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Life and Death Matters: Data for Public Health Policy

Life and Death Matters: Data for Public Health Policy. Katrina Hedberg, MD, MPH Oregon State Epidemiologist. June 9, 2014. “ The flip side of democracy is bureaucracy: if everyone counts, everyone must be counted.” Kathryn Schulz, New Yorker , April 7, 2014. Public Health Division.

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Life and Death Matters: Data for Public Health Policy

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  1. Life and Death Matters:Data for Public Health Policy Katrina Hedberg, MD, MPH Oregon State Epidemiologist June 9, 2014

  2. “ The flip side of democracy is bureaucracy: if everyone counts, everyone must be counted.” Kathryn Schulz, New Yorker, April 7, 2014 Public Health Division

  3. Recording Births and Deaths • Historically realm of the church • Birth: baptism, christening • Death: burial and afterlife Public Health Division

  4. Black Death in Europe • 1350’s • Italy: quarantine to track living • England: track the dead Public Health Division

  5. Causes of Death • 1500’s: Bill of Mortality periodically published • 1600’s: • Weekly • Deaths other than plague Public Health Division

  6. Public Health Division

  7. Dr. William Farr: 1807-83 • Modern Vital Statistics • Disease classification • Creation of ICD in 1860 Public Health Division

  8. Public Health Division

  9. Dr. John Snow: 1807-83 • Modern Epidemiology • Mapping of cholera deaths Public Health Division

  10. Deaths from Cholera, London 1850’s • Miasma theory • Focused around the Broad Street Pump • Water intake from the Thames Public Health Division

  11. The Broad Street Pump Removing pump handle decreased cholera cases Public Health Division

  12. Birth Certificates • Documentation of birth: Ancient China, Egypt, Greece, Rome, Persia • Purpose: taxation, military service Public Health Division

  13. Types of Vital Record Data • Birth • Death • Marriages; divorce • Domestic partnership; dissolution • Fetal death; induced abortion • Other? Surveys… Public Health Division

  14. Vital Records: Dual Purpose • Legal documents • Birth: document age, nationality for school, health care, job, marriage, driver’s license, etc • Death: settling the estate after death • Health Status of the population • Birth: trends; prenatal care; etc • Death: causes; contributing factors Public Health Division

  15. Vital Records: Competing Issues • Legal documents • Privacy; identify theft; access to public services • Health Statistics • Complete picture • Accurate data • Timely data Focus on Vital Statistics for Public Health

  16. Public Health Essential Services

  17. Vital Statistics & Public Health • Monitor Health:trends in births, deaths • Diagnose and Investigate: work with ME’s; data on contributing factors • Inform, educate: issue annual reports/ briefs • Mobilize partnerships: funeral directors; licensing boards • Develop plans, policies: provide data to target appropriate interventions

  18. Vital Statistics & Public Health (2) • Enforce laws: Real ID Act; same-sex marriage • Link people to service: data for Medicaid; paternity determination • Assure competent workforce: vital stats basics for epidemiologists • Evaluate effectiveness/ health services quality: prenatal care; tobacco use • Research innovative solutions: death with dignity, out-of-hospital births

  19. Mortality Statistics Public Health Division

  20. Leading Causes of Death 2000 heart disease cancer stroke lung disease diabetes 1900 pneumonia influenza tuberculosis Public Health Division

  21. Causes of Death, Oregon 2011

  22. Death Rates for Selected Diseases, Oregon, 1980-2005 ICD-9 ICD-10

  23. Cancer cases and deathsOregon women, 2010

  24. Cancer cases and deathsOregon men, 2010

  25. Motor Vehicle Occupant and Opioid Overdose Deaths Deaths per 100,000 population

  26. Drug Overdose Policies • Providers: education; dosing guidelines • Patients: screening; monitoring; education; storage • Regulatory: Board of Pharmacy, DEA • E-prescribing; FDA black box warnings • Law Enforcement ( diversion) • Drug take-back • Public Health • Naloxone for overdoses; • Prescription Drug Monitoring Programs Public Health Division

  27. Causes of Death/ Premature Death Oregon 2011

  28. Mortality by Race/ Ethnicity: Oregon

  29. Contributing Factors Public Health Division

  30. Modifiable Factors assoc with DeathsU. S. 2000 Number of deaths

  31. Behaviors that kill Oregonians Public Health Division

  32. Tobacco Public Health Division

  33. Cigarette smoking prevalence by year, Oregon 1996 – 2011

  34. Smoking-Attributable DeathsOregon Rate per 100,000 Public Health Division

  35. Tobacco Control:Community Interventions • Limit access • Vending machines • Placement of cigarettes • Cost: taxes • Smoke-free air policies • Media Public Health Division

  36. Alcohol Public Health Division

  37. Binge Drinking in Adultsby Age; Oregon, 2011 Public Health Division

  38. Alcohol-related deaths, by age group, Oregon, 2011

  39. Alcohol Policies • Dram shop liability • Limiting hours of sale • Regulate outlet density • Increase price • Enhanced enforcement prohibiting sales to minors • No privatization of sales

  40. Pandemic Influenza Public Health Division

  41. Influenza Hospitalization Rates by Age & Sex; Oregon, 2009 80 60 Rates per 100,000 40 20 Age (yrs)

  42. Influenza Death Rates by AgeOregon, 2009

  43. Influenza Immunization Rates, Oregon, 2013-2014 Source: Oregon Immunization Program, Oregon Health Authority

  44. Birth Statistics Public Health Division

  45. Oregon Teen Pregnancy (15-17 yrs) Rate per 1,000 females Public Health Division

  46. Teen Pregnancy Rates by Race / Ethnicity, 2010

  47. Data on Birth Certificate to Inform Policy • Tobacco use during pregnancy: • 1990: 22%; 2012: 11% • Unmarried mothers age 20-24 yrs: 25% • Married mothers >40 yrs: 2% • Receipt of prenatal care • Early: 76%; inadequate: 24%; no care: 1% Public Health Division

  48. Objective Data to Inform Societal Debates • Death with Dignity • Out-of-hospital Births Public Health Division

  49. Oregon’s Death with Dignity Act • Citizens' initiative, passed in 1994, 1997 • Allows: terminally-ill Oregonians; prescription for lethal dose of meds; self-administered • Public Health Division: monitor / report participation • Debate: who chooses DWDA? poor? less-educated?

  50. Oregon DWDA Prescriptions and Deaths Public Health Division

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