- Vital Statistics
· The birth and death data that appear in this report was collected at the county level and cleaned and reallocated by the California Department of Health Services (DHS), Office of Vital Records and Statistics.

· County population data and projections were provided by a California Department of Finance (DOF) 1997 publication for aggregate numbers and by DOF 1996 publications for ethnic-specific proportions. Age proportions for age-adjustment were calculated by applying age-group proportions from the old (1993) DOF population summaries to the newer aggregate numbers. Small area-specific population data were derived from this same source as well as from the 1990 US Census Data files provided by the US Census Bureau.

· Housing stock data and associated population data was derived directly from the 1990 US Census Data files provided by the US Census Bureau.

- Infectious Diseases
· Local incidence data on most infectious diseases was provided by the Automated Vital Statistics System (AVSS) as run by the San Mateo County Disease Control and Prevention Unit (DCPU.). State and national disease incidence figures were taken from CDC-MMWR Summaries of Notifiable Diseases for the various Years 1990 - 1996 and from CD Summaries published by the DHS Division of Communicable Disease Control. The tuberculosis data came from the Tuberculosis Control Branch of DHS. Original case definitions for measles, syphilis and tuberculosis are contained in the Morbidity and Mortality Weekly Report (MMWR), Vol. 39, Number RR-13,Oct. 19, 1990.

· AIDS case data was received from the AIDS Surveillance Section of the DCPU. The original case definition for AIDS is contained in the Morbidity and Mortality Weekly Report (MMWR), Supplement 1S, Vol. 367, Aug. 14^th, 1987. This definition was revised in 1993, and this revised classification system and the accompanying expanded definition for surveillance can be found in the MMWR, Vol. 41, Number RR-17, Dec. 18, 1992.

- Other
· Data on cancer incidence was provided both by the Northern California Cancer Center and by the DHS Cancer Surveillance Section.

· Hospital discharge data for San Mateo County residents was culled from a statewide data for 1992 through 1995 made available by the California Office for Statewide Health Planning and Development (OSHPD).

· Materials on the incidence of obesity and anemia were provided by the Child Health and Development Program (CHDP), which is a part of the San Mateo County Health Services Agency.

· Data on adolescent smoking prevalence was collected via a questionnaire administered in most local schools in the Fall of 1997. This data set was provided to the Tobacco Prevention Program by the County Office of Education.

Data Definitions
· The Kessner Index used to determine adequate rates of prenatal care was calculated using the Institute of Medicine Three-Factor Prenatal Care Index. The index uses gestational age, number of prenatal visits and trimester prenatal care began to determine adequacy of that care. A complete description of this methodology can be found in the following publication:  Institute of Medicine, Contrasts in Health Status - Vol. 1, " Infant Death: An Analysis by Maternal Risk and Health Care." David Kessner

Project Director, published by the National Academy of Sciences, Washington, DC, 1973, p. 58-60.

· Mortality data and hospital discharge data were categorized according to standard diagnostic categories contained in the International Classification of Diseases, Ninth Revision (ICD-9) as follows:

Due to space concerns, some causes of death in the rank charts DTH3-5 were abbreviated. A key for these terms is provided below:

Table 1. Cause of Death Abbreviations for DTH3-5

Table 2. Cause of Death – ICD-9 Codes

Table 4. Ambulatory Care Sensitive Diagnoses – ICD9 Codes*

These are included in a separate table for reference and because slight variations may exist in the ICD-9 cut points used for analysis of ACS diagnoses and those used in the breakout of death data.

Race/Ethnicity Categories

The race/ethnicity divisions used in the report are mutually exclusive and are consistent with those used by the State Census Data Center.

Years of Potential Life Lost (YPLL)

YPLL is a measure intended to highlight causes of death which have a disproportionate effect on younger age brackets and thus result in more overall time (and often more economically productive years) lost in the population. There are a number of varying ways to calculate YPLL, but for the purposes of this report, one of the earliest and simplest is used:

YPLL = 75 – (Age at death in years)

Age-Adjusted Rates

The age adjusted rates that appear in this report were calculated by the direct method, in which a standard age distribution is chosen and the age specific death or incidence rates for the group of interest are weighted according to that standard. The cancer incidence data generated by the Northern California Cancer Center was adjusted using the 1970 US age-distribution standard, while all others adjustments used the 1940 US standard.

CONTRIBUTORS

Francis Wiser, MSPH, is an Epidemiologist with the County of San Mateo Disease Control and Prevention Unit.

Scott Morrow, MD, MPH, MBA, is the Health Officer for the County of San Mateo.

Mark Breda, MPH, is an Epidemiologist with the County of San Mateo Disease Control and Prevention Unit.

ACKNOWLEDGEMENTS

The authors would like to thank the following for their supporting activities, ranging from data collection to analysis and editing, that made the compilation of this report possible:

Bev Thames, Alesia Landeros, Karen Pertschuk, Edith Cabuslay, Alicia Goldstein, Teresita Larcina, Shirley Ventura, Robyn Ziegler, Terry Rooney, John Conley, Margaret Taylor, Tito Dela Cruz, Brian Zamora, Maya Altman, John Volanti, Arthur Morris, Marie McKenzie, Sally Brother, Jerry Mucha, Beth Schulz, Vera Edstrom, Shirley Rudd, Jim Olson, Jerry Millin, Stacy Goldsby, Kathy Heckman, Frank Alvarez, Michael Nachtigall and the staff of the Public Health Laboratory, Mark Constantz, Gail Gannon, Mindy Hollenbeck, Sylvia Moreno, Marina Glumaz, Susan Ohms, Mary Jane Wood, Jonathan Mesinger, as well as Gordon Helms and Vernon Lee of Health Services Information Technology and Rita Leung and Martha Davis of the Northern California Cancer Center.

Cover Design and Photo Manipulation: Bev Thames

Cover Photo: Francis Wiser