Mortality Patterns -- United States, 1997

In 1997, a total of 2,314,245 deaths were registered in the United States--445 fewer than the record high of 2,314,690 in 1996 (1). The overall age-adjusted death rate* was 479.1 per 100,000 standard (1940) population, the lowest ever recorded. In 1997, nearly two thirds of deaths resulted from heart disease, cancer, and stroke. This report summarizes mortality patterns in 1997 (1) and compares them with patterns in 1996.

National death statistics are based on information from death certificates filed in state vital statistics offices and are compiled by CDC into a national database. Cause-of-death statistics are based on the underlying cause of death**. Causes of death are recorded on the death certificate by the attending physician, medical examiner, or coroner using a format specified by the World Health Organization and endorsed by CDC.

Compared with 1996, death rates decreased for all age groups except persons aged greater than or equal to 85 years. The largest percentage decreases occurred in persons aged 25-34 years (9.2%), 35-44 years (8.2%), and 1-4 years (6.5%).

From 1996 to 1997, age-adjusted death rates declined among whites (from 466.8 to 456.5) and among blacks (from 738.3 to 705.3)***. In 1997, the overall death rates for the black population were higher than for the white population; for seven of the 15 leading causes, age-adjusted death rates were at least 1.5 times greater for blacks than for whites. The largest differences in rates were for human immunodeficiency virus (HIV) infection (7.5 times) and homicide (6.0 times) (Table 1)****. Death rates were lower for blacks than whites for three leading causes: chronic obstructive pulmonary disease (0.8 times), Alzheimer's disease (0.7 times), and suicide (0.6 times). The 1997 age-adjusted death rates declined 4.3% from 1996 for the Hispanic population (from 365.9 to 350.3). The three leading causes of death for Hispanics were heart disease, cancer, and unintentional injuries.

In 1997, age-adjusted death rates for males were higher than for females (Table 1). From 1996 to 1997, age-adjusted death rates declined for males (from 623.7 to 602.8) and for females (from 381.0 to 375.7). Of the 15 leading causes of death, the greatest difference between the rates for the sexes was for suicide; the suicide rate was more than four times greater for males than for females. Also higher for males was the death rate for homicide (3.8 times) and HIV infection (3.5 times).

In 1997, 327 women died from maternal causes, including complications of pregnancy, childbirth, and the puerperium***** within 42 days after pregnancy termination. The maternal mortality rate was 8.4 deaths per 100,000 live births, and was more than three times higher for black than for white women.

In 1997, the infant mortality rate was 7.2 infant deaths per 1000 live births; in 1996, infant mortality was higher but the difference was not statistically significant. Among the 10 leading causes of infant death******, only pneumonia and influenza decreased by a statistically significant amount during 1996-1997. The infant mortality rate was two times higher for black infants than for white infants (1).

From 1996 to 1997, mortality increased from septicemia (2.4%) and kidney disease (4.4%); however, mortality decreased for the three leading causes of death: heart disease (3.0%), cancer (1.8%), and stroke (1.9%). HIV-infection mortality dropped in ranking from the eighth leading cause in 1996 to the 14th in 1997 (Table 1). The age-adjusted death rate for HIV infection decreased 47.7%, the largest decline among the 15 leading causes of death. In 1997, 16,516 deaths were attributed to HIV infection. Age-adjusted death rates for HIV were highest for black males (38.5), black females (13.3), white males (5.6), and white females (1.0). HIV infection continued to be the fifth leading cause of death for black females aged 15-24 years, the sixth for black males aged 5-14 years, the sixth for black males aged 15-24 years, and the leading cause for black males aged 25-44 years.

In 1997, overall life expectancy (LE) at birth was 76.5 years (Figure 1). The overall LE increased by 0.4 years from the 1996 LE primarily because of decreases in mortality from HIV infection, heart disease, cancer, stroke, and homicide. White females continue to have the highest LE at birth (79.9 years), followed by black females (74.7 years), white males (74.3 years), and black males (67.2 years). All four race-sex groups had increases in LE during 1996-1997 and achieved record high life expectancies. The gap between the white and black population is 6.0 years, down from 6.6 years in 1996. The gap between men and women is 5.8 years, down from 6.0 years in 1996.

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

Editorial Note:

This report is based on all the death records registered in the United States in 1997 and indicates that decreases have occurred in the risk for death from the top three causes and from HIV infection. Progress in preventing and treating these conditions, however, is offset by increases in mortality from septicemia, kidney disease, and drug-induced causes. The differences in LE by race and sex narrowed in 1997 but disparities remain large and may reflect such factors as socioeconomic status, access to medical care, and the prevalence of specific risks.

Advances in treatment for HIV and acquired immunodeficiency syndrome (AIDS), such as the use of triple combination antiretroviral therapy, resulted in decreases in AIDS incidence and HIV mortality and increases in the number of persons living with HIV and AIDS (2,3). During 1987-1994, HIV infection mortality increased an average of 16% annually. In 1995, the age-adjusted death rate for HIV infection was approximately the same as in 1994. Then mortality began to decrease: in 1996 by 28.8% and in 1997 by 47.7%.

LE has increased every year since 1993, the major reasons during 1996-1997 being reduced risk for homicides among teenagers and HIV infection among working age adults, and reduced risk for deaths attributable to heart disease, cancer, and stroke among older persons.

Data in this report are subject to at least two limitations. First, death rates for the American Indian/Alaskan Native and Asian/Pacific Islander populations are not included because of inaccuracies on death certificates and in population censuses that result in reported death rates being lower than actual death rates (4). Similar but less severe problems affect the Hispanic population (4). Targeted research and evaluation is needed to assess reporting problems and to identify methods that would compensate for inaccuracies (4). A second limitation is the quality of medical cause-of-death information on the death certificate. Physicians, medical examiners, and coroners sometimes are not trained in the correct completion of this form. Approaches to address this problem include expanded availability of continuing medical education, instructional materials (5-7), and World-Wide Web resources*******.

Mortality data from the National Vital Statistics System have been used to document public health trends since 1900 and are key indicators for monitoring groups at risk for death from specific diseases and injuries (8). Additional information is available from the National Center for Health Statistics, CDC, 6525 Belcrest Rd., Room 1064, Hyattsville, MD 20782; telephone (301) 436-8500; or from the World-Wide Web, http://www.cdc.gov/nchswww/about/major/dvs/mortdata.htm.

References

1. Hoyert DL, Kochanek KD, Murphy SL. Deaths: final data for 1997. Hyattsville, Maryland: US Department of Health and Human Services, CDC, National Center for Health Statistics, 1999.
2. CDC. HIV/AIDS surveillance report; vol 10, no. 1. Atlanta, Georgia: US Department of Health and Human Services, 1998.
3. Jones JL, Hanson DL, Dworkin MS, et al. Surveillance for AIDS-defining opportunistic illnesses, 1992-1997. MMWR 1999;48(no. SS-2).
4. Rosenberg HM, Maurer JD, Sorlie PD, et al. Quality of death rates by race and Hispanic origin: a summary of current research, 1999. Vital Health Stat 1999 2;(128) (in press).
5. National Center for Health Statistics. Physicians' handbook on medical certification of death. Hyattsville, Maryland: US Department of Health and Human Services, CDC, 1996.
6. National Center for Health Statistics. Medical examiners' and coroners' handbook on death registration and fetal death reporting. Hyattsville, Maryland: US Department of Health and Human Services, 1987.
7. Hanzlick R, ed. Cause-of-death statements and certification of natural and unnatural deaths. Northfield, Illinois: College of American Pathologists, 1997.
8. National Center for Health Statistics. Healthy people 2000 review, 1998-99. Hyattsville, Maryland: US Department of Health and Human Services, CDC, 1999.

* Age-adjusted to the 1940 U.S. population. Age-adjusted death rates indicate changes in the risk for death more effectively than crude death rates and are better indicators for comparing mortality of population groups with different age structures.

** Defined by the World Health Organization's International Classification of Diseases, Ninth Revision (ICD-9) 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."

*** Hispanic ethnicity is independent of race, therefore, Hispanics are included in the race categories. Data for other racial groups were not included because of reporting inaccuracies on death certificates and population censuses.

**** "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."

***** ICD-9, codes 630-676.

****** Congenital anomalies; disorders relating to short gestation and unspecified low birthweight; sudden infant death syndrome; respiratory distress syndrome; newborn affected by maternal complications of pregnancy; newborn affected by complications of placenta, cord, and membranes; infections specific to the perinatal period; accidents and adverse effects; intrauterine hypoxia and birth asphyxia; and pneumonia and influenza.

******* From the National Center for Health Statistics, information on writing cause-of-death material is available at http://www.cdc.gov/nchswww/about/major/dvs/handbk.htm, and from the National Association of Medical Examiners, information is available at http://www.thename.org/ main.htm. References to sites of nonfederal organizations on the World-Wide Web are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites.

Table 1



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TABLE 1. Age-adjusted death rates* for 1997, percentage changes in age-adjusted death rates for the 15 leading causes of
death, 1996-1997 and 1979-1997, and ratio of age-adjusted death rates, by sex and race of decedent, 1997 -- United States
==========================================================================================================================================
                                                               1997           Percentage change
                                                           Age-adjusted  ---------------------------
Rank+  Cause of death (ICD-9& code)                         death rate   1996 to 1997   1979 to 1997  Male:female   Black:white@
-------------------------------------------------------------------------------------------------------------------------------
 1     Diseases of heart (390-398, 402, 404-429)               130.5          -3.0          -34.6         1.8            1.5
 2     Malignant neoplasms, including neoplasms of             125.6          -1.8          - 4.0         1.4            1.3
         lymphatic and hematopoietic tissues
         (140-208)
 3     Cerebrovascular diseases (430-438)                       25.9          -1.9          -37.7         1.2            1.8
 4     Chronic obstructive pulmonary diseases and               21.1           0.5           44.5         1.5            0.8
         allied conditions (490-496)
 5     Accidents** and adverse effects (E800-E949)              30.1          -1.0          -29.8         2.4            1.2
         Motor vehicle accidents (E810-E825)                    15.9          -1.9          -31.5         2.1            1.1
         All other accidents and adverse effects                14.2           0.0          -27.6         2.8            1.4
          (E800-E807, E826-E949)
 6     Pneumonia and influenza (480-487)                        12.9           0.8           15.2         1.5            1.4
 7     Diabetes mellitus (250)                                  13.5          -0.7           37.8         1.2            2.4
 8     Suicide (E950-E959)                                      10.6          -1.9          - 9.4         4.2            0.6
 9     Nephritis, nephrotic syndrome, and nephrosis              4.4           2.3            2.3         1.5            2.6
         (580-589)
10     Chronic liver disease and cirrhosis (571)                 7.4          -1.3          -38.3         2.3            1.2
11     Alzheimer's disease (331.0)                               2.7           0.0         1250.0         0.9            0.7
12     Septicemia (038)                                          4.2           2.4           82.6         1.2            2.8
13     Homicide and legal intervention (E960-E978)               8.0          -5.9          -21.6         3.8            6.0
14     Human immunodeficiency virus infection                    5.8         -47.7             --&&       3.5            7.5
         (042-044++)
15     Atherosclerosis (440)                                     2.1          -4.5          -63.2         1.3            1.0

       All causes                                              479.1          -2.5          -17.0      1.6            1.5
-------------------------------------------------------------------------------------------------------------------------------
 * Per 100,000 standard population, age-adjusted to the 1940 U.S. population.
 + Based on number of deaths.
 & International Classification of Diseases, Ninth Revision.
 @ Both groups include Hispanics. Data for other racial groups were not included because of reporting inaccuracies on death certificates
   and population censuses.
** When a death occurs under "accidental" circumstances, the preferred term within the public health community is "unintentional
   injury."
++ These codes are not printed in ICD-9 but were introduced as *042-*044 by CDC's National Center for Health Statistics for classifying
   and coding human immunodeficiency virus infection.
&& Data not available.
==========================================================================================================================================

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