title: Monitoring progress in population health: trends in premature death rates.
abstract: BACKGROUND
  Trends in population health outcomes can be monitored to evaluate the performance of population health systems at the national, state, and local levels. The objective of this study was to compare and contrast 4 measures for assessing progress in population health improvement by using age-adjusted premature death rates as a summary measure of the overall health outcomes in the United States and in all 50 states.
  
  
  METHODS
  To evaluate the performance of statewide population health systems during the past 20 years, we used 4 measures of age-adjusted premature (<75 years of age) death rates: current rates (2009), baseline trends (1990s), follow-up trends (2000s), and changes in trends from baseline to the follow-up periods (ie, "bending the curve").
  
  
  RESULTS
  Current premature death rates varied by approximately twofold, with the lowest rate in Minnesota (268 deaths per 100,000) and the highest rate in Mississippi (482 deaths per 100,000). Rates improved the most in New York during the baseline period (-3.05% per year) and in New Jersey during the follow-up period (-2.87% per year), whereas Oklahoma ranked last in trends during both periods (-0.30%/y, baseline; +0.18%/y, follow-up). Trends improved the most in Connecticut, bending the curve downward by -1.03%; trends worsened the most in New Mexico, bending the curve upward by 1.21%.
  
  
  CONCLUSIONS
  Current premature death rates, recent trends, and changes in trends vary by state in the United States. Policy makers can use these measures to evaluate the long-term population health impact of broad health care, behavioral, social, and economic investments in population health.
authors.affiliation: Population Health Institute, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 4263 Health Science Learning Center, 750 Highland Ave, Madison, WI 53705. E-mail: plreming@wisc.edu.
authors.forename: Patrick L
authors.initials: PL
authors.lastname: Remington
authors.affiliation: Population Health Institute, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Bridget B
authors.initials: BB
authors.lastname: Catlin
authors.affiliation: Population Health Institute, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: David A
authors.initials: DA
authors.lastname: Kindig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S. / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature / Q000639:trends*; D011159:Population Surveillance; D064890:Social Determinants of Health; D014481:United States / Q000453:epidemiology; D055815:Young Adult