Health Indices
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HEALTH INDICIES
Health indicies are critically important to epidemiological study of disease and health trends and thus important to the overall understanding of community health and areas of community health in need of help.
Crude death rates are affected by many population characteristics, particularly age structure2. Age Adjusted Death Rates (AADR) are thus useful, since they eliminate the confounding variable of age. In Zip Code 11105, the death rates from the years 1997 to 1999 according to age breakdown were:
Table 1
Standard Population
Exp. deaths NYC per 1000000
Exp. Deaths
Queens per 1000000
Exp. deaths 11105 per 1000000
Age 0-14
214700
228.8284
174.2995
142.2891
Age 15-24
138646
88.10401
57.21468
54.58074
Age 25-34
135573
153.6383
94.49073
98.45057
Age 35-44
162613
437.0423
242.9525
285.6618
Age 45-54
134834
717.6034
435.0099
382.4828
Age 55-64
87247
912.6513
628.3179
556.6589
Age 65-74
66037
1524.299
1106.048
906.6035
Age 75-84
44842
2195.015
1792.483
1584.596
Age 85+
15508
2016.215
1791.611
2125.958
1000000
8273.397
6322.428
6137.281
AADR per 1000:
6.137281
Source: NYC Dept. of Health
The calculated AADR, using HP2010 as the standard population was 6.14 per 1000 people for all deaths. The New York City AADR was 8.27 per 1000 people and Queens AADR was 6.32 per 1000 people. The HP2010 standard population was used for all values, rendering the calculated AADRs comparable2. Although the AADR for Zip Code 11105 was slightly lower than that of Queens, it was significantly lower than that of New York City. This means that people were dying at a slower rate in Zip Code 11105.
Upon further breakdown, the leading causes of death can be examined to determine what actions can be taken to avoid unnecessary deaths. The two leading causes of death for Zip Code 11105 on average during the period of 1997-1999 were Ischemic Heart Disease and Gastrointestinal Neoplasms, or gastrointestinal cancers :
Table 2
New York City
Queens
Zip Code 11105
Ischemic Heart Disease Death Rate per 1000 (1997-1999)
2.8171
2.6505
3.143599
Gastrointestinal Neoplasm Death Rate per 1000 (1997-1999)
0.5452
Source: Pantaleo, Nick. Blackboard website.
The main cause of death in terms of AADR for the years 1997-1999 was ischemic heart disease with 3.14 per 1000 deaths occurring due to ischemic heart disease. In comparison to Healthy People 2010 (HP2010), this value is not good. HP2010 takes into account coronary heart disease, of which ischemic heart disease is a portion of. Still, the target value of HP2010 is 1.66 per 1000 deaths to be due to coronary heart disease3 ; Zip Code 11105 is therefore doing poorly. The second leading cause of death in Zip Code 11105 is gastrointestinal neoplasms, with 1.96 per 1000 deaths occurring because of this cancer. In comparison to New York City and Queens, both of these values are higher. Compared to HP2010, which has a value of 1.39 per 1000 deaths to be due to colorectal cancer3, Zip Code 11105 has a similar value. Colorectal cancer, however, does not take into account any stomach cancers or other cancers that gastrointestinal neoplasms may entail. Zip Code 11105 therefore is doing well. The AADR for New York City in the same time period were 2.82 per 1000 deaths due to Ischemic Heart Disease and 0.22 per 1000 deaths due to gastrointestinal neoplasms4.
Years of Potential Life Lost (YPLL) is another important indicator of why people are not living to their life expectancies2. YPLL rates are age adjusted and account for the confounding variable of age :
Table 3
YPLL Factors
YPLL Rates (per 1000 1997-1999)
ischemic
2.189
unknown
g.i. neoplasms
1.751
respiratory neoplasms
0.875
other heart disease
0.584
hypertension
breast neoplasms
0.584
cirrhosis of liver
accidents
diabetes
0.584
Figure 1
According to the data, the factor that accounted for the highest YPLL rate in Zip Code 11105 was due to unknown causes. This may be due to patients aged 65 and up dying ; at these ages, sentinel events become less predictable2 and the health of a patient can deteriorate rapidly even through mild injury or disease. The second leading factor according to the YPLL rates in Zip Code in the same time frame was ischemic heart disease. The third leading factor was gastrointestinal neoplasms.
Since the highest YPLL rate was due to unknown causes, one cannot give a concrete reason as to why such a high rate occurs. Perhaps it is simply due to age; perhaps a combination of factors. However, the indicators of ischemic heart disease and gastrointestinal neoplasms are clearly targetable problems. The highest results of death due to these diseases were in the population of ages 65 and up, and even higher when the ages reach 85 years of age. However, since sentinel events in these ages are unpredictable, the group of most significance in terms of help needed (and also second in resulting deaths due to these diseases) are the subgroup of people ages 55-64. By targeting cholesterol/ fat intake problems and gastrointernal problems in the group next in line to the highest rates of deaths due to ischemic heart disease and gastrointernal neoplasms, it can be hoped that the rates of death would decrease. To determine whether these diseases were truly of significance in terms of occurrence, or simply a result of inadequate health care, Ambulatory Care Sensitive Indices (ACSI) and the determination of whether the neighborhood is a Medically Underserved Area (MUA) must be examined.
ACSI calculation has grown in usage, as environmentally related