OFFICE of binational Border health

Border Health Status Report to the Legislature

Annually, the Office of Binational Border Health publishes the Border Health Status Report to the Legislature to provide a general overview of the health status of border communities in the California border region. The 2019 report includes the following topics:

demographics;
obesity;
diabetes;
mental health;
tuberculosis;
sexually transmitted infections;
HIV/AIDS; and
Pertussis.

Introduction

The California border region, defined as the area within 62 miles (100 km) on the north side of the U.S.- Mexico border, is a unique region in the State of California. There are geographical, demographical and health-related differences between this area and other regions of California. The goal of this report is to highlight those differences with a specific focus on health. This report summarizes demographic information and health indicators including obesity, diabetes, mental health, tuberculosis (TB), sexually transmitted infections (STIs), HIV and vaccine-preventable diseases in the California border region. This report describes the burden of each of these diseases in the southern border region counties (San Diego and Imperial). To understand the health disparities that exist among the border region counties, it is important to include California as a reference point. Sources including Healthy Border 2020 and Healthy People 2020 were reviewed for guidance as to the most important health indicators in the California border region. The Healthy Border 2020 is a binational initiative that works in collaboration with Mexico to address priority binational health concerns along this border region. The Healthy People 2020 is a 10-year U.S. national initiative that works to improve the health of Americans. The 2017-2018 Border Health Status Report to the Legislature health indicators were selected on the basis of results from border health key-informant interviews and results obtained from a survey conducted among border health stakeholders.

The population data used in this report were obtained from the State of California, Department of Finance (DOF). Race, education, unemployment, obesity and diabetes data were obtained from the 2016-2017 California Health Interview Survey (CHIS). CHIS is the nation’s largest state health survey and a very important source of data for various health indicators at the ethnic and racial level. CHIS is conducted by the University of California, Los Angeles, Center for Health Policy Research in collaboration with the California Department of Public Health (CDPH). CHIS research scientists consider some data unreliable. As recommended by CHIS research scientists, unreliable data were not used in this report. Communicable disease data were obtained directly from the CDPH, Office of AIDS, TB Control Branch, Sexually Transmitted Disease Branch and Vaccine- Preventable Disease Epidemiology Section. When available, we will present the number of cases and the rate (i.e., the number of cases divided by the population). For the CHIS data, we will provide the percent of cases, because the data obtained represent a randomly selected subgroup of the population, and total numbers are not provided.

Throughout this report, we compare data primarily from Latino and White populations and include other races when their rates or proportions were higher than the two main groups we are referencing for this report. Latino will be used for race/ethnicity instead of Latino/Hispanic.

This report, “2017-2018 Border Health Status Report to the Legislature,” provides a summary of the current health status in the California border region1. The report was prepared by CDPH’s Office of Binational Border Health (OBBH). It summarizes important health indicators for border communities in California but is not a fully comprehensive report of all health issues in the California border region. Instead, the report aims to provide a general overview of the health status of the population living in the California border region.

¹In the past, the Border Health Status Report had been prepared and published for a single calendar year. However, this report, "2017-2018 Border Health Status Report to the Legislature" has been prepared to encompass calendar years 2017 and 2018.

Report Sections

Conclusion

This report covered a wide variety of health topics that help illustrate the health status of the California border counties, San Diego and Imperial Counties. It is important to understand the unique challenges faced by these communities in combating obesity, diabetes, mental health issues, TB, STIs, HIV/AIDS and vaccine-preventable diseases.

The population of the California border counties continues to grow. In terms of race/ethnicity, in Imperial County Latinos make up the majority of the population, whereas in San Diego County, they are the largest majority. The Latino population in the California border region is less likely to have graduated from college and is more likely than the White population to live at or below 200% of the Federal Poverty Level. Furthermore, the percent of Imperial County residents living below 200% of the Federal Poverty Level rose from 61% in 2015 to 65% for 2016-2017.

Chronic diseases are important indicators of the health of communities. This report includes data on obesity, diabetes and mental health. As of 2017, 23% of adults in San Diego County and 39% of adults in Imperial County were obese. Whereas both San Diego County and the State of California as a whole met the Healthy People 2020 target for obesity, Imperial County did not meet this target and has one of the highest rates of obesity in the entire state. This finding highlights the importance of health promotion programs and the creation of policies that help create a healthy environment promoting improved health at the California border region.

Similarly, diabetes is a significant and growing challenge in the region. In 2016-2017, 9% of adults in San Diego County and 18% of adults in Imperial County were reported to be diagnosed with diabetes. In the realm of mental health issues, regarding suicide, Latinos have had significantly lower rates of suicide than Whites in the California border region.

Infectious diseases, such as TB, STIs, HIV/AIDS and vaccine-preventable diseases, continue to be a significant challenge in the California border region. In California and border counties, the rate of TB was higher among Latinos than Whites. A large proportion of TB cases in California and the border counties are of Mexican origin. Overall, the rate of tuberculosis remained constant in the State of California at 5 per 100,000 since 2016; however, the percent of cases contributed by the border counties increased from 12.6% in 2016 to 14% for 2017-2018. The border region and Southern California at large experience a higher incidence of M. bovis cases than the statewide incidence. CDPH is committed to preventing and controlling TB in California. Continued collaboration with international health partners, especially those in Mexico, as well as public health interventions aimed at reducing TB are essential in effectively controlling TB in California.

The California border counties had 28,242 total individuals living with HIV infection in 2016 and 2017 combined. In addition, the California border counties reported 981 new cases of HIV during the same period. Most of the population living with HIV and the individuals newly diagnosed with HIV in the border region are male. The higher rates for individuals living with HIV and new cases are in the African-American population.

STIs in California increased during recent years. The California border region had an increase in gonorrhea, syphilis and congenital syphilis. Most of the STIs cases in the California border region were among men, and a comparison by race indicated that the highest rates were among African-Americans. In 2015, the rate of gonorrhea was 139 per 100,000 in California whereas the rate for 2016-2017 was reported as 177 per 100,000; this represents a 27% increase in rate. This trend was also observed for the border counties, with a 118% increase in rate for Imperial County and a 46% increase in rate for San Diego County. The rates of congenital syphilis in California also rose by 82%, with a rate of 28 per 100,000 live births in 2015 and 51 per 100,000 in 2016-2017. During 2016-2017, San Diego County had 20 cases of congenital syphilis, and Imperial County had three cases. This disease is preventable with access to prenatal care and timely treatment.

During the period of 2016-2017, there were three cases of measles in San Diego County and no cases in Imperial County. For pertussis, there were 1,558 cases in San Diego County and four cases in Imperial County. The rate of pertussis cases for San Diego in this period was more than three times higher than that in California statewide.

Differences in health outcomes highlight the key health needs of the region and can aid in identifying necessary resources and services for the California border residents. The CDPH, OBBH develops this report to inform and educate the California Legislature on the health needs of the California border region. This information is important to enable a more focused approach to address the needs of the region.

References

Bureau of Labor Statistics. (2017). Local Area Unemployment Statistics (LAUS). Retrieved April 3, 2019 from http://www.bls.gov/lau/lauavail.htm

California Department of Finance. (2018). State and County Total Population Projections by Race/Ethnicity and Detailed Age 2010-2060. Retrieved February 6, 2019 from http://www.dof.ca.gov/research/ demographic/reports/projections/p-1/

California Department of Public Health. (2019). EpiCenter-California Injury Data Online. Retrieved March 11, 2019 from http://epicenter.cdph.ca.gov

California Department of Public Health. (2019). Immunization Branch. Received March, 2019 California Department of Public Health. (2019). Office of AIDS. Received March, 2019

California Department of Public Health. (2019). Sexually Transmitted Diseases Control Branch.

Received March, 2019

California Health Interview Survey. (2016-2017). AskCHIS Online. Retrieved February 6, 2019, from http://ask.chis.ucla.edu.

Centers for Disease Control and Prevention. (2017). Obesity Causes | Adult | Obesity | DNPAO | CDC. Retrieved March 21, 2019 from http://www.cdc.gov/obesity/adult/causes.html

Centers for Disease Control and Prevention. (2017). Who’s at Risk? Retrieved March 21, 2019 from https:// www.cdc.gov/diabetes/basics/risk-factors.html

Centers for Disease Control and Prevention. (2018). Violence Prevention. Retrieved March 25, 2019 from https://www.cdc.gov/violenceprevention/suicide/prevention.html

Centers for Disease Control and Prevention. (2018). Vital Signs- Suicides Rising Across the US. Retrieved March 25, 2019 from https://www.cdc.gov/vitalsigns/suicide/infographic.html

Healthy People 2020. (2019). U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved March 21, 2019 from https://www.healthypeople.gov/2020/topics-objectives

National Institutes of Health. (2013). Why Obesity is a Health Problem. Retrieved March 21, 2019, from https://www.nhlbi.nih.gov/health/educational/wecan/healthy-weight-basics/obesity.htm

National Institutes of Health. (n.d). How are overweight and obesity diagnosed? Retrieved March 21, 2019, from http://www.nhlbi.nih.gov/health/health-topics/topics/obe/diagnosis

Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, Su J, Xu F, Weinstock H. (2013).“Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008”. Sex Transm Dis.; 40(3):187-93.

Border Health Status Reports to the Legislature

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