This dataset of U.S. mortality trends since 1900 highlights trends in age-adjusted death rates for five selected major causes of death.

Age-adjusted death rates (deaths per 100,000) after 1998 are calculated based on the 2000 U.S. standard population. Populations used for computing death rates for 2011–2017 are postcensal estimates based on the 2010 census, estimated as of July 1, 2010. Rates for census years are based on populations enumerated in the corresponding censuses. Rates for noncensus years between 2000 and 2010 are revised using updated intercensal population estimates and may differ from rates previously published. Data on age-adjusted death rates prior to 1999 are taken from historical data (see References below).

Revisions to the International Classification of Diseases (ICD) over time may result in discontinuities in cause-of-death trends.

SOURCES

CDC/NCHS, National Vital Statistics System, historical data, 1900-1998 (see https://www.cdc.gov/nchs/nvss/mortality_historical_data.htm); CDC/NCHS, National Vital Statistics System, mortality data (see http://www.cdc.gov/nchs/deaths.htm); and CDC WONDER (see http://wonder.cdc.gov).

REFERENCES

1. National Center for Health Statistics, Data Warehouse. Comparability of cause-of-death between ICD revisions. 2008. Available from: http://www.cdc.gov/nchs/nvss/mortality/comparability_icd.htm.

2. National Center for Health Statistics. Vital statistics data available. Mortality multiple cause files. Hyattsville, MD: National Center for Health Statistics. Available from: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm.

3. Kochanek KD, Murphy SL, Xu JQ, Arias E. Deaths: Final data for 2017. National Vital Statistics Reports; vol 68 no 9. Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf.

4. Arias E, Xu JQ. United States life tables, 2017. National Vital Statistics Reports; vol 68 no 7. Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_07-508.pdf.

5. National Center for Health Statistics. Historical Data, 1900-1998. 2009. Available from: https://www.cdc.gov/nchs/nvss/mortality_historical_data.htm.

Age-Adjusted Death Rates

Death Rates and Life Expectancy in the United States, 2011-2013

By Health [source]

About this dataset

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How to use the dataset

In order to use this dataset, start by selecting a particular set of variables to investigate. You can choose from Measure Names (e.g., Death Rates or Life Expectancy), Race (e.g., All Races), Sex (Male/Female) and Year (2011-2013). Once you have selected your desired variables, you can begin analyzing the data by looking at mortality rates and life expectancy averages amongst different populations in the United States over time.

You may also wish to perform more detailed analyses such as identifying trends or examining correlations between features, regional disparities in mortality rates or changes in average life expectancies over time. If so, you can do so by creating line graphs plotted against one or more independent variables such as Race and Sex to see how demographics impact these statistics overall and on a yearly basis using the Year variable computed from July 1st 2010 estimates

Research Ideas

• Analyzing mortality and life expectancy trends among certain races and sexes over time.
• Examining the effects of different socioeconomic factors on death rates and life expectancies.
• Making predictions about future mortality rates and average life expectancies with machine learning algorithms

Acknowledgements

If you use this dataset in your research, please credit the original authors. Data Source

License

License: Open Database License (ODbL) v1.0 - You are free to: - Share - copy and redistribute the material in any medium or format. - Adapt - remix, transform, and build upon the material for any purpose, even commercially. - You must: - Give appropriate credit - Provide a link to the license, and indicate if changes were made. - ShareAlike - You must distribute your contributions under the same license as the original. - Keep intact - all notices that refer to this license, including copyright notices. - No Derivatives - If you remix, transform, or build upon the material, you may not distribute the modified material. - No additional restrictions - You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.

Columns

File: rows.csv | Column name | Description | |:----------------------------|:----------------------------------------------------------------------| | Measure Names | The type of measure being reported. (String) | | Race | The race of the population being reported. (String) | | Sex | The gender of the population being reported. (String) | | Year | The year the data was collected. (Integer) | | Average Life Expectancy | The average life expectancy of the population being reported. (Float) | | Mortality | The mortality rate of the population being reported. (Float) |

Acknowledgements

If you use this dataset in your research, please credit the original authors. If you use this dataset in your research, please credit Health.

This dataset of U.S. mortality trends since 1900 highlights the differences in age-adjusted death rates and life expectancy at birth by race and sex.

Age-adjusted death rates (deaths per 100,000) after 1998 are calculated based on the 2000 U.S. standard population. Populations used for computing death rates for 2011–2017 are postcensal estimates based on the 2010 census, estimated as of July 1, 2010. Rates for census years are based on populations enumerated in the corresponding censuses. Rates for noncensus years between 2000 and 2010 are revised using updated intercensal population estimates and may differ from rates previously published. Data on age-adjusted death rates prior to 1999 are taken from historical data (see References below).

Life expectancy data are available up to 2017. Due to changes in categories of race used in publications, data are not available for the black population consistently before 1968, and not at all before 1960. More information on historical data on age-adjusted death rates is available at https://www.cdc.gov/nchs/nvss/mortality/hist293.htm.

SOURCES

CDC/NCHS, National Vital Statistics System, historical data, 1900-1998 (see https://www.cdc.gov/nchs/nvss/mortality_historical_data.htm); CDC/NCHS, National Vital Statistics System, mortality data (see http://www.cdc.gov/nchs/deaths.htm); and CDC WONDER (see http://wonder.cdc.gov).

REFERENCES

1. National Center for Health Statistics, Data Warehouse. Comparability of cause-of-death between ICD revisions. 2008. Available from: http://www.cdc.gov/nchs/nvss/mortality/comparability_icd.htm.

2. National Center for Health Statistics. Vital statistics data available. Mortality multiple cause files. Hyattsville, MD: National Center for Health Statistics. Available from: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm.

3. Kochanek KD, Murphy SL, Xu JQ, Arias E. Deaths: Final data for 2017. National Vital Statistics Reports; vol 68 no 9. Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf.

4. Arias E, Xu JQ. United States life tables, 2017. National Vital Statistics Reports; vol 68 no 7. Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_07-508.pdf.

5. National Center for Health Statistics. Historical Data, 1900-1998. 2009. Available from: https://www.cdc.gov/nchs/nvss/mortality_historical_data.htm.

This table provides the age-standardized mortality rates per 100,000 population, for the three selected causes of death and all causes combined. The three selected causes of death are Circulatory System, Neoplasms and External Causes (Injury). Age standardization is a technique applied to make rates comparable across groups with different age distributions. A simple rate is defined as the number of people with a particular condition divided by the whole population. An age-standardized rate is defined as the number of people with a condition divided by the population within each age group. Standardizing (adjusting) the rate across age groups allows a more accurate comparison between populations that have different age structures. Age standardization is typically done when comparing rates across time periods, different geographic areas, and or population sub-groups (e.g. ethnic group). This indicator dataset contains information at both Local Geographic Area (for example, Lacombe, Red Deer - North, Calgary - West Bow, etc.) and Alberta levels. Local geographic area refers to 132 geographic areas created by Alberta Health (AH) and Alberta Health Services (AHS) based on census boundaries. This table is the part of "Alberta Health Primary Health Care - Community Profiles" report published February 2013

County Cancer Death Rates

County-level cancer death rates with related variables

By Noah Rippner [source]

About this dataset

This dataset provides comprehensive information on county-level cancer death and incidence rates, as well as various related variables. It includes data on age-adjusted death rates, average deaths per year, recent trends in cancer death rates, recent 5-year trends in death rates, and average annual counts of cancer deaths or incidence. The dataset also includes the federal information processing standards (FIPS) codes for each county.

Additionally, the dataset indicates whether each county met the objective of a targeted death rate of 45.5. The recent trend in cancer deaths or incidence is also captured for analysis purposes.

The purpose of the death.csv file within this dataset is to offer detailed information specifically concerning county-level cancer death rates and related variables. On the other hand, the incd.csv file contains data on county-level cancer incidence rates and additional relevant variables.

To provide more context and understanding about the included data points, there is a separate file named cancer_data_notes.csv. This file serves to provide informative notes and explanations regarding the various aspects of the cancer data used in this dataset.

Please note that this particular description provides an overview for a linear regression walkthrough using this dataset based on Python programming language. It highlights how to source and import the data properly before moving into data preparation steps such as exploratory analysis. The walkthrough further covers model selection and important model diagnostics measures.

It's essential to bear in mind that this example serves as an initial attempt at creating a multivariate Ordinary Least Squares regression model using these datasets from various sources like cancer.gov along with US Census American Community Survey data. This baseline model allows easy comparisons with future iterations intended for improvements or refinements.

Important columns found within this extensively documented Kaggle dataset include County names along with their corresponding FIPS codes—a standardized coding system by Federal Information Processing Standards (FIPS). Moreover,Met Objective of 45.5? (1) column denotes whether a specific county achieved the targeted objective of a death rate of 45.5 or not.

Overall, this dataset aims to offer valuable insights into county-level cancer death and incidence rates across various regions, providing policymakers, researchers, and healthcare professionals with essential information for analysis and decision-making purposes

How to use the dataset

• Familiarize Yourself with the Columns:

  • County: The name of the county.
  • FIPS: The Federal Information Processing Standards code for the county.
  • Met Objective of 45.5? (1): Indicates whether the county met the objective of a death rate of 45.5 (Boolean).
  • Age-Adjusted Death Rate: The age-adjusted death rate for cancer in the county.
  • Average Deaths per Year: The average number of deaths per year due to cancer in the county.
  • Recent Trend (2): The recent trend in cancer death rates/incidence in the county.
  • Recent 5-Year Trend (2) in Death Rates: The recent 5-year trend in cancer death rates/incidence in the county.
  • Average Annual Count: The average annual count of cancer deaths/incidence in the county.

• Determine Counties Meeting Objective: Use this dataset to identify counties that have met or not met an objective death rate threshold of 45.5%. Look for entries where Met Objective of 45.5? (1) is marked as True or False.

• Analyze Age-Adjusted Death Rates: Study and compare age-adjusted death rates across different counties using Age-Adjusted Death Rate values provided as floats.

• Explore Average Deaths per Year: Examine and compare average annual counts and trends regarding deaths caused by cancer, using Average Deaths per Year as a reference point.

• Investigate Recent Trends: Assess recent trends related to cancer deaths or incidence by analyzing data under columns such as Recent Trend, Recent Trend (2), and Recent 5-Year Trend (2) in Death Rates. These columns provide information on how cancer death rates/incidence have changed over time.

• Compare Counties: Utilize this dataset to compare counties based on their cancer death rates and related variables. Identify counties with lower or higher average annual counts, age-adjusted death rates, or recent trends to analyze and understand the factors contributing ...

This dataset of U.S. mortality trends since 1900 highlights childhood mortality rates by age group for age at death. Age-adjusted death rates (deaths per 100,000) after 1998 are calculated based on the 2000 U.S. standard population. Populations used for computing death rates for 2011–2017 are postcensal estimates based on the 2010 census, estimated as of July 1, 2010. Rates for census years are based on populations enumerated in the corresponding censuses. Rates for noncensus years between 2000 and 2010 are revised using updated intercensal population estimates and may differ from rates previously published. Data on age-adjusted death rates prior to 1999 are taken from historical data (see References below). Age groups for childhood death rates are based on age at death. SOURCES CDC/NCHS, National Vital Statistics System, historical data, 1900-1998 (see https://www.cdc.gov/nchs/nvss/mortality_historical_data.htm); CDC/NCHS, National Vital Statistics System, mortality data (see http://www.cdc.gov/nchs/deaths.htm); and CDC WONDER (see http://wonder.cdc.gov). REFERENCES National Center for Health Statistics, Data Warehouse. Comparability of cause-of-death between ICD revisions. 2008. Available from: http://www.cdc.gov/nchs/nvss/mortality/comparability_icd.htm. National Center for Health Statistics. Vital statistics data available. Mortality multiple cause files. Hyattsville, MD: National Center for Health Statistics. Available from: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm. Kochanek KD, Murphy SL, Xu JQ, Arias E. Deaths: Final data for 2017. National Vital Statistics Reports; vol 68 no 9. Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf. Arias E, Xu JQ. United States life tables, 2017. National Vital Statistics Reports; vol 68 no 7. Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_07-508.pdf. National Center for Health Statistics. Historical Data, 1900-1998. 2009. Available from: https://www.cdc.gov/nchs/nvss/mortality_historical_data.htm.

This data set includes age-adjusted death rates as published by the Vital Statistics Administration, Maryland Department of Health for both Maryland and Howard County. The rates are adjusted to the 2000 U.S. standard population by the direct method and are calculated per 100,000 population. Single year age-adjusted rates are available for the five (5) leading causes of death in Howard County for 2020 - Heart Diseases, Malignant Neoplasms (Cancer), COVID-19, Cerebrovascular Diseases, and Accidents; and for selected leading causes of death for years 2021 to 2023.

These data represent the Age-Adjusted Colorado County Mortality Rate Per 100,000 Persons for Heart Disease as the Underlying Cause of Death (2015-2019). Population estimates for the denominator are calculated from the 2015-2019 American Community Survey. These data are from the Colorado Department of Public Health and Environment Vital Records Death Dataset and are published annually by the Colorado Department of Public Health and Environment.

BackgroundAccording to one USA Renal Data System report, 57% of end-stage renal disease (ESRD) cases are attributed to hypertensive and diabetic nephropathy. Yet, trends in hypertension related ESRD mortality rates in adults ≥ 35 years of age have not been studied.ObjectivesThe aim of this retrospective study was to analyze the different trends hypertension related ESRD death rates among adults in the United States.MethodsDeath records from the CDC (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were analyzed from 1999 to 2020 for hypertension related ESRD mortality in adults ≥ 35 years of age. Age-Adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, place of death, and geographic location.ResultsHypertension-related ESRD caused a total of 721,511 deaths among adults (aged ≥ 35 years) between 1999 and 2020. The overall AAMR for hypertension related ESRD deaths in adults was 9.70 in 1999 and increased all the way up to 43.7 in 2020 (APC: 9.02; 95% CI: 8.19-11.04). Men had consistently higher AAMRs than woman during the analyzed years from 1999 (AAMR men: 10.8 vs women: 9) to 2020 (AAMR men: 52.2 vs women: 37.2). Overall AAMRs were highest in Non-Hispanic (NH) Black or African American patients (45.7), followed by NH American Indian or Alaska Natives (24.7), Hispanic or Latinos (23.4), NH Asian or Pacific Islanders (19.3), and NH White patients (15.4). Region-wise analysis also showed significant variations in AAMRs (overall AAMR: West 21.2; South: 21; Midwest: 18.3; Northeast: 14.2). Metropolitan areas had slightly higher AAMRs (19.1) than nonmetropolitan areas (19). States with AAMRs in 90th percentile: District of Columbia, Oklahoma, Mississippi, Tennessee, Texas, and South Carolina, had roughly double rates compared to states in 10th percentile.ConclusionsOverall hypertension related ESRD AAMRs among adults were seen to increase in almost all stratified data. The groups associated with the highest death rates were NH Black or African Americans, men, and populations in the West and metropolitan areas of the United States. Strategies and policies targeting these at-risk groups are required to control the rising hypertension related ESRD mortality.

This dataset describes drug poisoning deaths at the U.S. and state level by selected demographic characteristics, and includes age-adjusted death rates for drug poisoning. Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug-poisoning deaths are defined as having ICD–10 underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), or Y10–Y14 (undetermined intent). Estimates are based on the National Vital Statistics System multiple cause-of-death mortality files (1). Age-adjusted death rates (deaths per 100,000 U.S. standard population for 2000) are calculated using the direct method. Populations used for computing death rates for 2011–2017 are postcensal estimates based on the 2010 U.S. census. Rates for census years are based on populations enumerated in the corresponding censuses. Rates for noncensus years before 2010 are revised using updated intercensal population estimates and may differ from rates previously published. Death rates for some states and years may be low due to a high number of unresolved pending cases or misclassification of ICD–10 codes for unintentional poisoning as R99, “Other ill-defined and unspecified causes of mortality” (2). For example, this issue is known to affect New Jersey in 2009 and West Virginia in 2005 and 2009 but also may affect other years and other states. Drug poisoning death rates may be underestimated in those instances. REFERENCES 1. National Center for Health Statistics. National Vital Statistics System: Mortality data. Available from: http://www.cdc.gov/nchs/deaths.htm. CDC. CDC Wonder: Underlying cause of death 1999–2016. Available from: http://wonder.cdc.gov/wonder/help/ucd.html.

Example of variations in expected mortality rate under external standardization: Parameter values.

Number of deaths, crude mortality rates and age standardized mortality rates (based on 2011 population) for selected grouped causes, by sex, 2000 to most recent year.

This dataset describes drug poisoning deaths at the U.S. and state level by selected demographic characteristics, and includes age-adjusted death rates for drug poisoning.

Deaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). Drug-poisoning deaths are defined as having ICD–10 underlying cause-of-death codes X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), or Y10–Y14 (undetermined intent).

Estimates are based on the National Vital Statistics System multiple cause-of-death mortality files (1). Age-adjusted death rates (deaths per 100,000 U.S. standard population for 2000) are calculated using the direct method. Populations used for computing death rates for 2011–2017 are postcensal estimates based on the 2010 U.S. census. Rates for census years are based on populations enumerated in the corresponding censuses. Rates for noncensus years before 2010 are revised using updated intercensal population estimates and may differ from rates previously published.

Death rates for some states and years may be low due to a high number of unresolved pending cases or misclassification of ICD–10 codes for unintentional poisoning as R99, “Other ill-defined and unspecified causes of mortality” (2). For example, this issue is known to affect New Jersey in 2009 and West Virginia in 2005 and 2009 but also may affect other years and other states. Drug poisoning death rates may be underestimated in those instances.

REFERENCES 1. National Center for Health Statistics. National Vital Statistics System: Mortality data. Available from: http://www.cdc.gov/nchs/deaths.htm.

1. CDC. CDC Wonder: Underlying cause of death 1999–2016. Available from: http://wonder.cdc.gov/wonder/help/ucd.html.

1. Database contents The Russian Short-Term Mortality Fluctuations database (RusSTMF) contains a series of standardized and crude death rates for men, women and both sexes for Russia as a whole and its regions for the period from 2000 to 2021. All the output indicators presented in the database are calculated based on data of deaths registered by the Vital Registry Office. The weekly death counts are calculated based on depersonalized individual data provided by the Russian Federal State Statistics Service (Rosstat) at the request of the HSE. Time coverage: 03.01.2000 (Week 1) – 31.12.2021 (Week 1148)
2. A brief description of the input data on deaths Date of death: date of occurrence Unit of time: week First and last days of the week: Monday – Sunday First and last week of the year: The weeks are organized according to ISO 8601:2004 guidelines. Each week of the year, including the first and last, contains 7 days. In order to get 7-day weeks, the days of previous years are included in this first week (if January 1 fell on Tuesday, Wednesday or Thursday) or in the last calendar week (if December 31 fell on Thursday, Friday or Saturday). Age groups: the entire population Sex: men, women, both sexes (men and women combined) Restrictions and data changes: data on deaths in the Pskov region were excluded for weeks 9-13 of 2012 Note: Deaths with an unknown date of occurrence (unknown year, month, or day) account for about 0.3% of all deaths and are excluded from the calculation of week-age-specific and standardized death rates.
3. Description of the week-specific mortality rates data file Week-specific standardized death rates for Russia as a whole and its regions are contained in a single data file presented in .csv format. The format of data allows its uploading into any system for statistical analysis. Each record (row) in the data file contains data for one calendar year, one week, one territory, one sex. The decimal point is dot (.) The first element of the row is the territory code ("PopCode" column), the second element is the year ("Year" column), the third element ("Week" column) is the week of the year, the fourth element ("Sex" column) is sex (F – female, M – male, B – both sexes combined). This is followed by a column "CDR" with the value of the crude death rate and "SDR" with the value of the standardized death rate. If the indicator cannot be calculated for some combination of year, sex, and territory, then the corresponding meaningful data elements in the data file are replaced with ".".

Figure 7.1 provides the age-standardized mortality rates per 100,000 population, for the three selected causes of death and all causes combined. The three selected causes of death are Circulatory System, Neoplasms and External Causes (Injury). Age standardization is a technique applied to make rates comparable across groups with different age distributions. A simple rate is defined as the number of people with a particular condition divided by the whole population. An age-standardized rate is defined as the number of people with a condition divided by the population within each age group. Standardizing (adjusting) the rate across age groups allows a more accurate comparison between populations that have different age structures. Age standardization is typically done when comparing rates across time periods, different geographic areas, and or population sub-groups (e.g. ethnic group). This indicator dataset contains information at both Local Geographic Area (for example, Lacombe, Red Deer - North, Calgary - West Bow, etc.) and Alberta levels. Local geographic area refers to 132 geographic areas created by Alberta Health (AH) and Alberta Health Services (AHS) based on census boundaries. This table is the part of "Alberta Health Primary Health Care - Community Profiles" report published August 2022

This data is compiled by the Cook County Department of Public Health using data from the Illinois Department of Public Health Vital Statistics. It includes the annual number of deaths, crude and age-adjusted death rates by selected causes of death. Further analysis is available by age group, race/ethnicity, gender and decedent's place of residence in suburban Cook County at the time of their death. Note: Counts suppressed for events between 1 and 4, Rates not calculated for events less than 20

Splitgraph serves as an HTTP API that lets you run SQL queries directly on this data to power Web applications. For example:

See the Splitgraph documentation for more information.

Background: In humans, the mortality rate dramatically decreases with age after birth, and the causes of death change significantly during childhood. In the present study, we attempted to explain age-associated decreases in mortality for congenital anomalies of the central nervous system (CACNS), as well as decreases in total mortality with age. We further investigated the age trajectory of mortality in the biologically related category “diseases of the nervous system” (DNS).Methods: The numbers of deaths were extracted from the mortality database of the World Health Organization (WHO) for the following nine countries: Denmark, Finland, Norway, Sweden, Austria, the Czech Republic, Hungary, Poland, and Slovakia. Because zero cases could be ascertained over the age of 30 years in a specific age category, the Halley method was used to calculate the mortality rates in all possible calendar years and in all countries combined.Results: Total mortality from the first day of life up to the age of 10 years and mortality due to CACNS within the age interval of [0, 90) years can be represented by an inverse proportion with a single parameter. High coefficients of determination were observed for both total mortality (R2 = 0.996) and CACNS mortality (R2 = 0.990). Our findings indicated that mortality rates for DNS slowly decrease with age during the first 2 years of life, following which they decrease in accordance with an inverse proportion up to the age of 10 years. The theory of congenital individual risk (TCIR) may explain these observations based on the extinction of individuals with more severe impairments, as well as the bent curve of DNS, which exhibited an adjusted coefficient of determination of R¯2 = 0.966.Conclusion: The coincidence between the age trajectories of all-cause and CACNS-related mortality may indicate that the overall decrease in mortality after birth is due to the extinction of individuals with more severe impairments. More deaths unrelated to congenital anomalies may be caused by the manifestation of latent congenital impairments during childhood.

The last columns show the percentage of registries with no health insurance data.

BackgroundDespite numerous studies of geographic variation in healthcare cost and utilization at the local, regional, and state levels across the U.S., a comprehensive characterization of geographic variation in outcomes has not been published. Our objective was to quantify variation in US health outcomes in an all-payer population before and after risk-adjustment.Methods and FindingsWe used information from 16 independent data sources, including 22 million all-payer inpatient admissions from the Healthcare Cost and Utilization Project (which covers regions where 50% of the U.S. population lives) to analyze 24 inpatient mortality, inpatient safety, and prevention outcomes. We compared outcome variation at state, hospital referral region, hospital service area, county, and hospital levels. Risk-adjusted outcomes were calculated after adjusting for population factors, co-morbidities, and health system factors. Even after risk-adjustment, there exists large geographical variation in outcomes. The variation in healthcare outcomes exceeds the well publicized variation in US healthcare costs. On average, we observed a 2.1-fold difference in risk-adjusted mortality outcomes between top- and bottom-decile hospitals. For example, we observed a 2.3-fold difference for risk-adjusted acute myocardial infarction inpatient mortality. On average a 10.2-fold difference in risk-adjusted patient safety outcomes exists between top and bottom-decile hospitals, including an 18.3-fold difference for risk-adjusted Central Venous Catheter Bloodstream Infection rates. A 3.0-fold difference in prevention outcomes exists between top- and bottom-decile counties on average; including a 2.2-fold difference for risk-adjusted congestive heart failure admission rates. The population, co-morbidity, and health system factors accounted for a range of R2 between 18–64% of variability in mortality outcomes, 3–39% of variability in patient safety outcomes, and 22–70% of variability in prevention outcomes.ConclusionThe amount of variability in health outcomes in the U.S. is large even after accounting for differences in population, co-morbidities, and health system factors. These findings suggest that: 1) additional examination of regional and local variation in risk-adjusted outcomes should be a priority; 2) assumptions of uniform hospital quality that underpin rationale for policy choices (such as narrow insurance networks or antitrust enforcement) should be challenged; and 3) there exists substantial opportunity for outcomes improvement in the US healthcare system.

Data source: Nepal demographic and health surveys 1996 and 2006.amaternal mortality rate from the later survey was used as the reference, so the incidence rate ratio in the earlier survey was 2.69 times greater.**denotes statistical significance at p<0.001;*p<0.01.