Tuesday, 26 March 2019 07:42

Nursing Pays In South Dakota

A great deal of concern has been voiced recently regarding wages for registered nurses (RNs) in South Dakota. A recent article argued that South Dakota’s RNs are drastically underpaid relative to the nation as a whole. The article pointed out that average annual wages for an RN in South Dakota were $57,010 in 2017; compared to $57,930 in Iowa and $62,210 in Nebraska, for example.

So why do RNs earn less in South Dakota? A full explanation might be too much, but a couple simple factors like taxes and the overall cost of living can explain much of the disparity.

Let’s start with taxes. The article points out that nationally, the highest average pay for an RN was found in California, $102,700 per year in 2017. An RN in California earning $102,700 would pay an estimated $6,591 in state income taxes, 9.3% of their annual income. They would also have to pay sales and use tax rates between 7.25% and 10.25%, depending on location. In contrast, an RN in South Dakota pays no state income tax and faces a state and local sales tax rate between 4.5% and 6.5%.

The second point of consideration is the general cost of living. Housing in South Dakota, though not necessarily in Rapid City, is generally less expensive than in many parts of the country. Food, transportation, and health care also tend to be less expensive in South Dakota than they are in other states. As a result of these regionally price disparities, a dollar goes farther in South Dakota than in many other areas of the country.

So how do RN wages stack up once we look at the actual purchasing power of RN wages by taking taxes and the cost of living into account? South Dakota jumps from 51st in the nation to 34th in the nation for RN pay. In fact, the purchasing power of the average RN wage is South Dakota ($53,005) was actually higher than the purchasing power of average RN wages in both Nebraska ($52,629) and Iowa ($49,531).

The same pattern shows up when looking at states with even higher average wages for RNs. In California, the purchasing power of the estimated $102,700 in RN wages drops to $63,269. That means that the original $45,690 disparity in wages between RNs in California and South Dakota drops to only $10,264 after taking taxes and the costs of living into account.

And RNs in Minnesota take a big hit as well once we look at purchasing power rather than just average wages. The average annual wage for an RN in Minnesota during 2017 was $77,540 but the purchasing power of that wage was only $58,528. The result, a $20,530 disparity in wages between RNs in Minnesota and South Dakota drops to only $5,523 after taking taxes and the costs of living into account.

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From 2008 to 2015, the percentage of American Indian adults without health insurance increased significantly, according to a recent report by Georgetown University. During the same time, the number of American Indian children without health insurance declined. The report focused on states with American Indian and Alaska Native (AI/AN) populations that comprised at least eight percent of the state’s total population.

The rate of uninsured American Indian children in South Dakota dropped from 28 percent to 16 percent from 2008 to 2015. However, during the same time period, the number of uninsured American Indian adults increased by 17 percent—from 40 percent in 2008, to 57 percent in 2015. This increase places the Rushmore State at odds with the national trend, which posted an 8.0 percent decline in the uninsured rate of AI/AN adults from 2008 to 2015.

Regionally, North Dakota and Montana also experienced declines in the rate of uninsured AI/AN children from 2008-2015. The rate of uninsured AI/AN children in both states declined by 12 percent—from 37 percent to 25 percent in North Dakota, and 36 percent to 24 percent in Montana. Of the states examined, New Mexico experienced the largest decline of uninsured AI/AN children—dropping from 38 percent in 2008 to just 11 percent in 2015. California—which already had a very low population of uninsured AI/AN children—dropped from 12 percent to 10 percent over the same time period.

Although American Indians and Alaska Natives have access to healthcare through the Indian Health Service (IHS), the U.S. Census Bureau considers those that have access to IHS, but not private health insurance coverage to be uninsured. IHS is not considered to be health insurance coverage because it is a health care delivery system operated by either the federal government or federally-recognized Indian Tribes.

Conversely, Medicaid is a jointly funded health insurance program operated in all 50 states and the District of Columbia. States and the federal government share the cost of health and long-term care services for children and families. Medicaid also covers services offered through IHS to eligible AI/AN beneficiaries.

For more information on health insurance coverage in South Dakota, visit the South Dakota Dashboard’s health insurance data hub

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More people were without health insurance in South Dakota in 2015 than in 2014, according to U.S. Census data released in September. The new data places South Dakota at odds with the national trend, which shows lower rates of uninsured individuals from 2014-2015. Overall, 12.0 percent of South Dakotans were uninsured in 2015 compared to 10.9 percent across the United States. South Dakota ranked 34th nationally.

Regionally, South Dakota finished ahead of Wyoming (13.4 percent uninsured) and Montana (14.0 percent uninsured). Minnesota, North Dakota and Nebraska all finished ahead of South Dakota with uninsured populations of 5.2, 8.9, and 9.5 percent, respectively.

Sioux City was the only metropolitan area in South Dakota that saw an increase in coverage from 2014-2015. With a 3.7 percent rise, Sioux City is now ranked number one for health insurance coverage out of the state’s metro areas, eclipsing Sioux Falls and Rapid City for the first time in recent history. In Sioux Falls, the share of people without insurance increased from 7.3 percent in 2014 to 8.7 percent in 2015 while Rapid City’s rate climbed from 13.2 percent in 2014 to 15.1 percent in 2015.

South Dakotans aged 35-44 saw the largest increase in the percentage of uninsured, jumping up to 15.0 percent in 2015 from 13.0 percent in 2014. The share of residents who were uninsured in the 25-34 year category also rose in 2015 to 19.7 percent, compared to 18.9 percent in 2014. However, 18-24 year olds actually improved their rate of health insurance coverage by 1.6 percent from 2014 to 2015. Forty-five to fifty-four year olds also saw a slight 1.0 percent decrease in the share of uninsured.

The number of individuals under 65 years old and living below the Federal Poverty Level (FPL) who did not have health insurance increased slightly in 2015 to 26.5 percent from 26.1 percent in 2014. A larger increase was seen among individuals living above the FPL— up to 9.7 percent from 9.0 percent in 2015, but both of these changes were well within the margin of error.

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A survey of mental health and substance abuse across South Dakota provides previously unavailable data to healthcare providers and policymakers, reports the Helmsley Charitable Trust.

The survey, conducted in 2013 with more than 8,000 South Dakotans, produced the report Focus on South Dakota: A Picture of Health released in 2015. The survey identified areas in the state with higher prevalences of mental and behavioral health needs that also had low access to this type of care. 

"The South Dakota health survey provides unpecedented statewide survey data on regional patterns of behavioral health prevalence and access to care," reads the report's executive summary. "The findings are intended to help local stakeholders plan and implement health service interventions that meet the needs of South Dakota communities." 


Primary Care Access in SD chart Helmsley trust


The survey broke results down by geographic type -- urban, rural, isolated and reservation. While residents who lived on or near Indian reservations reported higher rates of depression, anxiety and post-traumatic stress disorder than any of the other categories, they also reported less access to healthcare. 

Screened Positive for Current Mental Health Symptoms

Depression 5.6%   6.3% 4.3% 5.5%  8.2%
Anxiety  7.4%   7.8% 7.7% 5.6% 10.3% 
 PTSD 6%  6.4%  4.8% 5.9% 10.3% 






Access to Care

  Statewide  Urban  Rural  Isolated Reservation
  Have Primary Care Provider 77.4%  78.6%   81.6% 74.2% 48.3%
  All Needed Medical Care Received   87% 87.8%  88.8%  86.7% 65.8%
  All Needed Mental Health Care Received 64.2%  68%  62.6%  62.3% 39.1%
  All Needed Substancer Use Care Received 54.4% 56.7% 64.1% 32.7% 37.5%







This is the first in a series of posts detailing the findings of the Focus on the South Dakota: A Picture of Health survey, conducted by the Helmsley Charitable Trust in partnership with Oregon Health and Science University



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For seven years, South Dakota had breast cancer incidence rates below or at the national average until 2011, when the rate shot up from well below the national rate to well above. By 2012, the Rushmore state had the highest rate in the country, according to data presented by the South Dakota Health Department May 19 at the South Dakota Demography Conference in Sioux Falls. 

"Our rates began to increase starting in 2011 to where we have the highest rate in country. We don't know why," state epidemiologist Lon Kightlinger told conference attendees.

In 2012, South Dakota had 141.4 female breast cancer cases per 100,000 in population, according to the federal Centers for Disease Control. That's ahead of No. 2 Hawaii (139.8) and No. 3 Washington (137.2). Neighboring Wyoming tied with Arizona for the lowest incidence in 2012, 107.2 per 100,000 population. 

In 2012, South Dakota had 672 total female breast cancer cases, up from 629 in 2011 and 530 in 2010. The number climbed again in 2013 to 715 total cases, for an incidence rate of 146 per 100,000 in population. 

At the same time, South Dakota's breast cancer death rate in 2012 remained low, according to the CDC. With 19.1 deaths per 100,000 population, South Dakota was among the third of states with the lowest rates, although the state had the highest rate in that group. 

Read more about Health on the South Dakota Dashboard


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Wednesday, 25 May 2016 00:00

SD Worst In Nation For West Nile

South Dakota leads the nation for cases of West Nile disease, and Brown County leads the state for the mosquito-borne illness, a top state health official told attendees of the South Dakota Demography Conference on May 19 in Sioux Falls. 

"When it comes to West Nile, South Dakota is No. 1 in the country," said Lon Kightlinger, the state epidemiologist. "Every county in South Dakota has had human cases of West Nile, multiple cases."

Between 1999 and 2014, South Dakota had 2,168 cases of West Nile disease reported to the federal Centers for Disease Control. 

The Rushmore state also leads the nation for the neuroinvasive form of West Nile, which means the disease gets into the brain as encephalitis or menengitis. This dangerous form of West Nile occurs in about one out of every 150 cases. 


West Nile neuroinvasive slide SD Dept of Health

Between 1999 and 2014, South Dakota had 55 cases per 100,000 people of neuroinvasive West Nile disease, compared to 44.6 cases per 100,000 people in No. 2 North Dakota and zero cases in Alaska and Hawaii. The national rate was 5.5 cases per 100,000 people. 

In 2015, South Dakota had more than 1 case per 100,000 people of neuroinvasive West Nile disease, one of five states with that high rate, while four states had no cases. 

Inside the state's borders, Brown County in northeastern South Dakota claims the most West Nile cases -- 267 between 2002 and 2014. Pennington County in the Black Hills is No. 2 with 190 cases, and Minnehaha County in southeast South Dakota is No. 3 with 127 cases. Deuel County claims the lowest number of cases with 6. 


West Nile by counties SD Dept of Health

When measured per capita, Sanborn County in eastern South Dakota leads with 81.7 cases per 100,000 population during that time. Brown County comes in 7th with 55.3 cases per 100,000 people, while Pennington County ranks 56th with 14.5 cases per 100,000 people and Minnehaha County ranks lowest with fewer than 6 cases per 100,000 people. 


West Nile incidence by counties SD Dept of Health

See Dr. Kightlinger's full PowerPoint presentation attached to this post. Slides 26-33 focus on West Nile. 

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South Dakota's obesity rate hovered around the 30 percent mark for six years, marking at least a pause and perhaps an end to the steady rise since the 1990s, according to federal data

In 2014, the most recent year for which data is available, the state's obesity rate for adults weighed in at 29.8 percent, more than double 1995's 13.9 percent and only marginally lower than the all-time high of 30.3 percent hit in 2009. Nearly every year since at least the mid-1990s, the Rushmore State's obesity rate ticked up until 2010, when it dropped to 27.7 percent. Each year since, the rate has been between 27.7 percent and 30 percent. 

The trend appears to have held steady even when researchers tweaked their methodology starting in 2011. (An individual is considered to be obese if he or she has a Body Mass Index of 30 or greater.) 

In recent years, South Dakota has been on par with national obesity rates, ranking 28th among the 50 states and in the middle of the pack regionally in 2014. 

  • Montana (9th) -- 26.4 percent
  • Minnesota (15th) -- 27.6 percent
  • Wyoming (24th) -- 29.5 percent
  • South Dakota (28th) -- 29.8 percent
  • Nebraska (30th) -- 30.2 percent
  • Iowa (35th) -- 30.9 percent
  • North Dakota (42nd) -- 32.2 percent

The least obese state was Colorado, 21.3 percent, while the most obese was Arkansas, 35.9 percent. The national rate was 29.6 percent. 

South Dakotans who are older, poorer and male are more likely to be obese than their counterparts. Since at least 2004, more men than women have been obese in South Dakota. In 2014, 31.5 percent of men and 28.1 percent of women were obese in the state. 

In 2014, South Dakotans earning between $15,000 and $24,999 had the highest rate, 34.6 percent, followed by those earning less than $15,000 (32.5 percent), those earning more than $50,000 (31.4 percent), those earning between $25,000 and $34,999 (30.3 percent) and those earning between $35,000 and $49,999 (30 percent). 

Young adults had obesity rates nearly half that of the state average, while those in late middle age had the highest rate in 2014. South Dakotans ages 18-24 had a rate of 15.8 percent, followed by those 64 and over (26.7 percent), then those ages 25-34 (29.6 percent), then those ages 45-54 (33.4 percent), then those ages 35-44 (34.2 percent) and then those ages 55-64 (37.7 percent). 


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Registration is now open for the Fourth Annual South Dakota State Demography Conference. Hosted by the SDSU Rural Life and Census Data Center, this year’s event will focus on heath and population data in South Dakota. The conference, scheduled for May 19 (8 am-5 pm) and 20 (8 am-noon), will be held at the University Center in Sioux Falls.

The $45 registration fee includes breakfast, lunch and snacks. Topics to be discussed include:

  • Findings from the 2014 State Health Survey
  • Health disparities by age, gender, race and class
  • Heath data issues for American Indian communities
  • Methodology and geography for health statistics
  • Demographic trends in South Dakota
  • Access and use of available data tools and resources

A webinar, “Helping South Dakota Businesses Thrive: Introducing Census Business Builder” hosted by Andrew Hait  of the U.S. Census Bureau, will be offered to all attendants.

Presenters include Kimberly Davis of the U.S. Census Bureau, South Dakota State Epidemiologist Lon Kightlinger, South Dakota State Demographer Weiwei Zhang, Mary Killsahundred of the SDSU State Data Center, Patricia Da Rosa of SDSU, Carole Cochran of KIDS Count, Heide Schultz of the Helmsley Charitable Trust, Preston Renshaw and Daniel Steinwand of Avera Health, Jessica Hanson, Wyatt Pickner and Susan Puumala of Sanford Health, and Callie Tysdal, Denise Ross and Eric John Abrahamson of the Black Hills Knowledge Network/South Dakota Dashboard. 

You can register online

For more information contact Joni Mueller at [email protected].

To explore presentations and findings from the 2015 South Dakota Demography Conference, which focused on economic trends, see the 2015 South Dakota Demography Conference resource guide on the South Dakota Dashboard.


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Wednesday, 16 March 2016 00:00

County Health Rankings Updated

A measurement of wide-ranging health indicators on a county-by-county basis has been updated and posted online.

The County Health Rankings & Roadmaps program is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The annual County Health Rankings measure vital health factors, including high school graduation rates, obesity, smoking, unemployment, access to healthy foods, the quality of air and water, income, and teen births in nearly every county in America.

The South Dakota Dashboard provides links to key parts of the 2016 report. Read the eight-page summary for South Dakota online.

The health rankings focus primarily on two measures, Health Outcomes (how long people live and how healthy people feel) and Health Factors (behaviors, clinical care, social and economic, and physical environment). Below, see the top five and bottom five South Dakota counties, of the counties that were measured. A handful of counties were not measured due to unreliable data. 

Health Outcomes: Top Five South Dakota Counties 
Health Outcomes: Bottom Five South Dakota Counties 
Health Factors: Top Five South Dakota Counties
Health Factors: Bottom Five South Dakota Counties



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South Dakotans with disabilities are more likely to be older and in poverty than their counterparts without disabilities, according to federal data

Those over age 65 had a disability rate of 34.5 percent percent in 2014 compared to a rate of 10.3 percent for those ages 18-64. Those over age 85, 62.3 percent reported a disability in 2013, the most current year for which data is available. Children ages 5 to 17 had a disability rate of 4.1 percent in 2014, compared to a rate of 1.2 percent for those age 4 and younger. 

A disability is defined as serious difficulty in these areas of functioning: vision, hearing, ambulation, cognition and ability to care for oneself independently. In some subsets, this data was compiled and averaged for the years 2010-2014. 

21.9 percent of South Dakotans with disabilities lived in poverty in 2014, compared to the state's overall poverty rate of 14.2 percent. South Dakota's overall disability rate in 2014 was 12.1 percent, and its poverty rate for those with no disabilities is 13.1 percent.

Race also correlates to disability, with Native Americans and whites posting the highest disability rates while Asians and Blacks posted the lowest. The disability rates for American Indians, averaged for 2010-2014, was 13.5 percent and for whites, 12.2 percent. For Asians, it was 4.7 percent and for Blacks, 5.6 percent. Hispanics held the middle ground with a rate of 8.1 percent. 

Geographical Comparisons

South Dakota's overall disability rate in 2008 was measurably below the national rate, 10.7 percent vs. 12.1 percent. The state's rate rose steadily in subsequent years and is now nearly the same as the national rate, 12.1 percent vs. 12.6 percent.

At 12.1 percent in 2014, South Dakota ranks 20th among the 50 states for overall disability rate, compared to No. 1 Utah, at 9.6 percent, and No. 50 West Virginia, at 19.9 percent. Regarding the disability rate for those age 65 and older, South Dakota ranks 17th at 34.5 percent, compared to No. 1 Delaware at 30.4 percent and No. 50 Mississippi at 44.5 percent. 

Among South Dakota's 66 counties, Lincoln County posted the lowest disability rate at 6.2 percent for 2010-2014 compared to Fall River County with the highest rate of 21.1 percent. Among the 27 cities with populations of more than 2,500, Tea posted the lowest rate of 2.6 percent for the five-year period compared to Hot Springs with the highest rate of 21.4 percent. 

In general, cities in southeastern corner of South Dakota near Sioux Falls posted the state's lowest disability rates. With a rate of 14.1 percent for 2010-2014, the Black Hills region had a higher disability rate than did the state as a whole, at 12 percent. 

Disabilty rates varied widely among the state's nine Indian reservations, with the Rosebud reservation recording the highest rate of 17.4 percent. Here's a look rates on at all of the reservations:

  • Lower Brule -- 7.1%
  • Cheyenne River -- 11.4%
  • Standing Rock -- 11.6%
  • Pine Ridge -- 11.9%
  • Lake Traverse (Sisseton) -- 12.4%
  • Flandreau -- 12.9%
  • Yankton -- 13.8%
  • Crow Creek -- 17.2%
  • Rosebud -- 17.4%

South Dakotans living in a metropolitan or micropolitan area from 2010-2014 were less likely to have a disability than were those living in non-metropolitan areas. Disability rates were 11 percent for metropolitan areas, 12 percent for micropolitan areas and 14 percent for non-metropolitan areas, although rates among the micropolitan areas varied. Here's a look at the metropolitan and micropolitan areas:  

  • Sioux Falls metro -- 9.5%
  • Vermillion micro -- 9.5%
  • Aberdeen micro -- 9.8%
  • Brookings micro -- 9.9%
  • Pierre micro -- 10.2%
  • Yankton micro -- 13.2%
  • Rapid City metro -- 13.7%
  • Huron micro -- 13.7%
  • Watertown micro -- 13.7%
  • Mitchell micro -- 14.5%
  • Spearfish micro -- 14.8%
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