Module 3: Additional Measures of Disease Occurrence

World population growth The world population officially reached 7 billion on October 31, 2011 People under the age of 25 comprise 43% of the world's population Life expectancy is climbing Infant mortality is declining These are two critical indicators of the health of the population Experts say the world's population could reach 10 billion by 2050.

Health Indicator A marker of health status, service provision, or resource availability. May reflect physical or mental disease, impairments or disability, or social well-being

What are some common health indicators? How are they calculated? How are they interpreted?

Americans put off having babies amid poor economy By Haya El Nasser, USA TODAY “Twenty-somethings who postponed having babies because of the poor economy are still hesitant to jump in to parenthood — an unexpected consequence that has dropped the USA’s birthrate to its lowest point in 25 years.”

Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with current age-specific fertility rates.

Birth rate

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% difference. Immigrants from Mexico now residing in the US, for example, had 3.5 children per woman compared to 2.4 children for women still residing in Mexico. Among Chinese immigrants, fertility is 2.3 in the US compared to 1.7 in China Immigrants from Canada have 1.9 children compared to 1.5 children among women in Canada. © 2010 Jones and Bartlett Publishers, LLC

Contraceptive prevalence: Two definitions  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  Contraceptive prevalence rate is the percentage of women who are practicing, or whose sexual partners are practicing, any form of contraception. It is usually measured for married women ages only. © 2010 Jones and Bartlett Publishers, LLC

Contraceptive prevalence

U.S. mortality rate falls to all-time low By Lewis Krauskopf NEW YORK | Wed Mar 16, :36pm EDT (Reuters) - The U.S. mortality rate fell to an all-time low in 2009, marking the 10th consecutive year of declines as death rates from heart disease and crime dropped, the federal government said on Wednesday.

Number of deaths for leading causes of death; US 2009 Heart disease: 599,413 Cancer: 567,628 Chronic lower respiratory diseases: 137,353 Stroke (cerebrovascular diseases): 128,842 Accidents (unintentional injuries): 118,021 Alzheimer's disease: 79,003 Diabetes: 68,705 Influenza and Pneumonia: 53,692 Nephritis, nephrotic syndrome, and nephrosis: 48,935 Intentional self-harm (suicide): 36,909

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 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 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

Death Death certificates ▫Date of birth (for cohort studies) ▫Date of death (for accurate age) ▫Stated age ▫Place of death ▫Place of residence ▫Occupation ▫Sex ▫Cause of death (main cause listed first; two other contributing causes may be included) ▫marital status ▫Other information may include type of injury, place and time of injury, etc. ICD-9-CM ICD-10-CM

Crude mortality rate © 2010 Jones and Bartlett Publishers, LLC

Early mortality

Declining infant mortality rate

Infant mortality

© 2010 Jones and Bartlett Publishers, LLC

Maternal mortality: Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. 99% of all maternal deaths occur in developing countries. Maternal mortality is higher in women living in rural areas and among poorer communities. Young adolescents face a higher risk of complications and death as a result of pregnancy than older women. Skilled care before, during and after childbirth can save the lives of women and newborn babies. Between 1990 and 2010, maternal mortality worldwide dropped by almost 50%

Why do women die? Women die as a result of complications during and following pregnancy and childbirth. The major complications that account for 80% of all maternal deaths are: severe bleeding (mostly bleeding after childbirth) infections (usually after childbirth) high blood pressure during pregnancy unsafe abortion The remainder are caused by or associated with diseases such as malaria, and AIDS during pregnancy.

Public health implications The high number of maternal deaths in some areas of the world reflects inequities in access to health services, and highlights the gap between rich and poor. Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub- Saharan Africa Almost one third occur in South Asia.

© 2010 Jones and Bartlett Publishers, LLC

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

Example: TB case-fatality rate Worldwide, the case-fatality rate of smear- positive pulmonary tuberculosis among persons on treatment is 3.8%. One study assessed the case-fatality rate among such patients in Baltimore between January 1993 and June Tuberculosis incidence was < 17/ population, and 99% of patients received directly observed therapy. Of 174 patients, 42 (24%) died on treatment.

Why? Patients who died were older (mean age 62 vs. 47 years; AND were more likely to have underlying medical conditions. Older age, diabetes mellitus, and renal failure were independently associated with an increased risk of death. With effective control, tuberculosis may become concentrated in older persons with chronic diseases and be associated with high case-fatality rates. In such settings, acceptable treatment success rates may need to be revised.

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 As such, the death of a 25-year-old would account for 50 years of lost life, while the death of a 60-year-old would account for 15 years. Premature death is an indication of the number of useful years of life that are not available to a population due to early death. According to 2008 mortality data, cancer, unintentional injury, heart disease, suicide and deaths occurring during the perinatal period are the top five causes of premature death in the United States