Falling behind: life expectancy in US counties from 2000 to 2007 in an international context

<p>Abstract</p> <p>Background</p> <p>The United States health care debate has focused on the nation's uniquely high rates of lack of insurance and poor health outcomes relative to other high-income countries. Large disparities in health outcomes are well-documented in the US, but the most recent assessment of county disparities in mortality is from 1999. It is critical to tracking progress of health reform legislation to have an up-to-date assessment of disparities in life expectancy across counties. US disparities can be seen more clearly in the context of how progress in each county compares to international trends.</p> <p>Methods</p> <p>We use newly released mortality data by age, sex, and county for the US from 2000 to 2007 to compute life tables separately for each sex, for all races combined, for whites, and for blacks. We propose, validate, and apply novel methods to estimate recent life tables for small areas to generate up-to-date estimates. Life expectancy rates and changes in life expectancy for counties are compared to the life expectancies across nations in 2000 and 2007. We calculate the number of calendar years behind each county is in 2000 and 2007 compared to an international life expectancy time series.</p> <p>Results</p> <p>Across US counties, life expectancy in 2007 ranged from 65.9 to 81.1 years for men and 73.5 to 86.0 years for women. When compared against a time series of life expectancy in the 10 nations with the lowest mortality, US counties range from being 15 calendar years ahead to over 50 calendar years behind for men and 16 calendar years ahead to over 50 calendar years behind for women. County life expectancy for black men ranges from 59.4 to 77.2 years, with counties ranging from seven to over 50 calendar years behind the international frontier; for black women, the range is 69.6 to 82.6 years, with counties ranging from eight to over 50 calendar years behind. Between 2000 and 2007, 80% (men) and 91% (women) of American counties fell in standing against this international life expectancy standard.</p> <p>Conclusions</p> <p>The US has extremely large geographic and racial disparities, with some communities having life expectancies already well behind those of the best-performing nations. At the same time, relative performance for most communities continues to drop. Efforts to address these issues will need to tackle the leading preventable causes of death.</p

Detecting Unanticipated Increases in Emergency Department Chief Complaint Keywords

The chief complaint (CC) text field is a rich source of information, but its current use for syndromic surveillance is limited to a fixed set of syndromes defined a priori using keywords. To identify unanticipated sudden increases in word frequency, we developed a simple method that compares the frequency of every word in the CC text field on a given day against the average frequency of the same word during a baseline period. This could prove useful for situational awareness during routine surveillance and emergencies

Detecting Unanticipated Increases in Emergency Department Chief Complaint Keywords

The chief complaint (CC) text field is a rich source of information, but its current use for syndromic surveillance is limited to a fixed set of syndromes defined a priori using keywords. To identify unanticipated sudden increases in word frequency, we developed a simple method that compares the frequency of every word in the CC text field on a given day against the average frequency of the same word during a baseline period. This could prove useful for situational awareness during routine surveillance and emergencies

Building a Better Syndromic Surveillance System: the New York City Experience

The New York City (NYC) syndromic surveillance system has been monitoring syndromes from city emergency department (ED) visits since 2001. We conducted an evaluation of statistical aberration detection methods currently in use in our system as well as alternative methods, applying six temporal and four spatio-temporal aberration detection methods to two years of ED visits in NYC spiked with synthetic outbreaks. We found performance varied between the methods in regard to sensitivity, specificity, and timeliness, and implementation of these methods will depend on needs, frequency of signals, and technical skill

An assessment of the impact of the JSY cash transfer program on maternal mortality reduction in Madhya Pradesh, India

Background: The Indian Janani Suraksha Yojana (JSY) program is a demand-side program in which the state pays women a cash incentive to deliver in an institution, with the aim of reducing maternal mortality. The JSY has had 54 million beneficiaries since inception 7 years ago. Although a number of studies have demonstrated the effect of JSY on coverage, few have examined the direct impact of the program on maternal mortality. Objective: To study the impact of JSY on maternal mortality in Madhya Pradesh (MP), one of India's largest provinces. Design: By synthesizing data from various sources, district-level maternal mortality ratios (MMR) from 2005 to 2010 were estimated using a Bayesian spatio-temporal model. Based on these, a mixed effects multilevel regression model was applied to assess the impact of JSY. Specifically, the association between JSY intensity, as reflected by 1) proportion of JSY-supported institutional deliveries, 2) total annual JSY expenditure, and 3) MMR, was examined. Results: The proportion of all institutional deliveries increased from 23.9% in 2005 to 55.9% in 2010 province-wide. The proportion of JSY-supported institutional deliveries rose from 14% (2005) to 80% (2010). MMR declines in the districts varied from 2 to 35% over this period. Despite the marked increase in JSY-supported delivery, our multilevel models did not detect a significant association between JSY-supported delivery proportions and changes in MMR in the districts. The results from the analysis examining the association between MMR and JSY expenditure are similar. Conclusions: Our analysis was unable to detect an association between maternal mortality reduction and the JSY in MP. The high proportion of institutional delivery under the program does not seem to have converted to lower mortality outcomes. The lack of significant impact could be related to supply-side constraints. Demand-side programs like JSY will have a limited effect if the supply side is unable to deliver care of adequate quality

Evaluating and implementing temporal, spatial, and spatio-temporal methods for outbreak detection in a local syndromic surveillance system.

The New York City Department of Health and Mental Hygiene has operated an emergency department syndromic surveillance system since 2001, using temporal and spatial scan statistics run on a daily basis for cluster detection. Since the system was originally implemented, a number of new methods have been proposed for use in cluster detection. We evaluated six temporal and four spatial/spatio-temporal detection methods using syndromic surveillance data spiked with simulated injections. The algorithms were compared on several metrics, including sensitivity, specificity, positive predictive value, coherence, and timeliness. We also evaluated each method's implementation, programming time, run time, and the ease of use. Among the temporal methods, at a set specificity of 95%, a Holt-Winters exponential smoother performed the best, detecting 19% of the simulated injects across all shapes and sizes, followed by an autoregressive moving average model (16%), a generalized linear model (15%), a modified version of the Early Aberration Reporting System's C2 algorithm (13%), a temporal scan statistic (11%), and a cumulative sum control chart (<2%). Of the spatial/spatio-temporal methods we tested, a spatial scan statistic detected 3% of all injects, a Bayes regression found 2%, and a generalized linear mixed model and a space-time permutation scan statistic detected none at a specificity of 95%. Positive predictive value was low (<7%) for all methods. Overall, the detection methods we tested did not perform well in identifying the temporal and spatial clusters of cases in the inject dataset. The spatial scan statistic, our current method for spatial cluster detection, performed slightly better than the other tested methods across different inject magnitudes and types. Furthermore, we found the scan statistics, as applied in the SaTScan software package, to be the easiest to program and implement for daily data analysis

Worldwide mortality in men and women aged 15-59 years from 1970 to 2010: a systematic analysis

Background: Adult deaths are a crucial priority for global health. Causes of adult death are important components of Millennium Development Goals 5 and 6. However, adult mortality has received little policy attention, resources, or monitoring efforts. This study aimed to estimate worldwide mortality in men and women aged 15-59 years. Methods: We compiled a database of 3889 measurements of adult mortality for 187 countries from 1970 to 2010 using vital registration data and census and survey data for deaths in the household corrected for completeness, and sibling history data from surveys corrected for survival bias. We used Gaussian process regression to generate yearly estimates of the probability of death between the ages of 15 years and 60 years (45q15) for men and women for every country with uncertainty intervals that indicate sampling and non-sampling error. We showed that these analytical methods have good predictive validity for countries with missing data. Findings: Adult mortality varied substantially across countries and over time. In 2010, the countries with the lowest risk of mortality for men and women are Iceland and Cyprus, respectively. In Iceland, male 45q15 is 65 (uncertainty interval 61-69) per 1000; in Cyprus, female 45q15 is 38 (36-41) per 1000. Highest risk of mortality in 2010 is seen in Swaziland for men (45q15 of 765 [692-845] per 1000) and Zambia for women (606 [518-708] per 1000). Between 1970 and 2010, substantial increases in adult mortality occurred in sub-Saharan Africa because of the HIV epidemic and in countries in or related to the former Soviet Union. Other regional trends were also seen, such as stagnation in the decline of adult mortality for large countries in southeast Asia and a striking decline in female mortality in south Asia. Interpretation: The prevention of premature adult death is just as important for global health policy as the improvement of child survival. Routine monitoring of adult mortality should be given much greater emphasis. Funding: Bill & Melinda Gates Foundation. © 2010 Elsevier Ltd. All rights reserved

Age-specific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study 2010.

Estimation of the number and rate of deaths by age and sex is a key first stage for calculation of the burden of disease in order to constrain estimates of cause-specific mortality and to measure premature mortality in populations. We aimed to estimate life tables and annual numbers of deaths for 187 countries from 1970 to 2010