California Department of Public Health
The Trend and Burden of Chronic Diseases and Injury in California
Ron Chapman, MD, MPHDirector and State Health Officer
California Department of Public HealthSeptember 24, 2013
California Department of Public Health
Cost of Disease: California
• Health care spending 2009: $230.1 billion• Share of GDP: 12.2%• Government share of spending:
Medicare: 22% MediCal: 17%
• Per capita spending: All: $6,238, Medicare: $10,954, MediCal: $4,569
• Health spending growth trends 2009: – All: 4.5%, Medicare: 7.4%, MediCal: 9.8%
California Health Care Almanac, September 2013, California HealthCare Foundation
3
Leading causes of death, California, 1996-2010
Source: California Department of Public Health, Vital Records, 2012
1996199719981999200020012002200320042005200620072008200920100
50
100
150
200
250
300
Heart Disease
Cancer
Stroke
Respiratory Disease
Unintentional Injury
Alzheimer's Disease
Diabetes
Influenza & Pneumonia
Ag
e-a
dju
ste
d R
ate
pe
r 1
00
,00
0 P
op
ula
tio
n
Leading Actual Causes of Death in the United States in 1990 and 2000
Based on Mokdad, Marks, Stroup, and Gerberding, 2004
Tobacco
Poor Diet and Physical Activity
Alcohol consumption
Microbial agents
Toxic Agents
Motor Vehicle Collisions
Firearms
Sexual Behavior
Illicit Drug Use
0 2 4 6 8 10 12 14 16 18 20
2000
1990
Percent of Deaths
Expenditures on four most costly conditions, U.S, 1997 and 2009 (in billions)
Heart Disease Trauma Cancer Mental Health$0
$20
$40
$60
$80
$100
$120
19972009
Billi
ons
of d
olla
rs
Source: Agency for Healthcare Research and Quality. Total Expenses and percent Distribution for Selected Conditions by Source of Payment: U.S., 1997 and 2009. Adapted from California Healthcare Foundation
Share of adults with one or more chronic conditions, by county, 2007
Lui C, Wallace S. Chronic Conditions of Californians: California Health Interview Survey. Oakland, CA: California HealthCare Foundation, 2010.
Prevalence (%)
25.9 - 33.8
33.9 - 38.2
38.3 - 40.7
40.8 - 46.2
Antelope Valley
San Fernando
San Gabriel
West
East
South Bay
Metro
South
Los AngelesCounty
Los Angeles County ServicePlanning Areas
Age-Adjusted
California Department of Public Health
Cost of Chronic Disease: California
• Seven common chronic conditions: heart disease, cancers, stroke, hypertension, diabetes, mental disorders and pulmonary conditions shorten lives and reduce quality of life
• Economic impact in 2003: $133 billion– Treatment $26.9B (20%)– Lost productivity $106.2B (80%)
An Unhealthy America: The Economic Burden of Chronic Disease, Milken Institute, 2007 www.milkeninstitute.org
California Department of Public Health
Value of Prevention
• Preventing and managing chronic disease and injury will reduce future economic costs of disease
• Improvements in health will increase investments in human and physical capital, driving additional economic growth in the next generation
An Unhealthy America: The Economic Burden of Chronic Disease, Milken Institute, 2007 www.milkeninstitute.org
California Department of Public Health
Obesity
California Department of Public Health
Obesity Risk Factors and Major Causes of Death
Obesity
Type 2 diabetes
Heart disease
Stroke
Lack of physical activity
Poor diet
Some cancers
California Department of Public Health
Magnitude
Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2012.
In California, 35.3% of adults are overweight and 25.0% are obese
Both Black and Hispanic Californians have significantly higher rates of obesity
than white Californians
Californians with less than a high school (h.s.) diploma have twice the rate of obesity
than those with a college degree
Black 36.6% Hispanic 31.1% White 23.3%
Less than H.S. 34.8%College 16.0%
California Department of Public Health
19841987
19901993
19961999
20022005
200805
1015202530354045
Total Latino Black White Asian/Other
Year
Perc
ent O
bese
Adult Obesity by Race/EthnicityBehavior Risk Factor Surveillance System,
1984-2010
California Department of Public Health
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0.0
5.0
10.0
15.0
20.0
25.0
Age > or = 2 < 5Age > or = 5 < 20
Year
Perc
ent
Trends Child Obesity Among Participants in the California Child
Health and Disability Prevention Program, 1993-2010*
*Low-income Children; Obesity = BMI > 95th percentile. Source: California Dept. of Health Services, Children’s Medical Services Branch, California Pediatric Nutrition Surveillance System
Source: Babey SH, Wolstein J, Diamant AL, Bloom A, Goldstein H. A Patchwork of Progress: Changes in Overweight and Obesity Among California 5th, 7th, and 9th Graders, 2005-2010. Los Angeles, CA: UC Los Angeles: UCLA Center for Health Policy Research; 2011.
Fitnessgram Changes in Overweight and Obesity Among California
5th, 7th, & 9th Graders, 2005-2010
California Department of Public Health
Obesity-Attributable Expenditures by Payer (in millions*)
$3.429 billion95% confidence interval: (2,358 – 4,730)
$2.884 billion95% confidence interval: (950 – 4,920)
$15.223 billion95% confidence interval: (12,180 – 18,025)Percentage financed by Medicare and Medicaid: 41.5%
State-level
Medicaid
Medicare
*2009 dollarsSource: Trogdon JG, Finkelstein EA, Feagan CW, Cohen JW. State- and payer-specific estimates of annual medical expenditures attributable to obesity. Obesity. Jan 2012;20(1):214-220.
California Department of Public Health
Type 2 Diabetes
California Department of Public Health
Diabetes: Size of the Problem
2.4 million (8.6%) adults have been diagnosed with diabetes: 1 in 12 adult Californians
1.5 million (5.2%) adults are projected to have undiagnosed diabetes
About11.4 million (41%) of adults are estimated to have prediabetes
Diabetes in pregnancy has increased 60%, from 3.3% in1998 to 5.3% in 2005
California Department of Public Health
Diabetes: Trends in California and US
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
CA 6.8 6.5 7.4 7.2 7.1 7.1 8.2 7.6 8.5 9.1
US 6 6.3 6.5 6.7 7 7.3 7.5 8 8.3 8.3
0.5
1.5
2.5
3.5
4.5
5.5
6.5
7.5
8.5
9.5
Perc
ent
Behavioral Risk Factor Surveillance System, 2000-2009
California Department of Public Health
California: People with Diabetes
California Department of Public Health
Cost of Diabetes
• Diabetes costs in California exceed $24B each year
• Direct medical costs (hospitalizations, medical care, treatment, supplies): $18.7B
• Indirect costs (disability payments, time lost from work, premature death): $5.8B
• The average annual treatment cost per case for diagnosed diabetes in the US was nearly $10,000 in 2007
California Department of Public Health
Injury and Violence
California Department of Public Health
Injury and Violence in California
• Leading cause of death for people ages 1–44 in California• 16,569 deaths from injuries in 2011 for all ages
– 1 person every 32 minutes
• Over 250,000 hospitalizations for serious injuries each year– 1 person every 2 minutes
• An estimated 2.1 million people treated in Emergency Departments for injuries each year– 4 persons every 1 minute
• Injury and violence cost more than $48.6 billion in medical care and lost productivity each year
Injury data accessed from EpiCenter http://epicenter.cadph.ca.govInjury cost estimates adapted from http://www.cdc.gov/injury/wisqars/index.html
California Department of Public Health
Trends: Injury Deaths in California,2002-2011
Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov
California Department of Public Health
Trends: Suicides in California, 2002 -2011
Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov
California Department of Public Health
Trends: Unintentional Poisoning Deaths, California, 2002 -2011
Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov
California Department of Public Health
Trends: Unintentional Deaths Due to Falls, California, 2002-2011
Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov
California Department of Public Health
Trends: Homicides, California, 2002 -2011
Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov
California Department of Public Health
Trends: Unintentional Motor Vehicle-Related Deaths, California, 2002 -2011
Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov
Top Related