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

Results

All-cause UDR for Females and Males and Whites and Nonwhites, 1900–2010

From 1900 to 2010, the UDR among females in the United States decreased from 1,646.9 per 100,000 to 787.4 per 100,000, an overall decrease of 52.2% (Table 1). Among males, the UDR decreased from 1,791.1 per 100,000 in 1900 to 812.0 per 100,000 in 2010, an overall decrease of 54.7% (Table 1). The male UDR exceeded the female UDR in all decadal years except 2000; by 2010, the male excess had decreased to 24.6.

Decreases in all-cause UDRs from 1900 to 2010 were higher among nonwhites than among whites for females and males (Table 1). UDRs decreased by 78.5% among nonwhite females and 47.4% among white females and by 76.8% among nonwhite males and 51.2% among white males. Among females, the UDR among nonwhites exceeded that among whites by 814.1 per 100,000 in 1900; nonwhite excess deaths decreased steadily, and beginning in 1970 the white female UDR exceeded the nonwhite female UDR. Among males, the all-cause UDR among nonwhites exceeded that among whites by 790.5 per 100,000 in 1900; this excess decreased steadily, and by 2010 the UDR among white males exceeded the rate of nonwhite males by 270.5 per 100,000.

From 1970 to 2010, death rates increased by 5.5% among white females and decreased by 22.5% among black females. Rates decreased by 20.3% among white males and by 38.9% among black males.

All-cause AADR for Females and Males, Whites and Nonwhites, 1900–2010

From 1900 to 2010, the AADR among females decreased from 2,410.4 per 100,000 to 634.9 per 100,000, a decrease of 73.7% (Table 2). Among males, the AADR decreased from 2,630.8 per 100,000 in 1900 to 887.1 per 100,000 in 2010, a decrease of 66.3% (Table 2). The male AADR exceeded the female AADR in all decades, with the greatest excess in 1970 at 570.7 per 100,000; the male excess was higher in 2010 than in 1900.

Decreases in all-cause AADRs were higher among nonwhites than among whites for females and males (Table 2). The AADR decreased by 80.8% among nonwhite females and by 73.7% among white females and by 74.5% among nonwhite males and 66.4% among white males. Among females, the AADR among nonwhites exceeded that among whites by 914.0 in 1900; the excess decreased steadily to 5.4 per 100,000 in 2010. Among males, the all-cause AADR among nonwhites exceeded that among whites by 963.3 per 100,000 in 1900; the excess decreased inconsistently, and by 2010 the difference was 32.5 per 100,000. In 1970, the AADR from all causes was 30.2% higher among black than among white females. The difference remained at approximately this level until 2010, then fell to 19.3%. During the same period, the excess AADR among black males changed little, from 23.8% to 25.7% (Table 2).

Age-specific All-cause Death Rates Among Females, by White and Nonwhite Race, 1900–2010

Relative decreases in death rates decreased by increasing age (Table 3). The greatest decreases were among ages 1 to 4 years, a decrease of 98.8% among whites and 99.3% among nonwhites. Rates of decrease were greater among nonwhite females than among white females, except for females aged 85 years or older.

Although decreases in death rates among nonwhite females were continuous in all decades from 1900 through 2010, decreases did not continue for white females in recent decades. Among white females, death rates increased from 1960 to 1970 in females aged 15 to 24, 35 to 44, and 45 to 54 years; from 1990 to 2000 in females aged 35 to 44 years; and from 2000 to 2010 in females aged 25 to 34 and 45 to 54 years (data not shown).

Major Causes of Death Among Females in 1900 and 2010

The 5 major causes of death for females in 1900 (46.3% of all deaths) were pneumonia and influenza (198.5 per 100,000), tuberculosis (187.8 per 100,000), enteritis and diarrhea (134.9 per 100,000), heart disease (133.7 per 100,000), and stroke (107.7 per 100,000). Of these causes, only heart disease and stroke were among the 5 major causes in 2010. In 2010, the 5 major causes (59.7% of all deaths) were heart disease (184.9 per 100,000), all cancers (168.2 per 100,000), stroke (49.1 per 100,000), chronic lower respiratory diseases (46.3 per 100,000), and UI-NMV (21.8 per 100,000). Direct comparison of ranked causes between the 1900 and 2010 was not possible, because data for one major cause in 2010 (ie, chronic lower respiratory diseases) were not available in 1900.

Cause-specific AADR Among Females (per 100,000 Population)

From 1900 to 2010, the greatest decreases in AADRs were among selected infectious diseases: the AADR for pneumonia and influenza decreased by 95.7%, tuberculosis by 99.9%, and enteritis and diarrhea by 99.2%; by 1950, rates of each of these conditions had already decreased by more than 85% (Table 4, Figure 1). AADRs for diseases of the heart increased by 96.5% in 1950 and then decreased rapidly by 2010 by 70.6%. AADR for stroke peaked in 1920 and subsequently decreased by 84.5%. AADRs for UI-NMV decreased by 63.9%.

Figure 1.

Age-adjusted death rates for major causes of death among all females, United States, 1900–2010. Abbreviation: —, data not available.

The AADR for 3 causes of death increased greatly during the study period (Table 4). This was in contrast to the AADR for all cancers, which increased to a peak in 1940 and decreased by 22.6% thereafter. The AADR for cancers of the respiratory system (including lung cancer) was 6.9 per 100,000 in 1950 and increased to 38.8 per 100,000 in 2010. Chronic lower respiratory conditions, first reported in 1970 at 8.1 per 100,000, increased by 369.1% to 38.0 per 100,000 in 2010. The AADR for motor-vehicle injury-related deaths, first recorded in 1910 at 0.8 per 100,000, peaked at 16.0 per 100,000 in 1930 and subsequently decreased by 59.4%.

AADR Among White Females Compared With Nonwhite Females, 1920–2010

From 1920 through 2010, the decrease in AADR from all causes was greater among nonwhite females (76.9%) than among white females (68.9%) (Table 4). From 1920 through 2010, AADRs reached a peak one decade earlier for whites than for nonwhites for heart disease (1940 and 1950, respectively) and stroke (1920 and 1930, respectively), and subsequently decreased. AADRs decreased similarly for white and nonwhite females for tuberculosis, enteritis and diarrhea, and pneumonia and influenza; were slightly greater for UI-NMV deaths for nonwhite females than for white females; and were substantially greater for whites than for nonwhites for cancers (Table 4). The increase of UI-MV deaths was far greater for nonwhite females than for white females.

AADR Trends Among Females for Major Selected Chronic, Infectious, and Unintentional Injury Conditions, 1900–2010

In 1900, the selected chronic, infectious, and injury conditions assessed in this analysis accounted for 53.8% of the female AADR (Table 4, Figure 2). Trends in the AADR for these selected conditions varied markedly. Rates for selected chronic conditions increased to a peak in 1940 and 1950, then decreased. Rates for the infectious conditions decreased rapidly, began to level out in 1950, and decreased slowly thereafter. Unintentional injury rates rose slightly to a maximum in 1930, declining slowly thereafter.

Figure 2.

Age-adjusted death rates for chronic, infectious disease, unintentional injury among all females, United States, 1900–2010. Selected chronic conditions include heart disease, stroke, and cancers combined; selected infectious diseases include influenza and pneumonia, TB, and enteritis and diarrhea combined; unintentional injuries includes unintentional motor vehicle and nonmotor vehicle injuries combined. Abbreviations: CHD, coronary heart disease; TB, tuberculosis.

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