Quality of Life in Louisville for People with Chronic Illnesses

January 6, 2020

Improving the quality of life for people with chronic illnesses improves the community. 

Louisville ranks 6th out of its peer cities for the number of adults without a primary care provider, with 265,000 residents lacking this important healthcare service.

On this metric, Louisville ranks among the middle tier of its peers according to a natural breaks algorithm. Cities in green are those that outperform their peers, cities in yellow represent the middle cluster, and those in red are a group that lags behind its peers on this indicator.

Primary care providers offer chronic illness management, early detection and disease treatment, and preventive care. The US Office of Disease Prevention and Health Promotion (2019) asserts that primary care is critical to reducing health disparities and improving population health.

According to the Louisville Department of Health and Wellness, Louisvillians have a higher death rate from chronic illness than their fellow Kentuckians and fellow Americans. These illnesses include some cancers, diabetes, lung disease, and arthritis (n.d.). The percentage of Louisvillians without a primary care provider has been increasing since 2008 and is now slightly below the peer mean and above the peer 25th percentile.

Without a primary care provider, people turn to emergency services care. This puts a strain on emergency room resources and drives up the cost of healthcare and health insurance.

Based on data from Medicare enrollees (adults ages 18 and up, continuously enrolled in Medicare), Louisville ranks 2nd worst out of its peer cities. In 2017, there were over 5,500 preventable hospital stays in the city. The Department of Health and Human Services’ Agency for Healthcare Research and Quality defines a preventable hospital stay for any of the following reasons: diabetes, chronic obstructive pulmonary disease, asthma, hypertension, heart failure, dehydration, bacterial pneumonia, or urinary tract infection.

On this metric, Louisville ranks among the bottom tier of its peers according to a natural breaks algorithm. Cities in green are those that outperform their peers, cities in yellow represent the middle cluster, and those in red are a group that lags behind its peers on this indicator.

Increased hospitalizations leads to increased missed days of work. That has a negative effect on the local economy and can create tension in the workplace, as workers may begin to resent their increased workloads (Saez, 2018).

There are multiple factors contributing to the lack of primary care, including health insurance coverage, language barriers, lack of reliable transportation, a lack of available doctors, and limited office hours (US Office of Disease Prevention and Health Promotion 2019). According to the American Academy of Family Physicians, adding one primary care doctor per 10,000 people results in a 10.9% decrease in ER visits and a 5.5% decrease in inpatient admissions (American Academy of Family Physicians, 2019).

Our data in your hands can make a difference.

Twenty-first-century cities leverage data to improve the quality of life of their residents. The GLP is making that possible in Louisville by releasing annual Competitive City Reports which catalyze change and mobilize key players from across sectors to focus on Louisville’s areas of highest potential impact.

With your help, we can change these stats. And when we do, we can change the story for all Louisville citizens.

  • If you would like to be informed when we have new or updated data connected to health, please click here.
  • If you are working to improve quality of life for those with chronic illnesses in our community,  click here to access Greater Louisville Project data that can help. If you would like to see the full range of health data currently available through the Greater Louisville Project, click here.
  • Still don’t see the data you need? Fill out this form so we can serve you better.

References

American Academy of Family Physicians (2019). Why Primary Care Matters. Retrieved from https://www.aafp.org/medical-school-residency/choosing-fm/value-scope.html

Louisville-Jefferson County Metro Government. (2019). Cancer and Chronic Disease Prevention. Retrieved from https://louisvilleky.gov/government/health-wellness/cancer-and-chronic-disease-prevention

Saez, A. (2018, August). The Effect of Absenteeism and Tardiness on Work. Retrieved from https://yourbusiness.azcentral.com/effect-absenteeism-tardiness-work-4991.html

US Office of Disease Prevention and Health Promotion (2019). Access to Primary Care. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-primary

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Natural Breaks Algorithm

For each indicator, Greater Louisville Project assigns cities into one of three groups (high-performing, middle-of-the-pack, and low-performing) based on how they compare to other cities. The assignment is based on how cities naturally cluster on that indicator. Sometimes, the differences between cities are very small, and the difference between a city ranked 5th and 6th could simply be a matter of the sampling error that arises from using survey data. Thus, rather than always make a division that declares the top 5 to be the top tier, we use a natural breaks algorithm to look for a cluster of cities that is outperforming the rest, a cluster that is about average, and a cluster that is lagging. This clustering gives us a better indication of where Louisville is thriving and where Louisville has room to learn from cities that are doing better.

Z-Scores

Z-scores (or standardization) is a way to combine data with different units of measurement into a single index. The z-score is a measure of how far away a city (or census tract, etc.) is from the average city. In order to be comparable across different units of measurement, the z-score is the distance from the mean measured in standard deviations (e.g. if Louisville has a z-score of 1 it means Louisville is 1 standard deviation above the mean of its peer cities).

Data from the Robert Wood Johnson Foundation's County Health Rankings use z-scores and all z-scores are relative to the mean of Louisville's peer cities. (On the County Health Rankings site z-scores are relative to all the counties in each state - thus z-scores reported by GLP will be different, because we are using a different reference group). The Greater Louisville Project also uses z-scores in our multidimensional poverty index, which compares each census tract to the mean of all census tracts in Louisville.