Mortality Trends in the USA

Main Category: HIV / AIDS
Article Date: 28 Feb 2004 - 0:00 PDT

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National Center for Health Statistics

Life expectancy and infant mortality are measures often used to gauge the overall health of a population. Life expectancy shows a long term upward trend and infant mortality attained a record low in 2000 and remained unchanged in 2001.

In 2001 life expectancy at birth for the total population reached a record high of 77.2 years, based on preliminarydata, up from 75.4 years in 1990.

In 2001 the infant mortality rate did not change from its2000 record low of 6.9 infant deaths per 1,000 live births,based on preliminary data.

Since 1950 mortality among teens and young adults age15-24 years has declined by 38 percent to 80 deaths per100,000 population in 2000.

Overall mortality at ages 15-24years has declined, in part, due to decreases in death ratesfor unintentional injuries, cancer, heart disease, and infectiousdiseases. Homicide and suicide rates generally increasedover this period, but have declined since the mid-1990s.

Between 1950 and 2000 mortality among adults age 25-44years declined by 44 percent overall, to 155 deaths per100,000 population. Death rates for unintentional injuries,cancer, heart disease, and tuberculosis decreasedsubstantially during this period.

Suicide rates rose through1980 and have since declined slightly. HIV disease was theleading cause of death in this age group in the mid-1990s;with decreasing HIV disease death rates, it dropped to thefifth leading cause of death between 1997 and 2000.

Since 1950 mortality among adults age 45-64 years hasdecreased by 49 percent overall, to 648 deaths per 100,000population in 2000. During this period death rates for heartdisease, stroke, and unintentional injury decreased whilecancer mortality rose slowly through the 1980s and thendeclined.

Cancer was the leading cause of death for 45-64year olds in 2000, accounting for more than one-third ofdeaths in this age group.

During the past 50 years mortality among persons 65years of age and over has dropped by 35 percent to 5,169deaths per 100,000 population in 2000. During this perioddeath rates for heart disease and stroke have declinedsharply while the death rate for cancer rose until 1995 andhas since decreased slightly.

Disparities in Mortality

Despite overall declines in mortality, racial and ethnic disparities in mortality, as well as gender disparities, persist.

The gap in life expectancy between the sexes and between the black and white populations has been narrowing.

As a result of revised death rates that incorporate information from the 2000 Census, some of the racial disparities in mortality are not as large as previously reported, while others are wider.

Infant mortality rates have declined for all racial and ethnic groups, but large disparities remain. In 2000 the infant mortality rate was highest for infants of non-Hispanic black mothers (13.6 deaths per 1,000 live births) and lowest for infants of mothers of Chinese origin (3.5 per 1,000 live births) .

Infant mortality increases as mother's level of education decreases. In 2000 the mortality rate for infants of mothers with less than 12 years of education was 58 percent higher than for infants of mothers with 13 or more years of education.

This disparity was more marked among non-Hispanic white infants, for whom mortality among infants of mothers with less than a high school education was more than twice that for infants of mothers with more than a high school education.

Between 1990 and 2001 life expectancy at birth increased by more than 2 years for males and by 1 year for females. The difference in life expectancy between males and females narrowed from 7 years in 1990 to 5.4 years in 2001 (based on preliminary data) .

Between 1990 and 2001 mortality from lung cancer declined for men and increased for women. Although these trends reduced the sex differential for this cause of death, the age-adjusted death rate for lung cancer was still 86 percent higher for men than for women in 2000 and 83 percent higher in 2001 (preliminary data).

Since 1990 mortality from chronic lower respiratory diseases remained relatively stable for men while it increased for women.

These trends reduced the gap between the sexes for this cause of death. In 1990 the age-adjusted death rate for males was more than 100 percent higher than for females. In 2000 the difference between the rates had been reduced to 49 percent, and in 2001, to 44 percent (preliminary data).

Between 1990 and 2001 life expectancy at birth increased more for the black than for the white population, thereby narrowing the gap in life expectancy between these two racial groups. In 1990 life expectancy at birth was 7 years longer for the white than for the black population.

By 2000 the difference had narrowed to 5.7 years, and by 2001, to 5.5 years (preliminary data) . Overall mortality was 31 percent higher for black Americans than for white Americans in 2001 compared with 37 percent higher in 1990.

In 2001 age-adjusted death rates for the black population exceeded those for the white population by 40 percent for stroke, 29 percent for heart disease, 25 percent for cancer, and nearly 800 percent for HIV disease (based on preliminary data) .

The 5-year survival rate for black females diagnosed in 1992-98 with breast cancer was 15 percentage points lower than the 5-year survival rate for white females. In 2000 breast cancer mortality for black females was 31 percent higher than for white females, and in 2001, 34 percent higher, based on preliminary data, compared with 15 percent higher in 1990.

Homicide rates among young black males 15-24 years of age and among young Hispanic males were about 50 percent lower in 2000 than in the early 1990s when homicide rates peaked for these groups.

In spite of these downward trends, homicide was still the leading cause of death for young black males and the second leading cause for young Hispanic males in 2000, and homicide rates for young black and Hispanic males remained substantially higher than for young non-Hispanic white males.

Since 1995 death rates for HIV disease declined sharply for Hispanic males and black males 25-44 years of age. In spite of these declines, HIV disease was still the second leading cause of death for Hispanic males 25-44 years of age and the third leading cause for black males 25-44 years of age in 2000, and HIV death rates remained much higher for Hispanic and black males than for non-Hispanic white males in this age group.

In 2000 death rates for motor vehicle-related injury and suicide for young American Indian males 15-24 years of age were about 45 percent higher than the rates for those causes for young white males. Death rates for the American Indian population are known to be underestimated.

Overall mortality was almost 40 percent lower for Asian males than for white males throughout most of the 1990s. In 2000 age-adjusted death rates for cancer and heart disease for Asian males were 38-41 percent lower than corresponding rates for white males, whereas the death rate for stroke was only 3 percent lower. Death rates for the Asian population are known to be underestimated.

Death rates vary by educational attainment. In 2000 the age-adjusted death rate for persons 25-64 years of age with fewer than 12 years of education was nearly three times the rate for persons with 13 or more years of education.