High and Rising Mortality Rates Among Working-Age Adults (2021) / Chapter Skim
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4 U.S. Trends in Cause-Specific Mortality Among Working-Age Adults
4 U.S. Trends in Cause-Specific Mortality Among Working-Age Adults
Pages 95-168
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From page 95... ...
, the recent increase in all-cause mortality rates in the United States was due less to a break from earlier trends than to the accumulation and acceleration of long-term slowdowns and reversals of progress in mortality. These all-cause mortality trends demonstrate that there were important differences in where and among whom mortality rates increased between 1990 and 2017; however, they cannot establish which factors contributed to these mortality trends over time.
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From page 96... ...
Two of these categories, noted in the tables that follow, could not be made comparable over the 1990–2017 period because of a change in ICD coding. Mortality rates are presented separately by sex and age group for non-Hispanic (NH)
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From page 97... ...
slower progress in lowering mortality from heart diseases and other leading causes of death that drove improvements in all-cause mortality rates before 2010. Mortality due to drug poisoning increased throughout the 1990–2017 period among working-age White, Black, and Hispanic adults of both sexes, with the largest increases occurring among younger (ages 25–44)
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From page 98... ...
briefly review cause-specific mortality for these populations. 1 "Other diseases of the circulatory system" include all circulatory diseases besides ischemic heart disease and hypertensive heart disease.
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From page 99... ...
, an important takeaway is that mortality rates from several causes of death -- including liver cancer; ENM diseases;3 hypertensive heart disease; drug poisoning; 3 ENM diseases include, but are not limited to, diabetes mellitus, disorders of the thyroid gland, hypoglycemia, disorders of other endocrine glands, malnutrition, obesity, disorders of lipoprotein metabolism and other lipidemias, cystic fibrosis, amyloidosis, and other metabolic disorders. In 2017, the most common cause of death within this category was diabetes mellitus, which was responsible for most of the deaths in this category, followed by obesity and hyperlipidaemia (CDC, 2020b)
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From page 100... ...
The table below shows the 10 leading causes of death for the AI/AN popula tion compared with Whites, Blacks, and Hispanics in 2017. Because these results are based on vital statistics reports that do not correct for errors in race reporting, these tables do not include the estimated mortality rates for these populations; however, other research has demonstrated that the AI/AN population has the highest mortality rates for more causes of death relative to any racial/ethnic group (Espey et al., 2014; Sancar, Abbasi, and Bucher, 2017)
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From page 101... ...
Nonetheless, drug poisoning was the single largest contributor to the increase in all-cause mortality rates among White males and females in all three age groups, with its contribution to the increase in all-cause mortality over the period ranging from a low of 17.5 percent among males ages 4 In this analysis, the category of suicide excludes suicides due to drug poisoning, which are classified with other drug poisoning deaths. 5 Among younger working-age White females, mortality due to ischemic heart disease was very low and did not change over the period.
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From page 102... ...
Other significant contributors to the overall increase in mortality among working-age White adults were cardiometabolic diseases. Although combined mortality from all of these diseases decreased overall because of large decreases in mortality from ischemic heart disease and other circulatory system diseases, mortality from hypertensive heart disease and ENM diseases increased over the period among both males and females in all three age groups.
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From page 103... ...
4.87 –5.26 –19.28 Mortality Rate Change Mortality Rate Change Mortality Rate Change % of % of % of 1990– 2015– Abs Total 1990– 2015– Total 1990– 2015– Total Cause of Death 1993 2017 Chg +/– Chg 1993 2017 Abs Chg +/– Chg 1993 2017 Abs Chg +/– Chg Infectious and Parasitic Diseases HIV/AIDS 35.83 1.05 –34.78 –56.7 25.76 3.81 –21.95 –15.4 10.16 3.49 –6.67 –1.6 Non-HIV/AIDS 3.62 2.57 –1.05 –1.7 6.54 11.03 4.49 3.9 13.68 29.26 15.59 9.5 Cancers Liver Cancer 0.49 0.52 0.03 0.0 2.54 5.03 2.50 2.2 8.75 25.79 17.04 10.3 Lung Cancer 4.34 1.61 –2.73 –4.5 52.60 21.22 –31.37 –22.0 198.91 90.90 –108.02 –25.5 continued 103
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From page 104... ...
TABLE 4-1 Continued 104 Mortality Rate Change Mortality Rate Change Mortality Rate Change % of % of % of 1990– 2015– Abs Total 1990– 2015– Total 1990– 2015– Total Cause of Death 1993 2017 Chg +/– Chg 1993 2017 Abs Chg +/– Chg 1993 2017 Abs Chg +/– Chg All Other Cancers 20.90 15.55 –5.35 –8.7 91.52 70.23 –21.29 –14.9 271.79 206.16 –65.63 –15.5 Cardio and Metabolic Diseases Endocrine, Nutritional, & Metabolic 5.12 7.00 1.88 2.6 14.95 24.93 9.97 8.6 36.03 56.26 20.23 12.3 Hypertensive Heart Disease 1.08 3.86 2.78 3.9 5.61 16.00 10.39 9.0 15.20 32.61 17.40 10.6 Ischemic & Other Circulatory System 30.76 24.52 –6.25 –10.2 177.57 110.92 –66.65 –46.7 517.49 279.65 –237.84 –56.1 Substance Use and Mental Health Drug Poisoning 9.55 62.43 52.88 73.7 4.39 47.73 43.34 37.6 2.58 31.42 28.84 17.5 Alcohol-Induced* 4.81 6.70 1.89 2.6 13.33 21.83 8.50 7.4 20.73 31.58 10.85 6.6 Suicide 23.09 32.30 9.21 12.8 22.36 35.21 12.85 11.1 24.75 32.79 8.03 4.9 Mental & Behavioral Disorders 3.84 5.10 1.26 1.8 7.35 12.69 5.34 4.6 11.37 21.01 9.64 5.9
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From page 105... ...
71.74 115.33 164.70 Total Change: Decrease (–) –61.40 –142.74 –424.09 continued 105
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From page 106... ...
TABLE 4-1 Continued 106 Non-Hispanic White Females Age Group 25–44 45–54 55–64 All-Cause Mortality Rate 1990–1993 88.93 295.15 767.20 All-Cause Mortality Rate 2015–2017 121.90 314.97 659.91 Change 1990–1993 to 2015–2017 32.97 19.82 –107.29 (Change as % of 1990– 1993 mortality) 37.07 6.72 –13.98 Mortality Rate Change Mortality Rate Change Mortality Rate Change % of % of % of 1990– 2015– Abs Total 1990– 2015– Total 1990– 2015– Abs Total Cause of Death 1993 2017 Chg +/– Chg 1993 2017 Abs Chg +/– Chg 1993 2017 Chg +/– Chg Infectious and Parasitic Diseases HIV/AIDS 2.09 0.37 –1.72 –13.3 1.07 0.71 –0.36 –0.6 0.67 0.58 –0.08 0.0 Non-HIV/AIDS 1.43 2.41 0.98 2.1 3.79 8.45 4.66 5.8 9.40 19.68 10.28 11.0 Cancers Liver Cancer 0.24 0.39 0.14 0.3 1.37 2.14 0.77 1.0 3.79 7.52 3.74 4.0 Lung Cancer 3.07 1.48 –1.59 –12.3 33.42 19.34 –14.08 –23.1 104.57 67.85 –36.72 –18.3 All Other Cancers 26.62 19.19 –7.43 –57.6 111.06 76.40 –34.67 –57.0 248.27 173.33 –74.95 –37.3
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From page 107... ...
2.68 3.75 1.06 2.3 9.47 13.70 4.22 5.2 24.41 29.13 4.72 5.0 Other Causes of Death Homicide 3.36 2.59 –0.77 –5.9 2.48 2.10 –0.38 –0.6 1.72 1.57 –0.16 –0.1 Transport Accidents 9.60 8.22 –1.39 –10.7 8.54 8.04 –0.51 –0.8 9.29 7.12 –2.17 –1.1 continued 107
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From page 108... ...
Dark green highlights indicate that a cause of death is responsible for ≥10 percent of the total decrease in mortality. The table shows mortality rates and change in all-cause and cause-specific mortality rates among non-Hispanic White working-age adults by age group (25–44, 45–54, and 55–64)
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From page 109... ...
. These widespread mortality increases were offset by remarkable improvements in mortality rates from HIV/AIDS; lung and other cancers,7 excluding liver cancer; and ischemic heart disease and other diseases of the circulatory system.
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From page 110... ...
For this reason, by 2015–2017, working-age Whites generally had higher rates of mortality from alcohol-induced causes, suicide, and mental and behavioral disorders relative to similarly ages Black adults. Among Black males and younger Black females, mortality due to ENM diseases and hypertensive heart disease increased.
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From page 111... ...
After drug poisoning, liver cancer was the second largest contributor to the increase in mortality among males ages 55–64, and this increase in mortality from liver cancer was larger among Black males ages 55–64 than among similarly ages White males. Relative to working-age Whites, working-age Blacks experienced declines in mortality from a wider range of causes, including HIV/AIDS (except Black females ages 55–64)
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From page 112... ...
–45.12 –43.62 –32.31 Mortality Rate Change Mortality Rate Change Mortality Rate Change % of Total % of % of 1990– 2015– +/– 1990– 2015– Total 1990– 2015– Abs Total Cause of Death 1993 2017 Abs Chg Chg 1993 2017 Abs Chg +/– Chg 1993 2017 Chg +/– Chg Infectious and Parasitic Diseases HIV/AIDS 134.82 10.16 –124.66 –43.9 98.09 20.96 –77.13 –13.2 44.75 30.07 –14.68 –1.6 Non-HIV/AIDS 16.23 4.78 –11.46 –4.0 30.71 18.09 –12.62 –2.2 45.06 54.76 9.70 7.7 Cancers Liver Cancer 1.84 1.18 –0.66 –0.2 7.90 7.51 –0.39 –0.1 18.95 49.60 30.65 24.4 Lung Cancer 10.43 2.36 –8.07 –2.8 108.93 23.84 –85.10 –14.6 320.63 119.64 –200.99 –21.8 All Other Cancers 31.45 17.42 –14.03 –4.9 176.23 85.03 –91.21 –15.6 461.08 274.10 –186.98 –20.3
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From page 113... ...
15.93 4.79 –11.13 –3.9 45.89 19.39 –26.50 –4.5 72.29 54.58 –17.71 –1.9 Other Causes of Death Homicide 92.84 69.24 –23.59 –8.3 45.41 27.69 –17.72 –3.0 29.74 17.05 –12.69 –1.4 Transport Accidents 34.30 30.37 –3.93 –1.4 31.78 27.25 –4.53 –0.8 31.16 29.09 –2.07 –0.2 Other External Causes of Death 23.88 11.50 –12.38 –4.4 31.46 17.58 –13.88 –2.4 43.80 30.69 –13.11 –1.4 All Other Causes of Death 24.03 12.46 –11.57 –4.1 32.33 21.84 –10.49 –1.8 43.67 39.35 –4.32 –0.5 113 continued
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From page 114... ...
–283.93 –584.38 –922.47 Non-Hispanic Black Females Age Group 25–44 45–54 55–64 All-Cause Mortality Rate 1990–1993 243.70 627.87 1367.98 All-Cause Mortality Rate 2015–2017 162.89 455.25 1002.30 Change 1990–1993 to 2015–2017 –80.81 –172.62 –365.68 (Change as % of 1990–1993 mortality) –33.16 –27.49 –26.73 Mortality Rate Change Mortality Rate Change Mortality Rate Change % of % of % of 1990– 2015– Abs Total 1990– 2015– Abs Total 1990– 2015– Total Cause of Death 1993 2017 Chg +/– Chg 1993 2017 Chg +/– Chg 1993 2017 Abs Chg +/– Chg Infectious and Parasitic Diseases HIV/AIDS 32.04 5.89 –26.15 –27.5 15.70 11.37 –4.33 –2.2 7.36 10.70 3.33 5.8 Non-HIV/AIDS 8.75 4.26 –4.49 –4.7 16.04 14.21 –1.83 –0.9 28.04 36.95 8.91 15.4
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From page 115... ...
Cancers Liver Cancer 0.59 0.53 –0.05 –0.1 2.30 3.19 0.90 3.7 6.52 13.48 6.97 12.0 Lung Cancer 4.59 1.19 –3.40 –3.6 39.66 16.35 –23.31 –11.8 108.58 68.08 –40.50 –9.6 All Other Cancers 41.80 27.61 –14.18 –14.9 163.83 107.15 –56.68 –28.8 342.25 242.89 –99.36 –23.5 Cardio and Metabolic Diseases Endocrine, Nutritional, & Metabolic 8.34 11.31 2.97 20.9 35.09 31.95 –3.13 –1.6 92.73 70.97 –21.76 –5.1 Hypertensive Heart Disease 5.65 7.51 1.87 13.1 28.67 27.15 –1.51 –0.8 61.95 53.22 –8.72 –2.1 Ischemic & Other Circulatory System 42.31 27.90 –14.40 –15.2 180.18 101.56 –78.62 –40.0 476.99 244.29 –232.70 –54.9 Substance Use and Mental Health Drug Poisoning 6.72 13.88 7.16 50.3 4.01 22.56 18.55 76.8 1.59 18.80 17.21 29.8 Alcohol-Induced* 5.38 2.15 –3.23 –3.4 11.24 6.58 –4.66 –2.4 12.18 9.26 –2.92 –0.7 Suicide 2.42 2.83 0.41 2.9 1.86 1.70 –0.16 –0.1 1.98 1.57 –0.41 –0.1 Mental & Behavioral Disorders 5.30 1.78 –3.52 –3.7 7.92 4.46 –3.46 –1.8 8.39 9.35 0.96 1.7 Other Body System Diseases Nervous System 4.21 5.93 1.72 12.1 9.31 13.72 4.41 18.3 15.27 27.98 12.71 22.0 115 continued
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From page 116... ...
Dark green highlights indicate that a cause of death is responsible for ≥10 percent of the total decrease in mortality. The table shows mortality rates and change in all-cause and cause-specific mortality rates among non-Hispanic Black working-age adults by age group (25–44, 45–54, and 55–64)
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From page 117... ...
, relatively large increases occurred in mortality from non-HIV/AIDS infectious and parasitic diseases, liver cancer, hypertensive heart disease, and diseases of the nervous system among males, along with increased mortality from non-HIV/AIDS infectious and parasitic diseases, liver cancer, and diseases of the nervous system among females. As was true for Black males, Hispanic males experienced widespread improvements across multiple causes of death over the period, although the reductions among Hispanic males were much smaller because they began the period with much lower mortality rates.
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From page 118... ...
Despite their limited number, these studies consistently found that increases in mortality due to drug poisoning, alcohol-induced causes, and suicide were the largest contributors to the growing gap in mortality by education among working-age Whites, and that increases in drug poisoning mortality were increasingly concentrated among working-age Whites with a high school degree or less. This group also experienced larger increases in mortality across a wide range of other causes of death, and this was especially true for White women with less education.
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From page 119... ...
–49.56 –33.77 –26.07 Mortality Rate Change Mortality Rate Change Mortality Rate Change % of % of % of 1990– 2015– Abs Total 1990– 2015– Abs Total 1990– 2015– Total Cause of Death 1993 2017 Chg +/– Chg 1993 2017 Chg +/– Chg 1993 2017 Abs Chg +/– Chg Infectious and Parasitic Diseases HIV/AIDS 70.91 2.38 –68.53 –45.5 57.24 6.36 –50.88 –25.0 30.35 7.86 –22.49 –6.3 Non-HIV/AIDS 6.84 2.32 –4.52 –3.0 11.55 12.28 0.73 2.6 19.35 31.13 11.78 16.5 Cancers Liver Cancer 0.83 0.54 –0.29 –0.2 5.32 8.93 3.61 13.1 16.59 35.64 19.05 26.6 Lung Cancer 2.08 0.73 –1.35 –0.9 18.58 5.51 –13.07 –6.4 77.14 30.51 –46.63 –13.1 All Other Cancers 15.65 11.95 –3.70 –2.5 64.00 48.70 –15.29 –7.5 194.86 143.86 –51.00 –14.3 119 continued
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From page 120... ...
TABLE 4-3 Continued 120 Mortality Rate Change Mortality Rate Change Mortality Rate Change Cardio and Metabolic Diseases Endocrine, Nutritional, & Metabolic 4.65 5.09 0.44 5.4 18.19 20.72 2.53 9.2 54.32 58.01 3.70 5.2 Hypertensive Heart Disease 1.64 3.07 1.44 17.5 7.92 11.99 4.07 14.7 21.36 29.08 7.72 10.8 Ischemic & Other Circulatory System 23.58 16.19 –7.39 –4.9 128.06 70.47 –57.59 –28.3 385.36 200.92 –184.44 –51.8 Substance Use and Mental Health Drug Poisoning 16.26 22.39 6.13 74.8 10.16 24.45 14.29 51.7 4.25 19.36 15.11 21.1 Alcohol-Induced* 12.60 7.78 –4.82 –3.2 37.36 27.02 –10.34 –5.1 50.36 43.74 –6.62 –1.9 Suicide 14.42 12.94 –1.48 –1.0 14.04 11.59 –2.45 –1.2 16.28 10.78 –5.50 –1.5 Mental & Behavioral Disorders 7.33 2.92 –4.41 –2.9 14.66 8.26 –6.40 –3.1 15.28 13.83 –1.46 –0.4 Other Body System Diseases Nervous System 2.53 2.72 0.19 2.3 5.60 7.13 1.53 5.5 10.49 17.62 7.13 10.0 Genitourinary System 1.46 1.14 –0.33 –0.2 5.28 6.14 0.86 3.1 13.55 19.06 5.51 7.7 Respiratory System 6.30 2.97 –3.33 –2.2 17.25 10.39 –6.86 –3.4 51.06 37.73 –13.33 –3.7 Digestive System*
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From page 121... ...
Other Causes of Death Homicide 38.69 12.75 –25.94 –17.2 22.98 6.89 –16.10 –7.9 14.04 5.47 –8.56 –2.4 Transport Accidents 30.75 19.41 –11.34 –7.5 27.37 17.55 –9.82 –4.8 27.08 20.08 –6.99 –2.0 Other External Causes of Death 13.90 8.68 –5.22 –3.5 15.85 13.24 –2.62 –1.3 20.54 19.69 –0.86 –0.2 All Other Causes of Death 8.26 4.96 –3.30 –2.2 10.26 8.69 –1.57 –0.8 15.26 16.80 1.54 2.2 Total Change: Increase (+) 8.20 27.62 71.54 Total Change: Decrease (–)
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From page 122... ...
TABLE 4-3 Continued 122 Hispanic Females Age Group 25–44 45–54 55–64 All-Cause Mortality Rate 1990–1993 89.67 243.72 596.84 All-Cause Mortality Rate 2015–2017 66.32 184.45 440.99 Change 1990–1993 to 2015–2017 –23.35 –59.27 –155.85 (Change as % of 1990–1993 mortality) –26.04 –24.32 –26.11 Mortality Rate Change Mortality Rate Change Mortality Rate Change % of % of Total % of 1990– 2015– Total 1990– 2015– Abs +/– 1990– 2015– Abs Total Cause of Death 1993 2017 Abs Chg +/– Chg 1993 2017 Chg Chg 1993 2017 Chg +/– Chg Infectious and Parasitic Diseases HIV/AIDS 11.74 0.54 –11.20 –37.8 7.38 1.33 –6.05 –8.5 4.38 1.88 –2.50 –1.4 Non-HIV/AIDS 2.57 1.41 –1.16 –3.9 5.38 6.13 0.75 6.2 13.41 16.70 3.29 14.7 Cancers Liver Cancer 0.29 0.39 0.10 1.7 1.90 2.24 0.35 2.9 6.17 9.96 3.79 17.0 Lung Cancer 1.03 0.71 –0.32 –1.1 8.09 4.92 –3.18 –4.4 26.69 18.45 –8.25 –4.6 All Other Cancers 21.79 17.24 –4.56 –15.4 85.51 60.52 –24.99–35.0 178.44 135.29 –43.15 –24.2
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From page 123... ...
Cardio and Metabolic Diseases Endocrine, Nutritional, & Metabolic 2.50 2.88 0.39 6.2 12.99 11.82 –1.17 –1.6 50.36 35.63 –14.73 –8.3 Hypertensive Heart Disease 0.80 1.00 0.20 3.3 4.06 4.73 0.67 5.5 12.34 13.04 0.70 3.1 Ischemic & Other Circulatory System 10.17 7.07 –3.10 –10.5 53.33 28.78 –24.55–34.4 175.91 81.51 –94.41 –53.0 Substance Use and Mental Health Drug Poisoning 2.91 7.25 4.34 69.7 2.24 9.05 6.81 55.8 2.15 7.54 5.39 24.2 Alcohol-Induced* 2.00 2.50 0.50 8.1 6.07 6.95 0.88 7.2 8.38 9.27 0.89 4.0 Suicide 2.24 2.66 0.42 6.7 1.78 2.40 0.62 5.1 1.92 1.97 0.05 0.2 Mental & Behavioral Disorders 1.29 0.83 –0.46 –1.5 1.63 2.03 0.40 3.3 3.03 4.02 0.99 4.4 Other Body System Diseases Nervous System 1.54 1.80 0.26 4.2 3.30 5.00 1.71 14.0 7.38 13.44 6.07 27.2 Genitourinary System 0.98 0.99 0.01 0.2 4.48 4.33 –0.15 –0.2 12.33 12.98 0.66 2.9 Respiratory System 3.47 1.93 –1.54 –5.2 10.53 8.00 –2.53 –3.5 29.20 27.01 –2.19 –1.2 Digestive System*
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From page 124... ...
Dark orange highlights indicate that a cause of death is responsible for ≥10 percent of the total increase in mortality. Light green highlights indicate an absolute decrease in the overall mortality rate of ≥5 deaths/100,000 population.
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From page 125... ...
. Changes in mortality are presented as both the absolute change in mortality rates and the percentage of the total increase (or decrease)
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From page 126... ...
found that among White adults, increasing drug-related mortality was especially concentrated among those with less education, accounting for 73 percent and 44 percent of the increased educational disparity in working-age mortality for White men and White women, respectively. White men and women also exhibited modest increases in educational disparities in working-age mortality due to suicide and liver disease.
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From page 127... ...
. The findings reported in this section show that most cause-specific mortality rates followed a similar trend, suggesting that the growing geographic mortality gap was the cumulative result of underlying processes that produced metro status differences for multiple causes of death.
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From page 128... ...
Black adults living in nonmetros also experienced a smaller overall increase in drug poisoning mortality. TEMPORAL PATTERNS IN CAUSE-SPECIFIC MORTALITY TRENDS The changes described above reflect changes in cause-specific mortality rates over the full period (1990–1993 to 2015–2017)
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From page 129... ...
This pattern appeared most consistently for ischemic heart disease and other circulatory diseases, which saw a slowing rate of improvement in mortality over the period among most working-age adults. Among White females, younger Black males, and younger Hispanic males and females, progress in lowering mortality from ischemic heart disease and other circulatory diseases ceased in the 2010s as all-cause mortality rates began to increase.9 Most of the progress in reducing mortality from HIV/AIDS occurred in the 1990s among White and Hispanic males and younger Black males.
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From page 130... ...
NH White Males Ages 45-54 HIV/AIDS HIV/AIDS Other Infectious Disease Other Infectious Disease Liver Cancer Liver Cancer Lung Cancer Lung Cancer Other Cancers Other Cancers ENM Diseases ENM Diseases Hypertensive Disease Hypertensive Disease Ischemic & Circulatory Ischemic & Circulatory Drug Poisoning Drug Poisoning Alcohol-Induced Alcohol-Induced Mental & Behavioral Mental & Behavioral Suicide Suicide Nervous System Nervous System Genitourinary System Genitourinary System Respiratory System Respiratory System Digestive System Digestive System Homicides Homicides Transport Injuries Transport Injuries Other External Causes Other External Causes All Other Causes All Other Causes -50 -25 0 25 50 75 -100 -50 0 50 Absolute Change in Mortality Rate 1990-93 to 2000-02 to 2009-11 to 2000-02 2009-11 2015-17 Increase Decrease FIGURE 4-1 Decomposition of changes in cause-specific mortality rates (deaths per 100,000 population) by time period: Males.
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From page 131... ...
NH Black Males Ages 25-44 e. NH Black Males Ages 45-54 HIV/AIDS HIV/AIDS Other Infectious Disease Other Infectious Disease Liver Cancer Liver Cancer Lung Cancer Lung Cancer Other Cancers Other Cancers ENM Diseases ENM Diseases Hypertensive Disease Hypertensive Disease Ischemic & Circulatory Ischemic & Circulatory Drug Poisoning Drug Poisoning Alcohol-Induced Alcohol-Induced Mental & Behavioral Mental & Behavioral Suicide Suicide Nervous System Nervous System Genitourinary System Genitourinary System Respiratory System Respiratory System Digestive System Digestive System Homicides Homicides Transport Injuries Transport Injuries Other External Causes Other External Causes All Other Causes All Other Causes -150 -100 -50 0 50 -200 -150 -100 -50 0 50 Absolute Change in Mortality Rate 1990-93 to 2000-02 to 2009-11 to 2000-02 2009-11 2015-17 Increase Decrease continued
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From page 132... ...
Hispanic Males Ages 25-44 h. Hispanic Males Ages 45-54 HIV/AIDS HIV/AIDS Other Infectious Disease Other Infectious Disease Liver Cancer Liver Cancer Lung Cancer Lung Cancer Other Cancers Other Cancers ENM Diseases ENM Diseases Hypertensive Disease Hypertensive Disease Ischemic & Circulatory Ischemic & Circulatory Drug Poisoning Drug Poisoning Alcohol-Induced Alcohol-Induced Mental & Behavioral Mental & Behavioral Suicide Suicide Nervous System Nervous System Genitourinary System Genitourinary System Respiratory System Respiratory System Digestive System Digestive System Homicides Homicides Transport Injuries Transport Injuries Other External Causes Other External Causes All Other Causes All Other Causes -100 -75 -50 -25 0 25 -75 -50 -25 0 25 Absolute Change in Mortality Rate 1990-93 to 2000-02 to 2009-11 to 2000-02 2009-11 2015-17 Increase Decrease FIGURE 4-1 Continued
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From page 133... ...
Mortality rates within each age group are age-adjusted by single-year of age to match the age distribution of the U.S. population in 2000 in order to improve comparability over time.
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From page 134... ...
Black and Hispanic females ages 55–64 continued to experience reductions in mortality from hypertensive heart disease until the 2010s, during which it increased. As noted earlier, previous studies have considered mortality from drug poisoning, alcohol-induced causes, and suicide together as a group.
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From page 135... ...
rising mortality from drug poisoning and other causes of death, such as nervous system diseases, hypertensive heart disease, and ENM diseases; and (2) slower progress in lowering mortality from heart diseases and other leading causes of death that drove improvements in all-cause mortality rates in prior decades.
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From page 136... ...
NH White Females Ages 45-54 HIV/AIDS HIV/AIDS Other Infectious Disease Other Infectious Disease Liver Cancer Liver Cancer Lung Cancer Lung Cancer Other Cancers Other Cancers ENM Diseases ENM Diseases Hypertensive Disease Hypertensive Disease Ischemic & Circulatory Ischemic & Circulatory Drug Poisoning Drug Poisoning Alcohol-Induced Alcohol-Induced Mental & Behavioral Mental & Behavioral Suicide Suicide Nervous System Nervous System Genitourinary System Genitourinary System Respiratory System Respiratory System Digestive System Digestive System Homicides Homicides Transport Injuries Transport Injuries Other External Causes Other External Causes All Other Causes All Other Causes -25 0 25 50 -50 -25 0 25 50 c. NH White Females Ages 55-64 HIV/AIDS Other Infectious Disease Liver Cancer Lung Cancer Other Cancers ENM Diseases Hypertensive Disease Ischemic & Circulatory Drug Poisoning Alcohol-Induced Mental & Behavioral Suicide Nervous System Genitourinary System Respiratory System Digestive System Homicides Transport Injuries Other External Causes All Other Causes -100 -75 -50 -25 0 25 50 FIGURE 4-2 Decomposition of change in cause-specific mortality rates (deaths per 100,000 population)
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From page 137... ...
NH Black Females Ages 45-54 HIV/AIDS HIV/AIDS Other Infectious Disease Other Infectious Disease Liver Cancer Liver Cancer Lung Cancer Lung Cancer Other Cancers Other Cancers ENM Diseases ENM Diseases Hypertensive Disease Hypertensive Disease Ischemic & Circulatory Ischemic & Circulatory Drug Poisoning Drug Poisoning Alcohol-Induced Alcohol-Induced Mental & Behavioral Mental & Behavioral Suicide Suicide Nervous System Nervous System Genitourinary System Genitourinary System Respiratory System Respiratory System Digestive System Digestive System Homicides Homicides Transport Injuries Transport Injuries Other External Causes Other External Causes All Other Causes All Other Causes -50 -25 0 25 -100 -75 -50 -25 0 25 f. NH Black Females Ages 55-64 HIV/AIDS Other Infectious Disease Liver Cancer Lung Cancer Other Cancers ENM Diseases Hypertensive Disease Ischemic & Circulatory Drug Poisoning Alcohol-Induced Mental & Behavioral Suicide Nervous System Genitourinary System Respiratory System Digestive System Homicides Transport Injuries Other External Causes All Other Causes -250 -200 -150 -100 -50 0 50 Absolute Change in Mortality Rate 1990-93 to 2000-02 to 2009-11 to 2000-02 2009-11 2015-17 Increase Decrease continued
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From page 138... ...
Hispanic Females Ages 45-54 HIV/AIDS HIV/AIDS Other Infectious Disease Other Infectious Disease Liver Cancer Liver Cancer Lung Cancer Lung Cancer Other Cancers Other Cancers ENM Diseases ENM Diseases Hypertensive Disease Hypertensive Disease Ischemic & Circulatory Ischemic & Circulatory Drug Poisoning Drug Poisoning Alcohol-Induced Alcohol-Induced Mental & Behavioral Mental & Behavioral Suicide Suicide Nervous System Nervous System Genitourinary System Genitourinary System Respiratory System Respiratory System Digestive System Digestive System Homicides Homicides Transport Injuries Transport Injuries Other External Causes Other External Causes All Other Causes All Other Causes -25 -15 -5 5 15 25 -50 -25 0 25 i. Hispanic Females Ages 55-64 HIV/AIDS Other Infectious Disease Liver Cancer Lung Cancer Other Cancers ENM Diseases Hypertensive Disease Ischemic & Circulatory Drug Poisoning Alcohol-Induced Mental & Behavioral Suicide Nervous System Genitourinary System Respiratory System Digestive System Homicides Transport Injuries Other External Causes All Other Causes -125 -100 -75 -50 -25 0 25 Absolute Change in Mortality Rate 1990-93 to 2000-02 to 2009-11 to 2000-02 2009-11 2015-17 Increase Decrease FIGURE 4-2 Continued
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From page 139... ...
Throughout the period, more than 70 percent of all deaths due to a mental or behavioral disorder were due to either alcohol or drug use. For this reason, the explanations for mortality due to drug poisoning, alcohol-induced causes, and mental and behavioral disorders are discussed together in Chapter 7.
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From page 140... ...
The results presented in Table 4-4 indicate that in addition to these key causes of death, several other causes -- including infectious and parasitic diseases other than HIV/AIDS, liver cancer, diseases of the nervous system, transport accidents, and homicide -- also contributed to rising mortality over the period. The results presented in this chapter demonstrate that drug poisoning mortality rose throughout the study period and was the single largest contributor to the overall increases in mortality among working-age adults, except older (ages 45–64)
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From page 141... ...
TABLE 4-4 Summary of Findings: Cause-Specific Mortality Among Working-Age Adults, 1990–2017 Ages 25–44 Ages 45–54 Ages 55–64 Males Females Males Females Males Females Black Black Black Black Black Black White White White White White White Hispanic Hispanic Hispanic Hispanic Hispanic Hispanic Infectious and Parasitic Diseases HIV/AIDS Non-HIV/AIDS Cancers Liver Cancer Lung Cancer All Other Cancers Cardio and Metabolic Diseases Endocrine, Nutritional, & Metabolic Hypertensive Heart Disease Ischemic & Other Circulatory System Substance Use & Mental Health Drug Poisoning Alcohol-Induced* 141 continued
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From page 142... ...
TABLE 4-4 Continued 142 Ages 25–44 Ages 45–54 Ages 55–64 Males Females Males Females Males Females Black Black Black Black Black Black White White White White White White Hispanic Hispanic Hispanic Hispanic Hispanic Hispanic Suicide Mental & Behavioral Disorders Other Body System Diseases Nervous System Genitourinary System Respiratory System Digestive System* Other Causes of Death Homicide Transport Accidents Other External Causes All Other Causes
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From page 143... ...
Significant contributor to decreasing LEGEND: Significant contributor to rising mortality mortality Minor contributor to rising mortality Minor contributor to decreasing mortality Mortality is unchanged Progress has stagnated or reversed * Changes in the International Classification of Diseases (ICD)
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From page 144... ...
Unlike increased mortality due to drug poisoning, increases in suicide deaths occurred primarily among working-age Whites, particu larly White men. Among White adults, suicide rates were highest in non metros and lowest in large central metros -- whereas the largest increases in mortality from drug poisoning were within large central metros -- and were higher among older (ages 45–64)
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From page 145... ...
These increases were larger outside of large central metros, particularly among White males and females, contributing to the growing mortality gap between large central metros and less-populated areas. As discussed at length in Chapter 9, although mortality due to the combined category of ischemic heart disease and other circulatory diseases declined dramatically overall during the study period among working-age adults, these gains slowed and, in some cases, reversed in the 2010s.
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From page 146... ...
For example, mortality from ischemic heart disease and other circulatory system diseases was examined as a combined group, but "other circulatory system diseases" encompassed all circulatory system diseases besides ischemic heart disease and hypertensive heart disease, including arrhythmias, cardiomyopathy, heart failure, cardiac arrest, stroke, intracerebral hemorrhage, and pulmonary embolism. Because the committee's purpose was to identify the key drivers of recent changes in working-age mortality rather than to fully explore recent changes in all causes of death, this report focuses on mortality trends for entire body systems, such as the nervous, genitourinary, respiratory, and digestive systems, without detailing more pronounced increases in mortality from specific diseases within these body systems.
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From page 147... ...
However, to the extent that the recent increases in mortality due to liver cancer are linked to drug and alcohol use or diabetes, the explanations for these trends in Chapters 7 and 9, respectively, may be relevant. This "collateral" mortality effect could also have contributed to changes in more detailed causes of death contained within the 20 broad cause-ofdeath categories examined in this chapter.
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From page 148... ...
ANNEX 4-1 Trends in Cause-Specific Mortality Among American Indians and Alaska Natives The American Indian/Alaska Native (AI/AN) population has the highest mortality rates for more causes of death of all racial/ethnic groups.
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From page 149... ...
CAUSE-SPECIFIC MORTALITY AMONG WORKING-AGE ADULTS 149 FEMALE MALE AI/AN W AI/AN W Cancer 1 2 2 2 Heart Disease 2 1 1 1 Accidents 3 6 3 4 Diabetes mellitus 4 8 4 6 Stroke 5 3 8 5 Chronic liver disease 6 12 5 10 Chronic lower respiratory disease 7 4 7 3 Influenza and pneumonia 8 7 10 8 Kidney disease 9 9 11 11 Sep cemia 10 10 12 13 Alzheimer disease 11 5 Suicide 12 16 6 7 Assault (homicide) 9 19 ANNEX FIGURE 4-1 Leading causes of death in Contract Health Service Delivery Area (CHSDA)
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From page 150... ...
CAUSE-SPECIFIC MORTALITY TRENDS BY METROPOLITAN AREA STATUS 150 ANNEX TABLE 4-1 Absolute Change in Cause-Specific Mortality and Percentage of Total Increase or Decrease in Mortality by Size of Metropolitan Area, 1990–1993 to 2015–2017: Non-Hispanic White Adults MALES Ages 25–44 Ages 45–64 Small or Small or Large Central Large Fringe Medium Large Central Large Fringe Medium Metro Metro Metro Nonmetro Metro Metro Metro Nonmetro All-Cause Mortality Rate 1990–1993 224.09 196.33 195.06 206.06 838.81 830.48 865.54 878.35 All-Cause Mortality Rate 2015–2017 198.33 238.70 236.00 267.70 643.75 767.65 812.83 872.60 Change 1990–1993 to 2015–2017 –25.76 42.37 40.94 61.63 –195.06 –62.83 –52.71 –5.75 (Change as % of 1990– 1993 mortality) –11.50 21.58 20.99 29.91 –23.25 –7.57 –6.09 –0.65 % of % of % of % of % of % of % of % of Total Total Total Total Total Total Total Total Abs +/– Abs +/– Abs +/– Abs +/– Abs +/– Abs +/– Abs +/– +/– Cause of Death Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Abs Chg Chg Infectious and Parasitic Diseases HIV/AIDS –51.60 –57.9 –23.30 –55.5 –16.18 –44.9 –10.39 –41.1 –27.71 –9.2 –8.42 –3.8 –5.14 –2.4 –3.09 –1.7 Non-HIV/AIDS –2.36 –2.6 0.13 0.1 0.63 0.8 1.58 1.8 6.20 5.8 12.20 7.6 12.17 7.5 14.61 8.4 Cancers Liver Cancer 0.00 0.0 –0.02 0.0 0.18 0.2 0.11 0.1 6.72 6.3 10.02 6.2 9.62 5.9 9.75 5.6 Lung Cancer –2.88 –3.2 –2.55 –6.1 –2.62 –7.3 –2.44 –9.7 –66.59 –22.1 –58.74 –26.3 –61.14 –28.5 –51.07 –28.4 All Other Cancers –7.48 –8.4 –5.33 –12.7 –4.36 –12.1 –3.07 –12.1 –46.97 –15.6 –27.35 –12.2 –22.27 –10.4 –12.66 –7.0
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From page 151... ...
–2.15 –2.4 –0.06 –0.2 0.10 0.1 1.55 1.8 –1.14 –0.4 6.56 4.1 9.83 6.1 12.49 7.2 Other Causes of Death Homicide –4.01 –4.5 –1.64 –3.9 –0.53 –1.5 –1.40 –5.5 –3.00 –1.0 –0.92 –0.4 –1.64 –0.8 –0.86 –0.5 Transport Injuries –5.05 –5.7 –3.84 –9.1 –6.70 –18.6 –5.52 –21.8 0.85 0.8 3.40 2.1 4.29 2.6 5.03 2.9 Other External Causes of Death –1.30 –1.5 0.25 0.3 –1.54 –4.3 –2.47 –9.8 4.59 4.3 6.72 4.2 5.56 3.4 4.94 2.8 151 continued
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From page 152... ...
–89.19 –42.01 –36.05 –25.31 –301.35 –223.29 –214.88 –179.94 FEMALES Ages 25–44 Ages 45–64 Small or Small or Large Central Large Fringe Medium Large Central Large Fringe Medium Metro Metro Metro Nonmetro Metro Metro Metro Nonmetro All-Cause Mortality Rate 1990–1993 87.28 87.77 90.17 94.04 483.81 474.45 490.11 485.17 All-Cause Mortality Rate 2015–2017 103.91 132.37 132.61 156.66 396.31 471.08 503.41 557.48 Change 1990–1993 to 2015–2017 16.63 44.60 42.43 62.63 –87.50 –3.37 13.29 72.31 (Change as % of 1990– 1993 mortality)
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From page 153... ...
% of % of % of % of % of % of % of % of Total Total Total Total Total Total Total Total Abs +/– Abs +/– Abs +/– Abs +/– +/– +/– Abs +/– Abs +/– Cause of Death Chg Chg Chg Chg Chg Chg Chg Chg Abs Chg Chg Abs Chg Chg Chg Chg Chg Chg Infectious and Parasitic Diseases HIV/AIDS –2.70 –14.7 –1.18 –10.6 –0.90 –7.6 –0.43 –6.1 –0.69 –0.5 –0.24 –0.2 –0.08 –0.1 0.13 0.1 Non-HIV/AIDS 0.41 1.2 1.20 2.2 1.42 2.6 2.58 3.7 5.08 8.4 7.43 7.4 8.66 7.8 10.59 7.8 Cancers Liver Cancer 0.13 0.4 0.25 0.4 0.08 0.2 0.10 0.1 1.77 2.9 1.96 2.0 2.23 2.0 2.32 1.7 Lung Cancer –1.98 –10.8 –1.52 –13.7 –1.02 –8.5 –0.72 –10.1 –31.63 –21.4 –20.18 –19.5 –17.77 –18.3 –5.75 –9.1 All Other Cancers –8.72 –47.5 –6.37 –57.3 –7.59 –63.5 –5.66 –79.9 –62.00 –41.9 –45.07 –43.5 –46.05 –47.3 –33.41–53.0 Cardio and Metabolic Diseases Endocrine, Nutritional, & Metabolic 0.84 2.4 2.06 3.7 2.15 4.0 4.51 6.5 1.61 2.6 5.19 5.2 6.75 6.1 9.92 7.3 Hypertensive Heart Disease 0.95 2.7 1.54 2.8 1.57 2.9 1.98 2.8 4.66 7.7 6.68 6.7 6.55 5.9 8.07 6.0 Ischemic & Other Circulatory System –1.30 –7.1 1.95 3.5 3.20 5.9 6.77 9.7 –50.49 –34.1 –36.65 –35.4 –32.76 –33.7 –23.66–37.6 Substance Use and Mental Health Drug Poisoning 24.73 70.7 30.63 55.0 25.58 47.0 27.23 39.1 23.64 39.0 27.91 27.8 25.61 23.2 26.92 19.9 Alcohol-Induced* 0.94 2.7 2.12 3.8 2.35 4.3 2.09 3.0 4.68 7.7 7.20 7.2 7.73 7.0 6.58 4.9 153 continued
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From page 154... ...
35.01 55.71 54.38 69.70 60.58 100.20 110.58 135.28 Total Change: Decrease (–)
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From page 155... ...
Dark green highlights indicate that a cause of death is responsible for ≥10 percent of the total decrease in mortality. The table shows the change in all-cause and cause-specific mortality rates among non-Hispanic White working-age males (upper table)
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From page 156... ...
ANNEX TABLE 4-2 Absolute Change in Cause-Specific Mortality and Percentage of Total Increase or Decrease in 156 Mortality by Size of Metropolitan Area, 1990–1993 to 2015–2017: Non-Hispanic Black Adults MALES Ages 25–44 Ages 45–64 Small or Small or Large Central Large Fringe Medium Large Central Large Fringe Medium Metro Metro Metro Nonmetro Metro Metro Metro Nonmetro All-Cause Mortality Rate 1990–1993 642.70 477.67 430.49 466.44 1728.58 1622.77 1717.77 1809.05 All-Cause Mortality Rate 2015–2017 314.95 336.96 323.99 316.37 1033.27 1128.13 1176.07 1255.89 Change 1990–1993 to 2015–2017 –327.75 –140.71 –106.50 –150.07 –695.31 –494.64 –541.70 –553.16 (Change as % of 1990–1993 mortality) –51.00 –29.46 –24.74 –32.17 –40.22 –30.48 –31.53 –30.58 % of % of % of % of % of % of % of % of Total Total Total Total Total Total Total Total +/– Abs +/– Abs +/– Abs +/– Abs +/– +/– Abs +/– Abs +/– Cause of Death Abs Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Abs Chg Chg Chg Chg Chg Chg Infectious and Parasitic Diseases HIV/AIDS –162.04 –47.2 –81.50 –45.7 –45.50 –30.4 –39.25 –22.1 –77.72 –10.1 –26.20 –4.3 –10.06 –1.6 –7.98 –1.2 Non-HIV/AIDS –12.25 –3.6 –4.90 –2.7 –2.80 –1.9 –0.96 –0.5 –4.33 –0.6 12.25 11.2 8.95 10.4 14.35 14.9
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From page 157... ...
Cancers Liver Cancer –0.55 –0.2 –1.18 –0.7 –0.23 –0.2 –0.53 –0.3 9.88 13.9 18.67 17.0 12.89 14.9 12.74 13.2 Lung Cancer –8.09 –2.4 –7.39 –4.1 –6.04 –4.0 –8.52 –4.8 –134.27 –17.5 –124.09 –20.5–131.94 –21.0–117.10 –18.0 All Other Cancers –14.93 –4.3 –13.49 –7.6 –11.47 –7.7 –13.93 –7.9 –111.57 –14.6 –94.25 –15.6–108.05 –17.2 –83.64 –12.9 Cardio and Metabolic Diseases Endocrine, Nutritional, & Metabolic 0.38 2.4 4.81 12.8 10.49 24.3 6.26 22.9 3.58 5.1 13.13 12.0 5.77 6.7 17.77 18.4 Hypertensive Heart Disease 4.18 26.6 7.13 19.0 5.95 13.8 6.00 22.0 1.28 1.8 10.33 9.4 10.95 12.7 14.99 15.5 Ischemic & Other Circulatory System –28.35 –8.3 –17.41 –9.8 –20.47 –13.7 –30.82 –17.4 –256.29 –33.5 –235.33 –38.9–254.34 –40.5–299.87 –46.2 Substance Use and Mental Health Drug Poisoning 11.05 70.3 22.90 61.1 24.57 57.0 13.34 48.8 50.97 71.9 39.01 35.6 29.02 33.6 19.22 19.9 Alcohol-Induced* –12.07 –3.5 –9.45 –5.3 –8.81 –5.9 –8.91 –5.0 –26.93 –3.5 –18.42 –3.0 –18.61 –3.0 –13.97 –2.1 Suicide –2.03 –0.6 1.09 2.9 –2.70 –1.8 –1.70 –1.0 –2.65 –0.3 –0.44 –0.1 0.44 0.5 –2.83 –0.4 Mental & Behavioral Disorders –12.03 –3.5 –7.93 –4.4 –6.72 –4.5 –8.77 –4.9 –18.97 –2.5 –13.54 –2.2 –15.63 –2.5 –18.73 –2.9 Other Body System Diseases Nervous System 0.10 0.7 1.06 2.8 1.65 3.8 0.65 2.4 5.14 7.2 8.96 8.2 11.32 13.1 8.96 9.3 157 continued
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From page 158... ...
15.71 37.51 43.10 27.32 70.86 109.71 86.48 96.51 Total Change: Decrease (–)
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From page 159... ...
FEMALES Ages 25–44 Ages 45–64 Small or Small or Large Central Large Fringe Medium Large Central Large Fringe Medium Metro Metro Metro Nonmetro Metro Metro Metro Nonmetro All-Cause Mortality Rate 1990–1993 252.59 218.15 217.28 231.14 919.69 889.80 948.43 951.95 All-Cause Mortality Rate 2015–2017 150.31 180.52 184.40 217.15 640.65 701.81 762.33 805.23 Change 1990–1993 to 2015–2017 –102.28 –37.62 –32.88 –13.99 –279.04 –187.99 –186.10 –146.71 (Change as % of 1990– 1993 mortality) –40.49 –17.25 –15.13 –6.05 –30.34 –21.13 –19.62 –15.41 % of % of % of % of % of % of % of % of Total Total Total Total Total Total Total Total +/– Abs +/– Abs +/– Abs +/– Abs +/– Abs +/– Abs +/– Abs +/– Cause of Death Abs Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Infectious and Parasitic Diseases HIV/AIDS –35.37 –31.4 –16.95 –26.6 –7.03 –10.7 –5.16 –10.4 –6.61 –2.1 2.83 5.1 1.67 2.5 4.64 6.5 Non-HIV/AIDS –4.08 –3.6 –2.00 –3.1 –2.31 –3.5 2.95 8.3 1.79 5.5 8.67 15.5 11.32 16.7 11.65 16.4 Cancers Liver Cancer 0.00 0.0 –0.16 –0.3 –0.01 0.0 –0.22 –0.5 3.11 9.6 4.96 8.9 2.19 3.2 2.84 4.0 Lung Cancer –3.55 –3.2 –3.15 –4.9 –3.52 –5.4 –1.97 –4.0 –34.61 –11.1 –23.38 –9.6 –26.96 –10.6 –12.41 –5.7 All Other Cancers –14.26 –12.7 –11.25 –17.7 –11.10 –16.9 –16.42 –33.2 –77.78 –25.0 –62.91 –25.8 –71.53 –28.2 –41.80 –19.2 159 continued
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From page 160... ...
ANNEX TABLE 4-2 Continued 160 Cardio and Metabolic Diseases Endocrine, Nutritional, & Metabolic 0.99 9.7 6.51 25.0 8.44 25.9 9.23 26.0 –11.21 –3.6 –12.12 –5.0 –3.65 –1.4 –3.58 –1.6 Hypertensive Heart Disease 1.13 11.1 3.42 13.1 4.21 12.9 3.45 9.7 –6.99 –2.2 2.71 4.9 –4.48 –1.8 2.93 4.1 Ischemic & Other Circulatory System –15.89 –14.1 –7.93 –12.4 –16.67 –25.5 –7.11 –14.4 –139.59 –44.8 –130.14 –53.4 –127.93 –50.4 –145.76 –67.0 Substance Use and Mental Health Drug Poisoning 6.68 65.5 10.37 39.8 10.66 32.7 6.76 19.0 21.16 65.4 15.30 27.3 14.01 20.7 10.15 14.3 Alcohol-Induced* –4.01 –3.6 –3.28 –5.2 –2.61 –4.0 –3.59 –7.3 –4.97 –1.6 –4.50 –1.8 –4.06 –1.6 –3.26 –1.5 Suicide 0.26 2.5 0.68 2.6 0.84 2.6 0.77 2.2 –0.25 –0.1 0.05 0.1 –0.99 –0.4 –0.31 –0.1 Mental & Behavioral Disorders –3.78 –3.4 –2.51 –3.9 –1.93 –2.9 –3.13 –6.3 –1.45 –0.5 –1.99 –0.8 –3.50 –1.4 –0.79 –0.4 Other Body System Diseases Nervous System 1.15 11.2 2.79 10.7 2.46 7.5 2.82 7.9 6.28 19.4 10.19 18.2 10.24 15.1 11.90 16.8 Genitourinary System –0.70 –0.6 1.43 5.5 1.45 4.4 3.66 10.3 –2.33 –0.7 6.43 11.5 8.74 12.9 6.08 8.6 Respiratory System –6.59 –5.9 –1.25 –2.0 –1.97 –3.0 –0.36 –0.7 –5.20 –1.7 1.77 3.2 13.01 19.2 13.47 19.0 Digestive System*
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From page 161... ...
Dark green highlights indicate that a cause of death is responsible for ≥10 percent of the total decrease in mortality. The table shows the change in all-cause and cause-specific mortality rates among non-Hispanic Black working-age males (upper table)
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From page 162... ...
ANNEX TABLE 4-3 Absolute Change in Cause-Specific Mortality and Percentage of Total Increase or Decrease in 162 Mortality by Size of Metropolitan Area, 1990–1993 to 2015–2017: Hispanic Adults MALES Ages 25–44 Ages 45–64 Small or Large Central Large Fringe Small or Large Central Large Fringe Medium Metro Metro Medium Metro Nonmetro Metro Metro Metro Nonmetro All-Cause Mortality Rate 1990–1993 305.04 245.27 220.74 241.11 743.83 731.25 699.50 783.61 All-Cause Mortality Rate 2015–2017 136.69 165.00 156.08 165.45 493.84 604.94 571.72 614.95 Change 1990–1993 to 2015–2017 –168.35 –80.28 –64.67 –75.66 –249.99 –126.30 –127.78 –168.67 (Change as % of 1990–1993 mortality) –55.19 –32.73 –29.30 –31.38 –33.61 –17.27 –18.27 –21.52 % of % of % of % of % of % of % of Total % of Total Total Total Total Total Total Abs +/– Abs Total Abs +/– +/– Abs +/– Abs +/– +/– Cause of Death Abs Chg +/– Chg Chg Chg Chg +/– Chg Chg Chg Abs Chg Chg Chg Chg Chg Chg Abs Chg Chg Infectious and Parasitic Diseases HIV/AIDS –86.08 –48.9 –31.87 –34.9 –20.92 –25.6 –14.90 –16.2 –54.30 –18.6 –10.18 –5.4 –12.18 –6.4 –5.14 –2.2 Non-HIV/AIDS –5.29 –3.0 –1.42 –1.6 –1.35 –1.6 –0.53 –0.6 3.74 8.9 11.34 18.5 11.98 19.2 13.81 21.4 Cancers Liver Cancer –0.39 –0.2 –0.04 0.0 –0.45 –0.5 0.48 3.0 8.21 19.4 12.74 20.8 13.01 20.9 14.16 22.0 Lung Cancer –1.59 –0.9 –0.48 –0.5 0.16 1.0 –1.64 –1.8 –26.36 –9.0 –24.47 –13.0 –24.03 –12.6 –29.55 –12.7 All Other Cancers –4.04 –2.3 –3.28 –3.6 –3.93 –4.8 –3.98 –4.3 –25.68 –8.8 –27.68 –14.7 –22.46 –11.8 –20.00 –8.6
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From page 163... ...
Cardio and Metabolic Diseases Endocrine, Nutritional, & Metabolic 0.32 4.2 0.37 3.3 2.35 13.8 1.09 6.7 4.87 11.5 0.96 1.6 –9.40 –4.9 –0.75 –0.3 Hypertensive Heart Disease 1.36 17.6 1.68 15.1 1.09 6.4 2.30 14.2 4.52 10.7 9.08 14.8 6.66 10.7 6.79 10.5 Ischemic & Other Circulatory System –8.06 –4.6 –5.16 –5.6 –5.65 –6.9 –4.11 –4.5 –108.74 –37.2 –94.01 –50.1 –83.15 –43.7 –131.73 –56.5 Substance Use and Mental Health Drug Poisoning 6.01 78.2 8.44 75.6 8.30 48.6 11.02 68.1 15.14 35.9 18.98 30.9 18.61 29.9 15.29 23.7 Alcohol-Induced* –7.03 –4.0 –5.04 –5.5 –3.80 –4.6 –6.84 –7.4 –14.79 –5.1 –3.21 –1.7 0.41 0.7 –7.06 –3.0 Suicide –1.79 –1.0 –1.47 –1.6 2.68 15.7 –3.01 –3.3 –4.40 –1.5 –0.14 –0.1 –5.33 –2.8 –3.36 –1.4 Mental & Behavioral Disorders –4.49 –2.5 –3.87 –4.2 –4.88 –6.0 –3.32 –3.6 –4.67 –1.6 –4.85 –2.6 1.08 1.7 –3.13 –1.3 Other Body System Diseases Nervous System –0.16 –0.1 0.56 5.0 2.28 13.4 1.07 6.6 3.00 7.1 5.08 8.3 5.99 9.6 4.28 6.6 Genitourinary System –0.51 –0.3 0.12 1.1 0.18 1.1 0.23 1.4 2.39 5.7 1.28 2.1 4.30 6.9 7.70 12.0 Respiratory System –4.02 –2.3 –1.67 –1.8 0.04 0.2 –1.98 –2.2 –10.84 –3.7 –7.04 –3.8 –5.11 –2.7 –3.46 –1.5 Digestive System*
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From page 164... ...
ANNEX TABLE 4-3 Continued 164 % of % of % of % of % of % of % of Total % of Total Total Total Total Total Total Abs +/– Abs Total Abs +/– +/– Abs +/– Abs +/– +/– Cause of Death Abs Chg +/– Chg Chg Chg Chg +/– Chg Chg Chg Abs Chg Chg Chg Chg Chg Chg Abs Chg Chg Other Causes of Death Homicide –31.86 –18.1 –13.15 –14.4 –11.69 –14.3 –13.57 –14.8 –17.63 –6.0 –6.02 –3.2 –4.89 –2.6 –8.28 –3.6 Transport Injuries –8.66 –4.9 –15.28 –16.7 –22.63 –27.7 –25.82 –28.1 –6.93 –2.4 –10.01 –5.3 –15.16 –8.0 –18.44 –7.9 Other External Causes of Death –3.68 –2.1 –2.99 –3.3 –3.75 –4.6 –10.32 –11.2 0.35 0.8 –0.06 0.0 –1.65 –0.9 0.03 0.0 All Other Causes of Death –3.42 –1.9 –1.41 –1.5 –0.83 –1.0 –0.03 0.0 –4.78 –1.6 1.55 2.5 0.25 0.4 –2.14 –0.9 Total Change: Increase (+) 7.69 11.16 17.09 16.20 42.23 61.36 62.28 64.39 Total Change: Decrease (–)
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From page 165... ...
FEMALES Ages 25–44 Ages 45–64 Small or Large Central Large Fringe Medium Large Central Large Fringe Small or Metro Metro Metro Nonmetro Metro Metro Medium Metro Nonmetro All-Cause Mortality Rate 1990–1993 90.29 84.27 86.95 92.35 368.11 402.60 416.57 450.12 All-Cause Mortality Rate 2015–2017 60.57 77.35 77.73 89.30 266.90 327.26 309.09 364.25 Change 1990–1993 to 2015–2017 –29.71 –6.92 –9.22 –3.05 –101.21 –75.33 –107.49 –85.87 (Change as % of 1990– 1993 mortality) –32.91 –8.21 –10.60 –3.30 –27.49 –18.71 –25.80 –19.08 % of % of % of % of % of % of % of Total Total Total Total Total Total % of Total Abs +/– Abs +/– Abs +/– Abs +/– Abs +/– Abs +/– Abs Total Abs +/– Cause of Death Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg +/– Chg Chg Chg Infectious and Parasitic Diseases HIV/AIDS –14.03 –41.0 –5.60 –29.0 –2.97 –12.7 –0.95 –4.9 –6.70 –5.9 –0.61 –0.6 –0.59 –0.4 0.21 0.6 Non-HIV/AIDS –1.68 –4.9 0.42 3.4 0.32 2.3 0.63 3.8 0.69 5.8 4.78 16.6 7.52 28.1 4.00 10.9 Cancers Liver Cancer 0.12 2.7 0.11 0.9 –0.08 –0.3 0.14 0.8 1.89 15.8 1.12 3.9 1.49 5.6 2.15 5.9 Lung Cancer –0.49 –1.4 –0.05 –0.3 0.52 3.7 0.29 1.8 –4.42 –3.9 –6.68 –6.4 –6.39 –4.8 –7.15 –5.8 165 continued
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From page 166... ...
ANNEX TABLE 4-3 Continued 166 % of % of % of % of % of % of % of Total Total Total Total Total Total % of Total Abs +/– Abs +/– Abs +/– Abs +/– Abs +/– Abs +/– Abs Total Abs +/– Cause of Death Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg Chg +/– Chg Chg Chg All Other Cancers –3.71 –10.8 –5.46 –28.3 –5.64 –24.0 –7.28 –37.6 –29.93 –26.5 –28.06 –27.0 –40.93 –30.5 –47.70 –39.0 Cardio and Metabolic Diseases Endocrine, Nutritional, & Metabolic 0.18 3.9 0.91 7.4 0.78 5.5 0.72 4.4 –3.86 –3.4 –10.14 –9.7 –15.25 –11.4 –16.33 –13.3 Hypertensive Heart Disease 0.10 2.1 0.51 4.1 0.57 4.0 0.59 3.6 0.27 2.3 2.14 7.5 0.74 2.7 2.19 6.0 Ischemic & Other Circulatory System –3.24 –9.4 –2.74 –14.2 –1.59 –6.8 –2.08 –10.7 –51.57 –45.6 –52.02 –50.0 –58.10 –43.3 –47.75 –39.0 Substance Use and Mental Health Drug Poisoning 3.75 82.8 6.37 51.5 7.23 50.7 7.91 48.5 5.41 45.2 10.36 36.1 8.15 30.4 7.51 20.5 Alcohol-Induced* –0.11 –0.3 0.36 2.9 0.12 0.8 2.28 14.0 –0.28 –0.2 0.64 2.2 2.31 8.6 5.48 15.0 Suicide 0.23 5.0 0.59 4.8 1.31 9.2 1.62 9.9 –0.06 –0.1 1.50 5.2 1.83 6.8 1.18 3.2 Mental & Behavioral Disorders –0.53 –1.5 0.03 0.3 0.41 2.9 –0.51 –2.6 0.52 4.3 0.82 2.9 0.09 0.3 2.55 7.0 Other Body System Diseases Nervous System 0.15 3.4 0.54 4.4 –0.37 –1.6 –0.37 –1.9 2.83 23.6 4.58 16.0 3.56 13.3 5.54 15.1 Genitourinary System –0.05 –0.1 0.12 1.0 0.53 3.7 0.02 0.1 –0.05 0.0 0.71 2.5 –1.03 –0.8 2.57 7.0
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From page 167... ...
Dark green highlights indicate that a cause of death is responsible for ≥10 percent of the total decrease in mortality. The table shows the change in all-cause and cause-specific mortality rates among Hispanic working-age males (upper table)
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