Diabetes Treatments

Diabetes is a complex, serious, costly, and increasingly common disease that According to the Centers for Disease Control and Prevention Diabetes …

CENTER FOR HEALTH STATISTICS

DATA SUMMARY
REPORT REGISTER NO DS98-09000 September 1998

DIABETES DEATHS, CALIFORNIA, 1980-1996

Introduction Diabetes is a complex, serious, costly, and increasingly common disease that disproportionately affects minority populations and the elderly According to the Centers for Disease Control and Prevention Diabetes Surveillance report for 1997, the incidence of diabetes is likely to increase as minority populations grow and the US population becomes older The human suffering caused by diabetes and its complications is tragic considering that diabetes can have a harmful effect on most of the organ systems in the human body It is the leading cause of end-stage renal disease, non-traumatic lower-extremity amputation, and blindness among working age adults Persons with diabetes are at increased risk for ischemic heart disease, neuropathy, and stroke1 According to the California Diabetes Control Program, in 1992 the health care costs of diabetes in California were approximately 12 billion dollars2 In 1996 an estimated 1,078,800 adults in California were afflicted with diabetes3 Thus, diabetes poses an immense public health challenge in California This
report focuses on trends in diabetes deaths during the period 1980 through 1996, and provides analysis of trend data on crude and age-adjusted death rates for California residents by sex, age, race/ethnicity, and county The definition of diabetes used in this report is based on the ICD-9 code 250 traditionally presented in the National Center for Health Statistics NCHS Monthly Vital Statistics Report4 In this Data Summary as in the previously mentioned NCHS report, diabetes related deaths are counted only when diabetes is the underlying cause of death The United States Public Health Service has established a number of health objectives pertaining to diabetes, which are published in Healthy People 20005 Since these objectives are based on both underlying and contributing causes of diabetes deaths rather than underlying cause only, Californias progress in meeting the year 2000 national health objective for diabetes will not be addressed in this report The Center for Health Statistics publication Healthy California 2000 is a reference for research related to the Healthy People 2000 goals as they pertain to California6 Diabetes Deaths, Crude and Age-Adjusted Death Rates by Sex As shown
in Table 1 page 5, there was an increase of 106 in the total number of diabetes deaths from 1980 2,616 to 1996 5,380 During the time span covered by this report, the number of deaths attributed to diabetes was consistently higher among females than among males The average number of deaths among females 1,9307 was 25 higher than the average number of deaths among males 1,5429 for the 17-year period

This Data Summary was prepared by Daniel H Cox, Center for Health Statistics, 304 S Street, P O Box 942732, Sacramento, CA 94234-7320, Telephone 916 445-6355
STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF HEALTH SERVICES

Gray Davis, Governor

Grantland Johnson, Secretary

Director

The overall crude death rate Table 1 increased significantly during the time span of this report Crude rates ranged from a low of 107 per 100,000 population in 1982 and 1983 up to a high of 166 in 1996, a 55 rise Analysis of the data by sex shows that in 1980 the crude death rate for females 127 was significantly higher than for males 92, a difference of 38 Though the difference was lower 10 in 1996, the crude death rate for females 174 was still significantly higher than the crude death
rate for males 158 From 1980 to 1996 the crude death rate increased 72 for males and 37 for females Crude death rates, as discussed above, show the actual rate of dying in a given population, but the age composition of that population is not taken into consideration Comparing crude death rates could be misleading if one sex has a disproportionately older population since most deaths occur among older persons Age-adjusted death rates eliminate the age differences that exist among population subgroups and allow a more direct comparison of their varying risks of mortality For the purpose of comparing death rates between males and females, it is preferable to use age-adjusted death rates In 1996 the United States diabetes ageFIGURE 1 DIABETES DEATH RATES adjusted death rate 136 was significantly BY SEX AGE-ADJUSTED CALIFORNIA, 1980-1996 DEATH RATE higher than the California rate 1147 As By Place of Residence 14 shown in Figure 1, Californias age13 adjusted death rate rose from 79 in 1980 Male to 114 in 1996, a 44 increase 12 Total Regression analysis showed this to be a 11 statistically significant increase Unlike Female 10 the crude death rate comparison, after ageadjusting, male
death rates were slightly 9 higher than female death rates except in 8 the years 1980 and 1983 Males had 7 significantly higher rates in 1985, 1989, and 1992 through 1996 From 1980 to 6 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1996 age-adjusted death rates rose 63 for males, from 78 in 1980 to 127 in 1996 Females experienced an increase of 29 in their age-adjusted death rate, from 80 in 1980 to 103 in 1996 These increases were statistically significant for both males and females
Note: Rates are per 100,000 Population; ICD-9 code 250 Source: Table 1

Diabetes Deaths, Crude and Age-Adjusted Death Rates by Race/Ethnicity Table 2 page 6 shows diabetes death data by the four major race/ethnic groups from 1985 to 1996 During this period, the average number of diabetes deaths among Whites 2,3849 was higher than Hispanics 6974, Blacks 4712, and Asian/Other 2430 Table 2 also shows that the crude death rate for Blacks increased by 56, from 198 per 100,000 population in 1985 to 308 in 1996 The crude death rate for Whites increased by 46 from 126 in 1985 to 184 in 1996 For Hispanics the crude death rate increased by 63 from 73 in 1985 to 119 in 1996
Asian/Other showed the sharpest increase at 79, with crude death rates of 63 in 1985 and 113 in 1996 These were all statistically significant increases The highest crude death rate for Blacks 308 and Whites 184 occurred in 1996, for Asian/Other 123 in 1995, and for Hispanics 119 in both 1995 and 1996

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As illustrated in Figure 2, from FIGURE 2 1985 to 1996 the age-adjusted DIABETES DEATH RATES death rates among all four BY RACE/ETHNICITY AGE-ADJUSTED CALIFORNIA, 1985-1996 DEATH RATE race/ethnic groups increased by By Place of Residence 30 33 or more Regression analysis Black showed all of the increases to be 25 statistically significant The highest age-adjusted death rate for Blacks 20 Hispanic 283 and for Whites 92 15 occurred in 1996, for Hispanics 173 and for Asian/Other 104 it Asian/Other 10 occurred in 1995 The lowest ageWhite adjusted death rate for Blacks 5 182 and for Hispanics 109 Asian / Other Black Hispanic White occurred in 1986, for Asian/Other 0 64 and for Whites 65 it 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 occurred in 1991 In all years, Blacks had significantly higher age-adjusted death rates than the other three race/ethnic groups At its
highest point in 1996, the Black age-adjusted death rate was 17 times higher than the Hispanic rate, three times higher than the Asian/Other rate, and 31 times higher than the White rate
Note: Rates are per 100,000 population; ICD-9 code 250 White, Black, and Asian/Other exclude Hispanic ethnicity Hispanic includes any race category Source: Table 2

Diabetes Deaths and Death Rates by Age, Race/Ethnicity, and Sex, 1996 Table 3 page 7 shows diabetes death data by the four major race/ethnic groups, by age group, and by sex for 1996 Diabetes deaths occur predominantly among the elderly and this held true in 1996 with 73 of these deaths involving people 65 years of age and older Also shown in Table 3, the number of diabetes deaths among Whites 3,151 was higher than Hispanics 1,115, Blacks 701 or Asian/Other 413 Figure 3 shows that Black females FIGURE 3 had the highest age-adjusted death DIABETES DEATH RATES BY RACE/ETHNICITY AND SEX rate 289 in 1996, which was 4 AGE-ADJUSTED CALIFORNIA, 1996 DEATH RATE By Place of Residence higher than the rate for Black males 279, though the difference between the two was not Male Female statistically significant The rates for Black females and males
were significantly higher than male and female rates in the other three race/ethnic groups Hispanic males had a rate of 180, Asian/Other males had a rate of 113, and White males had a rate of 107 The male age-adjusted death rates in these three race/ethnic groups were higher by 12 or more, than the corresponding female rates Hispanic females had a rate of 161, White females had a rate of 80, and Asian/Other females had a rate of 78
30 25 20 15 10 5 0 Total 127 103 Asian/Other 113 78 Black 279 289 Male Female

Hispanic 180 161

White 107 80

Note: Rates are per 100,000 population; ICD-9 code 250 White, Black, and Asian/Other exclude Hispanic ethnicity Hispanic includes any race category Source: State of California, Department of Finance, Race/Ethnic Population Estimates by County with Age and Sex Detail, 1970-1996, January 1998 State of California, Department of Health Services, Death Records

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In Table 3 page 7 reliable diabetes age-specific death rates show that males in the Asian/Other and White race/ethnic groups consistently had higher rates than females in the same age groups Among Hispanics, males had higher age-specific rates than females except for the 85 and Older age
group Among Blacks, females had the highest age-specific rates in four of the six age groups with reliable rates One notable pattern is the agespecific death rate among Blacks in 1996 Starting in the age group 35 to 44 and continuing through the age group 85 and Older, Blacks had significantly higher death rates than the other three race/ethnic groups Figure 4 graphically shows the higher age-specific death rates for Blacks in the age group 35 to 44, through the age group 85 and Older Figure 4 also shows that Hispanics in the 45 to 54 through the 85 and Older age groups had the second highest age-specific death rates among the four race/ethnic groups Whites had the lowest age-specific death rate in the age groups 55 to 64, 65 to 74, 75 to 84, and 85 and Older, though it was not significantly different from the Asian/Other rate

FIGURE 4 DIABETES DEATH RATES
AGE-SPECIFIC DEATH RATE 600

BY RACE/ETHNICITY AND AGE CALIFORNIA, 1996 By Place of Residence

500

400

Asian/Other Black Hispanic White

300

200

100

0 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85 Older
Note: Rates are per 100,000 population; ICD-9 code 250 White, Black, and Asian/Other exclude Hispanic ethnicity
Hispanic includes any race category Source: Table 3

Diabetes Death Rates among California Counties Table 4 page 8 displays the number of deaths, crude death rates, and age-adjusted death rates by county averaged over a three-year period, 1994 to 1996 This averaging is done to reduce the large fluctuations in the death rates that are inherent among counties with a small number of events and/or population The highest average number of diabetes deaths occurred in Los Angeles County 1,5370 and the lowest in Alpine County, which had no deaths due to diabetes The highest and lowest reliable crude death rates due to diabetes were in Glenn County 415 per 100,000 population and Imperial County 87 Kings County had the highest reliable age-adjusted death rate due to diabetes 246 per 100,000 population and Marin County had the lowest 52

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State of California Department of Health Services

Center for Health Statistics August 1998

TABLE 1 DEATHS DUE TO DIABETES BY SEX CALIFORNIA, 1980-1996
By Place of Residence SEX EVENT YEAR DEATHS POPULATION CRUDE RATE AGE-ADJUSTED RATE 95 CONFIDENCE LIMITS LOWER UPPER

TOTAL 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981
1980 MALE 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 FEMALE 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 2,816 2,711 2,662 2,055 1,951 1,804 1,911 1,864 1,971 1,838 1,743 1,662 1,667 1,600 1,535 1,498 1,534 16,155,887 16,000,360 15,869,548 15,733,587 15,570,183 15,262,093 14,952,881 14,568,118 14,211,394 13,891,742 13,578,094 13,271,959 12,997,526 12,776,467 12,529,398 12,284,160 12,057,299 174 169 168 131 125 118 128 128 139 132 128 125 128 125 123 122 127 103 102 102 81 77 75 79 80 86 81 79 76 78 77 75 77 80 99 98 98 77 73 71 75 76 82 77 75 72 74 73 70 72 75 108 107 107 84 81 79 83 84 90 86 83 80 82 82 79 81 84 2,564 2,385 2,256 1,776 1,608 1,504 1,467 1,500 1,445 1,445 1,285 1,335 1,219 1,100 1,120 1,138 1,082 16,227,924 16,062,552 15,921,009 15,782,166 15,616,376 15,301,183 14,989,516 14,573,988 14,181,700 13,825,118 13,474,197 13,130,674 12,818,768 12,559,834 12,275,613 11,993,514 11,722,769 158 148 142 113 103 98 98 103 102 105 95 102 95 88 91 95 92 127 122 118 95 87 83 84 90 87 90 83 87 82 75 77 81 78 122 117 113 90 83 79 79 85 83 85 78 82 77 71 73 76 73 132 127 123 99 92 88 88 95 92 95 87 92
87 80 82 85 83 5,380 5,096 4,918 3,831 3,559 3,308 3,378 3,364 3,416 3,283 3,028 2,997 2,886 2,700 2,655 2,636 2,616 32,383,811 32,062,912 31,790,557 31,515,753 31,186,559 30,563,276 29,942,397 29,142,106 28,393,094 27,716,860 27,052,291 26,402,633 25,816,294 25,336,301 24,805,011 24,277,674 23,780,068 166 159 155 122 114 108 113 115 120 118 112 114 112 107 107 109 110 114 111 109 87 82 79 81 85 87 85 81 81 80 76 76 78 79 111 108 106 84 79 76 78 82 84 82 78 78 77 73 73 75 75 117 114 113 90 85 81 84 88 90 88 84 85 83 79 79 81 82

Note : Rates are per 100,000 population ICD-9 code 250 Source : State of California, Department of Finance, Race/Ethnic Population Estimates by County with Age and Sex Detail, 1970-1996, January 1998 State of California, Department of Health Services, Death Records

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State of California Department of Health Services

Center for Health Statistics August 1998

TABLE 2 DEATHS DUE TO DIABETES BY RACE/ETHNICITY CALIFORNIA, 1985-1996
By Place of Residence RACE/ ETHNICITY ASIAN/OTHER 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 BLACK 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 HISPANIC 1996 1995 1994 1993 1992 1991 1990 1989 1988
1987 1986 1985 WHITE 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 3,151 2,977 2,996 2,330 2,189 2,071 2,106 2,155 2,272 2,230 2,106 2,036 17,131,672 17,180,485 17,245,625 17,320,246 17,363,576 17,249,291 17,131,831 16,886,542 16,674,150 16,504,967 16,351,870 16,216,876 184 173 174 135 126 120 123 128 136 135 129 126 92 89 91 71 67 65 66 70 75 74 72 69 88 85 87 68 64 62 63 67 71 70 69 66 96 93 94 74 70 68 69 74 78 77 75 73 1,115 1,085 970 757 689 607 626 591 559 494 431 445 9,330,740 9,100,994 8,882,966 8,658,118 8,421,133 8,097,870 7,774,789 7,419,574 7,077,579 6,754,398 6,428,436 6,103,662 119 119 109 87 82 75 81 80 79 73 67 73 170 173 164 136 129 121 130 130 130 121 109 122 160 163 154 126 119 111 119 119 119 110 98 110 180 184 175 146 139 130 140 140 142 132 119 133 701 600 625 481 420 426 435 430 403 408 344 381 2,275,401 2,250,502 2,232,841 2,214,376 2,192,451 2,147,691 2,105,207 2,061,823 2,024,779 1,992,361 1,958,844 1,923,209 308 267 280 217 192 198 207 209 199 205 176 198 283 257 268 213 191 199 209 212 202 210 182 209 262 235 247 193 172 180 189 192 182 189 162 188 305 278 290 233 210 219 229 233 223 230 202 231 413 434 327 263 261 204 211 188 182 151 147
135 3,645,998 3,530,931 3,429,125 3,323,013 3,209,399 3,068,424 2,930,570 2,774,167 2,616,586 2,465,134 2,313,141 2,158,886 113 123 95 79 81 66 72 68 70 61 64 63 94 104 81 70 73 64 69 68 72 65 67 68 84 94 72 61 64 55 60 58 61 54 56 57 103 114 90 78 82 73 79 78 82 75 78 80 EVENT YEAR DEATHS POPULATION CRUDE RATE AGE-ADJUSTED RATE 95 CONFIDENCE LIMITS LOWER UPPER

Note : Rates are per 100,000 population ICD-9 code 250 White, Black, and Asian/Other exclude Hispanic ethnicity Hispanic includes any race category Source : State of California, Department of Finance, Race/Ethnic Population Estimates by County with Age and Sex Detail, 1970-1996, January 1998 State of California, Department of Health Services, Death Records

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State of California Department of Health Services

Center for Health Statistics August 1998

TABLE 3 DEATHS DUE TO DIABETES BY RACE/ETHNICITY, AGE, AND SEX CALIFORNIA, 1996 By Place of Residence
RACE/ ETHNICITY AGE GROUPS 1996 DEATHS TOTAL TOTAL
Under 1 1 to 4 5 to 14 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85 Older Unknown Total 0 1 3 11 79 202 409 766 1,502 1,579 828 0 5,380 0 0 1 0 7 13 29 69 124 116 54 0 413 0 0 0 1 13 35 72 121 199 174 86
0 701 0 0 2 6 0 1 2 8 48 111 232 396 746 733 287 0 2,564 0 0 1 0 4 8 16 39 67 58 25 0 218 0 0 0 0 7 12 35 52 79 77 24 0 286 0 0 1 4 0 0 1 3 31 91 177 370 756 846 541 0 2,816 0 0 0 0 3 5 13 30 57 58 29 0 195 0 0 0 1 6 23 37 69 120 97 62 0 415 0 0 1 2 308 00 00 01 04 255 00 00 01 05 360 00 00 01 03 285 00 01 331 03 08 225 -01 00 285 03 11 325 -01 -01 394 03 07 113 00 00 00 03 33 94 297 794 1947 3257 5415 122 00 00 00 00 34 67 307 729 1810 3914 5140 105 00 00 00 06 31 120 288 852 2050 2874 5529 102 -03 15 63 228 653 1677 2773 4270 124 09 51 125 365 936 2218 3740 6559 106 09 29 205 531 1411 3039 3084 138 60 104 408 927 2209 4788 7197 90 -06 06 71 195 651 1683 2302 4153 120 18 56 169 380 1053 2417 3446 6905 166 00 00 02 00 12 21 66 269 658 1256 2050 158 00 00 03 00 13 26 77 323 819 1463 2226 174 00 00 00 00 10 15 56 220 534 1100 1920 162 -02 03 09 42 205 542 1027 1504 171 05 20 32 90 332 774 1484 2597 152 -03 00 08 39 222 623 1087 1353 164 10 26 45 115 424 1015 1840 3099 168 -01 02 26 142 395 817 1221 181 21 29 87 299 673 1383 2619 00 00 01 03 15 37 107 325 769 1359 2231 00 01 01 04 17 40 123 345 848 1574 2557 00 00 00 01 12 34 92
305 704 1216 2090 00 00 01 11 32 97 302 730 1292 2079 01 01 04 18 43 118 348 807 1426 2383 -01 00 01 12 33 107 311 787 1460 2261 03 02 06 22 48 139 379 909 1688 2852 00 00 08 27 79 274 654 1134 1914 01 03 17 41 106 336 754 1297 2266

AGE-SPECIFIC DEATH RATE TOTAL MALE FEMALE

MALE

FEMALE

95 CONFIDENCE LIMITS TOTAL MALE FEMALE LOWER UPPER LOWER UPPER LOWER UPPER

ASIAN/OTHER
Under 1 1 to 4 5 to 14 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85 Older Unknown Total

BLACK
Under 1 1 to 4 5 to 14 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85 Older Unknown Total

HISPANIC
Under 1 1 to 4 5 to 14 15 to 24

25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85 Older Unknown Total

12 43 105 199 380 250 118 0 1,115 0 1 0 4 47 111 203 377 799 1,039 570 0 3,151

7 29 69 96 178 101 39 0 524 0 1 0 4 30 62 112 209 422 497 199 0 1,536

5 14 36 103 202 149 79 0 591 0 0 0 0 17 49 91 168 377 542 371 0 1,615

07 31 140 478 1357 2047 2676 119 00 01 00 02 18 37 85 246 578 1163 2001 184

07 40 183 480 1408 2100 2524 108 00 02 00 04 23 40 94 277 672 1387 2460 181

06 21 97 477 1315 2012 2758 131 00 00 00 00 14 33 77 215 499 1012 1820 187
-

03
22 114 412 1220 1793 2193 112 -01 00 13 30 74 221 538 1092 1837 178

10 41 167 545 1493 2301 3158 127 04 04 24 44 97 270 618 1233 2166 190

02 26 140 384 1201 1691 1732 99 -02 00 15 30 77 239 608 1265 2118 172

12 55 227 576 1615 2510 3316 118 07 08 31 50 112 314 736 1509 2801 190

01 10 65 385 1133 1689 2149 121 07 24 61 183 449 927 1634 178

12 33 129 569 1496 2336 3366 142 20 42 92 248 550 1098 2005 196

WHITE
Under 1 1 to 4 5 to 14 15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85 Older Unknown Total

Note : Rates are per 100,000 population ICD-9 code 250 White, Black, and Asian/Other exclude Hispanic ethnicity Hispanic includes any race category Source : State of California, Department of Finance, Race/Ethnic Population Estimates by County with Age and Sex Detail, 1970-1996, January 1998 State of California, Department of Health Services, Death Records

Death rate unreliable, relative standard error is greater than 30 Standard error indeterminate, death rate based on no zero deaths Upper and lower limits at the 95 confidence level are indeterminate

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State of California Department of Health Services

Center for Health Statistics June 19,1998

TABLE 4 DEATHS
DUE TO DIABETES BY COUNTY CALIFORNIA, 1994-1996
By Place of Residence
COUNTY 1994-1996 DEATHS Average 5,1313 2487 00 57 380 47 27 1420 80 197 1583 110 343 120 40 1097 313 137 37 1,5370 267 253 20 170 457 20 03 467 223 103 3163 313 13 1940 1853 67 3007 3533 1153 1120 310 947 523 2247 347 287 13 83 523 620 773 113 163 13 720 93
1240 213 93

PERCENT

1995 POPULATION

CRUDE RATE

AGE-ADJUSTED RATE

95 CONFIDENCE LIMITS LOWER UPPER

CALIFORNIA ALAMEDA ALPINE AMADOR BUTTE CALAVERAS COLUSA CONTRA COSTA DEL NORTE EL DORADO FRESNO GLENN HUMBOLDT IMPERIAL INYO KERN KINGS LAKE LASSEN LOS ANGELES MADERA MARIN MARIPOSA MENDOCINO MERCED MODOC MONO MONTEREY NAPA NEVADA ORANGE PLACER PLUMAS RIVERSIDE SACRAMENTO SAN BENITO SAN BERNARDINO SAN DIEGO SAN FRANCISCO SAN JOAQUIN SAN LUIS OBISPO SAN MATEO SANTA BARBARA SANTA CLARA SANTA CRUZ SHASTA SIERRA SISKIYOU SOLANO SONOMA STANISLAUS SUTTER TEHAMA TRINITY TULARE TUOLUMNE
VENTURA YOLO YUBA

1000 48 00 01 07 01 01 28 02 04 31 02 07 02 01 21 06 03 01 300 05 05 00 03 09 00 00 09 04 02 62 06 00 38 36 01 59 69 22 22 06 18 10 44 07 06 00 02 10 12 15 02 03 00 14 02
24 04 02

a

a a

a

a

a

32,062,912 1,347,739 1,185 32,572 196,108 36,907 17,799 867,315
27,597 144,158 754,045 26,523 124,481 137,445 18,571 616,701 114,902 54,984 28,678 9,352,192 106,429 238,981 15,903 84,269 198,522 10,064 10,624 361,840 117,735 86,506 2,614,851 203,454 20,484 1,370,338 1,117,748 42,604 1,581,620 2,669,280 751,532 524,611 228,401 689,731 391,425 1,603,340 241,510 160,877 3,410 44,616 370,556 419,459 413,806 73,721 54,195 13,363 349,860 51,516
712,762 150,812 62,255

160 185 00 174 194 126 150 164 290 136 210 415 276 87 215 178 273 249 128 164 251 106 126 202 230 199 31 129 190 119 121 154 65 142 166 156 190 132 153 213 136 137 134 140 144 178 391 187 141 148 187 154 301 100 206 181

112 128 00 82 94 48 92 106 167 83 153 228 166 72 86 140 246 101 74 126 168 52 62 103 187 83 12 96 95 52 90 88 26 89 121 103 160 91 75 140 61 78 76 106 83 97 153 83 120 79 138 98 149 34 159 63

108 111 07 58 01 -24 88 36 42 126 73 105 28 -12 112 153 36 -09 119 98 30 -56 47 129 -48 -29 66 49 14 80 53 -28 75 103 17 141 81 59 111 35 61 53 91 52 58 -126 18 86 56 104 36 66 -25 119 20
94 58 43

115 145 158 130 95 208 125 298 124 179 384 228 116 183 168 339 166 156 132 238 73 180 159 246 215 53 126 141 90 101 122 81 103 140
188 180 102 90 169 87 95 99 120 115 136 433 149 153 101 171 160 231 94 199 106
138 154 212

174 141 150

116 106 127

Note : Rates are per 100,000 population ICD-9 code 250 Death rate unreliable, relative standard error is greater than 30 a Represents a percentage of more than zero but less than 005

Standard error indeterminate, death rate based on no zero deaths - Upper and lower limits at the 95 confidence level are indeterminate

Source : State of California, Department of Finance, Race/Ethnic Population Estimates by County with Age and Sex Detail, 1970-1996, January 1998 State of California, Department of Health Services, Death Records

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State of California Department of Health Services

Center for Health Statistics June 1998

TABLE 5 POPULATION ESTIMATES BY RACE/ETHNICITY, SEX, AND AGE CALIFORNIA, 1996

RACE/ ETHNICITY

TOTAL Under 1 1 to 4 2,298,325 1,175,708 1,122,617 254,397 131,069 123,328 170,539 86,386 84,153 1,034,656 527,237 507,419 838,733 431,016 407,717 5 to 14 4,914,945 2,514,194 2,400,751 564,354 288,489 275,865 388,094 196,545 191,549 1,816,510 925,990 890,520 2,145,987 1,103,170 1,042,817 15 to 24 4,217,867 2,198,841 2,019,026 533,767 274,693 259,074
345,698 182,527 163,171 1,436,639 749,483 687,156 1,901,763 992,138 909,625 25 to 34 5,357,377 2,828,447 2,528,930 599,056 301,165 297,891 395,287 203,575 191,712 1,808,376 1,012,882 795,494 2,554,658 1,310,825 1,243,833

AGE GROUPS 35 to 44 5,401,744 2,741,290 2,660,454 631,504 303,109 328,395 371,892 180,097 191,795 1,372,005 720,340 651,665 3,026,343 1,537,744 1,488,599 45 to 54 3,806,109 1,887,994 1,918,115 438,067 207,939 230,128 242,802 114,139 128,663 747,447 376,227 371,220 2,377,793 1,189,689 1,188,104 55 to 64 2,359,866 1,146,990 1,212,876 256,917 120,782 136,135 152,306 71,336 80,970 416,154 200,126 216,028 1,534,489 754,746 779,743 65 to 74 1,954,134 879,924 1,074,210 188,491 81,782 106,709 102,194 43,656 58,538 280,103 126,447 153,656 1,383,346 628,039 755,307 75 to 84 1,161,701 465,740 695,961 92,392 39,642 52,750 53,430 19,675 33,755 122,130 48,089 74,041 893,749 358,334 535,415 85 Older 371,118 112,258 258,860 26,336 11,231 15,105 15,883 4,669 11,214 44,103 15,454 28,649 284,796 80,904 203,892

TOTAL MALE FEMALE ASIAN/OTHER MALE FEMALE BLACK MALE FEMALE HISPANIC MALE FEMALE WHITE MALE FEMALE

32,383,811 16,227,924 16,155,887 3,645,998 1,791,148 1,854,850 2,275,401
1,121,544 1,153,857 9,330,740 4,830,901 4,499,839 17,131,672 8,484,331 8,647,341

540,625 276,538 264,087 60,717 31,247 29,470 37,276 18,939 18,337 252,617 128,626 123,991 190,015 97,726 92,289

Note : White, Black, and Asian/Other exclude Hispanic ethnicity Hispanic includes any race category Source : State of California, Department of Finance, Race/Ethnic Population Estimates with Age and Sex Detail, 1970-1996, January 1998

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Notes: The diabetes death data presented in this report is ICD-9 code 250 The term significant within the text indicates either statistically significant based on the slope of a leastsquares line not equal to zero p05 for regression analysis, or statistically significant based on the difference between two independent rates p05 As with any vital statistics data, caution needs to be exercised when analyzing small numbers, including the rates derived from them Death rates calculated from a small number of deaths and/or population tend to be unreliable and subject to significant variation from one year to the next To assist the reader, 95 confidence intervals are provided in the data tables as a tool for measuring the reliability of the death rates Rates with
a relative standard error coefficient of variation greater than 30 are indicated with an asterisk Also, three-year averages were used in Table 4 page 8 to increase the reliability of the rates derived from small numbers, and to reduce the year-to-year variability inherent among these rates The four race/ethnic groups presented in the tables are mutually exclusive White, Black, and Asian/Other exclude Hispanic ethnicity, while Hispanic includes any race/ethnic group In order to remain consistent with the population data obtained from the Department of Finance, the White race/ethnic group includes: White, Other specified, Not Stated, and Unknown, and the Asian/Other race/ethnic group includes: Aleut, American Indian, Asian Indian, Asian specified/unspecified, Cambodian, Chinese, Eskimo, Filipino, Guamanian, Hawaiian, Japanese, Korean, Vietnamese, Other Pacific Islander, Samoan, Thai, and Laotian Race/ethnic data are not presented for years prior to 1985 due to the unavailability of mutually exclusive data for Hispanics and Whites In addition, caution should be exercised in the interpretation of mortality data by race/ethnicity Misclassification of race/ethnicity on the death
certificate may contribute to death rates that may be underestimated among Hispanics and Asian/Other8 The method used to analyze vital statistics data is also important Analyzing only the number of deaths has its disadvantages and can be misleading because the population at risk is not taken into consideration Crude death rates, on the other hand, show the actual rate of dying in a given population, but the age composition of that population is not taken into consideration Therefore, the use of age-adjusted death rates becomes the preferred method for measuring death rates over time, and for comparing death rates between race/ethnic groups, sex, and geographic areas The 1940 United States standard million population was used as the basis for age-adjusting in this report For a more complete explanation of the age-adjusting methodology see the Healthy People 2000 Statistical Notes publication 9 Detailed information on data quality and limitations as well as the formulas used to calculate vital statistics rates are presented in the appendix of the annual report, Vital Statistics of California10 Another source of information is the Department of Health Services, Center for Health
Statistics Home Page [wwwdhscagov/org/hisp/chs/chsindexhtm]

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References: 1 Centers for Disease Control and Prevention Diabetes Surveillance, 1997 Atlanta, GA, US Department of Health and Human Services, 1997 Diabetes Data: Prevalence and Risk Factors Health Services, March 1997 The Burden of Diabetes in California Services, March 1998 Diabetes Control Program, California Department of

2

3

Diabetes Control Program, California Department of Health

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