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1993.08.31 :  Report on Final Mortality Statistics for 1991

Contact:  NCHS Press Office Jeff Lancashire (301) 436-7551 or
          Sandra Smith (301) 436-7135
August 31, 1993

     A sharp decline in the number of deaths from motor vehicle
crashes is the primary reason why "accidents" or injuries dropped
from fourth to fifth among leading causes of death for all
Americans in 1991, according to a new report issued today by
Health and Human Services Secretary Donna E. Shalala.
     The report on final mortality statistics for 1991, prepared
by the National Center for Health Statistics, reveals that death
rates from unintentional injuries fell in almost all age, sex and
race categories.  Overall, age-adjusted death rates from
unintentional injuries fell by 5 percent from 32.5 deaths per
100,000 population in 1990 to 31 deaths per 100,000 in 1991,
continuing a steady downward trend which has occurred since 1968. 
     Deaths from motor vehicle crashes dropped 8 percent over the
past year.
     "We are certainly not a 'risk-free' society by any means,
but our nation's success in reducing unintentional injury deaths
proves what can happen with sound prevention strategies," said
Secretary Shalala.  "The use of safety belts and other safety
devices has been on the rise, and we're now seeing how effective
injury control programs and highway design can be in preventing
premature injury and death."
     While unintentional injury mortality dropped significantly,
death rates for chronic obstructive pulmonary diseases and allied
conditions (such as emphysema and asthma) increased, and this
category overtook injuries as the fourth leading killer of all
Americans.  The age-adjusted death rate for chronic obstructive
pulmonary diseases and allied conditions has been rising steadily
since 1950, while the rate for other leading killers such as
heart disease and stroke has been on the decline.  
     "This increased mortality from chronic obstructive pulmonary
diseases is disturbing, particularly since many of these diseases
are linked to smoking," said Assistant Secretary for Health 
Philip R. Lee, M.D., head of the Public Health Service.  "While
we've made a lot of progress in our anti-smoking efforts, the
conditions which are often associated with smoking continue to
take an enormous toll on society."   
     Meanwhile, death rates for HIV and homicide continue to
rise.  HIV is now the ninth leading cause of death for all
Americans, and homicide is 10th.  
     -- The age-adjusted death rate for HIV increased 15 percent
in 1991, while the rate for homicide increased by 7 percent.  
     -- The homicide rate increased 15 percent in 1991 among the
black population aged 15-24, and remains the leading killer for
both black males and black females in that age group.  Among
white persons aged 15-24, homicide is the second leading cause of
death among females and third among males.
     -- HIV is now the leading killer for black men aged 25-44,
and ranks third among black women in that age group.  For the
white population aged 25-44, HIV is the second leading cause of
death among men and sixth among women. 
     Despite increased mortality from HIV and homicide, life
expectancy for black males as a whole increased slightly between
1990 and 
1991.  This increase can be explained in part by
declining death rates for cancer.  
     Life expectancy for black males is 64.6 years, and 73.8
years for black females.  For white females, life expectancy is
79.6 years and for white males it is 72 years.  Overall, life
expectancy is 72 years for males, 78.9 years for females.
     The infant mortality rate in 1991 reached a new low of 8.9
infant deaths per 1,000 live births, with the rate for black
infants about two-and-a-half times the rate for white infants. 
Congenital anomalies, sudden infant death syndrome, disorders
relating to short gestation and unspecified low birthweight, and
respiratory distress syndrome accounted for just over half (54
percent) of all infant deaths.
     The data shown in this report are based on information
collected from all death certificates filed in the 50 states and
the District of Columbia.
     The National Center for Health Statistics, which prepared
the report, is a part of the Centers for Disease Control and
Prevention within the U.S. Public Health Service in HHS.