1.1 Life Expectancy Summary for 2019 - By Race and Sex

• This chart shows Life Expectancy at Birth in 2019 for males and females, for each race/ethnic group. Calculation of life expectancy is complex, and requires use of assumptions applied to high-quality data.

• For all race/ethnic groups, females live longer than males. Among males, the life expectancy for Blacks is 11.9 years less than for Asians; among females the difference is 10.1 years–this difference in life expectancy is a key summary measure of disparity, and is caused by a cascade of inequities in social determinants of health, and other factors.

1.2 Life Expectancy by Race and Sex, by Year, 2000 to 2019

• This chart shows the trends in Life Expectancy at Birth for the past 20 years by sex and race/ethnicity.

• Life expectancy has increased for all groups over this period. Black males have had a substantially lower, and Asian females a substantially higher, life expectancy than all other groups in all years.

1.3a All-Cause Mortality Trend by Sex and by Race/Ethnicity (2000-2019), and All-Cause Mortality County Rankings (2019)

• These line charts show the trends in age-adjusted rate for mortality due to all causes, by sex and by race. In a simple sense, “all-cause” mortality is the “opposite” of life expectancy–when all cause mortality goes down, life expectancy goes up, and vice versa.
  
  The bar chart displays county rates of age-adjusted mortality (and 95% confidence intervals) due to all causes. The counties listed have the highest rates, and a reference line is included for comparison with the state rate.

• All-cause mortality rates have decreased for both males and females over this period. Rates have also decreased for all race/ethnic groups over this period. All cause mortality appears to have increased for Native Hawaiian/Pacific Islanders this decade.

1.3b All-Cause Mortality Map - California, Bay Area, and Los Angeles County

• These maps display all-cause mortality rates by place; statewide and with a regional view for the Bay Area and Los Angeles county. The rates are compared at the subcounty level using Medical Service Study Areas (MSSAs), an aggregation of census tracts, to demonstrate variation between communities within each county.

• In both rural and urban areas there are concentrations of high all-cause mortality rates within counties and regions.

1.4a 2020 PRELIMINARY DATA: Top Causes of Death for Each Quarter of 2020, Including COVID-19

• Due to the urgency of sharing COVID-19 related information, this section includes preliminary 2020 data, which were received in mid-July 2021. The charts display the 2020 quarterly trend in leading causes for (adjusted) death rate, number of deaths, and years of life lost.

• By the fourth quarter of 2020, COVID-19 had become the leading cause of death, had the highest age-adjusted death rate, and caused the most Years of Life Lost in California.

1.4b 2020 PRELIMINARY DATA: All-Cause Mortality Quarterly Trend (2016-2020)

• This chart shows quarterly all-cause mortality trends for each of the past five years. These data are preliminary and rates for the last quarter of 2020 will increase with final data.

• The all-cause mortality rate was significantly higher in the 2nd, 3rd and 4th quarters of 2020 compared to any of the prior 4 years. The 2020 fourth quarter mortality rates are the highest of any single quarter in the past five years.The quarterly pattern for 2020 is also different, with rates increasing in the second and third quarters compared to the usual seasonal decreases.

1.4c 2020 PRELIMINARY DATA: All-Cause Mortality Monthly Trend (2016-2020)

• This chart shows monthly all-cause mortality trends for each of the past five years.

• All-cause mortality rates began increasing in April of 2020 relative to the same months in the prior four years, and have been high throughout 2020. The dip in September almost certainly reflects decreases in COVID-19 deaths after the first “surge”.

1.4d 2020 PRELIMINARY DATA: All-Cause Mortality Quarterly Trend by Race Ethnicity and Year Group (2016-2019 vs 2020)

• This chart shows, for the four largest race/ethnicity groups, all-cause age-adjusted quarterly mortality rates, for 2020 and for the 2016-2019 average.

• All populations had increased all-cause death rates over prior years in the 2nd, 3rd , and 4th quarters of 2020.
  
  While the Black all-cause death rate has been significantly higher than other race/ethnicity groups in prior years, that rate was even higher in 2020 (e.g. 26% higher in the 4th quarter 2020 compared to the prior 4-year 4th quarter average). The greatest increase was in the Latino death rate, with a 64% 4th quarter increase, followed by a 38% 4th quarter increase in Asian death rate. The 4th quarter increase for Whites (13%) was lower, but nevertheless represents a very large number of deaths.

1.4e 2020 PRELIMINARY DATA: Top 5 Causes of Death and Years of Life Lost in 2020

2.1 Multiple Lenses - Top 5 Conditions based on Multiple Measures, 2019

• This multi-chart emphasizes that there are many ways to view the health status of Californians, and that public health looks across multiple measures to identify public health challenges.
  
  The first four charts use measures relating to deaths (number, YLL, increase, and race disparity). The next four charts look at additional lenses of public health burden (reportable diseases, hospitalization, disability, and risk factors). County-level versions of this same multi-chart and a downloadable “report” can be found here. https://skylab.cdph.ca.gov/lghcBurdenView/

2.2 Broad Condition Groups (5) - Rankings of Number of Deaths and Years of Life Lost in 2019

• This set of charts compares all causes of death using five “broad condition groupings” These broad groupings are important for a very “high level” understanding of the burden of death/disease, and these groupings (indicated by color) are used to frame the data in many of the charts that follow. The top chart ranks the number of deaths in California in 2019 according the five broad condition groupings.
  
  The bottom chart shows the ranking of Years of Life Lost according to the five broad condition groupings. Years of life lost “weights” conditions that impact younger people, sometimes referred to as “premature death”.

• Cardiovascular Diseases caused the most deaths in California in 2019. This category includes Ischemic Heart Disease and Stroke. Injuries caused the most years of life lost in 2019. This category includes Drug Poisoning, Suicide, and Road Injury. Other Chronic Diseases were major contributors to both total number of deaths and years of life lost. This category includes Alzheimer’s Disease, Cirrhosis, COPD, and Kidney Disease.

2.3 Public Health Condition Groupings - Top 15 Number of Deaths in 2019

• These charts show a more detailed view of causes, disaggregated into what we call the “public health level” groupings. This grouping is based on programmatic areas of public health and/or clinical aspects of the conditions, such that action can be taken.
  
  This chart shows the ranking of the top 15 causes based on numbers of deaths.

• At this “public health level”, the conditions contributing the most deaths are Ischemic Heart Disease, Alzheimer’s Disease, and Stroke. Note that five of the top eight top causes of death are in the Cardiovascular broad grouping.

2.4 Public Health Condition Groups - Top 15 Years of Life Lost in 2019

• This chart shows the ranking of the top 15 “public health level” causes for years of life lost.

• The top contributors to years of life lost are Drug Overdose, Ischemic heart disease and Road Injury. Note that four of the top seven causes of years of life lost are in the Injury broad grouping.Due to the magnitude of deaths from Ischemic Heart Disease, it has been the leading cause both in terms of numbers and years of life lost for the past 20 years. For the first time in 2019, Drug Poisoning overtook Ischemic Heart Disease, becoming the top cause of years of life lost.

3.1 TRENDS in Broad Conditions Groups - Age-adjusted death rate, 2000-2019

• This chart shows the age-adjusted death rate trends of the five “broad condition groupings” in California from 2000-2019.

• Great progress has been made in the past 20 years with the decreasing death rates for Cardiovascular Disease and Cancer. In contrast, death rates for Other Chronic Diseases have been increasing somewhat since 2000, and more recently, since 2010 there are increases in death rates for Injury.

3.2 TRENDS In Top Public Health Conditions (by Broad Groups), 2000-2019

• This chart provides a deeper look into the trends in cause of death by showing the age-adjusted death rate trends of the top 5 “public health conditions” within each “broad condition group.”

• The previous chart showed good progress for Cardiovascular and Cancer condition groups. This chart reveals the main drivers for those downward trends, which are Ischemic Heart Disease and Lung Cancer. Furthermore, respiratory infections from the communicable group has also greatly declined since 2000. In contrast, Alzheimer’s disease in the Other Chronic Group and Drug Poisonings in the Injury group have sharply increased since 2000.
  
  The increase in Alzheimer’s appears to be driving the observed increase in the broader Other Chronic group. In the Injury broad condition group, Drug Poisonings have more than doubled, and Road Injury is increasing after a previous decline.
  
  Note: The y-axis scales for each chart are different.

3.3 Trends in age-adjusted rates for Top 15 Public Health Level Conditions (log-y-axis)

• This chart offers a different angle from the previous chart by looking at the trends of the top 15 public health conditions overall (regardless of the broader groups). These conditions are selected based on the age-adjusted death rates in 2019, allowing one to examine trends in the past 20 years for the conditions that have most affected Californians recently.

• Age-adjusted death rates from Ischemic Heart Disease and Stroke have greatly reduced in the past 20 years. In contrast, Alzheimer’s disease has more than doubled since 2000, resulting in it having the second-highest rate in 2019. Also of note are Drug Poisonings and Kidney Diseases. While these conditions are lower on the list, their age-adjusted death rates have more than doubled since 2000.

4.1 All-cause death rates, and rate ratios: Asian, Black, Latino, White

• This table compares deaths at different age levels across race/ethnicity groups. It displays the age-specific number and rate for all-cause deaths, for the four largest racial/ethnic groups, based on 2017-2019 data. Shading is included in the background of these columns to reflect magnitude and proportion.
  
  It also shows the ratio of the age-specific Asian, Black and Latino rates to White rates (Whites are used as the reference group since they have historically been the largest group in the State, and are, on average, relatively advantaged).A rate ratio of 1.0 means that the rates are the same for both groups.
  
  Total “crude” death rate and the age-adjusted rate are also shown at the bottom of the table for each racial/ethnic group.

• Of the many observations that can be seen in this table, one especially important observation is seen in the “Black:White” rate ratio column. In the 0-4 year old age group the death rate is 2.9 times higher for Black infants/toddlers than for Whites. For children/teens/early 20’s the rates are 1.9 higher for Blacks than Whites. In general, this ratio decreases as age increases–among 75-84 year olds the ratio is 1.2, and among the oldest age group the rate among Blacks is less than the rate among Whites.
  
  Many complex factors interweave to create these disparities and patterns. The much higher rate of death among Black 0-4 year olds is due to the cascade of social determinants of health and structural inequities.
  
  Among the Latino population, rates are better (lower) than Whites for ages 25 and older, but worse (higher) between ages 0 and 24, with the greatest difference at the youngest (0-4) age level.

4.2 Change in Race/Ethnicity All-Cause Mortality Rate Disparity, 2002-2019

• This set of charts presents information on trends in all-cause mortality by race using both rates and rate ratios.

• The first chart demonstrates that all-cause mortality has been decreasing overall among all race-ethnicity groups in California, with a small increase in 2017-2019 rates for Blacks, Latinos, and Asians compared to 2014-2016.
  
  The second chart, shows changes over time in the rate ratio of Black, Latinos and Asians compared to White. The top line shows that, overall, there has been a decrease in the disparity between the Black and White rates.

4.3a Top Ranking Causes of Deaths, Hospitalization, and ED Visits for Californians, Age 15-24

• This set of charts shows the leading causes of Deaths, Hospitalizations and Emergency Department (ED) visits for selected age groups at different stages of the life course.
  
  These age groups have been selected to highlight different patterns in causes of death, Hospitalizations, and ED Visits at each stage. Additional age groups, race/ethnicity and county level views for these same ranked data can be seen in the California Community Burden of Disease engine (https://skylab.dev.cdph.ca.gov/communityBurden/) in the “Ranks” section, in the “DEATH HOSP ED” Tab.

• This first chart is for the 15-24 year old age group, and shows that five of the top six causes of death and many of the top causes of ED visits, are injury-related. The top causes of hospitalization are mental health and perinatal-related.

4.3b Top Ranking Causes of Deaths, Hospitalization, and ED Visits for Californians, Age 45-54

• This next chart is for the 45-54 year old age group, and shows the leading causes of death include Cardiovascular, Other Chronic (Cirrhosis) and Injury; most of the causes of hospitalization are Other Chronic including mental health issues; and that ED visits are due to a wide range of conditions. Of note, septicemia is the leading cause of hospitalization, which will also be seen for older age groups.

4.3c Top Ranking Causes of Deaths, Hospitalization, and ED Visits for Californians, Age 85+

• This third chart is for the 85+ age group and indicates that Alzheimer’s disease is the leading cause of death. Cardiovascular Diseases are also leading causes of both death and hospitalization. Septicemia is the leading cause of hospitalization, and urinary tract infections are the second leading cause of ED visits—these two may well be related and deserve further investigation.

4.4a Top Ranking Causes by Hospitalization Rate

• These next two charts look at hospitalization and ED visit data by race/ethnicity; showing all race groups, with the ranks sorted based on one selected race group. These same charts, and for all age groups, for all California counties are also available in the CCB in the “Ranks” section, in the “AGE RACE FOCUS” Tab.

• This chart is for Hospitalizations, ordered for Whites, and indicates the leading causes for hospitalization for Whites, in order, are septicemia, arthritis, and mood disorders. The chart indicates this is not the same ordering for all other race/ethnic groups. For example, among Blacks, schizophrenia is the second highest cause of hospitalizations; and among Latinos, there are more hospitalizations for mood disorders than for arthritis.

4.4b Top Ranking Causes by Emergency Department Rate

5.1 Risk Factors Associated with the Largest Number of YEARS LIVED WITH DISABILITY 1990 and 2017

• These two charts present information about the risk factors associated with causes of death and disability. They are based on complex model estimates from the Institute for Health Metrics and Evaluation. They provide information for prioritizing public health resources and action based on assessing the prevalence of a wide range of behavioral and environmental risk factors, and the associations of these factors with specific conditions. These associations are modeled based on the three outcomes of deaths, years lived with disability, and disability adjusted life years.

• This chart shows that in 2017 [2019] the top two and fifth risk factors associated with the greatest number of Years Lived with Disability are related to heathy eating, exercise, and living in a place that facilitates these behaviors. Tobacco was the leading cause of Years Lived with Disability in 1990, but has dropped to the forth leading risk factor in 2017 [2019], due in larger part to effective public health programs over the last many years.

5.2 Risk Factors Associated with the Largest Number of DEATHS 1990 and 2017

• Similarly, the top three risk factors associated with numbers of deaths are related to heathy eating, exercise, and other factors associated with obesity and high-blood pressure. Again, tobacco has decreased from being the leading risk factor contributing to deaths to the forth leading cause.

6.1 Ischemic Heart Disease

6.2 Alzheimer’s Disease

6.3 Kidney Disease

6.4 Drug Poisonings

6.5 Suicide/Self-harm

6.6 Homicide/Interpersonal Violence

6.7 Road Injury

6.8 Hepatitis C

7.1a All-Cause Death Rate (Mean) by Quartiles of Community Poverty and Community Educational Attainment

• Bar charts

• The average all-cause mortality rate decreases steadily as poverty decreases. The mortality rate also decreases as education increases, but with the highest mortality rates among the second-lowest education quartile .

7.1b Life Expectancy (Mean) by Quartiles of Community Poverty and Community Educational Attainment

• These chart displays communities (MSSAs) grouped into quartiles based on poverty and educational attainment, and compares the mean mortality rates life expectancy across those quartiles. Note that the y-axis here starts at 65

• Average life expectancy increases with decreasing poverty and with increasing education.

7.2a All-cause Death Rate (Distribution) by Quartiles of Community Poverty and Community Educational Attainment

• The “Violin Charts” show the distribution of communities within each quartile.

• These charts corroborate the overall observations from the bar charts above, that community disadvantage is associated on average with worse health outcomes. But, these charts also make clear that with disadvantaged and advantaged communities there is wide variance in outcomes, and that this variance appears to be strikingly wider in disadvantaged communities compared to advantaged communities.
  
  In-depth and careful examination of these observations are a priority for the Fusion Center and our partners.

7.2b Life Expectancy (Distribution) by Quartiles of Community Poverty and Community Educational Attainment

7.3a Correlation of Age-Adjusted Death Rates with Community Poverty and Community Educational Attainment

• In these Scatter Plots each point represents a community (MSSA) and its positioning for the selected social determinant and health outcome. The grouping of points along a trend reflects the level and direction of correlation.

• Review of the scatter plots emphasizes the need to carefully review these data, especially before next complex multivariable steps are considered. The scatter plots show some likely influential outliers, and emphasizes the wide variance noted above.

7.3b Correlation of Life Expectancy with Community Poverty and Community Educational Attainment

• Because the life expectancy estimation procedure excludes small communities with less stable estimates, the correlation here are larger than for age-adjusted death rates. The correlation coefficient of -0.64 for poverty and life expectancy is striking.

7.4 County level social determinants and life expectancy

• Maps

• These maps indicate that at the county level poverty, education, and life expectancy are ecologically roughly correlated. The many observed exceptions to this correlation indicate the need for further in-depth analysis.

7.5 Communities with highest and lowest life expectancy

• This table shows the communities (MSSAs) with the 10 highest and lowest levels of life expectancy in the State. It also presents the mortality rate, percent living in poverty and percent with educational attainment of high school graduation and below, as well as overall population.

• This tabular view of the data highlights the strong community-level associations seen above, and emphasizes some extreme differences in life expectancy. The life expectancy in the “Clearlake /Clearlake Oaks” community in Lake County, with high levels of poverty and lower levels of education at 72.2 is about 16 years less than the life expectancy of 88.1 in the very advantaged community of “Bel Air /Beverly Glen /Beverly Hills /etc.” in Los Angeles County.

A.1 Ranking of Race/Ethnic Disparities in Death Rate, 2017-2019 (combined)

A.2 “Public Health Level” Ranking of Decreases in Deaths 2009 to 2019

A.3 “Public Health Level” Ranking of Increases in Deaths 2009 to 2019

A.4 Ranking of Years Lived with Disability 2017 (UNDER CONSTRUCTION)

A.5 Ranking of Number of Hospitalizations by Condition, 2019

A.6 Ranking of Number of Emergency Department Visits by Condition, 2019

A.7 CCB “Public Health Level” Number of Deaths by Top Level

C.1 Case Death Trends

• This chart of smoothed daily COVID-19 cases and deaths shows increases in deaths following increases in cases, and the tragic magnitude of the pandemic in California, with over 40,000 cases diagnosed per day and over 300 deaths per day in the final days of 2020.

C.2 Cases, Case Rates, and Case-Fatality Rates by Detailed Age and Gender

• This chart with detailed in 5-year age groupings shows: (1) the highest number of cases in the 20-24 to 30-34 year-old age groups, with more female than male cases in every age group except infants; (2) a similar pattern in rates except for relatively higher rates in the older age groups, and (3) steadily and strongly increasing case fatality rates with increasing age, and much higher case fatality rate for males than females in every age group.

C.3 Case Rates by Race/Ethnicity and Age Group

• This chart shows the higher rates of COVID-19 cases among Native Hawaiian/Pacific Islanders and Latinos than other race/ethnicity groups in all age groups.

C.4 Case Fatality Rates by Race/Ethnicity and Age Group

• This chart indicates that in the older age group, where by far the most deaths occur, that the case-fatality rate is higher for Asians, Blacks, and Latinos and lower for Whites and NH/PI.