ILA (Epidemiology Thread) (Hundley/ Weber)

Hundley/ Weber

The routine recording of births, marriages, divorces, and deaths can provide a snapshot of a population’s health status.

Simple vital statistics

Important indicators to follow are:

maternal deaths

infant mortality

low birth weights

births to teenage mothers.

(death of a child before his or her first birthday) measures the health of the most vulnerable children directly and reflects the health of the mother indirectly.

Infant mortality 

Used as an indicator of the level of health in a community

Infant mortality 

However, effective health systems can greatly limit the number of infant deaths, particularly by addressing life-threatening issues during the first __ days of life (neonatal period).

28

Infant mortality rate =

# of deaths to live born infants under 1 yo

---

number of live births

x 1,000

Neonatal mortality rate=

# of deaths to live born infants occurring with first 27 days of life

---

number of live births

x 1,000

The US ranks __th in infant mortality among 48 countries

38

Some countries, US among them, register all live births including very small babies with low odds of survival. In contrast, several countries apply a minimum threshold of a gestation period of __ weeks (or a birth weight threshold of 500 grams) for babies to be registered as live births.

22

US infant mortality adjusted to 22 week minimum threshold (500 g birth weight)

Infant mortality rate by state 

In 2020, Alabama’s Infant Mortality Rate of ___ per 1000 live births was higher than the US average of 5.42 per 1000 live births.

6.99

By 2020, the US Infant Mortality rate was ___ per 1000 live births.

5.5

The new goal for healthy people 2030 is to reduce the US Infant Mortality rate to __ per 1000 live births

5

Infant mortality rates through years 

Infant mortality by county

Infant Mortality Rates in Alabama are the ____ highest in the US (2019)

4th

Infant Mortality Rates in Alabama are ___ as high among women of African American descent as compared to Caucasian women

2x

seeks to identify critical community strengths and weakness as well as unique health and social issues associated with poor outcomes of pregnancy

 Fetal Infant Mortality Review Program (FIRM)

Collaborates with the Federal Maternal and Child Health Bureau to implement the FIRM Program

American College of Obstetricians and Gynecologists

Percents of births with adequate prenatal care in Alabama

Roughly ___/___ of women who gave birth in Alabama in 2020 did not have adequate pre-natal care.

1/4

Infant deaths and births by payment source at birth in Alabama

50% percent of all births in Alabama are paid for via

Medicaid

___/___ of infant deaths occur to mothers on Medicaid

2/3

RR of infant deaths under Medicaid as compared to Private Insurance = ___

2.5

Infant deaths are ____% higher among women delivering under Medicaid Insurance

150

Infant mortality by payment in Alabama

Leading causes of infant mortality US

1. Congenital malformations, deformations and chromosomal abnormalities (11.2 per 1,000 live births)

2. Short gestation / low birth weight (8.7 per 1,000 live births)

3. Sudden Infant Death syndrome (3.8 per 1,000 live births)

4. Accidents (unintentional injuries) (3.3 per 1,000 live births)

5. Newborn affected by maternal complications of pregnancy (3.1 per 1,000 live births)

For minority women, the most frequent source for payment for the delivery is ______.

Medicaid

Represents the average number of years that a group of infants would live if they were to experience throughout life the age-specific death rates prevailing during a specified period.

Life expectancy at birth

The COVID-19 pandemic has made a definitive dent in life expectancy in the US: overall, there was a drop of ___ years in life expectancy from 2019 to 2020

1.8

Life expectancy at birth

While all ethnicities experienced a decrease in life expectancy in the first half of 2020, the largest decrease was experienced by ___, non-Hispanic persons (-2.7 years).

Black

Disparities in the death toll from COVID-19

Persons of Hispanic descent experienced a decrease of 1.9 years

White persons experienced a drop of 0.8 years

Non-Hispanic black males experienced a drop of -3.0 years. The highest drop of any subgroup

White males and white females experienced the smallest drops in life expectancy

Types of mortality rates 

• CRUDE

• CAUSE-SPECIFIC

• AGE-SPECIFIC

(* INFANT MORTALITY RATE)

• SEX-SPECIFIC

• RACE/ETHNICITY -SPECIFIC

• COMBINATIONS: AGE, SEX, RACE SPECIFIC

• AGE-ADJUSTED DEATH RATES

COVID ranked as the ____ cause of death in 2021, while _______ and _______ remained as first and second, respectively.

3rd

heart disease and cancer

Accidents are the _____ major cause of death

4th

10 major causes of death, US 2021

Mortality rates general formula

Deaths during a given time period

---

Population among which deaths occured

Crude mortality rate =

Deaths from all causes in a year 

---

Total population at Mid-year 

Mortality rate from a specified cause for a population (Cause specific MR)

Deaths from specified cause

---

Total population at Mid-year

Two major Cancer Registries operate in the United States:

Surveillance Epidemiology and End Results (S.E.E.R Registry) supported by the National Cancer Institute, covers geographic areas representing 28% of the US population

The National Program of Cancer Registries, administered by the Centers for Disease control and Prevention (CDC), operates in 45 States

• Alabama’s Cancer Registry is part of the National Program for Cancer Registries

The most numbers of NEW cases of cancer (INCIDENCE) are for ______ cancer in men and ______ cancer in women. Cancer of the _____ _____is the fourth cause of INCIDENT cancer in females.

Prostate 

Breast 

uterine corpus 

With regards to MORTALITY, cancer of the prostate and cancer of the breast fall ______ to lung cancer. Cancer of the ovary ranks _____ in cancer mortality among females, and cancer of the uterine corpus, which ranked fourth in incidence ranks ___ in mortality

second

5th

6th

cancer of the uterine corpus, which ranked fourth in incidence ranks __ in mortality

6th

Cancer of the ovary ranks __ in cancer mortality among females

5th

With regards to MORTALITY, cancer of the prostate and cancer of the breast fall second to ___ cancer

Lung

The graph shows trends in cancer incidence and mortality. Both show a tendency to decrease

Crude death rates =

No. deaths/population

Crude death rates are very sensitive to the ___ structure of a population

age

For 2017, per 100000

Crude death rate in Alaska = 596.2

Crude death rate in Florida = 970.4

But, the difference could be due to the higher proportion of older people in Florida as compared to Alaska

For a fair comparison we need to “remove” the difference in age structure

For 2017, per 100000

Age adjusted death rate in Alaska = 708.8

Age adjusted death rate in Florida = 672.1

They are FICTITIOUS RATES generated to account for different age distributions of a population: for example, the age distribution of the US population in 1975 would be different from the age distribution of the US population in 2020

Age adjusted rates

Solve the issue of how to compare mortality rates between populations (e.g., Florida to Alaska) or across time frames.

Age adjusted rates

You need age-specific death rates for ____ of the populations being compared and a single standard population to calculate Age adjusted rate

Each

Alabama has the highest crude death rate, but Mississippi has the highest age-adjusted death rate.

Therefore, relative speaking, Mississippi is doing worse with respect to mortality than Alabama.

If we look at the crude death rate by ethnicity, the Caucasian population in the United States has the _______mortality.

When we age-adjust we see that, relatively speaking, the African American population has the ____ mortality of all ethnicities in the US

highest

most

Are real numbers

Their magnitude represents the actual number of deaths in a population

Have REAL value

Crude death rates

Are fictitious numbers

Their magnitude depends on the standard population chosen for their calculation

Have RELATIVE value

Age adjusted death rates 

The leading cause of infant mortality in the US is:

A. Maternal eclampsia

B. Child abuse

C. Congenital malformations, deformations and chromosomal abnormalities

D. Sudden infant death syndrome

E. Rotovirus

C. Congenital malformations, deformations and chromosomal abnormalities

The leading cause of death in the adult US population is:

A. Heart disease

B. Chronic obstructive lung disease

C. Diabetes

D. Cancer

E. Alzheimer’s disease

A. Heart disease

With regards to mortality rates, all of the following are true, EXCEPT:

A. Age adjusted mortality rates do not count actual deaths, rather, they are fictitious numbers with only relative value

B. The denominator of the formula for the infant mortality rate is the number of live births in the year

C. Crude mortality rates show the actual mortality experience of a population

D. Age-adjusted death rates will vary depending on the standard population being used in their calculation

E. The United States has a very low infant mortality rate in comparison with other developed countries in the world

E. The United States has a very low infant mortality rate in comparison with other developed countries in the world

Which of the following is true regarding age-adjusted death rates?

They are based on real numbers

They represent the actual number of deaths in a population

They do not allow compatibility between populations

They are very sensitive to the age structure of a population

They have a relative value

They have a relative value