DISEASE AND INJURY IN CALIFORNIA WITH PROJECTIONS TO THE YEAR 2007 - IMPLICATIONS FOR MEDICAL-EDUCATION

In this article, as part of an evaluation of the future of medical edu cation in California, we characterize the distribution of disease and injury in California; identify major factors that affect the epidemiol ogy of disease and injury in California, and project the burden of dis ease and injury for California's population to the year 2007. Our goal is to elucidate the major causes of illness and disability at present and in the near future in order to focus state resources on the inter ventions likely to have the greatest impact. Data from various governm ental agencies were utilized; the base year, 1993, is the most recent year with sufficient information available when this report was prepar ed. Several major risk factors have decreased, including smoking (30% decline from 1984 to 1993) and drinking and driving. However, hyperten sion prevalence has not changed, and overweight has increased dramatic ally. Poverty continues to burden about 15% of Californians, with pove rty highest among children. During 1993, 220,271 Californians died, wi th 3 major causes accounting for 61% of these deaths: coronary heart d isease (31%), cancer (23%), and stroke (7%). In terms of potential yea rs of life lost (years lost before age 65), the most important causes of death in 1993 were unintentional injury (756 years lost/100,000 pop ulation), cancer (632 years), and the acquired immunodeficiency syndro me (AIDS; 491 years). Mortality rates were highest among blacks and lo west among Asians. Overall mortality in California has been declining for decades; ire just 1 decade, from 1980 to 1991, mortality declined from 780 to 680 deaths per 100,000 population. Several major causes of death have declined, including coronary heart disease, stroke, uninte ntional injury, cirrhosis, and suicide, while others have increased, f or example, chronic obstructive lung disease and diabetes mellitus. De ath from AIDS increased dramatically in the past decade, but is leveli ng off, and death from cancer is beginning to decline. Rates for overa ll mortality and morbidity, and for most specific conditions, should c ontinue to decline. A projected 28% population increase by 2007 will y ield a corresponding increase in the absolute level of disease cages a nd death; a disproportionate increase in younger and older groups will yield increased conditions affecting young (unintentional injury, AID S) and older (heart disease, cancer, stroke, diabetes mellitus) people . Californians should experience overall improved health in coming yea rs, reaping benefits of reduced environmental and behavioral risk fact ors as well as improved medical treatment and rehabilitation. Coordina ted strategies for health promotion, disease prevention, delivery of m edical treatment, and rehabilitation are needed to maintain and improv e present levels of health across the life span.