Figure 2 Diabetes-Related Hospital Discharges by Race/Ethnicity and Gender, 1988 conditions include diabetes, cancer, hearing or visual impairments and …
Community Health Improvement Partners
CHRONIC AND DISABLING CONDITIONS
Figure 1 Assessment of Overall Health Status by Gender San Diego County 1997 121 Figure 2 Assessment of Overall Health as Excellent by Race/Ethnicity 1997 121
Diabetes 126
Figure 1 Estimated Diagnosed Diabetes by Race/Ethnicity, San Diego County 1996 127 Figure 2 Diabetes-Related Hospital Discharges by Race/Ethnicity and Gender, 1988-1992, San Diego County 129 Table 1 San Diego vs the Nation: Estimated Diabetes Prevalence 127 Table 2 Estimated Diagnosed Diabetes by Race/Ethnicity and Age, San Diego County, 1996 129
Asthma 134
Figure 1 Asthma Hospitalization Rates by Race/Ethnicity San Diego County, 1995-1996 135 Table 1 San Diego vs the Nation–Asthma Hospitalization Rates 135
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CHRONIC AND DISABLING CONDITIONS
Diabetes
Background
A chronic disease is a prolonged illness that is recurring and seldom cured1 The most common chronic conditions responsible for disabilities for adults are arthritis, heart disease, back conditions, lower extremity impairments and intervertebral disc disorders Other chronic conditions include diabetes, cancer,
hearing or visual impairments and Alzheimers Disease1 The most common chronic conditions for youth under 18 years of age are asthma, mental retardation, mental illness and learning disabilities1 Learning disabilities include developmental speech and language disorders, academic skill and attention disorders, and coordination disorders and learning handicaps2
Asthma
Size
San Diego County
One-third of women and one-fourth of men surveyed in San Diego in 1996 reported excellent health5
Fig 1
Asian/PI and Hispanics were less likely to report overall excellent health Native Americans were the most likely to report excellent health5 African Americans were the most likely to report excellent health from ages 18 24 40 but least likely after age 65 85 Fig 2
National
Over 90 million Americans about 33 of the US population live with a chronic disease1 At least 10 of Americans have a disability, which is a limitation of the ability to perform major activities caused by chronic health conditions and impairments5
Children and Adolescents
Seven percent of children age 5 17 are physically limited by a chronic condition6 At least one in five children and adolescents may have a diagnosable
mental, emotional, or behavioral problem that can lead to school failure, alcohol or other drug use, violence, or suicide Early onset mental disorders have been found to be strongly associated with reduced educational attainment7 Nine to thirteen percent 35 to 4 million of youth age 9 to 17 years experience a serious emotional disturbance SED that imposes substantial functional impairment in daily living, school, family, and community activities7 Nearly four million school-age children have learning disabilities Of these, at least 20 have a type of disorder that leaves them unable to focus their attention2 Attention deficit disorder is one of the most common mental disorders among children If affects 3 to 5 percent of all children, perhaps as many as two million American children On the average, at least one child in every classroom in the US needs help for attention deficit disorder2 Cardiovascular Diseases and Cancer are highlighted in separate Health Issue Briefs
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Figure 1
Assessment of Overall Health Status by Gender San Diego County 1997,4
Excellent 283 252 305
349 361 341 204 181 220 116 Fair 90 48 Poor
00
Very Good
C H R O N
Overall Male Female
Good
155
I C
500
21 45
100 200 300
400
Figure 2
C O N
290
Assessment of Overall Health as Excellent by Race/Ethnicity 1997,4
Asian/PI
00 170 230 260 400
D I T
380 400
Black
80 230
270 300
Hispanic
140
210
Native American White
190
290 290 310
I O N
Overall 18-24 26-64 65
360 340
Other
N/A
180
240 260 283 316 295
S
Overall
182
00
100
200
300
400
500
Based upon self-report
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Arthritis
In 1994, over 33 million Americans had arthritis with 275 million being over the age of 455 Arthritis affects more than 15 of the US population over 40 million Americans, more than 20 percent of the adult population, and 50 percent of persons age 65 and older, making it one of the most prevalent conditions and the leading cause of disability in the US7
Low Back Pain
The annual incidence of low back pain is 5 to 14 percent and the lifetime reported prevalence ranges from 60 to 90 percent Low back pain disables 54 million Americans each year7
Alzheimers
Five to six percent of older people, approximately 3 to 4 million
Americans, have Alzheimers disease or a related dementia2 Research indicates that 1 percent of the population aged 65-74 has severe dementia, increasing to 7 percent of those aged 75-84, and 25 percent of those 85 or older2 At least half of the people in US nursing homes have Alzheimers disease or a related disorder2 Alzheimers disease is thought to be responsible for 60 to 70 of all cases of dementia and one of the leading causes of nursing home placements7
Seriousness
Years of Productive Life Lost: Chronic diseases account for one third of the years of productive life
lost before the age of 651 Seventy percent of all deaths in the US are attributed to a chronic disease, including cardiovascular diseases and cancer1 Sixty percent of the nations medical costs are spent on chronic ailments1
Alzheimers
In 1996, there were 21,166 deaths in the United States from Alzheimers Disease an age adjusted death rate of 3 deaths per 100,000 population5 In 1996, Alzheimers Disease ranked as the 14th cause of deaths for all age groups and the 9th cause of death for Americans age 65 and over5 In 1985, the annual cost of caring for individuals with Alzheimers disease and related dementias in
institutional and community settings was estimated between 24 billion and 48 billion for direct costs alone2
Low Back Pain
Low back pain costs at least 16 billion each year in the US7
Community Concerns
Focus Group Discussion Points:
The South San Diego County group ranked chronic disease among their primary priorities This group felt that they needed proper education and care The African American and Senior groups both felt that chronic diseases are prevalent in their communities but they are not receiving the necessary care
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Risk Factors
Risk factors for adult chronic conditions include:7 Smoking and substance abuse Weight, diet, and physical inactivity Race/Ethnicity Risk factors for Alzheimers disease include:2 Increased age 25 of people over 85 suffer from Alzheimers or other severe dementia Genetics or inherited factors Biochemistry People who are overweight and people who frequently bend over or lift heavy objects are more likely to report low back injuries7 Risk factors for learning disabilities include: Brain development and genetics Tobacco, alcohol,
and other drug use Complications during pregnancy or delivery Toxins in the childs environment
2
C H R O N I C C O N D I T I O N S
High Risk Populations
Ages: Seniors Ethnicitys: Not Available County Areas: Not Available
Two to three time more boys than girls are affected by attention deficit disorder2 Arthritis is more prevalent among women than among men5
Prevention
Prevention recommendations for chronic conditions include:1 Increasing physical activity Improving diet Smoking cessation Interventions to prevent low back injury include education, physical conditioning, weight loss, and/or task or environmental redesign7
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Resources
Local
San Diego Regional Center for the Developmentally Disabled, 619 576-2996 Autism Society, 619 281-7165 Down Syndrome Association, 619 670-4494 United Cerebral Palsy Association, 619 571-7803 Easter Seal Society, 619 541-0991
National
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, wwwcdcgov/nccdphp
Older Adults
Alzheimers Association, 619 537-5040, wwwalzorg Alzheimers Family Center, 619 543-4700 Arthritis
Foundation, 619 492-1090, wwwarthritisorg National Institute on Aging, National Institutes of Health, wwwnihgov/nia National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, wwwnihgov/niams
Children/Youth
San Diego Center for Children, 619 277-9550 Exceptional Family Resource Center, 619 268-8252 Childrens Hospital and Health Center, Outpatient Psychiatry, 619 576-5832 Mental Health Services, Children and Adolescents, 619 221-8672 California Childrens Services, 619 560-3400 San Diego Unified School District, Special Education, 619 293-8686 Office of Education, Special Education, 619 292-3500 American Academy of Child and Adolescent Psychiatry, wwwaacaporg American Academy of Pediatrics, wwwaaporg
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References
1 2 3 4 5 6 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion Retrieved from the World Wide Web: http://wwwcdcgov/nccdphp National Institutes of Mental Health Retrieved from the World Wide Web: http://wwwnimhnihgov California Department of Health Services
1996 Behavioral Risk Factor Survey Sacramento, CA United Way of San Diego County 1998 San Diego County Report Card: Outcomes and Community Impact Measurement Program Centers for Disease Control and Prevention National Center for Health Statistics FASTATS Retrieved from the World Wide Web: http://wwwcdcgov/nchswww/fastats/fastatshtm Federal Interagency Forum on Child and Family Statistics 1998 Americas Children: Key National Indicators of Well-Being, 1998 Retrieved from the World Wide Web: http://wwwchildstatsgov United States Department of Health and Human Services 1998 Healthy People 2010, Draft Report for Public Comment Washington, DC: US Government Printing Office
C H R O N I C C O N D I T I O N S
7
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Community Health Improvement Partners
DIABETES
Background
Diabetes is a chronic illness in which the body cannot produce or properly use insulin, a hormone needed to convert sugar into energy Diabetes is a disorder of metabolism–the way the body digests food for energy and growth1 Approximately 5-10 of individuals with diabetes have Type I diabetes, also known as insulindependent diabetes mellitus or juvenile-onset diabetes The other 90-95 have Type II
diabetes which is non-insulin dependent or adult-onset diabetes Gestational diabetes develops in 2-5 of all pregnancies but disappears when the pregnancy is over2
Size
San Diego County
In San Diego County, it is estimated that 84,000 or 43 of the countys adult population have been diagnosed with diabetes3 Of these, it is estimated that 5-10 have type 1 diabetes and 90-95 have type 2 diabetes An estimated 1,170 of San Diegos children and youth under age 18 have diabetes3
Fig 1
In 1995, there were 370 deaths directly due to diabetes in San Diego County, plus many more deaths for which diabetes was a contributing cause3
County Rates and Trends: Not Available
National
Diabetes is the seventh leading cause of death in the US4 Six percent or 157 million people in the US have diabetes Approximately 90-95 149 million have type 2 diabetes While an estimated 103 million have been diagnosed with diabetes, unfortunately, 54 million people are not aware that they have the disease2 Each day approximately 2,200 people are diagnosed with diabetes About 798,000 people will be diagnosed this year2 Approximately one half of all diagnosed cases of diabetes are among persons over the age of 652
Although diabetes occurs most often in older adults, it is one of the most common chronic disorders in children in the United States About 127,000 children and teenagers age 19 and younger have diabetes1
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Figure 1
Estimated Diagnosed Diabetes by Race/Ethnicity,
70 60 50 40 30
643
C H R O
227
N I
53 76 Asian/ PI
20 10 0 White Hispanic Black
C C O N D I T I O N S
San Diego County 19963
Table 1
San Diego vs the Nation: Estimated Diabetes Prevalence3
San Diego County 1996 43 County Trends California National HP2000 Objective
Not Available
44
59
25
Based on adult self-report
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Seriousness
Years of Productive Life Lost: Not Available Healthy People Objective 2000: The San Diego County prevalence of diabetes 43 of the
population is higher than the Healthy People 2000 objective 253 In 1996, there were 61,767 deaths from diabetes in the US an age adjusted death rate of 136 deaths per 100,000 population4 In 1996, there were 503,000 hospital discharges and 189 million ambulatory care visits from
diabetes See Table 2 for San Diego County information The average length of a hospital stay for diabetes was 63 days4 Diabetes is the seventh leading cause of death in the United States and contributed to more than 187,000 deaths in 19952 Compared to persons without diabetes, diabetic patients have a higher hospitalization rate, longer hospital stays, and increased ambulatory care visits5 Health care and other costs directly related to diabetes treatment, as well as the costs of lost productivity, run 92 billion annually Some estimates run as high as 138 billion which includes all health care costs incurred by people with diabetes2 Diabetes is the leading cause of blindness in adults ages 20-74 and accounts for over 8,000 new cases of blindness each year Infants born of diabetic women are at increased risk of fetal malformation, prematurity, spontaneous abortion, macrosomia, and metabolic derangements People with diabetes experience mortality rates 2 to 4 times greater than nondiabetic persons, especially from cardiovascular disease6
The American Diabetes Association reports that:2
Diabetes can cause: School and work absenteeism Increased hospitalization Frequent emergency room
visits Permanent physical disabilities Diabetes can cause health problems leading to: Vision impairments including glaucoma and blindness Kidney disease Nerve disease Amputation Heart disease and stroke
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Table 2
Estimated Diagnosed Diabetes by Race/Ethnicity and Age, San Diego County, 19963
Females All Ages All Races White 84,300 49,100 18-34 35-54 55 All Ages Males 18-34 35-54 55
8,200
13,700 27,200 35,200
3,800
10,200 21,200
C H R O N I C
54,200 29,900
4,400 2,500 700
7,500 4,100 1,100
18,000 24,300 5,900 1,400 6,600 1,300
2,500 500 na
6,000 3,200 400
15,800 2,800 900
Hispanic 19,100 12,500 Black API/ Other 4,500 3,200
6,400
3,500
600
900
1,900
3,000
800
600
1,600
Figure 2
C O N D I T I O N S
Diabetes-Related Hospital Discharges by Race/Ethnicity and Gender, 1988-1992, San Diego County3
35,000 30,000 25,000 20,000 15,000 10,000 6,268 5,000 0 5,321 3,970 2,382 30,976 28,754
Females Males
2,925
2,102
White
Hispanic
Black
Other
Based on adult self-report
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Community
Concerns
Focus Group Discussion Points:
African Americans report lack of awareness in the community about problems associated with diabetes Diabetes was a major concern for Latinos and African Americans and the Asian/PI group Latinos said they did not have educational programs to teach them about diabetes All groups reported poor continuity of care
Risk Factors
Risk factors for diabetes include: 2,6 Family history and genetics Overweight Sedentary lifestyle Poor diet Being over the age of 45 High cholesterol Ethnicity Culture/Community Traditions Social/Economic Factors
High Risk Populations
Ages: Seniors
184 of all senior persons have diabetes Seniors who suffer from the disease are twice as likely to be hospitalized for a kidney infection2
Ethnicitys: People of color2
Nationally, 122 of Native Americans, 108 of African Americans and 106 of Hispanic Americans have diabetes compared to 59 of Americans overall
Gender: Women3
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County Areas: Not Available
For Type 1 diabetes:2 Siblings of people with type 1 diabetes Children of parents with type 1 diabetes For Type
2 diabetes:2 People over age 45 People with a family history of diabetes People who are overweight People who do not exercise regularly People with low HDL or high triglycerides Certain racial and ethnic groups eg, African Americans, Hispanic Americans, Asian Pacific Islanders, and Native Americans Women who had gestational diabetes, a form of diabetes occurring in 2-5 percent of all pregnancies or who have had a baby weighing 9 pounds or more at birth
C H R O N I C C O N D I T I O N S
Prevention
Diabetes can be controlled with medication and lifestyle changes eg, exercise and healthy diet1 It may be possible to prevent or delay the onset of type 2 diabetes by reducing lifestyle risk factors through weight loss and increased physical activity2 Interventions that are inexpensive and safe including exercise, prudent diet, and weight loss5
Model Programs
Project Dulce, Community Diabetes Care Program, Scripps Whittier Institute for Diabetes, San Diego, California8
Goal of the program is to improve the quality of life among low-income persons with diabetes Specifically focuses on Latino, African-American, and Asian-American populations Proactively addresses the cultural,
behavioral, and health system barriers to optimum diabetes management Program components include self management education programs, community outreach programs, and intensive one on one case management
State Diabetes Control Programs include:7
The Maine Diabetes Control Program arranged a diabetes outpatient education program in more than 30 hospitals and health centers throughout the state In a 3-year period, this state education program resulted in a 32 reduction in hospital admissions related to diabetes–a savings of 300 per participant
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The Michigan Diabetes Control Programs Upper Peninsula Diabetes Outreach Network established a diabetes care and education program with hospitals, health departments, and home care agencies Participants in the program experienced a 45 lower rate of hospitalizations, a 31 lower rate of lower-extremity amputations, and a 27 lower death rate than nonparticipants This program has been replicated in five new outreach networks throughout the state The Oregon Diabetes Control Program helped improve the delivery of preventive care by developing measurements that describe both the care
provided to people with diabetes and their health status These measures match those in Oregons Population-Based Guidelines for Diabetes Mellitus The specifications are available for use by managed care organizations that are ready to develop reporting systems that describe the organizations diabetic population and the services provided to these people
Resources
American Diabetes Association, 619 234-9897, wwwdiabetesorg Juvenile Diabetes Association, 619 279-9160 California Diabetes Control Program, California Department of Health Services, 916 445-2547 Scripps Whittier Institute for Diabetes, 619 450-1280 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, wwwcdcgov/nccdphp National Institute for Diabetes and Digestive and Kidney Diseases , National Institutes of Health, wwwniddknihgov
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References
1 2 3 4 5 6 7 8 National Diabetes Information Clearinghouse Retrieved from the World Wide Web: http://wwwniddknihgov/health/diabetes/ndichtm American Diabetes Association Retrieved from the World Wide Web:
http://wwwdiabetesorg California Diabetes Control Program 1998, March The Burden of Diabetes in San Diego County California Department of Health Services Sacramento, CA Centers for Disease Control and Prevention National Center for Health Statistics FASTATS Retrieved from the World Wide Web: http://wwwcdcgov/nchswww/fastats/fastatshtm US Preventive Services Task Force 1996 Guide to Clinical Preventive Services, 2nd Edition Retrieved from the World Wide Web: http://textnlmnihgov United States Department of Health and Human Services 1998 Healthy People 2010, Draft Report for Public Comment Washington, DC: US Government Printing Office National Center for Chronic Disease Prevention and Health Promotion Retrieved from the World Wide Web: http://wwwcdcgov/nccdphp/diabeteshtm Project Dulce, Scripps Whittier Institute for Diabetes, 619 450-1280
C H R O N I C C O N D I T I O N S
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ASTHMA
Background
Asthma is a disease characterized by shortness of breath, wheezing, tight chest, and coughing Asthma is attributed to familial, infectious, allergenic, socioeconomic, psychosocial and environmental factors Some of the triggers of
asthma include:1 Dust Emotional upsets Smoke Pollen Mold
Size
San Diego County
During 1996, over 3,000 people in San Diego County were hospitalized for asthma Fig 1
San Diego County Asthma Hospitalizations Table 1 1996 Rate: 1122 per 100,000 population 1995-1996 Trend: Decreased from 1450 to 1122 per 100,000
National
Nationwide, the prevalence and death rates of asthma have increased over the last several years2 An estimated 149 million Americans have asthma The prevalence of asthma is increasing in all age groups, especially younger than age 18 nearly 5 million3 Among chronic conditions affecting children, asthma is the one condition that is most prevalent It is estimated that more than 7 percent of children in the US have asthma4 People with asthma experience well over 100 million days of restricted activity annually, and the total annual costs of the disease are estimated at 62 billion4
Seriousness
Healthy People 2000 Objective: The San Diego County rate of asthma hospitalizations 1122 per
100,000 is less than the Healthy People 2000 Objective 1600 not age adjusted Asthma is the leading cause of chronic illness in children3 Between 400,000 and 1 million asthmatic children
have their condition worsened by exposure to secondhand smoke5 In 1996, there were over 5,500 asthma-related deaths in the US2 Annually, there are approximately 11 million office visits resulting in an asthma diagnosis and 284 million drug mentions for asthma2 Over 500,000 hospitalizations, 5,000 deaths, and more than 133 million days of restricted activity are due to asthma every year3 The rate of hospitalizations among African Americans was nearly triple that of whites in 19934 Some of the impacts of asthma include:2 School absenteeism Increased hospitalization Frequent emergency room visits Economic cost hospital costs Inability to participate in physical activity
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Figure 1
Asthma Hospitalization Rates by Race/Ethnicity San Diego County, 1995-19966
3331 n543 1144 n236 2038 n1,222 904 n17 1046 n1,743 1450 n3,854 2768 n455 866 n184 1468 n909 826 n16 820 n1,363 1122 n3,008
0 100 200 300
Black Asian/PI Hispanic Native American White Overall
C H R O N I C C
500
1995
1996
400
O N D I T I O N S
Table 1
San Diego vs the Nation–Asthma Hospitalization Rates,6
San
Diego County 1996 County Trends 1995-1996 Decreased 1450-1122 California 1991 National 1995 HP2000 Objective
1122
1466
194
1600
not age adjusted
Rates per 100,000 population
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Risk Factors
The odds of developing asthma are twice as high among children whose mothers smoke at least 10 cigarettes a day5 Between 400,000 and 1 million asthmatic children have their condition worsened by exposure to secondhand smoke5 Socioeconomic status, particularly poverty, is an important contributing factor to asthma morbidity and mortality3 Asthma disproportionately affects children, minorities, and the poor3
High Risk Populations
Ages: All Ethnicitys: African Americans and Latinos
The San Diego County 1996 asthma hospitalization rates were much higher for African Americans 2768 and also high for Hispanics 1468 compared to the overall rate 1122
County Areas: Not Available
Asthma rates are higher is boys than in girls under 18 years The prevalence of asthma is greater for women 67 than for men 52 and greater for African Americans 67 than for whites 563
Prevention
Morbidity and mortality due to asthma are largely preventable
with improved education and management of disease2 According to Healthy People 2010, asthma education needs include: 3 Professional education to disseminate and promote adoption of the existing guidelines; to ensure appropriate diagnosis and management of asthma Patient education to teach patients essential asthma management skills Community education and outreach efforts to raise awareness about asthma Additional asthma recommendations include: 3 Interventions to ensure access to medical care and appropriate financial support for medication, monitoring aids, and environmental control measures are essential to reduce the disproportionate burden of asthma among minorities and the poor Early identification of patients with severe asthma and optimal management of asthma in such patients will prevent the development of irreversible lung changes Work with local community groups to mobilize community resources for a comprehensive approach to controlling asthma among high-risk populations remains a priority
Model Programs
National Asthma Education and Prevention Program, National Heart, Lung, and Blood Institute, National Institutes of Health4
For Patients and the Public:
Increase
public awareness of asthma as a significant public health problem Increase public awareness of the signs and symptoms of asthma
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Improve the knowledge, attitudes, and skills of patients regarding the detection, treatment, and control of asthma, particularly in high-risk populations Define guidelines for effective asthma education programs Promote development, dissemination, and use of patient and family education materials
For Health Professionals:
Increase knowledge, attitudes, and skills of all health professionals regarding signs, symptoms, and management strategies for asthma Encourage health professionals treating patients with asthma to adequately track and monitor patient status and to use objective measures of lung function Assist and encourage health professional schools and continuing education programs to include upto-date and accurate information on diagnosis, pathogenesis, and treatment of patients with asthma Promote and encourage the concept of active patient participation with the physician in the management of asthma Develop resources and materials
for use by health professionals Promote research to answer unresolved questions about underlying causes of asthma and appropriate asthma treatment and management practices
C H R O N I C C O N D I T I O N S
Resources
National Center for Chronic Disease Prevention and Health Promotion, wwwcdcgov/nccdphp/nccdhomehtm American Lung Association, 619 297-3901, wwwlungusaorg Global Initiative for Asthma, wwwginasthmacom National Center for Environmental Health, Centers for Disease Control and Prevention, wwwcdcgov/nceh National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, wwwcdcgov/nccdphp National Institute for Allergy and Infectious Diseases, wwwniaidnihgov National Heart, Lung, and Blood Institute, wwwnhlbinihgov
References
1 2 3 4 5 6 American Lung Association Retrieved from the World Wide Web: http://wwwlungusaorg Centers for Disease Control and Prevention National Center for Health Statistics FASTATS Retrieved from the World Wide Web: http://wwwcdcgov/nchswww/fastats/fastatshtm United States Department of Health and Human Services 1998 Healthy People 2010, Draft Report for Public Comment Washington, DC: US Government
Printing Office National Heart, Lung, and Blood Institute Retrieved from the World Wide Web: http://wwwnhlbinihgov Centers for Disease Control and Prevention Tobacco Information and Prevention Source TIPS Retrieved from the World Wide Web: http://wwwcdcgov/nccdphp/osh/indexhtm Data based on information provided to the County of San Diego Health and Human Services Agency from the Office of Statewide Health Planning and Development, Hospital Discharge Data, 1996
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