Annual summary of vital statistics: 2000.

The birth rate in 2000 (preliminary data) was 14.8 births per 1000 population, an increase of 2% from 1999 (14.5). The fertility rate, births per 1000 women aged 15 to 44 years, increased 3% to 67.6 in 2000, compared with 65.9 in 1999. The 2000 increases in births and the fertility rate were the third consecutive yearly increases, the largest in many years, halting the steady decline in the number of births and fertility rates in the 1990s. Fertility rates for total white, non-Hispanic white, black, and Native American women each increased about 2% in 2000. The fertility rate for black women, which declined 19% from 1990 to 1996, has changed little since 1996. The rate for Hispanic women rose 4% in 2000 to reach the highest level since 1993. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women remained about the same at one third, but the number of births rose 3%. The birth rate for teen mothers declined again for the ninth consecutive year. The use of timely prenatal care (83.2%) remained unchanged in 2000, and was essentially unchanged for non-Hispanic white (88.5%), black (74.2%), and Hispanic (74.4%) mothers. The number and rate of multiple births continued their dramatic rise, but all of the increase was confined to twins; for the first time in more than a decade, the number of triplet and higher-order multiple births declined (4%) between 1998 and 1999 (multiple birth information is not available in preliminary 2000 data). The overall increases in multiple births account, in part, for the lack of improvement in the percentage of low birth weight (LBW) births. LBW remained at 7.6% in 2000. The infant mortality rate (IMR) dropped to 6.9 per 1000 live births (preliminary data) in 2000 (the rate was 7.1 in 1999). The ratio of the IMR among black infants to that for white infants was 2.5 in 2000, the same as in 1999. Racial differences in infant mortality remain a major public health concern. The role of low birth weight in infant mortality remains a major issue. Among all of the states, Utah and Maine had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage LBW, and birth weight-specific neonatal mortality rates for each state. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a record high of 76.9 years for all gender and race groups combined. Death rates in the United States continue to decline. The age-adjusted death rate for suicide declined 4% between 1999 and 2000; homicide declined 7%. Death rates for children 19 years of age or less declined for 3 of the 5 leading causes in 2000; cancer and suicide levels did not change for children as a group. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.

Age-adjusted death rates: trend data based on the year 2000 standard population.

Age-adjusted death rates are routine mortality risk measures used to compare rates over time or between groups such as those living in different geographic areas. This type of measure eliminates differences that would be caused because one population is older than another. Beginning with mortality data for 1999, the standard population used by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) to calculate age-adjusted death rates based on the Year 2000 estimated population distribution replacing that of 1940 used previously. Comparisons of 1999 mortality data with that of 1998 and earlier years cannot be made unless age-adjusted death rates are based on the same standard population. Changing the standard population generally changes the magnitude of an age-adjusted death rate and may change the magnitude of the differential between two groups. Typically, the change in standard makes relatively little difference in the mortality trend but it can when age-specific rates have divergent patterns. This publication provides age-adjusted death rates by race and sex based on the year 2000 population standard and directs readers to the NCHS Web site for age-adjusted death rates by selected causes.

Deaths: final data for 1999.

OBJECTIVES: This report presents final 1999 data on U.S. deaths and death rates according to demographic and medical characteristics. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 1999. METHODS: In 1999 a total of 2,391,399 deaths were reported in the United States. This report presents tabulations of information reported on the death certificates completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the State registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. For the first time in a final mortality data report, age-adjusted death rates are based upon the year 2000 population and causes of death are processed in accordance with the Tenth Revision of the International Classification of Diseases (ICD-10). RESULTS: The 1999 age-adjusted death rate for the United States was 881.9 deaths per 100,000 standard population, a 0.7 percent increase from the 1998 rate, and life expectancy at birth remained the same at 76.7 years. For all causes of death, age-specific death rates rose for those 45-54 years, 75-84 years, and 85 years and over and declined for a number of age groups including those 5-14 years, 55-64 years, and 65-74 years. Aortic aneurysm and dissection made its debut in the list of leading causes of death and atherosclerosis exited from the list. Heart disease and cancer continued to be the leading and second leading causes of death. The age-adjusted death rate for firearm injuries decreased for the sixth consecutive year, declining 6.2 percent between 1998 and 1999. The infant mortality rate, 7.1 infant deaths per 1,000 live births, was not statistically different from the rate in 1998. CONCLUSIONS: Generally, mortality continued long-term trends. Life expectancy in 1999 was unchanged from 1998 despite a slight increase in the age-adjusted death rate from the record low achieved in 1998. Although statistically unchanged from 1998, the trend in infant mortality has been of a steady but slowing decline. Some mortality measures for women and persons 85 years and over worsened between 1998 and 1999.

Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates.

OBJECTIVES: This report presents preliminary results describing the effects of implementing the Tenth Revision of the International Classification of Diseases (ICD-10) on mortality statistics for selected causes of death effective with deaths occurring in the United States in 1999. The report also describes major features of the Tenth Revision (ICD-10), including changes from the Ninth Revision (ICD-9) in classification and rules for selecting underlying causes of death. Application of comparability ratios is also discussed. METHODS: The report is based on cause-of-death information from a large sample of 1996 death certificates filed in the 50 States and the District of Columbia. Cause-of-death information in the sample includes underlying cause of death classified by both ICD-9 and ICD-10. Because the data file on which comparability information is derived is incomplete, results are preliminary. RESULTS: Preliminary comparability ratios by cause of death presented in this report indicate the extent of discontinuities in cause-of-death trends from 1998 through 1999 resulting from implementing ICD-10. For some leading causes (e.g., Septicemia, Influenza and pneumonia, Alzheimer's disease, and Nephritis, nephrotic syndrome and nephrosis), the discontinuity in trend is substantial. The ranking of leading causes of death is also substantially affected for some causes of death. CONCLUSIONS: Results of this study, although preliminary, are essential to analyzing trends in mortality between ICD-9 and ICD-10. In particular, the results provide a means for interpreting changes between 1998, which is the last year in which ICD-9 was used, and 1999, the year in which ICD-10 was implemented for mortality in the United States.

Social epidemiology of chronic liver disease and cirrhosis mortality in the United States, 1935-1997: trends and differentials by ethnicity, socioeconomic status, and alcohol consumption.

This study examines trends and ethnic and socioeconomic differentials in chronic liver disease and cirrhosis mortality in the United States. Age-adjusted death rates from the National Vital Statistics System were used to analyze race and sex-specific mortality trends from 1968 through 1997. Age-adjusted liver cirrhosis mortality and per capita alcohol consumption data from 1935 through 1996 were modeled using time-series regression. Moreover, the Cox hazards regression was applied to the National Longitudinal Mortality Study, 1979-1989, to examine socioeconomic differentials at the individual level, whereas multivariate ordinary least squares regression was used to model state-specific cirrhosis mortality from 1990 to 1992 as a function of socioeconomic variables and alcohol consumption at the ecological level. Chronic liver disease and cirrhosis continues to be an important cause of death in the United States, even after three decades of consistently declining mortality rates. For both men and women aged 25 years and older, significant mortality differentials were found by age, race/ethnicity, marital status, family income, and employment status. For men, marked differentials were also found by nativity, rural-urban residence, and education. Unemployment, minority concentration, and alcohol consumption were major predictors of state-specific cirrhosis mortality. Both time-series and cross-sectional data indicate a strong correlation between alcohol consumption and US cirrhosis mortality. Substantial ethnic and socioeconomic differences in cirrhosis mortality suggest the need for social and public health policies and interventions that target such high-risk groups as American Indians, Hispanic Americans, the socially isolated, and the poor.

Maternal mortality, United States and Canada, 1982-1997.

BACKGROUND: The 1998 public awareness campaign on Safe Motherhood called attention to the issue of maternal mortality worldwide. This paper focuses upon maternal mortality trends in the United States and Canada, and examines differentials in maternal mortality in the United States by maternal characteristics. METHODS: Data from the vital statistics systems of the United States and Canada were used in the analysis. Both systems identify maternal deaths using the definition of the World Health Organization's International Classification of Diseases. Numbers of deaths, maternal mortality rates, and confidence intervals for the rates are shown in the paper. RESULTS: Maternal mortality declined for much of the century in both countries, but the rates have not changed substantially between 1982 and 1997. In this period the maternal mortality levels were lower in Canada than in the United States. Maternal mortality rates vary by maternal characteristics, especially maternal age and race. CONCLUSIONS: Maternal mortality continues to be an issue in developed countries, such as the United States and Canada. Maternal mortality rates have been stable recently, despite evidence that many maternal deaths continue to be preventable. Additional investment is needed to realize further improvements in maternal mortality.

Quality of death rates by race and Hispanic origin: a summary of current research, 1999.

OBJECTIVES: This report provides a summary of current knowledge and research on the quality and reliability of death rates by race and Hispanic origin in official mortality statistics of the United States produced by the National Center for Health Statistics (NCHS). It also provides a quantitative assessment of bias in death rates by race and Hispanic origin. It identifies areas for targeted research. METHODS: Death rates are based on information on deaths (numerators of the rates) from death certificates filed in the states and compiled into a national database by NCHS, and on population data (denominators) from the Census Bureau. Selected studies of race/Hispanic-origin misclassification and under coverage are summarized on deaths and population. Estimates are made of the separate and the joint bias on death rates by race and Hispanic origin from the two sources. Simplifying assumptions are made about the stability of the biases over time and among age groups. Original results are presented using an expanded and updated database from the National Longitudinal Mortality Study. RESULTS: While biases in the numerator and denominator tend to offset each other somewhat, death rates for all groups show net effects of race misclassification and under coverage. For the white population and the black population, published death rates are overstated in official publications by an estimated 1.0 percent and 5.0 percent, respectively, resulting principally from undercounts of these population groups in the census. Death rates for the other minority groups are understated in official publications approximately as follows: American Indians, 21 percent; Asian or Pacific Islanders, 11 percent; and Hispanics, 2 percent. These estimates do not take into account differential misreporting of age among the race/ethnic groups.

Annual summary of vital statistics--1998.

Most vital statistics indicators of the health of Americans were stable or showed modest improvements between 1997 and 1998. The preliminary birth rate in 1998 was 14.6 births per 1000 population, up slightly from the record low reported for 1997 (14.5). The fertility rate, births per 1000 women aged 15 to 44 years, increased 1% to 65.6 in 1998, compared with 65.0 in 1997. The 1998 increases, although modest, were the first since 1990, halting the steady decline in the number of births and birth and fertility rates in the 1990s. Fertility rates for total white, non-Hispanic white, and Native American women each increased from 1% to 2% in 1998. The fertility rate for black women declined 19% from 1990 to 1996, but has changed little since 1996. The rate for Hispanic women, which dropped 2%, was lower than in any year for which national data have been available. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women remained about the same at one third. The birth rate for teen mothers declined again for the seventh consecutive year, and the use of timely prenatal care (82.8%) improved for the ninth consecutive year, especially for black (73.3%) and Hispanic (74.3%) mothers. The number and rate of multiple births continued their dramatic rise; the number of triplet and higher-order multiple births jumped 16% between 1996 and 1997, accounting, in part, for the slight increase in the percentage of low birth weight (LBW) births. LBW continued to increase from 1997 to 1998 to 7.6%. The infant mortality rate (IMR) was unchanged from 1997 to 1998 (7.2 per 1000 live births). The ratio of the IMR among black infants to that for white infants (2.4) remained the same in 1998 as in 1997. Racial differences in infant mortality remain a major public health concern. In 1997, 65% of all infant deaths occurred to the 7.5% of infants born LBW. Among all of the states, Maine, Massachusetts, and New Hampshire had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage LBW, and birth weight-specific neonatal mortality rate for each state. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth increased slightly to 76.7 years for all gender and race groups combined. Death rates in the United States continue to decline, including a drop in mortality from human immunodeficiency virus. The age-adjusted death rate for suicide declined 6% in 1998; homicide declined 14%. Death rates for children from all major causes declined again in 1998. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.

Mortality from Alzheimer's disease: an update.

Alzheimer's disease is a progressive degenerative condition that has devastating implications for those afflicted. An estimated 4 million Americans, mainly elderly, have this condition, which is characterized by forgetfulness in early stages and increasingly severe debilitating symptoms as the disease progresses over what can be as long as a 20-year period. As an individual's impairment increases, informal or formal care giving becomes necessary to take care of basic needs. Annually, an estimated $80 to $100 billion dollars are spent on health care expenses or lost in wages for the persons with Alzheimer's disease or their care givers. At later stages of the disease, persons with Alzheimer's disease are bedridden and vulnerable to developing other medical conditions and dying before they would if they did not have Alzheimer's disease (1). Physicians report that Alzheimer's disease caused the death of 21,397 persons in 1996 and contributed to the death of 21,703 additional persons. This information is from death certificates completed by physicians for all deaths in the United States, a fundamental source of information on what caused death for the 2.3 million deaths in the United States. The risk of dying from Alzheimer's disease has leveled off in recent years after rapid increases in the early 1980's and subsequent slower growth in the 1990's. The trend likely reflects changes in attitudes of physicians and the public about attributing Alzheimer's disease as a cause of death as well as the availability of improved diagnostic procedures; the recent leveling in mortality trends from this condition may signal that death certificate diagnoses for Alzheimer's disease are more reliable now. Alzheimer's disease is a major cause of death, which exhibits variations by age, sex, race, and geographic area. This report provides recent mortality data on Alzheimer's disease. A previous report covers historic trends (2).

Deaths: final data for 1997.

OBJECTIVES: This report presents final 1997 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, race, Hispanic origin, marital status, educational attainment, injury at work, State of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 1997. METHODS: In 1997 a total of 2,314,245 deaths were reported in the United States. This report presents descriptive tabulations of information reported on the death certificates. Death certificates are completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the State registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. RESULTS: The 1997 age-adjusted death rate for the United States decreased to an all-time low of 479.1 deaths per 100,000 standard population, and life expectancy at birth increased to a record high of 76.5 years. The 15 leading causes of death remained the same as in 1996, although Human immunodeficiency virus (HIV) infection plummeted from the 8th leading cause of death to the 14th leading cause. Some of the 8th-14th leading causes of death shifted positions. HIV infection remained the leading cause of death for black persons aged 25-44 years. The largest decline in age-adjusted death rates among the leading causes of death was for HIV infection, which dropped 47.7 percent between 1996 and 1997. Mortality declined for all age groups, except for persons aged 85 and over. The infant mortality rate reached a record low of 7.2 infant deaths per 1,000 live births in 1997 although the decline in the rate from 1996 was not statistically significant. CONCLUSIONS: The overall improvements in general mortality and life expectancy in 1997 continue the long-term downward trend in U.S. mortality. The trend in U.S. infant mortality is of steady declines over the past four decades.

Asian or Pacific Islander mortality, selected states, 1992.

OBJECTIVES: In this report the National Center for Health Statistics (NCHS) presents mortality data in greater race detail than has previously been presented for the Asian or Pacific Islander (API) population. METHODS: Deaths, estimated death rates, age-adjusted death rates, exploratory life expectancies, and ranking of leading causes are presented for a selected area. RESULTS: In 1992 a total of 19,478 deaths occurred in the Asian or Pacific Islander population in the seven States examined in this report. Heart disease and cancer were the two leading causes of death for each of the Asian or Pacific Islander subgroups. By age there is striking variation in leading causes among the race groups. Among the API subgroups in these States, age-adjusted death rates are greatest for the Samoan and Hawaiian populations and smallest for the Asian Indian, Korean, and Japanese populations. Life expectancy is lowest for the Hawaiian and Samoan populations.

Alzheimer's disease as a cause of death in the United States.

OBJECTIVE: To describe the scope of mortality from and trends in Alzheimer's disease, to show how Alzheimer's disease ranks as a leading cause of death, to describe a methodological change regarding ranking, and to discuss issues related to the reporting of Alzheimer's disease on death certificates. METHODS: The authors analyzed mortality data from the National Vital Statistics System. RESULTS: Alzheimer's disease has increasingly been reported as a cause of death on death certificates in the United States; however, this increase may represent a variety of factors including improved diagnosis and awareness of the disease or changes in the perception of Alzheimer's disease as a cause of death. In 1995, Alzheimer's disease was identified as the underlying cause of 20,606 deaths. Overall, Alzheimer's disease was the 14th leading cause of death in 1995; for people 65 years of age or older, it was the 8th leading cause of death. Both death rates and cause-of-death ranking differed by selected demographic variables. CONCLUSIONS: In recognition of the importance of the condition as a major public health problem, Alzheimer's disease was added to the list of causes eligible to be ranked as leading causes of death in the United States beginning with mortality data for 1994. Several issues need to be kept in mind in interpreting mortality data on Alzheimer's disease, including how diagnoses are made, how the condition is classified, and the purpose of death certificates.

Medical and life-style risk factors affecting fetal mortality, 1989-90.

OBJECTIVES: This report presents fetal mortality data by medical and life-style risk factors of the mother and the fetus. METHODS: Deaths and fetal mortality rates are presented in this descriptive report. Data sources used are vital statistics data for fetal deaths and live births. RESULTS: The data that became available with the revision of the U.S. Standard Report of Fetal Death in 1989 expanded the medical and health data available on mothers and fetuses. Reporting of medical conditions is probably incomplete for fetal deaths as well as for live births. Therefore, caution should be exercised in using this data. Reported occurrences of medical and life-style risk factors of mother and fetus for fetal deaths and live births and fetal mortality rates are presented. Maternal medical conditions most often associated with having a fetal death were problems with amniotic fluid levels and blood disorders. Fetal mortality was 35 percent greater when tobacco was used during pregnancy and 77 percent higher when alcohol was consumed during pregnancy. The complication of labor most often associated with fetal mortality was abruptio placenta. Although a very small proportion of all deliveries have specific congenital anomalies reported, fetal mortality was close to 50 percent for anencephalus, about 25 percent for renal agenesis, and slightly more than 20 percent for hydrocephalus.

Perinatal mortality in the United States: 1985-91.

In 1991 a total of 35,926 perinatal deaths occurred in the United States; this includes fetal deaths occurring at 28 weeks of gestation or later and infant deaths occurring under 7 days of age. The perinatal mortality rate was at a record low of 8.7 perinatal deaths per 1,000 live births and fetal deaths, 19 percent lower than the rate in 1985. Perinatal mortality rates differ by race. In 1991 the rates for the white and black populations were 7.4 and 15.7 perinatal deaths per 1,000 live births and fetal deaths, respectively. The rate for the Hispanic population was 7.9 compared with a rate of 7.1 for the non-Hispanic white population of an area comprised of 36 States and the District of Columbia. This area includes those States that reported Hispanic origin and whose reporting completeness was considered adequate for analysis.

Effect on mortality rates of the 1989 change in tabulating race.

Effective with vital statistics data for 1989, the National Center for Health Statistics (NCHS) made the following change in most of its tabulations of race for live births and fetal death; race for live births and fetal deaths are shown by race of mother rather than by race of child. As a result of the change in the tabulation by race of live births and fetal deaths, infant, fetal, perinatal, and maternal mortality rates by race in NCHS tabulations for 1989 are not comparable with those of previous years. To facilitate comparison with previous years' data and analysis of current patterns, key tabulations and text analysis in reports from NCHS for 1989 and 1990 data (l-3) show infant, fetal, perinatal, and maternal mortality data computed on the basis of live births and fetal deaths tabulated by both race of mother and race of child. This makes it possible to distinguish the effects of this change in tabulation from real changes in the data. Beginning with data for 1991, NCHS publications show most tabulations by race of mother only.