NATIONAL CENTER Series 3 

For HEALTH STATISTICS Number 1 

VITAL and HEALTH STATISTICS 

ANALYTICAL STUDIES 

the change in 

Mortality Trend in the 

UnitedStates 

An analytical study of mortality trends by age, 

color, and sex to identify the diseases with a 

course of mortality causing the recent change in 

general mortal ity trend, and discussion of future 

prospects for further declines in mortality. 

March 1964 

Washington, D.C, 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION , AND WELFARE Public Health Service 

Anthony J. C,elebrezze Luther L. Terry 

Secretary Surgeon General 
See inside of back cover 

for catalog card. 

Public Health Service Publication No. 1000 -Series 3-No. 1 
NATIONAL CENTER FOR HEALTH STATISTICS 

Forrest E. Linder, Ph. D., Director 

Theodore D. Woolsey, Deputy Director 

Oswald K. Sagen, Ph. D., Assistant Director 

(for Professional Relations) 

Walt R. Simmons, M.A., Statistical Advisor 

Alice M. Waterhouse, M.D., Medical Advisor


James E. Kelly, D.D.S., Dental Advisor


Louis R. Stolcis, M.A., Executive Officer


OFFICE OF HEALTH STATISTICS ANALYSIS


Iwao M. Moriyama, Ph. D., Chief


DIVISION OF VITAL STATISTICS


Robert D. Grove, Ph. D., Chief


DIVISION OF HEALTH INTERVIEW STATISTICS


Philip S. Lawrence, SC.D., Chief


DIVISION OF HEALTH RECORDS STATISTICS


Monroe G. Sirken, Ph. D., Chief


DIVISION OF HEALTH EXAMINATION STATISTICS


Arthur J. McDowell, Chief


DIVISION OF DATA PROCESSING


Sidney Binder, Chief


Public Health Service Publication No. 1000-Series 3-No. 1 
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——. ——. —— 

CONTENTS 

Introduction


General Mortality Trend: United States


International Mortality Trends


Mortality Trends by State


Table 1. States Showing Changes in Trend of Death Rates: 1935-60---------

Trend of Death Rates byAge


Trend of Deati Rates by Cause


Table 2.	 Change in Mortality Trend by Age, Color, and Sex: United States,


1937-60


Method of Analysis


Age Group


1-4 Years


5-14 Years


15-24


25-34


35-44


45-54


55-64


65-74


75-84


Years 

Years 

Years 

Years 

Years 

Years 

Years 

Discussion


Summary and Conclusions


Page 

1 

2 

5 

5 

6 

7 

10 

10 

11 

11 

26 

27 

28 

29 

31 

33 

35 

37 

37 

42 
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CONTENTS—Continued 

Figure 1. Crude Death Rates: United States, 1900-1960 

2. Age-Adjusted Death Rates: United States, 1900 -1960 ------------

3. Crude Death Rates: Specified Countries, 1930-60---------------

4. Crude Death Rates: Specified States, 1935 -60------------------

5. Infant Mortality Rates by Color: United States, 1933-60---------

6. Death Rates by Age, Color, and Sex: United States, 1930-60-----

7.	 Death Rates for Infective and Parasitic Diseases, by Age, Color, 

and Sex: United States, 1939-60------------------------------

8.	 Death Rates for Influenza and Pneumonia, by Age, Color, and 

Sex: United States, 1930-60----------------------------------

9.	 Death Rates for Diseases of the Respiratory System Excluding 

Influenza and Pneumonia, by Age, Color, and Sex: United States, 

1933-60 

10.	 Death Rates for Major Cardiovascular-Renal Diseases, by Age, 

Color, and Sex: United States, 1930-60 

11.	 Death Rates for Malignant Neoplasms, by Age, Color, and Sex: 

United States, 1930-60---------------------------------------

12.	 Death Rates for Accidents and Other Violence, by Age, CoIor, 

and Sex: United States, 1933-60 

13.	 Example of Interaction of Mortality Trends for Groupsof Diseases 

Producing Change in Trend of Total Death Rates: United States, 

1938-60 

14.	 Death Rates for Congenital Malformations, Age Groups l-4 and 

5-14 Years: United States, 1930-60 

15.	 Death Rates for Cirrhosis of Liver, 35-44 Year Age Group, by 

Color and Sex: United States, 1930-60-------------------------

16.	 Death Rates for Diabetes, 45-54 Year Age Group, by Color and 

Sex: United States, 1930-60 

17.	 Death Rates for Cirrhosis of Liver, 45-54 Year Age Group, by 

Color and Sex: United States, 1930 -60------------------------

18.	 Death Rates for Malignant Neoplasms, 55-64 Year Age Group, by 

Color and Sex: United States, 1930-60-------------------------

19.	 Death Rates for Diabetes, 55-64 Year Age Group, by Colorant 

Sex: United States, 1930-60----------------------------------

20.	 Death Rates for Pneumonia, by Color and Sex: United States, 

1930-60 

21.	 Death Rates for the United States and Lowest Recorded Death 

Rates for Countries of Low Mortality, by Age and Sex, 1959-60 

Page 

2 

3 

4 

6 

7 

8 

12 

14 

16 

18 

20 

22 

25 

26 

30 

32 

33 

35 

36 

40 

41 
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SYMBOLS 

Data not available 

Category not applicable . . . 

Quantity zero -

Quantity more than Obutless tban0.05---- 0.0 

Figure doesnot meet standards of * reliabilityor precision 
THE CHANGE IN MORTALITY TREND


IN THE UNITED STATES


INTRODUCTION In this setting, it would seem reasonable to 

expect further reductions in mortality. On the 

In a preliminary report,1 attention was called other hand, the possible adverse effects on morto the recent change in the mortality trend for the tality of radioactive fall-out, air pollution, and 

United States and for a number of other countries. other manmade hazards cannot be completely 

After a long period of decline, the trend of the ignored. 

crude death rate now appears to have leveled off. Another consideration is the nature of morIn the United States, the crude death rate has been talit y trends. It is obviously impossible for the 

more or less stationary during the period 1950- death rate to decline indefinitely. At some point 

60. in time, the mortality rate must level off as it 

The failure to experience a decline in mor- reaches the irreducible minimum. Also, with an 

tality during this period is unexpected in view of aging population, the crude death rate may be exthe intensified attack on medical problems in the pected to increase even if no change in age-spepostwar years. As Spiegelman 2 pointed out, there cific death rates occurs. However, the nature of 

has been a growth in the volume and scope of the recent changes in mortality trend does not


health services in prevention, diagnosis, medical appear to be consistent with either of these possi­


and surgical therapy, and rehabilitation, and also bilities.


an improvement in their quality. The rapid growth It is estimated that if the downward trend ex-


of health insurance plans has made high quality perienced between 1937 and 1953 had continued,


medical care readily accessible to ever increas- over 300,000 fewer deaths would have occurred in


ing numbers of people. The rising level of living the 5-year period, 1956-60. The estimated excess


has resulted in improvement of work and home deaths (deaths in excess of the normally expected


environment, quality and variety of food, educa- number) is about 85,000 deaths for 1961 and


tional attainment, and facilities for recreation. 131,000 deaths for 1962. The consequences of the


Developments in medicine arising from the exi- failure of the general death rate to decline will


gencies of a global war have become readily increase with time and will have social and eco­


available for application to civilian health prob- nomic significance in terms of population growth


lems. At no time in the history of the country and life expectancy.


have conditions appeared so favorable for health In addition to the demographic implications,


progress.	 the change in mortality trend is of interest because of its possible public health significance. 

Mortality data have long been used as an indication of health and medical progress. They have 

reflected epidemic outbreaks as well as reduction 

This report was prepared by Iwao M. Moriyama, Ph. D., of the in mortality from many diseases, particularly 

Office of Herrlih Statistics Anolys!s. those of infectious origin. Also, the increasing 

1

death toll from the major chronic diseases has 3. Is the present stationary level of the crude


been made evident. If the leveling off of the death death rate a transitory phase in the course of


rate has resulted from failure to prevent deaths mortality, or does it mark the beginning of a new


that are preventable, this is of public health sig- trend with the prospect of eventual upturn in mor­


nificance. On the other hand, if the death rate has tality?


reached its minimum point, this is important in 4. What implications does this change in mor­


terms of future mortality. tality have for the future?


In the examination of the recent change in 

mortality trend, several questions such as the 

following need to be answered. GENERAL MORTALITY TREND: 1. Is the change in mortality trend real or due 

to some artifact such as change in completeness UNITED STATES 

of death registration or errors in population estimation? In the period 1900-1960, the crude death rate 

2. If the death rate has leveled off, what was dropped from 17.2 to 9.5 per 1,000 population, a 

the cause of this change? decrease of 45 percent. Although it is clear that 

RATE PER 1)000 POPULATION 

20 

15 II I 

10 v 

9 

1’”-

8 

7 . 111111111 111111111 11111111 11111111 111111111 

1900 1910 1920 1930 1940 1950 1960 

Figure 7. Crude death rates: United .$fotes, 7900-7960. 

2 
the rate of decline has not been uniform over this 

period (fig. 1), it is difficult to discern any welldefined series of linear trends. Part of the problem is that there is a great deal of annual variation in the crude death rate; superimposed on that 

is the effect of the changing age composition of 

the population. 

A large part of the variability in the death 

rate is due to the frequent outbreaks of influenza 

occurring during this time. Collins and Lehmann3 

described influenza epidemics which occurred in 

26 of the 33 years between 1918 and 1951. In the 

years 1954-60, there were two influenza outbreaks. 

RATE PER 1,000 POPULATION 

20 I 

kd’1


“iW-lThe excess in total mortality varied with the 

severity of the influenza epidemics. Also, Collins 

and Lehmann’s study indicated a“gradual diminution of the excess. Because these respiratory disease outbreaks have affected chronic disease mortalit y as well as influenza and pneumonia deaths, 

it is difficult to eliminate from the total death rate 

the variations due to these epidemics. 

However, it is possible to adjust the annual 

death rates for the changing age composition of 

the population. This factor is significant because 

the crude death rate for ,an aging population will 

increase even though there is no change in basic 

mortality. In the period 1900-1940, the median 

I 

7 1111111111111111111111111111111 111111111111111111111111111 1900 1910 1920 1930 1940 1950 1960 

Figure 2. Age-adjusted death rates: United States, 1900-1960. 

3 
UtllTED STATES 

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Figure 3. Crude death rates: specified countries, 7930-60. 

1960 
age of the U.S. population increased continuously 

with the declining birth and death rates. With the 

change in fertility pattern with the onset of World 

War II, the median age of the total population has 

declined. 

When the effects of the changing age composition are removed, the mortality trends become 

clearer. The age-adjusted rates show three major 

trends (fig. 2). The first of these is from 1900 to 

1937. Starting about 1938, there was an acceleration in the downward trend which has been attributed to the introduction of the sulfonamides and 

antibiotic therapy. Since 1954, the death rate has 

leveled off. 

The point of principal interest is the rapidly 

declining trend from 1938 to 1953 and the leveling 

off of the death rate after 1954 or 1955. Although 

there were a number of influenza outbreaks during 1938-53, Collins and Lehmann reported that 

the occurrences after 1940 have been small in 

terms of excess mortality. The years 1954 through 

1960 were relatively free of influenza except for 

1957-58 and 1960. It is possible that the type A2 

influenza virus outbreaks in these years may be 

responsible for the upturn in general mortality. 

However, according to estimates made by 

Eickhoff, et al.,4 the excess mortality from the recent influenza outbreaks ranged between 20,000 

and 39,300 per year. Annual excesses of this 

magnitude would not account for the observed 

leveling off of the general death rate. 

INTERNATIONAL MORTALITY 

TRENDS 

Examination of mortality trends for a number 

of countries shows that the United States is not 

alone in exhibiting a change in trend in recent 

years (fig. 3). Several countries experienced excess mortality during the war years, but in the 

postwar years there was a resumption of the 

downward trend of the prewar period. During the 

last decade, however, there has been a marked 

slowing down in the rate of decline. In some 

countries, such as Norway, the Netherlands, and 

Denmark, the movement of the death rate in recent years has been distinctly upward. In others, 

such as Canada (not included in chart), the crude 

death rates do not show any clear tendency. However, the age-adjusted death rates have leveled 

off for both sexes since 1954. ~ 

The mortality figures that were examined for 

the different countries are crude death rates. 

Therefore, some of the recent changes could be 

attributed to changing age composition of the population. However, the age-specific death rates for 

England and Wales, for example, show that the 

death rates for the ages under 4S years are leveling off in much the same way as the rates for the 

United States. Also, the age-specific rates for 

Norway, Sweden, Denmark, Finland, and the 

Netherlands have changed in recent years. Even 

countries with a relatively high mortality such as 

Chile show the same kind of mortality experience. 

MORTALITY TRENDS BY STATE 

Analysis of mortality trends for individual 

States is limited to the examination of crude death 

rates because population estimates by age, sex, 

or color are not available annually on a consistent 

basis. Nevertheless, it will be useful to look at 

the crude death rates to determine the geographic 

pattern, if any, of mortality trends. 

Because of the unusual variations in the crude 

death rates for a number of States, it is difficult 

to make a satisfactory determination of the trend 

for all of the States. It is particularly difficult to 

categorize in a satisfactory and consistent manner the character of the trend shown in table 1. 

Yet, it seems clear that the crude death rate has 

leveled off in virtually all of the States. Even for 

New Jersey, Pennsylvania, Nebraska, and 

Hawaii—the States where there is no clear-cut 

trend over a long-time period—the crude death 

rate in the past 10 years has been relatively flat. 

In 43 of the States and the District of Columbia, the crude death rates have leveled off or are 

increasing after a period of decline. In the majority of these States (31) the movement of the 

death rates in recent years has been level or only 

slightly upward. The trend for Indiana is more or 

less typical of this large group of States (fig. 4). 

In 12 States and the District of Columbia there 

appears to be a marked rise in the crude death 

rate during the past 5 to 10 years, as represented by the trend for North Carolina. These 

are mostly southern States, but the West North 

5 
Table 1. States showing changes in trend


of death rates: 1935-60


A. Relatively rapid increase after period


of decline


Alabama Nevada


Arkansas North Carolina


Colorado South Carolina


District of South Dakota


Columbia Tennessee


Louisiana West Virginia


Missouri Wyoming


B. Leveled offor slight rise after period


of decline


Alaska Maine Ohio


Arizona Maryland Oregon


Connecticut Massachusetts Rhode Island


Delaware Michigan Texas


Florida Minnesota Utah


Georgia Mississippi Vermont


Idaho Montana Virginia


Indiana New Hampshire Washington


Iowa New Mexico Wisconsin


Kansas New York


Kentucky North Dakota


INDIANA 

Central and the Mountain Statesare also rep­


resentedinthisgroup. 

In only two States,Californiaand Illinois, 

does itappear thatthecrude deathratesare still 

declining.‘The crude death rate for California 

dropped rapidlyduring the period 1935-54, but 

since then the downward movement ofthe death 

rate has slowed down. Oklahoma is the only State 

which has exhibited a long-term upward trend. 

Some of the increase in mortality may beassociated with thepopulation changewhich occurred 

during the decade 1950-60. In some States there 

has been asignificant increase inthe proportion 

of elderly persons in the population; inothers, the 

proportion of Negroes has increased. In both situations, the crude death ratewilltendtoincrease. 

However, the demographic changesthathave taken 

place during the past decade donot offera clear 

and consistent explanation of the course of the 

crude death rate in the individual States. Also, it 

seems apparent that the recent change immortality trend is not limited to any particular geographic subdivision. Unless the change in the 

NORTH CAROLINA 

13P-----4


t 1 

9 

7 

1935 1940 1945 1950 1955 1960 

Figure 4. Crude death rates: specified States, 1935-60. 

6 
crude death rate can be attributed to aging of the 

population or some other demographic factor, it 

would seem that the reason or reasons for the 

change in trend lie in some condition operating 

across the country. Another significant point is 

that the change in trend appears to have taken 

place regardless of the level of the crude death 

rate for the individual State. 

TREND OF DEATH RATES BY AGE 

Both the crude death rate and the age-adjusted death rate are composite measures weighted heavily by the population in the older age 

groups. Age-specific death rates are not subject 

to the same kind of problem and are more informative in tracing the course of mortality. 

In an earlier report, it was observed that 

there was a marked deceleration in the rate of 

decline of the infant mortality rate (fig. 5). Be­

“’%,,*,,,,+,,, I I I I I 1 

= 

) 1935 1940 1945 1950 1955 1960 

Figure 5. Infant mortality rates by color: United States, 7933-60, 

ginning about 1950, the rate of decrease in infant 

mortality dropped to about one-third of the rate of 

decline experienced in the preceding 17-year 

period. The mortality experience of white infants 

followed the trend for all infants, whereas the 

deceleration in the trend for nonwhite infants was 

even more marked. Between 1950 and 1960 the 

infant mortality trend was virtually flat. For white 

infants the neonatal mortality trend changed significantly, and the postneonatal trend was affected 

only slightly. For the nonwhite infants, both the 

posmeonatal and the neonatal mortality trends 

showed a marked decrease in th~ rate of decline, 

with the latter leveling off. 6 

Since the change in the infant mortality trend 

has been a subject of special study, the examination of the age-specific death rates will be limited 

to those of other ages. As may be seen in figure 

6, the same kind of change in trend observed for 

infants appears to be taking place in the death 

rates for other ages. 

In order to gain a better understanding of the 

nature of the mortality trends by age, the logarithms of the death rates for the various agecolor -sex groups were fitted with a straight line 

by the method of least squares taking +937 as the 

starting point. This was the year when the downward trend in the death rate began to accelerate. 

The end point of the trend for this period of rapid 

decline was determined by eye, A second trend 

line was fitted for the remainder of the period up 

to 1960. This represents the period when deceleration in the downward trend of the death rates 

occurred. 

Presented in table 2 are the slopes of the 

trend lines for the two periods (designated as periods I and II) expressed in terms of average percent change per year, and the results of tests of 

significance between the slopes for the two periods. These measures indicate generally the rapid 

rate of decline in the death rate, especially for the 

younger ages, starting in 1937, and the deceleration of the downward trend in the 1950 decade for 

most age groups. 

The downward trend for every age group has 

slowed down for the white population. For white 

males, there are signs of a reversal in the trend 

of the death rates for the age groups between 45-

74 years and 85 years and over with the rates 

rising in the period 1954-60. The mortality trend 

7 
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Figure 6A. Death rates per 100,000 population, by age and sex for the white population: United States, 7930-60. 
100 - i, - 100 

'*r 80 - \ 5-M ytorr \ -80 -. 

% * 

60 - \ '. -60 

-4+., 

40 - -40 

30 I I I I I I I I I I I I I I I I I I I I I I I I I 30 1930 1940 ,950 1960 

Figure 68. Death rates per 100,000 population, by age and sex for the nonwhite population: United States, 1930-60. 

9 
--- 

Table 2. Change in mortality trend by age, color, and sex: United States, 1937-60 

(a) Trend lines not fitted. (b) No change in slope. 

for the age group 75-84 years does not fit the pattern of rates for the adjoining age groups in that 

the death rates are still decreasing, although at a 

slower pace, Also, the decrease in therateof decline began 4 or 5 years earlier. 

deviate from the trend for period I about 1950 or 

1951. The assumption of the second trend (period 

II) did not begin until several years later-in 1954 

or 1955. 

The mortality trends for the nonwhite population have also changed. The only exception to this 

is the trend for females 45-54 years of age which 

shows a constant rate of decline through the whole 

period. The death rates for nonwhite males have 

leveled off during this past decade in every age 

group up to 55 years of age. At the older ages, 

and this applies also to the trends for nonwhite 

females, clear-cut trends are not discernible because the death rates exhibit a pronounced cyclical type of variation. Trend lines were not fitted 

to these data. However,, generally speaking, the 

death rates in the older ages decreased rather 

rapidly from 1937 to about 1946 or 1947 after 

which the general trend has been declining more 

slowly or remaining relatively flat. An exception 

to this is the trend for white males 85 years and 

over, which declined fairly regularly from 1946 

to 1954 and now appears to be rising. 

There are exceptions to this general rule. 

Period II trends for infants and white persons in 

the 75-84 year age group started about 1950. Period II trends for nonwhite males and females in the 

age group 55-64 years began earlier still, about 

1947. 

TREND OF DEATH RATES BY CAUSE 

There has been a notable shift in the pattern 

of mortality trends over the years. The death rate 

for many diseases of infectious origin which were 

once major public health problems has dropped to 

a low level. Improved sanitation, immunization, 

and new therapeutic procedures have all but eliminated a number of these diseases as causes of 

death. With the decline in mortality from the infective and parasitic diseases, the relative importance of accidental injuries and the chronic 

diseases as causes of death has increased. 

The point at which the rate of decline started The general mortality trend is the resultant 

to change cannot be determined with precision, of trends for various diseases, and the degree to 

but generally speaking the trend for period II be- which a particular disease influences the general 

gan about 1954 or 1955. This is true even of the trend depends upon the relative frequency of deaths 

death rates for the age group l-4 years despite involved. Although there are certain problems in 

the fact that the observed death rates started to interpretation of trends for various disease cat10 

As 

white Nonwhite 

Period I r Period II t l- lXgnificancf level of 

difference 

in slopes 

Period I Period II ;ip,“p~tC” 

difference 

in slopes 

L 

Years Years Years 

Rate of 

decline 

in 

percent 

Rate of 

decline 

in 

percent 

-1.5 

-1.1 

-6"b 

-0:s 

+0.5 

+0.3

+o.a 

-0.3 

+1.0 

-1.3 

-0.8 

-1.8 

-0.6 

-0.8 

-0.4 

-1.0 

-0.7 

-1.1 

+2.0 

Rate of 

decline 

in 

percent 

-8.3 

-5.0 

-5.0 

-5.1 

-4.0 

-2.3 

-2.4 

j"[ 

-8.3 

-6.4 

-7.9 

I:*; 

-$Pb 

Rate of 

decline 

in 

percent 

-0.8 

-1.2 

-2.2 

-1.0 

I:*$ 

-0:7 

(a

(a I

+2.9 

Years 

:E% 

y;:;; 

1955-60 

1954-60 

1947-60 

1955-60 

1954-60 

1956-60 

1954-60 

EE 

1947-60 

1937-49 

1937-55 

:;g::; 

:;;:::f; 

1937-46 

1940-52 

1937-49 

1937-55 

1937-53 

1937-53 

1937-55 

1937-46 

.OOl 

.05 

.05 

.OOl 

5% 

.DOl 

l-4-----------

5-14----------

15-24---------

25-34---------

35-44-------m45-54----m-m-- 55-64_________ 65-74-------m75~84------m--

*5+------

1937-50 

1937-54 

1937-54 

E:::~ 

1937-53 

1937-53 

1937-49 

1947-54 

1937-51 

1937-54 

1937-54 

1937-54 

z::;

1937-53 

1937-53 

1937-49 

1947-54 

1954-60 

1955-60 

:;::::i

1956-60 

1954-60 

:;:;I;; 

1955-60 

1955-60 

:;:::g 

1955-60 

:;:;:g 

1954-60 

1954-60 

1950-60 

1955-60 

-8.0 

-5.6 

-6.3 

-6.3 

-4.3 

-3.1 

-2.5 

-2.2 

-2.1 

-3.4 

:F 

.05 

.05 

.05 

.05 

.OOl 

.OOl 

.OOl 

.OOl 

.05 

:E 

.OOl 

.OOl 

.OOl 

.OOl 

.OOl 

.OOl 

.OOl 

.OOl 

.OOl 

.OOl 

.OOl 

.05 

l-4-----------

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15-24---------

25-34---------

35-44---m-----

45-54--------- .j+,j!,____--___ 65-74--m-m----

75&34---------

8H--------

.OOl 
egories, the study of these trends may provide 

some clues to the problem of change in the general mortality trend. 

METHOD OF ANALYSIS 

In examining mortality trends for various 

diseases and conditions, it did not appear practicable to study each disease category since rates 

based on small frequencies would not contribute 

much to the total death rate, Therefore, the examination was limited chiefly to trends of five principal causes of death. In addition, the trend for 

the infective and parasitic diseases (International 

Classification of Diseases Numbers 001-138) as a 

group was selected for study; another group selected was diseases of the respiratory system, 

excluding influenza and pneumonia (ICD Nos. 470-

475, 500-527). In grouping diseases, it is recognized that significant changes in the trends for 

specific diseases will be obscured. 

There does not appear to be a clear-cut method of evaluating, in an objective manner, effects 

of trends for specific diseases on the trend of the 

overall death rate. One approach considered was 

the exclusion of death rates for certain causes of 

death from the death rate for all causes. This 

would have eliminated any variation in the trend 

for specific diseases excluded from the total death 

rate. On the other hand, this procedure would 

have introduced an artificiality through the assumption of zero mortality from certain diseases. 

AIso, the successive exclusion of death rates for 

various diseases would reach a point of absurdity when the trend for “all remaining causes” 

included only a fraction of the total deaths. 

The approach used was to examine the dec lining trends of mortality from specific diseases. 

When the downward trend is linear, it may be 

assurned that the trend for that particular disease 

had no direct bearing on the leveling off of the total mortality trend. On the other hand, when there 

has been a significant change in the rate of decline in recent years, this would have contributed 

to the leveling off of the total mortality trend. The 

amount of contribution is the difference between 

the expected death rate (assuming a continuous 

downward trend) and the observed death rate. This 

difference represents the amount the general 

mortality trend would have declined if the trend 

for a particular disease had not changed. 

Conceptually, there does not appear to be any 

serious objection to this approach. However, because of the variations in the death rates, there 

are some practical problems in determining precisely the endpoints of the linear portion of the 

trend. Some subjectivity is involved in making 

this determination from the graphic representation of the death rates. In most cases, the differences resulting from fitting one trend line or 

another would not be very great because the death 

rates for these problem cases are relatively low. 

However, when significantly large discontinuities 

appeared in the mortality trend for certain population subgroups, the projection of the earlier 

trend sometimes resulted in expected death rates 

which were consistently higher than the observed 

rates for a series of years. This method of 

analysis was abandoned when this occurred. 

Because the causes of death differ by age and 

color, the course of mortality for the principal 

causes of death in each age and color group was 

examined. Of particular interest were those trends 

that contributed materially to the downward trend 

of the overall mortality between the late 1930’s 

and 1960, especially if these trends leveled off 

in recent years. Also of interest was the mortality experience in the same period where the 

trends for the principal causes of death are flat 

or rising. The significance of the contribution of 

deaths from the various diseases or conditions to 

the total mortality will depend upon the frequency 

of deaths involved. 

Figures 7 through 12 show the mortality 

trends for the causes of death to which frequent 

references will be made. 

Age Group 1—4 Years 

In 1940, pneumonia and influenza, accidents, 

the major cardiovascular diseases, and diarrhea 

and enteritis accounted for about one-half of the 

deaths in the 1-4 year age group. Tuberculosis, 

diphtheria, whooping cough, and dysentery contributed an additional 13 percent. 

The death rate for all of these causes of death, 

with the possible exception of accidents among 

nonwhites, declined substantially in the 20-year 

period following 1940. The drop in the tuberculosis death rate has been rapid, with a marked 

11

�

MALE FEMALE 

1111111111111111111111 600 

‘oo~ 

400 

2(X3 1 

. 

‘“%*%.%+*** Im 

80 \ 

60 

L 

. 

8 

40 

t 

.;* 

20 – 

10 

8 

6-

4 

— 85 yews and over 

.—.. 75.84 yt.x$ 

w-=- 65-74 flUrS 

_ 55-64 years 

t.....-. 45-54 Y*.,1 

7. -— . 35-44 ye.,, 

— 25-34 yaws 

..—. 15-24 y,.,, 

.— - 5.14 yin,’ 

=--w 1.4 yem I I 

- 400 

— 220 

—Im 

‘+* 

%* — 60 

— 60 

, 

\: 

~1 Iw.?o 1950 196CI 

Figure 7A. Death rates per 700,000 population for infective and parasitic diseases, by age and sex for the white population: Untied States, 

1939-60. 

12 
----

----

MALE 

‘“”~ 

65-74 yawl 

— 55-64 w,,

2	 ...... 45-54 yaws 

.- 35-44 yam 

— 25-34 yam,

.,— 15-24 yew. 

.— 5-14 pm 

I-4 Wm. 

I 

J_d~ 1940 1950 1960 

FEMALE 

1111111111111111111111 

‘\ 

\ 

I 

\ 

\-. 

\ 

1 

\ 

1 

\ 

1, 

\ 

\ 

\ 

\ 

‘L ‘. 

\ 

\ 

\ 

\ 

\ 

690 

400 1


\ 

\ 

\ i.. -

+ - ‘

\,.l. 

4

‘1

\/ , 

2 

,4, 1 -

1940 1950 !%0 

Figur* 7B. Death rates per JOO,OOOpopulation for infective and parasitic diseases, by age and sex far the nan white population: United States, 

1939-60. 

13

MALE v.I+$TE FEM!.LE 

Wno Illlllllllllli l“’1l’’’ 1111111 l’’’l’’lll’”ll 3/300 

2,000 

,poo -

800 

602 -

+00 -

’200 -

!00 

80 -

60 -

40 

20 

w 

8 -

6 -

4. 

2-

5.$4,..” 

,,~ ,940 ,*O ,960 

Figure 8A. Death rates per 100,000 population for influenza and pneumonia, by age and sex for fhe A ;fe popubtimr: United States, 1930-60. 

14 
3’000 MALE NONWHITE FEMALE 

3,000 11111 1 [111 I 1111 1111111111 I 

I ‘“1~“””o 

1,000 

900 

600 600 6CC7 

400 400 400 

c.” Zca eoc 

Iw ,CO ,Km 

#o 80 no 

en 60 , 60 

40 40 40 

20 20 20 

I! 10 ,0 

a . 8 

8 6 6 

4 4 4 

2

H — 

Figure 8B. Death rates per 100,000 population for influenza and pneumonia, by age and sex for the norrwh ite population: United States, 

1930-60. 

15

-----

-----

� 

MALE WHITE FEMALE 

111111111111111111111111111 II 500.0 

500’0 ~ 500’0 

~d 

‘\ 

\vA\,4 

\ 25,1”s 

b, 

\ 

200,0 - 2000 \ - 200.0 

\ 

\\ 

\ /-’ u300 100.0 – \.fl 10 

“L.-. ./”’ 

800 \. .4’/ 80.0 

\/ 

)1 

600 

t / ..4‘O’O 

40,0 

200 -

w%,

.-/,,.$.,, ,,$ ..t # 

* 

%.,.$ %. , !00 !0.0 I ,0@y;44 +. 4 ,,.s.!!..”2= 

>= 

8.0 - ..* 

60 -

40 -

2,0 -m 85 Non nod over 

..-. 75-04 pars 

— 65-74 yea,, 

55-64 Y*OIS 

Sibs,,.,,,,, 45-54 pats 

-—, 35-44 Yeors 

I .0 ,.-. 25-34 Y*O,S

,,,,,,,.s. ~-1~ Y*.~s 

0.8 — I-r Yeom 

E.-24 years 

I 

06 1- ~ 06 

~ 0.5 

1930 1940 1936 1960 

Figure 9A. Deaih rates perlM,OOO population fordiseases of therespirab~ system excluding influenza andpneunmia, by age andsox, 

forthe white population: United States, 1933-60. 

16 
NONWHITE FE L4ALE 

II / ImT- 5000 I (-rl 1- [1 T Trl-r 

[ 

l-T T-T ‘oo”o’’’’l’’’’ ”l’’~’~’”l T- T“ 

‘“/1 

I r 

20C? 

IOOG 

800 

60.0 

400 

200 

100 

8,0 

60 

4.0 

?,0 

LO 

iL 0.8 

0.6 -

05 L 

I ~“”” 

1 

: - 600 

8 

1 

1* 

. 

:%./; 

* v, 

‘ 15-24 , 

1 

: :-

5-14 i 

z., 

:,,%,.,,,, ,0
 1

~o. 1930 1940 1950 1960 1930 1940 1950 1960 

Figure 9B. Death rates per 100,000 population far diseases af the respiratory system excluding influenza and pneumanio, by ?ge and sex, 

for the nonwhite population: United States, 1933-60. 

17 
MALE WHITE FEMALE 

ZO,QOO II Ill llll\ll Ill Ill 11111111111” 20,000 l[ll!l[ 11 ] 1111111111111 111(11 20,000 

.s&%a/&fl-\ -4* 

-/ \/d~.AAdA- ~~ 

85 Ymr$ ,nd .“,, -./~ 

85,mrs md met 

10,000 - ! O,cm - 10,000 

8,000 ;&.*.*’-.@ .\,/. 75-04 “,0,, woo - 0,000 

--./. -.,.—.-.. ;#._/%*+”*, 75-84 yews 

6,000 - 6,C20 +-.4+*._,L- 6.000 

4,000 ‘IWO - 4.000 

65-74 m,,, 

.- . . . ..4*..4*”*-*”.- .*.. -.*. -.-.*. --*---

j 

�. .*- - -..* 

I ---*..*+b*- 65-74 “...s 

2,000 .-.. 2,000 � --..--* - 2,000 

t i �-.--.*­

55-64 “m,, 

1,000 - 1,000 - 1,000 

800 - 800 - 000 

55-U W.,* 

600 - 45-54 pots 600 

1

,* ,“,,”\,,,,. 

,,,,,,,,,..,.,,,.,-,$.? (,,,!,.,,,....!”.,,,, %,,..,.,,,.!.w 

~ ~. ,.!!O,,,.. !.+’”-’ 400 - 400 1 ““’”’’’J,,,), o.”r”,,,,,,,,,,,,, *,,~,, %,,%,, 

200 ‘%>.,

“%, 

‘%.,.. ,,,, 

.-/”---+ 

L.. 

100 - [00 ,00 

~T_, 

80 - w 

Y 35-44 ye.,% 80 

‘N+ 

60 - 60 

~\e-d_ 

35-44 ye.,, 

1290I

“+u-

“’’’’.,... !,,,4,,,,,,,,,+

45-54 Ymts 

.,,,,,

i 200 

‘\-\-’” 

‘+.&me. ,/$ “%-

40 - -.\./ \ 40 25-34 yin,, 40 “hay 

“L. .-. 

%e..aw \ 

.* .-. � “-. 

‘..+ . 25-34 years . --#.* ,,+; $------ \ 

“-.. -.., 

.-. # s, �. . �& \ 20 I H 20 “-. ~ 20 

\ .-. ‘s, 

*. � . ,.-,. “,.,, 

,,,.2, ,

..*...*.e 10 - 10 10 

,. 

e- 8 %.. e 

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6 - e 

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2L~ 2 

111111111111111111111111 I 1 !,1 1;30 ,935 !940 ,945 ,9x? (955 ,960 1930 1935 1940 [945 ,9S0 1955 19;0 

.—— ——. 

F;gure 70A. Death rates Perl OO,OOOpopu/ation formajor cardiovascu/ar-rena/ diseases, byageand sex fortlre wlri~epopulotiorr: 

United States, 7930-60. 

18 
.

�

MALE NONWHITE FEMALE 

2 O,aeo 20,000 20,C.JO 1111 11111111111~11111~1111111 1111] II 111111111111 /11 [1/1111 

1 

.Y. .-. -.,. ..— ,- - F-”\.+._. 

4,002 t 65-74 nom 4,000 

. 4@a 

$..* 

‘.* ..-4.8. � e %. � * +-% .-...% .* �*.....-%. % 65-74 wan 

+.. .%, � ,% . . _ . . . . . . . . . . . . . . . . . . . . . ...+ .*.* 

. . � ..** . . . . ‘“H. 

...* 

%-”

\.\.\ . 

1 

55-64 “,.,s 

2,000 2,’000~“yaa” i’”” ,, “’”’,..! ”. . . ....s”...l .. . .. .. ..!l$ .. . . . . 

1,000 “%,,,,,,> .’%.” “ “ “’,,$ ““”% 45-54 Pats 1,000 45-54 W..* 1,000 

“’%.,+$’”% ,,,,,,,,,, <.,, “’%,,. ... . .. ,.,!,,,,,,,,,,, G,,,,’ 

800 ‘%,,,,, 800 800 

t., “%.s..,,$$ 

‘%. , %,, ~ ~. 

600 -.4, 600 

,,. h“oh 400 VV~</.q 400 

-+ >< \, 35-44 yea,, 

I 35-44 “mm ~ 11 

!00 100 

. .

\. 25-34 “Mm – 100 

k----

80 80 \- 8“ 

.<,4, . 

L 

60 60 � - w 

[ “., 

..-.., 

�*. 

..--., 

.+ 

40 %,,..”.. - 40 

., ,5-24 Y..,, 

‘. 

* . . . . . �..** 

. % 

“.. 

20 

10 

e 

6 

:: 

:: 

:-:- 4 - 4

“t i : 

1-4 years I

2 - 2 

1 11111111111111111111111[ 11111. 

1930 1935 1940 1945 1950 1.955 19d0 

Figure 10B. Death rates per 100,000 population {ormajor cardiovascular-renal disease+ byageand sex forthenanwhite population: 

UnitedStates, 1930-60. 

19


122-367 0-64- 4 
---

----

--------------

MALE WHITE FEMALE 

!,000.0 2,000.0 I I I I I 1111 1111 1111 I II 2,000.0 

//\ -.. -4 

65 “,0,s md 0“,. l“’’’’’’’’’” /</-”- \+-

/Yy 0“” “’”’ 

H-H*,Z::::.H’;.:;.:’-’ ‘ p!e~ 

1 .- !

~’-’-._, \,d.\ .- .-,+ 

1,0000 t -1“000’0 75.8* “,0,s ‘\,. “OGOO 

-m... -. 

800.0 I #--- ..-.** 800.0 800,0 

--..-.-..--0”%. 65-14 pm 1 K5-74 “mm . . . . . . . . . 

600.0 600.0 -.....-.*--b- 600.0 

E “’’’’’’’’’’’’” I [’” ““: 

“000P4000Ho
 ~Q~,~ -..0% .!o,r,,,,,,,,,,,,,, o,,,,, o#,,,,s),,,,,,,,,, s,o,,,.,...##,,,,,,,,,,,,,,,,,,,,.,.w#,,,,,,,, 2VO0 200.6 . .. 45-54 ye.,, 

{ 

.,,,,,,,,,, ”,,”,,,,.. OO!sl.,,,$,.,,” 

,,,,. 

.,,,,,,,,,,,,,,,,,,,,,,. !!,,.”,,,,’$ ’’’” 45-54 ye.,. 

,..,., !!, 

%,$,.,* 

I 

1000 100,0 !00.0 

r d I 

60.0 80.0 .P---./\ 35-4.! year. 80.0 

t H- -----> 

-d 

,. ~- -*+:1 5-!4 mm% II A ~..! 

1.0 LO Lo 

0,8 11111111111111111111111111111 0,0 Lllllllllllllllll LuJ 0.8 

1930 1940 1950 1960 1930 1940 1950 .960 

Figure 11A. Death rotes per 700,000 popukrtion formalignant neoplasms, byage and sex for the white population: United States, 7930-60. 

20 
MALE NONWHITE FEMALE 

2’0000~w2’000”01’’’’’’’’’’’’’’’’’’’’’’’’’””l2,030.0 

. . . . . . ..- 200.0 200.0 45-5* ”*.rs 200.0 ,.. 

,....”” 

... . . . . . . .. 

.. 

35-44 ,...% .../” 

.*. j \*-@ ---A--L*+ 

..,. 

: % . .“ \-. 

100.0 1000 [ J 11 120.0 \ /- 1 

.+,%- “ H“0’0‘L/\.t’@’jjr”\.,.!}td.,z3-~~Y,..s 

1

40,0 

I “u. -

-“ -%-.% 120.0

I ..#%.A- i 15-24 “..,$ II I 

.8~800,8t T11111,1,1,,,,1,,1 111,11 110,8 

1950 ,930 1940 1950 1960 1!330 1940 

Figure 11 B. Death rates per 100,OOO popvlatfon for malignant neopl-ms, fv age and sex for the nonwhite population: united Sfates, 1930-M. 

21

.

..... . --

... .. ..

....

..........

.

---

I 

I 

MALE wHITE FE MALE 

2,000 11111 11111 1111111111111111111 Zpoo Ill I I 111111 , ZpOo 

‘/’y’’’’’’”” 

,/ -+v-fiw~ 

\\ 

,r/’\@LJ\ 85Yem md over 

\\ 

1,000 — i85yem .nd.ver 1,000 – Qoo . 

600 L /’1 ~ 600 ~ :’ “’\ d6W 

.-. ..W65-74 years 

200 .“””-.

.

k M ‘.”...”:.....

..,.

-\% ~--, L. %... 4200

‘\- -. 

;24 

55 -64years 35-~4yeofs . . . . . . . . . . 

\\ . . . . . . . .. . . . . . . . . . . .

“1“, 

45-54,.?.,s I ---., //” k 

=’\ . “. 

100 — , 

‘+,*W ~ -, \

\ ., / 

/0 \/ *~ 

,.- x,,. 

100 

i

\

\ 100 

15-24 yam , 65-74ymrs 

25-34 years %, 

80 — 80 

..... 

W 60 

.. . . . . . .

. . . ..

..

...

..

. . . . . . . . 

\ -\ %-.< 

-.% 

w 

.......

/...%.. 60 — .. , .. 60 

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

... “,.... ... . . . . . . . . . ../’\ -

\,we/.J.fi.\ . .. ..-.5:-64ym

. . . . . . . . . . . . . . . . . . ...4 

40 40 “. 

.. . . ...” qo 

.\ . “.”... “< .... .- -. : 

-’, 5-,4 ye,,; ... ... 

%-\, ... ....... 

7 

‘--i 

-L 

20 20 I i

1,~5~- 14years 1,,,,,,,,,,, n

. I 

m 

‘“1930 

Figure 12A. Death rates per 700,000 population for accidents and other violence, by age and sex for the WAife population: United States, 

1933-60. 

22 
MALE NONWHITE FEMALE 

2,000 11111111111111 [1111 ‘~-l_iTTHT 2,000 II I I I II II 11111 II I I I I I I I I II 1 ?,000 

I,ooo 1,000 ,000 

800 800 300 

600 J \ m, / \f4/4v/Q 

I \/4\ 

600 600 

400 ww.yq. w, 400 400

25-34~ \/’\ ,4 />, ,/”~.


35-44 A /:\


65.74y “;;* ..\


45.54, ,


55-64


200 200 200 

““24*


.-’ .


L. 

100 100 100 

80 80 00 

60 60 60 

‘\\.~--\\/.\ 40 .. A<, 40 40 

20 20 20 

10 10 [0 

0 1 > 

Figure 128, Death rates per 100,000 population for accidents and other violence, by age and sex for the nonwhite population: United states, 

7933-60. 

23 
acceleration in the rate of decline after 1950. 

However, the trend for the group of total infective 

and parasitic diseases is declining essentially in 

a straight line on a logarithmic scale. On the other 

hand, there has been a slowing down in the decline 

in the death rates for pneumonia and influenza, as 

well as other diseases of the respiratory system, 

diarrhea and enteritis, duodenitis, the major cardiovascular-renal diseases, and accidents and 

other violence. Although there has been a large 

reduction in the death rates for pneumonia and influenza and for diarrhea and enteritis, these diseases still ranked among the five principal causes 

of death in 1960. 

If the mortality trends for pneumonia and influenza, other diseases of the respiratory system, 

diarrhea and enteritis, the major cardiovascular 

diseases, and injury from violence (for whites) 

had continued from 1938 to 1960 at the same relative rate of decrease, the general mortality trend 

would have declined at a greater rate than was 

actually experienced after 1950. However, except 

in the case of nonwhite males, the failure of the 

trends involving these cause-of-death categories 

to continue in a straight line does not appear to 

account for much more than 40 percent of the difference between the expected and the observed 

death rates for all causes in this age group subsequent to 1950. For nonwhite males, the corresponding figure may be as much as 45 percent. 

The change in the pneumonia and influenza 

mortality trend starting about 1950 had the greatest effect on the course of the general mortality 

trend. However, this did not account for much 

more than one-fifth to one-third of the deviations 

from a straight-line trend of the total death rate 

for this age group. The change in the diarrhea and 

enteritis trend also appears to have played a relatively important role in affecting the total mortality trend. 

What seems significant about the trends for 

children of preschool age is that much of the 

change in trend in the general death rate appears 

to be associated with the change in mortality 

trends involving diseases of infectious origin. The 

death rates for all of the diseases mentioned 

here, including the cardiovascular diseases which 

are mainly rheumatic infections in this age group, 

have undergone rapid decline with the introduction 

of chemotherapy and antibiotic therapy. The recent leveling off of these rates raises an interesting question as to the reason or reasons for the 

change. 

Even if the mortality trends for influenza and 

pneumonia, diarrhea and enteritis, diseases of the 

heart, and accidents had continued downward, a 

similar trend for all causes of death would not 

necessarily have resulted. For example, a straight 

line was fitted to the logarithms of the death rates 

from 1938 to about 1950 for each of the akmementioned causes of death, infective and parasitic 

diseases, and diseases of the respiratory system 

excluding influenza and pneumonia, for white females 1-4 years of age. Each of these trends was 

extrapolated to 1960 on the assumption of a uniform rate of decline. The summation of these 

trends is shown in figure 13 as “A ,“ which is substantially a straight line until 1956 when it starts 

to deviate from the trend line. The plotted points 

“B” represent the observed death rates for malignant neoplasms and congenital malformations 

which show a gradual rise from 1938 to 1948. (The 

discontinuity in the death rates between 1948 and 

1949 are due to changes in the classification of’ 

malignant neoplasm.) Since 1949, these rates 

have been essentially level. When rates for trend 

“B’r are added to the rates for trend “A,” trend 

“C” is obtained. The points along this trend show 

much more marked deviations from the trend 

line and simulate the leveling off”observed in the 

trend of the death rate for all causes. Thus, it 

seems that a combination of forces is operating in 

shaping the pattern of the death rate for all causes. 

In 1960, pneumonia and influenza constituted 

about 13 percent of all deaths among white children 1-4 years of age and ahcmt 20 percent of the 

deaths among nonwhite children. Diarrhea and enteritis contributed from 3 to 4 percent of the total 

deaths, In addition, the group of other infective 

and parasitic diseases accounted for 6 to 8 percent of all deaths. If it were possible to completely eliminate these diseases as causes of 

death, the death rate for white children would be 

about 20 percent lower than the recorded rate of 

95.2 per 100,000 population in 1960. Similarly, 

the death rate for nonwhite children in this age 

group would be about 30 percent lower than the 

death rate of 190.8 per 100,000 population for 

1960. 

24 
� 

The future course of mortality in this age years has shown a tendency to level off. For nongroup is also highly dependent upon what happens white children, the rates did not decrease nearly 

to the death rate for injuries from accidents and so fast as for the white, but the general trend is 

other violence, and the rising mortality rates for still downward. Accidents and other violence acmalignant neoplasms and congenital malforma- counted for almut 30 percent of all deaths in this 

tions. The death rate for violence for white chil- age group. 

dren had been declining fairly rapidly but in recent 

300 > 300 I I I [ I I I I I I I I I I I I I I I I 

x 

200— x — 200 

\ 

I00 — — 100 

— z€

o€

G 80 — — 80


a€-1 

3 TRENO A

L “1 

: 

o 60 — Y o

0“ Y o 

~ \x K 

w \’ n. 

u 40 — 1-

< 

a 

\x IL 

xxx xx 

xx xxx x 1: 

20 — — 20 

xx 

xx x 

xx xx 

TREND B x x 

10 I I I 10 

1935 1940 1945 1950 1955 1960 

Figure 13. Example of irrtemctian af martalif y trends for groups af diseases praducing change in trend of fatal death rates: Unifed Sfafes, 

1938-60. 

25 
Malignant neoplasms and congenital malformations assumed greater relative importance in 

terms of frequency of deaths in 1960. This is because of the rising mortality from these diseases 

and the declining mortality from the infectious 

diseases. Prior to the use of the Sixth Revision 

of the International Classification of Diseases in 

1949, the death rate for malignant neoplasms was 

rising. With the revision in disease classification 

procedures, a large increase in the level of the 

death rate for malignant neoplasms occurred. 

This arose from the difficulty in maintaining a 

comparable series on cancer mortality for this 

age group. “The chief problem is adjusting past 

data for the leukemias and lymphosarcomas which 

constitute about half of all deaths from malignant 

neoplasms for the 1-4 year age group. However, 

the significant fact with respect to the problem of 

general mortality trend for this age group is that 

the death rate for malignant neoplasms has been 

stationary or declining slightly during the past 10 

years. 

The death rate for congenital malformations 

increased slowly until 1953 or 1954 and then 

leveled off (fig. 14). This may be related to the 

possible prolongation of life of those with congenital defects, as is suggested by the corresponding 

rise in the death rate for congenital malformations 

in the following age group, 5-14 years, 

The problem capable of solution, in view of 

present knowledge and facilities, is the prevention 

of deaths from infectious diseases. Much more 

can be done than has been accomplished during 

the past 10 years. However, there is a limit md it 

will become increasingly difficult to lower the total death rate by an attack solely on the infectious 

disease problem. The prospects of further reduction in mortality from the chronic diseases 

appear to be good, but the present rate of decline 

is fairly small. Therefore, unless major developments occur which would influence cancer mortality and deaths from congenital malformations 

among children of preschool age, large gains in 

the savings of lives cannot be expected. 

Age Group 5-14 Years 

Twenty years ago, accidental deaths accounted for the largest proportion of deaths among children of school age, except among nonwhite fe10 

2 

I 

1930 1935 1940 1945 1950 1955 1960 

Figure 74. Death rates for congen;fal malformations, age groups 

T-4 and 5-14 years: United States, 1930.60. 

males. In this group, tuberculosis was the most 

frequent cause of death and accidents, second. 

Tuberculosis was also one of the five leading 

causes of death among nonwhite males and white 

females, whereas malignant neoplasms were a 

significant cause of death among white males. The 

diseases of the heart, appendicitis, and influenza 

and pneumonia made up the remainder of the five 

principal ca~ses of death in this age group. 

Despite the importance of accidents as a cause 

of death, the number of deaths from infective and 

parasitic diseases, including influenza and pneumonia, as a group exceeded the frequency of ac26 
cidents as a cause of death for every group except 

white males. The mortality from the infective and 

parasitic diseases was especially high among the 

nonwhite children in 1940. 

With the rapid decline in mortality from the 

infective and parasitic diseases and from appendicitis, accidents increased in relative impcmtance. By 1960, malignant neoplasms had become 

~econd in importance to accidents as a causs of 

death in each color-sex group. Deaths from congenital malformations also moved into prominence, due partly to the increase in survivors 

with congenital defects from the 1-4 year age 

group. Despite the large decline in the influenza 

and pneumonia death rate, these respiratory diseases still remained one of the five leading causes 

of death in 1960. On the other hand, the number of 

deaths from appendicitis dropped to a low level, 

and appendicitis no longer appeared as one of the 

first five in the rank order of causes of death. 

Of the numerically significant causes of death 

in this age group, influenza and pneumonia and infective and parasitic diseases are the only disease groups where the death rates have not followed a straight-line downward trend. However, 

the assumption of a continuous decline in the 

rates for these diseases and for diseases of the 

respiratory system for white males would account 

for less than one-third of the deviations between 

the observed and expected death rates for all 

causes of death in this age group in the period 

1957-60. 

The death rate for accidents among white 

children in 1960 was about one-half of the rate of 

30 years ago. The rate of decline in the accident 

death rate for nonwhite children was not nearly 

so great, but the trend was definitely downward. 

Another significant change—which began in the 

mid-1940’s —was the marked acceleration in the 

rate of decline of cardiovascular-renal mortality 

among children of school age. This maybe attributed to the effects of antibiotic therapy on the 

deaths from rheumatic heart disease. Although 

heart disease still ranks as one of the five leading 

causes of death in this age group, the death rate 

is now at such a low level that it does not greatly 

affect the general death rate. On the other hand, 

the increasing death rates for malignant neoplasms and congenital malformations are opposing the general downward course of mortality for 

this age group. These opposing trends do not now 

constitute a strong force, but they will exert increasing influence on the general mortality trend 

if the death rates for neoplasms and congenital 

malformations continue to increase. It is significant that almost one-half of the deaths from 

malignant neoplasms in 1960 were attributed to 

leukemia and aleukemia. 

The difference between the observed and expected death rates for all causes is diverging at 

a rapid pace. However, the magnitude of the absolute difference of these deviations is still relatively small. At this point, it will not take a large 

change in the death rate for a particular disease 

or condition involving a relatively large frequency 

of deaths to significantly affect the present course 

of the general death rate. However, further reductions in infectious disease mortality cannot be 

expected to alter greatly the total death rate. 

Even if all the infective and parasitic diseases, including influenza and pneumonia, were eliminated 

as a cause of death, the death rate for children 

of school age would not decrease much more than 

10 to 12 percent below the rate recorded for 1960. 

The future course of mortality among children 5-14 years will depend primarily upon the 

death rate for accidental injuries. In 1960, accidents accounted for more than &e-half of all 

deaths among nonwhite males in this age group, 

and close to one-half (47 percent) of deaths among 

white males. The proportionate mortality rate for 

females was lower, but still high, with 30 percent 

of the white and 37 percent of the nonwhite female 

deaths resulting from accidents. Because of this, 

substantial reductions in the total death rate cannot be expected unless greater decreases in the 

accident rate are obtained. The rate of decline of 

the present trend of the accident rate is apparently not sufficient to maintain a constant percentage decline of the general mortality trend. 

Age Group 15–24 Years 

The pattern of causes of death in this age 

group is somewhat similar to that for the 5-14 

year age group, with the additional risk of deaths 

in childbirth. The most frequent cause of death in 

the 15-24 year age group in 1940 was tuberculosis, except among white males. In this group, 

27 
tuberculosis ranked second to accidents. Influenza and pneumonia also appeared in the rank 

order of five principal causes of death for all 

color-sex groups. In general, it would seem that 

the problems in this age group 20 years ago were 

principally deaths from diseases of infective origin and from violence. For example, in 1940 the 

diseases of the heart and complications of pregnancy, childbirth, and the puerperium were the 

two groups of diseases in the rank order of five 

leading causes of death which do not necessarily 

involve infection. However, over 50 percent of the 

deaths from diseases of the heart related to rheumatic infections, and more than 40 percent of maternal deaths involved sepsis. 

With the decline in the death rates for the infective diseases over this 20-year period, accident fatalities assumed an even greater relative 

importance as a cause of death in 1960 for this 

age group. Accidents became the leading cause of 

death in every sex-color group with the proportion of all deaths attributed to accidents ranging 

from 18 percent for nonwhite females to 64 percent for white males. Homicide and suicide also 

increased in relative frequency. In 1960, 69 percent of deaths among nonwhite males and 73 percent of deaths of white males were from some 

form of violence. The corresponding proportions 

for white females were 31 percent and for nonwhite females, 43 percent. 

By 1960, tuberculosis and influenza andpneumonia were no longer of numerical significance 

as causes of death in this age group, and malignant neoplasms emerged into prominence. However, the increase in the relative importance of 

the latter is due partly to the effects of a change 

in disease classification procedures in 1949. 

Substantial decreases in mortality from diseases of infectious origin have been experienced. 

However, the rate of decline in the death rate for 

influenza and pneumonia has decelerated during 

the past 10 years or so. The death rate for the total group of infective and parasitic diseases was 

higher in 1957-60 than had been expected on the 

basis of past trends. Also, the suicide rate for 

the 5 or 6 years before 1960 was higher than had 

been expected. However, none of these developments accounts for a large proportion of the 

change in the general mortality trends in this age 

group. Even collectively, the assumption of a 

straight-line trend for these diseases and suicide 

would account for much less than one-third of the 

difference between the expected and the observed 

values of the general mortality trends for white 

females and nonwhite males. (Trend lines were 

not fitted to death rates for white males. Because 

so many men in this age group were in military 

service overseas, there is an artificial rise in 

the death rates during the war years.) For nonwhite females, a larger proportion of deviations 

from the trend line of death rates for all causes 

can be accounted for. However, if there were a 

deceleration in the rate of decline of the general 

death rate for this color-sex group, it was of 

extremely short duration. 

The governing factor, with respect to future 

prospects for further declines in mortality in this 

age group, is mortality due to violence. The trend 

for violent deaths is virtually flat for white males 

and females. For nonwhites, there is a definite 

but slow downward trend. Unless a significant decrease occurs in the death rates for violence, 

there will be an increasing tendency for the general death rates in this age group to level off. The 

death rate for the infective and parasitic diseases 

has reached such a low level that further declines 

would not have a significant effect on the total 

death rate except, possibly, for nonwhite females. 

In this group, 11 percent of all deaths in 1960 

were attributed to infective and parasitic diseases, including influenza and pneumonia. 

Age Group 25-34 Years 

The principal cause of death in this age group 

in 1940 was tuberculosis, except among white 

males. For this group, accidental injuries was the 

leading cause of death followed by tuberculosis. 

For females, the complications of pregnancy, 

childbirth, and the puerperium ranked second 

after tuberculosis. Malignant neoplasms, cardiovascular diseases, accidents and other forms of 

violence, and influenza and pneumonia were also 

significant mortality problems for this age group 

in 1940. 

Significant declines in mortality were recorded between 1940 and 1960, particularly for 

the infective and parasitic diseases. The tuberculosis death rate, for example, dropped sharply, 

and numerically this disease is no longer of con28 
sequence as a cause of death. The trend for the 

infective and parasitic diseases as a group, as 

well as for influenza and pneumonia and other 

diseases of the respiratory system, declined 

rapidly and then began to level off in the decade 

1950-60. Similar changes in the movement of the 

death rate have occurred in the trends for cardiovascular-renal diseases and for maternal 

deaths for white females. The maternal death rate 

for nonwhite females is declining without interruption, but the level of the rate is still considerably higher than that for white females. 

Except for the general mortality trend for 

nonwhite males, the decreasing rate of decline 

for the various specified disease trends appears 

to account for possibly 55 to 65 percent of the 

change in the general mortality trend. For nonwhite males, less than one-third of the difference 

between the observed and the expected death rates 

might be attributed to the leveling off of component parts of the total death rate. 

It would appear that a good part of the leveling off of the general mortality trend for this age 

grouP is due to the fact that the death rate for accidents and other violence has been practical y 

flat over the past 15 years or so for all color-sex 

groups. For nonwhites, the death rate for violence 

had been declining generally until about 1945, 

when the decline abruptly ceased. Since then, the 

trend for nonwhite males appears to be 

slightly downward, whereas for nonwhite females 

the direction of the trend seems to be slightly 

upward. 

Violent deaths are numerically important, 

especially among males in this age group. More 

than half of the deaths in 1960 were from violence. The preponderance of deaths among white 

males were from accidents, whereas among nonwhite males there were almost as many homicidal deaths as there were accidental injuries. Almut 

one-fourth of the deaths of white females involved 

violence, while the corresponding proportion 

among nonwhite females was abut 20 percent. 

By 1960, malignant neoplasms had moved up 

in the ranking of causes of death for this age 

group although the death rate for malignancies 

remained unchanged. Cancer mortality accounted 

for 22 percent of all deaths among white females 

in 1Q60, whereas for white males and nonwhite 

females the proportionate mortality was about 

one-half of that for white females. Only about 5 

percent of all deaths recorded for nonwhite males 

was assigned to malignant neoplasms. 

The future course of mortality in the 25-34 

year age group will depend largely upon the trends 

of the death rates for violence and malignant neoplasms. Even the complete elimination of deaths 

from infective and parasitic diseases, including 

influenza and pneumonia, would not have too great 

an effect on the total death rate, except among 

nonwhite females. In this group, about 11 percent 

of all deaths are from infective and parasitic diseases, including influenza and pneumonia. 

At this point in time, it appears that the primary forces that had been driving the death rate 

down have almost lost their effect. The general 

death rate will probably not decrease much further unless new forces come into play to accelerate the decline. Violence and cancer appear to 

be the principal problems of the 25-34 year age 

group. 

Age Group 35–44 Years 

With approaching middle age, the principal 

causes of death in this age group are a mixture 

of infective and parasitic diseases, accidents and 

other violence, and the chronic diseases, with the 

latter begiming to show predominance. 

In 1940, diseases of the heart were the leading cause of death among white males and nonwhite females and the second ranking cause of 

death among white females and nonwhite males. 

Malignant neoplasms ranked first for white females and constituted one of the five leading 

causes among white males and nonwhite females. 

Tuberculosis was the most frequent cause of death 

among nonwhite males, the second ranking cause 

of death for nonwhite females, and third in the 

rank for white males and females. Syphilis was a 

significant cause of death among nonwhite males, 

as were maternal deaths for white females. 

In the period 1940-60, mortality from tuberculosis declined to the point where it was no longer numerically large enough to appear in the rank 

order of the five leading causes of death. In fact, 

the proportion of infective and parasitic diseases, 

including influenza and pneumonia, in 1960 ranged 

from about one-fifth to one-third of the corresponding figures in 1940 for the various colorsex groups. 

29 
The major mortality problems in the 35-44 

year age group in 1960 were the cardiovascularrenal diseases, malignant neoplasms, accidents 

and other forms of violence, and, for white males 

and females, cirrhosis of the liver. Influenza and 

pneumonia are assuming a position of greater numerical importance among nonwhite females. 

During the decade 19S0-60 the mortality 

trend for influenza and pneumonia definitely leveled off. For nonwhite females, there is a suggestion of an upturn in the influenza and pneumonia death rates. There was also a significant 

change in the trend for diseases of the respiratory system other than influenza and pneumonia 

which now is increasing after a period of steady 

decline. The death rate for infective and parasitic diseases has also leveled off since 1956. There 

has been a deceleration in the rate of decline in 

WHITE 

cardiovascular-renal mortality among the white 

population in this age group, but no such change 

is clearly evident in the rates for nonwhites. 

If it were assumed that no change occurred 

in the relative rate of decrease in the death rates 

for these diseases, the average difference between the expected general mortality trend and the 

observed rates would have been decreased by 

about 30 to 40 percent, depending upon sex and 

color. The other factors contributing to the change 

in trend are the present patterns of death rates 

for accidents and other violence, malignant neo ­

plasms, and cirrhosis of the liver. 

The death rate for accidents and other violence has been essentially level for the white 

population during the last 6 or 7 years; for nonwhites, the death rate has been level over a longer 

period of time. Because of the relatively high 

NONWHITE 

‘“~~ ’01 I I I 

;-----9 

llll:l:T::l:-:1-::;j60; 111111111 ,0 2330 1940 1950 

1 {111 1111 ,,50111111111“---:,0 — 

Figure 15. Deafh rafes for cirrhosis of liver, 35-44 year age group, by color ond sex: Unifed Sfaies, 1930.60. 

30 
frequency of deaths from violence in this age 

group,thispattern of mortality will influence the 

general mortality trend. 

Malignant neoplasms, particularly the increasing trend for males, also contributed significantly to the change in the general mortality 

trend. The cancer death rate for females is still 

decreasing slowly, but at a much lower rate of 

decline than that of the general mortality trend. 

Another contributory factor is mortality from 

cirrhosis of the liver. The magnitude of the rates 

is still relatively small, but the rising trend, especially in the nonwhite population, will have an increasing effect on the trend of the general death 

rate (fig, 15). 

Future gains are expected to be comparatively 

small insofar as the prevention of infectious dis -

ease mortality in the white population is concerned; 

whereas for nonwhites there are still some 9 to 

10 percent of all deaths attributed to infective and 

parasitic diseases and influenza and pneumonia. 

Judging from the trend of the cancer death rate, 

further declines in the total death rate for females 

may be expected, but the rate of decline will not 

be so great as in the past. The future prospects 

for males appear much poorer than those for females, 

Age Group 45–54 Years 

The problems of this group are similar to 

those of the 35-44 year age group, with the effects 

of the aging process becoming more evident in the 

nature of the principal causes of death. The acute 

hazards, namely infective and parasitic diseases 

and accidents, were, in 1940, still contributing 

significantly to the total death rate. By 1960 the 

p:~ttern of mortality had changed. Only accidents, 

except for nonwhite females, and influenza and 

pneumonia in the nonwhite population appeared 

among the five principal causes of death. The 

chrcmic diseases now figured even more prominently as a cause of death in this age group. Cardiovascular-renal diseases and malignant neoplusms accounted for the majority of deaths. Cirrhosis of the liver in the white population and diabetes mellitus among nonwhite females constituted the remainder of the five most frequent 

causes of death. 

me death rate declined rapidly for the infective and parasitic diseases, influenza and 

pneumonia, and other diseases of the respiratory 

system. However, during the past 10 years, the 

rate of decline has slowed down markedly in the 

trend of mortality from infective and parasitic 

diseases; the downward movement of the influenza and pneumonia death rate has virtually 

stopped; and the death rate for diseases of the 

respiratory system other than influenza and pneumonia is now increasing significantly. 

The recent changes in the course of the death 

rates for infective and parasitic diseases, influenza and pneumonia, and other diseases of the 

respiratory system may provide an explanation 

for more than half of the decrease in the rate of 

decline in the general mortality trend for white 

males and about one-third of the deviations from 

the expected trend for white females. For nonwhites, the effect is not easily determinable. The 

computed values involving diseases of infectious 

origin amounted to more than 100 percent of the 

differences between the expected and observed 

death rates for all causes. This was to be expected 

in the trend for nonwhite females because of the 

acceleration in the downward movement of the 

general death rate. This was not the case in the 

trend for nonwhite males. However, a reasonable 

explanation may be found in the trends of the cardiovascular-renal death rates. As seen in figure 

10, the cardiovascular-renal trend for the nonwhite population which is curvilinear starts to 

turn down about 1944, and the rate of decline 

accelerates about 1953 or 1954. The downward 

turn of the cardiovascular-renal death rate for 

nonwhite females is much greater than that for 

nonwhite males. This is apparently the reason for 

the acceleration observed in the decline in the 

general mortality trend for nonwhite females in 

recent years. The rate of decrease of the cardiovascular-renal mortality trend for nonwhite males 

is not sufficient to counteract the forces increasing the general death rate. 

The elimination of infective and parasitic 

diseases, including influenza and pneumonia, and 

violence as causes of death would not reduce the 

total death rate by more than 10 to 20 percent. 

Actually this reduction would be somewhat higher 

because intercurrent infections such as pneumonia 

would result in excess mortality from the chronic 

diseases. However, it seems clear that the 

31 
“acute” components of mortality in thisagegroup 

are not nearly so important as the “aging” components. 

The prospects of a further decline in mortality are much more favorable for females than 

for males. The death rate for cardiovascularrenal diseases for females is still decreasing at 

a fairly rapid pace, whereas for white males the 

rate is decreasing very slowly. The rate for nonwhite males is decreasing much faster than that 

for white males but not nearly so fast as that for 

nonwhite females. The death rate for malignant 

neoplasms is decreasing slowly for females, but 

it is not definite what the future course will lie in 

view of the hint of an uprurn in cancer mortality. 

70


60


50


40


30


20


10


9


s 

7


WHITE 

1


“-lI


I


I


I


1


MALE	 I


I


I


I


-+., 

t

*

* 

I $. J

‘--s- J 

11111111 111111111 I 1111 U.l~60


1940 1s50


.— —— 

Figure 16. Deofh rates for diabetes, 45-54 year age 

The death rate for cancer among males is rising 

fairly rapidly although the rate of increase has 

not been so great during the past 10 years. 

The diabetes mortality trend is difficult to 

assess because of the major change in the disease classification procedures in 1949. However, 

there appears to be an unusual change in the pattern of mortality for this disease. Overlooking 

the large discontinuity in the diabetes death rate 

between 1948 and 1949 due to the change in classification procedures, it may be seen from figure 

16 that the trend for females has been generally 

downward. However, the trend for white females 

appears to have definitely leveled off, and the 

same seems to be happening to the rates for non70


60


50


40


30


20 ~ —.— 

MALE 

10 —.1 ——-. 

I I
 9


_--t-----t - 8 ~-—-t—————— 

i ~b_LUJ_.Lll 1< ) 1940 1950


——— 

group, by color and sex: United States, 1930-60. 

32

I


white females. on the other hand, there has been 

a clear upturn in the diabetes death rate for males 

in the period 1955-60. In 1954 the death rate for 

white males for the first time exceeded the rate 

for white females, and this differential is widening rapidly. In the nonwhite population, mortality 

for females is still considerably higher than that 

for males. However, if the present increase in the 

mortality among males continues, it will not be 

long before it will exceed the mortality rate for 

females. 

The death rate for cirrhosis of the liver is 

continuing to rise for all sex-color groups in this 

age range (fig. 17). There seems to have been a 

spurt in the increase, particularly among nonwhites, after World War II. The mortality from 

cirrhosis of the liver in the white population in 

1960 was about 4 percent of the total (even less 

for the nonwhite), but it is probable that this disease will increase in numerical importance as a 

cause of death. 

Age Group 55–64 Years 

With increasing age, the cardiovascular-renal diseases increase in relative importance as a 

cause of death. In this age group, 55-64 years, the 

cardiovascular-renal diseases emerge for the 

first time with clear-cut superiority over other 

diseases as the leading cause of death in every 

sex-color group. Except for accidents among 

white males, and influenza and pneumonia in the 

nonwhite population, the leading causes of death 

in 1940 were the chronic diseases, principally 

cardiovascular-renal diseases and cancer. 

In the period 1940 to 1960, these chronic dis -

— 

NC?4WHITE 

5or– ‘---”-~ 

40 -.— ..— — .—— 

t 

so ; ._.. —___ —— z 

8 — 

7 1111 11111 I Ill 11111 I 1111 Ill I 1930 1940 [950 [960 

Figure 17. Death rates for c;rrhosis of liver, 45-54 year age group, by color and sex: United States, 1930-60. 

33 
eases increased in numerical importance. Although the death rate for the infective diseases 

declined significantly, influenza and pneumonia 

advanced in the rank order as one of the five 

principal causes of death for white males. Diabetes for the female population and accidents 

for white females and nonwhite males assumed 

positions of greater relative importance. However, in 1960, deaths from violence and infective 

and parasitic diseases, including influenza and 

pneumonia, constituted less than 10 percent of all 

deaths in each color-sex group, except nonwhite 

males. For this group, the proportionate mortality 

was 13 percent. The death rate for accidents and 

other violence for the white population is still declining, but the trend is more or less level for 

nonwhite males and slightly upward for nonwhite 

females. The rate of decline in the death rate for 

infective and parasitic diseases is decelerating 

for the white population, but there is no evidence 

of a similar change in the trend for the nonwhite 

population. The influenza and pneumonia death 

rates have increased for all color-sex groups. 

Of particular interest is the trend of the 

death rate for diseases of the respiratory system, excluding influenza and pneumonia. The mortality from these diseases had been declining 

steadily for females, but a sharp upturn maybe observed in the rates recorded during 1950-60 

(fig. 9). The trend of the death rate for white 

males was virtually level until 194S when a large 

upsurge started. The rate for nonwhite males was 

declining slowly until about 1948 when, as with the 

death rate for white males, a sharp rise began. 

The marked change in trend for the male 

population suggests that the revision in the classification of diseases and classification procedures adopted in 1949 might be responsible. However, the fact that the change in the trend for females did not occur until much later suggests 

that the classification revision was not the governing factor. There does not appear to be much 

question of increased reporting of these diseases 

in this age group. Whether this represents a real 

increase in mortality from the chronic bronchopulmonary diseases is a question. Although 

the magnitude of the rates is still relatively low, 

the trend for diseases of the respiratory system 

(chronic obstructive lung diseases) suggests an 

emerging public health problem .7,8 

The course of mortality from the infective and 

parasitic, including influenza and pneumonia, and 

the chronic obstructive lung diseases may account 

for a relatively large proportion of the leveling 

off of the general death rate for white females, 

but not for the nonwhite population (less than 10 

percent). For white males, this method of analysis involving projection of the general death rate 

gives rise to problems because of the discontinuity of trends. 

With regard to the major chronic diseases, 

there has been little change in the death rate for 

white males for cardiovascular-renal diseases 

during the period 1940-60. The death rate for females has been declining without interruption, 

thereby increasing the gap between the mortality 

from cardiovascular-renal diseases for males 

and females. For the nonwhite population, the 

sex differential in mortality was negligible between 1935 and 1945 when the death rate for males 

started to increase. Since 1948, the death rate for 

males has been paralleling that for females at 

a higher level. The reason for the change in the 

cardiovascular-renal disease death rate for nonwhite males between 1945 and 1948 seems worth 

studying. 

The course of mortality from malignant neoplasms shows a striking divergence in the death 

rates by sex (fig. 18). In both the white and nonwhite populations, the rate for males was at a 

much lower level than that for females in, for 

example, 1935. However, the death rates for white 

and nonwhite males have been increasing steadily 

whereas the rate for white females has been continuously downward. The trend for nonwhite females is slightly upward, but not increasing so 

fast as the trend for nonwhite males, The trends 

for the white population crossed about 1945, and 

those for the nonwhite about 1948. Another point 

of interest is the fact that the death rate for cancer for nonwhite males is now much higher than 

for white males. 

With regard to diabetes, the downward trend 

in the death rate for white females appears to 

have accelerated in the past 10 years, whereas 

the rate for white males has been fairly level. 

The diabetes death rate for both the nonwhite 

males and females is now rising rather rapidly 

after a period of flat trend (fig. 19). 

34 
-—---

WHITE NONWHITE 

600 

‘oo~ 

500 

400 

FEMALE 

300 —. -k —–—–—

1 ~ 200 

19 80 1940 I950 1960 

.——. 

Figure 78. Death rates for mal{gnant neop\asms, 55-64 year age group, by color and sex: Urrifed States, 7930-60. 

The changes in mortality from the major 

chronic diseases suggest that the death rate for 

white males will continue in its upward movement whereas the general trend for white females 

will be downward for some time. On the other 

hand, the death rates for the nonwhites in this 

age group will probably begin to level off. 

Age Group 65–74 Years 

The principal causes of death in this age 

grQuP in 1940 were the cardiovascular-renal dis. 

eases, malignant neoplasms, and influenza and 

pneumonia, except among white females where 

diabetes ranked in place of influenza and pneumonia. In the 20-year period between 1940 and 

1960 there were several changes in the rank order. Accidents increased in relative importance 

among males, influenza and pneumonia among 

white females, and diabetes among nonwhite 

females. 

The cyclical type of variation in the death 

rates for the nonwhite-population makes it difficult to ascertain any definite trends. However, 

the death rate for white females has leveled off 

and the rate for white males is now rising after 

a period of declining mortality. Part of the explanation may be in the change in the course of 

mortality from the infective and parasitic diseases, influenza and pneumonia, and other diseases of the respiratory system. The change in 

pattern for these diseases may account for a fairly large proportion of the change in the general 

death rate for white males and for a smaller proportion for white females. 

Of significance is the changing mortality from 

diseases of the respiratory system excluding influenza and pneumonia. The death rate for these 

chronic obstructive lung diseases has increased 

rapidly during the past 10 years, especially 

among white males, contributing substantially to 

their rising death rate (fig. 9). 

After a period of rapid decline, the influenza 

and pneumonia death rates began rising about 1955 

for the white population. This upward movement 

was more violent than any experienced in the pre35 
wHITE NcNWHITE 

150, I I I 1s3 I I I 

g 

a 

: 

1930 1940 1950 1960 1930 1940 1950 1960 

— ——— 

Figure 19. Death rates for d{abetes, 55-64 year age group, by color and sex: Unifed States, J930-60. 

vious 25 years. For the nonwhite population, the 

death rates for influenza and pneumonia began to 

level off in the late 1940’s among males and in 

the early 1950’s among females. 

The trend of mortality from the cardiovascular-renal diseases is downward for females 

and virtually flat for males. The trends for white 

females and for white males are clearly diverging, but those for nonwhite are more or less 

parallel. As for malignant neoplasms, the death 

rate for white females is declining whereas the 

rate for white males is increasing relatively 

rapidly. Among nonwhites, the cancer death rates 

for females have not changed much since 1950 

while the rates for males are increasing. 

The diabetes death rate for white females is 

declining, but the rate for white males has IIOt 

changed much in past years. On the other hand, 

the diabetes death rates for both nonwhite males 

and females show a definite upward tendency in 

recent years. 

Death rates for accidents and other violence 

show a steady downward trend for white males 

and females. The rate of decrease in the death 

rate is not so rapid for the nonwhite population, 

but there seems to be a tendency to decline. 

The mortality trends for the various causes 

of death indicate that the rate of decline in the 

death rates for the various subpopulations in this 

age group may be further slowed down. The mortality outlook for white males and for the nonwhite population does not appear to be too favorable, but further decreases in the death rate for 

white females may be expected. 

36 
I Age Gr’oup 75–84 Years 

The mortality problems in this age group are 

overwhelmingly cardiovascular-renal diseases. 

Malignant neoplasms are also relatively important causes of death but account for less than 

15 percent of all deaths in this age group. The 

influenza-pneumonia group also appears in the 

rank order with a proportionate mortality of less 

than 5 percent in 1960. 

The death rate for influenza and pneumonia 

stopped declining early in the 1950’s and has increased in every sex-color group. However, this, 

in addition to the change in the death rate for diseases of the respiratory system excluding influenza and pneumonia, does not appear to account 

for a large part of the change in the general mor -

t[~lity trend. 

The death rate for the major cardiovascularrenal diseases is declining slowly but steadily 

for white females, but the rate for white males 

has changed very little since 1945. For the nonwhite population, it is difficult to see any definite 

trend. 

With regard to malignant neoplasms, the 

death rate for white females is decreasing slowly 

while the trend for white males appears to be 

rising slightly. For the nonwhites, particularly 

males, the trend is upward. 

The death rate for accidents and other violence shows evidence of change in its downward 

course for white males and females. For the nonwhites, the wide swings in the death rate do not 

create a continuous pattern, but the general trend 

is definitely downward. However, even if all deaths 

from infective and parasitic diseases, including 

influenza and pneumonia, and accidents and other 

vioIence were completely eliminated, the total 

death rate for this group would not decrease by 

more than 7 to 10 percent. The future prospects 

of large gains in mortality are not very great except for the death rate for white females. 

DISCUSSION 

It is possible that the leveling offofthe death 

rate is due to an artifact, i.e., to changes in the 

completeness of death registration, errors in the 

intercensal population estimates, and errors in 

the statement of age in the census enumeration 

and on death certificates. In order for these factors to have affected the trend, there must have 

been a large improvement in registration completeness starting about 1954, or a significant 

error in population estimates for the same 

period. 

Although there has never been a reliable 

evaluation made of death registration completeness, it has always been assumed that virtually 

all deaths are reported in the United States. It is 

unlikely that more than 1 or 2 percent of deaths 

go unrecorded. It is also unlikely that this factor 

would be operative in the other countries of low 

mortality where death registration has not been 

considered a problem for many years. 

With regard to errors in population estimates, 

Tomasson 9 observed a curious pattern of death 

rates for nonwhites in the latter part of each 

decade which suggested that the nonwhite population was being underestimated for the years at 

the end of the decade. This type of error could 

account for the leveling off of the death rate in 

recent years. That this could be a problem was 

clearly evident in this study when the death rates 

based on the postcensal estimates showed an upturn in the death rates for 1951 to 1959 for the 

older nonwhite population as compared with the 

corresponding rates computed on intercensal population estimates by age based on the 1950 and 

1960 census returns. These errors in postcensal 

population estimates could be due to many factors. However, the revised estimates did not significantly influence the trend of the death rates 

for age groups under 55 years. Also, any errors 

in the population estimates would not have affected 

the infant mortality trend which does not depend 

upon population estimation procedures. 

Because of these considerations, and because 

of the consistency in occurrence of the phenomenon in various parts of the world, the recent 

changes in mortality trends do not appear to be 

artifacts arising from death registration improvements or errors in population estimation. 

This study indicates that the leveling off of 

the death rates can be accounted for by the combination of two sets of factors. The first is the 

dramatic drop in death rate for the diseases of 

infectious origin with the successive introduction 

37 
and application of pneumonia serum therapy, the 

sulfa drugs, and the antibiotics. The accelerated 

decline started about 1938 and then lost its impetus in the 1950’s. By that time, the mortality 

from diseases of infectious origin had reached a 

level where it no longer contributed in a major 

way to the total number of deaths. Even if the 

trend of the death rates for the infective and parasitic diseases, including pneumonia and influenza, 

had continued downward without interruption, this 

would not have accounted for all of the leveling 

off of the total death rate. 

However, the long-term decline in mortality 

from the infectious diseases resulted in a major 

realignment of the principal causes of death which 

uncovered a second set of factors. These factors 

involve the trends of mortality from the presently 

numerically important causes of death, namely, 

malignant neoplasms and cardiovascular-renal 

diseases at all ages, congenital malformations 

through the childhood years, accidents and other 

violence from childhood through middle age, 

cirrhosis of the liver in middle age, and diabetes 

mellitus from middle age into old age. Also, new 

problems are emerging. The dramatic upward 

trend of the chronic bronchopulmonary disease 

mortality from middle age onward seems particularly significant. None of the trends for these 

causes of death exhibits the same rate of decline 

as the trend for the infective diseases. In fact, 

many of the trends are rising by different degrees. The combined effect of these various 

trends is to slow down the rate of decline of the 

total death rate. 

It is difficult to determine precisely the roles 

played by the different factors in affecting the 

general mortality trend. The indications are, 

however, that the leveling off of the death rates 

for the infective and parasitic diseases, influenza and pneumonia, and the other diseases of 

the respiratory system did not account for a large 

part of the deceleration of the rate of decline of 

the death rates for all causes for most age 

groups. Much more important seem to be the 

trends for the chronic diseases such as cardiovascular-renal diseases and malignant neoplasms 

in the adult population, malignant neoplasms and 

accidents and other violence in the younger population, and congenital malformations among 

children, These diseases and conditions consti ­

tute the hard core for which prevention of deaths 

is more difficult. With the universal availability 

of antibiotics, the uncovering of this core may 

serve to explain the almost simultaneous leveling off of the death rate for the various countries 

and for the different population subgroups. 

Further reductions in total mortality in the 

United States are possible, but any substantial 

decreases must come from the lowering of the 

death rates for the chronic noninfective diseases 

and for accidents and other violence. On the basis 

of a life table analysis of data for 1949-51, Woodhall and Jablon 10 concluded that large increases 

in longevity will result, not as a consequence of 

the solution of any single disease process, but as 

the result of a general breakthrough on the whole 

front of aging. The elimination of certain causes 

of death such as the infective and parasitic cliseases, malignant neoplasms, diabetes, and accidents would result only in small increases in the 

average life expectancy. The largest increment 

would come from the elimination of cardiovascular diseases as a cause of death. The cardiovascular disease problem was noted as an exception 

to the generalization about future changes in life 

expectancy. 

Although Woodhall and Jablon’s study showed 

cardiovascular disease mortality to be the only 

significant factor in affecting the life expectancy 

at birth, it seems certain that the trends for malignant neoplasms and accidents and other violence will also play an important part in shaping 

the future course of the death rate for certain 

population subgroups. These are problems of 

long-standing importance. However, new problems may emerge. Cirrhosis of the liver has 

already come to the forefront as one of the five 

principal causes of death in the age groups 35-54 

years, and the death rate for this disease is still 

increasing rapidly. The death rate for diabetes in 

the 45-54 year age group which had been declining is now leveling off for females and turning 

upward for males. In the 55-64 year age group, 

the diabetes death rate for the nonwhite population is increasing rapidly after a period of flat 

trend. In the groups over 65 years of age, ~he 

trends of diabetes mortality for the white pofMlation do not appear to be unusual, whereas for 

the nonwhite the trends are definitely upward. 

Since diabetes occurs more commonly in later 

38 
life, Dublin 11 expected an increasing diabetic 

population corresponding to the increase in the 

proportion of older persons in the population. 

This is not yet evident in the mortality data for 

the white population, but the increasing death rates 

for the nonwhites in the older age groups may be a 

reflection of the increasing prevalence of diabetes among the nonwhite population. 

Another striking change in trend is presented 

by the death rates for diseases of the respiratory 

system other than influenza and pneumonia (fig. 

9). These are, for the most part, the chronic obstructive lung diseases such as emphysema, 

bronchiectasis, and chronic bronchitis. The death 

rate for these chronic obstructive lung diseases 

is still at a relatively low level, but it has been 

increasing rapidly especially among males over 

45 years of age. The rapidly rising death rate 

for cancer of lung and bronchus, another important chronic bronchopulmonary disease, has been 

well-recognized. 

One of the most significant developments in 

modern medical history was the discovery and 

widespread application of antibiotics. This has 

had a tremendous effect on mortality trends. 

However, in the decade 1950-60, the death rates 

for infective and parasitic diseases and for influenza and pneumonia 12 (predominantly pneumonia) have leveled off or are turning upward 

(fig. S). These diseases still contribute a 

relatively large proportion of deaths among infants and preschool children. In the other age 

groups, the proportionate mortality from diseases of infectious origin has decreased greatly, 

but the pneumonia death rate is high enough to 

constitute one of the five principal causes of 

death for certain sex-color groups. Pneumonia 

continues to be osler’s “friend of the aged. ” 

An interesting and important question is why 

the rate of decline of the pneumonia death rate 

changed during the past decade after a period of 

impressive decrease (fig. 20). These changes in 

the rate for age groups in which the death rate 

has reached a low level are understandable. However, the pneumonia death rates are still high for 

the older age groups, and for infants and preschool children (fig. S). Similarly, the rates for 

rmnwhit es ~me still higher than those for whites 

and the rates for males are higher than those 

for females. There is considerable differential 

spread in the level of the death rates for the 

various age, color, and sex groups, but the leveling off of the pneumonia death rate for all groups 

has taken place in about the same period. This 

parallelism in the trends by sex, color, and age 

appears too regular to be true. If the changes in 

the rates of decline are not artifacts of disease 

classification, why should they have occurred at 

about the same time when the magnitude of the 

death rates differs so greatly when they start to 

level off? For some segments of the population, 

the rates are so low that for all practical purposes, the notion of an irreducible minimum can 

be accepted. For the other subgroups of the population, it would seem that there should be further prospects of reduction in the death rate. 

Actually, the pneumonia death rate is now increasing for the older age groups, indicating the 

possibility of antibiotic-resistant organisms playing an increasing role in older pneumonia patients. 

With regard to the total death rate, there may 

be some question as to whether the irreducible 

minimum has been reached. The examination of 

the death rates by cause of death indicates that 

further declines are possible. Also, comparison 

of death rates by age and sex for the various 

countries of low mortality for the years 1959 and 

1960, depending upon their availability, shows 

that the structure of the death rate for the United 

States is far from the lowest. By taking the lowest death rate recorded by any country of low 

mortality for each age-sex group and applying 

these rates to the population of the United States 

for 1960, the expected number of deaths was obtained. The difference between these numbers and 

the recorded number may be considered the excess number of deaths in the United States. If the 

lowest age-sex specific death rate achieved by 

any country of low mortality in 1959 and 1960 had 

been obtained in the United States in 1960, there 

would have been about 397,000 fewer deaths in the 

United States. This means that the crude death 

rate for the United States would have been 7.3 

per 1,000 population as compared with the recorded death rate of 9.5 per 1,000 population. For 

males, the expected death rate would have been 

7 .S as compared with the recorded rate of 11.0 

per 1,000 population. For females the corresponding rates would have been 6.9 as compared 

with S.1 per 1,000 population. 

39 
� 

�

��

WHITE NONWHITE 

w MALE 

. 100 ——. ..— 

80-— 

,8%, MALE 

�. . .0’ : , � ,4 

60 p .; ~—\. 60 — “*. — 

s 

; -L*.* I A � *** *, 

‘8� FEMALE * &.**m. *, ;* � � 

* 

. ; $’ 

**•* 40 40t--- L ---1 1

‘; 

** 

** 

** 

; FE MALE , 

; ;I 0+

�*

,** ‘“”%.+, )* d------ 20

I —-———l—~— 

I 

15k 

) 

11111111 41960 15L D 

1111111 1950 1111111 ) 0 1930 1930 

— 

Figure 20. Death rafes~or Pneumonia, bYcolor andsex: United States, 1930-60. 

As may be seen from figure 21, mortality in 

the U.S. population is favorable, compared with 

conditions in other countries, only in extreme 

old age. At other ages, there is considerable difference between the rates for the United States 

and for countries with the lowest death rates. 

This is especially true of mortality among the 

male population in the United States. For males, 

the excess mortality in absolute numbers among 

infants and age groups from 35-84 years accounted 

for the greatest part of the difference between the 

cbserved and expected number of deaths. For females, the excess mortality was greatest in the 

infant population and in the age groups from 45-

74 years, but not to the same extent as for males. 

These differences between the age-specific 

death rates for the U.S. population and the corresponding rates for countries of low mortality 

show that the death rates in the United States have 

not yet reached the levels that have been attained 

elsewhere. 

It is difficult to say what the biological irrc+ 

ducible minimum is. However, it is obvious that 

the death rates in the United States are far above 

the 10JV levels established in the Scandinavian 

countries and in the Netherlands. Even for these 

countries, the rates cannot be considered the lowest possible figures because lower mortality 

40 
MALE 

30,000 [ [ 

— 30,000 

u.s. 

m....., Lowest recorded rate : 

$’ 

10,000 :

�J 10,000 IO,coo 

8,000 � 8,000 8,000 * 

6,000 1/! � 

**

~

#*

,* 

� $” 

6,000 6,000 

4,000 � 4,000 4,000 

8 

~ 2,000 2,000 

1,000 

800 

600 

c 

i! 400 4W u 

? 

c 

200 – 200 

1100 I 00 

80 m 80 

{ 

—Z* 60 

t 

?o~ v + 40 % 40 

*** 20_LwA_—J20 o 

[– 

0 10 20 30 40 50 60 70 80 85+ 10 

L_._L_L._~l~ 20 30 40 50 60 70 80 Z. 

63+ 

AGE AGE 

— -— __ ——— ..— ——. 

% � %*+.. 

Figure 21. Death rates for the United States and lowest recorded death rates for countries of low mortality, by age and sex, 7959-60. 

w (?jll “~ K 3(rJ~~ 

rates than those recorded in 1959 or 1960 have 

been observed for some age groups in the years 

prior to1959. 

The recent change in the rate of declineof 

the death rates in the United States does not 

appear to be a temporary phenomenon. The provisional death rates of 9.3 and 9.5 per 1,000 population in 1961 and 1962, respectively, are low 

-h::. A.# ~~.. 1 ‘“ ‘ 

relative to past rates, but they are far from the 

continuation of the downward trend established 

between 1938and 1954. Furtherdecreases maybe 

recorded in the future, but it seems unlikely that 

the death rate for the United States will soon 

approach the levels already attained by various 

other countries. 

41 
SUMMARY AND CONCLUSIONS 

After a long period ofrapid and substantial 

decline, the death rate forthe United States has 

reached the point where further decreases as experienced in the past cannot be anticipated. The 

mortality trend for virtually every State has 

been affected. Similar changes in the trend of the 

crude death rate may be observed in the data for 

a number of other countries. Studies now in 

progress in several of these countries may provide further information on this problem. 

In the United States, the mortality trends for 

ever y age group from infancy to late middle age 

or old age—whites as well as nonwhites, and females as well as males—have changed in recent 

years. The death rates for certain subpopulations 

in the older ages are now stationary or increasing. 

The recent changes in trend cannot be attributed to the aging of the population or to artifacts 

in the mortality rates, but stem from a combination of two factors. The first of these relates to 

past successes in the prevention of deaths from 

diseases of infectious origin through antimicrobial therapy which contributed greatly to the downward trend of the general mortality rate. The 

impetus imparted by the reduction in the death 

rate for the infective diseases gradually diminished as the proportion of deaths from these 

diseases decreased. The leveling off of the death 

rate for diseases of infectious origin explains 

part of the deceleration in the rate of decline of 

the total death rate. For the most part, however, 

me downward trend of the death rate was checked 

by the current mortality trends of diseases and 

conditions which constitute the core of mortality 

in the present population, namely the chronic 

diseases and accidents and other violence. The 

direction or the rate of change of these trends is 

such that they would retard the downward course 

of the total death rate. 

Certain important changes in the mortality 

pattern may be observed. The diabetes death rate 

for females in the 45-54 year age group appears 

to be leveling off while the death rate for males 

is increasing. The diabetes mortality in the nonwhite population over 55 years of age is now definitely increasing. 

The chronic bronchopulmonary diseases are 

emerging as a serious mortality problem. The 

death rates for diseases of the respiratory system excluding influenza and pneumonia are rising 

at an accelerated pace in the older age groups, 

particularly among males. 

The future course of mortality of males in 

the United States does not appear favorable as 

compared with the prospects for females. This 

is especially true of the trend for white males. In 

the past, the death rate among males was lower 

than that for females for at least two major disease components—diabetes and malignant neoplasms. This is no longer true. In almost every 

disease category, the death rate for males is 

higher than the corresponding death rate for females. Also, the death rate for females is still 

declining whereas the rate for males is decreasing 

more slowly or not at all. 

Further declines in mortality are possible 

but they are likely to be modest ones. However, 

it does not appear that the death rate for the 

United States has reached the irreducible minimum. If the mortality rates in this country were 

to equal the lowest rates achieved by any country 

of low mortality in 1959 or 1960, the crude death 

rate for the United States would be 7.3 per 1,000 

population as compared with the recorded rate of : 

9.5 in 1960. In view of the mortality eq?erience 

for the past decade, it does not seem likely that 

the death rate for the United States will soon 

approach the levels already attained by various 

other countries. 

42 
REFERENCES


lt,foriyma, I.hf,: PreIiminaqr observations on recent rnortdity 

trend. Pub, Health Rep. 76:1056-1058, Dec. 1961. 

2Spiegelmsn, M.: Mortrdiq trends and praspects nnd their implications. Ann. Am. A cad. Polit. and Social Sc. 316:25-33, Mar. 

1958. 

%allins, S.D. nod Leltmann, J.: Excess deaths from influenza 

and pneumonia nrrd from important chronic diseases during epidemic perinds, 1918-5 I. Pub, Health Monograph no. 10, Publication 

213, U.S. Public Health Service. 1953. 

4Eickho ff, c,, Shemm, I.I.., und Serfling, R. E.: Observations 

on excess mortality associated with epidemic influenza. J. A.hLA. 

176:776-782, June 3, 1961. 

(i![oriYma, Lhf.: Recent changes in infant mortality rrend. pub. 

ll,vlt[, Rep. ?5:391-4o5, hfay 1960. 

7V7alkup, H. E. and Connolly, E. C.: The dimensions of rhe 

chronic respiratory disease problems. Supplement to Am. J. Pub. 

HeaIth 5% 1-6, War. 1963. 

8V=mi11, M*H.: publjc hedrb responsibilities ~d progr~ r~ 

sponsibilitics in chronic respiratory diseases. Supplement to Am 

]. Pub. Health 5>25-33, Mar. 1963. 

9Tomasson, R. F.: Bias in estimates of the U.S. nonwhite population as indicated by rrends in death rates. J. Am. Statis. 

ASSOC. 5&44-5 1, Mar. 1961. 

10 ~ooaall ~. ad J ~blo~, S.: prO Spcts fnr further increase in 

average longevity. Geriatrics 12:586-591, Oct. 1957. 

llDublin L. I.: He~& progress, 1936 to 1945. snpplem~t ‘o 

Twenty -/ive years of health progress. Metro. Life Ins. Co. p. 71f75. 1948. 

12Ceuncell, C. E.: Recent ttends for pneumonia mortality. Pub. 

Health Rep. 78:178-182, Feb. 1963. 

000 

43 

U.S. GOVERNMENT PRINTING OFFICE , 19640-722-367 
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

SERIES 1-4, GENERAL SERIES. program descriptions, methodological research, and analytical studies of vitsl and health statistics. 

Earlier reports of this kind have appeared in ‘vim] Statistics-special Re~rtsn and in “Health Statistics from the National Health Survey,” Series 

A and D, PHS Publication No. 584. 

Series 1:	 Programs and collection procedures .- Rs~rts which describe the general programs of ths National Center for Health Statistics and 

its offices and divisions, data collection methorfs used, definitions, and other material necessary for understanding of the technical characteristic ce of publisbed data. 

Series 2:	 Data evaluation and methods reeearch. -Studiss of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, objective evaluations of reliability of collected data, 

contributions to statistical tbsory. 

Seriee 3: Analytical Studies.-Tbis series comprises reporte presenting analytical or interpretive stud es based on vital and health statistics. 

Series 4:	 Documents and committee repx ts,- Final reports of major commitbes concerned with vital and health statistics end documents 

euch as recommended model vital registration lawe and revised bkth and death certificates. 

SERIES 10-12. DATA FROM THE NATIONAL HEALTH SURVEY 

Earlier reports of the kind appearing in Series 10 have been issued as “Health Statistics from the National Health Survey,n Series B and C, PHS 

Puhliaation No. 584. 

Series 10: Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, End other services, and ctber health-related 

topics, based on data collected in tbe continuing National Health Intarvi ew Survey. 

Series 11:	 Data from the Health Examination Survey based on tbe direct examination, testing, and measurement of nationsl samples of the 

population of the United States, including tbe medically definml prevalence of specific diseases, and distributions of tbe population with respect to various physical and physiological measurements. 

Series 12: Data from tbe Health Recorde Survey relating to the health characteristics of persons in institutions, and m hospital, medical 

nursing, and personal care received, based on national samples of establishments providing theee services and samples of the 

residents of patients, or of records of the establishments. 

SERIES 20-!23, DATA FROM THE NATIONAL VITAL STATISTICS SYSTEM 

Earlier rcqrurts of this kind have been issuwl in “V1tAl Statistics-Special Reports.” 

Series 20: VariOUS reports on mortality, tabulations by cause of dear,b, age, etc., time series of ratee, data for geographic areas, States, 

cities, etc.-other than as included in annual or monthly reports. 

Series !21:	 Data on natality such as birth by age of mother, birtb order, geographic areas, States, cities, time series of rates, etc.–compilations of data not included in the regular annual volumes or montkly reports. 

Series X?: Data on marriage and divorce by various demographic factors, geographic areas, etc.-other than that included in annual or monthly 

reprts. 

Series 23: Data from the pregram of sample surveys related to vital records. Tbe subjects being ccwered in these surveys are varied including topics such as mortality by socioeconomic c1asses, hospitalization in the last year of life, X-ray exposure during pregnancy, 

etc. 

Catalog Card 

U.S. National Center for Health Statistics 

The change in mortality trend in the United States. An analytical study of mortality trends by age, color, and sex to identify the diseases with a course of mortality 

causing the recent change in general mortality trend, and discussion of future prospects for further declines in mortality. Washington, U.S. Department of Health Education, and Welfare, Public Health Servic% 1964. 

48 p. diagrs., tables. 27cm. (1/s Vital and Health Statistics, Series 3, no. 1) 

U.S. Public Health Service. Publication no. 1000, Ssries 3, no. 1. 

1.	 Mortality - Statistics - U.S. 2. U.S. - Statistics, Vital. I. Title, (Series. Series: 

U.S. Public Health Service. Publication no. 1000, Series 3, no. 1) 

Cataloged by Department of Health, Education, and Welfare Librsry.