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Unintentional Injury Death Data Trends for Years 2000-2010

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At a Glance

  • Unintentional injuries were California’s fifth leading cause of death from 2000 through 2009, and in 2010, it became the sixth leading cause of death, which represented the period for this mortality summary.
  • Out of the 114,025 unintentional injury deaths from 2000 to 2010, males accounted for 66.9 percent of unintentional injury deaths whereas females only represented 33.1 percent.
  • During this observational period, the top three fatal unintentional injuries included motor vehicle crashes (36.2 percent), poisoning and exposure to noxious substances (including drugs and other substances) (26.7 percent), and falls (16.2 percent). These three causes represented 79.1 percent of all unintentional injury deaths.
  • The majority of unintentional injury deaths occurred in people under age 65 (74.4 percent). The average age for unintentional injury death was 48.9 years with a standard deviation of 23.1 years. This identified the age range for the majority of unintentional injury deaths as 25.8 years to 72 years.
  • The unintentional injury age-adjusted death rate for California ranged from 26.9 to 31.7 during this period. The 2010 rate of 26.9 was the lowest in the eleven years studied in this report.
  • The 2010 age-adjusted death rate among females was 17.7, which represents a 6.6 percent increase from the 2000 rate of 16.6. The age-adjusted death rate among males in 2010 was 37.0, which indicates a 4.6 percent decrease from a rate of 38.8 in 2000.
  • For those race/ethnicity groups by sex who had reliable data during the study period, American Indian males had the highest unintentional injury age-adjusted mortality rate, with the exception of 2004 when Black males had the highest rate. The lowest age-adjusted unintentional injury mortality rates among race/ethnicity groups occurred in Asian females for all years.
  • Counties with reliable unintentional injuries age-adjusted death rates for each study year ranged from a high of 91.7 in Lake County to a low of 18.5 for San Mateo County.
  • Forty-three counties had reliable unintentional injuries age-adjusted death rates for every year from 2000 through 2010. Of these, 25 counties had a higher age adjusted rate by 2010 compared to 2000.

This report was authored by Alicia Van Hoy, MA, Research Program Specialist I, and independently peer reviewed by John Rudzinskas, MBA, Research Program Specialist I. Please contact DAReports@cdph.ca.gov for further information.

Background

Unintentional injuries are a subset of a larger category that represents all injuries referred to as “external causes of injury” based on the International Classification of Disease, Tenth Edition codes (ICD-10). The external ICD-10 codes are two-dimensional resulting in codes that indicate both the injury intent (such as unintentional, assault/homicide, intentional/self-harm) and the mechanism or cause (e.g. fall, burn, poison) of injury. Other subset categories within “external causes of injury” include assault (homicide), intentional self-harm (suicide), undetermined, legal intervention or operation of war.1 In 2010, unintentional injury deaths represented 62.3 percent of all injuries deaths in California followed by intentional self-harm (suicide) 23.6 percent, assault (homicide) 11.7 percent, undetermined intent 1.8 percent, and other less than 1.0 percent.2 This report examines unintentional injury deaths from 2000 through 2010.

Unintentional injury deaths result from a variety of causes such as motor vehicle traffic crashes, falls, firearms, drownings, suffocations, bites, stings, sports/recreational activities, natural disasters, fires or burns, and poisonings. From 2000 to 2010, California’s top three fatal unintentional injuries include motor vehicle traffic crashes (36.2 percent), poisoning and exposure to noxious substances (including drugs and other substances) (26.7 percent), and falls (16.2 percent). These three causes totaled 79.1 percent of all unintentional injury deaths.

Unintentional injury deaths have consistently ranked among the leading causes of death for the United States and California. In 2010, unintentional injuries ranked fifth nationally and sixth in California.2,3 During the same time period, unintentional injuries ranked first nationally as the leading cause of death for those 1 to 44 years old.4 Regardless of age, race, or economic status, unintentional injuries affects everyone, although differences do exist.5

Males account for more unintentional injury deaths than females. California’s 2010 data was used to identify the differences between unintentional injury causes by age groups. Drowning was the most common unintentional injury cause of death for those aged 1 to 4. Motor vehicle traffic crashes were the most frequent unintentional injury deaths for those aged 5 to 24. Poisonings (including drugs and other substances) were the most common unintentional injury death for people aged 25 to 64. Falls were the most prevalent unintentional injury cause of death for individuals over 65.2

Most unintentional injuries are preventable and predictable -- they are not “accidents.” 6 The word accident implies the events are inevitable and unavoidable.7 Like diseases, injuries are preventable if preventative strategies are in place. Preventative strategies such as minimum age drinking requirements, seatbelt and helmet laws, smoke alarms, tai chi and other exercise programs for older adults, and other safety awareness campaigns have saved lives.5

Due to the prevalence of unintentional injury deaths in this country, the U.S. Department of Health and Human Services (HHS) has established Healthy People 2020 objectives that pertain to all injuries. HHS has established Healthy People 2020 Objective IVP—11 to reduce unintentional injuries age-adjusted death rate to no more than 36.0 per 100,000 population.8 The definition of unintentional injuries used for the Healthy People Objective IVP—11 and the report’s content was based on the ICD-10 codes V01-X59, Y85-Y86.

California Total Population

Introduction

Unintentional injuries was California’s fifth leading cause of death from 2000 through 2009, and in 2010 it became the sixth leading cause of death.

See the Technical Notes for information about leading causes of death and rankings.

Age-Adjusted

The age-adjusted death rate for unintentional injuries was lower in California than the United States for each year during the study period. From 2000 until 2007, California age-adjusted rates gradually increased and peaked in 2007 at 31.7. After 2007, the age-adjusted rates continually declined to its lowest level of 26.9 in 2010. During the past eleven years, California consistently attained the Healthy People Objective 2020 IVP—11 of reducing the age-adjusted death rate for unintentional injuries to no more than 36.0 per 100,000 deaths.

The chart below displays California’s age-adjusted death rates from 2000 through 2010, compared with the available United States rates.

Annual unintentional injury age-adjusted death rates are displayed in Table 3Opens a new browser window..

Unintentional Injury Age-Adjusted Death Rates, All Race/Ethnic Groups, California 2000-2010

Age Distribution of Unintentional Injury Deaths

The total number of deaths in California from 2000 through 2010 was 2,571,224. During this time, unintentional injuries accounted for 4.4 percent of deaths.

Unintentional injury deaths occur at a younger average age than cancer or heart disease, which does affect a larger proportion of older adults. The average age for unintentional injury deaths was 48.9 years with a standard deviation of 23.1 years. The majority, 74.4 percent of unintentional injury deaths, occurred to people under age 65.

Due to the nature of unintentional injuries (e.g. fires, motor vehicle crashes, drownings, natural disasters), there were 175 unintentional injury deaths where age was reported as unknown. The unknown age classification represented less than 1 percent of all unintentional injury deaths.

Age Distribution of Unintentional Injury Deaths, California 2000-2010

Age-Specific Rates

Individuals under 14 years of age had the lowest age-specific death rates for unintentional injuries throughout the study. There are slight differences in age-specific death rates from ages 15 to 74. The risks of dying from unintentional injuries are greatest among those 85 and older.

The minimum and maximum annual age specific death rates per 100,000 population during the period from 2000 through 2010 for age groups that had reliable rates during each study year were as follows:

• Under 1 (8.7,15.1)
• 1-4 years (6.4, 9.9)
• 5-14 years (1.9, 5.3)
• 15-24 years (17.5, 28.2)
• 25-34 years (20.8, 26.3)
• 35-44 years (24.3, 33.2)
• 45-54 years (32.7, 45.3)
• 55-64 years (25.9, 38.8)
• 65-74 years (33.7, 37.8)
• 75-84 years (69.0, 76.6)
• 85+ years (172.5, 209.7)

The table below illustrates the differences between the 2000 to 2010 age-specific death rates by age group. Most notably, the 55 to 64 age group demonstrated the greatest percentage increase in age-specific rates from 2000 to 2010 from 25.9 to 38.8, which represented a 49.8 percent increase.

Unintentional Injury Age-Specific Death Rates, California 2000-2010

Annual age-specific unintentional injury death rates by race/ethnicity group are displayed in Table 2aOpens a new browser window..

Crude Death Rates

During this period, the actual risk of dying per 100,000 population, or crude rate, ranged from 25.9 to 31.3.

Annual unintentional injury crude death rates for the California population are displayed in Table 2aOpens a new browser window. under the “All Ages” column.

Unintentional Injury Age-Adjusted Death Rate by Mechanism

During the study period, the age-adjusted death rate for motor vehicle crashes showed a 25.3 percent decrease between 2000 and 2010. Both unintentional poisoning and unintentional falls demonstrated age-adjusted mortality rate increases during the period. The age-adjusted rate due to unintentional falls increased by 34.9 percent and the age-adjusted rate due to unintentional poisoning reflected a 62.5 percent growth.

Unintentional Injury Age-Adjusted Death Rates by Mechanism, California 2000-2010

Number of Unintentional Injury deaths by Mechanism

In California from 2000 to 2010, there were 114,025 unintentional injury deaths. The top three causes of unintentional injury deaths, which accounted for almost 80 percent of deaths were motor vehicle crashes (36.2 percent), unintentional poisoning and exposure to noxious substances (including drugs and other substances) (26.7 percent), and unintentional falls (16.2 percent).

Throughout the observational period, there were some upward and downward trends by specific type of unintentional injury deaths. Listed below are the percent changes based on the total number of deaths between 2000 and 2010.

• Fifteen percent decrease in unintentional injury deaths from motor vehicle traffic crashes.
• Eighty-five percent increase in unintentional deaths from poisoning.
• Sixty-five percent increase in deaths caused by unintentional falls.

Number of Unintentional Injury Deaths by Mechanism, California 2000, 2002, 2004, 2006, 2008, 2010

Male and Female Populations

Introduction

Although unintentional injury was California’s sixth leading cause of death as a whole in 2010, it was the third leading cause of death for males, and ranked sixth for females when these groups were examined separately.

See the Technical Notes for information about leading causes of death and rankings.

Age-Adjusted

Overall, the age-adjusted unintentional injury death rate was lower for females than males throughout the period. For both males and females, variations of age-adjusted rates occurred throughout the study. The age-adjusted death rate among females in 2010 was 17.7, which represents a 6.6 percent increase from a rate of 16.6 in 2000. The 2010 age-adjusted death rate among males was 37.0, which denotes a 4.1 percent decrease from a rate of 38.6 in 2000.

The chart below presents 2000 through 2010 age-adjusted rates for California residents by sex.

Annual unintentional injury age-adjusted death rates are displayed in Table 3Opens a new browser window..

Unintentional Injury Age-Adjusted Death Rates by Sex, California 2000-2010

Age Distribution of Unintentional Injury Deaths by Sex

Out of the 114,025 unintentional injury deaths from 2000 through 2010, males accounted for 66.9 percent and females represented 33.1 percent. Both males and females experienced an increase in unintentional injury deaths in 2010 when compared to the 2000 rate. Males demonstrated a 9.5 percentage increase while females showed a greater increase of 25.6 percent.

For unintentional injury deaths, the average age for males was 46.2, with a standard deviation of 21.7 years, and the average age for females was 54.3, with a standard deviation of 25.0 years.

Age Distribution of Unintentional Injury Deaths, by Sex, California 2000-2010

Age-Specific Rates

The actual risk of dying from unintentional injuries increased with age. For those age groups that had reliable data during the study period, age-specific death rates for males and females became greater with increasing age. Unintentional injury age-specific death rates were lower for females than males across all age categories and years.

Females in the age groups 1 to 24 and 65 to 84 showed an age-specific rate decrease for unintentional injuries from 2000 through 2010. However, females in the age ranges 25 to 34, 45 to 54, 55 to 64, and those 85 and older demonstrated an increase in the age-specific death rates in the same period.

Female Unintentional Injury Age-Specific Death Rates by Age, California 2000 and 2010

Males in age ranges 55 to 64 and those 85 and older experienced an age-specific unintentional injuries death rate increase in 2010 when compared to the 2000 rate. The 55 to 64 range demonstrated a 50.4 percent increase by 2010.

Male Unintentional Injury Age-Specific Death Rates by Age, California 2000 and 2010

Overall, annual age-specific unintentional injury death rates by race/ethnicity group are displayed in Table 2aOpens a new browser window..

Crude Rates

During the 2000 to 2010 period, the actual risk of dying (or crude death rate) from unintentional injuries ranged from 35.4 to 42.2 deaths for males per 100,000 and ranged from 16.5 to 20.6 deaths for females per 100,000.

Annual rates are displayed in Table 2bOpens a new browser window. for males and Table 2cOpens a new browser window. for females under the “All Ages” column.

Race/Ethnicity Group Differences

Leading Causes of Death by Race/Ethnicity

Unintentional injury deaths rank as a leading cause of death varied by race/ethnicity.

• Unintentional injuries ranked as the third leading cause of death for American Indians, Hispanics, and Two or More Races for all years.
• Beginning in year 2005 forward unintentional injury deaths became the seventh leading cause of death for Asians.
• Unintentional injury deaths have fluctuated between the fourth to sixth leading causes of death for Blacks. In the most current year analyzed, unintentional injuries ranked fifth.
• Since 2004, unintentional injuries ranked as the fifth leading cause of death for Pacific Islanders.
• Unintentional injury deaths were the sixth leading cause of death for Whites, except in 2003 and 2004 when it ranked fifth.

See the Technical Notes for information about leading causes of death and rankings.

Age-Adjusted

The age-adjusted death rates for unintentional injury deaths have fluctuated for many race/ethnicity groups. Among the race/ethnicity groups, American Indians had the highest age-adjusted rates for each year of this study. Between 2000 and 2010, the age-adjusted unintentional injury death rates ranged from:

• 39.9 to 57.6, American Indian
• 17.4 to 36.2, Pacific Islander
• 31.1 to 41.4, Black
• 30.3 to 37.3, White
• 21.3 to 28.8, Hispanic
• 12.2 to 17.6, Asian
• 3.9 to 19.8, Two or More Races.

It should be noted that the increase in the age-adjusted rates from 2000 to 2010 for Two or More Races reporting is possibly due to improved race recording on the death certificate.

The chart below displays age-adjusted death rates by race/ethnicity for the years 2000 through 2010.

Annual age-adjusted death rates by race/ethnicity are displayed in Table 3Opens a new browser window..

Unintentional Injury Age-Adjusted Death Rates by Race/Ethnicity, California 2000-2010

Age Distribution of Unintentional Injury Deaths by Race/Ethnicity

The average age of death due to an unintentional injury differed amid race/ethnicity groups. Two or More Races had the youngest average age of death at 35.6 years whereas Whites had the oldest average age, 53.7 years. This means on the average Two or More Races died more than 18.1 years earlier from unintentional injuries when compared to Whites. The average age of death from unintentional injuries between 2000 and 2010 was:

• 35.6 years for Two or More Races.
• 38.5 years for Pacific Islanders.
• 38.3 years for Hispanics.
• 42.4 years for American Indians.
• 45.0 years for Blacks.
• 53.7 years for Asians.
• 53.7 years for Whites.

The majority of unintentional injury deaths occurred to people under age 65 (74.4 percent). The distribution varied considerably among those people over the age of 65 based on race/ethnicity. Specifically, the proportion of unintentional injury deaths over the age 65 reflected:

• Less than 10 percent for Two or More Races.
• Between 10 and 15 percent for American Indians, Blacks, Hispanics, and Pacific Islanders.
• Between 30 and 40 percent for Whites.
• Greater than 40 percent among Asians.

The chart below shows the age distribution of unintentional injury deaths by race/ethnicity.

Age Distribution of Unintentional Injury Deaths by Race/Ethnicity, California 2000-2010

Age-Specific Rates

The risk of dying from unintentional injuries increased with age. Age-specific death rates for all race/ethnicity groups were higher in older age groups.

Annual age-specific unintentional injury death rates by race/ethnicity group are displayed in Table 2aOpens a new browser window..

Crude Death Rates

During the period, the ranges for actual risk of dying per 100,000 population, or crude death rate, by race/ethnicity categories were as follows:

• American Indian, 36.2 to 57.2
• Asian, 11.7 to 15.6
• Black, 29.1 to 40.2
• Hispanic, 17.0 to 23.6
• Pacific Islander, 16.8 to 32.1
• Two or More Races, 4.1 to 14.5
• White, 33.2 to 43.0

Annual unintentional injury crude death rates by race/ethnicity categories are displayed in Table 2aOpens a new browser window. under the “All Ages” column.


See the Technical Notes for information about rate calculation.

Sex Differences Within Race/Ethnicity

Introduction

For each year of study, unintentional injury deaths consistently ranked third as a leading cause of death for Hispanic males, American Indian males, and Two or More Races males. The remaining sex by race/ethnicity groups showed fluctuations in ranks between the years. In 2010, unintentional injuries was the:

• Fourth leading cause for American Indian females.
• Seventh leading cause for Asian males and females.
• Fifth leading cause for Black males and seventh leading cause for Black females.
• Sixth leading cause for Hispanic females.
• Fifth leading cause for Pacific Islander males and seventh leading cause for Pacific Islander females.
• Fourth leading cause for Two or More Races females.
• Fourth leading cause for White males and sixth leading cause for White females.

See the Technical Notes for information about leading causes of death and rankings.

Age-Adjusted

Age-adjusted unintentional injury death rates were higher for males than females within the same race/ethnicity. The highest age-adjusted unintentional injury rates among race/ethnicity categories occurred in American Indian males with the exception of 2004. Black males had the highest unintentional injury age-adjusted death rate in 2004. The lowest age-adjusted unintentional injury mortality rates by race/ethnicity occurred consistently in Asian females.

The chart below displays age-adjusted death rates by sex and race/ethnicity for the years 2000 through 2010.

All annual age-adjusted death rates by sex and race/ethnicity are displayed in Table 3Opens a new browser window..

Rates for Two or More Races males, Two or More Races female, Pacific Islander males and Pacific Islander females were unreliable during one or more years in the study and, therefore, their rates are not discussed.

Unintentional Injury Age-Adjusted Death Rates by Sex and Race/Ethnicity, California 2000-2010

Age Distribution of Unintentional Injury Deaths by Sex and Race/Ethnicity

The average age of death for males and females differed among race/ethnicity groups. Two or More Races males had the youngest average age of unintentional injury deaths and died on average more than 24 years earlier than White females, the longest surviving group. The average age of unintentional injury deaths by sex and race/ethnicity for 2000 through 2010 were as follows:

• American Indian: males 42.0 years, females 43.1 years.
• Asian: males 50.7 years, females 58.6 years.
• Black: males 44.1 years, females 46.8 years.
• Hispanic: males 37.3 years, females 41.4 years.
• Pacific Islander: males 39.1 years, females 37.5 years.
• Two or More Races: males 34.7 years, females 37.4 years.
• White: males 50.8 years, females 58.9 years.

The majority of unintentional injury deaths occurred to people under age 65. The distribution varied considerably among those people over the age of 65 based on race/ethnicity and sex. Specifically, the proportion of unintentional injury deaths over the age 65 reflected:

• Less than 10 percent for Two or More Races males and Hispanic males.
• From 10 percent but less than 20 for American Indian males and females, Pacific Islander males and females, Black males and females, and Two or More Races females.
• From 20 percent but less than 30 for White males and Hispanic females.
• From 30 percent but less than 40 for Asian males.
• Over 40 percent for White females and Asian females.

The charts below show the age distribution of unintentional injury deaths by sex and race/ethnicity.

Age Distribution of Male Unintentional Injury Deaths by Race/Ethnicity, California 2000-2010

Age Distribution of Female Unintentional Injury Deaths by Race/Ethnicity, California 2000-2010

Age-Specific Rates

The risk of dying from unintentional injuries increases with age.

Annual unintentional injury crude death rates by sex and race/ethnicity groups are also presented under the “All Ages” column in Table 2bOpens a new browser window. for males and Table 2cOpens a new browser window. for females.

See the Technical Notes for information about rate calculation.

County of Residence Populations

Age-Adjusted

Forty-three counties had reliable age-adjusted death rates for unintentional injuries every year from 2000 through 2010. Twenty-five counties had higher age-adjusted rates in 2010 than in 2000. Counties with reliable unintentional injury age-adjusted mortality rates for each study year ranged from a high of 91.7 in Lake County to a low of 18.5 in San Mateo County. From 2000 to 2010, Imperial County demonstrated the greatest percentage reduction in age-adjusted death rate from 42.0 to 26.1, which represented a 37.9 percent improvement. Butte County showed the largest percentage increase in age-adjusted mortality rate from 35.5 to 74.9, which represented a 111.0 percent rate worsening during the period.

Refer to Table 4 (PDF)Opens a new browser window., Table 5 (PDF)Opens a new browser window., and Table 6 (PDF)Opens a new browser window. for detailed counts of deaths, age-adjusted rates, and 95 percent confidence intervals by county of residence. Trend charts showing age-adjusted unintentional injury death rates by county are accessible through the links provided below. Regression analysis was not applicable for unintentional injuries, because of the data variability.

Forty-three counties exhibited rates that were reliable each year.

Alameda (PDF)Opens a new browser window. Butte (PDF)Opens a new browser window. Contra Costa (PDF)Opens a new browser window. El Dorado (PDF)Opens a new browser window.
Fresno (PDF)Opens a new browser window. Humboldt (PDF)Opens a new browser window. Imperial (PDF)Opens a new browser window. Kern (PDF)Opens a new browser window.
Kings (PDF)Opens a new browser window. Lake (PDF)Opens a new browser window. Los Angeles (PDF)Opens a new browser window. Madera (PDF)Opens a new browser window.
Marin (PDF)Opens a new browser window. Mendocino (PDF)Opens a new browser window. Merced (PDF)Opens a new browser window. Monterey (PDF)Opens a new browser window.
Napa (PDF)Opens a new browser window. Nevada (PDF)Opens a new browser window. Orange (PDF)Opens a new browser window. Placer (PDF)Opens a new browser window.
Riverside (PDF)Opens a new browser window. Sacramento (PDF)Opens a new browser window. San Bernardino (PDF)Opens a new browser window. San Diego (PDF)Opens a new browser window.
San Francisco (PDF)Opens a new browser window. San Joaquin (PDF)Opens a new browser window. San Luis Obispo (PDF)Opens a new browser window. San Mateo (PDF)Opens a new browser window.
Santa Barbara (PDF)Opens a new browser window. Santa Clara (PDF)Opens a new browser window. Santa Cruz (PDF)Opens a new browser window. Shasta (PDF)Opens a new browser window.
Siskiyou (PDF)Opens a new browser window. Solano (PDF)Opens a new browser window. Sonoma (PDF)Opens a new browser window. Stanislaus (PDF)Opens a new browser window.
Sutter (PDF)Opens a new browser window. Tehama (PDF)Opens a new browser window. Tulare (PDF)Opens a new browser window. Tuolumne (PDF)Opens a new browser window.
Ventura (PDF)Opens a new browser window. Yolo (PDF)Opens a new browser window. Yuba (PDF)Opens a new browser window.

Fifteen counties had rates that were unreliable or had no events during one or more of the years studied. Graphs are provided for these counties. However, this information should be interpreted with caution.

Alpine (PDF)Opens a new browser window. Amador (PDF)Opens a new browser window. Calaveras (PDF)Opens a new browser window. Colusa (PDF)Opens a new browser window.
Del Norte (PDF)Opens a new browser window. Glenn (PDF)Opens a new browser window. Inyo (PDF)Opens a new browser window. Lassen (PDF)Opens a new browser window.
Mariposa (PDF)Opens a new browser window. Modoc (PDF)Opens a new browser window. Mono (PDF)Opens a new browser window. Plumas (PDF)Opens a new browser window.
San Benito (PDF)Opens a new browser window. Sierra (PDF)Opens a new browser window. Trinity (PDF)Opens a new browser window.

A map of California is located here.

Technical Notes

Number of Events – The number of events provides a description of how a disease affects a population, but it is not useful for examining trends or comparison across groups because the number of events largely depends on population size.9

Crude Rates, Age-Specific Rates, and Age-Adjusted Rates – The crude death rate (number of deaths per population size) is a widely used mortality measure.9 This rate represents the average chance of dying during a specified period for persons in the entire population. However, crude death rates are influenced by the age distribution of the population. As such, crude death rate comparisons over time or between groups may be misleading if the populations being compared differ in age composition.

The age specific death rate is defined as the number of deaths occurring in a specified age group divided by the population for the specified age group, usually expressed per 100,000 population. Age-specific death rates allow one to compare mortality risks of a particular age group over time or between age groups at a particular point in time. Although effective in eliminating the effect of differences in age composition, age-specific comparisons can be cumbersome, because they require a relatively large number of comparisons, one for each age group.10

To control for the effect of age on death rates and provide a single measure, age-adjusted death rates are used.9 Age-adjusted rates are computed by separating deaths into their respective age groups based on the age of the decedent, and computing age-specific rates. These age-specific rates are then weighted according to the 2000 U.S. Standard Population, and are summed to produce the age-adjusted rate. Age-adjusted death rates are highly effective for making comparisons among population groups and among geographical areas because they remove the effects of dissimilar age distributions. Please note deaths of persons with age “Unknown” are included in “All” counts and crude rates, but are not distributed among age groups. Unknown age is not included in age-specific or age-adjusted rates.

Three important caveats apply when using age-adjusted rates. First, the age-adjusted death rate does not reflect the mortality risk of a “real” population. The actual risk of mortality is represented by the crude death rate. The numerical value of an age-adjusted death rate depends on the standard used and, as a result, is not meaningful by itself. Age-adjusted death rates are appropriate only when comparing groups or examining trends across multiple time periods. A comparison of age-adjusted death rates among groups or periods over time will reflect differences in the average risk of mortality.

Second, age adjusting may mask important information if the age-specific rates between comparison groups do not have a consistent relationship. As an example, Anderson and Rosenberg (1998)9 demonstrate that the trend in the age-adjusted death rate for cancer does not reflect the complexities in the underlying age-specific rates. As averages, age-adjusted rates, like other averages, may be misleading, especially when age-specific rates reflect divergent trends over time. However, usually age-specific rates move roughly in parallel. Thus, age-adjusted death rates are a widely accepted and useful convention for analyzing trends.

Finally, because age-adjusted death rates are averages, they represent merely the beginning of an analytical strategy that should proceed to age-specific analyses, and then to an examination of additional sociodemographic, temporal, and geographic variables.

Data Sources – Numerator data are taken from California Department of Public Health death records, and denominator population data are obtained from the Department of Finance 2012 “Race/Hispanics Population with Age and Gender Detail, 2000–2010. Sacramento, California, September 2012”. Due to the revised population estimates, rates may differ from previously published reports. The 2000 U.S. Standard Population was used for calculating age-adjustments in accordance with statistical policy implemented by NCHS.9 Age-adjusted death rates are not comparable when rates are calculated with different population standards, e.g., the 1940 U.S. Standard Population.

Variability of Rates – Rates are sensitive to size variations in both the numerator (the number of vital events that occurred) and the denominator (the estimated population at risk). For example, in small counties a numerator variation of only a few cases might cause a relatively large shift in a rate, while in a large county could cause no difference in the rate. Likewise, a minor revision in a small county population estimate may cause a relatively major change in a county’s vital event rate. Therefore, caution needs to be exercised when analyzing small numbers, including the rates derived from them.

Rates that are calculated from fewer than 20 deaths are considered unreliable (Tables 2a-2c). These rates are not shown, and are indicated with an asterisk (*). Unreliable age-adjusted rates by race/ethnicity and sex (Table 3) and county of residence (Table 5), are displayed with an asterisk (*) and are provided only as a point of information for further investigation. Rates based on no events are denoted with a dash (-).

Sampling Error and Vital Statistics – Vital events are essentially a complete count, because more than 99 percent of all vital events are registered. Although these numbers are not subject to sampling error, they may be affected by nonsampling errors in the registration process.

The number of vital events is subject to random variation and a probable range of values can be estimated from the actual figures, according to certain statistical assumptions. This is because the number of vital events that actually occurred can be thought of as one outcome in a large series of possible results that could have occurred under the same (or similar) circumstances.

A 95 percent confidence interval is the range of values for a measurement that would be expected in 95 out of 100 cases. The confidence intervals are the highest and lowest values of the range. Confidence intervals tell you how much a measurement could vary under the same (or similar) circumstances.

Confidence intervals based on 100 deaths or more – When there were 100 deaths or more, a normal approximation was used to calculate confidence intervals.

Confidence intervals based on fewer than 100 deaths – When there were fewer than 100 deaths, a gamma distribution was used to calculate confidence intervals.

Detailed procedures and examples for each type of calculation are given in Technical Notes of Deaths: Final Data for 2009; National Vital Statistics Reports; National Center for Health Statistics, 2011.11

Cause of Death – One of the most important uses for vital statistics data is the study of trends by cause of death. Vital statistics trend research yields valuable information about population health status, emerging public health problems, and at-risk populations, and can be used to develop strategies and allocate resources to improve public health.

Cause-of-death statistics are derived from the medical information reported on the death certificate by the certifying physician or coroner. The medical portion of the death certificate has fields for up to four causes of death (immediate, two intervening, and underlying) plus additional fields for recording contributing causes of death. Up to 20 causes can be entered onto a single death certificate. The cause-of-death field selected for coding and tabulation in this report is the "underlying cause of death." This is generally defined as the disease, injury, or complication that initiated the morbid events sequence leading directly to death.

Leading Causes of Death – This report presents death by leading cause of death in California by sex and race/ethnicity using the underlying cause of death ICD-10 codes. The leading causes-of-death are ranked according to the frequency of deaths within groups. Because the rank order of any particular cause of death will depend on the list of causes from which the selection is made and on the rules applied in making the selection, a clearly defined, uniform method for ranking causes of death is vital to maintain consistency in the reporting of leading causes by federal and state agencies.12 To maintain consistency and to determine rankable causes of death, the ‘‘List of 113 Selected Causes of Death and Enterocolitis due to Clostridium difficile’’ (March 2009) was utilized.

Cause-of-death ranking is a popular method of presenting mortality statistics and is a useful tool for illustrating the relative burden of cause-specific mortality, but it must be used cautiously with a clear understanding of the limitations underlying the method. Rankings do not illustrate cause-specific mortality risk or absolute burden as depicted by mortality rates. When comparing rankings across groups or over time, careful note should be made of the age distribution of the populations being compared. It is also important to note that rankings do not necessarily denote the causes of death of greatest public health importance.12

Detailed procedures and further information regarding the 113 Selected Causes-of-Death are provided in NCHS Instruction Manual, Part 9: ICD-10 Underlying Cause-of-Death Lists Tabulating Mortality Statistics. Updated March 2011; National Center of Health Statistics.13

Deaths by Place of Residence – Mortality data analysis in this report are based on records for all California resident deaths occurring in the fifty states, the District of Columbia, US territories, and Canada; all other worldwide resident deaths are excluded. Deaths to non-California residents were excluded from analysis.

Age Groups – The following age groups were used to compute age-specific and age-adjusted rates: under 1 year, 1-4 years, 5-14 years, 15-24 years, 25-34 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years, 75-84 years, and 85 and older.

International Classification of Diseases, Tenth Revision (ICD-10) – Beginning in 1999, cause of death has been coded using ICD-10.14 For more information; see the National Center for Health Statistics ICD-10 page at http://www.cdc.gov/nchs/icd.htm.

Race/Ethnicity – Beginning in 2000, the federal race/ethnicity reporting guidelines changed to allow more than one race to be recorded on death certificates. California initiated use of the new guidelines on January 1, 2000, and collects up to three races per certificate. To be consistent with population data, current reports tabulate race of decedent using all races identified on the certificate.

To meet the U.S. Office of Management and Budget minimum standards for race and ethnicity data collection and reporting, and to be consistent with the population data obtained from the California Department of Finance, this report presents Hispanic and the following non-Hispanic race/ethnicity groups: American Indian, Asian, Black, Pacific Islander, White, and Two or More Races. Hispanic origin of decedents is determined first and includes decedents of any race group or groups. Non-Hispanic decedents who were reported with two or more races are subsequently placed in the Two or More Races group. Single non-Hispanic race groups are defined as follows: the “American Indian” race group includes Aleut, American Indian, and Eskimo; the “Asian” race group includes Asian Indian, Asian (specified/unspecified), Cambodian, Chinese, Filipino, Hmong, Japanese, Korean, Laotian, Thai, and Vietnamese; the “Pacific Islander” race group includes Guamanian, Hawaiian, Samoan, and Other Pacific Islander; the “White” race group includes White, Other (specified), Not Stated, and Unknown.

Caution should be exercised in the interpretation of mortality data by race/ethnicity. Misclassification of race/ethnicity on death certificates may contribute to underreporting of deaths in American Indians, Asians, Hispanics, and Pacific Islanders.15 This could contribute to artificially low rates for these groups and the Two or More Races group. Race groups’ data that are not individually displayed on the tables or figures due to unreliable rates are collectively included the state data totals.

References

1 Fingerhut L. ICD Framework: External cause of injury mortality matrix [online]. Hyattsville, MD: National Center for Health Statistics. URL http://www.cdc.gov/nchs/injury/injury_tools.htm Accessed May 8, 2013.

2 State of California, Department of Public Health. Death Records, 2000-2010.

3 Hoyert DL. 75 years of Mortality in the United States, 1935–2010. NCHS data brief; No 88. Hyattsville, Maryland: National Center for Health Statistics. 2012. URL http://www.cdc.gov/nchs/data/databriefs/db88.htm Accessed February 8, 2013.

4 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, CDC using WISQARS™. 10 Leading Causes of Death by Age Group, United States- 2010. National Vital Statistics System, National Center for Health Statistics. URL http://www.cdc.gov/injury/wisqars/LeadingCauses.html Accessed February 11, 2013.

5 Centers for Disease Control and Prevention. Saving Lives and Protecting People from Violence and Injuries. URL http://www.cdc.gov/injury/overview/index.html Accessed February 8, 2013.

6 McKenzie et al. Classifying External Causes of Injury: History, Current Approaches, and Future Directions Epidemiol Rev (2012) 34(1): 4-16.

7 Giraske DC. How Members of the Public Interpret the Word Accident. Inj Prev 5(1):19-25. 1999.

8 U.S. Department of Health and Human Services. Healthy People 2020. URL
http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=5 Accessed February 12, 2012.

9 Anderson RN, Rosenberg HM. Age Standardization of Death Rates: Implementation of the Year 2000 Standard. National Vital Statistics Reports; Vol. 47, No. 3. National Center for Health Statistics. Hyattsville, Maryland. 1998.

10 Curtin, L. and Klein, R. Direct Standardization (Age-Adjusted Death Rates). Healthy People 2000 Statistical Notes; No. 6 - Revised. National Center for Health Statistics. Hyattsville, Maryland. 1995. URL http://www.cdc.gov/nchs/data/statnt/statnt06rv.pdf (PDF)Opens a new browser window. Accessed October 24, 2012.

11 Kochanek KD, Xu JQ, Hoyert DL, Murphy SL, Minino AM, Kung HC. Deaths: Final Data for 2009. National Vital Statistics Reports; Vol 60, No. 3. National Center for Health Statistics. Hyattsville, Maryland. 2011. URL http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf (PDF, 3.1MB)Opens a new browser window. Accessed October 26, 2012.

12 Heron, Melonie. Deaths: Leading Causes for 2008. National Vital Statistics Reports; Vol 60, No 6. National Center for Health Statistics. Hyattsville, Maryland. 2012. URL:http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_06.pdf (PDF, 2.8MB)Opens a new browser window.Accessed October 24, 2012.

13 National Center for Health Statistics. NCHS Instruction Manual, Part 9: ICD-10 Underlying Cause-of-Death Lists Tabulating Mortality Statistics. Updated March 2011. Hyattsville, MD. 2011. URL http://www.cdc.gov/nchs/data/dvs/Part9InstructionManual2011.pdf (PDF)Opens a new browser window. Accessed October 26, 2012.

14 World Health Organization. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. Geneva: World Health Organization. 1992.

15 Rosenberg HM, et al. Quality of Death Rates by Race and Hispanic Origin: A Summary of Current Research, 1999. Vital and Health Statistics, Series 2, No. 128. National Center for Health Statistics. September 1999.

 

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