1. Impact of Social Determinants on Life Expectancy Estimates in Denver County Rebekah Marshall, MPH Public Health Prevention Service Fellow Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2015 Summer Seminar June 2, 2015 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. Objectives  Emphasis on subpopulation differences  Health equity  Communication tool  Community mobilization  Funding prioritization  Policy decision-making

3. Denver Demographics 1  Total Population : 600,158*  Median age: 33.7 years  Sex: Men: 300,089 (50.0%) Women: 300,069 (50.0%)  Race: White or Caucasian 68.9% Black or African American 10.2% All Other Racial Groups 20.9%  Ethnicity: Hispanic or Latino 31.8% Non-Hispanic or Latino 68.2% 1 Bureau USC. American Fact Finder. 2010; http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml. Accessed 07/09/2014, 2014. *The U.S> Census Bureau estimated Denver’s 2013 population to be 649,495 persons

4. Methods (I)  Life expectancy (LE) at birth assessed for Denver County  Subpopulation analysis Sex Race/Ethnicity o Three categories included Aggregate level of poverty by census tract 2 o Assessed by % of population living below the Federal Poverty Level Geographic residence at time of death o Geocoded o Aggregated to city council districts (n=11) 2 Schulz AJ, Mentz, G., Lachance, L., Johnson, J., Gaines, C., & Israel, B. Associations between socioeconomic status and allostatic load: effects of neighborhood poverty and tests of mediating pathways. American Journal of Public Health. 2012;102(9):1706-1714.

5. Methods (II)  Period-abridged life table methodology 3  Small area considerations Required six years of deaths for analysis  Age-specific mortality rates  Conditional probabilities  Data Sources: 2007-2012 death certificates 2010 U.S. Census 2007-2011 American Community Survey 3 Chiang CL. On Constructing Current Life Tables. Journal of the American Statistical Association. 1972;67(339):538-541.

6.  LE analysis IS NOT:  Predictive  Explanatory  LE analysis IS:  Retrospective  Illustrative Interpretation of Results

7. 4 United States Centers for Disease Control and Prevention. Vital Statistics Data Available Online. 2013; http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm, 2015.

9. 2 Schulz AJ, Mentz, G., Lachance, L., Johnson, J., Gaines, C., & Israel, B. Associations between socioeconomic status and allostatic load: effects of neighborhood poverty and tests of mediating pathways. American Journal of Public Health. 2012;102(9):1706-1714.

12. Implications for Public Health  Communicating health data  Preliminary qualitative findings suggest LE is easier to understand than other mortality measures  Utility of social determinant surveillance  Emphasis on health equity  Local analysis  City council specific health assessments  Community action

13. Limitations  Small cohorts  Deaths from 2007-2012 included in analysis  Minimum cohort size needed for valid and reliable results  Census tract aggregation  Income  Geographic residence Missing for 6% of total deaths (N=1,503)  Demographic considerations  Race/ethnicity designation may be misclassified  Utilized cross-sectional demographic data

14. Acknowledgements  Denver Health and Hospital Authority, Denver Public Health  Emily McCormick, MPH  Arthur Davidson, MD  Lauren Snyder, MPH  University of Colorado: Denver, Anschutz Medical Campus  Sascha Larsen-Helbing, MPH  Alameda County Public Health Department  Matt Beyers, MA, MSCRP * Citations, references, and credits – Calibri, 11pt

15. Questions and Discussion www.behealthydenver.org

16. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Rebekah Marshall, MPH vvn2@cdc.gov (303)-602-3691 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support