1. Select Risk Factors and
Outcomes Related to Chronic
Diseases
Presented to
10/14/2011
The Cancer, Cardiovascular and Pulmonary Disease Grants
Committee

2. Acknowledgements
Renee Calanan, PhD
Chronic Disease Epidemiologist, PHS
&
Stephanie Kuhn
Barbara Gabella
Indira Gujral
Ashley Juhl

3. Factors Influencing Health Status
Biology
20%
Lifestyle
51%
Smoking
Obesity Health Care
Nutrtion 10%
Alcohol Use
Environment
19%
Source: McGinnis, J.M and Foege, W.H. (1993). ―Actual Causes of Death
in the United States,‖ Journal of the American Medical Association.

4. 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

5. Mortality

6. Number of deaths for the fifteen leading
causes of death — Colorado residents, 2010
Cancer (Malignant neoplasms) 7029
Heart Disease 6029
Chronic Lower Respiratory Disease 2199
Unintentional injuries 2102
Cerebrovascular Disease 1605
Cause of death
Alzheimer's Disease 1336
Suicide 867
Diabetes Melitus 721
Chronic Liver Disease and Cirrhosis 598
Influenza and Pneumonia 549
0 1000 2000 3000 4000 5000 6000 7000 8000
Source: CDPHE, Health Statistics Number of deaths
Section. Vital Records. Death statistics
obtain via CoHID Oct 10, 2011

7. Percent of total deaths for the leading
causes of death — Colorado residents, 2008
1.9%
1.7%
2.3% Influenza and Pneumonia
2.8% Chronic Liver Disease and Cirrhosis
4.3%
26.7% Diabetes Melitus
5.1%
Suicide
6.7% Alzheimer's Disease
Cerebrovascular Disease
7.0%
Unintentional injuries
Chronic Lower Respiratory Disease
22.4% Heart Disease
19.2%
Cancer (Malignant neoplasms)
Source: CDPHE, Health Statistics
Section. Vital Records. Death statistics All other causes
obtain via CoHID Oct 10, 2011

8. Outcomes Among
Adults

9. 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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10. 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

11. Risk Factors Among
Adults

12. Prevalence of selected risk factors, Colorado adults, 1997-2010 BRFSS
40
35
30
25
20
15
10
5
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Overweight High cholesterol Current smokers Hypertension Physical inactivity Obesity
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public Health and Environment

13. Percent of Colorado adult smokers, 1996-2009
25
22.8 22.3
19.8
20
17.1
16
Percent
15
Healthy People 2020 Objective: 12%
10
5
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Source: Colorado Behavioral Risk Factor Surveillance System, Health Statistics Section,
Colorado Department of Public Health and Environment

14. Prevalence of obesity among adult Coloradans, 1997-2010 BRFSS
25
20
15
10
Healthy People 2020 Objective: 30%
5
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Obesity
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public Health and Environment

16. Prevalence of select risk factors,
Colorado adults, 2009 (in pct.)
100
90
80
70
57
60
50
40 35
30 25 22
19 18 17
20
10
0
Fruit/vegetables High blood High cholesterol Obesity Meet physical Physically Current smoker
5+ times per day pressure activity recs inactive
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

17. High blood pressure by race/ethnicity
and income, Colorado adults, 2009
50 50
45 45
40 40
34
35 35
30 29 28
30
25 25
25 23 25
21
20 18 20 18
15 15
10 10
5 5
0 0
White non-Hispanic Black non-Hispanic Hispanic
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

18. High cholesterol by race/ethnicity and
income, Colorado adults, 2009
50 50
45 45 41
40 40 37 36 37
35 36 35
34 33
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
White non-Hispanic Black non-Hispanic Hispanic
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

19. Obesity by race/ethnicity and income,
Colorado adults, 2009
50 50
45 45
40 40
35 35
31
30 30
26
25 22 25 23 22
19 20
20 18 20 17
15 15
10 10
5 5
0 0
White non-Hispanic Black non-Hispanic Hispanic
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

20. Physical activity by race/ethnicity and
income, Colorado adults, 2009
100 100
90 90
80 80
70 70 63
59 55 55 58
60 56 60
51 51 50
50 50
40 40
30 30
20 20
10 10
0 0
White non-Hispanic Black non-Hispanic Hispanic
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

21. Physical inactivity by race/ethnicity and
income, Colorado adults, 2009
50 50
45 45
40 40
35 35 33
30 29 30 28
28
25 25 23
20
20 20
14 14
15 15
9
10 10
5 5
0 0
White non-Hispanic Black non-Hispanic Hispanic
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

22. Current smoking by race/ethnicity and
income, Colorado adults, 2009
50 50
45 45
40 40
35 35
30 30 28 28
27
25 25
20 20
20 20 18 17
16
15 15
9
10 10
5 5
0 0
White non-Hispanic Black non-Hispanic Hispanic
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

23. Screening Among Adults

24. Prevalence of preventive screening,
Colorado adults, 2008
100
90
84
80 76 76
73
70
62
60
50
40
30
20
10
0
Cholesterol within 5 years (18+ Colorectal cancer (50+ years) Cervical cancer within 3 years Breast cancer within 2 years Breast cancer within 2 years
years) (18+ years) (50+ 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)

25. Cholesterol screening by
race/ethnicity and income,
Colorado adults, 2009
100 100
90 90 86
79 78
80 80 77 78
68 70
70 70
61 62
60 60
50 50
40 40
30 30
20 20
10 10
0 0
White non-Hispanic Black non-Hispanic Hispanic
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

26. Colorectal cancer screening by
race/ethnicity and income, Colorado
adults aged 50+ years, 2008
100 100
90 90
80 80
72
68
70 64 70 64 64
59
60 54 60 56
50 50 47
40 40
30 30
20 20
10 10
0 0
White non-Hispanic Black non-Hispanic Hispanic
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

27. Cervical cancer screening by
race/ethnicity and income, Colorado
women aged 18+ years, 2008
100 100 93
87 89
90 86 90 84
81 79 80
80 80
71
70 70
60 60
50 50
40 40
30 30
20 20
10 10
0 0
White non-Hispanic Black non-Hispanic Hispanic
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

28. Breast cancer screening by
race/ethnicity and income, Colorado
women aged 50+ years, 2008
100
100
90 82
90 80
80 78
80 77 76 72
70
70 70
61
60 60
50 50
40 40
30 30
20 20
10 10
0 0
White non-Hispanic Black non-Hispanic Hispanic
Data source: Behavioral Risk Factor Surveillance System, Health Statistics Section, Colorado Department of Public
Health and Environment

29. 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.

30. Risk Factors Among
Youth

31. Select risk factors and outcomes,
Colorado adolescents, 2009
100
90
80 78
70
60
50
40
30 27
24
20
12
10
0
Healthy weight Recommended physical activity Fruit/vegetables 5+ times/day Current smoker
Data source: Colorado Youth Risk Behavior Survey, Colorado Department of Education; analyzed by Colorado Department of Public Health and Environment
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

32. Select risk factors and outcomes,
Colorado children, 2009
100
90
80
70
65
60
50 48
45
40
31
30
20 16
10 9
10
0
Healthy weight (5- Eat fruit 2+ times and Drink sweetened Active everyday for Watch TV >2 hours Sunburn in past 12 Current asthma (1-
14y) vegetables 3+ times drinks 1+ times per 60+ minutes (5-14y) per day (1-14y) months (1-14y) 14y)
per day (2-14y) day (1-14y)
Data source: Colorado Child Health Survey, Colorado Department of Public Health and Environment

33. Risk Factors’
Associations with
Outcomes

34. Reducing Cigarette Smoking
Cancers CVD
• 80-90% of lung • 2-4 x risk of coronary heart
• 30-50% of colon disease
• 75% of oral (w/ alcohol) • 2 x risk of sudden cardiac
• Cancers of the bladder death
cervix, esophagus, larynx, • Abdominal aortic aneurysm
kidney & pancreas • Strokes
• Atherosclerosis & congestive
heart failure
COPD
• 90% of Chronic
Diabetes
Obstructive Pulmonary
•Leads to neuropathy &
Disease
peripheral artery disease
•Smoking increases the risk of
amputation by 2 – 10 times 34

35. Lowering cholesterol & hypertension
CVD
• 30-40% of coronary CVD
heart disease • 20-30% of coronary heart
disease
• 10-20% of stroke
• 20-50% of stroke
Type 2 Diabetes
• End stage renal
• 65% of people with diabetes
die from heart disease or stroke
35

36. Nutrition & Physical Activity
Cancers
• 30% of cancer deaths Cancer
• Nutrition: Cancers of • 22% of colon cancers
the mouth, pharynx, • Cancers of breast, colon, and
esophagus, larynx, kidney, possibly endometrial &
colon, rectum, ovary, & prostate
bladder
CVD
CVD • 12% of hypertension
• heart disease by 20-40%
• stroke by 30%
Type 2 Diabetes Diabetes
• 12% of diabetes
36

37. Reducing Obesity
CVD
• Increased likelihood of heart
50-100% greater risk of disease and stroke
premature death
Cancers Diabetes
• Cancers of the colon, • Increased risk of Type 2
breast, kidney, Diabetes
gallbladder, prostate,
cervix, ovaries, &
esophagus
37

38. Thank you
Gabriel Kaplan, PhD., MPA,
Director
EPE | Epidemiology, Planning and Evaluation | Branch
Prevention Services Division
Colorado Department of Public Health and Environment
gabriel.kaplan@state.co.us