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Glossary

This list includes definitions of technical and non-technical terms commonly used in publications and reports of the North Carolina State Center for Health Statistics. Formulas are listed with their respective definitions. Understanding data provides information on computing and interpreting data.

Definitions

 

A

Abortion

The premature termination of a pregnancy, resulting in or caused by death of the fetus or embryo. Two types are considered in the context of public health reporting:

  1. Induced Abortion: The purposeful interruption of pregnancy with the intention other than to produce a liveborn infant or to remove a dead fetus and which does not result in a live birth. Liberalization of N.C.'s abortion laws began in 1967, but it was not until 1973 that abortion became available on demand, with the condition it be performed by a licensed physician in a hospital or licensed abortion clinic. Abortion data by mother's county of residence became available in 1978.
  2. Spontaneous Abortion: An interruption of pregnancy for some reason other than human choice, i.e., a miscarriage or stillbirth. Spontaneous abortions less than 20 weeks gestation are not reportable in North Carolina. Stillbirths of 20+ weeks gestation are reported as fetal deaths.

Abortion Fraction

The number of induced abortions per 1,000 reported pregnancies (live births + fetal deaths of 20+ weeks of gestation + induced abortions).
Formula:
Abortion Fraction Formula

Abortion Rate

The number of induced abortions per 1,000 women of reproductive age (15 to 44). Numerator and denominator may also be specific for ages within the 15 to 44 range, i.e., 15 to 19, 20 to 24, etc.
Formula:
Abortion Rate Formula

Adjusted Rate

A type of rate used specifically to make comparisons. An adjusted rate is calculated by a weighting procedure whereby populations are made comparable in their demographic characteristics. The adjustment can be made for race, sex, age, or any combination of these or other demographic factors. An adjusted rate can be compared only with another adjusted rate that is calculated in terms of precisely the same variables (and their categories) and precisely the same standard population. The method of direct adjustment is illustrated under Rate. Users should note: in the SCHS publication, North Carolina Vital Statistics, Volume 2: Leading Causes of Death, the 1996 and subsequent editions use the 1990 North Carolina population as the standard and rates are adjusted for age only. Earlier editions used a different standard and rates were adjusted for age, race and sex. Therefore, the adjusted rates in pre-1996 editions are not comparable to those published in 1996 and subsequent editions. Refer to the SCHS publication Age-Adjusted Death Rates.

Age-adjusted Cancer Incidence Rate

The age-adjusted cancer incidence rate is computed by the direct method. Also expressed as incidence per 100,000 population, these rates are those that would be expected if the age composition of each county's population were the same as that in a standard population (such as the state in 1990). These rates are not affected by age. However, the user should not compare an adjusted incidence rate to an unadjusted incidence rate. Also, adjusted rates for different time periods cannot be directly compared unless they were adjusted by the same standard population. More details and an example are in Technical Notes.

Age-adjusted Death Rate

The age-adjusted death rate is computed by the direct method. Also expressed as deaths per 100,000 population, these rates are those that would be expected if the age composition of each county's population were the same as that in a standard population (such as the state in 1990). These rates are not affected by age. However, the user should not compare an adjusted death rate to an unadjusted death rate. Also, adjusted rates for different time periods cannot be directly compared unless they were adjusted by the same standard population. More details and an example are in Technical Notes.

Age at Death

Reported age in completed years as of the last birthday. Errors in reporting are believed to include underestimates for ages 22 through middle age and overestimates for persons nearing their 21st and 65th birthdays and for those over age 65. Preferences for ages ending in certain digits (e.g., age ending in 0 and 5) may also result in uneven concentrations of reported ages.

Age of Mother

The mother's reported age in completed years on her last birthday.

Age-specific Death Rate

Formula:
Age Specific Death Rate Formula

Apgar Score

A system for rating the physical condition of newborns. The score varies from 0 to 10 and is a summation of individual scores ranging from 0 to 2, assigned to each of five items: heart rate, respiratory effect, muscle tone, reflex irritability and color. Apgar scores of 0 to 2 represent severe asphyxia; 3 to 6, mild to moderate asphyxia; 7 to 10, no or rare asphyxia. See SCHS STUDY No. 23, Predicting Infant Mortality: An Evaluation of Apgar Scores. To request this publication, contact SCHS.

Associated Causes of Death

Conditions listed on a death certificate that contributed to or otherwise were related to the death but were not the underlying cause of death.

Attendant

A physician (M.D. or D.O.) in a hospital, a physician not in a hospital, a certified nurse-midwife (CNM), or other attendant at birth or death. Legislation during 1983 (H.B. 814) regulates the practices of CNMs; these practitioners must have certification by the American College of Nurse-Midwives.

Commonly used rates used for this measure are expressed as follows:
Attendant Formula

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B

Births Out of Wedlock

Birth to a woman who has never been legally married or has been widowed or legally divorced for more than 280 days.

The percentage used for this measure is expressed as follows:
Birth Out Of Wedlock Formula 

Birth Order

The sum of all previous deliveries (live births + other reported terminations, i.e., spontaneous and induced at any time after conception) + the present live birth.

Birth Rate

Number of live births per 1,000 population. (Also see Fertility Rate.)
Formula:
Birth Rate Formula

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C

C-Section

Indicates that the method of delivery was either a primary or a repeat C-section.

The rate used for this measure is expressed as follows:
C-Section Formula 

Cause of Death

All those diseases, morbid conditions, or injuries that either resulted in or contributed to death. In the case of injuries, cause of death also encompasses the circumstances of the accident or violence. Unless otherwise specified, deaths are tabulated by underlying cause of death.

Cause-specific Death Rate

In general, a death rate due to a particular cause of death. See definitions under Rate.

Chronic Disease

A disease marked by long duration or frequent recurrence. Examples are diabetes, cancer, hypertension, heart disease, stroke, glaucoma, certain kidney and lung diseases.

Community Assessment

The process of collecting and analyzing data from various sources to provide information about the strengths and needs of the people and services within a community. Assessments generally serve two functions: they provide useful information for program planning and policy decisions and can serve as a baseline against which to evaluate the success of interventions.

Comparability Ratios

Comparability ratios statistically quantify differences between successive revisions of the ICD. Each comparability ratio corresponds to a particular cause of death and tells how similar or dissimilar the classifications are for a particular cause of death in the two revisions being compared.

Conceptions

The total number of times a woman has become pregnant, irrespective of the pregnancy outcome.

Congenital Anomaly

Any abnormal condition present at birth, not including injuries caused by the delivery. These are ICD-9 codes 740 to 759.

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D

Death

The permanent disappearance of any evidence of life at any time after live birth. Also, North Carolina law (G.S. 90-322) defines criteria for certifying "brain death."

Death Rate

Number of deaths per 1,000 population. This figure is also frequently presented per 10,000 or per 100,000 population.

Unadjusted Rate Formula:
Death Rate Formula

Dilation and Evacuation (D&E)

Used most frequently in the second trimester, this abortion procedure involves opening the cervix (dilation) and using primarily sharp instrument techniques, but also suction and other instrumentation such as forceps, for evacuation.

Divorces and Annulments

Legal dissolution of a legal marriage between a male and a female. By law (G.S. 130-48) the plaintiff must be a N.C. resident. The dissolution can occur only by decree of an authorized court. An annulment voids a marriage from the beginning.

The rate used for this measure is expressed as follows:
Divorce Rate Formula

DRG: Diagnosis-related Group

Diagnostic categories commonly used to classify diagnoses and procedures into groups in order to study inpatient hospital use.

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E

Education

The number of years of schooling completed. The 2003 revised Vital Certificates now classifies education by degree(s) or diploma(s) received.

Education of Mother

Years of schooling completed by the mother at time of the birth. The 2003 revised Vital Certificates now classifies education by degree(s) or diploma(s) received.

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F

Facility Utilization Rate

The rate according to which residents of a particular area use institutions of a particular kind.

General Computing Formula:
Facility Utilization Rate Formula

Fertility Rate

The number of live births per 1,000 women of reproductive age (15 to 44). Numerators and denominators may also be specific for ages within the 15 to 44 range, i.e., 15 to 19, 20 to 24.

Formula:
Fertility Rate Formula

Fetal Death

Death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the gestation of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Consistent with North Carolina law, SCHS publications include only fetal deaths that do not qualify as therapeutic abortions and that result from pregnancies of 20 or more weeks gestation.

Fetal Death Rate

The number of fetal deaths per 1,000 live births + fetal deaths.

Formula:
Fetal Death Rate Formula

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G

Geriatric Death Rate

Death rate per 1,000 population aged 65 and older.

Formula:
Geriatric Death Rate Formula

Gestation

Weeks of pregnancy as computed from the first day of the last menstrual period to the date of delivery.

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H

Home Health Agency

A public or private agency that provides skilled nursing care or at least one other therapeutic service on an intermittent or part-time basis.

Hospice Care

A coordinated program of home care that provides for inpatient care for terminally ill patients and their families.

Hospital

An institution providing medical, surgical, obstetric, or nursing care; and which maintains and operates facilities for the diagnosis, treatment, or care of two or more non-related individuals suffering from illness, injury, or deformity; or where obstetrical or other medical or nursing care is provided for more than 24 hours.

Hospital Length of Stay

The number of days from admission to discharge of a hospital inpatient. The average length of stay is often used as a measure of hospital use, and is arrived at by dividing the total number of days stayed by all patients during a year by the number of patients.

Household

One or more persons who occupy a group of rooms or a single room that constitutes a housing unit. A HOUSING UNIT is defined as "separate living quarter," that is, occupants do not live and eat with any other persons in the structure.

Hysterectomy/Hysterotomy

Hysterectomy is a procedure that removes the uterus either with the fetus inside or after the fetus has been removed. It is usually performed only when a pathological condition of the uterus, such as fibroid tumor, warrants removal or when a woman desires sterilization. Hysterotomy involves surgical entry into the uterus, as in a C-section, and removes a fetus too small to survive even with extraordinary life support measures.

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I

ICD: International Classification of Diseases

A numerical system used worldwide for classifying causes of death from information collected on death certificates.

ICD-CM: International Classification of Diseases, Clinical Modification

A numerical system used to code and classify diagnoses and reasons for visits from inpatient (hospitalization) and outpatient records, physician visits and other health care settings.

Immunization-preventable Morbidity and Deaths

Occurrences of, and deaths from, selected diseases where immunization is available, e.g., diphtheria and pertussis.

Incidence of Disease

Number of new occurrences of a disease within a particular time period.

Induced Abortion

The purposeful interruption of pregnancy with the intention other than to produce a liveborn infant or to remove a dead fetus and which does not result in a live birth. Liberalization of N.C.'s abortion laws began in 1967, but it was not until 1973 that abortion became available on demand, with the condition it be performed by a licensed physician in a hospital or licensed abortion clinic. Abortion data by mother's county of residence became available in 1978.

Infant Death

Death of a liveborn child under one year of age. Infant deaths are the sum of neonatal and postneonatal deaths.

Infant Death Rate

Number of infant deaths per 1,000 live births.

Formula:
Infant Death Rate Formula

Intra-uterine Instillation

This abortion procedure involves either withdrawing a portion of amniotic fluid from the uterine cavity by a needle inserted through the abdominal wall and replacing this fluid with a concentrated salt solution (known as saline instillation, saline abortion, or saline amniotic fluid exchange) or injecting a prostaglandin - a substance with hormone-like activity - into the uterine cavity through a needle inserted through the abdominal wall (known as intra-uterine prostaglandin instillation). The saline instillation process induces labor, which results in the expulsion of the usually dead fetus approximately 24 to 48 hours later. The interval between prostaglandin injection and expulsion tends to be shorter than in a saline abortion.

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J

K

L

Leading Causes of Death

The most frequently occurring underlying causes of death. SCHS publications use categories that follow the conventions of the National Center for Health Statistics.

Live Birth (WHO Definition, 1950)

The complete expulsion or extraction from its mother of a product of conception, irrespective of the gestation of pregnancy, which, after separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or any definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.

Living Children

The number of children still living at the time of this birth.

Low Birthweight

Liveborn infants who weigh less than 2,500 grams (5 pounds, 8 ounces or less) at birth, regardless of the gestation period.

Formula for Low Birthweight Percentage:
Low Birth Weight Formula

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M

Marital Status

The categories "married" and "not married" are usually used.

Marriage

The legal union of a male and a female (North Carolina G.S. 51-1).

Formula for Marriage Rate:
Marriage Rate Formula

Married

Includes women who are legally married and those who are separated but not legally divorced. In the case of live births and fetal deaths, the term also includes mothers who have been legally divorced 280 or fewer days.

Maternal

Of or pertaining to the mother.

Maternal Death (ICD definition)

The death of a woman while pregnant or within 42 days of pregnancy, irrespective of the gestation and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Maternal Death Rate

Number of maternal deaths per 100,000 live births.

Formula:
Maternal Death Rate Formula

Maternal Risk Factors

Maternal characteristics that are related to high fetal and infant death rates. For example,

  • Age: Under 18 or 35 or older
  • Education: Less than a high school diploma
  • Marital status: Unmarried
  • Birth order: 4 or more children
  • Pregnancy history: Fetal and/or Infant Death

MDC: Major Diagnostic Category

One of 25 principal diagnosis categories commonly used in studying inpatient hospital use and other health care utilization data.

Medicaid

A public assistance program that pays for the medical care of people who are eligible for cash assistance payments or who have medical needs greater than their resources. The five categories of eligibility are Temporary Assistance to Needy Families (formerly called Aid to Families with Dependent Children), Aid to the Aged (persons 65 and older), Aid to the Disabled, Aid to the Blind and children who are in foster care or adoptive homes under Title IV-E. The federal government pays the largest share of Medicaid costs.

Medicare

An insurance program authorized under Title XVIII of the Social Security Act and funded from federal trust funds to provide basic protection from hospital costs (Part A) and to allow purchase of supplemental coverage for non-institutional services by the individual through premium payments (Part B). Individuals must pay deductibles and coinsurance. Coverage is available: for persons 65 and over who are receiving either Title II (basic Social Security) or railroad retirement benefits; for persons who have received Title II or railroad disability benefits for at least two years; and for persons who are medically determined to have end-stage renal disease.

Medical (Non-surgical) Abortion

This non-surgical procedure involves the administration of a medication(s) to induce an abortion. Medications (e.g., methotrexate, mifepristone/RU 486, misoprostol) are used most frequently early in the first trimester of pregnancy. However, some medications (e.g., prostaglandin suppositories, injectable prostaglandins) may also be administered during the second trimester of pregnancy to induce abortion. Medications may be administered orally, by injection, or intravaginally.

Mother Smoked

Percentage of live births to mothers who used tobacco during pregnancy.

The percentage used for this measure is calculated as follows:
Mother Smoked Formula 

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N

Natural Increase Rate

The excess of births over deaths among residents of an area.

Formula:
Natural Increase Rate Formula

Neonatal Death

Death of an infant under 28 days of age.

Neonatal Death Rate

Number of neonatal deaths per 1,000 live births.

Formula:
Neonatal Death Rate Formula

Non-geriatric Death Rate

Death rate per 1,000 persons ages 1 year through 64 years.

Formula:
Non-Geriatric Death Rate Formula

Non-resident Physician

A medical doctor who is not currently in a hospital residency program.

Not Married

A category of persons who are widowed, divorced, or have never legally married. In the case of live births and fetal deaths, the first two groups are specifically restricted to mothers who have been widowed or legally divorced for more than 280 days.

Nursing Care Bed

A bed in a nursing home occupied by a patient receiving skilled or intermediate nursing care. Patients receiving only custodial care do not occupy nursing care beds. Nursing care beds exist also in hospitals that offer extended services.

Nursing Home

A facility licensed to offer nursing care to infirm or aged patients. In North Carolina, nursing homes are licensed to operate in any of three ways:

  1. As a Skilled Nursing Facility that offers only skilled nursing care
  2. As an Intermediate Care Facility that offers only intermediate nursing care or
  3. As a Combination Home that offers skilled and intermediate levels of care

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O

Occupancy Rate

The percentage of the bed capacity (of a hospital or nursing home) that is occupied on the average.

Formula:
Occupancy Rate Formula

Occurrence

The facility, county, region, or state where the event occurred, irrespective of the place of residence. For example, in the tables in N.C. Vital Statistics, Volume 1, item 9 (births) and 18 (deaths) provide occurrence data. All marriage and divorce counts are by place of occurrence.

Formula for Occurrence Rate:
Occurrence Formula

Occurrence Birth Formula

Percentage of N.C. live births occurring in area.

The percentage used for this measure is expressed as follows:
Occurrence Births Formula 

Occurrence Death Formula

Percentage of N.C deaths occurring in an area.

The percentage is expressed as follows:
Occurrence Deaths Formula 

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P

Perinatal Deaths

The sum of registered fetal deaths and neonatal deaths.

Perinatal Death Rate

Fetal and neonatal deaths per 1,000 live births and fetal deaths.

Formula:
Perinatal Deaths Formula

Place of Death

The hospital, other institution, or non-institution place of death.

Formulas:

Percentage of deaths occurring in hospitals Formula for Percentage of Hospital Deaths
Percentage of deaths occurring in non-hospital institutions Formula for non-hospital institutions death rate
Percentage of deaths occurring in home or non-institutions Formula for percentage of home deaths

Population

The estimated population of an area as of July 1 of the event year.

Formula:

Percentage of N.C. population residing in area Population Formula

Postneonatal Death

Death of an infant aged 28 days and over but less than 1 year of age.

Postneonatal Death Rate

Number of postneonatal deaths per 1,000 live births - neonatal deaths.

Formula:
Postneonatal Death Rate Formula

Poverty Level

Poverty statistics are based on a set of money income thresholds that vary by family size and makeup. Families or persons with income below their appropriate thresholds are classified as below poverty level. The U.S. Census Bureau defines and revises poverty levels annually.

Pregnancies (reported)

The total number of live births + fetal deaths of 20 or more weeks gestation + induced abortions.

Pregnancy Rate

The number of pregnancies per 1,000 women of reproductive age (15 to 44). Numerators and denominators may be specific for ages within the 15 to 44 range, e.g., 15 to 19 or 20 to 24.

Formula:
Pregnancy Rate Formula

Prenatal

Occurring, existing, or taking place before birth.

Preterm Birth

The live birth of an infant born at less than 37 weeks gestation.

Prevalence of Disease

Number of people having a disease at a particular point in time.

Previous Abortions

The number of previous induced abortions the abortee has had. The current procedure is not included.

Previous Live Born Now Dead

The number of liveborn children who died prior to the present delivery.

Primary Care Physician

As currently used in SCHS publications, the term refers to a federal or non-federal practitioner who:

  • Is licensed or registered with the Board of Medical Examiners
  • Holds the Doctor of Medicine or Doctor of Osteopathy degree and
  • Practices in one of the following categories:
    • Pediatrics
    • Family Practice
    • General Practice
    • Internal Medicine
    • Obstetrics/Gynecology

Physicians who are not primary care physicians would include surgeons and emergency room practitioners. Physician assistants and nurse practitioners may each be counted as .66 of a physician and added to primary care physicians as referred to in the SCHS publication N.C. Pocket Guide.

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Q

R

Race

In most data collected by the SCHS, race and ethnicity are collected as two separate dimensions. The major racial categories are white, African American, American Indian and Asian. Ethnicity is defined as Hispanic and non-Hispanic. Thus, persons of Hispanic ethnicity may be of any race. In the past, SCHS typically published statistics for "minorities" compared with “white” racial groups. Currently, we publish more specific race and ethnicity data, where feasible, such as non-Hispanic whites, non-Hispanic African Americans and Hispanics.

Users should note a change race reporting in live birth or fetal death data. For 1989 and prior years, race of child was based on race of mother and race of father (when known). Due to an increasing number of records missing father’s race, beginning in 1990, race of the child is taken to be that of the mother regardless of race of father. Users should be aware of this change when assessing trends before and after 1990.

Rate

A rate is a number computed as (A/B) x C. A percent is also a rate, expressed per 100. Every rate is measured for a definite time period, usually a calendar year or a five-year period.

  1. the numerator: the number of events of interest observed in a population during a given time period. Events in A usually are a part of the denominator B.
  2. the denominator: the size of the population at risk.
  3. the quantity: is the unit of measure by which the rate is expressed, e.g., the number of deaths per 1,000 population.

Crude (Unadjusted) Rate, such as the birth rate for all of North Carolina
Crude Rate Formula

Specific Rate The class could be categories of age, race, sex, education, or related combinations.
Specific Rate Formula

Residence

The place (county, state, region) where a person lives at the time of an event. College students and military personnel are considered residents of the college or military community. For deaths of inmates of long-term institutions, the institution is considered the residence if the decedent has lived there at least one year. For births, residence is that of the mother, regardless of the place of occurrence.

Resident Events and Rates

Unless otherwise specified, all SCHS publications provide resident data. Examples are in the main tables in the SCHS publication N.C. Vital Statistics, Volume 1. Items 9 and 18 provide data on the occurrence of births and deaths respectively, while items 19 and 20 provide marriage and divorce data by place of occurrence.

Formula for Resident Rate:
Resident Formula

Retained Products

Fetal tissue that may remain in the uterus after an abortion.

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S

Sentinel Health Event

An event (a case or a death) that has the following characteristics:

  1. A single occurrence would justify asking "Why did it happen?"
  2. A high rate of the event is not the issue; the occurrence of a single event is of importance no matter what the rate.
  3. The event is of such a nature that the local health director would have the responsibility for devising intervention strategies or, acting as the county health officer, would have responsibility for making the board of health, county commissioners, or other agencies aware of these events.
  4. The event is such that the health department or some other local agency could develop a reasonable intervention strategy to combat future occurrences.

Sharp Curettage

An abortion procedure that involves the dilation of the cervix as in suction, although usually to a larger diameter. The fetal and placental tissues are then scraped out with a curette, a tool resembling a small spoon.

Spontaneous Abortion

An interruption of pregnancy for some reason other than human choice, i.e., a miscarriage or stillbirth. Spontaneous abortions less than 20 weeks gestation are not reportable in North Carolina. Stillbirths of 20+ weeks gestation are reported as fetal deaths.

Suction Curettage

In this abortion procedure the cervical canal is dilated by the successive insertion of instruments of increasing diameter. When the opening is large enough, a flexible tube is inserted into the uterine cavity and the fetal and placental tissues are then suctioned out by an electric vacuum pump.

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T

TANF: Temporary Assistance to Needy Families

A joint federal/state/local money-payment program for families with documented need. This program is administered through the N.C. Division of Social Services and local departments of social services. Effective in 1999, the AFDC: Aid to Families with Dependent Children program became Temporary Assistance to Needy Families (TANF). This program is also referred to as "Work First."

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U

Unemployment Rate

The number of unemployed persons who are able, available and looking for work as a percentage of the civilian labor force.

Underlying Cause of Death

The disease or injury that initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence that produced the fatal injury.

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V

Very Low Birthweight

Liveborn infants who weigh less than 1,500 grams (3 pounds, 4 ounces or less) at birth, regardless of the gestation period.

Violent Deaths

Number of deaths due to:

  1. Homicide
  2. Suicide
  3. Legal interventions

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W

X

Y

Years of Life Lost/Years of Potential Life Lost

The numerical difference between a predetermined end point age (e.g. age 65 or age 75) and the age at death for a death or deaths that occurred prior to that end point age. The (potential) years of life lost (YLL) for each death (usually to residents of a geographic area for a specific time period) are summed to represent the total years of (potential) life lost for that area.

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Z

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