QuickStats: Age-Adjusted Death Rates for Alzheimer Disease Among Adults Aged ≥65 Years, by Sex — National Vital Statistics System, United States, 1999–2019

April 23, 2021

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The age-adjusted death rate for Alzheimer disease increased from 128.8 per 100,000 in 1999 to 233.8 in 2019.

The trend for the total population and for men and women alternated between periods of general increase and periods of stability. Rates were stable from 2016 to 2019, and in 2019 were 263.0 for women and 186.3 for men.

Throughout the 1999–2019 period, the rate was higher for women than for men.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data, 1999–2019. https://www.cdc.gov/nchs/nvss/deaths.htm


NCHS UPDATES”STATS OF THE STATES” PAGE WITH LATEST FINAL DATA

March 26, 2021

SOS_Nav_Page

The CDC National Center for Health Statistics web page “Stats of the States” has been updated to include the latest state-based final data on selected vital statistics topics, including:

  • General fertility rates
  • Teen birth rates
  • Selected other maternal and infant health measures
  • Marriage & divorce rates
  • Leading causes of death
  • Other high profile causes of death.

The site’s map pages allow users to rank states from highest to lowest or vice versa.  This latest version of “Stats of the States” also includes two new topics:  Life expectancy by state and COVID-19 death rates by state (provisional data on a quarterly basis, through Q3 of 2020).  All death rates are adjusted for age.  Rates are featured in the maps because they best illustrate the impact of a specific measure on a particular state.

The main “Stats of the States” page can be accessed at:  https://www.cdc.gov/nchs/pressroom/stats_of_the_states.htm


QuickStats: Age-Adjusted Death Rates for Influenza and Pneumonia, by Urbanization Level and Sex — National Vital Statistics System, United States, 2019

March 26, 2021

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In 2019, age-adjusted death rates for influenza and pneumonia were higher among males (14.4 per 100,000) than females (10.7) and among those who lived in rural counties (15.3) compared with those who lived in urban counties (11.7).

Among males, the age-adjusted death rate for influenza and pneumonia was 17.4 in rural counties and 13.9 in urban counties.

Among females, the age-adjusted death rate for influenza and pneumonia was 13.6 in rural counties and 10.2 in urban counties.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality file. https://www.cdc.gov/nchs/nvss/deaths.htm

https://www.cdc.gov/mmwr/volumes/70/wr/mm7012a5.htm


PODCAST: Death Certificate Data & COVID-19, Part 3

March 26, 2021

STATCAST, MARCH 2021: DISCUSSION WITH ROBERT ANDERSON, A STATISTICIAN, ABOUT DEATH CERTIFICATE DATA & COVID-19.

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210326/20210326.htm

HOST:  In Part Three of our conversation with Dr. Robert Anderson, the chief of mortality statistics at NCHS, we discussed the subject of excess deaths in the United States during the pandemic, and also the differences between when COVID-19 is listed as the underlying cause of death on the death certificate and those occasions when it is listed as a contributing cause but not the primary cause of death.

HOST:  So now you mentioned excess deaths – what are excess deaths, how has COVID-19 contributed to these excess deaths?

ROBERT ANDERSON:  So excess deaths are defined as the difference between the observed number of deaths in a specific time period and the expected or normal number of deaths in the same time period. So with the pandemic we’re looking at the total number of weekly deaths that occurred in 2020 and so far in 2021, and we’re comparing it with what we would expect in a comparable time period, essentially based on average weekly data from previous years.  The advantage of looking at excess deaths is that it’s not dependent on the accuracy of cause of death reporting – the focus is just on the total deaths, not deaths by cause.  Now at this point COVID-19 explains about 3/4 of total excess deaths and the other quarter likely includes three components: there are deaths that should have been attributed to COVID-19 but were instead attributed to some other cause for whatever reason.  Second, indirect deaths.  And these are deaths that can be attributed to the circumstances of the pandemic but not directly to the virus.  And this may be things like people not able to get health care during a crisis not related to the virus.  Or perhaps they’re afraid to seek care because the hospitals are full of people with COVID.  And then, three: a third component is other causes of excess deaths.  So you know there may be some excess deaths not associated with pandemic.  This could include things like deaths due to natural disasters.  This is generally going to be relatively small in comparison to what we’re dealing with the pandemic but these are sort of another category of excess deaths.

HOST:  There was some other speculation out there – rumors or what have you – that 2020 might have been actually a normal year in terms of total mortality in comparison to past years despite COVID-19.  How were people getting confused about that?

ROBERT ANDERSON:   Yeah the problem was that some folks were comparing incomplete counts for 2020 with complete counts for earlier years.  And so it did look like there were about a normal number of deaths.  The problem was that they weren’t including all of the deaths that occurred for 2020.  So we’ve made some changes to our website to try to make it more clear what the total number of deaths were for 2020.

HOST:  So NCHS ranks leading causes of death according to the underlying cause of death, and you mentioned earlier that in 92%, approximately, of COVID-19 related deaths, COVID-19 was listed as the underlying cause of death. And in roughly the other 8% of COVID-19 related deaths COVID-19 was not listed as the underlying cause of death.  Could you talk about that a little bit?

ROBERT ANDERSON:  Sure.  Let me start by saying that leading causes are ranked by the total number of deaths, and it’s based on a standard cause of death tabulation list that we typically used.  And if folks are interested in that we have a publication called “Deaths: Leading Causes for… insert the year – I think the most recent one that we have published right now is for 2018 -but you get the idea of exactly how NCHS does the rankings and how all of that came about.  Now when tabulating and comparing causes of death it’s important that we assign a single cause to each death so that we don’t double count.  We don’t want to have deaths falling into multiple categories, so we select a single cause.  And as we discussed earlier, certifiers typically report more than one condition on death certificates.  Now fortunately, as we also discussed, the death certificate is designed to elicit the single underlying cause, and that’s defined as the disease or injury that initiated that sequence of events leading to death.  That sequence gets reported in Part One on the certificate, and if completed correctly the underlying cause will be at the beginning of the sequence on the lowest use line in Part One.  So as I mentioned before you could have a sequence like respiratory distress due to viral pneumonia due to COVID-19.  That’s a logical sequence starting with the immediate cause – which is respiratory distress – and then working backwards through viral pneumonia, back to COVID-19, which is the underlying cause.  So that is the condition then that we would select for tabulation when comparing causes of death.  Now if the certificate is not completed correctly – and this does happen – we actually have a set of standardized selection rules to choose the best underlying cause for among those conditions listed.  These rules are part of ICD-10, which we used to code mortality, and they’re an international standard.  So the all those rules get applied regardless of the cause of death in the same way and as a result we would select an underlying cause from among those conditions, assuming that the certificate is not completed correctly.  Now with regard to the other 8 or 9 percent – I think it’s something on the order of 91 point-something percent, underlying cause and then about 8 point-something percent not underlying cause.  In cases where COVID-19 is not the underlying cause, we’re typically seeing it reported in Part Two as a significant contributing factor.  So if reported in Part Two, it may not be the underlying cause. It should be considered a significant factor that contributed to death.  And this is an important distinction – if COVID-19 is not a factor it’s not supposed to be reported on the death certificate.

MUSIC BRIDGE

HOST:  Still to come next week in our discussion with Dr. Robert Anderson:  How COVID-19 will be categorized among the other leading causes of death in the country, as well as more complicated scenarios facing certifiers on how to list COVID-19 on the death certificate.

MUSIC BRIDGE

HOST:  The rate of multiple births in the United states declined in 2019, according to the latest final birth data released this week by NCHS.  The new report also shows that more than 3 in 4 women began prenatal care during the first trimester of pregnancy.  The percentage of women who smoke during pregnancy declined in 2019 – to 6% of all women who gave birth. Medicaid was the source of payment for over 4 in 10 births that occurred in 2019.

Another report published this week by NCHS looks at drug overdose death rates in the U.S. on a state by state basis.  The report documents that the highest death rates from overdoses in 2019 were concentrated in jurisdictions that are in fairly close geographical proximity to one another: West Virginia, Delaware, DC, Ohio, Maryland and Pennsylvania.  Nebraska had the lowest overdose death rate in the nation in 2019.


Drug Poisoning Mortality, by State and by Race and Ethnicity: United States, 2019

March 25, 2021

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NCHS released a Health E-Stat that provides information on drug overdose mortality by state (and the District of Columbia) and by race and ethnicity, and adds to findings from a recently published Data Brief on drug overdose death rates.

Findings: 

  • The age-adjusted rate for drug overdose deaths in the United States for 2019 was 21.6 per 100,000 standard population.
  • The five states with the highest rates were West Virginia (52.8), Delaware (48.0), District of Columbia (43.2), Ohio (38.3), and Maryland (38.2). 
  • The five states with the lowest rates were Nebraska (8.7), South Dakota (10.5), Texas (10.8),
    North Dakota (11.4), and Iowa (11.5).
  • The age-adjusted drug overdose death rate for the non-Hispanic white population in 2019 (26.2
    per 100,000 standard population) was 21.3% higher than the national rate.
  • The rate for the non-Hispanic black population (24.8) was 14.8% higher than the national rate.
  • The rate for the non-Hispanic American Indian or Alaska Native population (30.5) was 41.2% higher than
    the national rate.
  • The rate for the non-Hispanic Asian population (3.3) was 84.7% lower than the national rate.
  • The rate for the non-Hispanic Native Hawaiian or Other Pacific Islander population (9.5) was 56.0% lower than the national rate. The rate for the Hispanic population (12.7) was 41.2% lower than the national rate.

Motor Vehicle Traffic Death Rates, by Sex, Age Group, and Road User Type: United States, 1999–2019

March 18, 2021

A new NCHS report provides national trends in motor vehicle traffic deaths by sex, age group, and type of road user (i.e., motor vehicle occupant, motorcyclist, pedestrian, or pedal cyclist) from 1999 through 2019 using the latest mortality data from the National Vital Statistics System.

Findings:

  • Motor vehicle traffic death rates were stable from 1999 to 2006, declined on average by 8% each year from 2006 (14.5 per 100,000) to 2010 (10.7), and then increased from 2010 through 2019 (11.1).
  • Among males, differences in the rates by age group diminished over time; by 2019, the rate for males aged 15–24, the group with the highest rate in 1999, was lower than the rate for males aged 25–64 and 65 and over.
  • Among females, rates for all age groups decreased from 1999 through 2019.
  • Rates for motor vehicle occupants decreased by 37% from 12.0 in 1999 to 7.6 in 2019.

PODCAST: COVID-19 Death Tracking Questions

March 12, 2021

STATCAST, MARCH 2021: DISCUSSION WITH ROBERT ANDERSON, A STATISTICIAN, ABOUT HOW COVID-19 DEATHS ARE TRACKED AND ENTERED ONTO THE DEATH CERTIFICATE .

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210312/20210312.htm

TRANSCRIPT

HOST: Since the beginning of the pandemic, there have been a lot of questions about how COVID-19 deaths are tracked and how they are entered onto the death certificate.  Joining us to talk about those topics is Robert Anderson, Chief of Mortality Statistics at NCHS.

HOST:  There are two CDC sources of COVID-19 deaths.  Could you talk a little bit about each source – what they are and what role they play in providing key information about the pandemic?

ROBERT ANDERSON:  Sure – there are two main sources for COVID-19 deaths.  The first piece is the case surveillance system which is built on the national notifiable diseases surveillance system.  So anytime that there’s what’s called a reportable disease – these are things like measles or mumps or things that are of significant public health import – a case report has to be filed.  And of course at the beginning of the COVID-19 pandemic it was decided that COVID-19 would be a reportable disease as well.  So anytime any health care provider comes across a COVID-19 case they’re supposed to file a case report with the state health Department, with the County Health Department – it varies from state to state – so on that form there is a line that asks did the patient die from this disease.  It is capturing the fact of death from that particular disease.  So the case surveillance system then collects these reports and then aggregates them – they also do some, for those states that are really slow in sending reports, they also scrape websites in order to get numbers that they can report in a timely fashion.  The second source is from vital statistics and these data are based on death certificates. And the death certificate is filled out typically by a funeral director who provides demographic personal information and then physician/ medical examiner/coroner provides the cause of death information.  And these are permanent legal records of the fact of death and the cause of death, and so they take a little bit more time to complete.  These have to be done in a certain, specific way and they have to be done correctly.  And so it takes a little bit longer.  In general the death certificates lag the case reports by about two weeks on average, although that does vary quite a bit from state to state.

HOST: For the death certificate, NCHS issued a guidance report – a guidance document – for certifiers on how to include COVID-19 on the death certificate.  That came out about a year ago.  Can you talk about that a little bit?

ROBERT ANDERSON:  Sure.  At the beginning of the pandemic, we realized that we had an opportunity to reach out to physicians to help them understand how to complete the death certificate – in general, not just with regard to COVID-19.  And so we created this document that was specific to COVID-19 that showed them how to fill out the death certificate properly in general, and then once they determined that COVID-19 was either the cause of death or a contributing factor, how to report it on the death certificate.  This guidance just sort of builds on guidance that we issued several years earlier –  I think the last time we issued guidance, general guidance, was in 2003.  This guidance is essentially the same – it’s just specific to COVID-19. This builds on the guidance that we issued before.

HOST:  Turning to another topic here: comorbidities, other conditions contributing or involved with COVID-19 deaths.  There was some confusion about the note on Table 3 on the website on COVID-19 deaths by contributing condition.  The note says “For 6% of these deaths COVID-19 was the only cause mentioned on the death certificate.”  And this has led to some wild and inaccurate speculation that the other 94% of the deaths may have been really some other cause of death and not COVID-19.  Could you talk about that a little bit?

ROBERT ANDERSON:  Yeah sure.  I can provide a little bit of background here.  The cause of death section on the death certificate is designed in a specific way and it’s designed to elicit a sequence of events leading to death.  And then also to gather any significant conditions that contributed to death.  So you have Part One about “cause of death” section which asks the certifier to provide the causal sequence.  And so you would start on the top line and you would put the immediate cause of death.  To use a COVID-19 example, you might have “respiratory distress syndrome” which is a common complication of COVID-19.  And then you would work backwards from that immediate cause of death. And let’s suppose that respiratory distress was brought on by pneumonia, viral pneumonia, and so you would put on the second line “viral pneumonia.” And then on the third line – because we want to know what the cause of viral pneumonia was – if it was COVID-19, then you would write COVID-19 on the third line.  So you’d have respiratory distress due to viral pneumonia due to COVID-19.  That’s a logical causal sequence from the immediate cause working back to the underlying cause.  And then in Part Two, you could put any other conditions that might have contributed to death but weren’t part of that causal pathway in Part One.  Now with a disease like COVID-19, it should be fairly unusual to see only COVID-19 reported –  I mean normally we should at least see the complications caused by the disease, such as pneumonia or respiratory distress.  In cases where only COVID-19 is reported, the certifier is indicating that COVID-19 was the cause of death, but really they left it – the cause of death statement – somewhat incomplete.  They neglected to provide the entire causal pathway.  Now with regard to the other 94% which mentioned other diseases or conditions, it’s important to understand that in the overwhelming majority of these cases the additional diseases or conditions are either complications of COVID-19 – they are in the causal pathway, like pneumonia or respiratory distress – or they’re reported in Part Two as contributing conditions. So for about 92% of the deaths involving COVID-19 that mention other conditions –  91 or 92% – the certifiers indicated that COVID-19 is the primary or underlying cause.  This is not a situation where the certifier is writing all of the diseases that the person had equally; they’re actually reporting it in this causal sequence.  And in the overwhelming majority of cases, COVID-19 has been indicated as the cause of the death.  It’s the cause that started that causal pathway, that causal sequence leading to death.

HOST:  So to summarize, in some cases COVID-19 leads to complications such as pneumonia which can lead to death, and then in other cases a person already has a pre-existing condition – maybe diabetes or COPD – and in those cases COVID-19 can then cause serious illness and death in those individuals.  Is that correct?

ROBERT ANDERSON:  That’s essentially correct.  In almost all cases COVID-19 leads to some other complications, even if there are pre-existing chronic diseases.  So for those that die from COVID-19, COVID almost always initiates a sequence of conditions and those can include respiratory, cardiovascular, neurological complications.  And then the pre-existing chronic diseases seem to make things much worse and do seem to make people more prone to having a serious illness or death.

(MUSIC BRIDGE)

HOST: Join us next time for a further discussion with Robert Anderson about how COVID-19 is documented on death certificates.

HOST:  A few weeks ago NCHS released a provisional report on how the pandemic impacted life expectancy in 2020.  Each year NCHS releases national life tables for the country.  This week for the first time in several years NCHS released state estimates on life expectancy.  These life tables were based on final data for 2018, and showed that Hawaii had the highest life expectancy of any state – 81 years at birth. West Virginia had the lowest life expectancy in 2018 at 74.4 years.

This week NCHS also released its latest summary of visits to hospital emergency departments, using data from the National Hospital Ambulatory Medical Care survey.  The report showed ER visit rates were higher for infants than other age groups, and were also higher for females than for males.

in, specific way and they have to be done correctly.  And so it takes a little bit longer.  So in general the death certificates lag the case reports by about two weeks on average, although that does vary quite a bit from from state to state.

HOST: For the death certificate, NCHS issued a guidance report – a guidance document – for certifiers on how to include COVID-19 on the death certificate.  That came out about a year ago.  Can you talk about that a little bit?

ROBERT ANDERSON:  Sure.  At the beginning of the pandemic, we realized that we had an opportunity to reach out to physicians to help them understand how to complete the death certificate – in general, not just with regard to COVID-19.  And so we created this document that was specific to COVID-19 that showed them how to fill out the death certificate properly in general, and then once they determined that COVID-19 was either the cause of death or a contributing factor, how to report it on the death certificate.  This guidance just sort of builds on guidance that we issued several years –  I think the last time we issued guidance, general guidance, was in 2003.  This guidance is essentially the same – it’s just specific to COVID-19. This builds on the guidance that we issued before.

HOST:  Turning to another topic here: comorbidities, other conditions contributing or involved with COVID-19 deaths.  There was some confusion about the note on Table 3 on the website and COVID-19 deaths by contributing condition.  The note says “For 6% of these deaths COVID-19 was the only cause mentioned on the death certificate.”  And this has led to some wild and inaccurate speculation that the other 94% of the deaths may have been really some other cause of death and not COVID-19.  Could you talk about that a little bit?

ROBERT ANDERSON:  Yeah sure.  So I can provide a little bit of background here.  So the cause of death section on the death certificate is designed in a specific way and it’s designed to elicit a sequence of events leading to death.  And then also to gather any significant conditions that contributed to death.  So you have Part One about “cause of death” section which asks the certifier to provide the causal sequence.  And so you would start on the top line and you would put the immediate cause of death.  So to use a COVID-19 example, you might have “respiratory distress syndrome” which is a common complication of COVID-19.  And then you would work backwards from that immediate cause of death and let’s suppose that respiratory distress was brought on by pneumonia, viral pneumonia, and so you would put on the second line “viral pneumonia.” And then on the third line – because we want to know what the cause of viral pneumonia was – if it was COVID-19 then you would write COVID-19 on the third line.  So you’d have respiratory distress due to viral pneumonia due to COVID-19.  That’s a logical causal sequence from the immediate cause working back to the underlying cause.  And then in Part Two, you could put any other conditions that might have contributed to death but weren’t part of that causal pathway in Part One.  Now with a disease like COVID-19 it should be fairly unusual to see only COVID-19 reported –  I mean normally we should at least see the complications caused by the disease, such as pneumonia or respiratory distress.  In cases where only COVID-19 is reported, the certifier is indicating that COVID-19 was the cause of death, but really they left it – the cause of death statement – somewhat incomplete.  They neglected to provide the entire causal pathway.  Now with regard to the other 94% which mentioned other diseases or conditions, it’s important to understand that in the overwhelming majority of these cases the additional diseases or conditions are either complications of COVID-19 – they are in the causal pathway, like pneumonia or respiratory distress – or they’re reported in Part Two as contributing conditions. So for about 92% of the deaths involving COVID-19 that mention other conditions –  91 or 92% – the certifiers indicated that COVID-19 is the primary or underlying cause.  So this is not a situation where the certifier is writing all of the diseases that the person had equally; they’re actually reporting it in this causal sequence.  And in the overwhelming majority of cases, COVID-19 has been indicated as the cause of the death.  It’s the cause that started that causal pathway, that causal sequence leading to death.

HOST:  So to summarize, in some cases COVID-19 leads to complications such as pneumonia which can lead to death, and then in other cases a person already has a pre-existing condition – maybe diabetes or COPD – and in those cases COVID-19 can then cause serious illness and death in those individuals.  Is that correct?

ROBERT ANDERSON:  That’s essentially correct.  In almost all cases COVID-19 leads to some other complications, even if there are pre-existing chronic diseases.  So for those that die from COVID-19, COVID almost always initiates a sequence of conditions and those can include respiratory, cardiovascular, neurological complications.  And then the pre-existing chronic diseases seem to make things much worse and do seem to make people more prone to having a serious illness or death.

(MUSIC BRIDGE)

HOST: Join us next time for a further discussion with Robert Anderson about how COVID-19 is documented on death certificates.

HOST:  A few weeks ago NCHS released a provisional report on how the pandemic impacted life expectancy in 2020.  Each year NCHS releases national life tables for the country.  This week for the first time in several years NCHS released state estimates on life expectancy.  These life tables were based on final data for 2018, and showed that Hawaii had the highest life expectancy of any state – 81 years at birth. West Virginia had the lowest life expectancy in 2018 at 74.4 years.

This week NCHS also released its latest summary of visits to hospital emergency departments, using data from the National Hospital Ambulatory Medical Care survey.  The report showed ER visit rates were higher for infants than other age groups, and were also higher for females than for males.


QuickStats: Rates of Firearm-Related Deaths Among Persons Aged 15 Years or Older, by Selected Intent and Age Group

March 12, 2021

Among persons aged 15 years or older, for all firearm-related deaths (all intents), rates were highest among those aged 15–24 years (17.4 per 100,000).

For deaths involving firearm-related suicides, rates increased with age, from 6.6 among persons aged 15–24 years to 11.8 among those aged 65 years or older.

A different pattern was found for firearm-related homicides, in which rates decreased with age, from 10.2 among those aged 15–24 years to 0.9 among those aged 65 years or older.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data, 2019. https://www.cdc.gov/nchs/nvss/deaths.htm

https://www.cdc.gov/mmwr/volumes/70/wr/mm7010a5.htm


QuickStats: Death Rates Attributed to Excessive Cold or Hypothermia† Among Persons Aged15 Years or older, by Urban-Rural Status and Age Group

February 19, 2021

In 2019, among persons aged 15 years or older, death rates attributed to excessive cold or hypothermia were higher in rural areas than in urban areas across every age group.

Crude rates were lowest among those aged 15–34 years at 0.2 and 0.5 per 100,000 population in urban and rural areas, respectively.

Rates increased with age, with the highest rates among those aged 85 years or older at 4.6 in urban areas and 8.6 in rural areas. Differences between urban and rural rates also increased with age.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data 2019. https://wonder.cdc.gov/mcd-icd10.html

https://www.cdc.gov/mmwr/volumes/70/wr/mm7007a6.htm


Provisional Drug Overdose Death Counts (thru June 2020)

January 14, 2021

 

NCHS released the latest monthly provisional data on drug overdose deaths in America on Wednesday.  This release covers the one-year period ending in June of 2020, and the impact of the pandemic on drug abuse in the country is reflected in the new numbers.

Provisional data show that the reported number of drug overdose deaths occurring in the United States increased by 19.5% from the 12 months ending in June 2019 to the 12 months ending in June 2020, from 67,787 to 81,003.  After adjustments for delayed reporting, the predicted number of drug overdose deaths showed an increase of 21.3% from the 12 months ending in June 2019 to the 12 months ending in June 2020, from 68,711 to 83,335.

Source: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm