Texas ICD-10 Multiple Cause Deaths
VitalWeb Standard
Online Help

Introduction

Quick Guide to Using VitalWeb Standard

Multiple Windows
Basic Table Layout

Main Statistic

Table Axes (Rows and Columns)

Statistic / Axis Conflicts
Data Variables

Categorical Variables

Range Variables

Statistic / Variable Conflicts

Other Settings
Chart Settings

Bar Chart Coloring

Bar Chart Layout

Line Chart Settings #1

Line Chart Settings #2

Pie Chart Coloring

Pie Chart Layout

Tabular Charts / Chart Links
Map Settings

Map Coloring

Map Layout

Map Color Palettes
Producing and Using Results

Getting Results

Viewing Results

Printing Results

Saving Results

When Charts and Maps are Made
Other Information

Glossary

County Groupings

95% Poisson Confidence Limits

Age Adjustment Standards

Statistical Methods

Confidence Intervals

Data Sources and Limitations

Links to Related Resources

Whom to Contact

Legal Information

Quick Guide to Using VitalWeb Standard

First, select settings from within the Main Window:

• Main Statistic, for example "Death Rate"
• Rows and columns, for example year rows
• Values for data variables, for example race

Next, whenever you are ready:

• Click on "Make Table Now" or "Make Map" to submit your query.
• Results will appear in a separate "Results Window".
• Browse through your results.
• Print your results (if desired).
• Save your results (if desired).

After you have made output:

• Go back to the the Main Window.
• Modify settings as desired.
• Make another map or table.

Multiple Windows

VitalWeb Standard uses multiple browser windows.

• It does not require full-screen windows.
• You can easily switch between browser windows.
• To switch to another window, simply click on it.
• When you exit the Main Window, the other windows go away.

Main Window ("command center") has the majority of settings and action buttons.

Map Settings Window customizes all map settings.

Other Settings Window:

• Click on "Other Settings" near bottom of the Main Window.
• A separate "Other Settings Window" pops up.
• Casual users can mostly ignore the other options.
• Advanced users will appreciate the extra power.

Help Window is what you are currently viewing.

Results Window displays any output maps or tables.

• Normally, each new result is appended to the Results Window.
• Review previous results by clicking on browser "Back" button.

Chart Setting Windows modify bar, line, and pie chart settings.

Main Statistic

Example Statistic Selector:

Table Axes (Rows and Columns)

Year	0-19	20-39	40-59	60+
1990	1,032	302	545	79
1991	1,134	317	555	88
1992	1,236	348	602	86

Example Table: Year Rows - Age Columns

• Rows - Horizontal lines of data, such as the row for 1991.
• Row Sort - Rows can be sorted, low to high, or high to low.
• Columns - Go up and down, such as the column for age 0-19.

Example Row Variable Selector:

Selecting - Click on desired setting, such as "Age" or "Race".

Statistic / Axis Conflicts

If there is a conflict between statistic, rows, or columns:

• Vitalnet alerts you of the conflict.
• Vitalnet does not allow a table until the conflict is corrected.

Examples of conflicting settings (mismatches) include:

• Age-adjusted rates, age rows.
• Race rows, race columns.
• Year rows, year columns.

To correct a conflict, select a different Main Statistic, Row Variable, or Column Variable.

Selecting Data Variables

Data variables include - age, race, sex, year, cause of death, area of residence.

Example selector
for data variable:

Age of Individual:

Change Groups

Practice for selecting data variable:

• Select one value - Click on "Under 1".
• Add one value to selection - CTL-Click on "5 to 14".
• Delete one value from selection - CTL-Click on "Under 1".
• Select several values - Hold down mouse, drag over several.
• Select all values - Click on "All Ages".
• Change groups - Click on "Change Groups" at bottom.

Note: Can only "Change Groups" for "range variables", such as age or year.
Note: "CTL-Click" means: While holding down control key, click mouse.

Appearance of Data Selector for Geographic Areas:

Unselected Areas:

Selected Areas:

To select areas (in actual interface only):

1. Highlight unselected area - Click on "Armstrong".
2. Move area to "selected" column - Click on green arrow.

To unselect areas (in actual interface only):

1. Highlight selected area - Click on "Mills".
2. Move area to "unselected" column - Click on red arrow.

Notes on geographic selection:
• Use Shift-Click to select / deselect more than one area at a time.
• For causes of death, the data selector is similar.
• Vitalnet resolves duplications where one area includes another.

Selecting Data Variable Groupings

Certain data variables allow different "groupings".
For example, 5-year or 10-year age groups.

To change the grouping:

• Click on "Change Groups" - Brings up popup similar to below.
• In popup, click on desired grouping - Selects grouping, removes popup.

Select Standard Age Grouping:

Example data grouping popup

Statistic / Variable Conflicts

Sometimes, a conflict exists between a variable and a population-based rate. Vitalnet automatically prevents this from producing misleading output.

This is best shown with an example: Suppose there are 408,000 births, and the population is 12,000,000 females. Thus, the birth rate is 34 births per 1,000 females (408,000 / 12,000,000).

Now, suppose we try limiting the analysis to women with 12 years education. We know there are 108,000 births to such women. The result would seem to be 9 births per 1,000 such women (108,000/ 12,000,000). But of course this is totally wrong, because the denominator is not adjusted. And we do not have the population denominator data for women with 12 years education, so there is no easy solution.

To resolve this problem, when Vitalnet makes a rate calculation, it automatically prevents spurious results from being produced, by automatically adding all categories to demographic variables that are not included in the population data set.

So, for example, if you try to calculate a birth rate for women with 12 years of education, Vitalnet simply ignores the limitation to 12 years of education. Instead, it includes all levels of education, so the numerator and denominator match up. And it correctly reports that all levels of education were analyzed.

In contrast, if you try to calcuate a cesarean rate for women with 12 years of education, this does not require population data, only requires information on the births, so Vitalnet calculates the cesarean rate, limited to women with 12 years of education.

Other Settings

If you click on "Other Settings" in the Main Window, a separate "Other Settings Window" pops up. It lets you modify the following options:

Statistic Modifiers:
• Age-Adjust Standard - Standard Population to Use
• SMR Standard - Standard for Calculating SMR
• YPLL Age Limit - YPLL Cutoff, such as 65

Secondary Statistics:
• Cell Confidence Level - Set Level, or Turn Off
• Cell Suppression - Hide Result if Low Count
• Table Percents - Row or Column Percents
• Trend Algorithm - Trend Analysis Method
• Trend Confidence - Set Level, or Turn Off

Miscellaneous Details:
• Decimal Digits - Example: Two in 5.78
• HTML Line Style - Line Style for Output HTML
• HTML Output Font - Text Font for Output HTML
• HTML Padding - Padding for Output HTML Table
• Spreadsheet Format - Spreadsheet Data Format
• Tabular Chart - Chart Width, or Omit Chart
• Unique ID - Put ID on Maps and Charts?

Example Selector, for One Setting:

HTML Output Font -

Bar Chart Coloring

• Background color behind the chart.
• Color palette to use for the bars.
• First color in palette to use for bars.

Below are shown the settings, with examples:

Background Color for Chart (20 options)

White

Grey 95

Lemon Chiffon

Light Cyan

Color Palette for Bars (4 options)

Bright Colors

Subdued Colors

Bright + Subdued

Black + White

First Color in Palette to Use (10 options)

A Forward

D Reverse

E Forward

J Reverse

Bar Chart Layout

Vertical or Horizontal Bars

Vertical Bars

Horizontal

Stacked Bars?

Stacked Bars

Not Stacked

Height of Each Bar (9 options)

2 cm High

4 cm High

Width of Each Bar (8 options)

0.2 cm Wide

0.6 cm Wide

Include Grid Lines?

Include Grid

Omit Grid

Font Size for Chart Text (8 options)

10 pt Font

14 pt Font

Line Chart Settings #1

Eight ways to customize Vitalnet line charts:

Background Color for Chart (20 options)

Alice Blue

Light Yellow

Include Data Point Symbols? (2 options)

Include Symbols

Omit Symbols

Radius for Chart Symbols (10 options)

1.0 mm Radius

1.4 mm Radius

Line Chart Height (9 options)

4.0 cm (Not Shown)

7.0 cm (Not Shown)

Line Chart Settings #2

Width of Lines (3 options)

Thin Lines

Thick Lines

Include Grid Lines? (2 options)

Include Grid

Omit Grid

Colored Lines, or Black + White (2 options)

Colored Lines

Black + White Lines

Font Size for Chart Text (8 options)

10 pt Font (Not Shown)

12 pt Font (Not Shown)

Pie Chart Coloring

Three settings for customizing pie chart coloring:

• The background color behind the chart.
• The color palette to use for the pie chart.
• First color in palette to use (for slice #1).

Background Color for Chart (20 options)

Cornsilk Background

Grey Background

Light Cyan

Color Palette for Pie Chart (3 options)

Bright Colors

Subdued Colors

Mixed Colors

Slice #1 Color to Use (10 options)

Color A for #1

I Forward

F Reverse

Pie Chart Layout

Four settings for customizing pie chart layout:

Slice #1 Clock Position (12 options)

Slice #1 at Noon

Slice #1 at 3:00

Slice #1 at 6:00

How to Label Pie Chart (9 options)

Line + Label

Label Only

Use Legend

How to Display Slice Percents (3 options)

Percent After Label

Under Label

Omit Percents

Pie Chart Radius (9 options)

3.0 cm (Not Shown)

4.0 cm (Not Shown)

5.0 cm (Not Shown)

Tabular Charts / Chart Links

A "tabular chart" is a convenient way of making comparisons.

The tabular chart is always made, unless turned off from the "Other Settings" menu. Also, you may specify the width of the columns within the chart.

Chart links: Note the links below the tabular chart. The links connect to additional graphical and data output formats. The example above links to bar chart, text, database, and spreadsheet formats.

Map Coloring

Color Combination (36 options)

Orange-Red

Grey

Red-Blue

Number of Colors (8 options)

3 Colors

5 Colors

7 Colors

How to Set Ranges (3 options)

Equal Ranges

Equal Counts

Natural Breaks

Map Layout

Boundaries to Display (6 options)

County Boundaries

HSR Boundaries

Border Counties

Cell Suppression (14 options)

Suppression Off

Suppress if < 10 Events

Suppress if < 30 Events

Map File Format (PNG, PDF, SVG, GIS)

PNG Map (Imports Best)

SVG Map (Prints Best)

GIS Map (Interesting)

Map Color Palettes

1	2	3	4	5	6	7	8	9	Diverging Palette	BW	CB
									Brown-BlueGreen	-	Y
									Pink-Green	-	Y
									Purple-Green	-	Y
									Purple-Orange	Y	Y
									Red-Blue	-	Y
									Red-Grey	-	-
									Red-Yellow-Blue	-	Y
									Red-Yellow-Green	-	-
									Spectral	Y	-
1	2	3	4	5	6	7	8	9	Sequential Palette	BW	CB
									Blue	Y	Y
									Blue-Green	Y	Y
									Blue-Purple	Y	Y
									Green-Blue	Y	Y
									Green	Y	Y
									Grey	Y	Y
									Orange	Y	Y
									Orange-Red	Y	Y
									Purple-Blue	Y	Y
									Purple-Green	Y	Y
									Purple-Red	Y	Y
									Purple	Y	Y
									Red-Purple	Y	Y
									Red	Y	Y
									Yellow-Green	Y	Y
									Yellow-Blue	Y	Y
									Yellow-Brown	Y	Y
									Yellow-Red	Y	Y

All palettes are OK for color printing. BW - OK for black and white printing? CB - OK for red-green color blindness?

References for Vitalnet map color palettes - • LW Pickle, M Mungiole, GK Jones, AA White, "Atlas of United States Mortality", National Center for Health Statistics, 1997. • CA Brewer, "Color Use Guidelines for Mapping and Visualization", in "Visualization in Modern Cartography", Elsevier, 1994. • ColorBrewer web site showing color palettes.

Getting Results

To produce results:

1. Click on button - Click on "Make Map" or "Make Table". The program sends the query to the server.

2. View Results Window - Output will display in separate window. It takes a few seconds, depending on the analysis, the data set, and how much data.

3. Conflicts prevented - The program does not permit an invalid request. If a problem, such as row / column mismatch, you will be prompted to correct it before submitting request.

Viewing Results

After you click "Make Map" or "Make Table", a separate "Results Window" appears.

To view results:

1. Scroll results - Use scroll bar, PgUp, PgDn, etc.
2. Print or Save results - Sends to printer or disk.
3. Click on footnote links - Access charts and data files.

Note: If viewing a map, pointing to a map area (use your mouse to position the cursor over a map area) displays the name of the area.

Note: Output forms a queue. In other words, new output replaces old output in the Results Window. Therefore, to review previous output, simply click the browser "Back" button in the Results Window.

Returning to Main Menu - To carry out another analysis:

• Click on the Main Window, OR
• Minimize the Results Windows.

If graphics do not display in output, refresh the browser.

Printing Results

To print results from your browser, use one of the following methods:

• Press CTL-P - Hold down Control key, and press 'P' key.
• Use Browser Icon - Click on Print Icon (if available).
• Use Browser Menu - Select "File / Print" (if menu available).

If output table is too wide or long, here are two ways to make it fit:

• Use fewer rows or columns. Also makes it easier to understand.
• Change browser font size. Typical command is: View / Text Size.

How to print from a spreadsheet or word processor:

1. Click on link for desired format in output footnotes.
2. Download and import the data file:
• CSV / TSV / DIF for spreadsheets, such as Excel or StarOffice.
• ASCII for word processor, such as Word or WordPerfect.
3. Format and print from within your spreadsheet or word processor.

Saving Results

To save results displayed in your browser, do one of the following:

• Press CTL-S - Hold down Control key, and press 'S' key.
• Use Browser Menu - Select "File / Save" (or equivalent).

To save an alternate data format, click on a footnote link:

• ASCII text - Import into word processing software.
• CSV/TSV/DIF format - Import into spreadsheet software.
• dBASE III - For database, GIS, mapping, stats software.

To save a map as an image file, minus any surrounding text:

1. Position cursor over map, using your mouse.
2. Press right mouse button to bring up popup menu.
3. Select "Save" option from popup menu.
4. Specify directory (folder) to save file.

Here are some suggestions on naming files:

• Memorable - Select a name that will remind you of the content.
• Organized - Organize files into project directories (folders).
• Linkable - Use provided unique ID for data files, such as "112jdhkm.dbf".

When Charts and Maps are Made

Vitalnet is smart about making output. Whenever you make a table, Vitalnet usually makes one or more accompanying charts. But it only produces the charts that make sense. If a chart would look terrible, or not be epidemiologically valid, the software does not make it.

Vitalnet avoids making misleading or useless charts. To prevent misinterpretation and embarassing results, Vitalnet intelligently decides when it appropriate to make a chart, as explained below:

Bar charts are only made if the following conditions are met:

• 1 to 20 rows (groups of bars).
• 1 to 10 columns (bars per group).
• No suppressed results (for stacked bar chart).

Line charts are only made if the following conditions are met:

• Range rows (such as age or year).
• No breaks in ranges (not 2000, 2002).
• Rows not sorted. No suppressed results.
• No more than 10 lines (10 columns).

Pie charts are only made if the following conditions are met:

• Cumulative data (counts, some rates).
• One set of numbers (one row or column).
• 2 to 9 pie slices. No suppressed results.

Time trend maps (that cycle from map to map) are only produced when all selected year ranges are the same width. For example, 1995-1996, 1997-1998, 1999-2000 is OK. But 1995-1996, 1997-1998, 1999 is not OK. Also, at least two year ranges are required. So if you just have 1995-1996 (a single range) selected, Vitalnet does not make a series of time trend maps.

Time trend analysis, when making a table with year rows, is only carried out when: 1) at least three year ranges are selected, 2) there are no gaps in the ranges, 3) the ranges are the same width, and 4) the rows are not sorted. When these conditions are met, the time trend analysis is epidemiologically valid.

Glossary

Age-adjusted death rate - Deaths per 100,000 population, adjusted to a standard population (such as US 1940 or US 2000), by the direct method. Age-adjusted rates are often better for making comparisons than unadjusted rates, because they adjust for differences in age distribution between populations. An age-adjusted rate is a summary synthetic measure. Besides calculating overall age-adjusted rates, it is also recommended to compare age-specific rates.

Age-adjustment standard - A standard population for calculating an age-adjusted death rate. The 1940 and 2000 US Census population are the most common standards.

Area set - One or more areas combined.

ASCII file - A text file, with only alphabetical, numerical, and punctuation characters, like you would see in normal text. Vitalnet can produce output in ASCII format.

Cause of death - Any condition which leads to or contributes to death, and is classifiable according to the International Classification of Diseases (ICD) system.

CDC - Centers for Disease Control and Prevention. US federal health agency.

Cell - A space for a single numerical result in a table, at a row-column intersection.

Cell suppression - An asterisk "*" is placed in cells with fewer events (such as deaths) than a limit set by the user. Row / column totals with exactly one suppressed cell in the row / column are also suppressed. If more than one cell in the row / column is suppressed, the row / column total may be displayed.

Columns - Vertical groupings of data in a Vitalnet table, such as a column for each race group.

Confidence interval (confidence limits) - A range of values within which the true value of a variable is thought to lie, with a specified level of confidence. For a result of 23.5, a confidence interval might be (23.1-23.9). The smaller the interval, the more reliable the result, so 23-24 is more reliable than 13-34. If the 95% confidence intervals do not overlap, there is probably a statistically significant difference. Vitalnet uses several methods to calculate confidence intervals. The output table documents which method was used.

Confidence level - The likelihood that the true value of a variable is within a confidence interval. For example, for confidence intervals at the 95% level, we are statistically 95% certain that the actual value of the variable is within the interval.

CSV format - Comma-separated-value format. CSV files are readily imported into spreadsheet software. Each output item is separated by a comma from surrounding items, and each output text item is surrounded by "double quotes". A comma-separated-value file has "csv" extension. Similar to TSV format.

Data warehouse - A software system, such as Vitalnet, making large complex databases readily available for querying and analysis. A related term is "data mining", finding unexpected relationships in a data set, for further study. Data mining is similar to exploratory data analysis. Vitalnet is excellent at data mining. Of course, keep in mind that the more you look, the more unusual events you will find, just by chance.

dBASE III format - A widely used file format originally for the database software of the same name. Files in dBASE III format may be readily imported into almost any data analysis, graphing, mapping, or other presentation software. Uses dbf extension. Suppressed cells are represented as the number "-1".

Death rate - Deaths per 100,000 population. May be used to compare the burden of disease between different groups. Also called crude death rate.

DIF format - Data interchange format. DIF files are readily imported into spreadsheet software. The DIF format is too complex to explain in this glossary. Has "dif" extension.

Denominator - The number on the bottom of a fraction. Population data are often referred to as "denominator data", as they are used as denominators to calculate population-based rates.

Export - Produce output that can be read into other computer programs. Vitalnet produces ASCII text (txt), comma-separated-value (csv), HTML (htm), and dBASE III (dbf) files for export.

Filter variable - A variable solely used to filter which records are included in the output. For example, for a single table with race rows and sex columns, age 10-19 is a filter variable.

FIPS Code - FIPS = "Federal Information Processing Standards". A five-digit number which uniquely identifies counties, territories, and certain other areas in the United States. States have two-digit FIPS codes.

Footer - Last part of a Vitalnet table. Lists less important details of the analysis, such as the date produced, and data sources. Also contains a unique ID to assist in keeping track of analyses.

Header - First part of a Vitalnet table. Lists key analysis parameters, such as years analyzed.

ICD - International Classification of Diseases. A widely used system for classifying diseases and injuries. Each disease or set of diseases has an ICD code or ICD group assigned to it. Vitalnet uses the ICD-9 system, for 1979-1998 mortality data, and the ICD-10 system, for 1999-present mortality data. An "ICD code" is a single ICD number representing a single disease or injury. For example, ICD E10 for insulin-dependent diabetes. An "ICD group" is a range of continuous ICD codes. For example, ICD E10-E14 for diabetes mellitus. An "ICD set" is one or more ICD groups or codes combined, for example ICD C50 (breast cancer) and ICD C53 (cervical cancer).

Import - Read information into a computer program. ASCII text, CSV, TSV, DIF, HTML, and dBASE III files from Vitalnet are easily imported into word processing, spreadsheet, data analysis, mapping, graphing, and other presentation software programs.

Leading causes for ICD-10 - The ten causes of death with the highest number of deaths, out of a standard National Center for Health Statistics list of 51 rankable causes. Vitalnet makes it easy to select and rank the 51 cause list.

Least-squares - A standard method for fitting the best straight line to a set of points. Produces a Y-intercept and a slope defining the least-squares line.

Mean age of death - If the ages were 50, 51, and 58, the mean age of death is (50 + 51 + 58) / 3 = 53

Multiple age groups - One age group for each table row (or column). Example: 0-19, 20-59, 60-99+.

Multiple cause mortality data - Data which include all causes of death listed on the death certificate. Contrast with underlying cause mortality data.

Multiple causes of death - All diseases or injuries which led directly to death, or all circumstances of the accident or violence which produced the fatal injury.

Natural Breaks - Method for determining map ranges. Minimizes "squared deviations from class means".

NCHS - National Center for Health Statistics. US health statistics agency. Part of the CDC.

Place of occurrence mortality data - Data compiled by the location the death occurred, without regard to the place of residence of the deceased. Vitalnet does not currently analyze for place of occurrence.

Place of residence mortality data - Data compiled by the place of residence of the deceased, without regard to the location where the death occurred. Vitalnet analyzes mortality data by place of residence.

Population - The number of people living in an area.

Rows - Horizontal lines in a Vitalnet table, such as a row for each race group.

Row sort settings - Vitalnet rows may be sorted in ascending or descending order.

Set - A combination of one or more things. For example, several areas may be combined into an area set.

Single age group - Only one age group (30-49, for example) is selected. A single age group is used for tables that do not have age columns or age rows.

Standardized mortality ratio (SMR) - The ratio of the expected number of deaths to the observed number of deaths. The expected number of deaths is derived by applying a standard set of rates (usually state or national rates) to a population. SMRs help assess whether the mortality in a population is higher than expected.

Statistic (Main Statistic) - The basic type of numerical result displayed in a table, chart, or map. For example, birth rate, death rate, population, pregnancy rate, etc.

Table - A set of results produced by Vitalnet. A table has several parts:

1. Header - basic analysis settings
2. Data section - numerical results
3. Bar graphs - horizontal charts
4. Footer - other analysis settings

Tabular chart - A section of a Vitalnet table. Gives an scaleable graphical representation of the data. May be omitted from the output table.

TSV format - Tab-separated-value format. TSV files are readily imported into spreadsheet software. Each output item is separated by a tab from surrounding items, and each output text item is surrounded by "double quotes". A tab-separated-value file has "tsv" extension. Similar to CSV format.

Underlying cause - The disease or injury that initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury. A single underlying cause is assigned to each death.

Underlying cause mortality data - Data which include only the underlying cause of death listed on the death certificate. Contrast with multiple cause mortality data.

Unknown Values - Unknowns are automatically inserted into a Vitalnet table. For example, a separate row (or column) for unknown race. The rate is assigned as zero for an unknown category, since there is no population denominator to use. Some fields, such as sex for certain data sets, are never unknown, so unknowns are left off the table. When, such as for age-adjusted rates, the unknown variable (age) is different from the rows or columns, the number of unknowns for age is shown below the table.

Vitalnet / VitalPro / VitalWeb - Vitalnet is data warehouse / data analysis software for analyzing health data sets. VitalPro is a Vitalnet system that runs directly on a PC, for example VitalPro for Win32. VitalWeb is a Vitalnet system that runs over the internet, for example VitalWeb Ajax.

Windows - Microsoft PC operating systems. VitalPro runs under any version of Windows.

World Wide Web (WWW) - A widely used part of the internet that may be easily accessed with a web browser. Vitalnet runs on the WWW.

Years of potential life lost (YPLL) - Sum of the years of life lost by persons who die "early". Early death is usually defined as death occurring before the age of 65 (the YPLL age limit). For example, death at age 40 (40.5) results in 24.5 YPLL to age 65. YPLL is a widely used measure of premature mortality.

YPLL age limit - The age used for calculating YPLL. The most common YPLL age limit is 65.

YPLL rate - YPLL per 100,000 population in the appropriate age category. The YPLL rate up to age 65 is calculated as follows: (YPLL up to age 65) / (population for age group 0-64). Not commonly used.

County Groupings

8 Health Service Regions - HSR 1: Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith, Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, Yoakum HSR 2 / 3: Archer, Baylor, Brown, Callahan, Clay, Coleman, Collin, Comanche, Cooke, Cottle, Dallas, Denton, Eastland, Ellis, Erath, Fannin, Fisher, Foard, Grayson, Hardeman, Haskell, Hood, Hunt, Jack, Johnson, Jones, Kaufman, Kent, Knox, Mitchell, Montague, Navarro, Nolan, Palo Pinto, Parker, Rockwall, Runnels, Scurry, Shackelford, Somervell, Stephens, Stonewall, Tarrant, Taylor, Throckmorton, Wichita, Wilbarger, Wise, Young HSR 4 / 5 North: Anderson, Angelina, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Houston, Jasper, Lamar, Marion, Morris, Nacogdoches, Newton, Panola, Polk, Rains, Red River, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Smith, Titus, Trinity, Tyler, Upshur, Van Zandt, Wood HSR 6 / 5 South: Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Matagorda, Montgomery, Orange, Walker, Waller, Wharton HSR 7: Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, McLennan, Madison, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson HSR 8: Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, La Salle, Lavaca, Maverick, Medina, Real, Uvalde, Val Verde, Victoria, Wilson, Zavala HSR 9/10: Andrews, Borden, Brewster, Coke, Concho, Crane, Crockett, Culberson, Dawson, Ector, El Paso, Gaines, Glasscock, Howard, Hudspeth, Irion, Jeff Davis, Kimble, Loving, McCulloch, Martin, Mason, Menard, Midland, Pecos, Presidio, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, Winkler HSR 11: Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata

11 Public Health Regions (Effective 3/1/93) - PHR 1: Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith, Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, Yoakum PHR 2: Archer, Baylor, Brown, Callahan, Clay, Coleman, Comanche, Cottle, Eastland, Fisher, Foard, Hardeman, Haskell, Jack, Jones, Kent, Knox, Mitchell, Montague, Nolan, Runnels, Scurry, Shackelford, Stephens, Stonewall, Taylor, Throckmorton, Wichita, Wilbarger, Young PHR 3: Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise PHR 4: Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, Wood PHR 5: Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, Tyler PHR 6: Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton PHR 7: Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, McLennan, Madison, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson PHR 8: Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, La Salle, Lavaca, Maverick, Medina, Real, Uvalde, Val Verde, Victoria, Wilson, Zavala PHR 9: Andrews, Borden, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble, Loving, McCulloch, Martin, Mason, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, Winkler PHR 10: Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio PHR 11: Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata

24 Councils of Government - COG 1: Armstrong, Briscoe, Carson, Castro, Childress, Collingsworth, Dallam, Deaf Smith, Donley, Gray, Hall, Hansford, Hartley, Hemphill, Hutchinson, Lipscomb, Moore, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Wheeler COG 2: Bailey, Cochran, Crosby, Dickens, Floyd, Garza, Hale, Hockley, King, Lamb, Lubbock, Lynn, Motley, Terry, Yoakum COG 3: Archer, Baylor, Clay, Cottle, Foard, Hardeman, Jack, Montague, Wichita, Wilbarger, Young COG 4: Collin, Dallas, Denton, Ellis, Erath, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise COG 5: Bowie, Cass, Delta, Franklin, Hopkins, Lamar, Morris, Red River, Titus COG 6: Anderson, Camp, Cherokee, Gregg, Harrison, Henderson, Marion, Panola, Rains, Rusk, Smith, Upshur, Van Zandt, Wood COG 7: Brown, Callahan, Coleman, Comanche, Eastland, Fisher, Haskell, Jones, Kent, Knox, Mitchell, Nolan, Runnels, Scurry, Shackelford, Stephens, Stonewall, Taylor, Throckmorton COG 8: Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio COG 9: Andrews, Borden, Crane, Dawson, Ector, Gaines, Glasscock, Howard, Loving, Martin, Midland, Pecos, Reeves, Terrell, Upton, Ward, Winkler COG 10: Coke, Concho, Crockett, Irion, Kimble, McCulloch, Mason, Menard, Reagan, Schleicher, Sterling, Sutton, Tom Green COG 11: Bosque, Falls, Freestone, Hill, Limestone, McLennan COG 12: Bastrop, Blanco, Burnet, Caldwell, Fayette, Hays, Lee, Llano, Travis, Williamson COG 13: Brazos, Burleson, Grimes, Leon, Madison, Robertson, Washington COG 14: Angelina, Houston, Jasper, Nacogdoches, Newton, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, Tyler COG 15: Hardin, Jefferson, Orange COG 16: Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton COG 17: Calhoun, DeWitt, Goliad, Gonzales, Jackson, Lavaca, Victoria COG 18: Atascosa, Bandera, Bexar, Comal, Frio, Gillespie, Guadalupe, Karnes, Kendall, Kerr, Medina, Wilson COG 19: Jim Hogg, Starr, Webb, Zapata COG 20: Aransas, Bee, Brooks, Duval, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio COG 21: Cameron, Hidalgo, Willacy COG 22: Cooke, Fannin, Grayson COG 23: Bell, Coryell, Hamilton, Lampasas, Milam, Mills, San Saba COG 24: Dimmit, Edwards, Kinney, La Salle, Maverick, Real, Uvalde, Val Verde, Zavala

32 La Paz Border Counties - Brewster, Brooks, Cameron, Crockett, Culberson, Dimmit, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth, Jeff Davis, Jim Hogg, Kenedy, Kinney, La Salle, McMullen, Maverick, Pecos, Presidio, Real, Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy, Zapata, Zavala (The 32 counties either touching the US - Mexico border or touching a county on the border)

15 Immediate Border Counties - Brewster, Cameron, El Paso, Hidalgo, Hudspeth, Jeff Davis, Kinney, Maverick, Presidio, Starr, Terrell, Val Verde, Webb, Willacy, Zapata (The 14 counties touching the US - Mexico border, plus Willacy)

Age Adjustment Standards

Age group	1940 US	1970 US	2000 US
Birth-11m	15,343	17,151	13,818
1-4	64,718	67,265	55,317
5-14	170,355	200,508	145,565
15-24	181,677	174,406	138,646
25-34	162,066	122,569	135,573
35-44	139,237	113,614	162,613
45-54	117,811	114,265	134,834
55-64	80,294	91,480	87,247
65-74	48,426	61,195	66,037
75-99+	20,073	37,547	60,350
Total	Million	Million	Million

Statistical Methods

The "Main Statistic" (numerical outcome) is the basic type of number in a Vitalnet table. It is best understood by looking at the examples below.

Deaths - The number of deaths. Vitalnet analyzes "multiple cause" mortality data. That includes all causes listed on the death certificate. Also, Vitalnet uses "place of residence" mortality data. The "place of residence" is the location where the death occurred. The deaths are assigned to the usual county of residence of the deceased, without regard to the location where the death occurred.

Crude Mortality Rate - Deaths per 100,000 population. This rate may be used to compare the burden of disease between different groups. Crude rates do not take into account the age distribution of the population. Since death is highly dependent on age, older populations will have higher crude mortality rates than populations that are younger.

Age-Adjusted Rate - The number of deaths per 100,000 population, adjusted to a standard population (such as US 1940), by the direct method. Age-adjusted rates are often better for making comparisons than crude rates, because they adjust for differences in age distribution between populations. An age-adjusted rate is a single summary measure. Be aware that it may mask trends detectable by examining age-specific rates. Age-adjusted rates are synthetic rates that are only useful in comparison with other age-adjusted rates. Age-adjusted rates are used to compare one area or population to another because age distribution is controlled for in the calculations. Age-adjusted rates are not typically calculated for individual age ranges, such as 40-49, and Vitalnet does not do so.

Standardized Mortality Ratio (SMR) - The ratio of the number of observed deaths to the number that were expected. Also called indirect adjustment. An SMR greater than 1 indicates more events were observed than expected. The number expected is derived by applying age-specific standard rates for a general population (Texas) to the population in the area under study. The standard rates can include all races, or only the races being studied in the smaller area (race-specific). Similarly, the standard rates can include both male and female, or only the sex being studied in the smaller area (sex-specific). A standardized mortality ratio is a single summary measure. It may mask trends detectable by examining age-specific rates. Standardized mortality ratios are not usually calculated for individual age ranges, such as 40-49, and Vitalnet does not calculate such rates.

Percent Deaths with One Cause - The proportion of deaths with only one cause of death on the death certificate. For example, if there were 100 deaths due to diabetes, and 5 of those deaths had only one cause, percent deaths with one cause = 5 percent. Or, if there were 100 deaths due to motor vehicle accident, and 90 of those deaths had only one cause, percent deaths with one cause = 90 percent.

Mean Causes per Death (MCPD) - The average number of causes of death listed on the death certificate. For example, if there were 100 deaths due to diabetes, and 430 causes listed on the diabetes death certificates, mean causes per death = 4.3 per death. Or, if there were 100 deaths due to motor vehicle accident, and 120 causes listed on the motor vehicle accident death certificates, mean causes per death = 1.2 per death.

Years of Potential Life Lost (YPLL) - The sum of the years of life lost by persons who suffered early deaths, used to measure premature mortality. Early death is usually defined as death occurring before the age of 65 (the YPLL age limit). For example, death at age 40 (40.5) results in 24.5 YPLL to age 65.

YPLL Rate - YPLL per 100,000 population in the appropriate age category. For example, the YPLL rate to age 65 is calculated as follows: (YPLL to age 65) / (population for age group 0-64). YPLL rate is seldom used.

Age-Adjusted Rate Methodology - 1) Determine age-specific rates in the Study population. (Set age-specific rate to zero if age-specific population is zero.) 2) Multiply age-specific rates by Standard age-specific populations, such as 1940 US. 3) Sum the results from the previous step. 4) Divide the sum by the total size of the Standard population.

SMR Methodology - 1) Determine the age-specific death rate for each age group in the Standard (State) population. The age-specific rates may be based on all races combined, or just on the races that are selected (race-specific). 2) For each age group, multiply the age-specific rate by the number of people in that group in the Study population. 3) Sum the results from the previous step. This is the expected number of deaths. 4) Divide the actual number of deaths observed by the number expected (SMR = observed / expected). For example, if 10 deaths were expected in a county (based on the State rate), and 20 occurred, the SMR is 2.

YPLL Methodology - 1) For each death, calculate the difference between the age at death and age 65 (or other chosen limit). For example, death at age 40 (40.5) results in 24.5 YPLL to age 65. 2) Sum the results of the previous step.

Confidence Intervals

Definition - A "confidence interval" is a range of values within which the true value of a variable is thought to lie, at a certain "confidence level", such as 95%. A larger percentage (such as 99%) is more stringent than a smaller percentage (such as 80%). Use 95% if you are unsure.

Interpretation - The smaller the interval, the more reliable the result. Two results that overlap at the 95% level are less likely to be significantly different than results which do not overlap.

Methods - The method Vitalnet uses to calculate confidence intervals depends on the context. The method is listed in the footnotes to the table.

Z * Rate / Sqrt (Events) - This method is recommended by the NCHS. Technical Appendix of the Vital Statistics of the United States, Vol II, Mortality, Part A

Rothman and Boice - This method is for SMRs. Rothman KJ and Boice JD (1979): Epidemiologic analysis with a programmable calculator. NIH Publication No. 79-1649, Washington, DC: U.S Department of Health.

Poisson distribution - This method is valid if events are relatively rare, which usually applies to health events. Scientific Tables, Diem and Lentner (ed), Giegy, 1970, page 189.

95% Poisson Confidence Limits

Events	Lo Factor	Hi Factor	Events	Lo Factor	Hi Factor	Events	Lo Factor	Hi Factor
1	0.025318	5.571647	70	0.779549	1.263440	4,000	0.969250	1.031230
2	0.121104	3.612346	80	0.792938	1.244587	5,000	0.972473	1.027911
3	0.206224	2.922426	90	0.804118	1.229170	6,000	0.974857	1.025464
4	0.272466	2.560398	100	0.813640	1.216268	7,000	0.976711	1.023564
5	0.324697	2.333667	200	0.866209	1.143395	8,000	0.978207	1.022034
6	0.366982	2.176580	300	0.890041	1.116362	9,000	0.979446	1.020767
7	0.402052	2.060382	400	0.904401	1.100401	10,000	0.980496	1.019696
8	0.431729	1.970399	500	0.914267	1.089575	20,000	0.986189	1.013907
9	0.457263	1.898312	600	0.921584	1.081617	30,000	0.988716	1.011348
10	0.479539	1.839036	700	0.927291	1.075453	40,000	0.990224	1.009824
20	0.610826	1.544419	800	0.931904	1.070497	50,000	0.991254	1.008785
30	0.674696	1.427562	900	0.935734	1.066400	60,000	0.992014	1.008018
40	0.714415	1.361716	1,000	0.938980	1.062941	70,000	0.992606	1.007422
50	0.742219	1.318376	2,000	0.956653	1.044307	80,000	0.993082	1.006942
60	0.763105	1.287198	3,000	0.964536	1.036105	90,000	0.993477	1.006544

Data Sources and Limitations

VitalWeb Standard uses data from authoritative sources.

Mortality data - All Texas mortality data were provided by the Bureau of Vital Statistics, Texas DSHS

Population data - Pre-1990 population data are from the Center for Health Statistics, Texas DSHS. Population data for 1990 and subsequent years are from the State Population Center at Texas A&M.

Links to Related Resources

Internet resources related to ICD-10 Multiple Cause Deaths:

• Bureau of Vital Statistics - Texas DSHS
• Center for Health Statistics - Texas DSHS

Whom to Contact

For additional assistance with analyzing and interpreting the data, contact:

• Mortality data - Bureau of Vital Statistics - 512-458-7509
• Mortality data - Center for Health Statistics - 512-458-7261
• Population data - Center for Health Statistics - 512-458-7261

Legal Information

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Texas ICD-10 Multiple Cause Deaths VitalWeb Standard Online Help

Table of Contents

Quick Guide to Using VitalWeb Standard

Multiple Windows

Main Statistic

Table Axes (Rows and Columns)

Statistic / Axis Conflicts

Selecting Data Variables

Selecting Data Variable Groupings

Statistic / Variable Conflicts

Other Settings

Bar Chart Coloring

Bar Chart Layout

Line Chart Settings #1

Line Chart Settings #2

Pie Chart Coloring

Pie Chart Layout

Tabular Charts / Chart Links

Map Coloring

Map Layout

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Getting Results

Viewing Results

Printing Results

Saving Results

When Charts and Maps are Made

Glossary

County Groupings

Age Adjustment Standards

Statistical Methods

Confidence Intervals

95% Poisson Confidence Limits

Data Sources and Limitations

Links to Related Resources

Whom to Contact

Legal Information

Texas ICD-10 Multiple Cause Deaths
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