© 2010 Jones and Bartlett Publishers, LLC

Chapter 6 General Health and Population Indicators

© 2010 Jones and Bartlett Publishers, LLC Objectives  Identify common indices used in identifying the health status of populations.  Calculate, interpret, and apply selected health status measures.  Understand the vital statistics registration system in the United States.

© 2010 Jones and Bartlett Publishers, LLC World population growth  On July 1, 2009, the estimated world’s population was 6,760,087,438  This number represented a net increase of 79,751,007 over the prior year 6,645,917 per month 218,496 per day 9,104 per hour 152 per minute

© 2010 Jones and Bartlett Publishers, LLC Health Indicator  A marker of health status (physical or mental disease, impairments or disability, and social well-being), service provision, or resource availability.

© 2010 Jones and Bartlett Publishers, LLC Categories of Health Indicators  Health and well-being  Health resources  Collective justice  Social capital  Collective capacity  Resiliency  Functionality

© 2010 Jones and Bartlett Publishers, LLC Objective: Identify common indices used in identifying the health status of populations  Descriptive epidemiology uses several indices to identify the health status of populations  These indices are typically related to births and deaths because such data has been more readily available than morbidity data  The indices are also often expressed as rates

© 2010 Jones and Bartlett Publishers, LLC What are some common health indicators? How are they calculated? How are they interpreted?

© 2010 Jones and Bartlett Publishers, LLC Birth rate

© 2010 Jones and Bartlett Publishers, LLC Fertility rate

© 2010 Jones and Bartlett Publishers, LLC Fertility rate among immigrant women  In 2002, immigrant women (legal and illegal) from the top 10 immigrant-sending countries had 2.9 children on average, compared to a fertility rate of 2.3 children in their home countries -- a 23-percent difference.  Mexico immigrants in the US, for example, had 3.5 children per woman compared to 2.4 children for women in Mexico. Among Chinese immigrant fertility is 2.3 in the US compared to 1.7 in China, and immigrants from Canada have 1.9 children compared to 1.5 children in Canada.

© 2010 Jones and Bartlett Publishers, LLC Total Fertility Rate  The average number of births per woman.

© 2010 Jones and Bartlett Publishers, LLC Contraceptive prevalence  The proportion of women of reproductive age (15-49 years) who are using (or whose partner is using) a contraceptive method at a given point in time  During , 59% in developing countries 29% in developed countries

© 2010 Jones and Bartlett Publishers, LLC Mortality  Mortality is the epidemiologic and vital statistics term for death  In our society there are generally three things that cause death: 1. Degeneration of vital organs and related conditions; 2. Disease states; and 3. Society or the environment (homicide, accidents, disasters, etc.).

© 2010 Jones and Bartlett Publishers, LLC Vital statistics registration system in the United States  All deaths are recorded and reported to local health departments and to the state office of vital statistics  Reports of vital event statistics including deaths are reported to the National Center for Health Statistics

© 2010 Jones and Bartlett Publishers, LLC Vital statistics registration system in the United States  Legal authority for the registration of births, deaths, marriages, divorces, and fetal deaths resides individually with the 50 States, Washington, DC, and five territories (Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands)  Each of these jurisdictions are responsible for maintaining registries of vital events and for issuing copies of birth, death, marriage, and divorce certificates

© 2010 Jones and Bartlett Publishers, LLC Vital statistics registration system in the United States  The laws of each state provide for a continuous and permanent vital registration system  Each system depends on the conscientious efforts of physicians, hospital personnel, funeral directors, coroners, and medical examiners in preparing or certifying information needed to complete the original death records

© 2010 Jones and Bartlett Publishers, LLC Death  Death certificates date of birth (for cohort studies) and of death (for accurate age) stated age place of death place of residence Occupation sex cause of death marital status Other information may include type of injury, place and time of injury, etc.  ICD-9-CM  ICD-10-CM

© 2010 Jones and Bartlett Publishers, LLC Underlying cause of death  The underlying cause is any disease or injury which initiated the set of events leading to the death

© 2010 Jones and Bartlett Publishers, LLC Death certificate data  The main cause of death is entered first on a death certificate  Two additional or contributing causes can also be listed  The existing diseases and conditions at the time of death may hold as much epidemiological value as the listed cause of death

© 2010 Jones and Bartlett Publishers, LLC Crude mortality rate

© 2010 Jones and Bartlett Publishers, LLC Cause-specific mortality rate

© 2010 Jones and Bartlett Publishers, LLC Infant mortality rate

© 2010 Jones and Bartlett Publishers, LLC Declining infant mortality rate

© 2010 Jones and Bartlett Publishers, LLC Neonatal mortality rate

© 2010 Jones and Bartlett Publishers, LLC Postneonatal mortality rate

© 2010 Jones and Bartlett Publishers, LLC Perinatal mortality rate

© 2010 Jones and Bartlett Publishers, LLC Fetal death rate

© 2010 Jones and Bartlett Publishers, LLC Abortion rate

© 2010 Jones and Bartlett Publishers, LLC Abortion  The abortion rate was 16 per 1,000 women ages years in the United States in 2001  Surveillance indicates that women most likely to report an abortion are unmarried (82%) white (55%) and younger than 25 years (52%)

© 2010 Jones and Bartlett Publishers, LLC Abortions  Among all abortions performed, 88% were performed at less than 13 weeks gestation (59% less than 9 weeks gestation).  There were a limited number of abortions performed at later gestational age (4.3% at weeks gestation and 1.4% after 20 weeks gestation)

© 2010 Jones and Bartlett Publishers, LLC Maternal mortality rate

© 2010 Jones and Bartlett Publishers, LLC Maternal Mortality Per 100,000 Live Births Number of Maternal Deaths Lifetime Risk of Maternal Death: 1 in World total400536,00092 Developed regions*99607,300 Developing regions450533,00075

© 2010 Jones and Bartlett Publishers, LLC Proportionate mortality ratio

© 2010 Jones and Bartlett Publishers, LLC Example  Two cities each had a population of 1,000,000.  Death rate from all causes in Metro City was 400, or 40 per 100,000.  Death rate from all causes in Suburban City was 900, or 90 per 100,000.  Cancer deaths in both cities were 4 per 100,000, or 40 deaths per city. Risk of a cancer-caused death for both cities was the same.  Percent of all deaths from cancer are the proportionate mortality ratio. For each city the PMR was: Metro City = 40/400 x 100 = 10% Suburban City = 40/900 x 100 = 4.4%

© 2010 Jones and Bartlett Publishers, LLC Case fatality rate The rate base 10 n is usually 10 2 = 100

© 2010 Jones and Bartlett Publishers, LLC Case-fatality rates  SARS – 14.7% in 2003  Avian Influenza Exceed 60% in Qinghai China Might be exaggerated by under-reporting of less serious cases, which might not be recognized as avian flu

© 2010 Jones and Bartlett Publishers, LLC Years of potential life lost YPLL  Quantify premature mortality  A measure of public health related to the value of human life and the economic implications of the loss of individuals in a society  Improvements in life expectancy can cause the increase in an available work force which, in turn, benefits society by increased productivity

© 2010 Jones and Bartlett Publishers, LLC YPLL rate  Comparison of YPLL across different groups or populations has the same problem as when we compare crude mortality rates  Size of the populations and the age structures may vary  To compensate for different population sizes we calculate the YPLL rate  To compensate for different age distributions, can use the direct method of standardization

© 2010 Jones and Bartlett Publishers, LLC Age Group (years) Midpoint (age) Years to 65No.Population Age-specific YPLL Cumulative YPLL ,812, ,952, ,410, ,2148,249, ,4658,277, ,9077,656, ,0798,451, ,5468,887, ,4949,427, ,9498,761, ,7157,770, ,6816,261, ,1264,773, ,9653,860, ,3513,434, ,9392,763, ,1511,818, ,4841,244,614 Deaths attributed to accidents and adverse effects for males in the U.S.