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.

 

  1. Yes / No, because ……

 

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

This matters because …

 

  1. 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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  1. 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.

  1. 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

 

  1. 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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  1. 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

 

  1. 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.

 

  1. 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

 

  1. 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,

 

  1. 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    

 

  1. 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.

 

  1. _______ 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.

 

  1. 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.

 

  1. 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
  1. _________ 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).

 

  1. 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

 

  1. Yes / No, because ….

 

  1. Factors to control for fair comparison include ________________________________

 

  1. 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

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