A Tale of Two Regions

Our recent research on premature death rates in Georgia produced a couple of unexpected revelations, and we decided to loop back for a closer look.  The revelations involve two of our five regions, North Georgia and Middle Georgia.  (For a quick primer on that earlier work, click here, here and here.)

For our purposes, North Georgia is made up of 41 counties that lie outside Metro Atlanta and above the gnat line (see map below and click on the map for a larger view).  As a region, it has clearly benefited from its proximity to Metro Atlanta; in recent decades, it has posted far and away the second-strongest population and economic growth in the state, outpacing not only Middle and South Georgia, but the Coastal region as well.

Our Middle Georgia region is a 43-county territory that runs across the belly of the state from Columbus and the Alabama line on the west to Augusta and the South Carolina line on the east.  In most respects, Middle Georgia has more in common with South Georgia than with other regions of the state.  It’s heavily rural and relatively poor; its economic performance lags significantly behind North Georgia and Metro Atlanta and is only modestly better than its cousins to the south.

But when it comes to premature death, Middle Georgia seems to be making admirable progress – especially when contrasted to North Georgia.  To be clear, North Georgia’s premature death rates (formally known as YPLL 75 Rates, for Years of Potential Life Lost Before Age 75) are significantly better than Middle Georgia’s.  But over the 20-year period for which the State of Georgia’s Department of Public Health (DPH) has compiled data[i], Middle Georgia has been steadily gaining ground while North Georgia’s performance in some respects lags behind even South Georgia.

This table, for example, illustrates the progress over that 20-year period in our five regions’ overall YLL 75 Rates.[ii]

With YPLL 75 Rates, the lower the number, the better.  Metro Atlanta started out with the best rates and improved by nearly 30 percent; its premature death rates today would compare favorably with many of the healthiest urban areas in the country.  North Georgia started the 20-year period with the second-best rates but slipped to third place by the end of the period, falling behind Coastal Georgia.  Middle Georgia started and finished in third place, but it improved by 15.9 percent, slightly outpacing the more affluent and healthier Coastal Georgia region.  North Georgia, meanwhile, barely outperformed South Georgia.

Another, admittedly unconventional way to illustrate the widening difference in premature death performance between North Georgia and Middle Georgia is to look not at the YPLL 75 Rates themselves – which can be a little abstract – but at the literal number of years of potential life lost in the two regions.  This is data the public health community collects and compiles as part of the process of calculating the premature death rates.  Here’s how it works.  If a 60-year-old man dies in Fulton County, he contributes 15 years to Fulton’s pot of “potential life lost” before age 75 (75 – 60 = 15).  If a baby girl dies at the age of two in Cobb County, she adds 73 years to Cobb’s roster of “potential life lost”.  And so on.  All those years of potential life lost are then added up and used to calculate the premature death rates, by county and year.

In 1994, there were a total of 630,152 years of potential life lost in Georgia; by 2013, that number was up to 706,347, an increase of 12.1 percent.  During that same period, the state’s YPLL-eligible population grew 39 percent – so the 12.1 percent increase in years of potential life lost wasn’t bad.  With a growing population, you’d expect the raw number of years of potential life lost to rise as well.[iii]  The gap between the two might be seen as a crude macro measure of the quality of health care in a given area.

Against that backdrop, the regional differences are a little startling.

Between 1994 and 2013, North Georgia’s YPLL-eligible population[iv] grew 45 percent, to 1.77 million from 1.22 million.  During this same period, the raw number of years of potential life lost in the 41-county region grew from 109,470 to 138,828, an increase of 26.9 percent.

Middle Georgia, meanwhile, saw population in its 43 counties grow at a more modest 19.1 percent rate – to 1.63 million from 1.37 million.  But its raw total of years of potential life lost before age 75 actually dropped slightly – from 145,969 to 144,252, a 1.2 percent improvement.

That seems remarkable – to literally reduce the number of years of potential life lost in a given area over a 20-year period, even with a near-20 percent increase in population.

The obvious question is why?  What’s happening in these two regions of the state that is producing such different premature death patterns?

The answers to those questions will require more time and on-the-ground research, but a couple of observations seem in order.  Middle Georgia pretty clearly has a much more robust health care infrastructure than North Georgia.  The region is anchored by the cities of Columbus, Macon and Augusta, which among them have about 10 major hospitals (three of which are trauma centers) and strong medical communities, as well as a handful of mid-sized hospitals across the region.  It also boasts three of the most significant military installations in the state – Fort Benning, Robins Air Force Base and Fort Gordon – which provide health care to military personnel.  And, of course, Middle Georgia is home to two of the state’s medical colleges – Regents University in Augusta and Mercer in Macon.  Is all that paying off in terms of improved premature death rates?

Most North Georgians, of course, probably have easier access to Metro Atlanta’s hospitals and medical community, but outside the metro region there are only a handful of major hospitals – two apiece in Athens and Rome, and one in Gainesville.  And without a local hospital, it’s very difficult to recruit physicians to a community.  Has North Georgia’s explosive population growth outstripped the region’s capacity to provide health care for its residents?  Is the region paying a price in terms of worse premature death rates – and perhaps other health metrics?

We’ll explore those questions in a future post.

2015 North and Middle Georgia Map

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[i] Unless otherwise indicated, all the data referenced in this post was drawn initially from DPH’s online OASIS system; the analysis, however, is entirely our own.

[ii] For the purposes of this analysis, we’ve calculated and are using three-year rolling average YPLL 75 Rates.  There are a couple of reasons for that.  One is that it’s a preferred technique in this kind of analysis; the multi-year averages smooth out big one-year swings (up or down) that may not be truly indicative of actual trends.  The second reason is that 2013, the last year for which DPH has data, produced one of those big one-year swings.  According to the OASIS system, Georgia’s statewide YPLL 75 Rate suffered a 4.37 percent increase, the second biggest recorded by DPH (the biggest was a 4.84 percent improvement in 2010).  We felt that using the 2013 single-year data as the end-point in our analysis might paint an artificially poor picture and that the three-year rolling averages would be more reliable.  That said, it seems worth emphasizing that the 2013 increase was a big one and that it showed up no matter how we sliced the data – by region, by age group, by ethnicity and by gender.

[iii] Here, we’re using single-year numbers in discussing the actual number of years of potential life lost and population figures.  That seemed more appropriate in developing an end-to-end look at these two data points.

[iv] YPLL-eligible population refers to the number of people below the age of 75; it excludes people 75 and older.

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