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Increase in Pneumonia Mortality Among Young Adults and the HIV Epidemic -- New York City, United States

Most pneumonia-attributable deaths occur among the elderly. In New York City (NYC), however, the number and rate of such deaths among younger persons have increased in association with human immunodeficiency virus (HIV) infections in intravenous-drug abusers (IVDAs) (1,2). In addition, data from CDC's 121 Cities Mortality Surveillance System (CMSS) suggest that similar trends may be occurring in other cities.

New York City. In NYC, concurrent with the high incidence of acquired immunodeficiency syndrome (AIDS), mortality rates for pneumonia or bronchopneumonia not otherwise specified (International Classification of Diseases, Ninth Revision, codes 485.0-486.0) in persons 25-44 years of age increased from 4.2 deaths/100,000 population in 1978 to 19.1 in 1987 for males and from 2.4 to 6.5 for females. Investigations of 192 (83%) of 230 clinical records of persons 25-44 years of age who were hospitalized in 1986 and died from pneumonia revealed the following: 153 (80%) were in groups at increased risk for AIDS, 126 (82%) of whom were IVDAs; 50 (26%) had evidence of oral thrush on hospital admission, and 26 (14%) had a condition diagnosed that would fulfill the criteria of the revised surveillance case definition for AIDS (3).

121 Cities. To determine whether similar changes in pneumonia-attributable deaths may be occurring in other cities, trends in pneumonia and influenza (P&I) deaths were examined using a mortality surveillance system that provides more recent city-level data than are available from national vital records.

Each week, 121 cities, constituting one fourth of the U.S. population, report to CDC the total number of registered deaths and the number of P&I-attributable deaths by age ("pneumonia" being the immediate or underlying cause, "influenza" appearing anywhere on the death certificate) (4). The cities were ranked by cumulative AIDS incidence (total cases reported to CDC since 1981 per 100,000 population) into deciles from highest to lowest incidence, and trends in the age distribution of persons who died from P&I were examined for 1962 through 1987.

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