New Study of Patterns of Death in the United States

For Release: February 23, 1998

The National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention, announces the first release of data from the latest National Mortality Followback Survey–the first study since the 1980’s to examine detailed patterns of mortality by supplementing the information provided through death certificates with interviews of next of kin. The survey allows for the examination of trends in mortality, differences by income and education, risk factors and causes of death, and health care utilization in the last year of life.

Highlights of the data show

• Where does death occur: The majority of deaths (56 percent) occur in a hospital, clinic, or medical center; 19 percent in a nursing home; and some 21 percent of people died at home.
• Who gets health care: While 10 percent of decedents were reported to have never visited a doctor during the last year of life, an almost equal number made 50 or more visits.
• Who pays for health care: Medicare was the principal source of payment for the largest number of decedents (46 percent). Private insurance paid most of the medical expenses for about 20 percent; about 10 percent of people paid for their own medical care; and Medicaid was the source of payment for another 10 percent. Over half of the decedents were covered by private insurance or HMO and about three-quarters by Medicare.
• Who needs health care: Almost 200,000 decedents needed but had not received health care, primarily for problems in paying bills or in finding or getting treatment.
• What diseases do people have: One-quarter of decedents have had a heart attack and about an equal number had angina. Over 40 percent were reported to have had hypertension. Other frequent conditions were cancer and arthritis, each reported for about one-third of decedents. Fifteen percent suffered from some type of memory impairment.
• How was their last year of life: Illness or injury kept one in 10 in bed most of their last year of life. About half of decedents were reported to have had a functional limitation due to physical or mental conditions during their last year of life. Some 58 percent of those with limitations received help at home from a spouse; daughters provided care for 46 percent and 31 percent received help from visiting nurses. In the last year of life, 39 percent of decedents took pain medication.
• How many smoked or used drugs or alcohol: Slightly more than half of all decedents smoked cigarettes at some point during their lives. About one-quarter of all decedents used alcohol during their last year of life; 29 percent of drinkers used alcohol every day. About 2-percent used marijuana during their last year of life and less than 1 percent were reported to have used other types of illicit drugs.
• What circumstances were related to homicide, suicide, or fatal motor vehicle crashes: For those who died of homicide, suicide, or unintentional injuries, 19 percent had an alcoholic beverage within 4 hours of death and 17 percent had taken drugs or medication within 24 hours of death. Of the 36,000 firearm related deaths, almost three-quarters (72 percent) involved the use of handguns. One-third of decedents involved in fatal motor vehicle crashes were reported to not have been wearing safety belts.

The 1993 National Mortality Followback Survey (NMFS) is the latest in a series of followback surveys that supplement information on the death records of a sample of United States citizens who die in a given year with telephone or in-person interviews of the next of kin or other persons familiar with the decedent’s life history. The 1993 survey is based on almost 23,000 records of individuals aged 15 years or over who died in 1993. All States (with the exception of South Dakota where State law restricts the use of death certificate information) and the District of Columbia participated in the survey.

For more information visit the survey on the NCHS home page at the National Mortality Followback Survey page