Chronic & Infectious Conditions

Chronic Conditions
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A note on obesity 
Traditionally, BMI is used to define obesity and is used as a health metric by state and federal agencies. However, there are many issues with determining obesity by solely looking at BMI. Issues include body composition differences according to gender, race, height, and lifestyle that are not encompassed by the BMI formula. Critics of the BMI formula suggest waist circumference as a more reliable way to associate health outcomes with body fat composition. Additionally, this method is strongly associated with diabetes risk independent of BMI. However, since that data is not routinely collected at the federal, state, or county level, there are no current data sources for Napa County that reliably reflect the health risks associated with obesity. 
Diabetes
Diabetes is considered an epidemic in the United States. Nearly half of all adults in California are estimated to have prediabetes or undiagnosed diabetes. People with diabetes are at high risk of heart disease, stroke, and other serious complications, such as kidney failure, blindness, and amputation. Risk for type 2 diabetes and prediabetes includes obesity and lack of routine physical activity, which is impacted by lack of access to physical space, time, and/or financial ability to regularly practice these activities. Limited or no healthy food access is another risk factor. 
Traditionally, minorities have been identified as having a higher risk for developing diabetes. This is because ethnic and racial minorities have experienced and continue to experience societal and environmental conditions that create fewer opportunities to exercise frequently in addition to having less access to fresh, healthy foods. These conditions include neighborhoods without grocery stores but with fast food chains and alcohol and tobacco retailers. The chart to the left shows California Health Interview Survey Neighborhood Edition data on diabetes diagnosis for adults by city of residence. When looking at this graph, reflect on the following: Does your city have healthy food options, recreational spaces, and opportunities for its residents to live a healthy life? Are those opportunities the same across the city, or are there privileged and less-privileged neighborhoods? 
Cancer
Toggle the linked  CDC United States Cancer Statistics dashboard to visualize information on overall cancer rates (shown as numbers of cases per 100,000 residents) for Napa County, as well as rates for selected cancers. The California Healthy Maps dashboard to the right relays information on the incidence (show as the number of new cases of cancer in a given period of time) of 12 of the most common invasive cancer sites, with additional filters for race/ethnicity and gender. Click on this link (California Health Maps) - to toggle the filters and download the most recent available data. 
Oral Health
Dental Emergency Department Visits 
Visiting the emergency department (ED) for a dental issue should not be a common practice. Accidents that involve dental fractures or loss of teeth are expected, but that is not the most common reason for dental ED visits. Many children and adults in Napa County seek dental care for non-traumatic and preventable causes, such as dental caries or periodontal conditions. Factors like access to healthcare, sick time workplace policies, availability and wait times for specialists, and a lack of providers that accept Medi-Cal can all affect the community's access to preventative dental  services. Certain groups are more at risk than others: people that work in the service industry and that do not always have sick time off policies, people that live in rural areas and have little access to specialized providers, and people that cannot find providers in a timely manner that accept their insurance. Many people that find themselves in these situations belong to racial minority groups. Therefore, looking at data in this context helps illuminate the challenges and identify who is most in need of supportive services.
The two charts to the left display ED dental visit data for Napa County. The first chart shows the number of visits for various populations (some have small numbers and have been suppressed). However, to make that data available for all groups, the chart on the second page below shows the rates per race and age group for all listed race categories in the ED discharge data from the California Department of Health Care Access and Information (HCAI). 
Rates calculate the number of visits per year per 10,000 residents. Therefore, it standardizes all data to the same population size and allows for better comparison across groups. Rates vary by age group and race. Both children and adults that identify as Asian have low rates (fewer than 10 people visiting the ED for every 10,000 residents), whereas those that identify as Black or African American, despite a smaller population size in Napa, have much higher rates for both children and adults.
Category Definitions: Race Categories available in the source data include: Asian, American Indian/Native American, Black or African American, Latine, Native Hawaiian/Pacific Islander, and White. All Latine/Hispanic identifying patients are included in the Latine category, all other races are Not-Latine. Data categories with fewer than 5 entries were suppressed to protect privacy. Click here for details about the privacy and data suppression guidelines we follow.
Infectious Diseases
COVID-19
Napa County continues to update COVID-19 disease severity and trends, vaccination, and outbreak data. We also have an FAQ section on commonly asked questions. All that information is available by clicking on the image to the right. 
Impact of COVID-19: Selected Demographics for Hospitalizations and Deaths
Below are selected demographics for COVID-19 hospitalizations in the first tab and deaths in the second tab. Among hospitalized cases, the detailed Asian demographics were possible after implementation of AB 1726, the AHEAD Act, requiring disaggregation of race categories for data collection of Asian and Pacific Islander groups. In Napa County, the Filipino population is the largest population within Asian and Pacific Islander groups and is also the only population large enough to show detailed information without the risk of potentially identifying individuals. Approximately 2% of all Napa County cases hospitalized for COVID-19 identify as Filipino, as of June 2023. The chart showing rates by race allows for a better understanding of most affected groups in Napa County.
The primary language bar graph indicates that 75% of hospitalized cases were English speakers and 19% were Spanish speakers. Other languages were also spoken by a small percentage of cases. Access to adequate hospital translation services is fundamental for adequate inpatient and outpatient care. 
Death certificate data for cases that died from COVID-19 have detailed race information, allowing for disaggregated analysis by race. In Napa County, 100% of expired cases that identified as Asian also identified as Filipino. The number of deaths per year graph shows distinct increases in deaths in the first quarters of 2020, 2021 and 2022. During these winter months, the population is more vulnerable due to increased socialization indoors and circulation of highly contagious variants. Finally, the rates for both hospitalized and expired COVID-19 cases by race indicate the vulnerability among certain groups with small population sizes and higher disease severity rates compared to more populous groups. 
Category Definitions: Race categories available in the source data include: Asian, American Indian/Native American, Black or African American, Latine, Native Hawaiian/Pacific Islander & White. All Latine/Hispanic identifying patients are included in the Latine category, all other races are Not-Latine.
The California Community Burden of Disease Engine is a tool that has county-level data about the impact of diseases and other health conditions on longevity, hospitalizations, and emergency department visits. The two charts below show data on COVID-19 associated deaths, where COVID-19 was listed as primary (left) or secondary (right) cause of death. This data provides information on the most common conditions that are present in cases that die of COVID-19, as well as the people most vulnerable to having COVID-19 as a contributing cause of death.  
COVID-19 Primary Cause of Death
COVID-19 Secondary Cause of Death

References
The links below provide additional information for many of the health topics discussed on this page: