Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
1
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
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
2
Inf . Disease
Cancer
Heart Disease
Injuries
0%
10%
20%
30%
40%
50%
60%1
84
2
18
48
18
54
18
60
18
66
18
72
18
78
18
84
18
90
18
96
19
02
19
08
19
14
19
20
19
26
19
32
19
38
19
44
19
50
19
56
19
62
19
68
19
74
19
80
19
86
19
92
19
98
20
06
Year
Pe
rce
nt
of
To
tal D
ea
ths
Causes of Death Massachusetts: 1842-2006
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
3Outline
• Highlights
• Selected Causes of Death- Cancer- Heart Disease- Diabetes- Injury: Poisonings and Falls
• Disparities in Mortality
• Single Mortality Measures
• Summary
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
4
Highlights
• Trends
• Comparisons with U.S.
• Leading Causes of death
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
5
On anaverage day
146deaths
1Infant Death
35Heart Disease
37Cancer
8Stroke
8Injury
7 CL Respiratory
<1HIV/AIDS
(15 per month)
4Alzheimer’s
3 Diabetes
On An Average Day, in Massachusetts, in 2006
53,293 Total deaths
in 2006
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
6
79.8 80.0
77.8
40
50
60
70
80
90
1900 1910 1920 1930 1940 1950 1960 1970 1980 1987 1997 2000 2004 2005 2006
Year
Lif
e E
xp
ec
tan
cy
in
Ye
ars
Life Expectancy at BirthMassachusetts vs. U.S.: 1900-20061
Massachusetts
United States
1 2006 U.S. data was not available at the time of this release, 2005 US data used.
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
7
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
868.2
717.6
920.0
798.8
600
700
800
900
1,000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
De
ath
s p
er
10
0,0
00
Massachusetts
United States
Overall Mortality Rates Massachusetts and U.S.: 1994-20061
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
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
8Leading 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
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
9Ranking of Leading Causes of Death by Race and EthnicityMassachusetts: 2006
1 Non-Hispanic, 2 Chronic Lower Respiratory Disease Note: The lower the number the higher the rank
White1 Asian1 Black1 Hispanic
Cancer 1 1 1 1
Heart Disease 2 2 2 2
Injuries (all combined) 4 4 3 3
Stroke 3 3 4 4
CLRD2 5 5 7 12
Influenza & Pneumonia 6 7 11 11
Alzheimer’s Disease 7 9 13 14
Diabetes 9 8 5 5
HIV/AIDS 24 26 10 6
Homicide 28 21 7 10
Suicide 15 8 17 16
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
10
% of Total in Total Age Leading Cause Age Group Deaths
1-14 Injuries 33% 124
15-24 Injuries 69% 471
25-44 Injuries 44% 1,953
45-64 Cancer 38% 8,660
65-74 Cancer 40% 7,572
75-84 Cancer 27% 15,333
85+ Heart Disease 31% 18,811
Leading Causes of Death by Age Massachusetts: 2006
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
11Changes in Mortality RatesMassachusetts: 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 2000 2006
Cancer 206.1 186.3 ** 10%
Heart Disease 216.7 168.8 ** 22%
Injuries 35.9 42.5 * 18%
Stroke 50.9 37.4 ** 27%
Chronic Lower
Respiratory Disease 41.8
34.5 ** 17%
Diabetes 19.6 15.3 ** 22%
Alzheimer’s Disease 19.5 19.3 1%
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
12
Selected Causes of Death
• Cancer
• Heart Disease
• Diabetes
• Injury
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
13Cancer Mortality Rates Massachusetts and U.S. : 1994-20061
186.3184.9
226.0
183.8
212.4
150
200
250
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
Dea
ths
per
100
,000
Massachusetts
United States
Rates are per 100,000 population. Age-adjusted to the 2000 US standard population1 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
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
14Mortality Rates of Most Common Types of Cancer Death by Gender
Massachusetts: 2006
13.1
230.5
66.1
24.521.2 23.214.1 9.9
43.3
158.0
0
40
80
120
160
200
240
Lung Colorectal Pancreas FemaleBreast
Prostate Total
De
ath
s p
er
10
0,0
00
Male Female
Rates are per 100,000 population. Age-adjusted to the 2000 US standard population
*
*
* *
* Statistically higher than female rates (p<0.05)
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
15
168.0172.2
261.5
211.1
300.2
150
170
190
210
230
250
270
290
310
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Dea
ths
per
100
,000
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.: 1994-20061
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
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
16
197436
723949
6,015
1,8061,904
6,876
121569
30757
1,801
4,021
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
< 45 45-54 55-64 65-74 75-84 85+ Total
Ages
Nu
mb
er o
f D
eath
s
Males Females
Number of Heart Disease Deathsby Age and Gender
Massachusetts: 2006
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
17
1,327 1,353 1,422 1,418 1,420 1,271 1,127
2,911 2,9002,997 3,020 2,843
2,660 2,6522,681
1,327
0
1,000
2,000
3,000
4,000
5,000
1999 2000 2001 2002 2003 2004 2005 2006
Year
Nu
mb
er
of
de
ath
s
10
22
34
46
De
ath
s (
as
un
de
rly
ing
ca
us
e)
pe
r 1
00
,00
0
Contributing Cause OnlyUnderlying Cause Death Rate as Underlying Cause
Diabetes-Related DeathsMassachusetts: 1999-2006
7.5%* APC
* Statistically significant (p<0.05)APC= Annual Percent Change
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
18
Injury Deaths
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
19Causes of Injury Deaths
Massachusetts: 2006
Poisonings 34%
Total Injuries = 2,910
Firearm 7%
Other18%
Falls 15%
Hanging, Suffocation,, or Strangulation
10%Motor Vehicle-related
16%
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
20Leading Causes of Injury DeathsMassachusetts: 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)
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
21
363
487449
574
475
544
637586
716690
836
734
989
802
0
250
500
750
1,000
2000 2001 2002 2003 2004 2005 2006
Year
Nu
mb
er
of
de
ath
sPoisoning Deaths
Where Opioids Are MentionedMassachusetts: 2000-2006
Total Poisoning Deaths
Opioid-mentioned Agent
* Statistically significant (p<0.05)APC= Annual Percent Change
6.7%* APC
7.3%* APC
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
22
All3.3
5.7*
3.7
Male
7.2*
5.0
Female2.0
4.6*
0
2
4
6
8
1999 2000 2001 2002 2003 2004 2005 2006
Dea
ths
per
100
,000
Rates are per 100,000 population. Age-adjusted to the 2000 US standard population
Fall Related Mortality RatesMassachusetts: 1999-2006
* Statistically higher than 2005 rate (p<0.05)
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
23
24.3
Ages 65+
16.5
39.8
2.1
Ages 15-64 1.9
0
10
20
30
40
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Ag
es 6
5+,
Dea
ths
per
100
,000
1.2
1.8
2.4
3.0
3.6
4.2
4.8
Ag
es 1
5-64
, D
eath
s p
er 1
00,0
00
Rates are per 100,000 population ages 65+ and 15-64 respectively.
Fall Related Mortality RatesAges 15-64 and 65+
Massachusetts: 1994-2006
6.3%* APC
0.7% APC
* Statistically significant (p<0.05)APC= Annual Percent Change
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
24
8.1 Suicide
6.5
3.7
2.9
Homicide
0
2
4
6
8
10
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Dea
ths
per
100
,000
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
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
25
Disparities in Mortality
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
26Diabetes Mortality Rates by Race and EthnicityMassachusetts: 2006
14.4
36.1
24.0
15.4
8.5
0
10
20
30
40
White non-Hispanic
Black non-Hispanic
Asian non-Hispanic
Hispanic Total
Dea
ths
per
100
,000
Rates are per 100,000 population. Age-adjusted to the 2000 US standard population
N=969 N=91 N=13 N=51 N=1,127
*
**
*
* Statistically higher than state rate (p<0.05)** Statistically lower than state rate (p<0.05)
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
27Mortality Rates by Education and Race/Ethnicity, Adults 25-64 Years1
Massachusetts: 2006
728.6
482.0
185.3
365.7
172.5
530.5
0
200
400
600
800
White non-Hispanics Black non-Hispanics Hispanics
Dea
ths
per
100
,000
High School or Less
13+ Education
Rates are per 100,000 population. Age-adjusted to the 2000 US standard population 1Uses 2000 Population Estimates
* Statistically higher than those with 13+ yrs of education (p<0..05)
*
**
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
28
1.31.8
18.2
29.1
5.5
10.3
0
5
10
15
20
25
30
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Dea
ths
per
100
,000
Black non-Hispanic
Hispanic
White non-Hispanic
Rates are per 100,000 population. Age-adjusted to the 2000 US standard population
Homicide Rates by Race and Ethnicity Massachusetts: 1994-2006
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
29
Single Mortality Measures for Improving Health
– Premature Mortality– Mortality Amenable to Health Care
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
30Premature Mortality Rates by Race and Hispanic Ethnicity
Massachusetts: 2006
300.5279.8
140.3
427.3
298.8
0
200
400
600
White non-Hispanic
Black non-Hispanic
Asian non-Hispanic
Hispanic Total
Dea
ths
per
100
,000
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)
*
**
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
31
Rates per 100,000 population under 75 years of age; age-adjusted to the 2000 US standard population.
CHNA PMR1. Community Health Network of Berkshire = 330.82. Upper Valley Health Web-Franklin County = 334.23. Partnership for Health in Hampshire County = 285.74. The Community Health Connection = 370.75. Community Health Network of Southern Worcester County = 354.96. Community Partners for Health = 277.17. Community Health Network of Greater Metro West = 2508. Community Wellness Coalition = 3399. Fitchburg/Gardner Community Health Network = 324.510. Greater Lowell Community Health Network = 333.411. Greater Lawrence Community Health Network = 285.612. Greater Haverhill Community Health Network = 328.113. Community Health Network North = 248.8
14. North Shore Community Health Network = 303.515. Greater Woburn/Concord/Littleton Community Health Network = 217.816. North Suburban Health Alliance = 294.517. Greater Cambridge/Somerville Community Health Network = 255.718. West Suburban Health Network = 208.219. Alliance for Community Health = 365.420. Blue Hills Community Health Alliance = 297.321. Hampshire County Partnership = 367.522. Greater Brockton Community Health Network = 349.223. South Shore Community Partners in Prevention = 31324. Greater Attleboro-Taunton Health & Education Response = 347.125. Partners for a Healthier Community = 378.426. Greater New Bedford Health & Human Services Coalition = 35127. Cape Cod & Islands Community Health Network = 295.1
45
8
24
26
22
21
25
19
1
2 9
3
27
23
20
12
1011
1416
7
6
15
13
18
17
Rates are per 100,000 persons under 75 years of age, age-adjusted to the 2000 US standard population and are calculated using MDPH population estimates for 2005, which are the most updated estimates available at the sub-state level by age groups.
PMR by CHNA
Significantly higher than state rate
Not different from state rate
Significantly lower than state rate
Premature Mortality Rates (PMR) by Community Health Network Area Massachusetts: 2006
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
32
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
Potentially useful tool to assess Performance of health care systems and Track changes over time1
Originally developed in U.S. in 1970’s; adopted and updated by many researchers especially in Europe2
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
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
33Mortality 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
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
34Percent Deaths Amenable to Health Care
Massachusetts: 2006
90% 72%
All Deaths Deaths to Persons Ages 0-74
Deaths Amenable to Health Care
28%
Deaths Amenable to Health Care
10%
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
35
133.7
101.8 103.6
84.0
67.6
86.0
0
40
80
120
160
Male Female Total
Dea
ths
per
100
,000
2000 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)
****
**
Mortality Rates for Causes Amenable to Health Care by Gender
Massachusetts: 2000 and 2006
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
36Mortality Rates for Causes Amenable to Health Care
by Race and EthnicityMassachusetts: 2000 and 2006
105.4
142.9
40.6
103.6
64.5
84.081.4
48.1
128.4
82.5
0
40
80
120
160
White non-Hispanic
Black non-Hispanic
Asian non-Hispanic
Hispanic Total
Dea
ths
per
100
,000
2000 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)
**
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
37
Summary
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
38Summary 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
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
39Summary (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
Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics, Research, and Evaluation
40
How Can You Access This Information?
• Hard Copies: (617) 740-2670
• TDD/TTY: (617) 624-6001
• MDPH Website: http://www.mass.gov/dph/resep
• MassCHIP Website: http://masschip.state.ma.us (DPH’s Internet-based public health information service)