Current Trends Mortality Patterns -- United States, 1992

In 1992, a total of 2,175,613 deaths were registered in the United States -- 6095 more than in 1991 and the most ever recorded in one year (1). Despite this increase, the overall age-adjusted death rate * (504.5 per 100,000 population) was the lowest ever recorded. In comparison, provisional data indicate that the overall rate increased in 1993 (2). This report summarizes an analysis of final mortality data for 1992 (1) and compares patterns with 1991.

This analysis used information from death certificates filed in state vital statistics offices as required by state law and compiled by CDC's National Center for Health Statistics into a national database. The causes of death are recorded on the death certificate by the attending physician, medical examiner, or coroner in a manner specified by the World Health Organization. In this report, cause-of-death statistics were based on the underlying cause of death **. Data are presented only for blacks and whites because of inconsistent reporting of other races on death certificates.

For 12 of the 15 leading causes of death, the death rate decreased in 1992 from 1991 Table_1. The age-adjusted death rate for heart disease -- the leading cause of mortality in the United States -- declined by 2.6%. The rate for atherosclerosis decreased 7.7%, the largest decline among the 15 leading causes of death. Death rates from cancer decreased 1.0%, and from stroke decreased 2.2%. In contrast, rates from human immunodeficiency virus (HIV) infection and diabetes mellitus increased 11.5% and 0.8%, respectively. The death rate from HIV infection in 1992 was the highest annual rate ever recorded; in 1992, HIV infection was the eighth leading cause of death, while in 1991, it was the ninth leading cause (1).

Compared with 1991, age-adjusted death rates in 1992 declined for whites *** (from 486.8 to 477.5, respectively) and for blacks (from 780.7 to 767.5, respectively). For most of the leading causes, age-adjusted death rates were higher for blacks than for whites. The differences in rates were greatest for homicide and HIV infection, for which rates for blacks were 6.5 times and 3.7 times those for whites, respectively Table_2. Death rates were lower for blacks for two of the 15 leading causes of death -- chronic obstructive pulmonary diseases and allied conditions and suicide.

During 1992, age-adjusted death rates for males were higher than those for females Table_2. Compared with 1991, age-adjusted death rates in 1992 declined both for males (from 669.9 to 656.0, respectively) and females (from 386.5 to 380.3, respectively). The sex-specific difference was greatest for HIV infection: the rate for males was 7.0 times that for females. Rates for suicide and homicide were 4.3 and 4.0 times, respectively, higher for males, and the rate for unintentional injuries was 2.6 times higher for males. The sex-specific difference was lowest for diabetes mellitus (rate ratio=1.1).

In 1992, a total of 318 women were reported to have died from causes associated with pregnancy and childbirth; however, this total consisted of only deaths assigned to complications of pregnancy, childbirth, and the puerperium. The maternal mortality rate was 7.8 deaths per 100,000 live-born infants. The maternal mortality rate for blacks was 4.2 times greater than that for whites.

In 1992, overall life expectancy (LE) at birth was 75.8 years Figure_1. Despite increases in death rates from HIV infection and diabetes mellitus, overall LE increased by 0.3 years compared with 1991, primarily reflecting decreases in mortality from heart disease among older persons and decreases in unintentional injuries for persons in most age groups 15-64 years. LE at birth remained highest among white females (79.8 years), followed by black females (73.9 years), white males (73.2 years), and black males (65.0 years) -- although LE increased for all four racial-sex groups in 1992 over 1991. The race-specific difference in LE between blacks and whites decreased slightly from 1991 (7.0 years) to 1992 (6.9 years). Reported by: Mortality Statistics Br, Div of Vital Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that death rates have declined for most leading causes, including chronic diseases (e.g., heart disease and stroke) and unintentional injuries; however, death rates associated with HIV infection have increased. Race-specific differences in death rates may reflect variations in factors such as socioeconomic status, access to medical care, and the prevalence of specific risks. LE summarizes death rates by age into a single measure used as an indicator of the nation's health. Each of these approaches can be used to monitor health status and progress toward national health objectives and to identify groups at increased risk for specific diseases and injuries.

Overall, LE has increased every year since 1980. Improvements in LE reflect decreases in the occurrence of many of the leading causes of death, particularly heart disease; however, larger increases in overall LE may have been offset by mortality patterns for HIV infection.

Some disease categories (e.g., infections) may not be adequately represented by one classification system, such as the International Classification of Diseases, because of their dispersion throughout the coding system. Therefore, alternative analyses or data sources may provide better measures of mortality associated with these diseases.

References

1. NCHS. Advance report of final mortality statistics, 1992. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1994. (Monthly vital statistics report; vol 43, no. 6, suppl).

2. NCHS. Annual summary of births, marriages, divorces, and deaths: United States, 1993. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1994. (Monthly vital statistics report; vol 42, no. 13).

3. NCHS. Vital statistics of the United States, 1988. Vol 2, mortality, part A. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1991; DHHS publication no. (PHS)91-1101.

* Age-adjusted to the 1940 U.S. population. Age-adjusted death rates indicate changes in the risk for death more effectively than crude death rates and are better indicators for comparisons of mortality by race or sex. 

** Defined by the International Classification of Diseases, Ninth Revision, 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." 

*** Hispanics and non-Hispanics are included in both racial groups.

TABLE 1. Age-adjusted death rates * for 1992 and percentage changes in age-adjusted
death rates from the 15 leading causes of death from 1991 to 1992 and 1979 to 1992 --
United States, 1992
======================================================================================
                                                                      % Change
                                                                     ----------
                                                         1992        1991  1979
                                                     Age-adjusted     to    to
Rank +   Cause of death (ICD-9 & code)                 death rate    1992  1992
--------------------------------------------------------------------------------------
  1     Diseases of heart (390-398, 402, 404-429)        144.3       -2.6  -27.7
  2     Malignant neoplasms, including neoplasms
          of lymphatic and hematopoietic tissues
          (140-208)                                      133.1       -1.0    1.8
  3     Cerebrovascular diseases (430-438)                26.2       -2.2  -37.0
  4     Chronic obstructive pulmonary diseases
          and allied conditions (490-496)                 19.9       -1.0   36.3
  5     Accidents @ and adverse effects (E800-E949)       29.4       -5.2  -31.5
          Motor-vehicle accidents (E810-E825)             15.8       -7.1  -31.9
          All other accidents and adverse effects
            (E800-E807, E826-E949)                        13.7       -1.4  -30.1
  6     Pneumonia and influenza (480-487)                 12.7       -5.2   13.4
  7     Diabetes mellitus (250)                           11.9        0.8   21.4
  8     Human immunodeficiency virus infection
          (042-044) **                                    12.6       11.5    --
  9     Suicide (E950-E959)                               11.1       -2.6   -5.1
 10     Homicide and legal intervention (E960-E978)       10.5       -3.7    2.9
 11     Chronic liver disease and cirrhosis (571)          8.0       -3.6  -33.3
 12     Nephritis, nephrotic syndrome, and nephrosis
          (580-589)                                        4.3         0      0
 13     Septicemia (038)                                   4.0       -2.4   73.9
 14     Atherosclerosis (440)                              2.4       -7.7  -57.9
 15     Certain conditions originating in the perinatal
          period ++ (760-779)                               --       -5.2  -42.6

        All causes                                       504.5       -1.8  -12.6
------------------------------------------------------------------------------------
 * Per 100,000 population, age-adjusted to the 1940 U.S. population.
 + Based on number of deaths.
 & International Classification of Diseases, Ninth Revision.
 @ When a death occurs under "accidental" circumstances, the preferred term
   within the public health community is "unintentional injury."
** These codes are from addenda to the ICD-9 (3).
++ Based on infant mortality rates.
====================================================================================

TABLE 2. Ratio of age-adjusted death rates * from the 15 leading causes of death,
by sex and race of decedent -- United States, 1992
==================================================================================
Rank +   Cause of death (ICD-9 & ) code                  Male:female Black:white @

  1      Diseases of heart (390-398, 402, 404-429)          1.9          1.5
  2      Malignant neoplasms, including neoplasms
           of lymphatic and hematopoietic tissues
           (140-208)                                        1.5          1.4
  3      Cerebrovascular diseases (430-438)                 1.2          1.9
  4      Chronic obstructive pulmonary diseases
           and allied conditions (490-496)                  1.7          0.8
  5      Accidents ** and adverse effects (E800-E949)       2.6          1.3
           Motor-vehicle accidents (E810-E825)              2.3          1.0
           All other accidents and adverse effects
             (E800-E807, E826-E949)                         3.0          1.6
  6      Pneumonia and influenza (480-487)                  1.7          1.4
  7      Diabetes mellitus (250)                            1.1          2.4
  8      Human immunodeficiency virus infection
           (042-044) ++                                     7.0          3.7
  9      Suicide (E950-E959)                                4.3          0.6
 10      Homicide and legal intervention (E960-E978)        4.0          6.5
 11      Chronic liver disease and cirrhosis (571)          2.4          1.5
 12      Nephritis, nephrotic syndrome, and nephrosis
           (580-589)                                        1.5          2.8
 13      Septicemia (038)                                   1.3          2.7
 14      Atherosclerosis (440)                              1.3          1.1
 15      Certain conditions originating in the perinatal
           period && (760-779)                              1.2          3.2

         All causes                                         1.7          1.6
----------------------------------------------------------------------------------
  * Per 100,000 population, age-adjusted to the 1940 U.S. population.
  + Based on number of deaths.
  & International Classification of Diseases, Ninth Revision.
  @ Hispanics and non-Hispanics are included in both racial groups. Data are
    presented only for blacks and whites because of inconsistent reporting of
    other races on death certificates.
**  When a death occurs under "accidental" circumstances, the preferred term
    within the public health community is "unintentional injury."
++  These codes are from addenda to the ICD-9 (3).
&&  Based on infant mortality rates.
==================================================================================

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