age adjustment issues in healthy people 2010 john aberle-grasse, mph national center for health...

Age Adjustment Issues in Age Adjustment Issues in Healthy People 2010Healthy People 2010

John Aberle-Grasse, MPHJohn Aberle-Grasse, MPH

National Center for Health StatisticsNational Center for Health Statistics

Calculation of age-adjusted rateCalculation of age-adjusted rate

Age-adjusted rate = Age-adjusted rate =

ii (m (mii*w*w

sisi))

mmii = d = dii / p / p

i i * 100,000 * 100,000

wwsisi = standard population weight in age group i = standard population weight in age group i

ddii = deaths in age group i = deaths in age group i

ppii = population in age group i = population in age group i

Calculation of age-adjusted rateCalculation of age-adjusted rate

• Spreadsheet vs. “manual” calculation Spreadsheet vs. “manual” calculation

NCHS continues to use “manual” method NCHS continues to use “manual” method

Healthy People 2010 rate calculations are Healthy People 2010 rate calculations are rounded/truncated to one decimal place rounded/truncated to one decimal place

Weights are rounded/truncated to six places Weights are rounded/truncated to six places

Age group (years)

di pi

mi (per 100,000) rounded

mi (per 100,000)

wsi

(US 2000)

mi*wsi

roundedmi*wsi

under 1 845 3,819,903 22.10 22.12 0.013818 0.31 0.311 to 4 1,898 15,122,239 12.60 12.55 0.055317 0.70 0.695 to 14 3,091 39,495,230 7.80 7.83 0.145565 1.14 1.1415 to 24 13,656 37,773,512 36.20 36.15 0.138646 5.02 5.0125 to 34 11,890 37,935,812 31.30 31.34 0.135573 4.24 4.2535 to 44 15,231 44,812,649 34.00 33.99 0.162613 5.53 5.5345 to 54 11,639 35,802,358 32.50 32.51 0.134834 4.38 4.3855 to 64 7,285 23,389,085 31.10 31.15 0.087247 2.71 2.7265 to 74 8,208 18,218,248 45.10 45.05 0.066037 2.98 2.9875 to 84 12,282 12,146,695 101.10 101.11 0.044842 4.53 4.5385 and older 11,729 4,175,082 280.90 280.93 0.015508 4.36 4.36Total 97,860 272,690,813 35.90 35.89 1.000000

35.9 35.9

Unintentional injury deaths, US, 1999

Age-adjusted rate per 100,000 standard population

Sum (mi*wsi) =

Standard population- a population Standard population- a population based on some age distributionbased on some age distribution

• NCHS in the pastNCHS in the past

mortality data used 1940 standard mortality data used 1940 standard

survey data used mostly 1970 & 1980 standard survey data used mostly 1970 & 1980 standard

• NCHS now uses year 2000 US resident NCHS now uses year 2000 US resident population as standard for all age population as standard for all age adjustmentadjustment

Age group (years)

Population (in thousands)

Adjustment weight

Standard million

all ages 274,634 1.000000 1,000,0000 3,795 0.013818 13,8181 3,759 0.013687 13,6872-4 11,433 0.041630 41,6305 3,896 0.014186 14,1866-8 11,800 0.042966 42,9669 4,224 0.015380 15,38010-11 8,258 0.030069 30,06912-14 11,799 0.042963 42,96315-17 11,819 0.043035 43,03518-19 8,001 0.029133 29,13320-24 18,257 0.066478 66,47825-29 17,722 0.064530 64,53030-34 19,511 0.071044 71,04435-39 22,180 0.080762 80,76240-44 22,479 0.081851 81,85145-49 19,806 0.072118 72,11850-54 17,224 0.062716 62,71655-59 13,307 0.048454 48,45460-64 10,654 0.038793 38,79365-69 9,410 0.034264 34,26470-74 8,726 0.031773 31,77375-79 7,415 0.027000 27,00080-84 4,900 0.017842 17,84285+ 4,259 0.015508 15,508

Master list: 2000 U.S. projected populaiton and age-adjustment weights


• NCHS in the pastNCHS in the past

mortality data used 1940 standard mortality data used 1940 standard

survey data used mostly 1970 & 1980 standard survey data used mostly 1970 & 1980 standard

• NCHS now uses year 2000 US resident NCHS now uses year 2000 US resident population as standard for all age population as standard for all age adjustmentadjustment

2000-adjusted rates better reflect national 2000-adjusted rates better reflect national demographics and current crude rates demographics and current crude rates

0

200

400

600

800

1000

1200

1979 1982 1985 1988 1991 1994 1997 2000

Crude and age adjusted death rates based on year 1940 and 2000 standard populations:

United States, 1979-2000

1940 standard

2000 standard

crude rate


• IMPORTANT REMINDER:IMPORTANT REMINDER: Comparisons Comparisons can only be made between rates can only be made between rates calculated using the calculated using the samesame standard standard population population

Age group (years)

di pimi (per

100,000)

wsi

(US 2000)mi*wsi

under 1 0 12,236 0.0 0.013818 0.0000001 to 4 0 49,762 0.0 0.055317 0.0000005 to 14 0 115,369 0.0 0.145565 0.00000015 to 24 2 117,466 1.7 0.138646 0.23569825 to 34 1 104,500 1.0 0.135573 0.13557335 to 44 2 125,039 1.6 0.162613 0.26018145 to 54 13 95,449 13.6 0.134834 1.83374255 to 64 22 67,848 32.4 0.087247 2.82680365 to 74 69 62,093 111.1 0.066037 7.33671175 to 84 160 40,677 393.3 0.044842 17.63635985 and older 183 13,179 1,388.6 0.015508 21.534409Total 452 803,618 56.2 1.000000

51.8

Stroke deaths (ICD-10 I60-I69), Pima County, AZ, 1999


Sum (mi*wsi) =

Age group (years)

di pimi (per

100,000)

wsi

(US 2000)mi*wsi

wsi

(US 1940)mi*wsi

under 1 0 12,236 0.0 0.013818 0.000000 0.015343 0.0000001 to 4 0 49,762 0.0 0.055317 0.000000 0.064718 0.0000005 to 14 0 115,369 0.0 0.145565 0.000000 0.170355 0.00000015 to 24 2 117,466 1.7 0.138646 0.235698 0.181677 0.30885125 to 34 1 104,500 1.0 0.135573 0.135573 0.162066 0.16206635 to 44 2 125,039 1.6 0.162613 0.260181 0.139237 0.22277945 to 54 13 95,449 13.6 0.134834 1.833742 0.117811 1.60223055 to 64 22 67,848 32.4 0.087247 2.826803 0.080294 2.60152665 to 74 69 62,093 111.1 0.066037 7.336711 0.048426 5.38012975 to 84 160 40,677 393.3 0.044842 17.636359 0.017303 6.80527085 and older 183 13,179 1,388.6 0.015508 21.534409 0.002770 3.846422Total 452 803,618 56.2 1.000000 1.000000

51.8 20.9

Stroke deaths (ICD-10 I60-I69), Pima County, AZ, 1999


Sum (mi*wsi) =

• Mortality dMortality dataata

• Health outcomes, risk factors, and health Health outcomes, risk factors, and health services dataservices data

Age-adjustment inAge-adjustment inHealthy People 2010Healthy People 2010

Diabetes prevalence by Diabetes prevalence by race/ethnicity (Obj. 5-3), 1999race/ethnicity (Obj. 5-3), 1999

0

1

2

3

4

5

6

7

pe

rce

nt

Source: National Health Interview Survey (NHIS), CDC, NCHS.Source: National Health Interview Survey (NHIS), CDC, NCHS.

Ove

rall

Ove

rall

Amer

ican

Indi

an/

Amer

ican

Indi

an/

Alask

a Nat

ive

Alask

a Nat

ive

Asian

/

Asian

/ Pac

ific

Isla

nder

Pacifi

c Is

land

er

Hispa

nic/

Hispa

nic/

Latin

o

Latin

oNot

-His

pani

c

Not-H

ispa

nic

Whi

te

Whi

te

Not-H

ispa

nic

Not-H

ispa

nic

Africa

n Am

eric

an

Africa

n Am

eric

an

Diabetes age specific rates, 1999Diabetes age specific rates, 1999

0

5

10

15

20

25

<18 18-44 45-64 65-74 75+

perc

ent

Hispanic not-Hispanic White


2000 Census age distribution2000 Census age distribution

0

10

20

30

40

50

<18 18-44 45-64 65-74 75+

pe

rce

nt

Hispanic not-Hispanic White

Diabetes prevalence Diabetes prevalence (Obj. 5-3), 1999(Obj. 5-3), 1999

0

1

2

3

4

5

6

7

8

9

Crude

pe

rce

nt

Overall

American Indian/Alaska Native

Asian/ PacificIslander

Hispanic

Not-HispanicWhite

Not-HispanicAfrican American


Diabetes prevalence Diabetes prevalence (Obj. 5-3), 1999(Obj. 5-3), 1999

0

1

2

3

4

5

6

7

8

9

Crude Age-adjusted

pe

rce

nt

Overall

American Indian/Alaska Native

Asian/ PacificIslander

Hispanic

Not-HispanicWhite

Not-HispanicAfrican American


• Mortality dMortality dataata

• Main purposes:Main purposes: Observe trends in populations over timeObserve trends in populations over time Monitor disparity between populations Monitor disparity between populations

both at a point in time and over timeboth at a point in time and over time

• Health outcomes, risk factors, and health Health outcomes, risk factors, and health services dataservices data

Age-adjustment inAge-adjustment inHealthy People 2010Healthy People 2010

Standard population- Standard population- age distributionsage distributions

• Several different age groupings are used Several different age groupings are used to age-adjust data from different sourcesto age-adjust data from different sources

Data systems Age distributions used

Healthy People 2010 age-adjusted measures and age adjustment groups

Data Standard Source Distribution**NVSS-M # 1 <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+NHIS # 3 <18, 18-44, 45-54, 55-64, 65-74, 75+NHDS # 4 <18, 18-44, 45-64, 65-74, 75+CSFII # 5 2-5, 6-11, 12-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+NHIS # 9 18-24, 25-34, 35-44, 45-64, 65+NHANES # 11 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+NHANES # 12 20-39, 40-59, 60+NHIS # 15 40-49, 50-64, 65+NHIS # 16 45-49, 50-64, 65+NHIS # 17 50-64, 65+NHDS # 18 65-74, 75+NHIS # 19 0-4, 5-11, 12-17NHDS # 21 5-17, 18-44, 45-64NHIS # 22 18-24, 25-34, 35-44, 45-64

** Healthy People Statistical Notes, no. 20. January 2001.Education group breakouts begin age groups at age 25.

Age Adjustment Groups

Standard population- Standard population- age distributionsage distributions

• Several different age groupings are used Several different age groupings are used to age-adjust data from different sourcesto age-adjust data from different sources

• Some data sources use fewer age Some data sources use fewer age groupings to stabilize the rates of less groupings to stabilize the rates of less common events and smaller subpopulations common events and smaller subpopulations (e.g. age groups for chronic disease)(e.g. age groups for chronic disease)

Hispanics aged 2+ years with diabetes Hispanics aged 2+ years with diabetes who have seen a dentist in the past year who have seen a dentist in the past year

(Obj. 5-15)(Obj. 5-15)

20

40

60

80

1997 1998 1999 2000

CrudeCrude

Age-adjustedAge-adjusted



(Obj. 5-15)(Obj. 5-15)

1997 1998age numer denom rate weights rates numer denom rate weights rates2-17 0 5965 0.00 0.236742 0.00 13264 13264 1.00 0.236742 0.2418-44 78732 217001 0.36 0.404935 0.15 141216 272108 0.52 0.404935 0.2145-54 106567 231432 0.46 0.138647 0.06 156417 305156 0.51 0.138647 0.0755-64 161850 281698 0.57 0.089715 0.05 169255 305041 0.55 0.089715 0.0565-74 98880 275980 0.36 0.067905 0.02 100710 200877 0.50 0.067905 0.0375+ 45279 90760 0.50 0.062056 0.03 42525 138804 0.31 0.062056 0.02total 491308 1102836 0.45 0.32 623387 1235250 0.50 0.62

2-44 78732 222966 0.35 0.641677 0.23 154480 285372 0.54 0.641677 0.3545-54 106567 231432 0.46 0.138647 0.06 156417 305156 0.51 0.138647 0.0755-64 161850 281698 0.57 0.089715 0.05 169255 305041 0.55 0.089715 0.0565-74 98880 275980 0.36 0.067905 0.02 100710 200877 0.50 0.067905 0.0375+ 45279 90760 0.50 0.062056 0.03 42525 138804 0.31 0.062056 0.02total 491308 1102836 0.45 0.40 623387 1235250 0.50 0.52



(Obj. 5-15)(Obj. 5-15)

20

40

60

80

1997 1998 1999 2000

CrudeCrude

< 45 separate< 45 separate

< 45 combined< 45 combined


Healthy People 2010 age-adjusted measures and age adjustment groups

Data Standard Source Distribution**NVSS-M # 1 <1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+NHIS # 3 <18, 18-44, 45-54, 55-64, 65-74, 75+NHDS # 4 <18, 18-44, 45-64, 65-74, 75+

NHDS/NHIS # 4 (revised)1 0-44, 45-64, 65-74, 75+CSFII # 5 2-5, 6-11, 12-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+

NHIS # 6 (revised)1 2-44, 45-54, 55-64, 65-74, 75+

NHIS # 8/9(revised) 1,2 18-44, 45-64, 65-74, 75+NHIS # 9 18-24, 25-34, 35-44, 45-64, 65+

NHIS # 9 (revised) 1 18-44, 45-64, 65+

NHANES # 10 (revised)3 18-49, 50-59, 60-69, 70-79, 80+NHANES # 11 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+

NHANES # 11 (revised)3 20-49, 50-59, 60-69, 70-79, 80+NHANES # 12 20-39, 40-59, 60+NHIS # 15 40-49, 50-64, 65+NHIS # 16 45-49, 50-64, 65+NHIS # 17 50-64, 65+NHDS # 18 65-74, 75+NHIS # 19 0-4, 5-11, 12-17NHDS # 21 5-17, 18-44, 45-64NHIS # 22 18-24, 25-34, 35-44, 45-64

NHIS # 22 (revised)1 18-44, 45-64

* For datalines where denominator is people with chronic conditions.** Healthy People Statistical Notes, no. 20. January 2001.1 <45 age groups aggregated (denominator is people with chronic conditions).2 65+ age group diaggregated (workgroup's request).3 <50 age groups aggregated (denominator is people with chronic conditions). Education group breakouts begin age groups at age 25.

Age Adjustment Groups

Some exceptionsSome exceptions

• Data that are not age-adjusted Data that are not age-adjusted

National Household Survey on Drug AbuseNational Household Survey on Drug Abuse

Occupational injury and deathOccupational injury and death

Fatality Analysis Reporting SystemFatality Analysis Reporting System

Census of Fatal Occupational InjuriesCensus of Fatal Occupational Injuries

Maternal/Infant mortality Maternal/Infant mortality

(live births as denominator)(live births as denominator)

Some exceptionsSome exceptions

When to be careful in age-adjustingWhen to be careful in age-adjusting

Age specific rates for a measure vary Age specific rates for a measure vary differently between two population groups differently between two population groups

Age specific cancer death rates among females, 1970 to 1995

0

200

400

600

800

1000

1200

1400

1600

<1 1-4 5-14 15-25 25-34 35-44 45-54 55-64 65-74 75-84 85+

1995

1970

Source: National Vital Statistics System, CDC, NCHS.

Female cancer death rates, by age adjustment standard

75

95

115

135

155

175

195

215

1970 1980 1985 1990 1995

1940 standard population

2000 standard population

Source: National Vital Statistics System, CDC, NCHS.

Crude rate

age adjustment issues in healthy people 2010 john aberle-grasse, mph national center for health...

Documents

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age adjustmentnchs

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