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PRESENTATION: Massachusetts Deaths 2007

Slide #1: Cover Page

Massachusetts Deaths 2007

Dr. Bruce Cohen, DPH

Massachusetts Department of Public Health

Bureau of Health Information, Statistics, Research, and Evaluation

Division of Research and Epidemiology

April 2009
Slide #2: Causes of Death in Massachusetts: 1842-2007

This slide shows 165 years of Massachusetts mortality data for the leading cause of death among state residents. The leading causes of death are defined as those with the most frequent number of deaths. At least since 1842, infectious disease was the leading cause of death until 1927; that year deaths to heart disease surpassed those to infectious disease’s deaths. Since then, heart disease remained as the leading cause of death for 80 years, until 2006 when deaths to cancer surpassed those to heart disease.

Slide #3: Outline

This slide shows the outline for this presentation:

1) Highlights

2) Selected causes of death: cancer, heart disease, diabetes, and injuries

3) Race, Education and Mortality

4) Applications of Mortality Data

5) Summary
Slide #4: Highlights

Title Page

Slide #5: On an Average Day in Massachusetts, in 2007

This slide shows the number of deaths each day for selected causes of death.

In 2007 there were 52,690 deaths and on an average day, 144 Massachusetts residents died: including 36 deaths due to cancer, 35 to heart disease, 8 injury deaths, and 1 infant death.
Slide #6: Life Expectancy at Birth Massachusetts vs. U.S.: 1900-2007

This slide shows Life Expectancy at birth for Massachusetts and the U.S. since 1900.

Life expectancy at birth is a typical measure used for worldwide comparisons, and it is based on the expected age at death for a newborn infant, based upon the actual experience of mortality of the population in Massachusetts, and it is given in years.
This figure shows a continuation of the trend toward longer life expectancy for both Massachusetts and the U.S. since 1900. As shown here, life expectancy at birth in Massachusetts has been consistently higher than the national figure since 1920. And, in 2007, life expectancy reached an all-time high of 80.2 years in Massachusetts compared with 78.1 in the U.S in 2006. For this presentation, we will be using Preliminary 2006 data for the U.S. as 2007 data were not available at the time of this release.

Slide #7: Overall Mortality Rates Massachusetts and U.S.: 1994-2007

This slide shows overall mortality rates for Massachusetts and the U.S. since 1994.

Age-adjusted death rates fell to a record low of 704.4 deaths per 100,000 population in 2007, down from 717.6 deaths per 100,000 in 2006, continuing a trend toward lower rates and mirroring a decline nationwide.
The overall mortality rate in MA has been consistently lower than that the rate for the US. Both with similar downward trends up to 2002. Since 2002 the rate of decline for the MA rate has been 2.4% per year compared with 1.9% per year for the US.
Please note that for this slide and for the slides to follow, an asterisk means statistical significance; that is, these changes could not have happened by chance.
Slide #8: Percentage Difference in Mortality Rates, Massachusetts vs. U.S.1: 2007

Here, the green bars show death rates that are lower in MA than then US, below the line, and rates higher and shown on red, above the line.

As you can see, MA numbers are significantly lower (statistically significant results are flagged with an asterisk) than the US most of the causes of death shown: they are as much as 52% lower for homicides to 25% higher for nephritis. AND, the state's overall mortality is 9% below that of the US. Here asterisks denote statistical significance from US rates.
Slide #9: Leading Causes of Death

This slide shows the distribution of leading causes of death in 2007.

Cancer and Heart disease remained the leading causes of death, collectively accounting for about half of all deaths in Massachusetts in 2007. Notice here the large drop in the contribution of the next leading causes of deaths: injuries of all types, stroke, and chronic respiratory disease, collectively accounted for 15%.
Slide #10: Ranking of Leading Causes of Death by Race and Ethnicity

This next slide examines the rankings of selected causes of death by race and ethnicity.

The leading causes of death varied by race and ethnicity in 2007 as they have in previous years. Cancer and Heart disease were the leading causes of death for all racial groups.
Cancer and Heart disease were the top 2 leading causes for all groups. Stroke is the 3rd leading cause of death for whites and Asians while nephritis is the 3rd leading cause of death for Blacks and unintentional injuries for Hispanics. Diabetes is the 4th for Black and Hispanics while Chronic-lower respiratory disease is the 4th for whites. HIV/AIDS was among the top 10 for Blacks and Hispanics while it ranked 29th for whites. Homicide was the 7th leading cause of death for blacks and Hispanics while it was the 30th for Whites and 21st for Asians.
Slide #11: Leading Causes of Death by Age

This slide shows the leading causes of death by age groups.

As seen in this table, injuries were the leading cause of death for Massachusetts residents between the ages of 1-44. Cancer continues to be the leading cause of death for MA residents ages 45-74. Heart disease was the leading cause of death for MA residents age 85 and above.
On this slide, you can also see that the largest number of deaths continues to occur among the older age groups. About 2/3 of all deaths occur in these age groups. Also we continue to see Injuries as the most prevalent cause of death among persons 15-24. About 7 in 10 deaths are to Injuries for this age group.
Slide #12: Changes in Mortality Rates, Massachusetts: 2000 vs. 2007

This slide presents changes between 2000 and 2007 in death rates for some of the leading causes of death.

When compared with 2000, in 2007, there were statistically significant declines HD, Cancer, stroke, CLRD, and diabetes. And in 2007, there was also a significant increase in Injury death rates.
Slide #13: Selected Causes of Death

Title Page

Slide #14: Cancer Mortality Rates, Massachusetts and U.S.: 1994-2007

This slide shows cancer death rates for Massachusetts and the U.S. since 1994.

Cancer Mortality rates continue their downward trend in Massachusetts and at the national level. The cancer death rate in MA has been declining at a faster rate than the US, at about 1.9% per year, while that national rate has been declining by 1.6% per year.
Slide #15: Female Breast Cancer Mortality Rates, Massachusetts: 1994-2007

This slide shows female breast cancer death rates for Massachusetts since 1994. Female breast cancer mortality is declining at 4% per year since 1994 and in 2007 it declined by 14% from 2006- a one year significant drop.

Slide #16 Heart Disease Mortality Rates, Massachusetts and U.S.: 1994-2007

This slide shows heart disease mortality rates for both Massachusetts and the U.S. since 1994.

Here is a closer look at the MA heart disease mortality which has been consistently lower than the U.S. rate. As you can see, heart disease reached its lowest point so far in 2006 at 166.0 deaths per 100,000 population. In 2007, the MA heart disease rate was 17% lower than the US rate.
Using trend analysis, we see that the MA heart disease rate has been declining at about 4% per year since 1994.
Slide #17: Number of Heart Disease Deaths by Age and Gender

This slide shows heart disease deaths by age and gender.

Heart disease deaths increase with age. Overall, more women die from heart disease than men in 2007. However up to age 84, more men than women die from heart disease, and at age 85 and older women die 2.2 times the number of men making the overall number of deaths for women higher than that of men.
Slide #18: Diabetes-related deaths, Massachusetts: 2007

Traditionally we have looked at diabetes only as the underlying or main cause of death. Since our 2004 report, we have also included deaths where diabetes is mentioned as a contributory cause of death.

By examining both, we have a better ascertainment of the burden of diabetes mortality among Massachusetts residents.
In 2007, there were 3,899 diabetes-related (underlying or a contributing cause) deaths. In about one-third of these deaths, diabetes was reported as the underlying cause of death.
Slide #19: Diabetes Mortality Rates by Race and Ethnicity, Massachusetts: 2007

Diabetes rates vary enormously by race and ethnicity as shown on this next slide. In 2007, Blacks and Hispanics continue to have the highest rates in Massachusetts, significantly higher than for whites and Asians-- the diabetes mortality rate for blacks and Hispanics were 2.3 times and 1.6 times the state’ rate, respectively.

Slide #20: Number of HIV/AIDS deaths, Massachusetts: 1987-2007

This next graph shows HIV/AIDS deaths in Massachusetts since 1987. In 2007, there were 143 HIV/AIDS deaths, which was the lowest annual numbers of deaths in Massachusetts since the epidemic began in 1987

Slide #21: Percent of HIV/AIDS Deaths by Age Group, Massachusetts: 1994-2007

Here we look at the distribution of HIV/AIDS deaths by age. In 2007, 73% of HIV/AIDS deaths occur among persons over the age of 45, indicating that HIV/AIDS is becoming more of a chronic condition. Most of the deaths of those 45+ occur in the late forties and early 50s.

Slide #22: Injury Deaths

Title Page

Slide #23: Causes of Injury Deaths

Here is a look at injury deaths by cause:

  • Poisonings, which include drug overdoses, was the leading cause of injury death, accounting for 34% of all injury deaths. Within poisonings: 66% of deaths were opioid-related

  • The second leading cause of injury death was falls accounting for 16% of all injury deaths.

  • The next leading causes of injury deaths were motor vehicle-related, suffocation (which includes hanging and strangulation), followed by firearms.

Slide #24: Poisoning Deaths Where Opioids Are Mentioned

Starting with deaths in 2006, among poisoning deaths, we have identified agents mentioned as contributory causes if deaths. This slide shows the contribution of opioids in poisoning deaths since 2000. After increases in several years, the contribution of opioids to poisonings was the same as in 2006.

Slide #25: Unintentional Fall Related Mortality Rates, Ages 65+, Massachusetts and the U.S.: 1994-2007

This slide shows unintentional fall rates for both Massachusetts and the U.S., for persons ages 65 and older since 1994. Unintentional fall rates for persons ages 65 and older continue their upward trend in Massachusetts and at the national level although rates are consistently lower in Massachusetts.

The unintentional fall related death rate among persons ages 65 and older has been increasing by 5% per year between 1994 and 2004. Since 2005, unintentional fall related death rate has been increasing at 26% per year.
Slide #26: Intentional Injury Deaths by Cause Massachusetts: 2007

In 2007, 23% of all injury deaths were intentional---There were more than twice the number of suicides as homicides (504 vs. 183)

    • The leading causes of suicide deaths were “hanging, strangulation, or suffocation” (44%), followed by poisoning (23%), and firearm (22%)

In 2007, there were 183 homicides in MA (here on the left hand side). The leading cause of homicides were firearm, accounting for 62% of all homicides

Slide #27: Suicides by Gender and by Age, Massachusetts: 2007

Here is a look at the number of suicides by gender and age in Massachusetts. We can see that there are more suicides among males at any age and that the number of suicides peak at 25-44 for males and at 45-54 for females. Suicide rate for males ages 25-44 is almost 5 times higher than for females ages 25-44.

Slide #28: Suicide Rates by Gender, Massachusetts: 1994-2007

Here is a look at suicide since 1994. And, according to the trend analysis (in red), after a continued decline of 3% per year, suicide rates have leveled off since 2002 (have not changed significantly- but appear to be increasing.

Suicide rate for males is 4 times higher than for females. Overall increase in the suicide rate was 15%; a decline of 8.6% for women and an increase of 29% for males. The 2006 rate was 6.5 per 100,000, and the 2007 rate was 7.5 per 100,000, but this was not statistically significant.
The overall rate is not significantly higher than that of 2006, so it is not the highest since 1998, and the male rate, while higher than that of 2006, is not statistically higher than previous years.
Slide #29: Child Homicides (Ages 1-14), Massachusetts: 1997-2007

Homicide was the second leading cause of death among children 1-14, overall and for both males and females, whereas, in 2006, homicide ranked 6th for this age group.  The number of homicides in this age group was 5 in 2006, and in 2007, it was 16. 

Slide #30: Race, Education and Mortality

Title slide

Slide #31: Mortality Rates by Education and by Race/Ethnicity

This slide shows the interaction of race and ethnicity and education with mortality. Both are important factor affecting mortality. The death rate for those with a high school education or less was between 2 and 3 times higher than the rate for those with 13 years of education or more.

Slide #32: Mortality Rates by Race/Ethnicity, Adults 25-64 Years with 13+Years of Education
Massachusetts: 2007

In this slide we also see that regardless of education, Blacks have higher mortality rates than whites: the rate for more educated blacks was twice as high higher as the rate for more educated whites

Slide #33: Applications of Mortality Data

Title slide

Slide #34: Premature Mortality Rate (PMR) by Race and Hispanic Ethnicity

  • Definition

    • Deaths before age 75, per 100,000 population, age-adjusted to the 2000 US standard population under 75 years of age.

  • Rationale

    • Excludes deaths to persons ages 75+

    • Focusing on causes of death that may be more preventable

  • Summary health statistic

    • Excellent measure to reflect the health status of a population

    • Indicator that can be used to focus on preventive initiatives

Slide #35: Premature Mortality Rate (PMR) by Race and Hispanic Ethnicity: 2007

In 2007, we continue to see that PMR among BNH is significantly higher than the other racial and Hispanic groups. The PMR for black residents was 1.5 times the state PMR, while the PMR among Asian residents was 52% lower than the state PMR. The PMR for whites and Hispanics were not different than the state PMR.

Slide #36: Premature Mortality Rate by Community Health Network Areas

This map shows the 27 Community Network Areas (CHNA) of the state color coded to indicate those areas of the state that have PMR significantly higher or lower than the state PMR. We see that there were nine CHNAs with PMR statistically higher than the state PMR and six areas with PMR statistically lower than the state PMR.

Slide #37: Mortality Amenable to Health Care

  • Definition: deaths for persons ages 0-74 from certain causes that should not occur in the presence of timely and effective health care1,2

  • Originally developed in U.S. in 1970’s; adopted and updated by many researchers especially in Europe2

Slide #38: Causes of Mortality Amenable to Health Care

Causes considered as amenable to health care:

    • Amenable to secondary prevention

      • where screening and treatment are effective;

        • for example colorectal, breast, cervical, and skin cancer

    • Amenable to improved treatment and medical care:

      • that require direct medical and/or surgical intervention

        • for example appendicitis and hypertension

      • that rely on efficient medical care delivery

        • accurate and timely diagnosis, transport, and treatment

      • that respond to antibiotic treatments and immunizations

        • infectious diseases

Slide #39: Percent Deaths Amenable to Health Care, Massachusetts: 2007

In 2007, deaths amenable to health care accounted for 10 % of all deaths. However, deaths amenable to health care accounted for 28% of all premature deaths

Slide #40: Mortality Rates for Causes Amenable to Health Care by Race and Ethnicity
Massachusetts: 2000 and 2007

When we observe changes in time in the mortality rates to causes amenable to health care by race we see that it declined only among Whites. Changes in the other groups were not statistically significant

Again, this new approach is just a starting point to help us identify missed opportunities in areas where there is room for improvement in access, quality, efficiency and equity in the delivery of health care.
Slide #41: Summary

Title slide

Slide #42-44: Summary of Massachusetts Deaths 2007

  • Life expectancy reached an all-time high

  • Massachusetts continues to compare favorably with the U.S.

  • Cancer remained the leading cause of death followed by heart disease. As in previous years, cancer and heart disease accounted for almost half of all deaths

  • Death rates for chronic lower respiratory disease, overall cancer, and female breast cancer declined from 2006

  • Lowest annual number of HIV/AIDS deaths in Massachusetts

    • Almost ¾ of HIV/AIDS deaths occurred among persons 45+ years

  • Poisoning deaths, the leading cause of injury deaths, were stable from 2006 to 2007

    • Two out of 3 poisoning deaths were associated to opioids

  • Suicide rates had leveled off since 2002 but increased for men from 2006

  • Continued increasing trend in unintentional fall-related deaths

  • Disparities Persist:

    • The cancer death rate for men was 46% higher than the rate for women

    • Blacks had the highest premature mortality rate, 1.5 times the rate of whites

    • The death rate for those with less education was almost 3 times higher than the rate for those with more education

    • Springfield, Lowell, Fall River, Taunton, Worcester, and New Bedford had the highest premature mortality rates

Slide #45: How Can You Access This Information?

  • Hard Copies: (617) 740-2670

  • TDD/TTY: (617) 624-6001

  • MDPH Website:

  • MassCHIP Website:

(DPH’s Internet-based public health information service)


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