Strategic Plan to Eliminate Health Disparities in NJ, 2007

IV. Technical Notes

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Race/Ethnicity Groups

Throughout this report the following mutually exclusive race and ethnicity groups are used: white, black, Hispanic, and Asian/Pacific Islander.  Data for white, black, and Asian/Pacific Islander do not include Hispanics and Hispanics may be of any race.  Race and ethnicity are reported as separate characteristics on most of the forms used to collect data reported in this document.  Among these are birth and death certificates, the New Jersey Behavioral Risk Factor Survey, the UB-92 hospital discharge file, and the Cancer Registry.  The HIV registry collects race/ethnicity as one characteristic: non-Hispanic white, non-Hispanic black, non-Hispanic other race, and Hispanic. 

The reporting of Hispanic ethnicity on some major data systems is problematic due to a relatively large percentage of records with ethnicity not stated.  Additionally, Asians and Pacific Islanders are sometimes misreported.  Efforts are underway to improve the reporting of Hispanic ethnicity and Asian and Pacific Islander races on the health data collected by the New Jersey Department of Health and Senior Services.  For now, data presented for Hispanics and Asian/Pacific Islanders should be used with caution as they may understate the true rates.

Definitions

Birth Weight -- the first weight of the newborn obtained after delivery. 
 
Cause of Death Classification -- a system of specification of the diseases and/or injuries which led to death and the sequential order of their occurrence.  The version of the system in use since 1999 is the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), sponsored by the World Health Organization
 
Healthy Migrant Effect -- Selective in- and out-migration, also known as the “healthy migrant effect” and the “salmon-bias effect,” may contribute to the Hispanic and Asian/Pacific Islander mortality advantages, since a relatively high proportion of those living in New Jersey are foreign-born (Singh, 2001, Palloni, 2004).
 
Infant Death -- a death within the first year of life.
 
Live Birth -- the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after such separation, breathes or shows any evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.
 
Low Birth Weight -- birth weight of less than 2,500 grams or approximately 5 pounds, 8 ounces.
 
Motor Vehicle-Related Injuries -- Motor vehicle-related injury is a broad term encompassing a number of different types of motorized vehicles and a variety of circumstances covering an encounter of an individual with a motorized vehicle.  A motor vehicle is defined in Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death, Volume 1 as “any mechanically or electrically powered device, not operated on rails, upon which any person or property may be transported or drawn upon a highway.  Any object such as a trailer, coaster, sled, or wagon being towed by a motor vehicle is considered a part of the motor vehicle.”  The Manual includes automobile; bus; construction, industrial, or farm machinery; fire engine; motorcycle; moped; motorized scooter; trolley bus not operating on rails; truck; and van in its definition of motor vehicle.  Persons killed or injured by a motor vehicle can be drivers, passengers, bicyclists, or pedestrians.  Injuries and fatalities related to the use of motor vehicles are not currently labeled “accidents” by public health professionals, as these events are considered preventable.
 

Underlying Cause of Death -- the disease or injury which initiated the train of events leading directly to death or the circumstances of the unintentional injury or violence which produced the fatal injury.
 
Very Low Birth Weight -- birth weight of less than 1,500 grams or approximately 3 pounds, 5 ounces.

Rates

The presentation of statistics in the form of rates facilitates comparisons between political subdivisions with populations of different sizes or between subgroups of a population.  Age-adjusted rates are used to compare the mortality and morbidity experience among groups with differing age distributions.  The definitions of rates used in this report follow.  Caution should be exercised in the interpretation of rates based on small numbers. Death rates based on fewer than 20 deaths do not meet National Center for Health Statistics standards for reliability and precision.

Age-Adjusted Incidence or Death Rate -- the application of age-specific rates to a standard population to arrive at the theoretical number of events that would occur in the standard population at the rates prevailing in the actual population.  The number of events is divided by the total number of persons in the standard population to arrive at the adjusted rate.  The resulting age-adjusted rate is an index number and can only be compared to other rates age-adjusted using the same standard population and cannot be compared to crude or other actual rates.  The standard population used in this report for age-adjustment of rates is the United States 2000 standard million, derived from projected 2000 decennial census counts.
 
Emergency Department (ED) Visit Rate -- the number of resident ED visits per 100,000 population.
 
Hospitalization Rate -- the number of resident hospital admissions per 100,000 population.
 
Infant Mortality Rate -- the ratio of the number of deaths to children less than one year of age in a given year per 1,000 births in the same year.
 
Ratio – an expression of the quantity of one outcome in relation to that of another.  For example, for the age-adjusted death rate due to breast cancer among blacks as compared to whites, the ratio for whites as the reference group is 1.0 and for blacks, it is 1.24.  In this example, the age-adjusted death rate among blacks is 24 percent higher than the rate among whites.

ICD-10 Codes

Population Estimates

Population estimates used to calculate various rates in this report were derived from the bridged-race postcensal population estimates prepared by the National Center for Health Statistics (NCHS) in collaboration with the U.S. Bureau of the Census.  These estimates result from bridging the 31 race categories used in the 2000 Census, as specified in the 1997 federal OMB standards for the collection of data on race and ethnicity, to the four race categories specified under the 1977 standards.  Many data systems are continuing to use the 1977 standards during the transition to full implementation of the 1997 standards.  Population estimates as of April 1, 2000 were used with 2000 data, Vintage 2003 estimates were used with 2001 - 2003 data, and Vintage 2004 estimates were used with 2004 data.  For more information about the bridged-race population estimates:  www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm

The estimates presented below have not been rounded.  However, it should not be presumed that they have the degree of accuracy which such precise figures might imply. 

Data Sources