Trends in Mortality Among Females in the United States, 1900–2010: Progress and Challenges

Robert A. Hahn, PhD, MPH; Man-Huei Chang, MPH; R. Gibson Parrish, MD; Steven M. Teutsch, MD, MPH; Wanda K. Jones, DrPH

Disclosures

Prev Chronic Dis. 2018;15(3):e30 

In This Article

Methods

Data for the analysis of decadal trends in mortality rates were obtained from yearly tabulations of causes of death from published compilations and from public use computer data files. Data for 1900 through 1940 were taken from mortality information from death registration states, which included 10 states and the District of Columbia in 1900 (40.5% of the US population) and gradually expanded to include all 48 states and the District of Columbia by 1933.[2] For decennial mortality rates from 1940 through 1960, a compilation of mortality information was used.[3] The Centers for Disease Control and Prevention's (CDC's) Compressed Mortality File 1968–1992 and WONDER data system (Wide-ranging Online Data for Epidemiologic Research; http://wonder.cdc.gov) were used for mortality counts and census denominators from 1970 through 2010. Two physician epidemiologists linked ICD (International Classification of Diseases) codes. Because data specific to the black population became available beginning in 1970, we summarized only all-cause trends for this population for the available period and concentrated on prior trends for "nonwhites," a category that also includes other racial groups. Because data for age-specific rates by race became available beginning in 1920, the tabulation of AADRs began in this year (Appendix I and Appendix II). We used the term "females" in this study, because all ages were included in the analysis. We refer to "major causes of death" to distinguish from slightly different classifications of "leading causes of death" used by CDC's National Center for Health Statistics.

We analyzed all-cause unadjusted death rates (UDRs) for males and females and for white and nonwhite males and females from 1900 through 2010 in decadal years to indicate mortality burden. We analyzed UDRs for black persons beginning in 1970 when the data were first made available. We also computed age-adjusted all-cause death rates (AADRs) by the direct method using age-specific death rates and the 2000 US standard population.[4] We analyzed several trends in mortality rates among females only. We analyzed trends in all-cause, age-specific death rates by white/nonwhite race from 1900 through 2010 in decadal years, major causes of death in 1900 and 2010, trends in all-cause AADRs from 1900 to 2010, and trends in AADRs for specific causes of death from 1920 to 2010 by white/nonwhite race. We also analyzed trends in AADRs from 1900 through 2010 for selected chronic conditions (ie, heart disease, stroke, and cancers combined), selected infectious diseases (ie, influenza and pneumonia, tuberculosis, and enteritis and diarrhea combined), and unintentional injuries (ie, unintentional motor vehicle [UI-MV] and nonmotor vehicle injuries [UI-NMV] combined).

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