Racial/ethnic trends in fetal mortality--United States, 1990-2000

Fetal deaths at > or =20 weeks' gestation account for 49% of all deaths that occur between the 20th week of pregnancy and the first year of life. Although the risk for fetal death has declined substantially since the 1950s, disparities in the risk for fetal death by race/ethnicity exist. One of the national health objectives for 2010 is to reduce deaths among fetuses of > or =20 weeks' gestation to 4.1 deaths per 1,000 live births plus fetal deaths for all racial/ethnic populations (objective no. 16-1a). To assess progress toward meeting this objective, CDC analyzed 1990-2000 data from the National Vital Statistics System (NVSS). The findings indicate substantial reductions in fetal deaths, primarily because of reductions in late fetal deaths (> or =28 weeks' gestation) compared with early fetal deaths (20-27 weeks' gestation). Despite these reductions, racial/ethnic disparities in fetal deaths persist, particularly among non-Hispanic blacks. Prevention strategies should recognize fetal deaths as a public health problem, improve fetal death surveillance and reporting, target etiologic research, and educate practitioners in identifying women at risk.     

Trends in childhood cancer mortality--United States, 1990-2004

Cancer is the fourth most common cause of death (after unintentional injury, homicide, and suicide) among persons aged 1-19 years in the United States. Because recent childhood cancer mortality has not been well characterized in terms of temporal, demographic, and geographic trends, CDC analyzed cancer death rates among children (defined as aged 0-14 years) and adolescents (defined as aged 15-19 years) for the period 1990-2004 by sex, age group, race, ethnicity, U.S. Census region, and primary cancer site/leading diagnosis, using the most recent data available from the National Vital Statistics System (NVSS). This report describes the results of that analysis, which indicated that, overall, age-adjusted childhood cancer death rates decreased significantly during 1990-2004 among both sexes, both age groups, all races (except American Indians/Alaska Natives [AI/ANs]), Hispanics, non-Hispanics, and all U.S. Census regions. However, decreases in death rates varied among U.S. Census regions and between Hispanics and non-Hispanics. Eliminating racial/ethnic health disparities is one of the overarching goals of Healthy People 2010. Further research is needed to understand geographic and ethnic disparities in childhood cancer death rates. Moreover, cancer prevention and intervention measures should be designed to reach populations that are underserved and at high risk.     

Increases in age-group-specific injury mortality--United States, 1999-2004

From 1979 to 1999, total injury mortality rates declined overall in the United States, despite increases in suicide rates in the late 1980s and in homicide rates in the early 1990s (CDC, unpublished data, 2007). From 1999 to 2004, however, total injury mortality rates increased 5.5%, from 53.3 to 56.2 per 100,000 population, the first sustained increase in 25 years. To assess this increase, CDC analyzed the most recent data from the National Vital Statistics System (NVSS). This report summarizes the results of that analysis, which determined that U.S. mortality rates increased from 1999 to 2004 for unintentional injuries, suicides, and injuries of undetermined intent; homicide rates were stable. Among persons aged 45-54 years, the total injury mortality rate increased 24.5%, including an 87.0% increase in the mortality rate from unintentional poisoning (most commonly drug poisoning) and a 48.0% increase in suicide by hanging/suffocation. Among persons aged 20-29 years, the total injury mortality rate increased 7.7%, including a 92.5% increase in the death rate from unintentional poisoning and a 31.7% increase in suicide by hanging/suffocation. Parallel increases in multiple categories and mechanisms of injuries within these two age groups suggest an increase in one or more shared risk factors (e.g., drug abuse); prevention programs that focus on shared risk factors might help reduce deaths from injuries.     

Racial/ethnic disparities in infant mortality--United States, 1995-2002

A national health objective for the year 2000 was to reduce the infant mortality rate (IMR) in the United States to 7.0 deaths per 1,000 live births among infants aged <1 year. The national health objective for 2010 targets a rate of 4.5 infant deaths per 1,000 live births; an overarching goal calls for eliminating disparities among racial and ethnic populations. To examine racial and ethnic disparities in IMRs, data were analyzed from the National Vital Statistics System for the period 1995-2002. IMRs were calculated by race/ethnicity of the mother in each of the 50 states and the District of Columbia (DC). During 1995-2002, the overall IMR in the United States declined from 7.6 infant deaths per 1,000 live births in 1995 to 6.8 in 2001, and then increased to 7.0 in 2002. On the basis of data for 1995-2002 combined, the target of 4.5 infant deaths per 1,000 live births had been achieved by few racial/ethnic populations in few states. To reach the target in all racial/ethnic populations, strategies should identify and address those factors that contribute to high IMRs and disparities among populations.     

Racial/ethnic disparities in neonatal mortality--United States, 1989-2001

Neonatal mortality (i.e., death at age <28 days) accounts for approximately two thirds of infant deaths in the United States. During 1989-2001, neonatal mortality rates (NMRs) declined; however, 2002 preliminary data indicated an increase. To characterize trends in neonatal mortality by gestational age and race/ethnicity, CDC analyzed linked birth/infant death data sets for 1989--1991 and 1995-2001 (2002 linked data were not available). This report summarizes the results of that analysis, which indicated that 1) extremely preterm infants (i.e., born at <28 weeks' gestation) accounted for 49%-58% of neonatal deaths during 1989-2001 and 2) racial/ethnic disparities persisted despite NMR declines among infants of all gestational ages. Public health practitioners, researchers, and clinicians can use these results to determine the efficacy of prevention programs at a national level and consider new studies and programs aimed at reducing preterm births and NMR disparities among racial/ethnic populations.     

Excess salmonellosis in women in the United States: 1968-2000

We describe recent epidemiological changes in salmonellosis. Linking 1968-2000 National Salmonella Surveillance System to census data, we calculated population-based age- and sex-stratified rates of non-urinary salmonellosis for the top 30 non-typhoidal serotypes. Using 1996-1997, 1998-1999, and 2000-2001 population-based FoodNet surveys, we compared reported diarrhoea, medical visits, and stool cultures. Despite an overall female-to-male incidence rate ratio (FMRR) of 0.99, the sex-specific burden of salmonellosis varied by age (<5 years FMRR 0.92; 5-19 years 0.85; 20-39 years 1.09; 40-59 years 1.23, and 60 years 1.08) and serotype (FMRR range 0.87 for Mississippi to 1.25 for Senftenberg). Serotype-specific FMRRs and median age (range 2 years for Derby to 29 years for Senftenberg) were related (correlation 0.76, P<0.0001). Recently, the relative burden of salmonellosis in women has increased. FoodNet data suggest that this change is real rather than due to differential reporting. Excess salmonellosis in women may reflect differences in exposure or biological susceptibility.     

Changing patterns of surgical care in the United States, 1980-1995

National inpatient and ambulatory surgery data were combined to examine changes over time in the location and amount of surgical care. The main pattern was a decline in the rate of inpatient operations that was outweighed by growth in ambulatory operations. However, the rate of inpatient operations did not decrease for patients age 65 years or over, despite the growth in ambulatory surgery. Other patterns seen for specific types of operations were the substitution of ambulatory for inpatient operations, increases primarily in the rate of inpatient operations, and decreases in total operations. These patterns have implications for control of health care costs.     

Tularemia--United States, 1990-2000

Tularemia is a zoonotic disease caused by the gram-negative coccobacillus Francisella tularensis. Known also as "rabbit fever" and "deer fly fever," tularemia was first described in the United States in 1911 and has been reported from all states except Hawaii. Tularemia was removed from the list of nationally notifiable diseases in 1994, but increased concern about potential use of F. tularensis as a biological weapon led to its reinstatement in 2000. This report summarizes tularemia cases reported to CDC during 1990-2000, which indicate a low level of natural transmission. Understanding the epidemiology of tularemia in the United States enables clinicians and public health practitioners to recognize unusual patterns of disease occurrence that might signal an outbreak or a bioterrorism event.     

Pertussis--United States, 1997-2000

Pertussis was a major cause of morbidity and mortality among infants and children in the United States during the prevaccine era (i.e., before the mid-1940s). Following the introduction and widespread use of whole-cell pertussis vaccine combined with diphtheria and tetanus toxoids (DTP) among infants and children in the late 1940s, the incidence of reported pertussis declined to a historic low of 1,010 cases in 1976 (Figure 1). However, since the early 1980s, reported pertussis incidence has increased cyclically with peaks occurring every 3-4 years. In 1996, less reactogenic acellular pertussis vaccines (DTaP) were licensed and recommended for routine use among infants. This report summarizes national surveillance data for pertussis during 1997-2000 and assesses the effectiveness of pertussis vaccination in the United States during this period. The findings indicate that pertussis incidence continues to increase in infants too young to receive 3 doses of pertussis-containing vaccine and in adolescents and adults. Prevention efforts should be directed at maintaining high vaccination rates and managing pertussis cases and outbreaks.     

Changing patterns of ischaemic heart disease mortality in New Jersey 1968-1982, and the relationship with urbanization

Geographical variations in the declining rates of ischaemic heart disease (IHD) mortality may provide clues about various environmental risk factors responsible as a mass influence on the population IHD rate. The rate of IHD decline in 18 of 21 NJ counties was 2 to 45% less than the USA national rate of decline. The overall decline of IHD mortality in New Jersey (NJ) counties lagged significantly (p less than 0.05 to p less than 0.0003) behind the national trend. Age-adjusted mortality rate (AAMR) for IHD in NJ's 21 counties were 4% to 56% higher than the US rates. The IHD mortality rate of 14 of 21 NJ, counties and the entire state were significantly (p less than 0.005 to p less than 0.000001) above the US rate. Highly urbanized, industrialized, and densely populated NJ counties had the highest IHD rates. In these highly urbanized, industrialized and overcrowded NJ counties the AAMR for IHD was significantly higher and the IHD decline was significantly lower than that in the US. There was a significant (p less than 0.02 to p less than 0.00001) inverse association between annual per capita income and IHD rates. These data suggest that a high degree of urbanization, extensive industrialization, high population density and low socioeconomic status were acting as mass influences on the NJ population IHD rate.     

Enterovirus surveillance--United States, 2000-2001

Enteroviruses are common viruses associated with diverse clinical manifestations ranging from mild febrile illness to severe and potentially fatal syndromes including aseptic meningitis, encephalitis, neonatal systemic enteroviral disease, and paralytic poliomyelitis. A total of 64 enterovirus serotypes are recognized, including 61 nonpolio enteroviruses. Individual serotypes have different temporal patterns of circulation and often are associated with different clinical manifestations. This report describes temporal trends in reported enterovirus infections in the United States during 2000-2001, including widespread activity of two serotypes (echoviruses 13 and 18) that previously were detected rarely. Monitoring of circulating enterovirus serotypes helped identify these two agents as the primary causes of aseptic meningitis outbreaks in the United States in 2001. Further improvements in timeliness of reporting and geographic representation of the system are needed to allow more complete surveillance for enteroviruses.     

Iron deficiency--United States, 1999-2000

Iron deficiency, the most common nutritional deficiency worldwide, has negative effects on work capacity and on motor and mental development in infants, children, and adolescents, and maternal iron deficiency anemia might cause low birthweight and preterm delivery. Although iron deficiency is more common in developing countries, a significant prevalence was observed in the United States during the early 1990s among certain populations, such as toddlers and females of childbearing age. One of the national health objectives for 2010 is to reduce iron deficiency in these vulnerable populations by 3-4 percentage points (objective no. 19-12). CDC has published recommendations to prevent iron deficiency in the United States. To characterize the iron status of persons in the United States, CDC calculated the prevalence of iron deficiency and iron deficiency anemia by applying a multiple-indicator model to data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES 1999-2000). These values were compared with those observed in the third National Health and Nutrition Examination Survey (NHANES III [1988-1994]) using the same multiple-indicator model. This report summarizes the results of this analysis, which indicate that iron deficiency remains 2-5 percentage points above the 2010 national health objectives. To prevent iron deficiency, vulnerable populations should be encouraged to eat iron-rich foods and breast-feed or use iron-fortified formula for infants.     

Changing patterns in health behaviors and risk factors related to chronic diseases, 1990-2000

PURPOSE: Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. DESIGN: Stratified cross-sectional design. SETTING: United States. SUBJECTS: 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. MEASURES: Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. RESULTS: Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%-36% current smokers among white women and men), the largest increases in smoking (10%-12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%-9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high levels of sedentary behavior (approximately 20%-30%) and low vegetable or fruit intake (approximately 35%-50%). In contrast, older Hispanic women and men and older black men, ages 65 to 74, showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women), largest decreases in sedentary behavior (Hispanic women and black men), and largest increases in vegetable or fruit intake (Hispanic women and men, and black men). CONCLUSION: The poor and worsening health profile of young women and men is a particular concern, as they will soon enter the ages of high chronic disease burden.     

Changing patterns of low birthweight and preterm birth in the United States, 1981-98

Low birthweight (LBW) and preterm birth are primary risk factors for infant morbidity and mortality in the US. With increasing multiple births and delayed childbearing, it is important to examine the separate contributions of these characteristics to the increases in LBW and preterm birth rates. US natality records from 1981, 1990 and 1998 were used to calculate LBW (% births <1500, 1500-2499, <2500 g) and preterm (% births <29, 29-32, 33-36, <37 weeks gestation) rates. Data were stratified by maternal race (black or white) and plurality (singleton vs. multiple birth). LBW and preterm rates among singletons were adjusted for maternal age to examine the influence of demographic shifts on LBW trends. From 1981 to 1998, LBW increased 12% among white infants, but remained relatively stable among black infants. During the same time, preterm birth increased 23% among white infants compared with 3% among black infants. For both black and white infants, the increase in LBW and preterm births was greater among multiple births than among singletons. Adjustment for maternal age did not reduce the temporal increase in LBW or preterm birth among singletons. Black infants continue to experience a markedly higher incidence of LBW and preterm birth, but the racial gap in these outcomes has narrowed slightly in recent years as a result of increasing LBW and preterm birth among white births. The differing trends for white and black infants are the consequence of a disparate trend in the incidence and outcome of multiple births coupled with increases in LBW and preterm birth among white singletons. Understanding the differential patterns in birth outcomes among white and black infants is necessary to develop effective interventions designed to decrease racial disparities in pregnancy outcome.     

Silicosis mortality, prevention, and control--United States, 1968-2002

Silicosis is a preventable occupational lung disease caused by inhaling dust containing crystalline silica; no effective treatment for silicosis is available. Deaths from inhalation of silica-containing dust can occur after a few months' exposure (1). Crystalline silica exposure and silicosis have been associated with work in mining, quarrying, tunneling, sandblasting, masonry, foundry work, glass manufacture, ceramic and pottery production, cement and concrete production, and work with certain materials in dental laboratories. To describe patterns of silicosis mortality in the United States, CDC analyzed data from the National Institute for Occupational Safety and Health (NIOSH) National Occupational Respiratory Mortality System (NORMS) for 1968-2002. This report summarizes the results of that analysis, which indicated a decline in silicosis mortality during 1968-2002 and suggested that progress has been made in reducing the incidence of silicosis in the United States. However, silicosis deaths and new cases still occur, even in young workers. Because no effective treatment for silicosis is available, effective control of exposure to crystalline silica in the workplace is crucial.     

Influenza activity--United States, 1999-2000 season

Influenza activity was low during October 3-November 6, 1999; influenza virus isolates were reported from 30 states, and four long-term-care facility outbreaks were reported from three states. The predominant viruses isolated were influenza type A(H3N2) viruses. This report summarizes influenza activity in the United States during October 3-November 6, 1999. It also summarizes U.S. influenza surveillance methodology, including the four primary sources of surveillance data, a modification to pneumonia and influenza (P&I) mortality reporting, and discusses detection and control of institutional influenza outbreaks.     

Influenza activity--United States, 2000-01 season

This report summarizes influenza activity in the United States during October 1-November 25, 2000 (1). Influenza activity was low during this period, and influenza virus isolates were reported from 11 states. The viruses most frequently isolated were influenza A (H1N1) and were well matched by the 2000-01 influenza vaccine strain.