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Changes in Premature Mortality -- New York City

Between 1982 and 1984, major changes occurred in mortality patterns of New York City residents aged 15-64 years. Among males in the study group, the mortality rate increased 4%, from 657 to 683 deaths per 100,000 population, and the total years of potential life lost before age 65 years (YPLL) increased 7%. Among females, the mortality rate increased 1%, from 329 to 333/100,000, and the YPLL increased 5%. Before 1982, mortality rates and YPLL had steadily declined for at least 7 years.

The underlying causes of death were classified according to the International Classification of Diseases, 9th Revision (ICD-9), with the exception of acquired immunodeficiency syndrome (AIDS) (Table 1). The classification of AIDS required either a death certificate with the underlying cause of death listed as AIDS (code 279.1) or a death certificate that matched the New York City AIDS surveillance registry. For both sexes, the largest increases in YPLL were due to AIDS and to pneumonia and influenza (P&I). Among males, there was a 14% increase in YPLL due to cerebrovascular disease; and among females, a 5% decrease. Large decreases in YPLL were due to external causes of death: for men, a 14% decrease due to homicide and suicide and a 19% decrease due to accidents; for women, a 4% increase due to homicide and suicide and a 34% decrease due to accidents. Other leading causes of YPLL did not change markedly.

The main difference between the leading causes of death in 1984 and 1982 is the addition of AIDS. Since 1980, AIDS has become the sixth leading cause of YPLL for women in New York City and the fourth leading cause for men. In 1984, AIDS was the underlying cause of death for 923 men and 132 women, accounting for 10% and 4%, respectively, of premature mortality in New York City (Figure 1). Reported by A Kristal, DrPH, Office of Epidemiologic Surveillance and Statistics, Bureau of Preventable Diseases, New York City Dept of Health; Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office, AIDS Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: YPLL highlights premature deaths compared with measures of crude mortality by giving greater weight to deaths occurring in younger age groups (1). YPLL can be used at the community or state level to identify localized patterns of premature mortality and to quantify the relative local importance of individual causes of mortality. Differences in sex- and race-specific rates of YPLL may also distinguish particular population subgroups at increased risk of premature death.

The relative ranking of specific causes of premature mortality in the United States as a whole differs markedly from that of New York City, but the increasing importance of AIDS is evident in national data. Information from AIDS cases reported to CDC indicates about 11,000 years of potential life lost in the United States due to AIDS in 1982, 34,000 in 1983, and 74,000 in 1984. Although AIDS was not one of the top 15 causes of premature mortality nationally in 1984, it may emerge as a leading cause in 1985 if present patterns of YPLL for other causes remain constant and YPLL were to double along with case projections.

The decreases in YPLL due to unintentional injuries and suicide/homicide are consistent with trends in national data, with injuries decreasing 5% and suicide/homicide decreasing 7% from 1982 to 1984. YPLL from cerebrovascular diseases, however, has increased 1% from 1982 to 1984.

The cause of the increase in YPLL due to P&I is uncertain but may in part be related to AIDS. Although Pneumocystis carinii pneumonia (which meets the CDC AIDS case definition) is not included in the ICD-9 rubric used to specify the P&I category, unspecified pneumonia would be included and may reflect undiagnosed or unreported AIDS cases. Continued study will be necessary to clarify the cause of this increase in YPLL associated with P&I.

Reference

  1. CDC. Changes in premature mortality--United States, 1982-1983. MMWR 1985;34:17-8.

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