Running head: SAN BERNARDINO COUNTY HEALTH OUTCOMES 1

San Bernardino County Health Outcomes

Allison Bateman

Andrea Pineda-Gutierrez

Jeanette Montoya

Nickole Argentieri

Rae Chelle Gabriel

California State University, San Bernardino

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Introduction

Being one of the highly populated counties in California, San Bernardino is prone to

represent some of the major health outcomes as those that are seen in the state. Some of the

major health issues San Bernardino County and the state are facing are cancer, heart disease, and

gonorrhea. There are countless factors contributing to these issues, some of which could be due

to the demographics of the county. It is important to determine and highlight those who are at a

higher risk for these diseases to help educate and prevent as many cases as possible to make San

Bernardino County and California a healthier place.

Analysis

Top Deaths in San Bernardino County

Cancer. Cancer is the second leading cause of death in California accounting for 1 in 4

deaths, but sits at the top as the leading cause of death in San Bernardino County. Between 2012-

2014, the cancer death rate in the county was 164.7 per 100,000 persons, higher than state

average and Healthy People 2020 Objective of 161.4 (Dignity Health, 2017). The top cancer

mortality rates are due to cancers within the digestive system, respiratory system, and breast. In

2010, Black or African Americans within the county had the highest age-adjusted cancer death

rate of 221.8 per 100,000, following Hispanic/Latinos with an age-adjusted death rate of 132.9

per 100,000, and Asians and Pacific Islanders with an incidence rate of 108.9 per 100,000

(Figure A1) (California Pan-Ethnic Health Network, 2018).

Several factors contribute to the high cancer mortality rates in San Bernardino County

including the most common causes of cancer like diet and physical exercise, and smoking and

tobacco use. Twenty percent of San Bernardino County’s population have poor to fair health

contributing to the diet and physical exercise aspect of cancer causes. Additionally, 13% of the
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adult population are cigarette smokers. According to the American Cancer Society (2018), 85%

of lung cancers are caused by cigarette smoking and half of all people who continue to smoke

will die from smoking-related diseases. Among current smokers in San Bernardino County,

36.7% of adults smoke 6-10 cigarettes a day, 18.3% smoke 11-19 per day, and 35.9% smoke 20

or more a day, more than Californians in general (Dignity Health, 2017).

Heart Disease. In San Bernardino County, heart disease is the second leading cause of

death. In the time period between 2012 -2014 approximately 1,811 people died due to heart

disease problems. The death rate was at an alarming 113.4. The Healthy People 2020 Objective

is of 103.4 deaths per 100,000 persons which would be lowering the rate by 10 percent (Dignity

Health, 2017). While the death rate has declined, there has been an increase in the percentage of

county residents who were diagnosed with heart disease from 5.7% in 2005 to 6.5% in 2013 (San

Bernardino County, 2015). Heart disease mainly targets elderly adults since blood vessels

become less flexible and is harder to move blood throughout their bodies over time (Resnick,

2014). As a result, adults 65 years or older are more at risk of dying of Heart Disease.

Top Diseases in San Bernardino County

Gonorrhea. One of the top diseases in San Bernardino county is gonorrhea. Per the

Annual Morbidity Report, 3,384 new cases of gonorrhea were reported in 2016 (2017).

According to the Center for Disease Control (CDC) gonorrhea is a sexual transmitted disease

that infects multiple parts of the body including, genitals, rectum and throat (2017). Those who

are at risk of contracting the STD are those who participate in unprotected sex, especially with a

partner who is infected with the bacteria, Neisseria gonorrhoeae (2017). Thus, the high number

of cases reported in 2016 are not shocking due to the easy mode of transmission. As seen in

Figure A2, the top three races reported who were infected with the disease was Hispanics, Black
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and White (2017). This is not including the 1,492 cases that were reported without a known race.

As mentioned in the demographics assignment, these are the top three populated races reported

in the county as well. As shown in Figure A3, gonorrhea is seen mostly in those who are between

ages 20-24, 25-29 and 15-19. There are countless reasons as to why these age groups are at a

high risk for contracting the disease. Such reasons could include the lack of monogamous

relationships and education.

Although Gonorrhea can be treated with antibiotics, it is important for individuals that

are at a high risk to be screened yearly for the disease. Screening for this highly communicable

disease is imperative to help lower the spread of the disease and reduce further complications

that can arise if it is left untreated. If left untreated the following problems can arise, ectopic

pregnancies, infertility and increase in HIV susceptibility (2017).

Heart Disease. Since heart disease is the second leading causes of death, it heavily

affects the county’s population as one of the top chronic diseases. Among the county population,

15.1% reported being in fair or poor health. This rate is lower than the California rate of 17%.

According to Institute for Health Metrics and Evaluation (2016), in 2014, heart disease it was

more common in males with 195.2 males per 100,000 and 135.7 females per 100,000, both

higher than state average (see Figure A4). Among the 4.1% of the adults in San Bernardino

County that have been diagnosed with heart disease, about 75.6% has a disease management

plan. Although the number seems high and not concerning, about 4.2% of the population that is

diagnosed with heart disease do not feel confident that they have the condition under control.

Prevention Quality Indicators (PQIs) identify hospital admissions that may be avoided through

access to high-quality outpatient care. The three PQIs related to heart disease are hypertension,
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heart failure, and angina without procedure. In 2014, there were 376.5 adults admitted into

hospitals due to Congestive Heart Failure.

Discussion/Comparing Data

As discussed, the leading cause of death in the County of San Bernardino is cancer. The

highest rate of cancer deaths of people living in San Bernardino includes breast cancer, rectum

and colon, tracheal, bronchus, and lung cancer. As stated above, there are many factors that

contribute to the high cancer mortality such as diet, physical activity, and smoking and tobacco

usage. Looking into the demographics of San Bernardino County, 17.6% of San Bernardino

County’s population is currently living under the poverty line (San Bernardino County, 2017).

Individuals living under the federal poverty line are more likely to have higher obesity rates and

less likely to have access to healthy and nutritious foods, contributing to the high risk factors for

cancer. According to the CDC, among males and females in California, lung and bronchus

cancer have high rates of deaths also like San Bernardino County, along with breast, colon and

rectum. In comparison to the United States the same three cancers are ranked in the top three

with the only difference is colon and rectum cancer rank higher with being second, and breast

cancer third. This information shows the whole United States follow the same unhealthy

patterns.

The second leading cause of death in the San Bernardino county is heart disease, with

cancer being the top, heart disease following makes perfect sense due to the unhealthy lifestyles.

Along with the mentioned diet, physical activity, smoking, and tobacco usage, high blood

pressure and high cholesterol are also contributing factors. Again, this could be in relations to the

17.6% of San Bernardino County’s population living under the poverty line with limited access

to nutritious foods. Another contributing factor is gender. Heart disease was once known as a
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man’s disease, but it is now the leading cause of both men and women. In San Bernardino

County, the sex demographic is almost even between females and males with 50.2% females and

49.8% males. The United States along with California, ranks heart disease as the leading cause of

death. Even as California’s leading cause of death, it ranks 40th as a state among deaths (CDC).

Smoking, overeating, and lack of exercise, which causes obesity and puts a hard weight on your

heart, which is why it is the leading cause of death.

Previously stated, one of the top diseases in the San Bernardino county is Gonorrhea is

ranks third as one of the leading causes of diseases and continues to increase in cases. San

Bernardino is currently having a concerning increase in syphilis, especially with pregnant

women. In 2017, gonorrhea was more prevalent in Blacks with 225.1, Hispanics with 76.3 and

Whites with 44.5 per 100,000 (Ibrahim, 2018). Taking a deeper look at the demographics, the top

three ethnicities for San Bernardino County consists of the Hispanic/Latino descent (53.4%),

followed by White (28.6%), Black or African American (9.4%) (US Census Bureau, 2018).

According the California Department of Public Health (CDPH), the two leading STD rates in

California were chlamydia and Gonorrhea with rates continuing to increase dramatically. In the

United States the number 1 reported STD is Human Papillomavirus Virus (HPV). Second and

third most reported STDs are similar among San Bernardino county, and California’s being

Gonorrhea and Chlamydia (CDC). The rates of STDs are increasingly getting higher and this

could be due to the lack of education in schools providing education on protection. Dating apps

have also been said to be a stigma in the reason of why STD rates are becoming extremely high.

Conclusion

As stated, San Bernardino County is one on California’s largest and most populated

counties. San Bernardino County is prone to represent some of the major health outcomes, such
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as top deaths with cancer and heart disease, and top diseases with gonorrhea and heart disease.

After taking a deeper look and comparing the demographics, cancer and heart disease are

prevalent in San Bernardino County due to the high percentage of the population that fall under

the federal poverty line. This relates to the unhealthy lifestyles of the residents in San Bernardino

County in result of being overweight, not having access to nutritious foods and participating in

unhealthy behaviors. Gonorrhea was found to be more prevalent in Blacks, Hispanics and

Whites, which represents San Bernardino County’s top three ethnicities. It is important to utilize

this information to identify and better assist those who are at a higher risk for these diseases to

implement preventative measures to make San Bernardino County and California a healthier

place.
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References

American Cancer Society. (2018). What Causes Cancer? Retrieved from

https://www.cancer.org/cancer/cancer-causes.html

California Pan-Ethnic Health Network. (2018). Cancer Death Rates (San Bernardino County,

2010). Retrieved from https://cpehn.org/chart/cancer-death-rates-san-bernardino-county-

2010

Center for Disease Control and Prevention. (2017). Gonorrhea-CDC Fact Sheet. Retrieved from

https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm

Dignity Health. (2017). Community Hospital of San Bernardino Community Health Needs

Assessment 2017. Retrieved from https://www.dignityhealth.org/socal/-

/media/Service%20Areas/socal/PDFs/CHSB%202017%20CHNA%2062817.ashx?la=en

&hash=4479946F6ABA3D4B92DF76BEB510D47227B2ACF5

Ibrahim, D. (2018). STI/HIV Update 2018. San Bernardino County Public Health Department

Communicable Disease Section. Retrieved from http://wp.sbcounty.gov/dph/wp-

content/uploads/sites/7/2018/05/std-2018-final.pdf

Institute for Health Metrics and Evaluation (IHME). (2016). US County Profile: San Bernardino

County, California. Retrieved from

http://www.healthdata.org/sites/default/files/files/county_profiles/US/2015/County_Repo

rt_San_Bernardino_County_California.pdf

San Bernardino County. (2016). 2016 Annual Morbidity Report. Retrieved from

http://wp.sbcounty.gov/dph/wp-content/uploads/sites/7/2017/11/annual-report-2016-

final.pdf

San Bernardino County. (2017). Community Indicators Report. Retrieved from

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http://cms.sbcounty.gov/Portals/21/Resources%20Documents/CIR_2017_report.pdf?ver=

2018-03-23-132312-883

National Center for Health Statistics. (2018, April 13). Retrieved from

https://www.cdc.gov/nchs/pressroom/states/california/california.htm

USCS Data Visualizations. (n.d.). Retrieved from

https://gis.cdc.gov/Cancer/USCS/DataViz.html

Sexually Transmitted Diseases Data. (n.d.). Retrieved from

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/STD-Data.aspx#

US Census Bureau. (2018). About Race. Retrieved from

https://www.census.gov/topics/population/race/about.html
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Appendix

Figure A1. This bar graph is a representation of age-adjusted cancer death rate per 100,000 by

race in San Bernardino County.

Figure A2. This bar graph is a representation of the number of gonorrhea cases that were

reported by race.
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Figure A3. This pie chart is a representation of all the age groups of the reported cases of

gonorrhea.

Figure A4. This bar graph is a representation of heart disease between San Bernardino County

and California by males and females per 100,000.