For persons ages one to 64 years, years of potential life lost (YPLL) is used to describe leading causes of premature death. Years of potential life lost is a statistic that measures the total number of years lost due to premature death in a population from a certain cause. Premature death is defined as death at an age less than 65 years. YPLL is calculated by subtracting the age of death from 65 years. The YPLL rate is the number of years of potential life lost before age 65 per 100,000 population ages one to 64. For example, a person who dies at age 27 in a motor vehicle accident has 38 years (65 –

– 27 = 38) of potential life lost, but a person who dies at age 56 of heart disease

has nine years (65 56 = 9) of potential life lost. YPLL emphasizes the impact of a disease on the length of life for younger individuals; it does not describe the numbers of deaths.

From 1994 to 1996, HIV/AIDS was the leading cause of premature death (Figure 19). After 1995, HIV/AIDS premature death rates decreased due to improved testing and early treatment of people with HIV infection (10). The HIV/AIDS premature death rate decreased 70% from 1,377 per 100,000 in 1994 to 411 in 2002, dropping to become the fifth leading cause of premature death in DeKalb County. Unintentional injury, heart disease, homicide and suicide had less dramatic decreases in premature death rates from 1994 through 2002, and there was a small increase in premature death rates of cancer during the same period.

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Figure 19. Trends in premature deaths among those age 1-64

DeKalb County, Georgia, 1994-2002

Data Source: Georgia Division of Public Health

Leading Causes of Premature Death, Ages 1-64

Trends Over Time

36 Status of Health in DeKalb Report, 2005

Trends by Race/Ethnicity and Gender

Black females From 1994 to 2002, the leading causes of premature death for black females, in rank order, were: (1) cancer, (2) heart disease, (3) HIV/AIDS, (4) unintentional injuries and (5) homicide (Table 12). Cancer was the leading cause of premature death in all females, regardless of race/ethnicity (Figure 20). Racial disparities exist in the premature death rates among females. Black females had a heart disease premature death rate 2.3 times higher, an HIV/AIDS premature death rate 8.7 times higher and a homicide premature death rate 3.5 times higher than white females.

Table 12. Premature death rate in black femalesDeKalb County, Georgia, 1994-2002

Nine-year avg % change fromCause of Premature Death YPLL rate 1994 to 2002Cancer 772.1 13.7%Heart disease 516.5 10.8%HIV/AIDS 380.8 -53.1%Unintentional injuries 364.3 34.1%Homicide 228.4 -50.6%Data Source: Georgia Division of Public Health

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Figure 20. Trends in premature deaths among black females age 1-64

DeKalb County, Georgia, 1994-2002

Data Source: Georgia Division of Public Health

Breast and lung cancer contributed 33% and 13%, respectively, to the total cancer years of potential life lost from 1994 to 2002 (Figure 21). Breast cancer deaths fluctuated and slightly increased 5% from 1994 to 2002. Lung cancer deaths increased 11% from 32.5 deaths per 100,000 females in 1994 to 35.6 deaths in 2002. Lung cancer deaths among black females increased 39% from 1994 to 2002.

Status of Health in DeKalb Report, 2005 37

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DeKalb County, Georgia, 1994-2002

Figure 21. Breast and lung cancer age-adjusted mortality rates among females by race

Data Source: Georgia Division of Public Health Health

White females

Table 13. Premature death rate in white females

DeKalb County, Georgia, 1994-2002Nine-year avg % change from

Cause of Premature Death YPLL rate 1994 to 2002Cancer 723.0 6.8%Unintentional injuries 331.8 16.7%Heart disease 228.1 74.5%Suicide 144.2 -27.9%Stroke 69.8 -83.1%Data Source: Georgia Division of Public Health

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Figure 22. Trends in premature deaths among white females age 1-64

Data Source: Georgia Division of Public Health

38 Status of Health in DeKalb Report, 2005

Health

From 1994 to 2002, the leading causes of premature death for white females, in rank order, were: (1) cancer, (2) unintentional injuries, (3) heart disease, (4) suicide and (5) stroke (Table 13). There was a significant increase of heart disease premature death rates, which increased by 75% from 209 in 1994 to 365 in 2002 (Figure 22). Though fluctuating throughout the nine-year period, stroke premature death rates decreased 83% from 1994 to 2002.

DeKalb County, Georgia, 1994-2002

Hispanics and Asians It is difficult to analyze trends in premature deaths in the Hispanic and Asian populations of DeKalb County because of the small number of total deaths in these groups and a lack of age-specific population figures. However, an analysis of the leading causes of years of potential life lost (YPLL) for the years of 1998 to 2002 by gender gives a basic understanding of the major causes of premature deaths. Generalizations should not be made from these data because the total number of deaths associated with these years of life lost is very small. Hispanic females

Figure 25. Premature deaths among Hispanic females DeKalb County, Georgia, 1998 - 2002

Cancer 29%

Homicide15%

Heart Disease6%

Neurologic Disease6%

Unintentional Injuries26%

All Others 6%

Congenital Anomalies3%

Stroke4%Pregnancy/Childbirth

Complications5%

Total years of potential life lost = 1,715Data Source: Georgia Division of Public Health

Figure 26. Premature deaths among Hispanic males DeKalb County, Georgia, 1998 - 2002

Unintentional Injuries37%

Heart Disease9%

Suicide8%

Cancer 7%

HIV/AIDS5%

Homicide21%

Ill-Defined3%

All Others10%

Total years of potential life lost = 4,530

Status of Health in DeKalb Report, 2005 41

Hispanic males

Cancer claimed 492 years of potential life or 29% of the premature deaths for Hispanic females from 1998 to 2002 (Figure 25). Leukemia accounted for 54% of premature death due to cancer, while breast and lung cancer accounted for 7% and 4%, respectively. Unintentional injuries (i.e., motor vehicle and other injuries) claimed 440 YPLL. Motor vehicle injuries represented 64% of injury YPLL among Hispanic females. The third leading cause of death among Hispanic females was homicide, accounting for 251 YPLL or 15% of premature death.

The leading cause of premature death among Hispanic males from 1998 to 2002 was unintentional injuries, accounting for 1,630 YPLL or 37% of all premature deaths (Figure 26). Motor vehicle injuries represented the majority of these injuries, accounting for 59% of all premature deaths due to injuries and claiming 968 YPLL. The second leading cause of premature death among Hispanic males was homicide, which claimed 966 YPLL. Heart disease was the third leading cause of death representing nine percent of premature deaths and 424 YPLL.

Data Source: Georgia Division of Public Health

Asian females

Figure 27. Premature deaths among Asian females DeKalb County, Georgia, 1998 - 2002

Cancer 38%

Heart Disease10%

Suicide7%

Homicide7%

Unintentional Injuries16%

Pregnancy/Childbirth Complications

5%

Stroke4%

Muscoskeletal & Connective Tissue Disease

4%

All Others 9%

Total years of potential life lost = 894

Asian males

Figure 28. Premature deaths among Asian males DeKalb County, Georgia, 1998 - 2002

Unintentional Injuries24%

Cancer 19%

Suicide16%

Homicide13%

Heart Disease10%

Stroke5%

Infectious Diseases3%

All Others 10%

Total years of potential life lost = 2,067Data Source: Georgia Division of Public Health

42 Status of Health in DeKalb Report, 2005

Cancer was the leading cause of premature death among Asian females, accounting for 38% of premature death (Figure 27). From 1998 to 2002, a total of 332 years of potential life (YPLL) were claimed by cancer. Brain, ovarian and liver cancers were the most prevalent of all types of cancers, representing 33% of cancer YPLL. The second leading cause of premature death was unintentional injuries with 143 YPLL. Motor vehicle injuries accounted for 71% of YPLL due to injuries. Heart disease had the third highest YPLL of 92 or 10% of total YPLL for Asian females.

Unintentional injuries were the leading cause of premature death among Asian males (Figure 28). Injuries claimed 498 YPLL or 24% of premature deaths. Motor vehicles accounted for 50% of injuries to Asian males. The second leading cause of premature death among Asian males was cancer, accounting for 19% of YPLL. From 1998 to 2002, cancer claimed 384 YPLL of Asian males. Brain cancer claimed the majority of YPLL, 28% of all cancers. The third leading cause of premature death among Asian males was suicide. A total of 325 years of potential life was lost from 1998 to 2002, representing 16% of all premature deaths.

Data Source: Georgia Division of Public Health