Measuring Our Health The Health Status Report of County 2008
Table of Contents Page Page Introduction & Methodology Data Sources 1 Crude and Age Adjusted Rates 2 Reliability of Rates 3 Healthy People 2010 3 County Demographics 4 Executive Summary 5 Chronic Disease Coronary Heart Disease 13 Cerebrovascular Disease (Stroke) 14 Diabetes 15 Asthma 16 All Cancers 17 Lung Cancer 18 Female Breast Cancer 19 Prostate Cancer 20 Colorectal Cancer 21 Melanoma (Skin Cancer) 22 Infectious Disease HIV/AIDS 23 Chlamydia 24 Hepatitis B 25 Hepatitis C 26 Tuberculosis 27 Unintentional Injuries Mothers and Infants Infant Mortality 40 Prenatal Care 41 Low Birthweight 42 Births to Adolescents 43 Children and Adolescents Immunization Coverage 44 School Achievement 45 Children in Poverty 46 Children with Health Insurance 47 Senior Citizen Health Senior Citizen Health Issues 48 Alzheimer s Disease 49 Economy Income 50 Unemployment 51 Poverty 52 Other Health Indicators Access to Care 53 Air Quality 54 Water Quality 55 Unintentional Injuries 28 Motor Vehicle Crashes 29 Violent and Abusive Behavior Child Abuse and Neglect 30 Domestic Violence 31 Suicide 32 Homicide 33 Drug Abuse 34 Firearm Related Deaths 35 Health and Social Behaviors Physical Activity 36 Adult Obesity 37 Childhood Obesity 38 Smoking 39
2008 Health Status Report Introduction and Methodology The field of public health in the United States has seen many changes in the past 100 years. For example, the leading causes of death in 1900 were infectious diseases like pneumonia, influenza, and tuberculosis, and life expectancy was 49.2 years. Due to improvements in sanitation brought about by public health policies, as well as the development of numerous vaccines, by 2000 the leading causes of death had changed from infectious diseases to chronic diseases such as cancer, heart disease and diabetes. Furthermore, life expectancy at birth has increased to 76.9 years. As time has passed, the definition of health changed. In the first half of the 20 th century, health was defined as the absence of illness or death. In 1948, the World Health Organization (WHO) defined health as a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity. Because WHO s definition of health is fairly broad, there is no single standard measure of health status for individuals or population groups. Individual health status may be measured by an observer (e.g., a physician), who performs an examination and rates the individual along any of several dimensions. The health of an entire population is determined by aggregating data collected on individuals and by measuring certain environmental factors, such as air and water quality, that affect the entire population. Since 1997, the County Public Health Department has collected data on the health status of the community and published the results in the County Health Status Report. In order to obtain a balanced look at the health of the community, the Health Status Report contains data on traditional health indicators such as mortality and morbidity rates, as well as broader health indicators such as educational attainment, employment and behavioral issues. The data that are reported for each indicator are the most recent that are available. Health status indicators can serve as a reference for health and human services agencies and other organizations in assessing the impact of programs, services, systems and policy changes on the health and well being of individuals and communities. In determining which health indicators to include in this report, the following criteria were generally used to assess the utility of each indicator: Data Sources The indicator is quantifiable It can be uniformly defined and has the same meaning across programs Local data on the indicator are available The indicator definitions are consistent with documented authoritative standards where possible The information is relevant and informative to public health policy makers There are significant costs associated with a negative outcome The condition impacts a large number of individuals or is severe The data included in the Health Status Report come from a variety of sources. Most of the data on mortality are provided by the State of Department of Public Health. Other data sources include the Department of Finance, U.S. 1
2008 Health Status Report Census Bureau, Office of Statewide Health Planning and Development, National Cancer Institute, Cancer Registry, Child Welfare Research Center, Both crude rates and age adjusted rates are used to define data in this report. A Department of Justice, Center for Public Health Advocacy, Department of Education, Community Foundation, Employment Development Department, National Association of Clean Air Agencies, and Irrigation District. A significant amount of the data on behavior was provided by results from the Health Interview Survey (CHIS). CHIS is a telephone survey of health and social behaviors that is conducted every two years in every county by the UCLA Center for Health Policy Research. Crude Rates and Age Adjusted Rates Both crude rates and age adjusted rates are used to define data in this report. A crude rate is obtained by dividing the total number of vital events, (e.g. deaths) by the total population at risk, then multiplying by some convenient basis (e.g. 100,000). Subpopulations (such as counties) with varying age compositions can have highly disparate death rates, since the risk of dying is primarily a function of age. Therefore, counties with a large component of elderly individuals tend to have a high death rate simply because the risk of dying is determined mostly by age. Any unwanted effect of different age compositions among counties can be removed from the county death rates by the process of age adjustment. By removing the effect of different age compositions, counties with age adjusted rates are more directly comparable with other areas and the Healthy People 2010 National Objectives. Age adjusted death rates are hypothetical rates obtained by calculating age specific rates for each county and multiplying these rates by proportions of the same age categories in a standard population, then summing the apportioned specific rates to a county total. The standard population used in the age adjusted county death rates in this report is the 2000 United States Standard Million Population. Age adjusted rates put all counties on the same footing with respect to the effect of age and permit direct comparisons among counties. It is important to understand that age adjusted death rates should be viewed as constructs or index numbers rather than as actual measures of the risk of mortality. Crude death rates, which are not adjusted by the age of the population, are the rates that should be applied when measuring the actual risk of dying in a specific population. Data for morbidity tables were not age adjusted due to the unavailability of data by age. Hence, only crude rates can be calculated for morbidity. Although age and aging do impact morbidity, the effect is not as prominent as its impact on mortality. However, morbidity is confounded by access to primary care. Populations lacking preventive services may have lower or higher rates of reported disease thereby masking real differences in incidence. In order to determine how County s health status compares to the state, other localities and the nation, whenever possible, County data are compared with data from surrounding counties (,,, and/or Yolo), the State of and the Healthy People 2010 objectives. 2
2008 Health Status Report Reliability of Rates All vital statistic rates, including both mortality (death) and morbidity (disease) rates, are subject to random variation. This variation is inversely related to the number of events (e.g. deaths) used to calculate the rate. The smaller the frequency of occurrence of an event, the greater the likelihood of random fluctuations within a specific time period. The more rare an event, the relatively less stable is its occurrence from observation to observation. As a consequence, counties with only a few deaths, or a few cases of morbidity, can have highly unstable rates from year to year. The observation and enumeration of rare events is beset with uncertainty. This report reduces some year to year fluctuation in the occurrence of rare events by basing some rates on three or five year average number of vital events (i.e. 2003 2005), divided by the population in the middle year (e.g. 2004) or the average of the three or five year population. The standard error of a death rate and coefficient of variation (or relative standard error) provide a rational basis for determining which rates may be considered unreliable. Although reliability of a rate is not either or/on off, in this report, data with a relative standard error of greater than or equal to 23% of the rate or percent are marked with an asterisk (*). This criterion conforms to the standard used by the National Center for Health Statistics in determining the reliability cut off for rates and percents. While data that are statistically unreliable must be used with caution, they may still be used with some degree of confidence when looking at trends and relative comparisons over time. Healthy People 2010 In January 2000, the Federal Department of Health and Human Services launched Healthy People 2010, a comprehensive, nationwide health promotion and disease prevention agenda. Healthy People 2010 contains 467 objectives designed to serve as a road map for improving the health of all people in the United States during the first decade of the 21 st century. Healthy People 2010 builds on similar initiatives pursued over the past two decades. Two overarching goals increasing quality and years of healthy life, and eliminating health disparities served as a guide for developing objectives that will actually measure progress. The objectives are organized in 28 focus areas, each representing an important public health area. Each objective has a target for improvements to be achieved by the year 2010. For the indicators that are listed in this Health Status Report that have a Healthy People 2010 objective, the County s data are compared with the objective so that readers can see how County is doing with respect to the national objective. For more information on Healthy People 2010, visit the website at www.health.gov/healthypeople/. 3
2008 Health Status Report County Demographics The following demographic information on County is based on estimates as of January 1, 2004 provided by the Department of Public Health. Category Number Percent of Total Population Total Population 171,207 100% Population 65 years 21,743 12.7% and older Population ages 18 108,032 63.1% through 64 Population ages 5 32,700 19.1% through 17 Population under 5 8,732 5.1% years old Total Males 85,261 49.8% Total Females 85,946 50.2% Race: * White 143,300 83.7% Hispanic 17,634 10.3% African American 1,027 0.6% American Indian and 2,226 1.3% Alaska Native Asian and Pacific 4,623 2.7% Islanders 2 or More Races 3,253 1.9% Births 1,897 Deaths 1,235 Total population 13,183 7.7% below poverty level Population under age 18 below poverty level 15,409 9.0% * Numbers and percentages regarding race do not match the total population numbers and percentages because of individuals who report more than one race. Source: Health Data Summaries for Counties 2006, Department of Public Health 4
2008 Health Status Report Executive Summary Overall, the health status of County is good. When compared to other counties, routinely ranks in the top third for key population health indicators. Generally, County s measurements for chronic disease and infectious disease are better than the State and most other counties. Our homicide death rates are low and our air quality is excellent. Senior citizens indicate they are in good health and economic indicators are comparatively good. Children and adolescents in the County measure well in indicators related to school achievement, children in poverty, childhood obesity, and children without health insurance. Although the County generally measures well, like most communities, we face some challenges. Our death rates for melanoma (skin cancer) and prostate cancer are high, as are our death rates for unintentional injuries and motor vehicle crashes. Our low immunization rates and prenatal care visits are also an area of concern. Perhaps the biggest areas of concern for the County are related to violence and abusive behavior. Our measurements for child abuse and neglect, domestic violence, suicide, drug abuse, and firearm related deaths are poor and worsening. In the table below, each of the health indicators in the 2008 Health Status Report is ranked as to whether it is good, average, or poor. The ranking is based on how El Dorado County compares to the State and other counties and whether we have improved or worsened in recent periods. Areas Where We Do Better At or Near Average Areas Where We Do Worse Coronary Heart Disease All Cancers Melanoma (Skin Cancer) Cerebrovascular Disease (Stroke) Lung Cancer Prostate Cancer Diabetes Female Breast Cancer Immunization Coverage HIV/AIDS Colorectal Cancer Prenatal Care Chlamydia Asthma Child Abuse and Neglect Tuberculosis Hepatitis B Domestic Violence Homicide Hepatitis C Suicide Childhood Obesity Alzheimer s Disease Firearm Related Deaths Infant Mortality Low Birthweight Unintentional Injuries Births to Adolescents Drug Abuse Motor Vehicle Crashes School Achievement Smoking Adult Obesity Children in Poverty Physical Activity Children with Health Insurance Access to Care Senior Health Issues Water Quality Income Unemployment Poverty Air Quality Following is a summary of each health indicator that appears in the report. Chronic Disease: Coronary Heart Disease: In 2003 2005, County ranked 16 th best among s 58 counties in coronary heart disease death rate. The County s age adjusted death rate was better than that of the State, the Healthy People 2010 objective, and nearby counties of,, and. Recent trends show a decline in the County s death rate. 5
2008 Health Status Report Cerebrovascular Disease (Stroke): In 2003 2005, County ranked 11 th best among s 58 counties in cerebrovascular disease death rate. The County s death rate was below that of the State, the Health People 2010 objective and the nearby counties of,, and. In recent years, the County s rate has consistently remained below the State s rate. Diabetes: In 2003 2005, County ranked 5 th best among s 58 counties in deaths due to diabetes and had a lower death rate than the State and the nearby counties of,, and. The County death rate has been consistently below the State s rate during recent reporting periods. Asthma: According to the 2005 Health Interview Survey, 15.9% of County residents reported that they had been diagnosed with asthma in their lifetime. This percent is lower than the nearby counties of, and Yolo, but higher than the State. The County s percent has been consistently higher than the State s during recent reporting periods. All Cancers: In 2003 2005, County ranked 22 nd best among s 58 counties in the death rate for all cancers. The County s ageadjusted cancer death rate was lower than the nearby counties of, and, but higher than the State and the Healthy People 2010 objective. During the past three reporting periods, County s rate has experienced a steady decline. Lung Cancer: During the period 2003 2005, County ranked 19 th best among s 58 counties in lung cancer death rate. The County s age adjusted death rate was higher than the State, but lower than the nearby counties and the Healthy People 2010 objective. Both the State and El Dorado County death rates have declined during the past three reporting periods. The incidence rate of lung cancer in County was also higher than that of the State, especially among females. Female Breast Cancer: During the period 2003 2005, County ranked 31 st best among s 58 counties in female cancer death rate. The County s age adjusted death rate is higher than the State and the Healthy People 2010 objective but lower than nearby counties. The County s rate declined significantly during the recent reporting period. Prostate Cancer: During the period 2003 2005, County ranked 39 th best among s 58 counties in prostate cancer death rate. The County death rate was higher than the State and the nearby counties of, and. However, the County s rate is statistically unreliable due to the small numbers of actual prostate cancer deaths in the County. While the State s rate has declined steadily within the past decade, County s rate has fluctuated. 6
2008 Health Status Report Colorectal Cancer: During the period 2003 2005, County ranked 29 th best among s 58 counties in the death rate for colorectal cancer. The County s age adjusted colorectal cancer death rate was higher than the State, the Healthy People 2010 objective, and and counties. Although County s rate was lower than County s, s rate was unreliable due to the small numbers of actual colorectal cancer deaths in that county. During the past decade, the County s incidence rate was almost identical to the State s. Melanoma (Skin Cancer): During the period 2000 2004, County s age adjusted malignant melanoma incidence rate was significantly higher than that of the Region as a whole. The County s age adjusted death rate was also higher than the region and and counties as well as the Healthy People 2010 objective. Infectious Disease: HIV & AIDS: During the period 2003 2005, County ranked 11 th best among s 58 counties in AIDS crude case rate. However, the County s rate is unreliable due to small numbers of actual AIDS cases. Nonetheless, the County s rate is lower than the State and the nearby counties of, and, but is higher than the Healthy People 2010 objective. Trends from the last 5 years suggest that AIDS cases are decreasing in the County and in the State. Chlamydia: Chlamydia is the most commonly reported sexually transmitted disease in County. During the period 2003 2005, County ranked 14 th best in the crude case rate of Chlamydia among s 58 counties. The County s rate was lower than the State and the nearby counties of and, but higher than County. Over the last three reporting periods, the crude case rate of Chlamydia has increased in County. Hepatitis B: In 2005, County s Acute Hepatitis B Crude Case Rate of was higher than the State and and counties, but lower than County. However, the small number of actual cases makes these data unreliable. Similarly, the apparent increase and decline of cases in County within the past several years is probably due to a normal fluctuation in numbers rather than a true increase or decline. Hepatitis C: Hepatitis C cases are not reported in a consistent manner among different counties and, therefore, it is difficult to get reliable data on the actual incidence of Hepatitis C. The rates reported from 2002 2004 in El Dorado County are unreliable due to small numbers. Tuberculosis: During the period 2003 2005, County ranked 13 th best among s 58 counties in the reported crude case rate of tuberculosis. The County s rate, while unreliable due to the small numbers of actual cases, was better than the State and, and 7
2008 Health Status Report counties, but worse than the Healthy People 2010 objective. The County s rate has remained low and stable for the past several years. Unintentional Injuries: Unintentional Injuries: During the period 2003 2005, County ranked 25 th best among s 58 counties in unintentional injuries death rate. The County s age adjusted death rate was higher than the State, the Healthy People 2010 objective, and and counties, but lower than County. The county s rate has increased during the most recent reporting period. Motor Vehicle Crashes: During the period 2003 2005, County ranked 21 st best among s 58 counties in motor vehicle crash death rate. The County s age adjusted death rate was higher than the State, the Healthy People 2010 objective, and and counties. Although the County s rate was lower than County, s rate was unreliable due to the small number of actual motor vehicle crashes deaths. County s death rate has remained fairly stable during the past two reporting periods. Violent and Abusive Behavior: Child Abuse and Neglect: Since 2002, County s substantiated child abuse rate has steadily increased and in 2005 surpassed the State s rate for the first time. In 2005, the County had a substantiated child abuse rate of 12.1 per 1,000 children ages 0 through 17. The County s rate was less than County, but higher that the State, the Healthy People 2010 objective and and counties. Domestic Violence: Since 2000 County s rate for domestic violence related calls for assistance has steadily increased and in 2005 surpassed the State s rate for the first time. In 2004, the County s rate was higher than the State and and County, but lower than County. Suicide: During the period 2003 2005, County ranked 39 th best among the State s 58 counties in suicide death rate. The county s rate was higher than the State, the Healthy People 2010 objective and all of the nearby counties except, whose rate was unreliable due to small numbers of actual suicides. The County s rate increased during the most recent reporting period while the State s rate declined. Homicide: During the period 2003 2005, County ranked 15 th best among the State s 58 counties in homicide death rate. The county s death rate was lower than the State, County and the Healthy People 2010 objective. However, County had so few actual homicides that the calculated death rate is not reliable. The same is true of and counties rates. 8
2008 Health Status Report Drug Abuse: During the period 2003 2005, County ranked 37 th best among the State s 58 counties in the rate of drug induced deaths. The county s rate was lower than the Healthy People 2010 objective and and counties, but higher than the State and County. However, and counties had so few actual druginduced deaths that the calculated death rate for those counties is not reliable. Firearm Related Deaths: During the period 2003 2005, County ranked 41 st best among the State s 58 counties in firearm related death rate. The county s rate was higher than the State, the Healthy People 2010 objective and nearby counties. For the past three reporting periods, the State s rate has declined slightly while County s rate has risen substantially. Health and Social Behaviors: Physical Activity: According to the 2005 Health Interview Survey, 75.8 percent of County adults indicated that they had a vigorous or moderate physical activity level. This percentage was higher than that of the State and and counties, but lower than Yolo County. The same survey showed that 67.3 percent of County teenagers indicated they had vigorous physical activity at least 3 days per week. This percent was higher than that of the State and, Yolo and counties. Adult Obesity: According to the 2005 Health Interview Survey, 57.1 percent of County adults are overweight or obese. County s percentage of overweight and obese adults has increased at a higher rate than the State s over the past three reporting periods, and in 2005 surpassed the State s percentage. County s rate is higher than and Yolo counties; however, it is lower than County. Childhood Obesity: In 2004 County had a lower percentage of overweight children in grades 5, 7 and 9 than did the State and, and counties. According to the Health Interview Survey, the percent of children in County ages 13 to 19 who indicated that they ate fast food at least once during the previous day decreased from 42.4% in 2003 to 26.0% in 2005. Smoking: The 2005 Health Interview Survey showed that 13.8 percent of County s population indicated that they were current smokers. This percentage was lower than the State and the nearby counties of and, but higher than Yolo County. The 2005 survey also found that the percent of current smokers in County dropped from 16.6 percent in 2003. 9
2008 Health Status Report Mothers and Infants: Infant Mortality: During the period 2002 2004, County ranked 23 rd best among s 58 counties in infant mortality rates. The County s infant mortality rate was lower than the State, and and Counties, but higher than the Healthy People 2010 objective and County. However, the rates of,, and counties are statistically unreliable due to small numbers of actual infant deaths in those counties. County s rate has remained fairly stable during the past three reporting periods. Prenatal Care: During the period 2002 2004, County ranked 46 th best among s 58 counties in adequate use of prenatal care. The County s average percent was worse than the State, the Healthy People 2010 objective, and the nearby counties of,, and. Within the past three reporting periods, the county s percent has steadily declined while the State s percent has increased. Low Birthweight: During the period 2003 2005, County ranked 26 th best among s 58 counties in low birthweight babies. The County s average percent was lower than County and the State, but higher than and counties and the Healthy People 2010 objective. The County s percent has improved during the most recent reporting period. Births to Adolescents: During the period 2003 2005, County ranked 5 th best among s 58 counties in births to adolescent mothers. The County s rate for females ages 15 19 years was lower (better) than the State, and and counties, but higher than County. Following national and state trends, the county s rate has declined in each of the past three reporting periods. Children and Adolescents: Immunization Coverage: County s immunization rates among kindergarteners ranks 8 th worst among the State s 58 counties and is lower than the State and, and counties. The county s immunization rate among 7 th graders ranks in the lower half of the State s counties and is lower than the State and and counties, but higher than County. School Achievement: Schools in County consistently score well above State levels relative to graduation rates and standardized test scores. In the 2005 2006 school year, high schools in County had a graduation rate of 91.6 compared with the State rate of 83.1. The percent of students in County who scored at Proficient or Advanced levels in English Language Arts and Mathematics exceeded the percent of students in the State in every category in grades 2 though 11. 10
2008 Health Status Report Children in Poverty: In 2004, County ranked 4th best among s 58 counties in the percent of children living in poverty. The county s percentage was lower than the State and and counties, but higher than County. The County s percent has historically been well below that of the State. Children with Health Insurance: According to the 2005 Health Interview Survey, 96.2 percent of children ages 0 to 18 in County had health insurance. This percent was higher than the State and the nearby counties of and Yolo. Only County had a higher percent. County s percent of insured children has increased during the past three reporting periods. Senior Citizen Health: Economy: Senior Citizen Health Issues: A survey of 2,300 adults in County ages 65 and over was administered by the Community Foundation in an effort to learn more about the health and social needs of the county s senior population. The results of the survey show that, in general, the County s senior population considers themselves healthy and relatively problem free. Alzheimer s Disease: During the period 2003 2005, County ranked 34 th best among the State s 58 counties in deaths due to Alzheimer s disease. The County s aged adjusted death rate is less than the State and the nearby counties of and. Although County s death rate is higher than County s, County s rate is unreliable due to small numbers of actual Alzheimer s deaths. Income: In 2005, County ranked 11 th best among s 58 counties in per capita income. The County s per capita income was higher than that of the State and and counties but lower than that of County. The County s per capita income has steadily increased in recent reporting periods. Unemployment: In 2006, County had a lower unemployment rate than the State and and counties, but higher than County. Both County and the State have seen a decrease in unemployment rates since peaking in 2003. Poverty: In 2005, County had a lower percentage of people of all ages in poverty than the State and County, but higher than County. For the past four reporting periods, County s percentage of people in poverty was nearly one half that of the State as a whole. 11
2008 Health Status Report Other Health Indicators: Access to Care: County s percent of total population who are covered by health insurance is higher than that of the State and has increased to a greater degree than the State s during the period 2001 2005. The county s percent is also higher than, and Yolo counties. However, the county s percent of Emergency Department use for non urgent care, while lower than County, is higher than Yolo and counties. Air Quality: During 2006, County had 266 days that were designated as Good as defined by the Air Quality Index. By comparison, the number of Good days for County was 121, for County it was 196, and for the Yolo/Solano area it was 298. Water Quality: The clarity of Lake Tahoe reached a ten year high in 2002. However, recent years have seen a drop in clarity. Testing of the County s El Dorado Main Water System in 2006 revealed that the water meets or exceeds all state and federal health related standards. 12
Chronic Disease CORONARY HEART DISEASE Coronary heart disease is a condition that affects the arterial blood vessels that are responsible for delivering blood, oxygen and other nutrients to the heart muscle itself. Coronary heart disease results when a fibrous tissue, called plaque, builds up inside the arterial walls, causing a partial or complete obstruction of blood flow. This condition is more commonly called atherosclerosis. When the heart muscle s supply of oxygen is completely cut off, a heart attack, or myocardial infarction, occurs, resulting in permanent tissue death for a portion of the heart muscle. 200 180 160 140 120 100 Three Year Average Age Adjusted Coronary Heart Disease Death Rate 186.0 142.6 164.7 162.6 145.5 127.5 2000 2002 2002 2004 2003 2005 Coronary heart disease remains the leading cause of death for both men and women in the United States,, and County. It affects more than 7 million Americans, and causes over 500,000 deaths annually. Experts agree that many of these deaths can be prevented by changes in lifestyle, which can directly reduce risk of developing the disease. The major modifiable risk factors for coronary heart disease are high blood pressure, high blood cholesterol, smoking, obesity, sedentary lifestyle, diabetes, and stress. Immediate action at the first evidence of a heart attack is critical in saving heart tissue, thereby reducing morbidity and mortality from coronary heart disease. How are we doing in County? In 2003 2005, County ranked 16 th best among s 58 counties in coronary heart disease death rate. The County s age adjusted death rate was better than that of the State, the Healthy People 2010 objective, and the nearby counties of,, and. Recent trends show a decline in the County s death rate. HP 2010 2003 2005 Three Year Average Age Adjusted Coronary Heart Disease Death Rate Comparison 129.3 127.7 150.7 162.0 163.1 178.1 50 100 150 200 Source: Department of Public Health, Death Statistical Master Files For more information on Coronary Heart Disease, visit the American Heart Association website at www.americanheart.org. 13
Chronic Disease CEREBROVASCULAR DISEASE (STROKE) Cerebrovascular disease affects the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die. When part of the brain dies from lack of blood flow, the part of the body it controls is affected. Strokes can cause paralysis, affect language and vision, and cause other problems. Treatments are available to minimize the potentially devastating effects of stroke, but to receive them, one must seek medical care quickly. Stroke is currently the third leading cause of death in the United States, with women accounting for 3 out of every 5 deaths. Cerebrovascular disease is also a major cause of disability with 400,000 to 500,000 Americans suffering non fatal strokes each year. The major modifiable risk factors for stroke include high blood pressure, high blood cholesterol, physical inactivity, obesity, and excessive alcohol consumption. 70 50 30 Three Year Average Age Adjusted Cerebrovascular Disease Death Rate 58.9 42.3 52.4 46.5 51.7 44.7 2000 2002 2002 2004 2003 2005 2003 2005 Three Year Average Age Adjusted Cerebrovascular Disease Death Rate Comparison HP 2010 50.0 How are we doing in County? In 2003 2005, County ranked 11 th best among s 58 counties in cerebrovascular disease death rate. The County s death rate was below that of the State, the Health People 2010 objective and the nearby counties of,, and. In recent years, the County s rate has consistently remained below the State s rate. 51.7 66.2 61.0 59.0 44.7 30 40 50 60 70 Source: Department of Public Health, Death Statistical Master Files For more information about stroke, visit the website of the National Stroke Association at www.strokeassociation.org. 14
Chronic Disease DIABETES Diabetes is a disease in which the body does not produce insulin (Type 1 diabetes) or is resistant to insulin (Type 2 diabetes). Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Although the exact cause of diabetes continues to be a mystery, major risk factors for Type 2 diabetes include older age, obesity, family history of diabetes, physical inactivity, and race/ethnicity. African Americans and Hispanics are at a greater risk than other races for Type 2 diabetes. There are 20.8 million people in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes another 6.2 million people (or nearly onethird) are unaware that they have the disease. Regular physical examinations and screenings are important for monitoring blood glucose levels and other important factors. Impaired glucose tolerance and elevated fasting glucose are two indicators for pre diabetes. Only 5 10% of people diagnosed with diabetes have Type 1 diabetes the other 90 95% are Type 2. Type 2 diabetes accounts for the majority of diabetes deaths. 30 25 20 15 10 5 Three Year Average Age Adjusted Diabetes Death Rate 21.0 13.6 21.3 11.9 22.3 12.0 2000 2002 2002 2004 2003 2005 2003 2005 Three Year Average Age Adjusted Diabetes Death Rate Comparison Diabetes can cause complications that can be lifethreatening. Diabetes is a leading cause of blindness, kidney failure, leg and foot amputations, pregnancy complications, and deaths related to flu and pneumonia. Even though diabetes was the sixth leading cause of death listed on U.S. death certificates in 2000, it is likely to be under reported as a cause of death. 11.8* 15.2 21.1 22.3 How are we doing in County? 12.0 In 2003 2005, County ranked 5 th best among s 58 counties in deaths due to diabetes and had a lower death rate than the State and the nearby counties of,, and. The County death rate has been consistently below the State s rate during recent reporting periods. 10 15 20 25 *Unreliable, relative standard error greater than or equal to 23 percent. Source: Department of Public Health, Death Statistical Master Files For more information on Diabetes, visit the American Diabetes Association website at www.diabetes.org. For more information on Coronary Heart Disease, visit the American Heart Association website at www.americanheart.org. 15
Chronic Disease ASTHMA Asthma, a chronic disease that affects the lungs, is increasing in prevalence in the United States. It is one of the most common long term diseases of children. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. According to the American Lung Association, in 2005 approximately 20 million Americans had asthma, including 9 million children under the age of 18. When asthma symptoms become worse than usual, it is called an asthma episode or attack. During an asthma attack, muscles around the airways tighten up, making the airways narrower so less air flows through. Asthma attacks account for one quarter of all emergency room visits in the United States. Currently, there is no way to prevent the initial onset of asthma, and there is no cure. However, people who have asthma can still lead quality, productive lives if they control their asthma. Asthma can be controlled by taking medication and by avoiding contact with environmental triggers such as cockroaches, dust mites, furry pets, mold, tobacco smoke, and certain chemicals. Air quality can also impact asthma. 20 15 10 5 Percentage of Population Ever Diagnosed with Asthma 14.2 12.0 15.8 13.1 15.9 13.6 2001 2003 2005 2005 Percentage of Population Ever Diagnosed with Asthma Comparison How are we doing in County? 13.6 According to the 2005 Health Interview Survey, 15.9% of County residents reported that they had been diagnosed with asthma in their lifetime. This percent is lower than the nearby counties of, and Yolo, but higher than the State. The County s percent has been consistently higher than the State s during recent reporting periods. Yolo 16.4 17.7 17.6 15.9 For more information on Asthma, visit the Centers for Disease Control and Prevention website at www.cdc.gov/asthma. 12 14 16 18 Source: 2001, 2003 and 2005 Health Interview Survey 16
Chronic Disease ALL CANCERS Cancer is not one disease, but a general term covering many distinct diseases. In all, there are around 200 different types of cancer that can affect the human body. Some types of cancer are more serious than others; some can be treated more easily than others. A large percentage of people will be affected by some form of cancer in their lifetime. Each type of cancer has patterns that may differ from other types of cancer, and the same disease often affects one person differently from another. Symptoms, treatment and survival rates depend on the cancer type and how advanced it is. The leading sites of cancer deaths for males and females in the United States are shown below. Rank Females Males 1 Lung Lung 2 Breast Prostate 3 Colorectal Colorectal 4 Pancreas Pancreas 5 Ovary Leukemia 6 Leukemia Liver and bile duct 7 Lymphoma Esophagus 8 Uterine Urinary bladder 9 Brain and other Lymphoma nervous system 10 Liver and bile duct Kidney and renal 190 185 180 175 170 165 160 155 150 HP 2010 Three Year Average Age Adjusted All Cancers Death Rate 184.2 169.6 178.6 164.1 166.5 165.1 2001 2003 2002 2004 2003 2005 2003 2005 Three Year Average Age Adjusted All Cancer Death Rate Comparison 158.6 How are we doing in County? 165.1 In 2003 2005, County ranked 22 nd best among s 58 counties in the death rate for all cancers. The County s age adjusted cancer death rate was lower than the nearby counties of, and, but higher than the State and the Healthy People 2010 objective. During the past three reporting periods, County s rate has experienced a steady decline. For more information on Cancer, visit the American Cancer Society website at www.cancer.org and the Cancer Registry Surveillance Program, Region, website at www.cspreg3.org. 166.5 171.8 181.9 183.2 150 160 170 180 190 Source: National Cancer Institute; County Health Status Profiles 2007 17
Chronic Disease LUNG CANCER While lung cancer is the leading cause of cancer death among both men and women in the U.S., men develop lung cancer more frequently than women. According to the American Lung Association, there will be an estimated 160,390 deaths from lung cancer in the U.S. in 2007, accounting for about 29% of all cancer deaths. More people die of lung cancer than of colon, breast, and prostate cancer combined. An estimated 213,380 new cases of lung cancer are expected in 2007, accounting for about 15% of cancer diagnoses. 50 45 40 35 30 Three Year Average Age Adjusted Lung Cancer Death Rate 50.1 43.8 45.7 41.8 42.6 41.5 2001 2003 2002 2004 2003 2005 Tobacco smoking is by far the leading cause of lung cancer, causing 8 of every 10 cases of lung cancer. The longer a person has been smoking and the more packs smoked per day, the greater the risk. Cigar and pipe smoking are almost as likely to cause lung cancer as cigarette smoking. There is no evidence that smoking low tar cigarettes reduces the risk of lung cancer. If a person stops smoking before lung cancer develops, the lung tissue can slowly return to normal. Stopping smoking at any age lowers the risk of lung cancer. How are we doing in County? During the period 2003 2005, County ranked 19 th best among s 58 counties in lung cancer death rate. The County s age adjusted death rate was higher than the State, but lower than nearby counties and the Healthy People 2010 objective. Both the State and County death rates have declined during the past three reporting periods. The incidence rate of lung cancer in County was also higher than that of the State, especially among females. HP 2010 2003 2005 Three Year Average Age Adjusted Lung Cancer Death Rate Comparison 43.3 41.5 45.4 42.6 46.3 50.2 0 10 20 30 40 50 60 1999 2003 Five Year Average Age Adjusted Incidence Rate for Lung Cancer by Gender 100 50 71.5 69.5 54.3 47.9 0 Males Females For more information on Lung Cancer, visit the American Lung Association website at www.lungusa.org and the American Cancer Society website at www.cancer.org. Source: County Health Status Profiles 2007; National Cancer Institute 18
Chronic Disease FEMALE BREAST CANCER Breast cancer is the most frequently diagnosed cancer in women. Breast cancer ranks second among cancer deaths in women, after lung cancer. The American Cancer Society estimates that 178,480 new cases of invasive breast cancer will occur among U.S. women during 2007, with 40,460 women expected to die. Although it is rare, men can also develop breast cancer. 26 25 24 23 22 21 Three Year Average Age Adjusted Female Breast Cancer Death Rate per 100,000 female population 24.1 23.4 25.3 22.9 22.8 22.7 2001 2003 2002 2004 2003 2005 Aside from being female, age is the most important factor affecting breast cancer risk. Inherited genetic mutations also increase the risk. Breastfeeding, moderate or vigorous physical activity, and maintaining a healthy body weight are all associated with a lower risk of breast cancer. Numerous studies have shown that early detection saves lives and increases treatment options. Early detection strategies include regular breast exams and mammograms. Recent declines in breast cancer mortality among women have been attributed to a combination of early detection and improvements in treatment. How are we doing in County? During the period 2003 2005, County ranked 31 st best among s 58 counties in female cancer death rate. The County s ageadjusted death rate was higher than the State and the Healthy People 2010 objective but lower than nearby counties. The County s rate declined significantly during the recent reporting period. 2003 2005 Three Year Average Age Adjusted Female Breast Cancer Death Rate Comparison per 100,000 female population HP 2010 21.3 22.7 24.6 24.7 22.9 31.1* 0 10 20 30 40 * Percentage is unreliable, relative standard error is greater than or equal to 23%. For more information on Breast Cancer, visit the American Cancer Society website at www.cancer.org and the Cancer Registry Surveillance Program, Region, website at www.cspreg3.org. Source: National Cancer Institute; County Health Status Profiles 2007 19
Chronic Disease PROSTATE CANCER Prostate cancer is the most frequently diagnosed cancer in men and the second leading cause of cancer death in men (after lung cancer). The American Cancer Society estimates that 218,890 new cases will occur in the U.S. during 2007 with an estimated 27,050 deaths. Incidence rates of prostate cancer have changed substantially over the last 20 years: rapidly increasing from 1988 to 1992, declining sharply from 1992 to 1995, and increasing modestly since 1995. These trends in large part are reflective of an increase in prostate cancer screening with the prostate specific antigen (PSA) blood test. Detecting prostate cancer at early stages has a significant impact on survival rates. Over the past twenty years, the 5 year survival rate for prostate cancer has increased from 67% to 97%. There is no sure way to prevent prostate cancer, although it is thought that a diet low in fat and high in vegetables, fruits, and grains can reduce the risk of developing prostate cancer. Men should have periodic prostate health checkups. 30 28 26 24 22 20 Five/Three Year Average Age Adjusted Prostate Cancer Death Rate per 100,000 male population 29.3 24.9 28.9 27.1 26.3* 23.8 1996 2000 2000 2004 2003 2005 2003 2005 Three Year Average Age Adjusted Prostate Cancer Death Rate Comparison per 100,000 male population How are we doing in County? During the period 2003 2005, County ranked 39 th best among s 58 counties in prostate cancer death rate. The County death rate was higher than the State and the nearby counties of, and. However, the County s rate is statistically unreliable due to the small numbers of actual prostate cancer deaths in the County. While the State s rate has declined steadily within the past decade, County s rate has fluctuated. For more information on Prostate Cancer, visit the American Cancer Society website at www.cancer.org and the Cancer Registry Surveillance Program, Region, website at www.cspreg3.org. HP 2010 23.8 23.6 21.1* 25.3 28.2 26.3* 0 10 20 30 *Percentage is unreliable, relative standard error is greater than or equal to 23%. Source: National Cancer Institute; Cancer Registry; County Health Status Profiles, 2007 20
Chronic Disease COLORECTAL CANCER What is it and why it is important? Colorectal cancer is the third most common cancer in both men and women. Colorectal cancer incidence rates have been decreasing for most of the last two decades, from 66.3 cases per 100,000 population nationwide in 1985 to 49.5 cases in 2003. This decrease is partly attributable to an increase in screening, which can detect and remove colorectal polyps before they progress to cancer. The American Cancer Society estimates that in 2007, 112,340 cases of colon and 41,420 cases of rectal cancer will be diagnosed in the U.S., with an estimated 52,180 deaths. 60 50 40 30 20 10 0 Five Year Average Age Adjusted Colorectal Cancer Incidence Rate 42.7 40.0 49.1 47.2 45.7 45.4 1994 1998 1996 2000 2000 2004 Screening is necessary to detect colorectal cancer in its early stages, when it is more treatable and survival rates are higher. Colon cancer screening include colonoscopy and fecal occult blood tests. Several modifiable factors are associated with increased risk of colorectal cancer. Among these are obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meat, and inadequate intake of fruits and vegetables. HP 2010 2003 2005 Three Year Average Age Adjusted Colorectal Cancer Death Rate Comparison 13.7 How are we doing in County? During the period 2003 2005, County ranked 29 th best among s 58 counties in the death rate for colorectal cancer. The County s age adjusted colorectal cancer death rate was higher than the State, the Healthy People 2010 objective, and and counties. Although County s rate was lower than County s, s rate was unreliable due to the small numbers of actual colorectal cancer deaths in that county. During the past decade, the County s incidence rate was almost identical to the State s. For more information on Colorectal Cancer, visit the American Cancer Society website at www.cancer.org and the Cancer Registry Surveillance Program, Region, website at www.cspreg3.org. 14.1 16.0 15.4 16.2 17.6* 0 5 10 15 20 * Mortality rate is unreliable, relative standard error is greater than or equal to 23%. Source: National Cancer Institute. County Health Status Profiles 2007 21
Chronic Disease MELANOMA (SKIN CANCER) Skin cancer is the most common form of cancer in the United States. The three major types of skin cancer are the highly curable basal cell and squamous cell carcinomas ( nonmalinomas ) and the more serious malignant (invasive) melanoma. Although malignant melanoma accounts for only about 4% of all skin cancer cases, it causes most skin cancer related deaths. The good news is that melanoma is often curable if it is detected and treated in its early stages. In men, melanoma is found most often on the area between the shoulders and hips or on the head and neck. In women, melanoma often develops on the lower legs. It may also appear under the fingernails or toenails or on the palms or soles. The chance of developing melanoma increases with age, but it affects all age groups and is one of the most common cancers in young adults. Malignant melanoma is the most rapidly increasing form of cancer in the United States. The American Cancer Society estimates that in 2007, 59,940 new cases of melanoma will be diagnosed in the U.S. and 10,850 people will die of it. Skin cancer is largely preventable when sun protection measures are used consistently. Most skin cancers can be cured if detected and treated early. How are we doing in County? During the period 2000 2004, County s age adjusted malignant melanoma incidence rate was significantly higher than that of the Region as a whole. The County s age adjusted death rate was also higher than the region and and counties as well as the Healthy People 2010 objective. 30 25 20 15 10 Five Year Average Age Adjusted Malignant Melanoma Incidence Rate 20.7 28.9 18.6 24.1 13.2 1994 1998 1996 2000 2000 2004 HP 2010 Sac Region Sac Region 2000 2004 Five Year Average Age Adjusted Malignant Melanoma Death Rate Comparison 2.2 2.5 2.7 3.6 4.3 0 1 2 3 4 5 Source: National Cancer Institute, Cancer Registry For more information on Melanoma, visit the American Cancer Society website at www.cancer.org and the Cancer Registry Surveillance Program, Region, website at www.cspreg3.org. 22