Measuring the Risks and Causes of Premature Death Summary of Workshops (2015) / Chapter Skim
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2 Data Sources and Methodology in the Study of Premature Mortality
2 Data Sources and Methodology in the Study of Premature Mortality
Pages 7-26
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and later Schroeder (2007) published work on the causes of premature mortality.
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McGinnis indicated a need "to move our sense of what the vital statistics for the nation are away from the autopsy table and into society, as a whole, so that we have a much better means and reason for tracking the real sources of problems and opportunities that confront Americans." The following sections describe various approaches to measuring premature mortality and associated risk factors presented at the workshops. APPROACHES TO MEASURING PREMATURE MORTALITY AND RISK FACTORS Samuel Preston, University of Pennsylvania, described two basic approaches to identifying deaths attributable to a particular type of b ehavior.
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Categorical Approaches The assigned cause of death is key information used in the categorical approach to measuring premature mortality. Robert Anderson, National Center for Health Statistics (NCHS)
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Electronic health and death records and the potential for linkages between them and other sources of data have the potential to increase the timeliness, amount, and quality of data on the risk factors for premature mortality, Anderson said. Currently, only a portion of the states and jurisdictions using the standard form are registering them electronically.
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Study, which applies this methodology to collaborative efforts to systematically understand the risks associated with premature death and health loss around the world. Years of Life Lost Christopher Murray, University of Washington, and Vos described YLL as a method of conceptualizing premature mortality.5 The reference life table chosen for GBD 2010 and beyond defines the ideal life expectancy at each age.
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Vos defined life expectancy as a "measure synthesizing mortality rates in a population by age into what a hypothetical birth cohort would live to on average if the same mortality rates would continue indefinitely into the future." Health expectancy is a related concept, calculated as life expectancy minus the prevalence of all types of disability weighted by severity, as illustrated in Figure 2-1. Figure 2-1 also shows how DALY, described in a later section, relate to both life expectancy and health expectancy.
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FIGURE 2-1 Life expectancy, health expectancy, and health gap.
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DALY are the simple addition of YLL and YLD. Murray and others noted that the proportions of various risk factors associated with DALY are different than those associated with premature mortality.
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started to fall short of other countries for men in the 1950s, for women in the 1980s," adding that "at this point, the shortfall is very, very considerable." Preston described the methods used by the panel to determine why the United States had high mortality rates relative to nine other countries.6 The panel primarily used the counterfactual approach, which he described as "estimates of relative risk associated with a particular risk factor combined with a comparative distribution of exposures across populations." Preston 6Australia, Canada, Denmark, France, Italy, Japan, the Netherlands, Spain, and United Kingdom.
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This approach assumes that the lung cancer death rates in the absence of smoking are the same as those for nonsmokers in the American Cancer Society longitudinal study. Obesity Obesity is another single risk factor that has received a great deal of attention, although the populations of people who smoke and who are obese are largely independent of one another.
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Despite the uncertainty of the risk estimate, obesity remains an important risk factor implicated in explaining a sizeable amount of the differences in life expectancy between the United States and other countries, he said. Physical Activity Preston noted the existing epidemiology on physical activity is inconclusive in part because of the challenges of accurately measuring how much people do.
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The second method they applied was the use of cause-deleted life tables. Global Burden of Disease Christopher Murray described the risk factors included in the GBD.
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For analyses conducted for the 2014 meeting, Murray and his colleagues examined all behavioral risk factors combined at their theoretical minimums. This analysis was designed to address the question, "what would the premature mortality in the U.S.
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urray M stated, "We want to actually complete a Venn Diagram [illustrating the amount of overlap between behavioral, metabolic, environmental, and occupational risk factors] because a tremendous amount of metabolic risks are actually explained by the behavioral risks [with]
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• Level 3: 12 clusters of risk factors: Dietary risks, tobacco, air pollution, physical inactivity and low physical activity, other envi ronmental risks, water and sanitation, occupational risks, unsafe sex, alcohol and drug use, child and maternal undernutrition, sexual abuse and violence, and physiological risks. • Level 4: Full detail with all 70 risk factors (e.g., 15 components of diet)
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factors and 12 environmental factors.10 Census data served as the major source for these factors. Cullen said the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention was only a useful source of data for counties with a primarily white population.
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acknowledging the dynamic nature of risk factor distributions; (3) taking into account the independence of risks; (4)
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Dynamic Nature of Risk Factor Distributions Participants discussed a number of other issues that affect the measurement of premature mortality. John Haaga, National Institute on Aging, noted that risk factor distributions are dynamic rather than constant, citing the decline in deaths from heart disease and stroke occurring at a faster rate than the decline in associated risk factors.
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Murray and Ezzati indicated adding risk factors to the models' approaches explaining up to 100 percent of the occurrence of a given cause of death, with the marginal error becoming smaller and smaller. Determining Whose Behavior Is Being Measured Participants considered key behavioral risk factors for causes of premature death; however in some cases, determining whose behavior constitutes a risk is an issue.
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SUMMARY Various sources of data and approaches to studying premature mortality exist. Presenters described the ways in which premature mortality has been conceptualized, and the data sources that they have used to gather data on causes of death and risk factors.
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