Notice to Readers Introduction to Table V
Premature Deaths, Monthly Mortality, and Monthly
Physician Contacts -- United States
Beginning with this issue, a new table will appear monthly in
the
MMWR: "Table V. Potential Years of Life Lost, Deaths, and Death
Rates,
by Cause of Death, and Estimated Number of Physician Contacts, by
Principal Diagnosis" (see page 117). By displaying a variety of
measures that gauge the importance and relative magnitude of
certain
public health issues, this table will call attention to those
issues
where strategies for prevention are needed. Publication of this
table
reflects CDC's increased responsibility for promoting action to
reduce
unnecessary morbidity and premature mortality and continues the
MMWR's
tradition of disseminating public health information to its
readership.
Further improvements in health can be achieved through actions
taken by individuals as well as by administrators in the public and
private sectors to promote a safer and healthier environment (1).
To
this end, the new table provides information regarding areas that
provide the greatest potential for health improvement.
Causes of death are listed in Table V in descending order of
the
potential years of lost life that are attributed to each cause. In
1980, heart disease, cancer, and cerebrovascular disease accounted
for
67.9% of all deaths in the United States; motor-vehicle and other
accidents, suicide, and homicide accounted for 8.1% (2). In terms
of
age at the time of death, the relative importance of causes of
death
changes remarkably; motor-vehicle and other accidents, suicide, and
homicide accounted for 40.8% of the total years of life lost
prematurely (before age 65 years); and heart disease, cancer, and
cerebrovascular disease accounted for 37.2%.
"Potential years of life lost before age 65" in the table is
estimated for persons between 1 year and 65 years old at the time
of
death and is derived by multiplying the annual number of deaths in
each age category by the difference between 65 years and the age at
the mid-point of each category. If deaths of persons older than 65
years were included, greater weight would be given to natural
causes
of death, and premature and preventable causes of death would no
longer be distinguishable. If deaths of persons younger than 1
year
were included, causes of death affecting this age group would be
weighted heavily and would therefore contribute a
disproportionately
large share of potential years of life lost. However, "Infant
mortality" in the table is a measure of deaths occurring in this
age
group and "Prenatal care" reflects efforts to prevent death in this
group.
Cause-specific mortality rates, published in the Monthly_Vital_
Statistics_Report by the National Center for Health Statistics, are
estimated from a systematic sample of 10% of death certificates
received in state vital statistics offices during a 1-month period
using the underlying cause of death recorded on the certificate.
Because complete information concerning the underlying cause of
death
is not available when the sample is taken, estimates for certain
causes are biased in the monthly sample but then are corrected when
annual estimates are made. The estimated number of deaths each
month
is obtained by multiplying the corresponding estimated mortality
rate,
which is computed on an annual basis, by the provisional population
estimate for the United States and then dividing by the number of
days
for that month as a proportion of the total days in the year.
The measure for morbidity is obtained from the National Disease
and Therapeutic Index (NDTI), a random sample of data from
office-based physicians in 19 major specialties in the continental
United States. Each physician in the sample records all his
contacts
with private patients for 2 consecutive days each quarter. These
contacts comprise telephone calls (7% of total in 1981); office
visits
(68%); and patients visited by the physician in hospitals (22%),
nursing homes (1%), and their own homes (1%). As a result, this
measure gives greater weight to those diseases that prompt a visit
to
a private physician or require hospitalization. When the physician
cannot make a diagnosis at the time of the visit, the suspected
diagnosis or presenting symptom is recorded. Although
misclassification might occur, the potential for this bias is
reduced
by using broad categories in the table.
Publication of Table V is an effort to use measures of
morbidity
and mortality as reminders of the impact on public health of some
of
these preventable problems. However, when data are summarized,
their
complexity and detail are sacrificed; and when information is
simplified, although the overall effect may be clarified, subtle
issues may be obscured. Therefore, a series of articles exploring
different aspects of preventable problems will be published in the
MMWR to complement this table . These articles will present more
detailed analysis of what is known about health status indicators,
risk factors, and other factors affecting public health.
References
Healthy People, The Surgeon General's Report on Health
Promotion
and Disease Prevention, 1979. Public Health Service, Office
the
Assistant Secretary for Health and Surgeon General, DHEW (PHS)
Publication No. 79-55071.
National Center for Health Statistics. Monthly Vital Statistics
Report, Vol. 29, No. 13, September 17, 1981.
Disclaimer
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