Changes in Premature Mortality -- United States, 1983-1984
Premature mortality in the United States, as measured by years
of
potential life lost before age 65 (YPLL), increased from 1983 to
1984
for the first time since 1980. Total YPLL from all causes of death
increased from 11,712,000 in 1983 to 11,761,000 in 1984, a 0.4%
increase. The rate of YPLL per 1,000 persons under 65 years old,
however, decreased by 0.4% from 1983's level to 56.5/1,000 persons.
An increase of 1.5 million persons under 65 years of age accounts
for
this discrepancy.
The relative rankings of the leading causes of YPLL did not
change
substantially from 1983 to 1984. The only change was
cerebrovascular
diseases replacing chronic liver diseases as the eighth leading
cause
of YPLL. Unintentional injuries (accidents) continue to head the
list, accounting for 20% of the total YPLL, followed by malignant
neoplasms (15%), diseases of the heart (13%), and
suicides/homicides
(11%).
The rate of YPLL per 1,000 persons increased for eight of the
12
leading causes (Figure 3). The largest proportionate increase in
the
rate of YPLL was recorded for cerebrovascular diseases, up 13.1%.
Increases in YPLL rates were also noted for prematurity, up 3.3%;
sudden infant death syndrome, 2.7%; pneumonia and influenza, 2.6%;
and
diabetes mellitus, 1.8%. In contrast, the rate of YPLL for chronic
liver diseases and cirrhosis decreased by 7.4%; diseases of the
heart
declined 3.6%; chronic obstructive pulmonary diseases and allied
conditions, 3.3%; and malignant neoplasms, 1.3%.
Reported by Epidemiologic Studies Br, Div of Surveillance and
Epidemiologic Studies, Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: With this issue, CDC announces a change in the
method
of calculation of YPLL to include causes of mortality in the first
year of life. The relatively high age-specific death rate of these
infants, combined with the years of life remaining before age 65,
adds
two new causes to the list of leading causes of YPLL--sudden infant
death syndrome (ICD code 798) and deaths attributable to
prematurity,
including neonatal respiratory distress syndrome (ICD code 769) and
disorders relating to short gestation and unspecified low
birthweight
(ICD code 765). The updated Table V appears on page 27 of this
issue.
The inclusion of deaths in the first year of life does not
account
for the increase in total YPLL from 1983 to 1984. Although total
YPLL
decreased each year from 1980 to 1984, the slight increase in 1984
is
present when YPLL is calculated by either the birth-to-age-65-years
or
the age 1- to 65-years method (Figure 4). The rate of YPLL per
1,000
persons, however, has decreased each year since at least 1979 with
both methods of calculation and now stands 12.3% below the 1979
level
when measured from age 1 year to 65 years, and 14.1% when measured
from birth to age 65 years.
Considerable variability continues to be demonstrated in the
year-to-year comparison of YPLL rate due to specific causes of
mortality. The rate of YPLL attributable to cerebrovascular
diseases,
for example, increased by 13.1% in 1984, reversing the 12.4%
decline
in the previous year. In contrast, the YPLL rate for unintentional
injuries, which has consistently decreased from 1979 until 1984,
increased by 0.4% in 1984, but remains 22.5% below the 1979 level.
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