Transcript Age-adjustment in HP2010

Age Adjustment Issues in
Healthy People 2010
John Aberle-Grasse, MPH
National Center for Health Statistics
Calculation of age-adjusted rate
Age-adjusted rate =
Si (mi*wsi)
mi = di / pi * 100,000
wsi = standard population weight in age group i
di = deaths in age group i
pi = population in age group i
Calculation of age-adjusted rate
• Spreadsheet vs. “manual” calculation

NCHS continues to use “manual” method

Healthy People 2010 rate calculations are
rounded/truncated to one decimal place

Weights are rounded/truncated to six places
Unintentional injury deaths, US, 1999
Age group
(years)
under 1
1 to 4
5 to 14
15 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 to 84
85 and older
Total
di
pi
m i (per
100,000)
rounded
845
1,898
3,091
13,656
11,890
15,231
11,639
7,285
8,208
12,282
11,729
97,860
3,819,903
15,122,239
39,495,230
37,773,512
37,935,812
44,812,649
35,802,358
23,389,085
18,218,248
12,146,695
4,175,082
272,690,813
22.10
12.60
7.80
36.20
31.30
34.00
32.50
31.10
45.10
101.10
280.90
35.90
m i (per
100,000)
w si
(US 2000)
m i *w si
rounded
m i *w si
22.12
12.55
7.83
36.15
31.34
33.99
32.51
31.15
45.05
101.11
280.93
35.89
0.013818
0.055317
0.145565
0.138646
0.135573
0.162613
0.134834
0.087247
0.066037
0.044842
0.015508
1.000000
0.31
0.70
1.14
5.02
4.24
5.53
4.38
2.71
2.98
4.53
4.36
0.31
0.69
1.14
5.01
4.25
5.53
4.38
2.72
2.98
4.53
4.36
35.9
35.9
Age-adjusted rate per 100,000 standard population
Sum (mi*w si) =
Standard population- a population
based on some age distribution
• NCHS in the past

mortality data used 1940 standard

survey data used mostly 1970 & 1980 standard
• NCHS now uses year 2000 US resident
population as standard for all age
adjustment
Master list: 2000 U.S. projected populaiton and ageadjustment weights
Age group
Population
Adjustment
Standard
(years)
(in thousands)
weight
million
all ages
0
1
2-4
5
6-8
9
10-11
12-14
15-17
18-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
274,634
3,795
3,759
11,433
3,896
11,800
4,224
8,258
11,799
11,819
8,001
18,257
17,722
19,511
22,180
22,479
19,806
17,224
13,307
10,654
9,410
8,726
7,415
4,900
4,259
1.000000
0.013818
0.013687
0.041630
0.014186
0.042966
0.015380
0.030069
0.042963
0.043035
0.029133
0.066478
0.064530
0.071044
0.080762
0.081851
0.072118
0.062716
0.048454
0.038793
0.034264
0.031773
0.027000
0.017842
0.015508
1,000,000
13,818
13,687
41,630
14,186
42,966
15,380
30,069
42,963
43,035
29,133
66,478
64,530
71,044
80,762
81,851
72,118
62,716
48,454
38,793
34,264
31,773
27,000
17,842
15,508
Standard population- a population
based on some age distribution
• NCHS in the past

mortality data used 1940 standard

survey data used mostly 1970 & 1980 standard
• NCHS now uses year 2000 US resident
population as standard for all age
adjustment

2000-adjusted rates better reflect national
demographics and current crude rates
Crude and age adjusted death rates based on
year 1940 and 2000 standard populations:
United States, 1979-2000
1200
1000
2000 standard
800
crude rate
600
1940 standard
400
200
0
1979
1982
1985
1988
1991
1994
1997
2000
Standard population- a population
based on some age distribution
• IMPORTANT REMINDER: Comparisons
can only be made between rates
calculated using the same standard
population
Stroke deaths (ICD-10 I60-I69), Pima County, AZ, 1999
Age group
(years)
under 1
1 to 4
5 to 14
15 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 to 84
85 and older
Total
di
pi
m i (per
100,000)
w si
(US 2000)
0
0
0
2
1
2
13
22
69
160
183
452
12,236
49,762
115,369
117,466
104,500
125,039
95,449
67,848
62,093
40,677
13,179
803,618
0.0
0.0
0.0
1.7
1.0
1.6
13.6
32.4
111.1
393.3
1,388.6
56.2
0.013818
0.055317
0.145565
0.138646
0.135573
0.162613
0.134834
0.087247
0.066037
0.044842
0.015508
1.000000
Age-adjusted rate per 100,000 standard population
Sum (mi*w si) =
m i *w si
0.000000
0.000000
0.000000
0.235698
0.135573
0.260181
1.833742
2.826803
7.336711
17.636359
21.534409
51.8
Stroke deaths (ICD-10 I60-I69), Pima County, AZ, 1999
Age group
(years)
under 1
1 to 4
5 to 14
15 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 to 84
85 and older
Total
di
pi
m i (per
100,000)
w si
(US 2000)
0
0
0
2
1
2
13
22
69
160
183
452
12,236
49,762
115,369
117,466
104,500
125,039
95,449
67,848
62,093
40,677
13,179
803,618
0.0
0.0
0.0
1.7
1.0
1.6
13.6
32.4
111.1
393.3
1,388.6
56.2
0.013818
0.055317
0.145565
0.138646
0.135573
0.162613
0.134834
0.087247
0.066037
0.044842
0.015508
1.000000
Age-adjusted rate per 100,000 standard population
Sum (mi*w si) =
m i *w si
0.000000
0.000000
0.000000
0.235698
0.135573
0.260181
1.833742
2.826803
7.336711
17.636359
21.534409
51.8
w si
(US 1940)
0.015343
0.064718
0.170355
0.181677
0.162066
0.139237
0.117811
0.080294
0.048426
0.017303
0.002770
1.000000
m i *w si
0.000000
0.000000
0.000000
0.308851
0.162066
0.222779
1.602230
2.601526
5.380129
6.805270
3.846422
20.9
Age-adjustment in
Healthy People 2010
• Mortality data
• Health outcomes, risk factors, and health
services data
Diabetes prevalence by
race/ethnicity (Obj. 5-3), 1999
7
6
percent
5
4
3
2
1
0
Source: National Health Interview Survey (NHIS), CDC, NCHS.
Diabetes age specific rates, 1999
Hispanic
not-Hispanic White
25
percent
20
15
10
5
0
<18
18-44
Source: National Health Interview Survey (NHIS), CDC, NCHS.
45-64
65-74
75+
2000 Census age distribution
Hispanic
not-Hispanic White
50
percent
40
30
20
10
0
<18
18-44
45-64
65-74
75+
Diabetes prevalence
(Obj. 5-3), 1999
9
Overall
8
American Indian/
Alaska Native
percent
7
6
Asian/ Pacific
Islander
5
Hispanic
4
3
Not-Hispanic
White
2
Not-Hispanic
African American
1
0
Crude
Source: National Health Interview Survey (NHIS), CDC, NCHS.
Diabetes prevalence
(Obj. 5-3), 1999
9
Overall
8
American Indian/
Alaska Native
percent
7
6
Asian/ Pacific
Islander
5
Hispanic
4
3
Not-Hispanic
White
2
Not-Hispanic
African American
1
0
Crude
Source: National Health Interview Survey (NHIS), CDC, NCHS.
Age-adjusted
Age-adjustment in
Healthy People 2010
• Mortality data
• Health outcomes, risk factors, and health
services data
• Main purposes:
 Observe trends in populations over time
 Monitor disparity between populations
both at a point in time and over time
Standard populationage distributions
• Several different age groupings are used
to age-adjust data from different sources
Data systems
Age distributions used
Healthy People 2010 age-adjusted measures and age adjustment groups
Data
Source
NVSS-M
NHIS
NHDS
CSFII
NHIS
NHANES
NHANES
NHIS
NHIS
NHIS
NHDS
NHIS
NHDS
NHIS
Standard
Distribution**
#1
#3
#4
#5
#9
# 11
# 12
# 15
# 16
# 17
# 18
# 19
# 21
# 22
Age Adjustment Groups
<1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
<18, 18-44, 45-54, 55-64, 65-74, 75+
<18, 18-44, 45-64, 65-74, 75+
2-5, 6-11, 12-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
18-24, 25-34, 35-44, 45-64, 65+
20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
20-39, 40-59, 60+
40-49, 50-64, 65+
45-49, 50-64, 65+
50-64, 65+
65-74, 75+
0-4, 5-11, 12-17
5-17, 18-44, 45-64
18-24, 25-34, 35-44, 45-64
** Healthy People Statistical Notes, no. 20. January 2001.
Education group breakouts begin age groups at age 25.
Standard populationage distributions
• Several different age groupings are used
to age-adjust data from different sources
• Some data sources use fewer age
groupings to stabilize the rates of less
common events and smaller subpopulations
(e.g. age groups for chronic disease)
Hispanics aged 2+ years with diabetes
who have seen a dentist in the past year
(Obj. 5-15)
80
Age-adjusted
60
Crude
40
20
1997
1998
Source: National Health Interview Survey (NHIS), CDC, NCHS.
1999
2000
Hispanics aged 2+ years with diabetes
who have seen a dentist in the past year
(Obj. 5-15)
age
2-17
18-44
45-54
55-64
65-74
75+
total
2-44
45-54
55-64
65-74
75+
total
1997
numer denom
rate
0
5965
0.00
78732 217001
0.36
106567 231432
0.46
161850 281698
0.57
98880 275980
0.36
45279
90760
0.50
491308 1102836
0.45
78732 222966
106567 231432
161850 281698
98880 275980
45279
90760
491308 1102836
0.35
0.46
0.57
0.36
0.50
0.45
weights
rates
0.236742
0.00
0.404935
0.15
0.138647
0.06
0.089715
0.05
0.067905
0.02
0.062056
0.03
0.32
0.641677
0.138647
0.089715
0.067905
0.062056
Source: National Health Interview Survey (NHIS), CDC, NCHS.
0.23
0.06
0.05
0.02
0.03
0.40
1998
numer denom
rate
13264
13264
1.00
141216 272108
0.52
156417 305156
0.51
169255 305041
0.55
100710 200877
0.50
42525 138804
0.31
623387 1235250
0.50
154480 285372
156417 305156
169255 305041
100710 200877
42525 138804
623387 1235250
0.54
0.51
0.55
0.50
0.31
0.50
weights
rates
0.236742
0.24
0.404935
0.21
0.138647
0.07
0.089715
0.05
0.067905
0.03
0.062056
0.02
0.62
0.641677
0.138647
0.089715
0.067905
0.062056
0.35
0.07
0.05
0.03
0.02
0.52
Hispanics aged 2+ years with diabetes
who have seen a dentist in the past year
(Obj. 5-15)
80
< 45 separate
60
< 45 combined
Crude
40
20
1997
1998
Source: National Health Interview Survey (NHIS), CDC, NCHS.
1999
2000
Healthy People 2010 age-adjusted measures and age adjustment groups
Data
Source
NVSS-M
NHIS
NHDS
NHDS/NHIS
CSFII
NHIS
NHIS
NHIS
NHIS
NHANES
NHANES
NHANES
NHANES
NHIS
NHIS
NHIS
NHDS
NHIS
NHDS
NHIS
NHIS
Standard
Distribution**
#1
#3
#4
# 4 (revised)1
#5
# 6 (revised)1
# 8/9(revised) 1,2
#9
# 9 (revised) 1
# 10 (revised)3
# 11
# 11 (revised)3
# 12
# 15
# 16
# 17
# 18
# 19
# 21
# 22
# 22 (revised)1
Age Adjustment Groups
<1, 1-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, 85+
<18, 18-44, 45-54, 55-64, 65-74, 75+
<18, 18-44, 45-64, 65-74, 75+
0-44, 45-64, 65-74, 75+
2-5, 6-11, 12-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
2-44, 45-54, 55-64, 65-74, 75+
18-44, 45-64, 65-74, 75+
18-24, 25-34, 35-44, 45-64, 65+
18-44, 45-64, 65+
18-49, 50-59, 60-69, 70-79, 80+
20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+
20-49, 50-59, 60-69, 70-79, 80+
20-39, 40-59, 60+
40-49, 50-64, 65+
45-49, 50-64, 65+
50-64, 65+
65-74, 75+
0-4, 5-11, 12-17
5-17, 18-44, 45-64
18-24, 25-34, 35-44, 45-64
18-44, 45-64
* For datalines where denominator is people with chronic conditions.
** Healthy People Statistical Notes, no. 20. January 2001.
1
<45 age groups aggregated (denominator is people with chronic conditions).
2
65+ age group diaggregated (workgroup's request).
3
<50 age groups aggregated (denominator is people with chronic conditions).
Education group breakouts begin age groups at age 25.
Some exceptions
• Data that are not age-adjusted

Maternal/Infant mortality
(live births as denominator)

National Household Survey on Drug Abuse

Occupational injury and death

Fatality Analysis Reporting System

Census of Fatal Occupational Injuries
Some exceptions
When to be careful in age-adjusting

Age specific rates for a measure vary
differently between two population groups
Age specific cancer death rates
among females, 1970 to 1995
1600
1400
1200
1995
1000
800
1970
600
400
200
0
<1
1-4
5-14 15-25 25-34 35-44 45-54 55-64 65-74 75-84 85+
Source: National Vital Statistics System, CDC, NCHS.
Female cancer death rates, by
age adjustment standard
215
Crude rate
195
175
2000 standard
population
155
135
115
1940 standard
population
95
75
1970
1980
Source: National Vital Statistics System, CDC, NCHS.
1985
1990
1995