1. California Department of Public Health The Trend and Burden of Chronic Diseases and Injury in California Ron Chapman, MD, MPH Director and State Health Officer California Department of Public Health September 24, 2013

2. 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. 3 Leading causes of death, California, 1996-2010 Source: California Department of Public Health, Vital Records, 2012

4. Leading Actual Causes of Death in the United States in 1990 and 2000 Based on Mokdad, Marks, Stroup, and Gerberding, 2004

5. Expenditures on four most costly conditions, U.S, 1997 and 2009 (in billions) 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

6. 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 Los Angeles County Los Angeles County Service Planning Areas Age-Adjusted

7. 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

8. 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

9. California Department of Public Health Obesity

10. 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

11. 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% Less than H.S. 34.8% College 16.0%

12. California Department of Public Health Adult Obesity by Race/Ethnicity Behavior Risk Factor Surveillance System, 1984-2010

13. California Department of Public Health 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

14. 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 5 th, 7 th, & 9 th Graders, 2005-2010

15. California Department of Public Health Obesity-Attributable Expenditures by Payer (in millions*) State- level Medicaid Medicare *2009 dollars Source: 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.

16. California Department of Public Health Type 2 Diabetes

17. 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

18. California Department of Public Health Diabetes: Trends in California and US Behavioral Risk Factor Surveillance System, 2000-2009

19. California Department of Public Health California: People with Diabetes

20. 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

21. California Department of Public Health Injury and Violence

22. 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.govhttp://epicenter.cadph.ca.gov Injury cost estimates adapted from http://www.cdc.gov/injury/wisqars/index.htmlhttp://www.cdc.gov/injury/wisqars/index.html

23. California Department of Public Health Trends: Injury Deaths in California, 2002-2011 Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov

24. California Department of Public Health Trends: Suicides in California, 2002 -2011 Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov

25. California Department of Public Health Trends: Unintentional Poisoning Deaths, California, 2002 -2011 Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov

26. California Department of Public Health Trends: Unintentional Deaths Due to Falls, California, 2002-2011 Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov

27. California Department of Public Health Trends: Homicides, California, 2002 -2011 Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov

28. California Department of Public Health Trends: Unintentional Motor Vehicle- Related Deaths, California, 2002 -2011 Injury data accessed from EpiCenter http://epicenter.cadph.ca.gov