Increase in Pneumonia Mortality Among Young Adults and the HIV
Epidemic -- New York City, United States
Most pneumonia-attributable deaths occur among the elderly. In New
York City (NYC), however, the number and rate of such deaths among
younger persons have increased in association with human
immunodeficiency virus (HIV) infections in intravenous-drug abusers
(IVDAs) (1,2). In addition, data from CDC's 121 Cities Mortality
Surveillance System (CMSS) suggest that similar trends may be
occurring
in other cities.
New York City. In NYC, concurrent with the high incidence of
acquired
immunodeficiency syndrome (AIDS), mortality rates for pneumonia or
bronchopneumonia not otherwise specified (International
Classification
of Diseases, Ninth Revision, codes 485.0-486.0) in persons 25-44
years
of age increased from 4.2 deaths/100,000 population in 1978 to 19.1
in
1987 for males and from 2.4 to 6.5 for females. Investigations of
192
(83%) of 230 clinical records of persons 25-44 years of age who
were
hospitalized in 1986 and died from pneumonia revealed the
following:
153 (80%) were in groups at increased risk for AIDS, 126 (82%) of
whom
were IVDAs; 50 (26%) had evidence of oral thrush on hospital
admission,
and 26 (14%) had a condition diagnosed that would fulfill the
criteria
of the revised surveillance case definition for AIDS (3).
121 Cities. To determine whether similar changes in
pneumonia-attributable deaths may be occurring in other cities,
trends
in pneumonia and influenza (P&I) deaths were examined using a
mortality
surveillance system that provides more recent city-level data than
are
available from national vital records.
Each week, 121 cities, constituting one fourth of the U.S.
population,
report to CDC the total number of registered deaths and the number
of
P&I-attributable deaths by age ("pneumonia" being the immediate or
underlying cause, "influenza" appearing anywhere on the death
certificate) (4). The cities were ranked by cumulative AIDS
incidence
(total cases reported to CDC since 1981 per 100,000 population)
into
deciles from highest to lowest incidence, and trends in the age
distribution of persons who died from P&I were examined for 1962
through 1987.
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