Healthy Behaviors

As a physician for more than a quarter-century, I am equally certain that much of what affects our health actually happens outside the doctor’s office, such as whether we eat nutritious food, engage in physical activity, or breathe clean air.

—Dr. Gerard Clancy, University of Tulsa President, 2015

Chronic diseases such as heart disease, diabetes, and obesity are some of the most common and costly diseases in the US. In fact, eight of the top ten causes of death in Tulsa County in 2018 were chronic conditions. Chronic diseases also account for more than three-quarters of the nation's health care expenditures. 

However, chronic diseases are often preventable, as they are associated with specific unhealthy and risky behaviors. According to the American Public Health Association, four behaviors are at the root of a large portion of the nation's chronic disease burden: physical inactivity, poor eating habits, tobacco use, and alcohol consumption. These behaviors are often influenced by the conditions in which people live, work, learn and play (social determinants of health).

Efforts to address these health behaviors include interventions at both a personal and a policy level. For example, policies that support walkable neighborhoods or school nutrition guidelines can help promote physical activity and good eating habits (1). 

Data for this section are obtained from the Behavioral Risk Factor Surveillance Survey (BRFSS).

Weight Status

Definition

This indicator is the percentage of Tulsa County residents who were overweight or obese (total overweight) in 2018. Overweight is defined by the World Health Organization as individuals who have a body mass index (BMI) greater than or equal to 25. Obesity refers to individuals who have a BMI greater than or equal to 30. BMI is calculated by taking the person’s weight in kilograms divided by the square of his height in meters (kg/m2).

Data in this section is not available at the zip code or regional level.


Why is this indicator important?

A variety of factors, including behavioral, environmental, and genetic factors can all play a role in being overweight/obese. Individuals who are overweight or obese have an increased risk of many health conditions: heart disease, type 2 diabetes, certain cancers, hypertension, and stroke, as well as other conditions. Being obese or overweight (and their associated health problems) have a significant economic impact on the health system through direct medical costs, lost productivity in the general workforce, and early death (2).

How are we doing?

In 2018, Tulsa County had an almost identical  percentage of individuals who were overweight or obese (69.4 percent) compared to Oklahoma (69.6 percent) and both were slightly higher than the percentage for the the US (65.8 percent).  This indicator has been somewhat erratic for Tulsa County; however, after a sharp increases from 2016 to 2017, it has remained relatively stable.    

In 2018, 69.4 percent of Tulsa County residents were overweight or obese (39.3 percent overweight; 30.1 percent obese). In general, the percentage of obese Tulsa County residents has been lower than the percentage of overweight residents since 2011, although there was a sharp increase in the percentage of those who are obese from 2016 to 2017, and an additional slight increase from 2017 to 2018.  

Men were more likely to be overweight/obese than women (for 2018, men were at 77.1 percent compared to women at 61.5 percent). This has been true since 2014, with both genders showing a very slight  increase overall from 2014 to 2018.  The prevalence of total overweight was also highest among individuals (55-64), although it was high for those 25-34 as well. There were only enough cases to be reported in terms of overweight and obese and race for those who reported as White, non-Hispanic Black non-Hispanic and American Indian/Alaskan Natives individuals.  Of these three racial groups in Tulsa County in 2018, the percentages of those who were reportedly overweight or obese was highest among American Indian/Alaskan Natives.  

With regard to socioeconomic factors, total percentage of those overweight or obese, the highest percentage was for adults who had an income between $15,000 and $24,999 annually.  The percentage of individuals reportedly overweight or obese was lowest among those who made between  $25,000 and $49.999 a year.  Percentages of those who were overweight or obese were lowest among adults who have less than a high school education.   

Physical Activity

Definition

This indicator is presented as the percentage of adults in 2018 who reported no physical activity in the past month, other than their regular job.

Why is this indicator important?

Regular physical activity can improve the health and quality of life of people of all ages, regardless of the presence of a chronic disease or disability.  Among adults and older adults, physical activity can lower the risk of early death, coronary heart disease, stroke, high blood pressure, type 2 diabetes, breast and colon cancer, falls, and depression.  Among children and adolescents, physical activity can improve bone health, improve cardiorespiratory and muscular fitness, decrease levels of body fat, and reduce symptoms of depression.  For people who are inactive, even small increases in physical activity are associated with health benefits.  Although there are many factors that can increase physical activity, some environmental influences include the presence of sidewalks, access to public transportation, low traffic density, and access to a neighborhood or school play area (3). 

How are we doing?

Overall, about 25 percent (25.4 percent) of Tulsa County adults reported no leisure time physical activity in the previous month in 2018. This was  lower, but similar to Oklahoma (27.2 percent), and about 2 points higher than the US (23.8 percent). This trend has been true since 2011, although the rate of no leisure time physical activity has been variable for all regions. It is interesting to note that the up and down pattern for this indicator from 2011 to 2018 is reflected at each level of analysis: county, state and national.  In 2018, all of these regions met the Healthy People 2020 national target of 32.6 percent of adults reporting no leisure time physical activity.

In Tulsa County, males were slightly less likely than females to have no leisure time physical activity (23.8 percent compared to 26.8 percent). This was true for Oklahoma overall, as well, with males at 25.2 percent with no leisure time physical activity in the past month compared to 29.1 percent for females.  Additionally, as shown in the graph to the right, adults showed a very obvious increase in those who reported no leisure time physical activity in the past month as they age.  With regard to race and ethnicity, there were only three racial/ethnic categories with enough data for percentages to be reported for Tulsa County; white, non-Hispanic, Black, non-Hispanic and American Indian/Alaskan Natives.  Of these three categories, black, non-Hispanics had a higher percentage of no leisure time physical activity compared to American Indian/Alaskan Natives.  Hispanics had the highest percentage of individuals who reported no leisure time physical activity in the past month.

Leisure time physical activity is also interesting when looked at by income level, as shown in the graph below.  It is clear that the percentages of those reporting no leisure time physical activity in the past month decreased sharply as income level increased for both Tulsa County and Oklahoma; but for Tulsa County, individuals who reported annual incomes between $25,000 and $49,999 annually were almost as high as for those making less than $15,000 annually.  A clear pattern is also evident for both Tulsa County and Oklahoma in terms of leisure time physical activity in the past month and education level.  As education level increased, percentages of those who reported no leisure time physical activity in the past month decreased.   

Nutrition


Fruits

Definition

This indicator is the percentage of Tulsa County residents who reported that they consumed less than one serving of fruit daily.  Data for this indicator is gathered through the BRFSS in alternating years.  The most recent year of data is from 2017.   

Why is this indicator important?

Fruits and vegetables are part of a well-balanced and healthy diet. Eating more fruits and vegetables along with whole grains and lean meats, nuts, and beans is a way to lose weight or maintain a healthy weight. Along with helping to control weight, diets rich in fruits and vegetables may reduce the risk of some types of cancer and other chronic diseases. Fruits and vegetables also provide essential vitamins and minerals, fiber, and other substances that are important for good health (4).

How are we doing?

In 2017, 43.0 percent of Tulsa County residents reported that they consumed less than one serving of fruit daily. This was slightly lower than Oklahoma (45.8 percent) but higher than the United States (36.6 percent).  This trend has been true since 2013.

Men were more likely to report low fruit consumption than women in 2015 (55.6 percent compared to 42.3 percent). In 2017, the percentage of men who reported they ate less than one serving of fruit daily decreased, and was much closer to the percentage for females on this indicator (44.0 percent compared to 42.1 percent).  For Tulsa County, adults ages 25–34 were most likely to report that they consumed less than one serving of fruit daily and adults over 75 were least likely to report having consumed less than one serving of fruit daily.  For Oklahoma, the highest percentages of those who reported having consumed less than a serving of fruit daily were for adults 18-24 and 35-44.

In terms of race/ethnicity, there were too few participants in the BRFSS for any race/ethnicity other than white, non-Hispanic to be reported.  For Oklahoma, the highest percentages of those who reported having consumed less than a serving of fruit daily were those who reported being multiple races, non-Hispanic and those who reported being black, non-Hispanic.  

For Tulsa County, low fruit consumption was highest among adults who had an incomes between $25,000 and $49,999 annually (49.5 percent) and lowest in adults making $50,000 to $74,999 annually (33.2 percent). For Oklahoma the pattern was clearer that as income level increased, the percentages of those reporting low fruit consumption decreased.  The same pattern is seen generally in terms of fruit consumption and education;  as education levels increased, the percentages of those reporting low fruit consumption decreased. 




Vegetables

Definition

This indicator is the percentage of Tulsa County residents who reported that they consumed less than one serving of vegetables daily.  Data for this indicator is gathered through the BRFSS in alternating years.  The most recent year of data is from 2017.   

Why is this indicator important?

Most fruits and vegetables are naturally low in fat, sodium, and calories. None have cholesterol. Nutrients that are obtained from fruits and vegetables include potassium, dietary fiber, folate (folic acid), vitamin A, and vitamin C. These nutrients can help lower cholesterol and blood pressure, as well as keep the body healthy overall. Consumption of folate (folic acid) is especially important for women of childbearing age who may become pregnant. Folate (folic acid) lowers the risk of birth defects during fetal development (5).

How are we doing?

In 2017, 16.2 percent of Tulsa County residents reported that they consumed less than one serving of vegetables daily. This was lower than both Oklahoma and the US (17.1 percent and 18.1 percent, respectively).  The percentages of those who reportedly consumed less than a serving of vegetables daily has been decreasing for Tulsa County and Oklahoma since 2011.

In Tulsa County, men were more likely to report low vegetable consumption than women (20.7 percent compared to 17.8 percent). However, the percentage of males who reported low vegetable consumption decreased slightly from 2015.  For Tulsa County, adults ages 25–34 were most likely to report that they consumed less than one serving of vegetables daily, for Oklahoma the highest percentage on this indicator were for adults age 18-24.  In terms of race/ethnicity, for Tulsa County there were too few respondents from Tulsa County to the BRFSS for any racial or ethnic group but white, non-Hispanic to be reported on this indicator.  For Oklahoma in 2017, the highest percentage of low vegetable consumption was for people who reported as black, non-Hispanic and for Hispanics.

With regard to socioeconomic factors, both Tulsa County and Oklahoma showed the same pattern; as income level increased, the percentages of those who reported low vegetable consumption decreased.  The same pattern was true of education level for both locations in 2017; the percentages of those reporting low vegetable consumption decreased as education levels increased. 










Tobacco Use

Definition

This indicator is the percentage of Tulsa County residents who smoked cigarettes in 2018.

Why is this indicator important?

Tobacco use is the single most preventable cause of death and disease in the United States. Tobacco use causes cancer, heart disease, lung diseases (including emphysema, bronchitis, and chronic airway obstruction), premature birth, low birth weight, stillbirth, and infant death. Secondhand smoke causes heart disease and lung cancer in adults and a number of health problems in infants and children, including severe asthma attacks, respiratory infections, ear infections, and is associated with Sudden Infant Death Syndrome (SIDS). There is no risk-free level of exposure to secondhand smoke (6).

How are we doing?

In 2018, 18.2 percent of Tulsa County residents reported smoking cigarettes on some days or every day (current smokers). This was lower than Oklahoma (19.7 percent) and higher than the United States (16.1 percent). The percentage of current smokers rose sharply for Tulsa County from 2016 to 2017, from 14.3 percent to 20.0 percent, before declining again from 2017 to 2018.  The percentages of those who reported as current smokers showed a gradual decrease for both Oklahoma and the US since 2011.  None of these regions met the Healthy People 2020 national goal of reducing smoking prevalence to 12.0 percent. 

Males in Tulsa County were more likely to smoke cigarettes than females (24.5 percent compared to 12.4 percent). This trend has been true in Tulsa County and Oklahoma since 2014.  Almost two-fifths of adults age 35-54 were current smokers (37.5 percent) in Tulsa County. Oklahoma had lower percentages overall for all age categories for current smokers than Tulsa County in 2018, except, notably, those ages 45 to 54, those ages 65 to 74 and those over the age of 75.  With regard to race and ethnicity, there were only enough respondents to the BRFSS on this indicator from the white, non-Hispanic and Black, non-Hispanic, which were very similar in terms of current smokers.  For Oklahoma overall, those who reported as being of multiple races, non-Hispanic had the highest percentage of current smokers in 2018.  

Although the price of cigarettes has continuously increased over time, adults who had an income of less than $15,000 were over six times as likely to be current smokers compared to adults with an income of over $75,000. For the most part, as income level increased, the percentage of current smokers decreased.  The prevalence of current smokers among individuals with a college education was about four times lower than for individuals with less than a high school education.  This pattern held true for both Tulsa and Oklahoma in 2018.   

Alcohol Use


Heavy Drinking

Definition

This indicator is the percentage of Tulsa County residents who reported heavy drinking in 2018. Heavy drinking is defined as 8 or more drinks per week for women and 15 or more drinks per week for men.

Why is this indicator important?

Excessive alcohol use led to approximately 88,000 deaths and shortened the lives of those who died by an average of 30 years. The economic costs of excessive alcohol consumption were estimated to be $249 billion in 2010. Excessive drinking includes binge drinking, heavy drinking, and any drinking by pregnant women or people under 21. Short-term health risks of excessive alcohol use include injuries, violence, alcohol poisoning, risky sexual behaviors, and miscarriage or stillbirth. Long-term health risks include high blood pressure, heart disease, stroke, liver disease and digestive problems, cancer, learning and memory problems, mental health problems, social problems, and alcohol dependence or alcoholism (7).

How are we doing?

In 2018, 5.5 percent of Tulsa County residents reported heavy drinking. This was lower than the United States (6.5 percent) and higher than Oklahoma overall (4.2 percent). The prevalence of heavy drinking has been somewhat variable since 2013, after showing an overall decrease in Tulsa County from 2011 to 2015.

When looking at heavy drinking by gender in Tulsa County, we see that the data are highly variable from year to year, without a clear pattern.  In 2018, the percentage of men reported to be heavy drinkers was higher than for females (7.5 percent compared to 3.5 percent).  In Tulsa County in 2018, there was only sufficient data for two age groups, 35-44 and 65-74.  Of these two age groups, adults 35-44 had the higher percentage of heavy drinkers reported.  For Oklahoma in 2018, the highest percentage of heavy drinkers was the 45-54 age group at 6.7 percent.  In terms of race/ethnicity, there were only sufficient data to report for one group in Tulsa County (white, non-Hispanic at 5.0 percent) which was higher than the percentage for the same group in Oklahoma overall (4.3 percent) .

There was only sufficient data for three income levels in 2018 ($25,000 to $49,000, $50,000 to $74,999 and Over $75,000).  The data presented in the graph below showing heavy drinkers for Tulsa County and Oklahoma for 2018 hints at a pattern; it appeared that as income increases through $74,999, heavy drinking also increases.  For Tulsa County and Oklahoma overall, heavy drinking appeared to decrease in the highest income level.  In 2018 in Tulsa County, adults with a high school education had the highest prevalence of heavy drinking, while for Oklahoma, the group with the highest percentage of heavy drinkers were adults with less than a high school education..

Health Screenings


Primary Care

Definition

This indicator is the percentage of Tulsa County residents who reported that they had a personal doctor or health care provider in 2018. This does not identify whether or not they regularly visited this doctor.

Why is this indicator important?

Having a primary care provider (PCP) as a usual source of care can improve health outcomes, as well as decrease disparities and costs. In general, individuals with a PCP have greater trust and communication with their provider and are more likely to receive appropriate care. Having a PCP can also increase access to clinical preventive services that can detect early warning signs and symptoms in order to detect diseases earlier and at an (often) more treatable stage (8).

How are we doing?

In 2018, 75.2 percent of Tulsa County residents reported that they have at least one person who they think of as their regular doctor. This was very similar to, although slightly lower than,  Oklahoma (75.8 percent) and the United States (77.3 percent). 

In Tulsa County and Oklahoma in 2018, a higher percentage of females had a regular doctor than males; for Tulsa County females were at 84.3 percent, males at 65.5 percent and for Oklahoma females at 81.1 percent, males at 70.3 percent).  In terms of age group, both Tulsa County and Oklahoma showed a clear pattern that as age increased, so did the percentage of those who reported they had a regular doctor.  When examining racial/ethnic groups on this indicator, there were only sufficient data for white, non-Hispanics and American Indian/Alaskan Natives (non-Hispanic) in Tulsa County, where white, non-Hispanics had a higher percentage reporting they had a regular doctor.  For Oklahoma overall, white, non-Hispanics had the highest percentage who reported having a regular doctor.  People who reported they were mulitracial and those who reported they were of Hispanic ethnicity had the lowest percentages.

In terms of socioeconomic factors, for Tulsa County in 2018, there was not very much variation among the income categories in terms of those who reported having a regular doctor.  For Oklahoma overall, there appeared to be a pattern; as income increased, so did the percentage of those who reported they had a regular doctor.  The same pattern generally held true in both locations in terms of level of education, although Tulsa County had a higher percentage of adults with less than a high school education who reported having a regular doctor than did Oklahoma overall.  




Oral Health

Definition

This indicator is the percentage of Tulsa County residents who had visited a dentist in the previous year in 2018.  Data for this BRFSS indicator is collected in alternating years.

Why is this indicator important?

Good oral health improves an individual’s ability to speak, smile, smell, taste, touch, chew, swallow, and make facial expressions to show feelings and emotions. However, oral diseases, such as cavities or oral cancer, cause pain and disability for many Americans. In addition, studies have shown that gum disease is associated with an increased risk of developing heart disease, that poor dental health can increase the risk of a bacterial infection in the blood stream which can affect the heart valves, that tooth loss patterns are connected to coronary artery disease and that there is a strong connection between diabetes and cardiovascular disease (18).

Good self-care such as brushing, flossing, and regular dental exams are important to oral health. People who do not have access to preventive dental services and treatment have greater rates of oral diseases. Additionally, certain health behaviors such as tobacco use, excessive alcohol use, and poor dietary choices can lead to poor oral health. Barriers to good oral health can include limited access, availability or awareness of dental services, cost, and fear, as well as social determinants such as lower levels of education and income and specific racial/ethnic groups (9).


How are we doing?

In 2018, 61.8 percent of Tulsa County residents reported that they had been to the dentist in the previous year. This was slightly higher than Oklahoma (60.4 percent) and lower than the US (67.6 percent). For all locations, the percentages of those who reported visiting the dentist in the previous year have remained relatively stable.  In Tulsa County, the percentage of those who visited a dentist in the previous year decreased from 2016 to 2018.  

For both Tulsa County and Oklahoma in 2018, females were more likely than males to have visited a dentist in the previous year (Tulsa County with females at 63.9 and males at 60.1 percent; Oklahoma with females at 62.9 percent and males at 57.8 percent).   In terms of age, in Tulsa County, people aged 65 to 74 and over 75 had the highest percentage of those having visited a dentist in the past year, in Oklahoma overall, those aged 65 to 74 had the highest percentage, followed very closely by those aged 18 to 24.  

For race/ethnicity, for Tulsa County there were only sufficient data for the racial/ethnic categories white, non-Hispanic and Black, non-Hispanic.  The percentage for those having visited a dentist in the past year was highest for the white, non-Hispanic  population.  For Oklahoma, citizens who were reported as American Indian/Alaskan Native had the highest percentage who had visited a dentist in the previous year in Oklahoma overall in 2018.

In general, the trend in both Tulsa County and Oklahoma showed that as income increased, the percentage of those who reported visiting a dentist in the past year also increased.  Additionally, as education level increased, so did the percentages of those who reported having visited a dentist in the past year.


Cervical Cancer

Definition

This indicator is the percentage of Tulsa County women who had received a PAP test in the previous three years.

Why is this indicator important?

Cervical cancer is almost always caused by the human papilomavirus (HPV). Risk factors for HPV infection include having a weakened immune system, being sexually active at a young age, and having many sexual partners. Prevention methods include getting a HPV vaccine, utilizing barrier protection (i.e., condoms) during sexual activity, and avoiding sexual activity. Avoiding other cancer risk factors, such as smoking, being overweight, and lack of physical activity, may also help prevent cancer. Screening methods include a regular PAP test for women between 21 and 65. After certain positive Pap tests, an HPC test may be done to identify if there is an infection caused by a type of HPV that is known to cause cervical cancer (11).

How are we doing?

In 2018, one-third (66.6 percent) of women in Tulsa County reported having a PAP test in the previous three years. This was lower than both the US (80.2 percent) and Oklahoma (76.1 percent). Overall, the percentage had been decreasing slightly in Tulsa County and the US and relatively stable in Oklahoma; however, from 2016 to 2018, the percentage in the US remained stable, the percentage in Oklahoma increased slightly and the percentage in Tulsa County decreased from 74.8 percent.  

For Tulsa County in 2018, there were only sufficient data for reporting for women in the age group 55 to 64.  Of women in that age group, 54.2 percent reported having a PAP tests in the past 3 years.  In Oklahoma overall, the age group with the highest percentage of women who reported they had a PAP Test in the previous 3 years was ages 25-34.  There were only sufficient data in Tulsa County for white, non-Hispanic women for this indicator; of those, 65.9 percent reported a PAP test in the past 3 years, while for Oklahoma overall, the highest percentage was for black, non-Hispanic women.  

Income data was only available in Tulsa County for the level $25,000 to $49,999 annually.  Of these women in Tulsa County, 76.8 percent reported having a PAP test in the past 3 years.  For Oklahoma overall, the income level with the highest percentage of women who reported a PAP test in the previous 3 years was the over $75,000 annually group, although the variation between the income levels on this indicator in Oklahoma was not wide.  In general, for both Tulsa County and Oklahoma, as education level increased, the percentage of women who reported a PAP test in the previous three years also increased. 


Breast Cancer

Definition

This indicator is the percentage of Tulsa County women over 40 who received a mammogram in the previous two years.

Why is this indicator important?

Breast cancer starts when cells in the breast begin to grow out of control, which usually forms a tumor that can be felt as a lump. After skin cancer, breast cancer is the most common cancer in American woman. The American Cancer Society estimated that 2018 would have about 266,120 cases of invasive breast cancer diagnosed and 40,920 women would die from breast cancer. Deaths rates from breast cancer decreased 39 percent from 1989 to 2015, which is believed to be a result of finding breast cancer earlier though screening and increased awareness, as well as better treatments. Mammograms are recommended for women age 45 and older who are at average risk of breast cancer. Women at higher risk are recommended to get an MRI and mammogram annually starting at age 30. High risk includes family history, certain genes, specific medical conditions, or history of radiation (12). 


How are we doing?

In 2018, 67.8 percent of Tulsa County women over 40 reported that they had received a mammogram in the previous two years. This was lower than both Oklahoma (69.4 percent) and the US (71.8 percent).

There was only sufficient data in 2018 on this indicator for one racial/ethnic group which was white, non-Hispanic women.  Of these women, 71.4 percent had received a mammogram in the previous 2 years.  For Oklahoma overall, the percentage of women who had received a mammogram was highest in black, non-Hispanic women at 78.1 percent. Additionally, for Oklahoma overall, the percentage of women who reported a mammogram increased with income.  For Tulsa County, the available data suggest the same pattern, although there was only sufficient data for the income levels $15,000 to $24,999 and $25,000 to $49,999. 

For both Tulsa County and Oklahoma, the percentage of women who had received a mammogram increased as education increased.

Chronic Conditions


High Blood Pressure

Definition

Data for this indicator was not available for 2018; therefore, the data presented as the percentage of Tulsa County residents who had ever been diagnosed with high blood pressure is from 2017.

Why is this indicator important?

Uncontrolled high blood pressure can lead to serious health consequences if untreated. It is sometimes called ‘the silent killer,’ because it has no symptoms, so individuals may not be aware that it is damaging their arteries, heart, and other organs. Possible health consequences include heart disease, stroke, kidney damage, as well as other complications. Risk factors for high blood pressure include family history, age, low physical activity, poor diet, overweight/obese, and high alcohol consumption (13).

How are we doing?

In 2017, 35.5 percent of Tulsa County residents reported having been diagnosed with high blood pressure. This was lower than in Oklahoma (37.7 percent) but higher than the United States (32.3 percent). These regions did not meet the Healthy People 2020 national goal of reducing the proportion of individuals with high blood pressure to 26.9 percent.

Males in Tulsa County had a slightly higher prevalence of high blood pressure compared to women (37.1 percent compared to 34.0 percent). The same was true for Oklahoma overall (39.2 percent compared to 36.4 percent).  For both Tulsa County and Oklahoma, high blood pressure prevalence increased with age. 

In terms of race/ethnicity, there were only sufficient data for two racial categories in Tulsa County in 2017, white, non-Hispanic 39.6 percent, and black, non-Hispanic at 28.7 percent.  For Oklahoma, the percentage of individuals who had been diagnosed with high blood pressure was highest for black, non-Hispanic individuals, although the variance between the racial categories was not large.  In Oklahoma, people of Hispanic ethnicity had the lowest prevalence of diagnosed high blood pressure among racial/ethnic groups.

For both Tulsa County and Oklahoma with regard to high blood pressure and income, as income increased, the percentages of those reportedly diagnosed high blood pressure decreased.  This pattern held true for education level for both locations as well.




Diabetes

Definition

This indicator is presented as the percentage of Tulsa County residents who had ever been diagnosed with diabetes in 2018. It is important to note that this includes both type 1 and type 2 diabetes.

Why is this indicator important?

Diabetes mellitus (diabetes or DM) occurs when the body cannot produce or respond appropriately to insulin. Insulin is a hormone that the body needs to absorb and use glucose (sugar) as fuel for the body’s cells. Without a properly functioning insulin signaling system, blood glucose levels become elevated and other metabolic abnormalities occur, leading to the development of serious, disabling complications. There are three types of diabetes:  type 1, where the body loses its ability to produce insulin; type 2, which is a combination of resistance to insulin and insufficient insulin production; and gestational, which is a complication of pregnancy that can increase the risk of type 2 diabetes in the child later in life. 

Effective therapy can prevent or delay diabetic complications. However, about 28 percent of Americans with DM are undiagnosed, and another 86 million Americans have blood glucose levels that greatly increase their risk of developing DM in the next several years. Few people receive effective preventative care, which makes DM an immense and complex public health challenge (14). 


How are we doing?

In 2018, 11.9 percent of Tulsa County residents reported that they had been diagnosed with diabetes. This was higher than the percentages for Oklahoma (12.5 percent) and the rate in the U.S. (10.9 percent). The rate of diabetes in Tulsa County increased sharply from 2016 – 2018.

In Tulsa County, the percentages for males who had been diagnosed with diabetes was higher than for females; for Oklahoma the percentages for the genders were almost identical (Tulsa County, females at 11.2 percent and males at 12.7 percent; Oklahoma, females at 12.6 percent and males at 12.4 percent).  For Oklahoma, adults age 65 - 74 had the highest percentages of those diagnosed with diabetes; for Tulsa County, individuals over 75 had the highest percentages of those who had been diagnosed with diabetes.  For both locations, percentages generally increased as age increased.  

For Tulsa County, there were only sufficient data for two racial/ ethnic groups; white, non-Hispanics at 12.1 percent having been diagnosed with diabetes, and black, non-Hispanic at 14.3 percent.  For Oklahoma overall, American Indian/Alaskan Natives had the highest percentage of those diagnosed with diabetes at 16.8 percent. People of Hispanic ethnicity reported having been diagnosed with diabetes at 9.0 percent.

For Tulsa County and Oklahoma in 2018 generally, the percentages of those reportedly diagnosed with diabetes decreased as income level increased.  The exception to this trend was in Tulsa County, where those making $15,000 to $24,999 had the highest percentage of those diagnosed with diabetes, while those making $25,000 to $49,000 were much lower.  For level of education and diabetes, we see that as level of education increased, the percentages of those reportedly diagnosed with diabetes decreased.


Cardiovascular Disease

Definition

This indicator is presented as the percentage of Tulsa County residents who had ever been diagnosed with a heart attack in 2018.

Why is this indicator important?

A heart attack occurs when blood flow to the heart muscle is severely reduced or cut off, limiting the amount of oxygen the heart receives. This can happen because the coronary arteries can become narrow from a buildup of fat, cholesterol, and other substances called plaque. Someone in the US has a heart attack about every 40 second. Preventable risks of heart attacks include high cholesterol, tobacco use, high blood pressure, physical inactivity, obesity and overweight, and diabetes (15).

How are we doing?

In 2018, 5.3 percent of Tulsa County residents reported that they had been diagnosed with a heart attack. This percentage was similar to the rate in Oklahoma (5.6 percent) and higher than the percentage for the US (4.5 percent). The rate of heart attack diagnosis in Tulsa County decreased from 2014 to 2016, and then increased from 2016 to 2018.

In Tulsa County, the percentages of males who had been diagnosed with a heart attack (7.7 percent) was higher than the percentage of females (3.2 percent).  For Oklahoma overall, the percentage of males who had been diagnosed with a heart attack was higher  than for females (7.2 percent compared to 4.0 percent.  

There were only sufficient data for reporting for three age categories in Tulsa County for 2018, and of these categories, the percentage was highest for those over 75 years.  For Oklahoma overall, the highest percentage of those diagnosed with heart attack were over age 75, as well.  Data were only available for white, non-Hispanic respondents in Tulsa County for 2018; of those respondents, 6.1 percent reported they had been diagnosed with having had a heart attack. 

Generally, for Tulsa County and Oklahoma, percentages of those diagnosed with heart attack decreased as income level increased.  This is especially clear in Tulsa County as shown in the graph below.  In the case of Tulsa County, the percentage of those who had ever had a heart attack decreased sharply as income rose above $15,000 annually.  

This same general pattern was discernible when examining education levels as well; the percentages of those diagnosed with heart attack generally decreased as level of education increased.


Asthma

Definition

This indicator is presented as the percentage of Tulsa County residents who had a current asthma diagnosis in 2018.

Why is this indicator important?

Asthma is a chronic inflammatory disorder of the airways characterized by episodes of reversible breathing problems due to airway narrowing and obstruction. These episodes can range in severity from mild to life threatening. Symptoms of asthma include wheezing, coughing, chest tightness, and shortness of breath. Daily preventive treatment can prevent symptoms and attacks and enable individuals who have asthma to lead active lives. 

Currently, more than 25 million people in the US have asthma, and the estimated annual health care expenditures are estimated at 20.7 billion. Asthma affects people of every race, sex, and age. However, significant disparities in asthma morbidity and mortality exist, particularly for low-income and minority populations (16). 

How are we doing?

In 2018, 10.8 percent of Tulsa County residents reported that they currently had asthma. This was slightly higher than the rate in Oklahoma (10.3 percent) and the US (9.5 percent). The percentage of those with a current asthma diagnosis has fluctuated in Tulsa County, but has increased overall from 8.2 percent in 2011.    

In 2018, percentages of individuals with current asthma diagnosis were higher for females than for males, both in Tulsa County (females at 14.2 percent, males at 7.1 percent) and Oklahoma (females at 13.6 percent, males at 7.0 percent.  In Tulsa County and in Oklahoma, asthma was most common among adults  45-54. 

There were sufficient data for two racial groups in Tulsa County in 2018, white, non-Hispanic at 11.9 percent and Black, non-Hispanic at 12.1 percent.  In Oklahoma overall, the percentage of those with a current asthma diagnosis were people who reported as black, non-Hispanic.  The percentage of respondents who reported being of Hispanic ethnicity in Tulsa County in 2018 was 5.7 percent, which was lower than the percentage for Oklahoma at 7.7 percent.

The highest percentage of those with a current asthma diagnosis in terms of income level was for those with annual incomes of less than $15,000 in Tulsa County.  Both Tulsa County and Oklahoma showed the same general pattern as some of the previous indicators; as income levels increased, the percentage of those with a current diagnosis of asthma decreased.  

In Tulsa County, the percentages of those with a current asthma diagnosis were highest for those with a high school education.  For Oklahoma overall, the highest percentage of those with a current asthma diagnosis were those who had completed some college.  


Cancer

Definition

This indicator is presented as the percentage of Tulsa County residents who had ever been diagnosed with cancer (excluding skin cancer) in 2018. 

Why is this indicator important?

Due to advances in screening, detection, and treatment, cancer incidence and death rates have been decreasing in the US, although it is still the second leading cause of death. Among people who develop cancer, more than half will be alive in 5 years. However, there are many disparities in incidence and death among races, ethnicities, and underserved groups, often releated to low socioeconomic status (17). 

How are we doing?

In 2018, 7.7 percent of Tulsa County residents reported that they had been diagnosed with cancer (excluding skin cancer). This was higher than both Oklahoma (7.2 percent) and the U.S. (7.1 percent). The rate of cancer in Tulsa County has been variable since 2012, but has increased overall. 

In both Tulsa County and Oklahoma, females had  higher percentages of cancer than males (Tulsa County, females at 8.9 percent, males at 6.3 percent; Oklahoma, females at 9 percent, males at 5.3 percent).  In addition, in both locations, as age increased, generally the percentages of those diagnosed with cancer  increased as well.  

Again, there were only sufficient data for two racial categories in Tulsa County in 2018; white, non-Hispanic at 9.2 percent and Black, non-Hispanic at 13.5 percent.  For Oklahoma overall, the white, non-Hispanic population had the highest percentage of cancer diagnoses in 2018.   

The prevalence of cancer among income levels showed the same general pattern for both Tulsa County and Oklahoma overall; as income levels increased, percentages of those with cancer diagnosis decreased.  In Tulsa County, the percentage of those with incomes less than $15,000 annually had a percentage of those diagnosed with cancer that was more than double that for people with incomes over $75,000 annually.  

The prevalence of cancer in Tulsa County was highest in individuals who had a high school education, and there was no clear pattern; whereas for Oklahoma overall, the variability of this indicator was much less among education levels.  

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Data Sources

Behavioral Risk Factor Surveillance System: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online].

Oklahoma Statistics on Health Available for Everyone: Oklahoma State Department of Health (OSDH), Center for Health Statistics, Health Care Information, Behavioral Risk Factor Surveillance System, on Oklahoma Statistics on Health Available for Everyone (OK2SHARE).