1. Large differences in the rates of mortality were evident across counties and regions of the United States.
2. The reported county-level analyses provides a novel method to trace disease-specific mortality trends across the United States.
Evidence Rating Level: 2 (Good)
Study Rundown: Previous studies on country-wide estimates of cause-specific mortality in the US have focused only on single causes of mortality. Information about the variation in different causes of death could provide important insights into geographic differences and trends in life expectancy and the most common causes of death. However, this data is typically complicated by the presence of “garbage codes”, causes of death that are either implausible or nonspecific.
This study presented a novel method for redistributing garbage codes into usable information, allowing for the widespread comparison of cause-specific mortality data. The authors found large between-county differences for every cause of mortality identified. Additionally, mortality rates for certain diseases differed across geographic regions—for instance, heart disease mortality was increased in the southeast.
It is important to note that the redistribution methodology has not been validated against a gold standard at the county level, and changes in mortality rates may reflect differences in registration practices as much as underlying deaths. However, this study provides cause-specific mortality data at much finer levels of detail than had been previously available. Rather than national aggregate data, the results of this study enable greater insights for state and local health agencies as they combat the diseases impacting their constituents.
Click to read the study in JAMA
Relevant Reading: Algorithms for enhancing public health utility of national causes-of-death data
In-Depth [public health surveillance]: Information about 80 412 524 deaths, including 19.4 million assigned with garbage codes, was collected between 1980 and 2014. Cardiovascular diseases caused 39.8% of all deaths over the time period and were the second leading cause of years-of-life-lost (YLLs) and the leading cause of death. Cardiovascular diseases were the leading cause of death in 97.1% of counties in the US. Neoplasms caused 24.3% of all deaths during this study. Likewise they accounted for the leading cause of YLLs and second leading cause of death. Very high neoplasm mortality rates were observed in counties along the southern half of the Mississippi River, in eastern Kentucky and western West Virginia, and in western Alaska. Self-harm and interpersonal violence resulted in 2.5% of all deaths over the time period and were the 5th leading cause of YLLs and 8th leading cause of death in 2014. The highest mortality rates were observed in counties in Alaska, in Native American reservations in North Dakota and South Dakota, and in states in the southwest. Death and trends for diabetes, urogenital, blood and endocrine diseases; neurological disorders; chronic respiratory diseases; transport injuries; mental and substance use disorders; cirrhosis and other chronic liver diseases; diarrhea, lower respiratory, and other common infectious diseases were also analyzed in the study.
Image: PD
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