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Age Adjustment Issues in Healthy People 2010

This document explores the age adjustment methods used by the National Center for Health Statistics (NCHS) in the Healthy People 2010 initiative. It details the calculations of age-adjusted rates using different standard populations, including the transition from the 1940 mortality data to the 2000 U.S. resident population data. Emphasis is placed on how these adjustments reflect national demographics, affect the interpretation of health outcomes, and improve monitoring of health disparities over time. Understanding these practices is crucial for comparing health trends accurately across varying populations.

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Age Adjustment Issues in Healthy People 2010

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  1. Age Adjustment Issues in Healthy People 2010 John Aberle-Grasse, MPH National Center for Health Statistics

  2. Calculation of age-adjusted rate • Age-adjusted rate = • Si (mi*wsi) • mi = di / pi * 100,000 • wsi = standard population weight in age group i • di = deaths in age group i • pi = population in age group i

  3. Calculation of age-adjusted rate • Spreadsheet vs. “manual” calculation • NCHS continues to use “manual” method • Healthy People 2010 rate calculations are rounded/truncated to one decimal place • Weights are rounded/truncated to six places

  4. Standard population- a population based on some age distribution • NCHS in the past • mortality data used 1940 standard • survey data used mostly 1970 & 1980 standard • NCHS now uses year 2000 US resident population as standard for all age adjustment

  5. Standard population- a population based on some age distribution • NCHS in the past • mortality data used 1940 standard • survey data used mostly 1970 & 1980 standard • NCHS now uses year 2000 US resident population as standard for all age adjustment • 2000-adjusted rates better reflect national demographics and current crude rates

  6. Crude and age adjusted death rates based on year 1940 and 2000 standard populations: United States, 1979-2000 2000 standard crude rate 1940 standard

  7. Standard population- a population based on some age distribution • IMPORTANT REMINDER: Comparisons can only be made between rates calculated using the same standard population

  8. Age-adjustment inHealthy People 2010 • Mortality data • Health outcomes, risk factors, and health services data

  9. Diabetes prevalence by race/ethnicity (Obj. 5-3), 1999 Overall Hispanic/ Latino Asian/ Pacific Islander Not-Hispanic African American Not-Hispanic White American Indian/ Alaska Native Source: National Health Interview Survey (NHIS), CDC, NCHS.

  10. Diabetes age specific rates, 1999 Source: National Health Interview Survey (NHIS), CDC, NCHS.

  11. 2000 Census age distribution

  12. Diabetes prevalence (Obj. 5-3), 1999 Source: National Health Interview Survey (NHIS), CDC, NCHS.

  13. Diabetes prevalence (Obj. 5-3), 1999 Source: National Health Interview Survey (NHIS), CDC, NCHS.

  14. Age-adjustment inHealthy People 2010 • Mortality data • Health outcomes, risk factors, and health services data • Main purposes: • Observe trends in populations over time • Monitor disparity between populations both at a point in time and over time

  15. Standard population- age distributions • Several different age groupings are used to age-adjust data from different sources

  16. Data systems Age distributions used

  17. Standard population- age distributions • Several different age groupings are used to age-adjust data from different sources • Some data sources use fewer age groupings to stabilize the rates of less common events and smaller subpopulations (e.g. age groups for chronic disease)

  18. Hispanics aged 2+ years with diabetes who have seen a dentist in the past year (Obj. 5-15) Age-adjusted Crude Source: National Health Interview Survey (NHIS), CDC, NCHS.

  19. Hispanics aged 2+ years with diabetes who have seen a dentist in the past year (Obj. 5-15) Source: National Health Interview Survey (NHIS), CDC, NCHS.

  20. Hispanics aged 2+ years with diabetes who have seen a dentist in the past year (Obj. 5-15) < 45 separate < 45 combined Crude Source: National Health Interview Survey (NHIS), CDC, NCHS.

  21. Some exceptions • Data that are not age-adjusted • Maternal/Infant mortality (live births as denominator) • National Household Survey on Drug Abuse • Occupational injury and death • Fatality Analysis Reporting System • Census of Fatal Occupational Injuries

  22. Some exceptions • When to be careful in age-adjusting • Age specific rates for a measure vary differently between two population groups

  23. Age specific cancer death rates among females, 1970 to 1995 1995 1970 Source: National Vital Statistics System, CDC, NCHS.

  24. Female cancer death rates, by age adjustment standard Crude rate 2000 standard population 1940 standard population Source: National Vital Statistics System, CDC, NCHS.

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