Population Health Data Brief YG 2 PDF

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POPULATION HEALTH DATA BRIEF TEMPLATE Informatics for Transforming Nursing Care February, 2021

Los Angeles County, California

A. SOCIODEMOGRAPHIC PROFILE 1. Key Findings ● Los Angeles County (LAC) population is 10.1 million ● The median household income is $68,093 ● Of those residing in LAC 83.9% are citizens and 34.2% of residents were born outside

of the country ● The most common foreign languages spoken in Los Angeles County, CA are Spanish

(3,746,931 speakers), Chinese (Incl. Mandarin, Cantonese) (392,084 speakers), and Tagalog (Incl. Filipino) (233,814 speakers). ● Most students graduating from Universities in Los Angeles County, CA are Hispanic

or Latino (66,483 and 41.9%), followed by White (41,869 and 26.4%), Asian (25,608 and 16.1%), and Black or African American (11,135 and 7.01%). (Deloitte, n.d.)

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2. Introductory paragraph The sociodemographic data is collected from the United States census, quick facts for the United States. Sociodemographic data was gathered for Los Angeles County, California, then compared to data for the United States as a whole. When comparing the characteristics of Los Angeles County, there are many similarities to the United States. These comparisons include the percentage of persons under the age of 18 (21.4 vs 22.3), percent of the population that are women (50.7 vs 50.8), total retail sales per capita (12,184 vs 13,443). Notable differences are the Hispanic population of Los

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Angeles County (48.6%) when compared to the United States (18.5) (United States Census Bureau, n.d.). 3. Sociodemographic Profile Table Population Characteristics

County

United States

10,192,376

328,239,52

Population Estimates

3

Population Percent Change

2.2

6.3

Percentage of Persons Under the Age of 18 Percentage of Persons 65 Years and Over

21.4 14.1

22.3 16.5

Percentage of Women

50.7

50.8

Percentage White Alone

52.1

76.3

Percentage Hispanic Alone

48.6

18.5

Percentage of Foreign-Born Persons Percentage Language Other Than English Spoken

34

13.5

58.9

21.5

at Home, Percent of Persons Age 5+ Percentage of Houses with a Computer

91.6

88.8

Percentage with High School Graduate or Higher

77.6

87.7

Percentage with a Disability, Under Age 65 Years Percentage without Health Insurance, Under Age

22.6

8.6

17.3

9.5

56.4

62.9

64.6

58.2

N/A

2,040,441,

$12,18

203 $13,443

65 Years Percentage in Civilian Labor Force Age 16 Years+ Percentage of Women in Labor Force Age 16 Years+ Total Healthcare and Social Assistance Revenue

Total Retail Sales Per Capita

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Per Capita Income in the Past 12 Months

$35,26 1 3

$32,621

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Percentage of Persons in Poverty

10.5%

N/A

Population Per Square Mile

87.4

B. COUNTY HEALTH TRENDS & RANKINGS 1. Introductory Paragraph The data collected for this brief was obtained through the County Health Rankings and roadmap (CHR&R). A mix of local, state, and federal data in collaboration with the University of Wisconsin and the Robert Wood Johnson Foundation is used to create a ranking list. The County Health Rankings & Roadmaps yearly ranking measures variables such as health behavior, clinical care, socioeconomic factors, and physical environment. The health outcomes used in the following section focuses on health behaviors, clinical care, socioeconomic, and physical environmental factors in Los Angeles County. The elements chosen were based on comparisons to top U.S. performers. The seven specific health factors included: adult obesity, physical inactivity, children in poverty, air pollution, alcohol-impaired driving death, sexually transmitted infections (STI), and uninsured. 2. Discussion of Health Trends

This section will provide a brief overview of the health outcome overall rankings and life expectancy in Los Angeles County. The area will also provide a summary of health trend graph results. Based on the health outcomes overall ranking for 2020, Los Angeles County ranked 21 out of 58. This ranking indicates a steady improvement based on the last three years, 2017 (25), 2018 (23), 2019 (23). Currently, the length of life expectancy is 15. Based on the graph, adult obesity rates have worsened in Los Angeles county. The adult obesity rates in Los Angeles county have steadily increased. In 2004 the obesity rates were 4

19%, and in 2016 that rate increased to 22%. In contrast, the physical inactivity rates in Los Angeles County have improved. Physical inactivity in 2004 was 20%; in 2016, the rate decreased to 16%. The graph for alcohol-impaired driving death showed the most drastic change. In 2008 the death rate was 30%, the largest increase was in 2015 at 33%, followed by a steady drop in 2018, the rate was 19%. The trend graph for sexually transmitted infections (STI) showed the rates deteriorated as there has been a steady increase. In 2007 infections were at 443 and increased to 633 in 2017. The trend graph for the uninsured showed an improvement. In 2008 the uninsured rate was 24%; as of 2017, that rate decreased to 10%. The trend graph for children in poverty has remained about the same with a slight improvement. In 2002 25% of children were in poverty compared to 2018 at 20%. Air pollution has seen steady progress. In 2002 the average density of fine particulate matter was 25, while that number decreased to 14 in 2014.

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3. Health Trends • Adult Obesity Figure 1: Adult Obesity in Los Angeles County, California

Figure 1: Suggested increased rated in county adult obesity rates from 2004 to 2016 of 3% as compared to a 3% increase in the state of California and a 5% increase nationally.

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• Physical Inactivity Figure 2: Physical inactivity in Los Angeles County, California

Figure 2: Suggested increased rated in county physical inactivity trend rates from 2004 to 2016 of 4% as compared to a 1% decrease in the state of California and a 1% decrease nationally.

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• Alcohol-impaired driving deaths Figure 3: Alcohol-impaired driving deaths in Los Angeles County, California

Figure 3: Suggested increased rated in county alcohol-impaired driving death rates from 2008 to 2018 of 11% as compared to a 7% decrease in the state of California and a 8% decrease nationally.

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• Sexually transmitted infections (STI) Figure 4: Sexually transmitted infections (STI) in Los Angeles County, California

Figure 4: Suggested increased rated in county sexually transmitted infections (STI) rates from 2007 to 2017 of 190 cases per 100,000 as compared to a 154 cases per 100,000 increase in the state of California and a 155 cases per 100,000 increase nationally.

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• Uninsured Figure 5: Uninsured in Los Angeles County, California

Figure 5: Suggested increased rated in county uninsured rates from 2008 to 2017 of 14% as compared to a 11% decrease in the state of California and a 7% decrease nationally.

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• Children in poverty Figure 6: Children in poverty in Los Angeles County, California

Figure 6: Suggested increased rated in county children in poverty rates from 2002 to 2018 of 5% as compared to a 2% decrease in the state of California and a 1% increase nationally.

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• Air Pollution Figure 7: Air Pollution in Los Angeles County, California

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Figure 7: Suggested increased rated in county air pollution rates from 2002 to 2014 of 11 micrograms per cubic Meter (MCM) as compared to a 3 (MCM) decrease in the state of California and a 2 (MCM) decrease nationally.

4. Health Trends Discussion The health care trend of obesity has increased in Los Angeles County, which mirrors the states and the nation's results. On the other hand, physical inactivity has gradually decreased. The decline reflects the general trend of the state and the nation. Alcohol-impaired driving deaths have greatly improved in Los Angeles County, with rates being lower than the nation and a continual downward trend since 2008. Sexually transmitted infections (STI) continue to trend upward at all levels, but higher rates are seen in Los Angeles County. As for 14

the uninsured rate, Los Angeles County continues to show improvement in this area, rating equal to those seen in the nation. Trends for children in poverty saw no significant trend for the last 16 years; however, there has been a decrease in poverty rates within recent years. Air pollution particulate matter micrograms per cubic meter in Los Angeles County saw a downward trend. Despite the progress made, the microgram pollution rates for Los Angeles County continue to be higher than the natation. The health trends data reflects a need for Los Angeles to focus resources on education and intervention in obesity prevention and sexual health. There is also an indication for intervention in child poverty. The childhood poverty data displayed a stagnation in the county's rates, and when compared to national rates, Los Angeles County faired worst with higher rated of child poverty.

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C. Health Factors 1. Health Factors Table

County

Top U.S.

Data 11%

Performer 14%

11%

98%

91%

93%

19%

13%

19%

1,370:

1030:

126

1

1

0:1

82%

96%

83%

63%

73%

65%

4.7%

2.6%

4.2%

35%

20%

31%

Households Social Associations (Number of

5.7

18.4

5.9

Associations Per 10,000) Violent Crime (Number of Violent Crimes

488

63

421

Per 100,000) Injury Deaths (Number of Injury Deaths

39

58

50

Per 10,000) Percentage of Children Eligible for Free or

70%

32%

60%

Reduced-Price Lunch Air Pollution (Average Daily Density of

14.2

6.1

9.5

State Data

Factors Influencing Health Percentage Adult Smoking Percentage with Access to Exercise Opportunities Percentage Excessive Drinking Primary Care Physicians (Ratio of Population to 1 Physician) Percentage with High School Graduation

Percentage with Some College

Percentage with Unemployment Percentage of Children in Single-Parent

Air Pollutants) 16

33%

Percentage with Severe Housing Problems

9%

27%

2. Comparison of Data Evaluating the data between county, state, and top performers provides a chance for stakeholders at all levels to identify best practices in other communities. A focused assessment of resources, similarities, and differences can be used as a change model, and targeted interventions can be created. When compared to overall state data, there are significant areas that need improvement. Violent crime in Los Angeles was 488 per 100,000 compared to states 421, and the top performs were 63. The percentage of children eligible for free or reduced lunch was 70%, the state was 60%, and 32% for top performs. Air pollution – particulate matter micrograms per cubic meter were 14.2, the state was 9.5, and 6.1 for top performers. Percentage with severe Housing Problems was 33%, state 27%, and 9% for top performers. The most significant discrepancy can be seen between the county and the top performer data. When comparing this data to the top performers in general, California requires improvement.

D. SUMMARY 1. Significant Finding(s) Adult obesity is a health care trend that could benefit from an action plan to improve community health in Los Angeles County. Obesity rates in Los Angeles county have stayed between 19% to 22% between 2004 – 2016. The reason obesity is such a concern is due to the increased risk of other chronic health issues such as type 2 diabetes, heart disease, stroke, and certain cancers. Social determinants of Health (SDOH) such as income, education, and environment can affect healthy eating and activities. The SDOH states environmental determinants include

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access to healthy foods throughout an individual's lifetime (Office of Disease Prevention and Health Promotion [ODPHP], n.d). 2. Action Plan(s) This section will list examples already in place to combat obesity in Los Angeles County. These examples mentioned demonstrate programs in place that have been both successful and unsuccessful. These serve as templates and can help guide the county as trends change over time. To combat food insecurity, the Los Angeles Department of Public Social Services(DPSS) initiated the objective of increasing CalFresh enrolment by 20%. This endeavor began in 2017, and by October of 2019, DPSS saw an increased enrolment rate of 4% (Shah-Patel, 2019). A secondary program created by the Los Angeles County Department of Public Health (DPH) was Nutrition Education and Obesity Prevention (NEOP). NEOP aimed to create a collaborative effort with a faith-based organization that would deliver nutritional education and preventative health care strategies directly to parishioners. This program saw some success with parishioners actively participating in health food delivery and education, but this was limited to members of the congregation (Robles, Wright, Caldwell, & Kuo, 2019). Finally, there is the 2008 fast-food ban. This attempt to combat adult obesity was an unfortunate failure with no reduction in healthy eating norms of obesity rates (Sturm & Hattori, 2015). a. Services or Programs One strategy for reducing obesity rates is to focus intervention on nutritional education targeting high-risk areas like food deserts. Collaboration between local community liquor stores offers an educational opportunity point. Often time the term liquor store comes with a negative connotation. It may be assumed that only junk food is sold at these establishments. Despite these beliefs, healthy 18

foods are found at these establishments but may not necessarily be displayed in a prominent matter. With enhanced health food displays, consumers now have a port for nutritious foods. Presently a similar program is in place with the Sustainable Economic Enterprise of Los Angeles (SEE-LA). SEE-LA begins the program by engaging local businesses in an assessment, followed by nutritional education and creating healthy food displays(SEE-LA, 2019). An additional example of healthy nutrition through education would be the Supplemental Nutrition Assistance Program Education (SNAP-Ed). Critical findings for SNAP-Ed showed an implementation of 108 nutritional education centers, the creation of seven farmer's markets, and 18 liquor stores that had health food corner makeovers (Babey, Lee, Meng, Chen, Kominski & Pourat, 2018). b. Raise Public Awareness and Promote Public Engagement The first approach to raising public awareness and engagement through technology for obesity would be using the local media. The use of local radio and television stations may create awareness, effects, resources, and prevention of obesity. The second approach would be the use of the Los Angeles County Department of Public Health website. This site is an information hub. Consumers would have the ability to review up-to-date information, apply for programs, and even get healthy recipes. The third approach is the use of social media to engage the community. The use of Twitter, Instagram, and TikTok can be used as public service announcement platforms. These media platforms can engage with a large audience and provide education, statistics, and trends. Participants would be able to actively engages and show progress and discuss the benefits of programs being used. c. Monitoring and Evaluating Action Plan 19

Monitoring and evaluation could be obtained through the US Department of Agriculture(USDA) Supplemental Nutrition Assistance Program (SNAP) data tables. Specific information on the SNAP-Ed program can also be found on the USDA site. For data and statistics specific to Los Angeles County, the Department of Public Health epidemiology division would be the best source. E. DATA SOURCES & METHODS This data brief was supplemented by information from the County Health Rankings & Roadmaps – A Robert Wood Johnson Foundation Program in collaboration with the University of Wisconsin Population Health Institute. The United States Diabetes Surveillance System date was the source of information for adult obesity and physical inactivity. The data source for Alcoholimpaired driving deaths came from Fatality Analysis Reporting System. The data source for uninsured and Children in poverty came from the US Census Bureau's Small Area Health Insurance Estimates (SAHIE). The data source for Air pollution - particulate matter came from CDC's National Environmental Public Health Tracking Network. https://www.countyhealthrankings.org/app/california/2020/rankings/losangeles/county/outcomes/overall/snapshot

Socioeconomic data was gathered from the US Census Bureau Quick facts website. QuickFacts delivers statistical information for all 50 states and the District of Colombia, Puerto Rico, and cities with a population of 5,000 or more. Information from QuickFacts was obtained from multiple community, state, and federal sources, which include survey, census, and various databases (U.S. Census Bureau, n.d.). https://www.census.gov/quickfacts/losangelescountycalifornia

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References Babey, S. H., Lee, C., Meng, Y. Y., Chen, X., Kominski, G., & Pourat, N. (2018). Nutrition Education and Obesity Prevention in Los Angeles County Final Report for the Evaluation of the Local Supplemental Nutrition Assistance Program Education (SNAP-Ed) Efforts. UCLA Center for Health Policy Research. https://healthpolicy.ucla.edu/publications/search/pages/detail.aspx? PubID=1722.

Deloitte. (n.d). Los Angeles County, CA. Data USA. https://datausa.io/profile/geo/los-angelescounty-ca#education. Office of Disease Prevention and Health Promotion. (2020). Access to Foods that Support Healthy Eating Patterns. HealthyPeople. https://www.healthypeople.gov/2020/topicsobjectives/topic/social-determinants-health/interventions-resources/access-to-foods-thatsupport-healthy-eating-patterns#1.

Robles, B., Wright, T. G., Caldwell, J., & Kuo, T. (2019). Promoting congregant health in faithbased organizations across Los Angeles County, 2013–2016. ScienceDirect. https://www.sciencedirect.com/science/article/pii/S2211335519301342. Sturm, R., & Hattori, A. (2015, May). Diet and obesity in Los Angeles County 2007-2012: Is there a measurable effect of the 2008 "Fast-Food Ban"? Social science & medicine (1982). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410074/. U.S. Census Bureau. (n.d.). U.S. Census Bureau QuickFacts: Los Angeles County, California. United States Census Bureau. https://www.census.gov/quickfacts/losangelescountycalifornia.

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