Cause-Specific Mortality in Allegheny County, PA, Pittsburgh Summer Institute in Applied Public Health Allegheny County Health Department--Office of Epidemiology and Biostatistics Ashley Parsons Faculty Advisor: Nancy W. Glynn, Ph.D. Preceptor: John Kokenda

These data are provided by the Allegheny County Health Department, Office of Epidemiology and Biostatistics through a cooperative agreement with the Pennsylvania Department of Health which requires the following disclaimer: "These data were supplied by the State Health Data Center, Pennsylvania Department of Health, Harrisburg, Pennsylvania. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations or conclusions.” The confidentiality of death certificates is strictly maintained by the Bureau of Health Statistics and Research. All published reports of vital statistics contain only aggregated data. Individually identifiable information is only released, as provided for in Act 66, Vital Statistics Law of 1953, for health research purposes and to government agencies in pursuance of their official duties upon completion, review and approval of an application for access to protected data. Certified copies are also released to family members or legal representatives for determination of personal or property rights.

Background Centers for Disease Control, Vital Statistics, 2010 Accidents/unintentional injuries ranked 5 th in leading causes of death in the United States (126,438 total deaths) Only cause of death in the top 5 that is not a chronic condition Outranked intentional self-harm (39,518 deaths); the only other non-chronic condition in the top 10 causes of death 29.3 million emergency department visits for unintentional injuries were recorded Unintentional poisoning deaths accounted for 36,280 total deaths, 11.6 per 100,000 people

Objective To analyze cause-specific mortality within a five year period, , from ACHD community health assessment

Scope of Project Community health assessment Allegheny County (AC) survey data Looked at largest contributors to years of potential life lost due to external causes of deaths Analyzed death rates in AC to identify disparities, differences, and trends Data to be shared with ACHD employees, AC Board of Health, AC council district leaders, and general population

Data Source ACHD Oracle Database All death certificates for Allegheny County residents Focus: External causes of death Accidental/Unintentional Non-transport Accidental poisoning and inhalation of noxious substances (ICD-10: X40-X499) Homicide Suicide

Methods Assessed and corrected 2011 county death records for missing data (age, cause of death, and descendant’s residence); entered corrections into ACHD death record database Abstracted and examined external causes of death for Created a program within Oracle to obtain crude number of deaths for all county, City of Pittsburgh, and remainder of county Calculated age-adjusted rates for underlying causes of death Stratified by decedent’s residence, race, and sex

Median Age at Death, All Causes, Allegheny County, Number of DeathsMedian Age at Death TotalWhiteBlackWhiteBlack Allegheny County13,690*12,0321, District District District 31, District 41,1561, District District 61,1621, District 71,2411, District 81, District 91,3521, District District District 121, District *Districts do not match AC total due to individuals with unknown council district

Accidental Poisonings in Allegheny County, District Number of Deaths Median Age at Death Age-Adjusted Rate*Rank Allegheny County1,055** *Rate per 100,000 based on US 2000 Standard Population **Districts do not match AC total due to individuals with unknown council district

1. Downtown Pittsburgh - Bluff - Duquesne University 2. Downtown Pittsburgh - Part of Lower Hill District - Strip District 3. Lower Hill District 4. Oakland - Soho 5. Upper Hill District 6. Strip District - Polish Hill 7. Shadyside 8. Bloomfield 9. Lawrenceville 10. Morningside - Garfield 11. East End - Mall Area - Highland Park Area 12. East Liberty 13. Homewood 14. Squirrel Hill - Point Breeze - Frick Park 15. Hazelwood - Greenfield 16. South Side - 21st Street - Mountain Street - Arlington Heights 17. South Side - 21st Street - St. Pauls' Monastery - St. Michael's 18. Allentown - Beltzhoover 19. Brookline - Mt. Washington - Beechview 20. West End - Corliss 21. Manchester 22. Stadium - Allegheny Center - North Side Proper 23. Latimer Jr. High School - H. J. Heinz Co. Area 24. Troy Hill - Spring Garden 25. Pineview - Federal Street Ext., Area 26. Perrysville - Riverview 27. Woods Run - Brighton Road 28. Chartiers - Crafton Hts. - Westwood - Esplen 29. Carrick 30. Knoxville 31. Hays - Lincoln Place 32. Overbrook Allegheny County Ordinance approved March 6, 2012

Accidental Poisonings by Type, Allegheny County Cause Number of Deaths AC Median Age at Death (years) X40: Nonopiod analgesics, antipyretics, & antirheumatics649.0 X41: Antiepileptic, sedative-hypnotic, antiparkinsonism, & psychotropic drugs X42: narcotics and psychodysleptics (hallucinogens) X43: Drugs acting on the autonomic nervous system0- X44: unspecified drugs, medicaments, & biological substances X45: Alcohol X46: Organic solvents & halogenated hydrocarbons & their vapors149.5* X47: Other gases & vapors X48: Pesticides0- X49: Other & unspecified chemicals & noxious substances244.5* *n≤2, median age derived from average of age group(s)

Accidental Poisonings Classification X40: 4-amniophenol derivatives, nonsteroidal anti-inflammatory drugs (SAID), pyrazolone derivatives X41: Antidepressants, barbiturates, hydantoin derivatives, iminostilbenes, methaqualone compounds, neuroleptics, psychostiumlants, succinimides and oxazolidinediones, tranquillizers X42: cannabis (derivatives), cocaine, codeine, heroin, lysergide (LSD), mescaline, methadone, morphine, opium (alkaloids) X43: Accidental poisoning by and exposure to other drugs acting on the autonomic nervous system X44: Accidental poisoning by and exposure to other and unspecified drugs, medicaments, and biological substances X45: Accidental poisoning by and exposure to alcohol X46: benzene and homologues, carbon tetrachloride, chlorofluorocarbons, petroleum (derivatives) X47: Accidental poisoning by and exposure to other gases and vapors X48: Accidental poisoning by and exposure to pesticides X49: Accidental poisoning by and exposure to other and unspecified chemicals and noxious substances

Results Summary Allegheny County ,690 deaths total 1,055 deaths attributed to accidental poisonings and inhalation of noxious substances Median age at death (all causes) was 77.9 yrs for Whites and 66.9 yrs for Blacks Median age at death for accidental poisonings was 39.2 yrs Large contributor to years of potential life lost Council district rankings RankDistrict Number of Deaths Median Age at Death Age- Adjusted Rate

Strengths & Limitations Death Certificates Strength: All deaths in county reported to ACHD, resulting in a complete data set—not a sample Weakness: Possible discrepancies between reported cause of death and actual cause of death & missing/inadequate data provided on certificates Age-adjustment Strength: Allowed for comparison between different municipalities and neighborhoods Weakness: Is affected by population size (i.e. high number of deaths in a high population area can result in low cause-specific rates)

Future Directions Policy change and increased programming Prescription drug monitoring Change in prescribing naloxone Targeted interventions in high-risk areas Compare drug mortality trends with hospital admission data Data to serve as a measure of the health of the county during the community health assessment process Compare data with national rates and comparable counties (Philadelphia, Cook, and Wayne Counties) to further evaluate the health of Allegheny County Master’s Essay

Other Internship Experiences Finalized death certificate data for 2011 Organized and recorded death certificates for 2013 & 2014 Created Allegheny County Child Death Review Fact Sheets Suicide, homicide, motor vehicle accidents, drug- overdose Attended weekly lectures Outbreak investigation, health disparities, West Nile Virus control, Incident Command System (ICS) training

Skills Gained & Lessons Learned Worked with a biostatistician with vital records and was exposed to unfamiliar data Learned valuable data analysis and interpretation skills Expanded my knowledge of public health practice and discovered my interest in drug abuse health policy Previous public health experience focused primarily on clinical research, this opportunity allowed for application of health assessment at the community level through public programming and monitoring of population health Further solidified my goal to work in a health department

Acknowledgements The Allegheny County Health Department staff for their involvement in the Pittsburgh Summer Institute in Applied Epidemiology Preceptor: John Kokenda Program supervisor: Ronald Voorhees, MD, MPH

References Allegheny County Pennsylvania. (2012). Allegheny County Council Districts. Retrieved on Sep 15, From: Centers for Disease Control. (2010). FastStats A to Z. Retrieved on Sep 22, From: International statistical classification of diseases and related health problems. Geneva: World Health Organization, 2011.