Premature Mortality: An Indicator of Preventable Chronic Disease Deaths and Health Equity for St. Louis County

BACKGROUND: Chronic diseases represented seven of the ten leading causes of death, accounting for 66 percent of all-cause mortality in St. Louis County, Missouri, during 2010–2014. Chronic diseases, including heart disease, cancer, stroke, chronic lung diseases, and diabetes, have modifiable risk factors that can lead to premature mortality. Premature mortality, deaths among adults aged 45-64 years, is a chronic disease indicator (CDI) that estimates preventable deaths. This study examined trends in premature mortality and rates by demographic characteristics and cause of death using local public health data.   

METHODS: Death certificate data for St. Louis County resident deaths during 2010–2014 from Missouri Department of Health and Senior Services included age, sex, race (black and white), and underlying cause-of-death using ICD-10 codes. Annual and 5-year (2009–2013) American Community Survey population estimates were used. Calculated rates—number of deaths among resident adults aged 45-64 years per 100,000 population aged 45-64 years per year—and 95% confidence intervals (CI). Poverty categories based on proportion of residents below federal poverty level in census tracts. Five sub-county geographic areas based on census tracts. Analyses conducted using SAS v9.3.   

RESULTS: During 2010–2014, premature mortality rates increased 7.8 percent in St. Louis County (526.8, 95%CI 500.1─554.0 to 568.0, 95%CI 540.7─596.0, respectively). Premature mortality rate was significantly higher among males compared to females (689.2, 95%CI 669.3─709.3 and 420.6, 95%CI 406.1─435.4); black/African Americans had significantly higher rate compared to whites (905.4, 95%CI 870.6─940.8 and 472.2, 95%CI 459.2─485.3). Premature mortality rates increased significantly with poverty level: low (400.7, 95%CI 387.6─414.0), medium (660.4, 95%CI 632.7─688.6), high (939.5, 95%CI 890.3─990.0), and very high (1126.9, 95%CI 1043.3─1213.7). Premature mortality rate for West county (309.4, 95%CI 293.5─325.7) was significantly lower compared to all other areas: Central (437.1, 95%CI 406.3─469.0), South (506.3, 95%CI 481.0─532.2), Outer North (516.5, 95%CI 492.3─541.4), Inner North (979.0, 95%CI 940.0─1018.8). Seven chronic diseases were among the ten leading causes of premature mortality including cancer, heart disease, stroke, diabetes, chronic lower respiratory disease, chronic liver disease, and kidney disease. The leading causes of premature mortality were similar across demographics; however, there were differences in rank order and significant disparities in rates. 

CONCLUSIONS: Increasing preventable chronic disease deaths are an important public health concern. Premature mortality rate disparities expose potential health equity issues among males, black/African Americans, and high poverty groups. Premature mortality is a useful CDI for the St. Louis County chronic disease surveillance program to inform essential public health interventions.