Technical Notes

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References

Relative Standard Error (RSE): A tool for assessing reliability of a rate or estimate. Estimates with large RSEs are considered less reliable than estimates with small RSEs. While there is not absolute cutoff point, the guidelines used by National Center for Health Statistics recommends that estimates with RSEs above 30 percent should be considered unreliable and have been suppressed in this report.

Social determinants of health: Conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at global, national and local levels and can influence health outcomes of individuals and populations.

Years of Potential Life Lost (YPLL): A count of the average years a person would have lived if he or she had not died prematurely—before some selected time period. For the purposes of this report a death before age 75 years was considered premature.

Methods

Average life expectancy was calculated using a revised method developed by Chiang.⁷ Premature death rates were calculated and age-adjusted to the 2000 US Standard Population using the direct method applying the same age groupings and proportions as those established by the National Center for Health Statistics for the Department of Health and Human Services. Death data where less than five cases occurred in a three-year period were suppressed and rates were not calculated. Rates with RSEs greater than 23% but less than 30% were noted with caution for interpretation. Rates with RSEs greater than or equal to 30% were suppressed. Rates were considered statistically different if their confidence intervals did not overlap. Confidence intervals and margins of error were 95% unless elsewhere specified.

Limitations

Data derived from death certificates are subject to a number of limitations but from a surveillance and epidemiological perspective they provide invaluable information about a population’s health status. When a person dies, it is likely that several factors or conditions contributed to the death. For this report, we analyzed the underlying cause of death, which is the condition that most directly caused the death. By using a single cause of death rather than considering all the conditions present at the time of death, the number of deaths and rates in this report do not reflect the full impact of certain diseases and conditions. Additionally, race and ethnicity is reported on the death certificate by the funeral director or coroner who may not ascertain the decedent’s race and/or ethnicity directly from next of kin, which could lead to inaccuracies. Still, data from death certificates represent an important endpoint in the spectrum of disease and help us to better understand the burden of disease in our community.

Mortality Codes

The mortality statistics presented in this report were compiled in accordance with World Health Organization regulations, which specify that member countries classify and code causes of death in accordance with the current revision of the International Classification of Diseases (ICD). Effective with deaths occurring in 1999, the United States began using the Tenth Revision of this classification (ICD-10). ICD not only details disease classifications but also provides definitions, tabulation lists, the format of the death certificate, and the rules for coding cause of death. Cause-of-death data presented in this publication were coded using procedures outlined in annual issues of the National Center for Health Statistics Instruction Manual. This manual includes rules for selecting underlying cause of death and regulations on the use of ICD.

The following table lists causes of death presented in this report and their corresponding ICD-10 code(s).

Cause of Death	IDC-10
All Causes of Death	A00-Y89
All Cancers	C00-C97
Colorectal Cancer	C18-C21, C26.0
Pancreatic Cancer	C25.9
Lung Cancer	C34
Female Breast Cancer	C50
Prostate Cancer	C61
Diabetes	E10-E14
Heart Disease	I00-I09, I11, I13, I20-I51
Stroke	I60-I69
Chronic Lower Respiratory Disease	J40-J47
Chronic Liver Disease and Cirrhosis	K70, K73-K74
Unintentional Injuries	V01-X59, Y85-Y86
Unintentional Motor Vehicle Collisions	V02-V04(.1,.9), V09.2, V12-V14(.3-.9), V19(.4-.6), V20-V28(.3-.9), V29-V79(.4-.9), V80(.3-.5), V81.1, V82.1, V83-V86(.0-.3), V87(.0-.8), V89.2
Unintentional Falls	W00-W19
Unintentional Drug Poisonings	X40-X44
Suicide	U03, X60-X84, 87.0