Diabetes in California Counties

Introduction by Dean Schillinger, MD

As a primary care physician in a safety net hospital, I see patients every day who either have diabetes or are at high risk of developing diabetes. Our patients are the uninsured and the underinsured, the old and the young. Many are poor and their needs are great. I see how diabetes, for many people, can be a devastating disease that can alter their life’s trajectory and present a challenge to family caregivers. Over the last 15 years, I have been working with a multidisciplinary team of clinical staff, researchers, and public health experts to develop ways to improve communication about diabetes and improve health outcomes. In 2008, I was able to join the wonderful team of the California Diabetes Program to try and bridge the gap between research and practice and to find ways to scale-up and disseminate successful interventions into population-based solutions.

Diabetes is a complex disease that is sweeping the country. Its prevalence is strongly influenced by social circumstances and social policy and its management by health policy. California has nearly three million people with diabetes, meaning that more than 1 out of 10 adult Californians has diabetes. From 1998 to 2007, the prevalence of diagnosed diabetes rose from 5.5 to 7.6 percent, representing a 38 percent increase in one decade. California has the greatest number of people in the US who are newly diagnosed with diabetes. In 2007, about 7.9 million (29 percent, or nearly 1 in 3) adults in California had prediabetes, a condition that often precedes type 2 diabetes. Prevalence of gestational diabetes (diabetes that occurs in the context of pregnancy) has increased 60 percent in California in just seven years, from 3.3 percent of hospital deliveries in 1998 to 5.3 percent in 2005. In addition, small studies suggest a consistent increase in diabetes among children and youth. California’s ethnically diverse population has a higher risk and prevalence of type 2 diabetes. Total health care and related costs for the treatment of diabetes in California alone is about $24.5 billion each year. As such, diabetes in California represents a significant and growing economic drain for families, employers, and communities, especially during these difficult economic times.

This document presents some key diabetes statistics in California counties. Its purpose is to provide background information and facts about diabetes. In California, diabetes data are not captured in one statewide registry. Therefore, we have used data collected from the 2005 California Health Interview Survey (CHIS) and compiled a summary of information for each county. CHIS is the nation’s largest state health survey. A randomdial telephone survey conducted every two years on a wide range of health topics, CHIS data give a detailed picture of the health and health care needs of California’s large and diverse population. CHIS 2005 is currently the best data source in terms of county-level information, sub-population analyses, and diabetes indicators. More than 50,000 Californians are surveyed by CHIS. Participants in the CHIS survey are chosen at random and the sample is extensive enough to be statistically representative of California’s diverse population. CHIS is especially known for its hard-to-find data on ethnic subgroups.

The information herein can be used by county health departments, community-based organizations, and those providing clinical services to make strategic decisions about their current and future activities. Environmental planners, industry partners, the media, restaurants, schools, parks and recreation services, and many other groups also need to engage with these data to inform their work and modify their activities to help create the conditions in which people can make healthy choices.

Compared to prior years, there are a number of new components to this report and some striking findings worthy of special comment. For this report, we have added annual cholesterol tests, annual eye exams, and annual flu shots received by people with diabetes under the Diabetes and Related Services section; current smoking in the Diabetes Risk Factors section; and a new section, Health Status and Access to Care, which includes history of high blood pressure, high cholesterol, heart disease, type of insurance (Medicare, Medi-Cal, uninsured), and no usual source of care. All data are reported by county demographics in the general adults population and for adults with diabetes, when applicable. All data are reported in percentage rates. The county adult population total and adults with diagnosed diabetes total are provided at the top of each county table. Unlike the previous report, total numbers for each health condition/status are not provided in this report. Readers can easily calculate the total number by simply multiplying the rate with either the county adult population or the diagnosed diabetes population.

Notable findings include:

• especially high rates of diabetes in California’s Central Valley;
• high prevalence of being uninsured and having diabetes (especially among the Hispanic/Latino population), and the tremendous county-by-county variation in coverage of uninsured people with diabetes; and
• growing prevalence of diabetes in young adults (ages 18-44) and the behavioral and health access risk profiles that make them particularly vulnerable to developing complications in the prime of their lives. These include especially high rates of con-current tobacco use (20%) and heart disease (8%), high rates of un-insurance (30%), and low rates of receipt of recommended services such as eye exams and influenza vaccination.