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Atlas Reveals New Mortality Patterns for the United States
The first atlas to map the leading causes of death by race and sex for small geographic areas throughout the United States has identified high risk areas for heart disease, cancer, stroke and violence deaths in America, the Department of Health and Human Services (HHS) announced today. "Atlas of United States Mortality," developed by the Centers for Disease Control and Prevention's National Center for Health Statistics, reveals shifts from previously documented mortality patterns and points to new areas now at greater risk.
"The mortality atlas is truly a road map to better understanding the differential
patterns of mortality in this country," said HHS Secretary Donna E. Shalala. "For
the first time we have a compendium of maps for all leading causes of death which pinpoint
problem areas so that national, state and local efforts can be coordinated and targeted.
The atlas maps death rates for 198892 for 805 Health Service Areas (HSA), which are
clusters of counties defined on the basis of where county residents obtain hospital care. This
approach provides much more local detail than maps of states and allows a more reliable
analysis than could be performed at the county level, especially in sparsely populated areas.
Key findings show important geographic patterns or shifts in the three top causes of death
-- heart disease, cancer and stroke.
Death rates for heart disease, the nation's leading cause of death, are higher in the
southeastern United States than in the northeastern states -- previously the region with the
highest rates. While heart disease death rates have dropped in all areas for more than 30
years, rates in northeastern states have declined faster than in the Southeast, leaving the
southeastern states with relatively high rates today.
Cancer is the second leading cause of death, and the atlas maps death rates for several
major cancer sites -- lung, breast, prostate and colorectal. Lung cancer has been the leading
cause of cancer deaths in men for several decades, and during that time high rates for black
men were concentrated in urban centers, while rates for white men were highest along the
Mississippi River and the south Atlantic coast. Now, for white men, the cluster of high rates
extends into the Ohio River Valley, and rates for black men are highest in the southeastern
For women the lung cancer mortality pattern has been similar to that for men, but a cluster
of high rates for white women appeared in the Pacific States about 20 years ago. The western
cluster of high rates among white females now encompasses the entire Pacific region and
portions of the Mountain region, and appears to be limited to older women.
Prostate cancer is primarily a disease of older men. For older white men rates are highest
along the Canadian border in the upper north central states; for black men high rates are
found along the south Atlantic coast.
The stroke belt -- a band of southeastern states (excluding Florida) with high stroke death
rates -- has dispersed, with rates dropping in this area and high rates now found to the north
and west of the original cluster. Stroke is the third leading cause of death.
HIV death rates are highest in States on both the East and West Coasts and in nearly every
urban area of the United States.
Homicide, suicide and motor vehicle injury deaths are also major public health problems
with well-defined geographic patterns. For example, homicide rates are high for young black
adults in urban areas but for young white men the high rates are in the south and southwestern
states. Among whites, suicide rates are highest in the western states and in nonmetropolitan
areas throughout the country. For young adults, motor vehicle death rates are higher in the
southeastern states and generally in less densely populated areas.
"The atlas is an excellent prevention tool," said CDC Director Dr. David Satcher.
"The atlas offers clues to the relationship and the impact of behavioral, environmental,
genetic, and demographic factors and points to promising areas for additional, in-depth
research or where prevention and intervention activities should be focused," he said.
The atlas can be used to determine the rate of an individual area; discern clusters of
areas with similar rates; visualize broad geographic patterns; and compare regional
differences by age, race and sex for each cause of death.
The research underlying the atlas has resulted in improved statistical methods for modeling
death rates and innovative presentation formats for maps and graphics, according to Dr. Edward
J. Sondik, NCHS Director. To determine the best way to present the information in the most
understandable format, NCHS conducted numerous studies to evaluate how people interpret maps
and selected the final format, based on these studies.
In addition to maps with age-adjusted death rates for each HSA, the atlas includes maps
which show the statistical significance of the difference of each HSA rate to the national
rate, generalized maps which show the broad regional patterns for selected ages (40 and 70 for
diseases and 20 and 70 for injuries), and a chart with regional rates for each cause of death.
The causes included in this atlas account for more than 80 percent of all deaths in the
United States. The atlas maps death rates for heart disease, all cancer, lung cancer,
colorectal cancer, prostate cancer, breast cancer, stroke, unintentional injuries, motor
vehicle injuries, chronic obstructive pulmonary disease, pneumonia and influenza, diabetes,
suicide, firearm suicide, liver disease, HIV, homicide, firearm homicide and a total of all
The "Atlas of United States Mortality," by Linda Williams Pickle, Michael Mungiole, Gretchen K. Jones, and Andrew A. White, is available from the National Center for Health Statistics, 6525 Belcrest Road, Hyattsville, MD.
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