Health Indices

HEALTH INDICIES

Health indicies are critically important to epidemiological study of disease and health trends and thus important to the overall understanding of community health and areas of community health in need of help.

Crude death rates are affected by many population characteristics, particularly age structure2. Age Adjusted Death Rates (AADR) are thus useful, since they eliminate the confounding variable of age. In Zip Code 11105, the death rates from the years 1997 to 1999 according to age breakdown were:

Table 1

Standard Population Exp. deaths NYC per 1000000 Exp. Deaths

Queens per 1000000 Exp. deaths 11105 per 1000000

Age 0-14 214700 228.8284 174.2995 142.2891

Age 15-24 138646 88.10401 57.21468 54.58074

Age 25-34 135573 153.6383 94.49073 98.45057

Age 35-44 162613 437.0423 242.9525 285.6618

Age 45-54 134834 717.6034 435.0099 382.4828

Age 55-64 87247 912.6513 628.3179 556.6589

Age 65-74 66037 1524.299 1106.048 906.6035

Age 75-84 44842 2195.015 1792.483 1584.596

Age 85+ 15508 2016.215 1791.611 2125.958

1000000 8273.397 6322.428 6137.281

AADR per 1000: 8.27 6.32 6.137281

Source: NYC Dept. of Health

The calculated AADR, using HP2010 as the standard population was 6.14 per 1000 people for all deaths. The New York City AADR was 8.27 per 1000 people and Queens' AADR was 6.32 per 1000 people. The HP2010 standard population was used for all values, rendering the calculated AADRs comparable2. Although the AADR for Zip Code 11105 was slightly lower than that of Queens, it was significantly lower than that of New York City. This means that people were dying at a slower rate in Zip Code 11105.

Upon further breakdown, the leading causes of death can be examined to determine what actions can be taken to avoid unnecessary deaths. The two leading causes of death for Zip Code 11105 on average during the period of 1997-1999 were Ischemic Heart Disease and Gastrointestinal Neoplasms, or gastrointestinal cancers :

Table 2

New York City Queens Zip Code 11105

Ischemic Heart Disease Death Rate per 1000 (1997-1999) 2.8171 2.6505 3.143599

Gastrointestinal Neoplasm Death Rate per 1000 (1997-1999) 0.5452 0.41 1.96

Source: Pantaleo, Nick. Blackboard website.

The main cause of death in terms of AADR for the years 1997-1999 was ischemic heart disease with 3.14 per 1000 deaths occurring due to ischemic heart disease. In comparison to Healthy People 2010 (HP2010), this value is not good. HP2010 takes into account coronary heart disease, of which ischemic heart disease is a portion of. Still, the target value of HP2010 is 1.66 per 1000 deaths to be due to coronary heart disease3 ; Zip Code 11105 is therefore doing poorly. The second leading cause of death in Zip Code 11105 is gastrointestinal neoplasms, with 1.96 per 1000 deaths occurring because of this cancer. In comparison to New York City and Queens, both of these values are higher. Compared to HP2010, which has a value of 1.39 per 1000 deaths to be due to colorectal cancer3, Zip Code 11105 has a similar value. Colorectal cancer, however, does not take into account any stomach cancers or other cancers that gastrointestinal neoplasms may entail. Zip Code 11105 therefore is doing well. The AADR for New York City in the same time period were 2.82 per 1000 deaths due to Ischemic Heart Disease and 0.22 per 1000 deaths due to gastrointestinal neoplasms4.

Years of Potential Life Lost (YPLL) is another important indicator of why people are not living to their life expectancies2. YPLL rates are age adjusted and account for the confounding variable of age :

Table 3

YPLL Factors YPLL Rates (per 1000 1997-1999)

ischemic 2.189

unknown 5.66

g.i. neoplasms 1.751

respiratory neoplasms 0.875

other heart disease 0.584

hypertension 1.46

breast neoplasms 0.584

cirrhosis of liver 1.31

accidents 1.02

diabetes 0.584

Figure 1

According to the data, the factor that accounted for the highest YPLL rate in Zip Code 11105 was due to unknown causes. This may be due to patients aged 65 and up dying ; at these ages, sentinel events become less predictable2 and the health of a patient can deteriorate rapidly even through mild injury or disease. The second leading factor according to the YPLL rates in Zip Code in the same time frame was ischemic heart disease. The third leading factor was gastrointestinal neoplasms.

Since the highest YPLL rate was due to unknown causes, one cannot give a concrete reason as to why such a high rate occurs. Perhaps it is simply due to age; perhaps a combination of factors. However, the indicators of ischemic heart disease and gastrointestinal neoplasms are clearly targetable problems. The highest results of death due to these diseases were in the population of ages 65 and up, and even higher when the ages reach 85 years of age. However, since sentinel events in these ages are unpredictable, the group of most significance in terms of help needed (and also second in resulting deaths due to these diseases) are the subgroup of people ages 55-64. By targeting cholesterol/ fat intake problems and gastrointernal problems in the group next in line to the highest rates of deaths due to ischemic heart disease and gastrointernal neoplasms, it can be hoped that the rates of death would decrease. To determine whether these diseases were truly of significance in terms of occurrence, or simply a result of inadequate health care, Ambulatory Care Sensitive Indices (ACSI) and the determination of whether the neighborhood is a Medically Underserved Area (MUA) must be examined.

ACSI calculation has grown in usage, as environmentally related