from population differences. Nonetheless, crude rates characterize the experience of a population at a given point in time and are useful for planning and funding purposes.
Population density is the calculated number of persons per square mile, based on the U.S. Census county population and report of county size. An area is “Frontier” if the population density is 6 or fewer persons per square mile. A “Rural” area has more than 6 and fewer than 50 persons per square mile. These designations were developed by the U.S. Department of Health and Human Services, Bureau of Primary Health Care (1986). A more detailed designation of frontier-rural-urban status can be found at the University of Washington's Rural Health Research Center website.
2002: Calculated using Census 2000 population enumerations. All Montana counties were rural or frontier.
2004: Calculated using U.S. Census 2002 population estimates (September 2004 release). All Montana counties,
except Yellowstone, were rural or frontier.
The percent of the population living in Urbanized Areas or Urban Clusters (defined by the U.S. Bureau of the Census,
from the Census 2000 Montana population). Urban Area and Urban Cluster boundaries encompass densely settled
territories consisting of:
- Core census block groups or blocks that have a population density of at least 1,000 people per square mile and
- Surrounding census blocks that have an overall density of at least 500 people per square mile.
Additionally, an Urbanized Area must have a population of at least 50,000 people. An Urban Cluster must have a
population of at least 2,500 and less than 50,000. All other territory is classified “Rural.”
“White” and “American Indian” race categories include those of one race only; “Other” includes all other single race persons as well as those indicating two or more races.
2002: From the 2000 U.S. Census enumeration of county and state population.
2004: From the U.S. Census estimates of the 2002 county and state population, released in September 2004.
From the 2000 U.S. Census enumerations of counties and state.
2002: Lists the three largest industries in the county/state in terms of the percent of all full- and part-time jobs in the year 2000; it includes both wage/salary employment and proprietors’ employment. These employment by industry data were reported using the Standard Industrial Classification System (SIC). Data are from the Montana Department of Commerce Regional Economic Information System (REIS) and were released May 6, 2002.
2004: Lists the three largest industries in the county/state in terms of the percent of all full- and part-time jobs in the year 2002; it includes both wage/salary employment and proprietors’ employment.
Since 2001, employment by industry data have been reported using a new classification system, the North American Industrial Classification System (NAICS). Prior to 2001, employment by industry data were reported by the Standard Industrial Classification System (SIC). Data from the two classification systems cannot be directly compared. For example, even though both systems include categories titled manufacturing, the industries included within each category are different. The U.S. Census Bureau’s NAICS website clarifies the differences between the two classification systems.
The statement “Incomplete data” in this section means information about the number of jobs was not available for more than one industry in the county and the missing information corresponded to more jobs than the next largest industry (with number of jobs reported). Therefore, industries listed after the statement “Incomplete data” are the largest industries for which the number of jobs was reported; industries listed prior to this statement are accurate in their rank order. Percents associated with all listed industries are accurate because the total number of jobs in each county was available. However, in two cases in this document an estimated percent (indicated by the symbol “~”) is reported for incomplete data, based on additional information.
Data are from the Regional Economic Information System of the U.S. Bureau of Economic Analysis and were released May 25, 2004.
2002: 2001 unemployment data tabulated for each county by the Montana Department of Labor and Industry, Office of Research & Analysis.
2004: 2003 unemployment data tabulated for each county by the Montana Department of Labor and Industry, Research & Analysis Bureau (March 2004).
Fifty percent (50%) of the households in the county/state reported this total annual income or less in 1999. Data are from the 2000 Census, U.S. Bureau of the Census.
2002: Per capita income in 1999 is the mean income computed for every man, woman, and child in a particular group (in this case, each county and the state). It is computed by dividing the total income of the group by the number of individuals in the group. Data are from the 2000 Census, U.S. Bureau of the Census.
2004: Per capita income in 2002 is the mean income computed for every man, woman, and child in a particular group (in this case, each county and the state). It is computed by dividing the total income of the group by the number of individuals in the group. Data are from the Regional Economic Information System of the U.S. Bureau of Economic Analysis.
Poverty status is shown in two ways:
These data are from the U.S. Census 2000 Summary File 3 (SF3) data and are based on reported income in 1999.
2002: The percent of the population on Medicaid is the count of persons enrolled in Medicaid for a minimum of one month during the 2001 state fiscal year (July 1, 2000 to June 30, 2001) divided by the 2000 Census population for the area. An individual is counted for each county of enrollment but only once for the total state enrollment. The Medicaid Services Bureau of the Montana DPHHS provided these data.
The percent of the population on Medicare is the count of all Montana resident beneficiaries with any type of Medicare coverage during the month of June 2000 (mid-year) and not known to be deceased as of June 1, 2000 divided by the 2000 total area population. Medicare data were provided by the Mountain-Pacific Quality Health Foundation in Helena, MT.
2004: The percent of the population on Medicaid is the count of persons enrolled in Medicaid for a minimum of one month during the 2003 state fiscal year (July 1, 2002 to June 30, 2003) divided by the 2002 Census population estimate for the area. An individual is counted for each county of enrollment (duplicated) but only once (unduplicated) for the total state enrollment. The Medicaid Services Division of the Montana DPHHS provided these data.
The percent of the population on Medicare is the count of all Montana resident beneficiaries with any type of Medicare coverage during the month of June 2002 (mid-year) and not known to be deceased as of June 1, 2002, divided by the 2002 Census population estimate for the area. Medicare data were provided by the Mountain Pacific Quality Health Foundation in Helena, MT.
From the 2000 U.S. Census, this measure indicates disability of the civilian, non-institutionalized population 21 years and older. People 5 years old and over are considered to have a disability if they have one or more of the following: (a) blindness, deafness, or a severe vision or hearing impairment; (b) a substantial limitation in the ability to perform basic physical activities, such as walking, climbing stairs, reaching, lifting, or carrying; (c) difficulty learning, remembering, or concentrating; or (d) difficulty dressing, bathing, or getting around inside the home. In addition to the above, people 16 years old and over are considered to have a disability if they have difficulty going outside the home alone to shop or visit a doctor’s office, and people 16-64 years old are considered to have a disability if they have difficulty working at a job or business.
Number of vital events (births or deaths) divided by the total area midyear population and multiplied by 1,000. Births are enumerated by the mother’s county of residence; deaths by the decedent’s county of residence. Data are from the Office of Vital Statistics, Montana DPHHS.
2002: Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
The midpoint in the range of ages (i.e. 50 percent of the persons in the category were the median age or older). “White” and “Am Ind” include those of one race only. Data are from the U.S. Census Bureau, Census 2000.
The midpoint in the range of ages at death (i.e. 50% of the persons in the category were the median age or older at the time of death). Either racial category may include “Hispanic”; “All” also includes unknown race. Data are from the Office of Vital Statistics, Montana DPHHS.
2002: For the five-year period 1996-2000.
2004: For the five-year period 1998-2002.
The teen fertility rate per 1,000 population is the five-year sum of births to females aged 15 to 19 divided by the five-year sum of females in the population aged 15 to 19, multiplied by 1,000. The fertility rate for all women is the five-year sum of births to all females divided by the five-year sum of females in the population aged 15 to 44, multiplied by 1,000. The populations of women younger than 15 and older than 44 are not used in this denominator because relatively few of the women in these age groups are likely to give birth. Including total populations for those age groups in the denominator would yield an underestimate of the true fertility rate. This calculation method, used throughout the U.S., yields a slight overestimate of the true rate. Data on births are from the Office of Vital Statistics, Montana DPHHS; population estimates are from the Montana Census and Economic Information Center.
2002: Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
Measured by the births to women who began receiving prenatal care during the first trimester (first three months) of pregnancy as a percent of all births for which the timing of prenatal care is known. Data on births were provided by the Office of Vital Statistics, Montana DPHHS; population estimates are from the Montana Census and Economic Information Center.
2002:Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
Based on birth certificate data from the Office of Vital Statistics, Montana DPHHS, this index attempts to characterize two dimensions of prenatal care.
These two dimensions are combined into a single “Adequacy of Prenatal Care Utilization Index”. Readers unfamiliar with this index, its assumptions and limitations are referred to: Kotelchuck, M. 1994. Am. Journal of Public Health. Vol. 84: 1414-1420. Births with unknown prenatal care status were excluded from the total number of births (denominator) in calculating this percent.
2002: Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
Percent of births for which the weight of the newborn was less than 2,500 grams (5 lbs. 8 oz.). Data are from the Office of Vital Statistics, Montana DPHHS.
2002: Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
Rate of infant (from birth to 364 days old) deaths per 1,000 live births. Data are from the Office of Vital Statistics, Montana DPHHS.
2002: Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
Number of new cancer cases diagnosed per 100,000 population. This incidence is age-adjusted to the U.S. 2000 standard-million population. The 1999 and earlier editions of this publication used the U.S. 1970 standard-million population and therefore, the cancer incidence rates in this edition cannot be compared to the rates in those editions. These age-adjusted rates include all malignant cancers plus in-situ bladder cancers. Since county incidence rates may be based upon a small number of cases and unstable; the 95% confidence interval is also provided. Cancer incidence data are from the Montana Tumor Registry, DPHHS.
2002: Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
The three causes of death that occurred with greatest frequency (the first cause listed being the most frequent). Death rates are not shown because they may be unreliable for many counties. Data are from the Office of Vital Statistics, Montana DPHHS. [CLRD = chronic lower respiratory diseases, an ICD-10 category which replaced the ICD-9 category chronic obstructive pulmonary diseases (COPD). The categories differ in that CLRD does not contain those causes of death in ICD-9 rubric 495, which include “extrinsic allergic alveolitis.”]
2002: For the five-year period 1996-2000.
2004: For the five-year period 1998-2002.
The number of resident deaths from heart disease per 100,000 population. Both the crude rate and the age-adjusted rate are reported for heart disease because of the significant contribution of age to the incidence of death from heart disease. County level statistics may be unreliable due to small numbers and should be used cautiously. Heart disease includes: acute rheumatic fever; chronic rheumatic heart diseases; hypertensive diseases (except essential hypertension); hypertensive heart and renal disease; ischemic heart diseases; pulmonary heart disease and diseases of pulmonary circulation; and other forms of heart disease. Data are from the Office of Vital Statistics, Montana DPHHS.
2002: Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
The number of resident deaths from the stated cause per 100,000 population. These rates are presented because Montana death rates are generally higher than national rates for these causes. County-level statistics may be unreliable and should be used cautiously. Deaths are tabulated by the deceased’s county of residence and therefore do not indicate where the accident, suicide or injury occurred. Data are from the Office of Vital Statistics, Montana DPHHS.
2002: Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
The percent of all motor vehicle crashes that occurred in the county or state, were reported to the Montana Highway Patrol, and involved the use of alcohol. When used as an indicator of the prevalence of drinking and driving among residents of the county/state, this measure may be limited by the inclusion of crashes involving non-residents, the exclusion of resident crashes that occurred in other counties/states, or by the absence of accidents that were not reported. Data are from the Montana Department of Transportation.
2002: Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
The number of Medicaid eligible persons who received mental health services divided by the total number of Medicaid eligible persons in the county/state. Mental health service data were provided by the Addictive and Mental Disorders Division, Montana DPHHS; Medicaid eligibility data were provided by the Medicaid Services Division, Montana DPHHS.
2002: Data are for state fiscal year 2001 (July 1, 2000 to June 30, 2001).
2004: Data are for state fiscal year 2003 (July 1, 2002 to June 30, 2003).
A sample proportion of children, from 24 through 35 months of age, who have a vaccination history on file with a vaccine provider indicating their immunization status as up to date. Up to date immunization status means: diphtheria, tetanus and pertussis – 4 doses; polio – 3 doses; H. influenzae type b (Hib) – 3 doses; measles, mumps and rubella – 1 dose; hepatitis B – 3 doses. This statistic is an indicator of the vaccination status of children from 24 to 35 months of age who are seen by a health care provider. Data are from the Immunization Section of the Communicable Disease Control and Prevention Bureau, Montana DPHHS.
2002: Data are for the year 2001.
2004: Data are for the year 2003.
The number of reportable new cases of sexually transmitted diseases (chlamydia, gonorrhea, syphilis) per 100,000 population. Data are from the STD/HIV Section of the Communicable Disease Control and Prevention Bureau, Montana DPHHS.
2002: Five-year average for the period 1996-2000.
2004: Five-year average for the period 1998-2002.
Numbers of state licensed facilities are counts of licenses recorded in the Licensure Bureau, Quality Assurance Division, Montana DPHHS. Home health and hospice agencies may be licensed to deliver services in more than one county and are listed by each county of service delivery (a duplicated count of agencies). The licensure list is continuously updated – the most current information available can be obtained by accessing the Montana DPHHS website.
Critical access hospitals are limited service hospitals designed to provide essential services to rural communities. The Balanced Budget Act of 1997 established the Medicare Rural Hospital Flexibility Program (RHFP), which provided grants to states for designation of hospitals as critical access hospitals. Because of relaxed staffing requirements and cost-based reimbursement for Medicare and Montana Medicaid patients, converting a struggling rural hospital to a CAH can allow the community to stabilize and maintain local health care access.
When the number of beds is shown, it represents the total number of beds in all facilities of the stated type in the county/state.
2002: Data (except CAH) are from licenses recorded as of February 2002. The count of critical access hospitals was obtained from the MHA: An Association of Montana Health Care Providers (August 2002) and includes one Indian Health Service facility in Blaine County (Harlem).
2004: Data are from licenses recorded as of July 2004. The count of critical access hospitals includes two Indian Health Service facilities, one in Big Horn County (Crow Agency) and one in Blaine County (Harlem).
2002: The Office of Primary Care, Montana DPHHS, provided the information on Rural Health Clinics and Federally Qualified Health Centers. The Federally Qualified Health Centers include five urban Indian clinics, one each located in Great Falls, Helena, Missoula, Butte, and Billings. This information was current in July 2002.
The Billings Area Indian Health Service (IHS) provided IHS/Tribal health facility information in July 2002. IHS facilities include hospitals, health centers/clinics, and health stations. Tribal health facilities include health centers and health stations. Counts are combined into a single statistic, “IHS and Tribal Health Facilities.”
2004: The Montana Primary Care Association maintains information on certified Rural Health Clinics and on federally qualified Community Health Centers (supported in part by federal grants). The count of Community Health Centers in this publication includes satellite locations as well as five urban Indian health clinics (one each located in Great Falls, Helena, Missoula, Butte, Billings). This information was current in September 2004.
The Billings Area Indian Health Service (IHS) provided IHS-Tribal health facility information in September 2004. IHS facilities include hospitals, critical access hospitals, and health centers/clinics; health centers/clinics that are part of a hospital facility are not counted separately from the hospital. Tribal health facilities include health centers/clinics. Counts are combined into a single statistic, “IHS-Tribal Health Facilities.”
Based on information from the Montana Department of Administration 9-1-1 Program. A 9-1-1 call goes over dedicated phone lines to the 9-1-1-answering point closest to the caller, and trained personnel then send the emergency help needed. Enhanced 9-1-1 is a system which routes an emergency call to the 9-1-1 center closest to the caller AND automatically displays the caller’s phone number and address. In most areas, information about phone number and location is not yet available for 9-1-1 calls made from a cellular/wireless phone.
2002: Information was current in September 2002.
2004: Information was current in September 2004.
The Emergency Medical Services and Trauma Systems Section of the Chronic Disease Prevention and Health Promotion Bureau, DPHHS, provided information on the type, number, and location of emergency medical service providers in each county. “Basic life support service” means an emergency medical service capable of providing care at the EMT-Basic equivalent level (includes defibrillation). “Advanced life support service” means an emergency medical service that has the capacity to provide care above basic life support, including EMT-Intermediate, EMT-Paramedic and associated special endorsements. The summarized categories of service include transporting, air, and non-transporting services.
2002:Information was current in May 2002.
2004: Information was current in July 2004.
Provided by the Public Health and Safety Division, Montana DPHHS, and based on a survey of county health departments. This section lists the count of full-time equivalent (FTE) public health nurses, registered sanitarians, registered dietitians, and health educators. One FTE equals forty (40) hours per week.
The “Chart” option presents the number of FTE public health nurses per 10,000 population and the number of FTE registered sanitarians per 10,000 population.
The Central Montana Health District provides environmental health services and public health nurse services to a six county region (Fergus, Golden Valley, Judith Basin, Musselshell, Petroleum, Wheatland); public health nurse services provided by the Central Montana Health District outside of Fergus County are limited.
2002: The survey was completed between July and August, 2002.
2004: The survey was completed between May and September, 2004.
The Board of Medical Examiners (Montana Department of Labor and Industry) maintains records of active, licensed physicians in Montana. The Billings Area Indian Health Service (IHS) office maintains a list of IHS physicians.
The count of primary care physicians includes those listed with one or more of the following practice areas – family practice, general practice, geriatric medicine, internal medicine, pediatrics, and obstetrics-gynecology. This count includes specialists who provide primary care services in conjunction with their specialty. This list was cross-referenced, as necessary, with the current edition of the Montana Medical Association Directory of Montana Physicians to clarify practice area or retirement.
The “Chart” option presents the number of physicians per 3,500 population. This rate is used to identify health professional shortage areas; a value less than 1.0 suggests inadequate primary care physician resources.
2002: MD/DO and IHS physician counts were current as of July 2002.
2004:MD/DO and IHS physician counts were current as of September 2004.
The Board of Nursing (Montana Department of Labor and Industry) maintains records of active, licensed nurse practitioners and nurse midwives in Montana.
2002: Counts are from a licensure list obtained in July 2002.
2004: Counts are from a licensure list obtained in September 2004.
The Board of Medical Examiners (Montana Department of Labor and Industry) maintains records of active, licensed PACs in Montana.
2002: Counts are from a licensure list obtained in August 2002.
2004: Counts are from a licensure list obtained in September 2004.
Mid-level primary care practitioners include nurse practitioners, nurse midwives, and physician assistants. See the definition for each group for further information.
The “Chart” option presents the number of mid-level primary care practitioners per 1,750 population. This rate is used to identify health professional shortage areas; a value less than 1.0 suggests inadequate mid-level primary care provider resources.
The Board of Dentistry (Montana Department of Labor and Industry) maintains records of active, licensed dentists and dental hygienists in Montana.
The “Chart” option presents the number of dentists per 5,000 population. This rate is used to identify dental shortage areas; a value less than 1.0 suggests inadequate dental care provider resources.
2002: Counts are from a licensure list obtained in July 2002.
2004:Counts are from a licensure list obtained in September 2004.
