Mortality Trendsf“Or Leading Causesof Death

Data from the Series 20 NATIONAL VITAL STATISTICSSYSTEM Number 16

Mortality Trendsf“or leading Causesof Death

United States- 1950-69

A study of the trends during 1950-69 for the 15 leading causes of death which accounted for 89 percent of the 1,921,990 deaths occurring in the United States in 1969.

DHEW Publication No. (Hi?A) 74-1853

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service

Heaith Resources Administration Nationai Center for Heaith Statistics Rockviiie, Md. March 1974 I

Library of CongressCataloging in Publication Data

Mortahty trends for leading causes of death: United States, 1950-69.

(National Center for Health Statistics. Data from the national vital statistics system, Series 20, no. 16) (DHEW publication no. (HRA) 74-1853) Bibliography: p. Supt. of Dots. no.: HE20.6209: 20/16 1. United States-Statistics, Vital. 2. Death–Causes. 3. Mortality. I. Title. II. Series: United States. National Center for Health Statistics. Vital and health statistics. Series 20: “Data from the national vital statistics system. Data on mortality, no. 16. III. Series: United States. Dept. of Health, Education, and Welfare. DHEW publication no. (HRA) ?’4-1853, [DNLM: 1. Mortalky–U.S. W2 A N148vt no. 16 1974/ HB1335 K63m 1974] HB1335.A18 no. 16 312’.2’0973s [312’.2’0973] 73-20401

For sale by tbe Snperfntendent of Dammed+ U.S. Government Pintfng 05cc, Wmhfrgton, D.C. 2Mfi2- Price $1,16 NATIONAL CENTER FOR HEALTH STATISTICS

EDWARD B. PERRIN, Ph.D., Director

PHILIP S. LAWRENCE, SC.D., Deputy Dtrector GAIL F. FISHER, Assistant Director for Health Statistics Development JAMES E. KELLY, D.D.S., Dental Adukor EDWARD E. MINTY, Executive Officer ALICE HAYWOOD, Information Officer

DIVISION OF VITAL STATISTICS

ROBERT A. ISRAEL, M.S., Director JOHN E. PATTERSON, Assistant Director for Demographic Affairs ROBERT J. ARMSTRONG, M..$ ChieJ Mortality Statistics Branch

Vital and Health Statistics-Serie# 20-No. 16

DHEW Publication No. (HRA) 74-1853

Libray of Congress Catalog Card Number 73-20401 CONTENTS

Page

Introduction ------1

Summary ------3 Leadiog Causes With Upturn in Mortality: 1950-69 ------3 Leading Causes With Downturn inMortaIity: 1950-69------5

I. Diseases of Heart ------7 . II. Malignant Neoplasms ------10

111. Cerebrovascuk Diseases ------18

IV. Accidents ------__:------21 v. Influenza and Pneumonia ------29

VI. Certain Causes of Mortality in Early Infancy ------31

VII. Diabetes Mellitus ------32

VIII. Arteriosclerosis ------36

Ix. Bronchitis, Emphysema, and Asthma ------39 x. Cirrhosis of Liver ------40 x I. Suicide ------44

XII. Congenital Anomalies ------46

XIII. Homicide ------___--J------:- 48

XIV, Nephritis and Nephrosis------"------.--l------52 xv. Peptic Ulcer ------53

... 111 CONTENTS-Con. .. “

Page

References ------56

List of Deta~edTables ------57

Appendix I. Technical Notes ------68

Appendix II. The United States Standard Certificate of Death, as Revised l968------71

Appendix III. Components of Comparability Ratios for 15 Leading Causea of Death and Their Major Subcategories for Comparing Assignments by Eighth Revision With Those by Seventh Revision, Based on Deaths Occurring in l966------72

Appendix IV. Technical Note on Assignments to Accidents With Category Numbers E916-E921, E923-E928------:------74

SYMBOLS

Data not available ------

Category not applicable ------. . .

Quantity zero ------

Quantity more than O but less than 0.05---- 0.0

Figure does not meet standards of reliability or precision ------* MORTALITY TRENDS LEADING CAUSES OF DEATH:

UNITED STATES, ‘1950-69

A. JoenKlebba,M.A.,JeffreyD. Maurer,B.S.A.,andEvelynJ.Glass,B.S., Divisionof ViAzlStatistics

INTRODUCTION by age,sex,and color.1This reportexamines mortalitytrendsfor 1950-69for the 15 leading causesof deathby age,color,and sex.These 15 Thisisthesecondreportina serieson mor- causesaccountedfor89 percentofthe1,921,990 talitytrendsin theUnitedStates.The firstre- deathsthatoccurredintheUnitedStatesin1969 port analyzedtrendsin deathratesfor1950-69 (tableA).

Table A. Deaths and death ratea for the 15 leading causes of death: United States, 1969

[Rates per 100,000 estimated population] .—

Cauae of death (Eighth Revision, InternationalClaasifica- Number Rate Rank tion of Diseasea, Adapted, 1965) . . . I All cauaea------1,921,990 951.9 1 Diseaaes of heart------39O-398,4O2,4O4,4lO-429 739,265 366.1 2 Malignant neoplasms, including ~eoplasms of lymphaticand hematopoietic tissues------140-209 323,092 160.0 3 Cerebrovasculardiseases------430-438 207,179 102.6 4 Accidents------E8OO-E949 116,385 ;;,: Motor vehicle accidents------E810-E823 55,791 All other accidents------E800-E807,E825-E949 :5,;:; 30:0 5 Influenza and pneumonia------470-474,480-486 , 33.9 6 Certain causea of mortality in early infancy------76O-769.2,769.4-772,774-778 43,171 21.4 7 Diabetes mellitus------250 38,541 19.1 8 Arteriosclerosis------~------44O 33,063 16,4 9 Bronchitis, emphysema, and as‘&ma------490-493 31,144 “15.4 10 Cirrhosis of liver------57l 29,866 14.8 11 Suicide------E95o-E959 22,364 11.1 12 Congenital:anomalies------740-759 17,008 8.4 13 Homicide------E96O-E978 15,477 14 Nephritis and nephrosis------580-584 9,417 ::; 15 Peptic ulcer------53l-533 9,312 ... All other causes------Residual 218,341 10::!

1 TOTAL DEATH RATE3 AGE ADJUSTED DEATH RATES

Raviions Of Ihe rmematianal Clammatim of DMMS?S Rewsto.s of the !nlermumal Cfaslfmtmn of Dmeaw

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%ft.’. ,9.** ..* c.d=fm.” Em.k.m- “.?.1. .,,---- a..- byw.-... - “-” . . -MA

Figurs 1. Fiftsen leading causesof death: tota[ and age-adjusted death rates for 1950-69.

Deaths and death rates for 1969 for the ma- stsndard certificate of death adopted with some jor components of these 15 leading causea are modifications by most States is shown in appen- shown in table 1 (69 cauae list); death rates for ciix H.) 1950-69 for a shorter list of these components During 1900-1969 causes of death were clas- are shown in table 2 (48 cause list); and the cor- sified according to eight revisions of the Inter- responding numbers of deaths for these causes national Classification of Dfseases (lCD). These are shown in table 3. (A description of the sources revisions are made about every 10 years to re- of data, the definitions of rates and other terms, flect progress in medical knowledge. The Re- and the method of ranking cause of death are given vision in use in the United States beginnhtg with in appendix I—Technical Notes. A copy of the data year 1968 is the Eighth Revision of the Znter- .“

2 Reuki.I!s oft6e Imrnationd C[asification of Dmea% sixth SYmel Eighth Sixth and Seventh Revisions are described in a study published in 1965.3 2,000 The direction of 13 of 15 of these leading causes—that is, whether mortality from the cause ~ -ma” .“= .,htid,”;. is increasing or decreasing during 1950-69—is ,.,,my measured by age-adjusted death rates (see figure : : 1 and the age-adjusted death rate tables in the ; I,occl 900 text). The other two leading causes occur almost Y : 800 ‘entirely among infants, and, for these two causes ~ 7MI = the direction is measured by infant mortality ~ Boo rates (figure 2 and tables 4 and 5). : boo For each of the 13 leading causes for which u ? deaths occur at all ages, age-adjusted death rates c 400 ...... c Cmm,ld are used to compute mortality differentials by ...... ;-..yb : color end sex. Trend tables of age-specific rates , 300 used in the construction of the age-adjusted rates are available upon request from the National 200 Center for Health Statistics. For each separate year these age-specific rates are shown in the 160 1 1 I 1 1 1 1 I r 1 I I 1 1 I I I annual report entitled Vihz,lStatistics of the United 1950 1955 1860 1865 1970 States. YEAR A summary of the principal findings in this study is presented in the following section for the reader’s convenience. T%is is followed by 15 Figure 2. Infant mortality rates for Congenital anoma[ies separate sections presenting detailed findings on ( ICDA Nos. 740-759) and for Cartain esuses of mortalitv in early infancy ( ICDA NOS. 760-769.2, 769.4-772, 77& the leading causes of death. 778): 1950-69.

SUMMARY national Ckzssification of Diseases, Adapted fov Use in the United Stites, 1965 (hereinafter cfe- Leading Causes With Upturn in Mortality: 4 noted by ICDA). 1950-69 Deaths occurring during 1950-69, the period covered by this report, were classified accord- As measured by age-adjusted death rates for ing to three Revisions—the Sixth, Seventh, and the total population, there were increases between Eighth. 1950 and 1969 for the followfng six leading causes The important breaks in continuity of mor- of death (in order of the magnitude of their total tality statistics for causes in tables 2 and 3 re- death rates for 1969): (1) Malignant neoplasma, sulting from the introduction of the Eighth Re- including neoplasms of lymphatic and hemato- vision are shown in appendix III. Some of the major poietic tissue~ (2) Diabetes mellitus; (3) Bron- cbsnges in classification and coding procedures chitis, emphysema, and asthm%, (4) Cirrhosis of that brought about these breaks in continui~ are live~ (5) Suicide; and (6) Homicide. presented in another National Center for Health iWaligrtant neopiksms, including neopfasms Statistics (NCHS) report.2 of lymphatic and hemntopoietic tissues. —As Introduction of the Seventh Revision for data measured by age-adjusted death rates, the in- year 1958 also resulted in some breaks in the crease between 1950 end 1969 in mortrdi~ for continuity of mortality statistics in tables 2 and malignant neoplasms amounted to only 3.4 per- 3. But for the most part these breaks were not cent. so large as those resulting from the introduction This moderate increaee resulted tiom tbe of the Eighth Revision. These breaks between the offsetting of substantial increases in the age- adjusted death rate” for male persons (16.2 and for both white’ and other real; persons (with in- 54.9 percent, respectively, for white and all other creases of 145.5 and 121.1 percent, re$pectfw?ly) male persons) by decreases for female persons than for their female counterparts (wfth increases (10.3 and 2.5 percent, respectively, for white and of 53.3 and 37.8 percent, respectively, for white all other female persons). female and other female persons). These disparate changes in mortality for ‘fI-ds steep rise for male persons resulted malignant neoplssms are reflected in both the in a large increase for the mortality sex ratio higher mortality sex ratio’ for this cause (from for these diseases-from 2.81 for 1954 to 4.49 1.08 for 1950 to 1.43 for 1969) and the bigher mor- for 1969. tality color ratiob (from 1.03 for 1950 to 1.25 This cause of death is one of only four of the for 1969). 15 leading causes for which mortality for 1969 Diabetes metlitus. -The nominal increase in was higher for white than for other persous. the age-adjusted death rate for Diabetes mellitus (The other three causes are Suicide, Arterio- between 1950 and 1969 (an increase of only 1.4 sclerosis, and Congenital anomalies.) percent) reflects even more disparate changes Ciwhosis of liver, -The age~adjusted death in mortality from this cause for the four color- rate for this disease increased 67.1 percent be- sex groups than occurred for malignant neo - aveen 1950 and 1969. Although there were sub- plasms. stantial fncreases in mortality from tbfs cause The decrease in the age-adjusted death rate for each of the four color-sex groups, the percent for diabetes for white female persons (18.9 per- increase for persons of races other than white cent) almost offset the substantial increases in was by far greater than that for white persons. mortality from this cause for the other three The percentage increases in the age-adjusted color-sex groups: increases of 13.3, 80.5, and death rates for cirrhosis for white male, white 46.9 percent, respectively, for white male, other femaIe, other male, and other female persons male; and other female persons. were, respectively, 55.2, 46.6, 248.9, and 198.3. Diabetes mellitus is the only one of the 15 As a result of these greater increases for leading causes for which -mortality for male persons of races other than white, the mortality persons was lower then that for female persons; color ratio for Cirrhosis of liver increased from but during 1950-69 the steep increase in mor- 0.86 for 1950 to 1.86 for 1969. tality from this disease for male persons has The excess mortalfty for this disease among narrowed the gap between their rate and that for males over that among females remained about female persons. The mortality sex ratio for dia- the same—with a mortality sex ratio of 1.97 for betes increased from 0.67 for 1950 to 0.90 for 1950 and 2.04 for 1969. 1969. Suicide. -“f’be trend of the age-adjusted death The mortaliq color ratio also increased— rate for this cause was slowly downward during from 1.24 for 1950 to 2.10 for 1969. 1950-57, but for 1958-69 the trend was upward. Bronchitis, emphysema, and asthma. —The The 1969 age-adjusted death rate for Suicide was age- adjusted death rate for these three diseases 7.6 percent higher than the corresponding rate taken together more than doubled between 1954 for 1958. This increase was recorded despite the (the earliest year for whfch these data are avsfl- fact that for 1968 and 1969, for which years deaths able) and 1969. The increase of 106.9 percent were classified by the Eighth Revision, 5.3 per- reflects increases in the age-adjusted death rate cent fewer deaths were assigned to Suicide than for these diseases for each of the four color- would have been assigned to dds cause if the sex groups. But the rise in mortality was greater Sevetith Revision had been used, as it was for the years 1958-67, TMs relative increase in Suicide for the ‘Age-adjusteddeathratefor the mde population divided by thecorrespondingracefor thefemalepopulation. total population reflects very large relative in- bAge-adjusteddeathratefor thepopulationof racesother creases in the age-adjusted death rates for Sui- “&anwhite dbided by the cortesponttingrate for the white cide for female persons (38.0 and 52.4 percent, population. respectively, for white and other female persons);

4 a substantially smaller relative increase for male persons, to about 25 percent. The corre- other male persons (21.4 percent); and a decrease sponding reduction for wKlte male persons was for white male persons (1.1 percent). only about 7 percent and for other male persons, As mentioned earlier Suicide is one of only also only about 7 percent. As a result of this un- four of the 15 leading causes of death for which equal reduction for male and female persons, the mortality for persons of races other than white mortality sex ratio increased; the 1969 age- is lower than that for white persons. For 1950 adjusted death rate for Diseases of heart for the color mortality ratio for Suicide was 0.41; male persons was about 1.95 times the corre- and for 1969, 0.55. spcmding rate for female persons. For 1950 this Male persons continue to have by far higher mortality sex ratio was only 1.64. mortality for Suicide than female persons; but The mortality color ratio for Diseases of the mortality sex ratio for Suicide is decreasing, heart (the age-adjusted death rate for the pop- dropping from a ratio of 3.53 for 1950 to 2.57 for ulation of races other than white &lvided by the 1969. corresponding rate for the white population) was Homicide. —After turning downward and then lower than the corresponding mortaliW sex ratio, leveling off during the 1950’s, the death rate for and remained quite stable during 1950-69, de- Homicide continued upward throughout the 1960’s. creasing slightly from 1.25 for 1950 to 1.22” for The relative increase of 75.5 percent in the total 1969. (See downturn of Ischemic beart disease, Homicide rate between 1958 and 1969 reflects the pages 9-10.) following increases for the four color-sex groups: Ce-rebvouoscukw diseases.-The percentage white male, 83.3 percenv, other male, 74.0 per- decrease in the age-adjusted death rate for Cere- cent; white female, 50 percent; and other female, brovascular diseases between 1950 and 1969 :31.4 percent. (about 23 percent) was even greater than that for Despite the larger relative increases in the Diseases of heart. Again, as for Diseases of heart, age-adjusted death rate for Homicide for white this reduction reflects decreases in mortali~ persons,the 1969 rate for other persons was 9.60 from Cerebrovascular diseases for each of the times the corresponding rate for white persons. four color-sex groups-but particularly for white This 1969 mortality color ratio for Homicide, and other female persons. however, was somewhat lower than the corre- The long- established mortality differential sponding mortality color ratio for 1950 (11 .35). by color for Cerebrovascular diseases became For 1969 the age-adjusted death rate for even greater between 1950 and 1969. For tbe Homicide for male persons was 3.97 times the latter year the age-adjusted death rate for these corresponding rate for female persons. This 1969 dise?ses for persons other than wtite was 1.84 mortality sex ratio for Homicide showed a slight times the corresponding rate for white persons. increase over that for 1950 (3.36). For 1950 this ratio was 1.79. The mortality sex ratio for Cerebrovascular diseases was much lower than the mortality color Leading Causes With Downturn in ratio through the first half of this century, but Mortality: 1950-69 this mortslity sex ratio increased somewhat be- The following nine causes of death with de- tween 1950 (with a ratio of 1.07) and 1969 (with creases in mortality during 1950-69 are also a ratio of 1.18). presented in order of the magnitude of their total Accidents.—A word of caution is in order death rates for 1969. about including Accidents under the title’ ‘Leading Diseases of keavt.-The age-adjusted death Causes With Downturn in Mortality: 1950-69.” rate for Diseases of heart decreased between While it is true that the age-adjusted death rate 1950 and 1969 about 15 percent. This reduction for Accidents for 1969 (55.3 deaths per 100,000) reflects lowering of this rate for each of the four is 3.8 percent lower than the corresponding rate color - sex groups—but especially for female per- for 1950, Accidents is one of several of the 15 sons. For white female persogs the reduction leading causes for which during 1950-69 there amounted to about 22 percent, and for other fe- was first a downturn in mortality (during the

5 I 1950’s)and then an upturn (during the 1960’s). But infant mortality rate for the nearly comparable i by 1969 the age-adjusted death rate for Accidents group of diseases under the Sixth and Seventh ‘had not yet reached the level recorded for 1950. Revision title “Certain diseases of early infancy.f’ The comparability ratio for Accidents between Part of this reduction proceeds from thqfact the Seventh and Eighth Revisions indicates that that about 8 percent fewer deaths were assigned about 4.3 percent fewer deaths were assigned to to the Eighth Revision title ~han were assigned to accidents for 1968 and 1969. Adjusting the 1967 the Seventh Revision title. The 30 percent re- , I rate by this ratio reduces it from 54.8 deaths to duction in mortali~ from these causes between 52.4 deaths per 100,000 population. This adjusted 1950 and 1969 reflects lowering of the death rate 1967 figure, together with the rates for 1968 and for these diseases for each of the four color- 1969 (55.1 and 55.3 deaths per 100,000 population), sex groups of infants, the reduction for white shows that over this 3-year period mortality infants being somewhat greater than that for other from Accidents was clearly upward. infants. For 1969 the age-adjusted death rate for Ac- The 1969 mortality color ratio for these cidents for male persons was 2.83 times the cor- diseases of early infancy (1.66) was somewhat responding rate for female persons. This mor- greater than the 1969 mortality sex ratio (1.35). tality sex ratio was somewhat greater than that Whereas the mortality sex ratio for infants dying for 1950 (2.64). from these diseases remained fairly constant The mortality color ratio for 1969 for Ac- between 1950 and 1969, the corresponding mor- cidents (1.44) was also greater than that for 1950 tality color” ratio incressed—from 1.46 for 1950 (1.29). to 1.66 for 1969. Infi!uensa and pneumonia. —For these dls- “-‘t ‘?~?~h~ias~~~”~ti~ e.~edutiti of about 43 easea there appears to be a moderate decrease per&nt’ hi”’the age%djwsted death rate for Arte- (about 6 percent) between the age-adjusted death riosclerosis is attributable to a considerable ex- rates for 1950 end 1969—both nonepidemic years tent to the changes in coding procedures intro- for influenza. The level of mortality from these duced with the Eighth Revision, as indicated by the diseases is, of course, greatly affected by the low comparsf.ility ratio between the Seventh and occurrence of epidemics. Eighth Revisions (0.8963). But the major part of Since the year 1968 had a severe epidemic, this reduction may have resulted from the follow- it may be more useful to compare mortality from ing two developments: (1) an actual decrease in Influenza and pneumonia for the two nonepidemic or better control of Arteriosclerosis in the popu- years 1967 and 1969. Increasing the 1967 age- lation as a condition contributing to death and (2) adjusted death rate (20.8 deaths per 100,000) to more complete reporting by physicians of Mor- what it would have been if the Eighth Revision bad mation about the specific manifestations of this been in use for that year raiees it to 21.7 deaths generalized disease of Arteriosclerosis. Accord- per 100,000. Comparing this age-adjusted rate ing to present coding procedures, more specffic with that for 1969 (24.6 deaths per 100,000) shows conditions are usually preferred for tabulation as that mortality from Influenza and pneumonia was the underlying cause of death. appreciably upward during 1967-69. Very similar patterns are found when the The mortality color ratio for these diseases color ratios for mortality from this cause are remained greater during 1950-69 than the mor- examined separately for th~ male population (with taf.fty sex ratio; but the former ratio decreased a mortality color ratio of 0.98 for 1950 and 0.99 between 1950 and 1969 (from 2.48 to 1.88), while for 1969) and for the female population (with a the mortali~ sex ratio increased (from 1.39 for mortality color ratio of 0.96 for both 1950 and 1950 to 1.64 for 1969). 1969). CeYtoin causes of mwikzlity in eavly infancy.— The sex ratio for mortality from Arterio- The 1969 infant mortality rate for the group of sclerosis was higher than the corresponding color diseases brought together under the Eighth Re- ratio during 1950-69, but the trend for the sex vision title “Certain causes of mortality in early ratio appears to be downward-from 1.29 for 1950 infancy” was about 30 percent lower than the 1950 to 1.20 for 1969.

6 Congenial anomalies. —The 1969 infant mor- Peptic WZCW.—Mortality from Peptic ulcer tal.fty rate for Congenital anomalies was about as measured by age-adjusted death rates de- 21 percent lower than the 1950 inftit mortality creased about 28 percent between 1950 and 1969. rate for this group of causes. The true reduction For the most part this reduction represents an for these causes may be even greater, because actual lowering of mortality from this cause—and about 3.6 percent more deaths were assigned to proceeds only in small measure from changes these diseases by the Eighth Revision than had in coding procedures. been assigned to the comparable causes by the The reduction reflects, however, the dropping Seventh Revision. of tbfs death rate only for male persons (both for This lowering of the infant mortality rate for white male and for other male persons). For white Congenital anomalies results primarily from the female persons the 1969 age-adjusted death rate dropping of the death rate for these conditions for Peptic ulcer was 17.6 percent higher than the for white infants, both male and female. Actually corresponding rate for 1950, and for other fe- a slight increase in mortali~ from Congenital male persons, 4.5 percent higher than the rate ‘anomalies between 1950 and 1969 was recorded for 1950. for both male and female infants of races other The 1969 mortality sex ratio for Peptic ulcer than white. White infants, however, still had a (2.70) was more than twice the 1969 mortality , hfgher infant mortality rate for these conditions color ratio for this cause (1.14). But as a result for 1969 than did infants ,of races other than of the decrease in the death rate for Peptic ulcer white. for male persons and the concomitant increase For white infantK thfi~excx~s~:mo~tality for for female persons, the 1969 mortality sex ratio these conditions decreased considerably between dropped far below the corresponding ratio for 1950 and 1969—the mortality color ratio chsng- 1950 (4.61). ing from 0.67 for 1950 to 0.93 for 1969. Nephvitis and nephvosis. —The greatest rel- atfve decrease in mortal.fty for any one of the 15 1. DISEASES OF HEART leading kauses of death occurred for Nephritis end nephrosis—for which the age-adjusted death Diseases of heart (ICDA Nos. 390-398, 402, rate was about 77 percent lower for 1969 (3.9 404, 410-429). —Based on the sample of deaths deaths per 100,000) than for 1950 (16.6 deaths” occurring in 1966, the introduction of the Eighth per 100 ,000). Although part of this reduction re- Revision resulted in an estimated net increase sults from the assignment of about 11 percent of 3,259 deaths assigned to Diseases of heart, fewer deaths to this cause by the Eighth Revision givfng a comparability ratio of 1.0045. There than were assigned by the Seventh Revfsion, the were an estimated 10,711 deaths transferred to steady decline in mortality from these diseases, this title by the Eighth Revision and an estimated year after year, during 1950-69, is believed to 7,452 deaths transferred from this title (appendix represent for the most part a true decrease in III). their death rate. The net effect of these changes, based on The 1969 mortality color ratio for Nephritis coding the sample of deaths occurring in 1966 by and nephrosis (3.52) was higher than that for any both the Seventh and the Eighth Revisions, re- of the 15 leading causes of death except Homicide sulted in increasing the number of deaths as- @.6o) and also was higher than the color ratio for signed to Dkeases of heart from 727,002 by the Nephritis and nepbrosis for 1950 (2.98). The sex Seventh Revision to 730,261 deaths by the Eighth ratio for mortality from this cause was lower for Revision. both white and other populations than was the During the period 1950-67 the total death rate corresponding color ratiq but for both groups for Dkeases of heart rose from 356.8 deaths per the mortality sex ratio was somewhat upwsrd— 100,000 population for 1950 to 364.5 deaths for increasing for the white population from 1.30 for 1967 (table 2 and figure 1). The rise in this total 1950 to 1.52 for 1969 and increasing for the other death rate for 1968 to 372.6 deaths per 100,000 is population from 1.08 for 1950 to 1.30 for 1969. attributable in part to the above-mentioned

7 changes in classification and coding mocedures marked declines for this cause for younger men used with ~he Eighth Revision. Apply%g the comp- “and women. The decrease in this age-a-dj&ted arability ratio of 1.0045 to the 1967 death rate death rate (from 307.6 per 100,000 for 1950 to for Diseases of heart raises it from 364.5 to 262.3 per 100,000 for 1969) reflects substantial 366.1, an adjusted rate that is closer to the 1968 decreases in the corresponding age-adjusted death rate, based on coding deaths by the Eighth Re- rates for each of the four color-sex groups, vision (372.6 deaths per lC0,000). The fact that For 1969 the sex ratio for this cause of death even after adjustment the 1968 death rate is higher (the age-adjusted death rate for the male pop- than the 1967 rate reflects the serious influenza ulation divided by the corresponding rate for the epidemic in 1968. For 1969 the total death rate female population) was 1.95. The trend for this for D@eases of heart fell to 366.1. ratio was upward during 1950-69, increasing from As measured by age-adjusted death rates, 1.64 for 1950. however, mortality from Diseases of heart was The mortality color ratio for Diseases of clearly downward during 1950-69 (table B and heart (the age-adjusted death rate for the popu- figure 1). These age-adjusted death rates reflect lation of races other than white divided by the

Table B. Age-adjusted death rates for Diseases of heart, by color and sex: United States, 1950-69 [For 1968 and 1969 rates are basedon deathsassignedto categorynumbers390-398,402,404; 410-429of theEighth ReuiJon uj the International CLmi&tion o~l)kemes, Adapted for Use in the United Sfatss, adoptedin 1965;for 1950-67ratesare based on deathsassignedto categorynumbers400402, 410J143 of the>iq~ #~e& R&~q~~ ~dg~~~dfi$~~:f~$+,in1948=d 1955.For methodof ageadjustment,seeappendix1] 4’- I c.r,, r,r,,,, ,-,,,, .,. cd-r ,,.

Total II White I All other Year Both Both ‘e - Both ‘e - Male ‘e - sexes Male male sexes Male male saxes male

Rate per 100,000 population

1969 ------262.3 356.8 182.6 257.1 ‘ 354.8 174.9 312.8 378.1 256.8 1968 ------270.0 ‘365.6 189.1 264.1 362.9 180.5 326.5 391.4 271.4 W67------267’.7 362.6 186.8 263.1 361.6 ;;; .; 310.1 370.7 257.8 1966 ------275.8 371.6 193.4 270.5 369.8 324.3 385.5 270.5 1965 ------275.6 369.7 194.1 270.6 368.6 185:9 319.4 376.1 269.2 1964------276.9 369.0 196.6 271.7 367.7 187.9 323.0 375.2 276.4 1963 ------285.4 379.2 203.1 277.9 375.7 192.3 333.8 387.0 286.9 1962? ------282.7 373.4 202.3 275.5 370.3 191.6 326.8 376.4 283.0 ;;: :1 ------278.6 367.5 199.2 273.8 367.3 190.5 318.4 362.7 278.0 ------286.2 375.5 205.7 281.5 375.4 197.1 324.2 368.3 283.3 1959 ------283.3 369.9 204.8 278.7 369.4 196.6 326.7 365.9 279.2 195$ ------289.3 374.7 211.6 284.0 373.7 202.4 335.4 377. r 1957 ------293.0 377.4 215.5 286.9 .;;:; 205.8 Mpg 387.2 :, ‘W 1956------288. i’ 371.2 212.6 283.4 203.5 372.7 298.7 1955 ------287.5 368.4 212.5 282.6 367:4 204.0 330:3 369.2 293.0 1954 ------284.7 363.4 211.3 279.6 362.2 202.6 328.5 367.0 292.1 1953------298.9 379.2 223.6 292.7 376.5 214.1 355.8 398.3 314.6 1952 ------299.6 377.8 225.6 292.9 374.7 215.7 362.1 402.8 323.0 1951 ------302.9 380.6 229.1 296.3 378.0 218.9 364.4 400.5 329.5 1950: ,------307.6 384.2 234.4 300..5 381.1 223.6 375.1 407.5 342.9

1 “ Figures by color exclude data for residents of New Jersey because this State did not2require reporting of the item for these years. Based on enumerated populatf.on adjusted for age bias in the 1population of races other ehan white. corresponding rate for the white population) was for 1968 to 8.2 is attributable in great part to lower than the correspondhtg morta@y sex ratio, the above-mentioned change in interpretation. and remained quite stable during 1950-69, de- Applying the adjustment factor of 1.1519to creasing slightly. from 1.25 for 1950 to 1.22 for the 1967 death rate of 7.2raises it to 8.3 deaths 1969. perlOO,OOO, an adjusted rate that is very close For 1969 themortality aexratiofor Diseases to the 1968 rate of 8.2. The downward trend con- of heart for thewhite population wassubatantially tinued through 1969, for which year the rate was greater than the corresponding sexratio for the 7.6 per 100,000. population of other races (based on age-adjusted Hypertensive heavt disease with w without death rates in table B). The 1969 age-adjusted ve~ldismse (ICDA Nos. 402, 404). -During the . death rate for Diseases of heart for the white period 1950-69 there were two major breaks msle population was 2.03 times thecorresponding in the continuity of the death rate for this group age-adjusted death rate for thewbite female pop- of diseases. The first break occurred between ulatton. The 1969 mortality aexratiofor Diseases 1957 and 1958 with the introduction of the Sev- of heart for the population of races other than enth Revision (in use during 1958-67). There white was 1.47. The trend for these mortality sex were about 11 percent more deaths assigned to ratios was upward during 1950-69 for both color this group of causes by the Seventh Revision thsn groups, increasing forthewhite population from had been assigned to the same csuses by the 1.70 for 1950 t02.03 andincreasing for the other Sixth Revision.a population from 1.19 for 1950 to 1.47 for 1969. The second break incontinuity occurred be- For these diseases the 1950 color ratio for tween 1967 and 1968. The comparability ratio the male pOpUlWi-On%%S-1:07anthremainedquite for Hypertensive heart disease with or without stable during 1950-69. ~e_corJrespc@gtg rnQr- renal disease (ICDA Nos. 402, 404) is 0.3941, tality color ratio for the female-population was obtained by dividing the estimated number of greater-l.53 for 1950 andl.47 for 1969. deaths in 1966 assigned by the Eighth Revision Although the comparability ratio for the en- to this group of causes (21,350 deaths) by the tire group of Diseases ofhesrt isclosetol.00, number assigned by the Seventh Revision to the some major components of this group have com- most nearly comparable title Hypertensive heart parability ratios that differ substantially from disease (ICD Nos. 440-443) (54,176 deaths) (ap- 1.00. The breaks in trends measured by these pendix III). ratios for five components of Diseases of heart During 1958-67thedeath rate for Hyperten- shown in tables 2 and 3 are discussed below. sive heart disease (ICD Nos. 440-443) declined Active rheumatic fever and chronic rhsu. from 42.7 to 25.3 deaths per 100,000. Applying matic heart disease (ICDA Nos. 390-398).—A the comparability ratio of 0.3941 to the 1967 death change in interpretation resulted intbe transfer rate of 25.3 lowers it to 10.0, an adjusted rate by the Eighth Revision tothisgroup of diseases that is very close to the 1968 rate of 8.8 deaths of almost all deaths that by the Seventh Revision per 100,000. procedures were assigned to Chronic endocarditis The downward trend for this cause continued of aortic valve, not specified asrhemnatic (ICD through 1969, for which year the rate was 8.1 No. 421.1). With the Seventh Revision, these dis- deaths per 100,000. eases of_the:aprtic:~:ly~ .~~:e:a@U~edlto, be Ischernic hsai-t disesse (ICDA Nos. 410- nonrheumattc unless specified as ‘rheumatic, 413).—During tbeperiod 1950 -69there were two whereas in the Eighth Revision such diseases breaks, one major and one minor, intheconti- are assumed to be rheumatic uniess specified nutty of the death rate for this group of causes. as nonrheumatic. The most nearly comparable title in the Sixth and During theperiod 1950-67 thedeath rate for Seventh Revisions is Arteriosclerotic heart dis- Rheumatic fever and chronic rheumatic heart ease, includiig coronary disease (ICDNO. 420). disease (ICD Nos. 400-402, 410-416) declined The first break in continuity occurred between from 14.8 deaths per 100,000 population to 7.2 1957 and 1958 with the introduction of the Sev- deaths per 100,000. The rise in this death rate enth Revision. About 2 percent fewer deaths (an

9 1 estimated 7,780) were assigned to Arterioscle- endocarditis and other myocartilal degeneration I rotic heart disease, including coronary disease (ICD Nos. 421, 422), for which figures are shown (ICD NO. 420), by the Seventh Revision thanhad in tables 2 and 3 for 1950-67, sounds similar to been assigned to the same title bytbe Sixth Re- the above Eighth Revision title. The comparability vision.3” ratio for these two closely sounding titles, how- The second break in continui~ was in the ever, is only 0.1823. opposite direction. Based on the 1966 compara- Adjusting the 1967 death rate for Nonrheu- bly study, an estimated 14.57 percent more matic chronic endocarditis and other myocardial deaths (totaling about 83,500) were assigned by degeneration (ICD Nos. 421, 422) (26.6 deaths per the Eighth Revision totheone mostnearlycom- 100,000 population) to the level it wouid have been parable title Ischemic heart disease (ICDA Nos. if the 1967 deaths had been coded by tbe Eigbtb 410-413) then had been assigned by the Seventh Revision reduces it to 4.8 deaths per 100,000 Revision to Arteriosclerotic heart disease, in- (26.6 multiplied by 0.1823). cluding coronary disease (ICD No. 420) (appen- This adjusted rate is close to the 1968 rate dix III). of 3.9 deaths per 100,000, based on codfng deaths Adjusting the 1967 death rate for Arterio- by the Eighth Revision. For 1969 the total death sclerotic heart disease, includiig coronary dis- rate for this cause dropped to 3.7 deaths per ease (ICDNo. 420) (289.7 deaths perlOO,OOOpop- 100,000. ulation), to the level it would have been if the All othq f-rrms of, hea@_dissase (ICDA Nos. 1967 deaths had been coded by the Eighth Re- 420-423, 425-427, 4-2kiJ._-iltring the period 1950- vision raises it to 331.9 deaths per 100,000 (289.7 69 there were two breaks in the continuity of the multiplied by 1.1457). This adjusted rateiscloser to the 1968 rate of 337.6 deaths per 100,000, ‘q’%$’r7t’’3wJT2’’~fu!-@’’’’’”’memene@y co~pa~a . ,q,Qt.q fo -tia. group m the ‘Os’Sixth based on coding deaths by the Eighth Revision. akd “Sevenfi’%kmioris is Other diseases of heart For 1969 the total death rate for this cause is (ICD Nos. 430-434).The first break in continuity 331.7 deaths per 100,000. occurred between 1957 and 1958. About 10 per- The trend of theage-adjusted death rate for cent more deaths (an estimated 2,300) were as- Arteriosclerotic heart disease, including coro- signed to Other diseases of heart (ICD Nos. 430- nary disease, was in general upward during 434) by the Seventh Revision than had been 19s0-63, rising from 185.2 in1950t0221.2deaths assigned to the same tttle by the Sixth Revfsion.8 per 100,000 in 1963. Since that year the trend Most of the 2,300 additional deaths were has been downward. By 1967 it was down to 213.3 transferred to Functional dieease of heart (ICD deaths perlOO,OOO. Theage-adjusted death rates No. 433) as a result of the priority given by the for 1968 and 1969 for Iscbemic heart disease Seventh Revision to this cause over Other myo- (ICDA Nos. 410-413) are, respectively, 243.0 and cardial degeneration (ICD No. 422) and over Gen- 23.5.9 deaths per 100,000 population. That these eral arteriosclerosis (ICD No. 450). (For other rates for 1968 and 1969 arehlgher than the cor- transfers, see the study of comparability ratios respon$mg age-adjusted rate for 1967 reflects for the Sfxth and Seventh Revisions.)3 not an actusl upturn inmortali~ from thiscause, The comparability ratio between the Seventh but the transfer, described above, ofabout 14.6 and Eighth Revisions for this residual group of percent more de&hs to Ischemic heart dtsesse heart di:ea

All other

Year

Rate per’ 100,000 population

1969 ------129.7 155.9 109.1 126.8 152.1 107.1 158.6 194.9 127.7 1968 ------7 130.2 155.9 109.9 127.4 152.3 lo;.; 158.3 193.3 128.8 1967 ------129.1 153.6 109.7 126.6 150.3 154.3 .186.6 126.6 1966 ------128.4 151.9 109.6 125.9 148.9 107:6 152.7 182.3 127.0 1965 ------127.9 150.2 109.9 125.8 148.0 108.1 147.7 173.3 125.2 ------126.7 147.9 109.3 124.6 145.6 107.6 145.7 170.1 124.0 lW!------126>.7 147.1 109.9 123.7 143.8 107.3 145.1 168.7 124.4 Ii9621 ----=:~:--=:= “1~~!6 14GZ6 109.9 123.0 142.0 107.4 140.9 159.1 124.7 1961 ------125.4 143.5 110.2 123.7 142.0 108.5 140.3 157.9 124.3 1960------+?& ,. :$;.? 1$1.%.2 124.2 141.6 109.5 139.3 154.8 125.0 1959----:~~~fW:~ 1 lib-.% 123.1 139.4 109.4 136.2 152.5 121.3 1958 ------’J---’-L ~~.?J~6-: f139

I ~iWeG by ~oloz exclude data for residents of New Jersey because this State did not rei@re reporting of the item for these yeare. %ased on enumerated Romlation adjusted for age bias in the population of races other than white.

vision reetdted in en estimated net increase of For 1969’ this death rate wae 160.0 deaths per less than 0.2 of 1 percent in the number of deaths 100,000 population, representing a total number aesigned to this group of causes (appendix III). of 323,092 deaths from this complex of causes Based on the sample of deaths in 1966 coded by both (table 3). the Seventh and,the, Eighti.R.qvisiona@ere ,Wqe The age-adjusted death rate for these dis - 2,342 deaths tralisfei-red to this title by the Eighth eases grouped under malignant neoplaeme showed Revision and 1,816 deaths transferred from this an increase of from 125.4 deaths per 100,000 for title.2 1950 to 129.7 for 1969 (table C and figure 1). During tbe period 1950-67 the total death rate This increase was moderate because the sub- for malignant neoplasms rose almost uninterrupt- stantial increases in the age-adjusted death rates edly from 139.8 for 1950 to 157.2 deaths per for these diseaees for the male population of both 100,000 population for 1967 (table 2 and ffgttre 1). white” and all other races were offset by the de- Lees then 0.2 of 1 percent of the rise in the total creases in the corresponding rates for the female’ death rate to 159.4 deaths per 100,000 for 1968 population of both white and all other races (table is attributable to the change to the Eighth Revision. c). The sex differenti~ for this cause (based on estimated 96.6 percent of the deaths thatbadbeen age-adjusted death rates in table C) increased assigned to the comparable Seventh Revision title from 1.08 for 1950 to 1.43 for” 1969. “Malignant neoplasm of digestive organs and Throughout 1950-69 the age-adjusted death peritoneum, not specified as secondary” (ICD rate for malignant neoplasms was higher for the Nos. 150-156A, 157-159) (appendix III). population of races other than white thanfor the The death rate for groups of causes entitled white population. The mortality color ratio also in the Eighth Revision “Malignant neoplasms of increased, from 1.03 for 1950 to 1.25 for 1969. digestive organs and peritoneum” (ICDA NOS. An upturn in the mortality color ratio was re- 150-159) rose almost steadily from 1900 through corded for both male ‘and female populations. 1945, for which year the rate was 60.5 deaths per The rise in the mortali~ sex differential for 100,000 population. Since 1945,however, thetrend the total population reflects marked increases in has been generally downward,falling to 48.2 deaths the sex differential for this cause, for both the per 100,000 population in 1967. The deathrate for white population and the population of races other 1968 was 46.8 per 100,000 (table 2). Butinasmitch than white-but especially for this latter popu- as onIy an estimated 91,848 deathsz in 1966 were lation. For them the mortali~ sex ratio for ma- assigned to ICDA Nos. 150-159 by the Eighth Re- lignant neoplasms increaaed from 0.96 for 1950 vision and 95,079 deaths in 1966 were assigned to 1.53 for 1969. to ICD Nos. 150-156A and 157-159 by the Sev- The trends for the major components of the enth Revision, an adjustment factor of 0.9660 diseases brought together under the title “Ma- (91,848 divided by 95,079 deaths) should be ap- lignant .neoplasms, including neoplasms of lym- plied to the 1967 death rate (48.2 deaths per phatic and hematopoietic tissues” (ICDA Nos. 100,000) to lower it to thelevel it would have been 140-209) are considered in thefollowing sections. (46.6 deaths per 100,000) if deaths in 1967 had Malignant ?wopbwns of buccal cavity and been coded by the Eighth Revision. @avynx (ICDA ivos. 140-149).-Based on the It appears that the downwardtrend may have above-mentioned sample of deaths in 1966, there leveled off in recent years: in 1968 thedeath rate was a net increase of 405 deaths assigned by the for this group of causes was’ 46.8; and in 1969, Eighth Revtsion to this group of causes? As are- 46.5 deaths per 100,000. This deceleration result the comparability ratio is 1.0596 (appendix flects the opposite trends of the principal com- 111). ponents of this group of causes. Malignantneo- During the period 1950-67 the total death plasms of stomach, biliary passages, and liver rate for Malignant neoplasms of buccal cavity continued downward through the 1960’s, wtdle and pharynx (ICD Nos. 140-148) remained quite malignant neoplasms of the intestines continued stable. The lowest rates were for 1951-53 (3.2 to rise. The upward trend for malignant neo- deaths per 100,000), and the highest rates were plasms of the pancreas during 1914-68 may also for 1961, 1962, and 1966 (3.5 deaths per 100,000). have begun to level off for both 1968 and 1969 The rise in the total death rate between 1967 (3.4 the death rate for this cause was 8.7 per 100,000 deaths per 100,000) and 1968 (3.6 deaths per population. 100,000) is attributable to the above-mentioned Malignant neoptasms of respiratory system break in comparability introduced withtheEighth (fCDA Nos. 160-163).-During the period 1950- Revision. Applying the comparability ratio of 69 there was a break ~ continuity for thk group 1.0596 to the 1967 death rate for this group of of cauaes between 1967 and 1968 resulting from causes raises it to 3.6, an adjusted rate that is the introduction of the Eigbtb Revision. The com- the same as that for 1968. For 1969 the death psrabtlfty ratio is 1.0316 (appendix III) (56,668 rate for Malignant neoplasms of buccal cavi~ deaths when tabulated by the Eighth Revision and pharynx (ICDA Nos. 140-149) was 3.7 deaths divfded by 54,934 deaths when tabulated by the per 100,000 population. SeventhRevfsion).2 Malignantneoplas?ns of digestive ongms and Dm.ing the period 1950-67 the total death peritoneum (ICDA Nos. 150-159).—me ~%hth rate for Malignantneoplasms of respiratory sys- Revision assigned to ICDA Nos. 150-159 only an tem (ICD Nos. 160-164) rose from 14.1 deaths b. per 100,000 population for 1950 to 29.4 fo~ 1967 (table 2). Age-adjusted death Applying the above-mentioned comparability rate for Malignant neoplasm of breast ratio of 1.0316 to the death rate for 1967 (29.4 (ICDA No. 174)1 deaths per 100,000 population) raises this rate Year to 30.3 deaths per 100,000 population, the level at which the 1967 death rate would have been if White All female other deaths for that year had been classified by the female persons Eighth Revision. This adjustment of the 1967 rate persons reduces the percentage rise between 1967 and 1968 from 8.16 percent to 4.95 percent. For 1969 Rate per 100,000 the death rate for Malignant neoplasms of res- population piratory system (ICDA Nos. 160-163)was 32.7 1969 ------23.0 22.7 deaths per 100,000 population. 1968 ------23.4 23.0 ‘Malignant neopkzsm of beast gCDA No. 1967 ------23.2 22.6 174L-There were no serious breaks during 1966 ------23.1 21.2 1965 ------23.0 21.3 1950-69 in the comparability of mortali~ sta- 1964 ------22.8 21:1 tistics for this cause. The comparability ratio 19632 ------22.1 21.2 for the Seventh and Eighth Revisions is 0.9913 19622 ------22.2 20.2 (appendix 111). 1961 ------22.4 20.4 1960 ------22.4 20.7 Tbe trend figures (table 2) for mortsli~ 1959 ------22.1 19.5 from Malignant neoplasm of breast (ICDA No. 1958 ------22.2 19.2 174) show a slight but quite steady increase during 1957 ------22.6 19.8 , 1956 ------22.6 20.4 1950-69. The rate rose over this 20-year period 1955 ------22.9 19.6 from 12.6 deaths per 100,000 population for 1950 1954 ------22.2 19.8 to 14.4 deaths for 1969. These figures are based 1953 ---’ ------22.5 18.7 1952 ------22.4 18.9 on the total population-male and female. inas- 1951 ------21.9 18.8 much as this cause of death occurs almost en- 19503 ------22.5 19.0 tirely among female persons, a more useful rate 1 is that based only on female persons. For 1968 and 1969, rates are based on As shown in the table at right, for white deaths assigned to category number 174 of female persons the age-adjusted death rate for the Eighth Revision of the International Class if icati.on of Dis eas es. Adapted for this cause declined slightly, from 22.5 deaths per Use in the United States, adopted in 1965 100,000 in 1950 to 22.1 deaths per 100,000 for for 1950-67, rates are based on deatlu! 1963. But since 1963 the age-adjusted death rate assigned to category nutnber 170 of the Sixth and Seventh Revisions, adopted, re- for this cause for white female persons appears spectively, in 1948 and 1955. For method to be upward, with a rate of 23.0 for 1969. of age adj ustmsnt, see appendix 1. Ttds higher mortality reflects an upturn in mor- 2F@mes by color exclude data for res- tality for this cause during the 1960’s for the idents of New Jersey because this State did not require reporting of the item for three 10-year age groups in the span 45-54 these years. through 65-74 years. The only age groups of 3Based on enumerated population adjuat- whfte female persons that experienced appre- ed for age biaa in the population of races other than whit e. ciable declines in mortality from this cause were 75-84 years and 85 years and over. The 1969 death rates for Mal@mnt neoplasm greater at these ages for all other women than of breast for each 10-year age group of white for white women. For example, for all other women in the span 15-24 through 45-54 years women for the age group 45-54 years the death were somewhat lower than the corresponding rate increased from a low of 41.9 deaths per rates for all other women. The absolute increase 100,000 population for 1952 to 52.6 deaths for in mortality for thk cause during 1950-69 was 1969. The corresponding increase for white women .

was from a low of 45.6 deaths per 100,00”0 The corresponding comparability ratio for for 1951 to 51.5 deaths for 1969. Malignant neoplssms of the male gerkal organs iWalig7Unt neopihsms of .s&nital%vga?ts(ICDA is 1.0133 (see table at top of page 15 for pertinent Nos. 180-187). —During the period 1950-69 there data). were two breaks in the comparability of mortali~ As shown in the table at bottom of page 15, statistics for this group of causes. The fikst break the trend of the age-adjusted death rates for fe- occurred between 1957 and 1958 with the ‘ktro- male genital organs was generally downward duction of the Seventh Revision. The comparability during 1950-69 for both white and all other women. ratio for this title for the Sixth and Seventh Re- The age-adjusted death rate for Malignant visions is 0.98.3 But there was no serious break neoplasms of male genital organs fell slightly in continuity of mortalfty statistics for ‘Malignant during 1950-69 for white male persons, but the neoplasms of genital organs with the introduction corresponding rate for male persona of races of the Eighth Revision. The comparability ratio other than white rose aubstentielly. As shown in is 1.0034 (appendix III). the table on page 16, for this latter group the Inasmuch as the trend figures in table 2 are rate increased from 18.2 deaths per 100,000 based on the total population (mate and female), for 1950 to 24.7 deaths per 100,000 for 1969.+ they are of limited use. In the table below data Most of this ris; reflects the higher level of mor- are provided for Malignant neoplasms of female tality from Malignant neoplasm of prostate genital organs from the comparability study of (ICDA N&-185): h““--- ‘--- ‘“J”JI deaths in 1966. From these data tbe comparability ratio for this group of neoplasms has been calculated to be 0.9963. ‘ - —— , -!+:~,~.:–--?~,~i I ......

Seventh Revision Eighth Rev;s ion -

Estimated ieatbs in CO1- mm (1) that 7ent to Malig - Estimated Iant neoplasma deaths in Deaths in of female :Olumn (1) 1966 ~enital organs Cause of death end category numbers (ICDA ttos . :hat went to >ther causes 180-184).

(1) (2) (3)

All causes ------001 -E999 l;863,1~9a j :23,-337 1,839,812

Malignant neoplasma of female genital organs ------l7l-l76 -. 23,424 23,169 255 Of cervix uteri ------171 7,665 1- 7,562 103 Of other and unspecified parts of uterus ------172-174 5,731 5,680 51 Of ovary, fallopian tube, and broad ligament------l75 9,163 9,092 71 Of other and unspecified female genital organs ------176 865 835 Other causes --:------”------Residual 1,839,725 168 1,839,5% 1 Seventh Revision I Eighth Revision

Estimated deaths in column (1) that went to Estimated Malignant neo- deaths in Deaths in plasms of male Collmnl (1) 1966 genital organs Cause of death and category numbers 1 that went to (ICDA Nos. other causes 185 -187)

(1) (2) (3) I

All causes ------.----OOl-E999 I 1,863,1491 17,1791 1,845,970

Malignant neoplasms of male genital organs ---.------177-179 Of prOstate------l77 Of all other and unspecified male genital organs Other causes ------Residusl------—. Age-adjusted Age-adjusted death rate for death rate for Malignant neo- Malignant neoplasms of female plasms of female genital organs genital orgsns (ICDA NOS. 180- (IcDA NOS. 180- Year 184)1 Year 184)1

All White All White other female other female female female persons persons Persons persons

1 1 Rate per 100,000 Rate per 100,000 population population

1969------17.2 28.1 1959------20.9 35.0 1968------17.4 ;;.; 1958------21.6 37.4 1967------17.8 1957------22.1 38.1 1966------18.4 31:4 1956------21.9 ;;.; 1965------19.0 31.6 1955------22.8 ------==49.2 _3.2.O 1954------23.1’ 39:6 :%------19.6 32.8 1953------23.7 41.6 19622------20.0 33.4 1952------23.7 41.7 1961------20.2 34.6 1951------24.1 41.3 20.7 34.2 L9503------25.3 44.0 1

IFO= 1968 and 1969, rates are based on deaths assigued to category numbers 180-184 of the Eighth Revision of the International Classification of Diseases, Adapted for Use in the United States, adopted in 1965; for 1950-b~ , rates are based on deaths assigned to category numbers 171-176 of the Sixth and Seventh Revisions, adopted, respectively, in 1948 and 1955. For method of age adjustment, see appendix I. ‘Figures by color exclude data for residents of New Jersey because this State did not require reporting of the item for these years. 3Based on enumerated population adjus ted for age bias in the population of racea other than white.

15 Age-ad justed Age-ad justed death rate for death race for Malignant neo- Malignant neo- vlasms of male plasms of male genital organs genital organs (1-1% jl185- (ICDA NO. 185- Year 187)1 .

All All White Nhite other male other male male male persons persons Persms persons

1 I Rate per 100,000 Rate per 100,000 population population

1969------13.3 24.7 1959------14.4 22.5 1968------13.4 25.5 1958------14.0 21.1 1967------13.2 24.3 1957------14.3 22.2 1966------13.4 22.4 1956------1.4.5 21.3 1965------13.5 22.3 1955------14.5 20.6 1964------13.5 23.0 1954------14.6 20.9 19632------13.6 22.7 1953------14.3 19.0 19622------13.4 23.7 1952 14.3 18.7 1961------13.6 22.3” Ig5r~l~~l~~GlIIl;lZ;; ----IA:I 18.2 ------...... -. 1960------13.5 21.8 T950$. ------. ...-. -- 14.4 18.2

lFor 1968 and 1969, rates are based on deaths assigned to category numbers 185-187 of th~ EightK Revision of the International Classification of Diseases. Adapted for Use in the United States, adopted in 1965. for 1950-67, rates are based on deaths assigned to category numbers 177-179 of the S&th and Seventh Revisions, adopted, respectively, in 1948 and 1955. For method of age adjustment, sea appendix I. . ZFiggres bY ,..oIorexclude data for residents of New Jersey because this State did nOt require reporting of the item for these years. 3Based on enmerated population adjusted & age bias in the population of races other than white.

Malignant neoplasms of wrinwy organs (TCDA The age-adjusted-- death rate for all other Nos. 188, 189). —There were two breaks during male Demons continued lower than the corre- 1950-69 in the comparability of mortality sta- sponding rate for whitemalepersone during 19SO- tistics for this group of causes. The comparability 69. But the increase in mortality from this cause ratio between the Sixth and Seventh Revisions is was much greater for male persons of races 0.98~ The comparability ratio between the Sev- other thanwhite. enth end Eighth Revisions is 1.0171 (appendix -The age-adjusted death rate for whitefemale III). persons was not only much lower. in 1950 (3.8 The mortality trend for the total death rate deathe per 100,000) then the corresponding rate for Malignant neoplasms of urinary. organs was for white male per:onsJ8.2 deaths per 100,OOO), upward during 1950-69, ricing from 6.7 deaths but, as shown in the table on page 17, during per 100,000.for 19s0 to 7.-Ideathsfor 1969 (table 1950-69 this rate declined for white female per- 2). Thfs upturn reflects pritmrcily increasing sons. The pattern for the age-adjusted death rate death ratesfor thisgroup of causes for the male for female persons of races other than white population.As shown in the tableon page 17,t%e fluctuated during 1950-69. This irregular varia- age-adjusteddeath rate for thtscause for white tion may result from the small numbere of deaths male ‘personsrose ‘tYom 8.2 deathsper 100,000 for some of the age-specific rates on which the for 1950 to 8.6 deaths per 100,000 for 1969. age-adjusted rates are k-seal.

!L6-

I ige-adjueted death rate for Malig- nant neoplasme of urinary,organs (ICDA NOS. 188, 189)

Year All White ‘#r White other male female female ?ersons male persons Pera‘ns persons 1 J 1 Rates per 100,000 population l969------8.6 7.6 *3.8 “ l968------8.7 7.9 ::: 3.7 l967------8.7 7.7 3.2 *&.4 l966------8.6 7.1 3.3 3.8 l965------8.4 *6.9 3.4 *4.O l964--:------8.4 *6.8 3.3 3.8 ;;%;;------8.5 6.8 3.3 *3.7 .------8.3 *6.7 3.4 4.4 1961------y:~-.----~z--.=?=----=--,=------8.4 6.8 3.4 *3.8 1960------8.5 *6.4 3.4 *4:2 l959------8.4 *6.4 3.5 *3.7 1958------nT------8.2 6.5 3.5 *3.8 1957------~;-*+----~------::::------~+tel ,’ 8.4 *6.5 3.7 *3.9 1956------<------====-=-.===-.=--.-a------8.3 3.6 .3.8 l955------z------u 3.8 3.3 l954------::: 6.1 3.6 3.8 l953------8.3 *5.8 3.7 *4.O l952------,*5.9 3.7 *3.6 1951------M *5.7 3.7 *3.5 19503------8.2 *5.6 3.8 *4.O

lFor 1968 and 1969? rates are baeed on deaths assigned to category numbers 188 and 189 of the Eighth Revxsion of the International Classificationof Diseases, Adapted for Use in the Umted States, adopted In ; or O-67, ratea are based on deatha aa- signed to category numbers 180 and 181 of the Sixth and Seventh Rwis ions, adopted, respectively, in 1948 end 1955. For method of age adjustment, see appendix 1. ‘Figures by color exclude data for residents of New Jersey because this State did not require reporting of the item for these years. %aa ed onen~erated population adjusted for age bias in the populationOf races other than white. NOTE: Asterisk indicates age-adjusted rates based on age-specific rates where more than half of the rates were based on a frequency of less then 20.

,., : ,, .,, ~!c , M;,. ,, nQ :1 M@&nant neoplusms of all otherand w.ns#ec- and Eighth Revisionsis 0.9974 (appendirIII). ified sites (ICDA Nos. 170-173, 190-199). —About The totaldeathrateforthiscausecontinued 2 percentmore deathswere assigned~othistitle in generalupward during1950-69(table2).As by the EighthRevisionthanhadbeenassigmedto shown in the—tableon page 18 by age-adjusted itby theSeventhRevision(appendix111).Thisie, deathrates,mortalityfrom thisdiseaseishigher ofcourse,a residu~lcategory. for whitemale personathenfor allothermale Lewbnia (ICDA Nos. 204-207).-There has persons. been no appreciablebreak in compsrabili~of Also the age-adjusteddeathratefor white mortalitystatisticsfrom thiscauseduring1950- female personsfor thiscause continuedhigher 69. The comparabilityratiobetweentheSeventh than;he correspondingrateforall%her female

17 Age-adjusted death rate for Leukemia (ICDA Nos. 204-207)1

Year All All White White other other male male female female persons persons persons persons

Rate per 100,000 population

;;:; ------7.5 3.9 ------7.5 2; 4.1 l967------7.7 6.1 3.7 l966------7.7 5.2 3.9 l965------7.5 5.6 3.5 l964------7.5 5.6 l9632------7.6 6.0 $: l9622------7.5 5.2 1961------7.7 3:4 1960------7.8 M 3.7 l959------7.6, , 5.0 l958------7.5 5.1 H l957------7.4 5.4 3.2 l956------7.3 3.6 l955------:= .=,;:; 3.0 l954------“% l953------7.0 4:4 ::: l952------4.2 3.3 1951------;:: 4.4 2.8 19503------6.5 3.8 2.8

lFor 1968 and 1969, rates are based on deaths assigned to category numbers 204-207 of the Eighth Revision of the InternationalClassificationof Disease% Adapted for Use in the United States, adopted in 1965; for 1950-67, rates are based on deaths assigned to category number 204 of the Sixth and Seventh Revisions, adopted, respectively, in 1948 and 1955. For method of age adjustment, see appendti 1. ‘F’i$zures—–.. .;-. bv color exclude data for residents of New Jersey because this State did not requme reporting of the item for these years. s~ased on enwerated ROPulat%On adjusted for age bias in the population of races other than white.

persons.For bothgroupsoffemalepersonsthe m. iEREBROVASCULAR DISEASES earlier(1950-60)upwardtrendinmortalityfrom ., : , T,L.. i, <.9 .- . ..------thiscause appearstohaveleveledoffduringthe Cerebrouzscuiar disssses [ICDA Nos. 430- 1960’s,as sh~= inthetableabove. 438). —The, comparable SeventhRevisiontftle Other neo@asms of lympha?ic asd hemati- ofor Cerebrovasculardiseaseswas Vascularle- poietic tissues (ICDA Nos. 200-203, 208, 209). - sionsaffectingcentralnervoussyet’em(ICDNos. About 5 percentmore deathswere assignedby 330-334).In the SeventhRevisionthistitlewas the EighthRevisionto thisgroupofcausesthan inclndedin SectionVI”’‘Diseasesofthenervous were assignedby the SeventhRevisionto the systemand senseorgans.”Buthy theEighthKe- comusrabletifie‘Lvmuhosarcomaandotherneo- visionthe titleCereb’rovasculardiseases(ICDA plas~s of“lymphatic-and hemacopoietictissues NOS. 430-438)was transferredfrom Secti’onVI (ICDNos.200-203,205)(appendixIII). to SectionVII “Dfseasesofthecirculatoryays-

---iu tern.”The Eighth Revision reserved Section VI - conwol of mortality from these diseases was made rlDiseases of the nervous system and sense or- during thk 20-year period (table D and figure gans” for hereditary end familial diseases of 1), nervous system, including hereditary neuromus - The age-adjusted death rate for Cerebro- cular disorders. vascnlar diseases decreased quite steadily-from The comparability ratio between these com- 88.8 deaths per 100,000 for 1950 to 68.5 deaths parable titles for Cerebrovascular diseases is for 1969. T&’ decrease reflects lowering of the 0.9905 (appendix III). age-adjusted rates for each of the four color- The total death rate for Cerebrovascular dis- sex groups. But the excessively highMortality eases (ICDA Nos. 430-438) appears to have de- colorratio that characterized morta@ from this clined only slightly during 1950-69, from 104.0 cause throughout the first half of tbe century deaths per 100,000 to 102.6 (table 2 and figure 1). increased even further during 1950-69. For 1950 But the age-adjusted death rate for this group of the age-adjusted death rate for Cerebrovascular causes shows that substantial progress in the diseases for the population of ‘races other than

‘Yable D. Age -adjusted death rates for Cerebrovasculardiseases, by color and sex: United States. 1950-69

[For 1968in/1969rated ak’ b.sed onl dea(hs assizsed to catezorv &mbers 430-438 of the HoW! Revision of the Intemdimkd Classijbtion of Diseases, . dapted for Use in f?-z;United S%&s,’adopted in 1965; for 1950-6? rates are based’on deaths assigned ~f the Six:! :nd Seventh Revisions adopted, respectively, in 1948 and 1955. For method of age ad- , ~:z::::. &~=J%b=3iY ,1 T [~:~ I :--:

Total White All other

Year Both Both Fe- Both Fe- Male ~; Male Male sexes sexes male sexes male

Rate per 100,000 population

1969 ------68.5 74.9 63.3 63.8 70.1 58.6 117.1 124.1 111.1 1968 ------71,5 78.1 66.0 66.3 72.9 60.9 124.4 132.2 117.9 1967 ------70.0 76.2 64.9 65.2 71.5 59.9 118.8 124.4 114.1 ;;:; :--: -:------72.6 78.8 67.3 67.3 73,6 62.0 125,5 131.5 120.3 ------73.1 79.1 67.9 67.5 73.8 62.1 129.6 134.2 125.5 1964 -::------73.9 .79.7 69.1 68.5 74.6 63.3 128.3 131.1 125.8 19631 ------76.6 82.5 71.6 71.3 77.6 65.9 133.4 135.7 131.7 19621 ------76.8 82.1 72.2 7’1.5 77.4 66.5 132.5 133.4 132.2 1961 ------76.7 82.0 72.1 71.4 77.3 66.3 128.8 127.5 130.2 1960 ------79.7 85.4 74.7 74.2 80,3 68.7 134.8 135.2 134.4 1959 ------80.7 85.8 76.2 75.3 80.9 70.2 135.7 134.8 136.5 1958 ------, 83.0 78.4 77.4 82.9 72.5 140.0 141.2 139.4 1957 ------+ ---- ;’;:< ,..~~;$;)“79.5 78.6 84.4 73.4 141.1 140.2 142.2 1956 ------78.2 77.0 82.1 72.3 136.8 134.3 139.1 1955 ------83:0 87:4 79.0 77.7 82.7 73.2 137.8 136.2 139.3 1954 ------83.0 86.7 79.5 77.6 82.0 73.5 139.0 136.0 142.0 1953 ------86.9 90.5 83.6 81.5 85.6 77.7 143.9 141.7 145.7 1952 ------87.8 91.3 84.6 82.3 86.4 78.4 146.9 143.9 149.9 1951 ------89.0 92.0 86.2 83.6 87.3 80.1 147.3 142.6 152.1 19502 ------88.8 91.9 86.0 83.2 87.0 79.7 148.8 144.0 153.4 y I ~iWes by color exclude data for residents of New Jsrsey because this State”did not “requirereporting of the item for these years. ‘2Based on enwerated population adjusted for age bias in the1population of races other than white. white was 1.79 times the correspondhg rate for No. 431), Cerebral thrombosis (ICDA No. 433), the white population and by 1969 this ratio had and a residual group-All other cerebrovascular increased to 1.84. dkeases (ICDA Nos. 432, 434-438). The category The mortality sex ratio for Cerebrovascular numbers of the Sixth end Seventh Revisions that diseases was much lower than the mortsli~ color are most nearly comparable to the caregory nnm- ratio through the first half of this century, but bers of the four subgroups of the Eighth Revision this mortali~ sex ratio increased somewhat be- are shown together with the mortality trend dur- tween. 1950 (with a ratio of 1.07) and 1969 (with ing 1950-69 for each of these four major sub- a ratio of 1.18). groups in figure 3. During 1950-69 the age-adjusted death rate for Cerebrovascular diseases for women of races other than white was about 1.9 times the corre- Re.imm of the lmrnatmd C1.wfmtm of simas Sixth Savmth E,$)th sponding rate for white women. The correspond- 200 ing ratio of the age-adjusted death rate for men of races other than white over that for white men r was somewhat lower, but the trend for this ratio I I C..t.o”-a.!. atweas to be slowly upward— 1.66 for 1950 and 1.77 for 1969. For both the white population and the population of races other than white the mortali~ sex ratio for Cerebrovascular diseases increased during 19S0-69—for the white population, from I 1.09 for 1950 to 1.20 for 1969; and for the other 4cr I 1.0 m population, from 0.94 for 1950 to 1.12 for 1969 -— --- *., -. t L J r.”, 4 (based on age-adjusted death rates in table D). For both male and female persons of races other than” white, the death rate for Cerebro- vascular diseases continued through 1950-69 to be substantially bigher for most age groups than the corresponding rates for white persons. TYsnds for mojor components of Ceretrro- o%sculor d&oses.-Although the introduction of the Eighth Revision for data year 1968 did not produce any appreciable break in the compara- 6 9,*,*”.,. &;$mw bility of mortality etatietics for the entire group 5 CD m . . . . . of Cerebrovascular diseases, it did produce a .“...... -,” 4 ./a- considerable degree of discontinuity for the com- , ...... l,. =, ,,,,., ” ponents of this group of diseases. One of the rea- 3 ...... ’ sons for the lack of comparability for the com- ,“ /’ ponents ie that while the Sixth and Seventh ,~ Revisions were in use (1949-67), Cerebrovas- cular ctiseases were dktributed among only five components, but according to the Eighth Revision 11” they are distributed among nine components. 1 I I I I !,,, To lessen the degree of discontinuity the 1950 19a5 19an 1%5 1070 nine components of Cerebrovascukr diseases YEAR according to the Eighth Revision have been divided for the purpose of this report into the following four subgroups: Subarachnoid hemor- Figure 3. Death retes for major components of Cerebrovaecular rhage (ICDA No. 430), Cerebral hemorrhage (ICDA diseaaes United Statea, 1950-69, IV. ACCIDENTS parability ratio for Motor vehicle accidents is 1.00, and that for All other accidents, 0.95.3 Accidents (ICDA Nos. E800-E949). —There The comparability ratio for Accidents (with were two breaks in continuity for mortali~” sta- motor vehicle and other accidents taken together) tistics for this group of causes during 1950-69. be~een the Seventh and Eighth Revisions is The first break occurred as the result of the 0.9570 (appendix III). Again, as was the case re- introduction of the Seventh Revision, in use 1958- tween the Sixth and Seventh Revisions, this re- 67. The comparability ratio for Accidents (ICD duction in the number of deaths assigned to Ac - Nos. E800-E962) between the Sixth and Seventh cid~nts by the Eighth Revision over the number Revisions was 0.97.3 This reduction in the num- assigned by the Seventh Revision resulted pri - hers of deaths assigned m accidents by the Sev- marily from transfers from accidents other than enth Revision over the number assigned by the motor vehicle accidents. The comparability ratio Sixth Revision resulted primarily from transfers for Motor vehicle accidents between the Seventh of some deaths attributed to falls and to a num - and Eighth Revisions was close to 1.00— actually ber of other categories for accidents, excludfng 0.9921; while the comparability ratio for All motor vehicle accidents, The corresponding com - other accidents was 0.9250 (appendix III).

Table E. Age -adjusted death rates for Accidents, by color and sex: United states, 1950-69 [For 1968 and 1969 rates are based on deathsassignedto category numbers E800-E949 of the Eighth Revision o~fhe Iniemational Classification o~Diseases, Adapted for Use in the United Stafss, adopted in 1965; for 1950-67 rates are based on deathsassi ned to category numbers E800-E962 of the sith and SeventhRmi.4onsadopted, respectively,is 1948 and 1955. For method o! age adjustment,seeappendix-- I]

Total II White I All other Year Both Both Both Male ‘e - Male ‘e - Male ‘e - sexes male sexes. ruale sexes male

Rate per 100,000 population

1969 ------55.3 82.9 29.3 52.6 78,5 28.1 75.5 118.9 36.9 1968 ------55.1 82.5 29.2 52.2 77.7 28.1 77,0 122:1 36.8 1967 ------54.8 81.8 29.3 52.4 77.8 28.2 73.2 114.7 35.9 1966 ------55.6 82.6 30.0 53.0 78.5 28.7 75.8 116.4 39.1 1965 ------53.4 79.1 28.8 51.0 75.4 27.7 70.8 109.3 35.8 1964 ------52.1 76.8 28.3 49.9 73.4 27.3 68.4 105.2 34.9 1963i------50.9 75.0 27,8 49.1 72.4 26.7 68.2 103.4 36.1 19621 ------49.7 73.2 27.2 48.0 70.7 26.2 66.5 100.5 35.4 1961 ------48.1 71.4 25.8 46.1 68.5 24.5 63.2 95.1 33.9 1960 ------49.9 73.9 26.8 47.6 70.6 25.4 67.3 101.1 36.1 1959 ------49.8 74.3 26.3 47.7 71.2 25.1 66.1 100.2 34.6 1958 ------49.8 74.1 26.5 47.7 71.1 25.1 66.6 100.2 35.8 1957 ------53.4 79.3 28.5 51.2 76.1 27.0 71.0 106.5 38.4 1956 ------54.4 81.2 28.7 52.2 77.8 27.4 72.0 109.7 37.3 1955 ------54.4 80.7 29.0 52.3 77.7 27.6 71.2 106.5 38.5 1954 ------53.1 78.9 28.4 51.1 75.9 27.1 69.7 104.6 37.8 1953 ------57.3 85.3 30.5 54.9 81.8 29.1 76.4 116.2 39.8 1952 ------58.8 86.8 32.0 56.4 83.2 30.6 78.4 118.2 41.6 59.4 87.5 32.0 57.3 84.5 30.7 76.4 114.1 41.0 ;%~===: 57.5 83.7 31.7 55.6 81.0 30.6 72.0 107.1 38.8 ——i 11

lFi.~res by CO1O: exclude data for residents of New Jersey becauae this State did not require reporting of the item for these years. 2Based on en&nerat~d1population adjusted for age bias in the1population of races other than white.

21 Mortality from’ Accidents (motor ve~lcle and 27.6 deaths per 100,000 for 1969, representing other accidents taken together), as measured by 55,791 deaths in that year (tables 2 and 3). the total death rate for this group of causes, fell The 1969 age-adjusted deathrate for themale during 1950-60, reaching a low of 50.4 deaths population was ahout 2.9 times the corresponding per 100,000 for 1961, and then rose during 1961- rate for the female population (tabIe G). The 69 (table 2 and figure 1). A similar pattern is highest age-adjusted rate for 1969 ,by color and found for the trend of mortality from Accidents sex was for the male population of races other when measured hy age-adjusted deathrates (table than whke (54.4 deaths per 100,000 population). E and figure 1). The total age-adjusted deathrate For 1969, as for most years during 1950-69, for this group of causes decreased from 57.5 the mortality curve by age for this cause is bi- deatha per 100,000 for 1950to alowof 48.1 deaths modal, reaching the first peakatages 15-24 yesrs for 1961, and then rose during 1962-69 to 55.3 (51.0 deaths per 100,000 population) and the sec- deatb~ per 100,000. ond peak at ages 75-84 years (42.9 deaths per This trend for the total age-adjusted death 100,000). rate reflects similar patterns for the four color- During 1950-69 the death rate for Motor ve- sex groups, except that for the male population hicle accidents increased for each of the four of races other than white,- the increase during color-sex groups (table H). Inasmuch as thedeath 1962-69 was far greater than the increase for rate changed direction during the period, de- the other three groups. For the other-than-white clining to a I?w,,for 1961{~imdther,e,afterturning male population the age-adjusted death rate rose upward, the amount“&f‘“increase in the rate is, of to 118.9 deaths uer 100.000 for 1969. a level of course. much wrester for the ueriod 1961-69. mortality that was hizher than even that for 1950 v j I [.!f+o~eale~ ~e@tiv+@cre&e-Huring 1961- (107.1 d~athsper 100~000)(table E). 6~ in the deakh r~te for iblotdrvehicle sccidents For the population aa a whole tbe mortality waa for infants in each of the following three sex ratio for Accidents is much higher than the color-sex groups: white male, all other male, corresponding color ratio (based on age-adjusted and all other female. For the white female pop- death rates in table E). The 1950 age-adjusted ulation the greatest relative increase in the rate death rate for Accidents for the male population was for the age group 15-24 years (table H).The was 2.64 times the corresponding death rate for relative increase for these women was S7.1 per- the female population-by 1961 this mortality cent betweeti 1961 and 1969. The corresponding sex ratio had increased to 2.77 and by 1969 tn increaae for wpmen of races other thanwhite at 2.83. The mortsii~ sex ratio for Accidents in- ages 15-24 years (54.8 percent) was almost as creased during 1950-69 for both the white pop- great as that for white women. White men at ages ulation and the populationof races other than 15-24 years had a htgher death rate for Motor white—with by far the largest increase for the vehicle accidents in 1969 thandid any other age- latter population. For 1950 for the male pop- color-sex group (82.0 deaths per 100,000 population of races other thanwhfte the age-adjusted ulation). death rate for Accidents was 2.76 times the cor- An unexplained phenomenon is that men of responding rate for the female populationof races races “other thaq white experienced their b~ghest other than wbit~ and by ‘1969 this sex ratio bad rqo~tali~’ ~,qm,‘this,,cayse’ at older ages (25-34 risen to 3.22. Deaths and death rates by external yest’s}tWnWfdwhit& then (15-24,@v%J. ‘11-iepeak cauae of injury are shown in table F. death rate from this cause for menof races other Mo@Y vehicle accidests (ICDA Nos. E810- than white at these ages (72.2 deatha per 100,000) Jf828).-As stated ahove there were no substan- was lower than the peak death rate for white men tial breaks incomparability of mortaii~ statistics (82.0 destbs per 100,000 at ages 15-24 years]. for Motor vebfcle accidents during 1950-69. Another outstanding difference among men, The death rate for this cauae decreased from in this case a difference that is unfavorable for 23.1 per 100,000 in 1950 (representing 34,763 men of other races, is that throughoutthe mid- deaths) to a low of 20.8 deatha per 100,000 in dle years of life (35-44, 4S-54, and 55-64 years) 1961 and then rose in subsequentyesm, reaching the motor vehicle death rates for men of races

Q2- Table F. Deaths and death rates for Accidents, by external cause of injury: Umlted state., 1958, 1966, 1967, 1968, and 1969 [Satesw 100,000p.p.hti.n. Nunkrs k. .WSSSof death .r~catego~ ,n.rnkrs of theEghtkRam.. of ih. klemtm..l f%u$..twn of JJ.cmm, Ad.[ted for k m d,. Unit.d stats, .d. tcd in 1965. ~or1968and 1969ratmarc&d.. dc,dfia+wd ,.d,m E,@h R“..,.” catcgmy .u”dm,, f., 1958md 1967ratesam bos.d.“dear,as,g..dm ,hm,cgc.ry.undmrs 1955.2%- G,,.!ZOW..,,,brsareshown,. —..f ,r,. S.,.”,1, Rmm”, ,dmted ,“ nextm d,.1s,CL&m d d,. rabl.1

Eighth Revisim Seventh Revision mv2.- ional cause of death 1969 1968 1967 1966 1958 m ar- . — . — bifity ati. z Number ate Number late r“tier at, Ihnber ate — — 1 All accidents-E800-E949 116 385 ;7. 6 1X, S64 i7.3 .13,169 7.2 ,13,563 58. C OJy 5.3 E800-E962 0.9370 L — — — ...... accidente------EE1O -E823 55,791 !7.E6 54,862 !7.5 52,924 6.7 53,041 :7.1 6,98] 0.8 E81O-E835 0.9921 Accidemal falls----E8E887887 17,821 8.8 18,651 9.3 20,120 0.2 20,066 LO.2 8,24f 0.5 E900-E904 0.8344 Acciderus caused by fires and f lanms------E890 -E399 7,163 3.5 7,335 3.7 7,423 3.8 8,084 4.1 7,291 4.2 E916 0.922s Accidental drming and subriersion------E9lO 6,181 3.1 5,950 3.0 5,724 2.9 5,687 2.9 5,065 2.9 E929 0.9755 Accidents assigned t. fol- 10Wing3--E916-E921, E923-E928 6,095 3.0 3,?28 3.0 ------Accident caused by cutting or piercing i“stru- LnenL------E920 156 0.1 178 0.1 149 0.1 137 0.1 104 0.1 E913 --- Accidemt caused hy explo- Si”. makcr2al------E923 553 0.3 642 0.3 ------..------Accident caused by hot substance, corrosive M uid steam, or r. ! i8.tk------E9Z4, E,926 288 0.1 278 0.1 376 0.2 409 0.2 3S2 0.2 E917,E918 0.7647 Accident .attded- bw elec tiic ~‘- b L :,! , , currmt------E925 1,148 0.6 0.3 992 0.5 1,025 0.5 951 0.5 E914 1.0240 Other eccidents of ab.a”e Ermp-----EE919E9 l9, E921 E927, l192?f 3,930 2.0 3,782 1.9 --- ..- .-. .-. ------

‘?~=~~,~~~~~~Z&?0~3&7 Vtitift M fi97J,qo!5 E.1 4,080 2.1 3,931 2.0 2,616 1.5 E870-E888, 0.9123 Xnhalatim and ingest+n, .f, ,} 7 -,.3 ~ ES90-E893 . . . . .- . . . . . a.. ”.-. 1 ; rl mb gr f’fi i xzir~ xFtxGi-or suf - focation------E9 ll, E912 ‘&3,712 ‘1.8 ““I3,;1OO 1.6 1,980 1.0 1,s31 0.9 2,191 1.3 E921, E922 1.4415 Surgical and medical cmPli- 1 Catiom a-~ill. m,,–~ - - adventure ZS------E93O-E936 52,572 ;1.3 2,023 1.0 1,530 0.s 1,411 0.7 1,023 0.6 E940-E959 1.1714 Accident c:tmsed by fireimr, mimile-- .------E92Z 2,309 1.1 2,394 1.2 2,896 1.5 2,538 1.3 2,172 1.3 E919 0.8767 .,— --- -- n.. -u. .pac. transp.rt accidents------ES4O-ES43 1,77s 0.9 1,904 1.0 1,799 0.9 1,510 0.8 1,511 0.9 E860-ES66 1.0017 water transport amid emts ------E830-E838 1,743 0.9 1,62; 1,545 0.8 1,630 0.8 1,653 1.0 E850-E85S 0.9634 ltnilway accidetWs---E8OE80707 884 O.r M 997 0.5 1,027 0.5 1,164 1.1 E800-E802 1.0081 Other mad vehicle accident s------ES25 -E827 236 0.1 264 0.1 2S8 0.1 292 0.1 304 0.2 E840-E845 0.8S89 All other acciderm-----E900- 911, E913, E915, E909, E913-E915 , E929, E940- E920, E923-E928 E9491 5.578 2.8 5,s70 2.9 6,909 3.3 7,001 3.6 i,723 3.3 930, E932-E936 --- E960-E962f 1

he List .f 258 causes .f Deat ,re “. t ent cam ed by mmchi”ery, lCD . E912; mh Revision co the first m< E these E927, E928. The third cicle :e.ssive ed with the Seventh 8evisim. B“c the f .I1.wing residual title in the List 929, E940-E949. D the Seventh Revision. nbers , E916-E921, E923-E928. Erom charwes in c.dine i“tenz Etation.

23 Table G. Age-adjusted death rates for Motor vehicle accidents, by color and sex:United States, 1950-69 [For1968and1969ratesarebasedon deathsassigned to category numbers E81O-E823oftbeEighthRevision of the Mem.tfond Classificationofl)iseates, Adaptedfor use in the UnitedSMss,adopredin1965;for1950-67rstesarebasedon deatk assigned to category numbersE81O-E835oftheSixthandSeventhRevisions adnpted,respecthw]y,in1948and1955.Formethodofage adjustment,seeappendir

Total - II White All other Year 1, , Both Both Male ‘e- Male ‘e- sexes male sexes male

Rate per 100,000 population

1969------28.5 42.9 14.9 27.9 41.6 14.8 33.7 54.4 15.3 1968------28.4 43.1 14.6 27.8 41.8 14.5 33.3 53.9 14.9 1967------27.8 41.9 14.5 27.4 41.1 14.4 31.1 49.4 14.6 1966------28.3 42.7 14.7 28.0 41.9 14.7 31.6 50.1 15.0 1965------26.6 40.1 13.7 26.2 39.4 13.7 29.2 46.4 13.7 1964------25.8 38.6 13.4 25.6 38.1 13.6 27.5 44.2 12.5 19631------24.3 36.9 12.3 24.4 36.7 12.6 26.5 42.7 11.8 19621------23.1 35.1 11.8 23.2 34.9 12.0 25.2 11.4 1961------22.1 33.8 10.9 21.9 33.4 10.8 23.9 :fi:::: 11.0 1960------22.5 34.5 11.0 22.3 34.0 11.1 24.4 39.5 10.6 1959------22.8 35.1 11.0 22.5 34.5 11.0 25.0 40.5 10.8 1958------22.5 34.9 10.7 22.3 34.3 10.8 10.2 1957------24.1 37.4 11.4 23.8 36.8 11.2 ;$:# :;”; 12.5 1956------25.2 39.4 11.6 24.7 38.5 11.5 29:5 47:9 &5 1955------24.6 38.4 11.6 24.3 37.8 11.4 28.1 45.1 1954---’------23.0 36.0 10.7 22.6 35.4 10.6 26.5 42.6 11:8 1953------24.8 38.9 11.6 24.4 38.0 11.5 29.3 47.8 12.3 1952------25.0 39.2 11.7 24.6 38.4 11.6 28.9 46.9 12.4 1951------24.6 38.5 11.4 24.2 37.8 11.2 28.3 45.2 12.5 19509------23.3 36.4 10.7 23.1 35.9 10.6 25.7 41.2 11.1 - lFi@res by color excludedata or residentsof New Jersey because this S1 :edid not requirereportingof the item or these vears. 2Basedon enumeratedpopulationadjusted~or age bias in the populationof races other than white. 1 1

Table H. Percentagechange in the death rate for Motor vehicleaccidents,by age, sex, and color: United States,1950-69and 1961-69

1961-69 1950-69

Age Male Female Male Female I I I

* I I I I I Percentagechange All ages------+29.9! +43.3 +37.3 I +$0.8 +14.0I +23.0 +38.5 +34.3 1 I I I Under 1 year------+48.6 +60.0 +4:.; +62.5 +17.6 +7.9 +44.9 +13.o 1-4 years------y---- +13.8 +34.2 +51.9 -6.1 +41.0 +30.9 5-14 years------+20.4 -I-41.1+40:8 +42.4 -1.7 +46.3 +%; 4-31.3 15-24 years------4=35.3 +44.5 +57.1 +54.8 +$0.7 +51.7 +83.3 +58.7 25-34 years---: ------+29.2 +41.9 +39.8 +33.6 i-26.6’+30.3 +44.4 -1-39.5 35-44 years------+24.1 -1-52.3+43.5 +35.3 +14.9 +39.0 +63.O +36.5 45-54 years------+15.8 +48.7 +21.1 +45.6 +9.2 +21.0 +27.8 +49.6 55L64 years------+13.5 +44.3 +15.5 +21.9 -9.5 +21.8 +14.o +26.6 65-74 years------4-7.6 +28.4 -1-25.4+50.7 -18.3 +16.2 +13.4 +40.9 75-84 years------+4.0 +25.1 -I-16.0 -21.4 -22.5 -1.8 +8.7 -29.8 85 years and ove~---- -3.1 -69.5 +16.6 +108.3 -17.2 -69.4 -8.5 -73.8 I I I

.24 I 100

80 Allah- p L.armns) 7a

I c I I I I I I I I I I I I I I I I u I se 10.14 25-19 20-24 25= 3034 35S9 4044 4549 5M4 5539 ~ =- 7&74 7573 8C-S4 :,g

ASE IN YEARS

i Flmm farallotiw femalepm.m 65 yea. a.d crier isnotshown beeaa d smallfmww.

Figure 4. Percentof all pemons dying from Motorvehicleaccidentsreportedto be pedestrians,by W, color, andsex UnitedStates, 1969. oth:r th~ w~te we ::,8%times the ~orr:~~onding cent of the 55,791 deaths from Motor vehicle rates~afof whi@khenL.+For kh@a@~ )groups~~-39 1, accidents that occurred in 1969. The Eighth and 40-44 years, the proportion of deaths from Revision classification provided fourth-digit cate- Motor vehicIe accidents that Wiq.$ r~pg~te~ go be gories for specifying whether a decedent from a deaths to pedestrians was more than two times Motor vehicle accident was a driver, passenger, the corresponding proportion for white mem, and.. pedestrian, etc. About 70.6 percent of the 48,303 for the age groups 45-49, 50.54, 55-59, and 60- white persons who died in Motor vehicle accidents 64 years, this proportion for men of races other were thus identified (figure 5). The corresponding than white was 1.5 or more times the correspond- percentage identified of the 7,488 persons of races ing proportion for white men (figure 4). other than white who”- died ~-Motor vehicle It should be stressed, however, that ~he accidents was 78.6 percent. decedent injtired was not identified for 28.4 per- Younger persons in rhe population of races All ,=7 14

5.34

15-24

Z5.?d

3544

45.54

5564 , . ES.74 ? I

76s4 1 I

a5+ 1 t 1 I I

ml other male J& 14

5.14

15.24 z s 2=?4 > g 3544

; 45=4 I S5w

66-74

75a4

85+ , 0 10 20 30 40 50 60 70 ao 90 100

PERGENT DISmlBUT1ON OF ALL MOTOR VEHICLE FATALITIES

other than white who were reported to have for, mortality statistics, which occurred between died from Motor vehicle accidents were rela- 1957 an’if’’’lk$d, resulted in the assignment of tively more often reported as pedestrians than about 3.000 fewer deaths to All other accidents were younger persons in the white population by the Seventh Revision than had been assigned (&ure 5). At ages 1-4 yesrs sbout56.3 percent of to these causes by the Sixth Revision.8 all children who died from Motor vehicle accidents The trend during 1950-57 for the death rate were reported to be “pedestrians.” for All other accidents (ICD NOS. E800-E80Z, All other accid%ts (ICbA Nos. E800-E807, E840-E962) was in general slowly downward E825-_E949).-The first break in comparability (table 2). About 74 percent of the drop from

26 All other female -.. ml 14

5.14

U,*4

26-W

=&i+ 466!

6544 .-...... -.:......

-ti.74= ...y.v~—=;-.,q .... .?.,;s.%:.:.: J .1< t=== 75s4 . .. ,. :.,.: != ,. .:. I $-:4 r 0 10 20 m .s0 60 60 70 80 90 100

PERCEN7 D15TRIBUTION OF ALL MOTOR VEHICLE FATALITIES

.97? ~_wr i. M.W Oam M~rw~. Driwr of Motor Vehkle Othw ihz. M. fnwde v.hi.!e am. Motorqdii ., Pase”wr o“ Mowcycle Pedtirian illll~ Stifbd Pm,m52 IiiUnsp6&iwJ Pemc.m

WerCOr@W are bamxl.. dwIJu assiwd to h fc.llowhw fourth dwircdlewy numb?. for w with rstewne4 E81O.E823 of the Hghth Rwisio. of the tntwd.od cI=mIti.. of m-, Named for w i. the United stntas Driver of motor vchml. .emr *.. m.mwda {.0); PasseIw+,. ~mr ~fide other thm nmmrwla (.11; MtiorcvdisI ❑ P=-WW.. motowde (.2, Sk Pcde$QIa. L71: *I SW,fiti Fmm IA..5.5 .ek WJKIf~ -m {91.1

1F,mnu far am .ni d includti in “T.td- but not d,stnbutcd .IIW”9 am maw %ikzr speclmd -. includes“Occamantof $umccar L41,”Rider of ..imaldm$vn aid.” (51, “P6dal CY.IW [.6). and ‘,O*r SF6413EZ+wmm” 1.8). “Pe&l cqdkts,< m4wa up WE 94% of the tmd for *IIIs Utba

33.2 for 1957 to 30.9 deaths per 100,000 popula-. the comparability ratio for this group of accidents cion for 1958, however, was attributable to the was only 0.9250 (representing an estimated 4,539 changes introduced with the Seventh Revision. fewer deaths assigned to this group of actidents An even greater break than that between by the Eighth Revision).2 the Sixth and Seventh Revisions in the continuity The age-adjusted death rate for accidents of mortality statistics for these accidents (all other than motor vehicle accidents declined accidents excluding motor vehicle accidents) from 34.2 for .1950 .to a low of 26.1 for 1961 and occurred with the introduction of the Eighth then rose to 27.0 for 1967 (table J). The age- Revision for data year 1968. As stated above, adjusted death rate remained at a high level for.

2? Table J. Age-adjusted death rates for All other accidents, by color and sex: United States, 1950-69 [For 1968 and 1969 rates are based on deaths assigned to category numbers E800-E807, E825-E949 of the Eighth Rtwfsiorto~fhe Intemafiona[ Cks~ication o~Dsema, Adapfedjor Use in the Unifed States, adopted in1965; for1950-67 rates are basedon deaths Mgaed to category numbers E800-E802, E840-E962 of the Sith andSeventhRevisionsadopted,respectively,in 1948 snd 1955. Formethodof ageadjustment,seeappendixI]

Total

Year Fe- Isle = Rate per 100,000 population

1969 ------26.8 39.9 14.4 24.8 36.8 13.3 41.8 64.5 21.6 1968 ------26.7 39.4 14.7 24.4 35.8 13.6 43.7 68.2 21.9 1967 ------27.0 39.9 14.8 25.0 36.7 13.8 42.1 65.3 21.3 1966 ------27.3 39.9 15.3 25.1 36.6 14.0 ::.; 66.2 24.1 1965 ------26.8 39.0 15.1 24.8 36.0 14.0 63.0 22.1 1964 ------26.3 38.2 14.9 24.3 35.3 13.7 40:8 61.0 22.5 1963? ------26.6 38.2 15.5 24.7 35.6 14.1 41.7 60.8 24.3 1962~ ------26.6 38.1 15.4 24.8 35.7 14.2 41.3 60.2 24.0 1961 ------26.1 37.6 14.9 24.2 35.2 13.6 39.3 ::.; 23.0 1960 ------27.4 39.3 15.8 25.3 36.5 14.4 42.9 25.5 1959 ------27.1 39.2 :;.$ 25.2 36.6 14.1 41.1 59:7 23.8 1958 ------27.3 39.3 25.4 36.7 14.3 42.0 59.7 25.6 M57------29.3 41.8 17:1 ;;.; 39.2 15.8 43.7 63.0 25.9 1956 ------29.2 41.8 17.0 39.4 15.8 42.5 61.7 24.8 1955 ------29.7 42.3 17.4 27:9 40.0 16.2 43.0 61.5 25.8 1954 ------30.1 42.9 17.7 28.4 40.6 16.6 43.3 62.0 26.0 1953 ------32.4 ::.: 18.8 30.6 43.8 17,6 47.2 68.4 27.5 1952 ------33.8 20.3 31.8 44.8 19.0 49.5 71.4 29.2 1951 ------34.8 49:1 20.7 33.0 46.7 19.5 48.1 68.8 28.6 19502 ------34.2 47.3 21.0 32.5 45.0 20.0 46.3 66.0 27.7 —_-_—. — _ i~iwre~b~ color exclud. dam for residents of New Jersey because this State did not require reporting o.f the item for these years. s~ased on en-rated ~oPUlation adjusted for age bias in the Population of ‘aces other than white. 111 1968 and 1969 (26.7 end26.8deaths per 100,000) per 100,000 population. About 2.5 percent of despite the fact that about 7.5 percent fewer deaths these fatalities from fires and flames (182 deaths) were aesigned to this group of cauees by the occurred among infants, anti about 11.6 percent Eighth Revision, which was used for 1968 and 1969, (830 deaths) occurred among children l-4 years than had been assigned by the Seventh Revision of age. The risk of death by fires and flsmes (in use 1958-67). was about 4.1 times greater among children me five major causes of these accidental of races other than white under 5 years of age fatalities (other than motor vehicle fatalities) (15.2 deaths per 100,000 poptdetion)t ftanamong in 1969 were accidental falls, accidents caused white children at these ages (3.7). This dif- by fires and flamea, accidental drowning and ferential reflects a slight improvement over the submersion, accidental poisoning, and inhalation situation in 1960, forwhichyear thecorrespondiug and ingestion of food or other objects causing differential was 5.7 (with a rate of 4.3 per obstruction or suffocation (table F). 100,000 white children at these ages and 24.4 There were 17,827 deaths from falls in 1969, per 100,000 children of races other than white). with a rate of 8.8 deaths per 100,000 population. The highest risk of death from Inhalation and For the same year there were 7,163 deaths ingestion of food or other object causing obstruc- from fires end flames,, with arateof 3.5 deaths tionor suffocation (ICDANos. E911, E912)occurs

28 .

during infancy (with 768 deaths in 1969, giving other than white who have by far the highest a rate of 22.0 deaths per 100,000 at ages under rates (table K and figure 1). 1 year). The risk of death from this cause is Mortality from Influenza and pneumonia by also substantial at ages 1-4 years (with 244 age, for each year throughout 1950-69 followed deaths in 1969, giving a rate of 1.7 deaths per the J-curve: the death rates were very high for 100,000 at these ages). For these accidents the infants, dropped to a low for the age group 5-14 risk of death in 1969 was about 2.0 times greater years, and then rose with advance in age throughout among infants of races ot,her than white (whose the remainder of life. This pattern held for each rate was 37.7 deaths per 100,000) than among of the four color-sex groups. white infants and about 1.7 times greater among The male population of persons other than children of races other than white at ages I-4 white had greater mortality from these causes years (whose rate was 2.5 deaths per 100,000) than did any one of the other three color-sex than among white children at these ages, groups. The very moderate decline in the age-adjusted V. INFLUENZA AND death rate for the total population between 1950 PNEUMONIA and 1969 (from 26.2 deaths per 100,000 to 24.6) (figure 1) reflects the offsetting to some extent of InfLuenza and gmsumonia (ICDA Nos. 470-474, the increase in mortality from this cause for 480-4t36).-Durtng the period 1950-69 there were the white male population by decreases for the two breaks in comparability of mortality statistics other three color-sex groups (table K). for this group of diseases. The first break, In 1950 the age-adjusted death rate for this which occurred between 1957 and 1958, with the cause for the population of races other than white introduction of tbe Seventh Revision, resulted in was 2.48 times the corresponding,rate for the white assigning about 6 percent fewer deaths to these population, but by 1969 this mortality color ratio diseases than had been assigned by the Sixth hid dropped to 1.88. On the other band, although Revision (in use 1949 -S7).3 The second break, as in the past the mortality sex ratio for this which occurred between 1967 and”1968, with the cause still remains lower than the color ratio, introduction of the Eighth Revision, resulted in the sex ratio has been increasing: for 1950 the assigning about 4 percent more deaths to these age-adjusted death rate for btfluenza and pneu- diieases than had been assigned by the Seventh monia for male persons was 1.39 times the Revision (appendix III). corresponding rate for female persons, and by Between 1967 and 1968 the death rate for 1969 this sex ratio had increased to 1.64. Influenza and pneumonia (ICDA Nos. 470-474, The above-mentioned improvement in the 480-486) increased from 28.8 to 36.8 deaths per mortality color ratio for this disease was ex- 100,000 population-an increase of 27.8 percent perienced by both the male and the female popula- (table 2 and figure 1). Applying the factor 1.0440 tions. For the former group the mortality color (appendix III) to the 1967 death rate for this ratio decreased between 1950 and 1969 from group of causes raises it to the level that it 2.34 to 1.93; and for the female population the would have reached (30.1 deaths per 100,000) if mortality color ratio decreased from 2.68 to 1.79 deaths in 1967 had been coded by the Eighth (with all ratios based on age-adjusted death rates Revision rather than by the Seventh Revision. The in table K). remaining increase in this death rate for 1968, For 1969 excess mortality from Influenza and .6.7 deaths per 100,000 population, may be attribut- pneumonia for the male population of races other able to the widespread influenza epidemic in 1968. than white over that for their female counterparts Throughout the period 1950-69 the fluctua- was greater than the corresponding differential tions in the mortality trend for these diseases for the white population. For the population of reflect tbe occurrence of influenza epidemics. racek other than white the age-adjusted death rate Age-adjusted death rates, however, indicate some for the male group was 1.25 times the corre- improvement during the 19601s in mortality from sponding rate for the female group. By 1969 this these diseases, especially for persons of races mortality sex ratio had increased to 1.77.

2$! Table K. Age-adjusted death rates for Influenza and pnaumoniq by color and se~-United States, 1950-69 [For 1968and1969rates are based on deaths assignedto categorynumbers470-474,480486 of the Eighth Rsviu’.rr of t%.lnter- rurtional Cftmification of Diseases, Adapted for Use in the United States, a&pted in 1965; for 1950.67 ratesarebased on deaths assignedto category numbers 480483, 490493 of the Sixth and Seventh Revisionsadopted, respectively, in 1948 and 1955. For method of age adjustment, see appendix I]

Total White All other

Year Both Both Both Male ‘e- Male ‘e- Male q; sexes male sexes male sexes

Rate per 100,000 population 1969--’------24.6 31.3 19.1 22.3 28.4 17.3 41.9 54.8 30.9 1968------26.8 34.0 :;.; 24.1 30.7 18.8 47.3 60.7 35.8 1967------20.8 26.8 18.8 24.2 14.3 36.4 47.6 26.6 1966------23.8 30.2 18:5 21.2 27.1 16.4 43.3 55.2 32.8 1965------23.4 29.8 18.2 21.0 26.9 16.1 41.7 52.3 32.3 1964------22.8 28.8 17.7 20.3 25.9 15.7 40.8 51.2 31.4 19631------27.7 34.5 21.8 24.4 30.7 19.0 55.3 66.6 45.1 ;;%;1------23.7 29.4 18.9 21.2 26.5 16.7 43.4 52.1 35.4 ------22.1 27.6 17.4 19.8 24.8 15.5 39.6 49.6 30.5 1960------28.0 35.0 21.8 24.6 31.0 19.0 55.2 68.0 43.3 1959------23.4 28.9 18.5 20.7 25.8 16.2 44.1 53.6 35.2 1958------25.1 31.2 19.6 22.1 27.7 17.2 49.7 61.4 39.0 195i’------27.9 34.1 22.3 24.5 30.5 19.3 55.3 65.o 46.4 1956------21.6 26.2 17.3 19.1 23.5 15.1 41.6 :;.; 34.6 1955------21.0 25.3 17.1 18.4 22.3 14.9 42.2 33.9 1954------19.9 24.1 16.1 17.4 21.2 13.9 41.3 :;:: 33.8 1953------26.3 31.6 2L 3 22.7 27.5 18.2 58.6 49.1 1952------24.0 28.5 19.7 20.7 24.8 16.9 52.1 60:6 44.0 1951------25.7 30.2 21.5 22.5 26.6 18.6 54.6 62,3 47.2 19509------26.2 30.6 22.0 22.9 27.1 18.9 56.9 63.4 50.6

lFiakres bv. color exclude data for residents of New Jersey because this State did not rehire reporting of the item for” these years. ~ Based on enuerated population adjusted for age bias in the population of races o,ther than white. 11

32 32

23 28

24 24 g ~ ~ .20 20 m— .= 16 ;; 16 Z:, 5812 12

~~’ * k yj !T4 4

0 0

1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 : 1960 1~61 1962 1963 1964 1985 1966 1967 t968 1969 YEAR AN% MOi?H

Figure 6. D;ath rates for Influenza, by month: United Ststss, 1950-89. Influenza (ICDA Nos. 4?’O-47’4).-There were It may be assumed that the 8.17 percent about 4 percent more deaths assigned to this reduction found for the sample of 1966 deaths disease by the Seventh Revision than were assigned also is the percent reduction between 1967 and to it by the Sixth Revision.3 The comparability 1968 ~hat is attributable to the change to the ratio for Influenza between the Seventh and Eighth Eighth Revision. Revisions is 0.9572 (appendix III). The number of deaths in 1968 coded to this Tbe mortality curve for kfluenza during cause by the Eighth Revision was only 43,840, and 1950-69, emphasizing the severe epidemics that the number for 1967 coded to the comparable occurred during that 20- year period, is shown in group of causes by the Seventh Revision was figure 6. 48,314 deaths, a reduction of 4,474 deaths (table Pneumonth (lCDA Nos. 480-486).-An es- 3). timated 4.8 percent more deaths were assigned Inasmuch as 8.17 percent of the 48,314 deaths by tbe Eighth Revision to Pneumonia (ICDA NOS. in 1967 is 3,947 deaths, the difference between 480-486) than were assigned by the Seventh 4,474 and 3,947 deaths (527 deaths) is the es- Revision to the most nearly comparable category timated maximum number that may be attributed Pneumonia, except pneumonia of the newborn to an actual lowering of the death rate for this (ICD Nos. 490-493) (appendix III). group of causes. Most of the deaths assigned to Influenza and A more precise measure of the true decline, pneumonia, for which the trends of age-adjusted in mortality among infants from these causes may death rates are described above, are actually be obtained by applying the comparability ratio of deaths from Pneumonia. For example, for 1969 0.9183 to the 1967 infant mortality rate from these the death rate for htfluenza was only 3.0 deaths causes (1,371.0 deaths per 100,000 live births) per 100,000, while that for Pneumonia was 30.9 (table 4). Multiplying the rate of 1,371.0 by O.9183 deaths per 100,000 (table 1), gives a death rate of only 1,259.0 per 100,000 live births. The difference between the 1968 rate (1,248.2 deaths per 100,000 live births) and the V!. CERTAIN CAUSES OF MORTALITY adjusted 1967 rate (1,259.0) is 10.8, constituting IN EARLY INFANCY a real decrease in mortality of only 0.86 percent. The reduction in the assignment of deaths to Despite the fact that during 1950-69 there the Eighth Revision title “Certain causes of were two breaks in the continuity of the number mortality in early infancy” reflects primarily the ‘ of deaths assigned to Certain causes of mortality change in classification which provided that only in early infancy (ICDA Nos. 760-769.2,769.4-772, diseases specific for the newborn (e.g., hemolytic 774- 778), tbe trend was clearly downward (table disease of the newborn) be included under this 3 and figure 1). title and that conditions not different from those The introduction of the Seventh Revieion classified out aide the perinatal classification, (used for data years 1958-67) resulted in an such as pneumonia and diarrhea, be excluded.. estimated increase of about 2 percent in the About 2,232 of the 2,477 dearbe that were number of deaths assigned to these causes over assigned by the Seventh Revision to Pneumonia of the number assigned to the identical group of the newborn (ICD No. 763) were assigned by causes during 1949-57, for which period the the Eighth Revision to Pneumonia (ICDA Nos. Sixth Revision was in use.a 480-486).1 Tabulations of deaths assigned by the The second break in continuity resulted from Eighth Revision to this latter cause for the age the introduction of tbe Eighth Revision, used group under 1 year will give tbe number of beginning with data year. 1968. This change in infants dying from pneumonia. Revisions reduced deaths assigned to this group About 233 of the 250 deaths that were assigned of causes by 8.17 percent (appendix III) (from by the Seventh Revision to Diarrhea of the newborn 51,644 to 47,425 deaths, based on the coding of (ICD No. 764) were assigned by the Eighth the sample of deaths occurring in 1966 by both Revision to Enteritis and other diarrheal diseases the Seventh and the Eighth Revisions).z (ICDA Nos. 008, 009). Similarly as for the pneu- monias, tabulations of deaths for the age group the same period, Arteriosclerosis (ICDA No. 440) under 1 year assigned to Enteritis and other ranked as the seventh leading cause of deat~ and diarrheal diseases (ICDA Nos. 008, 009) will give in 1968 it exchanged rank with Diabetes mellitus, the number of infants dying from this cauae. primarily as a result “of the assignment of about The decrease between 1950 and 1969 in the 10.4 percent fewer deaths to Arteriosclerosis infant mortality rate for these diseases (from with the introduction of the Eighth Revision than 1,715.4 deaths to 1;196.0 per 100,000 live births) had been assigned to this cause by the Seventh (figure 2) reflects decreases in the corresponding Revision. rates for each of the four color-sex groups (table There were no serious breaks in continuity 4). for mortality statistics for Diabetes mellitus For 1950 the mortality rate for infants of (ICDA No. 250) during 1950-69. The comparability races other than white was 1.46 times the ratio between the Sixth and Seventh Revisions is corresponding rate for white infants, and for 1.01.3 Tbe comparability ratio between the Seventh 1969 it was 1.66 times the corresponding rate for and Eighth Revisions for Diabetes mellitus is white infants. This increasing color differential 0.9971 (appendix 111). for mortality from these diseases reflects in- During the period in which the Seventh Re- creases in the corresponding differentials for both vision was in uae (1958-67), the death rate for male and femaIe infants-with an especially large Diabetes mellitus increased from 15.9 to 17.7 increase for female infants. For female infants deaths per 100,000 population, representing 27,501 of races other than white the 1950 mortality rate deaths for 1958 and 35,049 deaths for 1967 for these causes was 1.56 times the corresponding . (tables 2 and 3). The rate continued at a bigb level rate for white female infants, and by 1969 this for 1968 (19.2 deaths per 100,000) and 1969 differential had increased to 1.73 times the rate (19.1 deaths per 100,000). for white female infants (based on rates in table Age-adjusted death rates also show a rise in 4). , mortality from this cause during 1958-69 (table L Male infants continued throughout 1950-69 to and figure 1). Although the death rate for the have a death rate for these causes that was” about female population continued somewhat higher than 1.35 times the corresponding rate for female in- that for the male population, the absolute increase fants. The stability of @is mortality sex ratio for in the death rate for the latter group was higher the total population of infants during 1950-69 than that for the female population;. was experienced by both the white population and A glance backward over the age-adjusted the population of races other than white: but the death rates by sex and color for the entire period mortality sex ratio for” white infants (about 1.38) for which such rates are available (1914-69) continued higher during 1950-69 than the corre- shows an unusual sex-differential morrality pat- sponding ratio for inf=ts of races other thanwhite tern ‘for this disease. The ratio of the age- (1.29 for 1969). adjusted death rate for this cause for the male population divided by the corresponding rate for “VII. DIABETES MELLITUS the female population was 0.80 for 1914.4 This sex differential decreased to an even more favorable Jn 1968 Diabetes mellitus (ICDA No. 250) level for the male population between 1914 and moved up to become the seventh Ieading cause of the early 1940’s. By 194S the above-described death. This disease held this rank throtigh 1969, ratio Was down from 0.80 to 0.62, but since that during which 38,541 persons died from this condi- time the gap between the age-adjusted death rate tion. (Data from a 10-percent sample show that for this cause for the male population and that diabetes continued to rank as the seventh leading for the female population has been steadily cause of death for 1970 and 1971.) In 1950 closing. For 1969 the ratio of the age-adjusted diabetes ranked only as the 10th leading cause and death rate for diabetes for the male population in 1“951, as the ninth leading cause. It reached the divided by the corresponding rate for the female rank of eighth leading cause in 1952 and maintained population was 0.90 (with ratios for 1950-69 based that rank for each year during 1953-67. During on rates in table L). This first widening of the

32 Table L. Age-adjusted death rates for Diabetes mellitus, by color and sex: Un;ee.d States, 1950-69 [For 1968 and 1969 ratu are based on deathsassignedto categorynumber 250 of the Eighth Rsvisio. oftfze InternationalCkssif- Cdh”on of Diseases,Adaptedjor Use in the United States,adopted in 1965; for 1950-67 rates are based on deathssssignedto category number 260 of the Sixth and SeventhRevisions adopted, respectively,in 1948 and 1955. For method of age adjustment,see appendix I]

Total White All other

Year Both Male Fe- Both Male ‘e- Both Male ‘e- sexes male sexes male sexes male

Rate per 100,000 population

1969------14.5 13.6 15.1 13.2 12.8 13.3 27.7 21.3 33.2 1968 ------14.7 14.0 15.3 13.4 13.2 13.5 28.0 21.3 33.7 1967------13.7 12.9 14.4 12.7 12.4 12.8 24.5 18.5 29.7 1966 ------13.9 12.8 14.6 12.7 12.3 13.0 24.8 18.3 30.5 1965------13.5 12.5 14.4 12.5 11.9 12.9 23.6 18.1 28.6 1964------13.5 12.4 14.4 12.5 11.8 12.9 23.6 17.6 29.0 19631 ------13.8 12.4 14.9 12.7 11.9 13.3 23.1 16.6 29.1 19621 ------13.5 12.3 14.5 12.5 11.8 13.1 21.8 16.1 27.1 1961 ------13.3 11.7 14.6 12.5 11.4 13.3 21.0 14.9 26.7 1960 ------13.6 12.0 15.0 12.8 11.6 13.7 21.6 16.1 .26.8 1959 ------13.0 11.3 14.5 12.4 11.0 13.5 19.4 14.1 24.2 1958 ------13.0 11.3 14.6 12.5 11.1 13.6 18.8 13.0 24.3 1957 ------13.2 11.1 15.2 12.7 10.9 14.3 18.2 12.5 23.6 1956 ------13.0 11. O 14.8 12.6 10.9 14.0 17.1 11.7 22.2 1955 ------13.0 10.9 14.8 12.6 10.9 14.1 16.5 11.2 21.6 1954 ------13.1 10.9 15.2 12.8 10.9 14.5 16.4 11.3 21.2 1953 ------13.9 11s2 16.3 13.5 11.2 15.6 17.2 11.3 22.9 1952------14.1 11.5 16.4 13.8 11.5 15.8 16.5 11.5 21.5 1951 ------14.2 11.3 16.9 13.9 11.2 16.4 16.6 11.8 21.3 19509 .------14.3 11.4 17.1 13.9 11.3 16.4 17.2 11.8 22.6

lFiWre~ by color exclude data for residents of New Jersey becauee this State did not require reporting of the itetn for these years. 2Based on en~erated population adjusted for age bias in the pOpUhItiOtI Of races other than white. I gap between the sexes formortalityfromdiabetes death rate for the white male population (with for the total population (until the early 1940’s) a very slow decline for this latter rate until and then the subsequent narrowing of the gap are about 1957, followed by a very slow rise from shown also for the white population and for the that year to 1969). population of races other than white. But the gap This narrowing of tbe sex differential for continued through 1969 to be much narrower mortality from diabetes during 1950-69 reflects for the white population (with a mortality sex on the one band almost steady increases for the ratio of 0.96) than for the population of races white male population in the death rate for other than white (with a mortality sex ratio diabetes for the age groups 35-44, 45-54, and for 1969 of 0.69). For the white population this 55-64 years andonthe other hand almost steady narrowing of the gap between the sexes for decreases in the &orresponding death rate for mortality from diabetes occurred as a result tbe age groups 55-64 and 65-74 years of the of the concomitant decline in the sge-adjusted white female popuf.etion. death rate for the white female population and the Focus~g on the age-adjusted death rates for maintenance of a relatively stable age-adjusted tbe population of racee other than white for this

, period shows adifferent pattern than that for the white population. Instead of being a relatively Number of diabetics stable rate, the age-adjusted death rate for the in thousands male population of races other than white rose rapidly during 1950-69, reaching a level for Sex and July July ?ercent 1969 (21.3 deaths per 100,000) that was 1.8 color 1966 - 1964- kmrease Jnne ;U& (:);of2) times the corresponding rate for 1950 (11.8 1967 deaths per 100,000) (table L). These rapidIy increasing age-adjusted death rates for these men (1) (2) (3) reflect substantial rises in mortality for this cause for each age group in the span 45-54 years Male through 85 years and over, with a smaller rise for the age group 25-34 years. WhLte ----- 1,145 873 31.2 All other- 128 89 43.8 Data from the Health Interview Survey of the National Center for Health Statistics show that Female the percentage increase between July 1964 and White ----- 1,558 1,12$ 38.0 June 1965 and July 1966 and June 1967 in the All other- 261 208 25.5 number of reported diabetics in the population is also grearer for these men of racea :fier Iu.sc civilian, noninstitutiona lized than white than “for the other three color-sex population reported in health interviews. ~oupSaM (See table at right.) Further studies (See references 5 and 6.) areneeded todetermine the cause for therapidly increasing death rate for diabetes among men groups. Buttberelative increase during 1950-69 of races other thsnwbite. in the death rate for these female persons (46.9 For female persons other than white the -percent) was lower than the corresponding in- curve of the age-adjusted death rate for this crease in the death rate for male persons of cause continued for each year during 1950-69 races other than white (80.5 percent). at a substantially higher level than the corre- An examination of the age-color-sex specific sponding curves for the other three color-sex mortality trends for 1950-69 for diabetes shows

,- Cohortand period of birth Se., colmj ma age at death from Diabetes m.llitus 9.S5- 1940- KE5- 1950- 1925- 1’320- 1915- lslO- 1905- 1900- 1295- 1.890- M8s- 18&)- ~,y7~- ~~,,j- 949 1944 1939 1934 1929 1824 1919 1914 1209 3.S04 1899 1894 1889 1884 1879 1874 . Female persons of racesother Ikdh. ates per KX3,CO0 poplaticm i. age gr.atig than white

20-24 years------1.8 1.3 1.2 1.0 2.9 25-29 Tears------2.9 2.8 3.1 2.5 3.3 20-34 yea.rs------3.5 4.2 3.7 3.5 5.3 35-39 years------9.2 6.’! 6.7 5.9 8.9 40-44 years------16.8 15.9 16.5 M .2 20.0 45-49 yeaIs------28.0 33.3 29.4 28.8 35.3 50-34 years------55.5 53.6 47.8 56.4 56.4 55-59 years------90.3 91.3 86.4 82.1 73.9 60-66 years----- 63.5 .53.7 19.9 93.3 95.s 65-69 yx?.r,------!26.8 .74.6 !Z5.6 88.1 KM.7 70-74 wars ------Isl.1 !76.0 129.1 12S.3 ,20.4 75-79 yea.ts------;14.4 183.0 157.4 11.8 126.2 80-94 years---=- 230.6 130.0 39.6 80.0

lK7T8:‘f& first fisure in each row, moving from right ‘m left,2s the aeath rate for data year 1949; the .emnd figure,for 1934; the third fime, for 1959;1the fourth fime, for 1964; end tbe f12th Zi@re, for 1969. J Tor data years 1948,1954,1928,and 1964 these rates are based on deaths assigned to categozy number 260 or the Sixth and Seventh Revisions of the Intermtional Lists, adopted,respectively,in 1348 and1S55;f0r data year 1969 rates are based on deaths assfgmd to category number 230 of the Eighth Revision of the Intemtatimal Lists, wlmpt:d in 1965.

34 that for women of races omer than white, th~ correspondhg rates for wrote women horn in level of mortality for the age groups under 55 1910-14. years remained quite stable. But for older age This widening of the female color differential groups the death rate for this cause among for diabetes may reflect lass satisfactory results these women increased markedly. Part of this from diabetes control programs for these women increase in mortality at older ages may be than for white women. The same data referred to , attributable to the prolongation of the life of above from the Health Interview Survey of the diabetics by increased frequency of early diag- National Center for Health Statistics suggest that nosis and successful treatment programs (in- this widening of the female color differential is cluding the use of insulin therapy beginning in not attributable to’s faster rising prevalence rate the 1920ts, followed by antibiotics, diet, andother of the disease among women of races other than therapeutic measures). whi_te.5.6 Cohort analysis shows that for women of l%e estimated number of white female dia- races other than white mortality from diabetea betics increased fram 1,129,000 for July 1964- increased. rapid~- wfth adv&ce–in age ‘during June 1965 to 1,558,000 for July 1966-June 1967, 1949-69. (See table at Lmttom of page 34.). This representing an increase of about 38.0 percent; method of analysis also shows that the cohort whereas the corresponding increase for women of of women of raceq other than white born in races other than White was from 208,000 to the period 1900-1904 had death rates for diabetes 261,000, representing an increase of only about at ages 45-49, 50-54, and 55-59 years that were, 25.5 percent. respectively, 4.7, 4.2, and 3.3 times the corre- Part of tbe increase in the number of diabetics sponding rates for the cohort ofwhitewomenborn reported in the Health Interview Survey is believed in the same period.: (see ~bleb~ow.) by personnel of the survey to be attributable to For women born in 1910-14 the color dif- increasing awareness of the presence of the ferential in mortality from diabetes was even disease by those interviewees who have the greater than that for the above-considered cohort condition and to better interviewing techniques to of women (1900-1904): for women of races other obtain the reporting of the disease. than white born in 1910-14 the death rates for Age-adjusted death rates hy geographic divi- diabetes at ages 45-49: 50-54, and 55-59 years sions for 1950, 1960, and 1969 show that the East were, respectively, 5.3, 4.6, and 4.2 times the North Central and Middle Atlantic Divisions had

Cohort and pericd of birth Color,se&aud age at 6e.zthfrom — . Diabetesmellltvs ,945- 1940- .933- 930- ,923- 1920- 1915- 1910- 1905- 1900- 1895- 1890- 1685- 18’eo- 1.275- 1870- I949 1944 .939 934 .929 1924 1919 1914 1909 1904 1899 1894 1889 1824 1879 1874 Whitefemale Death rates $er 1S0,000Fpulati.n in age @YJUP persons

20-24 yeara------1.1 0.9 1.0 1.0 1.5 25-29 ysars------1.7 1.5 1.5 1.5 1.6 30-34 years------2.7 2.3 2,4 2.0 1.5 35-39 years------3.2 2.5 1.9 2.3 2.1 40-44 yeal’e------4.1 3.8 3.2 2.9 3.7’ 45-49 ye8rs------6.9 5.4 5.6 5.4 7.5 m-s.l yeal’------U .4 3.3..6 12.2 13.5 18.3 55-59tiars---- 21.5 23.9 26.0 30.8 42.0 60-6k years------, 40.6 42.7 57,.0 57.9 77.5 65-69”years------70.5 75.7 83.4 96.1 114.o 70-74 WWXs------121..1 122.6 130.7 136.3 165.9 75-79years----- 174.3 162.8 163.5 169.2 189.3 20-84 ym,------2SL.1 197.5 188.2 191.7 1

NOT8: The Zl?mt figure in each row, moving from rigb%to left, is the death rate for data year 1949;the secondfigure,for 1954; the third figure,for 1959; the fourthfigure,fc.r1964; ana the fifthUfigure,for 1969. 11 For data years 1949, 1954, 1959,and 1961 these rate6 are based on .ieatb.aassi2nedto categorynumber 260of the Sixth and Seventh RtiBio.s 02bhe intern’a.WLomal.14.6ts,aciopted,respecti%?ely,in1949 8n6.1955; for 6ata year 1969 rates are b.se6 on &.ths assigmed to categorynumber 250 of the Eighth Retisi.nof the InternationalIi+s, =&pbe& in 1965. Table M. Death rates.for Diabetes mellitus,by broad age groups,and correspondingage. adjusted rates: United States and each geographic division, 1940, 1950, 1960, and 1969 [Deathsarethose-attributedtocategorynumber61oft] FifdtRevki.noftheInternationalL~ts,1938;tocategorynumber260 oftheSixthandSeventhRevisions.ado,d,respectivein194Sand1955:andtocatezorvnumber25ooftheEighthRe.vk~on, adopteditt1965.Formethodofa& ad nnent,seeq :ndix I]

Age- Geographic division All adjusted and year ages rates a

United States Rate ,er100,000 population

1969------19.1 ------23.6 136.2 ;;.; 1960------16.7 3.5 23.3 118.0 1950------16.2 ;;; 25.4 120.3 14:5 1940------26.6 1.7 ::: 50.2 211.8 26,6 New England 1969------20.9 --- P-- 21.0 141.7 14,9 1960------19.7 0.4 3.5 20.8 132.8 14.4 1950------21.0 0.5 27.2 142.3 16.2 1940------35.6 L 2 ::: 55.8 254.1 30.3 Middle Atlantic 1969------L------22.1 ------23.5 151,5 16.3 1960------21.1 3.6 26.8 140.8 16.2 1950--:------20.5 ::: 31.3 146.1 17.3 1940------38.4 1.4 ;:; 73.7 301.2 37.1 East North Central 1969------21.6 ------24.8 162.3 1960------19,9 0.5 27.0 144.3 1950------20.6 0.8 ::2 31.3 148.2 1940------30.5 1.8 4.8 54.4 225.2 West North Central 1969------20.5 ------20.9 128.6 1960------17.3 3.4 18.8 110.9 1950------” 17.9 ::! 21.7 122.8 1940------26.5 2.1 ::: 37.7 201.8 - lRates are not shown for 1969 for the age groups under 25 and 25-44 years because ‘thepopulation bases for these particular broad age groups are not available. 2The 1969 age-adj us ted rates are based on age grOups under 20 years, 20-44 years, 45-64 years, and 65 years and over.

. the highestmortalityfrom thiscauseand the Vlll. ARTERIOSCLEROSIS Mountain and PacificDivisionshad the lowest mortality(tableM). A similargeographicpattern ItappearsthatthetrendforArteriosclerosis was found in an earlierstudyfor the average (ICDA No. 440)was downwsrd between1950and &nual ratesfortheyears1950-51and1959-61.7 1969 (tables2 and 3 andfigure1).But theactual

M Table M. Death rates for Diabetes mellitus,by broad age groups,and correspondingage- adjusted rates: United States and each geographic division, 1940, 1950, 1960, and 1969—Con. . [Deaths are those attributed to category number 61 of the Fifth Revision of the Internationst Lsts, 1938; to category number 26o oftbeSixthandSeventh Revisions, adopted, respectively, in 1948 and 1955; snd to category nuinber 250 of the Eighth Reti]on, adopted in 1965. For method of age adjustment, see appendix I] I I 65 Geographic division All Under 25-44 45-64 ye&s Age- and year ages 25 years1 years adjusted years I rate 2 over I I I

South Atlantic Rate per 100,000 population

1969------18,1 ------30.5 123.8 15.9 1960------14.1 26.6 98.3 13.3 1950------12.6 ::: $; 25.6 99.6 13.4 1940------18.2 1.7 44.3 157.0 21.9 Eaet South Central 1969------18.2 ------27.0 122.0 15.3 1960------13.1 0.6 3.6 21.7 89.6 11.7 1950------10.2 0.9 3,3 18.9 79.1 10.5 1940------13.9 1.9 5.5 30.3 115.9 16.4

West South Central 1969------17,5 ------26,0 126.8 15.1 1960------15,1 0.5 3.3 23.9 111.6 13.5 1950------11,6 0.8 3,0 20.1 93.8 11.6 . 1940------14,4 1.7 4.6 33.3 119.9 16.9 Mountain 1969------13.5 ------16.1 113.6 12.3 1960------=------10.6 0.5 2.9 16.9 86.8 10,3 1950------10.3 0.6 3.1 17.0 85.5 10.4 1940------: 16.1 1.9 2.5 28.2 153.7 17.6 Pacific 1969------13.8 ------16.4 107.4 11.7 1960------10.i’ 0.5 14.3 78.9 9.2 1950------10.0 0.6 ;:? 13.1 73.5 1940------25.1 2.0 3,3 35.7 185,0 2!:2 — - lRates are not shown for 1969 for the age groups under 25 and 25-44 years because the population bases for these particular broad age groups are not available. ~The 1969 age-adjusted rates are baaed on age gxotIPS under 20 years, 20-44 years, 45-64 years, and 65 years and over.

amount of declbe isnotevidentfrom theannual the latterrevisionusedbeginningw;thdatayear deathratesfor theperiod1950-69owingtothe 1958)thecomparabilityratjowas 1.02.3The break factthatthere were two breake in thecom- intrendbetweentheSeventhandEighthRevisions,, parabilityofmortalitystatisticsforthisdisease. introducedfordatayear 1968,was much more Between the Sixthand SeventhRevisions(with serious,resultingina comparabilityratioforthe Seventh and Eighth Revisions of only 0.8963 tfon as for the population of other than white (appendix III). races-the color ratio being 0.99 .This color ratio During 1950-69 the almost halving of the age- had remained quite stable since 1950, when it was adjusted death rate for Arteriosclerosis (ICDA 0.98. Very “similar patterns are found when t$e No. 440) @om 16.2 deaths per 100,000 population color ratios for mortality from this cause are for 1950 to 9.2 deaths for 1969) (figure 1) examined separately for the male population (with reflects sizable reductions in the death rate for a mortality color ratio of 0.98 for 1950 and this cause for each of the four color-sex groups 0.99 for 1969) and for the female population (table N). (with a mortality color ratio qf 0.96 for both Because this disease is associated with the 1950 and 1969). aging process, it is not surprising that about 95- The sex ratio for mortali~ from Arterio- percent (31,535 deaths) of thetotsldeaths (33,063) sclerosis was higher than the corresponding color from Arteriosclerosis in 1969 occurred at ages 65 ratio during 1950-69, but the trend for tbe sex years and over. ratio appears to he downward—from 1.29 for The age-adjusted death rate for this cause 1950 to 1.20 for 1969. For 1969 the sex ratio for 1969 was about the same for the white popiila- for this disease for the white population (1.20)

Table N. Age-adjusted death rates for Arteriosclerosis, by color and sex: United SCates, 1950-69 [For1968 and 1969 ratesarebasedon deathsassignedtocategorynumber440 oftheEighfh Revision o~the Itztematimml Ch@- cation o~Dfseases, Adapted for Use in the United States, adoptedin 1965; for 1950-67ratesarebasedon deathsassignedto cate- gorynumber450 oftheSixthandSeventhRevisionsadopted,respectively,in194Sand 1955. Formethodot%ge~djm.tment,see appen~ 11 I Total White I All other

Year II I Both Both Male ‘e- Tide ‘e’ sexes male sexes male

. . Rate per 100,000 population

1969 ------9.2 10.1 8.4 9.2 10.2 8.5 9.1 10.1 8.2 1968 ------10.5 8.8 9.6 10.6 9.9 ‘“”14.0 9.0 1967 ------1?:? 12.2 10.2 11.2 12.3 1;:: 10.7 ‘11.8 1966 ------11.9 13.2 10.9 11.9 13.2 10.9 ;;.: - “13.2 1?:1 1965 ------”-- 12.0 13.4 11.0 12.0 13.4 10.9 ‘.13.6 11.3 1964------12.1 13.2 11.2 12.0 13.1 11.1 12:6- ‘13.6 11.8 19631 ------12.5 13.9 11.5 12.5 13.8 11.4 13.4- ““14.7 ;;.: 19621 ------.----- 12.6 13.8 11.6 12.5 13.7 11.5 ;;;; : --15.0 1961------12.4 13.8 11.3 12.4 13.7 11.2 ‘--14.2 11:5 1960 ------13.2 14.8 11.8 13.1 14.7 11.7 13%- --15.5 12.3 1959 ------13.0 14.5 11.8 12.9 14.4 11.7 13;7- 7.15.2 12.3 1958 ------13.4 15.0 12.1 13.3 14.9 11.9 14:7- ‘.16.0 13.7 1957 ------13.3 14.8 12.1 13.3 14.8 11.9 Uira - “ ‘-15.2 13.1 1956 ------13.3 14.8 12.0 13.2 14.7 11.9 i.3X-- “ - 14.8 12.5 1955------13.9 15.7 12.4 13.9 15.6 12.4 14,3 16.2 12.5 1954------13.5 14.9 12.2 13.4 14.8 12.1 13.9 15.5 12.6 1953 ------15.0 16.8 13.5 14.9 16.7 13.4 15.5 17.7 13.5 1952 ------15.3 16.9 13.9 15.3 16.8 13.9 15.0 17.1 13.1 1951------16.0 17.9 14.4 L6.1 17.9 14.5 15.1 17.1 13.1 19502 ...... 16.2 18.4 14.3 16.2 18.4 14.3 15.8 18. (J 13.7 1 II

1~iWre~ by color exclude data f Or residents of New Jersey because this State did aot require reporting of the item for these years. 2Based ou enumerated population adjusted for age biae in the population of races other than white. .

-za was close to the corresponding sex ratio for the 1957 and 1958. The introduction of the Seventh population of races other than white (1.23); and Revision reduced the number of_deaths assigned the trend for E&h of these groups was downward to these causes by about 6.2 percent over the during 1950-69, decreasing from 1.29 for the number assigned to the same titles by the Sixth white population and from 1.31 for the population ‘ Revision.3 of races other, than white. The comparability ratio for this group of causes between the Seventh and Eighth Revisions IX. BRONCHITIS, EMPHYSEMA, is 1.0034 (appendix III). Although this ratio is t~ND ASTHMA close to 1.00, the corresponding factors for the three components of this group of diseases, as Bronchitis, emphysema, and asthma (ICDA’ shown below, vary considerably from 1.0,0. Nos. 490-493).--During 1950-69 there were two The trend of the age-adjusted death rate breaks in the continuity of mortality statistics for this entire group of causes was steeply for this group. The first break occurred between upward during 1954-69 (table O and figure 1).

Table O. Age-adjusted death ratee for Bronchitis, emphysema, and asthma, by color and eex: United States- 1950-69 [For 1968and 1969 rates basedon deaths.assignedto categorynumbers 490~93 of the Eighth Revision of the International Ck.wification of Diseases dapted for Use in the United State+ adopted in 1965; for 1950-67 rates are bssed on deaths assigned 02, 527.1, and 241 of the Sixth and Seventh Revisions adopted, respectively, in 1948 and 1955. For %%R$::;:::: :. appendix I] .,,’ It 11’ I Total II White I All other Year r Fe- Both Both Fe - Nale ‘e - Male Dale eexes male sexes nale

Rate per 100,000 population .. 1969 ------12.0 21,1 &.7 12.0 21.6 4.6 10,0 15.7 1968 ------12.9 22.8 13,0 23.2 4.9 11.3 17.7 1967 ------12.1 21,4 ::+ 12.2 21.8 4.5 10.3 15.9 1966 ------12.2 21.4 4.6 12.3 21.9 10,0 15.6 1965 ------11.6 20.4 11.7 20.7 ::: 9.8 15”.2 1964 ------10.5 18.1 ::: 10.5 18.5 3.9 9.0 13.9 19631 ------10.6 18,3 :.; 10.7 18.8 3.9 9.7 14.2 19621 ------J-7-- 9.2 15..6 9.2 16.0 3.5 8.4 12.1 1961 ------8.2 13,7 8.1 13.9 3.2 7.9 11.5 1960 ------~-T-- 8.2 13.7 H 8.2 13.8 3.3 8.0 11.2 1959 ------+ ----- 12.1 3.0 12.2 2.8 9.9 1958 ------=;T i:: 11.4 2.9 ::; 11.5 2.7 ::; 1957 ------11.7 3.3 11.7 3.1 7.9 1%; 1956 ------=;:$ ::: 9.9 2.9 ;:; 10.0 2.8 5.9 8.-0 1955 ------9.1 9.2 2.9 5.6 7.5 1954 ------1=: r ;:; 8.7 ::! 2:: 8.8 3.0 5.3 ;;;; :------4.8 6.6 3.1 4.7 6.6 2.9 5.0 N ------4.9 6.7 3.2 4.8 6.7 3.1 5.5 6.3 19519 ------: - 5.0 3.3 4.9 3.2 u)5d~~3------3.7 ::: 2.7 3.6 ::$ 2.6 ::; ::; 1 — - 1 -

1Figwes by color exclude data for residents of New Jersey because this State did not require reporting of the item for these yeare. 2 Excludes data for ICD No. 527.1, because for these years data were not available by age, color, and sex. S,Based on enumerated population ad-jus ted for age biae in the population of races other than white.

.4 (The base line 1954 instead of 1950 is used bemuse The death rate for Chronic &d unqualified the number of deaths for one componefit-Emphy- bronchitis (ICDA Nos. 490, 491) rose durfng sema without mention of bronchitis (ICD No. 1958-67, when the Seventh Revi~%n W~S in use, 527.1)—for the years 1950-53 is not available.) from 1.5 to 2.7 deaths per 100,000 (table 2). These age-adjusted death rates” show that Applying the comparability ratio of 1.0620 to this for 1969 mortality for the male population from latter rate raised it to 2.9, the magnitude this these causes was 4.49 times the corresponding rate would have had if the 1967 deaths had been mortality for the female population. This mortal- coded by the Eighth Revision. ity sex ratio had increased considerably over Emphysema (ICDA No. 492).-About 2 percent - the ratio of 2.81 for 1954. The mortality sex more deaths were assigned by tlfe Seventh Re- differential in 1969 was large for both color vision to Emphysema, without mention of bron- groups, but higher for the white group (4.70) chitis (ICD No. 527.1) than were assigned by the than for the other group (3.08). For both color Sixth Revision to this causes groups the mortality sex diierentials increased On the basis of the sampIe of deaths in 19661 during 1954-69. . coded by both the Seventh and Eighth Revisions, On the other hand the mortality color ratio there were 21,350 deaths assigned by the Seventh for Bronchitis, emphysema, and asthma appears Revision to the nearly comparable title Emphy- to have been relatively stable during 1954-69. sema, without mention of bronchitis (ICD No. The 1969 age-adjusred death rate for these 527.1)? a ratio of 1.0542 (appendfx HI). diseases for the population of races other than Applying the factor 1.0542 to the 1967 death white was only 83 percent of the corresponding rate for Emphysema (10.6) -sises it td 11.3 rate for the white population. This obtains because that is, to the level it would have been if the of the relatively low mortality color ratio for deaths in 1967 had been coded by the Eighth these diseases for the male population: for 1969 Revision. This is another respiratory disease for the age-adjusted death rate for the male popula- which the death rate was clearly upward during tion of races other than white was only 73 percent 1950-69 (table 2). of the corresponding rate for the male population Asthma (ICDA No. 493).—Th;&troduction of of the white races; while for the femsle population the Seventh Revision for data year 1958 resulted of races other than white, this rate was 1.11 in about 20 percent fewer deaths being assigned times that for the white female population. to asthma than had been assigned by the Sixth The death rate for Bronchitis, emphysema, Revision.3 and asthma, taken as a group of diseases, is On the basis of the sample o~deaths in 1966 higher for older th~ fOr younger age 90UP%. coded by the Seventh and Eighth-Revisions, there This is true for each of tbefour color-sex groups. were only 3,007 desths assigned------tb this cause by For both the white male and the other male the Eighth Revision and 4,324 .dea.@ assigned to populations the death rate for the age group it by the Seventh Revision,%+- ratio of 0.6954 . ---- 65-74 years is more than double that for the (appendix HI). -– ..” age group 55-64 years. .------Chronic andungualified bronchitis (ICDANoe. X. CIRRHOSIS-W--LIVER , -“------490, 491).—The introduction of rhe Seventh Re------vision resulted in the assignment of about 7 For 1969 Cirrhosis ‘of liver (ICDA No. S71) percent more deaths to Chronic and unqualified ranked as the 10th leading cause of death+he bronchitis than had been assigned by the Sixth rate being 14.8 deaths per 100,000 population, Revision to these causes.a representing 29,866 deaths. Its rank for each On the basis of the sample of deaths in of the four color-sex groups was even higher. 1966 coded by the Seventh and Eighth Revisions, 2 For 1969 this disease ranked ninth for the white there were 5,484 deaths assigned to this cause female population and eighth for each of the other by “the Eighth Revision and s,164 deaths asaigned three color- sex populations. to the comparable title by the Seventh Revision, There were no serious breaks in com- a ratio of 1.0620 (appendix III). parability of mortality. statistics for cirrhosis

4iQ during1950-69.The comparabilityratiois0.99 color-sexgroups.The 1969 age-adjusteddeath between the Sixthand SeventhRevisions~ and ratefor the male populationofracesotherthan 1.0055betwe~ theSeventhand EighthRevisions white (31.4deathsper 100,000population)was (appendixIII).! 3.5 times their correspondingrate for 1950 Between 1950 and 1969 the deathratefor (9.0deathsper 100,000)(tableP). Increasesin cirrhosisincqeased,from 9.2to14.8deathsper mortalityfrom this cause were even greater for 100,000 (table 2 and figure 1). This represents an men of races other than white in the early increasefrom 13,855deathsfor 1950 to29,866 middleyearsoflife.Forexample,formen atages deathsfor1962(table3). 35-44 years,the deathratefor thiscausewas Althoughan increasein mortalityfor this almoat seventimeshigherfor1969(66.8deaths cause occurred foreach of thefourcolor-sex per 100,000)than for 1950 (10.0deathsper groups,age-adjusteddeathratesshow thatboth 100,000). the absoluteand relativeincreaaesinmortality The mortalitysexdifferentialforthiscause were by far greaterfor the male population (basedon age-adjusteddeathratesin tableP) ofracesotherthanwhitethanfortheotherthree was somewhat greaterfor1969thanthecorre-

T.ableP. Abe-adjusted death rates for Cirrhosis of liver, by color and sex: United States. 1950-69 [For 196S and 1969 rates are basedondeathsassignedto cate&y number 571 of the Eighth IZe.kion of the InternationalCfa.w& cationoflheases, Adapted for Use in the United States,ado ted in 1965; for 1950-67 rates are based on deaths assigned to category number 581 of the %tb and Seventh Revisions adopte J , respectively, in 1948 and 1955. For method of age adjustment, see append~ 11

fi?l hl Total White All other I iJ_ Year,t Both ‘e- Both Both sexes Male male sexes Male male‘e- sexes Male male‘e-

i Rate per 100,000 p relation -r - 1969------14.2 19.4 9.5 12.9 18.0 8.5 24.0 31.4 17.6 1968------+’F ------14.0 19.0 9.5 12.9 17.8 8.5 22.9 29.8 17.0 1967------13.5 18.3 9.1 12.5 17.2 8.4 20.7 27.2 15.0 1966------13.0 17.8 8.7 12.1 16.8 7.9 20;4 26.6 15.0 1965------J ------12.1 16.5 S.3 11.4 15.6 7.6 18.0 23.3 13.4 1964------+------11.5 15.5 11.0 15.0 15.2 19.6 11.3 19631 ----- .(77-. --- 11.2 15.1 ;:; 10.7 14.7 ;:; 13.9 17.1 *11. O 19621------11.0 15.1 7.4 10.5 14.6 6.8 13.8 16.8 11.0 1961------10.6 14.5 7.1 10.3 14.2 12.8 1s.9 9.9 1960------s ------10.5 14.5 6.9 10.3 14.4 ::: 11.9 14.9 9.1 1959------10.1 13.8 10.0 13.7 11.3 13.7 9.1 1958------13.6 ::; 13.7 ::: 9.9 12.5 7.4 1957------1::? 14.4 6.8 1::: 14.4 6.6 10.8 13.4 *8.4 1956------F&%-- 9.9 13.3 6.6 9.8 13.4 6.5 9.7 11.8 1955------;.; 12.7 6.2 9.4 12.9 6.1 8.5 10.3 ;:: 1954------12.6 6.1 12.8 6.0 8.1 6.5 1953------9:5 12.8 6.4 M 13.0 6.4 1::; *6.3 1952------9.5 ‘ 12.8 6.2 9.5 13.0 6.2 ::: 10.6 *5.7 1951------9.1 12.1 6.2 9.2 12.3 6.2 8.1 9.9 6.3 19502------8.5 11.4 5.8 8.6 11.6 5.8 7.4 9.0 *5.9 .--. — - lFigures by color exclude data for residents of New,Jersey because this State did not require reporting of the item for these,years. ~Baeed on enumeratedpopulation adjusted for age bias in the population of races other than white. NOTE: Asterisk indicates age-adju&ed rates where more than halfof the age-epecific rates are based on fewer than 20 deaths.

. spending mortality color differential. Fo~ 1969 the age-adjusted death rate forcirrhosis for the Age at! male population was 2.04 times thecorresponding death (in Death rate for the female poptdation. Thismortality sex Color, sex, and ye&s ) rate per ratio was quite stable during 1950-69; for 1950 year of death from 100,000 this ratio was 1.97. Cirrhosis of liver cohort popu- born lation The mortality color ratio for cirrhosis shows 1895- increasing excess mortality for the population of 1899 races other than white. Actually for 1,950 their ,: age-adjusted death rate for this cause was only White, male 86 percent of that for the white population. But by 1958 both groups had the same age-adjusted 1969 ------70-74 57.2 1964 ------65-69 62.0 death rate forthis cause (9.9deathsper 100,000), 1959------60-64 46.4 and by 1969 the age-adjusted death rate for 1954 ------55-59 40.2 cirrhosis for the population of races other than 1949 ------50-54 29.3 white (24.0 deaths per 100,000) wasl.86timesthe All other, male corresponding rate-for the white population (12.9 deafis per 100,000). 1969 --”------70-74 49.0 1964 ------For this disease tbemortality color ratio is 65-69 42.4 1959 ------60-64 35.4 greater for the female populationthanfor the male 1954 ------55-59 35.9 population; but for each of thesexes the excess 1949 ------50-54 22.3 mortality from cirrhosis for persons of races White, female ----- other than white (as measured hy age-adjusred death rates) more than doubled between 1950 and 1969 ------70-74 21.4 1964 ------1969 (table P). 65--69 22.7 1959 ------60-64 18.4 The age-adjusted death rate for the white 1954 ------55-59 16.0 male population continued during 1950-69 to be 1949------5044 13.6 shout twice the corresponding rate for the white — All other, female female population. This mortality sex differential Jr‘3 was lower duFing 1950-69 for the population of 1969 ------L ------7!L 4 11.4 races otber than-white than for the white popula- L964------65- i 9 20.1 1959 ------60-64 17.1 tion, butincreased between 1950 and 1969, rising 1954 ------55-59 16.0 e from a ratio of 1.53 for 1950 to 1.78 for 1969. 1949 ------5LJJ54 LI.7 / For 1969 the death rate for cirrhqsis for the 1< total population increased for each succeeding differs from that for cohor~~’~df men of races age group up through ages 55-64 years and then other than white bomprior~o &&i-99. Forthese declined for the age groups in Eheremainder of earlier born cohorts the-d~athkmte does apuear the life. span~ A nearly similar pattern held for topeak at this Iatter age &’rttit~e~tums dowuward 1969 for ‘each of the four color-sex groups. duriing ~he last part of the lif~gfia~$ This apparent Whether the death rate for cirrhosis actually break in pattern for men of races other than does peak, before theendof the lifespan maybe white should he examined again when data for determined by cohort analysis. An examination of more recent years become available. It is possible the death rate for persons born 1895-99 shows that that this broken pattern refleck the extraor- for three of the four coloz-sex groups (white male, dinarilygreat increases during tlte1960ts in the white female, and other female) the death rate death rate for cirrhosis for men of races other for cirrhosis does peskatages 65-69 years (see than white at ages 70-74 years (from 25.2 for table at right). For the fourth group (the all 1960 to 49.0 deaths per 100,000 for 1969). other male group), however, the death rate for “The percentage of deaths from Cirrhosis of’ cirrhosis continues to rise for the age group 70- liver in 1969 for male persons of races other 74 years. This pattern for these men also than white for which alcoholism was mentioned

“42 on thedeathcertificate(44.4percent)was higher more completereportingof“alcoholic’’cirrhosis thanthecorrespondingpercentagesfortheother for thesepersonsthanfortheotherthreecolor- three color-s~xgroups (table-Q).Inasmuchas sexgroups. men of races other than white also have the Completenessofreportingon thecertificate lowest percent of deathsfrom “unspecified” of death as to the etiologyof cirrhosisvaries Cirrhosisof liver (35.7percent)t~eirhigh from State to State.California,which had a percentageas “alcoholic”rrtayreflectin part lower percentagefor 1969 of“unspecified”cir-

Table Q.,Number and percent distribution of deaths from Cirrhosis of liver by subcategories al~oholic,other specified, and unspecified,according to color and sex: United States, 1969 [Deaths am those assignedto category number 571 of the Eighth R..ision of the International Classification of Diseases, Adapted for Usein the United Statss, adopted in 1965] ,’

Cir- rhosis Alco- Other un- Of holic speci- speci- Color and sex liver (p fied fied (IJDA (ICDA (::DA 571:0) 57y&i 57i) 571.;)1

. ..! Number Percent distribution Total------29,866 10,520 5,404 13,942 100.0 35.2

;.1’ White, male--,---- 16,517 5,988 2,633 7,896 100.0 36.3 15.9 47.8 white, female---- 8,634 2,533 1,786 4,315 100.0 29.3 20.7 50.0 All other,male--- 2,863 1,;;:, “ 571 1,022 100.0 44.4 19.9 35.7 All other,female- 1,852 414 709 100.0 39.4 22.4 38.3 n I lThe Eighth Revision adapted for use in the United StatesThas the three subcategories shown in the report, whereas the Revision adopted by the World Health Organization hae only twq-subcategories:Alcoholic (ICDA No. 571.0) and Other (ICDA No. 571.9). The inclusion terms under the three subcategoriesin use in the United States are as follows: :- 571.0 Alcoh@ic 571.8 Other specified Alcoholic: Cirrhosis (hepatic) . Cirqhosis (liver): Hepatitis Biliary Laennec!s cirrhosis Cardiac Any condition in 571.8 or 571.9 Congenital Without men~ion with pe~tio,nof alcohol or Due to passive of alcohol or alcohol~sm congestion alcoholism ,.,lr.,,=:.:,, Portal POstnecrotic Fatty degeneration of liver ) 571.9 Unspecified Banti’a disease Chronic hepatitis Cirrhosis (hepatic) (I&er) : Without mention of alcohol or-alcoholism Hepatolienal Splenomegalic Hepatolienal fibrosis1

.43 rhosison deathcertificates(30.5percent)than between1967and 1968,withtheintroductionofthe the percentagefor thenationas a whole (46.7 EighthRevision.The comparabilityratiobetween percent),also reports for 1969 thatmen of theseRevisionsis0.9472(appendix111). races other than white have the highestper- Afteradjustingforthesetwobreaksincom- centage of reported deaths from “alcoholic” parabilityof mortality.statistics,itisfoundthat cirrhosis(52.2percent)and the lowestpercent the totaldeathrateforSuicideturneddownward of deaths from “unspecified”cirrhosis(21.6 during1950-57and thenincreasedslightlyduring percent). 1958-69(tables2 and 3 and figure1). Age-adjusteddeath ratesfor Suicideshow Xl. SUICIDE thatthisupturnresultedfrom appreciablein- During 1950-69therewere two appreciable creasesinthedeathrateforthiscauseforthree breaksin continuityin theassignmentofdeaths of the four color-sexgroups.For the fourth to Suicide(ICDA Nos. E950-E959). me first group-the white male population-theage-ad- break occurredbetween1957 and 1958 withthe justedrateremainedrelativelystableduringthe introductionof the SeventhRevision.The com- 1960’s,hutat a verymuch higherlevelthanthe parabilityratiobetween the Sixthand Seventh levelsfortheotherthreecolor-sexgroups(table Revisionsis 1.03.3The secondbreakoccurred R).

Table R. Age-adjusted death rates for Suicide,by color and sex:united States,I!150-69 [For 1968 and 1969 rates are basedondeathsresignedtocategmynumbersE95C-E959 of the Eighth Rsvkion of the Int.rn.t/ona/ Cksification of Diseases, Adapted for Us. in the United States, adoptedin1965; for 1950-67 rates are basedondeathsassigned to category numbers E963, E970-E979 of tbe Sixth andSeventhRevisions adopted, respectively, in 1948 and 1955. For method of am adjustment. see annendix 11

Total II White I All other Year &oth Both Male ‘e- Both Male ‘e- sexes Male male‘e- sexes male sexes male

Rate per 100,000 population 1969------11.3 16.7 6.5 11.9 17.4 6.9 10.2 3.2 1968------11.0 16.4 6.1 11.5 17.1 6.5 9.3 1967------11.1 16.4 6.3 11.7 17.1 6.7 9.7 ::; 1966------11.1 16.7 11.7 1.7.4 6.5 1965------11.4 16.9 ::; 11.9 17.7 6.7 ;:? 3:0 1964------11.0 16,6 5.8 11.6 17.4 6.2 2.6 19631------11.3 17.0 6.0 11.9 17.9 6.4 H 2.7 1962i------11.0 16.8 5.6 11.7 17.9 6.0 2.7 1961------10.5 16.4 5.0 10.9 17.1 5.3 ;:; 2.2 1960------10.6 16.6 11.1 17.5 8.7 2.3 1959------10.5 16.6 :;; 11.0 17.4 U 9.1 2.3 1958------10.5 16.8 4.7 11.1 17.6 8.4 *2.1 1957------9.6 15.3 4.2 10.0 16.0 ::2 8.1 >YL.6 1956------9.7 15.5 4.4 10.3 16.3 4.6 7.1 1.8 .1955------?------9.9 15.7 4..5 10.4 16.5 4.8 7.1 1.7 1954------9.9 16.0 4.1 10.4 16.8 4.3 7.8 1.7 1953------9.8 15.7 4.2 10.3 16.5 *1.4 1952------15.3 4.3 10.2 16.1 !:2 ::; *1.4 1951------1::; 15.8 4.6 10.5 16.5 ;.; 7.3 1.9 19502...... --.. 11.0 17.3 4.9 11.6 18.1 . 7.8 1.8 I

iF@xes “by color exclude data fox residents of New Jersey because this State did not require reporting of the item for these years. ~Based on en~erated population adjusted for age bias in the Population of races o t_h.er.than white. I NOTE: Asterisk indicates age-adjusted rates where more than half of the age-specific rates are based on fewer than 20 deaths.

44 Table S. Death rates for suicide. by color, sex. bf.rthof cohort, and am at death: united states. 5-fear intervals d..im 1949.69 ~,., [R%cs Pcr 100,000 PO mm. m +wafiedagmior.six group. FCU 196; rams am bad am H&igp,d ,;c,mgmy..ndmsE950.E959 .f the E&I km. of,he l.,miw,d Ci+,tim ofIMaws,Adqm far U,. m he United Slates, adopted m 196S; for 1949, 1954, 1959, and 1964 rams am bed on death, assbgned to catepry “mnbm E963, E970.P.979 of the Srxth and Smemh Rm+s&.s doped, r.,pmivdy, in 1948 and 1955]

Period of Wrth or cohort color, sex, and age — — — — — — — — at death L3m L345. ,34C 930 1925. W* ,915- 910. 9E- 13m- L395 1B9C a8?- 880 B75 LET( k%5- L954 s 49 .944 934 Isa L924 .918 914 9C9 L20i L3B9 1694 #a9 BB4 879 L37! !239 — — — — — — — — v white, male

E-u wars— ------9. c s.6 5., 3.1 3. E 2C-24 years ------17.0 la{ u. # LD.: 9.9 2!3-29 win. --... - . . . . . ------18.. s.: L2. f 13. C l% 0 SC-34 jear ------18. Z La. s 15.9 14.1 14.7 35-.39 war------?0. 4 20. c 19.3 11.2 ?D. 9 4C-44 ye . . ..------—-. 24.2 24.5 24.0 ?2. 7 !7. 3 45-49 mm------27.8 50.0 ?9. 8 m 5 3L31 50.54 Fws------?9. 6 53.8 56.2 35.9 37.5 55-59 years ------53.4 19. s 40.7 38.4 &.: 6M& years ...... -. ----- n. 3 37.5 4.3.1 45.: k9. 6 65- E&l .YeU1’s------.... 33.5 37. a 43. I L4.7 il. 5 70-’74 WM------37.7 40.1 $7.4 la z iO 7 75.79 Y.2nrs------44. ! L7. 7 ;3. : i2. 6 57. 8C-84 year.------—---- ;0. 6 !5. s i?. e 52., 63.0

All ‘+bm., male

B-B W-8------5.8 3.( 1.1 2.4 20-24 war, ------k: m.: m. e .0.1 7.0 23.23 yee.re ------L7. [ 67 .3.7 B. 3 9.8 30-s4 W,=- ...... ------w 6 5.6 I.& 1 u. 7 Lo. 1 35-39 W,,B ------.6.7 la 4 u. 0 u. 4 m 0 40-44 ve8rn ------14.9 B. 1 u. D 9.7 .0.6 dE-43 bm-Li------u. 5 u. 1 E. 3 .09 12.5 5*54 year, ------L2. 8 La 5 .4,6 Il. 9 u. 4 55-59 year, ------m 3 .Ck7 E. 7 9.6 Uf. : 6*64 yet.m ------Lo 14-2 13.5 E.> D. 6 35.39 pm------1.4.0 E. 4 17. ? B. 8 5.8 7*7* Yee.1’s------15. s l.% : u. .3 s. 4 .5. a 75-79 year ------17.: u.. 2 !3. 2 2. a L3. ! BO-E4 year ------!4. 5 .4.7 2.2 L4. I 14.3

mite, femnle

E-19 Yee.l’, ------2.6 1.7 1.( 1. z 1.5 W-24 yecxe ------5.0 4.: 2. E 2.4 3.7 25-29 Warn ------7.( 6.2 5.4 4.2 4.2 W-34 war------e.9 8.3 5.9 4.1 6.0 S5-39 ram------L9 10.9 6. e 5.6 7.7 4644 Yeun ------I.& 4 Lo, 9 8.2 8.2 8.9 G-49 Win, ------Is. 1 La 2 a ‘f 7.8 9.9 5C-54 .veU,---.--..--..--————— L% 4 2.9 8.8 m-8 55-59 yem’B------2.2 :: m7 9.3 la 1 m-m rearm ------1.4 9.9 LO.5 9.7 0.9 3%63 be .. ..- . . . . . ------Lo. 6 m. .9 m 4 8.7 0.8 7C-74 Yeal’, ------a. 8 9.7 s. o 8.7 B. s 75-79 war, ------7.7 7.0 8.0 6.2 8. f 8*8L w-,------1.1 6.2 6.6 6.: 6.0

.411 mm., final,

3.5-IS .vear, ------3.2 1.8 1.7 1.8 2*2d We,------5.2 2.? 2.9 :: 2.4 25.29 years ------G. 4 5.2 &. o 3.5 2.0 3*34 pm,------5.8 4.1 3.5 2.0 3.0 35-32 Year, ------s. o 4.5 2.9 1.6 2:9 4D-44 Yec,rs ------4.6 3.7 2.5 2.4 2.2 43.49 Vein...---.:------4.6 3.2 s. 0 1.9 2.2 5C-54 Yeara ------2.6 .%6 2. !3 3.9 2.0 55.59 Fu....------2.4 4.5 .5. s z. 5 2.5 6C-64 year ------2.1 s. 4 5. s 3.3 1.9 ES-69 were ------2.7 4.7 3.8 1.3 2.& 7D-74 Jearn-.. -----.----. +- 3.0 1.4 1.1 4.8 3.9 75-79 year, ------3.4 e. e 1.9 L. 3 3.3 80-04 yearn ------3..0 3.8 L. 9 . — — A J — _ — — — — — No!% : me ff.mtI’igure in each m, moving flnm l.lght to kft, 1. the deem! rate for 3.’349 ; tie second figure, ml’ 1254; the W rigul.e, for B52; the fmrtb fiSIUW, for 196* and thefifthfl&me, for 3.269.

45 These surnma&fig&es (both the total and the many, excluding West Berlin; and Denmark) have age-adjusted death rates for Suicide) result from rates that are about two times the rate for the the offsetting of decreases in Suicide for persons United States (table T). 45 years and over by increases for the age groups The moderate upturn in the age-adjusted under 45 years. Increases at these younger ages Suicide rate between 1957 and 1969 reflects much occurred for each of the four color-sex groups. ” greater increases in mortality for this cause The data in table S (excluding the age group for the other three color-sex groups than for the 85 years and over) show that the death rate for white male group (table” R). But for none of the Suicide for 1969 reached peaks for each of tbe other three groups did the level of mortality from four color-sex groups as follows: Suicide reach anywhere near the high level as that . for.the white male group. Peak The excess mortality from Suicide for the total male population over that for the total female Color and sex Age in death years rate per population decreased between 1950 and 1969. For 100,000 1950 the male Suicide rate was 3.53 times tbe corresponding female Suicide rate, hut by 1969 White *le------80-84 50.6 the male Suicide rate was down to 2.57 times the White female---Y-- 40-44,50-54 13.4 female Suicide rate. This decrease in the sex All other male---- :;-:: 18.6 All other female-- 6.4 differeritial for Suicide between 1950 and 1969 reflects substantial decreases in this differeritial for both white and races other than white. ,. k should be emphasized that thes? peaks are The white population continues to have by far for data year 1969 only and therefore &e not higher Suicide rates than the p~puJation of races related to the peak for cohorts of persons born other than white. But t-his color differential is in” given periods. That the suicide’ rates increase. aiso ‘decreasing for 1950- the Suicide rate for with advance in age (at least up to about ages races other than white was only 41 percent of 50-54 years) is indicated for almost all cohorts the corresponding rate for the white population, (for each of the four color-sex groups) born since but by 1966 this percentage had reached 55. This about 1915 (table S). , decrease in the color differential for Suicide Age-specific death rates for Suicide for the reflects decreases -in this differential for each three cohorts of white men horn during 1900-1904, of the sex groups. 1895-99, and 1890-94 suggest that these older cohorts may have experienced their highest rates for Suicide (at about 55-59 and 60-64 years) X11. CONGENITAL considerably before the end of the usual life ANOMALIES span. (The reader should be reminded that the comparability ratio for the Seventh and Eighth During the period 1950-69 there were two Revisions of 0.9472 for Suicide may be applicable breaks in the continuity of the death rate for to the age-specific rates for 1964 and 1959 in Congenital anomalies (ICDA Nos. 740-759). The table S). Similarly for about three cohorts of first break resulted in tbe assignment of about men ‘of races other than white (those born. in 2 percent fewer deaths to this group of causes by 1910-14, 1905-09, and 1900-1904) theage-specific the Seventh Revision than had been assigned to it death rates in table S appear to indicate that by the Sixth Revieion.3 The comparability ratio they also experienced their highest rate for between the Seventh and Eighth Revisions is Suicide before the usual end of the life epan. 1.0204 (appendix 111). Based on data collected by the United Nations, A more precise measure of the true decline one country (Hungs@) has a total Suicide rate ihar in mortality may be obtainable by limiting con- is about three times the rate for the United sideration to only’ those deaths occurring at ages States; and five countries (Czechoslovaki~; Aus- u-rider 1 year from Congenital anomalies. (Deaths ti%q Finlsn@ Swedem, Federal Republic of Ger- at ages tinder 1 year assigned to Congenital

-. Table T. Deaths rates for Suicide, by rank, selected countries, revision of Interna- tional Classification of Diseases, and data year [Deaths are those attributed to category numbers E963, E970-E979 of the Seventh Rwismn of the International Classification of Diseases, 1955, and to category numbers E950-E959 of the Eighth Revision of the International Classification of Dkeases, 1965. Rates are deaths per 100,00~ population]

I Rank Country Rwi.sion Data year Rate

1 Ireland Eighth 1969 2 Chile Eighth 1968 3 Costa Rica Seventh 1967 4 Greece Eighth 1969 5 Guatemala Seventh 1968 1$; 6 Italy Seventh 1967 5.4 7 Israel Seventh 1969 6.4 8 Trinidad and Tobago Seventh 1968 7.3 9 Netherlands Eighth 1969 10 Norway Seventh 1968 ;:; 11 Portugal Seventh 1969 8.2 12 United Kingdom Eighth 1969 8.6 13 Singapore Eighth 1969 14 New Zealand Eighth 1969 W 15 United States Eighth 1968 10.7 16 Canada Eighth 1969 10.9 17 Poland Seventh 1969 11.2 18 Bulgaria Eighth 1969 11.3 19 Australia Eighth 1969 12.2 20 Japan Eighth 196S 14.4 21 Belgium Seventh 1968 15.5 22 France Eighth 1969 115.6 23 Switzerland Seventh 1968 17.0 24 Denmark Seventh 1968 20.5 25 Federal Republic of Germany (excluding West Berlin) Seventh 1967 121.3 26 Sweden Seventh 1968 121.5 27 Finland Seventh 1968 21.6 28 Austria Eighth 1969 22.3 29 Czechoslovakia Seventh 1967 23.9 30 Hungary Eighth 1969 33.1

lProvisional. NOTE : This table is limited to soverei~ countries with “reliable’! :s:.~?ted POPuT lations of 1 million or more and with “complete” counts of deaths by cause lists that include Suicide, as shown in table 19 in the 1970 Demographic Yearbook of the United Nations. anomaliee constituteahout 66 percentof total to adjustthe 1967infantmortalityrateforCon- number assignedtothiscause.) genitalmalformations(330.4per 100,000live On thebasisof thedualcodingstudy,using births)to theleveltheratewouldhavereached deaths occurringin 1966,itwaa foundthatan if the EighthRevisionhad been used for 1967, estimated12,644infantdeathswere assignedby resultsinan adjustedrateof342.3.Thedifference the Eighth Revisionto Congenitalanomalies between the 1968 rate (315.6per 100,000live (lCDANos. 740-759)and12,200infantdeathswere births)and the adjustedratefor 1967 is 26.7 assignedby tbe SeventhRevisionto Congenital deathsper 100,000livebirths,constitutinga real malformations(lCD Nos. 750-759).2Use ofthe decreaeeof 7.8percentbetween1967 and 1968 comparabilityratio1.0364(obtainedby dividing in the infantmortalityrate for thisgroup of the12,644deathsfor1968by the12,200for1967) causes. Measured over the entire” period 1950-69 tbe 1960;s for each of the four color-sex groups infant mortality from Congenital anomalies was (table U). For men of races other than white downward-from 396.0 deaths per 100,000 live both the absolute and relative increases in the . births for 1950 to 314.1 deaths per 100,000 live Homicide rate between 1960 (41.9 deaths per bfrths for 1969 (figure 2). This decline reflects 100,000 population) and 1969 (72.4 deaths per substantial lowefing of this mortality rate for 100,000 population) were higher than for each white infants (both male and female). For white of the other tltree color-sex groups. But since male infants the rate dropped from 438.5 deaths 1962 this color differential for Homicide has per 100,000 live births for 1950 to 338.6 for 1969, again been upward. The color mortality ratio - and for white female infants it dropped from for this cause for 1969 (9.60) was, however, 390.2 deaths per 100,000 live births for 1950 to stilI not so great as it was for 1950 (11.35). 296.3 for 1969. For other infants, however, there The color differential by sex continued was little change in the death rate for Congenital through 1950-69 to be much higher for male per- anomalies between 1950 and 1969: for male infants sons than for femaIe persons. For both groups in this group the rate for this cause increased the color differential for Homicfde was smaller from 298.5 deaths per 100,000 live births for for 1969 thenfor 1950 (based on age-adjusted death 1950 to 313.5 deaths for 1969, and for their rates in table U). female counterparts this rate increased from For 1969 the sex differential for Homicide 255.5 deaths per 100,000 live births to 275.2 was less than half the color differential for this (table 5). cause of death. The mortality sex ratio (based - For 1950 the death rate for Congenital mal- on age-adjusted death rates for Homicide in formations for other infants was only 67 percent table U) decreased from 3.36 for 1950 to 3.00 of the corresponding rate for white infants. But for 1958; but between 1958 and 1969 this ratio by 1969 this percentage- had increased to 93. again increased, reaching 3.97 for 1969. For The mortality sex ratio for this cause re- 1969 white male persons had a Homicide rate mained stable between 1950 and 1968, with both (age-adjusted) that was 3.14 times the corre- years having” a ratio of 1.13. For 1969 total sponding rate for white female persons, and other infants and both white and other infants had male persons had a Homicide rate that was 5.25 a mortality sex ratio for this cause of 1.14. times, the corresponding rate for their female counterparts. X111.HOMICIDE The 1969 death rate for Homicide was high There was no sizable disruption in the for infants (4. 3 deaths per 100,000 population), comparability of statistics for Homicide (ICDA then dropped to 1.6 deaths for children 1-4 Nos. E960-E978) either w~ththe introduction of the years, anti to 0.7 deaths for children 5-14 years. Seventh Revision (with a comparability ratio of Then the rate rose from 11.0 deaths for the age 1:00) 3 or with tbe introduction of the Eighth group 15-24 years to a peak of 15.9 deaths for ‘ Revision’ (&th a comparability ratio of 0.9969) the age group 25-34 years. For succeeding age (appendix 111). groups the 1969 Homicide rate was downward. An examination of the death rates for Hom- The 1969 death rate for Homicide reached the icide during this century shows that both the total following peaks for each of the four color-sex rate end the age-adjusted rate increased from groups: 1900 to about 1933. (For 1933 the total rate was —. +. 9.8 deaths per 100,000 and the age-adjusted rate Peak Color and sex Age in death was 10.0 deaths per 100,000.) Then both rates years rate per declined slowly through the 1940’s and. 1950’s.4 100,000 But the trend in the 1960’s was again clearly upward—4.7 deaths per 100,000 for 1960 to 7.7 deaths for 1969 (tables 2 an~ 3 and figure 1). Age-adjusted death rates for Homicide show that a rise in these violent deaths occurred during

!4Q Table U. Age-adjusted death rates for Homicide, by color and sex: United States, 1950-69 [For1968and1969ratesarebased on deathsassignedto categorynumbersE960-E978 of the EighthRevisionojthe International Classificationo~Diseasss, Adaptedjor Usein the UnitedStates,adopted in 1965; for 1950-67 ratesarebasedon deaths assigned to cate~ory numbersE964, E980-JS985of the Sixth and SeventhRevisionsadopted,. respectively,. , in 1948 and 1955. For method of age~dj&tment, seeappendix I]

Total Nhite All other

Year II I Both Both Fe- sexes I Male nmle‘e- sexes Male male - EzlEIPE Rate per 100,000 population

1969------8.6 13.9 4.3 6.6 41.3 72.4 13.8 1968 ------8.2 13.4 4.2 6.5 N 39.6 68.9 13.6 1967 ------12.1 3.5 3.9 2.0 36.9 62.7 14.0 1966 ------;:; 10.4 3.2 3.4 ;:; 1.9 32.4 54.8 12.4 1965 ------6.2 2.9 3.2 4.8 1.7 30.1 50.7 11.7 1964------5.7 ::: 2.7 3.0 4.3 1.7 27.9 47.1 10.6 19631 ------5.5 :::2.6 2.9 4.2 26.7 44.8 10.5 1962 ~------::; 2.9 ;.; ::! 26.5 44.4 10.3 1961------;:$ 8.0 ;:: 1.6 25.0 41.5 10.1 1960------5.2 7.9 2.6 ::; 3:9 1.5 25.7 41.9 11.2 1959 ------7.7 2.6 3.8 1.5 25.8 42.3 *IO .7 1958 ------::: 7.5 H 3.6 1.4 25.3 41.6 10.5 1957 ------4.9 7.6 ;:; 3.5 1.4 25.9 43.1 10.3 1956 ------7.6 ;:: 2.4 3.5 1.3 26.5 43.2 11.3 1955 ------2:: 2.3 2.4 3.5 1.3 25.7 42.6 *lo .3 1954 ------::: 2.4 2.5 3.6 1.4 27.4 46.2 *lo .3 1953 ------;:; 1.3 27.4 46.5 *1O. 2 1952 ------5.4 M’ ;:2 N ::; 1.3 29.9 50.4 11.3 1951------5.0 3.6 1.4 27.5 45.3 11.1 1950~------5.4 i:: 2:: ;:: 3.9 1.4 29.5 49.1 *11. 5

l)?igu-res by color exclude data for residents of New . rsey because ibis State did not reqoire reporting of the item for these years. ~Based on enumerated population adlusted for age biaa in the DODUlatiOn Of races other than white. 11 NOTE: Asterisk indicates age-adjusted rates where more than half of the age-specific rates are based on fewer than 20 deaths.

Iti ehould be stressed, however, that this 1969 either at ages 25-29 or 30-34 years (table W). The mortality pattern, with the peaking of the death pattern of peaking & various ages was, in fact, rate at agee 25-34 years, results from the very different from that for a nufiher of diseasee, admixture of differing mortality experience for including tuberculosis, which peaks most fre- cohorts of pereons born in successive years. quently at ages 20-24 years of age and at other When the mortality experience for Homicide times at ages 25-29 years (table 12 in Series 20, for separate cohorts (with cohort defined aga~ as No. 8ag ). a group of persons horn during the same 5-year Consider, for example, the pattern of avail- period) was examined over successive 5-year able death rates for Homicide for cohorts of fmervals, beginning with the ear~est year’ for white men born in successive 5-year intervals which data by age, color, and eex are available from 1865-69 through 1950-54 (table W). For the (1914), it wae found that the death rate for Hom~” four cohorts horn from 1895-99 through 1910-14, icicle for 5-year age groups did not alwaya peak it appears that the peaking of the death rate for Table w. Death rates for Homicide, by color, sex, birth cohort, and age at death: United States, S-year intervals &urinc 1914-69 fada@colo,.scxPUP. For 1969 rat,,arebased.. deaths ass~ed teca,.gcry .umf,eu E960-E978ofA. Eglih Revis,om oftlmf”tem”flonakd ,cdIio” lhited Stafq ,d+md in 1965;for1949,1954,ad 1959,“tcgmy numf,,ra S964,E980.E985ofthes,x,h,ndSmm,h F.evmns..dopted,re,fmJ-+,,” cmcewrynumbers 165-168 of ‘he F,fth Rev”,.”, .dop,ed m 1938, for 1934, cs.,.~,y ..rnbers 172-175 c.( the Fourth Rews, o”,,dop,ed in 192% f.. 19i4 I of d,. Third R,risi.”, ,dopkd i“ 1920; and for 1914 and 1919. UW,Y ,,wnbe,, 182.184 of AC Second F.ev,.m,, Aped m 1909. ?,,., to 1930 f@m! 1930 such &a& a.mntcd for 2 prcent of homicides for whm rm.,with a h@ of 4 percent at w 2w4pars, md for 2 perccnf for all c&r mm, wxh

F.erIc.l of bZrth of cohort . color, .ex, end — age at death 350- 145- .w40- &- 930- 925- l.920- L890- ea5- 9En- 1a15- 1870- )65- 354 349 1944 339 934 929 X+24 L894 599 9e4 1.919 1.874 )69 — —

white> male —.—— 4.9 2.9 2.7 2.3 2.6 2.5 ,.. 20-24 yenl’s...—------LO.9 6.4 6.0 5.8 5.3 5.6 U.6 25-29 years------—--- 12 .C 7.2 5..? 5.6 6.2 14.1 15.4 m-u yeal’s------11.o 5.1 14.5 1s.7 13.6 35-39 yenrs------—------;:: :: 5.7 14.6 14.3 16.1 13.8 40-44 Yenrs------—--- 9.5 5.9 14.1 13.0 L3.O 1.I.9 11.6 45-49 >Er6 ....------—---- 7.7 7.6 13.3 10.9 II ,1 lZ.Z 10,8 W-54 Yenl’s--——-——------5.1 7.0 12 .Z 10.9 m .2 9,1 55-59 Yemrs—--—-— ----- 4 .a 5.2 6.3 u .Z !7.0 8.1 En-w yeal’s------3.3 4.6 4.1 5.5 9,7 7.4 65-69 .——.remrs...------3.B 3.1 4.0 3.5 7,1 8.8 ?0-74 YWS------2.1 3.0 3.1 4.2 3.6 5.7 75-79 yeu’s------——--- 5.9 2.6 5.5 z .9 $.6 2<5 So-w Wiire------1 4.3 3.9 z .1 4.0 4,3

All mer, male I M-M years--— ------59.7 Y3.a 23.2 28.2 =.3 35.e 39.3 20-24 yeara---—-— ------!6 .1 75.1 73.1 75.6 B7 .1 84.8 S8 .0 25-29 years------U!a .1 90.2 83.3 97.1 102.4 S8.7 14.1 m-w [email protected]+9.1 89.0 85.2 92.6 1.37.5 66.9 12.1 130.1 5s.7 31.5 79.0 =-= Y=s-— ------29.0 9a.1 16.1 40-44 yea.r,-----————— 16.7 15.5 L16.2 62.8 77.6 65.1 %.6 45-49 -s------— ------SO.2 70.8 W.a 56.6 59. s 55.3 ?,5.4 50-54 bs-..— ------42.0 $7.5 %.2 44.9 51.0 ?,5 .1 3S.1 55-59 year9------4X.8 ?4 .4 ?4 .2 53.9 .52 J 60-64 years------28.1 L&l 1.5.9 ?4.s 31.s, ?,5,3 S5-69 years------22,4 Ez .9 La,7 17.4 2%5 4s.6 70-74 Years------17.3 LZ.6 14.9 17.5 lZ.O f.9,~ 15-79 yeerB----—-——-———— 10.2 19.0 L6.2 19.2 19.0 23.1. m-e4 yeez5------7.9 7.4 J,3.3 7 .s 8.6

White, fmde

154.9 [email protected]— ------1.9 1.4 1.C 1.3 1.1 0.8 1.0 20-24 yeers-----—---———— 3.0 1.1 1.8 1.6 1.7 1.3 5.3 25-29 yeErs-— ------3.C 2.5 2.5 1.9 1.9 4.4 4.2 ,0-s4 -s---..-.— ------3.5 2.s 2.3 1..9 3.7 3.4 S.9 3.5-39kam—----—-— ------2.5 2.5 2.. 3.8 3.9 3.1 3.0 40-44 years----—------2.8 2.2 2.6 z .3 2.5 Z..f 3.0 45-49 Years------2.5 1.9 2,2 2.3 1.6 2,5 50-54 years------0.9 z 1.9 1.8 1A 1.7 55-59 yenm------—--- 1.0 1.1 1.6 1.7 1,6 1.2 60-34 Yee.rs------0.8 1.3 1.1 1.3 1.4 0.9 65-69 years------— ------1.1 1.1 0.8 0.9 1.0 7..4 70-74 year.------—------1.4 1.2 0.9 0.6 O.c 1.1 7s79 year.------——------1.4 1.2 1.0 1.Z 1.s 1.Z aO-@4 Veai-s------2.1 1.7 1.7 0,9 2.5

All owl., female ls-ls years------U.o 7.7 8.5 7.2 9.1 7.8 14.8 ZC-Z4 yenrs——-—-——---- 21.7 15.5 16. E 3.6. c 24.5 22.1 21.9 25-29 years------2S.E 21.E 21.6 22.0 22 .s 25.3 LB.1 30-34 years------28.0 19.2 24.2 3.9:5 28.8 18.4 M .0 3s39 yee.rs------25.0 20.6 2.I..7 23.2 24.6 L5.7 19.6 40-44 years------22.6 M .1 14.2 14.9 w .5 9.Z 14,6 45-49 [email protected] 8.5 n.s 8.2 7.8 4.4 4.9 50-% yeaH+------4.2 7.1 9.2 9.1 4.8 5,1 55-59 [email protected] 2.9 6.9 9.4 6.0 0,9 W-64 yeP.l’s--——------1.3 6.5 3.2 5.5 6A &,9 65-69 years------—------3.4 3.s 3.0 1.4 3.6 9,1 70-74 yam--—-— ------3.6 3.6 6.2 3.5 1.1 z ,3 75-79 yenTs--—------4.0 0.7 2.8 6.3 6.2 S0-84 yeaIs------z .0 1.3 1.9 lZ.O 2.6 — —

XW33: ~ first fiwre in each -, mmlne, h left t. rieht, %8 the death rate Z=.r 1969; the second ff.wre> for 1964; the third f imm, for 1959, et. a

50 Homicide occurred, in general, at successively mortality for any given color-sex group reflects younger age groups: for example, the highest decreases for almost every age group for tha~ death rate for Homicide for white men born in color-sex group. 1895-99 shown in table W occurred for the age The following table showa tb.e changes in the group 35-39 years; the highest death rate for this specified death. rates for Homicide for the white cause for white men born in the next 5-year male population between the years 1933 and 1959 interval (1900-1904) occurred for the next young- (when the trend waa downward): est age group (30-34 years); and the pattern of highest rates at successively younger age groups continued up to the cohort born in 1910-14. For Age 1959 1933 this latter cohort the death rate for Homicide is shown for the age group 20-24 years (with a rate I All ages ------of 12.8 deaths per 100,000) (table W). The pattern L&ll_-J?2z that may be emerging from the recorded data for 15-19 years ------2.7 —4: 9 the four cohorts of white men born between 1895-99 20-24 years:------;.; 12.4 and 1910-14 is that for each cohort the death 25-29 years ------. 16.7 rate for Homicide tends to peak at the oldest 30-34 years ------15.9 35-39 years ------;:: 16.3 age reached by the cohort in the period of upturn 4.0-44 years ------5.1 15.6 in mortality (the period’ of upturn it will he 45-49 years ------5.3 ;;. $ remembered ended about 1933-34). 50-54 years ------:.; 55-59 years ------. 11:1. For the cohort born in 1880-84 and for those 60-64 years ------4.5 9.8 born prior to those years, this pattern of peaking 65-69 years ------3.8 7.7 at the oldest age reached by the,cohort as of 1934 70-74 years ------3.0 75-79 years ------3.5 ;:: is less regular. This may be due in part to the go -84 years ------2.1 7.4 fact that mortality data for these earlier years are less reliable tbsn for later years. But in any event, even for each of these cohorts the death The corresponding levels of mortality from Hom- rate reached at the end of the period of upturn icide for the male population of races other than in mortality from Homicide (1934) was about white are higher at every age than tbe corre- twice the death rate for the succeeding age group, sponding rates shown above for the white male and, moreover, the death rate continued to population. 4 decline throughout the remaining years lived by The rise in the Homicide rate for the elderly these cohorts. These remaining years, it Ml be in the population during the 19601s, together with recalled, were lived in a period of downturn in tbe rise for all other age groups, shows as mortality from Homicide. commented upon by many persons studying the As indicated earlier the cohort of white men problem, including Coombs#O that “no age group born in 1895-99 lived about their first 40 years is spared in the on-going upturn in mortality in a period of rising mortality from Homicide. from Homicide. Their peak mortality occurred for the age group The period of the first upturn covered by 35-39 years. On the other hand the cohort born available data lasted only from 1914 through 1933. in 1910-14 lived only about their first 20 years in If the pattern of peaking that occurred around a period of rising mortality from Homicide, and 1933-34 occurs again and if. the present period of their peak mortality occurred for a much younger upturn in the death rate for Homicide continues age group-+t ages 20-24 years (with a rate of through 1974, one may expect that the peak ages 12.8 deaths per 100,000). for Homicide mortality in 1974 for all birth Available data show that, in general, a rise cohorts will occur in the next higher age group in the death rate for Homicide for any given than in 1969. For example, the cohort of men of color-sex group reflects rises in mortality from races other than white who were born in 1935-39 this &use for almost every age group for that may be expected to have a death rate for Homicide CoI&r-sex group, and conversely a drop in in 1974 (when they are at ages 35-39 years)

51 that will be higher then their death rate of 138.7 The dual coding study of deaths occurring in per 100,000, in 1969, when they were in the age 1966 showed that en estimated 10,227 deaths were group 30-34 years. assigned to Nephritis and nephrosis (ICDA Nos. 580-584),whereas the number assigned by the XIV. NEPHRITIS AND NEPHROSIS Seventh. Revision to this group of causes was 11,540 deaths,z giving a comparability ratio of Between 1950 and 1967 the number of deaths only 0.8860 (appendix III). If the 10,941 deaths attributed to Nephritis and nephrosis (ICD Nos. in 1967 were decreased by applying this factor, 590-594 of the Sixth and Seventh Revisions) the adjusted figures for 1967 would be 9,696, dropped from 28,147 to 10,941 (table 3). Mortality a reduction between 1967 and 1968 of only 4.0 from this cause continued to fall between 1967 percent. and 1968, from 10,941 to 9,311 deaths. Part of- Because of the increase in the population, this reduction of 14.9 percent between these 2 a more precise measure of the amount of reduc- years, however, is attributable to the introduction tion in mortality may be obtained by applying the of the Eighth Revision. comparability ratio to the death rate rather than

Table Y. Age-adjusted death rates for Nephritis and nephrosk, by color and sex: United States, 1950-69 [For 1968 and 1969 rates are based on deaths assigned to category numbers 580-584 of the Eighth Revision of fhe Inf.rnafional Classification of Diseases, Adapfed for Use in theUnited Stats-$ adoptedin 1965; for 1950-67 rates are based on deaths assigned to category numbers 590-594 of the Sith and seventh Revisionsadopted,. respectively,. . in 1948 and 1955. For method of age adjustment, ;ee appendix1]

Total White All other

Year Both ‘e- Both Both sexes Male male sexes Male male‘e- sexes Male male‘e-

Rate per 100,000 population

1969------3.9 4.6 3.2 3.1 3.8 2.5 10.9 12.5 1968------3.9 4.7 3.2 3.1 2.4 11.1 12.5 1::; 1967------4.7 5.7 3.8 ::: 2.9 12.8 14.3 11.7 1966------5.0 6.0 4.0 ::: 5.1 3.3 13.3 15.5 11.4 1965------5.2 4.3 4.4 5.4 3.4 13.7 15.7 12.0 ------H 3.7 14.3 15.9 12.9 :;%1 ------;:: 6.9 ::;” ::: ::: 14.9 :;.; 13.0 19621------6.0 7.2 ;.; . i:; 14.9 13.4 1961------5:1 4.2 15.1 16:9 13.3 1960------H ;:; 5.5 5:6 H 4.5 16.5 18.4 14.8 1959------6.9 8.1 5.8 5.8 6.9 4.7 17.7 19.3 16.3 1958------6.8 6.7 8.0 5.6 20.1 21.6 18.8 1957------U 1::: 7.6 7.5 8.8 6.3 22.1 23.2 21.2 1956------9.1 10.3 7.9 7.8 9.0 6.6 23.2 24.5 22.0 1955------9.6 10.9 8.3 8.3 9.7 6.9 23.6 24.2 22.9 1954------10.6 12.0 10.4 7.9 25.7 28.3 23.4 1953------11.9 13.4 1%2 1::; 11.8 8.8 29.9 31.1 28.8 1952------13.4 15.3 11.8 11.4 1“3.3 35.7 37.7 33.8 1951------14.7 16.4 13.3 12.7 14.4 1?:: 38.3 39.4 37.2 19509------16.6 18.6 14.9 14.4 16.3 12.5 42.9 44.5 41.3 I I II

lFigUes by color exclude data for reside?ts of New Jersey because this State did not require reporting of the item for these years. 2Based on enumerated population adjusted fOr age bias in the population of races other than white.

52 to the number of deaths. Using the adjusted death of 4.7 deaths per 100,000 population). Then this rate for 1967 (4.9 deaths per 100,OOO)gives a disease moved down again to the 15th leading reduction between 1967 ?nd 1968 of 4.1 percent. cause for 1969 (with 9,312 deaths, giving a rate The total death rate for Nephritis and ne- of 4.6 deaths per 100,000). phrosis remained the same for 1969 as for 1968 One reason for the move from 17th to 14th (4.7 deaths per 100,000). place for Peptic ulcer between 1967 and 1968 The age-adjusted death rate for Nephritis was (as described in appendix I) that the rules and nephroais also shows a steep decline-from for ranking causes of death were changed between 16.6 deaths per 100,000 for 1950 to 3.9 for 1969 1967 and 1968. (table Y and figure 1). This downturn for the Another reason that Peptic ulcer moved up age-adjusted death rate for the total population to the 14th place for 1968 (despite the fact reflects reductions in mortality from this cause that the rate was declfning) is that the following for each of the four color-sex groups. Moreover, two causes, whose nearly comparable causes each of the color-sex groups experienced reduc- according to the Seventh Revision ranked higher tions in mortality from this cause for every age in 1967 than did Peptic ulcer, had substantial group. reductions in the number of deaths assigned-to For 1969 the mortality color ratio for them by the Eighth Revision from the number Nephritis and nephrosis (the age-adjusted death that had been assigned for 1967 to their nearly rate for 1969 for the population of races other comparable Seventh Revision titles’ ‘Nephritis and than white over the corresponding rate for the nephrosis” (ICD NOS. 580-584) and “Hyperten- white population) was 3.52. The trend of this color sive disease” (ICD Nos. 400, 401, 403). The ratio’ was upward during 1950-69, increasing from ranks for 1968 for these two causes were, 2.98 for 1950. respectively, only 16 and 17. The mortality sex ratio for Nephritis and Part of the reported higher level of the death nephrosis for 1969 (the age-adjusted death rate rate for Peptic ulcer for 1958-63 and part of for 1969 for the male population over ‘the corre- the downturn for this rate during the latter half sponding rate for the female population) was much ‘ of the 1960~s (table 2 and figure 1) are attributable lower than the color ratio. The sex ratio also to changes fn coding procedures for selecting the increased between 1950 and 1969, from 1.25 to underlying cause of death from the medical entities 1.44. on the death certificate. The color ratio for mortality from Nephritis The comparability ratio for Ulcer of stomach and nepbrosis for the male population increased and duodenum (ICD Nos. 540, 541) for the Sixth from 2.73 for 1950 to 3.29 for 1969; and the and Seventh Revisions was 1.01.3 corresponding colbr ratio for tbe female popula- A reduction in the assignments of death to tion also increased-from 3.30 for 1950 to 3.84 the Eighth Revision title “Peptic ulcer” (ICDA for 1969. The sex ratio for mortality from this Nos. 531-533) from the number that had been cause was lower for both white and other popula- assigned to the comparable cause, Ulcer of tions than was the corresponding color ratiq stomach and duodenum (ICD Nos. 540, 541), re- but for both groups the mortality sex ratio sulted in a comparability ratio of 0.9856 (appendix was somewhat upward—increasing for the white III). population from 1.30 for 1950 to 1.52 for 1969 Both multiple cause and prevalence data and increasing for the other population from 1.08 indicate that this disease is wider spread in the for 1950 to 1.30 for 1969. population than mortality statistics alone may lead XV. PEPTIC ULCER one to believe. Gn the basis of the study of multiple causes of death fox 1955, while the group Despite the fact that the mortality trend for title Ilulcer of stomach and duodenum” (ICD Peptic ulcer (ICDA Nos. 531-533) moved slowly Nos. 540, 541) was selected as the underlying downward during the 1960tst this disease moved cause of 9,784 deati,a, this disease was entered up from the 17th leading cause of death for 1967” 16,413 times on the death certificates for that to the 14th for 1968 (with 9,460 deaths, a rate year.li Surveys of the prevalence of Peptic ulcer in The age-adjusted death rate for Peptic ulcer the United States ‘conducted by the National (ICDA Nos. 531-533) declined, as did the total Center for Health Statistics show that this disease death rate for this cause, during most of the is quite common as reported in health interviews. 1960’s (table Z and figure l).l’bi sdownturnfor Following are unpublished data from the Health the total population reflects declines in the age- Interview Survey, NCHS, showing for four periods adjusted death rates for both the white male and the prevalence of Peptic ulcer, by age, for the the white female populations and for the male civilian noninstitutionalized population. population of races other than white. The fre- quencies of deaths from this cause for the female population of races other than white are too small for some years to give a reliable indication of the mortality trend forti.is group. Each of the color-sex groups experienced reductions immortality from this cause for most Prevalence of Peptic ulcers age groups during the 1960?s. Deaths from in thousands I Peptic ulcer occur much more frequently at ages July-Dee em- 45 years and over (with 8,661 deaths for 1969) ‘ ber 1968-- 3,360 1,481 1,344 535 than at ages under 45years(with 651 deaths for Jdy 1965- 1969). ‘June 1967- 3,752 1,672 1,516 ’564 JUIY 1963- For 1969 the mortality sexratio for Peptic June 1965- 3,499 1,524 1>471 505 ulcer (the age-adjusted death rate for 1969 for JUIY 1961- the male population over the corresponding rate June 1963- 3,079 1,382 1,284 413 for tbefemale population) was2.70. The trend of Prevalence of Peptic ulcers this sex ratio was downward during 1950-69, I per 100 persons decreasing from 4.61 for 1950 (based on age- July -Decem-” adjusted death rates shown in table Z). The color ber 1968-- 1.7 1.1 3.3 2.9 ratio for Peptic ulcer (theage-adjusted death rate July-1965 - for 1969 for the population of races other than June 1967- 2.0 1.2 3.9 3.2 July 1963- white over the corresponding rate for the white June 1965- 1.9 1.2 3.9 2.9 population) was 1.14. The trend for this color ratio July 1961- was slightly upward during 1950-69, increasing June 1963- .1.7 1.1 3.5 2.5 : from 1.04 for 1950. S The color differential for the male population was also upward (from 0.98 for 1950 to 1.11) It should be mentioned that chronic conditions for 1969, while the color differential for the reported inhousehold interviews may redescribed female population was downward (from 1.29 for as those of which the respondent is aware and is 1950 to 1.15) for 1969. willing to report to the interviewer. Thus these The gap between the excess death rate for estimates may differ from estimates based on Peptic ulcer for the white male population and the medical records or clinical examinations. corresponding rate for the white female population The above figures indicate that the prevalence narrowed substantially between L950 and 1969; of this diseaie rose from July 1961 through June the sex ratio for this cause of death for the white 1967. But for July-December 1968 tbeprevalence population decreased from 4.82 for 1950 to 2.70 of Peptic ulcer was lower (3,360,000 cases) for 1969. than it had been for the previous 4 years. There was also a sizable reduction in the Estimates for July-December 1968, however, sex ratio for this death rate for the population of may not be so reliable as forthe prior periods” races other than white—from 3.64 for 1950 to because of the smaller size of the sample. 2.61 for 1969.

54 Table Z. Age-adjusted death rates for ;;;~9ulcer, by color and sex: United States, - [For 1968and 1969 rates are based on daths assigned to category numbers 531-533 of the Eighth Revision of the Intematimz.d Ck-ifcation of Diseases, Adapted for Use in the C6tited States, adopted in 1965; for 1950-67 rates are based on deaths assigned to category numbers 540-541 of the Sixth and Seventh Revtilons adopted, respectively, in 1948 and 1955. For method of age adjustment, see appendix 1]

I Total

Year Fe- Both Male Fe- sexes male male

Rate per 100,000 population

1969------3.6 5.4 2.0 3.5 2.0 4.0 6.0 2.3 1968------3.7 5.7 2.1 3.6 22 2.0 4.4 6.8 2.3 1967------6.1 2.1 6.0 2.1 4.3 6.5 2.3 1966 ------2:; 6.5 2.2 H 6.4 2.2 4.7 7.3 2.5 1965------6.8 2.2 4.3 6.8 2.2 4.4 6.7 1964------M 4.6 2.3 ::: ;;;;:...... ------5.2 ;:: M 5.2 ;:: 2.5 ;:! M *2.8 ------5.4 8.5 2.6 5.3 8.4 2.6 5.3 8.3 2.6 1961------5.2 8.3 2.5 8.3 2.4 5.2 7.8 2.8 1960------2.4 H 8.5 2.4 7.8 *2.4 1959------::: ;:: 2.3 5.0 8.1 i:! 7.4 2.2 1958------5.3 8.4 2.4 8.5 H 2.9 1957------5.1 8.3 2.3 ;:: 8.4 2.3 ::: ;:; 2.2 1956------5.1 8.4 2.1 5.1 8.5 2.1 4.6 6.8 1955------8.4 2.1 5.1 8.4 2.0 4.8 7.2 ;;; 1954------H 8.4 2.0 5.1 8.5 1.9 4.9 7.4 *2.5 1953------5.1 8.6 1.9 5.1 8.6 1.8 *2.3 1952------5.0 8.3 1.8 5.0 8.4 1.8 ::: ;:; *1.9 1951------5.0 8.3 1.8 8.3 4.8 *2.5 1950~------5.0 8.3 1.8 ;:: 8.2 H 5.1 HI *2.2

lFi~res by color exclude data for residents of New Jersey because this State did not ?equire reporting of the item for these years. ZBased on enumerated population adjusted for age bias in the pOPUlatiOn of races other than white. \ NOTE: Asterisk indicates age-adjusted rates where more than half of the age-specific rates are based on fewer than 20 deaths.

_s5. REFERENCES

lNational Centw for Health Statistics: Mortality trends: 7National Center for Heahh Statistics Diabetes melks age, color, and sex, United States, 1950-69. vitalmd Health mortality in the United States: 1950-67. Vital and Heafth Sfa. .stafistics. %ties 20-NO- 15. DHEW Pub. No. (HRA) 74-1852. fistics. PHS Pub. No. 1000-Series 20-No. 10. Pubfic Health Health Resources Administration. Washington. U.S. Goven- Se+e. Washington. U.S. Government Printing Office, July mem Printing Office, Nw. 1973. 1971. 2Natio~af ~nter for Heafth” Statistics: Comparab&ty of 8National Center for Health Statistics: I.eadmg com- mortality statistics for the Seventh and E@th Revisbs of the ponents of upturn in mortality. for men: United States, International Classification of Diseases: United States. V?tal 195>67. Vital and Healfk Statistics. Series 20-No. 11. DHPW and Health Statistics. Series 2. Health Resources Admini* Pub. No. (HSM) 72-1008. Health Services and Mental Health tration, DHEW, RockviUe, Md. To be published. Administration. Washington. U.S. Government Printing Office, 3Nationaf Center for Heaftb Statistic* Comparabfity of Sept. 19~1. mortality statistics for the Siith and Seventh Revisions, United 9Nationa( Center for Heakb Statistics: Mortality from States, 1958, by M. M. Faust and A. B. Dobmn. V&[ selected causes by maritaf status, United States–Part A. Vifaf Statisfi.s-Special Repoti, VOL 51, No. 4. public Health Serv- and Healfk Statistics. PHS Pub. No. 1000-Series 20-No. 8*. ice. Wasbii6n, D.C., Mar. 1965. pubfic Health Service. Washington. U.S. Government Priming 4NatiIxMd Office of Vital Statistics: Death rates by age, Office, Dec. 1970. race, and sex, United States, 190 G1953, selected causes. Vital 10coombs, o.: It,s Blacks Who Must Stop Crime, New Statistics-Special Reports, Vol. 43, Nos. 1-31. Public Health York &aziie, Nov. 20, 1972. Service. Wasbiigton, D.C., Oct. 1956. 11Nafiomd Center for Health Statistic~ Vital Sfafistics of 5 NatioIIaI Center for Health Statistics: Characteristics of fhe United Sfafes, 1955 .%tpple”menf, Mortality Data, Multiple persons with diabetes, United States, July 1964-June 1965. CUuses ofDeafk. Public Heafth Setvice. Washington. U.S. Gov- V7fd ond Health Statistics. PHS Pub. No. 1000-Sties 1O-NO. ernment Printing Office, 1965. 40. Public Health Service. Washington. U.S. Government Print- ing Office, Oct. 1967. 6Heakh Interview Survey, National Center for Health Statistics: Prevalence of diabetes by race and sex: United States, July 196&June 1967. Unpublished data.

5.!5. - LIST OF DETAILED TABLES

Page

Table 1. Deaths and death rates for 6Y selected causes: United States, 1969------59

2. Death rates for 48 selected causes: United States, 1950-69------60

3. Deaths for 48 selected causes: United States, 1950-69------62 4. Deaths and death rates for Certain causes of mortality in early infancy, and estimsted number of live births, by color and sex: United States, 1950-69------64

5. Deaths and death rates for Congenital anomalies, and estimated number of live births, by color and sex: United States, 1950-69------66

d Table 1. Deaths and death rates for 69 selectedcauses:United States,1969

-100,000p.pulatmn Numbers aNcr causes of dealb arc category numbers of lbc Sigh!h Rcvkmn of the Imtcm.ti.nal Classik,tion of DIsmscs, Adapted,19651

C?”., of death Number Rate

All Ca"S~S ------1,921,99(

Ba.ilhw Ws.nf=w and aebtisti------00&,0o6 Enteritisand c.kherdtarrhealdiseases----..------.------...---.--.------.-Oo8,oog z,6? ‘I’ubercul.sis? a11 fO~S------S------010-O19 5,56; ‘zubercul.s,s.f respiratorysysta------.------.--olo-ol2 4,49: Tubcrculwis, other foms------.-.----.-.---.----0l~-olg 1,07! Whoopingc.ugh------7------.------.------.------o33 1: 0.0 StrePt.x.accalsore throatand scarletfewer------.--..----.----.------.-.-.------.--o3~ 41 0.0 lfeninwco==l ~fe.ti~s------.o36 0.4 Septic~a------o383,;: A=te e0li.myeliris------,------o4o-o&3 1: ::; Measles------.------.--..-.----...-----.--0~~ 41 Sy hilis and its seq"elae------.....-.------.-.-..---.------.....---.--.---•9O-O97 SC otE.r infectiveand P.r~5itiC disease.------Rmi"derof 000-136 4,1L~ ilali ant ne.plasms,includingneoplasmsof lymphaticand bemat.p.ietictissues------140-2og 323,092 160.0 MS‘F’is”$+”t“eOP1asw Of bnccal cavity and pti_------.--.-...---.-.--..-.-.--I4O-1&9 7,55: 3.7 Malignantne.aplasu,sOf digestive.rgansand petiConm.------.----.------l5O-l59 93,98f 46.5 Malignant“MPlaSMS Of respiratorySySt~.-.--.-.-..--.------_------l6o-l63 66,036 32.7 Mali@ant Qeopla.nof hreasc------l7429,0s? L4.4 Malignantneoplasm of genitalOrganS------.-.--.------_------I~O-L~7 41,00f 20.3 Malistra”tneqlasn!sof urinay organs------1S8,1S9 14,89; 7.4 Malignantne.plas!ns.afall .x er and unspecifiedsiEes------.------.----....-.--_I7o_I73.190-lw 37,82! 1S.7 L=k~*a------.------zM-2o714,45C 7.2 Other neoplasm. of I.pmphaticand hematopoietictissues------200-203,208,209 18,252 9.0 Benignneoplasm and neqlasms of unspecifiedMture-. ------.------.------2lO-23g 4,67i 2.3 Diabetesme11itus------25o 38,541 19.1 AVfUmillOS.S a“d other [email protected] 2,534 1.3 An&s------....------.------..-.-----.--...-...... ------....--.---.-.--Z~D-283 3,318 1.6 M-ingitis------.....-.------..------.--.------.-...... ------32o 1,719 0.9 fJ@oz ca~iovas.=ler disea.es------39O-448 501.7 Diseasesof heart------39O-398,4O2,4O4,4lO-429 366.1 Active rhmtic fev,r and cbr.nicrheumaticheart disease------390-398 Rppertensiveheart disease------.---.------..---..--.-.--.....-.------402 z:: Hypertensiveheart and renal dis.a.e------..--....-.-..-.-.------.------4o4 3.6 Isch.=fcheart disease------41o-413 331.7 Acute a+meardialinfarctim------.-----.------.---...------.....--.....-.--.---4lo 179.1 Other acute and stibactiteform. .f is.bemic heart disease--..------.------.-----4l1 Chroniciachemicheart dis~se------.------.--..---.-.-----4l2 15::: @i= pect0tis------4l3 0.1 Chr.nicdisease of e“docardiwnand other ray.cardialinsufficiency------424,428 3.7 All Other fornlsof heart disease------.---.------42O-&23,425-427,42$! 15.0 Byp..tensi~------F------400,401,403 4.2 Cerebrov$wwtirdisea.es------430-438 102.6 Cerebralh.rno=haEe------.--431 21.4 Cer.bralthrnrnb.sis------.------433 2:.; cerebral~bolism------434 All other cerebrowascu2ardiseases------43O,432,435-438 51:6 Artcrioscler.sis------.------.------.-.------.--440 16.4 Other diseasesof arteries, arterioles,and .apillaries------.-----..--.--.-.------til-Ms 12.4 A.”te bronchitisand br.nchi.1itis------...------.----.---__------.------.--4661,286 0.6 lnflue=a and Pneu~Uia------47O-474,48O-48668,365 33.9 Influe=a------47o-47&3,971 pneu~nia------480-48662,394 3::: BrOn=biti.,emphysew and asti------49o-493 31,144 ~xo.lc and unwQ1ifiiedbrnnchitis------490,491 5,843 Emphysema------22,939 Asthma------...... -..------.-...-.---.------_-_----.---~;;2,362 PepticU1c------.------...... ---.------.---..-...--...-..-----_------53I-533 9,312 Appendicitis------y7.-...... ---.------.-.-----.------.------54o-5431,407 Hernia and intestinalObszrWtX~------....----.------..--.-..-.-----..------.53o.553.360 7,500 cirrhosisof 1iver------.------..-.-.---.--...-----..---.-..--.----STI29,866 Ch.lelitbia.is,.h.lecystitisand cb.langitis------...-.-.------.-....-.-.--.....------5T4.STE, 4,262 Nephritisand nepbr.si.------:------58o-5849,417 Acnte nephritisa“d nephr.ti.s~drme---.-.-.--.--.....-..--.---..------.------58o.581 1,392 skr.n~.a-d unqualifiednephritisand renal sclex0sis------5SZ-584 8,025 Infectionsof kidney------.-.------~go8,750 4.3 WPer@asia .f prostate----.---.------.------..-----...------6oo 2,499 1.2 Complicationsof pregnancy,childbirth,a“d the p"eqerim------630-678 801 0.4 Ab.rtians------.------.------.-.--...---.------.--.-.-.------.---.64o-64~ 132 0.1 Other complicationsof pregnancy,childbirth,a“d the ~eqerium------63O-639,63o-678 669 0.3

c-s~tal an~l%e.------740-759 17,00S Certaincausesof mortalityin early infancy------760-769.2,769.4-772,774-778 43,171 2?:: Birth injury,dtfficulclabor,and ocher a“c.xic-“d hyp.xicc.”ditio”s------764-768,772,776 21,939 10.9 Other CaUSESOf ~Ortalityillearly infaacy------.------.------Rmind,r of 760-778 21,232 10.5 W@= and iii-definedc.nditt0n.------78o-79626,160 13.0 All other diseeses------..------.---.-.--..--..------.-.---.---..-.---Re,idua197,982 4s.5 Accidents------.------.-----..------E800-Eg4g116,385 57.6 MOtOC vehiclea.cidents------E8lO-E82355,791 27.6 All otbec accident,------..------.-...E8OO-ESO7,E825-Eg4g60,594 30.0 S"icide------.--.--.------_------.....-....-.-----.-.-----E93o-E95g22,364 11.1 H0ticidC------E960-E97815,477 7.7 Other exteml aUSeS------E9S0-E999 5,L47 2.5

59 Table 2. Death rates for 48 selected cases: Cnited states. 1950-69 . [Rat., W. 100.000.omladom Numbers mfluaum ofdcah me ciucww mmb.xs d ,hcE;,kt6Ro,iw, tic r.f. in1965.Far196i&d 1969rala= basedm,deathstip,d ,.th;x“fi-~h,hRc,kio.<.+ “uInk ,,1950. cnfiltctisims.admtcd.resmcmdv.in1942and1955.- catemmv.umbm areshownk elan. m ofth!

l!ause m? death S.@ .tqory — e Ecghth F.evision .969 L968 1967 966 L96S 1964 L96S L9&2

— ,.,

1 All .Mls.s------—------—-----——------—--- 95L9 935.7 951.3 945.2 9S9.6 961.5 ‘245.0 . -1-= 2 Ihteritia ad other diarrhealtiseBes--..-.------008,m9 1.3 1.5 3.8 3.s 4.1 4.3 4.4 4.4 4.3 4.4 3 Itbenwlosis,e.11fmms-_-----—------Ol0-0l9 2.8 3.1 S.5 3.s 4.1 4.3 4.9 5.1 6.4 4 %mhi~. ~ it..ewek-—---—---—------o=97 0.s 0.3 1.2 1.1 1.3 1.4 1.4 1.5 1.6 !:; 5 otherfnr.ti,eallapl’aaitscdfa.se.---wlaina.m? Ooo-x 4.0 4.0 3.5 3.8 3.9 &.0 4,1 4.0 4.0 4,Z

6 Ma3&mllt neaplnsms, ~ ~a .f~i. ma hcmtoroietictissues—------—--—------14O-209 m.o 15s.& 157.2 M-5.1 LS?..5 1S..3 151.3 149.9 149,4 14’3.2 =liW=Ut =OPkSMS d ~~1 CWIW M ghawnx---1414949 3.1 3.6 3.4 5.5 3.4 3.4 3.4 3.5 5.5 3.4 : !fSlimar.tneomams e dizesti.Orgensma WXt—--.------——-.-—-—--—------lmm 46.s 46.0 42.2 4a.5 48.7 48.7 49.7. 49.5 =.1 W.q Msli_ mecmlammof reqirat,,ryw.k-.------..--16D-1E3 32.7 =.8 29.4 28.0 26.8 25.7 24.9 24.0 23.1 2*.2 2 [email protected]’rallt..*. M *,———-——-—174 14.4 14.6 14.3 14.1 14.0 I?.7 13.5 ls.4 13.4 13.4 U Me.l%lmlltneomaslnsof ger.MalOrgens—------1ma.97 20.3 20.5 20.4 20.6 2Q.9 20.9 21.2 21.3 21.4 21.E MaligmmtIleoPlamsof UrilmryOrgans------lz%,lw7.4 1.+ 7.4 7.2 1.2 7.1 ,.2 1.2 1.1 1.1 : Malignant.OIMSMS of allotk d Unsl=ifiti I siteS------l70-173,190-l9912.7 18.6 18.6 17.9 17.9 17.2 11.0 16,6 16.4 1C,5 14 _..---..----- ....----...------...---2O4.2071.2 7.2 7.2 -i.z 7.0 7.0 7.2 1.0 7.0 7.1 ls Othermwlnsm of Wwhatie andbend.ar-aletic tiEs.e*--—------—---——----—--

16 Belli@mqlam, an&m%ti W llnqwifie.il18tllr.-ZMJ-239 2.3 2.5 2.5 2.5 2.C z.7 17 DiabetesmlHtm------.----—-—------.----25O I-9.1 19.2 17.7 1: 1::: In 1:: 16.8 16.4 led? 18 AmMiaS------..------2S0-2851.6 1.7 1.7 1.8 1.8 1.0 1.8 1.8 1.% 1,9 19 -@tl*—-.----—----——.----...-.-..-..---zo 0.9 0.9 1.0 1.2 1.2 1.3 1.2 1.2 1.2 1.3

2D km, -.- ~m---—-—--——-—-----W-448 sol.? az .1 S6.5 5N .1 5M.9 sm.= 521.3 515J 9X.1 513.1 21 mseases of hear%--———------32O-S38>429,YM,4l0-429 366.1 312.6 364.5 sn.2 367.4 365.7 375.2 370.1 352.$ 363.0 22 A.*1w rheumaticseverandcbzwic rheumaticheart ~s=+----—------.-———-- .....----S598 1.6. 9.2 1.2 1.1 8.0 8.? e.8 9,5 9.8 ZO.3 23 m-l= heartdiseasetitbor without,- a.-*---—------——-----_-.--_m,M4 8.1 6.9 25.3 27.7 28.4 33.4 .54.6 37A I.ched.hesrtdi6_e———--—.—-—-..-----4l@-4l3 5m..7 537.6 289.7 m .7 2M.6 2ss.8 274.4 27.5.6 2 -. sise.e or elma— eraO- WraCa’dial ir@fSiCieW---—------424,428 3.7 3.9 26.6 27.4 27.4 27.8 29.7 29.4 29.8 31,9 AU othexZ- .2 heartdisease-----4Z3,4Z5,427,427,429 1.5.o 14.0 15.8 u .8 u .1 14.5 14.5 13.9 13.8 14.3 z mwim------._----.__-_-----_.-4m,4ol,@5 4.2 5.8 5.8 6.0 6.4 6.7 6.7 6.1 7.1 28 Cerebmwculax fisewes..-----.-.-.-.-...-....--430.G010Z.6 10G 102.2 104.6 103.7 10s.6 106.6 106.2 105.4 108.0 29 Ar&riasc1msis------440 x.4 16.8 19.0 18.9 19.7 12.4 U3.8 B. 8 19.3 20,0 30 other w.-,, of arkrle., al-k+.ole., and .@ue.—-—-—-—---———-—------.a-449 Iz.4 E-.4 3.5.1 14.6 14.1 13.5 12.9 12.2 11.3 11.0

31 acutebm.chitisd lJrnncbi01iti6------46s0.6 0.7 0.5 0.5 0.5 0.5 0.E 0.6 O.G 0.7 32 nwlIleMZaand.Pnemvllie—-—---—---—------470-474,4?0-4%33.9 36.8 20.8 32.5 31.9 .U.1 37.5 S2.3 30.1 37,s 33 Ir.t---—------—------47c-474 3.0 3.s 0.7 1.4 1.2 0.9 3,8 1.8 1.2 4.4 34 ——---—------—--—------4-426 30.9 33.2 28.0 %.0 W3.8 33.2 32.8 33.4 29.0 Z2,Y

35 Emnchlti., E@ryseua, ad, asti---——----—.--42Q-493 15.4 16.6 15.3 .15.2 14.4 12.9 13.0 11..z 9.9 9.9 36 Chl.anieallaUlqual.ifled—tti-..----..------49o,e1 z.9 3.1 z.7 Z.6 2.5 2.3 z.3 1.9 1.7 1.9 37 m----.-.------–------_---.-_--.-4gz n.4 Zz.1 10.8 10.3 9.6 8.3 8.0 6.7 5.s 5.2 38 Ast2ma------—--——------—------493 1.2 i.3 2.1 2.2 2.3 2.3 2.7 2.6 2.7 3.0

33 Pepticti=—--..—----.-.------—__---__--m-ss .!.6 4.7 5.0 5.3 5.4 5.7 6.4 G.G 6,5 6.3 40 _ andintestinal.abstictim—-—------.5S3-5S3,560 3.7 3.s 5.D s.1 5.2 5.2 5.3 5.2 5.0 5.1 41 Cil’rhc.sisor Mva...------——-.--—------5m 14.8 14.6 14.1 1.3.6 12.8 1’2.1 rL.9 12.7 II.3 I&$ 4Z ChOlelithiil.is,[email protected]@.ti.---_---s74,57s 2.1 2.2 2.2 2.3 2.4 2.4 2.5 2.6 2.6 Z.f) 43 MIU’lti$allammsl*..-..-- ....-.--- ....-..-5m-m .2.7 4.7 5.5 5.9 6.2 6.5 6.7 7.0 7.2 7.6

44 Mectiams of aw---—---——-__.---_-—-_5m 4.3 4.7 4.6 ..8 5.1 5.2 4.7 4.7 4.4 4.3 45 -man or m.a5tate—--—----————------6Lw 1.2 1.3 1.6 1.6 1.8 z.0 z.3 2.3 2.s 2.5 46 congenital—s-—---—------—----—------740-759 8.4 8.4 8.B 9.5 10.1 10.6 n .0 11.4 12.0 lZ.Z 47 Cerbainc@Jlnes0? mrtalitJJin ,.W ~------—-----76~769.2, 769.4-772,774-778 21.4 21.9 24.4 26.4 28.6 ?J.5 ~~.$ 37.4 * Sw@m8 an.3W-M!.nea .OnditfOns------..-----7m-796 3.3.0 11.a 12.2 32.2 3.2.1 13.Z H H 10.4 Il.& 49 Allotherss-es.-----——----...----—~stil S3.9 =.1 54.4 34.7 34.1 34.1 54.7 34.0 3.2 35,3

57.6 57.5 57.2 58.0 SS.7 54.3 53.4 52.3 sO.4 52,3 vator.ehicleaccident.s----—--——------=0-W3 27.6 2T.5 26.7 27.1 25.4 24.5 23.1 22.0 ZO.B 21.5 AU otheracXtitS-=.--__-----_-.=-W7>=5.~~ r.’).0 30.0 3’3.4 3.2.s .50.4 2s.7 33.3 2D.3 23.s 31.0 s mci&------.----.-—.--—..mw-m59 H..1 10.7 10.8 10.9 11..1 10.8 11.o J.O.S 10.4 lCI.G 54 Hm@ide------—------E960-E978 7.7 1.3 6.8 5.9 5.5 5.1 4.9 4.0 4.7 4.1 55 u 0*hE7ertema ._e*—-— .....-——--—ma&m99 2.5 2.2 ------~ — — .

60 Table 2. Death rates for 4S selected causes: United States, 1950-69--con. @CS per100,oooPWIAII. N.mbm after mm OEdeath m-mtcgov numbers if h EidIth .%-i.. oftheI.tmtimd CIastfi..,C...fn~-$=sAtit.df..USC,.:JI.u~@s~@ ~v~d in1965.For1968and1969rataorp=.c.”.ly, u .=.! u!. J . . . . :rr.s m,.,.. , . ..”.”=.. a. =..”... “. ., ......

category mbem 1950 accc.rdliwto the 19s7 E= 1.957 H56 ~= 1954 1953 -= 1951 Sw allaseventh Re-ioms

936.6 950.0 9=.6 9=-1 =43.4 9=.9 959.0 9Q .4 966-7 963*E ...

4.5 *.7 4.5 4.7 4.9 5.4 5.6 5.2 5.1 54S,S71,572 2: 7.1 7.B 8.4 9.1 10.Z 12.4 15.8 20.1 22.5 001-019 1.7 2.0 z.Z 2.3 2.3 3.0 3.3 3.7 4.1 5.0 020-029 4.5 4.4 4.2 4.5 4.8 5.3 5.0 7.4 6.7 6.7 031-!.33,nenllinlk’ of

147.s 146.8 148.6 3.47.8 146.5 145-s 14~n M3.4 140.6 139.s 140-205 3.4 3.3 3.4 3.3 3.4 3.3 3.2 3.2 3.2 3.4 140-148 50.7 sm.9 51.7 S2.4 == = -0 =.~ =.5 5-3.4 54.2 1%156A,157-15S 23..2 20.4 Is.9 19.2 18.2 17.1 y.: g:: ~2.514.7 14.1 160-1E4 13.1 =.1 1-3.3 =.3 3’3.4 =-0 12.6 lm 21.6 22.1 22.6 22.6 =.8 2::; z= 22.7 22.5 23.1 171-119 7.1 7.0 ‘1.L 7.0 7.0 6.9 6.6 6.7 Mv,lm 16.2 1.6.1 16.7 l.s.s 16.4 1s.5 16.3 =.6 16.1 14.7 3.56E,165,19.l-199 1.0 6.9 6.9 6.8 6.6 6.5 6.s 6.3 6.1 5.9 m4 1.1 6.9 7.0 6.8 6.5 6.3 6.1 5.8 5.s 5.2 2C0-ZIX,205

. 2.0 2.9 3.0 2.9 3.1 3.2 3.3 5.3 3.4 3.8 21O-K52 1.5.9 25.9 16.0 y.: 15.5 15.13 16.3 1::; ~:j 16.2 Zw 1.8 1.8 1.8 1.9 z.0 2.5 2.7 290-293 1.3 1.3 1.2 1.2 1.1 1.1 1.3 1.2 1.2 1.2 340

%8.s 51.5.5 =4.6 501.4 496.3 484.6 503.0 498.5 ;:4: 494.4 333-334,4C0-468 363.2 367.7 369.4 3::: 356.5 W:; s% =;; 14.1 356.8 400-402,410-443 10.4 lo.a 1.1.8 12.0 14,8 4MM02,410-416 38.6 42.7 42.5 4.3.s 45.0 46.6 ~.3 53.9 55.6 56.5 440>441>44Z>443 268.6 Z66.2 ?.85.6 255.5 247.0 ._ .L=27_ __ 236 J 226-2 =9% . m> 422 31..O 33.0 s.a 31.1 39.9 41.0 ~ 46.3 49,3 52.6 56.5 a, 422

13..9 lb-z X2.8 7.2.6 12.6 3X6 14.3 14.J ‘15.1 ls.sl 450-434 7.s 8.s 8.s 444-447 10U ULW s 1~ 10::: M;:: 101.3 10J:: =7 104.9 :’-=4 1s.6 19.9 U.5 19.1 19.8 la.: ZQ.4 20.8 20.4 10,3 9.9 9.0 0.4 7.s 6.0 5.7 5.4 4.9 451-i68

0.6 O.e - 0.7 0.7 0.7 0.6 0.6 0.7 0.6 0.7 S20 31-.Z 33.1 ss.a 28.2 27.1 ’25.4 33.0 29.1 3L4 m..s ‘MD-495 1.7 1.7 6.0 3.6 4.5 4.4 4ao-4a3 2?6 ::: ::: 2E 25.4 23.8 27.0 26.1 =.9 26.9 480-4s3

8.7 B.3 a.7 7.5 6.8 7.2 6.9 6.9 5.0 501,W+S7.1,2U 1.5 1.5 1.4 1.2 E 1.2 1.s 1.2 1..5 1.3 531,502 *.* 3.9 .3.4 2.7 2.2 1.s 1.6 1.2 1.1 0.8 527.1 2.8 2.9 3.9 3.6 3.6 3.8 4.s 4.5 4.5 z.9 al

6.0 6.2 6.1 6.0 5.9 5.8 5.8 5.6 5.5 5.5 w,541 5.1 5.0 5.1 5.3 5.3 5.5 5.4 5.6 5.9 560,S61,570 ;:: I&2 U-.3 10.7 10.2 10.1 10.4 10.2 9.8 9.2 ml. 2.s 2.7 2.9 3.1 3.6 3.5 3.5 3.8 3.7 3.9 584,585 8.0 9.2 10.2 10.6 11.1 3.2.2 13.6 15.3 16.8 18.7 550-594

3.9 4.0 3.1 3.4 3.0 2.7 2.8 2.4 2.1 2.1 m 2.6 2.7 3.0 3.Z 3.1 3.8 S.9 4.0 4.2 4.2 m 12.3 r2.4 12..8 U >6 ls.s r?.s 1’2.6 p: g.: 32.2 750-759 3a.5 39.0 39.1 38.6 39.0 39.4 ~.1 40.5 760-776 M.8 1.1.4 1.L2 SL.5 =.1 1.S.5 13.7 14.I 14.8 14.9 7tW-195 54.8 34.1 33.8 S2.5 32.2 32.0 33.6 =.8 35.1 35.4 Reslaml

52.7. 52.3 55.9 56.7 56.9 55.9 ~ =.8 62.5 EO.6 EXO-E362 21.5 21.s 22.7 23.7 23.4 22.1 24..5 24.1 23.1 mO-E335 33.7 =0.s 33.2 33.0 33.5 33.0 36.1 37-5 ~-: ~ Eaw-re02,m40-lt362 10.6 10.7 9.8 10.0 10.2 3.0.1 m -1 ~.o W63>E97C-B379 4.6 4.5 4.5 4.6 4.s 4.8 4.8 5.2 4.9 5.3 E964,ES80-ES= ..- -. -. ..------

61 Table 3. Deaths for 48 selected causes: United States, 195D-69 asahtrauxs of4catharccakgorynumb-sofIh,.&&b Reuirim of tie In . ..OIIUI [email protected] of %.-.s. A4ipt.J for usei. the LJmf=dstate.. .ilopkdm 1965.For196$ad Ideaih.arctboscasiwd m ih.scEighthRevisio,:g.w.~~Is. f..1951 t.atluarchostasigmd t. the.ateg.xynumbersoftheSixthandScvmlhRcviions,=d.pkd,msFc- “,lF1948ad 1955.TIKSCcategorynumber, arc u in the last column d *bI.]

7 calm. death 6n& mmbers of category .967 1966 1965 1964 1963 1961 1960 M Ei@h Revision

WI,’390 m3,0@2 151,323 ,86.5,149 8Z8, U6 798,D51 313,549 756,1m 701,522 ,711,98Z _ hterltis MM other .liarrhcal aisea.es---—..——------CQ8,QX z>612 2,940 7,5C4 7,552 7,899 8,178 8,246 8,194 7,@o 7,93Z WmrmlO,is, au fame-.---—-- Omcm 5,561 6,292 6,901 7,625 7>934 8,503 9,311 9,m 9,938 Io,e&F, Wuhilisma m, ..QU-—-—--D9C-O9 s 586 Z>ml 2,lx 2,434 2,61.9 2,666 2,ml Z,@so 2,945 ii-mIm?ectiv.a.u-wr-iti. di.ea.es——---—--mmailm=-m? Dm-lst e,c69 7,958 6,964 7,4% 7,465 7,5’30 7,756 7,457 T,mu 7,576

111.m.tImPlamS, incluafng moplams of [email protected] h~ktlc ti.sue-————————----lm-zo, 323,032 310,547 31a,9e3 %, 736 297,580 2.99,577 205,362 278,562 267,627 MEJigr,amzl.Ple6m6of‘eucCalCevi+w ma PharYnx——------140-14! 7,553 7>2s4 6,‘ID 6,X4 6,501 6,571 6,4al 6,322 6,175 w-t .ep=. ~ ~ge~s= ‘n’Ws alaE.entOnem——_..KcK1$l$ 93,9e6 S3,563 95,320 95,079 94,31x 93,l% 97.,914 02,(347 91,727 91,0Z5 [email protected],lasmsof [email protected] aystm——------—------lw.H3 66,030 63,4a5 s, D% 54,934 52>0?$ 49,U7 45,913 44,644 4z,zll 39,733 Wm@nt neoplasmd bren6*..----H 29,0s. 29,Oal 2s,21-7 27,5.33. 27,0U 26,16z 25,401 24,958 24,S43 23,970 W-* ..@== .f g~+~ orgen,-———------—---mla 40,936 40,408 40>378 40,454 39,95C 39>933 39,590 39,2X - 38,6ss MalipentWollasmsd? Ursnuay .-.m=----_-__.._.—-—---mB.m.. . .. u, 897 14,792 14,656 14,Es 33,9D1 x$,w 13,5S 1.3,299 l$om E’,3M *UIt .wl.=. ~ U .~= =~ Ullswcifled sites—----173,173,190-l!+ 37,825 37,247 %7= 35,cm 34,644 3Z,E3E 32,0% 3$:: 29,977 29,WI mti.-----—------—--.---2w20 14,4= 14,375 14,336 U,ol.z 13,62c 1.3,4s 13,s07 > Elan E, 725 other neOP1.a6m8 of lymphatic and hm- toEOieti.tis5ne.—---2m203,208,20 u, 252 i7,774 IL7,”m 15,em ls,cm 1.,7* 14,407 33,755 13,s’S4 .IZ,9s9 lenigm llenplc.sm ma nfmplmns of 4,677 4,948 5,013 4,225 5,051 4,9% 4,905 4,ml 4,751 14,093 unspecified llature-----..---2lc-239 Hahete, rwllibus---—------—-----z50 38,W 38,352 35,049 54,591 33>17! 32,275 32,465 31,22’2 50,098 29,971 bmnu.as----——-——-—-—-----2ec-2a5 3,318 32494 3,%0 3,452 3,53! .5,51f 3,409 3,598 3,2@2 3,330 1,719 1,707 2,045 2,324 2,36 2,46! Z,343 2,322 2,265 Z,316

JP.@ c@a@iOvascm=alseasew---39&448 013,0= 023,399 002,ul L,OIO,W? 9%?,1% 973,m 953,X!4 951,431 924,622 923,6s5 Disease,M h,al-t---—----34LE,9a.4LE,40%41c-4’29 739,265 744,65@ 721,268 727,W2 Tlz,ox 699,SS 707,@3c 63%039 663,391 661,71e Active rheme.ticfeveima chiati. r-atic heartdiGeas—----S9E-S9E Is,432 ls,35s u, 176 WOK? E,.7 E, 9’Z X3,61$ 17,751 18,4U ~ert-i.e henrtdiseasewithor tith.autrenalLlleen6e—----40z,404 16,206 11,698 49>915 54,176 54,w 57,4X 61,b91 62,176 63,262 &5,3ca 16chemieheartdise=sa=------41C-W? 669,62S 674,147 573,m 573,191 559,2s 545,49! 546,eE 527,%1 502,351 494,292 Chronicdiseaaeof enanmtilnnma at%. IEvcC.aiel insufficiency------~4,42C 7,47C 7,asfi 52>691 53>581 53,11) 53,2X 55,WC 54,645 54,632 57,029 Au O*= i- of heart di.eas—--—---e& 423,4=-427,429 30,24? 2*,03s 31,267 x, 042 29,17 27,74 27,32? 25,S/6 25,Z64 Z5,682 gw!tmlan.——— ---400,401,4Cf 8,4ze 9>C63 n, la m.,WI 11,66 lz,w U> 694 1.Z,497 lZ,E u+,cez Ceremowa,dq aiseases--.---uwus 207,17s ZIL,3SC 202,U34 204,EAI 201,05 198,20 201,161 197>451 192,951 193,23s , Arteri.ascl=osfs------——----44C 33,052 33,s+3s 37,564 38,901 38,10 .57,171 37,4X 56,SK 35,388 S5,816 Otmerai,eaae.or arteries,Ua+erifl.s, ! alaea@uarie,--—------44G&4e Z5,0G 24,72C 29,?44 28,682 27,27< 25,74: Z4,3E 2Z,632 20,7m 19,?97

I 1 mute mwnchitisma brunmt.i6---46E l,zet 1,-2 95e 987 1,O(I 99! 1,13s 1,1X l,CC.1 1,1?0 —a andpl-a--47c-474, 4a0-4@f 68,365 T3,492 56>@92 6S,6= 61>Ba 59,45 70,761 59,9’35 % 175 66,WJ2 Ir,fl”er+J.--—---———------41-474 5,911 7*W 1,475 2,850 2,29! 1,6E 7,w 3,431 2,U31 7,W/z PnwxOri.——----—-----.----4m-4e4 6Z,394 66,43C 55,417 60,7.95 59,613 57,76. .53,S7C 5.5,564 53,036 59,951 mvn’=hitis,mpmseme,alla.tJx4a-49c-493 n. 144 30,SE 29>740 27,9s 24,64! 24,501 20,8U Wzll 11,820 mronie andunqualified %rMIchltW—-—------490,491 5,8.K 6,ZIX 5,30f Q64 4>16 4,4X 4,3Z 3,m 3,173 --.-———-——-—-—------492 22,93s 24,1= 20,87: 20,252 12,66 Is,7s1 E, la 12,361 ‘5% 9,ZS3 I 2,365 2,68C 4,H 4,324 4,52 4,44 3,DS 4,w 4,9X 5,394

PertieuIce>-—-—---——---531-5X 9,311 9,46< 9,82: 10,?.2I ln,42 10,96, E> m n, 22( ll,w =,%0 I&i. .< titestm .kh’uCti--,-—---55c-553,56l 1,w 7,75! S,814 m, 07P 10,w 9,m’ 9,72? 9,lZ 9,081 cirrhosisof 1.iTez---—------5m 29,w 29,131 2?,elf Ze,6s2 24,71 2; z 22,451 21,82” 20,7X z0,z96 Cholelitl!lasis,Chok?ystitisfad Cl,olnngit.1.———--.-—-—-—----5,4,57: 4,2% 4,3= 4,3a! +92 4,86 $ a 4,61( 4,s 4,7C 4,619 Ikphritisallampflrusis-——------mc-mi 9,4X 9,3U 10,94] II,%( u> 92 U, 41 12,.w U.,94: IS.,la 13,6e4

Ineecti.sor 2idluY—-----591 E!,751 9,39: 9,acf 9,*9E 9,al 9,m 8,95 8,74, B,crs! ?,645 Ir.merplasi.of p-ost.te----- .. ..m. 2,49! 2,64; 3,13f 3,21> 3>41 3,64 4,24 4,ZE 4,lw 4,449 ‘ Colwnitel-es------—---74c-75! 17,Cal B, 1% 17,3ZC U, 15[ 19,51 20,28 20,8T 21,2’3 Z1,5Z? 21>860 certainme. of mart.as.vin ealw iPfancY----76&72,16%4617Z,7Z,‘f74r77f 43,1?: G, 84( 48>W 51,644 55,39 60,3Z 62,68! 34,2LT 65,67$ 6?,b’34 Sgmptcm andill-defined COn.3itions------nc-nl 26,Id 23,651 24,03[ 23,s6< 23,41 25,25 22,42< 19,731 19,C9’ 20,385 All other.5iSease—----—---nesiauti m.m 102,1% 68,16? 67,94> 66,35 65,35 65,454 65,14 62,57! 63,314

AceldentE-—----——-—---E@JX-ESE U6,3U 114,H m, 3S IIS,m lQe@3 la3,84 103,66 97,15! 9Z,Z4! 93,em Wtm’ vehicleac.idellts----mz,mz, 55,79 z,% 52>924 53,041 49,16 46,93 43,S3. .46,20 38,03 38,151 AllotheraccideIIt,-B3DW3397,EBZ5-133ti60,59 .50,m 60>2C 60>52: 58,89 56,91 57>NI 56,33 54,151 55,669 slad@-----———------mw=! 22,30 21,w 21,32: 21,2e1 21,5C 20,58 20>82! 20,2V 18,9Y 19,041 -*---—————--E960_E97$ 15,&1 14>691 m, 42! u, 60! 3.0,71 9,m !3,22’ 9,01 8,571 0,464 4,3X -. -— .. -- -, -- -. ~ Otk= e=th .cuse.—---E98wE39! 5,1U , . ..” . . ...-.. Table 3. 1 m. ear *, se.ect.d Ca.ls=s , united states> L!),”- by-- con. Illlb.” arm Luse, of dead ,crs of the h R&o. , :.m-~i.m kn~c.ztio. .flhmar.s, Aa%pted for UK! {. the Umt.d ~tntes, adopted m 1965. For 1968 ad 969 dcak t III- as,m R.*.,.. .“ y ..IUIIUS; 1950.67 dead K -m,,~cd m d,. mmgorj mnnbms of the Sixth ““d Swenth l+rwsv=”s, adqmi. r.qm. My, h 19 and 1955. ~ X5 arc she! Ill. last ml , of ,hm tabk]

Ce.t%ory numbers .mra511g to 1959 ls5s ).956 19s5 195.4 1353 1352 1951 ?.950 the sixth end seventh revisions

,356,3M 1,347,806 1, 3.33,3.2( 1,5.5+47( 1,528,717 1,431, Cel 1,517,541 1,496,832 1,432, m! 1,453,45 ... . 1

7,Km 7,971 7,5CI 7 ,7s% 7,892 8,510 a, 743 a,cin 7,33 54S, 571,572 2

U.+56 12,361 13,s’24 14,ffi 14,94!2 1.3,392 19,344 24,321 30,69? 33,95 COLO19 33 3,W9 3,469 3,82: 3,87( 3,834 4,855 5,273 5>713 6,274 7,56 K2C-C29 4 7,aB6 7,577 7,1m 7, 44; 7.S21 8, W? 9,145 1.1,499 10,26I 10, u? 001-13S , I@mmde, 5 of

260,047 254,426 253,13? 247, .35i 240,331 254,663 323,079 22.3,217 215,5E 210,73, 14C-2C6 6

6, !F3 5,s61 5,56+ 5,322 5,382 5,m9 5, U23 4, 89C 5,13( 14c-14E 7

89>4’30 88,1.44 00, W 07,74( a5,872 85,433 84,444 33,2% 81,807 31,121 15c-153A,157-159 e

37,413 S5,423 33,895 32, El 29,914 27,621 26,m3 24,350 22,3E 21,21 16’2-134 9

23,c95 22,375 22,72C 22,26] 21,945 20, 9m 20,5.% 19,89Z 19,179 19,9?: 170 10 33,1m 38,330 30,472 37,741 31,5m 36,941 36,241 55,319 34,491 34,7.# 173A79 II

u?, 495 12,1.32 12,1&7 ll,71f ll,5ce l?.> 133 m,915 10,679 10,I.58 10,04 130,131 12

28,663 2’7,978 28,425 e7,271 26,958 +561 25,870 25,783 24,632 22J3: J.56B,165,H?-M9 13

12,270 11,980 11,713 n, 39[ 10,916 10,443 9,919 S,ul 9,357 a, 64! 2C4 L4 lZ,411 U.,943 ll,lM3 11,444 10,6#3 10,114 9, 6s3 9,1.C6 8,439 7,93-’ 2CC-2C6,2C5 E

4,949 4,9m 5,066 4,807 5, m4 5,2!33 5,1S3 5,166 5,37, 16

20,030 27,5!3J. 27,1n0 26,E4 25>423 25,1.51 25,7s6 35,414 25,047 24,4= 26o 17 3,244 3,195 2,987 3,143 3,107 3,3CJ 3,580 3,987 4> WE 4, mz 29+293 m Z,W9 2,24’/ 2,CQ5 1,9?2 1,873 1,829 2,c69 1,9W 1,8e1 1, ax 340 19

898,336 895,489 876,793 838,843 B15,533 7a1, OM 795, e88 776>114 764>281 743,074 33C-334,40L?-469 20 643.,M 637,246 EC29,4LW 6M, CQ3 LW5,751 SG,371 1571,798 556,724 541,325 537,629 4GC-4@,4W4a 21

13,!290 13,796 20,174 20,a29 13,757 19,553 2JJI0 21,337 21,336 22, se 4LXWC2,4JWJ6 22

68,!69 ‘H,93L 72,372 12>393 73,883 75,039 2133.49 33,911 35,257 85,133 440, Ml, 442,443 23

474,143 461, s73 452,507 427>516 4S,030 319,788 373,597 S52,1.55 33%, 619 321, Om 2. 56, cs9 S+5s5 E2,61E 93, Ce8 65,622 .5E,CE!1 73>330 76,69. eo, 635 a5,15s E:,42-2 25

24,355 21,733 21,00? 20, 35s 20;905 23,313 a?> 657 23,176 23,958 43%434 26

13,798 U, 128 10,943 II,S93 12,3m 12,5L!6 ).3.256 12.S63 444447 27 U!E 190,150 MJ1,1C3 177,843 1%= 167,777 139,800 166>331 163,550 U56,751 33*334 28 34, m 34,435 3s,272 .32, w 32,42.9 so, 225 32,551 31, E35 31,8!34 30.734 450 29 18,175 17,204 E,290 14, 0G3 11,991 10, E59 9,552 8,863 8,266 7,ss7 451-4ea m

1,2C2 1,W3 l,ceo 990 1, Ilo 1>038 980 1,(J36 500 31 5:% Ll,ool 47, M3 44,51a 40,991 32,23B 46,235 43,1.39 47,120 4m?-49s 32 2,845 7,4E3 2,323 2,755 2,630 9,460 6,946 6,597 46C-43S 33 53,194 53,5ss 44,7a0 41,753 s, 3U .2,778 4%2 41,223 40>525 49!2-493 34

ls>al 14,363 14,813 u?, 500 1.1,576 U., 013 11,394 10,7.99 10,531 7,479 5@l,5ce,5z7. 1,2.U 35 2,11n 2,621 2,379 2,m1 1, 97’/ 1,832 2,C63 1,932 1,943 1,953 5@l,5c2 36

7,7Z8 6,7($I 5,757 3,639 2,995 2,594 1,914 1,714 1,2C4 527.1 37 4,984 s, m 6,377 $% 5,960 6,136 6,7s’/ 6,943 6,871 4,322 241 38

10,674 m, 801 10,323 10, C28 9,750 9,391 9,240 8,770 9,4s7 8>214 540,541 39 9,103 .9,833 8,511 6,453 8,654 8,498 0,121 a, Ml 8,327 8,894 560,591,570 40

19,242 13,338 19,317 17,924 13,763 16>2Dl 16>399 13,934 E,075 1.3,255 501 41 4,497 4,720 4,%4 5,262 5,939 5,630 5,6cQ 5,903 5,724 5,670 5!34,533 42

14,120 16, LED 17,3u7 17, em 13>214 1.3,588 21,563 23,899 25,732 28,141 59C-594 43

6,L%3 6,=9 6,?,43 5,737 4,3C0 4,62 3,6$1 3,261 3,1.29 600 44 4,533 < 3E3 6,095 6>173 6,286 6,417 610 45 ~1,71J0 2, z 2?S ’213065 20, Cal 20, @m 19,739 16,835 $R 75C-759 46 rl,s.m 63,960 66,563 64,546 63,486 63,444 G, E59 63,C86 60,989 76+776 47

3.3,0?.6 19,72a 19,124 lB, 913 M, 914 20,2m m, 633 21,950 22,647 32,S17 78!2-795 4=3

m, 484 60,072 51,571 54,586 53,900 51,642 53,23B 54J38 53,81.I. 33,3@l Re.,aunl 49

92, mO 90,60$ 95,307 94,7a0 93,443 9C,,032 95,032 963172 95,871 91,249 Eecc-E952 50 37,910 36,981 S8,7L?2 39,628 m, 426 35,586 57,255 37,794 36,996 34>163 Ee10-3835 51 54,170 53,623 56, 6C6 55, OrI 54,446 57,077 S3,378 58,875 56,436 F8LWE9C2,E34C-F.W 52 u, 633 le,w 16,632 1?% 16,76o 16,356 15,947 15,561 33,9G3 17,145 .G923-ES7’X+379 5’3 8,=9 7,835 7,641 7,.923 7,4M 7,735 7,640 e,c64 7,435 7,942 E964, H3c-K3ffi 54 . . . ------55 — Table 4. Deaths and death rates for Certain causes of mortality in early infanty, and estimated nuder of live births, by color and sex: United States, 1950-69 [wtesarcdeathsunder 1 year per 100,000 I& b%. Beginningwith1968deathsand death ratis are based on deathsassignedto category numbers 760-769.2,769.4772,774778 of the Eighth Rt-ui-ionofthe International Ck.m@tfon ofDkues, Adaptedfor Use ti the United States, adopted h 1965; for 1950-67 rates are based on deaths assigned ~ Cateww numbc~ 760-776 of tie giifi ~d .3menthR~~w adopted. resp@ive” ly in 1948 and 1955]

Deaths

Total Under 1 year Year Male Female Male Fam Both Both 5 axes All All 3 exes All All White White White White other other other >thef

1969------43,171 19,201 6,168 13,132 4,670 $3,060 19,148 6,163 13,091 4,658 I 1968------43,840 19,814 6,065 13,206 4,755 k3,707 19,761 6,047 13,160 4,739 1967------48,314 21,231 7,030 i4,472 5,581 k8,271 21,206 7,027 14,462 5,576 1966------51,644 22,637 7,589 15,462 5,956 51,608 22,624 7,585 15,445 5,954 [

1965------55,39,8 24,279 8,225 16,587 6,307 55,375 24,268 8,223 16,578 6,306 I 1964------60,322 26,470 8,852 18,148 6,852 60,298 26,459 8,851 18,140 6,848 19631------62,688 27,112 8,535 18,494 6,434 62,664 27,102 8,53L 18,486 6,433 . 196z~------”-..--64,205 28,058 8,478 19,059 6,573 64,185 28,050 8,477 19,050 6,571 1961------65,679 29,579 8,809 20,409 6,882 65,662 29,573 8,807 20,401 6,881 1960------67,094 30,211 8,892 21,065 6,926 67,074 30,201 8,890 21,059 6,924 1959------67,934 30,640 9,061 21,157 7,076 67,916 30,627 9,061 21,153 7,075 1958------: 68,960 30,928 9,114 21,686 7,232 68,939 30,915 9,114 21,679 7,231 1957------56,569 30,145 5,632 20,995 6,797 j6,552 10,141 3,630 20,984 6,797 1956------54,546 29,546 8,334 20,429 6,237 54,515 ?9,530 3,333 20,417 6,235 1955------54,043 29,558 7,845 20,516 6,124 54,016 29,546 7,843 20,505 6,122 1954------53,486 29,557 7,579 20,435 5,915 ?3,450 Z9,537 7,578 20,422 5,913 1953--:------53,444 30,024 7,3.88 20,424 5,808 53,423 30,013 7,188 20,414 5,808 1952------63,659 30,102 7,145 20,854 5,558 53,632 30,088 7,145 20,844 5,555 1951------63,096 30,266 6,917 20,711 5,202 53,044 30,245 6,912 20,689 5,198 1950------60,989 29,326 6,481 20,086 5,096 60,967 29,311 6,4S0 20,080 5,096

‘Figuresby color exclude data for New Jersey.

k4 Table 4. Deaths and death rates for Certain causes of mortality in early infancy, and es timsted number of live births, by color and ssx: United States, 1950-69-con. [Rates aredeathskder 1 yearper 100,000 k births.Beginningwith 1968 deathsand death ratesarebased on deathsassk+ne~to categorynumbers 760.769.2,769.4772,774-778 of theEi~hth Revuion of the Intematt”on.1 Chmific.ti”on of Diseases,Aakpted for Use in.the United States, adopted, Iin ‘I 9,55; f.~ 1950.67 ,IW m bad on death. assigned to category numbers 760.776 of the .%xthand SeventhRevisions,adopted, ,esp.ctive- iy, in 1948 and 1955]

Live births Rate

I Male Famale Male Both Both saxes sexes All All All All White White White White other other other other

3,600,206 1,539,420 307,152 1,454,194 299,440 1,196.0 1,243.8 2,006.5 900.2 1,555.6 3,501,564 1,497,612. 298,714 1,414,612 290,626 1,248.2 1,319.5 2,024.3 930.3 1,630.6 3,520,959 1,501,228 302,160 1,421,274 29.6,297 1,371.0 1,412.6 2,325.6 1,017.5 1,881.9 3,606,274 1,535,486 310,376 1,457, J44 302,668 1,431.1 13473.4 2,443.8 1,059.5 1,967.2 3,760,358 1,604,422 322,632 1,519,438 313,866 1,472.6 1,512.6 2,548.7 1>091.1 2,009.1 4,027,490 1,727,416 332,746 1,641,744 325,584 1,497.2 1,531.7 2,660.0 1,104.9 2,103.3 4,098,020 1,709,174 324,206 1,617,170 314,722 1,529.1 1,585.7 2,631.4 1,143.1 2>044.0 4,167,362 1,740,358 324,572 1,653,710 317,008 1,540.2 1,611.7 2,611.7 1,152.0 2,072.8 4,268,326 1,848,794 337,480 1,752,070 329,982 1,538.4 1,599.6 2,609.6 1,164.4 2,085.3 4,257,850 1,848,192 331,516 1,752,552 325,590 1,575.3 1,634.1 2,681.6 1,201.6 2,126.6 4,244,796 1,846,240 327,398 1,751,190 319,968 1,600.0 1,658.9 2,767.6 1,207.9 2,211.2 4,203,812 1,833,238 319,308 1,739,06S 312,198 1,639.9 1,686.4 2,854.3 1,246.6 2,316.2 4,254,784 1,859,148 320,812 1,762,308 312,516 1,564.2 1,621.2 2,690.0 1,190.7 2,174.9 4,163,090 1,820,740 312,848 L,724,61O 304,892 1,549.7 1,621.9 2,663.6 1,183.9 2,045.0 4,047,295 1,776,355 297,364 1,682,093 291,483 1,581.7 1,663.3 2,637.5 1,219.0 2,100.3 4,017,362 1,769,246 289,822 1,674,384 283,910 1,579.4 1,669.5 2,614.7 L,219.7 2,082.7 3,902,120 1,725,958 275,840 L, 630,814 269,508 1,625.3 1,738.9 2,605.9 1,251.8 2,155.0 3,846,986 1,707,656 263,606 L,615,002 260,722 1,654.1 1,761.9 2,710.5 L,290.6 2,130.6 3,750,850 1,663,782 259,238 L,573,290 254,540 1,680.8 1,817.8 2,666.3 L,315. O 2,042.1 3,554,149 1,575,309 248,246 L,488,318 242,276 1,715.4 1,860.7 2,610.3 1,349.2 2,103.4 Table 5. Deaths and death rates for Congenital anomalies, and estimated number of live births, by color and sex: United States, 1950.69 ~tes aredeathsunder1yearper100,000livebirths.B.egintingwkb1968deathsanddembratesam basedondeaths assigned to category numbers 740-759 of tbe Eighth Reuirion of the International C1as@catim ofDiseases, Adapted for Usein the United States, adopted in 1965; for 1950.67, rates are bwd cm deaths assigned to category numbem 750-759 of tbe Sixth and Seventh Revisions,adopted, respectively, in 1948 and 1955] . . . Deaths

Total Under 1 year Year Female Male Female Both All exes Osite bite All All )ther ,ther ?bite mher ““,,I=T=1

1969 ------17,008 7,763 1,384 6,627 L,234 11,309 5,213 963 4,309 824 1968 ------16,793 7,740 1,335 6,590 L,128 11,052 5,122 885 4,283 762 1967 ------17,328 7,959 1,387 6,783 L,199 11,632 5,345 962 4,507 818 1966------18,158 8,265 1,456 7,199 L,238 12,200 5,636 989 4,762 813 1965------19,512 8,825 1,550 7,822 L,315 13,443 6,062 .,116 5,358 907 1964------20,288 9,308 1,532 8,175 1,273 14,197 6,537 .,079 5,692 889 19631------20,817 9,344 1,490 8,008 L,302 14,581 6,603 !,067 5,570 866 19621------21,192 9,671 1,519 8,141 1,192 14,832 6,835 .,096 5,618 829 1961------21,922 10,389 1,530 8,691 L,312 15,515 7,439 .,103 6,034 939 1960------21,860 10,392 1,573 8,664 L,231 15,389 7,383 .,122 6,043 841 1959------21,780 10,428 1,468 8,632 L,252 15,579 7,497 .,072 6,097 913 1958------21,411 10,070 1,514 8,583 L,244 15,555 7,327 !,131 6,185 ’912 1957------21,818 10,347 1,464 8,794 L,213 15,801 7,588 L,063 6,267 883 1956------21,065 10,105 1,358 8,505 L,097 15,676 7,558 ,,018 6,271 829 1955------20,502 9,839 1,291 8,283 L,089 15,356 7,4Q9 983 6,131 833 1954------20,081 9,762 1,207 8,167 945 L5,116 7,433 894 6,074 715 1953------20,012 9,780 1,172 8,175 885 15,166 7,484 870 6,154 658 1952------19,768 9,667 1,108 8,152 841 15,185 7;449 854 6,260 622 1951------18,865 9,138 1,042 7,901 784 14,721 7,170 805 6,125 621 1950------18,425 9,042 984 7,579 820 14,074 6,907 741 5,807 619 II I

$?igures by color exclnde data for New Jersey.

,f)6- . Table 5. Deaths and death rates for Congenital anomalies, and estimsted number of live births, by color and SSX: United States, 1950-69,—.Con.

[Rateswe deathsunder1 yew per100,000livebirths.Begi.ningwhh 1968 deathsand deathratesarebasedon deathsassignedtocategorynumbers 740.759oftheEighth Revision of the Intimation.1 Clmif7.at!on of Diseases,Adapted for Use in the Unzted.St.tes, adoptedk 1965;for1950.67, ratesarebmsedon &aths assignedtocategorynumbers 750-759of theSixthand SeventhRevisions,adopted,respectively, in 1948 and 1955]

Live births Rate

Male Female Msle Femsle Both Both sexes sexes White All White All White All White All other other other )ther

3,600,206 1,539,420 307,152 1,454,194 299,440 314.1 338.6 313.5 296.3 275.2 3,501,564 1,497,612 298,714 1,414,612 290,626 315.6 342.0 296.3 302.8 262.2 3,520,959 1,501,228 302,160 1,421,274 296,297 330.4 356.0 318.4 317.1 276.1 3,606,274 1,535,486 310,376 1,457,744 302,668 338.3 367.0 318.6 326.7 268.6 3,760,358 1,604,422 322,632 1,519,438 313,866 357.5 377,8 345.9 352.6 289.0 4,027,490 1,727,416 332,746 1,641,744 325,584 352.5 378.4 324.3 346.7 273.0 4,098,020 1,709,174 324,206 1,617,170 314,722 355.8 386.3 329.1 344.4 275.2 4,167,362 1,740,358 32.4,572 1,653,710 317,008 355.9 392.7 337.7 339.7 261.5 4,268,326 1,848,7!?4 337,480 1,752,070 329,982 363.5 402.4 326.8 344.4 284.6 4,257,850 1,848,192 331,516 1,752,552 325,590 361.4 399.5 338.4 344.8 258.3 4,2.44,796 1,846,240 327,398 1>751,190 319,968 367.0 406.1 327.4 348.2 285.3 4,203,812 1,833,238 319,308 1,739,068 312,198 370.0 399.7 354.2 355.7 292.1 4,254,784 1,859,148 320,812 1,762,308 312,516 371.4 408.1 331.3 355,6 282.5 4,163,090 1,820,740 312,848 1,724,610 304,892 376.5 415.1 325.4 363.6 271.9 4,047,295 1,776,355 297,364 1,682,093 291,483 379.4 417.1 330.6 364.5 285.8 4,017,362 1,769,246 2893822 1,674,384 283,910 376.3 420.1 308.5 362.8 251.8 3,902,120 1,725,95S 275,840 1,630,814 269,508 388.7 433.6 315.4 377.4 244.1 3,846,986 L,707,656 263,606 1,615,002 260,722 394.7 436.2 324.0 387.6 238.6 3,750,850 L,663,782 259,238 1,573,290 254,540 392.5 430.9 310.5 389,3 244.0 3,554,149 L,575,309 248,246 1,488,318 242,276 396.0 438.5 298.5 390,2 255.5

67. APPENDIX I

TECHNICAL NOTES

Death Statistics 1. Other diseaaes of circulatory system (ICDNOS. 451-468) , Tabulations of deaths used is this report are based on information obtained from microfilm copies of the 2. Other bronchopnlmonfc dfseases (ICD Nos. origiual certificates. These copies were received tlom 525-527), and the registration offices of all Stares, certain cities, and tbe District of Columbia. The statistical informa- 3. Other hypertensive diseases (ICD Nos. 444- tion on these records was edited, classified, trans- 447). ferred to a tape for computer processing, and tsbu- latsd in the National Center for Health Statistics The most nearly comparable titles in the Eighth Ke- (NCHS). vision Iist of 69 causes for these three causes wsre, The rates showu in this report are basedon deaths respectively, as follows tabulated by place of occurrence, that is, all deaths occurring in the death-registration States from 1900 1. Other diseasee of arteries, arterioles, and to 1932 and all deaths occurring is the contirmmal capillaries (ICDA Nos. 441-448), United States thereafter, wftb Alaaka added beginning 1959 and Hawaii, 1960. Deatba among ‘armed forces 2. Bronchitis, emphysema, and aathma (ICDA Nos. overseas and among U.S. nationals living abroad are 490-493), and excluded for atl yeara. 3. Hypertension (ICDA Nos. 400,401, 403). Ranking Causes of Death

The ranking of diseases and accidents among tbe Consequently, as indicated above, the first of these leading causes of death is based en the number of meet nearly comparable titles was dropped because deaths sssigned to causes iscluded in specffied fiats the comparable Eighth Revisian tftte also began with of causes of death (for example, us the List of 60 “other.” But inaemucb ae the remaising two compa- Selected Causes of Death for the years 1949-67 ssd on rable Eighth Revision titles no longer bagin with the the List of- 69 Selected Causes ox Death for 1968 and word “other,” they are included in the list of 15 Iead- 1969). Two group titf.es, “Major cardiovascular-resal ing cauaee. diseases” and “Symptome and ill-deflmed ceuditiuns,” are not ranked. bI addftion, beginning with data year Race 1968, category titles that begin with the worde “Otherr’ or “All other” are not ranked. The category “white” includes in addition to per- The only cause dropped as a reeult of this pro- sons reported as “white,” persone reported to be cedure that othsrwise would have appeared as one of Mexican or Puerto Rican. The categories “races other the 15 leading caueee was the Eighth Revfeion cauae, than white” or “all bther” consist of persona reported Other dieeaaes of arteries, arterioles, and capillaries as Negro, American Isdias, Chinese, and Japaneee; (lCDA Nos. 441-448). Its level of morteli~ in 1968 othsr numerically small racial groups; and per~ons (12.4 deatbe per 100,000) would have placed it as the of mixed white and other races. llth leadisg cause of death for that ysar. The droppisg of this cause resultad, of course, in the moving up Population Bases into the next places tbe succeeding six causes that had fewer deaths attributed to them tbas did the dropped Rstes were computed on the bases of population cause. ststistice made available ky the U.S. Bureau of the For 1967 there were, is all, three causes h“ the C&eus. Rates for demnufal years are based on the Sevsnth Revision list of 15 leading causes whose titles populations enumerated in cessuees of those years, began with tbe word “other,” as follows: which are taken as of April 1. Rates for alt other years

W/.. are based on midyear (July 1) estimates. Sources of No~416. “Estimates .of the Population of the United the populations used, publfshed by the Bureau of the States, by Age, Color, and Sex: July 1, Census, are given below. 1968,”1969. No. 441. ,,Estimates of the Pomdation of the United VW1 SfMstics Rates in the United Stafes, 1900- States, by Age, Col&, and Sex July 1, 1940, Wssbfngtnn, U.S. Government Printfng Office, 1969,”1970. 1943. CuWent Population Repovts, Series P-25 The population estimates by color used for 1962 No. 98. ,,Estimates of thepopulation of the United and 1963 exclude New Jersey. The birtb, death, and States and of the Components of Change, fetal death records of the State of New Jersey did not by Age, Color, end Sex: 1940 to 1950,” contais the race item in the beginning of 1962. The 1954. certificate revision without this item was used for most No. 265. ilEetfmates of the Population of the United of 1962 as well as for 1963. Therefore the National Statee, by Age, Color, and Sex July 1, Center for Health Statistics estimated a population 1950 to 1962 ,“ 1963. (Used only for data base by color for these years which excluded New years 1961 and 1962.) Jersey. The estimates for 1963 are shown fn table 6-5, No. 276. ,,Estfmstee of the Population Ofthe Utlfted Part A, Volume 11, of Viffd SWf.sties ofthe United States, by Age, Color, snd Sex July 1, Stales, 1963. Thoee for 1962 are ehown in the compa- 1963,”1963. rable report for that yesr. No. 310. ,,Estimates of the population of the United States and Components of Change, by Age-Adiusted Rates Age, Color, end Sex 1950 to 1960,”1965. No. 321. ,,Es~mates of the Popsladon of the United The sge-adjusted rates presented in this report Statea, by Age, Color, and Sex July 1, were computed by the direct method, that is, by apply- 1960 to 1965,” 1965. (Used only for data ing the age-specific death rates for a given cause of yeSrS 1964 and 1965.) death to the standard population distributed by age. The No. 352. “Estimates of the Population of the United total population as enumerated in 1940 was selected as States, by Age, Color, and Sex July 1, the standard. The rates for the total population and for 1966,”1966. each color- sex group were adjusted separately, using No. 385. “Estimates of the Population of th~ United the same stsndsrd population. Statee, by Age, Color, and Sex July 1, Age-adjueted rates are shown with an aeterisk 1964 to 1967,” 1968. (Used only for data where more than half of the age-specific death rates year 1967.) are based on fewer than 20 deaths.

. APPENDIX II

THE UNITED STATES STANDARD CERTIFICATE OF DEATH, AS REVISED 1968

Standard Certificates certificates of most States, however, conform closely in content and arrangement to the standard certificates. Standard certiflcatea of death iaaued by the Na- The most recent revision of the standard certifi- tional Center for Health Statfatics and its predecessor cate of death is sfIown below. It was made in close offices have served for mauy years as the principal collaboration with State health officers and regiatrara; means of attaining uniformity in the content of the doc- federal agenciea concerned with vital atatiatica; na- uments used to collect information on these events. tional, State, and county medical societies; and others They have been modified in each State to the extent worKmg in the fields of public health, social welfare, necessitated by the particular needs of the State or by demography, and insurance. It waa recommended to the special proviaiona of the State vital statistics law. The Statea for adoption as of January 1, 1968.

#m.0.l. “ . Go”E,H”mT ,1,.,, ”..,,,,, ,“, .,-m,.,, row (..”9.!..) .“-” .“..A” “o .,-.,.0, “.s srANDAR. r 1 r 1 ,“,,, ORP,!., IN ma . . “w,,. CERTIFICATE OF DEATH ,,.. FM W,,. ‘[mMANENr INK LKCEASm-- ,,., Mw. l-m .m DAm 0, OEATH i...... r-., !5 HINOIOOK Fo! Inmnm ,

.. I . m. . . w. ,,.,, .,, % JMlutm ADmss-,m,,w ..,,:, F D . . J I ~ 0.0, m S,.. g . ? .Am ,-!.. 0“,, “M, ,“.,,. “+WE mm MnRFsl , ,,,,!, . . E ‘,. . . . am .! m.., ‘,.,,, .,! :

, m+lna-slmu.,, DA. ,.””En ,“ Ucu WG”,u..

z] APPENDIX Ill

COMPONENTs OF COMPARABILITY RATlOS FOR 15 LEADING CAUSES OF DEATH AND THEIR MAJOR SUBCATEGORIES FOR COMPARING ASSIGNMENTS I BY EIGHTH REVISION WITH THOSE BY SEVENTH REVISION, BASED ON 1 DEATHS OCCURRING IN 1966

Data shown in the foZlowing table are from a study This particular set of category numbers according of tie comparability between the Seventh and Eightb Re- to the Sixth and Seventh Revisions was used in the con- visions of the Zntemationsl Classification of Diseases. struction of these comparability rati~s because trend Provisional estimates of selected comparability ratios data for 1950-67 were available for the titles corre- and a brief summary of the statistical design of the spondittg to these category numbers. It turns out that, compsrabiliry study have heen published in MonfhZy with few exceptions (which are f?o;nqted in the table WoZ .Wfiafics Ra@-f, Vol. 17, No. 8, Supplement, Oc- below), this set of category numbersjfor the Sixth and tokr 25, 1968. Seventh Revisions is the same as the set used to com- The set of comparability ratios sbowq here was pare for these same Eighth Revision tit~es for the above- computed to assess the degree of discontinuity between mentioned pubfished provisions comparability ratios. 1967 and 1968 for the 15 leading causes of death and It wiZZ be observed that even for those Eighth Re- their subcategories aa shown in detailed tables 2 and 3. vision titles for which the set of Sixth,and Seventh Re- For each of these 15 causes and their subcategories, a vision categories used for the present report are iden- comparablZity ratio was especisZZy computed for this tical with tbe aet used for the pubf%bed provisional present report by dividing the estimated number of rat:oa, the provisional ratios are sometimes slightly deaths ia 1966 assigned to the Eighth Revision category lower than the ratios ahown in this tieport. This dif- numbers corresponding to the title shown in the stubs ference results from a better computational procedure of tahZea 2 and 3 by the numkr of deaths in 1966 as- used to compute the ratios for tb:i present report. signed to the nearly comparable category numbers of tie Sixth and Seventh Revisions shown in the last column of tables 2 sud 3. -$

.. > -----

k% \

Category numbers Yovi - List title according to the Eighth Revision Category numbers accord- ,ional of the International Classification of ing to the Eighth according to the .ompar- Diseases, Adapted, 1965 Revision Seventh Revision, !bility adopted in 1955 ratio

1. Diseases of heart------390-398,402,404,410429 400-402,410-443 1.0045 Active rheumatic fever and chronic rheumatic heart disease------390-398 “ 400-402,410-416 11.1519 Hypertensive heart disease with or withoui?crenaldisease----:------402,404 440-443 0.3941 Ischemic heart disease------410-413 420 11.1457 Chronic disease of endocardium and other myocardial insufficiency------424,428 421,422 10,1823 All other forms of heart disease------420-423,425-427,429 430-434 0,8104 11. Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues--- 140-209 140-205 11.0017 Malignant neoplasms of buccal cavity and pharynx------140-149 140-148 “1.0596 Malignant neoplasms of digestive organs and peritoneum------150-159 150-156A, 157-159 10.9660 ,. Malignant neoplasms of respiratory system------160-163 160-164 1.0316 Malignant neoplasm of breast------174 170 0.9913 Mali~a#%&plasnw of genital organs----- 180-187 171-179 1.0034 Malignan: neoplasms of urinary organs----- 188,189 180,7.81 1.0171 lkalignan~‘ieopIasmsof all other and unspeci’kiedsites------170-173,190-199 156B,165,190-199 11.0212 Leukemia------204-207 204 0.9974 Other neoplasms of lymphatic and hematopoietic tissues------200-203,208,209 200-203,205 11.0506 III. Cerebro;asculardiseases------“430-438 330-334 0.9905

IV. Accidents------E800-E949 E800-E962 0.9570 Motor vehicle accidents------E81O-E823 E81O-E835 0.9921 All othe!raccidents------E800-E807,E825-E949 E800-ES02,E840-E962 0.9250 v. Influenza and pneumonia------$70-474,480-486 480-493 1.0440 Influenza------470-474 480-483 0.9572 Pneumonia------480-486 490-493 : 11.0480 VI. Certain causes of mortality in early infancy------;;;60;;;.2,769.4-772, 760-776 10.9183

VII. Diabetes mellitus------250 260 0.9971 ‘VIII.Arteriosclerosis------440 450 0.S963 IX. Bronchitis, emphysama, and asthma------490-493 241,501,502,527.1 1.0034 Chronic and unqualified bronchitis------490,491 501,502 1.0620 Emphysema------492 527.1 1.0542 Asthma------493 241 0.6954 x. Cirrhosis of liver------571 581 1.0055 XI. Suicide------E950-E959 E963,E970-E979 0.9472 XII. Congenital anomalies------740-759 750-759 1.0204 XIII.Homicide------E960-E978 E964,E980-E985 0.9969 XIV. Nevbr%tis and nevhrosis------580-584 590-594 0.8860 xv. Peptic ulcer------531-533 540,541 0.9856

*For reasons described in the foreword to this table, the set of Seventh Revision category numbers uaed to consmuc.t this ratio is different from the set used to construet the published provisional comparability ratio for this same Eighth Revision title.

73 APPENDIX IV

TECHNICAL NOTE ON ASSIGNMENTS TO ACCIDENTS WITH CATEGORY NUMBERS E916-E921, E923-E928

The World Heskb Organization (WHO) in its List Both for accideqts assigned to E916-E921 and E923- A (List of 150 Causes @v Tabukztion of Morbidity and E928 and for-a number of other nontransport accidente, MortaMy) introduced with the Eighth Revision of the fourth-digit subdivisions have been provided by the International CWssification of Diseases, 1965, included Eighth Revision. fn addition, beginning with data year as the 145tb title, AE145 Accidents mainly of industrial 1969, the United States has made special tabukitions type, E916-E921, E923-E928. showing “place of accident” by fntrcifuction of fifth There are no figures available to substantiate that digits ueing the epecial fourth-digit codes introduced the deaths assigned to the category numbers under this with the Seventh Revision. For example, the cross-tab- title are actually “mainly of industrial type.” To avoid ulation of Accident caused by electric current (lCDA possibly misleading the reader, therefore, although No. E925) by fourth and fifth subdivisions is as follows 1968 and 1969 figures (bmh deaths and death rates) are for data year 1969: shown for these catego~ numbers (E916-E921, E923- E928), the WHO group title “Accidents mainly of industrial type” is “not shown.

Place of accfdent (with fifth digits) — [:fi - P~=e -C&et -,re: ; Wher -lace All Mine Ublic Ca.s. of death (with fourth digits) lace ecre- yi:j- not eaths me a.rnl md and tf.” igh- uild- Uarry i“g mti - l~c - rem- *“d Way “t ion lIace* ises part

0) - 1) :.2) (.3> (.4) (.5) (.6) (.7) (.8) (,9)

E925 Accident caused by electric current---- 1,148 18 71 6 146 13 134 49 3 137 271 Include,: burn by elec- exposed wize tic current faulty appli- ante -” electric shock from bigh- voltege cable .Iactrocution live rail 00F=osocket Excludes: bum by heat from elecuical a##nce fs924), lightning . . E925.O Hame wiring .. appliances ------222 22 E925.1 Imdustrial wiring.. appliances- L52 6 146 E925.8 653 96 71 13 134 “ 49 3 137 150 rnclndes: wiring and appliances illor on, farm (not farmhouse) outdoor, public btildi.gs .esidemt instit=tims sChc.ols E925.9 Specified ------121 121 Includes: bum b. electric c.r- rent Nbs electric shock N02 electmctlti.mIKE — — A word might be said about 96 of the 318 accidental facilities such as “private garden to home,” “home deaths caused by electric current that are shown above swimming pool,” etc. These same terms are, however, as occurring at home, but are not class ified as Home inclusion ‘terms under the fifth subdivision “home.” wiring and appliances (ICDA Nos. E92.5.0). This results Tfie specisl tabulation made by the United States from the fact that the inclusion term “outdoors” under by fifth-digit subdivisions shows the following distri- Accidem caused by electric current—other (lCDA No. bution of deaths in 1969 assigned m tbe so-called “Ac- E925.8) is interpreted as covering home premises snd cidents mainly of industrial type,” by place of accident:

J Plsce of accident I I I Indus- All Mine trial Other Place deaths Home Farm and pl&Je specified not quarry places specified pramises (.0) (.1) (.2) (.3) (.8) (.9)

6,09! 180 1,252 718 781 I*

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-- 7

njyersity of Wisconsfn VITAL AND HEALTH STATISTICS PUBLICATION SERI + Ibra[y, Center for Demography Originally Pablic HecdthSeruic el%blicationNo. 1000 3z16%C-~CienceB1dg” Madison, w! 53706

Se7iesl, Prag7ums andcollection p70csdwes. —Reports which describe the general progrsms of the National Center for Health Ststietica and its offfces anddivfsions, data collection methods used, definitions, end other material neceaeary for understanding the date.

Sw”es 2. Data evaluation amf methods reseuvch.-Stndies of new ststfeticsl methodolo~ includiu~ expert- mentsl tests of new survey methods, studfes of vital statistics collection methods, new snslyttcsl tecfndques, objective valuations of reliabilby of collected data, contributions to statistical theory.

Sm”es 3. Analytical etudies.-Reporte presenting analytical or interpretive studies baeedon vftd and health etstietics, carrying the analysis timber than the expository types of reports @ the other series.

‘SWies 4. Doswnants and committee r.@m+e .—Finsl reports of major committees concerned with vital end health statistics, and docmne&s aucb as recommended m;del vital registration lawe and revfeed birth end death certificates.

Sm”es 10. Data from the Health Intem”sw Swvev.-Ststiatics on illness, accidental injuries, diasbilily, use of hospftsl, medical, dental, end other services, and other health-related topics, based on date collected in a continuing national household intervtew survey.

Sen”es 11. Data from the Hcnlth Examination Swvey. —Dats from direct examination, testing, and measure- ment of national asmples of the civilian, noninstitutional population provide me basis for two types of reports: (1) esttmat.es_of_thr. medicell?deffned m==zek=--=f ==ecitlc diseases in the Unfted States and the di’ hysiological, end psycho- ,$ logical characte? .. ‘,,., hs measurements without reference to an ( ..’”’ ; S+”es 12. Data from the I?L.JJZ ....”-- -. .,,,~‘-“othe health characteristics of per eons in idtitntions, ~ .< -. ..?’cdre rf+eived, based on national eamples of esfahlisbrnente provki: . of -- residents or patients. . . .._

Sin-es 13. Data from the Hospifal,pkchaw -. :.>!.. ,[. .,<. zed patients in ehort-stsy hospitals, based on a $~ple o ..zcords.Ln .+,. -T- , : jitsls.

Series 14. Data on health resources: ir and facilities. -Sui< ’..,:. . hems, geographic dWri- bution, end cheracteristice ~, ;i reeources including p‘i; Ci,-JT w, nurses, other heslrb occupations, hospitals, nurr” ,.mes, end outpatient facilid-~. ).’ ‘;r “ ‘ Series 20. Data on [email protected] xatistics on mortality otb+ thsrii; ‘- Suded in regular annual or monthly reporte-epecisl . lyees hy cause of cdeatb, @, ~d o ‘ .“ demographic vsrtsbles, also geographic and time .serieJ. ~alyses. \ j 1!.. Swies 21. Data on natility, m ~~%-“ ad dimce. —Varioue statietks on .’ marrisge, end divorce o&r then aa inclL ?d{m regular annual or mon~~~eparts=1’1 ..”. 1analyses by demographic variables, also geogi Jhfc sad time series analyses, studiee Of fytil.? . Je> ~, .J 1 ‘>’-- Series .22?.D@ Jrom the Nat W Natality and Mortality 3wveys.~ St&istics on characteristics of hfrths end deaths not avar’ ‘de from the vital records, based on s;mple surveys stemmfng from these records, includiug . % topi?sjas mortality by socioeconomic class, hospital experience in the last year of lifejm~~ S1care during pregnancy, heslth.,insursnce coverage, etc. /., , ,.*. ----- ~ For a Iiet of titles of re$~~p$blished inke~

-“’;/-/ ‘ “L, Nationat Center fbr Health Statistics ~..., ,2 ~~l?u~lic FLs.th Service, HRA Rockville, Md. 20852