Outpatient Immunization Clinic Capstone

Outpatient Immunization Clinic Capstone essay assignment

Outpatient Immunization Clinic Capstone essay assignment

CASE F: MORTALITY IN KENTUCKY: A COMPARISON OF JEFFERSON AND FAYETTE COUNTIES TEMPLATE

1. Crude Mortality rate for Jefferson County ??

Crude Mortality rate for Fayette County??

_________ County has a higher overall rate than _________ county.

 

2. Yes / No, because ……

 

3. ________ County has a higher percent of elderly in the top five age groups (>45).

This matters because …

 

4. Fill in values for highlighted columns

 

Exhibit F.3. Direct Standardization of Kentucky Mortality Rates, 2011
		Population		Age-Specific Rates (per 100,000)		Expected Deaths
	Jefferson	Fayette	Pooled	Jefferson Fayette		Jefferson	Fayette
<1 year	10,198	31,934	14,132	666.8	483.0
1–4 years	39,032	15,030	54,062	43.6	26.6
5–14 years	94,197	33,228	127,425	14.2	13.2
15–24 years	95,746	53,387	149,133	100.3	48.7
25–34 years	106,007	49,352	155,359	135.8	87.1
35–44 years	95,235	39,796	135,031	252.0	198.5
45–54 years	109,184	39,487	148,671	539.5	435.6
55–64 years	95,967	33,611	129,578	1,025.4	859.8
65–74 years	52,200	17,527	69,727	2,086.2	1,968.4
75–84 years	33,943	9,924	43,867	5,394.3	4,463.9
85+ years	14,740	4,548	19,288	14,403.0	14,358.0
ALL	746,449	299,824	1,046,273	963.8	692.7

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5. There are ????? expected deaths using Jefferson County rates and ????? expected deaths using Fayette County rates.

Using the compared pooled population in the denominator, this would translate into ? / ? × ? = ? per ? for Jefferson County and ? /? × ? = ? per ? for Fayette County.

The age-adjusted rate for ____ County is lower than the crude rate but that the rate for _____ County is higher than the crude rate.

6. See Exhibit F.4. Please Fill in the values for the highlighted columns

Exhibit F.4. Mortality in Two Kentucky Counties, Direct Method of Adjustment Using Kentucky Population as the Standard
	Kentucky Age Distribution	Age-Specific Rates (per 100,000)		Expected Deaths
		Jefferson	Fayette	Jefferson	Fayette
<1 year	56,065	666.8	483.0
1–4 years	225,096	43.6	133.1
5–14 years	567,946	14.2	13.2
15–24 years	591,188	100.3	48.7
25–34 years	569,158	135.8	87.1
35–44 years	570,028	252.0	198.5
45–54 years	637,556	539.5	435.6
55–64 years	560,468	1,025.4	859.8
65–74 years	334,546	2,086.2	1,968.4
75–84 years	185,832	5,394.3	4,463.9
85+ years	71,473	14,403.0	14,358.0
All	4,369,356	963.8	692.7

 

7. There are ????? expected deaths using Jefferson County rates and ?????? expected deaths using Fayette County rates.

Using the total population in Kentucky in the denominator, this would translate into: ? /?  × ? = ? per ? for Jefferson County and ? / ? × ? = ? per ? for Fayette County.

The age-adjusted rate for ______ County is lower than the crude rate but that the rate for ______ County is higher than the crude rate.

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8. See Exhibit F.5. Please Fill in the values for the highlighted columns

Exhibit F.5. Mortality in Two Kentucky Counties, Indirect Method of Adjustment Using Kentucky Age-Specific Death Rates as a Standard
	Mortality Rates	Population			Expected Deaths
		Jefferson		Fayette	Jefferson	Fayette
<1 year	624.3	10,198	3,934
1–4 years	39.1	39,032	15,030
5–14 years	13.4	94,197	33,228
15–24 years	76.3	95,746	53,387
25–34 years	155.8	106,007	49,352
35–44 years	258.1	95,235	39,796
45–54 years	575.6	109,184	39,487
55–64 years	1,069.1	95,967	33,611
65–74 years	2,421.2	52,200	17,527
75–84 years	5,693.3	33,943	9,924
85+ years	15,335.9	14,740	4,548
All	975.6	746,449	299,824

 

9. Rates would be 7,686.9/746,449 × 100,000 = 1,029.8 for Jefferson County and 2,528.7/299,824 × 100,000 = 843.4 for Fayette County.

Standardized Mortality Ratio (SMR) makes a lot more sense. Exhibit F.1 reports 7,194 actual deaths in Jefferson County and 2,077 actual deaths in Fayette County.

The SMR for Jefferson County would be (? / ? ) × ? = ?.

The SMR for Fayette County would be ? /?  × ? = ?. The rule is always “the lower the better.”

Since Fayette County has a lower SMR than Jefferson County, this means that Fayette County has _____ using indirect age adjustment. Since both rates are lower than 100, both counties have lower rates than the entire state of Kentucky because Kentucky rates were used as the standard.

 

10. See the chart below. . Please Fill in the values for the highlighted columns

 

Comparison of Mortality Standardization Methods
Methods of Adjustment and Standard	Age-Adjusted Mortality Rates (per 100,000)
	Jefferson	Fayette
Direct with Pooled Population
Direct with Kentucky Population
Indirect with Kentucky Rates

 

11. Please note that infant and maternal mortality rates are usually expressed in terms of every 1,000 live births so “live births” in the denominator in these measures.

Both counties have higher / lower rates among both blacks and whites compared to the state.

The infant mortality rate among blacks in Jefferson County is more than __ percent higher/ lower than the rate among whites.

The rate among blacks in Fayette County is _______comparted to the rate among whites,

 

12. See Exhibit F.7. Please Fill in the values for the highlighted columns

Exhibit F.7. Race-Adjusted Infant Mortality Rates Using the Direct Method
Race	Kentucky Population	Race-Specific Infant Mortality Rates (per 1000 live births		Expected Deaths
		Jefferson	Fayette	Jefferson	Fayette
White	99,883
Black	11,152
Total	111,035

 

13. Race adjusted rates would be ? / ? × ? = ? per ? live births in Jefferson County and ? / ? × ? = ? per ? live births in Fayette County.

It appears that _____ County has a somewhat higher infant mortality rate using a standard Kentucky mix of live births.

 

14. _______ County has a higher rate of perinatal mortality among whites than both Kentucky and ________ County.

The rate among blacks is higher / lower/ similar to the state of Kentucky but much higher / lower / similar than Fayette County.

Fayette Country has _____ the rate of neonatal mortality among whites than the state of Kentucky, higher / lower rates or perinatal mortality than both Kentucky and Jefferson County but slightly higher / lower  rates of neonatal mortality among black newborns.

 

15. Of the 42,626 deaths in Kentucky, the proportional mortality rates are:

? / ? × ? = ?% were due to heart disease;

? / ? × ? = ?% were due to cancer;

? / ? × ? = ?% were due to stroke.

For Jefferson County:

? / ? × ? = ?% heart disease;

? / ? × ? = ?% cancer;

? / ? × ? = ?% stroke.

For Fayette County:

? / ? × ? = ?% heart disease;

? / ? × ? = ?% cancer;

? / ? × ? = ?% stroke.

___________ County has proportionately fewer deaths in these top three categories.

 

16. See Exhibit F.10. Please Fill in the values for the highlighted columns

 

Exhibit F.10. Cases and Deaths for Five Major Diagnostic Categories, University of Kentucky (UK) and University of  Louisville (UL) Hospitals

	UK		UL		UK	UL
	Cases	Deaths	Cases	Deaths	Rate	Rate
Heart diseases	4,120	42	2,764	28
Respiratory diseases	2,393	136	1,814	105
Gastrointestinal diseases	2,369	90	1,728	64
Musculoskeletal diseases	2,072	16	1,451	14
Nervous system diseases	1,480	30	1,037	31
Total	12,434	314	8,794	242

17. _________ has higher rates for heart diseases and GI diseases, ________ has higher rates for the other categories. _____________ has a higher overall rate for these five Major Diagnostic Categories (MDCs).

 

18. See Exhibit F.11.

The SMR is:

? / ? = ? for UK

? / ? = ? for UL.

____________ has a better SMR,  better than the overall state rate.

 

Please Fill in the values for the highlighted columns

Exhibit F.11. Cases and Expected Deaths Using Statewide Rates, University of Kentucky (UK) and University of  Louisville (UL) Hospitals

		UK		UL
	State Rates	Cases	Expected Deaths	Cases	Expected Deaths
Heart diseases	0.010	4,120		2,764
Respiratory diseases	0.057	2,393		1,814
Gastrointestinal diseases	0.038	2,369		1,728
Musculoskeletal diseases	0.008	2,072		1,451
Nervous system diseases	0.022	1,480		1,037
Total		12,434		8,794

 

19. Yes / No, because ….

 

20. Factors to control for fair comparison include ________________________________

 

21. See Exhibit F.12. Please Fill in the values for the highlighted columns

Overall expected deaths is ? for Chandler and ? for Louisville.

The SMR is ? / ? = ? for Chandler and ? / ? = ? for Louisville.

After adjusting for severity within MDC, _____ has a better SMR than _____, and _______have a better rates than the state.

 

Exhibit F.12. Cases and Expected Deaths Using Statewide Rates. University of Kentucky (UK) and University of  Louisville (UL) Hospitals Five Major Diagnostic Categories and Severity

		UK		UL
	State Rates	Cases	Expected Deaths	Cases	Expected Deaths
Heart disease, severe	0.07	800		900
Heart disease, mild	0.008	3,320		1,864
Respiratory diseases, severe	0.1	700		400
Respiratory diseases, mild	0.02	1,693		1,414
GI diseases, severe	0.08	650		600
GI diseases, mild	0.02	1,719		1,128
Musculoskeletal, severe	0.02	400		351
Musculoskeletal, mild	0.005	1,672		1,100
Nervous system, severe	0.1	300		237
Nervous system, mild	0.01	1,180		800
Total		12,434		8,794