CLAY COUNTY PUBLIC HEALTH CENTER
Chronic Disease Data
Clay County, Missouri
Health Planning and Policy Section
2011
1
800 HAINES DRIVE, LIBERTY MISSOURI 64068
2
Table of Contents
Introduction ..................................................................................................................................... 1
Summary of Key Findings .............................................................................................................. 3
Discussion ....................................................................................................................................... 5
Supporting Data .............................................................................................................................. 9
Ten-Year County Overview. Top Ten Leading Causes of Chronic Disease Deaths in Clay
County (1999 -2008). ................................................................................................................ 10
Figure1: Ranking Table ......................................................................................................... 10
Figure 2: Trend for the Top Four Leading Causes of Deaths ................................................ 11
Figure 3: Trend for top fourth to tenth ranked leading chronic disease deaths. .................... 11
Figure 4: Hospital Charges for Clay County Residents, 2008 .............................................. 12
Figure 5: Comparison (1999 and 2008) ................................................................................. 13
Figure 6: Comparison (2006-2009) ....................................................................................... 13
Figure 7: Comparison on the top 7 Leading Chronic Disease deaths ................................... 14
Disease Specific Information ........................................................................................................ 15
SUMMARY- Cancer................................................................................................................. 15
Figure 1: Trend ...................................................................................................................... 16
Figure 2: Comparison by Sex ................................................................................................ 17
Figure 3: Rates of New Cancer Cases ................................................................................... 18
SUMMARY – Heart Disease .................................................................................................... 19
Figure 1: Trend ...................................................................................................................... 19
Figure 2: 10-year Comparison by Sex ................................................................................... 20
Figure 3: Comparison by Sex ................................................................................................ 20
Figure 4: Hospital Charges for Heart and Circulation Diseases ............................................ 21
Figure 5: 10 Year Comparison by Age group and Sex.......................................................... 22
Figure 6: Conditions .............................................................................................................. 22
SUMMARY – Chronic Lower Respiratory Disease (CLRD) ...................................................... 23
Figure 1: Trend ...................................................................................................................... 23
Figure 2: Comparison by Sex ................................................................................................ 24
Figure 3: Conditions .............................................................................................................. 25
SUMMARY – Stroke ................................................................................................................ 26
Figure 2: 10-year Comparison by Sex ................................................................................... 27
Figure 3: 10-year comparison by Sex .................................................................................... 27
SUMMARY – Alzheimer’s disease .......................................................................................... 28
3
Figure 3: Comparison by Age group and by Sex .................................................................. 29
SUMMARY – Diabetes ............................................................................................................ 30
Figure 1: Trend ...................................................................................................................... 30
Figure 2: Comparison by Sex ................................................................................................ 31
Figure 3: Comparison by Sex ................................................................................................ 31
SUMMARY - Kidney Disease (nephritis/nephritic syndrome/nephrosis) ............................... 33
Figure 1: Trend ...................................................................................................................... 33
SUMMARY – Chronic Liver Disease ...................................................................................... 35
Figure 1: Trend ...................................................................................................................... 35
SUMMARY – Essential hypertension ...................................................................................... 36
Figure 1: Trend ...................................................................................................................... 36
Figure 2: 10-year Comparison by Sex ................................................................................... 37
SUMMARY- Atherosclerosis ................................................................................................... 38
Figure 1: Trend ...................................................................................................................... 38
Existing Programs at the Clay County Public Health Center ....................................................... 39
Conclusion .................................................................................................................................... 40
Glossary ........................................................................................................................................ 41
References ..................................................................................................................................... 43
Disclaimer: Information used in this report was pulled from credible sources such as the Centers for Diseases
Control and Prevention (CDC), Missouri Department of Health and Services (MDHSS), American Cancer Society,
etc. Also, some data were further analyzed or compiled by the County Epidemiologist to meet the assessment need.
Diseases discussed were not at all inclusive of all chronic diseases, but were limited to the top ten leading causes of
deaths from chronic diseases in the county.
Published: October 2011
4
Introduction
The purpose of this document is to assess the impact and burden of the top ten leading
causes of deaths from chronic disease on the citizens of Clay County for the community
assessment projects. It could also be used as a tool in the development of new programs in the
county to target chronic diseases in order to mitigate and control the impacts of chronic diseases
on lives of individuals in Clay County community, and also improve the quality of lives of
individuals living with chronic diseases.
Chronic diseases can be defined as diseases that have a prolonged temporal course, that
do not resolve spontaneously, and which a complete cure is rarely achieved. They are
characterized by uncertain etiology, multiple risk factors, a long latency period, a prolonged
course of illness, noncontiguous origin, functional impairment or disability, and incurability.1
Chronic diseases comprise of several diseases that fit the above stated definition. However, for
the purpose of this assessment, we will focus on the top ten leading causes of deaths from
chronic diseases on the residents of Clay County, an approach similar to what was used by the
Centers for Disease Prevention and Control in the National Vital Statistics Reports.17
Chronic diseases are the leading causes of death and disability in the U.S. They are
associated with high healthcare cost, low productivity and loss of quality of life, yet they are the
most preventable of all health problems. According to the Missouri Department of Health and
Senior Services, nearly 7 out of every 10 Missourians who die each year will die of a chronic
disease.
The health status of our county population in general is comparable to or better than that
of the entire State of Missouri. However, there are a few health disparities. Compared with
Missouri:

The death rates of chronic lower respiratory diseases and breast cancer in Clay County
are 25% and 27% higher, respectively. Death rates of cardiovascular disease (stroke) and
Alzheimer’s disease also show higher rates in our county population.2

Adults in our county are 38% more likely to be obese than all adults statewide.2 Though,
some improvement had occurred since 2007 when the State of Missouri put out this
report.

According to the Robert Woods Johnson Foundation (RWJF) report in the 2011 County
Health Rankings, the percentage of adult obesity in Clay County is the same as the State
of Missouri at 30% of the adult population which is higher when compared to the nation
at 25%.25 Data show that we are doing better, but still worse than our nation as a whole.

The 2007 data showed that 31% of the children in Missouri ages 10-17 years are
overweight or obese.3 Obesity increases the risk of developing conditions such as
1
diabetes and heart disease. The national statistics also show that without big change, that
one in 3 babies born today will develop diabetes in their lifetime.4

In 2008, six out of the 10 leading causes of deaths in Clay County were due to chronic
disease. From 1999 through 2008, deaths due to chronic diseases accounted for 76% of
all deaths in the County, while heart disease (23.5%) and cancer (24.3%) alone accounted
for 48% of deaths from chronic conditions.
2
Summary of Key Findings

An estimated 10,284 years of potential life lost were attributed to the ten leading causes
of chronic disease deaths in 2008. Of these years, 8,088 years of potential life lost were
attributed to cancer (3754), heart disease (3189) and chronic lower respiratory disease
(1145) only.

The July 2011 release by Trust for American’s Health (TFAH) and Roberts Wood
Johnson Foundation (RWJF) show that in the nation, Missouri ranked 17 in the number
of estimated new cancer cases in 2010 compared to Kansas (33) and Iowa (30). If similar
estimate holds for Clay County, the years of potential life lost to cancer will be expected
to increase.10 Available data show that Clay county incidence rate for all cancer types
increased from 506.6 (2003-2005) to 511.7 (2006-2008).12

Heart disease death rates in Clay was high but stayed significantly lower than the state
rate in both males and females from 1999-2008.

Chronic lower respiratory disease (CLRD) is the third leading cause of chronic disease
death, next only to heart disease and cancer. Death rates from CLRD over the ten-year
period from 1999-2008 remained higher than the state rates.

Death rates from cancer, heart disease, chronic lower respiratory disease and diabetes in
the county male population remained higher than in the female population. For heart
disease and CLRD, adults 65-years old and over were mostly affected.

The majority of the deaths from CLRD were NOT from asthma, emphysema or
bronchitis. They were grouped under ‘other chronic lower respiratory diseases.’

Except for the years 2000 and 2007 for stroke, and 2001and 2002 for Alzheimer’s, death
rates for these two diseases in the county female population remained consistently higher
than the male population. The reason for this difference is not known.

From 2007 through 2008 death rate from stroke increased in the county female
population but decreased in the male population.

Alzheimer’s disease was the 5th leading cause of chronic disease death from 2003 through
2008, but 6th from 1999 to 2002. In 2009, Alzheimer ranked fourth in Clay County
residents. Alzheimer’s death rates were higher than the state rates from 1999 through
2007. However, if our death rates are higher than the states, with the most recent from
TFAH and RWJF, only more deaths would be expected. The report showed that in 2010,
Missouri ranked 16 in the number of Alzheimer’s estimated cases in persons aged 65
years and over, compared to Kansas which ranked 32, and Iowa 30.10

Diabetes was the 5th leading cause of death from 1999-2002, and the 6th from 2003
through 2008.
3

The diabetes rate in the male population in 2008 almost doubled from 2007, but a slight
decrease was seen in the female population over the same time period.

Kidney disease was the 7th leading cause of chronic disease deaths in Clay County except
for the year 2002 when it became the 8th.

The majority of the county’s deaths from kidney disease in 2008 were due to renal
failure.

The county rates for kidney disease, chronic liver disease, essential hypertension and
atherosclerosis were unstable (this means that the number of cases were less than 20 most
of the time for each year).

Chronic liver disease was the 8th leading cause of chronic disease deaths in 2004, 2005
and 2007. The 9th in 1999 through 2003, 2006 and 2008.

In 2008, deaths from chronic liver disease were due to alcoholic liver disease, other
chronic liver disease and cirrhosis.

Essential hypertension over the ten-year period was the 7th leading cause of chronic
disease deaths in 2002, the 8th in 1999 through 2001, 2003, 2006 and 2008 and the 9th in
2004, 2005 and 2007.

Atherosclerosis is the 10th leading cause of chronic disease death in Clay County, and the
county rates remained lower that the state’s.

The majority of diseases share some common risk factors such as tobacco use, smoking,
unhealthy diet, physical inactivity and overweight/obesity (see table 1).
4
Discussion

Creating, implementing and sustaining programs that would delay the onset of chronic
disease in individuals in our community would prevent early deaths from such
conditions, and could save the county more money on management of such diseases.
Chronic diseases account for $3 of every $4 spent on healthcare.4

Chronic conditions share risk factors. Therefore, developing health programs or
interventions aimed collectively towards prolonging the onset of major but common
chronic diseases could help save money on the treatment and management of such
diseases and their complications. For example, according to CDC, people with diabetes
are more likely to suffer from complications such as heart attacks, strokes, high blood
pressure, kidney failure, blindness, and amputations of feet and legs. Diabetes costs $174
billion annually nationwide, including $116 billion in direct medical expenses.4. From
1999 through 2008, hospital charges on diabetes averaged over $5,000,000.00 per year.
Of those, an annual average of $ 174,209.30 costs were due to hospitalizations of noncomplicated diabetes mellitus. The remainder $4,847,747.00 were for complicated
diabetes mellitus. The main source of payment for complicated diabetes mellitus was
Medicare/Medicaid, while for non-complicated diabetes was private insurance.11

Locally identifying and implementing measures to reduce healthcare disparities would
help bridge some of the gaps seen in chronic disease prevention, management and
deaths.25 Low income and the least educated individuals are more likely to be uninsured,
and are also more likely not to seek medical services at early onset, thus are more likely
to present with advanced stages of chronic conditions and the associated complications
which leads to overall higher healthcare cost and deaths from preventable diseases.

Ways should be explored locally to continue to provide or expand incentives to safety net
clinics and individuals utilizing their services. This would enhance accessibility,
affordability, and some quality of care including screening and appropriate follow-up of
new and existing chronic conditions to individuals utilizing their services who otherwise
would not have such access to medical care. This would be essential in the prevention
and management of chronic diseases and their complications especially with the current
economic stress in terms of unemployment and high cost of food and living facing
individuals and households.

A coordinated approach by the community to address chronic disease risk factors could
have a significant impact towards lowering chronic disease rates in Clay County.
Examples include: support and increase in cigarette taxes and possibly applying that to
healthcare and education on chronic diseases. This would affect smoking and also
increase awareness and knowledge of smoking related diseases. Although, CLRD deaths
were noted not to be as a result of asthma, emphysema or bronchitis, but grouped under
‘other chronic lower respiratory diseases.’ There is no information on deaths specifically
attributed to tobacco use in Clay County.
5

The release from Trust for Americans Health noted that the percent of adult current
smokers (2007-2009 average) in Missouri ranked fifth in the nation compared to Kansas
which ranked 33 and Iowa 26.10 Implementing more measures that will decrease smoking
in the county could affect the second hand effects that smoking may have on individuals
with CLRD and could help reduce the death rates.

The June 2011 National American Cancer Society Cancer Action Network (ACS CAN)
report stated that “the state average for cigarette taxes is $1.45 per pack, but the health
and economic costs attributed to smoking are estimated at $10.28 per pack. According to
“Saving Lives, Saving Money,” if every state raised its per-pack tax by $1.00, nearly 1.4
million adults would quit smoking and 1.7 million youth would never start smoking.
More than 1.3 million lives would be saved, and states would raise $25.7 billion in tax
revenue and save more than $600 million in health care costs over 5 years.” 13 The
Missouri cigarette tax per pack is only $0.17.35

Structured education in schools on healthy eating and increased physical activities would
help in the fight against childhood overweight and obesity, which would in turn reduce
the burden of chronic illnesses later in life. The effects of such education in schools could
result in secondary benefits in the reduction of incidence of chronic diseases in the entire
community at large. Data shows that Clay County obesity rate is the same as that of the
state (30).

According to TFAH and RWJF release, in 2009 the percent of fruits and vegetable intake
in Missouri students was ranked twenty-fifth, the same as Kansas. The percent of adults
obese in Missouri (2008-2010 average) ranked eleventh in the nation compared to Kansas
which ranked 16 and Iowa 20.10 Overweight and obesity have been noted as major risk
factors to most chronic diseases and a growing epidemic in United States.

Increasing education on viral hepatitis and promoting vaccination against hepatitis B
would help in the control of the growing trend of liver cancer especially hepatocellular
carcinoma. Educating high risk and at risk populations would also increase individual
responsibility in seeking care for co-existing conditions that pose extra stress to the liver.

With the baby boomers and the growing trend of Alzheimer’s disease, an age-related
genetic chronic debilitating disease, programs should be used to expand and ensure that
all those who are involved in the care of affected adults have the capability to foster and
improve quality of life for people with Alzheimer’s and dementia.

Considering new environmental policies and strictly implementing existing ones on air
quality would reduce the level of occupational and environmental pollution exposures.
Increased exposures to pollutants could be a contributory factor in the growing trend of
respiratory illnesses and death from chronic lower respiratory diseases.

Ways should be explored to expand access to dental care in our communities, especially
to the medically underserved population. This would improve oral health and reduce
6
related illnesses, since evidence shows that decay and other oral health complications
may be associated with respiratory disease, cardiovascular disease, and diabetes.18

Trust for American Health and Robert Wood Johnson Foundation’s report show that
Missouri ranked seventh both as a dental care health professional shortage area and
primary care professional shortage area. Although the 2011County Health Rankings did
not identify Clay County as a shortage area in any of these care indicators in general,
more could be done to sustain and improve access to healthcare in some of our
communities.
Present and Future Champions
Saint Luke’s Hospital-Smithville Campus
North Kansas City Hospital
Liberty Hospital
Excelsior Springs Hospital
State of Missouri Veterans Commission
Alzheimer’s Association
Eldercare Locator-US Administration on Aging
Shepherd’s Center of the Northland
Kansas City Partnership for Caregivers
Administration on Aging
Family Caregiver Alliance
National Association of Professional Geriatric Care Managers
MetroCare-Northland Health Care Access
Asthma and Allergy Foundation of America
ARC of Clay and Platte Counties
Alzheimer’s Association Heart of America Chapter
American Cancer Society
American Diabetes Association MO Affiliate
American Heart Association
American Lung Association
American Red Cross
Arthritis Foundation
Cancer Information Service
Crohn’s and Colitis Foundation
Epilepsy Foundation-Heart of America
National Osteoporosis Foundation
Northland CARE/Metro CARE
Missouri Primary Care Association (MPCA)
Kansas City Quality Improvement Consortium (KCQIC)
Missouri Department of Health and Services
Ashton Court Care & Rehabilitation Center
Beverly Health and Rehabilitation Center
7
Golden Living Center-Smithville
Liberty Terrace Care Center
Pleasant Valley Manor Care Center
Royal Care Center
Valley Manor Nursing Center
Woodbine Healthcare Centre
Center for Practical Bioethics
Clay County Senior Services
Good Samaritan Center-Excelsior Springs
Kearney Fitness Center
The Gardens at Northgate Village Yoga for Seniors
YMCA-Clay-Platte
County Providers
Northland Medical Managers
8
Supporting Data
Tobacco Use
+
+
+
Alcohol
+
+
+
High Cholesterol
+
+
High blood pressure
+
+
+
Atherosclerosis
Chronic Liver
Disease
Essential
Hypertension
Kidney Disease
Diabetes
Alzheimer’s
Stroke
CLRD
Heart Ds.
Cancer
Table 1: Interrelationships Among Various Chronic Diseases and Modifiable Risk Factors1
+
+
+
+
+
+
Diet
+
+
+
+
+
+
Physical inactivity
+
+
+
+
+
+
Obesity/Overweight
+
+
+
+
Stress
?
+
Environmental Tobacco
smoke
+
+
+
Occupation
+
?
+
Pollution
+
+
+
Low socioeconomic status
+
+
+
+
+
+
+
+
?
+
?
Age*
Infection*
+
?
+
Note * = non modifiable; + = a risk factor; ? = possible risk factor
Most of the data used in this assessment have been retrieved from the Missouri
Information for Community Assessment (MICA). Information collected from other sources will
be noted for proper referencing. Rates used throughout the document are per 100,000 population
for deaths and per 10,000 population for hospitalization, unless stated otherwise. All hospital rate
data will be denoted with an asterisk (*) beside the risk factor.
Also, due to the limitation of data at the county level on new cases of chronic diseases
and the fact that most chronic diseases are not reportable, incidence and surveillance data will be
presented when available.
9
Ten-Year County Overview.
Top Ten Leading Causes of Chronic Disease Deaths in Clay County (1999 -2008).
Figure1: Ranking Table
Ranking of the Top 10 Leading Causes of Death from Chronic Diseases
Clay County, 1999-2008.
Ranking
1
2
3
4
5
6
7
8
9
10
1999
Heart Ds
Cancer
CLRD
Stroke
Diabetes
Alzheimer’s
Kidney Ds.
Hypertension
CLD
Atherosclerosis
2000
Heart Ds.
Cancer
CLRD
Stroke
Diabetes
Alzheimer’s
Kidney Ds.
Hypertension
CLD
Atherosclerosis
2001
Heart Ds.
Cancer
CLRD
Stroke
Diabetes
Alzheimer’s
Kidney Ds.
Hypertension
CLD
Atherosclerosis
2002
Heart Ds.
Cancer
CLRD
Stroke
Diabetes
Alzheimer’s
CLD
Kidney Ds
CLD
Atherosclerosis
2003
Heart Ds.
Cancer
CLRD
Stroke
Alzheimer’s
Diabetes
Kidney Ds.
Hypertension
CLD
Atherosclerosis
2004
Cancer
Heart Ds.
CLRD
Stroke
Alzheimer’s
Diabetes
Kidney Ds.
CLD
Hypertension
Atherosclerosis
2005
Cancer
Heart Ds.
CLRD
Stroke
Alzheimer’s
Diabetes
Kidney Ds.
CLD
Hypertension
Atherosclerosis
2006
Cancer
Heart Ds.
CLRD
Stroke
Alzheimer’s
Diabetes
Kidney Ds.
Hypertension
CLD
Atherosclerosis
2007
Cancer
Heart Ds.
CLRD
Stroke
Alzheimer’s
Diabetes
Kidney Ds.
CLD
Hypertension
Atherosclerosis
2008
Cancer
Heart Ds.
CLRD
Stroke
Alzheimer’s
Diabetes
Kidney Ds.
Hypertension
CLD
Atherosclerosis
Cancer was the leading cause of deaths from chronic diseases in Clay County from 2004
through 2008. The current data released for 2009 show that cancer maintained the first position
as the leading cause of death from chronic diseases. Heart Disease was in the second position.
Chronic lowest respiratory disease (CLRD) consistently was the third leading cause of chronic
disease deaths for the ten year period (1999-2008). Deaths from heart disease and cancer stayed
significantly higher than deaths from the third leading cause of chronic disease deaths (CLRD)
throughout the period. CLRD and stroke remained comparable and alternated for the third and
fourth position (See figure 2 below).
10
Figure 2: Trend for the Top Four Leading Causes of Deaths
Age-Adjusted Death Rate
Top Four Leading Causes of Chronic Disease Deaths
Clay County 1999-2008
300
250
200
150
100
50
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Heart disease
Cancer
Chronic lower respiratory diseases
Cerebrovascular disease (Stroke)
Following the top four causes were diabetes and Alzheimer’s, which alternated for the
fifth and sixth positions for most part of the ten-year period except for 2007. Other diseases
ranked in the top ten leading causes of chronic disease deaths were kidney disease, essential
hypertension, chronic liver disease (CLD), and atherosclerosis which consistently stayed in the
tenth position throughout the 10-year period (see figure 3 below).
Figure 3: Trend for top fourth to tenth ranked leading chronic disease deaths.
The Top Fifth to Tenth Leading Causes of Chronic Disease Deaths
Clay County, 1999-2008
40
Diabetes
Age-Adjusted Death Rate
35
30
Alzheimer's
disease
25
Kidney disease
20
15
Essential
hypertension
10
5
Atherosclerosis
0
Year
Chronic liver
disease and
cirrhosis
11
The 2009 death data followed the same pattern as 2008 except that Alzheimer’s disease
became the fourth leading cause of chronic disease deaths, and cerebrovascular disease (stroke)
the fifth. Also, a drop in mortality rates was seen in eight out of the top ten leading causes of
death in the county, except for Alzheimer’s disease which show an increase in mortality rate
from 27.9 in 2008 to 28.8 in 2009. Deaths from atherosclerosis remained the tenth leading cause
of chronic disease deaths in 2009 (1.4) as was in 2008 (1.4).
Figure 4: Hospital Charges for Clay County Residents, 2008
Hospital Charges for Clay County Residents, 2008.
$26,550,738
$28,863,371
Neoplasma, malignant cancer
Heart and circulation
Respiratory (throat and lung)
$66,622,953
Kidneys - bladder - genitalia
$129,764,248
In 2008, a total estimate of 10,284 years of potential life lost was attributed to the leading
causes of chronic disease deaths in Clay County. Of these deaths, 8,088 years of potential life
lost was attributed to cancer (3,754), heart disease (3,189) and chronic lower respiratory disease
(1,145).
12
Figure 5: Comparison (1999 and 2008)
Age-Adjusted Rates
Comparison of the Top10 Leading Chronic Disease Deaths
Clay County (1999 Versus 2008)
300
250
200
150
100
50
0
Heart disease
Cancer
CLRD
Stroke
Diabetes
Alzheimer's
Kidney
disease
Other
1999
243.7
186.6
61.1
53.1
29.7
22.1
15.5
16.9
2008
177.7
188.6
71.4
48.3
20.4
27.9
18.8
16.6
Leading Causes of Death
* Other includes Essential hypertension, Atherosclerosis and Chronic liver disease..
Figure 6: Comparison (2006-2009)
Age-Adjusted Rates
Top 10 Leading Chronic Disease Deaths
Clay County
250
200
150
100
50
0
Heart
disease
Cancer
CLRD
Stroke
Alzheimer's
Diabetes
Kidney
disease
Hypertensi
-on
CLD
Atheroscle
-rosis
2006
170.7
188.4
63.5
35.7
28.1
21.8
12.2
2007
154.2
213.7
65.8
39.7
26.3
16.2
17.8
6.3
6
2.9
5.5
9.3
2008
177.7
188.6
71.4
48.3
27.9
20.4
2.9
18.8
8.2
7
2009
139.7
180.5
61.5
27.9
28.8
17.7
1.4
13.5
6.9
6.7
1.4
Leading Causes of Death
* 2009 data became available and was added to this comparison. Rates dropped in 2009 except for Alzheimer’s which increased and
atherosclerosis which remained constant.
Figure 6 shows that death rates in Clay County due to heart disease, diabetes,
Alzheimer’s, and hypertension gradually decreased from 2006-2007, but increased in 2008.
Other conditions; chronic lower respiratory disease (CLRD), stroke and kidney disease
consistently increased in rates for the same time period. In 2008, deaths from chronic liver
disease and cancer decreased after a significant increase from 2006 to 2007. Atherosclerosis
showed significant decrease from 2007 to 2008.
13
Figure 7: Comparison on the top 7 Leading Chronic Disease deaths
Comparison of the Top 7 Leading Chronic Disease Deaths,
Clay County, MO and U.S.* (2007-2008)
Age-Adjusted Rates
250
200
150
100
50
0
Heart
disease
Cancer
CLRD
Stroke
Diabetes
Alzheimer's
Kidney
disease
Clay
177.7
188.6
71.4
48.3
20.4
27.9
18.8
MO
189.6
213
56.8
47.6
20.1
18.6
28.5
U.S.*
204.3
177.5
41.2
41.6
22.4
22.8
14.4
Leading Causes of Death.
CLRD = Chronic Lower Respiratory Disease.
*2007 is the available data on U.S.
Figure 7 shows how chronic disease death rates in Clay County compare to the State of
Missouri and the U.S. Clay County has higher death rates due to CLRD, and Alzheimer’s, while
cancer remains almost equivalent to the State of Missouri, but higher than the U.S rate. In 2008,
Clay County showed a significantly higher death rate than the State of Missouri for chronic
lower respiratory disease. The County death rate for Alzheimer’s disease is higher than that of
the state, but this rate is not significant (Figure 7).
14
Disease Specific Information
SUMMARY- Cancer

The leading cause of chronic disease deaths from 2004 through 2008.

Second only to heart disease from 1999 through 2003.

Rates stayed lower or comparable to the state rates except for the year 2007 when the county rate
was significantly higher than the state rate.

Rates remained consistently higher in the male population.

Prostate cancer showed an increase in number of new cancer cases

Although liver cancer is not one of the three leading causes of cancer deaths in Clay County, the
rate had remained unstable over the years. However, rates of liver cancer had more than doubled
from 3.1(6 cases) in 2006 to 6.4 (14 cases) in 2008.

In 2008, deaths from cancer caused 3,754 years of potential life lost among Clay County residents.

Top three leading causes of cancer deaths in Clay County by sex in 2008:
Males
1. Tracheal/bronchus/lung cancer
2. Pancreatic cancer
3. Colon, rectum/anus
Females
1. Tracheal/bronchus/lung cancer
2. Breast cancer
3. Colon, rectum/anus
15
Figure 1: Trend
Age-Adjusted Death Rates
Ten-Year Trend comparison of Age-Adjusted Death Rates for Cancer
(1999-2008)
220
215
210
205
200
195
190
185
180
175
170
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
CLAY
186.6
192.3
210.9
190.8
198
199
200.7
188.4
213.7
188.6
MO
207.8
205.6
205.6
202.9
200.9
200.6
197.2
195.6
190.9
189.6
Year
The cancer death rate in the county male population followed the same trend as the state
rates in the male population and remained consistently higher than the female rates. In the female
population, only 2007 rate showed a slightly significant lower difference to the state female rates
over the ten-year period. In 2008, among cancer deaths, tracheal/bronchus/lung cancer (62.2)
was the leading cause of cancer deaths in the county (among male population: 90.8; among
female population: 41.9). Among the male population, cancer of the pancreases was second at
20.4, followed by cancer of the colon, rectum/anus at 17.5. In the female population, among
cancer deaths, breast cancer (20.6) was second followed by cancer of the colon, rectum/anus at
15.4.
16
Figure 2: Comparison by Sex
Age-Adjusted Death Rate
Comparison of Age-Adjusted Cancer Death
in Clay County by Sex (2004 and 2008)
250
200
150
100
50
0
Male
Female
2004
224.8
180.1
Both Sexes
199
2008
237.6
155.6
188.6
Sex
The years of potential life lost from cancer in 2008 among residents of Clay County was
estimated at 3,754 years.
The increase in death rates of liver cancer appears to be a new trend for the county.
However, this should be watched closely to ensure that it is not as a result of statistical anomaly
from unstable data (cases less than 20). According to the trend data, liver cancer was not among
the top ten leading causes of cancer deaths in Clay County, and the rates were unstable over the
years. However, rates of liver cancer among Clay County residents had more than doubled from
3.1(6 cases) in 2006 to 6.4 (14 cases) in 2008. In 2009, the rate was 6.9 (16 cases).
Hepatitis, the major cause of liver cancer, has been described by United States
Department of Health and Human Services as a hidden epidemic with significant public health
consequences. This is because viral hepatitis can persist for decades without symptoms. About
65%-75% of infected Americans remain unaware of their infection status and are not receiving
care and treatment.21 The Mortality and Morbidity Weekly Report (MMWR) also showed that
from 2001-2006, that the average percent change in the incidence rate of hepatocellular
carcinoma in the State of Missouri was 6.4% compared to the United States at 3.5%.22 In the past
6-years from 2005 through 2010, the communicable disease report for Clay County showed that
an average of 89 cases of chronic viral hepatitis were reported in every given year, but many
more go undiagnosed.
State data showed that incidence rate for all cancer sites in Missouri dropped from 468.3
in 2007(U.S. = 465.1) to 453.4 in 2008 (U.S. = 462.9). However, Clay County incidence rate for
all cancer sites increased from 506.6 (2003-2005) to 511.7 (2006-2008).12 For specific cancer
sites, prostate cancer showed a significant increase in number of new cases from 2003-2005 to
2006-2008 (Figure 3 below).
17
Figure 3: Rates of New Cancer Cases
Age-Adjusted Rstes
Incidence Rates by Cancer Sites and by Year
Clay County 1997-2008
120
100
80
60
40
20
0
1997-1999
2003-2005
2006-2008
Breast
Cervix
102.2
84.8
82.1
4
3.5
2.5
Colon
Lung
rectum/re
and
ctosigmoi
bronchus
d
70.7
87.9
52
88.6
53.4
79.9
Prostate
Urinary
bladder
64.1
52.7
67.9
18
24.5
20.2
Corpus
and
Uterus
NOS
13.5
12.2
14.3
Cancer Sites
The rate of hospitalization for all cancer; malignant neoplasm between 2004 and 2008
was 42.6* compared to the state at 40.2* and Platte County at 36.2*.15 In 2008 a total of hospital
charges of $37,884,649.00 was due to cancer in Clay County residents. $28,863,371.00 was due
to malignant cancer alone and $9,021,278.00 was due to other cancers.14
18
SUMMARY – Heart Disease

Heart disease was the second leading cause of chronic disease deaths from 2004 through
2008.

In 2008, rates increased in the Clay County population after a steady gradual decrease
from 2002 through 2007.

Rates stayed significantly lower than the state rate in both males and females from 19992008.

Over the ten-year period, rates were higher in the male population.

Adults males 65 years-old and over were most often affected.

The years of potential life lost from heart disease among Clay County residents in 2008
was estimated at 3,189 years.

In 2008, a total of 2,894(134.7*) discharges from inpatient hospitalization among Clay
County residents were as a result of heart disease while preventable hospitalization for
congestive heart failure was 110 (4.9*), and angina 7(0.3*).

The top three specific causes of death grouped under heart disease were:
1. Chronic ischemic heart disease
2. Acute myocardial infraction
3. Heart failure
Age-Adjusted Death Rates
Figure 1: Trend
Ten -Year trend comparison of Age-Adjusted Death Rates for
Heart Disease
(1999-2008)
350
300
250
200
150
100
50
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Clay
243.7
258.6
216
217.7
201.1
185.2
179.5
170.7
154.2
177.7
MO
300
288.3
268.7
267.7
259.5
243.3
229.4
222.6
212.4
213
Year
19
Clay County rates for heart disease for the ten-year trend (1999-2008) remained
significantly lower than the state rates. Significant changes were seen in Clay County rates from
1999 to 2001 and from 2007 to 2008.
Figure 2: 10-year Comparison by Sex
Ten-Year Heart Disease Death Rate by Sex
1999-2008
Age-Adjusted Death Rate
400
350
300
250
200
150
100
50
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Clay-Male
MO-Male
Clay-Female
MO-Female
Figure 3: Comparison by Sex
Comparison of Heart Disease Death Rates by Sex
Clay County (2004 and 2008).
Age-Ajusted Death Rate
250
200
150
100
50
0
Male
Female
Both Sexes
2004
232.4
148.2
185.2
2008
230.7
135.6
177.7
20
Clay County rates remained significantly lower than the state rates except in the male
population for the year 2008. In the female population there was an increase in death rate from
1999 to 2000. In 2003, the death rate decreased and remained stable with minimal variation over
the years up to 2008. In males, rate increased significantly in 2008.
In 2008, diseases grouped under all other forms of chronic ischemic heart disease were
the leading causes of death from heart disease. Among specific disease conditions, acute
myocardial infarction was the leading cause of death followed by heart failure.
In 2008, a total of 2,894 (134.7*) discharges from inpatient hospitalization among Clay County
residents was as a result of heart disease. Preventable hospitalization for congestive heart failure
was 110 (4.9*), and 7(0.3*) for angina.11 Among the hospital charges for heart and circulatory
diseases for Clay County in 2008, charges for disease of the heart made up most of the charges
(see figure 4 below).14
Figure 4: Hospital Charges for Heart and Circulation Diseases
Hospital Charges for Heart and Circulation Diseases
Clay County, 2008.
$3,703,278
$5,616,012
$12,442,812
Hypertension
Diseases of the heart
$18,200,519
Cerebrovascular disease
Diseases of arteries - arterioles - and
capillaries
$89,801,627
Diseases of veins and lymphatics
21
Figure 5: 10 Year Comparison by Age group and Sex
Heart Disease Death Rates in Selected Age groups by Sex
Clay County
(1999-2008)
CrudeDeath Rates
2000
1500
1000
500
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Male 45-64
Female 45-64
Male 65+
Female 65+
Female 45-64 years old had some unstable rates over the ten-year period (number of cases were less than 20).
The death rates for heart disease in males, 65-years old and over for the ten-year period
remained significantly higher than in the female population of the same age, except for the years
2000 and 2007.
Age-Adjusted Death Rates
Figure 6: Conditions
70
60
50
40
30
20
10
0
Specific Conditions Listed Under Heart Disease
Clay County (2008)
Acute RH
fever&Chr.RH
heart ds
Hypertensive Hypertensive
heart ds
heart&renal ds
Acute
myocardial
infarction
Other acute Atherosclerotic Chr. ischemic
ischemic heart
cardio. ds
heart ds
ds
(others)
Heart failure
heart disease
(all others)
Conditions listed Heart Disease
**RH = Rheumatic, Chr. = Chronic, ds = Disease
22
SUMMARY – Chronic Lower Respiratory Disease (CLRD)

Chronic lower respiratory disease is the third leading cause of chronic disease death next only to
heart disease and cancer among the leading ten.

Death rates over the ten-year period from 1999-2008 remained higher than the state rates.

Death rates in the county male population remained higher than in the female population.

Adults 65-years old and over were mostly affected

Majority of the deaths were NOT from asthma, emphysema or bronchitis. They were grouped
under ‘other chronic lower respiratory diseases.’

In 2008, a total of 765 (36.3*) discharges from inpatient hospitalization among Clay County
residents were as a result of chronic obstructive pulmonary disease and bronchiectasis.
Discharges from inpatient hospitalization from other lower respiratory diseases were low at 134
(6.2*).

Preventable hospitalization for chronic obstructive pulmonary disease in 2008 was 292 (13.2*).
Age-Adjusted Death Rates
Figure 1: Trend
Ten-Year Trend of Deaths from Chronic Lower Respiratory Disease
Clay County
(1999-2008)
80
70
60
50
40
30
20
10
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Clay
61.1
57.6
61.4
63.4
64
54.5
62.1
63.5
65.8
71.4
MO
51.6
47
47.3
46.8
47.7
44
48.6
47.1
47.1
56.8
Year
Clay County rates for chronic lower respiratory disease stayed consistently higher than
the state rates over the ten-year period in both sexes. However, the rates of CLRD remained
higher in the male population than in female population. In the female population, there was a
rapid increase in rates from 2007 through 2008, similar to what was seen at the state level. In the
male population, rates slightly decreased from 2007 through 2008, differing from the state trend
in which rates rapidly increased over the same time period.
23
Figure 2: Comparison by Sex
Age-Adjusted Death Rate
Comparison of Death Rates from Chronic Lower Respiratory Diseases by Sex
Clay County (2004 vs 2008)
90
80
70
60
50
40
30
20
10
0
Male
Female
Both Sexes
2004
69.8
46.6
54.5
2008
82.5
65.6
71.4
Sex
From 1999 through 2008, the death rates from chronic lower respiratory disease remained
consistently higher in the male population 65-years old and over. No significant differences in
rates were seen between the male and female population of this age group. However, over the ten
year period for all ages, the differences in rates for the years 2000, 2003 and 2005 showed low
significance.
In 2008, diseases grouped under ‘other chronic lower respiratory diseases’ as categorized
by the Missouri Information for Community Assessment (MICA) were the leading causes of
deaths from CLRD. The inpatient hospitalization rate for this group of diseases was 6.2*,
compared to 36.3* for chronic pulmonary obstructive disease and bronchiectasis.16
Clay County hospitalization rate between 2004 and 2008 for chronic obstructive
pulmonary disease excluding asthma was 33.0*. This rate was higher than the state rate of 22.9*
and Platte County rate of 20.2*15 Preventable hospitalization rate for chronic obstructive
pulmonary disease was 13.2* in 2008 for Clay County, compared to 11.7* for the state and 6.2*
for Platte County (Please note that the age adjusted rates for hospitalizations are per 10,000
population.11
24
Age-Adjusted Death Rates
Figure 3: Conditions
Deaths Due to Chronic Lower Respiratory Disease
Clay County (2008)
70
60
50
40
30
20
10
0
Bronchitis - chronic and
unspecified
Emphysema
Asthma
Other chronic lower
respiratory diseases
Conditions
25
SUMMARY – Stroke
The 4th leading cause of chronic disease death from 1999 through 2008

General death rates from stroke in the county remained lower or comparable to the state
rates.

Except for the years 2000 and 2007, rates in the female population remained consistently
higher than the male population.

From 2007 through 2008 death rate increased in the county female population but
decreased in the male population.


The highest rates in the county were seen in 2002 in both sexes.
Adults 65-years old and over were affected more. Among this age group the death rate
was higher in the female population.
Age-Adjusted Death Rates

Ten-Year Trend of Deaths from Stroke
1999-2008
80
70
60
50
40
30
20
10
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Clay
53.1
51.2
54.5
62.8
47.2
52.5
36.7
35.7
39.7
48.3
MO
66.7
63.6
61.4
62.3
56.4
54.6
51.1
49.4
48
47.6
Year
26
Age-Adjusted Death Rates
Figure 2: 10-year Comparison by Sex
Ten-Year Trend of Death from Stroke by Sex
1999-2008
70
60
50
40
30
20
10
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Male
Female
Both Sexes
CrudeDeath Rates
Figure 3: 10-year comparison by Sex
Stroke Death Trend in Selected Age group by Sex
Clay County (1999-2008)
600
500
400
300
200
100
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Male 65+
Female 65+
Both Sexes 65+
Crude rates for age specific data. Few rates were unstable; numerators less than 20, in males 65-years old and over.
Death rates in females’ 65-years old and over remained consistently higher than rates in
male 65-years old and older. The difference in rates was statistically significant between the
groups in 2008.
Rate of hospitalization from stroke was 30.7* between 2004 and 2008; this rate was
lower than the state rate (31.3*), but higher than Platte County rate (28.4*).15 In 2009, 16.2% of
Clay County residents reported that they had never had their cholesterol checked, while 80%
incorrectly answered questions on the sign and symptoms of stroke.20
27
SUMMARY – Alzheimer’s disease

Alzheimer’s disease was the 5th leading cause of chronic disease death from 2003 through
2008, but 6th from 1999 to 2002.

Over the ten-year period, death rates in Clay County female population were higher than
in the male population except for the years 2001 and 2002 when rates were comparable.

In adults 65-years old and over, death rate in female remained consistently higher than
rates in the male population.

Clay County death rates were higher than the state rates from 1999 through 2007.

The county rate became lower than the state rate in 2008.
Figure 1: Trend
Age-Adjusted Death Rates
Ten -Year Trend of Death from Alzheimer's Disease
(1999-2008)
40
35
30
25
20
15
10
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Clay
22.1
30.4
28.2
20.2
28.8
25.8
35.6
28.1
26.3
27.9
MO
15.1
18.6
17.6
18.7
20.1
21.1
24.5
24
24.3
28.5
Year
28
Figure 2: 10-year Comparison by Sex
Ten-Year Trend of Death Rates from Alzheimer's by Sex
Clay County (1999-2008)
40
35
Age-Adjusted Death Rates
30
25
20
15
10
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Sex
Male
Female
Both Sexes
Figure 3: Comparison by Age group and by Sex
Death from Alzheimer's in Selected Age group by Sex
Clay County (1999-2008)
350
Crude Death Rates
300
250
200
150
100
50
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Male 65+
Female 65+
Both Sexes 65+
***Male rates were all unstable in 65+
29
SUMMARY – Diabetes

Diabetes was the 5th leading cause of death from 1999-2002, and the 6th from 2003
through 2008.

Over the ten year period (1999-2008), county rates were comparable to the state rates,
except for 2000 and 2004.

Death rates were consistently higher in the county male population compared to females
except for the year 2007.

In the male population, the rate in 2008 almost doubled in 2007, but a slight decrease was
seen in the female population over the same time period.

The death trend (1999-2008) in the female population followed the state trend. The trend
in the male population was slightly different from the state rate.
Figure 1: Trend
Age-Adjusted Death Rates
Ten-Year Trend Comparison of Death Rates for Diabetes
Clay County and Missouri
(1999-2008)
40
35
30
25
20
15
10
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Clay
29.7
33.4
28.9
23.1
27.2
14.8
18.5
21.8
16.2
20.4
MO
26.3
24.6
25.2
26.5
26.8
23.5
24.6
23.3
22.1
20.1
Year
Over the ten-year period (1999-2008), Clay County death rates for diabetes in all ages
remained comparable to the state rates, except for 2000 and 2004 when significant differences in
rates were seen. In 2000, Clay County had a slightly significant higher rate than the state, and in
2004 the rate was significantly lower than the state rate.
30
Figure 2: Comparison by Sex
Age-Adjusted Death Rates
Diabetes Death Trend by Sex
Clay County
(1999-2008)
50
40
30
20
10
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
All Ages Male
All Ages Female
All Ages Both Sexes
Age-Adjusted rates for All Ages based on 2000 population data
Rates were unstable in age specific groups; most numerators were less than 20.
Few of the rates for all ages, gender specific were also unstable.
From 1999 through 2008, the death rates for diabetes in Clay County male population
remained higher than in the female population expect for the year 2007.
Age-Adjusted Death Rates
Figure 3: Comparison by Sex
Comparison of Deaths from Diabetes by Sex
Clay County and Missouri
(2006 -2008)
30
25
20
15
10
5
0
Clay-Both
Sexes
MO-Both
Sexes
20
21.8
23.3
18
18.3
16.2
22.1
14.1
16.7
20.4
20.1
Clay-Male
MO-Male
Clay-Female MO-Female
2006
25
27.2
18.4
2007
14.6
26.8
2008
28.4
24.4
Sex
2006, 2007, 2008 were the last three years that data was available. Age-Adjusted based on 2000 population. .
The diabetes death trend in the county male population was different from that seen at the
state level; however, the county female rates followed the same trend as the state rates (see figure
3 above).
The rate of hospitalization from diabetes was 16.9* between 2004 and 2008. However,
preventable hospitalization rate for diabetes in 2008 among Clay County residents was 10.5*,
lower than the state (17.5*), but higher than Platte County (12.4*).15
31
The 2008 surveillance data showed that the age-adjusted percentage of people diagnosed
with diabetes in Clay County was 8.6%, while 30% were obese and 27% were physically
inactive.19 The table below showed some Clay County risk factor data on diabetes compared to
surrounding counties.
Table 1: Comparison of Risk Factors
Diabetes: 2008 Age-adjusted Percentages
County
Diagnosed with diabetes Obese Physically Inactive
Cass
8.4
29.6
27.3
Clay
8.6
29.5
26.5
Clinton
8.6
30.5
28.8
Jackson
8.7
31
26
Platte
8.3
28.6
27.2
Ray
9.1
30.5
30.4
Source: CDC: Chronic Disease Prevention and Health Promotion, State Profile. Retrieved, May 2011
http://www.cdc.gov/chronicdisease/states/missouri.htm#cancer
32
SUMMARY - Kidney Disease (nephritis/nephritic syndrome/nephrosis)

Kidney disease was the 7th leading causes of chronic disease deaths in Clay County
except for the year 2002 when it became the 8th.

County rates were unstable (i.e. number of cases were less than 20) over the ten-year
period.

County rates remained lower than the state rates except the years 2000 and 2005 when
rates were comparable to the state rates.

Rates in the county male population continue to increase since 2006 unlike in the female
population.

Most of the deaths in 2008 were due to renal failure.
Figure 1: Trend
Age-Adjusted Death Rates
Ten-year Trend of Death Rates from Kidney disease(nephritis/nephrotic
syndrome/nephrosis)
1999-2008
20
18
16
14
12
10
8
6
4
2
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Clay
15.5
17.6
13.4
13.7
13.8
10.8
16.6
12.2
17.8
18.8
MO
15.2
15.9
16.1
17.2
17.4
17.1
18
16.9
17.9
18.6
Year
33
Figure 2: 10-year trend by Sex
Ten-Year Trend of Death Rates of Kidney Disease(nephritis/nephrotic
syndrome/nephrosis) by Sex
Clay County 1999-2008
Age-Adjusted Death Rate
35
30
25
20
15
10
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Sex
Male
Female
Both Sexes
The ten-year trend for kidney disease showed lower rates in Clay County from 2001
through 2006 when compared to the state rates. The rest of the ten-year period was either
comparable or slightly higher than the state rates. Rates remained unstable (total number of cases
in each sex was less than 20) in both male and female populations except for the year 2005 when
rates were stable for the female population as well as in both sexes combined. Death rates were
higher in individuals’ 65-years and older. More than 88% (236) of all the cases (267) seen over
the ten year period were with people 65-years old and over.
Death rates from kidney disease dropped from 17.8 in 2008 to 13.5 in 2009. Most deaths
were as a result of renal failure.
34
SUMMARY – Chronic Liver Disease

Chronic liver disease was the 8th leading cause of chronic disease deaths in 2004, 2005
and 2007. The 9th in 1999 through 2003, 2006 and 2008.

Rates were unstable over the ten-year period (i.e. number of cases was less than 20).

In 2008, deaths from chronic liver disease were due to alcoholic liver disease, other
chronic liver disease and cirrhosis.
Figure 1: Trend
Age-Adjusted Death Rates
Ten-Year Trend of Death from Chronic Liver Disease
(1999-2008)
12
10
8
6
4
2
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Clay
7.6
10.5
3.4
10.6
2.8
5.6
8
6
9.3
7
MO
7.4
6.9
7.5
7.4
7.2
7.1
6.7
7.3
6.7
7.8
Year
The death rates of chronic liver disease over the ten-year period were unstable (total
number of cases were less than 20) expect for the years 2002 and 2007 when total number of
cases was 20 for each year. In 2008, deaths from chronic liver disease were due to alcoholic liver
disease, other chronic liver disease and cirrhosis.
In 2008, the rate of preventable hospitalization from kidney disease in Clay County was
8.2*, higher than the state (8.1*) and Platte County (47.8*).15
35
SUMMARY – Essential hypertension

Essential hypertension over the ten-year period was the 7th leading cause of chronic disease
deaths in 2002, the 8th in 1999 through 2001, 2003, 2006 and 2008 and the 9th in 2004, 2005 and
2007.

Rates remained very unstable over the years (i.e. number of cases were less than 20 for each
period analyzed). However, rates were consistently higher in females compared to males.

From 2004, Clay County rates were comparable to the state rates.
Figure 1: Trend
Age-Adjusted Death ates
Ten-Year Trend Comparison of Death from Essential Hypertension
Clay County and Missouri
(1999-2008)
18
16
14
12
10
8
6
4
2
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Clay
MO
36
Figure 2: 10-year Comparison by Sex
Ten-Year Comparison of Death from Essential Hypertension by Sex
Clay County (2004 and 2008)
Age-Adjusted Death Rate
9
8
7
6
5
4
3
2
1
0
Male
Female
Both Sexes
2004
4.7
5.9
5.4
2008
8.1
8.3
8.2
Sex
Essential hypertension maintained unstable rates (total number of death cases less than
20) over the ten-year period except for the year 2002 when the total number of death cases was
25. It followed similar trend as chronic lower respiratory disease (although the CLRD rates were
stable) with the rates in 2008 in male population close to rates in 1999; and the female rate in
2008 much higher than in 1999. Over the ten-year trend, death rates were at its’ highest in 2002;
13.6 in male and 17.5 in female. While the rates in male population steadily decreased until the
sharp increase in 2008, the female rates decrease from 2002 through 2004 with an increase
through 2006, and then stabilized through 2008.
37
SUMMARY- Atherosclerosis

Atherosclerosis is the 10th leading cause of chronic disease deaths in Clay County.

Over the ten-year period, rates remained unstable.

County rates were lower than the state rates
Figure 1: Trend
Ten-Year Trend of Death Rates from Atherosclerosis
(1999-2008)
Age-Adjusted Death Rates
6
5
4
3
2
1
0
1999
200
2001
2002
2003
2004
2005
2006
2007
2008
Year
Clay
MO
Rates for atherosclerosis remained unstable for the ten-year period. Rapid decrease in rate
was seen from 2007 through 2008.
38
Existing Programs at the Clay County Public Health Center
At Clay County Public Health Center, the Behavioral and Community Health Promotion
section teaches Chronic Disease Self-Management courses. The Chronic Disease SelfManagement Program (CDSMP) is taught in a variety of community settings (churches,
community centers, hospitals, etc.) for adults with one or more chronic conditions. The
workshop is administered through six, 2.5 hour sessions. Topics covered during the workshop
include determining differences between chronic and acute diseases, reducing risk factors for
disease, coping techniques, creation of action plans, problem solving, exercise, deep breathing,
pain management strategies, nutrition, communication, medication management, and stress and
depression. Program participants are asked to complete “homework” readings in Living a
Healthy Life with Chronic Conditions, the textbook that accompanies the workshop.
The course is taught by two trained and certified instructors who utilize various
techniques in order to make the course learning style-friendly. These teaching strategies
include role-play, lecturettes, brainstorming, demonstration and practice, problem-solving,
group participation, and discussion. The purpose of the program is to empower individuals
to manage their health and live active, fulfilling lives. When the program was tested,
individuals who took the program, compared to those who did not, demonstrated significant
improvements in exercise, cognitive symptom management, communication with physicians,
self-reported general health, health distress, fatigue, disability, and social/role activity
limitations. They spent fewer days in the hospital, and there was also a trend toward fewer
outpatient visits and hospitalizations. These data yield a cost to savings ratio of
approximately 1:10. Many of these results persist for as long as three years.
The program also provided blood pressures at health fairs or events, and presentations on
request that typically center around delaying the onset of chronic disease (nutrition, exercise,
etc.).
39
Conclusion
A dollar spent on prevention through effective health education and intervention of the
risk factors to chronic diseases could save millions of dollars. The American Cancer Society
states that with only comprehensive smoke-free laws in all states, “more than 690,000 lives
would be saved and states would save nearly $1.2 billion over 5 years in costs to treat lung
cancer, heart attack, and stroke.” 13
According to the 2009, CDC The Power of Prevention Report, “Without concerted
strategic intervention, chronic diseases and their risk factors can be expected to cause more
harm—and be more costly to society. We cannot effectively address escalating health care costs
without addressing the problem of chronic diseases.”23 With a growing and aging population,
unless moderate changes become effective, an increased burden of these conditions could be
expected.
Based on U.S. statistics, “The American Cancer Society estimates that of the 565,650
cancer deaths expected in 2008 about 170,000 cancer deaths will be caused by tobacco use alone
and another third can be attributed to poor eating habits, overweight and obesity, and physical
inactivity. If we can effectively promote healthy behaviors, much of the suffering and death from
cancer can be prevented or reduced.”5
Tobacco use, poor eating habits and physical inactivity are the most common modifiable
risk factors associated with main chronic disease conditions including heart disease, stroke,
chronic lower respiratory disease, diabetes and cancer.
Studies have also shown that most common chronic diseases not only share risk factors,
but that they tend to occur together. According to the CDC, diabetes and high blood pressure are
common causes of kidney disease. However, most people with kidney disease are not aware of
their condition.
In 2008, more than 110,000 people in the United States began treatment for end-stage
renal disease. For every 10 new cases, seven had diabetes or hypertension listed as the primary
cause. In that same year, more than half a million people in the United States were living on
chronic dialysis or with a kidney transplant. It was also noted that most people with chronic renal
disease will die of cardiovascular disease before they get to the end-stage renal failure6. The
TFAH and RWJF release shows that in the nation, Missouri ranked eleventh in percent of obese
adults(2008-2010 average), and thirteenth in percent of adults with hypertension (2005-2010
average).10
Expanded, effective health education could lead to increased awareness on the
interrelationship between chronic illnesses, and could prevent some of the complications
resulting from poor management of existing conditions. This will in turn save lives and money.13
40
Glossary
Alcoholic liver disease is damage to the liver and its function due to alcohol abuse
Alzheimer's is a type of dementia that causes problems with memory, thinking and behavior.
Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere
with daily tasks. 31
Cancer is a term used for diseases in which abnormal cells divide without control and are able to
invade other tissues. Cancer cells can spread to other parts of the body through the blood and
lymph systems.26
Cardiovascular disease is heart and blood vessel disease; includes numerous problems, many of
which are related to a process called atherosclerosis.27
Chronic obstructed pulmonary disease, emphysema, chronic bronchitis and other respiratory
illnesses are all grouped together under the name chronic lower respiratory disease.28
Comprehensive smoke free laws are the law that ban smoking in all restaurants, bars, and
workplaces with no exceptions or loopholes.
Cirrhosis is a chronic degenerative disease in which normal liver cells are damaged and are then
replaced by scar tissue.
Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way
our bodies use digested food for energy and growth.30
Essential hypertension is the term used to describe high blood pressure. Essential hypertension
refers to high blood pressure when no cause been identified.
Etiology is the cause or origin of a disease or disorder as determined by medical diagnosis.
Incidence is the rate of new cases of a disease in a specified population over a defined period.
Malignant: The term "malignancy" refers to cancerous cells that have the ability to spread to
other sites in the body (metastasize) or to invade and destroy tissues. Malignant cells tend to
have fast, uncontrolled growth due to changes in their genetic makeup.32
Morbidity is the state of being diseased.
Mortality is the condition of being susceptible to death.
Non Malignant (benign tumor): an abnormal new mass of tissue that serves no purpose.
Obese*** is having excessive body fat, very overweight; (BMI = 30 and up).
41
Prevalence is defined as the total number of cases of the disease in the population at a given
time.
Physical inactivity/ physically inactive: A sedentary state.
Preventable hospitalization (also called ambulatory care sensitive conditions) are "diagnoses
for which timely and effective outpatient care can help to reduce the risks of hospitalization by
either preventing the onset of an illness or condition, controlling an acute episodic illness or
condition, or managing a chronic disease or condition..."34
Rate is the speed or frequency with which an event or circumstance occurs per unit of time,
population, or other standard of comparison.
Risk factor is something that increases your chances of getting a disease. Sometimes, this risk
comes from something you do. For example, smoking increases your chances of developing
colon cancer.
Statistically significant is the likelihood that a result or relationship is caused by something
other than mere random chance.
Sedentary is a near-synonym of inactive, especially referring to remaining in a seated position.
This adjective is used to describe a person or lifestyle characterized by much sitting.
Stroke sometimes called a brain attack, occurs when the blood supply to part of the brain is
blocked or when a blood vessel in the brain bursts. In either case, parts of the brain become
damaged or die.29
Years of Potential Life Lost (YPLL65) is the years of potential life lost before age 65.
Trend is the general direction in which something tends to move.
Unstable rate is rate obtained when the frequency with which the event occurs is less than 20.
42
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45