Calculating census tract-based life expectancy in New York state: a generalizable approach.

BACKGROUND: Life expectancy at birth (LE) has been calculated for states and counties. LE estimates at these levels mask health disparities in local communities. There are no nationwide estimates at the sub-county level. We present a stepwise approach for calculating LE using census tracts in New York state to identify health disparities. METHODS: Our study included 2751 census tracts in New York state, but excluded New York City. We used population data from the 2010 United States Census and 2008-2010 mortality data from the state health department. Tracts were assigned to 99.97% of the deaths. We removed tracts which had a majority of people living in group quarters. Deaths in these tracts are often recorded elsewhere. Of the remaining 2679 tracts, 6.6% of the tracts had standard errors ≥ 2 years. A geographic aggregation tool was used to aggregate tracts with fewer than 60 deaths, and then aggregate areas that had standard errors of ≥ 2 years. RESULTS: Aggregation resulted in a 9.9% reduction in the number of areas. Tracts with < 2% of population living below the poverty level had a LE of 82.8 years, while tracts with a poverty level ≥ 25% had a LE of 75.5. We observed differences in LE in border areas, of up to 10.4 years, when excluding or including deaths of study area residents that occurred outside the study area. The range and standard deviation at the county level (77.5-82.8, SD = 1.2 years) were smaller than our final sub-county areas (64.7-92.0, SD = 3.3 years). The correlation between LE and poverty were similar and statistically significant (p < 0.0001) at the county (r = - 0.58) and sub-county level (r = - 0.58). The correlations between LE and percent African-American at the county level were (r = 0.11, p = 0.43) and at the sub-county level (r = - 0.25, p < 0.0001). CONCLUSION: The proposed approach for geocoding and aggregation of mortality and population data provides a solution for health departments to produce stable empirically-derived LE estimates using data coded to the tract. Reliable estimates within sub-county areas are needed to aid public health officials in focusing preventive health programs in areas where health disparities would be masked by county level estimates.

Development of an interactive environmental public health tracking system for data analysis, visualization, and reporting.

Healthcare providers and governmental agencies routinely collect and report data on health outcomes. In addition, governmental agencies and industry collect and report information on environmental hazards and exposures that may impact health. Use of these data for environmental public health tracking has been a challenge because these data are managed by different data stewards, may contain confidential information that must be protected, and have not been collected in a manner to facilitate linkages. Available tools for analysis, visualization, and reporting of these data are either difficult to use or not available through a common user interface. The New York State Department of Health has developed a user-friendly interactive system to access and link these data while protecting confidential information. The Environmental Public health tracking system provides tools for describing the geographic patterns, trends, and statistical associations between health, environmental exposure, and environmental hazard data. These tools provide descriptive statistics and automated techniques that smooth the data in order to protect patient confidentiality and reduce random fluctuations in rates due to small numbers. This article describes the user interface, data linkages, and analytic, visualization, and reporting tools.

Development of a web-based integrated birth defects surveillance system in New York State.

BACKGROUND: Over the past decade, the Internet has become a powerful and effective tool for public health surveillance. The objectives of this project were to develop secure Web-based applications for Birth Defects Surveillance and to integrate them into routine surveillance activities of the New York State (NYS) Congenital Malformations Registry (CMR). METHODS: The Web-based applications were developed on infrastructure of New York State Health Provider Network using JAVA programming language. In addition, SAS/IntrNet software (SAS Institute Inc, Cary, NC) was also used to leverage the data analysis and processing capabilities of SAS for generating real-time reports and performing statistical and spatial analyses. RESULTS: Congenital Malformations Registry staff have developed and implemented a Web-based integrated birth defect surveillance system, which enables staff to routinely perform surveillance activities including monitoring the quality, timeliness, and completeness of case reporting by hospitals; matching the CMR cases to the vital records; conducting trends analysis on birth defect prevalence and mortality with data query and visualization capabilities; and performing temporal and spatial analysis. CONCLUSIONS: The CMR's Web-based integrated birth defects surveillance system empowers authorized users to perform routine surveillance activities using only a PC and a Web browser. This system will help NYS public health professionals and epidemiologists perform trend analyses and identify possible clusters of birth defects in space and time that may be related to environmental toxins.

Use of CUSUM and Shewhart charts to monitor regional trends of birth defect reports in New York State.

BACKGROUND: Cumulative sum (CUSUM) charts were originally developed for industrial quality control, but may be adapted for the surveillance of health outcome data, such as birth defects. The reported prevalence of birth defects can vary due to differences in case ascertainment, surveillance practices, or true changes in prevalence. We examined the utility of CUSUM and Shewhart charts for detect-ing changes in prevalence of two different birth defect groups. We chose obstructive renal defects because we expected an increase in reporting due to improved diagnosis. We chose oral clefts for comparison because we expected reporting to be unaffected by changes in diagnostic technologies. METHODS: Data from the New York State Congenital Malformations Registry from 1992-1999 were analyzed using self-starting binomial CUSUM and Shewhart charts for four regions of New York State. RESULTS: CUSUM charts show that reports of obstructive urinary defects have increased from 1992-1999 in all regions of New York State. Reports of oral clefts increased only on Long Island. CONCLUSIONS: The CUSUM method proved useful for identifying changes in birth defect reporting and was able to detect the expected increases in obstructive renal defects. The apparent increase is likely due to improvements in diagnostic imaging techniques. In contrast, we only detected an increase in oral clefts on Long Island, which may be related to under report-ing of cases in the earlier years. CUSUM charts are useful in detecting small, sustained increases in prevalences over time while Shewhart charts are easier to interpret and can detect large sharp increases.