Small Area Analysis of Premature

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Small Area Analysis of Premature Cardiovascular
Disease Mortality by Zip Code Robert O. Bonow,
MD Gary A. Puckrein, PhD Sean D. Cleary, PhD,
MPH Hala Nsouli, MPH Josette Kelly Northwestern
University Feinberg School of Medicine,
National Minority Health Month Foundation,
GWU School of Public Health Health Services
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Cardiovascular Mortality
700
659
600
Men ages 55 - 64 2000 data
500
400
358
Deaths per 100,000
300
200
121
100
40
0
White
White
Black
Black
Heart Disease
Stroke
National Center for Health Statistics
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Chicago Sun-Times
SUNDAY, JULY 1, 2001
Heart risk higher here for blacks
BY JIM RITTER Black men are more likely to die of
heart disease than those in other groups -- and
their risk is especially high in Illinois. A
new federal study shows that Illinois has the
nations third highest rate of death from heart
disease among African-American men. Only Maine
and Mississippi have higher rates.
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Hospitalizations for Heart Failure 2000
Rate per 100,000 Medicare enrollees
11.5-17.5
17.6-22.9
Centers for Disease Control and Prevention
23.0-33.7
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Hospitalizations for Stroke 2000
Rate per 100,000 Medicare enrollees
11.8-14.2
14.3-16.6
Centers for Disease Control and Prevention
16.7-21.9
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Men and Heart Disease An Atlas of Racial and
Ethnic Disparities in Mortality First Edition
Office for Social Environment and Health Research
West Virginia University National Center for
Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention, 2000
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Women and Heart Disease An Atlas of Racial and
Ethnic Disparities in Mortality
Office for Social Environment and Health Research
West Virginia University National Center for
Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention, 2001
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Objective Describe a small area analysis (SAA)
of premature mortality due to cardiovascular
disease in the United States with the intent of
investigating whether SAA can be used as a tool
to geographically identify communities with
significant health disparities.
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• Methods
• Premature mortality due to cardiovascular
  disease
• Data from state Vital Statistics offices
• Persons aged 5-64 years
• Geocoded to zip code level
• 1998-2000 ICD9 ICD10 codes for CHD CVD
• The appropriate correction factor was applied
• to 1998 (ICD9) data to facilitate comparison
• to later years.
• Population estimates
• 2000 U.S. census, 10-year age groups for each
  zip code
• Minority zip code
• 50 or greater African American, Native
  American,
• Hispanic, Asian or Pacific Islander

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Methods Premature mortality rates due to
cardiovascular disease were calculated by the
direct standardization method, to adjust for
different underlying age distributions within zip
codes, using the US 2000 standard population.
To minimize unstable estimates due to few cases
or to a small population within a zip code, rates
were only computed for zip codes in which the
population was greater than or equal to 1000
persons and the number of premature deaths due to
cardiovascular disease was greater than or equal
to 1 per year.
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Results Age-adjusted premature mortality rates
for cardiovascular disease were calculated for
each zip code for which data were available
10,849 total zip codes 1,689 minority zip
codes 30 states plus the District of Columbia
are included This represents 84 of premature
deaths due to CVD during the study period. New
York data do not include NYC Age-adjusted
mortality rates and minority zip codes were
mapped using ArcView 8.2 (ESRI, 2001) software.
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Premature Mortality Rates for Cardiovascular
Disease (age-adjusted per 100,000
population) adjPMR
Zip codes with adjPMR less than National mean
of 71.4 Zip codes with adjPMR between
National and Minority means 71.5-94.9 Zip codes
with adjPMR above Minority mean of 95.0
Mapped Green
Mapped Yellow
Mapped Red
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Premature CV Deaths
lt 71.4 71.5 94.9 gt
71.4
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Premature CV Deaths
lt 71.4 71.5 94.9 gt
71.4
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Premature CV Deaths
lt 71.4 71.5 94.9 gt
71.4
Minority Zip Code
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Premature CV Deaths
lt 71.4 71.5 94.9 gt
71.4
Minority Zip Code
Health Centers
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Premature CV Deaths
lt 71.4 71.5 94.9 gt
71.4
Minority Zip Code
Health Centers
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Premature CV Deaths
lt 71.4 71.5 94.9 gt
71.4
Minority Zip Code
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Premature CV Deaths
lt 71.4 71.5 94.9 gt
71.4
Minority Zip Code
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Premature CV Deaths
lt 71.4 71.5 94.9 gt
71.4
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Conclusions Higher rates of premature
mortality due to cardiovascular disease were
observed in predominantly minority zip codes
Variation in rates within minority zip codes was
also observed Results inform community-based
prevention and treatment programs targeting high
risk, underserved areas, thus illustrating the
value of small area analysis for public health
practice
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Future Plans Cluster analysis will be used to
classify zip codes by cardiovascular premature
mortality rate in order to identify behavioral,
social, and cultural risk factors Focus will
be on identifying socioeconomic factors, such as
race/ethnicity, income, poverty, education that
predict elevated levels of premature
cardiovascular deaths at the zip code level to
monitor changes in health status and to evaluate
the impact of specific interventions
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Age and Sex Adjusted Treated Prevalence Rates
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Medication Persistency by New/Existing Status
after 10-month follow-upHigh Cholesterol
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Eliminating Racial and Ethnic Health Disparities
The future of the nation will be determined to a
large extent by how effectively we work with
communities to reduce and eliminate health
disparities between non- minority and minority
populations experiencing disproportionate
burdens of disease, disability, and premature
death.
-Guiding Principle for Improving Minority
Health Centers for Disease Control and
Prevention, 2005
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