Introduction

Methods

Results

Conclusions

Background

Methods

Results

Conclusions

Although asthma occurs among Californians at all socio-economic levels, it disproportionately affects low-income Californians, who miss more days of work and school, are more likely to have frequent asthma symptoms, and are more likely to go to the emergency department or be hospitalized for asthma care. In this report, the burden of asthma on low-income Californians is examined by geography, race/ethnicity, age and access to care, among other factors. The authors suggest that disparities in asthma prevalence and care are likely due to a number of factors including inadequate access to health insurance coverage, lack of continuity and quality of health care, and an increased likelihood of exposure to asthma triggers and they point to policy and environmental changes that will likely help address these disparities, including adequate health care coverage, quality health care for low-income Californians with asthma, and asthma-friendly environments.

In California, 90,000 adults with current asthma have experienced problems understanding their doctors. There are significant disparities in who experiences these communication problems according to education, income, insurance status, English proficiency, race/ethnicity and nativity. In addition, adults with asthma who experience these problems are more likely to go to the emergency department or urgent care facility (ED/urgent care) for asthma care and are less likely to receive asthma management plans from their health care providers. The authors of this policy brief suggest that improvements in education and communication strategies are needed to facilitate understanding between health care providers and asthma patients, especially when patients have limited English proficiency (LEP) or have low health literacy. Support for this policy brief was provided by a grant from The California Endowment.

Many Californians are exposed to environmental conditions in the home -- such as the presence of tobacco smoke and furry pets -- which can trigger asthma symptoms. In addition, many who have not been diagnosed with asthma experience asthma-like breathing problems when exposed to these same indoor conditions. Using results from the 2003 California Health Interview Survey (CHIS), this policy brief examines the association of asthma symptoms and asthma-like breathing problems with smoking and the presence of tobacco smoke in the home, and with the presence of dogs and cats in the home. This brief presents the prevalence of monthly asthma symptoms among adults and children with active asthma and the prevalence of wheezing and other asthma-like symptoms in the previous year among those not diagnosed with asthma.

Only 27 percent of non-elderly adults in the United States have a "medical home" –- a place where they regularly receive medical care and advice. Shifting from more costly emergency care to the preventative and coordinated care provided by a medical home impacts costs, access, quality of care and the overall health status of low-income uninsured individuals. In this policy brief, the authors present interim findings on the efforts of ten California counties to explore the medical home model as part of the state's Health Care Coverage Initiative (HCCI), a three-year program to expand health care coverage for eligible low-income, uninsured individuals not otherwise covered by Medi-Cal. Among the innovations described are efforts to create electronic health and medical records, modify e-referrals to two-way communication between primary care physicians and other providers and standardize chronic disease registries.

This new policy brief from the UCLA Center for Health Policy Research presents diabetes prevalence rates among adults by California Assembly and Senate districts. These data are relevant to policymakers and advocates concerned with the impact of chronic conditions on the health of Californians. Estimating the prevalence of diabetes at the local level is increasingly important as rates continue to climb and the state's population continues to age and become more ethnically diverse. Diabetes prevalence rates were estimated using a small-area methodology with data from the 2001 California Health Interview Survey (CHIS 2001), 2000-2002 Current Population Surveys (CPS) and 2000 Census.

This policy note represents the first time that data has been made available to describe Chronic Obstructive Pulmonary Disease (COPD) prevalence, COPD health care utilization and outcomes, and characteristics of adults with COPD in the state of California, as well as the regions of Southern California and Los Angeles County. The analysis finds that COPD remains a significant health burden, affecting approximately 1.1 million or 4% of California adults. Among them, more than half live in Southern California, and nearly one-fifth of California adults with COPD reside in Los Angeles County. California's COPD profile is complex, as many Californians are under age 45, female, and have never smoked. Not all Californians with COPD are receiving appropriate care, evidenced by the finding that nearly one-third of those with diagnosed COPD were not given a breathing test (i.e. spirometry), the only approved method for diagnosing COPD. More Californians with COPD report poor overall health, poor mental health status and co-morbidities compared to those without COPD.

In order to adequately and strategically reduce the negative impact of this disease, it is important to understand the characteristics and obstacles faced by those with COPD. Early and appropriate treatment and interventions to reduce the barriers to care will be influential in diminishing the social and economic impact of COPD in California.

Children and adults who suffer from asthma and live near heavy vehicular traffic are nearly three times more likely to visit the emergency room or be hospitalized for their condition than those who live near low traffic areas, according to this policy brief from the UCLA Center for Health Policy Research. For adults with asthma, medium and high traffic exposure increases the likelihood of daily or weekly asthma symptoms by 40 percent and 80 percent, respectively, compared with low traffic exposure. The policy brief also notes that living in areas of heavy traffic is a burden borne disproportionately by asthma sufferers who are ethnic/racial minorities or from low-income households. Researchers were able to link traffic-related air pollution to asthma severity after merging data from Los Angeles and San Diego County respondents to the 2001 California Health Interview Survey with traffic counts provided by the California Department of Transportation.

This policy brief highlights the geographic variations in hypertension rates among California adults for counties, county-groups, Los Angeles Service Planning Areas, as well as for state legislative and Congressional districts. The first-of-its-kind sub-county data in this publication are useful for policy makers, advocates and medical providers in understanding the burden of the condition in local communities across California. Hypertension rates were estimated by applying a small-area methodology to multiple data sources, including the 2001 California Health Interview Survey (CHIS 2001), 2000-2002 Current Population Surveys, and the 2000 Census.