Avoidable Mortality and Health Disparities in the US 5.2.08

James Macinko, RWJ Health and Society Scholars Program, University of Pennsylvania ,[object Object],[object Object],[object Object],[object Object],Methods ,[object Object],[object Object],[object Object],Annual % Change in Mortality below Age 65 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],“ Avoidable Mortality” and Health Disparities in the US, 1980-2005 Categories of Avoidable Mortality (AM) ,[object Object],[object Object],[object Object],[object Object],[object Object],Preliminary Results: Avoidable Mortality Trends Medical Care AM Ranks: US States, 1980 and 2004 Irma Elo of the University of Pennsylvania is a co-PI on this project. We thank the RWJ HSS Program and Penn site for support. Acknowledgments From negative binomial regression models with linear term for number of years since 1980 and log population size as offset. Average annual percent change =100[exp(b 1 )-1]. Medical care-avoidable causes only. Numbers in parentheses indicate state rank for all-cause mortality. Rates are age-standardized death rates <age 65 per 100,000. States with <10,000 Black individuals and Washington, DC excluded (n=7). Exponentiated Incident Rate Ratios from negative binomial regression models controlling for age, race, sex, race*sex interactions, and log population size as an offset. Background Objectives Discussion 1. Sensitive to Medical Care Treatment and Prevention * I ntestinal infections 1 , Tuberculosis, Other infectious (Diphtheria, Tetanus, Poliomyelitis, Septicemia, Whooping Cough 1 ), Measles 1 , Malignant neoplasm of colon and rectum, skin, breast; cervix uteri, testis, Hodgkin’s disease, Leukemia, 1 Diseases of the thyroid, Diabetes mellitus, 2 Epilepsy, Chronic rheumatic heart disease, Hypertensive disease, Cerebrovascular disease, All respiratory diseases (excl. pneumonia/influenza) 1 , Influenza & Pneumonia, Peptic ulcer, Appendicitis, Abdominal hernia, Cholelithiasis & cholecystitis, Nephritis and nephrosis, Benign prostatic hyperplasia, Maternal deaths, Congenital cardiovascular anomalies, All perinatal deaths (excluding stillbirths), Misadventures to patients during surgical/medical care 2. Ischemic Heart Disease (IHD) (Amenable to both medical care AND policy/behavioral interventions) 3. Sensitive to Policy and Behavioral Interventions ** Malignant neoplasm of the trachea, bronchus, and lung, Road traffic injuries; Homicide; Cirrhosis of the liver 4. Not-avoidable Residual from all-cause mortality –all categories of avoidable mortality (e.g. *Adapted from Nolte & McKee (2008); **From Tobias and Jackson, 2001 1. Below ages 14; 2. below age 40; All others below age 65 0 100 200 300 400 B-W Difference 1980 1985 1990 1995 2000 2005 year of death Not avoidable Medical care Policy/Behavior Ischemic Heart Disease All-cause mortality Black-White Difference: Age-Standardized Death Rates-Males 0 100 200 300 400 B-W Difference 1980 1985 1990 1995 2000 2005 year of death Not avoidable Medical care Policy/Behavior Ischemic Heart Disease All cause mortality Black-White Difference: Age-Standardized Death Rates-Females Mortality Category Men Women 1980 ASDR /100,000 Annual % change 1980-2005 1980 ASDR /100,000 Annual % change 1980-2005 Black White Black White Black White Black White All-Cause 791 407 -1.67 -1.79 402 210 -1.3 -1.12 Medical care 146 51 -1.05 -0.58 131 60 -1.08 -0.76 Policy 164 76 -2.11 -1.81 38 28 -0.2 0.15 IHD 135 108 -2.7 -3.97 62 29 -2.79 -3.43 Not Avoid. 357 172 -1.95 -1.26 179 94 -1.48 -1.02 Black Males White Males AM Rank 1980 AM Rate 2004 AM Rate 1980 AM Rate 2004 AM Rate 1 SC (1) 345 IL (4) 245 SC (6) 103 AR (4) 106 2 DE (19) 332 TN (6) 242 WV (1) 102 NV (8) 105 3 KY (10) 310 AR (2) 234 KY (2) 100 WV (1) 104 4 IA (22) 307 NV (19) 230 OK (10) 98 AL (2) 98 5 GA (4) 305 LA (1) 229 PA (19) 98 TN (3) 97 6 NC (2) 303 OH (10) 228 LA (5) 96 KY (5) 96 7 FL (3) 298 TX (14) 220 NY (24) 96 OK (6) 93 8 NE (13) 294 AL (3) 219 NC (12) 95 LA (7) 92 Black Females White Females AM Rank 1980 AM Rate 2004 AM Rate 1980 AM Rate 2004 AM Rate 1 DE (10) 284 LA (3) 227 NY (12) 117 WV (1) 113 2 GA (1) 272 IL (4) 216 PA (15) 116 OK (2) 105 3 SC (4) 270 AR (1) 213 OH (5) 116 AR (3) 100 4 KY (7) 260 TN (10) 201 NH (19) 115 TN (6) 100 5 FL (3) 260 OH (9) 200 KY (4) 115 LA (5) 99 6 TN (8) 258 MI (6) 197 WV (2) 112 AL (4) 99 7 OR (26) 254 SC (12) 195 NJ (31) 112 KY (7) 99 8 IN (12) 252 NC (15) 194 IN (16) 111 NV (8) 98

Avoidable Mortality and Health Disparities in the US 5.2.08

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Avoidable Mortality and Health Disparities in the US 5.2.08