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CHARTing Health Information: Glossary

This Web site has been designed to provide a comprehensive collection of links to publicly available health and health determinants data. While the emphasis is on the state of Texas, there are links to sites that cover all of the U.S.

Data Glossary

Census glossary
This link will take you to the Census Bureau's AmericanFactfinder Glossary site. You can find definitions to terms such as Census tract, Metropolitan Statistical Area (MSA), Primary Metropolitan Statistical Area (PMSA), and more.

Determinants of health can include:

  • Income and Social Status
  • Education
  • Physical Environment
  • Economic environment
  • Social Support Network
  • Genetics
  • Health Services Access and Use
  • Gender

(From World Health Organization: http://www.who.int/hia/evidence/doh/en/)

Diagnosis Related Group (DRG): A classification system that groups patients according to diagnosis, type of treatment, age, and other relevant criteria. Under the prospective payment system, hospitals are paid a set fee for treating patients in a single DRG category, regardless of the actual cost of care for the individual. A zip file of DRGs is available from the Centers for Medicare & Medicaid Services.

Geographic Information Systems
Geographic information systems (GIS) is a means by which data that has a geographic component can be digitally mapped and displayed. "They can store, manipulate, analyze, and display the spatial (geographic location) relationships between unlike types of data." (National Cancer Institute)

As an example, let's say you have block-by-block crime data as well as income/poverty data down to the Census tract. With GIS, you could map both the crime data and the income/poverty data and display them individually. You could also create relationships between the crime and income/poverty data to display high crime/low income areas and vice versa. Any data that has a geographic variable attached to it-- zip code, Census tract, street address, county-- can be mapped but only down to the geographic level of the most complete data and providing confidentiality is not lost.

Health Service Regions

Healthy People 2020 (US Department of Health and Human Services)
"Healthy People is the prevention agenda for the Nation. It is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. " If you are developing an assessment of your community, you can use HP 2020 as a guideline for where your community needs to go in terms of health.

ICD-9 & ICD-10: The International Classification of Diseases (ICD) is used to code and classify diseases from death certificates. ICD-9 codes are numeric codes; ICD-10 are alpha-numeric.

The most complete version of the ICD-9 can be found in the front pages of the reports for total deaths for each cause by 5-year age groups, also called the GMWK 1 (pdf, 2.4 MB)

The World Health Organization has the complete ICD-10 online. A pdf version of the ICD-10-CM (Clinical Modification) can be found at the CDC.

FIPS lookup for states, counties, places, Metro areas, MMSAs, Urbanized areas, Urban clusters, School Districts, and County subdivisions (Missouri Census Data Center)
FIPS lookup for states and counties (Census Bureau)
"Federal information processing standards codes (FIPS codes) are a standardized set of numeric or alphabetic codes issued by the National Institute of Standards and Technology (NIST) to ensure uniform identification of geographic entities through all federal government agencies. The entities covered include: states and statistically equivalent entities, counties and statistically equivalent entities, named populated and related location entities (such as, places and county subdivisions), and American Indian and Alaska Native areas."

States have a two-digit number [TX=48] while counties are given three-digit numeric codes. Each County Code is preceding by the corresponding two-digit State Code. For example, Uvalde would be 48463-- 48 is the state two-digit code for Texas and 463 is the three digit code for Uvalde. Additional information can be found at the NIST FIPS home page.

Kessner Index (South Carolina Dept. of Health & Environmental Control): The Kessner Index is a measure of adequacy of prenatal care based on the month when prenatal care began (which trimester), gestational age, and the number of prenatal visits. Prenatal care is considered "adequate" if care begins in the first trimester with 9 or more visits over a 36 week or more pregnancy. Prenatal care is considered "intermediate" or includes 5 to 8 visits for a 36-week pregnancy. It is "inadequate" if it begins in the third trimester or includes 4 or fewer visits for a pregnancy of 34 or more weeks (Prenatal Care: Reaching Mothers, Reaching Infants. Institute of Medicine, 1988). TX Vital Statistics used to use the Kessner Index but stopped in 2003 or so. You may still see references to it in some of their documentation.

Morbidity refers to illness
Mortality refers to death

Numerical descriptions of morbidity and mortality

A comprehensive collection of Rates & Formulae can be found on a separate page. A brief definition of statistical types is given below.

Count: Simplest measure; refers to the raw number of cases of a disease or deaths.
Why this is meaningful: Easy to do comparisons within a time frame for the same population or same geographic area.
Ex: In 1999 there were 16 deaths in Harris County from tuberculosis and 17 in 2002.  It dropped to only 9 in 2006 but rose quite substantially to 21 in 2009. (From Texas Health Data Deaths of Texas Residents)
Why this is not meaningful: Since population size is not part of the equation, it is difficult to determine what it means in relationship to the rest of the population, i.e. we don't have a mortality rate, just a count. The crude rate is not terribly large-- 0.5, 0.5, 0.2, and 0.5 respectively. However, 21 deaths from TB in King County would be very significant as the population is significantly smaller than that of Harris County. Unless we know that, though, the crude count does not give any sense of the severity. 

Proportion: Count relative to the size of the group; the numerator is always part of the denominator and denominator must be meaningful; X/(X+Y) expressed as a percentage
Ex.: 250 people out of 425 came down with the Norwalk virus while on a cruise
250/425 = 58.8%

Ratio: This is similar to a proportion in that it is also a fraction but the numerator is not included in the denominator; X/Y.
Ex: From 2006 through 2009, 21 men were reported to have died from breast cancer in Harris County; 1642 women died in those same years. (From Texas Health Data Deaths of Texas Residents) The ratio of women's mortality from breast cancer to men's mortality would be 1642/21 or 78.19:1.

Prevalence: The number of existing cases of a disease or health condition in a population at some designated time. Prevalence can be as short as a day, which can be a useful measure when tracking outbreaks of influenza or measles.

Incidence: Rate of development of a disease in a group over a certain time period; only those considered "at risk" should be included in the denominator.

Rate: Rate is also expressed as a fraction but it involves a measure of time. To determine the rate of death for women in Harris county from breast cancer, we would also need to know the total number of women living in Harris County at the midyear point.

Crude death rate = # of deaths in a given year x 100,000
Reference population

Either 1,000 or 100,000 are used as the multiplier

Age-adjusted rate: Also called "age standardization"; reduces the confounding effects of age on morbidity and mortality rates. For example, the crude death rate for the United States was 852.2 per 100,000 population in 1979. It rose to 880.0 in 1995. However, the US population also saw an increase in proportion of the number of older people. By using an age-adjusted rate, the rate actually dropped from 577.0 per 100,000 to 503.9.
Many tables use an age-adjusted rate; you need to be careful that you don't confuse your data by quoting an age-adjusted rate alongside a crude death rate. Also, if you are comparing data, make certain the data use the same standard, i.e. don't compare data using the 1940 Standard with the 1970 Standard.
For further explanation along with a complicated formula, take a look at the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) site for age adjustment.

References

Friis, RH, and Sellers, TA. Epidemiology for Public Health Practice. 2nd ed. Gaithersburg, MD: AspenPub., 1999.