Missouri Resident Chronic Disease Comparisons Profile

 

Heart Disease

Deaths

Resident deaths during the eleven-year period for which the underlying cause of death was given on the death certificate as heart disease.

This category of "heart disease" is one of the National Center for Health Statistics standard categories for ranking the leading causes of death. In addition to "Ischemic Heart Disease" (below), some of the causes included are: rheumatic heart disease, hypertensive heart disease, pulmonary embolism, various valve disorders, cardiomyopathy, atrial fibrillation, and congestive heart failure.

International Classification of Diseases (ICD-10) codes: I00-I09.9, I11-I11.9, I13-I13.9, and I20-I51.9.

Hospitalizations

Resident hospitalizations with a primary diagnosis solely of the heart itself. Includes any pathological condition of the heart, including "ischemic heart disease" - a temporary and local deficiency of blood supply to the heart or heart muscle.

Emergency Room Visits

Resident emergency room visits with a primary diagnosis solely of the heart itself. Includes any pathological condition of the heart, including “ischemic heart disease” – a temporary and local deficiency of blood supply to the heart or heart muscle.

Clinical Classifications Software (CCS) Categories: 96-97, 100-108.

International Classification of Diseases (ICD-9) codes: 032.82, 036.40-036.43, 074.20-074.23, 112.81, 115.03, 115.04, 115.13, 115.14, 115.93, 115.94, 130.3, 391.0-392.0, 393-398.98, 410.0-414.01, 414.10-415.1, 415.19-429.1, 429.5-429.9, 785.0-785.3, 786.50, 786.51, 786.59, V42.2, V43.3, V50-V50.9, V45.81, V45.82, V53.3-V53.39.

Ischemic Heart Disease

Deaths

Resident deaths for which the underlying cause of death was given on the death certificate as ischemic heart disease. This category of "ischemic heart disease" is a subset of "heart disease". The vast majority of “ischemic heart disease” deaths are attributed to either “acute myocardial infarction, unspecified” or “atherosclerotic heart disease.”

Note: Counts for this category are not comparable with counts of “ischemic heart disease” deaths for 1998 or earlier. A definitional change between ICD-9 and ICD-10 added over 700 Missouri deaths per year to the category.

International Classification of Diseases (ICD-10) codes: I20-I25.9.

Hospitalizations

Resident hospitalizations with a primary diagnosis of ischemic heart disease. This disease is caused by prolonged, persistent deficiency of blood to the heart muscle. The symptoms may include chest pain and a sensation of constriction about the heart.

International Classification of Diseases (ICD-9) codes: 410-414.

Emergency Room Visits

Resident emergency room visits with a primary diagnosis of ischemic heart disease. This disease is caused by prolonged, persistent deficiency of blood to the heart muscle. The symptoms may include chest pain and a sensation of constriction about the heart.

International Classification of Diseases (ICD-9) codes: 410-414.

Stroke/Other Cerebrovascular Disease

Deaths

Resident deaths for which the underlying cause of death was given on the death certificate as cerebrovascular disease (stroke), whether due to bleeding or to blockage of arteries in the brain. Late effects of strokes are also included.

International Classification of Diseases (ICD-10) codes: I60-I69.8.

Hospitalizations

Resident hospitalizations with a primary diagnosis of stroke or other diseases involving blood vessels to the brain, whether due to bleeding or to blockage of arteries in the brain. This category also includes hospitalizations due to transient cerebral ischemia (TIA) and the late effects of strokes.

Clinical Classifications Software (CCS) Categories: 109-113

International Classification of Diseases (ICD-9) codes: 430-438.9.

Emergency Room Visits

Resident emergency room visits with a primary diagnosis of stroke or other diseases involving blood vessels to the brain, whether due to bleeding or to blockage of arteries in the brain. This category also includes emergency room visits due to transient cerebral ischemia (TIA) and the late effects of strokes.

Clinical Classifications Software (CCS) Categories: 109-113.

International Classification of Diseases (ICD-9) codes: 430-438.9.

All Cancers (Malignant Neoplasms)

Deaths

Resident neoplasm (cancer). This includes leukemia and cancers of various organs, but excludes benign neoplasms, carcinoma in situ, and neoplasms of uncertain behavior.

International Classification of Diseases (ICD-10) codes: C00-C97.

Hospitalizations

Resident hospitalizations with a primary diagnosis in this category suffer from an uncontrolled growth of cells derived from normal tissues. Includes leukemia, cancers of various organs, and carcinomas in situ but excludes benign neoplasms and neoplasms of unspecified nature or uncertain behavior.

Clinical Classifications Software (CCS) Categories: 11-43.

International Classification of Diseases (ICD-9) codes: 140.0-208.91, 230.0-234.9, 795.0, 795.1, V10.00-V10.52, or V10.59-V10.9.

Colorectal Cancer

Deaths

Resident deaths for which the underlying cause of death was given on the death certificate as malignant neoplasm (cancer) of the colon, rectum, or anus.

This grouping is used by the National Center for Health Statistics; it is slightly different from “Colon and Rectum Cancer” (next indicator below). The differences are that this NCHS definition includes cancers of the anus but does not include those of the “intestinal tract, part unspecified.” Those two differences approximately offset each other in statewide data but, for counties and cities, the difference can be in either direction.

International Classification of Diseases (ICD-10) codes: C18-C21.8.

Hospitalizations

Resident hospitalizations with a primary diagnosis in this category suffer from an uncontrolled growth of cells derived from normal tissues. Includes malignant neoplasms (cancers) of the colon, rectum, or anus; also includes cancer of the intestinal tract, part unspecified.

Clinical Classifications Software (CCS) Categories: 14-15

International Classification of Diseases (ICD-9) codes: 153.0-154.8, 159.0, 230.3-230.6, V10.05, or V10.06.

Colon and Rectum Cancer (SEER)

Deaths

Resident deaths for which the underlying cause of death was given on the death certificate as malignant neoplasm (cancer) of the colon, rectum, or recto sigmoid junction.

This set of criteria is from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. It is slightly different from the criteria used in "Cancer of colon, rectum, and anus" (above) because SEER excludes cancer of the anus and anal canal and includes cancers of "intestinal tract, part unspecified.”

International Classification of Diseases (ICD-10) codes: C18-C20, C26.0.

Lung Cancer (SEER)

Deaths

Resident deaths during the eleven-year period for which the underlying cause of death was given on the death certificate as malignant neoplasm (cancer) of the lung and/or bronchus.

This set of criteria is from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Note that some sources, including Healthy People 2010 and the National Center for Health Statistics, include cancer of the trachea with "lung cancer."

International Classification of Diseases (ICD-10) code: C34-C34.9.

Hospitalizations

Resident hospitalizations with a primary diagnosis in this category suffer from an uncontrolled growth of cells derived from normal tissues. This indicator includes malignant neoplasms (cancers) of the lung and bronchus, but excludes cancer of the trachea, which is grouped in the CCS category for "other respiratory and intrathoracic" cancer. These criteria are also consistent with the definition used by the National

Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program.

Clinical Classifications Software (CCS) Category: 19.

International Classification of Diseases (ICD-9) codes: 162.2-162.9, 231.2, or V10.11.

Breast Cancer

Deaths

Missouri resident deaths during the eleven-year period for which the underlying cause of death was given on the death certificate as breast cancer. This includes deaths to both male and female residents. Rates based on females alone are available from the Women's Health Profile and the Death MICA.

International Classification of Diseases (ICD-10) code: C50-C50.9.

Hospitalizations

Resident hospitalizations, both male and female, with a primary diagnosis of breast cancer. The hospitalization rate for this indicator will differ from that for a similarly named indicator found in the Women’s Health Profile, because it not only includes male breast cancer but also uses the entire population to calculate the age-adjusted rate.

Clinical Classifications Software (CCS) Category: 24

International Classification of Diseases (ICD-9) codes: 174.0-175.9, 233.0, or V10.03.

Cervical Cancer

Deaths

Resident deaths during the eleven-year period for which the underlying cause of death was given on the death certificate as cervical cancer. Although only females are subject to this cancer, rates are annualized per 100,000 total residents, age-adjusted to the 2000 U.S. Standard Population. Gender-specific rates for females are available from the Women's Health Profile and the Death MICA.

International Classification of Diseases (ICD-10) code: C53-C53.9.

Hospitalizations

Resident hospitalizations of female patients with a primary diagnosis of cervical cancer. The cervix is the lower and narrow end (neck) of the uterus. The hospitalization rate for this indicator will differ from that for a similarly named indicator found in the Women’s Health Profile, because it uses the entire population to calculate the age-adjusted rate rather than only the female population.

Clinical Classifications Software (CCS) Category: 26.

International Classification of Diseases (ICD-9) codes: 180.0-180.9, 233.1, 795.0, or V10.41.

Prostate Cancer

Deaths

Resident deaths during the eleven-year period for which the underlying cause of death was given on the death certificate as prostate cancer. Although only males are subject to this cancer, rates are annualized per 100,000 total residents, age-adjusted to the 2000 U.S. Standard Population. Gender-specific rates for males can be calculated using the Death MICA.

International Classification of Diseases (ICD-10) code: C61-C61.9.

Hospitalizations

Resident hospitalizations of male patients with a primary diagnosis of prostate cancer. The prostate is a gland in males which surrounds the neck of the bladder and the urethra. It uses the entire population to calculate the age-adjusted rate rather than the male population only.

Clinical Classifications Software (CCS) Category: 29.

International Classification of Diseases (ICD-9) codes: 185, 233.4, or V10.46.

Diabetes Mellitus

Deaths

Resident deaths during the eleven-year period for which the underlying cause of death was given on the death certificate as diabetes.
International Classification of Diseases (ICD-10) codes: E10-E14.9.

Hospitalizations

Resident hospitalizations with a primary diagnosis of diabetes mellitus. This disease is characterized by an excessive urine excretion and an inability to metabolize carbohydrates, proteins, and fats with insufficient secretion of insulin. Symptoms may be unremarkable, with long-term complications involving kidneys, nerves, blood vessels, and eyes. Included in this category is diabetes both with and without complications.

Clinical Classifications Software (CCS) Categories: 49-50.

International Classification of Diseases (ICD-9) codes: 250.00-250.93, 790.2, 791.5, or 791.6.

Emergency Room Visits

Resident emergency room visits with a primary diagnosis of diabetes mellitus. This disease is characterized by an excessive urine excretion and an inability to metabolize carbohydrates, proteins, and fats with insufficient secretion of insulin. Symptoms may be unremarkable, with long-term complications involving kidneys, nerves, blood vessels, and eyes. Included in this category is diabetes both with and without complications.

Clinical Classifications Software (CCS) Categories: 49-50.

International Classification of Diseases (ICD-9) codes: 250.00-250.93, 790.2, 791.5, 791.6.>

Chronic Obstructive Pulmonary Disease Excluding Asthma

Deaths

Residentdeaths during the eleven-year period for which the underlying cause of death was given on the death certificate as a chronic lower respiratory disease other than asthma. This category is based on "Chronic lower respiratory diseases" in the National Center for Health Statistics' current listing of leading causes of death, except that the NCHS grouping includes asthma, which is counted separately in this profile. Included here are: bronchitis (unless it is specified as acute bronchitis), emphysema, bronchiectasis, and chronic obstructive pulmonary disease, unspecified. The vast majority of the deaths in this category are attributed to "Chronic obstructive pulmonary disease, unspecified."

Included are: bronchitis (unless it is specified as acute bronchitis), emphysema, asthma, bronchiectasis, and chronic airway obstruction not elsewhere classified. The vast majority of the deaths in this category are attributed to "Chronic airway obstruction not elsewhere classified."

International Classification of Diseases (ICD-10) codes: J40-J44.9, J47-J47.9.

Hospitalizations

Resident hospitalizations with a primary diagnosis of chronic obstructive pulmonary disease (COPD). Includes chronic (non-acute) bronchitis, emphysema, bronchiectasis, and chronic airway obstruction not elsewhere classified. Hospitalizations for asthma are not included in this definition.

Clinical Classifications Software (CCS) Category: 127.

International Classification of Diseases (ICD-9) codes: 490-492.8, 494-494.1, or 496.

Emergency Room Visits

Resident emergency room visits with a primary diagnosis of chronic obstructive pulmonary disease (COPD). Includes chronic (non-acute) bronchitis, emphysema, bronchiectasis, and chronic airway obstruction not elsewhere classified. Emergency room visits for asthma are not included in this definition.

Clinical Classifications Software (CCS) Category: 127.

International Classification of Diseases (ICD-9) codes 490-492.8, 494-494.1, 496.

Asthma

Deaths

Resident deaths during the eleven-year period for which the underlying cause of death was given on the death certificate as asthma.
International Classification of Diseases (ICD-10) codes: J45-J46.9.

Hospitalizations

Resident hospitalizations with a primary diagnosis of asthma.

Clinical Classifications Software (CCS) Category: 128.

International Classification of Diseases (ICD-9) codes: 493.00-493.92.

Emergency Room Visits

Resident emergency room visits with a primary diagnosis of asthma.

Clinical Classifications Software (CCS) Category: 128.

International Classification of Diseases (ICD-9) codes: 493.00-493.92.

Smoking-Attributable (Estimated)

Deaths

An estimate of the number of resident deaths over the eleven-year period which were attributable to smoking. This is the only mortality indicator for which the numbers of events are estimates. All other mortality numbers are counts of actual death certificates. The table below shows the smoking-attributable fractions used in calculating the estimates in these profiles.
Smoking-attributable deaths are estimated based on smokers' greater likelihood (relative risk) of dying of various diseases. The Office on Smoking and Health (OSH) within the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention reviews biomedical studies to identify diseases causally related to (cigarette) smoking and to estimate how much more likely smokers are than non-smokers to die of those diseases.

To calculate estimates of smoking-attributable deaths for states, OSH developed a software program called SAMMEC (Smoking-Attributable Morbidity, Mortality, and Economic Costs). SAMMEC uses relative risk formulas to estimate the number of smoking-related deaths from selected diseases. Over the years, more conditions have been linked to smoking, and differences in relative risk by gender and age have been identified. SAMMEC has been revised periodically to take new information into account.

SAMMEC also incorporates estimates of the prevalence of smoking in the population from survey data from the Behavior Risk Factor Surveillance System. The algorithm below used prevalence estimates for Missouri 2001-2005. (Updating prevalence estimates makes very small changes in the smoking-attributable fractions.) SAMMEC then calculates disease- and gender-specific smoking-attributable fractions by age group. Finally, those fractions are applied to the disease- gender- and age-specific numbers of deaths from smoking-related diseases in the population to derive an estimate of smoking-attributable deaths. Estimates in these profiles apply fractions calculated from national and state data to smaller areas; this may introduce additional error.

Like SAMMEC, this algorithm omits deaths in fires and automobile crashes caused by smoking. Unlike SAMMEC, it also omits deaths of infants due to the mother’s smoking.

Relative risk ratios are updated periodically in light of new research. In addition, SAMMEC now includes deaths attributed to secondhand smoke. However, this algorithm cannot be updated in the way in which it was created, because SAMMEC is no longer available to states to enter their population, mortality and prevalence data. Rather, OSH calculates and publishes estimates by state. Updated data from OSH can be obtained from https://www.cdc.gov/statesystem/index.html.

A detailed description of how OSH estimates smoking-attributable mortality and morbidity can be found in chapter 12 of the U.S. Department of Health and Human Services The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

Males

Females

Cause of Death

35–64

65+

35–64

65+

Malignant Neoplasms

Lip, Oral Cavity, Pharynx

78%

72%

57%

44%

Esophagus

73%

73%

68%

54%

Stomach

30%

28%

14%

11%

Pancreas

30%

19%

31%

22%

Larynx

85%

82%

81%

71%

Trachea, Lung, Bronchus

90%

88%

80%

69%

Cervix Uteri

-

-

16%

09%

Urinary Bladder

50%

47%

34%

27%

Kidney and Renal Pelvis

42%

38%

08%

04%

Acute Myeloid Leukemia

26%

23%

11%

11%

Cardiovascular Diseases

Ischemic Heart Disease

42%

15%

38%

11%

Other Heart Disease

23%

18%

14%

08%

Cerebrovascular Disease

41%

09%

46%

05%

Atherosclerosis

34%

26%

18%

08%

Aortic Aneurysm

68%

64%

65%

48%

Other Arterial Disease

24%

11%

25%

13%

Respiratory Diseases

Pneumonia, Influenza

25%

23%

25%

13%

Bronchitis, Emphysema

90%

91%

84%

81%

Chronic Airways Obstruction

82%

82%

82%

74%

Arthritis/Lupus

Deaths

The total number of deaths of Missouri residents over the eleven-year period for which the underlying cause of death was given on the death certificate as one of the diagnoses in a grouping of ICD-9 codes for arthritis and other rheumatic conditions designated by the National Arthritis Data Workgroup. (See https://www.cdc.gov/mmwr/PDF/wk/mm4324.pdf .) The ICD- 10 codes were chosen to be as equivalent as possible to the ICD-9 codes.

Most deaths in this indicator are attributed to diffuse disease of connective tissue (including systemic lupus erythematosus), rheumatoid arthritis (RA), osteoarthrosis, and various forms of arteritis. Many of the RA deaths involve pneumonia.

International Classification of Diseases (ICD-10) codes: A54.4, D69.0, E79.8- E79.9, G54.0, G56.0, G57.5, G83.4, I00 - I01.9, I67.7, I73.0, I77.6, L40.5, M00-M03.6, M05-M06.9, M08-M08.9, M10- M13.9, M15-M19.9, M20.1, M25.4, M25.5- M25.9, M30-M35.9, M36-M36.9, M45-M47.9, M48.1- M48.3, M48.9, M60-M62.9, M65- M67.9, M70-M71.9, M72.0- M72.5, M72.8- M72.9, M75 -M77.9, M79.0, M79.1, R26.2.

Hospitalizations

Resident hospitalizations with a primary diagnosis of arthritis, lupus, or associated conditions.

International Classification of Diseases (ICD-9) codes: 095.6-095.79, 098.5-098.59, 099.3-099.39, 136.1-136.19, 274-274.99, 277.2-277.29, 287.0-287.09, 344.6-344.69, 353.0-353.09, 354.0-354.09, 355.5-355.59, 357.1-357.19, 390-391.99, 437.4-437.49, 443.0-443.09, 446-446.99, 447.6-447.69, 696.0-696.09, 710-716.99, 719.0-719.09, 719.2-719.99, 720-721.99, 725-727.99, 728.0-728.39, 711, 728.6-728.99, 712, 729.0-729.19, or 729.4-729.49.

Emergency Room Visits

Resident emergency room visits with a primary diagnosis of arthritis, lupus, or associated conditions.

International Classification of Diseases (ICD-9) codes: 095.6-095.79, 098.5-098.59, 099.3-099.39, 136.1-136.19, 274-274.99, 277.2-277.29, 287.0-287.09, 344.6-344.69, 353.0-353.09, 354.0-354.09, 355.5-355.59, 357.1-357.19, 390-391.99, 437.4-437.49, 443.0-443.09, 446-446.99, 447.6-447.69, 696.0-696.09, 710-716.99, 719.0-719.09, 719.2-719.99, 720-721.99, 725-727.99, 728.0-728.39, 711, 728.6-728.99, 712, 729.0-729.19, 729.4-729.49.