period life tables for the non- hispanic american indian and alaska native population in chsda...
TRANSCRIPT
Period Life Tables for the Non-Hispanic American Indian and Alaska Native Population in CHSDA Counties
Elizabeth Arias, Ph.D.Mortality Statistics BranchDivision of Vital Statistics
National Center for Health Statistics
2014 Concurrent NAPHSIS Annual Meeting and VSCP Project Directors Meeting
Seattle, WashingtonJune 8-11, 2014
Background Period life tables provide the most
succinct snapshot of the mortality profile of a population at a point in time.
Age-specific life expectancy Age-specific probability of dying Age-specific probability of surviving
The life table is used to describe the mortality profile of populations by race, ethnicity, SES, and other demographic and social characteristics
Background Official US life tables have been
produced decennially since 1900 and annually since 1945
From inception, the racial categories included in the program are white and black,
With 2006 data, the ethnic and racial categories Hispanic, non-Hispanic white and black were added to the program.
To date, as a result of concerns about poor data quality, official US life tables for the AI/AN or API populations have not been produced
Data Quality Issues I) Ethnic and racial incongruence between
the two data systems used to estimate death rates:
Numerators are derived from death certificates Denominators are derived from census
population estimates Evaluation studies show that the main reason
for the incongruence is misclassification on the death certificate. Nationally, approximately 30% of self-identified
AI/AN are classified as some other race upon death.
In CHSDA counties, 20% and in non-CHSDA counties 82%.
Data Quality Issues
II) Age misstatement (misreporting) in the oldest ages results in the underestimation of death rates at the oldest ages
NCHS uses Medicare data to supplement vital statistics data at the oldest ages for the total, white and black populations.
Unfortunately, reliable Medicare data is not available for the AI/AN population.
Data and Methods
We used the AI/AN Mortality Data Base (AMD). AMD consists of National Vital Statistics System (NVSS) mortality data corrected for AI/AN misclassification on death certificates and covers years 1990-2009. Indian Health Service (IHS) patient registration
records were linked to the National Death Index (NDI) to identify IHS AI/AN deaths.
IHS AI/AN records identified as deceased through the NDI linkage were then linked to the NVSS mortality files, adding an additional AI/AN identifier to the files.
Data and Methods
We use 3-years (2007-2009) final death counts for ages 0-99 from the AMD .
Final death counts classified as AI/AN used to estimate the life tables include those classified as AI/AN in the NVSS mortality files AND those identified as AI/AN as a result of the linkage of the IHS to the NDI. Further, deaths were classified as non-Hispanic if so designated on the death certificate.
We used midyear 2008 sex and age-specific census revised bridged race inter-censal population estimates.
Data and Methods
The target population is the non-Hispanic AI/AN population residing in one of the 637 CHSDA counties.
The methods used are the same as those used to estimate official annual US life tables with some minor modifications.
The Brass Relational Logit Model is used to estimate mortality for ages 85 and older:
=
Age Pattern of Mortality Comparisons Between the Non-Hispanic American Indian and Alaska Native and the Non-Hispanic White Population
Males
0 7 14 21 28 35 42 49 56 63 70 77 84 91 98
-10
-8
-6
-4
-2
0
ln
(qx)
Females
0 6 121824303642485460667278849096
-10
-8
-6
-4
-2
0
---NH-AI/AN Vital ---NH-AI/AN Brass ---NH-White
Results
Life Expectancy at Birth
Male Female0
10
20
30
40
50
60
70
80
90
100
68.074.3
78.483.3
75.980.7
70.5
77.0
Non-Hispanic AI/ANHispanicNon-Hispanic WhiteNon-Hispanic Black
Life Expectancy at Age 65
Male Female0
5
10
15
20
25
15.1
17.518.7
21.6
17.4
20.0
15.4
18.8
Non-Hispanic AI/ANHispanicNon-Hispanic WhiteNon-Hispanic Black
Life Expectancy at Age 85
Male Female0
1
2
3
4
5
6
7
8
9
10
5.3
6.26.2
7.4
5.6
6.7
5.7
7.0
Non-Hispanic AI/ANHispanicNon-Hispanic WhiteNon-Hispanic Black
0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
-2
0
2
4
6
8
10
Difference in Age-Specific Life Expectancy Between the Non-Hispanic American Indian and Alaska Native and
Hispanic, Non-Hispanic White, and Non-Hispanic Black Female Populations
Hispanic - NH-AI/AN (Female) NH-White - NH-AI/AN (Female) NH-Black - NH-AI/AN (Female)Age in years
Diff
ere
nce in
years
0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
-2
0
2
4
6
8
10
Difference in Age-Specific Life Expectancy Between the Non-Hispanic American Indian and Alaska Native and
Hispanic, Non-Hispanic White, and Non-Hispanic Black Male Populations
Hispanic - NH-AI/AN (Male) NH-White - NH-AI/AN (Male) NH-Black - NH-AI/AN (Male)Age in years
Diff
ere
nce in
years
Ratio of Non-Hispanic American Indian and Alaska Native to Hispanic, Non-Hispanic White and Non-Hispanic Black Age-Specific Probabilities of Dying
Males
0 6 1218243036424854606672788490960.0
1.0
2.0
3.0
4.0
5.0
6.0
4.2
3.2
Rati
o o
f q
(x)
Females
0 6 1218243036424854606672788490960.0
1.0
2.0
3.0
4.0
5.0
6.05.3
3.2
---NH-AI/AN to Hispanic ---NH-AI/AN to NH-White ---NH-AI/AN to NH-Black
Percent Surviving by Age, Females
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 951000
10
20
30
40
50
60
70
80
90
100
NH-AI/AN Female NH-Black Female NH-White Female Hispanic Female
Percent Surviving by Age, Males
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 951000
10
20
30
40
50
60
70
80
90
100
NH-AI/AN Male NH-Black Male NH-White Male Hispanic Male
Percent Surviving to Selected Ages, Males
One Year
25 Years
50 Years
85 Years
0 10 20 30 40 50 60 70 80 90 100
99.0
95.8
82.3
19.3
99.4
98.3
93.9
39.7
99.4
98.1
92.6
33.1
98.6
96.5
88.0
21.5 NH-BlackNH-WhiteHispanicNH-AI/AN
Percent Surviving to Selected Ages, Females
One Year
25 Years
50 Years
85 Years
0.0 20.0 40.0 60.0 80.0 100.0
99.2
97.5
89.5
31.7
99.5
99.0
97.0
55.3
99.5
98.9
95.7
47.0
98.9
98.0
92.8
37.9 NH-BlackNH-WhiteHispanicNH-AI/AN
Summary and Conclusions The AMD largely eliminated the problem of
racial/ethnic misclassification on death certificates
Therefore, for the first time ever, we were able to produce reliable life tables for the NH-AI/AN population in CHSDA counties
NH-AI/AN life expectancy at birth was lower by close to a decade in comparison to the national Hispanic and non-Hispanic white populations
The mortality disadvantage of the NH-AI/AN population remained exceedingly large throughout the younger ages and only diminished in the very oldest ages
Limitations The life tables represent the mortality
profile of a segment of the AI/AN population: Represent 64% of the NH-AI/AN population
The use of the Brass Relational Logit Model to estimate mortality in ages 85 – 100+ fit very well and produced robust estimates, but relied on an unverified assumption that the relationship between the standard and the NH-AI/AN population in ages 45-84 extended to ages 85 and older.
Contact Information
Elizabeth Arias, PhD National Center for Health Statistics 3311 Toledo Road, Room 7331 Hyattsville, MD 20782 (301)458-4727 [email protected]