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Leading Health Indicators

The Profile of Leading Health Indicators contains high-level summary data, derived from local and state sources, highlighting major health conditions or events that compromise the health and healthy development of children and contribute most prominently to illness and injury, disability and death for Sonoma County adults and children. The Profile begins with population-wide data on leading causes of death by total population and by age group. Data on the burden of premature death are presented, as is information on types of disability by age.

ollowing this overview, leading health indicators are presented within a framework of five age range categories: children pre-natal up to age 1; children 1 to 12 years; children 13 to 17 years; adults 18 to 59 years and; adults 60 years and over. Some data are presented that do not align exactly with these ranges in order to capture key indicators of morbidity and mortality.

Within each age category, leading causes of death are highlighted. Information on significant causes of morbidity is also presented, along with data on risk factors and behaviors that contribute to morbidity. Where it is helpful to understanding conditions of morbidity, hospitalization data are included. It should be noted that children in all age categories experience death and hospitalization at far lower rates than adults. For this reason, indicators of health and healthy development are likely to be more meaningful than data on deaths and hospitalization when seeking insight into children’s overall health status.

When available, comparative information on how Sonoma County measures against California rates, Healthy People 2020 goals and Health Action Sonoma goals is also displayed. Where local indicators are significantly worse than California or do not meet Healthy People 2020 targets, they are highlighted. Disparities in health status, health risk behaviors and access to care related to social determinants such as income and educational attainment are also highlighted.

The last section of the Profile presents information on health system performance, comparing Sonoma County indicators to state and national benchmarks. Information on preventable hospitalization is provided along with selected indicators of health system effectiveness for both adults and children. 

Leading Cause of Death

The two tables below summarize leading causes of death for all age groups in Sonoma County.

Highlights:

  • Sonoma County significantly exceeds California averages for cancer, stoke, chronic lower respiratory disease, Alzheimer’s disease, unintentional injuries, suicide and chronic liver disease deaths.
  • Sonoma County does not meet Healthy People 2020 targets for cancer, coronary health disease, stroke or suicide.

Table 1. Death rates* from leading causes of death, Sonoma County and California 2008- 2010 with Healthy People 2020 Objectives

Cause of Death Sonoma County CA HP 2020

Cancer

180 151.7 160.6
Coronary heart disease 116.8 121.6 100.8
Stroke 47.5 37.4 33.8
Chronic lower respiratory disease 44 36.7 **
Alzheimer 's disease 44 28.2 NA
Unintentional injuries 31.1 27.1 36
Diabetes 16.5 19.5 NA
Suicide 14 9.7 10.2
Pneumonia and influenza 13.3 17.2 NA
Chronic liver disease and cirrhosis 11.4 10.8NA

Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

Source:

*Age adjusted per 100,000 **HP2020 objective is for adults 45+ years (98.5)

Cancer:

Lung cancer, with 234 annual deaths, is the leading cause of cancer death, exceeding the state average. Other leading causes are colorectal cancer (84 deaths), female breast cancer (80) and prostate cancer (53), all of which are higher than the California rate and do not meet Healthy People 2020 targets. Males have slightly higher rates of lung cancer while females have slightly higher rates of colorectal cancer. With the exception of stomach cancer, Sonoma County’s incidence rate – the number of new cases reported - for all cancers (all ages) is higher than the California rate. Cancers with highest incidence rates are breast cancer and prostate cancer.

Source: California Dept. of Public Health, California Cancer Registry

    Chronic Lower Respiratory Disease:

    Individuals age 65 and older are those most affected by Chronic Lower Respiratory Disease, predominantly emphysema. Death rates are 230.2/100,000 for the 65-85 age group and 877.6/100,000 for those over 85, as compared with 16.8/100,000 for those 45-64 years.

    Source: California Department of Public Health, County Health Status Profiles 2012)

    Leading Causes of Death by Age Group

    Highlights:

    • Cancer, heart disease and unintentional injuries are the leading causes of death for adults, together representing 50% of all adult deaths.
    • Unintentional injuries are the leading cause of death for children ages 1–17, representing 21% of deaths in the 1-12 age range and 28% in the 13-17 age range.

    Table 2. Leading Causes of death by age category, Sonoma County 2008-2010 (3-year totals)

    Age#Cause 1Cause 2Cause 3

    < 1

    7152% Conditions originating in perinatal period21% Congenital anomalies4% Unintentional injuries
    1-1228 21% Unintentional injuries 14% Cancer

    14% Diseases of nervous system

    13-171828% Unintentional injuries17% Cancer17% Diseases of nervous system
    18-591796 29% Cancer 15% Unintentional injuries

    10% Coronary heart disease

    60+955524% Cancer18% Coronary heart disease8% Stroke

    Source: California Department of Public Health, Death Statistical Master Files (2008-2010)

    Years of Potential Life Lost

    Years of potential life lost before age 75 (YPLL-75) are those years lost when a person dies prematurely, such as from preventable disease or unintentional injury. YPLL-75 calculations assume all people would naturally live to age 75. Diseases or events that lead to disproportionate mortality in younger age groups and those that affect large numbers of people have higher YPLL-75 values and represent a greater burden of disease and injury.

    Highlights:

    • The leading causes of YPLL-75 for the Sonoma County population as a whole are cancer and unintentional injury.
    • YPLL values for cancer are similar for men and women but are significantly higher for White non-Hispanics than for Hispanics.
    • YPLL values for unintentional injury are significantly higher for males than for females and slightly higher for White, non-Hispanics than for Hispanics.

    Table 3. Years Of Potential Life Lost*(Ypll-75) Per 1000 Population, Sonoma County 2007-09

    Cause of Life LostTotal PopulationMaleFemaleWhite, Non HispanicHispanic
    All Causes49.9962.3937.6340.2940.29
    Cancer12.212.5611.8513.129.03
    Unintentional Injuries8.2411.494.859.047.03
    Coronary Heart Disease4.466.752.294.623.27
    Diabetes1.111.420.670.991.64
    Stroke1.040.961.10.950.88
    Chronic Lower Respiratory Diseases1.011.0411.070.6

    Source: California Department of Public Health, Death Statistical Master Files (2007-2009)/ *Age-adjusted

    Disability by Age Group

    About 10% of Sonoma County residents report having one or more disabilities. Conditions of disability are most prominent in older age groups, especially in the over-65 population.

    Ambulatory disabilities are most common except in the 5-17 age group.

    • Over 22,000 Sonoma County seniors over age 65 reports having one or more disability.
    • Over 10,000 seniors in this age group report a disability that interferes with living independently.

    Table 4. Disability characteristics by age and disability type, Sonoma County

    AgeTotal Pop.Any DisabilityHearingVisionCognitiveAmbulatorySelf-careIndependent living
    Total475,03410.7%3.5%1.9%4.0%5.5%2.6%4.3%
    < 528,1241.5%1.2%0.6%N/AN/AN/AN/A
    5-1776,9984.2%0.7%1.0%2.4%0.7%1.2%N/A
    18-64305,5448.1%2.0%1.4%3.6%3.8%1.8%3.4%
    6564,36835.1%15.3%5.8%9.5%21.6%9.4%16.1%

    Disparities in Health

    While differences in the health of individuals can be attributed to a multiplicity of causes – heredity, environmental factors, health behaviors, access to medical care and others - socio- economic factors such as income, educational attainment and racism are recognized as powerful “social determinants” of population health. Disequities in income and education, for example, have been found to drive inequalities in access to health care and disparities in health status among population sub-groups. Disparities in health outcomes related to social determinants have been well documented at the national and state levels but are less well documented at the local level. Where this information is available, data on health disparities related to social determinants in Sonoma County are highlighted throughout the Profile, particularly related to risk behaviors, access to health care services and self-reported health status.

    The two graphs which follow use census data on neighborhood poverty groups to highlight the relationship between mortality, chronic disease and income. In neighborhoods where more than 15% of residents are living at or below Federal Poverty Level (FPL), the death rate from chronic disease is substantially higher (528.5/100,000) than in neighborhoods where fewer than 5% of residents are living below FPL (428.9/100,000). Similarly, all-cause mortality rates are higher in neighborhoods with high concentrations of low-income residents.

    Death rates from leading causes of chronic disease* by neighborhood poverty, Sonoma County 2005-2009

    Death rates from leading causes

    *Cancer, coronary heart disease, stroke, chronic lower respiratory disease, and diabetes

    All cause mortality by neighborhood poverty, Sonoma County 2005-2009

    Cause mortality by neighborhood poverty

    Source:California Department of Public Health, Death StatisticalMaster Files (2005-2009)

    Information gathered through the St. Joseph Health System Behavioral Risk Factor Survey, conducted in Sonoma County in June 2012, further illustrates the links between social determinants, predominantly income and educational attainment, and disparities in health and health care access.

    Source:St. Joseph Health, Behavioral Risk Factor Surveillance System

    Self-reported physical health status varies significantly by income and education. For example:

    • Among respondents, 62.8% of individuals with incomes over 200% of FPL rated their health as “very good” or “excellent” as compared with 23.1% of those living below FPL.
    • Respondents with the highest education levels (college graduate or above) reported very good/excellent health nearly three times more often than did those without a high school diploma (66.4%/22.2%).
    • And, 29% of survey respondents with incomes below FPL reported that their health was “not good” on 10 or more days of the past 30 days as compared with 9% of those living above 200% FPL.

    The survey demonstrated similar links with regard to mental health status.

    • Among respondents living under 200% of FPL, 40.2% reported “excellent” or “very good” mental health as compared with 71.2% of those with higher incomes.
    • Among those living below FPL, over 30% report only “fair” or “poor” mental health.
    • Among Sonoma County adults with the highest education levels (college graduate or above), 72% report excellent/very good mental health as compared with 28.6% of those without high school degree. Over 30% of these respondents report fair/poor mental health.

    Social determinants can also drive differences in access to health care and services.

    • More respondents with incomes below FPL reported difficulty finding medical care “when they needed it” than did those living at 200% FPL and above (5.3%/23%).
    • Among adults with incomes between 100-200% of FPL, over 15% reported similar difficulty.
    • Over 25% of those with incomes below 200% FPL reported that they did not get “a prescription medicine that they needed” during the past year because they could not afford it while 5.8% of those reporting higher incomes did.

    The survey revealed similar disparities with regard to dental care access.

    • 77% of survey respondents with incomes at 200% of FPL or higher reported having had their teeth cleaned by a dentist or dental hygienist within the past year, as compared with 47% of those with incomes below that level.
    • Among respondents living below FPL, only 35% report cleaning within the past year; 16% report not having had their teeth cleaned in the past 5 years; and 11% report never having had them cleaned.

    Ethnicity, per se, is not a social determinant of health. However, because Hispanics and other populations of color in Sonoma County are more likely, on average, to be lower-income and less well educated than White, non-Hispanics, they are often disproportionately impacted by social determinants and more likely suffer health disparities because of this. For example:

    • While 58.7% of non-Hispanic whites rated their health as “very good” or “excellent,” only 35.9% of Hispanics did so.
    • Hispanic survey respondents also reported higher rates of fair/poor mental health (18.9%) than did white non-Hispanics (11.7%).
    • Among Hispanic survey respondents, 12.4% reported difficulty finding a doctor as compared with 7.1% of non-Hispanic Whites.
    • 19% of Hispanic respondents said they did not have a usual source of care, as compared with 8.9% of non-Hispanic Whites.
    • Just fewer than 50% of Hispanic respondents reported that they had no health insurance coverage, as compared with 12% of non-Hispanic Whites.

    More data on which groups are most affected by social determinants and how these determinants are impacting health outcomes over time are needed to create a clear picture of population health status in Sonoma County and to develop strategies to address resulting health disparities.

    Children: Prenatal Period to 1 Year Indicators Mortality and Morbidity Highlights

    • During the 2008-10 period, the annual average for infant deaths (birth to age 1) was 24 deaths. The mortality rate for children in this age group is lower than California and meets the Healthy People 2020 goal for infant mortality.
    • The three leading causes of death in this age group are: conditions originating in the perinatal period (including birth trauma, respiratory distress and prematurity); congenital malformations of the infant; and unintentional injury. Source:California Department of Public Health Death Statistical Master Files (2008-2010)
    • Though the number of fatal unintentional injury deaths is very small, the leading causes are suffocation, falls, and burns with hot objects or substances. Source:California Department of Public Health,Death Statistical Master Files (2008-2010)
    • Nearly one in five births were to mothers who received late (not first trimester) or no prenatal care.
    • Some “perinatal conditions” and all unintentional injuries are considered preventable with enhanced access to prenatal care, improved maternal health status and effective parent education on child health and safety.

    Table 5. Indicators of Mortality and Morbidity – Children: Prenatal – 1 year

    IndicatorData Year(s)Annual AverageSonoma CountyCaliforniaHealthy People 2020
    Non-fatal unintentional injury hospitalization rate per 10,00012008-201010165.4239.2N/A
    Infant mortality rate per 1,000 live births22008-2010244.24.96.0
    Percent of births born low birth weight ( <2500 g)32008-20103275.8%6.8%7.8%
    Percent of births born preterm ( <37 weeks)32008- 20104498.2%10.4%11.4%
    Percent of births to mothers who received late (not first trimester) or no prenatal care32008-201094918.3%17.1%22.1%
    Teen birth rate per 1,000 females 15-19 years32008-201039022.632.1N/A

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    California Department of Public Health, EPICenter: California Injury Data Online, Overall Injury Surveillance

    California Department of Public Health, Death Statistical Master Files (2008-2010)

    California Department of Public Health, Birth Statistical Master Files (2008-2010)

    Indicators of Health & Healthy Development

    Highlights

    • Nearly one quarter of women report food insecurity during pregnancy.
    • Self-reported maternal use of tobacco and alcohol during pregnancy exceeds statewide rates.
    • Over 20% of mothers report being obese prior to pregnancy.
    • 12% of mothers report postpartum depression, a condition that can interfere with the critical infant bonding process.
    • An estimated 5.1% of births were to mothers aged 19 and younger. The teen birth rate, a risk factor for poor birth outcomes, is significantly lower than the statewide rate.
    • Sonoma County mothers report exclusive breastfeeding at 3 months and appropriate infant sleep hygiene at higher rates than do California mothers in general, exceeding the Healthy People 2020 goal.

    Table 6. Indicators of Health and Healthy Development – Children: Prenatal – 1 year

    IndicatorData Year(s)Sonoma CountyCaliforniaHealthy People 2020
    % of mothers who reported any smoking in 1st or 3rd trimester of pregnancy420108.7%5.6%N/A
    > % of mothers who reported any alcohol use in 1st or 3rd trimester of pregnancy4201018.3%12.1%N/A
    % of mothers who reported being obese before pregnancy4201022.1%20%N/A
    % of mothers who reported postpartum depression4201012.0%13.4%N/A
    % of mothers who reported having no practical or emotional support during pregnancy420105.1%5.8%N/A
    % of mothers who reported food insecurity during pregnancy4201024.4%18.8%N/A
    % of infants receiving any breastfeeding at hospital discharge5201096.9%90.8%81.9%
    % of women who reported exclusively breastfeeding 3 months after delivery4201047.6%31.6%46.2%
    % of women who reported placing infant on back to sleep4201082.5%74.4%75.9%
    Substantiated child abuse incidence per 1,000 children <1 year6201016.822.1N/A

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    California Department of Public Health, Maternal and Infant Health Assessment (MIHA) Survey (2010)

    California Department of Public Health, In-Hospital Breastfeeding Initiation Data (2010)

    California Department of Social Services / Univercity of California at Berkeley, Child Welfare Dynamic Report System, Single Time Period Table (2010

    Indicators of Disparity

    Children: 1 to 12 Years

    Indicators of Mortality and Morbidity Highlights

    • During the 2008-10 period, the annual average for deaths in this age group was 9. The mortality rate for children in this age group is lower than California as a whole.
    • The three leading causes of mortality are cancer, unintentional injury and diseases of the nervous system.
    • Each year, an average of two children in this age range die and another 99 children are hospitalized for non-fatal unintentional injuries – all of which are considered preventable.
    • The leading causes of non-fatal unintentional injury hospitalizations are falls, poisoning and motor vehicle collisions. Just under half of these hospitalizations were for falls. Source: California Department of Public Health, EPICenter: California Injury Data Online
    • Over 300 children under age 5 visit hospital emergency rooms each year for asthma.

    Table 7. Indicators of Mortality and Morbidity – Children: 1 - 12 years

    Source:California Department of Public Health, Asthma Data Query

    Indicator - Per 100,000 ChildrenData Year(s)Annual AverageSonoma CountyCaliforniaHealthy People 2020
    Child death rate 1-14 years2008-20101112.413.8N/A
    Cancer death 1-14 years2008-201011.12.4N/A
    Unintentional injury death rate 1-12 years2008-201022.63.6N/A
    Non-fatal unintentional injury hospitalization rate 1-12 years2008-201099125.9166.4N/A
    Non-fatal unintentional injury hospitalization rate from falls 1-12 years2008-20104456.267.9N/A
    Non-fatal unintentional injury hospitalization rate from motor vehicle collisions 1-12 years2008-2010810.217.5N/A
    Non-fatal unintentional injury hospitalization rate from poisonings 1-12 years2008-2010911.511.6N/A
    Asthma hospitalization rate <5 years20095818.222.718.1
    Asthma hospitalization 0-17 years2010978.011.0N/A
    Rate of hospital emergency department visits for asthma <5 years200930395.3109.995.5

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    Source: California Department of Public Health, Asthma Data Query

    Indicators of Health and Healthy Development

    Highlights

    • One quarter of Santa Rosa City Schools’ 5th graders are obese.
    • Nearly three-quarters of Sonoma County 5th graders failed to meet 6 of 6 criteria of the California Physical Fitness Test.
    • Nearly 20% of Sonoma County children aged 1-12 years did not see a doctor in the preceding year.
    • Sonoma County immunization rates for kindergarteners do not meet the Healthy People 2020 goal.
    • 18% of survey respondents reported that their child had not visited a doctor for a routine check-up or general exam within the past year. Source: St. Joseph Health, Behavioral Risk Factor Surveillance System.
    • 11% of survey respondents reported that their child had not visited a dentist or dental clinic within the past year. Source: St. Joseph Health, Behavioral Risk Factor Surveillance
    • 72% of survey respondents reported that their child “always” wears a helmet when riding a bicycle. Source: St. Joseph Health, Behavioral Risk Factor Surveillance

    Table 8. Indicators of Health and Healthy Development – Children: 1 - 12 yrs

    IndicatorData Year(s)Sonoma CountyCaliforniaHealthy People 2020
    % of low income children 2-4 years who are obese2008-201015.4%17.3% 9.6%
    % of low income children 5-11 years who are obese2008-201023.4%21.3%15.7%
    % of 5th-graders who are obese (Santa Rosa City Schools) 2008-201025%N/AN/A
    % of low income children 1-2 years who have iron deficiency anemia2008-201017.5%14.8% 14.3%
    % of low income children 3-4 years who have iron deficiency anemia2008-201014.0%13.0%4.3%
    % of kindergarteners who are up-to-date on recommended immunizations201189.9%90.9% 95%
    % of children 3-11 who have seen a dentist in the past year2009N/A84.7%49%
    % of children 1-12 who have seen a doctor in the past year200980.2%90.5%N/A
    Rate of substantiated child abuse per 1,000 children 1-12 years20108.09.78.5
    % of 5th graders who meet 6 of 6 fitness criteria (in Healthy Fitness Zone)2010-1126.5%25.2%N/A
    % of 3rd graders who are proficient at language arts201046%46%N/A

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    Indicators of Disparity

    • 17.5% of low-income children aged 1-2 yrs. have iron deficiency anemia, a symptom of poor nutritional status.
    • In school fitness testing, 15.4% of Hispanic 5th-graders met 6 out of 6 criteria, as compared with 34.2% of White, non-Hispanic children. Source: CA Department of Education, DataQuest Physical Fitness Testing
    • Among children 0-4 yrs., the hospital emergency department visit rate for asthma by African Americans was 231.6, as compared to 100.6 for Hispanics and 67.9 for Whites. For children 5-14 years, the asthma ED visit rate was similar for Hispanics and Whites (45.2/40.1), while African American rate continued to be far higher (189.2).
    • The 2009 Sonoma County Smile survey found that low-income kindergarteners and 3rd- graders had more than twice the level of untreated decay of more affluent children (21%/9%).
    • The Smile Survey found that 65% of Hispanic children had a history of tooth decay as compared to 32% of White children. Hispanic children had nearly twice the level untreated decay as White children (20%/11%).
    • In 2011, 61% of White 3rd graders were proficient or advanced in English Language Arts while 27% of Latino students were. Source:CA Department of Education, DataQuest STAR Testing
    • Only 30% of economically disadvantaged 3rd graders were proficient or advanced, compared with 62% non-disadvantaged students. Source:CA Department of Education, DataQuest STAR Testing

    Children: 13 - 17 Years

    Indicators of Mortality and Morbidity Highlights

    • The three leading causes of mortality are unintentional injury (28%), cancer (17%) and diseases of the nervous system (17%). (refer to Table 2)
    • The leading causes of hospitalization for non-fatal unintentional injury are falls, motor vehicle collisions, and injury from other transportation. Source:California Department of Public Health, EPICenter: California Injury Data Online
    • Non-fatal hospitalizations for children in this age group are higher than the California rate.

    Table 9. Mortality and Morbidity Indicators - Children: 13 - 17 years

    Indicator: Per 100,000 ChildrenData Year(s)Annual AverageSonoma CountyCaliforniaHealthy People 2020
    Child death rate 15-19 years2007-20091039.544.255.7
    Unintentional injury death rate 13-17 yrs.2008-201025.06.1NA
    Non-fatal unintentional injury hospitalization rate 13-17 years2008-201072213.7204.7NA
    Non-fatal unintentional injury hospitalization rate from falls 13-17 years2008-20101853.751.7NA
    Non-fatal unintentional injury hospitalization rate from motor vehicle collisions 13-17 years2008-20101750.747.3NA
    Non-fatal unintentional injury hospitalization rate from poisonings 1-12 years2008-2010515.912.7NA
    Suicide death rate 13-17 years2008-201012.02.8NA
    Non-fatal hospitalization rate from self-harm injury 13-17 years2008-20101030.853.8NA

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    Indicators of Health and Healthy Development Highlights

    • Nearly one-quarter of low-income children, 12-19 years, are obese. This is higher than the California average and does not meet the Healthy People 2020 goal.
    • Only 34.6% of 9th graders meet 6 out of 6 fitness criteria. Fitness levels for both 7th and 9th graders are below California averages.
    • The percentages of Sonoma County 11th-graders who report smoking, binge drinking and use of prescription painkillers are higher than statewide averages.
    • 28% of 9th graders report “feeling sad or hopeless” in the past 12 months.

    Table 10. Indicators of Health and Healthy Development- Children: 13 - 17 years

    IndicatorData Year(s)Sonoma CountyCaliforniaHealthy People 2020
    % of low-income children 12-19 yrs who are obese2008-1024.1%22.6%16.1%
    % of teens 12-17 who reported eating 5+ fruits or vegetables per day2007-09Not stableNA
    % of teens 12-17 who reported eating fast food more than 2 times in the past week200931.4%48.2%NA
    % of 9th graders who are current smokers (smoked a cigarette in past 30 days)2007-0911%9%16%
    % of 11th graders who are current smokers (smoked a cigarette in past 30 days)2007-0916%13%16%
    % of 9th graders who reported drinking alcohol in past mo.2007-0928%27%NA
    % of 11th graders who reported drinking alcohol in past mo.2007-0944%36%NA
    % of 9th graders who reported binge drinking in past mo.2007-0912%15%8.5%
    % of 11th graders who reported binge drinking in past mo.2007-0926%22%8.5%
    % of 9th graders who reported ever taking prescription painkillers2007-0913%13%NA
    % of 11th graders who reported ever taking prescription painkillers2007-0924%17%NA
    Chlamydia rate per 100,000 females 15-19 years20101400.72247.0NA
    Percent of 9th graders who meet 6 of 6 fitness criteria (in Healthy Fitness Zone)2010-1134.6%36.8%NA
    Rate of substantiated child abuse per 1,000 children 13-17 yrs.20104.96.98.5
    Percent of 9th graders who reported feeling safe at school (safe or very safe)2007-0960%56%NA
    Percent of 11th graders who reported feeling safe at school (safe or very safe)2007-0962%59%NA
    Percent of 9th graders who reported feeling sad or hopeless in past 12 months2007-0928%32%NA
    Percent of 11th graders who reported feeling sad or hopeless in past 12 months2007-0930%33%NA

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    Indicators of Disparity

    • In 2010-2011 fitness testing, 48.8% of White, non-Hispanic 9th graders were able to meet 6 out of 6 criteria, as compared with 23.7% of Hispanic children.
    • Students identified as “socioeconomically disadvantaged” (based on school criteria for parental education level and family income) were less likely to meet fitness criteria than more advantaged students – 22% versus 36% for 7th graders and 25.4% versus 40.2% for 9th graders. Source:CA Department of Education, DataQuest Physical Fitness Testing

    Adults: 18 - 59 Years

    Indicators of Mortality and Morbidity Highlights:

    • During the 2008-10 periods, the annual average for deaths in this age group was 599.
    • The three leading causes of mortality are cancer (29%), unintentional injury (15%), and coronary hearth disease (10%).
    • The unintentional injury rate for this age group is higher than California as a whole.
    • The leading causes of non-fatal unintentional injury hospitalization are falls, motor vehicle collisions and poisoning. Source: California Department of Public Health, EPICenter: California Injury Data Online
    • Approximately 31,000 Sonoma County adults in this group report being diagnosed with hypertension.
    • Approximately 24,000 individuals in this group report living with at least one disability.

    Table 11. Mortality and Morbidity Indicators - Adults: 18 - 59 years

    IndicatorData Year(s)Annual AverageSonoma CountyCaliforniaHealthy People 2020
    Death rate per 100,000 persons 18-

    59 years
    2008-2010599224.8NANA
    Cancer death rate per 100,000 persons 18-59 years2008-201017666.1NA160.6
    Coronary heart disease death rate per 100,000 persons 18-59 years2008-20105922.2NA100.8
    Unintentional injury death rate per 100,000 persons 18-59 years2008-20108931.628.336.0
    Death rate from unintentional motor vehicle collisions per 100,000 persons 18-59 years2008-20102599.712.4
    Hospitalization rate for non-fatal unintentional injuries per 100,000 persons 18-59 years2008-20101014361.1344.9NA
    Hospitalization rate for non-fatal unintentional injuries from falls per 100,000 persons 18-59 years2008-2010307109.3106.5NA
    Hospitalization rate for non-fatal unintentional motor vehicle collisions per 100,000 persons 18-59 years2008-201033379.081.0NA
    Hospitalization rate for non-fatal unintentional poisonings per 100,000 persons 18-59 years2008-201011340.333.5NA
    Suicide death rate per 100,000 persons 18-59 years2008-20105218.612.010.2
    Non-fatal hospitalization rate from intentional self-harm injury per 100,000 persons 18-59 years2008-201015856.158.3NA
    Percent of adults 18-59 years who have been diagnosed with diabetesNot stableNA
    % of adults 18-59 years who report having been diagnosed with hypertension20093100011.8%18.2%26.9%
    % of adults 18-64 years with at least one disability2008-2010247008.1%8.0%NA

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    Indicators of Health and Wellbeing Highlights

    Table 12: Health and Wellbeing Indicators - Adults: 18 - 59 years

    IndicatorData Year(s)Sonoma CountyCaliforniaHealthy People 2020
    % of adults 18-59 years who are obese200917.6%22.6%30.6%
    % of adults 18-59 years who reported receiving no leisure time physical activity20077.7%12.9%32.6%
    % of adults 18-59 years who report eating 5 or more fruits and vegetables daily200555%49%NA
    % of adults 18-59 years who report being a current smoker200916%14.9%12%
    % of adults 18-59 years who report binge drinking in the past year200943.2%63.3%NA
    % of adults 18-59 years who needed help for emotional/mental health problems or use of alcohol/drugs200916.1%NA
    % of adults 18-59 years who saw healthcare provider when they needed help for an emotional problem/use of alcohol/drugs200957.4%54.1%NA
    Chlamydia rate per 100,000 females 15-44 years2010875.51278.5NA
    % of adults 18-59 years who reported being in fair or poor health200910.2%16.3%NA

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    Indicators of Disparity

    Adults: 60 Years and Over

    Indicators of Mortality and Morbidity Highlights

    • During the 2008-10 period, the annual average number of deaths in this age group was 3,185.
    • Sonoma County’s death rate in the 60-69 group is slightly lower than the state rate but significantly higher than the state rate for ages 80 years and over.
    • The three leading causes of mortality in this age group are cancer (24%), coronary heart disease (18%) and stroke (8%).
    • The death rate for falls for this age group is higher than the California rate and almost three times higher than the Healthy People 2020 goal.
    • The leading causes of hospitalization for non-fatal unintentional injury in this age group are falls, poisoning and motor vehicle collision. Source: California Department of Public Health, EPICenter: California Injury Data Online
    • 44,000 individuals, age 60 and older, report having been diagnosed with hypertension.

    Table 13. Mortality and Morbidity Indicators – Adults: 60 years and Over

    IndicatorData Year(s)Annual AverageSonoma CountyCaliforniaHealthy People 2020
    Death rate per 100,000 persons 60+ years2008-1031853532.33144.3 (2007-09)NA
    Cancer death rate per 100,000 persons 60+ yrs2008-10774904.7NA160.6
    Female breast cancer death rate per 100,000 persons 60+ years2008-105966.7NA20.6
    Colorectal cancer death rate per 100,000 persons 60+ years2008-107180.7NA14.5
    Coronary heart disease death rate per 100,000 persons 60+ years2008-10575630.3NA100.8
    Stroke death rate per 100,000 persons 60+ yrs2008-10248270.6NA36.0
    Alzheimer’s disease death rate per 100,00 persons 60+ years2008-10245260.9NANA
    Chronic lower respiratory disease death rate per 100,000 persons 60+ years2008-10221257.4NANA
    Death rate from unintentional falls per 100,000 persons 60+ years2008-103335.727.212.4
    Hospitalization rate for non-fatal unintentional injuries per 100,000 persons 60+ years2008-1017101932.51874.8NA
    Hospitalization rate for non-fatal unintentional injuries from falls per 100,000 persons 60+ yrs2008-1012481410.91347.3NA
    Hospitalization rate for non-fatal unintentional poisonings per 100,000 persons 60+ years2008-108797.783.5NA
    Suicide death rate per 100,000 persons 60+ yrs2008-101920.815.910.2
    Non-fatal hospitalization rate from intentional self-harm injury per 100,000 persons 60+ years2008-102424.423.2NA
    Percent of adults 60+ years who have been diagnosed with diabetes200910,00010.6%18.3%NA
    Percent of adults 60+ years who report having been diagnosed with hypertension2009 4400047%55.2%26.9%
    Percent of adults 65+ years with at least one disability (Census)2008-10 2261135.1%37.5%NA
    Percent of adults 60+ years with who were disabled due to physical, mental or emotional condition (CHIS)2007-0940,00042.3%47.1%NA

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    The following tables provide a more detailed breakdown on death rates (per 100,000) for leading causes among individuals over age 65. While death rates for those in the 65-74 year age range are slightly higher than for California as a whole, this differential increases for those aged 75 and over. Hispanics have significantly lower death rates than White non-Hispanics in both the 65-74 and 75-84 age ranges.

    Table 13 a. Age Specific Death Rates (per 100,000) by Cause

    Sonoma County 2010 - Age

    AgeTotal Cancer Unintentional InjuryStrokeCLRD Alzheimer's
    65-741,571.1 636.6 34.778.1 127.3 17.4
    75-845,093.5 1,449.1 97.3335.2459.6 324.4
    85+ 15,640.31,916.8 234.51,386.6897.2 2,130.9

    California 2010 - Age

    AgeTotalCancer Unintentional Injury Stroke CLRDAlzheimer's
    65-741,504.3550.8 32.5 73.3 10419.4
    75-844,109.11,09567.9 270.3 319.6203.8
    85+ 12,1591,646.9193.4 947 703.41,183.4

    Sonoma County 2010 - Gender / Ethnicity

    AgeMaleFemaleWNH HISP
    65-741,790.6 1,377.6 1,663 991.5
    75-845,887.64,512.7 5,597.9 2,429.8
    85+ 17,041.314,932.517,441.4 5,327.9

    Sonoma County 2010 - Gender / Ethnicity

    AgeMaleFemale WNHHISP
    65-741,797.61247.7 1,597.8 1,313
    75-844,851.93,563.7 46193,369.3
    85+ 5,327.911,432.613,878 8,606.7

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    Indicators of Health and Wellbeing Highlights

    • Nearly one-quarter of adults in this age group are obese, failing to meet the Healthy People 2020 goal.
    • 16.9% of adults 60 and over report binge drinking in the past year, significantly exceeding the California rate.
    • 63.4% of adults in this age group report having had a flu shot during the previous year.
    • Over 35% of adults 65 years and older are living with at least one disability. This percentage rises to 50% for those 75 years and older.
    • The most common disabilities are those that interfere with: ambulation (21.6%), living independently (16.1%), and hearing (15.3%).

    Table 14. Indicators of Health and Wellbeing – Adults: 60 years and Over

    IndicatorData Year(s)Sonoma CountyCaliforniaHealthy People 2020
    Percent of adults 60+ years who are obese 2009 23.8%23.0% 30.6%
    Percent of adults 60+ years who reported receiving no leisure time physical activity200715.3%18.4%32.6%
    Percent of adults 18-59 years who report eating 5 or more fruits and vegetables daily200557.4%47.9%NA
    Percent of adults 60+ years who report being a current smoker2009 (2007) Not stable (7.4%)(8.5%)12%
    Percent of adults 60+ years who report binge drinking in the past year200916.9%11.7%NA
    Percent of adults 60+ years who needed help for emotional/mental health problems or use of alcohol/drugs200910.5%7.4%NA
    Percent of adults 60+ years who saw healthcare provider when they needed help for an emotional problem/use of alcohol/drugs2009Not stableNot stableNA
    Percent of adults 60+years who reported having a flu shot in past 12 months2007-200963.4%59.9%NA
    Percent of adults 60+ years who reported being in fair or poor health200916.7%25.9%NA
    Percent of adults 60+ years who reported being in good or better health2007-200983.3%74.1%NA

    Bold highlight indicates county indicator is worse than California or does not meet the Healthy People 2020 objectives.

    Indicators of Disparity

    Health System Performance Indicators

    Preventable Hospitalization

    Rates of preventable hospitalization are considered a good index of primary care access and effectiveness. Sonoma County performs better than California as a whole in every measure in the table below. The county’s preventable hospitalization rate is less than half the statewide rate for both hypertension and diabetes.

    Table 15. Preventable Hospitalizations (Prevention Quality Indicators), Sonoma County and California 2009

    HospitalizationsSonoma
    Risk – Adjusted Rate
    Sonoma
    Number of Cases
    California
    Risk – Adjusted Rate
    California
    Number of Cases
    Bacterial Pneumonia203.5%819235.8%64,185
    Congestive Heart Failure (CHF)148.4%605272.4%73,213
    Urinary Tract Infection106.3%424155.9%42,133
    Chronic Obstructive Pulmonary Disease (COPD)89.4%360134.7%36,310
    Diabetes Long-term Complication58.6%233109.2%30,076
    Adult Asthma54.3%21187.3%24,386
    Dehydration28.8%11657.7%15,681
    Lower-extremity Amputation Among Patients With Diabetes24.4%9928.3%7,747
    Angina Without Procedure15.9%6425.4%6,989
    Hypertension8.6%3436%9,882
    Uncontrolled Diabetes4.7%1811.9%3,329

    Source:California Office of Statewide Health Planning and Development, AHRQ-Prevention Quality Indicators, Patient Discharge Data (2009)

    • Rate = Per 100,000 state or county population with the exception of Perforated Appendix (per 100 appendicitis cases).
    • All rates are age-sex adjusted. Blank cells indicate that no procedures were performed or conditions treated.

    Measures for health system performance in the tables below are selected from the Commonwealth Fund’s 2012 Scorecard on Local Health System Performance and Fund’s 2011 State Scorecard of Child Health System Performance. The Scorecards provide communities with comparative data on the performance of their health care systems and include indicators spanning dimensions of health system performance including: access, treatment, and potentially avoidable hospital use and cost. The unit of analysis in the first table is the “hospital referral region” (HRR), which is an area that represents a regional market for health care. While HRR’s do not precisely align with county or state boundaries, the Santa Rosa HRR corresponds closely to Sonoma County. Local HRR values are not available for pediatric measures, however four measures are included below for comparison with California rates.

    Highlights:

    • Sonoma County exceeds California in all measures related to access and is in the top 10th percentile for annual adult dental visits.
    • Sonoma County lags the California rate for risk-adjusted 30-day mortality among Medicare patients hospitalized for pneumonia.
    • Sonoma County is in the top 10th percentile for all of the following measures of potentially avoidable hospital use and cost: admissions for ambulatory care-sensitive conditions (Medicare); re-admissions within 30 days of discharge (Medicare); hospitalization of long- stay nursing home patients; and re-admission of first-time nursing home residents.
    • Sonoma County exceeds statewide measures for children with healthcare insurance, usual source of care and annual dental visits (3-11 years).

    Health System Perfomance Measueres - Santa Rosa California

    Table 16. a. Access

    Dimension and IndicatorYearHRR Rate*Top 10th %State RateQuartile
    % of adults ages 18 – 64 insured2009-201080.7%87.5%75.1%2
    % of children ages 0 – 17 insured2009-201093.4%96.3%90.8%3
    % of adults reported no cost-related problem seeing a doctor when they needed to within the past year2009-201086.8%90.7%82.9%2
    % of at-risk adults visited a doctor for routine checkup in the past two years2009-201086.1%90.4%84.1%2
    % of adults visited a dentist, dental hygienist, or clinic within the past year201078.1%77.9%69.7%1

    Table 16.b. Prevention and Treatment

    Dimension and IndicatorYearHRR Rate*Top 10th %State RateQuartile
    % of adults with a usual source of care2009-201079.5%88.8%73.0%3
    % of adults age 50 and older received recommended screening and preventive care2008 & 201046.0%50.8%41.4%2
    % of adult diabetics received recommended preventive care2008-2010N/A55/7%N/AN/A
    % of hospitalized patients given information about what to do during their recovery at home201082.2%86.2%79.8%3
    Risk-adjusted 30-day mortality among Medicare patients7/07 – 6/1014.914.415.53
    Risk-adjusted 30-day mortality among Medicare patients hospitalized for heart attack7/07-6/1014.914.415.53
    Risk-adjusted 30-day mortality among Medicare patients hospitalized for pneumonia7/07- 6/1012.010.611.83
    % of Medicare decedents with a diagnosis of cancer without any hospice or who enrolled in hospice during the last three days of life200751.9%46.6%62.4%2

    Table 16.c. Potentially Avoidable Hospital Use and Cost

    Dimension and IndicatorYearHRR Rate*Top 10th %State RateQuartile
    Hospital admissions among Medicare beneficiaries for ambulatory care-sensitive conditions, per 100,000 beneficiaries20092,9344,0454,9131
    Readmissions within 30 days of discharge as percent of all admissions among Medicare beneficiaries200814.4%15.1%18.2%1
    % of long-stay nursing home residents hospitalized within six-month period20089.6%11.9%20.4%1
    % of first-time nursing home residents readmitted within 30 days of hospital discharge to the nursing home200813.5%15.8%20.4%1

    *Hos. Referral Region

    Table 17. Pediatric Performance Measures

    Performance MeasuresSonoma - EstimateSonoma - Rate or %California - EstimateCalifornia -Rate or %Source
    % of children < 18 years insured9870092.9%845593991.0%USCensus, 2010
    % of children with a medical home (usual source of care*)11000094.9%891600090.8%CHIS, 2009
    % of children 3-11 years with a dental visit in the past year (not necessarily preventative6200093.1%450300084.7%CHIS, 2009
    Hospital discharge rate for pediatric asthma per 100,000 children 2-17 years18658.8OSHPD, PDD 2008 - 2010

    *Includes Dr. office