Appendices

MethodologyGlossary of terms

References

Methodology

68 Status of Health in DeKalb Report, 2005

The method of data analysis chosen for the Status of Health in DeKalb: Opportunities for Prevention and Community Service, 2005 presents the results in a format that is compatible with the previous documents in this series. All health data presented in this report were the latest available data released from the Georgia Department of Human Resources or from the DeKalb County Board of Health.

The birth and death data were compiled from official birth and death certificate data from the Georgia Division of Public Health, Office of Health Information and Policy. The data were checked for errors and missing information and geographically coded to census tracts within Community Health Assessment Areas (CHAAs). Using the International Classification of Diseases, 9th Edition (ICD-9) and 10th Edition (ICD-10), primary causes of death found on the death certificates were grouped into cause of deathcategories (Table 23). The causes of death groups used in this report were those recommended by the Assessment Protocol for Excellence in Public Health (APEX-PH), developed in 1991 by the National Association of County Health Officials (now known as the National Association of County and City Health Officials).

The whole county population estimates were obtained from the U.S. Bureau of the Census and were broken down by year, age, race, sex and ethnic origin. The population estimates for each of the CHAAs in DeKalb County were derived from 2000 U.S. Census Bureau census tract estimates. DeKalb County has large numbers of people who identify themselves as Asians or of Hispanic origin compared to other counties in Georgia. However, the total populations for each of these groups are small for statistical purposes and make analysis by age or sex problematic. Therefore, only limited analysis of these groups is included in this report.

All birth-related rates were computed per 1,000 females, and infant mortality rates were computed per 1,000 live births. All disease and mortality-related rates were computed per 100,000 population. This was done so that the statistics would be consistent with those presented by other sources and to make comparisons across populations.

Years of potential life lost (YPLL) rate is used to show comparative causes of premature death to specific populations. The YPLL rates were calculated per 100,000 population between the ages of one and 64 years of age.

We computed separate lifestage-specific mortality rates for populations in DeKalb County age 65 and older. Lifestage-specific age groupings were adopted to calculateage-specific mortality rates. These categories are the same as those presented in the Georgia Vital Statistics Report, printed by the Georgia Division of Public Health, and were used to help facilitate comparisons with this significant source.

Status of Health in DeKalb Report, 2005 69

Table 23. Cause of death grouping by International Classification of Diseases, 9th Edition and 10th Edition

ICD-9 ICD-10 Category042-044 B20-24 AIDS, HIV infection140-208 C00-C97 Cancer191-192 C71-C72 Brain cancer174-175 C50 Breast cancer153-154 C18-C21 Colon/rectal cancer204-208 C91-C95 Leukemia155 C22 Liver cancer162 C34 Lung cancer183 C56 Ovarian cancer72-173 C43-C44 Skin cancer430-438 I60-I69 Cerebrovascular Disease490-496 J40-J47 Chronic Obstructive Pulmonary Disease250 E10-E14 Diabetes520-569, 574-579 K00-K67, K80-87, K90-93 Digestive tract conditions580-629 N00-N99 Genitourinary disease390-429 I00-I52 Heart disease410 I21 Heart attack411-414 I20-I25 Other ischemic heart disease401-405 I10-I15 Hypertensive disease390-398, 415-429 I00-I09, I26-I52 Other heart diseaseE960-E969 X85-Y09, Y87.1 HomicideE965 X93-X95 FirearmE963 X91 Hanging001-041, 045-139 A00-A99, B00-B19, B25-B99 Infectious & parasitic diseases570-573 K70-K77 Liver disease290-319 F00-F99 Mental and behavioral disorders710-739 M00-M99 Musculoskeletal & connective tissue diseases320-359, 780.5 G00-G99 Neurological diseases240-246, 251-279 E00-E07, E15-E16, E20-E35, E40-E46,

E50-E68, E70-E90Nondiabetic endocrine diseases

480-487 J10-J18 Pneumonia/InfluenzaE950-E959 X60-X84, Y87 SuicideE952.0, E952.1 X67 Carbon monoxideE950 X60-X64 Drug overdoseE955 X72-X74 FirearmE953 X70 HangingE957-E958.0 X80-X81 JumpingE958.8 X69, X76, X83, Y87.0 Other methodE800-E949 V01-X59, Y85-Y86 Unintentional injuriesE810-E819 V03-V04, V09, V13-V14, V19.4, V19.6, V23-

V24, V27-V29, V43-V44, V47-V49, V57-V59, V68-V69, V86-V87, V89

Motor vehicle accidents

E910 W65-W74 DrowningE880-E888 W00-W19 FallsE890-E899 X00-X09 Fire/smokeV81.2, V89.9, V90.6, V95.9, W28, W31, W40, W75, W76, W78, W79, W80, W83, W84, W85, W86, W94, X11, X30, X31, X53, X57, X58, X59, Y85, Y86

E830.0, E830.9, E832.9, E838.9, E841.2, E841.3, E841.5, E844.7, E848, E900.0, E901.0, E901.9, E906.8, E907, E911, E912, E913.0, E913.8, E913.9, E919.0, E919.2, E919.8, E920.8, E924.0, E925.0, E925.1, E927, E928.9, E929.0, E929.3, E929.5

Other accidents

E850-E858 X40-X49 Poisoning761-763, 767-768 P00-P04, P10-P15, P20-P21 Newborn complications764-766, 769 P05, P07, P22 Prematurity and respiratory distress syndrome770 P23-P29 Other perinatal respiratory conditions771 P35-P39 Perinatal infections760, 766, 772-779 P00, P08, P50-P61, P70-P78, P80-P83,

P90-P96Other perinatal conditions

740-759 Q00-Q99 Congenital anomalies798 R95 Sudden Infant Death Syndrome

Community Health Assessment Areas

70 Status of Health in DeKalb Report, 2005

Information for geographic areas within the county were calculated by totaling data from census tracts, using the 1995-1996 senior high school districts as a guide to create 13 Community Health Assessment Areas (CHAAs). The boundaries of the CHAAs are not identical to the school district lines, but they conform to the census tract boundaries that are the "best fit" to the high school districts. Though the senior high districts have changed (e.g., M.L. King, Jr., and Stephenson high schools are new senior high schools, and Shamrock and Henderson have been converted into middle schools), the original CHAAs have been maintained to provide consistency in reporting and allow comparisons between Status of Health in DeKalb reports. Table 3 provides population estimates of the CHAAs, based on data provided by the U.S. Bureau of the Census.

The CHAA maps were created using ArcGIS software. The CHAA maps show the average five-year (1998 to 2002) infant mortality and premature death rates. The causes of premature death selected were those conditions that ranked among the topeight for the county: cancer, unintentional injuries, heart disease, homicide, HIV/AIDS, suicide, stroke and infectious diseases. For the five-year time period and each cause of death, the average number of years of potential life lost (YPLL) were calculated per 100,000 persons per CHAA. Based on natural breaks in the data set, the YPLL rates were partitioned into five subsets. Finally, each CHAA was charted with a shade of color indicative of the value of its YPLL rate; CHAAs with YPLL rates in the lower subsets have a lighter shade of color than those in the higher subsets.

Status of Health in DeKalb Report, 2005 71

Glossary of Terms Adolescence: 13 to 19 years of age. Age-Specific Mortality Rate: Total deaths in a specified age group per 100,000 total population in that age group. AIDS: Acquired immunodeficiency syndrome is a weakening of the immune system caused by the HIV virus. APEX-PH: Assessment Protocol for Excellence in Public Health. BMI: Body Mass Index is a relationship between weight and height that is associated with body fat and health risk. BRFSS: Behavioral Risk Factor Surveillance System. Cancer: Includes all types of cancer. Cause-Specific Mortality Rate: Total deaths from a specific cause per 100,000 total population. CDC: Centers for Disease Control and Prevention. CHAA: See Community Health Assessment Area. Community Health Assessment Area (CHAA): A group of adjacent census tracts combined, used in geographic mapping, based on senior high school district boundaries. Child: One to 12 years of age. Chronic Liver Disease: Examples include cirrhosis of the liver and chronic hepatitis. Chronic Lung Disease: Examples include asthma, chronic bronchitis, emphysema and chronic obstructive pulmonary disease. Early Adult: 20 to 44 years of age. Ethnicity: See Race. General Fertility Rate: Total live births per 1,000 women 15 to 44 years of age. Heart Disease: Includes acute myocardial infarction, atherosclerosis, chronic rheumatic heart disease, diseases of arteries/capillaries, diseases of veins, hypertensive disease, ischemic heart disease and other forms of heart disease. Highway: Roadways that are part of the Georgia Department of Transportation state road system. Usually a four-lane divided highway, but can have fewer than four lanes and a divider. HIV: The human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS). ICD-9: International Classification of Diseases, 9th Edition. ICD-10: International Classification of Diseases, 10th Edition. Induced Abortion: Intentional termination of a pregnancy. Infancy: Under one year of age. Infant Mortality: A death occurring to a person less than one year of age. Infant Mortality Rate: Total infant deaths per 1,000 live births. Later Adult: 60 to 74 years of age. Middle Adult: 45 to 59 years of age.

Morbidity: Illness or injury due to a particular cause. Mortality: Deaths to a specific geographic population over a specific period of time. Motor Vehicle Injuries: Includes all injuries where a motor vehicle was involved. Neurological Disease: Diseases related to the brain, such as meningitis, encephalitis and multiple sclerosis. Obese: At or above the 95th percentile for body mass index by age and sex. Older Adult: 75 years of age and older. Overweight: At or above 85th and below the 95th percentile for body mass index by age and sex. Pedestrian Deaths: Motor vehicle-related deaths to individuals not in a motorized vehicle. Pediatric: Related to infants and children. Premature Mortality: Death before age 65. Race: Racial/ethnic classifications are tabulated into mutually exclusive Asian, black, Hispanic, Native American, and white groups. Because of the way population estimates are computed, members of "other" populations are estimated as part of the white group. Refugee: Person admitted to the U.S. who has been persecuted or has fear of persecution on account of race, religion, nationality, membership in a particular social group or political opinion. SOH: Status of Health. Stroke: All cerebrovascular disease. Caused by blockage of blood flow to the brain or bleeding into the brain. Teenage: 10 to 19 years of age. Teen Birth Rate: Total live births to females 10 to 19 years of age per 1,000 females 10 to 19 years of age. Teen Pregnancy Rate: Total pregnancies to females 10 to 19 years of age per 1,000 females 10 to 19 years of age. Unintentional Injuries: Injuries that are a result of an unplanned action or are accidental (e.g., motor vehicle accidents, falls, drowning, fire/smoke exposure, poisoning). It excludes homicide and suicide. YPLL: See Years of Potential Life Lost. Years of Potential Life Lost (YPLL): Years of potential life lost after one year of age and prior to age 65 is an index used to determine the relative number of potential years lost for a specific cause of mortality. This index is calculated by subtracting the age of death from 65. YPLL Rate: Years of potential life lost after one year of age and prior to age 65 per 100,000 population. YRBS: Youth Risk Behavior Survey.

72 Status of Health in DeKalb Report, 2005

References 1. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and

Health Promotion. Improving Nutrition and Increasing Physical Activity. Retrieved January 22, 2004, from www.cdc.gov/nccdphp/bb_nutrition/index.htm .

2. DeKalb County Board of Health. DeKalb County Youth Risk Behavior Survey. 2003. 3. DeKalb County Board of Health. DeKalb County Behavioral Risk Factor Survey. 2001. 4. Schwartz M, Jacob AE. DeKalb County Pedestrian Crash Report, DeKalb County, Georgia,

August 2003. Report available on www.dekalbhealth.net/information/injury-prevention-injurydata.asp .

5. Healthy People 2010 Goals. Retrieved July 9, 2004, from www.healthypeople.gov .6. Maternal and Child Health Epidemiology Section, Epidemiology Branch, Division of Public

Health, Georgia Department of Human Resources. Trends in Pregnancy Rates in 15-19 Year Old Females in Georgia, 1994-2002. January 15, 2004. Retrieved January 26, 2004, from http://health.state.ga.us/epi/mch/publications.asp .

7. Hoban CA. Georgia Immunization Study 2002 Final Report. Retrieved January 27, 2004, from http://health.state.ga.us/epi/mch/publications.asp .

8. Georgia Epidemiology Report. Vol. 17, No. 11. November 2001. Retrieved May 11, 2004, from http://health.state.ga.us/epi/manuals/ger.asp .

9. Centers for Disease Control and Prevention, Foodborne and Diarrheal Diseases Branch. Campylobacter, Cyclospora, Cryptosporidia, E.coli O157:H7, Listeria, Salmonella, Shigella, Vibrio and Yersinia. Retrieved May 11, 2004, from www.cdc.gov/foodnet .

10. Georgia Department of Human Resources, Division of Public Health. Georgia HIV/STD Report 1998-1999. Retrieved May 11, 2004, from http://health.state.ga.us/epi/manuals/pdf/hivstd01.pdf .

11. Georgia Department of Human Resources, Division of Public Health. An Overview of Gonorrhea and Chlamydia in Georgia. Retrieved September 14, 2004, from http://health.state.ga.us/epi/manuals/pdf/gonorrhea_chlamydia.pdf .

12. Georgia Department of Human Resources, Division of Public Health. 2002 Georgia Tuberculosis Report. Retrieved May 11, 2004, from http://health.state.ga.us/pdfs/epi/tb/tbreport.02.pdf .

13. National Vital Statistics Reports. Vol. 52, No. 3. 2003. Retrieved December 29, 2003, from www.cdc.gov/nchs/fastats/pdf/mortality/nvsr52_03t33.pdf .

14. Kochanek KD, Smith BL. Deaths: Preliminary Data for 2002. National Vital Statistics Reports. Vol. 52, No. 13. Hyattsville, Maryland, National Center for Health Statistics 2004. Retrieved March 9, 2004, from www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_13.pdf .