by Melonie P. Heron, Ph.D.,
and Betty L. Smith, B.S., Ed., Division of Vital Statistics
This report from the
Centers for Disease Control and Prevention’s (CDC) National Center for
Health Statistics (NCHS) presents findings from the final 2003 data on
the 10 leading causes of death in the United States. It summarizes a
more detailed forthcoming report (1).
Key findings, illustrated in Tables 1–4, and Figure 1 show:
The 2003 mortality experience
In
2003, the 10 leading causes of death were (Table
1):
Diseases of heart (heart disease)
Malignant neoplasms (cancer)
Cerebrovascular diseases (stroke)
Chronic lower respiratory diseases (CLRD)
Accidents (unintentional injuries)
Diabetes mellitus (diabetes)
Influenza and pneumonia
Alzheimer’s disease
Nephritis, nephritic syndrome and nephrosis (kidney disease)
Septicemia
These
leading causes accounted for about 78 percent of all U.S. deaths in
2003.
The
top two causes, heart disease and cancer, accounted for roughly
one-half
(50.7 percent) of all deaths in 2003.
Despite
some changes in the number of deaths due to specific causes, the actual
ranking of the 10 leading causes remained unchanged from 2002 to 2003.
Leading
causes of death varied substantially by age (1).
Unintentional
injuries, cancer, Assault (homicide), heart disease and Congenital
malformations, deformations and chromosomal abnormalities were the major
causes of death in the population aged 1–14 years.
Unintentional
injuries, cancer, homicide, Intentional self-harm (suicide), and heart
disease were the top five killers of the population in the 15–34
year age
group.
Human
immunodeficiency virus (HIV disease) was among the 10 leading causes of
death for the population aged 20–54 years.
Unintentional
injuries, suicide, and homicide had lower rankings among the age 45 and
over population than among the under age 45 population; chronic diseases
such as heart disease, cancer, stroke, CLRD, and diabetes were more
prominent leading causes in older age groups. Alzheimer’s disease was
the fifth leading cause of death in the population aged 65
years and over.
Heart
disease and cancer were the first and second leading causes of death,
respectively, of both men and women (Table
2). Both populations also had in common the sixth and ninth
leading causes, which were diabetes and Nephritis, nephrotic syndrome
and nephrosis (kidney disease). However, men and women diverged on the
ranking of other leading causes. For example, unintentional injuries
were the third leading cause of death for men but the seventh for women.
Alzheimer’s disease ranked 10th for males but
5th for females.
Leading
causes varied by major race group (Table
3).
The
four major race groups, White,
Black or African American, American Indian or Alaska Native (AIAN),
and Asian or Pacific Islander (API), shared 7 of the 10 leading causes
of death. The ranking of these causes was not necessarily the same
across populations. For example, heart disease and cancer were the first
and second leading causes of death for the white, black, and AIAN populations. However, for the API population, cancer was the top
killer, followed by heart disease. These top two causes accounted for
51.2 percent of all deaths in the white population, 48.1 percent in the
black population, 37.0 percent in the AIAN population, and 51.5 percent
in the API population.
For
three race groups, at least one of the 10 leading causes was unique to
each group. For the AIAN population, Chronic liver disease and cirrhosis
ranked fifth, but was not ranked in the top 10 for the other 3 race
groups. Homicide ranked sixth and HIV disease ninth for the black
population, whereas Alzheimer’s disease ranked sixth for the white
population; these causes were not ranked among the top 10 for the other
race groups.
Leading
causes varied by Hispanic origin (Table
4).
Heart
disease and cancer were the first and second leading causes of death for
Hispanics as well as the total non-Hispanic, non-Hispanic white, and
non-Hispanic black populations. In general, these 4 race-ethnic
groups had 6 of the 10 leading causes in common.
However,
the groups also had interesting differences. For example, in the 3
non-Hispanic groups, Chronic liver disease and cirrhosis was not a top
10 killer; however, this cause ranked sixth among Hispanics.
Unintentional injuries accounted for roughly 9 percent (ranked third) of
all Hispanic deaths compared with roughly 4 percent (ranked fifth) in the
total non-Hispanic, non-Hispanic white, and non-Hispanic black
populations. The higher ranking of deaths due to unintentional injuries
in the Hispanic population partly reflects the comparatively younger age
distribution of this population.
The
top five leading causes of infant death in 2003 were, in order of rank,
Congenital malformations, deformations and chromosomal abnormalities,
which accounted for one-fifth of all infant deaths; Disorders related to
short gestation and low birth weight, not elsewhere classified; Sudden
infant death syndrome (SIDS); Newborn affected by maternal complications
of pregnancy; and Newborn affected by complications of placenta, cord
and membranes. From 2002 to 2003, the ranking of the 10 leading causes
of infant death did not change (1).
Trends
The
top five causes, heart disease, cancer, stroke, CLRD, and unintentional
injuries, accounted for about 67 percent of all deaths in 2003, down
from 76 percent in 1980 (Figure 1).
Much of this progress can be attributed to declines in the mortality
burden of heart disease relative to other causes.
The
proportion of deaths due to heart disease, stroke, and unintentional
injuries has trended downward, whereas that of cancer and CLRD has trended
upward between 1980 and 2003.
Technical Notes
Cause-of-death ranking
Cause-of-death ranking is a useful tool for illustrating the relative
burden of cause-specific mortality. However, it should be used with a
clear understanding of what the rankings mean. Literally, the rankings
denote the most frequently occurring causes of death among those causes
eligible to be ranked. The rankings do not necessarily denote the causes
of death of greatest public health importance.
Nature and sources of data
Data in this report are based on information from all death certificates
filed in the 50 states and the District of Columbia in 2003. The U.S.
Standard Certificate of Death—which is used as a model by the states—was
revised for 2003 (2,3).
Prior to this, it had last been revised for 1989 (4,5).
This report includes data for five areas (California, Idaho, Montana,
New York City, and New York State) that implemented the 2003 revision in
2003, as well as for the remaining 46 states and the District of
Columbia that continued to use the 1989 revision in 2003. Most of the
items presented in this report are largely comparable despite changes to
item wording and format in 2003; hence, data from both groups of
reporting areas are combined unless otherwise stated.
Information from death certificates is coded by the states and provided
to the National Center for Health Statistics (NCHS) through the Vital
Statistics Cooperative Program and from copies of the original
certificates received by NCHS from the state registration offices. In
2003, all the states and the District of Columbia participated in this
program and submitted part or all of the mortality data for 2003 in
electronic data files to NCHS.
Race, multiple race, and Hispanic origin
Race and Hispanic origin are reported separately on the death
certificate. Therefore, data shown by race include persons of Hispanic
or non-Hispanic origin, and data for Hispanic origin include persons of
any race. In this report, unless otherwise specified, deaths of Hispanic
origin are included in the totals for each race group—White,
Black or African American,
American Indian or Alaska Native (AIAN), and Asian or Pacific Islander
(API)—according to the decedent’s race as reported on the death
certificate. Data shown for Hispanic persons include all persons of
Hispanic origin of any race.
The 2003 revision of the U.S. Standard Certificate of Death allows the
reporting of more than one race (multiple races) (3).
This change was implemented to reflect the increasing diversity of the
U.S. population and is consistent with the decennial census. The race
and ethnicity items on the revised certificate are compliant with the
new standards issued by the Office of Management and Budget (OMB) in
1997, which mandate the collection of more than one race for federal
data (6). In addition, the new
certificate is compliant with the OMB-mandated minimum of five races to
be reported for federal data. Multiple race includes any combination of
white, black or African American, AIAN, and API. If two or more specific
subgroups such as Korean and Chinese are reported, these count as a
single race of Asian rather than as multiple races.
In 2003, multiple race was reported on the revised death certificates of
California, Idaho, Montana, and New York, as well as on the unrevised
certificates of Hawaii, Maine, and Wisconsin. More than one race was
reported for 0.6 percent of the records in the seven states for which
multiple race reporting has been implemented. Data from the remaining 43
states and the District of Columbia are based on the 1989 revision of
the U.S. Standard Certificate of Death, which follows the older 1977 OMB
standard of allowing only a single race to be reported (4,7).
In addition, these states report a minimum of four races as stipulated
by said standard: white, black or African American, AIAN, and API.
In order to provide uniformity and comparability of the data during the
transition to the new multiple-race format, it was necessary to “bridge”
the responses of those who reported multiple races to one, single race
in a procedure similar to that used to bridge multiracial population
estimates (8,9).
Multiracial decedents are imputed to a single race (either white, black, AIAN, or API) according to their combination of races, Hispanic origin,
sex, and age indicated on the death certificate. The imputation
procedure is described in detail on the NCHS website.
4. Tolson GC, Barnes JM, Gay GA, Kowaleski JL. The
1989 revision of the U.S. standard certificates and reports. National
Center for Health Statistics. Vital Health Stat 4(28). 1991.
5. National Center for Health Statistics. Technical
appendix. Vital Statistics of the United States, 1989, vol II,
mortality, part A. Washington: Public Health Service. 1993.
6. Office of Management and Budget. Revisions to the
standards for the classification of federal data on race and ethnicity.
Federal Register 62FR58782-58790. October 30, 1997. Available from:
http://www.whitehouse.gov/omb/
fedreg/ombdir15.html
7. Office of Management and Budget. Race and ethnic
standards for federal statistics and administrative reporting.
Statistical Policy Directive 15. 1977.
8. Ingram DD, Parker JD, Schenker N, Weed JA, et al.
U.S. census 2000 population with bridged race categories.
National Center for Health Statistics. Vital Health
Stat 2(135). 2003.
9. Schenker N, Parker JD. From single-race reporting
to multiple-race reporting: Using imputation methods to bridge the
transition. Stat Med. 22:1571-87. 2003.
In
2003, the 10 leading causes of death were (
Unintentional
injuries, cancer, Assault (homicide), heart disease and Congenital
malformations, deformations and chromosomal abnormalities were the major
causes of death in the population aged 1–14 years.
