MICA User Group Newsletter Practice Exercise Solutions

Issue #6

You work for the Washington County Health Department and are interested in applying for a grant to prevent tobacco use and support tobacco cessation programs in your county.  Use the 2011 County-Level Study Profiles to research tobacco use in Missouri.

The answers to questions 1-3 are found on the Health and Preventative Practices Profile.

1. What is the Washington County prevalence of current cigarette smoking?  36.4%
   Is the Washington County prevalence statistically significantly different from the state prevalence?  Yes – significantly higher
   
   
2. What is the Central Region (which includes Washington County) prevalence of current cigarette smoking?  22.5%
   Is the Central Region prevalence statistically significantly different from the state prevalence?  No
   
   
3. Use the Download Indicator Data column (available only on the Missouri Profile) to determine which region has the highest current cigarette smoking prevalence.  Southeastern Region (27.5%)
   Which region has the lowest prevalence?  St. Louis Metro Region (20.0%)
   Which county/city has the highest prevalence of current cigarette smoking? Pemiscot County (45.5%)
   Which has the lowest? Scotland County (8.4%)

The answers to questions 4-6 are found on the Tobacco Use Profile.

4. What is the Washington County prevalence of former cigarette use?  22.1%
   Is the Washington County prevalence statistically significantly different from the state prevalence?  No
   
   
5. What is the Washington County prevalence of smokeless tobacco use?  7.2%
   Is the Washington County prevalence statistically significantly different from the state prevalence?  No
   
   
6. What are the Washington County prevalence rates for belief that smoking cigarettes causes the following conditions?

Condition	Prevalence Rate
Heart attack	76.5%
Colon cancer	36.1%
Stroke	67.5%
Low-birth weight	78.4%
Impotence	41.5%

Visit http://health.mo.gov/data/mica/MICA/solutions.html to check the solution.

Issue #5

You are researching the use of caesarean sections in Missouri.  You would like to determine which mothers are at highest risk for a caesarean delivery.  Use the Birth MICA to complete the following tables and determine which demographics groups are at significantly higher risk for caesarean deliveries based on 2009 data.

	Number	Rate	95% Confidence Interval
Whites	20,494	32.3	31.9 to 32.6
African Americans	3,967	32.9	32.1 to 33.8
American Indians/Alaskan Natives	107	30.1	25.5 to 35.0
Asians/Native Hawaiians/Pacific Islanders	677	33.7	31.6 to 35.8
Groups at significantly higher risk:	None – The confidence intervals overlap.

	Number	Rate	95% Confidence Interval
Hispanic	1,184	27.6	26.3 to 29.0
Non-Hispanic	24,310	32.6	32.3 to 33.3
Group at significantly higher risk:	Non-Hispanics, when compared to Hispanics

	Number	Rate	95% Confidence Interval
10-14	20	27.0	18.2 to 38.1
15-17	509	21.5	19.9 to 23.2
18-19	1,527	24.9	23.9 to 26.0
20-24	6,300	28.7	28.1 to 29.3
25-29	7,612	32.0	31.4 to 32.6
30-34	6,039	36.9	36.2 to 37.7
35-39	2,865	41.9	40.8 to 43.1
40+	643	46.7	44.1 to 49.4
All Ages	25,517	32.4	32.0 to 32.7
Groups at significantly higher risk:	Ages 30+ are at significantly higher risk than the overall state population.

	Number	Rate	95% Confidence Interval
Married	15,656	33.6	33.2 to 34.0
Not married	9,858	30.6	30.1 to 31.1
Group at significantly higher risk:	Married women, when compared to not married women

Issue #4

1. Highest - Madison -170.9       Lowest – Lewis – 17.4
2. Yes to both
3. No, CI’s overlap
4. Saline (2709)
5. Crawford
6. Open Wounds and Strains and Sprains

Issue #3

Use the Birth MICA to answer the following questions related to premature births in Jackson County and the Kansas City metropolitan area.

1. Using the 2008 and 2009 data years, what is the premature birth rate for Jackson County?  12.2% of live births (or 12.2 per 100 live births  What is the rate for the State of Missouri? 12.6% of live births (or 12.6 per 100 live births)
2. Use 95% confidence intervals to determine if the difference between your answers to Question 1 represents a statistically significant difference.  Is the Jackson County rate significantly higher than, significantly lower than, or not significantly different from the State of Missouri rate?  The Jackson County and State of Missouri rates are not significantly different.
3. Now calculate the premature birth rate using the same time period for a region that includes Jackson, Cass, Clay and Platte Counties.  What is the rate?  11.8% of live births (or 11.8 per 100 live births)  Is this rate significantly higher than, significantly lower than, or not significantly different from the state rate at a 95% confidence level?  This rate is significantly lower than the state rate.
4. If we change the confidence level to 99%, does that change the answer to Question 3?  If so, how?  No
5. Now use the Kansas City ZIP Code option on the Birth MICA to determine which ZIP Code in the range from 64011 through 64030 had the highest number of premature births for 2008-2009.  64030 (109)  Do you get the same answer if you look for the ZIP Code with the highest rate of premature births?  If the answer is not the same, which ZIP Code has the highest rate?  No – 64024 (15.5%)

Issue #2

As a health educator in Miller County, you are preparing some materials for American Heart Month.  You would like to include the prevalence of current high blood pressure in your county, because this is one of the most important risk factors for heart disease.  After reviewing the MICA suite of tools, you remember that the County-Level Study is the only source of county-specific prevalence rates for many risk factors and conditions.  Use the 2007 Health and Preventive Practices Profile to answer the following questions about current high blood pressure in Miller County and the state.

1. What is the age-adjusted rate for current high blood pressure in Miller County?  23.6% (Use the Age-adjusted weighted percent link in the upper right corner of the screen to view age-adjusted weighted percents rather than weighted percents.)
2. How does this rate compare to the state rate?  The Miller County rate is significantly higher than the state rate.
3. How does it compare to the rate for the Central Region, which contains Miller County?  The Miller County rate is significantly higher than the Central Region rate.
4. While reviewing the current high blood pressure map from the Missouri 2007 Health and Preventive Practices Profile, you notice that there are a few pockets or clusters of counties with high rates.  In general, where are these clusters located?  Use the Select a different geographical area link at the top of the screen to view the Missouri Profile.  Choose the Missouri icon in the Current high blood pressure row to view the map.  A large cluster exists in the Southeastern part of the state and extends into South Central Missouri and towards the St. Louis Metro area.  There is also a small cluster in the Central part of the state that includes only Miller County and Morgan County.
5. From the Missouri Profile, how could you determine the number of counties that have significantly higher or significantly lower rates than the state overall?  Select either the Microsoft Excel icon or the Adobe PDF icon in the Download Indicator Data column.  Both options provide the number of interviews, the weighted (or age-adjusted weighted) percent, significance compared to the region, and significance compared to the state for every geographic area for which data are available.  In Microsoft Excel, you could sort the list by state significance to more easily determine the number of counties in each category.
6. You want to know if the prevalence of current high blood pressure is increasing or decreasing in Miller County.  Use the 2003-2007 CLS Comparison – Health and Preventive Practices Profile to determine how the Miller County rate changed during that time period.  (NOTE:  The 2007 Miller County rate on the Comparison Profile will differ from your answer to #1.  Fewer interviews were completed in 2003, so Miller County data was combined with Camden County data to produce a more stable and reliable bi-county rate.)  What was the 2003-2007 percentage change for Camden-Miller?  3.42% increase  Was this change statistically significant, and, if so, how?  This change was not statistically significant.

Issue #1

You have been asked to write an article about methods of cataract prevention.  You decide to use the Procedures MICA to find statistics on the number of older adults who received cataract treatment.  Set up your query to determine which of the following groups of older adults underwent more cataract procedures in Missouri during 2008:  White Males, White Females, African-American Males, or African-American Females.  What settings did you use?

Step One:

Row variable Race (or Sex)

Step Two:    

Column variable Sex (or Race)

Step Three (Optional):

 

Race All Races, Ethnicity All Ethnicities, Sex All,
Age 65 and Over, Pay Source All Pay Sources, Setting All Settings

Step Four:    

Year(s) of Interest 2008

Step Five:     

Statewide/County/Cities Missouri

Step Six:      

Indicator variable Operations on the eye

Step Seven: 

Statistics to be displayed Frequencies and Rates,
Standard population 2000 Population,
Confidence intervals No Confidence Intervals

Drill-down hyperlink(s) (Optional): 

Drill down on Procedure:  Operations on the eye in the table headings to choose Lens and cataract procedures

Interpretation:  White Females had the highest number (54,990) and highest rate of lens and cataract procedures at 1,283.4 per 10,000 population.

Note:  Although most hospital data are reported using age-adjusted rates, this particular table contains crude (not age-adjusted) rates because an age-specific category (65 and Over) was selected.  Only the total population needs to be age-adjusted.