Deaths from cysticercosis, United States

Cysticercosis has emerged as a cause of severe neurologic disease in the United States. We evaluated cysticercosis-related deaths in the United States for 1990-2002 by race, sex, age, state of residence, country of birth, and year of death. A total of 221 cysticercosis deaths were identified. Mortality rates were highest for Latinos (adjusted rate ratio [ARR] 94.5, relative to whites) and men (ARR = 1.8). The mean age at death was 40.5 years (range 2-88). Most patients (187 [84.6%]) were foreign born, and 137 (62%) had emigrated from Mexico. The 33 US-born persons who died of cysticercosis represented 15% of all cysticercosis-related deaths. The cysticercosis mortality rate was highest in California, which accounted for = 60% of all deaths. Although uncommon, cysticercosis is a cause of premature death in the United States. Fatal cysticercosis affected mainly immigrants from Mexico and other Latin American countries; however, US-born persons were also affected.     

Atrial fibrillation as a contributing cause of death and Medicare hospitalization--United States, 1999

Stroke is the leading cause in the United States of serious long-term disability and the third leading cause of death. One of the major risk factors for stroke is atrial fibrillation (AF), a common cardiac disorder characterized by cardiac arrhythmia and the absence of coordinated contractions, which increases the risk for blood stasis, clot formation, and embolic stroke. AF affects approximately 2.2 million adults in the United States and is the most common sustained heart rhythm disturbance observed in clinical practice. The rate of AF increases with age, from < 1% among persons aged < 60 years to approximately 10% among persons aged > or = 80 years. The frequency with which AF is reported on death certificates as a contributing cause of death has increased since 1980. To assess the burden of AF-related deaths and hospitalizations among U.S. residents, CDC analyzed national and state multiple-cause mortality statistics and Medicare hospital claims for persons with AF in 1999 (the latest year for which data were available) for the 50 states and the District of Columbia. The findings indicate that AF as a contributing cause of death and hospitalization affects primarily persons aged > or = 75 years and that death and hospitalization rates vary by state. Public and medical education are needed to prevent and reduce AF-related disability and death.     

Motor vehicle crash deaths in metropolitan areas--United States, 2009

Although rates have declined in recent years, motor vehicle crashes (MVCs) remain a leading cause of injury death in the United States. In 2009, a total of 34,485 MVC deaths were reported among U.S. residents, and 22% of those who died were aged 15-24 years. MVCs were the leading cause of death for that age group, which represents approximately 14% of the total U.S. population. To assess patterns in MVC death rates for persons of all ages and for those aged 15-24 years, in recognition of the elevated risk for this age group, CDC used data from the National Vital Statistics System (NVSS) and the U.S. Census Bureau for 2009 representing the 50 most populous U.S. metropolitan statistical areas (MSAs). The overall MVC death rate (age-adjusted) for all 50 MSAs combined was 8.2 per 100,000 residents, compared with a national rate of 11.1; among MSAs, rates ranged from 4.4 to 17.8. For persons aged 15-24 years, the MVC death rate was 13.0 per 100,000 residents for all MSAs combined (range: 7.3-25.8), compared with a national rate of 17.3. Although rates for the MSAs generally were lower than the rate for the nation as a whole, higher rates for persons aged 15-24 years were observed both in the MSAs and nationally. The wide variation in rates among MSAs suggests a need to better understand how urban development patterns might relate to MVC deaths and to identify and implement effective strategies to reduce the number of such deaths.     

Preface: The Role of the Epidemiologist in Injury Prevention and Control--An Unmet Challenge

More young people in the United States aged 1–34 yearsdie from injuries than from all other causes of death combined.Injuries, the fourth leading cause of death, kill nearly 150,000US residents each year (1). They account for approximately 25percent of all premature deaths before age 65 years in thiscountry, 10 times the number of premature deaths from the humanimmunodeficiency virus. As outlined by Segui-Gomez and MacKenzie(2)     

Injury mortality among non-US residents in the United States 1979-1984

More than 20 million non-US residents visit the United States each year. Data on deaths in this country among these non-US residents were obtained from US vital records. These data showed that from 1979 through 1984, 17,988 deaths occurred. Cardiovascular disease (International Classification of Diseases [ICD-9] 390-459) was the leading cause of death among non-residents. Injuries (ICD-9 E800-E999) ranked second as a cause of death and accounted for 23% of the deaths (4078). More than half of these injury deaths occurred among people aged 15-34 years and 79% of the people who died from injuries were males. The most frequent causes of injury deaths were motor vehicle traffic crashes (37%), drownings (15%), and homicides (11%). Although general patterns of injury mortality among non-US residents and US residents were similar, there were differences in the proportion of deaths due to homicides, drownings, and falls. Prevention efforts targeted to the major causes of injury mortality in the US will affect both US and non-US residents.     

Mortality among young immigrants to California: injury compared to disease deaths

According to a variety of indicators, immigrants are in better health than the U.S.-born population. Little research, however, has investigated foreign- and U.S.-born differentials in mortality. We investigated adolescent and young adult immigrants' risk of death due to disease and injury, the leading cause of death of young persons in the United States. The death certificates of 15- to 34-year-old California residents who died from 1989 through 1993 comprised the study population. Disease and injury deaths were identified using ICD-9 codes on the California Master Mortality data files. Frequencies and gender-standardized rates and risk ratios were calculated by nativity (U.S., non-U.S.) and by ethnicity and nativity. Immigrants are represented appropriately in unintentional injury deaths but underrepresented in suicides and overrepresented in homicides among 15- to 34-year-old California residents. Hispanics appear to account for the foreign- and U.S.-born differences in suicide and homicide. By contrast, immigrants constitute a lower proportion of disease deaths than expected. Empirical data about health risks to immigrants are needed to develop informed policy. These data indicate that young immigrants, at least in terms of mortality, do not constitute a burden in that they are at lower or similar risk of death than U.S.-born youth. Homicide is the sole exception to this pattern.     

Epidemiology of salmonellosis in California, 1990-1999: morbidity,mortality, and hospitalization costs

Salmonella is a common cause of bacterial foodborne illness in the United States. The epidemiology and costs of nontyphoidal salmonellosis in California from 1990 through 1999 are described using surveillance, hospitalization, and death data. Trends in Salmonella rates and factors associated with prolonged hospitalization were evaluated using Poisson and linear regression models, respectively. There were 56,660 reported cases, 11,102 hospitalizations, and 74 deaths attributed to Samonella. Reported case and hospital discharge rates have decreased since 1996. Among reported cases, infants had the highest rate (121 cases per 10(5) person-years), followed by children 1-4 years of age (40 cases per 10(5) person-years). The highest hospitalization rates were among the elderly and young children. Most deaths occurred among persons aged 65 or more years (59%). Among hospitalizations, gastroenteritis (61%) and septicemia (23%) were the most common Salmonella diagnoses. Salmonella pneumonia patients were the oldest (median age, 55 years) and Salmonella meningitis patients the youngest (median age, 0.3 years). These two diagnoses were the costliest, approaching 30,000 dollars (median) per hospitalization. Having an acquired immunodeficiency syndrome diagnosis or multiple Salmonella diagnoses was independently associated with prolonged hospitalization. The estimated 10-year hospitalization costs for Salmonella were $200 million. Salmonellosis is a costly disease that disproportionately affects the young and elderly.     

Electronic record linkage to identify deaths among persons with AIDS--District of Columbia, 2000-2005

An estimated 1 million persons in the United States are living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS); approximately 500,000 persons with AIDS have died since 1981. In 2005, the District of Columbia (DC) had an estimated adult AIDS prevalence rate of 2%, one of the highest AIDS prevalence rates in the United States. Accurate death ascertainment is an important part of HIV/AIDS surveillance. Manual methods can substantially underestimate deaths by missing death certificates that do not mention HIV infection or deaths of residents that occur in other states. CDC and the Council of State and Territorial Epidemiologists (CSTE) recommend performing electronic record linkages to ascertain deaths annually as part of routine HIV/AIDS surveillance activities. In 2007, to identify all deaths that occurred during 2000-2005 among persons with AIDS who resided or received their diagnosis in DC, the HIV/AIDS Administration of the DC Department of Health, with assistance from CDC, performed an electronic record linkage. This report summarizes the results of that linkage, which determined that 54% of deaths among persons with AIDS had not been reported previously to the DC HIV/AIDS Reporting System (HARS). The results indicated that electronic record linkage for death ascertainment is necessary to more accurately estimate the prevalence of persons living with HIV/AIDS.     

Unintentional injuries in the home in the United States Part I: mortality

BACKGROUND: Unintentional injuries are a leading cause of death in the United States. It is unclear, however, what proportion of these injuries occur in the home. The purpose of this paper is to quantify and describe fatal unintentional injuries that take place in the home environment. METHODS: Data from the National Vital Statistics System (NVSS) were used to calculate average annual rates for unintentional home injury deaths, with 95% confidence intervals from 1992 to 1999 for the United States overall, and by mechanism of injury, gender, and age group. RESULTS: From 1992 to 1999, an average of 18,048 unintentional home injury deaths occurred annually in the United States (6.83 deaths per 100,000). Home injury deaths varied by age and gender, with males having higher rates of home injury death than females (8.78 vs 4.97 per 100,000), and older adults (>/=70 years) having higher rates than all other age groups. Falls (2.25 per 100,000), poisoning (1.83 per 100,000), and fire/burn injuries (1.29 per 100,000) were the leading causes of home injury death. Rates of fall death were highest for older adults, poisoning deaths were highest among middle-aged adults, and fire/burn death rates were highest among children. Inhalation/suffocation and drowning deaths were important injury issues for young children. CONCLUSIONS: Unintentional injury in the home is a significant problem. Specific home injury issues include falls among older adults, poisonings among middle-aged adults, fire/burn injuries among older adults and children, and inhalation/suffocation and drowning among young children. In addition, recommendations are presented for improvements to the NVSS.     

Alcohol-attributable deaths and years of potential life lost among American Indians and Alaska Natives--United States, 2001--2005

Excessive alcohol consumption is a leading preventable cause of death in the United States and has substantial public health impact on American Indian and Alaska Native (AI/AN) populations. To estimate the average annual number of alcohol-attributable deaths (AADs) and years of potential life lost (YPLLs) among AI/ANs in the United States, CDC analyzed 2001-2005 data (the most recent data available), using death certificate data and CDC Alcohol-Related Disease Impact (ARDI) software. This report summarizes the results of that analysis, which indicated that AADs accounted for 11.7% of all AI/AN deaths, that the age-adjusted AAD rate for AI/ANs was approximately twice that of the U.S. general population, and that AI/ANs lose 6.4 more years of potential life per AAD compared with persons in the U.S. general population (36.3 versus 29.9 years). These findings underscore the importance of implementing effective population-based interventions to prevent excessive alcohol consumption and to reduce alcohol-attributable morbidity and mortality among AI/ANs.     

Vital Signs: Avoidable Deaths from Heart Disease,Stroke, and Hypertensive Disease — United States, 2001–2010

Background

Deaths attributed to lack of preventive health care or timely and effective medical care can be considered avoidable. In this report, avoidable causes of death are either preventable, as in preventing cardiovascular events by addressing risk factors, or treatable, as in treating conditions once they have occurred. Although various definitions for avoidable deaths exist, studies have consistently demonstrated high rates in the United States. Cardiovascular disease is the leading cause of U.S. deaths (approximately 800,000 per year) and many of them (e.g., heart disease, stroke, and hypertensive deaths among persons aged <75 years) are potentially avoidable.

Methods

National Vital Statistics System mortality data for the period 2001–2010 were analyzed. Avoidable deaths were defined as those resulting from an underlying cause of heart disease (ischemic or chronic rheumatic), stroke, or hypertensive disease in decedents aged <75 years. Rates and trends by age, sex, race/ethnicity, and place were calculated.

Results

In 2010, an estimated 200,070 avoidable deaths from heart disease, stroke, and hypertensive disease occurred in the United States, 56% of which occurred among persons aged <65 years. The overall age-standardized death rate was 60.7 per 100,000. Rates were highest in the 65–74 years age group, among males, among non-Hispanic blacks, and in the South. During 2001–2010, the overall rate declined 29%, and rates of decline varied by age.

Conclusions

Nearly one fourth of all cardiovascular disease deaths are avoidable. These deaths disproportionately occurred among non-Hispanic blacks and residents of the South. Persons aged <65 years had lower rates than those aged 65–74 years but still accounted for a considerable share of avoidable deaths and demonstrated less improvement.

Implications for Public Health Practice

National, state, and local initiatives aimed at improving health-care systems and supporting healthy behaviors are essential to reducing avoidable heart disease, stroke, and hypertensive disease deaths. Strategies include promoting the ABCS (aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation), reducing sodium consumption, and creating healthy environments.     

State-specific unintentional-injury deaths--United States, 1999-2004

Deaths from unintentional injuries account for approximately two thirds of deaths from all injuries in the United States. Among persons aged 1-44 years, unintentional injuries are the leading cause of death and the leading cause of potential years of life lost before age 65 years. A Healthy People 2010 national objective calls for reducing the rate of deaths caused by unintentional injuries to 17.5 per 100,000 population from a baseline of 35.0 in 1998 (objective 15-13). A second objective calls for reducing the rate of deaths caused by unintentional injuries involving motor-vehicle traffic to 9.2 per 100,000 population from a 1998 baseline of 15.6 (objective 15-15). To determine the progress of states toward meeting these objectives, CDC analyzed vital statistics data for the period 1999-2004. This report summarizes the results of that analysis, which determined that, as of 2004, none of the states had achieved the first Healthy People 2010 objective, and four states and the District of Columbia (DC) had achieved the second. From 1999 to 2004, a total of 13 states reduced their unintentional-injury death rates, and 19 states reduced their motor-vehicle--traffic death rates. Overall in the United States, the rate of deaths caused by unintentional injuries increased 7%, from 35.3 per 100,000 population in 1999 to 37.7 in 2004. These findings underscore the need for states to continue to develop, implement, and evaluate injury-prevention programs and policies to reduce the number of deaths from unintentional injuries.     

Vital Signs: Alcohol Poisoning Deaths — United States, 2010–2012

Background

Alcohol poisoning is typically caused by binge drinking at high intensity (i.e., consuming a very large amount of alcohol during an episode of binge drinking). Approximately 38 million U.S. adults report binge drinking an average of four times per month and consuming an average of eight drinks per episode.

Methods

CDC analyzed data for 2010–2012 from the National Vital Statistics System to assess average annual alcohol poisoning deaths and death rates (ICD-10 codes X45 and Y15; underlying cause of death) in the United States among persons aged ≥15 years, by sex, age group, race/ethnicity, and state.

Results

During 2010–2012, an annual average of 2,221 alcohol poisoning deaths (8.8 deaths per 1 million population) occurred among persons aged ≥15 years in the United States. Of those deaths, 1,681 (75.7%) involved adults aged 35–64 years, and 1,696 (76.4%) involved men. Although non-Hispanic whites accounted for the majority of alcohol poisoning deaths (67.5%; 1,500 deaths), the highest age-adjusted death rate was among American Indians/Alaska Natives (49.1 per 1 million). The age-adjusted rate of alcohol poisoning deaths in states ranged from 5.3 per 1 million in Alabama to 46.5 per 1 million in Alaska.

Conclusions

On average, six persons, mostly adult men, die from alcohol poisoning each day in the United States. Alcohol poisoning death rates vary substantially by state.

Implications for Public Health Practice

Evidence-based strategies for preventing excessive drinking (e.g., regulating alcohol outlet density and preventing illegal alcohol sales in retail settings) could reduce alcohol poisoning deaths by reducing the prevalence, frequency, and intensity of binge drinking.     

Work-related fatalities in the agricultural production and services sectors, 1980-1989

A total of 6,727 workers died of work-related injuries in the agricultural production and agricultural services sectors between 1980 and 1989, as established by data from the National Institute for Occupational Safety and Health (NIOSH) National Traumatic Occupational Fatalities (NTOF) surveillance system. The agricultural production sector accounted for the higher fatality rate (22.9 deaths per 100,000 workers), due largely to deaths caused by machinery and motor vehicles. The leading cause of death in the agricultural services sector was being struck by falling objects, primarily trees. Fatality rates were highest in the East South Central United States and lowest in the New England states. Blacks had the highest fatality rate (26.4 deaths per 100,000 workers) while workers other than white or black had the lowest rate (18.9 per 100,000 workers). Males were at higher risk of death than females, with the 65 years of age and older male group having the highest rate (60.5 deaths per 100,000 workers). Males 16-24 years of age exhibited the largest decrease in their average annual fatality rate during the 10-year period, down to 7.2 from 20.6 deaths per 100,000 workers. Possible reasons for this decrease are suggested.     

Disparities in deaths from stroke among persons aged <75 years--United States, 2002

Despite declines in deaths from stroke, stroke remained the third leading cause of death in the United States in 2002, and age-adjusted death rates for stroke remained higher among blacks than whites. In 1997, excess deaths from stroke occurred among persons aged <65 years in most racial/ethnic minority groups, compared with whites. A younger age distribution among Hispanics and other racial/ethnic groups compared with whites might partly explain the disproportionate burden in deaths at younger ages. To examine disparities in stroke mortality among persons aged <75 years, CDC assessed several characteristics of mortality at younger ages by using death certificate data for 2002. This report summarizes the results of that assessment. Overall, 11.9% of all stroke deaths in 2002 occurred among persons aged <65 years; the proportion of stroke decedents who were aged <65 years was higher among blacks, American Indians/Alaska Natives, and Asians/Pacific Islanders, compared with whites. In addition, the mean ages of stroke decedents were statistically significantly lower in these racial groups than among whites. Blacks had more than twice the age-specific death rates from stroke than whites aged <75 years. Approximately 3,400 excess stroke deaths would not have occurred among blacks in 2002 if blacks had had the same death rates for stroke as whites aged <65 years. Moreover, age-adjusted estimates of years of potential life lost (YPLL) before age 75 years from stroke were more than twice as high for blacks than for all other racial groups. Reducing premature death from stroke in these groups will require early prevention, detection, treatment, and control of risk factors for stroke in young and middle-aged adults.     

Maternal mortality surveillance, United States, 1979-1986

To understand further the epidemiology and causes of maternal death, the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, reviewed all identified maternal deaths in the United States, including Puerto Rico, for the period from 1979 through 1986. The maternal mortality ratio for the period was 9.1 deaths/100,000 live births. The ratios increased with age and were higher among women of black and other minority races than among white women for all age groups, particularly for women ages greater than or equal to 40 years. Unmarried women had a higher risk of death than married women. Women who had received any prenatal care had a lower risk of dying than women who had received no care (RR = 0.19, 95% confidence limits (CL) 0.15, 0.23). Women who received no prenatal care had a gestational age-adjusted risk of maternal death 5.7 times that of women receiving care defined as "adequate." The risk of maternal death increased with decreasing levels of education for all age groups, particularly among women ages greater than or equal to 35 years. The causes of death varied for different outcomes of pregnancy; pulmonary embolism was the leading cause of death following the delivery of a live birth. Future studies aimed at developing strategies to reduce the risk of maternal deaths in the United States should use enhanced surveillance and collect more information about each death, which would allow for better understanding of factors associated with maternal mortality.     

Trends in encephalitis-associated deaths in the United States

The United States national mortality statistics and HIV/AIDS surveillance data were analysed to determine trends in encephalitis-associated deaths and to assess the impact of HIV infection on those deaths during 1979-1998, a period when ICD-9 codes were used for coding deaths in the United States. A total of 25125 encephalitis deaths were reported; 4779 of them (19%) had concurrent HIV infection. Overall encephalitis death rates remained stable, but they increased for groups where HIV infection was common and declined or remained unchanged for others. For persons without HIV infection, the rates declined in all demographic groups. Encephalitis deaths in HIV-infected persons followed general trends for HIV deaths in the United States. The rates in the HIV-infected population were several hundred- to thousand-fold higher than in the HIV-uninfected population. HIV infection was largely responsible for the lack of overall decline in the considerable mortality associated with encephalitis in the United States during 1979-1998.     

Tuberculosis from Mycobacterium bovis in binational communities, United States

The epidemiology of tuberculosis (TB) in the United States is changing as the incidence of disease becomes more concentrated in foreign-born persons. Mycobacterium bovis appears to be contributing substantially to the TB incidence in some binational communities with ties to Mexico. We conducted a retrospective analysis of TB case surveillance data from the San Diego, California, region from 1994 through 2005 to estimate incidence trends, identify correlates of M. bovis disease, and evaluate risk factors for deaths during treatment. M. bovis accounted for 45% (62/138) of all culture-positive TB cases in children (<15 years of age) and 6% (203/3,153) of adult cases. M. bovis incidence increased significantly (p = 0.002) while M. tuberculosis incidence declined (p<0.001). Almost all M. bovis cases from 2001 through 2005 were in persons of Hispanic ethnicity. Persons with M. bovis were 2.55x (p = 0.01) as likely to die during treatment than those with M. tuberculosis.     

Clinical causes of death of 2372 older persons in a nursing home during 15-year follow-up

OBJECTIVE: To investigate the causes of death in older persons in a nursing home. DESIGN: The major clinical cause of death of all persons aged 60 years older residing in a nursing home during a 15-year period was investigated in a prospective study. The author carefully reviewed the major cause of death with the physicians who took care of all persons who died either in the nursing home or after transfer to a general hospital. SETTING: A large nursing home in which 2372 of 3164 older persons (75%) died during a 15-year period. PATIENTS: The 2372 persons who died included 766 men and 1606 women, mean age 81 +/- 8 years. MEASUREMENTS AND MAIN RESULTS: A total of 2372 of 3164 persons (75%) died during the 15-year period,. Seven hundred sixty-six of 1023 men (75%) and 1606 of 2141 women (75%) died (P not significant). The major cause of death in these 2372 persons was sudden cardiac death in 25%, myocardial infarction in 18%, refractory congestive heart failure in 11%, thromboembolic stroke in 6%, cerebral hemorrhage in 1%, pulmonary embolism in 2%, mesenteric vascular infarction diagnosed at surgery in 1%, peripheral vascular disease, including dissecting aneurysm of aorta and ruptured abdominal aneurysm, in <1%, pneumonia in 15%, urosepsis in 4%, bacterial endocarditis in 1%, sepsis from abdominal abscess or gastrointestinal or biliary tract in 1%, sepsis from decubiti, gangrene of lower extremity, and osteomyelitis in <1%, cancer in 9%, renal failure in 3%, gastrointestinal or liver disease in 2%, hematologic disorders in 1%, and chronic obstructive pulmonary disease in 1% of persons. CONCLUSIONS: The major cause of death of persons in the nursing home was cardiovascular disease, which accounted for 63% of deaths. The second major cause of death was infectious disease, accounting for 21% of deaths. Cancer accounted for 9% of deaths, renal failure for 3% of deaths, gastrointestinal or liver disease for 2% of deaths, hematologic disorders for 1% of deaths, and chronic obstructive pulmonary disease for 1% of deaths.