| Course | NUR 603 Epidemiology |
|---|---|
| Module | Module 5 |
| Paper type | Milestone: descriptive epidemiology with age-adjusted rates |
| Length | About 1,060 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 603 Module 5
Milestone Two: Person, Place and Time, Age-Adjusted Alcohol-Induced Death Rates for Ridgeline County Women in Midlife, 2018 to 2022
[Student Name]
Southern New Hampshire University
NUR 603: Epidemiology
Milestone Two
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Milestone Two: Person, Place and Time, Age-Adjusted Alcohol-Induced Death Rates for Ridgeline County Women in Midlife, 2018 to 2022
Milestone One defined an alcohol-induced death among Ridgeline County women aged 45 to 64 and chose to pool 2018 through 2022 because single-year counts are small. This milestone describes the problem. It calculates age-specific and age-adjusted rates, compares them by sex, by residence within the county, with the state and over time, and attaches a confidence interval to each so that the reader can judge how much chance alone might explain. It argues that the county rate is high and rising, that two comparisons are statistically clear and that two others, though suggestive, are not yet.
Methods
Deaths were counted using the NCHS alcohol-induced ICD-10 codes, by county of residence, from death certificate data. Denominators came from the Census Bureau's yearly county estimates for the two ten-year age bands, added across the five years to give person-years. Rates are expressed per 100,000 person-years. Because the older age group has a higher death rate and makes up a different share of the population in different places, rates were age adjusted by the direct method using the 2000 US standard population, which is the standard used in national reporting (Spencer et al., 2022). Within the 45 to 64 range, the standard gives a weight of 0.607 to ages 45 to 54 and 0.393 to ages 55 to 64. Confidence intervals were calculated with a normal approximation to the Poisson distribution, and rate ratios with intervals on the log scale. With small counts these intervals are approximate and, if anything, slightly too narrow.
Person: Age and Sex
Over the five years, 64 women aged 45 to 64 died of alcohol-induced causes, for a crude rate of 31.1 per 100,000 person-years. Table 1 shows the age-specific rates. The rate among women aged 55 to 64 was about twice the rate among women aged 45 to 54, consistent with national data showing the highest alcohol-induced death rates in the 55 to 64 age group (Spencer et al., 2022). Applying the standard weights gives an age-adjusted rate of 0.607 multiplied by 20.9 plus 0.393 multiplied by 41.0, or 28.8 per 100,000, with a 95% confidence interval of 21.5 to 36.0.
Table 1. Alcohol-Induced Deaths by Age and Sex, Ridgeline County, 2018 to 2022
| Group | Deaths | Person-years | Rate per 100,000 (95% CI) |
|---|---|---|---|
| Women 45 to 54 | 21 | 100,500 | 20.9 |
| Women 55 to 64 | 43 | 105,000 | 41.0 |
| Women 45 to 64, age adjusted | 64 | 205,500 | 28.8 (21.5 to 36.0) |
| Men 45 to 54 | 52 | 97,900 | 53.1 |
| Men 55 to 64 | 79 | 101,900 | 77.5 |
| Men 45 to 64, age adjusted | 131 | 199,800 | 62.7 (51.7 to 73.7) |
Note. Composite county data. Age adjusted to the 2000 US standard population within ages 45 to 64.
Men of the same age died at an age-adjusted rate of 62.7 per 100,000. The rate ratio of men to women is 62.7 divided by 28.8, or 2.18, with a 95% confidence interval of 1.62 to 2.94. The gap is real, but it is narrower than the national figure of 2.88 across all ages reported by Karaye et al. (2023), which fits the national finding that women's rates have been rising faster. Among the 64 deaths in women, 49 (77%) were from alcoholic liver disease, 11 (17%) from mental and behavioral disorders due to alcohol, 3 from alcohol poisoning and 1 from another code.
Place
Within the county, women in the rural townships had a crude rate of 39.7 per 100,000 (31 deaths over 78,000 person-years), compared with 25.9 in the urban core (33 deaths over 127,500 person-years). The rate ratio is 1.53, with a 95% confidence interval of 0.94 to 2.50. Because the interval includes 1 and these rates are crude, the rural excess may partly reflect an older rural population and cannot be called statistically clear. Compared with the state rate for women aged 45 to 64 of 24.1 per 100,000, the county's age-adjusted rate is 1.19 times higher, but the county interval of 21.5 to 36.0 includes the state value. Variation between places is large nationally: the share of deaths among adults aged 20 to 64 attributable to alcohol ranged from 9.3% to 21.7% across states (Esser et al., 2022).
Time
In 2018 and 2019 combined, 18 women died, a rate of 22.1 per 100,000 person-years. In 2021 and 2022, 32 died, a rate of 38.6. The ratio of the later to the earlier period is 1.75, with a 95% confidence interval of 0.98 to 3.12. The single year of 2020, with 14 deaths, had a rate of 34.0. The direction matches the national increase during and after the first pandemic year, and the size of the change is large, but the interval just includes 1, so chance cannot be excluded with only five years of county data. These period rates are crude, although the age structure of the population changed little over five years.
Interpretation
Three findings are firm enough to act on. The age-adjusted rate is substantial, at 28.8 per 100,000. Older women in the range carry about twice the risk of younger ones. And most deaths are from alcoholic liver disease, which develops over years and is therefore preventable at several stages. Two findings are suggestive: a higher rate in the rural townships and a rise after 2020. The undercounting described in Milestone One means all these rates are probably minimums. A larger sample, from adding years or linking to hospital data, would be needed to confirm the rural and time differences.
Two alternative explanations deserve mention before the findings are used. First, if certifiers in the rural townships are less likely than hospital physicians in the urban core to record alcohol on a death certificate, the true rural excess could be larger than it appears; if rural deaths are more often reviewed by a coroner who orders toxicology, it could be smaller. Second, the rise after 2020 could partly reflect deaths that would have occurred later being brought forward by delayed care during the pandemic, rather than a lasting increase in risk. Neither possibility can be settled with these data, but both shape how cautiously the findings are presented to the county health board.
Conclusion
Alcohol-induced deaths among Ridgeline County women aged 45 to 64 occurred at an age-adjusted rate of 28.8 per 100,000 in 2018 through 2022, higher among women aged 55 to 64 and dominated by liver disease. Milestone Three will use these findings to design primary, secondary and tertiary prevention and to choose measures for evaluating them.
References
Esser, M. B., Leung, G., Sherk, A., Bohm, M. K., Liu, Y., Lu, H., & Naimi, T. S. (2022). Estimated deaths attributable to excessive alcohol use among US adults aged 20 to 64 years, 2015 to 2019. JAMA Network Open, 5(11), Article e2239485. https://doi.org/10.1001/jamanetworkopen.2022.39485
Karaye, I. M., Maleki, N., Hassan, N., & Yunusa, I. (2023). Trends in alcohol-related deaths by sex in the US, 1999-2020. JAMA Network Open, 6(7), Article e2326346. https://doi.org/10.1001/jamanetworkopen.2023.26346
Spencer, M. R., Curtin, S. C., & Garnett, M. F. (2022). Alcohol-induced death rates in the United States, 2019-2020 (NCHS Data Brief No. 448). National Center for Health Statistics. https://doi.org/10.15620/cdc:121795
What the NUR 603 Module 5 instructions ask for
Milestone Two of the NUR 603 project usually asks you to describe your population health problem by person, place and time using rates rather than counts. Expect to calculate or report incidence or mortality rates, age-specific and age-adjusted rates where age differs between groups, and comparisons such as rate ratios, with tables and a short interpretation. Many versions run three to five pages in APA 7. Use the same case definition and data sources you set in Milestone One, state the standard population you adjust to and show at least one calculation step by step, since graders check the arithmetic and whether each comparison is interpreted within its uncertainty. Keep units consistent throughout.
How this NUR 603 Module 5 milestone two example is built
The sample counts 64 alcohol-induced deaths among women aged 45 to 64 in a composite county over 205,500 person-years. It explains its methods, including the 2000 US standard population weights of 0.607 and 0.393, and works the age adjustment to 28.8 per 100,000 with an interval of 21.5 to 36.0. A table sets age-specific rates for women and men side by side. It reports a men-to-women rate ratio of 2.18 with its interval and compares it with the national ratio, then examines rural and urban residence, the state rate and the change after 2020, noting that each of those intervals includes 1. A cause breakdown and an interpretation separating firm from suggestive findings close the paper.
Where the NUR 603 Module 5 rubric puts the points
Milestone Two rubrics typically weigh correct calculation of rates, appropriate use of age adjustment, comparisons by person, place and time, interpretation, presentation of data in tables and APA 7 writing. Top-band work states the numerator, denominator, units and period for every rate, names the standard population and reports uncertainty. Graders reward interpretation that distinguishes statistically clear differences from suggestive ones and that considers alternative explanations, such as age structure or reporting. Consistency with the case definition and sources from Milestone One is often checked. A clear link to the prevention planning in the next milestone usually earns points under synthesis, as does a table that could stand on its own.
NUR 603 Module 5 help: the mistakes that cost points
Descriptive milestones often lose points by comparing counts between populations of different sizes, by comparing crude rates between groups with different age structures, by leaving out denominators or time periods or by calling every difference significant without an interval. Another error is changing the case definition from the first milestone. Report rates with person-years, adjust for age when groups differ, give confidence intervals, show one calculation in full and say which differences chance could explain. If your project uses a different outcome, such as incidence from a registry or survey prevalence, send your data and milestone guidelines for a draft built on your numbers.
Get NUR 603 Module 5 written to your instructions
Send your Milestone One, your counts and population figures and the milestone guidelines. A descriptive analysis with age-adjusted rates, rate ratios and intervals, every calculation shown, comes back in 24 to 48 hours, and the first draft is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 603 Module 5 questions, answered
Where can I find a free NUR 603 Module 5 Milestone Two sample?
The complete milestone is published here: age-adjusted rates, rate ratios and confidence intervals for alcohol-induced deaths among women aged 45 to 64 in a composite county, with the calculations shown.
How do you calculate an age-adjusted rate?
Multiply each age-specific rate by the share of a standard population in that age group and add the results. National reporting uses the 2000 US standard population for this direct method.
What is a rate ratio?
It is one group's rate divided by another's. A ratio of 2.18 means the first group's rate is a little more than twice the second's. A confidence interval that includes 1 means chance could explain the difference.
Why describe a health problem by person, place and time?
These three dimensions show who is affected, where and when, which points to causes and to where prevention should focus. They are the core of descriptive epidemiology.
When should crude rates not be compared?
When the groups differ in age structure and the outcome depends on age. An older population will have a higher crude death rate even with the same age-specific risk, so age adjustment is needed.