Series 4

No. 30

Report of the

Second Workshop

on Age Adjustment

December 1998

Vital and

Health Statistics

From the CENTERS FOR DISEASE CONTROL AND PREVENTION / National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
Copyright Information

All material appearing in this report is in the public domain and may be

reproduced or copied without permission; citation as to source, however, is

appreciated.

Suggested citation

Anderson RN, Rosenberg HM. Report of the second workshop on age

adjustment. National Center for Health Statistics. Vital Health Stat 4(30). 1998.

Library of Congress Catalog Card Number

Workshop on Age Adjustment (2nd: 1997: National Center for Health Statistics)

Report of the Second Workshop on Age Adjustment.

p. cm. — (Vital and health statistics. Series 4, Documents and committee

reports ; no. 30) (DHHS publication ; no. (PHS) 99-1467)

‘‘December 1998.’’

‘‘This report contains a summary of the Second Workshop on Age

Adjustment held at the National Center for Health Statistics on June 5–6, 1997.

The Second Workshop was held as a follow up to the First Workshop held in

1991 to consider changing the standard used for age-adjusting death rates and

to develop an implementation plan.’’

ISBN 0-8406-0550-1

1. Mortality—United States—Statistics—Congresses. 2. Age factors in

disease—United States—Statistics—Congresses. 3. Age distribution

(Demography)—United States—Statistics—Congresses. 4. Medical

policy—United States—Congresses. 5. Health survey—United States—

Statistics—Congresses. I. Title. II. Series. III. Series: DHHS publication ; no.

(PHS) 99-1467.

[DNLM: 1. Mortality—United States congresses. 2. Health Policy—United

States Congresses. 3. Age Factors congresses. 4. Data Collection—standards—

United States Congresses. 5. Age Distribution. W2 A N148vd no. 30 1998]

HA37.U1693 no. 30

[RA407.A2]

362.1'07'23 s—dc21

[614.4'273]

DNLM/DLC

for Library of Congress 98-37767

CIP

For sale by the U.S. Government Printing Office

Superintendent of Documents

Mail Stop: SSOP

Washington, DC 20402-9328

Printed on acid-free paper.
Report of the

Second Workshop

on Age Adjustment

Series 4:

Documents and Committee

Reports

No. 30

Hyattsville, Maryland

December 1998

DHHS Publication No. (PHS) 99-1467

Vital and

Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jack R. Anderson, Deputy Director

Jack R. Anderson, Acting Associate Director for

International Statistics

Lester R. Curtin, Ph.D., Acting Associate Director for

Research and Methodology

Jennifer H. Madans, Ph.D., Acting Associate Director for

Analysis, Epidemiology, and Health Promotion

P. Douglas Williams, Acting Associate Director for Data

Standards, Program Development, and Extramural Programs

Edward L. Hunter, Associate Director for Planning, Budget,

and Legislation

Jennifer H. Madans, Ph.D., Acting Associate Director for

Vital and Health Statistics Systems

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Division of Vital Statistics

Mary Anne Freedman, Director

James A. Weed, Ph.D., Deputy Director

Harry M. Rosenberg, Ph.D., Chief, Mortality Statistics

Branch

Nicholas F. Pace, Chief, Systems Programming and

Statistical Resources Branch
Foreword

The Second Workshop on Age Adjustment, sponsored by the National Center for Health Statistics, focused on important

policy issues related to this widely used index in health statistics, thereby complementing an earlier workshop that was devoted

to technical issues. I am particularly pleased that the recommendations of the Second Workshop have been translated into a

change in Departmental statistical policy effective with Secretary Shalala’s directive of August 26, 1998. I am using this as an

opportunity to thank the participants of the first and second workshops for their contributions to improving the Federal

Government’s statistical practices in the area of health.

Edward J. Sondik, Ph.D.

Director

National Center for Health Statistics

iii
Contents

Abstract ............................................................................................... 1

Chapter 1. Introduction ................................................................................... 1

Chapter 2. Recommendations of the Second Workshop on Age Adjustment ......................................... 2

Chapter 3. Recommendations of the First Workshop and Follow Up .............................................. 4

Chapter 4. Summary and Conclusion ........................................................................ 7

References.............................................................................................. 8

Appendix I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Appendix II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Workshop Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Appendix III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Comments on Age Adjustment by Robert Schoen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Text Tables

A. Age-adjusted death rates for 15 leading causes of death using National Center for Health Statistics 10-year age groups

and expanded 10-year age groups: United States, 1994 ..................................................... 5

B. Unadjusted and age-adjusted death rates for selected causes of death for all ages and by three broad age categories:

United States, 1979–94............................................................................... 6

Detailed Tables

1. Age-adjusted death rates for 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s

disease using National Center for Health Statistics 10-year age groups and expanded 10-year age groups:

United States, 1994 ................................................................................. 9

2. Unadjusted death rates for 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s

disease by three broad age categories: United States, 1979–94 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

3. Age-adjusted death rates for 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s

disease by three broad age categories: United States, 1979–94 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

4. Age-adjusted death rates for 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s

disease: United States, 1979–94 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Appendix Figures

1. Age-specific death rates per thousand population. Coale-Demeny (1966) ‘‘West’’ life tables for females . . . . . . . . . . . . 36

2. Percent differences in mortality rates by sex for whites: United States, 1950, 1960, and 1970 . . . . . . . . . . . . . . . . . . . . 37

v
This report contains a summary of

the Second Workshop on Age

Adjustment held at the National Center

for Health Statistics on June 5–6, 1997.

The workshop, which was a follow up to

the First Workshop on Age Adjustment

(1991), was held to consider changing

the standard used for age-adjusting

death rates and to develop an

implementation plan. This report

includes follow up to the

recommendations from the first

workshop.

Participants in the second workshop

included representatives from selected

Federal agencies, State health

departments, nongovernmental

agencies, and academia. The

participants recommended that the

current population standard for

age-adjusting death rates be changed

from the 1940 standard million

population to a standard based on a

projected year 2000 population. On

August 26, 1998, the Secretary, U.S.

Department of Health and Human

Services approved the

recommendations of the second

workshop as departmental policy

effective with the 1999 data year. In

addition, the proposed change has

been widely publicized in presentations

to State vital statistics programs and to

Federal agencies.

Report of the Second Workshop

on Age Adjustment

by Robert N. Anderson, Ph.D., and Harry M. Rosenberg, Ph.D.

Chapter 1

Introduction

Age standardization, often called

‘‘age adjustment,’’ has been used

broadly for about 150 years to

eliminate the confounding effects of

differences in age composition. In 1844

F.G.P. Neison presented a paper to the

Statistical Society of London in which

he proposed a method to account for the

differences in age composition of

communities when comparing mortality

(1). Since then experts have met at least

nine times to discuss age adjustment (2).

Most recently the National Center for

Health Statistics (NCHS) held two

workshops (1991, 1997) to examine

aspects of age-adjusting death rates.

This report provides a description and

the recommendations of the 1997

workshop. This report also provides a

summary of the results and

recommendations of the 1991 workshop

as well as the follow up to those

recommendations. A record of the first

workshop, which addressed technical

issues, can be found in ‘‘Reconsidering

Age Adjustment Procedures: Workshop

Proceedings (3).’’

The crude death rate is a widely

used measure of mortality. However,

crude death rates are heavily influenced

by the age composition of populations.

As such, comparisons of crude rates

over time or between groups may be

misleading if the groups differ in age

composition. This is relevant, for

example, in trend comparisons of U.S.

mortality given the aging of the U.S.

population over the past few decades

(4). Age adjustment is one of the key

tools used in mortality statistics to

account for the changing age

distribution of the population, and

thereby to make meaningful

comparisons over time and among

groups in the risk of mortality.

Age adjustment by the direct

method requires a standard age

distribution or ‘‘standard population.’’

The selection of an appropriate standard

population is to some extent an arbitrary

decision, i.e., there is no theoretically

correct standard population. In fact there

are few statistical reasons to guide the

selection of a standard (5–7). The only

guidance given in the statistical

literature is that the standard population

selected should not be considered

abnormal relative to the populations

being studied. That is, it should reflect a

reasonable age distribution (8). Thus,

the choice of a standard has typically

been driven by practical considerations.

Currently, the most commonly used

standard in the United States is based on

the 1940 U.S. population (9). Termed

the ‘‘U.S. standard million population,’’

this standard has been used by NCHS

for age adjustment since 1943. Although

there are no compelling statistical

This report was prepared in the Division of Vital Statistics. Susan A. Hawk and Kimberley D. Peters of

the Division of Vital Statistics served as facilitators during the workshop. Jennifer Madans provided

helpful comments and suggestions. The Registration Methods staff and the Data Acquisition and

Evaluation Branch of the Division of Vital Statistics provided consultation to State vital statistics offices

regarding collection of the death certificate data on which chapter 3 of this report is based. This report

was edited by Patricia Keaton-Williams and typeset by Jacqueline M. Davis of the Publications Branch,

Division of Data Services.

Page 1
reasons to change from the 1940

standard, the question of whether the

public health community would be

better served by a new standard is valid.

On March 7, 1991, NCHS convened

the first workshop on age adjustment to

examine technical issues and problems

related to the calculation and

interpretation of age-adjusted death

rates. The first workshop recommended

the continued use of the 1940 standard

by NCHS and encouraged other Federal

and State governmental agencies to use

this standard when publishing official

mortality statistics (10). In addition, the

workshop recommended that NCHS

study issues that might lead to the

introduction of a new or additional

standard by the year 2000.

Recently NCHS and other Federal

agencies have come under renewed

pressure to change standards. The 1940

standard is viewed by some as an

anachronistic set of population weights

for two reasons.

+ The 1940 population sounds too old.

That is, it gives the impression to

the media and other audiences that

the technical procedures used by the

Federal Government are outdated.

+ The 1940 population has a younger

age distribution than the current

population. Although it is a matter

of judgment as to whether the 1940

population is ‘‘abnormal’’ or

‘‘unnatural’’ relative to the current

population, the negative perceptions

remain.

Further, some agencies have departed

from the 1940 standard in favor of more

recent standards. At least three different

standards, based on the 1940, 1970, and

1980 U.S. populations, are used by

Federal agencies (9,11–13). These

multiple standards have led to confusion

among data users and have placed

unnecessary burden on State health

agencies, and have resulted in a renewed

emphasis on the need for a single

population standard among

governmental agencies in the publication

of mortality statistics.

The Second Workshop on Age

Adjustment was convened by NCHS to

reach agreement on a coordinated

approach to age standardization in the

presentation of mortality statistics within

the U.S. Department of Health and

Human Services (DHHS) and among

State health departments. Participants of

the workshop were asked to address

four questions with the goal of

formulating recommendations to the

Secretary, U.S. Department of Health

and Human Services.

+ Should a single standard or multiple

standards be used?

+ Which standard should be used?

+ How often should standards be

updated?

+ How should recommendations of the

workshop be publicized?

Presentations that addressed these

questions were given by representatives

from academia, the National Cancer

Institute (NCI), the National Heart,

Lung, and Blood Institute (NHLBI),

NCHS, the National Center for Chronic

Disease Prevention and Health

Promotion, the National Association for

Public Health Statistics and Information

Systems, the National Academy of

Sciences, and the National Committee

on Vital and Health Statistics. See

appendix I for the workshop agenda and

appendix II for a list of workshop

participants. The presentations were

followed by a facilitated discussion of

the major issues and formulation of

recommendations.

The report proceeds as follows:

Chapter 2 presents the

recommendations, which reflect the

consensus of the workshop participants.

Included with each recommendation are

related considerations raised during the

discussion. Chapter 3 contains a

summary of the first workshop and

presents the results of research that

addressed questions raised as a result of

the first workshop recommendations.

Chapter 4 provides a summary and

conclusion of the second workshop and

implementation issues. A paper,

‘‘Comments on Age Adjustment,’’ by

Robert Schoen is presented in appendix

III. The purpose of this paper is to

provide background on a proposal that

received serious consideration by the

workshop participants.

Chapter 2

Recommendations of

the Second Workshop

on Age Adjustment

Nine recommendations resulted

from the Second Workshop on

Age Adjustment. The

recommendations reflect the consensus

of the participants and are listed here

with considerations that were raised

during the development of the

recommendations. In these

recommendations, ‘‘agencies’’ refers to

agencies in DHHS. For comparability

and consistency, it would be

advantageous if the recommendations

were adopted by other Federal agencies,

State agencies, and the private sector.

1. The population standard for

age-adjusting death rates should be

changed from the 1940 U.S. standard

million population to the projected

2000 U.S. population to be published

by the Census Bureau in the spring of

1998. A single standard should be used

by all agencies for official presentation

of data. For special analyses,

alternative standards may be used as

appropriate to the research.

Currently, at least three different

standards are used by DHHS agencies.

Although most agencies use the 1940

standard, NCI uses a 1970 standard

(11,12), and some centers of the Centers

for Disease Control and Prevention use

a 1980 standard (13). There is a need

for consistency among DHHS agencies

and States when publishing mortality

statistics to minimize confusion and

misunderstanding. Thus, when releasing

official mortality statistics to the public,

age-adjusted death rates should be based

on a single, uniform standard.

Alternative standards may be used for

special analyses when appropriate. To

avoid confusion researchers should note

their departure from standard practice

when publishing their results.

From a statistical standpoint, when

it is appropriate to standardize, the

choice of population standard matters

very little. However, even though

Page 2 [ Series 4, No. 30
changing the standard is not a scientific

necessity, there exists a significant

public relations problem related to the

1940 standard. The 1940 population

standard is perceived as outdated and

misrepresenting the current population.

These problems are considered sufficient

reason to discard the 1940 standard and

replace it with a standard that better

reflects the current population.

The projected 2000 population was

chosen as the replacement for the 1940

standard. The 2000 standard has the

advantage of being similar in structure

to the current population and will likely

remain so for at least the next 10 years.

The 2000 standard has the added appeal

of being associated with a millennial

year. Although there is no overriding

statistical reason for choosing the 2000

standard over other age distributions, it

is appropriate to choose a year that is

similar to current reality and with which

data users can be comfortable.

Other standards were considered by

the workshop participants. These

included the life table stationary

population, the projected 2020 U.S.

population, the projected 2050 U.S.

population, and a uniform population

distribution. The life table stationary

population has the advantage of being a

hypothetical standard not associated

with a particular year. The concept of a

standard based on a life table’s

stationary population was generally well

received by the workshop participants.

(The rationale for the life table standard

is outlined in appendix III.) However,

the life table standard lacks the

simplicity and intelligibility of the 2000

standard. The projected 2020 and 2050

populations are significantly older than

the current population and could be

viewed in much the same manner as the

1940 population is now viewed. The

uniform population distribution gives

equal weight to each age group.

However, the uniform standard is highly

sensitive to the age categories used. In

addition it is expected that any standard

should reflect a reasonable age

distribution (8).

Implementation of the new 2000

population standard in data year 1999

(see recommendation 2) necessitates the

use of a projected population. Each

spring the U.S. Bureau of the Census

releases an updated set of U.S.

population projections. The weights for

the new 2000 standard should be based

on population projections available in

the spring of 1998 from the U.S. Bureau

of the Census. Concerns have been

raised regarding the use of a projected

2000 population rather than the actual

2000 Census population. However, the

2000 Census will not be available until

2002 or 2003, which would substantially

delay implementation. It is very likely

that differences between the actual and

projected populations will be small.

Thus, weights based on the projected

population calculated to five or six

decimal places will be, in all likelihood,

identical to weights based on the actual

Census population. Finally, it is worth

noting that the current 1940 standard is

not based on the enumerated 1940

census population.

2. Agencies should implement the new

population standard by data year 1999.

The workshop participants

recommended that official

implementation of the new 2000

standard take place with data year 1999,

i.e., beginning with publications

reporting 1999 data. NCHS will begin

publishing provisional 1999 data in June

1999.

Earlier implementation dates were

considered. However, resource

limitations particularly at the State level

necessitate a somewhat later

implementation date. Participants from

all agencies were confident that

implementation could become effective

with the data year 1999.

3. Agencies should continue to use and

publish their current standards until

the official implementation data year

(1999) when the new common standard

will be adopted. To avoid confusion,

agencies implementing the new

standard prior to data year 1999 should

simultaneously publish rates adjusted

to both the old and new standards.

Some DHHS agencies indicated a

desire to implement the new standard

before data year 1999. To maintain the

current level of consistency, each agency

will continue to publish age-adjusted

death rates using their current official

standard until data year 1999 when the

new 2000 standard will be used

exclusively for the publication of official

mortality statistics. Rates based on the

new standard may be published before

data year 1999 provided that rates using

the old standard are also published until

data year 1999.

4. After the implementation date,

agencies should use the new standard

in all press releases and other

communication with the public.

Beginning with data year 1999, all

age-adjusted death rates reported to the

media or to the general public should be

calculated using the new standard. These

statistics will be considered official.

Rates using the old or other standards

may be disseminated for research

purposes as appropriate.

5. NCHS will be responsible for

naming the new standard and will

determine the number of significant

digits.

The new standard will be referred

to as the year 2000 standard population

and will be a standard million.

Therefore, weights will be calculated to

six decimal places.

6. Agencies should continue to use the

current 11 age groups (less than 1

year, 1 to 4 years, 5 to 14 years, 15 to

24 years, 25 to 34 years, 35 to 44 years,

45 to 54 years, 55 to 64 years, 65 to 74

years, 75 to 84 years, and 85 years and

older) for calculating age-adjusted

rates using the new standard.

The participants considered two

proposals for expanding the number of

age groups used to calculate ageadjusted rates. The first was to

disaggregate the 85 years and older

category to 85 to 94 years and 95 years

and older. However, because the

statistical stability of the rates for these

upper age groups was of concern

(especially for small geographical areas),

the group decided that age-adjusted rates

should continue to be based on the

current standard 10-year age groups.

A second proposal recommended

the use of 5-year age groups in the

calculation of age-adjusted rates. Again,

the statistical stability of the rates for

those smaller age groups are a potential

problem, especially for less common

Series 4, No. 30 [ Page 3
causes of death. It is clear, however, that

in special cases, the standard 10-year

age groups may not be appropriate.

Consequently, population weights will

be made available by 5-year age groups

for special studies.

7. NCHS will convene an

implementation committee that will be

responsible for developing a time table

and strategies for implementation and

for commissioning papers to publicize

the change in standard.

The implementation committee will

be responsible for addressing the

practical matters related to

implementation of the new

age-adjustment standard. This will

include the development of a time table

and strategies for implementation and

the commission of at least two papers—

one technical and one nontechnical—

drawing on publications developed by

NHLBI (14). The committee will also

need to garner support from such offices

and organizations as the Secretary of

DHHS, the DHHS Data Council, all

DHHS agencies, the CDC Excellence in

Science Committee, the Committee on

National Statistics of the National

Academy of Science, the National

Cancer Policy Board, the National

Committee on Vital and Health

Statistics, and the Office of Management

and Budget.

8. NCHS will publicize the new

standard in NCHS publications, the

Morbidity and Mortality Weekly

Report, Public Health Reports, and

appropriate professional newsletters.

Scholarly papers could also be

published in appropriate professional

and technical journals.

It is important that the new standard

be publicized as widely as possible,

particularly in the public health,

medical, and statistical communities

where age-adjusted death rates are most

used in scientific study and in reports of

health trends. This can be accomplished

by publications in professional

newsletters and scholarly and technical

journals, particularly those with wide

readership.

In addition to the scientific

community, the public should also be

educated about the new standard in

particular and age adjustment in general,

e.g., a definition of age-adjusted rates

and an explanation on appropriate usage.

This education will take the form of

publications oriented to a nontechnical

audience. NHLBI has taken the lead and

is producing publications designed to

educate the public on age adjustment

(14).

9. NCHS will convene a workgroup to

evaluate the age-adjustment standard at

least every 10 years.

It is hoped that the new 2000

standard will be useful for many years.

However, it is probable that another

change will be needed. Therefore, the

workshop participants recommend that

the standard be evaluated at least every

10 years. A change in the standard

should be made only if differences

between the standard population and the

actual population become problematic.

The results of the second workshop

are nine recommendations to the

Secretary of DHHS. On August 26,

1998, these recommendations were

approved by the Secretary as DHHS

policy.

Chapter 3

Recommendations of

the First Workshop

and Follow Up

On March 7, 1991, NCHS

convened the First Workshop on

Age Adjustment to examine

technical issues and problems related to

the calculation and interpretation of

age-adjusted death rates (3). These

issues arose during the formulation of

the year 2000 health objectives. Among

the issues examined were historical

perspectives, advantages and

disadvantages of age adjustment, the

effect of the choice of standard on

mortality patterns, and statistical and

nonstatistical considerations in the

selection of standard populations.

Overall the need for age adjustment was

reaffirmed by the workshop participants.

A set of four recommendations was

formulated from the First Workshop on

Age Adjustment (10):

+ NCHS will continue to use the 1940

U.S. population as the basis for

calculating age-adjusted death rates.

This population will be converted

into a relative distribution totaling

1,000,000 and will be referred to as

the ‘‘U.S. Standard Million

Population.’’

+ NCHS will study the following

issues that may lead to the

introduction of a new or an

additional standard by the year

2000:

+ The effects on age-adjusted

death rates of using rates for

ages 85–94 years and 95 years

and over, in place of 85 years

and over in their calculation.

+ The feasibility of producing

tables of trends for leading

causes of death from 1960 to the

present for broad age groupings

and the desirability of finer age

adjustment within the broad age

groups.

+ The utility and timeliness of

producing age-adjusted rates

based on the latest decennial

census.

+ NCHS shall develop suitable

technical notes and expository

material concerning the appropriate

use of age adjustment, differences in

interpretation from crude and other

rates used in the scientific literature,

and clarification of issues expressed

by data users.

+ Other official agencies should use

the standard million population

when publishing age-adjusted

mortality rates. Researchers

examining unique issues might

consider the use of other standard

populations when appropriate and, to

minimize confusion, point out this

departure from standard practice.

The first recommendation was that

all should refer to the 1940 population

standard as the ‘‘U.S. Standard Million

Population,’’ which NCHS has done in

its publications since 1991. The third

recommendation was to develop suitable

technical notes and expository material

concerning age adjustment. NCHS has

also implemented this recommendation

in its publications (9,15), including a

Page 4 [ Series 4, No. 30
Healthy People 2000 Statistical Notes

on age standardization (6). The second

recommendation charged NCHS to

investigate three additional areas:

Expanded age categories—NCHS

examined the effect on age-adjusted

death rates of expanding the number of

age group categories used in the

calculation by disaggregating the 85

years and over group into two

categories—85–94 years and 95 years.

Table A compares age-adjusted death

rates for the 15 leading causes of death

in 1994 using the standard age

categories with rates calculated using

age groups 85–94 and 95 years. The

effect of using the different age groups

is negligible for virtually all of the 15

leading causes of death (see table 1 for

other causes). For example, for heart

disease the age-adjusted rate calculated

using the standard age groups is 140.4

per 100,000 standard population,

compared with 139.7 when calculated

using the 85–94 and 95 and over age

categories. The difference between these

rates is only 0.49 percent. For most of

the 15 leading causes of death, the

difference in rates resulting from these

two procedures is less than 1 percent. A

similar result is obtained when the 1990

population is used as the standard (see

tables A and 1).

NCHS does not currently produce

death rates for specific age groups older

than 85 years because of problems in

age reporting and instability in

population estimates at the older ages.

These issues are presently being

examined. As the U.S. population ages

and life expectancy increases, NCHS

will be under pressure to present

mortality statistics in more detail for the

older age groups. In 1994 the life

expectancy of white females at birth

was 79.6 years; at age 65 years, it was

84.1 years (16). When NCHS begins to

routinely show age-specific death rates

separately for the age groups 85–94

years and 95 years, NCHS can

consider expanding the age categories in

the standard population to match these

more detailed categories. Because the

effects of expanding the age categories

would be inconsequential, comparability

with years before the change will not be

substantially affected.

Age adjusting for broad age

groups—NCHS examined the feasibility

of producing trend tables for leading

causes of death for three broad age

groupings—0–24, 25–64, and 65 years

and over—and age adjusting within each

of the broad groups. These broad age

groups are useful from a programmatic

standpoint and for showing complex

patterns. Table B shows unadjusted and

age-adjusted death rates from 1979 to

1994 for selected causes of death for

these three broad age groups. Tables 2

and 3 show these data for 72 selected

causes of death, Human

immunodeficiency virus infection, and

Alzheimer’s disease.

Age adjusting within the broad age

groups does result in cases of trends that

differ from those based on unadjusted

rates. In the top panel of table B,

unadjusted and age-adjusted rates are

compared for all causes of death

combined. For all causes at the youngest

ages (0–24 years), the trends based on

unadjusted and age-adjusted rates are

virtually the same. In contrast, among

the older age groups, the rate of change

is substantially different depending on

which type of rate is used. This is

particularly true for the age group 65

years and over where the percent change

is 0.92 percent for the unadjusted rates

and 9.07 percent for the age-adjusted

rates. The difference in trends reflects

the shifts in the age distribution that

Table A. Age-adjusted death rates for 15 leading causes of death using National Center for Health Statistics 10-year age groups and

expanded 10-year age groups: United States, 1994

[Age-adjusted death rates are calculated per 100,000 U.S. standard population. National Center for Health Statistics 10-year age groups are under 1 year, 1–4, 5–14,

15–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84, and 85 years and over. Expanded 10-year age groups are the National Center for Health Statistics age groups

expanded to include the age groups 85–94 years and 95 years and over]

Rank1 Cause of death (ICD–9 category)

Age-adjusted rates

Percent

difference

NCHS

age

groups

Expanded

age

groups

. . . All causes ........................................................ 507.4 506.1 -0.26

1 ....... Diseases of heart ....................................(390–398,402,404–429) 140.4 139.7 -0.49

2 ....... Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues . . . (140–208) 131.5 131.5 0.01

3 ....... Cerebrovascular diseases ....................................... (430–438) 26.5 26.4 -0.47

4 ....... Chronic obstructive pulmonary diseases and allied conditions ................. (490–496) 21.0 21.0 0.00

5 ....... Accidents and adverse effects .................................. (E800–E949) 30.3 30.3 -0.06

. . . Motor vehicle accidents ..................................... (E810–E825) 16.1 16.1 0.01

. . . All other accidents and adverse effects ....................(E800–E807,E826–E949) 14.2 14.2 -0.14

6 ....... Pneumonia and influenza ....................................... (480–487) 13.0 12.9 -1.08

7 ....... Diabetes mellitus ............................................... (250) 12.9 12.9 -0.05

8 ....... Human immunodeficiency virus infection ............................. (*042–*044) 15.4 15.4 0.00

9 ....... Suicide ................................................ (E950–E959) 11.2 11.2 0.01

10 . . . . . . . Chronic liver disease and cirrhosis .................................... (571) 7.8 7.8 0.02

11 . . . . . . . . Homicide and legal intervention ................................. (E960–E978) 10.2 10.2 -0.00

12 . . . . . . . Nephritis, nephrotic syndrome, and nephrosis ........................... (580–589) 4.3 4.3 -0.42

13 . . . . . . . Septicemia ................................................... (038) 4.0 4.0 -0.25

14 . . . . . . . Alzheimer’s disease ............................................. (331.0) 2.5 2.5 -0.79

15 . . . . . . . Atherosclerosis ................................................ (440) 2.3 2.3 -2.18

0.0 Quantity more than zero but less than 0.05.

*Beginning with data year 1987, the National Center for Health Statistics introduced categories *042–*044 for classifying and coding Human immunodeficiency virus infection. The asterisks indicate

that these categories are not part of the Ninth Revision, International Classification of Diseases, 1975. 1Rank based on number of deaths.

Series 4, No. 30 [ Page 5
have occurred within the age group 65

years and over. Consequently, trend

analysis for the three broad age groups

benefits greatly by age adjusting within

the groups.

Age adjusting within three broad

age groups also has some advantage

over a single age-adjusted rate for all

age groups combined. For some causes

of death, a single summary measure

cannot adequately describe the mortality

experience of the population over time.

Cancer (malignant neoplasms) is a

notable example. In table B age-adjusted

rates for all ages combined for cancer

from 1979 to 1994 show that the risk of

death remained fairly stable rising only

Table B. Unadjusted and age-adjusted death rates for selected causes of death for all ages and by three broad age categories:

United States, 1979–94

[Unadjusted rates per 100,000 population in specified group; age-adjusted death rates per 100,000 U.S. standard population]

Cause of death, age group, and type of rate

Percent change

1979 1994 1979–94

All causes

All ages

Unadjusted ..................................... 852.2 875.4 2.72

Age-adjusted .................................... 577.1 507.4 –12.07

0–24 years

Unadjusted ..................................... 121.0 88.1 –27.17

Age-adjusted .................................... 117.6 85.6 –27.20

25–64 years

Unadjusted ..................................... 500.2 398.6 –20.31

Age-adjusted .................................... 461.5 403.4 –12.59

65 years and over

Unadjusted ..................................... 5,060.5 5,014.1 –0.92

Age-adjusted .................................... 4,317.9 3,926.3 –9.07

Malignant neoplasms, including neoplasms of lymphatic and hematopoietic

tissues (140–208)

All ages

Unadjusted ..................................... 179.6 205.2 14.25

Age-adjusted .................................... 130.8 131.5 0.54

0–24 years

Unadjusted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 3.6 –29.77

Age-adjusted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 3.7 –27.70

25–64 years

Unadjusted ..................................... 142.7 115.6 –19.02

Age-adjusted .................................... 129.6 117.9 –9.00

65 years and over

Unadjusted ..................................... 986.6 1,134.5 14.99

Age-adjusted .................................... 932.4 1,036.6 11.18

Diabetes mellitus (205)

All ages

Unadjusted ..................................... 14.8 21.8 47.30

Age-adjusted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.8 12.9 32.24

0–24 years

Unadjusted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 –33.33

Age-adjusted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2 0.2 –26.09

25–64 years

Unadjusted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.5 10.4 21.90

Age-adjusted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 10.6 37.13

65 years and over

Unadjusted ..................................... 95.3 128.5 34.82

Age-adjusted .................................... 84.8 110.3 30.08

Diseases of heart (390–398,402,404–429)

All ages

Unadjusted ..................................... 326.5 281.3 –13.84

Age-adjusted .................................... 199.6 140.4 –29.66

0–24 years

Unadjusted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 2.5 –2.78

Age-adjusted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5 2.4 –2.44

25–64 years

Unadjusted ..................................... 155.2 89.4 –42.39

Age-adjusted .................................... 139.2 91.2 –34.45

65 years and over

Unadjusted ..................................... 2,256.1 1,840.7 –18.41

Age-adjusted .................................... 1,883.2 1,369.2 –27.29

Page 6 [ Series 4, No. 30
very slightly (0.54 percent) over this

period. However, age-adjusted rates for

the three broad age groupings show a

much more complex pattern. For those

aged 0–24 years, cancer death rates

showed a consistent decline of nearly

30 percent. Age-adjusted rates for those

aged 25–64 years also declined by

9 percent from 1979 to 1994. In

contrast, age-adjusted cancer death rates

for the age 65 and over population

increased by 11 percent from 1979 to

1994.

Trends in age-adjusted death rates

for diabetes show similar limitations of

the single summary measure.

Age-adjusted death rates for diabetes

show a 32-percent increase in risk from

1979 to 1994 for all age groups

combined. However, this increase is

only evident in the 25–64- and 65-year

and over age groups. In the 0–24-year

age group, age-adjusted diabetes

mortality declined by 26 percent over

the same period.

For heart disease from 1979 to

1994, the age-adjusted death rate

declined by nearly 30 percent for all

ages. Although declines are evident in

each of the three age groups, the

distribution of decline is not uniform.

For those aged 65 years and over, the

decline is 27 percent; for those aged

25–64 years, 35 percent, but only

2 percent for those under 25 years of

age.

In terms of quality of data for

cancer and diabetes, there is a clear

advantage to using three age groups as

compared with the single summary

measure for presenting trends in

mortality. However, for most other

causes of death, the single value

summary measure works well in

showing trends in ‘‘average’’ risk.

There are some advantages to

presenting age-adjusted death rates for

three broad age groups compared with

the age-specific death rates for 5- or

10-year age groups routinely produced

by NCHS. Although some information

is lost in collapsing detailed age groups,

overall trends in mortality can be more

easily perceived by examining trends in

three age categories rather than 11 age

categories in the case of 10-year age

groups or 19 age categories in the case

of 5-year age groups.

If NCHS were asked to consider

replacing the current age-adjusted death

rates for all ages with age-adjusted rates

for the three broad age groups, its

response might be as follows:

+ It would be difficult and probably

unwise to discontinue what has

become the most relied upon

summary measure of mortality in

the field of public health. The single

age-adjusted death rate is highly

useful and only in some cases does

it obscure the complexity of

divergent age-specific trends. A

more thorough analysis requires

age-specific comparisons. If very

broad age groups are used, age

adjustment of these groups is

justified.

+ If NCHS were asked if the

advantages of presenting

age-adjusted death rates for three

broad age groups warrant their

inclusion in public health reports as

a standard fixture along with

age-adjusted rates and age-specific

rates for 5- or 10-year age groups,

the response would be ‘‘probably

not.’’ The potential advantages of

presenting death rates for three

broad age groups over the

presentation of age-adjusted rates

and rates by 5- and 10-year age

groups are probably not substantial

enough to warrant their addition.

Nevertheless, this approach may be

useful on a limited basis for specific

types of reports.

Using the most recent decennial

census—NCHS was asked to consider

the utility and timeliness of producing

age-adjusted death rates based on a

population standard derived from the

latest decennial census. NCHS has used

the 1940 standard for over 50 years. In

the past staying with one standard

proved to be prudent and efficient,

mainly because of the level of effort

required to recalculate trend tables, etc.,

when much of the data was not

computerized. However, using current

technology, historic rates can be

recalculated with far less effort. In

addition, while NCHS consistently

adhered to the 1940 standard, other

Federal agencies have discarded it in

favor of more contemporary population

standards. Therefore, it would be useful

to review the population standard every

10 years to evaluate its appropriateness.

Chapter 4

Summary and

Conclusion

T wo workshops were convened by

NCHS to reexamine technical and

policy issues related to the age

adjustment of mortality statistics. The

first workshop examined technical issues

and problems related to the calculation

and interpretation of age-adjusted death

rates. The results of the second

workshop, the focus of this report, are a

set of recommendations to the Secretary

of DHHS.

Participants of the second workshop

recommended adopting a new standard

based on the 2000 U.S. population to

replace the old standard based on the

1940 U.S. population. Implementing this

recommendation would effect the

following:

+ Bring departmental coherence to the

age-adjustment issue

+ Facilitate public understanding

+ Address technical concerns

In addition, participants recommended

that a periodic review process be

instituted to ensure the continuing

appropriateness of the standard.

Implementation of the year 2000

standard has implications for the

presentation and interpretation of

mortality patterns based on age-adjusted

death rates. Important issues include:

+ Time series showing trends of

age-adjusted death rates must be

recalculated retrospectively as far

back as possible. Age-adjusted death

rates calculated using the 1940

standard will not be comparable to

those calculated using the year 2000

standard.

+ The Healthy People 2010 goals

based on age-adjusted death rates

must be recalibrated to reflect the

change in population standard.

+ The change in standard population is

likely to affect some group

Series 4, No. 30 [ Page 7
comparisons and trends, particularly

for race and ethnic groups and for

selected causes of death. These

effects will be explained.

These and other issues related to

age adjustment will be addressed in a

series of publications and presentations

oriented to the scientific community and

to the public.

References

1. Neison FGP. On a method recently

proposed for conducting inquiries into

the comparative sanatory condition of

various districts. London J Royal Stat

Soc 7:40–68. 1844.

2. Feinleib M. A reconsideration of age

adjustment. In: Feinleib M, Zarate AO,

eds. Reconsidering age adjustment

procedures: Workshop proceedings.

National Center for Health Statistics.

Vital and Health Statistics 4(29). 1992.

3. Feinleib M, Zarate AO, eds.

Reconsidering age adjustment

procedures: Workshop proceedings.

National Center for Health Statistics.

Vital Health Stat 4(29). 1992.

4. Treas JT. Older Americans in the 1990s

and beyond. Population Bulletin 50(2).

1995.

5. Curtin LR. A short history of

standardization for vital events. In:

Feinleib M, Zarate AO, eds.

Reconsidering age adjustment

procedures: Workshop proceedings.

National Center for Health Statistics.

Vital and Health Statistics 4(29). 1992.

6. Curtin LR, Klein RJ. Direct

standardization (age-adjusted death

rates). National Center for Health

Statistics. Healthy People 2000:

Statistical Notes. 6. 1995.

7. Curtin LR, Maurer J, Rosenberg HM.

On the selection of alternative

standards for the age-adjusted death

rate: Proceedings of the social statistics

sections. American Statistical

Association. 218–23. 1980.

8. Wolfenden HH. On the methods of

comparing the mortalities of two or

more communities, and the

standardization of death rates. Journal

of the Royal Statistical Society

86:399–411. 1923.

9. National Center for Health Statistics.

Vital Statistics of the United States,

1993, vol II, mortality, part A, section

7. Washington: Public Health Service.

1997.

10. Feinleib M. Summary and

recommendations. In: Feinleib M,

Zarate AO, eds. Reconsidering age

adjustment procedures: Workshop

proceedings. National Center for Health

Statistics. Vital and Health Statistics

4(29). 1992.

11. Sondik EJ. Use of age-adjusted disease

rates for cancer. In: Feinleib M, Zarate

AO, eds. Reconsidering age adjustment

procedures: Workshop proceedings.

National Center for Health Statistics.

Vital and Health Statistics 4(29). 1992.

12. Ries LAG, Kosary CL, Hankey BF, et

al., eds. SEER Cancer Statistics

Review, 1973–1994. Bethesda, MD:

National Cancer Institute. 1997.

13. Centers for Disease Control and

Prevention. Trends in ischemic heart

disease deaths—United States,

1990–1994. Morbidity and mortality

weekly report 46(7): 146–50. 1997.

14. National Heart, Lung, and Blood

Institute. Comparing death rates over

time. National Heart, Lung, and Blood

Institute data fact sheet. 1997.

15. Anderson RN, Kochanek KD, Murphy

SL. Report of final mortality statistics,

1995. Monthly vital statistics report;

vol 45 no 11, supp 2. Hyattsville,

Maryland: National Center for Health

Statistics. 1997.

16. National Center for Health Statistics.

Vital Statistics of the United States,

1994, preprint of vol II, mortality, part

A, section 6, life tables. Hyattsville,

MD. 1998.

Page 8 [ Series 4, No. 30
Table 1. Age-adjusted death rates for 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease using

National Center for Health Statistics’ 10-year age groups and expanded 10-year age groups: United States, 1994

[Age-adjusted death rates are calculated per 100,000 using 1940 and 1990 U.S. standard populations. National Center for Health Statistics 10-year age groups are less

than 1 year, 1–4, 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84 years, and 85 years and over. Expanded 10-year age groups are the National Center for

Health Statistics age groups expanded to include the age groups 85–94 years and 95 years and over]

Cause of death (ICD–9 category)

Age-adjusted rates

1940 standard 1990 standard

NCHS

age

groups

Expanded

age

groups

NCHS

age

groups

Expanded

age

groups

All causes .............................................. 507.4 506.1 849.2 838.0

Shigellosis and amebiasis .............................. (004,006) 0.0 0.0 0.0 0.0

Certain other intestinal infections ..........................(007–009) 0.2 0.2 0.3 0.2

Tuberculosis ......................................(010–018) 0.4 0.4 0.6 0.6

Tuberculosis of respiratory system .......................(010–012) 0.3 0.3 0.4 0.4

Other tuberculosis .................................(013–018) 0.1 0.1 0.1 0.1

Whooping cough ..................................... (033) 0.0 0.0 0.0 0.0

Streptococcal sore throat, scarlatina, and erysipelas ............. (034–035) 0.0 0.0 0.0 0.0

Meningococcal infection ................................. (036) 0.1 0.1 0.1 0.1

Septicemia ......................................... (038) 4.0 4.0 7.5 7.5

Acute poliomyelitis .................................... (045) ––––

Measles ........................................... (055) ––––

Viral hepatitis ........................................ (070) 0.9 0.9 1.2 1.1

Syphilis ........................................ (090–097) 0.0 0.0 0.0 0.0

All other infectious and parasitic diseases ................ (001–003,005,

020–032,037,039–041,*042–*044,046–054,056–066, 071–088,098–139) 17.5 17.5 18.6 18.5

Malignant neoplasms, including neoplasms of lymphatic and hematopoietic

tissues ........................................ (140–208) 131.5 131.5 201.6 201.6

Malignant neoplasms of lip, oral cavity, and pharynx ........... (140–149) 2.1 2.1 3.0 3.0

Malignant neoplasms of digestive organs and peritoneum ........ (150–159) 29.3 29.3 47.2 47.2

Malignant neoplasms of respiratory and intrathoracic organs ...... (160–165) 40.1 40.1 58.9 58.9

Malignant neoplasm of breast ......................... (174–175) 11.6 11.6 16.5 16.5

Malignant neoplasms of genital organs ................... (179–187) 13.2 13.2 22.9 22.9

Malignant neoplasms of urinary organs ................... (188–189) 5.1 5.1 8.4 8.4

Malignant neoplasms of all other and unspecified sites .... (170–173,190–199) 17.0 17.0 24.8 24.8

Leukemia ...................................... (204–208) 4.9 4.9 7.4 7.4

Other malignant neoplasms of lymphatic and hematopoietic tissues . . (200–203) 8.2 8.2 12.6 12.6

Benign neoplasms, carcinoma in situ, and neoplasms of uncertain behavior

and of unspecified nature ............................ (210–239) 1.7 1.7 2.8 2.8

Diabetes mellitus ..................................... (250) 12.9 12.9 21.3 21.3

Nutritional deficiencies ............................... (260–269) 0.5 0.5 1.3 1.2

Anemias ........................................ (280–285) 0.9 0.9 1.6 1.6

Meningitis ....................................... (320–322) 0.2 0.2 0.3 0.3

Major cardiovascular diseases .......................... (390–448) 176.8 175.9 347.9 347.2

Diseases of heart ......................... (390–398,402,404–429) 140.4 139.7 271.2 270.6

Rheumatic fever and rheumatic heart disease ............... (390–398) 1.2 1.2 2.0 2.0

Hypertensive heart disease .............................. (402) 5.0 5.0 8.9 8.9

Hypertensive heart and renal disease ....................... (404) 0.5 0.5 0.9 0.9

Ischemic heart disease ............................. (410–414) 91.5 91.0 178.4 178.2

Acute myocardial infarction .............................. (410) 45.7 45.6 82.8 82.8

Other acute and subacute forms of ischemic heart disease . . . . . . . . . . (411) 0.6 0.6 1.1 1.1

Angina pectoris ..................................... (413) 0.2 0.2 0.3 0.3

Old myocardial infarction and other forms of chronic ischemic heart

disease ...................................... (412,414) 45.0 44.7 94.1 94.0

Other diseases of endocardium ........................... (424) 2.6 2.6 5.7 5.7

All other forms of heart disease .................. (415–423,425–429) 39.7 39.4 75.3 75.0

Hypertension with or without renal disease ................. (401,403) 2.2 2.2 4.4 4.3

Cerebrovascular diseases ........................... (430–438) 26.5 26.4 56.4 56.2

Intracerebral and other intracranial hemorrhage .............. (431–432) 5.0 5.0 8.1 8.1

Cerebral thrombosis and unspecified occlusion of cerebral arteries (434.0,434.9) 2.4 2.4 5.4 5.4

Cerebral embolism .................................. (434.1) 0.1 0.1 0.3 0.3

All other and late effects of cerebrovascular diseases ..... (430,433,435–438) 19.0 18.9 42.6 42.5

Atherosclerosis ..................................... (440) 2.3 2.3 6.2 6.2

Other diseases of arteries, arterioles, and capillaries ........... (441–448) 5.3 5.3 9.8 9.7

Acute bronchitis and bronchiolitis ........................... (466) 0.1 0.1 0.2 0.2

See footnotes at end of table.

Series 4, No. 30 [ Page 9
Table 1. Age-adjusted death rates for 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease using

National Center for Health Statistics’ 10-year age groups and expanded 10-year age groups: United States, 1994—Con.

[Age-adjusted death rates are calculated per 100,000 using 1940 and 1990 U.S. standard populations. National Center for Health Statistics 10-year age groups are less

than 1 year, 1–4, 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84 years, and 85 years and over. Expanded 10-year age groups are the National Center for

Health Statistics age groups expanded to include the age groups 85–94 years and 95 years and over]

Cause of death (ICD–9 category)

Age-adjusted rates

1940 standard 1990 standard

NCHS

age

groups

Expanded

age

groups

NCHS

age

groups

Expanded

age

groups

Pneumonia and influenza ............................. (480–487) 13.0 12.9 29.8 29.5

Pneumonia ..................................... (480–486) 12.8 12.7 29.3 29.1

Influenza ......................................... (487) 0.2 0.2 0.4 0.4

Chronic obstructive pulmonary diseases and allied conditions ....... (490–496) 21.0 21.0 38.2 38.1

Bronchitis, chronic and unspecified ...................... (490–491) 0.7 0.7 1.3 1.3

Emphysema ....................................... (492) 3.7 3.7 6.5 6.5

Asthma .......................................... (493) 1.5 1.5 2.1 2.1

Other chronic obstructive pulmonary diseases and allied conditions . . (494–496) 15.1 15.1 28.2 28.2

Ulcer of stomach and duodenum ......................... (531–533) 1.2 1.2 2.3 2.2

Appendicitis ..................................... (540–543) 0.1 0.1 0.1 0.1

Hernia of abdominal cavity and intestinal obstruction without mention

of hernia .................................... (550–553,560) 1.0 1.0 2.3 2.2

Chronic liver disease and cirrhosis .......................... (571) 7.8 7.8 9.5 9.5

Cholelithiasis and other disorders of gallbladder ............... (574–575) 0.5 0.5 1.1 1.0

Nephritis, nephrotic syndrome, and nephrosis ................. (580–589) 4.3 4.3 8.5 8.4

Acute glomerulonephritis and nephrotic syndrome ............. (580–581) 0.1 0.1 0.1 0.1

Chronic glomerulonephritis, nephritis and nephropathy, not specified

as acute or chronic, and renal sclerosis, unspecified ....... (582–583,587) 0.3 0.3 0.6 0.6

Renal failure, disorders resulting from impaired renal function,

and small kidney of unknown cause .............. (584–586,588–589) 3.9 3.9 7.8 7.7

Infections of kidney .................................... (590) 0.2 0.2 0.4 0.4

Hyperplasia of prostate ................................. (600) 0.1 0.1 0.2 0.2

Complications of pregnancy, childbirth, and the puerperium ........ (630–676) 0.1 0.1 0.1 0.1

Pregnancy with abortive outcome ....................... (630–638) 0.0 0.0 0.0 0.0

Other complications of pregnancy, childbirth, and the puerperium . . . (640–676) 0.1 0.1 0.1 0.1

Congenital anomalies ................................ (740–759) 4.4 4.4 4.3 2.0

Certain conditions originating in the perinatal period ............. (760–779) 5.7 5.7 4.9 0.1

Birth trauma, intrauterine hypoxia, birth asphyxia, and respiratory

distress syndrome ............................... (767–769) 0.9 0.9 0.8 0.0

Other conditions originating in the perinatal period ...... (760–766,770–779) 4.8 4.8 4.1 0.0

Symptoms, signs, and ill-defined conditions .................. (780–799) 6.8 6.7 9.2 7.5

All other diseases .................................. (Residual) 40.2 40.1 75.3 74.8

Accidents and adverse effects ........................ (E800–E949) 30.3 30.3 34.9 34.6

Motor vehicle accidents ........................... (E810–E825) 16.1 16.1 16.5 16.5

All other accidents and adverse effects .......... (E800–E807,E826–E949) 14.2 14.2 18.4 18.1

Suicide ...................................... (E950–E959) 11.2 11.2 12.0 12.0

Homicide and legal intervention ....................... (E960–E978) 10.2 10.2 9.8 9.7

All other external causes ........................... (E980–E999) 1.3 1.3 1.3 1.3

Human immunodeficiency virus infection1 .................. (*042–*044) 15.4 15.4 15.9 15.9

Alzheimer’s disease2 .................................. (331.0) 2.5 2.5 6.8 6.8

0.0 Quantity more than zero but less than 0.05.

– Quantity zero.

* Beginning with data year 1987, the National Center for Health Statistics introduced categories *042–*044 for classifying and coding Human immunodeficiency virus infection. The asterisks indicate

that these categories are not part of the Ninth Revision, International Classification of Diseases, 1975.

1Included in All other infectious and parasitic diseases shown above.

2Included in All other diseases (Residual category).

Page 10 [ Series 4, No. 30
72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States,

ed age group]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 121.02 120.96 114.00 109.61 104.50 103.16 102.96 104.39 102.09 103.12 101.92 99.54 97.14 91.34 91.27 88.14

. 500.21 498.04 481.87 462.65 453.71 445.72 441.41 434.13 426.86 423.20 414.07 406.23 400.72 394.66 400.09 398.64

. 5,060.51 5,251.97 5,117.26 5,056.39 5,134.53 5,118.73 5,174.88 5,130.17 5,095.81 5,146.30 5,012.35 4,963.15 4,924.03 4,880.60 5,047.68 5,014.09

. 0.01 0.01 0.01 0.00 0.01 0.00 0.01 0.00 0.01 0.01 0.01 0.00 0.01 0.00 0.00 0.00

. 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00

. 0.05 0.04 0.04 0.02 0.05 0.04 0.05 0.01 0.02 0.02 0.03 0.02 0.02 0.02 0.02 0.02

. 0.14 0.15 0.18 0.18 0.17 0.17 0.13 0.14 0.13 0.11 0.12 0.13 0.16 0.16 0.16 0.25

. 0.04 0.05 0.04 0.04 0.04 0.04 0.03 0.06 0.04 0.03 0.03 0.04 0.04 0.04 0.05 0.06

. 0.51 0.65 0.61 0.45 0.58 0.46 0.50 0.50 0.50 0.58 0.60 0.79 0.84 1.00 1.26 1.30

. 0.03 0.02 0.03 0.02 0.03 0.04 0.04 0.03 0.04 0.04 0.04 0.04 0.03 0.03 0.02 0.02

. 0.79 0.71 0.72 0.61 0.60 0.61 0.59 0.63 0.59 0.62 0.64 0.61 0.58 0.54 0.49 0.42

. 4.57 4.67 4.29 4.12 3.89 3.54 3.58 3.45 3.37 3.69 3.70 3.21 2.95 3.02 2.94 2.69

. 0.01 0.01 0.01 0.01 0.02 0.02 0.01 0.02 0.02 0.01 0.02 0.02 0.02 0.01 0.00 0.01

. 0.65 0.58 0.58 0.49 0.47 0.46 0.45 0.47 0.45 0.46 0.47 0.43 0.43 0.39 0.37 0.30

. 3.82 3.93 3.59 3.43 3.18 2.85 2.90 2.85 2.79 3.00 3.02 2.63 2.32 2.44 2.40 2.18

. 0.02 0.02 0.02 0.01 0.01 0.02 0.02 0.01 0.01 0.02 0.02 0.02 0.02 0.02 0.02 0.01

. 0.14 0.13 0.14 0.13 0.13 0.15 0.14 0.16 0.14 0.16 0.16 0.18 0.14 0.14 0.12 0.13

. 0.76 0.73 0.70 0.69 0.72 0.69 0.68 0.60 0.57 0.69 0.67 0.58 0.64 0.58 0.54 0.51

. 0.01 0.01 0.01 0.00 0.01 0.01 0.00 0.01 0.00 0.00 0.01 0.01 – 0.01 0.01 0.01

. – – – – – –––––––––––

. – – – – – – – 0.00 ––––––––

. 0.01 0.00 0.00 0.00 – – – 0.00 0.00 0.00 0.00 0.00 – – 0.00 0.00

. 0.01 0.00 0.00 0.01 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01

. 0.04 0.03 0.03 0.03 0.02 0.01 0.02 0.01 0.02 0.02 0.02 0.02 0.01 0.01 0.02 0.01

. 0.28 0.28 0.32 0.26 0.22 0.22 0.19 0.20 0.20 0.20 0.19 0.15 0.15 0.14 0.17 0.19

. 0.09 0.08 0.09 0.07 0.05 0.06 0.04 0.06 0.05 0.05 0.05 0.04 0.03 0.03 0.05 0.05

. 0.16 0.17 0.21 0.15 0.14 0.11 0.12 0.11 0.07 0.09 0.13 0.09 0.08 0.09 0.10 0.10

. 0.48 0.46 0.54 0.49 0.54 0.56 0.57 0.57 0.55 0.53 0.56 0.55 0.52 0.47 0.49 0.47

. 1.78 2.01 2.18 2.22 2.38 2.61 2.76 2.87 2.91 2.88 2.71 2.62 2.58 2.56 2.52 2.60

. 22.67 26.78 28.76 31.91 37.17 41.20 47.16 51.09 53.56 56.03 50.29 49.39 50.04 49.21 51.40 49.58

. – – – – – –––– 0.00 ––––––

. 0.00 0.00 – – – – 0.00 ––––– 0.00 – – –

. – 0.01 – – – – 0.01 –––––––––

Series 4, No. 30 [ Page 11
72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States,

ed age group]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.00 0.01 0.00 0.00 0.00 – 0.00 0.00 0.00 0.00 0.03 0.06 0.02 0.00 – –

. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.00 – –

. – – – – – – –––– 0.00 – – – – –

. 0.11 0.12 0.12 0.10 0.12 0.10 0.09 0.08 0.08 0.05 0.08 0.05 0.05 0.04 0.05 0.04

. 0.37 0.37 0.43 0.37 0.38 0.40 0.41 0.42 0.51 0.54 0.60 0.61 0.77 0.82 1.06 1.27

. 1.02 1.17 1.06 1.14 1.17 1.11 1.31 1.46 1.66 1.90 2.24 2.43 2.51 2.75 3.19 3.97

. 0.01 0.00 0.01 0.01 0.01 0.01 0.01 0.01 0.02 0.02 0.02 0.03 0.03 0.02 0.02 0.01

. 0.04 0.02 0.03 0.03 0.02 0.01 0.02 0.01 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.01

. 0.51 0.49 0.37 0.31 0.33 0.29 0.18 0.21 0.19 0.15 0.17 0.15 0.14 0.15 0.12 0.14

. 0.65 0.62 0.58 0.63 0.61 0.64 0.70 0.78 1.48 1.55 1.71 1.66 1.72 1.67 1.84 1.87

. 1.37 1.42 1.54 1.58 1.88 2.58 3.40 4.61 12.29 14.72 19.00 21.26 24.13 26.84 29.24 32.51

. 6.18 7.69 7.72 8.01 8.30 9.03 9.83 10.49 10.91 12.01 12.47 12.03 11.54 11.68 12.24 12.02

. 5.14 5.19 4.84 4.98 4.75 4.44 4.35 4.33 4.11 4.00 3.99 3.87 3.85 3.79 3.70 3.61

. 142.71 142.91 139.41 138.35 136.56 136.21 134.64 130.96 128.75 127.02 124.52 123.37 121.30 118.60 117.13 115.56

. 986.60 1,011.33 1,008.60 1,023.90 1,033.97 1,045.17 1,051.07 1,062.41 1,067.30 1,076.25 1,095.85 1,111.32 1,117.27 1,121.80 1,133.69 1,134.53

. 0.04 0.03 0.04 0.05 0.04 0.03 0.03 0.04 0.03 0.04 0.04 0.03 0.03 0.03 0.03 0.03

. 3.94 3.80 3.62 3.50 3.42 3.35 3.10 3.01 2.83 2.84 2.79 2.71 2.65 2.51 2.55 2.37

. 17.46 17.41 17.14 17.03 16.59 16.30 16.21 16.02 15.17 15.43 14.88 15.89 15.25 14.87 14.78 14.24

. 0.22 0.26 0.22 0.26 0.22 0.19 0.22 0.18 0.19 0.17 0.18 0.17 0.19 0.19 0.19 0.20

. 31.56 30.88 29.98 29.41 28.81 28.74 27.97 26.89 26.40 25.55 24.82 24.70 24.46 24.02 23.91 23.80

. 300.88 302.48 298.10 296.40 295.36 298.07 293.47 289.76 287.11 284.28 287.91 287.30 283.66 282.87 282.74 281.38

. 0.08 0.09 0.08 0.09 0.10 0.10 0.08 0.07 0.06 0.07 0.07 0.07 0.07 0.07 0.06 0.06

. 43.42 43.81 43.32 43.48 42.88 42.88 42.54 41.48 41.25 40.77 39.93 39.79 38.36 37.38 36.70 35.45

. 227.89 240.47 242.72 252.37 259.47 264.90 271.08 277.79 285.67 291.23 300.18 308.51 313.71 317.12 322.18 323.26

. 0.02 0.02 0.02 0.03 0.03 0.02 0.02 0.02 0.02 0.02 0.01 0.02 0.02 0.01 0.02 0.01

. 16.60 16.81 16.33 16.20 15.96 16.08 16.01 15.54 15.32 15.31 14.89 14.75 14.48 13.80 13.52 13.39

. 67.95 69.88 71.64 72.89 73.20 75.51 75.57 76.24 76.00 78.00 79.65 80.27 79.27 78.44 79.38 78.63

Page 12 [ Series 4, No. 30
72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States,

ed age group]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.24 0.25 0.22 0.21 0.24 0.19 0.18 0.16 0.14 0.14 0.14 0.13 0.11 0.12 0.12 0.11

. 12.05 11.90 11.53 11.14 10.89 10.56 10.33 10.18 9.71 9.63 9.53 9.60 9.35 9.23 8.88 8.93

. 129.17 130.87 129.18 130.19 131.85 131.01 131.40 134.02 134.55 137.12 139.69 145.42 147.36 148.36 148.10 147.74

. 0.14 0.12 0.12 0.11 0.13 0.09 0.09 0.10 0.08 0.11 0.09 0.08 0.09 0.08 0.07 0.08

. 4.62 4.57 4.43 4.46 4.31 4.20 4.21 4.14 4.09 3.91 4.01 4.00 4.00 3.96 3.89 3.87

. 49.47 50.17 49.66 49.88 49.41 48.97 48.72 48.42 48.38 48.27 49.29 49.91 50.19 50.80 50.53 51.81

. 2.04 2.06 1.97 2.03 1.92 1.85 1.83 1.83 1.76 1.73 1.75 1.72 1.70 1.66 1.70 1.64

. 18.62 18.97 18.66 18.61 18.78 18.76 18.99 18.55 18.30 18.09 17.44 16.81 16.95 16.72 16.82 16.64

. 107.50 111.18 112.01 113.73 115.73 117.52 119.01 122.39 123.51 123.40 122.41 120.13 121.27 122.37 126.61 126.49

. 1.75 1.72 1.55 1.60 1.48 1.41 1.35 1.36 1.33 1.26 1.24 1.22 1.20 1.21 1.15 1.13

. 4.70 4.87 4.57 4.45 4.49 4.53 4.39 4.26 4.13 4.06 4.14 4.09 3.98 4.00 3.97 3.88

. 37.36 37.99 37.40 38.23 37.78 37.79 38.35 37.96 37.24 37.89 38.86 39.48 40.06 40.05 40.32 40.46

. 0.62 0.64 0.64 0.60 0.59 0.55 0.55 0.58 0.49 0.47 0.47 0.43 0.45 0.43 0.38 0.36

. 7.19 7.31 6.97 7.11 7.02 7.12 7.11 6.91 6.71 6.86 6.97 6.91 7.07 6.98 6.89 7.24

. 48.93 50.90 50.74 53.17 54.60 55.10 57.26 59.81 59.68 60.63 62.97 64.42 66.49 66.91 69.05 70.52

. 0.34 0.36 0.33 0.37 0.34 0.33 0.35 0.39 0.33 0.37 0.32 0.37 0.34 0.35 0.33 0.38

. 1.90 1.92 1.73 1.75 1.63 1.50 1.56 1.52 1.34 1.39 1.33 1.31 1.29 1.31 1.37 1.37

. 14.25 14.86 15.33 15.51 15.75 15.74 15.97 15.69 15.63 15.54 15.43 15.28 15.82 15.60 16.25 16.06

. 0.24 0.19 0.21 0.21 0.19 0.17 0.18 0.19 0.18 0.18 0.21 0.17 0.18 0.18 0.17 0.16

. 8.54 8.81 8.43 8.18 8.45 7.89 8.06 8.12 8.20 8.61 9.44 9.46 9.51 9.62 10.00 10.41

. 95.30 98.69 96.04 94.15 96.61 94.99 96.01 93.96 95.78 98.09 113.42 114.30 115.04 115.66 123.58 128.48

. 0.06 0.05 0.05 0.05 0.06 0.03 0.05 0.04 0.05 0.04 0.03 0.03 0.04 0.04 0.04 0.04

. 0.27 0.24 0.22 0.19 0.19 0.17 0.19 0.19 0.16 0.17 0.17 0.17 0.15 0.17 0.16 0.16

. 7.41 8.06 7.77 8.09 8.73 8.49 9.15 8.96 8.94 9.06 9.13 8.92 8.70 8.91 9.77 9.65

. 0.36 0.32 0.29 0.31 0.33 0.32 0.28 0.28 0.25 0.26 0.27 0.28 0.25 0.33 0.28 0.26

. 0.63 0.63 0.60 0.55 0.60 0.54 0.60 0.54 0.61 0.56 0.63 0.64 0.61 0.62 0.60 0.67

. 8.63 8.87 9.03 8.89 9.11 9.35 9.62 9.65 9.57 9.60 9.63 9.74 9.78 9.69 9.93 9.78

. 0.75 0.82 0.72 0.64 0.63 0.57 0.53 0.46 0.45 0.46 0.41 0.38 0.25 0.24 0.22 0.23

. 0.33 0.29 0.35 0.29 0.28 0.27 0.26 0.29 0.31 0.25 0.27 0.27 0.23 0.22 0.21 0.22

. 1.34 1.32 1.32 1.34 1.37 1.27 1.45 1.37 1.27 1.43 1.13 1.08 1.14 0.91 0.93 0.80

Series 4, No. 30 [ Page 13
72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States,

ed age group]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 3.42 3.83 3.51 3.52 3.74 3.78 3.69 3.72 3.62 3.63 3.20 3.22 3.22 3.11 3.15 3.14

. 184.35 179.95 172.79 164.61 159.99 153.64 148.17 141.29 135.00 129.74 121.44 116.20 112.81 110.47 110.46 108.08

. 3,025.74 3,099.23 2,974.10 2,912.38 2,906.01 2,839.49 2,812.87 2,740.06 2,685.52 2,673.81 2,530.61 2,463.60 2,418.25 2,375.11 2,437.96 2,391.45

. 2.52 2.88 2.68 2.74 2.91 2.98 2.91 3.02 2.93 2.91 2.53 2.53 2.52 2.45 2.42 2.45

. 155.21 151.87 146.05 139.62 135.74 130.04 125.57 119.47 113.69 109.00 101.59 96.87 94.02 91.86 91.79 89.41

. 2,256.05 2,330.41 2,253.52 2,227.21 2,240.05 2,193.26 2,182.08 2,133.93 2,089.34 2,083.18 1,968.60 1,914.03 1,880.98 1,844.51 1,891.03 1,840.67

. 0.11 0.13 0.08 0.10 0.08 0.11 0.10 0.07 0.07 0.08 0.06 0.06 0.04 0.06 0.05 0.07

. 2.95 2.82 2.47 2.21 2.16 1.96 1.80 1.65 1.51 1.42 1.29 1.25 1.17 1.10 1.05 0.97

. 18.23 18.35 17.51 16.75 15.91 16.29 15.44 15.14 15.15 15.22 14.39 14.09 13.89 13.05 13.16 12.20

. 0.02 0.02 0.02 0.03 0.01 0.02 0.03 0.02 0.02 0.03 0.02 0.02 0.03 0.02 0.02 0.02

. 5.40 5.10 5.08 4.76 4.77 4.49 4.47 4.23 4.23 4.11 4.06 3.92 3.91 4.04 4.05 4.27

. 60.73 61.07 57.95 57.52 56.79 55.51 54.81 53.11 52.32 52.03 51.65 51.75 51.30 51.25 53.88 54.89

. 0.01 0.00 0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.01 0.00 0.00 0.01 0.00

. 0.44 0.44 0.38 0.32 0.32 0.27 0.32 0.29 0.30 0.28 0.25 0.29 0.27 0.28 0.26 0.27

. 12.66 12.65 11.16 9.94 9.89 9.10 8.51 7.42 7.26 6.95 6.73 6.43 6.59 6.59 6.43 6.42

. 0.20 0.22 0.24 0.25 0.24 0.26 0.20 0.18 0.20 0.20 0.18 0.18 0.19 0.16 0.19 0.17

. 115.40 111.52 106.20 101.21 96.00 90.71 86.03 79.65 74.72 69.97 65.98 62.70 60.33 58.06 56.97 55.23

. 1,708.36 1,745.15 1,671.31 1,639.50 1,618.28 1,563.15 1,530.60 1,464.19 1,420.40 1,403.48 1,352.67 1,317.57 1,283.19 1,251.68 1,264.80 1,228.38

. 0.13 0.15 0.15 0.16 0.15 0.14 0.13 0.10 0.12 0.11 0.11 0.11 0.10 0.10 0.09 0.10

. 79.03 74.22 69.64 65.98 61.60 57.45 53.43 48.30 44.66 40.99 38.94 36.66 34.97 33.38 32.30 31.27

. 863.11 860.42 823.21 810.07 789.16 761.62 742.55 699.38 671.58 654.30 645.22 619.14 598.55 575.20 563.41 544.12

. 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.01 0.00 0.01 0.00 0.00 0.00

. 1.57 1.52 1.43 1.30 1.18 1.10 1.10 1.03 0.87 0.76 0.76 0.80 0.75 0.69 0.63 0.58

. 12.30 12.25 11.34 9.93 9.92 9.86 9.35 8.99 8.32 8.14 7.88 7.46 7.31 7.01 6.49 6.25

. 0.00 – – 0.00 0.00 0.00 0.00 0.00 – – – 0.00 – 0.00 0.00 0.00

. 0.10 0.11 0.11 0.12 0.12 0.15 0.13 0.14 0.12 0.11 0.12 0.09 0.09 0.08 0.09 0.09

. 1.56 1.72 1.72 1.77 2.20 2.41 2.72 2.84 2.98 2.96 3.00 3.07 2.97 2.76 2.63 2.38

. 0.06 0.07 0.08 0.08 0.08 0.10 0.07 0.07 0.08 0.07 0.06 0.07 0.08 0.06 0.09 0.07

. 34.70 35.66 35.02 33.81 33.10 32.01 31.37 30.19 29.06 28.11 26.17 25.15 24.51 23.89 23.95 23.28

. 831.39 870.77 835.03 817.74 817.00 789.26 775.98 752.98 737.52 738.08 696.56 687.91 674.36 666.71 692.27 675.63

Page 14 [ Series 4, No. 30
72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States,

ed age group]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.09 0.10 0.08 0.09 0.09 0.09 0.10 0.08 0.09 0.07 0.09 0.08 0.09 0.08 0.06 0.07

. 1.43 1.49 1.40 1.38 1.31 1.30 1.33 1.30 1.36 1.34 1.31 1.34 1.23 1.24 1.25 1.21

. 19.48 21.42 21.83 23.03 24.84 25.59 27.60 29.27 31.11 33.24 34.11 36.15 37.97 39.23 41.15 41.40

. 2.09 2.41 2.25 2.28 2.48 2.51 2.48 2.66 2.55 2.52 2.18 2.18 2.17 2.12 2.09 2.11

. 29.59 30.49 30.51 29.74 31.19 31.30 31.62 32.34 31.57 31.89 28.70 27.37 27.11 27.14 28.21 27.45

. 436.61 471.76 473.75 480.46 514.34 523.62 545.13 564.81 563.11 572.26 509.06 488.04 488.03 482.71 511.62 497.37

. 0.03 0.03 0.02 0.02 0.02 0.01 0.02 0.02 0.02 0.01 0.03 0.02 0.02 0.02 0.02 0.03

. 1.39 1.45 1.35 1.24 1.23 1.24 1.21 1.18 1.15 1.21 1.18 1.20 1.20 1.23 1.40 1.34

. 22.99 24.43 23.22 23.00 23.07 22.70 22.21 22.59 22.66 23.05 23.64 24.55 25.07 26.77 28.60 29.99

. 0.72 0.78 0.68 0.62 0.67 0.65 0.62 0.53 0.55 0.60 0.53 0.55 0.57 0.52 0.59 0.54

. 22.64 21.51 20.63 19.15 18.38 17.88 17.02 16.44 16.03 15.53 14.65 14.33 13.82 13.69 13.61 13.78

. 576.59 573.07 534.71 506.47 489.72 476.97 465.71 445.94 438.07 434.05 412.84 403.52 394.10 388.51 401.40 405.15

. 0.32 0.33 0.30 0.28 0.29 0.28 0.25 0.22 0.20 0.21 0.21 0.19 0.19 0.18 0.18 0.16

. 6.30 6.03 5.84 5.56 5.24 5.25 5.13 4.96 5.00 4.92 4.72 4.59 4.45 4.47 4.46 4.56

. 58.89 54.80 51.45 50.07 48.11 49.66 50.85 49.33 48.58 49.66 47.43 46.92 46.50 46.83 46.92 46.90

. 0.06 0.06 0.05 0.05 0.06 0.06 0.06 0.05 0.06 0.07 0.06 0.06 0.07 0.04 0.06 0.07

. 3.06 2.81 2.45 2.22 2.17 2.08 1.89 1.80 1.68 1.53 1.35 1.32 1.18 1.06 1.00 0.95

. 129.05 121.25 107.83 96.39 87.36 81.79 78.20 73.27 68.51 64.10 58.82 53.21 47.58 43.87 42.29 40.10

. 0.00 0.01 0.00 0.00 0.00 0.01 0.00 0.01 0.00 0.00 0.00 – 0.01 – 0.00 –

. 0.14 0.14 0.13 0.11 0.09 0.10 0.09 0.08 0.09 0.07 0.06 0.06 0.05 0.05 0.06 0.06

. 2.77 2.49 2.52 2.38 2.32 2.34 2.39 2.34 2.14 2.15 1.95 1.87 1.76 1.74 1.72 1.90

. 0.34 0.38 0.33 0.29 0.32 0.30 0.31 0.25 0.29 0.32 0.26 0.30 0.31 0.30 0.34 0.31

. 13.13 12.54 12.21 11.27 10.88 10.44 9.92 9.60 9.26 9.00 8.51 8.37 8.12 8.11 8.10 8.21

. 385.88 394.53 372.90 357.63 351.94 343.19 334.27 321.00 318.84 318.14 304.64 301.52 298.26 296.08 310.47 316.26

. 0.00 0.00 0.00 0.01 0.01 0.01 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00

. 1.21 1.27 1.16 1.13 1.11 0.96 0.96 0.94 0.90 0.83 0.75 0.70 0.66 0.64 0.61 0.58

. 109.52 109.91 101.90 95.33 91.70 83.71 80.13 74.31 72.14 69.90 60.02 55.21 52.18 49.56 50.22 49.25

. 0.15 0.14 0.13 0.12 0.14 0.13 0.14 0.15 0.12 0.10 0.11 0.11 0.11 0.12 0.11 0.11

. 3.90 3.86 3.61 3.47 3.52 3.53 3.41 3.26 3.23 3.17 3.27 3.11 3.12 3.06 3.05 2.97

. 60.58 61.41 60.75 60.37 61.47 62.84 62.75 63.31 63.31 63.64 65.50 66.30 65.92 65.77 66.71 66.38

Series 4, No. 30 [ Page 15
72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States,

ed age group]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.15 0.15 0.13 0.12 0.12 0.10 0.10 0.09 0.11 0.11 0.11 0.11 0.10 0.13 0.11 0.12

. 0.09 0.10 0.08 0.08 0.08 0.07 0.07 0.05 0.06 0.07 0.06 0.06 0.06 0.06 0.07 0.05

. 1.24 1.55 1.37 1.13 1.27 1.33 1.51 1.51 1.26 1.47 1.49 1.44 1.44 1.17 1.43 1.21

. 2.07 1.94 1.64 1.55 1.51 1.43 1.43 1.41 1.36 1.35 1.39 1.29 1.32 1.22 1.18 1.14

. 6.14 6.78 6.51 5.72 5.82 5.87 6.30 6.40 6.10 6.53 6.28 6.19 5.96 5.43 5.94 5.71

. 145.64 178.13 171.75 153.16 174.70 182.05 207.02 209.60 204.35 226.89 219.67 226.79 217.18 209.11 225.34 219.44

. 2.03 1.89 1.59 1.52 1.49 1.40 1.40 1.37 1.34 1.32 1.33 1.25 1.26 1.19 1.14 1.11

. 6.09 6.61 6.28 5.65 5.73 5.79 6.18 6.29 6.04 6.44 6.16 6.08 5.87 5.37 5.87 5.62

. 143.58 168.47 161.42 150.81 169.96 178.56 200.40 203.84 202.56 220.92 215.13 220.64 214.13 206.35 222.59 216.16

. 0.04 0.05 0.05 0.02 0.03 0.03 0.03 0.04 0.02 0.03 0.06 0.04 0.06 0.03 0.05 0.02

. 0.05 0.17 0.22 0.07 0.10 0.08 0.12 0.11 0.06 0.10 0.12 0.12 0.09 0.07 0.07 0.09

. 2.06 9.67 10.34 2.36 4.74 3.49 6.62 5.76 1.80 5.97 4.54 6.16 3.05 2.76 2.76 3.28

. 0.34 0.35 0.37 0.44 0.42 0.39 0.42 0.43 0.47 0.42 0.43 0.44 0.48 0.43 0.48 0.49

. 10.77 11.31 11.29 10.74 11.35 11.31 11.55 11.25 11.07 11.19 11.14 10.66 10.70 10.22 10.73 10.54

. 152.21 170.60 175.76 177.04 193.36 199.52 213.37 215.97 217.55 227.79 228.05 234.10 240.64 242.24 263.71 262.52

. 0.13 0.09 0.10 0.09 0.08 0.08 0.08 0.07 0.10 0.08 0.08 0.08 0.10 0.08 0.08 0.07

. 0.74 0.69 0.65 0.58 0.55 0.52 0.48 0.47 0.43 0.46 0.43 0.42 0.44 0.41 0.40 0.37

. 10.94 11.35 10.97 10.31 10.51 10.28 10.46 10.75 10.00 10.22 10.24 9.61 9.67 9.48 9.68 9.10

. 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.00 0.00 0.01 0.01 0.01

. 3.03 2.91 2.69 2.45 2.44 2.32 2.37 2.36 2.28 2.25 2.22 2.14 2.08 1.95 2.10 1.96

. 41.25 42.08 39.67 37.46 38.36 37.87 39.92 40.09 39.47 42.23 41.28 41.80 43.30 42.78 45.15 43.99

. 0.17 0.21 0.21 0.29 0.28 0.26 0.31 0.32 0.34 0.31 0.30 0.33 0.35 0.33 0.37 0.39

. 1.00 1.04 1.14 1.13 1.31 1.22 1.31 1.24 1.39 1.45 1.45 1.43 1.48 1.37 1.43 1.57

. 5.51 6.20 6.13 6.05 6.65 6.85 7.22 7.50 7.97 8.36 9.04 8.72 9.04 8.89 8.95 9.11

. 0.02 0.04 0.05 0.05 0.05 0.04 0.03 0.03 0.03 0.03 0.03 0.03 0.03 0.02 0.02 0.02

. 6.01 6.68 6.81 6.58 7.06 7.24 7.39 7.18 6.97 7.02 7.04 6.67 6.69 6.48 6.80 6.64

. 94.51 110.97 118.99 123.22 137.85 144.51 155.77 157.64 160.10 166.98 167.48 173.97 178.64 181.09 199.92 200.32

. 0.05 0.06 0.05 0.04 0.03 0.03 0.03 0.03 0.03 0.05 0.03 0.03 0.02 0.02 0.03 0.03

. 1.39 1.35 1.32 1.23 1.09 1.10 1.04 0.99 0.90 0.89 0.85 0.80 0.81 0.74 0.76 0.76

. 17.44 18.05 19.05 19.87 18.62 18.87 18.95 18.14 17.65 17.55 17.47 16.56 15.91 15.92 14.99 15.21

Page 16 [ Series 4, No. 30
72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States,

ed age group]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.07 0.08 0.05 0.06 0.05 0.04 0.04 0.05 0.03 0.04 0.04 0.04 0.03 0.03 0.04 0.03

. 0.19 0.21 0.15 0.13 0.12 0.11 0.11 0.12 0.10 0.10 0.09 0.10 0.09 0.08 0.09 0.08

. 1.66 1.59 1.42 1.20 1.28 1.18 1.19 1.12 1.12 1.02 0.97 0.88 0.75 0.85 0.67 0.71

. 0.28 0.25 0.23 0.23 0.19 0.19 0.16 0.21 0.19 0.15 0.17 0.17 0.16 0.16 0.15 0.13

. 0.81 0.80 0.65 0.63 0.59 0.56 0.55 0.54 0.53 0.52 0.51 0.47 0.50 0.46 0.43 0.49

. 16.82 16.96 16.61 15.45 15.52 16.07 16.06 15.89 15.96 16.00 15.46 16.35 16.74 16.50 15.92 16.15

. 0.16 0.19 0.17 0.15 0.12 0.13 0.10 0.11 0.11 0.09 0.10 0.08 0.07 0.07 0.08 0.06

. 19.52 19.47 17.70 16.14 15.49 14.88 14.29 13.47 13.34 13.23 12.80 12.08 11.60 11.26 11.19 11.21

. 35.64 37.26 37.03 35.38 34.69 35.58 34.48 34.07 33.19 33.00 34.34 33.51 32.76 32.43 31.51 31.18

. 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.02 0.01 0.01 0.01 0.01 0.02 0.01 0.01 0.02

. 0.48 0.48 0.41 0.38 0.40 0.37 0.35 0.29 0.31 0.31 0.30 0.27 0.27 0.28 0.25 0.28

. 10.44 10.77 10.00 9.34 9.22 9.25 8.97 8.95 8.92 9.05 8.67 8.58 7.93 7.86 7.36 7.42

. 0.46 0.42 0.46 0.43 0.40 0.45 0.44 0.43 0.37 0.38 0.33 0.28 0.32 0.31 0.30 0.26

. 3.15 3.16 2.97 2.98 2.94 2.93 3.01 2.93 2.84 2.91 2.63 2.53 2.41 2.42 2.49 2.29

. 47.62 50.76 51.81 53.61 55.81 58.48 61.21 61.54 61.60 61.26 57.07 55.68 56.57 57.97 60.24 59.31

. 0.03 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.01 0.02 0.02 0.02 0.02 0.02 0.01

. 0.06 0.07 0.05 0.07 0.06 0.06 0.07 0.05 0.04 0.05 0.05 0.05 0.05 0.04 0.04 0.04

. 0.97 0.88 0.86 0.82 0.98 0.84 0.88 0.73 0.69 0.78 0.75 0.69 0.77 0.71 0.67 0.74

. 0.06 0.04 0.04 0.04 0.04 0.03 0.02 0.03 0.03 0.02 0.03 0.02 0.03 0.02 0.02 0.01

. 0.51 0.46 0.40 0.37 0.33 0.33 0.25 0.25 0.23 0.24 0.24 0.25 0.21 0.20 0.20 0.19

. 7.06 6.72 6.00 5.57 5.40 5.08 4.43 4.07 4.05 4.01 3.87 3.82 3.83 3.80 3.98 3.87

. 0.38 0.36 0.40 0.38 0.34 0.41 0.40 0.38 0.33 0.34 0.29 0.23 0.27 0.27 0.26 0.24

. 2.58 2.63 2.51 2.54 2.56 2.55 2.70 2.64 2.56 2.62 2.34 2.24 2.16 2.18 2.25 2.06

. 39.60 43.16 44.95 47.22 49.44 52.57 55.90 56.73 56.85 56.47 52.45 51.17 51.96 53.47 55.58 54.70

. 0.03 0.02 0.02 0.02 0.02 0.02 0.02 0.01 0.02 0.02 0.02 0.02 0.03 0.01 0.01 0.01

. 0.36 0.33 0.28 0.25 0.23 0.24 0.19 0.19 0.17 0.16 0.14 0.14 0.13 0.11 0.12 0.10

. 9.79 9.23 7.55 7.16 6.60 6.40 6.14 5.62 5.14 4.62 3.97 3.54 3.25 2.87 2.62 2.49

Series 4, No. 30 [ Page 17
72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States,

ed age group]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. – – – – – – ––––––––––

. 0.03 0.03 0.02 0.02 0.02 0.02 0.02 0.02 0.01 0.02 0.02 0.01 0.01 0.01 0.01 0.01

. 3.11 2.83 2.54 2.36 2.00 1.83 1.62 1.67 1.52 1.42 1.40 1.41 1.31 1.21 1.20 1.19

. 0.13 0.12 0.13 0.09 0.12 0.09 0.10 0.10 0.08 0.12 0.11 0.12 0.11 0.12 0.09 0.12

. 0.20 0.21 0.17 0.18 0.15 0.18 0.17 0.15 0.14 0.18 0.18 0.19 0.17 0.16 0.16 0.16

. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

. 0.03 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.01 0.03 0.02 0.02 0.02 0.02 0.02 0.01

. 0.03 0.04 0.03 0.03 0.03 0.03 0.02 0.03 0.03 0.03 0.02 0.03 0.03 0.03 0.02 0.02

. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

. 0.10 0.10 0.11 0.07 0.10 0.06 0.08 0.08 0.07 0.10 0.09 0.10 0.09 0.10 0.07 0.11

. 0.17 0.17 0.14 0.15 0.13 0.15 0.15 0.12 0.12 0.15 0.15 0.16 0.15 0.13 0.14 0.14

. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

. 11.82 12.16 11.84 12.01 11.54 11.41 11.29 11.07 10.75 11.07 11.04 11.11 10.37 9.99 9.58 9.07

. 1.55 1.58 1.45 1.39 1.38 1.41 1.29 1.28 1.31 1.33 1.36 1.34 1.34 1.38 1.43 1.42

. 3.12 3.27 3.27 3.28 3.38 3.23 3.24 3.47 3.32 3.57 3.85 4.13 4.33 4.61 5.09 5.04

. 24.93 24.37 23.12 22.35 20.86 20.51 21.01 20.17 20.07 20.08 20.67 19.42 18.32 17.05 16.25 15.51

. 0.01 0.01 0.00 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01

. 0.01 0.01 0.01 0.01 0.01 – 0.00 0.01 0.01 0.01 0.01 0.02 0.00 0.02 0.02 0.01

. 8.53 8.08 7.14 6.64 5.80 5.61 5.70 5.15 4.79 4.65 5.10 4.25 3.73 3.17 2.81 2.54

. 0.00 0.00 0.00 0.01 0.00 0.00 0.01 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.01

. – – – 0.00 – – –––– 0.00 – – 0.00 0.01 0.01

. 16.40 16.29 15.98 15.71 15.05 14.90 15.31 15.03 15.27 15.43 15.57 15.17 14.59 13.88 13.43 12.97

. 0.01 0.01 0.00 0.00 0.01 0.01 0.00 0.01 0.00 0.01 0.01 0.00 0.01 0.01 0.01 0.01

. 0.01 0.01 0.01 0.00 0.01 – 0.00 0.01 0.01 0.01 0.01 0.02 0.00 0.02 0.01 0.01

. 7.63 7.90 7.82 7.86 7.70 7.57 7.74 8.09 8.24 8.61 8.64 8.27 8.09 7.45 7.29 6.43

. 7.32 7.37 7.56 7.64 6.83 6.66 6.96 7.05 7.50 6.89 6.14 5.33 5.13 4.67 5.55 5.02

. 50.15 52.56 52.61 51.84 53.53 53.71 54.80 53.33 49.13 48.25 37.02 31.46 32.26 32.24 37.74 37.58

Page 18 [ Series 4, No. 30
72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States,

ed age group]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 7.38 7.33 7.01 6.61 6.68 6.50 6.43 6.36 5.87 5.86 6.07 5.82 5.88 5.58 5.61 5.24

. 31.03 31.51 30.43 28.84 29.75 29.74 31.85 33.61 28.75 29.21 28.28 27.62 27.66 27.35 27.93 28.23

. 269.33 291.99 296.72 304.54 328.85 347.95 373.66 385.82 405.96 419.77 425.21 426.56 430.86 433.77 468.12 486.24

. 39.08 38.29 34.86 32.18 30.36 30.07 29.67 30.79 29.49 29.27 27.15 25.74 24.65 22.08 22.55 22.31

. 42.11 41.84 40.32 36.68 35.49 35.15 34.91 34.93 34.69 35.11 34.63 33.35 31.20 30.37 31.54 31.52

. 95.63 97.24 90.55 85.95 87.18 87.49 87.87 86.65 87.21 89.62 87.46 84.34 83.28 82.52 84.78 85.39

. 25.33 24.75 22.68 20.36 19.21 19.73 19.44 20.60 19.87 19.92 18.13 17.38 16.12 14.36 14.60 14.82

. 22.57 22.53 22.10 19.08 18.44 18.96 18.58 18.86 19.22 19.25 19.01 18.75 16.83 15.81 15.88 15.73

. 23.43 22.61 22.42 20.45 20.64 21.89 21.66 22.10 22.89 23.77 23.63 23.20 22.18 21.85 22.34 22.93

. 13.75 13.54 12.18 11.82 11.15 10.35 10.24 10.19 9.62 9.35 9.02 8.36 8.54 7.72 7.95 7.49

. 19.54 19.31 18.22 17.60 17.05 16.19 16.33 16.07 15.47 15.86 15.63 14.59 14.37 14.55 15.67 15.79

. 72.21 74.62 68.13 65.51 66.53 65.60 66.21 64.55 64.33 65.86 63.82 61.14 61.10 60.67 62.44 62.46

. 5.75 5.74 5.70 5.62 5.46 5.72 5.90 5.90 5.70 5.71 5.64 5.65 5.48 5.44 5.57 5.66

. 16.19 15.79 16.18 16.16 15.75 15.94 15.48 16.03 15.70 15.23 15.04 15.28 15.13 14.77 14.90 14.81

. 18.71 17.76 17.08 18.36 19.31 19.79 20.37 21.63 21.82 21.12 20.30 20.57 19.74 19.09 18.94 18.12

. 7.49 8.09 7.67 7.23 6.39 6.34 6.27 7.20 7.02 7.64 8.19 9.44 10.36 10.16 10.66 10.16

. 13.39 14.17 13.76 12.74 11.39 10.97 10.91 11.48 10.89 11.05 11.25 11.84 12.13 11.36 11.23 10.64

. 5.21 5.55 5.00 4.93 4.54 4.27 4.30 4.50 4.59 4.42 4.17 4.03 4.11 3.81 3.69 3.46

. 1.13 1.02 0.96 0.82 0.77 0.75 0.63 0.68 0.68 0.68 0.55 0.49 0.50 0.50 0.62 0.63

. 2.24 2.10 2.03 1.83 1.74 1.65 1.61 1.76 1.66 1.64 1.51 1.32 1.36 1.65 1.92 1.90

. 1.74 1.80 1.86 1.38 1.46 1.43 1.20 1.24 1.21 1.20 0.91 0.82 0.83 0.79 0.88 0.84

. ... ... ... ... ... ... ... ... 0.80 0.87 1.00 0.94 1.05 1.02 1.14 1.20

. ... ... ... ... ... ... ... ... 10.19 12.47 16.53 18.83 21.75 24.48 26.89 30.10

. ... ... ... ... ... ... ... ... 1.07 1.25 1.33 1.44 1.73 1.92 1.97 2.09

. – – – 0.00 – 0.00 0.00 –––– 0.00 – – 0.00 0.00

. 0.19 0.26 0.26 0.33 0.35 0.35 0.37 0.37 0.36 0.35 0.30 0.28 0.27 0.23 0.25 0.27

. 2.60 4.06 5.62 8.44 14.76 20.97 27.52 30.96 36.71 39.31 41.51 43.08 43.36 43.80 50.11 54.94

er for Health Statistics introduced categories *042–*044 for classifying and coding Human immunodeficiency virus infection. The asterisks indicate that these categories are not part of the Ninth Revision,

ses shown above.

Series 4, No. 30 [ Page 19
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 117.60 115.89 108.21 103.54 98.63 98.10 96.73 97.95 95.94 96.82 95.10 92.72 91.07 86.32 87.67 85.61

. 461.49 461.73 452.39 437.54 432.52 428.80 428.85 426.62 423.99 423.18 417.49 411.52 408.18 401.24 406.03 403.40

. 4,317.87 4,454.11 4,320.12 4,255.26 4,290.10 4,256.68 4,275.51 4,224.95 4,175.46 4,185.91 4,064.64 4,009.74 3,949.97 3,894.69 3,979.69 3,926.32

. 0.02 0.01 0.01 0.00 0.01 0.00 0.01 0.00 0.01 0.01 0.01 0.00 0.01 0.00 0.00 0.00

. 0.01 0.01 0.01 0.00 0.01 0.00 0.01 0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00

. 0.04 0.04 0.04 0.02 0.05 0.03 0.04 0.01 0.02 0.01 0.02 0.02 0.01 0.02 0.02 0.01

. 0.14 0.15 0.17 0.16 0.15 0.16 0.12 0.13 0.11 0.10 0.11 0.11 0.13 0.14 0.14 0.22

. 0.04 0.05 0.04 0.04 0.04 0.04 0.04 0.06 0.04 0.03 0.03 0.04 0.04 0.04 0.05 0.06

. 0.40 0.50 0.47 0.35 0.43 0.34 0.38 0.36 0.39 0.43 0.46 0.57 0.60 0.71 0.92 0.92

. 0.03 0.02 0.03 0.02 0.03 0.04 0.04 0.03 0.03 0.04 0.04 0.04 0.03 0.03 0.02 0.02

. 0.75 0.68 0.69 0.59 0.59 0.60 0.59 0.63 0.60 0.63 0.65 0.62 0.58 0.54 0.49 0.43

. 4.13 4.27 3.88 3.63 3.47 3.18 3.15 3.00 2.97 3.17 3.21 2.80 2.53 2.63 2.55 2.26

. 0.01 0.01 0.01 0.01 0.02 0.01 0.01 0.01 0.02 0.01 0.02 0.02 0.02 0.01 0.00 0.01

. 0.62 0.55 0.56 0.47 0.46 0.45 0.45 0.47 0.45 0.47 0.48 0.44 0.44 0.40 0.37 0.30

. 3.46 3.59 3.25 3.02 2.82 2.55 2.54 2.47 2.45 2.56 2.60 2.28 1.98 2.11 2.07 1.79

. 0.02 0.02 0.02 0.01 0.01 0.02 0.02 0.01 0.01 0.02 0.02 0.02 0.02 0.02 0.02 0.01

. 0.13 0.13 0.13 0.12 0.13 0.15 0.14 0.16 0.14 0.16 0.17 0.19 0.14 0.14 0.12 0.13

. 0.67 0.68 0.63 0.62 0.64 0.64 0.62 0.54 0.52 0.61 0.61 0.52 0.56 0.52 0.47 0.47

. 0.01 0.01 0.01 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.01 0.01 – 0.00 0.01 0.01

. – –––––––––––––––

. – –––––– 0.00 ––––––––

. 0.01 0.00 0.00 0.00 – – – 0.00 0.00 0.00 0.00 0.00 – – 0.00 0.00

. 0.01 0.00 0.00 0.01 0.00 0.01 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.01

. 0.03 0.02 0.03 0.02 0.01 0.01 0.01 0.01 0.01 0.02 0.01 0.02 0.01 0.01 0.01 0.01

. 0.29 0.28 0.32 0.25 0.21 0.21 0.18 0.19 0.18 0.19 0.18 0.14 0.14 0.13 0.16 0.18

. 0.09 0.08 0.09 0.07 0.05 0.06 0.05 0.06 0.05 0.06 0.05 0.04 0.03 0.03 0.05 0.05

. 0.15 0.16 0.19 0.15 0.13 0.11 0.11 0.11 0.07 0.08 0.12 0.08 0.07 0.07 0.09 0.09

. 0.47 0.45 0.51 0.46 0.51 0.53 0.53 0.53 0.51 0.49 0.50 0.49 0.46 0.42 0.44 0.43

. 1.64 1.85 2.04 2.08 2.25 2.50 2.65 2.81 2.88 2.88 2.73 2.65 2.62 2.61 2.56 2.63

. 19.09 22.20 23.57 25.94 29.87 32.85 37.29 39.80 41.74 43.09 37.88 37.42 37.51 36.92 37.99 36.45

. – –––––––– 0.00 ––––––

. 0.00 0.00 –––– 0.00 ––––– 0.00 – – –

. – 0.01 –––– 0.01 –––––––––

Page 20 [ Series 4, No. 30
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.00 0.01 0.00 0.00 0.00 – 0.00 0.00 0.00 0.00 0.03 0.05 0.02 0.00 – –

. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.00 – –

. – – ––––––– – 0.00 –––––

. 0.11 0.11 0.11 0.09 0.12 0.10 0.09 0.08 0.08 0.05 0.08 0.05 0.05 0.04 0.05 0.04

. 0.35 0.36 0.42 0.36 0.37 0.40 0.41 0.42 0.51 0.55 0.61 0.62 0.78 0.83 1.06 1.26

. 0.99 1.11 1.03 1.11 1.16 1.08 1.31 1.43 1.64 1.85 2.18 2.38 2.50 2.69 3.17 3.93

. 0.01 0.00 0.01 0.01 0.01 0.01 0.01 0.00 0.02 0.02 0.02 0.03 0.03 0.02 0.01 0.01

. 0.03 0.02 0.03 0.02 0.02 0.01 0.02 0.01 0.02 0.02 0.02 0.03 0.02 0.02 0.02 0.01

. 0.47 0.44 0.33 0.27 0.29 0.25 0.15 0.18 0.17 0.12 0.14 0.12 0.11 0.12 0.10 0.13

. 0.65 0.61 0.57 0.61 0.58 0.62 0.66 0.75 1.41 1.50 1.64 1.60 1.66 1.62 1.80 1.85

. 1.30 1.36 1.49 1.54 1.85 2.56 3.40 4.61 12.25 14.67 18.87 21.06 23.81 26.44 28.76 31.91

. 5.65 6.90 6.91 7.30 7.55 8.11 8.85 9.46 9.99 10.90 11.44 11.10 10.71 10.81 11.27 11.27

. 5.09 5.13 4.80 4.93 4.72 4.40 4.32 4.31 4.09 4.00 4.01 3.90 3.90 3.85 3.76 3.68

. 129.60 130.58 129.32 129.61 129.22 130.30 130.28 128.53 128.05 127.43 126.27 125.94 124.72 121.69 119.96 117.94

. 932.37 953.97 949.75 962.26 970.61 979.43 984.27 994.34 996.44 1,001.33 1,017.43 1,028.21 1,029.31 1,030.96 1,037.78 1,036.61

. 0.04 0.03 0.04 0.05 0.04 0.03 0.03 0.04 0.02 0.04 0.04 0.03 0.03 0.03 0.03 0.03

. 3.58 3.48 3.36 3.29 3.25 3.22 3.02 2.98 2.84 2.88 2.84 2.78 2.74 2.59 2.62 2.42

. 17.02 16.94 16.79 16.51 16.11 15.88 15.85 15.47 14.70 14.95 14.39 15.17 14.54 14.21 14.09 13.50

. 0.21 0.25 0.22 0.25 0.21 0.19 0.21 0.18 0.19 0.17 0.18 0.17 0.19 0.20 0.19 0.20

. 28.13 27.72 27.37 27.15 26.94 27.19 26.81 26.19 26.10 25.52 25.11 25.22 25.13 24.66 24.51 24.33

. 277.28 277.84 273.06 270.87 268.95 270.73 266.16 262.71 259.28 255.48 258.13 256.58 251.97 250.72 250.26 248.63

. 0.08 0.09 0.07 0.09 0.10 0.10 0.08 0.06 0.06 0.07 0.07 0.07 0.07 0.07 0.06 0.06

. 38.86 39.48 39.71 40.23 40.14 40.57 40.74 40.37 40.77 40.70 40.39 40.57 39.51 38.47 37.74 36.36

. 230.38 242.82 245.12 254.77 261.86 267.03 273.24 279.22 286.93 291.60 300.39 307.87 311.94 315.19 319.53 320.31

. 0.02 0.02 0.02 0.03 0.03 0.02 0.02 0.02 0.02 0.02 0.01 0.02 0.02 0.01 0.02 0.02

. 15.66 15.93 15.73 15.72 15.58 15.87 15.95 15.67 15.59 15.65 15.32 15.23 14.98 14.18 13.82 13.57

. 64.21 65.88 67.49 68.18 68.48 70.48 70.45 71.10 70.69 72.10 73.47 73.75 72.27 71.61 71.23 70.70

Series 4, No. 30 [ Page 21
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.22 0.24 0.20 0.20 0.23 0.18 0.17 0.15 0.14 0.14 0.14 0.13 0.12 0.12 0.13 0.12

. 10.97 10.88 10.66 10.38 10.25 10.06 9.95 9.94 9.62 9.60 9.61 9.75 9.56 9.42 9.06 9.09

. 117.12 118.00 116.19 116.77 118.12 116.60 117.33 119.45 119.27 121.16 122.55 127.23 127.52 127.70 125.69 125.04

. 0.14 0.12 0.12 0.11 0.13 0.09 0.09 0.10 0.09 0.11 0.09 0.08 0.09 0.08 0.07 0.08

. 4.13 4.08 4.04 4.14 4.02 3.99 4.05 4.04 4.06 3.91 4.06 4.08 4.12 4.07 4.00 3.96

. 45.00 45.76 44.80 45.02 44.42 43.78 43.57 43.16 43.06 43.06 43.71 43.90 44.18 44.24 44.27 45.10

. 2.03 2.05 1.96 2.02 1.91 1.84 1.82 1.82 1.75 1.73 1.75 1.73 1.71 1.67 1.70 1.65

. 17.25 17.68 17.62 17.70 18.02 18.17 18.58 18.35 18.29 18.22 17.72 17.15 17.39 17.11 17.16 16.90

. 101.12 104.34 104.86 106.17 107.81 109.74 110.36 113.81 114.52 114.01 112.68 110.32 111.47 111.74 115.37 114.95

. 1.75 1.72 1.56 1.60 1.48 1.41 1.36 1.36 1.34 1.26 1.25 1.23 1.21 1.22 1.16 1.14

. 4.40 4.57 4.33 4.26 4.33 4.40 4.28 4.19 4.11 4.07 4.17 4.15 4.06 4.08 4.03 3.95

. 33.73 34.28 33.73 34.14 33.70 33.74 34.11 33.72 32.89 33.29 34.52 34.75 35.05 34.90 35.07 34.91

. 0.60 0.62 0.62 0.58 0.58 0.54 0.54 0.57 0.49 0.47 0.48 0.44 0.47 0.45 0.40 0.38

. 6.61 6.75 6.51 6.74 6.69 6.84 6.89 6.80 6.68 6.88 7.04 7.02 7.23 7.12 7.02 7.36

. 46.51 48.11 47.72 49.82 51.15 51.45 53.20 55.70 55.10 55.67 57.58 58.64 60.36 60.66 62.29 63.47

. 0.34 0.36 0.33 0.36 0.34 0.33 0.34 0.38 0.32 0.36 0.31 0.36 0.33 0.34 0.32 0.37

. 1.76 1.80 1.65 1.67 1.57 1.44 1.53 1.50 1.34 1.40 1.35 1.33 1.31 1.33 1.39 1.38

. 12.95 13.38 13.72 13.79 13.66 13.67 13.77 13.33 13.39 13.07 12.87 12.68 12.99 12.71 13.02 12.64

. 0.23 0.19 0.20 0.21 0.19 0.16 0.18 0.19 0.18 0.18 0.21 0.17 0.19 0.19 0.18 0.17

. 7.73 8.03 7.82 7.64 7.97 7.54 7.76 7.95 8.13 8.63 9.53 9.61 9.75 9.84 10.21 10.60

. 84.81 87.97 84.95 82.93 85.15 82.79 83.55 81.69 83.43 84.96 98.61 99.02 99.71 99.89 106.19 110.32

. 0.06 0.05 0.05 0.05 0.05 0.03 0.04 0.03 0.05 0.04 0.03 0.03 0.03 0.04 0.03 0.03

. 0.25 0.22 0.21 0.17 0.18 0.17 0.19 0.18 0.16 0.17 0.17 0.17 0.15 0.17 0.17 0.16

. 5.40 5.80 5.49 5.70 5.97 5.73 6.09 5.95 5.83 5.87 5.82 5.64 5.44 5.47 5.95 5.72

. 0.36 0.32 0.29 0.31 0.32 0.31 0.27 0.28 0.25 0.25 0.27 0.28 0.24 0.32 0.28 0.26

. 0.60 0.59 0.58 0.53 0.58 0.53 0.58 0.53 0.61 0.55 0.63 0.64 0.62 0.63 0.61 0.67

. 6.86 7.05 7.14 6.91 7.01 7.07 7.19 7.10 6.99 6.95 7.02 6.94 6.87 6.78 6.73 6.67

. 0.76 0.81 0.70 0.61 0.60 0.54 0.49 0.42 0.42 0.42 0.36 0.33 0.22 0.21 0.20 0.21

. 0.32 0.28 0.34 0.29 0.28 0.26 0.26 0.28 0.31 0.25 0.28 0.27 0.23 0.22 0.21 0.22

. 1.27 1.25 1.18 1.18 1.26 1.13 1.32 1.25 1.12 1.30 1.04 0.98 1.01 0.81 0.85 0.72

Page 22 [ Series 4, No. 30
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 3.34 3.70 3.37 3.38 3.57 3.63 3.51 3.52 3.44 3.46 3.04 3.05 3.08 2.98 3.06 3.07

. 165.46 162.60 158.80 152.89 150.28 146.01 142.63 137.93 133.79 129.66 122.87 118.41 115.91 113.26 113.03 110.20

. 2,483.59 2,528.34 2,410.60 2,350.23 2,326.22 2,259.46 2,222.92 2,154.85 2,098.37 2,073.55 1,948.98 1,888.89 1,836.03 1,788.53 1,810.03 1,757.79

)

. 2.46 2.79 2.58 2.63 2.77 2.85 2.76 2.86 2.77 2.76 2.39 2.39 2.40 2.34 2.35 2.40

. 139.16 137.08 134.11 129.58 127.43 123.48 120.83 116.59 112.67 108.94 102.81 98.72 96.63 94.24 93.97 91.22

. 1,883.20 1,932.09 1,856.46 1,825.65 1,821.19 1,771.67 1,749.29 1,700.87 1,654.39 1,636.10 1,534.94 1,484.68 1,444.52 1,405.28 1,420.77 1,369.23

. 0.10 0.12 0.08 0.09 0.08 0.10 0.09 0.07 0.07 0.08 0.06 0.06 0.04 0.06 0.05 0.07

. 2.73 2.63 2.32 2.08 2.08 1.89 1.76 1.63 1.50 1.43 1.31 1.27 1.19 1.13 1.07 0.99

. 17.56 17.64 16.72 15.90 14.77 15.13 14.16 13.74 13.70 13.58 12.65 12.27 11.94 11.19 11.14 10.40

. 0.02 0.02 0.02 0.02 0.01 0.02 0.03 0.02 0.02 0.03 0.02 0.02 0.03 0.03 0.02 0.03

. 4.92 4.66 4.74 4.49 4.52 4.33 4.36 4.19 4.25 4.15 4.15 4.02 4.04 4.15 4.15 4.34

. 52.21 52.10 49.15 48.59 47.87 46.33 45.26 43.62 42.89 42.21 41.20 40.99 39.93 39.76 40.96 40.90

. 0.01 0.00 0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.01 0.00 0.00 0.01 0.00

. 0.39 0.40 0.34 0.29 0.29 0.26 0.31 0.28 0.30 0.28 0.25 0.30 0.28 0.28 0.27 0.27

. 9.93 9.79 8.64 7.56 7.50 6.99 6.44 5.63 5.49 5.23 5.07 4.93 4.93 4.84 4.71 4.67

. 0.19 0.21 0.23 0.24 0.23 0.25 0.19 0.18 0.19 0.19 0.17 0.18 0.19 0.17 0.19 0.18

. 102.92 100.17 97.08 93.61 89.83 85.90 82.59 77.57 73.93 69.88 66.75 63.91 62.07 59.65 58.43 56.46

. 1,434.80 1,456.07 1,386.78 1,354.32 1,326.15 1,273.06 1,237.34 1,177.57 1,134.17 1,111.64 1,062.83 1,029.95 993.34 961.40 958.52 922.33

. 0.13 0.14 0.14 0.15 0.14 0.14 0.12 0.10 0.11 0.11 0.11 0.11 0.10 0.10 0.10 0.10

. 70.62 66.80 63.83 61.13 57.74 54.48 51.32 47.14 44.30 41.00 39.44 37.42 36.04 34.33 33.14 31.98

. 772.46 766.93 730.63 715.90 692.52 663.31 641.38 599.97 571.23 550.95 535.81 510.90 488.40 465.76 451.46 432.62

. 0.01 0.00 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.01 0.00 0.01 0.00 0.00 0.00

. 1.42 1.40 1.33 1.23 1.14 1.06 1.08 1.02 0.88 0.78 0.77 0.83 0.77 0.71 0.64 0.60

. 10.92 10.83 9.97 8.81 8.64 8.53 8.06 7.76 6.99 6.76 6.49 6.22 6.02 5.67 5.20 4.79

. 0.00 – – 0.00 0.00 0.00 0.00 0.00 – – – 0.00 – 0.00 0.00 0.00

. 0.09 0.10 0.10 0.11 0.12 0.14 0.13 0.13 0.12 0.10 0.12 0.09 0.10 0.09 0.09 0.09

. 1.32 1.50 1.43 1.52 1.81 2.01 2.20 2.33 2.33 2.32 2.29 2.31 2.20 1.97 1.84 1.65

. 0.05 0.06 0.08 0.08 0.08 0.10 0.06 0.07 0.08 0.07 0.06 0.07 0.08 0.06 0.09 0.07

. 30.79 31.86 31.82 31.14 30.83 30.21 30.07 29.28 28.64 28.00 26.43 25.57 25.16 24.52 24.55 23.79

. 650.10 676.82 644.76 628.10 623.17 599.20 585.69 567.51 553.62 551.61 518.25 510.52 496.73 488.01 500.02 483.27

Series 4, No. 30 [ Page 23
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.09 0.09 0.08 0.09 0.09 0.09 0.10 0.08 0.09 0.07 0.08 0.08 0.09 0.08 0.06 0.07

. 1.30 1.35 1.31 1.29 1.23 1.23 1.29 1.27 1.34 1.33 1.31 1.36 1.25 1.26 1.27 1.23

. 17.02 18.37 18.54 19.15 20.37 20.68 21.91 23.03 23.93 25.39 25.50 26.67 27.18 27.76 28.37 28.35

. 2.06 2.34 2.17 2.18 2.36 2.40 2.34 2.51 2.40 2.38 2.05 2.04 2.05 2.01 2.02 2.05

. 26.90 27.87 28.32 27.83 29.46 29.86 30.52 31.66 31.35 31.87 29.04 27.87 27.79 27.77 28.80 27.92

. 351.67 378.12 376.63 380.13 404.53 409.49 424.18 437.28 434.21 438.05 387.69 369.87 367.19 360.33 377.07 362.58

. 0.03 0.03 0.02 0.02 0.02 0.01 0.02 0.01 0.02 0.01 0.03 0.02 0.02 0.03 0.03 0.03

. 1.27 1.33 1.26 1.15 1.16 1.17 1.17 1.16 1.15 1.22 1.20 1.22 1.23 1.25 1.42 1.36

. 18.38 19.61 18.58 18.35 18.29 18.25 17.61 17.87 17.91 18.03 18.29 18.90 19.22 20.34 21.20 22.10

. 0.70 0.75 0.65 0.60 0.64 0.63 0.60 0.51 0.53 0.58 0.51 0.53 0.54 0.49 0.57 0.52

. 20.57 19.66 19.18 18.01 17.46 17.21 16.53 16.17 15.96 15.58 14.86 14.63 14.20 14.00 13.90 14.00

. 452.67 446.93 413.51 389.13 372.66 360.32 349.49 333.35 324.80 320.19 301.87 294.27 284.02 277.23 282.05 282.09

. 0.31 0.32 0.29 0.27 0.28 0.27 0.24 0.21 0.20 0.21 0.20 0.18 0.18 0.17 0.18 0.16

. 5.88 5.66 5.58 5.36 5.10 5.17 5.09 4.98 5.07 5.01 4.84 4.72 4.60 4.58 4.55 4.62

. 51.64 47.62 44.74 43.66 41.80 43.15 43.63 42.49 41.66 42.64 39.96 39.85 39.26 39.38 39.46 39.01

. 0.06 0.06 0.05 0.05 0.06 0.06 0.05 0.05 0.05 0.06 0.06 0.06 0.07 0.04 0.06 0.07

. 2.66 2.44 2.19 2.02 1.99 1.94 1.78 1.72 1.64 1.52 1.35 1.33 1.21 1.08 1.02 0.97

. 98.90 92.46 81.73 72.08 64.98 60.24 57.57 53.71 49.90 46.40 41.88 37.90 33.64 30.61 29.10 27.52

. 0.00 0.01 0.00 0.00 0.00 0.01 0.00 0.01 0.00 0.00 0.00 – 0.01 – 0.00 –

. 0.13 0.13 0.12 0.10 0.09 0.09 0.08 0.08 0.09 0.07 0.06 0.06 0.05 0.05 0.06 0.06

. 2.35 2.10 2.14 1.95 1.91 1.96 1.92 1.90 1.69 1.71 1.54 1.45 1.36 1.33 1.26 1.44

. 0.33 0.36 0.31 0.28 0.31 0.30 0.30 0.24 0.28 0.31 0.25 0.29 0.29 0.28 0.33 0.30

. 11.89 11.43 11.29 10.53 10.28 10.00 9.58 9.39 9.17 8.98 8.60 8.52 8.33 8.29 8.27 8.36

. 299.78 304.75 284.90 271.45 263.98 254.98 246.37 235.25 231.56 229.44 218.49 215.07 209.75 205.90 212.22 214.12

. 0.00 0.00 0.00 0.01 0.01 0.01 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00

. 1.03 1.10 1.02 1.00 1.01 0.87 0.89 0.89 0.86 0.81 0.74 0.70 0.67 0.65 0.62 0.60

. 75.15 74.93 68.23 63.49 60.41 54.56 51.91 47.88 46.79 44.75 38.11 35.01 32.81 30.78 30.65 29.86

Page 24 [ Series 4, No. 30
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.15 0.14 0.12 0.12 0.14 0.12 0.13 0.14 0.12 0.10 0.10 0.11 0.11 0.12 0.12 0.12

. 3.43 3.42 3.24 3.15 3.22 3.28 3.21 3.11 3.14 3.12 3.26 3.13 3.18 3.12 3.11 3.02

. 54.18 54.78 53.82 53.61 53.66 54.66 54.62 54.88 54.48 54.48 55.77 56.04 55.46 54.90 55.37 54.50

. 0.16 0.15 0.13 0.12 0.11 0.10 0.09 0.08 0.10 0.10 0.10 0.10 0.09 0.11 0.09 0.10

. 0.09 0.09 0.08 0.07 0.08 0.07 0.07 0.05 0.06 0.07 0.06 0.06 0.07 0.07 0.07 0.05

. 0.99 1.17 1.05 0.83 0.91 0.97 1.10 1.13 0.91 1.07 1.09 1.02 0.98 0.85 1.00 0.85

. 2.05 1.89 1.58 1.47 1.43 1.37 1.33 1.31 1.25 1.24 1.26 1.16 1.19 1.09 1.09 1.05

. 5.69 6.29 6.10 5.40 5.55 5.65 6.12 6.27 6.06 6.53 6.32 6.26 6.05 5.51 6.01 5.77

. 108.47 130.72 124.48 110.44 123.60 128.56 143.73 145.01 140.51 153.78 147.76 151.91 143.47 137.84 146.02 141.42

. 2.01 1.84 1.52 1.45 1.40 1.33 1.30 1.27 1.23 1.21 1.21 1.12 1.13 1.07 1.04 1.03

. 5.64 6.13 5.90 5.34 5.46 5.58 6.00 6.16 6.00 6.43 6.20 6.14 5.96 5.44 5.94 5.67

. 107.03 124.13 117.37 108.88 120.47 126.24 139.51 141.29 139.38 150.07 144.89 147.97 141.54 136.10 144.35 139.39

. 0.04 0.05 0.05 0.02 0.03 0.03 0.03 0.04 0.02 0.03 0.05 0.04 0.05 0.03 0.05 0.02

. 0.05 0.16 0.20 0.06 0.09 0.07 0.12 0.11 0.06 0.10 0.12 0.12 0.09 0.07 0.07 0.09

. 1.44 6.60 7.11 1.56 3.13 2.32 4.22 3.72 1.13 3.71 2.86 3.94 1.93 1.74 1.67 2.04

. 0.33 0.35 0.37 0.43 0.41 0.38 0.41 0.42 0.47 0.41 0.43 0.44 0.48 0.43 0.48 0.50

. 9.29 9.81 9.95 9.60 10.26 10.32 10.73 10.64 10.63 10.92 11.04 10.69 10.87 10.42 10.98 10.80

. 142.74 159.00 163.58 163.93 177.73 182.07 193.37 195.47 195.03 203.67 202.39 206.43 211.14 211.04 228.81 225.32

. 0.13 0.09 0.10 0.09 0.08 0.07 0.07 0.07 0.09 0.07 0.08 0.07 0.09 0.07 0.08 0.06

. 0.63 0.60 0.57 0.52 0.50 0.48 0.45 0.45 0.42 0.45 0.43 0.43 0.45 0.42 0.41 0.38

. 9.88 10.13 9.67 9.02 9.10 8.82 8.84 9.02 8.26 8.53 8.36 7.82 7.90 7.77 7.80 7.31

. 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.00 0.00 0.01 0.01 0.01

. 2.60 2.50 2.37 2.18 2.19 2.10 2.19 2.23 2.18 2.18 2.19 2.14 2.12 1.99 2.15 2.01

. 39.37 39.89 37.89 35.55 36.28 35.68 37.67 37.68 36.79 39.39 38.37 38.66 39.67 39.23 41.32 39.86

. 0.17 0.21 0.21 0.28 0.27 0.26 0.31 0.31 0.34 0.31 0.31 0.33 0.36 0.34 0.38 0.40

. 0.94 0.98 1.08 1.10 1.27 1.20 1.29 1.24 1.41 1.47 1.47 1.46 1.52 1.40 1.45 1.59

. 5.21 5.82 5.79 5.69 6.14 6.37 6.66 6.90 7.32 7.61 8.23 7.80 8.02 7.84 7.90 8.03

. 0.02 0.04 0.05 0.05 0.05 0.04 0.02 0.03 0.03 0.03 0.03 0.03 0.03 0.02 0.02 0.02

. 5.12 5.73 5.93 5.80 6.30 6.55 6.80 6.72 6.63 6.82 6.95 6.66 6.78 6.61 6.97 6.82

. 88.28 103.16 110.24 113.67 126.21 131.20 140.19 141.86 142.67 148.14 147.43 152.16 155.55 156.20 171.79 170.12

Series 4, No. 30 [ Page 25
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.05 0.06 0.05 0.04 0.03 0.03 0.03 0.03 0.03 0.04 0.03 0.03 0.02 0.02 0.03 0.03

. 1.28 1.23 1.22 1.15 1.03 1.04 1.01 0.96 0.90 0.89 0.86 0.81 0.83 0.75 0.78 0.77

. 14.66 15.22 15.79 16.22 15.17 15.16 15.09 14.29 13.87 13.73 13.50 12.79 12.06 11.98 11.21 11.30

. 0.07 0.08 0.05 0.06 0.05 0.04 0.04 0.05 0.03 0.04 0.04 0.04 0.03 0.03 0.04 0.03

. 0.17 0.19 0.15 0.13 0.11 0.10 0.10 0.11 0.10 0.10 0.10 0.10 0.09 0.08 0.09 0.08

. 1.46 1.35 1.27 1.01 1.10 1.00 1.01 0.98 0.93 0.85 0.83 0.74 0.63 0.72 0.58 0.59

. 0.27 0.24 0.22 0.21 0.18 0.18 0.15 0.19 0.17 0.14 0.15 0.16 0.14 0.14 0.13 0.12

. 0.74 0.74 0.61 0.59 0.55 0.53 0.52 0.53 0.52 0.52 0.51 0.48 0.51 0.47 0.44 0.50

. 13.37 13.14 12.81 11.61 11.71 11.83 11.74 11.59 11.54 11.38 11.00 11.42 11.71 11.32 10.81 10.79

. 0.16 0.18 0.16 0.15 0.12 0.13 0.10 0.11 0.11 0.09 0.09 0.08 0.07 0.07 0.08 0.06

. 18.87 18.92 17.41 15.93 15.38 14.90 14.40 13.66 13.60 13.54 13.13 12.40 11.91 11.48 11.31 11.26

. 37.42 38.97 38.68 36.97 36.10 37.06 35.75 35.37 34.19 34.06 35.22 34.21 33.45 33.14 32.22 31.99

. 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.02 0.01 0.01 0.02

. 0.43 0.44 0.37 0.36 0.37 0.35 0.34 0.28 0.31 0.31 0.30 0.27 0.27 0.29 0.25 0.28

. 8.45 8.59 7.93 7.35 7.12 7.20 6.83 6.83 6.79 6.70 6.40 6.41 5.79 5.76 5.36 5.36

. 0.45 0.40 0.44 0.40 0.37 0.43 0.40 0.39 0.34 0.34 0.30 0.25 0.28 0.27 0.27 0.24

. 2.91 2.91 2.76 2.77 2.77 2.79 2.89 2.86 2.81 2.90 2.64 2.56 2.45 2.46 2.53 2.32

. 39.40 41.53 42.32 43.31 44.61 46.38 48.12 47.95 47.62 47.00 43.89 42.55 42.78 43.54 45.00 43.88

. 0.03 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.01 0.02 0.02 0.02 0.02 0.02 0.01

. 0.06 0.07 0.05 0.06 0.06 0.06 0.06 0.05 0.04 0.05 0.05 0.05 0.05 0.04 0.04 0.04

. 0.83 0.72 0.74 0.68 0.80 0.68 0.71 0.59 0.58 0.63 0.62 0.54 0.57 0.56 0.50 0.54

. 0.05 0.04 0.04 0.04 0.04 0.03 0.02 0.03 0.03 0.02 0.03 0.02 0.03 0.01 0.02 0.01

. 0.48 0.43 0.38 0.36 0.31 0.32 0.24 0.24 0.23 0.24 0.24 0.25 0.21 0.20 0.20 0.19

. 5.91 5.54 4.95 4.53 4.35 4.02 3.51 3.29 3.12 3.10 3.01 2.97 2.93 2.84 3.01 2.88

y

. 0.37 0.34 0.37 0.35 0.31 0.38 0.37 0.35 0.30 0.31 0.25 0.20 0.23 0.24 0.23 0.21

. 2.37 2.41 2.33 2.36 2.40 2.41 2.59 2.57 2.54 2.61 2.35 2.26 2.19 2.22 2.29 2.10

. 32.66 35.27 36.63 38.10 39.46 41.68 43.90 44.07 43.92 43.28 40.26 39.05 39.27 40.13 41.49 40.47

Page 26 [ Series 4, No. 30
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 0.03 0.02 0.02 0.02 0.02 0.02 0.01 0.01 0.01 0.02 0.02 0.02 0.02 0.01 0.01 0.01

. 0.33 0.31 0.27 0.24 0.22 0.23 0.18 0.19 0.17 0.17 0.14 0.14 0.13 0.12 0.12 0.10

. 7.61 7.12 5.76 5.43 4.87 4.71 4.46 3.97 3.72 3.26 2.82 2.50 2.24 1.93 1.77 1.70

. – – ––––––––––––––

. 0.02 0.02 0.02 0.02 0.02 0.02 0.01 0.02 0.01 0.02 0.02 0.01 0.01 0.01 0.01 0.01

. 2.38 2.12 1.89 1.67 1.45 1.29 1.14 1.16 1.05 1.00 0.96 0.95 0.88 0.78 0.78 0.79

. 0.12 0.11 0.12 0.09 0.12 0.08 0.10 0.10 0.08 0.12 0.11 0.12 0.12 0.13 0.10 0.13

. 0.20 0.21 0.17 0.18 0.15 0.17 0.16 0.14 0.14 0.17 0.17 0.18 0.17 0.15 0.16 0.16

. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

. 0.03 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.01 0.03 0.02 0.02 0.02 0.02 0.02 0.02

. 0.03 0.04 0.03 0.03 0.03 0.03 0.02 0.02 0.02 0.03 0.02 0.03 0.02 0.03 0.02 0.02

. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

)

. 0.10 0.09 0.10 0.07 0.10 0.06 0.08 0.08 0.07 0.10 0.09 0.10 0.09 0.11 0.08 0.12

. 0.17 0.17 0.14 0.14 0.12 0.14 0.14 0.12 0.11 0.14 0.14 0.15 0.14 0.13 0.14 0.14

. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

. 11.67 11.69 11.14 11.13 10.60 10.60 10.19 9.91 9.59 9.74 9.50 9.40 8.71 8.45 8.29 7.96

. 1.53 1.55 1.43 1.37 1.37 1.40 1.28 1.28 1.31 1.33 1.37 1.35 1.35 1.38 1.44 1.42

. 2.97 3.15 3.08 3.12 3.13 2.99 3.00 3.23 3.06 3.30 3.48 3.70 3.81 4.02 4.31 4.22

. 24.27 22.98 21.29 20.26 18.78 18.77 18.58 17.66 17.48 17.22 17.25 15.91 14.87 13.96 13.67 13.28

. 0.01 0.01 0.00 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01

. 0.01 0.01 0.00 0.01 0.01 – 0.00 0.01 0.01 0.00 0.01 0.01 0.00 0.02 0.02 0.01

. 8.30 7.62 6.57 6.02 5.23 5.14 5.04 4.51 4.18 3.99 4.26 3.49 3.03 2.60 2.37 2.18

. 0.00 0.00 0.00 0.01 0.00 0.00 0.01 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.01

. – – – 0.00 –––––– 0.00 – – 0.00 0.01 0.01

al

. 15.97 15.36 14.71 14.24 13.56 13.63 13.54 13.15 13.30 13.23 12.99 12.42 11.84 11.36 11.30 11.10

. 0.01 0.01 0.00 0.00 0.01 0.01 0.00 0.01 0.00 0.01 0.01 0.00 0.01 0.01 0.01 0.01

. 0.01 0.01 0.00 0.00 0.01 – 0.00 0.01 0.01 0.00 0.01 0.01 0.00 0.01 0.01 0.00

Series 4, No. 30 [ Page 27
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. 7.43 7.50 7.27 7.22 7.02 6.99 6.96 7.23 7.34 7.57 7.42 6.99 6.80 6.31 6.34 5.69

. 6.94 6.99 7.28 7.40 6.62 6.48 6.84 6.99 7.47 6.87 6.15 5.34 5.15 4.68 5.56 5.01

. 42.76 44.45 44.27 43.12 43.62 43.66 43.94 42.39 38.77 37.56 28.18 23.76 23.97 23.46 27.15 26.41

. 7.32 7.19 6.82 6.39 6.43 6.29 6.16 6.08 5.61 5.58 5.78 5.50 5.54 5.30 5.37 5.07

. 29.27 29.85 29.11 27.73 28.80 29.01 31.37 33.41 28.75 29.39 28.60 28.06 28.18 27.76 28.28 28.49

. 229.01 246.25 247.36 251.33 268.12 280.05 296.94 303.77 315.63 322.11 323.39 321.26 321.20 320.49 338.79 347.74

. 37.75 36.87 33.59 31.12 29.48 29.29 29.00 30.15 29.07 29.10 27.22 25.98 25.14 22.67 23.26 23.13

. 41.79 41.47 39.92 36.34 35.16 34.82 34.58 34.59 34.35 34.87 34.41 33.17 31.08 30.30 31.46 31.48

. 82.49 83.03 76.94 72.73 73.21 73.25 73.43 72.04 72.33 73.69 71.76 68.66 66.76 65.91 66.60 67.04

. 24.17 23.57 21.64 19.54 18.56 19.15 18.97 20.18 19.64 19.91 18.35 17.75 16.72 15.02 15.36 15.66

. 22.51 22.44 21.89 18.92 18.27 18.73 18.36 18.60 18.96 19.05 18.83 18.60 16.75 15.78 15.88 15.78

. 22.85 21.77 21.70 19.71 19.74 20.95 20.63 21.03 21.75 22.50 22.37 21.75 20.71 20.51 20.54 21.35

. 13.58 13.30 11.96 11.58 10.92 10.14 10.03 9.97 9.43 9.19 8.87 8.23 8.42 7.65 7.90 7.46

. 19.28 19.02 18.03 17.42 16.89 16.09 16.21 15.98 15.39 15.82 15.58 14.56 14.34 14.51 15.58 15.70

. 59.64 61.26 55.24 53.01 53.47 52.30 52.80 51.01 50.58 51.19 49.39 46.91 46.05 45.40 46.06 45.69

. 5.37 5.34 5.33 5.30 5.20 5.49 5.71 5.74 5.62 5.71 5.75 5.83 5.78 5.80 6.00 6.14

. 16.15 15.77 16.16 16.12 15.72 15.91 15.45 16.03 15.71 15.20 15.03 15.26 15.16 14.76 14.89 14.80

. 18.55 17.54 16.88 18.19 18.99 19.63 20.01 21.25 21.29 20.54 19.70 19.84 18.84 18.28 18.08 17.15

. 7.09 7.63 7.25 6.87 6.11 6.11 6.07 6.98 6.87 7.58 8.24 9.61 10.75 10.67 11.28 10.83

. 13.57 14.32 13.83 12.76 11.36 10.92 10.81 11.33 10.72 10.84 11.06 11.62 11.97 11.25 11.18 10.65

. 5.26 5.60 4.95 4.90 4.46 4.25 4.31 4.47 4.52 4.38 4.15 3.94 4.09 3.78 3.68 3.44

. 1.08 0.97 0.92 0.78 0.74 0.72 0.61 0.66 0.66 0.68 0.55 0.49 0.51 0.51 0.65 0.66

. 2.25 2.10 2.03 1.83 1.74 1.65 1.61 1.75 1.63 1.62 1.49 1.30 1.34 1.62 1.89 1.88

. 1.68 1.73 1.78 1.32 1.36 1.37 1.12 1.18 1.13 1.15 0.88 0.77 0.77 0.75 0.83 0.76

. ... ... ... ... ... ... ... ... 0.78 0.85 0.99 0.93 1.06 1.03 1.15 1.22

. ... ... ... ... ... ... ... ... 10.15 12.41 16.39 18.61 21.41 24.06 26.40 29.50

. ... ... ... ... ... ... ... ... 1.15 1.37 1.49 1.63 1.97 2.22 2.28 2.45

Page 28 [ Series 4, No. 30
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease by three broad age categories: United States

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. – – – 0.00 – 0.00 0.00 – – – – 0.00 – – 0.00 0.00

. 0.16 0.22 0.22 0.28 0.30 0.30 0.33 0.33 0.33 0.34 0.29 0.27 0.27 0.23 0.26 0.28

. 2.45 3.77 5.03 7.41 12.46 17.01 21.56 23.71 27.11 28.51 29.23 29.64 29.25 28.92 32.19 34.82

er for Health Statistics introduced categories *042–*044 for classifying and coding Human immunodeficiency virus infection. The asterisks indicate that these categories are not part of the Ninth Revision,

ses shown above.

Series 4, No. 30 [ Page 29
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease: United States, 1979–94

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

...... 577.05 585.77 568.60 554.73 552.48 548.11 548.83 544.78 539.21 539.90 528.01 520.24 513.76 504.46 513.26 507.40

(004,006) 0.02 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.01 0.01 0.00 0.00 0.00 0.00 0.00

(007–009) 0.10 0.12 0.12 0.11 0.11 0.11 0.09 0.11 0.09 0.08 0.09 0.11 0.12 0.13 0.15 0.19

(010–018) 0.67 0.64 0.62 0.55 0.55 0.53 0.53 0.53 0.52 0.55 0.56 0.52 0.48 0.46 0.43 0.38

(010–012) 0.55 0.53 0.51 0.44 0.43 0.41 0.40 0.41 0.40 0.42 0.42 0.38 0.36 0.35 0.33 0.27

(013–018) 0.12 0.12 0.12 0.11 0.11 0.13 0.12 0.12 0.11 0.13 0.13 0.14 0.12 0.11 0.10 0.10

.. (033) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 – 0.00 0.00 0.00

(034–035) 0.01 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00

.. (036) 0.18 0.17 0.20 0.15 0.13 0.13 0.11 0.12 0.11 0.11 0.11 0.09 0.08 0.08 0.10 0.11

.. (038) 2.33 2.64 2.85 3.01 3.39 3.73 4.11 4.36 4.52 4.60 4.17 4.10 4.08 4.01 4.07 4.00

.. (045) 0.00 0.00 –––– 0.00 – – 0.00 – – 0.00 – – –

.. (055) 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.03 0.01 0.00 – –

.. (070) 0.29 0.31 0.33 0.30 0.32 0.31 0.33 0.34 0.40 0.42 0.49 0.50 0.58 0.62 0.77 0.92

(090–097) 0.05 0.04 0.04 0.04 0.03 0.03 0.02 0.02 0.03 0.02 0.03 0.03 0.03 0.03 0.02 0.02

. . (001–

4,046–

1.32 1.42 1.46 1.53 1.69 2.10 2.59 3.27 7.41 8.72 10.91 11.97 13.34 14.65 15.91 17.51

of

(140–208) 130.79 132.77 131.71 132.77 133.06 134.06 134.35 134.16 133.97 133.96 134.49 135.01 134.48 133.06 132.62 131.50

(140–149) 2.97 2.91 2.84 2.79 2.75 2.71 2.61 2.56 2.44 2.48 2.42 2.44 2.38 2.28 2.29 2.15

(150–159) 33.13 32.98 32.47 32.22 31.97 32.20 31.71 31.15 30.88 30.32 30.30 30.25 29.89 29.57 29.47 29.27

(160–165) 35.22 36.39 36.65 37.58 38.03 38.59 39.09 39.31 40.04 40.33 40.78 41.38 41.13 40.83 40.76 40.13

(174–175 12.23 12.47 12.49 12.53 12.48 12.76 12.80 12.70 12.63 12.76 12.69 12.67 12.44 11.99 11.79 11.63

179–187) 13.60 13.62 13.37 13.27 13.31 13.09 13.08 13.21 13.03 13.15 13.26 13.64 13.56 13.50 13.19 13.16188–189) 5.21 5.22 5.14 5.20 5.10 5.03 5.05 5.02 5.01 4.95 5.06 5.08 5.12 5.10 5.06 5.10

,190–199) 16.42 16.86 16.83 16.99 17.21 17.39 17.62 17.75 17.73 17.65 17.33 16.87 17.06 16.92 17.21 17.03

(204–208) 5.26 5.37 5.15 5.16 5.11 5.12 5.06 4.99 4.89 4.86 4.98 4.98 4.95 4.95 4.92 4.85

(200–203) 6.75 6.93 6.79 7.03 7.09 7.17 7.32 7.46 7.32 7.45 7.67 7.71 7.95 7.91 7.94 8.19

nspecified

(210–239) 1.91 1.97 1.91 1.93 1.87 1.80 1.85 1.83 1.72 1.75 1.69 1.69 1.69 1.68 1.72 1.72

.. (250) 9.77 10.12 9.81 9.59 9.89 9.51 9.68 9.65 9.85 10.21 11.61 11.65 11.78 11.84 12.45 12.92

(260–269) 0.52 0.53 0.50 0.50 0.52 0.49 0.53 0.51 0.50 0.50 0.50 0.48 0.46 0.48 0.50 0.49

(280–285) 0.93 0.92 0.90 0.87 0.91 0.88 0.90 0.87 0.89 0.86 0.91 0.91 0.88 0.92 0.88 0.90

(320–322) 0.57 0.58 0.55 0.49 0.48 0.44 0.43 0.41 0.41 0.40 0.37 0.35 0.28 0.26 0.25 0.25

(390–448) 254.20 255.99 245.88 238.80 235.94 229.26 225.01 218.01 212.03 208.28 196.18 189.83 184.98 180.36 181.75 176.77

,404–429) 199.56 202.01 195.25 190.90 189.58 184.26 181.36 175.97 170.79 167.67 157.52 152.03 148.24 144.33 145.27 140.38

(390–398) 2.61 2.57 2.34 2.17 2.09 2.02 1.89 1.79 1.72 1.68 1.54 1.50 1.43 1.35 1.32 1.24

.. (402) 6.04 5.90 5.74 5.58 5.54 5.35 5.29 5.09 5.07 4.98 4.90 4.83 4.77 4.81 4.89 4.98

.. (404) 0.88 0.87 0.77 0.67 0.66 0.61 0.60 0.52 0.53 0.50 0.48 0.49 0.48 0.47 0.46 0.46

(410–414) 149.77 149.86 143.57 139.62 135.80 130.21 126.09 119.47 114.70 111.13 106.21 102.54 99.12 95.71 94.92 91.45

.. (410) 88.23 85.96 81.99 79.63 76.34 72.71 69.61 64.68 61.30 58.26 56.45 53.73 51.50 49.09 47.52 45.65

Page 30 [ Series 4, No. 30
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease: United States, 1979–94—Con.

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

. . .(411) 1.46 1.44 1.35 1.22 1.16 1.12 1.10 1.04 0.92 0.85 0.83 0.84 0.80 0.75 0.68 0.63

.. (413) 0.14 0.15 0.15 0.16 0.18 0.21 0.21 0.23 0.22 0.21 0.22 0.20 0.20 0.18 0.17 0.16

(412,414) 59.93 62.30 60.09 58.61 58.12 56.18 55.16 53.53 52.26 51.80 48.72 47.77 46.63 45.70 46.55 45.01

.. (424) 1.85 1.97 1.96 1.99 2.05 2.07 2.19 2.24 2.35 2.43 2.44 2.54 2.52 2.57 2.60 2.59

,425–429) 38.41 40.83 40.88 40.88 43.44 44.00 45.31 46.85 46.44 46.95 41.95 40.13 39.92 39.42 41.08 39.66

(401,403) 1.91 2.02 1.91 1.84 1.84 1.84 1.80 1.81 1.81 1.85 1.87 1.91 1.94 2.03 2.17 2.21

(430–438) 41.58 40.76 38.18 35.91 34.52 33.55 32.45 31.13 30.45 29.96 28.32 27.69 26.78 26.20 26.51 26.54

(431–432) 6.61 6.22 5.98 5.78 5.53 5.66 5.63 5.49 5.47 5.51 5.24 5.17 5.06 5.06 5.05 5.05

4.0,434.9) 8.13 7.58 6.71 5.97 5.47 5.12 4.86 4.56 4.26 3.96 3.57 3.29 2.94 2.65 2.53 2.40

. (434.1) 0.23 0.21 0.21 0.18 0.18 0.18 0.17 0.17 0.16 0.15 0.14 0.13 0.12 0.12 0.12 0.13

ar

,435–438) 26.62 26.74 25.29 23.97 23.35 22.59 21.79 20.91 20.56 20.34 19.37 19.11 18.65 18.36 18.81 18.97

.. (440) 5.66 5.68 5.18 4.85 4.65 4.17 4.00 3.72 3.64 3.47 2.98 2.75 2.58 2.43 2.41 2.34

(441–448) 5.49 5.52 5.36 5.29 5.34 5.44 5.40 5.38 5.35 5.33 5.49 5.45 5.43 5.37 5.40 5.29

.. (466) 0.18 0.19 0.17 0.14 0.15 0.14 0.15 0.14 0.14 0.15 0.15 0.14 0.14 0.14 0.14 0.13

(480–487) 11.16 12.91 12.25 10.90 11.85 12.22 13.47 13.63 13.19 14.33 13.82 14.03 13.36 12.67 13.48 13.02

(480–486) 11.02 12.36 11.64 10.75 11.58 12.01 13.11 13.31 13.08 14.01 13.54 13.69 13.16 12.50 13.31 12.83

.. (487) 0.14 0.55 0.61 0.15 0.27 0.21 0.36 0.33 0.12 0.32 0.28 0.34 0.20 0.16 0.17 0.19

(490–496) 14.56 15.94 16.33 16.21 17.48 17.79 18.78 18.88 18.87 19.58 19.56 19.67 20.10 19.84 21.37 21.04

(490–491) 1.05 1.03 0.99 0.92 0.91 0.88 0.86 0.87 0.81 0.84 0.82 0.78 0.80 0.77 0.77 0.72

.. (492) 4.00 3.99 3.78 3.53 3.59 3.50 3.68 3.70 3.61 3.79 3.73 3.72 3.78 3.69 3.91 3.74

.. (493) 0.90 0.98 1.03 1.06 1.18 1.15 1.23 1.23 1.35 1.39 1.43 1.41 1.46 1.38 1.43 1.52

ases

(494–496) 8.61 9.94 10.53 10.71 11.81 12.27 13.01 13.09 13.10 13.56 13.58 13.76 14.05 14.01 15.26 15.07

(531–533) 1.67 1.68 1.71 1.70 1.57 1.57 1.55 1.47 1.41 1.41 1.37 1.29 1.25 1.21 1.17 1.17

(540–543) 0.22 0.22 0.18 0.16 0.15 0.14 0.14 0.15 0.13 0.13 0.12 0.12 0.11 0.11 0.10 0.10

struction

–553,560) 1.41 1.37 1.28 1.18 1.16 1.15 1.13 1.14 1.13 1.10 1.07 1.09 1.12 1.07 1.02 1.04

.. (571) 12.06 12.19 11.41 10.55 10.21 10.03 9.68 9.29 9.18 9.13 9.01 8.57 8.27 8.03 7.89 7.84

(574–575) 0.80 0.81 0.73 0.69 0.68 0.67 0.64 0.61 0.62 0.62 0.59 0.58 0.54 0.54 0.50 0.52

(580–589) 4.35 4.47 4.46 4.53 4.60 4.75 4.91 4.88 4.81 4.81 4.46 4.30 4.27 4.33 4.47 4.27

(580–581) 0.10 0.09 0.08 0.08 0.09 0.08 0.09 0.07 0.07 0.07 0.08 0.07 0.07 0.07 0.06 0.06

hronic,

–583,587) 0.67 0.61 0.55 0.50 0.47 0.45 0.37 0.36 0.34 0.34 0.34 0.34 0.32 0.30 0.32 0.30

Series 4, No. 30 [ Page 31
or 72 selected causes of death, Human immunodeficiency virus infection, and Alzheimer’s disease: United States, 1979–94—Con.

standard population]

1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

paired

,588–589) 3.58 3.77 3.83 3.94 4.04 4.22 4.46 4.45 4.40 4.40 4.04 3.89 3.89 3.96 4.09 3.91

.. (590) 0.70 0.65 0.53 0.50 0.45 0.44 0.40 0.37 0.35 0.31 0.27 0.25 0.23 0.19 0.18 0.17

.. (600) 0.17 0.16 0.14 0.12 0.11 0.10 0.08 0.09 0.08 0.08 0.07 0.07 0.07 0.06 0.06 0.06

(630–676) 0.16 0.15 0.14 0.13 0.12 0.12 0.12 0.11 0.10 0.14 0.13 0.14 0.13 0.13 0.12 0.14

(630–638) 0.03 0.03 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.03 0.02 0.02 0.02 0.02 0.02 0.02

rth,

(640–676) 0.13 0.12 0.12 0.10 0.10 0.10 0.10 0.09 0.09 0.11 0.11 0.12 0.11 0.11 0.10 0.12

(740–759) 6.01 6.04 5.74 5.71 5.48 5.49 5.25 5.14 5.01 5.10 5.03 4.99 4.70 4.62 4.60 4.44

al

(760–779) 10.49 9.93 9.20 8.76 8.12 8.12 8.03 7.63 7.56 7.44 7.46 6.88 6.43 6.04 5.91 5.75

sphyxia,

(767–769) 3.59 3.29 2.84 2.60 2.26 2.22 2.18 1.95 1.81 1.73 1.84 1.51 1.31 1.12 1.03 0.94

al

,770–779) 6.90 6.64 6.36 6.15 5.86 5.89 5.85 5.69 5.75 5.72 5.62 5.37 5.12 4.91 4.89 4.80

(780–799) 9.61 9.78 9.81 9.77 9.33 9.25 9.43 9.52 9.56 9.27 8.21 7.31 7.15 6.67 7.37 6.77

(Residual) 33.47 34.88 34.43 33.83 35.53 36.39 38.67 40.12 38.40 39.15 38.93 38.39 38.47 38.11 39.65 40.24

00–E949) 42.83 42.33 39.72 36.58 35.31 35.07 34.83 35.23 34.67 35.03 33.86 32.49 30.96 29.44 30.32 30.30

10–E825) 23.25 22.88 21.77 19.24 18.49 19.06 18.78 19.45 19.45 19.66 18.86 18.45 17.01 15.78 15.97 16.11

26–E949) 19.58 19.45 17.95 17.34 16.82 16.00 16.05 15.78 15.22 15.38 15.00 14.04 13.95 13.66 14.35 14.19

50–E959) 11.65 11.39 11.53 11.59 11.40 11.66 11.55 11.94 11.73 11.47 11.34 11.50 11.36 11.13 11.27 11.21

60–E978) 10.20 10.83 10.38 9.68 8.62 8.38 8.32 8.98 8.63 8.99 9.37 10.23 10.90 10.49 10.71 10.23

980-E999) 1.71 1.59 1.53 1.34 1.28 1.23 1.14 1.24 1.18 1.18 1.04 0.92 0.95 1.08 1.28 1.27

042–*044) . . . . . . . . . . . . . . . . . . . . . . . . 5.49 6.66 8.71 9.81 11.28 12.61 13.84 15.42

. (331.0) 0.25 0.37 0.45 0.65 1.00 1.32 1.64 1.79 2.02 2.12 2.15 2.17 2.14 2.10 2.33 2.53

er for Health Statistics introduced categories *042–*044 for classifying and coding Human immunodeficiency virus infection. These asterisks indicate that these categories are not part of the Ninth Revision,

ses shown above.

Page 32 [ Series 4, No. 30
Appendix I

AGENDA

Second Workshop Age Adjustment

National Center for Health Statistics

Centers for Disease Control and Prevention

Hyattsville, Maryland

June 5–6, 1997

Auditorium

Thursday, June 5

9:00–9:05 a.m. Logistics and introduction—Dr. Rosenberg

9:05–9:15 Welcome and introductions—Dr. Madans

9:15–10:30 10-minute presentations and discussions

10:30–11:00 Break

11:00–12:30 p.m. 10-minute presentations and discussions

12:30–1:30 Lunch

1:30–3:00 Remaining presentations and discussions

3:00–3:30 Break

3:30–4:30 Facilitated discussion to identify salient issues

Friday, June 6

9:00–9:05 a.m. Logistics and messages—Dr. Rosenberg

9:05–10:30 Facilitated discussion to make recommendations

10:30–11:00 Break

11:00–12:00 Facilitated discussion to make recommendations

12:00–12:30 p.m. Closing remarks—Dr. Sondik

12:30 Adjourn

Series 4, No. 30 [ Page 33
Appendix II

Workshop Participants

William Apao, Ph.D.

Director, Public Health Statistics

Vermont Department of Health and

National Association for Public Health

Statistics and Information Systems

Robert N. Anderson, Ph.D.

Statistician, Mortality Statistics Branch

Division of Vital Statistics

National Center for Health Statistics

Alice S. Clague

Chief, Demographic Statistics Section

United Nations

Lester R. Curtin, Ph.D.

Acting Associate Director,

Office of Research and Methodology

National Center for Health Statistics

Brenda K. Edwards, Ph.D.

Associate Director, Cancer Control

Research Program

National Cancer Institute

Jacob Feldman, Ph.D.

Associate Director,

Office of Analysis, Epidemiology, and

Health Promotion

National Center for Health Statistics

Mary Anne Freedman

Director, Division of Vital Statistics

National Center for Health Statistics

Daniel H. Freeman, Jr., Ph.D.

Professor,

Department of Preventive Medicine

University of Texas Medical School

Lawrence Friedman, M.D.

Director, Division of Epidemiology and

Clinical Applications

National Heart, Lung, and Blood

Institute

Benjamin Hankey, Sc.D.

Chief, Cancer Statistics Branch Cancer

Control Research Program

National Cancer Institute

Susan Hawk

Special Assistant to the Director

Division of Vital Statistics

National Center for Health Statistics

Richard Klein

Chief, Data Monitoring and Analysis

Branch

Office of Analysis, Epidemiology, and

Health Promotion

National Center for Health Statistics

Barnett S. Kramer, M.D.

Deputy Director,

Division of Cancer Prevention

National Cancer Institute

Jennifer H. Madans, Ph.D.

Acting Associate Director for Vital and

Health Statistics Systems

National Center for Health Statistics

Diane M. Makuc, Ph.D.

Director, Division of Health and

Utilization Analysis

Office of Analysis, Epidemiology, and

Health Promotion

National Center for Health Statistics

Teri Manolio, M.D., MHS

Director, Epidemiology and Biometry

Program

Division of Epidemiology and Clinical

Applications

National Heart, Lung, and Blood

Institute

Jeffrey D. Maurer

Statistician, Mortality Statistics Branch

Division of Vital Statistics

National Center for Health Statistics

Kimberley D. Peters

Statistician, Mortality Statistics Branch

Division of Vital Statistics

National Center for Health Statistics

Paul R. Rosenbaum, Ph.D.

University of Pennsylvania and

National Academy of Sciences

Harry M. Rosenberg, Ph.D.

Chief, Mortality Statistics Branch

Division of Vital Statistics

National Center for Health Statistics

John Santelli, M.D., MPH

Medical Epidemiologist,

National Center for Chronic Disease

Prevention and Health Promotion

Robert Schoen, Ph.D.

Professor of Population Dynamics

Johns Hopkins University

Edward J. Sondik, Ph.D.

Director,

National Center for Health Statistics

Thomas Thom

Health Statistician,

Division of Epidemiology and Clinical

Applications

National Heart, Lung, and Blood

Institute

George Van Amburg

Senior Fellow,

Michigan Public Health Institute and

U.S. National Committee on Vital and

Health Statistics

Page 34 [ Series 4, No. 30
Appendix III

Comments on Age

Adjustment

by Robert Schoen, Ph.D., ASA

Department of Population

Dynamics, Johns Hopkins

University

Over 30 years ago, Kitagawa

discussed summary measures and

identified two distinct classes of

demographic indexes (1). The first are

called aggregative indexes, and

age-adjusted (or age-standardized) death

rates are one example. The general form

is

IA =∑Ps(x) m(x) /∑Ps(x) (1)

where IA is an aggregative index, Ps(x)

is the number of persons in a designated

standard population at age x, m(x) is the

rate at age x, and the summations range

over all ages. These indexes aggregate

the number of deaths in terms of a

standard population, and present the

crude death rate of that standard

population. The choice of standard

population is important because different

standards can yield substantially

different results (2–4).

The second class are called average

of relatives indexes. They can be written

IR = (1/n)∑[m(x) / ms(x)] (2)

where IR is an average of relatives

index, ms(x) is a standard rate at age x,

n is the number of age categories, and

the summation ranges from 1 to n. Here

individual rates are compared, and an

average of those ratios is taken. There is

no need for a standard population. In

fertility analysis the Total Fertility Rate

(an average of relatives index) is the

preferred measure. In mortality analysis,

however, aggregative indexes dominate.

Some years ago, I tried to introduce the

del index—the geometric mean of the

age-specific death rates—as an

alternative, but without much success

(5,6). Yet, I remain convinced that it

does matter whether one thinks of

weighted deaths (as in crude or

standardized death rates) or in terms of

patterns of death rates.

I regard the age-specific death rates

as the basic measures. They represent

the behavior of interest, and the age

curve of death rates is remarkably

constant over widely varying levels of

mortality. Figure 1 shows that, apart

from level, the age pattern of mortality

changes little as life expectancy at birth

goes from 25 years to 70 years in the

Coale-Demeny Model ‘‘West’’ life tables

(7). That regularity contrasts sharply

with the change in life table death rates.

When mortality is very high, most

deaths occur to infants and children. At

contemporary mortality levels, the great

bulk of deaths occur at the high ages.

Large proportional changes in death

rates at ages under 65 can have only

small effects on standardized death rates,

regardless of what standard is used.

Consider the pattern of mortality

differentials by sex for whites in the

United States, 1950, 1960, and 1970,

which is shown in figure 2 (8, p.35).

Looking at the sex differential by age,

we see that it varies from around

10 percent at the high ages to over

200 percent at ages 20–24. The average

differential seems to be around 75 to

80 percent. Yet the ratio of male and

female life expectancies was 9 percent

in 1950, 10 percent in 1960, and

11 percent in 1970. The high death rates

and smaller differentials at the older

ages make the sex differential in

aggregative indexes look much smaller

than it is.

Those considerations lead me to

two recommendations. First, if we

believe aggregative indexes are

appropriate, let the rates determine the

standard. One could choose a life table

with mortality rates similar to the

population to be examined, and use the

age composition of the life table’s

‘‘stationary population’’ as the standard.

For example, we could use the ‘‘West’’

female life table with a life expectancy

at birth of 77.5 years (7). Such a

standard would not be tied to any time

or place, would be conceptually different

from any crude rate, and could be used

as long as that level of mortality

remains a reasonable approximation.

However, there are a number of

reasons not to emphasize aggregative

indexes. As noted, they can seriously

distort the nature of differences between

populations. Furthermore, when

standardized rates differ substantially

from crude rates, those differences can

lead to misunderstandings. To minimize

the difference between crude and

standardized rates, a contemporaneous

population can be taken as the standard.

Thus, the age distribution for the year

2000 is a logical choice. The aging of

the U.S. population over the past 60

years makes the 1940 age distribution

quite obsolete.

Implicit in the recommendation for

a year 2000 standard is the idea that the

standard will be changed when crude

and standardized rates begin to differ

appreciably, something that is likely to

occur in 10 to 20 years. Deemphasizing

the standard population makes sense. It

reinforces the principle that careful

analysis must look at the rates

themselves, and not be content with any

single summary measure.

References

1. Kitagawa EM. Standardized

comparisons in population research.

Demography 1:296–315. 1964.

2. Kitagawa EM. Theoretical

considerations in the selection of

mortality indexes and some empirical

comparisons. Human biology

38:293–305. 1966.

3. Spiegelman, M. Introduction to

Demography. Chicago: Society of

Actuaries. 1955.

4. Spiegelman, M, Marks HH. Empirical

testing of standards for the age

adjustment of death rates by the direct

method. Human biology 38:280–92.

1966.

5. Schoen R. The geometric mean of the

age-specific death rates as a summary

index of mortality. Demography

7:317–24. 1970.

6. Schoen R. Measuring mortality trends

and differentials. Social biology

23:235–43. 1976.

7. Coale AJ, Demeny P. Regional model

life tables and stable populations.

Princeton: Princeton University Press.

1966.

8. Schoen R, Collins M. Mortality by

cause: Life tables for California

1950–1970. Berkeley: California State

Department of Public Health. 1973.

Series 4, No. 30 [ Page 35
Figure 1. Age-specific death rates per thousand population. Coale-Demeny (1966) ‘‘West’’ life tables for females.

Page 36 [ Series 4, No. 30
Figure 2. Percent differences in mortality rates by sex for whites: United States, 1950, 1960, and 1970.

Series 4, No. 30 [ Page 37
Vital and Health Statistics

series descriptions

SERIES 1. Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

SERIES 2. Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

SERIES 3. Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports in the other series.

SERIES 4. Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

SERIES 5. International Vital and Health Statistics Reports—These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

SERIES 6. Cognition and Survey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

SERIES 10. Data From the National Health Interview Survey—These

reports contain statistics on illness; unintentional injuries;

disability; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

SERIES 11. Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributions of the population with respect to

physical, physiological, and psychological characteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

SERIES 12. Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

SERIES 13. Data From the National Health Care Survey—These

reports contain statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14. Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

SERIES 15. Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16. Compilations of Advance Data From Vital and Health

Statistics—Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10–13.

SERIES 20. Data on Mortality—These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21. Data on Natality, Marriage, and Divorce—These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22. Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

SERIES 23. Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriage; adoption; use of medical

care for family planning and infertility; and related maternal

and infant health topics. These statistics are based on

national surveys of women of childbearing age.

SERIES 24. Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly Vital Statistics Report (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782-2003

(301) 436–8500

E-mail: nchsquery@cdc.gov

Internet: www.cdc.gov/nchswww/
DHHS Publication No. (PHS) 99-1467, Series 4, No. 308-0779 (12/98)

COVER 4

PRINTER: ADJUST SPINE TO FIT

PRINTER:

POSITIVE ART FOR BACK COVER (cover 4): PRINT SOLID PMSNEGATIVE ART FOR FRONT COVER (cover 1): PRINT SOLID PMS