Current Trends Mortality Patterns -- United States

Based on death certificate information compiled by CDC's National Center for Health Statistics (NCHS) (1), 2,123,323 deaths were registered in the United States in 1987. This is 17,962 more deaths than in 1986 and the largest annual final number ever recorded. In 1987, nearly three fourths of deaths were caused by the first four leading causes of death--heart disease, cancer, stroke, and unintentional injuries. This report summarizes mortality data compiled by NCHS for 1987 (1).

Despite the increase in the number of deaths, the overall age-adjusted death rate* for 1987 declined to a record low of 535.5 per 100,000 population--or approximately 1.0% lower than in 1986 (541.7). From 1986 to 1987, rates declined for 13 of the 15 leading causes of death (Table 1). The rate for heart disease, the greatest contributor to U.S. mortality, declined by 3.1%. The rate for cancer declined for the second consecutive year, in contrast to the general increase since 1950. Mortality from homicide decreased by 4.4%, the largest decline among the 15 leading causes of death. From 1986 to 1987, the ranking of the leading causes of death remained unchanged with the exception of congenital anomalies, which was replaced as the 15th leading cause of death by human immunodeficiency virus (HIV) infection.

In 1987, age-adjusted death rates for men were higher than those for women (Table 2). The greatest sex differential in mortality was for HIV infection, for which the rate for males was 9.1 times that for females. The rate for unintentional injuries (International Classification of Diseases, Ninth Revision (ICD-9) "accidents and adverse effects"** (rubrics E800-E949) (2)) was 2.7 times higher for males than for females. The smallest difference between the sexes was for diabetes mellitus (male/female ratio=1.1:1).

When compared with 1986, age-adjusted death rates declined for white persons*** (from 518.0 to 511.1) and remained essentially unchanged for black persons (from 781.0 to 778.6). The largest difference between rates was for homicide, with the rate for blacks 6.0 times that for whites (Table 2). Of the 15 leading causes of death, two--suicide and chronic obstructive pulmonary disease and allied conditions--had lower death rates for blacks than for whites.

In 1987, HIV infection accounted for 13,468 deaths. Of these, 8700 (64.6%) were in white males, 3301 (24.5%) in black males, 739 (5.5%) in black females, and 628 (4.7%) in white females. Most (72.9%) HIV-associated deaths occurred in persons aged 25-44 years. Age-adjusted death rates were highest for black males (25.4), followed by white males (8.3), black females (4.7), and white females (0.6). Age-specific death rates followed a similar pattern.

In 1987, overall life expectancy at birth reached an all-time high of 75 years, increasing to 75.6 years for whites and remaining stable (69.4 years) for blacks. The difference in life expectancy between whites and blacks narrowed from 7.6 years in 1970 to 5.6 years in 1984, then increased to 6.2 years from 1984 to 1987. The difference in life expectancy between the sexes, which widened from 1900 to 1972, narrowed after 1979. Women are still expected to outlive men by an average of 6.9 years. Reported by: Div of Vital Statistics, National Center for Health Statistics; Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Death rates are usually based on the underlying cause of death, defined by the 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" (2). During a time when the age distribution is changing, age-adjusted death rates indicate more effectively than crude death rates changes in the risk of death. In addition, age-adjusted rates are better indicators for comparisons of mortality by sex or racial subgroup.

Factors that contributed to the increased number of deaths in 1987 included population growth and the aging of the U.S. population (i.e., the increasing proportion of older persons). Beginning with data for 1987, the ICD-9 was supplemented by new categories for coding HIV infection and acquired immunodeficiency syndrome (AIDS) (042-044) (3). Before 1987, many HIV-associated deaths were assigned codes for deficiency of cell-mediated immunity (ICD-9 279.1) (adapted for HIV/AIDS in 1983-1986), Pneumocystis carinii pneumonia (ICD-9 136.3), and other conditions. The national surveillance of AIDS cases reported a 32% increase in deaths from 1986 to 1987 (CDC, unpublished data). Although part of this increase may be due to modification of the AIDS case definition in 1987 (4), mortality from AIDS appears to be increasing more rapidly than mortality from other conditions.

References

1. NCHS. Advance report of final mortality statistics, 1987. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989. (Monthly vital statistics report; vol 38, no. 5, suppl).

2. World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death--based on the recommendations of the Ninth Revision Conference, 1975. Geneva: World Health Organization, 1977.

3. CDC. Human immunodeficiency virus (HIV) infection codes: official authorized addendum ICD-9-CM (revision no. 1). MMWR 1987;36(no. S-7).

4. CDC. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987;36(no. 1S). *Age-adjusted to the 1940 U.S. population. **When a death occurs under "accidental" circumstances, the preferred term within the public health community is "unintentional injury." ***Hispanics are included in totals for both white persons and black persons.

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