Heart of the Matter

We know exactly what you said the minute “The Local Burden of Cardiovascular Disease: Deaths From Heart Disease and Stroke in California Cities” was released to the media last week:

“Honey, call the moving company. We’re gonna go live in Monterey Park, where we’ll be least likely to die of stroke. Or would you prefer South Lake Tahoe, where we’ll be least likely to die of heart disease?”

Meanwhile, you Yucaipans and Citrus Heighters were probably too stressed out to even think about picking up the phone after hearing that you had the state’s highest death rates from stroke and heart disease, respectively.

So what accounts for the differences? Why is it that a person living in Yucaipa is three times as likely to die of stroke as a resident of Monterey Park, and a person living in Citrus Heights is four times as likely to die of heart disease as someone living in South Lake Tahoe? The accompanying snapshot assessment of each community (see graphic) is a start in the search for answers.

Citrus Heights, of course, is a suburb of Sacramento, not exactly a low-stress city. South Lake Tahoe, on the other hand, is the land of Many Recreational Opportunities with Sporting Goods Stores to Match. Residents of Monterey Park--City of a Billion Asian Restaurants--may very well benefit from healthy meal-time choices of steamed vegetables and seafood. But what about Yucaipa? Why does it have the highest death rate from stroke when it’s nestled in the peaceful San Bernardino foothills?

According to the “Local Burden” study, the state’s first-ever city-by-city breakdown, several risk factors account for stroke and heart disease. The study looked at each of the 245 California cities with a population of 20,000 or more in 1990 and examined deaths over the three-year period 1989-91. Causes of death in each city were obtained from state statistical records and an absolute rate, adjusted for age and race, was calculated for each city.

That rate was then compared to the rate for the state as a whole.

Citrus Heights, for example, had an annual heart disease rate of 283.94 deaths per 100,000 people, while the state as a whole had 158.99 deaths per 100,000.

Behavior such as smoking and a dislike for physical activity are routinely cited as contributors to heart disease and stroke. Also weighing in are socioeconomic status, limited access to health care, and environmental factors, such as limited access to low-fat foods.

“The study is important because, with limited resources, we want to target prevention in areas where there is the highest rate of death,” said George Kaplan, chief of the state’s Human Population Laboratory in Berkeley. “It shows that there are a substantial number of cities, 15% or so of the total, which have elevated death rates from heart disease. I don’t think we could have predicted which cities those would be.”

The cities themselves were greatly surprised, says Jeannie Gazzaniga, who directed the program for the California Department of Health Services. “We’ve been flooded with phone calls for the past week. The cities with high death rates want to know why, and what’s encouraging is they also want to know what they can do to prevent such high amounts of deaths in their own backyards.”

The department hasn’t heard from the cities with low death rates, which is unfortunate, she said, because the study wasn’t intended to be a report card on disease prevention and there’s room for improvement everywhere.

“Cardiovascular disease is the leading cause of death in California for all race and ethnic groups and both genders--across the board,” Gazzaniga said.

She looks forward to stepped-up cooperation among city governments, doctors, hospitals and recreation departments.

Meanwhile, we suggest holding off on the moving van until more research is available.

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South Lake Tahoe (Heart Disease: Lowest)

With its tourism-based economy, South Lake Tahoe has more restaurants and night life than most larger cities, plus a High Sierra park-like setting. Attracted by summer and winter sports, its residents are “consciously willing to make a trade-off of dollars for the quality of life,” says one.

Population: 22,565

Average Household Income: $35,829

Hospitals: 1, plus several urgent care centers

Doctors: 80

Parks: Beaches and campgrounds; large wilderness area, miles of hiking trails.

Public Swimming Pools: Under development in complex with tennis courts, new ice skating rink

Public Golf Courses: 4

Bike Paths: Extensive Network

Fast Food Restaurants: 6

Sporting Goods Stores: 3, plus dozens of specialty rental stores

Health Food Stores: 4

Chiropractors: 21

Acupuncturists: 4

Senior Citizen Centers: 1

Farmers Market: 1

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Citrus Heights (Heart Disease: Highest)

Developed on acres of wooded ranchland crisscrossed by creeks and streams, this Sacramento suburb is a typical bedroom community of residences, and small businesses, plus the sprawling Sunrise shopping mall. This unincorporated community is on the November ballot for cityhood.

Population: 113,205

Average Household Income: $49,071

Hospitals: 2

Doctors: More than 100

Parks: More than a dozen, including a large urban park with walking paths

Public Swimming Pools: 1

Public Golf Courses: 1, plus many in area

Bike Paths: Extensive network

Fast Food Restaurants: Dozens

Sporting Goods Stores: 20

Health Food Stores: 30

Chiropractors: 50

Acupuncturists: 12

Senior Citizen Center: 1

Farmers Market: 1

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Monterey Park (Stroke: Lowest)

The original hub of Asian immigration for the San Gabriel Valley, Monterey Park is a bustling city in transition from a bedroom community to self-sufficiency. Fifteen minutes from downtown Los Angeles and ringed with freeways, it is sprouting new businesses daily, including a gourmet mecca of Chinese restaurants.

Population: 57,176

Average Household Income: $45,559

Hospitals: 3

Doctors: 80

Parks: 5 large, many small

Public Swimming Pools: 2

Public Golf Courses: 1

Bike Paths: 1

Fast Food Restaurants: 8

Sporting Goods Stores: 2

Health Food Stores: 3 general stores and dozens of Chinese stores

Chiropractors: 10

Acupuncturists: At least 40

Senior Citizens Center: 1

Farmers Market: None

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Yucaipa (Stroke: Highest)

Incorporated in 1989, Yucaipa occupies a picturesque valley in the San Bernardino foothills, 80 miles east of Los Angeles. Ringed by mountains and forests, it offers the clean air of its 3,000-foot altitude and commuter convenience to several urban centers for a growing number of young families, attracted by its small-town flavor.

Population: 37,842

Average household income: $37,120

Hospitals: 2 clinics (nearest hospital is 10 miles away in Redlands)

Doctors: 20

Parks: 6

Public Swimming Pools: 2

Public Golf Courses: 1 planned

Bike Paths: Hiking, equestrian and mountain bike trails in the works; miles of hiking trails

Fast Food Restaurants: 3

Sporting Goods Stores: 1

Health Food Stores: 3

Chiropractors: 10

Acupuncturists: 1

Senior Citizens Center: 1

Farmers Market: 1 (June through September)

* Additional research provided by Janet Lundblad, Times library.

* Sources: Claritas Inc.; “The Local Burden of Cardiovascular Disease: Deaths From Heart Disease and Stroke in California Cities” by Cardiovascular Disease Outreach, Resources and Epidemiology (CORE) Program, UC San Francisco, California Department of Health Services; staffs of city halls and chambers of commerce for Yucaipa, South Lake Tahoe, Monterey Park and Citrus Heights.