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Chronic Diseases
Chronic diseases are the leading cause of death and disability in
Travis County, Central Texas, and the State of Texas. Multiple risk
factors, a long development period, and a prolonged course of illness
generally characterize chronic diseases. The occurrence of chronic
diseases generally increases with age.
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A major challenge for public heath and health services is to develop
and implement programs that can effectively reduce the risk factors
and therefore prevent or postpone the onset of chronic diseases.
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A major challenge is to reduce
risk factors and prevent or postpone the onset of chronic diseases.
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Chronic diseases are considerably influenced by individual behaviors
and lifestyles. The determinants that most effect an individual's
risks are behaviors such as smoking, an inactive lifestyle, and a
high calorie, high fat diet. These determinants give insight into
strategies for preventing or delaying the on set of chronic diseases.
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Coronary Heart Disease
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Stroke
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Cancer
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- Cancer is a diverse group of diseases characterized by a disruption
in the orderly growth of cells and is caused by a complex interaction
of genetic abnormalities and environmental exposures.
- Cancer accounts for one out of every five deaths in the United States
(American Cancer Society, September 2000).
- Cancer is the second leading cause of death in Texas, the MSA, and
Travis County (TDH, September 2000, Epigram).
- The rate of cancer deaths in Travis County has not changed significantly
in the past ten years. The ten year average rate for Blacks (196.4
per 100,000) is 62.2 percent higher than that of Whites (121.1 per
100,000). The ten year rate for Hispanics (99.0 per 100,000) is below
that of Whites (TDH, September 2000, Epigram).
- The rate of new cancer cases and deaths for all cancers combined
as well as for most of the top 10 cancer sites (in the body) declined
between 1990 and 1997 in the United States (National Cancer Institute,
September 2000).
- All local cancer death rates are well below the Healthy People national
year 2000 objective of no more than 130 per 100,000 people (Public
Health Service, 1990).
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Lung Cancer
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- Cancer of the lung and bronchus (hereafter, lung cancer) is the
most common cancer among both men and women and is the leading cause
of cancer death in both sexes. The rates among men are about two
to three times greater than the rates among women in each of the
racial/ethnic groups (American Cancer Society, September 2000).
- As with all cancers, the rate of lung cancer deaths in Travis
County has not changed significantly in the past ten years. The ten
year average rate for Blacks (59.7 per 100,000) is 62.2 percent higher
than that of Whites (36.8 per 100,000). The rate for Hispanics (16.5
per 100,000) is less than half that of Whites (American Cancer Society,
September 2000).
- The Travis County ten year average lung cancer death rate in men
(35.9 per 100,000) is 43 percent higher than that of women (25.1
per 100,000) (TDH, September 2000, Epigram).
- The Healthy People national year 2000 objective was no more than
42 lung cancer deaths per 100,000 people (Public Health Service,
1990).
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Colorectal Cancer
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- Colorectal cancer, or cancer of the colon and rectum, is the second
leading cause of cancer death in Travis County (American Cancer Society,
September 2000).
- Spanning from 1989 to 1998, the ten year average death rate for
Blacks (22.3 per 100,000) is more than twice that of Whites (10.9
per 100,000) and the rate for Hispanics (8.9 per 100,000) is less
than that of Whites (TDH, September 2000, Epigram).
- The Healthy People national year 2000 objective was no more than
13.2 colorectal cancer deaths per 100,000 people (Public Health Service,
1990).
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Breast Cancer
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- In Travis County, breast cancer accounts for 23 percent of all
cancer deaths in women (TDH, September 2000, Epigram).
- The 1989-1998 ten year average breast cancer death rate for Black
women (32.4 per 100,000 women) is 55.8 percent higher than that of
White women (20.8 per 100,000 women). The rate for Hispanic women
(13.3 per 100,000 women) is 36 percent lower than that of White women
(TDH, September 2000, Epigram).
- The Healthy People national year 2000 objective was no more than
20.6 breast cancer deaths per 100,000 women (Public Health Service,
1990).
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Diabetes Mellitus
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Oral Health
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- The first-ever Surgeon General's Report on Oral Health states that
oral health means much more than healthy teeth and is integral to the
general health and well being of all Americans. No one can be truly
healthy unless he or she is free from the burden of oral and carniofacial
diseases and conditions (National Center for Chronic Disease Prevention
and Health Promotion [NCCDPHP], September 2000, Children's Oral Health).
Oral health must be included in the provision of health care and design
of community programs (National Center for Chronic Disease Prevention
and Health Promotion [NCCDPHP], September 2000, Oral Health in America).
- Dental caries is the single most common chronic disease of childhood,
occurring five to eight times as frequently as asthma, the second most
common chronic disease in children (NCCDPHP, September 2000, Children's
Oral Health).
- Cases of dental caries have declined dramatically among school-aged
children. This decline is the result of various preventive regimens
such as community water fluoridation and increased use of toothpaste
and rinses that contain fluoride, and protective sealants. Dental caries,
however, remain a significant problem in some populations, particularly
among certain racial and ethnic groups and poor children.
- The Austin Dental Collaboration provides under-served second through
seventh graders in Austin with dental screening and sealants to help
prevent cavities. This program is a collaboration between the Austin
Independent School District, Austin/Travis County Primary Care Department,
St. David's Foundation, Children's Hospital of Austin, and the Capital
Area Dental Society. The comprehensive school dental health program
includes:
- A sealant program
- A surveillance system
- An acute care system
- A wraparound education/oral hygiene instruction program.
- In the 1999-2000 school year the Austin Dental Collaboration screened
1,817 second and third graders (typically aged 7-8) for untreated tooth
decay. Thirty eight percent of those screened had untreated dental
decay (personal communication with Nana Lopez, DDS, December 2000;
Austin Dental Collaboration, 2000).
- One of the Healthy People 2000 national objectives was to reduce
untreated dental caries so that the proportion of children with untreated
caries in permanent or primary teeth is no more than 20 percent among
children age 6 through 8 (Public Health Service, 1990).
- Client visits to two clinics, the Austin/Travis County Primary Care
Department's RBJ Dental Clinic and the Manos de Cristo Dental Clinic,
were reviewed. Both clinics serve predominantly low-income under-served
populations.
- A random sampling of client charts from the RBJ Dental Clinic
revealed that 53 percent of the client visits were for emergency
care (personal communication with Nana Lopez, DDS, December 2000).
- In 1999, the Manos de Cristo Dental clinic saw 6,163 patients,
of which 2,738, or 44.4 percent, were emergency care (Manos de
Cristo Dental Clinic, 2000).
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The implication of this data is that individuals, particularly those
of low-income medically under-served populations, do not put a priority
on dental care and seek services only as a last resort. This could
suggest that better oral health access and education is needed in this
targeted population.
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