mortality trends and disparities - western north …mortality trends and disparities - western north...

Mortality Trends and Disparities - Western North Carolina

Report #2.206, June 2007

Page Center for Health Services Research and Development, ECU

A Resource for Healthy Communities

Health Indicator Series - Report #2.206 June 2007

Center for Health Services Research and Development East Carolina University

Mortality Trends and Disparities in Western North Carolina

Total Deaths, Premature Mortality, and Deaths for Ten Leading Causes: 1979-2004




Table of Contents List of Figures ................................................................................................................................................................................................. iii 1. Introduction ............................................................................................................................................................................................ 1.1 2. Data Highlights....................................................................................................................................................................................... 2.1 3. Methods, Interpretation, and References ............................................................................................................................................ 3.1

Data Sources .......................................................................................................................................................................................... 3.1 Measures ................................................................................................................................................................................................ 3.1 Interpreting the Pie Charts...................................................................................................................................................................... 3.2 Interpreting the Trend Figures ................................................................................................................................................................ 3.3 Caveats about the Concepts of Race, Gender, and Geography............................................................................................................ 3.5

References............................................................................................................................................................................................3.6 y 4. Current Disparities in Mortality by Geography, Race and Gender, and Race: Total and Five General Leading Causes of Death ....................................................................................................................................................................................... 4 5. Trends and Disparities in Mortality in WNC: All Causes of Death and All Causes of Premature Mortality, 1979-2004 ................. 5 All Causes of Death ................................................................................................................................................................................ 5.1 All Causes of Premature Mortality .......................................................................................................................................................... 5.7 6. Trends and Disparities in Mortality in WNC: Ten Specific Leading Causes of Death, 1979-2004 ................................................... 6

Diseases of Heart ................................................................................................................................................................................... 6.1 Cancer - Trachea, Bronchus, Lung......................................................................................................................................................... 6.7 Cerebrovascular Disease ..................................................................................................................................................................... 6.13 Chronic Lower Respiratory Diseases ................................................................................................................................................ 6.19 Alzheimer’s Disease ............................................................................................................................................................................. 6.25 All Other Unintentional Injuries and Adverse Effects............................................................................................................................ 6.31 Pneumonia and Influenza ..................................................................................................................................................................... 6.37 Diabetes Mellitus................................................................................................................................................................................... 6.43 Cancer - Colon, Rectum, Anus ............................................................................................................................................................. 6.49 Nephritis, Nephrotic Syndrome, and Nephrosis ................................................................................................................................... 6.55

7. Trends and Disparities in Mortality in WNC: Cancer - All Sites, 1979-2004....................................................................................... 7 8. Trends and Disparities in Mortality in WNC: HIV Disease, 1987-2004................................................................................................ 8 9. Appendix ................................................................................................................................................................................................... 9

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List of Figures Figure 4.1 i. General leading causes of death for Western North Carolina (2000-2004), ENC41 (2004), NC (2004), and US (2003). Mortality rate per 100,000 population ...................................................................................................................................... 4.1 Figure 4.1 ii. General leading causes of death for Western North Carolina (2000-2004), ENC41 (2004), NC (2004), and US (2003). Age-adjusted mortality rate per 100,000 population................................................................................................................ 4.2 Figure 4.2 i. General leading causes of death for Western North Carolina by race and gender, (2000-2004). Mortality rate per 100,000 population................................................................................................................................................................. 4.3 Figure 4.2 ii. General leading causes of death for Western North Carolina by race and gender, (2000-2004). Age-adjusted mortality

rate per 100,000 population .................................................................................................................................................... 4.4 Figure 4.3 i. General leading causes of death for Western North Carolina by race, (2000-2004). Mortality rate per 100,000

population................................................................................................................................................................................ 4.5 Figure 4.3 ii. General leading causes of death for Western North Carolina by race, (2000-2004). Age-adjusted mortality rate per 100,000 population.................................................................................................................................................................. 4.6 Figure 5.1 i. All Causes of Death: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010 .................. 5.2 Figure 5.1 ii. All Causes of Death: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010................................................................................................................................................................... 5.3 Figure 5.1 iii. All Causes of Death: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010................................................................................................................................................................... 5.4 Figure 5.1 iv. All Causes of Death: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010 ........... 5.5 Figure 5.1 v. All Causes of Death: Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010................................................................................................................................................................... 5.6 Figure 5.2 i. All Causes of Premature Mortality: Trends in premature mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010 ........................................................................................................................................................... 5.8 Figure 5.2 ii. All Causes of Premature Mortality: Trends in age-adjusted premature mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010........................................................................................................................... 5.9 Figure 5.2 iii. All Causes of Premature Mortality: Trends in age-adjusted premature mortality rates by race and gender for WNC, 1979-2004 with projections to 2010 ............................................................................................................................ 5.10 Figure 5.2 iv. All Causes of Premature Mortality: Trends in age-adjusted premature mortality rates by race for WNC, 1979-2004 with projections to 2010....................................................................................................................................... 5.11 Figure 5.2 v. All Causes of Premature Mortality: Measuring disparity in age-adjusted premature mortality rates by race for WNC, 1979-2004 with projections to 2010 ............................................................................................................................ 5.12 Figure 6.1 i. Diseases of Heart: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010 ...................... 6.2 Figure 6.1 ii. Diseases of Heart: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010 ........................................................................................................................................................... 6.3 Figure 6.1 iii. Diseases of Heart: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010................................................................................................................................................................... 6.4 Figure 6.1 iv. Diseases of Heart: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010................ 6.5

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Figure 6.1 v. Diseases of Heart: Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010................................................................................................................................................................... 6.6 Figure 6.2 i. Cancer - Trachea, Bronchus, Lung: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010 ..................................................................................................................................................................................... 6.8 Figure 6.2 ii. Cancer - Trachea, Bronchus, Lung: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010 ........................................................................................................................................................... 6.9 Figure 6.2 iii. Cancer - Trachea, Bronchus, Lung: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010 ......................................................................................................................................................... 6.10 Figure 6.2 iv. Cancer - Trachea, Bronchus, Lung: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010................................................................................................................................................................. 6.11 Figure 6.2 v. Cancer - Trachea, Bronchus, Lung: Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004

with projections to 2010 ........................................................................................................................................................ 6.12 Figure 6.3 i. Cerebrovascular Disease : Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010 ....... 6.14 Figure 6.3 ii. Cerebrovascular Disease : Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010................................................................................................................................................................. 6.15 Figure 6.3 iii. Cerebrovascular Disease : Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010................................................................................................................................................................. 6.16 Figure 6.3 iv. Cerebrovascular Disease : Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010 ................................................................................................................................................................................... 6.17 Figure 6.3 v. Cerebrovascular Disease : Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010................................................................................................................................................................. 6.18 Figure 6.4 i. Chronic Lower Respiratory Diseases: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010................................................................................................................................................................. 6.20 Figure 6.4 ii. Chronic Lower Respiratory Diseases: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010....................................................................................................................................... 6.21 Figure 6.4 iii. Chronic Lower Respiratory Diseases: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010....................................................................................................................................... 6.22 Figure 6.4 iv. Chronic Lower Respiratory Diseases: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010................................................................................................................................................................. 6.23 Figure 6.4 v. Chronic Lower Respiratory Diseases: Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010....................................................................................................................................... 6.24 Figure 6.5 i. Alzheimer’s Disease: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010 ................ 6.26 Figure 6.5 ii. Alzheimer’s Disease: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010 ................................................................................................................................................................................... 6.27 Figure 6.5 iii. Alzheimer’s Disease: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010................................................................................................................................................................. 6.28 Figure 6.5 iv. Alzheimer’s Disease: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010.......... 6.29 Figure 6.5 v. Alzheimer’s Disease: Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010................................................................................................................................................................. 6.30

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Figure 6.6 i. All Other Unintentional Injuries and Adverse Effects: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010....................................................................................................................................... 6.32 Figure 6.6 ii. All Other Unintentional Injuries and Adverse Effects: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010.................................................................................................... 6.33 Figure 6.6 iii. All Other Unintentional Injuries and Adverse Effects: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010 ............................................................................................................................ 6.34 Figure 6.6 iv. All Other Unintentional Injuries and Adverse Effects: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010....................................................................................................................................... 6.35 Figure 6.6 v. All Other Unintentional Injuries and Adverse Effects: Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010 ............................................................................................................................ 6.36 Figure 6.7 i. Pneumonia and Influenza: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010........ 6.38 Figure 6.7 ii. Pneumonia and Influenza: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with

projections to 2010................................................................................................................................................................ 6.39 Figure 6.7 iii. Pneumonia and Influenza: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with

projections to 2010................................................................................................................................................................ 6.40 Figure 6.7 iv. Pneumonia and Influenza: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010 ................................................................................................................................................................................... 6.41 Figure 6.7 v. Pneumonia and Influenza: Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004 with

projections to 2010................................................................................................................................................................ 6.42 Figure 6.8 i. Diabetes Mellitus: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010 ................................................................................................................................................................................... 6.44 Figure 6.8 ii. Diabetes Mellitus: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010 ......................................................................................................................................................... 6.45 Figure 6.8 iii. Diabetes Mellitus: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010 ......................................................................................................................................................... 6.46 Figure 6.8 iv. Diabetes Mellitus: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010 ................................................................................................................................................................................... 6.47 Figure 6.8 v. Diabetes Mellitus: Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010................................................................................................................................................................. 6.48 Figure 6.9 i. Cancer - Colon, Rectum, Anus: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010................................................................................................................................................................. 6.50 Figure 6.9 ii. Cancer - Colon, Rectum, Anus: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010....................................................................................................................................... 6.51 Figure 6.9 iii. Cancer - Colon, Rectum, Anus: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010....................................................................................................................................... 6.52 Figure 6.9 iv. Cancer - Colon, Rectum, Anus: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010................................................................................................................................................................. 6.53 Figure 6.9 v. Cancer - Colon, Rectum, Anus: Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010....................................................................................................................................... 6.54

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Figure 6.10 i. Nephritis, Nephrotic Syndrome, and Nephrosis: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010................................................................................................................................................................ 6.56

Figure 6.10 ii. Nephritis, Nephrotic Syndrome, and Nephrosis: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010....................................................................................................................................... 6.57 Figure 6.10 iii. Nephritis, Nephrotic Syndrome, and Nephrosis: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010...................................................................................................................................... 6.58 Figure 6.10 iv. Nephritis, Nephrotic Syndrome, and Nephrosis: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010............................................................................................................................................................... 6.59 Figure 6.10 v. Nephritis, Nephrotic Syndrome, and Nephrosis: Measuring disparity in age-adjusted mortality rates by race for WNC,

1979-2004 with projections to 2010..................................................................................................................................... 6.60 Figure 7.1 i. Cancer - All Sites: Trends in mortality rates for WNC, ENC41, and NC, 1979-2004 with projections to 2010 ...................... 7.2 Figure 7.1 ii. Cancer - All Sites: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1979-2004 with projections to 2010.................................................................................................................................................................. 7.3 Figure 7.1 iii. Cancer - All Sites: Trends in age-adjusted mortality rates by race and gender for WNC, 1979-2004 with projections to 2010.................................................................................................................................................................. 7.4 Figure 7.1 iv. Cancer - All Sites: Trends in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010 ............... 7.5 Figure 7.1 v. Cancer - All Sites: Measuring disparity in age-adjusted mortality rates by race for WNC, 1979-2004 with projections to 2010.................................................................................................................................................................. 7.6 Figure 8.1 i. HIV Disease: Trends in mortality rates for WNC, ENC41, and NC, 1998-2004 with projections to 2010.............................. 8.2 Figure 8.1 ii. HIV Disease: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US, 1998-2004 with projections to 2010.................................................................................................................................................................. 8.3 Figure 8.1 iii. HIV Disease: Trends in age-adjusted mortality rates by race and gender for WNC, 2000-2004 with projections to 2010.................................................................................................................................................................. 8.4 Figure 8.1 iv. HIV Disease: Trends in age-adjusted mortality rates by race for WNC, 2000-2004 with projections to 2010 ....................... 8.5 Figure 8.1 v. HIV Disease: Measuring disparity in age-adjusted mortality rates by race for WNC, 1987-2004 with projections to 2010.................................................................................................................................................................. 8.6

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1. Introduction

Health Indicators Series: A Resource for Healthy Communities

June 2007

Report Series #2: Mortality Trends for Western North Carolina - (1979 to 2004)

Health Indicators is a series of reports describing community health at the state, regional, and county level. Health Indicators supplements the Eastern North Carolina Health Care Atlas published by the Center for Health Services Research and Development at East Carolina University. These reports are intended to provide state policy makers, local health departments, hospitals, and community-based health planning groups with a wide range of information useful for diagnosing the health of North Carolina’s population and its local communities, evaluating the effectiveness of existing services, and envisioning and planning new interventions. The reports in this periodically published series can be used in conjunction with the County Health Data Book, produced by the North Carolina Office of Healthy Carolinians, as part of the Community Health Assessment Process. Individual reports in ECU’s Health Indicator Series are custom made for the counties of North Carolina. Reports in this series will describe trends in mortality, including premature mortality for all causes of death, mortality (crude) and age-adjusted mortality for leading causes of death, and measures of race disparities or inequalities in mortality rate. Report Series #2 of the series focuses attention on the two overarching goals of Healthy People 2010, the national blueprint for health improvement. The first goal is to increase the span and quality of life and the second is to eliminate health disparities. North Carolina’s companion plan, Healthy Carolinians 2010, has also embraced these two goals. Report Series #2 is a tool to help evaluate how well Western North Carolina* is doing in relation to the goals set forth in Healthy People 2010 and Healthy Carolinians 2010 as well as important differences in life span. Using rate comparisons, this report describes the inequalities in mortality among Western North Carolina and other regions, and among four demographic groups. Premature mortality, the focus of Report Series #1, is included in the death from all causes section located at the beginning of this report. The measure used to quantify premature mortality is described in more detail in the Methods and Interpretations section. This report describes the leading contributors to mortality, provides a geographic context, and examines trends and inequalities over a 26-year period (1979 to 2004). The report begins with data highlights, provided as an introduction to the data, rather than a summary of it. Readers are encouraged to draw their own conclusions from the data and pose new questions suggested by what they see. The following section presents both the overall and five leading contributors to mortality for the state by race and gender. In this section, pie charts describe the relative contribution of each of five leading contributors to the overall, general rate. These charts also make regional and demographic comparisons. Making the area of each pie chart equivalent to the rate for the

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population group helps convey the dimension of disparity across population groups. The next section charts recent trends and disparities in mortality and provides projections to the year 2010. These charts place Western North Carolina’s health status in a historical context and provide a glimpse into the future. * The region Western North Carolina is comprised of 24 counties located in the extreme west of North Carolina and approximates the mountain physiographic province of the state.

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2. Data Highlights Trends and Disparities in Mortality in Western North Carolina The following highlights of mortality in Western North Carolina (WNC) describe current status and trends in the causes of death from major diseases and how they vary across different population groups. The graphs, charts, and tables paint a picture of the region’s health with a broad brush. The study of mortality in populations should include consideration of time and geographic space as well as underlying demographic, political-economic, and socio-cultural conditions. Readers are encouraged to think of these factors as they consider the data presented in this report, formulate their own questions about the causes of mortality, and think about strategies to reduce mortality in the population described. Current Disparities in Mortality by Geography, Race, and Gender The five-year (2004), age-adjusted mortality rate for Westerm North Carolina is 840 deaths per 100,000. This rate is 4% higher than the state rate. Within Western North Carolina, the age-adjusted non-White rate is 18% higher than the White rate. The non-White Male rate is 20% higher than the rate for White male. The non-White Female rate is 16% higher than the rate for White Females. (All rates age-adjusted). The five general leading causes of death in Western North Carolina (2004) are: 1. Diseases of Heart 2. Cancer - Trachea, Bronchus, Lung 3. Cerebrovascular Disease 4. Chronic Lower Respiratory Diseases 5. Alzheimer’s Disease (Unless otherwise noted, trends are considered reliable if R2 ≥ 0.35, moderately reliable if 0.35 > R2 ≥ 0.10, and unreliable if R2 < 0.10.) Twenty-six Year Trends in Mortality Rates (1979-2004) • WNC’s all-cause mortality rates are increasing and diverging from ENC and NC trends. WNC’s mortality rates are increasing more than

twice ENC’s and three and a half times that of the state. • When age-adjusted, all-cause mortality rates for WNC are lower than ENC41 and the state, but it has the slowest rate of decrease. • The non-White male mortality rates remain higher than the other demographic groups. Non-White males have seen the greatest percentage

decrease in all-cause mortality (22%). • The trends for all-cause mortality rates for non-Whites is decreasing at a rate twice that of Whites. The relative disparity between the two

groups has declined from 34% to 27% during the measurement period. • There is a 45% increase in racial disparity over the 26 year time period, in a moderately reliable trend. All Causes of Premature Mortality (1979-2004) • WNC’s premature mortality rate has decreased by 12% over 26 years, with (4.36 deaths/year).

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• The relative regional disparity in age-adjusted rates between WNC and ENC was 22% in 1979 and decreased to 16% in 2004. • The rate disparity between non-White males and White males was 80% -- in 2004 it was 57%. This indicates that the rate gap is closing. • White females have the lowest rate and the lowest rate of decrease. • The non-White female fitted rate was 94% greater than that of White females in 1979, decreasing to 66% greater in 2004, indicating a

decreasing disparity. • A recent decrease in the premature mortality rate for non-White males and a leveling of rates for White males suggests a reduction in racial

disparity. • In 2004, the non-White rate is about 59% greater than the White rate. • In a moderately reliable trend, there has been a 30% decrease in racial disparity in WNC. Diseases of Heart • There is a decreasing trend in heart disease mortality for all regions. The rates for heart disease mortality in WNC are below those of all other

regions. • After age-adjustment, the rates for heart disease mortality for WNC remain below those for all other regions, with the least amount of change

White males have the highest rate of decrease. • The trends for males, both non-White and White, are converging with those of non-White and White females. • Non-Whites have seen a 41% decrease in heart disease mortality; Whites have seen a 48% decrease, the relative disparity has increased in

2004. • The increasing trend for racial disparity is unreliable. Cancer – Trachea, Bronchus, Lung • The cancer -TBL mortality rate for WNC shows the largest increase (85%), and the highest rate of increase in a reliable trend, followed by

ENC (54%) and NC (48%). In 2004, the mortality rate for WNC is 19% greater than ENC. • The rates for age-adjusted mortality for WNC are below that for the state and eastern region. However, this mortality rate shows the largest

increase (42%) over the years, while NC (30%) and ENC (26%) show smaller rates of increase. WNC has a higher rate of increase. • The mortality rate for males, both non-White and White, is greater than that of non-White and White females, but White and non-White

females are showing the largest amount of increase over 26 years. • The White mortality rate shows a significant 44% increase over the 26-year period, which is three times that of non-Whites. • There is a 127% decrease in the racial disparity, favoring non-Whites, in a reliable trend. Cerebrovascular Disease • WNC’s stroke mortality rate is increasing, but the trend is unreliable. However, the ENC and state rates are decreasing with reliable trends. • The WNC age-adjusted stroke mortality rate is decreasing (37%) but at a lower rate than the nation (42%), the state (46%) and ENC (49%). • Non-White males have the highest mortality rates for stroke, but they are decreasing and converging on those of the other gender-race

demographic groups.

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• The mortality rates for non-Whites are decreasing but was relatively 48% greater than that of Whites in 2004. • The flat trend for racial disparity is not reliable. Chronic Lower Respiratory Diseases • The trends in mortality rate for WNC, ENC, and NC are all increasing, but WNC shows the sharpest increase (213%) when compared to the

other regions (185% and 156%, respectively). • The trends for age-adjusted mortality rate for ENC, WNC, NC, and the US are all increasing similarly, with WNC exhibiting the highest rate of

increase while diverging from the other rates. • Non-White female and White female mortality are increasing by 107% and 406%, respectively, and White females are converging on non-

White male and White male mortality, which are increasing at a slower rate (21% and 43%, respectively). • The White mortality trend is reliable and increasingly divergent from the non-White mortality rate. • The decreasing trend for racial disparity is not reliable. Alzheimer’s Disease • WNC’s mortality rates for Alzheimer’s Disease exhibits the largest rate of increase, but the overall greatest increase was experienced by

ENC at 660%. • Although rates are increasing the relative disparity between WNC and ENC has decreased between 1979 and 2004 by 40%. • Although White females possess the highest rate of increase, White males experienced the greatest percentage increase over the

measurement period. • White age-adjusted rates increased at a slightly higher rate that non-Whites, with very little change in relative disparity over the measurement

period. • There is a decrease trend for the percentage difference between Whites and non-Whites, with the trend favoring non-Whites. All Other Unintentional Injuries and Adverse Effects • The mortality rate for WNC was 20% less than ENC in 1979. In 2004, this rate was relatively 45% relatively greater than the ENC rate. • The age-adjusted mortality rate for WNC is increasing and divergent from ENC, NC, and the US, with an unreliable trend. • The non-White male rate is converging on White males after a 47% decrease in 26 years. White females are the only demographic with an

increasing mortality rate trend yielding an 80% increase. • The non-White rate has seen a 45% decrease and has converged with White rates. • There is a 120% decrease in racial disparity, favoring non-Whites. Pneumonia and Influenza • WNC’s influenza and pneumonia mortality rates are above those for ENC and NC with a trend that has produced a 29% increase in 26 years. • There is a decreasing trend in age-adjusted mortality rate for WNC, and it is converging on the regional, NC, and the US rates, with similar

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rates of decrease. • The mortality rates for males, both White and non-White, are decreasing significantly and converging on the relatively flat female trends. • In 1979, the non-White rate was 11% greater than the White rate; it was 2% less than the White rate in 2004. • The decreasing trend for racial disparity, favoring non-Whites, was not reliable. Diabetes Mellitus • WNC’s diabetes mortality rates increased by 159% over 26 years and was similar to that for NC (147%). ENC shows the largest relative

increase (204%) diverging from WNC. • The divergent trend for ENC persists even after age-adjustment, and WNC rates fall below those for ENC, NC and the US. • The non-White male and non-White female mortality rates are increasingly divergent from those of White males and White females. White

males and non-White males have lower rates than White females and non-White females. Non-White females have the highest rate of increase.

• Non-White mortality rates have increased by 67%, compared to 82% for White mortality, however, the 2004 non-White rate was 194% greater than the White rate, and the rate of change was two and a half times greater than the White rate.

• The relatively flat trend for racial disparity, are not reliable. Cancer – Colon, Rectum, Anus • The cancer-CRA mortality rates for WNC and ENC have had similar increases in rates (20%) with slightly increasing and diverging trends. • The age-adjusted mortality rates are slightly greater (15%) than ENC’s (13%). The state and national rates increased by 18% and 29%,

respectively. • The mortality rates for non-White males are increasing, while the rates for White and non-White females are decreasing. The trend for

White males is not reliable. • In 1979 the non-White rate, though decreasing, was 30% relatively greater than the White rate. In 2004 the relative rate increased to 44%. • The increasing trend for racial disparity is not reliable. Nephritis, Nephrotic Syndrome, and Nephrosis • The mortality rate for WNC was 26% less than ENC in 1979 and 10% greater than ENC is 2004. WNC experienced the largest increase in

rates (294%) as compared to ENC (164%) and NC (156%) over 26 years. • The age-adjusted mortality rate for WNC is increasing by 111%, compared to 65% and 76% for ENC and NC, respectively. • The rates for non-White males and females are significantly above those for White males and females. Also, females, both non-White and

White, have seen a greater percent increase in mortality (150% and 121%, respectively), compared to their male counterparts (135% and 109%, respectively).

• The rate of increase (the slope) for non-White mortality nephritis, nephrotic syndrome, and nephrosis is twice that for Whites, diverging trend. • The flat trend for racial disparity is not reliable. Cancer - All Sites

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• WNC shows the largest increase in mortality rates in all cancer (43%) when compared to ENC (33%) and NC (23%). • The age-adjusted mortality trend shows a 5% increase in WNC during the 26-year period. The other trends are not reliable. • In a reliable trend, White females show a 14% increase in mortality. The trends for the other demographic groups are not reliable. • The non-White trend is decreasing but unreliable, with the White trend showing a 7% increase in a moderately reliable trend. • There is a 54% decrease in disparity between non-Whites and Whites, in a moderately reliable trend. The trend favors non-Whites. HIV Disease • Between 1998 and 2004, WNC experienced a 34% decrease in its HIV mortality rates. Its rates are the lowest among the regions. • From 1998 to 2004, WNC’s age-adjusted rates decreased by 37%. • The only reliable trend (five years) is for non-White females between 2000 and 2004, who experienced a 26% increase in their age-adjusted

mortality rates. • Non-Whites experienced a 57% decrease in their age-adjusted mortality rates from 2000-2004, while White rates remained flat during that

time. • Between 2000 and 2004 the percentage difference between Whites and non-Whites has decreased by 239%. The trend, though reliable, is

for five years only.

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3. Methods, Interpretation, and References Data Sources The data for mortality and premature mortality in Western North Carolina were obtained from death certificate data from the North Carolina State Center for Health Statistics and population data from the North Carolina Office of State Planning. For the US, data were obtained from the Compressed Mortality File compiled by the National Center for Health Statistics. Measures Two types of mortality measures are covered in this report. The first, called mortality rate, is a rate based on the number of deaths per population (or, deaths normalized by the population that produced them) for a given unit area, such as the county, region, or state over a specified time interval. The mortality rate is expressed in two ways, the basic true (actual or observed) rate, and an age-adjusted rate (see below). Mortality rates are used to evaluate the impact and burden of mortality on a population and to make comparisons, where appropriate, among populations. Like the mortality rate, the second type, called premature mortality rate, is also a density measure, but instead of deaths, it is the number of person-years lost in a population before a specified age. In this report mortality rates are emphasized with premature mortality (YLL-75) shown only for the total number of deaths from all causes (general mortality). Premature mortality in detail is the focus of Report Series #1. A simple count of deaths occurring in an area for a given time interval is useful for identifying potential problems or issues of public concern--particularly if the deaths result from a rare cause or they are believed to be an emerging problem for at-risk socio-demographic groups. In this sense, count data are used for sentinel surveillance. Because counts reveal nothing about the underlying population base from which deaths arise, the analytical or practical utility of count data is limited. The size of the underlying population will have an expected effect on the numbers of deaths that occur. Deaths measured in relation to a population, are an expression of density. When measured over a given interval of time (usually 1 to 5 years), the density is called a rate. (The rate is typically multiplied by 100,000 for ease in interpreting the usually small resultant value.) The mortality rate is an improvement over simple count data because it accounts for the relative size and effect of the underlying population. The chief advantage of the mortality rate is that it is useful for focusing attention on the burden of public health problems more rigorously than simple counts. However, the mortality rate is also affected by the age structure of the population, which can confound interpretation when making comparisons of rates among different areas. Because aging is the greatest risk factor for death, the age structure of a population will have a substantial effect on the mortality rate. For example, two counties may have similar population sizes but one has a larger number of people over the age of 45 than the other. It is more likely that the older population will generate more deaths over an interval of time and this will be reflected in a higher mortality rate. Differing age structures among populations will confound any comparisons of mortality rates among those populations. Therefore, a method for controlling the effects of age structure on the mortality rate is required if any meaningful comparisons are to be made. Age-adjustment to control for a population’s age structure requires an external reference or standard to weight the comparison populations by age groups. Currently, the US 2000 Standard Million Population (SMP) is used as the external reference. The US 2000 SMP is divided into a number of age groups whose sizes or proportions serve as weights to be applied to the corresponding age groups of the study population. This proportional redistribution generates new numbers of expected deaths in each of the corresponding age groups of the study population. These expected deaths are the number of deaths we would expect if the study population had the same age structure as the US 2000 SMP. The

3.1




expected number of deaths are summed and normalized by the total population yielding an age-adjusted death rate. Once the effects of age structure are controlled, the way is paved for making comparisons among populations (Buescher, 1998). The second measure, premature mortality, focuses on the burden of disease and death expressed in terms of accumulated person years lost before a benchmark age. We use 75 years of age as a benchmark because it approximates current life expectancy at birth in the United States and gives weight to deaths from chronic disease occurring in later life. It considers only deaths of people who die before age 75. To calculate the number of years lost, the mid-point age of the age group to which each decedent belongs is subtracted from 75 and the differences (the lost years) are summed. After all lost years are summed; the result is normalized by the population under age 75 and multiplied by 10,000. Premature mortality is expressed as a rate measured over a time interval, and it can also be age-adjusted. Age-adjusted rates for both mortality and premature mortality have little intrinsic meaning, however, and can mask the burden and trends of mortality (or health event) that may be of local importance. A casual inspection of adjusted rates may divert attention from the actual health problems of a population and inappropriately guide interventions or resource allocation. Thus, it is important to consider the actual number of deaths (count data) in conjunction with the basic non-adjusted mortality rate first, and then use the adjusted rate only if one wishes to factor out age in understanding the pattern of mortality among populations and regions. For regions with larger populations the statistics presented here are for the year 2004. Smaller areas like counties will usually be aggregated into 5-year intervals (e.g., 2000 to 2004). A five-year interval is used because it provides a useful summary of the mortality experience while minimizing wide year-to-year fluctuations in the rate due to the effect of small numbers. Interpreting the Pie Charts Pie charts are provided as a visual representation of the burden of mortality. They depict the proportion of mortality accounted for by each of the leading contributors. (The leading causes of death are found in the table preceding the pie chart section.) The pie charts compare the relative levels of burden and proportions by region and demographic groups. Each regional and demographic set of pie charts is based on the observed mortality rate and the age-adjusted (expected) mortality rate. The area of each pie is based on the age-adjusted mortality rate for the year 2004--larger pie charts will represent larger mortality rates. For purposes of presentation, we set the smallest area of a circle on the lowest meaningful rate as a benchmark, the age-adjusted rate for White females in North Carolina. We then scaled up the circles for all other groups proportionately based on their rates. The first two pie chart figures compare the proportions of leading causes of death across regions at the national, state, and regional/county level. The first figure in this set compares absolute mortality (the burden) using mortality rates, which sheds light on any differences in the burden of mortality by disease intrinsic to each region. The second figure, which is age-adjusted, allows for direct comparisons among regions. The same pattern is repeated in the following figures that show differences among demographic groups. While comparing the pie charts, the reader should remember that the slices of the pie show differences in how much of the mortality rate (including age-adjusted) is accounted for by a specific cause. Finally, the reader will see that some pies are composed of different leading causes of mortality, so they have different colored slices. The variable sizes of pie slices demonstrate differences in the mortality patterns across populations and are of significant importance in studying inequalities and disparities in population health.

3.2




Interpreting the Trend Figures Four types of figures are used to show trends in mortality, for all causes combined and for each of the ten leading causes in the region/county over a 26-year period. Premature mortality is described for deaths by all causes only. The first of the four types of figures depicts the observed mortality rates for the region/county and state. The second figure type shows age-adjusted mortality rates for the region/county, state, and nation allowing comparisons among geographical areas. The third figure type compares trends in age-adjusted mortality rates by race and gender. Adjustment is made for age structure differences among demographic groups, which permits observation on the effects of race and gender on these groups. The last figure type depicts racial differences (or disparities) expressed as a ratio (in percent) of age-adjusted mortality for non-Whites to the age-adjusted rates for Whites over the twenty-six year time series. Trend lines provide historical depth to mortality processes and a basis for prediction, future comparisons, and action. The trend line concept is borrowed from statistical modeling. However, unlike true modeling, we are not assuming the statistical independence of each sequential observation (the rate at time interval x). Instead, our assumption is that each observation is dependent to some degree on previous observations, forming a trend. If the degree of dependence is high, then the observations (rates) should lie close to the trend line. If observations appear to bounce around the fitted line in a random fashion (indicating high variability), then there is less dependence and less of a trend in the observations. We use trend lines to uncover any general patterns found in the data for the purpose assisting the investigator in understanding the underlying processes which generate them. The equation of the line is derived from a set of observation points. This line is an estimate of where each observed rate would be if the previous observation could predict with 100% accuracy the value of the next observation. In nature, this situation seldom arises and the degree to which individual observations deviate from this linear trend line is an indication of how well they “fit” or conform to the trend. The linear trend lines in the time series figures project expected rates to the year 2010 from known historical values (1979 to 2004) to provide a general idea about where mortality trends are heading. The equation of the line allows the user to calculate an expected or fitted rate for any given year, x. For example, in figure 6.4 ii the year 1990 is the 12th year in the series, so 12 would be substituted for x in the equation of the line derived from WNC’s age-adjusted mortality rate series for a selected cause of death. For chronic lower respiratory diseases (1979 to 2004), the 1990 expected or fitted age-adjusted rate is calculated to be a little more than 38 deaths per 100,000 people. The observed age-adjusted rate for 1990 is 36 deaths per 100,000 people. (The observed rates are the values found in the table that runs along the x-axis of the time series chart.) The numeric difference between the expected and observed rates for 1990 is 2—the model (the equation of the line) overestimates the observed value by 5 deaths. Each previous and subsequent year’s difference between the expected and observed rates will vary to a greater or lesser degree depending on the size of the population under study (see below). This variation can be measured to determine how well the line fits or models the observed data. In the time series figures, the investigator will find several statistical tools to assist in the analyses of trend lines and fitted rates. These tools include the coefficient of determination, percent change values, and slope coefficients. These tools enable the investigator to form not only a mental picture of the comparative impact of mortality by cause on a region and population but to also gain insight into what the near demographic future holds for them. Coefficients of determination (R2) are provided to indicate how well the fitted line predicts or explains the observed rates. When variation in the observed rates is relatively high (the fitted trend line does not correspond well to the observed trend line) R2 approaches 0.0, when the variation

3.3




is low, R2 approaches 1.0. A low R2 implies low reliability and a larger R2 indicates that a greater degree of confidence can be placed in the trend line. The trend lines are generally unreliable when R2 is less than 0.10, moderately reliable when R2 is between 0.10 and 0.35, and most reliable when R2 is equal to or greater than 0.35. Graphically, data points, data lines and trend lines are weighted according to their reliability and significance. The thinnest, dashed trend lines are for those where R2 is less than 0.10 and should be considered not reliable. The thickest dotted lines are used for trends where the R2 is equal to or greater than 0.35. In some cases, the trend lines do not fit the data well (i.e. small R2). In other words, the presentation of a trend line does not necessarily indicate a linear trend in the data line. In several instances a non-linear trend may be present. It should be noted that the linear trend modeling undertaken here is a major simplification of real world processes. These processes are dynamical in nature and can be modeled and fitted with certain limitations and assumptions. In this series (#2), we begin to explore alternative methods for examining trends that show discontinuities and reversals within the set of time series observations, particularly within the mortality time series for HIV/AIDS. Time series of epidemic infectious disease mortality rates typically exhibit a curvilinear pattern. A marked curvilinear pattern is seen in the mortality series for HIV/AIDS mortality, which can be approximated into one or more sequential linear segments. Each segment is joined to another in the sequence at a point in time or year. We are currently experimenting with a publicly available program, Joinpoint, which calculates these points in time points (or years) the linear segments are joined (Statistical Research and Applications Branch, National Cancer Institute, 2005). Of particular interest is objectively finding the year that marks the end of the epidemic phase—the rapid rise and fall of rates—and the beginning of the more or less linear endemic phase/segment. The last segment is projected to the year 2010 and information regarding current and future trends (equations of the line and percent decrease/increase) is also provided. Joinpoint analyses of trends for other leading causes of mortality that exhibit curvilinear reversals and discontinuities in their observed time series will be included in future editions of this series. Percent change provides a measure of the estimated change in mortality from the beginning of the series (1979) to the last observation year. The percent value is followed by the term increase or decrease to help denote the direction of the overall trend. This information is in boldface and included with the R2 value and the equation of the line. Percent change and the direction of that change is provided on the graphs for trends where R2 is greater than 0.10. Another tool is the equation of the line that fits a trend among the observed data point (the rates). The slope coefficient of this equation, b, is the estimated/expected number of deaths per unit of time (x) or the rate of change in deaths per annum. The direction of change is indicated with a negative sign preceding the b and if positive, b is unsigned. Visually, a negative slope shows a trend decreasing in annual rates from left to right and a positive slope will be rising (increasing) from left to right. An examination of the different slopes for regional or demographic group trends will quickly reveal that they are not equal. Visual inspection combined with slope coefficients also provides a means for making comparisons between any two trend line series in the time series figure. Trends will diverge, converge, or run parallel with one another indicating, respectively, increasing separation, decreasing separation, or very little change in rates between two trend lines. Setting two equations of the line equal to one another can yield an estimated year of convergence in the future (or the year the two trends diverged in the past). However, the investigator is cautioned to not put too much stock in the results if the forward or backward projections are very distant in time. Recent (or temporally adjacent) short term trends with good correspondence between the fitted trend line and observed trend line will be better indicators of rates in the near future or past (if historical rates are unknown). The final tool is the pair of comparison tables located in the lower portion of the page. The tables, found in every time series figure (except the ones showing comparisons by race and disparity) are structured so that the reader can make comparisons of rates derived from the equation of the line (i.e., the fitted rates) among all regions or demographic groups portrayed in the figure. The 1979 and 2004 tables compare the fitted

3.4




rates calculated for the beginning and end of the observed time series in terms of percent difference. Returning to figure 6.4 ii, WNC’s age-adjusted fitted rate for chronic lower respiratory diseases in 1979 is 2% greater than (GT) ENC’s fitted rate. In 2004, WNC’s fitted rate is 4% greater than (GT) ENC’s fitted rate. The tables permit a quick assessment of trends calculated from observed time series data. The reader should notice that some data lines in the trend figures fluctuate widely. This fluctuation is due to two main factors. In a small population, the number of deaths may vary widely from year-to-year and lead to large changes in annual mortality and premature mortality rates, a phenomenon known as the effect of small numbers. In addition, because mortality is based on the age of death, any fluctuation in the distribution of deaths across age groups from year-to-year can cause rates to change dramatically. Both the number of deaths and the age of decedents influence trends in mortality. The reader should evaluate all available data carefully before drawing conclusions about current, past and future mortality patterns.

Caveats about the Concepts of Race, Gender, and Geography Several caveats are offered about the concepts of race, gender, and geography as they apply to the analysis of mortality patterns. While we do intend to bring attention to the stark racial inequalities in mortality across North Carolina, we do not mean to imply that this is a biological phenomenon. Other factors such as differences in socioeconomic status, educational attainment, occupation, and lifestyle probably account for the large racial gaps in mortality rates. Likewise, gender inequalities may have less to do with biological differences between men and women than with socially structured gender roles, health behaviors, occupational exposures, and use of health services. Finally, it is important to consider that county borders may not always be the most appropriate way to look at specific health problems. Few of our health care problems begin or end at political boundary lines and many of our health problems in North Carolina are common to large groups of counties. Counties and larger regions composed of counties are convenient units of data collection and readers should not jump to conclusions about health problems or possible solutions based solely on the way data appear when aggregated to this level. In some cases, data at multi-county, zip code, or minor civil division levels are a better way to understand problems and solutions. Similarly, as indicated in Healthy Carolinians 2010, consideration needs to be given to whether or not a county is characterized as rural or urban, as this can be an indication to the level of development and amount of resources available in a county.

3.5




General References Fastrup, J., Vinkeness, M., & O’Dell, M. (1996). Public Health: A Health Status Indicator for Targeting Federal Aid to States. Washington, DC: US General Accounting Office. Office of Healthy Carolinians/Health Education. Healthy Carolinians 2010: North Carolina’s Plan for Health and Safety. Conference Ed. United States Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington D.C.: US Government Printing Office, November 2000.

Cited References

Buescher, P. A. (1998). Age-adjusted death rates (13th ed.). Raleigh, North Carolina: North Carolina Center for Health Statistics.

Statistical Research and Applications Branch, National Cancer Institute. (2005). Joinpoint regression program. Silver Spring, MD: from http://srab.cancer.gov/joinpoint

3.6




3.7




4. Current Disparities in Mortality by Geography, Race and Gender, and Race: Total and Five Leading Causes of Death

in WNC

4




Figure 4.1 i. General leading causes of death for Western North Carolina (2004), NC (2004), and US (2003). Mortality rate per 100,000 population.

North Carolina

United States, 2003

845 deaths/100,000 842 deaths/100,000 1063 deaths/100,000

NC rate is <1% higher than US WNC rate is 26% higher than NC

Diseases of Heart Cancer – All Sites

Cerebrovascular Disease Chronic Lower Respiratory Diseases

Diabetes Mellitus

Alzheimer’s Disease

All Other Unintentional Injuries and Adverse Effects

All Other Deaths



Diabetes Mellitus



All Other Deaths

4.1

Western North Carolina

28%35%

5%6%

23%

28%35%

5%6%

23%

38%24%

23%

7%5%

38%24%

23%

7%5%

25%36%

22%

7%6%

25%36%

22%

7%6%

Pie Charts are proportionately scaled using the NC 2004 age-adjusted mortality rate of White females (703 deaths/100,000 pop) as a standard. The areas are proportional to the rates. Slices without percentages constitute less than 5% of the deaths within that chart.




Figure 4.1 ii. General leading causes of death for Western North Carolina (2004), NC (2004), and US (2003). Age-adjusted mortality rate per 100,000 population.

NC rate is 5% higher than US WNC rate is 4% lower than NC

28%35%

5%6%

23%

28%35%

5%6%

23%

38%24%

23%

7%5%

38%24%

23%

7%5%

25%36%

22%

7%6%

25%36%

22%

7%6%

4.2

North Carolina

United States, 2003

873 deaths/100,000 833 deaths/100,000 840 deaths/100,000

Western North Carolina



Diabetes Mellitus



All Other Deaths



Diabetes Mellitus



All Other Deaths





Figure 4.2 i. General leading causes of death for Western North Carolina by race and gender, (2004). Mortality rate per 100,000 population.

Non-White Males

Non-White Females White Females

White Males

1103 deaths/100,000

1059 deaths/100,000 814 deaths/100,000

832 deaths/100,000

The non-White male rate is 25% lower than the White male rate and 2% higher than non-White female rate.

The non-White female rate is 2% lower than the non-White male rate, and 23% lower than the White female rate.

34%

26%

23%

5%

34%

26%

23%

5%

35%

5%5%

7%

23%

25%35%

5%5%

7%

23%

25%

24%

20%

11%5%

37% 24%

20%

11%5%

37%25%

21%

34%

6% 8%6%

25%

21%

34%

6% 8%6%

Diabetes Mellitus

Cancer – All Sites

Diseases of Heart

Cerebrovascular Disease

Chronic Lower Respiratory Diseases


All Other Deaths


Diabetes Mellitus


Diseases of Heart




All Other Deaths


Diabetes Mellitus


Diseases of Heart




All Other Deaths


4.3





Figure 4.2 ii. General leading causes of death for Western North Carolina by race and gender, (2004). Age-adjusted mortality rate per 100,000 population.

Non-White Males

Non-White Females White Females

White Males

1014 deaths/100,000

689 deaths/100,000 801 deaths/100,000

1220 deaths/100,000

The non-White male rate is 20% higher than the White male rate and 52% higher than non-White female rate.

The non-White female rate is 34% lower than the non-White male rate, and 16% higher than the White female rate.

Diabetes Mellitus


Diseases of Heart




All Other Deaths


Diabetes Mellitus


Diseases of Heart




All Other Deaths


Diabetes Mellitus


Diseases of Heart




All Other Deaths


34%

26%

23%

5%

34%

26%

23%

5%

35%

5%5% 7%

23%

25%35%

5%5% 7%

23%

25%

24%

20%

11%5%

37%24%

20%

11%5%

37% 25%

21%

34%

6% 8%6%

25%

21%

34%

6% 8%6%

4.4





Fig. 4a. General leading causes of death for Western North Carolina by race, (2000-2004). Mortality rate per 100,000 population.

Non-Whites Whites

823 deaths/100,000 1081 deaths/100,000

The non-White rate is 24% lower than the White rate.

Diseases of Heart




Diabetes Mellitus

All Other Deaths





Diabetes Mellitus

All Other Deaths



Diseases of Heart




Diabetes Mellitus

All Other Deaths





Diabetes Mellitus

All Other Deaths



25%

21%

8%

36%

25%

21%

8%

36%

25%

7%

22%

6%

36%25%

7%

22%

6%

36%

4.5

Figure 4.3 i. General leading causes of death for Western North Carolina (2004). Mortality rate per 100,000 population.





Figure 4.3 ii. General leading causes of death for Western North Carolina by race, (2004). Age-adjusted mortality rate per 100,000 population.

Non-Whites Whites

Diseases of Heart




Diabetes Mellitus

All Other Deaths





Diabetes Mellitus

All Other Deaths



Diseases of Heart




Diabetes Mellitus

All Other Deaths





Diabetes Mellitus

All Other Deaths



25%

21%

8%

36%

25%

21%

8%

36% 25%

7%

22%

6%

36%25%

7%

22%

6%

36%

983 deaths/100,000 832 deaths/100,000

The non-White rate is 18% higher than the White rate.

4.6





4.9




5. Trends and Disparities in Mortality in Western North Carolina All Causes of Death and

All Causes of Premature Mortality; 1979-2004

5




All Causes of Death

5.1

• WNC’s all-cause mortality rates are increasing and diverging from ENC and NC trends. WNC’s mortality rates are increasing more than twice ENC’s and three and a half times that of the state.

• When age-adjusted, all-cause mortality rates for WNC are lower than ENC41 and the state, but it has the slowest rate of

decrease. • The non-White male mortality rates remain higher than the other demographic groups. Non-White males have seen the

greatest percentage decrease in all-cause mortality (22%). • The trends for all-cause mortality rates for non-Whites is decreasing at a rate twice that of Whites. The relative disparity

between the two groups has declined from 34% to 27% during the measurement period. • There is a 45% increase in racial disparity over the 26 year time period, in a moderately reliable trend.




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WNC 871 879 893 890 902 917 937 974 972 1028 999 993 1021 1008 1059 1049 1063 1105 1073 1094 1125 1093 1065 1092 1089 1063

ENC41 799 823 826 817 829 824 851 856 872 896 869 873 874 875 905 899 913 916 900 914 933 917 910 895 912 892

NC 803 824 826 807 826 828 848 863 864 889 874 862 872 871 899 895 902 904 887 899 906 887 864 863 871 845

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 5.1 i. All Causes of Death: Trends in mortality rates for WNC, ENC41, and NC,

1979-2004 with projections to 2010

5.2

WNC ENC41 NC29% increase 14% increase 8% increase

R2 = 0.87 R2 = 0.79 R2 = 0.44y = 9.75x + 878 y = 4.38x + 818 y = 2.67x + 828

1979 WNC rate is 7% greater than ENC412004 WNC rate is 21% greater than ENC41

WNC ENC41 NC WNC ENC41 NC7% LT 6% LT WNC 17% LT 20% LT WNC

7% GT 1% GT ENC41 21% GT 3% LT ENC416% GT 1% LT NC 25% GT 4% GT NC

Comparison of Fitted Rates in 2004Comparison of Fitted Rates in 1979




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WNC 951 953 944 921 916 915 924 939 916 955 910 896 896 869 900 884 885 895 859 864 873 844 859 868 861 840

ENC41 1108 1144 1124 1095 1107 1087 1119 1092 1101 1115 1067 1064 1046 1032 1058 1039 1043 1018 995 995 1003 970 993 971 980 949

NC 1037 1057 1040 1000 1018 1010 1024 1021 1007 1025 994 974 968 956 977 965 964 944 921 923 920 895 910 903 903 873

US 1012 1040 1008 986 991 983 988 979 970 976 951 939 923 906 926 913 909 894 878 870 875 869 855 846

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 5.1 ii. All Causes of Death: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


5.3

WNC ENC41 NC US11% decrease 16% decrease 16% decrease 18% decrease

R2 = 0.83 R2 = 0.92 R2 = 0.93 R2 = 0.97y = -4.11x + 953 y = -7.04x + 1,146 y = -6.57x + 1,059 y = -7.78x + 1,034

1979 WNC rate is 17% less than ENC412004 WNC rate is 12% less than ENC41

WNC ENC41 NC US WNC ENC41 NC US20% GT 11% GT 9% GT WNC 14% GT 5% GT 1% LT WNC

17% LT 8% LT 10% LT ENC41 12% LT 8% LT 13% LT ENC4110% LT 8% GT 2% LT NC 5% LT 8% GT 6% LT NC8% LT 11% GT 2% GT US 1% GT 15% GT 7% GT US





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NWM 1646 1617 1571 1577 1548 1790 1507 1555 1498 1657 1594 1581 1662 1615 1803 1502 1419 1570 1616 1398 1460 1159 1254 1339 1325 1220

WM 1281 1276 1241 1192 1201 1184 1182 1223 1183 1215 1168 1167 1139 1111 1119 1125 1124 1119 1077 1065 1062 1032 1039 1042 1035 1014

NWF 807 911 959 882 1015 985 903 949 851 973 978 905 857 866 989 923 980 947 863 953 870 652 874 781 974 801

WF 688 693 694 693 680 681 719 708 702 736 692 674 694 669 701 684 685 698 666 685 708 696 703 711 702 689

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 5.1 iii. All Causes of Death: Trends in age-adjusted mortality rates by race and gender for WNC,


5.4

NWM WM NWF WF22% decrease 20% decrease 9% decrease

R2 = 0.46 R2 = 0.94 R2 = 0.10 R2 = 0.00y = -14.19x + 1,710 y = -9.83x + 1,272 y = -3.37x + 947 y = 0.06x + 693

NWM WM NWF WF NWM WM NWF WF26% LT 45% LT 59% LT NWM 24% LT 36% LT 49% LT NWM

34% GT 26% LT 45% LT WM 32% GT 16% LT 32% LT WM81% GT 34% GT 27% LT NWF 57% GT 19% GT 19% LT NWF

147% GT 83% GT 37% GT WF 95% GT 48% GT 24% GT WF

Comparison of Fitted Rates in 1979 Comparison of Fitted Rates in 2004




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NW 1160 1208 1210 1173 1226 1304 1146 1190 1117 1253 1233 1166 1165 1167 1327 1147 1165 1204 1166 1145 1104 860 1016 1024 1108 983

W 939 939 929 908 899 895 912 926 906 939 892 882 882 854 879 870 871 879 843 849 862 842 851 858 850 832

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

5.5

Figure 5.1 iv. All Causes of Death: Trends in age-adjusted mortality rates by race for WNC,


NW W16% decrease 11% decrease

R2 = 0.37 R2 = 0.81y = -7.83x + 1,258 y = -3.89x + 937

1979 Non-white rate is 34% greater than White2004 Non-white rate is 27% greater than White




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ge d

iffer

ence

- N

on-w

hite

to W

hite

% difference 23 29 30 29 36 46 26 28 23 33 38 32 32 37 51 32 34 37 38 35 28 2 19 19 30 18

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

5.6

Figure 5.1 v. All Causes of Death: Measuring disparity in age-adjusted mortality rates by race for WNC,


Disparity

R2 = 0.07y = -0.33x + 35



Page Center for Health Services Research and Development, ECU 5.7

All Causes of Premature Mortality

• WNC’s premature mortality rate has decreased by 12% over 26 years, with (4.36 deaths/year).

• The relative regional disparity in age-adjusted rates between WNC and ENC was 22% in 1979 and decreased to 16% in 2004. • The rate disparity between non-White males and White males was 80% -- in 2004 it was 57%. This indicates that the rate gap

is closing. • White females have the lowest rate and the lowest rate of decrease. • The non-White female fitted rate was 94% greater than that of White females in 1979, decreasing to 66% greater in 2004,

indicating a decreasing disparity. • A recent decrease in the premature mortality rate for non-White males and a leveling of rates for White males suggests a

reduction in racial disparity. • In 2004, the non-White rate is about 59% greater than the White rate. • In a moderately reliable trend, there has been a 30% decrease in racial disparity in WNC.




Figure 5.2 i. All Causes of Premature Mortality: Trends in premature mortality rates for WNC, ENC41, and NC,


750

850

950

1050

1150

1250

Year

s of

life

lost

per

10,

000

popu

latio

n <7

5 ye

ars

of a

ge

WNC 1013 1020 958 969 884 894 886 936 921 974 924 901 900 860 871 892 906 905 867 884 890 871 839 852 884 894

ENC41 1227 1182 1159 1126 1099 1063 1076 1099 1077 1101 1066 1072 1064 1062 1071 1064 1042 1034 986 999 996 966 958 950 953 962

NC 1106 1098 1059 1019 978 977 980 1002 991 1005 997 970 967 947 966 963 945 921 886 886 880 857 840 832 841 841

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

WNC ENC41 NC12% decrease 20% decrease 23% decrease

R2 = 0.52 R2 = 0.88 R2 = 0.90y = -4.36x + 966 y = -8.82x + 1,175 y = -9.55x + 1,081


WNC ENC41 NC WNC ENC41 NC22% GT 12% GT WNC 11% GT 2% LT WNC

18% LT 8% LT ENC41 10% LT 12% LT ENC4111% LT 9% GT NC 2% GT 13% GT NC





Figure 5.2 ii. All Causes of Premature Mortality: Trends in age-adjusted premature mortality rates for WNC, ENC41, NC, and US,


700

800

900

1000

1100

1200

1300

1400

Age

-adj

uste

d ye

ars

of li

fe lo

st p

er 1

0,00

0 po

pula

tion

<75

year

s of

age

WNC 1039 1036 969 980 880 889 876 924 905 958 901 875 866 822 827 850 863 859 818 832 836 816 787 796 831 844

ENC41 1319 1266 1249 1200 1167 1124 1133 1153 1131 1151 1107 1111 1093 1085 1091 1082 1060 1048 997 1005 998 960 957 946 946 950

NC 1170 1157 1115 1067 1021 1016 1016 1034 1021 1030 1016 983 976 953 967 963 944 920 882 880 871 842 835 823 829 825

US 1055 1053 1016 977 954 943 943 944 935 936 925 910 898 874 882 872 858 818 782 763 758 755 755 751

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10


R2 = 0.71 R2 = 0.94 R2 = 0.94 R2 = 0.96y = -7.53x + 982 y = -12.97x + 1,265 y = -12.72x + 1,139 y = -13.01x + 1,053








Figure 5.2 iii. All Causes of Premature Mortality: Trends in age-adjusted premature mortality rates by race and gender for WNC,


450550650750850950

1050115012501350145015501650175018501950205021502250235024502550265027502850

Age

-adj

uste

d ye

ars

of li

fe lo

st p

er 1

0,00

0 po

pula

tion

<75

year

s of

age

NWM 2574 2353 1957 2185 1825 2122 1878 1909 2007 2262 2154 1952 1886 1968 2324 1861 1841 1994 1897 1881 1710 1408 1241 1717 1284 1457

WM 1364 1398 1312 1297 1146 1158 1113 1212 1153 1206 1147 1154 1121 1043 1017 1086 1095 1107 1050 1036 1031 1042 996 1002 1036 1055

NWF 1077 1160 1115 997 1250 1128 1026 1168 1059 1123 1299 1032 1120 948 903 1052 1160 958 940 1061 1007 675 919 841 971 935

WF 658 629 593 623 557 568 593 588 607 641 571 540 553 542 563 556 564 551 520 561 586 565 547 529 598 590

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

NWM WM NWF WF35% decrease 25% decrease 24% decrease 10% decrease

R2 = 0.57 R2 = 0.75 R2 = 0.38 R2 = 0.28y = -31.52x + 2,335 y = -12.56x + 1,299 y = -10.68x + 1,180 y = -2.40x + 609








Figure 5.2 iv. All Causes of Premature Mortality: Trends in age-adjusted premature mortality rates by race for WNC,


700

800

900

1000

1100

1200

1300

1400

1500

1600

1700

1800

1900

Age

-adj

uste

d ye

ars

of li

fe lo

st p

er 1

0,00

0 po

pula

tion

<75

year

s of

age

NW 1769 1705 1504 1547 1510 1575 1414 1515 1497 1659 1689 1466 1472 1420 1579 1441 1483 1448 1386 1455 1339 1022 1076 1274 1118 1185

W 994 999 937 947 839 850 842 888 869 913 850 839 830 785 782 813 823 823 779 793 804 801 768 761 813 821

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10


R2 = 0.64 R2 = 0.66y = -19.57x + 1,708 y = -6.95x + 939





Figure 5.2 v. All Causes of Premature Mortality: Measuring disparity in age-adjusted mortality rates by race for WNC,


15

25

35

45

55

65

75

85

95

105

115

Perc

enta

ge d

iffer

ence

- N

on-w

hite

to W

hite

% difference 78 71 60 63 80 85 68 71 72 82 99 75 77 81 102 77 80 76 78 83 67 28 40 67 37 44

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Disparity30% decrease

R2 = 0.18y = -0.95x + 84




6. Trends and Disparities in Mortality in Western North Carolina:

Ten Specific Leading Causes of Death, 1979-2004

6




Diseases of Heart

• There is a decreasing trend in heart disease mortality for all regions. The rates for heart disease mortality in WNC are below those of all other regions.

• After age-adjustment, the rates for heart disease mortality for WNC remain below those for all other regions, with the least

amount of change white males have the highest rate of decrease. • The trends for males, both non-white and white, are converging with those of non-white and white females. • Non-whites have seen a 41% decrease in heart disease mortality; whites have seen a 48% decrease, the relative disparity has

increased in 2004. • The increasing trend for racial disparity is unreliable.




Figure 6.1 i. Diseases of Heart: Trends in mortality rates for WNC, ENC41, and NC,


175

200

225

250

275

300

325

350

375

Mor

talit

y ra

te p

er 1

00,0

00 p

opul

atio

n

PNC 295 293 299 286 300 295 293 296 292 286 276 265 266 265 260 255 252 251 240 237 230 223 205 200 199 183

ENC41 288 293 301 292 305 302 305 302 304 299 287 280 277 275 279 275 272 278 265 266 261 259 249 238 240 223

NC 299 299 307 297 310 306 305 306 304 300 289 279 281 278 277 273 269 271 259 258 250 243 229 222 222 205

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10


R2 = 0.64 R2 = 0.81 R2 = 0.87y = -2.76x + 367 y = -2.67x + 313 y = -3.72x + 325








Figure 6.1 ii. Diseases of Heart: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


150

200

250

300

350

400

450

500

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

WNC 369 370 370 360 361 358 347 343 333 328 311 298 300 284 288 282 274 269 258 252 235 220 227 220 216 204

ENC41 430 434 429 415 427 419 419 402 401 386 364 358 343 337 337 329 320 315 299 296 286 277 276 262 262 241

NC 404 402 399 382 393 385 381 374 365 355 337 325 319 311 308 300 293 286 272 267 256 246 243 234 232 214

US 402 412 397 389 389 379 375 365 356 352 332 322 313 304 308 297 293 286 278 271 266 258 248 241

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10


R2 = 0.99 R2 = 0.98 R2 = 0.99 R2 = 0.99y = -7.14x + 392 y = -8.06x + 457 y = -7.92x + 425 y = -7.53x + 420


WNC ENC41 NC US WNC ENC41 NC US17% GT 9% GT 7% GT WNC 20% GT 7% GT 9% GT WNC

14% LT 7% LT 8% LT ENC41 17% LT 11% LT 9% LT ENC418% LT 7% GT 1% LT NC 6% LT 13% GT 2% GT NC7% LT 9% GT 1% GT US 8% LT 10% GT 2% LT US





100

200

300

400

500

600

700

800

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NWM 515 589 569 432 477 615 523 446 509 512 440 477 594 477 590 474 384 431 465 384 290 285 358 345 311 331

WM 536 505 487 478 484 483 454 455 427 433 408 394 392 361 365 372 359 333 340 312 314 280 291 283 274 255

NWF 284 328 356 314 332 313 250 283 263 310 282 273 263 293 308 267 219 246 232 310 226 172 209 177 252 182

WF 246 268 273 270 267 260 266 258 257 244 235 222 227 220 218 212 211 214 189 196 174 175 175 167 166 160

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

6.4

Figure 6.1 iii. Diseases of Heart: Trends in age-adjusted mortality rates by race and gender for WNC,



R2 = 0.57 R2 = 0.98 R2 = 0.60 R2 = 0.93y = -9.58x + 584 y = -10.57x + 530 y = -4.99x + 334 y = -4.72x + 286








Figure 6.1 iv. Diseases of Heart: Trends in age-adjusted mortality rates by race for WNC,


150

200

250

300

350

400

450

500

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NW 379 435 441 366 393 432 358 349 363 394 343 349 380 369 420 343 281 312 323 351 254 218 262 253 279 248

W 368 367 366 360 359 354 347 342 331 324 310 296 296 280 281 279 274 267 255 247 234 220 225 218 213 202

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10


R2 = 0.69 R2 = 0.99y = -6.80x + 434 y = -7.15x + 389





Figure 6.1 v. Diseases of Heart: Measuring disparity in age-adjusted mortality rates by race for WNC,


-5

0

5

10

15

20

25

30

35

40

45

50

55

Perc

enta

ge d

iffer

ence

- N

on-w

hite

to W

hite

% difference 3 19 21 2 10 22 3 2 10 22 11 18 28 31 49 23 3 17 27 42 9 -1 16 16 31 23

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Disparity

R2 = 0.09y = 0.50x + 11




Cancer - Trachea, Bronchus, Lung

• The cancer -TBL mortality rate for WNC shows the largest increase (85%), and the highest rate of increase in a reliable trend, followed by ENC (54%) and NC (48%). In 2004, the mortality rate for WNC is 19% greater than ENC.

• The rates for age-adjusted mortality for WNC are below that for the state and eastern region. However, this mortality rate

shows the largest increase (42%) over the years, while NC (30%) and ENC (26%) show smaller rates of increase. WNC has a higher rate of increase.

• The mortality rate for males, both non-white and white, is greater than that of non-white and white females, but white and non-

white females are showing the largest amount of increase over 26 years. • The white mortality rate shows a significant 44% increase over the 26-year period, which is three times that of non-whites. • There is a 127% decrease in the racial disparity, favoring non-whites, in a reliable trend.




35

45

55

65

75

85

95

105

Mor

talit

y ra

te p

er 1

00,0

00 p

opul

atio

n

WNC 42 43 44 44 46 55 55 54 57 63 65 68 64 74 73 75 71 75 76 77 74 74 77 72 69 75

ENC41 40 42 42 46 47 50 50 49 54 58 59 61 60 59 65 66 63 64 66 63 65 62 65 60 59 61

NC 38 40 43 45 46 48 50 51 53 57 59 59 57 60 62 64 60 64 62 62 61 60 60 58 58 59

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.2 i. Cancer - Trachea, Bronchus, Lung: Trends in mortality rates for WNC, ENC41, and NC,



R2 = 0.81 R2 = 0.72 R2 = 0.69y = 1.44x + 44 y = 0.92x + 44 y = 0.82x + 44

1979 WNC rate is the same as ENC412004 WNC rate is 19% greater than ENC41

WNC ENC41 NC WNC ENC41 NC0 0 WNC 16% LT 20% LT WNC

0 1% LT ENC41 19% GT 4% LT ENC410 1% GT NC 24% GT 4% GT NC





40

45

50

55

60

65

70

75

80

85

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

WNC 42 41 42 42 43 50 49 48 50 54 55 58 54 61 59 61 57 59 59 59 56 57 61 57 54 58

ENC41 48 51 52 55 55 58 58 57 62 65 66 69 66 65 71 71 67 67 70 65 66 63 67 63 60 62

NC 43 46 49 50 51 52 54 55 57 60 61 62 60 62 64 65 61 64 62 62 60 59 62 60 58 59

US 48 50 50 52 53 54 55 55 56 57 58 59 59 59 59 59 58 58 58 57 55 56 55 55

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

6.9

Figure 6.2 ii. Cancer - Trachea, Bronchus, Lung: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


WNC ENC41 NC US42% increase 26% increase 30% increase 13% increase

R2 = 0.68 R2 = 0.44 R2 = 0.55 R2 = 0.40y = 0.71x + 44 y = 0.55x + 55 y = 0.57x + 50 y = 0.29x + 52



21% LT 9% LT 5% LT ENC41 11% LT 7% LT 14% LT ENC4112% LT 10% GT 5% GT NC 4% LT 7% GT 8% LT NC16% LT 5% GT 4% LT US 4% GT 16% GT 8% GT US





0

25

50

75

100

125

150

175

200

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NWM 105 103 74 146 100 101 94 97 98 133 113 116 75 146 119 73 75 86 112 91 128 83 89 51 83 88

WM 75 72 74 78 75 87 82 82 86 92 88 97 90 91 94 97 90 93 88 90 79 81 88 79 74 80

NWF 10 32 18 10 12 37 24 19 25 25 29 23 27 23 13 33 45 34 45 36 31 37 49 38 42 36

WF 15 16 19 13 20 21 25 22 23 25 29 30 28 38 33 35 32 33 36 37 38 38 40 41 38 42

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

6.10

Figure 6.2 iii. Cancer - Trachea, Bronchus, Lung: Trends in age-adjusted mortality rates by race and gender for WNC,


NWM WM NWF WF22% decrease 179% increase 197% increase

R2 = 0.10 R2 = 0.06 R2 = 0.51 R2 = 0.92y = -0.97x + 112 y = 0.24x + 81 y = 1.04x + 15 y = 1.11x + 15


38% GT 82% LT 82% LT WM 1% GT 53% LT 52% LT WM646% GT 441% GT 3% LT NWF 115% GT 114% GT 3% GT NWF669% GT 458% GT 3% GT WF 108% GT 107% GT 3% LT WF





35

40

45

50

55

60

65

70

75

80

85

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NW 50 61 42 63 49 64 53 49 55 67 62 59 46 72 57 50 57 54 72 56 70 55 66 43 60 59

W 41 40 43 41 43 50 49 48 50 53 54 58 54 60 59 61 57 59 58 59 56 57 61 57 53 58

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

6.11

Figure 6.2 iv. Cancer - Trachea, Bronchus, Lung: Trends in age-adjusted mortality rates by race for WNC,


NW W44% increase

R2 = 0.04 R2 = 0.68y = 0.23x + 54 y = 0.74x + 43

1979 Non-white rate is 26% greater than White2004 Non-white rate is 2% less than White




-40-35-30-25-20-15-10-505

1015202530354045505560

Perc

enta

ge d

iffer

ence

- N

on-w

hite

to W

hite

% difference 20 53 -2 55 15 29 7 2 11 25 14 2 -17 20 -3 -23 -1 -9 25 -5 25 -3 9 -33 12 1

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

6.12

Figure 6.2 v. Cancer - Trachea, Bronchus, Lung: Measuring disparity in age-adjusted mortality rates by race for WNC,



R2 = 0.23y = -1.28x + 26





• WNC’s stroke mortality rate is increasing, but the trend is unreliable. However, the ENC and state rates are decreasing with reliable trends.

• The WNC age-adjusted stroke mortality rate is decreasing (37%) but at a lower rate than the nation (42%), the state (46%) and

ENC (49%). • Non-white males have the highest mortality rates for stroke, but they are decreasing and converging on those of the other

gender-race demographic groups. • The mortality rates for non-whites are decreasing but was relatively 48% greater than that of whites in 2004. • The flat trend for racial disparity is not reliable.




55

60

65

70

75

80

85

90

95

100

105

110

Mor

talit

y ra

te p

er 1

00,0

00 p

opul

atio

n

WNC 87 75 81 74 73 73 77 80 76 85 77 73 80 68 77 78 79 87 83 88 93 90 84 77 73 73

ENC41 80 87 83 82 77 75 79 72 74 78 73 68 68 68 67 75 74 72 71 73 74 72 66 63 66 64

NC 81 81 79 76 75 73 74 71 70 74 70 67 68 67 69 73 72 73 70 72 73 70 66 63 62 58

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

6.14

Figure 6.3 i. Cerebrovascular Disease: Trends in mortality rates for WNC, ENC41, and NC,


WNC ENC41 NC 20% decrease 18% decrease

R2 = 0.05 R2 = 0.64 R2 = 0.61y = 0.19x + 77 y = -0.63x + 82 y = -0.55x + 78

1979 WNC rate is 6% less than ENC412004 WNC rate is 23% greater than ENC41

WNC ENC41 NC WNC ENC41 NC6% GT 2% GT WNC 19% LT 21% LT WNC

6% LT 4% LT ENC41 23% GT 2% LT ENC412% LT 4% GT NC 26% GT 2% GT NC





35

45

55

65

75

85

95

105

115

125

135

145

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

WNC 103 88 92 81 78 77 80 80 73 81 71 66 71 59 65 65 65 69 65 67 70 67 66 59 56 55

ENC41 131 138 128 123 117 112 115 103 103 107 98 91 89 86 84 93 90 85 82 83 83 78 75 71 74 70

NC 120 117 112 104 102 99 98 91 89 91 86 81 80 77 79 83 80 78 75 75 76 72 71 67 65 61

US 97 96 90 84 81 79 76 73 72 71 67 65 63 61 63 63 63 62 61 59 62 61 58 56

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

6.15

Figure 6.3 ii. Cerebrovascular Disease: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,



R2 = 0.75 R2 = 0.92 R2 = 0.91 R2 = 0.85y = -1.28x + 89 y = -2.45x + 130 y = -1.97x + 112 y = -1.56x + 90








40

50

60

70

80

90

100

110

120

130

140

150

160

170

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NWM 132 87 115 147 139 152 139 130 106 133 142 101 118 96 68 117 68 123 89 104 100 84 111 93 90 71

WM 105 99 98 85 78 77 88 85 79 86 73 76 72 67 63 67 67 66 63 74 65 63 67 58 56 57

NWF 92 105 106 99 124 132 121 121 84 91 67 77 100 74 108 91 95 126 88 116 75 67 81 58 67 82

WF 100 78 86 75 73 70 70 73 67 75 67 58 66 52 63 60 62 65 62 59 69 67 62 58 52 52

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

6.16

Figure 6.3 iii. Cerebrovascular Disease: Trends in age-adjusted mortality rates by race and gender for WNC,



R2 = 0.37 R2 = 0.81 R2 = 0.27 R2 = 0.60y = -1.97x + 136 y = -1.57x + 96 y = -1.41x + 113 y = -1.09x + 82


43% GT 19% GT 14% LT WM 55% GT 38% GT 3% LT WM20% GT 16% LT 28% LT NWF 12% GT 28% LT 30% LT NWF67% GT 17% GT 39% GT WF 60% GT 3% GT 43% GT WF





40

60

80

100

120

140

160

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NW 109 100 108 116 129 141 130 122 94 109 98 85 107 83 97 100 90 127 90 113 87 77 92 72 76 78

W 102 87 91 79 76 73 77 78 72 80 70 65 69 58 63 64 64 66 63 65 69 66 64 58 54 54

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

6.17

Figure 6.3 iv. Cerebrovascular Disease: Trends in age-adjusted mortality rates by race for WNC,



R2 = 0.42 R2 = 0.73y = -1.59x + 123 y = -1.26x + 87





0

10

20

30

40

50

60

70

80

90

100

Perc

enta

ge d

iffer

ence

- N

on-w

hite

to W

hite

% difference 7 14 18 47 71 92 69 57 30 36 40 31 55 43 53 56 40 91 42 72 26 17 43 23 40 43

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

6.18

Figure 6.3 v. Cerebrovascular Disease: Measuring disparity in age-adjusted mortality rates by race for WNC,


Disparity

R2 = 0.00y = 0.07x + 44





6.19

• The trends in mortality rate for WNC, ENC, and NC are all increasing, but WNC shows the sharpest increase (213%) when compared to the other regions (185% and 156%, respectively).

• The trends for age-adjusted mortality rate for ENC, WNC, NC, and the US are all increasing similarly, with WNC exhibiting the

highest rate of increase while diverging from the other rates. • Non-white female and white female mortality are increasing by 107% and 406%, respectively, and white females are

converging on non-white male and white male mortality, which are increasing at a slower rate (21% and 43%, respectively). • The white mortality trend is reliable and increasingly divergent from the non-white mortality rate. • The decreasing trend for racial disparity is not reliable.




10

20

30

40

50

60

70

80

90

100

Mor

talit

y ra

te p

er 1

00,0

00 p

opul

atio

n

WNC 27 24 29 31 30 32 35 40 39 44 39 42 48 49 56 49 57 58 61 62 69 68 60 67 71 63

ENC41 15 19 20 22 24 22 25 27 28 32 27 31 30 33 38 36 39 41 42 40 46 45 44 45 45 42

NC 19 21 22 23 25 24 27 29 28 32 29 31 34 35 41 36 40 41 43 42 47 46 43 44 46 42

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.4 i. Chronic Lower Respiratory Diseases: Trends in mortality rates for WNC, ENC41, and NC,



R2 = 0.95 R2 = 0.95 R2 = 0.94y = 1.87x + 23 y = 1.20x + 17 y = 1.13x + 19



35% GT 12% GT ENC41 49% GT 1% GT ENC4121% GT 11% LT NC 47% GT 1% LT NC


6.20




15

25

35

45

55

65

75

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

WNC 27 24 29 30 28 29 32 37 35 39 33 36 40 41 46 39 45 45 46 47 51 50 47 52 54 48

ENC41 20 25 27 29 30 29 33 34 34 39 33 38 35 39 44 42 44 45 46 43 49 47 48 49 48 45

NC 23 26 27 27 29 28 31 33 32 36 32 34 37 38 43 38 42 42 44 43 47 46 45 46 48 44

US 26 28 29 29 32 32 35 35 35 36 37 37 38 38 41 40 40 41 41 42 45 44 44 43

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.4 ii. Chronic Lower Respiratory Diseases: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


6.21


R2 = 0.92 R2 = 0.91 R2 = 0.94 R2 = 0.95y = 1.10x + 25 y = 1.04x + 24 y = 0.97x + 24 y = 0.76x + 27


WNC ENC41 NC US WNC ENC41 NC US2% LT 4% LT 11% GT WNC 4% LT 8% LT 11% LT WNC

2% GT 2% LT 13% GT ENC41 4% GT 4% LT 8% LT ENC414% GT 2% GT 15% GT NC 9% GT 4% GT 3% LT NC

10% LT 12% LT 13% LT US 13% GT 8% GT 4% GT US





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NWM 51 37 49 25 40 30 76 72 34 74 31 45 42 41 84 50 52 22 94 31 66 58 36 81 26 53

WM 48 47 55 51 48 54 49 62 61 65 53 53 63 63 68 54 67 68 66 68 67 65 64 65 73 64

NWF 20 8 3 0 10 21 17 20 3 18 31 13 8 17 18 12 26 15 24 21 27 18 28 15 19 14

WF 13 9 12 19 16 13 20 20 20 22 20 27 28 27 31 31 31 32 34 35 42 43 38 46 45 39

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.4 iii. Chronic Lower Respiratory Diseases: Trends in age-adjusted mortality rates by race and gender for WNC,


6.22

NWM WM NWF WF 43% increase 107% increase 406% increase

R2 = 0.02 R2 = 0.64 R2 = 0.18 R2 = 0.94y = 0.37x + 45 y = 0.81x + 49 y = 0.44x + 11 y = 1.38x + 9

NWM WM NWF WF NWM WM NWF WF9% GT 76% LT 80% LT NWM 28% GT 60% LT 20% LT NWM

9% LT 78% LT 82% LT WM 22% LT 69% LT 37% LT WM325% GT 365% GT 16% LT NWF 152% GT 222% GT 102% GT NWF409% GT 456% GT 20% GT WF 25% GT 60% GT 50% LT WF





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NW 32 20 20 10 20 24 37 38 16 37 31 26 21 26 41 24 35 17 49 25 39 32 31 37 21 29

W 27 24 29 32 29 30 31 37 36 39 33 37 41 41 46 40 45 46 46 48 52 51 48 53 56 49

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.4 iv. Chronic Lower Respiratory Diseases: Trends in age-adjusted mortality rates by race for WNC,


6.23

NW W118% increase

R2 = 0.09 R2 = 0.93y = 0.36x + 23 y = 1.13x + 25

1979 Non-white rate is 6% less than White2004 Non-white rate is 39% less than White




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% difference 19 -21 -49 -214 -43 -21 17 5 -126 -4 -8 -41 -96 -59 -11 -66 -31 -176 7 -93 -33 -62 -57 -44 -167 -70

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.4 v. Chronic Lower Respiratory Diseases: Measuring disparity in age-adjusted mortality rates by race for WNC,


6.24

Disparity

R2 = 0.05y = -1.79x - 31





6.25

• WNC’s mortality rates for Alzheimer’s Disease exhibits the largest rate of increase, but the overall greatest increase was experienced by ENC at 660%.

• Although rates are increasing the relative disparity between WNC and ENC has decreased between 1979 and 2004 by 40%. • Although white females possess the highest rate of increase, white males experienced the greatest percentage increase over

the measurement period. • White age-adjusted rates increased at a slightly higher rate that non-whites, with very little change in relative disparity over the

measurement period. • There is a decrease trend for the percentage difference between whites and non-whites, with the trend favoring non-whites.




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WNC 0 1 0 1 3 3 5 7 7 7 9 7 10 8 11 13 13 15 17 14 30 32 37 39 43 42

ENC41 0 0 1 0 1 1 2 2 4 4 4 4 5 5 5 5 7 6 6 7 12 14 15 15 17 17

NC 0 1 1 1 2 2 4 4 6 5 6 6 7 6 7 8 9 9 10 10 19 21 22 24 25 26

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.5 i. Alzheimer’s Disease: Trends in mortality rates for WNC, ENC41, and NC,


6.26


R2 = 0.83 R2 = 0.86 R2 = 0.85y = 1.62x - 8 y = 0.65x - 3 y = 0.98x - 4








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WNC 0 1 0 1 3 3 5 7 7 6 8 6 9 7 9 10 11 12 13 11 22 23 28 29 32 31

ENC41 0 1 1 1 2 2 4 3 5 5 6 6 6 6 7 7 9 8 7 8 15 16 17 17 19 20

NC 0 1 1 1 3 3 5 5 7 6 8 7 9 8 9 9 11 10 11 11 20 22 24 26 28 28

US 0 1 1 1 2 3 4 5 5 6 6 6 6 6 7 8 8 8 9 9 16 18 19 20

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.5 ii. Alzheimer’s Disease: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


6.27


R2 = 0.84 R2 = 0.88 R2 = 0.86 R2 = 0.84y = 1.18x - 5 y = 0.75x - 2 y = 2.10x - 4 y = 0.74x - 2


WNC ENC41 NC US WNC ENC41 NC US47% LT 20% LT 59% LT WNC 35% LT 10% LT 33% LT WNC

88% GT 50% GT 24% LT ENC41 53% GT 38% GT 2% GT ENC4125% GT 33% LT 49% LT NC 11% GT 28% LT 26% LT NC

147% GT 32% GT 98% GT US 50% GT 2% LT 36% GT US





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NWM 0 0 0 0 11 0 5 0 0 0 9 13 4 16 6 6 7 0 11 0 5 4 22 29 33 26

WM 0 1 1 2 3 4 5 8 9 7 9 6 9 5 10 9 10 10 11 11 19 17 23 22 26 24

NWF 0 0 0 0 4 0 4 0 7 0 0 0 3 9 9 9 9 5 2 15 13 18 24 19 34 36

WF 0 0 0 1 3 3 5 6 6 6 8 7 9 7 8 11 11 13 14 10 25 27 32 33 35 34

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.5 iii. Alzheimer’s Disease: Trends in age-adjusted mortality rates by race and gender for WNC,


6.28


R2 = 0.44 R2 = 0.84 R2 = 0.68 R2 = 0.83y = 0.85x - 3 y = 0.90x - 2 y = 1.12x - 7 y = 1.34x - 6

NWM WM NWF WF NWM WM NWF WF40% LT 90% GT 70% GT NWM 15% GT 20% GT 56% GT NWM

67% GT 218% GT 184% GT WM 13% LT 5% GT 36% GT WM47% LT 69% LT 11% LT NWF 17% LT 5% LT 29% GT NWF41% LT 65% LT 12% GT WF 36% LT 26% LT 23% LT WF





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NW 0 0 0 0 7 0 5 0 4 0 2 4 4 10 8 8 8 3 6 11 11 13 23 22 32 33

W 0 1 0 1 3 3 5 7 7 7 9 7 9 6 9 11 11 12 13 11 23 24 29 29 32 31

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.5 iv. Alzheimer’s Disease: Trends in age-adjusted mortality rates by race for WNC,


6.29


R2 = 0.67 R2 = 0.84y = 1.02x - 5 y = 1.19x - 5





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% difference 0 0 0 0 144 0 -2 0 -77 0 -260 -57 -130 58 -12 -29 -39 -251 -132 1 -104 -79 -24 -31 -1 8

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.5 v. Alzheimer’s Disease: Measuring disparity in age-adjusted mortality rates by race for WNC,


6.30

Disparity

R2 = 0.06y = -2.76x - 2





6.31

• The mortality rate for WNC was 20% less than ENC in 1979. In 2004, this rate was relatively 45% relatively greater than the ENC rate.

• The age-adjusted mortality rate for WNC is increasing and divergent from ENC, NC, and the US, with an unreliable trend. • The non-white male rate is converging on white males after a 47% decrease in 26 years. White females are the only

demographic with an increasing mortality rate trend yielding an 80% increase. • The non-white rate has seen a 45% decrease and has converged with white rates. • There is a 120% decrease in racial disparity, favoring non-whites.




Figure 6.6 i. All Other Unintentional Injuries and Adverse Effects: Trends in mortality rates for WNC, ENC41, and NC,


6.32

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WNC 27 27 24 25 24 22 20 21 25 25 25 24 21 23 21 21 23 24 21 23 26 28 31 37 37 41

ENC41 27 30 24 22 27 24 24 25 22 27 25 21 21 21 21 21 20 22 18 21 22 22 21 20 25 25

NC 24 26 23 21 23 21 21 22 22 23 22 20 19 19 19 19 19 20 18 20 22 23 22 24 26 27

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

WNC ENC41 NC48% increase 20% decrease

R2 = 0.29 R2 = 0.30 R2 = 0.00y = 0.38x + 21 y = -0.20x + 26 y = -0.01x + 22



20% LT 15% LT ENC41 45% GT 4% GT ENC416% LT 17% GT NC 39% GT 4% LT NC





Figure 6.6 ii. All Other Unintentional Injuries and Adverse Effects: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


6.33

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WNC 29 28 25 26 25 22 21 21 25 24 24 23 20 22 19 20 21 21 18 20 22 24 28 33 34 37

ENC41 31 35 29 26 32 27 26 28 25 30 28 23 23 24 23 23 22 23 20 22 24 23 22 21 27 26

NC 28 30 26 24 25 24 24 24 24 25 24 22 20 20 20 20 20 21 19 20 22 23 22 25 26 28

US 24 24 22 21 21 20 20 19 19 19 19 18 18 17 18 18 18 18 18 19 20 20 20 21

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

WNC ENC41 NC US 30% decrease 14% decrease 15% decrease

R2 = 0.05 R2 = 0.51 R2 = 0.14 R2 = 0.26y = 0.14x + 22 y = -0.35x + 30 y = -0.14x + 25 y = -0.13x + 21


WNC ENC41 NC US WNC ENC41 NC US35% GT 13% GT 5% LT WNC 17% LT 16% LT 31% LT WNC

26% LT 16% LT 30% LT ENC41 21% GT 1% GT 16% LT ENC4111% LT 20% GT 16% LT NC 19% GT 1% LT 17% LT NC6% GT 42% GT 19% GT US 44% GT 20% GT 21% GT US





Figure 6.6 iii. All Other Unintentional Injuries and Adverse Effects: Trends in age-adjusted mortality rates by race and gender for WNC,


6.34

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NWM 105 63 61 75 73 64 38 50 32 50 77 63 56 29 66 39 58 27 41 36 58 27 12 68 73 37

WM 41 42 41 40 38 33 30 30 36 31 33 34 30 33 30 28 30 33 26 30 28 36 39 49 43 50

NWF 13 23 23 15 21 20 14 19 19 20 27 18 6 9 6 10 10 16 16 13 3 9 17 19 22 21

WF 16 15 10 11 11 11 12 12 15 17 14 12 9 12 10 12 12 13 11 11 17 14 20 19 24 27

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

NWM WM NWF WF47% decrease 80% increase

R2 = 0.22 R2 = 0.01 R2 = 0.07 R2 = 0.29y = -1.27x + 70 y = 0.06x + 34 y = -0.22x + 19 y = 0.31x + 10


104% GT 46% LT 71% LT WM 7% GT 63% LT 51% LT WM276% GT 84% GT 47% LT NWF 192% GT 173% GT 34% GT NWF603% GT 245% GT 87% GT WF 118% GT 104% GT 25% LT WF





Figure 6.6 iv. All Other Unintentional Injuries and Adverse Effects: Trends in age-adjusted mortality rates by race for WNC,


6.35

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NW 55 41 40 43 44 39 25 33 26 31 51 38 27 19 32 24 32 21 25 24 27 15 14 42 41 29

W 27 27 24 25 24 21 20 21 24 24 22 22 19 22 19 20 20 21 18 20 22 25 29 33 33 38

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

NW W45% decrease

R2 = 0.28 R2 = 0.09y = -0.73x + 42 y = 0.19x + 21





Figure 6.6 v. All Other Unintentional Injuries and Adverse Effects: Measuring disparity in age-adjusted mortality rates by race for WNC,


6.36

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% difference 99 51 62 73 86 83 25 60 7 29 127 72 45 -13 68 21 56 -4 42 20 22 -63 -102 28 24 -31

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10


R2 = 0.41y = -4.14x + 90




Pneumonia and Influenza

6.37

• WNC’s influenza and pneumonia mortality rates are above those for ENC and NC with a trend that has produced a 29% increase in 26 years.

• There is a decreasing trend in age-adjusted mortality rate for WNC, and it is converging on the regional, NC, and the US rates,

with similar rates of decrease. • The mortality rates for males, both white and non-white, are decreasing significantly and converging on the relatively flat

female trends. • In 1979, the non-white rate was 11% greater than the white rate; it was 2% less than the white rate in 2004. • The decreasing trend for racial disparity, favoring non-whites, was not reliable.




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WNC 24 28 32 25 32 33 36 38 31 36 40 42 39 38 46 42 45 53 49 48 33 33 32 35 35 29

ENC41 18 19 23 19 19 20 27 25 24 26 27 27 26 27 30 28 31 30 30 34 23 22 19 22 22 20

NC 18 21 24 20 23 23 28 28 25 30 29 29 28 28 33 31 34 34 33 36 25 24 22 23 24 20

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.7 i. Pneumonia and Influenza: Trends in mortality rates for WNC, ENC41, and NC,


6.38

WNC ENC41 NC29% increase

R2 = 0.14 R2 = 0.06 R2 = 0.05y = 0.36x + 32 y = 0.14x + 23 y = 0.15x + 25








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WNC 29 34 37 28 36 36 38 39 31 35 38 40 35 33 40 35 38 42 38 37 25 25 25 27 26 22

ENC41 29 31 36 30 30 31 42 36 34 36 38 37 35 35 38 36 38 36 36 39 26 24 22 25 24 22

NC 27 32 34 28 32 32 38 38 33 38 36 37 34 33 38 36 38 38 36 38 26 25 24 25 25 21

US 26 31 30 27 30 31 35 35 34 37 36 37 35 33 35 34 33 33 33 35 24 24 22 23

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.7 ii. Pneumonia and Influenza: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


6.39

WNC ENC41 NC US21% decrease 21% decrease 20% decrease

R2 = 0.17 R2 = 0.16 R2 = 0.14 R2 = 0.07y = -0.31x + 38 y = -0.30x + 37 y = -0.27x + 36 y = -0.17x + 33


WNC ENC41 NC US WNC ENC41 NC US2% LT 4% LT 11% LT WNC 2% LT 2% LT 3% LT WNC

2% GT 2% LT 9% LT ENC41 3% GT 0 0 ENC414% GT 2% GT 7% LT NC 2% GT 0 0 NC

12% GT 10% GT 8% GT US 3% GT 0 0 US





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NWM 38 86 86 25 51 78 61 49 37 55 57 90 47 41 73 57 76 63 55 74 63 25 60 16 16 19

WM 43 47 50 43 52 45 57 50 40 43 50 49 42 45 44 49 48 57 48 43 31 27 28 30 31 29

NWF 8 24 21 22 33 28 37 17 26 25 36 26 32 13 26 28 28 24 27 31 21 14 10 20 33 11

WF 22 26 29 18 26 28 28 31 26 30 31 34 31 27 36 27 32 33 32 32 20 24 23 26 24 18

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.7 iii. Pneumonia and Influenza: Trends in age-adjusted mortality rates by race and gender for WNC,


6.40

NWM WM NWF WF40% decrease 35% decrease

R2 = 0.13 R2 = 0.39 R2 = 0.02 R2 = 0.01y = -1.03x + 68 y = -0.71x + 53 y = -0.15x + 26 y = -0.05x + 28


28% GT 51% LT 47% LT WM 20% GT 36% LT 23% LT WM162% GT 104% GT 8% GT NWF 89% GT 57% GT 20% GT NWF141% GT 88% GT 8% LT WF 56% GT 31% GT 17% LT WF





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NW 20 46 46 24 40 44 44 32 31 35 44 49 38 22 43 37 43 40 36 46 39 17 29 20 25 13

W 30 34 37 28 35 35 38 39 31 35 38 39 35 34 40 35 38 42 38 36 24 25 25 27 26 22

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.7 iv. Pneumonia and Influenza: Trends in age-adjusted mortality rates by race for WNC,


6.41


R2 = 0.13 R2 = 0.17y = -0.49x + 41 y = -0.30x + 37





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% difference -51 38 24 -13 13 24 15 -24 1 0 17 25 9 -52 8 5 15 -6 -4 28 59 -45 19 -35 -6 -73

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.7 v. Pneumonia and Influenza: Measuring disparity in age-adjusted mortality rates by race for WNC,


6.42

Disparity

R2 = 0.04y = -0.83x + 11




Diabetes Mellitus

6.43

• WNC’s diabetes mortality rates increased by 159% over 26 years and was similar to that for NC (147%). ENC shows the largest relative increase (204%) diverging from WNC.

• The divergent trend for ENC persists even after age-adjustment, and WNC rates fall below those for ENC, NC and the US. • The non-white male and non-white female mortality rates are increasingly divergent from those of white males and white

females. White males and non-white males have lower rates than white females and non-white females. Non-white females have the highest rate of increase.

• Non-white mortality rates have increased by 67%, compared to 82% for white mortality, however, the 2004 non-white rate was

194% greater than the white rate, and the rate of change was two and a half times greater than the white rate. • The relatively flat trend for racial disparity, are not reliable.




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WNC 14 13 12 14 13 14 14 15 17 22 22 19 21 20 25 24 25 26 23 25 29 28 28 28 28 25

ENC41 15 16 15 14 14 14 15 17 16 21 23 22 23 23 25 25 26 27 28 29 32 31 30 32 35 32

NC 14 15 13 13 14 14 14 15 16 20 21 20 22 21 23 23 24 25 25 26 27 26 27 26 28 26

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.8 i. Diabetes Mellitus: Trends in mortality rates for WNC, ENC41, and NC,


6.44


R2 = 0.87 R2 = 0.94 R2 = 0.93y = 0.70x + 11 y = 0.88x + 11 y = 0.66x + 12

1979 WNC rate is 3% greater than ENC412004 WNC rate is 12% less than ENC41

WNC ENC41 NC WNC ENC41 NC3% LT 2% GT WNC 14% GT 3% LT WNC

3% GT 5% GT ENC41 12% LT 15% LT ENC412% LT 5% LT NC 3% GT 17% GT NC





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WNC 16 14 12 14 13 13 13 14 16 21 19 17 18 18 21 20 20 21 18 20 23 22 22 22 22 20

ENC41 20 21 20 19 18 17 19 21 20 25 27 26 27 27 28 28 29 30 31 31 34 32 33 34 37 34

NC 17 18 16 16 17 17 16 17 18 23 23 22 24 23 24 24 26 26 25 26 27 26 28 28 29 27

US 17 18 18 17 18 17 17 17 17 18 21 21 21 21 22 23 23 24 24 24 25 25 25 25

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.8 ii. Diabetes Mellitus: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


6.45


R2 = 0.74 R2 = 0.91 R2 = 0.89 R2 = 0.91y = 0.38x + 13 y = 0.75x + 16 y = 0.54x + 15 y = 0.42x + 15



21% LT 7% LT 5% LT ENC41 36% LT 18% LT 26% LT ENC4115% LT 8% GT 2% GT NC 22% LT 23% GT 9% LT NC17% LT 6% GT 2% LT US 14% LT 35% GT 10% GT US





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NWM 72 41 7 22 38 54 31 37 30 70 72 65 47 50 60 36 68 57 63 85 52 54 34 39 76 44

WM 15 14 12 13 14 12 12 12 14 17 20 17 21 18 22 22 18 22 20 21 24 23 20 23 21 21

NWF 39 16 38 45 53 27 28 51 44 60 49 63 20 42 64 56 94 70 46 47 57 46 57 77 50 28

WF 13 13 12 12 9 12 13 13 14 18 16 13 16 15 17 16 16 16 14 16 19 18 21 17 19 17

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.8 iii. Diabetes Mellitus: Trends in age-adjusted mortality rates by race and gender for WNC,


6.46

NWM WM NWF WF51% increase 98% increase 62% increase 64% increase

R2 = 0.10 R2 = 0.73 R2 = 0.15 R2 = 0.61y = 0.78x + 40 y = 0.45x + 12 y = 0.88x + 37 y = 0.28x + 11

NWM WM NWF WF NWM WM NWF WF70% LT 7% LT 71% LT NWM 61% LT 0 69% LT NWM

231% GT 208% GT 5% LT WM 155% GT 154% GT 21% LT WM8% GT 68% LT 69% LT NWF 0 61% LT 69% LT NWF






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NW 50 26 25 37 44 36 30 45 39 66 61 62 32 46 62 48 88 66 52 63 56 50 49 65 60 38

W 14 14 12 12 11 12 12 13 15 18 17 15 18 16 19 18 17 19 17 18 21 20 21 20 20 19

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.8 iv. Diabetes Mellitus: Trends in age-adjusted mortality rates by race for WNC,


6.47

NW W67% increase 82% increase

R2 = 0.24 R2 = 0.77y = 0.96x + 37 y = 0.37x + 12





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% difference 257 95 115 197 297 206 139 252 169 258 248 312 77 186 223 160 411 251 213 252 164 150 136 221 199 100

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.8 v. Diabetes Mellitus: Measuring disparity in age-adjusted mortality rates by race for WNC,


6.48

Disparity

R2 = 0.00y = -0.47x + 210




Cancer - Colon, Rectum, Anus

6.49

• The cancer-CRA mortality rates for WNC and ENC have had similar increases in rates (20%) with slightly increasing and diverging trends.

• The age-adjusted mortality rates are slightly greater (15%) than ENC’s (13%). The state and national rates increased by 18%

and 29%, respectively. • The mortality rates for non-white males are increasing, while the rates for white and non-white females are decreasing. The

trend for white males is not reliable. • In 1979 the non-white rate, though decreasing, was 30% relatively greater than the white rate. In 2004 the relative rate

increased to 44%. • The increasing trend for racial disparity is not reliable.




15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Mor

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00 p

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WNC 20 20 20 20 21 17 20 22 23 25 24 24 25 26 24 24 22 24 22 27 26 24 22 26 23 20

ENC41 17 16 16 17 17 16 19 18 19 20 20 20 21 19 21 20 22 20 21 20 21 20 20 19 18 19

NC 18 18 18 19 18 18 19 20 20 21 21 20 20 21 21 21 22 21 20 20 20 19 19 19 18 18

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.9 i. Cancer - Colon, Rectum, Anus: Trends in mortality rates for WNC, ENC41, and NC,


6.50

WNC ENC41 NC20% increase 20% increase

R2 = 0.27 R2 = 0.37 R2 = 0.06y = 0.16x + 21 y = 0.13x + 17 y = 0.04x + 19








15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

WNC 22 21 21 20 22 17 19 20 21 23 21 21 21 22 20 20 18 19 17 21 20 18 17 20 18 16

ENC41 24 23 22 22 23 20 25 23 24 25 24 24 25 23 25 22 24 22 23 21 22 20 21 20 19 20

NC 23 22 22 22 22 21 23 24 23 23 23 22 22 22 22 22 23 21 20 20 20 19 20 20 18 18

US 27 27 27 27 26 27 26 26 25 25 25 24 24 23 23 23 22 22 21 21 21 21 20 20

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.9 ii. Cancer - Colon, Rectum, Anus: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


6.51


R2 = 0.29 R2 = 0.28 R2 = 0.62 R2 = 0.99y = -0.12x + 21 y = -0.12x + 24 y = -0.17x + 24 y = -0.34x + 28



11% LT 2% LT 17% GT ENC41 13% LT 7% LT 7% LT ENC4110% LT 2% GT 19% GT NC 6% LT 8% GT 0 NC24% LT 14% LT 16% LT US 6% LT 8% GT 0 US





0

10

20

30

40

50

60

70

80

Age

-adj

uste

d m

orta

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rate

per

100

,000

pop

ulat

ion

NWM 25 5 38 35 9 17 24 25 31 37 33 21 20 17 38 27 35 31 29 55 27 51 38 34 17 26

WM 24 24 24 20 24 20 20 23 27 28 23 24 22 25 23 25 21 25 22 21 24 19 20 24 22 19

NWF 24 8 19 33 42 27 24 36 34 23 48 26 23 29 32 28 28 14 14 23 21 17 20 21 20 15

WF 20 20 18 18 19 15 18 17 16 19 18 17 19 19 17 16 15 15 13 19 16 17 15 17 15 13

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.9 iii. Cancer - Colon, Rectum, Anus: Trends in age-adjusted mortality rates by race and gender for WNC,


6.52

NWM WM NWF WF65% increase 33% decrease 22% decrease

R2 = 0.13 R2 = 0.08 R2 = 0.11 R2 = 0.34y = 0.54x + 21 y = -0.09x + 24 y = -0.39x + 30 y = -0.16x + 19

NWM WM NWF WF NWM WM NWF WF13% GT 41% GT 11% LT NWM 37% LT 42% LT 57% LT NWM

11% LT 25% GT 21% LT WM 59% GT 7% LT 31% LT WM29% LT 20% LT 36% LT NWF 71% GT 7% GT 26% LT NWF12% GT 26% GT 57% GT WF 130% GT 45% GT 35% GT WF





0

10

20

30

40

50

60

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NW 24 7 27 32 31 25 24 32 32 29 44 24 22 24 34 28 31 20 21 37 22 30 27 27 19 18

W 22 21 20 19 21 17 19 20 20 22 20 21 21 22 20 20 18 19 17 20 20 18 17 20 18 16

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.9 iv. Cancer - Colon, Rectum, Anus: Trends in age-adjusted mortality rates by race for WNC,


6.53

NW W15% decrease

R2 = 0.00 R2 = 0.29y = -0.06x + 27 y = -0.12x + 21





-225

-200

-175

-150

-125

-100

-75

-50

-25

0

25

50

75

100

125

150

Perc

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to W

hite

% difference 11 -201 35 70 49 44 30 64 58 28 121 16 6 9 73 40 78 4 23 79 11 70 60 37 6 12

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.9 v. Cancer - Colon, Rectum, Anus: Measuring disparity in age-adjusted mortality rates by race for WNC,


6.54

Disparity

R2 = 0.04y = 1.48x + 12




Nephritis, Nephrotic Syndrome, and Nephrosis

6.55

• The mortality rate for WNC was 26% less than ENC in 1979 and 10% greater than ENC is 2004. WNC experienced the largest increase in rates (294%) as compared to ENC (164%) and NC (156%) over 26 years.

• The age-adjusted mortality rate for WNC is increasing by 111%, compared to 65% and 76% for ENC and NC, respectively. • The rates for non-white males and females are significantly above those for white males and females. Also, females, both

non-white and white, have seen a greater percent increase in mortality (150% and 121%, respectively), compared to their male counterparts (135% and 109%, respectively).

• The rate of increase (the slope) for non-white mortality nephritis, nephrotic syndrome, and nephrosis is twice that for whites,

diverging trend. • The flat trend for racial disparity is not reliable.




0

5

10

15

20

25

30

Mor

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WNC 6 8 8 7 8 9 10 9 6 6 8 9 10 8 9 10 9 12 12 12 19 16 19 18 20 19

ENC41 8 9 8 9 10 10 10 9 9 8 8 10 10 8 8 10 10 9 9 9 17 17 17 18 19 18

NC 8 8 9 9 9 9 10 9 7 7 8 9 9 8 8 9 9 10 9 9 15 16 16 17 16 17

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.10 i. Nephritis, Nephritic Syndrome, and Nephrosis: Trends in mortality rates for WNC, ENC41, and NC,


6.56


R2 = 0.72 R2 = 0.56 R2 = 0.60y = 0.50x + 4 y = 0.37x + 6 y = 0.35x + 6



26% LT 3% LT ENC41 10% GT 6% LT ENC4124% LT 3% GT NC 17% GT 6% GT NC





0

5

10

15

20

25

30

Age

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orta

lity

rate

per

100

,000

pop

ulat

ion

WNC 6 9 9 8 8 9 10 9 6 6 8 8 9 7 8 8 7 10 9 9 14 12 15 14 15 14

ENC41 11 14 12 13 14 14 14 12 12 11 11 12 12 10 10 11 12 11 11 10 18 19 19 20 20 20

NC 10 11 11 11 11 11 12 11 9 9 10 10 11 9 9 10 10 10 10 10 15 16 17 18 17 18

US 9 9 9 9 10 10 10 10 10 10 10 9 9 9 10 9 9 9 10 10 13 13 14 14

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.10 ii. Nephritis, Nephritic Syndrome, and Nephrosis: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


6.57


R2 = 0.48 R2 = 0.32 R2 = 0.38 R2 = 0.42y = 0.26x + 6 y = 0.25x + 10 y = 0.25x + 8 y = 0.15x + 8








0

10

20

30

40

50

60

70

80

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NWM 36 32 10 30 20 20 14 32 28 13 3 34 15 15 35 21 29 15 49 29 55 41 41 53 42 31

WM 8 9 14 10 11 10 11 10 6 7 10 12 11 8 10 10 10 13 11 12 17 15 18 15 19 17

NWF 0 19 13 19 26 14 7 21 0 7 3 26 13 15 9 8 9 24 19 9 22 16 27 33 27 22

WF 4 7 6 5 6 7 10 7 5 5 6 5 7 5 6 6 5 7 7 8 11 10 12 11 11 12

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.10 iii. Nephritis, Nephritic Syndrome, and Nephrosis: Trends in age-adjusted mortality rates by race and gender for WNC,


6.58

NWM WM NWF WF135% increase 109% increase 150% increase 121% increase

R2 = 0.25 R2 = 0.48 R2 = 0.19 R2 = 0.44y = 0.87x + 17 y = 0.31x + 7 y = 0.51x + 9 y = 0.21x + 5


124% GT 18% GT 39% LT WM 152% GT 41% GT 36% LT WM91% GT 15% LT 48% LT NWF 79% GT 29% LT 54% LT NWF






0

5

10

15

20

25

30

35

40

45

50

Age

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lity

rate

per

100

,000

pop

ulat

ion

NW 14 25 11 24 25 15 10 25 12 8 3 26 14 16 18 13 16 21 29 15 34 25 31 37 31 26

W 6 8 9 7 8 8 10 8 6 6 8 7 9 6 8 8 7 9 8 9 13 12 14 13 15 14

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.10 iv. Nephritis, Nephritic Syndrome, and Nephrosis: Trends in age-adjusted mortality rates by race for WNC,


6.59

NW W119% increase 115% increase

R2 = 0.26 R2 = 0.49y = 0.57x + 12 y = 0.25x + 6





-200

-150

-100

-50

0

50

100

150

200

250

300

Perc

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- N

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to W

hite

% difference 141 211 26 226 228 83 -5 195 114 48 -135 255 61 147 132 71 142 132 253 61 155 112 119 182 113 86

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

Figure 6.10 v. Nephritis, Nephritic Syndrome, and Nephrosis: Measuring disparity in age-adjusted mortality rates by race for WNC,


6.60

Disparity

R2 = 0.00y = -0.08x + 122




7. Trends and Disparities in Mortality in Western North Carolina:

Cancer - All Sites, 1979-2004

7




Cancer - All Sites

• WNC shows the largest increase in mortality rates in all cancer (43%) when compared to ENC (33%) and NC (23%). • The age-adjusted mortality trend shows a 5% increase in WNC during the 26-year period. The other trends are not reliable. • In a reliable trend, white females show a 14% increase in mortality. The trends for the other demographic groups are not

reliable. • The non-white trend is decreasing but unreliable, with the white trend showing a 7% increase in a moderately reliable trend. • There is a 54% decrease in disparity between non-whites and whites, in a moderately reliable trend. The trend favors non-

whites.




Figure 7.1 i. Cancer - All Sites: Trends in mortality rates for WNC, ENC41, and NC,


140

160

180

200

220

240

260

280

300

320

340

Mor

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WNC 173 184 180 182 186 192 196 203 212 228 227 231 231 245 243 241 241 248 241 249 258 239 236 246 234 238

ENC41 152 161 158 168 167 168 173 176 188 195 192 197 200 198 209 204 211 210 207 200 211 200 206 202 196 205

NC 157 165 166 169 171 173 178 183 189 196 197 199 198 204 207 207 207 207 204 203 206 195 196 194 192 192

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10


R2 = 0.77 R2 = 0.75 R2 = 0.56y = 2.99x + 182 y = 2.09x + 162 y = 1.50x + 170








Figure 7.1 ii. Cancer - All Sites: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


170

180

190

200

210

220

230

240

250

260

Age

-adj

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rate

per

100

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pop

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ion

WNC 178 187 179 179 181 184 183 186 191 203 199 201 197 206 201 198 196 197 190 194 198 184 189 195 184 186

ENC41 199 209 205 211 211 210 214 213 226 232 225 229 229 225 237 227 232 226 222 211 220 206 218 213 204 212

NC 190 198 197 198 198 199 203 206 210 216 215 216 212 217 219 216 214 212 207 204 205 193 203 200 195 195

US 204 208 206 208 209 211 211 212 212 212 214 216 215 214 214 212 210 207 203 201 201 200 196 193

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

WNC ENC41 NC US5% increase 5% decrease

R2 = 0.12 R2 = 0.03 R2 = 0.00 R2 = 0.27y = 0.38x + 186 y = 0.22x + 215 y = 0.08x + 204 y = -0.45x + 213



14% LT 5% LT 1% LT ENC41 11% LT 6% LT 8% LT ENC419% LT 5% GT 4% GT NC 5% LT 7% GT 2% LT NC

13% LT 1% GT 4% LT US 3% LT 9% GT 2% GT US





Figure 7.1 iii. Cancer - All Sites: Trends in age-adjusted mortality rates by race and gender for WNC,


100

150

200

250

300

350

400

450

500

550

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NWM 289 324 316 407 321 434 298 343 358 364 366 324 353 421 419 270 282 369 390 315 364 256 300 254 310 288

WM 234 250 231 221 234 239 230 243 248 264 255 269 252 264 260 262 258 255 242 246 248 231 238 242 226 225

NWF 160 172 165 211 193 185 182 158 216 187 240 166 160 173 180 223 243 196 210 167 184 122 196 147 218 165

WF 136 140 139 139 139 137 149 145 146 158 154 154 158 165 158 151 150 152 148 156 161 152 150 163 149 157

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

NWM WM NWF WF 14% increase

R2 = 0.09 R2 = 0.00 R2 = 0.00 R2 = 0.46y = -1.96x + 362 y = 0.03x + 244 y = -0.05x + 186 y = 0.73x + 140








Figure 7.1 iv. Cancer - All Sites: Trends in age-adjusted mortality rates by race for WNC,


150

175

200

225

250

275

300

325

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NW 214 236 225 287 243 285 227 224 270 256 291 223 235 268 271 240 255 262 283 214 249 172 232 187 257 213

W 176 185 177 173 178 179 181 184 187 200 195 200 196 204 198 196 193 194 186 193 196 185 187 195 181 184

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

NW W7% increase

R2 = 0.06 R2 = 0.17y = -0.96x + 256 y = 0.46x + 182





Figure 7.1 v. Cancer - All Sites: Measuring disparity in age-adjusted mortality rates by race for WNC,


-10

0

10

20

30

40

50

60

70

80

Perc

enta

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iffer

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- N

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to W

hite

% difference 22 28 27 66 37 59 26 22 44 28 49 11 20 32 36 22 32 35 52 11 27 -7 24 -4 42 15

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10


R2 = 0.14y = -0.84x + 41



Page Center for Health Services Research and Development, ECU 8

8. Trends and Disparities in Mortality in Western North Carolina: HIV Disease, 1987-2004




HIV Disease

• Between 1998 and 2004, WNC experienced a 34% decrease in its HIV mortality rates. Its rates are the lowest among the regions.

• From 1998 to 2004, WNC’s age-adjusted rates decreased by 37%. • The only reliable trend (five years) is for non-white females between 2000 and 2004, who experienced a 26% increase in their

age-adjusted mortality rates. • Non-whites experienced a 57% decrease in their age-adjusted mortality rates from 2000-2004, while white rates remained flat

during that time. • Between 2000 and 2004 the percentage difference between whites and non-whites has decreased by 239%. The trend,

though reliable, is for five years only.




-3

0

3

6

9

12

15

18

21

Mor

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00 p

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n

WNC 1 1 2 2 3 4 5 7 5 6 2 2 2 2 2 1 2 1

WNC JP 2.10 1.99 1.88 1.77 1.66 1.56 1.45 1.34 1.23 1.12 1.02 0.91 0.80

ENC41 3 4 5 6 7 10 10 13 14 11 7 6 6 6 6 7 7 5

ENC41 JP 6.67 6.57 6.47 6.38 6.28 6.18 6.09 5.99 5.89 5.79 5.70 5.60 5.50

NC 2 3 5 5 8 10 12 14 14 11 6 6 6 6 6 6 5 5

NC JP 6.02 5.87 5.73 5.58 5.43 5.29 5.14 4.99 4.85 4.70 4.56 4.41 4.26

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

8.2

Figure 8.1 i. HIV Disease: Trends in mortality rates for WNC, ENC41, and NC,


WNC ENC41 NC34% decrease 17% decrease

R2 = 0.57 R2 = 0.09 R2 = 0.59y = -0.11x + 2.20 y = -0.10x + 6.77 y = -0.15x + 6.16


WNC ENC41 NC WNC ENC41 NC207% GT 180% GT WNC 297% GT 240% GT WNC

67% LT 9% LT ENC41 75% LT 14% LT ENC4164% LT 10% GT NC 71% LT 17% GT NC





-6

-3

0

3

6

9

12

15

18

21

24

Age

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rate

per

100

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pop

ulat

ion

WNC 1 1 3 2 3 4 5 7 5 6 3 2 2 2 2 1 2 1

PNC JP 2.24 2.09 1.94 1.79 1.65 1.50 1.35 1.20 1.05 0.91 0.76 0.61 0.46

ENC41 3 4 6 6 7 10 11 13 14 11 8 7 7 7 6 8 7 5

ENC41 JP 6.86 6.75 6.65 6.55 6.45 6.35 6.25 6.15 6.05 5.95 5.85 5.75 5.65

NC 2 3 5 5 7 10 11 14 14 11 6 6 6 6 6 6 5 5

NC JP 5.98 5.84 5.69 5.55 5.41 5.26 5.12 4.97 4.83 4.69 4.54 4.40 4.26

US 6 7 9 10 12 13 14 16 16 12 6 5 5 5 5 5

US JP 5.60 5.44 5.28 5.13 4.97 4.81 4.66 4.50 4.34 4.19 4.03 3.87 3.72 3.56

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

8.3

Figure 8.1 ii. HIV Disease: Trends in age-adjusted mortality rates for WNC, ENC41, NC, and US,


WNC ENC41 NC US37% decrease 14% decrease 11% decrease

R2 = 0.68 R2 = 0.09 R2 = 0.57 R2 = 0.45y = -0.15x + 2.39 y = -0.10x + 6.96 y = -0.14x + 6.12 y = -0.16x + 5.60



66% LT 12% LT 20% LT ENC41 76% LT 17% LT 22% LT ENC4161% LT 14% GT 9% LT NC 72% LT 21% GT 6% LT NC57% LT 24% GT 9% GT US 70% LT 28% GT 6% GT US





-5

5

15

25

35

45

55

65

75

85

95

105

115

Age

-adj

uste

d m

orta

lity

rate

per

100

,000

pop

ulat

ion

NWM 3 5 17 19 13 21 39 60 21 87 9 15 11 29 14 17 6 16

NWM JP 21.71 21.78 21.85 21.92 22.00 22.07 22.14 22.22 22.29 22.36 22.44 22.51 22.58 22.66 22.73 22.80 22.88 22.95 23.02 23.10 23.17 23.24 23.31 23.39

WM 2 2 4 3 5 7 7 11 9 6 4 3 2 1 3 1 2 1

WM JP 2.50 2.44 2.39 2.33 2.28 2.23 2.17 2.12 2.06 2.01 1.95

NWF 0 4 4 0 6 0 0 10 0 7 9 7 9 3 15 3 6 3

NWF JP 2.12 2.43 2.74 3.05 3.35 3.66 3.97 4.28 4.59 4.90 5.21 5.51 5.82 6.13 6.44 6.75 7.06 7.36 7.67 7.98 8.29 8.60 8.91 9.22

WF 0 0 0 0 0 1 2 1 1 2 0 1 1 1 0 1 1 0

WF JP 0.43 0.45 0.47 0.49 0.51 0.53 0.55 0.57 0.59 0.61 0.63 0.65 0.67 0.69 0.71 0.73 0.75 0.77 0.79 0.81 0.83 0.85 0.87 0.89

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

8.4

Figure 8.1 iii. HIV Disease: Trends in age-adjusted mortality rates by race and gender for WNC,


NWM WM NWF WF 26% increase

R2 = 0.00 R2 = 0.00 R2 = 0.15 R2 = 0.04y = 0.07x + 22.58 y = -0.05x + 2.55 y = 0.31x + 5.82 y = 0.02x + 0.67


785% GT 128% GT 74% LT WM 880% GT 202% GT 68% LT WM288% GT 56% LT 88% LT NWF 224% GT 67% LT 89% LT NWF






-10

-5

0

5

10

15

20

25

30

35

40

45

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55

Age

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rate

per

100

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pop

ulat

ion

NW 2 4 10 9 9 10 19 34 10 45 9 11 10 15 15 9 6 9

NW JP 23.80 22.06 20.33 18.59 16.86 15.12 13.39 11.66 9.92 8.19 6.45 4.72 2.98 1.25 -0.48 -2.22 -3.95

W 1 1 2 2 3 4 4 6 5 4 2 2 1 1 1 1 1 1

W JP 1.03 1.04 1.05 1.06 1.08 1.09 1.10 1.11 1.12 1.13 1.14

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

8.5

Figure 8.1 iv. HIV Disease: Trends in age-adjusted mortality rates by race for WNC,


NW W57% decrease

R2 = 0.29 R2 = 0.00y = -1.73x + 15.12 y = 0.01x + 1.02





-1000

-500

0

500

1000

1500

2000

Perc

enta

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iffer

ence

- N

on-w

hite

to W

hite

% difference 90 400 382 448 262 141 362 494 112 1022 346 499 624 1687 1015 981 359 922

% difference JP 1429.6 1211.2 992.79 774.36 555.94 337.51 119.08 -99.35 -317.7 -536.2 -754.6

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

8.6

Figure 8.1 v. HIV Disease: Measuring disparity in age-adjusted mortality rates by race for WNC,



R2 = 0.54y = -218.43x + 1,648



Page Center for Health Services Research and Development, ECU 9

9. Appendix

Disease ICD 10 Code ICD 9 CodeDiseases of Heart I00-I09, I11, I13, I20-I51 390-398, 402, 404, 410-429Cerebrov ascular Disease I60-I69 430-434, 436-438Atherosclerosis I70 440Cancer - All Sites C00-C97 140-208Cancer - Lip, Oral Cavity, and Pharynx C00-C14 140-149Cancer - Stomach C16 151Cancer - Colon, Rectum, and Anus C18-C21 153-154Cancer - Liver C22 155Cancer - Pancreas C25 157Cancer - Larynx C32 161Cancer - Trachea, Bronchus, and Lung C33-C34 162Cancer - Malignant Melanoma of Skin C43 172Cancer - Breast C50 174-175Cancer - Cerv ix Uteri C53 180Cancer - Ovary C56 183.0Cancer - Prostate C61 185Cancer - Bladder C67 188Cancer - Brain C71Cancer - Non-Hodgkin's Lymphoma C82-C85 200, 202Cancer - Leukemia C91-C95 204-208HIV Disease B20-B24 042-044Septicemia A40-A41 038Diabetes Mellitus E10-E14 250Pneumonia and Influenza J10-J18 480-487Chronic Lower Respiratory Diseases J40-J47 490-494, 496Chronic Liver Disease and Cirrhosis K70, K73-K74 571Nephritis, Nephrotic Syndrome, and Nephrosis N00-N07, N17-N19, N25-N27 580-589Unintentional Motor Vehicle Injuries V02-V04, V09.0, V09.2, V12-V14, V19.0-V19.2,

V19.4-V19.6, V20-V79, V80.3-V80.5, V81.0-V81.1, V82.0-V82.1, V83-V86, V87.0-V87.8, V88.0-V88.8, V89.0, V89.2

E810-E825

All Other Unintentional Injuries and Adverse Effects V01, V05-V06, V09.1, V09.3-V09.9, V10-V11, V15-V18, V19.3, V19.8-V19.9, V80.0-V80.2, V80.6-V80.9, V81.2-V81.9, V82.2-V82.9, V87.9, V88.9, V89.1, V89.3, V89.9, V90-V99, W00-X59, Y85, Y86

E800-E807,E826-E829,E830-E848,E929.0,E929.1,E850-E869,E880-E928,E929.2-E929.9

Suicide X60-X84, Y87.0 E950-E959Homicide X85-Y09, Y87.1 E960-E969Legal Intervention Y35, Y89.0 E970-E978Alzheimer's Disease G30 331.0

mortality trends and disparities - western north …mortality trends and disparities - western north...

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