Dekalb Status of Health 20005

2005
Status of Health in DeKalb Report

opportunities for prevention and community service
Presented by the Status of Health in DeKalb Committee and the DeKalb County Board of Health
2005
Status of Health in DeKalb Report

opportunities for prevention and community service
For updates on the Status of Health in DeKalb Report, visit

DeKalb County Board of Health online at www.dekalbhealth.net
Acknowledgements
The DeKalb County Board of Health and the Status of Health in DeKalb Committee would
like to thank the following individuals for their time and expertise in the creation of this
report:
Data analysis and report development by the Division of Health Assessment and
Promotion and the Center for Public Health Preparedness:
Chris Crane
Sara Forsting, M.S.P.H.
Charlie Ishikawa, M.S.P.H.
Mary Patrick, M.P.H.
Van Tong, M.P.H.
Design and production by the Office of Public Relations:
James Carver
Vickie Elisa
Beth Ruddiman, M.S.
Julie Smith
Contributors and expert reviewers:
Elise M. Beltrami, M.D., M.P.H. Edna Holloway, M.Ed.

Jyotsna M. Blackwell, M.P.H. Marlon Hunter, M.A.
Robert Blake, M.P.H. Mohamed Koita
Stuart Brown, M.D. Alawode Oladele, M.D., M.P.H.
Janice Buchanon, M.A. Ariane Reeves, R.N.
Ryan Cira, M.P.H. Mehrdad Sabzehi
Kathleen Collomb Marie Jose Schwartz, R.N., M.P.H.
Susan Cookson, M.D., M.P.H. Robin Tanner
Frank Coye , M.A. Robert Taylor, M.Ed.
Teresa Daub Ann Ussery-Hall, M.P.H.
William Dyal Scott Wetterhall, M.D., M.P.H.
Christena Hancock Sharon Wilson, M.S.P.H.
Christopher Holliday, M.P.H.
The DeKalb County Board of Health and the Status of Health in DeKalb Committee also
thank the Healthy DeKalb Steering Council and the North DeKalb Health Center Advisory
Board for reviewing the report. We offer special recognition to the following community
members for their constructive feedback:
Fred Agel Melissa Manrow

Kathy Brooks Nynikka Palmer
Carolyn Galvin Alice Smith
Arlene Parker Goldson Paula Swartzberg
Victor Lui, M.D. Tingsen Xu, M.D.
The DeKalb County Board of Health
Crawford Lewis, Ph.D. Leonard Thrower Vernon Jones Darold Honore

/
County school Consumer representing Chief executive officer Chief executive officer
superintendent; ex the needy, of DeKalb County; ex of any municipality in
officio underprivileged or officio county appointed by
elderly county governing
authority; mayor of
Lithonia
J. Frederick Agel Anthony George, Jr. Victor Lui, M.D.
Consumer appointed by Public health consumer Physician appointed by

county governing appointed by governing county governing
authority; chair authority of largest authority
municipality; appointed
by the mayor of Atlanta;
vice chair
"Here for Your Health"

At the DeKalb County Board of Health, we envision safe,
healthy communities in which all individuals have access to
quality, affordable health services.
Our mission is to promote and provide quality preventive

and primary care. The prevention of disease, injury, disability
and premature death is the primary purpose of the DeKalb
County Board of Health. We unite individuals, families and
Stuart Brown, M.D.
communities to serve the people who live, work and play Interim Director
in DeKalb. DeKalb County Board of Health
In Memory of Two Staunch Public Health Supporters
Manuel Maloof
1924 - 2004
Member of the DeKalb County Board of Health

from 1981 to 1992, both as a County Commissioner
and as the County Chief Executive Officer
Mr. Maloof tackled tough issues in human services by

appointing task forces to study day care, affordable
housing and the problems of youth and the elderly. His
personal concern over teenage pregnancy led to the
creation of the Task Force on Teenage Pregnancy,
staffed by a full-time coordinator.
It would be difficult to find an elected official with more

compassion and understanding of health care for needy populations. Mr. Maloof
was unyielding in his advocacy and used his official position to provide support for
important health initiatives. He was a man with very strong convictions and a soft
and caring heart. He will be missed by all who had the privilege of knowing him.
Lou Walker
1938 – 2004
DeKalb County Commissioner, Super District 7,
2000-2004
Commissioner Walker was elected to the Board of

Commissioners in a special election in August
2000. A long-time community activist, Commissioner
Walker lived and worked in the south DeKalb
community for more than 25 years.
A former member of the DeKalb County Primary

Care Task Force, he supported the DeKalb clean
indoor air ordinance. Commissioner Walker will be missed, but he leaves a
legacy of service to this community.
Table of Contents
Introduction
Demographics of DeKalb County

2000 U.S. Census data 2
Public schools in DeKalb County 3
Community Health Assessment Areas 4
Health priority areas

Nutrition and physical activity 8
Tobacco use prevention 10
Injury prevention 11
Health disparities elimination 13
Trends in births and teen pregnancies

Live births 16
Teen pregnancy 16
Health behaviors
Youth Risk Behavior Survey 20
Behavioral Risk Factor Survey 21
Infectious diseases and leading causes of hospitalizations

Infectious diseases 24
Vaccine -preventable diseases 24
Immunization coverage 25
Hepatitis A 25
Gastrointestinal infections 26
Sexually transmitted diseases 26
Tuberculosis 27
HIV/AIDS 27
Leading causes of hospitalizations 29
Causes of death
Leading causes of death 32
Infant mortality 32
Adults age 65 and over 35
Leading causes of premature death, ages 1-64 36
Trends over time 36
Trends by race/ethnicity and gender 37
County-wide trends and community-specific rates 43
Opportunities for prevention 64
Appendices
Methodology 68
Glossary of terms 71
References 72
Status of Health in DeKalb Report, 2005

Introduction
Developing and sustaining a healthy community requires the efforts of many
diverse civic, commercial and community organizations, as well as the efforts of
individuals who live, work and play in DeKalb County. An essential function of
county boards of health is to assess the status of health in their communities and to
present this information to the public in order to identify opportunities for health
promotion and disease prevention. This report is the sixth in a series produced by
the DeKalb County Board of Health that describes time and geographic patterns of
diseases and injuries, birth trends, leading causes of death and premature death,
and health behaviors. The purpose of the Status of Health report series is to
identify priority areas for health improvement and to serve as a catalyst for
community action.
In 1990, the DeKalb County Board of Health established the Status of Health
Committee to provide a community voice in setting health priorities for the county.
The purpose of the Status of Health Committee is to assist in the assessment and
analysis of community health needs and risk factors, to facilitate community-based
interventions, to evaluate the interventions and to promote broad implementation
of effective interventions.
The Small Grants Program was created by the Status of Health Committee to
stimulate and support grassroots prevention. Since 2001, the Small Grants
Program has focused its efforts on promoting healthy eating and physical activity
and reducing tobacco use among school-aged children. This program, now based in
schools, begins with a school self-assessment, using the Centers for Disease Control
and Prevention’s School Health Index for Physical Activity, Healthy Eating and
Tobacco Free Lifestyle. Schools use the index as a self-assessment and planning
tool to improve their health and safety policies and programs. After completing the
assessment, they develop action plans for improving school health that have been
funded through competitive grants awarded by the DeKalb County Board of Health.
To date, 40 schools have received funds through this program. In addition, the
DeKalb County Board of Education has adopted physical education and nutrition
policy changes and procedure revisions to support schools in their health
improvement efforts.
In 2001, DeKalb County began a community-wide strategic planning process for

health improvement. This effort led to Healthy DeKalb, which has a vision of
“healthy people living in healthy communities.” Participants in this planning
process reviewed data and trends in health status, developed action plans and
encouraged community collaboration to positively impact health. Healthy DeKalb
identified three strategic issues: (1) healthy behaviors, (2) health disparities and (3)
strengthening community partnerships for healthy communities.

Action groups were established to develop, implement and evaluate activities to
support progress toward these strategic issues. The Physical Activity and Nutrition
Action Group seeks to improve behaviors to reduce obesity, to improve nutrition and
to increase physical activity. In addition, this group endorses efforts to reduce
tobacco use behaviors. The Cultural Competency and Disparities Action Group
focuses on improving cultural c ompetency among health care providers serving
immigrant and refugee populations and supports efforts to reduce health
disparities. The Community Network Committee has sought to strengthen
partnerships to improve progress toward community health goals.
The 2005 Status of Health in DeKalb Report analyzes available data through 2003
on the leading health issues and some of the risk factors associated with these
issues in DeKalb County. This report emphasizes information related to identified
priority areas and provides specific opportunities for prevention in these areas.

Demographics of DeKalb County
2000 U.S. Census Data

Public schools in DeKalb County
Community Health Assessment Areas
2000 U.S. Census Data
Based on the 2000 U.S. Census, DeKalb County has grown and become more racially and
ethnically diverse since 1990. The total population of DeKalb County grew 22% from
545,837 in 1990 to 665,865 in 2000 (Table 1). The proportion of males to females has
remained the same, with 52% of the population female. The population aged 65 years
and over grew the least at 15% compared to growth of the population of other ages.
The 2000 Census was modified from previous censuses to allow respondents to check more
than one race and also divided the Asian and Pacific Islander group into two separate
groups: (1) Asian and (2) Native Hawaiian and Other Pacific Islander. As a result, the
data on race in the 2000 Census are not directly comparable to those collected in previous
years, and changes in population by race may be a result of changes in the classification of
the race categories. In 2000, 14,121 (2%) of DeKalb residents identified themselves as more
than one race. The Hispanic population more than tripled from 15,619 in 1990 to 52,542 in
2000. Asians and Pacific Islanders, blacks, and American Indians and Alaska Natives also
experienced an increase in population from 1990 to 2000.
Table 1. Demographic characteristics of DeKalb County residents from the 1990 and 2000 U.S. Census
DeKalb County, Georgia

1990 2000 % change
General Characteristics
Total Population 545,837 665,865 22%
Male 261,592 322,780 23%
Female 284,245 343,085 21%
Under 5 years 38,657 47,357 23%
5 to 17 years 90,896 116,621 28%
18 to 64 years 369,828 448,663 21%
65 years and over 46,456 53,224 15%
Race:
White 292,310 238,521 -18%
Black or African American 230,425 361,111 57%
American Indian and Alaska Native 998 1,548 55%
Asian and Pacific Islander* 16,266 27,047 66%
Other races 5,838 23,517 303%
Two or more races** - 14,121
Hispanic or Latino (of any race) 15,619 52,542 236%
Average household size 2.57 2.62 2%
Average family size 3.12 3.20 3%
Social Characteristics
% High school graduate or higher (25 and older) 83.9% 85.1% 1%
% Bachelor's degree or higher (25 years and older) 32.7% 36.3% 11%
% Foreign Born 6.7% 15.2% 127%
% Speak a language other than English at home (5 years and
older) 8.6% 17.4% 102%
Economic Characteristics
In Labor Force (16 years and older) 318,844 368,086 15%
Median household income (dollars) 35,721 49,117 38%
Median family income (dollars) 41,495 54,018 30%
Per capita income (dollars) 17,115 23,968 40%
*Includes Native Hawaiian
**New to the 2000 Census
Data Source: U.S. Census Bureau
2 Status of Health in DeKalb Report, 2005

There was no change in the proportion of residents who were high school graduates.
The proportion of residents who had a bachelor's degree or higher increased 11%
from 1990 to 2000. DeKalb County had an influx of immigrants and refugees
during this time period. The proportion of the population that identified
themselves as foreign-born more than doubled from 6.7% in 1990 to 15.2% in
2000. In addition, the proportion of people who spoke a language other than
English at home also more than doubled from 8.6% in 1990 to 17.4% in 2000.
Public Schools in DeKalb County

In the 2002-2003 academic school year, a total of 104,490 students were enrolled in the
public schools in DeKalb County (Table 2). The majority of students were
black/African American (78%), twice the state proportion. DeKalb had a higher
proportion of students who have limited English proficiency, are eligible for
free/reduced meals and are economically disadvantaged compared to the state. The
DeKalb graduation rate and average SAT score were lower than the state averages,
and the average SAT score was lower than the national average score of 1016.
Table 2. Profile of Public Schools in DeKalb County*

Academic School Year 2002-2003
Demographics and Other Factors DeKalb State

Total enrollment 104,490 1,496,012
Male 51% 51%
Female 49% 49%
Asian/Pacific Islander 3% 2%
Black/African American 78% 39%
Hispanic 6% 7%
Multiracial 2% 2%
Native American <1% <1%
White/Non-Hispanic 10% 50%
Students with disabilities 10% 13%
Limited English proficiency 11% 4%
Eligible for free/reduced meals 59% 45%
Economically disadvantaged 57% 44%
Students absent 15 or more days 13% 14%
Graduate rate 59% 63%
Average SAT score 928 980
* Includes DeKalb County School System, City of Decatur Schools and Alonzo A. Crim High School
feeder school system of the Atlanta Public Schools
Data Source: Governor's Office of Student Achievement
Status of Health in DeKalb Report, 2005 3

The Board of Health has divided the county into 13 geographic areas called
Community Health Assessment Areas, or CHAAs (see Methodology section), for the
purposes of health planning. These areas are based on “natural communities” of
the local DeKalb County high schools. The demographic profile of the CHAAs is
provided in Table 3.
Since the Board of Health first began using CHAAs to display geographic
differences in health status, there have been changes in the distribution of high
schools in DeKalb County. For example, Shamrock and Henderson high schools are
now middle schools, and Martin Luther King, Jr. and Stephenson are new high
schools. The original census tracts for the CHAAs, based on the 1995-1996 school
districts, continue to be used in this report to compare health status trends by
communities over time (Figure 1).
Table 3. Demographic profile of DeKalb Community Health Assessment Areas

(CHAAs) from the 2000 U.S. Census
DeKalb County, Georgia, 2000
Community Health 2000 Population % All % Hispanic
% White % Black
Assessment Areas # % Others Ethnicity
Atlanta 28,282 4.2% 32.4 64.4 3.2 3.0
Avondale/Towers/Columbia 70,634 10.6% 14.5 80.8 4.7 2.6
Chamblee/Cross Keys 85,562 12.8% 57.8 14.6 27.6 33.2
Clarkston 30,559 4.6% 17.3 63.8 18.9 3.8
Decatur 18,121 2.7% 65.6 30.5 3.9 1.7
Druid Hills/Lakeside 75,386 11.3% 80.8 8.9 10.3 4.9
Dunwoody 43,535 6.5% 75.3 9.7 15.0 11.5
Lithonia 63,157 9.5% 9.9 87.2 2.9 1.9
McNair/Cedar Grove 65,716 9.9% 5.2 92.9 1.9 1.4
Redan 51,081 7.7% 9.9 85.5 4.6 2.2
Southwest DeKalb/MLK Jr. 32,587 4.9% 4.7 93.3 1.9 1.0
Stone Mountain/Stephenson 43,980 6.6% 17.8 75.1 7.1 4.8
Tucker 57,265 8.6% 60.5 24.8 14.7 9.7
Total 665,865 100.0% 35.8 54.2 9.9 7.9

Figure 1.

Health Priority Areas
Nutrition and physical activity

Tobacco use prevention
Injury prevention
Health disparities elimination
Nutrition and Physical Activity
Lifestyle choices made early in life have a significant impact on the patterns of
chronic disease developed in adulthood. In the U.S., poor diet and physical
inactivity lead to 300,000 deaths each year—second only to tobacco use (1). People
who are overweight or obese increase their risk for cardiovascular disease, diabetes,
high blood pressure, arthritis-related disabilities and some cancers. Chronic
diseases are the leading causes of death among DeKalb residents. In 2002, cancer,
cardiovascular disease, diabetes and liver disease accounted for 51% of premature
deaths (death before age 65) and 10,043 years of potential life lost (1,642 years per
100,000 population).1 Avoiding alcohol, tobacco and other drugs; choosing healthy
diets (e.g., increasing fruit and vegetable consumption) and engaging in regular
physical activity (30 minutes per day at least five days per week) substantially
improves health.
Compared to national
averages, DeKalb County
Figure 2. Overweight and obesity among DeKalb County high
high school students, grades school students
9-12, are overweight, have DeKalb County, Georgia, 2003
poorer dietary habits and are Total
less physically active (2). In Male Overweight
2003, 17% were overweight, Female Obese

and 12% of students were White
2,3
obese (Figure 2). Hispanic Black
students (21%) were more Hispanic
likely to be obese than other All other races
races/ethnicities. Eighty- Multiple races
three percent (83%) of high 0 10 20 30 40
school students did not eat Percent
at least five fruits and Data Source: DeKalb County Youth Risk Behavior Survey, 2003
vegetables per day

(compared to the U.S. rate
of 78%) (Figure 3). Female students were less likely to eat five or more fruits and vegetables
per day compared to males. White and black students were less likely to eat five or more
fruits and vegetables per day compared to other races/ethnicities.
1
Years of potential life lost (YPLL) is an index of premature death. It is calculated by subtracting the age of death
from 65.
2
Overweight is defined as at or above the 85th and below the 95th percentile for body mass index by age and sex.
3
Obese is defined as at or above the 95th percentile for body mass index by age and sex.

Only 23% of students engaged in
moderate physical activity Figure 3. Nutrition and physical activity factors of DeKalb
(compared to the U.S. rate of County high school students
25%), and 58% of students DeKalb County, Georgia, 2003
engaged in vigorous physical Total Ate 5 or more

fruits and
activity (compared to the U.S. Male vegetables
rate of 63%). Sixty-six percent

4,5
Female Moderate
physical activity
(66%) of students did not attend White Vigorous
physical activity
physical education class on a Black
daily basis (compared to the Hispanic
U.S. rate of 56%). In addition, All other races
56% of students watched more Mutiple races
than three hours a day of 0 20 40 60 80 100

Percent
television (compared to the
U.S. rate of 38%). The nutrition
Data Source: DeKalb County Youth Risk Behavior Survey, 2003
and physical activity behaviors

indicate that our DeKalb youth
are at increased risk for cardiovascular disease and cancer-related problems later in life.
Approximately 35% of DeKalb County adults are overweight and 21% are obese (Figure 4)
(3).6,7 Thirty-six percent (36%) of adults reported trying to lose weight, and 60% were trying to
maintain their current weight. Twenty-four percent (24%) of adults consumed five or more
fruit and vegetable servings per day. Males and non-whites were least likely to consume
five or more fruit and vegetable servings per day compared to females and whites.
Seventy-two percent (72%) of

Figure 4. Nutrition and physical activity, ages 18 and over
DeKalb County adults reported
that their jobs involved mostly 50
Total
percent of population
sitting or standing. Twenty-two 40

Male
Female
percent (22%) of adults reported White
30 Non-White
being physically inactive outside
of work. Less than half of adults 20
reported that they engaged in 10
vigorous physical activities 0

(e.g., running, aerobics). Of these, % overweight % obese _5
%> % physically
males (57%) were more likely than fruit/veggie inactive
per day
females (36%) to engage in vigorous
physical activity. Data Source: DeKalb County Behavioral Risk Factor Survey, 2001
4
Moderate physical activity is defined as participation in physical activities that do not make individuals sweat or
breathe hard for at least 30 minutes on five or more of the past seven days (e.g., fast walking, slow bicycling,
skating, pushing a lawn mower or mopping floors).
5
Vigorous physical activity is defined as exercised or participated in physical activities for at least 20 minutes that
made them sweat and breathe hard on three or more of the past seven days (e.g., basketball, soccer, running,
swimming laps, fast bicycling, fast dancing or similar aerobic activities).
6
Overweight is defined as body mass index (BMI) greater than 25 kg/m2and less than 30 kg/m2. To calculate your
BMI, visit http://www.cdc.gov/nccdphp/dnpa/bmi/ .
7
Obese is defined as body mass index 30 kg/m2 and greater.
Tobacco Use Prevention 8
Each year, tobacco kills more than 10,000 Georgians and results in $2 billion in health care
costs. Tobacco use has caused a tremendous burden of disease for DeKalb County residents.
In 2002, tobacco-related diseases
(cardiovascular disease; oral, Figure 5. Tobacco use among DeKalb County high school
throat and lung cancers; stroke; students
asthma and emphysema) caused
Total Ever tried
1,603 total deaths (40% of all smoking
Male
deaths in DeKalb County) and Current
Female
nearly 5,500 years of potential tobacco use
life lost. White
Black
Fifty-one percent (51%) of DeKalb Hispanic

County high school students have All other races
tried smoking cigarettes, and Multiple races
10% report current cigarette
0 20 40 60 80
use (Figure 5) (2). Males were Percent
slightly more likely to try Data Source: DeKalb County Youth Risk Behavior Survey, 2003
smoking compared to females,

and Hispanic students were
significantly more likely to engage in cigarette smoking behavior compared to other
races/ethnicities. Twenty percent (20%) of underage smokers (less than 18 years)
purchase cigarettes at a store or gas station. Thirteen percent (13%) of DeKalb County
high school students began smoking cigarettes before the age of 13 years.
Thirty-five percent (35%) of

DeKalb County adults (18 years Figure 6. Adults who have smoked at least 100 cigarettes in their
and older) have smoked at entire life DeKalb County, Georgia, 2001
least 100 cigarettes in their Total

Male
lifetime (Figure 6) (3). Seventeen
Female
percent (17%) of all DeKalb White
County adults currently smoke Non-White
either every day or some days. 18 to 24
25 to 34
The average age of initiation of 35 to 44
smoking is 16 years, and the 45 to 54
average age of initiation of 55 to 64
regular smoking is 19 years. 65 +
Of those who have smoked, just 0 10 20 30 40 50 60

over half have quit, and of those Percent
who currently smoke, 61% have
Data Source: DeKalb County Behavioral Risk Factor Survey, 2001
tried to quit within the past year.
8
The Status of Tobacco Control in DeKalb County 2003 is available at www.dekalbhealth.net .

Injury Prevention
Injuries are a significant problem in DeKalb County. Unintentional injuries, suicide and
homicide ranked in the top eight leading causes of premature death in DeKalb County
from 1994 to 2002. Not only do injuries result in death, but injuries lead to disability,
chronic pain, loss of normal functioning, and excessive medical and therapy costs. In
2002, injuries were the fourth leading cause of hospitalization. Fortunately, most
injuries are preventable, and there are lifestyle and environmental changes that can
reduce the chances of becoming injured (e.g., wearing seatbelts, using child safety seats,
wearing a helmet, constructing pedestrian crosswalks, locking firearms).
The leading cause of unintentional injuries in DeKalb County is motor vehicle crashes.
From 1994 to 2002, a total of 821 DeKalb residents were killed in motor vehicle crashes.
Each year, approximately 350 pedestrians are hit by a motor vehicle in DeKalb County.
Between 2001 and 2003, 28% of 678 pedestrian/motor vehicle crashes occurred on five state
highways in DeKalb: Buford Highway, Memorial Drive, Glenwood Road, Candler Road and
Covington Highway (4). These five roads combined were responsible for 47% of the 62
pedestrian fatalities in the county. Since state highways represent only 8% of all roads
in DeKalb County, these five highways account for an overburden of motor vehicle
crashes and fatalities.
Motor vehicle crashes are caused
by a number of factors, such as
driver distraction, speeding or
reckless driving, or being under
the influence of alcohol or drugs.
Among DeKalb County high
school students, 5% of
students drove a vehicle
when they had been drinking
alcohol, and 24% rode in a vehicle
driven by someone who had been
drinking alcohol (2). Safety
behaviors that can reduce serious
injuries in an accident include wearing a seat belt and wearing a helmet when bicycling.
However, 5% of students rarely or never wore a seatbelt when riding in a car, and 87%
of students rarely or never wore a helmet when bicycling.
Suicide claimed 1,384 years of potential life annually among DeKalb residents. A
risk factor of suicide is feelings of depression. Twenty-nine percent (29%) of DeKalb
high school students felt depressed, and 14% seriously considered attempting suicide
in the past year. Though females were more likely to think about suicide and attempt
suicide, males were more likely to die from suicide. Males lost 390 years of potential life
compared to 85 years in females. Specifically, white males had the highest premature
death rate compared to females and other races. .

Homicide claimed 2,779 years of
Figure 7. Nine-year age-specific mortality rates for homicide
potential life annually among and suicide
DeKalb residents. Adolescents DeKalb County, Georgia, 1994 - 2002
25
aged 13 to 19 years had a higher
Deaths per 100,000 population

Infancy (<1)
homicide mortality rate than other 20
Child (1-12)
age groups (Figure 7). Homicide Adolescence (13-19)

Early Adult (20-44)
premature death rates were four 15 Middle Adult (45-59)
to five times higher for black males Later Adult (60-74)

Older Adult (75+)
than for white males or black 10
females. High levels of violence

5
were reported in DeKalb County
high schools. Thirty-seven percent 0
(37%) of students had a physical Homicide Suicide
fight in the last year (compared to Data Source: Georgia Division of Public Health
the U.S. rate of 33%), and 3% of

students in fights required medical
treatment. Students who were male, Hispanic or black were more likely to be in a fight
than other students. Fifteen percent (15%) of students carried a weapon to school, and
6% of students did not go to school in the 30 days preceding the survey because they
felt unsafe.
Injuries are also a significant problem among the elderly in DeKalb County. Suicide
mortality rates were the highest among this age group compared to other age groups
(Figure 7). From 1994 to 2002, adults aged 75 and over had the highest mortality rate
due to unintentional injury; 174 deaths per 100,000 population, which was four times
higher than the age group with the second highest rate (Figure 8).
Figure 8. Nine-year age-specific mortality rates for

unintentional injuries
DeKalb County, Georgia, 1994 - 2002
200
Deaths per 100,000 population
Infancy (<1)
180 Child (1-12)
Adolescence (13-19)
160
Early Adult (20-44)
140 Middle Adult (45-59)
Later Adult (60-74)
120
Older Adult (75+)
100
80
60
40
20
0
Age group
Data Source: Georgia Division of Public Health

Health Disparities Elimination
A Healthy People 2010 goal is to eliminate health disparities among segments of the
population (5).9 Health disparities are differences in health status based on certain
characteristics (race/ethnicity, gender, education, income, disability, geographic location,
sexual orientation, etc.). Because of DeKalb County's diverse population, health
disparities are priorities of concern.
The following are examples of the notable health disparities in DeKalb County:
South DeKalb: Based on 2000 U.S. Census data, communities in south DeKalb County
have a higher proportion of African Americans, persons with lower educational
attainment and lower economic status than the northern part of the county (Table 4).
Communities in south DeKalb have a higher rate of premature death due to chronic
diseases such as cancer, diabetes and heart disease. Overall, premature death rates
from cancer are higher in blacks than whites. The premature death rate of diabetes is
1.7 times greater in south DeKalb when compared to the remainder of the county.
The premature death rate for heart disease is 2.3 times higher for black females
than for white females.
North DeKalb: Communities in north DeKalb have a higher proportion of Hispanics

and Asians than the southern part of the county. Residents in north DeKalb are more
likely to be foreign-born, to speak a language other than English at home and to be
linguistically isolated. Hispanic high school students are more likely to be overweight
than other races/ethnicities and less likely to engage in vigorous physical activities.
Hispanic students also report a higher percentage of current tobacco use. Hispanics
and Asians face numerous challenges, such as language and cultural barriers and
limited access to adequate health care. It is suspected that additional health
disparities affect immigrants and refugees, but details are lacking because existing
data sources do not record whether a person is an immigrant or refugee.
Gender: Among all Community Health Assessment Areas (CHAAs), injuries and homicide
are the leading causes of premature death among males, while cancer is the leading cause
of premature death among females. This pattern of mortality may reflect riskier
behaviors among males than females.
Suicide: The rate of premature death from suicide is highest in the Chamblee/Cross
Keys and Tucker CHAAs. Males had a premature death rate 4.6 times higher than
females, and white males had the highest rate of suicide.
Infant Mortality: Infant mortality is higher among blacks than any other race/ethnicity.
The black infant mortality rate was 2.5 times higher than the white infant mortality rate.
Infant mortality rates are highest in south DeKalb.
9
Healthy People 2010 is the prevention agenda for the United States. It is a statement of national health objectives designed to
identify the most significant preventable threats to health and to establish national goals to reduce these threats
(www.healthypeople.gov).

HIV/AIDS: HIV/AIDS predominantly affects males and African Americans in DeKalb.
From 1994 to 2002, the majority of AIDS cases were male (81%) and black (76%).
From 1992 to 1999, males and blacks were more likely to test positive for HIV than
females and other races.
Table 4. Demographic characteristics of south versus north DeKalb County residents,

Census 2000
* **
South DeKalb North DeKalb
General Characteristics No. No.
Total population 327,155 338,710
Race:
White 34,380 204,141
Black or African American 280,252 80,859
American Indian and Alaska Native 551 997
Asian and Pacific Islander 3,073 23,874
Other race 3,511 20,106
Two or more races 5,388 8,733
Hispanic or Latino (of any race) 7,537 45,005
Average household size 2.91 2.43
Average family size 3.35 3.01
No. family households (with >1 own children <18yrs) 52,169 35,796
Married couple family 27,192 23,259
Single parent (male) 3,779 2,934
Single parent (female) 21,198 9,603
Social Characteristics
% High school graduate or higher (25 years and older) 67.5% 84.9%
% Bachelor's degree or higher (25 years and older) 14.8% 46.2%
% Foreign-born 14.7% 22.8%
% Speak a language other than English at home (5 years and older) 8.2% 26.2%
No. linguistically-isolated households (5 years and older) 1,837 10,836
Economic Characteristics
In labor force (16 years and older) 170,103 197,983
Median household income 1999 $40,935 $51,619
Median family income 1999 $41,513 $58,788
Median per capita income 1999 $18,099 $30,486
No. households with public assistance income 3,310 2,133
*
Includes Community Health Assessment Areas of Avondale/Towers/Columbia, Lithonia, McNair/Cedar Grove, Redan, Southwest
DeKalb/MLK Jr. and Stone Mountain/Stephenson.
**
Includes Community Health Assessment Areas of Atlanta, Decatur, Druid Hills/Lakeside, Clarkston, Dunwoody, Chamblee/Cross
Keys and Tucker.

Trends in Births and
Teen Pregnancies
Live births
Teen pregnancy
Live Births
The general fertility rate (GFR), used to measure birth rate of a population, takes
into account the age and sex structure of the population and is defined as the total
number of births per 1,000 females age 15 to 44 years. The total GFR for DeKalb
increased 11% from 58.7 live births per 1,000 in 1994 to 65.2 in 2002 (Figure 9).
Between 1994 and 2002, the average Hispanic GFR was 115.8 live births per 1,000
compared to whites (59.5), blacks (65.1) and Asians (62.8).
Figure 9. General fertility rate per 1,000 females age 15 to 44 years by

race/ethnicity
160
140
120
Rate per 1,000
100
80
60
40
20
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Total White Black Hispanic Asian
Teen Pregnancy
Between 1994 and 2002, the total teen pregnancy rates of females aged 15 to 19
years declined in Georgia and nationally (6). In DeKalb County, the total teen
pregnancy rate of females aged 10 to 19 years declined 31% from 55.1 pregnancies
per 1,000 in 1994 to 38.2 pregnancies in 2002 (Figure 10). Hispanic teen
pregnancies increased 37%, and whites and Asians had smaller increases. Black
teen pregnancies decreased 42% between 1994 to 2002.
The total live birth rate among females aged 10 to 19 years decreased 22% from
31.4 live births per 1,000 in 1994 to 24.5 in 2002 (Figure 11). Total teen abortion
rates also declined 42% from 23 induced abortions per 1,000 females in 1994 to 13.4
per 1,000 in 2002 (Figure 12).

Figure 10. Pregnancy rate per 1,000 females age 10 - 19 years by
race/ethnicity
120
100
Rate per 1,000 80
60
40
20
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Figure 11. Live birth rates per 1,000 females age 10 - 19 years by race/ethnicity

100
80
Rate per 1,000
60
40
20
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year

Figure 12. Induced abortion rates per 1,000 females aged 10 - 19 years by
race/ethnicity
35
30
25
Rate per 1,000
20
15
10
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year


Health Behaviors
Youth risk behavior survey

Behavioral risk factor survey
1
Youth Risk Behavior Survey, 2003
The 2003 DeKalb County Youth Risk Behavior Survey (YRBS) was conducted in the
DeKalb County School System among students in grades 9 through 12. The survey
assesses risky health behaviors contributing to the leading causes of illness, injury and
death. The system monitors six categories of priority health-risk behaviors that contribute
to: (1) unintentional injuries and violence, (2) tobacco use, (3) alcohol and other drug use,
(4) sexual behaviors that contribute to unintentional pregnancy and sexually transmitted
diseases, (5) unhealthy dietary behaviors and (6) physical inactivity.
Table 5: Comparison of DeKalb Youth Risk Behavior Survey to State and National Results (%), 2003
Risk Behavior DeKalb Georgia National
Unintentional injuries and violence
Rarely/never wore seatbelt when riding in a car 5.4a 9.4 18.2
Rarely/never wore a bicycle helmet 86.7 85.9 85.9
Carried a weapon in past 30 days 14.5b 18.7 17.1
Did not go to school on >1 of past 30 days because felt unsafe 5.5 --- 5.4
One or more physical fights during past 12 months 37.4b 31.4 33.0
Tobacco use
Used any tobacco during past 30 days 13.6a 26.1 27.5
Smoked cigarettes on >1 of past 30 days 9.5a 20.9 21.9
Alcohol use
Had at least one drink of alcohol on >1 day during lifetime 69.5c 72.2 74.9
Drank alcohol on >1 of past 30 days 28.7a 37.7 44.9
Sexual behaviors
Have ever had sexual intercourse 53.3c --- 46.7
Had sexual intercourse for the first time before age 13 years 14.5c --- 7.4
Nutrition
Ate >5 servings of fruits and vegetables per day 17.2c 16.8 22.0
Drank >3 glasses of milk per day 8.2a 13.0 17.1
Physical activity
Participated in vigorous physical activity 57.9 59.0 62.6
Participated in moderate physical activity 23.2 --- 24.7
Participated in insufficient amount of physical activity 37.2 36.7 33.4
Watched >3 hours/day of TV 55.8a 42.4 38.2
a
Result is statistically different from Georgia and National.
b
Result is statistically different from Georgia.
c
Result is statistically different from National.
---Data not available.
Data Sources: DeKalb County Youth Risk Behavior Survey (2003), Georgia Student Health Survey Report (2003)
and National YRBS (2003).
1
The DeKalb County Youth Risk Behavior Survey 2003 is available at www.dekalbhealth.net .

Behavioral Risk Factor Survey, 2001
Modeled after the Centers for Disease Control and Prevention's (CDC) Behavioral Risk
Factor Surveillance System (BRFSS), DeKalb County conducted its own Behavioral
Risk Factor Survey in 2001 to provide county-level data about its residents aged 18
years and older. The survey focuses on individual behaviors linked to chronic diseases,
such as lack of physical activity; eating high-fat, low-fiber diets; using tobacco and alcohol
and lack of preventive medical care.
Table 6. Comparison of DeKalb Behavioral Risk Factor Survey to State and National Results (%), 2001
Risk Behavior DeKalb Georgia National
Health care access
No health care coverage 14.1 13.8 13.3
Of those with coverage, no coverage for any time during the past 7.3 7.2 6.5
12 months
Health status
High blood pressure 23.4 26.9 ---
High blood cholesterol 26.3 31.9 30.2
Diabetes 5.6 6.9 6.5
Asthma 11.5 11.0 11.2
Disabilities (physical, mental or emotional) 12.2 15.5 ---
Preventive services
Blood cholesterol checked 80.9 78.9 77.0
Received a flu shot in past 12 months 23.6 26.8 31.8
Mammogram for females 58.6 63.5 63.4‡
Clinical breast exam for females 90.4 89.9 91.0‡
Pap smear for females 95.6 96.7 95.2‡
Blood stool test 47.6 32.4 44.8‡
Sigmoidoscopy or colonoscopy exam 55.1 48.4 48.1‡
HIV test 64.0 54.7 ---
Nutrition
Consumed 5 or more fruits and vegetables per day 24.3 23.0† 22.6‡
Physical activity
Participated in vigorous physical activities 45.8 --- ---
Participated in moderate physical activities 73.5 --- ---
Participated in any physical activities 76.7 72.7 74.2
Tobacco and alcohol use
Currently smoke 17.0 23.7 23.0‡
Binge drinking (5 or more drinks on an occasion) 9.7 11.9 ---
† State data from 2002; ‡ National data from 2002.
---Data not available.
Data Sources: DeKalb County Behavioral Risk Factor Survey (2001), Georgia BRFSS (2001) and National BRFSS
(2001).

Infectious Diseases and Leading
Causes of Hospitalizations
Infectious diseases
Vaccine-preventable diseases
Immunization coverage
Hepatitis A
Gastrointestinal infections
Sexually transmitted diseases
Tuberculosis
HIV/AIDS
Leading causes of hospitalizations
Infectious Diseases
All Georgia laboratories, physicians and health care providers are required by law
to report certain infectious diseases or conditions to their county, district or state
health department (see http://health.state.ga.us/epi/disease/report.asp for reporting
requirements). This section provides an overview of some of the more commonly
reported and/or important infectious diseases or conditions of DeKalb County
residents between 1994 and 2003.1
Vaccine-Preventable Diseases
In DeKalb County, the overall incidence of childhood vaccine-preventable disease
was low across the ten-year period from 1994 to 2003 (Table 7). Six cases of
Haemophilus influenzae Group B (Hib) have been reported since 1997. Four cases
of measles have been reported since 1997; three cases were imported from other
countries and one case could not be located for interview. On average, one case of
mumps and five cases of pertussis (whooping cough) were reported each year. One
case of imported rubella (German measles) was reported in 1994.
Table 7. Number of selected vaccine-preventable diseases by year of diagnosis

DeKalb County, Georgia, 1994-2003
Disease 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Total
Haemophilus influenzae (Grp B) 0 0 0 1 1 1 2 1 0 0 6
Measles 0 0 0 1 1 0 0 0 1 1 4
Mumps 2 2 1 0 0 2 1 0 0 1 9
Pertussis 7 3 4 2 7 6 5 3 5 8 50
Rubella 1 0 0 0 0 0 0 0 0 0 1
1
Numbers in 2003 are based on data received by April 30, 2004. The 2003 rates are calculated based on population
estimates in 2002.
Table 7. Number of selected vaccine-preventable diseases by year of diagnosis

Immunization Coverage
The Georgia Immunization Study assesses the immunization coverage rates of two-
year-old children throughout the state (7). In 2002, 84.6% of children in DeKalb
County were adequately immunized, compared to 83.9% for children statewide. 2
Since 1997, DeKalb’s immunization coverage has increased steadily from 58.3% to
84.6% (Figure 13).
Figure 13. Immunization coverage of two-year-old children in Georgia and

DeKalb County, 1997-2002
100
Georgia
80 DeKalb
Percent
60
40
20
0
1997-1998 1998-1999 1999-2000 2001 2002
Years
Table 8. Number of cases of selected notifiable diseases by year of diagnosis

Disease 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Total
Hepatitis A 0 3 63 110 103 76 64 127 68 49 663
Gastrointestinal infections 504 409 355 320 436 299 411 460 527 388 4,109
Syphilis 83 94 74 60 45 41 41 63 67 79 647
Chlamydia -- -- -- -- 2,899 3,282 3,428 3,772 4,130 3,490 21,001
Gonorrhea -- -- -- -- 2,306 2,165 2,264 1,946 2,163 1,719 12,563
Tuberculosis 115 92 99 102 84 104 85 78 88 83 930
Hepatitis A
Between 1994 and 2003, 663 people were newly diagnosed with Hepatitis A (Table
8). Seventy-seven percent were male, and 63% were aged 20-39 years. Prior to
1996, the incidence of Hepatitis A was less than one per 100,000 annually. In 1996,
the incidence increased dramatically due to an outbreak in an apartment complex.
Between 1997 and 2000, a steady decrease in incidence occurred. In 2001, a metro-
wide outbreak occurred. Cases were primarily male (86%), and of those
interviewed, 54% identified themselves as either bisexual or homosexual (8). Men
who have sex with men were targeted for an intervention plan that focused on
2
Adequate immunization status is based on meeting the 4:3:1 schedule of four DTP/DTaP (diphtheria, tetanus and
pertussis), three OPV/IPV (polio) and one MMR (measles, mumps and rubella).

education and immunization. Following this campaign, the incidence of Hepatitis A
decreased from 18.8 cases per 100,000 population in 2001 to 7.2 cases in 2003.
Gastrointestinal Infections
Reports of gastrointestinal diseases have increased in the past decade due to
improved disease surveillance. Since 1995, DeKalb County has been a sentinel site
for the Centers for Disease Control and Prevention’s (CDC) Emerging Infections
Program, which conducts active surveillance for nine gastrointestinal pathogens (9).
Between 1994 and 2003, 4,109 cases of gastrointestinal illnesses were reported in
DeKalb County residents (Table 8). 3 Fifty-seven percent of cases were male, and
31% were in children aged 1-9 years. The incidence of gastrointestinal infections
declined from 83.7 per 100,000 in 1994 to 57.3 per 100,000 in 2003. Giardia has
been the most frequently reported infection, in part due to the routine screening of
immigrants and refugees.
Sexually Transmitted Diseases

In recent years, Georgia has ranked in the top ten among all states for reported
cases of sexually transmitted diseases (STDs), with gonorrhea and chlamydia being
the two most frequently reported (10). Serious early consequences of gonorrhea and
chlamydia infections include pelvic inflammatory disease, infertility, ectopic
pregnancy and chronic pelvic pain (11).
Between 1994 and 2003, 647 cases of primary and secondary syphilis were reported
in DeKalb County residents (Table 8). Seventy-five percent of cases were among
males, and 90% of cases occurred among persons 20-49 years.
Between 1998 and 2003, 21,001 cases of chlamydia were reported in DeKalb County
residents (Table 8). Eighty percent of cases were among females, and 85% of cases
occurred among persons 10-29 years. Chlamydia cases increased from 449.8 cases
per 100,000 in 1998 to 515.5 in 2003.
Between 1998 and 2003, 12,563 cases of gonorrhea were reported in DeKalb County
residents (Table 8). Fifty-four percent of cases were among males, and 45% of cases
occurred among persons 20-29 years. Gonorrhea cases decreased from 357.8 per
100,000 in 1998 to 253.9 per 100,000 in 2003.
3
Gastrointestinal illnesses include Campylobacter, Cyclospora, Cryptosporidia, Escherichia coli O157:H7, Giardia,
Listeria, Salmonella, Shigella, Vibrio and Yersinia.

Tuberculosis
Since 1992, national rates of tuberculosis (TB) have shown a dramatic decline,
decreasing 44% by 2002. Despite declining trends, Georgia was ranked seventh in
the nation for the highest TB case rates in 2002, and DeKalb County reported the
second highest number of cases among all Georgia counties (12).
Between 1994 and 2003, 930 cases of TB were reported in DeKalb County residents
(Table 8). Sixty-two percent of cases were male, and 66% were African American.
The TB cases decreased from 19.1 cases per 100,000 population in 1994 to 12.3 per
100,000 in 2003. The percentage of people with TB who were foreign- - born increased
from 26% in 1994 to 42% in 2003. Countries of origin most frequently reported
included Vietnam, Somalia, Ethiopia, Mexico and India. Sixty-two percent of cases
had multiple TB risk factors, such as HIV, being foreign-born, homelessness,
substance abuse, or living in correctional institutions or long-term care facilities. Of
471 TB cases for which HIV status was known, 26% were HIV positive. Of 664
bacteria samples tested, 51 (8%) were resistant to a single antibiotic, and 10 (2%)
were resistant to multiple antibiotics.
HIV/AIDS
Human immunodeficiency virus (HIV) is the virus that causes acquired
immunodeficiency syndrome (AIDS), a disease that leaves a person vulnerable to
life-threatening infections. From 1981 to 2002, there were 3,795 diagnosed cases of
AIDS and 2,049 deaths caused by AIDS in DeKalb County. AIDS decreased from
55.1 cases per 100,000 in 1994 to 26.3 cases per 100,000 in 2002, while deaths due
to AIDS decreased from 31.1 deaths per 100,000 in 1994 to 3.4 in 2002 (Figure 14).
In 1994, 56% of diagnosed AIDS cases died that same year. By 2002, the
number of diagnosed cases who died in that same year decreased to 13%.
Figure 14. AIDS case and death rates by year of diagnosis

Rate per 100,000 population
60
Cases
50
Deaths
40
30
20
10
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year

From 1994 to 2002, the majority of AIDS cases were male (81%) and black (76%).
During this time, the rate of disease decreased in all gender and race categories (Figure 15).
The numbers of AIDS cases were very small for Hispanics and Asians with a total
of 63 cases and 1 case
reported, respectively,
from 1994 to 2002. The Figure 15. AIDS rates by sex and race
exposure categories DeKalb County, Georgia, 1994-2002
associated with the most 120
Rate per 100,000 population

Males
AIDS cases were men 100 Females
who have sex with men 80
Black
White
(46%), injecting drug use
60
(15%) and heterosexual
contact (14%). Between 40
1994 and 2002, 90% of 20

AIDS cases were between 0
the ages of 20 to 49 years, 1994 1995 1996 1997 1998 1999 2000 2001 2002
with the highest Year
proportion aged 30-39 Data Source: Georgia Division of Public Health
years (46%). Pediatric

AIDS cases (ages 0 to
12 years) represent a very small proportion of total AIDS cases, with nine reported cases
in DeKalb County from 1994 to 1995 and only three cases from 1996 to 2002.

Leading Causes of Hospitalizations
In 2002, 66,752 hospitalizations of DeKalb County residents were reported by non-
federal hospitals (Table 9). The leading causes of hospitalizations, in rank order,
were: (1) complications of pregnancy and childbirth (18%), (2) major cardiovascular
diseases (11%) and (3) bone and muscle conditions (3%). Of major cardiovascular
diseases, heart disease accounted for the majority of hospitalizations (72%) with a
rate of 800.4 hospitalizations per 100,000 population.
Females accounted for 63% of hospitalizations. The leading cause of hospitalization

for females was pregnancy and childbirth complications, and major cardiovascular
diseases were the second leading cause. The leading cause of hospitalization for
males was major cardiovascular diseases with heart disease accounting for 65% of
those hospitalizations.
Table 9. Hospital discharges and rates per 100,000 population

Female Male Total
Principle Diagnosis No. Rate No. Rate No. Rate
Pregnancy & childbirthing complications 11,840 222,975.5 0 - 11,840 109,184.8
Major cardiovascular diseases 3,775 1,084.0 3,732 1,135.3 7,507 1,108.9
Bone & muscle diseases 1,296 372.1 813 247.3 2,109 311.5
Accidents 999 286.9 1,022 310.9 2,021 298.5
Cancers 1,048 300.9 804 244.6 1,852 273.6
Pneumonia 927 266.2 769 233.9 1,696 250.5
Infectious & parasitic diseases 694 199.3 864 262.8 1,558 230.1
Diabetes 495 142.1 508 154.5 1,003 148.2
Blood diseases 592 170.0 389 118.3 981 144.9
Asthma 564 161.9 352 107.1 916 135.3
Kidney disease 167 48.0 172 52.3 339 50.1
Drug overdoses 121 34.7 169 51.4 290 42.8
Homicide 36 10.3 208 63.3 244 36.0
Birth defects 106 30.4 119 36.2 225 33.2
Fetal & infant conditions 77 22.1 91 27.7 168 24.8
Suicide 93 26.7 71 21.6 164 24.2
Chronic liver disease & cirrhosis 50 14.4 81 24.6 131 19.4
Alzheimer's disease 52 14.9 26 7.9 78 11.5
Parkinson's disease 18 5.2 18 5.5 36 5.3
Emphysema 11 3.2 8 2.4 19 2.8
Flu 6 1.7 6 1.8 12 1.8
Other causes 19,229 5,521.4 14,334 4,360.4 33,563 4,957.6
All causes 42,196 12,116.2 24,556 7,469.8 66,752 9,860.0

Causes of Death
Leading causes of death

Infant mortality
Adults age 65 and over
Leading causes of premature death, ages 1-64
Trends over time
Trends by race/ethnicity and gender
County-wide trends and community-specific rates
Leading Causes of Death
Mortality rates, which are the number of deaths per population at risk, are used to describe
the leading causes of death. Mortality rates provide a measure of magnitude of deaths within
a population. However, behaviors and exposures to hazardous agents often take many years
to impact health outcomes, like exposure to tobacco smoke and the development of lung cancer.
In this report, mortality rates are presented for infants (less than 1 year) and for persons age
65 and over. Deaths occurring between ages 1-64 are presented in the Leading Causes of
Premature Death section which follows.
Infant Mortality
In 2001, Georgia had the ninth highest infant mortality rate in the United States with a
rate of 8.6 deaths per 1,000 live births (13). Infant mortality rates in DeKalb County have
been increasing slightly from 9.9 deaths per 1,000 live births in 1994 to 10.5 in 2002
(Figure 16). From 1994 to 2002, there was an average of 12 black infant deaths per 1,000
live births and 4.7 white infant deaths per 1,000 live births. However, the infant mortality
rate of whites increased 84% from 3.5 deaths per 1,000 per live births in 1994 to 6.8 in 2002.
Because of small annual numbers of deaths to Asian and Hispanic infants, a detailed analysis
of these groups is not possible. Compared to whites and blacks, Asians and Hispanics had
the lowest nine-year average infant mortality rates from 1994 to 2002 (Table 10).
Figure 16. Infant mortality rates by race, age 0 - 1 year

Rate per 1,000 live births
16
14
12
10
8
6
4
2
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Total White Black

Table 10. Average nine-year infant mortality rates*
Post-Neonatal No. of No. of
Race/Ethnicity Neonatal Rate Rate Total Rate Infant Deaths Infant Births
White 3.3 1.4 4.7 153 32,649
Black 8.4 3.5 12.0 682 56,961
Asian 1.7 1.9 3.6 15 4,196
Hispanic 2.3 1.1 3.4 37 10,832
* Per 1,000 live births
Of the 13 Community Health Assessment Areas, McNair/Cedar Grove and Lithonia

have the highest infant mortality rate of 13.5 deaths per 1,000 live births
(Figure 17). The communities with infant mortality rates higher than the county
average are concentrated in the southeastern part of DeKalb:
Avondale/Towers/Columbia, Clarkston, Lithonia, McNair/Cedar Grove, Stone
Mountain/Stephenson and Southwest DeKalb/MLK Jr. Dunwoody had the lowest
infant mortality rate of 2.6 infant deaths per 1,000 live births.
The overall DeKalb trend in infant mortality appears to be representative of a

national trend (14). It has been suggested that the rise in infant mortality reflects a
trend among women toward delaying motherhood.

Figure 17.

Adults Age 65 and Over
For the nine-year period from 1994 through 2002, the five leading causes of death to
DeKalb County residents ages 65 and over were heart disease, cancer, stroke,
neurologic disease and chronic lung disease (Figure 18). An average of 2,552
residents aged 65 and over died in each of these nine years. Of these, 1,487 (58%)
were female and 1,812 (71%) were white. The five leading causes of death account
for an average of 1,747 deaths per year, or 68% of all deaths in this age range, for
the period of 1994 to 2002. The neurologic mortality rate, which includes
Parkinson’s and Alzheimer’s diseases, increased the most, by 128% (Table 11).
Figure 18. Trends in mortality among residents aged 65 and over

1800
1600
1400
Deaths per 100,000
1200
1000
800
600
400
200
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Heart disease Cancer Stroke Neurologic disease Chronic lung disease
Table 11. Mortality rates of residents aged 65 and over

Nine-year % change from
Cause of Death avg rate* 1994 to 2002
Heart disease 1437.4 -23%
Cancer 1046.2 -5%
Stroke 403.3 7%
Neurologic disease 227.5 128%
Chronic lung disease 225.1 -16%
* Per 100,000 population
The majority of heart disease deaths in this age group were due to ischemic heart
disease (34%), heart attacks (23%) and heart failures (10%). For women, the major
types of cancer-related deaths were lung cancer (23%), breast cancer (14%) and
colon cancer (12%). For men, lung cancer (31%), prostate cancer (18%) and
colon cancer (9%) were the leading cancer death types.

Leading Causes of Premature Death, Ages 1-64
For persons ages one to 64 years, years of potential life lost (YPLL) is used to
describe leading causes of premature death. Years of potential life lost is a statistic
that measures the total number of years lost due to premature death in a
population from a certain cause. Premature death is defined as death at an age less
than 65 years. YPLL is calculated by subtracting the age of death from 65 years.
The YPLL rate is the number of years of potential life lost before age 65 per 100,000
population ages one to 64.
For example, a person who dies at age 27 in a motor vehicle accident has 38 years
(65 – 27 = 38) of potential life lost, but a person who dies at age 56 of heart disease
has nine years (65 – 56 = 9) of potential life lost. YPLL emphasizes the impact of a
disease on the length of life for younger individuals; it does not describe the
numbers of deaths.
Trends Over Time

From 1994 to 1996, HIV/AIDS was the leading cause of premature death (Figure
19). After 1995, HIV/AIDS premature death rates decreased due to improved
testing and early treatment of people with HIV infection (10). The HIV/AIDS
premature death rate decreased 70% from 1,377 per 100,000 in 1994 to 411 in 2002,
dropping to become the fifth leading cause of premature death in DeKalb County.
Unintentional injury, heart disease, homicide and suicide had less dramatic
decreases in premature death rates from 1994 through 2002, and there was a small
increase in premature death rates of cancer during the same period.
Figure 19. Trends in premature deaths among those age 1-64

1600
1400
YPLL rate per 100,000
1200
1000
800
600
400
200
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Cancer Injury Heart Disease Homicide HIV/AIDS Suicide

Trends by Race/Ethnicity and Gender
Black females
From 1994 to 2002, the leading causes of premature death for black females, in
rank order, were: (1) cancer, (2) heart disease, (3) HIV/AIDS, (4) unintentional
injuries and (5) homicide (Table 12). Cancer was the leading cause of premature
death in all females, regardless of race/ethnicity (Figure 20). Racial disparities
exist in the premature death rates among females. Black females had a heart
disease premature death rate 2.3 times higher, an HIV/AIDS premature death rate
8.7 times higher and a homicide premature death rate 3.5 times higher than white
females.
Table 12. Premature death rate in black females

Nine-year avg % change from
Cause of Premature Death YPLL rate 1994 to 2002
Cancer 772.1 13.7%
Heart disease 516.5 10.8%
HIV/AIDS 380.8 -53.1%
Unintentional injuries 364.3 34.1%
Homicide 228.4 -50.6%
Figure 20. Trends in premature deaths among black females age 1-64
1200
1000
800
600
400
200
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Cancer Heart Disease HIV/AIDS Injury Homicide
Breast and lung cancer contributed 33% and 13%, respectively, to the total cancer
years of potential life lost from 1994 to 2002 (Figure 21). Breast cancer deaths
fluctuated and slightly increased 5% from 1994 to 2002. Lung cancer deaths
increased 11% from 32.5 deaths per 100,000 females in 1994 to 35.6 deaths in 2002.
Lung cancer deaths among black females increased 39% from 1994 to 2002.

Figure 21. Breast and lung cancer age-adjusted mortality rates among females by race

60
Deaths per 100,000 females

50
40
30
20
10
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Breast Cancer - White Breast Cancer - Black Lung Cancer - White Lung Cancer - Black

Health
Health
White females
From 1994 to 2002, the leading causes of premature death for white females, in rank
order, were: (1) cancer, (2) unintentional injuries, (3) heart disease, (4) suicide and (5)
stroke (Table 13). There was a significant increase of heart disease premature death
rates, which increased by 75% from 209 in 1994 to 365 in 2002 (Figure 22). Though
fluctuating throughout the nine-year period, stroke premature death rates decreased
83% from 1994 to 2002.
Table 13. Premature death rate in white females

Cancer 723.0 6.8%
Unintentional injuries 331.8 16.7%
Heart disease 228.1 74.5%
Suicide 144.2 -27.9%
Stroke 69.8 -83.1%
Figure 22. Trends in premature deaths among white females age 1-64
1000
900
800
700
600
500
400
300
200
100
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Cancer Injury Heart Disease Suicide Stroke

Black males
From 1994 to 2002, the leading causes of premature death for black males, in rank
order, were: (1) HIV/AIDS, (2) homicide, (3) unintentional injuries, (4) heart disease
and (5) cancer (Table 14). The greatest change from 1994 to 2002 was in HIV/AIDS
premature death rates with a 61% decrease (Figure 23). Cancer was the only cause
of premature death that experienced an increase in rates. Black males are more
likely to die prematurely due to injuries, both intentional and unintentional, as
opposed to chronic diseases.
Table 14. Premature death rate in black males

HIV/AIDS 1489.8 -61%
Homicide 1262.2 -21%
Unintentional injuries 1160.8 -14%
Cancer 815.5 19%
Figure 23. Trends in premature deaths among black males age 1-64

3500
3000
2500
2000
1500
1000
500
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
HIV/AIDS Homicide Injury Heart Disease Cancer

Health
Data Source: Georgia Division of Public

White males
From 1994 to 2002, the leading causes of premature death for white males, in rank
order, were (1) HIV/AIDS, (2) unintentional injuries, (3) cancer, (4) heart disease
and (5) suicide (Table 15). The greatest change from 1994 to 2002 was in HIV/AIDS
premature death rates with an 87% decrease (Figure 24).
Table 15. Premature death rate in white males

HIV/AIDS 1164.4 -87%
Unintentional injuries 1085.9 -26%
Cancer 681.0 -25%
Suicide 503.3 2%
Figure 24. Trends in premature deaths among white males age 1-64
3000
2500
2000
1500
1000
500
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
HIV/AIDS Injury Cancer Heart Disease Suicide

Hispanics and Asians
It is difficult to analyze trends in premature deaths in the Hispanic and Asian
populations of DeKalb County because of the small number of total deaths in these
groups and a lack of age-specific population figures. However, an analysis of the
leading causes of years of potential life lost (YPLL) for the years of 1998 to 2002 by
gender gives a basic understanding of the major causes of premature deaths.
Generalizations should not be made from these data because the total number of
deaths associated with these years of life lost is very small.
Hispanic females
Cancer claimed 492 years of potential life or 29% of the premature deaths for
Hispanic females from 1998 to 2002 (Figure 25). Leukemia accounted for 54% of
premature death due to cancer, while breast and lung cancer accounted for 7% and
4%, respectively. Unintentional injuries (i.e., motor vehicle and other injuries)
claimed 440 YPLL. Motor vehicle injuries represented 64% of injury YPLL among
Hispanic females. The third leading cause of death among Hispanic females was
homicide, accounting for 251 YPLL or 15% of premature death.
Hispanic males
The leading cause of premature death among Hispanic males from 1998 to 2002 was
unintentional injuries, accounting for 1,630 YPLL or 37% of all premature deaths
(Figure 26). Motor vehicle injuries represented the majority of these injuries, accounting
for 59% of all premature deaths due to injuries and claiming 968 YPLL. The second
leading cause of premature death among Hispanic males was homicide, which claimed
966 YPLL. Heart disease was the third leading cause of death representing nine percent
of premature deaths and 424 YPLL.
Figure 25. Premature deaths among Hispanic females Figure 26. Premature deaths among Hispanic males
DeKalb County, Georgia, 1998 - 2002 DeKalb County, Georgia, 1998 - 2002
All Others
Congenital Anomalies All Others Ill-Defined 10%
3% 6% 3%
Stroke
Pregnancy/Childbirth Cancer HIV/AIDS
4%
Complications 29% 5% Unintentional Injuries
5% 37%
Cancer
Neurologic Disease 7%
6%
Suicide
Heart Disease 8%
6%
Heart Disease
Unintentional Injuries 9% Homicide
Homicide
26% 21%
15%
Total years of potential life lost = 4,530
Total years of potential life lost = 1,715 Data Source: Georgia Division of Public Health

Asian females
Cancer was the leading cause of premature death among Asian females, accounting
for 38% of premature death (Figure 27). From 1998 to 2002, a total of 332 years of
potential life (YPLL) were claimed by cancer. Brain, ovarian and liver cancers were
the most prevalent of all types of cancers, representing 33% of cancer YPLL. The second
leading cause of premature death was unintentional injuries with 143 YPLL. Motor
vehicle injuries accounted for 71% of YPLL due to injuries. Heart disease had the third
highest YPLL of 92 or 10% of total YPLL for Asian females.
Asian males
Unintentional injuries were the leading cause of premature death among Asian males
(Figure 28). Injuries claimed 498 YPLL or 24% of premature deaths. Motor vehicles
accounted for 50% of injuries to Asian males. The second leading cause of premature
death among Asian males was cancer, accounting for 19% of YPLL. From 1998 to 2002,
cancer claimed 384 YPLL of Asian males. Brain cancer claimed the majority of YPLL,
28% of all cancers. The third leading cause of premature death among Asian males
was suicide. A total of 325 years of potential life was lost from 1998 to 2002, representing
16% of all premature deaths.
Figure 27. Premature deaths among Asian females Figure 28. Premature deaths among Asian males
DeKalb County, Georgia, 1998 - 2002 DeKalb County, Georgia, 1998 - 2002
Muscoskeletal & Connective All Others

Tissue Disease All Others Infectious Diseases 10% Unintentional Injuries
4% 9% 3% 24%
Stroke Stroke
4% 5%
Cancer
Pregnancy/Childbirth 38%
Heart Disease
Complications
10%
5%
Homicide
7%
Suicide Cancer
Homicide 19%
7%
13%
Heart Disease Unintentional Injuries
10% 16% Suicide
16%
Total years of potential life lost = 894 Total years of potential life lost = 2,067
Data Source: Georgia Division of Public Health Data Source: Georgia Division of Public Health

County-Wide Trends and Community-Specific Rates
In this section, years of potential life lost (YPLL) is used to compare the causes of
premature death among the 13 Community Health Assessment Areas (CHAAs)
within DeKalb County. Analysis by CHAA is provided for a five-year period
because of the availability of census tract data of the CHAAs, and time-trend data is
provided for a nine-year period. Based on five-year average YPLL rates, the eight
leading causes of premature death are highlighted in this section (Table 16).
Table 16. Leading causes of premature death, ages 1-64

Five-year
Cause of Premature Death YPLL rate*
Cancer 732
Unintentional injuries 698
Heart disease 577
Homicide 461
HIV/AIDS 457
Suicide 225
Stroke 148
*Per 100,000 population
Each CHAA has a unique population, with needs that may be different than the
populations of other areas. These differences may be a result of geographic,
economic, social or cultural factors that influence the health of communities.
Comparison of the average 1998 to 2002 YPLL rates (five-year average) for leading
causes of premature death (e.g., cancer or stroke) among CHAAs provides a starting
point for developing prevention strategies for these communities.

Cancer
Between 1998 and 2002, cancer was the leading cause of premature death among
DeKalb residents. The cancer premature death rate was 732 per 100,000
population. The overall trend for cancer premature death rates did not change
significantly from 1994 to 2002 (Figure 29). Lung cancer caused the highest
proportion of premature death among males, and breast cancer caused the highest
proportion of premature death among females (Table 17).
Cancer premature death rates were highest in the McNair/Cedar Grove CHAA,
with a premature death rate of 1,008 per 100,000 population (Figure 30).
Chamblee/Cross Keys CHAA has the lowest premature death rate of 549 per
100,000. McNair/Cedar Grove CHAA’s premature death rate was approximately
84% higher than the Chamblee/Cross Keys rate.
Figure 29. Cancer premature death rates, ages 1-64

1000
YPLL per 100,000 population
800
600
400
200
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Table 17. Leading causes of premature death due to cancer

based on YPLL
Males* Percent Females** Percent
Lung cancer 22% Breast cancer 32%
Colon cancer 10% Lung cancer 13%
Leukemia 8% Colon cancer 8%
Ill-defined 8% Ill-defined 6%
Brain cancer 8% Brain cancer 6%
Other 44% Other 35%
* Total male YPLL = 19,042; ** Total female YPLL = 19,558

Figure 30.

Unintentional injuries
Injuries were the second leading cause of premature death in DeKalb County, with
a premature death rate of 698 per 100,000 population from 1998 to 2002. The
unintentional injuries premature death rate decreased 11% from 793 in 1994 to 704
in 2002 (Figure 31). Between 1994 and 2002, the leading cause of premature death
due to unintentional injuries for both males and females was motor vehicle
crashes, accounting for 64% of the years of potential life lost (Table 18). From
1994 to 2002, a total of 821 DeKalb residents were killed in motor vehicle crashes.
Premature death due to unintentional injuries was highest in the McNair/Cedar

Grove and Chamblee/Cross Keys CHAAs, with an average premature death rate of
861 and 833 per 100,000 population, respectively (Figure 32). The Decatur CHAA
had the lowest premature death due to unintentional injuries with a rate of 423 per
100,000 population.
Figure 31. Unintentional injuries premature death rates,

ages 1-64
1000
800
600
400
200
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Table 18. Leading causes of premature death due to unintentional

injuries based on YPLL
Motor vehicle 64% Motor vehicle 64%
Poisoning 12% Poisoning 12%
Other accidents 7% Other accidents 11%
Drowning 6% Fire 4%
Falls 5% Drowning 3%
Other 6% Other 6%

Figure 32.

Heart disease
From 1998 to 2002, the third leading cause of premature death in DeKalb County
was heart disease, with a premature death rate of 577 per 100,000 population.
Overall, there was a 12% decline in the premature death rate due to heart disease
from 1994 to 2002 (Figure 33). The premature death rate was 626 per 100,000
population in 1994 and 548 in 2002.
The majority of premature death due to heart disease was categorized as ischemic
heart disease, which excludes heart attacks (Table 19). Ischemic heart disease
accounted for 33% and 18% of years of potential life lost for males and females,
respectively.
Heart disease premature deaths were highest in Atlanta and the McNair/Cedar Grove
CHAAs, with premature death rates of 967 and 947 per 100,000 population, respectively
(Figure 34). The Druid Hills/Lakeside CHAA had the lowest heart disease premature death
rate of 293 per 100,000.
Figure 33. Heart disease premature death rates, ages 1-64

1000
800
600
400
200
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Table 19. Leading causes of premature death due to heart disease

based on YPLL
Ischemic excluding Ischemic excluding
heart attack 33% heart attack 18%
Cardiomyopathy 14% Hypertensive 16%
Heart attack 13% Cardiomyopathy 13%
Ill-defined 12% Pulmonary 11%
Hypertensive 10% Ill-defined 11%
Other 18% Other 31%

Figure 34.

Homicide
As the fourth leading cause of premature death from 1998 to 2002, homicide
claimed an average of 461 years of potential life per 100,000 population. From 1994
to 2002, the homicide premature death rate decreased 16% from 541 per 100,000
population in 1994 to 456 in 2002 (Figure 35). Firearms were the leading method of
homicide for both males and females, accounting for 83% and 46% of years of
potential life lost, respectively (Table 20).
Premature death due to homicide was highest in Atlanta and the Avondale/Towers/
Columbia CHAAs, with premature death rates of 951 and 802 per 100,000 population,
respectively (Figure 36). The Druid Hills/Lakeside CHAA had the lowest homicide
premature death rate with a premature death rate of 73 per 100,000 population.
Figure 35. Homicide premature death rates, ages 1-64

700
600
500
400
300
200
100
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Table 20. Leading methods of homicide based on YPLL

Firearm 83% Firearm 46%
Other/unspecified 10% Other/unspecified 19%
Sharp object 5% Hanging/strangulation 15%
Hanging/strangulation 1% Sharp object 15%
Other 1% Other 5%

Figure 36.

HIV/AIDS
From 1998 to 2002, HIV/AIDS dropped to the fifth leading cause of premature death
after being the leading cause of premature death from 1994 to 1997. The premature
death rate due to HIV/AIDS was 457 per 100,000 population from 1998 to 2002.
Overall, the HIV/AIDS premature death rate decreased 70% from 1994 to 2002
(Figure 37). The HIV/AIDS premature death rate reached a high of 1,510 per
100,000 in 1995, but declined to 411 per 100,000 in 2002.
The HIV/AIDS premature death was, by far, the highest in the Atlanta CHAA, with a rate
of 1,498 per 100,000 population (Figure 38). The premature death rate of Atlanta was
more than double that of the McNair/Cedar Grove CHAA, which had the second highest
rate of 693 per 100,000. The Dunwoody CHAA had the lowest HIV/AIDS premature
death rate of 120 per 100,000 population.
Figure 37. HIV/AIDS premature death rates, ages 1-64

1600
1400
1200
1000
800
600
400
200
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year

Figure 38.

Suicide
Suicide wa s the sixth leading cause of premature death from 1998 to 2002, with a
premature death rate of 225 per 100,000 population. From 1994 to 2002, the
suicide premature death rate declined 15% (Figure 39). The premature death rate
was 294 per 100,000 population in 1994 and 250 in 2002. Similar to homicide,
firearms were the leading method of suicide, accounting for 66% and 60% of years of
potential life lost due to suicide among males and females, respectively (Table 21).
Premature death due to suicide was the highest in the Chamblee/Cross Keys and
Tucker CHAAs, with rates of 365 and 333 per 100,000 population, respectively
(Figure 40). The Decatur CHAA had the lowest premature death rate due to suicide
of 72 per 100,000 population.
Figure 39. Suicide premature death rates, ages 1-64

350
300
250
200
150
100
50
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Table 21. Leading methods of suicide based on YPLL

Firearm 66% Firearm 60%
Hanging 17% Drug overdose 19%
Drug overdose 6% Hanging 14%
Carbon monoxide 4% Jumping 5%
Jumping 4% Carbon monoxide 2%
Other 3%

Figure 40.

Stroke
As the seventh leading cause of premature death from 1998 to 2002, stroke claimed
an average of 148 years of potential life lost annually. Premature death rates due
to stroke declined 6% from 1994 to 2002 (Figure 41). The premature death rate was
145 per 100,000 population in 1994 and 136 in 2002.
Premature death due to stroke was highest in the Avondale/Towers/Columbia,

Atlanta and McNair /Cedar Grove CHAAs, with premature death rates of
245, 226 and 224 per 100,000 population, respectively (Figure 42). The
Chamblee/Cross Keys CHAA had the lowest stroke premature death rate of
73 per 100,000 population.
Figure 41. Stroke premature death rates, ages 1-64

200
180
160
140
120
100
80
60
40
20
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year

Figure 42.

Infectious diseases were the eighth leading cause of premature death from 1998 to
2002 in DeKalb. The premature death rate from infectious diseases was 123 per
100,000 population. From 1994 to 2002, the premature death rate for infectious
diseases increased 16% from 113 in 1994 to 131 in 2002 (Figure 43). The premature
death rate peaked in 1998 at 158 per 100,000, and it decreased the following year to
97. Since 1999, premature death rates due to infectious diseases have been
increasing slightly each year.
For 1998 to 2002, premature death due to infectious diseases was highest in the Atlanta
and Avondale/Towers/Columbia CHAAs, with rates of 234 and 206 per 100,000 population,
respectively (Figure 44). The Dunwoody CHAA had the lowest infectious diseases
premature death rate of 39 per 100,000.
Figure 43. Infectious diseases premature death rates, ages 1-64

180
160
140
120
100
80
60
40
20
0
1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
1
Infectious diseases include blood poisoning, tuberculosis and meningitis; HIV/AIDS is excluded.

Figure 44.

Summary
From a map summarizing the eight leading causes of premature death by
Community Health Assessment Area (CHAA), associations can be made between
causes of deaths and the DeKalb communities most greatly affected (Figure 45).
For the most part, the south DeKalb communities have a higher degree of
premature death due to chronic disease (cancer and heart disease), HIV/AIDS,
homicide, infectious disease and stroke. Suicide and unintentional injuries are
more prevalent in the Chamblee/Cross Keys CHAA, and unintentional injuries are
high in the McNair/Cedar Grove CHAA. Strategies for prevention should focus on
geographic, economic, social and cultural factors that play a role in making these
areas susceptible to higher death rates.

Figure 45.

Opportunities for Prevention
Opportunities for Prevention
There are opportunities for preventing diseases and premature death throughout
DeKalb County and its communities. They may be found where disparities in health
are observed. These disparities are seen where rates of health behaviors, disease or
death vary widely among demographic groups (by age, sex, race/ethnicity) or among
geographic regions (Community Health Assessment Areas).
Many aspects of community life contribute to health. Opportunities for prevention can
be found among any of the factors that affect health status: personal lifestyle choices,
the health care system, policies, and the physical and social environments. These
factors are not independent of each other, and changes in one factor may complement
or support changes in another. For example, individuals who decide to eat more fruits
and vegetables will need accessible and affordable food choices in their community and
workplace for this lifestyle change to be effective. In this example, a lifestyle choice
would be supported by changes in policies and the environment.
Based on the Status of Health priority areas (promoting healthy eating and physical
activity, reducing tobacco use, preventing injuries and eliminating health disparities)
and the four factors of health status (personal lifestyle choices, the health care system,
policies, and the physical and social environments), the following are just a few examples
of opportunities for prevention in DeKalb County:
Actions for Healthy Lifestyles
Increase physical activity and eat better - Take the stairs, take the dog for a walk, drink
more water, eat five fruits and vegetables a day. See www.smallstep.gov or
www.5aday.gov for more ideas on incorporating movement into your everyday life
and improving your diet.
Avoid tobacco - If you smoke, stop; if you don't smoke, don't start. Call the toll-free
Georgia Tobacco Quit Line (1-877-270-STOP) to get help to quit smoking.
Drive responsibly and practice injury prevention - Wear your seatbelt, use child-safety
seats, limit driver distractions, don't drink and drive. See www.safekids.org for
more safety tips.
Actions for the Health Care System
Increase culturally competent resources - Provide translation services, train health care
staff on cultural competency issues. See www.omhrc.gov about cultural
competence issues.
Promote a comprehensive plan for health promotion and disease prevention - Partner
with other providers, implement weight control and disease management strategies.

Actions for Healthy Policies
Support clean indoor air ordinances - Don't allow smoking in confined areas, advocate
for local and state ordinances. Contact the Prevention Alliance for Tobacco Control and
Health (PATCH) coalition to find out about clean indoor air ordinances in DeKalb County:
www.dekalbhealth.net/community-collaborations/tobacco-prevention.asp .
Develop healthy workplaces - Provide healthy food options in cafeterias, promote use of
stairs, provide time for physical fitness.
Implement a plan for healthy schools - Support implementation of the nutrition and
physical activity policy in all DeKalb County schools, advocate for policies to keep our
children healthy. See www.cdc.gov/HealthyYouth for information on school health.
Actions for a Healthy Environment
Build and maintain safe communities - Improve lighting on roads and sidewalks and
construct sidewalks, pedestrian refuge islands and crosswalks. See
www.nhtsa.dot.gov/people/injury/safe_communities for information about making your
community safer.
Participate in partnerships with community groups - Work to improve the social and
physical environment of areas suffering from health disparities. See
www.healthydekalb.org for information about community partnerships.
Healthy communities mean more than the absence of disease and early death. Intact,
supportive families; economic vitality leading to quality jobs; clean and safe environments;
and trusted and effective institutions (school, faith, health, government and business),
social associations and alliances that respect diversity all contribute to the quality of life
in DeKalb County. Community assets are the essential building blocks for preventing
disease and premature deaths. These same assets are the resources that also preserve
the advances that have occurred in health status. Healthy people grow up and live in
healthy communities.

Prevention Opportunities
Premature mortality is preventable. Experts estimate that more than 50% of the disease
and conditions that lead to early death can be eliminated. A practical approach focuses on
the risk factors that lead to disease. By identifying and reducing risk factors, communities
reduce premature death. The following table depicts the relationship between several
important risk factors and the diseases and conditions described in this report.
Table 22. Risk reduction by disease or condition

Prevention by Risk HIV/AIDS Injuries Cancer Homicide Heart Suicide Stro ke Infant Teen
Reduction Disease Health Pregnancy
Eat a healthy diet
X X X X
Maintain normal body
weight X X X
Exercise regularly
X X
Control blood pressure
X X
Control blood sugar
X X X
Reduce cholesterol
X X
Avoid tobacco use
X X X X X X
Reduce alcohol
consumption X X X X X X
Avoid drug use
X X X X X X X
Avoid sexual risks
X X X
Avoid violence/stress
X X X X
Limit availability of
guns X X X
Use seatbelts
X
Use car seats
X
Avoid sun exposure
X
Perform breast self
exam X
Perform testicular self
exam X
Have a colorectal exam
X
Have a mammogram
X
Have a Pap smear
X
Plan families
X X

Appendices
Methodology
Glossary of terms
References
Methodology
The method of data analysis chosen for the Status of Health in DeKalb: Opportunities
for Prevention and Community Service, 2005 presents the results in a format that is
compatible with the previous documents in this series. All health data presented in this
report were the latest available data released from the Georgia Department of Human
Resources or from the DeKalb County Board of Health.
The birth and death data were compiled from official birth and death certificate data
from the Georgia Division of Public Health, Office of Health Information and Policy.
The data were checked for errors and missing information and geographically coded to
census tracts within Community Health Assessment Areas (CHAAs). Using the
International Classification of Diseases, 9th Edition (ICD-9) and 10th Edition (ICD-10),
primary causes of death found on the death certificates were grouped into cause of death
categories (Table 23). The causes of death groups used in this report were those
recommended by the Assessment Protocol for Excellence in Public Health (APEX-PH),
developed in 1991 by the National Association of County Health Officials (now known
as the National Association of County and City Health Officials).
The whole county population estimates were obtained from the U.S. Bureau of the
Census and were broken down by year, age, race, sex and ethnic origin. The population
estimates for each of the CHAAs in DeKalb County were derived from 2000 U.S. Census
Bureau census tract estimates. DeKalb County has large numbers of people who identify
themselves as Asians or of Hispanic origin compared to other counties in Georgia.
However, the total populations for each of these groups are small for statistical purposes
and make analysis by age or sex problematic. Therefore, only limited analysis of these
groups is included in this report.
All birth-related rates were computed per 1,000 females, and infant mortality rates
were computed per 1,000 live births. All disease and mortality-related rates were
computed per 100,000 population. This was done so that the statistics would be consistent
with those presented by other sources and to make comparisons across populations.
Years of potential life lost (YPLL) rate is used to show comparative causes of premature
death to specific populations. The YPLL rates were calculated per 100,000 population
between the ages of one and 64 years of age.
We computed separate lifestage-specific mortality rates for populations in DeKalb

County age 65 and older. Lifestage-specific age groupings were adopted to calculate
age-specific mortality rates. These categories are the same as those presented in the
Georgia Vital Statistics Report, printed by the Georgia Division of Public Health, and
were used to help facilitate comparisons with this significant source.

Table 23. Cause of death grouping by International Classification of Diseases, 9th Edition and 10th Edition
ICD-9 ICD-10 Category

042-044 B20-24 AIDS, HIV infection
140-208 C00-C97 Cancer
191-192 C71-C72 Brain cancer
174-175 C50 Breast cancer
153-154 C18-C21 Colon/rectal cancer
204-208 C91-C95 Leukemia
155 C22 Liver cancer
162 C34 Lung cancer
183 C56 Ovarian cancer
72-173 C43-C44 Skin cancer
430-438 I60-I69 Cerebrovascular Disease
490-496 J40-J47 Chronic Obstructive Pulmonary Disease
250 E10-E14 Diabetes
520-569, 574-579 K00-K67, K80-87, K90-93 Digestive tract conditions
580-629 N00-N99 Genitourinary disease
390-429 I00-I52 Heart disease
410 I21 Heart attack
411-414 I20-I25 Other ischemic heart disease
401-405 I10-I15 Hypertensive disease
390-398, 415-429 I00-I09, I26-I52 Other heart disease
E960-E969 X85-Y09, Y87.1 Homicide
E965 X93-X95 Firearm
E963 X91 Hanging
001-041, 045-139 A00-A99, B00-B19, B25-B99 Infectious & parasitic diseases
570-573 K70-K77 Liver disease
290-319 F00-F99 Mental and behavioral disorders
710-739 M00-M99 Musculoskeletal & connective tissue diseases
320-359, 780.5 G00-G99 Neurological diseases
240-246, 251-279 E00-E07, E15-E16, E20-E35, E40-E46, Nondiabetic endocrine diseases
E50-E68, E70-E90
480-487 J10-J18 Pneumonia/Influenza
E950-E959 X60-X84, Y87 Suicide
E952.0, E952.1 X67 Carbon monoxide
E950 X60-X64 Drug overdose
E955 X72-X74 Firearm
E953 X70 Hanging
E957-E958.0 X80-X81 Jumping
E958.8 X69, X76, X83, Y87.0 Other method
E800-E949 V01-X59, Y85-Y86 Unintentional injuries
E810-E819 V03-V04, V09, V13-V14, V19.4, V19.6, V23- Motor vehicle accidents
V24, V27-V29, V43-V44, V47-V49, V57-
V59, V68-V69, V86-V87, V89
E910 W65-W74 Drowning
E880-E888 W00-W19 Falls
E890-E899 X00-X09 Fire/smoke
V81.2, V89.9, V90.6, V95.9, W28, W31, E830.0, E830.9, E832.9, E838.9, E841.2, Other accidents
W40, W75, W76, W78, W79, W80, W83, E841.3, E841.5, E844.7, E848, E900.0,
W84, W85, W86, W94, X11, X30, X31, E901.0, E901.9, E906.8, E907, E911, E912,
X53, X57, X58, X59, Y85, Y86 E913.0, E913.8, E913.9, E919.0, E919.2,
E919.8, E920.8, E924.0, E925.0, E925.1,
E927, E928.9, E929.0, E929.3, E929.5
E850-E858 X40-X49 Poisoning
761-763, 767-768 P00-P04, P10-P15, P20-P21 Newborn complications
764-766, 769 P05, P07, P22 Prematurity and respiratory distress syndrome
770 P23-P29 Other perinatal respiratory conditions
771 P35-P39 Perinatal infections
760, 766, 772-779 P00, P08, P50-P61, P70-P78, P80-P83, Other perinatal conditions
P90-P96
740-759 Q00-Q99 Congenital anomalies
798 R95 Sudden Infant Death Syndrome

Information for geographic areas within the county were calculated by totaling data
from census tracts, using the 1995-1996 senior high school districts as a guide to create
13 Community Health Assessment Areas (CHAAs). The boundaries of the CHAAs are
not identical to the school district lines, but they conform to the census tract boundaries
that are the "best fit" to the high school districts. Though the senior high districts have
changed (e.g., M.L. King, Jr., and Stephenson high schools are new senior high schools,
and Shamrock and Henderson have been converted into middle schools), the original
CHAAs have been maintained to provide consistency in reporting and allow comparisons
between Status of Health in DeKalb reports. Table 3 provides population estimates of
the CHAAs, based on data provided by the U.S. Bureau of the Census.
The CHAA maps were created using ArcGIS software. The CHAA maps show the
average five-year (1998 to 2002) infant mortality and premature death rates. The
causes of premature death selected were those conditions that ranked among the top
eight for the county: cancer, unintentional injuries, heart disease, homicide, HIV/AIDS,
suicide, stroke and infectious diseases. For the five-year time period and each cause of
death, the average number of years of potential life lost (YPLL) were calculated per
100,000 persons per CHAA. Based on natural breaks in the data set, the YPLL rates
were partitioned into five subsets. Finally, each CHAA was charted with a shade of
color indicative of the value of its YPLL rate; CHAAs with YPLL rates in the lower
subsets have a lighter shade of color than those in the higher subsets.

Glossary of Terms
Adolescence: 13 to 19 years of age. Morbidity: Illness or injury due to a particular
Age-Specific Mortality Rate: Total deaths in a cause.
specified age group per 100,000 total population in Mortality: Deaths to a specific geographic
that age group. population over a specific period of time.
AIDS: Acquired immunodeficiency syndrome is a Motor Vehicle Injuries: Includes all injuries where
weakening of the immune system caused by the HIV a motor vehicle was involved.
virus. Neurological Disease: Diseases related to the
APEX-PH: Assessment Protocol for Excellence in brain, such as meningitis, encephalitis and multiple
Public Health. sclerosis.
BMI: Body Mass Index is a relationship between Obese: At or above the 95th percentile for body mass
weight and height that is associated with body fat index by age and sex.
and health risk. Older Adult: 75 years of age and older.
BRFSS: Behavioral Risk Factor Surveillance Overweight: At or above 85th and below the 95th
System. percentile for body mass index by age and sex.
Cancer: Includes all types of cancer. Pedestrian Deaths: Motor vehicle-related deaths to
Cause-Specific Mortality Rate: Total deaths from individuals not in a motorized vehicle.
a specific cause per 100,000 total population. Pediatric: Related to infants and children.
CDC: Centers for Disease Control and Prevention. Premature Mortality: Death before age 65.
CHAA: See Community Health Assessment Area. Race: Racial/ethnic classifications are tabulated into
Community Health Assessment Area (CHAA): mutually exclusive Asian, black, Hispanic, Native
A group of adjacent census tracts combined, used in American, and white groups. Because of the way
geographic mapping, based on senior high school population estimates are computed, members of
district boundaries. "other" populations are estimated as part of the
Child: One to 12 years of age. white group.
Chronic Liver Disease: Examples include cirrhosis Refugee: Person admitted to the U.S. who has been
of the liver and chronic hepatitis. persecuted or has fear of persecution on account of
Chronic Lung Disease: Examples include asthma, race, religion, nationality, membership in a
chronic bronchitis, emphysema and chronic particular social group or political opinion.
obstructive pulmonary disease. SOH: Status of Health.
Early Adult: 20 to 44 years of age. Stroke: All cerebrovascular disease. Caused by
Ethnicity: See Race. blockage of blood flow to the brain or bleeding into
General Fertility Rate: Total live births per 1,000 the brain.
women 15 to 44 years of age. Teenage: 10 to 19 years of age.
Heart Disease: Includes acute myocardial Teen Birth Rate: Total live births to females 10 to
infarction, atherosclerosis, chronic rheumatic heart 19 years of age per 1,000 females 10 to 19 years of
disease, diseases of arteries/capillaries, diseases of age.
veins, hypertensive disease, ischemic heart disease Teen Pregnancy Rate: Total pregnancies to
and other forms of heart disease. females 10 to 19 years of age per 1,000 females 10 to
Highway: Roadways that are part of the Georgia 19 years of age.
Department of Transportation state road system. Unintentional Injuries: Injuries that are a result
Usually a four-lane divided highway, but can have of an unplanned action or are accidental (e.g., motor
fewer than four lanes and a divider. vehicle accidents, falls, drowning, fire/smoke
HIV: The human immunodeficiency virus (HIV) that exposure, poisoning). It excludes homicide and
causes acquired immunodeficiency syndrome (AIDS). suicide.
ICD-9: International Classification of Diseases, 9 th YPLL: See Years of Potential Life Lost.
Edition. Years of Potential Life Lost (YPLL): Years of
ICD-10: International Classification of Diseases, 10th potential life lost after one year of age and prior to
Edition. age 65 is an index used to determine the relative
Induced Abortion: Intentional termination of a number of potential years lost for a specific cause of
pregnancy. mortality. This index is calculated by subtracting
Infancy: Under one year of age. the age of death from 65.
Infant Mortality: A death occurring to a person less YPLL Rate: Years of potential life lost after one year
than one year of age. of age and prior to age 65 per 100,000 population.
Infant Mortality Rate: Total infant deaths per YRBS: Youth Risk Behavior Survey.
1,000 live births.
Later Adult: 60 to 74 years of age.
Middle Adult: 45 to 59 years of age.

References
1. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and
Health Promotion. Improving Nutrition and Increasing Physical Activity. Retrieved January 22,
2004, from www.cdc.gov/nccdphp/bb_nutrition/index.htm .
2. DeKalb County Board of Health. DeKalb County Youth Risk Behavior Survey. 2003.
3. DeKalb County Board of Health. DeKalb County Behavior al Risk Factor Survey. 2001.
4. Schwartz M, Jacob AE. DeKalb County Pedestrian Crash Report, DeKalb County, Georgia,
August 2003. Report available on www.dekalbhealth.net/information/injury-prevention-
injurydata.asp .
5. Healthy People 2010 Goals. Retrieved July 9, 2004, from www.healthypeople.gov .
6. Maternal and Child Health Epidemiology Section, Epidemiology Branch, Division of Public
Health, Georgia Department of Human Resources. Trends in Pregnancy Rates in 15-19 Year Old
Females in Georgia, 1994-2002. January 15, 2004. Retrieved January 26, 2004, from
http://health.state.ga.us/epi/mch/publications.asp .
7. Hoban CA. Georgia Immunization Study 2002 Final Report. Retrieved January 27, 2004, from
http://health.state.ga.us/epi/mch/publications.asp .
8. Georgia Epidemiology Report. Vol. 17, No. 11. November 2001. Retrieved May 11, 2004, from
http://health.state.ga.us/epi/manuals/ger.asp .
9. Centers for Disease Control and Prevention, Foodborne and Diarrheal Diseases Branch.
Campylobacter, Cyclospora, Cryptosporidia, E.coli O157:H7, Listeria, Salmonella, Shigella,
Vibrio and Yersinia. Retrieved May 11, 2004, from www.cdc.gov/foodnet .
10. Georgia Department of Human Resources, Division of Public Health. Georgia HIV/STD Report
1998-1999. Retrieved May 11, 2004, from http://health.state.ga.us/epi/manuals/pdf/hivstd01.pdf .
11. Georgia Department of Human Resources, Division of Public Health. An Overview of Gonorrhea
and Chlamydia in Georgia. Retrieved September 14, 2004, from
http://health.state.ga.us/epi/manuals/pdf/gonorrhea_chlamydia.pdf .
12. Georgia Department of Human Resources, Division of Public Health. 2002 Georgia Tuberculosis
Report. Retrieved May 11, 2004, from http://health.state.ga.us/pdfs/epi/tb/tbreport.02.pdf .
13. National Vital Statistics Reports. Vol. 52, No. 3. 2003. Retrieved December 29, 2003, from
www.cdc.gov/nchs/fastats/pdf/mortality/nvsr52_03t33.pdf .
14. Kochanek KD, Smith BL. Deaths: Preliminary Data for 2002. National Vital Statistics Reports.
Vol. 52, No. 13. Hyattsville, Maryland, National Center for Health Statistics 2004. Retrieved
March 9, 2004, from www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_13.pdf .

We appreciate your comments regarding The Status of Health in DeKalb Report
Direct inquiries and comments to :
DEKALB COUNTY BOARD OF HEALTH
Division of Health Assessment and Promotion
445 Winn Way, P.O. Box 987
Decatur, GA 30031
(404) 294-3700
Info@dekalbhealth.net
The DeKalb County Board of Health gratefully acknowledges the supporters

of the Status of Health in DeKalb Report:
Children's Healthcare of Atlanta
DeKalb Medical Center
Grady Health System
Kaiser Permanente
Check out the Status of Health in DeKalb Report online at www.dekalbhealth.net

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2005

Status of Health in DeKalb Report

Status of Health in DeKalb Report

For updates on the Status of Health in DeKalb Report, visit

Design and production by the Office of Public Relations:

Contributors and expert reviewers:

Elise M. Beltrami, M.D., M.P.H. Edna Holloway, M.Ed.

Fred Agel Melissa Manrow

Crawford Lewis, Ph.D. Leonard Thrower Vernon Jones Darold Honore

J. Frederick Agel Anthony George, Jr. Victor Lui, M.D.

Consumer appointed by Public health consumer Physician appointed by

"Here for Your Health"

Our mission is to promote and provide quality preventive

Member of the DeKalb County Board of Health

Mr. Maloof tackled tough issues in human services by

It would be difficult to find an elected official with more

Commissioner Walker was elected to the Board of

A former member of the DeKalb County Primary

Demographics of DeKalb County

Health priority areas

Trends in births and teen pregnancies

Infectious diseases and leading causes of hospitalizations

Opportunities for prevention 64

Status of Health in DeKalb Report, 2005

In 2001, DeKalb County began a community-wide strategic planning process for

Status of Health in DeKalb Report, 2005

Status of Health in DeKalb Report, 2005

2000 U.S. Census Data

DeKalb County, Georgia

2 Status of Health in DeKalb Report, 2005

Public Schools in DeKalb County

Table 2. Profile of Public Schools in DeKalb County*

Demographics and Other Factors DeKalb State

Status of Health in DeKalb Report, 2005 3

Table 3. Demographic profile of DeKalb Community Health Assessment Areas

4 Status of Health in DeKalb Report, 2005

Status of Health in DeKalb Report, 2005 5

Nutrition and physical activity

2003, 17% were overweight, Female Obese

vegetables per day

8 Status of Health in DeKalb Report, 2005

engaged in vigorous physical Total Ate 5 or more

rate of 63%). Sixty-six percent

daily basis (compared to the Hispanic

U.S. rate of 56%). In addition, All other races

56% of students watched more Mutiple races

than three hours a day of 0 20 40 60 80 100

and physical activity behaviors

Seventy-two percent (72%) of

sitting or standing. Twenty-two 40

reported that they engaged in 10

vigorous physical activities 0

Fifty-one percent (51%) of DeKalb Hispanic

smoking compared to females,

Thirty-five percent (35%) of

least 100 cigarettes in their Total

Of those who have smoked, just 0 10 20 30 40 50 60

tried to quit within the past year.

10 Status of Health in DeKalb Report, 2005

Status of Health in DeKalb Report, 2005 11

Deaths per 100,000 population

age groups (Figure 7). Homicide Adolescence (13-19)

to five times higher for black males Later Adult (60-74)

females. High levels of violence