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Changes in Premature Mortality -- United States, 1983-1984

Premature mortality in the United States, as measured by years of potential life lost before age 65 (YPLL), increased from 1983 to 1984 for the first time since 1980. Total YPLL from all causes of death increased from 11,712,000 in 1983 to 11,761,000 in 1984, a 0.4% increase. The rate of YPLL per 1,000 persons under 65 years old, however, decreased by 0.4% from 1983's level to 56.5/1,000 persons. An increase of 1.5 million persons under 65 years of age accounts for this discrepancy.

The relative rankings of the leading causes of YPLL did not change substantially from 1983 to 1984. The only change was cerebrovascular diseases replacing chronic liver diseases as the eighth leading cause of YPLL. Unintentional injuries (accidents) continue to head the list, accounting for 20% of the total YPLL, followed by malignant neoplasms (15%), diseases of the heart (13%), and suicides/homicides (11%).

The rate of YPLL per 1,000 persons increased for eight of the 12 leading causes (Figure 3). The largest proportionate increase in the rate of YPLL was recorded for cerebrovascular diseases, up 13.1%. Increases in YPLL rates were also noted for prematurity, up 3.3%; sudden infant death syndrome, 2.7%; pneumonia and influenza, 2.6%; and diabetes mellitus, 1.8%. In contrast, the rate of YPLL for chronic liver diseases and cirrhosis decreased by 7.4%; diseases of the heart declined 3.6%; chronic obstructive pulmonary diseases and allied conditions, 3.3%; and malignant neoplasms, 1.3%. Reported by Epidemiologic Studies Br, Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: With this issue, CDC announces a change in the method of calculation of YPLL to include causes of mortality in the first year of life. The relatively high age-specific death rate of these infants, combined with the years of life remaining before age 65, adds two new causes to the list of leading causes of YPLL--sudden infant death syndrome (ICD code 798) and deaths attributable to prematurity, including neonatal respiratory distress syndrome (ICD code 769) and disorders relating to short gestation and unspecified low birthweight (ICD code 765). The updated Table V appears on page 27 of this issue.

The inclusion of deaths in the first year of life does not account for the increase in total YPLL from 1983 to 1984. Although total YPLL decreased each year from 1980 to 1984, the slight increase in 1984 is present when YPLL is calculated by either the birth-to-age-65-years or the age 1- to 65-years method (Figure 4). The rate of YPLL per 1,000 persons, however, has decreased each year since at least 1979 with both methods of calculation and now stands 12.3% below the 1979 level when measured from age 1 year to 65 years, and 14.1% when measured from birth to age 65 years.

Considerable variability continues to be demonstrated in the year-to-year comparison of YPLL rate due to specific causes of mortality. The rate of YPLL attributable to cerebrovascular diseases, for example, increased by 13.1% in 1984, reversing the 12.4% decline in the previous year. In contrast, the YPLL rate for unintentional injuries, which has consistently decreased from 1979 until 1984, increased by 0.4% in 1984, but remains 22.5% below the 1979 level.

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