Community Health Assessment. South Dallas Service Area

Transcription

1 Community Health Assessment Service Area

2 Organizational Model For the Community Health Dashboard Health Outcomes Mortality Years of Potential Life Lost Infant Mortality Very Low Birth Weight Births Morbidity Health Risk Behaviors Violence and Injury Prevention High Risk Sexual Behavior Alcohol Use Injury Mortality ED Visits for Injuries HIV/STD Rates Teen Birth Rate Liquor Store Density Health Factors Access to Clinical Care Quality of Clinical Care Percent Uninsured Physician-to-Population Ratio Emergency Department Use Prevention Quality Indicators

3 Demographic Profile Service Area The population of the Service Area is an older population that the county population with 11.8% over age 65 compared to the county with 9.1% over age 65. The Service Area population the largest percent of African Americans of the 13 service areas and much higher percentage than the county (67.9% compared to 19.9% respectively)/ This Service Area has a much higher percentage with less than a high school education (35.9% compared to the county (25.4%). 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 19, ,874 36, ,701 66,391 1,084,253 39, ,576 SA Age % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2, , ,536 4,870 SA 165, , , ,068 Race/ Ethnicity Other Non- Hispanic Hispanic Black Non- Hispanic White Non- Hispanic 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 31,270 32,428 35,673 SA 810, , ,087 Highest Educational Attainment More than HS HS Diploma Less than HS Source: Nielson/Claritas, Inc. Pop-Facts mid-2010 version 2

4 Demographic Profile Service Area The population of the Service Area has a larger number of households in poverty compared with the percentage, over 25% of all households. 100% 90% 80% 70% 60% 9,134 81,577 Poverty Status, (Households) The Service Area s per capita income was the lowest of the 13 service areas. The percent unemployed for this Service Area is the highest among the 13 Service Areas. 50% 40% 30% 20% 10% 0% 27,579 SA 504,943 below poverty above poverty $30,000 Percent Unemployed in the Civilian Labor Force $25,000 $20,000 $15,000 $10,000 $13,399 $24,240 Per Capita Income 14.0% 12.0% 1% 8.0% 6.0% 4.0% 2.0% % 4.1% 6.2% 6.1%5.5% 6.0% 4.4% 3.2% 3.8% 13.1% 7.9% 9.1% 6.0% 5.5% $5,000 $0 SA Source: Nielson/Claritas, Inc. Pop-Facts mid-2010 version 3

5 Access to care Percent Uninsured Access to Clinical Care Physician-to- Population Ratio Emergency Department Use

6 Access to Healthcare: Percent Without Healthcare Insurance Service Area Percent Uninsured 100% 90% 80% Healthy People 2020 Goal 0% uninsured Percent Without Health Insurance, Service Area 70% % 60% % 50% 40% 30% 20% 10% 24% 26% 21% 21% 19% 12% 11% 11% 47% 36% 32% 25% 21% 30% 24% 8% 18% 18% 19% 17% 15% 9% 9% 44% 31% 27% 20% 17% 31% 28% % 41.1% 44.0% 43.9% 0% % Wilmer/Hutch/Seag 09 Texas Wilmer/Hutch/Seag Texas % 2% 4% 6% Source: 2006 Solucient, Inc.; 2010 Market Planner Plus; Denominator population data from Claritas, Inc.; except 2010 from Nielson/Claritas, Inc. Pop-Facts mid 2010 version; and Texas rates from US Census Bureau s American Community Survey

7 Access to Healthcare: Primary Care Physician-to-Population Ratio Service Area Primary Care Physicians per 100, Primary Care Physician-to- Population Ratio, per 100,000, Service Area Texas Texas Source: Texas Medical Association Physician Practice Address files; denominator population data from Claritas, Inc., except 2010 from PopFacts.mid 2010 version. County and State sources is Texas Bureau of Primary Care. Care-Physicians-(PC)-by-County-of-Practice---September,-2010/ and 6

8 Access to Healthcare: Non- Emergent ED Utilization Service Area Non-Emergent ED Visits, per 1,000 Population Rate of Non-Emergent ED Visits, per 1,000, South Dallas Service Area Source: DFWHC, Outpatient Data System; NYU Algorithm for determining appropriate Emergency Dept. Use; denominator population data from Claritas, Inc. 7

9 Access to Care Doing better than the benchmark Same as/not significantly different from the benchmark Worse than the benchmark Compared to Healthy People 2020 Goal Compared to Benchmark Counties* (Quartiles) Compared to Past Years Data (CI) Percent Uninsured Access to Clinical Care Physician-to- Population Ratio N/A *Benchmark Counties are: Maricopa, Los Angeles, Cook, Miami-Dade, Bexar, Harris and Tarrant Emergency Department Use N/A N/A

10 Quality of care Diabetes- Related Quality of Clinical Care Prevention Quality Indicators Cardiovascular Acute/Infectious Chronic Pulmonary

11 Healthcare Quality: Rate of Preventable Hospitalizations, Diabetes-Related Hospitalizations Service Area Diabetes Short Term Complications, Diabetes Long Term Complications, Uncontrolled Diabetes, Lower Extremity Amputation Among Diabetics, Source: Texas Department of State Health Services, Texas Health Care Information Council, unpublished data; denominator population data from Claritas, Inc.; County and State rates from Texas Department of State Health Services, Texas Health Care Information Council, 2003, 2005 and 10

12 Healthcare Quality: Rate of Preventable Hospitalizations, Cardiovascular Disease Hospitalizations Service Area Congestive Heart Failure, Hypertension, Angina Without Cardiac Procedure, Source: Texas Department of State Health Services, Texas Health Care Information Council, unpublished data; denominator population data from Claritas, Inc.; County and State rates from Texas Department of State Health Services, Texas Health Care Information Council, 2003, 2005 and 11

13 Healthcare Quality: Rate of Preventable Hospitalizations, Acute/Infectious Disease Hospitalizations Service Area Bacterial Pneumonia, Dehydration, Urinary Tract Infection, Source: Texas Department of State Health Services, Texas Health Care Information Council, unpublished data; denominator population data from Claritas, Inc.; County and State rates from Texas Department of State Health Services, Texas Health Care Information Council, 2003, 2005 and 12

14 Healthcare Quality: Rate of Preventable Hospitalizations, Chronic Pulmonary Disease Hospitalizations Service Area Chronic Obstructive Pulmonary Disease, Adult Asthma, Source: Texas Department of State Health Services, Texas Health Care Information Council, unpublished data; denominator population data from Claritas, Inc.; County and State rates from Texas Department of State Health Services, Texas Health Care Information Council, 2003, 2005 and 13

15 Healthcare Quality Doing better than the benchmark Same as/not significantly different from the benchmark Worse than the benchmark Compared to 12 Other Service Areas (Quartiles) Diabetes ST Comp Quality of Clinical Care Prevention Quality Indicators Diabetes LT Comp Uncontrolled Diabetes Lower Extremity Amputations Among Diabetics Congestive Heart Failure Hypertension Angina Without Cardiac Procedure Bacterial Pneumonia Dehydration Urinary Tract Infection Chronic Obstructive Pulmonary Disease Adult Asthma

16 Health Risk Behaviors Health Risk Behaviors Injury Prevention High Risk Sexual Behavior Mortality ED Use HIV/STD s Teen Birth Rate Alcohol Use Liquor Store Density

17 Risk Factors: Auto Accident Mortality Rates Service Area Age-Adjusted Deaths per 100, Healthy People 2020 Goal Auto Accident Mortality Rate, Age- Adjusted Death Rate per 100,000, Service Area Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 16

18 Risk Factors: Accidental Poisoning Mortality Rates Service Area Age-Adjusted Deaths per 100, Healthy People 2020 Goal Accidental Poisoning Mortality Rate, Age-Adjusted Death Rate per 100,000, Service Area Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 17

19 Risk Factors: Accidental Falls Mortality Rates Service Area Age-Adjusted Deaths per 100, Healthy People 2020 Goal Accidental Falls Mortality Rate, Age-Adjusted Death Rate per 100,000, Service Area Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 18

20 Risk Factors: Falls Death Rates Among Seniors Service Area Falls Deaths Age Healthy People 2020 Goal Falls fatality rates, ages 65+, per 100,000, Service Area Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics, unpublished data; denominator population data from Claritas, Inc.; 2005 data from Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death File CDC WONDER On-line Database, compiled from Multiple Cause of Death File Series 20 No. 2L, Accessed at on Mar 25, :52:15 PM; 2005 Texas data from 19

21 Risk Factors: Suicide Mortality Rates Service Area Age-Adjusted Deaths per 100, Healthy People 2020 Goal Suicide Mortality Rate, Age- Adjusted Death Rate per 100,000, Service Area Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 20

22 Risk Factors: Homicide Mortality Rates Service Area Age-Adjusted Deaths per 100, Healthy People 2020 Goal Homicide Mortality Rate, Age- Adjusted Death Rate per 100,000, Service Area Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 21

23 Risk Factors: Rate of Injury- Related ED Visits Service Area Rate of Injury-Related ED Visits Healthy People 2020 Goal Rate of Injury-Related ED Visits, per 1,000, South Dallas Service Area Source: Dallas Fort Worth Hospital Council, COGNOS application, unpublished data; denominator population data from Claritas, Inc. 22

24 Risk Factors: High Risk Sexual Behavior, Sexually Transmitted Disease Incidence Rates, 2009 Service Area Chlamydia Incidence per 100,000 1,40 1,20 1, , Gonorrhea Incidence per 100, Primary & Secondary Syphilis Incidence per 100, New HIV Incidence per 100, Source: Texas Department of State Health Services, Bureau of STD/HIV, unpublished data; Denominator population data from Claritas, Inc.; and Texas Rates are from and 23

25 Risk Factors: High Risk Sexual Behavior, Teen Birth Rates Service Area Teen Birth Rate Healthy People 2020 Goal Teen Births, Rate Per 1,000 Girls Ages 15-17, Service Area Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 24

26 Risk Factors: Liquor Store Density, 2007 Service Area Liquor Stores Per 100,000, Liquor Store Density, Stores per 100,000, State of Texas Texas Source: US Census Bureau, 2007 Economic Census; denominator population data from Claritas, Inc.; and State of Texas data from US Census Bureau, NIACS annual business estimates, denominator is American Community Survey 2007 population estimate 25

27 Health Risk Behaviors Doing better than the benchmark Same as/not significantly different from the benchmark Worse than the benchmark South Dallas Compared to Healthy People 2020 Goal Compared to Benchmark Counties* (Quartiles) South Dallas Compared to Past Years Data (CI) Motor Vehicle Crash Death Rate Health Risk Behaviors Injury Prevention Accidental Poisoning Death Rate Accidental Falls Death Rate Senior Falls Death Rate Suicide Death Rate *Benchmark Counties are: Maricopa, Los Angeles, Cook, Miami-Dade, Bexar, Harris and Tarrant Homicide Death Rate Emergency Department Injury Visits

28 Health Risk Behaviors Doing better than the benchmark Same as/not significantly different from the benchmark Worse than the benchmark *Benchmark Counties are: Maricopa, Los Angeles, Cook, Miami-Dade, Bexar, Harris and Tarrant Teen Birth Rate South Dallas Compared to Healthy People 2020 Goal Compared to Benchmark Counties* (Quartiles) Compared to Past Years Data (CI) Health Risk Behaviors High Risk Sexual Behavior Chlamydia Incidence Rate Gonorrhea Incidence Rate Syphilis Incidence Rate HIV Incidence Rate N/A N/A N/A N/A Alcohol Use Liquor Store Density N/A N/A

29 Health Outcomes Heart Disease Cancer Health Outcomes Mortality Infant Mortality Low Birth Weight Births Years of Potential Life Lost Communicable Disease Morbidity Cerebrovascular Disease Chronic Obstructive Pulmonary Disease Diabetes Mellitus Aseptic Meningitis Cryptosporidiosis Pertussis Salmonellosis

30 Health Outcomes: Heart Disease Mortality Rates Service Area Age-Adjusted Deaths per 100, Healthy People 2020 Goal Heart Disease Mortality Rate, Age- Adjusted Death Rate per 100,000, Service Area Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 29

31 Health Outcomes: Cancer Mortality Rates Service Area Age-Adjusted Deaths per 100, Healthy People 2020 Goal Cancer Mortality Rate, Age- Adjusted Death Rate per 100,000, Service Area Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 30

32 Health Outcomes: Cerebrovascular Disease Mortality Rates Service Area Age-Adjusted Deaths per 100, Healthy People 2020 Goal Cerebrovascular Disease Mortality Rate, Age-Adjusted Death Rate per 100,000, Service Area Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 31

33 Health Outcomes: Chronic Obstructive Pulmonary Disease Mortality Rates Service Area Age-Adjusted Deaths per 100, Chronic Obstructive Pulmonary Disease Mortality Rate, Age- Adjusted Death Rate per 100,000, Service Area Texas NOTE: No Healthy People 2020 goal matches this metric. Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 32

34 Health Outcomes: Diabetes Mortality Rates Service Area Age-Adjusted Deaths per 100, Diabetes Mellitus Mortality Rate, Age-Adjusted Death Rate per 100,000, Service Area 5 Healthy People 2020 Goal Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 33

35 Health Outcomes: Birth Outcomes, Rate of Very Low Birth Weight Births Service Area Very Low Birth Weight Rate 3.0% 2.7% 2.5% 2.0% 1.5% 1.0% 2.5% 1.9% 1.5% 1.3% 1.7% 1.2% Healthy People 2020 Goal 1.4% 1.5% 2.2% 1.8% 1.6% 1.6% 2.2% 2.4% 2.4% 1.8% 1.5% 1.8% 1.7% 1.3% 1.2% 2.4% 1.5% 1.7% 1.1% 1.3% Very Low Birth Weight Rate, % of Births Below 1500 Grams at Birth, Service Area % 2.2% 2.5% 0.5% % % % Texas Texas % 1.0% 2.0% 3.0% Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 34

36 Health Outcomes: Birth Outcomes, Infant Mortality Rate Service Area Infant Mortality Rate Healthy People 2020 Goal Infant Mortality Rate, Deaths per 1,000 Live Births, South Dallas Service Area Texas Texas Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 35

37 Health Outcomes: Years of Potential Life Lost, All Causes Service Area Years of Potential Life Lost Rate per 100,000* 16,000 14,000 14,016 13,958 Years of Potential Life Lost Rate*, per 100,000, South Dallas Service Area 12,000 10,000 8,000 6,000 4,000 6,556 7,816 6,128 6,046 4,495 4,324 4,568 4,451 8,690 7,339 7,153 6,727 5,024 6,169 8,271 6,625 6,921 5,733 5,075 4,862 3,960 9,149 8,806 5,518 7,509 7, ,016 14,017 15,444 2, , , ,000 12,000 18,000 *Years of Potential Life Lost Rate is defined as the rate of deaths under age 75 per 100,000 population under age 75. Source: Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc. 36

38 Health Outcomes: Reportable Communicable Disease Rates Service Area Aseptic Meningitis Incidence, per 100, Aseptic Meningitis Incidence Rate, per 100,000, South Dallas Service Area Source: Texas Department of State Health Services, Infectious Disease Control Unit, unpublished data; denominator population data from Claritas, Inc.; 2005 data from Health and Human Services web site: denominator population data from American Community Survey. 37

39 Health Outcomes: Reportable Communicable Disease Rates Service Area Cryptosporidiosis Incidence, per 100, Cryptosporidiosis Incidence Rate, per 100,000, South Dallas Service Area Source: Texas Department of State Health Services, Infectious Disease Control Unit, unpublished data; denominator population data from Claritas, Inc.; 2005 data from Health and Human Services web site: denominator population data from American Community Survey. 38

40 Health Outcomes: Reportable Communicable Disease Rates Service Area Pertussis Incidence, per 100, Pertussis Incidence Rate, per 100,000, Service Area Source: Texas Department of State Health Services, Infectious Disease Control Unit, unpublished data; denominator population data from Claritas, Inc.; 2005 data from Health and Human Services web site: denominator population data from American Community Survey. 39

41 Health Outcomes: Reportable Communicable Disease Rates Service Area Salmonellosis Incidence, per 100, Healthy People 2020 Goal 11.4 Salmonellosis Incidence Rate, per 100,000, Service Area Source: Texas Department of State Health Services, Infectious Disease Control Unit, unpublished data; denominator population data from Claritas, Inc.; 2005 data from Health and Human Services web site: denominator population data from American Community Survey. 40

42 Health Outcomes Doing better than the benchmark Same as/not significantly different from the benchmark Worse than the benchmark South Dallas Compared to Healthy People 2020 Goal Compared to Benchmark Counties* (Quartiles) South Dallas Compared to Past Years Data (CI) Heart Disease Death Rate Health Outcomes Mortality Cancer Death Rate Cerebrovascular Disease Death Rate *Benchmark Counties are: Maricopa, Los Angeles, Cook, Miami-Dade, Bexar, Harris and Tarrant Chronic Obstructive Pulmonary Disease Death Rate Diabetes Death Rate N/A

43 Health Outcomes Doing better than the benchmark Same as/not significantly different from the benchmark Worse than the benchmark *Benchmark Counties are: Maricopa, Los Angeles, Cook, Miami-Dade, Bexar, Harris and Tarrant Infant Mortality Rate Very Low Birth Weight Birth Rate South Dallas Compared to Healthy People 2020 Goal South Dallas Compared to Benchmark Counties* (Quartiles) South Dallas Compared to Past Years Data (CI) Health Outcomes Years of Potential Life Lost Rate Aseptic Meningitis Incidence Rate N/A N/A N/A Communicable Disease Morbidity Cryptosporidiosis Incidence Rate Pertussis Incidence Rate N/A N/A N/A N/A Salmonellosis Incidence Rate N/A

44 Summary Model With Stoplight Pie Charts, Service Area Health Outcomes Mortality Years of Potential Life Lost Infant Mortality Very Low Birth Weight Births Morbidity Health Risk Behaviors Violence and Injury Prevention High Risk Sexual Behavior Alcohol Use Injury Mortality ED Visits for Injuries HIV/STD Rates Teen Birth Rate Liquor Store Density Health Factors Access to Clinical Care Quality of Clinical Care Percent Uninsured Physician-to-Population Ratio Emergency Department Use Prevention Quality Indicators

45 Deviations from the mean Wilmer Hutchins Seagoville Southwest Dallas Southeast Dallas idor aster Northwest Dallas Northeast Dallas Outer Northeast NOTE: All data are from the years , years available varies by topic. Each vertical line represents 100% difference from the average. More Unfavorable More Favorable Percent Difference from the Average Mortality Years of Potential Life Lost Infant Mortality Very Low Birth Weight Morbidity Violence and Injury High Risk Sexual Behavior Access to Clinical Care Preventable Hospitalizations Socioeconomic

46 Methods of calculating deviations from the mean for the preceding chart. Mortality. For each service area and for, add the 2009 age-adjusted death rates per 100,000 for the five leading causes of death, to get a single number. Calculate for each service area the percent deviation from the total, from -infinity to +infinity. That deviation is the mortality deviation for the chart. Because heart disease and cancer predominate, this tends to over-weight these two causes compared to the other three (stroke, COPD and diabetes). Years of potential life lost. Using the Years of Potential Life Lost Rate per 100,000, calculate for each service area the percent deviation from the YPLL rate, from -infinity to +infinity. That deviation is the YPLL deviation for the chart. Infant Mortality. Using the Infant mortality rate per 1,000 live births, calculate for each service area the percent deviation from the infant mortality rate, from -infinity to +infinity. That deviation is the infant mortality deviation for the chart. Very Low Birth Weight. Using the Very Low Birth Weight rate per 1,000 live births, calculate for each service area the percent deviation from the VLBW rate, from -infinity to +infinity. That deviation is the VLBW deviation for the chart. Morbidity. For each service area and for, add the 2009 incidence rates per 100,000 for the four reportable diseases (aseptic meningitis, cryptosporidiosis, pertussis, salmonellosis), to get a single number. Calculate for each service area the percent deviation from the total, from -infinity to +infinity. That deviation is the morbidity deviation for the chart. Meningitis and salmonellosis are more common, so this tends to over-weight them, although all are fairly rare in a population sense. Violence and Injury. Three steps: For each service area and for, add the 2009 age-adjusted death rates for the injury-related causes of death (motor vehicle crashes, poisoning, falls, suicide and homicide) and the age-specific seniors falls death rate (all of which are in units of deaths per 100,000), to get a single number. Calculate for each service area the percent deviation from the Dallas County total, from -infinity to +infinity. Then using the rate per 100,000 of ED visits for injuries, calculate for each service area the percent deviation from the rate, from -infinity to +infinity. Calculate the arithmetic mean of these two percent deviations. That is the Violence and Injury deviation for the chart. This might over-weight ED visits somewhat, but it is qualitatively different from mortality.

47 Methods of calculating deviations from the mean for the preceding chart. High Risk Sexual Behavior. Three steps: For each service area and for, add the 2009 incidence rates for three non-hiv STDs (Chlamydia, gonorrhea and syphilis), to get a single number in units of cases per 100,000. Calculate for each service area the percent deviation from the total, from -infinity to +infinity. Then using the rate of new HIV diagnoses per 100,000, calculate for each service area the percent deviation from the rate, from -infinity to +infinity. The using the rate of births to girls 15-17, per population of girls 15-17, calculate for each service area the percent deviation from the rate, from - infinity to +infinity. Calculate the arithmetic mean of these three percent deviations. That is the High Risk Sexual Behavior deviation for the chart. This might under-weight syphilis somewhat. By giving the three equal statistical weight (STDs, HIV and teen births) you could set off debates over which has the most impact over harm to the area s health status, but since they are qualitatively quite different we probably can t resolve that to everyone s satisfaction. Access to Clinical Care. For each service area and for, add the 2010 percent of people without health insurance and rate of non-emergent ED user per 1000 population, then subtract the rate of primary care physicians per 100,000 population (since higher is better for this measure), to get a single number. Calculate for each service area the percent deviation of this total from the total, from -infinity to +infinity. That deviation is the access to care deviation for the chart. Although these three measures are in different units, the values were in the range of (in different units), such that the contributions of each of the three measures to the total was approximately equal. Quality of Clinical Care. There are 12 preventable hospitalization discharge rates for each service area, age-adjusted in units of discharges per 100,000. Some are more common, such as bacterial pneumonia (in the range of discharges per 100,00), while some are more rare (around 5-10 per 100,000). So for each service area and for, for each discharge category calculate the percent deviation from the rate. Calculate the arithmetic average of these 12 deviations, that deviation is the quality of care deviation for the chart. Socioeconomic indicators. There are four socioeconomic indicators percent age 65 or older, percent age birth to 14, percent of adults age 25+ without a high school diploma, percent of the population below the federal poverty limit. For each service area and for, for each of these four indicators calculate the percent deviation from the rate. Calculate the arithmetic average of these four deviations, that deviation is the socioeconomic deviation for the chart. 46

48 Notes: Age Adjusted Death Rates: Death rates that control for the effects in population age distributions. The centers for Disease Control and Prevention established the standard population weights for direct age adjustments. The need for age adjustment becomes particularly important when cause-specific mortality is of interest. Unadjusted rates for chronic diseases (cardiovascular diseases, cancers, or chronic lower respiratory diseases) may appear to be higher for older populations when compared to a younger population. With age-adjustment those differences may be reduced or even reversed. A mechanism for adjusting the age structure differences is needed to determine if there really are mortality differences between two populations. By applying age-specific mortality rates to a standard population, direct standardization controls for differences in population composition. Mortality trends can be more accurately compared along geographic, temporal, or race/ethnicity lines, etc. In short, standardization lets us look at what the death rate would be in one population if that population had the same age structure as the standard population. Beginning with 1999 events, the United States year 2000 population is used as the standard for age-adjusting.