Mortality Patterns -- Preliminary Data, United States, 1996

In 1996, the estimated number of deaths in the United States totaled 2,322,265, slightly higher than the final total in 1995 of 2,312,132. Despite this slight increase in the total number of deaths in 1996, the preliminary crude death rate (875.4 per 100,000 population) declined slightly from that in 1995 and was equal to the crude death rate in 1994; in addition, in 1996 the age-adjusted death rate * (493.6 per 100,000 U.S. standard population) reached an all-time low. This report summarizes preliminary 1996 vital statistics data from CDC's National Center for Health Statistics (NCHS) (1) and compares these data with data from 1995 and, for life expectancy, data from 1900 to 1995. The findings indicate declines in the rates for most leading causes of death and the infant mortality rate and an increase in overall estimated life expectancy.

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. In this report, general mortality data are presented for blacks and whites only; infant mortality data are presented for non-Hispanic whites, non-Hispanic blacks, and Hispanics. For general mortality, data for smaller minority groups are not presented because of inconsistent reporting between death certificates and censuses and surveys. The findings in this report are based on 1996 data received through May 8, 1997, and represent greater than 85% of deaths that occurred in 1996. NCHS also receives independent monthly counts of deaths registered in state vital statistics offices. To produce the estimates in this report, the sample records in the preliminary files were weighted to the independent counts of infant deaths and total deaths registered during 1996.

Preliminary age-adjusted death rates for 13 of the 15 leading causes of death declined from 1995 to 1996 (Table_1). The most substantial decline was for mortality attributed to human immunodeficiency virus (HIV) infection (approximately 26%). The age-adjusted death rates for the two leading causes of death, heart disease and cancer -- which together account for more than half of all U.S. deaths -- also continued to decline: heart disease mortality by 3% and cancer mortality by 1%. Preliminary age-adjusted death rates also declined for homicides (11%), suicides (4%), mortality caused by accidents *** (including motor-vehicle and all other accidents) (1%), and pneumonia and influenza (2%). In comparison, diabetes-associated mortality increased by 2%, the 10th consecutive year mortality from this cause has increased.

Overall estimated life expectancy increased in 1996 to 76.1 years, surpassing the previous high of 75.8 years recorded in 1992 and 1995. Record highs occurred for black females (74.2 years), black males (66.1 years), and white males (73.8 years). The life expectancy for white females, which has remained unchanged since 1994, was 79.6 years. The difference in life expectancy between males and females narrowed from 6.4 years in 1995 to 6.0 years in 1996, and the difference between whites and blacks narrowed from 6.9 years to 6.5 years. The largest difference in life expectancy between males and females occurred in the late 1970s, when life expectancy for females was 7.8 years greater than for males (Figure_1).

The overall infant mortality rate (7.2 infant deaths per 1000 live births) for 1996 declined 5% from 1995 (7.6). Declines occurred for neonates (aged less than 28 days), postneonates (aged 28 days through 11 months), and for non-Hispanic white, non-Hispanic black, and Hispanic infants. The three leading causes of infant mortality were congenital anomalies, disorders related to short gestation and unspecified low birthweight, and sudden infant death syndrome (SIDS). SIDS declined nearly 15% in 1996 and accounted for one third of the overall decline in infant mortality.

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

Editorial Note

Editorial Note: Death rates and life expectancy are especially useful for monitoring the nation's health. The preliminary data for 1996 indicate that death rates have declined for causes of death such as heart disease, cancer, and cerebrovascular diseases -- causes most likely to affect the elderly -- and for causes of death such as unintentional injuries, homicide, suicide, and HIV infection -- causes most likely to affect younger persons. Reductions in death rates for these causes, along with increases in life expectancy, indicate positive changes in U.S. mortality patterns. Although race-specific differences in life expectancy narrowed in 1996, death rates were still higher for blacks than whites, probably reflecting variations in factors such as socioeconomic status, access to medical care, and the prevalence of specific risks.

The decrease in mortality attributable to HIV infection in 1996 marked the first time deaths attributed to this cause have declined. From 1987 (when HIV infection was first reported) to 1994, HIV deaths rose an average of 16% annually. The 1995 increase of only 1.3% indicated that mortality attributable to this cause might be slowing (2). In addition, HIV-related morbidity decreased for the first time in 1996, and the incidence of acquired immunodeficiency syndrome opportunistic illnesses declined 6% overall compared with 1995 (3). These recent decreases in HIV-related morbidity and death probably resulted from a combination of a reduced rate of new HIV infections and improvements in the medical care of HIV-infected persons.

The 1996 preliminary mortality data in this report were produced by a new system of vital statistics data preparation initiated in 1995. This system provides data that are nearly complete a year before the final data are released. Through an agreement with the state vital statistics offices, data are continually transmitted to NCHS. Preliminary data, although subject to revision, are particularly helpful for surveillance purposes and for gauging progress toward national health objectives for 2000.

References

1. Ventura SJ, Peters KD, Martin JA, Maurer JD. Births and deaths: United States, 1996. Hyattsville, Maryland: US Department of Health and Human Services, CDC, National Center for Health Statistics, 1997. (Monthly vital statistics report; vol 46, no. 1, suppl 2).

2. Anderson RN, Kochanek KD, Murphy SL. Report of final mortality statistics, 1995. Hyattsville, Maryland: US Department of Health and Human Services, CDC, National Center for Health Statistics. 1997. (Monthly vital statistics report; vol 45, no. 11, suppl 2).

3. CDC. Update: trends in AIDS incidence -- United States, 1996. MMWR 1997;46:861-7.

* Age-adjusted death rates adjust for differing age distributions of population groups and are more effective for comparing relative risks for mortality among groups and over time. They should be used as relative indexes rather than as actual measures of risk. The age-adjusted rates were computed using the 1940 U.S. standard population. 

** 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." 

*** When a death occurs under "accidental" circumstances, the preferred term within the public health community is "unintentional injury."

TABLE 1. Preliminary number of deaths, death rates*, and age-adjusted death rates+ for 1996 and percentage changes in age-adjusted death rates for the
15 leading causes of death from 1995 to 1996 -- United States
==============================================================================================================================================================================================================
Rank &             Causes of death (ICD-9 @ code)                                                                         No.            Rate           Age-adjusted death rate   % Change from 1995 to 1996
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 1                 Diseases of heart (390-398,402,404-429)                                                            733,834           276.6                     134.6                        - 2.7
 2                 Malignant neoplasms,including neoplasms of lymphatic and hematopoietic tissues (140-               544,278           205.2                     129.1                        - 0.6
                   208)
 3                 Cerebrovascular diseases (430-438)                                                                 160,431            60.5                      26.5                        - 0.7
 4                 Chronic obstructive pulmonary diseases  and allied conditions (490-496)                            106,146            40.0                      21.0                          1.0
 5                 Accidents** and adverse effects (E800-E949)                                                         93,874            35.4                      30.1                        - 1.3
                     Motor-vehicle accidents (E810-E825)                                                               43,449            16.4                      16.2                        - 0.6
                     All other accidents and adverse effects (E800-E807,E826-E949)                                     50,425            19.0                      13.9                        - 2.1
 6                 Pneumonia and influenza (480-487)                                                                   82,579            31.1                      12.6                        - 2.3
 7                 Diabetes mellitus (250)                                                                             61,559            23.2                      13.6                          2.3
 8                 Human immunodeficiency virus infection (042-044++)                                                  32,655            12.3                      11.6                        -25.6
 9                 Suicide (E950-E959)                                                                                 30,862            11.6                      10.8                        - 3.6
10                 Chronic liver disease and cirrhosis (571)                                                           25,135             9.5                       7.5                        - 1.3
11                 Nephritis,nephrotic syndrome,and nephrosis (580-589)                                                24,392             9.2                       4.3                            0
12                 Septicemia (038)                                                                                    21,395             8.1                       4.1                            0
13                 Alzheimer's disease (331.0)                                                                         21,166             8.0                       2.7                            0
14                 Homicide and legal intervention (E960-E978)                                                         20,738             7.8                       8.4                        -10.6
15                 Atherosclerosis (440)                                                                               16,803             6.3                       2.2                        - 4.3

All other causes                                                                                                      346,574           130.6                      75.0                          0.9

All causes                                                                                                          2,322,421           875.4                     494.1                        - 1.9
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
*  Per 100,000 population.
+  Per 100,000 1940 U.S. standard 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 not part of ICD-0 but were introduced by CDC's National Center for Health Statistics for classifying and coding
   human imunodeficiency virus infection.
==============================================================================================================================================================================================================

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