Current Trends Mortality Patterns -- United States, 1988

In 1988, 2,167,999 deaths were registered in the United States--a total of 44,676 more deaths than in 1987 and the largest annual final number ever recorded (1). As in previous years, nearly three fourths of deaths were caused by the first four leading causes of death-heart disease, cancer, stroke, and unintentional injury. This report summarizes mortality data compiled by CDC's National Center for Health Statistics (NCHS) for 1988 (1) and compares patterns with 1987.

National death statistics are based on information contained on death certificates that have been filed in state vital statistics offices as required by state law and compiled by NCHS into a national data base for monitoring the nation's health and for research. In this report, cause-of-death statistics are based on the underlying cause of death.* 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 (WHO) and endorsed by CDC.

Despite the increase in the total number of deaths in 1988, the overall age-adjusted death rate** remained the same as the record low of 535.5 per 100,000 population in 1987. For six of the 15 leading causes of death, rates decreased from 1987 to 1988 (Table 1)***; the rate for heart disease (International Classification of Diseases, Ninth Revision (ICD-9) rubrics 390-398, 402 and 404-429), the greatest contributor to U.S. mortality, declined by 1.9%, and the rate for cancer (ICD-9 rubrics 140-208) declined for the third consecutive year. Mortality from atherosclerosis (ICD-9 rubric 440) decreased by 5.6%, the largest decline among the 15 leading causes of death.

Compared with 1987, age-adjusted death rates declined for whites**** (from 511.1 to 509.8) but increased for blacks (from 778.6 to 788.8). Major causes of death that contributed to the differential in mortality between blacks and whites from 1987 to 1988 included heart disease, human immunodeficiency virus (HIV) infection (ICD-9 rubrics 042-044), and homicide (ICD-9 rubrics E960-E978). For most of the leading causes, age-adjusted death rates were higher for blacks than for whites. The largest difference in rates was for homicide: the rate for blacks was 6.4 times that for whites (Table 2). Death rates were lower for blacks for two of the 15 leading causes of death--chronic obstructive pulmonary diseases and allied conditions (ICD-9 rubrics 490-496) and suicide (ICD-9 rubrics 950-959).

As in the past, in 1988, age-adjusted death rates for men were higher than those for women (Table 2). However, when compared with 1987, age-adjusted death rates declined for males (from 698.6 to 696.7) but increased for females (from 403.3 to 404.4). The narrowing differential in gender-specific mortality reflected mortality associated with cancer and heart disease. The greatest gender differential in mortality was associated with HIV infection, for which the rate for males was 8.6 times that for females. Rates for suicide and for homicide were 4.0 and 3.3 times, respectively, higher for males than for females, and the rate for unintentional injuries (ICD-9 ``accidents and adverse effects''**** rubrics E800-E949) was 2.7 times higher for males. The smallest gender-specific difference was for diabetes mellitus (ICD-9 rubric 250) (male-to-female ratio=1.1:1).

In 1988, 330 women were reported to have died of maternal causes; however, this number includes only those deaths assigned to complications of pregnancy, childbirth, and the puerperium (ICD-9 rubrics 630-676). Based on this total, the maternal mortality rate was 8.4 deaths per 100,000 live births, 27% higher than in 1987.

In 1988, 16,602 deaths were attributed to HIV infection. Of these, 10,479 (63.1%) were among white males, 4,202 (25.3%) among black males, 995 (6.0%) among black females, and 788 (4.7%) among white females. Most (73.6%) HIV-associated deaths occurred among persons aged 25-44 years. Age-adjusted death rates per 100,000 persons were highest for black males (29.3), followed by white males (10.3), black females (6.3), and white females (0.7).

Overall life expectancy (LE) at birth in 1988 was 74.9 years. Although LE was stable for whites (75.6 years) when compared with 1987, it decreased for blacks (from 69.4 to 69.2 years). LE for whites was at the record high achieved in previous years, while black LE was only slightly above the level achieved in 1981 (68.9 years). The difference in LE between whites and blacks widened steadily to 6.4 from 1984 to 1988, after narrowing from 7.6 years in 1970 to 5.6 years in 1984 (Figure 1). Although the difference in LE between the sexes has narrowed since 1979, women are still expected to outlive men by an average of 6.9 years. Reported by: Div of Vital Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: The mortality data in this report can be used to monitor the health of the nation and to identify groups at greatest risk for specific diseases, injuries, and death. One indicator of the nation's health is expectation of life at birth. Although LE has generally been increasing, in recent years the gap in LE between the black and white populations has begun to widen, reversing a previous trend. Mortality data indicate that the particular causes of death contributing to this divergence are heart disease, HIV infection, and homicide. Moreover, although the data indicate that for both racial groups, mortality from some chronic diseases (e.g., cancer and cerebrovascular diseases (ICD-9 rubrics 430-438)) has declined, these gains are offset by trends in younger age groups in which mortality is increasing.

Reference

1. NCHS. Advance report of final mortality statistics. 1988. Hyattsville, Maryland: U.S. Department of Health and Human Services, Public Health Service, CDC, 1990. (Monthly vital statistics report; vol 39, no 7, suppl).

*Defined by the World Health Organization's (WHO) International Classification of Diseases, Ninth Revision (ICD-9) as ``(a) the disease or injury which initiated the train of morbid events leading directly to death, or (b) the circumstances of the accidents or violence which produced the fatal injury.''

**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.

***``Certain conditions originating in the perinatal period'' is not included as one of the causes of death for which the rate has decreased because this occurs mainly among infants aged less than 1 year and is based on an infant mortality rate.

****Hispanics are included in totals for both white persons and black persons. ****When a death occurs under ``accidental'' circumstances, the preferred term within the public health community is ``unintentional injury.''

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