|WV | DHHR | BPH | OEHP | HSC | PUBLICATIONS|
|Back to County List |||Tables extracted from the West Virginia County Health Profiles 2000|
Introduction to West Virginia County Health Profiles - 2000
This 2000 edition of the West Virginia County Health Profiles updates the previous editions published in 1997 and 1992. While a few changes have been made to the latest edition, the majority of the presentation has been kept consistent to allow comparisons between data in the earlier and later editions. We have attempted to incorporate suggestions from County Health Profile users around the state to make the updated version even more useful to researchers, health planners, health educators, grant writers, policymakers, and other health data consumers.
The attached health profiles compose an overview of the health status of West Virginia residents on the state and county levels. The first page of each county's profile provides a snapshot of that county's health status through a comparison of the county to the United States on the basis of 33 selected health indicators, including mortality rates, behavioral prevalences, birth statistics, and prenatal care measures. Each indicator has been tested for statistical significance in relation to the U.S. (see Appendix A for testing methodology) and classified as falling within a range of values (percentages or rates) that is lower than, the same as, or higher than that found for the nation as a whole. Based on these standards, county indicators were then categorized as better than, similar to, or worse than the U.S. For example, in Barbour County, the prevalence of seatbelt nonuse was found to be significantly lower than the national prevalence, the teen fertility rate was found to be neither significantly lower nor significantly higher than the U.S. rate, and the diabetes mortality rate was significantly higher than the national average. While the homicide rate in Barbour County was similar to the U.S. rate, the actual number of deaths over the study period was too small for valid significance testing (indicated by a double asterisk [**]).
This information is provided to allow counties to more accurately identify specific problems among their residents. This method of presentation is not meant to infer that indicators falling in ranges similar to or even lower than those for the nation do not pose serious problems to county residents or should not be addressed in health planning. However, a knowledge of a county's worst health problems is necessary in determining the priority of community interventions.
County and state data on selected causes of death from 1989 through 1998 are presented on the second page of each profile. The total number of deaths from 1989-98 are given, followed by the county's crude mortality rate (deaths among county residents per 100,000 population) and adjusted mortality rate (adjusted by age to the 2000 U.S. standard million) for each cause. The 1994 U.S. adjusted rate is provided for comparison purposes, together with the percentage difference between the county adjusted rate and the U.S. adjusted rate. (The percentage differences presented in the profile tables cannot be reproduced in all cases from the rates given due to rounding.) Finally, to provide comparability among counties, each county is ranked according to its adjusted rates, from highest rate (1) to lowest rate (55). As an example, in Barbour County, the 1989-98 adjusted rate for deaths due to diseases of the heart was 7.8% higher than the 1994 U.S. rate (322.4 deaths per 100,000 population vs. 299.2 deaths per 100,000 population). Statistically significant differences are noted with an asterisk (*) in the significance indicator (SI) column. (Barbour County's heart disease rate was not significantly higher than the national rate.) Barbour County ranked 43rd among the 55 counties in heart disease mortality.
The second page of each profile also presents data for each county on premature mortality, or years of potential life lost before the age of 65 (YPLL), calculated as the difference between the age of 65 and the age at death. For example, a person dying of lung cancer at the age of 45
contributes 20 years to the total YPLL for lung cancer (65-45=20 YPLL). The sum of YPLL for a specific cause of death is the total YPLL from all persons dying from that cause before the age of 65. YPLL is an important tool for emphasizing and evaluating causes of premature death.
The total number of YPLL for selected causes of death from 1989-98 are presented in column 1 of the YPLL table, followed by the crude YPLL rate (number of years of potential life lost by county residents per 100,000 population) and the adjusted YPLL rate (adjusted by age to the 2000 U.S. standard million). The 1994 adjusted YPLL rate for the United States is provided, as well as the percentage difference between the county adjusted YPLL rate and the U.S. adjusted rate. Significance is indicated in the next column by an asterisk (*). The county's rank for each cause from highest (1) to lowest (55) is found in the last column. In Barbour County, our example, there were a total of 1,401 YPLL due to cancer from 1989-98, yielding a crude rate of 1026.5 YPLL per 100,000 population in the county. Barbour County's adjusted rate for YPLL due to cancer was 1,064.6, which was 32.9% higher than the 1994 U.S. rate of 800.8, a statistically significant difference. Based on its adjusted rate, Barbour County ranked 9th in premature deaths due to cancer.
The graph and table on the third page of each profile present and illustrate changes in the numbers and rates for selected causes of death between 1984-93 and 1989-98. The graph illustrates the percentage change in the adjusted rates for each of the selected causes between the two time periods. (Percentages are calculated using rates carried to 15 places past the decimal point and thus cannot be reproduced from rounded rates given in the table.) Both the number of deaths and the adjusted rates for each cause are provided in the table, followed by the percent difference depicted in the graph and an indication that the difference is statistically significant, if applicable. Using Barbour County once again as an example, the adjusted rate for heart disease mortality declined from 356.2 deaths per 100,000 population in 1984-93 to 322.4 deaths per 100,000 population in 1989-98, a 9.5% decrease. This decline was not statistically significant, however, when tested. (Due to space limitations, 1984-93 and 1989-98 are referred to by their midpoints, 1988 and 1993, respectively, in the titles to the graph and table.)
The graph on the top of the fourth page of each profile illustrates the difference in gender-specific rates for the eight leading causes of death in each county, with an indication of statistically significant differences when applicable. The average age at death over the 10-year period is also supplied for men and women. In Barbour County, the average age at death among men from 1989-98 was 69.8, while the average age at death among women was 76.2. Mortality rates were higher among women for heart disease, stroke, and diabetes, while rates for deaths from cancer, COPD, pneumonia and influenza, unintentional injuries, and suicide were higher among men.
The table on the fourth page presents the total number of reported cases and the incidence rates for each county for all cancer sites, as well as for the four leading causes of cancer mortality, i.e., lung, colorectal, female breast, and prostate cancer, for each year from 1994 through 1998. Data on cancer cases diagnosed among West Virginia residents (with the exception of basal cell and squamous cell carcinomas of the skin and carcinoma in situ of the cervix) have been collected and reported by the West Virginia Cancer Registry (WVCR) since 1993. The Registry adjusted the 1994-98 incidence rates to the age distribution of the 1970 U.S. population (instead of the 2000 U.S. standard million used for the state's mortality rate adjustments reported in this document) to allow comparisons with national data published by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Inquiries involving cancer incidence rates should be directed to the WVCR, 350 Capitol Street, Room 125, Charleston, WV 25301-3715, (304) 558-5358, (800) 423-1271.
In Barbour County, there were a total of 407 diagnoses of cancer reported from 1994 through 1998, representing an average annual age-adjusted rate of 377.0 per 100,000 population. The average annual rate of cancer of the lung and bronchus was 59.5 diagnoses per 100,000 population. The county's rate for colorectal cancer was 55.9 per 100,000 population, the rate for prostate cancer was 108.9 per 100,000 male population, and the rate for cancer of the female breast was 67.7 per 100,000 female population.
Behavioral risk factor prevalences are found on the fifth page of each profile. Prevalences are given for nine behavioral risk factors that have been determined to affect health adversely: physical inactivity, obesity, hypertension, seatbelt nonuse, cigarette smoking, smokeless tobacco use, binge drinking, uninsured status, and difficulty in seeing a doctor because of the cost. County prevalences from 1995 through 1999 have been aggregated and compared to (1) the estimated 1997 U.S. prevalence for each of the nine risk factors and (2) aggregated county prevalences from 1990 through 1994.
For both the 1990-94 and 1995-99 prevalences, 24 counties had aggregated sample sizes large enough to yield individual prevalence calculations. Samples from the 31 counties that had sample sizes too small to stand alone were combined with samples from other less-populated, contiguous counties into 12 groupings, or multicounty regions. (A map depicting the final 36 groupings is found in Appendix B, as well as state trends for selected risk factors from 1984-99.) A single behavioral prevalence was then calculated for each grouping. This prevalence was provided as the prevalence for each county included in the grouping. Counties are ranked from highest to lowest prevalence on the basis of the final 36 areas, with counties within each grouping sharing a rank.
The graph compares 1995-99 risk factor prevalences to those from 1990-94. A statistically significant difference between the two time periods is indicated where appropriate. The table presents prevalences from 1990-94 and 1995-99, as well as estimated 1997 U.S. prevalences for additional comparisons. Statistical significance between county and national rates is indicated. The last column contains the county's rank for each risk factor. A rank of 1 denotes the highest prevalence of a risk factor, while 36 denotes the lowest prevalence. (Due to limited space, 1992 is used to refer to aggregated data from 1990-94; 1997 is used to refer to aggregated data from 1995-99.)
Continuing our example, the prevalence of obesity in Barbour County was 37.5% in 1990-94, increasing to 39.7% in 1995-99 (not a statistically significant difference). Although Barbour County's 1995-99 rate of 39.7% was 11.6% higher than the estimated 1997 U.S. prevalence of 35.6%, this was not found to be a statistically significant difference. Barbour County's grouping ranked 22nd among the 36 groupings in obesity prevalence.
Aggregated birth data from 1994 through 1998, found on the sixth page of each profile, are included to provide health educators, researchers, and planners with numbers of births, age-specific proportions of births, and age-specific fertility rates (the number of births to women in a specific age category per 1,000 women in that age category) by county. Comparable U.S. fertility rates are provided for 1996, followed by the percentage difference between the county and national rates, as well as significance indicators where applicable. Finally, for each age group, counties are ranked from highest fertility rate (1) to lowest fertility rate (55). In Barbour County, there were a total of 833 births from 1994-98 among women aged 15-44, yielding a fertility rate of 47.0 (births per 1,000 women aged 15-44). This was significantly lower than the comparable 1996 U.S. rate of 64.9. Barbour County ranked 46th among the 55 counties in fertility rates among women of childbearing age (15-44).
Age-specific fertility rates provide a more accurate measure of the problem of births to teen mothers than does the more traditional method of comparing the proportion of all births that occur among teenagers. Statewide, and in most counties in the state, the proportion of total births that are to teenagers is higher than that in the nation as a whole. This does not take into account, however, the drastic decline in both teen (15-19) and, in particular, older (20+) births occurring in West Virginia since 1980. Because women in the state over the age of 19 are having fewer babies, the proportion of teen births has remained high, while statewide, and in many counties, the teen fertility rate is actually significantly lower than the national average.
Selected birth certificate data collected over the five-year period from 1994 through 1998 have also been included for each county. Information is provided on the number and percentage of low-birthweight births, births to unwed mothers, early (1st trimester) vs. late (3rd trimester)/no prenatal care, mother's use of tobacco during pregnancy, and mother's educational level (i.e., percent of mothers having less than a high school education). Comparable U.S. data from 1996 are presented, as well as the percentage difference between county and national statistics and significance indicators where applicable. The counties are ranked for each category from the highest percentage (1) to the lowest percentage (55). In the example of Barbour County, there were 71 low-birthweight births from 1994-98, representing 8.5% of all births. This percentage was 14.6% higher than the 1996 U.S. rate of 7.4% (not a significant difference). Barbour County ranked 16th in percent of low-birthweight births.
Total infant and fetal deaths from 1991 through 1995 are provided with accompanying rates. Infant mortality is broken down into neonatal deaths (infants less than 28 days old) and postneonatal deaths (infants 28 days to one year of age). Fetal deaths are those deaths that occur before birth at or after 20 weeks of gestation. Both infant mortality rates and fetal death ratios are calculated as the number of occurrences per 1,000 births to county residents. The 1993 U.S. rates for infant and fetal mortality are provided, followed by the percentage difference between the county and the nation and statistical significance indicators where applicable. Counties are ranked from highest (1) to lowest (55) rate. There were 9 infant deaths in Barbour County from 1994 through 1998, yielding an infant mortality rate of 10.8 deaths per 1,000 live births to county residents. This rate was higher than the 1996 U.S. rate of 7.3; however, the number of deaths is too small for significance testing. Barbour County's infant death rate was 8th highest among the 55 counties.
The graph and table on the seventh page of each profile present changes in the numbers and rates of selected natality characteristics between 1989-93 and 1994-98. The graph illustrates the percentage change that occurred in the rates between two time periods, with statistical significance indicated where applicable. (Percentages are calculated using rates that are carried out to 15 places beyond the decimal point and thus cannot be reproduced from rounded rates given in the table.) For example, in Barbour County, the percentage of total births that occurred to unwed mothers was 28.9% higher in 1994-98 than in 1989-93 (25.6% in 1989-83 vs. 33.0% in 1994-98), a statistically significant increase. Both the number of births and the rates are provided in the table, together with the percentage difference between the time periods and significance indicators. (Because of limited space, 1989-93 and 1994-98 are referred to by their midpoints, 1991 and 1996, respectively, in the titles to the graph and table.)
The eighth page of each profile contains county population distributions by age, sex, and race based on 1995 estimates published by the Census Bureau. Each county's total population is broken down by five-year age groups and sex, with comparable breakdowns by race (white population, black population, and other races population). These data can be utilized in the calculation of age-, sex-, and race-specific mortality and birth statistics, information that is useful in determining the most effective intervention strategies on the individual county level.
If you have further questions about West Virginia vital statistics data, you may contact the Health Statistics Center at:
|WV | DHHR | BPH | OEHP | HSC | PUBLICATIONS | Top of Page|