Premature Mortality Trends 2000-2007
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At a Glance
- Years of potential life lost before age 75 (YPLL-75) is a measure used to reflect the impact of premature mortality on a population.
- In 2007, the age-adjusted YPLL-75 rate per 100,000 population for all California residents was 5,641.7 years, which represented a decrease of 9.4 percent from the 2000 rate of 6,224.1 years.
- For all causes of death selected for this report, men had a higher age-adjusted YPLL-75 rate than women.
- Blacks had the highest age-adjusted YPLL-75 rate among race/ethnic groups for all study years for all causes of death combined.
- The age-adjusted YPLL-75 rate for the total California population decreased relative to the year 2000 every subsequent year to 2007, a statistically significant trend. However, this trend was not consistent across all subsets or groupings within the population.
- Some geographic patterns were apparent among California counties. For example, the northwest counties reflected rates in the 75th percentile or above, and the central coastal and southern coastal counties fell below the state median.
This report was authored by Loran Sheley, MA, Research Program Specialist. Please contact PDATrends@cdph.ca.gov for further information.
Years of potential life lost before age 75 (YPLL-75) is a measure commonly used in public health that reflects the impact of premature mortality on a population. Deaths among people in younger age groups “are more likely to be attributable to preventable causes and therefore subject to prevention and intervention.”1 Because most deaths occur among people in older age groups, analyses of mortality data generally reflect disease processes of older people; therefore, an alternative measure is essential to reflect mortality trends in younger people.2
YPLL-75 reflects the impact of deaths occurring before the age of 75. The younger the decedent is, the greater the measured impact. For example, in the case of a 29 year-old woman who dies from human immunodeficiency virus (HIV) disease the event would be counted as 46 years of potential life lost. A 73-year-old man who dies from chronic lower respiratory disease would be counted as two years of potential life lost.
This report’s selected causes of death were chosen for their impact on California’s premature mortality. These selected causes contribute the most years to the total YPLL 75. They were not chosen to represent the greatest total number of deaths, as is the case when leading causes of death are analyzed. Therefore, selected causes of death discussed will differ from leading causes presented in other Office of Health Information and Research (OHIR) reports.
This report examines trends over the time period of 2000 to 2007. In addition, the most recent year data is analyzed in more depth. The report presents data in four major sections. The first section discusses YPLL-75 for the total population. The second section analyzes the male and female populations separately. The third section reviews differences in YPLL-75 by race/ethnic groups. The last section examines premature mortality trends among California residents at the county level.
Because this report covers trends over time, age-adjusted rates of YPLL-75 per 100,000 population under age 75 are used for comparison. Additional information regarding the calculation of YPLL-75 rates is located in the Technical Notes.
Detailed tables are provided with each analysis. Table 1 (PDF) shows age-adjusted YPLL-75 rates by sex and race/ethnicity for the years 2000 through 2007, as well as 2007 crude rates. Table 2 (PDF) displays YPLL-75 raw counts for the same period by sex and race/ethnicity. Table 3 (PDF) reflects 2000 through 2007 age-adjusted YPLL-75 rates by county of residence, and 2007 crude rates.
California Total Population
In 2007, the age-adjusted YPLL-75 rate per 100,000 population for all persons was 5,641.7 years, which was a decrease of 9.4 percent from the 2000 rate 6,224.1 years. This rate decreased every year except 2003. Refer to Table 1 (PDF) and Table 2 (PDF) for detailed YPLL-75 rates and raw counts of years lost.
A 2000 to 2007 trend analysis showed a statistically significant downward trend in the YPLL-75 rate for the total California population for all causes of death combined. For details on how the trend analysis was conducted, see Technical Notes.
While there was an overall decrease in the 2007 total YPLL-75 rate when compared to 2000, trends among specific causes of death varied. The cause that contributed the most to the decrease in the total 2007 YPLL-75 rate compared to 2000 was cancer, a rate decrease of 237.2 years. The cause that contributed most to offsetting the decrease in the total YPLL 75 rate was unintentional injuries, a rate increase of 87.2 years.
The cause that had the largest percentage decrease in the 2007 rate compared to 2000 was HIV disease, which decreased 39.0 percent. The cause that showed the largest percentage increase was viral hepatitis, which increased 56.0 percent.
In 2007, the top three causes of death affecting the total population YPLL-75 rate were cancer, unintentional injuries, and heart disease. These three causes combined accounted for 50.3 percent of the total YPLL-75 rate, and they comprised 51.0 percent of the total 2000 YPLL-75 rate.
The YPLL-75 rate due to cancer and heart disease as a proportion of the total rate decreased in 2007 compared to 2000. The YPLL-75 rate percentage attributed to cancer decreased from 22.9 (2000) to 21.1 (2007), and the percentage due to heart disease decreased from 15.5 to 13.7. In contrast, the percentage of the total YPLL-75 rate due to unintentional injuries increased from 12.6 in 2000 to 15.5 in 2007.
Male and Female Populations
For each of the selected causes of death reported, men consistently had a higher YPLL-75 rate than women. Refer to Table 1 (PDF) and Table 2 (PDF) for detailed YPLL-75 rates and raw counts of years lost.
In 2007, for all causes of death combined, the age-adjusted YPLL-75 rate per 100,000 men was 7,153.9 years. This was a decrease of 8.6 percent from the 2000 rate of 7,825.4 years. This rate decreased every year with the exception of 2003 when the rate increased by about 0.2 percent compared to 2000.
The age-adjusted 2007 YPLL-75 rate per 100,000 women was 4,122.0 years. This was a decrease of 11.1 percent from the 2000 rate of 4,637.2 years. This rate decreased every year with the exception of 2003 when the rate slightly increased but was still lower relative to 2000.
A trend analysis showed a statistically significant downward trend in YPLL-75 for both men and women in California for all causes of death combined during 2000 to 2007. For additional information about the trend analysis, see Technical Notes.
The causes that provided the biggest contribution to the decrease in the YPLL-75 rates were heart disease in men and cancer in women. The heart disease-specific YPLL-75 rate decreased by 272.2 years in men. The cancer-specific YPLL-75 rate decreased by 228.3 years in women. Unintentional injuries had the biggest increases for both men and women. The rate increased by 110.3 years for men and 61.8 years for women, although women had a greater percentage increase.
HIV disease had the largest percentage rate decrease. The HIV-specific YPLL-75 rate decreased by 40.6 percent for men and 30.2 percent for women. Viral hepatitis showed the largest percentage rate increase with an increase of 50.6 percent in men and 69.7 percent in women.
The top three 2007 causes of death contributing to the YPLL-75 rate for both men and women were cancer, unintentional injuries, and heart disease. These three causes combined accounted for 49.9 percent of the total YPLL-75 rate in men and 51.1 percent of the total in women. However, the proportion of total YPLL-75 due to cancer was greater for women and the proportions due to heart disease and unintentional injuries were greater for men. The greatest disparity in the 2007 YPLL 75 rate distribution was in homicide, which accounted for 3.1 times more of the total YPLL-75 rate for men than for women.
Race/Ethnic Group Differences
For all causes of death combined, Blacks had the highest age-adjusted YPLL-75 rate among all race/ethnic groups for all study years. The 2007 YPLL-75 rates were lower than the 2000 rates for all race/ethnic groups except Two or More Races, which had a higher YPLL-75 rate in 2007 than 2000. The increase in the rate for Two or More Races might be attributed to initial underreporting. Table 1 (PDF) and Table 2 (PDF) provide detailed YPLL-75 rates and raw counts by race/ethnic groups. More information about the race/ethnic categories studied is available in the Technical Notes.
A trend analysis showed statistically significant downward trends in the White, Black, and Asian YPLL-75 rates. The Two or More Races YPLL-75 rate demonstrated a statistically significant increasing trend. Additional information about the trend analysis is in the Technical Notes.
Specific results were as follows:
For Whites, the greatest decrease in YPLL-75 rate was in cancer, which decreased by 293.6 years. The greatest increase for Whites in YPLL-75 rate was in unintentional injuries, which increased by 139.2 years. The largest percentage decrease for Whites was 47.5 percent in HIV disease, and the largest percentage increase was 52.4 percent in viral hepatitis.
The causes that showed the greatest changes in YPLL-75 rate were the same in Blacks as in Whites. The cancer-specific YPLL-75 in Blacks decreased by 365.7, and the unintentional injuries-specific YPLL-75 rate increased by 150.3 years. The HIV disease-specific YPLL-75 rate decreased by 28.7 percent in Blacks, and the viral hepatitis-specific YPLL-75 rate increased by 68.2 percent.
For Asians, the greatest decrease in YPLL-75 rate was in cancer, which decreased by 118.5 years. The greatest increase for Asians in YPLL-75 rate was in suicides, which increased by 47.9 years. The largest percentage decrease for Asians was 43.8 percent in chronic lower respiratory disease, and the largest percentage increase was 29.9 percent in suicide.
The cause with the largest decrease in the YPLL-75 rate for Hispanics was heart disease, which decreased by 125.9 years. The largest increase for Hispanics in YPLL-75 rate was in unintentional injuries, which increased by 46.0 years. The largest percentage decrease for Hispanics was 36.8 percent in HIV disease, and the largest percentage increase was 88.7 percent in viral hepatitis.
Cause-specific YPLL-75 rates for American Indians, Pacific Islanders, and Two or More Races were unreliable and not displayed.
For Whites, Asians, and Hispanics the 2007 top three causes of death contributing to YPLL-75 were cancer, unintentional injuries, and heart disease. These three causes combined represented 54.1 percent of the total YPLL-75 rate for Whites, 53.5 percent for Asians, and 46.3 percent for Hispanics. Blacks’ top three YPLL-75 causes of death were heart disease, cancer, and homicide, which combined represented 45.7 percent of the total YPLL-75 rate. Cause-specific YPLL-75 rates among American Indians, Pacific Islanders, and Two or More Races were largely unreliable and not displayed.
County of Residence Populations
Of California’s 58 counties, 21 had age-adjusted YPLL-75 rates that were higher in 2007 than 2000, and 37 had lower rates. Trinity County in 2007 reflected the highest reliable YPLL-75 rate, 11,357.1 years per 100,000 population, and Mono County the lowest reliable YPLL-75 rate, 3,911.7 years per 100,000 population. Detailed YPLL-75 rates by county of residence for each year are shown in Table 3 (PDF).
Sixteen counties showed statistically significant trends in the 2000 to 2007 time period. The counties that showed statistically significant decreases were Alameda, Contra Costa, Los Angeles, Marin, Monterey, Orange, Placer, Riverside, San Bernardino, San Diego, San Francisco, San Joaquin, Santa Clara, Sonoma, and Yolo. Siskiyou County had a statistically significant increase during the period. Additional information about trend analysis is located in the Technical Notes.
San Francisco County exhibited the largest rate decrease between 2000 and 2007 (7,227.2 to 5,661.3 years per 100,000 population). Trinity experienced the largest rate increase (5,954.0 to 11,357 years per 100,000 population).
Mono County demonstrated the largest percentage decrease in YPLL-75 rate, 22.0 percent between 2000 and 2007. Trinity County had the largest percentage rate increase, 90.7 percent. The 90.7 percent increase was more than double any other county’s percentage change.
A California counties map grouped by YPLL-75 rate quartiles showed some apparent geographic differences in 2007. The state’s northwest area rates were in the 75th percentile or above. Most of the central valley and southern inland areas rates were above the state median. The central coastal, southern coastal, and the southern border areas were below the state median.
Detailed YPLL-75 rates for California and it's Counties are displayed in Table 3 (PDF).
The names of California's Counties are displayed on this map.
The methods used to analyze vital statistics data are important qualifiers providing the basis for data interpretation.
Years of Potential Life Lost (YPLL-75) YPLL-75 is the number of years of potential life lost before age 75. In the past, years of potential life lost before age 65 (YPLL-65) were calculated. However, this measure was replaced in the mid-1990s because of longer average life expectancy in the American population.3 YPLL-75 is obtained by subtracting the age at the time of death from 75. For example, 29 year-old woman who dies from HIV disease would yield 46 years of potential life lost. A 73-year-old man who dies from chronic lower respiratory disease would be counted as two years of potential life lost.
Crude rates for YPLL-75 are calculated by adding the total number of years lost and dividing by the population. This report primarily uses age-adjusted YPLL-75 rates. Compared to crude rates, age-adjusted rates more accurately identify changes in premature mortality occurring over time because age-adjusted rates control for differences in the age distributions of different populations.4 Age-adjusted rates for YPLL-75 are computed by separating years lost into their respective age groups based on the age of the decedent, and computing age-specific rates based on the age group populations. These age-specific YPLL-75 rates are then weighted according to the 2000 U.S. standard population and a single rate is calculated. The following age groups were used to compute age-adjusted YPLL-75 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, and 65-74 years.
As with any vital statistics data, caution needs to be exercised when analyzing small numbers, including the rates derived from them. Rates calculated from a small number of deaths and/or population tend to be unreliable and subject to significant variation. YPLL-75 rates based on fewer than 20 deaths are considered unreliable. These rates are not shown in Table 1 (PDF) and are indicated with a dash (-). Unreliable YPLL-75 rates by county of residence in Table 3 (PDF), are displayed in red text and italics and are provided only as a point of information for further investigation.
Numerator data are taken from California Department of Public Health death records, and denominator data are obtained from the California Department of Finance population estimates. The 2000 U.S. standard population was used for calculating age-adjustments in accordance with statistical policy implemented by NCHS.5 Age-adjusted death rates are not comparable when rates are calculated with different population standards, e.g., the 1940 standard population.
The causes of death selected for the YPLL-75 report are based on the following ICD-10 codes: Malignant Neoplasms (C00-C97); Unintentional Injuries (V01-X59,Y85-Y86); Diseases of Heart (I00-I09,I11,I13,I20-I51); Homicide (U01-U02,X85-Y09,Y87.1); Conditions Originating in the Perinatal Period (P00-P96); Suicide (U03,X60-X84,Y87.0); Congenital Malformations (Q00-Q99); Chronic Liver Disease and Cirrhosis (K70,K73-K74); Cerebrovascular Disease (I60-I69); Diabetes Mellitus (E10-E14); Chronic Lower Respiratory Diseases (J40-J47); Human Immunodeficiency Virus Disease (B20-B24); Influenza and Pneumonia (J09-J18); Viral Hepatitis (B15-B19); Nephritis, Nephrotic Syndrome and Nephrosis (N00-N07,N17-N19,N25-N27); and Sudden Infant Death Syndrome (R95).
Deaths by place of residence—The data include only those deaths occurring among residents of California, regardless of the place of death.
International Classification of Diseases, Tenth Revision (ICD-10)—Beginning in 1999, cause of death has been reported using ICD-10.6 For more information, see the National Center for Health Statistics ICD-10 page: http://www.cdc.gov/nchs/icd.htm.
Race/Ethnicity— Beginning in 2000, the federal race/ethnicity reporting guidelines changed, which permitted 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 with the population data obtained from the Department of Finance, this report presents Hispanic and the following non-Hispanic race/ethnic 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 three 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.7 This could contribute to artificially low rates for these groups as well as for the Two or More Races group. Race groups’ data that are not individually displayed on the tables due to unreliable rates are collectively included the state data totals.
Trend Analysis—In this report, linear regression was performed to establish the presence of statistically significant trends over the period examined. The trends identified in the report as statistically significant are those for which an F test yielded a p-value less than or equal to .05 and had R-square values greater than .50 unless otherwise specified. Trend analyses were not performed in cases where rates for one or more years examined were unreliable.
2 Centers for Disease Control and Prevention. Premature Mortality in the United States: Public Health Issues in the Use of Years of Potential Life Lost. Morbidity and Mortality Weekly Report: 35, Supplement No. 2. December 1986. URL http://www.cdc.gov/mmwr/preview/mmwrhtml/00001773.htm Accessed July 3, 2009.
3 National Center for Health Statistics. Health, United States, 1996–97 and Injury Chartbook. Hyattsville, Maryland. 1997. URL http://www.cdc.gov/nchs/data/hus/hus96_97.pdf (PDF, 3.31MB) Accessed August 20, 2009.
4 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) Accessed August 19, 2009.
5 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.
6 World Health Organization. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. Geneva: World Health Organization. 1992.
7 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.Return to full report