The Trend and Burden of Chronic Diseases and Injury in California

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


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


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


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


Obesity


Obesity Risk Factors and Major Causes of Death

Obesity

Type 2 diabetes

Heart disease

Stroke

Lack of physical activity

Poor diet

Some cancers


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%


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


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


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.


Type 2 Diabetes


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


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: People with Diabetes


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


Injury and Violence


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

http://epicenter.cadph.ca.gov/

http://www.cdc.gov/injury/wisqars/index.html


Trends: Injury Deaths in California,2002-2011

Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov


Trends: Suicides in California, 2002 -2011



Trends: Unintentional Poisoning Deaths, California, 2002 -2011



Trends: Unintentional Deaths Due to Falls, California, 2002-2011



Trends: Homicides, California, 2002 -2011



Trends: Unintentional Motor Vehicle-Related Deaths, California, 2002 -2011


Documents

The Trend and Burden of Chronic Diseases and Injury in California