Perspectives in Disease Prevention and Health Promotion Premature
Mortality in New Hampshire
The New Hampshire Division of Public Health Services has
analyzed
mortality data on deaths occurring in New Hampshire from 1980
through
1985 to determine the adequacy of current prevention and control
activities and to identify possible gaps in public health services.
These data were analyzed using three measures: 1) rates of years of
potential life lost (YPLL) before age 65, 2) premature mortality
rates
(deaths occurring before age 65), and 3) crude mortality rates.
YPLL
were calculated using the CDC methodology (1). Sex-specific YPLL
rates
for 12 major causes of death were derived and compared with
national
rates. Age-adjustment was performed by the direct method using the
1982 U.S. white population* as the standard.
From 1980 through 1985, New Hampshire residents had a total of
242,478 YPLL, or an average yearly total of 40,413 YPLL.
Unintentional
injuries were the leading cause and accounted for 21% of the total
YPLL, followed by malignant neoplasms (18%), heart disease (15%),
suicides and homicides (8%), congenital anomalies (7%), and other
causes (31%) (Table 1). Males accounted for 65% of the total YPLL.
YPLL rates for males were higher than those for females for all
causes
except malignant neoplasms, for which the rates were similar. The
New
Hampshire age-adjusted YPLL rate for all causes of death combined
was
8% lower than the national rate. However, cause-specific YPLL rates
exceeded national rates for pneumonia and influenza, sudden infant
death syndrome, and chronic obstructive lung disease. In New
Hampshire, males lose 11% more years of potential life from
diabetes
than men in the general U.S. population, and females lose 25% more
years of potential life from pneumonia and influenza than females
in
the general population. The rankings of the 12 leading causes of
death, based on YPLL and premature and crude mortality rates,
differed
considerably (Table 2).
Reported by: E Schwartz, MD, MPH, State Epidemiologist, and staff,
New
Hampshire State Dept of Health and Welfare. Div of Surveillance and
Epidemiologic Studies, Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: Crude and age-adjusted mortality data have
traditionally been used as a yardstick to evaluate the importance
of
public health problems. These measures count each death equally,
independent of the age of the decedent. However, since most deaths
occur among older individuals, crude and age-adjusted mortality
data
reflect diseases of the elderly. Measures based on premature deaths
or
YPLL emphasize causes of death that affect younger individuals
during
their early, productive years and, thus, provide a different view
of a
population's mortality burden. Since 1982, national data regarding
premature mortality have been published by CDC, and statewide
analyses
have recently been reported (1-3).
In New Hampshire, as in the rest of the country, the leading
causes of YPLL include injuries, malignant neoplasms, and heart
disease. An estimated two-thirds of the deaths in the United States
are attributable to a preventable precursor and are thus premature
(4). A recent study revealed that six precursors of premature death
(use of tobacco, use of alcohol, injury risks, high blood pressure,
overweight, and gaps in primary prevention) accounted for 75% of
all
YPLL nationally (4). The challenge to further reduce the current
burden of unnecessary morbidity and mortality will require
traditional
as well as innovative measures designed to modify these precursors
(5).
The choice of an epidemiologic measure suitable for public
health
planning depends on the goals of decision-makers. If the goal of
public health programs is to reduce premature mortality, prevention
and control efforts should focus on the leading causes of YPLL.
Alternatively, if the goal is to achieve a more uniform overall
mortality pattern, efforts should be targeted at causes or
populations
with elevated mortality rate ratios. Thus, epidemiologic data can
form
the basis for setting public health priorities. However, the choice
of
epidemiologic indicators may have a substantial bearing on the
focus
of the public health agenda (5).
References
Centers for Disease Control. Premature mortality in the United
States: public health issues in the use of years of potential
life
lost. MMWR 1986;35(suppl 2S):2S-3S.
Centers for Disease Control. Introduction to Table V: premature
deaths, monthly mortality, and monthly physician
contacts--United
States. MMWR 1982;31:109-10.
Centers for Disease Control. Premature mortality in West
Virginia,
1978-1982. MMWR 1987; 36:30.
Amler RW, Dull HB, eds. Closing the gap: the burden of
unnecessary
illness. New York: Oxford University Press, 1987:181.
Centers for Disease Control. Positioning for prevention: an
analytical framework and background document for chronic
disease
activities. Atlanta: US Department of Health and Human
Services,
Public Health Service, 1986.
*The population of New Hampshire is 98.9% white, according to 1980
Bureau of the Census data.
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