Leading Causes of Death Profile

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1 Leading Causes of Death Profile St. Louis County, Missouri Mortality is an indicator of the health of a population. Cause of death ranking is the standard method that is useful for illustrating the relative burden of particular diseases or injuries that cause mortality. 1 This report presents data from 2010 through 2014 for Saint Louis County, giving a broad overview of mortality for all causes overall and the 10 leading causes of death by sex, age, race and Hispanic origin, poverty level, and geographic area. The data are derived from death certificates from St. Louis County residents. During , there were a total of 46,261 resident deaths in St. Louis County. The age adjusted death rate in 2014 was deaths per 100,000 U.S. standard population. For , the 10 leading causes of St. Louis County resident deaths were: heart disease, cancer, cerebrovascular diseases (stroke), accidents (unintentional injuries), chronic lower respiratory disease (), Alzheimer s disease, influenza and pneumonia, nephritis, nephrotic syndrome and nephrosis (kidney disease), diabetes, and septicemia. Seven of the 10 leading causes of death during were chronic diseases, accounting for 66 percent of all deaths. Mortality from All Causes Figure 1. Age adjusted death rates for all cause mortality, St. Louis County, Missouri, and United States, Age Adjusted Rate per 100,000 Population Missouri United States St. Louis County Year Figure 1 shows trends in death rates for all causes that have been adjusted for differences in age distribution between populations, also called age adjusted, for St. Louis County, Missouri through 2013, and the United States. All cause mortality rates declined in recent years for all three populations. St. Louis County rates decreased 1.8%, from deaths per 100,000 population in 2010 to deaths per 100,000 in Appendix 1 includes details about these death counts and rates.

2 Leading Causes of Death Page 2 of 19 The following table breaks down average, all cause mortality rates for St. Louis County by demographic characteristics for Table 1. Deaths from All Causes per 100,000 population, St. Louis County, average. Rate 95% Confidence Interval Count per year St Louis County to 718 9,252 Age Group < 18 years to years to years to years to , years and over to ,153 Gender Male to 863 4,362 Female to ,889 Race/Ethnicity Asian to Black/African American to ,788 Hispanic/Latino to Multiple Races to White to ,326 Neighborhood Poverty Very High to High to ,075 Medium to ,250 Low to ,442 Geographic Area Central to ,086 Inner North to ,776 Outer North to ,791 South to ,146 West to ,452 Comparisons: Higher than St. Louis County rate Lower than St. Louis County rate Notes: Source: Missouri Department of Health and Senior Services (DHSS), Bureau of Vital Statistics. Case Definition: All deaths to St. Louis County residents between 2010 and 2014 from all causes. Rates are age adjusted to the 2000 US population (not including Age Group rates).

3 Leading Causes of Death Page 3 of 19 Figure 2. Age Adjusted Death Rates by Neighborhood Poverty, St. Louis County Residents, 2010 and Age adjusted Death Rate per 100,000 Polulation Very High (>=30 %) High (20 to <30%) Medium (10 to <20%) Low (< 10%) County wide Year 2014 In 2010 and 2014 age adjusted all cause death rates were 1.5 times greater in areas with very high poverty compared to areas with low poverty (957.8 vs deaths per 100,000 population in 2010 and vs in 2014, respectively). Figure 3. Age Adjusted Death Rates by Sex, St. Louis County Residents, 2010 to From 2010 to 2014, ageadjusted all cause death rates increased 2.2% among males, but decreased 1.7% among females. The age adjusted allcause death rates for males were higher than the St. Louis County rates. Age adjuste Death Rate per 100,000 Population Male St. Louis County Female Year Age adjusted Death Rate per 100,000 Population Figure 4. Age Adjusted Death Rates by Race and Ethnicity, St. Louis County Residents, Black/African American White Hispanic/Latino Multiple Races Asian Year From , ageadjusted all cause death rates among Asians and whites decreased 4% and 2%, respectively. Hispanic/Latinos and multiple race groups rates increased 35% and 44%, respectively. Black/African American rates increased 4%.

4 Leading Causes of Death Page 4 of 19 Map 1. All Cause age adjusted death rate per 100,000 population by zip code, St. Louis County, average. Age-Adjusted Death Rate per 100,000 Population for All Causes, Í Í Uq Zip Codes Unpopulated UN !"f$ Í Í %&h(!"f$ Un Iy!"e$ Iy!"e$ Un U U Í Un %&h( Iy!"e$ !"b$!"f$ City of St. Louis Iy!"e$!"b$ Iz!"c$ 63088!"b$ Iz Iz!"c$ !"b$ Iz Iz %&j( Miles!"c$ Data Source: Missouri Department of Health and Senior Services The average age adjusted death rates for all causes were highest in the northern parts of St. Louis County, although some zip codes in the western and southern parts of the county had high all cause death rates. The lowest rates were among zip codes in the central part of the county. Appendix 1 includes details about all cause mortality rates for St. Louis County by year (2010 to 2014) and demographic characteristics.

5 Leading Causes of Death Page 5 of 19 Leading Causes of Death Table 2 shows the 10 leading causes of death in St. Louis County, in ranked order, during Seven of the 10 leading causes were chronic diseases and conditions. Chronic diseases, including heart disease, cancer, stroke, chronic lung diseases, and diabetes, have modifiable risk factors that can lead to premature mortality. Table 2. Deaths, age adjusted rates, 95% confidence intervals, and percentage of total deaths 10 Leading Causes of Death, St. Louis County, average. Rank Cause of Death ICD 10 Codes Deaths Rate 1 95% Confidence Interval Percent of total deaths All Causes 46, Heart I00 I09, I11, I13, I20 I51 11, C00 C97 10, I60 I69 2, V01 X59,Y85 Y86 2, Chronic Lower Respiratory 5 J40 J47 2, Alzheimer's G30 1, Influenza and J09 J18 1, Kidney N00 N07,N17 N19,N25 N27 1, E10 E14 1, A40 A Rates are age adjusted to the 2000 U.S. population per 100,000 population. Rank based on number of deaths among St. Louis County Residents; International Classification of s, Tenth Revision (ICD 10). Cause of death statistics are based on the underlying cause of death. Figure 5. Age adjusted death rates for the 10 leading causes of death in St Louis County, comparing rates for Missouri and United States, Heart * Alzheimer's Influenza and Kidney St. Louis County Missouri United States Age adjusted Death Rates per 100,000 * injury rate for Missouri is a 3 year average,

6 Leading Causes of Death Page 6 of 19 The burden of chronic disease in St. Louis County is highlighted by the majority of the 10 leading causes of death are chronic diseases and conditions. The St. Louis County Department of Public Health established the Chronic Epidemiology (CDE) program to address chronic diseases among county residents. The program aims to publish more detailed surveillance reports on the most burdensome chronic diseases and their risk factors. Chronic diseases dominant in the 10 leading causes of death in St. Louis County Rank Heart Heart Heart Heart Heart Heart Alzheimer s 17.8 Alzheimer s 16.4 Alzheimer s 17.5 Alzheimer s 20.2 Alzheimer s 27.2 Alzheimer s Kidney Kidney 17.5 Influenza/ 16.3 Influenza/ 18.4 Influenza/ Influenza/ Kidney 15.2 Kidney 16.2 Kidney Influenza/ 14.1 Kidney 13.7 Influenza/ Suicide Source: Missouri Department of Health and Senior Services (DHSS), Bureau of Vital Statistics. Rates are per 100, US Standard population. Case Definition: International Classification of s, Tenth Revision (ICD 9) codes: I00 I09, I11, I13, I20 I51 (Heart ); C00 C97 (); I60 I69 (); V01 X59, Y85 Y86 ( ); J40 J47 (Chronic Lower Respiratory ); G30 (Alzheimer's ); J09 J18 (Influenza and ); N00 N07, N17 N19,N25 N27 (nephritis, nephrotic syndrome and nephrosis; kidney ); E10 E14 (); A40 A41 (), *U03, X60 X84, Y87.0 (Intentional self harm; suicide).

7 Leading Causes of Death Page 7 of 19 Differences by Sex Figure 6 shows similarities in the ranking of certain causes of death among males and females for For both populations, heart disease and cancer accounted for the highest percentages of death, 24.6% and 22.0% for women, and 27.0% and 23% for men, respectively. Males and females diverged in other causes of death. injury was the third leading cause of death and suicide ranked eighth among men, accounting for 5.9% and 2.4% of deaths to males, respectively. Females had a higher relative burden from stroke and Alzheimer s disease, 6.4% and 4.2%of deaths to females, respectively. Figure 6. Percent distribution of the 10 leading causes of death by sex: St. Louis County, average. Women Other 26.0 Heart 24.6 Kidney Influenza and Alzheimer's Men Alzheimer's Influenza and Suicide Kidney Other Heart

8 Leading Causes of Death Page 8 of 19 Differences by Age Group Table 4. Leading Causes of Death by Age Group, St Louis County, average. Less than 18 Years Rank Cause of Death Deaths Percent Rate 95% CI 1 Perinatal Causes Injuries Congenital Malformations Assault (Homicide) Suicide Heart * * * All Other Causes Total Years Rank Cause of Death Deaths Percent Rate 95% CI 1 Injuries Assault (Homicide) Suicide Heart * Congenital Malformations * * * Anemias * * All Other Causes Total Years Rank Cause of Death Deaths Percent Rate 95% CI 1 Injuries Heart Assault (Homicide) Suicide Chronic Liver and Cirrhosis HIV/AIDS All Other Causes Total 1,

9 Leading Causes of Death Page 9 of 19 Table 4. Leading Causes of Death by Age Group, St Louis County, average (Continued) Years Rank Cause of Death Deaths Percent Rate 95% CI 1 2, Heart 1, Injuries Suicide Chronic Liver and Cirrhosis Kidney All Other Causes 1, Total 7, Years and over Rank Cause of Death Deaths Percent Rate 95% CI 1 Heart 9, , , , Alzheimer's 1, Injuries 1, Influenza and Kidney All Other Causes 8, Total 35, Notes: Source: Missouri Department of Health and Senior Services (MoDHSS), Bureau of Vital Statistics. Case Definition: International Classification of s, 10th Revision (ICD 10) codes: I00 I09, I11, I13, I20 I51 (Heart ); C00 C97 (); I60 I69 (); V01 X59, Y85 Y86 ( ); J40 J47 (Chronic Lower Respiratory ); G30 (Alzheimer's ); J09 J18 (Influenza and ); N00 N07, N17 N19,N25 N27 (nephritis, nephrotic syndrome and nephrosis; kidney ); E10 E14 (); A40 A41 (), *U03, X60 X84, Y87.0 (Intentional self harm; suicide), D50 D64 (Anemias) K70, K73 K74 (Chronic Liver s and Cirrhosis), Human immunodeficiency virus(hiv)disease (B20 B24), Perinatal causes (P00 P96), Congenital Malformations (Q00 Q99). *Too few cases to meet precision standard (relative standard error <30%); interpret with caution.

10 Leading Causes of Death Page 10 of 19 Differences by Race and Hispanic Origin Figure 7 shows selected chronic disease causes of death that were among the 10 leading causes of death by race and ethnicity. Some racial or ethnic groups do not have a bar for a particular disease because that disease was not among the ten leading causes of death for the population. Heart disease and cancer were the two leading causes of death for all groups. However, the age adjusted death rates among Black/African Americans were the highest for all causes of death except for chronic lower respiratory disease (), Alzheimer s disease, and chronic liver disease. Alzheimer s disease was only a top ten leading cause of death for Black/African Americans and whites. Figure 7. Chronic s: age adjusted death rates for the leading causes of death by Race and Ethnicity, St. Louis County, Missouri, average Black/African American White Asian Multiple Race Hispanic Rate per 100,000 Population * * 10.4* 9.7* * 5..3* 11.7* * 7.3* 11.4* 4.9* 0 Heart Alzheimer's Kidney Chronic Liver *Too few cases to meet precision standard (relative standard error <30%); interpret with caution.

11 Leading Causes of Death Page 11 of 19 Figure 8 similarly shows selected external causes of death that were among the 10 leading causes of death by race and ethnicity. Some racial or ethnic groups do not have a bar for particular diseases because that disease was not among the ten leading causes of death for the population. Figure 8. External Causes of Death: age adjusted death rates for the leading causes by Race and Ethnicity, St. Louis County, Missouri, Black/African American White Asian Multiple Race Hispanic Rate per 100,000 Population * 3.2* * 0 Homicide Injuries Suicide *Too few cases to meet precision standard (relative standard error <30%); interpret with caution.

12 Leading Causes of Death Page 12 of 19 Differences by Poverty Level Figure 9 shows similarities and differences in the ranking of certain causes of death by poverty level for Figure 9. Percent distribution of the 10 leading causes of death by poverty level: St. Louis County, average. Low Poverty Medium Poverty Other 25.5 Heart 25.3 Other 24.9 Heart 26.3 Kidney Influenza and Alzheimer's Kidney Influenza and Alzheimer's High Poverty Very High Poverty Influenza and Homicide Alzheimer's Kidney Other 5.1 Heart Alzheimer's Kidney Homicide Other Heart

13 Leading Causes of Death Page 13 of 19 Differences by Geographic Area Map 2. Top 5 Leading Causes of Death by geographic area, St. Louis County, Heart Injuries Iy 1. Heart Injuries 5.!"e$ Un West U Í Un Iy!"e$!"b$!"f$ U Í Iy Iz Iz!"c$!"b$ Iz Iz South %&j(!"c$ Miles Data Source: Missouri Department of Health and Senior Services UN 364!"f$ Í!"e$ Outer North %&h(!"b$ %&h( Un Central Í Inner North Í!"f$ Uq City of St. Louis Iy!"e$!"b$ Iz!"c$ 1. Heart Injuries Heart Alzheimer s 1. Heart Injuries

14 Leading Causes of Death Page 14 of 19 Methods Data was obtained from the Missouri Department of Health and Senior Services, Bureau of Vital Statistics for the years 2010 to Causes of death classified using the International Classification of s, Tenth Revision (ICD 10) underlying cause codes are ranked according to the number of deaths assigned to rankable causes. The List of 113 Selected Causes of Death and Enterocolitis due to Clostridium difficile is used to select rankable causes for the leading causes presented in this report. 1 Data for rates of the leading cause of death in the United States were obtained from 2013 Mortality Multiple Cause Micro data Files, from the National Vital Statistics System (NVSS), National Center for Health Statistics (NCHS). 2 The data received captures all deaths of St. Louis County residents (within or outside of St. Louis County). The American Community Survey (ACS) was used to generate 1 year and 5 year estimates for the St. Louis County population by age, gender, race and Hispanic origin for The percent of residents living below the federal poverty level for each census tract was also obtained from ACS using the 5 year estimate for 2009 to In the analysis, neighborhood poverty level was assigned to each death based on residence within each St. Louis County 2010 census tract. Each census tract was assigned one of four categories of percent below federal poverty level 3 : Low (0 to < 10 percent); Medium (10 to <20 percent); High (20 to <30 percent); and Very high (30 to 100 percent). Age adjusted and age specific rates and 95% confidence intervals were calculated in Microsoft Excel using population estimates from ACS. The rates were ageadjusted to the 2000 U.S. population 4. Geographic regions were determined from St. Louis County Planning division region maps by assigning each census tract a matching region. Maps were generated using ArcGIS for the vital statistics data for rates by zip code, and geographic regions. Chronic Epidemiology Program The Chronic Epidemiology (CDE) program is responsible for analysis, interpretation, and presentation of health data related to chronic and their risk factors. The CDE program supports the Saint Louis County Department of Public Health (DPH) by providing the following services: Develop study designs, questionnaires, and case definitions. Evaluate chronic disease programs. Locate or develop surveillance systems, and analyze epidemiologic data sets. Provide county, state, and national comparison data. Interpret St. Louis County chronic disease and risk factor data. Conduct epidemiologic investigations and special studies of chronic diseases and chronic disease risk factors of public health importance. Monitor St. Louis County chronic disease trends. Provide scientific advice and technical assistance to community groups and outside partners with respect to surveillance and other epidemiology data expertise. Publish reports and web pages on chronic disease and risk factors.

15 Leading Causes of Death Page 15 of 19 For more information about the CDE program please contact us at: References 1. Heron M. Deaths: Leading causes for National vital statistics reports; vol 64 no 10. Hyattsville, MD: National Center for Health Statistics Mortality Multiple Cause Micro data Files. Deaths: Final Data for NVSR Volume 64, Number 2 will be published later. Accessed online February 3, 2016 at: 3. Toprani A, Hadler JL. Selecting and applying a standard area based socioeconomic status measure for public health data: Analysis for New York City. New York City DOHMH: Epi Research Report, May Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January Suggested citation Kret JE, Dalidowitz L, DeClue R. Leading Causes of Death Profile, St. Louis County Missouri. Chronic Epidemiology (CDE) program profile, no 2. St. Louis County, MO: Department of Public Health. February 2016.

16 Leading Causes of Death Page 16 of 19 Appendix 1: Mortality from All Causes Appendix 1.1. Number of deaths and age adjusted death rates for all causes, St. Louis County, Missouri, and United States, Year St. Louis County Missouri United States Rate Deaths Rate Deaths Rate Deaths , , ,468, , , ,515, , , ,543, , , ,596, , Sources: Missouri Department of Health and Senior Services (MoDHSS), Bureau of Vital Statistics and National Center for Health Statistics (NCHS), National Vital Statistics System (NVSS). Rates are age adjusted to the 2000 US population.

17 Leading Causes of Death Page 17 of 19 Appendix 1: Mortality from All Causes (cont.) Appendix 1.2. Deaths from all causes per 100,000 population, St. Louis County, Rate 95% CI Count Rate 95% CI Count Rate 95% CI Count Rate 95% CI Count Rate 95% CI Count St. Louis County to , to , to , to , to ,465 Age Group < 18 years to to to to to years to to to to to years to to to to to years to 596 1, to , to , to , to 554 1, years and over to , to 7, to 7, to 6, to 7, Sex Male to 887 4, to , to , to , to ,521 Female to , to , to , to , to ,943 Race/Ethnicity Asian** to to to to to Black/African American to , to , to , to 996 1, to ,930 Hispanic or Latino to to to to to Multiple to to to to to White to , to , to , to , to ,371 Neighborhood Poverty Very High to to to to to High to , to to , to , to ,138 Medium to 770 2, to , to , to 784 2, to ,291 Low to , to , to , to , to 677 5,526 Geographic Area Central to , to , to , to , to ,076 Inner North to , to , to , to , to ,844 Outer North to , to , to , to , to ,807 South to , to , to , to 754 2, to ,178 West to , to , to , to , to ,553 Notes: Source: Missouri DHSS, Bureau of Health Care Analysis and Data Dissemination. Case Definition: Deaths from all causes to St. Louis County residents between 2010 and Rates are age adjusted to the 2000 US population (not including Age Group rates). CI = Confidence Interval. *Too few cases to meet precision standard (relave standard error <30%); interpret with cauon. Too few cases to protect confidentiality and/or report reliable rates. ** Where 1 Year ACS estimates were zero, two adjacent years were averaged to calculate a non zero population denominator.

18 Leading Causes of Death Page 18 of 19 Appendix 2: Leading Causes of Death Appendix 2.1. Age adjusted death rates for the 10 leading causes of death in St Louis County compared to Missouri and United States, St. Louis County Missouri United States Cause of Death Rank Deaths Rate Rank** Deaths Rate Rank Rate Heart 1 2, , , , , * N/A , Alzheimer's , Influenza and , Kidney , , All Causes 9, , Rates are age adjusted to the 2000 US population. *Missouri rate for unintentional injury (accidents) is a 3 year average **Ranking of Missouri leading causes of death was based on the number of total deaths in the state for

19 Leading Causes of Death Page 19 of 19 Appendix 2.2. Leading causes of death, age adjusted rates, 95% Confidence Intervals (CI) by year, St. Louis County, Cause of Death Rate 95% CI Count Cause of Death Rate 95% CI Count Heart to ,470 Heart to , to 177 2, to , to to to to to to Alzheimer's to Alzheimer's to Kidney to Influenza and to to Kidney to Influenza and to to to to Heart to ,358 Heart to , to , to , to to to to to to Alzheimer's to Alzheimer's to to Influenza and to Influenza and to Kidney to Kidney to to to Suicide to Heart to , to , to to to Alzheimer's to Kidney to to Influenza and to to Notes: Rates are age adjusted to the 2000 US population (not including Age Group rates). CI = Confidence Interval. = Chronic Lower Respiratory. Source: Missouri DHSS, Bureau of Health Care Analysis and Data Dissemination. International Classification of s, Tenth Revision (ICD 9) codes: I00 I09, I11, I13, I20 I51 (Heart ); C00 C97 (); I60 I69 (); V01 X59, Y85 Y86 ( ); J40 J47 (Chronic Lower Respiratory ); G30 (Alzheimer's ); J09 J18 (Influenza and ); N00 N07, N17 N19,N25 N27 (nephritis, nephrotic syndrome and nephrosis; kidney ); E10 E14 (); A40 A41 (), *U03, X60 X84, Y87.0 (Intentional self harm; suicide).

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