Atlas Reveals New Mortality Patterns for the United States

The first atlas to map the leading causes of death by race and sex for small geographic areas throughout the United States has identified high risk areas for heart disease, cancer, stroke and violence deaths in America, the Department of Health and Human Services (HHS) announced today. "Atlas of United States Mortality," developed by the Centers for Disease Control and Prevention's National Center for Health Statistics, reveals shifts from previously documented mortality patterns and points to new areas now at greater risk.

"The mortality atlas is truly a road map to better understanding the differential patterns of mortality in this country," said HHS Secretary Donna E. Shalala. "For the first time we have a compendium of maps for all leading causes of death which pinpoint problem areas so that national, state and local efforts can be coordinated and targeted.

The atlas maps death rates for 1988­92 for 805 Health Service Areas (HSA), which are clusters of counties defined on the basis of where county residents obtain hospital care. This approach provides much more local detail than maps of states and allows a more reliable analysis than could be performed at the county level, especially in sparsely populated areas.

Key findings show important geographic patterns or shifts in the three top causes of death -- heart disease, cancer and stroke.

Death rates for heart disease, the nation's leading cause of death, are higher in the southeastern United States than in the northeastern states -- previously the region with the highest rates. While heart disease death rates have dropped in all areas for more than 30 years, rates in northeastern states have declined faster than in the Southeast, leaving the southeastern states with relatively high rates today.

Cancer is the second leading cause of death, and the atlas maps death rates for several major cancer sites -- lung, breast, prostate and colorectal. Lung cancer has been the leading cause of cancer deaths in men for several decades, and during that time high rates for black men were concentrated in urban centers, while rates for white men were highest along the Mississippi River and the south Atlantic coast. Now, for white men, the cluster of high rates extends into the Ohio River Valley, and rates for black men are highest in the southeastern states.

For women the lung cancer mortality pattern has been similar to that for men, but a cluster of high rates for white women appeared in the Pacific States about 20 years ago. The western cluster of high rates among white females now encompasses the entire Pacific region and portions of the Mountain region, and appears to be limited to older women.

Prostate cancer is primarily a disease of older men. For older white men rates are highest along the Canadian border in the upper north central states; for black men high rates are found along the south Atlantic coast.

The stroke belt -- a band of southeastern states (excluding Florida) with high stroke death rates -- has dispersed, with rates dropping in this area and high rates now found to the north and west of the original cluster. Stroke is the third leading cause of death.

HIV death rates are highest in States on both the East and West Coasts and in nearly every urban area of the United States.

Homicide, suicide and motor vehicle injury deaths are also major public health problems with well-defined geographic patterns. For example, homicide rates are high for young black adults in urban areas but for young white men the high rates are in the south and southwestern states. Among whites, suicide rates are highest in the western states and in nonmetropolitan areas throughout the country. For young adults, motor vehicle death rates are higher in the southeastern states and generally in less densely populated areas.

"The atlas is an excellent prevention tool," said CDC Director Dr. David Satcher. "The atlas offers clues to the relationship and the impact of behavioral, environmental, genetic, and demographic factors and points to promising areas for additional, in-depth research or where prevention and intervention activities should be focused," he said.

The atlas can be used to determine the rate of an individual area; discern clusters of areas with similar rates; visualize broad geographic patterns; and compare regional differences by age, race and sex for each cause of death.

The research underlying the atlas has resulted in improved statistical methods for modeling death rates and innovative presentation formats for maps and graphics, according to Dr. Edward J. Sondik, NCHS Director. To determine the best way to present the information in the most understandable format, NCHS conducted numerous studies to evaluate how people interpret maps and selected the final format, based on these studies.

In addition to maps with age-adjusted death rates for each HSA, the atlas includes maps which show the statistical significance of the difference of each HSA rate to the national rate, generalized maps which show the broad regional patterns for selected ages (40 and 70 for diseases and 20 and 70 for injuries), and a chart with regional rates for each cause of death.

The causes included in this atlas account for more than 80 percent of all deaths in the United States. The atlas maps death rates for heart disease, all cancer, lung cancer, colorectal cancer, prostate cancer, breast cancer, stroke, unintentional injuries, motor vehicle injuries, chronic obstructive pulmonary disease, pneumonia and influenza, diabetes, suicide, firearm suicide, liver disease, HIV, homicide, firearm homicide and a total of all causes.

The "Atlas of United States Mortality," by Linda Williams Pickle, Michael Mungiole, Gretchen K. Jones, and Andrew A. White, is available from the National Center for Health Statistics, 6525 Belcrest Road, Hyattsville, MD.

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