1 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics,...

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


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


3Outline

• Highlights

• Selected Causes of Death- Cancer- Heart Disease- Diabetes- Injury: Poisonings and Falls

• Disparities in Mortality

• Single Mortality Measures

• Summary


4

Highlights

• Trends

• Comparisons with U.S.

• Leading Causes of death


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


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.


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


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


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


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


11Changes in Mortality RatesMassachusetts: 2000 and 2006


* 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%


12

Selected Causes of Death

• Cancer

• Heart Disease

• Diabetes

• Injury


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



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


*

*

* *

* Statistically higher than female rates (p<0.05)


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


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



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


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



18

Injury Deaths


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%


20Leading Causes of Injury DeathsMassachusetts: 2000 and 2006


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)


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


6.7%* APC

7.3%* APC


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


Fall Related Mortality RatesMassachusetts: 1999-2006

* Statistically higher than 2005 rate (p<0.05)


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



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


Suicide and Homicide Rates Massachusetts: 1994-2006

1.9%* APC

5.7%* APC

16.4%* APC



25

Disparities in Mortality


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


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)


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)

*

**


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


Homicide Rates by Race and Ethnicity Massachusetts: 1994-2006


29

Single Mortality Measures for Improving Health

– Premature Mortality– Mortality Amenable to Health Care


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)

*

**


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


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


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


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%


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


** Statistically lower than 2000 rate (p<0.05)

****

**

Mortality Rates for Causes Amenable to Health Care by Gender

Massachusetts: 2000 and 2006


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


**

** Statistically lower than 2000 rate (p<0.05)

**


37

Summary


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


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


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)

1 Source: Massachusetts Department of Public Health, Bureau of Health Information, Statistics,...

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