Mortality Attributable to HIV Infection/AIDS Among Persons Aged 25-44 Years -- United States, 1990, 1991

During the 1980s, human immunodeficiency virus (HIV) infection emerged as a leading cause of death in the United States (1). This report updates national trends in deaths caused by HIV infection during 1990 and 1991 and indicates that HIV infection/acquired immunodeficiency syndrome (AIDS) continues to cause an increasing proportion of all deaths.

Data presented in this report were obtained from death certificates filed in all 50 states and the District of Columbia. Cause of death was reported by attending physicians, medical examiners, and coroners; demographic characteristics were recorded by funeral directors. Data for 1991 are provisional (2); 1990 is the latest year for which final and more detailed mortality data are available (3).

In 1991, 29,850 U.S. residents died from HIV infection; of these, 3% were aged less than 25 years; 74%, 25-44 years; and 23%, greater than or equal to 45 years. HIV infection was the ninth leading cause of death overall, accounting for 1% of all deaths, and the third leading cause of death among persons aged 25-44 years, accounting for 15% of deaths in this age group (Table 1). In 1990, HIV infection was the second leading cause of death among men aged 25-44 years and the sixth leading cause of death among women in this age group (accounting for 17% and 5% of deaths, respectively) (Table 2). In 1991, the proportion of deaths caused by HIV infection in these two groups increased to 19% and 6%, respectively.

While death rates from most other leading causes of death declined or remained relatively stable for men and women aged 25-44 years, the death rate for HIV infection steadily increased (Figures 1 and 2). In 1991, the death rate for HIV infection for men aged 25-44 years was seven times that for women in this age group; however, since 1985, proportionate increases in the rate were greater for women than for men.

For men aged 25-44 years, the proportion of deaths caused by HIV infection in 1990 was 22% for Hispanics, 19% for blacks (non-Hispanic), 15% for whites (non-Hispanic), 7% for Asians/Pacific Islanders (non-Hispanic), and 3% for American Indians/Alaskan Natives (non-Hispanic) (Table 3). HIV death rates* varied substantially by race/ethnicity: for men aged 25-44 years, rates for black, Hispanic, American Indian/Alaskan Native, and Asian/Pacific Islander men were approximately three times, twice, one third, and one fourth, respectively, the rate for white men (Table 3).

For women aged 25-44 years, HIV infection accounted for 11% of deaths in 1990 for both black and Hispanic women; however, the HIV death rate for black women was nearly three times that for Hispanic women (Table 3). Both the proportions of deaths caused by HIV infection and the HIV death rates were substantially higher for black and Hispanic women than for women of white and other racial/ethnic groups.

Among Hispanics aged 25-44 years, the proportion of deaths caused by HIV infection in 1990 varied widely by national origin (including ancestry, not necessarily birthplace) (Table 3). In particular, among men of Cuban and Puerto Rican origin, HIV infection was the leading cause of death, accounting for approximately 40% of all deaths, while among men of Mexican origin, the proportion was lower (13%). In this age group, HIV infection was the leading cause of death among women of Puerto Rican origin -- accounting for approximately 30% of all deaths -- but caused a smaller proportion of deaths among women of Cuban origin (9%), Mexican origin (2%), and other Latin American origin (6%).

Reported by: Surveillance Br, Div of HIV/AIDS, National Center for Infectious Diseases; Mortality Statistics Br, Div of Vital Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: The findings in this report underscore the role of HIV infection as a cause of death among men and women aged 25-44 years in the United States. Although deaths from all causes in this age group comprised only 7% of total U.S. deaths in 1991 (2), they impose a disproportionately high impact on society because of the loss of productive years of life and the loss of parents from families with young children. The impact of HIV infection on death patterns is even greater in many large cities than in the total U.S. population. For example, for persons aged 25-44 years in 1990, HIV was the leading cause of death among men in 64 (37%) of 172 cities with populations of at least 100,000 and among women in nine (5%) such cities (4).

In this report, the finding that rates of death for HIV infection were higher for blacks and Hispanics -- particularly Hispanics of Puerto Rican origin -- than for other racial/ethnic groups is consistent with reported rates for the incidence of AIDS (5,6). Such comparisons of racial/ethnic groups may assist in targeting prevention efforts to groups at greatest risk. Differences in risk among racial/ethnic groups may reflect social, economic, behavioral, or other factors, rather than race/ethnicity directly (7). Further analyses are needed to better understand these associations.

The impact of HIV infection on U.S. mortality patterns is greater than indicated in this report. This analysis was based on the underlying cause of death recorded on death certificates; however, previous studies suggest that, for persons aged 25-44 years, deaths for which HIV infection is designated as the underlying cause represent 65%-85% of all HIV-related deaths among men and 55%-80% of those among women (8,9). In addition, provisional data for 1992 suggest that the number and proportion of deaths caused by HIV infection will increase beyond the levels described in this report (10). Increased prevention efforts to interrupt transmission of HIV are needed to decrease morbidity and mortality from HIV infection.

References

1. CDC. Mortality attributable to HIV infection/AIDS -- United States, 1981-1990. MMWR 1991; 40:41-4.

2. NCHS. Annual summary of births, marriages, divorces, and deaths: United States, 1991. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992. (Monthly vital statistics report; vol 40, no. 13).

3. NCHS. Advance report of final mortality statistics, 1990. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993. (Monthly vital statistics report; vol 41, no. 7, suppl).

4. Selik RM, Chu SY, Buehler JW. HIV infection as leading cause of death among young adults in US cities and states. JAMA 1993;269:2991-4.

5. Diaz T, Buehler JW, Castro KG, Ward JW. AIDS trends among Hispanics in the United States. Am J Public Health 1993;83:504-9.

6. Selik RM, Castro KG, Pappaioanou M. Racial/ethnic differences in the risk of AIDS in the United States. Am J Public Health 1988;78:1539-45.

7. National Commission on AIDS. The challenge of HIV/AIDS in communities of color. Washington, DC: National Commission on AIDS, December 1992.

8. Buehler JW, Devine OJ, Berkelman RL, Chevarley FM. Impact of the human immunodeficiency virus epidemic on mortality trends in young men -- United States. Am J Public Health 1990;80:1080-6.

9. Buehler JW, Hanson DL, Chu SY. Reporting of HIV/AIDS deaths in women. Am J Public Health 1992;82:1500-5.

10. NCHS. Annual summary of births, marriages, divorces, and deaths: United States, 1992. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993. (Monthly vital statistics report; vol 41) (in press).

• In determining death rates by race/ethnicity, data were excluded from four states (Connecticut, Louisiana, New Hampshire, and Oklahoma) because information concerning Hispanic ethnicity was available for less than 85% of deaths. The criteria used in this report for determining which states were excluded from analysis of mortality data by Hispanic ethnicity differ somewhat from those used by CDC's National Center for Health Statistics; therefore, numbers of deaths in Table 3 differ from those published in Table 17 of reference 3.

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