Leading Causes of Death, by Age and Sex -- Utah, 1988-1992

Mortality statistics are frequently used to measure the health status of a population (1) and to assess the importance of public health problems. However, for most diseases, crude and age-adjusted death rates are primarily influenced by deaths among the elderly. Although years of potential life lost (YPLL) is one approach that has been used to identify causes of premature death (2), the results of YPLL analysis are subject to certain limitations (3). As an alternative approach to identifying causes of premature death, the Utah Department of Health (UDOH) analyzed age- and sex-specific death rates among Utah residents during 1988-1992. This report summarizes the results of that analysis and compares findings with national data.

The underlying cause of death was coded according to the International Classification of Diseases, Ninth Revision (4); the codes were grouped to be comparable with national vital statistics reporting based on the 72 selected causes of death (5). Deaths attributed to unintentional injury were separated into those attributed to motor-vehicle crashes and those from all other causes. Initially, death rates and the ordering of underlying causes were examined for 13 age groups (less than 1 year; 1-4 years; 5-year intervals from 5 through 24 years; 10-year intervals from 25 through 84 years; and greater than or equal to 85 years). Age groups were combined when the ordering of the leading underlying causes of death appeared comparable. Seven age groups resulted: less than 1 year, 1-14 years, 15-24 years, 25-44 years, 45-64 years, 65-84 years, and greater than or equal to 85 years. For each age and sex group, up to 10 causes of death for which at least 20 deaths occurred during the 5-year period were reported.

Injuries (i.e., suicide, homicide, motor-vehicle crashes, and all other unintentional injuries) were the leading causes of death among young persons in Utah, particularly men (Figure_1) and (Figure_2). Injuries accounted for 82% of deaths among men aged 15-24 years and 45% of all deaths among men aged 25-44 years; for women in these age groups, the percentages were 70% and 30%, respectively.

Injuries were also leading causes of death for young persons nationally; however, the pattern of violent deaths was substantially different in Utah (Table_1). Death rates from suicide were 25%-50% higher for Utah than nationally; deaths from most other types of injury occurred at higher rates nationally than in Utah.

Death rates for males were substantially higher than rates for females at every age. Among persons in younger age groups (i.e., less than or equal to 45 years), higher rates for males were attributed primarily to injuries; at older ages, higher rates were largely attributed to heart disease and cancer.

Reported by: C Schumacher, MD, Office of Surveillance and Analysis, Div of Community Health Svcs; J Brockert, MPH, Bur of Vital Records and Health Statistics, Utah Dept of Health. State and Local Support Br, Div of Health Promotion Statistics, Office of Analysis, Epidemiology, and Health Promotion, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that suicide has been an important cause of death for young men in Utah. From 1988-1992, the suicide rate for young men in Utah was higher than the national rate, and suicide was relatively more important in Utah because of lower death rates from other causes in these age groups. The UDOH is gathering and analyzing additional data on suicide in Utah to better identify high-risk populations and potential interventions.

The collection, analysis, and use of public health data at local levels offers at least two important advantages to public health agencies and other decision-makers. First, information at local levels will provide the most timely and accurate indication of the health status of that population. Second, local data may be the most useful to legislators and other decision-makers.

Presenting age-specific leading causes of death with simple graphics can effectively communicate information about premature mortality to a wide audience. To further increase the local applicability of this type of analysis, the UDOH has developed a computer information system that allows local health departments to replicate these analyses using data that are specific to local populations. This approach is consistent with the recommendations of the Institute of Medicine to improve local use of data to measure health status (6).

References

1. CDC. Consensus set of health status indicators for the general assessment of community health status -- United States. MMWR 1991;40:449-51.

2. CDC. Premature mortality in the United States: public health issues in the use of years of potential life lost. MMWR 1986;35(suppl):1s-11s.

3. Gardner JW, Sanborn JS. Years of potential life lost (YPLL) -- what does it measure? Epidemiology 1990;1:322-9.

4. 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.

5. NCHS. Vital statistics of the United States, 1989. Vol 2, mortality, part A. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993; DHHS publication no. (PHS)93-1101.

6. Institute of Medicine. The future of public health. Washington, DC: National Academy Press, 1988.

Figure_1


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Figure_2


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Table_1
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Table 1. Death rates* for injuries+ among men aged 15-44 years -- Utah, 1988-1992,
and United States, 1988-1991
================================================================================================

                          Motor-vehicle
Age group (yrs)              crashes      Homicide   Suicide   Other
------------------------------------------------------------------------------------------------
15-24
  Utah                         34.9          4.7       33.3     11.7
  United States                49.9         29.8       21.7     17.0

25-44
  Utah                         23.9          6.3       30.2     16.8
  United States                30.1         22.5       24.1     23.8
------------------------------------------------------------------------------------------------
*Per 100,000 men aged 15-44 years.
+Deaths associated with motor-vehicle crash (International Classification of Diseases, Ninth
Revision codes E810-E825), all other accidents and adverse effects (codes E800-E807, and
E826-E949), homicide and legal intervention (codes E960-E978), and suicide (codes E950-E959).
================================================================================================

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