Death Data: CDC Wonder, Texas Health Data, and VitalWeb Evidence-Based Public Health Practice Step 2: Quantify the Issue This handout demonstrates how to access CDC Wonder, Texas Health Data, and VitalWeb sites and how to set up reports using each. The emphasis will be on building reports that will allow you to easily transfer information from the screen to your community assessment workbook. Note: All of these sites include data from underlying cause of death (single cause of death) only. The example used in this handout will demonstrate how to find mortality from motor vehicle accidents by gender, race/ethnicity, and age groups. To access Mortality Data from CHARTing: http://www.sph.uth.tmc.edu/charting Click on Data for: Cause of Illness or Death Click on Mortality Data All Causes. To the right is the list of resources this handout will cover. Page 11 of this handout outlines a comparison between all three. To begin, select Underlying Cause of Death (CDC Wonder). This project has been funded in whole part with or in Federal part with funds Federal from the funds National from the Library National of Medicine Library of National Medicine lnstitutes National of Health, lnstitutes Department of Health, Department of Health and of Human Health Services, and Human under Services, Contract under No Contract NO1-LM-6-3505. No NO1-LM-6-3505. 1
CDC WONDER On CDC WONDER, data are available for the years 1999-2005 (ICD-10) and 1979-1998 (ICD-9). International Classification of Disease codes categorize mortality. ICD-9 codes were used from 1990 to 1998. ICD -10 codes are now used. Go the last page of this handout to view the broad classifications from ICD-10. The number of deaths, crude death rates or age-adjusted death rates can be obtained by place of residence (total U.S., state, and county), age group, race (white, black, and other), gender, year of death, and underlying cause-of-death (4-digit ICD code or group of codes). Note: If your county or a sub-population within your county has less than 100,000 people and there were less than 6 deaths in a year for that population, you will need to include more than one year, and possibly three years, of data to view the suppressed counts. This example will use Mortality for 1999 2005 with ICD-10 codes. Organize table layout In the first section of CDC WONDER, you will need to set up your table. By default, results are grouped by Age Groups. This can be changed to gender, cause of death, race, region, ICD codes, etc. As you select more options, you increase the number of rows on your final report. You may also Title your report here. Otherwise, your report title will default to: Compressed Mortality, 1999-2005 Request Select Location Highlight +48 Texas and select Open to get to County selections. Use <Ctrl>+click to select more than one county; hold the <Shift> key and click the top and bottom counties of the range you want to select all counties in-between. Hint: The larger the area you choose the more reliable your Rates become. 2
CDC WONDER (cont d) Select years and demographics Age Group, Year, Gender, and Race: You can pick Age Groups or Infant Age Groups. Urbanization lets you choose the kind of city area you want. Use <Ctrl>+click to select more than one item; hold the <Shift> key and click the top and bottom items of the range you want to select all items in-between. Note: CDC Wonder does not provide data by ethnicity. Black or African American, or Other. Data for Hispanics is categorized under White, Select cause of death Browse ICD-10 Codes or ICD-10 Groups. If you know the ICD-10 code, search for it directly using the Search Tab. The back page has a full list of broad ICD-10 categories. Expand ICD-codes by clicking on Open or Open Fully. Click on an item to automatically select it. If you click on another item, it replaces the first. Use <Ctrl>+click to select more than one ICD-10 code; hold the <Shift> key and click the top and bottom ICD-10 codes of the range you want to select all codes in-between. The Currently Selected box displays all currently selected items. Select injury intent and mechanism If you want to get really detailed you may further narrow your results here. Use <Ctrl>+click to select more than one item; hold the <Shift> key and click the top and bottom items of the range you want to select all items in-between. 3
CDC WONDER (cont d) Select rate options If you are grouping by Age Groups, you can select only No age-adjusted rates. However, if you have grouped results by race, gender, You want to adjust your age rate to the US 2000 Standard population only when you are selecting multiple Age Groups. Click on any Send button on the page to generate a report. Results All reports are titled Compressed Mortality 1999-2005: Results by default. You can click on the arrows at the top of the columns to re-order your table if you want. For example, you could click on the down arrow next to Crude Rate Per 100,000 to view the highest to lowest values. You can change some aspects of your report from this page if it does not look like you want. To review your criteria options, click on Query Criteria. If you want to change your report criteria or table layout or even create a new report, go to the top of the page and click the Request Form tab. Do not use the browser s back button as you can loose your entire report! Maps can be created only when you select a geographic division as a grouping (See p.2 Organize table layout.) For example, if the table had included all Texas counties as a grouping, you could create a map that might look something like the one on the right. 4
Texas Health Data: Death Data From CHARTing Health Information for Texas: Mortality Data: All Causes, click on Texas Health Data: Deaths. This site provides mortality data by underlying cause (single cause) of death only. It does not show mortality by multiple causes of death. Click on Death Tables (1999 2004). The default setting is the most recent year of data that is available. Select Cause of Death After range of years, the next variable to select is cause. This will show single cause of death; instructions are provided on the site for selecting multiple single causes of death. The back page of this handout has a complete list of ICD-10 codes. Select County of Residence Choose your county of interest by clicking on it. Use <Ctrl>+click to select more than one county; hold the <Shift> key and click the top and bottom counties of the range you want to select all counties in-between. For example, you might use this feature if you were looking at mortality by motor vehicle accidents for a large metropolitan area that encompassed multiple counties. 5
Texas Health Data: Death Data (cont d) Select Optional Table Parameters This section allows you to include/exclude particular populations. For example, if you wanted to see mortality trends for motor vehicle accident deaths over several years for 25 to 34 year old Hispanic men, you could specify that group here. Further down, you would then set as one of your table parameters years to view data from individual years. For the community assessment workbook, you will need mortality data by gender and Select Row and Column for Output Table This section is where you indicate how you want your table laid out, i.e. which variable makes up the rows and which makes up the columns. Hint: Choose the variable that has the most items to be the row and the variable with the least items to be the column. Race/Ethnicity is selected for the row labels and Gender for the columns. Once you have the data you need for Race/Ethnicity, come back to this screen and change it to Age Group. Note: the age groups used in these tables do not match the age groups exactly as they appear in Healthy People 2010. Select Statistics for Output Table Select Age Adjusted Rates using the 2000 Population. (Note: If age groups is one of your selections for row or column, select Crude Rates as you cannot get age adjusted rates by age groups.) For additional information about selecting statistics for the table, see the handout on birth data. If your values are small, include Confidence Intervals to determine the reliability of the results. Click Submit Query. 6
Texas Health Data: Death Data (cont d) Results To the right are the results for mortality from all accidents. Right away, we can see some interesting patterns. For example, look at the rate of mortality for Both Sexes, then compare the rate for Males vs. Females. What a difference! If you look at the rates by sex and race/ ethnicity, there are even larger differences. The rate for males All Races nearly doubles that of females All Races. However, the rate for Hispanic males is nearly 2 1/2 times that of Hispanic females. But, the data needed is for motor crashes, so click on the link Accidents to get the breakout of this category. Select a Sub-Category This shows the categories by all types of accidents. Click on Motor Vehicle Accidents to get data for that subcategory. Results Even though motor vehicle accidents is a sub-category, you can dig deeper if you wish and find data for motorcycles, pedestrians, heavy vehicles and buses, trains, etc. Looking at this data, though, we see the trend holds for males and females the mortality rate is at least double for males. If your county holds true to this pattern, what kind of program could be developed and implemented to try to reduce deaths among males? How might you target by race/ethnicity or age groups? 7
VitalWeb From CHARTing Health Information for Texas: Mortality Data: All Causes, click on Texas Data from Vital Web. On VitalWeb click on Texas ICD-10 Deaths VitalWeb Standard. ICD-10 Codes on VitalWeb range from 1999-2003 As with CDC Wonder, select table layout first. Set basic table layout Primary Statistic - The numerical result in the output. The Primary Statistic will usually remain Deaths, the default or choose Age-Adjusted Death Rate (AADR). The Row and Column Variables are the same choices. Display rows from highest to lowest or from lowest to highest. Note: If there is a conflict between statistic, rows, or columns, Vital Web will not allow a table until the conflict is corrected. Examples of conflicting settings include: Age-adjusted rates, age rows. Race rows, race columns. Year rows, year columns. To correct a conflict, select a different primary statistic, row, or column setting. 8
VitalWeb (cont d) Choose values for deceased The default is all All Races, Both Sexes, All Ages, All Years. Hold down <Ctrl>+click to select more than one item; hold the <Shift>+click key to select a range of items. VitalWeb lists White, Black, Hispanic and Other as race. Select county and county groupings All Texas Counties is the default setting Highlight your selection or choose multiple counties or PHRs and click on the Add arrow to add it to your report. Select causes of death Scroll to find the cause of death, highlight your selection, and click on the Add arrow to send it to your selection box. Notice motorcyclists involved with train and motorcyclists involved in accident except trains had to be selected separately. Unlike CDC Wonder, if you have an item selected in the right column and you click on an item in the left, the right item does not get replaced by the new item. You have to remove the item from the right column. Create your report Click on Make Table Now 9
VitalWeb (cont d) The top or the report indicates the statistic (deaths), your row and column variables (Race and Sex respectively), Age (25 to 34 years), Year of Death (2001 to 2003), and Causes of Death. VitalWeb creates both a static table and a bar graph. You cannot drill down by narrower ICD-10 codes as you can with Texas Health Data. Only one value per row is displayed, if you want to show separate years instead of gender or race you must make another table. From this report, we can see that during a 3-year time period 189 males between the ages of 25 to 34 in Texas were killed in some sort of motorcycle accident; 26 women were killed during the same time period. White males had the highest count. Below are two additional tables in which all age groups were select (left) and an adjusted age rate is provided and the column variable was changed from Sex to Year (right). A benefit of this site is that each report has a unique ID which is listed below the table. Copy the URL or address of the table if you would like to recreate the report, share it with others, or cite it in a report or community assessment. 10
Comparison Table What s the difference? CDC WONDER Mortality Data Texas Heath Data Death Tables VitalWeb Standard Dates of Coverage 1999-2005 (ICD-10) 1979-1998 (ICD-9) 1999-2004 (ICD-10) 1990-1998 (ICD-9) 1999-2003 (ICD-10) 1980-1998 (ICD-9) ICD-10 Code Specification Limited to table set up General- during table set up Drill down - after table results Limited to table set up Customize Options Customize age group, year, race, and urbanization Customize year only Customize age group, year, and race Location Coverage Race/Ethnicity Choice Table Results US Region State - Texas County White Black Hispanic Other Texas County White Black Hispanic Other Texas County PHR White Black Hispanic Other Static Dynamic Static Other Variables Age Gender Year Location Cause Injury Intent Injury Mechanism Urbanization ICD Chapter and Sub- Chapter ICD 113 Groups Age Gender Year Location Cause Age Gender Year Location Cause 11
Most of the ICD-10 classifications shown have narrower terms. For example, Malignant Neoplasms ranges from C00-C97. It wouldn t be very helpful if all you could see were the sum totals of deaths by all cancers. Fortunately, you can view the subcategories by creating a table for all cancers. At the next screen, you have an opportunity to click on a link to show more detail. Below is a partial listing: Malignant Neoplasms of Lip, Oral Cavity and Pharynx (C00-C14) Malignant Neoplasm of Lip (C00) Malignant Neoplasm of Tongue (C01-C02) Malignant Neoplasm of Pharynx (C10-C13, C14.0) Malignant Neoplasms of Other and Unspecified Sites within the Lip, Oral Cavity and Pharynx (C03- C09, C14.2-C14.8) Malignant Neoplasm of Esophagus (C15) Malignant Neoplasm of Pancreas (C25) Malignant Neoplasms of Trachea, Bronchus and Lung (C33-C34) Malignant Neoplasm of Cervix Uteri (C53) Non-Hodgkin's Lymphoma (C82- C85) Leukemia (C91-C95) As mentioned previously, this handout demonstrates how to build a table showing mortality from motor accidents with the variables gender, race/ethnic, and age. Select Accidents (V01-X59, Y85- Y86). 12