Monitoring the Healthcare Safety Net

Book 1. Data for Metropolitan Areas

Table A-1: Safety Net Measures in this Data Book, their Definitions, and Data Sources (Continued)

Community Context—Economy

Measure Definition Data Source(s) Methodological Notes
   Community Context—Economy
% Below Poverty
Percent of total population that is below 100 percent of Federal poverty line Number of individuals with incomes less than 100 percent of the Federal poverty level, divided by the total population for whom poverty status is reported. U.S. Census 2000  
Percent of population ages 0–17 below 100 percent of Federal poverty line Number of individuals ages 0–17 with incomes less than 100 percent of the Federal poverty level, divided by the total population ages 0–17 for whom poverty status is reported. U.S. Census 2000  
Percent of population ages 18–64 below 100 percent of Federal poverty line Number of individuals ages 18–64 with family incomes less than 100 percent of the Federal poverty level, divided by the total population ages 18–64 for whom poverty status is reported. U.S. Census 2000  
Percent of population age 65 and older below 100 percent of Federal poverty line Number of individuals age 65 and older with family incomes less than 100 percent of the Federal poverty level, divided by the total population age 65 and older for whom poverty status is reported. U.S. Census 2000  
Median Household Income ($)
Median household income Median household income. U.S. Census 2000  
% Households Income Under $15,000
Percent of households with incomes less than $15,000 Number of households with total incomes less than $15,000 per year, divided by the total number of households. U.S. Census 2000  
% Households Income Over $75,000
Percent of households with incomes greater than $75,000 Number of households with total incomes greater than $75,000 per year divided by the total number of households. U.S. Census 2000  
% Households Under $15,000 on Public Assistance
Percent of households with incomes below $15,000 receiving public assistance Number of households with incomes less than $15,000 per year receiving public assistance, divided by the total number of households with incomes below $15,000 per year. U.S. Census 2000  
Mean Public Assistance Amount ($)
Mean amount of public assistance Mean public assistance income of households receiving public assistance. U.S. Census 2000  
% Ages 16+ Not in Labor Force
Percent of the population age 16 and older that is not in the labor force Number of individuals age 16 and older who are not in the labor force, divided by the total population age 16 and older reporting employment status. The labor force includes people age 16 and older who are either employed, actively seeking work, or awaiting recall from layoff. U.S. Census 2000  
% Ages 16+ Unemployed
Percent of the population age 16 and older that is unemployed Number of individuals age 16 and older who are unemployed, divided by the total population age 16 and older reporting employment status. U.S. Census 2000  

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Community Context—Living Arrangements, Housing, Education, and Crime

Measure Definition Data Source(s) Methodological Notes
   Community Context—Living Arrangements, Housing, Education, and Crime
Living Arrangements
Percent living alone Number of people living alone divided by the total population. U.S. Census 2000  
Percent living alone, age 65 and older Number of people age 65 and older living alone divided by the total population age 65 and older. U.S. Census 2000  
Percent of families with non-married couple or single parent Number of family households with a single parent or a non-married couple, divided by the total number of family households. U.S. Census 2000  
Housing
Housing: Percent owner occupied Number of housing units occupied by their owner divided by the total number of occupied housing units. U.S. Census 2000  
Housing: Vacancy rate Number of vacant housing units divided by the total number of housing units (not including seasonal, recreational, and occasional use units). U.S. Census 2000  
Housing Age: 0–10 years Number of housing units built between 1990 and March 2000, divided by the total number of housing units. U.S. Census 2000  
Housing Age: more than 30 years Number of housing units built in 1969 or earlier divided by the total number of housing units. U.S. Census 2000  
Education
Educational attainment: high school or less Number of individuals age 25 years and older with educational attainment of a high school degree (or equivalent) or less, divided by the total population age 25 years and older reporting educational attainment. U.S. Census 2000  
Educational attainment: some college or more Number of individuals age 25 years and older with educational attainment of some education beyond a high school degree, divided by the total population age 25 years and older reporting educational attainment. U.S. Census 2000  
Index Crimes per 10,000
Index crime rate per 10,000 population Number of index crimes (murder, forcible rape, robberies, aggravated assaults, burglaries, larcenies, and auto theft), divided by the total area population, multiplied by 10,000. Numerator from Federal Bureau of Investigations Uniform Crime Reports; Denominator from 2001 Claritas (1999 interpolated estimate)  

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Access-Related Outcome Measures—Preventable/Avoidable Hospitalizations (Ambulatory Care Sensitive Conditions)

Measure Definition Data Source(s) Methodological Notes
Preventable/Avoidable Discharges
These are conditions for which timely and effective ambulatory care can help prevent or avoid the need for hospitalization.
Ages 0-17
Preventable/avoidable hospitalization rate, ages 0–17 Preventable/avoidable discharges per 1,000 persons ages 0–17 in the area, adjusted for age and sex. Patient discharge data– 1999 HCUP and other sources; 2001 Claritas (1999 interpolated estimate)  
Adjusted ratio to mean for preventable/avoidable discharges, ages 0–17 Ratio of area rate of preventable/avoidable discharges for persons ages 0–17 to the mean rate for all areas for persons ages 0–17, adjusted to take into account differences in physician practice style. See Methods section for more detailed discussion. Patient discharge data– 1999 HCUP and other sources; 2001 Claritas (1999 interpolated estimate)  
Observed to expected ratio for preventable/avoidable discharges, ages 0–17 Actual ("observed") area rate of preventable/avoidable discharges for persons ages 0–17, divided by "expected" area rate for persons ages 0–17, adjusted for physician practice style and area income and race/ethnic composition. See Methods section for more detailed discussion. Patient discharge data– 1999 HCUP and other sources; 2001 Claritas (1999 interpolated estimate)  
Ages 18-39
Preventable/avoidable hospitalization rate, ages 18–39 Preventable/avoidable discharges per 1,000 persons ages 18–39 in the area, adjusted for age and sex. Patient discharge data– 1999 HCUP and other sources; 2001 Claritas (1999 interpolated estimate)  
Adjusted ratio to mean for preventable/avoidable discharges, ages 18–39 Ratio of area rate of preventable/avoidable discharges for persons ages 18–39 to the mean rate for all areas for persons ages 18–39, adjusted to take into account differences in physician practice style. See Methods section for more detailed discussion. Patient discharge data– 1999 HCUP and other sources; 2001 Claritas (1999 interpolated estimate)  
Observed to expected ratio for preventable/avoidable discharges, ages 18–39 Actual ("observed") area rate of preventable/avoidable discharges for persons ages 18–39, divided by "expected" area rate for persons ages 18–39, adjusted for physician practice style and area income and race/ethnic composition. See Methods section for more detailed discussion. Patient discharge data– 1999 HCUP and other sources; 2001 Claritas (1999 interpolated estimate)  
Ages 40-64
Preventable/avoidable hospitalization rate, ages 40–64 Preventable/avoidable discharges per 1,000 persons ages 40–64 in the area, adjusted for age and sex. Patient discharge data– 1999 HCUP and other sources; 2001 Claritas (1999 interpolated estimate)  
Adjusted ratio to mean for preventable/avoidable discharges, ages 40–64 Ratio of area rate of preventable/avoidable discharges for persons ages 40–64 to the mean rate for all areas for persons ages 40–64, adjusted to take into account differences in physician practice style. See Methods section for more detailed discussion. Patient discharge data– 1999 HCUP and other sources; 2001 Claritas (1999 interpolated estimate)  
Observed to expected ratio for preventable/avoidable discharges, ages 40–64 Actual ("observed") area rate of preventable/avoidable discharges for persons ages 40–64, divided by "expected" area rate for persons ages 40–64, adjusted for physician practice style and area income and race/ ethnic composition. See Methods section for more detailed discussion. Patient discharge data– 1999 HCUP and other sources; 2001 Claritas (1999 interpolated estimate)  

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Access-Related Outcome Measures—Births

Measure Definition Data Source(s) Methodological Notes
Number of Births
Number of births Number of births occurring in the area during 1999. 1999 Vital Statistics data  
% Late or No Prenatal Care
Rate of late or no prenatal care, in percent Number of births in area with no prenatal care or prenatal care initiated in the third trimester, divided by the total number of births for which prenatal care status is known. 1999 Vital Statistics data  
Ratio to mean for late or no prenatal care Area rate for births with no prenatal care or prenatal care initiated in the third trimester, divided by mean rate for all areas. 1999 Vital Statistics data  
Observed to expected ratio for late or no prenatal care Actual ("observed") area rate for births with no prenatal care or prenatal care initiated in the third trimester, divided by the "expected" area rate, adjusted for area income and racial/ethnic composition. See Methods section for more detailed discussion. 1999 Vital Statistics data  
% Low Birth Weight (Full- Term Births)
Rate of low birth weight for full-term births in percent Number of low birth weight (less than 2,500 grams) full- term (37 weeks or longer) births in area, divided by the total number of births for which birth weight and gestation period is known. 1999 Vital Statistics data  
Ratio to mean for low birth weight for full-term births Area rate for low birth weight (less than 2,500 grams) full- term (37 weeks or longer) births, divided by the mean rate for all areas. 1999 Vital Statistics data  
Observed to expected ratio for low birth weight for full-term births Actual ("observed") area rate for low birth weight (less than 2,500 grams) full-term (37 weeks or longer) births, divided by the "expected" area rate, adjusted for area income and racial/ethnic composition. See Methods section for more detailed discussion. 1999 Vital Statistics data  
% Preterm Births
Rate of preterm births, in percent Number of preterm births (less than 37 weeks gestation) in area, divided by the total number of births for which gestation period is known. 1999 Vital Statistics data  
Ratio to mean for preterm births Area rate for preterm births (less than 37 weeks gestation), divided by the mean rate for all areas. 1999 Vital Statistics data  
Observed to expected ratio for preterm births Actual ("observed") area rate for preterm births (less than 37 weeks gestation), divided by the "expected" area rate, adjusted for area income and racial/ethnic composition. See Methods section for more detailed discussion. 1999 Vital Statistics data  

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Access-Related Outcome Measures—Survey-Based Reported Barriers to Access

Measure Definition Data Source(s) Methodological Notes
% Population Below 200% of Poverty Reporting
Percent of population below 200 percent of the Federal poverty line reporting they have no usual source of care Number of individuals with family incomes below 200 percent of the Federal poverty line reporting that they have no usual place to go if they are sick or in need of advice about their health, divided by the number of individuals with family incomes below 200 percent of the Federal poverty line. 1999–2000 National Health Interview Survey– 2-year average Data available only for very large MSAs because of NHIS sample size limits.
Percent of population below 200 percent of the Federal poverty line reporting they are unable to obtain "needed" care Number of individuals with family incomes below 200 percent of the Federal poverty line reporting that they delayed or did not obtain health care they thought they needed because of cost, divided by the number of individuals with family incomes below 200 percent of the Federal poverty line. 1999–2000 National Health Interview Survey– 2-year average Data available only for very large MSAs because of NHIS sample size limits.
Percent of population below 200 percent of the Federal poverty line reporting no doctor's visit in the past year Number of individuals with family incomes below 200 percent of the Federal poverty line reporting that they had not had any doctor's visits within the last year, divided by the number of individuals with family incomes below 200 percent of the Federal poverty line. 1999–2000 National Health Interview Survey– 2-year average Data available only for very large MSAs because of NHIS sample size limits.
Percent of population below 200 percent of the Federal poverty line reporting no doctor's visit in the past 2 years Number of individuals with family incomes below 200 percent of the Federal poverty line reporting that they had not had any doctor's visits within the last 2 years, divided by the number of individuals with family incomes below 200 percent of the Federal poverty line. 1999–2000 National Health Interview Survey– 2-year average Data available only for very large MSAs because of NHIS sample size limits.
Contents of Data Books
Contents of Table A-1: Safety Net Measures in this Data Book, their Definitions, and Data Sources