Mortality Patterns -- United States, 1993

In 1993, a total of 2,268,553 deaths were registered in the United States -- 92,940 more than in 1992 and the highest number ever recorded (1). In addition, life expectancy at birth declined for the first time since 1980. This report characterizes mortality patterns in 1993 (the most recent year for which complete data were available) (1) and compares these with patterns in 1992.

National mortality statistics are based on information from death certificates filed in state vital statistics offices as required by state law and are compiled by CDC into a national database. Cause-of-death statistics are based on the underlying cause of death *, which is recorded on the death certificate by the attending physician, medical examiner, or coroner in a manner specified by the World Health Organization (WHO) and endorsed by CDC. Data are presented only for blacks and whites because of inconsistent reporting of other racial/ethnic groups on death certificates.

From 1992 to 1993, the crude death rate increased 3.2% (from 852.9 to 880.0 deaths per 100,000 population); the age-adjusted death rate ** increased 1.7% (from 504.5 to 513.3 per 100,000 population). The 10 leading causes of death and their rankings were unchanged during this period; mortality decreased only for cancer (-0.4%) (Table_1) ***. The largest increase in age-adjusted death rate (9.5%) was for human immunodeficiency virus (HIV) infection (International Classification of Diseases, Ninth Revision {ICD-9}, codes 042-044 ****); this rate (13.8) was the highest ever recorded for HIV infection (1).

From 1992 to 1993, age-adjusted death rates increased 1.6% for whites ***** (from 477.5 to 485.1) and 2.3% for blacks (from 767.5 to 785.2). Rates were higher for blacks than for whites for eight of the 10 leading causes (Table_2). Race-specific ratios were greatest for homicide (6.8) and HIV infection (4.0). Death rates for blacks were lower for chronic obstructive pulmonary diseases and allied conditions (COPD) (ICD-9 codes 490-496; 0.8) and suicide (ICD-9 codes E950-E959; 0.6).

From 1992 to 1993, age-adjusted death rates increased 1.3% for males (from 656.0 to 664.9) and 2.1% for females (from 380.3 to 388.3). Rates were higher for males than females for all 10 leading causes (Table_2). Sex-specific ratios were greatest for HIV infection (6.3), suicide (4.4), and homicide (3.8). Compared with 1992, sex-specific ratios decreased for HIV infection and homicide. The sex-specific ratio was lowest for diabetes mellitus (ICD-9 code 250; 1.2).

In 1993, a total of 302 women were reported to have died from causes associated with pregnancy and childbirth (i.e., deaths assigned to complications of pregnancy, childbirth, and the puerperium {ICD-9 codes 630-676}). The overall maternal mortality rate was 7.5 deaths per 100,000 live-born infants. However, this rate was approximately four times higher for blacks than for whites (20.5 versus 4.8).

From 1992 to 1993, overall life expectancy (LE) at birth declined from 75.8 years to 75.5 years. As in 1992, LE at birth continued to be highest among white females (79.5 years), followed by black females (73.7 years), white males (73.1 years), and black males (64.6 years). Although LE declined for all four racial-sex groups during 1992-1993, the overall race-specific difference in LE for blacks and whites increased slightly, from 6.9 years in 1992 to 7.1 years in 1993.

Reported by: Mortality Statistics Br, Div of Vital Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: LE summarizes death rates by age into a single measure used as an indicator of the nation's health. Death rates and LE can be used to monitor health status and progress toward national health objectives and to identify groups at increased risk for specific diseases and injuries. The findings in this report indicate that, in 1993, crude and age-adjusted death rates increased and LE decreased from 1992. The decline in LE most likely reflects increases in death rates for 1) chronic diseases during the two influenza outbreaks of 1993, 2) pneumonia and influenza, and 3) HIV infection and unintentional injuries. Race-specific variation in death rates are accounted for, in part, by differences in factors such as socioeconomic status, access to medical care, and risk behaviors. The increases in both the crude and age-adjusted rates in 1993 are the first since 1988 and 1975, respectively; however, preliminary analysis of provisional data for 1994 suggest small, but statistically significant, decreases in these rates (3).

In 1993, death rates for some chronic diseases -- heart disease, stroke, COPD, and diabetes -- and for pneumonia and influenza accounted for nearly 75% of all deaths during the year. This analysis especially highlights the role of heart disease and cancer as leading causes of death in the United States; these two causes accounted for approximately 56% of deaths in 1993. Although increases in the rates for HIV infection and unintentional injuries among younger persons contributed to the decline in LE, most increases in mortality were among persons aged greater than or equal to 65 years.

References

1. NCHS. Advance report of final mortality statistics, 1993. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1996. (Monthly vital statistics report; vol 44, no. 7, suppl).

2. NCHS. Vital statistics of the United States, 1988. Vol 2, mortality, part A. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1991; DHHS publication no. (PHS)91-1101.

3. NCHS. Annual summary of births, marriages, divorces, and deaths: United States, 1993. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1994. (Monthly vital statistics report; vol 43, no. 13).

* Defined by the World Health Organization's International Classification of Diseases, Ninth Revision, as "(a) the disease or injury which initiated the train of morbid events leading directly to death, or (b) the circumstances of the accident or violence which produced the fatal injury." 

** Age-adjusted to the 1940 U.S. population. Age-adjusted death rates indicate the risk for death relative to a standard population and are more effective than crude death rates for comparing mortality of population groups with different age structures. 

*** "Motor-vehicle accidents" and "all other accidents and adverse effects" are not included as causes of death for which the rate has decreased because these causes are subcategories of the leading cause "accidents and adverse effects." When a death occurs under "accidental" circumstances, the preferred term within the public health community is "unintentional injury." 

**** These codes are from addenda to the ICD-9 (2). 

***** Hispanics and non-Hispanics are included in totals for both whites and blacks.

TABLE 1. Age-adjusted death rates * for 1993 and percentage changes in age-adjusted death rates
for the 10 leading causes of death from 1992 to 1993 and from 1979 to 1993 -- United States
================================================================================================
                                                                              % Change
                                                                            --------------
                                                                   1993      1992    1979
                                                               Age-adjusted   to      to
Rank +    Cause of death (ICD-9 & code)                         death rate   1993    1993
------------------------------------------------------------------------------------------------
  1     Diseases of heart (390-398, 402, 404-429)                 145.3       0.7   -27.2
  2     Malignant neoplasms, including neoplasms
         of lymphatic and hematopoietic tissues (140-208)         132.6      -0.4     1.4
  3     Cerebrovascular diseases (430-438)                         26.5       1.1   -36.3
  4     Chronic obstructive pulmonary diseases
         and allied conditions (490-496)                           21.4       7.5    46.6
  5     Accidents @ and adverse effects (E800-E949)                30.3       3.1   -29.4
         Motor-vehicle accidents (E810-E825)                       16.0       1.3   -31.0
         All other accidents and adverse effects
          (E800-E807, E826-E949)                                   14.4       5.1   -26.5
  6     Pneumonia and influenza (480-487)                          13.5       6.3    20.5
  7     Diabetes mellitus (250)                                    12.4       4.2    26.5
  8     Human immunodeficiency virus infection (042-044) **        13.8       9.5    --
  9     Suicide (E950-E959)                                        11.3       1.8   - 3.4
 10     Homicide and legal intervention (E960-E978)                10.7       1.9     4.9
------------------------------------------------------------------------------------------------
*  Per 100,000 population, age-adjusted to the 1940 U.S. population.
+  Based on number of deaths.
&  International Classification of Diseases, Ninth Revision.
@  When a death occurs under "accidental" circumstances, the preferred term within the
   public health community is "unintentional injury."
** These codes are from addenda to the ICD-9 (2).
================================================================================================

TABLE 2. Ratio of age-adjusted death rates * from the 10 leading causes of death,
by sex and race of decedent -- United States, 1993
================================================================================================
Rank +  Cause of death (ICD-9 & code)                          Male:female       Black:white @
------------------------------------------------------------------------------------------------
  1     Diseases of heart (390-398, 402, 404-429)                  1.9               1.5
  2     Malignant neoplasms, including neoplasms
         of lymphatic and hematopoietic tissues (140-208)          1.5               1.4
  3     Cerebrovascular diseases (430-438)                         1.2               1.8
  4     Chronic obstructive pulmonary diseases
         and allied conditions (490-496)                           1.6               0.8
  5     Accidents ** and adverse effects (E800-E949)               2.6               1.3
         Motor-vehicle accidents (E810-E825)                       2.3               1.0
         All other accidents and adverse effects
          (E800-E807, E826-E949)                                   2.9               1.6
  6     Pneumonia and influenza (480-487)                          1.6               1.4
  7     Diabetes mellitus (250)                                    1.2               2.4
  8     Human immunodeficiency virus infection (042-044) ++        6.3               4.0
  9     Suicide (E950-E959)                                        4.4               0.6
 10     Homicide and legal intervention (E960-E978)                3.8               6.8
------------------------------------------------------------------------------------------------
*  Per 100,000 population, age-adjusted to the 1940 U.S. population.
+  Based on number of deaths.
&  International Classification of Diseases, Ninth Revision.
@  Both groups include Hispanics. Numbers for other racial/ethnic groups were too small for
   meaningful analysis.
** When a death occurs under "accidental" circumstances, the preferred term within the
   public health community is "unintentional injury."
++ These codes are from addenda to the ICD-9 (2).
================================================================================================

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