HEALTHY SAN SAN MATEO 2000
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MORTALITY AND MORBIDITY RATES

Mortality Rates

As would be expected from a county characterized by advanced economic development and an older population, San Mateo County’s death numbers and rates have remained relatively stable in the period under study. Chronic diseases and degenerative conditions of the elderly play the major role among causes of death, while accidental injury and cancer are the a major factors in deaths among young adult age groups. (AIDS and homicide were leading killers in younger individuals in our last report, but have since declined.)

In 1995-1996, heart disease and cancer were the most common causes of death among San Mateo County residents. (DTH1)

The numbers of AIDS and homicide deaths declined 35% and 48%, respectively, from 1993 to 1996. (DTH1)

Injuries and cancer were the leading causes of death among 15 to 44 years olds in 1996. (DTH2)

Leading causes of death for each age group by gender are displayed in grids on graphs (DTH3-5).

The age-adjusted heart disease death rate for San Mateo residents from 1994-1996 was 79.9/100,000, substantially less than both the equivalent rate for California and the Year 2000 Goal of 100/100,000. (DTH6)

The age-adjusted cancer death rate for San Mateo residents in 1994-1996 was 116/100,000, which is almost exactly equal to the same rate for California, and somewhat under the Year 2000 Objective of 130/100,000. (DTH6)

The 1994-1996 age-adjusted death rate for stroke in San Mateo (28.8/100.000) was much higher than Year 2000 Goal of 20/100,000. (DTH6)

San Mateo County has met the Year 2000 objectives for deaths due to heart disease, cancer, homicide, suicide and unintentional injuries, but exceeds the objective for stroke-related deaths. (DTH6,7)

Whites account for the majority of deaths in San Mateo County and have the second highest rate of heart disease and cancer deaths among racial/ethnic groups. When compared to other racial and ethnic groups, Blacks have higher death rates for all major causes except suicide. (DTH7-9)

All ethnic groups exceed the Year 2000 Goal for deaths from stroke, and Blacks in San Mateo County also experience death rates in excess of the Year 2000 Goals for heart disease and cancer. (DTH8-10)

The homicide rate in San Mateo County (5.3 per 100,000) is lower the Year 2000 objective (7.2 per 100,000) and continues to decline. (DTH7, VIOL3)

The age-adjusted suicide rate for San Mateo County (10.0 per 100,000) is lower than the Year 2000 objective (10.5/100,000). (DTH7, VIOL9)

From 1994 to 1996 the average annual age-adjusted death rate due to unintentional injuries was 18.2 per 100,000. This is lower than the Year 2000 objective (29.3 per 100,000). (DTH7, INJ2)

Firearms caused the majority of injury deaths among San Mateo County residents, more than any other type of injury death, including death from motor vehicle accidents and drug overdose. (DTH11,12)

There were over 130,000 Years of Potential Life Lost (YPLL is equivalent to the sum of years not lived through age 75 for all individuals dying prior to that age) due to deaths from AIDS, cancer, suicide, homicide and unintentional injury, from 1992 through 1996. (DTH13)

Using YPLL measures, it was apparent that homicide caused the greatest mean loss of productive life span per occurrence, followed closely by AIDS, suicide and injury. (DTH13)

In each year between 1992-1996, lung cancer on average claimed almost 3 times as many lives (323) as colorectal cancer (110), the second leading cause of cancer death. (DTH14)

The leading causes of cancer deaths by site were, in order: lung, colorectal and breast cancers. (DTH14)

There are large differences in breast cancer death rates among race groups in female residents of San Mateo County. There is an overall decline in breast cancer death rates in most race groups, but the rate in Blacks remains stable and elevated over the Year 2000 Goal of 20.6 /100,000. (DTH15)

Infant Deaths

The San Mateo County infant mortality rate declined from 6.3 deaths per 1,000 births in 1990 to 4.0 deaths per 1,000 births in 1996. Overall, San Mateo County has met the Year 2000 objective for infant mortality of 7.0 deaths per 1,000 births since 1990. (DTH16)

Blacks had the highest infant mortality rate among racial and ethnic groups each year. However, the rate has declined from 14.8 per 1,000 births to 7.9 per 1,000 births, incidentally below the Year 2000 Objective of 11.0/ 1000. Due to the small number of deaths among Black infants, the rates are considered unreliable and may exhibit extreme fluctuations in any one year. Despite this limitation the overall trend in Black infant mortality appears to be declining. (DTH17)

Violence: Homicide Deaths and Assault Injury Hospitalization

From 1992 to 1996, 187 San Mateo County residents were victims of homicide. Almost three-quarters of the victims of homicide were male. One hundred and thirty-six (73%) of these homicides were committed using a firearm. The overall homicide rate declined in this time period. (VIOL1-2)

Among males aged 15 to 24 years the homicide rate was 14.7 deaths per 100,000 population. This is higher than any other age group, male or female. (VIOL3)

The age-adjusted homicide rate was 5.3/ 100,000, lower than the Year 2000 Objective of 7.2/100,00. (VIOL3)

The homicide rate for Blacks in San Mateo County has moderated substantially since the previous report, although Blacks still have a higher homicide rate than other racial and ethnic groups in all age categories from 15-64 years of age. The highest rates were among 35-44 year old Blacks (26.8 per 100,000), which was twice the rate among similarly aged Hispanics and eleven times the rate among similarly aged Whites. (VIOL2,4)

Four times as many males as females were hospitalized for assault injuries between 1994 and 1995. (VIOL5)

In general, 15 to 24-year olds had higher rates of hospitalization for assault injuries for male and female and all racial and ethnic groups, except in Blacks, where the rate peaked in the 25-34 age group. Overall, between 1992-1995, the assault injury hospitalization rates declined. (VIOL5VIOL7 )

Among types of assaults, firearm injuries accounted for the largest number of the male assault hospitalizations (29%) while unarmed fights accounted for the largest proportion of female assault hospitalizations (35%). (VIOL6)

Blacks had by far the highest rates of assault injury hospitalization between the ages of 15-64. Those rates in Hispanics were elevated, although less so, between the ages of 15-44. (VIOL7)

Self-inflicted Violence: Suicide and Self-inflicted Injury Hospitalization

Firearms were the most common method of suicide among males (48%). Among females, drug overdose was the most common method of suicide (33%). (VIOL8)

Suicide death rates were higher in males in all age groups. Generally, rates increased with increasing age, ranging from 16 deaths per 100,000 among 15 to 24 year olds to 63 deaths per 100,000 for those 85 years and over. (VIOL10)

Whites tended to have higher death rates from suicide, particularly among those 45 years and over, when compared to other racial and ethnic groups. Because of the small number of suicide deaths among Blacks, rates can not be calculated. (VIOL10)

Among hospitalized intentional injuries, drug overdose was the most common cause of self-inflicted injury for males (70%) and females (80%). (VIOL11)

In contrast to assault hospitalizations, females had higher rates than males of self-inflicted injury hospitalizations during 1992 to 1995. In addition, between 1992-3 and 1994-5 these rates increased in females. (VIOL12)

 

Whites aged 15-24 years and Blacks aged 25-34 years had the highest rate of hospitalization for self-inflicted injuries. Among Whites and Asian/Others, hospitalization rates decline after 24 years of age but begin to increase after 55 years of age. (VIOL13)

Accidental Death and Hospitalization for Unintentional Injuries

Males had a higher rate of unintentional injury death for all age groups, with the highest such rate occurring in the 85 years old and older group. (INJ1)

The rate of unintentional injury (18.2/100,000) was lower than the Year 2000 Objective (29.3/100,000). (INJ1)

The annual average amount charged for an unintentional injury hospitalizations during 1992 and 1993 was in excess of $103 million. Medicare was the expected source of payment for 45% of these hospitalizations, with an additional 11% coming from other public funding sources. In all, public sources covered 56% (or just over $68 million) of the total. (INJ2)

The rate of deaths from motor vehicle crashes (6.0/100,000) was lower than the Year 2000 Objective (18.8/100,000) and has declined 25% in the period 1994 to 1996. (INJ3)

The local injury death rate for falls (1.4/ 100,000) was lower than the Year 2000 Objective (2.3/100,000). Despite this, the death rate from falls increases dramatically after age 65. (INJ4)

In addition, the elderly in general had the highest rates of death and hospitalization resulting from motor vehicle accidents and falls, the exception being that the age group 15-24 had similarly high rates of motor vehicle-related hospitalizations. (INJ3,4,9,10)

The most common cause of hospitalizations during 1994 and 1995 was adverse reactions to medication. The second most common cause of hospitalization was falls. (32%) (INJ5)

For hospitalizations, unintentional injury rates were higher for males under 55 years of age. After this age group, females generally have higher rates than males. For both genders, hospitalization rates from unintentional injuries were by far the highest among groups over 85 years of age. (INJ6)

Unintentional injury hospitalizations were generally highest among Whites over the age of 65. However, among those under 55 years of age, Blacks tended to have the highest hospitalization rate. (INJ7)

Between 1992 and 1995, injury hospitalization rates for age groups over 65 appear to be steadily increasing. (INJ8)

Hospitalizations for motor vehicle crashes peak among the 15 to 24 age group, decline to a stable rate between 35 and 65 years of age, and then increase in older individuals. Unintentional poisoning hospitalizations are high among zero to 4 years olds, decrease in middle age groups and rise again among the elderly. (INJ9)

The rate of hospitalization for fall injuries is over 50 times higher among those over 85 years of age than the rate in young adult age groups. (INJ9)

Substance Use Related Hospitalization

Hospitalizations where discharge records indicated involvement of drugs or alcohol in the primary or contributing diagnoses were examined separately from other discharges to determine demographic patterns. These records included both admissions related to short-term toxicity and long-term sequelae of substance abuse. Discharges citing an involvement of tobacco without the presence of other substance use were not included. Readers should note that these figures almost certainly understate medical expenses due to these of hospitalizations, as Kaiser system charges are not included.

During the period 1992-1993, over $78 million was charged for directly substance-use related hospitalizations in San Mateo County. Over 62% of this total (more than $48 million) was public funds dispensed via MediCal, MediCare, Worker’s Compensation or other governmental payment sources. (SUB1)

Rates of substance use-related hospitalization were consistently lower among women then men, with the greatest proportional difference occurring in Hispanics. For race groups overall, Blacks had almost uniformly higher rates of such hospitalization, especially in the 25-64 age groups (SUB2-3)

Tobacco Use Prevention and Surveillance

In 1997, the County Office of Education conducted a survey of all High School Seniors in San Mateo County covering the topic of past and present use of various forms of tobacco.

The prevalence of cigarette smoking was highest among Caucasians and Hispanics, with slightly higher proportions in females in those ethnic groups. Overall of prevalence of cigarette smoking was 40% in males and 41% in females. (TOB1)

Cigar smoking prevalence was close behind that for cigarette smoking in all ethnic groups, and was actually higher in Blacks. The most frequent use of smokeless tobacco was reported in Whites (14%) and Blacks (12%). (TOB2)

Cancer Incidence

Data on newly diagnosed cancers of a wide array of anatomical sites during the period 1990-1994 were abstracted for San Mateo County residents from overall state data, and were then analyzed for demographic trends and totals. Racial breakdowns for selected cancer sites are also provided. Age-adjusted incidence rates were not calculated for the Black segment of the county’s population due to their relatively small population numbers and resulting imprecision in rate results. Cancer death rates for Blacks and other race groups are discussed in the mortality section, above.

The most common types of cancer diagnosed in San Mateo County residents were female breast cancer, prostate cancer, lung and colorectal cancer, each with over 1800 cases in the period 1990-1994, and to a lesser extent, leukemia, melanomas and oropharyngeal tumors. (CX1)

After age-adjustment of rates for all cancer sites, breast, lung, colorectal, leukemia and prostate cancers, Whites consistently had higher rates of cancer then Hispanic and Asians. However, rates in Hispanics and Asians varied substantially by type of cancer. (CX2-8)

Hispanic men had higher rates of prostate cancer than Asian men, while Asian/Other groups had an overall higher incidence of colorectal and lung cancers. In contrast, Asian women had lower lung cancer and leukemia rates then in either gender among Hispanics. (CX3-7)

Hispanic women showed a significantly higher rate of cervical cancer 16.7 per 100,000) than other race groups, almost twice as high as the next highest group. This rate was also substantially in excess of state and national average rates. (CX6)

Ambulatory Care Sensitive Diagnoses

There have been both increases and decreases in rates of hospitalizations due to diagnoses that are believed to be reducible with improved access to primary care services. Most notable were major increases in hospitalizations for invasive cervical cancer and chronic obstructive pulmonary disease (ACS1).

RECOMMENDATIONS
The two most common causes of death, by far, are heart disease and cancer. Nearly 70-80% of these deaths are lifestyle-related and potentially preventable. All residents of San Mateo County should stop smoking, continue to lower the amount of fat in their diet, increase their consumption of fruits and vegetables (to a minimum of five servings per day) and drink little, if any, alcohol. They should also exercise regularly, with activity at least the equivalent of at least 30 minutes of brisk walking on most days of the week. Government agencies, schools, businesses, the media, the faith community and other community-based organizations should all be involved in developing chronic disease prevention policies and programs that incorporate the above recommendations.

Substance abuse is one of the biggest threats to the health of our community. The economic burden to our community is estimated at 400-500 million dollars annually in this county alone. These costs include those for medical care, incarceration, crime and worker productivity problems. Although we commit very few resources to prevention and early intervention in relation to the magnitude of the problem, many of the consequences of substance abuse – along with the associated costs - are preventable with the appropriate reallocation of resources. We must provide more education to our children and the community about substance abuse.

There should be no barrier to substance abuse treatment for San Mateo residents. We must dramatically increase substance abuse treatment slots available in both residential and non-residential categories. We should also increase treatment activities in our correctional facilities and find ways to address the particularly dire need for long-term residential slots, especially for those previously incarcerated. The courts should more strongly incorporate proven treatment options into their sentences. Health care providers must become more aware of substance abuse, approach it in a nonjudgmental manner, assess for it at every opportunity, counsel patients and refer to appropriate drug treatment providers and community programs.

A Community Oriented Health Systems (COHS) approach, like the one currently being piloted in the southern part of the County and in various cities, is one of the most efficient ways of dealing with many of the above noted-issues. This approach should be supported and replicated.

Smoking causes over 85% of lung cancer deaths, and should be discouraged at every opportunity. Ordinances restricting exposure to second hand smoke should be developed and enforced. Youth access to tobacco products must be prevented in every possible way.

Youth smoking is increasing. A surveillance system around use patterns should begin in the 4th or 5th grade and continue through high school. Comprehensive, community-based, primary prevention efforts should begin in early grade school and continue in each grade through high school. All tobacco prevention funding coming into our community should be used appropriately and leveraged with other funding.

Breast cancer screening should be available on a routine basis to all regardless of ability to pay.

Easy access to firearms, especially handguns, must be eliminated. Ordinances ought to be passed by each city and the county severely limiting access to firearms by individuals under the age of 25 and other high-risk groups.

Injuries relating to falls account for a huge societal cost, especially in the elderly. Falls are preventable, and every "at-risk" elderly person’s home should be inspected for fall risk. Deficiencies should be promptly corrected. Fall risk and preventive measures should be addressed at every visit of an "at-risk" individual.

In addition, public education campaigns addressing the effects of falls, and the vulnerability of the elderly to such accidents, should be developed. Assessment for fall prevention should be incorporated into every medical visit.

Cervical cancer rates are very high is Hispanic women, probably related to inadequate access to screening. Hospitalizations related to invasive cervical cancer recently increased 150%. Increased community education and outreach aimed at improving screening rates must be developed.

Prostate cancer is the most frequently diagnosed cancer in males in San Mateo County. Efforts should be made to raise public awareness of this issue. Efforts should also be directed at increasing screening.

Faith and Health collaboratives have been shown, in many parts of the country, to be effective tools in dealing with many of the issues in this section. The faith community and health care providers should become more closely connected and should begin working jointly on programs to prevent disease and injury.

 

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