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Perspectives in Disease Prevention and Health Promotion Premature Mortality in New Hampshire

The New Hampshire Division of Public Health Services has analyzed mortality data on deaths occurring in New Hampshire from 1980 through 1985 to determine the adequacy of current prevention and control activities and to identify possible gaps in public health services. These data were analyzed using three measures: 1) rates of years of potential life lost (YPLL) before age 65, 2) premature mortality rates (deaths occurring before age 65), and 3) crude mortality rates. YPLL were calculated using the CDC methodology (1). Sex-specific YPLL rates for 12 major causes of death were derived and compared with national rates. Age-adjustment was performed by the direct method using the 1982 U.S. white population* as the standard.

From 1980 through 1985, New Hampshire residents had a total of 242,478 YPLL, or an average yearly total of 40,413 YPLL. Unintentional injuries were the leading cause and accounted for 21% of the total YPLL, followed by malignant neoplasms (18%), heart disease (15%), suicides and homicides (8%), congenital anomalies (7%), and other causes (31%) (Table 1). Males accounted for 65% of the total YPLL. YPLL rates for males were higher than those for females for all causes except malignant neoplasms, for which the rates were similar. The New Hampshire age-adjusted YPLL rate for all causes of death combined was 8% lower than the national rate. However, cause-specific YPLL rates exceeded national rates for pneumonia and influenza, sudden infant death syndrome, and chronic obstructive lung disease. In New Hampshire, males lose 11% more years of potential life from diabetes than men in the general U.S. population, and females lose 25% more years of potential life from pneumonia and influenza than females in the general population. The rankings of the 12 leading causes of death, based on YPLL and premature and crude mortality rates, differed considerably (Table 2). Reported by: E Schwartz, MD, MPH, State Epidemiologist, and staff, New Hampshire State Dept of Health and Welfare. Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Crude and age-adjusted mortality data have traditionally been used as a yardstick to evaluate the importance of public health problems. These measures count each death equally, independent of the age of the decedent. However, since most deaths occur among older individuals, crude and age-adjusted mortality data reflect diseases of the elderly. Measures based on premature deaths or YPLL emphasize causes of death that affect younger individuals during their early, productive years and, thus, provide a different view of a population's mortality burden. Since 1982, national data regarding premature mortality have been published by CDC, and statewide analyses have recently been reported (1-3).

In New Hampshire, as in the rest of the country, the leading causes of YPLL include injuries, malignant neoplasms, and heart disease. An estimated two-thirds of the deaths in the United States are attributable to a preventable precursor and are thus premature (4). A recent study revealed that six precursors of premature death (use of tobacco, use of alcohol, injury risks, high blood pressure, overweight, and gaps in primary prevention) accounted for 75% of all YPLL nationally (4). The challenge to further reduce the current burden of unnecessary morbidity and mortality will require traditional as well as innovative measures designed to modify these precursors (5).

The choice of an epidemiologic measure suitable for public health planning depends on the goals of decision-makers. If the goal of public health programs is to reduce premature mortality, prevention and control efforts should focus on the leading causes of YPLL. Alternatively, if the goal is to achieve a more uniform overall mortality pattern, efforts should be targeted at causes or populations with elevated mortality rate ratios. Thus, epidemiologic data can form the basis for setting public health priorities. However, the choice of epidemiologic indicators may have a substantial bearing on the focus of the public health agenda (5).


  1. Centers for Disease Control. Premature mortality in the United States: public health issues in the use of years of potential life lost. MMWR 1986;35(suppl 2S):2S-3S.

  2. Centers for Disease Control. Introduction to Table V: premature deaths, monthly mortality, and monthly physician contacts--United States. MMWR 1982;31:109-10.

  3. Centers for Disease Control. Premature mortality in West Virginia, 1978-1982. MMWR 1987; 36:30.

  4. Amler RW, Dull HB, eds. Closing the gap: the burden of unnecessary illness. New York: Oxford University Press, 1987:181.

  5. Centers for Disease Control. Positioning for prevention: an analytical framework and background document for chronic disease activities. Atlanta: US Department of Health and Human Services, Public Health Service, 1986. *The population of New Hampshire is 98.9% white, according to 1980 Bureau of the Census data.

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