Mortality from Alzheimer Disease -- United States, 1979-1987

Although age-adjusted death rates for many leading causes of death inthe United States declined from 1979 through 1987 (1), the rates for Alzheimer disease (AD)* (International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) rubric 331.0) increased substantially. To characterize mortality patterns for AD and related disorders, CDC analyzed U.S. mortality data for 1979-1987. This report provides a preliminary summary of findingsfrom this analysis.

Deaths from AD were analyzed using data from multiple cause-of-death data tapes supplied by CDC's National Center for Health Statistics. Denominators for calculating rates were obtained from intercensal population estimates. Age-adjusted death rates were standardized to the 1980 U.S. population.

From 1979 through 1987, AD was listed as the underlying cause of death for 46,202 persons in the United States. The age-adjusted annual death rate increased from 0.4 per 100,000 persons in 1979 to 4.2 per 100,000 persons in 1987 (Figure 1). For men, the annual rate increased from 0.5 to 4.6 per 100,000, and for women, from 0.3 to 3.9 per 100,000. For blacks and whites, rates increased with age; increases were higher for the older age groups (Table 1). Within each age group, the rate for whites was higher than for blacks.

In 1987, age-adjusted death rates were highest in the Rocky Mountain states and in New England (Table 2). Montana and Utah had the highest rates in 1987 and the greatest differences in rates between 1979 and 1987. New York and Alaska had the lowest rates in 1987 and the smallest differences in rates between 1979 and 1987.

To examine the hypothesis that shifts in diagnoses accounted for the changes in rates, investigators compared age-adjusted death rates for AD, senile and presenile dementias (ICD-9-CM rubrics 290.0 and 290.1, respectively), and senility (ICD-9-CM rubric 797) (Table3). For both AD and the dementias, rates increased from 1979 to 1987; in comparison, the rate for senility declined. Reported by: Div of Chronic Disease Control and Community Intervention, Office of Surveillance and Analysis, and Office of the Director, Center for Chronic Disease Prevention and Health Promotion,CDC.

Editorial Note

Editorial Note: Although death rates represent a potential measure of the public health impact of AD, variations in the accuracy of diagnosis and in the completion of death certificates limit the value of mortality data for estimating the prevalence of AD(3-7). Nonetheless, the patterns for AD death rates in this report are consistent with those in England(4), Australia(5), Norway(6), and Canada(7). In these countries, deaths from or death rates for AD and related disorders have also increased.

At least two factors may be responsible for the observed increase in death rates for AD in the United States. First, the incidence or prevalence of AD may have increased. Second, heightened awareness of AD may have caused physicians to diagnose cognitive impairment as AD more frequently than in the past; caused physicians to change their diagnoses and recording of deaths (i.e., increases in mortality attributable to dementia have been accompanied by decreases in deaths from senility); or caused the death certificate to be a more sensitive or less specific record of the premortem diagnosis of AD. Further investigation may clarify the contribution of these two factors to increased death rates for AD.

The heightened awareness of AD among health-care providers may be due in part to educational efforts by the Alzheimer's Disease and Related Disorders Association (created in 1979) and to increased federal funding for research on AD and related disorders (from $3.9 million in 1976 to $53.9 million in 1986 (8)).

References

1. CDC. Mortality patterns--United States, 1987. MMWR 1990;39:193-6,201.

2. McKhann G, Drachman D, Folstein M, Katzman R, Price D,Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-44

3. Chandra V, Bharucha NE, Schoenberg BS. Patterns of mortality from types of dementia in the United States, 1971 and 1973-1978. Neurology 1986;36:204-8.

4. Martyn CN, Pippard EC. Usefulness of mortality data in determining the geography and time trends of dementia. J Epidemiol Community Health 1988;42:134-7.

5. Jorm AF, Henderson AS, Jacomb PA. Regional differences in mortality from dementia in Australia: an analysis of death certificate data. Acta Psychiatr Scand 1989;79:179-85.

6. Flaten TP. Mortality from dementia in Norway, 1969-83.J Epidemiol Community Health 1989;43:285-9.

7. Newman SC, Bland RC. Canadian trends in mortality from mental disorders, 1965-1983. Acta Psychiatr Scand 1987;76:1-7.

8. Office of Technology Assessment. Losing a millionminds: confronting the tragedy of Alzheimer's disease and other dementias. Washington, DC: US Congress, Office of Technology Assessment, 1987; document no. OTA-BA-323.

• Clinically, AD is characterized by progressive dementia without a disturbance in consciousness. The diagnosis of AD requires exclusion of other diseases associated with dementia(2).

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