Search | Employees

• Acronyms/ Abbreviations

Table of Contents                                                                   

ABORTION AND PREGNANCY RATES

Abortion and pregnancy rates measure the frequency of abortions and pregnancies among women of childbearing age in the population and among women in specific age ranges. Rates also measure the frequency of abortions occurring within gestational age ranges such as trimesters of pregnancy or any user-specified range in weeks. Rates can also be examined by specific age groups of pregnant women.  While race is reportable on abortion certificates, the large amount of missing data precludes computing accurate race-specific rates, so the race panel is disabled.

Definition of Terms

Abortion Rate - The number of induced abortions among women of all ages per 1,000 women of childbearing age (i.e. age 15-44 years).

Pregnancy Rate - The number of births plus induced abortions among women of all ages per 1,000 women of childbearing age (i.e. age 15-44 years). Fetal deaths are not included due to the unreliability of reported statistics and small numbers of events.  VistaPHw differs in this calculation from the DOH Center for Health Statistics where fetal deaths are included in the calculation of this statistic.

Abortion Percent - The number of induced abortions per 100 pregnancies (not including pregnancies ending in fetal death).

Percent Abortions by Gestational Age - The percent of all abortions occurring within gestational age groups.

Abortion and Pregnancy Data Source: WA State Department of Health, Center for Health Statistics, Abortion System
 

Table of Contents

BIRTH RISK FACTORS

A wide range of indicators related to pregnancy and birth are risk factors for adverse health outcomes among infants. For example, Low Birth Weight and Pre-term Delivery are significant risk factors for infant mortality.  Additionally, socioeconomic status (SES) and birth risk factors combined can provide important information about the health of the entire community.  All Birth Risk Factor data are derived from birth certificates. Racial data for Birth Risk Factors is by maternal race. The rate for any risk factor is given per 100 (i.e., percent of) live births for which the status of the risk factor is known.

Definition of Terms

Normal Birthweight -  Percentage of live births in which the infant weighed 2,500 grams (5 pounds, 8 ounces) or more among live births for which the birth weight is known.

Low Birthweight -  Percentage of live births in which the infant weighed less than 2,500 grams (5 pounds, 8 ounces) among live births for which the birth weight is known.

Moderately Low Birthweight -  Percentage of live births in which the infant weighed at least 1,500 but less than 2,500 grams (3 pounds 5 ounces to 5 pounds 6 ounces) among live births for which the birth weight is known.

Very Low Birthweight -  Percentage of live births in which the infant weighed less than 1,500 grams (3 pounds, 5 ounces) among live births for which the birth weight is known.

Multiple Birth -  Percentage of live births in which more than one baby was delivered (Twins, Triplets, etc.).

Mother's Age <18 -  Percentage of live births to women less than age 18 among births for which the mother's age is known. The indicator is often called the "school-age" birth rate or the "adolescent" birth rate.

Mother's Age <20 -  Percentage of live births to women less than age 20 among births for which the mother's age is known. This indicator is often called the "teen" birth rate.

Mother Unmarried -  Percentage of live births to an unmarried mother, among births for which the mother's marital status is known.

Premature Birth, Calculated -  Percentage of live births in which the infant was born before the end of the 37th week of gestation based on a calculated gestational age, among births for which the calculated gestational age is known. The calculated gestational age is determined by subtracting the last menses date from the date of birth.  If the month but not the day of the last menses is known, 15 is used for the day of the month.

Premature Birth, Estimated -  Percentage of live births in which the infant was born before the end of the 37th week of gestation based on an estimated gestational age, among births for which the estimated gestational age is known.  The estimated gestational age of infant is determined by physician's estimate at time of birth.

Care Began in the First Trimester -  Percentage of live births in which the mother started prenatal care in the first trimester of the pregnancy, among births for which the month care begin is known.

Late or No Prenatal Care -  Percentage of live births in which the mother received late (Third Trimester) or no prenatal care, among births for which the month care began is known.

Adequate/Inadequate Care - Kotelchuck Index -  Percentage of live births in which the mother received adequate or inadequate prenatal care according to the Kotelchuck Index of prenatal care, among births for which the Kotelchuck Index can be computed. The index reflects both date of initiation and number of prenatal care visits.

Weight Gain <25 Pounds -  Percentage of live births for which the mother had a weight gain of less than 25 pounds during pregnancy, among births for which the maternal weight gain is known. 1989 was the first year maternal weight gain data were recorded on Washington State birth certificates.

Maternal Smoking -  Percentage of live births in which the mother reported smoking during pregnancy, among births for which the mother's smoking status is known. For 1989-1991, the birth certificate orientation of maternal smoking questions may make data for those years unsuitable for inclusion in trend analysis. For more information, press the ALT key and click on this option.
 

Maternal Smoking Trimester -  Percentage of live births for which the mother reported smoking during a particular trimester of pregnancy (1st, 2nd, or 3rd), among births for which the mother's smoking status is known.
 

Maternal BMI -  Percentage of live births for which the mother is underweight, normal weight, overweight, or obese by the mother's BMI (body mass index, calculated from the mother's height and weight), among births for which the mother's BMI is known.

Mother has Anemia -  Percentage of live births in which the mother had anemia among births for which the mother's anemia status is known. 1989 is the first year anemia data are available.  Washington State Department of Health stopped collecting this item in 2003.

Age-Specific Rates -  Age-Specific rates for birth risk factors are limited to breakdowns of potential child-bearing years. Age group combinations are possible by clicking on the COMBINE box located below the Age Groups.

Birth Risk Factor Data Source: WA State Department of Health, Center for Health Statistics, Birth Certificate System

Table of Contents

OTHER COMMUNICABLE DISEASES

The importance of communicable diseases as a cause of death has declined dramatically since 1990 thanks to improved social and economic conditions such as better housing and clean water, as well as public health improvements including immunization, improved sanitation and the widespread availability of antibiotics. However, communicable diseases remain a major cause of illness and disability. 

Health care providers are required to report cases of certain diseases.   (STD and TB are separate assessment topics in VistaPHw).   Communicable disease options in VistaPHw include:

Counts can be given for male, female and total.  Note that to get counts only, we select the "Crude Rate" option, then suppress all columns except CNT in the OUTPUT PREFERENCES panel.  Also, note that if we were to select age-adjusted rate instead of crude rate, the counts might be lower because cases with missing age are not included.  Rates are per 100,000 population.

Communicable Disease Data Concerns:

1. Surveillance case definitions are usually more stringent than criteria applied in diagnosing and treating communicable diseases. The Centers for Disease Control and Prevention (CDC) case definitions are used for communicable disease surveillance in Washington State. Case definitions are published by the CDC (MMWR 1997;46:RR-10).

For example, counties may have higher rates of hepatitis A than the state because the CDC definition of Hepatitis A includes both a positive test for Hepatitis A AND recorded Jaundice.  Counties may have records that are positive for Hepatitis A but, DO NOT record Jaundice. 

2.  Incomplete reporting occurs with any surveillance system. The proportion of patients seeing a health care provider, diagnosed by clinical and laboratory methods, and reported to local health agencies varies according to the specific disease. Common and mild illnesses are typically underdiagnosed and underreported while unusual or severe illnesses are typically more completely reported. The Communicable Disease database contains reported cases, with completeness of reporting varying by diseases.

3.  Communicable disease cases are reported by the patient's state and county of residence. For some diseases, there is close correlation between residence and geographic location of exposure, while for others, exposure invariably occurs out of state, reflecting travel or immigration.

epiTRENDS newsletter

DOH Communicable Disease Website

Table of Contents

DEATH RATES

Death rates are one of the most common measures of the health of a community. They serve as markers for major health problems of a population. Race, Sex and Age-Specific analysis of death rates provide insight into the often vastly different health problems of each demographic group.  Data for death rates are derived from death certificates. Rates are per 100,000 population.

Cause of Death Categories:

There are three sets of mortality categories to choose from in VistaPHw:

1) NCHS ICD10 Causes

2) NCHS Leading Causes

3) Injuries

For each cause of death, the list of ICD-9/ICD-10 codes used to define the cause is displayed when you press the ALT key while clicking on the category.  If you are attempting to compare VistaPHw data to another data source it is important to check that the same ICD codes are used. When using death data that crosses over 1999 (i.e. 1997-2006), use comparability ratios.  Causes of death that occurred beginning in 1999 are coded with ICD-10.

Definition of Terms

Underlying Cause of Death - The disease or injury which initiated the train of morbid events leading directly or indirectly to death or the circumstances of the accident or violence which produced the fatal injury.

Fetal Death - Death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy. The death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Reporting of fetal deaths to the state is required only when the gestational period is twenty weeks or more.

Infant Death - Death of a child under one year of age.

Maternal Death - Death attributed to complications of pregnancy, childbirth, or the puerperium for women of childbearing age; includes abortion related death. (ICD 10: 000 - 099)  In 2004, a pregnancy check box was added to the death certificate and this has resulted in an increased number of these deaths being recorded.

Neonatal Death - Death of an infant within the first 27 days of life.

Perinatal Death - Fetal deaths plus deaths to infants within the first six days of life.

Postneonatal Death - Death of an infant of 28-364 days of age.

Death Data Source: WA State Department of Health, Center for Health Statistics, Death Certificate System

Table of Contents

FERTILITY RATES

Fertility rates measure the frequency of births among women of child bearing age in the population, among women of specific age groups in the population, and in the total population.  The age-specific rate among adolescents is of particular importance because of the impact a birth has on the futures of both mother and infant.  Looking at factors such as age, fertility rates and socioeconomic status (SES) together can be a good indicator of the health of your community.  Fertility rates are derived from birth certificate data and population data. The various types of fertility rates computed by VistaPHw are described below.

Definition of Terms

Crude Birth Rate -  The number of live births per 1,000 total population.  It is generally used as a measure of population growth due to childbirth.  It is not a measure of fertility.  In order to measure fertility it is more appropriate to use general or age-specific fertility rates.

=[Number of Live Births / Total Population] *1,000

General Fertility Rate -  The total number of resident live births per 1,000 women of childbearing age.

=[Number of Live Births / Female Population Ages 15-44] *1,000

Age-Specific Fertility Rate -  The number of resident live births to women in a specific age group (e.g., 20-44 years) per 1,000 women in the same age group.

=[Number of Live Births in a Specific Age Group / Female Population in the Same Specific Age Group] *1,000

Teenage Fertility Rate -  The number of resident live births to women 15-19 years of age per 1,000 women 15-19 years of age.

=[Number of Live Births to Women Ages 15-19 / Female Population Ages 15-19] *1,000

Fertility Data Source: WA State Department of Health, Center for Health Statistics, Birth Certificate System
 

Table of Contents

HOSPITALIZATION RATES
 

The Center for Health Statistics (CHS) of the Washington State Department of Health (DOH) collects and maintains Washington hospital inpatient discharge data.   The data and system are called the Comprehensive Hospital Abstract Reporting System, or CHARS.  The CHARS data contain inpatient records for most hospitalizations occurring in Washington State.

The data include:  hospitalization records from Washington state licensed acute care facilities as defined in RCW 70.14.020; all persons treated in those facilities, including patients from other states and countries; patient demographics such as age, sex, and zip code of residence; diagnosis, procedure, and injury causation codes; treating hospital, length of stay, admission source, and discharge status; and payer, total billed hospital charges, DRG, DRG relative weights and revenue category breakdown. 

The data do not include:  emergency room or outpatient records; records from hospitalizations in US military hospitals, US veterans hospitals, state psychiatric hospitals, birthing centers, private alcoholism or private rehabilitation facilities; measures of race/ethnicity, occupation, education, or income; hospitalization costs or payments; hospitalizations of Washington residents treated outside the state; or professional charges (physicians, anesthesiologists, etc.).

The primary uses of the CHARS data are for public health and health care system analyses. Although hospitalization data primarily record the extremes of illness and injury, they are often the only population based data available to measure these conditions prior to death. The data can also be used in other ways, such as in the hospital business where it forms the basis of market share studies.

The CHARS system was originally designed to aid in cost containment and rate regulation of hospitals. The variables in CHARS are taken from the billing form (the Uniform Bill, or UB) which is filled out when a patient is discharged. By law, hospitals are given 45 days after the end of each month to submit a record to CHARS. These records are then edited for a variety of factors, corrected, and compiled into the CHARS database that is released. CHARS is a discharge based database, meaning the calendar year of patient’s discharge determines which year of CHARS in which the record is included.  Admission date and fiscal years do not determine that placement.

The CHARS data are edited for internal and logical consistency, but are not routinely audited for external validity. For internal consistency, each hospital must certify that at least 95% of the total records and total charges generated by that facility over the reporting period are represented in the data. The system did not allow missing data prior to 1993. 

Some CHARS limitations.   Patient residence is collected at the zip code level, which does not fit perfectly into counties in some cases where zip codes cross county lines, such as in Clark, Skamania, and Asotin. Counties with veterans and military hospitals and a large military population, such as Pierce and Island, will find their populations underrepresented in the CHARS data. Border counties will experience similar problems with residents who are treated outside the state.

With the move to managed care, a smaller percentage of the population is being hospitalized and often all but the most critical cases are being seen and treated in an outpatient setting. This limits the types of analyses which are possible using only CHARS data.  However, the CHARS data still provide valuable information for some projects and sometimes is the only source of information available.

Some potential uses of the data include:

1.      Monitoring trends in causes of hospitalization

2.      Hospital and health care marketing and planning

3.      Developing Washington State specific reimbursement information (DRG weights and case mix indices).

4.      Conducting clinical health research

5.      Conducting surveillance on selected health conditions

6.      Evaluating health care quality and outcomes

7.      Quantifying resource utilization

8.      Identifying health assessment issues

9.      Measuring health status

Some potential public health uses of the data include:

1.      Measuring access to care via ambulatory care sensitive conditions

2.      Evaluating program effectiveness

3.      Developing local measures for comparisons to state and national indictors

CHARS data are available from 1987 on. Other key data elements in CHARS include:   discharge dates, length of stay, admission source, admit type, discharge status, payer, attending and other physician, DRG and DRG relative weights.

Definition of Terms Used for Data Elements in CHARS

Principal Diagnosis - the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.  This is the first diagnosis on a CHARS record.

Secondary Diagnosis  - any condition that is not the principal diagnosis.  All conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received and/or length of stay.  Up to eight of these can be coded into a CHARS record.

Principal Procedure - the procedure performed for definitive treatment rather than for diagnostic or exploratory purposes, or to treat a complication.  It is the procedure most related to the principal diagnosis.

Complication - a secondary condition that arises during hospitalization and is thought to increase the length of stay by at least one day for approximately 75% of the patients.

Co-morbid Condition - is a condition that existed on admission and is thought to increase the length of stay at least one day for approximately 75% of the patients.

CC – complication and co-morbid condition which assigns the principal diagnosis to a higher paying level of DRG.

DRG - Diagnosis Related Group – a group of ICD-9 codes which receive the same capitated reimbursement

ICD-9-CM - International Classification of Diseases, 9th Revision, Clinical Modification.  This is the WHO coordinated disease classification system prior to ICD-10 and the one by which hospitalization diseases and procedures are coded. NCHS issues corrections, additions, and deletions of some of these codes to be effective October 1 each year, which is the annual change of the federal fiscal year.  Disease codes can contain up to 5 digits.   Procedure codes can contain up to 4 digits.

A VistaPHw Convention: (F) and (M) Categories - The Categories listed below are always presented as sex-specific rates, even in output where sex breakdowns were not requested.  Such categories, which also occur in death categories, are identified with (F) or (M) preceding or following category labels, both in screen menus and in the computed results. 

A VistaPHw Convention and Option:  Diagnosis Categories - Analyses in VistaPHw use grouped ICD-9 codes.  For common medical problems, more than one ICD code might apply to the condition to be studied.  The hospitalization categories were devised by Jim Krieger some time ago.  There are several different ways to group the diagnoses into categories.  Users can see what is included in an individual VistaPHw category by  holding the ALT key while clicking on a category and VistaPHw will display a listing of the ICD-9 codes included under that topic.  There is also an option for displaying ICD codes in the output results: On the Launch screen users can check the box for "display codes" and the output will show the ICD codes for each subset topic.  There may be differences in ICD-9 codes for topics under reported vs. modified E-codes.  If you are doing any comparisons of your community to state or national level data (comparing to data outside of that in VistaPHw) you must make sure the ICD-9 codes are exactly the same for each analysis.

Hospitalization Data Source: WA State Department of Health, CHARS
 

Table of Contents

INFANT DEATH RATES AND CAUSES

Infant Mortality is one of the most widely used indicators of maternal and infant health. Infant mortality is defined as the death of a live-born infant before the age of 1 year. Infant mortality reflects the health of pregnant women and infants, which is sensitive to a wide range of social, economic, biological, health service, and environmental factors. The infant mortality rate responds to these diverse factors, and thus may serve as a sentinel event warning of problems that may affect the entire population. Infant mortality can be separated into two components, neonatal mortality and post neonatal mortality. Neonatal mortality is death through the end of the 27th day of life, and post neonatal mortality is death from day 28 of life up to one year. Neonatal mortality usually reflects adverse events during pregnancy. Low birth rate or preterm delivery can result in neonatal mortality.  Postneonatal mortality is usually related to social and environmental factors early in the infant's life, although deaths from birth defects also occur in this period.  Data for infant mortality rates and causes of infant mortality are derived from linked birth and death certificates. Rates are per 1,000 live births.

Definition of Terms

Fetal Death - Death prior to the complete expulsion or extraction from its mother as a product of human conception, irrespective of the duration of pregnancy. The death is indicated by the fact that after such expulsion or extraction the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Reporting of fetal deaths to the state is required only when the gestational period is twenty weeks or more.

Infant Death - Death of a child under one year of age.

Maternal Death - Death attributed to complications of pregnancy, childbirth, or the puerperium for women of childbearing age; includes abortion related death.

Neonatal Death - Death of an infant within the first 27 days of life.

Perinatal Death - Fetal deaths plus deaths to infants within the first six days of life

Postneonatal Death - Death of an infant of 28-364 days of age.

Total Infant Mortality Rate - The number of deaths (those occurring from birth up to, but not including, the first birthday) of live-born infants in a given year per 1000 live births occurring in the same year.

Neonatal Mortality Rate - Number of neonatal deaths of live-born infants per 1000 live births in the same year.

Post Neonatal Mortality rate - Number of post neonatal deaths (those occurring from the 28th day of life up to, but not including, the first birthday) of live-born infants per 1000 live births in the same year.

Causes of Infant Mortality - The list below contains major categories (upper case) and subcategories.  One can examine any combination of major categories or sub-categories in any analysis.  The categories are combinations of the National Infant Mortality Surveillance Project (NIMS) causes.

PREMATURITY
    Prematurity/Low Birth Weight
    Respiratory Distress Syndrome/Bronchopulmonary Dysplasia
PERINATAL CONDITIONS
    Other Perinatal Respiratory
    Birth Trauma
    Other Perinatal Conditions
    Perinatal Infection
OTHER INFECTION
CONGENITAL ANOMALY
EXTERNAL CAUSES
SIDS
OTHER
    Non-specific
    Other causes

Race-specific rates - For race-specific rates, VistaPHw uses the mother's race and ethnicity from the birth certificate.

Age-specific rates - Age-specific rates are limited to categories of potential child-bearing years.  Age group combinations are available by clicking on the Combine box located below the Age Groups.

Death Data Source: WA State Department of Health, Center for Health Statistics, Death Certificate System
 

Table of Contents

LIFE EXPECTANCY

Life expectancy is the average length of time persons of a particular age in a population are expected to live, assuming that as they age their probability of dying will reflect the age-specific mortality rates observed during the reported year.   When life expectancies are computed for race-specific and sex-specific subpopulations, calculations are based on age-specific mortality rates for corresponding subpopulations.  For example, life expectancy at birth for males is lower than life expectancy for females because age-specific mortality rates for males are usually higher.

Life expectancies can be computed for the sex, race, and geographic units available for mortality analysis in VistaPHw.  While life expectancy at birth is the most commonly used rate, life expectancy at five-year age increments up to age 85, plus age 1 and age 18, are also available in VistaPHw.  The ages listed in VistaPHw are the lower bounds of the twenty age groups used to define the life-expectancy tables used in the calculations.

While life expectancy does not identify specific health problems, it is a useful summary measure for comparing populations in different places, demographic groups, and over time.  Data for calculating life expectancy are obtained from death certificates and population estimates.  Rates are given in years of life.

Table of Contents

POPULATION TABLES

Population data support most VistaPHw assessment topics, since they are required for most rate calculations.  Besides using population data for rate calculations, VistaPHw can also produce tables of population data.

The Washington State VistaPHw subcounty populations includes population estimates and projections for age by sex by race subpopulations for each county. Subcounty population estimates are available for 2000 census tracts and block groups from 1990-2006. VistaPHw also includes population data by zipcode, and local jurisdictions should be able to obtain similar data for regions in the state defined by census geography.

The usual VistaPHw Age and Sex breakdowns are available for the population data set.  Custom age groupings can be constructed from the standard twenty age groups.  The standard twenty age groups include 5-year intervals from zero to eighty-five, except the 0-4 age group is broken down into <1 and 1-4, and the 15-19 age group is broken down into 15-17 and 18-19.  The oldest age group is 85 and over.

Four race breakdowns are available.  They are selected by choosing a race option in the pop-up menu when selecting the population assessment topic.  From 1990-2006, populations estimates are available for single race, Hispanic as race and ethnicity; for 2000-2006 multiple race, Hispanic as race and ethnicity.

Why Use Population Data?

-Provide a basis of comparisons of communities over time and in different geographic areas
-Denominators for rates

Sources of Population Data

-U.S. Census (an actual count once every 10 years)
Q: What about the other years?
A: Intercensal estimates
-Census Bureau (state level)
-Washington State OFM (official state, county and city level figures)
-Washington State DSHS (census tract, zip code level)
-Private vendors (e.g., Claritas Corporation)

 

Links

US Census Bureau
National Center for Health Statistics
Washington State Department of Health Center for Health Statistics
Washington State Office of Financial Management

Table of Contents

TUBERCULOSIS RATES 

Tuberculosis is an important health indicator because of its association with chronic illness, poverty and its potential for contagion. In recent years tuberculosis has generated more concern nationally because of the increase in cases associated with HIV infection, and because of the rise of drug-resistant strains. Health care providers are required to report cases of tuberculosis. Data for TB rates are obtained from The Washington State Department of Health. Rates are per 100,000 population. Standard Year, Age, and Race options are available for this topic in VistaPHw.

DOH Home | Access Washington | Privacy Notice | Disclaimer/Copyright Information

Washington State Department of Health
Center for Health Statistics
101 Israel Road SE, P.O. Box 47814
Olympia, Washington, 98504-7814

Last Update : 03/17/2008 11:39 AM
Send inquires about DOH and its programs to the Health Consumer Assistance Office
Comments or questions regarding this web site? Send mail to the EHSPHL - Informatics Office Customer Service Center.