California State Highlights

In 2000, the California population was 33,871,648 and had been estimated to increase by 5 percent to 35,484,460 in 2003.^[2]  The California population in 2003 was 47 percent Non-Hispanic White, 33 percent Hispanic/Latino(a), 6 percent Black/African-American, 11 percent Asian/ Pacific Islander, and 3 percent Other Races.  With a birth rate of 94 births per 1,000 women of childbearing ages, Hispanics/Latinos(as) were the fastest growing race/ethnic group in California.^[3]  The population of California made up 55 percent of the 65 million people who lived in the four States (Arizona, California, New Mexico, and Texas) that share a Border with Mexico.  While Texas contributed 34 percent of the population of the four Border States, Arizona and New Mexico contributed 9 percent and 2.9 percent, respectively.

This report provides information about three regions of California based on proximity to the U.S.-Mexico Border.  As defined by the U.S.-Mexico Border Health Commission, California has 58 counties, of which 2 are within 62 miles (100 kilometers) of the U.S.-Mexico Border, excluding Riverside County.  These are identified as Border Counties in this report.  There are 14 counties between 62 and 300 miles of the U.S.-Mexico Border.  Finally, there are 42 counties more than 300 miles from the U.S.-Mexico Border that make up the rest of the State.

Population Dynamics

Geographic Distribution
Estimates for 2000 show that 67 percent of the California population lived within 300 miles of the U.S.-Mexico Border.  While 8.7 percent of the population lived in counties within 62 miles of the Border, 58 percent the population lived in counties between 62 and 300 miles of the Border.  Counties more than 300 miles from the U.S.-Mexico Border were home to 34 percent of the State population.  The two California counties within 62 miles of the U.S.-Mexico Border were metropolitan.  They include the Southern California cities of San Diego, Chula Vista, Oceanside, Escondido, El Cajon, Vista, Carlsbad, Spring Valley, Encinitas, National City, Santee, La Mesa, Poway (San Diego County), and El Centro (Imperial County).^[4]

Race/Ethnicity
Table 2 shows that in 2003 an estimated 3.1 million California residents lived in the counties within 62 miles of the U.S.-Mexico Border, of whom 29 percent were Hispanic/Latino(a); this reflects a similar proportion to the California State population (33 percent Hispanic/Latino(a)).  Of the 6.9 million people who lived in Border Counties in the 4 Border States, 49 percent were Hispanic/Latino(a).^[5]

Education
In 2000, 82 percent of California residents in the counties within 62 miles of the U.S.-Mexico Border had completed high school or higher education.  This compares favorably with California State (77 percent) and the U.S. population (80 percent) in educational attainment (Table 6).

Income^[6]
The Border Counties in California and Arizona were different from New Mexico and Texas in the nature of the populations included in the Border Counties.  The median family income in 2000 in the Metropolitan Statistical Areas (MSAs) in San Diego, California, was $53,438.  In Arizona, the median family incomes were $51,126 in Phoenix-Mesa and $44,446 in Tucson.  In comparison, the median family incomes were lower in New Mexico and Texas MSAs; $33,576 in Las Cruces, New Mexico, $33,410 in El Paso, Texas, and $29,394 and $27,853, in Laredo and Brownsville–Harlingen, Texas, respectively.  The Texas MSAs included as Border Counties according to the definition used by the Texas Comptroller of Public Accounts, but not directly on the U.S.-Mexico Border (San Antonio and Corpus Christi), had median family incomes similar to those reported for Arizona and California.  Hispanic/Latino(a) median family incomes ranged from $31,000 to $34,000 in California and Arizona Border MSAs compared to a range of $24,500 to $28,500 in New Mexico and Texas Border MSAs.

Poverty
Table 4 shows that 23 percent of families lived below 150 percent of the Federal poverty guidelines in the California Border population (within 62 miles of the U.S.-Mexico Border) in 2000; this was similar to the rate for the overall California population (24 percent).  The U.S. Federal Poverty Thresholds^[7] were established as a baseline to develop guidelines for determining eligibility for Federal and State programs such as Medicaid.  In 2000, $17,761 for a family of four was established as the poverty threshold.

Health Access
The annual Behavioral Risk Factor Surveillance System (BRFSS) collects information about health insurance coverage.^[8],[9]  The California Border counties had similar rates of health insurance coverage as the State at 15.2 percent and 15.4 percent respectively; this rate was similar to the 15.2 percent of the U.S. population without coverage (Table 5).

Health Professional Shortage Areas (HPSAs) were the method that HRSA used to identify areas of a State that did not have a sufficient supply of health professionals to meet the health needs of the population.  Thirty-one percent of the population within 62 miles of the Border in Californiaresided in a partial county primary care HPSA (Table 35).  While 6.2 percent (Table 36) of the Border Counties population lived in a partial county dental HPSA, 11.5 percent (Table 37) of residents lived in a single or partial county mental HPSA.  Statewide, 26 percent of the population lived in a primary care HPSA, 9.8 percent lived in a dental HPSA, and 11.8 percent lived in a mental HPSA.

Health Status

Health status indicators for this Report were based on the Healthy Border 2010 Goals and Objectives established by the U.S.-Mexico Border Health Commission in 2003.  The Commission is a binational organization dedicated to addressing the pervasive health needs of the U.S.-Mexico Border.

The overarching goals of the Healthy Border Program are:

1. Improve the quality and increase the years of healthy life, and
2. Eliminate health disparities

The twenty Healthy Border (HB) 2010 objectives fall into eleven principal areas with their specific objectives as follows:

1. Improve access to primary health care
2. Reduce cancer mortality in women through improved screening for breast and cervical cancers
3. Reduce morbidity and mortality from diabetes mellitus
4. Improve water quality through improved sanitation and reduce amount of acute pesticide poisoning
5. Reduce transmission of HIV
6. Improve rates of immunization and reduce rates of infectious diseases
7. Reduce mortality from unintentional injuries
8. Reduce infant mortality and increase the number of women receiving prenatal care
9. Reduce the suicide mortality rate by improving mental health
10. Increase the usage of dental and oral health services
11. Reduce morbidity from asthma

The tables in this report provide detailed information about health status in California.  Comparisons to the Healthy Border objectives are used to highlight disparities in health with a focus on the Border Counties(those within 62 miles of the U.S.-Mexico Border).

Breast and Cervical Cancer

• Screening for breast cancer is an important aspect of women’s health.  Evidence from the BRFSS in 2002 shows that 82 percent of women living in the California Border Counties had a mammogram within the past 2 years; this was similar to the proportion of women living in California (83 percent) and the Border States (83 percent) who have had a mammogram within the past 2 years.^[10]
• The breast cancer incidence rate for counties within 62 miles of the U.S.-Mexico Border was 66 per 100,000 females; this was higher than the California incidence rate of 61 per 100,000 (Table 7).
• The age-adjusted^[11] breast cancer mortality rate in the California Border Counties was 15.4 per 100,000 population; this was higher than the California rate of 13.2 per 100,000 and the Border States rate of 13.3 per 100,000 (Table 7).  When the rate is calculated only for women, the rate was 28.0 deaths in the California Border Counties.  The loss due to premature breast cancer death cost 87 years of life per 100,000 population in California Border Counties.  The years of potential life lost rate varied somewhat across California, but the State rate was consistent with the rate in the Border States (72 years per 100,000 females) and notably lower than the U.S. rate of 86 years per 100,000 females.  The number of years of life lost to breast cancer is brought more into focus when the rate is calculated for those most affected by breast cancer:  139 years of life were lost per 100,000 women, in 2002, in California.
• Regular screening with pap smears helps with early detection of cervical cancer.  Eighty-seven percent of women living in California Border Counties had received a pap smear within the past 2 years; this rate was similar to California (82 percent) women and women living in the Border States (82 percent) in general.^[12]
• In the California Border Counties, the cervical cancer incidence rate was 7.0 per 100,000 females; this was lower than the California incidence rate of 8.4 per 100,000 females (Table 7).
• In the California Border Counties, the age-adjusted cervical cancer mortality rate at 2.0 per 100,000 females was lower than the California rate of 2.4, the Border States rate of 2.6, and the U.S. rate of 2.7 per 100,000 females.

Diabetes Mellitus

In 2002, diabetes was the sixth leading cause of death in the United States.^[13] and the seventh in California.^[14]  Recent studies show that Type 2 diabetes is preventable.^[15]  Overweight and obesity contribute to diabetes prevalence.^[16]  Findings from the BRFSS indicate that Hispanic/Latinos(as) have a higher prevalence of diabetes than Non-Hispanic Whites at comparable Body Mass Index (BMI) ranking.^[17]  Table 8 provides information about diabetes in California.

Sources:  Office of Statewide Health Planning and Development, California Health and Human Services Agency (2002), and Office of Health Information and Research, California Department of Health Services (2002).

• Fifty-seven percent of California residents were overweight based on Body Mass Index:  38 percent were overweight but not obese, and 19 percent were obese.  There was little variation across geographic regions of the State in overweight and obesity rates (Table 9).
• The reported prevalence of diabetes in the California Border Counties was 5.3 percent of adults responding to the BRFSS; this was lower than the State rate of 7.5 percent and the rate of 7.3 percent for the Border States.  People living in the California counties between 62 and 300 miles from the U.S.-Mexico Border reported a diabetes prevalence of 8.3 percent (Table 8).
• Residents in the California Border Counties were slightly less likely to be hospitalized for diabetes related issues (10.9 hospital discharges) than California residents in general (13.4 per 100,000 population); this was lower than the Border States rate of 14.5 and notably lower than the U.S. rate of 20 hospital discharges per 100,000 population (Table 8).
• The diabetes age-adjusted mortality rate was 18.6 per 100,000 population in California Border Counties; this was lower than the California rate of 22 deaths per 100,000 population as well as the Border States and U.S. rates at 26 and 25 deaths per 100,000 population, respectively.
• In the California Border Counties, premature death due to diabetes results in 40 years of potential life lost per 100,000 population; this was 25 years of life per 100,000 population less than in the counties between 62 and 300 miles from the Border and 14 years fewer than the counties more than 300 miles from the U.S.-Mexico Border.  This suggests that many of the people in the other parts of California who die as a result of diabetes or diabetes complications die at a younger age than those in the Border Counties who die of diabetes.  California diabetes years of potential life lost rates were distinctly lower than the Border States (73 years lost per 100,000 population) and the U.S. rates (79 years lost per 100,000 population).

Hospital discharge rates for diabetes in the California Border Counties were approaching the HB 2010 goals and diabetes age-adjusted mortality rates already exceeded the goal.

HIV/AIDS

HIV/AIDS, despite recent advances in treatment, is an increasing concern in Mexico and a major cause of illness and death in the United States.^[18]  While the latest therapies have reduced death rates from AIDS in the Border region, their costs are prohibitive for some segments of the population.¹⁸  Estimates in the United States of the lifetime costs associated with health care for HIV/AIDS have increased from $55,000 to $155,000 or more, contributing to the burden of illness, disability, and death.¹⁸  In this context, HIV prevention becomes even more cost-effective.

• The incidence rate for HIV in the counties within 62 miles of the U.S.-Mexico Border was 22 cases per 100,000 population in 2002, while the AIDS incidence rate was 14.6 cases per 100,000 population.  Both rates were higher than the California HIV and AIDS incidence rates (14.1 per 100,000 and 11.8 per 100,000, respectively) and similar to the Border States rates (15.5 per 100,000 and 11.5 per 100,000, respectively, Table 11).
• The HIV incidence rate in the California Border Counties (22 per 100,000) was five times the objective established by HB 2010.

Hepatitis and Tuberculosis

The TB incidence rate of 11.7 cases per 100,000 population in the California Border Counties was higher than the State rate of 9.1 and the Border States rate of 7.8 cases per 100,000 population (Table 12).

Sources:  Infectious Diseases Branch, Division of Communicable Disease Control, California Department of Health Services (2002), and Tuberculosis Control Branch, Division of Communicable Disease Control, California Department of Health Services (2002).

The counties within 62 miles of the U.S.-Mexico Border exceed the HB 2010 objectives for hepatitis B and are approaching the objective for hepatitis A.  However, the incidence rate for tuberculosis in the California Border Counties was more than twice the HB 2010 goal.

Immunization Coverage

If children are properly immunized, most childhood diseases could be prevented.  This could result in a significant reduction in the cost of health care.  The only reliable data available about childhood immunization status come from the National Immunization Survey (NIS).  These data were available only for the Nation and individual States.

• The NIS results estimated that 76 percent (plus or minus 3.7 percent)^[19] of Arizona children 19 to 35 months of age had coverage for the prescribed vaccination series.  Nationally, the NIS estimated that 73 percent of children in this age group (plus or minus 1.0) had received this coverage.
• Non-Hispanic White and Hispanic/Latino(a) children had similar rates of coverage for the prescribed vaccination series:  75 percent (plus or minus 6.8 percent) and 75 percent (plus or minus 5.1 percent), respectively.  Data for other race/ethnic groups were not available (Table 13).

Injury-Related Deaths

Injury is identified as the leading health threat in the first 4 decades of life.^[20]  Unintentional injury was the fifth leading cause of death among all persons in California,^[21] the Border States, and the United States^[22] in 2002.  Most injuries are preventable.  Intentional injury is also among the leading causes of death with suicide being eleventh and homicide being the fourteenth in the United States.²²  Injuries sustained by violent-intentional or accidental-unintentional means are responsible for more than 146,000 deaths each year nationwide.^[23]

Source:  Office of Health Information and Research, California Department of Health Services (2002).

• The motor vehicle crash age-adjusted mortality rate in the Border Counties was 11.5 deaths per 100,000 population; this was similar to the California rate of 11.7 (Table 14).
• In 2002, lives claimed by premature deaths due to motor vehicle crashes resulted in the loss of 338 years of life per 100,000 population in California.  There were 102 fewer years of potential life lost in California than in the Border States (436 years lost per 100,000 population) in general.
• In 2002, there were a total of 233 deaths among children ages 0 to 4 due to unintentional injuries in California.^[24]  Approximately 62 percent of these deaths (144 of 233) occurred in the counties within 62 and 300 miles of the U.S.-Mexico Border.  Hispanic/Latino(a) children accounted for 54 percent of these deaths (126 of 233) statewide.

The counties within 62 miles of the U.S.-Mexico Border in California are approaching the mortality rates due to motor vehicle crashes set out in the HB 2010 objectives.

Prenatal Care

Early prenatal care is important to a healthy pregnancy and is critical in identifying potential problems that may put the pregnancy at risk.  Risk factors and maternal health conditions including pregnancy-related hypertension, gestational diabetes, and cigarette smoking, among others, which can contribute to poor infant outcomes can be identified by screenings as a part of prenatal care.^[25]

Source:  Office of Health Information and Research, California Department of Health Services (2002).

• In California, 85 percent of women received prenatal care in the first trimester.  The proportion of women receiving prenatal care varies only slightly by geographic area (Table 16).
• In 2002, 90 percent of California’s Non-Hispanic White mothers began prenatal care in the first trimester.  Eighty-two percent of Hispanic/Latino(a) mothers began prenatal care in the first trimester.
• Black/African-American, Hispanic/Latina, and American Indian/Alaskan Native women in California fell below the desired goal set out in the Healthy Border 2010 Objective for the proportion of women who should start prenatal care in their first trimester of pregnancy.  In 2002, these rates were 81 percent of Black/African-American, 82 percent of Hispanic/Latina, and 74 percent of American Indian/Alaskan Native mothers.
• Additional efforts may be needed to help achieve the HB 2010 goal of 85 percent of mothers beginning prenatal care in the first trimester of pregnancy among Hispanic/Latina, Black/African-American, and American Indian/Alaskan Native mothers in California.

Prenatal Care—Border Teenage Mothers by Race/Ethnicity
Teenage mothers who live in the California Border Counties fell well below the goal established in the Healthy Border 2010 Objectives of 85 percent of mothers beginning prenatal care in the first trimester of pregnancy.  In 2002, the proportions of teenage mothers receiving prenatal care in the first trimester were:

• 79 percent of Non-Hispanic White mothers
• 65 percent of Hispanic/Latina mothers
• 63 percent of Black/African-American mothers

Prenatal Care—California State Teenage Mothers by Geographic Distribution
In California, the proportion of mothers ages 15 to 17 who received prenatal care in the first trimester varied by geographic region.  The rates were:  66 percent of mothers residing in counties within 62 miles of the Border, 71 percent of mothers residing in the counties between 62 and 300 miles from the Border, and 62 percent of mothers residing in the counties more than 300 miles from the U.S.-Mexico Border (Table 18).

Prenatal Care of Border Teenage Mothers—Comparison of Race/Ethnicity to State
In the Border Counties, Non Hispanic White, Black/African-American, and Hispanic/Latina teenage mothers, while below the 2010 goals, were more likely to receive early prenatal care than teenage mothers in other areas of the State.  One factor that may have contributed to this is the fact that both Border Counties in California were metropolitan.

Source:  Office of Health Information and Research, California Department of Health Services (2002).

Teenage Pregnancy

• Statewide, there were 22 births for each 1,000 females between the ages of 15 to 17 in 2002 (Table 17); this was lower than the Border State teenage birth rate of 29.

Source:  Office of Health Information and Research, California Department of Health Services (2002).

• There was considerable variation in the teenage birth rate by race/ethnicity for the State.  The Hispanic/Latina birth rate was 49 per 1,000 females between 15 to 17 years old in California, while the rate in the California Border Counties was somewhat higher at 54 births per 1,000 Hispanic/Latina teenage women.  The teenage birth rate for Blacks/African-Americans was 27 per 1,000 and 6 per 1,000 among Non-Hispanic White teenage women.
• Overall, the teenage birth rate in California (22 per 1,000) was lower than that of the Border States (29 per 1,000), but slightly higher than the U.S. (18 per 1,000).  Higher teenage birth rates were reflected in all race/ethnic categories except Non-Hispanic White.

Infant Mortality

Table 15 shows that in California the infant mortality rate in 2002 was 5.5 deaths per 1,000 live births.

Source:  Office of Health Information and Research, California Department of Health Services (2002).

• For Non-Hispanic Whites and Hispanic/Latinos(as), the infant mortality rate was 5.1 and 5.2 per 1,000 live births, respectively.
• The Black/African-American infant mortality rate was 12.6 deaths for each 1,000 live births.  This reflected an infant mortality rate that was 2.4 times greater than occurred in the Non-Hispanic White and Hispanic/Latino(a) populations.
• There was little variation in infant mortality rates across the geographic areas in California.  However, the Black/African-American infant mortality rate was consistently more than two or more times that of the Non-Hispanic White and Hispanic/Latino(a) populations, regardless of geographic area.

In the California Border Counties, in 2002, infant mortality rates were lower for all racial/ethnic groups, except Black/African-American, than the Healthy Border 2010 Objective of 4.6 deaths per 1,000 population.

Mental Health

Meeting mental health needs has been identified as a national priority in the United States.  The National Action Agenda, established by the Surgeon General, notes specific action steps aimed to decrease the burden of mental illness including promoting public awareness, supporting mental health-related research, improving early assessment, recognition and access to care, and training appropriate personnel to recognize and manage mental disorders.^[26]

Hospitalizations for psychiatric-related conditions occurred at the rate of 42 per 10,000 population in California in 2002; this was similar to the rate of 38 per 10,000 population for the Border States (Table 19).

• At a rate of 47 per 10,000 population, the rate for psychiatric related conditions in the counties within 62 miles of the Border was somewhat higher than the rest of California.
• The counties more than 300 miles from the U.S.-Mexico Border in California have the lowest rate (33 per 10,000) in the State for psychiatric related hospital discharges.

Suicide takes a disproportionate toll in the community as well as on the family and friends of the deceased.  It also results in a significant loss of years of potential life of a productive community member.  Suicide was the tenth leading cause of death in California^[27] and the eleventh in the United States.^[28]

• Table 19 shows that the California 2002 age-adjusted suicide mortality rate was 9.5 deaths per 100,000 population.  This was similar to the Border States and the U.S. rate (10.9 per 100,000 each).
• In the California Border Counties the rate of loss due to suicide was 10.6 deaths per 100,000 and 228 years of life lost per 100,000 population.
• In California, suicide resulted in the loss of 188 years of life per 100,000 population.

Oral Health

“You are not healthy without good oral health,” noted Dr. C. Everett Koop, former U.S. Surgeon General.^[29]  The importance of meeting oral health care needs in communities in the Border Counties, Border States and nationwide is increasing as research continues to link oral health with general well-being.  Oral infection has been associated with the onset and severity of systemic diseases such as cardiovascular disease and diabetes, and negative birthing outcomes.^[30]  Despite increased use of dental sealants and water fluoridation, preventable oral diseases still afflict many children and adults during their lifetimes, impacting their self-image and quality of life as well as compromising their health and well-being.³⁰  Disparities in access to preventative and therapeutic oral care are demonstrated by the unmet needs of those with lower income and education levels, underserved populations, and a notable proportion of untreated tooth decay (over 40 percent in persons between 2 and 19 years, and approximately 90 percent of adults) observed in individuals regardless of sociodemographic characteristics.^[31]  While it is now possible to maintain healthy teeth throughout a lifetime, currently available preventive measures, knowledge, and technologies must be utilized universally by professionals and consumers alike.^[32]

Information collected in the Behavioral Risk Factor Surveillance System (BRFSS) results from answers to the question, “Have you visited the dentist or dental clinic within the past year for any reason?”

• In 2002, California residents were close to reaching the HB 2010 goal of 75 percent visiting a dentist each year. Sixty-eight percent of adults statewide visited a dentist or dental clinic within the past year. The California rate for dental visits was higher than the Border States (66 percent) but slightly lower than the U.S. rate (70 percent).
• Residents of the California Border Counties met the HB goal and had a higher percentage of residents that visited a dentist within the last year (75 percent) than the rest of California, the Border States, and the U.S. (Table 20).

Source: Behavioral Risk Factor Surveillance System (2002).

Asthma

Of the California respondents to the BRFSS in 2002, 12.7 percent reported that they had been diagnosed as ever having asthma by a health professional.

• The asthma rate was 10.5 percent among residents in the California Border Counties.
• The highest prevalence of asthma (13.1 percent) was reported in the California counties within 62 and 300 miles of the U.S.-Mexico Border.
• In 2002, the asthma discharge rate (8.9 per 10,000) in the counties within 62 miles of the U.S.-Mexico Border was almost twice the HB 2010 goal.
• The hospitalization rate reflects only cases that were severe enough to be admitted to the hospital, not cases that presented themselves in the emergency department, treated and released.
• Death due to asthma was a relatively rare cause of death; the age-adjusted mortality rate in California was 1.6 deaths per 100,000 population. This was similar to the U.S. and Border States rates and was consistent across the State.