PBS Program on Data and Pandemics

PBS has a good series on how medicine has learned to fight pandemics.  This particular episode focuses on how data is used to understand and limit pandemics.  It starts with how William Farr used data to track a cholera outbreak.  I've embedded this episode here for your enjoyment and information.

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Why do African Americans live to be 64.8 years in Cambria County? Not drug overdoses.

COVID-19 Cases Have Risen in Cambria County but Deaths Have Not Due to Vaccinations (so far)

The second installment of We Are All In This Together: Pandemic-Johnstown 1918 has come out and can be seen above.  Recently there has been a rise in cases as spring has sprung.  Since the terrible months of December and January, the 7 day average for new cases fell from 214.29 on Dec 11 to 14.29 on March 20.  Since then, the 7 day average has risen to a high of 58.43 on April 19 to 49.29 today as can be seen in the graph below.  This rise has occurred after the vaccine rollout began on Jan 8.

Since the cases have risen, the deaths in the county have remained fairly stable as can be seen in the above graph.  The 7 day average for deaths reached a high of 8.14 deaths per day on Dec 17 (6 days after the spike in cases).  Since March 16, the average has not risen above 1 death per day.  

The graph above shows the trend in the 7 day average for new cases (black line), testing (red dotted line) and full vaccinations (orange line).  The lines for testing and vaccinations are on a logarithmic scale.  The number of full vaccinations per day has fallen from a high of 855.4 on April 14 to 399.9 today.  On April 13 all Pennsylvanian's over age 16 became eligible to receive the vaccine.  To date 40,920 of 31.43% in Cambria County have been fully vaccinated.

This graph from the state department of health shows that the majority of cases are between the ages of 20 and 59 throughout the state.  This information is not available at the county level.

This final graph shows that the vast majority of deaths in PA have been between ages 60 and 99.  The early phases of the vaccine rollout have focused on groups most vulnerable such as the elderly.  The vaccinations seem to be curtailing the number of deaths even though there has been a rise in cases.  The younger age groups still need to be vaccinated to stop the spread of the virus.  

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Some Clues for Racial Disparities for Cambria County

Last week I posted on the racial disparities in health outcomes in Cambria County.  These disparities are primarily what is driving the low rankings for the county in the County Health Rankings.

County Health Rankings provides a wealth of statistics called health factors which provide clues to these disparities.  Here is a list:

• 9% of the live births in the county from 2013-2019 are low birthweight which is 1% higher then the state rate. 16% of African American births are low birthweight compared to 12% of Hispanic and 6% of Caucasian births. in the county
• The teen birth rate is 20 per 1,000 live births from 2013-2019 compared to 17/1,000 for PA.  For African Americans it is 54/1,000, 19/1,000 for Hispanics, and 18/1,000 in the county.
  
• The drug overdose death rate from 2017-2019 was 52 per 100,000 for the county.  For Pennsylvania it is 37/100,000.  For African-Americans the rate was 112/100,000  and for Caucasians it was 50/100,000.  According to the website Overdose free PA, there were 18 overdose deaths among African Americans (orange bar in the above graph) in the county from 2017-2019 out of 204 total overdose deaths or 8% of the total.

• The rate of preventable hospital stays per 100,000 Medicare enrollees for 2018 is 5,762 in the county compared 4464 for PA.  The African American Rate is 6,154 while it is 5,779 for Caucasians in the county.
  
• The rate of mammography screening is 42% for the county for Medicare enrollees for 2018 while it is 45% for the county.  For African Americans it is 31% compared to 38% for Asians, 50% for Hispanics, and 42% of Caucasians in the county.
• The rate of flu vaccinations is 41% overall for the county for Medicare enrollees in 2018 compared to 53% for PA.  For African Americans the rate was 36% in the county while it was 45% for Asians and Hispanics and 41% for Caucasians.
• The overall rate of child poverty was 23% for the county for 2019 while it was 17% for PA.  For African Americans it was 67% in the county while it was 19% for Asians, 42% for Hispanics, and 20% for Caucasians.
• Median income in the county was $48,800 for 2019 while it was $63,500 in PA.  For African Americans it was 18,900 in the county while for Asians it was $90,000, for Hispanics it was $35,100, and for Caucasians it was $48,100.
• The injury death rate was 128 per 100,000 for the county from 2015-2019 while it was 89/100,000 for PA.  For African-Americans it was 221/100,000 and 126/100,000 for Caucasians in the county.
• The homicide death rate was 6/100,000 for the county from 2013-2019 while it was 5/100,000 from 2013-2019.  For African Americans it was 50/100,000 while it was 4/100,000 for Caucasians in the county.
• For firearm fatalities the rate was 16/100,000 from 2015-2019 while it was 12/100,000 for PA.  For African Americans it was 41/100,000 and 15/100,000 for Caucasians in the county.
• For reading scores, the average grade level was 3.1 for 3rd graders in both the County and PA in 2018.  For African Americans it was at a 2.2 grade level and 3.2 for Caucasians in the county.
• For math scores, the average grade level for 3rd graders was 3.1 for both the county and PA in 2018.  For African Americans it was at a 2.0 grade level and 3.2 for Caucasians in the county
• Finally the % of residents who drive alone to work for the county was 82% from 2015-2019 while it was 76% for PA.  For African Americans, 62% drives alone to work in the county while it was 65% for Hispanics and 84% for Caucasians.  This could be due to African Americans and Hispanics being more likely to rely on public transportation to get to work.

These 14 statistics provide some clues to the nature of the racial/ethnic disparities in Cambria County.  They suggest violence and poverty as the main explanatory factors.  One must be careful not to assume that they tell the whole story.  They do provide some clues to where public health resources need to be allocated.  It remains to be seen how the Coronavirus pandemic will interact with these health issues.

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African Americans Still Lag Behind in Life Expectancy in Cambria County

Group	Cambria County	Pennsylvania	U.S.
Overall	76.1	78.4	78.7
Caucasian	76.4	78.9*	78.6
African American	67.3	73.4*	74.7
Hispanic	91.3	85.3*	81.8

*Pennsylvania life expectancy by race numbers are from 2010 (Measure of America, 2013) 

In my book, Wuthering Depths in Johnstown: By the Numbers.  I wrote extensively on the 2020 County Health Rankings for Cambria County (where Johnstown is located).  The number that jumped out at me most was racial disparities in mortality data in Cambria county where African Americans had a life expectancy of 65.6 years, Caucasians 76.2 years, and Hispanics 89.0 years.  

This year's life expectancy numbers from the 2021 County Health Rankings are displayed above in the table above for the years 2017-2019 (corona virus deaths are not included).  Cambria County's overall life expectancy increased from 75.6 to 76.1 years (63rd in PA).  Among counties with life expectancies by race, African American life expectancy increased by 1.7 years to 67.3 (the lowest in PA).  Caucasians increased by 0.2 years to 76.4 (3rd lowest ).  Hispanics increased the most by 2.3 years to 91.3 (5th highest in the state).  

Counties with miniscule racial/ethnic minority populations do not have a breakdown for life expectancy by race.  African Americans comprise 3.5% (10.9% of PA) of the county and Hispanics make up 1.8% (7.8% of PA).  Caucasians comprise 92.6% of the county (75.7% of the state).  Approximately 59% of the African Americans in the county live inside the city of Johnstown

Overall the county is 2.6 years behind the US life expectancy.  Caucasians are 2.2 years behind, African Americans are 7.4 years behind, and Hispanics are 9.5 years ahead of the US rate.  Life expectancy is not included in the overall County Health Rankings for Health Outcomes.  Mortality Measured as Years of Potential Life Lost is factored into the rankings which is a measure related to life expectancy.

Years of potential life lost (YPLL) is the number of years lost if someone dies before age 75.  For example, if someone dies at age 25, they have 50 years for potential life lost.  The overall YPLL rate is 9,700 years per 100,000 for the county.  It is 19,900 years per 100,000 for African Americans and 9,400 years per 100,000 for Caucasians.  

The premature age adjusted death rate for the county is the number of deaths under age 75 per 100,000 for the years 2017-2019.  For Cambria it is 440 deaths/100,000.  For African Americans it is 840 deaths/100,000 and for Caucasians it is 430 deaths/100,000.  For Pennsylvania, the overall rate is 350 deaths/100,000.  This measure is provided by County Health Rankings but not factored into the rankings.

The most shocking mortality rate is the child mortality rate which is the number of deaths under the age of 18 per 100,000 for the years 2016-2019.  For Cambria the rate is 50 deaths/100,000 which is the same as PA's rate.  For African Americans in the county, it is 210 deaths/100,000 (the highest in PA) while for Caucasians it is 40 deaths/100,000.  The rate is more than 5 times higher for African Americans. 

The health factors data for the county provides some clues for this discrepancy.  I will discus it in my next post.

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The 2021 County Health Rankings are Out

 

The 2021 County Health Rankings are now out for every county in the US.  The rankings use more than 60 government statistics to assess the overall health of each county.  Above is a video description of their model.  They have two overall rankings for the state: Health Outcomes (mortality and quality of life data) and Health Factors (things that contribute to the health outcomes).

The maps above show the rankings for each county in Pennsylvania.  The darker green counties have lower health outcomes rankings while the counties with darker color blue have lower health factors ranking in the map on the right.  Cambria County ranks 62nd in health outcomes (up 2 spots from last year which is not cause for celebration) and 47th on health factors which is down 3 spots since last year.

For me the overall rankings are not as interesting as the underlying statistics used to determine them.  Two individuals can have the exact some IQ score but one can have a high verbal aptitude while another can have an equally high math ability. The graph below shows the trend in mortality data (measured as years of potential life lost or YPLL).

In my book, I went in depth into the rankings to explain why last year's rankings were so low.  It was mostly racial disparities in life expectancy in the county.  In the next few posts I will go in depth into this years numbers.  Corona virus numbers are not yet factored into the rankings as 2019 is the most recent year for mortality data.  The graph above shows that Cambria's rate, though decreasing, is still higher than the state and U.S. rates. 

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The graph above shows that Cambria's rate, though decreasing, is still higher than the state and U.S. rates. 

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One Year of Corona Virus in Cambria County

March 23 will be the one year anniversary of the first case of coronavirus in Cambria County.  The graph above shows the trend in cases and vaccinations over the past year.  The graph below shows the trend in deaths.  The first death was reported on April 7.  The county now (as of this writing) has 12,059 cases, 402 deaths, and 19,664 full vaccinations.  As I update the numbers on Google sheets, the numbers on the graphs in this post will be updated.

I have been tracking the number of cases and deaths almost every day over the past year.  It has been a labor of love keeping track of the pandemic here.  The feedback has been mostly positive to this effort.  As more publicly available data has been released over the year, the effort has taken more and more of my time every day.  In addition to the daily posting of numbers, I have written 34 out of 47 posts on corona virus on this blog.  The more insights that I can provide for the public to guide decision making the better.

In This Together Cambria is putting together a slideshow showing the resilience of the area to the past years challenges.  Submissions are due by March 26.  One story I can add is the passing of Rosie Caeti, an old family friend who passed away last on March 13 from complications from Corona Virus at 87.  She used to babysit my dad when he was young.

Soon, the county health rankings for every county in the US will be released for 2021.  I do not yet know how or if coronavirus deaths will factor into the rankings.  

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Why the New York COVID-19 Nursing Home Scandal Matters

 

Last week I posted on coronavirus mortality in nursing homes in Pennsylvania.  By coincidence, just to the north of PA is the state of New York where it's Governor, Andrew Cuomo, has come under fire for underreporting the number of deaths in nursing homes there.  In the above clip, NY Assemblyman Ron Kim claims that Cuomo called him to threaten him not to go public with the underreporting.  The state assembly will vote to curtail Cuomo's emergency powers.

When I report on the Pennsylvania numbers, I and those that use the numbers trust that their reporting is accurate.  There is already a certain level of distrust of the federal, state, and local government's honesty.  Scandals like these only reinforce this mistrust.  It makes it harder to track and sound the alarm about the spreading of cases. 

Impeachment or some other accountability by the voters is warranted.  Cuomo will not be up for reelection for a fourth term until 2022.  His father Mario (once a potential Presidential candidate) was defeated for a fourth term by George Pataki in 1994.

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Size of PA County Elderly Population Predicts Smaller Nursing Home COVID-19 Mortality

This week I thought I would take a look at mortality in nursing homes (or Long Term Care Facilities (LTCF)) in Pennsylvania.  Statewide, nursing home deaths account for 52.1% of the total coronavirus deaths.  Looking at the county level there is considerable variability in the rates where the 10 counties with the highest rates are seen below.  The rates for this group rage from 115.8% for Forest county to 67.2% for Delaware County.  Forest county actually has 3 more LTCF deaths than total deaths with one facility.  This suggests that at least 3 of their residents reside outside the county.  You can see the full list of counties here.

Facility County	Number of Facilities with Cases	Number of Cases Among Residents	Number of Cases Among Employees	Number of Deaths in LTCF	Total Deaths in the County	% of death in LTCF	Case Mortality in LTCF
FOREST	1	121	26	22	19	115.8%	15.0%
ERIE	35	1354	717	287	363	79.1%	13.9%
MCKEAN	9	372	110	47	60	78.3%	9.8%
CENTRE	16	675	146	155	203	76.4%	18.9%
BUTLER	29	1421	156	257	350	73.4%	16.3%
LACKAWANNA	35	1423	295	290	395	73.4%	16.9%
LYCOMING	19	922	283	165	232	71.1%	13.7%
MONTGOMERY	111	4723	186	1026	1456	70.5%	20.9%
CARBON	7	407	48	95	138	68.8%	20.9%
DELAWARE	59	3197	871	796	1184	67.2%	19.6%

The bottom 10 counties are listed below.  The percentage of deaths in the in LTCFs for this group rage from 35.7% in Sullivan County to 15.0% in Potter County.  Surprisingly, Philadelphia county is in this bottom tier with 26.1% of their deaths in LTCFs.  Another way of looking at mortality in LTCFs is the case mortality or the % of cases who have died.  Philadelphia ranks 11th in the state on this measure with Pike county ranking 1st at 27.0% and Cameron County ranking last at 4.3%.

Facility County	Number of Facilities with Cases	Number of Cases Among Residents	Number of Cases Among Employees	Number of Deaths in LTCF	Total Deaths in the County	% of death in LTCF	Case Mortality in LTCF
SULLIVAN	3	94	13	5	14	35.7%	4.7%
WAYNE	5	88	19	20	58	34.5%	18.7%
BEDFORD	5	269	29	43	126	34.1%	14.4%
FRANKLIN	26	799	94	106	313	33.9%	11.9%
CAMERON	1	36	10	2	7	28.6%	4.3%
SNYDER	2	124	31	20	73	27.4%	12.9%
PHILADELPHIA	85	4222	16	782	3001	26.1%	18.5%
ELK	3	122	50	8	34	23.5%	4.7%
CLINTON	6	112	48	9	53	17.0%	5.6%
POTTER	3	45	15	3	20	15.0%	5.0%

I looked at the percentage of the population in each county over the age of 65 and found some interesting patterns.  For the correlation with % of deaths in LTCFs, as the proportion of the population over 65 increases the % of deaths decreases as seen with the graph below.  Forest county is an outlier and is labeled green in the scatterplot.  With Forest county included, this relationship accounts for 6% of the variability in the data.  When Forest county is excluded, the relationship accounts for 11.6% of the variability in the data and is still negative.  I don't have a good explanation for this but will investigate further.

I then looked at the correlation between case mortality and the % of the county over 65.  This relationship was also negative accounting for 11.3% of the variability.  Pike county is a mild outlier.  With Pike excluded, this relationship accounts for 16.6% of the variability.  This pattern is similar to the one with the percentage of deaths in the county.  

 

Case mortality and % of deaths in LTCFs are positively associated but not strongly accounting for 15.3% of the variability.  There may be stronger relations ships among the variables not considered yet.  There also may be variables at the facility level to which I do not have access.  Investigating will continue.

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