Cdphe cd presentation for ccpd 10 14 11a

Select Risk Factors and

Outcomes Related to Chronic

Diseases

Presented to

10/14/2011 The Cancer, Cardiovascular and Pulmonary Disease Grants

Committee

Acknowledgements Renee Calanan, PhD

Chronic Disease Epidemiologist, PHS

&

Stephanie Kuhn

Barbara Gabella

Indira Gujral

Ashley Juhl

Biology 20%

Health Care 10%

Environment 19%

Lifestyle 51%

Smoking Obesity Nutrtion

Alcohol Use

Source: McGinnis, J.M and Foege, W.H. (1993). ―Actual Causes of Death

in the United States,‖ Journal of the American Medical Association.

Factors Influencing Health Status

Determinants of Health (Evans - Stoddart Model)

Social Physical Genetic

Environment Environment Environment

Individual

Response

– Behavior

– Biology

Health Disease Health &

& & Medical

Function Injury Care

Well – Being Prosperity

Paul Simon, MD, MPH, UCLA, 2007

Mortality

Number of deaths for the fifteen leading

causes of death — Colorado residents, 2010

549

598

721

867

1336

1605

2102

2199

6029

7029

0 1000 2000 3000 4000 5000 6000 7000 8000

Influenza and Pneumonia

Chronic Liver Disease and Cirrhosis

Diabetes Melitus

Suicide

Alzheimer's Disease

Cerebrovascular Disease

Unintentional injuries

Chronic Lower Respiratory Disease

Heart Disease

Cancer (Malignant neoplasms)

Cau

se o

f d

eath

Number of deaths Source: CDPHE, Health Statistics Section. Vital Records. Death statistics obtain via CoHID Oct 10, 2011

Percent of total deaths for the leading

causes of death — Colorado residents, 2008

1.7% 1.9%

2.3%

2.8%

4.3%

5.1%

6.7%

7.0%

19.2%

22.4%

26.7%

Influenza and Pneumonia

Chronic Liver Disease and Cirrhosis

Diabetes Melitus

Suicide

Alzheimer's Disease

Cerebrovascular Disease

Unintentional injuries

Chronic Lower Respiratory Disease

Heart Disease

Cancer (Malignant neoplasms)

All other causes

Source: CDPHE, Health Statistics Section. Vital Records. Death statistics obtain via CoHID Oct 10, 2011

Outcomes Among

Adults

How many people are affected?

• 751,000 had hypertension(22%)

• 307,000 had current asthma (8%)

• 190,000 were cancer survivors (4%)

• 113,000 had coronary artery disease (3%)

• 219,000 had diabetes (6%)

• 70,000 had a stroke (2%)

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Select outcomes by race/ethnicity and

income, Colorado adults, 2009

Outcome Race/ethnicity Income

Asthma No disparity No disparity

Coronary artery disease No disparity Most lower incomes > $75k+

Hypertension Black>White>Hispanic Lower incomes > $75+

Diabetes Black, Hispanic > White Most lower incomes > $75k+

Cancer Not assessed Not assessed

Risk Factors Among

Adults

Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public Health and Environment

0

5

10

15

20

25

30

35

40

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Prevalence of selected risk factors, Colorado adults, 1997-2010 BRFSS

Overweight High cholesterol Current smokers Hypertension Physical inactivity Obesity

22.8 22.3

19.8

17.1 16

5

10

15

20

25

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Perc

en

t

Percent of Colorado adult smokers, 1996-2009

Healthy People 2020 Objective: 12%

Source: Colorado Behavioral Risk Factor Surveillance System, Health Statistics Section,

Colorado Department of Public Health and Environment


0

5

10

15

20

25

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Prevalence of obesity among adult Coloradans, 1997-2010 BRFSS

Obesity

Healthy People 2020 Objective: 30%

25 22

35

19

57

18 17

0

10

20

30

40

50

60

70

80

90

100

Fruit/vegetables 5+ times per day

High blood pressure

High cholesterol Obesity Meet physical activity recs

Physically inactive

Current smoker

Prevalence of select risk factors,

Colorado adults, 2009 (in pct.)


High blood pressure by race/ethnicity

and income, Colorado adults, 2009

29 28 25 25

21 18

0

5

10

15

20

25

30

35

40

45

50

23

34

18

0

5

10

15

20

25

30

35

40

45

50

White non-Hispanic Black non-Hispanic Hispanic


High cholesterol by race/ethnicity and


35 34 36

0

5

10

15

20

25

30

35

40

45

50


37

41

36 37 35

33

0

5

10

15

20

25

30

35

40

45

50


Obesity by race/ethnicity and income,

Colorado adults, 2009

26 23 22

19 20

17

0

5

10

15

20

25

30

35

40

45

50

18

31

22

0

5

10

15

20

25

30

35

40

45

50



Physical activity by race/ethnicity and


51 50 55 55 58

63

0

10

20

30

40

50

60

70

80

90

100

59 56

51

0

10

20

30

40

50

60

70

80

90

100



Physical inactivity by race/ethnicity and


33

28

23

20

14

9

0

5

10

15

20

25

30

35

40

45

50

14

29 28

0

5

10

15

20

25

30

35

40

45

50



Current smoking by race/ethnicity and


16

20 20

0

5

10

15

20

25

30

35

40

45

50


27 28 28

18 17

9

0

5

10

15

20

25

30

35

40

45

50


Screening Among Adults

Prevalence of preventive screening,


76

62

84

76 73

0

10

20

30

40

50

60

70

80

90

100

Cholesterol within 5 years (18+ years)

Colorectal cancer (50+ years) Cervical cancer within 3 years (18+ years)

Breast cancer within 2 years (50+ years)

Breast cancer within 2 years (40+ years)

Colorectal cancer: colonoscopy within 10 years, sigmoidoscopy within 5 years, or FOBT within 1 year

Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public Health and Environment (cholesterol screening, 2009)

Cholesterol screening by

race/ethnicity and income,


79 78

61

0

10

20

30

40

50

60

70

80

90

100


68 62

70

77 78

86

0

10

20

30

40

50

60

70

80

90

100


Colorectal cancer screening by

race/ethnicity and income, Colorado

adults aged 50+ years, 2008

47

56 59

64 64 68

0

10

20

30

40

50

60

70

80

90

100

64

72

54

0

10

20

30

40

50

60

70

80

90

100



Cervical cancer screening by


women aged 18+ years, 2008

71

79 80 84

89 93

0

10

20

30

40

50

60

70

80

90

100

86 87 81

0

10

20

30

40

50

60

70

80

90

100



Breast cancer screening by


women aged 50+ years, 2008

77 76

0

10

20

30

40

50

60

70

80

90

100


61

70 72 78

80 82

0

10

20

30

40

50

60

70

80

90

100


Disparities in Screening

• Hispanics had a lower prevalence of

cholesterol screening and colorectal

cancer screening than Whites and Blacks.

• In general, screening increased as annual

household income increased.

Risk Factors Among

Youth

78

27 24

12

0

10

20

30

40

50

60

70

80

90

100

Healthy weight Recommended physical activity Fruit/vegetables 5+ times/day Current smoker

Select risk factors and outcomes,

Colorado adolescents, 2009

Current smoking data source: Healthy Kids Colorado Survey on Tobacco and Health, Colorado Department of Public Health and Environment, analyzed by Amendment 35 Program Evaluation Group (APEG), University of Colorado Cancer Center

Data source: Colorado Youth Risk Behavior Survey, Colorado Department of Education; analyzed by Colorado Department of Public Health and Environment

Select risk factors and outcomes,

Colorado children, 2009

65

10

31

48

16

45

9

0

10

20

30

40

50

60

70

80

90

100

Healthy weight (5-14y)

Eat fruit 2+ times and vegetables 3+ times

per day (2-14y)

Drink sweetened drinks 1+ times per

day (1-14y)

Active everyday for 60+ minutes (5-14y)

Watch TV >2 hours per day (1-14y)

Sunburn in past 12 months (1-14y)

Current asthma (1-14y)

Data source: Colorado Child Health Survey, Colorado Department of Public Health and Environment

Risk Factors’

Associations with

Outcomes

34

COPD • 90% of Chronic Obstructive Pulmonary Disease

Diabetes •Leads to neuropathy & peripheral artery disease •Smoking increases the risk of amputation by 2 – 10 times

Cancers • 80-90% of lung • 30-50% of colon • 75% of oral (w/ alcohol) • Cancers of the bladder cervix, esophagus, larynx, kidney & pancreas

Reducing Cigarette Smoking

CVD • 2-4 x risk of coronary heart disease • 2 x risk of sudden cardiac death • Abdominal aortic aneurysm • Strokes • Atherosclerosis & congestive heart failure

35

Type 2 Diabetes • End stage renal • 65% of people with diabetes die from heart disease or stroke

CVD • 30-40% of coronary heart disease

• 10-20% of stroke

Lowering cholesterol & hypertension

CVD • 20-30% of coronary heart disease • 20-50% of stroke

36

Type 2 Diabetes

CVD • heart disease by 20-40% • stroke by 30%

Diabetes • 12% of diabetes

CVD • 12% of hypertension

Cancers • 30% of cancer deaths • Nutrition: Cancers of the mouth, pharynx, esophagus, larynx, kidney, colon, rectum, ovary, & bladder

Nutrition & Physical Activity

Cancer • 22% of colon cancers • Cancers of breast, colon, and possibly endometrial & prostate

37

Cancers • Cancers of the colon, breast, kidney, gallbladder, prostate, cervix, ovaries, & esophagus

50-100% greater risk of premature death

Diabetes • Increased risk of Type 2 Diabetes

Reducing Obesity

CVD • Increased likelihood of heart disease and stroke

Thank you

Gabriel Kaplan, PhD., MPA, Director

EPE | Epidemiology, Planning and Evaluation | Branch

Prevention Services Division

Colorado Department of Public Health and Environment

[email protected]

mailto:[email protected]

Cdphe cd presentation for ccpd 10 14 11a

Health & Medicine

high blood

death statistics

health statistics

coronary artery

lower incomes

chronic liver

select risk

death colorado