Mortality and Fertility Rates and Proportions

46 Total Points plus up to 4 possible extra credit points (6% of Grade)

This is an individual homework assignment. While you are allowed to use any notes, textbooks or readings, and to consult with the faculty instructor, if having trouble, you are expected to think through this assignment and do it on your own without the collaboration of classmates. You should wait until after you have listened to Lecture #9, read pages 66-75 and pages 94-99 of the textbook before starting this homework assignment. Remember to have your notes in front of you while doing this homework.

Absolutely no late homework assignments will be accepted. Please type your answers, numbering all of the questions.
Part I: General Vital Statistics of Imaginary County (20 points, 2 points each)
Table 1: Measures of Disease Occurrence: Vital Statistics
Type of Count Number
Total Population 160,000
Number of Live Births 3,300
Number of Maternal Deaths 5
Number of Infant Deaths (<1 year old) 88
Number of Deaths from Heart Disease 133
Number of Deaths from Cancer 66
Number of Deaths from Accidents 45
Number of Deaths from Stroke 56
Total Number of Deaths from All Causes Combined 1,444
Number of People Diagnosed with Heart Disease 5,600
The table above gives the mortality statistics for a fictitious county in a rural state for the period of July 1st to June 30th (one year). After reviewing the health status indicators and mortality data, calculate the following mortality rates. Show all numerators and denominators, as well as the final answers with multipliers.
1) Crude Mortality Rate (per 100,000)
2) Crude Birth Rate (per 1,000)
3) Cause-Specific Mortality Rate for Heart Disease (per 100,000)
4) Proportional Mortality Ratio for Heart Disease (%)
5) Case-Fatality Rate for Heart Disease (%)
6) Cause-Specific Mortality Rate for Cancer (per 100,000)
7) Cause-Specific Mortality Rate for Stroke (per 100,000)
8) Cause-Specific Mortality Rate for Accidents (per 100,000)
9) Infant Mortality Rate (per 1,000)
10) Maternal Mortality Ratio (per 100,000)

Part II: Proportional Mortality Ratios with Pie Graph (9 total points, plus 2 possible extra credit points)
Table 2: Ten Leading Causes of Death in the United States in 2017

Cause of Death Number of Deaths Proportional Mortality Ratio
Heart Disease 647,457
Cancer 599,108
Unintentional Injuries (Accidents) 169,936
Chronic Lower Respiratory Diseases 160,201
Stroke 146,383
Alzheimer’s Disease 121,404
Diabetes 83,564
Influenza and Pneumonia 55,672
Kidney Disease 50,633
Suicide 47,173
All Other Causes 731,972
Total Deaths All Causes Combined 2,813,503 100%

1) Calculate all 11 proportional mortality ratios from the data below. You do not need to show all steps (numerator and denominator.) (Fill in Table 2. 5.5 points.)
2) Using Excel construct a pie graph for the proportional mortality ratios of the U.S. in 2017. This should be similar in design to the pie graph for proportional mortality ratios in the world in 2016 shown on slide 21 of Lecture 9. You will need to copy the proportional morality ratios you have calculated into Excel to do this. Remember that you will have to add an 11th proportional mortality ratio that accounts for all other causes of death combined that are not listed in the top 10 (since the rest of the deaths were due to all other causes, and these are part of the total 100% of deaths). Be sure that your graph has a title, which includes the type of statistic shown, the place and date. Also display a key with percentages. If possible, print the pie charts in color. Otherwise, choose contrasting versions of grey or patterns (like stripes). (3.5 points)
3) Extra Credit: Why have I not asked you to construct a pie graph for the cause-specific mortality rates? (2 points)

Part III: Case-Fatality Rates for Avian Flu (17 points, plus 2 possible extra credit points)
Avian Influenza A (H5N1) is highly pathogenic. It first came to the attention of the world in November 2003. The virus has been constantly evolving. From being 100% in wild birds (such as geese) it first evolved to infect domestic poultry. Later it evolved to infect humans. Most cases of infection have been traced to human contact with infected poultry. While the virus currently does not yet transmit efficiently from person to person, some cases of person to person transmission have occurred.

Table 2 shows the number of reported cases and deaths from Avian flu around the world as of June 24th, 2019. Empty cells mean that there were no cases in that country during that period of time. Please use Table 2 (below) for the following calculations. Express all final answers as percentages.

1) Calculate the total case-fatality rate for Avian flu in the world (all countries combined and years combined). (Show all steps, including numerator and denominator.) (2 points)
2) For all countries combined, please calculate the case-fatality rates for avian influenza for each of the following time periods: 2003-2009, 2010-2014, 2015, 2016, 2017 and 2018-2019 (up until June 24th). These are time-specific case-fatality rates. After calculating these rates, place them in table 3 below. (You do not need to show all steps.) (3 points)
3) Describe in words how the case-fatality rate for avian influenza has changed over time. (2 points)
4) For all time periods combined, calculate the case-fatality rates for avian influenza for each country where it has occurred for all years combined. These are category-specific (country-specific) case-fatality rates. After calculating these rates, place them in table 4 below. (You do not need to show all steps.) (8 points)
5) Including all countries which have reported any cases, which countries have had the highest case-fatality rate for this disease? Which countries have had the lowest? (2 points)
6) Including only countries with at least 25 total cases, which country has had the highest case-fatality rate and which the lowest? (2 points)
7) Extra Credit: After reading about the disease at the beginning of this problem, explain why it is necessary to maintain surveillance of this particular disease. (2 points)

Table 2: Cumulative Number of Confirmed Human Cases and Deaths from Avian Influenza A (H5N1) Reported to WHO, 2003- June 24, 2019
Country 2003-2009 2010-2014 2015 2016 2017 2018-2019 Total
Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths
Azerbaijan 8 5 8 5
Bangladesh 1 0 6 1 1 0 8 1
Cambodia 9 7 47 30 56 37
Canada 1 1 1 1
China 38 25 9 5 6 1 53 31
Djibouti 1 0 1 0
Egypt 90 27 120 50 136 39 10 3 3 1 359 120
Indonesia 162 134 35 31 2 2 1 1 200 168
Iraq 3 2 3 2
Lao People’s Democratic Republic 2 2 2 2
Myanmar 1 0 1 0
Nepal 1 1 1 1
Nigeria 1 1 1 1
Pakistan 3 1 3 1
Thailand 25 17 25 17
Turkey 12 4 12 4
Viet Nam 112 57 15 7 127 64
Total 468 282 233 125 145 42 10 3 4 2 1 1 861 455

Table 3: Case-Fatality of Avian Influenza over Time
Date 2003-2009 2010-14 2015 2016 2017 2018-2019
Case-Fatality Rate (%)

Table 4: Case-Fatality Rates of Avian Influenza by Country
Country Case-Fatality Rate (%) Country Case-Fatality Rate (%)
Azerbaijan Laos
Bangladesh Myanmar
Cambodia Nepal
Canada Nigeria
China Pakistan
Djibouti Thailand
Egypt Turkey
Indonesia Viet Nam

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