Community Health Profile 2013 - Riverside County Public Health

Transcription

The Health of Riverside County
A Community Health Profile
2
3
TABLE OF CONTENTS
Executive Summary .…………………………………………………………………………………………. 3
Acknowledgements ………………………………………………………………………………………….. 5
Introduction ……………………………………………………………………………………………………... 6
I.
Demographic and Social Indicators
Riverside County Profile …...…..…...…………………………………………………………… 8
Population Changes .…….…………………..………..…..………………….……………...……. 9
Education ..……………………………...…………………………………………………………….…. 10
Unemployment …………………….……....…………………………………………………………. 11
Poverty ..…………………..……………………………………………………………….……………... 12
Health Insurance …………………...…….….……………………………………………………….. 14
Commuting to Work ..……..………………...……………………..……………………………... 15
II.
Health Status
Fertility, Births and Infant Mortality …………..……………………………..……………... 18
Births …………..…………………………………………………………………………………………... 20
Low Birth Weight and Prenatal Care ...…….……………………………………..………... 22
Infant Mortality …...…………………………………………………………………………………... 24
Mortality ..………………………………………………………………………………………………... 25
Heart Disease .…………………………………..……………………………………………………... 30
Cancer .…………………………………………………………………………………………………….. 32
Chronic Lung Disease ………………………………….…………………………………………... 35
Stroke ………………………….…………………………………………………………………………… 37
Diabetes …………………………………………….…………………………………………………….. 40
Intentional and Unintentional Injury .………………………………………………………. 42
The Chronic Disease Burden …………………………………………………….……………… 48
Asthma …………………………………………………….………………………………………………. 49
Diabetes Prevalence ………………………………………………………………………………... 51
Overweight and Obesity Prevalence …….…………………………………..……………... 53
III.
Health Behaviors
Nutrition and Dietary Practices .………………………………………………………………. 58
Physical Activity .………………………………………………………………………………………. 63
Alcohol and Tobacco Use …………….………………………………………………………….. 64
TABLE OF CONTENTS
Children’s Leisure Time …..……..…………………………………………..……………………. 67
Prevention and Early Detection …………….…….…..………………………………………. 69
IV.
Appendix
Data Tables ……..…………...………………………………………………………………………….. 76
Technical Notes ………………………………………………………………………………………. 80
2
EXECUTIVE SUMMARY
The mission of the County of Riverside Department of Public Health (DOPH) is to promote and
protect the health of all county residents and visitors. This report, the 2013 Community Health
Profile, will help guide our efforts and highlight areas where we can improve the health and
well-being of Riverside County residents.
The residents of Riverside County could be healthier. Better diet, more physical
activity, and less substance use can significantly improve health outcomes and advance the
quality of life.
♦ Fast food consumption has risen in Riverside County, with more residents consuming fast
food four or more times during the recent survey week. By comparison, fewer residents
ate five or more servings of fruits and vegetables.
♦ Nearly three-quarters of Riverside County children were physically active for at least three
days each week, however, only one-quarter were physically active for at least one hour each
day. Physical activity levels may be hindered by an excessive amount of television viewing,
because 90 percent of children report 2-5 hours of screen time during the weekend.
♦ In terms of substance use, binge drinking rates have remained stable for the past few years,
while tobacco use has increased since 2005.
The 2013 Community Health Profile and other community health assessments will be used to
set health priorities. Addressing risk factors of chronic disease such as poor nutrition, physical
inactivity, tobacco use and exposure, and the physical/built environment will be key priorities.
DOPH looks forward to working with our community partners and residents to realize our
vision of a healthy Riverside County.
Susan Harrington, MS RD
Director of Public Health
3
EXECUTIVE SUMMARY
As 2013 begins, the County of Riverside Department of Public Health (DOPH) is positioning
itself for a new era of community involvement and population health improvement. The 2013
Community Health Profile will serve as the foundation to assess the health of the community
and is a starting point for our joint efforts to affect change. Let’s work together to make
Riverside County a healthier place to live.
I look forward to 2013 and to the many fruitful collaborations it will bring.
Cameron Kaiser, MD
Interim Public Health Officer
4
ACKNOWLEDGEMENTS
This report was prepared by: Marshare Penny
Other County of Riverside, Department of Public Health staff who assisted with this
Report include: Jose Arballo, Erin Curlee, Aaron Gardner, Lael Gardner-Stalnaker, Susan
Harrington, Wayne Harris, Wendy Hetherington, Cameron Kaiser, Sarah Mack, Kevin Meconis,
and Michael Osur.
Please use the following citation when referencing this report:
County of Riverside, Department of Public Health. Community Health Profile, 2013.
We appreciate any questions or comments that you may have about this report and welcome
recommendations for improving subsequent reports. If you have any comments to share
please contact us at:
Epidemiology and Program Evaluation
County of Riverside, Department of Public Health
4065 County Circle Drive, STE 211
Riverside, CA 92503
or electronically at:
www.rivcohealthdata.org
5
INTRODUCTION
The Community Health Profile 2013 is a report summarizing the health of the residents of
Riverside County. Herein, health is described with a valuable look at the health issues and
risk factors affecting Riverside County residents. The report is divided into three sections: (a)
Demographic and Social Indicators, (b) Health Status, and (c) Health Behaviors. These
sections provide an overview of the health of Riverside County residents measured by an
array of indicators. These indicators include births, deaths, illness, and behavioral measures
to name a few.
Data described in this report come from multiple sources, including California’s Birth and
Death Statistical Master Files, the California Health Interview Survey (CHIS), the US Census
Bureau, and the California Department of Public Health. These data provide an opportunity
to highlight the County’s successes as well as areas where challenges remain.
To best understand the data reported for Riverside County, where possible and appropriate,
Riverside County is compared to California and Healthy People 2020 national objectives. This
practice allows for better contextualization of outcome measures as well as the circumstances
that contribute to such measures. An asterisk (*) may be present on graphics to indicate the
statistical instability of a rate. The instability may be due to the small population size of the
group being measured. In this instance, the rate is considered statistically unreliable and
should be interpreted with caution. For further information on rate stability, refer to the
Technical Notes in the Appendix.
Health disparities are illustrated across differing race and ethnic groups, sex, and ages.
Health disparities are differences in the incidence, prevalence, mortality, and survival of a
disease.1 These disparities are most often the result of inequalities in the social determinants
of health, where we live, work and play. The relationship between the social determinants of
health and health outcomes will be investigated further in subsequent reports.
The release of the 2013 edition of the Community Health Profile is an important first step in
improving the health for all in Riverside County and realizing our vision of Healthy People,
Healthy Community!
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I. DEMOGRAPHIC AND SOCIAL INDICATORS
Demographics are ways to measure the characteristics of a population. The makeup of a
population, such as its race and ethnic profiles, sex, age groups, and many additional social
factors helps in examining trends and determining needs for the community.
This section of the report will describe the demographic profile of the population of Riverside
County. Indicators such as race and ethnicity, sex, education, poverty, unemployment, health
insurance status, and commuting practices will be described here in brief.
7
A PROFILE OF RIVERSIDE COUNTY
Spanning 200 miles across and encompassing beautiful fertile river valleys, magnificent
mountains, deserts, foothills, and rolling plains, Riverside County is the fourth largest county in
California comprising over 7,200 square miles. The County covers the same land area as the
state of New Jersey. The County shares borders with Imperial, Orange, San Diego and San
Bernardino counties; as well as the State of Arizona.
Established in 1893, Riverside County has grown from a population of 18,000 to 2.2 million
residents. Within the last decade, the County has experienced a 44% increase in population,
placing the County in fifth place for population growth in the US.2
There are 28 incorporated cities in Riverside County. Since the 2008 Community Health Profile,
two additional cities have been incorporated. These include Eastvale, which was incorporated
on October 1, 2010 and Jurupa Valley, which was incorporated on July 1, 2011. Nearly 20% of
the County’s growth between 2001 and 2010 occurred in the two cities of Temecula and
Murrieta.3 If current projections continue, the population of Riverside County will reach 2.9
million in 2020 and 4.7 million in 2050.
8
POPULATION CHANGES
Overview
Population demographics is an indicator used
to measure changes in the age, gender, and
racial and ethnic distribution of a population.
Why does this matter to health?
Monitoring demographic indicators is critical in
anticipating levels of demand and utilization of
the health care system. Changes in the age distribution, racial and ethnic groups, those who
identify as LGBT, and those with disabilities
illustrate social, economic, educational, and
cultural diversity that will impact health
planning. Health disparities among diverse
groups exist at elevated levels.
Riverside County Population by Race/Ethnicity,
Years 2000, 2010, and 20204
Asian/PI,
4%
White,
51%
Hispanic,
36%
American
Indian,
1%
Multirace,
2%
Year 2000 Population: 1,559,039
On average, more than 32,000 babies are born
and nearly 14,000 deaths occur each year in
Riverside County. In addition to the 44%
increase in population between 2000 and
2010, Riverside County has experienced
changes in its racial and ethnic composition.
Asian/PI,
5%
Black, 6%
White, 45%
Hispanic,
42%
During the last decade, the proportion of
those identifying as Hispanic increased from
36% to 42%. The proportion of Whites
decreased from 51% to 45%. For the other
racial and ethnic groups within the County,
there was little to no change in population
proportions.
Multirace,
2%
American
Indian, 1%
Year 2010 Population: 2,239,053
Asian/PI,
5%
Black, 6%
Based on current projections, the groups
that will experience the greatest changes
include those of Hispanic origin and
Whites.
♦ By 2020, Riverside County population will
be primarily comprised of Hispanics and
Whites (46% and 40%, respectively).
♦ Between 2009 and 2010, Riverside
County’s population increased by almost
40,000 residents. Approximately 6,000 of
those residents (15%) were in the Riverside
and Corona areas.2
♦
Black, 6%
White, 40%
Hispanic,
46%
Multirace,
2%
American
Indian, 1%
Year 2020 Population Projection: 2,904,848
9
EDUCATION
Overview
Educational attainment is an indicator used to measure the percent of residents 18 and older
who have completed various levels of education. Riverside County trails the state in the
proportion of residents with bachelor’s and advanced college degrees. Nearly one-quarter of
residents have less than a high school diploma.
It is well documented that education is a positive predictor of income which in turn is
correlated with better access to resources such as healthy foods, knowledge of healthier eating
practices, and health care. These can have a positive effect on health outcomes. The rate of
poverty for adults over the age of 25 is nearly six times higher among those with no high
school diploma compared to those with a bachelor’s degree or higher.
Educational Attainment for Persons Age 25 and Older Educational Attainment for Persons Age 25 and Older Riverside County, California, and the US, 2010
Riverside County, California, and the US, 2010
40
40
Percent of Persons Age 25 and Older
Percent of Persons Age 25 and Older
35
35
28.5
28.5
30
30
25
25
20
20
Riverside County
Riverside County
California
California
US
US
33.4
33.4
29.8
29.828.9
28.9
25.1
25.1
21.1
21.119.3
19.3
20.8
20.8
19.1
19.117.7
17.7
14.4
14.4
15
15
13.3
13.3
10
10
5
0
11 10.4
11 10.4
7.1
7.1
5
0
Less than High School Less than High School Diploma
Diploma
High School Diploma
High School Diploma
Some College
Some College
Bachelor's Degree
Bachelor's Degree
Advanced Degree
Advanced Degree
When compared to California, Riverside County has a greater proportion of its population with
high school education completion. About 50% of Riverside County residents 18-24 years old
have a high school education or less. Fewer (4.4%) residents 18-24 years have a bachelor’s
degree or higher, compared to those in California (7.8%) and in the US (9.2%). Twenty percent
of residents 25 years and older have a bachelor’s degree or higher. This is higher than the rate
among those 24 years and under, where only 4.4% have bachelor’s degrees or more. According
to census data for Riverside County, fewer males are high school graduates or above compared
to females.
Completing high school positively affects the choice to attend and complete college. The high
school dropout rate for Riverside County is 3.7%. This rate is lower than California’s rate of
4.2%. Asian students have the lowest drop out rate (1.4%), while Black students have the
highest rate (5.3%).
10
UNEMPLOYMENT
Overview
The health of an economy is gauged by the strength of its employment. Strong employment
boosts the economy and helps support community services. High unemployment may lead to
an increase in the need for community services. Riverside County has elevated rates of
unemployment compare to California and the US. Between 2008 and 2010, the county lost
151,900 jobs. Nearly half of the jobs that were lost were in construction and manufacturing.
Employment is positively related to health. Those who work often report better physical
health when compared to those who are unemployed or retired.4 In a study by the Harvard
School of Public Health, workers who lost a job, through no fault of their own were twice as
likely to report developing an ailment such as high blood pressure, diabetes, or heart disease
over the following year and a half, compared to those who maintained continuous
employment.5
Annual Average Rate of Unemployment
Annual Average Rate of Unemployment
Riverside County, California and the US, 2001‐2010
Percent of persons Unemployed
Percent of persons Unemployed
16%
16%
Riverside County
Riverside County
California
California
US
US
14%
14%
12%
12%
10%
10%
8%
8%
6%
6%
4%
4%
2%
2%
0%
0%
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
Rates of unemployment in Riverside County, California and the US have been on a steady
increase since 2007 reaching its peak in 2010. Since 2007, the unemployment rate in Riverside
County more than doubled, from 6% to 14.7%. Between 2000 and 2010, rates of
unemployment in Riverside County have exceeded the rates for California and the US (except
in years 2002, 2003, and 2004).
In the Inland Empire* the unemployment rate for 2010 was 15.3%, with the lowest rate among
Asians (9.8%) and the highest rate among Blacks (21.6%). In 2010, Inland Empire residents with
less than a high school diploma experienced unemployment at a rate 2.5 times higher than
those with a bachelor’s degree or higher (18.9% and 7.1% respectively).
* Inland Empire refers to Riverside and San Bernardino Counties. Data solely for Riverside County was not available.
11
POVERTY
Overview
Poverty is defined as having little or no money, food, or many other resources. Poverty is
estimated based upon reported income and family size.
It is well established that an individual’s health is based on the combined effect of many
different factors acting on each other. Poverty and health are closely intertwined. Poverty has
a negative effect on health by limiting access to healthier food, better housing and safer
environments.
Federal Poverty Measure
Poverty is measured by the federal government using poverty guidelines. More specifically,
the US Census Bureau uses a set of income thresholds to determine poverty status based
upon family size. When a family’s income is less than the threshold set for the family’s size,
the family and all members are considered at or below poverty. For example, according to the
2010 poverty thresholds, a family of four with an annual household income of $22,314 or less
is considered at or below the federal poverty level.
Families Below the Poverty Level, Families Below the Poverty Level, Riverside County, California and the US, 2005‐2010
Percentage of Families
Percentage of Families
12.5%
12.5%
12.0%
12.0%
11.5%
11.5%
11.0%
11.0%
10.5%
10.5%
10.0%
10.0%
9.5%
9.5%
9.0%
9.0%
8.5%
8.5%
8.0%
8.0%
2005
2005
2006
2006
2007
2007
Riverside County
Riverside County
2008
2008
California
California
2009
2009
2010
2010
US
US
In 2005, the percent of families below the poverty level was lower in Riverside County
compared to the rate for California and the US. For Riverside County, California and the US,
the percentage of families below the poverty level has been increasing steadily since 2007;
however, the increase has been much greater in Riverside County compared to the other areas.
In 2010, Riverside County, California, and the US maintained similar rates of families in poverty
(12.2%, 11.8%, and 11.3%, respectively).
12
Families Below the Poverty Level for Past 12 Months, Families Below the Poverty Level for Past 12 Months, Riverside County, California and the US, 2010
Riverside County, California and the US, 2010
Riverside County
Riverside County
California
California
US
US
25%
25%
Percentage of Families Percentage of Families 20%
20%
15%
15%
19.3%
19.3%
15.9% 15.8%
15.9% 15.8%
18.2% 17.6% 17.9%
18.2% 17.6% 17.9%
12.2% 11.8%
12.2% 11.8%11.3%
11.3%
10%
10%
5%
5%
0%
0%
All families
All families
With related children under 5
Poverty is experienced disproportionately by families with children. Families with children
fare poorly, with poverty rates much higher than the rates for all families. This is particularly
important because children in poverty can experience learning difficulties, and social,
emotional and behavioral problems.
13
HEALTH INSURANCE
Overview
Health insurance is important in assisting with health care expenses that may result from
significant illness. Having health insurance also effects a person’s ability to access health care
services.
According to Healthy People 2020, people without health insurance are more likely to lack a
usual source of medical care and are more likely to avoid routine care. This may increase the
likelihood of serious or disabling health conditions. Further, when the uninsured seek care,
they often have large medical bills and out-of-pocket expenses.
25%
25%
Percent with No Health Insurance Coverage, Percent with No Health Insurance Coverage, Riverside County and California, 2001‐2009
Riverside County and California, 2001‐2009
Riverside County
Riverside County
California
California
Percent of Total
Percent of Total
20%
20%
15%
15%
15.7%
15.7%14.6%
14.6%
16.6%
16.2%
16.6%
16.2%
14.0% 13.7%
13.7%
13.2%
14.0%
13.5%
13.2%
13.5%
19.1%
19.1%
14.5%
14.5%
10%
10%
5%
5%
0%
0%
2001
2001
2003
2003
2005
2005
2007
2007
2009
2009
The proportion of Riverside County residents with no health insurance coverage has increased
from 15.7% in 2001 to 19.1% in 2009. This means Riverside County residents have lower health
insurance coverage. Residents of Riverside County have consistently maintained lower health
insurance coverage rates, compared to residents of California. In 2009, one in five (19.1%)
Riverside County residents reported no health insurance coverage, up from 15.7% in 2001.
Differences across racial and ethnic groups in Riverside County for years 2007 and 2009:
♦ 74.5% of Hispanics had health insurance coverage, while 88.5% of Whites had health
Insurance coverage.
Differences in health insurance coverage between children and adults
♦ Since 2001, the rate of children (ages 0-17) with health insurance coverage has increased
from 89.9% to 96.2% in 2009.
♦ Conversely, the rate of adults (ages 18-64) with health insurance coverage has decreased
from 78% in 2001 to 70.5% in 2009.
These differences may reflect an increase in children qualifying for programs such as Healthy
Families and the loss of employee sponsored health coverage through job loss.
14
COMMUTING TO WORK
Overview
Commuting, also described as Journey to Work, refers to a worker’s travel from home to their
place of work. The US Census Bureau conducts surveys that obtain information on the means
of transportation as well as the departure times, travel distance, commuting expenses, and
average travel time.
Increased time spent commuting has been linked to increases in obesity due to more time
spent away from home, less time available to prepare meals, and less engagement in physical
activity. Further, studies have linked long drive times to sleep disturbances, increased stress,
exhaustion, poor self-rated health, and illness.6
In Riverside County, the average travel time to work is:
31.7 minutes each way
15% higher (4.8 minutes longer) than the average for California
20% higher (6.4 minutes longer) than the average for the US
♦
♦
♦
Percent of Commuters Age 16 and Older
Percent of Commuters Age 16 and Older
Employed residents of Riverside County spend, on average, more than 30 minutes commuting
to work, which is higher than commute times for California and the nation. Since 2008, the
average travel time has remained stable in Riverside County, California and the US.
Commuting to Work for those 16 Years and Older,
Commuting to Work for those 16 Years and Older,
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Riverside County
Riverside County
California
California
US
US
78.3%
76.6%
78.3%
73.2% 76.6%
73.2%
12.4%11.5% 9.7%
12.4%11.5% 9.7%
Drive Alone
Drive Alone
Carpooled
Carpooled
5.2% 4.9%
1.5% 5.2% 4.9%
1.5%
Use of Public Use of Public Transportation
Transportation
Among commuting residents (16 yrs. and older) in Riverside County:
♦ Most (78.3%) drive alone; rates have increased 3% since 2008.
♦ Only 1.5% use public transportation.
♦ Since 2008, the proportion of those using public transportation have remained stable;
4 percentage points lower than rates for California and the US.
♦ More Riverside County residents carpool compared to those in California and the nation;
however rates have decreased 2 percentage points (1% drop for CA & US).
15
References:
1.
2.
3.
4.
5.
6.
National Cancer Institute. Health Disparities Defined. Rockville, MD: U.S. Department of Health and
Human Services, National Institutes of Health, National Cancer Institute.
US Census Bureau. (2011). Population Distribution and Change: 2000 to 2010. 2010 Census Briefs.
Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-01.pdf
State of California Department of Finance (2011). E-4 Population Estimates for Cities, Counties and
the State, 2001-2010, with 2000 & 2010 Census Counts. Retrieved from http://www.dof.ca.gov/
research/demographic/reports/estimates/e-4/2001-10/view.php
Ross, C.E. & Mirowsky, J. (1995). Does Employment Affect Health? Journal of Health and Social
Behavior, 36(3), 230-243.
Rabin, R.C. (2009, May 9). Unemployment may be hazardous to your health. The New York Times.
Retrieved from http://www.nytimes.com/2009/05/09/health/09sick.html?_r=0&pagewanted=print
Hanson, E., Mattison, K., Ostergren, P. & Jakobsson, K. (2011). Relationship between commuting
and health outcomes in a cross-sectional population survey in southern Sweden. BioMedical Central
Public Health, 11, 834.
16
II. HEALTH STATUS
Measures of health status provide information about the health of populations. Over the past
four decades the health of the nation has been monitored through the Healthy People initiative
by the use of health indicators. These indicators are useful in determining the effectiveness of
health strategies and indicating where the nation can strive for improvement. According to the
CDC, life expectancy and overall health have improved for most Americans in recent years, but
not all Americans have benefited equally.
This section will describe the health trends for Riverside County residents using health status
indicators. These indicators include: fertility rates, birth rates, mortality rates, as well as
incidence and prevalence rates. Where possible and appropriate, Riverside County data is
compared to that of California and the nation’s Healthy People indicators. This is done to best
illustrate differences, similarities, and where there have been successes or where there are
needs for improvement.
17
FERTILITY, BIRTHS AND INFANT MORTALITY
Overview
Trends in fertility, births, and infant mortality are predictors of population growth and change.
Monitoring these trends are important in planning and resource allocation. Infant mortality is
an indicator of the health of newborns as well as their mothers. High fertility results in
elevated birth rates, which in turn effect the need to plan for child care and schools.1
Conversely, lower fertility rates, sustained over a period of time, result in the aging of a
population, which changes our planning and the allocation of resources.
Healthy People 2020
A goal of Healthy People 2020 is to improve the health and well-being of women, infants,
children, and families. The 33 objectives developed for this topic aim to address the health
risks and factors that affect the health of the next generation by taking a life course
perspective to promote health and prevent illness.2
Births per 1,000 Females Ages 15‐44
Fertility Rate for Women Ages 15‐44 by Year Fertility Rate for Women Ages 15‐44 by Year Riverside County and California, 2000‐2010 Riverside County and California, 2000‐2010 Riverside County
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
Riverside County
California
California
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Fertility rates are the rate of live births for every 1,000 women of childbearing age (15-44
years). This indicator is important in providing insight into potential population changes, such
as growth. These rates are derived from births which are fueled by changes in population
subgroups. Historically, migration was the dominating contributor to the growth of states like
California, but based upon the magnitude of the State’s size, current growth is propagated
primarily by natural increase, more births than deaths.3
Riverside County’s fertility rate is at its lowest in a decade, 62.4 births for every 1,000 women
ages 15-44 years. The fertility rate has decreased by 17% since its peak of 75.3 births for every
1,000 women ages 15-44 years in 2006. For the past decade, the fertility rates for Riverside
County have been higher than the rates for California. This trend has begun to change. In
2010 the fertility rate in California was 63.0 per 1,000 live births to females ages 15-44 years
and the rate for Riverside County was 62.4.
18
120
120
Fertility Rate for Women Ages 15‐44 by Race/Ethnicity
Fertility Rate for Women Ages 15‐44 by Race/Ethnicity
Riverside County, 2000 and 2010
Riverside County, 2000 and 2010
98.1
98.1
85.7
85.7
100
100
80
80
60
60
74.9
74.9
62.4
62.4
Year 2000
Year 2000
Year 2010
Year 2010
67.5
67.5
54.2
54.2
66.2
66.2
54.7
54.7
58.0
58.049.8
49.8
40
40
20
20
0
0
All Races
All Races
Asian/PI
Asian/PI
Black
Black
Hispanic
Hispanic
White
White
Since the year 2000, fertility rates have dropped in Riverside County and across most racial and
ethnic groups. Asian/Pacific Islanders were the only group that experienced an increase in
fertility rate from the year 2000 to the year 2010 (54.2 and 67.5 live births per females ages 1544, respectively).
Fertility Rate for Women Ages 15‐44 by Race/Ethnicity Fertility Rate for Women Ages 15‐44 by Race/Ethnicity Riverside County and California, 2010
Riverside County and California, 2010
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
85.7 84.5
85.7 84.5
62.4 62.8
62.4 62.8
67.5
67.563.8
63.8
All Races
All Races
Asian/PI
Asian/PI
57.8
54.7 57.8
54.7
Black
Black
Riverside County
Riverside County
California
California
55.1
49.8 55.1
49.8
Hispanic
Hispanic
White
White
In Riverside County, the fertility rate remains highest among Hispanics and lowest among
Whites. Asian/Pacific Islanders have the second highest fertility rates. Nearly 60% of all births
in Riverside County were to Hispanic women, followed by 28% to Whites.
Asian/Pacific Islanders, Blacks, and Whites are more likely to have babies when they are
between the ages of 30-34 years; while Hispanic women are more likely to have babies when
they are between the ages of 25-29 years.
19
BIRTHS
Birth Rate by Year
Birth Rate by Year
18.0
18.0
Rate per 1,000 Population
17.0
17.0
16.0
16.0
15.0
15.0
16.0
16.0
15.6
15.6
15.7
15.7
15.2
15.2
14.0
14.0
15.9
15.9
15.0
15.0
15.9
15.9
15.1
15.1
16.4
16.4
16.3
16.3
16.8
16.8
Riverside County
Riverside County
California
California
16.8
16.8
birth rates
in more
15.5
15.5
15.0
15.0
14.8
14.8
15.0
15.0
than 10
14.5
14.5
15.0
15.0
years.
13.7
13.7
14.4
14.4
13.6
13.6
13.0
13.0
12.0
12.0
The lowest
13.0
13.0
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
The birth rate is the rate of live births for every 1,000 females (regardless of age). This
indicator, along with fertility rates, is used to indicate population trends and can be used to
examine and describe many social issues. The birth rates in Riverside County and California
have dropped over the past five years.
Since its peak in 2007 of 16.8 births for every 1,000 residents, the birth rate has dropped 18.5%,
to its lowest rate of 13.7 births for every 1,000 residents. In 2010, the birth rate in Riverside
County was highest among Hispanics and lowest among Whites, 19.3 and 8.6 per 1,000
population, respectively.
Birth Rate by Race/Ethnicity Birth Rate by Race/Ethnicity Riverside County and California, 2010
Riverside County
Riverside County
California
California
25
25
19.3
19.317.7
17.7
20
20
15
15
13.7 13.0
13.7 13.0
15.1
15.1
13.0
13.0
11.4 12.1
11.4 12.1
8.6 9.1
8.6 9.1
10
10
5
0
5
0
All Races
All Races
Asian/PI
Asian/PI
20
Black
Black
Hispanic
Hispanic
White
White
Rate per 1,000 Female Population Age 15‐19
Rate per 1,000 Female Population Age 15‐19
120
120
Births to Teenage Mothers by Race/Ethnicity Births to Teenage Mothers by Race/Ethnicity Riverside County,1997‐2010
Riverside County,1997‐2010
100
100
80
80
60
60
40
40
20
20
0
0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
All Teens
Black
Hispanic
White
All Teens
Black
Hispanic
White
Teen births have been on a gradual decline. Between 1997 and 2010, the rate of teen births
has dropped 54.3%. Since 1997, the largest drop in teen births was among Blacks and Whites,
73.7% and 73.5%, respectively. These declines mirror national trends in teen births. Among
teen births, Whites have the lowest rate, while Hispanic teens have the highest rate of birth.
120
120
Births to Teenage Mothers by Age Group
Births to Teenage Mothers by Age Group
Riverside County, 1997‐2010
Under 15 Years
Under 15 Years
15 to 17 Years
15 to 17 Years
18 to 19 Years
18 to 19 Years
Rate per 1,000 Female Population
Rate per 1,000 Female Population
100
100
80
80
60
60
40
40
20
20
0
0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Teen births are more likely to occur among older teens (18-19 years). Since its peak in 1997,
births among older teens have dropped 56%.
Reduction in teen births is important in reducing poor birth outcomes observed among infants
of teen moms as well poor maternal outcomes such as incomplete schooling, single parentage,
and inadequate prenatal care.
21
LOW BIRTH WEIGHT AND PRENATAL CARE
Infant birth weight is a well established predictor of health outcomes. Low birth weight infants
are more likely to die within the first year of life, compared to infants of normal weights. The
percent of low birth weight delivery increases with age, except among Blacks where the risk
decreases with older maternal age.
Since 2001, the percentage of low birth weight deliveries has remained lower in Riverside
County compared to California. Over the past decade low birth weight deliveries in Riverside
County has remained stable, from 6.3% in 2000 to 6.5% in 2010, lower than the HP 2020 goal
of 7.8% (not illustrated).
Percentage of Low Birth Weight (<2500 grams) Live Births by Percentage of Low Birth Weight (<2500 grams) Live Births by Race/Ethnicity and Age of Mother Race/Ethnicity and Age of Mother Riverside County, 2010
Riverside County, 2010
12%
12%
Percent of Total Births
10%
10%
7.8%
7.0% 7.8%
7.0%
8%
8%
10.2% 10.6%
10.2% 10.6%
8.7%
8.7%
6.9%
6.8%
6.8%5.6% 6.9%
5.6%
6%
6%
4%
4%
9.6%
9.6%
6.3% 6.2%
6.3% 6.2%
7.9%
7.9%
6.9%
6.9%6.1%
6.1%
3.8%
3.8%
2%
2%
0%
0%
Asian/PI
Asian/PI
Black Black <19 years
<19 years
Hispanic
Hispanic
20‐34 years
20‐34 years
22
White
White
35 + years
35 + years
All Races
All Races
First Trimester Entry into Prenatal Care First Trimester Entry into Prenatal Care Riverside County and California, 1999‐2010
HP 2010 Goal
HP 2010 Goal
90%
90%
88%
88%
86%
86%
84%
84%
82%
82%
80%
80%
78%
78%
76%
76%
74%
74%
72%
72%
70%
70%
HP 2020 Goal 1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Riverside County
Riverside County
California
California
HP 2010 Goal
HP 2010 Goal
HP 2020 Goal
HP 2020 Goal
Prenatal care is important in ensuring the delivery of a healthy baby. Infants of mothers who
do not get prenatal care are three times more likely to have a low birth weight infant and five
times more likely to die than those infants born to mothers who do receive prenatal care.4
Since 1999, there have been small changes in the percentage of births to women that received
prenatal care during the first trimester of pregnancy. There was a 2.3% dip in the rate among
Riverside County women and a 5.3% increase among women in California overall. In 2010,
more mothers in Riverside County received prenatal care, compared to mothers in California
(83.05 and 81.7%, respectively). These rates were both higher than the Healthy People 2020
goal of 77.9%.
23
INFANT MORTALITY
Riverside County
Riverside County
California
California
Rate per 1,000 Live Births
20
20
18
18
16
16
14
14
12
12
10
10
8
8
6
6
4
4
2
2
0
01970
1970
Infant Mortality Rate by Year Infant Mortality Rate by Year Riverside County and California, 1970‐2010
1975
1975
1980
1980
1985
1985
1990
1990
1995
1995
2000
2000
2005
2005
2010
2010
The rate of deaths among infants under 1 year of age for every 1,000 live births is referred to as
infant mortality. This is a predictor of health or development as well as an indicator of success
or failure of interventions. It is often utilized as a marker of a community’s ability to provide
adequate prenatal care, labor and delivery services, and education on the needs of a
developing infant. This measure is an important indicator of the overall health of a community.
Infant mortality in Riverside County and California has dropped significantly over the past four
decades, dropping 70% since its rate in 1970 of 17.1 infant deaths per 1,000 live births. The
2010 infant mortality rate in Riverside County was slightly higher than the Healthy People 2010
objective of 4.5 and lower than the Healthy People 2020 objective of 6 infant deaths per 1,000
live births.
Infant Mortality Rates by Race/Ethnicity Infant Mortality Rates by Race/Ethnicity Riverside County, 1990‐2009
30
30
25
25
20
20
15
15
10
10
5
5
0
0 1990
1990
1992
1992
1994
1994
1996
1998
2000
1996
1998
2000
Black
Hispanic
Black
Hispanic
2002
2002
White
White
2004
2006
2004
2006
All Races
All Races
2008
2008
2010
2010
Large disparities in rates of infant mortality remain, with Blacks bearing a significant burden of
the mortality. Infant morality rates among Blacks are double the County’s overall rate as well as
that of all other subgroups.
24
MORTALITY
Overview
Mortality is one of the most reliable measurements of a population’s health status. Reduction
in mortality, which is measured in death rates, is used as an indicator of the effectiveness of
various public health strategies to improve health.5 Since changes in mortality are small over
the short term, several years of data must be used to identify true changes.
When studying subpopulations by ethnicity, age, sex, or other classifications, mortality data
reveals a great deal about unequal health outcomes. Of most concern to public health are
premature and preventable deaths, resulting in significant loss in years of productivity.
Additionally, disparate rates of mortality across subpopulations is of significant public health
concern and continues to be addressed through targeted prevention and intervention efforts.
Healthy People 2020
An overarching goal of Healthy People 2020 is to attain high-quality, longer lives free of
preventable disease, disability, injury, and premature death. Nearly 80 national objectives
address mortality.6
900
900
800
800
700
700
600
600
500
500
400
400
300
300
200
200
100
100
0
0
Age‐Adjusted Mortality, Age‐Adjusted Mortality, Riverside County and California, 1996‐2010
Riverside County
Riverside County
California
California
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Since 1996, Riverside County’s age-adjusted mortality rate has dropped 14% to a low of 699.4
deaths per 100,000 in the year 2010. In Riverside County and California people have been
living longer. However, since 2000 mortality rates in Riverside County have remained slightly
higher than rates for California. Factors contributing to the differences in mortality between
Riverside County and California, such as differences in health behaviors; diagnosis and
treatment of chronic conditions; as well as environment, need to be explored.
25
When comparing all-cause mortality for Riverside County to other California Counties,
Riverside is ranked 39 out the 58 counties in California. The four leading causes of death were
coronary heart disease, cancer, chronic lower respiratory disease (CLRD), and stroke; where
Riverside County ranked 54th, 47th, 45th, and 42nd, respectively.7
In 2010, there were 13,976 deaths in Riverside County; 6% of California’s 233,143 deaths. The
actual risk of death (crude death rate) was 642.2 per 100,000 population. This risk is equivalent
to one death for every 160 residents.
Age‐Adjusted Mortality Rate by Race/Ethnicity and Sex
Age‐Adjusted Mortality Rate by Race/Ethnicity and Sex
1200
1200
1000
1000
Males
Males
Females
Females
1079.7
1079.7
897.5
897.5
840.7
840.7
800
800
728.7
728.7
584.0
584.0
600
600
906.2
906.2
792.4
792.4
508.2
508.2
899.1
899.1
698.9
698.9
611.9
611.9
487.8
487.8
400
400
200
200
0
0
All Races
All Races
Asian/PI American Indian
Asian/PI American Indian
Black
Black
Hispanic
Hispanic
White
White
Hispanic males have a mortality rate one-third lower than American Indian males who have a
rate of 1079.7 per 100,000 population; the highest rate among all males.
Since 2005, the mortality rate among Black males improved, dropping from a rate of 1130 to
906.2 per 100,000 population in 2010. The mortality rate for males is 44% higher than the rate
for females. This disparity is evident among all racial and ethnic subgroups. The largest
gender disparity is among Whites, where the mortality rate among White males is 47% higher
than the rate for White females.
26
Mortality Rates by Cause and Year
Mortality Rates by Cause and Year
300
300
250
250
200
200
150
150
100
100
50
50
0
0
2001
2001
2002
2002
2003
2003
Cancer
Cancer
2004
2004
2005
2005
Diabetes
Diabetes
2006
2006
2007
2007
Heart Disease
Heart Disease
2008
2008
2009
2009
2010
2010
Stroke
Stroke
Mortality rates for cancer, diabetes and stroke have remained relatively stable, while heart
disease mortality rates have declined 28% over the past decade. In 2010, heart disease
mortality reached a low of 188.2 deaths for every 100,000 residents. This is a decline from its
peak of 261.3 deaths for every 100,000 residents in 2001.
27
The ten leading causes of death have remained
relatively stable over the past half decade. Between
2005 and 2010, Chronic Lower Respiratory Disease
(formerly referred to as Chronic Obstructive
Pulmonary Disease (COPD)) has moved up from
fourth to the third leading cause of death, switching
rankings with stroke.
CLRD
Stroke
Ten Leading Causes of Death, Ten Leading Causes of Death, Riverside County and California, 2010
Heart Disease
Heart Disease
Cancer
Cancer
CLRD
CLRD
Riverside County
Riverside County
California
California
Stroke
Stroke
Unintentional Injuries
Unintentional Injuries
Alzheimer's Disease
Alzheimer's Disease
Diabetes Mellitus
Diabetes Mellitus
Influenza and Pneumonia
Influenza and Pneumonia
Chronic Liver Chronic Liver Disease/Cirrhosis
Disease/Cirrhosis
Suicide
Suicide
0
0
50
100
150
50
100
150
Age‐Adjusted Rate per 100,000 Population
Age‐Adjusted Rate per 100,000 Population
200
200
Cause-specific mortality rates for Riverside County were higher than rates for California, with
the exception of rates for CLRD, influenza and pneumonia, and suicide. The top ten causes for
mortality were responsible for 79.4% of all deaths in 2010. Fifty percent of deaths were caused
by heart disease and cancer, a total of 7,086 deaths. Two out of every three deaths in 2010
resulted from a chronic illness. The most notable chronic health conditions include heart
disease, cancer, CLRD, stroke, and diabetes.
28
Differences in the Leading Causes of Death
Five Leading Causes of Death by Race/Ethnicity, Riverside County 2010
Ranking
1
2
3
4
5
Riverside County
Heart Disease
Cancer
Lung Disease
Stroke
Unintentional
Injuries
Cancer
Heart Disease
Stroke
Lung Disease
Unintentional
Injuries
American Indian
Heart Disease
Cancer
Unintentional
Injuries
Diabetes
Chronic Liver
Disease
Black
Heart Disease
Cancer
Stroke
Lung Disease
Unintentional
Injuries
Cancer
Heart Disease
Unintentional
Injuries
Stroke
Diabetes
Heart Disease
Cancer
Lung Disease
Stroke
Alzheimer’s
Disease
Asian/PI
Hispanic
White
In 2010, the top five causes of death in Riverside County included heart disease, cancer, lung
disease (CLRD), stroke, and unintentional injuries. These causes comprised 68% of all deaths.
♦
There were slight differences in the leading causes of death when stratified by racial and ethnic
subgroups.
♦
Diabetes is ranked as a fourth leading cause of death for American Indian’s and fifth for
Hispanic’s. For Riverside County overall diabetes is ranked as the seventh leading cause of
death.
♦
Chronic liver disease is the fifth leading cause of death for American Indian’s; however it is
ranked ninth for the County overall.
♦
Alzheimer’s disease is the fifth leading cause of death for Whites; yet ranks as the sixth leading
cause of death for Riverside County.
29
HEART DISEASE
Overview
Heart disease includes diseases and conditions of the heart and arteries such as coronary heart
disease, heart failure, heart attack, arrhythmias, angina, and many others. The most common
forms of heart disease result from excess lipids (fats) and cholesterol in the blood stream.
Of all deaths in Riverside County, 27% (n=3,574) in 2010 were attributed to heart disease,
down from 34% in 1999. According to the American Heart Association, more than one in
three American adults have one or more types of cardiovascular disease (illness of the heart
and vessels). They further estimate that 80% of heart disease and stroke can be prevented. 8
Age‐Adjusted Heart Disease Mortality Rate by Race/Ethnicity Age‐Adjusted Heart Disease Mortality Rate by Race/Ethnicity Riverside County, 2006‐2010
400
400
350
350
300
300
250
250
200
200
150
150
100
100
50
50
0
0
2006
2006
All Races
All Races
2007
2007
American Indian
American Indian
2008
2008
Asian/PI
Asian/PI
2009
2009
Black
Black
2010
2010
Hispanic
Hispanic
White
White
Heart disease mortality rates among Whites mirrors that of the County, with an 18% drop.
Most racial and ethnic subgroups experienced declines in heart disease mortality, with one
exception. The mortality rate for Asians and Pacific Islanders rose 51.4% from 114.1 per
100,000 in 2006 to 172.8 per 100,000 in 2010.
In 2010, the highest rates of heart disease were among American Indians (289.6 per 100,000)
and Blacks (269.3 per 100,000). These rates were much higher than the overall County rate of
188.2 per 100,000 population.
30
Age‐Adjusted Heart Disease Mortality Rate by Age‐Adjusted Heart Disease Mortality Rate by Race/Ethnicity and Sex, Riverside County, 2010
Race/Ethnicity and Sex, Riverside County, 2010
400
400
350
350
300
300
250
250
200
200
150
150
100
100
50
50
0
0
372.7
372.7
267.1
267.1
310.6
310.6
265.5
265.5
287.6
287.6 257.9
257.9
165.5
165.5
All Races American
All Races American
Indian
Indian
216.3
216.3
170.9
170.9
159.9
159.9
Asian/PI
Asian/PI
Male
Male
Female
Female
Black
Black
Hispanic
Hispanic
279.6
279.6
160.7
160.7
White
White
There is a gender disparity in heart disease mortality. The mortality rate is 61.4% higher among
males compared to the rate among females. Among males, the highest heart disease mortality
rates were among American Indians and Blacks (372.7 and 310.6 per 100,000, respectively).
The lowest rate was among Hispanic males (216.3 per 100,000). The lowest rate for males was
still 31% higher than the overall rate for females. Among females, the highest heart disease
mortality rates were among American Indians and Blacks (287.6 and 265.5 per 100,000,
respectively). The lowest rate for females was among Asian/Pacific Islanders and Whites (159.9
and 160.7 per 100,000, respectively).
7000
7000
6000
6000
5000
5000
4000
4000
3000
3000
2000
2000
1000
1000
0
0
Age‐Specific Heart Disease Mortality by Sex, Age‐Specific Heart Disease Mortality by Sex, Riverside County, 2010
Male
Male
Female
Female
0‐14 15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐84 85+
0‐14 15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐84 85+
Age Group (Years)
Age Group (Years)
As we age the risk of death increases. The risk of heart disease-related death is disparately
higher among males in all age groups. As expected, there is a sharp increase in mortality
among those 65 and older. Those 85 and older have the greatest heart disease mortality rates.
In 2010, heart disease mortality rate for males age 85 and older was 5,724.4 and for females
was 4,669.8 per 100,000 population.
31
CANCER
Overview
Cancer is the uncontrolled growth of abnormal cells. It is the second leading cause of death in
the US, California, and Riverside County. As a chronic disease many cancers are associated
with lifestyle factors such as poor dietary choices, sedentary behaviors and smoking.
In 2010, one in four (n=3,332) deaths in Riverside County was attributed to cancer. Cancer
surveillance is key in monitoring trends in cancer incidence, prevalence, cancer-related health
behaviors, and screening practices. Further, surveillance allows for the prevention of and early
intervention against cancer resulting in longer life free of disease and disability.
Age‐Adjusted Cancer Mortality Rate by Race/Ethnicity Age‐Adjusted Cancer Mortality Rate by Race/Ethnicity Riverside County, 2006‐2010
250
250
200
200
150
150
100
100
50
50
0
0
2006
2006
All Races
All Races
2007
2007
American Indian
American Indian
2008
2008
Asian/PI
Asian/PI
2009
2009
Black
Black
2010
2010
Hispanic
Hispanic
White
White
Cancer mortality has remained relatively stable over the past half decade. In 2010 the cancer
mortality rate was 171.2 per 100,000 population.
Most racial and ethnic groups experienced stable cancer mortality rates over the past decade;
however, the cancer death rate for American Indians doubled from a low of 79.7 per 100,000 in
2006 to a high of 163.9 per 100,000 in 2010. This large increase may be a reflection of the
small population size where numerically small changes may reflect large rate changes. In 2010,
Blacks and Whites had cancer mortality rates higher than the County rate (191.1 and 185.1 per
100,000, respectively).
32
350
350
300
300
250
250
200
200
150
150
Age‐Adjusted Cancer Mortality Rate by Race/Ethnicity
Age‐Adjusted Cancer Mortality Rate by Race/Ethnicity
299.3
299.3
208.1
208.1
242.6
242.6
195.8
195.8
144.2
144.2
141.1
141.1
154.9
154.9
Male
Male
Female
Female
159.2 159.3
159.2 159.3
227.0
227.0
153.7
153.7
111.6
111.6
100
100
50
50
0
0
All Races American Asian/PI
Indian
Indian
Black
Black
Hispanic
Hispanic
White
White
In 2010, cancer mortality was 31% lower among females compared to males (144.2 and 208.1
per 100,000, respectively). Among females, cancer mortality rates are comparatively similar
across racial and ethnic groups; however, all rates are lower than the overall County rate. This
indicates that cancer mortality among males drives the County's overall mortality.
Hispanic females maintain the lowest cancer mortality rate of 111.6 per 100,000 population.
Among males, the highest cancer mortality rate was among Asians and Pacific Islanders (299.3
per 100,000), nearly double the lowest rate which was among Hispanic males (159.3 per
100,000).
Cancer mortality increases sharply with age, most notably among males. Mortality rates for
males and females are similar through age 54. Beginning at age 55, rates soar, increasing
gradually among females. The increases in mortality among males is double the increase
among females. This gender disparity is greater than that of heart disease and stroke.
3000
3000
Age‐Specific Cancer Mortality by Sex,
Age‐Specific Cancer Mortality by Sex,
Male
Male
Female
Female
2500
2500
2000
2000
1500
1500
1000
1000
500
500
0
0
0‐14 15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐64 85+
0‐14 15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐64 85+
Age Groups (years)
Age Groups (years)
33
Leading Causes of Cancer Mortality by Sex, Riverside County, 2005‐2009
Males
Females
Site
# of Deaths
% of Total
Site
# of Deaths
% of Total
All Cancers
8,321
100%
All Cancers
7,593
100%
Lung and Bronchus
2,182
26%
Lung and Bronchus
1,844
24%
Prostate
955
11%
Breast
1,235
16%
Colon and Rectum
778
9%
Colon and Rectum
733
10%
Pancreas
558
7%
Pancreas
463
6%
Miscellaneous
500
6%
Ovary
449
6%
From 2005-2009, there were more cancer deaths among males than females. One quarter of
all cancer deaths were lung and bronchus cancers, followed by prostate cancers for males and
breast cancer for females. Ten percent of all cancers were colon and rectal cancers.
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
Age‐Adjusted Lung and Brochus Cancer Mortality by Sex,
Age‐Adjusted Lung and Brochus Cancer Mortality by Sex,
Male
78.17
78.17
62.77
62.77
43.19
43.19
2009
2009
67.01
67.01
2008
2008
65.15
65.15
62.95
62.95
46.31
46.31
44.59
44.59
2007
2007
Male
Female
Female
48.69
48.69
2006
2006
51.93
51.93
2005
2005
Males consistently have higher rates of cancers of the lung and bronchus. The difference in
mortality rates for lung and bronchus cancers between males and females may reflect the
difference in risk behaviors, particularly the use of tobacco. Males smoke more cigarettes per
day and begin smoking at a younger age than females. This difference in tobacco exposure
may explain the difference in mortality.
34
CHRONIC LUNG DISEASE
Overview
Chronic Lung Disease, often referred to as chronic lower respiratory disease (CLRD) and
chronic obstructive pulmonary disease (COPD), includes asthma, chronic bronchitis,
emphysema, and other lower respiratory illnesses.
According to the American Lung Association, deaths from chronic lung disease are on the rise
surpassing stroke as the third leading cause of death in the US.9 In 2010, CLRD contributed to
the death of nearly seven percent (n=918) of Riverside County residents. CLRD is the third
leading cause of death for Riverside County and the fourth leading cause for California.
Age‐Adjusted Chronic Lung Disease Mortality Rate by Race/Ethnicity Age‐Adjusted Chronic Lung Disease Mortality Rate by Race/Ethnicity Riverside County, 2006‐2010
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
2006
2006
All Races
All Races
2007
2007
American Indian
American Indian
2008
2008
Asian/PI
Asian/PI
2009
2009
Black
Black
2010
2010
Hispanic
Hispanic
White
White
CLRD mortality has remained relatively stable over the past half decade. In 2010 the CLRD
mortality rate was 47.4 per 100,000 population. Most racial and ethnic subgroups experienced
stable CLRD mortality rates over the past decade; however, CLRD mortality rate for American
Indians dropped from a high of 69.3 per 100,000 in 2006 to a low of 20.7 per 100,000 in 2010.
This large decline may be a reflection of the small population size where numerically small
changes may reflect large rate changes. Whites maintained CLRD mortality rates higher than
all other groups.
35
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
Age‐Adjusted Chronic Lung Disease Mortality Rate by Age‐Adjusted Chronic Lung Disease Mortality Rate by Race/Ethnicity and Sex, Riverside County, 2010
Race/Ethnicity and Sex, Riverside County, 2010
Male
Male
Female
Female
67.7
67.7
52.6
52.6
45.8
45.8
39.9
39.9
38.8
38.8
63.0
63.0
53.6
53.6
43.3
43.3
30.9
30.9
19.6
19.6
11.0
11.0
American Asian/PI
American Asian/PI
Indian
Indian
Black
Black
Hispanic
Hispanic
White
White
All Races
All Races
In 2010, CLRD mortality was lower among females compared to males (43.3 and 53.6 per
100,000, respectively). Among females, CLRD mortality rates varied across racial and ethnic
subgroups; with Blacks having the highest rate (45.8 per 100,000) and Asian/Pacific Islanders
having the lowest rate (11.0 per 100,000). Among males, the highest CLRD mortality rate was
among Asian/Pacific Islanders (67.7 per 100,000) followed by Whites (63.0 per 100,000). The
rate among Asian/Pacific Islander males is six times the rate among Asian/Pacific Islander
females. The elevated mortality among Asian/Pacific Islander males should be interpreted with
caution. The reason behind such an increased rate is unknown and requires further
investigation.
Age‐Specific Chronic Lung Disease Mortality by Sex,
Age‐Specific Chronic Lung Disease Mortality by Sex,
1200
1200
1000
1000
Male
Male
Female
Female
800
800
600
600
400
400
200
200
0
0
0‐14
0‐14
15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐84
15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐84
Age Groups (years)
Age Groups (years)
85+
85+
As with overall mortality, CLRD mortality increases sharply with age. The mortality disparity
between males and females increases at age 85, with males maintain the highest rate
compared to females (1097.4 and 742.6 per 100,000, respectively).
36
STROKE
Overview
Stroke is a disease of the blood circulation of the brain which when limited, or interrupted, can
interfere with brain functioning.
In 2010, stroke attributed to the death of nearly six percent (n=802) of Riverside County
residents. Stroke is the fourth leading cause of death for Riverside County and the third
leading cause for California.
Age‐Adjusted Stroke Mortality Rate by Race/Ethnicity Age‐Adjusted Stroke Mortality Rate by Race/Ethnicity Riverside County, 2006‐2010
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
2006
2006
All Races
All Races
2007
2007
American Indian
American Indian
2008
2008
Asian/PI
Asian/PI
2009
2009
Black
Black
2010
2010
Hispanic
White
Hispanic
White
Stroke mortality has remained relatively stable over the past half decade. With the exception
of Blacks, most racial and ethnic groups experienced slight declines in stroke mortality. The
mortality rate for Blacks rose 14.2% from 52.1 per 100,000 in 2006 to 59.5 per 100,000 in 2010.
The rate among Blacks in 2010 was the highest rate of stroke among all subgroups, higher than
the County rate of 40.5 per 100,000 population.
From 2006 to 2010, the mortality rate among American Indians was unstable. This may be due
to the small population size resulting in spurious data points. In 2010, the mortality rate for
this group dropped 50% to a low of 22.6 per 100,000 population.
37
Age‐Adjusted Stroke Mortality Rate by Race/Ethnicity Age‐Adjusted Stroke Mortality Rate by Race/Ethnicity and Sex, Riverside County, 2010
70
and Sex, Riverside County, 2010
70
62.6
62.6
60
60
50
50
40
40
30
30
20
20
10
10
0
0
42.4
42.438.9
38.9
47.8
47.8
32.2
32.2
54.8
54.8
Male
Male
Female
Female
46.8
46.8
37.2
37.2
40.8
40.837.9
37.9
27.2
27.2
12.4
12.4
Indian
Indian
Black
Black
Hispanic
Hispanic
White
White
Stroke mortality differs slightly between males and females, with males maintaining a higher
mortality rate in 2010. Conversely, American Indian and Black females have higher stroke
mortality rates, compared to their male counterparts. American Indian females have a stroke
mortality rate more than double that of American Indian males.
Among males, the highest stroke mortality rate was among Blacks (54.8 per 100,000). Blacks
maintain a stroke mortality rate much higher than the overall County rate, while all other
groups have rates similar to the Riverside County rate (40.5 per 100,000). The lowest rate was
among American Indian males (12.4 per 100,000). Among females, the highest stroke mortality
rate was also among Blacks (62.6 per 100,000, respectively). The lowest rate for females was
among Asian/Pacific Islanders (27.2 per 100,000).
38
1200
1200
Age‐Specific Stroke Mortality by Sex,
Age‐Specific Stroke Mortality by Sex,
1000
1000
Male
Male
Female
Female
800
800
600
600
400
400
200
200
0
0
0‐14 15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐84
0‐14 15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐84
Age Group (years)
Age Group (years)
85+
85+
As with other chronic disease-related mortality, stroke mortality is linked to age. Rates are
lowest among those under age 65. Rates are highest among males, until age 85 and older,
where rates among females are greater.
39
DIABETES
Overview
Diabetes mellitus, often referred to as diabetes, is a group of diseases indicated by high levels
of blood sugar. This elevation in blood sugar may result from defects in insulin production,
action, or a combination of the two.8 The Centers for Disease Control and Prevention estimate
that as many as 25.8 million people, or 8.3% of the US population may have diabetes. Of
those, as many as 7 million people are undiagnosed.8 Diabetes contributes to heart disease,
stroke, hypertension, kidney disease, blindness, nervous system disease, amputations, and
many other complications.
In 2010, diabetes contributed to the death of nearly three percent (n=380) of Riverside County
residents. Diabetes is the seventh leading cause of death for Riverside County. It is thought
that diabetes-related deaths are underreported. Some studies have determined that as many
as 40% of decedents with diabetes had it listed anywhere on their death certificate, while up to
15% had it listed as an underlying cause of death.10
60
60
Age‐Adjusted Diabetes Mortality Rate by Race/Ethnicity Age‐Adjusted Diabetes Mortality Rate by Race/Ethnicity Riverside County, 2006‐2010
50
50
40
40
30
30
20
20
10
10
0
0
2006
2006
All Races
All Races
2007
2007
American Indian
American Indian
2008
2008
Asian/PI
Asian/PI
2009
2009
Black
Black
2010
2010
Hispanic
Hispanic
White
White
Diabetes mortality has remained relatively stable over the past half decade. In 2010 the
diabetes mortality rate was 19.4 per 100,000 population. This is a slight decline from a rate of
21.4 per 100,000 population in 2006.
Diabetes mortality rates have remained higher among American Indians compared to all other
racial and ethnic subgroups, except in the year 2008, where no diabetes-related deaths were
documented for this group. This data anomaly should be interpreted with caution. From 2006
to 2010, Whites maintained diabetes mortality rates lower than that of all other groups.
40
Age‐Specific Diabetes Mortality by Sex,
Age‐Specific Diabetes Mortality by Sex,
350
350
300
300
Male
Male
Female
Female
250
250
200
200
150
150
100
100
50
50
0
0
0‐14 15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐84 85+
0‐14 15‐24 25‐34 35‐44 45‐54 55‐64 65‐74 75‐84 85+
In 2010, diabetes mortality was lower among females compared to males (16.5 and 23.1 per
100,000, respectively). A gender disparity in diabetes mortality exists across most racial and
ethnic subgroups; however, among Blacks, the male and female mortality rates are the same
(22.7 and 22.5 per 100,000, respectively). Moreover, Hispanic females maintain a slightly higher
diabetes mortality compared to Hispanic males (32.9 and 31.6 per 100,000, respectively).
Among females, Hispanics had the highest mortality rate (32.9 per 100,000) and Whites had the
lowest rate (11.3 per 100,000). Among males, American Indians had the highest rate (57.1 per
100,000) and Whites maintained the lowest rate (20.6 per 100,000).
Age‐Adjusted Diabetes Mortality Rate by Race/Ethnicity Age‐Adjusted Diabetes Mortality Rate by Race/Ethnicity and Sex, Riverside County, 2010
and Sex, Riverside County, 2010
60
60
57.1
57.1
Male
Male
Female
Female
50
50
40
40
30
30
20
20
25.7
25.7
31.6 32.9
31.6 32.9
21.9
21.9
16.8
16.8
22.7 22.5
22.7 22.5
20.6
20.6
11.3
11.3
10
10
0
0
American Asian/PI
American Asian/PI
Indian
Indian
Black
Black
41
Hispanic
Hispanic
White
White
23.1
23.1
16.5
16.5
All Races
All Races
INTENTIONAL AND UNINTENTIONAL INJURY
Overview
Injuries are not random. Instead, injuries result from predictable and preventable events and
are categorized by intent. Those injuries which are not planned are often referred to as
accidental and categorized as unintentional. Those injuries where harm is self-directed or
inflicted upon others is categorized as intentional.
In 2010 injuries attributed to deaths of nearly seven percent (n=929) of Riverside County
residents. Two-thirds (n=651) of all injuries were unintentional. Unintentional injuries are the
fifth leading cause of death for Riverside County and the sixth leading cause for California.
Intentional injuries (inclusive of homicides and suicides) are the eighth leading cause of death
for Riverside County and the ninth in California. According to the CDC, injuries are the leading
cause of death for those ages 1-44. In the US, one person dies every three minutes from
injuries.
Top Five Causes of Non‐Fatal Injury, Riverside County, 2010
Unintentional Falls
♦
Unintentional falls are
the leading cause of
injury in Riverside
County.
♦
In 2010, 1 out of every
55 Riverside County
residents had been
injured due to an
unintentional fall,
totaling 38,531 fallrelated injuries.
1720.9
Unintentional‐ Struck by
Object
692.2
Motor Vehicle, Occupant
484
Unintentional ‐ Overexertion
465.3
Unintentional ‐ Cut/Pierce
377.9
0
500
1000
1500
2000
♦
Unintentional
poisonings are the
leading cause of injury
-related mortality in
Riverside County.
Top Five Causes of Injury Mortality, Riverside County, 2010
Unintentional Poisoning
10.0
Suicide/Self‐Inflicted
♦
In 2010, 233 Riverside
County residents died
as a result of
accidental poisoning.
8.6
Unintentional Falls
5.3
Motor Vehicle, Occupant
4.9
Homicide/Assault
3.7
0.0
42
5.0
10.0
15.0
Unintentional Injury Mortality by Type, Unintentional Injury Mortality by Type, Riverside County, 2000‐2010
20
20
15
15
10
10
5
0
5
0
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
Motor Vehicle Crash
Motor Vehicle Crash
2005
2005
Poisoning
Poisoning
2006
2006
2007
2007
Falls
Falls
2008
2008
Drowning
Drowning
2009
2009
2010
2010
Fire
Fire
Age‐adjusted rate per 100,000 Population
Age‐adjusted rate per 100,000 Population
Motor vehicle crashes have consistently been the leading cause of unintentional injury
mortality. In 2009, poisoning surpassed motor vehicle crashes as the leading cause of
unintentional injury mortality. Since its peak in 2005, motor vehicle crash mortality has
dropped 47% to a rate of 8.8 per 100,000, while the rate of poisoning deaths have doubled
from a low of 5.4 per 100,000 in 2000 to a rate of 10.0 per 100,000 in 2010.
Unintentional Injury Mortality by Race/Ethnicity and Sex, Unintentional Injury Mortality by Race/Ethnicity and Sex, Riverside County, 2010
160.0
160.0
140.0
140.0
120.0
120.0
100.0
100.0
80.0
80.0
60.0
60.0
40.0
40.0
20.0
20.0
0.0
0.0
137.0
137.0
Male
Male
Female
Female
33.2
33.2
21.8
21.8
11.5
11.5
America Asian/PI
America Asian/PI
Indian
Indian
29.8
29.820.7
20.7
Black
Black
37.4
37.4
11.7
11.7
Hispanic
Hispanic
49.7
49.7
24.3
24.3
White
White
42.9
42.9
18.8
18.8
All Races
All Races
Most (68%) unintentional injury-related deaths are among males. American Indian males
maintain the highest unintentional mortality rate (137 per 100,000), more than 3 times that of
the overall mortality rate for all males (42.9 per 100,000).
43
Unintentional Injury Mortality by Injury Type Within Age Groups, Unintentional Injury Mortality by Injury Type Within Age Groups, Riverside County, 2010
1‐14
1‐14
15‐24
15‐24
25‐34
25‐34
Age Groups
Age Groups
35‐44
35‐44
45‐54
45‐54
55‐64
55‐64
65‐74
65‐74
75‐84
75‐84
85+
85+
0%
0%
10%
10%
20%
20%
Motor Vehicle Collisions
Motor Vehicle Collisions
30%
30%
40%
40%
50%
50%
60%
60%
Drowning
Drowning
Fire
Fire
Falls
Falls
Firearms
Firearms
70%
70%
80%
80%
Poisoning
Poisoning
90%
90%
100%
100%
All Other Causes
All Other Causes
The causes of unintentional injury mortality vary among each age grouping. Motor vehicle
crash is the leading cause of mortality among those ages 15-24. Accounting for 62% of all
unintentional injury deaths, these crashes disproportionately claim the lives of our youth and
young adults.
Drowning also disproportionately takes the lives of young children in Riverside County. All
childhood drowning deaths (among those ages 1-14) occurred to children under age 6.
Our aging residents are particularly vulnerable to falls as their flexibility and balance decrease
dramatically which increase the risk and severity of a fall. Deaths due to falls increase with
age, as conditions such as osteoporosis and poor mobility make falls more severe. Eighty-two
percent of fall-related deaths occurred to those ages 65 and older, and 79% occurred to those
who identified as White, non-Hispanic.
Poisoning is a leading cause of unintentional injury mortality for those ages 25-64, accounting
for half (n=191) of all deaths in this age group. In 2009, most (91%) of all unintentional
poisoning deaths in the US were caused by prescription painkillers, followed by cocaine and
heroin (CDC, 2011). Most (65%) poisoning occurred among males and most (67%) were
among those who identified as White, non-Hispanic.
In 2010, unintentional firearm-related deaths were just as likely to occur among those 65-74
years of age as it was to those 35-44 years of age (2.1% and 2.5% of deaths in each respective
age group).
44
Intentional Injury Mortality by Cause, Intentional Injury Mortality by Cause, Riverside County and California, 2000‐2010
12
12
10
10
8
6
4
2
0
8
6
4
2
0
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
Suicide‐Riverside County
Suicide‐Riverside County
Homicide‐Riverside County
Homicide‐Riverside County
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
Suicide‐California
Suicide‐California
Homicide‐California
Homicide‐California
Homicide rates have remained slightly lower in Riverside County compared to rates for
California. Over the past decade homicide rates in Riverside County have declined by 20%
from a rate of 5.2 per 100,000 in 2000 to a rate of 3.7 per 100,000 in 2010.
Suicide rates in Riverside County have, at times, exceeded rates for California. In 2010, the
suicide rate for California was higher than the rate for Riverside County. Suicide rates in
Riverside County have dropped 29% from a rate of 10.8 per 100,000 in 2000 to a rate of 8.6
per 100,000 in 2010.
45
Age‐Adjusted Homicide Rate by Race/Ethnicity and Sex, Age‐Adjusted Homicide Rate by Race/Ethnicity and Sex, Riverside County, 2010
16
16
14
14
12
12
10
10
8
8
6
6
4
4
2
2
0
0
14.0
14.0
Female Male
Female Male
12.8
12.8
10.6
10.6
7.2
7.2
2.0
2.0
American Asian/PI*
American Asian/PI*
Indian*
Indian*
3.4
3.4
Black
Black
3.1
3.1
1.4
1.4
1.4
1.4
Hispanic
Hispanic
White
White
1.8
1.8
All Races
All Races
* No cases reported for females
In 2010, the homicide rate among males was nearly 5.8 times higher than that among females.
American Indian and Black males had the highest homicide rates (14 and 12.8 per 100,000,
respectively). Asian/Pacific Islander males had the lowest homicide rate of 2 per 100,000.
Homicide is the third leading cause of death for Black males ages 15-24 in Riverside County,
and the second leading cause for Hispanic males in the same age group.
Black females maintain the highest homicide rate (3.4 per 100,000)among all females, about
twice that of the overall female rate of 1.8 per 100,000.
46
40.0
40.0
35.0
35.0
30.0
30.0
25.0
25.0
Age‐Adjusted Suicide Rate by Race/Ethnicity and Sex, Age‐Adjusted Suicide Rate by Race/Ethnicity and Sex, Riverside County, 2010
35.0
35.0
Male
Male
Female
Female
25.7
25.7
18.5
18.5
20.0
20.0
15.0
15.0
11.9
11.9
10.0
10.0
5.0
5.0
0.0
0.0
14.5
14.5
8.7
8.7
8.4
8.4
1.3
1.3
American
American
Indian
Indian
Asian/PI
Asian/PI
Black
Black
4.9
4.9
1.1
1.1
Hispanic
Hispanic
White
White
4.0
4.0
All Races
All Races
In 2010, suicide rate among males was 3.5 times higher than the rate among females.
American Indian and White males had the highest suicide rates (35 and 18.5 per 100,000,
respectively). Hispanic and Black males had the lowest suicide rates of 8.4 and 8.7 per 100,000,
respectively.
American Indian females maintain the highest suicide rate among all females (25.7 per
100,000). The rate among American Indian females is 5 times higher than the rate among
White females (4.9 per 100,000), which maintain the second highest suicide rate among all
females.
47
THE CHRONIC DISEASE BURDEN
Overview
Over the past 100 years the burden of disease has shifted from that of infectious diseases to
those conditions that are considered chronic. Chronic health conditions significantly impair
and limit the quality of life for people and treatment is often costly. The most notable chronic
conditions include heart disease, cancer, stroke, and diabetes. These illnesses are the most
common, costly, and preventable.
Seven out of 10 deaths in the US are caused by chronic illnesses. In 2005, it was estimated
that 1 out of every 2 adults had at least one chronic disease.11 According to the Oxford Health
Alliance, a collaborative aimed at reducing chronic disease, three health behaviors: physical
inactivity, poor diet, and tobacco/harmful alcohol use contribute to four chronic
diseases: heart disease, diabetes, lung disease, and some cancers, and as a result contribute to
more than 50% of preventable deaths around the world.12 This concept, referred to as 3-four50, has been used to describe the chronic disease burden across the nation. In Riverside
County, the leading four chronic diseases are heart disease, cancer, lung disease, and stroke
which accounted for 63% of all deaths in 2010.
48
ASTHMA
Overview
Asthma is a chronic condition that affects the lungs. It is characterized by inflammation and
constriction of the airways, causing wheezing, coughing, and chest tightness. Although the
cause is unknown, specific exposures such as tobacco smoke, allergens, and respiratory
infections can trigger and exacerbate symptoms.
Asthma contributes to significant illness. Each year more than 500,000 hospitalizations result
from asthma illness. The federal Office of Disease Prevention and Health Promotion estimates
that annually, asthma is responsible for 4,500 deaths and 134 million days of restricted activity.
Percent of Population
40%
40%
35%
35%
30%
30%
25%
25%
20%
20%
15%
15%
10%
10%
5%
5%
0%
0%
Ever Diagnosed with Asthma by Race/Ethnicity and Year,
Ever Diagnosed with Asthma by Race/Ethnicity and Year,
2001
2001
Asian/PI
Asian/PI
2003
2003
Black
Black
2005
2005
Hispanic
Hispanic
2007
2007
White White 2009
2009
All
All
Since 2001, those who reported ever being diagnosed with asthma increased from 11.3% to
17.8%. Asthma diagnoses are not evenly distributed across groups, with evident disparities in
Riverside County and across the US. The largest increase in self-reported asthma diagnosis was
among Blacks with rates doubling from 16.8% in 2001 to 35.1% in 2009.
49
Ever Diagnosed with Asthma by Race/Ethnicity,
Ever Diagnosed with Asthma by Race/Ethnicity,
35%
35%
30%
30%
25%
25%
20%
20%
15%
15%
10%
10%
5%
5%
0%
0%
30.6%
30.6%
20.1%
20.1%
20.4%
20.4%
12.3%
12.3%
Asian/PI
Asian/PI
Riverside County Riverside County California
California
11.3% 11.1%
11.3% 11.1%
Black
Black
Hispanic
Hispanic
14.5%
14.3% 14.8%
14.3% 14.8% 14.5%13.6%
13.6%
White White All Races
All Races
Asthma prevalence is higher in Riverside County compared to California (14.5% and 13.6%,
respectively). The prevalence of asthma is higher for Blacks than for any other racial and ethnic
group in Riverside County and California (30.6% and 20.4%, respectively).
In Riverside County adults are more likely (16.4%) to have received an asthma diagnosis;
however, in California adolescents are more likely (19.1%) to have received an asthma
diagnosis. Seniors are less likely to have received an asthma diagnosis in both Riverside
County and California (10.7% and 11.2%, respectively). According to the California Department
of Public Health, about 366,000 Riverside County children under age 17 have been diagnosed
with asthma.13
Ever Diagnosed with Asthma by Age,
Ever Diagnosed with Asthma by Age,
25%
25%
19.1%
19.1%
20%
20%
15%
15%
11.9%
11.1% 11.9%
11.1%
13.4%
13.4%
16.4%
16.4%
13.3%
13.3%
10%
10%
Riverside County
Riverside County
California
California
10.7% 11.2%
10.7% 11.2%
14.5%
14.5%13.6%
13.6%
5%
5%
0%
0%
Children (≤ 11) Adolescents Adults (18‐64) Seniors (65+)
Children (≤ 11) Adolescents Adults (18‐64) Seniors (65+)
(12‐17)
(12‐17)
50
All Ages
All Ages
DIABETES PREVALENCE
Overview
Diabetes is a disease in which high levels of glucose (blood sugar) result from problems with
production of or the body’s response to insulin. Serious complications including premature
death can result from diabetes and there are many risk factors which predispose a person to
develop diabetes.
The economic burden of diabetes in the US is astounding. It has been estimated that costs
attributed to diabetes reach near $174 billion annually. According to the California Health
Interview Survey (CHIS), most (95.1%)of those who report having diabetes have type II
diabetes, which is linked to obesity. This is concerning as obesity has been continuously linked
to many preventable health conditions.
Diabetes Prevalence by Year,
Diabetes Prevalence by Year,
Percent with Diabetes
Percent with Diabetes
10%
10%
Riverside County
Riverside County
California
California
9%
9%
8%
8%
7%
7%
6%
6%
5%
5%
4%
4%
2003
2003
2005
2005
2007
2007
2009
2009
Prevalence estimates are based upon those clinically diagnosed with diabetes, which may
underestimate the true burden of disease. Diabetes prevalence in Riverside County has
decreased since a high of 8.5% in 2005. In 2009, diabetes prevalence was lower in Riverside
County compared to California (6.9% and 8.5%, respectively).
51
Diabetes Prevalence by Sex and Year,
Diabetes Prevalence by Sex and Year,
11%
11%
10%
10%
9%
9%
8%
8%
7%
7%
6%
6%
5%
5%
4%
4%
Male Male Female
Female
Both Sexes
Both Sexes
2003
2003
2005
2005
2007
2007
2009
2009
Mirroring the decline in diabetes prevalence in Riverside County was a drop in prevalence
among males. Prevalence among females has increased since 2003.
In Riverside County, as well as across California, a higher proportion of American Indians and
Blacks report having diabetes; while fewer Whites and Asian/Pacific Islanders report having
diabetes. Across most racial and ethnic groups, diabetes prevalence is lower in Riverside
County compared to California. Whites in Riverside County, however, maintain slighter higher
diabetes prevalence rates than the average rates for Whites in California (7.0% and 6.5%,
respectively).
Diabetes Prevalence by Race/Ethnicity, Diabetes Prevalence by Race/Ethnicity, Riverside County and California, 2007‐2009
25%
25%
20%
20%
Riverside County
Riverside County
California
California
19.5%
19.5%
15%
15%
*11.7%
*11.7%
10%
10% *6.5% 7.2%
*6.5% 7.2%
12.0%
10.6% 12.0%
10.6%
10.0%
10.0%
8.1%
7.8%
8.1%
7.0% 6.5% 7.4%
7.8%
7.0% 6.5% 7.4%
5%
5%
0%
0%
Asian/PI American Indian Black
Asian/PI American Indian Black
Hispanic
Hispanic
White White All Races
All Races
* Rates are unstable, refer to technical notes section for details
52
OVERWEIGHT AND OBESITY PREVALENCE
Percent of Population 12 Years and Older
Overview
Clinically the terms “overweight” and “obese” refer to body weight greater than what would be
considered healthy for a specific height. The increased prevalence of overweight and obesity
is staggering, with millions of Americans identified as having increased body weights. Obesity
prevalence among children and teens have almost tripled since 1980. It has been recognized
that the ways in which our communities are designed have an effect on our health and may
promote unhealthy behaviors that in turn lead to overweight and obesity.
The health implications of overweight and obesity include heart disease, high blood pressure,
diabetes, depression, and certain cancers. These obesity-related conditions are also the
leading causes of preventable death. In 2008, medical costs associated with obesity were
estimated to be $147 billion.14
Prevalence of Overweight and Obesity, Prevalence of Overweight and Obesity, Riverside County and California, 2001‐2009 Riverside County and California, 2001‐2009 Riverside County
Riverside County 57.1%
58.0%
58.0%
55.4%
55.4%
56.0%
56.0%
54.0%
54.0%
52.0%
52.0%
50.0%
50.0%
53.7%
53.7%
53.6%
53.6%
50.4%
50.4%
57.1%
56.4%
56.4% California
California
50.8%
50.8%
50.7%
50.7%
51.5%
51.5%
51.4%
51.4%
48.0%
48.0%
46.0%
46.0%
2001
2001
2003
2003
2005
2005
2007
2007
2009
2009
Overweight and obesity prevalence for teens and adults in California have remained stable
since 2001. Obesity rates for teens and adults in Riverside County are higher than rates for
California. In 2009, the overweight and obesity prevalence for Riverside County and California
were at their highest (57.1% and 51.4%, respectively).
53
70.0%
70.0%
Prevalence of Overweight and Obesity by Prevalence of Overweight and Obesity by Race/Ethnicity, Riverside County, 2001‐2009 Race/Ethnicity, Riverside County, 2001‐2009 60.0%
60.0%
50.0%
50.0%
40.0%
40.0%
30.0%
30.0%
Asian/PI
Asian/PI
Black
Black
Hispanic
Hispanic
White
White
20.0%
20.0%
10.0%
10.0%
0.0%
0.0%
2001
2001
2003
2003
2005
2005
* No 2009 data for Asian/Pacific Islanders
2007
2007
2009
2009
Since 2001, overweight and obesity rates among most racial and ethnic groups in Riverside
County have remained stable. Asian/Pacific Islanders have maintained the lowest overweight
and obesity prevalence. In 2009, the highest rate of overweight and obesity was among
Hispanics (66.4%). Blacks had the largest change, with a drop in prevalence from a high of
66.0% in 2005 to a low of 41.3% in 2009.
Percent of Population 12 years and Older
Percent of Population 12 years and Older
80.0%
80.0%
70.0%
70.0%
Prevalence of Overweight and Obesity by Prevalence of Overweight and Obesity by Federal Poverty Level, Riverside County, 2009
Federal Poverty Level, Riverside County, 2009
67.1%
67.1%
57.2%
57.2%
60.0%
60.0%
50.0%
50.0%
40.0%
40.0%
42.8%
42.8%
Not Overweight or Obese
Not Overweight or Obese
Overweight or Obese
Overweight or Obese
55.2%
55.2%
51.7%
48.3% 51.7%
48.3%
44.8%
44.8%
32.9%
32.9%
30.0%
30.0%
20.0%
20.0%
10.0%
10.0%
0.0%
0.0%
0‐99FPL
0‐99FPL
100‐199FPL
100‐199FPL
200‐299FPL
200‐299FPL
300+FPL
300+FPL
There are evident disparities in overweight and obesity prevalence. Those at or below 100% of
the federal poverty level (FPL) are more likely to be overweight or obese. In 2009, 67.1% of
those at the FPL were overweight or obese. As income levels rise, the prevalence of
overweight and obesity decrease.
54
Percent of Students Grades 5, 7 and 9
Percent of Students Grades 5, 7 and 9
33.0%
33.0%
32.0%
32.0%
31.0%
31.0%
30.0%
30.0%
29.0%
29.0%
28.0%
28.0%
27.0%
27.0%
26.0%
26.0%
25.0%
25.0%
Percent of Overweight* Students, Percent of Overweight* Students, Riverside County and California, 2007‐2012 Riverside County and California, 2007‐2012 31.7%
31.7%
31.1%
31.0%
31.1% 30.7% 31.0%
30.7%
2007‐2008
2007‐2008
2008‐2009
2008‐2009
Riverside County
Riverside County
California
31.5% California
30.8%
30.8%
30.4%
30.4%
2009‐2010
2009‐2010
School Year
* Not in the Healthy Fitness Zone (HFZ) for body composition
School Year
31.5%
29.8%
29.8%
2010‐2011
2010‐2011
30.9%
30.9%
29.8%
29.8%
2011‐2012
2011‐2012
Students in public schools across California participate in physical fitness tests to evaluate
performance according to established benchmarks. Students are placed into categories based
upon how they compare to other students of similar age and sex. Students that do not meet
the standard are said to fall outside of the Healthy Fitness Zone (HFZ). Body composition
results are used as a proxy for overweight status of students.
Across all school years (2007-2012), students in Riverside County and California maintain
similar overweight prevalence. The prevalence of overweight students in Riverside County and
California has remained stable at 30%.
55
1.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Coale, A.J. (1987). How a Population Ages or Grows Younger. Pp. 365-369 in S.W. Mendard and
E.W. Moen (eds.), Perspectives on Population: An Introduction to Concepts and Issues. Oxford:
Oxford University Press; Weeks, John R. 2002. Population: An Introduction to Concepts and Issues
(8th edition). Belmont, CA; Wadsworth Publishing Company.
Centers for Disease Control and Prevention (CDC), Agency for Toxic Substances and Disease
Registry (ATSDR). Recommendations to improve preconception health and health care—United
States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on
Preconception Care. MMWR 2006;55(RR-6).
Johnson, H.P. (2007). Birth Rates in California. California Counts: . November 2007, Vol. 9, No 2.
Schmitt, J.W. (2009, March 6). Prenatal care fact sheet. Retrieved from http://
www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.cfm
Hoyert D.L. (2012). 75 years of mortality in the United States, 1935–2010. NCHS data brief, no 88.
Hyattsville, MD: National Center for Health Statistics. 2012.
U.S. Department of Health and Human Services. (2012). Healthy People 2020. Retrieved from
http://www.healthypeople.gov/2020/default.aspx
California Department of Public Health. County Health Status Profiles 2012. Retrieved from http://
www.cdph.ca.gov/pubsforms/Pubs/OHIRProfiles2012.pdf
American Heart Association. http://www.heart.org/HEARTORG/
American Lung Association. Chronic Lower Respiratory Disease. http://www.lung.org/associations/
states/wisconsin/news/chronic-lower-respiratory.html
Centers for Disease Control and Prevention (2011).. National diabetes fact sheet: national estimates
and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S.
Wu S.Y. & Green A. Projection of chronic illness prevalence and cost inflation. Santa Monica, CA:
RAND Health; 2000.
3Four50. Retrieved from http://www.3four50.com/
California Breathing (2012). Riverside County Asthma Profile. Retrieved from http://
www.californiabreathing.org/asthma-data/county-asthma-profiles/riverside-county-asthma-profile
Finkelstein, E.A., Fiebelkorn, I.C., & Wang, G. (2003). National medical spending attributable to
overweight and obesity: How much and who’s paying? Health Affairs 2003; W3, 219-226.
56
III. HEALTH BEHAVIORS
Health behaviors are those actions used to ensure good health and prevent illness.1 There are
daily behaviors and actions that we engage in that can be protective or harmful to our health
and well being. These factors, often referred to as lifestyle factors, increase or decrease our
chance of illness.
Certain behaviors have been found to increase risk factors contributing to chronic disease as
well as excess and premature death. These behaviors, referred to as risk factors, include
excessive alcohol consumption, use of tobacco, poor dietary practices, and physical inactivity.2
People who engage in healthier practices such as not using tobacco, eating healthy, getting
regular exercise, and limiting alcohol consumption will live longer.
This section will examine the incidence of risk and protective factors as well as potential
disparities across subgroups including age, sex, and racial and ethnicity. More specifically,
discussion of nutritional and dietary practices, physical activity, alcohol and tobacco use,
children’s leisure time, and the prevention and early detection of disease will take place in this
section of the report. Data from the California Health Interview Survey (CHIS) is used to
describe the health behaviors of Riverside County residents. Throughout the section, when
possible and appropriate, the CHIS survey questions are stated. An asterisk (*) will be used to
denote rates that are considered statistically unstable. For further details on rate instability,
please refer to the technical notes section in the appendices.
57
NUTRITION AND DIETARY PRACTICES
Overview
Nutrition and dietary practices are those that include what we eat, how much, and how often.
Where and in what situation we eat can also affect our food choices and dietary habits.
Dietary practices may vary depending on factors such as one’s personal beliefs, life experience,
and emotions.
The consumption of fast and convenient foods as well as sugary beverages has steadily
increased. It is well established these behaviors are associated with obesity and other health
problems.3 Further, diets that include fruits and vegetables are important for the prevention of
chronic illness, weight management, and child growth.4
Percent of People Who Ate Fast Food in the Past Week, Percent of People Who Ate Fast Food in the Past Week, Riverside County and California, 2009 Riverside County and California, 2009 40%
40%
35%
35%
Riverside County
Riverside County
California
California
35.3%
35.3%
30%
30% 25.9%
25.9%
25%
25%
28.3%
28.3%
25.5%
25.5%
19.6%
19.6%
16.7%
16.7%
20%
20%
15%
15%
18.9%
18.9%
10.1%
10.1%8.6%
8.6%
10%
10%
11.0%
11.0%
5%
5%
0%
0%
No times
No times
One time
One time
Two times Three times Four or more
Two times Three times Four or more
times
times
Many Americans spend a significant amount of their day at work, school, or commuting. This
reduces the amount of time available to prepare meals. Increased consumption of fast foods
has been linked to increased body weight. Riverside County residents are more likely to eat
fast food compared to California residents as a whole. Nearly 20% of Riverside County
residents reported eating fast food four or more times in the past week. Since 2007, the
proportion of those who report eating fast food in the past week has risen from 13.1%, to
18.9% in 2009.
CHIS Survey Question: “In the past 7 days, how many times did you eat fast food?
Include fast food meals eaten at work, school, home, or at fast food restaurants, carryout
or drive through.”
58
Percent of Children 2‐11 Years Old Who Ate Fast Food in Percent of Children 2‐11 Years Old Who Ate Fast Food in the Past Week, Riverside County and California, 2009 the Past Week, Riverside County and California, 2009 40%
40%
35%
35%
32.7%
32.7%
32.5%
32.5%
30%
30%
35.9%
35.9%
Riverside County
Riverside County
California
California
27.5%
27.5%
25%
25%
21.4% 19.8%
21.4% 19.8%
20%
20%
15%
15%
8.3% 7.0%
8.3% 7.0%
10%
10%
5%
5%
0%
0%
No times
No times
One time
One time
Two times
Two times
*10.3%
*10.3%
4.6%
4.6%
Three times Four or more
Three times Four or more
times
times
Compared to adults, children consumed less fast food during the past week. One third of
children in Riverside County and California did not eat fast food during the past week, but
compared to children in California, children in Riverside County were twice as likely to eat fast
food four times in the past week.
59
Percent of Fast Food Consumption in the Past Week by Race/Ethnicity, Percent of Fast Food Consumption in the Past Week by Race/Ethnicity, Riverside County, 2009
Asian/PI
Asian/PI
Black
Black
Hispanic
Hispanic
White
White
50%
50%
45%
45%
40%
40%
35%
35%
30%
30%
25%
25%
20%
20%
15%
15%
10%
10%
5%
5%
0%
0%
No times
No times
One time
One time
Two times
Two times
Three times
Three times
Four or more times
Four or more times
In 2009, more Whites reported not consuming fast food at all (27.8%), while more Hispanics
reported consuming fast food four or more times during the past week (27.8%). Asian/Pacific
Islanders were more likely to report consuming fast food two or three times in the past week
(66.9%).
From 2007 to 2009, there was a slight decrease in the percent of residents who reported no
consumption of fast food in the past week (from 27.4% to 25.9%). During the same timeframe,
the amount that reported eating fast food four or more times increased from 13.1% to 18.9%.
Among adult women who reported participating in the County’s Women, Infants and
Children's (WIC) nutrition program, their consumption of fast food in the past week was lower
(41.0%) than that of those not enrolled in the WIC program (87.6%).
60
Percent of Children 2‐11 Years that Eat 5 or More Servings of Percent of Children 2‐11 Years that Eat 5 or More Servings of Fruits/Vegetables Daily by Race/Ethnicity, Fruits/Vegetables Daily by Race/Ethnicity, Riverside County and California, 2009
60%
60%
50%
50%
Riverside County
Riverside County
California
California
51.6%
50.9%
51.6%
50.9%
46.6%
*46.8%
46.6%
*46.8%
48.4%
47.1% 48.4%
47.1%
40%
40%
49.3%
49.3%
46.6%
46.6%
33.9%
33.9%
30%
30%
25.2%
25.2%
20%
20%
10%
10%
0%
0%
All Races
All Races
Asian /PI
Asian /PI
Black
Black
Hispanic
Hispanic
White
White
Increased consumption of fruits and vegetables coupled with the reduction of fast food
consumption are healthier eating practices. The amount of fruits and vegetables needed by
the body depends on age, sex, and physical activity level. Five servings is a good marker for
daily intake. A single serving is, in many cases, a half cup.
In Riverside County, a greater percentage of Whites ate five or more servings of fruits and
vegetables compared to the statewide average. Whites, Blacks, and Hispanics maintained
similar rates of fruit and vegetable consumption (49.3%, 46.8%, and 46.6%, respectively).
Asians were less likely to report eating five or more servings of fruits and vegetables when
compared to all other groups in Riverside County and Asians in California overall.
♦
Riverside County residents at or below 99 percent of the federal poverty level were more
likely (67.7%) to consume five or more servings of fruits and vegetables when compared to
the overall rate of consumption among all County residents (48.3%).
CHIS Survey Question: Respondents were asked multiple diet questions that inquired
about previous 24 hour eating habits among children 2 and older.
61
Consumption of sugary beverages is of concern as this often times replaces the consumption
of water. Since 2003, there has been a decrease in the consumption of two or more glasses of
sugary drinks among children 2-17 years.
Consumption of Two or More Sugary Drinks by Children on Consumption of Two or More Sugary Drinks by Children on the Previous Day, Riverside County and California, 2009
the Previous Day, Riverside County and California, 2009
Percent of Children 2‐17 Years
30%
30%
25%
25%
26.1%
26.1%
25.9%
25.9%
20%
20%
Riverside County
Riverside County
California
California
26.1%
26.1%
20.5%
20.5%
15%
15%
16.4%
16.4%
15.0%
15.0%
10%
10%
16.3%
16.3%
14.7%
14.7%
5%
5%
0%
0%
2003
2003
2005
2005
2007
2007
2009
2009
In 2009, on average, Riverside County children were more likely to consume two or more
glasses of sugary drinks, compared to the state. Whites in Riverside County consume soda and
other sugary beverages at a rate lower than all other ethnic groups.
Consumption of Two or More Sugary Drinks by Consumption of Two or More Sugary Drinks by Children on the Previous Day by Race/Ethnicity, Children on the Previous Day by Race/Ethnicity, Riverside County and California, 2009
20%
20%
18%
18%
16%
16%
14%
14%
12%
12%
10%
10%
8%
8%
6%
6%
4%
4%
2%
2%
0%
0%
17.2%
17.2%
18.5%
17.3% 18.5%
17.3%
Riverside County
Riverside County
California
California
11.5%
11.5%10.4%
10.4%
8.6%
8.6%
Asian/PI
Asian/PI
Black
Black
Hispanic
Hispanic
White
White
CHIS Survey Question: “Yesterday, how many glasses or cans of soda, such as Coke, or other sweetened drinks, such as fruit punch or sport drinks did {you/he/she} drink? Do not count diet drinks.”
62
PHYSICAL ACTIVITY
Overview
The benefits of regular physical activity have been well documented. Exercise of at least 30
minutes each day has been found to reduce the risk of heart disease, cancer, diabetes, obesity,
and premature death. Some studies have shown that for every hour of walking, life expectancy
may be increased by two years.
From weight control to building muscle and strength and living longer, physical activity,
according to the Centers for Disease Control and Prevention (CDC), is one of the most
important activities to promote health.5 Regular physical activity can improve health and
wellbeing and reduce the risk of chronic illness for all ages. The cost of physical inactivity is
high. An increasing number of Americans are overweight which costs the US billions in health
care.
Engagement in Vigorous Activity at Least 3 Days Each Week Engagement in Vigorous Activity at Least 3 Days Each Week Among Children 2‐11 Years by Race/Ethnicity, Among Children 2‐11 Years by Race/Ethnicity, Riverside County and California, 2007‐2009
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Riverside County
Riverside County
California
California
85.3%
85.3%78.5%
*79.7%
78.5%
*79.7%
75.3%
71.5%
75.3%
71.5% 68.6%
68.6%
61.9% 64.2%
*61.5%
61.9% 64.2%
*61.5%
52.0%
52.0%
All Races
All Races
Asian/PI
Asian/PI
Black
Black
Hispanic
Hispanic
White
White
In 2009, the rate of vigorous physical activity in children was slightly higher in Riverside County
compared to that of California. In Riverside County, Blacks and Hispanics were less likely to
engage in vigorous physical activity when compared to all other groups. Whites in Riverside
County and California overall are more likely to engage in vigorous physical activity.
In 2009, only 23.8% of children were physically active for at least one hour daily. Fewer teens
(16.5%), ages 12-17, reported being physically active for at least one hour daily.
CHIS Survey Question: “During a typical week, how many days are you physically active
for at least 60 minutes total per day? Do not include PE”
63
ALCOHOL AND TOBACCO USE
Overview
Excessive alcohol consumption or “heavy drinking”, and tobacco use are behaviors that have
been linked to negative health effects. Binge drinking is the most common form of excessive
alcohol use in the US, while cigarette smoking is the most common form of tobacco use.
The excessive consumption of alcohol and the use of tobacco greatly increase the risk of
morbidity and mortality from cancer and cardiovascular disease. Excessive alcohol use is the
third leading lifestyle-related cause of death for the nation and tobacco use is the leading
preventable cause of death in the US.6,7 The reduction of alcohol use and abstinence from
tobacco have been found to produce long term health benefits.
Percent of Population Ages 18‐64 Years
Percent of Adults Reporting Binge Drinking in the Past Year, Percent of Adults Reporting Binge Drinking in the Past Year, Riverside County and California, 2009
40%
40%
35%
35%
31.3%
29.7% 31.3%
28.8%
29.7%
30%
*27.2% 28.8%
30%
*27.2%
25%
25%
20%
20%
32.9%
32.9%
20.5%
20.5%
15%
15%
Riverside County
Riverside County
California
34.3%
California
33.1%
34.3%
33.1%
31.6%
31.6%
29.2%
29.2%
19.8%
19.8%
*9.8%
*9.8%
10%
10%
5%
5%
0%
0%
All Races American Indian Asian/PI
All Races American Indian Asian/PI
Black
Black
Hispanic
Hispanic
White
White
Binge drinking has been associated with many health problems, such as intentional and
unintentional injuries. In 2009, about 30% of residents in Riverside County and California
reported binge drinking in the past year. In Riverside County there were no notable differences
in binge drinking behaviors by subgroup, with the exception of fewer Black residents who
reported binge drinking in the past year. However, the rate is considered statistically unstable
due to the small sample size and should be interpreted with caution.
CHIS Survey Question: Respondents were asked a series of questions concerning their alcohol
consumption. Males were considered binge drinkers if they drank 5 or more alcoholic drinks
and females were considered binge drinkers if they drank 4 or more drinks on at least one
occasion in the past year.
64
It is well documented that tobacco use is harmful to the body. Smoking cessation has
immediate health benefits. Since 2003, the rate of smoking for people 12 years and older has
decreased in California. The inverse has been experienced in Riverside County, with increases
beginning in 2005. In 2009, the rate of smoking was higher in Riverside County (15.3%)
compared to California (12.5%) overall. This increase is of concern, given the health
consequences that accompany smoking behaviors.
Percent of Population 12 Years and 12 Years and Older
Older
Percent of Population Current Smokers, Current Smokers, Riverside County and California, 2003‐2009
18%
18%
17%
17%
16%
16%
15%
15%
14%
14%
13%
13%
12%
12%
11%
11%
10%
10%
Riverside County
Riverside County
California
California
16.9%
16.9%
15.3%
15.3%
14.2%
14.2%
12.8%
12.8%
2003
2003
2005
2005
14.8%
14.8%
15.3%
15.3%
13.3%
13.3%
12.5%
12.5%
2007
2007
2009
2009
According to the California Tobacco Survey, the rate of smoking among youth (those under 18
years) in Riverside County increased slightly from 13.7% in 2002 to 14.1% in 2010 (not
illustrated). Rates of smoking among adults in Riverside County dropped drastically from
20.3% in 2002 to 14.6% in 2008. Smoking initiation among youth remains a significant public
health concern. The younger a person is when they begin smoking the more packs-a-day they
smoke and the longer they smoke in their lifetime, increasing the risk for smoking related
morbidity and mortality.
65
Current Smokers by Race/Ethnicity, Current Smokers by Race/Ethnicity, Riverside County and California, 2007‐2009
35%
35%
30%
30%
25.0%
25.0%
25%
25%
20%
20%
15%
15%
Riverside County
Riverside County
California
California
*31.0%
*31.0%
15.1%
15.1%12.9%
12.9%
10%
10%
17.1%
16.5%
17.1%
16.5%13.8%
13.8%
*13.3%
*12.7%
12.5%
*13.3%
*12.7%
12.5%11.4%
10.4%
11.4%
10.4%
5%
5%
0%
0%
All Races
All Races
American Asian/PI
American Asian/PI
Indian
Indian
Black
Black
Hispanic
Hispanic
White
White
Across most racial and ethnic subgroups, Riverside County residents were more likely to be
current smokers when compared to their California peers. Blacks in Riverside County were less
likely to be current smokers compared to the statewide smoking average for Blacks. Of
significant challenge for Riverside County is obtaining an accurate picture of smoking
prevalence. Due to the small sizes of subgroups such as American Indian, Asian/Pacific
Islanders, and Blacks, rates are often unreliable limiting analysis and interpretation.
CHIS Survey Question: Respondents were asked a series of smoking-related questions.
66
CHILDREN’S LEISURE TIME
Overview
Recent research has found that the amount of free time we have has increased and most of
this leisure time is spent watching television.8 Screen time, which includes the use of the
television, DVDs, computers, video games, and handheld devices should be used in
moderation and is not recommended for children under 2 years of age.
Too much screen time has been found to interfere with healthy physical and social
development in children. Children who watch TV for more than four hours a day are more
likely to be overweight.9 Healthful development for children includes a diverse array of
activities including outdoor play and reading books.
Amount of TV Watching on the Weekends Among Children Amount of TV Watching on the Weekends Among Children and Teens, Riverside County and California, 2009
and Teens, Riverside County and California, 2009
60%
60%
50%
50%
47.1%
47.1%
Riverside County
Riverside County
California
California
50.3%
50.3%
42.7%
42.7%
37.2%
37.2%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
8.6% 8.8%
8.6% 8.8%
3.7%
*1.6% 3.7%
*1.6%
No TV time
No TV time
2 hours or less
2 hours or less
3‐5 hours
3‐5 hours
6‐20 hours
6‐20 hours
In 2009, children and teens in Riverside County were less likely to watch TV for two hours or
less compared to the average for California.
Inversely, children and teens in Riverside County were more likely to spend three to five hours
in front of the screen, compared to the average viewing time for California (51.3% and 46.0%,
respectively).
CHIS Survey Question: “Now, thinking about a typical SATURDAY AND
SUNDAY, about how many hours per day do {you/CHILD} usually watch TV or
play video games?”
67
Percent of Children Under 5 Years
Percent of Children Under 5 Years
Days Each Week Spent Reading with Child Under 5 Years, Days Each Week Spent Reading with Child Under 5 Years, Riverside County and California, 2009
80%
80%
Riverside County
70%
Riverside County
70%
California
California
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10% *3.8% 4.8% *3.7% 6.6%
10% *3.8% 4.8% *3.7% 6.6%
0%
0%
None
1‐2 Days
None
1‐2 Days
72.0%
72.0%
65.0%
65.0%
23.6%
20.6% 23.6%
20.6%
3‐6 Days
3‐6 Days
Every day
Every day
Reading to children has been found to provide benefits in language development and
scholastic achievement.10 Children in Riverside County were more likely to be read to every
day, when compared to the average rate for children in California (72% and 65%, respectively).
In Riverside County, when poverty rates are examined, children at or below 99% of the federal
poverty level were less likely (47.3%) to be read to every day, compared to the county average
of 72%.
CHIS Survey Question: “In a usual week, about how many days do you or any
other family members read stories or look at picture books with (CHILD)?”
68
PREVENTION AND EARLY DETECTION
Overview
Medical providers talking to their patients about nutrition and physical activity is key to raise
awareness of risk and protective factors for health. Additionally, flu vaccination and screening
practices are important in the prevention of disease and or decreasing its severity.
The prevention and early detection of illness is important to length and quality of life. Open
communication may facilitate prevention and early detection as well as ensure that patients
and medical providers work in partnership to improve health.
Percent of Population Ages 12‐17
Percent of Population Ages 12‐17
Percent of Teens Who Report Their Doctor Talked About Nutrition Percent of Teens Who Report Their Doctor Talked About Nutrition During Their Last Exam, Riverside County and California, 2009
During Their Last Exam, Riverside County and California, 2009
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
62.1%
62.1%
61.1%
61.1%
*54.1%
*54.1%
45.5%
45.5%
All
All
65.6%
65.6%
45.1%
45.1%
Black
Black
Hispanic
Hispanic
Riverside County
Riverside County
California
California
58.3%
58.3%
40.6%
40.6%
White
White
In 2009, teens in Riverside County were less likely to report that their doctor spoke with them
about nutrition during their last exam, when compared to the average for California (45.5% and
62.1%, respectively).
Whites were less likely (40.6%)to report that their doctor spoke with them about nutrition when
compared to their counterparts. Blacks were more likely (54.1%)to report that their doctor
spoke with them about nutrition during their last exam when compared to all other groups.
Since 2007, there has been a slight increase in the percentage of Riverside County teens who
report their doctor talked to them about nutrition, from 41.4% to 45.5%.
CHIS Survey Question: “When you had your last routine physical
exam, did you and a doctor talk about nutrition or healthy
eating?”…”talk about exercise or physical activity?”
69
Percent of Teens Who Report Their Doctor Talked About Percent of Teens Who Report Their Doctor Talked About Physical Activity During Their Last Exam, Physical Activity During Their Last Exam, Riverside County and California, 2009
Percent of Teens 12‐17 Years
Percent of Teens 12‐17 Years
70%
70%
60%
60%
50%
50%
61.2%
61.2%
58.2%
58.2%
48.1%
48.1%
47.7%
47.7%
40%
40%
64.8%
64.8%
60.9%
60.9%
52.6%
52.6%
*30.8%
*30.8%
30%
30%
20%
20%
10%
10%
0%
0%
All
All
Black
Black
Riverside County
Riverside County
Hispanic
Hispanic
California
California
White
White
In 2009, teens in Riverside County were less likely to report that their doctor spoke with them
about physical activity during their last exam, when compared to the average for California
(47.7% and 61.2%, respectively).
In the same year, Blacks in Riverside County were less likely (30.8%) to report that their doctor
spoke with them about physical activity, compared to all other groups. Whites in Riverside
County were more likely (52.6%)to report that their doctor spoke with them about physical
activity, compared to all other groups.
Since 2007, there has been a slight increase in the percentage of teens who have reported their
doctor talked to them about physical, from 41.4% to 47.7%.
70
Vaccinated for Flu in the Past 12 Months,
Vaccinated for Flu in the Past 12 Months,
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Riverside County
Riverside County
California
California
Healthy People 2020 Goal
Healthy People 2020 Goal
80.0%
80.0%
80.0%
80.0%
40.6%
40.6%
49.9%
49.9%
26.9%
26.9%
Children (6 months ‐ 11 years)
Children (6 months ‐ 11 years)
34.8%
34.8%
Adults (18+ years)
Adults (18+ years)
In 2009, children in Riverside County were more likely to have been vaccinated for the flu,
compared to adults (40.6% and 26.9%, respectively). Vaccination rates in Riverside County
remain lower than the average rates for California. Rates among children and adults in
Riverside County are substantially lower than the national goal of 80%.
In 2009, those at or below the federal poverty level were less likely to have been vaccinated for
the flu in the past year (24.5%). Of all children vaccinated for the flu, most (77.4%) were above
the federal poverty level.
CHIS Survey Question: “During the past 12 months, have you (child) had a flu shot?”
This questions was asked of all adults and children ages 6 months to 11 years.
71
Vaccination for Flu in the Past 12 Months by Age Groups and Vaccination for Flu in the Past 12 Months by Age Groups and Race/Ethnicity, Riverside County, 2009
Race/Ethnicity, Riverside County, 2009
70%
70%
60%
60%
*59.5%
*59.5%
Children (6 months‐ 11 years)
Children (6 months‐ 11 years)
Adults (18+ Years)
Adults (18+ Years)
50%
50%
42.0%
42.0%
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Black
Black
40.6%
40.6%
26.9%
26.9%
20.2%
*17.9% 20.2%
*17.9%
11.9%
11.9%
Asian/PI
Asian/PI
36.3% 36.2%
36.3% 36.2%
18.8%
18.8%
Hispanic
Hispanic
White
White
All Races
All Races
The overall vaccination rate for influenza in Riverside County is lower than the rate for
California (29.7% and 37.5%, respectively). Children (6 months to 11 years) are more likely to be
vaccinated compared to adults (18 years and older).
When comparing adult and children vaccination rates across racial and ethnic groups, Black
children were less likely than their adult counterparts to be vaccinated (17.9% and 20.2%,
respectively). Whites maintained equal vaccination rates across age groups. Sixty percent of
Asian children were vaccinated for flu, the largest vaccination rate across all age and racial and
ethnic groups. Although the rate is statistically unstable, it is similar to the rate among Asians
in California, where 63.4% of Asian children were vaccinated for flu.
72
Vaccinated for Flu in the Past 12 Months by Race/Ethnicity,
Vaccinated for Flu in the Past 12 Months by Race/Ethnicity,
50%
50%
45%
45%
40%
40%
35%
35%
30%
30%
25%
25%
20%
20%
15%
15%
10%
10%
5%
5%
0%
0%
46.1%
46.1%
30.9%
30.9%
16.3%
16.3%
Asian/PI
Asian/PI
Riverside County
Riverside County
California
California
38.9%
36.2% 38.9%
36.2%
33.9%
33.9%
24.8%
24.8%
19.7%
19.7%
Black
Black
Hispanic
Hispanic
White
White
Vaccination rate differences between Riverside County and California continue to be evident
across all ethnic groups. The average vaccination rate for California, as well as rates for all
racial and ethnic subgroups, is higher compared to rates for Riverside County. The greatest
disparity between Riverside County and California vaccination rates exists among Asian/Pacific
Islanders, where the difference is three fold. In Riverside County Asians maintain the lowest
vaccination rate (16.3%), whereas in California they maintain the highest vaccination rate
(46.1%).
73
References:
1.
2.
Mosby's Medical Dictionary, 8th edition (2009). Elsevier.
Ford ES, Zhao G, Tsai J, & Li C. (2011). Low-risk lifestyle behaviors and all-cause mortality: Findings
from the National Health and Nutrition Examination Survey III Mortality Study. American Journal of
Public Health, 101(10),1922-1929.
3. Anderson B, Rafferty AP, Lyon-Callo S, Fussman C, Imes G. (2011). Fast-food consumption and
obesity among Michigan adults. Prev Chronic Dis,8 (4):A71. Retrieved from http://www.cdc.gov/
pcd/issues/2011/jul/10_0186.htm.
4. U.S. Department of Health and Human Services (DHHS) and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th Edition, Washington, DC: U.S. Government Printing Office,
January 2005. Retrieved from http://www.health.gov/DietaryGuidelines/dga2005/document/html/
chapter5.htm.
5. Centers for Disease Control and Prevention (2011). Physical Activity and Health. Retrieved from
http://www.cdc.gov/physicalactivity/everyone/health/index.html
6. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. (2004). Actual causes of death in the United
States, 2000. Journal of the American Medical Association; 291(10):1238–1245.
7. U.S. Department of Health and Human Services (2004). The Health Consequences of Smoking: A
Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
8. Bronson, PO. (2006, October 23). How we spend our leisure time. Retrieved from http://
www.time.com/time/nation/article/0,8599,1549394,00.html
9. Dowshen, S. (2011, October). How TV affects your child. Retrieved from http://kidshealth.org/
parent/positive/ family/tv_affects_child.html#
10. Pitts, J. (2012). The Benefits of Reading to Your Child. Retrieved from http://
www.healthguidance.org/entry/12511/1/The-Benefits-of-Reading-to-Your-Child.html
74
IV. APPENDIX
75
15.7
16.0
15.9
2002
15.9
2003
16.3
2004
16.4
2005
16.8
2006
16.8
2007
15.5
2008
76
30.1
94.1
15 to 17 Years
18 to 19 Years
90.7
26.7
0.6
2001
83.6
24.1
0.4
2002
76.2
23.1
0.6
2003
74.5
22.3
0.6
2004
72.1
22.4
0.4
2005
72.2
22.0
0.6
2006
76.4
22.2
0.5
2007
66.3
20.7
0.4
2008
14.5
2009
54.6
54.3
81.3
32.0
All Teens
Black
Hispanic
White
2000
28.6
76.0
45.1
51.1
2001
25.8
69.3
37.9
46.8
2002
25.6
62.9
30.7
43.5
2003
23.8
62.7
25.4
42.5
2004
16.8
70.1
30.4
41.6
2005
16.1
68.5
35.3
41.4
2006
16.5
70.1
33.5
43.4
2007
15.0
61.7
34.8
38.9
2008
13.0
55.6
26.9
34.8
58.9
18.1
0.3
11.4
47.3
25.2
29.9
50.6
15.4
0.3
2010
2010
13.7
2010
2009
2009
Teen Birth Rates (per 1,000 population) by Year and Race/Ethnicity, Riverside County, 2000-2010
0.6
Under 15 Years
2000
Teen Birth Rates (per 1,000 population) by Year and Age Group, Riverside County, 2000-2010
2001
2000
Birth Rates by Year (per 100,000 population), Riverside County 2000-2010
DATA TABLES
77
11.4
6.8
5.9
Black
Hispanic
White
4.7
4.0
9.5
4.5
2001
6.4
5.8
8.9
6.4
2002
5.4
6.8
10.7
6.5
2003
5.4
5.6
7.4
5.4
2004
5.0
6.2
14.6
6.1
2005
810.0
810.0
2001
770.0
2002
770.0
2003
750.0
2004
790.0
2005
179.4
19.3
261.3
63.4
Cancer
Diabetes
Heart
Disease
Stroke
2001
54.9
248.8
16.5
176.4
2002
58
240.7
14.8
167.9
2003
53.3
222.8
17.5
169.9
2004
52.8
230
23.1
181
2005
46.6
229.8
21.4
174.5
2006
Crude Mortality Rate by Cause and Year, Riverside County, 2001-2010
Rate
2000
Age-Adjusted Mortality Rate by Year, Riverside County, 2000-2010
6.7
All Races
2000
44.7
213.7
23.6
170.8
2007
772.8
2006
4.2
65.2
6.2
5.0
2006
41.9
205.5
20.4
179.1
2008
749.5
2007
4.0
5.5
10.8
5.4
2007
42
191.9
22.2
172.8
2009
737.5
2008
3.5
5.8
14.7
5.7
2008
705.3
2009
5.8
4.6
11.2
5.3
2009
40.5
188.2
19.4
171.2
2010
Infant Mortality Rates (per 1,000 live births) by Year and Race/Ethnicity, Riverside County, 2000-2010
699.4
2010
5.7
4.3
9.5
5.1
2010
78
79.7
128.6
200.4
137.8
186.4
American Indian
Asian/Pl
Black
Hispanic
White
186.6
122.9
194
128.7
158.3
170.8
2007
195.5
137.9
200.5
134.8
115.8
179.7
2008
189.4
132
184.9
128.9
105.6
172.8
2009
185.1
131.4
191.1
159.7
163.9
171.2
2010
194.5
263.5
Hispanic
White
114.1
Asian/Pl
317.4
351.7
American Indian
Black
229.8
All Races
2006
252.6
173.6
258.9
135.6
265.7
213.7
2007
238.2
158.1
293.7
157.5
238.3
205.5
2008
223.9
151.2
252.2
139.3
193.9
191.9
2009
216.9
154.3
269.3
172.8
289.6
188.2
2010
Heart Disease Mortality Rates (per 100,000 population) by Year and Race/Ethnicity, 20062010
174.5
All Races
2006
Cancer Mortality Rates (per 100,000 population) by Year and Race/Ethnicity, Riverside
County, 2006-2010
79
21.4
52.8
21.1
36.2
35.2
17.8
All Races
American Indian
Asian/Pl
Black
Hispanic
White
2006
18.1
41.3
50.1
27.9
48.8
23.6
2007
16.4
32.2
35.3
21.8
0.0
20.4
2008
18.5
29.5
41.7
25.2
56.3
22.2
2009
Diabetes Mortality Rates (per 100,000 population) by Year and Race/Ethnicity,
Riverside County, 2006-2010
15.4
32.6
22.5
21.0
38.9
19.4
2010
TECHNICAL NOTES
Racial/Ethnic Category Labels
Please note that the following racial/ethnic categories were used to compile the data:
• American Indian/Alaska Native
• Asian/Pacific Islander
• Black, not Hispanic
• Hispanic
• White, not Hispanic
In an effort to condense data displayed, the following labels were used:
• American Indian
• Asian
• Black
• Hispanic
• White
Definitions and Rate Calculations
Place of Residence: The place where a person lives or maintains legal residency. For purposes
of this report, all totals used are based on “Residence” in the County of Riverside.
Birth rate is the number of births during a stated period of time, usually one year.
Birth Rate = number of births in specified time period X 1,000
Estimated total population
Death Rate is the number of deaths during a stated period of time, usually one year.
Death Rate = number of deaths in specified time period X 100,000
Fertility Rate is the number of births to women of child bearing age (15-44 years) during a
stated period of time, usually one year.
Fertility Rate = number of live births during time period X 1,000
Estimated population of females ages 15-44
Incidence is the number of new cases of a specific illness diagnosed or reported during a
stated period of time, usually one year.
Incidence Rate = number of observed cases reported in specified time period X 100,000
Prevalence is the number of current cases of a condition or illness at one time, no matter
when it started. Usually used to describe conditions that last a long time, or are chronic.
Prevalence Rate = number of cases living with disease at specified time period X 100,000
80
Age-Adjusted Rates
Rates calculated as the total number of events divided by the total population are called
crude rates. Most health outcomes vary with age, therefore in order to compare populations
with differing age distributions statistical adjustments must be made. Age-adjustment allow
one to "adjust for" differences in both the size and age distribution of populations. The
age-adjusted rates are used to compare mortality or morbidity across populations with
different age distributions and sizes. Age-adjusted rates can only be compared if they are
adjusted to the same population standard. The current standard used is the US 2000 standard million population (Anderson, 1998).
Data Limitations and Rate Instability
Rate instability refers to the increased relative standard error rate resulting from the small
number of cases measured. In this instance, the calculated rate is considered unreliable and
should be interpreted with caution. When sample sizes are insufficient, there is no way to
distinguish random fluctuations in data from true changes. When possible, the pooling of
multiple years data may be done to reduce instability and increase reliability. There may the
be exclusion of some groups when data is not available or when rates remain unstable even
after pooling multiple years. Throughout the publication the asterisk symbol (*) may also be
used to denote rates that are unstable.
Readers of this publication should observe caution when interpreting rates based on few
events and/or small populations (ex: American Indians comprise 0.5 percent of the total
population of the County of Riverside) For more information, please refer to Guidelines for
Statistical Analysis of Public Health Data with Attention to Small Numbers, Revised, July 2003.
This publication may be found at:
http://familymedicine.medschool.ucsf.edu/fhop/_docs/pdf/prods/smallnumbers2003.pdf
Such factors may prevent or make it difficult to interpret a measure for a population that is
small in size. Another limitation is that such a measure may inadvertently disclose
confidential information about an individual in a community. In data tables, this publication
employs masking (“*”symbol) for totals less than five, in efforts to protect identity of reported
individuals from possible disclosure.
81
Changes in COPD definition
Chronic lower respiratory disease (CLRD) is inclusive of chronic obstructive pulmonary disease
(COPD), asthma, chronic bronchitis, emphysema, and other lower respiratory illnesses. Prior to
1999, CLRD was called COPD and in 2008 a revision to CLRD coding and classification was
made. This change may effect reported mortality, however there is uncertainty as to how it
may affect rates.
Data Sources and Additional References
To complete the Community Health Profile data was gathered from the birth and death statistical masterfiles, the Cancer Registry for the California Department of Public Health, EPiCenter:
California Injury Data Online, Healthy People 2020 National Objectives, the US Census Bureau,
California Department of Finance, California Department of Education, and others. Additionally,
data was gathered and analyzed from the California Health Interview Survey (CHIS), the largest
state health survey in the US, with more than 50,000 Californians surveyed biennially.
Anderson, R.N. & Rosenberg, H.M. (1998). Age standardization of death rates: Implementation
of the year 2000 standard. National Vital Statistics Reports, 47(3), 1-17.
Husing, J. (2012). Inland Empire Quarterly Economic Report. Retrieved from http://
www.johnhusing.com/.
State of California Department of Finance (2011). Race/Ethnic Population with Age and Sex Detail—Data Files.
State of California Employment Development Department (2010). Unemployment and Labor
Force. Labor Market Information.
US Census Bureau. (2010). Age Groups and Sex: 2010. American FactFinder.
US Department of Labor (2010). Unemployment Rates for States. Local Area Unemployment
Statistics.
82
83
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Community Health Profile 2013 - Riverside County Public Health

Transcription

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