Between 1982 and 1984, major changes occurred in mortality
patterns of New York City residents aged 15-64 years. Among males
in
the study group, the mortality rate increased 4%, from 657 to 683
deaths per 100,000 population, and the total years of potential
life
lost before age 65 years (YPLL) increased 7%. Among females, the
mortality rate increased 1%, from 329 to 333/100,000, and the YPLL
increased 5%. Before 1982, mortality rates and YPLL had steadily
declined for at least 7 years.
The underlying causes of death were classified according to the
International Classification of Diseases, 9th Revision (ICD-9),
with
the exception of acquired immunodeficiency syndrome (AIDS) (Table
1).
The classification of AIDS required either a death certificate with
the underlying cause of death listed as AIDS (code 279.1) or a
death
certificate that matched the New York City AIDS surveillance
registry. For both sexes, the largest increases in YPLL were due
to
AIDS and to pneumonia and influenza (P&I). Among males, there was
a
14% increase in YPLL due to cerebrovascular disease; and among
females, a 5% decrease. Large decreases in YPLL were due to
external
causes of death: for men, a 14% decrease due to homicide and
suicide
and a 19% decrease due to accidents; for women, a 4% increase due
to
homicide and suicide and a 34% decrease due to accidents. Other
leading causes of YPLL did not change markedly.
The main difference between the leading causes of death in 1984
and 1982 is the addition of AIDS. Since 1980, AIDS has become the
sixth leading cause of YPLL for women in New York City and the
fourth
leading cause for men. In 1984, AIDS was the underlying cause of
death for 923 men and 132 women, accounting for 10% and 4%,
respectively, of premature mortality in New York City (Figure 1).
Reported by A Kristal, DrPH, Office of Epidemiologic Surveillance
and
Statistics, Bureau of Preventable Diseases, New York City Dept of
Health; Div of Surveillance and Epidemiologic Studies, Epidemiology
Program Office, AIDS Br, Div of Viral Diseases, Center for
Infectious
Diseases, CDC.
Editorial Note
Editorial Note: YPLL highlights premature deaths compared with
measures of crude mortality by giving greater weight to deaths
occurring in younger age groups (1). YPLL can be used at the
community or state level to identify localized patterns of
premature
mortality and to quantify the relative local importance of
individual
causes of mortality. Differences in sex- and race-specific rates
of
YPLL may also distinguish particular population subgroups at
increased
risk of premature death.
The relative ranking of specific causes of premature mortality
in
the United States as a whole differs markedly from that of New York
City, but the increasing importance of AIDS is evident in national
data. Information from AIDS cases reported to CDC indicates about
11,000 years of potential life lost in the United States due to
AIDS
in 1982, 34,000 in 1983, and 74,000 in 1984. Although AIDS was not
one of the top 15 causes of premature mortality nationally in 1984,
it
may emerge as a leading cause in 1985 if present patterns of YPLL
for
other causes remain constant and YPLL were to double along with
case
projections.
The decreases in YPLL due to unintentional injuries and
suicide/homicide are consistent with trends in national data, with
injuries decreasing 5% and suicide/homicide decreasing 7% from 1982
to
1984. YPLL from cerebrovascular diseases, however, has increased
1%
from 1982 to 1984.
The cause of the increase in YPLL due to P&I is uncertain but
may
in part be related to AIDS. Although Pneumocystis carinii
pneumonia
(which meets the CDC AIDS case definition) is not included in the
ICD-9 rubric used to specify the P&I category, unspecified
pneumonia
would be included and may reflect undiagnosed or unreported AIDS
cases. Continued study will be necessary to clarify the cause of
this
increase in YPLL associated with P&I.
Reference
CDC. Changes in premature mortality--United States, 1982-1983.
MMWR 1985;34:17-8.
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