Persistent and extreme outliers in causes of death by state, 1999-2013

New York State Cancer Registry, New York State Department of Health, Albany, New York, United States
DOI
10.7287/peerj.preprints.1268v2
Subject Areas
Epidemiology
Keywords
events of undetermined intent, mortality, ICD-10, outliers
Copyright
© 2015 Boscoe
Licence
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ PrePrints) and either DOI or URL of the article must be cited.
Cite this article
Boscoe FP. 2015. Persistent and extreme outliers in causes of death by state, 1999-2013. PeerJ PrePrints 3:e1268v2

Abstract

In the United States, state-specific mortality rates that are high relative to national rates can result from legitimate reasons or from variability in coding practices. This paper identifies instances of state-specific mortality rates that were at least twice the national rate in each of three consecutive five-year periods (termed persistent outliers), along with rates that were at least five times the national rate in at least one five-year period (termed extreme outliers). The resulting set of 71 outliers, 12 of which appeared on both lists, illuminates mortality variations within the country, including some that are amenable to improvement either because they represent preventable causes of death or highlight weaknesses in coding techniques. Because the approach used here is based on relative rather than absolute mortality, it is not dominated by the most common causes of death such as heart disease and cancer.

Author Comment

This is a preprint submission to PeerJ. There are only several minor wording changes from the originally posted version.