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2022 Transylvania County State of the County Health Report

Significant/Notable Changes in Morbidity and Mortality

The following represent significant or notable morbidity and mortality changes in our community in 2022:

  • Overall causes of death as reported by the latest County Health Data Book from NCDHHS remained largely similar to the 2015-2019 data reported in the 2021 Community Health Assessment. However, there were a few notable changes for data collected in 2016-2020. (Source: 2022 County Health Data Book, North Carolina State Center for Health Statistics)
    • Cancer and heart disease remain the leading causes of death. Deaths from cancer decreased slightly, while deaths from heart disease increased slightly, but both remain well below the state rates.
    • Deaths from diabetes; pneumonia and influenza; nephritis, nephrotic syndrome, and nephrosis; and unintentional motor vehicle injuries all decreased and remain below the state rates.
    • For the three causes of death where Transylvania County rates were higher than state rates in the 2015-2019 data, all had smaller discrepancies from the state rate in 2016-2020. Deaths from chronic liver disease and cirrhosis fell, resulting in lower rate that is now the same as the state rate. The rate of all other unintentional injuries rose, but is now less than 1 point higher than the state rate. The number of deaths from suicide remained the same (40 total over 5 years); the death rate decreased but remains about 66% higher than the age-adjusted state rate.
    • Septicemia was included as a leading cause of death, with a county rate of 7.1 compared to a state rate of 12.5.
    • Deaths from homicide and COVID-19 were also recorded in the 2016-2020 data, but the number of cases (6 and 14) were too small to be calculated as a rate.

Emerging Issues Impacting Health Since Last CHA

The following are new or emerging health issues in our community in 2022 that were not identified as priorities in our CHA:

  • Transylvania Public Health continued its response to the COVID-19 pandemic throughout 2022. A total of 3,552 cases, 70 hospitalizations, and 20 deaths among Transylvania County residents were reported from January 1 to December 31, 2022. Of these, 210 cases and 5 deaths were associated with 8 separate outbreaks at 5 skilled nursing and assisted living facilities and congregate living settings. Clusters of 5 or more cases were identified at 1 worksite, 1 college athletic team, 1 school athletic team, and 2 classrooms. Data integrity for cases and percent of positive tests decreased with the increased use of home tests.

  • The nationwide infant formula shortage impacted WIC clients. Local WIC staff responded with increased contact with local vendors, frequent scans of store inventory, and communication to clients on where to access formula and alternatives to their regular brands and sizes as approved by a federal waiver.

  • Our local vital records staff and funeral homes are moving ahead with use of the state's new electronic death certificate system. However, errors and other delays are creating problems for some families.

  • Communicable disease staff monitored a county resident with recent travel to Uganda in connection to the Ebola outbreak starting in September. This person had no symptoms and no suspected exposures. Staff prepared for monkeypox response, but no cases were identified among county residents. One suspect case was assisted with accessing testing and follow-up. Staff identified multiple cases of Campylobacter, C. perfringens, Cryprosporidosis, Norovirus, probable E. coli, and Salmonella, including one case associated with a nationwide outbreak. In addition, staff identified cases of active and latent tuberculosis, haemophilus influenza, vector-associated encephalitis, Strep A invasive, and probable Creutzfeldt-Jacob. Cases of Hepatitis and sexually-transmitted diseases are trending downward.

New/ Paused/ Discontinued Activities Since Last CHA

The following are new initiatives or changes in our community in 2022:

  • CARE Coalition received funding to support a behavioral health clinician and a re-entry coordinator for the county detention center late in 2021. Both positions were filled in 2022 and staff are working to support evidence-based treatment services to detainees with mental health and substance use disorders and to provide re-entry coordination and linkages to care to support recovery and reduce crime risk factors and recidivism. 

  • Transylvania County is serving as the fiscal agent for $1 million in ARPA Public Health Workforce Initiative funding that will support workforce development for local public health departments in Region 1. This funding will support a regional project director and projects focused on shared communication efforts around regional health priorities and legal training for public health employees to be implemented through June 2023.

  • A community collaborative was formed to bring together schools and community to support the emotional wellness of our school-aged youth. Known as TC STRONG, this collaborative began meeting in January 2022, with Transylvania Public Health, Transylvania County Schools, and The Family Place serving as lead organizations. The leadership team meets weekly; the steering team meets 6 times a year with delegates from schools, community sectors, parents, and youth themselves; and the "network" meets monthly with nearly 180 interested community members. TC STRONG prioritized, developed, and implemented a number of projects in 2022, and was awarded a $100,000 grant from Dogwood Health Trust to pursue project implementation and hire program staff. In addition, public health staff advocated for use of selected COVID-19 funding to support population-based mental health programs for students in K-12 school settings.

  • Community interest is also growing for work around mental health for all ages, supported by a research project from Georgia Insititute of Technology to map access points for mental health care. An initial convening was scheduled for early 2023 to move forward.

  • Transylvania Public Health began to ease its COVID-19 response efforts and return to normal operations for personal health services and immunizations. In early 2022, communicable disease staff continued work to track cases, conduct case investigations, perform contact tracing, keep an internal line list, and report to NCDHHS using the COVID-19 electronic surveillance system. The agency received assistance with contact tracing and case investigations through state CCTO contracts. Nurses continued to work with the county’s 6 skilled nursing and assisted living facilities to prevent and mitigate outbreaks. School nurses and the agency’s childcare consultant continued providing technical assistance and conducting case investigations and contact tracing for their populations. Staff also communicated guidance and provided technical assistance to the general public and to stakeholder groups including physicians, schools, churches, and businesses. As the year progressed, the scale and scope of these efforts began to be reduced in response to lower COVID-19 case numbers and as normal health department services began to resume. The agency continued offering COVID-19 vaccinations and boosters (along with flu vaccines) via in-office appointments. Transylvania Public Health provided a total of 1,281 COVID-19 vaccinations in 2022, including 187 first and second doses and 1,094 additional or booster doses. Uptake of the new bivalent vaccines and for vaccines for young children has been much lower compared to initial vaccines. Local data updates moved to a monthly distribution. COVID-19 vaccines remain available through in-office appointments that can be scheduled online or by phone. 

  • WIC continued to offer its services via telephone, email, and automatic voucher renewal, and continued to maintain a client load of over 100% of the state allocation. WIC clients also continued to receive additional benefits.

  • Affordable workforce housing remains a concern for residents and local government. Transylvania County SCORE hosted a roundtable to discuss barriers and strategies to overcome them in October. Two proposed sites for an affordable housing development were rejected, but a 60-unit complex to be constructed on Asheville Highway received $12 million in federal housing tax credits over 10 years through the North Carolina Housing Finance Agency. Applications for new septic and well installation remains high, which is indicative of demand for new residential construction.

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