Massachusetts Deaths 2007 Bruce Cohen, PhD Massachusetts Department of Public Health Bureau of Health Information, Statistics, Research, and Evaluation Division of Research and Epidemiology Registry of Vital Records and Statistics April 2009

Causes of Death Massachusetts: 1842-2007

Outline Highlights Selected Causes of Death Cancer Heart Disease Diabetes HIV/AIDS Injury Race, Education and Mortality Applications of Mortality Data Summary

HIGHLIGHTS

On An Average Day in Massachusetts 144 DEATHS 36 Cancer 6 CLRD 8 Injury 35 Heart Disease 1 Infant death 5 Alzheimer’s 7 Stroke 3 Diabetes 52,690 Total deaths in 2007

Life Expectancy at Birth Massachusetts vs. U.S.1: 1900-2007 United States 1 2007 U.S. data was not available at the time of this release, 2006 U.S. data used.

Overall Mortality Rates Massachusetts and U.S.1 : 1994-2007 United States - 1.9%* APC Massachusetts - 2.4%* APC * Statistically significant (p<0.05) APC= Annual Percent Change Rates are per 100,000 population. Age-adjusted to the 2000 US standard population. 1 2006 Data. 2007 U.S. Data was not available at the time of this release

Percentage Difference in Mortality Rates Massachusetts vs. U.S.1: 2007 Nephritis* Homicide* Diabetes* Heart Disease* Infant Mortality* Cancer* Suicide* Overall* % difference Higher than US Lower than US Rates are per 100,000 population. Age-adjusted to the 2000 US standard population. *Statistically Significant (p ≤ .05) 1 2006 Data. 2007 U.S. Data was not available at the time of this release

Leading Causes of Death Massachusetts: 2007 Other 23.4% Cancer 24.6% Septicemia 1.7% Diabetes 2.3% Nephritis 2.6% Heart Disease 24.2% Alzheimer’s 3.2% Pneumonia & Influenza 2.9% In 2007: 12,961 cancer deaths 12,735 heart disease deaths Chronic Lower Respiratory Disease 4.4% Stroke 5.1% Injury 5.6%

Ranking of Leading Causes of Death by Race and Ethnicity Massachusetts: 2007 White1 (N=48,.518) Black1 (N=2,211) Asian1 (N=610) Hispanic (N=1,264) Cancer 1 Heart Disease 2 Stroke 3 6 5 CLRD2 4 9 16 Unintentional Injuries Alzheimer’s Disease 14 15 Influenza & Pneumonia 7 17 Nephritis 8 Diabetes HIV/AIDS 29 -- Homicide 30 21 Note: The lower the number the higher the rank 1 Non-Hispanic, 2 Chronic Lower Respiratory Disease

Leading Causes of Death by Age Massachusetts: 2007 % of Total in Total Age Leading Cause Age Group Deaths 1-14 Injuries 32% 128 15-24 Injuries 72% 505 25-44 Injuries 44% 2,023 45-64 Cancer 37% 8,560 65-74 Cancer 40% 7,494 75-84 Cancer 27% 14,781 85+ Heart Disease 30% 18,816

Changes in Mortality Rates Massachusetts: 2000 and 2007 Cause Rate % Change 2000 2007 Cancer 206.1 179.0 * 13% Heart Disease 216.7 166.0 23% Stroke 50.9 35.0 31% Chronic Lower Respiratory Disease 41.8 31.5 25% All Injuries 35.9 42.5 18% Alzheimer’s Disease 19.5 20.9  7% Nephritis 17.6 17.9  2% Diabetes 19.6 16.5 16% All Diabetes-related 61.5 52.9 14% Rates are per 100,000 population. Age-adjusted to the 2000 US standard population. * Statistically different than 2000 rate (p<0.05)

SELECTED CAUSES OF DEATH

Cancer Mortality Rates Massachusetts and U.S. : 1994-20071 United States Rates are per 100,000 population. Age-adjusted to the 2000 US standard population 1 2006 Data. 2007 U.S. Data was not available at the time of this release

Female Breast Cancer Mortality Rates Massachusetts: 1994-2007 - 4%* APC Rates are per 100,000 population. Age-adjusted to the 2000 US standard population * Statistically significant (p<0.05) APC= Annual Percent Change

Heart Disease Mortality Rates Massachusetts and U.S.: 1994-20071 United States Massachusetts Rates are per 100,000 population. Age-adjusted to the 2000 US standard population * Statistically significant (p<0.05) APC= Annual Percent Change 1 2006 Data. 2007 U.S. Data was not available at the time of this release

Number of Heart Disease Deaths by Age and Gender Massachusetts: 2007

Diabetes-Related Deaths Massachusetts: 2007 All Diabetes-related N=3,899 Underlying Cause (Disease or injury which initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury)1 N=1,216 Contributing Cause (Looking at all other 15 conditions mentioned on death certificates) N=2,683 1 World Health Organization. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. 2d ed. Geneva: World Health Organization. 2004.

Diabetes Mortality Rates by Race and Ethnicity Massachusetts: 2007 * * * N=1,041 N=96 N=15 N=62 N=1,216 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population * Statistically different than state rate (p<0.05)

Number of HIV/AIDS Deaths Massachusetts: 1987-2007 Highly Active Antiretroviral Therapy HAART

Percent of HIV/AIDS Deaths by Age Group Massachusetts: 1994-2007 Less than 45 years 45+ years

Injury Deaths

Causes of Injury Deaths Massachusetts: 2007 Total Injuries = 2,967 Other 18% 66% Opioids 18% Alcohol 16% Other (gases, vapor, NSAIDS, etc) Poisonings 33% Firearm 8% Suffocation, Hanging or Strangulation 11% Falls 16% Motor Vehicle-related 15%

Number of Poisoning Deaths Where Opioids Are Mentioned Massachusetts: 2000-2007

Unintentional Fall Mortality Rates Persons Ages 65+ Massachusetts and U.S.: 1994-2007 United States1 Massachusetts Rates are per 100,000 population ages 65+. 1 Available from URL: www.cdc.gov/ncipc/wisqars

Intentional Injury Deaths by Cause Massachusetts: 2007 Other (n=55) Other (n=37) Suicide (n=504) Homicide (n=183) Firearm (n=112) Firearm (n=113) Hanging (n=220) Cut/Pierce (n=33) Poisoning (n=117) N= 687 deaths (183 homicides) (504 suicides)

Suicides by Gender and by Age Massachusetts: 2007

Suicide Rates by Gender Massachusetts: 1994-2007 Males - 3%* APC Massachusetts Females * Statistically significant (p<0.05) APC= Annual Percent Change Rates are per 100,000 population. Age-adjusted to the 2000 US standard population.

Child Homicides (Ages 1-14) Massachusetts: 1997-2007

Race, Education, and Mortality

Mortality Rates by Education and Race/Ethnicity, Adults 25-64 Years1 Massachusetts: 2007 * * * * Statistically higher than those with 13+ yrs of education (p<0..05) Rates are per 100,000 population. Age-adjusted to the 2000 US standard population 1Uses 2000 Population Estimates

Mortality Rates by Race/Ethnicity Adults 25-64 Years1 with 13+Years of Education Massachusetts: 2007 * * Statistically higher than the rate for whites (p<0..05) Rates are per 100,000 population. Age-adjusted to the 2000 US standard population 1Uses 2000 Population Estimates

Applications of Mortality Data

Premature Mortality Rate (PMR)1 Definition deaths before age 75, age-adjusted to the 2000 US standard population under 75 years of age Focus two-thirds of deaths to persons ages 75+ majority of deaths to persons age 75+ are due to chronic conditions associated with aging deaths to persons less than 75 years may be preventable Value excellent measure to reflect the health status of a population used as a health status indicator that can be used to focus prevention initiatives and target programs 1 Age-adjusted to the 2000 US standard population under 75 years of age.

Premature Mortality Rates by Race and Hispanic Ethnicity Massachusetts: 2007 * * (*) Statistically different from State (p ≤.05) Rates are per 100,000 population. Age-adjusted to the 2000 US standard population persons ages 0-74

Premature Mortality Rates (PMR) by Community Health Network Area (CHNA) Massachusetts: 2007

Mortality Amenable to Health Care Definition: Deaths for persons ages 0-74 from certain causes that should not occur in the presence of timely and effective health care1,2 Value: A useful tool to assess Performance of health care systems and Track changes over time1 1 Nolte E and McKee CM. Measuring The Health of Nations: Updating An Earlier Analysis. Health Affairs 2008; Vol 27, Number 1: 58-71; Jan/Feb 2008. 2 Nolte E and McKee CM . Does Health Care Save Lives? Avoidable Mortality Revisited. The Nullfield Trust. 2004. London, England

Mortality Causes Amenable to Health Care Causes considered as amenable to health care: Amenable to secondary prevention where screening and treatment are effective; for example colorectal, breast, cervical, and skin cancer Amenable to improved treatment and medical care: that require direct medical and/or surgical intervention for example appendicitis and hypertension that rely on efficient medical care delivery accurate and timely diagnosis, transport, and treatment that respond to antibiotic treatments and immunizations infectious diseases

Percent Deaths Amenable to Health Care Massachusetts: 2007 All Deaths Deaths to Persons Ages 0-74 Amenable Deaths Amenable Deaths

Mortality Rates for Causes Amenable to Health Care by Race/Ethnicity Massachusetts: 2000 and 2007 ** ** ** Statistically lower than 2000 rate (p<0.05) Rates are per 100,000 population. Age-adjusted to the 2000 US standard population persons ages 0-74

SUMMARY

Summary The Massachusetts death rate was the lowest on record Life expectancy reached an all-time high Massachusetts continues to compare favorably with the U.S. Cancer remained the leading cause of death followed by heart disease. As in previous years, cancer and heart disease accounted for almost half of all deaths Death rates for chronic lower respiratory disease, overall cancer, and female breast cancer declined from 2006

Summary (continued) Lowest annual number of HIV/AIDS deaths in Massachusetts Almost ¾ of HIV/AIDS deaths occurred among persons 45+ years Poisoning deaths, the leading cause of injury deaths, were stable from 2006 to 2007 Two out of 3 poisoning deaths were associated with opioids Suicide rates had leveled off since 2002 but increased for men from 2006 to 2007 Continued increasing trend in unintentional fall-related deaths

Summary (continued) Disparities Persist: The cancer death rate for men was 46% higher than the rate for women Blacks had the highest premature mortality rate, 1.5 times the rate of whites The death rate for those with less education was almost 3 times higher than the rate for those with more education Springfield, Lowell, Fall River, Taunton, Worcester, and New Bedford had the highest premature mortality rates

How to Access the Death Report and Data To access the 2007 Report: Hard Copies: (617) 740-2670 TDD/TTY: (617) 624-6001 DPH Website: http:// mass.gov/dph/bhsre/resep/resep.htm#birth To access Death data via MassCHIP (DPH’s Internet based public health information service): Website: http://masschip.state.ma.us Telephone: 1-888-MASCHIP (Mass only) (617) 624-5629