Bruce Cohen, PhD Massachusetts Department of Public Health Bureau of Health Information, Statistics,...

Bruce Cohen, PhD

Massachusetts Department of Public Health Bureau of Health Information, Statistics,

Research, and Evaluation

Division of Research and EpidemiologyRegistry of Vital Records and Statistics

April 2009

Massachusetts Deaths 2007

Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation

Infectious Disease

Cancer

Heart Disease

Injuries0%

10%

20%

30%

40%

50%

60%

18

42

18

48

18

54

18

60

18

66

18

72

18

78

18

84

18

90

18

96

19

02

19

08

19

14

19

20

19

26

19

32

19

38

19

44

19

50

19

56

19

62

19

68

19

74

19

80

19

86

19

92

19

98

20

07

Pe

rce

nt

of

To

tal D

ea

ths

Causes of Death Massachusetts: 1842-2007


Outline

• Highlights

• Selected Causes of Death-Cancer-Heart Disease-Diabetes-HIV/AIDS-Injury

• Race, Education and Mortality• Applications of Mortality Data• Summary

HIGHLIGHTS


On An Average Day in Massachusetts

52,690Total deaths in 2007

144 DEATHS

36 Cancer

6 CLRD

8 Injury

35 Heart Disease

1 Infant death

5 Alzheimer’s

7 Stroke

3 Diabetes


80.2

47.3

78.1

40

50

60

70

80

90

1900 1910 1920 1930 1940 1950 1960 1970 1980 1987 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Lif

e E

xp

ec

tan

cy

in

Ye

ars

Life Expectancy at BirthMassachusetts vs. U.S.1: 1900-2007

Massachusetts

United States

1 2007 U.S. data was not available at the time of this release, 2006 U.S. data used.


704.4

868.2

776.4

920.0

600

700

800

900

1,000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

De

ath

s p

er

10

0,0

00

1 2006 Data. 2007 U.S. Data was not available at the time of this release

Massachusetts

United States

Overall Mortality Rates Massachusetts and U.S.1 : 1994-2007

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population.

- 1.9%* APC

- 2.4%* APC

* Statistically significant (p<0.05)APC= Annual Percent Change


-52%

-29% -29% -27%

-17%

-1%

25%

-9%

-70%

-50%

-30%

-10%

10%

30%

50%

Percentage Difference in Mortality Rates Massachusetts vs. U.S.1: 2007

% d

iffer

ence

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population. *Statistically Significant (p ≤ .05)

Cancer* Overall*

HeartDisease*

Diabetes* Homicide*

Nephritis*

InfantMortality*Suicide*

Higher than US

Lower than US

1 2006 Data. 2007 U.S. Data was not available at the time of this release


Leading Causes of Death Massachusetts: 2007

Heart Disease 24.2%

Cancer 24.6%

Other 23.4%

Stroke 5.1% Injury

5.6%

Chronic Lower Respiratory

Disease 4.4%

Pneumonia & Influenza

2.9%

Alzheimer’s 3.2%

Nephritis 2.6%

Diabetes 2.3%

Septicemia 1.7%

In 2007:•12,961 cancer deaths•12,735 heart disease deaths


Ranking of Leading Causes of Death by Race and EthnicityMassachusetts: 2007

1 Non-Hispanic, 2 Chronic Lower Respiratory Disease Note: The lower the number the higher the rank

White1

(N=48,.518)

Black1

(N=2,211)

Asian1

(N=610)

Hispanic(N=1,264)

Cancer 1 1 1 1

Heart Disease 2 2 2 2

Stroke 3 6 3 5

CLRD2 4 9 6 16

Unintentional Injuries 5 5 5 3

Alzheimer’s Disease 6 14 14 15

Influenza & Pneumonia 7 15 4 17

Nephritis 8 3 8 9

Diabetes 9 4 7 4

HIV/AIDS 29 8 -- 8

Homicide 30 7 21 7


% of Total in Total Age Leading Cause Age Group Deaths

1-14 Injuries 32% 128

15-24 Injuries 72% 505

25-44 Injuries 44% 2,023

45-64 Cancer 37% 8,560

65-74 Cancer 40% 7,494

75-84 Cancer 27% 14,781

85+ Heart Disease 30% 18,816

Leading Causes of Death by Age Massachusetts: 2007


Changes in Mortality RatesMassachusetts: 2000 and 2007


* Statistically different than 2000 rate (p<0.05)

Cause

Rate

% Change2000 2007

Cancer 206.1 179.0 * 13%Heart Disease 216.7 166.0 * 23%Stroke 50.9 35.0 * 31%Chronic Lower Respiratory Disease

41.8

31.5 * 25%

All Injuries 35.9 42.5 * 18%Alzheimer’s Disease 19.5 20.9 7%

Nephritis 17.6 17.9 2%

Diabetes 19.6 16.5 * 16%All Diabetes-related 61.5 52.9 * 14%

SELECTED CAUSES OF DEATH


Cancer Mortality Rates Massachusetts and U.S. : 1994-20071

179.0

226.0

180.8

212.4

150

200

250

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

Dea

ths

per

100

,000

Massachusetts

United States

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population1 2006 Data. 2007 U.S. Data was not available at the time of this release


Female Breast Cancer Mortality Rates Massachusetts: 1994-2007

20.4

35.4

15

20

25

30

35

40

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Dea

ths

per

100

,000

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population * Statistically significant (p<0.05)APC= Annual Percent Change

- 4%* APC


166.0

261.5

199.4

300.2

130

150

170

190

210

230

250

270

290

310

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Dea

ths

per

100

,000

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population

Massachusetts

United States

Heart Disease Mortality Rates Massachusetts and U.S.: 1994-20071

1 2006 Data. 2007 U.S. Data was not available at the time of this release * Statistically significant (p<0.05)

APC= Annual Percent Change


202456

742995

6,112

1,9131,804

6,622

150556

30779

1,750

3,780

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

< 45 45-54 55-64 65-74 75-84 85+ Total

Ages

Nu

mb

er o

f D

eath

s

Males Females

Number of Heart Disease Deathsby Age and Gender

Massachusetts: 2007


Diabetes-Related DeathsMassachusetts: 2007

Underlying Cause (Disease or injury which

initiated the train of events leading directly to death, or

the circumstances of the accident or violence which produced the fatal injury)1

N=1,216

Contributing Cause (Looking at all other 15

conditions mentioned on death certificates)

N=2,683

All Diabetes-relatedN=3,899

1 World Health Organization. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. 2d ed. Geneva: World Health Organization. 2004.


Diabetes Mortality Rates by Race and EthnicityMassachusetts: 2007

15.5

37.4

28.2

16.5

9.9

0

10

20

30

40

Whites Blacks Asians Hispanics Total

Dea

ths

per

100

,000

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population

N=1,041 N=96 N=15 N=62 N=1,216

* Statistically different than state rate (p<0.05)

*

*

*


143

277

648

998

241

0

200

400

600

800

1,000

1,200

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Nu

mb

er

of

De

ath

sNumber of HIV/AIDS Deaths Massachusetts: 1987-2007

Highly Active Antiretroviral Therapy

HAART


Percent of HIV/AIDS Deaths by Age GroupMassachusetts: 1994-2007

27%

80%

73%

20%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Per

cen

t o

f H

IV/A

IDS

Dea

ths

45+ years

Less than 45 years

Injury Deaths


Causes of Injury Deaths Massachusetts: 2007

Poisonings 33%

Total Injuries = 2,967

Firearm 8%

Other18%

Motor Vehicle-related 15%

Suffocation, Hanging or Strangulation

11%

Falls 16%

66% Opioids

18% Alcohol

16% Other (gases, vapor, NSAIDS, etc)


363

487449

574

475

544

637 637

0

250

500

750

1,000

2000 2001 2002 2003 2004 2005 2006 2007

Year

Nu

mb

er

of

de

ath

sNumber of Poisoning Deaths Where Opioids Are Mentioned

Massachusetts: 2000-2007


15.8

42.3

22.1

43.0

0

10

20

30

40

50

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Ag

es 6

5+,

Dea

ths

per

100

,000

Rates are per 100,000 population ages 65+.

Unintentional Fall Mortality RatesPersons Ages 65+

Massachusetts and U.S.: 1994-2007

Massachusetts

United States1

1 Available from URL: www.cdc.gov/ncipc/wisqars

http://www.cdc.gov/ncipc/wisqars/default.htm

http://www.cdc.gov/ncipc/wisqars/default.htm


(183 homicides)

Firearm (n=113)Cut/Pierce

(n=33)

Other (n=37)

(504 suicides)

Poisoning (n=117)

Hanging (n=220)

Firearm (n=112)

Other(n=55)

N= 687 deaths

Suicide (n=504)

Homicide (n=183)

Intentional Injury Deaths by Cause Massachusetts: 2007


48

7

34

116

0

141

159

43

1613

24

0

20

40

60

80

100

120

140

160

15-24 25-44 45-64 65-74 75-84 85+

Nu

mb

er o

f D

eath

s

Female Male

Suicides by Gender and by Age Massachusetts: 2007


7.58.1

13.6

12.4

3.5 3.0

0

2

4

6

8

10

12

14

16

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Dea

ths

per

100

,000


Suicide Rates by GenderMassachusetts: 1994-2007

* Statistically significant (p<0.05)APC= Annual Percent Change

Females

Males

Massachusetts

- 3%* APC


54

54

7

11

87

3

5

16

0

2

4

6

8

10

12

14

16

18

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Nu

mb

er o

f D

eath

sChild Homicides (Ages 1-14)Massachusetts: 1997-2007

Race, Education, and Mortality


Mortality Rates by Education and Race/Ethnicity, Adults 25-64 Years1

Massachusetts: 2007

727.3

467.7

181.0

358.5

231.0

533.7

0

200

400

600

800

Whites Blacks Hispanics

Dea

ths

per

100

,000

High School or Less

13+ Education

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population 1Uses 2000 Population Estimates

* Statistically higher than those with 13+ yrs of education (p<0..05)

*

*

*


Mortality Rates by Race/EthnicityAdults 25-64 Years1 with 13+Years of Education

Massachusetts: 2007

181.0

358.5

231.0

0

200

400

600

Whites Blacks Hispanics

Dea

ths

per

100

,000

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population 1Uses 2000 Population Estimates

* Statistically higher than the rate for whites (p<0..05)

*

Applications of Mortality Data


Premature Mortality Rate (PMR)1

• Definition– deaths before age 75, age-adjusted to the 2000 US

standard population under 75 years of age

• Focus– two-thirds of deaths to persons ages 75+

– majority of deaths to persons age 75+ are due to chronic conditions associated with aging

– deaths to persons less than 75 years may be preventable

• Value– excellent measure to reflect the health status of a population

– used as a health status indicator that can be used to focus prevention initiatives and target programs

1 Age-adjusted to the 2000 US standard population under 75 years of age.


Premature Mortality Rates by Race and Hispanic Ethnicity

Massachusetts: 2007

295.4277.4

141.3

428.3

293.5

0

200

400

600


Dea

ths

per

100

,000

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population persons ages 0-74

*

*

(*) Statistically different from State (p ≤.05)


Rates per 100,000 population under 75 years of age; age-adjusted to the 2000 US standard population.

CHNA PMR1. Community Health Network of Berkshire = 331.02. Upper Valley Health Web-Franklin County = 303.53. Partnership for Health in Hampshire County = 319.14. The Community Health Connection = 384.35. Community Health Network of Southern Worcester County = 335.96. Community Partners for Health = 290.27. Community Health Network of Greater Metro West = 238.68. Community Wellness Coalition = 355.69. Fitchburg/Gardner Community Health Network = 322.610. Greater Lowell Community Health Network = 350.911. Greater Lawrence Community Health Network = 281.912. Greater Haverhill Community Health Network = 331.313. Community Health Network North = 267.4

14. North Shore Community Health Network = 316.515. Greater Woburn/Concord/Littleton Community Health Network = 192.016. North Suburban Health Alliance = 285.617. Greater Cambridge/Somerville Community Health Network = 232.718. West Suburban Health Network = 210.619. Alliance for Community Health = 358.420. Blue Hills Community Health Alliance = 298.421. Hampshire County Partnership = 351.522. Greater Brockton Community Health Network = 366.623. South Shore Community Partners in Prevention = 284.924. Greater Attleboro-Taunton Health & Education Response = 35425. Partners for a Healthier Community = 378.926. Greater New Bedford Health & Human Services Coalition = 343.527. Cape Cod & Islands Community Health Network = 295.9

1

45

8

24

26

12

10

22

21

25

19

2 9

3

6

27

23

20

1311

1416

7

15

18

17

Rates are per 100,000 persons under 75 years of age, age-adjusted to the 2000 US standard population and are calculated using MDPHpopulation estimates for 2005, which are the most up-to-date estimates available at the sub-state level by age groups.

2007 PMR by CHNA

Significantly higher than state rate

Not significantly different from state rate

Significantly lower than state rate

Massachusetts PMR= 295.4

Premature Mortality Rates (PMR) by Community Health Network Area (CHNA)

Massachusetts: 2007


Mortality Amenable to Health Care

Definition: Deaths for persons ages 0-74 from certain causes that should not occur in the presence of timely and effective health care1,2

Value: A useful tool to assess

Performance of health care systems and

Track changes over time1

1 Nolte E and McKee CM. Measuring The Health of Nations: Updating An Earlier Analysis. Health Affairs 2008; Vol 27, Number 1: 58-71; Jan/Feb 2008.2 Nolte E and McKee CM . Does Health Care Save Lives? Avoidable Mortality Revisited. The Nullfield Trust. 2004. London, England


Mortality Causes Amenable to Health Care

Causes considered as amenable to health care:

– Amenable to secondary prevention • where screening and treatment are effective;

– for example colorectal, breast, cervical, and skin cancer

– Amenable to improved treatment and medical care:• that require direct medical and/or surgical intervention

– for example appendicitis and hypertension

• that rely on efficient medical care delivery– accurate and timely diagnosis, transport, and treatment

• that respond to antibiotic treatments and immunizations– infectious diseases


Percent Deaths Amenable to Health Care Massachusetts: 2007

10%

90% 72%

28%

All Deaths Deaths to Persons Ages 0-74

Amenable Deaths

Amenable Deaths


Mortality Rates for Causes Amenable to Health Care by Race/Ethnicity

Massachusetts: 2000 and 2007

105.4

142.9

40.6

103.6

64.5

82.180.5

53.1

122.9

80.8

0

40

80

120

160


Dea

ths

per

100

,000

2000 2007

Rates are per 100,000 population. Age-adjusted to the 2000 US standard population persons ages 0-74

** **

** Statistically lower than 2000 rate (p<0.05)

SUMMARY


Summary

The Massachusetts death rate was the lowest on record

Life expectancy reached an all-time high

Massachusetts continues to compare favorably with the

U.S.

Cancer remained the leading cause of death followed by

heart disease. As in previous years, cancer and heart

disease accounted for almost half of all deaths

Death rates for chronic lower respiratory disease, overall

cancer, and female breast cancer declined from 2006


Summary (continued)

Lowest annual number of HIV/AIDS deaths in Massachusetts

Almost ¾ of HIV/AIDS deaths occurred among persons 45+ years

Poisoning deaths, the leading cause of injury deaths, were stable from 2006 to 2007

Two out of 3 poisoning deaths were associated with opioids

Suicide rates had leveled off since 2002 but increased for men from 2006 to 2007

Continued increasing trend in unintentional fall-related deaths


Disparities Persist:

• The cancer death rate for men was 46% higher than the rate for women

• Blacks had the highest premature mortality rate, 1.5 times the rate of whites

• The death rate for those with less education was almost 3 times higher than the rate for those with more education

• Springfield, Lowell, Fall River, Taunton, Worcester, and New Bedford had the highest premature mortality rates

Summary (continued)


How to Access the Death Report and Data

To access the 2007 Report:

•Hard Copies: (617) 740-2670

•TDD/TTY: (617) 624-6001

•DPH Website:

http:// mass.gov/dph/bhsre/resep/resep.htm#birth

To access Death data via MassCHIP (DPH’s Internet based public health information service):

•Website: http://masschip.state.ma.us

•Telephone: 1-888-MASCHIP (Mass only)

(617) 624-5629

Bruce Cohen, PhD Massachusetts Department of Public Health Bureau of Health Information, Statistics,...

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