College of Public Health and Human Sciences

1. College of Public Health and Human Sciences Public Health Policy Institute Presenter: Stephanie Bernell Date: August 21, 2013

2. Data is necessary • By the middle of the 21st century, the U.S. population is projected to reach 400 million • More than 20% of the population will be over 65 years, an increase from 12.5% in 2003 • Approximately half the U.S. population in 2050 will be white; the largest increases will be seen in Hispanic and Asian populations. Public Health Policy Institute

3. Data is necessary • In 2002, spending for health care in the United States was $1.6 trillion (adjusted for inflation) • this is a fivefold increase from 1970 • The projections for prevalent cases of Alzheimer’s disease will more than double by 2030 Public Health Policy Institute

4. Current measures of the public’s health - mortality • Absolute numbers and death rates are common measures of disease burden • Chronic diseases—cardiovascular disease, cancer, chronic lung disease, and diabetes—are leading causes of death, followed closely by unintentional injuries and influenza • Age-specific mortality rates provide additional insights • infant deaths are dominated by congenital anomalies, short gestation, and sudden infant death syndrome (SIDS) • young adults are killed primarily by intentional and unintentional injuries Public Health Policy Institute

5. Current measures of the public’s health - mortality • Stratification of mortality data by race and ethnicity helps to quantify health disparities • Blacks suffer higher rates of death for almost all leading causes • Hispanics and American Indians have lower rates than whites for the leading causes of death • Except for diabetes in Hispanics and unintentional injury in American Indians • Asians have the lowest rates for all major causes of death except cerebrovascular disease Public Health Policy Institute

6. Designation of Categories • Designation of categories of death affects ranking • if we combine injuries across all causes (motor vehicle injuries, homicide, suicide, etc.), as cancer is combined across all sites, injuries would become the leading cause of premature mortality Public Health Policy Institute

7. Current measures of the public’s health - morbidity • The number or rate of nonfatal outcomes is not used as often as mortality in assessing disease burden • The only chronic, non-infectious condition for which the United States has national data for incident cases is cancer Public Health Policy Institute

8. Hospitalization Data • Hospitalization rates are sometimes used to estimate disease burden • Heart disease is the leading cause of hospitalization entry, followed by childbirth, psychoses, pneumonia, cancer, and fractures • Hospitalization data advantage: relatively easy to obtain; useful for certain analyses • Hospitalization data disadvantage: biased indicators of burden for the majority of conditions • Ex, the increasing use of outpatient treatment for conditions previously requiring hospitalization can substantially affect the utility of these data Public Health Policy Institute

9. Summary measures • Summary measures assess overall health status of a population • These measures combine morbidity, mortality, and disability data, but can also reflect perceived quality of life or functional status • Ex - physical functioning, mental and emotional well-being, social functioning, general health perceptions, pain, and energy Public Health Policy Institute

10. Summary measures • Quality-of life measures are especially critical for conditions that cause considerable suffering but limited numbers of deaths • Quality-adjusted life years (QALY) combines quality and quantity of life (in years) Public Health Policy Institute

11. Cost Data • Economic cost as a consequence of a health condition is a key summary measure of economic burden • Cost of illness information is available • Considerable variability in methods and data sources make comparisons difficult • Medical Expenditure Panel Survey (MEPS), provides estimates of national health care spending among the noninstitutionalized U.S. population Public Health Policy Institute

12. Cost Data - Example • An analysis using 2000 MEPS data reveals that heart disease is the most costly condition, followed by trauma, cancer, pulmonary disease and mental disorders • The estimates do not provide a comprehensive measure of economic burden • The MEPS data do not include indirect costs and productivity loss Public Health Policy Institute

13. Caution • A reliance on a single measure of public health burden may be misleading • Ex - suicide and homicide do not appear in leading causes for total mortality, but these events are very important as causes of premature death • Ex - depression may not be the cause of death, yet it responsible for the fourth largest source of disability Public Health Policy Institute

14. Caution • Even the best measures of burden can not capture certain public health practice • emergency preparedness • effective preventive practices (e.g., immunization or fluoridation) • environmental quality (e.g., air- and water-quality monitoring), mental health, and socioeconomic status are limited in scope and precision • Ex, in most states, departments of the environment are administered separately from departments of health and public health Public Health Policy Institute

15. CHARACTERISTICS OF USEFULMEASURES OF THE PUBLIC’S HEALTH • Measures should detect either an absolute or a relative change in health status over time • Measures should be valid • Does the indicator measure what it purports to measure? • Measures should be able to evaluate major health policy changes • Ex: if taxation on tobacco is increased, youth initiation may be a more immediate measure of effect • Measures should be stable over time and equivalent across settings • Ex: self-rated health, while useful from a societal standpoint, may not be comparable from one population to another Public Health Policy Institute