NC in Focus: County Health Rankings – Length of Life in North Carolina

The Robert Wood Johnson Foundation (RWJF) releases annual health rankings at the county-level for each state in the nation. These rankings are divided into categories measuring different aspects of community wellness: Length of Life, Quality of Life, Health Behaviors, Clinical Care, and Social and Economic Factors.

Each factor is calculated by one or more markers of wellness – each deserving of a separate blog. This blog will focus on Length of Life in North Carolina counties.

How RWJF Develops the Length of Life County Health Ranking

RWJF assigns a Length of Life ranking to each county based on total “premature deaths,” defined as the total years of potential life lost before age 75 (YPLL) per 100,000 residents. Every death prior to age 75 contributes to the county’s YPLL. For example, a person who dies at age 30 contributes 45 years of life lost to a county’s total years of potential life lost. Statewide, North Carolina’s YPLL was 7,300 per 100,000, nearly on par with the national rate of 7,214.

Premature death rates provide a better indication of local risk factors in a county than measures of overall deaths, as they highlight deaths that could have been preventable. On the other hand, total mortality rates are influenced by the age structure of the region. This measure of premature death thus allows local policymakers and health officials to target higher-risk areas.

County Health Rankings

The top five counties with lowest rates of premature death are:

  • Orange County (4,471)
  • Wake County (4,514)
  • Camden County (5,420)
  • Watauga County (5,492)
  • Union County (5,589)

Of these, three fall within either the Triangle or the Charlotte metropolitan areas (followed by Mecklenburg County at #6 and Durham County at #7). This likely reflects the positive role of higher educational attainment and wide access to healthcare on health outcomes on enhancing length of life. These counties have substantially lower rates of premature death than the state and nation overall.

In fact, Orange and Wake counties fall in the 10th percentile for all US counties (up to 5,300 potential years of life lost). By comparison, the state’s overall YPLL is 7,300 potential years of life lost per 100,000 residents.

Meanwhile, the five counties with the lowest-ranking premature death rates were primarily in the Sandhills:

  • Robeson County (12,129)
  • Swain County (11,550)
  • Bladen County (11,524)
  • Columbus County (11,463)
  • Vance County (11,139)

Across the state, counties in the northeast, Sandhills, and some Western portions of the state were among those with the worst length of life outcomes.

Racial/Ethnic Disparities in Length of Life

Length of life also differs widely across racial/ethnic demographic groups. American Indian and Black residents have much higher premature death rates than the state average and are described by RWJF as being “most similar in health to those living in the least healthy quartile of counties.”

White residents closely match the state’s overall premature death rate, while Asian and Hispanic residents are much lower than the state rate. In fact, the premature death rate for Asian and Hispanic residents is lower than even the top-ranked counties (Orange and Wake), indicating a very low overall presence of preventable death in these communities.

Next week’s series will focus on Quality of Life rankings by county. When assigning a ranking for this measure, the Robert Wood Johnson Foundation considers factors related to citizens’ overall wellbeing, including presence of illness, mental health, physical wellbeing, and infant birthweights. This comprehensive health measure allows policymakers and healthcare professionals to identify areas where citizens frequently report the worst health outcomes, and to develop targeted strategies based on the four sub-measures.


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2017 Population Estimates: Declining Municipalities

From 2010 to 2017, 247 North Carolina municipalities experienced population decline – approximately 45% of all cities, towns, and villages in the state. This represents an increase of 22 municipalities since last year’s population estimates were reported. After accounting for municipalities growing at a stagnant pace – below the state growth rate of 8% – this figure rises to 427 in total. This means that over three-fourths of all places are declining or growing slower than the state average. Growth is increasingly concentrated in a select few regions of the state and population decline is gradually becoming more prevalent.

The 2017 Census population estimates largely follow the same patterns observed last year. Most importantly, North Carolina’s northeast corridor continues to experience the largest population declines. In fact, just two counties from the Northeast housed all ten of the municipalities with the largest percentage decreases since 2010: Bertie and Northampton.

Every municipality on this list has lost a tenth or more of its population in the decade so far.

Among the municipalities with the largest recorded numeric decreases from 2010 to 2017, nine out of ten were also found on this list in the previous year. There is not a clear geographic distribution to this list of municipalities, though several fall within counties located in either the northeast or the Sandhills region of the state.

Municipalities with the largest single-year percentage declines from 2016 to 2017 were predominantly located in Martin, Northampton, and Edgecombe counties – all located in the Northeast. The long history of population decline in this area shows little sign of reversing.

Finally, five of the municipalities with the largest single-year numeric declines (from 2016 to 2017) also had the largest recorded declines since 2010, indicating that these population trends are likely to continue.

Interestingly, two municipalities from Davidson County – Thomasville and Lexington – recorded single-year losses not previously seen in last year’s estimates. Davidson County was just added to the Winston-Salem Metropolitan Statistical Area in 2013, reflecting the “increasing urbanization of bedroom rural counties”, according to the director of data and information services for the Piedmont Triad Council of Governments, Anne Edwards. These two municipalities are of importance to Davidson County, as Lexington is the county seat and Thomasville its largest city.

No predictions can be made yet on whether or not this trend will continue for Lexington and Thomasville, though it may support other patterns of growth witnessed in the 2017 population estimates. Contrary to the 2016 estimates, population growth was more concentrated in larger metropolitan cities (>40K), rather than the rural, exurban communities surrounding these cities. Winston-Salem and Greensboro, in particular, both appeared on the top-10 list of municipalities with the largest single year of growth from 2016 to 2017, though they did not rank in the previous year.

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NC in Focus: Grandparents Living with their Grandchildren

There are currently over 210,000 grandparents living with their own grandchildren (under age 18) in North Carolina, according to the 2012-16 American Community Survey 5-year Estimates. This is approximately 3.5% of the adult population 30 years and older. Of those living with their grandchildren, slightly less than half of grandparents (46%) were primary caregivers, meaning they had financial responsibility for the basic needs of grandchildren in their household. For many individuals, this is a long-term role. Forty-three percent of grandparents with caregiver responsibilities in NC had been providing support for five years or more, and over 80% had been responsible for their grandchild or grandchildren for at least one year.

There is a nearly even split among grandparents living with their grandchildren by employment status: 49.6% are currently working and 50.4% are not in the labor force. A majority of grandparents currently working also had caregiver responsibilities (54%), while just 39% of those out of the labor force were financially responsible for their grandchildren.

Overall, there are over 175,000 grandchildren currently living with their grandparents; 58% of them were being taken care of by their grandparents. In the majority of cases (62%), there was a parent present in the household, as well.

Across counties, the percentage of grandparents living with their grandchildren ranges from under 2% to over 7%. Counties with the largest shares of grandparents living with their grandchildren tended to cluster in the Sandhills and northeastern regions of the state. The top five counties were:

  • Anson County: 7.2%
  • Scotland County: 6.9%
  • Robeson County: 6.4%
  • Halifax County: 6.1%
  • Perquimans County: 5.9%

Meanwhile, many of the counties with the smallest shares of grandparents living with their grandchildren were located in the western and north-central portions of the state. These included:

  • Mitchell County: 1.8%
  • Orange County: 1.9%
  • Polk County: 2%
  • Yancey County: 2.1%
  • Chatham County: 2.2%

In 46 counties, half or more of the grandparents living with their grandchildren acted as caregivers. Nearly everywhere, the majority of them were grandmothers, except in three counties:

  • Pender County: 54% of caregivers were grandfathers
  • Davie County: 52%
  • Camden County: 51%

Additionally, in nearly three-fourths of counties, grandparents who lived with their grandchildren and were in the labor force were also providing financial support.

For a deeper dive, explore this interactive county map below.
Note: Some percentages may not sum to 100 due to rounding errors.

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Population Growth May Be More Concentrated than Last Year’s Estimates Suggested

Population estimates from July 1, 2016 to July 1, 2017 indicate that growth may be more concentrated around urban centers than suggested by last year’s estimates.

Many of the top 10 fastest-growing municipalities from 2015-2016 were exurbs – largely rural areas located a greater distance from a metro center. They were thought to be possibly absorbing suburban overflow. The majority of these municipalities had previously seen slim annual population growth from 2010-2015, and eight out of ten were located less than 20 miles from a large metropolitan area. These included:

  • #1: Stem in Granville County (20% growth from 2015-2016)
  • #2: Simpson in Pitt County (12%)
  • #4: Swepsonville in Alamance County (11%)
  • #10: Fletcher in Henderson County (7%)

However, this year’s estimates do not display this pattern of growth. Only Rolesville, Wendell, and Fuquay-Varina were among the top 10 fastest-growing municipalities in 2016 and in 2017; these are all immediate suburbs of Raleigh. While eight unique counties were represented in the top 10 list last year, only five are represented this year.

In total, six of the 2016-2017 fastest-growing municipalities were located in Wake County alone: Rolesville, Wendell, Fuquay-Varina, Knightdale, Morrisville, and Apex. Clayton in Johnston County represents a seventh municipality from the Triangle metro region. Meanwhile, Jamestown (Guilford) and Mebane (Alamance) fall within the Triad metro area, and Waxhaw (Union) within the Charlotte-Concord metros.

By comparison, the state only grew by 1.1% from 2016 to 2017. Major cities such as Charlotte, Raleigh, and Winston-Salem also grew by just 1-2% last year. Even the slowest-growing municipality on this top 10 list exceeded these cities’ and the state’s growth rate by more than double.

Meanwhile, the list of municipalities with the largest single-year numeric growth is comprised entirely of North Carolina’s larger municipalities – all ten of them rank among the largest cities within their respective metropolitan statistical areas.   This also distinguishes the 2017 population estimates from the 2016 estimates.

Last year, some of the municipalities with the largest numeric growth were smaller metro suburbs, such as Fuquay-Varina in Wake County or Huntersville in Mecklenburg County. The top 10 list this year features a larger assortment of municipalities with populations over 100K – seven in 2017 compared to five in 2016. This includes Winston-Salem and Greensboro, which did not rank in the top 10 in the previous year’s estimate.

Another point of interest is Apex in Wake County, which was found on both lists this year. This means that it recorded some of the largest and fastest single-year growth in the state, after failing to make either single-year list in the previous year.

Though future estimates may slightly differ from these trends, the fact remains that North Carolina’s metro areas drive the large majority of population growth in the state.

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NC’s Metropolitan Areas Central to Growth Since 2010

Topline data from the Census Bureau’s recently released 2017 municipal population estimates  shows little change from previous years’ estimates. Municipalities located near major metropolitan areas continue to grow, while North Carolina’s rural communities continue to experience population decline.

255 NC municipalities, or 46%, have experienced either population decline or zero-percent growth since 2010. Adding municipalities with stagnant growth – i.e. those that grew slower than the state growth rate of 8% – this totals over three in four municipalities in the state (77%). Just 125 municipalities are growing on par or faster than the state since 2010, many of which are located around the Charlotte, Triangle, and Wilmington metropolitan areas.

The ten municipalities with the largest percentage growth from 2010 to 2017 were ranked in the top ten in 2016, as well. More than half—6 out of 10—are in Wake County. The remaining are represented by Brunswick County (St. James and Leland), Onslow County (Holly Ridge), or Union County (Waxhaw). St. James, Leland, and Holly Ridge are located in the southeastern portion of the state – notable for its high appeal to retirees and rapid growth in this decade – while Waxhaw falls within the Charlotte metro area.

All municipalities in this list have increased by over a third or more of their 2010 population. Rolesville (Wake County), the fastest-growing municipality in the state, has officially doubled its population in less than a decade, growing by 3,853 residents or 103% since 2010. Nonetheless, the majority of these fastest-growing municipalities appear to have hit their growth peak in this decade; just three municipalities experienced their single-largest year of numeric growth in 2017 – Knightdale, Morrisville, and Leland.

The top 10 municipalities with the greatest numeric growth since 2010 also experienced no change since last year’s estimates. This list is comprised entirely of principal cities in North Carolina’s major metros, or their neighboring suburbs with populations of 40,000 inhabitants or more.  The combined numeric growth of these ten municipalities accounted for nearly half of the total state population growth (47%) from July 1, 2010 to July 1, 2017.

2017 was also a banner year for several of these municipalities with the largest numeric growth over the decade. From July 1, 2016 to July 1, 2017, Wilmington (New Hanover), Concord (Cabarrus), and Apex (Wake) experienced their single-largest year of growth. This suggests a continuing pattern of growth around metro suburbs, and a shift towards southeastern North Carolina.

Errata Note: A previous version of this blog incorrectly listed the entry for “Apex” as “Winston-Salem”, and vice versa, in the second table (Largest Numeric Growth). All data is correct in both tables, and the two entries have been corrected.

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