California Child and Youth Injury Hot Spots Project by ewghwehws

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									        Do We Have a Trend?



Jennifer Rienks, PhD, MS   Sacramento CA
Linda Remy, PhD, MSW        June 27 2007
Geraldine Oliva, MD, MPH
                                           1
        Why Trend Analysis?
 Allows us to look at rates over the time
  period of 1994-2005 and see if there are
  significant upward or downward trends on
  key indicators (as opposed to the
  inaccurate eyeballing approach)
• Useful for identifying and monitoring trends
  in disparities among racial/ethnic groups
• Allows for comparisons with the statewide
  trends on key indicators for different
  racial/ethnic groups
                                             2
        Why Trend Analysis?

• Useful for identifying whether a
  problem is affecting people across
  groups or disproportionately impacting
  subgroups
• Allows local health jurisdictions to track
  their progress toward reaching Healthy
  People 2010 Goals


                                               3
What do the trend charts and tables
              tell us?
• If there are significant upward or
  downward trends in rates over time in the
  local jurisdiction
• If there are significant upward or
  downward trends in rates over time at the
  state level
• If the local trend and the state trend are
  significantly different
                                               4
  What do the trend charts and tables
                tell us?
• If the local or state trend is curvilinear (as
  opposed to linear). Note: When the state or
  local has a curvilinear trend, we can’t test
  whether the curvilinear trend is significantly
  different from a linear trend
• Were the average rates at the beginning
  time period from 1994-1996 at the local
  level significantly different from the average
  rates at the state level
                                               5
What do the trend charts and tables
              tell us?

• Were the average rates at the end
  of the time period from 2003-2005
  at the local level significantly
  different from the average rates at
  the state level



                                        6
1. No trend, No differences in rates

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          1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
                      California       Local        HP 2010 Goal

                          Trend Regression Results
                            Intercept               Slope
  Level         Date Range Est. Std. Err     Est. Std. Err P-Value Sig?
  State         1994-2005 15.72     0.11     0.00    0.02   0.857 No
  Local         1994-2005 13.47     1.79     0.27    0.28   0.370 No
                Different?                                    0.343 No

  State Avg     1994-1996    15.77    0.11
  Local Avg     vs State     15.34    1.89                    0.821 No
  State Avg     2003-2005    15.82    0.13
  Local Avg     vs State     16.48    1.94                    0.734 No

Neither state nor local had a statistically significant trend, and
Local was not different from state. At period start and period end,
Local rate was not significantly different from State rate. Both          7
State and local rates did not meet the HP2010 goal.
2. No trend, Local below State at period start and end

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             1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
                        California        Local        HP 2010 Goal

                               Trend Regression Results
                                    Intercept              Slope
 Level            Date Range        Est. Std. Err    Est. Std. Err   P-Value Sig?
 State            1994-2005        15.72     0.11    0.00    0.02     0.857 No
 Local            1994-2005        13.54     0.56   -0.15    0.09     0.142 No
                  Different?                                          0.126 No

 State Avg        1994-1996       15.77     0.11
 Local Avg        vs State        13.61     0.87                      0.014 Yes
 State Avg        2003-2005       15.82     0.13
 Local Avg        vs State        11.95     1.00                      0.000 Yes

Neither Local nor State had statistically significant trends. Local trend
not significantly different from State trend. At period start and period
end, Local rate was lower than State rate. Both State and local rates               8
did not meet the HP2010 goal.
3. No trend, Local same as State at start, above at end

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        1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
                   California       Local        HP 2010 Goal

                          Trend Regression Results
                               Intercept             Slope
Level        Date Range        Est. Std. Err   Est. Std. Err   P-Value Sig?
State        1994-2005         9.94     0.12   0.02    0.02     0.231 No
Local        1994-2005        10.49     0.37   0.08    0.06     0.185 No
             Different?                                         0.337 No

State Avg    1994-1996       10.04     0.07
Local Avg    vs State        10.56     0.48                     0.280 No
State Avg    2003-2005       10.27     0.07
Local Avg    vs State        11.27     0.47                     0.034 Yes

Neither Local nor State had statistically significant trends. Local
trend not significantly different from State trend. At period start,
Local rate was not significantly different from State rate. At period
end, local rate was significantly higher than State rate. Both State          9
and local rates did not meet the HP2010 goal.
4. Local trend, local trend different, local rates different

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             1994      1996      1998    2000      2002     2004
           1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
                      California        Local         HP 2010 Goal
                     California        Local          HP 2010 Goal
                          Trend Regression Results
                            Intercept           Slope
   Level        Date Range Est. Std. Err Est. Std. Err P-Value Sig?
   State        1994-2005 9.94      0.12 0.02    0.02 0.231 No
   Local        1994-2005 19.03     0.90 -0.53   0.13 0.003 Yes
                Different?                                      0.000 Yes

   State Avg    1994-1996     10.04     0.07
   Local Avg    vs State      19.35     1.10                    0.000 Yes
   State Avg    2003-2005     10.27     0.07
   Local Avg    vs State      14.12     1.05                    0.000 Yes

State trend was flat while Local had a statistically significant
downward trend. Local trend significantly different from state trend.
At period start and period end, Local rate was significantly higher         10
than State rate. Both State and Local rates did not meet the
HP2010 goal but Local trend moving toward the goal.
5. Upward trend, Local lower start and end
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      1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

                   California           Local         HP 2010 Goal

                        Trend Regression Results
                                  Intercept             Slope
  Level       Date Range         Est. Std. Err   Est. Std. Err P-Value Sig?
  State        1994-2002         9.00     0.04   0.08    0.01   0.000 Yes
               2002-2005         7.39     0.49   0.28    0.05   0.001 Yes
  Local        1994-2005         8.14     0.08   0.13    0.01   0.000 Yes

  State Avg    1994-1996         9.06    0.04
  Local Avg    vs State          8.28    0.08                   0.000 Yes
  State Avg    2003-2005        10.18    0.04
  Local Avg    vs State          9.53    0.09                   0.000 Yes

Both Local and State had statistically significant upward trends.
Trends cannot be compared because State trend was curvilinear.
At period start and end, Local rate significantly less than State             11
rate. State and local trends are moving away from the HP2010
Goal.
6. Upward trend, Local lower start, same at end

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          1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
           1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
                     California       Local         HP 2010 Goal
                       California        Local        HP 2010 Goal
                         Trend Regression Results
                               Intercept               Slope
  Level        Date Range     Est. Std. Err   Est.   Std. Err P-Value Sig?
  State        1994-2002      9.00     0.04   0.08      0.01   0.000 Yes
               2002-2005      7.39     0.49   0.28      0.05   0.001 Yes
  Local        1994-2005      8.17     0.18   0.19      0.03   0.000 Yes

  State Avg    1994-1996      9.06    0.04
  Local Avg    vs State       8.43    0.14                     0.000 Yes
  State Avg    2003-2005     10.18    0.04
  Local Avg    vs State      10.24    0.17                     0.760 No


Both Local and State had statistically significant upward trends.
Trends cannot be compared because State trend was curvilinear.
At period start, Local rate significantly less than State rate. At
period end, Local rate was not significantly different from State
rate. State and local trends are moving away from the HP2010
Goal.
                                                                             12
7. Upward trend, Local lower start, same at end
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        1994    1995   1996   1997   1998   1999     2000   2001     2002   2003   2004   2005
                              California        Local               HP 2010 Goal

                              Trend Regression Results
                                 Intercept                            Slope
Level          Date Range        Est.     Std. Err           Est.      Std. Err    P-Value       Sig?
State          1994-2002        10.31        0.06            0.03         0.01      0.060        No
               2002-2005         8.75        0.64            0.22         0.06      0.010        Yes
Local          1994-2005        10.36        0.15           -0.08         0.02      0.006        Yes

State Avg      1994-1996       10.30         0.02
Local Avg      vs State        10.14         0.12                                   0.192        No
State Avg      2003-2005       11.00         0.03
Local Avg      vs State         9.42         0.12                                   0.000        Yes

State had statistically significant upward trends. Local had
statistically significant downward trend. Trends cannot be
compared because State trend was curvilinear. At period start,
Local rate was not significantly different from State rate. At period
end, Local rate was significantly lower than State rate. Both State
and Local rates did not meet the HP2010 goal but Local trend                                            13
moving toward the goal.
8. No trend, Local rate higher than state, then same

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          1994       1996      1998       2000    2002   2004
          1994     1996      1998      2000   2002  2004
                   California
                  California              Local HP 2010HP 2010
                                      Local             Goal     Goal

                            Trend Regression Results
                             Intercept           Slope
  Level          Date Range Est. Std. Err Est. Std. Err P-Value Sig?
  State          1994-2005 15.72     0.11 0.00    0.02 0.857 No
  Local          1994-2005 16.67     0.29 -0.06   0.04 0.201 No
                 Different?                                0.226        No

  State Avg      1994-1996    15.77      0.11
  Local Avg      vs State     16.66      0.34              0.012 Yes
  State Avg      2003-2005    15.82      0.13
  Local Avg      vs State     16.30      0.34              0.184        No

Neither state nor local had a statistically significant trend, and
Local was not different from state. At period start, Local rate was
significantly higher than State rate. At period end, Local rate was
not significantly different from State rate. Both State and local
rates did not meet the HP2010 goal.                                          14
9. Local trend downward, Local higher at start and end

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             1994      1996      1998    2000      2002     2004
           1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
                      California        Local         HP 2010 Goal
                     California        Local          HP 2010 Goal
                          Trend Regression Results
                            Intercept           Slope
   Level        Date Range Est. Std. Err Est. Std. Err P-Value Sig?
   State        1994-2005 9.94      0.12 0.02    0.02 0.231 No
   Local        1994-2005 19.03     0.90 -0.53   0.13 0.003 Yes
                Different?                                      0.000 Yes

   State Avg    1994-1996     10.04     0.07
   Local Avg    vs State      19.35     1.10                    0.000 Yes
   State Avg    2003-2005     10.27     0.07
   Local Avg    vs State      14.12     1.05                    0.000 Yes

State trend was flat while Local had a statistically significant
downward trend. Local trend significantly different from state trend.
At period start and period end, Local rate was significantly higher
than State rate. Both State and Local rates did not meet the                15
HP2010 goal but Local trend moving toward the goal.
10. No trend, Different from State, Local higher then same

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        1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

                    Ca lifornia           Loc a l      HP 2 0 10 G oa l


                          Trend Regression Results
                                   Intercept                Slope
Level        Date Range             Est. Std. Err     Est. Std. Err P-Value Sig?
State        1994-2005             9.94     0.12     0.02     0.02    0.231 No
Local        1994-2005            11.62     0.44    -0.12     0.06    0.094 No
             Different?                                                   0.033 Yes

State Avg    1994-1996            10.04     0.07
Local Avg    vs State             11.52     0.33                          0.000 Yes
State Avg    2003-2005            10.27     0.07
Local Avg    vs State             10.63     0.28                          0.204 No

 Both State and Local trends were statistically non-significant but
 moving in different directions. As a result, Local trend is
 significantly different from State trend. At period start, Local rate
 was higher than State rate. At period end, Local rate was same as
 State rate. Local and state rates did not meet HP2010 Goal.                          16
Exercise Time!




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                                   African-American
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        1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

                    Ca lifornia            Loc a l       HP 2 0 10 G oa l



                          Trend Regression Results
                                   Intercept                 Slope
Level        Date Range             Est. Std. Err      Est. Std. Err P-Value Sig?
State        1994-2005            15.72     0.11      0.00     0.02    0.857 No
Local        1994-2005            13.75     0.44      0.09     0.07    0.203 No
             Different?                                                     0.173 No

State Avg    1994-1996            15.77     0.11
Local Avg    vs State             13.93     0.42                            0.000 Yes
State Avg    2003-2005            15.82     0.13
Local Avg    vs State             15.22     0.44                            0.183 No

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                                          White
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        1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

                    Ca lifornia            Loc a l      HP 2 0 10 G oa l


                         Trend Regression Results
                                   Intercept                  Slope
Level        Date Range             Est. Std. Err     Est.   Std. Err P-Value Sig?
State        1994-2002             9.00     0.04     0.08       0.01    0.000 Yes
             2002-2005             7.39     0.49     0.28       0.05    0.001 Yes
Local        1994-2005             8.29     0.21     0.11       0.03    0.006 Yes

State Avg    1994-1996             9.06      0.04
Local Avg    vs State              8.32      0.16                          0.000 Yes
State Avg    2003-2005            10.18      0.04
Local Avg    vs State              9.39      0.18                          0.000 Yes
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                                          White
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        1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

                    Ca lifornia            Loc a l       HP 2 0 10 G oa l


                         Trend Regression Results
                                   Intercept                   Slope
Level        Date Range             Est. Std. Err      Est.   Std. Err P-Value Sig?
State        1994-2002             9.00     0.04      0.08       0.01    0.000 Yes
             2002-2005             7.39     0.49      0.28       0.05    0.001 Yes
Local        1994-2000             8.25     0.09      0.16       0.03    0.006 Yes
             2000-2003             9.65     1.39     -0.08       0.19    0.703 No
             2003-2005             4.70      1.98    0.47       0.19        0.065 No

State Avg    1994-1996             9.06      0.04
Local Avg    vs State              8.35      0.13                           0.000 Yes
State Avg    2003-2005            10.18      0.04                                       20
Local Avg    vs State              9.43      0.14                           0.000 Yes

								
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