Study Charts Heart Disease Rate of Cities

By THOMAS H. MAUGH II

Oct. 9, 1996 12 AM PT

TIMES MEDICAL WRITER

The first-ever city by city breakdown of deaths from heart disease and stroke in California shows that residents of Los Angeles suburbs have the highest heart disease risk, while those in the San Francisco Bay Area and the coast of San Diego County have the lowest.

Although deaths from cardiovascular diseases in California have declined almost 50% since 1972, an estimated 87,000 people die from them each year. Cardiovascular disease--which includes heart disease and stroke--accounts for about 42% of all deaths in the state, making it the leading killer.

The researchers, from UC San Francisco and the California Department of Health Services, pointed out that, aside from the risks posed by air pollution, it is not simply physical presence in the cities that defines heart attack risk. Instead, a person’s address is a tip-off that they may share social, economic and cultural factors that increase their risk. Those factors include access to health care, diet, smoking and poverty.

The new report, issued today, finds that Maywood, Montclair, Riverside and Whittier in the Los Angeles area and Citrus Heights in Sacramento County have the highest death rates from heart disease.

A person living in Citrus Heights is four times as likely to die from heart disease as a person in South Lake Tahoe, which has the lowest rate.

The cities with the highest death rates from stroke were Danville, Redwood City, Santa Barbara, Whittier and Yucaipa. A person living in Yucaipa is three times as likely to die from stroke as a resident of Monterey Park, the city with the lowest rate.

The study “gives us the opportunity to identify high-risk areas and to let leaders in those areas know there is a problem,” said Jeannie M. Gazzaniga, co-author of the report. “And there are solutions. Heart disease and stroke are largely preventable.”

“The study is important because, with limited resources, we want to target prevention in areas where there is the highest rate of death,” said George Kaplan, chief of the state’s Human Population Laboratory in Berkeley. “It shows that there are a substantial number of cities, 15% or so of the total, which have elevated death rates from heart disease. I don’t think we could have predicted which cities those would be.”

“One of the things this report tells me is that we need to be addressing some of the chronic diseases,” said Dr. James Haughton, medical director of public health for Los Angeles County. “To date, the emphasis has been on control of acute communicable diseases.”

The most surprising aspect of the report, he added, was that in six of the cities in Los Angeles County, women had a higher death rate from heart disease than men, which bucks the trend elsewhere in the state and nation. “It does seem we need to give more attention to the heart problems of women,” he said.

The study was conducted by the health department’s Cardiovascular Disease Outreach, Resources and Epidemiology program, which was created in 1992 to focus resources for combating heart disease. Gazzaniga is the program’s director.

The study looked at each of the 245 California cities with a population of 20,000 or more in 1990, the most recent year for which death statistics are available. Causes of death in each city were obtained from state statistical records and an absolute rate, adjusted for age and race, was calculated for each city.

That rate was then compared to the rate for the state as a whole.

Citrus Heights has a heart disease rate of 283.94 deaths per 100,000 people, while the state as a whole has 158.99 deaths per 100,000. The relative rate in the city is thus 1.78, the highest in the state.

For strokes, Yucaipa has a rate of 90.87 deaths per 100,000 people, compared to the statewide average of 52.78 per 100,000, giving a relative rate of 1.72. Stroke and heart disease rates were generally higher among men.

Many of the cities with the highest rates are in San Bernardino County. The high incidence in the county “is not new information to us,” said Dr. Tom Prendergast, the county’s director of public health. The county had been shown to have the highest death rate from heart disease in the state, but the new study is the first to point to specific problem areas. One reason for the high risk, he noted, is that the county has the highest rate of smoking in the state.

The health department there has had a number of campaigns to attempt to change people’s behavior, he noted, “but hopefully this [report] will stimulate both us and the communities to take a look at what else can be done.”

The study says nothing about how a city might contribute to cardiovascular disease. But it is well known from prior studies that unhealthy habits, poverty, air pollution and lack of medical insurance all are important contributors, Gazzaniga said. “We just don’t know the extent to which each factor is important,” she said.

CORE has therefore launched an intensive 18-month study of two adjacent cities, Fontana and Rancho Cucamonga, to try to tease apart the relative importance of each factor. Fontana has a high risk while Rancho Cucamonga has a low risk.

“We’re just getting our toes wet in a problem with enormous proportions,” Kaplan said.

Meanwhile, Mary Anne Morgan of the Contra County Health Services Department said the results cry out for local investigation of the reasons for elevated rates in the worst cities and implementation of corrective measures. “We do have a prescription for what works in preventing [cardiovascular disease],” she said.

Much can be done to improve the situation, experts agreed. Some approaches that have been successful include expanding farmers markets to make more fresh fruits and vegetables available, promoting biking and walking, investing in economic development in poverty areas, and reducing air pollution.

* TALE OF 2 CITIES: Fontana has twice the risk as its neighbor Rancho Cucamonga. A3

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Heart Disease Hot Spots

A new report for the first time gives a city-by-city breakdown of deaths from heart disease in California. The map shows the cities in Los Angeles, Ventura, Orange and San Bernadino counties with the highest relative rates of death from heart disease, compared to the state as a whole.

Mortality rate significantly higher than state’s for:

Men and women

Anaheim

Colton

Fontana

Hesperia

Long Beach

Montclair

Ontario

Pomona

Redlands

Rialto