Contents
- Introduction
- A brief introduction to the CVD maps
- Data Sources and Methods
- An explanation of what data was used and how it was analyzed
- Instructions
- Instructions for using maps
- Proceed to maps
- Click to view maps
Contents
|
|
This site provides information about disparities in cardiovascular disease (CVD) mortality and health-care resources and utilization at the local level. Health disparities are presented through maps of the continental U.S. that show three-year age-adjusted mortality rates in small geographic units called Health Service Areas (HSA). Health-care resource and utilization information is presented in tables that show the numbers of physicians, hospitals, and other resources and their utilization rates within the HSAs.
Four major CVD-related disease categories and nine population subgroups are displayed in the maps, including
| Disease Category | Population Subgroup |
|---|---|
|
|
Mortality rates for every disease category are shown for every population subgroup.
The HSAs were defined by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention, to be a single county or a cluster of contiguous counties which are relatively self-contained with respect to hospital care. For further information about the definition of HSAs, please visit Atlas of United States Mortality.
The maps and tables utilize two secondary data sources:
All mortality data were provided by the Centers for Disease Control and Prevention (CDC) via their National Center for Health Statistics (NCHS). These annual files contain information on decedents in the United States, including their residential status, place of residence, age, sex, race, year of death and the underlying cause of death as classified by the International Classification of Diseases, 9th Edition (ICD-9). The maps and tables reflect the place of residence (where decedents lived), not the place of death (where they died). The following ICD-9 codes for underlying cause of death correspond to each disease category:
The total number of deaths within the three-year period (1996-98) for each disease category, state and population subgroup were first aggregated from the Mortality files by county and age and then aggregated into the HSAs. Population estimates for calculating death rates (also received from NCHS) were similarly aggregated. Death rates were then age-adjusted to the year 2000 standard population using the direct method. The maps display five levels of the age-adjusted mortality rates corresponding to the quintiles of the HSA rates among the overall population within each disease category. That is, the rates that determine each level distribute the HSAs into five groups with roughly equal numbers of HSAs in each (lowest 20%, next highest 20%, on up to the highest 20%). The same levels were then applied to each population subgroup within the disease category to facilitate comparisons by race and/or sex.
The tables displayed below the maps show the actual numbers of deaths and population counts upon which the rates are based, and the crude and age-adjusted death rates by HSA. Deaths where the age of the decedent was missing are included in the death count and crude rates, but are omitted from the age-adjusted death rates. If the number of deaths or population count are less than 20, the resulting rates are marked as "UNSTABLE" and users should exercise caution when drawing conclusions based on those rates.
The public use version of the Mortality Multiple Cause of Death files, the Compressed Mortality File (CMF) is accessible via CDC Wonder, an internet-based data-retrieval system implemented by the Centers for Disease Control and Prevention. Please note that unlike the rates displayed here, the death rates generated by CDC Wonder from the CMF substitute the number of live births for a population estimate when calculating death rates for the "under 1" age group. For more information about the CMF, CDC Wonder, or ICD-9, please visit the homepage of CDC Wonder.
All data on health-care providers, hospital resources and utilization, HMOs and HMO utilization, population demographics, employment, income and education were extracted from the 2001 Area Resource File (ARF), a secondary data source maintained under contract to the Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services. The ARF contains county-level data on the numbers of health professionals (eg, MDs, ODs, nurses), health-care facilities (eg, hospitals, clinics, nursing homes), utilization (eg, in-patient bed days in short-term general hospitals) among other things. The county-level summary counts (eg, total number of MDs, total number of hospitals, etc) were summed over the counties within the HSAs; the county-level summary averages (eg, median household income, unemployment rate, etc) were averaged over the counties within the HSAs using the county total populations as a weighting factor. For more information on the ARF, please visit the homepage of the ARF.
The maps and tables are displayed in a two-column frame. The left side contains a navigation tool which allows users to specify a disease category, population subgroup and/or area of the country to display. Selecting from the pull-down menus on the left updates the map displayed on the right.
In addition, the maps themselves include hotspots in which users can click to drill down to smaller geographic areas. From any map of the continental US, users can click within a state to see a more detailed view of the HSAs within the state. From any state map, users can click within an HSA to view the details of the HSA, including the mortality rates and health care resources and utilization rates.
Click proceed to maps to continue.