Section VI

Appendix

NOTE: This document is provided for historical purposes only.

Technical Notes

	On this Page Background Information on Death Rates Differences in Death Rates in Different Publications Cause-of-Death Classifications Surveillance of Behavioral Risk Factors and Preventive Services Among Adults Chronic Conditions Adult Risk Behaviors Preventive Services Surveillance of Behavioral Risk Factors and Chronic Conditions Among Youth BMI Reference Data for Overweight

Background Information on Death Rates

All mortality data for 2001 were obtained from the National Vital Statistics System (NVSS), which contains information from all death certificates filed in the 50 states and the District of Columbia. Mortality data from the NVSS are compiled by CDC’s National Center for Health Statistics (NCHS) in cooperation with state vital statistics offices and processed in accordance with regulations from the World Health Organization. These regulations specify that member nations use the current International Classification of Diseases (ICD) to classify causes of death. The Tenth Revision of the ICD (ICD-10) is currently in use.

Death rates in this report are presented by state, sex, race/ethnicity, and cause-of-death category. Death rates are based on the decedent's state of residence and exclude the deaths of nonresidents of the United States. Population data (denominators for death rates) were obtained from the vintage 2002 postcensal estimates for the year 2001. (Note: The race-specific postcensal bridged estimates are published not by the Census Survey but by NCHS.) Thus, death rates in this publication may differ from those in NCHS publications using 2001 vintage estimates. Death rates for a particular racial/ethnic group are not presented if there were 20 or fewer deaths in that group.

In this publication, racial ethnic categories are defined as white, black, Asian/Pacific Islander, American Indian/Alaska Native, and Hispanic. According to definitions from the Office of Management and Budget, people of Hispanic origin can be of any race, and conversely, people listed as white, black, Asian/Pacific Islander, or American Indian/Alaska Native can be of Hispanic or non-Hispanic origin. More information on race/ethnicity standards and the OMB directives may be obtained from the Federal Register (Volume 62, No. 210, October 30, 1997) or the OMB Web site: www.whitehouse.gov/omb/fedreg/ombdir15.html.

Cause-of-death categories are classified by ICD-10. Death rates in this publication may differ from rates reported in previous publications because of changes to the titles and content of some cause-of-death categories and changes in coding rules used to select the underlying cause of death. More information on ICD-10 codes may be obtained from the NCHS Web site: http://www/cdc.gov/nchs.

All death rates included in this publication are age-adjusted. Age-adjusted rates are more appropriate for making comparisons between groups or over time because, unlike crude rates, they take into account the effect of different or changing age distributions in different populations. Age-adjusted death rates are weighted averages of the age-specific death rates where the weights correspond to a standard population age distribution.

Age-adjusted rates should not be compared with crude rates or with rates adjusted to a different standard population. For example, rates adjusted to the 1940 or 1970 U.S. standard populations should not be compared with rates adjusted to the 2000 US standard population. The magnitude of age-adjusted rates typically depends on the standard population used. Additional information on age-adjusted death rates and the 2000 U.S. standard population may be found at the NCHS Web site: http://www/cdc.gov/nchs.

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Differences in Death Rates in Different Publications

The state-specific numbers of deaths and the mortality rates due to a specific cause in this publication may differ from those published by the states or by other groups for the following reasons:

1. The cut-off dates for accepting vital statistics records into the annual file for producing statistics may differ between states.
2. The interstate exchange program, through which states receive data on events that involved residents but occurred in other states, might not include all records.
3. The standard U.S. population used for age-adjustment may not have been the 2000 standard population used here.
4. Race/ethnicity may have been classified differently. Some states may have implemented the 1997 OMB-15 directive, the standard for collecting and publishing data on race and ethnicity, while others may still be using the 1977 OMB-15 directive.

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Cause-of-Death Classifications

The following ICD-10 codes are used in this report:

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Surveillance of Behavioral Risk Factors and Preventive Services Among Adults

Most of the prevalences of behavioral risk factors, chronic conditions, and use of preventive services among adults are state-based estimates from CDC's 2002 Behavioral Risk Factor Surveillance System (BRFSS). The exceptions are the estimates for hypertension and high cholesterol, which are based on 2001 BRFSS data.

Initiated in 1981 and developed in conjunction with the states, the BRFSS now enables all states to gather information on the prevalence of behavioral risk factors and other health-related measures in their individual jurisdictions. The BRFSS is an annual, state-based, random-digit-dialed telephone survey of health-related behavior. Each participating state selects a probability sample of its noninstitutionalized civilian adult population (aged ≥ 18 years) who have telephones. The data are reported by sex and race/ethnicity (white, black, Asian/Pacific Islander, American Indian/Alaska Native, Hispanic, and multiracial origin). The design of the BRFSS allows for comparisons both between states and between individual states and the nation.

Missing responses, respondents who refused to answer, or respondents who said they did not know the answer are excluded from the denominator in the prevalence calculations except for the arthritis estimates. Estimates are not provided for a racial or ethnic category if the denominator had fewer than 50 respondents because the estimate would be unreliable. The average value for a risk factor, chronic condition, or preventive service is used as a prevalence estimate for the United States as a whole; in addition, it is used to provide an estimate for all the respondents within the sex and race/ethnicity categories.

The methods used for calculating the results are consistent with the methods used in previous editions of this publication. In this publication, neither Puerto Rico nor the five territories are included in the overall prevalence estimates for the United States.

The following questions from the BRFSS were included in this report.

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Chronic Conditions:

• About how much do you weigh without shoes?
• About how tall are you without shoes?
• Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?
• Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?
• Have you ever been told by a doctor that you have diabetes?
• Have you ever been told by a doctor that you have arthritis?

For adults, overweight in this report is defined by the 1998 guidelines released by the National Institutes of Health’s National Heart, Lung, and Blood Institute (NHLBI) for identifying overweight and obese adults. Overweight is based on self-reported height in inches and weight in pounds. These values are converted into height in meters and weight in kilograms and used to calculate a body mass index (BMI), the number of kilograms divided by the number of meters squared (BMI = kg/m²). BMI represents a height-to-weight ratio. According to the 1998 guidelines, people with BMI values of 25 or greater are overweight, and those with BMI values of 30 or greater are obese.

Adults with diabetes are defined as those having doctor-diagnosed diabetes. Women with diabetes diagnosed only during pregnancy are excluded from the numerator in the prevalence calculation. Estimates are based on data from 2001 and 2002 to obtain an adequate sample of people with diabetes.

In this report, arthritis is defined as self-reported doctor-diagnosed arthritis among adults. In previous publications, the definition of arthritis included both doctor-diagnosed arthritis and self-reported chronic joint symptoms. For calculating percentages, or prevalence estimates, the numerator is the number of respondents with doctor-diagnosed arthritis, and the denominator is the total number of respondents, including those who for whatever reason did not answer the question. The BRFSS program generally excludes such missing responses from the denominator in prevalence calculations. Therefore, arthritis prevalence estimates in this publication will be somewhat lower than those in BRFSS publications. Prevalence estimates are not reported for any racial and ethnic groups with fewer than 50 respondents in the denominator because these estimates would be unreliable.

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Adult Risk Behaviors:

• Have you smoked at least 100 cigarettes in your entire life?
• Do you smoke cigarettes everyday, some days, or not at all?
• During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?
• How often do you drink fruit juices, such as orange, grapefruit, or tomato?
• Not counting juice, how often do you eat fruit?
• How often do you eat green salad?
• How often do you eat potatoes, not including french fries, fried potatoes, or potato chips?
• How often do you eat carrots?
• Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat?

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Preventive Services:

A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram? How long has it been since you had your last mammogram?

A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Have you ever had this test using a home kit? How long has it been since you had your last blood stool test using a home kit?

Sigmoidoscopy or colonoscopy are exams in which a tube is inserted in the rectum to view the bowel for signs of cancer and other health problems. Have you ever had either of these exams?

How long has it been since you had your last sigmoidoscopy or colonoscopy?

Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?

Limitations and Caveats:

To be consistent with estimates in BRFSS publications, prevalence estimates based on BRFSS data are not age adjusted.

More information about the BRFSS is available at CDC’s Web site, located at www.cdc.gov/nccdphp/brfss.

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Surveillance of Behavioral Risk Factors and Chronic Conditions Among Youth

The Youth Risk Behavior Survey (YRBS) is part of CDC’s Youth Risk Behavior Surveillance System (YRBSS). Since 1990, the YRBSS has provided vital information on health-related practices among U.S. high school students. This information enables states and school jurisdictions to better target efforts to prevent health risk behaviors among young people. The data in this report are from the national and state 2001 YRBSS surveys. Students in grades 9–12 participated in the surveys, which were conducted by CDC and state departments of education and health. This report summarizes selected results from the national survey and 35 state surveys. Of the 35 states that reported results, 13 did not have an overall response rate of at least 60%. These states are Colorado, the District of Columbia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Louisiana, Nebraska, New Hampshire, New York, South Carolina, and Tennessee. The data from these states are unweighted and thus apply only to the students participating in the survey. The Illinois survey excludes students from Chicago; the Louisiana survey excludes students from New Orleans; and the New York survey excludes students from New York City. Data were not available for the remaining 16 states. YRBS data are reported by sex and by race/ethnicity (white, black, Hispanic, other).

The following questions from the YRBS were used to determine the prevalence of the risk behaviors among high school students included in this report:

• During the past 30 days, on how many days did you smoke cigarettes?
• In an average week when you are in school, on how many days do you go to physical education (PE) classes?
• During the past 7 days, how many times did you drink 100% fruit juices, such as orange juice, apple juice or, grape juice?
• During the past 7 days, how many times did you eat fruit?
• During the past 7 days, how many times did you eat green salad?
• During the past 7 days, how many times did you eat potatoes?
• During the past 7 days, how many times did you eat carrots?
• During the past 7 days, how many times did you eat other vegetables?
• How tall are you without your shoes on?
• How much do you weigh without your shoes on?

For the YRBS, overweight is defined as having a body mass index (BMI) greater than or equal to the 95th percentile by age and sex. The BMI values in the following table represent the 95th percentile for each age:

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BMI Reference Data for Overweight

Limitations and Caveats:

• These data apply only to youth who attend school and, therefore, are not representative of all people in this age group
• Although the survey questions demonstrate good test-retest reliability, the extent of under-reporting and over-reporting of behaviors cannot be determined.
• Prevalence estimates based on YRBS data are not age-adjusted. Generally, YRBS data are not age-adjusted because the age range for high school students varies little from state to state.

For more information about the YRBSS, call (888) 231-6405 or visit the Web site, located at www.cdc.gov/yrbs.

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Page last reviewed: October 31, 2005
Page last modified: October 31, 2005
Archive Date: April 8, 2008

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