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Years of Potential Life Lost Before Age 65 -- United States, 1990 an 1991
Years of potential life lost (YPLL) is a public health measure that reflects the impact of deaths occurring in years preceding a conventional cut-off year of age, usually 65 years. YPLL is calculated using final mortality data from CDC's National Center for Health Statistics (1) for the most recent year available, provisional mortality data (i.e., a 10% sample of deaths) (2) for the following year, and population estimates from the U.S. Census. This report summarizes final YPLL data for 1990 and provisional data for 1991.
During 1990, years of potential life lost before age 65 years (YPLL-65) totalled 12,237,379 in the United States (Table 1). Unintentional injuries accounted for the largest proportion of YPLL-65 from all causes (17.5%), followed by malignant neoplasms (15.1%), suicide/homicide (12.2%), diseases of the heart (11.2%), congenital anomalies (5.4%), and human immunodeficiency virus infection including acquired immunodeficiency syndrome (HIV/AIDS) (5.4%).
From 1989 to 1990, YPLL-65 decreased by less than 1% (Table 1). The largest percentage decreases were for prematurity (9.2%), pneumonia/influenza (4.2%), and unintentional injuries (4.1%); the largest increases were for HIV/AIDS (12.7%) and suicide/homicide (6.5%).
Based on provisional data, unintentional injuries remained the leading cause of YPLL-65 during 1991, accounting for 17.1% of all YPLL-65, followed by malignant neoplasms (15.2%), suicide/homicide (12.7%), and diseases of the heart (11.7%). HIV/AIDS, which accounted for 6.3% of all YPLL-65, replaced congenital anomalies as the fifth leading cause of YPLL-65.
Reported by: Applications Br, Div of Surveillance and Epidemiology, Epidemiology Program Office, CDC.
Editorial Note: Leading causes of death in the United States are ranked by using absolute counts of death for selected causes of death, thus giving each death a weight of 1.0. In comparison, YPLL gives a weight to each death proportionate to its distance from the arbitrarily designated age of 65 years. YPLL-65 emphasizes deaths at early ages in two ways: 1) by not including deaths occurring at ages beyond the cut-off, and 2) by giving greater computational weight to deaths among younger persons. YPLL-65 is calculated as 65 minus the middle age for each age group, times the number of deaths from a specific cause within that age group, added for all age groups to 65.
Provisional mortality estimates for selected conditions are based on a 10% sample of death certificates and are adjusted for reporting biases (e.g., provisional reporting of cause of death) (4). Because 1991 data are provisional, YPLL estimates based on 1990 final mortality data are not compared with 1991 data.
The causes of death with the largest increases in YPLL-65 from 1989 to 1990 are HIV/AIDS and suicide/homicide. The 12.7% increase in YPLL-65 for HIV/AIDS corresponds to increases in the annual number of deaths from AIDS. Prevention programs for communities and individuals are crucial for reducing behaviors that lead to transmission of HIV. The 6.5% increase in YPLL-65 for suicide/homicide reflects 1.8% and 10.8% increases in YPLL-65 for suicide and homicide, respectively. Several factors may have contributed to these changes, including increases in substance abuse, access to handguns, poverty, urbanization and crowding, and family disruption and disorganization (5). For prevention of suicide/homicide, CDC has recommended interventions that can be incorporated in community programs. These include use of school-based curricula based on nonviolent conflict-resolution skills; peer-counseling programs; enforcement or enactment of local drinking and firearms-control regulations; crisis-intervention services; and improved recognition and comprehensive treatment of persons with mental disorders (6,7).
The 9.2% decrease in YPLL-65 for prematurity from 1989 to 1990 reflects a 1.2% increase in YPLL-65 for disorders related to short gestation and unspecified low birthweight and a 21.5% decrease in YPLL-65 for respiratory distress syndrome. Recent improvements in medical management of respiratory distress syndrome may have contributed to this trend (8,9).
Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993. (Monthly vital statistics report; vol 41, no. 7, suppl).
2. NCHS. Annual summary of births, marriages, divorces, and deaths: United States, 1991. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992. (Monthly vital statistics report; vol 40, no. 13).
3. NCHS. Vital statistics of the United States, 1987. Vol 2, mortality, part A. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1990; DHHS publication no. (PHS)90-1011.
4. NCHS. Annual summary for the United States, 1978. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1979. (Monthly vital statistics report; vol 27, no. 13)
5. Reiss AJ Jr, Roth JA, eds. Understanding and preventing violence. Washington, DC: National Academy Press, 1993:101-81.
6. Hammett M, Powell KE, O'Carroll PW, Clanton ST. Homicide surveillance -- United States, 1979-1988. In: CDC surveillance summaries (May 29). MMWR 1992;41(no. SS-3):1-33.
7. CDC. Position papers from the Third National Injury Control Conference: setting the national agenda for injury control in the 1990s -- executive summaries. MMWR 1992;41(no. RR-6):5-7.
8. CDC. Infant mortality -- United States, 1990. MMWR 1993;42:161-5. 9. Long W, Corbet A, Cotton R, et al. A controlled trial of synthetic surfactant in infants weighing 1250 g or more with respiratory distress syndrome. N Engl J Med 1991;325:1696-703.
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