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Notice to Readers Introduction to Table V Premature Deaths, Monthly Mortality, and Monthly Physician Contacts -- United States

Beginning with this issue, a new table will appear monthly in the MMWR: "Table V. Potential Years of Life Lost, Deaths, and Death Rates, by Cause of Death, and Estimated Number of Physician Contacts, by Principal Diagnosis" (see page 117). By displaying a variety of measures that gauge the importance and relative magnitude of certain public health issues, this table will call attention to those issues where strategies for prevention are needed. Publication of this table reflects CDC's increased responsibility for promoting action to reduce unnecessary morbidity and premature mortality and continues the MMWR's tradition of disseminating public health information to its readership.

Further improvements in health can be achieved through actions taken by individuals as well as by administrators in the public and private sectors to promote a safer and healthier environment (1). To this end, the new table provides information regarding areas that provide the greatest potential for health improvement.

Causes of death are listed in Table V in descending order of the potential years of lost life that are attributed to each cause. In 1980, heart disease, cancer, and cerebrovascular disease accounted for 67.9% of all deaths in the United States; motor-vehicle and other accidents, suicide, and homicide accounted for 8.1% (2). In terms of age at the time of death, the relative importance of causes of death changes remarkably; motor-vehicle and other accidents, suicide, and homicide accounted for 40.8% of the total years of life lost prematurely (before age 65 years); and heart disease, cancer, and cerebrovascular disease accounted for 37.2%.

"Potential years of life lost before age 65" in the table is estimated for persons between 1 year and 65 years old at the time of death and is derived by multiplying the annual number of deaths in each age category by the difference between 65 years and the age at the mid-point of each category. If deaths of persons older than 65 years were included, greater weight would be given to natural causes of death, and premature and preventable causes of death would no longer be distinguishable. If deaths of persons younger than 1 year were included, causes of death affecting this age group would be weighted heavily and would therefore contribute a disproportionately large share of potential years of life lost. However, "Infant mortality" in the table is a measure of deaths occurring in this age group and "Prenatal care" reflects efforts to prevent death in this group.

Cause-specific mortality rates, published in the Monthly_Vital_ Statistics_Report by the National Center for Health Statistics, are estimated from a systematic sample of 10% of death certificates received in state vital statistics offices during a 1-month period using the underlying cause of death recorded on the certificate. Because complete information concerning the underlying cause of death is not available when the sample is taken, estimates for certain causes are biased in the monthly sample but then are corrected when annual estimates are made. The estimated number of deaths each month is obtained by multiplying the corresponding estimated mortality rate, which is computed on an annual basis, by the provisional population estimate for the United States and then dividing by the number of days for that month as a proportion of the total days in the year.

The measure for morbidity is obtained from the National Disease and Therapeutic Index (NDTI), a random sample of data from office-based physicians in 19 major specialties in the continental United States. Each physician in the sample records all his contacts with private patients for 2 consecutive days each quarter. These contacts comprise telephone calls (7% of total in 1981); office visits (68%); and patients visited by the physician in hospitals (22%), nursing homes (1%), and their own homes (1%). As a result, this measure gives greater weight to those diseases that prompt a visit to a private physician or require hospitalization. When the physician cannot make a diagnosis at the time of the visit, the suspected diagnosis or presenting symptom is recorded. Although misclassification might occur, the potential for this bias is reduced by using broad categories in the table.

Publication of Table V is an effort to use measures of morbidity and mortality as reminders of the impact on public health of some of these preventable problems. However, when data are summarized, their complexity and detail are sacrificed; and when information is simplified, although the overall effect may be clarified, subtle issues may be obscured. Therefore, a series of articles exploring different aspects of preventable problems will be published in the MMWR to complement this table . These articles will present more detailed analysis of what is known about health status indicators, risk factors, and other factors affecting public health.

References

  1. Healthy People, The Surgeon General's Report on Health Promotion and Disease Prevention, 1979. Public Health Service, Office the Assistant Secretary for Health and Surgeon General, DHEW (PHS) Publication No. 79-55071.

  2. National Center for Health Statistics. Monthly Vital Statistics Report, Vol. 29, No. 13, September 17, 1981.



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