Advance Report of Final Mortality Statistics, 1994 by Gopal K. Singh, Ph.D.; Kenneth D. Kochanek, M.A.; and Marian F. MacDorman, Ph.D., Division of Vital Statistics Abstract Objectives—This report presents 1994 data on U.S. deaths and death rates accord- ing to such demographic and medical characteristics as age, sex, race, Hispanic origin, marital status, educational attain- ment, State of residence, autopsy status, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. Methods—Descriptive tabulations of data reported on the death certificates of 2,278,994 deaths are presented. Changes between 1993 and 1994 in numbers of deaths and death rates and differences in death rates across demographic groups in 1994 are tested for statistical significance. A decomposition procedure is used to identify causes of death accounting for changes in age-specific death rates and life expectancy. Results—The age-adjusted death rate for the total population in 1994 decreased, and life expectancy at birth increased by 0.2 years to 75.7 years. The improvement in life expectancy was primarily due to a decrease in mortality from heart disease, cancer, pneumonia and influenza, and homicide, although offsetting the positive improvements were increases in mortality from Human immunodeficiency virus (HIV) infection and diabetes. The list of the 15 leading causes of death was the same as in the previous year, but the rank of some causes changed. Thus, Chronic liver disease and cirrhosis replaced homi- cide as the 10th leading cause of death, and Alzheimer’s disease moved past ath- erosclerosis as the 14th leading cause. Mortality declined for those under 15 years of age and those at ages 55 years and older but increased for those aged 35–44 years; causes of death contributing to this increase were HIV infection and viral hepatitis. Mortality declined for each of the major race and sex groups. Infant mortality rate declined by 4.8 percent to a record low of 8.0 infant deaths per 1,000 live births in 1994. Neonatal and postneo- natal mortality rates also declined for white and black infants. The causes con- tributing the most to the improvement in the overall infant mortality were sudden infant death syndrome and respiratory distress syndrome. Conclusions—The overall improve- ments in general mortality and life expect- ancy suggest a resumption of the long- term downward trend in U.S. mortality, which was briefly interrupted in 1993 by an increase in mortality associated with the influenza epidemics. The decline in U.S. infant mortality continues the steady downward trend of the past four decades. Acknowledgments This report was prepared in the Division of Vital Statistics under the general direction of Harry M. Rosenberg, Chief of the Mortality Statistics Branch. Jeffrey D. Maurer of the Mortality Statistics Branch and Van L. Parsons of the Office of Research and Methodology contributed to the ‘‘Technical notes.’’ Thomas D. Dunn of the Statistical Resources Branch provided statistical tables and content review. Charles E. Royer of the Systems and Programming Branch provided computer programming support. Staff of the Registration Methods Branch and the Technical Services Branch provided consultation to State vital statistics offices regarding collection of the death certificate data on which this report is based. This report was edited by Patricia Keaton-Williams and typeset by Jacqueline M. Davis of the Publications Branch, Division of Data Services. Vol. 45, No. 3, Supplement + September 30, 1996 Final Data From the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Center for Health Statistics U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Centers for Disease Control and Prevention National Center for Health Statistics CENTERS FOR DISEASE CONTROL AND PREVENTION
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Advance Report of Final Mortality Statistics, 1994ward mortality trend, which was inter-rupted by a substantial increase in mortality associated with the influenza epidemics of 1992–93.
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Advance Report of Final Mortality Statistics, 1994by Gopal K. Singh, Ph.D.; Kenneth D. Kochanek, M.A.; andMarian F. MacDorman, Ph.D., Division of Vital Statistics
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Vol. 45, No. 3, Supplement + September 30, 1996
Final Data From the CENTERS FOR DISEASE CONTROLAND PREVENTION/National Center for Health Statistics
Abstract
Objectives—This report presents 199data on U.S. deaths and death rates accing to such demographic and mediccharacteristics as age, sex, race, Hispaorigin, marital status, educational attaiment, State of residence, autopsy statand cause of death. Trends and patterngeneral mortality, life expectancy, aninfant and maternal mortality are alsdescribed.
Methods—Descriptive tabulations odata reported on the death certificates2,278,994 deaths are presented. Chanbetween 1993 and 1994 in numbersdeaths and death rates and differencedeath rates across demographic group1994 are tested for statistical significancA decomposition procedure is usedidentify causes of death accounting fchanges in age-specific death rates alife expectancy.
This report was prepared in the Division of VJeffrey D. Maurer of the Mortality Statistics BrThomas D. Dunn of the Statistical ResourcesBranch provided computer programming suppvital statistics offices regarding collection of thetypeset by Jacqueline M. Davis of the Publica
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Results—The age-adjusted death rafor the total population in 1994 decreaseand life expectancy at birth increased0.2 years to 75.7 years. The improvemein life expectancy was primarily due todecrease in mortality from heart diseacancer, pneumonia and influenza, ahomicide, although offsetting the positivimprovements were increases in mortalfrom Human immunodeficiency viru(HIV) infection and diabetes. The list othe 15 leading causes of death wassame as in the previous year, but the raof some causes changed. Thus, Chroliver disease and cirrhosis replaced homcide as the 10th leading cause of deaand Alzheimer’s disease moved past aerosclerosis as the 14th leading cauMortality declined for those under 1years of age and those at ages 55 yeand older but increased for those ag35–44 years; causes of death contribut
Acknowledgments
ital Statistics under the general direction of Harry Manch and Van L. Parsons of the Office of ResearchBranch provided statistical tables and content rev
ort. Staff of the Registration Methods Branch and thedeath certificate data on which this report is basedtions Branch, Division of Data Services.
RTMENT OF HEALTH AND HUMAN SEPublic Health Service
Centers for Disease Control and PreventionNational Center for Health Statistics
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to this increase were HIV infection andviral hepatitis. Mortality declined for eachof the major race and sex groups. Infanmortality rate declined by 4.8 percent to arecord low of 8.0 infant deaths per 1,000live births in 1994. Neonatal and postneo-natal mortality rates also declined forwhite and black infants. The causes contributing the most to the improvement inthe overall infant mortality were suddeninfant death syndrome and respiratorydistress syndrome.
Conclusions—The overall improve-ments in general mortality and life expect-ancy suggest a resumption of the long-term downward trend in U.S. mortality,which was briefly interrupted in 1993 byan increase in mortality associated withthe influenza epidemics. The decline inU.S. infant mortality continues the steadydownward trend of the past four decades
. Rosenberg, Chief of the Mortality Statistics Branch.and Methodology contributed to the ‘‘Technical notes.’’iew. Charles E. Royer of the Systems and ProgrammingTechnical Services Branch provided consultation to State. This report was edited by Patricia Keaton-Williams and
RVICES
CENTERS FOR DISEASE CONTROLAND PREVENTION
Errata
The Death Rates onTable 15, page 52, column two under the section "White non-Hispanic origin, 5-14 years" have been corrected and differ from the original publication. Table I was omitted from the original publication. It is now shown on page 79 of this document. Data was changed on Table 25 (page 66) and Table 29 (page 70). These changes were made to the internet copy only on 5/29/97.
In 1994 a record 2,278,994 deathwere registered in the United State10,441 more than the previous high2,268,553 deaths recorded in 1993. Tcrude death rate for 1994 was 875.4deaths per 100,000 population, slightlower than the 1993 rate of 880.0. Thage-adjusted death rate, which elimi-nates the distorting effects of the agingthe population, was 507.4 per 100,00U.S. standard million population, 1.1 pecent lower than the 1993 rate of 513.and 0.6 percent higher than the recolow of 504.5 in 1992.
The overall decline in mortalitybetween 1993 and 1994 representsresumption of the long-term down-ward mortality trend , which was inter-rupted by a substantial increasemortality associated with the influenzaepidemics of 1992–93. The age-adjustrate decreased between 1993 and 19for all four major race and sex groupWhite males, white females, black maleand black females.
By agedeath rates decreased substtially for those under 15 years of age anthose at ages 55 years and older. Tdeath rate increased by 1.4 percebetween 1993 and 1994 for those ag35–44 years. The causes of death contruting most to the increase in the dearate for those aged 35–44 years weHIV infection andviral hepatitis .
In 1994 life expectancyat birth was75.7 years, an increase of 0.2 years copared with life expectancy in 1993, buslightly lower than the record high o75.8 years in 1992. Women currently aexpected to outlive men by an average6.6 years, and white persons are expecto outlive black persons by an average7.0 years. Among the four major race-sgroups, white females continue to hathe highest life expectancy at birth (79years), followed by black females (73.years), white males (73.3 years), and blamales (64.9 years). The gain in life expecancy of 0.2 years for the total populatiocan be explained primarily by decreasindeath rates forheart disease, cancer,pneumonia and influenza, and homi-cide, despite increases in death ratesHIV infection and diabetes.
The ranking of theleading causesofdeath for the total population in 199
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changed as follows:Chronic liver dis-ease and cirrhosis, the 11th leading causof death in 1993, replacedhomicide asthe 10th leading cause of death in 199Alzheimer’s diseasereplacedatheroscle-rosisas the 14th leading cause of death1994. However, the first nine leadincauses of death in 1994—heart disease,cancer, stroke, Chronic obstructive pul-monary diseases and allied conditions(COPD), accidents, pneumonia andinfluenza, diabetes, HIV infection, andsuicide—remained the same leadincauses as those in 1993 with identicrankings. These nine causes accounfor 80 percent of all deaths in 1994.
Age-adjusted death ratesfor eightof the leading causes of death for the topopulation declined between 1993 and1994, with largest percentage declinoccurring fornephritis, atherosclerosis,pneumonia and influenza, homicide,and heart disease. Mortality for all otheraccidents, a component of the overaaccidents category, declined by 1.4 pcent between 1993 and 1994. In additiomortality from cancer, the second leading cause of death, showed a small bsignificant decrease.
Age-adjusted death rates increasedbetween 1993 and 1994 for three leadicauses of death:HIV infection, diabetes,and Alzheimer’s disease. The age-adjusted death rate for HIV infectioincreased by 11.6 percent between 19and 1994, higher than the rate of increain the previous year. The age-adjustdeath rate also increased by 8.7 percfor Alzheimer’s disease and by 4 percefor diabetes. The increase in Alzheimerdisease mortality likely reflects improvements in reporting and diagnosis of thdisease rather than increases in prevale
Mortality from drug-induced andalcohol-induced causesincreased signifi-cantly between 1993 and 1994. Howevthe age-adjusted death rate forfirearminjuries decreased by 3 percent betwe1993 and 1994.
In terms of mortalitysex differen-tials, the age-adjusted death rate formaleswas 70 percent higher than that ffemalesfor all causes of death combineFor each of the 15 leading causesdeath, except Alzheimer’s disease, mamortality was higher than female mortaity. The greatest sex differential was foHIV infection, where the age-adjuste
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rate for males was 5.5 times that fofemales. The smallest sex differential wafor Alzheimer’s disease, with a male-tofemale ratio of about 1.0.
In 1994mortality levels varied byrace. Overall, age-adjusted death ratefor the black population exceeded thoseof thewhite population by about 61 per-cent. Rates for the black population weralso higher for most of the leading causeof death. The largest race differentiacontinued to be forhomicide, for whichthe age-adjusted rate for the black poplation was 6.6 times that of the whitepopulation. The three leading causes thhad lower mortality rates for the blackpopulation wereCOPD, suicide, andAlzheimer’s disease.
Leading causes of death differedby age. Overall, accidents were the leading cause of death for age groups 1–5–14, and 15–24 years. HIV infectionwas the leading cause of death for thosaged 25–44 years. Cancer was the leadicause of death for those aged 45–6years, while heart disease was the leadicause for those aged 65 years and oldThe leading cause of death was the samfor the white and black populations for alage groups except 15–24 years and 25–years. For the white population, accidenwere the leading cause for these two aggroups. For the black population, homicide was the leading cause for those ag15–24 years, while HIV infection was theleading cause for those aged 25–44 yea
The infant mortality rate (8.0 infantdeaths per 1,000 live births) reachedrecord low in 1994, continuing the longterm downward trend in infant mortality.
Among theleading causes of infantdeath, the causes contributing the mosto the improvement in the 1994 rate wersudden infant death syndrome and respratory distress syndrome. Sudden infadeath syndrome decreased from the seond to the third leading cause of infandeath between 1993 and 1994. Increasinfant mortality from perinatal infections,pneumonia and influenza, and neonathemorrhage prevented the infant mortaity rate from decreasing even furtheInfant, neonatal, and postneonatamortality rates declined for white andblack infants between 1993 and 1994. I1994 the infant mortality rate for blackinfants remained at more than twice thafor white infants.
This report, the release of nationmortality statistics for 1994, presendetailed data on deaths and death raaccording to a number of social, demgraphic, and medical characteristics. Thdata provide important information omortality patterns among Americans bsuch variables as age, sex, race, Hispaorigin, marital status, educational attaiment, State of residence, autopsy statand cause of death. Information on themortality patterns is critical in understaning shifts in the health and social statusthe U.S. population (1).
The mortality data in this report cabe used to monitor and evaluate the crent status and long-term trends in motality and in the health of the Nation anto identify segments of the U.S. popultion at greatest risk for death from spcific diseases and injuries. Differencesdeath rates among demographic grouincluding racial/ethnic groups, may reflegroup differences in factors such as soceconomic status, access to medical caand the prevalence of specific risks.
Methods
Data shown in this report are bason information from all death certificatefiled in the 50 States and the DistrictColumbia. It is believed that more tha99 percent of deaths occurring in thcountry are registered (2). Tables shoing data by State also provide informtion for Puerto Rico, the Virgin Islandsand Guam. Cause-of-death statistics psented in this report are classifiedaccordance with theNinth Revision of theInternational Classification of Disease(ICD–9). A detailed discussion of causeof-death classification is provided in th‘‘ Technical notes.’’
Mortality data on specific demographic and medical characteristics, exceducational attainment and Hispanic ogin, cover all 50 States and the DistrictColumbia. For educational attainmendata are provided for 45 States and tDistrict of Columbia. For Hispanic origin, data reported exclude Oklahombecause it does not include the Hispaorigin item on its death certificates. Detaon reporting areas for education
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In this report the number of deathcrude death rate, age-specific and aadjusted death rates; infant, neonatal, pneonatal, and maternal mortality ratelife expectancy; and rate ratios are usas measures of mortality. Changes betw1993 and 1994 in numbers of deaths adeath rates and differences in death raacross demographic groups in 1994tested for statistical significance. A decoposition procedure is used to identicauses of death accounting for changeage-specific death rates and life expeancy (3,4). Additional information onthese statistical methods; random vartion and relative standard error; the coputation of derived statistics and ratepopulation denominators; and the defition of terms is presented in the ‘‘Techni-cal notes.’’
Results and discussion
Deaths and death rates
In 1994 a total of 2,278,994 deathoccurred in the United States, 10,4more than in 1993 and 103,381 more thin 1992. Before 1994 the 1993 total2,268,553 deaths was the largest finumber ever recorded. Although the nuber of deaths increased between 19931994, the crude death rate for 1994, 87per 100,000 population, was 0.5 percelower than the rate of 880.0 in 1993.1992 the death rate was 852.9.
Age-adjusted death rates are costructs that show what the level of motality would be if no changes occurredthe age composition of the populatiofrom year to year. (For a discussionage-adjusted death rates, see ‘‘Technicalnotes.’’) Thus, they are better indicatorthan unadjusted death rates for showchanges in the risk of death over a periof time when the age distribution of thpopulation is changing. Also, they abetter indicators of relative risk whecomparisons of mortality are being mafor sex or race subgroups of the popution that have different age compositionThe age-adjusted death rate in 1994 w507.4 deaths per 100,000 U.S. standmillion population, 1.1 percent lower tha
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the rate of 513.3 in 1993 and 12.1 percelower than the rate of 577.0 in 1979(figure 1). The 1994 rate was, howeverslightly higher than the record low rate o504.5 in 1992. Since 1979, the ageadjusted death rate has decreased evyear except 1985, 1988, and 1993, yeawhen major influenza outbreaks increasemortality in the United States (5–9).
Death rates by age, sex, andrace—Between 1993 and 1994, deatrates for both sexes combined declinefor these age groups: Under 1 year, 1–years, 5–14 years, 55–64 years, 65–years, 75–84 years, and 85 years and ov(table A). The largest decrease (4.2 pecent) occurred for the age group 1–years. The death rate increased for thage group 35–44 years (1.4 percenChanges in death rates between the twyears for the age groups 15–24 year25–34 years, and 45–54 years were nstatistically significant.
The death rate for males declinebetween 1993 and 1994 for these aggroups: Under 1 year, 1–4 years, 55–6years, 65–74 years, 75–84 years, andyears and over (table A). The largestdecreases for males were for those agunder 1 year (4.9 percent) and 1–4 yea(4.4 percent). The only statistically significant increase in the male death rate wfor those aged 35–44 years (1.3 percenThe increase in death rates between 19and 1994 for males aged 35–44 yeacontinued the increase begun betwee1983 and 1984, a reversal of the downward trend for this age group since thlate 1960’s(figure 2andtable A).
For females age-specific rates havgenerally been decreasing since 195Between 1993 and 1994, death ratedeclined for these age groups: Underyear, 5–14 years, 55–64 years, 75–8years, and 85 years and over. The largedecrease in death rates between 1993 a1994 occurred for females 5–14 year(6.3 percent). The only significant increaswas for the age groups 35–44 yea(1.7 percent). Changes in female dearates between the two years for the othage groups were not statisticallysignificant.
The pattern of changes in agespecific death rates between 1993 an1994 was similar for the four major
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NOTE: Crude death rates on an annual basis per 100,000 population; age adjusted rates per100,000 U.S. standard million population; see "Technical notes."
Figure 1. Crude and age-adjusted death rates: United States, 1930–94
race-sex groups: Death rates generdecreased for the age groups under 11–4 years and for those aged 55 yearsolder. For black males aged 5–14 yeahowever, the death rate increased4.2 percent. In addition, for white maland black females aged 35–44 years,death rate increased by 1.5 and 3.2 pcent, respectively.
Between 1993 and 1994, agadjusted death rates decreased bypercent for white males and 2.1 perc
0.0 Quantity more than zero but less than 0.05.1Includes races other than white and black.2Death rates for ‘‘Under 1 year’’ (based on population estimates) dfor further discussion of the difference.
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for black males. The age-adjusted derate decreased by 0.8 percent for whfemales and 1.2 percent for black fema(table 1). Age-adjusted death ratedecreased almost every year between 1and 1992 for white males and females bincreased between 1992 and 1993. T1994 age-adjusted rate of 617.9 waslowest ever recorded for white males. Fblack males, rates decreased between 1and 1982, increased between 1984 a1988, decreased between 1988 and 19
iffer from infant mortality rates (based on live births); see tables C
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and increased again between 1992 a1993. Rates for black females fluctuatebetween 1980 and 1987, decreased eayear between 1988 and 1992, anincreased between 1992 and 1993.
In 1994 the age-adjusted death rafor males of all races was 1.7 times thafor females. In 1950 the male-to-femalratio was 1.5. The 1970 ratio (1.7increased to 1.8 during the late 1970until 1987 when the ratio again declineto 1.7. For 1994 the ratio between maland female age-adjusted death rates w1.7 for the white population and 1.8 fothe black population.
In 1994 the age-adjusted death rafor the black population was 1.6 timesthat for the white population, the samratio that has prevailed since 1987. Fo1960–86 the race ratio was 1.5.
Expectation of life at birth and atspecified ages
In 1994 the average expectation olife at birth was 75.7 years, an increase o0.2 years compared with life expectancin 1993, but slightly lower than the recordhigh of 75.8 years in 1992. The increasbetween 1993 and 1994 representsresumption of a generally upward trenin U.S. life expectancy that has beeobserved throughout this century but, morecently, was interrupted by a 0.3-yeadecline between 1992 and 1993.
The expectation of life at birth for1994 represents the average numberyears that a group of infants would live i
and 24–29 for 1994 infant mortality rates and ‘‘Technical notes’’
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Deaths rates for "Under 1 year" (based on population estimates) differ from infant mortality rates (based on live births); see figure 5 for infant mortalityrates and "Technical notes" for further discussion of the difference.1
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Figure 2. Death rates by age and sex: United States, 1950–94
the infants were to experience througholife the age-specific death rates prevailinin 1994. In 1994 life expectancy fofemales was 79.0 years compared w72.4 years for males; both figures reprsent increases over 1993. The differenin life expectancy between the sexes w6.6 years in 1994, the same differencein 1993. In contrast to the widening gafrom 1900 to 1972 (2.0 years in 1900, 5years in 1950, and 6.5 years in 1960), tdifference in life expectancy between thsexes narrowed between 1979 and 19(7.7 and 7.8 years throughout the perifrom 1972 through 1979, 7.1 years1984, and 6.9 years in 1988) and betwe1990 and 1993.
Between 1993 and 1994, life expecancy for the white population increasefrom 76.3 years to 76.5 years, equalinthe record high reached in 1992. Lifexpectancy for the black population alsincreased from 69.2 years in 1993 to 69years in 1994; in 1992 it was 69.6 year
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The difference in life expectancy betwethe white and black populations was 7years in 1994, slightly lower than thdifference of 7.1 years in 1993. Althougthe white-black difference in life expecancy narrowed from 7.6 years in 19705.7 years in 1982, it increased to 7years in 1989 before declining to 7years in 1990 and 1991, and 6.9 years1992.
Among the four race-sex groups (fig-ure 3), white females continued to havthe highest life expectancy at birth (79years), followed by black females (73years), white males (73.3 years), and blamales (64.9 years). Between 1993 a1994, life expectancy increased for blamales (from 64.6 years in 1993 to 64years in 1994) and for black female(from 73.7 in 1993 to 73.9 in 1994Black males experienced an unpreedented decline in life expectancy eveyear for 1984–89 (3), but an annuincrease in 1990, 1991, 1992, and 19
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However, life expectancy for black maleswas still 0.4 years shorter than the pealife expectancy of 65.3 years attained in1984. Before 1988 life expectancy forblack females fluctuated but increasefrom 1988 to 1992. Overall, the largesgain in life expectancy between 1980 an1994 was for white males (2.6 years)followed by white females (1.5 years),black females (1.4 years), and black male(1.1 years).
The 1994 life table may be used tocompare life expectancies at any age frobirth onward. For example, a person whohas reached age 65 years may look foward to living to an older age, on theaverage, than one who has reached 5years. On the basis of mortality experienced in 1994, a person aged 50 yeacould expect to live an average of 29.3more years for a total of 79.3 years, andperson aged 65 years could expect to livan average of 17.4 more years for a totaof 82.4 years (table 4).
The 15 leading causes of death1994 accounted for 86 percent of adeaths in the United States (table B). (Forranking procedures, see ‘‘Technicalnotes.’’) For the first time, beginning withthis report, Alzheimer’s disease is beintreated as a rankable cause of death (‘‘ Technical notes’’). The leading causesof death for 1984–94 have generally bethe same, but the order has often variFor 1994 the 1st nine and the 12th a13th leading causes of death were tsame causes and in the same order as1993. The only changes in the rankinwere as follows: Chronic liver diseasand cirrhosis, the 11th leading causedeath in 1993, became the 10th leadicause of death in 1994; Homicide anlegal intervention (homicide), the 10tleading cause of death in 1993, becathe 11th leading cause of death in 199Alzheimer’s disease became the 14th leing cause of death in 1994; Atherosclersis, the 14th leading cause of death1993, became the 15th leading causedeath in 1994.
For most leading causes, agadjusted death rates are better indicatthan crude death rates for showing chanin mortality risk over time. Thereforeage-adjusted rates are used to depict tre
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for all 15 leading causes of death (fig-ure 4). Among these causes, age-adjusdeath rates were lower in 1994 than1993 for eight leading causes—Diseaof heart (heart disease); Malignant nplasms, including neoplasms of lymphatic and hematopoietic tissues (cancChronic obstructive pulmonary diseasand allied conditions (COPD); Pneumnia and influenza; homicide; Nephritnephrotic syndrome, and nephro(nephritis); Septicemia; and atherosclesis (table B). The largest declines in motality were for nephritis (4.4 percenatherosclerosis (4.2 percent), pneumoand influenza (3.7 percent), homici(3.7 percent), and heart disease (3.4cent). Mortality from all other accidenand adverse effects, a component of adents and adverse effects (accidendeclined by 1.4 percent between 19and 1994. The declines in mortality froheart disease, stroke, and atherosclerwere consistent with the generally dowward trends observed since 1950. Canmortality has shown a gradual but constently downward trend since 1990. Tage-adjusted death rate for homicdecreased by 3.7 percent between 1and 1994, reversing the increase dur1992 through 1993, and resumingdownward trend observed during 1991–
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For 1987–91 homicide mortality had riseat an average rate of more than 6 percper year. Although the age-adjusted dearate for pneumonia and influenzdecreased significantly in 1994 from thin 1993 (a year with excess influenzmortality), the rate for1994 remained at arelatively high level—2.4 percent higher thathe rate for 1992.
The age-adjusted death rate whigher in 1994 than in 1993 for three othe leading causes of death: Diabemellitus (diabetes), Human immunodeciency virus (HIV) infection, and Alzhe-imer’s disease. The age-adjusted rateHIV infection has increased consistentsince 1987, the year in which HIV infection was added to the list of rankabcauses (see ‘‘Technical notes’’). Between1993 and 1994, the rate for HIV infectioincreased by 11.6 percent, larger thanrate of increase of 9.5 percent betwe1992 and 1993. Diabetes mortality hbeen increasing consistently since 198The increase of 4.0 percent in the agadjusted death rate for diabetes betwe1993 and 1994 was similar to that fo1992–93, and larger than the rateincrease during 1990 through 1992.was considerably smaller than the anomlous 14-percent increase during 1988–8which has been attributed in part to th1989 revision of the death certificate (7
Between 1993 and 1994, the agadjusted death rate for Alzheimer’s diease increased by 8.7 percent (figure 4).Reporting of Alzheimer’s disease deathas increased since the classificationthis disease was introduced in 1979 (s‘‘ Technical notes’’). The increase in Alzhe-imer’s disease mortality likely reflectimprovements in reporting and diagnosof the disease rather than increasesprevalence (10). For three leading causof death, including Cerebrovascular dieases (stroke), Chronic liver disease acirrhosis, and accidents, age-adjustdeath rates did not change between 19and 1994.
In 1994 the leading causes of deadiffered substantially by age (table 7). Forthe younger age groups—1–4, 5–14, a15–24 years—accidents were the leadicause of death. HIV infection was thleading cause of death for the age gro25–44 years. In the older age groupchronic diseases were the leading caus
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Table B. Percent of total deaths, death rates, age-adjusted death rates for 1994, percent change in age-adjusted death rates from 1993 to1994 and 1979 to 1994, and ratio of age-adjusted death rates by race and sex for the 15 leading causes of death for the total populationin 1994: United States[Crude death rates on an annual basis per 100,000 population; age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ For explanationof asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Rank1Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Cancer, for those aged 45–64 years, aheart disease, for those aged 65 yearsover. At ages below 25 years, homicidranked between the second and fouleading cause of death, while for the agroups 5–14, 15–24, and 25–44 yeasuicide ranked between the third and sixleading cause of death.
In 1994 the patterns in leading causof death varied by sex (table 7). For thetotal male and female populations, 7the 10 leading causes of death were tsame but differed by rank. While accdents was the third leading cause of deafor males, it was the seventh leadincause for females. Similarly, while diabetes was the ninth leading cause of deafor males, it was the sixth leading caufor females. Moreover, while HIV infec-tion, suicide, and homicide were respetively the 7th, 8th, and 10th leading causof death for males, they did not ranamong the ten leading causes of deathfemales. The sex patterns in leading cauof death also differed according to agNot only did the relative rankings of thleading causes of death vary by sex forgiven age group, but the causes of de
ndndethers,th
es
fhei-thg-the
c-eskforsese.
ath
representing the list of top 10 causes adiffered. For example, for the age grou25–44 years, HIV infection was the leaing cause of death for males but was tfourth leading cause of death for femaleFurthermore, while stroke was the 10leading cause of death for males ag15–24 years, it was not among theleading causes of death for females ag15–24 years.
In 1994 the patterns in leading causof death also varied according to ra(table 7). Within broad age groups for thwhite and black populations, the leadincause was the same except for the agroups 15–24 and 25–44 years. For tage group 15–24 years, the leading cafor the white population was accidentwhile the leading cause for the blacpopulation was homicide. For the aggroup 25–44 years, the leading causethe white population again was accidenwhile the leading cause for the blacpopulation was HIV infection. For theage groups 15–24 through 65 years aover, accidents ranked higher for the whpopulation than for the black populationwhile homicide and HIV infection
sop-es.hd0ed
se
ggeese,keors,k
ndte;
consistently ranked higher for the blacpopulation than for the white populationfor all age groups under 65 years.
Age-adjusted death rates for malewere higher than the rates for females foall causes of death combined and for 1of the 15 leading causes of death (table B).Eight of the leading causes of deatshowed differentials in which age-adjusted death rates for males wereleast 1.5 times those for females. Thlargest differential was for HIV infection,for which the death rate for males was 5.times that for females. Other largedifferentials were for suicide (4.5);homicide (4.1); accidents (2.6); chroniliver disease and cirrhosis (2.4); headisease (1.9); COPD (1.6); pneumonand influenza (1.6); nephritis (1.4); ancancer (1.4). The smallest sex differencin mortality was for Alzheimer’s diseasewith a male-to-female ratio of 1.04.
Mortality was higher for the blackpopulation than for the white populationfor most of the leading causes of deatfor the total population (table B). Thelargest differential was for homicide, forwhich the age-adjusted death rate for th
ia
necu
s
atfri
eg
di
f
o
a
n
nIVnh
d
m
sinu-ri-fy,
2ofe,ni-
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Diseases of heart
Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues
Cerebrovascular diseases
Accidents and adverse effects
Chronic obstructive pulmonary diseases and allied conditions
Pneumonia and influenza
Diabetes mellitus
Suicide
Human immunodeficiency virus infection
Homicide and legal intervention
Chronic liver disease and cirrhosis
Nephritis, nephrotic syndrome, and nephrosis
Septicemia
Atherosclerosis
2
1
7
6
3
4
5
8
9
10
11
12
13
15
0.1
0.5
1.0
5.0
10.0
50.0
100.0
500.0
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995
0.2
0.30.4
2.0
3.0
4.0
20.0
30.0
40.0
200.0
300.0400.0
1
2
3
5
6
7
9
10 4
1211
15
13
8
14
Alzheimer’s disease14
Revisions of the International Classification of Diseases
Sixth Seventh Eighth Ninth
Rat
e p
er 1
00,0
00
U.S
. st
and
ard
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ion
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tion
Figure 4. Age-adjusted death rates for the 15 leading causes of death: United States, 1950–94
black population was 6.6 times that of thwhite population. Other causes for whicthe differential was large include HIVinfection (4.4); nephritis (2.7); septicem(2.6); diabetes (2.4); stroke (1.9); headisease (1.5); cancer (1.4); and chroliver disease and cirrhosis (1.4). Agadjusted rates were lower for the blapopulation than rates for the white poplation for three leading causes odeath—COPD (18 percent), suicid(40 percent), and Alzheimer’s disea(31 percent).
Causes of death can be identified thaccount for changes in age-specific derates between 1993 and 1994. Thus,4.2-percent decrease in the death ratethose aged 1–4 years was due primato declines in mortality from congenitaanomalies and accidents. The 3.8-percdecrease in the death rate for those a5–14 years was due mainly to declinesmortality from homicide, pneumonia aninfluenza, and COPD. Increases
eh
rtic-k-fee
atthheorlylntedin
n
mortality from HIV infection and viralhepatitis were largely responsible for1.4-percent increase in the death ratethose aged 35–44 years. Decreasesdeath rates for those in the age grou55–64, 65–74, 75–84, and 85 years aover were due primarily to decreasesmortality from heart disease.
The increase in the death rate fwhite males aged 35–44 years betwe1993 and 1994 was due largely toincreased mortality from HIV infectionand viral hepatitis. The 4.1-percedecrease in the death rate for black maaged 15–24 years was due primarilydecreases in mortality from homicide aaccidents. Increases in mortality from Hinfection and stroke were largely resposible for the 3.2-percent increase in tdeath rate for black females aged 35–years.
The overall life expectancy improvefrom 75.5 years in 1993 to 75.7 years1994, despite increases in mortality fro
aorinpsndin
renn
tlestod
-e44
in
HIV infection, diabetes, and Alzheimer’disease, primarily because of decreasesmortality from heart disease, cancer, pnemonia and influenza, homicide, and penatal conditions. (For discussion ocontribution to change in life expectancsee ‘‘Technical notes.’’) Among whitemales, life expectancy improved by 0.year between 1993 and 1994 becausedecreases in mortality from heart diseascancer, COPD, pneumonia, and congetal anomalies although mortality fromdiabetes, viral hepatitis, suicide, anAlzheimer’s disease increased. For whifemales, the improvement in life expecancy also reflected decreases in mortalfrom heart disease, pneumonia, and homcide, but was limited to a gain of 0.1 yeabecause of increases in mortality froHIV infection, diabetes, Alzheimer’s disease, accidents, and COPD. For blamales, decreases in mortality from headisease, homicide, cancer, and accidecontributed to the 0.3-year gain in life
expectancy. This gain occurred despoffsetting increases in mortality from HIVinfection, diabetes, stroke, hypertensioand viral hepatitis. The life expectancfor black females improved by 0.2 yeain part, because of declines in mortalifrom heart disease, cancer, and homici
Life expectancy for white males wa8.4 years higher than that for black malin 1994. Specific causes of death wimuch lower mortality for white maleinfluenced this difference. The causesdeath contributing the most to this diffeence were homicide, HIV infection, headisease, cancer, and perinatal conditioThe life expectancy for white femalewas 5.7 years higher than that for blafemales in 1994. The causes of deacontributing the most to this differencwere heart disease, cancer, HIV infectiostroke, and diabetes.
Hispanic mortality
Hispanic mortality data for 1994 arbased on deaths to residents of 49 Staand the District of Columbia. Data showin tables 14and 15 exclude Oklahomabecause it does not include the Hispaorigin item on its death certificates. (Fodetails on reporting area, see ‘‘Technicalnotes’’.) The crude, age-specific, and agadjusted death rates for the Hispanic polation can be compared with those for tnon-Hispanic white population (table 14).The crude death rate for the Hispanpopulation was 64 percent lower than thfor the non-Hispanic white populationThis difference reflects the lower agspecific mortality for the older age groupand the younger age composition of tHispanic population compared with thof the non-Hispanic white populationThe age-adjusted death rate, which cotrols for age-compositional differencewas 20 percent lower for the Hispanpopulation than for the non-Hispanic whipopulation. The ratio of the age-adjustdeath rate for the Hispanic populationthat for non-Hispanic white populatiowas 0.84 for males and 0.73 for femaleMortality of Hispanics may be somewhunderstated because of net underreporof Hispanic origin on the death certifica(see ‘‘Technical notes’’).
Within the Hispanic population, thage-adjusted death rate for males was
ite
n,yr,ye.ssth
of-rtns.skthen,
tesn
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icat.-set.n-,cedo
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1.9
times that for females. The male-tfemale ratio differed substantially by agwith Hispanic males experiencing threto four times higher death rates thHispanic females for ages 15–44 yeaThe sex ratio in Hispanic mortality rangebetween 1.2 and 1.6 for ages belowyears and between 1.4 and 2.2 for agesyears and older.
Among specified subgroups of thHispanic population, the age-adjustdeath rate was substantially lower fCuban Americans (358.1 deaths p100,000 U.S. standard million popultion), Mexican Americans (370.4), anCentral and South Americans and othand unknown Hispanics (354.0) than tage-adjusted death rate for Puerto Ric(565.8). Among Hispanic males, Mexcans had the lowest age-adjusted derate, while Puerto Ricans had the highrate. Among Hispanic females, Cubahad the lowest age-adjusted death rawhile Puerto Ricans had the highest ra
Leading causes of death for all agroups combined for the Hispanic poplation differed by rank and cause frothose for the non-Hispanic white popultion in the Hispanic reporting are(table 15). Although the two leadingcauses of death—heart disease acancer—were the same for both grouthey accounted for 57 percent of all deain 1994 for the non-Hispanic white population but for only 42 percent of the deatfor the Hispanic population.
These were the major differencesleading causes of death between the tgroups: Of the 10 leading causes of defor the Hispanic population, homicid(sixth leading cause) was not among t10 leading causes for the non-Hispanwhite population. Conversely, suicide, teighth leading cause of death for tnon-Hispanic white population, was namong the 10 leading causes for tHispanic population (table 15).
Differences in the ranking of thleading causes of death between the tpopulation groups largely reflect diffeences in age composition betweentwo groups; that is, the Hispanic popultion has a greater proportion of younpersons, and, accordingly, a largproportion of deaths due to causes tare more prevalent at younger ages. Wit
-,ens.d545
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broad age groups, leading causes wemore similar between the two populatiogroups. However, even within age categries some differences exist. Homicide anHIV infection consistently ranked highefor the Hispanic population than for thnon-Hispanic white population for all aggroups between 1–4 years and 45–years. Chronic liver disease and cirrhosalso ranked higher for the Hispanic poplation than for the non-Hispanic whitepopulation for those aged 45–64 yeaand 65 years and over.
Firearm mortality
In 1994 a total of 38,505 persondied from firearm injuries in the UnitedStates. This number was 2.8 percent lowthan the 39,595 deaths in 1993. Firearsuicide and homicide, the two major component causes, accounted for 49 a46 percent, respectively, of all firearminjury deaths in 1994.
Of the 38,505 firearm injury deathin 1994, 58.2 percent were for whitmales, 25.7 percent for black male10.4 percent for white females, an3.5 percent for black females. The largenumbers of firearm deaths for males afemales were for the age groups 15–and 25–34 years. Although the numbeof deaths were highest for white malethe age-adjusted and age-specific derates for firearm injuries were generalhighest for black males, followed by whitmales, black females, and white female
In 1994 the age-adjusted death rafor firearm injuries was 15.1 deaths pe100,000 U.S. standard million population, 3 percent lower than the rate of 15in 1993. The rate decreased by 14.2 pcent between 1980 and 1985, increasevery year between 1987 and 1991, bdecreased again by 2 percent betwe1991 and 1992. The 1993 age-adjustdeath rate for firearm injuries was, however, 5 percent higher than the 1992 ra
Between 1993 and 1994 the agadjusted death rate for firearm injuriedecreased by 5 percent for black male9 percent for black females, and 8 percefor white females; the rate did not decreasignificantly for white males. In 1994 therate for males was 6.2 times that fofemales, and the rate for the blac
population was 3.0 times that of the whipopulation.
Between 1993 and 1994 the agadjusted death rate decreased by 4 pcent for firearm homicide and 14 percefor firearm accidents. The rate did ndecrease significantly for firearm suicidbetween the two years, however. In 19the age-specific death rates for fireahomicide were highest for the age grou15–24 and 25–34 years, while the ratfor firearm suicide peaked for those ag75–84 years and 85 years and older.
Drug-induced mortality
In 1994 a total of 13,923 persondied of drug-induced causes in the UnitStates (table 19). The category druginduced causes includes not only deafrom dependent and nondependent usedrugs (legal and illegal use), but alspoisoning from medically prescribed another drugs. It excludes accidents, homcides, and other causes indirectly relatto drug use (for drug-induced causes, s‘‘ Technical notes’’). The age-adjusteddeath rate for drug-induced causes1994 was 5.0 deaths per 100,000 Ustandard million population, 4 percehigher than the rate of 4.8 in 1993. Thrate increased by 35 percent from 19831988, then declined 14 percent betwe1988 and 1990, and increased by 39 pcent between 1990 and 1994. In 1994 tage-adjusted death rate for drug-induccauses for males was 2.3 times the rfor females, and the rate for the blacpopulation was 1.8 times that for thwhite population.
Alcohol-induced mortality
In 1994 a total of 20,163 persondied of alcohol-induced causes in thUnited States (table 20). The categoryalcohol-induced causes includes not ondeaths from dependent and nondependuse of alcohol, but also accidental poisoing by alcohol. It excludes accidenthomicides, and other causes indirecrelated to alcohol use. (For alcohoinduced causes, see ‘‘Technical notes.’’)The age-adjusted death rate for alcohinduced causes in 1994 was 6.8 deaper 100,000 U.S. standard million poplation, 1.5 percent higher than the rate6.7 in 1993. The rate decreased by 20 pcent from 1980 to 1986, increased b
e
-er-tte4mssd
d
hsofodi-dee
inS.tetonr-edtek
e
lynt-,ly-
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9 percent from 1986 to 1989, and thdecreased by 7 percent from 1989 to 19since 1991 it has shown very little changIn 1994 the age-adjusted death ratealcohol-induced causes for males wastimes the rate for females, and the ratethe black population was 2.0 times thrate for the white population.
Marital status
Eighty-nine percent of the person15 years of age and over who died1994 had been married (table 21). Theproportion was larger for females (92 pecent) than for males (86 percent) andthe white population (90 percent) than fthe black population (79 percent). Thproportion who were widowed at the timof death was considerably greater fwomen (58 percent) than for men (18 pcent) but fairly similar for both majorace groups—38 percent of the whpopulation and 33 percent of the blapopulation. Some of the differencebetween groups can be accounted fordifferences in age composition.
Educational attainment
In an area comprised of 45 Statand the District of Columbia, about 63 pecent of the persons who died in 1994 hcompleted high school (table 22) (see‘‘ Technical notes’’). In 1994 the percentwas about the same for males (63 pcent) and females (62 percent), but somwhat different for the white populatio(64 percent) compared with the blapopulation (52 percent). About the samproportion of white females and whitmales (65 percent) who died in 1994 hcompleted high school. The proportiowho had completed 4 years of collewas smaller for white females (9.6 pecent) than for whitemales (14.2 percent). Asimilar proportion of black females and blamales had completed high school (ab52 percent). Slightly more black femal(6.6 percent) than black males (5.8 percehad completed 4 years of college at the tiof death.
Infant mortality
In 1994, 31,710 infant deaths wereported (table C), 5.2 percent fewer infandeaths than the 1993 total of 33,466. Tinfant mortality rate of 8.0 infant death
n1;e.or.5ore
sn
r-rre
rr-
eksby
sr-d
r-e-
ke
dne-
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e
e
per 1,000 live births is the lowest finarate ever recorded for the United State(figure 5). It represents a decline of4.8 percent from the rate of 8.4 for theprevious year (table 24). The mortalityrate for white infants declined 2.9 percen(6.8 in 1993 compared with 6.6 in 1994)and the rate for black infants declined4.2 percent (16.5 in 1993 compared wit15.8 in 1994).
In 1994 the infant mortality rate forblack infants (15.8) was 2.4 times the ratfor white infants (6.6), the same ratio ain the previous year. Historically, theblack-white ratio has been increasin(11,12).
Between 1993 and 1994 the neonatmortality rate declined by 3.8 percentfrom 5.3 to 5.1 deaths for infants unde28 days per 1,000 live births. For whiteinfants, the rate was 4.2, compared witthe 1993 rate of 4.3; the change in thneonatal mortality rate between the twyears was not statistically significant. Foblack infants the neonatal mortality ratedeclined by 4.7 percent, from 10.7 in1993 to 10.2 in 1994. Neonatal mortalityrates historically have declined for bothraces although the declines have beemore rapid for the white population(11,12).
The postneonatal mortality rate—deaths to infants 28 days–11 months p1,000 live births—declined by 6.5 per-cent, from 3.1 in 1993 to 2.9 in 1994. Fowhite infants the postneonatal mortalityrate declined from 2.5 to 2.4 deaths pe1,000 live births. For black infants therate was 5.6 in 1994, compared with 5.in 1993; the change in the postneonatmortality rate between the two years wanot statistically significant. The historicatrend for postneonatal mortality was omore rapid declines in postneonatal motality for black than for white infants(11,12).
Among the 10 leading causes oinfant death, the first 4—Congenitaanomalies, Disorders relating to short getation and unspecified low birthweightand Respiratory distress syndrome—accounted for just over hal(53 percent) of all infant deaths in 1994and the remaining 6 causes accounted fonly 16 percent of all infant deaths(table 26). The list of 10 leading causesof infant death was unchanged betwee1993 and 1994, but the rankings of two
t
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a
r
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Table C. Number of infant, neonatal, and postneonatal deaths and mortality rates, by race and sex: United States, 1994[Rates are infant (under 1 year), neonatal (under 28 days), and postneonatal (28 days–11 months) deaths per 100,000 live births and specified group]
of the leading causes of infant deachanged slightly. Sudden infant death sydrome, the second leading cause in 19and Disorders relating to short gestatiand unspecified low birthweight, the thirleading cause, switched rankings in 199
Between 1993 and 1994 the infamortality rate decreased for three leadicauses of infant death: Respiratory dtress syndrome (12.8 percent), Suddinfant death syndrome (11.7 percent), aDisorders relating to short gestation aunspecified low birthweight (0.1 percenInfant mortality from Respiratory distressyndrome showed a rapid downward trebetween 1972 and 1994. Mortality fromSudden infant death syndrome h
6
789
10
20
30
40
50
60
7080
1940 1950 1960
All races
White
Black
Dea
ths
unde
r 1
year
per
1,0
00 li
ve b
irths
0
NOTES: Infant deaths are classified by race of deby race of child and for 1980 94, by race of moth
Figure 5. Infant mortality rates by race: United Sta
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d
s
declined since 1988 (11,12). Infant motality from Respiratory distress syndromshowed a rapid downward trend betwe1972 and 1994. Mortality from Suddeinfant death syndrome has declin26.5 percent since 1988, from a rate140.1 to 103.0 in 1994, and betwe1993 and 1994 dropped from the secoleading cause of infant death to the th(11,12). For other leading causes of infadeath, the infant mortality rate did nchange significantly between 1993 a1994. The causes contributing the mosthe improvement in the overall infamortality rate were Respiratory distresyndrome and Sudden infant death sdrome. The increasing rate for Infectio
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nsor
ofs
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1970 1980 1990 1995
6
789
10
20
30
40
50
60
7080
0
cedent. For 1940 90, live births are classifieder. See "Technical notes."
Race of mother
tes, 1950–94
-en
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specific to the perinatal period (perinatinfections) was the principal cause prventing the infant mortality rate fromdecreasing more than it did.
Differences between infant mortalitrates for white and black infants by cauare reflected in differences in rankingthe leading causes of infant death as was in differences in cause-specific infamortality rates. Congenital anomalies wthe leading cause of death for whiinfants, followed by Sudden infant deasyndrome, Disorders relating to short getation and unspecified low birthweighand Respiratory distress syndrome. Cobined these four causes accounted54.4 percent of white infant deaths. Icontrast, for black infants the leadincause of death was Disorders relatingshort gestation and unspecified low birtweight, followed by Sudden infant deatsyndrome, Congenital anomalies, and Rpiratory distress syndrome. These focauses accounted for 50 percent ofblack infant deaths (table 27).
Although the difference betweeblack and white infant mortality ratevaried by cause, the risk was higher fblack than for white infants for all theleading causes. Expressed as the ratiothe infant mortality rate for black infantto that for white infants, beginning withthe highest ratio, the leading causes rankare Disorders relating to short gestatioand unspecified low birthweight (4.5Pneumonia and influenza and Newboaffected by maternal complications opregnancy (maternal complications) (2each); Respiratory distress syndrome (2.perinatal infections (2.5); Sudden infadeath syndrome and Newborn affectedcomplications of placenta, cord, anmembranes (2.3 each); accidents a
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References1. Hoyert DL, Singh GK, Rosenberg HM.
Sources of data on socioeconomic differ-ential mortality in the United States.Journal of Official Statistics. 11(3):233–60. 1995.
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6. Gardner P, Hudson BL. Advance reportof final mortality statistics, 1993. Monthlyvital statistics report; vol 44 no 7, supp.Hyattsville, Maryland: National Centerfor Health Statistics. 1996.
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10. Hoyert DL. Mortality trends for Alzhe-imer’s disease, 1979–91. National Cen-ter for Health Statistics. Vital and HealthStat 20 (28). 1996.
11. MacDorman MF, Rosenberg HM. Trendsin infant mortality by cause of death andother characteristics, 1960–88. NationalCenter for Health Statistics. Vital andHealth Stat 20 (20). 1993.
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14. National Center for Health Statistics.Technical appendix. Vital statistics ofthe United States, 1989, vol II, mortality,part A. Washington: Public Health Ser-vice. 1993.
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Intrauterine hypoxia and birth asphyx(2.2 each); and Congenital anomali(1.8).
Between 1993 and 1994 decreasesmortality from Sudden infant death syndrome, congenital anomalies, Respiratodistress syndrome, Other respiratory coditions of newborn, and maternal compcations made the largest contributionsthe 3.7-percent decrease in the white infmortality rate. However, the white infanmortality rate would have decreased evfurther had it not been for increasesmortality from perinatal infections, Neonatal hemorrhage, and Pneumonia ainfluenza. Decreases in mortality froSudden infant death syndrome, Respitory distress syndrome, and Congenianomalies made the largest contributioto the 4.2-percent decrease in the blainfant mortality rate; further decrease wahowever, offset by increases in mortalifrom short gestation and low birthweighaccidents, and Pneumonia and influenz
Hispanic infant mortality—The infantmortality rate was 6.5 deaths to Hispaninfants under 1 year of age per 1,000 libirths in an area comprised of 49 Statand the District of Columbia. This wathe same as the rate for non-Hispanwhite infants. Among specified subgroups of the Hispanic population, thmortality rate for Mexican infants wa6.6 infant deaths per 1,000 live births, 8for Puerto Rican infants, and 4.5 foCuban infants. Infant mortality rates bspecified Hispanic origin and race fonon-Hispanic origin may be somewhunderstated. (For description of Hispanreporting area, see ‘‘Technical notes’’).
Maternal mortality
In 1994, 328 women were reportedto have died of maternal causes (table 30),compared with 302 in 1993. As in previ-ous years, the number does not includall deaths occurring to pregnant womenbut only to those deaths assigned to Complications of pregnancy, childbirth, andthe puerperium (ICD–9 Nos. 630–676)The maternal mortality rate for 1994 wa8.3 deaths per 100,000 live births, compared with a rate of 7.5 in 1993. Thedifference in the rates between the twyears was not statistically significant.
Black women have a higher risk omaternal death than white women. I
s
in-ryn--tonttnn
d
a-alsks,y,a.
ces
ic
1994 the maternal mortality rate for blacwomen was 18.5, three times the rate6.2 for white women. The race ratiomaternal mortality rate was 3.0 for Direobstetric causes.
Report of autopsy
For 1994 all States requested infomation on the death certificate aswhether autopsies were performed. Thwere reported as performed on 213,8decedents, or 9.4 percent of the deathat occurred in 1994 (table 31), a reduc-tion from the 9.7 percent reported for thprevious year. This continues the dowward trend in the percent of deaths autosied. The percent autopsied for all cauof death combined was heavily influenced by the low rates for the threleading causes of death—heart dise(6.6 percent), cancer (2.3 percent), astroke (2.9 percent). Among the 15 leaing causes of death, the highest percereported were for traumaticauses—homicide (97.2 percent), suic(55.1 percent), and accidents (48.4 pcent). The highest percents for nontramatic causes were for chronic liver diseaand cirrhosis (13.4 percent) and Alzhimer’s disease (7.1 percent).
e,-
.s-
o
fn
part A. Washington: Public Health Ser-vice. 1996.
3. Kochanek KD, Maurer JD, RosenbergHM. Causes of death contributing tochanges in life expectancy: United States,1984–89. National Center for Health Sta-tistics. Vital and Health Stat 20 (23).1994.
4. Arriaga EE. Changing trends in mortal-ity decline during the last decades. In:Ruzicka L, Wunsch G, Kane P, eds.Differential mortality: Methodologicalissues and biosocial factors. Oxford: Clar-endon Press. 1989.
5. Singh GK, Mathews TJ, Clarke SC, etal. Annual summary of births, marriages,divorces, and deaths: United States, 1994.Monthly vital statistics report; vol 43 no13. Hyattsville, Maryland: Public HealthService. 1995.
census record: United States, May–Aug1960. National Center for Health Statis-tics. Vital Health Stat 2(32). 1969.
16. Sorlie PD, Rogot E, Johnson NJ. Valid-ity of demographic characteristics on thedeath certificate. Epidemiology3(2):181–4. 1992.
17. Poe GS, Powell-Griner E, McLaughlinJK, et al. Comparability of the deathcertificate and the 1986 national mortal-ity followback survey. National Centerfor Health Statistics. Vital Health Stat2(118). 1993.
18. National Center for Health Statistics.Technical appendix. Vital statistics ofthe United States, 1989, vol I, natality.Washington: Public Health Service. 1992.
19. Hoyert DL. Effect on mortality rates ofthe 1989 changes in tabulating race.
National Center for Health Statistics.Vital Health Stat 20(25). 1994.
20. World Health Organization. Manual ofthe International Statistical Classifica-tion of Diseases, Injuries, and Causes ofDeath, based on the recommendations ofthe Ninth Revision Conference, 1975.Geneva: World Health Organization.1977.
21. Klebba AJ, Scott JH. Estimates ofselected comparability ratios based ondual coding of 1976 death certificates bythe Eighth and Ninth Revisions of theInternational Classification of Diseases.Monthly vital statistics report; vol 28 no11, supp. Hyattsville, Maryland: PublicHealth Service. 1980.
22. Klebba AJ, Dolman AB. Comparabilityof mortality statistics for the Seventhand Eighth Revisions of the Interna-tional Classification of Diseases, UnitedStates. National Center for Health Statis-tics. Vital Health Stat 2(66). 1975.
23. National Center for Health Statistics.Comparability of mortality statistics forthe Sixth and Seventh Revisions, UnitedStates, 1958. Vital Statistics–Specialreports; vol 51 no 4. Washington: PublicHealth Service. 1965.
24. National Center for Health Statistics.Vital statistics, instructions for classify-ing the underlying cause of death. NCHSinstruction manual; part 2a. Hyattsville,Maryland: Public Health Service. Pub-lished annually.
25. National Center for Health Statistics.Vital statistics, instructions for classify-ing multiple causes of death. NCHSinstruction manual; part 2b. Hyattsville,Maryland: Public Health Service. Pub-lished annually.
26. National Center for Health Statistics.Vital statistics, nonindexed terms, stan-dard abbreviations, and State geographiccodes used in mortality data classifica-tion. NCHS instruction manual; part 2e.Hyattsville, Maryland: Public Health Ser-vice. Published annually.
27. National Center for Health Statistics.Vital statistics, ICD–9 ACME decisiontables for classifying underlying causesof death. NCHS instruction manual; part2c. Hyattsville, Maryland: Public HealthService. Published annually.
28. National Center for Health Statistics.Vital statistics, data entry instructions forthe mortality medical indexing, classifi-cation, and retrieval system (MICAR).NCHS instruction manual; part 2g.Hyattsville, Maryland: Public Health Ser-vice. Published annually.
29. National Center for Health Statistics.Vital statistics, dictionary of valid termsfor the mortality medical indexing, clas-sification, and retrieval system (MICAR).NCHS instruction manual; part 2h.Hyattsville, Maryland: Public Health Ser-vice. Published annually.
30. Lampe TH. The nature of Alzheimer’sdisease. Alzheimer’s caregiver: Strate-gies for support. Seattle: University ofWashington Press. 1987.
31. Macera CA, Sun RK, Yeager KK,Brandes DA. Sensitivity and specificityof death certificate diagnoses for dement-ing illnesses, 1988–90. J Am GeriatrSoc. 40:479–81. 1992.
32. Newen AJ, Forster DP, Kay DWK. Deathcertification after a diagnosis of pres-enile dementia. J Epidemiol CommunityHealth. 47:293–7. 1993.
33. U.S. Bureau of the Census. Unpublisheddata from the 1990 census for persons ofSpanish origin by State.
34. U.S. Bureau of the Census. U.S. popula-tion estimates by age, sex, race, andHispanic origin: 1993. Census fileRESD0794. 1995.
35. U.S. Bureau of the Census. Residentpopulation of States, 1990–1994 bysingle year of age and sex. Census fileE94SASUS. 1995.
36. National Center for Health Statistics.Technical appendix. Vital statistics ofthe United States, 1990, vol II, mortality,part A. Washington: Public Health Ser-vice. 1994.
37. U.S. Bureau of the Census. Populationestimates based on unpublished tabula-tions prepared by the Housing and House-hold Economic Statistics Division. 1996.
38. Sirken MG. Comparison of two methodsof constructing abridged life tables byreference to a ‘‘standard’’ table. NationalCenter for Health Statistics. Vital HealthStat 2(4). 1966.
39. U.S. Bureau of the Census. Moneyincome of households, families, and per-sons in the United States: 1992. Currentpopulation reports, consumer income.Series P60–184. 1993.
40. Feinleib M, Zarate AO, eds. Reconsider-ing age adjustment procedures: Work-shop proceedings. National Center forHealth Statistics. Vital Health Stat 4(29).1992.
1. Number of deaths, death rates, andage-adjusted death rates, by raceand sex: United States, 1940, 1950,1960, 1970, and 1975–94. . . . . . . 15
2. Number of deaths and death rates,by age, race, and sex: United States,1994. . . . . . . . . . . . . . . . . . . . . . 17
3. Abridged life table for the totalpopulation, 1994. . . . . . . . . . . . . 18
4. Life expectancy at selected ages byrace and sex: United States, 1994 . 18
5. Life expectancy at birth by raceand sex: United States, 1940, 1950,1960, and 1970–94. . . . . . . . . . . . 19
6. Age-specific and age-adjusted deathrates for the 15 leading causes ofdeath for the total population in1994 and selected components:United States, 1979, 1993, and1994. . . . . . . . . . . . . . . . . . . . . . 20
7. Number of deaths and death ratesfor the 10 leading causes of deathin specified age groups, by raceand sex: United States, 1994. . . . . 23
8. Number of deaths from 72 selectedcauses, Human immunodeficiencyvirus infection, andAlzheimer’s dis-ease by age: United States, 1994. . 34
9. Death rates for 72 selected causes,Human immunodeficiency virusinfection, and Alzheimer’s diseaseby age: United States, 1994. . . . . 37
10. Number of deaths from 72 selectedcauses, Human immunodeficiencyvirus infection, andAlzheimer’s dis-ease by race and sex: United States,1994. . . . . . . . . . . . . . . . . . . . . . 40
11. Death rates for 72 selected causes,Human immunodeficiency virusinfection, and Alzheimer’s diseaseby race and sex: United States,1994 . . . . . . . . . . . . . . . . . . . . . . 43
12. Age-adjusted death rates for 72selected causes, Human immunode-ficiency virus infection, and Alzhe-imer’s disease by race and sex:United States, 1994. . . . . . . . . . . 46
13. Number of deaths and death ratesfrom 16 selected subcategories ofMalignant neoplasms, includingneoplasms of lymphatic andhematopoietic tissues, by race andsex: United States, 1994. . . . . . . . 49
14. Number of deaths and death rates,by age, and age-adjusted death ratesaccording to specified Hispanic ori-gin, race for non-Hispanic origin,and sex: Total of 49 States and theDistrict of Columbia, 1994. . . . . . 50
15. Number of deaths and death ratesfor the 10 leading causes of deathfor Hispanic and white non-Hispanic origins, for specified agegroups: Total of 49 reporting Statesand the District of Columbia,1994. . . . . . . . . . . . . . . . . . . . . . 52
16. Number of deaths from injury byfirearms by age, race, and sex:United States, 1994. . . . . . . . . . . 55
17. Age-specific and age-adjusted deathrates for injury by firearms by age,race, and sex: United States, 1994 . .56
18. Number of deaths, death rates, andage-adjusted death rates for injuryby firearms, by race and sex: UnitedStates, 1979–94. . . . . . . . . . . . . . 57
19. Number of deaths, death rates, andage-adjusted death rates for drug-induced causes, by race and sex:United States, 1979–94. . . . . . . . . 58
20. Number of deaths, death rates, andage-adjusted death rates for alcohol-induced causes, by race and sex:United States, 1979–94. . . . . . . . . 59
21. Number of deaths and percent dis-tribution of deaths for ages 15 yearsand over, by marital status, raceand sex: United States,1994. . . . . . . . . . . . . . . . . . . . . . 60
22. Number of deaths and percent dis-tribution of deaths for ages 15 yearsand over, by educational attain-ment, race, and sex: Total of 45
reporting States and the District ofColumbia, 1994. . . . . . . . . . . . . . 61
23. Number of deaths and death ratesfor major causes of death for theUnited States, each division, eachState, Puerto Rico, Virgin Islands,and Guam; and by race and sex forthe United States, 1994. . . . . . . . 62
24. Infant, neonatal, and postneonatalmortality rates by race and sex:United States, 1940, 1950, 1960,1970, and 1975–94. . . . . . . . . . . . 64
25. Number of infant, neonatal, andpostneonatal deaths and mortalityrates, by specified Hispanic originand race for non-Hispanic origin:Total of 49 States and the Districtof Columbia, 1994 . . . . . . . . . . . 66
26. Percent of total deaths and infantmortality rates for 1994, percentchange in infant mortality ratesfrom 1993 to 1994 and 1979 to1994 for the 10 leading causes ofinfant death in 1994: UnitedStates. . . . . . . . . . . . . . . . . . . . . 66
27. Number of deaths under 1 year andinfant mortality rates for the 10leading causes of infant death byrace: United States, 1994. . . . . . . 67
28. Number of deaths under 1 year andinfant mortality rates for 61 selectedcauses and Human immunodefi-ciency virus infection, by race:United States, 1994. . . . . . . . . . . 68
29. Number of infant and neonataldeaths and mortality rates, by racefor the United States, each divi-sion, each State, Puerto Rico, Vir-gin Islands, and Guam, and sex forthe United States, 1994. . . . . . . . 70
30. Number of maternal deaths andmater-nal mortality rates for selected causes,by race: United States, 1994. . . . . . 71
31. Number of autopsies and percentof deaths for which autopsies werereported for the 15 leading causesof death: United States, 1994. . . . 71
List of figures
1. Crude and age-adjusted death rates:United States, 1930–94. . . . . . . . . 4
2. Death rates by age and sex: UnitedStates, 1950–94. . . . . . . . . . . . . . 5
Table 1. Number of deaths, death rates, and age-adjusted death rates, by race and sex: United States, 1940, 1950, 1960, 1970, and 1975–94[Crude rates on an annual basis per 100,000 population in specified group; age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ Rates are based on populations enumerated as ofApril 1 for census years and estimated as of July 1 for all other years. Beginning 1970, excludes deaths of nonresidents of the United States. Data for specified races other than white and black should be interpretedwith caution because of inconsistencies in reporting race on the death certificate; see ‘‘Technical notes’’]
Year
All races1 White Black American Indian2 Asian or Pacific Islander 3
Table 1. Number of deaths, death rates, and age-adjusted death rates, by race and sex: United States, 1940, 1950, 1960, 1970, and 1975–94—Con.[Crude rates on an annual basis per 100,000 population in specified group; age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ Rates are based on populations enumerated as ofApril 1 for census years and estimated as of July 1 for all other years. Beginning 1970, excludes deaths of nonresidents of the United States. Data for specified races other than white and black should be interpretedwith caution because of inconsistencies in reporting race on the death certificate; see ‘‘Technical notes’’]
Year
All races1 White Black American Indian2 Asian or Pacific Islander 3
- - - Data not available.1For 1940–91 includes deaths among races not shown separately; see ‘‘Technical notes.’’2Includes deaths among Aleuts and Eskimos.3Includes deaths among Chinese, Filipino, Hawaiian, Japanese, and other Asian or Pacific Islander.4For method of computation, see ‘‘Technical notes.’’
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Table 2. Number of deaths and death rates, by age, race, and sex: United States, 1994[Rates per 100,000 population in specified group. Data for specified races other than white and black should be interpreted with caution because of inconsistencies in reporting race on the death certificate; see‘‘Technical notes’’]
Age
All races White Black American Indian1 Asian or Pacific Islander 2
1Includes deaths among Aleuts and Eskimos.2Includes deaths among Chinese, Filipino, Hawaiian, Japanese, and other Asian or Pacific Islander.3Figures for age not stated are included in ‘‘All ages’’ but not distributed among age groups.4Death rates for ‘‘Under 1 year’’ (based on population estimates) differ from infant mortality rates (based on live births); see tables C and 24–29 for infant mortality rates, and ‘‘Technical notes’’ for further discussion of the difference.
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Table 3. Abridged life table for the total population, 1994[For explanation of the columns of the life table, see section 6 of Vital Statistics of the United States, 1991, Volume II]
Age intervalProportiondying Of 100,000 born alive Stationary population
Averageremaininglifetime
Period of life between twoexact ages stated in years
Table 6. Age-specific and age-adjusted death rates for the 15 leading causes of death for the total population in 1994 and selected components: United States, 1979, 1993, and1994[Age-specific rates on an annual basis per 100,000 population in specified group; age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ For explanation of asterisks precedingcause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975) Year
Table 6. Age-specific and age-adjusted death rates for the 15 leading causes of death for the total population in 1994 and selected components: United States, 1979, 1993, and1994—Con.[Age-specific rates on an annual basis per 100,000 population in specified group; age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ For explanation of asterisks precedingcause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975) Year
AgeAge-
adjustedrate3
Allages1
Under1 year2
1–4years
5–14years
15–24years
25–34years
35–44years
45–54years
55–64years
65–74years
75–84years
85 yearsand over
Malignant neoplasms, including neoplasms oflymphatic and hematopoietic tissues—Con.
Table 6. Age-specific and age-adjusted death rates for the 15 leading causes of death for the total population in 1994 and selected components: United States, 1979, 1993, and1994—Con.[Age-specific rates on an annual basis per 100,000 population in specified group; age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ For explanation of asterisks precedingcause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975) Year
* Figure does not meet standards of reliability or precision (see ‘‘Technical notes’’).- - - Data not available.. . . Category not applicable.1Figures for age not stated are included in ‘‘All ages’’ but not distributed among age groups.2Death rates for ‘‘Under 1 year’’ (based on population estimates) differ from infant mortality rates (based on live births); see tables C and 24–29 for infant mortality rates, and ‘‘Technical notes’’ for discussion of the difference.3For method of computation, see ‘‘Technical notes.’’
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Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Rank1
Cause of death, race, sex, and age(Based on the Ninth Revision, International
Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Table 7. Number of deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States,1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
. . . Category not applicable.* Figure does not meet standards of reliability or precision (see ‘‘Technical notes’’).1Rank based on number of deaths; see ‘‘Technical notes.’’2Includes races other than white and black.3Includes deaths under 1 year of age.
Table 8. Number of deaths from 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by age: United States, 1994[For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 8. Number of deaths from 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by age: United States, 1994—Con.[For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 8. Number of deaths from 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by age: United States, 1994—Con.[For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
– Quantity zero.. . . Category not applicable.1Includes data for deaths due to Human immunodeficiency virus infection (categories *042–*044) below; see ‘‘Technical notes.’’2Included in All other infectious and parasitic diseases shown above.
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Table 9. Death rates for 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by age: United States, 1994[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 9. Death rates for 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by age: United States, 1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 9. Death rates for 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by age: United States, 1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
* Figure does not meet standards of reliability or precision (see ‘‘Technical notes’’).0.0 Quantity more than zero but less than 0.05.. . . Category not applicable.1Figures for age not stated included in ‘‘All ages’’ but not distributed among age groups.2Death rates for ‘‘Under 1 year’’ (based on population estimates) differ from infant mortality rates (based on live births); see tables C and 24–29 for infant mortality rates, and ‘‘Technical notes’’ for further discussion of the difference.3Includes data for deaths due to Human immunodeficiency virus infection (categories *042–*044) below; see ‘‘Technical notes.’’4Included in All other infectious and parasitic diseases shown above.
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Table 10. Number of deaths from 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by race and sex: United States, 1994[For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 10. Number of deaths from 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by race and sex: United States, 1994—Con.[For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 10. Number of deaths from 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by race and sex: United States, 1994—Con.[For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
All other
All races White Total Black
Bothsexes Male Female
Bothsexes Male Female
Bothsexes Male Female
Bothsexes Male Female
Renal failure, disorders resulting from impairedrenal function, and small kidney ofunknown cause . . . . . . . . . . . . . . .584–586,588–589 21,125 9,996 11,129 17,180 8,215 8,965 3,945 1,781 2,164 3,624 1,626 1,998
– Quantity zero.. . . Category not applicable.1Includes data for deaths due to Human immunodeficiency virus infection (categories *042–*044) below; see ‘‘Technical notes.’’2Included in All other infectious and parasitic diseases shown above.
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Table 11. Death rates for 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by race and sex: United States, 1994[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 11. Death rates for 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by race and sex: United States, 1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 11. Death rates for 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by race and sex: United States, 1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
All other
All races White Total Black
Bothsexes Male Female
Bothsexes Male Female
Bothsexes Male Female
Bothsexes Male Female
Nephritis, nephrotic syndrome, and nephrosis—Con.
Renal failure, disorders resulting from impairedrenal function, and small kidney ofunknown cause . . . . . . . . . . . . . . .584–586,588–589 8.1 7.9 8.4 7.9 7.7 8.1 9.0 8.5 9.4 11.1 10.5 11.6
* Figure does not meet standards of reliability or precision (see ‘‘Technical notes’’).0.0 Quantity more than zero but less than 0.05.. . . Category not applicable.1Includes data for deaths due to Human immunodeficiency virus infection (categories *042–*044) below; see ‘‘Technical notes.’’2Included in All other infectious and parasitic diseases shown above.
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Table 12. Age-adjusted death rates for 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by race and sex: United States, 1994[Age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 12. Age-adjusted death rates for 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by race and sex: United States, 1994—Con.[Age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 12. Age-adjusted death rates for 72 selected causes, Human immunodeficiency virus infection, and Alzheimer’s disease by race and sex: United States, 1994—Con.[Age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
* Figure does not meet standards of reliability or precision (see ‘‘Technical notes’’).0.0 Quantity more than zero but less than 0.05.. . . Category not applicable.1Includes data for deaths due to Human immunodeficiency virus infection (categories *042–*044) below; see ‘‘Technical notes.’’2Included in All other infectious and parasitic diseases shown above.
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Table 13. Number of deaths and death rates for 16 selected subcategories of Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues, by race andsex: United States, 1994[Rates per 100,000 population in specified group]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
. . . Category not applicable.1Includes figures for subcategories not shown.
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Table 14. Number of deaths and death rates, by age, and age-adjusted death rates according to specified Hispanic origin, race for non-Hispanic origin, and sex: Total of 49States and the District of Columbia, 1994[Age-specific rates on an annual basis per 100,000 population in specified group; age-adjusted rates per 100,000 U.S. standard million population; see Technical notes. For a listing of States, see ‘‘Technical notes’’]
Hispanic origin, race fornon-Hispanic origin, and sex Total
Table 14. Number of deaths and death rates, by age, and age-adjusted death rates according to specified Hispanic origin, race for non-Hispanic origin, and sex: Total of 49States and the District of Columbia, 1994—Con.[Age-specific rates on an annual basis per 100,000 population in specified group; age-adjusted rates per 100,000 U.S. standard million population; see Technical notes. For a listing of States, see ‘‘Technical notes’’]
Hispanic origin, race fornon-Hispanic origin, and sex Total
– Quantity zero.. . . Category not applicable.* Figure does not meet standards of reliability or precision (see ‘‘Technical notes’’).1Death rates for ‘‘Under 1 year’’ (based on population estimates) differ from infant mortality rates (based on live births); see tables C and 24–29 for infant mortality rates, and ‘‘Technical notes’’ for further discussion of the difference.2For method of computation, see ‘‘Technical notes.’’3Includes races other than white and black.4Includes deaths that occurred in Oklahoma that did not report Hispanic origin on the death certificate.5Includes Central and South American and Other and Unknown Hispanic.
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Table 15. Number of deaths and death rates for the 10 leading causes of death for Hispanic and white non-Hispanic origins, for specifiedaged groups: Total of 49 reporting States and the District of Columbia, 1994[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes.’’ For a listing of reportingStates, see ‘‘Technical notes’’]
Hispanic
Rank
Cause of death and age(Based on the Ninth Revision, International
The Death Rates in column two under the section "White non-Hispanic origin, 5-14 years" have been corrected and differ from the original publication.
Table 15. Number of deaths and death rates for the 10 leading causes of death for Hispanic and white non-Hispanic origins, for specifiedaged groups: Total of 49 reporting States and the District of Columbia, 1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes.’’ For a listing of reportingStates, see ‘‘Technical notes’’]
Hispanic
Rank
Cause of death and age(Based on the Ninth Revision, International
Table 15. Number of deaths and death rates for the 10 leading causes of death for Hispanic and white non-Hispanic origins, for specifiedaged groups: Total of 49 reporting States and the District of Columbia, 1994—Con.[Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes.’’ For a listing of reportingStates, see ‘‘Technical notes’’]
Hispanic
Rank
Cause of death and age(Based on the Ninth Revision, International
Table 17. Age-specific and age-adjusted death rates for injury by firearms by age, race, and sex: United States, 1994[Age-specific rates per 100,000 population in specified group; age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes’’]
Cause of death (Based on the NinthRevision, International Classification of
* Figure does not meet standards of reliability or precision (see ‘‘Technical notes’’).. . . Category not applicable.1Includes races other than white and black.2Figures for age not stated are included in ‘‘All ages’’ but are not distributed among age groups.3Death rates for ‘‘Under 1 year’’ (based on population estimates) differ from infant mortality rates (based on live births); see tables C and 24–29 for infant mortality rates and ‘‘Technical notes’’ forfurther discussion of the difference.4For method of computation, see ‘‘Technical notes.’’
Table 18. Number of deaths, death rates, and age-adjusted death rates for injury by firearms, by race and sex: United States, 1979–94[Crude rates on an annual basis per 100,000 population in specific group; age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ Forlisting of injury by firearms, see ‘‘Technical notes’’]
Table 19. Number of deaths, death rates, and age-adjusted death rates for drug-induced causes, by race and sex: United States, 1979–94[Crude rates on an annual basis per 100,000 population in specified group; age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ Forlisting of drug-induced causes, see ‘‘Technical notes’’]
Table 20. Number of deaths, death rates, and age-adjusted death rates for alcohol-induced causes, by race and sex: United States,1979–94[Crude rates on an annual basis per 100,000 population in specified group; age-adjusted rates per 100,000 U.S. standard million population; see ‘‘Technical notes.’’ Forlisting of alcohol-induced causes, see ‘‘Technical notes’’]
Table 22. Number of deaths and percent distribution of deaths for ages 15 years and over, by educational attainment, race, and sex:Total of 45 reporting States and the District of Columbia, 1994
Table 23. Number of deaths and death rates for major causes of death for the United States, each division, each State, Puerto Rico,Virgin Islands, and Guam; and by race and sex for the United States, 1994[Rates per 100,000 population in each race-sex group and area. Numbers after causes of death are categories of the Ninth Revision, International Classification ofDiseases, 1975. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Table 23. Number of deaths and death rates for major causes of death for the United States, each division, each State, Puerto Rico,Virgin Islands, and Guam; and by race and sex for the United States, 1994—Con.[Rates per 100,000 population in each race-sex group and area. Numbers after causes of death are categories of the Ninth Revision, International Classification ofDiseases, 1975. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
- - - Data not available. * Figure does not meet standards of reliability of precision (see ‘‘Technical notes).’’1Excludes some amended records for selected external causes; see ‘‘Technical notes.’’
NOTES: Caution should be used in comparing crude death rates by State. Death rates are affected by the population composition of the area.
Table 24. Infant, neonatal, and postneonatal mortality rates by race and sex: United States, 1940, 1950, 1960, 1970, and 1975–94[Rates are infant (under 1 year), neonatal (under 28 days), and postneonatal (28 days–11 months) deaths per 1,000 live births in specified group. Beginning in 1980,race for live births in tabulated according to race of mother; see ‘‘Technical notes’’]
Table 24. Infant, neonatal, and postneonatal mortality rates by race and sex: United States, 1940, 1950, 1960, 1970, and 1975–94—Con.[Rates are infant (under 1 year), neonatal (under 28 days), and postneonatal (28 days–11 months) deaths per 1,000 live births in specified group. Beginning in 1980,race for live births in tabulated according to race of mother; see ‘‘Technical notes’’]
1Infant deaths based on race of decedent; live births based on race of mother; see ‘‘Technical notes.’’2Infant deaths based on race of decedent; live births based on race of child; see ‘‘Technical notes.’’
Table 25. Number of infant, neonatal, and postneonatal deaths and mortality rates, by specified Hispanic origin and race fornon-Hispanic origin: Total of 49 States and the District of Columbia, 1994[Rates per 1,000 live births in specified group. Live births based on race and Hispanic origin of mother; see ‘‘Technical notes.’’ For a listing of States, see ‘‘Technicalnotes.’’ Data revised on Internet copy only, as of 5/29/97]
. . . Category not applicable.1Includes Central and South American and other and unknown Hispanic.2Includes races other than white and black.3Includes infant deaths that occurred in States that did not report Hispanic origin on the death certificate.4Figures for origin not stated included in ‘‘All origins’’ but not distributed among origin groups.
Table 26. Percent of total deaths and infant mortality rates for 1994; percent change in infant mortality rates from 1993 to 1994 and 1979to 1994 for the 10 leading causes of infant death in 1994: United States[Infant mortality rates on an annual basis per 100,000 live births]
Rank1Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 27. Number of deaths under 1 year and infant mortality rates for the 10 leading causes of infant death, by race: United States, 1994[Rates per 100,000 live births]
Rank1Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975) Number Rate
Table 28. Number of deaths under 1 year and infant mortality rates for 61 selected causes and Human immunodeficiency virus infection,by race: United States, 1994[Rates per 100,000 live births in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Table 28. Number of deaths under 1 year and infant mortality rates for 61 selected causes and Human immunodeficiency virus infection,by race: United States, 1994—Con.[Rates per 100,000 live births in specified group. For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Allraces1 White Black
Allraces1 White Black
Certain conditions originating in the perinatal period—Con. Number Rate
* Figure does not meet standards of reliability or precision (see ‘‘Technical notes’’).– Quantity zero.1Includes races other than white and black.2Includes data for deaths due to Human immunodeficiency virus infection (categories *042–*044); see ‘‘Technical notes.’’3Included in All other infectious and parasitic diseases shown above.
Table 29. Number of infant and neonatal deaths and mortality rates, by race for the United States, each division, each State, Puerto Rico,Virgin Islands and Guam, and by sex for the United States, 1994[Rates per 1,000 live births in specified group. Live births based on race of mother; see ‘‘Technical notes.’’ Data revised on Internet copy only, as of 5/29/97]
Race, sex, and area
Infant deaths Neonatal deaths
All races White Black All races White Black
Number Rate1 Number Rate Number Rate Number Rate1 Number Rate Number Rate
Table 29. Number of infant and neonatal deaths and mortality rates, by race for the United States, each division, each State, Puerto Rico,Virgin Islands and Guam, and by sex for the United States, 1994—Con.[Rates per 1,000 live births in specified group. Live births based on race of mother; see ‘‘Technical notes’’]
Race, sex, and area
Infant deaths Neonatal deaths
All races White Black All races White Black
Number Rate1 Number Rate Number Rate Number Rate1 Number Rate Number Rate
*Figure does not meet standards of reliability or precision (see ‘‘Technical notes’’).–Quantity zero.- - - Data not available.1Includes races other than white and black.
Table 30. Number of maternal deaths and maternal mortality rates for selected causes, by race: United States, 1994[Maternal deaths are those assigned to Complications of pregnancy, childbirth, and the puerperium; categories 630–676 of the Ninth Revision, InternationalClassification of Diseases, 1975. Rates per 100,000 live births in specified group]
Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Allraces White
All otherAll
races White
All other
Total Black Total Black
Number Rate
Complications of pregnancy, childbirth, and the puerperium . . . . . .630–676 328 193 135 118 8.3 6.2 16.2 18.5
* Figure does not meet standards of reliability of precision (see ‘‘Technical notes’’).– Quantity zero.
Table 31. Number of autopsies and percent of deaths for which autopsies were reported for the 15 leading causes of death:United States, 1994[For explanation of asterisks preceding cause-of-death categories, see ‘‘Technical notes’’]
Rank1Cause of death (Based on the Ninth Revision,International Classification of Diseases, 1975)
Data in this report are based on infomation from all death certificates filedthe 50 States and the District of Colubia. The U.S. Standard Certificate of Dewas revised in 1989; for additional detasee the 1989 revision of the U.S. standcertificates and reports (13) and TechnAppendix ofVital Statistics of the UniteStates, 1989,Volume II, Mortality, part A(14).
Mortality statistics are based on infomation coded by the States and providto the National Center for Health Stattics (NCHS) through the Vital StatisticCooperative Program (VSCP) and frocopies of the original certificates receivby NCHS from the State registratiooffices. In 1994 all the States and tDistrict of Columbia participated in thiprogram and submitted part or all of tmortality data for 1994 in electronic dafiles to NCHS. The 40 States in the VSCthat submitted precoded medical dataall deaths are Alabama, Alaska, ArkansCalifornia, Colorado, Connecticut, Delware, Florida, Georgia, Hawaii, IdahIndiana, Iowa, Kansas, Louisiana, MainMaryland, Massachusetts, Michigan, Mnesota, Mississippi, Montana, NebrasNevada, New Hampshire, New York Sta(excluding New York City), North Carolina, North Dakota, Oklahoma, OregoPennsylvania, Rhode Island, South Calina, South Dakota, Texas, Vermont, Vginia, Washington, Wisconsin, anWyoming. Of these 40 States, MainMontana, North Dakota, and Wyomincontracted with a private companyprovide precoded medical data to NCHKansas continued to provide the medidata for Alaska. The remaining 10 StatNew York City, and the District of Columbia submitted copies of the original cetificates from which NCHS coded thmedical data. For 1994 all States submted precoded demographic data fordeaths.
Data for the entire United States reto events occurring within the UniteStates. Data shown for geographic arare by place of residence. Beginning w1970 mortality statistics exclude deaof nonresidents of the United States.data exclude fetal deaths.
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Race
Quality of race data—A number ofstudies have been conducted on the rability of race reported on the death cetificate by comparing race on the deacertificate with that reported on anothdata collection instrument, such as tcensus or a survey. Differences may arbecause of differences in who providrace information on the compared recorRace information on the death certificais reported by the funeral director aprovided by an informant or in the absenof an informant, on the basis of observtion. In contrast, race on the census orthe Current Population Survey is sereported and, therefore, may be consered more valid. A high level of agreemebetween the death certificate and the csus or survey report is essential to assunbiased death rates by race.
Results from several studies (15–1show that a person self-reported as Amecan Indian or Asian on census or survrecords was sometimes reported as whon the death certificate. The net effectmisclassification is an underestimationdeaths and death rates for the smaminority races.
Other races and race not stated—Beginning in 1992 all records coded a‘‘Other races’’ (0.01 percent of the totadeaths) were assigned to the specifirace of the previous record. Records fwhich race was unknown, not stated,not classifiable (0.26 percent of the totdeaths) were assigned the racial desigtion of the previous record.
Infant and maternal mortality rates—Beginning with the 1989 data year, thmethod of tabulating live births by racwas changed from race of child to racemother. This change affects infant anmaternal mortality rates because live birtare the denominators of these rates. (Fadditional details see the Technical Appedix to Vital Statistics of the United State1989, Volume I, Natality (18,19).) Toimprove continuity and ease of interprtation, trend data by race in this repohave been retabulated by race of mothfor all years beginning with the 1980 dayear. For 1989–94, as in previous yeainfant and maternal deaths continue totabulated by the race of the decedent.
Quantitatively, the change in the basfor tabulating live births by race results i
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more white births and fewer black birthsand births of other races. Consequentlinfant and maternal mortality rates undethe new tabulating procedure tend to babout 2 percent lower for white infantsand about 5 percent higher for blackinfants than when they are computed bthe previous method of tabulating livebirths by race of child. Rates for mosother minority races also are higher whecomputed by race of mother (14,19).
Infant mortality rates for specifiedrace may be biased because of inconstencies in reporting race between the birtand death certificates for the same infanEstimates of reporting bias have beemade by comparing rates based on thlinked files of infant deaths and livebirths with those in which the race ofinfant death is based on information fromthe death certificate (14).
Cause-of-death classification
The mortality statistics presented herwere compiled in accordance with theWorld Health Organization (WHO) regu-lations, which specify that member nationclassify causes of death by the currenManual of the International StatisticalClassification of Diseases, Injuries, andCauses of Death(20). Causes of death for1979–94 were classified according to thmanual. For earlier years causes of deawere classified according to the revisionthen in use—1968–78, Eighth Revision1958–67, Seventh Revision; and 1949–5Sixth Revision. Changes in classificatioof causes of death due to these revisionmay result in discontinuities in cause-ofdeath trends. Consequently, cause-odeath comparisons among revisionrequire consideration of comparabilityratios and, where available, estimates otheir standard errors. Comparability ratiobetween the Eighth and Ninth Revisionsbetween the Seventh and EightRevisions, and between the Sixth anSeventh Revisions may be found in otheNCHS reports (21–23).
Besides specifying the classificationWHO regulations outline the form ofmedical certification and the procedureto be used in coding cause of deathCause-of-death data presented in this pulication were coded by procedures outlined in annual issues of theNCHSInstruction Manual(24–26).
Before data for 1968, mortality medcal data were based on manual codingan underlying cause of death for eacertificate in accordance with WHO ruleEffective with data year 1968, NCHconverted to computerized coding of tunderlying cause and manual codingall causes (multiple causes) on the decertificate. In this system, called Autmated Classification of Medical Entitie(ACME) (27), the multiple cause codserve as inputs to the computer softwthat employs WHO rules to select tunderlying cause. Many States haimplemented ACME and provide mutiple cause and underlying cause dataNCHS in electronic form; for those Statthat did not, NCHS coded the mortalimedical data using ACME.
The ACME system is used to selethe underlying cause of death fordeath certificates in the United States.addition, NCHS recently introduced twcomputer systems as inputs to ACMBeginning with 1990 data, the systecalled Mortality Medical Indexing, Classification, and Retrieval (MICAR) (28,29was introduced to automate coding mtiple causes of death. In addition, MICAprovides more detailed information othe conditions reported on death certcates than is available through the Intnational Classification of Diseases (ICcode structure. Then, beginning with dyear 1993, a system called SuperMICAwas introduced as an enhancement ofMICAR system. SuperMICAR allows fototal literal entry of the multiple cause-odeath text as reported by the certifiThis information is automatically codeby the MICAR and ACME computesystems.
For 1994 approximately 12 perceof the Nation’s death records wemultiple-cause coded using SuperMCAR; 72 percent, using MICAR; an16 percent, using ACME. This represedata from 10 States that were codedSuperMICAR and data from 32 Statethe District of Columbia, and New YorCity that were coded by MICAR. Datfor the remaining eight States were pcessed using only the ACME system.
In this report tabulations of cause-odeath statistics are based solely onunderlying cause of death. The undering cause is defined by WHO as tdisease or injury that initiated the seque
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of events leading directly to death or athe circumstances of the accident or vilence that produced the fatal injury. Itselected from the conditions enteredthe physician in the cause-of-death setion of the death certificate. When mothan one cause or condition is enteredthe physician, the underlying causedetermined by the sequence of conditioon the certificate, provisions of the ICDand associated selection rules. Generamore medical information is reported odeath certificates than is directly reflectin the underlying cause of death.
Codes for HIV infection
Beginning with data for 1987, NCHSintroduced categories *042–*044 for clasifying and coding Human immunodeficiency virus (HIV) infection. The asteriskbefore the category numbers indicate ththey are not part of theNinth Revision,International Classification of Disease(ICD–9). Deaths classified to HIV infection for 1994 are intables 8–12. They areincluded, but not shown separately, in tcategory ‘‘All other infectious and parasitic diseases’’ in the List of 72 SelecteCauses of Death and in the catego‘‘Remainder of infectious and parasitidiseases’’ in the List of 61 Selected Causof Infant Deaths. Before 1987 deathinvolving HIV infection were classifiedto ‘‘Deficiency of cell-mediated immu-nity’’ (ICD–9 No. 279.1), contained inthe category ‘‘All other diseases’’; to‘‘Pneumocystosis’’ (ICD–9 No. 136.3)contained in the category ‘‘All other infectious and parasitic diseases’’; to ‘‘Malignant neoplasms, including neoplasmslymphatic and hematopoietic tissues’’; anto a number of other causes. As a conquence, cause-of-death data beginnwith 1987 are not strictly comparablwith data for previous years.
Alzheimer’s disease deaths
Alzheimer’s disease is a progresively debilitating disease that falls withia class of disorders generally referredas dementia. These disorders, characized by cognitive and mental deteriortion, may manifest in sudden oprogressive forms. Alzheimer’s diseasethe major type of progressive demenwithin the class of disorders (30).
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Alzheimer’s mortality is believed tobe underreported. Research shows thasubstantial number of death certificatefor persons diagnosed with dementia dnot mention the condition (31,32). Underreporting is believed to be due to failureto report a condition considered to contribute to death, judgment that this condtion did not contribute to death, or failureto diagnose the condition. A separate caegory for Alzheimer’s disease death(ICD–9 No. 331.0) was introduced in theICD–9.
Codes for firearm deaths
Causes of death attributable to firearm mortality include ICD–9 No. E922,Accident caused by firearm missile; NosE955.0–E955.4, Suicide and self-inflicteinjury by firearms; E965.0–E965.4 andE970, Assault by firearms and legal intevention; and E985.0–E985.4, Injury byfirearms, undetermined whether accidetally or purposely inflicted. Injury byfirearm causes exclude explosives another causes indirectly related to firearm
Codes for drug-induced deaths
Causes of death attributable to druginduced mortality include ICD–9 No. 292Drug psychoses; No. 304, Drug dependence; Nos. 305.2–305.9, Nondependeuse of drugs not including alcohol andtobacco; Nos. E850–E858, Accidental posoning by drugs, medicaments, and biologicals; Nos. E950.0–E950.5, Suicide bdrugs, medicaments, and biologicals; NE962.0, Assault from poisoning by drugand medicaments; and NosE980.0–E980.5, Poisoning by drugsmedicaments, and biologicals, undetemined whether accidentally or purposelinflicted. Drug-induced causes excludaccidents, homicides, and other causindirectly related to drug use.
Codes for alcohol-induced deaths
Causes of death attributable talcohol-induced mortality include ICD–9No. 291, Alcoholic psychoses; No. 303Alcohol dependence syndrome; No. 305.Nondependent abuse of alcohol; No357.5, Alcoholic polyneuropathy; No.425.5, Alcoholic cardiomyopathy; No.535.3, Alcoholic gastritis; Nos.571.0–571.3, Chronic liver disease an
cirrhosis, specified as alcoholic; No. 790Excessive blood level of alcohol; and NE860, Accidental poisoning by alcohonot elsewhere classified. Alcohol-inducecauses exclude accidents, homicides, aother causes indirectly related to alcohuse.
Quality of reporting of cause ofdeath
One index of the quality of reportingcauses of death is the proportion of deacertificates coded to the Ninth RevisioChapter XVI; Symptoms, signs, and ildefined conditions (ICD–9 Nos. 780–799Although deaths occur for which thunderlying causes are impossible to detmine, this proportion indicates the caand consideration given to the certifiction by the medical certifier. This proportion also may be used as a rough measof the specificity of the medical diagnoses made by the certifier in variouareas. In 1994, 1.11 percent of all reportdeaths in the United States were assignto Symptoms, signs, and ill-defined coditions compared with 1.17 percent1993. Although the percent of deathfrom this cause for all ages combinegenerally has remained stable since 19decreases have occurred for 10-year agroups for 15–44 years. Increases sin1990 have occurred for age groups 5–years and 85 years and over.
Cause-of-death rankings
The cause-of-death rankings infig-ure 4 and tables B, 6, 7, 15,and 31 arebased on the List of 72 Selected Causof Death, HIV Infection (ICD–9 Nos.*042–*044) and Alzheimer’s diseas(ICD–9 No. 331.0). The cause-of-dearanking for infants intables 26and27arebased on the List of 61 Selected Causof Infant Death and HIV Infection. HIVinfection was added to the lists of rankabcauses effective with data year 198Alzheimer’s disease was added to tlists of rankable causes of death effectiwith data year 1994.
The group titles Major cardiovascular diseases and Symptoms, signs, aill-defined conditions are not ranked fromthe List of 72 Selected Causes; Certaconditions originating in the perinata
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period and Symptoms, signs, and idefined conditions are not ranked frothe List of 61 Selected Causes of InfaDeath. In addition, category titles thabegin with the words ‘‘Other’’ and ‘‘Allother’’ are not ranked to determine thleading causes of death. When one oftitles that represents a subtotal is rank(for example, Tuberculosis), its component parts are not ranked (in this casTuberculosis of respiratory system anOther tuberculosis).
Hispanic origin
For 1994 mortality data for theHispanic-origin population are based odeaths to residents of 49 States andDistrict of Columbia whose data werapproximately 80 percent or more complete on a place-of-occurrence basis aconsidered to be sufficiently comparabto be used for analysis. Data includeStates except Oklahoma, which wexcluded because its death certificatesnot include an item to identify Hispanior ethnic origin.
Infant mortality rates for theHispanic-origin population are based onumbers of resident infant deaths reporto be of Hispanic origin and numbers oresident live births by Hispanic origin omother for the same 49 States and tDistrict of Columbia. In computing infanmortality rates, deaths and live birthsunknown origin are not distributed amonthe specified Hispanic and non-Hispangroups. Because the percent of infadeaths of unknown origin was 1.3 and tpercent of live births of unknown originwas 1.1 for the 49 States and the Distrof Columbia for 1994, infant mortalityrates in this report by specified Hispanorigin and race for non-Hispanic origimay be underestimated.
Small numbers of infant deaths fospecific Hispanic-origin groups can resuin infant mortality rates subject to relatively large random variation (see ‘‘Ran-dom variation’’).
In 1990 the 49 States and the Distriof Columbia accounted for 99.6 perceof the Hispanic population in the UniteStates, including about 99.5 percentthe Mexican population, 99.8 percentthe Puerto Rican population, 99.9 perce
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of the Cuban population, and 99.7 pecent of the Other Hispanic population(33).
Educational attainment
Beginning with the 1989 data yearmortality data on educational attainmenare being tabulated from informationreported on the death certificate. Asresult of the revision of the U.S. StandarCertificate of Death (14), an item indicating educational attainment was addedthe certificates of numerous States. Motality data on educational attainment fo1994 are based on deaths to residentsthe 45 States and the District of Columbiwhose data were approximately 80 pecent or more complete on a place-ooccurrence basis. Data include all Statexcept Georgia, Kentucky, OklahomaRhode Island, and South Dakota.
Population bases for computingrates
The population used for computingdeath rates in this report (furnished by thU.S. Bureau of the Census) represents tpopulation residing in the specified areaDeath rates for 1994 are based on poplation estimates as of July 1, 1994 (34,35The estimates are based on the 19census level counts. The 1990 censlevel counts by race were modified to bconsistent with U.S. Office of Management and Budget categories and historiccategories for death data (36). The poplation estimates for Mexicans, PuertRicans, Cubans, and Other Hispanics abased on the Current Population Surveadjusted to resident population contrototals (37) for 49 States (excluding Oklahoma) and the District of Columbia andas such, are subject to sampling variatio(see ‘‘Random variation’’).
Infant mortality rates infigure 5andtables Cand 24–29 are the most com-monly used index for measuring the risof dying during the first year of life. Theyare calculated by dividing the number oinfant deaths in a calendar year by thnumber of live births registered for thesame period and are presented as raper 1,000 or per 100,000 live births
Infant mortality rates use the numberlive births in the denominator to approxmate the population at risk of dying befothe first birthday.
In contrast to infant mortality ratebased on live births, infant death ratesfigure 2andtables A, 2, 6, 9, 14,and17are based on the estimated populatiunder 1 year of age. Infant death ratthat appear in tabulations of age-specideath rates are calculated by dividing tnumber of infant deaths in a calendyear by the midyear population of infanunder 1 year of age (estimated frobirths occurring in the 12-month perioending with June) and are presentedrates per 100,000 population in this agroup. Because of differences in thdenominators, infant death rates may dfer from infant mortality rates.
Computation of percentdistributions
Deaths of persons of unknown martal status and unknown educational attament were subtracted from figures fototal deaths used as denominators befpercent distributions were computed.
Life tables
U.S. abridged life tables are constructed by reference to a standard ltable (38). The life table providescomprehensive measure of the effectmortality on life expectancy. It is composed of sets of values showing the motality experience of a hypothetical grouof infants born at the same time ansubject throughout their lifetime to thspecific mortality rates of a particulatime, usually a given year.
Causes of death contributing tochanges in life expectancy
Causes of death contributing tchanges in life expectancy were esmated using a life table partitioning technique. The method partitions changes incomponent additive parts. This methoidentifies the causes of death having tgreatest influence, positive or negativon changes in life expectancy (3,4).
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Random variation
Although the mortality data in thireport except data for 1972 are not suject to sampling error, they may baffected by random variation in the number of deaths involved. When the numbof events is small (perhaps less than 1and the probability of such an eventsmall, considerable caution mustobserved in interpreting the data. Suinfrequent events may be assumedfollow a Poisson probability distributionFor this distribution, the relative standaerror (RSE) is a measure of the variabity. For computing RSE’s in percent, thformula may be used for all tables excefor the death rates shown intable 14(seesubsection below):
1. RSE (D) = RSE (R) = 100Œ 1
DwhereD = number of deaths
R= rate
Beginning with 1989 data, an asteisk is shown in place of a rate basedfewer than 20 deaths, which is the equivlent of an RSE(R) of 23 percent or morA RSE(R) of 23 percent is considerestatistically unreliable. For age-adjustdeath rates, this criterion was basedthe sum of the age-specific deaths. Tsame procedure is used in this repexcept for the death rates showntable 14(see subsection below).
For tables showing the numberdeaths (D), the chances are 95 in 100 th
2. D – 1.96v D vRSE(D)
100
and
D + 1.96v D vRSE(D)
100
cover the ‘‘true’’ number of deaths. Thiis referred to as a 95-percent confideninterval.
For tables showing a crude death ra(R) or an age-specific death rate for tith age group,Ri except the rates intable 14, the 95-percent confidencinterval
3. R –1.96v R vRSE(R)
100
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and
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100
will include the ‘‘true’’ rate.For testing the difference betwee
two rates (R1 andR2), the followingz-testmay be used to define a significance testatistic:
4.
z=R1 –R2
˛ R21SRSE(R1)100 D2
+ R22SRSE(R2)100 D2
If ?z? ≥ 1.96, the difference is statisti-cally significant at the 0.05 level; and if?z? < 1.96, the difference is not significant
For tables showing an age-adjustedeath rate (R′) except the rates intable 14,the RSE’s in formulas 3 and 4 would besubstituted by this formula:
5.
RSE(R′) = 100
ŒΣ{w2i R2i S 1DiD}
R′
where
Ri = age-specific rate for theithage group
wi = ith age-specific U.S. standarmillion population such that
∑(wi) = 1.000000 (see age-adjustedeath rate under ‘‘Definitionof terms’’ )
Di = number of deaths for theithage group
For tables showing an infant mortality rate (based on live births in thedenominator), IMR, the RSE’s in formu-las 3 and 4 would be substituted by thfollowing formula:
6. RSE(IMR) = 100Œ1
D+
1
B
whereB = number of live births
Table 14—The crude, age-specificand age-adjusted death rates for Mexcans, Puerto Ricans, Cubans, and OthHispanics are based on population esmates derived from the Current Population Survey produced by the U.S. Burea
of the Census. As a result, the ratessubject to the variability of the denomnator as well as the numerator. Ftable 14the following RSE formulas werused to determine a RSE of 23 percentmore for the purpose of showing the raor an asterisk.
For crude,R, and age-specific deatrates,Ri,
7.
RSE(R) = 100ŒS1DD + 0.67 Sa + bPDand for age-adjusted death rates,R′,
RSE(R′) = 100•
8.
˛ S{w2i R2i S 1DiD+ 0.67Sa+ b
PiD }R'
where
D = number of deathsP = population estimate used fo
computing the rateDi = number of deaths for theith age
groupPi = population estimate used for com
puting for the ith age-specificdeath rate
For all origins, total Hispanic, totanon-Hispanic, non-Hispanic white, annon-Hispanic black populations,
a = 0.000000 andb = 0
and for Mexican, Puerto RicanCuban, and Other Hispanic populations
a = –0.000297 andb = 6,865
Thea andb factors are Current Population Survey standard error paramete(39).
3 4
re-r
orte
h
r
-
ld
,,
-rs
To compute 95-percent confidenintervals andz-tests for the death rateshown in table 14, the RSE formulas 7and 8 may be substituted as appropriafor the RSE’s used in formulas 3 and 4
Infant and maternal mortality rates—Comparisons made in the text amoinfant, neonatal, postneonatal, and manal mortality rates, unless otherwise spefied, are statistically significant at th0.05 level of significance. Lack of comment in the text about any two rates donot mean that the difference was tesand found not to be significant at thlevel.
Availability of mortality data
Mortality data are available in electronic format (data tapes and CD-ROM’from the National Technical InformatioService. Data are also available in tVital Statistics of the United States, Vol-ume II, Mortality, Parts A and B,Vitaland Health Statistics, Series 20, and thMonthly Vital Statistics Reportand supple-ments through NCHS. Additional unpublished tabulations are available froNCHS or through its Internet site ahttp://www.cdc.gov/nchswww/nchshome.h
Crude death rate—Total deaths pe100,000 population for a specified perioThe crude death rate represents the aage chance of dying during a specifiperiod for persons in the entire populatio
e
te,.
gr-i-
-sds
-)
e
-
tm.
.
Age-specific death rate—Deaths per100,000 population in a specified agegroup, such as 1–4 years or 5–9 years foa specified period.
Age-adjusted death rate—The deathrate used to make comparisons of relativmortality risks across groups and overtime. However, it should be viewed as aconstruct or an index rather than as direcor actual measure of mortality risk. Sta-tistically, it is a weighted average of theage-specific death rates, where the weighrepresent the fixed population proportionsby age (40). The age-adjusted rates presented in this report were computed bythe direct method, that is, by applying theage-specific death rates for a given causof death to the U.S. standard millionpopulation (relative age distribution of1940 enumerated population of the UnitedStates), which is shown below along withthe corresponding weights used for computing the RSE(R′) in the preceding for-mulas:
Age Number Weight (wi)
All ages . . . . . . . . . 1,000,000 1.000000
Under 1 year . . . . . . 15,343 0.0153431–4 years . . . . . . . . 64,718 0.0647185–14 years. . . . . . . . 170,355 0.17035515–24 years . . . . . . . 181,677 0.18167725–34 years . . . . . . . 162,066 0.16206635–44 years . . . . . . . 139,237 0.13923745–54 years . . . . . . . 117,811 0.11781155–64 years . . . . . . . 80,294 0.08029465–74 years . . . . . . . 48,426 0.04842675–84 years . . . . . . . 17,303 0.01730385 years and over . . . 2,770 0.002770
By using the same standard population, the rates for the total population andfor each race-sex group were adjusteseparately. The age-adjusted rates werbased on 10-year age groups. It is important not to compare age-adjusted deatrates with crude rates.
Table I. Estimated population by age, according to specified Hispanic origin, race for non-Hispanic origin, and sex: Total of 49 States and the District of Columbia, 1994
Hispanic origin, race fornon-Hispanic origin, and sex Total
1Includes Central and South American and Other and Unknown Hispanic.2Includes races other than white and black.
SOURCE: Population estimates based on unpublished tabulations prepared by the Housing and Household Economic Statistics Division, U.S. Bureau of the Census.
MonthlyVita
lStatistic
sReport+Vol.45,
No.3(S)
+October25,
199679
Errata
This table was omitted from the original publication.
Suggested citation
Singh GK, Kochanek KD, MacDorman MF.Advance report of final mortality statistics,1994. Monthly vital statistics report; vol 45no 3, supp. Hyattsville, Maryland: NationalCenter for Health Statistics. 1996.
Copyright information
All material appearing in this report is in thepublic domain and may be reproduced orcopied without permission; citation as tosource, however, is appreciated.
This report presents summary tabulations from the final mortality statistics for 1994. More detailedtabulations for 1994 will be published inVital Statistics of the United States, 1994 Volume II—Mortality. Prior to the publication of that volume, the National Center for Health Statistics willrespond to requests for unpublished data whenever possible.
Keywords: Death certificate, mortality dynamics, health status, and infantand maternal health
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