LOS MEDANOS COMMUNITY HEALTHCARE DISTRICT

STRATEGIC PLAN

Part II

Summary of Community Needs Assessment
and District Health Profile

Los Medanos Community Healthcare
District Strategic Planning

Year 2002

The District’s need to assess the health status of the residents of the District as a prerequisite to District service planning was greatly aided by the availability of the Contra Costa County United Way/Hospital Council Collaborative Community Assessment of 1999 and a District Health Profile for the Year 2000 was developed. We have recently received the Contra Costa County Community Needs Assessment 2001, Quantitative Overview prepared for the Hospital Council of Northern and Central California, and the Community Perceptions of Health Care Needs in Contra Costa County prepared for the Hospital Council on December 11, 2001, and this data is currently being analyzed for our healthcare district and will be available in the very near future. In the interim, we include the District Health Profile for the Year 2000 until the update is available.

Los Medanos Community Health District
District Health Profile – Year 2000

(Note: This District Health Profile relies primarily on data for
Pittsburg/Bay Point zip code 94565.)

DISTRICT DEMOGRAPHICS – WHO WE ARE
(From the 1990 US Census for zip code 94565, unless otherwise noted.)

Population: 63,949.

Households: 21,382.

Races, Ethnicity: White, 38,899 ; Hispanic origins, 14,717; Black, 10,467; Asian or Pacific Islander, 7,599; American Indian, 537; other race, 6,447. (Percentage breakdowns from 1997 Claritas Demographic Data; White, 40.5%; Latino, 28.3%; African-American, 16.8%; Asian, 13.7%, Native American or other, 8%.)

Language Spoken at Home: (Top three for persons 5 years and over) English only, 41,333; Spanish, 9,848; Tagalog, 2,969.

Gender: Female 32,371; male, 31,570.

Age: Early childhood, 5 years old and younger, 7,842 (12.26 percent); elderly, 65 years old and older, 5,075 (7.94 percent); largest adult age group, ages 30-34, 7,187 (11.13 percent).

Income: Median household income in 1989, $36,201.

DISTRICT COMMUNITIES – WHERE WE LIVE
(Percentages based on voter registration of 27,748 as of 10/27/99 in Los Medanos Community Health District. Voter numbers in parentheses).

Pittsburg 73.24 percent (20,322); Bay Point, 22.33 percent (6,197); Clayton, 1.94 percent (539); Clyde, 1.25 percent (348); Antioch, 0.51 percent (142); Concord 0.37 percent (103); unspecified, 0.35 percent (97).

Pittsburg/Bay Point total (zip code 94565), 95.57 percent.

DISTRICT MORTALITY – CAUSES OF DEATH
(Data from Contra Costa Health Services web site for zip code 94565)

Total in 1997 for Pittsburg/Bay Point residents, 407 deaths.

Causes of Pittsburg/Bay Point deaths in 1997:
     Heart Disease, 106 deaths;
     Cancer, 90 deaths;
     Stroke, 39 deaths;
     Pneumonia and influenza, 20 deaths;
     Unintentional injuries, 20 deaths;
     Chronic obstructive pulmonary disease, 17 deaths;
     Homicide, 9 deaths;
     Suicide, 8 deaths;
     AIDS, 8 deaths;
     Diabetes mellitus, 7 deaths;
     All other causes, 79 deaths.

DISTRICT DISEASE HOSPITALIZATION RATES
(The data below provided by the Contra Costa Chronic Disease Organizing Project, shows rates per 100,000 population of hospital discharges for seven chronic diseases of residents in the Pittsburg/Bay Point zip code in 1997, compared to Contra Costa rates (in parentheses) for 1997)

	Pittsburg/Bay Point	Contra Costa County
Heart Disease	1,117.13	(1,057.06)
Cerebrovascular	309.23	(300.48)
Obstructive Pulmonary	305.05	(239.73)
Malignant Neoplasm	254.91	(396.33)
Diabetes Mellitus	167.15	(105.06)
Asthma	161.58	(117.78)
Liver Disease	29.25	(44.3)

The rates of hospitalization for heart disease, obstructive pulmonary disorders, diabetes mellitus and asthma were higher in Pittsburg/Bay Point than in Contra Costa as a whole in 1997.

The greatest number of chronic disease deaths of Pittsburg/Bay Point residents were due to heart disease (602 deaths) and cancer (500 deaths) from 1993-97.

RESPIRATORY AND LUNG DISORDERS
(The data below was supplied by the American Lung Association of the East Bay)

Prevalence and incidence of lung disease in Contra Costa County, estimated in April 1999 report:

CHRONIC LUNG DISEASES Lung Cancer, 548 Emphysema, 6,188; Chronic Bronchitis, 48,324; Adult Asthma, 32,195. Pediatric Asthma, 17,166

ACUTE LUNG DISEASES Acute Bronchitis, 43,836; Common Cold, 200,258; Influenza 357,919 Pneumonia, 17,106;

HEALTH TRENDS
(From Contra Costa County Epidemiology, Surveillance and Health Data Unit.)

Tuberculosis cases reported from 1993-98: Pittsburg 57 cases; Bay Point, 8 cases; countywide total 634 cases.

People living with AIDS in Pittsburg, 70, deceased 102; people living with AIDS in Bay Point, 19, deceased 43, as of 7/12/99. Highest cumulative incidence of AIDS in Contra Costa per 1,000 population: Richmond, 5; San Pablo, 4.4; Pittsburg 3.2.

Reportable communicable diseases by Contra Costa region for Jan.-Jun, 1999, top five in east county: Hepatitis C (carrier), 221 cases; Hepatitis B (carrier) 30 cases; campylobacter, 11 cases; tuberculosis, 9 cases; giardiasis and Hepatitis A, 8 cases each.

DISTRICT CONDITIONS AND ISSUES
(Note: This section is a compilation of issues, conditions, successes and shortcomings in health-related matters that affect residents of the District. Although quick solutions to problems may not be possible locally, their listing may help shape future efforts. The public is invited to comment and contribute during annual updates of the District Health Profile in pursuit of the District’s Pathways to Health Program. The items are listed by number for purposes of identification. There is no ranking implied or intended. The data is from the 1999 Contra Costa Collaborative Community Assessment prepared by the Northern California Council of the Community, unless otherwise noted.)

Item No. 1 – Physicians – East Contra Costa has the lowest per capita rate of primary care physicians in the county at 21 physicians per 100,000 people. The statewide average is 67 primary care physicians per 100,000 people. (Assessment Vol.1, Pages 277-78) Note Bay Point status with no physician availability according to the Assessment. See key statistics chart.

Item No. 2 – Infants – African American infants in Contra Costa County are almost twice as likely to die before their first birthday as infants in other groups. (Assessment Executive Summary, Page 5)

Item No. 3 – Uninsured – Californians are disproportionately more likely to be uninsured than other Americans (18 percent in a west county study). The lack of health coverage in California is most prevalent among young adults, lower income families, Latinos, African Americans and Asian Americans. (Assessment Executive Summary, Page 8)

Item No. 4 – Cancer – Breast cancer is the leading form of cancer in Contra Costa County, nearly half of all breast cancer cases are among women ages 60 and older, and 90 percent of Contra Costa County’s prostate cancer cases are among men over 60 years old, with significantly higher rates for African Americans. (Assessment Executive Summary, Page 10)

Item No. 5 – Abuse – Calls reporting possible child abuse, neglect or abandonment in Contra Costa County have increased 44 percent since 1990. Reports of elder abuse in Contra Costa County have increased from 110 in 1990 to 514 in 1996. (Assessment Executive Summary, Page 8)

Item No. 6 – Asthma – While asthma can occur at any age and has a higher mortality rage among older persons, it more commonly firs occurs in children and youth. Asthma is a leading chronic childhood disease and the leading cause of hospital admissions among children in California. (Assessment Volume 1, Page 225)

Item No. 7 – Tobacco – Smoking took the lives of 20.7 percent of the men (148 deaths) and 15.6 percent of the women (93 deaths) who died in Pittsburg/Bay Point from 1989-91. Smoking-attributed deaths account for 19 percent of all California deaths. According to the 1989 Surgeon General’s report on tobacco, smoking accounted for 87 percent of lung cancer deaths, 82 percent of chronic obstructive pulmonary disease deaths, 21 percent of coronary heart disease deaths and 18 percent of stroke deaths. (Assessment Vol.1, Page 258)

Item No. 8 – Heart/Cancer – In 1993-97, African Americans living in Pittsburg/Bay Point had higher rates of death from heart disease (24.93 per 100,000) and cancer (22.19 per 100,000), than their white counterparts (13.45 per 100,000 and 11.11 per 100,000 respectively). Rates of death for Latino residents were similar to those of white residents (From Contra Costa Chronic Disease Organizing Project data)

Item No. 9 – Aging – With aging of the “baby boom” generation born just after World War II, the number of older adults in five Bay Area counties is projected to increase dramatically by the end of the decade. The largest proportional increase in the age 55+ population is expected in Contra Costa County, forecast 103.8 percent from 1990 to 2010 (from 153,388 actual in 1990 to 312,556 projected in 2010). The “old-old” population age 85+ will increase by 237.2 percent, from 7,259 in 1990 to 24,446 projected in 2010. (From “Coming of Age” 1997 Bay Area Regional Report demographic profile, provided Contra Costa Area Agency on Aging)

Item No. 10 – Transportation – Lack of transportation in Contra Costa County is reported to be a deterrent to receiving adequate care, especially for elderly and homebound people. (Assessment Executive Summary, Page 9)

Item No. 11 – Immunization – The level of early childhood immunizations in Contra Costa County (65 percent) is higher than the statewide level (57 percent) but still falls short of the Healthy People 2000 goal of 90 percent. (Assessment Executive Summary, Page 9)

Item No. 12 – Undocumented – Fear of deportation, language barriers and cost prevent many undocumented individuals from seeking physical and mental health care. Children of immigrant families have fewer referral services, are less likely to seek care, and are more likely to be uninsured. (Assessment Executive Summary, Page 6)

Item No. 13 – Tuberculosis – In 1996, 44 percent (186) of tuberculosis cases in Contra Costa County were from foreign-born residents. Of these foreign-born cases, 37 percent (69) were from the Philippines and 15 percent (27) were from Mexico. From 1995-96, the most significant increases in tuberculosis cases in the county were in African American women, ages 18-25, and in children ages 7-18, in the west county. (Assessment Executive Summary, Page 6)

Item No. 14 – Men – African American men suffer from rates of hospitalizations for cardiovascular disease, strokes, hypertension, heart disease and diabetes that are significantly higher than state rates, and have the highest rate of prostate cancer of all groups in Contra Costa County. (Assessment Executive Summary, Page 6)

Item No. 15 – Latina – In California, Latina women with breast cancer are more likely to be diagnosed at a late-stage, regardless of socioeconomic status. Latina teens (under age 20) had the highest number (397 of 1,070) of teenage births in 1997 in Contra Costa County. This represents 37 percent of all births in this age group in the county. (Assessment Executive Summary, Page 6)

Item No. 16 – Teens – Contra Costa teenagers (ages 15-19) have a chlamydia infection rate over six times higher than all other age groups. Homicide accounted for 30 percent of all deaths for adolescents/young adults (ages 15-24) and suicide accounted for 10 percent of the deaths (18 of 184) in 1995-96 in the county. (Assessment Executive Summary, Pages 9-10)

Item No. 17 – Prenatal – Early, comprehensive prenatal care can significantly reduce rates of infant and maternal illness and death. Contra Costa County is experiencing the adverse effects of having 16 percent of its pregnant women begin prenatal care after their first trimester. (Assessment Executive Summary, Page 11)

Item No. 18 – Alcohol, Drugs – A total of 4,979 alcohol-related and 2,838 drug-related hospitalizations, where alcohol or drugs was the principal diagnosis, were recorded among Contra Costa County residents from 1991 to 1995. A total of 1,751 Contra Costans died as a result of alcohol and 327 died due to drugs during the five-year span. (Assessment Vol.1, Pages 255,257,259)

Item No. 19 – Mental – In 1996, 1,244 hospitalizations of East Contra Costa residents received a primary diagnosis of mental disorder. Mental disorder hospitalizations accounted for 5.2 percent of the 22,887 hospitalizations of east county residents during the year. (Assessment Vol.1, Page 242)

Item No. 20 – Access – Contra Costa County residents may find it difficult to access physical and mental health services because of economic, service or social barriers to care. Among these barriers are: lack of service in poor communities, language and cultural barriers, immigrant status, transportation, and lack of awareness of services. (Assessment Executive Summary, Page 8)

Item No. 21 – Elderly – In 1996 and 1997 surveys of older Contra Costa County residents, the main problem cited by respondents was transportation, followed by “money to live on” and health care. Loneliness and isolation and in-home support services were all cited. (Assessment Vol.1, Pages 52, 53)

Item No. 22 – Children – Nearly 13 percent of California’s children are uninsured, despite the fact that, as a federal study suggests, nearly 40 percent of the uninsured children qualify for Medi-Cal. (Assessment Summary, Page 9)

Item No. 23 – Preventable – When access to health care is limited, medical conditions that are effectively treated with timely and quality outpatient care can become serious enough to warrant hospitalization. These ambulatory care sensitive (ACS) conditions include preventable illnesses, rapid onset conditions and chronic conditions. Of the 1996 hospitalizations of 90,782 Contra Costa residents, 7,805 or 8.6 percent were potentially preventable ACS conditions. These preventable hospitalizations included primary diagnosis of bacterial pneumonia (27 percent), congestive heart failure (25 percent) asthma (13 percent) or chronic obstructive pulmonary disease (13 percent). The rates of ACS hospitalizations were disproportionately high in East Contra Costa (nearly 9 percent) and in West County (10 percent). (Assessment Vol.1, Pages 281, 282)

Item No. 24 – Language – No community resource exists to inform consumers about the language capabilities of health care providers. (Assessment Vol. 1, Page 279)

Item No. 25 – Fragmentation – Services may be duplicated or essential services may fall through the cracks in the absence of a central registration system or system to ensure that patient records will accompany people who are seeing multiple providers. (Assessment Vol.1, Page 28)