Burden of Cardiovascular Disease in California August 25, 2020 - - PowerPoint PPT Presentation

California Department of Public Health

Burden of Cardiovascular Disease in California

August 25, 2020

Right Care Initiative Meeting

Catrina Taylor, PhD, MSPH Epidemiologist/Evaluation Lead

California Department of Public Health

Burden of Cardiovascular Disease in California

• 12 million Californians are affected by cardiovascular

disease (CVD).

• The most common forms of CVD are:

– Heart Disease (HD), – Heart Failure (HF), – Hypertension (HTN), and – Stroke.

Data Source: AskCHIS 2018. Last Accessed on May 21, 2020.

California Department of Public Health

Prevalence of the Common Forms of CVD by Race/Ethnicity

Data Source: AskCHIS 2012, 2017 and 2018 data. Last accessed on May 21, 2020.

4% 4% 45% 23% 6% 20% 41% 8% 4% 30% 10% 2% 3% 33% Heart Disease (2018) Heart Failure (2017) Stroke (2012) Hypertension (2018) African American American Indian/Alaska Native Asian Latino Native Hawaiian/Pacific Islander Two or More Races White

California Department of Public Health

Prevalence of Hypertension by Race/Ethnicity, 2015-2018

41% 38% 43% 45% 4… 29% 34% 41% 43% 32% 31% 30% 30% 31% 31% 33% 33% 2015 2016 2017 2018 African American American Indian/Alaska Native Asian Latino Native Hawaiian/Pacific Islander Two or More Races White

Data Source: AskCHIS 2015-2018 data. Last accessed on May 21, 2020.

California Department of Public Health

CA Leading Causes of Death, 2018

Disease or Condition Number of Deaths

• 1. Heart Disease

37,088

• 2. Alzheimer's Disease and other Dementias

25,070

• 3. Stroke

16,331

• 4. Chronic Obstructive Pulmonary Disease

13,042

• 5. Hypertension

11,801

• 6. Trachea, Bronchus and Lung Cancers

11,072

• 7. Other or Unspecified Cardiovascular Diseases

10,747

• 8. Kidney Diseases

7,546

• 9. Heart Failure

7,589

• 10. Other Malignant Neoplasms

7,207

California Community Burden of Disease and Cost Engine. Last accessed on 7/29/20.

California Department of Public Health

Leading Causes of Death

• In 2017, the age-adjusted coronary heart disease

death rate for California decreased from 97.4 to 87.4 per 100,000 people, a reduction of 10.3%.

• California met the HP 2020 HDS-2 objective to

reduce heart disease deaths.

• In 2017, the age-adjusted stroke death rate

increased 4.6%, from 34.7 to 36.3 per 100,000 people.

• California did not meet the HP 2020 HDS-3
• bjective to reduce stroke related deaths.

County Health Statistics, 2019.

California Department of Public Health

CVD Associated Risk Factors by Race/Ethnicity

Data Source: AskCHIS 2018 data. Last accessed on May 21, 2020.

69% 12% 14% 5% 45% 7% 5% 69%72% 17% 20% 17% 13% 12% Obese/Overweight Smoking Physical Inactivity No Access to Fresh Fruits/Veggies in Neighborhood

African American American Indian or Alaska Native Asian Latino Native Hawaiian and Other Pacific Ispander Two or More Races Whites

California Department of Public Health

Cost of CVD

• In 2018, it was reported that CVD costs

California an estimated $51.9 Billion

– These costs are specific to the four most common forms of CVD – Are related to direct (health care costs)and indirect (lost productivity and life years) costs

Economic Burden of Chronic Disease in California, 2018

California Department of Public Health

CVD Health Equity Lens

• Burden of Self-Reporting CVD is highest among

American Indian/Alaska Natives, African Americans, Native Hawaiian/Pacific Islanders, and Whites.

• Burden of CVD Associated Risk Factors is

highest among African Americans, Native Hawaiian/Pacific Islanders, and Multiple Races.

• Burden of Mortality from CVD is highest

among African Americans and Latinos.

California Department of Public Health

Equity Lens on CA COVID-19 Statistics including data for select chronic conditions

0% 10% 20% 30% 40% 50% Latino ​White ​Asian ​African American ​Multi-Race ​American Indian

• r Alaska Native

​Native Hawaiian and other Pacific Islander

COVID-19 Cases COVID-19 Deaths CA Population Hypertension Heart Disease Diabetes Prediabetes Obese

Data Source: AskCHIS 2018 data. Last accessed on May 21, 2020. Official California State Government Website Last accessed May 21, 2020

California Department of Public Health

A Closer Look Through the Equity Lens

8% 6% 17% 20% 40% 45% 58% 46% 6% 7% 9% 32% 17%

COVID-19 Cases COVID-19 Deaths CA Population Heart Disease Diabetes Prediabetes Obese HTN

African American Latino Native Hawaiian/Other Pacific Islander

Data Source: AskCHIS 2018 data. Last accessed on May 21, 2020. Official California State Government Website Last accessed May 21, 2020

California Department of Public Health

Other Nontraditional Risk Factors Affecting CVD among African Americans and Latinos

24% 41% 55% 32% 43% 61% 22% 42% 67% 23% Cost, lack of insurance, or other insurance-related reasons for delayed medical care Healthcare system/provider issues and barriers as reason for delayed medical care Experienced unfair treatment during your lifetime when getting medical care African Americans Latino HTN HD HF HTN HD HF HTN HD HF

Data Source: AskCHIS 2018 data. Last accessed on August 4, 2020.

California Department of Public Health

Other Nontraditional Risk Factors Affecting CVD among African Americans and Latinos

36% 18% 53% 7% 14% 8% 58% 8% 18% Experienced difficulty finding a primary care provider Was often unable to get a doctors appointment within 2 days in past 12 months Visited emergency room in the past 12 months

African Americans Latino

HTN HD HF HTN HD HF HTN HD HF

Data Source: AskCHIS 2018 data. Last accessed on August 4, 2020.

California Department of Public Health

CVD Health Equity Lens During COVID-19

• Why are racial/ethnic groups or economically disadvantaged

people of any background more susceptible of becoming infected or developing severe disease and dying?

• What are possible underlying causes of differential outcomes
• f COVID-19 in populations burdened by CVD?

California Department of Public Health

Addressing CVD Disparities Through Programs

Prevention Forward (PF) is the five-year Centers for Disease Control and Prevention grant the California Department of Public Health Chronic Disease Control Branch received to increase prevention and management of diabetes, prediabetes, hypertension, stroke, and high blood cholesterol.

California Department of Public Health

PF Objectives to Address the Burden of CVD

Objective 1: Assess and increase use of health care reporting

systems to identify, report standard clinical quality measures, and/or refer patients with chronic conditions to nationally recognized lifestyle change programs;

Objective 2: Identify policies and procedures within the

• rganization to identify, manage, and prevent chronic conditions;

and

Objective 3: Assess use of team-based models to manage,

monitor, and refer patients with chronic conditions to nationally recognized lifestyle change programs.

California Department of Public Health

Objective 1: Assess and increase use of health care reporting systems to identify, report standard clinical quality measures, and/or refer patients with chronic conditions to nationally recognized lifestyle change programs.

• PF is linking partner clinics, hospitals, and pharmacies to

electronic health systems technical assistance to ensure patients with chronic conditions are:

– Diagnosed (identified) – Referred to lifestyle change programs within their community, and – Receive standard clinical quality care.

• PF is promoting telehealth capacity to link patients to

health care services to reduce delayed care.

California Department of Public Health

Objective 2: Identify policies and procedures within the organization to identify, manage, and prevent chronic conditions.

• PF is promoting the patient care process, which

includes Comprehensive Medication Management/Medication Therapy Management to manage CVD.

• PF is promoting and hosting health education and

self-management of CVD webinars.

• PF is promoting adoption and implementation of

team-based care approaches with the inclusion of non-physician team members.

California Department of Public Health

Objective 3: Assess use of team-based models to manage, monitor, and refer patients with chronic conditions to nationally recognized lifestyle change programs.

• PF is promoting and sharing information about

Collaborative Practice Agreements and adoption.

• PF staff is working to increase equity capacity

with Community Health Workers and providers to promote improved awareness and treatment of patients with CVD.

• PF staff is hosting webinars on lifestyle

modification/referral topic area regarding self- measured blood pressure monitoring training.

California Department of Public Health

Prevention Forward Surveillance

• PF, on a quarterly, annual and biennial basis, monitors

treatment, management, referrals, and engagement of non-physician team members to reduce CVD burden and/or negative health outcomes from being diagnosed with CVD.

• Next steps are to implement evidence-based

interventions in PF partner clinics, hospitals, and pharmacies then monitor change in screening, treating, referring patients with CVD to lifestyle change programs, and medication management. PF will also monitor change in communication between team members and use of Collaborative Practice Agreements.

California Department of Public Health

Questions???

California Department of Public Health

Contact Information

For additional comments and/or questions pertaining to this presentation please contact: Catrina Taylor, PhD, MSPH Catrina.Taylor@cdph.ca.gov