1. 1 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Massachusetts Deaths 2006 Isabel A. Cáceres, Epidemiologist Massachusetts Department of Public Health Bureau of Health Information, Statistics, Research, and Evaluation Division of Research and Epidemiology April 2008

2. 2 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Causes of Death Massachusetts: 1842-2006

3. 3 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Outline Highlights Selected Causes of Death - Cancer - Heart Disease - Diabetes - Injury: Poisonings and Falls Disparities in Mortality Single Mortality Measures Summary

4. 4 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Highlights Trends Comparisons with U.S. Leading Causes of death

5. 5 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation On an average day 146 deaths 1 Infant Death 35 Heart Disease 37 Cancer 8 Stroke 8 Injury 7 CL Respiratory <1 HIV/AIDS (15 per month) 4 Alzheimer’s 3 Diabetes On An Average Day, in Massachusetts, in 2006 53,293 Total deaths in 2006

6. 6 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Life Expectancy at Birth Massachusetts vs. U.S.: 1900-2006 1 Massachusetts United States 1 2006 U.S. data was not available at the time of this release, 2005 US data used.

7. 7 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation 1 2005 Data. 2006 U.S. Data was not available at the time of this release Rates are per 100,000 population. Age-adjusted to the 2000 US standard population Massachusetts United States Overall Mortality Rates Massachusetts and U.S.: 1994-2006 1 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population.  1.3%* APC  1.2%* APC  2.6%* APC * Statistically significant (p<0.05) APC= Annual Percent Change

8. 8 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Leading Causes of Death Massachusetts: 2006 Heart Disease 24% Cancer 25% Other 22.5% Stroke 5.4% Injury 5.5% Chronic Lower Respiratory Disease 4.7% Pneumonia & Influenza 3.3% Alzheimer’s 2.9% Nephritis 2.6% Diabetes 2.1% Septicemia 1.7% In 2006: 13,375 cancer deaths 12,891 heart disease deaths

9. 9 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Ranking of Leading Causes of Death by Race and Ethnicity Massachusetts: 2006 1 Non-Hispanic, 2 Chronic Lower Respiratory Disease Note: The lower the number the higher the rank White 1 Asian 1 Black 1 Hispanic Cancer1111 Heart Disease2222 Injuries (all combined) 4433 Stroke3344 CLRD 2 55712 Influenza & Pneumonia6711 Alzheimer’s Disease791314 Diabetes9855 HIV/AIDS2426106 Homicide2821710 Suicide1581716

10. 10 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation % of Total in Total Age Leading Cause Age Group Deaths 1-14 Injuries33%124 15-24 Injuries 69%471 25-44 Injuries44% 1,953 45-64 Cancer38% 8,660 65-74 Cancer40% 7,572 75-84 Cancer27% 15,333 85+ Heart Disease31% 18,811 Leading Causes of Death by Age Massachusetts: 2006

11. 11 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Changes in Mortality Rates Massachusetts: 2000 and 2006 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population. * Statistically higher than 2000 rate (p<0.05) ** Statistically lower than 2000 rate (p<0.05) CAUSE Rate % Change 20002006 Cancer206.1186.3**  10% Heart Disease216.7168.8**  22% Injuries 35.9 42.5*  18% Stroke 50.9 37.4**  27% Chronic Lower Respiratory Disease 41.8 34.5**  17% Diabetes 19.615.3**  22% Alzheimer’s Disease 19.5 19.3  1%

12. 12 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Selected Causes of Death Cancer Heart Disease Diabetes Injury

13. 13 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Cancer Mortality Rates Massachusetts and U.S. : 1994-2006 1 Massachusetts United States Rates are per 100,000 population. Age-adjusted to the 2000 US standard population 1 2005 Data. 2006 U.S. Data was not available at the time of this release  1.8%* APC  1.0%* APC  1.7%* APC * Statistically significant (p<0.05) APC= Annual Percent Change

14. 14 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Mortality Rates of Most Common Types of Cancer Death by Gender Massachusetts: 2006 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population * * * * * Statistically higher than female rates (p<0.05)

15. 15 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Rates are per 100,000 population. Age-adjusted to the 2000 US standard population Massachusetts United States Heart Disease Mortality Rates Massachusetts and U.S.: 1994-2006 1 1 2005 Data. 2006 U.S. Data was not available at the time of this release  3.7%* APC  2.5%* APC  4.1%* APC * Statistically significant (p<0.05) APC= Annual Percent Change

16. 16 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Number of Heart Disease Deaths by Age and Gender Massachusetts: 2006

17. 17 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Diabetes-Related Deaths Massachusetts: 1999-2006  7.5%* APC * Statistically significant (p<0.05) APC= Annual Percent Change

18. 18 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Injury Deaths

19. 19 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Causes of Injury Deaths Massachusetts: 2006 Poisonings 34% Total Injuries = 2,910 Firearm 7% Other 18% Falls 15% Hanging, Suffocation,, or Strangulation 10% Motor Vehicle-related 16%

20. 20 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Leading Causes of Injury Deaths Massachusetts: 2000 and 2006 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population. Rate % CAUSE 2000 2006 Change Poisonings 9.0 14.9 *  66% Motor vehicle-related 7.6 7.1  7% Falls 3.2 5.7 *  78% Hanging/Suffocation 4.0 4.2  5% Firearm Deaths 2.7 3.2  19% * Statistically higher than 2000 rate (p<0.05)

21. 21 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Poisoning Deaths Where Opioids Are Mentioned Massachusetts: 2000-2006 Total Poisoning Deaths Opioid-mentioned Agent * Statistically significant (p<0.05) APC= Annual Percent Change  6.7%* APC  7.3%* APC

22. 22 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Rates are per 100,000 population. Age-adjusted to the 2000 US standard population Fall Related Mortality Rates Massachusetts: 1999-2006 * Statistically higher than 2005 rate (p<0.05)

23. 23 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Rates are per 100,000 population ages 65+ and 15-64 respectively. Fall Related Mortality Rates Ages 15-64 and 65+ Massachusetts: 1994-2006  6.3%* APC  0.7% APC * Statistically significant (p<0.05) APC= Annual Percent Change

24. 24 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Rates are per 100,000 population. Age-adjusted to the 2000 US standard population. Suicide and Homicide Rates Massachusetts: 1994-2006  1.9%* APC  5.7%* APC  16.4%* APC * Statistically significant (p<0.05) APC= Annual Percent Change

25. 25 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Disparities in Mortality

26. 26 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Diabetes Mortality Rates by Race and Ethnicity Massachusetts: 2006 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population N=969N=91N=13N=51 N=1,127 * ** * * Statistically higher than state rate (p<0.05) ** Statistically lower than state rate (p<0.05)

27. 27 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Mortality Rates by Education and Race/Ethnicity, Adults 25-64 Years 1 Massachusetts: 2006 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population 1 Uses 2000 Population Estimates * Statistically higher than those with 13+ yrs of education (p<0..05) * * *

28. 28 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Rates are per 100,000 population. Age-adjusted to the 2000 US standard population Homicide Rates by Race and Ethnicity Massachusetts: 1994-2006

29. 29 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Single Mortality Measures for Improving Health – Premature Mortality – Mortality Amenable to Health Care

30. 30 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Premature Mortality Rates by Race and Hispanic Ethnicity Massachusetts: 2006 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population persons ages 0-74 * Statistically higher than state rate (p<0.05) ** Statistically lower than state rate (p<0.05) * **

31. 31 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Premature Mortality Rates (PMR) by Community Health Network Area Massachusetts: 2006

32. 32 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation 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 care 1,2  Potentially useful tool to assess  Performance of health care systems and  Track changes over time 1  Originally developed in U.S. in 1970’s; adopted and updated by many researchers especially in Europe 2 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

33. 33 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation 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

34. 34 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Percent Deaths Amenable to Health Care Massachusetts: 2006 All Deaths Deaths to Persons Ages 0-74 Deaths Amenable to Health Care 28% Deaths Amenable to Health Care 10%

35. 35 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Rates are per 100,000 population. Age-adjusted to the 2000 US standard population persons ages 0-74 ** Statistically lower than 2000 rate (p<0.05) ** Mortality Rates for Causes Amenable to Health Care by Gender Massachusetts: 2000 and 2006

36. 36 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Mortality Rates for Causes Amenable to Health Care by Race and Ethnicity Massachusetts: 2000 and 2006 Rates are per 100,000 population. Age-adjusted to the 2000 US standard population persons ages 0-74 ** ** Statistically lower than 2000 rate (p<0.05) **

37. 37 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Summary

38. 38 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Summary Massachusetts Deaths 2006  The Massachusetts death rate was the lowest on record  Massachusetts compared favorably to the U.S.  Life expectancy reached a record high  Cancer is the leading cause of mortality in MA  Cancer and heart disease death rates continued to decline

39. 39 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation Summary (continued)  Increase in poisonings and fall deaths in 2006  Two out of 3 poisoning deaths are related to opioids  Increasing trend in homicide rates  Disparities persist by: gender race and ethnicity education geography

40. 40 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation How Can You Access This Information? Hard Copies: (617) 740-2670 TDD/TTY: (617) 624-6001 MDPH Website: http://www.mass.gov/dph/resep http://www.mass.gov/dph/resep MassCHIP Website: http://masschip.state.ma.us (DPH’s Internet-based public health information service) http://masschip.state.ma.us