Mortality Patterns -- United States, 1989

During 1989, 2,150,466 deaths were registered in the United States -- 17,533 fewer deaths than the record-high number recorded in 1988. In 1989, as for at least the past 20 years, nearly three fourths of deaths were attributable to 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 1989 (1) and compares patterns with 1988.

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 reported on death certificates by the attending physician, medical examiner, or coroner in a manner specified by the World Health Organization (WHO) and endorsed by CDC.

For 1989, the age-adjusted death rate ** reached a record low of 523.0 per 100,000 population in the United States, 2.3% lower than in 1988. For 10 of the 15 leading causes of death, rates decreased from 1988 to 1989 (Table 1). The rate for heart disease (International Classification of Diseases, Ninth Revision (ICD-9) codes 390-398, 402, and 404-429), the leading cause of death in the United States, and the rate for stroke (ICD-9 codes 430-438), the third leading cause of death, both declined, by 6.3% and 5.7%, respectively. Mortality from the second leading cause of death, cancer (ICD-9 codes 140-208), increased 0.2% from 1988 to 1989. Mortality from atherosclerosis (ICD-9 code 440) decreased by 14.7%, the largest decline among the 15 leading causes of death.

During 1989, as in previous years, age-adjusted death rates for the black *** population exceeded those for the white population by approximately 60% (Table 2). From 1988 to 1989, age-adjusted death rates declined from 509.8 to 496.1 per 100,000 for whites and from 788.8 to 783.1 per 100,000 for blacks. The largest difference between rates was for homicide (ICD-9 codes E960-E978), with the rate for blacks 6.6 times that for whites. Of the 15 leading causes of death, only two--chronic obstructive pulmonary diseases and allied conditions (ICD-9 codes 490-496) and suicide (ICD-9 codes E950-E959)--had lower death rates for blacks than for whites. Major causes of death contributing to the widening differential in mortality between blacks and whites from 1988 to 1989 were human immunodeficiency virus (HIV) infection (ICD-9 codes 042-044),**** homicide, diabetes mellitus (ICD-9 code 250), and cancer.

For 1989, the age-adjusted death rate for males was approximately 70% higher than for females (Table 2). The greatest sex differential in mortality was for HIV infection, for which the rate for males was 8.7 times that for females. Rates for suicide and homicide were 4.1 and 3.6 times as high for males as for females, respectively, and the rate for unintentional injuries ***** (ICD-9 codes E800-E949) was 2.6 times as high for males as for females. The smallest sex-specific difference was for diabetes mellitus (male-to-female ratio=1.1:1). When compared with 1988, age-adjusted death rates for 1989 declined for males from 696.7 to 678.7 per 100,000 population and for females from 404.4 to 395.3 per 100,000 population.

In 1989, 320 women were reported to have died of maternal causes. This number does not include all deaths occurring to pregnant women but only deaths assigned to complications of pregnancy, childbirth, and the puerperium (ICD-9 codes 630-676). The maternal mortality rate for 1989 was 7.9 deaths per 100,000 live births, compared to 8.4 in the previous year.

From 1988 through 1989, HIV infection increased from the 15th to the 11th leading cause of death. In 1989, 22,082 deaths occurred as a result of HIV infection, 33.0% more than the 16,602 deaths recorded in 1988. Of HIV-associated deaths, 14,114 (63.9%) were among white males; 5475 (24.8%), black males; 1320 (6.0%), black females; and 981 (4.4%), white females. Most (73.9%) HIV-associated deaths occurred among persons aged 25-44 years; for this age group, HIV infection was the second leading cause of death for men and the sixth leading cause of death for women. Age-adjusted HIV-associated death rates were highest for black males (40.3 per 100,000 population), followed by white males (13.1), black females (8.1), and white females (0.9).

In 1989, overall life expectancy at birth reached a record high of 75.3 years (Figure 1). Life expectancy for females was 78.6 years compared with 71.8 years for males; both figures represent increases from 1988. The difference in life expectancy between males and females has narrowed since the late 1970s; however, women are still expected to outlive men by an average of 6.8 years. From 1988 through 1989, life expectancy increased for whites (76.0 years) but remained unchanged for blacks (69.2), resulting in a widening gap in life expectancy between whites and blacks. Life expectancy for whites has continued to increase during the 1980s, while life expectancy for blacks has declined by 0.5 years since 1984. The difference in life expectancy between whites and blacks narrowed from 7.6 years in 1970 to 5.6 in 1984 but has widened steadily since then to 6.8 in 1989.

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, thereby improving the efficiency of health education and prevention efforts. The most substantial change in the number of deaths attributable to the 15 leading causes was for deaths due to HIV infection, which increased 33%. The recognition of a disease and its emergence as a leading cause of death within the same decade is without precedent.

One indicator of the nation's health is expectation of life at birth. Life expectancy has generally been increasing; however, in 1989, the gap in life expectancy between blacks and whites continued to widen, reversing a previous trend (Figure 1). Although mortality from some major chronic diseases (e.g., heart disease and stroke) has declined for both whites and blacks, these gains are offset in part by increases in mortality for young adults from HIV infection.

References

1. NCHS. Advance report of final mortality statistics, 1989. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992. (Monthly vital statistics report; vol 40, no. 8, suppl 2).

2. NCHS. Vital statistics of the United States, 1987. Vol 2, mortality, part A. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1990; DHHS publication no. (PHS)90-1011.

• Defined by the World Health Organization's 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." ** 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. *** Hispanics and non-Hispanics are included in totals for both white persons and black persons. **** These codes are from addenda to the ICD-9 (2). ***** Although the official ICD-9 title for this category is "Accidents and adverse effects," the preferred term within the public health community is "unintentional injury."

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