State of the County Health Report 2022
Conducting a community health assessment is an ongoing process that engages diverse agencies, providers, and individuals in identifying community assets and strengths, as well as unmet needs. Leadership for this collaborative process is provided by the Cabarrus Health Alliance (CHA) through Healthy Cabarrus. The following State of the County Health (SOTCH) Report, serves as an update and documented progress following the findings of the 2020 Community Health Needs Assessment. The 2022 Cabarrus County SOTCH was submitted to North Carolina Department of Human Services (NCDHHS) on March 6, 2023.

Information provided within this report is specific to the identified priority health issues: housing, behavioral health, and early childhood education and development. The report also provides updated data and information specific to Cabarrus County mortality and morbidity rates; emerging issues; new, paused and discontinued initiatives. 

Communication with stakeholders and community members regarding the identified community health priorities and progress to-date is vital to community health improvement. Following review by the Cabarrus County Public Health Authority Board of Commissioners and Healthy Cabarrus Executive Committee, copies and/or the shared link of the 2022 State of the County Health Report will be disseminated to the Healthy Cabarrus Advisory Board. The Advisory Board will also be asked to identified ways that they can assist with public and partner awareness of the report and its findings. Hard copies will be distributed to target community locations, which include local libraries, community centers, park and recreation departments, federally qualified health centers, in addition to other sites with high community member presence.

Cabarrus County Profile
Cabarrus County has experienced a 2% or higher annual population growth since at least 2010. The population of Cabarrus County, North Carolina in 2021 (ACS 1 Year Estimate) was 231,278, an increase of 29.5% from the 178,564 residents who lived in the county in 2010. For comparison, the US population grew 7.3% and North Carolina's population grew 10.2% during that same time period. 

Rapid population growth will not only impact how agencies and organizations serve residents, due to capacity and staff challenges, but communities can also experience lack of housing and schools, increased pollution, insufficient water availability and waste-disposal problems.

Often times vulnerable populations, such as persons with disabilities, limited English proficiency, children under 5 and persons over 65 are disproportionately affected. 

Total Cabarrus County Population: 231,278

Sources:
U.S. Census, American Community Survey 1-Year 2021 Estimate
US Bureau of Labor Statistics - December 2022

For data updates and progress specific to additional strategies outlined in the Community Health Improvement Plan for the Mental and Behavioral Health (Short Term) and Housing (Long Term) priorities, please visit each respective Scorecard here.

Housing and Homelessness

Cooperative Christian Ministry 

Rebuilders College and Brown Mill Commons – The Rebuilders College at Brown Mill Commons will initially provide 48 transitional, stable housing units, as well as nutritional support, resources for adult and child education, healthy habits and activities, connection to vital resources, access to public and other transportation, job training, career coaching and employment opportunities.  Participants who complete the program will have achieved: debt elimination, credit improvement, financial budgeting and savings, increased income and financial stability, established child care supports, reliable transportation strategy, academic achievement, successful parenting practices, healthy lifestyles, and household stability.  

Grace Place – Grace Place is an asset-based program, designed to provide the basic needs of food, housing and community for extremely low-income senior individuals in an environment that allows them to establish stability and connect with vital resources while promoting personal responsibility and community engagement. Serving extremely low income, seniors, Veterans, or those on disability (12-14 units), the campus will have multiple units strategically positioned around a community center which provides access to prepared meals, laundry facilities, transportation services, counseling, activities, educational opportunities, and life skills training.

HelpwithHousing.net – This site provides a selective referral for the homeless or those in housing crisis in Cabarrus County to a local entity that best serves their specific needs or condition.  The site also aggregates data to provide community leaders with insight into the real housing need in our community.  This site is a readily available digital platform for the homeless population or those serving others in housing crisis in our community to be CONNECTED to the appropriate resource that bests fit his/her needs. www.helpwithhousing.net 

Unsheltered Impact Report – The Unsheltered Impact Report is the product of a multi-agency focus group chartered by local Law Enforcement and Emergency Services to compile the working knowledge of the agencies working hand on with the unsheltered homeless in Cabarrus County.  The resulting report gives insight to quantifying the population, understanding the circumstances of the unsheltered and identifying potential corrective actions or solutions to improve the plight of the homeless in our cities.  The report has been presented to numerous local initiatives who address populations which are integrated with the unsheltered, in order to ensure appropriate considerations in all future corrective measures.

WeBuild Concord

WeBuild Concord expanded its mission in 2022 to provide housing opportunities through public and private partnerships for residents, including the building and development of homes, a community land trust, and advocacy for equitable housing and community development.

On November 30, WeBuild hosted a ground breaking for the Lincoln Street Townhome Project, a 26-unit townhome development designed to increase affordable housing and homeownership in the Logan Community. The Lincoln Street Project is a collaboration with the City of Concord, Cabarrus County Government and other community partners. The project will begin the most significant homeownership effort in the historic Logan Community. Currently, less than 35% of residents in the Logan Community own their homes, which is extremely low. The City of Concord and Cabarrus County support the effort with funding from the American Rescue Plan Act (ARPA) and the City’s affordable housing revolving fund. The Lincoln Street Townhome Project is the first of a more than $12 million investment in affordable and equitable housing projects by WeBuild Concord over the next several years.

Behavioral Health

Atrium Health Cabarrus - Behavioral Health Holding Unit (BHHU) 
The Cabarrus Healthcare Foundation received a $3.5 million grant from Cabarrus County Government – American Rescue Plan Act funding to build and upfit a Behavioral Health Holding Unit (BHHU) at Atrium Health Cabarrus. The 3,623 square-foot locked space will be located just outside the hospital’s existing emergency department (ED) and include eight beds which will be designated for behavioral health patients seeking crisis care through the ED.  The addition of the BHHU will allow for traditional ED beds, that were repurposed for behavioral health patients, to again be used for those needing emergency medical services.

The BHHU will provide a safe space that maintains the dignity and respect for mental health patients who are seeking care during crisis. The hospital will maintain five beds within the traditional ED, ensuring a total of 13 beds for patients in behavioral health crisis. The renovated space will have a dedicated tele-psych room, shower and activity space. 

Cabarrus County Government - Regional Mental Health Facilities 
In spring 2022, Cabarrus County released an initial Request for Proposals (RFP) from for-profit and not-for-profit providers, to operate a newly constructed regional behavioral health facility in Kannapolis. The facility is expected to begin operations in early 2025. The County is seeking to enhance existing crisis response service systems in the community and to divert individuals from hospitalization and emergency departments when appropriate. 

Although design concepts will be finalized in 2023, the County does anticipate one building with a single floor. The combination of Behavioral Health Urgent Care (BHUC) and traditional treatment beds, for adults, children and adolescents, is intended to provide a “no wrong door” center to receive walk-in and drop-off patients experiencing a behavioral health crisis. The goal of the facility is to provide initial treatment and stabilization leading to diversion of appropriate patients to less restrictive levels of care with only those who require 24-hour treatment being referred to the Facility Based Crisis (FBC), Substance Use Disorder (SUD), Psychiatric Residential Treatment Facility (PRTF), or other beds in the region. The treatment spaces (FBC, SUD, PRTF) within the facility will be designed to comply with the Facility Guidelines Institute (FGI) guidelines for inpatient treatment spaces to allow for flexibility in adjusting licensure and program types as the needs of the local population shift during the lifespan of the facility. 

Cabarrus County - NC Department of Health and Human Services, Mental Health Town Hall 
North Carolina Department of Health and Human Services Secretary (NCDHHS) Kody H. Kinsley — alongside N.C. State Senators Jim Burgin and Paul Newton and State House Representatives Kristin Baker, and Wayne Sasser — hosted a town hall in Kannapolis on November 29, to discuss mental health in North Carolina.  NCDHHS leadership and Cabarrus County Commissioners are committed to advancing behavioral health and resilience, as more than three million people in the state have mental health or substance use disorders.  Members of the public from Cabarrus and surrounding counties were able to attend, ask questions and contribute to the conversation. State officials offered comments on key policy issues, such as Medicaid Expansion, access challenges related to behavioral health and state legislation that restricts staff and billable services.

Click here to watch the full Mental Health Town Hall hosted in Cabarrus County. 

Cabarrus Health Alliance (CHA) School Nurse Program - Mental Health and Social Emotional Learning Supports 
CHA's School Health Department, which manages all school nurses in Cabarrus County and Kannapolis City Schools, was able to use state funds to provide school based mental health and social emotional learning interventions. The funds were approved to be used for hiring mental health providers to provide population-based mental health support, wrap around, non-clinical mental and behavioral health services for students, teachers, and staff as well as training and education in addition to the COVID testing services provided in 2021.
Through a collaborative approach with CCS and KCS, the School Health team identified and have been able to support the following activities:

• Train school health support staff in Question, Persuade, Refer (QPR) and Reconnect for Resilience
• Train all school nurses in QPR and Reconnect for Resilience
• Support Reconnect for Resilience Training for KCS and CCS staff
• Provide QPR Trainer Training and Reconnect Trainer Training to some KCS & CCS staff members, as well as the School Health Admin Team – This approach now allows these trainings to be incorporated into new school nurse orientation, creating sustainability for continued education and interventions.
• Hire nearly 10 additional Behavioral and Mental Health Support positions for KCS
• Make and distribute grade-level appropriate “Coping Skills Toolboxes” that can be used in classrooms, nurses’ offices, and by guidance counselors and social workers

Early Childhood Education

Cabarrus Partnership for Children

The Cabarrus Partnership for Children continues to lead the way by identifying and addressing needs of local childcare providers and families with children birth to five years old. 

Child Care Wage$ Program

The Cabarrus Partnership for Children provides education-based salary supplements to low-paid teachers, directors and family child care educators working with children ages birth to five years old through the Child Care WAGE$ Program. The program was created in response to research-based evidence that shows that the quality-of-care children receive is lowered by high turnover rates and inadequate teacher education. In November, the Partnership’s board voted to fully fund WAGE$ participants at a Tier II stipend. 

Lack of resources and an effort to maintain affordability for parents often make it difficult for individual child care programs to reward or encourage teacher education through salaries. As a result, many teachers leave the field or never even consider the profession an option. WAGE$ is designed to provide preschool children more stable relationships with better-educated teachers by rewarding teacher education and continuity of care.

Early Education Liaison Program   
In partnership with Rowan Cabarrus Community College (RCCC), the Cabarrus Partnership for Children created the Early Education Teacher Liaisons and Early Education Business Administrator Liaisons programs to address the needs of child care centers and strengthen the workforce within Cabarrus County.

The program addresses teacher education and business administration education for educators in child care facilities. The liaisons serve as a bridge between the college and local child care centers, offering academic support such as referrals for tutoring and scholarships for further education. Additionally, they place an emphasis on early education recruitment and business knowledge. 

The Chamber, Leading Business in Cabarrus - Legislative Agenda

The Chamber identified workforce recruitment and retention, as well as childcare challenges as the largest issues for local employers. Lack of access and affordability for childcare impacts worker availability as there are no third shift centers currently open in the community. It is also recognized that childcare centers have expensive overhead due to regulation and have difficulty hiring and retaining quality teachers, making it difficult for centers to afford healthcare and other benefits for staff.

The Chamber has incorporated five items within its Legislative Agenda to address increased access to childcare for workers:
•    Providing tax credits to businesses that provide childcare support for their employees.
•    Expanding the current Opportunity Scholarship* program to include Pre-Kindergarten education.
•    Revising existing childcare subsidy income limits to phase out subsidies rather than provide a hard income ceiling in order to encourage workers to seek higher paying opportunities.
•    Investing in additional childcare subsidies to help address the current worker shortage until long term solutions can be implemented.
•    Invest in pilot programs that seek innovative solutions to the current childcare shortage.

Mortality and Morbidity Data
Two measures commonly used for public health surveillance are mortality and morbidity. These measures can help describe and understand the progression and severity of a health event. Monitoring causes of death or rates of illnesses help public health professionals and epidemiologist to recognize cases or clusters of cases, to trigger interventions to prevent transmission or reduce morbidity and mortality.  Both are useful tools to learn about risk factors of diseases and compare and contrast health events between different populations, and identify appropriate health interventions.
The data within this section comes from the State Center for Health Statistics 2022 County Health Data Book and the Robert Wood Johnson Foundation – County Health Rankings. The data within the 2022 County Health Data Book spans 5 years, either 2016-2020 and is considered current for community health assessments and state of the county health reports due the March 2022. 
Source: https://schs.dph.ncdhhs.gov/data/databook/

Mortality

Infant and Child Death

Disparity ratios are calculated by dividing the rate for a population by the best rate for a selected health indicator to determine how much more likely a particular event is to occur in a population compared to another population. In the table above, infant mortality disparity for both the state and Cabarrus County compares the death rates of white and African American babies. In Cabarrus County, African American babies are 1.66 times more likely to die before 1 year of age when compared to white babies.

The red arrow indicates the data is worse than the previous reporting period. The green arrow indicates health improvements since the previous reporting period.

Leading Causes of Death

Data available for leading cause of death, shows that diseases of the heart has surpassed cancer – all sites as the number one leading causes of death among Cabarrus County residents. It is also important to know that data from 2016-2020 is the first reporting period where deaths caused by COVID-19 are reported. COVID-19 did rank as the 10th leading cause of death, replacing suicide from the previous report. It should be noted that although suicide has fallen out of the top 10, it remains the 3rd leading cause of death for residents Ages 20-39.

Other Unintentional Injuries also moved up one place from 5th to 4th. The most common unintentional injuries result from motor vehicle crashes, falls, fires and burns, drowning, poisonings and aspirations. Falls are the second leading cause of unintentional injury death for North Carolinians of all ages, and in every year from 1999 to 2019. Diabetes has jumped from 9th leading cause of death to 7th, which is an indicator that Cabarrus County consistently sees disparities among the demographic populations most frequently diagnosed. 

The only change in Leading Cause of Death by Age (2016-2020) among Cabarrus County residents was within the 0-19 age category. Congenital anomalies (birth defects) actually switched rankings with Other Unintentional Injuries, going from 2nd to 4th leading cause of death.

2016-2020 NC Resident Race/Ethnicity and Sex-Specific Age-Adjusted Death Rate Disparities 

• African Americans, both males and females, have higher rates of death associated with Disease of the Heart compared to White, non-Hispanic residents and two times higher rate for nephritis/nephrosis (kidney disease) 
• African American females consistently have the highest rates of death caused by Breast Cancer and three times rate for Diabetes
• African American males have two times the rate of Diabetes
• Females, both African American and White, have a much higher rate of Alzheimer’s disease than their male counterparts
• Suicide is highest among white males. All other races, sexes are too small a number to calculate rate

Cabarrus County saw a small drop in life expectancy (0.2 years), a similar decline was seen throughout the region and state. Two counties maintained a consistent life expectancy, Iredell and Union. It will be important for this data to continue to be monitored as it is anticipated to continue to be altered by pandemic impacts.

Morbidity
Morbidity is another term for illness, medical condition or being unhealthy from a disease. Morbidity often times refers to having a disease or a symptom of disease, or the amount of disease within a population.  Public health professionals are able to estimate morbidity among a population by using prevalence or incidence of the disease or illness. Some examples of common morbidities are heart disease, diabetes, and obesity, but morbidities can range from Alzheimer's disease to cancer to traumatic brain injury. When a person has more than one morbidity at a time, it is referred to as co-morbidity. Morbidities are NOT deaths.
Terms:

• Prevalence describes the proportion of the population with a given symptom or quality.
• Incidence shows the frequency at which individuals within a specific population develop a given symptom or quality.

*Items shaded in yellow indicate that Cabarrus County is doing better than or the same as the state of North Carolina, but not has good as Benchmark Counties or Top Performers in the U.S.
*Items shaded in red indicated that Cabarrus County is doing worse than the state of North Carolina and Top Performers

To learn more about the County Health Rankings or to see how other counties across North Carolina are performing, click here.

Oral Health - Increased Dental Decay

CHA’s Community Dental Program is designed to visit each elementary, middle and high school in Cabarrus County and Kannapolis City Schools twice per school year. As the program relaunched this school year, the team has been challenged to achieve this goal because patients are presenting with such higher rates of decay, requiring additional time at each school or the need to refer patients to a pediatric specialist. During the 22-23 School Year, 32% of Kindergarten children were reported to have untreated tooth decay. Oral Health Scorecard

CHA Dental staff are responsible for conducting decay screenings of the NC Pre-Kindergarten classes and the Head Start classes throughout the county. Public Health Hygienists have also done two days of education at preschools for children and caregivers while sending home education information. Staff also made themselves available to patients and families at childcare centers if a child does have a dental concern.

CHA recently hired a dental patient navigator; this position is a bilingual staff who will focus on the highest need patients and helping to close the loop on their dental care needs. Priority will be focused on patients with no insurance, missed appointments, and transportation barriers to their appointment.

Sexually Transmitted Infections and Sexually Transmitted Disease Rates  

According to 2021 Centers for Disease Control preliminary surveillance data, Chlamydia and Gonorrhea cases continue to increase with no signs of slowing. Cabarrus County has also experienced a steady increase in Chlamydia and Gonorrhea   cases since 2017 with the exception of 2020 where the county saw a slight decline in reported cases (due to the COVID-19 pandemic). Populations with highest rates of disease impact or infection are female residents and those who identify as Non-Hispanic Black/African American. Data shows that individuals between 15-29 years of age account for a majority of reported new cases. In 2022, there were more than 1,200 chlamydia and 400 gonorrhea new cases reported among Cabarrus residents. The CHA Epidemiology team is analyzing reinfection cases among priority subgroups and working with public health staff to develop education, engagement and outreach initiatives.

Red line represents Chlamydia cases. Blue line represents Gonorrhea cases.   

Workforce Shortages 

The pandemic caused a major disruption in our day-to-day lives, including our workforce. This impact and continued ripple effect has been referred to by many as The Great Resignation. Many sectors have become increasingly affected by growing workforce shortages over the last several years, and while COVID-19 left its impact, these shortages were already on the rise. According to an article from University of North Carolina - Chapel Hill's School of Government, North Carolina was already projected to face a shortage of around 12,500 nurses by 2033 before the pandemic and is now set to face projected shortages of up to 21,000 nurses in the coming decade due to burnout. Another profession heavily affected by shortages is teachers and school staff. A national survey indicated that nearly half of all teachers considered switching positions or professions. It February 2022, it was reported that 130 teachers left Cabarrus County Schools so far during the 22-23 School Year.  The district reported that many teachers left to teach elsewhere or got out of the profession completely. 

The leisure and hospitality industry, which includes restaurants and hotels, are still missing 7.2 percent of jobs. This reflects 1.2 million jobs statewide that haven’t been filled compared to job numbers before the pandemic, which has led restaurants to close, operate with alternative hours, or work with a smaller staff. Prior to the pandemic, stores and restaurants associated with Concord Mills Mall collectively represented 4,000 jobs in the county. 

Public Health Surveillance Data Dashboards
According to the field of epidemiology, public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data essential to planning, implementation, and evaluation of public health practice. Data monitoring and surveillance has long since been a role of public health, but during COVID-19 the public became much more aware and interested in their ability to monitor population health data. State and local dashboards were created to allow citizens to see the COVID-19 spread in their community, allowing them to consider their own health risk and adopt mitigation strategies that they believe necessary.  Cabarrus Health Alliance has launched three public health surveillance dashboards, with plans for more, all of which are publicly accessible and monitor both health and other social determinants which impact individuals' health and well-being. 
•    Influenza Like Illness
•    Housing
•    American Community Survey Dashboard

Cabarrus County Emergency Rental Assistance
Cabarrus County Government closed the Emergency Rental Assistance Program (ERAP) in late 2022. ERAP was funded through various state and federal COVID-19 relief programs and provided payments on behalf of residents for overdue rent and

utilities (electricity, gas, water and sewer, trash removal and energy costs).  To receive assistance, applicants documented financial needs related to the COVID-19 pandemic. Once approved, funds were sent directly to the vendor. Since March 2021, Cabarrus County has submitted over $13 million in vendor. The County also allocated $3 million in partnership with Cooperative Christian Ministry to help administer the program. The ERAP funds helped 2,158 households as of Dec. 31, 2022. 
 

Cabarrus Recovery and Resilience Coalition
Cabarrus Health Alliance (CHA) convened the Cabarrus Community Coalition for Recovery and Resiliency to discuss issues impacting our community as a result of the COVID-19 pandemic. The coalition met from May – December 2022 to routinely share their lived experience (personally and professionally), review data, and collect feedback from the community. The goal of the coalition was to identify: how the community has been impacted by the pandemic, what the community’s needs are post-pandemic, and how can we prepare our community and leaders now to address future emergencies in an improved manner?

Priority focus groups included adolescents, seniors, first responders and frontline workers, teachers, childcare providers, and Latinx community members. The coalition identified recovery needs and acknowledged constructive feedback from each group to improve responses to future emergencies (regardless of scale, public health, and non-public health incidents).

The coalition highly encourages all Cabarrus County leaders to consider these recommendations as response measures for future emergencies in their own organizations.